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Objective:To investigate the efficacy and safety of laparoscopic hepatectomy combined with microwave ablation in the treatment of hepatocellular carcinoma(HCC)in elderly patients.Methods:A total of 125 elderly patients with HCC were divided into the control group(n=73)and the observation group(n=52)according to the surgical method.The control group received laparoscopic hepatectomy and the observation group underwent microwave ablation during laparoscopic hepatectomy.The operation procedures, lymphocyte subsets and postoperative recurrence were compared between the two groups.Results:The bleeding volume, drainage tube removal time and hospitalization length were lower in the observation group than in the control group( t=6.370, 7.260 and 7.136, respectively, P<0.05). CD8 levels decreased with time in both groups( Ftime=43.716, P<0.05), and the decrease of CD8 in the observation group was greater than in the control group( Ftime×group=5.179, P<0.05). The overall level of CD8 was lower in the observation group than in the control group( Fgroup=3.792, P<0.05). The levels of CD3, CD4 and CD4/CD8 increased with time in both groups( Ftime=85.692, 62.534 and 37.589, all P<0.05), and the increases of CD3, CD4 and CD4/CD8 in the observation group were greater than in the control group( Ftime×group=5.213, 6.513 and 6.721, all P<0.05). The overall levels of CD3, CD4 and CD4/CD8 were higher in the observation group than in the control group( Fgroup=6.571, 4.538 and 5.363, all P<0.05). The 2-year survival rate was higher in the observation group than in the control group(41 cases or 78.8% vs.45 cases or 61.6%, χ2=4.186, P=0.041). The 1-year and 2-year relapse-free survival rates were higher in the observation group than in the control group(1-year: 44 cases or 84.6% vs.50 cases or 68.5%, χ2=4.233, P=0.041; 2-year: 37 cases or 71.1% vs.39 cases or 53.4%, χ2=4.005, P=0.045). Conclusions:Laparoscopic hepatectomy combined with microwave ablation can improve the systemic immunity and the immunity of the microenvironment at the site of the tumor, reduce recurrence, and has better clinical outcomes.
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Primary intrahepatic cholangiocarcinoma (ICC) is the second frequent malignant tumor in adult liver,and appears an increasing tendency worldwide.Gross type is frequently mass-forming and a tubular adenocarcinoma is shown as the typical histopathological appearance.Surgical resection is the only curative treatment,and liver transplantation is selected for the patients with early ICC.Rediofrequency ablation,transcatheter arterial chemoembolization or molecular targeted therapies should be considered in the treatment of the unresectable or recurrent patients.
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Objective To evaluate the effects of percutaneous cholecystostomy (PCT) for the treatment of acute cholecystitis (AC) in poor-risk patients.Methods A retrospective clinical analysis was undertaken in poor-risk AC patients receiving PCT or emergency cholecystectomy (CCY) from April 2007 to December 2012.The success rate,complications,hospital stay and mortality,and readmission rate were compared between PCT and CCY groups.Results Of the 51 poor-risk acute cholecystitis patients,25 underwent PCT drainages and 26 received emergency CCY at an average age of 75 and 74 years respectively.The average intensive care unit length of stay was 13 days in PCT group and 5 days in CCY group (t =5.175,P =0.001).The mean hospital length of stay in PCT patients (21.3 days) was longer than that in CCY patients (9.8 days) (t =3.213,P =0.002).However,there was no significant difference in the overall hospital mortality,complications and successful rate between the two groups.No recurrence was observed in 19 out of 25 PCT cases after removing PCT catheter.The remaining six patients were readmitted for recurrent AC.Three of them were conservatively treated,while another 3 patients had PCT drainage anew and one of the three underwent delayed CCY 4 weeks after PCT replacement.The overall successful rate of PCT treatment was 76％.Conclusions Compared with emergency CCY,PCT has similar treatment effects in the successful rate of surgical management,morbidity,and overall hospital mortality although it is associated with longer hospital stays and higher readmission rate,which indicated that PCT is a convenient,safe and effective treatment option for poor-risk AC patients.
