The value of Fib4 and APRI in predicting liver failure after hepatectomy in patients with hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To evaluate the value of preoperative aspartate aminotransferaseto platelet ratio index (APRI) and fibrosis index 4 (Fib4) in predicting posthepatectomy liver failure (PHLF) of primary hepatocellular carcinoma.Methods:The data of 587 patients with hepatocellular carcinoma admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2014 to January 2020 were retrospectively collected and analyzed, including 412 males and 175 females, aged (56.8±11.2) years. Univariate and multivariate logistic regression were used to analyze the influencing factors of PHLF. The ability of Child-Pugh score, model for end-stage liver diseas (MELD) score, APRI and Fib4 to predict PHLF was evaluated through the receiver operating characteristic (ROC) curve of subjects.Results:Among 587 patients, 186 (31.7%) had liver failure after hepatectomy. In multivariate logistic regression analysis, APRI ( OR=2.660, 95% CI: 1.314-5.384, P=0.007) and Fib4 ( OR=1.322, 95% CI: 1.157-1.511, P<0.001) were risk factors for PHLF in patients with hepatocellular carcinoma. The higher the number, the greater the risk of PHLF. The predicted area under the ROC curve of PHLF in patients with hepatocellular carcinoma was Fib4(0.719)>APRI(0.686)>MELD score(0.618)>Child-Pugh score(0.565). Conclusion:APRI and Fib4 were risk factors of PHLF in patients with hepatocellular carcinoma. They predict the occurrence of PHLF better than Child-Pugh score and MELD score.

Diagnostic value of TNF-α in patients with pulmonary infection after liver transplantation / 中国医师杂志

Objective:To explore diagnostic value of tumor necrosis factor-α (TNF-α) in patients with pulmonary infection after liver transplantation.Methods:The clinical data of 80 patients with pulmonary infection after liver transplantation in the the First Affiliated Hospital of Xinjiang Medical University from January 2016 to May 2019 were retrospectively analyzed. According to different pathogens, they were divided into bacteria infection group ( n=35) and non-bacteria infection group ( n=45). The general data, levels of serum TNF-α, C-reactive protein (CRP) and procalcitonin (PCT) were compared between the two groups. Logistic regression was performed to explore risk factors for pulmonary infection after liver transplantation. Receiver operating characteristic (ROC) curves were performed to analyze diagnostic value of TNF-α, CRP and PCT. Results:The levels of serum TNF-α, CRP and PCT in bacteria infection group were significantly higher than those in non-bacteria infection group ( P<0.05). Multivariate analysis showed that high TNF-α, CRP, and PCT levels were independent risk factors for bacterial pneumonia after liver transplantation. ROC analysis showed that sensitivity, specificity and areas under ROC curves (AUC) of TNF-α, CRP and PCT for diagnosis of bacterial pulmonary infection after liver transplantation were (80.12%, 72.12%, 80.18%), (83.45%, 73.46%, 83.38%) and (0.802, 0.751, 0.803), respectively. The AUC, sensitivity, and specificity between TNF-α and PCT for diagnosis of bacterial pulmonary infection after liver transplantation were similar ( P>0.05). The AUC, sensitivity and specificity of TNF-α for diagnosis of bacterial pulmonary infection after liver transplantation were better than those of CRP ( P<0.05). Conclusions:The diagnostic value of TNF-α for pulmonary infection after liver transplantation is similar to that of PCT, and is superior to CRP. It can be applied as a reliable index for identifying bacterial pneumonia and non-bacterial pneumonia.

Trends in the biological functions and medical applications of extracellular vesicles and analogues

Natural extracellular vesicles (EVs) play important roles in many life processes such as in the intermolecular transfer of substances and genetic information exchanges. Investigating the origins and working mechanisms of natural EVs may provide an understanding of life activities, especially regarding the occurrence and development of diseases. Additionally, due to their vesicular structure, EVs (in small molecules, nucleic acids, proteins, etc.) could act as efficient drug-delivery carriers. Herein, we describe the sources and biological functions of various EVs, summarize the roles of EVs in disease diagnosis and treatment, and review the application of EVs as drug-delivery carriers. We also assess the challenges and perspectives of EVs in biomedical applications.

