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Objective:To investigate the risk factors for overall survival in operable hepatocellular carcinoma with portal vein tumor thrombus (PVTT-HCC) patients and establish a scoring system.Methods:Survival data in 253 PVTT-HCC patients were retrospectively analyzed in Guangxi Medical University Affiliated Tumor Hospital. Survival curves were analyzed using the Kaplan-Meier method and log-rank test. Cox stepwise regression analysis was used to identify independent preoperative risk factors affecting overall survival. A prognostic scoring system based on independent risk factors and their relative coefficients was established to screen patients with greater hepatic resection benefits, and the identification ability of the model was based on ROC.Results:A total of 253 patients with PVTT-HCC were enrolled in this study, there were 222 males and 31 females, with a median age 44 years. The median survival time in all patients was (13.00±2.15) months. Rate of overall survival was 51.8% at 1 year, 25.0% at 3 years and 17.7% at 5 years. Multivariable Cox regression analyses showed four risk factors including: AST≥40 U/L, ALP (≥80 U/L), tumor number (>1), and incomplete tumor capsule. A prognostic scoring system was established based on these variables. The area under curve of the scoring system was 0.780 (95% CI: 0.715-0.845). Patients were classified as low- or high-risk group for hepatic resection depending on whether their score was <3 ( n=77) or ≥3 ( n=176), respectively. High-risk patients had a median survival of 10 months, compared to 29 months in low-risk patients. Low-risk patients also had better survival rates at 1 year (75.3% vs 41.5%), 3 years (47.6% vs 15.2%), and 5 years (34.7% vs 10.5%), P<0.05. Conclusion:A prognostic scoring system for hepatic resection in PVTT-HCC patients has been developed based entirely on preoperative variables. Using this system, patients belong to the low risk group have better prognosis after surgery, which can provide a basis for surgical treatment of PVTT-HCC patients.
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Objective To establish a preoperative nomogram model in predicting microvascular invasion (MVI) and to test its predictive effectiveness in hepatocellular carcinoma (HCC).Methods This retrospective study was conducted on 798 patients with HCC,including 690 males and 108 females,aged (49.8± 10.9) years old who underwent curative hepatectomy in the Guangxi Medical University Affiliated Tumor Hospital between January 2014 and December 2017 were retrospectively analyzed.The patients were divided into the model group (n=579) and the validation group (n=219) according to the periods of the operation time.Independent risk factors of MVI were identified by univariate and multivariate logistic regression analysis in the model group,and a nomogram model was established according to the independent risk factors.The accuracy of the nomogram model in predicting MVI was detected in the two groups by the computer consistency coefficient (C-index) and calibration graph method.The predictive value was evaluated by receiver operating characteristic curve.Results Histopathological diagnosis revealed 278 patients with MVI and no MVI in the 301 patients of HCC out of the 579 patients in the model group.In the validation group,there were 119 patients with MVI and 100 patients with no MVI out of the 219 patients.Total bilirubin ＞15 μmol/L(OR=1.519,95％ CI:1.041 ～ 2.217),alkaline phosphatase ＞60 U/L(OR =1.681,95％CI:1.059～2.670),alpha-fetoprotein ＞200 ng/L (OR=2.192,95％CI:1.531 ～3.134) and tumor maximum diameter (OR =1.120,95％CI:1.057 ～ 1.187) were the independent risk factors of MVI on multivariate analysis.After establishment of the nomogram model using the independent risk factors,the C-indexes were 0.680 and 0.773 respectively in the model group and the validation group.In the calibration graph,the standard curve properly fitted with the predicting calibration curve.The predicted value of MVI obtained was in good agreement with the observed value.The ROC curve analysis nomogram model predicted the low performance of MVI.Conclusion The nomogram model in predicting MVI in patients with HCC was successfully established.The model offered certain guiding significance in the clinical treatment of HCC.
