Since the 1980s, indications for resection of hilar cholangiocarcinoma have progressively improved. Operation is superior to any other therapeutic modalities with regard to survival rate and quality of life. Currently, hepatic lobectomy, extended hepatic lobectomy, extrahepatic bile duct resection, regional lymphadenectomy and Roux-en-Y hepatoenteric jejunos-tomy are recommended as the treatment of choice for most patients with hilar cholangiocarcinoma. However, controversy still remains regarding the diagnosis and treatment of hilar cholangiocarcinoma, including the assessment of longitudinal tumor extension, the evaluation of hepatic reserve function, the value of biliary drainage, the indication of portal vein emboliza-tion, the range of hepatic resection, the contribution of com-bined vascular resection, and the effectiveness of liver transplan-tation. This article summarizes these main issues requiring further investigation.

Objectives:To observe the role of parenteral nutrition(PN) in the elderly postoperative patients with gastric carcinoma. Methods:Forty cases were randomly divided into two groups. One group received PN after operation as PN group and another group was supported only with the general treatment without PN as control group. Results:①The rate of postoperative complications was 15% (3/20) with no death in PN group, and it was 45%(9/20) with mortality rate of 5%(1/20) in control group. ② Between the two groups, there were very significant differences in nitrogen balance, body weight, creatinine height index(CHI), serum albumin, serum transferrin and blood urea nitrogen(BUN) at the 8th postoperative day( P

Humans ; Liver Cirrhosis ; diagnosis

Objective To study the long-term results of using an autologous vascularized pedicled flap of gastric tissues in the repair of traumatic bile duct strictures.Methods From 2002 to 2016,38 patients with traumatic bile duct strictures underwent repair using an autologous vascularized pedicled flap of stomach tissues.The postoperative morbidity,mortality,long-term clinical results,liver function and the rate of biliary stricture recurrence were studied.Results The overall complication rate was 18.4％ (7/38).A delay in healing of the incision wound occurred in 4 patients,biliary fistula in 2,and ascites in 1.Two patients died of malignant tumor.The median follow-up was 92 (61 ～ 107) months and the follow-up rate was 100％.Excellent results were obtained in 97.2％ (35/36) of patients.Abnormal liver function was detected in 1 patient which improved with treatment using choleretic drugs.The remaining 35 patients had normal liver functions with absence of abdominal pain.Conclusions To repair traumatic bile duct strictures using an autologous vascularized pedicled flap of stomach tissues was safe and reliable,and good long-term outcomes are available.

Objective To analyse the cost-effectiveness analysis of the focal injection treatment under the guidance of contrast enhanced ultrasound(CEUS) for the severe abdominal parenchymal organs trauma.Methods One hundred and twelve patients with severe abdominal parenchymal organs trauma,including 42 hepatic injuries,52 splenic injuries and 33 renal injuries,were rolled in this study. The cost-effectiveness of this group was compared with that of surgery group. Results Treatment duration of single organ trauma under the guidance of CEUS was 20 - 30 minutes. During the first 72 hours after the focal injection, blood pressure and heart rate were improved ( P ＜0.05). Free intraperitoneal liquid did not increase on immediate US image of post-therapy and then it disappeared gradually. Heart rate returned to normal level after injection treatment ( P ＜0. 001 ). Lengths of stay in hospital was 3 - 11 (5.4 ± 2.4)days, which was not different with 3 - 9(5.1± 1.9) of surgery group( P ＞0.05). Treatment cost was 0.32 - 0.43 (0.36 ±0. 14) ten thousand RMB, which was obviously less than 3. 1 - 4. 2 (3.6 ± 10.8) ten thousand RMB of surgery group ( P ＜ 0.01 ). Conclusions The efficacy of the focal injection treatment of the severe abdominal parenchymal organs trauma under the guidance of CEUS was consistent with that of the operative treatment, but its cost was less. Especially it benefited for reserving organs and less pain.

