Objective To investigate the feasibility and indications of laparoscopic liver resection. Methods Five patients with small hepatocellular carcinoma in the left lateral lobe underwent laparoscopic liver resection from April 2002 to April 2003. The Endo-vascular GIA was employed to transect the liver parenchyma from the right side of the lesion. The resected liver tissues and tumor were removed via the prolonged incision. Results Laparoscopic hepatectomy was successfully accomplished in 3 cases, while conversions to open surgery were required in 2 cases because of severe hemorrhage or excessive thickness of resecting marge. There were no exudation or bile leakage on the cut surface of laparoscopic hepatectomy. The length of duration of laparoscopic hepatectomy ranged from 60 min to 90 min. The patients were dismissed 3～5 days after the surgery. No complications occurred. Conclusions Liver tumor in the left lateral lobe can be removed laparoscopically.

Hepatocellular carcinoma(HCC)is nowadays one of the leading common causes of cancer death and mostly occurs in hepatitis B endemic areas.Typically,HCC patients presented late and only about 20% of the patients are amendable to surgical interventions.Surgical resection is the main curative treatment option.Nevertheless,the recurrence rate after potential curative liver resection is still very high.On the other hand,liver transplantation is the treatment of choice for early small HCC but its application is limited by the availability of liver grafts.Radiofrequency ablation is more commonly used in cirrhotic patients with small tumours who are not surgical candidates.Nowadays,transarterial chemoembolisation,drugeluting bead transarterial chemoembolisation and radioembolisation are the mainstay of treatments for the patients with intermediate HCC.Other systemic approaches,such as hormonal therapy,immunotherapy and chemotherapy have disappointing results.In particular,HCC is highly refractory to cytotoxic chemotherapy.This is no convincing evidence thus far that systemic chemotherapy improves overall survival in advanced HCC patients.Recently,encouraging results have been shown in using sorafenib in the treatment of advanced HCC patients.Similar to sorafenib,other anti-angiogenic multi-targeted tyrosine kinase inhibitors,such as pazopanib,brivanib and axitinib also show promising activity in various stages of clinical trials.There is an urgent need to identify biomarkers that may guide the rational use of sorafenib and other targeted agents in the era of personalised medicine.More importantly,the multidisciplinary model in managing HCC patients is the important key to the future success.

Objective To compare the position,volume and matching index (MI) of patientspecific internal gross tumor volume (IGTV)delineated by 4 different approaches based on three- dimensional and four - dimensional CT ( 3 DCT and 4 DCT ) image for primary esophageal cancers.Methods Thirteen patients with primary esophageal cancer underwent 3DCT and 4DCT simulation scans during free breathing,and the patient were divided into group A (tumor located in the proximal thoracic esophagus) and B (tumor located in the mid-and distal thoracic esophagus).IGTV were delineated using four approaches: The gross tumor volume (GTV) contours from 10 respiratory phases were combined into IGTV10 ;IGTV2 was acquired by combining the GTV from 0％ and 50％ phases; IGTVMIP was the GTV contour delineated from the maximum intensity projection (MIP) ;IGTV3D was acquired from the enlargement of 3 DCT-based GTV by each spatial direction on the motion amplitude measured in the 4DCT.ResultsTarget movement in lateral (LR),anterio-posterior (AP),superio-inferior (SI) directions showed no statistically significant difference (0.11 cm,0.09 cm,0.18 cm,respectively; χ2 =1.06,P=0.589),and there was no statistically significant difference in centroid positions between IGTV10 and IGTV2 or IGTV3D in group A (t =-2.24,-0.00,P =0.089,- 1.000 ),MI between IGTV10 and IGTV2,IGTV10 and IGTV3D were 0.88,0.54,respectively. For group B, target movement amplitude in SI direction was bigger than in LR, AP ( 0.47 cm,0. 15cm,0. 12 cm,X2= 12.00,P = 0.002).Therewasno significantdifference betweenIGTV10 andIGTV3D inLR, AP, SI ( t =- 0.80.- 0.82,- 1.16,P = 0.450.0.438.0.285 ), MI was 0.59 ; but the target center coordinates was demonstrated significant difference in SI between IGTV10 and ICTV2 for group B ( t = 2.97.P = 0.021 ), Mlwas 0.86.Thevolume of IGTVMIPwassmaller thanIGTV10 ( t =- 2.84,P = 0.025 ), but the position of IGTv10 and ICTVMIp were with no statistically significant difference in the LR,AP,SI ( t =- 0.25,0. 84. - 1.22,P = 0. 809,0.429.0.263 ) ,MIbetweenIGTV10andIGTVMIp was 0.78.Conclusions Patient-specific IGTV can be acquired from 4DCT with correct target coverage while avoiding a geographic miss for the thoracic esophageal cancer,but IGTV2 and IGTVMIP can not contain all the information about primary tumor position,shape.and size at different phases of the respiratory cycle.

