Influential factors for failure of enhanced recovery after surgery from hepatectomy for hepatocellular carcinoma and the establishment of risk prediction model / 中华外科杂志

Objective@#To investigate the influential factors for failure of enhanced recovery after surgery(ERAS) from hepatectomy for hepatocellular carcinoma(HCC) patients and then to establish a risk prediction model.@*Methods@#The relevant clinical data of 180 patients with HCC undergoing hepatectomy at Department of Hepatic Surgery, Affiliated Provincial Hospital, Anhui Medical University from January 2016 to June 2017 were analyzed retrospectively.There were 149 male patients and 31 female patients aging of (56.5±11.0)years(from 33 to 84 years old). The factors affecting postoperative failure of ERAS of HCC patients were identified by univariate and multivariate analyses, and then, all the obtained factors and their statistical values were used to establish the risk prediction model.@*Results@#A total of 23 patients failed in the ERAS protocol(12.8%). The preoperative total bilirubin (TBIL), alanine aminotransferase(ALT) and amount of intraoperative bleeding were independent risk factors for failure of ERAS from hepatectomy(all P<0.05). The obtained risk prediction model was presented as follows: risk coefficient(R)=0.114×(TBIL)+ 0.082×(ALT)+ 0.008×(amount of intraoperative bleeding). At the cut of value of R=7.90, the area under the ROC curve of this model for predicting failure of ERAS was 0.866(95%CI: 0.788-0.945, P<0.01), with the sensitivity and specificity of 69.6% and 91.1%, respectively.External validation results indicated that the scoring system had good differential ability(area under the ROC curve=0.889, 95%CI: 0.811-0.967, P<0.01).@*Conclusions@#Higher level of preoperative TBIL(>21 μmol/L) and ALT(>50 U/L) and the larger amount of intraoperative bleeding (more than 400 ml) are independent risk factors for failure of ERAS inpatients undergoing hepatectomy for HCC and the established prediction model may have certain value for risk assessment.

Effects of parecoxib sodium and fentanyl multimodal analgesia on immune functions in patients undergoing hepatectomy for hepatocellular carcinoma / 中华普通外科杂志

Objective To investigate the effects of multimodal analgesia of parecoxib and fentanyl on perioperative immune functions in patients of hepatocellular carcinoma (HCC).Methods Eighty HCC patients scheduled for hepatectomy were randomly divided into two groups:parecoxib sodium combined with fentanyl group (group P,40 cases) and fentanyl group (group C,40 cases).The percentages of CD3 +,CD4+,CD8+,CD4+/CD8+ T cells,CD3-CD16+ CD56+ (NK),interleukin-4 (IL-4),interferon-γ (IFN-γ) and the ratio of IFN-γ/IL-4 were detected at the following time points:30 minutes before induction of anesthesia (T0),at the end of the surgery (T1),24 h after surgery (T2) and 72 h after surgery (T3).The analgesic effects were estimated by visual analogue scale (VAS) after surgery.Total fentanyl consumption and adverse effects were also recorded.Results The percentages of CD3 + T cells were significantly lower in group C than that in group P at T2 (t =2.155,P ＜0.05).The percentages of NK in group P were recovered nearly to baseline (T0) at T2,which was higher than that of group C (t =2.791,P ＜0.05).In group C,the percentages of CD3 + T cells and NK has not recovered to baseline at T3 (respectively t =3.065,3.231,P ＜ 0.05).In group P,IL-4 serum levels were significantly lower than those in group C,while IFN-γ serum levels were significantly higher than those in group C at T2 (respectively t =2.173,2.100,P ＜0.05).From T2 to T3,the ratio of IFN-γ/IL-4 significantly increased in group P than those in group C (respectively t =3.259,2.203,P ＜ 0.05).VAS scores at rest and on cough in group P were significantly lower than those in group C at 2 h,6 h,12 h and 24 h after operation (respectively t =8.661,9.726,9.147,7.109,P＜0.05;t =8.569,9.614,9.144,8.509,P＜0.05).The total fentanyl consumption in group P was lower than that in group C (t =2.636,P ＜ 0.05).There were no significant differences regarding the incidence of adverse effects between the two groups.Conclusions Perioperative multimodal analgesia of parecoxib sodium combined with fentanyl enhances the analgesic efficacy,and reduces the dosage of opioid consumption,helps recover the cell immunity function of HCC patients after hepatectomy.

