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The pandemic of Corona Virus Disease 2019 (COVID-19) continues, which shows the concentrated or sporadic cases in multiple places. Current COVID situation is still complex. During the COVID-19, routine diagnosis and treatment of liver cancer patients has been affected in different degrees. Under the premise of following the treatment guidelines, how to reduce the risk of infection of patients and medical staff, utilize limited medical resources to maximally ensure anti-tumor treatment and related emergency treatment, and help patients get through the epidemic period is a problem for liver oncologists. Thus, experts of liver cancer treatment related disciplines of Zhongshan Hospital, Fudan University have written the Expert guidance on overall management of liver cancer during the COVID-19, which aims to provide references for liver oncolo-gists to conduct clinical work safely and effectively under the epidemic prevention and control, and to help patients fight against the epidemic smoothly.
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Objective To investigate the expression of ENO3 gene in hepatocellular carcinoma and its effect on the sensitivity of hepatocellular carcinoma cell lines to OXA, and to explore the possible mechanism. Methods qRT-PCR and immunohistochemical analysis were used to detect the expression of ENO3 in 48 pairs of hepatocellular carcinoma tissues and normal liver tissues.Overexpression plasmid was constructed and transfected into MHCC97H and HepG2 cells.The experiments were divided into empty group (Vector group), ENO3 overexpression group (ENO3 group), empty+OXA group (Vector+OXA group) and ENO3 overexpression+OXA group (ENO3+OXA group).The proliferation ability of MHCC97H and HepG2 cells were detected by CCK-8 assay and cell colony formation assay.The apoptosis rate was determined by flow cytometry assay.Protein expressions of Bcl-2, Bax and Caspase-3 were detected by Western blot assay. Results The expression of ENO3 was significantly decreased in hepatocellular carcinoma tissues, compared with normal liver tissues adjacent to the carcinoma.The expression of ENO3 gene in the ENO3 overexpression group was significantly higher than that in the empty group.Compared with the Vector+OXA group, cell viability was decreased, apoptosis rate was increased, Bcl-2 protein expression was decreased, Bax and Caspase-3 protein expression were increased in the ENO3+OXA group. Conclusion The expression of ENO3 is down-regulated in hepatocellular carcinoma tissues, and the overexpression of ENO3 can enhance the sensitivity of hepatocellular carcinoma cell lines to oxaliplatin by promoting cell apoptosis.
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Objective@#To predict the efficacy of endoscopic tissue adhesives in the treatment of gastric varices in patients with liver cirrhosis by Nomogram model.@*Methods@#From August 2014 to September 2017, 158 patients with liver cirrhosis caused esophagogastric variceal bleeding and received endoscopic tissue adhesives treatment at Zhongshan Hospital, Fudan University were collected. All patients were followed for 12 months. The primary outcome was rebleeding. The factors of rebleeding after endoscopic treatment of esophagogastric varices were analyzed. Nomogram prognostic model was developed and compared with Child-Pugh grading, computed tomography angiography (CTA) and hepatic venous pressure gradient (HVPG) in prognostic accuracy in rebleeding after endoscopic treatment in liver cirrhosis caused esophagogastric varices. Univariate and multivaricate Cox regression analysis, Kaplan-Meier curve and log-rank test were performed for statistical analysis.@*Results@#During the follow-up, rebleading occurred in 18 cases (11.4%), 37 cases (23.4%) and 49 cases (31.0%) at 2, 6, and 12 months after endoscopic treatment. The results of univariate Cox regression analysis showed the risk factors of rebleeding after endoscopic treatment of gastric varices included gender, alcoholic liver cirrhosis, diabetes mellitus, Child-Pugh grade (Grade A vs. B or C), extraluminal vessels on CTA (presence vs. absence) HVPG (<16 mmHg vs. ≥16 mmHg, 1 mmHg = 0.133 kPa), extensive portal embolism, esophageal varices, type 2 gastric varices, injection points of tissue adhesive (≤3 points vs. > 3 points), injection volume of tissue adhesive (≤ 3 mL vs. > 3 mL) (hazard ratio (HR)=0.575, 2.018, 1.562, 3.433, 2.945, 1.859, 2.743, 0.324, 1.840, 1.477, and 1.716; 95% confidence interval (CI) 0.305 to 1.084, 0.902 to 4.514, 1.753 to 6.724, 1.663 to 5.217, 1.012 to 3.415, 0.852 to 8.830, 0.079 to 1.335, 1.012 to 3.317, 0.839 to 2.602, and 0.935 to 3.152; all P<0.2). The results of multivariate Cox regression analysis indicated that Child-Pugh grade, extraluminal vessels by CTA, and HVPG (HR = 2.095, 95% CI 1.099 to 3.995, P = 0.025) were all independent risk factors of rebleeding after endoscopic treatment of gastric varices (HR=2.665, 2.886, and 2.095; 95% CI 1.339 to 5.300, 1.580 to 5.271, and 1.099 to 3.995; all P<0.05). Kaplan-Meier curves showed that Child-Pugh grade (Grade A vs. B or C), extraluminal vessels on CTA (presence or absent) and HVPG (<16 mmHg vs. ≥16 mmHg) could effectively predict cumulative non-rebleeding rate in one year after endoscopic treatment of gastric varices, and the differences were statistically significant (all P<0.05). Receiver operataring characteristic curve analysis demonstrated that the predictive value of the model combined with Child-Pugh grade, extraluminal vessels on CTA and HVPG was higher than that of Child-Pugh grade and HVPG (AUC=0.746, 0.673 and 0.585; 95% CI 0.662 to 0.829, 0.583 to 0.762, and 0.486 to 0.683; P<0.01, P=0.001 and P=0.089, respectively). Patients were divided into low, medium, and high-risk groups according to the 25th and 75th percentiles of the Nomogram score. The results showed that Nomogram model could effectively distinguish high-risk groups of rebleeding after endoscopic treatment of gastric varices, and the difference was statistically significant (P <0.01).@*Conclusions@#Extraluminal vessels on CTA, HVPG and Child-Pugh grade are independent prognostic evaluation indexes of rebleeding after endoscopic treatment of gastric varices. The predictive accuracy of Nomogram model based on these three prognostic factors may be better than Child-Pugh grade and HVPG.
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Objective:To predict the efficacy of endoscopic tissue adhesives in the treatment of gastric varices in patients with liver cirrhosis by Nomogram model.Methods:From August 2014 to September 2017, 158 patients with liver cirrhosis caused esophagogastric variceal bleeding and received endoscopic tissue adhesives treatment at Zhongshan Hospital, Fudan University were collected. All patients were followed for 12 months. The primary outcome was rebleeding. The factors of rebleeding after endoscopic treatment of esophagogastric varices were analyzed. Nomogram prognostic model was developed and compared with Child-Pugh grading, computed tomography angiography (CTA) and hepatic venous pressure gradient (HVPG) in prognostic accuracy in rebleeding after endoscopic treatment in liver cirrhosis caused esophagogastric varices. Univariate and multivaricate Cox regression analysis, Kaplan-Meier curve and log-rank test were performed for statistical analysis.Results:During the follow-up, rebleading occurred in 18 cases (11.4%), 37 cases (23.4%) and 49 cases (31.0%) at 2, 6, and 12 months after endoscopic treatment. The results of univariate Cox regression analysis showed the risk factors of rebleeding after endoscopic treatment of gastric varices included gender, alcoholic liver cirrhosis, diabetes mellitus, Child-Pugh grade (Grade A vs. B or C), extraluminal vessels on CTA (presence vs. absence) HVPG (<16 mmHg vs. ≥16 mmHg, 1 mmHg = 0.133 kPa), extensive portal embolism, esophageal varices, type 2 gastric varices, injection points of tissue adhesive (≤3 points vs. > 3 points), injection volume of tissue adhesive (≤ 3 mL vs. > 3 mL) (hazard ratio ( HR)=0.575, 2.018, 1.562, 3.433, 2.945, 1.859, 2.743, 0.324, 1.840, 1.477, and 1.716; 95% confidence interval ( CI) 0.305 to 1.084, 0.902 to 4.514, 1.753 to 6.724, 1.663 to 5.217, 1.012 to 3.415, 0.852 to 8.830, 0.079 to 1.335, 1.012 to 3.317, 0.839 to 2.602, and 0.935 to 3.152; all P<0.2). The results of multivariate Cox regression analysis indicated that Child-Pugh grade, extraluminal vessels by CTA, and HVPG ( HR = 2.095, 95% CI 1.099 to 3.995, P = 0.025) were all independent risk factors of rebleeding after endoscopic treatment of gastric varices ( HR=2.665, 2.886, and 2.095; 95% CI 1.339 to 5.300, 1.580 to 5.271, and 1.099 to 3.995; all P<0.05). Kaplan-Meier curves showed that Child-Pugh grade (Grade A vs. B or C), extraluminal vessels on CTA (presence or absent) and HVPG (<16 mmHg vs. ≥16 mmHg) could effectively predict cumulative non-rebleeding rate in one year after endoscopic treatment of gastric varices, and the differences were statistically