Objective To analyze artifacts of gross tumor volume (GTV) and correlated factors in each phase images of four dimensional CT (4DCT) for peripheral lung cancer based on three dimensional CT (3DCT) assisted with active breathing control.Methods Nineteen patients with peripheral lung cancer underwent 3DCT (CTFB) and 4DCT simulation scans during free breathing and then underwent 3DCT simulation scans in end inspiration hold (CTEIH) and end expiration hold (CTEEH) assisted with active breathing control.The relative deviations (Devref) between the reference GTV (GTVref) and the GTVsdelineated based on CTFB (GTVFB) and all phases of 4DCT were calculated respectively.Correlations between GTVref and Devmax and between the tumor motion in the cranio-caudal (CC) direction and Devref were analyzed.Results The maximum median Devref of GTV was GTVFB with 17.83％,and the maximum median Devref of the GTV in all phases of 4DCT was GTV30 with 17.20％.A significant negative correlation was found between GTVEIH and Devmax (r =-0.691,P =0.001).The Devref was crrnelated with the tumor motion amplitude in the CC direction (r =0.323-0.617,P =0.005-0.150).The partial regression coefficient of influence of GTVref size and motion amplitude in the CC direction to the tumor Devmax were -0.500 and 0.583,P =0.002 and 0.001,respectively.Conclusions The GTV artifacts in different phase of 4DCT for the peripheral lung cancer were different to each other,and the influence of target displacement to artifacts was larger than that of target volume,so artifacts could be reduced by controlling breathing to reduce target displacement.

Objective To establish a Chinese hamster model of babesia infection, to find the changing pattern of organs and biochemical parameters in Chinese hamster infected with Babesia, and to promote the detection and treatment of babesiosis.Methods Healthy 5-week old Chinese hamsters were infected by intraperitoneal injection of blood containing Babesia.Blood samples were collected at 0, 2, 4, 6, 8, 10, 12, 14, 16, 23, 30, and 37 days after infection from 5 hamsters at each time point.Blood smears were prepared to detect the parasites using Giemsa staining.ELISA assay was employed to test the IL-2 concentration.The blood biochemical indexes were detected using an automatic biochemical analyzer.DNA was extracted from the whole blood and REAL-TIME RCR was performed to determine the reproduction of Babesia.Aftert the animals were sacrificed, the heart, lung, spleen, liver, and kidney were taken to analyze the changes of organ coefficients.Results The highest level of Babesia in the hamsters occurred on day 4 after the Babesia injection, and then showing a decreasing tendency.However, there was a transient increase on the 12th day after infection.The liver and spleen displayed most extensive response to the infection showing hepatomegaly and splenomegaly, but the variation of heart and kidneys coefficients was within the norm.There were prominent changes of blood cells, especially leucocytes, with two peaks at day 10 and 23 after the Babesia infection.The peak changes of blood biochemical indexes occurred at day 12 after infection.The concentration of serum IL-2 reached a peak on the 10th day after infection.Conclusions The Chinese hamsters display typical characteristics of tick-borne diseases such as hepatomegaly and splenomegaly.The immunological system is activated along with the infection and reaches a highest stage in the second week.Afterwards the Babesia can live in the hamster body for a long period of time.The results of this study provide useful information supporting further studies on the detection, treatment and prevention of Babesiosis.

Objective To investigate the effectiveness,safety of the percutaneous transluminal angioplasty and stenting(PTAS) in the management of the vertebrobasilar stenosis.Methods From April 2003 to June 2004,the PTAS was performed in 28 patients with the vertebrobasilar stenosis.Results Among the 28 patients,the unilateral significant stenosis of the dominant vertebral artery was found in 18 patients,the bilateral stenosis of the vertebral artery in 4 patients,the tandem stenosis of the vertebral artery in 1 patient,the stenosis of the basilar artery in 2 patients.According to Mori's division,the type A occurred in 24 patients,the type B in 3 patients,the type C in 1 patient.The successful rate of stent implantation was 100% without any serious complication.Twenty-eight patients underwent PTAS with a mean pre-procedural vertebrobasilar stenosis of 81.3% and the residual stenosis was less than 10%.Over a mean 6-month follow-up in 17 patients,according to Malek's scale,the scale 1 was in 15 patients,the scale 2 in 2 patients.No restenosis was in 3 patients by the cerebral angiography.Conclusion PTAS in the management of the vertebrobasilar stenosis is a safe and effective method.Meanwhile,PTAS may alleviate the vertebrobasilar ischemia and prevent stroke of the vertebrobasilar system.

Objective To identify clinical prevalence of untypical adefovir-resistant mutations of hepatitis B virus (HBV),and to analyze their phenotypic characteristics.Methods 1741 patients with chronic HBV infection were evolved.Untypical adefovir-resistant mutations were analyzed by direct sequencing.Longitudinal analysis was performed by clonal sequencing.Wild-type and mutant HBV genomic amplicons were constructed into pTriEx-HBV 1.1 vector and transfected into HepG2 cells.The replication capacity and the 50％ effective concentration of drugs (EC50) were calculated.Results Patients treated with adefovir alone were more likely to develop rtN238T mutation than those treated with other nucleos(t) ide drugs (x2 =17.10,P ＜ 0.01).The patient received adefovir for 47 months,and then viral rebound and biochemical breakthrough occurred with detection of rtN238T + A181V and rtN238T mutation.Switching-to entecavir therapy suppressed HBV DNA and ALT to an undetectable level and converted all viruses into wild type ones.The reulsts of viral replication capacity showed that rtN238T + A181V strain was higher than rtA181V strain (t =9.54,P ＜ 0.01).Compared to the wild type virus,rtN238T + A181V variant was relatively less susceptible to adefovir.Conclusions rtN238T mutation conferred no resistance to ADV but enhanced natural replication capacity,hence it might represent a novel compensatory drug-resistant mutation for adefovir.