Analysis of postoperative pain of hepatectomy / 中华普通外科杂志

Objective To investigate the occurrence of postoperative pain of hepatectomy and its possible related factors.Methods The clinical data of 555 cases undergoing hepatectomy was analyzed retrospectively,and the related influencing factors on postoperative pain of hepatectomy were analyzed by univariate analysis and multivariate logistic regression.Results Moderate postoperative pain was reported in 255 cases among 555 patients who underwent hepatic resection (with an incidence of 45.95％).Incision pain which was often sharp was most common,followed by postoperative complication caused pain.According to whether the postoperative pain occurred or not,all cases were divided into postoperative pain group (n =255) and non-postoperative pain group (n =300),univariate analysis showed that age (P ＜0.01),surgical history (P ＜ 0.01),surgical approach (P ＜ 0.01),incision length (P ＜ 0.01),xiphoid removal(P ＜ 0.01),the final outcome of incision (P ＜ 0.01),complications (P ＜ 0.01) were significantly different between the two groups.Logistic multiple regression analysis showed that the independent influencing factors of postoperative pain included surgical history (P =0.001),surgical approach (P =0.005),incision length (P =0.000),xiphoid process removal (P =0.001),complications (P =0.000).Conclusions The postoperative pain of hepatectomy has a high incidence.Surgical history,surgical approach,incision length,xiphoid process,removal and postoperative complications are the independent impact factors of postoperative pain.

Surgical treatment of primary liver cancer with diaphragmatic muscle invasion / 中华普通外科杂志

Objective To explore the way and the effect of surgical treatment of primary hepatic carcinoma with diaphragmatic invasion.Method Clinical data of 37 primary hepatic carcinoma patients with diaphragmatic muscle invasion undergoing enbloc liver resection in Anhui Provincial Hospital between January 2008 and January 2014 were retrospectively analyzed.Control group comprised 54 liver cancer patients without diaphragm involvement.Results All cases underwent surgery successfully,no significant statistical differences were found between pre-operation clinical data of two groups.The operation time of the group with diaphragmatic invasion is slightly longer than that of the group without (149.4 ± 23.4 min vs 137.9 ±24.6 min,t =2.228,P =0.028);meanwhile,there was no obvious difference between blood loss of the two groups (449.5 ±304.1 ml vs 304.1 ±222.3 ml,t =0.678,P =0.499).There were no significantly statistical differences in other aspects between the two groups such as postoperative pulmonary infection,pleural effusion,infection of the incision,mortality and hospitalization time.Based on Kaplan Meier-log-rank test analysis,it is found that the two groups had no significant differences in disease-free survival and overall survival (P1 =0.982,P2 =0.906).Conclusions Hepatic carcinoma patients with diaphragmatic invasion are still indicated for liver resection with a favorable prognosis.

Application of selective devascularization for the treatment of portal hypertension / 局解手术学杂志

Objective To determine efficacy of selective devascularization in management of portal hypertension. Methods The clini-cal data of 86 patients of portal hypertension in our hospital from Jan. 2010 to Aug. 2013 were retrospectively analyzed. The patients were divided into the selective group and the nonselectove devascularization group according to the different devascularization ways. The postopera-tive liver function index and complications were analyzed. Results In selective devascularization group, the surgery time was prolonged (P0. 05). The postoperative peak value of ALT and AST and postoperative pomplications in the selective devascularization group were low-er than those in the nonselectove devascularization group (P<0. 05). And patients in the selective devascularization group have a shorter hospital stay compared to the nonselectove devascularization group (P<0. 05). Conclusion Selective devascularization can lower free portal pressure more effectively, reduce incidence rates of postoperative early complications, and it is worthy of clinical promotion.

