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Recently, several clinical studies have evaluated the first-line use of immune checkpoint inhibitors (ICIs) combined with platinum-doublet chemotherapy in patients with non-squamous non-small cell lung cancer (NSCLC), however, the differences in safety and efficacy between the various types of ICIs still require investigation. In this study, we evaluated the efficacy and safety of the first-line use of ICIs combined with platinum-doublet chemotherapy in patients with non-squamous NSCLC by meta-analysis and indirect comparison.Literature searches were performed using PubMed, the Cochrane Library, Embase, China Knowledge Resource Integrated Database, and Wanfang Data to identify all relevant randomized clinical trials for non-squamous NSCLC after 2010. Overall survival (OS), progression-free survival (PFS), and adverse effects (AEs) were pooled for meta-analysis and indirect comparison. Subgroup analyses were conducted to examine the factors associated with PFS.The meta-analysis showed that the additional use of ICIs could significantly improve PFS and OS. The indirect comparison showed no significant difference in pembrolizumab + chemotherapy and atezolizumab + chemotherapy in the reducing of disease progression, while a significant difference in restricted mean survival time (RMST) was found between pembrolizumab + chemotherapy compared with atezolizumab + chemotherapy. A significant increase in grade ≥3 AEs was observed with the additional use of atezolizumab combined with chemotherapy. Subgroups including PD-1 status [high (50%), intermediate (1-49%), and negative (1%) expression], sex (male and female), smoking status (current or former smoker, and never smoked), liver metastases (with and without), age (65 and ≤65) and Eastern Cooperative Oncology Group (ECOG) score (ECOG=0 and ECOG=1) were all associated with better PFS.This meta-analysis confirmed the treatment effects of ICIs combined with chemotherapy for non-squamous NSCLC. The pembrolizumab combination group had a greater RMST benefit compared with the atezolizumab combination group. Furthermore, our study also demonstrated a PFS advantage for non-squamous NSCLC using ICIs combined with chemotherapy irrespective of programmed death-ligand 1 (PD-L1) expression level, smoking status, liver metastasis status, sex, age and ECOG score. Due to the significant increase in AEs (grade 3), more attention should be paid to the additional use of atezolizumab.

To investigate the clinical characteristics and prognosis of acute myeloid leukemia(AML) patients with ASXL1 mutation.The clinical data of 229 newly diagnosed AML patients treated in our hospital from April 2016 to October 2019 were analyzed retrospectively. The next-generation sequencing technology was used to detect gene mutations in all the patients, the clinical characteristics of the patients with ASXL1 mutation were analyzed.ASXL1 gene mutation was detected out in 45 patients(19.6%). Among these patients, the frameshift mutation (n=22,48.9%) was most common, followed by missense mutation (n=15, 33.3%) and nonsense mutation (n=8,17.8%), respectively, all of them were located at exon 12. The median mutation rate was 32.47%(range, 2.74%-53.50%). The median age of the patients with ASXL1 mutation was 54(range, 14-74) years old, and most of the patients were male, and most of them with the history of MDS or MPN, and low white blood cell count at the initial diagnosed (P0.05). Patients with ASXL1 mutation showed a lower CR rate than that of without ASXL1 mutation. Patients with or without ASXL1 mutation showed a statistically significant difference in survival at 20 months (P=0.042), while there was no significant difference between the patients in the two groups over 20 months (P=0.505). All the 6 patients with ASXL1 mutation in low-risk group were survived, while the median OS time was 16 months in the high-risk group(P=0.034). Multivariate analysis showed that the history of MDS or MPN and CR rate from induction therapy were the independent risk factors affecting survival of the patients.Frameshift mutation is commonly in AML patients with ASXL1 gene mutation, and ASXL1 mutation were more often in men, the history of MDS or MPN, and low white blood cell count. The CR rate of the patients with ASXL1 mutation was lower than that of the AML patients without ASXL1 mutations, AML patients with ASXL1 mutation showed poor short-term efficacy, but there was no significant difference between the two groups in long-term survival over 20 months.伴ASXL1基因突变的急性髓系白血病患者的临床特征及预后分析.探讨伴有ASXL1基因突变的急性髓系白血病（AML）患者的临床特征及预后.回顾性分析2016年4月至2019年10月就诊于空军军医大学唐都医院血液科的初诊AML患者229例的临床资料，采用二代测序技术进行基因突变检测，分析ASXL1基因突变患者的临床特征并进行预后分析.共45例（19.6%）患者检测到ASXL1基因突变，移码突变22例（48.9%），错义突变15例（33.3%），无义突变8例（17.8%），均位于12号外显子。中位突变比例为32.47%（2.74%-53.50%）。伴有ASXL1基因突变的患者中位年龄为54（14-74）岁，以男性患者多见、且前期多有MDS或MPN病史、初诊时外周血白细胞数不高。伴有ASXL1突变组的患者诱导化疗完全缓解率低于无ASXL1突变的患者。伴或不伴ASXL1突变的患者在20个月内的生存具有统计学差异（P=0.042），而20个月以上的两组患者OS时间无差异（P=0.505）。伴ASXL1基因突变患者中，预后良好者6例全部存活，预后不良组中位OS时间16个月（P＝0.034）。多因素分析显示，前期血液病史及诱导治疗是否获得CR是影响预后的独立不良因素.伴ASXL1突变的AML患者中以移码突变常见。ASXL1突变多见于男性，起病白细胞不高，且易存在前期血液病史。伴ASXL1突变AML患者的CR率低于无ASXL1突变组，且短期疗效更差（≤20个月），但20个月以上的长期生存无显著差异.

Thalidomide induces γ-globin expression in erythroid progenitor cells, but its efficacy on patients with transfusion-dependent β-thalassemia (TDT) remains unclear. In this phase 2, multi-center, randomized, double-blind clinical trial, we aimed to determine the safety and efficacy of thalidomide in TDT patients. A hundred patients of 14 years or older were randomly assigned to receive placebo or thalidomide for 12 weeks, followed by an extension phase of at least 36 weeks. The primary endpoint was the change of hemoglobin (Hb) level in the patients. The secondary endpoints included the red blood cell (RBC) units transfused and adverse effects. In the placebo-controlled period, Hb concentrations in patients treated with thalidomide achieved a median elevation of 14.0 (range, 2.5 to 37.5) g/L, whereas Hb in patients treated with placebo did not significantly change. Within the 12 weeks, the mean RBC transfusion volume for patients treated with thalidomide and placebo was 5.4 ± 5.0 U and 10.3 ± 6.4 U, respectively (P β0/β0 and HBS1L-MYB (rs9399137 C/T, C/C; rs4895441 A/G, G/G) genotypes. These results demonstrated that thalidomide is effective in patients with TDT.

