The primary curative modality for hilar cholangiocarcinoma is surgery. Some reports suggest that radical resection may provide the best survival rate for patients with hilar cholangiocarcinoma. In resected patients, however, gross or microscopic residual disease is common. Local recurrence is the most common cause of failure and mortality. In the past 10 years, preoperative, intraoperative and postoperative radiotherapy has been used as an adjuvant treatment for these patients. Some studies have proved adjuvant radiotherapy on hilar cholangiocarcinoma may be of value.

Objective To compare the effect of different methods of anesthesia on cerebral autoregulation in patients undergoing neurosurgery.Methods Sixty-nine ASA Ⅱ orⅢ patients with brain tumor, aged 23-62 yr, scheduled for neurosurgery under general anesthesia, were randomly divided into 3 groups ( n = 23 each) : propofol-remifentanil group (group PR), sevoflurane-remifentanil group (group SR) and propofol-sevoflurane-remifentanil group (group PSR) . Anesthesia was induced with target-controlled infusion (TCI) of propofol (target plasma concentration3 μg/ml, PR and PSR groups) or inhalation of 8% sevoflurane (group SR) and iv injection of remifentanil 1 mg/kg and atracurium 0.5 mg/kg. The patients were mechanically ventilated after tracheal intubation. PETCO2 was maintained at 32-35 mm Hg. Anesthesia was maintained with TCI of propofol (target plasma concentration 2.0-3.5 μg/ml) in group PR, with inhalation of 1.5%-2.5% sevoflurane in group SR, with TCI of propofol (target plasma concentration 1.5-3.0 μg/ml) and inhalation of 1% sevoflurane in group PSR, and with TCI of remifentanil (target plasma concentration 2.0-4.5 ng/ml) and iv infusion of atracurium at 6 μg · kg-1 · min-1 in all groups. Auditory evoked potential index was maintained between 40-45. The middle cerebral artery time-average peak flow velocity was recorded before induction (baseline) , immediately after intubation, immediately before craniotomy and at the beginning of skin suture. The unilateral carotid artery was compressed for 7 s at the corresponding time points mentioned above. The transient hyperemic response ratio (THRR) was calculated to reflect cerebral autoregulation. Results Compared with the baseline value at T0, THRR was significantly increased at T2in group PR and decreased at T2,3 in group SR (P <0.05) ,while no significant change was found in THRR at T1-3in group PSR (P >0.05). The THRR was significantly lower in SR and PSR groups than in group PR, and higher in group PSR than in group SR ( P < 0.05). Conclusion Propofol-remifentanil anesthesia can improve cerebral autoregulation, sevoflurane-remifentanil anesthesia can reduce cerebral autoregulation, and propofol-sevofluraneremifentanil anesthesia exerts no effect on cerebral autoregulation in patients undergoing neurosurgery.

Objective To investigate the clinical features,treatment and prognosis of paraneoplastic pemphigus (PNP).Methods A retrospective study was performed on 11 patients with PNP hospitalized in the Department of Dermatology,Ruijin Hospital.Clinical characteristics of these patients were analyzed.Results Of the 11 patients,10 had oral or labial erosions or ulcers,and 6 had obstructive bronchiolitis.Computed tomography (CT)showed solitary internal tumors in all the patients after appearance of skin lesions,and 8 of them were diagnosed with Castleman's disease.All the patients had been treated with corticosteroids before operation,but achieved no obvious improvement.After 2-7 months of postoperative treatment with low-dose prednisone and thalidomide,both cutaneous and mucosal lesions healed with the relief of pulmonary symptoms in 5 patients.Conclusions Oral erosions or ulcers appear to be the most common initial manifestation of PNP with Castleman's disease as the most frequent accompanying tumor.Early detection and timely resection of tumors are keys to successful treatment of PNP,and postoperative treatment with glucocorticoids and thalidomide proves to be effective for PNP.