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Objective@#To compare the prognosis of radiofrequency ablation (RFA) for postoperative recurrent hepatocellular carcinoma and primary hepatocellular carcinoma(HCC).@*Methods@#The clinical data of 179 patients with recurrent HCC (recurrent group) and primary HCC (primary group) treated by RFA from 2009 to 2015 were retrospectively analyzed. Overall survival rate (OS) and disease-free survival rate (DFS) were analyzed by Kaplan-meier log-rank test. The prognostic factors of RFA for recurrent HCC were analyzed by COX proportional hazard regression.@*Results@#The 1, 3 and 5year′s OS of the recurrent group were 93%, 73%, 61%, respectively and 85%, 75%, 61% for the primary group(χ2=0.017, P=0.896). The corresponding 1, 3 and 5year′s DFS were 61%, 39%, 21% and 79%, 64%, 46% respectively (χ2=3.899, P=0.048). The independent risk factors affecting the OS of the recurrent group were the interval between hepatectomy to recurrence≤12 months (HR=0.264, 95% CI=0.077-0.901, P=0.033) and the Child-Pugh grading B before RFA (HR=4.501, 95% CI=1.426-14.208, P=0.01).@*Conclusions@#The DFS of patients with recurrent HCC were shorter than that with primary HCC treated by RFA. The interval between hepatectomy to recurrence and the Child-Pugh grading before RFA were independent risk factors for OS of the recurrent group.
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Objective To compare the prognosis of radiofrequency ablation (RFA) for postoperative recurrent hepatocellular carcinoma and primary hepatocellular carcinoma(HCC).Methods The clinical data of 179 patients with recurrent HCC (recurrent group) and primary HCC (primary group) treated by RFA from 2009 to 2015 were retrospectively analyzed.Overall survival rate (OS) and disease-free survival rate (DFS) were analyzed by Kaplan-meier log-rank test.The prognostic factors of RFA for recurrent HCC were analyzed by COX proportional hazard regression.Results The 1,3 and 5year's OS of the recurrent group were 93％,73％,61％,respectively and 85％,75％,61％ for the primary group(x2 =0.017,P =0.896).The corresponding 1,3 and 5year's DFS were 61％,39％,21％ and 79％,64％,46％ respectively (x2 =3.899,P =0.048).The independent risk factors affecting the OS of the recurrent group were the interval between hepatectomy to recurrence ≤ 12 months (HR =0.264,95％ CI =0.077-0.901,P =0.033) and the Child-Pugh grading B before RFA (HR =4.501,95％ CI =1.426-14.208,P =0.01).Conclusions The DFS of patients with recurrent HCC were shorter than that with primary HCC treated by RFA.The interval between hepatectomy to recurrence and the Child-Pugh grading before RFA were independent risk factors for OS of the recurrent group.
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BACKGROUND: Acute renal failure following heart failure assisted circulation have been extensively reported. However, little data have been available concerning morphological analysis of kidney tissues under that condition.OBJECTIVE: To observe morphological change of ischemia/reperfusion kidney in a sheep pulsatile catheter (PUCA) pump short-term support for heart failure model and explore causes of acute renal failure in assisted circulation patients.DESIGN, TIME AND SETTING: Self-contrast animal experiment was performed at the laboratory of Department of Cardiothoracic Surgery, Renji Hospital of Shanghai Second Medical University between July 2003 and April 2004.MATERIALS: PUCA pump was provided by Gerhard Rakhorst, Professor of Biomedical Engineering, University of Groningen.METHODS: After ischemic heart failure in 10 sheep was induced successfully and subsequently ischemia/reperfusion kidney was developed, PUCA pump was activated to support the hemodynamics for 3 hours.MAIN OUTCOME MEASURES: Hemodynamic parameters were monitored and recorded before thoracotomy, heart failure, and every 45 minutes after the support. Kidney biopsy specimens for light and electron microscopy were obtained 3 hours after support.RESULTS: PUCA pump support was successful in 7 of 10 sheep for 3 hours. During support with the PUCA pump,Hemodynamic parameters gradually restored to normal and stable condition, and blood pressure was close to baseline at the end of experiment. On both light and electron microscopy examination, mild acute kidney change was observed after ischemia/reperfusion. Cytosis in renal glomerulus associated with vasodilatation hyperemia, endepidermis in renal tubules hydropic degeneration, vasodilatation hyperemia and Interstitial edema in renal medulla were the main findings.CONCLUSION: PUCA pump could successfully maintain the hemodynamics for 3 hours in a sheep acute heart failure model,but pathological change in ischemia/reperfusion kidney was remained. It is impossible to predict prognosis of renal function on hemodynamic data alone during support.