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Objective To investigate the effects of SAHA on the differentiation of human hepatocellular carcinoma(HCC)SMMC-7721 cells.Methods Cell morphology was examined by light microscopy;Cell viability was determined by MTT assay;The expression of Alpha-fetoprotein(AFP)and proliferating cell nuclear antigen(PCNA)was analyzed with immunocytochemistry;Flow cytometry(FCM)was used to investigate the cell cycle;The expression of p21 WAF1 mRNA was detected by semi-quantitative RT-PCR.Results Light microscopy showed that SMMC-7721 cells induced by SAHA underwent restorational alterations in morphology which were different from those of nontreated cells but were similar to those of normal cells;MTT assay showed that SAHA inhibited the proliferation of SMMC-7721 cells in a dose-dependent and time-dependent way;Immunocytochemistry assay showed that the expression of AFP and PCNA decreased significantly;FCM analysis showed SAHA could arrest SMMC-7721 cells at G0/G1 phase,with an accumulation of the cells at G0/G1 phase while a decrease of cells at S phase;Semi-quantitative RT-PCR detection revealed that the expression of p21 WAF1mRNA was upregulated remarkably in the cells treated with SAHA.Conclusion SAHA could induce differentiation of human HCC SMMC-7721 cells inhibiting enzymatic activity of HDAC,upregulating the expression of p21 WAFlmRNA as well as causing arrest of HCC cells at G0/G1 phase.
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ObjectiveTo study the early diagnosis and prevention of fungal infection in severe acute pancreatitis(SAP). Method 1.SAP patients from July 1998 to June 2002 were prospectively randomized into 3 groups: garlicin prevention group, fluconazole (low dosage) prevention group and control group, the incidence of fungal infection in SAP was compared between the groups. For fungal infection patients, the fungal clearance and mortality rate were observed. 2.Clinical data of SAP patients with fungal infection and with simple bacterial infection was compared by multivariate logistic regression, and clinical characters and risk factors of fungal infection were evaluated. Results 1.There were lower incidences of fungal infection in garlicin group (16% vs. 30%,P
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Objective To determine the prevention and therapy of fungal infection in patients with severe acute pancreatitis (SAP). Methods Seventy patients with SAP admitted from July,1998 to June,2002 were randomly divided into 3 groups: garlicin prevention group, fluconazole (low dosage) prevention group and control group.The incidence of fungal infection, the fungal clearance and mortality after the treatment were compared. Results The incidence of fungal infection in garlicin group and fluconazole group was lower than that in control group. (16%∶30%,P
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Objective To study the clinical characteristic and correlation factors of fungal infection in severe acute pancreatitis(SAP). Methods Clinical data of SAP patients with fungal infection (fungus infection group-F1 group) and with bacterial infection (bacteria infection group, B1 group) in January,1994-December,2001 were retrospective analysed and compared. Results There were 40 cases in F1 group, 84 cases in B1 group. There were no significant difference in age, sexual, causes, APACHE II score between the two groups, Hospitalization in F1 was significantly longer than that in B1 group (57.7d∶42.7d, P= 0.044 ).Diabetes-mellitus, SAP grade II, multi-operation, intestinal and/or bile duct fistulas were related to fungal infection in SAP; mortality in F1 group was significantly higher than that in B1 group (P= 0.02 ). Conclusions Diabetes-mellitus, SAP grade II, multi-operation, intestine and/or bile duct fistulas are the risk factors of patients with severe acute pancreatitis developing fungal infection; fungus infection can increase the mortalily of SAP patients.Extra-pancreas fungal infection is commonly seen in digestive tract, respiratory tract and urinary system. unknown consciousness change and massive bleeding may indicate that the patient is complicated with fungal infection.