Fungal sinusitis is relatively rare, but it has become more common in recent years. When fungal sinusitis invades the orbit, it can cause proptosis, chemosis, ophthalmoplegia, retroorbital pain, and vision impairment. We present a case of an extensive orbital floor defect due to invasive fungal sinusitis. A 62-year-old man with hypertension and a history of lung adenocarcinoma, presented with right-side facial pain and swelling. On admission, the serum glucose level was 347 mg/dL, and hemoglobin A1c was 11.4%. A computed tomography scan and a Waters’ view X-ray showed right maxillary sinusitis with an orbital floor defect. On hospital day 3, functional endoscopic sinus surgery was performed by the otorhinolaryngology team, and an aspergilloma in necrotic inflammatory exudate obtained during exploration. On hospital day 7, orbital floor reconstruction with a Medpor Titan surgical implant was done. In principle, the management of invasive sino- orbital fungal infection often begins with surgical debridement and local irrigation with an antifungal agent. Exceptionally, in this case, debridement and immediate orbital floor reconstruction were performed to prevent enophthalmos caused by the extensive orbital floor defect. The patient underwent orbital floor reconstruction and received intravenous and oral voriconazole. Despite orbital invasion, there were no ophthalmic symptoms or sequelae.

Objective: To analyze the correlations between cholecystolithiasis or cholecystectomy and the risk of colorectal cancer, and make a brief summary combining with the present study. Methods: Qualified studies about the correlations between cholecystolithiasis or cholecystectomy and the risk of colorectal cancer published in English and Chinese before April 2018 were retrieved from PubMed, Cochrane Library, China National Knowledge Infrastructure(CNKI), Wan Fang Data, and VIP. Case-control and cohort studies were selected according to the inclusion and exclusion criteria and assessed by the Newcastle-Ottowa Scale, then we chose the high-quality literature to extract the data and analyze those data by RevMan 5.3 software. Publication bias was analyzed by Stata 12.1 software. Results: A total of 28 articles were finally included in the systematic review, including 23 case-control studies and 5 cohort studies. The results showed that there is a significant relationship between cholecystolithiasis and the risk of colorectal cancer(OR=1.70, 95%CI: 1.39~2.08, P<0.05)、colon cancer(OR=1.74, 95%CI: 1.36~2.23, P<0.05)、rectal cancer (OR=1.35, 95%CI: 1.02~1.80, P<0.05). The results showed a risk of colorectal cancer(OR=1.31, 95%CI: 1.14~1.51, P<0.05) and colon cancer (OR=1.20, 95%CI: 1.05~1.36, P<0.05) after cholecystectomy, but the risk is significantly less than the risk in patients with gallstone. And there is no relevance between cholecystectomy and the risk of rectal cancer(OR=0.89, 95%CI: 0.73~1.08, P>0.05). Conclusion There is a positive association between cholecystolithiasis and colorectal cancer, but cholecystectomy itself may be not the risk of rectal cancer.

