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Objective:To investigate the application value of a new internal cold circula-tion bipolar radio frequency device in open hepatectomy.Methods:The retrospective cohort study was conducted. The clinical data of 85 patients with hepatocellular carcinoma who underwent open hepatectomy at the Affiliated Tumor Hospital of Zhengzhou University from February 2017 to January 2020 were collected. There were 48 males and 37 females, aged from 32 to 74 years, with a median age of 52 years. Of 85 patients, 45 cases undergoing hepatectomy assisted by the new internal cold circulation bipolar radio frequency device were allocated into new internal cold circulation bipolar radio frequency device group, and 40 cases undergoing hepatectomy assisted by Habib-4X bipolar radio frequency device were allocated into Habib-4X group, respectively. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient, inpatient reexamination and telephone interview to detect the postoperative complications and death of patient within postoperative 30 days up to May 2020. Measurement data with normal distribution were represented as Mean± SD, and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(range), and nonparametric Mann-Whitney U test was used for comparison between groups. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Repeated measurement data were anlyzed by the repeated ANOVA. Results:(1) Intraoperative situations: the time of crosscutting process for liver parenchyma, average area transection speed, coagulation tissue width, cases with needle bleeding rate and electrode needle charring were (55±16)minutes, (4.8±1.2)cm 2/minute, (1.4±0.2)cm, 6, 10 for the new internal cold circulation bipolar radio frequency device group, versus (64±15)minutes, (3.6±1.0)cm 2/minute, (1.8±0.2)cm, 14, 25 for the Habib-4X group, respectively, showing significant differences in the above indicators between the two groups ( t=2.665, 4.973, 9.204, χ2=5.525, 14.184, P<0.05). (2) Postoperative situations: for the new internal cold circulation bipolar radio frequency device group, the total bilirubin (TBil) was (20±12)μmol/L, (25±12)μmol/L, (20±14)μmol/L at postoperative 1, 3, 7 days, the prothrombin time (PT) was (15.4±2.2)seconds, (14.2±2.1)seconds, (12.7±0.8)seconds, the alanine aminotransferase (ALT) was (288±248)IU/L, (132±61)IU/L, (67±32)IU/L, the aspartate aminotransferase (AST) was (279±114)IU/L, (50±22)IU/L, (30±13)IU/L. For the Habib-4X group, the TBil was 1(22±15)μmol/L, (23±10)μmol/L, (19±8)μmol/L at postoperative 1, 3, 7 days, PT was (15.8±2.8)seconds, (14.3±2.0)seconds, (13.6±1.3)seconds, the ALT was (369±269)IU/L, (133±99)IU/L, (54±30)IU/L, the AST was (345±125)IU/L, (60±36)IU/L, (32±11)IU/L. There were significant differences in the time effect of PT, ALT, AST between the two groups ( F=18.364, 23.020, 93.786, P<0.05). There was no significant difference in the time effect, between-group effect, interaction effect of TBil or between-group effect, interaction effect of PT, ALT, AST between the two groups ( F=2.421, 1.424, 0.522, 1.593, 0.312, 0.121, 0.267, 1.027, 0.600, P>0.05). (3) Follow-up: 85 patients were followed up for 4 to 39 months, with a median follow-up time of 16 months. There were 5 patients in the new internal cooling circulation bipolar radiofrequency device group and 8 patients in the Habib-4X group with complications, respectively, showing no significant difference in overall complications between the two groups ( χ2=1.292, P>0.05). The number of deaths in the new internal cooling circulation bipolar radio frequency device group and Habib-4X group was 0 and 1, respectively, showing no significant difference between the two groups ( P>0.05). Conclusion:The new internal cold-circulating bipolar radio frequency device for open hepatectomy is safe and effective, which cuts the liver parenchyma faster, has lower carbonization rate at the tip of electrode needle, and has more accurate coagulation range.
