Corrigendum to “Quantitative determination of multi-class bioactive constituents for quality assessment of ten Anoectochilus, four Goodyera and one Ludisia species in China” Chinese Herbal Medicines 12 (2020) 430–439 (Chinese Herbal Medicines (2020) 12(4) (430–439), (S1674638420300824), (10.1016/j.chmed.2020.07.002)) / 中草药·英文版

The authors regret for the changes in Fig. 6 as follow: [Figure presented] Fig. 6. HPLC-ELSD chromatograms of ten Anoectochilus, four Goodyera and one Ludisia species on AQ-C

Anesthesia upstream of the alcoholic lesion point alleviates the pain of alcohol neurolysis for intercostal neuralgia: a prospective randomized clinical trial

OBJECTIVES: Alcohol for intercostal neuralgia may induce severe injection pain. Although nerve block provided partial pain relief, alcohol might be diluted, and the curative effect decreased when the local anesthetic and alcohol were given at the same point. Therefore, we observed the modified method for intercostal neuralgia, a Two-point method, in which the local anesthetic and alcohol were given at different sites. METHOD: Thirty patients diagnosed with intercostal neuralgia were divided into 2 groups: Single-point group and Two-point group. In the Single-point group, alcohol and local anesthetic were injected at the same point, named the "lesion point", which was the lower edge of ribs and 5 cm away from the midline of the spinous process. In the Two-point group, alcohol was injected at the lesion point, whereas the local anesthetic was administered at the "anesthesia point", which was 3 cm away from the midline of spinous process. RESULTS: After alcohol injection, visual analog scale (VAS) in the Two-point group was lower than the Single-point group, and the satisfaction ratio of patients in the Two-point group was higher (p<0.05). The degree of numbness in the Two-point group was greater than the Single-point group at 1 month and 3 months after operation (p<0.05). However, the long-term effects did not differ. CONCLUSIONS: Local anesthetic was given upstream of the point where alcohol was administered, was a feasible and safe method to relieve pain during the operation, and improved the satisfaction of the patients and curative effect.

Clinical effects of high frequency repeated transcranial magnetic stimulation therapy on dyskinesia in patients with incomplete spinal cord injury:a Meta-analysis / 中国骨伤

<p><b>OBJECTIVE</b>To systematically evaluate the clinical effect of high frequency repeated transcranial magnetic stimulation(HF rTMS)therapy on dyskinesia in patients with incomplete spinal cord injury.</p><p><b>METHODS</b>Randomized controlled trials(RCTs) about HF rTMS therapy on patients with motor incomplete spinal cord injury were searched electronically in PubMed, Google scholar, Cochrane library, Clinical trial, Medline, Web of science, CNKI, VIP, and Wanfang database before October 2016. Two reviewers independently screened the literatures according to the inclusion and exclusion criteria, as well as extracted the data and assessed the methodological quality. The observed outcomes included ASIA motor score, ASIA lower extremities motor score(LEMS), Modified Ashworth score (MAS), Ten-meter walking test (10MWT) and Walking index for SCI II(WISCI II), and the outcomes were analyzed using RevMan5.2 software provided by the Cochrane information management system.</p><p><b>RESULTS</b>Five RCTs involved 103 patients were included, and 61 patients(experimental group) accepted real rTMS and physical rehabilitation care for SCI, 51 patients(control group) accepted only physical rehabilitation care. There were significant differences in ASIA motor score, LEMS and 10MWT between two groups after HF rTMS therapy (statistics were=2.96,=0.003;=3.04,=0.002;=2.16,=0.03; respectively). When stimulating the leg motor cortex, there was significant difference in MAS between two groups(=2.79,=0.005), and when stimulating the vertex, there was no significant difference(=0.09,=0.93). There was no significant difference in WISCI IIscore after HF rTMS therapy between two groups(=0.90,=0.37).</p><p><b>CONCLUSIONS</b>HF rTMS can raise motor score in patients with incomplete spinal cord injury, improve the spasticity of the lower extremities, and increase the motor ability.</p>

