Association between metabolic syndrome severity score and cardiovascular disease: results from a longitudinal cohort study on Chinese adults.

Objective: This study aimed to quantify the severity of metabolic syndrome(MetS) and investigate its association with cardiovascular disease(CVD) risk on Chinese adults. Methods: 13,500 participants from the Zhejiang Adult Chronic Disease Study were followed up between 2010 and 2021. A continuous MetS severity score derived from the five components of MetS was used to quantify MetS severity, and the association between MetS severity and the risk of incident CVD was assessed using Cox proportional hazard and restricted cubic spline regression. Results: Both the presence and severity of MetS were strongly associated with CVD risk. MetS was related to an increased risk of CVD (hazard ratio(HR):1.700, 95% confidence interval(CI): 1.380-2.094). Compared with the hazard ratio for CVD in the lowest quartile of the MetS severity score, that in the second, third, and highest quartiles were 1.812 (1.329-2.470), 1.746 (1.265-2.410), and 2.817 (2.015-3.938), respectively. A linear and positive dose-response relationship was observed between the MetS severity and CVD risk (P for non-linearity = 0.437). Similar results were found in various sensitivity analyses. Conclusion: The MetS severity score was significantly associated with CVD risk. Assessing MetS severity and further ensuring intervention measures according to the different severities of MetS may be more useful in preventing CVD.

The association between diabetes and thyroid cancer risk: a hospital-based case-control study in China.

BACKGROUND: Previous studies have indicated inconsistent relationships of diabetes with thyroid cancer risk, yet little is known in China. In this study, we aimed to investigate the associations between diabetes, diabetes duration and the risk of thyroid cancer in Chinese population. METHODS: A 1:1 matched case-control study was performed between 2015 and 2017 in Zhejiang Province including 2,937 thyroid cancer cases and 2,937 healthy controls. Odds ratios (ORs) with 95 % confidence intervals (CIs) for thyroid cancer were estimated in logistic regression models. Specific effects stratified by age, as well as sex, body mass index (BMI) and family history of diabetes were also examined. RESULTS: Overall, neither diabetes (OR = 0.75, 95 % CI: 0.21-2.73) nor diabetes duration (OR = 0.14, 95 % CI: 0.02-1.22 for diabetes duration ≦ 5 years; OR = 2.10, 95 % CI: 0.32-13.94 for diabetes duration > 5 years) was significantly associated with thyroid cancer. In stratified analyses, significant lower risk of thyroid cancer was observed among subjects with diabetes and shorter diabetes duration ( ≦ 5 years), but limited to those who were aged more than 40 years, female, overweight/obese and had positive family history of diabetes. CONCLUSIONS: Diabetes and shorter diabetes duration were significantly associated with decreased risk of thyroid cancer in individuals characterized by older age, female sex, higher BMI and positive family history of diabetes.

Menstrual, reproductive and hormonal factors and thyroid cancer: a hospital-based case-control study in China.

BACKGROUND: There have been considerable studies on the effects of reproductive factors on thyroid cancer risk, while findings are inconsistent. In this analysis, we aimed to investigate the associations between menstrual, reproductive and hormonal factors with thyroid cancer occurrence in a population of Chinese women. METHODS: Using data from a 1:1 matched case-control study performed between 2015 and 2017 in Zhejiang Province of China, a second analysis of 2261 pairs of female subjects was conducted. The possible effects for thyroid cancer were evaluated in logistic regression models by odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Later age at first pregnancy (for > 25 vs. ≦ 20 years, OR: 0.47, 95% CI 0.23-0.96) and longer duration of breast feeding (for 6-12 vs. ≦ 6 months, OR: 0.49, 95% CI 0.24-0.98) were significantly associated with decreased occurrence of thyroid cancer, while no trend was observed. Stratified by age at enrollment, only the association with duration of breast feeding remained significant, but limited to younger women (≦ 50 years). CONCLUSIONS: Our results suggested that women with later age at first pregnancy or longer breast feeding duration were less likely to have thyroid cancer. These findings supported an influence role of reproductive factors in thyroid cancer risk.

Factors associated with glycemic control in community-dwelling elderly individuals with type 2 diabetes mellitus in Zhejiang, China: a cross-sectional study.

