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Objective:To explore the clinical effect of laparoscopic anatomical hepatic segment Ⅷ (S8) resection.Methods:Of 16 patients with liver cancer who underwent laparoscopic anatomical hepatic S8 resection at the National Cancer Center from October 2020 to October 2022 were were enrolled, including 13 males and 3 females, aged (59.1±10.9) years. The operation time, intraoperative blood loss, occurrence of intraoperative blood transfusion, and postoperative complications were retrospectively analyzed. Recurrence and survival were followed up by outpatient and telephone reviews.Results:Laparoscopic anatomical hepatic S8 resection was successfully performed in 16 patients without conversion to laparotomy. Among them, 10 patients underwent the intraoperative ultrasound guided hepatic parenchymal approach, and 6 underwent laparoscopic Glissonean pedicle puncture for the positive staining of S8 using indocyanine green. The operation time was (274.8±82.8) min, and the intraoperative blood loss was [ M( Q1, Q3)] 100.0 (50.0, 200.0) ml. There were no intraoperative blood transfusion or postoperative complication. The drainage tube was successfully removed and the patients were discharged 5 to 7 days after surgery. The patients were followed up for 5 to 24 months and all survived. Two patients had tumor recurrence. Conclusion:Laparoscopic anatomical S8 resection is safe and feasible.
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Liver is an organ with strong regenerative potential. After trauma, infection, surgery and so on, it will initiate a series of regulation for orderly regeneration to rapidly restore liver function and liver volume and thus maintain normal physiological function. This article summarizes the process of liver regeneration after hepatectomy, the evaluation methods for liver regeneration and the factors affecting liver regeneration, so as to provide references for clinical precision liver surgical treatment.
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ObjectiveTo perform a predictive analysis of the quality marker（Q-Marker） for the anticoagulant activity of Kunning granules. MethodThe chemical components of Kunning granules were analyzed by ultra high performance liquid chromatography-quadrupole-time of flight tandem mass spectrometry（UHPLC-Q-TOF-MS/MS） on a Waters ACQUITY UPLC HSS T3 column（2.1 mm×100 mm， 1.8 μm） with the mobile phase of acetonitrile（A）-25 mmol∙L-1 ammonium acetate aqueous solution（B） for gradient elution （0-5 min， 5%-22%A； 5-10 min， 22%-30%A； 10-15 min， 30%-95%A； 15-20 min， 95%-5%A； 20-30 min， 5%A）， flow rate of 0.2 mL∙min-1， column temperature at 30 ℃， injection volume of 1 μL， electrospray ionization（ESI）， positive and negative ion detection modes. Interaction analysis between the targets of chemical components and the targets of abnormal uterine bleeding（AUB） was performed by network pharmacology， and the key components were screened through network topology analysis. The fingerprints of 10 batches of Kunning granules were established by high performance liquid chromatography（HPLC）， the anticoagulant activity of the granules was determined by blood coagulation method and fibrinogen plate method， and the spectrum-effective relationship was established. The components co-occurring in the topological analysis and spectrum-effective relationship were selected as Q-Markers， and their anticoagulant activities were verified and confirmed. ResultA total of 475 chemical components were identified from Kunning Granule， of which 22 key components such as salvianolic acid B， paeoniflorin， naringin and neohesperidin， were the potential material basis for the treatment of AUB. The spectrum-effective analysis showed that peaks 7（paeoniflorin）， 9（naringin）， 10（neohesperidin） and 11（salvianolic acid B） were the optimal principal components， and in vitro activity test showed that these four components could better characterize their anticoagulant activity. ConclusionSalvianolic acid B， paeoniflorin， neohesperidin and naringin may be Q-Markers for the anticoagulant activity of Kunning granules.