CT assisted morphological study of lumbar endplate / 中国骨伤

OBJECTIVE@#To study and measure the anatomic structure of lumbar vertebral endplate structure in healthy adults by computed tomography(CT) technique in order to provide a useful guidance for the optimal design and clinical application of lumbar prostheses.@*METHODS@#Sixty healthy adults (male and female equals) were recruited for full-waist CT scan after signing the informed consent form in the imaging department of the Second Affiliated Hospital of Xi'an Jiaotong University. The scanning data was imported into the computer aided software Mimics 16.0 for 3D reconstruction and measurement. The acquisition indexes included median sagittal diameter, maximum coronal diameter, concavity depth, median sagittal depression angle, coronal depression angle and so on. Finally, the collected data were statistically analyzed by the statistical software.@*RESULTS@#The median sagittal diameter and the maximum coronal diameter of the upper and lower endplates were not only different between the different sexes(0.05), but had a little change from L₁ to L₅, fluctuating from 1.5 to 2.0 mm and from 2.2 to 3.9 mm, respectively. In the same sequence, the concavity depth of lower endplate in males was greater than that of upper endplate, and the difference was statistically significant(0.05). Sagittal concavity angle and coronal concavity angle of upper and lower endplates changed slightly with the increase of vertebral order, and there was no gender difference in sagittal and coronal concavity angle of most vertebral sequences (>0.05). Statistics showed that the largest concavity near the caudal lumbar endplate was located on the dorsal side of the endplate plane.@*CONCLUSIONS@#The anatomical structure of the lumbar endplate is very complicated. It is important to master the anatomical parameters of the endplate and make full use of CT before operation for the development and clinical application of the lumbar prosthesis.

Auditory brainstem response may predict behavior threshold of children with hearing loss / 基础医学与临床

Objective To investigate the impact of degree of hearing loss on auditory brainstem response predictions of behavioral thresholds. Methods A total of 179 patients with different hearing loss degree ( a total of 311 ears) patients from January 2012 to January 2016 in the affiliated hospital of Yan’an university were treated with auditory brainstem response (ABR), performed threshold behavior test, analyed the auditory brainstem electric response and behavioral threshold correlation, the factors that affect the ABR thresholds and behavioral threshold value and threshold of ABR and correction factor as well as linear regression equation for different frequency stimulation. Results ABR threshold was positively related to threshold behavior for the different frequencies stimulation, ABR threshold may predicte threshold behavior( P＜0.05) ; ABR threshold value can predicte behavioral threshold differ-ence error and the degree of hearing loss( P＜0.05) , through the relevant correction factors can reduce the predic-tion error. Conclusions Auditory brainstem responses may effectively predicte the hearing loss in children with be-havioural thresholds, differences in degree of hearing loss influence auditory brainstem response and behavioral threshold value, constant correction coefficient is conducive to auditory brainstem electric response and facilitates accuracy of the behavior threshold.

Recent Progress in the Construction of Functional Artificial Bone by Cytokine-Controlled Strategies / 中华医学杂志(英文版)

<p><b>Objective</b>Combining artificial scaffolds with stimulatory factors to reconstruct lost bone tissues is one of the hottest research directions. The purpose of this review was to conduct a retrospective survey on the latest reports on artificial bone fabrication with functional cytokines.</p><p><b>Data Sources</b>The status of related scientific research from the year 2005 to 2018 was analyzed through the mode of literature retrieval in PubMed and VIP Database. The retrieval words are as follows: "bone tissue engineering," "angiogenesis," "cytokines," "osteogenesis," "biomimetic bone marrow," "sol-gel," "delivery system," and the corresponding Chinese words.</p><p><b>Study Selection</b>After reading through the title and abstract for early screening, the full text of relevant studies was evaluated and those not related with this review had been ruled out.</p><p><b>Results</b>According to the literature retrospective survey, there were three key points for the successful construction of functional artificial bones: (1) the continuous supply of relatively low concentration of cytokines during the required period; (2) the delivery of two or more cytokines essential to the process and ensure the relatively spatial independence to reduce the unnecessary interference; and (3) supporting the early-stage angiogenesis and late-stage osteogenesis, respectively, regulating and balancing the crosslinking of both to avoid the surface ossification that would probably block the osteogenesis inside.</p><p><b>Conclusions</b>The synergistic effect of both angiogenic factors and osteogenic factors applied in bone regeneration is a key point in the combined functional artificial bone. Through analysis, comparison, and summary of the current strategies, we proposed that the most promising one is to mimic the natural bone marrow function to facilitate the regeneration process and ensure the efficient repair of large weight-bearing bone defect.</p>

