Objective To evaluate the value of DWI parameter ADC and intravoxel incoherent motion(IVIM) derived parameters in grading extrahepatic cholangiocarcinoma(EHCC).Methods Thirty-eight consecutive patients with surgically resected and pathologically confirmed EHCC while the minimum diameter of the lesions large than 5 mm were included in this retrospective study.Patients underwent upper abdomen 3.0 T MR(including conventional MRI and DWI scansequences).Importing original images into the IVIM post-processing software,each patient were set three times of ROIs and each time interval was one week.ROI were selected in the same position of the maximum solid part of lesions area,the average value of ADC,blood flow(BF),pure molecular diffusion(D),perfusion-based molecular diffusion(D*),perfusion fraction(f) were measured.According to WHO digestive tumor specimens grading method,divided these cases into Ⅰ,Ⅱ,Ⅲ grade group.Evaluate the association by Spearman correlation analysis and compare the diagnostic potential of parameters ADC、BF、D、D*、f by using ROC analysis.Results Thirty eight cases of EHCC include:grade Ⅰ 11 cases,grade Ⅱ] 15 cases and grade Ⅲ 12 cases.ADC values of these three groups were (1.33 ± 0.22) × 10-3,(1.21 ± 0.18) × 10-3,(0.98 ± 0.10) × 10-3mm2/s,respectively.BF values were (2.40± 1.01) × 10-3,(2.37± 1.19) × 10-3,(1.64±0.46) × 10-3mm2/s.D values were (1.30±0.13) × 10-3,(1.15 ±0.13) × 10-3,(0.87±0.11) × 10-3mm2/s.D* values were (5.67±0.70) × 10-3,(6.58 ± 1.82) × 10-3,(5.43±2.82) × 10-3mm2/s.And f values were (38.03± 10.02)％,(31.36±8.34)％,(22.04±7.93)％.ADC,D,and f values were significantly correlated with histologic grade(r=0.624,0.809,0.580;P＜0.01,respectively).BF and D* were both not significantly correlated(r=0.271,0.017;P=0.099,0.920,respectively).Areas under the ROC curve for the five parameters ADC,BF,D,D*,f were 0.785,0.603,0.889,0.421,0.781,respectively.Conclusions With the reduction of histological differentiation degree,ADC,D,f values decreased.Correlation between f value and pathological differentiation degree is poor whie the correlation of D and ADC were excellent,and the correlation of D is the highest.

Objective To observe the clinical effects of anterior plates with titanium mesh and bone graft (auto and allo) in treatment of cervical spine fractures. Methods 42 cases of fractures of cervical spine treated with anterior plates with titanium mesh. Results The bone graft (auto and allo) were followed up for 4 to 28 months (mean 17 months). The preoperative and postoperative nerve functions were evaluated according to JOA criteria. The cervical curvatures, sink or shift of the mesh and bone fusion were evaluated by X rays. There were no significant complications during perioperative periods. The functions of spinal cord were improved, the cervical curvatures were restored, and no sinking or shifting of the mesh was observed. There was also no loosening of plate or screw. The fusion began 3.5 months postoperatively, and a good fusion could be observed 1 year postoperatively. Conclusion By application of anterior plates with titanium mesh and bone graft (auto and allo) in treatment of cervical spine fractures, the cervical curvature and stability can be restored, the iliac lesion and long operation duration caused by the harvest from ilium can be avoided, better fusion and quicker recovery can be obtained.

Objective To explore different characteristics of the vertebral artery and basilar artery haemody-namics in different frequencies to provide a theoretical basis for clinical treatment .Methods 90 cases of sudden deaf-ness were induded and according to hearing curve ,the cases were divided into three groups with 30 cases for each while the control group had 30 subjects .All cases were examined by TCD ,the VA ,BA test .Results Compared with group of median and low frequency sudden deafness ,the abnormal blood flow rate were found with decreased hearing(P<0 .05) .High and the full frequency range showed the abnormal blood flow rate ,although results were different(P<0 .05) .There were more high velocity detection rates among patients of high frequency group than the other groups .The full-frequency group's blood flow detection rate increased significantly more than the first two groups of patients with sudden deafness .PI ,RI of sudden deafness increased slightly ,but there was no statistically significant difference compared with control group (P>0 .05) .High frequency hearing loss compared with the con-trol group patients with sudden deafness had a clear abnormal velocity (P<0 .05) ,characterized by high velocity . There was no statistically significant difference in blood flow rate among low and median frequency group ,full-fre-quency group and control group except for Vs of BA in low and median frequency group .Conclusion Vertebral and basilar arterial circulation disorders had present more significance in the incidence of sudden deafness ,evident espe-cially in high and all frequency sudden deafness .Early initiation of TCD examination can understand the change of the vertebral and basilar artery hemodynamics ,providing high clinical application values .