significant (all P<0.05). Receiver operataring characteristic curve analysis demonstrated that the predictive value of the model combined with Child-Pugh grade, extraluminal vessels on CTA and HVPG was higher than that of Child-Pugh grade and HVPG (AUC=0.746, 0.673 and 0.585; 95% CI 0.662 to 0.829, 0.583 to 0.762, and 0.486 to 0.683; P<0.01, P=0.001 and P=0.089, respectively). Patients were divided into low, medium, and high-risk groups according to the 25th and 75th percentiles of the Nomogram score. The results showed that Nomogram model could effectively distinguish high-risk groups of rebleeding after endoscopic treatment of gastric varices, and the difference was statistically significant ( P <0.01). Conclusions:Extraluminal vessels on CTA, HVPG and Child-Pugh grade are independent prognostic evaluation indexes of rebleeding after endoscopic treatment of gastric varices. The predictive accuracy of Nomogram model based on these three prognostic factors may be better than Child-Pugh grade and HVPG.
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Cell autophagy plays a key role in maintaining intracellular nutritional homeostasis during starvation through elimination of aberrant or obsolete cellular structures. The cellular cytoskeleton has a crucial role in multiple processes involving membrane rearrangements and vesicle-mediated events. Autophagy is mediated by both microtubules and actin networks: microtubules promote the synthesis of autophagosome and are related to the movement of autophagosome; actin networks have been implicated in structurally supporting the expanding of phagophore, moving autophagosomes and enabling their efficient fusion with the lysosome; non-muscle myosinⅡoperates in the early stages of autophagy during the initiation and expansion of the phagophore, whereas myosinⅥ and myosin 1C are involved in the late stages of autophagosome maturation and fusion with the lysosome, respectively. This review summarizes the multiple regulation of cytoskeleton on autophagy and focuses on the regulation of autophagy by actin and myosin, providing a new approach for the study of pathogenesis and innovative therapies of autophagy related diseases.
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Objective To investigate the clinical characteristics of tubal stump pregnancy, and to assess the value of interventional embolization in preventing tubal stump pregnancy. Methods Among the patients who were planned to receive preoperative treatment of hydrosalpinx before the performance of in vitro fertilization-embryo transfer (IVF-ET) at authors' hospital, 35 patients had stump of fallopian tube. Of the35 patients, previous surgery of unilateral fallopian tube was present in 28 and previous surgery of bilateral fallopian tubes in 7. The length of tubal stump ranged from 10mm to 45mm, with a mean of 25mm. Interventional embolization with micro-coils was carried out in all patients, after which IVF-ET was performed. The pregnancy rate and ectopic pregnancy rate were calculated. Results Embolization of both fallopian tubes was successfully accomplished in all 35 patients. The IVF-ET pregnancy rate was 48.5％ (17/35), and no tubal stump pregnancy occurred. Conclusion The use of interventional embolization to occlude tubal stump can effectively avoid the occurrence of tubal stump pregnancy.
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Objective To evaluate the short-term and long-term efficacy of interventional therapy for acute hepatic artery thrombosis.Methods We analyzed retrospectively the interventional treatment and long-term follow-up data of 34 patients with acute hepatic artery thrombosis in Zhongshan hospital of Fudan University from March 2003 to October 2015.Results Thirty-four patients with acute hepatic artery thrombosis were performed with urokinase thrombolytic therapy.Twenty-one patients were implanted stents in the thrombolytic therapy.Splenic artery embolization were performed in 3 patient with splenic artery steal syndrome.Technical and clinical success rates were 91％ (31/34).The complication associated with interventional procedures were observed in 2 patients.The patency rates of hepatic artery in 1,2,3 and 5 years were 82％,73％,57％ and 57％ respectively.The median obstruction free time was 94 months.Conclusions Good short-term and long-term effect have been obtained in interventional treatment for acute hepatic artery thrombosis,which can be used as the first treatment for acute hepatic artery thrombosis after liver transplantation.