Objective To investigate the status of clinical using of blood products in Shanghai area,clinicians' understanding on transfusion knowledge and consciousness of prevention of transfusion risk.Methods Two hundreds of clinicians who were randomly selected from level two and above hospitals of Shanghai were inquired by questionnaire.Data including understanding of transfusion techniques,prevention of transfusion risk,application of blood components and grasp of new techniques were collected and analyzed.Results Among all interviewed clinicians,those who realized the importance of transfusion on clinical work,who understood the basic contents of clinical guideline for transfusion issued by Ministry of Health People's Republic of China,and who had the basic knowledge of blood component products and transfusion applications account for 62%,60% and 81% respectively.But only 28% clinicians knew all the side effects,27.3% learned the new techniques of transfusion,including leukocyte reduced,virus elimination,clinical application of irradiation.This investigation also showed 97% clinicians would like to accept training of transfusion,68% thought they need more relevant information about prevention of transfusion risk.Conclusions Clinicians in Shanghai area had the basic knowledge of clinical guideline for transfusion,but some knowledge of transfusion were insufficient including blood components and their applications,side effects and new techniques of transfusion.Clinicians in Shanghai had active response for being trained on knowledge of transfusion.

The method of acupuncture combined with rehabilitation training in the treatment of shoulder hand syndrome after stroke is reliablet, quick, with simple operation and less adverse reactions. Among them, characteristic acupuncture could focus on the targeted points with obvious effect than ordinary acupuncture, and the combination with rehabilitation training could greatly improve the curative effect. However, there still exist some problems in the current research, such as the difficulty of conducting blind clinical trials of acupuncture therapy; the lack of follow-up data in the evaluation of curative effect, the uncertainty of long-term curative effect; the small sample size of clinical research, etc., so multi-centered and large sample RCT research are still needed.

Objective To detect the induction of inducible nitric oxide synthase (iNOS) and nitric oxide (NO) production in immunostimulated retinal pigment epithelial (RPE) cells to seek for the supplying of the arginine, a substrate for NOS; as well as the effects of produced NO on the tight junction of RPE-J cells. Methods Rat′s RPE-J cells were treated with interferon-?(INF-?), tumor necrosis factor-?(TNF-?) and lipopolysaccharide (LPS), and Northern and Western blotting were applied to analyze the expression of the citrulline-NO cycle enzymes and related enzymes and the effect of dexamethasone and cyclic adenosine monophosphate (camp) on the expression of iNOS. Immunocytochemistry reaction and Western blotting were used to evaluate the effect of produced NO on the tight junctions of RPE-J cells. Results iNOS and argininosuccinate synthetase (AS) were highly induced at both mRNA and protection levels in immunostimulated RPE cells while arginiosuccinate lyase (AL) was not induced. NO was produced by cells after stimulation with TNF?, IFN? and LPS. The induction of iNOS mRNA and the production of NO by these immunostimulated cells was further enhanced by cAMP. NO was produced from citrulline as well as from arginine. And the produced NO impaired the tight junction of RPE-J cells, decreased the production of tight junction related protein ZO-1. Conclusion In activated RPE-J cells, citrulline-arginine recycling is important for NO production, and the produced NO weakened the function of tight junction of RPE-J cells.

Objective To investigate the expression and distribution of STAT3 in the retina during the early development of postnatal hamster. Methods Immunocytochemical method and Western blot analysis were used. Results The expression of STAT3 was found in all layers of the retina in all newborn hamsters,most pronounced in the ganglion cell layer(GCL),the inner plexiform layer(IPL)and the inner area of neuroblastic layer(NBL).With the development,the STAT3 immunoreactivity was gradually restricted in the cytoplasm and the nucleus of the retinal ganglion cells.The result of the Western blot showed that the STAT3 was highly expressed in the first week of postnatal development and then reduced gradually till the lowest point in the adulthood.Conclusion The expression of STAT3 protein may be closely related to the early development of the retina in the postnatal hamster.

