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Objective: To establish a method for simultaneous determination of wogonoside, 4'-hydroxywogonin, norwogonin, baicalein, wogonin and chrysin in health care products by high performance liquid chromatography （HPLC）. Methods: The samples were extracted with acetone, C18 solid phase extraction column was used for purification. The target compounds were determined by HPLC, quantified by matrix-matched standard curve method. Phenomenex Luna®C18（250 mm×4.6 mm, 5 μm）column was applied, mobile phase was acctonitrile-acetic acid, using gradient elution）at the flow rate of 1.0 mL/min. The temperature of column was 30 ℃ and the detection wavelength was set at 280 nm. Results: The results showed that these 6 target compounds had good separation and the corresponding concentration had a good linear relationship with the peak area. Correlation coefficients （R2） were all greater than 0.99, RSDs of precision and stability tests were within 3.08% and the average recoveries were 83%~100% （RSD＜4.63%）. The limits of detection were 0.02~0.07 mg/kg. The limits of quantification were 0.08~0.25 mg/kg. Conclusion: This method is suitable for simultaneous determination of flavonoids in health care products with good reproducibility, and less consumption of organic solvents.

Objective: To observe the protective effect of Xuebijing injection pretreatment on hepatic ischemia reperfusion (I/R) injury and coagulopathy in liver cancer patients undergoing excision of hepatic cancer after occlusion of hepatic blood flow., Methods: A prospective randomly controlled study was conducted. Sixty patients with liver cancer classified as Child-Pugh class A undergoing hepatectomy in the Department of Hepatobiliary Surgery of Sun Yat-sen University Cancer Center from October 2011 to March 2013 were enrolled. The patients were randomized into control group and Xuebijing group (each patient received 100 mL Xuebijing injection added to 0.9% saline as a preoperative treatment for 3 days). Complete blood count, coagulation function, hepatic function, serum pro-inflammatory cytokines and alpha-fetoprotein (AFP) levels were determined before and after operation., Results: Forty-five out of 60 patients were enrolled eventually, with 23 patients in control group and 22 in Xuebijing group, and among them 43 patients were positive for hepatitis B surface antigen (HBsAg) at admission. Compared with those before operation, the postoperative levels of alanine transaminase (ALT), aspartate transaminase (AST) and lactate dehydrogenase (LDH) in control and Xuebijing groups were significantly elevated, prothrombin time (PT) and activated partial prothrombin time (AfYIT) were significantly prolonged, and white blood cells (WBC) , proportion of neutrophils (N) and C-reactive protein (CRP) were significantly increased (P<0.05 or P<0.01 ). Although the above indexes in Xuebijing group after operation were lower than those in control group in different degrees [ALT (U/L): 213.1 (80.4-796.6) vs. 265.8 (15.6-882.3), AST (UIL): 194.1 (65.4-914.2) vs. 264.3 (15.4-475.9), LDH (lg,U/L): 5.69 ± 0.72 vs. 5.71 ± 0.72, PT (s): 15.24 ± 2.16 vs. 14.41 ± 1.33, AfYIT (s): 31.51 ± 7.04 vs. 29.47 ± 4.90, WBC (x 109/L) : 13.4 7 ± 4.66 vs. 14.58 ± 4.40, N: 0.87 ± 0.06 vs. 0.87 ± 0.04, CRP (mg/L): 40.64 (16.93-189.59) vs. 45.64 ( 1.65-349.40) J, no statistical significance was found between the groups (all P>0.05 ). The preoperative levels of tumor necrosis factor-a (TNF -a) and interleukin-6 OL-6) were both less than 1.0 ng/L, and the postoperative levels of TNF-a showed no significant change, and IL-6 was increased to 485.10 (104.00-837.50) ng/L and 193.26 (95.10-385.20) ng/L in control and Xuebijing groups respectively (P<0.01). The serum high mobility group box-1 ( HMGB1 ) protein levels after operation were higher than those of preoperative in both groups (both P<0.01), but the postoperative HMGB1 in Xuebijing group were significantly lower than those in control group (j.Lg/L: 268.73 ± 5.56 vs. 277.12 ± 2.92, P<0.01). Acute physiology and chronic health evaluation ll (APACHE ll) score in Xuebijing group was significantly lower than that in control group (4.18 ± 3.75 vs. 4.53 ± 2.34, t=5.328, P=0.027), and the first passage of flatus and defecation after operation in Xuebijing group were significantly earlier than those in control group [exhaust time (days): 3 (2-4) vs. 3 (2-4), U=-2.023, P=0.043; defecation time (days): 4 (2-6) vs. 5 (3-8), U =-2.926, P=0.003 J. However, no difference was found between two groups in the postoperative and total hospital days. Spearman rank correlation analysis showed there were positive correlations between hepatitis B virus (HBV)-DNA levels and preoperative ALT (r=0.414, P=0.044) and AST (r=0.405, P=0.024) in 33 HBV-DNA positive patients, but there was no significant correlation between HBV -DNA levels or other preoperative liver function indicators., Conclusions: Hepatic I/R injury and coagulopathy may occur in liver cancer patients undergoing resection of cancer with occlusion of hepatic blood flow. Xuebijing injection may inhibit the release of serum pro-inflammatory cytokines, thereby alleviate hepatic I/R injury and promote the recovery of intestinal function. But it does not offer protective effect on coagulopathy.

