Prognosis after hepatectomy for primary liver cancer of segment 7 or 8 / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the results of surgical treatment for primary liver cancer of segment VII or VIII.</p><p><b>METHODS</b>The clinical data of 149 patients with primary liver cancer who underwent hepatectomy between January 2005 and December 2010 was retrospectively analyzed. There were 120 male and 29 female patients, aging from 19 to 75 years with a mean of 53.1 years. Among 149 patients, tumors were located at segment VII, VIII or several segments containing VII or VIII (VII/VIII group) in 53 patients, located at other segments (non-VII/VIII group) in 96 patients. The results of surgical treatment for VII/VIII group and non-VII/VIII group were compared by using t test, χ(2) test, Kaplan-Meier survival analysis and Cox proportion hazard regression analysis.</p><p><b>RESULTS</b>Right liver lobe was turned over completely in VII/VIII group, hepatic lobe which tumor was located at was not or partly turned over in non-VII/VIII group. Compared with non-VII/VIII group, VII/VIII group had longer operative time ((215 ± 68) min vs. (123 ± 36) min, t = 2.860, P = 0.01). No significant difference was found for tumor size, tumor number, tumor encapsulation, microvascular invasion, Edmondson grade, pTNM stage, intraoperative blood loss, blood transfusion rate, R0 resection rate and postoperative complication rate between two groups. The cumulative 1-, 3-, and 5-year overall survival rates were 74.6%, 42.3%, 15.4% respectively, in VII/VIII group, and 89.3%, 63.0%, 40.4% respectively, in non-VII/VIII group (χ(2) = 13.501, P = 0.000). Univariate and multivariate analysis of prognostic factors indicated that tumor location (tumor was located at segment VII or VIII) had unfavorable prognostic influence on overall survival (χ(2) = 10.329, P = 0.001; HR = 1.693, 95%CI: 1.232 - 2.694, P = 0.013).</p><p><b>CONCLUSION</b>The results of surgical treatment for primary liver cancer located at segment VII or VIII are worse than that located at other segments.</p>

Design and finite-element evaluation of a partially bioabsorbable interbody fusion cage / 第二军医大学学报

Objective To design a partially bioabsorbable interbody fusion cage (PBIFC) and to analyze its biomechanics using finite-element evaluation method. Methods A new type of PBIFC was designed and made from nano-hydroxyapatite/polyamide 66 (n-HA/PA66) and multi-(amino acid) copolymer-calcium sulfate; a 3D finite-element model of L3-L4 segment was constructed and validated. A PBIFC or a non-absorbable cage of identical shape (n-HA/PA66 cage) was implanted via anterior approach on the model, and four models were established, including the immediate implantation model and 4-week implantation model of each cage. An axial compressive preload of 400 N and a torque of 10 Nm were applied to the L3 segment to simulate spinal compression, flexion, extension, rotation, and lateral bending. The stress and stress contour of different loading conditions were calculated. Results Immediately after implantation, stresses of the bone graft in PBIFC model were higher than those in n-HA/PA66 cage model, while stresses of the cage and endplate in PBIFC model were lower; and no significant difference in stress contours on endplate was found between the two models. Four weeks after implantation, stresses of the bone graft in PBIFC were higher than those in n-HA/PA66 cage, and stresses of the cage and endplate in PBIFC model were lower, with the stress differences being greater than those of immediately after implantation. The stress contours on endplate in PBIFC model was larger than that in the n-HA/PA66 cage model. Conclusion PBIFC is probably more suitable than a non-absorbable cage of identical shape for lumbar interbody fusion.

