Objective To evaluate the efficacy of mini-clamp crushing combined with saline-linked diathermy in hepatectomy for giant hepatocellular carcinoma(HCC).Methods The clinical data of 58 patients with giant HCC(diameter≥10 cm)who received hepatectomy with the mini-clamp crushing technique(miniclamp crushing group)at the Southwest Hospital from April 2006 to December 2009 were retrospectively analysed.According to the tumor size,location and Child classification,the clinical data of 58 patients with similar parameters and received hepatectomy with traditional clamp crushing technique(control group)were selected from the database to conduct the matched case-control study.All the peri-and postoperative data were compared and analysed via one-way ANOVA,chi-square test and Fisher's exact test.Results The median blood loss and transfusion of control group were 850 ml and 650 ml,which were significantly higher than 400 ml and 550 ml of mini-clamp crushing group(F=16.23,5.63,P＜0.05).Twenty-four patients in control group needed blood transfusion,which was significantly larger than 6 of mini-clamp crushing group(χ~2=14.57,P＜0.05).The median time for parenchymal transection and portal triad clamping of control group were 45 minutes and 16 minutes,which were significantly shorter than 86 minutes and 35 minutes of mini-clamp crushing group(F=12.76,11.23,P＜0.05).The numbers of patients in control group who had complications and blood loss were 43 and 28,which were significantly larger than 13 and 8 of mini-clamp crushing group(χ~2=18.69,16.11,P＜0.05).The numbers of patients who had bile leakage,encapsulated effusion of the liver cut face and hepatic insufficiency were 8,5 and 2 in control group,and were 2,3,0 in mini-clamp crushing group,with no significant difference(χ~2=3.04,0.54,2.04,P＞0.05).Conclusion Mini-clamp crushing combined with saline-linked diathermy for the treatment of g4ant HCC is mone effective and available than traditional clamp crushing in terms of reducing blood loss and complications.

Aim To investigate the cardioprotective effects and the possible mechanism of trimetazidine in the risky areas during late reperfusion after acute myocardial infarction in canine.Methods Twenty-four adult dogs were randomized into three groups:sham operation group(n=8),late reperfusion group(LR,n=8),late reperfusion after trimetazidine treatment group(LR+TMZ,n=8).Physiological saline was orally given in the sham operation group and LR group and trimetazidine(2 mg?kg-1?d-1) in the LR+TMZ group for fourteen days.After that later,all chests were opened and coronary areteries were exposed.Exceptly shame operation group,the late reperfusion of acute myocardial infarction model was made by ligating the coronary for 10 h,followed by reperfusion of 10 h.Apoptotic index were detected by TUNEL.The Bcl-2,Bax,Cytochrome C and apoptosis-inducing factor(AIF) proteins were detected by immunohistochemistry.Results Compared with those of LR group,myocardial apoptotic index and the expression of Bax,Cytochrome C and AIF proteins in LR+TMZ decreased significantly(all P

Objective To compare the effects of radiofrequency ablation and clamp crushing resection on intraoperative blood loss and postoperative complications.Methods The clinical data of 130 patients with hepatic cancer who were admitted to the Southwest Hospital from January 2011 to June 2012 were retrospectively analyzed.Sixty-five patients who received radiofrequency ablation were in the radiofrequency ablation group; the clinical data of 65 hepatic cancer patients with similar tumor size,position and Child-Pugh scores who received traditional clamp crushing resection were selected from the data base,and they were in the clamp crushing resection group.The intra-and postoperative clinical data of the 2 groups were statistically analyzed.The measurement data were presented in the format of median plus range,and were analyzed using the analysis of variance; the enumeration data were analyzed using chi-square test,when the number of patients was under 10,the Fisher exact probability was used for