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Objective:To investigate the feasibility and safety of laparoscopic liver tumor resection in children.Methods:The clinical data of 6 children undergoing laparoscopic liver tumor resection from June 2018 to March 2020 in the Affiliated Tumor Hospital, Zhengzhou University were retrospectively analyzed.Results:There were 4 males and 2 females among the 6 cases, with the average age of (7±2)years.All the children were admitted to the hospital with a liver occupying examination due to physical discomfort.Preoperative diagnosis: 3 cases of hepatoblastoma, 1 case of primary liver cancer, 1 case of hepatic adenoma and 1 case of hepatic nodular hyperplasia.All the children successfully completed laparoscopic liver tumor resection without conversion to open surgery.Among them, 3 children obtained left hemihepatectomy, 1 child underwent hepatic left lobectomy, 1 child was given VI hepatectomy, and 1 child accepted hepatic caudate lobectomy.The operation time was(90±9)min, and the average intraoperative blood loss was (83±26) mL.All children had no blood transfusion during or after operation.There were no bleeding, bile leakage, infection and liver failure after operation.All children had no gastric tube before surgery and the fluid diet was given on the first day after operation, and the postoperative median hospital stay was 4(3-5) days.The pathology were consis-tent with the preoperative diagnosis, and the resections were all radical operation resections.The follow-up period was from 2 to 23 months, and all the children recovered well and no recurrence was observed.Conclusions:Laparoscopic liver tumor resection in children is safe and feasible, which can minimize trauma, reduce intraoperative bleeding and shorten the hospital stay without increasing the incidence of postoperative complications.Laparoscopic liver tumor resection in children has certain advantages.
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Hepatocellular carcinoma (HCC) is one of the most common malignant tumors, and its features of insidious onset, rapid development, and high recurrence bring great challenges to the long-term survival of HCC patients. Molecular-targeted drugs and immune checkpoint inhibitors have become the research hotspots in the treatment of HCC, and a large number of clinical trials have found that combined therapy has achieved a good clinical effect. This article mainly introduces the application of combined therapy with molecular-targeted drugs and immune checkpoint inhibitors and other combined therapies in HCC and points out that combined therapy related to systemic therapy or local therapy has become the latest research hotspot in HCC treatment.
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Objective:To study the safety and efficacy of liquid isolation assisted technology in ultrasound-guided percutaneous radiofrequency ablation for hepatocellular carcinoma adjacent to liver surfaces.Methods:A retrospective study was conducted on 246 patients with hepatocellular carcinoma near liver surfaces treated by radiofrequency ablation from November 2016 to November 2019 at the Department of Hepatobiliary and Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University. There were 182 males and 64 females, aged (56.7±9.2) years. The patients were divided into the liquid isolation group with liquid isolation assisted technology for radiofrequency ablation ( n=131) and the conventional treatment group with conventional radiofrequency ablation ( n=115). The complication, one-time complete ablation and progression-free survival rates were compared between the two groups. Results:The incidence of intraoperative complications in the liquid isolation group was 21.4% (28/131), versus 20.9% (24/115) in the conventional treatment group. There was no significant difference between the two groups ( P>0.05). The incidence of postoperative complications in the liquid isolation group was 20.6% (27/131), which was significantly lower than that in the conventional treatment group 33.9% (39/115) ( P<0.05). The incidence of postoperative pain in the liquid isolation group was 6.1% (8/131), which was significantly lower than that in the conventional treatment group 15.7% (18/115) ( P<0.05). For the 131 patients in the liquid isolation group, there were 183 tumors near to liver surfaces. For the 115 patients in the conventional treatment group, there were 142 lesions near to liver surfaces. The one-time complete ablation rate in the liquid isolation group was 94.0% (172/183), which was significantly higher than the 75.4% (107/142) in the conventional treatment group ( P<0.05). The progression-free survival rate in the liquid isolation group was significantly better than that in the conventional treatment group ( P<0.05). Conclusion:The liquid isolation technique increased the one-time complete ablation rate of liver cancer adjacent to liver surfaces, reduced the incidence of postoperative complications and improved prognosis.
