Biliary tract infection is the most commonly seen severe complication of malignant obstructive jaundice (MOJ)with a high mortality rate. Bile bacterial infection in MOJ patients is related with a variety of clinical factors and the therapeutic approaches including surgical operation,ERCP and percutaneous transhepatic cholangial drainage( PTCD). Bile bacterial culture combined with drug sensitivity test is of great importance for selection of optimal antibacterial agents. In this article,the related factors,current status of therapeutics,biliary bacterial spectrum and drug sensitivity in MOJ with biliary tract infection were reviewed for defining the clinical indicators and guiding the use of antibacterial agents.

Based on a study of children’s behavior and psychological characteristics,the article introduced Maslow’s hierarchy of needs to discuss children’s special needs for medical environment.Hence the authors proposed to meet children’s physiological needs,security needs,social needs,esteem needs,and self-realization needs.Shanghai Children’s Hospital was cited as an example,to present the humanistic expression practices in designing children’s medical environment.

Objective To investigate the risk factors of spontaneous rupture of BCLC stage A and stage B hepatocellular carcinoma (HCC),and to review the surgical outcomes.Methods From April 2002 to November 2006,89 patients who suffered from spontaneous rupture of HCC of BCLC stage A and stage B were included into this study.A control group of 171 patients was selected by matching the sex,age and BCLC stage.Clinical data and survivals were collected and analysed.Results On multivariate analysis,hypertension (HR 7.38,95％CI:1.91 ～28.58,P＜0.05),cirrhosis (HR6.04,95％ CI:2.83 ～12.88,P ＜ 0.05) and tumor location in segments Ⅱ,Ⅲ,Ⅵ (HR 5.03,95％ CI:2.70 ～ 6.37,P ＜ 0.05) were predictive factors of spontaneous rupture of HCC.In the study group,the median survival and median disease-free survival were 12 months (range,1 ～ 78 months) and 4 months (range,0 ～ 78 months) respectively.The overall survival rates and disease-free survival rates at 1-,3-and 5-year were 66.3％,23.4％,10.1％ and 57.0％,16.8％,4.5％,respectively.Only radical resection remained predictive of overall survival (HR 0.32,95％ CI:0.08 ～ 0.61,P ＜ 0.05) and disease-free survival (HR 0.12,95％ CI:0.01 ～ 0.73,P ＜ 0.05).Conclusions Tumor location,as well as hypertension and cirrhosis were associated with spontaneous rupture of HCC.One-stage hepatic resection should be recommended to patients with ruptured HCC of BCLC stage A and stage B.

Objective To investigate the appropriate cutoff point of CA19-9 in prognosis and to determine other potential prognostic factors which may affect survival of patients with hilar cholangiocarcinoma (HC) after radical surgery.Methods 168 patients who had undergone radical surgery for hilar cholangiocarcinoma with R0 and R1 resection were selected for the study.Categorized versions were used in univariate model to determine the appropriate cutoff point of CA19-9.CA19-9 and other clinicopathologic factors were analyzed for their influence on survival using multivariate methods.Results The strongest univariate predictor among the categorized preoperative CA19-9 measures was CA19-9 of less than 150 IU/L (P ＜0.001).On univariate analysis,age,differentiation,tumor size,Bismuth-Corlette classification,portal vein invasion,lymph node metastasis,hepatic artery invasion,liver invasion,preoperative biliary drainage,resection margin and preoperative CA19-9 levels were identified as significant prognostic factors.On multivariable analysis,lymph node metastasis,resection margin and preoperative CA19-9 levels were independent prognostic factors of survival.Conclusions A raised preoperative CA19-9 level was an independent prognostic factor of survival for hilar cholangiocarcinoma.The most discriminative cutoff point of CA19-9 for prognosis was at 150 kU/L.