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Objective To assess the effect of the pulsatile catheter (PUCA) pump support on cardiac resuscitation in sheep,and to provide a new approach for saving cardiac arrest patients. Methods Cardiac arrest was induced by ventricular fibrillation in 11 sheep. These sheep were divided into three groups including no support (n=3), delayed support (n=2) and immediate support (n=6). Time for cardiac resuscitation and the ratio of success to failure in each group were recorded. Hemodynamic parameters including heart rate (HR), cardiac output (CO), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), central venous pressure(CVP),right ventricular end-diastolic pressure (RVEDP),left atrial pressure (LAP), and left ventricular end-diastolic pressure (LVEDP) were monitored and recorded at 5, 60 and 180 min after cardiac resuscitation with PUCA pump. Results Time for cardiac resuscitation in no support group, delayed support group and immediate support group was (38.3±5.8),(43.5±9.2) and (48.7±23.8)minutes, respectively(P＞0.05),and the ratio of success to failure was 0/3,0/2 and 5/1, respectively ( P＜0.05). After cardiac resuscitation with the PUCA pump support, MAP, SBP and DBP increased gradually(P＜0.05).Conclusions PUCA pump can maintain the hemodynamic stability in a sheep model of cardiac arrest,and can thus increase the success rate of cardiac resuscitation. It may be suitable for resuscitating cardiac arrest patients.
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Objective Compared with different decellularization procedures for their potential of cell removal and the ability to preserve the matrix. Methods Specimens of bovine pericardiums were treated by 3 approaches (detergent and enzyme extraction、trypsin 、Triton-X 100 and sodium-deoxycholate). Tissue samples were then observed by HE staining and scanning electron microscopy to confirm the removal of cells. Von Gieson(VG) staining and Gomori staining were used for showing the integrity of collagen and elastin. DNA content was examined by the method of DNA extraction. Tissue shrinkage temperature and mechanical properties were also studied. Results Completely decellularization were achieved in 3 groups. While trypsin、Triton-X 100 and sodium-deoxycholate caused severe structural destruction and declined of mechanical properties of the matrix. In contrast, detergent and enzyme extraction achieved completely deeellularization and effectively preservation the matrix structure. Conclusion This research demonstrated detergent and enzyme extraction could achieve both complete decellularization and preservation of the matrix structure. This approach may provide an ideal platform for the construction of tissue-engineering heart valves.
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The arterial anastomosis of the atrioventricular(A-V)junctional area of 14adult human hearts was studied with techniques of the coronary radiography,micro-dissection and corrosion.The anastomotic arteries related are the A-V node artery,Kugel's artery,theostial branch of the coronary sinus,the first and second anterior septal arteries,theposterior superior septal artery,the first posterior septal artery and the descendingseptal artery.All the arteries mentioned above form lots of intercoronary andintracoronary anastomoses in the upper interventricular septum and the lower intera-trial septum.The anastomotic branches exist in every heart.The average numberof anastomotic branches is 5 in each heart,and in one of the 13 hearts studied withthe coronary radiographic technique,9 branches were found,being the highestnumber.So far as the normal adult hearts are concerned,the diameter of theanastomotic branches in and/or around the A-V junctional area are 101～200 micrain general and increased in case of coronary occlusions or heart hypertrophy.The characteristics of the terminal branches of the A-V node artery are descri-bed in detail in this article.The A-V node artery was found the only artery whichcould be anastomosed with all other arteries of the A-V junctional area.It is themost important collateral branch.The junctional area could be supplied from otherarteries through its anastomotic branches.In view of the characteristic of the arterial anastomosis of the A-V junctionalarea,it is suggested that an effective compensation for the anemia of the A-V junc-tional area could be obtained from the anastomotic branches when coronary occlu-sions involve the A-V node artery.