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Targeted therapy is one of the conventional treatments for advanced hepato-cellular carcinoma (HCC). In recent years, immunotherapy has created a new era of HCC treatment. The combination of targeted therapy and immunotherapy has synergistic effects, which taking survival benefits to patients with advanced HCC. Local therapy, represented by interventional treatment, can rapidly control the development of tumor and promote the expression and releasing of tumor antigen. On the basis of local therapy and combination of immunotherapy plus targeted therapy, it can offer the possibility to prolong the survival of patients, and even obtain the chance of cure. The authors introduce the diagnosis and treatment of an advanced HCC patient with inter-ventional treatment combined with immunotherapy plus anti-angiogenesis targeted therapy. Results show that patient achieving pathological complete response and undergoing resection after conver-sion therapy. The patient has a good prognosis with a better quality of live.
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The constitutive androstane receptor (CAR, NR3I1) belongs to nuclear receptor superfamily. It was reported that CAR agonist TCPOBOP induces hepatomegaly but the underlying mechanism remains largely unknown. Yes-associated protein (YAP) is a potent regulator of organ size. The aim of this study is to explore the role of YAP in CAR activation-induced hepatomegaly and liver regeneration. TCPOBOP-induced CAR activation on hepatomegaly and liver regeneration was evaluated in wild-type (WT) mice, liver-specific YAP-deficient mice, and partial hepatectomy (PHx) mice. The results demonstrate that TCPOBOP can increase the liver-to-body weight ratio in wild-type mice and PHx mice. Hepatocytes enlargement around central vein (CV) area was observed, meanwhile hepatocytes proliferation was promoted as evidenced by the increased number of KI67
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Intrahepatic cholangiocarcinoma (ICC) is a primary liver cancer with malignant biological behaviors and ranks only second to hepatocellular carcinoma in incidence rate, and in recent years, the incidence and mortality rates of ICC have been increasing significantly. Since ICC has significant different biological characteristics from hepatocellular carcinoma and extrahepatic cholangiocarcinoma, ICC lacks characteristic clinical symptoms and specific tumor markers and has strong invasion, a low surgical resection rate, and a tendency of recurrence and metastasis after surgery, which results in poor overall prognosis. With the development of molecular biology techniques and the accumulation of diagnosis and treatment experience, there is a gradually deepened understanding of the biological characteristics and clinical outcomes of ICC, and the corresponding surgical diagnosis and treatment strategies and technical means are undergoing profound transformation. At present, multidisciplinary comprehensive treatment, mainly surgery, is the mainstream paradigm for the treatment of ICC, and emphasis on R0 resection and regional lymph node dissection helps to improve clinical outcome and prognosis. However, there are still some problems for consideration on the way to the early diagnosis and the precise, standardized, and individualized treatment of ICC.
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Objective To explore the therapeutic effect and safety of endoscopic resection and laparoscopic surgical treatment for colorectal submucosal tumors under the guidance of ultrasound endoscopy.Methods The clinical data of 90 patients with colorectal submucosal tumors in Tengzhou Central People′s Hospital form January 2013 to January 2018 were retrospectively analyzed.Among them,60 patients underwent endoscopic resection ( hereinafter referred to as endoscopic resection group) and 30 patients underwent laparoscopic resection ( hereinafter referred to as laparoscopic resection group).The complete resection rate, average diameter of resected lesions, average operation time, average hospital stay, average intraoperative bleeding volume, incidence of complications and recurrence rate of colorectal submucosal tumors were compared between the two groups.Results The complete resection rate of endoscopic resection groups was 96.7%,The complete resection rate of laparoscopic surgical treatment groups was 96.6%,there was no statistical difference between the two groups( χ2＝0.16,P＝0.759).The average diameter of the lesion was larger in laparoscopic surgical treatment group (( 29.7 ± 5.3) mm) than that in endoscopic resection group((14.9±4.3) mm,P＝0.013).The operation time was shorter in endoscopic resection group ((32.1±6.1) min) than that in laparoscopic surgical treatment group((75.3±9.8) min,P＝0.007).There was statistically statistical difference in the intraoperative blood loss between endoscopic resection group ((13.2± 5.5) ml ) and laparoscopic surgical treatment group (( 28.3 ± 7.6) ml, P ＝ 0.009).The postoperative hospital stays was less in endoscopic resection group((3.1±1.4) d) than that in laparoscopic surgical treatment group((6.9±2.2) d,P＝0.007).The complicationgs rate in endoscopic resection group (3.33%) was significantly lower than that in laparoscopic surgical treatment group(13.3%),(χ2＝4.89,P＝0.021).The average hospitalization expenses of endoscopic resection group was significantly lower than that of the laparoscopic surgical treatment group(( 18 745± 6 281) vs(42 961± 10 423) yuan,P＝0.006) .There were no relapse and distant metastasis in two groups,followed up for 6 to 12 months.Conclusion Endoscopic resection and laparoscopic resection are both safe and effective methods for the treatment of rectal submucosal tumors.Endoscopic resection has less trauma,quicker recovery,shorter hospitalization time and lower hospitalization costs.
