Objective To study the safety and efficacy of surgical treatment for hilar cholangiocarcinoma (HC).Methods We retrospectively analyzed the clinical data of 56 patients with HC who underwent resection at the Beijing YouAn Hospital,Capital Medical University,from January 2010 to July 2015.The patients were divided into two groups according to the types of operations:the minor hepatectomy group (n =12) and the major hepatectomy group (n =44).The postoperative complications,mortality and long-term survival rates were compared and the clinical data were analyzed using uni-and multivariate analyses to examine the significant factors of survival.Results (1) The morbidity rates of the two groups were 33.3％ and 63.6％,respectively,with the latter group being significantly higher than the former group;(2) The 1-and 3-year overall survival rates were 60％ and 15％ in the minor liver resection group and 64％ and 15％ in the major resection group,and there was no significant difference between the two groups (P ＞ 0.05).The median survival was 16 months;(3) The median survival of R0 resection was significantly longer than the R1/R2 resection group (22 months vs 10 months,P ＜0.05);(4) Age,preoperative CA19-9 level,vascular invasion,surgical margin,tumor differentiation and nodular metastasis were significantly correlated with prognosis on univariate analysis.Multivariate analysis showed surgical margin and tumor differentiation to be significant prognostic factors.Conclusions RO resection obviously prolonged survival of HC patients,and histopathology negative surgical margin should be emphasized.With R0 resection,minor liver resection significantly reduced postoperative complications and mortality in selected patients.

Hilar cholangiocarcinoma (HCC) resection is a difficult and complicated surgery with high complication risk because of the special anatomic position.The detailed preoperative assessment is very important.Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) can provide important information on the tumor location, vascular invasion and distant metastasis, which is necessary for the resection.Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) can be used to determine the tumor location and size, and achieve bile drainage.Magnetic resonance Cholangiopancreatolography (MRCP) as a noninvasive examination with fewer complications has comparable accuracy in identifying tumor extent with PTC and ERCP.The ultimate goal of surgical treatment is R0 resection.Preoperative resectablility evaluation mainly depends on the bile duct involvement, hilar vessels invasion, extent of hepatic lobe atrophy, lymphatic metastasis and nerve plexus infiltration.HCC radical resection often demands extended liver resection and accurate assessment of the residual liver function is very important for clinical strategy.Preoperative biliary drainage could be conducted in patients with cholangitis, long-term refractory jaundice (direct bilirubin level ＞ 200 μmol/L), poor nutrition status and residual liver volume ＜40％ of the total liver volume.Portal vein embolization decreases the long-term complications for HCC patients with enlarged liver resection.Portal vein embolization can be considered when residual liver volume ＜ 30％ ～40％.

Objective To investigate the safety and efficacy of sirolimus-based immunosuppression therapy in liver transplantation. Methods Immunosuppression in 12 patients after liver transplantation was converted from calcineurin Inhibitor (CNI) to sirolimus for at least one month. Safety evaluations consisted of regular measurements of serum creatinine and liver enzymes to assay the restoration of CNI related nephrotoxicity and hepatoxicity. Efficacy analysis was performed by biopsy to evaluate the rejection incidence. Results The patients were followed up for a mean of 37 months after liver transplantation. Immunosuppression therapy was converted after a mean of 11 months. The average sirolimus conversion therapy period was 14 months. Among 12 patients experiencing sirolimus conversion therapy, 6 did not develop rejection on biopsy. Among 7 patients with CNI-related nephrotoxicity, 5 showed the restoration of serum creatinine to normal but1 developed albuminuria. All four patients with mild liver dysfunction did not improve. Conclusion The conversion from CNI to sirolimus is treatable based on liver biopsy in some selected liver transplant recipients,