Background To investigate the reference value of blood gas analysis and related factors in healthy adults in Diqing Tibetan Autonomous Prefecture in Yunnan Province. Methods From August 24, 2018 to August 11, 2020, healthy people between the ages of 18 and 70 years were observed at the Physical Examination Center of People's Hospital of Diqing Tibetan Autonomous Prefecture in Yunnan province. Participant information and clinical characteristics were collected. Blood gas analyzer was used to measure PH value, arterial partial oxygen pressure (PaO2), arterial partial pressure of carbon dioxide (PaCO2), arterial oxygen saturation (SaO2), acidity (pH), actual bicarbonate (AB) and residual base (BE). The participants' basic and blood gas indicator data were analyzed, and the blood gas reference values and related factors were analyzed using chi-squared tests, Mann-Whitney-Wilcoxon Test, and Spearman's correlation analysis. Results A total of 1,218 eligible health examination participants were included. They had an average age of 40 [31-47] years, and males accounted for 51.0%. In terms of blood gas reference values, the average pH value was moderate, and the values of PaO2, SaO2, PaCO2, AB, and BE were low. PaO2 was basically matched with the estimated value of the domestic model formula. These indexes were found to be correlated with social demographic characteristics such as sex, age, and smoking history. Conclusions The correlations between the indexes and social demographic characteristics may be helpful in the prediction of blood gas analysis results in clinical practice. For men, middle-aged and elderly people, or adults with a history of active smoking/biofuel exposure, blood gas PaO2 and PaCO2 should be monitored to facilitate the early intervention of respiratory failure. The PaO2 data basically matched the estimated values of the domestic model formula, suggesting that other regions in the Prefecture could use comprehensive epidemiological data and model methods to guide clinical work.

Aim. To explore the associations between adverse events and pharmacotherapy in patients with non-small cell lung cancer. Methods. 16,527 patients with non-small cell lung cancer admitted to the Cancer Hospital, Chinese Academy of Medical Sciences, between January 1, 2010, and December 31, 2016, were included in the study. Their medication and laboratory examinations data were extracted from the medical records. Common Terminology Criteria for Adverse Events Version 4.03 were utilized for adverse events reporting. A new association algorithm was developed based on Apriori algorithm and used to investigate the associations between drugs and adverse events. In addition, a statistical comparison was conducted to compare the modified Apriori algorithm with the conventional Apriori algorithm. Results. Different types and levels of adverse events were identified from the abnormal laboratory findings. The three most common adverse events were hypocalcemia, elevated creatine phosphokinase, and hypertriglyceridemia. In addition, using the modified Apriori algorithm, 380 association rules were found between adverse events and chemotherapy. Moreover, the statistical comparison of the two methods demonstrated that the modified Apriori algorithm was more advantageous in analyzing the correlation between drugs and adverse events than the conventional Apriori algorithm. Conclusions. The modified Apriori algorithm can be used to more efficiently associate pharmacotherapy with adverse events. Based on the modified Apriori algorithm, meaningful association rules between drugs and adverse events were found, demonstrating a promising way to reveal the risk factors of adverse events during cancer treatment.

The objective of this study was to evaluate the efficacy and safety of a traditional Chinese medicine, Fufang Xuelian Burn Ointment (FXBO), to treat superficial and deep second-degree burn wounds. A four-center, randomized, controlled, and prospective study was conducted. Overall, 240 patients with either superficial or deep second-degree burn wounds were enrolled consecutively in this study. Patients who were randomly assigned to the control group (superficial: 72, deep: 48) underwent common burn wound therapy, whereas those randomized to the treatment group (superficial: 72, deep: 48) received common burn wound therapy plus topical FXBO. The healing rate, healing time, effective rate, and safety data were compared between the two groups. The baseline characteristics were comparable for the two groups. The healing rate was 94.79(±7.50) in the control group and 98.60(±5.69) in the FXBO group after 14 days for patients with superficial second-degree burn wounds (P = 0.000), and 95.17(±9.68) versus 97.44(±9.81) at 28 for deep second-degree burn wounds (P = 0.025). The median healing time in the FXBO group were 9 and 21 days for superficial and deep second-degree burns, respectively, compared to 10.5 and 22.5 days, respectively, in control group (P(superficial) = 0.000 and P(deep) = 0.009). The results of the effective rate showed that comprehensive efficacy of the FXBO group was improved compared to the control group for either superficial or deep second-degree burns (P(superficial) = 0.035 and P deep = 0.003). There were no reported drug-related adverse events in both groups. Therefore, FXBO was well tolerated and more effective than control group for treating superficial and deep second-degree burn wounds.

To observe the effect of geniposide on non-alcoholic fatty liver disease (NAFLD), and discuss the mechanism of geniposide for NAFLD from the aspect of free fatty acid, forty healthy Wistar male rats were randomly divided into normal group, model group, geniposide and Xuezhikang group. The rats in normal group were fed with normal diets, and the rats in other 3 groups were given with high-fat diet for 8 weeks to induce the NAFLD models. From the week 5 to end of week 8, the rats in geniposide and Xuezhikang group were intervened with corresponding medicines. The body weight, liver wet weight, and fat weight of the rats were recorded. Visual and pathological changes in hepatic tissues were observed with HE staining. The contents of TG, FFA, FAS, AMPK, ACCase and Malonyl-CoA in hepatic tissue, contents of CHO and LDL-C in serum and activities of AST and ALT in serum were detected by using corresponding methods. The results showed that the body weight, liver wet weight, and fat weight of the rats, CHO, LDL-C, ALT and AST levels in serum, TG, FFA, FAS, ACCase and Malonyl-CoA levels in hepatic tissues of the rats in model group were significantly higher than those in normal group (P

Objective To investigate the effects of Zhi Zi (Fructus Gardeniae) on non-alcoholic fatty liver disease (NAFLD) induced by a high-fat diet in the rat. Methods A rat model of NAFLD was established using a high-fat diet. Twenty one rats were randomly divided into a normal group, a model group and a Zhi Zi treatment group, 7 rats per group. Drinking water and the drug were intragastrically administrated for 5 weeks. Samples were then taken to observe pathological changes of the liver tissue (HE staining); changes in the fat metabolism pathway e. g. triglyceride (TG) and free fatty acid (FFA) content; alterations in liver function, i.e. serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity; and differences in tumor necrosis factor α (TNF-α) and P-lkB protein expression in the liver tissue. Results Fatty degeneration and vacuole-like changes of different degrees occurred in hepatic cells of the model group. Markers for fat metabolism, serum ALT and AST activities, and expression of TNF-α and P-lkB proteins in liver tissue significantly increased. Fat metabolism in the Zhi Zi group significantly reduced, as shown by a drop in marker levels. Serum ALT and AST activities, and expression of TNF-α, P-lkB proteins in liver tissue were also significantly decreased in this group. Conclusion Zhi Zi has a very strong inhibitory action on lipidosis and inflammatory injury in the rat model of NAFLD. This mechanism may possibly be related to the inhibition of the free fatty acid metabolism pathway.