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Objective To investigate the safety and efficacy of transarterial chemoembolization (TACE) combined with implantation of irradiation IVC stent in treating hepatocellular carcinoma (HCC)complicated by inferior vena cava tumor thrombosis (IVCTT).Methods The clinical data of 61 consecutive patients with HCC complicated by IVCTT were retrospectively analyzed.Irradiation IVC stent was prepared by strapping 125I particles on the bare stent,and it was employed in 33 patients (group A).Bare stent was adopted in 28 patients (group B).Propensity score matching method was used to conduct randomized analysis of the original data in order to reduce the selection bias.The survival time,remission rate of symptom and procedure-related adverse events of both groups were calculated and the results were compared between the two groups.Results The incidence of adverse reactions was similar in the two groups,and symptomatic treatment with internal medicine was adopted.The survival time in group A was superior to that in group B.The median survival time in group A was (203.0±28.1) days,which was (93.0±24.3) days in group B (P=0.006).Propensity score matching (24 pairs in total) cohort analysis showed that the median survival time was (200±31) days in group A and (66±23) days in group B (P=0.019).The edema remission rates in group A and in group B were 97.0％ and 96.4％ respectively.Multiple factor analysis revealed that irradiation stent implantation and objective tumor response were independent factors predicting a good prognosis.Conclusion For the treatment of HCC associated with IVCTT,TACE combined with irradiation stent implantation is safe and effective,this therapy can prolong the patient's survival time
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Objective To evaluate the safety and efficacy of brachytherapy with 125I seed strand in treating implanted main portal vein tumor thrombus (MPVTT) in experimental rabbits.Methods VX2 tumor cell line was implanted in the main portal vein (MPV) of 32 New Zealand white rabbits to establish MPVTT models.The rabbits were randomly divided into the treatment group (group T,n=16) and the control group (group C,n=16).125I seed strand was implanted in the MPVTT of the rabbits of group T,while blank seed strand was implanted in the MPVTT of the rabbits of group C.After the implantation,the changes in general condition,body weight and laboratory testing results were recorded.Two weeks after the treatment,every 8 rabbits from each group were sacrificed,and the specimens were collected and sent for pathological examination.The remaining rabbits were fed till they died,and then autopsy was conducted.Multi-slice spiral CT manifestations,histopathological findings,Ki-67 labeling index and apoptosis index were used to assess the curative effect,and the results were compared between the two groups.Results At each observation time point after brachytherapy,the weight loss of the experimental rabbits was more obvious in group C than in group T.No statistically significant differences in liver functions and white blood cell count existed between the two groups (P＞0.05).The mean MPVTT volume of group T and group C were (565.40±220.90) mm3 and (2 269.90±437.00) mm3 respectively (P＜0.001);the Ki-67 labeling indexes were (4.14±1.84)％ and (33.82± 6.07)％ respectively (P=0.001);the median survival days were (39.50±2.37) d and (27.38±1.22) d respectively (P=0.001).Conclusion For the treatment of implanted MPVTT in experimental rabbits,brachytherapy with 125I seed strand is safe and effective.
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Hepatocellular carcinoma (HCC) is the most common primary malignant liver cancer.Transarterial chemoembolization (TACE) has been the preferred effective treatment for unresectable advanced HCC TACE with drug-eluting beads is a newly emerging therapeutic means,with which the chemotherapy drugs can be continuously and slowly released into the tumor tissue,thus,increasing the local drug concentration and reducing serum drug concentration.The use of drug-eluting beads with ＞100 μm diameter is safe and effective when super-selective catheterization of the tumor-feeding artery is successfully accomplished.TACE with drug-eluting beads is superior to traditional TACE in improving tumor remission rate,decreasing the number of operations,reducing adverse reactions,shortening hospitalization time,improving the quality of life,etc.This therapy is more effective for the patients who have advanced liver cancer,Child-Pugh B grade liver function,level Ⅰ physical activity status,lesions of two hepatic lobes,and recurrent HCC.Because of expensive medical cost,need of high-quality medical conditions and experienced medical staffers,as well as need of fully guaranteed health insurance policy,the clinical application of drugeluting beads has been limited.The clinical effect of TACE with drug-eluting beads needs to be further studied and proved.