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Objective To investigated the change of endogenous heme oxygenase-1 (HO-1)/carbon monoxide (CO) system and resolvin E1( RvE1 ) in patients with crohn disease (CD), and its effects on the pathogenesis of ulcerative colitis. Methods The distribution and expression of HO-1 proteins in the colonic mucous in 40 cases with CD and 15 cases of normal control group were detected by SABC immunohistochemistry. The average optical density value of HO-1 was analyzed with an Image Analyzing systems. The concentration of CO in the colonic mucosa was detected with chemical methods. The levels of RvE1 in serum was detected by enzyme linked immunosorbent assay (ELISA). Results The expression of HO-1 proteins in patients with active CD were significantly higherin the colonic mucous membrane epithelia. The average optical density value of HO-1 in patients with active CD was higher than that in normal group and remission of CD( 0.358 ± 0.021 vs. 0.163 ± 0.018 and 0.177 ± 0.032)(P<0.01). The concentrations of CO in active CD was significantly higher than that in the normal control group and remission of CD [(23.79 ± 1.81) μmol/g vs. (18.68 ± 1.64) and (17.13 ± 1.23) μmol/g] (P <0.01). The levels of RvE1 in patients with active CD were significantly higher than those in normal group and remission of CD [(41.35 ± 2.76) ng/ml vs. (15.34 ± 2.19) and (14.51 ± 1.47) ng/ml] (P < 0.01). Conclusions The abnormal expression of HO-1/CO system and RvE in activity of the CD may play an important role in the pathogenesis of CD.
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Objective To explore the therapeutic effect and safety of endoscopic multi-band mucosetomy (EMBM) and endoscopic submucosal dissection(ESD) for colorectal submucosal tumors under the guidance of ultrasound endoscopy. Methods From January 2013 to June 2016,the clinical data of sixty patients with colorectal submucosal tumors in Center People's Hospital of Tengzhou who received either EMBM (32 cases) or ESD ( 28 cases) were included in this retrospective study. The complete resection rate, average diameter of resection lesion, operative time, complications and recurrence rate of two groups were compared. Results The complete resection rate of EMBM groups was 96. 9%(31/ 32),the complete resection rate of ESD groups was 96. 4%(27/ 28),there was no statistically significant difference between the two groups (χ2 = 0. 07,P= 0. 812). The average diameter of was ESD group (12. 3±2. 6) mm,significantly greater than that of EMBM group ((9. 1± 2. 2) mm) (P = 0. 038),and the mean operation time of EMBM group was (20. 5 ±5. 1) min,which was significantly less than that of ESD group ( (36. 8±4. 5) min) (P = 0. 008),and the percentage of perforation in EMBM group was 0,significantly lower than that of ESD group (10. 7%(3/ 28))(χ2 = 6. 37, P = 0. 013). The severe bleeding rate of EMBM group was 3. 1% (1/ 32),which was significantly lower than that in ESD group(14. 3%(4/ 28)) (χ2 = 4. 89, P = 0. 021) . After 6-12 months of follow-up,no recurrence or distant metastasis was found in EMBM or ESD group. Conclusion EMBM and ESD are safe and effective for colorectal submucosal tumors,However the average diameter of the lesion was larger in EMBM group than that in ESD group.
