Surgical resection remains the only curative option of treatment for hepatocellular carcinoma,but centrally located tumors remain problematic.Extended right or left hepatectomy removes 60％ to 85％ of the hepatic parenchyma and is associated with more hepatic failure.Mesohepatectomy,resection of central hepatic segments (Couinaud's segments Ⅳ,Ⅴ,Ⅷ) and leaving the right and left segments in situ,preserves more functional hepatic tissues than extended hepatectomy.Despite its technical demands,mesohepatectomy should be considered as an alternative treatment for central huge hepatic tumors.

Intrahepatic bile duct stones located at the upper part of the hepatic duct.The percentage of intrahepatic biliary cholesterol calculus is increasing in recent years,and the incidence of this type of bile duct stones is free from infection or obstruction.The formation of intrahepatic bile duct stones might not only related to the micro-environment changes in the biliary tract,but also related to the changes of metabolic function of hepatocytes or cholangiocytes.In this article,the mechanism of biliary hydrodynamics on the formation of intrahepatic bile duct stones was reviewed.

Objective To detect the levels of the mRNA expression of TIM-3,TIM-1,T-bet,GATA-3,IFN-γ,IL-4 and Galectin-9 in the peripheral blood monocytes (PBMCs) of the patients with Graves disease(GD),and to explore their potential role in the pathogenesis of GD.Methods We used fluorescence quantitative real-time reverse transcription-polymerase chain reaction to measure the mRNA expression of TIM-3,TIM-1 and other associated genes in PBMCs of 70 patients with GD and 22 healthy controls.In addition,we analyzed the relationship of TIM-3,TIM-1 and other associated genes.Results The expression of TIM-3 and TIM-1 mRNA in the PBMCs from GD patients were abnormally higher,the GD patients with Graves' ophthalmopathy group had significantly higher level of TIM-3 mRNA expression than that of GD patients without Graves' ophthalmopathy group,but no statistically significant difference was found in the expression of TIM-1 mRNA.Untreated GD patients had significantly higher level of TIM-3 mRNA expression than that of GD patients in recurrence group,however the expression of TIM-1 mRAN was opposite.But no statistically significant difference was found in TIM-3 mRNA expression of recovery GD patient and healthy control group.Though the expression of TIM-1 mRNA was significantly decreased,it was still higher than that of the normal control group.Conclusion TIM-3 and TIM-1 may participate in the occurrence,development and turnover of GD.TIM-3 or TIM-1 may prove to be an important target for developing new drugs and treatments to GD.

Objective:To investigate the impact of self-concealment,self-disclosure,coping style and per- ceived social support on university students'loneliness.Methods:Loneliness and related factors were assessed among 482 university students using scales including UCLA Loneliness Scale,Self-concealment Scale(SCS),Self-disclosure Index(SDI),Simplified Coping Style Questionnaire(SCSQ)and Perceived Social Support Scale(PSSS).Results: The level of university students'loneliness was not high(36.5?7.4);males experienced more loneliness than fe- males(37.4?7.5/35.4?7.3,F=8.25,P0.05). Regression analysis showed that SCS,SCSQ and PSSS predicted UCLA effectively(?=0.207,-0.218,0.157, -0.380).The testing of mediating effect indicated that SCS had direct and indirect impact on UCLA through nega- tive coping style and PSSS;SDI had only indirect impact on UCLA through positive coping style and PSSS.Conclusion:SCS,SDI,SCSQ and PSSS are important factors influencing UCLA,and the intervention of univer- sity students'loneliness should focus on these variables.

Objective To investigate the levels of the mRNA expression of TIM-3 and Galectin-9 in peripheral blood mono-cytes (PBMCs)of acute exacerbation asthma patients and their clinical significances.Methods 60 patients with acute exac-erbation asthma (eliminating 15 cases of non-conform to the regulations)and 30 cases of healthy subjects were collected from January to October of 2014.Used fluorescence quantitative real-time reverse transcription-polymerase chain reaction to measure the mRNA expression of TIM-3 and Galectin-9 in PBMCs of patients with asthma and healthy controls.Results The expression of TIM-3,Galectin-9 and IFN-γmRNA in the PBMCs from acute exacerbation asthma patients were all ab-normally higher than healthy controls (U =458.5,P =0.019;U =437.5,P =0.010;U =260,P <0.001).There were statis-tically significant differences between them.Conclusion TIM-3/Galectin-9 pathway may participate in the occurrence,devel-opment of asthma.TIM-3 or (and)Galectin-9 may prove to be an important target for treatments to asthma.

