Surgical resection offers hilar cholangiocarcinoma patients the only chance for cure and long-term survival.Hepatectomy,extrahepatic bile duct resection,regional lymphadenectomy and hepatojejunostomy are the current treatment of choice for most patients with hilar cholangiocarcinoma.Because of the aggressive nature of hilar cholangiocarcinoma and the absence of effective adjuvant therapy,surgical therapy still remains a challenge to hepatopancreatobiliary surgeons even in the precise surgery era.Controversies exist over preoperative assessment and staging,the use of preoperative biliary drainage,preoperative portal vein embolization,the range of hepatic resection,portal vein resection and construction,hepatic arteriectomy and the range of lymphadenectomy.This article reviews the surgical management of hilar cholangiocarcinoma with a focus on these controversies.

The application of enhanced recovery after surgery (ERAS) in hepatectomy is safe and feasible.The related researches of the clinical strategies of ERAS involved in colonic surgery instead of management of basic diseases of liver,and the influence of portal hypertension and hepatitis B virus infection on the ERAS has not been emphasized.According to the clinical strategies of ERAS in colon surgery,the basic diseases and the characteristics of liver were focused,and the clinical strategies of ERAS in the era of precision liver surgery were proposed.Through concerted efforts of the multidisciplinary team and a joint of surgeons,nurses and patients,the establishment of multicentre clinical studies under guidance of evidence-based medicine (EBM) will show clearly a development direction of the clinical strategies of ERAS in the era of precision liver surgery.

The progress of liver surgery is characterized by precision,minimal invasion and effectiveness in the 21 st century.Establishment of painless liver surgery ward and implementation of pain management in the perioperative period are not only the central content of enhanced recovery after surgery,but also one of the core connotation in precision liver surgery research.Conducting training programs for medical staffs,emphasizing health education of pain,selecting the reasonable pain assessment strategy,combination of preemptive analgesia and multimodal analgesia in the perioperative period and paying attention to individualized analgesia are important contents of construction of painless liver surgery ward.To carry out multicentre clinical study energetically,explore clinical pathway for the construction of painless ward and perioperative analgesic model are the development orientation for the construction of painless liver surgery ward.

Perioperative immunosuppression exists in cancer patients are as a result of their own disease,and postoperative pain inhibit immunological function.The effective postoperative analgesia can relieve the suppression of cell-mediated immunity,as well as reducing tumor recurrence and metastasis.However,diverse range of analgesic agents and techniques have a different impact on immune function.This article reviews the influence of various analgesic agents and techniques on the perioperative immune function of cancer patients so as to provide more suitable analgesia techniques,which is beneficial for regulating of immune balance,lessening tumor recurrence and improving prognosis.

Blood transfusion in liver surgery still plays an important role.However,blood transfusions may cause immunosuppression recipients and hinder the body' s immune response against the tumor,promotes tumor metastasis and recurrence.How to resolve this contradiction? We must study and research the effects of allogeneic blood transfusion on liver cancer metastasis and recurrence after hepatic resection,and to find strategies to improve the liver cancer prognosis.

To find out the health need of the city population in Guangzhou and the service level of the city's medical units and to set up a public health service system to answer the need of the market e- conomy,an investigative analysis is here focused on the health state and health service need of the city's population,the allocation of the health resources and the utilization of the city's health resources,eco- nomic factors,ways of medical payment,the cultural and age composition of the population structure, and the impact of the service personnel quality on the utilization of the service.It is suggested that the government increase its fund appropriation on public health,establish neighborhood medical leagues, start medical insurance,speed up cooperative medicine in the countryside,and complete the medical se- curity system.

Objective To compare cerebralspinal fluid acetylcholine (ACh) and choline (Ch) in patients with Alzheimer's disease (AD) and vascular dementia (VD), and their correlation with cognitive impairment.Methods First, dementia scales of 22 ADs, 22 VDs and 20 controls were scored using MMSE. Then the concentrations of CSF ACh and Ch in AD and VD were examined using the high-performance liquid chromatography with electrochemical detector (HPLC-ECD). Finally, the scores of MMSE and concentrations of ACh and Ch were compared. Results The ACh concentrations in AD[(10.7?5.1)nmol/L] and VD [(16.8?7.4)nmol/L] were found to be significantly lower than in controls [(34.5?9.0)nmol/L]( P =0.001), and showed a significant positive correlation with MMSE scores. The Ch concentration in AD CSF [(627.6?145.1)nmol/L] was approximately the same as in controls [(716.0?159.4)nmol/L], and showed no correlation with MMSE scores. The Ch concentration in VD CSF [(887.4?187.4)nmol/L] was significantly higher than in AD ( P =0.001) and controls ( P =0.002).Conclusion (1)The depression of ACh is correlated with cognitive impairment, suggesting ACh is an important neurotransmitters for memory. (2) VD may have a similar pathogenesis as AD. (3) The depression of AD ACh concentration and elevation of VD Ch concentration in CSF may be a role in their differentiation. (4) The application of acetylcholinesterase inhibitors is suitable for AD and VD.

Objective To observe the therapeutic efficacy of different schemas in partients with contagious atypical pneumonia outbreaking in GuangZhou area.Methods Patient who were hospitalized in our ward from Feb,2003 to May,2003 were allocated to different groups according to the therapentic schema.To compare and analyse the efficacy.Results resnlts indicate that the effects of antivirus drugs of all groups have no difference.The use of glucocorticoid decreased the opportunity of mechanical ventilation and intubation.Conclusion Patients who have severe condition or present with adult respiratory dyspnea syndrome will relieve in pulmonary inflammatory bleeding at some degree if they get proper glucocorticoid and positive pressure nonivasive ventilation,the possibility of intubation and fatality will decrease

Objective To study the brain distribution of propofol and its effect on memory under intravenous combined anesthesia. Methods 20 patients undergoing elective abdominal abdomen and limb operations were randomly divided into propofol 8mg?kg -1 ?h -1 group (n=10) and 10mg?kg -1 ?h -1 group (n=10). The perioperative EEG non-linear topographic map of approximate entropy was recorded. The perioperative patients' memory was estimated by process dissociation procedure (PDP) after operation. Results Comparing with pre-operative examination results, the intra-operation explicit and implicit memory markedly declined in both propofol 8mg?kg -1 ?h -1 group and 10mg?kg -1 ?h -1 group. There was statistically significant difference between the pre-operative and intra-operative explicit and implicit memory (P

Objective To study the cerebral distribution of inhalational anesthetics and their effect on memory under inhalational combined with intravenous anesthesia. Methods 45 patients, undergoing elective abdominal and limb operations, were randomly divided into: isoflurane group (n=15), sevoflurane group (n=15), and desoflurane group (n=15). The narcosis was maintained by inhalational anesthetics combined with intravenous anesthetics. EEG non-linear topographic map of approximate entropy was recorded. The perioperative memory of the patients was estimated by process dissociation procedure (PDP) after patients awoke. Results Comparing with pre-operative examination results, there was distinct declination of intra-operation explicit and implicit memory in all three groups, and the difference was statistically siqnificant (P