Expression of Nodal in hepatocellular carcinoma and its relationship with angiogenesis and epithelial-mesenchymal transition / 中华外科杂志

<p><b>OBJECTIVE</b>To detect the expression of Nodal in hepatocellular carcinoma (HCC), and explore its relationship with angiogenesis and epithelial-mesenchymal transition (EMT).</p><p><b>METHODS</b>From September 2006 to June 2010, the 16 self-paired frozen HCC specimens were collected and the expression of Nodal was detected by qPCR and Western blot. The 10 normal liver tissues and 96 cases of HCC tumor and paracarcinomatous tissues were collected. The expression of Nodal and relationship among Nodal, clinicopathological characteristics of HCC and patients' prognosis were detected and analyzed using immunohistochemistry. The expressions of Nodal, Vimentin and CD34 in 96 HCC tumor tissues were detected by immunohistochemistry, and then judgment relationship between the expression of Nodal, EMT and angiogenesis.</p><p><b>RESULTS</b>Immunohistochemistry showed that Nodal mainly expressed in the cytoplasm. The high expression rate of Nodal in HCC tumor tissues was 72.9% (70/96), which was remarkably higher than that in paracarcinomatous tissues (8.3%) and normal liver tissues (0) (χ(2) = 83.001 and 24.470, both P < 0.001). qPCR and Western blot analysis showed that the expression level of Nodal in HCC was significantly higher than that in paracarcinomatous and normal tissues (P < 0.05). The high expression of Nodal in HCC was correlated with tumor size (χ(2) = 15.318, P = 0.000), alpha-fetoprotein (χ(2) = 3.850, P = 0.049), indocyanine green retention rate at 15 minutes (χ(2) = 6.590, P = 0.010), and invasion and metastasis (χ(2) = 17.824, P = 0.000). High expression of Nodal was positively correlated with high microvascular density in HCC (t = 3.070, P = 0.006), but not with Vimentin (r = 0.198, P = 0.053). Survival analysis showed that accumulated survival rate of patients with high expression of Nodal was significantly less than that the low expression (χ(2) = 487.053, P < 0.001). The Cox multivariate analysis demonstrated that high expression of Nodal was independent risk factors for cumulative survival in patients with hepatocellular carcinoma after a curative resection (RR = 2.757, 95%CI: 1.450-5.240, P = 0.002).</p><p><b>CONCLUSIONS</b>Nodal does not participate in EMT of HCC, but can promote angiogenesis, and it could be used as a predictor of poor prognosis.</p>

Precision right hemihepatectomy combined with caudate lobectomy for the treatment of huge carcinoma in the caudate lobe / 中华消化外科杂志

Hepatectomy for huge hepatocellular carcinoma (HCC) is difficult due to its huge size and the compression and invasion to the surrounding tissues as well as the important vascular systems.Surgical resection of huge carcinoma in the caudate lobe is a big challenge for hepatobiliary surgeons because of its special location and complex anatomical structure.As the improvement of surgical techniques in recent years,especially the promotion of the concept of precision liver surgery,many surgeons begin to take the challenge of resection of huge HCC in the caudate lobe in a variety of ways.In April 2014,a male patient aged 58 years with huge HCC in the caudate lobe was admitted to the Anhui Provincial Hospital.Precision right hemihepatectomy combined with caudate lobectomy was performed on this patient without occlusion of the hepatic inflow,and the efficacy was satisfactory.The key techniques involved in this procedure were discussed in this article.

Development and biomechanical evaluation of a model of lumbar interbody fusion device / 重庆医学

objective To introduce the design concept and structure of a new type of lumbar intervertebral fusion cage ,and to e-valuate its biomechanical properties .Method A partially bioasorbable interbody fusion cage(PBIFC) made of nano hydroxyapatite and poly amino acid /calcium sulfate copolymer materials was developed .Range of motion(ROM ) ,compressive load ,and pull-out test on flexion ,extension ,lateral bending ,and torsion moment on fresh calf L3/L4 specimens of functional spinal union were carried out of iliac bone group ,PBIFC group ,and nano hydroxyapatite/polyamide 66(nHA/PA66) group .Result Of each movement ,the ROM value of iliac bone group are higher than the other two groups ,the difference was statistically significant (P0 .05) .The pull-out strength of PB-IFC group are higher than iliac bone group ,and the difference was statistically significant (P0 .05) .The compressive load of iliac bone group was lower than that of two cage group ,the difference was statistically significant (P0 .05) .Conclusion With good implant stability ,pull-out resistance ,and compression resistance performance ,PBIFC can meet the biomechanics requirements of clinical implant .