analysis.Results The time for liver resection and hepatic inflow occlusion in the radiofrequency ablation group were 28 minutes (range,12-55 minutes) and 10 minutes (range,0-15 minutes),which were significantly shorter than 45 minutes (range,25-92 minutes) and 15 minutes (range,10-32 minutes) in the clamp crushing resection group (F =10.35,9.05,P ＜0.05).The volumes of intraoperative blood loss and blood transfusion were 150 ml (range,50-350 ml) and 0 ml in the radiofrequency ablation group,which were significantly lesser than 450 ml (range,250-2500 ml) and 550 ml (range,0-2000 ml) in the clamp crushing resection group (F =15.86,P ＜ 0.05).The number of patients who did not receive blood transfusion in the radiofrequency ablation group was 65,which was significantly greater than 48 in the clamp crushing resection group (x2 =19.58,P ＜ 0.05).The levels of aspartic transaminase (AST) and total bilirubin (TBil) at postoperative day 3 and 7,prothrombin time (PT) at postoperative day 3,Clavien classification of surgical complications,duration of hospital stay were 302 U/L (range,89-823 U/L),54 U/L (range,16-325 U/L),37 μmol/L(range,18-112 μmol/L),24 μmol/L (range,9-66 μmol/L),15 s (range,11-20 s),22％ (14/65),12 days (range,8-36 days) in the radiofrequency ablation group,and 253 U/L (range,63-876 U/L),62 U/L(range,22-376 U/L),41 μmol/L (range,19-105 μmol/L),25 μmol/L (range,11-59 μmol/L),14 s (range,11-21 s),26％ (17/65) and 13 days (range,9-35 days) in the clamp crushing resection group.There were no significant differences in the 7 indexes between the radiofrequency ablation group and the clamp crushing resection group (F=2.59,1.93,3.96,1.58,2.35,x2 =0.381,F=1.58,P＞0.05).The incidence of complications of the radiofrequency ablation group was 17％ (11/65),which was significantly lower than 52％ (34/65) of the clamp crushing resection group (x2 =17.38,P ＜ 0.05).The number of patients who had postoperative bleeding in the radiofrequency ablation group was 2,which was significantly lesser than 22 patients in the clamp crushing resection group.Eight patients in the radiofrequency ablation group had encapsulated effusion,and 5 of them need drainage.Two patients in the clamp crushing resection group had hepatic insufficiency.Two patients in the radiofrequency ablation group had hemoglobinuria.Conclusion Compared with clamp crushing resection,radiofrequency ablation has advantages of less blood loss and safer manipulation.

Objective To investigate the value of continuous occlusion of hepatic artery proper to intermittent Pringle maneuver in partial hepatectomy for ruptured hepatocellular carcinoma(HCC).Methods The clinical data of 36 patients(test group)who received partial hepatectomy for ruptured HCC by adding continuous occlusion of hepatic artery proper to intermittent Pringle maneuver at the Southwest Hospital were retrospectively analyzed.Thirty-six patients(control group)who received intermittent Pringle maneuver only were selected as the control.All data were analyzed using the chi-square test,Fisher exact probability and analysis of variance.Results The mean hepatic artery occlusion time of the test group was 58 minutes(range,36-98 minutes).The median blood loss of the test group was 400 ml,which was significantly less than 750 ml of the control group(F =16.47,P ＜ 0.05);78%(28/36)of patients in the test group did not receive blood transfusion,which was significantly more than 53%(19/36)of the control group(x2 =6.01,P ＜0.05).The levels of postoperative serumaspartate transaminase and total bilirubin of the 2 groups were peaked at postoperative day 2 and then decreased to the normal level 1 week later.There were no significant differences in the incidences and levels of complications between the 2 groups(x2 = 1.83,0.89,P ＞ 0.05).Conclusion The addition of continuous occlusion of hepatic artery proper to intermittent Pringle maneuver significantly reduces intraoperative blood loss and doesn't bring any adverse effects to hepatic function for partial hepatectomy in patients with ruptured HCC when compared with intermittent Pringle maneuver alone.