CT assisted goat lumbar vertebrae anatomical measurement and comparison with human lumbar vertebrae / 中国骨伤

<p><b>OBJECTIVE</b>To study the anatomical measurement of goat lumbar vertebrae and to compare with human lumbar vertebrae, so as to build the foundation for establishing animal models of lumbar prosthesis.</p><p><b>METHODS</b>The anatomical parameters of the vertebral body, pedicle and intervertebral disc in the fresh lumbar vertebrae of Boer goat and the lumbar vertebrae of healthy adults were collected by computer aided software Mimics16.0, and the anatomical characteristics of the two lumbar vertebrae were compared with the statistical software.</p><p><b>RESULTS</b>The anterior vertebral body height(VBHa) of goat lumbar was less than the middle vertebral body height(VBHm), which was less than the posterior vertebral body height(VBHp), and the maximum values were (38.7±2.9), (40.1±2.6) and (40.7±2.7) mm respectively. Its endplate width was greater than its depth, with the whole shaped like a heart or a kidney. The cranial endplate of goats was convex while the caudal endplate was depressed and the depression was small, with a maximum value of (1.6±0.6) mm. The pedicle height of goats increased from L₁1 to L̀ with the maximum of (30.5±1.9) mm; its pedicle width and angle increased firstly and then decreased with the increase of vertebra level and the minimum values were (6.7±0.4) mm and(45.9±2.6)° respectively. The anterior intervertebral disc height was larger than the middle which was larger than the posterior and all varied slightly with the changes of intervertebral spaces; the height and width of intervertebral foramen separately waved at (12.9±0.3) to (14.3±1.0) mm and (5.7±1.0) to (6.7±0.9) mm. The comparative results showed that the vertebral body height, pedicle height and angle of goats were greater than those of humans (<0.05) while the width and depth of the endplate, the intervertebral disc height, and etc. were significantly smaller than those of humans (<0.05). In addition, some structures, such as the height of pedicle and intervertebral disc, also showed different changing laws with the increase of vertebra level.</p><p><b>CONCLUSIONS</b>Although there are similarities in goat lumbar spine in some aspects, such as endplate and foramen foramen, there are still many differences in many aspects. Understanding the anatomical characteristics of goat lumbar vertebrae and the difference between goat and human is of great guiding significance for the research of goat prosthesis and related technology.</p>

Construction of a 3D finite element model of temporomandibular joints including the musculoskeletal system / 医用生物力学

Objective To discuss the feasibility of constructing a 3D finite element model of the temporomandibular joint (TMJ) including the musculoskeletal system based on imaging and anatomy, and to provide new ideas of modeling for TMJ biomechanical researches. Methods CT images of the skull, MRI images of masticatory muscles and bilateral TMJ from No.23 Chinese virtual human in the second generation were collected and imported in batches into Mimics in format of DICOM for 3D reconstruction. Then the model was integrated and optimized by Geomagic Studio, and the TMJ capsule and articular cartilage were also constructed. After the material properties of TMJ tissues were defined, a 3D finite element model of TMJ including the musculoskeletal system was finally constructed by ANSYS. Results The 3D finite element model of TMJ with the musculoskeletal system was constructed, including TMJ disc, articular cartilage, TMJ capsule, maxilla (including zygoma and nasal), mandible, sphenoid, temporal bones (including part of parietal), maxillary teeth, mandibular teeth, temporalis muscles, masseter muscles, medial/lateral pterygoid muscles, temporomandibular ligaments, sphenomandibular ligaments and sylomandibular ligaments. Conclusions Based on CT and MRI images and anatomy, the 3D finite element model of TMJ including the musculoskeletal system can be precisely and feasibly constructed by Mimics, Geomagic Studio and ANSYS. This model can restore the biomechanical environment of the TMJ, provide new ideas of modeling for biomechanical researches on the TMJ, and offer the simulation platform for visualization treatment of TMJ disease in clinic.