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Objective To investigate the safety and feasibility of intraluminal brachytherapy using iodine-125 seed strand for locally advanced pancreatic ductal adenocarcinoma with obstructive jaundice.Methods Clinical data of 17 consecutive patients,from January 2010 to February 2015,diagnosed with pancreatic ductal adenocarcinoma (4 cases of T4 N0 M0 and 13 of T4 N1M0) with obstructive jaundice and received intraluminal brachytherapy using iodine-125 seed strand were collected and analyzed retrospectively.Liver function was evaluated using paired-samples t test.The iodine-125 seed strand radiation doses were calculated using iodine-125 radiation field distribution calculation software (version 0.1,Institute of Radiation Medicine,Fudan University,Shanghai,China) based on the American Association of Physicists in Medicine TG43U1 brachytherapy formula.Obstruction free survival and overall survival were calculated using the Kaplan-Meier method.Complications were assessed according to the CTCAE 4.0 criteria.Results The estimated mean accumulating dose (r =5 mm,240 days) was 167.2Gy,from 164.19Gy to 170.05Gy.The mean and median obstruction free survival time were (9.62 ± 1.47) months (95％CI:6.73-12.50) and (7.26 ± 1.71) months (95 ％CI:3.90-10.62).The mean and median overall survival time were (9.89 ± 1.59) months (95％CI:6.78-13.00) and (7.26 ± 1.71) months (95 ％ CI:3.90-10.62),retrospectively.Total bilirubin and conjugated bilirubin decreased significantly after the therapy.Two patients had adverse event of Grade 3,one of Grade 4.Stent dysfunction occurred in 1/17 (5.9 ％) patients.Conclusions Intraluminal brachytherapy using iodine-125 seed strand might be considered as a safe treatment option for the locally advanced pancreatic duct adenocarcinoma complicated by obstructive jaundice.
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Objective To compare the safety and efficacy of endovascular brachytherapy (EVBT)with those of sequential three-dimensional conformal radiotherapy (3-D CRT) in treating main portal vein tumor thrombus (MPVTT).Methods The clinical data of a total of 176 hepatocellular carcinoma (HCC)patients complicated by MPVTT,who were treated with portal vein stenting and TACE during the period from May 2012 to June 2014,were retrospectively analyzed.Of the 176 patients,additional EVBT by using 125I seeds strand was carried out in 123 patients (group A) at the same time,and in the remaining 53 patients (group B) sequential 3-D CRT was conducted.The overall survival,progression free survival,stent patency period and the incidence of treatment-related complications were compared between the two groups.Results No serious treatment-related complications occurred after therapy.During a mean of (11.7±8.3) months followup period,the mean survival was (11.7±1.2) months in group A and (9.5±1.8) months in group B (P=0.002).The mean progression free survival in group A and in group B was (5.3±0.7) months and (4.4±0.4)months respectively (P=0.010).The mean stent patency period in group A and in group B was (10.3±1.1)months and (8.7±0.7) months respectively (P=0.003).Conclusion Compared to sequential 3-D CRT,EVBT combined with portal vein stenting and TACE can significantly improve the overall survival of patients with HCC complicated by MPVTT.
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In Europe and America,especially in the United States,transcatheter arterial radiotherapy embolization(TARE) with yttrium-90(90Y)microspheres has become one of the major treatment for primary and secondary liver malignancy that cannot be resected or ablated.Its safety and efficacy were verified with large amounts of studies.It is imperative for TARE with 90Y microspheres in China mainland,though there are no 90Y microspheres available at present.But it is hard to popularize TARE only with 90Y microspheres imported for the unique characters based on techniques.Since we had experience in making 90Y glass microspheres in early 1990s,we must work hard with many joints to remake home made 90Y microspheres to benefit patients in China.