BACKGROUND: Although exercise seems to be beneficial for type 2 diabetes mellitus (T2DM) patients, there is limited research elucidating the optimal accessible indices of adiposity and insulin resistance for identifying elderly T2DM patients with poor glycemic control, which could be improved by performing regular exercise. METHODS: A community-based, cross-sectional study was conducted with 918 Chinese elderly individuals with T2DM in Zhejiang. Relevant risk factors for poor glycemic control, as determined using glycated haemoglobin A1c (HbA1c) > 7%, were explored using logistic regression analyses and included body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), fasting blood glucose (FBG), triglycerides (TGs), total cholesterol (TC), the product of fasting triglycerides and glucose (TyG), visceral adiposity index (VAI), lipid accumulation product (LAP), TyG-BMI, and TyG-WC. Comparisons of the risk factors' ability to discriminate poor glycemic control as well as their optimal cutoff values were determined using receiver operating characteristic (ROC) analyses, and then the extent of poor glycemic control risk reduction through regular exercise was examined using multivariate logistic regression analyses. RESULTS: The overall poor glycemic control rate was 49.3%. The factors associated with poor glycemic control included FBG > 3.869, TyG > 8.73, TyG-BMI > 222.45, and TyG-WC > 713.48 in logistic regression analyses. The optimal cutoff points of FBG, TyG, TyG-WC, and TyG-BMI in discriminating poor glycemic control were 7.38, 9.22, 813.33, and 227.77, and their corresponding areas under the ROC curves were 0.864(0.840-0.886), 0.684(0.653-0.714), 0.604(0.571-0.635), and 0.574(0.541-0.606), respectively. Occasional and regular exercise reduced the odds ratios (95% confidence interval) of poor glycemic control to 0.187 (0.063-0.557) and 0.183 (0.059-0.571) for subjects with TyG-WC > 813.33 (p = 0.008), to 0.349 (0.156-0.782) and 0.284 (0.123-0.652) for subjects with TyG > 9.22 (p = 0.011), and to 0.390 (0.175-0.869) and 0.300(0.130-0.688) for subjects with TyG-BMI > 227.77 (p = 0.017), respectively, after adjusting for multiple confounding factors. CONCLUSION: Among elderly individuals with T2DM, poor glycemic control risk might be identified using indices calculated from FBG, TG, BMI, and WC measurements, which are indicative of adiposity and insulin resistance. TyG-WC seems to be an accessible and useful indicator to identify which elderly T2DM patients would benefit from performing regular exercise to achieve good glycemic control.

Association between carotid plaque and Parkinson's disease.

BACKGROUND: Epidemiological studies show that patients with Parkinson's disease (PD) are prone to have a reduced incidence of ischemic cerebrovascular disease. Previous studies show the correlation between PD and the lipids serum levels. The PD,s patients are found with a reduced serum level of triglyceride and low-density lipoprotein cholesterol (LDL-C); thus, the level of serum uric acid (UA) is closely related to the occurrence and development of PD. Patients with low serum UA levels have a higher chance of developing PD than the ones who do not. However, the relationship between carotid plaques and PD is still unknown. METHODS: Our study was based on 68 patients with PD (known as the PD group) and 81 people without PD (known as the control group). Patients in the PD group were of the same age and gender. Both groups were recorded and analyzed for UA, LDL-C, and carotid plaques or intima-media thickness (IMT). The PD group was then divided into three subgroups: the stable plaque group, the unstable plaque group, and the non-plaque group. RESULTS: In the present study, the PD group showed a significantly lower level of UA and LDL-C than the control group (P<0.01); somehow there were no statistically significant differences in the IMT and plaque incidence between the two groups (P>0.05). There were also no significant differences (P>0.05) in both the LDL-C and UA levels in all subgroups, but there was a close relation in both age and duration of disease to IMT. According to the Hoehn and Yahr staging scale, serum levels of LDL-C were inversely correlated in PD patients, while UA was related to the duration of the disease. CONCLUSIONS: Our study suggested that there were no differences in carotid artery arteriosclerosis plaque and IMT, but the PD progress was indeed correlated with IMT. Meanwhile, LDL-C and UA had different priorities in H&Y and disease progression.

Circulating MicroRNA-21 is Downregulated in Patients with Metabolic Syndrome.