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Objective:To investigate the long-term outcome of centrally located hepatocellular carcinoma treated by radical resection and adjuvant radiotherapy(RT).Methods:A retrospective study was used to collect and analyze the clinical and pathological data of 193 patients with centrally located HCC who underwent surgery from Jun 2015 to Jun 2020. According to whether RT was used, these patients were allocated into liver resection (LR) combined RT (88 cases) and LR alone group (105 cases).Results:The 1-, 3-, and 5-year OS rates were 98%, 85%, and 74% for patients in the LR+RT group, and 79%, 66%, and 59% for patients in the LR group, respectively. The 1-, 3-, 5-year RFS rates were 76%, 55% and 44% for patients in the LR+RT group, and 51%, 40%, and 37% for patients in the LR group, respectively. OS and RFS was significantly different in LR+RT group compared with that in LR group (χ 2=5.825, P=0.016;χ 2=5.230, P=0.022, respectively). Cox analysis showed that RT was the independent prognostic factor for centrally located HCC in OS and RFS ( P=0.009, P=0.017, respectively). Subgroup analysis suggested that RT could reduce early recurrence ( HR=0.41,95% CI:0.21-0.80, P=0.002). Conclusion:Liver resection combined with adjuvant radiotherapy for centrally located HCC is safe and effective.
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Objective:To study the use of the Glissonean pedicle approach based on the triangular area among the right anterior pedicle, the right posterior pedicle and the right hepatic vein ( "APR triangle" ), followed by indocyanine green fluorescence negative staining in laparoscopic anatomical resection of right hepatic segments.Methods:The clinical data of 34 patients with liver tumors who underwent laparoscopic anatomical right hepatic segmentectomy at the Chinese Academy of Medical Sciences and Peking Union Medical College from September 2020 to September 2021 were analyzed retrospectively. Of the 34 patients, there were 24 males and 10 females, aged (58.3±10.3) years old. Data on completion of operation, operation time, intraoperative blood loss, intraoperative blood transfusion, postoperative complications and postoperative hospital stay were collected.Results:All the 34 patients had malignant liver tumors, and they were successfully operated using total laparoscopic surgery. There was no conversion to open surgery. Three patients underwent segment V resection, 3 patients segment VI resection, 5 patients segment VII resection, 2 patients segment V + segment VI resection, 9 patients segment VI + segment VII resection, 3 patients segment V + segment VII resection, 5 patients segment V dorsal segment + segment VI + segment VII resection, 3 patients right posterior section resection + anterior dorsal segment resection and 1 patient anterior dorsal section resection. The operation time was (275.58±82.28) min, the amount of intraoperative blood loss was 100(100, 300) ml, and there were no patients requiring blood transfusion during the operation. Liquid food was started on the first day after operation, and out-of bed activities were carried out on the second to third days after operation. The Clavien Dindo classification of postoperative complications was grade I in 32 patients and grade III in 2 patients. The postoperative hospital stay was (7.23±3.10) d. All tumor margins were negative for malignancy. All the 34 patients were followed-up for (8.94±2.94) months. By the end of follow-up, 34 patients had survived without tumor recurrence.Conclusion:The right Glisson pedicle approach based on the "APR triangle" and the anatomical resection of right hepatic segments with fluorescence negative staining were safe and feasible.
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Objective:To investigate the long-term outcome of centrally located hepatocellular carcinoma with microvascular invasion(MVI)after radical resection.Methods:A retrospective cohort study was used to collect and analyze the clinical and pathological data of 81 patients with centrally located HCC who underwent surgery in the Cancer Hospital Chinese Academy of Medical Sciences from January 2016 to January 2018. According to the classification of MVI, patients were divided into 41 low-level group (MVI M1) and 40 high-level group (MVI M2). The 1, 3, 5-year OS and relapse free survival were calculated in all patients. The main outcomes were overall survival (OS), disease-free survival (DFS) and postoperative complications. OS and DFS of patients was estimated using Kaplan-Meier method and the difference between groups was assessed using Log-rank test. COX proportional-hazards regression models were used to estimate the association between exposure factors and prognosis. The measurement data of normal distribution were expressed by mean±standard deviation ( ± s), and t-test was used for comparison between the two groups. Measurement data with non-normal distribution were represented by M ( Q1, Q3), and rank sum test was used for comparison between the two groups.Chi-square test was used for comparison between the two groups of count data. Results:The 1-, 3-, 5-year OS and relapse free survival were 88%, 76%, 73%, and 57%, 42%, 27% for all 81 centrally located HCC patients, respectively. The DFS and OS of the MVI M1 group were 26(11, 39) months and 36(25, 53) months, respectively, and the MVI M2 group were 9(4, 29) months and 22(10, 45)months, respectively, and the difference was statistically significant ( P<0.05). In survival analysis, OS and DFS was significantly different in MVI M1 group compared with that in MVI M2 group ( HR=4.69, 95% CI: 1.539-14.286, P=0.0027; HR=1.92, 95% CI: 1.111-3.333, P=0.016). The incidence of postoperative mild complications in the MVI M1 group and the MVI M2 group was 95.1% and 90.0%, respectively. There was no significant difference between the two groups ( P=0.379). Cox analysis showed that MVI M2 was the independent prognostic factors for centrally located HCC in OS and DFS ( P<0.05). Conclusion:Surgical treatment for centrally located HCC with MVI is safe and effective, and MVI classification is an independent risk factor for its prognosis.
