From ancient to present,liver has always been a mystery and magical organ.As the largest glandular organ of the body,liver has many vital functions.Its regenerative capabilities and functional reservation allow major resection of up to 80%of its volume.Many diseases,such as liver cancer,cirrhosis and hepatolithiasis Can affect liver,and the mainstay of curative treatment is liver resection.Technological advances play an important role in modern surgery,and a new surgical paradigm characterized by precision has evolved.Recently,we haveadvocated the concept of"precise hepatectomy"on the basis of modem anatomy,physiology,oncology,imaging and surgical techniques,which is characterized by minimal invasion,liversaving and maximally restoration of liver function.Related subjects,including computer sciences,imaging and information are needed to be combined to create a new alliance of treatment.Although,there are still many theoretical and technical problems about liver resection and liver function preservation.With the development of science and technology,precise hepatectomy will further improve the outcomes of liver surgery.

BACKGROUND: Recently, researchers separate neural stem cells (NSCs) from neural system. As the progenitor of nerve cell and glia cells, NSCs have strong ability of self-renewal and proliferation, and play a very important role in repair process after nerve injury. OBJECTIVE: To review the repairing effect of NSC transplantation on hypoxic-ischemic encephalopathy. RETRIEVAL STRATEGY: Using the "Neural stem cells, brain, hypoxic-ischemic", we searched PubMed database for related articles published in English between 1993 and 2007. 131 articles were collected, and after the first trial, only articles ① related to neural stem cell transplantation for brain injury, and ②published in recently or in authoritative journals were selected. Repetitive researches were excluded. LITERATURE EVALUATION: The articles were about the studies of NSCs and randomized and controlled experiment for hypoxic-ischemic brain injury. Thirty-three English articles were included involving the biological characteristics of NSC, distribution, separation and culture in vitro, and the basic experiment or clinical research about the repair of hypoxic-ischemic brain injury by NSC. Of these articles, there are 7 review articles, and the others were about clinic or basic experiment researches. DATA SYNTHESIS: Researches show that after transplantation NSC can survive in host, furthermore, it proliferates and differentiates to repair the configuration and function of injured brain area. Even though we have achieved much in NSC transplantation for brain injury, yet there are many problems to be resolved, such as NSC source and conservation, the control mechanism of differentiation and proliferation when NSC is cultured in vitro. In addition, the amount or functional activity of NSCs acquired is lower, and the molecular biological features of cells in repaired tissue are uncertain. CONCLUSION: As a kind of ideal seed cell, NSC provides an approach for the repair of hypoxic-ischemic brain injury, and starts a new era of clinic therapy by stem cells.

Objective To observe the clinical effect of tigecycline combined with cefoperazone sulbactam for the treatment of pneumonia caused by muitidrug-resistant acinetobacter baumannii pneumonia. Methods 68 patients with muitidrug-resistant acinetobacter baumannii pneumonia were randomly divided into two groups, control group and observation group, with 34 patients in each group. The control group was treated with cefoperazone sulbactam, and the observation group was treated with tigecycline combined with cefoperazone sulbactam. The level of PCT, CRP, WBC and clinical cure rates, as well as microbiological eradication and side effect, before and after treatment were collected and compared. Results After treatment, the level of PCT, WBC and CRP in two groups was decreased, and the observation group was more significant than the control group(P < 0.05). The side effect rate in two groups were 14.7% and 17.6% respectively (P > 0.05), while the clinical cure rates and microbiological eradication in observation group were significantly higher than the control group (P<0.05). Conclusion With a higher rate of clinical efficacy and a lower rate of side effect, the combination treatment with tigecycline and cefoperazone sulbactam would be a promising alternative for the treatment of muitidrug-resistant acinetobacter baumannii pneumonia infection.

