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Hepatocellular carcinoma with portal vein tumor thrombus has a high incidence rate and rapid progression, and there are limited therapies with a poor clinical effect. Although sorafenib is recommended as the sole therapy for such patients in foreign guidelines, studies have shown that some patients may achieve a better outcome via surgical treatment, especially those with tumor thrombus in the first- or second-order branches of the portal vein (type Ⅰ/Ⅱ thrombus according to Cheng’s classification). However in clinical practice, a large proportion of patients cannot undergo radical resection due to extensive lesions, or there may be a high possibility of residual tumor thrombus after surgery due to the presence of tumor thrombus in the main portal vein (type Ⅲ according to Cheng’s classification), and therefore, downstaging resection is needed to improve prognosis. Studies have shown that with the help of palliative therapies including neoadjuvant three-dimensional conformal radiotherapy, (90)Y-loaded microsphere radioembolization, and hepatic arterial infusion chemotherapy, some patients may achieve regression or disappearance of portal vein tumor thrombus, tumor shrinkage, and disappearance of satellite lesions, which helps to achieve tumor downstaging, increase surgical resection rate, and prolong survival time. Multidisciplinary therapy is of vital importance in improving downstaging resection rate in patients with hepatocellular carcinoma and portal vein tumor thrombus.
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Hepatocellular carcinoma (HCC) is prone to invading portal vein system known as portal vein tumor thrombus (PVTT).PVTT is one of the main reasons for poor prognosis of HCC because of its rapid progress and lack of effective treatments.In recent years,with the development of new therapeutic concepts and methods,the curative effect of PvTr has been improved.But there are still many difficulties of treatment of PVTT:how to definite the indications of various treatment of PVTT,how to innovate treatment methods,how to carry out the multidisciplinary treatment and how to conduct high-quality evidence-based clinical research.The strategies need to be built for these bottlenecks.Chinese Expert Consensus on Multidisciplinary Diagnosis and Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus (2016 edition) also provided a powerful reference experience for clinical treatment and research.Researchers should develop new treatment methods,popularize the idea of multidisciplinary treatment and conduct high-quality evidence-based clinical research in the future to improve the curative effect of PVTT patients.
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Through analysis of Lau Wan Yee's published papers,monographs,conference speeches,research designs / revisions for major hospitals in China,combined with analysis of articles revised by Academician Lau in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University for the past decade,authors came up with 9 points in Academician Lau's research ideas.Academician Lau has played a huge and leading role in improving clinical skills and scientific research levels,as well as in development and internationalization of hepatobiliary and pancreatic surgery in China.To summarize the research ideas of Lau is of great importance to the future generations of surgeons.
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As the key features of tumor, metastasis has multiple mechanisms and could cause poor survival. Accumulated evidences indicate that platelet plays an important role in tumor metastasis. Platelet count had become a significant indicator for predicting tumor prognosis,and antiplatelet therapy is an effective way for tumor treatment. Here, the recent advancements of the relationship between platelets and tumor metastasis are reviewed.
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Objective@#To investigate the incidence of occupational diseases in Chongqing, China, from 2006 to 2014, and to analyze the harm, features, and trend of occupational diseases in Chongqing.@*Methods@#The data of new cases of occupational diseases from 2006 to 2014 were collected, and the patients with a confirmed diagnosis of occupational diseases were selected as study subjects to analyze the incidence of occupational diseases in Chongqing.@*Results@#There were 17499 cases of occupational diseases in total in Chongqing from 2006 to 2014. Among these patients, 17124 (97.86%) were male, most of whom (95.40%) had occupational pneumoconiosis, and 375 (2.14%) were female, most of whom (72.80%) had occupational chemical poisoning. There were 16400 cases (93.72%) of occupational pneumoconiosis in total, mainly coal workers' pneumoconiosis (55.87%) and silicosis (43.02%) , and the main industries involved were coal mining and washing, railway transport equipment manufacturing, and mining and washing of bituminous coal and anthracite. There were 724 cases of occupational poisoning in total; there were 281 cases of acute occupational poisoning, mainly gas poisoning (39.86%) and carbon monoxide poisoning (33.10%) ; there were 443 cases of chronic occupational poisoning, mainly poisoning caused by benzene (47.63%) , mercury and its inorganic compounds (32.74%) , and lead and its inorganic compounds (9.03%) .@*Conclusion@#Occupational diseases in Chongqing are mainly occupational pneumoconiosis, and occupational health supervision should be enhanced in the industries of coal mining and washing and railway transport equipment manufacturing to protect workers’ health.