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Hepatocellular carcinoma (HCC) is mostly treated by surgery combined with interventional therapy, chemotherapy, radiotherapy and local treatment. However, it often relapses after the operation. And the prognosis of advanced patients is poor, and the effective rate of chemotherapy and molecular targeted therapy is low. Recent studies indicated that the occurrence and progress of HCC are closely related to the immune function of the body. Immunotherapy, as a new type of tumor therapy, has drawn much attention. By improving the immunogenicity of tumor cells and the killing sensitivity of effector cells, it stimulates the immune function of the body, prolongs the progression-free survival time and the overall survival time of patients, and becomes an integral part of the comprehensive treatment of liver cancer. This article reviewd the progress in immunotherapy of HCC in the recent years.
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Objective To investigate the safety, efficacy and the key points of ultrasound-guided percutaneous radiofrequency ablation (RFA) in treatment of caudate lobe liver tumor. Methods The clinical data of 30 patients with caudate lobe liver tumor (57 lesions, 33 caudate lobe lesions) in the Affiliated Tumor Hospital of Zhengzhou University from January 2017 to December 2018 were retrospectively analyzed. All the patients were treated with ultrasound- guided percutaneous radiofrequency ablation. The puncture approach and single-needle or double-needle radiofrequency ablation were chosen according to the lesion location. The efficacy after treatment was evaluated according to the imaging examination. The deadline of follow-up was January 31, 2019, and the median follow-up time was 10 (1 to 20) months. After ablation, CT/MR was performed to evaluate whether the lesions were completely ablated. The effect of treatment and short-term complication were recorded. Results Thirty patients were successfully treated with ultrasound-guided percutaneous radiofrequency ablation. Among the 33 caudate lobe lesions, complete ablation rate at one time was 81.8% (27/33); local tumor progression rate after treatment was 12.1% (4/33), and the median time was 2.5 months. The new lesion rate was 26.7% (8/30), and the median time was 3.0 months. Two patients had significant abdominal pain, 1 patient had fever, 1 patient had hypoxemia during the ablation, and total incidence of complication was 13.3% (4/30). There was no bile leakage, gastrointestinal tract injury, uncontrollable bleeding and other serious complications and related deaths. Conclusions For the caudate lobe liver tumor, ultrasound-guided percutaneous radiofrequency ablation is safe and effective. It is necessary to select the appropriate puncture approach, avoid the intrahepatic duct reasonably and master the key points of ablation.
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Objective@#To investigate the safety, efficacy and the key points of ultrasound-guided percutaneous radiofrequency ablation (RFA) in treatment of caudate lobe liver tumor.@*Methods@#The clinical data of 30 patients with caudate lobe liver tumor (57 lesions, 33 caudate lobe lesions) in the Affiliated Tumor Hospital of Zhengzhou University from January 2017 to December 2018 were retrospectively analyzed. All the patients were treated with ultrasound-guided percutaneous radiofrequency ablation. The puncture approach and single-needle or double-needle radiofrequency ablation were chosen according to the lesion location. The efficacy after treatment was evaluated according to the imaging examination. The deadline of follow-up was January 31, 2019, and the median follow-up time was 10 (1 to 20) months. After ablation, CT/MR was performed to evaluate whether the lesions were completely ablated. The effect of treatment and short-term complication were recorded.@*Results@#Thirty patients were successfully treated with ultrasound-guided percutaneous radiofrequency ablation. Among the 33 caudate lobe lesions, complete ablation rate at one time was 81.8% (27/33); local tumor progression rate after treatment was 12.1% (4/33), and the median time was 2.5 months. The new lesion rate was 26.7% (8/30), and the median time was 3.0 months. Two patients had significant abdominal pain, 1 patient had fever, 1 patient had hypoxemia during the ablation, and total incidence of complication was 13.3% (4/30). There was no bile leakage, gastrointestinal tract injury, uncontrollable bleeding and other serious complications and related deaths.@*Conclusions@#For the caudate lobe liver tumor, ultrasound-guided percutaneous radiofrequency ablation is safe and effective. It is necessary to select the appropriate puncture approach, avoid the intrahepatic duct reasonably and master the key points of ablation.