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Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. Surgery is the most important way to treat HCC currently. The high recurrence rate after hepatectomy is the most important reason to affect its prognosis, and it is also the key clinical problem to be solved. According to the recurrence time, the recurrence can be divided into early recurrence and late recurrence. The prognosis of patients with early recurrence is worse than that of patients with late recurrence. Therefore, it is very important for surgical decision-making to identify the two kinds of recurrence. This article reviews the research progress of early recurrence cut-off time of hepatocellular carcinoma after radical hepatectomy.
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Objective:To study the nutritional risk and nutritional support in patients with liver cancer during perioperative period.Methods:In Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical, the clinical data of 507 liver cancer patients who underwent surgery College from January 2019 to January 2020 were retrospectively analyzed. The perioperative nutrition was assessed by nutritional risk screening 2002 (NRS 2002), ≥3 scores was diagnosed nutritional risk, and the nutritional support was counted.Results:Among 507 patients, 82 cases (16.2%) had nutritional risk. There was no statistical difference in rate of nutritional risk between male and female: 15.3% (58/379) vs. 18.8% (24/128), χ2 = 0.838, P>0.05. There was no statistical difference in rate of nutritional risk between primary liver cancer patients and secondary liver cancer patients: 18.0% (63/350) vs. 12.1% (19/157), χ2 = 2.781, P>0.05. The rate of nutritional risk in ≥ 60 years old patients was significantly higher than that in <60 years old patients: 25.9% (62/239) vs. 7.5% (20/268), and there was statistical difference ( χ2 = 31.819, P<0.01). The age, incidence of dystrophy and rate of nutritional support before surgery in patients with nutritional risk were significantly higher than those in patients without nutritional risk: (65.3 ± 12.7) years old vs. (55.9 ± 8.9) years old, 13.4% (11/82) vs. 0 and 24.4% (20/82) vs. 2.6% (11/425), and there were statistical differences ( P<0.01); there were no statistical differences in sex composition, tumor origin, rate of nutritional support after surgery and albumin between patients with nutritional risk and patients without nutritional risk ( P>0.05). Among 31 nutritional support patients before surgery, parenteral nutrition (PN) was in 1 case, enteral nutrition (EN) was in 30 cases; among 453 nutritional support patients after surgery, PN was in 297 cases, EN was in 27 cases, and PN + EN was in 129 cases. Conclusions:The incidence of nutritional risk in patients with liver cancer during perioperative period is high, and especially elderly patients should pay attention to nutritional support. NRS 2002 is a powerful tool and should be recommended to use at patients with liver cancer, and provide the evidence of nutritional therapy.
