Objective To discuss the clinical features, diagnostic methods and treatment of the primary hepatic sarcomas. Methods The clinical data of 4 patients with primary hepatic sarcoma admitted to our hospital from January 1998 to December 2008 were viewed. Results There were 3 males and 1 female with age from 25 to 65 years. Abdominal pain, fatigue, weight loss and mass were among the complains. All 4 cases were misdiagnosed as liver cyst, liver cancer and liver adenoma respectively, and final diagnosis was established only by laparotomy and pathology. They were malignant mesenchymoma, carcinosarcoma, leiomyosarcoma and malignant fibrous histiocytoma respectively. Till now, 3 cases were still alive (respectively 4, 56 and 84 months after surgery), 1 case died intraoperatively. One case recurred 5 years after the operation. Conclusions Primary liver sarcoma is difficult to diagnose. Postoperative pathology and immunohistochemical examination remain the mainstay for final diagnosis. The prognosis is dependent on pathological type, differentiation, tumor invasion and metastasis.

Objective To study the operative technique and operative field exposure of laparoscopic splenectomy (LS). Methods The clinical data of 11 cases including 1 case of cirrhosis with splenosis and 10 cases of idiopathic thrombocytopenic purpura (ITP) who underwent laparoscopic splenectomy since June 1999 were analyzed retrospectively. Results 9 cases of LS were successfully performed. 6 cases took dorsal desubitus position, whose mean operative time was 3.5 hours and mean blood loss was 200ml. The operative time of the case who took right lateral desubitus position was 4 hours and the blood loss was 80ml. 2 cases took right inclined lateral desubitus position, and the operative time was 2.5 hours and 3.0 hours and the blood loss all was 100ml. 1 ITP patient of the 9 cases underwent novo-laparotomy in 6 hours after LS because of intraabdominal hemorrhage. 2 ITP cases required conversion into open splenectomy. Conclusions Satisfactory exposure and dissection of peri-splenic ligaments and constitution as well as successful control of splenic pedicel are the

Sepsis is a common acute systemic infection,severe sepsis has a high rate of mortality,and its incidence rate is rising year by year.Due to the overproduction of free radicals in sepsis,microcirculation blood is drived disorder,multiple organ function can be impaired.This review describes the role of ascorbic acid in sepsis patients,which can reverse the oxidative stress injury rapidly through an eNOS-dependent mechanism,resisting platelet adhersion,preventing capillary embolism,resevering microcirculation blood flow,so as to improve patients' survival.

In order to study the constituents and pharmacology of Tripterygium plants (Tripterygium willfordii Hook.f), a variety of chromatography methods were used. Four compounds were isolated from Tripterygium plant and their structures were elucidated by UV, IR, MS, HR-MS, 1H NMR, 13C NMR and 2D-NMR techniques. The isolated compounds were named as triptonide (1), neo-triptetraolide (2), 2alpha-hydroxytriptonide (3), and 15-hydroxytriptonide (4), separately. Compounds 3, 4 belong to new diterpenoids, which can inhibit the growth of K562 cells (leukemia cells) and HL60 cells (acute myeloid leukemia cells).

Objective To compare the value among three hilar cholangiocarcinoma (HCC) staging systems,Bismuth-Corlette classification,TNM staging system and MSKCC classification,in predicting the resection rate and prognosis of HCC patients.Methods The clinical and histopathological data of 154 HCC cases were analyzed retrospectively.Three different staging methods were performed respectively to analyze the correlations with respectability and survival.Chi-square test and Kaplan-Meier analysis were applied to find clinical and histopathological factors related to prognosis.Results There was no significant difference in resectability between Bismuth-Corlette classification or TNM stage Ⅰ,Ⅱ,Ⅲ and Ⅳ.The resection rates of MSKCC T1,T2 and T3 were 68.6％,44.8％,19.2％respectively (x2 =20.03,P =0.000).With higher T stage,resection rate obviously declined.The survival predicted by TNM staging and MSKCC classification was better than Bismuth-Corlette classification.Tumor differentiation,LN involvement,distant metastasis,margin status,TNM stage and MSKCC classification were significantly correlated with survival.Conclusions The MSKCC classification predicted resectability better than Bismuth-Corlette classification and TNM staging system,while both MSKCC classification and TNM staging system predicted survival better than Bismuth-Corlette classification.Clinical and histopathological factors such as tumor differentiation,LN involvement,metastasis,margin status,TNM staging,MSKCC classification were correlated with survival.

