Objective To investigate influence and significance of preoperative transcatheter arterial chemoembolization (TACE) on disease-free survival rates and overall suvival rates in patients with respectable large hepatocellular carcinoma(HCC). Methods One hundred and eight patients with respectable large primary liver cancers were prospectively randomized into two groups: preoperative TACE group(n=52) and one-stage operation group(n=56). We compared between two groups according to daughter nodules and tumor thrombus. Results There were no significant differences in the incidence of disease-free survival rates and overall suvival rates in the two groups. Conclusion Preoperative TACE for resectable large HCC should be used on bases of strict selection because it does not decrease the recrudescence rates and results in delayed surgery in some cases.

Currently,since a single treatment standard of benign tumors of liver is not established,many serious out-comes due to the excessive treatment of benign tumors of liver still happen sometimes.We should pay attention to composing the guideline on the treatment for the different types of benign tumors of liver on the basis of the multidisciplinary cooperation and the randomized controlled trials,and achieving the goals of an unified standard and the standardized therapy,meanwhile,avoiding the pain and burden of excessive treatment on the patients.

Recently,basic and clinical researches have shown that blood glucose variability is an independent risk factor for diabetic complications.Thus,ideal control of blood glucose is not only to reach the HbA1Ctarget,but also to minimize blood glucose variability.Different glycemic parameters could be selectedaccording to different purpose of evaluation,in which the mean amplitude of glucose excursions(MAGE) and the standard deviation of blood glucose (SDBG) could be used as accurate and simple assessment parameters respectively.

The treatment principle for primary liver cancer referring as hepatocellular carcinoma (HCC) in this article is comprehensive treatment based on radical hepatectomy. Focusing on improving the resection rate and reducing the recurrence rate after operation, the conversion therapy, preoperative neoadjuvant therapy and postoperative adjuvant therapy have emerged to become potentially curative strategies and research hotspots. HCC is highly invasive and often complicated with cirrhosis, so comprehensive treatment is essential for better prognosis. However, due to the controversy of surgical indications and heterogeneity among individuals, the concepts and treatment methods of above three therapies, especially between the conversion therapy and the preoperative neoadjuvant therapy, remain overlap and puzzle sometimes. Moreover, because of the different therapy goals, the above three therapies are different in the selection of treatment methods, duration of therapy and evaluation criteria. Based on clinical practice, the authors investigate the progress and hot spots of the conversion therapy, preoperative neoadjuvant therapy and post-operative adjuvant therapy of HCC, expecting more clinical evidence-based medicine to standardize the development of comprehensive treatment, so as to become a breakthrough to improve the diagnosis and treatment of HCC.

Dead-in-bed syndrome (DBS) is a rare but devastating sudden death condition that mainly affects young patients with type 1 diabetes.Its mechanism is quite complicated and may involve multiple factors.Acute onset of recurrent and severe nocturnal hypoglycemia,abnormal cardiac repolarization,genetic factors,and obstructive sleep apnea may all contribute to ventricular arrhythmias and even sudden death.The future research plans include elucidating and understanding the underlying mechanisms and triggers for DBS,developing a risk stratification system,using real-time continuous glucose monitoring system to detect severe nocturnal hypoglycemia,and initiating appropriate therapeutic interventions to uhimately prevent the tragedy.

Objective To discuss the main features and experiences of surgical treatment of congenital spinal bifida and tethered cord syndrome. Methods Spinal bifida and tethered cord syndrome are congenital malformations. A study was conducted to analyse the morphology and the microsurgical operation of the diseases. During the Sept, 1993 to Feb, 2003, 528 patients were admitted to the hospital. The age ranged from 5 months to 45 years old (mean age 9 years). 239 cases(45.3%) were diagnosed as myelomeningocele, 123 cases(23.3%) were meningocele, 107 (20.3%) were spinal bifida with lipoma, and 59 cases of spinal bifida occulta (1.2%). Surgical removal of the arachnoid cyst and lipoma relieved compression of the spinal dural sac and the tethered spinal cord. Results Improvement was achieved in 322 cases (61%), no improvement in 194 cases (36.7%), and exacerbation of symptoms in 12 cases (2.3%). Conclusion Careful planning for the surgical treatment of spinal bifida is imperative. It is also important to release the compression tissues, in the spinal canal and to loosen the tethering.