Objective: To explore the significance and evaluate the early structural erosion through the expressions of Th17 cells in peripheral blood of patients with rheumatoid arthritis (RA) in clinical remission., Methods: A total of 41 active RA patients without structural erosion were selected. Intracelluar flow cytometric detection of Th17 cells in peripheral blood was performed. And the supernatant level of interleukin (IL)-17A was determined simultaneously in RA patients and control groups at baseline and endpoint of 24-month therapy. The correlations were analyzed between Th17 cells and RA disease activity index DAS28. They were classified into radiographic progression (P, n = 10) and radiographic non-progression groups (NP, n = 26) by the Sharp/van der Heijde score (SHS) at the endpoint. The differences of Th17 cells and IL-17A levels were analyzed between P (SHS > 0.5) and NP groups (SHS ≤ 0.5)., Results: The expression of Th17 cells in active RA patients was significantly higher than that of controls [(1.63 ± 0.45)% vs (0.91 ± 0.26)%, P < 0.01]. And the results of IL-17A level were similar [1510 ± 280) vs (320 ± 31) ng/L, P < 0.05]. The expression of Th17 cells was positively correlated with DAS28 score (r = 0.87, P < 0.01). Thirty-six RA patients were followed up at the endpoint and all of them stayed in clinical remission (DAS28 < 2.6). The peripheral blood expressions of Th17 cells of P group were significantly higher than those of NP group . At the same time, no differences of IL-17A levels existed between two groups., Conclusion: Structural erosion still progresses in some RA patients despite an apparent clinic remission. And a high-level peripheral expression of Th17 hints at structural erosion.

Objective: To explore the expression and significance of Th17 and Treg cells in peripheral blood of patients with systemic lupus erythematosus (SLE)., Methods: Thirty active SLE patients (including 17 SLE patients with lupus nephritis), 20 inactive SLE patients and 20 healthy controls were enrolled. The expressions of Th17 cells and CD4+CD25+Foxp3+Treg cells in peripheral blood mononuclear cells (PBMC) were evaluated by flow cytometry. The correlations between the expression of Th17 cells, CD4+CD25+Foxp3+Treg cells and disease activity (SLEDAI), as well as the ratios of Th17 cells and Treg cells (Th17/Treg) in SLE patients and healthy controls were analyzed respectively., Results: The expression of Th17 cells in PBMC of SLE patients was higher than that in healthy controls [(1.39 ± 0.60)% vs (0.80 ± 0.33)%, P < 0.01] while the expression of CD4+CD25+Foxp3+Treg cells decreased in SLE patients [(3.09 ± 1.54)% vs (6.04 ± 1.49)%, P < 0.01]. The increased expression of Th17 cells and reduced CD4+CD25+Foxp3+Treg cells in PBMC were positively correlated with SLEDAI and negatively correlated with complements C3 and C4. There were increased expression of Th17 cells and reduced CD4+CD25+Foxp3+Treg cells in PBMC of lupus nephritis versus SLE patients without nephritis., Conclusion: There is an abnormal elevation of Th17 cells and decrease of CD4+CD25+Foxp3+Treg cells in PBMC of SLE patients. The imbalance between Th17 and Treg cells may play a critical role in the pathogenesis of SLE.