Objective: To evaluate the efficacy and safety of high-dose fluconazole alone or combined with flucytosine as initial therapy for cryptococcal meningitis (CM) in non-human immunodeficiency virus (HIV)-related patients. Methods: Twenty-five non-HIV-infected patients with CM from June 2015 to September 2018 in Huashan Hospital, Fudan University, who were initially treated with high-dose fluconazole with or without flucytosine for at least seven days were retrospectively reviewed.Clinical features and antifungal (600-800 mg/d) regimens were recorded, clinical responses and drug-related adverse events were evaluated. Mann-Whitney test and Fisher′s exact probabilities test were applied to compare variables between groups. Results: Of the 25 patients enrolled in this study, 15 had predisposing factors. Headache (25 cases), fever (21 cases), vomiting (13 cases) and neck stiffness (13 cases) were common manifestations. Abnormalities of cranial computed tomography (CT) scan and/or magnetic resonance imaging (MRI) were found in 22 cases.Nineteen patients were treated with high-dose fluconazole plus flucytosine for initial therapy, and six patients were treated with high-dose fluconazole alone. The course of initial regimens with high-dose fluconazole was 42 (29, 120) days. At the end of initial therapy, partial response in 20 patients, stable response in three patients and death in two patients were observed, and the overall effective rate was 80%(20/25). In treatment failure group of initial treatment, the proportion of patients with baseline cerebrospinal fluid opening pressure over 300 mmH₂O (1 mmH₂O=0.009 8 kPa) and with altered mental status were both significantly higher compared with those in treatment success group. Fluconazole related adverse drug events were observed including elevated transaminases (one case), gastrointestinal symptoms combined with hypokalemia (two cases), and systemic rash (three cases). Except for three patients with rash reduced the dosage of fluconazole, no other patients were given dosage adjustment. Conclusion High-dose fluconazole alone or combined with flucytosine is effective and safe for the initial therapy of non-HIV-related CM patients.

Objective:To evaluate the efficacy and safety of eltrombopag for children with thrombocytopenia after hematopoietic stem cell transplantation (HSCT).Methods:Clinical data of 24 patients with thrombocytopenia after HSCT,who were treated with eltrombopag in the Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University from August 1, 2018 to April 1, 2019 were analyzed retrospectively. The response rate and adverse reactions of eltrombopag were evaluated. Patients were divided into groups by source of hematopoietic stem cells (umbilical cord blood group and peripheral stem cell group) and type of disease (malignant and non-malignant disease group) and the clinical outcomes between groups were compared. Rank Sum test was used for comparisons between groups.Results:Among 24 cases, 15 were males and 9 females, the age of starting eltrombopag was 7.7 (2.6-13.7) years, the time of eltrombopag treatment after HSCT was 27.5 (8.0-125.0) days, the time from treatment to complete response (CR) was 23.5 (6.0-83.0) days, with the treatment course 36.5 (8.0-90.0) days. The total dose of eltrombopag was 1 400(200-5 900) mg. Complete response rate was 92% (22/24),without eltrombopag related adverse reactions. Comparing with peripheral stem cell group ( n=8), the course and total dose of eltrombopag in umbilical cord blood group ( n=16) were significantly reduced(24.5 (8.0-81.0) vs. 65.5 (35.0-90.0) d, Z=-3.004, P=0.002; 900.0 (200.0-3 850.0) vs. 2 862.5 (1 175.0-5 900.0) mg, Z=-2.604, P=0.007), but no significant differences were found in the time from treatment to complete response, platelet count after 2 weeks of eltrombopag withdrawal or platelet count at the end point of follow-up (all P>0.05). Comparing malignant patients ( n=12) and non-malignant patients ( n=12), no significant differences were found in the time from treatment to complete response, course, total dose, platelet count after 2 weeks of eltrombopag withdrawal, and platelet count at the end point of follow-up in non-malignant patients (all P>0.05). Conclusion:Eltrombopag is safe and maybe effective for thrombocytopenia after HSCT, especially for umbilical cord blood transplantation.