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Malignant biliary obstruction is often in an advanced stage at the time of diagnosis, and palliative relief of obstruction has become the main treatment option. Biliary stent implantation is currently the most widely used treatment for the relief of biliary obstruction, but stent reobstruction has become a common problem in clinical practice. Endoscopic retrograde cholangiopancreatography (ERCP) combined with intraductal radiofrequency ablation can solve the problem of direct obstruction in malignant biliary obstruction and improve stent patency rate, survival time, and survival rate, with few complications and a low surgery-related mortality rate, and therefore, it can be used as a safe and feasible palliative treatment method for malignant biliary obstruction.
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Objective To systematically evaluate the clinical efficacy of ABO-incompatible living donor liver transplantation (ABO-I LDLT) and compare with ABO-compatible LDLT (ABO-C LDLT). Methods A systematic search of multiple databases at home and abroad was conducted to retrieve the literatures related to the statistical comparison of clinical efficacy between ABO-I LDLT and ABO-C LDLT. The literature screening was conducted, the quality of literatures was evaluated and data extraction was performed. Using Rev Man 5.3 software, a Meta-analysis was performed by random effect model or fixed effect model. Results A total of 432 articles were searched, and 6 articles published in English were eventually included according to the inclusion criteria. The Meta-analysis demonstrated that there was no significant difference in the postoperative 1-, 3- and 5-year survival rate of the recipients and grafts and the incidence of rejection responses between the ABO-I LDLT and ABO-C LDLT groups (all P≥0.05). The incidence of postoperative biliary complications and hepatic artery embolization in the ABO-I LDLT group was significantly higher than that in the ABO-C LDLT group [odds ratio (OR)=2.08, 95% confidence interval (CI) 1.25-3.45, P=0.005; OR=2.24, 95%CI 1.03-4.89, P=0.04]. Conclusions Compared with the ABO-C LDLT, ABO-I LDLT yields lower clinical efficacy, whereas it is still an effective method for the treatment of end-stage liver disease.
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Objective To evaluate the role of emergency and staged hepatectomy in peritoneal metastasis associated with ruptured hemorrhage of resectable hepatocellular carcinoma (HCC) patients,and investigate the impact of surgery timing-selecting on peritoneal metastasis of postoperative HCC patients.Methods A retrospective analysis was conduct on the pooled data from 38 HCC patients with spontaneously ruptured hemorrhage treated in our hospital from August 2011 to January 2016.These patients were divided into emergency group who underwent hepatectomy within 24 hours at admission,and staged group who underwent the procedure one week after admission.Perioperative events,overall survival (OS) and disease-freesurvival (DFS) rates,incidence of recurrent and metastatic disease were compared between the two groups.Results The perioperative blood loss and transfusion were much more in emergency group than staged group (both P ＜ 0.05).Nevertheless,the incidence of postoperative mortality was not significantly different (6.0％ vs 0％,P ＞ 0.05).The median survival was 22.5 months in emergency group versus 14.2 months in staged group.The 6-month,1-year,3-year OS rates in emergency group were 88.2％,82.4％ and 30.3％ respectively,and 6-month,1-year,3-year DFS rates were 81.3％,54.7％ and 27.3％.The 1-year OS and 6-month DFS rates were higher than those of staged group (both P ＜ 0.05).The incidence of peritoneal metastasis in staged group was higher than that in emergency group,but it was not significantly different (38.1％ vs 29.4％,P ＞ 0.05).Univariate and multivariate analysis indicated that tumor diameter ≥ 10 cm and AFP ＞ 10 000 μg/L were the risk factors for peritoneal metastasis after hepatectomy for HCC patients with spontaneously ruptured hemorrhage.Conclusions Emergency hepatectomy would warrant a better short-term prognosis compared with staged hepatectomy for the HCC patients with spontaneously ruptured hemorrhage.Staged hepatectomy would not raise the possibility of postoperative peritoneal metastasis.The predictors of tumor diameter ≥ 10 cm and AFP ＞ 10 000 μg/L were risk factors for peritoneal metastasis after hepatectomy for spontaneously ruptured HCC patients.
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Neuroendocrine carcinoma of the pancreas is uncommon in clinic,which has a low malignancy,maintains indolent patterns of growth,and has a good long-term prognosis.However,because of its atypical clinical manifestation,its delayed presentation often results in distant metastasis,in which the liver is the most common site.Currently,the treatment of pancreatic neuroendocrine liver metastasis is limited and requires a diverse and multidisciplinary combination of therapy.This manuscript will discuss the current status of treating pancreatic neuroendocrine carcinoma liver metastasis.
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Teacher's career development in British medical school has experienced a very long process from establish to gradually mature.So far,it has already set up its system and its own characters in strategy and teacher's self-development.By analyzing characters of teacher's career development in British medical school including teacher development center,teacher's self-development and assessment for medical educators,we aimed to raise enlightenments on teacher's career development in China.
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Objective:To establish multidrug resistant human hepatoma cell subline(HepG2/DOX) and study its biological features.Methods:Doxorubincin-resistant human hepatoma cell subline (HepG2/DOX) was induced by doxorubincin-gradually increasing concentration.To observe cells by light microscope and analyze number and structure of chromosomes of these tumor cells.Sensitivity of anticancer drugs was screened in HepG2,HepG2/DOX cells by MTT method.The immunohistochemistry method was used to measure MDR-1 gene product Pgp expression.Results:HepG2/DOX and HepG2 were different in shape,growth speed.The number and structure of their chromosomes were also different.The value of 50% inhibitory concentration(IC50,?g/ml) for DOX,CDDP,MMC,5-FU,and MTX in HepG2,HepG2/DOX cells was (0.070 and 1.161),(0.214 and 1.317),(0.162 and 0.498),(0.313 and 1.683),(0,007 and 0.217) respectively.MDR-l gene product Pgp170 expression was found either in HepG2/DOX or HepG2 cells.Pgp170 exprssion in HepG2/DOX was higher than in HepG2.Once HepG2/DOX had been cultured in DOX free RPMl1640 medium for 5 weeks,the IC50(?g/ml)for DOX in HepG2/DOX reduced to 0.684.Conclusion:HepG2/DOX has the characteristics of MDR.The drug-resistance was correlated with over expression of MDR-1 gene product Pgp 170 and slow growth.