Objective: To explore the role of fas apoptosis signal transduction pathway in the abnormal apoptosis of Foxp3+CD4+CD25+ Treg in patients with systemic lupus erythematosus (SLE)., Methods: Twenty-five active SLE patients, 20 remission SLE patients and 25 controls were selected. The level of fas expression on peripheral blood Foxp3+CD4+CD25+ Treg surface was detected in SLE patients. And analyzed the expression rate of Foxp3 on CD4+CD25+ T cells was analyzed to explore the relationship between the expression rate and disease activity., Results: (1) The expression rate of fas on Foxp3+CD4+CD25+ Treg was (23.72 ± 2.35)%, (14.0 ± 2.1)% in active and remission SLE groups respectively versus (10.1 ± 1.2)% in control group. The fas expression rate of active SLE group was significantly higher than those of remission SLE group(P < 0.01)and control group (P < 0.01). And the remission SLE and control groups were not statistically significant (P > 0.05). The expression rate of fas on the Foxp3+CD4+ CD25+ Treg was positively correlated with the SLEDAI (SLE disease activity index) score (r = 0.336, P < 0.05). (2) The expression rate of Foxp3 on CD4+CD25+ T cells was (2.83 ± 0.30)%, (5.38 ± 0.63)% in active and remission SLE groups respectively versus (8.12 ± 0.70)% in control group. The expression rate of Foxp3 was significantly lower in active SLE group than that in remission SLE group (P < 0.01)and control group (P < 0.01). And the Foxp3 expression rate of remission group was also lower than that of control group (P < 0.05). The expression rate of Foxp3 was negatively correlated with the SLEDAI score (r = -0.581, P < 0.01). (3) The expression rate of Foxp3 was negatively correlated with fas (r = -0.349, P < 0.01)., Conclusion: The abnormal apoptosis of Foxp3+CD4+CD25+ Treg mediated by the fas apoptosis signal transduction pathway may be one of the pathogenic mechanisms of disease activity in SLE patients.

Objective: To observe the efficacy and safety of sorafenib monotherapy in Chinese patients with advanced hepatocellular carcinoma (HCC)., Methods: Thirty-eight patients with advanced HCC of Child-Pugh status A or B were included in this study. Patients received orally administered sorafenib at a dose of 400 mg twice a day on a continuous schedule. Adverse events were documented. The efficacy and safety were evaluated every four to six weeks., Results: During the treatment, partial response (PR) was observed in 1 patient (2.6%), minor response (MR) in 5 (13.2%), stable disease (SD) in 16 (42.1%), and progressive disease (PD) in 16 (42.1%), respectively. The median oral administration time of sorafenib was 180 days (range, 15-550 d), and the mean overall survival was 370 days (range, 42-562 days). The median response duration was 169 days (range, 42-426 days). The mean overall survival of 22 patients with controlled disease (PR + MR + SD) was 428 days (95% CI 330-526 days). The most frequent adverse events were dermal reaction (27 cases, 71.1%), gastrointestinal reaction (25 cases, 65.8%), and constitutional symptoms (14 cases, 36.8%). Most of the drug related adverse events were mild and easily to manage and reversible., Conclusion: Sorafenib monotherapy is effective and tolerable in a part of Chinese patients with advanced hepatocellular carcinoma and liver function of Child-Pugh A or B, and may prolong their survival.