Objective To determine whether the candidates who are disqualified because of ear diseases during medical selection of flying cadets in China are qualified or not according to United States Air Force ( USAF ) Medical Standards Directory in order to raise suggestions for revising PLAAF medical standards for flying cadets.Methods Data of final selections from 2013 to 2015 and the conclusions were compared by different standards.Results and Conclusion There was a marked difference (x2 =7.99,P<0.05) in the disqualification rate of cadets that rose each year.There was no difference (x2 =5.39,P>0.05) in the disqualification rate related to ear diseases.Vestibular dysfunction and dysacousis were the leading causes of disqualification among ear diseases, making up 45.54% and 38.84% respectively, with other diseases less than 5%.Medical standards for ear diseases in China are more strict than in the USAF, so we should revise some PLAAF standards according to the USAF standards for reference, such as those for vestibular neuritis, dysacousis and tympanic disease in order to enlarge the source of cadets.

The HIV susceptibility and resistance alleles in the HLA genes were determined by investigating the distribution characteristics of the HLA alleles (A,B,and DRB1) in HIV-infected individuals of the Han population in Hubei,and by comparing these alleles with HIV-negative individuals from the same area.A cohort of 424 HIV-1 infected individuals were chosen as study subjects,and 836 HIV-negative healthy subjects from the same area served as the control population.HLA-A,B,and DRB 1 allele typing was performed using polymemse chain reaction-sequence-specific oligonucleotide probes (PCR-SSOP) and polymerase chain reaction-sequencing based typing (PCR-SBT) techniques.Arlequin ver3.0 was used to analyze the allele and haplotype frequencies of HLA-A,B,and DRB l,whereas Epi Info 7 and SPSS18.0 was used to analyze the differences in the HLA alleles between the HIV-1 positive and HIV-1 negative groups.A*02:03,DRB1*01:01,and DRB1*15:01 alleles and their haplotypes as well as the HLA_Bw4-Bw6 hybrid showed a protective effect on HIV-1 infection.After adjusting for confounding factors such as age and sex,multivariate logistic regression analysis revealed that B* 15:02G,DRB 1*01:01,and DRB 1 * 15:01 subtypes were the resistance genes of HIV-1 infection,while B * 13:01 might increase susceptibility to HIV-1 infection.The correlation between A*02:06 and B*15:01G subtypes and HIV-1 susceptibility was independent of the age and sex of the host.This study demonstrated the influence of genetic factors in humans such as HLA polymorphism on individuals to resist HIV-1 infection.Association studies of HLA polymorphism,susceptibility/resistance to HIV-1 infection,and hosts' genetic background are of significant importance for research on HIV-1 pathogenesis and vaccine design.

Objective To investigate the risk factors resulting in the perioperative liver failure and death for the HBV-associated hepatocellular carcinoma (HCC) patients with or without cirrhosis.Methods The method of retrospective case-control study was performed.The clinicopathological data of 1 083 HCC patients with positive HBsAg who received curative liver resection at the Southwest Hospital from January 2008 to December 2012 were collected.According to the absence or presence of cirrhosis,the HCC patients with positive HBsAg were divided into the 2 groups,including the cirrhosis group (633 patients) and the non-cirrhosis group (450patients).The intraoperative conditions (operation time,volume of intraoperative blood loss,rate of blood transfusion,rate of pringle maneuver) and postoperative conditions (incidence of perioperative complications,duration of postoperative hospital stay,perioperative mortality) of HCC patients were observed.The gender,age,alanine transaminase (ALT),aspartate transaminase (AST),albumin (Alb),total