Clinical characteristics of triceps brachii tendon rupture at olecranon ending / 中国骨伤

<p><b>OBJECTIVE</b>To observe the clinical characteristics of triceps brachii tendon rupture at olecranon ending.</p><p><b>METHODS</b>From June 2005 to November 2011,19 patients with triceps brachii tendon rupture at olecranon ending were treated with surgical technique. Among the 19 patients, 7 patients were male, with an average age of 24.1 years old (ranged, 15 to 41 years old); 12 patients were female, with an average age of 51.4 years old (ranged, 16 to 73 years old). Eight patients had injuries in the left elbows, and 11 patients had injuries in right elbows. Seventeen patients had injuries induced by walking fall and 2 patients had injuries induced by falling down. Thirteen patients were simple triceps brachii tendon rupture at olecranon ending, 6 patients were associated with other elbow injuries. Five patients were associated with radial fracture; 1 patient with capitellum fracture; 1 patient with coronoid process fracture; 1 patient with epitrochlear. All the lateral radiographs of the injuried elbow demenstrated the flecks of avulsed osseous material from the olecranon (flake sign). The associated injuries had the homologus presence. All the patients were treated with surgical techniques:15 patients were treated with figure-of-eight tension-band wire; figure-of-eight tension band wire and Kirschner wire in 1 patient; wire cerclage in 1 patient; nonabsorbable suture in 2 patients. The associated injuries were treated simultaneously. Plaster was applied after operation in 2 patients with heavier elbow associated injuries, other patients without any external fixation. The Mayo elbow score were observed to determinate the function of the elbow.</p><p><b>RESULTS</b>All the patients were followed up, 1 patient died of other disease at one year after operation, the other 18 patients were followed up with an average of 47.9 months (ranged from 14 to 91 months). According to the Mayo elbow score, 16 patients got an excellent result and 2 good.</p><p><b>CONCLUSION</b>Traumatic rupture of triceps brachii tendon at olecranon ending is not a rare injury, which is common in female older than fifty and in male younger then thirty. Surgical results are generally excellent. But dysfunction frequently remains in patients with associated elbow injuries.</p>

A new anastomosis method for choledochojejunostomy by the way behind antrue pyloricum / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Reflux cholangitis has been the most common complication after Roux-en-Y choledochojejunostomy. In this study we intended to evaluate the perioperative and long-term efficacy of a new anastomosis method for choledochojejunostomy.</p><p><b>METHODS</b>Clinical data of 143 eligible patients who underwent choledochojejunostomy in the Eastern Hepatobiliary Surgery Hospital affiliated to the Second Military Medical University, China between January 2007 and December 2010 were retrospectively analyzed. Among the patients, 38 consecutive cases underwent this new anastomosis method for choledochojejunostomy (improved group, IG) and 105 underwent standard Roux-en-Y choledochojejunostomy (control group, CG). Changes in the incidence of cholangitis, the time of beginning to eat liquid meals, post-operative delayed gastric emptying and liver function between the two groups were compared.</p><p><b>RESULTS</b>There was no statistical difference in the levels of alanine transaminase, alkaline phosphomonoesterase and gamma-glutamy transferase between the two groups. The time of beginning to eat liquid meals was significantly shorter in IG than CG (P < 0.05). The incidence of delayed gastric emptying was lower in IG than CG, with statistical tendency between the two groups (P = 0.052). Among nine patients with different degrees of acute cholangitis in the two groups, one patient (2.6%) in IG and eight (7.6%) in CG suffered from acute cholangitis within six months of follow-up after discharge, but with no statistical difference between the two groups (P > 0.05). Of the nine patients with acute cholangitis, none in IG and four in CG were hospitalized for further treatment (P > 0.05).</p><p><b>CONCLUSIONS</b>Patients in IG had satisfactory perioperative and long-term prognosis with shorter time of beginning to eat liquid meals and lower incidence of delayed gastric emptying. This new procedure of choledochojejunostomy by the way behind antrue pyloricum was easy and safe to perform with no mortality and low complication rates.</p>