Objective: To investigate the influences of different treatment patterns on the cost-effectiveness in treating acute myocardial infarction (AMI)., Methods: Data about referral of AMI patients who called for help because of chest pain to the nearby hospitals from October 2003 to December 2005 were collected from the Guangzhou 120 Call Center. All these patients were followed up 6 months after discharge to survey the cost during hospitalization, major treatment, prognosis (death, re-infarction, stroke etc. ), and secondary prevention for coronary heart disease. We used SF-36 scale was used to quantify the health status., Results: 101 AMI patients referred to grade 2 A hospitals (Group A) and 137 patients referred to grade 3 A hospitals (Group B) were successfully followed up. The cost during hospitalization of Group B was (33965 +/- 963) yuan RMB, significantly higher than that of Group A (18943 +/- 893) yuan, P = 0.021). 11 patients of Group B died, and 5 patients suffered from stroke with the mortality and stroke rate both significantly lower than those of Group A (18/101 and 12/101, P = 0.022, P = 0.015). There was no significant difference in the re-infarction rate between the 2 groups. The scores in physical function, general health status, vitality, social function, role-emotional, mental health of Group B were all significantly higher than those of Group A (all P < 0.05) , however, there were not significant differences in body pain and role-physical between these 2 groups. The smoking cessation rate, specialist outpatient department follow-up rate, statins use rate of Group B were significantly higher than those of Group A (P = 0.017, P = 0.016, P = 0.038)., Conclusion: The 120-grade 3 A hospital CCU pattern is more cost-effective in treatment of AMI.

Background & Objective: Alpha-fetoprotein (AFP) is a marker often used to detect carcinoma cells in peripheral blood of patients with hepatocellular carcinoma (HCC). This study was to explore the correlation of perioperative AFP expression in peripheral blood to recurrence of HCC., Methods: Peripheral blood samples from 56 HCC patients, obtained perioperatively, were tested for the presence of AFP mRNA by nested reverse transcription-polymerase chain reaction (RT-PCR) and TaqMan MGB probe real-time quantitative PCR. The peripheral blood samples from 15 patients with benign liver masses and cirrhosis, and 30 healthy volunteers were used as control., Results: The positive rate of AFP mRNA in preoperative peripheral blood was significantly higher in HCC patients than in patients with benign liver masses and cirrhosis (42.9% vs. 13.3%, P=0.035) and healthy volunteers (42.9% vs. 10.0%,P=0.002). The expression of AFP mRNA in preoperative peripheral blood was significantly related to tumor vascular invasion, either observed macroscopically (P=0.029) or microscopically (P<0.001). The 1-, 2-, and 3-year overall and disease-free survival rates were significantly higher in AFP-negative patients than in AFP-positive patients (P=0.003, P=0.039). Cox multivariate analysis showed that preoperative expression of AFP mRNA in peripheral blood was an independent factor for predicting recurrence (P=0.018). The positive rate of AFP mRNA in postoperative peripheral blood samples from HCC patients was 37.5%. The presence of AFP mRNA in postoperative peripheral blood was not related to any clinicopathologic factors, AFP mRNA levels in preoperative peripheral blood, and prognosis of the HCC patients., Conclusion: The presence of AFP mRNA in preoperative peripheral blood is related to tumor invasion of HCC, and may be a predictor maker of tumor recurrence.