Summary Aims Although compelling evidence suggests that human hypothalamic hamartoma (HH) is intrinsically epileptogenic for gelastic seizures, the molecular mechanisms responsible for epileptogenesis within HH remain to be elucidated. The aim of this study was to test the hypothesis that hyperactivation of BDNF-TrkB signaling pathways in surgically resected HH tissue is a possible mechanism for downregulation of KCC2 expression, which in turn underlies GABA-mediated excitation within HH. Methods Activation of three major BDNF-TrkB signaling pathways including MAPKs, Akt, and PLCγ1 were evaluated in surgically resected HH tissue (n = 14) versus human hypothalamic control tissue (n = 8) using combined methodologies of biochemistry, molecular biology, cell biology, and electrophysiology. Results Our data show that compared with hypothalamic control tissue, in HH tissue, (i) activation of TrkB and expression of mature BDNF are elevated; (ii) MAPKs (including ERK1/2, p38, and JNK), Akt, and PLCγ1 are highly activated; (iii) KCC2 expression is downregulated; and (iv) pharmacological manipulation of TrkB signaling alters HH neuronal firing rate. Conclusion Our findings suggest that multiple BDNF-TrkB signaling pathways are activated in HH. They act independently or collaboratively to downregulate KCC2 expression, which is the key component for GABA-mediated excitation associated with gelastic seizures.

To investigate the antiproliferative effect of cycloartan-24-ene-1alpha, 2alpha, 3beta-triol from Myrrh against human prostate cancer cells.Morphological changes of compound-treated human prostate PC3 cells were determined by staining cells with Hoechst. The cell cycle progression and apoptosis were evaluated using flow cytometry assay. Apoptosis related protein levels were analyzed using Western blotting.Treatment of PC3 cells with cycloartan-24-ene-1alpha,2alpha,3beta-triol caused an increase ratio of apoptotic cells, which was verified by flow cytometry. It was also found that cycloartan-24-ene-1alpha,2alpha, 3beta-triol arrested cell cycle at the G0/G1 phase. Apoptosis related proteins, such as BCL-2, BAX, Caspase-3 and Caspase-9 were changed.These observes data indicate that cycloartan-24-ene-1alpha,2alpha,3beta-triol inhibit the proliferation of PC3 cells via induction of apoptosis and cell cycle arrest.

To understand the demographic, occupational and clinic characteristics of occupational poisoning case due to trichloroethylene in Dongguan in recent years for the purpose of prevention.Using the trichloroethylene patients of poisoning diagnosed in the years between 2002 to 2009 as subjects, their age, sex, industry, job, working duration and exposure level were analysed.In Dongguan between 2002 and 2009 altogether 82 cases were reported, among the 82 cases 8 patients were dead with case fatality rate of 9.8%. among them there were 12 cases of poisonings(8 females ,4 males); 9 cases were classified as mild poisonings and the rest serious ones, among the 12 cases 3 patients were dead with case fatality rate of 25.0%; Dermatitis caused by TCE there were 70 cases (37 males and 33 females), among the 70 cases 5 patients were dead with case fatality rate of 7.1%. 11 persons (91.7%) were engaged in the job of cleaning and 1 (8.3%) in water gun, and they performed the job only for 3 days in shortest and for 450 days in longest. The cases were distributed in the jobs as the following: 29 (41.4%), 12 (17.1%), 8 (11.4%), 5 (7.1%), 4 (5.7%), cases respectively in the job of cleaning, parts hanging, board washing, painting, gun water spraying; a job duration of 1-50 d (27.4 days in average).In summary the TCE poisonings in Dongguan were two types of poisoning, i.e., systematic poisonings and drug rash-like dermatitis, occupational TCE poisonings took place mainly in the cleaning workers. Dermatitis caused by TCE can cure but hard to prevent, we should strengthen the early examination of new works.

To study the effects of genistein on the proliferation, apoptosis induction and expression of related gene proteins of human colon cancer cells in vitro and in vivo, and its mechanisms of action.MTT colorimetric assay was used to detect the effects of genistein on the proliferation of human colon adenocarcinoma SW480 cells. Light and transmission electron microscopy were used to study the histological and ultrastructural changes. Flow cytometry was used to determine the effects of genistein on cell cycle and apoptosis. Flow cytometry and immunohistochemistry were used to determine the effects of genistein on apoptosis induction and expression of related gene proteins of colon cancer cells.The MTT colorimetric assay showed that genistein inhibited the proliferation of SW480 cells in a dose-dependent and time-dependent manner, and the highest inhibition rate was 60.2% after 80 microg/ml genistein treatment for 72 h. The light microscopy revealed that many genistein-treated cancer cells were shrunken, disrupted, or showing cytoplasmic vacuolization. The electron microscopic examination showed cell shrinkage, nuclear fragmentation and pronounced chromatin condensation, sometimes formed crescent chromatin condensation attached to the nuclear membrane. The results of flow cytometry showed that: after SW480 cells were treated with 0, 20, 40, 80 microg/ml genistein for 48 h, the FI values of PCNA were 1.49 +/- 0.02, 1.28 +/- 0.04, 1.14 +/- 0.03, and 0.93 +/- 0.08; the FI values of VEGF were 1.75 +/- 0.02, 1.34 +/- 0.06, 1.32 +/- 0.04, and 1.23 +/- 0.04; the fluorescence index (FI) values of p21 were 1.26 +/- 0.05, 1.36 +/- 0.06, 1.61 +/- 0.03, and 1.73 +/- 0.03, respectively. There were statistically significant differences between the control group and each treatment group (P0.05 or P0.01). The scores of immunohistochemical staining of PCNA and VEGF proteins were decreased, while p21 increased. There were statistically significant differences between the control group and each treatment group (P0.05 or P0.01).Genistein can inhibit the growth of colon cancer cells via apoptosis induction and cell cycle arrest at G(2)/M phase. The anti-tumor mechanisms of genistein may be related with the down-regulation of expression of VEGF and PCNA, and up-regulation of the expression of p21.

To investigate the effects of arginine enriched enteral nutrition (EN) on nutritional status and cellular immunity of severely burned patients.Randomized, single blind, parallel and positive control investigation was employed in the study. Thirty severely burned patients were divided into enteral immune nutrition (EIN) group and EN group. Sixteen patients in EIN group received enteral nutrition enriched with arginine, while the other 14 patients in EN group received standard enteral nutrition. Nutritional support was continued for 14 days. Gastrointestinal reaction of patients in 2 groups was observed. Fasting venous blood was drawn from patients of both groups before receiving nutrition treatment and on the morning of 7th, 14th day of treatment. Level of serum protein, hepatic function parameters, renal function parameters, fasting-blood glucose, and subpopulations of T lymphocytes in peripheral blood were determined.(1) Incidence of gastrointestinal side effect in EIN group (25.0%) was close to that of EN group (21.4% , P0.05). (2) Compared with pre-treatment days, levels of prealbumin and transferrin in serum of patients in 2 groups on 7th and 14th post-treatment days were significantly increased (P0.05 or P0.01), but there was no significant difference between 2 groups. The level of total serum protein on 14th day of treatment of patients was significantly increased in both groups, and that of EIN group (66 +/- 7 g/L) was significantly higher compared with that in EN group (64 +/- 11 g/L, P0.05). The level of serum albumin (29 +/- 5, 32 +/- 5 g/L, respectively) of patients in EIN group on 7th and 14th day of treatment were significantly higher than that (26 +/- 4 g/L, P0.05) in pre-treatment days, however there was no significant difference in EN group. (3) There was no significant difference in respect of hepatic function, renal function, and fasting-blood glucose between pre-treatment and post-treatment periods in both groups (P0.05). (4) The ratio of CD4(+), CD8(+) on 14th day of treatment in EIN group was close to that of pretreatment level. In EN group, cell percentage of CD4(+) significantly decreased, while that of CD8(+) significantly increased (P0.05), and CD4(+) was significantly higher [(56 +/- 8)%] in EIN group than that in EN group [(55 +/- 12)%, P0.05]. In both groups, cell percentage of CD3(+) was significantly higher than that in pre-treatment days (P0.05), while there was no obvious change in CD4(+)/CD8(+).Arginine enriched enteral nutrition can effectively improve nutritional status and cellular immune function of burn patients.

