The prognosis of hepatocellular carcinoma (HCC)is poor,and tumor thrombus in the portal vein or in the bile duct is an important influencing factor.Approximately 30%of HCC patients are found to have portal vein tumor thrombus (PVTT)when diagnosed,and their median survival time is about 2.7-4.0 months if they do not receive any treatment.The incidence of HCC complicated with bile duct tumor thrombus (BDTT)is less than 10%,while the prognosis is dismal.Once tumor thrombus extends to the major bile ducts,obstructive jaundice and subsequent hepatic dysfunction are inevitable.The survival time of patients with HCC complicated with BDTT is less than 4 months if they only receive palliative biliary stenting.The management of HCC complicated with PVTT or BDTT is challenging with controversy at present.Different treatment approaches and their benefits for patients with HCC complicated with PVTT or BDTT are introduced in this paper.

The management of hilar cholangiocarcinoma was challenging to the surgeons due to difficult operations and low resection rate.Recently,a new mode of multidisciplinary team (MDT) is applied to the diagnosis and treatment of hilar cholangiocarcinoma,which leads to significant changes and development of the diagnosis and treatment for hilar cholangiocarcinoma.In this article,the authors first introduced the recent application of MDT treatment for hilar cholangiocarcinoma on diagnostic methods,staging systems,evaluation for resectability,radical resection,application of liver transplantation and other systematic therapies.Considering the complexity of hilar cholangiocarcinoma,a surgery-centered MDT for hilar cholangiocarcinoma is important and should be promoted.

Objective To study the clinical effect of minimally invasive treatment of 24 patients with hemor-rhagic moyamoya disease.Methods The clinical features of onset,bleeding location of the lesions and the type,ther-apeutic results of minimally invasive treatment were studied retrospectively.Results 24 patients with hemorrhagic moyamoya disease spontaneous intracerebral hematoma who need to acutely remove the hematoma were examined by CT angiography ( CTA) .Emergency minimal invasive puncture was performed according to the result of CTA,and the role of CTA in operation was analyzed.In all 24 patients,most of them were cerebral hemorrhage breaking into ventri-cles,5 cases with intracranial aneurysm.In all the hemisphere of hemorrhage,dilatation and abnormal branching of the AchA and P-CoM were observed in 9 patients,superficial temporal artery.Conclusion Minimally invasive treat-ment of hemorrhagic moyamoya disease scheme is simple,practical and effective,the maneuverability is strong.