Objective: To summarize the 8-year experience of radiofrequency ablation (RFA) on liver malignancies and explore the effect and prognostic factors., Methods: From August 1999 to February 2007, 803 patients with liver malignancies, among which there were 672 with primary liver cancer (PLC) and 131 with liver metastasis, were treated with RFA. There were 781 cases who were performed percutaneously under the guidance of ultrasound, 8 cases under CT, 9 cases with laparoscopy and 5 cases with laparotomy. And there were 117 cases who were treated by RFA combined with percutaneous ethanol injection and 108 cases by RFA combined with trans-catheter arterial chemoembolization., Results: In the treatment of all the 803 patients with liver malignancies, the mortality was 0.25%, the rate of severe complications was 0.37%. The rate of complete ablation was 92.5%, the loco-recurrence rate was 13.8% and the 1, 2, 3, 4, 5-year survivals were 95.1%, 85.6%, 75.7%, 60.7% and 47.5%, respectively. For the 672 patients with PLCs, the 1, 2, 3, 4, 5-year survivals with stage Ia (Chinese staging system) were 97.8%, 91.5%, 84.6%, 77.1% and 61.9%, respectively, with stage Ib were 93.9%, 83.7%, 69.8%, 45.1% and 42.2%, respectively, with stage II were 86.2%, 67.3%, 47.3%, 17.2% and 0, respectively, and the 1, 2-year survivals with stage III were 67.8% and 0, respectively (P < 0.01)., Conclusions: RFA is a safe and effective method for liver malignancy, and the tumor size and stage are important prognostic factors.

Background & Objective: Recent researches have revealed that chemokine-chemokine receptor network plays an important role in tumor metastasis. This study was to investigate the expression of CXCR3, a chemokine receptor, and its correlation to clinicopathologic features of hepatocellular carcinoma (HCC)., Methods: CXCR3 mRNA expression in 7 human HCC cell lines, 18 normal liver tissues and 64 pairs of HCC tissues and adjacent liver tissues was detected by reverse transcription-polymerase chain reaction (RT-PCR) and real-time quantitative PCR; CXCR3 protein expression was detected by immunohistochemistry. The correlation of CXCR3 expression to the metastasis of HCC was analyzed., Results: CXCR3 mRNA was expressed in 2 HCC cell lines (MHCC97-H and MHCC97-L) with metastatic potential, but not in 5 HCC cell lines without metastatic potential. The CXCR3/beta2M expression ratio in MHCC97-H cells (high metastatic potential) was 33.0x10(-4), and that in MHCC97-L cells (low metastatic potential) was 8.7x10(-4). Strong staining of CXCR3 protein in MHCC97-H and MHCC97-L cells was observed. However, the staining of CXCR3 protein was not detected in 4 HCC cell lines without metastatic potential; only weak staining was detected in HepG-2 cells. The expression of CXCR3 protein in HCC is significantly correlated to the invasiveness of tumors (P=0.003). The 1-and 2-year tumor-free survival rates of the HCC patients with strong positive CXCR3 expression were significantly lower than those of the patients with weak positive CXCR3 expression (66.7% vs. 75.0%, 31.3% vs. 59.5%, P=0.044)., Conclusion: The expression of CXCR3 might play a role in the invasion and metastasis of HCC.

Objective: To evaluate the suitable treatment methods of small hepatocellular carcinoma (SHCC)., Methods: From 2000 to 2004, 849 cases of SHCC (< or = c5 cm) were enrolled and divided into two groups: resection group (n = 406) and minimally invasive treatment (MIT) group (n = 443). The survival rates, recurrence rates, and post-treatment complications were compared retrospectively., Results: The 3-year survival rate in the resection group was 72.1%. The 3-year survival rates in tumor < or = 3 cm and tumor 3-5 cm of resection group were 73.3% and 70.5% (P = 0.46), respectively. The 1-year, 2-year, and 3-year recurrence rates in resection group were 13.5%, 29.9%, and 39.8%, respectively. The 3-year survival rates in MIT group was 73.8%. The 3-year survival rates in tumor < or = 3 cm and tumor 3-5 cm of MIT group were 74.7% and 72.2% (P = 0.45), respectively. The 1-year, 2-year, and 3-year recurrence rates in MIT group were 12.6%, 28.7%, and 40.4%, respectively. The 3-year survival rate was significantly different between these two group in tumor < or = 3 cm (P < 0.05). The post-treatment complication rates of these two group were 30.8% and 6.1% (P < 0.01), respectively., Conclusions: MIT is as effective as the traditional resection in SHCC. However, MIT is superior to the traditional resection in terms of minimal invasion and less post treatment complication rate. The recurrence rate of HCC was still high after treatment. Comprehensive therapies, including MIT, may increase the survival rate and life quality in SHCC patients.

