Hepatic cancer is currently the fifth most common malignant neoplasm in the world.Surgical resection is considered as radical treatment.Patients with hepatic cancer in middle or advanced stage according to the Barcelona clinic liver cancer staging system (BCLC) are usually with huge and (or) multinodular lesions and vascular invasion,which are not generally recommended for surgical resection because of high operative mortality,recurrence rate and dismal survival benefit.However,many centers have proved an opposite and encouraging result against the opinions above.With the development of surgical techniques and intensive medical care,the concern of high postoperative mortality for middle or advanced stage hepatic cancer patients is no longer unsolvable.Precise preoperative assessment is essential.The estimation of the liver functional reserve has developed from simple Child-Pugh score to an integrated system including computed tomography evaluation,indocyanine green clearance test,hepatic venous pressure gradient,etc.The estimation of the remnant liver volume after hepatectomy is especially important for surgical treatment for the middle or advanced stage hepatic cancer.Insufficient liver remnant was absolute contraindication for major hepatectomy because of high incidence of postoperative liver failure.In-situ liver transection with one branch of the portal vein ligation has been invented as a novel method to stimulate fast liver regeneration; by this way,a second-stepped radical resection can be performed with a plenty of liver remnant one week later.However,the reliability for hepatic cancer patients with liver cirrhosis is still unknown.Meticulous surgical procedure is another key factor for a safe major hepatectomy.Radical resection is most expected to provide better survival.The development of the technique of liver blood flow occlusion has a markedly influence on partial hepatectomy.Highly selective occlusion and even occlusion-free hepatectomy can reduce warm ischemia injury and improve postoperative survival.Anterior approach is a reasonable maneuver for huge hepatic cancer resection.Cancer thrombosis usually indicates poor prognosis,however,if en-bloc resection or separate thrombectomy can be achieved,surgical resection for the middle and advanced stage hepatic cancer still can provide a better survival benefit to this category of patient than palliative treatment as TACE.

Before the technique of advanced high-throughput sequencing comes up , less is known about the human gut microbiota .It has been understood that trillions of microbes , in which 99% are bacteria , inhabit the human gut, forming a complicated ecological community .The gut microbiota has a great impact on human physiology and suscepti -bility to disease through its integrative metabolic activities and interactions with the host .In physiology , gut microbiota con-tributes to the host acquisition of nutrition and energy from diets , promoting development and maturation of gastrointestinal tract and immune system , and protecting host from invasion of enteropathogens .In pathology , dysbiosis underlying altered gut microbiota is associated with the susceptibilities to various diseases , including inflammatory bowel disease , type 1 dia-betes, asthma, obesity, metabolic syndrome , autism and cancer .Understanding of the factors that underlie alterations in the composition and function of gut microbiota will be helpful in the development of drugs and the design of therapies that target it.This goal is formidable .It is because that the compositions of gut microbiota are immensely diverse , varying be-tween individuals in a population and fluctuating over time in an individual , especially during early development and disea-ses.Viewing the gut microbiota with an ecological perspective will provide new insights into how to improve our health by targeting this microbial community in clinical treatments .

Gastrointestinal hemorrhage from angiodysplasiamay may be associated with degenerative aortic valve stenosis , the associated of the two conditions termed Heyde ’ s syndrome.Gastrointestinal angiodysplasia and aortic valve stenosis areboth chronic degenerative diseases, and the incidence rate increased with age.Degenerative aortic stenosis can enhance high molec-ular weight polymer damage, which subsequently increases the risk of gastrointestinal bleeding.Aortic valve replacement is considered as the first-line treatment for patients with severe aortic stenosis , and can effectively improve the outcomes of hemor-rhagic angiodysplasia and acquired coagulopathy .However, the substantial connection between aortic valve stenosis and gastro-intestinal bleeding remains unclear, and the clinical diagnosis and treatment of this syndrome need more evidences.Herein, we will review the knowledge of epidemiology, pathogenesis and clinical diagnosis and treatment of Heyde’ s syndrome.

With the intense development of neoadjuvant chemotherapy for breast cancer research in recent years, this approach has been used widely in clinical treatment. Neoadjuvant chemotherapy can increase the chance of operation for patients with local y advanced breast cancer. Moreover, it can improve breast-conserving rate in larger-tumor patients, thereby improving the quality of life of these patients. However, some controversies regarding the use of neoadjuvant chemotherapy for breast cancer patients remain to be resolved. This review focuses on clinical studies and re-recognition of neoadjuvant chemotherapy as a viable treatment for breast cancer.

Nosocomial infection had been the focus conc erned by society at home and abroad since the viral infection such as HIV、HBV and HCV which had seriously threaten the human health worldwide. We should strengthen t he blood products and syringe management and implement sterilization measure，wi th that safe blood starts with me. Because of that quite a few of new human viru ses continually emerged in recent years， control and prevention of nosoc omial viral infection was currently imperative, important and formidable project s and global thorny issue of public health in the 21st century too.