Expression of Mortalin in human hepatoma-derived cell lines and its role in epithelial-mesenchymal transition / 中华肝胆外科杂志

Objective To detect the expression of Mortalin in human hepatoma-derived cell lines and explore its effect on epithelial-mesenchymal transition in hepatocellular carcinoma (HCC) cell lines.Methods Six HCC cell lines and 1 normal liver cell line (L02) were chosen.The expression of Mortalin was detected using Western blot and real-time quantitative PCR (qPCR).The endogenous gene expression of Mortalin was inhibited by RNA interference (shRNA).Cell viability was detected using MTT assay and flow cytometry.The expression of Mortalin,E-cadherin and Vimentin were detected by Western blot and qPCR.The experiment was divided into three groups; blank,control,and shRNA.Results Mortalin was detected in Hep3B,MHCC97H,HepG2,and HCCLM3,but not in MHCC97L and L02.After 24 h transfection,GFP fluorescence showed that plasmid Mortalin shRNA was successfully transfected into MHCC97H cells.MTT assay indicated that cytotoxicity was 0％,2.5％,and 3.5％ in the blank,control,and shRNA group respectively.Similarly,flow cytometric showed that early apoptosis rates were 0.8％,4.5％,and 9.2％ in the blank,control,and shRNA group respectively.These results indicated that transfection did not cause severe cell damage.After 48 h of interference,Western blot and qPCR analysis showed that shRNA significantly inhibited the expression of Mortalin.Moreover,cells were collected after 24 h,48 h,72 h and 96 h of interference and analyzed for the relationship between Mortalin,E-cadherin and Vimentin by Western blot and qPCR.It was found that decreased expression of Mortalin was accompanied by elevated E-cadherin expression and reduced Vimentin expression.Conclusion Overexpression of Mortalin correlated with the metastatic phenotype of HCC cells and could promote epithelial-mesenchymal transition.

Research progress of proteomics and prediction of metastasis and recurrence in hepatocellular carcinoma / 国际外科学杂志

Tumor metastasis and recurrence had become a key to curative effect and long-term survival,and it's hotspot of current clinical oncology research.Differential expression of proteomics between cancer and normal tissue can be used for discovering new tumor markers.Clinical detection of liver cancer-related protein molecules was useful to monitor and assess early diagnosis,recurrence and prognosis of hepatocellular carcinoma.Herein,this article reviewed the research progression of protein molecules in hepatocellular carcinoma.

Advances in the mechanism and prevention of liver ischemia reperfusion injury / 国际外科学杂志

Ischemia reperfusion injury is an important factor which has been affected the recuperation of hepatic function after hepatectomy and liver transplantation,and is a complex course in pathophysiology with many factors.With the development of research on ischemia reperfusion injury,effective prevention measures of ischemia reperfusion injury also have made new progress.And this will greatly improve the prognosis of hepatic surgery.The mechanism and its prevention measure of hepatic ischemia reperfusion injury were reviewed in this paper.

Use health-reated quality of life assessment in clinical treatment of hepatic hemangioma / 国际外科学杂志

Hepatic hemangioma is the most common benign liver tumors in the clinic.Most of hemangioma does not require aggressive treatment,and the indications for resection remain controversial.Different scholars may have different ideas about the surgical treatment of hemangioma.This article will focus on reviewing literatures about indications of hepatic hemangioma.In this paper,we proposed a new standard of surgical indications that named health-related quality of life.

99mTc-GSA SPECT imaging in liver diseases / 中华肝胆外科杂志

Asialogycoprotein receptor (ASGPR) is a specific receptor of mammalian hepatocytes,exclusively up-take the glycoprotein in the blood.The number of ASGPR correlates significantly with liver function,and the reduction of the number of ASGPR suggest liver dysfunction.Decreased ASGPR in patients with liver cirrhosis or portal hypertension or hepatocellar carcinoma,lead to varying degrees of liver dysfunction,which made it more susceptible to post operative complications.liver ASGPR scintigraphy with Technetium-99 m DTPA-galactosyl human serum albumin (99m Tc-GSA),combinating with single photon emission computed tomography (SPECT) technology can assess the functional reserve of remnant liver and predict incidence of postoperative complications,then assist to evaluate the use fulness for clinically surgical decisions.Current situation and progress of 99mTc-GSA SPECT imaging in hepatic surgery were reviewed in the paper.