bilirubin (TBil),platelet (PLT),Child-Pugh classification,operation time,volume of intraoperative blood loss,blood transfusion,pringle maneuver,extent of liver resection,number of tumors,tumor diameter,tumor thrombus and liver cirrhosis were enrolled and prognostic factors resulting in perioperative liver failure and death for the HCC patients were explored.Measurement data with skewed distribution were presented as M (range) and comparison between the 2 groups was analyzed using Mann-Whitney U test.Count data were presented as counts (percentage) and comparison between the 2 groups was analyzed using chi-square test or Fisher exact probability.Univariate analysis was performed by chi-square test and multivariate analysis was performed by Logistic regression model (forward).Results (1) The intraoperative conditions:the volume of intraoperative blood loss were 500 mL (range,30-7 000 mL) in the cirrhosis group and 400 mL (range,50-8 000 mL) in the non-cirrhosis group,with a statistically significant difference between the 2 groups (Z =-2.209,P ＜ 0.05).The operation time,rate of blood transfusion and rate of pringle maneuver were 250 minutes (range,82-715 minutes),29.86％ (189/633),62.24％ (394/633) in the cirrhosis group and 242 minutes (range,85-738 minutes),27.11％ (122/450),66.67％ (300/450) in the non-cirrhosis group,respectively,with no statistical differences between the 2 groups (Z =-1.212,x2 =0.969,2.236,P ＞0.05).(2) The postoperative conditions:the incidence of perioperative complications was 30.49％(193/633) in the cirrhosis group and 21.11％ (95/450) in the non-cirrhosis group,with a statistically significant difference between the 2 groups (x2 =11.851,P ＜ 0.05).The incidence of lung infection,abdominal infection and liver failure were 6.48％ (41/633),2.69％ (17/633),5.53％ (35/633) in the cirrhosis group and 3.56％ (16/450),0.89％ (4/450),1.33％ (6/450) in the non-cirrhosis group,respectively,with statistically significant differences between the 2 groups (x2 =4.502,4.465,12.713,P ＜ 0.05).The duration of postoperative hospital stay was 15 days (range,0-70 days) in the cirrhosis group and 14 days (range,0-71 days) in the non-cirrhosis group,with a statistically significant difference between the 2 groups (Z =-3.448,P ＜ 0.05).The perioperative mortality was 5.85％ (37/633) in the cirrhosis group and 2.44％ (11/450) in the non-cirrhosis group,with a statistically significant difference between the 2 groups (x2=7.181,P ＜ 0.05).(3)Results of risk factors affecting perioperative liver failure:①results of univariate analysis showed that age,AST,Alb,Child-Pugh classification,operation time,volume of intraoperative blood loss,blood transfusion,extent of liver resection,tumor diameter,liver cirrhosis with positive HBsAg were associated with perioperative liver failure in HCC patients (x2=5.013,7.979,8.855,16.968,14.148,9.764,18.511,11.749,5.534,12.713,P＜0.05);age,AST,Alb,Child-Pugh classification,operation time,blood transfusion,extent of liver resection and tumor diameter were associated with perioperative liver failure in the cirrhosis group (x2=5.877,5.380,11.087,13.672,8.849,13.170,12.418,5.805,P ＜ 0.05);volume of intraoperative blood loss was associated with perioperative liver failure in the non-cirrhosis group (P ＜ 0.05).②Results of multivariate analysis showed that age≥60 years,Child-Pugh class B,operation time ＞ 360 minutes,blood transfusion,extent of liver resection ≥3 segments and liver cirrhosis were independent risk factors affecting perioperative liver failure in HCC patients with positive HBsAg [OR =2.285,2.716,2.315,2.159,2.459,4.322;95％ confidence interval (CI):1.081-4.831,1.100-6.706,1.064-5.038,1.068-4.362,1.264-9.786,1.763-10.598,P＜0.05];Alb ＜38 g/L,Child-Pugh class B,blood transfusion and extent of liver resection ≥ 3 segments were independent risk factors affecting perioperative liver failure in the cirrhosis group (OR =2.231,2.857,2.186,2.927,95％ CI:1.038-4.795,1.095-7.451,1.045-4.576,1.426-6.008,P ＜ 0.05);volume of intraoperative blood loss ＞ 1 200 mL was an independent risk factor affecting perioperative liver failure in the non-cirrhosis group (OR =15.077,95％CI:2.695-84.353,P ＜ 0.05).