Objective To investigate influence and significance of preoperative transcatheter arterial chemoembolization (TACE) on disease-free survival rates and overall suvival rates in patients with respectable large hepatocellular carcinoma(HCC). Methods One hundred and eight patients with respectable large primary liver cancers were prospectively randomized into two groups: preoperative TACE group(n=52) and one-stage operation group(n=56). We compared between two groups according to daughter nodules and tumor thrombus. Results There were no significant differences in the incidence of disease-free survival rates and overall suvival rates in the two groups. Conclusion Preoperative TACE for resectable large HCC should be used on bases of strict selection because it does not decrease the recrudescence rates and results in delayed surgery in some cases.

Currently,since a single treatment standard of benign tumors of liver is not established,many serious out-comes due to the excessive treatment of benign tumors of liver still happen sometimes.We should pay attention to composing the guideline on the treatment for the different types of benign tumors of liver on the basis of the multidisciplinary cooperation and the randomized controlled trials,and achieving the goals of an unified standard and the standardized therapy,meanwhile,avoiding the pain and burden of excessive treatment on the patients.

Recently,basic and clinical researches have shown that blood glucose variability is an independent risk factor for diabetic complications.Thus,ideal control of blood glucose is not only to reach the HbA1Ctarget,but also to minimize blood glucose variability.Different glycemic parameters could be selectedaccording to different purpose of evaluation,in which the mean amplitude of glucose excursions(MAGE) and the standard deviation of blood glucose (SDBG) could be used as accurate and simple assessment parameters respectively.

The treatment principle for primary liver cancer referring as hepatocellular carcinoma (HCC) in this article is comprehensive treatment based on radical hepatectomy. Focusing on improving the resection rate and reducing the recurrence rate after operation, the conversion therapy, preoperative neoadjuvant therapy and postoperative adjuvant therapy have emerged to become potentially curative strategies and research hotspots. HCC is highly invasive and often complicated with cirrhosis, so comprehensive treatment is essential for better prognosis. However, due to the controversy of surgical indications and heterogeneity among individuals, the concepts and treatment methods of above three therapies, especially between the conversion therapy and the preoperative neoadjuvant therapy, remain overlap and puzzle sometimes. Moreover, because of the different therapy goals, the above three therapies are different in the selection of treatment methods, duration of therapy and evaluation criteria. Based on clinical practice, the authors investigate the progress and hot spots of the conversion therapy, preoperative neoadjuvant therapy and post-operative adjuvant therapy of HCC, expecting more clinical evidence-based medicine to standardize the development of comprehensive treatment, so as to become a breakthrough to improve the diagnosis and treatment of HCC.

Hepatic vein hemorrhage and air embolism are easily caused during the resection of the tumor involving the second hepatic hilum.Hepatic vein occlusion has been proven to decrease this risk,while classic selective hepatic vein occlusion with tourniquet is technique demanding.We modified the classic method by using Satinsky clamp in hepatic vein dissection and occlusion.Based on the clinical data of 220 patients who received hepatic vein occlusion with tourniquet and 330 patients with Satinsky clamp,we proved that hepatic vein occlusion with Satinsky clamp is simpler,safer and with high success rate.

MicroRNA (miRNA) is a class of endogenous,single-stranded non-coding small RNA that contains 21 to 23 nucleotides and is widely distributed in eucaryon,miRNA plays an important regulatory role in cell proliferation,apoptosis,growth and development through the regulation of gene translation after transcription and expression,miRNA has a close relationship with pathogenesis and development of hepatocellular carcinoma.And in this process,part of miRNA acts as oncogenes or tumor suppressor genes.A number of miRNA,such as miR-30d,miR-221,miR-222 and miR-101,had been found to express abnormally in hepatoeellular carcinoma.Here we summarize the related progress in research of miRNA and hepatocellular carcinoma.

Dead-in-bed syndrome (DBS) is a rare but devastating sudden death condition that mainly affects young patients with type 1 diabetes.Its mechanism is quite complicated and may involve multiple factors.Acute onset of recurrent and severe nocturnal hypoglycemia,abnormal cardiac repolarization,genetic factors,and obstructive sleep apnea may all contribute to ventricular arrhythmias and even sudden death.The future research plans include elucidating and understanding the underlying mechanisms and triggers for DBS,developing a risk stratification system,using real-time continuous glucose monitoring system to detect severe nocturnal hypoglycemia,and initiating appropriate therapeutic interventions to uhimately prevent the tragedy.

Objective To probe into the anatomy and clinical application of the facial nerve canal surface by multislice spiral CT image curved planar reformation. Methods Fifty patients with facial nerve disease were selected as study group from January to November in 2010, 50 healthy subjects were selected as control group, using models of multislice spiral CT scan for the patient, scanning from the upper edge of the orbital under external auditory canal edge of the connection as a horizontal line, ranging from the lower edge of mastoid process to the petrous bone on the edge of the data obtained in the Wizard workstation reconstruction. All the measurements were more than two measurements of the average physician. Results Normal facial nerve canal in control group could be displayed clearly in an image, display rate was 100.00%(50/50), and the segment data could be accurately measured; axial reconstruction, reconstruction of coronal and sagittal reconstruction of the three comparison of measured direction, fan sections, horizontal and vertical segments of the length and diameter were not significantly different (P＞0.05), and the first and second bending angle of bending angle was no significant difference (P ＞ 0.05 ). Compared with control group, the patients with vascular disease in study group showed significantly decreased rate, the difference was significant (P ＜ 0.05). Conclusion Curved planar reformation of multislice spiral CT diagnosis of facial nerve canal disease has great clinical significance, should be widely applied.

Objective To evaluate the risk factors for the postoperative acute renal failure requiring dialysis (ARF-D)after heart valve surgery. Methods Adult patients (age≤18 years) underwent valve surgery with preoperative serum creatinine ＜300 μmol/L were included between January 2005 and December 2008. Fifty patients developed ARF-D within 30 days postoperatively (ARF-D group). While random 220 patients had the same operation without ARF-D served as the control group. Univariate analysis and multivariable logistic regression were used to identify risk factors of ARF-D after valve surgery.Results The incidence of ARF-D was 1.78%, and the early mortality rate was 65.5%. Multivariate analysis identified the following independent risk factors of ARF-D: age, previous cardiac surgery, preoperative serum creatinine, NYHA class Ⅳ,and low cardiac output syndrome. ARF-D group had a longer hospital stay and ICU stay than that of the control group ( P ＜0.001 ). Conclusion Conclusion ARF-D had a higher mortality rate and longer hospital stay following heart valve surgery.Age, previous cardiac surgery, preoperative serum creatinine, NYHA class Ⅳ, and low cardiac output syndrome were the independent risk factors of ARF-D after heart valve surgery.

[Summary] Thedawn phenomenon is a term used to describe hyperglycemia or an increase in the amount of insulin needed to maintain normoglycemia, occurring in the absence of antecedent hypoglycemia, during the early morning hours, and mostly affecting children with type 1 diabetes. Currently, hyperglycemia before breakfast time is defined as dawn phenomenon, and postbreakfast abnormal hyperglycemia is referred as the extended dawn phenomenon. Dawn phenomenon is regarded as the result of the β cell dysfunction, which increased endogenous glucose production and the persistent insulin resistance. By using continuous glucose monitoring technology, dawn phenomenon can be effectively identified:The difference between the lowest glucose level during nocturnal time and the glucose value before breakfast over 1. 11 mmol/L. And the long-acting insulin analogs and insulin pump are effective treatments for dawn phenomenon.