The prognosis of hepatocellular carcinoma (HCC)is poor,and tumor thrombus in the portal vein or in the bile duct is an important influencing factor.Approximately 30%of HCC patients are found to have portal vein tumor thrombus (PVTT)when diagnosed,and their median survival time is about 2.7-4.0 months if they do not receive any treatment.The incidence of HCC complicated with bile duct tumor thrombus (BDTT)is less than 10%,while the prognosis is dismal.Once tumor thrombus extends to the major bile ducts,obstructive jaundice and subsequent hepatic dysfunction are inevitable.The survival time of patients with HCC complicated with BDTT is less than 4 months if they only receive palliative biliary stenting.The management of HCC complicated with PVTT or BDTT is challenging with controversy at present.Different treatment approaches and their benefits for patients with HCC complicated with PVTT or BDTT are introduced in this paper.

The management of hilar cholangiocarcinoma was challenging to the surgeons due to difficult operations and low resection rate.Recently,a new mode of multidisciplinary team (MDT) is applied to the diagnosis and treatment of hilar cholangiocarcinoma,which leads to significant changes and development of the diagnosis and treatment for hilar cholangiocarcinoma.In this article,the authors first introduced the recent application of MDT treatment for hilar cholangiocarcinoma on diagnostic methods,staging systems,evaluation for resectability,radical resection,application of liver transplantation and other systematic therapies.Considering the complexity of hilar cholangiocarcinoma,a surgery-centered MDT for hilar cholangiocarcinoma is important and should be promoted.

Translational medicine is a new concept in China.It sets up a bridge between basic research and clinical work,and aims to transfer the basic study results to clinical practice as soon as possible.It is necessary for a surgeon to master the research idea of translational medicine in order to be expert in science and technique.Many unsolved clinical problems could be found in routine work,which is an advantage for translational medicine research.How to raise questions in routine clinical work and get these questions resolved in laboratory,and then apply the results to clinical work is a demand for surgeons nowadays.In this article,the research idea of translational medicine is introduced based on an example of the research on the relationship between rapamycin and hepatocellular carcinoma.

Objective Misdiagnosis of benign hepatic mass as malignancy is not infrequent. This study was to improve the clinical diagnosis by reviewing our clinical data for space occupying hepatic lesions. Methods In this study 545 patients undergoing hepatic resection for suspected malignant hepatic lesions were retrospectively studied from Jan 1998 to Jun 2004. All patients were pre-operatively assessed with plasma tumor makers, ultrasonography, computed tomography or magnetic resornance imaging. Percutaneous liver biopsy was employed in selected patients. Final pathological data was reviewed to evaluate preoperative diagnosis. Results Twenty-four out of 545 patients were pathologically diagnosed as with benign lesion. Preoperative misdiagnosis involved atypical radiological characteristics, incomprehensive clinical data and inexperienced recognition for liver lesions. Two of 24 cases suffered from minor post-operative complications, and there was no mortality. No recurrence was found by a mean follow-up of 3 years and 1 month. Conclusions Some benign hepatic lesions are easily misdiagnosed as malignant tumor. Appropriate use of multimodality examination in combination with correct algorithm of diagnostic protocol could improve diagnostic accuracy in cases of benign solid space occupying lesions of the liver.

Hepatolithiasis is still a common biliary disease in China with unknown pathogenesis and poor long-term outcomes.Surgery is probably the only curative treatment to hepatolithiasis.However,surgeons and patients cannot keep trouble from high recurrence and reoperation rates after surgery.Hepatolithiasis is a serious disease,which can cause cholangitis,liver abscess,liver cirrhosis,and even cholangiocarcinoma.Sphincter of Oddi,which controls the unidirectional outflow of bile and separates the bile duct from the bacteria-filled intestinal tract,is thought to be a gatekeeper of the almost-sterile biliary tract.Dysfunction of sphincter of Oddi,including stenosis,spasm and laxity,is closely associated with biliary disease,A lax sphincter of Oddi will aggravate bilioenteric reflux,leading to biliary infection and calculi development eventually.This issue has gradually gained enough attention.How to evaluate sphincter of Oddi function reliably and restore or replace its function,which is key to treat hepatolithiasis and prevent its recurrence,remain unclear.

Pancreatic adenocarcinoma is a highly lethal disease with a high morbidity and dismal prognosis.A multidisciplinary consultation based on evidence-based medicine has become the main modality for treatment of pancreatic adenocarcinoma.National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology has been widely recognized and implemented.Recently,the guidelines (version 1.2017) in oncology have been published by NCCN.This article will summarize and interpret the updates of the new version of the NCCN guideline for pancreatic adenocarcinoma.