Hepatic vein occlusion with Satinsky clamp in hepatectomy for complicated liver tumor / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the application of an improved method of hepatic vein occlusion with Satinsky clamp when resecting the liver tumor involving second hepatic portal.</p><p><b>METHODS</b>From January 2003 to December 2010, there were totally 330 patients with liver tumor admitted, who underwent liver resection with Pringle maneuver plus hepatic vein occlusion with Satinsky clamp. Data regarding the intra-operative and post-operative course of the patients were analyzed. There were 245 male and 85 female patients, with a mean age of (50 ± 11) years. The diameter of tumor was (9 ± 6) cm. Among the 330 patients, there were 271 patients with viral hepatitis B, 215 patients with liver cirrhosis; 321 patients were in Child class A of liver function and 9 in class B. Pringle maneuver plus hepatic vein occlusion with Satinsky clamp was used to occlude the blood flow in the liver resection. The liver transection was performed with clamp-crushing technique.</p><p><b>RESULTS</b>Hepatic vein occlusion with Satinsky clamp was successful in all 330 patients. The operation time was (132 ± 29) minutes, while (7 ± 3) minutes for dissecting hepatic vein and (22 ± 7) minutes for inflow blood occlusion. The blood loss in operation was (480 ± 265) ml, with 20% of patients receiving blood transfusion. No patient had large hemorrhage and air embolism due to hepatic vein laceration. No patient died in the perioperative period. The complications included 31 patients of pleural effusion, 14 patients of seroperitoneum, 10 patients of biliary fistula, 2 patients of massive blood loss during liver resection and 2 patients of re-bleeding after operation.</p><p><b>CONCLUSION</b>The method of hepatic vein occlusion with Satinsky clamp was safe and effective.</p>

Correlation between the survival rate of the patients with synchronous hepatic metastases from gastric carcinoma after surgical resection and patient's index / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Many studies have reported the benefit of hepatic resection for solitary and metachronous metastases from gastric cancer. However, indications and surgical results for synchronous hepatic metastases from gastric carcinoma have not been clearly defined. This study was performed to assess the benefits and limits of simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases, as well as to identify prognostic factors affecting the survival.</p><p><b>METHODS</b>Between January 2005 and June 2008, 13 patients with synchronous hepatic metastases underwent simultaneous combined resection. The clinicopathologic features and the surgical results of the 13 patients were retrospectively analyzed. Patient, tumor (primary and metastatic carcinoma), and operative parameters were analyzed for their influence on survival.</p><p><b>RESULTS</b>No patient died and two patients (15.4%) developed complications during peri-operative course. The actuarial 6-month, 1-year, and 2-year survival rates after hepatic resection were 76.9%, 38.5%, and 30.8%, respectively, and two patients survived for more than 2 years after surgery without any signs of recurrences until latest follow-up. In univariate analysis, hepatic tumor distribution (P=0.01) and number of hepatic metastases (P=0.003) were significant prognostic factors that influenced survival. Factors associated with the primary lesion were not significant prognostic factors.</p><p><b>CONCLUSIONS</b>Satisfactory survival may be achieved by simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases in strictly selected patients. The number of hepatic metastases and hepatic tumor distribution are significant prognostic determinants of survival.</p>

Clinical study of 169 patients with hepatic angiomyolipoma / 中华外科杂志

<p><b>OBJECTIVE</b>To review and investigate the optimal preoperative diagnostic means and treatment principles of hepatic angiomyolipoma (HAML).</p><p><b>METHODS</b>The clinical features, treatment, prognostic and follow-up data of 169 HAML patients treated between January 1992 and May 2010 were retrospectively analyzed. The median age of the patients, including 46 male and 123 female (male/female, 1/2.7), was 45 years (range, 17 - 73 years). The mean case history was 0.54 year with a range of 2 d to 16 years.</p><p><b>RESULTS</b>Among the 169 patients, 149 patients (88.2%) had a solitary tumor and 96 patients (56.8%) were detected in the right lobe. The overall preoperative diagnostic rate was 13.6% and 119 patients (70.4%) were misdiagnosed as hepatocellular carcinoma or hepatic cavernous hemangioma. The diagnostic accuracy of MRI is higher than CT in distinguishing the nature of the tumor (χ² = 5.508, P = 0.019). One hundred and sixty-eight patients received surgical resection and one received percutaneous microwave coagulation therapy. One patient occurred postoperative hemorrhage and 3 patients developed hydrothorax. The postoperative mortality and recurrence for all the patients were 0. Postoperative pathology confirmed the diagnosis of hepatic angiomyolipoma. Follow-up study showed a benign course and no signs of recurrence.</p><p><b>CONCLUSIONS</b>MRI is the main diagnostic means of HAML. Treatment strategies of HAML depends largely on tumor size, location and growth rate. Surgical management is suggested to patients with the following criteria: (1) tumor size greater than 5 cm; (2) with clinical symptoms; (3) faster tumor growth; (4) the tumor located at 1, 4, 5, 8 segments of liver.</p>

