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.

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 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 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 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.

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 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.

Objective To investigate the effectiveness of disodium Aidi injection for cancer-related fatigue in nasopharyngeal carcinoma patients of Ⅲ-Ⅳ B stage undergoing radiotherapy and chemotherapy.Methods Eighty nasopharyngeal carcinoma patients of Ⅲ-Ⅳ B stage with fatigue symptoms from December 2011 to May 2012 in our hospital were divided into two groups.All patients received treatment of sequential 3 cycles with platinum-based chemotherapy after concurrent chemoradiation.One group of 40 patients also received intravenous infusion of disodium Aidi injection (experimental group),the other group of 40 patients only received conventional therapy (control group).Brief fatigue inventory (BFI) questionnaires data were collected at baseline,the eighth week and the twentieth week after treatment.The changes of fatigue severity and the occurrence of Ⅲ-Ⅳ degree adverse reactions in the two groups were compared.Results At the eighth week,the improvement in fatigue severity was not significantly different between two groups (x2 =1.758,P =0.32).However,significant improvement in cancer-related fatigue of experimental group was found than that of control group at the twentieth week(x2 =8.12,P =0.005).The Ⅲ-Ⅳ degree adverse reactions of experimental group were significantly lower than that of control group.Conclusion Disodium Aidi injection combined with radiotherapy and chemotherapy can improve the cancer-related fatigue of nasopharyngeal carcinoma patients of Ⅲ-ⅣB stage and it can also reduce the incidence rate of Ⅲ-Ⅳ degree adverse reactions.

National Health Information System is mainly used to support decision-making and to improve the current national health situation.Its importance to display the current national health situation and its problems in developing countries were analyzed with the need to construct its effective evaluation framework system pointed out.Construc-tion of UML-based evaluation framework system for National Health Information System was proposed in order to support decision-making and to provide evidence for the health policy makers by comparing the evaluation frame-work systems for National Health Information System in developing countries .

Objective To summarize the reasons of bleeding complications and the prevention methods in stenting for intracranial arterial stenosis.Methods The clinical data of 366 patients underwent stent-assistant angioplasty of intracranial artery stenosis from July 2006 to December 2011were analyzed retrospectively.Among them,14 patients with bleeding complications were found.The initial 100 patients were categorized as early stage group and the rest as mature stage group.The reasons of bleeding and the methods for preventing this complication were summarized.Results The overall incidence of bleeding complication was 3.8％ (14/366).In the early stage group and mature stage group,the rates was 10％(10/100) and 1.5％ (4/266).Six cases were related to the operational manipulation and 8 cases secondary to hyperperfusion injury.Death was found in 6 patients,severe disability in 3,mild paralysis in 2,and no neurological deficits in 3.Conclusions The bleeding complications in stent-assisted angioplasty of intracranial artery stenosis have a high disability and mortality.The improvement of operative techniques and the more strict indications decrease the bleeding complications rate effectively.