Objective: To investigate the role of intraoperative ultrasound(IOUS) and appropriate approach in local resection for the central small hepatocellular carcinoma(sHCC) which is deeply situated within the parenchyma and adjacent to the hepatic veins. Methods: under IOUS guidance, local resection was carried out for 8 cirrhotic patients with central sHCC which was deeply located and adjacent to hepatic veins by approach of splitting or unroofing superficial hepatic parenchyma. Results: All tumors were precisely localized by IOUS and excised successfully. Except for injury to central hepatic vein in 1 case, no other injury occurred to the hepatic veins in the remaining 7 cases. There was no postoperative mortality, and the liver function recovered well in all cases postoperatively. Conclusion: Local resection by using IOUS and appropriate approach is applicable for the cirrhotic patients with deeply located central sHCC. IOUS plays an important role in avoidance of injuries to the hepatic veins.

Objective To study the management of enterostomy in children.Methods The clinical data of 425 cases of enterostomy in children were analyzed retrospectively.Results The primary diseases of 425 cases underwent enterostomy included:intestinal perforation(119 cases),intestinal necrosis(36 cases),necrotizing enterocolitis(45 cases),congenital megacolon(61 cases),congenital anal atresia with rectourethral fistula(86 cases),and congenital anal atresia with rectovaginal fistula(78 cases).Among the 425 cases,159 cases underwent small bowel enterostomy and 266 cases had colostomy;single-stoma enterostomy was done in 225 cases,and double-stoma enterostomy in 197 cases.Follow-up was acquired in 389 patients,and all the stomas were closed successfully.The closure time of small bovvel enterostomy was 1-3 month(ayerage 1.87 months)later,and of colostomy was 3-12 month(averag 4.95 months)later.Conclusions When an enterostomy is to be adopted in pediatric surgery,a suitable time and enterostomal location should be chosen according to the state of illness.The timing of enterostomy closure is also very important.

Objective To investigate the value of multiple sequential MRI in the differential diagnosis of vater ampulla carcinoma (VPC).Methods MRI data of 53 patients with VPC confirmed by surgery and pathology were analyzed retrospectively,which included 17ampullary carcinomas,15 pancreatic head carcinomas,10 duodenal papillary carcinomas and 11 distal common bile duct carcinomas.All patients underwent routine MRI plain scan,MRCP and multi-phase dynamic enhancement scan for the upper abdomen.The morphological characteristics and model of multi-phase dynamic enhancement of the tumor,and the morphological changes of pancreaticobiliary duct were focused,and relevant data were also measured.Results The differences of tumor size,central location,and signal homogeneity among the four different histological types showed statistical significance(P＜0.05),and their patterns of multi-phase dynamic enhancement also had differences.Double-segment sign was most found in VPC (26/53),four-segment sign was easy showed in pancreatic head carcinoma (8/15)and three-segment sign in distal common bile duct carcinoma (8/11).Beak sign was common seen in ampullary carcinoma(10/17),rat-tail sign was easy discovered in pancreatic head carcinoma (7/15) and truncated sign in distal common bile duct carcinoma(10/11).Diameter of major pancreatic duct in pancreatic head carcinoma was maximum and minimum in distal common bile duct carcinoma,and their difference had statistical significance(P＜0.05).Distance between obstructive end of bile common duct and major papilla of duodenum,and between obstructive end of major pancreatic duct and major papilla of duodenum as well as the pancreaticobiliary conjunction angle in pancreatic head carcinoma and distal common bile duct carcinoma were greater than that in ampullary carcinoma and duodenal papillary carcinoma.Conclusion MRI can prominently demonstrate various imaging characteristics of VPC with different histological origins.It is very valuable in the differential diagnosis of VPC with different histological types by comprehensive analysis of these findings.