Mechanism of ferroptosis and its role in liver diseases / 临床肝胆病杂志

Ferroptosis is a newly discovered regulatory cell death induced by the accumulation of iron-dependent lipid peroxides, with the morphological manifestations of decreased mitochondrial volume, increased mitochondrial membrane density, and reduction or disappearance of mitochondria. The mechanism of ferroptosis is mainly associated with disturbance of iron metabolism, imbalance of amino acid antioxidant system, and accumulation of lipid peroxides. Studies have shown that ferroptosis plays different roles in different liver diseases, and ferroptosis can participate in the progression of various liver inflammatory diseases and inhibit the formation of liver fibrosis, the development of hepatocellular carcinoma, and sorafenib resistance. This article summarizes the advances in the mechanism of ferroptosis and its role in liver diseases, so as to provide a reference for further research and treatment of liver diseases.

New advances in the treatment of pancreatic cancer by targeting tumor microenvironment / 临床肝胆病杂志

Pancreatic cancer is the malignant tumor of the digestive tract with the lowest 5-year survival rate, and current first-line treatment regimens cannot significantly improve the overall prognosis of patients, so it is necessary to explore new treatment methods. A large number of studies have shown that the tumor microenvironment of pancreatic cancer, such as stromal barrier, immune microenvironment, and exosomes, plays an important role in promoting the proliferation, invasion, metastasis, and chemoradiotherapy resistance of pancreatic cancer cells. This article summarizes the potential targets associated with the tumor microenvironment of pancreatic cancer and related clinical research advances, in order to provide new ideas for the treatment of pancreatic cancer.

Advances in research on alcoholic liver disease complicated with sepsis / 中华全科医师杂志

Alcoholic liver disease is often complicated with sepsis at the end stage of the disease, inducing acute-on-chronic liver failure and multiple organ and system injuries, with high short-term mortality. At present, there is still a lack of effective methods for early diagnosis and prognosis, and measures for prevention and treatment in alcoholic liver disease complicated with sepsis. This article reviews the research progress of alcoholic liver disease complicated with sepsis to provide reference for clinical practice.

A case of primary lymphoma in bilateral middle cerebellar peduncles resembling demyelinating disease / 中华神经科杂志

Primary central nervous system lymphoma (PCNSL) is a rare,extranodal form of non-Hodgkin lymphoma that is confined to the central nervous system.It mainly involves the deep brain white matter,the lateral ventricle and the corpus callosum.A decline in cognitive function and headache are the typical clinical manifestations of the disease.We report a patient with PCNSL in bilateral middle cerebellar peduncles,whose clinical manifestations were only dizziness and unstable walking.Brain MRI manifestations were not typical in early time,with symmetrical hypointensity lesions on T1-weighted imaging,hyperintensity lesions on T2-weighted imaging,and edema zone around on FLAIR imaging.Enhanced scan showed marginal contrast enhancement,but no significant occupying effect.These changes were similar to the multiple characteristics of multiple sclerosis.The history of autoimmune diseases and cerebrospinal fluid examination highly indicated demyelinating disease.The differences of clinical manifestations,MRI characteristics,diagnosis,treatment and prognosis between PCNSL in bilateral middle cerebellar peduncles and multiple sclerosis were analyzed to imorove the understanding of the disease in clinical practice.

