Objective To review the recent studies regarding etiology and management of diarrhea after liver transplantation. Methods The current related literatures about the etiology and management of diarrhea after liver transplantation were reviewed. Results There were approximately 10.00% to 35.44% recipients developed diarrhea after liver transplantation. Other symptoms such as severe body fluid and electrolyte loss, discomfort, and increase blood level of immunosuppressive drug can be caused by diarrhea as well. Clostridium difficile, cytomegalovirus, rotavirus infection and immunosuppressant were main etiological factors. It is important to find out the inducement of diarrhea and work out the corresponding management and other supportive care on the basis of the etiology. Conclusion Diarrhea is a common complication of liver transplantation whose etiology is complex. Appropriate approaches may be helpful to decrease the risk of this complication.

Objective To explore the relationship between anomalous pancreaticobiliary ductal junction(APBDJ) and gallbladder carcinoma. Methods The current related literatures were reviewed.Results APBDJ was associated with gallbladder carcinoma development. A proposed mechanism was free reflux of pancreatic juice into the gallbladder and molecular alterations of gallbladder epithelial cells.Conclusion APBDJ is a high risk factor for gallbladder carcinoma. Prophylactic cholecystectomy is recommended for patients with APBDJ.

Peroxisome proliferator-activated receptor(PPAR) belongs to the superfamily of nuclear hormone receptor.Three PPAR subtypes have been identified to date(PPAR?,PPAR? and PPAR?)and the relationship between PPAR? and tumor has drawn great attention.Current data showed that PPAR? agonists exert their antineoplastic effect through inhibiting cell growth and angiogenesis,inducing cell apoptosis and differentiation,and reducing tumor invasive ability.PPAR? agonists may be a promising tool for cancer chemotherapy.

Objective To investigate the qualitative diagnosis of salivary gland mass with contrastenhanced ultrasound(CEUS).Methods The CEUS manifestations in 78 cases with salivary gland mass were observed after intravenous bolus injection with contrast agent SonoVue and confirmed by histology.Results Among 78 salivary gland masses,there were 29 cases with pleomorphic adenomas (37.2％),19with Warthin's tumors (24.4 ％),7 with basal cell adenomas (8.9 ％),and 11 with the other benign masses (14.1％),12 with malignant tumors (15.4％).The intensity of contrast-enhanced masses,whether the enhanced mass margin was clear,whether the peripheral enhancement rim was complete and whether the mass was enlarged were the diagnostic criteria to differentiate the benign and malignant tumors.The accuracy,the sensitivity,specificity,positive predictive value and negative predictive value were 87.2％,95.2％,56.3％,89.4％,75.0％ respectively,and the results also displayed positive likelihood ratio and negative likelihood ratio were 2.178,0.085 respectively.Although they presented with the highest incidence among benign tumors,their CEUS manifestations showed remarkable statistical differences when the pleomorphic adenoma was compared with Warthin' s tumor and basal cell adenoma respectively in enhancement intensity(P ＜0.01) while there were no statistical differences between Warthin's tumors and basal cell adenomas (P ＞0.05).Conclusions CEUS manifestations of salivary gland mass were helpful to the differential diagnosis of various salivary gland tumors.

Objective To evaluate the effects of exercise therapy in children with congenital heart disease. Methods To search databases such as PubMed, Medline, Science Direct, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang, VIP, China Biology Medicine for all the randomized controlled trials. After evaluating the quality of each article, the software of RevMan 5.3 were used to analyze. Results A total of 10 randomized controlled trials were included. Compared with the routine nursing, meta-analysis showed that exercise therapy can improve the peak oxygen uptake(MD=4.82,95%CI 2.25-7.39, P=0.0002) and the postoperative compliance (RR=2.84, 95%CI 1.75-4.63, P<0.01), shorten the postoperative hospital time(MD=- 4.41,95% CI - 6.15-- 2.68, P <0.01). Conclusions Exercise therapy can improve the pulmonary function and quality of life on children with congenital heart disease, shorten the postoperative hospital time, increasing the postoperative compliance. However, there were few research on present, so we need a large sample randomized controlled trials of long time to confirm the effects of exercise therapy.