Objective To investigate the expression of DNA methyltransferases (DNMTs) in liver cancer and its clinical significance. Methods The specimens of liver cancer tissues, adjacent tissues, cirrhotic tissues and chronic hepatitis tissues were collected from 50 patients who received radical resection at the First Affiliated Hospital of Sun Yat-Sen University from July 2007 to April 2008. The mRNA and protein expressions of DNMT1,DNMT3a and DNMT3b in liver cancer tissues, adjacent tissues, cirrhotic tissues and chronic hepatitis tissues were detected by real-time quantitative PCR and immunohistochemical staining. The mRNA expression of DNMTs in the liver cancer tissues was compared with those in the adjacent tissues, cirrhotic tissues and chronic hepatitis tissues by using t test and Mann-Whitney U test. The correlation between the protein expression of DNMTs in the liver cancer tissue and the clinicopathological features was analyzed by chi-square test or Fisher exact test, and the tumor-free survival time was analyzed by using Kaplan-Meier method and the difference in tumor-free survival rate between different patients was analyzed by Log-rank test. Results The mRNA expressions of DNMT1, DNMT3a and DNMT3b in the liver cancer tissue were 2.57, 2.29 and 4.86 times higher than those in the adjacent tissues (t = 3.94, 2. 72, 4. 06, P ＜ 0.05 ). The mRNA expressions of DNMT1, DNMT3a and DNMT3b were 2.38,2.14 and 4.66 times higher than those in the cirrhotic tissues, and 6.12, 4.58 and 12.99 times higher than those in the chronic hepatitis tissues. The mRNA expressions of DNMT1, DNMT3a and DNMT3b in the liver cancer tissue were significantly higher than those in the cirrhotic tissues and chronic hepatitis tissues ( U = 587.5,730. 0,562.5; 65.5, 64.5, 71.0, P ＜ 0.05). The protein expression of DNMT1 was correlated with the size, number,TNM stages and vascular invasion of tumors ( x2 = 4.08, 5.95, 4.08, P ＜ 0.05 ). The protein expression of DNMT3a was correlated with the size, number and TNM stages of tumors (x2 = 4.08, 5.95, 4.08, P ＜ 0.05 ).The mean tumor recurrence time of patients with low expressions of DNMT1 and DNMT3a were 9.4 and 8.7 months, which were significantly longer than 5.0 and 3.2 months of those with high expressions of DNMT1 and DNMT3a (x2 =3.89, 9.91, P＜0.05). Conclusions DNMTs play an important role in hepatocarcinogenesis.High expressions of DNMT1 and DNMT3a are correlated with the postoperative recurrence of liver cancer, which are valuable prognostic factors for liver cancer.

Objective To evaluate risk factors of hepatectomy for patients with large hepatocellular carcinoma (HCC). Methods Clinical data of 310 large HCC cases receiving hepatctomy were analyzed retrospectively. Results Hepatitis B infection rate was 60.7% in this group with cirrhosis rate of 66.8%. Tumor size averaged at (9.4?3.8) cm in diameter. Child A grade was found in 51.0% of cases, Child B in 36.8% and Child C in 12.3%. Pringle′s procedure, semi-liver blood occlusion and modified Heaney procedure were used in 31.6%, 11.0% and 2.3% of cases respectively, with occlusion time of ( 17?8) min, (25?9) min and (20?10) min, respectively. Left lateral lobectomy, left hemihepatectomy, right hemihepatectomy and segmentectomy were performed in 17.1%, 11.6%, 9.0%, and 62.3% cases, respectively. Blood loss, blood transfusion and operation duration were (820?1 151) ml, (966?945) ml and (182?74) min, respectively. The overall morbidity and liver failure were 22.3%, and 5.8%, respectively, with an operative mortality of 2.6%. The univariate analysis for liver failure revealed its risk factors being preoperative AST value(P

Objective To analyze the clinical risk factors of type 2 diabetes complicated with cerebral infarction .Methods 508 patients with type 2 diabetes were selected and divided into two groups :group A (complicated with cerebral infarction ,n=240) and group B (without cerebral infarction ,n=268) .The basic clinical information of two groups were recorded .The coagulation indica‐tors and biochemical indicators (including blood glucose ,blood lipid ,HbA1c ,blood β2 microglobulin ,urineβ2 microglobulin ,urine microalbuminuria ,fasting insulin ,fasting C peptide etc) were detected respectively .Results There were significant differences in age ,age at onset of diabetes ,duration of hypertension and systolic blood pressure between group A and group B (P<0 .05) .The in‐cidence of hypertension and coronary heart disease in group A were higher than group B (P<0 .05) .Comparing with group B ,the levels of HbA1c ,ApoB ,fasting insulin ,fasting C‐peptide ,lipoprotein (a) ,Hcy ,blood β2 microglobulin ,urineβ2 microglobulin ,and urine microalbuminuria of group A were significantly different (P<0 .05) .The ATⅢ level of group A was significantly lower than that of group B (P<0 .05) .Conclusion The risk factors of type 2 diabetes complicated with cerebral infarction include age ,hyper‐tension ,HbA1c ,ApoB ,fasting insulin ,fasting C‐peptide ,lipoprotein (a) ,Hcy ,etc make diabetics be more prone to cerebral infarc‐tion ect .