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Objective To evaluate the influence of thermal damage on the cell proliferation,invasive metastasis and epithelial-mesenchymal transition of hepatocellular carcinoma (HCC) through experiments in vitro,and to explore the relationship between thermal ablation and the recurrence,metastasis of HCC.Methods The McA-RH7777 HCC cell thermal damage model was established by using external heating method.The effect of thermal damage on the proliferation of HCC cells was detected by Kit-8 assay (CCK-8),and the cell cycle changes were studied by flow cytometry.The effect of thermal damage on the invasion potential of HCC cells was assessed by using Transwell assay.Fluorescence quantitative polymerase chain reaction (RT-PCR) and Western blot were used to evaluate the influence of thermal damage on HCC cell invasion potential,and on the mRNA and protein expression levels of EMT-related molecular markers,including VEGF,MMP-9,Nm23,E-cadherinand vimentin.Results Heating treatment of McA-RH7777HCC cells was performed by putting the cells in 43.5℃ water basin for 30 min.Two to five days after heating treatment the cell proliferative ability was significantly higher than that of control group (P＜0.05).At 48-72hours after heating treatment the proportion of HCC cells in G1 phase was obviously reduced and the proportion of HCC cells in S+G2 phase was significantly increased,the differences were statistically significant (P＜0.05).Compared with the control group,the difference in HCC cell invasion potential determined at 24 h after heating treatment was not significant,while the HCC cell invasion potential determined at 72 h after heating treatment was strikingly increased (22.3±2.46 vs.14.2±l.82,P＜0.001).Real-time PCR and Western blotting results indicated that at 72 h after heating treatment the expression levels of VEGF,MMP-9 and vimentin were significantly increased,while the expression level of E-cadherin was remarkably decreased,the differences were statistically significant (P＜0.05).Conclusion Thermal damage with sub-lethal heating dose can induce McA-RH7777 HCC cell to develop epithelial-mesenchymal transition and to enhance its proliferation and invasive metastasis potential,and HCC cells show higher malignant potential.
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Objective To evaluate the value of dynamic contrast-enhanced MRI (DCE-MRI)in the assessment of cervical cancer with different features.Methods A cohort study of 1 56 cervical cancer patients underwent routine MRI and DCE-MRI scanning on 3.0T MR unit.The semi-quantitative parameters from time-signal curve of DCE-MRI were divided into the following groups:1 ) squamous carcinoma and adenocarcinoma.2)different pathologic grades of cervical cancer (G1,G2,G3).3)early stage (FIGOⅠb/Ⅱa)tumor and advanced tumor (FIGOⅡb,Ⅲ and Ⅳ).4)cervical cancer with different lymph node status (no/yes).5)cervical cancer with dif-ferent tumor size (greatest diameter 4 cm).6)cervical cancer with different age range.Statistical analysis was performed with the data analysis program SPSS and R3.1.1.Results There was a statistically significant difference between the squamous carcinoma and adenocarcinoma in the SI30s% and Slope,as well as between the tumor FIGO early and advanced stage in TTP and Slope.There was no significant difference among other groups.Conclusion The semi-quantitative parameters from time-signal curve of DCE-MRI can be used to differentiate histologic type and FIGO early/advanced stage of cervical cancer.The diagnostic accuracy may be high for Slope for histologic type differentiation,and the diagnostic accuracy is equal for TTP and Slope in differenti-ation of FIGO early and advanced stage of cervical cancer.
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Luminal surface of vascular endothelium is decorated with a variety of polysaccharide-protein complexes,which constitute the glycocalyx.It has been demonstrated that vascular endothelial glycocalyx plays an important role in modulation of selective permeability of vessels,mediation of the blood cell-endothelial cell interactions and the release of nitric oxide induced by fluid shear stress under physiological condition.In inflammation condition,sheding of glycocalyx due to inflammation mediator leads to its functional weakening in vessel protection.At the same time,heparan sulfate as a major constituent of vascular endothelial glycocalyx could be involved in regulating the evolution of inflammation.Heparan sulfate interacts with L-selectin to mediating leukocyte rolling,presents chemokines on luminal surfaces of endothelial cells to mediate leukocyte crawling and firm adhesion,participates in transcytosis of chemokines from tissue to luminal side of endothelial cells during inflammation.Various risk factors of atherosclerosis,as an inflammatory disease,are closely associated with vascular endothelial glycocalyx.This paper is aimed to review the role of vascular endothelial glycocalyx in inflammation and atherosclerosis.