Objective To evaluate three-dimentional (3D) reconstruction technique and methylene blue staining in precise anatomic hepatectomy.Methods The clinical data of 12 patients with hepatocellular carcinoma who were admitted to the Chinese PLA General Hospital from February 2009 to August 2011 were retrospectively analyzed.The 3D reconstruction of the liver tumor and intrahepatic vessels were done based on the computed tomography data and magnetic resonance imaging data.The portal vein supplying the tumor and its anatomic relationship with adjacent vessels were evaluated.Precise anatomic hepatectomy was performed guided by sustained methylene blue staining.Results The accurate rate of 3D model of the portal triad was 12/12.The shape of target segments observed after methylene blue staining was consistent with the results of 3D evaluation.Two patients received hemihepatectomy,3 received lobectomy,5 received monosegmentectomy or subsegmentectomy,2 received multisegmentectomy.The mean tumor diameter,operation time,blood loss,postoperative hospital stay and complication rate were 5.6cm (2.5-16.0 cm),(150±24)minutes,(236±25)ml,(10±3)days and 2/12,respectively.After a median follow-up of 14 months,tumor recurrence was found in 2 patients,and 1 of them died of tumor progression.Conclusions The 3D reconstruction may contribute to precise evaluation of the anatomic relationship between the tumor and its adjacent vessels.The 3D technique combined with sustained methylene blue staining may significantly improve the accuracy of anatomic hepatectomy.

Multiple sclerosis (MS) is an autoimmune disease characterized by demyelination, axonal injury, and neuronal loss in central nervous system. Experimental autoimmune encephalomyelitis (EAE) animal model is widely used in MS. Accumulating evidences indicate that the programmed cell death-1/programmed cell death-ligands-1 (PD-1/PD-L1) pathway participates in pathogenesis of autoimmune diseases. The authors comprehensively review the roles of PD-1/PD-L1 pathway in pathogenesis of MS and EAE animal model, and discuss the potential of this pathway as a new therapeutic target for MS, to provide reference for immunotherapy research of MS.

Objective To provide the practical experience of association of liver partition and portal vein ligation for staged hepatectomy(ALPPS) procedure in portal vein tumor thrombosis(PVT) cases,and to explore its value in PVTT therapy.Methods Three cases of ALPPS were applied to PVTT in Department of Hepatobiliary Surgery of PLA General Hospital from 2015 to 2016.The patients data were retrieved and analyzed retrospectively,including the basic information,preoperative PVTT classification,preoperative Child-Pugh classification,ICG test results,future liver remnant (FLR),FLR growth rate between 2 phase operation,operation time,bleeding volume,postoperative complications,postoperative survival etc.We discussed the detail technology and discuss the surgical procedure combine our experience and the published papers.Results ALPPS was performed successfully in all 3 patients.According to the Cheng's Classification of PVTT,they were classified as type Ⅱ,1 case and Ⅲ type,2 cases.Preoperative liver function was Child-Pugh A grade,average ICG R15 was 7.3％ (4.2％-11.0％),and average FLR was 387 ml (333-484 ml).The mean time interval between 2 phases surgery was 24.7 days (9-50 days) and the average FLR growth rate was 50.3％ (24.4％-82.3％).Morbidity of Clavien-Dindo Ⅲ or more was recorded in 1 case,but no mortality occurred.During follow-up period,2 patients were treated with TACE for tumor recurrence.All patients survived with acceptable life quality till now.The portal vein tumor thrombosis necrosis was observed in all 3 specimens.Conclusions ALPPS is a valuable surgery for effective control of tumor thrombus and radical resection rate in well selected PVVT type Ⅱ and type Ⅲ patients.It is expected to improve the therapeutic effect in combination with TACE and other treatment methods.

The amyloid plaques (Aβ) hypotheses and Tau propagation hypothesis are still proposed as the most prevailing causes for Alzheimer's disease (AD). Recent compelling evidences have firmly demonstrated that there are tight involvements of dysfunction of the immune system in the pathogenesis and progression of AD. Here, we review the current knowledge on the role of immune system in pathogenesis of AD and discuss the most relevant findings in immunotherapies for AD to help clinician to further consider the possible direction of diagnosis and treatment of AD.

Objective: The present study aimed to examine the mediated moderation effect underlying the association between parental psychological aggression and phubbing, as well as the mediating role of anxiety and moderating role of sex and grade. Methods: Based on a cross-sectional study, a total of 758 Chinese junior high school students had completed measures on socio-demographic characteristics, parental psychological aggression, anxiety and phubbing. Structural equation modeling was adopted to examine the mediating effect of anxiety on the association between parental psychological aggression and phubbing. Multigroup analyses were conducted to explore whether the path coefficients differed by sex and grade. Results: Mediation analysis indicated that anxiety could mediate the association between parental psychological aggression and phubbing. The indirect effect of parental psychological aggression on phubbing via anxiety was 0.12. Multigroup analyses revealed that the higher mediation effect of anxiety was more likely to be reported by boys and students from grade eight. Conclusion Findings of the present study may inform prevention and intervention programs for phubbing in adolescents exposed to parental psychological aggression, by decreasing the anxiety and adopting selective strategies for different sex and grade groups.