This paper is about the clinical trials of preoperative concurrent chemoradiotherapy for advanced adenocarcinoma of the stomach or gastroesophageal junction reported in recent years. The radiation dose of most trials is 45 Gy. Chemotherapy drugs such as 5-fluorouracil, cisplatin and taxol are concurrently used as sensitizers. A number of trials have induction chemotherapy prior to chemoradiotherpy. The validity is evaluated by R0 resection rate, pathological complete response rate and overall survival rate. The safety is assessed by the adverse reaction, treatment related mortality, and its effect on postoperative complications and mortality. The results showed that preoperative chemoradiotherapy can significantly improve the R0 resection rate and benefit the prognosis of the patients. Meanwhile, the security and impact on operations of preoperative chemoradiotherapy is controllable. The recent researches are mostly in phase II, and more randomized controlled studies are needed. To fully accept the preoperative chemoradiotherapy as a standard treatment, more evidence and long-term efficacy index are indispensible.

Cirrhotic portal hypertension can lead to changes in the cardiovascular system,including hyperdynamic circulation,increased cardiac output,increased splanchnic blood flow,increased heart rate,peripheral vasodilatation,decreased resistance,and a drop in blood pressure.This hemodynamic disorder not only plays an important role in the maintenance of portal hypertension,but also causes retention of sodium and water,ascites,hepatorenal syndrome,and hepatopulmonary syndrome.Recently,there is an increased interest in clinical research reports that suggest treatments for cirrhotic portal hypertension.Therapies involve internal medicine,interventional treatment,and surgery for preventing and controlling upper gastrointestinal hemorrhage,splenomegaly,hypersplenism,and other symptoms.Various treatments had some positive effects on the hyperdynamic circulatory state of the cardiovascular system.

Objective:To study the eExecutive fFunctions Characteristics of Cchildren with Aattention dDeficit hHyperactivity Ddisorder in Cclock Ddrawing Ttest. Methods: 60 ADHD children and 60 normal children awere tested by CDT. Then analyze the data to detect the difference of Executive Functions of two growps. Results:ADHD group geot significant lower scores than control group on both time total score (data) and clock face structure score. (3.23?1.40/4.15?0.78,11.2?1.48/11.90?0.76,t=7.742、5.073,P0.05). Conclusions: the lower score in CDT showed that ADHD child have some weaknesses in planning , in attention regulating and in working memory. The core of these weaknesses is failing of execute function.

ObsjectiveTo investigate the clinical data,and to summarize the clinical experience of diagnosis and treatment of graft-versus-host-disease (GVHD) after liver transplantation.Methods 4 of 480 recipients undergone liver transplantation developed GVHD from Apr.2005 to Sep.2011.The 4 recipients'clinical courses and laboratory tests were recorded.ResultsThe diagnosis of GVHD depended on clinical syndrome involved skin rash,bone marrow depression and diarrhea.Skin biopsy and STR-PCR were matched.Among them,2 with successful treatment have been surviving for 7 and 24 months,and 2 died from infection.One recipient had the donor T lymphocyte microchimerism detected by STR-PCR.ConclusionsGVHD after liver transplantation can cause high mortality due to bone marrow depression.A reasonable treatment can be to reduce immunosuppressant and glucocorticoids and IVIG.

Objective: To investigate the relation between ser um hyaluronic acid (HA) concentration and cryopreservation-reperfusion injury. Methods: The animals were randomly assigned to 3 groups: (1 ) group A: the control; (2) group B: liver allografts were stored in lactated R inger's solution (0℃) for 2 h before implantation; (3) group C:liver allografts were stored in lactated Ringer's solution (0℃) for 4 h before implantation. Th e serum sample and liver specimen were taken up at 2 h and 4 h after transplanta tion to detect the concentration of HA, AST and LDH, and to get pathologic obser vation. Results: Serum HA increased earlier and decreased more s hortly than AST and LDH after transplantation in group A. Serum HA increased sig nificantly in group B and C, much higher than that in group A(P<0.01). The i njury of vascular endothelium and the disorder of hepatic sinuses and hepatic lo b ules were observed in group B and C. In the specimen of 4 h in group C, evident infiltration of inflammatory cell was present. Conclusion: Cryopreservation leads to injury of endothelial cell and reperfusion aggravat es this injury. The serum HA concentration indicates the degree of cold ischemia -reperfusion injury.