Objective To evaluate the long term results of regular hepatic resection for hepatolithiasis.Methods Five hundred and fourteen patients with hepatolithiasis underwent hepatic resection from Jan. 1975 to Dec. 1998 in Southwest Hospital. The indications included stones confined to one segment or one lobe of the liver, significant atrophy of the portion of the liver harboring the stones from repeated episodes of obstruction and infection, multiple strictures of the ducts in the affected portion of the liver. Resection of S 2 and S 3 was performed in 284 patients, S 2, S 3 and S 4 in 98 patients, S 6 and S 7 in 26 patients, S 5, S 6, S 7 and S 8 in 37 patients; both of the left and right hepatic lobes were partially resected in 23 patients. Additional biliary procedures including choledochojejunostomy and common bile duct exploration were performed in 296 patients.Results The operative mortality was 2 1%, and the morbidity rate was 8 4%. The majority of complications were biliary fistulas (2 9%), subphrenic infection (4 5%), peritoneal abscesses (0 4%) and liver failure (0 6%). Long term follow up on 436 patients at a median of 9 1 years showed that 75 9% were symptom free, 14 5% had occassional mild attacks of cholangitis, 9 6% had severe cholangitis requiring further surgical intervention.Conclusion Anatomic hepatic resection is the most effective treatment and the therapy of choise to eradicate intrahapatic stone foci in cases of hepatolithiasis .

Two systems which covered nearly 1. 1 billion people in China’s social health insurance, namely the New Rural Cooperative Medical Scheme ( NRCMS ) and the Urban Residents’ Health Insurance System ( URHIS ) , have been depended mainly on government support with high percentage of premium subsidies. This paper deals with the current situation and probes into the main subsidy policy problems by making an overall analysis on the policies of 31 cross-country provinces , and in result points out four problems including the long-term mechanism shortage, in-distinct responsibility between governments at different levels, the equity deficiency and the subsidies inefficiency. Finally, the paper concludes with enlightening some corresponding policies and suggestions.

Objective To study the morphological structure and the hemodynamics of peribiliary vascular plexus(PVP) of hepatic portal bile duct in rat in vivo,so as to provide an experimental method and accumulate data for further study on the bile duct complications occuring after liver transplantation,operations for bile duct stenosis and other hepatobiliary diseases.Methods Forty SD rats were randomly and equally divided into 2 groups: the control group and the ink-injection group(n=20),microcirculation laser scan confocal microscopy was used to observe the morphological structure and the hemodynamic features of PVP on rat′s hepatic portal bile duct after the bile duct was stained with indocyanine green and the hepatic artery was perfused with ink.Results Morphologically it was showed that PVP were comprised of three layers: the spatial structure of PVP appeared dentriform from outer layer to intermediate layer,and then transformed into a network from intermediate layer to inner layer.The outer layer vessels seemed to be dendritic and located within the ductal wall at 0-60?m scanning from the adventitia,and the branches appeared sparse and straight.The diameter of artery and vein was very different.The vessels of intermediate layer showed as an intricate network and located within the ductal wall in the depth of 40-80?m,and the ranification was rich and tortuous.Inner layer vessels adjacent to the intima appeared to be a plenus in hexagons with 120? intersect angles and uniform diameter.Hemodynamics showed that the flow rate in the artery was higher than that in the vein of PVP.Conclusion The technique,employing microcirculation laser scan confocalmicroscopy,to observe the morphological structure and the hemodynamic features of PVP,may reveal the morphological structure and hemodynamic features limpidly,both macroscopically and dynamically.It can be used as an important tool for the study of bile duct complications after liver transplantation,bile duct stenosis or other hepatobiliary diseases.

Objective To evaluate the treatment effect of Lobaplatin combined with Aidi Injection on patients with advanced NSCLC, and observe the influence on the level of serum VEGF by the treatment. Methods 60 patients, with advanced NSCLC and malignant pleural effusion, were divided into two groups (observation group and control group) randomly, with 30 cases in each group. All patients were treated with thoracentesis and inserted central venous catheter for the drainage of pleural effusion. After exhaustion of pleural effusion, the control group was treated with Lobaplatin by pleural perfusion, and the observation group was treated with Aidi Injection in addition to the treatment on control group. The treatment, side effects and quality of life and the level of serum VEGF were compared. Results After treatment, it is significant that clinical effects, side effect and KPS score of living quality of the observation group was better than that of the control group (P<0.05). The level of serum VEGF was significant lower than that before treatment in both groups (P<0.05). The decrease of VEGF serum level in the observation group was significantly lower than the decrease in the control group (P <0.05). Conclusion Lobaplatin combined with Aidi Injection was one of the effective method for the treatment of NSCLS with malignant pleural effusion, and was worthy of clinical application.

