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??Objective:To evaluate the clinical merit of contrast??enhanced ultrasound (CEUS) in the diagnosis of Small hepatocellular carcinoma (HCC) in patients with posthepatitic cirrhosis. Methods:Small hepatocellular carcinoma were examined and observed by CEUS between March 2004 and October 2005,using ultrasound contrast agent??Sonovue.Contrast enhanced CT and or MRI were performed in all cases. Results:The accuracy of diagnosing Small HCC by CEUS were 88.2% (60/68),according to the hypo??enhancement in arterial phase,iso??enhancement or hyo??enhancement in portal phase,hypo??enhancement in delayed phase.The accuracy and false positive rate of diagnosing Small HCC by CEUS were 97.1% (66/68) and 2.9%(2/68) according to the hypo??enhancement in delayed phase. Conclusion:CEUS might increase the diagnosis of small HCC.     

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??Objective??To detect the level of fecal primary and secondary bile acids in infants with infantile cholestatic hepatopathy??ICH??and analyze its clinical value. Methods??Thirty infants with ICH were enrolled in this study??who were diagnosed with infantile cholestatic hepatopathy. Thirty infants with good health condition were enrolled as the healthy control group. The fecal samples were collected respectively in the preparatory treatment phase and treatment phase from infants with ICH and from the healthy infants. Bile acids were extracted from infants’ feces and were quantitatively analyzed by liquid chromatography-mass spectroscopy. Results??Among the fecal primary bile acids??the level of cholic acid??chenodeoxycholic and glycochenodeoxycholic acid both in the ICH preparatory treatment group and ICH treatment group was significantly lower than that in the healthy control group??P??0.016??.The level of fecal cholic acid and chenodeoxycholic acid of ICH treatment group was higher than in the ICH preparatory treatment group??P??0.016??. Among the fecal secondary bile acids??the level of lithocholic acid both in the ICH preparatory treatment group and ICH treatment group was significantly lower than that in the healthy control group??P??0.016????and the level of ursodeoxycholic acid in the ICH preparatory treatment group was lower than that in the ICH treatment group and healthy control group??P??0.016??. Conclusion??In infants with ICH, the changes of fecal primary bile acids and fecal secondary bile acids have their own characteristics at the early stage of treatment, which may be caused by the short-term treatment, the prognosis of the disease itself and the changes of intestinal function, including intestinal bacteria. Clinical attention should be paid to these changes.     

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??Toward New Classification Criteria for Juvenile Idiopathic Arthritis??First Steps??Pediatric Rheumatology International Trials Organization International Consensus was published onJournal of Rheumatologyin October??2018??and then at the2018Annual Meeting of AmericanColleage of Rheumatology??ACR????the relevant experts introduced the samecontent. Although the new JIA classification criteria in the process of improvement in western countries is still??PRINTO has designed a two-step’sprospective study??which will form a mature new JIA classification criteria after itscompletion. The new trend and progress of this subject is of great significance to the diagnosis??treatment and research of JIAin the world. CCIHA has organized a group of relevant Chinese experts to interpret the international consensus??aiming at putting forward suggestions and opinions of Chinese experts on the new classification of JIA??providing a basis for future research on the real world researchof JIA in China??and putting forward the opinions of Chinese experts to be in line with the new international criteria. This paper only interprets faithfully the original English text. The formation and application of JIA’s new classification criteria in China still need further study and discussion.     

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??Clinical research for hepatocellular carcinoma??opportunities and challenges in the age of precision medicine and big data SHEN Feng??CHENG Zhang-jun. Department of Hepatic Surgery??the Eastern Hepatobiliary Surgery Hospital??the Second Military Medical University??Shanghai 200438??China
Corresponding author??SHEN Feng??E-mail??shenfengehbh@
sina.com
Abstract Hepatocellular carcinoma (HCC) is one of the most common malignancy in China. In the age of precision medicine and big data??to improve the treatment and prognosis of HCC??the clinical research must aim to reveal the molecular nature of HCC??characterize drive genes involved in the carcinogenesis of HCC??and achieve precise diagnosis and molecular subtyping of HCC. Further more??the present treatment protocols for HCC should be evaluated fully and staging system as well as clinical practice guideline should be updated to develop new standardized??individualized and comprehensive therapy strategies for HCC patients in China.     

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??Robot-assisted resection of choledochal cysts and Roux-en-Y bilioenterostomy??A report of 2 patients PENG Cheng-hong, LIU Fei. Department of General Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai200025,China
Corresponding author: PENG Cheng-hong, E-mail: chhpeng@188.com
Abstract Objective To investigate the feasibility and security of robot surgical system in resection of choledochal cysts and Roux-en-Y bilioenterostomy. Methods The clinical data of 2 patients who underwent choledochal cysts resection and Roux-en-Y bilioenterostomy with robotic system from July 2012 to July 2013 in Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. Results All the operations by robot were performed successfully and none was converted to laparotomy. The operation time was range 140 to 170 mins. The intraoperative blood loss was 50 ml. No transfusion was needed during and after the operation. The follow up of 23 months and 14 months were done postoperatively. Conclusion Robot-assisted resection of choledochal cysts and Roux-en-Y bilioenterostomy are secure, feasible and mini-invasive. The superiority remains to be confirmed by more cases and long-term follow-up.