Research advances in the role of IL-6/STAT3 signaling pathway in hepatic ischemia-reperfusion injury / 中华肝胆外科杂志

The occurrence and development of hepatic ischemia-reperfusion injury (HIR) has important clinical significance,while interleukin-6 (IL-6) is closely related to HIR and it plays an important role in the signaling pathway between downstream signal transducer and activator of transcription 3 (STAT3).IL-6 has been considered to be a typical proinflammatory cytokine.Activation of the gpl30 homodimer by IL-6 leads to the initiation of Janus kinase (JAK)-STAT path-way that is often constitutively switched on in inflammatory diseases.However,a plethora of studies in the last decade showed that only signaling via the soluble IL-6R (trans-signaling) accounts for the deleterious effects of IL-6,whereas the signaling via the membrane-bound receptor (classic signaling) is essential for the regenerative and anti-inflammatory effects of IL-6.In this paper,the latest progresses in the research field of the IL-6/STAT3 signaling pathway in HIR is discussed.

Variable number tandem repeats diversity of Mycobacterium tuberculosis isolates / 中华传染病杂志

Objective To investigate the genetic diversity of variable number tandem repeats (VNTR) of Mycobacterium tuberculosis (M,ib) isolates and their impact factors on transmission.Methods A total of 1 310 patients with smear-positive pulmonary tuberculosis registered during 2013 from 30 counties of drug-resistance monitoring sites in Guangxi were enrolled.The VNTR genotyping technique was used to identify and analyze M.tb genotypes.Count data was analyzed by Chi-square test using descriptive statistical method,unconditioned Logistic regression was used to analyze the characteristics of gene clusters.Results A total of 1 310 strains of M.tb were classified into 964 genotypes,of which 779 strains were classified into a single gene cluster,531 strains were classified into 185 clusters.Each cluster contained 2 to 40 strains (mean 6.6).Patients aged between 41 and 60 years old had a highest gene cluster proportion (45.5％).Seven hundred and forty-six strains were Beijing genotype,while 564 were nonBeijing genotype,among which 7.4％ was original Beijing genotype.The estimated recent infection (cluster rate) was 26.41％.The cluster rate was higher in sensitive strains (24.40％) than in drugresistant strains (9.55 ％,x2 =23.621,P =0.000) and multi-drug resistant (MDR) strains (8.97 ％,x2=-9.675,P=0.002),and that was higher in Beijing genotype (28.69％) than Non-Beijing genotype (23.40％,x2 =4.610,P=0.032).The clusters proportion in sensitive strain (37.43％) was higher than drug-resistant strains (14.09％) and MDR strains (15.38％),and that was higher in Beijing genotype (40.88％) than Non-Beijing genotype (37.77％).Conclusions M.tb genetic polymorphisms display highly diversity in Guangxi region.Sensitive strains and Beijing genotype strains are the main epidemic strains.

Storage effect and transplant outcomes of University of Wisconsin preservation solution and histidine-tryptophan-ketoglutarate preservation solution on liver allografts: a Meta-analysis / 中华消化外科杂志

Objective To systematically evaluate the storage effect and transplant outcomes of University of Wisconsin (UW) preservation solution and histidine-tryptophan-ketoglutarate (HTK) preservation solution on liver allografts.Methods Literatures were researched using PubMed,Embase (1980-),Ovid Medline (1948-),The Cochrane Library,Wanfang database,VIP database from the database establishement to October 2015 with the key words including organ preservation,storage solutions,Histidine-tryptophan-ketoglutarate or HTK,custodial,bretschneider,University of Wisconsin,UW solution,viaspan,cardiosol,belzer solution,hepatic transplantation,liver transplantation,viscera transplantation,liver grafts,hepatic grafts,liver allografts,hepatic allografts,器官移植,器官保存液,UW,HTK,肝移植and比较.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.All the patients using UW and HTK preservation solutions were respectively allocated into the UW group and HTK group.Count data were represented as the odds ratio (OR) and measurement data were represented as the standardized mean difference (SMD) and 95％ confidence interval (CI).The heterogeneity of the studies was analyzed using the I2 test.Results Eleven literatures were retrieved,and the total sample size were 34 475 patients including 25 248 in the UW group and 9 227 in the HTK group.The results of Meta analysis showed that there were no statistically significant differences in the primary transplants nonfunction,retransplant rate and 1-year grafts overall survival rate between the 2 groups (OR =1.18,0.84,0.97,1.02,95％ CI:0.55-2.57,0.47-1.50,0.66-1.42,0.66-1.58,P ＞0.05).There were also no statistically significant differences in the levels of alanine transaminase (ALT),aspartate transaminase (AST),total bilirubin (TBil) at postoperative day 1 between the 2 groups (SMD =-0.19,-O.30,0.30,95％ CI:-0.62-0.23,-0.70-0.10,-0.01-0.61,P ＞0.05).There were no statistically significant differences in the postoperative prothrombin time(PT) and alkaline phosphatase(ALP) between the 2 groups (P ＞0.05) and in the incidence of postoperative biliary complications between the 2 groups (OR =1.49,95％ CI:0.97-2.30,P ＞ 0.05).Conclusion There is similar storage effect between UW and HTK preservation solutions on liver allografts,and no difference in the transplant outcomes.

