Hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) is one of the difficult points of liver cancer treatment.At present,there are various clinical treatments of HCC with PVTT which have great significance to lengthen the survival time of patients with liver cancer and improve the quality of life.Surgical therapy and interventional treatment play important roles in the treatments of HCC with PVTT.

Thermoablation is a local treatment effectively used to prevent metastasis of colon cancer in the liver and can retain peripheral normal liver tissues. Ablation therapy is less invasive, easier to use, and more repeatable than surgery. This form of therapy also allows the local control of unresectable diseases. Furthermore, thermoablation can be applied as an alternative therapy for small re-sectable lesions in patients who manifest insufficient hepatic function after surgery or those with severe complications. Ablation therapy can artificially increase the surgical margin, thereby increasing the resection rate in patients. Multiple lesions in the liver and surgically inaccessible or unresectable diseases can also be removed. However, several limitations, including the local recurrence of the disease and treatment-related complications in patients, are also observed. The treatment outcome of thermoablation therapy can be further im-proved because this technique is used as a part of multimodality treatment.

The occurence and progress of hepatocellular carcinoma(HCC)is a complex network inter-action process connected by multiple signaling pathways involving genes,cells and various active molecules. The effects and functions of biological molecular markers also vary among different pathways. Moreover,wheth-er the molecular markers have prediction effects for the prognosis of HCC remains unclear,and studies investing this issue are still insufficient. The current studies reveal that molecular markers involves in multiple pathways including gene expression,gene regulation,cell cycle regulation,cancer stem cell proliferation and differentia-tion. These processes are intimately associated with the occurrence and prognosis of HCC. The relevant gene or molecular that may indicate the prognosis of HCC includes p53 gene,long non-coding RNA,cell cycle regula-tors,liver cancer stem cell surface-associated molecules,etc.

The present study aims to explore the effect of public trust in hospital on complaint behavior in healthcare service, which could provide the foundation for the practice of public trust in hospital.A total of 331 participants who had complained about having a poor consultation experience in hospital were asked to answer the online questionnaire.The results show that: (1) public trust in hospital had a positive effect on both general complaint and third-party complaint, but its effect on third-party complaint was much higher;(2) public trust in hospital affected general complaint via consultation dissatisfaction, but it influenced third-party complaint via anticipated benefits of complaint;(3) public trust in hospital also influenced both the two types of complaint behavior via expectation gap of healthcare service and patients'' trust in doctors, but their mediation effects, especially the one of patients trust in doctors which was much smaller than that of patient dissatisfaction and anticipated benefits of complaint.The results indicated that complaint management is important for the practice of public trust in hospitals.On one hand, complaint management personnel and communication skills could enhance public trust in health care.On the other hand, legal action about complaint management could guarantee public trust in health care providers.

Objective To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator(rt-PA)for acute limb embolism in patients with recent cerebral embolism.Methods Eight patients with atrial fibrillation history happened to suffer acute limb embolism after recent cerebral embolism.The affected arteries included 2 left common iliac arteries,4 femoral arteries(3 left,1 right),2 right popliteal arteries.Catheter-directed thrombolysis with rt-PA was applied with bolus administration plus continuous perfusion.Percutanous transluminal angioplasty with balloon dilatation was applied in 3 patients,and one stent placement in one patient.Results The mean duration of continous perfusion was 3.6 hours and the mean dose of rt-PA administered was 23.6 mg(range,20 ～ 28 mg)with complete recanalization rate of 100%.Clinical complete relief rate was 7/8 with one patient suffering from rest pain due to distal occlusion of anterior/posterior tibial artery.The complications included hematoma at puncture site(6/8),bleeding around the vascular sheath(2/8)and hematuria(1/8).No intracerebral hemorrhage was found on CT scans after the thrombolysis.During follow up of 3-6 months,no recurrent embolism or thrombosis occurred in the limbs except one patient with recurrent cerebral embolism and died.Conclusions Catheter-directed thrombolysis with rt-PA is probably to be a safe and effective method for acute limb embolism in patients with recent cerebral embolism and atrial fibrillation history.

Humans ; Hyperesthesia ; diagnosis ; etiology ; Pharynx ; physiopathology ; Syndrome

Four key attributes,position,rate,shape and force,are programs of pulse tracing put forward by ZHOU Xue-hai,a medical practitioner in late Qing dynasty.The essences of four key attributes are'images'of di erent levels.There are complex relationships between pulse tracing and position,rate,shape and force attributes,which include not only subordinate relationship and static-dynamic relationship between four attributes but double relationship between four attributes and pulse tracing.