Objective To study the expression of the excision repair cross complementing 1 ( ERCC1 ) and thymidylate synthase ( TS) in gastric cancer and to investigate the correlation between the ERCC 1 and TS ex-pression with the efficacy of FOLFOX adjuvant chemotherapy in gastric cancer patients .Methods A total of 73 gastric cancer patients received modified FOLFOX adjuvant chemotherapy .Real-time PCR was used to investi-gate the expression of ERCC 1 and TS in gastric cancer tissue .We also studied their correlation and association with prognosis .Results ERCC1 and TS expressed in gastric cancer tissues with the positive rate were 42 .5%(31/73)and 61.6%(45/73).There was no significant correlation between the ERCC 1 or TS expression and the clinical features .In this study ,the median of RFS and MST were 16 months and 27 months in patients with ER-CC1-negtive expression,9 months and 16months in patients with ERCC1-positive expression,the median of RFS and MST were significantly different in the two groups (P=0.000,P=0.002).There were no statistical differences on TS expression pattern in either median of RFS or MST (P=0.10,P=0.71).Conclusion The ex-pression of ERCC1 may be useful in prediction of the clinical outcome in gastric cancer patients who treated with FOLFOX7 adjuvant chemotherapy .Patients with ERCC1-negtive expression may benefit from the therapy .

From January 2005 to January 2008, 23 cases of fractures and dislocations of cervical spine treated with anterior decompression, reconstruction of bone graft with titanium mesh, and titanium locking plates fixation in Department of Orthopaedics, the 309 Hospital of Chinese PLA were retrospectively analyzed, including 16 males and 7 females, aged 41.9 years (ranging 25 ?65 years). The clinical effect and application value of this treatment was evaluated; the conditions at preoperative, immediate postoperative and follow-up were evaluated by JOA grade, and these radiographs were taken. Lordosis (kyphosis) of the fusion segment with Cobb's angle, and lordosis (kyphosis) of cervical spine with D value were measured to evaluate effect of reconstruction and cervical spine physiological curve. All cases were followed-up for 20.5 months (ranging 1-3 years). Clinical stability was reached in all cases during the follow-up. There were significant differences between preoperative and immediate postoperative, between preoperative and follow-up groups in terms of JOA grade, Cobb's angle and D value (P < 0.05). The JOA grade of immediate postoperative was improved compared with that during follow-up (P < 0.05). The mean improvement rate was 63% at 1 year of follow up. A good curative effect was obtained by using anterior locking plate with titanium mesh systems in treatment of cervical fractures and dislocations and a good effect of restoring and maintaining the lordosis of cervical spine can be also obtained.

Objective To summarize effect of hemiarthroplasty in treatment of femoral neck fractures in the elderly.Methods From January 1998 to January 2008,hemiarthroplaaties were performed in 84 patients with femoral neck fractures,including 24 males and 60 females,at age range of 75-97 years (mean 80 years).Of all,40 patients were treated with unipolar hemiarthroplasty and 44 with bipolar hemiarthroplasty.In the meantime,29 patients were treated with cement fixation and 15 with biological fixation with old femoral stems,and 40 with biological fixation with contemporary femoral stem.Results There were 50 patients(24 in unipolar and 26 in bipolar group)were followed up for average five years (1-10 years).X-ray showed total acetabular erosion rate of 50%(25/50),with 83%(20/24)in unipolar group and 19%(5/26)in bipolar group.Total definite loosening rate was 40%(20/50),which was distributed in six patients treated with cement fixation and 14 with biological fixation.Total revision rate was 24%(12/50),with 37.5%(9/24)in unipolar group and 12%(3/26)in bipolar group.Statistical analysis showed that acetabular erosion rate and revision rate in bipolar group were lower than those in unipolar group(P＜0.01).Definite loosening rate in cement fixation group was significantly lower than biological fixation group,with no statistical difference compared with biological fixation of contemporary stem(P＞0.05).Conclusions Bipolar replacement is significantly better than unipolar replacement for femoral neck fracture in the elderly.Cement fixation with old femoral stem is significantly better than biological fixation with old femoral stem,which is similar to biological fixation with contemporary femoral stem.

Objective To observe the efficiency and toxicity of Vinorelbine(NVB) combined with Cisplatin (DDP) in the treatment of advanced breast cancer patients resistent to Adriamycin (ADM) or Taxol treatment.Methods 34 patients with 8 cases simplex carcinoma,20 cases infiltrating duct carcinomas,3 cases medullary carcinoma,1 case large sweat gland-like carcinoma and 2 cases scirrhous carcinoma,who were relaped and refractory after ADM or Taxol treatment,were treated with NVB 25mg/m2,DDP 25mg/m2,Ⅳ.Both drugs were given in a 21-days cycle.The efficacy was evaluated every 2 or 3 cycles by using response evaluation criteria in solid tumor.Results 2 cases of 34 assessable patients achieved complete response (CR),18 patients had partial response (PR),8 cases had stable disease(S D),6 cases had progressive disease(PD).The total effective rate was 58.8％ (CR + PR).The medium duration of response and medium survival time were 8.5 months and 18.3 months,respectively.The predominant toxicity was hematological,with grade Ⅲ～ Ⅳ leukopenia occurring in 50.0％ (17/34) patients.Other toxicities were nausea,vomiting,anemia,phlebitis and so on.Conclusion The regimen of NVB combined with DDP is active and well tolerated,with an acceptable price,in treatment of advanced breast patients with refractory and relapsed after ADM or Taxol treatment.