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Most of the current experiments are obsolete and verified,the students are not interested in and the experiments are out of touch with the actual work.These are the common problems in the experiment teaching of occupational health and occupational medicine.By taking the students who majored in preventive medicine as the subjects,this study aimed to explore the effects of independent designed experiment teaching mode,which was based on dividing the groups before class,choosing the projects by students themselves,deciding the design of the program via the discussion of teacher and students and doing the experimental reports and sharing the experience.The results showed that,in the premise of the preliminary master of the theory and basic skills of occupational health and occupational medicine,carrying out independent designed experiments in the last three weeks of semester,to a certain extent,could arouse students' interest in learning,cultivate their abilities of independent thinking,practice,problem analysis and solution,and team cooperation.However,restricted by lack of teachers,inadequate equipment and high cost and other factors,this teaching mode is only suitable for small class.
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To improve the quality of experimental teaching,investigating the independent design experiments are carrying out in preventive medicine by public health experimental teaching center in our school.We take preventive medicine professional as an example,and besides the classical basis experiments,some experiments are verification project at present,in which students are not strongly interested.On the basis of the integration of the classic experiments,according to the national standard of the experimental method,we are trying to carry out part of the independent design experiments to meet the needs of students learning.The effect of those independent design experiments shows that it is appropriate carrying out independent design experiments on the basis of the existing classical experimental project in preventive medicine experimental teaching,to a certain extent,which will stimulate students' learning interest and enhance their sense of achievement.This study is conducive to the cultivation of medical students' innovation,independent thinking,analysis and problem-solving ability,practical ability and teamwork spirit.
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Objective To examine the expression of scinderin in primary hepatocellular carcinoma (HCC) and its paired portal vein tumor thrombus (PVTT) tissues; and to explore its role in the development of HCC and its relationship with prognosis of HCC.Methods Immunohistochemistry was used to detect the expressions of scinderin in tumor-adjacent normal liver tissues,HCC tissues and PVTT tissues from 33 patients.Results The positive expression rates of scinderin in tumor-adjacent normal tissues,HCC tissues and PVTT tissues were 69.7％ (23/33),45.5％ (15/33) and 24.2％ (8/33) respectively.A significantly lower scinderin expression was found in HCC tissues when compared with tumor-adjacent normal tissues (P ＜ 0.05).Also,the expression of scinderin in PVTT tissues was significantly lower than in HCC tissues (P ＜ 0.05).The expression of scinderin in HCC tissues significantly correlated with tumor size,absence of tumor capsule and serum AFP (P ＜0.05).The recurrence-free survival (RFS) and overall survival (OS) of Scinderin-positive patients were significantly longer than Scinderin-negative patients (P ＜ 0.05).Multivariate analysis revealed scinderin expression level to be an independent risk factor affecting RFS and OS after curative resection.Conclusions Scinderin was down-regulated in HCC tissues and PVTT tissues when compared with its paired tumor-adjacent normal liver tissues.The expression level of scinderin correlated with HCC recurrence and prognosis.Scinderin can be used as an indicator of prognosis of HCC patients with PVTT.