Objective :To study the effect and mechanism of retinoic acid(RA) on thymocytes development. Methods:Thymus tissue culture system was used to investigate the roles of RA in maturation development of thymocytes. Thymus tissues were cultured with or without retinoic acid and/or retinoic acid receptor antagonist. The cultures were harvested after 24, 48 and 72 hours, respectively. Thymocytes were stained with fluorescence labeled anti-CD3, anti-CD4, anti-CD8 antibodies and analyzed by flow cytometry. The real time quantitative RT-PCR assay was used to detect the retinoic acid receptor (RAR) mRNA expression in thymocytes. Results:The thymus tissue culture system was able to support the maturation of thymocytes. Addition of RA to the culture system promoted thymocytes differentiation from immature CD4+CD8+ cells to mature CD4+ cells, but inhibited the transformation from immature CD4+CD8+ cells to mature CD8+ cells. The effect was marked after 24h culture, and was antagonized by Ro41-5253. RA enhanced the expression of RAR mRNA in thymocytes. A positive correlation was found between the expression of RAR mRNA and the percentage of CD4+CD8+ cells and a negative correlation between the expression of RAR mRNA and the percentage of CD8+ cells. Conclusion:RA likely play an important role in thymocytes development, perhaps by affecting the relative expression of RAR gene.

Objective To evaluate the diagnostic value of dynamic contrast enhanced MRI (DCE-MRI)in angiogenesis and invasion of ovarian tumors .Methods 98 patients with pathological-confirmed ovarian tumors without any treatment underwent plain MRI and DCE-MRI before operation .The plain MR images and DCE-MRI data were retrospectively analyzed .Value of Ktrans and Ve was detected by pharmacokinetic model .The expression of VEGF and MMP-2 in ovarian tumors was examined by immunohistochemistry .The correlation between DCE-MRI parameters and immunohistochemical results was analyzed .Results The expression of VEGF and MMP-2 was sig-nificantly higher in the malignant group compared with that in the benign group (both P<0.05).The value of Ktrans and Ve was significantly lower in the benign group compared with that in the malignant group ( both P<0.05) .The value of Ktrans and Ve was positively correlated with the expression of VEGF and MMP-2.Conclusion DCE-MRI can noninvasively evaluate the angiogenesis and invasion of ovarian tumors in vivo , which has important signifi-cance for clinical treatment and prognostic assessment .

[Summary] Thedawn phenomenon is a term used to describe hyperglycemia or an increase in the amount of insulin needed to maintain normoglycemia, occurring in the absence of antecedent hypoglycemia, during the early morning hours, and mostly affecting children with type 1 diabetes. Currently, hyperglycemia before breakfast time is defined as dawn phenomenon, and postbreakfast abnormal hyperglycemia is referred as the extended dawn phenomenon. Dawn phenomenon is regarded as the result of the β cell dysfunction, which increased endogenous glucose production and the persistent insulin resistance. By using continuous glucose monitoring technology, dawn phenomenon can be effectively identified:The difference between the lowest glucose level during nocturnal time and the glucose value before breakfast over 1. 11 mmol/L. And the long-acting insulin analogs and insulin pump are effective treatments for dawn phenomenon.

The application and studies of reduced diameter implants(RDI)are increasing recently.A case with fracture of three 3.3 mm ITI implants in maxilla was reported in this paper.Combined with the related literature,overload,mechanical complications(such as fatigue, crevice corrosion and hydrogen embrittlement)and the insufficiency of mechanical properties of RDI may lead to the fracture.