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Objective@#To compare the therapeutic effect and safety of endoscopic multi-band mucosetomy (EMBM) and endoscopic mucosal resection (ESMR) in the treatment of colorectal submucosal tumors.@*Methods@#From January 2012 to June 2014, the clinical data of 40 patients with colorectal submucosal tumors in Tengzhou Central People′s Hospital were divided into EMBM group (22 cases) and ESMR group(18 cases) according to different treatment method.The complete resection rate, operation time and complications were compared between the two groups.@*Results@#The complete resection rate of the EMBM group was 95.45%, which of the ESMR group was 94.44%, the difference between the two groups was not statistically significant (χ2=0.273, P>0.05). The operation time was shorter in the EMBM group[(31.3.5±4.0)min]than that in the ESMR group[(47.2±4.5)min), t=-15.194, P<0.05]. The incidence rate of hemorrhage in the EMBM group was 9.0%, which was significantly lower than 33.3% in the ESMR group (χ2=3.952, P<0.05). There was no statistically significant difference between the two groups in the incidence of postoperative colorectal stricture (P>0.05). All the patients were followed up for 3~24 months after operation, and no local recurrence occurred.@*Conclusion@#EMBM is safe and effective for colorectal submucosal tumors and the complications are less.
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Objective To investigate the application value of magnetic-controlled capsule endoscopy (MCE) for gastric diseases in physical examination of asymptomatic population.Methods Data of 211 asymptomatic individuals who received MCE examinations from July 2015 to December 2016 in Changhai Hospital were collected and rctrospectively analyzed.The tolerance and safety of MCE were studied by analyzing the detection rate for the focal lesions and the rate of endoscopy transfer.Results Among 211 patients,the detection rate of the gastric focal lesions was 9.5％ (20/211).The detection rate in male was higher than that in female (P＜0.05).All patients completed MCE examination successfully and no adverse event was reported.Conclusion MCE,a non-invasive endoscopic modality,is safe and better tolerated than conventional endoscopy,and can be used as a promising approach to screening the gastric diseases in asymptomatic population due to high detection rate of these diseases.
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Objective To evaluate the clinical efficacy of application of hepatitis B surface antigen (HBsAg)-positive donor liver in adult liver transplantation. Methods Clinical efficacy of 28 recipients with liver diseases induced by virus B hepatitis (hepatitis B) undergoing liver transplantation using HBsAg-positive donor liver from July 2012 to October 2015 was retrospectively analyzed. Clinical prognosis and postoperative complications of the recipients were summarized. The changing features of serum levels of HBsAg and hepatitis B virus (HBV) DNA was investigated. Results After liver transplantation, 28 recipients were orally administered with entecavir to prevent the recurrence of hepatitis B. During perioperative period, 2 recipients died from sepsis and acute heart failure. During postoperative follow-up, 2 cases died from the recurrence of hepatocellular carcinoma (liver cancer). The remaining 24 patients were followed up for 12-26 months. Throughout the follow-up, 24 recipients were positive for serum HBsAg. After treatment, the titre of HBV DNA was significantly declined to <1×102 copies/mL at postoperative 12 months. No graft dysfunction induced by hepatitis B recurrence occurred in 24 recipients alive. Conclusions As a marginal donor liver, HBsAg-positive liver graft is safe for liver transplantation in the recipients with hepatitis B-related liver diseases. Postoperatively, anti-HBV treatment should be strengthened and intimate follow-up should be delivered.
