0.05), while CO, CI in both groups and SVI in OPCAB group increased significantly ( P 0.05). SVRI and PVRI were significantly lower in OPCAB group than those in CABG group (P

Objective To investigate the typing, staging and therapeutic outcome of intrahepatic cholan-giocarcinoma (ICC). Methods The clinical data of 60 ICC patients who were admitted to the Renji Hospital of Shanghai Jiaotong University from January 2000 to December 2008 were retrospectively analyzed. ICC was classi-fied according to the type and TNM staging proposed by the Liver Cancer Study Group of Japan (LCSGJ). The relationships between typing, staging, surgical procedures and therapeutic outcome were investigated, as well as the relationship between the LCSGJ staging system and UICC staging system. Results The 1-, 3-, and 5-year survivals of the 60 ICC patients were 44% (23/52), 19% (10/52) and 10% (5/52), respectively. The median survival time for patients with radical resection (n =30) , liver transplantation (n = 10), palliative surgery (n = 11) and exploratory laparotomy (n=9) were 13, 3, 3 and 1 months, respectively. The radical resection rates for mass-forming type, periductal-infiltrating type, intraductal growth type and mixed type were 23/31, 9/15, 5/6 and 3/8, respectively. There were significant relationships between tumor type, degree of differentiation and prog-nosis (χ2 = 8. 308, 10. 009, P < 0. 05), and between tumor type and lymph node metastasis (χ2 = 13. 261, 5.702, P <0.05). There was no significant difference in survival time between patients with different pathological types, but the prognosis of patients with mucinous adenocarcinoma was better than that in the other types, with a median survival time of 20months. The median survival time of patients in LCSGJ stage Ⅳ was 3. 0 months, which was significantly longer than that in UICC stage Ⅳ (χ2 =3. 877, P <0. 05). Tumor staging was intimately related to the macroscopic type χ2 =8.288, P <0. 05). Conclusions The prognosis of ICC is poor. The typing and staging of LCSGJ is concise and practical, which is helpful in guiding treatment and evaluating progno-sis. Surgical treatment should be applied to mucinous ICC, and liver transplantation is not recommended for the treatment of ICC.

Objective To study characters of pathology associated with functional alteration of primary brainstem injury (PBI) at different injury severities in rabbits .Methods Animal model of graded PBI was produced using rabbits .Animals were di‐vided into five groups ,group Ⅰ to Ⅳ with an increase of impact power ,10 cases in each group ,and the control group with 5 cases . The pathology characters of PBI were investigated combining dissection observation with unaided eye ,tissue HE histochemical stai‐ning and electron microscope .Results Slight brainstem injury were observed in group Ⅰ ,and pathological results showed regional subarachnoid hemorrhage (SAH) ,stripping of regional cerebral pia mater ,a few petechial hemorrhage in surface ,nerve cell edema , normal medulla sheath and axon roughly .The brainstem injuries were apparent in group Ⅱ ,and the pathological changes indicated SAH in sheet ,petechial and sheeted hemorrhage in surface ,and slight swelling and vacuoles in nerve cells .The brainstem injuries were observed obviously in group Ⅲ ,exhibiting thick SAH ,petechial and sheeted hemorrhage in surface and inside ,degeneration of nerve cells ,abruption of axon ,and atrophy of axoplasm .Eight of ten animals died of respiratory depression induced by brainstem in‐jury in group Ⅳ ,presenting thick hemorrhage in subarachnoid surrounding brainstem ,the whole brainstem injured ,microscopically with multiple small hemorrhage ,nerve cells only residual nuclei ,myelin lamellar severe stratification and fracture ,and axonal tran‐section ,disintegration .No abnormal pathological changes were shown in control group .Conclusion The impacts to brainstem with higher powers lead to more manifest functional and more severe pathological changes ,with an alternation of injury location from surface to deep .

Objective To investigate the imaging features of aggressive angiomyxoma.Methods CT findings in 3 patients and MRI finding among one of them with pathologically proved aggressive angiomyxoma were retrospectively analyzed and the relevant literature were reviewed.Results In all the 3 cases,CT and MR imaging demonstrated a well defined mass arising from the pelvis,perineum or vulva.The tumours displaced but did not invade adjacent structures of the pelvic.In 2 cases,there was marked enhancement following injecting contrast materials or T_2WI with internal swirling pattern.Recurrent tumour in one case was of similar imaging features to the primary lesion.The small cystiform area could be seen inside the lesion in one case.Conclusion Aggressive angiomyxoma carries certain characteristics in CT and MRI manifestations.MRI is more excellent than CT in delineating the site,shape and the extent of these lesions.