Telemedicine for the prevention, diagnosis, and treatment of echinococcosis in Xinjiang Uygur Autonomous Region / 中华普通外科杂志

Objective By analyzing 2 560 echinococcosis cases through telemedicine,to explore a new mode for preventing,diagnosing,and treating of echinococcosis.Method From January 2009 to December 2013 in our hospital through remote medical care and consulting we analyzed cases and conducted statistics on consultation's person time,location difference,spectrum of disease and upward referral rate as well as the cost of hospitalization.Result (1) The amount of consultation rose from 182 cases in 2009 to 873 cases in 2013.(2) The proportion of consultation from northern Xinjiang is about 83％-91％,obviously higher than that from south Xinjiang and eastern Xinjiang,which fits those areas mainly with the economical character of the husbandry.(3) Most consultation cases are echinococcosis (99.42％) followed by echinococcosis (0.24％),pelvic cystic echinococcosis (0.19％),cerebral echinococcosis (0.12％),and cardiac echinococcosis (0.03％).(4) Upward referral rate is nearly 7.97％ and about 92.03％ patients were treated in local community hospitals saving medical care budget by RMB 14.78 million.Conclusions Use and establishment of the three level network system for preventing,diagnosing,and treating the echinococcosis by telemedicine effectively enhances primary hospital's ability in the care of these patients and alleviates patients economical burden.

Comparisons of the clinical effectiveness between ultrasound-guided puncture drainage and open surgery in the treatment of pyogenic liver abscess / 中华普通外科杂志

Objective To compare the clinical effectiveness between puncture drainage and surgery in the treatment of pyogenic liver abscess.Methods Clinical date of 81 patients with pyogenic liver abscess were retrospectively analyzed.Patients were divided into the ultrasound-guided puncture drainage group (48 patients) and open surgical drainage group (33 patients).The demographic data,laboratory examination,efficient rate,complication rate,mortality,time for body temperature returned to normal and hospital stays were compared between the two groups.Results Klebsiella pneumoniae was positive in 45.45％ cases by blood culture,and in 62.50％ cases by pus culture.There was no statistically significant difference in the effective rate and mortality (x2 =0.91,2.05,P ＞ 0.05).For patients with puncture drainage hospital stay was (14 ± 5) days,significantly shorter than (17 ± 5) days in surgery group (t =-3.20,P ＜ 0.05).Time to normal temperature was (5.1 ± 1.6) days in puncture drainage group,which was shorter than (6.0 ± 1.1) days in open surgery group (t =-2.85,P ＜ 0.05).Postoperative complications were fewer in the puncture drainage group (6 cases) than open surgery group (10 cases) (x2=3.91,P ＜ 0.05).Conclusions Ultrasound-guided puncture drainage for liver abscess is safe,feasible,effective of low complication rate for the treatment of pyogenic liver abscess.