Objective To investigate the value of the preoperative Child-Pugh score and albuminbilirubin (ALBI) score predicting posthepatectomy liver failure (PHLF) and prognosis of patients with hepatocellular carcinona (HCC).Methods The retrospective cohort study was conducted.The clinical data of 226 HCC patients who were admitted into the People's Hospital of Peking University between January 2010 and October 2014 were collected.After preoperative related examinations,feasibility and extent of liver resection were discussed according to patients' conditions by muhidisciplinary team,and then surgery was performed.Observation indicators:(1) surgical situations;(2) factors analysis affecting PHLF of HCC patients;(3) receiver operating characteristic (ROC) curve analysis of Child-Pugh and ALBI scores predicting PHLF;(4) follow-up and survival situations;(5) prognosis analysis of HCC patients after hepatectomy.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to August 2016.Measurement data with normal distribution were represented as-±s.Measurement data with skewed distribution were described as M (P25,P75).The survival curve was drawn by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.The influencing factors of PHLF were analyzed using the logistic regression model.The prognostic factors were analyzed by the COX regression model.ROC analysis was used for predictive value of Child-Pugh and ALBI scores.Results (1) Surgical situations:226 patients underwent successful surgery,including 171 receiving localized liver resection (＜ 3 Couinaud hepatic segments resection) and 55 receiving extensive liver resection (≥ 3 Couinaud hepatic segments resection).Volume of intraoperative blood loss of 226 patients was 1-22 550 mL,with a median of 800 mL.Of 226 patients,89,9,4,4,3 and 1 were complicated with liver failure,pulmonary infection,bile leakage,gastrointestinal henorrhage,incision infection and infectious shock,respectively,they were cured and discharged from hospital by life-sustaining treatment and symptomatic treatment.Duration of hospital stay was 2-49 days,with a median of 12 days.(2) Factors analysis affecting PHLF of HCC patients:results of univariate analysis showed that gender,total bilirubin (TBil),albumin (Alb),prothrombin time (PT),international normalized ratio (INR),platelet (PLT),peritoneal effusion,volume of intraoperative blood loss,Child-Pugh score and ALBI score were related factors affecting PHLF of HCC patients [Odds ratio (OR) =O.490,1.077,0.763,1.613,26.342,0.990,2.458,5.052,2.875,34.570,95％ confidence interval (CI):0.248-0.971,1.030-1.127,0.699-0.833,1.248-2.087,2.722-254.936,0.985-0.995,1.386-4.361,2.467-10.347,1.807-4.576,11.674-102.376,P＜0.05].Child-Pugh score and ALBI score in the multivariate analysis were respectively analyzed using the logistic regression model for avoiding multicollinearity.Excluding TBil,Alb,PT and peritoneal effusion,logistic regression model of Child-Pugh score showed that PLT,volume of intraoperative blood loss and Child-Pugh score were independent factors affecting PHLF of HCC patients (OR=0.991,4.462,2.412,95％CI:0.986-0.996,2.090-9.527,1.479-3.934,P＜0.05).Excluding TBil and Alb,Logistic regression model of ALBI score showed that PLT,volume of intraoperative blood loss and ALBI score were independent factors affecting PHLF of HCC patients (OR=O.990,4.867,42.947,95％CI:O.984-0.995,2.088-11.346,12.409-148.637,P＜ 0.05).(3) ROC analysis of Child-Pugh and ALBI scores predicting PHLF:area under the ROC was respectively 0.652 (95％CI:0.577-0.727) in the Child-Pugh score and 0.801 (95％CI:0.741-0.861) in the ALBI score,with a statistically significant difference (Z=3.590,P＜0.05).The best critical value,sensitivity and specificity of PHLF that were predicted by ALBI score were-2.58,68.5％ and 86.9％,respectively.Further analysis showed that area under the ROC was respectively 0.642 (95％CI:0.554-0.731) in Child-Pugh score and 0.813 (95％CI:0.744-0.882) in ALBI score,excluding factors of extensive liver resection affecting PHLF,with a statistically significant difference (Z=3.407,P＜0.05).(4)Follow-up and survival situations:of 226 patients,217 were followed up for 1.3-79.5 months,with a median time of 29.5 months.During the follow-up,134 patients had survival and 92 died.(5) Prognosis analysis of HCC patients after hepatectomy:results of univariate analysis showed that Alb,PLT,alpha-fetoprotein (AFP),peritoneal effusion,tumor diameter,extent of resection,combined portal vein tumor thrombus (PVTT),combined vascular tumor thrombus and Child-Pugh score were related factors affecting prognosis of HCC patients [Hazard Ratio (HR)=0.954,1.003,2.958,1.698,1.155,1.785,2.326,3.001,1.324,95％CI:0.911-0.999,1.000-1.005,1.955-4.476,1.115-2.585,1.103-1.209,1.138-2.802,1.310-4.130,1.983-4.546,1.037-1.690,P ＜ 0.05].Excluding Alb and peritoneal effusion for avoiding multicollinearity,results of multivariate analysis showed that AFP,tumor diameter,combined vascular tumor thrombus and Child-Pugh score were independent factors affecting prognosis of HCC patients (HR =2.237,1.080,2.122,1.309,95％ CI:1.439-3.476,1.028-1.134,1.362-3.305,1.010-1.697,P＜0.05).Further analysis of Kaplan-Meier curve showed that median survival time in patients with grade A and B of Child-Pugh score were respectively 30.6 months and 25.2 months,with a statistically significant difference in survival (x2 =4.491,P＜0.05).The median survival time in patients with grade 1 and 2 of ALBI score were respectively 29.6 months and 31.0 months,with no statistically significant difference in survival (x2 =0.539,P＞0.05).Conclusion Preoperative ALBI score in predicting PHLF is superior to that of Child-Pugh score,but ALB1 score is not independent factor affecting prognosis of HCC patients.