Expression of estrogen receptor α in hepatitis B-related hepatocellular carcinoma and its clinical significance / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the expression and its clinical significance of estrogen receptor (ERα) and phosphorylated estrogen receptor (p-ERα) in patients with hepatocellular carcinoma. The associations between ERα, p-ERα and IL-6 were also analyzed.</p><p><b>METHODS</b>Immunohistochemistry was used to detect the expression of ERα, p-ERα and IL-6 in tumor tissues from 77 cases with hepatocellular carcinoma. The relations between ERα and the clinical pathological parameters and prognosis were also analyzed.</p><p><b>RESULTS</b>The positive rates of ERα, p-ERα and IL-6 in hepatocellular carcinoma were 39.0% (30/77), 45.4% (35/77) and 72.7% (56/77), respectively. The expression of ERα and p-ERα were negatively correlated with the expression of IL-6 (r=-0.468, P<0.01; r=-0.370, P<0.01, respectively). The positive rate of ERα in patients with tumor size≤5 cm, serum level of alpha-fetoprotein<400 µg/L, with complete encapsulation and non-microvascular invasion was significantly higher than those with tumor size>5 cm, serum level of alpha-fetoprotein≥400 µg/L, non-complete encapsulation and with microvascular invasion (all P<0.05). The overall survival rates of ERα-positive and ERα-negative patients were 66.7% and 23.4% (P<0.05). And the disease-free survival rates of ERα-positive and ERα-negative patients were 83.3% and 57.4% (P<0.05).</p><p><b>CONCLUSIONS</b>The tumor biological features of ERα-positive patients are better than that of ERα-negative patients. The role of ERα in hepatocellular carcinoma may be related to IL-6 level.</p>

Effects of celecoxib combined with fluvastatin on tumor growth and cell apoptosis in a xenograft model of hepatocellular carcinoma / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate effects of celecoxib (a selective cox-2 inhibitor)combined with fluvastatin (a HMG-CoA reductase inhibitor) on tumor growth and cell apoptosis in hepatocellular carcinoma xenograft in nude mice.</p><p><b>METHODS</b>Hepatocellular carcinoma BEL-7402 cells were inoculated subcutaneously into the left armpit of nude mice, the mice (n = 32) were then randomly divided into 4 groups: the control group, the celecoxib group,the fluvastatin group and the combination group. At the end of the study, Tumor Tissues were collected for analysis. Cell apoptosis was determined by flow cytometry analysis and TUNEL assay. Akt, p-Akt and survivin protein levels were measured by Western blot. Statistical comparisons were made using factorial analysis of variance (ANOVA) and multiple comparisons between each two groups were calculated using SNK-q test.</p><p><b>RESULTS</b>The combination of Celecoxib and fluvastatin resulted in a greater inhibition of tumor growth than either agent alone, the tumor inhibitory rate was 34.0% in the Celecoxib group, 25.0% in the fluvastatin group and 72.2% in the combination group. The percentages of TUNEL--positive cancer cells in the celecoxib and fluvastatin alone treatment groups were 8.5%+/-1.4% and 9.4%+/-1.7% respectively as compared to the control group which was 3.5%+/-0.8%. Combination therapy showed a significantly greater increase in tumor cell apoptosis in comparison with the control and single-therapy groups (apoptotic index: 19.4%+/-3.0%; P value is less than 0.01 versus celecoxib or fluvastatin groups). The results of flow cytometry analysis also showed the same tendency. a small number of apoptotic cells were detected in the control tumours (4.1%+/-1.6%), whereas a large number of apoptotic cells were detected in tumours treated with celecoxib (9.1%+/-2.1%) or fluvastatin (10.1%+/-2.3%) alone; and the combination therapy resulted in even more apoptotic cells (23.6%+/-5.8%; P value is less than 0.01 versus celecoxib or fluvastatin groups). Western blot analysis demonstrated that the combination of celecoxib and fluvastatin significantly down-regulated p-Akt (0.23+/-0.08 versus 1.12+/-0.07 and surviving (0.50+/-0.07 versus 1.47+/-0.19) in BEL-7402 tumours compared with the control (P value is less than 0.01 for all).</p><p><b>CONCLUSION</b>The present study provided evidence that treatment with celecoxib in combination with fluvastatin resulted in the inhibition of HCC tumour growth in an in vivo mouse model.</p>