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Objective To investigate the effect of sinomenine on the purinergic receptors A2A and P2X7 in endotoxemia mouse model and RAW264.7 macrophage model stimulated by lipopolysaccharide(LPS). Methods BALB/c mice were randomly divided into blank control group, model group and sinomenine group. Thirty minutes after the rats of sinomenine group were pretreated with intraperitoneal injection of sinomenine (40, 80, 160 mg/kg), the mice were given intraperitoneal injection of 15 mg/kg LPS to induce endotoxemia model. The serum levels of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6) were measured by enzyme-linked immunosorbent assay (ELISA). The expression levels of purinergic receptor A2A and P2X7 in the liver and spleen were detected by reverse transcription-polymerase chain reaction(RT-PCR). RAW264.7 macrophages were divided into blank control group, LPS group and sinomenine group. Sinomenine group was firstly treated with sinomenine(300μmol/L) for 2 h, and then LPS group and sinomenine group were treated with LPS (100 ng/mL) for another 8 hours. TNF-α in the cell supernatant was measured by ELISA, and the expression levels of A2A and P2X7 in RAW264.7 cells were detected by RT-PCR. Results Stimulation with LPS could induce the increase of the mouse serum levels of TNF-α and IL-6 as well as the expression of A2A and P2X7 in mouse liver and spleen, and sinomenine had a counteraction on the above indexes(P<0.05) . In-vitro stimulation with LPS could induce the increase of the content of TNF-α and the expression of A2A and P2X7 in RAW264.7 cells , and sinomenine decreased TNF-α content and P2X7 expression (P<0.05) , but had an effect on enhancing A2A expression. Conclusion Sinomenine suppresses the expression of purinergic receptor P2X7 in mouse spleen and liver as well as in RAW264.7 macrophages, but its effect on the expression of A2A in various tissues and cells varies, whose related mechanism is needed further study.
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Objective:To investigate sinomenine (Sinomenine,SIN) effect on RAW264.7 cells polarization to M1 or M2 phenotype induced by lipopolysaccharide (LPS) or interleukin-4 (IL-4) .Methods:RAW264.7 cells were induced to polarize to M1 by LPS ,and to M2 by IL-4.Sinomenine effects on LPS or IL-4 induced macrophages:TNF-αand IL-10 secretion induced by different condition were detected by Enzyme linked immunosorbent assay (ELISA);The expression level of mRNA of Arginase1(Arg-1),Nitric oxide synthase(iNOS),suppressor of cytokine signaling protein-2(SOCS2) and suppressor of cytokine signaling protein-3(SOCS3) of M1/M2 phenotypes were detected by real time PCR respectively.Results:Sinomenine inhibited the increase of TNF-αsecretion,iNOS and SOCS3 mRNA expression level induced by LPS.Sinomenine inhibited the increase of IL-10 secretion and Arg-1 mRNA expression level induced by IL-4,but SOCS2 mRNA expression level was not affected by Sinomenine.Conclusion: Sinomenine can inhibite the macrophage polarization to M1 and M2 induced by LPS and IL-4.Sinomenine plays a regulatory role on imbalance of M1/M2,and is conducive to maintain the dynamic balance.