Objective To explore the expression of ANLN in HCC and study the clinical value of ANLN expression for HCC patients after liver transplantation.Methods The protein and mRNA expression of ANLN was detected by immunohistochemistry and RNA-seq from TCGA respectively.Chi-square test and t test were used for correlation analysis between ANLN expression and clinicopathological characteristics.The predictive value of ANLN expression for HCC patients after liver transplantation was estimated by log-rank test and cox proportional hazards regression model.Results The positive protein expression rate of ANLN in HCC detected by immunohistochemistry was 37.0％ (34/92),significantly higher than 6.5 ％ (6/92) in para-carcinoma non-tumor tissue (P＜0.001,x2 =25.044).Upregulation of ANLN mRNA expression in HCC was also detected by the analysis of RNA-seq from the TCGA (P ＜ 0.000 1).The positive ANLN protein expression was positively correlated with AFP＞400 ng/L (P＜0.001,x2 =11.952) and tumor size ＞8 cm (P =0.034,x2 =4.506).The independent risk factors for poorer 5-year survival of patients after liver transplantation were confirmed,including positive ANLN protein expression (P =0.031,OR =1.965,95 ％CI =1.064-3.630),tumor size ＞8 em (P =0.003,OR =2.841,95 ％CI =1.437-5.617),worse differentiation degree (P =0.001,OR =3.613,95％ CI =1.646-7.928),peritumor intravascular cancer emboli (P =0.041,OR =1.896,95％CI =1.028-3.498) and tumor necrosis or hemorrhage (P=0.010,OR=2.195,95 ％CI=1.211-3.979).Conclusion The expression of ANLN in HCC is upregulated and the positive protein expression indicates the poor prognosis for long-term survival of patients after liver transplantation.

Objective To explore the clinical effect of embolectomy through incision of right atrium and inferior vena cava under normothermia cardiopulmonary bypass with beating heart + partial hepatectomy for hepatocellular carcinoma (HCC) combined with tumor thrombus in right atrium and inferior vena cava.Methods The retrospective and descriptive study was conducted.The clinical data of 1 patient with HCC combined with tumor thrombus in right atrium and inferior vena cava who were admitted to the Peking University People's Hospital in December 2014 were collected.The patient underwent embolectomy through incision of right atrium and inferior vena cava under normothermia cardiopulmonary bypass with beating heart + partial hepatectomy.Observation indicators:(1) intra-and post-operative situations:intraoperative findings,operation time,cardiopulmonary bypass time,volume of intraoperative blood loss,intraoperative blood transfusion,postoperative complication and duration of hospital stay;(2) postoperative pathological examination;(3) follow-up situation:survival of patient and tumor recurrence or metastasis.Follow-up using outpatient examination was performed to detect survival of patient and tumor recurrence or metastasis up to September 2016.Results (1) Intra-and post-operative situations size of tumor thrombus in right atrium,operation time,cardiopulmonary bypass time,volume of intraoperative blood loss,volumes of intraoperative red blood cell and blood plasma transfusions were 3.0 cm × 4.0 cm,630 minutes,85 minutes,4 000 mL,1 820 mL and 2 200 mL,respectively.The abnormal and transient liver and renal functions in early stage after surgery recovered quickly to the normal level.Patient with pleura1 effusion and pulmonary infection received active treatment,and then ventilator treatment was stopped at 5 days postoperatively and closed thoracic drainage-tube was removed at 15 days postoperatively.There was no occurrence of hemorrhage,bile leakage and wound infection.Patient was discharged from hospital at 25 days postoperatively.(2) Postoperative pathological examination:tumor with unclear boundary and gray-white section located in the right posterior lobe of the liver.Tumor thrombus in right atrium and inferior vena cava was gray-white,with a rough texture and size of 4.0 cm × 4.0 cm × 2.0 cm.Immunohistochemical staining dectection showed that liver cells,glypican 3 and CD34 were positive and alpha-fetoprotein was negative,with a positive index of Ki-67 of 15％.The moderate-differentiated HCC was confirmed by pathologic examination.(3) Follow-up situation:patient had a smooth recovery after discharge,without obvious discomfort.Hepatic arterial-venous fistula was confirmed at 45 days postoperatively by hepatic arterial angiography.Patient underwent preventive infusion chemotherapy with oxaliplatin and gemcitabine,and right hepatic arterial embolization with gelatin sponge.During the follow-up,patient received regular reexaminations of abdominal computed tomography and chest X-ray,without tumor thrombus in inferior vena cava and tumor recurrence.Conclusion Embolectomy through incision of right atrium and inferior vena cava under normothermia cardiopulmonary bypass with beating heart and partial hepatectomy are safe and feasible for patient with HCC combined with tumor thrombus in right atrium and inferior vena cava.

