Objective To summarize the experience of performing a variety of hepatectomies by occluding the branches of the hepatic artery (HA) and portal vein (PV) to the liver lobe, segment or subsegments in hilar H fissure for 344 patients in this hospital from 1987 to 2008. Methods (1) According to the size and location of the liver focus, major hepatectomy (66 cases), resection of separated hepatic subsegments (15 cases HS), resection of adjacent HS (216 cases) and resection of single HS (46 cases) were performed. (2) For left lateral HS, the left lateral inferior PV and left lateral superior PV originating from the lateral aspect of the left PV (LPV) were dissected, isolated and severed in umbilical fissure after the LHA was occluded. (3) For left medial HS, the left medial inferior PV and left medial superior PV originating from the medial aspect of the left PV were dissected、isolated and severed in umbilical fissure after the middle HA was occluded. (4) For right anterior HS, the right anterior PV was isolated and occluded in the anteior sulcus of the right longitudinal fissure (RLF) after the RHA behind the main hepatic duct was occluded. (5) For right posterior HS, the right posterior PV was isolated and occluded in the posterior sulcus of RLF after RHA was occluded.(6)The corresponding hepatic venous stem was protected as much as possible during the operation.Results (1) The operative mortality was 2.9% (10/344). Of these 10 patients, 8 died of liver failure and 2 bleeding. (2) Ten HCC patients (n=200) survived for 11～20 years, 4 for 7years, 19 for 5years and the 5-year survival rate was 18. 3% (33/180). For patients with hilar cholangiocarcinoma (n= 14), only 3 survived for 13, 6, 4 years, respectively. The patients with intrahepatic cholangiocarcinoma (n=13) survived for 1/2～3 years. Those with carcinoma of the gallbladder (n=12) survived for 1/2～1 year. All the patients with benign liver diseases (n=92) were cured. In 7 patients with intrahepatic lithiasis, the stones in other locations needed to be managed. Conclusion (1) Separated multiple hepatic subsegmentectctomy is an effective procedure to cure the compacted stones in 2～6 subsegmental hepatic ducts in both right and left lobes. (2) This procedure is reasonable, effective and of low cost for hepatectomy, worthy of being used because of the decrease in the ischemic liver mass and blood loss in operation, increase in the resectability of bulk liver cancer, alleviation of postoperative liver dysfunction and meeting the technical needs of a variety of hepatectomies for various liver diseases fulfilled by regional vascular occlusion at hepatic hilum instead of total hepatic afferent blood flow occlusion.

Whole rice grain was dissected by hand into fractions of pericarp, ale-urone, scutellum, embryo and endosperm. For the convenience of having enough amount of samples for amino acids assay some of which were recom-bined and finally three parts, pericarp +aleurone layer, scutellum + embryo and endosperm, were obtained. Protein, lysine, methionine, threonine and valine contents were determined for each part. The data obtained indicated that although total weight of the first two parts accounted for only 7.27-8.43% of the whole grain, they contributed 14.5-15.8% protein, 29.0-30.5% lysine, 11.8% melhionine, 16.8% valine and 19.4% threonine, contained in the whole grain. During husking process it indicated that the lesser amounts of pericarp, aleurone, scutellum and embryo were retained and the larger percentage of protein and lysine was lost. This fact was identified either by a specially designed miller in the laboratory or a commonly used sand wheel miller in the factory. The suitable degree of milling for rice was discussed and it was proposed that 92% extration for rice rather rational.

Lysine and methionine contents were determined in proteins of 21 rice samples including 17 varieties grown in 11 provinces. Ranges of lysine and methionine contents on crude protein basis were 3.21-3.76% and 1.63-2.06% respectively. The lysine content was found to be negatively correlated with the protein content of rice, but no correlation was found in case of methionine when they were expressed on the basis of crude protein. The absolute amounts of lysine and methionine were positively correlated with protein contained in the samples. The importance of breeding rice variety with protein of high lysine content was discussed in relation to promoting the protein nutritive status in South China.

A convenient microbiological method with high accuracy for cystine assay was introduced. Common foods including cereals, beans, sweet potato, fishes and other aquatic products as well as meats were selected for cystine and methionine analysis. Based on the data obtained, a brief discussion was made on the way for resolution of sulfur amino acids problem inherently in our traditional soy-cereal based diet.

ObjectiveTo investigate the cause of clinically missed diagnosis of thyroid microcarcinoma(TMC) and the management. Methods Clinical diagnostic and therapeutic data of 110 cases with TMC operated and confirmed by pathology from Jan. 1985 to Dec. 2000 were analysed. Results Diagnostic positive rates by ultrasonography and freezing section were respectively 58%(15/26) and 66 7%(14/21) in 26 cases diagnosed preoperatively. Diagnostic positive rate of freezing section was 80%(24/30) in 30 cases discovered intraoperatively. Through postoperative pathologic exam,54 cases were confirmed as TMC that was not discovered in 19 cases by intraoperative freezing section.Total or near total thyroidectomy was only performed on 35 cases,lobectomy of one or both lobes on other cases. Follow up rate was 80 1% with time ranging from 6 months to 15 years. One case recurred without mortality.Conclusion The clinical diagnosis of TMC is often difficult to establish. Careful palpation, ultrasonography with fine needle aspiratiou cytology before operation, and thorough exploration of the suspected nodules in operation will help to heighten the diagnostic rate. Total or near total lobectomy fulfils the eradication of TMC.

OBJECTIVETo observe the clinical effect of warm acupuncture at Zhongwan(CV 12) for chronic atrophic gastritis(CAG) with spleen-stomach deficiency cold by the comparison with conventional acupuncture.