The present study aimed to evaluate the long-term outcomes and prognostic factors of elderly patients with hepatocellular carcinoma (HCC) undergoing hepatectomy. From January 1983 to December 2006, 2,283 patients with HCC received hepatectomy in Sun Yat-sen University Cancer Center. The clinicopathological data and treatment outcomes of 67 elderly HCC patients (elderly group, ≥70 years of age) and 268 patients (control group

To investigate the effects of taurine on myocardial mitochondria and their enzyme activities in rats with severe burn.One hundred and twenty healthy adult Wistar rats were subjected to 30% TBSA full-thickness burn. They were randomly divided into burn group (B, with intraperitoneal injection of isotonic saline), treatment group (T, with intraperitoneal injection of taurine, 200 mg/kg),with 60 rats in each group . Ten rats with sham scald were used as control (S group). The myocardial tissue samples in B and T groups were harvested at 1, 3, 6, 12, 24 and 48 postburn hours (PBH) for determination of activity respectively of succinate dehydrogenase (SDH), cytochrome oxidase (CCO), the superoxide dismutase (SOD), Ca2+ -ATPase in mitochondria, and contents of cytochrome c (Cyt c), cytochrome aa3 (Cyt aa3), malondialdehyde (MDA), and Ca2+ in mitochondria and cytoplasm . The myocardial tissue samples of controls were harvested at 1 PBH for determination of above indices.The activity of CCO in B group was decreased at 1 PBH , especially at 6 ,12 PBH. The activity of SDH in B group was decreased to lowest level at 6 PBH, and its value was lower than that of S group at each time point. The activity of CCO or SDH in T group was not obviously decreased, and the activity of CCO at 3, 6, 12 PBH showed significant difference compared with B group (P0.05). The contents of Cyt aa3 and Cyt c in B group at 3, 6, 12, 24 PBH were obviously decreased, which were significantly lower than those in T group (P0.05). The activity of SOD in B group at 3, 6, 12 PBH was obviously decreased, the activity of Ca2+ -ATPase at 3, 6, 12 and 24 PBH was decreased to different extent, which was significantly lower than those in T group (P0.05). The MDA contents in B and T groups were higher than that in S group at 3-48 PBH ,and it was highest in B group (P0.05). The Ca2+ content of mitochondria in B group at 1 PBH was increased (13.7 +/- 1.5), and it was (24.8 +/- 2.6), (29.7 +/- 3.1), (16.3 +/- 1.9) and (13.5 +/- 1.7) at 3, 6, 12, 24 PBH respectively,and they were all higher than that of S group (10.7 +/- 1.6, P0.05). The Ca2 contents of cytoplasm in group B at 3 - 24 PBH were also higher than that in S group (P0.05). The Ca2+ content of mitochondria in T group at 3, 6, 12, 24 PBH was (16.8 +/- 2.8), (18.7 +/- 1.9), (10.5 +/- 1.8) and (13.3 +/- 1.7)respectively, which were lower than that in B group at every time point.Taurine have protective effect on mitochondria and their enzyme activities in myocardium in rats with severe burn, and it may be attributable to improving the ability of eradicating oxygen free radicals and alleviating Ca2+ overload in the mitochondria.

To investigate the effects of glutamine enriched enteral feeding on immunoregulation in burn patients.Twenty burn patients were randomly divided into enteral nutrition (EN) group and enteral immune nutrition (EIN) group, with 12 patients in each group. Patients in EN group received a standard enteral formula, while those in EIN group received an enteral formula enriched with glutamine after hospital admission. Nutritional support was continued for 10 days. Blood samples were obtained to determine plasma level of total protein (TP), albumin (ALB), prealbumin (PAB) and transferrin (TF) at 1, 4, 7, 10 post-burn days (PBD). At the same time the concentration of immunoglobulin (IgA, IgG and IgM) were determined, the percentage of CD3+, CD4+, CD8+ subpopulations of T lymphocytes, and the ratio of CD4+/CD8+ were determined by FCM.(1) There were no obvious difference of the plasma level of TP, ALB, TF, CD3+, IgM between the two groups at each time-point (P0.05). (2) The plasma PAB contents in EIN group were significant higher than that in EN group on 4 PBD [(90 +/- 14 vs 60 +/- 15) mg/L, P0.05], 7 PBD [(92 +/- 16 vs 64 +/- 13) mg/L, P0.05] and 10 PBD [(106 +/- 21 vs 72 +/-16) mg/L, P0.05]. (3) The percentage of CD4+ subpopulation and ratio of CD4+/CD8+ in EIN group were obviously higher than those in EN group on 7 PBD [CD4+ (55 +/- 5 vs 45 +/- 5)%, CD4+/CD8+ (1.92 +/- 0.31 vs 1.53 +/- 0.27)%, P0.05] and 10 PBD [CD4+ (56 +/- 5 vs 49 +/- 5)%, CD4+/CD8+ (2.36 +/- 0.36 vs 1.72 +/- 0.42), P0.05]. (4) The concentration of IgA and IgG in EIN group were markedly higher than that in EN group on 7 PBD [IgA (2.8 +/- 0.6 vs 2.2 +/- 0.5) g/L, IgG (12.1 +/- 1.3 vs 9.8 +/- 1.2) g/L, P0.05] and 10 PBD [IgA (3.1 +/- 0.6 vs 2.5 +/- 0.5) g/L, IgG (14.2 +/- 1.3 vs 10.4 +/- 1.3) g/L, P0.05].These findings suggest that glutamine enriched enteral feeding can improve nutritional status by promoting the synthesis of IgA, IgG, and increasing the PAB concentration, and corrected immunologic dysfunction in burn patients.