BACKGROUND:Gait analysis enable to convert qualitative analysis and description used for a long time in orthopedic examination and rehabilitative treatment into objective and precise quantitative assessment. At the present, with the development of science and technology, three-dimensional (3D) gait analysis is more and more widely, extensively used in orthopedic surgery and rehabilitation medicine abroad, while much less in China.OBJECTIVE: To study the parameters of time-distance, kinematics, kinetic and electromyography (EMG) in healthy subjects and patients with backbone, hip, knee or ankle joint diseases.DESIGN: Comparative observation and control study.PARTICIPANTS: From December 2004 to July 2005, 40 healthy subjects and 112 patients suffering from backbone and hip, knee, ankle joint disease were selected from the Department of Rehabilitative Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University and analyzed by three dimensional gait analysis system (VICON 612 system made by Britain VICON Company). 112 patients including 42 males with the mean age of (46.2 ± 2.3) years and 70 females with the mean age (41.2 ± 3.5) years were screened by skilled clinicians after surgical and rehabilitative treatment.Among them there were 21 patients with cervical vertebra, 26 patients with prolapse of lumbar intervertebral disc and lumbar spinal stenosis. The number of hip, knee, ankle joint disease was 12, 34, 19 respectively. Total hip replacement was included in hip joint disease, anterior cruciate ligament (ACL) reconstruction was included in knee joint disease, talipes equinovarus was included in ankle joint disease. Meanwhile, 40 healthy subjects who were 20-40 years old, male or female, without any clinical symptom of backbone and limbs volunteered in the study.METHODS :Gait analysis were carried out on 40 healthy volunteers and 112 operational and rehabilitative treatment patients with spinal and lower limb diseases using VICON 612 system made by Britain VICON Company.MAIN OUTCOME MEASURES: The time-distance parameters (cadence, step length, walking speed), kinematics parameters (knee flexion/extension degree, hip flexion/extension degree, ankle dorsi/plantar degree), kinetic parameters (knee force in Z axis, hip force in Z axis, normalized force in Z axis) and EMG parameters (vastus lateralis SEMG) of lower limbs were examined.RESULTS: A total of 40 healthy subjects and 112 patients were involved in the analysis of results. ① Time-distance parameter: Cadence, as well as step length and walking speed of patients with backbone disease, patients with hip joint disease, patients with knee joint disease, and patients with ankle joint disease were lower than those of healthy subjects,and the difference between two groups was significant (P ＜ 0.05-0.01). ② Kinematic and kinetic parameters of all joints in upper limbs: One year after left ACL knee reconstruction, the extension of left knee in initial contact phase was 9° less than that of right one and the stress in Z axis of left knee was much less than that of right one; One year after left THA,the flexion of left hip in initial contact phase was 8.5° less than that of right one, the extension of left hip in terminal stance phase was 3° less than that of right one, during stance phase the stress in Z axis of left hip was much less than that of right one; As to an infantile paralysis patient with talipes equinovarus, the dorsiflexion of left ankle in initial contact phase was 12° less than that of right one, the plantar flexion of left ankle in terminal stance phase was 5° less than that of right one. The stress in Z axis of left ankle during stance phase was much less than that of right one. However, the difference in range of motion and stress in Z axis was not significant between the left and right knee joint in healthy people. ③ One year after left total knee arthroplasty, the dynamic surface electromyogram signals of left vastus lateralis is much lower than that of right vastus lateralis in a gait cycle.CONCLUSION: 3D gait analysis enables tprovide objective basis for making operation scheme for orthopedic surgery and after-operation rehabilitation therapy, and assessing curative effect of rehabilitation therapy.

Objective: To investigate the effect of astragalus on the serum levels of hepatocyte growth factor (HGF), renal function and the damage of renal morphology in ischemic acute renal failure (IARF). To study the protective mechanism of astragalus in IARF. Methods: The rats were pretreated with astragalus or vehicle for 3 days. IARF was induced by left renal artery clipping for 60 min, after the right kidney was removed. Biochemical parameters for serum HGF,blood urea nitrogen(BUN),creatinine(Cr) were measured and histological analyses of the kidneys were performed by tubular grading. Results: There have no significant difference between the serum HGF levels of I/R controls and the levels observed in sham-operated group (P > 0.05). Serum HGF levels in astragalus treated group was significantly increased than those of I/R control group(P < 0.01) .After 4 h of I/R, serum levels of BUN and Cr were increased in I/ R control rats compare with Sham-operated rats(P < 0.01). Astragalus treatment reduced the levels elevation(P < 0.05). Simultaneously,. I/R-induced severe damage in renal morphology were significantly ameliorated by astragalus treatment(P < 0.01). Conclusions: Astragalus pretreatment can alleviate the damage of renal function in IARF. It is may be one of the mechanisms of astragalus for protecting renal tissue in IARF that astragalus can induce the expression of HGF.

Objective To observe the results of melatonin combined with alprostadil in the treatment of patients with acute pancreatitis.Methods Seventy patients with acute pancreatitis were included in the study,14 patients died after conventional treatment were set to group Ⅰ ,28 patients cured after conventional treatment were set to group Ⅱ and 28 cases cured after melatonin combined with alprostadil and conventional treatment were set to group Ⅲ.White blood cell count,blood gas analysis,serum amylase,endotoxin and malondialdehyde (MDA) content was detected at 6 h,48 h and 4 d.Results White blood cell count,serum amylase,endotoxin,MDA content at 6 h,48 h and 4 d in group Ⅰ were higher than those in group Ⅱ ,Ⅲ (P＜0.05).Endotoxin levels reached a maximum in the 4 d [(273.5 ± 20.4) pg/L],and MDA content reached a maximum in the 4 d [(5.12 ± 0.87) μmol/L].White blood cell count,partial pressure of carbon dioxide in artery (PaCO2),serum amylase,endotoxin and MDA content at 48 h,4 d in group Ⅲ were lower than those in group Ⅰ,Ⅱ (P <0.05).Conclusions Melatonin combined with alprostadil not only shows antioxidant,anti-inflammatory,anti-apoptotic effect but also improves the pancreas,lung,small intestine microcirculation,protects the cell membrane and the lysosomal membrane,and prevents effectively the pancreatic digestive enzymes release; also it inhibits intestinal bacterial translocation,reduces the generation of gut-derived endotoxin and pro-inflammatory cytokine release.It can reduce effectively the systemic inflammatory response in acute pancreatitis.