The microRNA-21 (miR-21) is known to play a major role in cancer progression; however, its function in the cardiovascular system appears to be even more complex and conflicting. To characterize miR-21 expression in the plasma of individuals with or without metabolic syndrome (MetS), 58 MetS cases and 96 non-MetS controls were investigated. Expression levels of miR-21 were significantly decreased in the circulation of MetS subjects (OR=0.52, 95% CI: 0.29-0.92) compared with that of non-MetS subjects. Body mass index (BMI) and the number of MetS components had a negative correlation with the level of miR-21, whereas age was inversely related to the level of miR-21. No significant difference was detected in miR-21 levels between the sexes (P=0.056). MiR-21 might be a negative regulating factor in MetS.

[Prevalence and risk factors of pre-hypertension among adults of Zhejiang province].

OBJECTIVE: To access the prevalence rates of pre-hypertensive patients at different stages and its associated risk factors among adults of Zhejiang province. METHODS: Study subjects were selected among local residents aged ≥ 18 years from 15 counties by multi stage stratified cluster random sampling method, from July to November, 2010. Each participant was required to complete questionnaire, physical examination and testing for overnight fasting blood specimen. RESULTS: 17 437 residents were surveyed including 8169 males and 9268 females. The overall prevalence of prehypertension was 34.39%. The prevalence of pre-hypertension appeared to be higher in males (38.57%) than in females (30.70%) (χ(2) = 119.36, P < 0.0001). The prevalence of pre-hypertension decreased with the increase of age in males who were above 25 year olds (χ(2) = 76.94, P < 0.0001) and in females who were above 45 year olds (χ(2) = 114.66, P < 0.0001). The prevalence of pre-hypertension appeared to be higher in the rural (35.60%) than in the urban (32.39%) areas (χ(2) = 18.69, P < 0.0001). Data from multivariable logistic regression showed that factors as being male, aged older than 35 years of age, with waist circumference as ≥ 85 cm for men and ≥ 80 cm for women, body mass index ≥ 25.0 kg/m(2) and triglyceride ≥ 1.7 mmol/L were risk factors of pre-hypertension while having had higher education was a protective factor. CONCLUSION: Pre-hypertension was prevalent among adults residents in Zhejiang province. Factors as overweight, obesity, dyslipidemia appeared to be major risk factors for pre-hypertension.

[Factors associated with awareness, treatment and control on diabetes in Zhejiang].

OBJECTIVE: To investigate factors associated with awareness, treatment and control of diabetes in Zhejiang. METHODS: Subjects under study were selected among local residents aged ≥ 18 years old by multi stage stratified-random sampling method. All participants received physical examinations including blood tests for lipids, fasting blood glucose, 2 h blood glucose and physical measurements for obesity and blood pressure in the year 2010. RESULTS: Totally, 17 437 residents were finally included in the study, including 1529 patients with diabetes. The rates of awareness, treatment and control of diabetes among the subjects under study, were 59.19%, 46.63% and 23.87%, respectively. Rate of treatment in patients with awareness of diabetes and the rate of under control among patients with treated diabetes were 78.78% and 51.19% respectively. Data from multivariate logistic regression method showed that factors as older age, having family history of diabetes were associated with higher awareness of diabetes, being alcohol drinker and obese patients with lower awareness etc. Treatment rate was significantly higher among those patients with primary education than those under situations as illiteracy, hypertension and longer course of diabetes. The control rate was significantly lower among patients with longer course of diabetes and dyslipidemia. CONCLUSION: Low rate on awareness, treatment and control of diabetes need to be changed.

[Association between dyslipidemia and different subtypes of hypertension among Zhejiang population in 2010].