Objective To analyse the CT radiation dose statistically using the standardized radiation-dose-structured report (RDSR) of digital imaging and communications in medicine (DICOM). Methods Using the self-designed software, 1230 RDSR files about CT examination were obtained searching on the picture archiving and communication system ( PACS ) . The patient dose database was established by combination of the extracted relevant information with the scanned sites. The patients were divided into adult group (over 10 years) and child groups (0-1 year, 1-5 years, 5-10 years) according to the age. The average volume CT dose index ( CTDIvol ) and dose length product ( DLP) of all scans were recorded respectively, and then the effective dose ( E) was estimated. The DLP value at 75% quantile was calculated and compared with the diagnostic reference level ( DRL) . Results In adult group, CTDIvol and DLP values were moderately and positively correlated ( r=0?41 ) , the highest E was observed in upper abdominal enhanced scan, and the DLP value at 75% quantile was 60% higher than DRL. In child group, their CTDIvol in group of 5-10 years was greater than that in groups of 0-1 and 1-5 years ( t=2?42, 2?04, P<0?05);the DLP value was slightly and positively correlated with the age (r=0?16), while E was moderately and negatively correlated with the age ( r = -0?48 ) . Conclusions It is a simple and efficient method to use RDSR to obtain the radiation doses of patients. With the popularization of the new equipment and the application of regionalized medical platform, RDSR would become the main tool for the dosimetric level surveying and individual dose recording.

Objective To investigate patient doses undergoing routine interventional cardiology procedures in China. Methods A retrospective analysis was performed on 238 adult patients who achieved one of interventional procedures including coronary angiography (CAG), percutaneous coronary angioplasty (PTCA) and radiofrequency catheter ablation (RF). According to intervention operations, all cases were divided into three groups:CAG (77), PTCA (95) and RF (66). Data of four special metrics, peak skin dose (PSD), dose-area product (DAP), cumulative dose (CD), and fluoroscopy time (FT), these parameters were measured and collected for these procedures. Frequencies of high-dose cases (PSD>2 Gy and PSD>3 Gy) were specifically recorded. Third quartile of DAP distribution was used to establish dose reference level (DRL) and then DRL values in this study were compared with ones reported in literatures. Wallis Kruskal rank-sum test was used to compare radiation dose of patients undergoing different intervention procedures. The total correlation among CD, DAP and PSD was analyzed by Spearman method. Results For patients undergoing CAG,PTCA and RF procedure, the median PSDs were 0.24, 1.05 and 0.62 Gy, respectively.The median DAPs were 34.99, 94.53 and 36.33 Gy · cm2, respectively.The median CDs were 0.39, 1.27 and 0.36 Gy, respectively.The median FTs were 4.50, 15.31 and 13.40 min, respectively. The difference among procedures was statistically significant (χ2=105.083, 92.032, 115.509, 100.883, respectively, P<0.01). For
all cases, DAP and CD were correlative (r=0.845, P<0.01), also PSD and CD (r=0.779, P<0.01), PSD and DAP (r=0.938, P<0.01). There were 9.2% (22/238) patients with PSD>2 Gy, including 14 patients undergoing PTCA and 8 patients undergoing RF. There were 1.6% (22/238) patients with PSD>3 Gy, including 1 patients undergoing PTCA and 3 patients undergoing RF. The DRL for PTCA in this study is 133 Gy · cm2 and higher than that in literatures. The DRL for CAG in this study is 46 Gy · cm2 and slight lower than that in literatures. The DRL for RF in this study is 49 Gy·cm2. Conclusion Data from this study are in the range of most reported values for CAG and RF procedure, while higher than that obtained in some literatures for PTCA.