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Background:Malnutrition is common in patients with cancer, whichadversely affectsthesurvival and quality of life ofcancer patients.However, there is no national data on the prevalence of malnutrition inChinese cancer patients. Thisstudy aims to evaluate the prevalenceof malnutrition and quality of life(QOL)ofChinese patients with localregional, recurrentor metastatic cancer,to address the prognostic value of nutritional status and QOLon the survival of cancer patients in China and to validate the patient-generated subjective global assessment (PG-SGA) questionnaire in Chinese cancer patients.Methods:Thisisanobservational,multi-centered,and hospital-based prospective cohort study.We aimed to recruit 50,000 cancer patients (age 18and above)overan 8-year period.Data collection will occur within 48hrafter patientsare admitted to hospital, 30-days after hospital admission, and the follow-up will be conducted1-8years after enrolment. The primary outcomeisoverall survival, and secondaryoutcomes arelength of hospital stay and hospital costs. Factors measured are demographic characteristics, tumor characteristics, anthropometry measurements,hematological measurement, body composition, PG-SGAscores,Karnofsky performance status scores,and QLQ C30 scores. This protocol wasapproved by local ethical committees of all the participant hospitals.Conclusions: This multi-centered, large-scale, long-time follow-up prospective study will help diagnose malnutrition in cancer patients in China, and identify the related risk factors associated with the negative outcomes. The anticipated results will highlight the need for a truly scientific appraisal of nutrition therapy, and help to improve outcomes among cancer patients in China.Trial Registration: The trial has been registered with the Chinese Clinical Trial Registry, ChiCTR1800020329. Registered on 19 December 2018
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Purpose@#To evaluate the safety and effectiveness of an enhanced recovery after surgery (ERAS) programme after curative liver resection in cirrhotic hepatocellular carcinoma (HCC) patients. @*Methods@#One hundred sixty-two patients were enrolled in the study; 80 patients whose data were collected prospectively were assigned to the ERAS group, and 82 patients whose data were collected retrospectively were assigned to the control group. Preoperative clinicopathologic factors, surgical factors, and postoperative outcomes of the 2 groups were compared. Logistic regression was applied to explore potential predictors of hospital stay and morbidity. @*Results@#The postoperative hospital stay, postoperative complication rate, and recovery of liver function on postoperative day 5 seemed to be better in the ERAS group. The composition of complications was different in the 2 groups; pleural effusion and postoperative ascites were more common in the control group, and indocyanine green retention at 15 minutes, operation time, preoperative alanine aminotransferase, and number of liver segmentectomies were associated with postoperative complications rather than ERAS intervention. @*Conclusion@#The ERAS programme is safe and effective for HCC patients with chronic liver disease undergoing hepatectomy, but it seems that surgical factors, such as operation type, have a greater impact on morbidity than other factors. Operative characteristics such as the method of blood loss control and the volume of liver resection should be augmented into ERAS protocol of hepatectomy.
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Objective:To compare the clinical effects of direct mechanical thrombectomy (MT) and intravenous thrombolysis (IVT) bridging MT (IVT+ MT) in the treatment of patients with acute anterior circulation large vessel occlusive stroke with high clot burden.Methods:Consecutive patients with acute anterior circulation large vessel occlusion with clot burden score ≤6 admitted to the Department of Neurology, Liuzhou People's Hospital and received endovascular treatment (MT or IVT+ MT) from June 2015 to April 2019 were enrolled retrospectively. The baseline clinical data, surgical status, clinical outcome, length of stay and cost of hospitalization in the direct MT group and the IVT+ MT group were compared. The modified Rankin Scale was used to evaluate the outcomes at 90 d after the onset of stroke. 