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Objective To evaluate the distribution of Pneumoconiosis and provide scientific basis for preventing the occur-rence of Pneumoconiosis and improving the life quality of patients for the workers in coal mine of Songzao.Methods Retrospective epidemiological research and chi-square test were used for all collected Pneumoconiosis cases in Songzao coal mine of Chongqing from 2010 to 2012.Results From 2010 to 2012,the incidence was significantly different(χ2 =25.048,P <0.05),and the prevalence was significantly different(χ2 = 11.223,P <0.05).Besides,the mean duration of dust exposure was(20.50± 5.45)years.Mean-while,the difference of proportion between stageⅠand stageⅡ、stage Ⅲ show statistical significance(χ2 =9.162,P <0.05).What′s more,the rate of complicated pulmonary tuberculosis with pneumoconiosis was 2.94%.From 1979 to 2012,the difference in propor-tion of different stage′s fatality was significantly different(χ2 = 174.101,P <0.05).Conclusion Nearly three years,although the incidence and prevalence were all decreasing,but the situation was not optimistic.Pneumoconiosis are mainly in stageⅠ,and the le-thality of Ⅲ period is far stronger than the other two.Prevention of complication should be paid high attention.
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Hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) or lymphatic/extrahepatic metastasis is classified as advanced stage (Stage C of Bacelona Clinic Liver Cancer Staging). There is few effective therapy for the advanced stage HCC, leading to an extremly poor prognosis. For these patients, Sorafinib is recommended as the only therapy by European and American guidelines, which has limited clinic effect. In China, besides Sorafinib, various therapies have also been suggested, including surgery, trans-arterial chemoembolization (TACE), radiotherapy, as well as traditional Chinese medicine. Recently, it is reported that several therapies may be effective in treating HCC with PVTT which is classified based on Cheng's classification, including surgery after "down-stage" radiotherapy, early use of sorafinib postoperatively, as well as postoperative antivirus treatment. The modified Folfox4 chemotherapy, is also a potential effective way to improve the prognosis of advanced stage HCC with lymphatic/extrahepatic metastasis. Mutiple disciplinary team which could faciliate the process of diagnosis and treatment of advanced stage HCC, is expected to favor the prognosis of these patients.
Subject(s)
Humans , Carcinoma, Hepatocellular , Therapeutics , Chemoembolization, Therapeutic , China , Liver Neoplasms , Therapeutics , Lymphatic Metastasis , Portal Vein , Prognosis , Thrombosis , Treatment OutcomeABSTRACT
Objective To investigate the safety and clinical effect of endovascular radiofrequency ablation (RFA) catheter, the HabibTM VesOpen, in treating portal vein tumor thrombus. Methods Fifteen patients of hepatocellular carcinoma associated with portal vein thrombus causing obstruction of blood flow were enrolled in this study. Guided by ultrasound percutaneous portal catheter implantation was performed, then, under DSA guidance RFA catheter was placed at portal vein tumor thrombus. RF generator (RITA) was connected to the electrodes, the power was set at 10 W for 2 - 10 minutes. The technical success rate, the postoperative complications, the hepatic and renal functions as well as routine blood tests, portal vein blood flow and the ablation extent of portal vein tumor thrombus were evaluated, and the results were analyzed. Results The procedure was successfully accomplished in all patients. No technique-related complications, such as hemorrhage, vessel perforation, bile leak complicated by infection, liver abscess, abdominal bleeding occurred. Direct portography performed immediately after RFA showed that the portal vein was re-opened. Laboratory examinations performed 4 weeks after RFA showed that no obvious changes in hepatic functions and routine blood tests were observed. Doppler ultrasound examinations revealed that flowing blood was obviously displayed within previously obstructed portal vein. CT scanning was carried out in some patients with portal vein thrombus, and it indicated that the portal vein tumor thrombus was reduced in size or even disappeared. Conclusion For the treatment of portal vein tumor thrombus in patients with hepatocellular carcinoma, endovascular radiofrequency ablation is technically feasible, and the initial results indicate that this technique is an effective treatment.
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The incidence of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is very high,and the prognosis is often unsatisfactory.Currently,some therapy such as radiotherapy or radiation combined with interventional therapy are effective and worth attention.Radiation therapy was divided into external beam radiation therapy and internal beam radiation therapy according to different administration pathway.This article summarized the current situation and prospect of radiotherapy.