OBJECTIVE: To explore the association between dyslipidemia and different subtypes of hypertension among Zhejiang population. METHODS: From June to October in 2010, 19 113 local residents aged ≥ 18 years old were selected among 7571 families from fifteen counties in Zhejiang by four stage stratified-random sampling method. A self-designed questionnaire was adopted to collect information on demographic characteristics, physical activity and life style. At the same time, physical examinations including height, weight, blood pressure and blood lipids were carried out. RESULTS: A total of 19 113 participants completed the interviews, physical examinations and collected the blood samples.Excluding those who did not meet the criteria, 14 731 were finally enrolled in the study. The prevalence rates of isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), systolic and diastolic hypertension (SDH) were 7.16% (1055/14 731, standardized rate:5.46%), 4.60% (677/14 731, standardized rate:4.41%), 7.09% (1045/14 731, standardized rate:5.75%), respectively. Among normal blood pressure group, subjects with normal TC, high TC and abnormal TC were separately 10 571 (88.43%), 1173 (9.81%) and 210 (1.76%); subjects with normal HDL-C and low HDL-C were separately 6885 (57.60%) and 5069 (42.40%); subjects with normal TG, high TG, abnormal TG were separately 9952 (79.91%), 1213 (10.15%) and 1189(9.95%).In ISH group, subjects with normal TC, high TC and abnormal TC were separately 826 (78.29%), 188 (17.82%) and 41 (3.89%); subjects with normal HDL-C and low HDL-C were separately 666(63.13%) and 389 (36.87%); subjects with normal TG, high TG and abnormal TG were separately 737 (69.86%), 150 (14.22%) and 168 (15.92%). Multi factor analysis showed that high TG and abnormal TG were associated with ISH (OR (95%CI):1.43 (1.16-1.76), 1.65 (1.34-2.03) respectively). Among IDH group, subjects with normal TC, high TC, abnormal TC were separately 556(82.13%), 99(14.62%) and 22 (3.25%); subjects with normal HDL-C, low HDL-C were separately 335 (49.48%) and 342 (50.52%); subjects with normal TG, high TG, and abnormal TG separately were 402 (59.38%), 107 (15.81%) and 168 (24.82%). The multi factor analysis showed that high TG and abnormal TG could increase the risk of IDH (OR(95%CI):1.57 (1.24-1.98), 2.18 (1.76-2.70) respectively). Among SDH group, subjects with normal TC, high TC and abnormal TC were 817 (78.18%), 193 (18.47%) and 35 (3.35%); subjects with normal HDL-C and abnormal HDL-C were separately 599 (57.32%) and 446 (42.68%); subjects with normal TG, high TG, abnormal TG were separately 675 (64.59%), 164 (15.69%) and 206 (19.71%). The multi factor analysis showed that high TC, high TG and abnormal TG were also associated with the increased risk of SDH (OR (95%CI):1.38 (1.14-1.67), 1.43(1.18-1.75), 1.73 (1.43-2.10) respectively). CONCLUSION: Dyslipidemia is an important factor of different subtypes of hypertension among Zhejiang population, especially triglycerides. Dyslipidemia screening should be strengthened to reduce the risk of cardiovascular diseases.

Cloning of acyl-ACP thioesterase FatA from Arachis hypogaea L. and its expression in Escherichia coli.

In this study, a full-length cDNA of the acyl-ACP thioesterase, AhFatA, was cloned from developing seeds of Arachis hypogaea L. by 3'-RACE. Sequence analysis showed that the open reading frame encodes a peptide of 372 amino acids and has 50-70% identity with FatA from other plants. Real-time quantitative PCR analysis revealed that AhFatA was expressed in all tissues of A. hypogaea L., but most strongly in the immature seeds harvested at 60 days after pegging. Heterologous expression of AhFatA in Escherichia coli affected bacterial growth and changed the fatty acid profiles of the membrane lipid, resulting in directed accumulation towards palmitoleic acid and oleic acid. These results indicate that AhFatA is at least partially responsible for determining the high palmitoleic acid and oleic acid composition of E. coli.

Ultrasound-guided percutaneous radiofrequency ablation of hepatic malignancies with cool-tip needle / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the efficacy, indication and complication of radiofrequency ablation (RFA) with cool-tip needle in patients with hepatic malignancies.</p><p><b>METHODS</b>421 patients with hepatic malignancies underwent ultrasound-guided RFA with cool-tip needle under local anaesthesia. The tumor size was from 1.0 to 15 cm in diameter with an average diameter of 4.3 cm.</p><p><b>RESULTS</b>The complete ablation (CA) rate was 91.4% (382/418) in the patients with a tumor < 3 cm, 78.9% (97/123) in those with a tumor of 3 to 5 cm and 37.6% (35/93) in the patients with a tumor > 5 cm. No patient died or changed to celiotomy during the 1121 times of RFA for 634 lesions in 421 patients. No hemorrhage occurred in any of these patients after the RFA treatment. The complications included abdominal pain in 32.3% (136/421), nausea in 9.0% (38/421), fever in 34.9% (147/421) and biliary leakage in 0.2% (1/421) of the patients.</p><p><b>CONCLUSION</b>Ultrasound-guided percutaneous radiofrequency ablation with cool-tip needle is effective and safe in the treatment of liver tumors.</p>