To investigate the influence of lanthanum on lipopolysaccharide (LPS) induced NF-KB activation in murine peritoneal macrophage.Peritoneal macrophages were isolated and cultured by routine method, and randomly divided into 5 groups: i. e, control group, LPS group (with LPS stimulation for 30 min), La3+ group (with 2.5 micromol/L La3+ group for 30 min) , La3+ + LPS group( with 1 microg/ml LPS stimulation for 30 min after 30 min incubation with DMEM-F12 containing 2.5 microM of lanthanum.) ; La3+/LPS group (with 2.5 microM of lanthanum stimulation for 30 min, and then with 1 microg/ml of LPS for another 30 min after lanthanum was removed. The location of NF-kappaB p65 subunit (NF-kappaB/p65) in Mphi was detected by immunofluorescence and fluorescence microscope. The binding activity of NF-kappaB/p65 with DNA in nuclei was detected by TransAMTM NF-kappaB/p65 Transcription Factor assay kit. Meanwhile, the expression of NF-kappaB/p65 in nuclei, as well as IkappaBalpha in cytoplasm was measured by Western blotting. TNF-alpha content in culture supernatant were detected by ELISA.(1) The green fluorescence in control, La3+, La3+ LPS and La+/LPS groups was mainly located in cytoplasm, while that in LPS group was located in nuclei. The fluorescent intensity in LPS group was (116 +/- 14), which was obviously higher than that in other 4 groups (42 +/-7,73 +/-30,48 +/- 11 and 67 +/- 19, respectively, P0.01). (2) The IkappaBalpha protein level in cytoplasm in control (0.048 +/- 0.027), La3+ group (0.062 +/- 0.049), La3+ + LPS group (0.066 +/-0.031) and La3+/LPS group (0.108 +/- 0.017) was significantly lower than that in LPS group (0.435 +/-0.066, P0.01). (3) The expression and activation of nucleus p65 protein in Mphi in LPS group was obviously higher than the other 4 groups, but changes in the IkappaBalpha expression between LPS group and other 4 groups was of controversy. (4) TNFalpha level in the culture supernatant in La3+ group was lower than that in control group ( P0.05) and below the detection limit (25 pg/ml). Moreover, it in La3+ + LPS group and La3*/LPS group was lower than that in LPS group (P0.01), but higher than that in control group.LPS can activate the nucleus translocation of NF-kappaB/p65 in Mphi of mice, increase NF-KB/p65 expression and activity, but reduce IkappaBalpha protein expression, which lead to increase of TNFalpha secretion. Lanthanum can inhibit lipopolysaccharide induced NF-kappaB activation.

Weak liver function reserve of hepatocellular carcinoma (HCC) patients with severe cirrhosis lead to high risk of operation. This study was to explore the safety and effects of hepatectomy for HCC patients with severe cirrhosis, and analyze prognostic factors.Clinical data of 67 HCC patients with severe cirrhosis, who underwent hepatectomy from 1998 to 2003, were reviewed. The patients were followed up till March 2006. The prognostic factors were studied by univariate and multivariate analysis.Three patients died after operation. The 1-, 3-, and 5-year cumulative survival rates were 62.6%, 46.7%, and 19.9%, respectively. Univariate analysis showed that Child-Pugh classification, indocyanine green retention rate at 15 min (ICGR15), platelet count, tumor size, number of tumors, and radical resection were significant prognostic factors. Cox multivariate proportional hazard model indicated that Child-Pugh classification and radical resection were independent prognostic factors.Correct preoperative assessment of liver function reserve can increase the safety of radical surgical resection for HCC patients with severe cirrhosis.

To analyze the correlation factors affecting the incidence of burn shock, so as to provide guidance for the clinical treatment of shock after burns.Retrospective analysis of clinical data of 15 624 patients hospitalized in our department from 1973 to 2005 was undertaken . The incidence of shock during every 10 years, as well as the relationship between shock incidence and age, burn area, interval between injury and hospitalization, and complications were analyzed statistically.The incidence of shock during 1973-1980, 1981-1990, 1991-2000 and 2001-2005 periods was 14.69%, 13.50%, 9.38% and 7.88%, respectively, and there was significant difference of shock incidence between each 10 years and its succeeding period (P0.01). The occurrence of shock was closely related to age, length of time between injury and hospitalization, and burn area. The shock incidence of children under 7 years old or elderly more than 60 years old was obviously higher than other age groups, and there was positive relationship between burn area and shock incidence. Moreover, the shock incidence of the patients hospitalized later than 4 to 12 hours after burn shock was also markedly higher than those hospitalized earlier (P0.01). In addition, the incidence of sepsis, alimentary tract hemorrhage, acute renal failure, pulmonary failure, and cardiac failure in patients with shock was obviously higher than those without shock (P0.01).For the children and aged people, special attention should be paid in the prevention and resuscitation of burn shock. Early fluid resuscitation is vital for the prevention of organ complication, and it is beneficial to promote wound healing.

Focal nodular hyperplasia (FNH), inflammatory pseudotumor (IPT), adenomatous nodular hyperplasia (ANH), and focal fatty change (FFC) are common hepatic tumor-like lesions, a group of benign liver diseases, which remains difficult to be distinguished from primary liver cancer (PLC). This study was to investigate the clinical features and treatment of these 4 kinds of hepatic tumor-like lesions.Clinical data of 70 patients with pathologically conformed hepatic tumor-like lesions, treated in Cancer Center of Sun Yat-sen University from 1992 to 2004, were studied retrospectively.Of the 70 patients, 34 (48.6%) had clinical symptoms, and most of them suffered mild pain in the abdomen; 22 (31.4%) were positive for hepatitis B virus (HBV) antigen; 21 had mild abnormal liver function; 6 had alpha fetal protein (AFP)25 microg/L. The ultrasonography and computed tomography (CT) presentations of the tumor-like lesions were various. Only 8 cases of FNH were diagnosed preoperatively. Sixty-one patients received resection, with no postoperative complication occurred. One case of FNH and 1 case of IPT were recurred during follow-up, and treated with non-resection therapy.Hepatic tumor-like lesions are difficult to be distinguished from PLC. Exploratory operation should be performed in cases suspicious of PLC.

Primary clear cell carcinoma of the liver (PCCCL) is a subgroup of hepatocellular carcinoma. At present, little is known about the relationship between the prognosis and the treatment of PCCCL. The purpose of the study was to analyze the clinical and pathological features, and to discuss the relationship between the prognosis and the surgical treatment of PCCCL.Eighteen cases with pathologically proved PCCCL between March 1999 and January 2003 were enrolled, the preoperative and intraoperative clinical features, pathological features and the follow-up data were analyzed.Histological examinations showed PCCCL was characterized by large numbers of vacuolated clear cells. The differentiation degree ranged from grade 1 to 3, liver cirrhosis or/and chronic hepatitis was present in paratumorous tissues. The 1- and 2-year survival rates were 76.5% (13/18) and 47.1% (8/18) respectively, and the median survival time was 23 months. The longest survival time was 97 months after surgery. Among the 13 cases with radical resection, nine cases had recurrence.The clear cells of PCCCL contain substantial quantities of glycogen and lipid. The clinical characteristics of the PCCCL are similar to those of conventional hepatocellular carcinoma. Surgical resection is an effective way to achieve favorable outcomes and even long-term survival of the patients with PCCCL.