Repair of minor tissue defect in hand by transfer of free tissue flap from the Toe

To introduce our experience of using the free neurovascular flap from great and second toe. Thirteen patients [fifteen fingers] sought surgical treatment for soft tissue defects of the hand at our medical institutin between March 2006 and September 2009. In two patients, fibular side skin-nail flaps of great toe were applied to cover the dorsal defect of distal thumb. In twelve, in the treatment of pulp defect of finger with fibular side flap of great toe or tibial side flap of second toe. In one, in the treatment of defect of distal middle with composite flap with distal digital bone of second toe. All flaps were survived. The average subjective satisfaction score was 8.08 [range 4-10]. Nine patients [69%] experienced cold intolerance, and 2 patients [15%] dysesthesia. The Semmes-Weinstein sensitivity score was between 3.47and 4.72 on the flap, and 0-4.18 on the donor site. The mean two-point discrimination was 6.8mm [range 4-12]. Grip strength was 10% less than in the unaffected hand. The proximal interphalangeal mobility loss was less than 15 degrees. Our results indicated that these free flaps from toe are useful for patients with a small soft-tissue defect in hand

Evaluation of reconstruction technique after esophagectomy for esophageal cancer / 中华胃肠外科杂志

Surgery remains the cornerstone of treatment for esophageal cancer, although improvements have been made in surgical maneuvers and perioperative care, serious complications still occur after operation. The reconstruction of alimentary tract is a key procedure to ensure success of operation, it is related to perioperative complication and prognosis. Selection of procedure should be individualized based on the stage and location of the disease, medical condition and the surgeon's experience.

Laparoscopic vs conventional open resection of liver hydatid cyst / 中华普通外科杂志

Objective To evaluate laparoscopic radical resection of liver hydatid cyst as compared with conventional open surgery.Methods From May 2006 to January 2013 clinical data of 41 patients undergoing laparoscopic radical resection of hepatic hydatid cyst were compared with those 112 cases treated by open surgery.Operation time,blood loss,conversion rate,length of hospitalization and recurrence rate were compared and analyzed.Results There was not statistical significant difference in operative time and blood loss between the two groups (t =1.97,P ＞ 0.05) (t =2.00,P ＞ 0.05).Five laparoscopic patients were converted to open surgery,conversion rate was 12.2 ％ (5/41),three due to inadequate exposure,and two for intraoperative bleeding.Postoperative hospital stay was significantly shorter in laparoscopic group than that in conventional group.The overall morbidity was 4.9％ (2/41) in laparoscopic and 16.0％ (18/112) in conventional group with statistical significance(x2 =3.92,P ＜ 0.05).Recurrence rate and mortality was 0 in both groups.Conclusions Laparoscopic radical resection of hydatid cyst is safe and effective in carefully selected patients and provides short hospital stay,good cosmetic result,fast recovery and fewer complications.

Effect of echinococcus granulosus antigen B on streptozotocin induced diabetes mellitus in mice / 中华普通外科杂志

Objective To investigate the effect of echinococcus granulosus antigen B on the severity of streptozotocin induced diabetes mellitus.Methods Thirty male BALB/c mice were randomly divided into 3 groups:echinococcus granulosus antigen B group (group A,n =10),normal saline group (group B,n =10),control group (group C,n =10).Mouse in group A was injected by echinococcus granulosus antigen B and mouse in group B was given normal saline,Type 1 diabetes was induced.After 3 weeks,mice were executed and pancreases were scored on insulitis by HE staining.Serum IFN-γ and IL-4 levels were measured by ELISA.Results After 3 weeks of the establishment of diabetes model mouse body weight in group B and C decreased significantly compared with that in group A.Mouse mean blood glucose level in group A was significantly lower than that in group B and C.There were less than 40％ of islets with lymphocytic infiltration in group A,compared with 80％ in group B.The average Ridit was 0.423,0.519,and 0.561 in group A,B and C respectively,P ＜ 0.05.IL-4 level in group A was significantly higher than that in group B and group C [(71.6 ± 12.4) ng/ml,(12.6 ± 5.6) ng/ml,(14.2 ± 7.2) ng/ml,P ＜ 0.05].IFN-γ level in group B and group C were higher than that in group A [(276.1 ± 41.7) ng/ml,(352.2 ± 52.2) ng/ml,(358.1 ± 53.4) ng/ml,P ＜ 0.05].Conclusions Type 1 diabetes is organ specific T lymphocyte mediated autoimmune disease.Echinococcus granulosus antigen B has protective effects on diabetes mellitus in mice couteracting autoimmune injury to the islets by streptozotocin,probably by a mechanism related to immune deviation of Th1 to Th2.