Diagnosis and surgical treatment of pancreatic endocrine tumors in 36 patients: a single-center report / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pancreatic endocrine tumors (PETs) are rare and their surgical treatment is often debated. The purpose of this retrospective study was to analyze the diagnosis and surgical strategy of functioning and non-functioning PETs.</p><p><b>METHODS</b>From May 1980 to March 2006, 36 patients with pancreatic endocrine tumors at the Second Affiliated Hospital of Zhejiang University were retrospectively studied.</p><p><b>RESULTS</b>Among the 36 patients, 29 (81%) had functioning tumors, and 7 (19%) had nonfunctioning tumors. Ninety-two percent of insulinomas were benign, whereas 4 (57%) of nonfunctioning PETs were malignant. The size of functioning tumors was (2.3 +/- 0.3) cm, that of nonfunctioning tumors was less than (5.1 +/- 0.5) cm. The combination CT and transabdominal ultrasonography resulted in a diagnostic sensitivity of 84%. Thirty-three primary lesions were precisely located in 32 patients (89%). Atypical tumor resection was performed for 73% of functioning tumors, while typical pancreatectomy was performed for 6 (85%) of nonfunctioning tumors. Moreover, 5 liver resections and 1 lymph node dissection were performed. During the follow-up, fifteen complications occurred in 12 (36%) patients after operation. The 5-year survival rate for patients with benign tumors was 92% compared to 50% for those with malignant tumors. Surgical cure was achieved in 95% of patients with benign insulinomas.</p><p><b>CONCLUSIONS</b>Surgical strategy for PETs depends on the size and location of the tumor and the risk of malignancy. The optimal surgical procedure is key to prevent postoperative complication. Radical resection including initial and metastatic lesion may benefit patients with malignant PETs.</p>

Surgical treatment of hepatocellular carcinoma with tumor thrombus in inferior vena cava / 中华外科杂志

<p><b>OBJECTIVE</b>To review the experience for the management of hepatocellular carcinoma with tumor thrombus in inferior vena cava.</p><p><b>METHODS</b>From July 2003 to May 2005, hepatectomy combined with thrombectomy were performed on 7 cases of hepatocellular carcinoma with tumor thrombus in inferior vena cava. In order to remove the tumor thrombus in inferior vena cava, total hepatic vascular exclusion were adopted on all cases to control the blood flow of IVC. According to the position of extension of tumor thrombus, 5 different procedures were adopted in the cases to control the suprahepatic IVC and extract the tumor thrombus out of IVC and atrium. Procedure 1: Median sternotomy, extracorporeal bypass, cardiac arrest, incision on right atrium and IVC were performed on 1 case for thrombectomy. Procedure 2: Median sternotomy, extracorporeal bypass without cardiac arrest, incision on IVC and (or without) incision on right atrium were performed on 2 cases for thrombectomy. Procedure 3: Abdominal approach to control intrapericardial IVC through an incision on diaphragm was performed on 1 case for thrombectomy. Procedure 4: Abdominal approach to control suprahepatic IVC above diaphragm through a small incision made on vena cava foramen for thrombectomy was performed on 1 case. Procedure 5: Abdominal approaches to control suprahepatic IVC below diaphragm for thrombectomy were performed on 2 cases.</p><p><b>RESULTS</b>All operations were successfully performed. The postoperative complications included pleural effusion in 1 case, subphrenic fluid collection in 1 case and wound infection in 1 case. The average survival time of 7 cases was 9.8 month. The longest survival time was 26 months.</p><p><b>CONCLUSION</b>Hepatectomy and thrombectomy can be safely performed on the case of HCC combined with tumor thrombus in IVC. Surgical treatment can relieve the patient from the risk of sudden death caused by heart failure and pulmonary.</p>