The prognostic significance of preoperative serum levels of extracellular matrix protein 1 in patients with hepatocellular carcinoma / 中华普通外科杂志

Objective To evaluate the prtognostic significance of preoperative serum extracellular matrix protein 1 ( ECM1 ) levels in patients with hepatocellular carcinoma (HCC).Methods Preoperative serum levels of ECM1 were detected by enzyme-linked immunosorbent assay (ELISA) in 117 HCC patients and 53 healthy volunteers.Corrrlations to the clinicopathological characteristics and patients survival were analyzed.Results ECM1 were detected in all the samples of 117 HCC patients and 53 healthy volunteers,the median serum ECM1 level in HCC patients was significantly higher than that in healthy volunteers ( 166.39 vs 108.06 pg/ml,Z =- 7.805,P ＜ 0.001 ).Median serum ECM 1 levels were significantly higher in patients with invasive phenotypes,such as larger tumor size (Z =- 3.454,P =0.001 ),multiple nodule ( Z =- 2.201,P =0.028 ),vascular invasion ( Z =- 4.685,P ＜ 0.001 ),and advanced TN M stage ( Z =-4.610,P ＜ 0.001 ).Patients with lower serum ECM1 level (≤ 180 pg/ml ) have significantly better overall and disease free survival thanthose with higher levels ( ＞ 180 pg/ml).By Cox proportional-hazard model multivariate analysis,high serum ECM1 level ( ＞ 180 pg/ml) was an independent factor for OS and DFS in HCC patients.Conclusions Serum ECM1 levels are significantly correhted to the invasive phenotypes and survival rate.Serum ECM1 level could be used as a predictive marker for HCC recurrence and prognostic factor of HCC patients after surgery.

Partial hepatectomy combined radiofrequency ablation in the treatment of medium-term liver cancer / 国际外科学杂志

ObjectiveInvestigate the value of partial hepatectomy combined radiofrequency ablation in the treatment of medium-term liver cancer.MethodsThe 19 cases were retrospectively analyzed which admitted by Anhui Provinical Hospital due to hepatocellular carcinoma from October 2008 to November 2011.Liver function in patients before surgery was assessed by Child-Pugh score and indocyanine green.The complications 7 days after surgery were evaluated by liver function.The short-term effect 4 weeks after surgery was evaluated by radiofrequency ablation,contrast enhanced CT and contrast enhanced ultrasound.The inspection per month was lined by radiofrequency ablation,contrast enhanced CT and contrast enhanced ultrasound 6 months after surgery.After then referral was done once every 2-3 months.ResultsAll patients had liver function damage 7 days after surgery,but there were no hepatic encephalopathy and death cases.Residual tumor and incomplete ablation accounted for 10.1％ (2/19)of all cases.For 1 year and 2 year survival rates were 83.2％ and 46.4％.The average survival time was 22.23 months and the median survival time was 24.87 months.ConclusionsPartial hepatectomy combined radiofrequency ablation has important application value in the treatment of medium-term liver cancer,expanding the indications of surgical exploration in hver cancer,especially medium-term liver cancer,and it can matimaly kill visible lesions.