(4) Risk factors affecting perioperative death:①results of univariate analysis showed that gender,Alb,TBil,Child-Pugh classification,blood transfusion,extent of liver resection,tumor diameter,tumor thrombus and liver cirrhosis were associated with perioperative death in HCC patients with positive H BsAg (x2=4.462,8.783,4.212,4.869,7.189,11.745,6.837,4.323,7.181,P ＜0.05);Alb,extent of liver resection and tumor diameter were associated with perioperative death in the cirrhosis group (x2=12.173,12.793,10.981,P ＜ 0.05);blood transfusion and tumor thrombus were associated with perioperative death in the non-cirrhosis group (x2 =5.836,6.417,P ＜ 0.05).② Results of multivariate analysis showed that Alb ＜38 g/L,extent of liver resection ≥ 3 segments and liver cirrhosis were independent risk factors affecting perioperative death in HCC patients with positive HBsAg (OR =2.560,2.657,2.567,95％ CI:1.382-4.742,1.471-4.800,1.283-5.134,P ＜ 0.05);Alb ＜ 38 g/L,extent of liver resection ≥ 3 segments and tumor diameter≥5 cm were independent risk factors affecting perioperative death in the cirrhosis group (OR =3.003,2.533,3.060,95％ CI:1.495-6.034,1.251-5.128,1.135-8.251,P＜0.05);blood transfusion and tumor thrombus were independent risk factors affecting perioperative death in the non-cirrhosis group (OR =3.755,4.036,95％ CI:1.047-13.467,1.126-14.469,P ＜ 0.05).Conclusions Liver cirrhosis is an independent risk factor for perioperative liver failure and death in HCC patients with positive HBsAg.The risk of perioperative liver failure and death in HCC patients with cirrhosis is significantly higher than that in HCC patients without cirrhosis,and there is a difference in the risk factors for perioperative liver failure and death.

Objective To evaluate the influence of hepatic ischemia-repeffusion injury (HIRI) induced by Pringle maneuver on the prognosis of hepatoceUular carcinoma (HCC) patients after hepatectomy. Methods The chnical data of 315 HCC patients who had been admitted to Southwest Hospital from January 2004 to December 2008 were retrospectively analyzed. The 194 patients who received Pringle maneuver during hepatectomy were in the HIRI group. The control group was composed of 121 patients without portal triad clamping. The pre- and peri-operative characteristics and the prognosis of the patients were analyzed by t test, chi-square test, Kaplan-Meier survival curve, Log-rank test and Cox regression model analysis. Results Patients in the HIRI group were significantly younger than those in control group (median age, 49 vs 59) (X2 =4. 12, P < 0.05). There were 108 patients (55.7%) with large HCC (diameter > 5 cm) in the HIRI group, while the number of patients with large HCC in the control group was 83 (68.6%), with statistical difference between the 2 groups (X2=4. 12, P <0.05). The serum levels of aspartate aminotransferase on postoperative day 3 and day 7 were 255 U/L and 112 U/L, which were significantly higher than 128 U/L and 35 U/L in the control group (X2 =4.57, 5.89, P <0.05). The level of total bilirubin on postoperative day 3 was 56 U/L in the HIRI group, which was significantly higher than 39 U/L in the control group (X2=4.79, P <0.05). The disease-free survival rate and cumulative survival rate in the HIRI group were significantly lower than those in the control group (X2 = 5.93, 8. 32, P < 0. 05). Perioperative blood loss, diameter of tumor, portal triad clamping and portal vein invasion were independent factors influencing the diseasefree survival rate. Conclusions HIRI induced by Pringle maneuver significantly decreases the disease-free survival rate and cumulative survival rate of HCC patients after hepatectomy.