0-2 was defined as a good outcome and >2 was defined as a poor outcome. Multivariate logistic regression analysis was used to identify the independent influencing factors of poor outcomes. Results:A total of 115 patients with acute anterior circulation large vascular occlusive stroke with high clot burden were enrolled, aged 65.4±12.0 years, 70 (60.9%) were male. The baseline National Institutes of Health Stroke Scale (NIHSS) score was 18.0 (14.0-22.0). Seventy patients (60.9%) in the direct MT group, 45 in the IVT+ MT group (39.1%). Forty-nine patients (42.6%) had a good outcome and 66 (57.4%) had a poor outcome. The time from onset to inguinal puncture (210 [130-255] min vs. 230 [187-268] min; Z=-1.982, P=0.047) and the time from onset to successful vascular recanalization (283 [228-358] min vs. 320 [268-385] min; Z=-2.017, P=0.044) were significantly shorter than the IVT+ MT group, but there were no significant differences in the successful recanalization rate (84.4% vs. 81.4%; χ2=0.173, P=0.677), the incidence of postoperative symptomatic intracranial hemorrhage (6.7% vs. 7.1%; P=1.000) and the good outcome rate at 90 d (40.0% vs. 44.3%; χ2=0.206, P=0.650) between the direct MT group and the IVT+ MT group. In addition, although there was no significant difference in length of stay between the two groups (12.1±7.1 d vs. 10.6±6.6 d; t=1.128, P=0.262), the total hospitalization cost of the direct MT group was significantly lower than that of the IVT+ MT group (80 328 [63 214-101 136] CNY vs. 88 517 [68 001-115 590] CNY; Z=-1.972, P=0.049). Multivariate logistic regression analysis showed that higher baseline systolic blood pressure (odds ratio [ OR] 1.033, 95% confidence interval [ CI] 1.005-1.062; P=0.019), higher baseline NIHSS score ( OR 1.117, 95% CI 1.029-1.213; P=0.008) and lower baseline Alberta Stroke Program Early CT Score ( OR 0.189, 95% CI 0.056-0.641; P=0.008) were independently associated with the poor outcomes, while there was no independent correlation between the endovascular treatment mode and the outcomes. Conclusions:For patients with anterior circulation large vessel occlusive stroke with high clot burden, the successful recanalization rate and good clinical outcome rate of direct MT were equivalent to IVT+ MT, but the cost was less. Therefore, direct MT may be a better choice for the treatment of anterior circulation large vessel occlusive stroke with high clot burden.
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Purpose@#To evaluate the safety and effectiveness of an enhanced recovery after surgery (ERAS) programme after curative liver resection in cirrhotic hepatocellular carcinoma (HCC) patients. @*Methods@#One hundred sixty-two patients were enrolled in the study; 80 patients whose data were collected prospectively were assigned to the ERAS group, and 82 patients whose data were collected retrospectively were assigned to the control group. Preoperative clinicopathologic factors, surgical factors, and postoperative outcomes of the 2 groups were compared. Logistic regression was applied to explore potential predictors of hospital stay and morbidity. @*Results@#The postoperative hospital stay, postoperative complication rate, and recovery of liver function on postoperative day 5 seemed to be better in the ERAS group. The composition of complications was different in the 2 groups; pleural effusion and postoperative ascites were more common in the control group, and indocyanine green retention at 15 minutes, operation time, preoperative alanine aminotransferase, and number of liver segmentectomies were associated with postoperative complications rather than ERAS intervention. @*Conclusion@#The ERAS programme is safe and effective for HCC patients with chronic liver disease undergoing hepatectomy, but it seems that surgical factors, such as operation type, have a greater impact on morbidity than other factors. Operative characteristics such as the method of blood loss control and the volume of liver resection should be augmented into ERAS protocol of hepatectomy.
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From December 2019, the new coronavirus pneumonia (COVID-19) broke out in Wuhan, Hubei, and spread rapidly to the nationwide. On January 20, 2020, the National Health Committee classified COVID-19 pneumonia as one of B class infectious diseases and treated it as class A infectious disease. During the epidemic period, the routine diagnosis and treatment of tumor patients was affected with varying degrees. In this special period, we performed the superiority of the multi-disciplinary team of diagnosis and treatment, achieved accurate diagnosis and treatment of patients with hepatobiliary malignant tumors, provided support for these patients with limited medical resources, and helped them to survive during the epidemic period.On the basis of fully understanding the new coronavirus pneumonia, the treatment strategy should be changed timely during the epidemic, and more appropriate treatment methods should be adopted to minimize the adverse effect of the epidemic on tumor treatment.