To investigate the effects of enteral immuno-nutrition (EIN) combined with recombinant human growth hormone (rhGH) on nutrition metabolism, immunological function and inflammatory response in rats with severe scald.Sixty-four SD rats subjected to 30% total body surface area (TBSA) III degree scalds were randomly divided into EIN and EIN combined with recombinant human growth hormone (EIN+rhGH) groups. Animals of both groups were fed isocaloric enteral nutrition. Nutrition metabolism, T lymphocyte subsets, serum levels of immunoglobulins and inflammatory mediators were determined on the 1, 4, 7 and 10 postinjury day (n=8). Another 8 rats served as controls, and the above-mentioned parameters were also determined.Total protein (TP), albumin (Alb), transferrin protein (TFP), CD3(+), CD4(+), CD4(+)/CD8(+), IgG, IgM and IgA in group EIN+rhGH were slightly higher than those of group EIN (all P0.05) at all time points after the injury, while CD8(+) slightly lowered (P0.05). Serum levels of lipopolysaccharide (LPS), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) plummeted significantly (P0.05 or P0.01)on 4th, 7th and 10th postinjury day compared with group EIN.Our findings indicate that EIN combined with rhGH is superior to EIN alone in the early stage of severe scald in rats, not only ameliorate the disturbance in metabolism and immunological function, but also reduce inflammatory response.

Focal nodular hyperplasia (FNH) is a rare benign hepatic tumor, and its diagnosis and treatment remain controversial. This study was to summarize the clinical features of FNH, and explore its diagnosis and treatment principles.Clinical data of 38 FNH patients, treated in our hospital from Jul. 1997 to Jul. 2004, were studied retrospectively with literature review to summarize the clinical feature, diagnosis, and treatment of FNH. All the patients were followed up till Jul. 2004.Among the 38 patients, 30 (78.9%) were under 40 years old, 26 (68.4%) were asymptomatic, 32 (84.2%) had normal liver function, and alpha fetoprotein (AFP) was negative in all the patients. Correct diagnosis rates were 5.3% (2/38) for B ultrasonography, 45.5% (5/11) for color Doppler ultrasound, 100% (2/2) for contrast-enhanced ultrasound, and 36.8% (14/34) for double-phase helical CT scan. Of the 38 patients, 34 (89.5%) underwent hepatic resection without any complication, 1 underwent biopsy and transcatheter arterial embolization (TAE), 2 underwent biopsy and percutaneous ethanol injection (PEI), 1 only underwent biopsy. The size of lesions didn't change after TAE or PEI. HCC appeared in 2 patients with hepatitis 69 and 32 months after the resection of FNH lesions. At the end of follow-up, 37 patients were survival, and the other one died of other disease 1 year after PEI.The patients with FNH usually have no clinical symptoms with good prognosis. The combination of multiple imaging measures is of help to the diagnosis of FNH. We recommend close observation for patients with confirmed diagnosis of FNH and without clinical symptoms, and recommend surgical resection for those with equivocal diagnosis, symptoms, lesion enlargement, or accompanied with hepatitis or cirrhosis.

The TNM staging system for hepatocellular carcinoma (HCC) was revised by the International Union Against Cancer (UICC) from the 5th edition (TNM5) to the 6th edition (TNM6) in 2002. This study was to evaluate the prognostic value of TNM6 staging in a large cohort study of HCC patients who underwent hepatectomy, and investigate its feasibility and applicability in China.Clinical and follow-up data of 478 HCC patients, who underwent hepatectomy in our center from Jan. 1993 to Dec. 1998, were reviewed retrospectively. Survival rates of the patients were compared according to TNM5 staging and TNM6 staging. The advantages and disadvantages of TNM6 staging were analyzed.According to TNM5 staging, 12 (2.5%) patients were in stage I, 224 (46.8%) in stage II, 95 (19.9%) in stage IIIA, 8 (1.7%) in stage IIIB, and 139 (29.1%) in stage IVA. The 5-year survival rates were 81.8%, 41.5%, 17.0%, 0%, and 10.2%, respectively; there were significant differences in survival rate between stage II and IIIA, between stage II and IIIB, and between stage IIIA and IIIB, but no significant differences were observed between stage I and II, or between stage IIIB and IVA. According to TNM6 staging, 234 (48.9%) patients were in stage I, 41 (8.6%) in stage II, 96 (20.1%) in stage IIIA, 88 (18.4%) in stage IIIB, and 19 (4.0%) in stage IIIC. The 5-year survival rates were 43.3%, 20.2%, 13.1%, 13.0%, and 0, respectively; there was significant difference in survival rate between stage I and II, but no significant differences were found between stage II and IIIA, between stage II and IIIB, and between stage IIIA and IIIB.TNM6 staging has important improvement, and is simpler than TNM5 staging. But TNM6 staging still has limitation, which is not very accurate to predict the prognosis in clinical practice, and is not suitable for Chinese HCC patients who were usually accompanied with cirrhosis.

To investigate the effect of taurine on myocardial injury in severely scalded rats.A total of 130 healthy adult Wistar rats were randomly divided into 3 groups: the control group (C, without burns), the burn group (B, subjected to a 30% TBSA III degree scalding) and the treatment group (T, treated with intraperitoneal injection of taurine (400 mg/kg) immediately after scald injury). The plasma and myocardial tissue samples in B and T groups were harvested at 1, 3, 6, 12, 24 and 48 postburn hours (PBH) for the determination of the contents of cardiac troponin T (cTnT), malondialdehyde (MDA), tumor necrosis factor-alpha (TNF-alpha), and angiotensin II (AngII) in plasma, and the contents of TNF-alpha, AngII and calcium ion in myocardial tissue. The morphological change in the myocardial tissue was observed with transmission electronic microscope (TEM) and was compared with that in C group. The changes in the plasma TNF-alpha and AngII were analyzed in relation to that of plasma cTnT.The plasma cTnT content in B group at 3 PBH was markedly higher than that in C group (0.16 +/- 0.03 microg/L) (P0.01), and it peaked (6.32 +/- 0.41) at 12 PBH and remained at high level at 48 PBH. While the plasma MDA content and the calcium ion level in B group were evidently higher than those in C group during 3 to 48 PBH (P0.01). The TNF-alpha contents in plasma and myocardial tissue during 6 to 48 PBH were significantly higher than those in C group (P0.01). The AngII contents in plasma and myocardial tissue during 3 to 24 PBH were obviously higher than those in C group (P0.01). All the indices in T group were significantly lower than those in B group (P0.01). Histological examination revealed that there was myocardial damage in various degrees during early postburn stage in B group, such as focal dissolution and fragmentation of myofilament, mitochondrial edema, myocyte sarcoplasmic protrusions like piano keys. But all the above changes in T group were evidently ameliorated to near normal. There was close positive correlation between the change in the concentrations of plasma content of TNF-alpha and AngII and cTnT in B group (r = 0.87 and 0.82, P0.05).The production of TNF-alpha, MDA, cTnT, AngII and high calcium ion level of myocardiocytes in severely burned rats can be inhibited by taurine, which was beneficial in the management of myocardial injury after severe burns.