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Objective To observe the anti-inflammatory effects of three kinds of aconine from Radix Aconiti Lateralis Preparata ( Fuzi) on macrophages, as well as the effects of their combination with sinomenine. Methods The effect of three monoester alkaloids from Fuzi, benzoylaconine ( BAC) , benzoylmesaconine ( BMA) and benzoylhypaconine ( BHA) , on RAW264.7 cells proliferation was detected by cell counting kit 8 (CCK8) in vitro. RAW 264.7 macrophage cells were stimulated by lipopolysaccharides (LPS) and then treated with different concentrations of BAC, BMA, and BHA. Tumor necrosis factor alpha ( TNF-α) and interleukin 6 (IL-6) secreted by RAW264.7 cells were measured by enzyme-linked immunosorbent assay (ELISA) . The anti-inflammatory effects of three monoester alkaloids combined with sinomenine were evaluated by Zhengjun Jin Q method. Results The concentrations of TNF-α and IL-6 secreted by LPS-stimulated RAW264.7 cells were increased significantly ( P<0.01) , and then were inhibited by BAC ( 20, 30 μmol/L) , BMA ( 40, 80, 160μmol/L) and BHA ( 40, 80, 160 μmol/L) significantly ( P<0.01) . Antagonistic effects were present when 30 μmol/L of BAC or 160 μmol/L of BMA or 160 μmol/L of BHA was respectively used together with 100 or 300 μmol/L of sinomenine (Q<0.85). Conclusion The three kinds of monoester alkaloids from Fuzi exert anti-inflammatory effect on macrophages, and the effective dose of BAC is lower than that of BMA and BHA. The combination of BAC, BMA or BHA at the analyzed dosage with sinomenine has antagonistic effect.
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Objective To illustrate the composition ratio of ERβ isoforms in paired cancerous and adjacent normal tissues from breast cancer patients.Methods Eighty-seven pairs of cancerous and adjacent normal tissues were obtained from breast cancer patients.RT-qPCR was used to determine the relative mRNA expression levels of ERβ isoforms (ER[β1,ERβ2 and ERβ5),and the composition ratios of ERβ isoforms were analyzed.Results The expression levels of all tested ERβ isoforms (ERβ1,ERβ2 and ERβ5) in breast cancer tissues were much lower than those in adjacent normal breast tissues (P ＜ 0.01).Isoform ratio analysis showed that ERβ5 was the dominant isoform in both cancerous and adjacent normal tissues with a positive detection rate of 54.02 ％ and 75.84 ％,respectively.Meanwhile,ERβ1 had the lowest detection rate (9.74 ％ and 6.77 ％ in cancerous and adjacent normal tissues,respectively).The positive rates for both ERβ1 and ERβ2 were much lower in adjacent normal tissues than those in cancer tissues (Z =-2.24,P =0.025 and Z =-4.85,P ＜ 0.01,separately),while more cancerous tissues were ERβ5-positive in comparison to adjacent normal tissues (Z =-5.32,P ＜ 0.01).Conclusions The expression levels of all the ERβ isoforms are differentially down-regulated with significant alterations in their composition ratios during breast carcinogenesis.Further understanding on molecular mechanisms underlying the differential down-regulation of ER[β isoforms will shed new light on breast carcinogenesis.
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Objective To investigate the effect of berberine on the polarization of mice RAW264.7 macrophages induced separately by lipopolysaccharide (LPS) and interleukin-4 (IL-4). Methods Mice RAW 264.7 macrophages cultured in vitro were divided into model group, medication group, and blank control group. Both model group and medication group were given either LPS (in final dose of 100 ng/mL) or IL-4 (in final dose of 10 ng/mL). Additionally, the medication group was treated with berberine in final dose of 20 μmol/L. The blank control group was given the same volume of phosphate buffered saline ( PBS). Real-time fluorescence quantitative polymerase chain reaction (PCR) was used to detect the mRNA expression of arginase-1 (Arg-1), inducible nitric oxide synthase ( iNOS) , suppressor of cytokine signaling2 ( SOCS2) and SOCS3. Enzyme-linked immunosorbent assay (ELISA) was used to determine the contents of tumor necrosis factor alpha (TNF-α) and IL-10. Results The content of TNF-αand the mRNA expression levels of iNOS and SOCS3 in macrophages induced by LPS were increased, and then were down-regulated by berberine (P0.05). Conclusion Berberine has an effect on inhibiting the M1 and M2 polarization of macrophages in vitro, suggesting that berberine may play a regulatory role in the dynamic balance of M1/M2.