Establishment and characterization of a human gallbladder carcinoma cell line EH-GB1 originated from a metastatic tumor / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To establish a human gallbladder carcinoma cell line derived from a metastatic gallbladder carcinoma and identify its biological characteristics.</p><p><b>METHODS</b>Tissue samples were separated from the surgical specimen obtained from a patient with metastatic carcinoma and single-cell suspension was prepared. Then the cells were cultured in DMEM medium supplemented with 15% fetal bovine serum. The morphology of tumor cells was observed under an electron microscope. The cell growth curve was plotted. The tumorigenicity of the cell line was studied by subcutaneous inoculation in SCID mice. The cells were infected by lentiviral vector carrying fluorescent report genes (lenti-GFP and lenti-Red2) separately for expressions of GFP and Red2, respectively.</p><p><b>RESULTS</b>A novel metastatic gallbladder carcinoma cell line was successfully established and named "EH-GB1". It could be passaged for over 20 generations with typical malignant epithelial morphology and a stable growth cycle of 24 h. Tumors were formed in all of the 10 SCID mice inoculated with EH-GB1 cells subcutaneously, and the tumor cells were tumor marker CA19-9-positive. Continuous expressions of fluorescent report genes were observed in EH-GB1 cells infected by lenti-GFP and lenti-Red2.</p><p><b>CONCLUSION</b>EH-GB1 cells might be the first stable cell line of human gallbladder carcinoma established from a metastatic focus of gallbladder carcinoma. This cell line with continuous expressions of GFP and Red2 might be a novel and perfect experimental model for clinical and basic research on gallbladder carcinoma.</p>

Hepatic blood inflow occlusion with/without hemihepatic artery control versus the Pringle maneuver in resection of hepatocellular carcinoma: a retrospective comparative analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The Pringle maneuver, which has been the standard for hepatic resection surgery for a long time, has the major flaw of ischemic damage in the liver. The aim of this research was to evaluate hepatic blood inflow occlusion with/without hemihepatic artery control vs. the Pringle maneuver in hepatocellular carcinoma (HCC) resection.</p><p><b>METHODS</b>Two hundred and eighty-one cases of resection of HCC with hepatic blood inflow occlusion (with/without hemihepatic artery control) and the Pringle maneuver from January 2006 to December 2008 in our hospital were analyzed and compared retrospectively; among them 107 were in group I (Pringle maneuver), 98 in group II (hepatic blood inflow occlusion), and 76 in group III (hepatic blood inflow occlusion without hemihepatic artery control). The operation time, intraoperative blood loss, postoperative liver function and complications were used as the endpoints for evaluation.</p><p><b>RESULTS</b>The operative duration and intraoperative blood loss of three groups showed no significant difference; alanine aminotransferase, total bilirubin and incidence of postoperative complications were significantly lower in groups II and III postoperation than those in group I.</p><p><b>CONCLUSION</b>Hepatic blood inflow occlusion without hemihepatic artery control is safe, convenient and feasible for resection of HCC, especially for cases involving underlying diseases such as cirrhosis.</p>

Biopathological characteristics of hilar cholangiocarcinoma and the clinical significance / 中华外科杂志