Objective To investigate the clinical efficacy of radiofrequency ablation for the treatment of metastatic hepatic carcinoma.Methods The clinical data of 87 patients with metastasis hepatic carcinoma who received radiofrequency ablation (RFA) at the Southwest Hospital from January 2004 to December 2008 were retrospectively analyzed.Of the 87 patients,34 were with liver metastasis from colonic cancer,33 with liver metastasis from rectal cancer,12 with liver metastasis from pancreatic cancer,and 8 with liver metastasis from gastric cancer.The survival of the patients was analyzed by life score and kamofsky performance status (KPS)scale.Patients were followed up via phone call and out-patient examination.Ultrasonography,computed tomography,liver function and tumor markers test were done every month within postoperative 6 months,and every 2 months at 6 months later.The follow-up was ended in Novermber 2013.All data were analyzed using chi-square test or rank sum test.The survival curve was drawn by Kaplan-Meier method,and the survival rate was compared using the Log-rank test.Results Of the 87 patients,84 were successfully treated by RFA,and 3 patients gave up RFA because of unbearable pain (2 patients with colonic cancer and 1 with gastric cancer).A total of 129 metastatic lesions were detected in the 84 patients,and 107 metastatic lesions were ablated after single RFA,with the success rate of 82.95％ (107/129).The other 22 lesions were ablated after a second RFA.The mean duration of hospital stay was (10.7 ± 2.3) days (range,4-29 days).Before operation,the life quality was excellent in 60.7％ (51/84) of patients,good in 22.6％ (19/84) of patients,fair in 10.7％ (9/84) of patients,and poor in 6.0％ (5/84) of patients.The candition of 63.1％ (53/84) of patients was improved,29.8％ (25/84) of patients was stable,and 7.1％ (6/84) of patients was deteriorated.At postoperative month 6,the life quality was excellent in 78.2％ (54/69) of patients,good in 11.6％ (8/69) of patients,fair in 5.8％ (4/69) of patients,and poor in 4.4％ (3/69) of patients.The condition of 73.9％ (51/69) of patients was improved,21.7％ (15/69) of patients was stable,and 4.4％ (3/69) of patients was deteriorated.There were significant differences in the life score and KPS scale between patients before and after operation (x2 =29.760,17.140,P ＜ 0.05).All patients were followed up for 6-60 months.The 1-,3-,5-year survival rates of patients with liver metastasis from colonic cancer after RFA treatment were 68.8％,21.9％ and 6.3％,and the median survival time was 21.5 months.The 1,3,5-year survival rates of patients with liver metastasis from rectal cancer after RFA were 66.7％,27.3％,12.1％,and the median survival time was 19.5 months.The 1-,3-,5-year survival rates of patients with liver metastasis from pancreatic cancer after RFA treatment were 41.7％,0 and 0,and the median survival time was 8.5 months.The 1-,3-,5-year survival rates of patients with liver metastasis from gastric cancer after RFA treatment were 71.4％,14.3％ and 0,and the median survival time was 16.5 months.The survival rates of patients with liver metastasis from pancreatic cancer and gastric cancer were significantly lower than those with liver metastasis from colorectal cancer after RFA (x2 =9.169,P ＜ 0.05).Conclusion The efficacy of RFA for selected patients with liver metastasis from digestive tract tumors is satisfactory.

Objective To analyze the feature of B cell epitope of soluble liver antigen(SLA) in autoimmune hepatitis. Methods Twenty-one autoimmune hepatitis(AIH) were enrolled the study. The control groups included 15 primary biliary cirrhosis(PBC) patients, 20 chronic virus hepatitis patients and 20 heaths. The serum incubated with coated one dimension of SLA peptide pools by ELISA for mapping the B cell epitopes. ELISPOT was performed to screen the SLA specific T cell response by observing the secretion of IFN-γ after PBMC simulated. Results Ten serum samples from AIH patients recognized the SLA peptide pools, the frequency was 47.62%, which was higher than PBC group, virus hepatitis group and normal control group, P value was 0.001, <0.001 and <0.001, respectively. The 10 positive serum dominant response to SLA 7 th pool(aa385-441), which laid in the unique no conservative region of the SLA molecular. T cell recognizing regions laid dominantly in first and second pool, the frequency was 30% and 40%, respectively, however the recognized frequency of 7th pool was 10%. Conclusion B cell linear epitopes lie in the sequence aa385-441, which is the unique unconservative region in the high conservative SLA molecular and overlaps with part sequence of T cell epitopes. The results show it is complex and interaction that SLA induced humoral-mediated immunity and cellular immunity to involve in AIH pathogenesis.