Comparison of wound healing after pancreaticojejunostomy with three anastomotic methods in piglets / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate wound healing after pancreaticojejunostomy of three anastomotic methods.</p><p><b>METHODS</b>Fifty-four domestic piglets were divided into three groups according to the types of anastomoses: group of end-to-end pancreaticojejunal invagination (EE group), group of binding pancreaticojejunostomy (BP group) and group of inkwell pancreaticojejunostomy (IP group). Bursting pressure, breaking strength and histopathological findings of anastomosis were assessed on operative day and on the 5th and 10th day after operation.</p><p><b>RESULTS</b>Bursting pressure was (67+/-8) mm Hg, (96+/-11) mm Hg and (131+/-9) mm Hg in EE group on day 0, 5 and 10; and (140+/-8) mm Hg, (179+/-10) mm Hg and (269+/-13) mm Hg in BP group; and (102+/-10) mm Hg, (171+/-18) mm Hg and (254+/-24) mm Hg in IP group. Compare to EE group, bursting pressure of BP group and IP group were all increased with significant differences (P<0.05). Another significant difference was observed between BP group and IP group after anastomoses on operative day. Breaking strength was (4.6+/-0.6) N, (5.8+/-0.5) N and (7.1+/-0.6) N in EE group on 0 d, 5 d and 10 d; and (4.5+/-0.4) N, (6.6+/-0.4) N and (10.0+/-0.6) N in BP group; and (4.6+/-0.3) N, (6.5+/-0.4) N and (9.1+/-0.9) N in IP group. A similar value of anastomoses was shown in BP group and IP group on day 0, day 5 and day 10, but significant increase was demonstrated compared to EE group on day 5 and 10. Anastomotic site was well repaired by connective tissue and the cut surface of pancreatic stump was covered by mucosal epithelium in BP group and IP group on day 10, but the cut surface was incompletely repaired by granulation tissue and no regeneration of the epithelium was found in EE group.</p><p><b>CONCLUSIONS</b>Wound healing of binding pancreaticojejunostomy and inkwell pancreaticojejunostomy is more rapid and better than end-to-end pancreaticojejunal invagination, but breaking strength of inkwell pancreaticojejunostomy is weaker than binding pancreaticojejunostomy.</p>

Surgical treatment of hepatocellular carcinoma originating from caudate lobe / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the significance of surgical treatment of HCC originating from caudate lobe.</p><p><b>METHODS</b>From 1995 to 2003, caudate lobectomy, including 19 cases of isolated lobectomy and 20 cases of combined lobectomy, were performed in 39 patients with HCC originating from caudate lobe, and the factors that might influence postoperative liver function were compared between the two groups.</p><p><b>RESULTS</b>All tumors were resected successfully. One patient died of postoperative renal failure. Hydrothorax occurred in 3 patients, ascites in 4 patients, and bile leakage in 1 patient. The survival rates of 1, 3, 5 year were 53%, 50%, 39% respectively.</p><p><b>CONCLUSIONS</b>Caudate lobectomy is a effective method for HCC originating from caudate lobe.</p>

Retrospective analysis of 47 cases with hilar cholangiocarcinoma using T-staging system / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical value of T-staging system for hilar cholangiocarcinoma which was adopted in memorial Sloan-Kettering cancer center of New York.</p><p><b>METHODS</b>The image data of these 47 patients were analyzed retrospectively from December 1997 to December 2002 whose data were according with our demand, and they were staged into three-stage according to the criteria of the T-staging system. The difference of respectability, ratio of tumor-free resection margin and actuarial survival rate were analyzed for different T-staging. And the coincident ratio of three different kinds of imaging methods was also analyzed.</p><p><b>RESULTS</b>Twenty patients had T(1) tumors, twenty three had T(2) tumors and four had T(3) tumors. The resectability of the three stage was 60%, 39% and 0% respectively, and the difference was significant (P = 0.013). The likelihood of achieving tumor-free margin decreased progressively with increasing T stage (P = 0.018). The cumulative 1-year survival rates of T(1), T(2) and T(3) patients were 60%, 39% and 0% respectively, and the cumulative 3-year survival rate was 35%, 9% and 0% respectively, the survival of different stage patients differed markedly (P = 0.0103). The coincident ratio of combined using MRCP and color Doppler-ultrasonography was higher than that of combined using MRCP and B-ultrasonography or combined using CT/SCT and color Doppler-ultrasonography (P = 0.007).</p><p><b>CONCLUSIONS</b>The T-staging system has a better value for preoperative assessment, and can be used to judge resectability and survival of hilar cholangiocarcinoma. It will be helpful to use MRCP and color Doppler-Ultrasonography combined to verdict the coverage of the tumor and the T-staging preoperatively.</p>