Objective To summarize surgical results of secondary tunnel-like subaortic stenosis( STSS) after congenital heart disease( CHD) operations, analyze the pathogenesis of STSS, evaluate the operative effect and prognosis.Methods We analyzed clinical data of 25 patients who underwent surgical repair for STSS in Fuwai Hospital from January 2009 to December 2015.There were 17 males and 8 females.CHD types included double outlet right ventricle, ventricular septal defect and par-tial atrioventricular septal defect, et al.The median age of the patients when they received their first CHD operations was 1 year (1 month to 42 years).The median age of the patients when they received TSS repair was 5 years and 8 months(2 years and 10 months to 48 years) .The surgical types contained modified Konno procedure , Konno procedure, resection of the conal sep-tum, resection of fibromuscular ridge and myectomy, removal and reconstruction of the intraventricular baffle.Results All the patients successfully received their TSS repair .There was no surgical death in this study .The preoperative gradient of aortic valve pressure was 81(43 to 159)mmHg(1 mmHg=0.133 kPa), and the postoperative gradient was 8.2(4.0 to 46.2) mm-Hg.Ⅲ degree atrioventricular block was occurred in 2 patients after operation and both 2 patients needed to set permanent pacemaker.All the patients were followed up after discharge for a median duration of 2 years( 4 months to 6 years) .During follow-up, none of the patients had any clinical symptom or subaortic restenosis , and there was no late death .Conclusion The pathogenesis of STSS is perhaps related to turbulent flow and shear stress to the left ventricular outflow tract , resulting in the proliferation of fibromuscular marterials and stenosis in the left ventricular outflow tract .The modified Konno procedure and resection of the conal septum are safe and effective.

Objective To study the survival outcome and the survival-related factors in patients who received liver resection for multiple (≥4) liver metastases of colorectal cancer.Method The results for patients who received partial hepatectomy for four or more colorectal hepatic metastases carried out in the 1 st Department of HPB Surgery,Peking University Cancer Hospital were studied retrospectively.Results Between 2002 and 2013,of 239 patients,60 patients with four or more colorectal hepatic metastases received partial hepatectomy.The median overall survival was 35.2 months and the 5-year survival was 28.2％ (17/60).There were two actuarial 5-year survivors.The median disease-free survival was 6.9 months,with 1 actuarial disease-free survivor at 5 years.There were no perioperative deaths,and the perioperative morbidity was 36.7％ (22/60).Major (hemi-liver or more) liver resection and 7 or more metastases were independently associated with poor survival outcome.Perineural Invasion (T4) of the primary tumor,size of the largest metastasis (≥4 cm),neoadjuvant chemotherapy,and resection of recurrent disease were also associated with survival outcome.Conclusions Long-term survival could be achieved after resection of multiple colorectal liver metastases.Minor resection for multiple colorectal metastases was superior in survival compared with major resection.Additional survival advantage could be achieved by resection of recurrent disease.

Objective To analyze the clinical data of patients with post-hepatectomy haemorrhage (PHH) and to discuss the treatment strategies.Method The clinicopathologic data of patients with PHH between 2005-2014 in the HPB Surgery Ward I,Peking University Cancer Hospital,were studied retrospectively.Results In the study period of 10 years,25 of 1 548 patients who underwent hepatectomy suffered from PHH,and 76％ (19/25) of these patients had underlying liver diseases.The common surgical operations followed by PHH were right hemihepatectomy (11/25),and segment Ⅶ/Ⅷ resection (8/25).The median time for PHH to be diagnosed was 27 h,and the median time from diagnosis of postoperative bleeding to reoperation or intervention was 3.5 h.Using the classification of PHH by the International Study Group of Liver Surgery (ISGLS),there were 1 patient in grade A,16 patients in grade B,and 8 patients in grade C.The perioperative mortality of PHH was 8％ (2/25).The most common bleeding site was from the hepatic artery.Conclusions PHH is a serious complication after liver resection,with low occurrence but high mortality.Most patients with PHH can be managed by conservative treatment.Emergency reoperation is required when instability in vital signs appears.Careful evaluation before operation,strict hemostasis during operation,and close monitoring after operation can effectively reduce the incidence and mortality of PHH.