The anterior lingual salivary cyst is a easily misdiagnosed disease. In this paper, 115 cases of patients were treated with conventional surgical method and modified surgical method respectively. The results were compared. Conventional surgical method had a 35% relapse rate. Modified surgical method had a 1.33% relapse rate. Modified surgical method for anterior lingual salivary cyst is the best choice.

Surgery has been considered as the most effective treatment for hepatocellular carcinoma (HCC). In spite of almost 100-year development, the survival benefits brought by surgery for HCC patients have not been further improved. In recent years, widespread application of targeted drugs and immune checkpoint inhibitors have provided a novel development direction for comprehensive treatment and related research of HCC. With widespread clinical application, the advantages of targeted immune therapy in the treatment of HCC at all stages are constantly presented, which make surgeons rethink whether the original concept of surgery for HCC is still correct. In this article, the problems and potential solutions in hepatectomy for HCC in the era of targeted immunotherapy were in-depth discussed.

Layered anatomy is a both ancient and novel conception, which is derived from topographic anatomy.Topographic anatomy and phylembryogenesis are basic academic knowledges of layered anatomy.With the development of laparoscopic surgery and robotic surgery, less bleeding, more meticulous dissection, faster postoperative recovery and lower recurrence rate are required in surgical operation, because of which layered anatomy is mentioned and valued again.Organs in abdominal cavity are composed of different layered tissues,between them are loose connective tissues which are poor in vessels.Layered anatomy in surgical operation can avoid the en bloc dissection of organs, which not only reach total lesion dissection, but also avoid hurting surrounded normal tissues, showing the best surgical results.

Objective To investigate clinical characteristic of primary Sjogren's syndrome(pSS) with initial manifestations in the extra-gland organs. Methods Clinical data, including symptoms, laboratory parameters and complications of 85 pSS patients with initial manifestations of extra-gland organs hospitalized at the People's Hospital of Peking University during 2003 to 2006 were collected and analyzed retrospectively, as compared to those of pSS with xerophthalmia or xerostomia as initial ones. Results Mean time interval from onset to diagnosis in these patients with initial manifestations involved in the extra-gland organs was 94.5 months, higher than that in those with xerophthalmia or xerostomia as initial ones. Arthritis was manifested initially in 38 of the 85 patients (44.7 percent), peripheral leukopenia in 16 (18.8 percent), thrombocytopenia in nine (10.6 percent) and abnormal liver function in 13 (15.3 percent), respectively. Percentage of serum positive autoantibedies was higher in the patients with initial manifestation of the extra-gland organs than that in those with xerophthalmia or xerostomia as initial ones. Conclusions Initial manifestation of primary Sjogren's syndrome varies, and some patients can be initially involved in their extra-gland organs, with more proportion of arthritis than of other symptoms, and xerophthalmia or xerestomia could appear in them during the course of disease. And, xerophthalmia or xerostomia would not appear even as pSS was diagnosed in some other pSS patients. More attention should be paid to these clinical characteristics mentioned above in practice to avoid misdiagnosis.

Objective:To observe the clinical features of primary Sjgren syndrome(pSS) in young people(≤34 years).Methods: The data of 232 patients with pSS who were in hospital from 2004 to 2008 were analysed in a prospective study.Results: A total of 23.7%(55/232)patients' symptoms came on in youth(≤34 years),who were all females,mean age was(27.6?6.2) years.The other 177 patients' symptoms came on when they were more than 34 years old.In young group,32.73%(18/55) patients' first symptoms were xerostomia and/or keratoconjunctivitis sicca,the other 67.27%(37/55)came on without xerostomia and keratoconjunctivitis sicca,while in the middle-aged and aged group,59.32%(105/177)patients' first symptoms were xerostomia and/or keratoconjunctivitis sicca,40.67%(72/177)without xerostomia and keratoconjunctivitis sicca.There was significant difference(P=0.001).The duration from first symptom to first diagnosis of pSS in the young group was(93?107) months,which was significantly longer than those of the middle-aged and aged group [(45?59) months,P=0.001].The systemic damage of the young group was 61.8%(34/55),which was significantly greater than 41.24%(73/177)in the middle-aged and aged group(P=0.026).Conclusion: Primary Sjgren syndrome in young people is not rare,and about 2/3 of them come on without xerostomia and/or keratoconjunctivitis sicca.Not only the duration from first symptom to first diagnosis of pSS in the young group is longer,but also the systemic damage of the young group is greater than those of the middle-aged and aged group.These findings should alert the clinician to make the possible diagnosis of pSS in young patients.

Objective To analyse the clinical features and risk factors of interstitial lung disease in primary SjSgren's syndrome (pSS).Methods A retrospective study was employed.All 130 pSS patients who were hospitalized during 2004 to 2006 were enrolled into this study.Thirty-seven clinical and laboratory variables were used as the research factors and interstitial lung involvement as the related factor.The data were analyzed with the Logistic regression model.Results of 130 patients,22(16.9%) had interstitial lung involvement.Twelve patients were asymptomic when pulmonary involvement was detected.Variables in the univariate analysis which were significantly associated with lung fibrosis were age,exocrine glands(including parotid,sublingual gland and submandibular gland) swelling,oral ulceration and fever.Positive rate of antiU1RNP antibody in group of lung damage was significantly higher than non-lung damage group [5/22(22.7%)vs 6/108 (5.6%),P=0.021].In the Logistic regression model.variables which were significantly associated with pulmonary involvement were exocrine glands swelling (OR=3.739,95%CI 1.069～16.079,P＜0.05).oral ulceration (OR=3.739,95%CI 1.069～16.079,P＜0.05)and fever (OR=3.067,95%CI 1.198～20.067,P＜0.05).Conclusions This study indicates that some of the pulmonary damages of pSS are subclinical.Exocrine glands swelling,oral ulceration and fever are the risk factors for interstitial pulmonary involvements in pSS.