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Biomarkers for hepatocellular carcinoma (HCC) following curative resection are not currently sufficient for prognostic indication of overall survival (OS) and disease-free survival (DFS). The aim of this study was to investigate the prognostic performance of osteopontin (OPN), matrix metalloproteinase 7 (MMP7), and pregnancy specific glycoprotein 9 (PSG9) in patients with HCC. A total of 179 prospective patients with HCC provided plasma before hepatectomy. Plasma OPN, MMP7, and PSG9 levels were determined by enzyme-linked immunosorbent assay. Correlations between plasma levels, clinical parameters, and outcomes (OS and DFS) were overall analyzed. High OPN ( ⩾ 149.97 ng/mL), MMP7 ( ⩾ 2.28 ng/mL), and PSG9 ( ⩾ 45.59 ng/mL) were prognostic indicators of reduced OS (P < 0.001, P < 0.001, and P = 0.007, respectively). Plasma PSG9 protein level was an independent factor in predicting OS (P = 0.008) and DFS (P = 0.038). Plasma OPN + MMP7 + PSG9 elevation in combination was a prognostic factor for OS (P < 0.001). OPN was demonstrated to be a risk factorassociated OS in stage I patients with HCC and patients with low α-fetoprotein levels ( < 20 ng/mL). These findings suggested that OPN, MMP7, PSG9 and their combined panels may be useful for aiding in tumor recurrence and mortality risk prediction of patients with HCC, particularly in the early stage of HCC carcinogenesis.
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Adult , Aged , Female , Humans , Male , Middle Aged , Biomarkers, Tumor , Blood , Carcinoma, Hepatocellular , Blood , Mortality , Enzyme-Linked Immunosorbent Assay , Hepatectomy , Liver Neoplasms , Blood , Mortality , Matrix Metalloproteinase 7 , Blood , Osteopontin , Blood , Pregnancy-Specific beta 1-Glycoproteins , Prognosis , Prospective Studies , Risk Assessment , Survival AnalysisABSTRACT
Objective@#To investigate the clinical effectiveness of postoperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma (HCC).@*Methods@#A total of 379 HCC patients who received partial hepatectomy from January 2010 to December 2013 in Department of Hepatobiliary Surgery of Cancer Hospital, Chinese Academy of Medical Sciences were selected. Based on the nutritional method, all of the enrolled patients were divided into two group: 142 patients who received early enteral nutrition (EEN) combined with parenteral nutrition (PN) were identified as EEN+ PN group; 237 patients who received total parenteral nutrition (TPN) were identified as TPN group. These two groups were even divided into two subgroups, centrally located HCC (cl-HCC) and non-centrally located HCC (ncl-HCC). The clinical effectiveness of different groups was assessed and compared.@*Results@#The age, gender, body mass index (BMI), the maximum diameter of the tumor, the amount of operative bleeding and postoperative infective rate did not show statistically significant differences between EEN+ PN group and TPN group (P>0.05). On the seventh postoperative day (7th POD), aspartate transaminase (AST) of EEN+ PN group and TPN group were (41.6±2.0) IU/L and (50.4±3.2) IU/L respectively, and the difference was statistically significant (P<0.05). Alkaline phosphatase (ALP) of these two groups were (80.8±2.4) IU/L and (90.2±2.3) IU/L, respectively, and the difference was statistically significant (P<0.05). Total bilirubin (TBIL) of these two groups were (15.8±0.7) μmol/L and (19.1±0.7) μmol/L, respectively, and the difference was statistically significant (P<0.05). On the 7th POD, AST in cl-HCC subgroups of EEN+ PN group and TPN group were (39.6±2.6) IU/L and (61.0±7.0) IU/L, respectively, and the difference was statistically significant (P<0.05). TBIL in cl-HCC subgroups of these two groups were (14.4±0.9) μmol/L and (20.7±1.3) μmol/L, respectively, and the difference was statistically significant (P<0.05). On the 7th POD, ALP in ncl-HCC subgroups of these two groups were (79.3±3.0) IU/L and (89.9±3.1) IU/L, respectively, and the difference was statistically significant (P<0.05). The total length of stay (t-LOS) of these two groups were (15.8±0.4) days and (17.1±0.4) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) of these two groups were (8.6±0.2) days and (10.1±0.3) days, respectively, and the difference was statistically significant (P<0.05). Total length of stay (t-LOS) in ncl-HCC subgroups of these two groups were (15.1±0.5) days and (16.6±0.3) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) in ncl-HCC subgroups of these two groups were (8.4±0.2) days and (9.5±0.2) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) in cl-HCC subgroups of these two groups were (8.7±0.2) days and (11.0±0.8) days, respectively, and the difference was statistically significant (P<0.05). Postoperative hospitalization expenses of these two groups were (20 855.0±549.8) yuan and (23 373.0±715.5) yuan, respectively, and the difference was statistically significant (P<0.05). Postoperative hospitalization expenses in cl-HCC subgroups of these two groups were (21 012.0±748.5) yuan and (24 697.0±1 409.0) yuan, respectively, and the difference was statistically significant (P<0.05).@*Conclusion@#EEN+ PN can improve the liver function, shorten the postoperative hospitalization time and reduce the postoperative hospitalization expenses of HCC patients in need of nutritional support.