Translational medicine is a new concept in China.It sets up a bridge between basic research and clinical work,and aims to transfer the basic study results to clinical practice as soon as possible.It is necessary for a surgeon to master the research idea of translational medicine in order to be expert in science and technique.Many unsolved clinical problems could be found in routine work,which is an advantage for translational medicine research.How to raise questions in routine clinical work and get these questions resolved in laboratory,and then apply the results to clinical work is a demand for surgeons nowadays.In this article,the research idea of translational medicine is introduced based on an example of the research on the relationship between rapamycin and hepatocellular carcinoma.

Objective To explore the effects of formaldehyde (FA) on the contents of CD3, CD4, CD8 and the activity of SOD and the contents of MDA in the spleen and thymus of mice. Methods 30 Kunming mice were randomly divided into 5 groups, 6 in each and treated with FA: the negative control group, 1 mg/m3, 3 mg/m3, 5 mg/m3 and the positive control group (treated with cyclophosphamide, CP). The mice were exposed to FA by static state inhalation in a chamber for 14 days, then the contents of CD3, CD4, CD8, MDA and the activity of SOD in the liver, spleen and thymus were determined. Results The contents of CD3, CD4, CD8 in the spleen and thymus showed a significant decreasing as the exposure dose increasing, an obvious dose-response relation was seen and there were significant differences between FA exposed groups and the control group (P

BACKGROUND:Evaluation plan for the neuro-musculo-skeletal system model and motor function was little.However,the three-dimensional gait analysis can transfer qualitative analysis and object description which widely used in orthopedics and rehabilitation medicine to quantitative evaluation with more objective and precise.OBJECTIVE:To evaluate gait kinematics and kinetic changes after total knee replacement based on 12 months follow up using three-dimensional gait analysis.DESIGN,TIME AND SETTING:The comparative observation and case-control study was performed in the Gait Analysis Room of the Department of Rehabilitation Medicine in the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University from January 2007 to May 2008.PARTICIPANTS:Ten patients with knee osteoarthritis following total knee replacement were chosen as treatment group;concurrently,ten patients whose baseline data were matched with the treatment group without problems in nerve,muscle,skeletal system and equilibrium were selected as the control group.METHODS:Ten patients in the treatment group underwent rehabilitation training,then compared time-distance,kinematic,and mechanical parameters which were measured at 3,6,12 months after total knee replacement with the control group.MAIN OUTCOME MEASURES:Time-distance parameter,kinematic parameter,mechanical parameter and knee functional scores.RESULTS:Pace,step frequency,gait speed,and time of injured leg standing were notably decreased,while time of uninjured leg standing,duration of gait cycle were obvious prolonged compared with the control group(P

Objective To compare the long-term survival rate and safety of laparoscopic surgery(LS)with those of open surgery(OS)in the treatment of colorectal cancer by using Meta-analysis.Methods Randomized controlled trails reported between January 1991 and July 2007 comparing the outcomes of LS and OS in patients with colorectal cancer were collected and analyzed by using RevMan4.2.Results Totally,14 reports involving 4989 colorectal cancer patients were enrolled in this study.Significant difference was found in the morbidity rate of bowel adhesion between the two groups(P=0.002).The long-term outcomes,including the 3-and 5-year survival rates,and the rates of local recurrence and distant metastasis,were not significantly different between the two groups.Conclusions Laparoscopic surgery is effective and safe for colorectal cancer with a similar long-term survival rate as that of the open surgery.