OBJECTIVETo determine the mutational profile and clinical implications of the viral reverse-transcriptase (rt)A 181T mutation in hepatitis B virus (HBV) through population-based analysis of clinical samples.

METHODSSerum samples from 3, 013 patients who visited The 302 Hospital (Beijing, China) were investigated.HBV DNA was extracted and HBV mutations and genotypes were determined by direct sequencing.Recombinant plasmids harboring the rtA181T/sW172* mutant or wild type sequence were constructed and transfected into the HepG2 cell line. The levels of HBsAg in culture supernatants were compared and statistically analyzed.

RESULTSThe incidence of rtA181T across the study population was 4.1% (165/3, 013), and most of the rtAl 81T-positive patients had received adefovir and/or lamivudine.Forty percent (66/165) of the rtA 181T cases were single mutants and treatment responsive, 46.1% (76/165) included the adefovir-resistant mutation rtA 181 V/N236T, 12.1% (20/165) included the lamivudine-resistant mutation rtM204V/rtM2041, and 1.8% (3/165) included multidrug-resistant mutations.Interestingly, 73.9% (122/165) of the rtA181T-positive samples were detected with co-existing wild-type nucleotides at the site. The rates of HBV/C to HBV/B were 92.1% to 7.9% in the rtA181T-positive patients, but 82.1% to 17.9% in the rtA181T-negative paticnts (P less than 0.01).Almost all (98.2%; 129/165) of the rtA181T led to sW172*, while only 1.8% of the rtA181T (3/165) led to sW172L or sW172S.HBsAg secretion in vitro was reduced from the rtA181T/ sW172* strain, but there was no significant difference observed in the average serum HBsAg and HBV DNA levels of patients who carried or did not carry the mutant.

CONCLUSIONThe HBV rtA181T mutation is closely associated with adefovir and lamivudine exposure.rtA181T may led to sW172*, culminating in suppression of HBsAg secretion.However, co-existence of the mutant with wild-type sequences was common among our patient population, suggesting that the mutation had little impact on serum HBsAg and HBV DNA levels across the clinical study population.

Adenine ; analogs & derivatives ; Antiviral Agents ; China ; Genotype ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Humans ; Lamivudine ; Mutation ; Organophosphonates

Objective To explore refined nursing in multi-channel percutaneous nephrolithotomy for the treatment of complicated renal calculi.Methods A total of 80 patients with complex renal calculi treated with multi-channel percutaneous nephrolithotomy were randomly divided into two groups.The patients in the control group were given routine nursing,while the patients in the experimental group were given refined nursing.Preoperative psychological mood,the related clinical index,the complication rate and the overall nursing satisfaction were compared.Results Compared with the control group,experimental group had lower scores of SAS and SDS,shorter hospitalization time,less complication rate and higher overall nursing satisfaction than the control group (P ＜ 0.05).Conclusion Refined nursing in multi-channel percutaneous nephrolithotomy is effective in the treatment of complex renal calculi,which can shorten the hospitalization time and increase the satisfaction.

Objective To Summarize perioperative nursing for 20 patients with the hyperreflexia of neurogenic detrusor by injection of botulinum toxin A.Methods Mental states of patients were assessed by Huaxi Emotional Distress Index questionnaire and psychological support was given to these patients,patients were assisted and instructed to record the urine diary correctly,cautions for the use of botulinum toxin A was interpreted,drinking water and activities were guided,and adverse reactions,follow-up results at 6,12 weeks were observed.Life quality by Incontinence Quality of Life Questionnaire was observed,the times of urinary incontinence,maximum pressure volume of bladder,maximum pressure of detrusor and the effect of urinary incontinence were compared.Results The absolute value of evasion and restrictive behavior,psychological effects,social fear disorders were (38.5 ± 19.6),(38.8 ±22.5),(28.1 ±20.3),respectively,on admission,and (41.2 ±27.1),(43.7 ± 26.5),(33.5 ± 28.8),respectively,at 6 weeks after nursing,and were (40.9 ± 27.7),(39.6 ± 24.3),(36.3 ± 28.7),respectively,at 12 weeks after nursing.The evasion and restrictive behavior,social fear disorderswere improved at 6,12 weeks after nursing as compared to nursing before.Conclusion Perioperative care for patients with the hyperreflexia of neurogenic detrusor by injection ofbotulinum toxin A can not only improve therapeuticeffect,improve social status,but also improve patients'self-management ability and quality of life.