<p><b>OBJECTIVE</b>To approach the biopathological features of hilar cholangiocarcinoma and surgical pathological factors which influence the long-term survivals of patients with hilar cholangiocarcinoma.</p><p><b>METHODS</b>A systemic and retrospective multi-parameter analysis was performed on 205 patients of hilar cholangiocarcinoma who received surgical treatments and had complete clinicopathological data as well as follow-up results during a ten-year-period from April 1998 to April 2008. The single factor analysis was performed on age, sex, content of pre-operative serum CA19-9, Child-pugh grading, TNM classification, operation pattern, resection margin status of bile duct, vascular invasion, adjacent liver involvement, grade differentiation, infiltration-depth of bile duct, lymph node metastasis and perineural infiltration. A multivariate analysis was performed through Cox proportional hazard model.</p><p><b>RESULTS</b>The single factor analysis showed that except age, sex and content of pre-operative serum CA19-9, the mainly significant factors influencing the survivals were Child-Pugh grading, TNM classification, operation pattern, bile duct margin, vascular invasion, adjacent liver involvement, grade differentiation, infiltrating-depth of bile duct, lymph node metastasis and perineural infiltration (P < 0.05). Lymph node metastasis and infiltration-depth of bile duct wall were found to be the two independent factors influencing overall survival by multivariate analysis through the Cox model.</p><p><b>CONCLUSIONS</b>The most important prognostic factors influencing the long-term survivals of patients with hilar cholangiocarcinoma after operation are lymph node metastasis and depth of tumor-infiltrating of involved bile duct. During the operation, standardized evaluation through frozen section should be carried out for detection of lymph node metastasis and depth of tumor-infiltrating of involved bile ducts, which can be used as the histological indicator for surgical expansion, and could be helpful to maximize avoiding the tumor cell residues and therefore, to improve the long-term effects of surgical resection.</p>

Risk factors of intrahepatic cholangiocarcinoma: a case-control study / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To explore the potential risk factors of intrahepatic cholangiocarcinoma (ICC) in China.</p><p><b>METHOD</b>A case-control study including 317 patients with pathologically confirmed ICC and 634 healthy individuals was conducted. The cases and controls were matched in age, sex and inhabitancy. Data were statistically analyzed by Chi-square test and conditional logistic regression.</p><p><b>RESULTS</b>Univariate analysis showed significant difference in HBsAg seropositivity, liver cirrhosis, hepatolithiasis, choledocholithiasis and schistosomiasis between ICC patients and healthy controls (P < 0.05). Multivariate analysis confirmed that HBsAg seropositivity, liver cirrhosis, hepatolithiasis and hepatic schistosomiasis were associated with ICC, and their adjusted odds ratio (95% confidence interval) were 10.265 (6.676-15.783), 13.101 (5.265-32.604), 18.242 (3.580-92.958), 18.435 (1.930-176.082), 15.102 (4.607-49.499) and 11.820 (3.522-39.668), respectively. The incidence of hepatic cyst, cholecystolithiasis, hepatic hemangioma, fatty liver, diabetes mellitus, smoking and drinking were not significantly different between ICC patients and controls.</p><p><b>CONCLUSIONS</b>The HBV infection, liver cirrhosis, hepatolithiasis and hepatic schistosomiasis may be the risk factors for ICC in China.</p>

Clinical observation on percutaneous autologous bone marrow grafting for treatment of fracture nonunion / 中国骨伤

<p><b>OBJECTIVE</b>To observe the effectiveness of percutaneous bone marrow grafting for treatment of fractures nonunion.</p><p><b>METHODS</b>From June 2001 to December 2007, 29 consecutive cases of fractures nonunion were treated with percutaneous autologous bone marrow grafting included 20 males and 9 females, ranging in age from 20 to 71 years, with an average of 40 years. All the cases were traumatic fractures involving 13 of tibia, 10 of femur, 3 of humerus, 2 of ulna, 1 of radius, 11 cases of them were open fractures. All the cases were performed internal or external fixation before marrow grafting, intramedullary pin in 15 cases, plate in 12 cases, external fixator in 2 cases. The time from injury to therapy were from 6 to 12 months, with an average of 8.5 months. The type of nonunion included atrophic in 26 cases,hypertrophic in 3 cases. All the cases were performed 3 times injection, the interval was 1 month. According to the different fracture, the amount of bone marrow was from 6 to 15 ml.</p><p><b>RESULTS</b>All the 29 cases were followed-up for from 5 to 22 months with an average of 14 months. Four of them were not observed obvious callus after 3 months from the 3rd injection, judged unsuccessful therapy, changed to perform autologous bone grafting (3 of them re-internal fixation), the follow-up ended. The other 25 cases obtained bone union during 3 to 8 months with an average of 4.5 months, the follow-up ended at the time of internal fixation removal.</p><p><b>CONCLUSION</b>Percutaneous autologous bone marrow grafting is an effective, easy and economic therapy for fracture nonunion. But stable internal or external fixation is the premise. Excessive bone defect, the gap more than 5 mm and mal-align requiring rectification is not appropriate for this therapy.</p>