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Objective To research the effect of GGCX gene on MMP13 in rabbit osteoarthritis cartilage cells and investigate its effect on osteoarthritis cartilage degeneration.Methods Six Japanese big ear rabbits weighted (2.0±0.2)kg were randomly di vided into three groups,each group seted a rabbit as control.Anterior cruciate ligament transection method was used to build osteoarthritis cartilage degeneration model at second,forth,sixth week.Articular cartilage was separated successfully after the model were built,cartilage cells were divided from articular cartilage and cultured in 6-well cell culture plate.Cartilage cells were divided into blank group,negative control group and transfection group.PCR method and Western blot were conducted to detect GGCX and MMP13 expressed at the level of mRNA and protein.Results Compare with blank group and negative control group,the expressin level of GGCX incresed,while the MMP13 expression level dcresed(P＜0.05).Conclusion Over expression of GGCX gene can ob viously decrease the expression of MMP13,it provide experimental basis for osteoarthritis of the in vitro gene therapy.
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Objective@#To carry out a prospective cohort study of combined intra-operative radiotherapy for centrally located hepatocellular carcinomas (HCC) and to observe the safety and postoperative complications.@*Methods@#A total of 79 patients with centrally located HCC who underwent hepatectomy were divided into two groups: experimental group (combined with targeted intra-operative radiotherapy, 32 cases) and control group (single surgical operation, 47 cases). Patients in the experimental group received intra-operative electron radiotherapy after tumor resection, while patients in the control group received to intra-operative electron radiotherapy.The haemorrhagia amount and operation time during the operation, intra-operative liver function and the recovery of liver and gastrointestinal tract of patients in these two groups were compared.@*Results@#No postoperative 30-day mortality was observed in all of the patients. The average total operation time of patients in the experimental group was (319±76) min, significantly longer than (233±76) min of the control group (P<0.001). The average aspartate transaminase (AST) level of patients in the experimental group at postoperative day 1 was 562.5 U/L, significantly higher than 347.0 U/L of control group (P=0.031). However, the average prothrombin activity levels of patients in the experimental group at postoperative day 3 and day 7 were (68.3±17.9)% and (73.4±10.2)%, respectively, significantly lower than (78.9±15.9)% and (80.0±10.6)% of control group (both P<0.05). There were no significant differences of tumor volume, differentiation degree, satellite lesion, dorsal membrane invasion, microvascular invasion between these two groups (all P>0.05). There were no significant differences of hospital stay, ventilation time, the incidence of hepatic insufficiency, ascites, pleural effusion, infection, biliary fistula between these two groups (all P>0.05). There were no significant differences of alanine aminotransferase (ALT), albumin, total bilirubin between these two groups at postoperative day 1, 3, 5 and 7 (all of P>0.05).@*Conclusion@#The resection of centrally located HCC combined with intra-operative radiotherapy may increase the total operation time, delay the early postoperative recovery of liver function, but it is still safe and feasible.@*Trial registration@#National Cancer Centre /Cancer Hospital, Chinese Academy of Medical Sciences, ChiCTR-TRC-12002802.