It is important to accurately estimate liver reserve function before hepatectomy for hepatocellular carcinoma (HCC), and to determine proper hepatic resection volume during operation, thus, to avoid postoperative liver failure. Recently, indocyanine green retention rate at 15 min (ICG(R15)) has been considered as a sensitive marker for liver reserve function. However, how to evaluate the maximal hepatic resection volume according to liver reserve function, especially ICG(R15), remains controversial. This study was to evaluate the influence of ICG(R15) and hepatic resection volume on postoperative liver failure.Records of 225 HCC patients who underwent hepatectomy were retrospectively reviewed. Preoperative ICG(R15) value, intraoperative hepatic resection volume, and postoperative liver function were analyzed.Of the 225 patients, 113 received resection of no more than 1 segment (group A), 76 received resection of 1-2 segments (group B), 36 received resection of more than 2 segments (group C). When ICG(R15) was below 10%, the incidences of postoperative ascites in groups A, B, and C were 21.2% (14/66), 14.3% (8/56), and 15.4% (4/26), respectively (P0.05); the incidences of jaundice were 3.0% (2/66), 7.1% (4/56), and 15.4% (4/26), respectively (P0.05). When ICG(R15) was 10%-20%, the incidences of ascites were 26.8% (11/41), 38.9%(7/18), and 50.0% (5/10), respectively (P0.05); the incidence of jaundice was lower in group A than in group B, and group C [0 (0/41) vs. 27.8% (5/18), and 20.0% (2/10), P0.01]; 2 patients, who had 2 or 3 segments resected, died of postoperative encephalopathy. When ICG(R15) was more than 20%, ascites occurred in 2 of 6 patients (33.3%) in group Au both of the 2 cases in group B developed postoperative ascites and jaundice, and 1 died.When ICG(R15) is below 10%, 2 or more segments can be resected safely when ICG(R15) is 10%-20%, 1 segment can be resected safely, 2 or more segments may be resected with great care when ICG(R15) is more than 20%, the patient's general condition and other liver function tests should be taken into consideration if 1 segment is resected, resection of 2 or more segments will cause high surgical risk.

Transcatheter arterial chemoembolization (TACE) is the routine treatment for unresectable primary liver cancer, but 3-year survival rate of patients received TACE alone is only about 20%. This research was to evaluate efficacy of external radiotherapy (RT) combined with TACE on unresectable primary live cancer.From Jun. 1994 to Apr. 2002, 114 patients with unresectable primary liver cancer were non-randomized to receive TACE plus RT (54 patients), or TACE alone (60 patients) as control. For TACE, after skiagram confirmed catheterization, suspension of 300 mg of carboplatin, 50-60 mg of epirubicin, 14-20 mg of mitomycin, and 10-30 ml of iodized oil was perfused into hepatic arteries, 1-2 mm of Gelfoam particles was given to embolize hepatic arteries according to blood supply conditions of tumors, this process was repeated every 4-8 weeks. Either group was treated with 1-4 sessions of TACE. In TACE+RT group, patients received radiation on tumor and generous margin 21-28 days after TACE. The radiation dose was 46-60 Gy in daily 2 Gy fractions.In TACE+RT group, response rate (AFP titer decrease of50%) was 61.1%, and 1-, 2-, 3-year survival rates of TACE+RT group were significantly higher than those of TACE group (66.5% vs. 53.9%, 48.4% vs. 37.2%, and 37.4% vs. 17.8%, P0.05). Three-year survival rate correlated with tumor size, liver function grade, and portal vein embolus.TACE combined with RT may prolong survival time of patients with unresectable primary live cancer.

Accurate estimation of liver reserve function before hepatectomy for liver cancer may avoid postoperative liver failure. Recently,it has been considered that indocyanine green retention rate at 15 minutes (ICG(R15))can assess liver reserve function with exactitude and high sensitivity. This study was to discuss the evaluation of liver cirrhosis severity and liver reverse function by ICG(R15), analyze the relationship between ICG(R15) and post-operative liver failure,and compare ICG(R15) with Child-Pugh grading.Records of 225 patients with resected hepatocellular carcinoma (HCC)have been collected. Pre-operative data, such as a variety of routine liver biochemistry tests, Child-Pugh grading, and ICG(R15) value, and intra-operative data, post-operative data were analyzed.The mean value of ICG(R15) was (9.9+/-6.2)% in cirrhosis group,and (7.4+/-3.8)% in non-cirrhosis group (P0.01). The mean value of ICG(R15) was (8.5+/-5.0)% in mild cirrhosis subgroup, (10.7+/-5.7)% in moderate cirrhosis subgroup, and (15.8+/-9.6)% in severe cirrhosis subgroup; significant differences can be observed while multiple comparisons were performed (P0.05). The mean values of ICG(R15) in patients who suffered from post-operative ascites, and jaundice were (11.5+/-6.8)%,and (12.1+/-7.1)%; significantly higher than those without ascites, and jaundice [(8.5+/-4.9)%,and (9.0+/-5.3)%] (P0.05). Possible predictor variables indicating risk factors of post-operative complications were entered into a multiple logistic regression model, the results showed that ICG(R15) significantly affected the occurrence of both post-operative ascites and jaundice (P0.05). The mean value of ICG(R15) of patients of Child-Pugh B grade was (15.2+/-8.6)%, much higher than that of patients of Child-Pugh A grade [(8.8+/-5.1)%](P0.01). ICG(R15) values were above 10% in 67 of the 212 patients of Child-Pugh A grade, and 6 of these 67 patients have a value above 20%.ICG(R15) value rises with the aggravation of liver cirrhosis,it affects the occurrence of post-operative liver failure significantly. Some correlation can be observed between ICG(R15) and Child-Pugh grading.

Primary liver cancer (PLC) larger than 10 cm in diameter is called huge PLC. Huge PLC accounts for a number of patients at the time of diagnosis in clinical practice. The outcome of resection in these patients has not been clearly demonstrated. This study was to evaluate the outcome and determined the prognostic factors affecting long-term survival following hepatectomy for huge PLC.One hundred and seventy-three patients with huge PLC who underwent hepatectomy from 1964 to 1993 were followed up to January 2003 and reviewed retrospectively. The factors affecting long-term survival were studied by univariate and multivariate analysis.The overall 3-, 5-, and 10-year survival rates were 31.9%, 21.8%, and 8.3%, respectively. Thirty-seven patients survived more than 5 years and 8 patients survived more than 10 years. Univariate analysis showed that sex, Child-Pugh classification, degree of coexisting cirrhosis and radical resection were significant prognostic factors. The Cox multivariate proportional hazard model indicated that independent prognostic factors for long-term survival were degree of coexisting cirrhosis and radical resection.Hepatic resection for huge PLC offers the chance of long-term survival. It should be used to treat patients with huge PLC at first choice. Degree of coexisting cirrhosis and radical resection were the only two prognostic factors for long-term survival following hepatectomy for huge PLC.