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Objective To investigate the expressions of endogenous cystathionine-γ-1yase (CSE)/ hydrogen sulfide (H2S) and resolvin E1 (RvE1) in patients with ulcerative colitis (UC),and its effect on the pathogenesis of ulcerative colitis.Methods The distribution and expression of CSE proteins in the rectum mucosa in 60 cases of UC and 30 cases of normal control group were detected by Strept Avidin-Biotin Complex (SABC) immunohistochemistry.The average optical density value of CSE was analyzed with an Image Analyzing systems.The expression of CSE mRNA in the rectum mucosa was detected by real-time polymerase chain reaction (RT-PCR).The levels of H2S and RvE1 in sera were detected by spectrophotometry.Results The expressions of CSE proteins in three groups were detected in the rectum mucosa membrane epithelia.The average optical density value of CSE and the expression of CSE mRNA in patients with active UC were higher than that in normal group and remission of UC.The levels of H2S and RyE1 in patients with active UC were significantly higher than that in normal group and remission of UC.Conclusions The abnormal expressions of CSE/H2S and RyE1 in activity of the UC might play an important role in the pathogenesis of UC.
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Objective To study the expression of endogenous cystathionine-β-synthase (CBS) and hydrogen sulfide in patients with ulcerative colitis (UC), and explore their possible role in the pathogenesis of UC. Methods Thirty patients with active period UC (active period UC group), 30 patients with remission period UC (remission period UC group) and 30 healthy controls (control group) were selected, and SABC method was used to observe the localization of CBS in rectal mucosal tissues. The optical density value of CBS was analyzed with image analysis systems. The relative expression of CBS mRNA in the rectal mucosa tissue was detected by reverse transcriptase-polymerase chain reaction (RT-PCR), and the expression of glyceraldehyde-3-phosphate dehydrogenase (GAPDH) was detected as an internal reference. The expression level of mRNA was detected by semi quantitative analysis with gel imaging analysis system, and the results were expressed as the ratio of the target bands to the GAPDH absorbance. The serum level of hydrogen sulfide was detected. Results The serum level of hydrogen sulfide, optical density value of CBS and relative expression of CBS mRNA of rectal mucosal tissues in active period UC group were significantly higher than those in remission period UC group and control group: (90.13 ± 3.12) μmol/L vs. (50.34 ± 2.34) and (48.13 ± 2.75) μmol/L, 0.433 ± 0.037 vs. 0.295 ± 0.064 and 0.214 ± 0.026, 1.532 ± 0.134 vs. 1.031 ± 0.107 and 0.986 ± 0.067, and there were statistical differences (P 0.05). Conclusions The abnomal expression of CBS and hydrogen sulfide in aactive period UC may play an important role in the pathogenesis of UC.
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Aim To determine the effective compo-nents of Semen Ziziphi Spinosae for sedative-hypnotic and its mechanism. Methods The extraction of Se-men Ziziphi Spinosae and the rat brain homogenates were prepared. High concentrations of Diazepam com-petitively replaced the ligand compounds of Semen Ziz-iphi Spinosae combining BDZ receptor in brain tissue, and all the compounds with sedative and hypnotic effects were collected and identified by HPLC and LC-MS technique, as the compounds extracted from the brain tissue were administered with Semen Ziziphi Spi-nosae. The brain tissue was administered with Diaze-pam, and with Semen Ziziphi Spinosae and Diazepam. Results The HPLC chromatograms show that the peak time of BDZ receptor ligand compounds was 2. 71 min and 46. 87min, when compared with Diazepam. And the LC-MS chromatograms display the relative molecu-lar weight of the ligand compounds was 274. 28 m/z, 453. 34 m/z,496. 34 m/z and 608. 38 m/z respective-ly. According to the fingerprint of Semen Ziziphi Spi-nosae, these compounds may be fatty acid substances and lupine pill triterpene compounds. Conclusions On the basis of the principle of receptor ligand bind-ing, we established a way to quickly analyze and iden-tify the role of natural products in the same drug target compounds. The method not only can clearly define the effective components of natural products, but also clar-ify the mechanism of action of the compounds. The ac-tive ingredient of calm hypnosis in Semen Ziziphi Spi-nosae may be fatty acid substances Palmitic acid ( C16 H32 O2 ) and lupine pill triterpene compounds Alphitolic acid( C30 H48 O4 ) and Spinosin( C28 H32 O15 ) . They exert their sedative and hypnotic effects by combining with BDZ receptor, and the research has laid a theoretical foundation for the further study about mechanism of Se-men Ziziphi Spinosae.