Surgical resection of hepatic tumor in segment IXb by anterior transhepatic approach / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and the effect of surgical resection of hepatic tumor originated from segment IXb.</p><p><b>METHODS</b>The cases with hepatic tumors in segment IXb who had been operated on between March 2003 and January 2007 were retrospectively reviewed.</p><p><b>RESULTS</b>A total of 15 tumors in segment IXb, including 13 primary liver cancers and 2 benign tumors with a mean diameter of (4.3 +/- 1.6) cm, were successfully resected by anterior transhepatic approach under sequential occlusions of portal tride and total hepatic vascularity or portal tride clamping only. There was no operative mortality,with a mean operative time of (190.3 +/- 37.6) min and a mean operative blood lose of (376.7 +/- 252.7) ml. All the patients had uneventful postoperative course except one who suffered from ascites and edema of the low body, which was successfully managed medically. The mean postoperative hospital stay was (13.3 +/- 6.0) d. During the follow-up of 1-47 months, two patients with benign tumor enjoyed a normal life. Among the 13 patients with primary live cancers, 1 patient died of recurrence, 2 patients remained alive with intrahepatic recurrence and 10 patients survived without any sign of relapse, with a median tumor-free survival time of 23.5 months.</p><p><b>CONCLUSIONS</b>Surgical resection of hepatic tumor in segment IXb, despite their sophisticated anatomic position, is feasible in technique with high safety. The local resection can provide the patients with potential to cure.</p>

Clinical application of hepatic venous occlusion for hepatectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Most liver resections require clamping of the hepatic pedicle (Pringle maneuver) to avoid excessive blood loss. But Pringle maneuver can not control backflow bleeding of hepatic vein. Resection of liver tumors involving hepatic veins may cause massive hemorrhage or air embolism from the injuries of the hepatic veins. Although total hepatic vascular exclusion can prevent bleeding of the hepatic veins effectively, it also may result in systemic hemodynamic disturbance because of the inferior vena cava being clamped. Hepatic venous occlusion, a new technique, can control the inflow and outflow of the liver without clamping the vena cava.</p><p><b>METHODS</b>A total of 71 cases of liver tumors underwent resection with occlusion of more than one of the main hepatic veins. All tumors involved the second porta hepatis and at least one main hepatic vein. Ligation or occlusion with serrefines, tourniquets and auricular clamps were used in hepatic venous occlusion.</p><p><b>RESULTS</b>Of the 71 patients, ligation of the hepatic veins was used in 28 cases, occlusion with a tourniquet in 26, and occlusion with a serrefine in 17. Right hepatic veins were occluded in 38 cases, both right and middle hepatic veins in 2, the common trunk of the left and middle hepatic veins in 24, branches of the left and middle hepatic veins in 2, and all three hepatic veins in 5. Thirty-five cases underwent hemihepatic vascular occlusion, 4 alternate hemihepatic vascular occlusion, 23 portal triad clamping plus selective hepatic vein occlusion, and 9 portal triad clamping plus total hepatic vein occlusion. The third porta hepatis was isolated in 26 cases. The amount of intraoperative blood loss averaged (540 +/- 283) (range 100 to 1000) ml in the group of total hemihepatic vascular occlusion and in the group of alternate hemihepatic vascular occlusion, (620 +/- 317) (range 200 - 6000) ml in the group of portal triad clamping plus selective or total hepatic vein occlusion. All tumors were completely removed.</p><p><b>CONCLUSIONS</b>Hepatic venous occlusion applied in hepatectomy can prevent bleeding and air embolism, and is safe and effective with stable hemodynamics.</p>