From April 1990 to December 1993, 140 patients were recruited to a randomized study to evaluate transcatheter hepatic arterial chemoembolization (TACE) as an adjuvant therapy for primary liver carcinoma after hepatectomy. This study investigated the principle, techniques and results of TACE. The results showed that the intrahepatic recurrence rate was 48.9% in the patients who underwent radical resection only, but only 21.3% in the patients who also underwent TACE 3-4 weeks after hepatectomy (P < 0.01). The 1-, 2-, 3-, and 4-year survival rates were 72.3%, 52.7%, 35.1%, and 35.1% respectively for the patients who underwent radical resection only, and were 97.9%, 85.5%, 69.5%, and 56.9% for the patients who also underwent TACE 3-4 weeks after radical resection (P < 0.001). The 1-, 2-, 3-, and 4-year survival rates were 38.9%, 0%, 0%, and 0% for the patients who underwent palliative resection only, and were 68.3%, 32.3%, 21.5%, and 21.5% respectively for the patients undergoing TACE 3-4 weeks after palliative hepatectomy (P < 0.001).

To conduct a randomized trial to evaluate the role of using high-dose iodized oil transcatheter arterial chemoembolization (TACE) in the treatment of large hepatocellular carcinoma (HCC).From January 1993 to June 1998, 473 patients with unresectable hepatocellular carcinoma were divided into two groups: 216 patients in group A received more than 20 mL iodized oil during the first TACE treatment; 257 patients in group B received 5-15 mL iodized oil in the same way. The Child's classification and ICG-R15 for evaluating the liver function of the patients were done before the treatment. During the TACE procedure the catheters were inserted into the target artery selectively and the tumor vessels were demonstrated with contrast medium in the hepatic angiography.The anticancer drugs mixed with iodized oil (Lipiodol) were Epirubicin and Mitomycin. In group A, 112 cases received 20-29 mL Lipiodol in the first procedure, 85 cases 30-39 mL, 19 cases more than 40 mL. The largest dose was 53 mL and the average dose was 28.3 mL. In group B, 119 cases received 5-10 mL Lipiodol,138 cases received 11-15 mL and the average dose was 11.8 mL.High-dose Lipiodol chemoembolization had tolerable side effects and a little hurt to the liver function in the patients with Child's A or ICG-R1520. But the patients with child's B or ICG-R1520 had higher risk of liver failure after high-dose TACE. More type I and type II in CT scan after 4 weeks of TACE were seen in the patients of group A than those in the patients of group B (P0.01). The resection rate and complete tumor necrosis rate of group A were higher than those of group B (P0.05). The 1-,2-, 3-year survival rates of group A patients with Child's A were 79.2 , 51.8 and 34.9 , respectively, better than those of group A (P0.001).High-dose Lipiodol can result in more complete tumor necrosis by blocking both arteries and small portal vein of the tumor. High-dose TACE for treatment of large and hypervascular hepatocellular carcinoma is practically acceptable with the better effect than the routine dose. For the patients with large and hypervascular tumor of Child grade A liver function or ICG-R15 less than 20%, oily chemoembolization with 20-40 mL Lipiodol is recommended.

Background Locally advanced (pT3-4N0M0) hepatocellular carcinoma (HCC) is a heterogeneous group of tumors, which consists of four different categories, including HCC with "multiple tumors more than 5 cm", "major vascular invasion", "invasion of adjacent organs", and "perforation of visceral peritoneum". The aim of our study was to verify whether the 2002 version of the Tumor-Node-Metastasis staging system could predict surgical outcomes in patients with locally advanced HCC. Methods We retrospectively reviewed 298 patients with pT3-4N0M0 HCC who underwent hepatic resection from 1993 to 2000 in an academic tertiary hospital. Overall survival (OS) and cumulative recurrence rate (CRR) of the four categories of locally advanced HCC patients were compared. Results In multivariate analysis, major vascular invasion was identified as the most significant factor (HR = 3.291, 95% CI 2.362-4.584, P < 0.001) followed by cirrhosis status on OS, and was found to be the only independent factor of CRR (HR = 2.242, 95% CI 1.811-3.358, P < 0.001) in patients with locally advanced HCC. Among the four categories of locally advanced HCC, OS was significantly worse, and CRR was significantly higher in patients with HCC with major vascular invasion (pT3) than with multiple tumors more than 5 cm (pT3); or tumor invasion of adjacent organs (pT4); or perforation of visceral peritoneum (pT4). No significant differences were observed in OS or CRR between the latter three groups of patients. Conclusions HCC with major vascular invasion, which are classified as pT3 under the current TNM staging, have the worst prognosis when compared with the other categories of pT3-4 disease. There is a need to redefine the T classification and to stratify locally advanced HCC.

Since the first report of inflammatory pseudotumor of the liver in 1953, 12 cases have been reported in the literature. The authors report herein five cases of inflammatory pseudotumor of the liver in our hospital. These tumors were resected and the diagnosis confirmed pathologically. Three of the patients were male and two female. Four of these patients had been misdiagnosed as having primary liver cancer by sonography and CT scan. Our experience has shown that if the patient had a long clinical course, few clinical symptoms, good general condition, and a negative alpha-fetoprotein assay, if the tumor was well encapsulated and the liver presented without cirrhosis, the patients should be suspected of having inflammatory pseudotumor of liver. In this series, all five patients underwent hepatectomy. There were no complications after operation. Surgical resection should be considered as the main therapeutic method for inflammatory pseudotumor of liver. If the patient proves unsuitable for surgical treatment, steroid therapy should be the treatment of choice. In this paper 12 cases of inflammatory pseudotumor of liver reported in the literature are reviewed and discussed.

From 1964 to 1985, 120 cases of primary liver carcinoma had undergone hepatectomy in our hospital. Seven of these cases underwent hepatic lobectomy, 28 cases had palliative hepatic resection, and 85 cases had partial hepatectomy. We introduced different surgical modes and compared the mortality, survival rates, and complications between the hepatic lobectomy and partial hepatectomy groups. The mortality rates of these two groups were 14.3 and 3.5%, respectively, and the 1, 3, and 5 year survival rates were 83.3, 33.3, and 16.7 and 68.8, 48.1, and 20%, respectively. In the palliative hepatectomy group (28 cases), ten cases received combined radiotherapy postoperation. Most of these cases died during the first year postoperation. Primary liver cancer in Asia is commonly associated with hepatic cirrhosis. We suggest that partial hepatectomy is suitable for such patients. The results of the present series showed that the outcomes of the hepatic lobectomy and partial hepatectomy groups did not differ, but in partial hepatectomy, the operative mortality and complications were reduced, bleeding minimized, and operation time also shortened.

From 1976 to 1984, 30 cases of asymptomatic primary liver cancer (subclinical primary liver cancer) have been treated in our hospital. The most important approaches used to uncover subclinical primary liver cancer were (1) the use of alpha-fetoprotein (AFP) monitoring in patients with liver disease; (2) the use of an AFP survey among high-risk area populations; and (3) X-ray examination of the diaphragm and sonography examination. The resectability rate of this series was 50%. The 3 and 5 year survival rates after hepatectomy were 62.5 and 57.1%, respectively. Hepatic arterial ligation combined with irradiation for the nonresectable cases had a better result. We discuss here the approaches and the diagnostic criteria of subclinical primary liver cancer.