Objective: To investigate the effect of Radix Astragali Injection on apoptosis of lymphocytes and immune function in treating patients with systemic lupus erythematosus (SLE)., Methods: Eighty SLE patients were randomly assigned into the routine treatment group (RT) treated with conventional therapy and the Radix Astragali treated group (RA) treated with Radix Astragali Injection besides routine treatment. The expressions of Fas and Bcl-2 antigen on lymphocytes and the changes of T lymphocyte subsets in peripheral blood before and after treatment were observed., Results: After treatment, the expression of Fas antigen on lymphocytes significantly lowered (P < 0.01), and that of Bcl-2 antigen, CD4+ lymphocyte subset and CD4+ / CD8+ ratio significantly increased in both groups (all P < 0.01). However, the changes of Fas antigen expression, CD4+ and CD4+ / CD8+ ratio were more significant in the RA group than those in the RT group (P < 0.05)., Conclusion: Radix Astragli Injection can enhance the inhibitory function of corticosteroid/immunosuppressant on apoptosis, and regulate the ratio and function of T lymphocyte subsets to normal range, which may be a useful approach for enhancing the efficacy of treatment to SLE.

Background & Objective: Iressa, a new molecular targeting medicine, has some effects on advanced non-small cell lung cancer, but its effect on hepatocellular carcinoma (HCC) has seldom been reported. This study was to observe the efficacy and adverse effect of Iressa on HCC Hep-3B and HepG2 cell xenografts in nude mice., Methods: The nude mice with Hep-3B and HepG2 cell xenografts were randomized into control group (8 mice), low-dose group (8 mice), and high-dose group (8 mice), and received daily oral gavage of 5% glucose solution, 100 mg/kg Iressa, and 200 mg/kg Iressa, respectively, by 5 days each week for 3 weeks. The mice were killed 2 days after treatment. Inhibitory rate (IR) of tumor growth was calculated. Tumor volume, mice weight, and spleen index (SI) were compared between groups., Results: Body weight and tumor volume of the mice were caparable before treatment. IRs of Hep-3B cell xenograft growth were 32.77% in low-dose group and 46.99% in high-dose group; IRs of HepG2 cell xenograft growth were 68.57% and 75.24%, respectively. Body weight and SI of nude mice with either Hep-3B or HepG2 cell xenografts were significantly lower in high-dose group than in control group, but no obvious difference was observed between low-dose group and control group., Conclusion: Iressa has obvious inhibitory effects on growth of both Hep-3B and HepG2 cell xenografts in nude mice, but high-dose (200 mg/kg) of Iressa may cause body weight lose and immunologic inhibition.

Background & Objective: 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., Methods: 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., Results: 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 (P>0.05); the incidences of jaundice were 3.0% (2/66), 7.1% (4/56), and 15.4% (4/26), respectively (P>0.05). 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 (P>0.05); 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), P<0.01]; 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., Conclusions: 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.