Objective To explore the effects of infusion per unit of weight on pulmonary edema and acute respiratory distress syndrome (ARDS).Methods The clinical data of 70 patients with cirrhosis who had accepted liver transplantation were retrospectively collected,including the age,height,weight,BMI,preoperative liver function,indexes during liver transplantation and the postoperative intake and output records in the first 5 days,and the emerging postoperative pulmonary complications (EPPCs) in the first 2 weeks were screened.The relationship between clinical data and new pulmonary edema and ARDS was analyzed.Results The incidence rate of NPPCs was 82.9 ％,in which the incidence rate of pleural effusion,atelectasis,pulmonary edema,ARDS and pulmonary infection was 60.0％,14.7％,8.6％,31.4％ and 10％ respectively.In the pulmonary edema group (n =6),the preoperative Child-Pugh score (9.3 ± 1.6),the total volume (2 667 ± 1 164) ml and the volume of unit weight (39.4 ± 19.0) ml/kg of plasma transfusion,the total volume (1 417 ± 376) ml of artificial colloid during operation,and the input of unit weight (53.2 ± 9.3 ml/kg) on the 3rd day after operation were significantly different from those (7.6 ± 1.9,1 753 ± 1 040 ml,24.2 ± 15.7 ml/ kg,2 347 ± 1 088 ml,and 44.6 ± 10.1 ml/kg) in the group (n =64) without pulmonary edema.Their P values in the order were 0.028,0.046,0.029,0.046,and 0.046.In the ARDS group (n =22),the plasma transfusion volume per unit of weight during operation (31.3 ± 20.4 ml/kg),the total balance volume equaled with the difference of input and output (1 504 ± 894 ml) and the balance volume per unit of weight (22.1 ± 13.1 ml/kg) on the first postoperative day and the total input volume per unit of weight on the third postoperative day (49.0 ± 10.1 ml/kg) were significantly distinguished with those (22.7 ± 13.4 ml/kg,910 ± 684 ml,12.7 ± 9.9 ml/kg,and 43.6 ± 9.9 ml/kg) in the group (n =48) without ARDS.The P values in the order were 0.045,0.003,0.001 and 0.042 respectively.Conclusion The incidence rate of NPPCs in the patients with cirrhosis receiving the liver transplantation is relatively higher.In order to reduce the risk of NPPCs,based on the hemodynamic stability during operation,the artificial colloids should be appropriately increased and excessive plasma transfusion reduced.In addition,the redundant input should be limited according to the weigh,in the first and third postoperative days.

Hepatocellular carcinoma (HCC) is still one of common malignant cancers worldwide, with increasing incidence and mortality rates. Early diagnosis and effective treatment for HCC remain to be explored. This article introduces the research advances in the early specific diagnosis and effective therapies for HCC in 2016, such as molecular markers in the specific diagnosis and targeted therapy for HCC, main therapeutic regimens, robot-assisted liver resection, and no-touch radiofrequency ablation.

Objective To investigate the clinical effectiveness of oral ganciclovir on prevention and treatment of cytomegalovirus (CMV) infections after liver transplantation.Method We tested archival peripheral blood of 69 kidney recipients for CYP3A5 genotyping by polymerase chain reaction sequence-specific primer.The dose,blood concentrations and dose-normalized blood concentrations of tacrolimus were measured at 1 st and 2nd month after the renal transplantation.Result pp65 antigen of CMV was negative in all the patients before liver transplantation.In 72 patients subject to acyclovir,9 cases (12.5％) were infected by CMV.By using oral ganciclovir to prevent CMV infection after 1iver transplantation in 376 patients,pp65 antigen of CMV was detected in 17 patients (4.5％).Fifteen patients received intravenous ganciclovir for treatment of CMV infection or CMV pneumonia,and 6 patients (40％) suffered from granulocytopenia because of the use of intravenous ganciclovir.Forty-six patients (12.2％) suffered from granulocytopenia because of the use of oral ganciclovir.Conclusion Oral ganciclovir is a safe and effective drug for prevention and treatment of CMV infection.