Objective:To evaluate the therapeutical effects of diplopore puncture of tympanum and intratympanic administration(DPTIA) on patients with acute secretory otitis media(ASOM).Method:One hundred and forty -one cases with ASOM were divided into two groups randomly,with 69 cases(80 ears) in group A(experimental group) and 72 cases(84 ears) in group B(control group).Group A was treated with DPTIA combined with medication, group B was treated with haplopore puncture of tympanum combined with medication. All patients accepted 1 to 3 courses of treament,and were observed during the period of treatment and 3 months after treatment.Result:The factors (including gender, age, side of ailing ear, course of disease, air-bone gap in the pure tone average,and acoustic immitance type in ailing ear) which may impact the prognosis were matched in two groups prior treatment(P＞0.05). While there was a significant difference in the cure rate and the total effective rate respectively between two groups after treatment(P＜0.05).No adverse reaction or complication was seen.Conclusion:DPTIA is a safe, reliable and effective way to manage patients with ASOM.

Objective To evaluate the feasibility of endovascular repair for retrograde type A aortic dissection.Method 35 patients of retrograde type A aortic dissection admitted to Peking University People's Hospital from December 2001 to March 2014 were treated with endovascular repair.There were 33 males and 2 females with mean age of 46 ± 9 years.29 were on acute stage,2 on subacute stage and 4 on chronic stage.The entry tear was in the descending thoracic aorta in 32 cases,between the left subclavian artery and the left common carotid artery in one,and between the left common carotid artery and the innominate artery in two.Results Entry closure was achieved in all patients with a covered stent.2 patients died in 30 days postoperatively (5.7％).1 patient with two chimney developed acute renal artery embolized which was infused by false lumin (2.9％).One patient developed transient paraparesis after graft deployment(2.9％).During the follow-up period,the aortic remodeling is perfect,no entry tear was noted in the ascending thoracic aorta.All the endografts for preserving supra-aortic branches were patent.Conclusions The endovascular repair for retrograde type A aortic dissection is feasible and effective.

Objective:To analyze the clinical characteristics of interstitial pulmonary fibrosis (IPF) in patients with Rheumatoid arthritis (RA). Methods: We retrospectively analyzed 198 RA patients with or without IPF. Characteristics of RA-IPF in clinical and lab data were analyzed. Age, duration of disease,clinical and laboratory parameters, history of smoking and medicine were compared between the patients with and without IPF. Results: (1) Among the 198 RA patients, 15.2% (30/198) were found with IPF. 100% RA-IPF patients had HRCT findings. However, 63.3% (19/30) had positive findings in chest X-ray, and only 46. 7% ( 14/30) had the complaints of cough and short breath. Velcro rales were found in 50.0% (15/30) patients with IPF and no acropachy occurred. Only one patient suffered from hypoxemia. IPF presented after the joint symptoms in most patients. (2 ) RA-IPF patients were older than those without IPF [(65.50±9.71) vs (55.22±12.98) years, P＜0.01]; Higher positivity of anti-keratin antibodies ( AKA) were found in RA-IPF compared to patients without IPF (61. 5% vs 35.9% , P =0.014). Furthermore, the levels of anti-cyclic citrullinated peptide (CCP) antibody were significantly higher in RA-IPF [(4.38±2.08) vs (3.20±2. 12) , P =0.01]. No differentiation of duration of disease, history of smoking and medicine, IgM rheumatoid factor, IgG rheumatoid factor, anti-nuclear antibody, anti-SSA antibody and levels of immunoglobins and complements were found between the two groups of RA patients with and without IPF. Conclusion: The clinical symptoms of IPF in RA patients are mild and more common in older patients. AKA and anti-CCP antibody might be important antibodies associated with RA-IPF.

Objective To analyze the clinical features of systemic lupus erythematosus (SLE) com-plicated by noncirrhotic portal hypertention (NCPH),and improve the recognition of NCPH.Methods Clinical data from SLE complicated by NCPH in our hospital were retrospectively analyzed and summarized,while the related literatures were reviewed.Results Four patients diagnosed as SLE complicated by NCPH were all women.NCPH presented with the clinical features of portal hypertension with normal or slightly elevated transaminase.Anticardiolipin (ACL) antibodies were positive in 2 patients.Two patients underwent liver needle biopsy,showing nodular regenerative hyperplasia,of which,one with liver portal fibrosis.The treatment strategy was managing the primary disorder and controling of portal hypertention in four patients.Twenty-two cases of SLE complicated by NCPH were reviewed and analyzed,including 18 cases from related literatures and our 4 cases.Among the 22 cases,the mean time between the diagnosis of SLE and NCPH was eight years,of which one patient with NCPH before SLE,one diagnosed at the same time and the rest with NCPH after SLE.19％ (4/21) of patients presented with Raynaud's phenomenon and 18％ (4/22) complicated by pulmonary hypertension.In serological tests,patients presented with positive ACL anti-bodies [33％(7/21)] and anti-dsDNA [48％(10/21)],as well as increased IgG and γ-Globulin [38％(8/21)].Liver needle biopsy showed nodular regenerative hyperplasia or liver portal fibrosis with the prevalence of 80％ (16/20) and 25％ (5/20),respectively.Conclusion SLE complicated by NCPH is very rare clinically and is easily being misdiagnosed without obvious symptoms and signs in the early stage.Positive ACL antibodies and Raynaud's phenomenon maybe be closely related to SLE complicated by NCPH.