Expression of programmed death receptor ligand 1 of peripheral blood mononuclear cells in patients with hepatic cystic echinococcosis and its relation with interferon-γ / 中华消化外科杂志

ObjectiveTo investigate the expression of programmed death receptor ligand 1 ( PD-L1 ) of peripheral blood mononuclear cells (PBMCs) in patients with hepatic cystic echincccccosis (HCE) and its relation with interferon-γ.MethodsThe clinical data of 63 patients with HCE who were admitted to the First Affiliated Hospital of Xinjiang Medical University from June 2010 to February 2011 were retrospectively analyzed.All patients were divided into HCE active group (38 patients) and HCE non-active group (25 patients) according to the system established by the World Health Organization's Informal Working Group on Echinocoecosis.Twenty patients with hepatic hemangioma or healthy individuals were recruited in normal control group.The positive rate of PD-L1 expression was detected by flow cytometry and immunocytochemistry.The expression of interferon-γ was detected by enzyme-linked immtmosorbent assay (ELISA).All data were analyzed by the t test,one-way analysis of variance,LSD test and chi-square test.The relationship between the expression of interferon-γ and positive rate of PD-L1 expression was analyzed by the Pearson test.ResultsThe results of flow cytometry showed that the positive rates of PD-L1 expression in the HCE active group,HCE non-active group and normal control group were 12.1％±3.8％,10.9％ ± 2.5％ and 9.1％ ±2.5％,respectively.There was a significant difference in the positive rate of PD-L1 expression between the HCE active group and normal control group (t =3.327,P ＜ 0.05 ).The results of immunohistochemistry showed that the positive rates of PD-LI expression in the HCE active group,HCE non-active group and normal control group were 11.9％ ± 3.4％,i0.6％ ± 2.9％ and 9.5％ ± 3.6％,respectively.There was a significant difference in the positive rate of PD-L1 expression between the HCE active group and normal control group (t =2.470,P ＜ 0.05 ).The expressions of intefferon-γ in the HCE active group,HCE non-active group and normal control group were ( 141 ± 38 ) μμg/L,( 124 ± 32 ) μg/L and ( 105 ± 42 ) μg/L.There wasasignificant difference in the expression of interferon-γ between the HCE active group and normal control group ( t =3.280,P ＜ 0.05).The results of flow cytometry and immunohistochemistry revealed that the positive rate of PD-L1 expression was positively correlated with the expression of interferon-γ( r =0.59,0.61,P ＜ 0.05 ).Conclusion With the help of interferon-γ,PD-L1 may play an important role in promoting the immune.evasion of echinococcus.