Objective: To compare the effectiveness of percutaneous radiofrequency ablation (PRFA) and surgical resection as an initial treatment for patients with small hepatocellular carcinoma (HCC)., Methods: Between March 2000 and June 2003, 112 patients with small HCC (with single nodule less than 5 cm in diameter) were divided at random into two groups: resection group (n = 65) and PRFA group (n = 47) to undergo surgical resection or PRFA respectively., Results: The 1-, 2- and 3-year recurrence rates were 10.7%, 18.4%, and 24.6% respectively in the 65 patients of the resection group and were 8.5%, 19.1%, and 23.4% respectively in the 47 patients of the PRFA group. The 1-, 2-, and 3-year survival rates were 93.18%, 85.69%, and 67.26% respectively in the 65 patients of the resection group and were 92.79%, 82.03%, and 64.46% respectively in the 47 patients of the PRFA group (P = 0.7534). The 1-, 2- and 3-year survival rates of the patients with tumor less than 3 cm in diameter were slightly higher in the PRFA group than in the resection group, however, insignificantly (P = 0.1253). The 1-, 2- and 3- year survival rates of the patients with tumor 3.1 to 5 cm in diameter were higher in the resection group than in the PRFA group, however, insignificantly (P = 0.4617). The 1, 2, and 3-year survival rates of the patients at stage Ia were slightly higher in the PRFA group than in the resection group, however, insignificantly (P = 0.1253). The 1, 2, and 3-year survival rates of the patients at stage Ib were slightly higher in the resection group than in the PRFA group, however, insignificantly (P = 0.4617)., Conclusion: PRFA treatment is a less invasive form of treatment for small HCC than surgical resection and is equally effective as the more invasive surgical resection. PRFA is superior to surgical resection when used in the treatment of patients with HCC less than 3 cm in diameter. PRFA can be used instead of surgical resection in proper situations.

Background & Objective: 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., Methods: 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., Results: The mean value of ICG(R15) was (9.9+/-6.2)% in cirrhosis group,and (7.4+/-3.8)% in non-cirrhosis group (P< 0.01). 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 (P< 0.05). 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)%] (P< 0.05). 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 (P< 0.05). 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)%](P< 0.01). 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%., Conclusions: 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.

Background & Objective: Most cases of hepatocellular carcinoma (HCC) are unresectable even without extra-hepatic metastasis. In addition, about 80%-90% patients in China are accompanied with cirrhosis. Liver transplantation is probably more proper for these patients than other treatments. This study was to explore the value of liver transplantation for treatment of advanced HCC without extra-hepatic metastasis, and to summarize the experience of liver transplantation performed in Cancer Center of Sun Yat-sen University., Methods: Ten patients with advanced HCC without extra-hepatic metastasis who underwent liver transplantation in Sun Yat-sen University Cancer Center from Sept. 2003 to Apr. 2004 were followed up to May 2004, and their clinical records were reviewed retrospectively., Results: The mortality within 1 month after operation was 0.0% for 10 cases of liver transplantation. One patient was alive for 7 month with tumor recurrence, and the remaining 9 patients were alive for 1-6 months without recurrence. Alpha fetoprotein (AFP) decreased to normal range within 2 months in 2 cases with macro tumor thrombus in the trunk of portal vein, and the left branch of portal vein, respectively., Conclusion: Advanced HCC without extra-hepatic metastasis, even with macro tumor thrombus in portal vein, is still indicated for liver transplantation.

Background & Objective: 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., Methods: 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., Results: 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., Conclusions: 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.

Background & Objective: Transcatheter arterial chemoembolization (TACE) has been proved to injure hepatic functional reserve. The current study was designed to evaluate the effect of Chinese herbal medicines in treatment of hepatic functional reserve injury after TACE., Methods: Sixty-one advanced hepatocellular carcinoma patients were divided into two groups: groups A (Western medicine combined with Chinese herbal medicine group, n = 30) and group B (Western medicine group, n = 31). Western medicines were used to protect hepatic function and alleviate TACE syndrome in both group A and group B. Invigorating the spleen and activating blood circulation Chinese herbal medicines were added only in group A before and after TACE. Retention rate of Indocyanine green at 15 minutes (ICGR15) was measured in both group A and group B before 1st, 2nd TACE and one month after 2nd TACE respectively., Results: Hepatic functional reserve before 1st TACE was 11.18% +/- 7.30% in group A and 11.83 +/- 7.18% in group B, (P > 0.05). Hepatic functional reserve before 2nd TACE was 11.69% +/- 5.13% in group A and 16.64 +/- 10.15% in group B, (P < 0.05). Hepatic functional reserve one month after 2nd TACE was 11.53% +/- 5.30% in group A and 19.80 +/- 11.26% in group B, (P < 0.05)., Conclusions: Invigorating the spleen and activating blood circulation Chinese herbal medicine can prevent hepatic functional reserve injury after TACE.