Objective To observe the efficacy and safety of sorafenib in the treatment of the unresectable hepatocellular carcinoma.Methods According to the inclusion criteria,33 patients with the unresectable hepatocellular carcinoma were given sorafenib (400 mg for twice per day).During the course of treatment,dose was adjusted based on the degree of the adverse effects.Tumor response to sorafenib and safety was assessed every 6-8 weeks using the modified RECIST criteria.The survial curve for the time to progression (TTP) and overall survival (OS) were estimated.Results In this series,there was no patients achieved complete response (CR) and partial response (PR),1 1 patients were evaluated as with stable disease(SD),22 patients were with progressive disease (PD).The median TTP was 5.6 months (2.3-8.9 months).The median TTP was longer in patients with BCLC B than BCLC C stage.TTP was longer in good than in poor performance status patients,and shorter in extrahepatic metastasis than in no extrahepatic metastasis patients.The overall incidence of adverse events was 75.8％.The most common adverse events were hand foot skin reaction,diarrhea,hypertension and rash.Three patients had grade 3 adverse events.Conclusions Sorafenib can extend the median time to progression in patients with unresectable hepatocellular carcinoma.Patients with earlier stage of HCC and better performance status are hopeful for more positive response to the treatment of sorafenib.

Objective To assess the safety and efficacy of the local nerve block anesthesia procedure in daysurgery inguinal herniorrhaphy practice.Methods Fifty-eight inguinal herniorrhaphy were performed under the local nerve block anesthesia in the form of day surgery between April 2014 and April 2015 other 58 inguinal hemiorrhaphy were performed under general anesthesia.Time of operation,hospitalization stay,complications and costs were evaluated.Results The average operating time of the day-surgery group was (47 ± 12) min.All operations were completed successfully.Fifty-six patients were discharged in 24 hours and 2 patients were discharged in 48 hours after the surgery.The average costs were 8437 yuan.The rate of postoperative complications was approximately 6.6％ (4/58),including hematoma(3 cases),urinary relention(1 case),and chronic pain (1 case).The VAS scores of 6 hours after the operation were (2.4 ± 0.8).Conclusions It suggests that preperitoneal hemiorrhaphy under the local nerve block anesthesia in the form of day-surgery was safe and effective.Also,it could significantly shorten the time of hospitalization and reduce medical costs.

BACKGROUND:Studies have shown that arthroscopic al-inside technology for meniscus repair has achieved good outcomes, and arthroscopic suture combined with sodium hyaluronate has an important role in the cartilage repair. OBJECTIVE:To observe the therapeutic effect of arthroscopic al-inside suture repair combined with sodium hyaluronate injection in the repair of discoid meniscus tears. METHODS:Twenty-two patients with discoid meniscus injury were subjected to arthroscopic al-inside suture repair combined with sodium hyaluronate injection. Al cases were confirmed to have attached edge relaxation or longitudinal crack in operation. After repair, effective rehabilitation training was done. RESULTS AND CONCLUSION:The operations for the 22 cases were al successful and there was no complication. Al patients were fol owed up for over 18 months. According to Ikenchi’s method (Lysholm knee score criterion), 11 cases were rated excel ent, 8 were rated good, and 3 were rated fair, with an excel ent/good rate of 86.36%. It is demonstrated that the al-inside suture repair under the guide of arthroscopy in discoid meniscus cases can remain the most appropriate anatomical structure of the meniscus that can play an effective function, and has the advantage of minimal invasion. Arthroscopic al-inside suture repair combined with intra-articular injection of sodium hyaluronate and standard rehabilitation training result in a lower complication rate and effectively promotes the meniscus repair.

Objective To study the effects of persistent atrial fibrillation (AF) on the expression of k1 opioid receptor and change of ultrastructure in heart atrium.Methods The mRNA and protein expressions of κ1 receptor in atrial tissue were detected with RT-PCR and immunochemistry,respectively,in 24 patients with AF and 24 patients with sinus rhythm (SR).Mitochondria were analyzed in the atrial tissue by electron microscopy in 4 patients with AF and 4cases with SR.Results The κ1 receptor mRNA in patients with AF was lower than in patients with SR (262±20 vs.196± 11,P＜0.05),and amount of protein expression was also deduced (1261±90vs.2325± 131,P＜0.05).Mitochondria size was decreased in persistent AF compared with SR[(1.0±0.2) μm vs.(0.8±0.2) μm,P＜0.05].Conclusions The decrease of k1 receptor expression suggests reduction of atrial protective capacity in persistent AF,combining with remodeling of ultrastructure.

A national health information system that can provide timely and reliable information plays a very im-portant role in improving public health and health system .However , the system must be assessed at first if it is to be strengthened .The assessment frameworks for the main health information systems in the world were summarized by defining the connotations of national health information system.The advances in assessment of health information systems in China were described with certain suggestions put forward for the research and development of assessment framework for national health information system .

Objective To assess the effects of thalidomide on VEGF mRNA level in human breast cancer cell lines. Methods Breast cancer cells were treated with thalidomide for 24～72h, RT-PCR was uced to detect the level of VEGF mRNA expression. Results When the concentration of drug is 50μg/L,thalidomide strongly inhibited the level of VEGF mRNA expression. Conclusion Within certain concentration range of thalidomide can inhibit the level of VEGF mRNA expression in breast cancer cell.