The relationship between CD4(-) CD8(-) T cells in the peripheral blood of patients with pancreatic carcinoma and IL-4, IFN-gamma levels / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the relationship between CD4- CD8- T cells ratio and IL-4, IFN-gamma levels in the peripheral blood of patients with pancreatic carcinoma.</p><p><b>METHODS</b>Flow cytometer was used to analyze the CD4- CD8- T cells ratio in the peripheral blood of patients with pancreatic carcinoma and the IL-4, IFN-gamma levels were detected by ELISA.</p><p><b>RESULTS</b>The ratio of CD4- CD8- T cell in CD3+ T cell from 25 pancreatic carcinoma patients was (4.2 +/- 1.7)%, the ratio of CD4- CD8- T cell in CD3+ T cell from 45 healthy person was (6.3 +/- 2.6)%, there was significant deviation between the two groups (P < 0.01). The IL-4 level of 25 pancreatic carcinoma patients was (86.3 +/- 23.3) fg/L, the IL-4 level of 45 healthy person was (56.2 +/- 9.2) fg/L,there was significant deviation between the two groups (P < 0.01). The IFN-gamma level of 25 pancreatic carcinoma patients was (16.4 +/- 4.8) fg/L before operation, the IFN-gamma level of 45 healthy person was (27.4 +/- 3.8) fg/L, there was significant deviation between the two groups (P < 0.01). The ratio of CD4- CD8- T cell in pancreatic carcinoma patient after operation was higher than before operation. It could be found negative correlation between CD4- CD8- T cells ratio and IL-4 level in pancreatic carcinoma patient,it could also be found positive correlation between CD4- CD8- T cells ratio and IFN-gamma level in pancreatic carcinoma patient. In pancreatic carcinoma patient, the CD4- CD8- T cells ratio and IL-4 level was significant associated with clinical stage (P < 0.05), but no relationship with histological differentiation (P > 0.05), it could be found no relationship between IFN-gamma level and clinical stage, histological differentiation (P > 0.05).</p><p><b>CONCLUSION</b>The CD4- CD8- T cells ratio in the peripheral blood of patients is decreased,it may be participate in the carcinogenesis and development of pancreatic carcinoma by influence the IFN-gamma levels.</p>

Prevention of hepatic tumor growth and metastasis in rats with rapamycin / 中华肝脏病杂志

<p><b>OBJECTIVES</b>To test the effect of rapamycin (RAPA) on hepatic tumor growth and metastasis in Sprague-Dawley (SD) rat model and explore the possible mechanism.</p><p><b>METHODS</b>SD rat hepatocellular carcinoma (HCC) model with metastatic potential was induced by diethylnitrosamine (DEN) and N-nitrosomorpholine (NMOR). 120 SD rats were randomized into four groups 16 weeks after DEN and NMOR treatment, and received 4-week intraperitoneal injection of RAPA (1.5 or 4.5 mg x kg(-1) x d(-1)), CsA (25 mg x kg(-1) x d(-1)) or equal volume of 0.9% saline, respectively. Tumor growth and metastasis were checked after the 4-week treatment. Serum vascular endothelial growth factor (VEGF) was determined by enzyme-linked immunosorbent assay (ELISA). Antiangiogenetic effects were assessed by CD34 immunostaining. The levels of hypoxia-inducible factor 1 alpha (HIF-1 alpha) and VEGF proteins and mRNAs were detected by immunohistochemistry, western blot and reverse transcriptase-polymerase chain reaction (RT-PCR).</p><p><b>RESULTS</b>The mean liver weight (5.58% +/- 0.42% and 5.69% +/- 0.74%), the metastatic liver nodules (5.12 +/- 0.68 and 5.67 +/-1.12), the metastasis lung nodules (0.43 +/- 0.11 and 0.45 +/- 0.83), and the lung metastasis rate (17.2% and 14.8%) were lower in rats treated with RAPA 1.5 mg x kg(-1) x d(-1) or 4.5 mg x kg(-1) x d(-1) than those in rats treated with saline, which were 10.42% +/- 1.86%, 12.36 +/- 3.45, 1.81 +/- 0.3 and 50.0% respectively (P < 0.01 or P < 0.05). The intratumoral microvessel density (MVD), serum VEGF, and the levels of HIF-1 alpha and VEGF were lower in RAPA-treated rats than those in control rats. However, CsA-treated rats showed an opposite trend compared with the RAPA-treated rats.</p><p><b>CONCLUSION</b>RAPA can repress the expression of angiogenesis-promoting factors HIF-1 alpha and VEGF, and significantly inhibits the growth and metastasis of HCC.</p>