Currently, radical resection offers hilar cholangiocarcinoma patients the only chance for cure and long-term survival. Preoperative biliary drainage is necessary to reduce the risk of liver failure when total bilirubin levels are greater than 300 μmol/L, especially in patients who are about to receive hemihepatectomy or extended hemihepatectomy. Caudate lobectomy (segment I) should be performed as an elemental procedure for radical resection of hilar cholangiocarcinoma. For patients with Bismuth type Ⅲor Ⅳ, extended hemihepatectomy combined with caudate lobectomy, and if necessary, preoperative portal vein embolization, vascular resection and reconstruction, is needed to achieve tumor-free margins. Segment Ⅰ, Ⅳ,Ⅴ and Ⅷ resection is recommended to prevent postoperative liver dys-function if the volume of the remaining segments is insufficient. Resection of segment Ⅳ b and partial Ⅴ segment combined with segment Ⅰ can lessen the surgical trauma, and this is beneficial to most patients with Bismuth type Ⅱ and some Chinese patients with Bismuth type Ⅲor Ⅳ. Resection of lymph nodes 5, 6, 7, 8, 9, 12 and 13 is considered to be essential for radical resec-tion of hilar cholangiocarcinoma. Adjuvant chemotherapy and radiotherapy may prolong the long-time survival after resection.

Objective To examine effect of intervention strategies on developing sustainable safe sex practice among MSM.Methods A total of 420 participants were divided into three non-clinical trial groups,i.e.BCC-based condom facilitation(BCC-CF)group,sub-culture-based socio-facilitation(SBC-SF)group and the control group,to assess the sustaining effect of different models of intervention by stepwise cross-sectional follow-up survey.Results The survey of 410 MSM who had homo-sex partners in the past 6 months indicated that the rate of consistent condom use in anal intercourse with casual partners as a key indicator significantly increased in the BCC-CF(62.0%,P

Inappropriate treatment of bile duct injury and traumatic biliary stricture may cause serious consequences such as recurrent cholangitis,formation of hepatolithiasis,and biliary cirrhosis.This article elaborates on the influencing factors for the effect of the repair of bile duct injtry and traumatic biliary stricture,repair principles,timing of repair or reconstruction,and related methods and techniques.It is pointed out that if there is no significant local infection and the bile duct wall defect is ＜ 2 cm,end-to-end anastomosis should be used for repair;if the bile duct wall defect is ＞ 2 cm,Roux-en-Y hepaticojejunostomy should be used for reconstruction.If the upper wall of the bile duct had a large defect and the lower wall has an integral structure,pedicled umbilical vein graft,pedicled jejunal wall seromuscular flap,or gastric wall seromuscular flap should be used for repair.The patients with severe congestion and edema at the site of injury should be treated with sufficient external drainage of the injured bile duct and then selective repair or reconstruction.Patients with hepatic duct stenosis in the liver lobe or hepatic segments and liver tissue atrophy can be treated with hepalobectomy or segmental hepatectomy.The key to successful repair is exposure and removal of high hilar bile duct stricture,while segmental hepatectomy of the Ⅳb segment can fully expose the left and right hepatic pedicles and help with the incision of the left and right hepatic ducts and secondary hepatic ducts,and therefore,it is a good method for exposing high bile duct stricture.

Objective To investigate the apoptosis of human bile duct carcinoma cell induced by Apoptin gene transfection in vitro. Methods Apoptin gene was amplified by polymerase chain reaction (PCR) and then inserted into pAdtrack-CMV containing green fluorescent protein gene through T4 DNA ligase. The reconstructed plasmids were identified by enzyme digestion and sequencing. Apoptin expression vector was transfected into human bile duct carcinoma cell line QBC_(939). The apoptosis of human bile duct carcinoma cell induced by Apoptin gene was detected by TUNEL. Results Reconstructed pAdtrack-CMV containing Apoptin gene was obtained successfully. TUNEL test showed that there was significant difference in apoptosis index between Apoptin gene transfection and the control group (P

ObjectiveTo investigate the protective effect of calcium channel blocker, verapamil against human hepatic ischemia-reperfusion injury.MethodsThe patients undergoing lobe/segment hepatectomy were injected with 5?mg/2ml verapamil through vena gastroepiploica dextra before blocking hepatic portal.ResultsThe levels of free calcium ions in the hepatic cell and serum enzyme from the test group increased significantly than those of the control group. The degree of hepatic pathological injury was lower and the hepatic function restored earlier in test group.ConclusionCalcium channel blockers administered by hepatic portal vein before blocking hepatic portal have an important protective effect against human hepatic ischemia-reperfusion injury.

Objective To find a method of therapy for pregnancy acute periapical periodontitis patients,which has no effect on development of foetus and also make pregnant women exercise normal masticatory function.Methods When the teeth of pregnant women diagnosed definitely acute periapical periodontitis were asymptomatic,Using calcium hydroxide and iodoform paste for temporary stopping in root canal;then the teeth would be filled conventionally after delivery.Results The teeth of 20 pregnant women were all good,without pain of oneself,excitation and occlusion.All the pregnant women delivered normally and the mother and infant were all right.Conclusions Considering the safety of foetus,the temporary treatment of acute periapical diseases in pregnant women,using calcium hydroxide was safe and effective.