The impact of different hepatic vascular occlusion methods on hepatic parenchymal function in partial hepatectomy / 中华肝胆外科杂志

Objective To investigate the impact of different hepatic vascular inflow occlusion methods on hepatic parenchymal function in partial hepatectomy.Methods Between 2009 and 2010,62 hepatocellular carcinoma (HCC) patients underwent partial hepatectomy.In 13 patients,partial hepatectomy was carried out without using any inflow occlusion (group A).In 29 patients intermittent Pringle's maneuver (group B) while in 20 patients selective hepatic inflow occlusion (group C) were used.Intraoperative indocyanine green retention rate at 15 minutes (ICGR15) was measured using pulse spectrophotometry before and during hepatectomy. Results (1) Blood loss in group A was greater than group B and C (P=0.016,P=0.001).(2) There was no significant difference in the preoperative ICGR15 values among group A,B and C.The intraoperative ICGR15 for group B was significantly higher than group A and C (P=0.011,P=0.030).(3) A significant correlation was found between the level of ICGR15 and total inflow clamp time (r =0.484,P =0.001) and blood loss (r=0.349,P=0.005),respectively.(4) Compared with group A and B,postoperative liver function recovered significantly faster in group C.Conclusion Selective hepatic inflow occlusion was useful in controlling blood loss and it was beneficial to the hepatic functional reserve in the liver remnant.

Expression of patterned matrix vasculogenic mimicry and its prognostic significance in hepatocellular carcinoma / 中华普通外科杂志

Objective To investigate the expression of patterned matrix vasculogenic mimicry in hepatocellular carcinoma (HCC) and its prognostic significance. Methods HCC tissues from 151 patients undergoing curative resection in Anhui Provincial Hospital from January 2003 to December 2008 were studied.Postoperative follow-up and clinicopathologic data were reviewed.Immunohistochemical staining of laminin,CD34 and transmission electron microscopy were used to identify patterned matrix VM in HCC.The relations between clinicopathologic features, prognosis and patterned matrix VM were analyzed.Results Patterned matrix VM was positive in 31 out of 151 cases (20.5％ ).The expression of patterned matrix VM was positively correlated with tumor size ( x2 =4.132,P =0.042),vascular invasion ( x2 =5.825,P=0.016),high Edmondson grade (x2 =5.256,P=0.022),and late pTNM stage (x2 =6.218,P =0.013).Kaplan-Meier survival analysis revealed that cases of the VM positive group had poor overall 1,3 and 5 year survival (OS) and disease-free survival (DFS) than that of the VM negative group (67.7％,34.6％,11.5％ and 86.7％,64.7％,40.3％,respectively,x2 =14.852,P ＜ 0.001 ; and 41.9％,19.4％,6.5％ and 63.3％,40.6％,19.6％,respectively,x2 =10.065,P =0.002).Univariate and multivariate analyses revealed that multiple tumor nodules,vascular invasion and VM were independent prognostic factors for overall survival,while vascular invasion and VM were independent prognostic factors for disease-free survival. Conclusions Patterned matrix VM exists in HCC. The expression of patternedmatrix VM is associated with tumor size,Edmondson grade,pTNM stage and vascular invasion,and it might serve as an unfavorable prognostic factor for HCC patients.

Effects of nodal gene RNA interference on biological behaviour and vasculogenic mimicry of human hepatocellular carcinoma cells / 中华普通外科杂志

Objective To evaluate the role of nodal gene modulating malignancy of a hepatocellular carcinoma cell lines SMMC7721. Methods To silence the expression of nodal gene in human hepatocellular carcinoma cells by RNA interference ( RNAi),and to observe the effect on cells biological behaviour and vasculogenic mimicry.4 expression vectors of nodal gene targeting small interference RNA were constructed and transfected into SMMC-7721 cells.Real-time quantitive PCR and Western blot were used to examine nodal gene expression. The effects of nodal gene RNA interference on proliferation,apoptosis,infestation,migration and vasculogenic mimicry of SMMC-7721 were studed. Results The expression of nodal gene was suppressed in SMMC-7721 cells by RNA interference.In the first 4,5,6 days of proliferation experiment,the proliferation of interference group was significantly lower than the control group(separately F =17 098.922,18 135.107,32 641.075,all P ＜ 0.05 ); 48 h after transfection,the apoptosis rate of interference group was significantly higher than the control group (F =1136.452,P ＜0.05); In the infestation and migration experiments,the cells through the transwell chamber in the interference group were less than the control group( separately F =83.6,1126.857,all P ＜ 0.05 ) ; 24 h and 48 h after transfection,the vasculogenic mimicry in the interference group did not form which was significantly different from the control group. Conclusions Interfering the expression of nodal gene inhibits the malignant biological behaviour and the formation of vasculogenic mimicry in human hepatocellular carcinoma cells.