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Objective To investigate the expression of peroxiredoxin 1 (Prx 1) in hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) and to evaluate the relationship between the expressions of Prx 1 and the postoperative recurrence of this disease. Methods Immunohisto chemistry and Western blotting were performed to examine the expression of Prx 1 protein in 40 patients with HCC with PVTT. Experiments on Sprague Dawley (SD) rat hepatoma model were further carried out to observe the pathological changes of Prx 1 by immunohistochemistry. Clinical outcomes were analyzed to find a correlation between the recurrence and positive rate of Prx 1. Results The expression level of Prx 1 was significantly up-regulated in primary tumor tissues than in tumor thrombosis samples (P＜0.01). Immunohistochemistry results showed that the positive rate of Prx 1 in primary tumor tissues were higher than that in tumor thrombosis. Western blotting confirmed a same trend in the level of Prx 1, the average luminosity of the blots were 1534.2 and 735.6, respectively. There was a significant difference in SD rat hepatoma model, the 4, 8, 12, 16, 20 and 24-week positive rates of Prx 1 in liver tumor tissues were 60%, 80%, 75% ,65%, 40% and 25% respectively. Clinical outcomes showed that the time to first postoperative recurrence of Prx 1 in the primary tumor positive group was significantly higher than that in the negative group (6. 3 vs 3. 7 months, P＜0. 01). Conclusions Prx 1 protein was down-regulated in HCC with PVTT. There was a negative correlation between the expression of Prx 1 and recurrence.
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<p><b>OBJECTIVE</b>The present study aimed to test whether exposure to benzo(a)pyrene [B(a)P] affects spatial learning and short-term memory by modulating the expression of the Gria1 and Grin2a glutamate receptor subunit genes in the hippocampus.</p><p><b>METHODS</b>Thirty-six 21-24-day-old, male rats were randomly assigned into high-, medium-, and low-dose toxin exposure groups (6.25, 2.5, and 1 mg/kg, respectively) and a control group, each containing nine rats. The behavioral performance of adult rats exposed to sub-chronic administration of B(a)P was monitored by learning and memory tests (Morris water maze). Real-time PCR assays were used to quantify Gria1 and Grin2a gene expression in the hippocampus.</p><p><b>RESULTS</b>At medium and high doses, B(a)P impaired spatial learning performance. The crossing-platform-location frequency and the time spent swimming in the platform area, which both relate to short-term memory, were significantly decreased in B(a)P-treated rats compared with controls. The level of Gria1 mRNA increased 2.6-5.9-fold, and the level of Grin2a mRNA increased 10-14.5-fold, with a greater fold increase associated with higher doses of B(a)P.</p><p><b>CONCLUSION</b>We demonstrated that sub-chronic administration of B(a)P inhibits spatial learning and short-term memory, and increases Gria1 and Grin2a expression in the hippocampus. This suggests a relationship of B(a)P exposure levels with Gria1 and Grin2a expression and impairment of short-term and spatial memory.</p>
Subject(s)
Animals , Male , Rats , Behavior, Animal , Benzo(a)pyrene , Toxicity , Dose-Response Relationship, Drug , Drug Administration Schedule , Gene Expression Regulation , Hippocampus , Metabolism , Learning , RNA, Messenger , Genetics , Metabolism , Receptors, AMPA , Genetics , Metabolism , Receptors, N-Methyl-D-Aspartate , Genetics , MetabolismABSTRACT
The knowledge of occupational health and occupational medicine is the basis for students of preventive medicine in the future work.The paper expatiates on how to make students build up their thought of preventive medicine during the teaching course,and raise their interest in it and cultivate their comprehensive capability.The purpose of the paper is to enhance the teaching result and quality.