The significance of liver hanging maneuver in liver-splitting anterior approach for hepatectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the feasibility of developing a tunnel between inferior vena cava (IVC) and caudate lobe before passing a tape through it, and to explore the significance of liver hanging maneuver in liver-splitting anterior approach for hepatectomy.</p><p><b>METHODS</b>Blunt dissection was used to develop the tunnel before a tape was passed through. A hemostatic plate was placed on the surface of liver parenchyma if needed. In the procedure of hepatectomy, the tape was pulled up to create an interspace between liver parenchyma and IVC so that the IVC can be protected during transection.</p><p><b>RESULTS</b>Liver hanging maneuver was performed successfully in 47 cases. There were no severe complications related to the procedure in these cases. The procedure was terminated in 1 case because of severe bleeding.</p><p><b>CONCLUSIONS</b>1. Liver hanging maneuver is feasible in terms of anatomy and technique. 2. With liver hanging maneuver, IVC can be protected safely and the intrahepatic vessels and ductal system at the transaction line can be exposed clearly. It also makes anterior approach for hepatectomy safer and easier.</p>

Retrograde caudate lobectomy in 7 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinical value and significance of retrograde caudate lobectomy.</p><p><b>METHODS</b>From December 2003 to January 2005, 7 patients underwent retrograde caudate lobectomy in which division and ligation of short hepatic veins were carried out at the final stage of the procedure in stead of at the initial stage.</p><p><b>RESULTS</b>The procedures were carried out smoothly with no operative death in all the 7 cases including isolated complete caudate lobectomy in 4 cases, isolated partial caudate lobectomy in 1 case, combined right half liver resection in 2 case. The average operation time, blood loss and length of stay after operation was (273 +/- 44) min, (1114 +/- 241) ml (800-1500 ml) and 16 days respectively. Complications including pleural effusion and ascites in 1 case respectively were fully recovered. During the follow-up, 1 patient died at 6 months for tumor recurrence in lung and the remaining 6 patients are alive at the follow-up of 5 to 16 months.</p><p><b>CONCLUSIONS</b>Retrograde caudate lobectomy is a new procedure suitable for those caudate neoplasms which are adhering to or infiltrating to IVC or too big to move side by side. The application of this technique can converse certain kind of caudate lobe tumor from non-resectable to resectable resulting in widening the indication.</p>

Role and significance of extrahepatic control of hepatic vein and inferior vena cava in difficult hepatectomies for patients with liver tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the role of extrahepatic control on blood flow of hepatic vein and inferior vena cava in hepatectomy, and observe its effect on minimizing hemorrhage.</p><p><b>METHODS</b>From 2001 to April 2003, 33 patients who had liver tumors involving segment IV, VII, VIII or half liver underwent major hepatectomies that required exposure of the inferior vena cava and main trunks of hepatic veins, during which the major hepatic veins and inferior vena cava were isolated and taped to control blood flow when necessary.</p><p><b>RESULTS</b>In 33 attempts, 32 were successful and all tumors were resected successfully. The placement of occlusion tape was unsuccessful in 1 case. 7 cases did not need blood transfusion during operation. The amount of blood transfusion for other cases were form 0 to 1 600 ml. there was no operative mortality.</p><p><b>CONCLUSIONS</b>Appropriate control of main truck of hepatic vein and inferior vena cava is effective in reducing blood loss during hepatectomies. It is also very helpful for performing difficult hepatectomies.</p>

Diagnosis and treatment of vasoactive intestinal peptide-secreting-tumors: one case report and 15 years review in China / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the experiences of diagnosis and treatment for vasoactive intestinal peptide-secreting-tumors (VIPoma) by summarizing clinical informations of 15 patients with VIPoma.</p><p><b>METHODS</b>To analyze Clinical manifestations, laboratory examinations, imaging features, operation, pathological findings and follow up survey of 15 patients, among them 1 case from our hospital and the other 14 cases were searched in chinese biological and medical literature database from Jan 1987 to Dec 2002.</p><p><b>RESULTS</b>The main clinical manifestation include periodical secretory watery diarrhea, hypokalemia, achlorhydria, in addition, periodical backache, skin rash, and polyps of colon were presented in the case in our hospital. The immunohistochemical expression of many kinds of digestive hormone including VIP presented positive; All clinical symptoms of which except polyps disappeared after operation, elevated VIP data in serum also markedly decreased. Part resection of superior mesenteric vein was performed in the same patient.</p><p><b>CONCLUSIONS</b>VIPoma is rare. Typical symptoms and the serum value of VIP were keys to diagnosis, the operation is the most effective means for treatment. Resection of tumor, Radiofrequency tissue ablation, liver transplantation can be selected for metastatic VIPoma in the liver.</p>