Objective To compare the occurrence of postoperative pain after applying two diferent root canalsealers in root canal treatment.Methods A total of 400 teeth were randomly divided into two groups:group A using ZincOxide engenol(ZOE),group B using Cortisomol sealer.The occurrence of postoperative pain was evaluated chnically 24~72h after root filling.Results The diference in pain among the two groups were statistically significant after treatment.The group B caused minimum irritation and least pain among the two groups.Conclusions The root canal therapy using Cortisomol sealer can significantly reduce pain.

Objective To evaluate the effects of continuous pulmonary artery Perfusion with hypothermic oxygenated blood on lung function in children with congenital heart defects (CHD) and pulmonary hypertension(PH). Methods 20 patients diagnosed with CHD and PH were divided into group 1( perfused with oxygenated blood) and group 2 (conventional CPB). A canula was inserted into the main pulmonary artery for the perfusion with a rate of 15～30 ml?kg -1 ?min -1 . CPB was established as usual. The data of two groups including the oxygen concentration, airway pressure, blood gas analysis were recorded. At fixed times, blood sample was taken out for the measurement of the sICAM-1 and MDA. Results The concentration of sICAM-1 and MDA in group 1 was much lower than that in group 2 on 12 and 24 hours after surgery. Issues of the lung function including OI?A-aDOa_2 and airway pressure was significantly different between the two groups. Conclusion The study showed that the continuous pulmonary perfusion with oxygenated blood could preserve lung function in patients with CHD and PH.

Objective　To investigate factors influencing the incidence of massive bleeding caused by stress ulcer in severe acute pancreatiti s (SAP) and explore the effectiveness of measures for its prevention and treatme nt.　Methods　Clinical data of 121 pat ients with SAP were reviewed retrospectively in our center between 1993 and 1998 .The incidence of massive bleeding caused by stress ulcer in SAP, its affecting factors and the results of prevention and treatment were evaluated.　Results　The incidence of stress ulcer massive b leeding in SAP was 11.6% (14/121). The risk factors included the age of patient s, the severity of the disease, concomitant bile duct lithiasis obstruction, pan creatic abscess, pseudocyst and a history of surgical debridement and drainage. Five out of 6 patients treated conservatively died, while only 1 out of 8 treate d surgically died (P＜0.01).　Conclusion　Massive bleeding stress ulcer most often occurred in elderly SAP p atients, especially those of biliogenic, with pancreatic abscess and pseudocyst. Somatostain administration effectively decreases the incidence of bleeding. E mergency operation is mandatory when conservative measures fail to stop the bl eeding.

Objective To investigate the effects of nerve growth factor (NGF) on the expression of 67-kDa laminin receptor (67LR) in human bile duct carcinoma QBC939 cells, and study the possible mechanism of perineural invasion and metastasis of bile duct carcinoma. Methods ( 1 ) The expression of a high-affinity receptor for NGF, TrkA, was detected by immunofluorescence staining. ( 2 ) QBC393 cells were pretreated by β-NGF at different concentrations ( 1, 10, 100,200 μg/L), and then the mRNA and protein expressions of 67LR were examined by Real-Time PCR and Western blot assay. QBC939 cells were divided into control group and β-NGF (1, 10, 100,200 μg/L) groups. (3) The ideal concentration of β-NGF was selected according to the results of previous tests, and then the mRNA and protein expressions of 67LR were re-examined by adding specific TrkA inhibitor K252a at different concentrations ( 100,200,300 nmol/L). QBC939 cells were divided into control group, β-NGF 100 μg/L group and K252a ( 100,200,300 nmol/L) groups. All data were analyzed by one-way analysis of variance or LSD-test. Results (1) A strong expression of TrkA was detected in the membrane of QBC939 cells. (2) The mRNA and protein expressions of 67LR in QBC939 cells were 0.35 ± 0.06 and 0. 32 ± 0.05 in the control group, 0.38 ±0.14 and 0.50 ±0.09 in the β-NGF 1 μg/L group, 0.62 ±0.14 and 0. 69 ±0. 13 in β-NGF 10 μg/L group, 0.90 ± 0.08 and 0.93 ± 0.07 in the β-NGF 100 μg/L group, and 0. 70 ± 0. 10 and 0. 76 ±0.07 in the β-NGF 200 μg/L group, there were significant differences among the five groups (F = 22. 4, 14. 6,P ＜0.05). The mRNA and protein expressions of 67LR in the β-NGF 100 μg/L group were significantly higher than those in the control group ( t = 19. 0, 21.0, P ＜ 0. 05 ). (3) The mRNA and protein expressions of 67LR in the QBC939 cells were 0.35 ±0.10 and 0.41 ±0.10 in the control group, 0. 88 ±0. 14 and 0.84 ±0.10 in the β-NGF 100 μg/L group, 0.80±0.08 and 0.76 ±0.04 in the K252a 100 nmol/L group, 0.67 ±0.12 and 0.61 ± 0.09 in the K252a 200 nmol/L group, and 0. 43 ± 0.07 and 0. 50 ± 0. 12 in the K252a 300 nmol/L group, there were significant differences among the five groups ( F = 14. 1, 8. 9, P ＜ 0.05 ). There were no significant differences in the mRNA and protein expressions of 67LR between the K252a 300 nmol/L group and the control group (t =1.02, 0. 85, P＞0.05). Conclusion In bile duct carcinoma cells, NGF enhances the expression of 67LR by combining with TrkA, which might be the mechanism of NGF mediating perineural invasion of bile duct carcinoma.