Value of indocyanine green excretion test in predicting hepatic failure after hepatectomy / 中华消化外科杂志

Objective To assess the value of indocyanine green excretion test in predicting hepatic failure after hepatectomy. Methods The retention rate of indocyanine green at 15 minutes (ICG R15), effective hepatic blood flow (EHBF) and clinical and biochemical parameters of 128 patients who received hepatectomy at the Affiliated Provincial Hospital of Anhui Medical University from June 2007 to June 2008 were detected by pulse dye densitometry. All patients were divided into non-hepatic failure group (n = 110) and hepatic failure group (n =18). ICG R15, EHBF, Child's score, histology activity index (HAI) score, clinical and biochemical parameters and other indexes were analyzed to predict hepatic failure by the t test, chi-square test, linear regression analysis or regression model. The relationship between positive predictive indexes and HAI score was studied. Results Eighteen patients suffered from hepatic failure after operation. ICG R15, Child's score, HAI score of patients without hepatic failure were 9% ±4%, 5.6 ±0.7, 3.8 ±0.5, which were significantly lower than 15% ±6%,6.1 ± 0. 8, 5.0 ± 0. 8 of patients with hepatic failure (t = 11. 121,2. 356, 3. 915, P ＜ 0.05). EHBF of patients without hepatic failure was (1.2 ±0.2) L/min, which was significantly higher than (1.0 ±0.2) L/min of patients with hepatic failure (t = 2. 802, P ＜ 0. 05). In a logistic regression model, age ≥ 65 years, ICG R15 ≥ 14% and EHBF ＜ 1.0 L/min were risk factors of postoperative hepatic failure (x2 = 4. 758, 9.709, 5. 362, P ＜ 0.05).ICG R15 was negatively correlated with EHBF (r =-0. 527, P ＜0.05). HAI score was positively correlated with ICG R15 (r =0. 638, P ＜0.05), while it was negatively correlated with EHBF (r =-0. 445, P ＜0. 05).Conclusions ICG R15 and EHBF are good predictive indicators for hepatic failure after hepatectomy. Patients with ICG R15≥14% and EHBF ＜ 1.0 L/min are prone to have postoperative hepatic failure.

Searching for vasculogenic mimicry-associated differentially expressed genes in human hepatocellular carcinoma cell line MHCC97 using functional grouping cDNA microarray / 中华消化外科杂志

Objective To observe vasculogenic mimicry formation difference in human hepatocellular carcinoma cell lines MHCC97-H/L with different metastatic potentials under three-dimensional culture condition,and to study extracellular matrix and adhesion molecules-related mechanism of vasculogenic mimicry.Methods Three-dimensional cell culture system of MHCC97-H/L was established to observe tubelike structures by inverted microscope.Human umbilical vein endothelial cell(HUVEC),human hepatocellular carcinoma cell line Hep3B with non-metastatic potentials and normal human hepatic cell line HL-7702 were taken as control.Gene expression profiles of MHCC97-H and MHCC97-L were detected by Oligo extracellular matrix and adhesion molecules microarray analysis.Two differentially expressed genes were verified with semi-quantitative reverse transcriptionpolymerase chain reaction(RT-PCR)and Western blot.All data were analyzed using two sample t test.Results After a 24-hour three-dimensional culture,the length of tubelike structures was(474 ± 16)mm/cm2 in MHCC97-H,which were significantly longer than(320 ±41)mm/cm2 in MHCC97-L(t =6.119,P ＜0.05).Hep3B and HL-7702 could not form tubelike structures.Compared with MHCC97-L,the expression of 7 genes were up-regulated and the expression of 3 genes were down-regulated among a total of 113 angiogenesis genes in MHCC97-H.Two of the genes with differential expressions including tenascin C and extracellular matrix protein 1 were further validated by RT-PCR and Western blot.Conclusion MHCC97-H has stronger ability to form vasculogenic mimicry than MHCC97-L,and this perhaps correlates with the differential expression of certain extracellular matrix and adhesion molecules-related genes in MHCC97-H.