Objective To evaluate the application of 64-slice computed tomography (CT) and software-assisted image analysis in preoperative evaluation and surgical planning of hilar cholangiocarcinoma. Methods The clinical data of six patients with hilar cholangiocarcinoma who were admitted to The First Affiliated Hospital of Sun Yat-sen University from June to December, 2009 were retrospectively analyzed. All six patients underwent 64-slice CT scanning before the operation, and then three-dimensional (3D) reconstruction of the liver, tumor, blood vessels and bile ducts was achieved with the assistance of Myrian (R) XP-Hepatic software. The relationships of the tumor, blood vessels and bile ducts were illustrated in the 3D model. Virtual liver resection was carried out for surgical planning. Results The 3D models of the liver, tumor, blood vessels and bile ducts were successfully constructed . The 3D models were able to be rotated and magnified as necessary. Preoperative evaluation and surgical planning were in accordance with actual surgery. The relative accuracy of the software-assisted image analysis system for calculating the hepatic volume to be resected was 5%. Patients recovered well without occurrence of hepatic failure. Conclusion Sixty-four-slice CT scanning and software-assisted image analysis are important for preoperative evaluation and surgical planning of hilar cholangiocarcinoma.

Objective To investigate the expression and clinical significance of ABCG2 protein in hepato-cellular carcinoma (HCC). Methods Specimens of HCC were collected at The First Aifiliated Hospital of Sun Yat-sen University from January 2005 to December 2006. The expression of ABCG2 protein in 165 samples of HCC tissue, 25 samples of normal liver tissue and 40 samples of cirrhotic liver tissue was detected using immunohisto-chemistry. The correlation between the expression of ABCG2 protein and clinicopathological characters was then analyzed. Enumeration data, survival rate and the difference between groups were analyzed with a chi-square test, the Kaplan-Meier method and Log-rank test, respectively. Results ABCG2 protein expression was weakly posi-tive in all normal and cirrhotic liver tissues. In HCC tissues, the expression of ABCG2 protein was strongly positive in 66 cases and weakly positive in 99 cases. The expression of ABCG2 protein was related to tumor diameter, tumor number, adjacent organ invasion and TNM stages (χ2 =8. 130, 14. 279, 4. 820, 21. 179, P <0. 05). Kaplan-Meier survival analysis revealed that patients with strongly positive ABCG2 protein had a significantly lower 3-year overall survival (24. 1%) compared with those with weakly positive ABCG2 protein (39. 4%) (χ2 = 15.716, P<0.05). Conclusions The expression level of ABCG2 protein is related to tumor invasiveness, TNM stage and prognosis. ABCG2 has the potential to become a new target for HCC treatment.

AIM: To investigate the homing effect of immature dendritic cells (iDC) after injection of iDC into the mouse hepatoma treated by microwave ablation and the possibility of stimulating tumor immunity after thermal ablation. METHODS: The model of hepatoma was established with Hepa 1-6 cells injected into the subcutaneous tissue of C57BL/6J mice. The tumors were treated by microwave ablation under different temperatures, and then fluorescent-labeled iDCs (PKH26-DC) were injected into the ablated tumor tissues. The influences of ablation to homing of PKH26-DC, maturation and excitation ability towards T-cell were observed. RESULTS: There were no homing PKH26-DCs and expression of CCR7 in draining lymph nodes in (65?5)℃ and (90?5)℃ ablation groups after intratumoral injection of iDCs. The number of homing PKH26-DCs was 32?8 in (50?5)℃ ablation group vs 21?6 in un-ablated group, and the expression rate of CCR7 was 100% vs 90%. The number of clusters with immunological synapsis was 8-12 in (50?5)℃ ablation group vs 4-6 in un-ablated group under 100-magnification visual field, and the number of lymphocytes in each cluster was 12-25 vs 3-10. CONCLUSION: Thermal ablation of hepatoma under an appropriate temperature level may promote maturing and homing of iDCs and stimulate immunity of lymphocytes.

Objective:To improve the radiologic diagnostic and treatable rate of mannmmary ductal diseases.Methods:We retrospectively analyzed the galactographic materials of 369 cases.Results:The mammary ducts were classified into 4 types according to their morpholgy,including general fruticoses,multiple fruticoses,less fruticoses and single fruticoses.In this group,the multiple and less fruticoses were the most common,the general and single fruticoses were the less.Conclusion:Understanding radiologic anatomy of mammary duct is very valuable in the diagnosis and treatment of mammary ductal diseases. [