METHODSSixty-two patients were randomly assigned into a warm acupuncture group and a conventional acupuncture group,31 cases in each one. The acupoints in the two groups were Zhongwan(CV 12),Zusanli(ST 36),Neiguan(PC 6),Gongsun(SP 4),Qihai(CV 6),Pishu(BL 20) and Weishu(BL 21). Warm acupuncture was intervened at Zhongwan(CV 12) in the warm acupuncture group. Twirling reinforcing was applied at Zhongwan(CV 12) in the conventional acupuncture group. All the treatment was given for 3 courses continuously,5 days as one course,once a day. TCM syndrome score and symptom rating scale were observed before and after treatment in the two groups,and the effects were compared.

RESULTSThe total effective rate was 93.5%(29/31) in the warm acupuncture group,which was better than 87.0%(27/31) in the conventional acupuncture group(<0.05). The TCM syndrome score and symptom rating score were improved in the two groups after treatment(<0.01,<0.05),with more apparent improvement in the warm acupuncture group(<0.01,<0.05).

CONCLUSIONSWarm acupuncture at Zhongwan(CV 12) can improve gastrointestinal discomfort,which is better than twirling reinforcing at Zhongwan(CV 12) for CAG with spleen-stomach deficiency cold.

Like rest of the world, the South Asian region is facing enormous challenges with the coronavirus disease 2019 (COVID-19) pandemic. The socio-economic context of the eight South Asian countries is averse to any long-term lockdown program, but the region still observed stringent lockdown close to two months. This paper analyzed major measures in public health preparedness and responses in those countries in the pandemic. The research was based on a situation analysis to discuss appropriate plan for epidemic preparedness, strategies for prevention and control measures, and adequate response management mechanism. Based on the data from March 21 to June 26, 2020, it appeared lockdown program along with other control measures were not as effective to arrest the exponential growth of fortnightly COVID-19 cases in Afghanistan, Bangladesh, India, Nepal and Pakistan. However, Bhutan, Maldives and Sri Lanka have been successfully limiting the spread of the disease. The in-depth analysis of prevention and control measures espoused densely populated context of South Asia needs community-led intervention strategy, such as case containment, in order to reverse the growing trend, and adopt the policy of mitigation instead of suppression to formulate COVID-19 action plan. On the other hand, mechanism for response management encompassed a four-tier approach of governance to weave community-led local bodies with state, national and international governance actors for enhancing the countries' emergency operation system. It is concluded resource-crunch countries in South Asia are unable to cope with the disproportionate demand of capital and skilled health care workforce at the time of the pandemic. Hence, response management needs an approach of governance maximization instead of resource maximization. The epidemiologic management of population coupled with suitable public health prevention and control measures may be a more appropriate strategy to strike a balance between economy and population health during the time of pandemic.

Objective To evaluate the clinical efficacy and safety of recipient-site pre-expansion via tumescent anesthesia in facial fat grafting .Methods Facial fat grafting was operated through the technology of recipient-site pre-expansion via tumescent anesthesia .The high-frequency ultrasonography was used to record the changes of soft tissue thickness , blood flow signal and transplant area in certain-points.Theresult were analyzed by SPSS 11.5.The survival rates of fat grafting were compared by Kruskal-Wallis H test.The area of soft tissue blood flow signals were analyzed by variance analysis .The patients' postoperative satisfaction rates and pain were evaluated by mean value .Results 14 cases were treated , with obvious improvement .Results of high frequency ultrasonography showed the median and quartile spacing of the soft tissue thickness was 70.1％(53.85％), 56.4％(51.95％), and 16.7％in the first month, third month and the sixth month after operation , separately.The difference between the three groups was statistically significant (H=1.4 ×108, P<0.05).The area of soft tissue blood flow signals was(3.97 ±0.84)‰,(2.21 ±0.55)‰,(6.89 ±2.39)‰,(14.61 ±4.66)‰,(9.39 ±3.94)‰, (15.87 ±3.02)‰before the operation, 24 hours, the first month, third month and the sixth month after operation,separately.The difference between the six groups were statistically significant (F=3.471, P <0.05).No complication occurred in the following-up period.Patients were satisfied with the pain relief. Conclusions It is safe and effective to apply recipient-site pre-expansion via tumescent anesthesia in fat grafting.

Objective To evaluate the clinical efficacy and safety of recipient-site pre-expansion via tumescent anesthesia in facial fat grafting .Methods Facial fat grafting was operated through the technology of recipient-site pre-expansion via tumescent anesthesia .The high-frequency ultrasonography was used to record the changes of soft tissue thickness , blood flow signal and transplant area in certain-points.Theresult were analyzed by SPSS 11.5.The survival rates of fat grafting were compared by Kruskal-Wallis H test.The area of soft tissue blood flow signals were analyzed by variance analysis .The patients' postoperative satisfaction rates and pain were evaluated by mean value .Results 14 cases were treated , with obvious improvement .Results of high frequency ultrasonography showed the median and quartile spacing of the soft tissue thickness was 70.1％(53.85％), 56.4％(51.95％), and 16.7％in the first month, third month and the sixth month after operation , separately.The difference between the three groups was statistically significant (H=1.4 ×108, P<0.05).The area of soft tissue blood flow signals was(3.97 ±0.84)‰,(2.21 ±0.55)‰,(6.89 ±2.39)‰,(14.61 ±4.66)‰,(9.39 ±3.94)‰, (15.87 ±3.02)‰before the operation, 24 hours, the first month, third month and the sixth month after operation,separately.The difference between the six groups were statistically significant (F=3.471, P <0.05).No complication occurred in the following-up period.Patients were satisfied with the pain relief. Conclusions It is safe and effective to apply recipient-site pre-expansion via tumescent anesthesia in fat grafting.