OBJECTIVE To investigate the biological and molecular biological characteristics of Klebsiella pneumoniae in burn patients in order to give the first hand information for preventing and controlling of hospital acquired infections.METHODS The identification was done by Bio-Merieux ATB expression.Antimicrobial susceptibility test was performed with K-B method.The plasmid DNA was extracted by Alkaline Lysis,and separated by electrophoresis on the gel.The ESBLs detection was based on NCCLS.RESULTS The K.pneumoniae from the burn patients and the environment were sensitive to CIP,FOX and IPM,but showed resistance to the rest 12 antibiotics.The plasmid DNA profile analysis showed 3 types,and the relative molecular mass was approximately 4.7?106,3.6?106 and 2.0?106.The molecular biological characteristics showed these pathogens were ESBLs-producing K.pneumoniae,which was different from the control bacteria.At the same time,the pathogens caused the original infection were detected,and they were accordingly Staphylococcus aureus,Streptococcus pyogenes,and Pseudomonas aeruginosa.CONCLUSIONS The outbreak in burn patients is caused by ESBLs-producing K.pneumoniae,which has the same antibiotic resistance spectrum and plasmid DNA profile.This ESBLs-producing K.pneumoniae has the same origin.The pathogen might be transmitted by the case history clips and the door knobs.It was suggested that something must be done to enhance the antisepsis administration in order to prevent the hospital acquired infection.

OBJECTIVE To investigate the bacterial distribution and the extent of drug resistance in ICU patients,and offer the first-hand information to the clinical preventive and therapeutic countermeasures. METHODS The antimicrobial susceptibility tests to 28 commonly used antibiotics were performed using the ATB Expression of Bio-Merieux with K-B method.The ESBLs were detected by the disk diffusion tests and the confirmatory tests,and the MRSA,MRCNS,and VRE were also tested at the sametime. RESULTS Totally 264 strains were isolated from the 201 positive samples,among them 192 strains were Gram-negative bacteria,43 strains were Gram-positive ones,and 29 strains were fungi.The percentage of these three groups were 72.7%,16.3% and 11.0%,respectively.The main strains of the Gram-negative bacteria were PAE,ABA,KPN,ECO and SMA,and of the Gram-positive bacteria were EC,SAU and CNS.The major strain of fungi was C.albicans.The pathogens tested showed high drug resistance.The Gram-negative bacteria showed tendency of sensitivity to IPM,AZT,CAZ,FEP,SFC,AMK and CIP,and the Gram-positive bacteria to VAN,SXT,RIF and NIF.For KPN and ECO,the percentage of strains producing ESBLs were 64.7% and 64.3%.And the percentage of MRSA,MRCNS,VRE were 80%,66.7% and 22.2%,respectively. CONCLUSIONS It was showed that the major pathogens infected the ICU patients are Gram-negative bacteria,and the pathogens show the high drug resistance.Doctors should pay more attention to analyze the bacterial resistance profile in order to decrease the incidence of drug resistance and use the antibiotics properly.

Objective To study the inhibitory effect of miR-199a on bladder cancer.Methods T24 bladder cancer cells were divided into control group, pre-scamble group and pre-miR-199a group according to different treatment.Cell proliferation was assayed by MTT, cell apoptosis and cell cycle by flow cytometry, and cell invasion by Transwell.ResuIts The OD value of pre-miR-199a group (0.436 ±0.042) was significantly lower than that of control group (0.634 ±0.020) and pre-scamble group (0.601 ±0.059)(P<0.05).Cell apoptosis of pre-miR-199a group(19.25 ±1.57)% was higher than that of control group(10.19 ±0.98)% and pre-scamble group(12.27 ±1.38)%(P<0.05).The cell ratio in G1 phase of control group、pre-scamble group and pre-miR-199a group was 45.09%, 47.57%, and 58.62%, respectively.The cell cycle arrested in G1 phase after transfected with pre-miR-199a.The cells migration number of pre-miR-199a group (46.00 ±1.58) was lower than those of control group(67.00 ±1.58) and pre-scamble group(61.20 ±1.30)(P<0.05).ConcIusion MiR-199a could inhibit the growth of bladder cancer cells.

Pancreatic cancer is a highly malignant tumor with a high mortality.Surgery is the only potential hope of cure for patients with pancreatic cancer.Imaging examination plays an essential role in both the early diagnosis and preoperative assessment.Accurate tumor staging has guiding significance for clinical practice.Appropriate therapeutic schedule will be selected according to the tumor staging,and then patients' prognosis can be evaluated.Recently,the TNM staging systems for pancreatic cancer have been updated by American Joint Committee on Cancer (AJCC).Major changes were made in the T and N staging.This article will review the updates of the 8th edition of AJCC cancer staging for pancreatic cancer from radiography aspect.