Objective To analyze the clinical performance of hepatitis C virus antibody detection by bi-direetional lateral flow method and evaluate whether the bi-directional lateral flow method is suitable for clinical use.Methods Four hurdred and nineteen samples were collected and tested anti-HCV antibodies with hi-directional lateral flow and CMIA kits.These samples contain:107 patients with confirmed hepatitis C virus infection,162 patients with other diseases than hepatitis C virus infection and 150 healthy controls.Two positive reference materials for ELISA were tested at the same time.The testing results were analyzed with statistical methods.Results Compared with RIBA,the sensitivity and specificity of bi- directional lateral flow method were 98.1% and 99.7% respectively,the agreement rate with CMIA was 99.0%.The reproducibility percentage of the+/-20% at the cutoff concentration were 97% and 99% respectively.No crossing reaction with hepatitis A/B/D/E virus infection and HIV-1/2 positive individuals were found in the tests.Conclusion The hi-directional lateral flow method for HCV detection shows good clinical performance and is suitable for clinical use.

Objective: To establish a rat model of multiple organ dysfunction syndrome (MODS) by subarachnoid hemorrhage (SAH), and to explore the pathogenesis of MODS occured in acute cerebrovascular diseases (ACVD). Methods: Model of SAH was induced in rats by injecting arterial blood around the Willis' circle. 48 Wister rats were randomly divided into three groups: normal control group (n = 6), sham-operative group (n = 6) and SAH group (n = 36). The SAH group was further divided into 6 groups according to the time points of 4h, 12h, 24h, 36h, 48h and 72h after SAH, each group has six rats. Changes of temperature, heart rate and respiratory rate of the rats in each group were recorded, the amount of white blood cell (WBC) and biochemical criteria were assayed. Pathological changes of lung, liver, intestines and kidney were observed under optical microscope. Systemic inflammatory response syndrome (SIRS) and MODS were diagnosed by their criteria. Results: 1 There were no significant differences of temperature, heart rate, respiratory rate and the levels of WBC, ALT, AST, BUN, Cr and CK between normal control group and sham-operative group (P > 0.05). The rats of SAH group had obviously higher temperature, heart rate, respiratory rate, WBC, ALT, AST, BUN, Cr and CK than that of the normal control group and sham-operative group (P < 0.01), the changes were most obvious at 24-36 hour point. 2 The vital organs of the rats showed inflammatory injuries in varying degree at each time point after SAH, and peaked on 24-36 h, alleviated after 48 h, and last to 72 h after SAH. 3 The incidences of SIRS, MODS and mortality were 100% (36/36), 69.4% (25/36) and 38.9% (14/36) respectively in the SAH group. Conclusion: 1 An experimental animal model of MODS can be established successfully by injecting arterial blood around the Willis' circle in rats. 2 SAH can cause inflammatory changes in lung, liver, intestines, kidney as well as SIRS, and SIRS may be the pathological basal of MODS after SAH.

Objective: To investigate the inhibitory effect of adenovirus-mediated herpes simplex virus-thymidine kinase (TK) gene combined with α-IFN on renal clear-cell carcinoma. Methods: Adenovirus containing suicide gene TK, in combination with GCV or α-IFN, was used to treat human renal clear-cell carcinoma cell line 786-0, and the in vitro cytotoxic effects against 786-0 were evaluated using MTT method. The subcutaneous transplantation model of 786-0 cells was established with nude mice. Adenovirus containing TK gene was injected intratumorally and the GCV (50 mg/kg) was injected intraperitoneally; α-IFN (104 U/L) was injected intratumorally in combined therapy. The growth of tumors was observed after treatments. Results: The survival rate of 786-0 cells was (35.07 ± 1.43)% in the TK+GCV+α-IFN group, (68.57 ± 1.41)% in the TK+ GCV group and (68.65 ± 1.45)% in the α-IFN group (P=0.000). There was an obvious synergic effect between Ad-TK and α-IFN in inhibiting 786-0 cells. Ad-TK combined with GCV and α-IFN significantly suppressed the growth of 786-0 cells growth in nude mice model. Conclusion: Adenovirus-mediated TK plus prodrug GCV combined with α-IFN has obvious therapeutic effect in treatment of human renal clear-cell carcinoma.