Objective To assess the efficacy and safety of drug therapy alone and stenting for symptomatic intracranial atherosclerotic stenosis (sICAS) in order to provide the best evidence for clinical practice.Methods PubMed,EMbase,Cochrane Library,CBM,CNKI,and Wanfang database were retrieved.The randomized controlled trials (RCTs) on the efficacy and safety of drug therapy and stent-assisted therapy for sICAS were enrolled.The RevMan 5.3 software was used for the meta-analysis.Results A total of 6 RCTs and 782 patients were enrolled.The results of meta-analysis showed that there were no significant differences in stroke or death (odds ratio [OR] 1.61,95％ confidence interval [CI] 0.89-2.91;P=0.12) and fatal stroke within l year (OR 1.60,95％ CI 0.96-2.67,P=0.07) between the stenting group and the drug therapy group.The risks of symptomatic intracerebral hemorrhage (OR 9.51,95％ CI 2.89-31.29;P＜0.01) and any stroke or death (OR 2.15,95％ CI 1.21-3.82;P＜0.01) in the stenting group were higher than those in the drug therapy group.The subgroup analysis showed the risks of any stroke or death within 30 d in the stenting group were significant higher than those in the drug therapy group (OR 2.94.95％ CI 1.55-5.60;P ＜0.01),and there were no sig-nificant differences in anv stroke or death within 1 year (OR 1.90,95％ CI 0.50-7.61;P=0.35) and 2 years (OR 1.38,95％ CI 0.91-2.08;P=0.13);the risks of symptomatic intracerebral hemorrhage within 30 d (OR 10.15,95％ CI 1.92-53.64,P ＜0.01) and within 1 year (OR 8.80,95％ CI 1.60-48.25,P =0.01) in the stenting group were higher than those of the drug therapy group.Conclusions The risks of symptomatic intracerebral hemorrhage and any stroke or death in the stenting group were significantly higher than those in the drug therapy group,therefore,the preferred stenting was not recommended in patients with sICAS.However,stenting still can be considered in patients who failed regular drug therapy and who may benefit greater from stenting.

Objective:To investigate the clinical efficacy of pancreaticodudenectomy (PD) using anterior approach in situ technique for pancreatic head cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 285 patients with pancreatic head cancer who were admitted to the First Affiliated Hospital of Kunming Medical University from January 2012 to June 2018 were collected. There were 164 males and 121 females, aged from 40 to 76 years, with an average age of 57 years. Of the 285 patients, 196 patients who underwent PD using anterior approach in situ technique were set as anterior approach group, 89 patients who underwent PD using traditional approach were set as traditional approach group. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was performed by outpatient examination, telephone or network interview once every 2 to 3 months to detect tumor recurrence, metastasis and survival of patients up to December 2018. The endpoint of follow-up was death of patients, and the secondary endpoint of follow-up was tumor recurrence or metastasis. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed by the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed by the Mann-Whitney U test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed by the chi-square test. Kaplan-Meier method was used to draw the survial curve and calculate the survival rates. Survival analysis was done by the Log-rank test. Results:(1) Surgical situations: 285 patients underwent surgery successfully. Cases with pylorus-preservaction, cases with superior mesenteric vein/ portal vein (SMV/PV) resection and reconstruction (end to end anastomosis, artificial vascular replacement, lateral wall resection and anastomosis), operation time, volume of intraoperative blood loss were 118, 37 (17, 11, 9), (303±107)minutes, 350 mL(range, 100-750 mL) in the anterior approach group, and 48, 9 (7, 1, 1), (335±103)minutes, 400 mL(range, 100-900 mL) in the traditional approach group, respectively, showing no significant difference between the two groups ( χ2=0.990, 3.474, t=0.722, Z=1.729, P>0.05). (2) Postoperative situations: the rate of R 0 resection, the number of lymph node dissected, the number of positive lymph node dissected, rate of nerve invasion, rate of vascular invasion, cases with postoperative severe complica-tions, the number of perioperative death, cases with postoperative chemotherapy were 93.88%(184/196), 12(range, 5-19), 4(range, 0-15), 45.41%(89/196), 31.12%(61/196), 28, 3, 69 in the anterior approach group, and 85.39%(76/89), 7(range, 4-17), 5(range, 0-13), 32.58%(29/89), 23.60%(21/89), 11, 2, 41 in the traditional approach group, respectively. There were significant differences in the rate of R 0 resection, the number of lymph node dissected, rate of nerve invasion between the two groups ( χ2=5.506, Z=4.637, χ2=4.149, P<0.05), while there was no significant difference in the number of positive lymph node dissected, rate of vascular invasion, cases with postoperative severe complications, the number of perioperative death, cases with postoperative chemotherapy between the two groups ( Z=0.052, χ2=1.962, 0.192, 0.001, 3.048, P>0.05). (3) Follow-up: of the 285 patients, 252 and 228 achieved the secondary endpoint and the endpoint of follow-up respectively with the follow-up time of 35 months (range, 6-58 months). There were 181 and 176 of 196 patients in the anterior approach group achieving the secondary endpoint and the endpoint of follow-up respectively with the follow-up time of 38 months (range, 6-58 months). There were 71 and 52 of 89 patients in the traditional approach group achieving the second endpoint and the endpoint of follow-up respectively with the follow-up time of 33 months (range, 7-53 months). The median tumor free survival time and median overall survival time were 31 months and 37 months in the anterior approach group, respectively, versus 24 months and 31 months in the traditional approach group. There was a significant difference in the tumor free survival between the two groups ( χ2=7.646, P<0.05), while no significant difference in the overall survival between the two groups ( χ2=3.265, P>0.05). Conclusion:PD using anterior approach in situ technique is safe and feasible for pancreatic head cancer, which can improve the rate of R 0 resection and prolong the tumor free survival time of patients.

Primary intrahepatic stones (PIS) is a refractory disease with a high incidence rate in southwest China, and some patients still require surgery again or even more times after initial treatment. Many studies in recent years have shown that some specific flora can colonize in the intrahepatic bile duct, leading to chronic infection and inflammation of the biliary system, and these specific types of flora, called "stone-causing flora", can produce metabolites such as β-glucuronidase and play an important role in the formation of pigmented stones. This article analyzes the role of stone-causing flora in the pathogenesis of PIS, so as to provide more treatment options for PIS patients.

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.