Objective To investigate the natural history and growth pattern of hepatic hemangioma in adults.Methods From April 2010 to March 2013, adult patients with hepatic hemangioma who had no prior treatment were enrolled.A routine follow-up was performed to observe the natural history and complications of these lesions.Results 236 patients were enrolled in the study.The median size of the hemangiomas was 4.5 cm (range 0.6 ～ 19.2 cm).During a median follow-up of 48 months (range 3 ～ 266 months), the hemangiomas increased in size in 61.0％ of patients, remained stable in size in 23.7％, decreased in size in 8.5％.The peak growth period was in patients ＜ 30 years age (0.46 ± 0.41 cm/year) and the growth rate decreased significantly after 50 years of age (0.21 ±0.40 cm/year).Hemangiomas with a size ＜2.0 cm had the lowest growth rate (0.16 ± 0.42 cm/year).The peak growth rate was in hemangiomas 8.0 ～ 10.0 cm (0.80 ± 0.62 cm/year) , but for hemangiomas ＞ 10.0 cm, the growth rate was only (0.47 ±0.91)cm per year.Only 9 patients had severe symptoms caused by the hemangioma.No patients presented with hemangioma-related complications.Conclusions The majority of hepatic hemangiomas have the tendency to increase in size but they rarely caused complications.All the hemangiomas could be safely managed by observation, and surgery should only be considered in patients with complications.

Objective To identify clinicopathologic factors which predict survival following hepatectomy in HBV-related cirrhotic patients with early hepatocellular carcinoma (HCC).Methods A database was used to identify patients with histologically confirmed early HCC (≤5 cm,no nodal involvement,metastases,or major vascular invasion) who underwent surgical resection (excluding ablation or transplantation).Among 20 700 patients with HCC who were diagnosed at the Eastern Hepatobiliary Surgery Hospital from April 2005 to November 2010,537 (2.6％) patients with early HCC were studied retrospectively.Prognostic factors were evaluated using the Kaplan-Meier curves,Cox proportional hazards models and the receiver operating characteristic (ROC) curves.Results The study included 537 patients.The median tumor size was 2.9 cm,and 33％ of patients had tumors ≤2 cm.Most HCC lesions were solitary (63％) and had no evidence of vascular invasion (64％).Following surgery,the overall median and 5-year survival were 45 months and 33％ respectively.After adjusting for demographic factors and histological grade,tumor size ＞2 cm (hazard ratio [HR]:1.56),multifocal tumors (HR:1.34),and vascular invasion (HR:2.03) remained independent predictors of poor survival (all P ＜ 0.05).Based on these findings,a prognostic scoring system was developed that allotted 1 point each for these factors.Patients with early HCC could be stratified into 4 distinct prognostic groups (median and 5-year survival,respectively):0 points (97 months,96％),1 point (85 months,76％),2 points (76 months,54％),3 points (56 months,39％) (P ＜0.01).Conclusions The present study emphasized the importance of pathologic staging even in patients with small HCC.Anatomical resection of HCC should be the preferred surgical procedure in cirrhotic patients.

Objective To observe any effect of transcutaneous electrical nerve stimulation (TENS) on pul monary function,airflow obstruction,dyspnea,exercise capacity and levels of tumor necrosis factor-α (TNF-α) in the sputum of patients with chronic obstructive pulmonary disease (COPD).Methods Thirty patients with stage Ⅰ or Ⅱ COPD were randomly divided into a treatment group and a control group with 15 cases in each.TENS applied at the Feishu acupuncture point (BL13) was used in the treatment group,while sham stimulation of the same point without current output was used in the control group.The treatment was administered 40 minutes once daily,5 days a week for a total of 4 weeks.The outcome measures were measured before and after 4 weeks of treatment.Results FVC,FEV1,FEV1％,and peak expiratory flow rate (PEFR) all improved significantly in the treatment group after 4 weeks of treatment.After treatment,the average TNF-α level in induced sputum and exercise capacity as indicated by the average BODE index had both improved significantly in the treatment group.Compared with the control group,pulmonary function,TNF-α and the BODE index in the treatment group were all significantly better.There was no significant difference in pulmonary function,BODE index or TNF-α before and after treatment in the control group.Conclusion TENS at the Feishu acupoint can reduce airway inflammation,improve pulmonary function and exercise capacity,and decrease TNF-α levels in patients with stage Ⅰ or Ⅱ COPD.This treatment should be very useful for enhancing their ability in the activities of daily living.