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Objective To evaluated the clinical significance of embolization of arterio-portal venous shunt (APVS) in hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus (MPVTT) treated by transcatheter arterial chemoembolization (TACE) and portal vein stenting. Methods Twenty-six HCC patients with MPVTT and marked APVS, who were treated with TACE and portal vein stenting, were enrolled in this study. Portal vein stenting was performed via percutaneous transhepatic approach, which was followed by the embolization of the feeding arteries of APVS by using suitable embolic agents. The portal vein pressure levels were separately measured before, after portal vein stenting and after APVS embolization. The results were statistically analyzed. Results Both the portal vein stenting and APVS embolization were successfully accomplished in all the 26 patients. Hepatic angiography and portal venography performed before portal vein stenting revealed bidirectional portal flow in 16 cases and hepatofugal portal flow in 10 cases. Among the 16 patients with bidirectional portal flow, remarkable improvement of portal vein to liver blood flow after portal vein stenting was seen in 14, and obvious recovery of main portal vein to liver blood flow after APVS embolization in 2. Obvious recovery of main portal vein to liver blood flow after APVS embolization was also demonstrated in 10 cases with hepatofugal portal flow. The portal vein pressure determined before, after portal vein stenting and after APVS embolization was (50.1±6.3) cmH2O,(43.5± 7.5) cmH2O and (36.9 ±8.2) cmH2O respectively. After portal vein stenting the portal vein pressure was significantly decreased when compared with the preoperative pressure, and the difference was statistically significant (P<0.05); after APVS embolization the portal vein pressure was further decreased (P<0.05). Conclusion For HCC patients with MPVTT and marked APVS, portal vein stenting can effectively restore the portal blood flow and reduce the portal vein pressure; and embolization of APVS can further reduce the pressure of portal vein, thus the bidirectional portal flow or hepatofugal portal flow will return to normal hepatopetal flow.
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To study the potential molecular mechanism of tumor angiogenesis in its microenvironment, we investigated the effects of HepG2 conditioned medium on the proliferation of vascular endothelial cell and vascular angiogenesis in our laboratory. Human umbilical vein endothelial EA. hy926 cells were co-cultured with HepG2 conditioned medium in vitro. The proliferation and the tubulogenesis of EA. hy926 cells were detected by teramethylazo salt azole (MTT) and tube formation assay, respectively. The results showed that the survival rate of the EA. hy926 cells was significantly increased under the co-culture condition. HepG2 conditioned medium also enhanced the angiogenesis ability of EA. hy926 cells. In addition, the expressions of intracellular VEGF and extracellular VEGFR (Flk-1) were regulated upward in a time-dependent manner. In conclusion, the proliferation of vascular endothelial cells and Vascula angiogenesis were improved under the condition of indirect co-culture.
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Humans , Carcinoma, Hepatocellular , Pathology , Cell Proliferation , Coculture Techniques , Culture Media, Conditioned , Endothelial Cells , Cell Biology , Hep G2 Cells , Human Umbilical Vein Endothelial Cells , Liver Neoplasms , Pathology , Neovascularization, Pathologic , Tumor Microenvironment , Vascular Endothelial Growth Factor A , Metabolism , Vascular Endothelial Growth Factor Receptor-2 , MetabolismABSTRACT
With the progress of imaging techniques, the diagnosis rate for portal vein thrombosis (PVT), that is used to be considered as a rare disease, has been rapidly increasing. PVT can be caused by systemic reasons such as various thrombophilic risk factors as well as a lot of local reasons such as cirrhosis, abdominal trauma and infection, malignant tumor, etc. At present, PVT is classified into acute and chronic entities based on the duration of clinical symptoms as well as on the presence or absence of portal cavernous transformation. The clinical manifestations and the treatment principles of the acute and chronic PVT are quite different. For acute PVT, the principle of treatment is to reopen the obstructed portal vein and to prevent the thrombus from entering into the superior mesenteric vein, while for chronic PVT the principle of treatment is focused on the management of the complications due to portal hypertension. The interventional management of portal thrombus plays an important role in reopening portal vein, reducing complications caused by portal hypertension, and restoring portal blood flow, etc. This paper aims to make a comprehensive review about the etiology and management of portal vein thrombosis.
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Objective To investigate the optimal interventional therapy for primary hepatocellular carcinoma (HCC) complicated by main portal vein tumor thrombus.Methods Three-stage treatment, i.e. transcatheter arterial chemoembolization (TACE) combined with portal vein stenting and 125I seeds strand implantation, biliary stenting plus 125I seeds strand implantation and endoscopic variceal ligation, was carried out in one patient with primary HCC complicated by main portal vein tumor thrombus. The clinical results were analyzed combined with a review of the relevant literature in order to compare the efficacies of various interventional therapies employed in clinical practice nowadays. Results The sequential therapies of the three-stage treatment program were successfully accomplished. The patient was followed up for over five years and lived well when the report was made. Conclusion At present, TACE combined with portal vein stenting and implantation of 125I seeds strand is the optimal treatment for primary HCC associated with portal vein tumor thrombus.