Objective To study the expression of LRP16 and E-cadherin(E-cad),ER,PR in eutopic endometrium and ectopic endometrium of endometriosis(EM),as well as to study the relation one another and the possible clinical significance.Methods The expression of LRP16 and E-cadherin,ER,PR in endometrium was detected by immunohistochemical two step staining methods in 72 patients with endometriosis which was finally confirmed by laparoscopic operation.Results The expression of LRP16 in epithelioglandular endochylema in eutopic endometrium of EM was significantly higher than that in ectopic endometrium(P

ObjectiveTo assess the degree of pain in elderly patients with mechanical ventilation in ICU using critical-care pain observation tool(CPOT) and to choose the correct sedative and analgesic method.Methods 110 elderly patients in ICU after neurosurgery were divided into three assessment stages,every stage had two record points and total six points (T1-T6):the first stage (intubation and unconsciousness,T1-T2),the second stage (intubation and consciousness,T3T4 ) and the third stage(extubation and consciousness,T5-T6 ).Among them T1,T3and T5were nonnocuity assessment points of every stage,while T2,T4 and T6 were nocuity assessment points of every stage.The assessment time was one minute at every point.After recorded at every point in second and third stages,patients were asked to use the pain intensity descriptive scale (PIDS) themselves.CPOT,heart rate and mean arterial pressure (MAP) from T1 to T6 were recorded as well as PIDS from T3 to T6 in second and third stages.Results In the three stages,CPOT〔(26.8 vs.0.54,3.36 vs.1.20,2.78 vs.0.68) scores〕,HR〔(95 vs.85,94 vs.82,94 vs.84)beat/min〕 and MAP〔(95 vs.85,95 vs.87,94 vs.87)mm Hg〕 at T2,T4and T6 were higher than T1 (t=-42.89,-55.95,-55.38),T3 (t =- 5.52,- 11.33,- 11.78) and T5 ( t =- 5.54,- 9.95,- 11.33 ) ( P＜ 0.05 ).The PIDS at T4 and T6were higher than at T3and T5in the second and third stages 〔(2.52 vs.1.69,2.12 vs.1.44)scores〕 (P＜0.05).The correlation coefficient between CPOT and PIDS at T3 and T4 in the second stage were 0.49 and 0.58,respectively (P＜0.05),and between CPOT and PIDS at T5 and T6 were 0.52 and 0.59 in the third stage,respectively (P ＜ 0.05),and they both reached moderate correlation.ConclusionsCPOT may be an effective way to assess the degree of pain in elderly patients with mechanical ventilation at present.

Objective To compare the effect of sevoflurane and propofol on cerebral metabolism in patients undergoing intracranial aneurysm clipping.Methods Sixty-eight ASA Ⅱ or Ⅲ patients aged 22-62 yr weighing 52-81 kg with Hunt-Hess Ⅱ or Ⅲ undergoing intracranial aneurysm clipping were randomly divided into 2 groups( n =34 each): group propofol(group P) and group sevoflurane (group S).Anesthesia was induced with target-controlled infusion(TCI) of propofol (target plasma concretration 2.0 μg/ml,group P) or inhalation of 8％sevoflurane (group S) and iv injection of remifentanil 0.8 mg/kg and atracurium 0.5 mg/kg.Anesthesia was maintained with TCI of propofol(target plasma concretration 1.5 μg/ml,group P) or inhalation of 2％ sevoflurane (group S) and TCI of remifentanil (target plasma concretration 2.0-3.5 ng/ml) and infusion of atracurium (4μg· kg- 1 · min- 1 ).Samples of dialysate in brain were collected at 5 min before temporary arterial occlusion (T0 ),5 min (T1),10 min (T2 ),15 min (T3) of temporary arterial occlusion,and 10 min (T4),20 min (T5),40 min (T6 ) after cerebral aneurysm clipping for determination of glucose,lactate and pyruvate concentrations.Lactate/pyruvate(L/P) ratio was calculated.Results Compared with group P,the concentrations of glucose,lactate and pyruvate were significantly increased at T1 -06,and L/P ratio was decreased at T2-T4 in group S( P ＜ 0.05).The glucose concentration was significantly lower,and lactate concentration higher at T1 -T6,pyruvate concentration was lower at T1 -T4,and higher at T5 and T6,and L/P ratio was higher at T1 -T5 in both groups than that at T0 ( P ＜0.05).The concentrations of glucose and pyruvate were higher and L/P ratio was lower at T4-T6,and lactate concentration was lower at T5,T6 in both groups than that at T3 ( P ＜ 0.05).Conclusion Compared with propofol,sevoflurane can better improve cerebral metabolites in patients undergoing intracranial aneurysm clipping.