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Objective To observe changes of the ultrastructure and the cell cycle of hepatoma cells exposed to ultrasound-mediated disruption. Methods Suspensions of Walker-256 hepatoma in vitro exposed to ultrasound disruption with the acoustic power output 0 22 W and the ultrasound frequency 42 kHz were observed by the scanning electron microscopy, the transmission electron microscopy and the flow cytometric analysis of DNA content. Results Cells after ultrasound disruption revealed by scanning electron microscopy exhibited ruptured membrance, disordered organellae and disrupted nucleus, showing typical severe destruction of the cells. Flow cytometric analysis of DNA content demonstrated an increased in the population of cells in the G 2 and M phases of the cell cycle but a decrease in number of cells in the S phase, suggesting an inhibition of the cell synthese and an increased sensitivity to radiation. Conclusions Ultrasound disruption can destroy tumor cells effectively at the cellular level.
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Objective To study on imagination features of tumor thrombi in the portal vein of primary liver cancer (PLC). Methods We established a new type system of tumor thrombi, with Ⅰ 0 to Ⅳ, a total of 5 types and 8 sub-types in the portal vein of PLC based on normal intrahepatic portal vein anatomy and growing features of the tumor thrombi. The relationship between the types and the imaging diagnosis of 130 PLC cases with tumor thrombi in the portal vein was studied. Results 85%(110/130) cases of PLC with tumor thrombi in the portal vein belongs to type Ⅱ or Ⅲ when being first diagnosed in the hospital. The resectability rates for type Ⅰ, Ⅱ, Ⅲ, Ⅳ were 62%(5/8), 16%(10/62), 10%(5/48), 0 (0/12), respectively, and chemoembolization therapy (TACE) was given in 38%(3/8), 40%(25/62), 27%(13/48), 16%(2/12), respectively. Conclusions The new types of tumor thrombi are helpful for diagnosis and treatment of PLC with tumor thrombi in the portal vein.
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Objective To study the relationship between gastroesophageal varices and bleeding and portal venous tumor thrombi in patients with hepatocellular carcinoma(HCC). Methods From Jan. 2000 to Jan. 2003, 84 HCC patients with portal vein tumor thrombi were divided into Ⅰ～Ⅳ groups according to Ⅰ～Ⅳ types of tumor thrombi. The grade of gastroesophageal varices, the median survival time and the death cause for group Ⅰ～Ⅳ were retrospectively analyzed. Results Mild grade of gastroesophageal varices accounted for 64.7%, 6.0%, 85.7%,100%, respectively in group Ⅰ(n=17), Ⅱ(n=26),Ⅲ( n=35) and group Ⅳ(n=6),respectively. Severe varices were found in less than 5% in all four groups. The median survival periods were 10.1, 7.2, 5.7 and 3.0 months, respectively (P=0.0001). Most cases died from esophageal and gastric variceal bleeding and hepatic failure, with each accounting for about 50% of the mortality in all the 4 groups. Conclusions Portal venous tumor thrombi of HCC patients was not the major cause leading to esophageal and gastric varices and bleeding.
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Hepatocellular carcinoma with portal vein tumor thrombus has a high incidence rate and rapid progression, and there are limited therapies with a poor clinical effect. Although sorafenib is recommended as the sole therapy for such patients in foreign guidelines, studies have shown that some patients may achieve a better outcome via surgical treatment, especially those with tumor thrombus in the first- or second-order branches of the portal vein (type Ⅰ/Ⅱ thrombus according to Cheng’s classification). However in clinical practice, a large proportion of patients cannot undergo radical resection due to extensive lesions, or there may be a high possibility of residual tumor thrombus after surgery due to the presence of tumor thrombus in the main portal vein (type Ⅲ according to Cheng’s classification), and therefore, downstaging resection is needed to improve prognosis. Studies have shown that with the help of palliative therapies including neoadjuvant three-dimensional conformal radiotherapy, (90)Y-loaded microsphere radioembolization, and hepatic arterial infusion chemotherapy, some patients may achieve regression or disappearance of portal vein tumor thrombus, tumor shrinkage, and disappearance of satellite lesions, which helps to achieve tumor downstaging, increase surgical resection rate, and prolong survival time. Multidisciplinary therapy is of vital importance in improving downstaging resection rate in patients with hepatocellular carcinoma and portal vein tumor thrombus.