Objective To evaluate the optimal surgical approach for huge liver neopiasms in the caudate lobe.Methods Thirty-three patients with huge liver neplasms（≥10cm) underwent caudate lobectomy at a single tertiary referral center between January 2001 and June 2007.The surgical out-comes of pateints who underwent isolated caudate lobectomy or caudate lobectomy combined with partial hepatectomy were compared.Result Fifteen（45.5％）of 33 patients underwent isolated total or partial caudate lobectomy（group A）,whereas 18（54.5％) had total or partial caudate lobectomy cellular carcinoma (HCC) (51.5％),followed by hemangioma(21.2％),intrahepatic cholangiocarcinoma(9.1％),angiomyolipoma(6.1％),hepatic adenoma (3％),focal nodular hyperplasia(3％),colorectal liver metastases(3％)and sarcoma(3％).The median diameter of the tumour was 12.3 (range,10.2-21)cm.Patients in group A had significantly longer operative time (280 minutes vs.170 minutes),longer length of hospital stay (17 days vs.12 days)and more blood loss(1250 ml vs.670 ml) than patients in group B.There was no perioperative death in the 2 groups of pateints.Complication rates in group A and group B were 26.7％ and 16.7％ respectively.There was no disease-related death in patients with benign lesions.The1-,3- and 5-year disease-free survivals of patients with malignant lesions in group A and group B were 25.9％,0％,0％and 74.3％,46.7％,31.2％,respectively.The 1-,3- and 5-year overrall survivals were 68.6％,19.7％,0％ and 100％,66.5％,41.8％,respecively.Conclusion The approach to caudate lobectomy depends on the size and location of the lesion and the liver functional reserve.For patients with sufficient liver functional reserve,caudate lobectomy combined with partial hepatectomy is preferred because it is technically less demanding.For patienls with marginal liver functional reserve,isolated caudate lobectomy is the only viable surgical option.

Objective To determine the efficacy of the double balloon catheter in ripening and dilatation of the unfavorable cervix for induction of labor .Methods A total of 332 full-term women who were underwent induction of labor with the double balloon devices were collected for retrospective analysis .Cervix was assessed before the double balloon insertion and after it was removed 12 hours later, then amniotomy alone or combined with oxytocin was performed .Cord blood gases were analyzed .Results The double balloon catheter increased Bishop score in all subgroups with a mean improvement of 2.5 ±0.7 ( P <0.05 ) .The mean insertion-deliv-ery interval was (19.07 ±4.31)h.Cesarean section was performed in 80/332 (24.1%) patients.Cord arterial pH value was 7.3 ± 0.1 .Conclusions The double balloon catheter induced significant ripening and dilatation of the unfavorable cervix .It was effective and safe.

Objective To examine the effects of a peroxisome proliferator-activated receptor γ ligand troglitazone on the proliferation and differentiation of HepG2 cells. Methods After the pretreatment of HepG2 cells with troglitazone, MTT and flow cytometry were used to analyze the proliferation and cell cycle of HepG2 cells, respectively. Immunocytochemistry, bromocresol green dye-binding method and chemiluminessence immunosorbent assay was used to determine E-cadherin, albumin and AFP, respectively. The expression of cyclin D1 and c-myc protein were detected by Western blot. Results Troglitazone inhibited the proliferation of HepG2 cells in a concentration-dependent manner and arrested HepG2 ceils at the G0>/G1> phase. After pretreated with troglitazone, HepG2 cells showed E-cadherin expression, a decreased expression of cyclin D1 and c-myc protein, a reduction of AFP level and a dramatic increase of albumin level. Conclusions Troglitazone inhibits proliferation and induces differentiation of HepG2 cells, the mechanism of which might be attributable to the down-regulation of cyclin D1 and c-myc expression.

Objective To assess hepatitis B virus(HBV)and hepatitis C virus(HCV)infections in different anatomic location of cholangiocarcinoma(CC)and relationship with abnormal p53 expression.Methods A total of 411 CC samples including intrahepatic cholangiocarcinoma(ICC 312 cases);perihilar cholangiocarcinoma(PHC,73 cases)and distal cholangiocarcinoma(DC,26 cases)underwent serologic test for HBsAg and anti-HCV using microparticle enzyme immunoassay.Abnormal p53 expression was detected in formalin-fixed.paraffin-embedded CC tissues by immunohistochemistry.Results Seropositivity for HBsAg and anti-HCV were found in 48.4%(151/312)and 2.9%(9/312)of ICC cases,and in 10.9%(8/73)and zero of PHC,and in 7.7%(2/26)and zero of DC,respectively.Abnormal p53 expression was detected in 30.1%(94/312)of ICC cases.23.3%(17/73)of PHC cases and 19.2%(5/26)of DC cases.There was no correlation between seropositivity of HBsAg and anti-HCV and p53 overexpression among three groups of CC. Conclusions HBV but not HCV infection may be associated with the development of ICC.p53 abnormality may not play a significant role in HBV-associated carcinogenesis of ICC.

Objective To explore the clinical features of hepatocellular carcinoma (HCC) during pregnancy. Methods Clinical data of 4 patients with HCC in pregnancy were retrospectively analyzed.Results All 4 patients were positive for hepatitis B surface antigen. A marked increase in maternal serum a-fetoprotein (AFP) was found in 3 patients (310.1-5630.0 ng/ml ). Three patients were diagnosed at their advanced stages and died of disease in the 4th, 6th and 7th months, respectively. One patient diagnosed as having early HCC underwent curative surgery and has been without recurrence for 26 months. Conclusion The overall survival of patients with HCC in pregnancy is grim because most patients are diagnosed in the advanced stage. Surveillance with AFP and ultrasonography should be recommended for pregnant woman for the detection of early HCC, especially in hepatitis B virus carriers from high endemic areas, to improve patient survival.