Liver transplantation for the treatment of end-stage hepatic alveolar echinococcosis / 中华消化外科杂志

Objectiye To investigate the value of liver transplantation for the treatment of end-stage hepatic alveolar echinococcosis(HAE).Methods The clinical data of 8 patients with end-stage HAE who received liver transplantation at the First Affiliated Hospital of Xinjiang Medical University from December 2000 to August 2010 were retrospectively analyzed.The operation time,anhepatic phase,infusion of suspension of red blood cells and postoperative complications were observed.Results The median operation time,anhepatic phase and infusion of suspension of red blood cells were 635 minutes(range,490-760 minutes),66 minutes(range,44-240 minutes)and 20 U(range,4-40 U).Liver transplantation was successfully carried out on 7 patients except for 1 patient who received emergent liver transplantation died of severe hepatic encephalopathy,renal failure and coagulation disorder on postoperative day 1.The median follow-up time was 6 months(range,3-29 months).One patient died of septicopyemia in postoperative month 3,1 died of incurable infection of bile duct in postoperative month 5,and 1 died of acute rejection in postoperative month 6.One patient was complicated with stricture of the bile duct anastomosis,and was cured by choledochojejunostomy.The size of the metastatic lesion in the left lung of 1 patient was reduced.One patient who underwent liver autotransplantation had no signs of residual liver disease with good liver function.Conclusion End-stage HAE is an indication for liver transplantation.A minimum dose of immunosuppressive agent and systemic administration of anti-HAE drugs are necessary to prevent the recurrence of HAE and ensure a long-term survival.Liver autotransplantation is the optimal method for the treatment of end-stage HAE,because no immunosuppressive agent is needed after operation.

Degenarative necrosis and calcification of hepatic cycstic echinococcosis / 中华普通外科杂志

Objective To study factors associated with necrosis and calcification of cyst echinococcosis. Methods This study retrospectively analyzed 191 cases of hepatic cycstic echinococcosis admitted from 2005 to 2008 in the First Affiliated Hospital of Xinjiang Medical University Department of General Surgery, possible relevant factors screened were the patients' gender, age, operation frequency, hepatitis, gall stones, calcium of blood serum, multiple hepatic hydatid cyst, biliary fistulae and hepatic cycstic echinococcosis degeneration. Single-factor analysis and multi-factors analysis were conducted. Results The single-factor independent samples t-test showed that age is significantly related to hepatic cycstic echinococcosis degeneration (t = - 2. 455, P = 0. 008). Single factor Chi-square test showed that factors impacting on hepatic cycstic echinococcosis degeneration were multiple hepatic hydatid cyst and the biliary fistulae (x2 = 6. 848, P = 0. 009; x2 = 7. 149, P = 0. 008). The multiple-factor Logistic regression analysis showed that the age, the multiple hepatic hydatid cyst, and biliary fistulae are the related risk factors(x2 =5. 306,P = 0. 021,OR = 1. 665;x2 = 10. 377,P =0. 001,OR =3. 300;x2 = 4.455,P =0. 035, OR =2. 164) of hepatic cycstic echinococcosis patients with cyst echinococcosis degeneration. Conclusions Age, multiple hepatic hydatid cyst and biliary fistulae are the risk factors associated with degenerative necrosis and calcification of hepatic echinococcosis.

Ex-vivo liver resection combined liver autotransplantation for the treatment of hepatic alveolar echinococcosis / 中华消化外科杂志

Ex-vivo liver resection and liver autotransplantation offers a chance to cure extensive regional liver diseases which are otherwise deemed untreatable in selected cases. A 33-year-old male patient with advanced alveolar echinococcosis (AE) which invaded the right lobes and adjacent retrohepatic inferior vena cava, while the left lobes were free from lesion and had proliferated to over 1200 ml in size except for a 1 cm × 1 cm solid lesion in the segment Ⅳ. No extrahepatic metastases were found in this patient. A lesion with a size of 4300 ml and other small lesions in the right lobes were removed extracorporeally,and the retrohepatic vena cava was repaired, then the remaining AE-free left lobes (more than 700 ml in size) and the retrohepatic inferior vena cava were re-implanted in situ. A temporary end-to-end cavo-caval shunt with interposition of a blood vessel prosthesis and end-to-side portocaval shunt were established to keep the blood flow during the four-hour anhepatic phase. The patient was followed up for six months, and he had no signs of residual liver disease with good hepatic function.