Objective:To explore the mediating effect of positive emotion on relationship between cognition reappraisal and meaning of life in freshmen.Methods:Totally 192 freshmen[62 males and 130 females,aged 18 to 22 years,mean age (20 ± 2) years] were assessed with the Chinese version of the Emotion Regulation Questionnaire (ERQ),Positive words of the Positive and Negative Affect Scale (PANAS) and Chinese version of the Meaning of Life Questionnaire (MLQ).Interval of 3 months of longitudinal data was used to investigate the mediating role of positive emotions in cognitive reappraisal sense and meaning of life.Results:The EPQ scores were positively correlated with the scores of PA,MLQ-P,and MLQ-S(r =0.17-0.26,Ps ＜ 0.05).The PA scores were positively correlated with the scores of MLQ-P and MLQ-S (r =0.16-0.35,Ps ＜0.05).Bootstrap test showed that positive emotions mediated meaning of life through cognitive reappraisal (95％ CI:0.065-0.295).The structural equation model proved to exhibit an appropriate data fit (x2/df=1.58,RMSEA =0.06,CFI =0.98,GFI =0.95).Conclusion:It indicates that cognitive reappraisal is related to meaning of life and positive emotions,and positive emotions mediate the relationship between cognitive reappraisal and meaning of life among freshmen.

Objective To explore the safe technique of caudate lobectomy for liver cancer in candafe lobe(LCCL).Methods The clinical data of 11 cases of primary liver cancer in caudate lobe who received hepatectomy successfully were retrospectively analyzed. four procedures were used in the operations:(1)selection of appropriate skin incision, so as to obtain excellent exposure of operative field;(2)adequate mobilization of the liver to allow the liver to be displaced upwards to the left or to the right;(3)preparatory placement of tapes for total hepatic vascular isolation,so that this procedure can be used when necessary;(4)selection of the ideal route for hepatectomy based on the condition of the tumor and, if necessary, the combined removal of multiple lobes. Among the 11 cases, simple occlusion of vessels of porta hepatis was used for candate lobectomy in 6 cases, while, in the other cases, the vessels were intermittently occluded several times or total hepatic vlascular isolation was used for the caudate lobectomy. combined partial right hepatectomy was done in 2 cases, combined left lateral lobectomy in 3 cases and caudate lobectomy alone in 6 cases.Results Operation was smooth and successful in all of the 11 cases, and there was no mortality. Conclusions Caudate lobectomy for LCCL can be safely performed when the above procedures are used.

Objective To investigate the lymph node micrometastasis and its clinicopathologic features on 5-year disease free survival rate for patients with pT1-3N0 gastric cancer.Methods One hundred and twenty patients with stage pT1-3N0 gastric tumors were included,and 2 106 lymph nodes were harvested and examined in all the specimens.There were 9-28 lymph nodes with average 18 lymph nodes from each patient.All the lymph nodes were negative by HE staining.The CK20 expression of lymph nodes was tested by immunohistochemistry.The relationships between clinicopathologic features or CK positive expression and 5-year disease free survival were analyzed.Results The positive expression rate of CK20 was 9.07%(191/2 106)in lymph nodes and 26.67%(32/120)in patients with pT1-3N0 gastric cancer by immunohistochemistry.Eleven cases were with micriometastasis,21 cases were isolated tumor cells(ITC).The average postoperative follow-up was 66.35(range 24-121)months.Five-year disease free survival rates were 87.4%,78.3%,and 40.9% for the lymph node negative,ITC,and micrometastasis groups,respectively.Five-year disease free survival rate in the micrometastasis group was lower than that in the lymph node negative group(P=0.000)and ITC group(P=0.046).However,there was no significant difference between the lymph node negative group and ITC group(P=0.253).Multivariate analysis identified tumor diameter(P=0.011),depth of tumor invasion(P=0.043),and lymphatic vessel invasion(P=0.002)were related with CK20 positive expression.There was no significant relationship between the pathologic parameters and the 5-year disease free survival rates.Lymph node micrometastasis of gastric cancer was detected in 11 patients who should belong to stage pN1(Mi),the restage rate was 9.17%.While the lymph node negative(88 patients)and ITC(21 patients)were recorded pN0(i-)and pN0(i+),respectively,and were not recommended restage(stage pN0).Conclusion Patients with stage pT1-3N0 gastric cancer and micrometastasis in lymph node are with high-risk and low 5-year disease free survival rate,for whom adjuvant therapies may be justified and effective.