Objective To investigate the effects of structured triglyceride (STG) and physical mixed medium chain/long chain triglycerides (MCT/LCT) on hepatic and renal function and lipometabolism of patients with acute necrotizing pancreatitis (ANP).Methods The clinical data of 30 patients with ANP who were admitted to the PLA General Hospital between January 2012 and June 2014 were prospectively analyzed.A double-blind,randomized,controlled study was performed in 30 patients who were allocated into the experimental group (15 patients received STG) and the control group (15 patients received physical mixed MCT/LCT).All the patients received isometrical nitrogen and isocaloric parenteral nutrition more than 5 days.The levels of alanine transaminase (ALT),aspartate transaminase (AST),glutamyl-transpeptidase (GGT),alkaline phosphatase (ALP),creatinine (Cr),blood urea nitrogen (BUN),triglyceride (TG) and total cholesterol (TC) were assayed before nutritional support treatment and at day 1,3 and 5 after nutritional support therapy.The measurement data with normal distribution was presented as (x) ± s.The skew distribution data were described as M (range).The comparison between groups were evaluated with an independent sample t test or one-way ANOVA.The count data were analyzed using the chi-square test.Results A total of 30 patients were screened for eligibility.The levels of ALT,AST,GGT,ALP,Cr,BUN,TG and TC were changed within a certain range at day 1,3 and 5 after nutritional support treatment.The levels of ALT,AST,GGT,ALP,Cr,BUN and TC before treatment and at day 5after treatment were changed from 29.0 U/L,25.4 U/L,83.2 U/L,(193 ± 115) U/L,(124 ± 97) μmol/L,(8±6)mmol/L and (2.4±1.1)mmol/L to 29.4 U/L,33.0 U/L,77.7 U/L,(172±74)U/L,(117 ±103)μmol/L,(8 ± 5) mmol/L and (2.3 ± 1.0) mmol/L in the experimental group,and from 23.8 U/L,22.9 U/L,96.2 U/L,(148 ± 108) U/L,(82 ± 57) μmol/L,(9 ± 7) mmol/L and (2.5 ± 0.7) mmol/L to 21.3 U/L,24.5 U/L,127.4 U/L,(179 ± 126) U/L,(80 ± 54) μmol/L,(10 ± 6) mmol/L and (2.4 ±0.8) mmol/L in the control group,respectively.There were no significant differences in the changing trends of the levels of ALT,AST,GGT,ALP,Cr,BUN and TC between the 2 groups (F =0.647,1.186,0.282,0.553,0.862,0.182,0.369,P＞0.05).The level of TG in the experimental group from pre-treatment to day 5 after treatment was changed from (1.5 ± 0.6) mmol/L to (1.5 ± 0.7) mmol/L,with increasing trend from pre-treatment to day 1 after treatment and reaching the normal level at day 3 and 5 after treatment.The level of TG in the control group from pre-treatment to day 5 after treatment was changed from (1.5 ± 0.6) mmol/L to (2.4 ± 0.6) mmol/L,with increasing trend from pre-treatment to day 1,3 and 5 after treatments.There were significant differences in the changing trends of TG before and after nutritional support therapy between the 2 groups (F =7.940,P ＜ 0.05).Conclusion STG and physical mixed MCT/LCT don't influence the hepatic and renal function of patients with ANP undergoing parenteral nutritional support therapy,while STG has a better effect of lipometabolism compared with physical mixed MCT/LCT.Registry This study was registered with the UMIN Clinical Trial Registry with the registry number of UMIN000016958

Objective To investigate the application of structured triglyceride (STG) in malignant obstructive jaundice (MOJ) patients after pancreaticoduodenectomy.Methods The records of 21 MOJ patients received pancreaticoduodenectomy in our hospital were retrospectively analyzed.The patients received parenteral nutrition on the first postoperative day, of whom 7 were given STG (STG group) and 14 were given medium and long chain triglyceride (MCT/LCT group).The changes of liver function, lipid profile, albumin, and postoperative complications were compared between the two groups.Results The triglyceride levels in the STG group on the 3rd and 7th postoperative days were significantly lower than those in the MCT/LCT group [3rd day:(1.85 ±0.90) mmol/L vs.(2.18 ±1.41) mmol/L;7th day: (1.62 ±0.78) mmol/L vs.(2.46± 1.62) mmol/L;both P =0.042];the level of high-density lipoprotein on the 7th postoperative day was significantly higher than that in the MCT/LCT group [(0.67 ±0.64) mmol/L vs.(0.45 ±0.15) mmol/L, P =0.046].The albumin in the STG group returned to normal on the 3rd postoperative day, which was significantly higher than that in the MCT/LCT group [(35.50 ±2.91) g/L vs.(30.66 ±5.08) g/L, P =0.048].There were no significant differences in terms of liver function, length of hospital stay, wound healing, systemic inflammatory response syndrome, and infection between the two groups.Conclusions Parenteral nutrition with structured triglyceride after pancreaticoduodenectomy in MOJ patients is tolerable and safe.STG has less influence on lipid metabolism than MCT/LCT does, and can increase albumin level rapidly.