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Objective@#To analyze the clinicopathological features and prognosis of patients with small hepatocellular carcinoma.@*Methods@#The clinicopathological and follow-up data of 98 patients with small hepatocellular carcinoma who underwent R0 resection from January 2009 to December 2013 were analyzed retrospectively.@*Results@#All of the patients were followed up. Their postoperative 1-year, 3-year and 5-year overall survival rates were 99.0%, 91.7%, and 76.3%, respectively. Their postoperative median overall survival (OS) period was 52 months. The postoperative progression-free survival rates were 86.7%, 66.2% and 55.0%, respectively, and the median progression-free survival (PFS) period was 43.5 months. The univariate analysis showed that satellite nodules, liver capsule invasion and postoperative recurrence time were associated with OS (P<0.05), and long-term heavy drinking, satellite nodules and liver capsule invasion with PFS (P<0.05). The multivariate analysis indicated that long-term heavy drinking was an independent factor influencing the progression-free survival period of patients with small hepatocellular carcinoma (P=0.003) and postoperative recurrence time and liver capsule invasion were independent factors affecting their overall survival period (P<0.05).@*Conclusions@#The treatment of small hepatocellular carcinoma still concentrates on the active treatment of surgery. It is beneficial to patients to minimize the resection scope of normal liver under the premise of R0 removal of tumor. Postoperative recurrence time of ≤2 years suggests poor prognosis of small hepatocellular carcinoma. Long-term heavy drinking can accelerate the recurrence of small hepatocellular carcinoma.
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OBJECTIVE:To optimize the ultrasonic extraction technology for Tianshu capsules. METHODS:Using the transfer rate of active ingredient ferulic acid in Ligusticum chuanxiong and gastrodin in Gastrodia elata of Tianshu capsules as investigation indexes,L9(34)orthogonal design test was adopted to investigate the effects of ethanol volume fraction,ethanol amount,extraction time and ultrasonic power on the extraction rate. Ultrasonic extraction technology for Tianshu capsules was optimized,and verifica-tion test was carried out. RESULTS:The optimized extraction technology for Tianshu capsules was as follow as 8-fold 70% etha-nol,extracting twice under 350 W,extracting 1.5 h every time. Results of verification test showed the average transfer rate was 94.06% for ferulic acid(RSD=0.18%,n=3)and 95.02% for gastrodin(0.47%,n=3). CONCLUSIONS:The optimized tech-nology is rapid,simple,stable and feasible,and can be used for extracting the active ingredients in Tianshu capsules.
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<p><b>OBJECTIVE</b>To explore the clinical and pathological factors influencing the prognosis of patients with hepatocellular carcinoma (HCC)(≤5 cm) after hepatectomy.</p><p><b>METHODS</b>Two hundreds and nineteen cases with HCC(≤5 cm) undergoing hepatectomy in Cancer Hospital, Chinese Academy of Medical Sciences between December 2003 and July 2013 were collected. The alpha fetoprotein (AFP) level, tumor number, tumor size (diameter), liver cirrhosis, vascular invasion, capsular invasion, differentiation, surgical methods, resection margin, the way of treatments, the situation of recurrence and time to recurrence were analyzed. Log-rank test and the stepwise Cox proportional-hazards models were used to compare the prognosis, respectively.</p><p><b>RESULTS</b>The 1-, 3-, 5- and 10- year overall survival rates were 95.9%, 85.3%, 67.8% and 53.3% respectively in all patients.Single factor analysis indicated that vascular invasion, capsular invasion, tumor size, hepatic vascular occult, liver cirrhosis, tumor differentiation, AFP, the way of treatments, the situation of recurrence and time to recurrence can affect the prognosis significantly (all P<0.05). The multifactor analysis showed that AFP, tumor differentiation, liver cirrhosis, capsular invasion, tumor size and the situation of recurrence and time to recurrence were independent prognostic factors (all P<0.05).</p><p><b>CONCLUSION</b>The prognosis of patients with HCC(≤5 cm) underwent hepatectomy are affected by multi-factors, such as AFP, tumor differentiation, liver cirrhosis, capsular invasion, tumor size and the situation of recurrence and time to recurrence.</p>