Objective To explore the current status of non-operative management strategy for blunt hepatic trauma. Methods The clinical data of patients with blunt hepatic trauma admitted to our hospital during the past 15 years were retrospectively analyzed, and the new standpoints in the selection of therapeutic strategy for blunt hepatic trauma were elucidated with referance to recent litereture, especially regarding the different opinions in non-operative management in the treatment of blunt hepatic trauma between the developed countries and China. Results The concept in the selection of therapeutic strategy for blunt hepatic trauma in China lagged relatively behind the advanced countries. Compared with that in the developed countries, the percentage of non-operative management was significantly lower in China (10%-30% vs 50%-80%), and the fewer CT scanning was carried out in the patients with stable hemodynamics. Conclusion Non-operative management is becoming one of the most important strategies in the treatment of blunt hepatic trauma nowadays. Non-operative management is widely acknowledged as the first choice for blunt hepatic trauma, especially for those with stable hemodynamics. This new trend should be more emphasized in China. Besides, CT scanning as a diagnostic tool should be carried out as frequently as possible in those patients with stable hemodynamics.

Objective To analyze the clinical characteristics and therapeutic effects of cutaneous metastasis from cholangiocarcinoma. Methods From 2006 to 2009, clinical data of 6 patients found with cutaneous metastasis from cholangiocarcinoma were reported. Perineural and vascular invasion were all found in the primary cholangiocarcinoma in these 6 cases with cutaneous metastasis and results were compared with 60 cases of cholangiocarcinoma without cutaneous metastasis. Follow-up to the 6 patients with cutaneous metastases was conducted at an interval of three months. Results One patient with mixed hepatocellular and cholangiocellular carcinoma developed cutaneous metastatic tumor and the pathological diagnosis was cholangiocellular carcinoma. Three patients with hilar cholangiocarcinoma and two patients with distal cholangiocarcinoma presented cutaneous metastases. All six cases of the primary cancers and cutaneous metastases were diagnosed as moderately- poorly differentiated adenocarcinoma. And there was perineural and vascular invasion in the primary tumors. Perineural and vascular invasion of primary cancer was found in 17of 60 patients with cholangiocarcinoma and without cutaneous metastasis. The cutaneous metastasis was positively correlated to the perineural and vascular invasion in the primary tumor (χ2 = 12. 7288, P ＜0. 001 ). Two of 6 cases presenting solitary nodular cutaneous metastasis received skin tumor excision. These two patients survived 8 and 10 months respectively. Among four patients with multiple cutaneous metastases,two cases received chemotherapy and survived 3 and 6 months respectively, the other two cases refusing treatment survived 3 and 4 months respectively. Conclusions Cutaneous metastasis usually occurred at cholangiocarcinoma with lower differentation and perineural and vascular invasion in the primary tumor.Solitary nodular cutaneous metastasis could be excised, multiple cutaneous metastases had poor prognosis.

Objective To establish a reproducible and controllable experimental swine model of abdominal multiple organ trauma.Method Fifteen pigs were included in the present study,and the method adopted conformed to the animal ethics.With the self-made explosive device,the electric firecrackers consisting of 0.3g,0.2g and 0.2g black powder were put respectively onto the surface of left lateral lobe of liver,lower pole of spleen and tail of pancreas to produce injuries by explosion.The operation time of exploratory laparotomy and isolation of the organs,blood loss,the maximum diameter and area of injury to the liver and spleen due to explosion,the length and extent of the pancreas that was injured in explosion,as well as the changes in mean arterial pressure(MAP) during the operation were detected and recorded.Finally,the injury severity score(ISS) was calculated.Results The damaged liver area was 9.2?0.3cm2,the maximum diameter of damaged liver was 5.4?0.2cm,the damaged spleen area was 5.2?0.1cm2,the maximum diameter of damaged spleen was 5.6?0.2cm,the damaged pancreas length was 6.3?0.2cm,the time for MAP's to lower by half was 8.8?0.5min,the blood loss for depression of MAP by half was 704.7?14.6ml,the time from injury to death in the first 5 pigs was 25.4?1.8min,ISS was 28.0?0.8.The experimental swine model of abdominal multiple organ trauma was reproduced successfully.Conclusions By using the self-made explosion device and electric firecrackers,the abdominal multiple organ trauma model is reproducible,controllable and stable.It can be generally used in the research of war trauma and traffic accident trauma.