A breakthrough has recently been made in the studies on pathogenesis of HIV disease,which result in some new theories.New strategies for HIV drug and vaccine development are emerging in the impact of these new understandings.The intestinal infection hypothesis proposes that HIV disease can be regarded as some kind of infectious disease of gut immune system as the major HIV infection is located in intestine.The acute catastrophe hypothesis suggests that the subsequent pathological changes are the fallout from a mucosal catastrophe of acute intestinal HIV infection,in which the majority of CD4+ T cells are deleted due to infection.The general immune overactivation hypothesis proposes that the general immune overactivation is harmful to patient as it increases the cell susceptibility to HIV infection and supportiveness of HIV replication.The host proteins related to HIV replication can be new targets for HIV drug discovery.The mucosal vaccine strategies,which attempt to induce HIV specific neutralizing antibodies on mucosal surface may be the first choice in development of prophylactic HIV vaccines.Induction of tolerance may be one of the strategies for HIV therapeutic vaccines because HIV disease can be regarded as autoimmune disease caused by HIV infection.

Kupffer cells, the resident macrophages of the liver, play an important role in ischemia/reperfusion(L/R)injury in liver transplantation. 1schemic liver is reperfused through portal vein, and then Kupffer cells are activated. The liver is damaged by the released reactive oxygen species, inflammatory mediators and cytokines. On the other hand, upregulation of HO-1, induced by the activated kupffer cells, exerts a cytoprotective function for the IYR injury in liver transplantation models. Thus, Kupffer cells play the dual role on L/R injury in liver transplantation.

Objective:To build a performance evaluation index system of family doctor contracting service for urban communities, so as to evaluate the effects of such service.Methods:Based on the conceptual framework of performance appraisal of family doctor contracting service, such means as Delphi method and analytic hierarchy process were employed to evaluate the performance appraisal system of such service. A measured simulation test was made in Guangzhou.Results:A library of performance appraisal candidate indexes for such service was established, based on the performance appraisal concept framework of " structure, input, output, result" of such service. A questionnaire made based on such a library was developed for correspondence inquiry of 20 experts from December 2018 to June 2019. Based on results of such inquiry, a performance appraisal system for family doctor contracting service in Guangzhou was developed, consisting of 4 level-1 indexes, 10 level-2 indexes and 34 level-3 indexes. In the system, level indexes include organizational structure and management(weight 0.21), resource input(weight 0.24), contracting service process(weight 0.19), and contracting service effect(weight 0.36). A community health center in Guangzhou was used as the measurement site, for adjustment and improvement of data acquisition methods of individual indexes or scoring criteria.Conclusions:The index system is developed scientifically; appraisal tools are designed focusing on results and outputs, ensuring the appraisal of contracting service quality from multiple perspectives of supply-demand sides and health management patterns; the system can provide appraisal tools for policy appraisal authorities to evaluate the performance of contracting service reform.

AIM: The aim of the present study is to explore the effects and mechanisms of HIV-1 glycoprotein gp120 on calcium-influx and ERK-phosphorylation of human microglia.METHODS: The level of intracellular calcium of human microglia grown on coverslip,which was loaded by calcium-probe,Fluo-4,and then treated in various experimental processing,was detected by confocal microscopy with time resolution mode.The binding of gp120 to human microglia was determined with confocal microscopy or flow cytometry after treatment with gp120 and stained with anti-gp120-FITC antibody.Phosphorylation of ERK within human microglia with or without gp120 stimulation was analyzed with confocal microscopy following the direct immuno-staining with anti-phosphorylated ERK antibody.RESULTS: The results of confocal microscopy showed that calcium-influx response was triggered by HIV-1 glycoprotein gp120 in human microglia.The results from analysis by confocal microscopy and flow cytometry showed that gp120 was able to bind to human microglia.ERK phosphorylation was enhanced in human microglia stimulated with gp120.CONCLUSION: HIV-1 glycoprotein gp120 induces calcium-influx in human microglia and enhances ERK phosphorylation in human microglia,indicating that gp120 is an activator of human microglia.So gp120 may be involved in the pathogenesis of HIV-associated dementia.

OBJECTIVE: To strengthen drug management in hospital.METHODS: Hospital Information System(HIS)-based drug management was supplemented and consummated with the help of Microsoft Excel worksheet's functions such as ranking,computing and advanced screening etc.RESULTS: Using the Microsoft Excel worksheet to help monitor inventory control,warehousing,and shortage of drug supply,unsalable drugs and expiration date in HIS-based drug management has facilitated the effective management on both the quality and the quantity of drugs in our hospital.CONCLUSIONS: Microsoft Excel worksheet can be utilized to consummate HIS-based electronic management of drugs in hospital.