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Objective To analysis the clinical features of dorsal pancreas agenesis ( DPA) and the associated diabetes, pancreatitis and other congenital organ malformations.Methods Chinese databases of Sinomed, CQVIP and CNKI using the term of short pancreas, pancreas agenesis, bulbar pancreas and dorsal pancreas, and English databases of PubMed using the term of dorsal pancreas agenesis, short pancreas and pancreas hypoplasia were searched.The clinical manifestation, pancreatic head characteristics and associations with diabetes, pancreatitis and other congenital organ malformations were analyzed.Results Six related publications from Chinese databases were searched and 21 patients were included with 2 cases excluded.Sixty-one publications from English database were searched and 71 patients were included.Thus, a total of 91 patients with DPA were analyzed.Abdominal pain was the most common manifestation, which was reported by 61.5% of the patients. 15.3% patients were identified during regular physical examination. Other manifestations including jaundice, fatigue, abdominal discomfort and diabetes were rare.After removing cases with insufficient information, 39 patients (61.9%) carried abnormal pancreatic head.Prevalence of diabetes or impaired glucose tolerance was 56.7% and the percentage of insulin-dependent diabetes in patients with abnormal glycaemia was 47.3%(n=18).20 patients (26.7%) were associated with pancreatitis, including 15 patients (75.0%) with acute pancreatitis, 1 patient (5.0%) with recurrent pancreatitis, and 4 patients (20.0%) with chronic pancreatitis. Thirty-three patients ( 36.2%) suffered other congenital organ malformations, including 21 patients (63.6%) with splenic malformation, 8 patients (24.2%) with heart malformation, and 17 patients (51.5%) with multi-organs malformations like gastrointestinal malformation, azygos vein and inferior cava vena fusion, duodenal and biliary atresia and renal absence.Conclusions The main diagnostic criteria of DPA was the absence of dorsal pancreatic duct.Diabetes was the most common complication followed by pancreatitis.
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Objective In this study,the change of HO-1,RvD1,LXA4 and IL-6 in the patient with ulcerative colitis (UC)was investigated.Effects on the pathogenesis of ulcerative colitis were dis-cussed.Methods The distribution of HO-1 proteins in the colonic tissues in 60 cases of UC and 30 cases of normal control group were detected by SABC immunohistochemistry and perfusion catheter manometer. The slides were then analyzed with an Image Analyzing system to obtain the density of stained proteins.The levels of RvD1,LXA4 and IL-6 in serum by using enzyme linked immunosorbent assay(ELISA).Results The expression of HO-1 in patients with active UC was higher than that in normal group and remission of UC.The levels of RvD1,LXA4 and IL-6 in patients with active UC were significantly higher than that in normal group and remission of UC.The levels of HO-1,RvD1,LXA4 in patients with active UC were posi-tively correlated with IL-6.The levels of HO-1,RvD1,LXA4 in patients with normal group and remission of UC had no relevance with IL-6.Conclusions The expression of HO-1,RvD and LXA4 in activity of the UC may plays an important role in the pathogenesis of gastrointestinal motility disorders such as UC.
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Objective To explore the correlation of fatigue and life quality of lung cancer patients after chemotherapy. Method A survey was conducted among 54 lung cancer patients after chemotherapy with revised piper fatigue scale ( PFS ) and medical outcomes study (SF-36). Result The total score of PFS of lung cancer patients was (6.44 ± 1.62). The score of SF-36 related area include physical dimension (58.47 ± 5.48), psychological dimension (55.04 ± 4.91) and social dimension (49.21 ± 4.77) environment dimension (52.86 ± 4.98). The total score of PFS was negatively correlated with physical, psychological and environmental dimensions (P<0.05), and not correlated with social dimension (P<0.05). Conclusions The cancer-related fatigue and life quality of lung cancer patient is at medium-severe level, and their life quality is at low level. Positive and effective psychological intervention and psychological nursing can reduce cancer-related fatigue and improve their life quality.
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Objective To investigate the occurrence and prevention measures of long term complications in long term survival recipients after liver transplantation.Methods In the recipients undergoing liver transplantation from Sept. 2003 to Dec. 2004,by Nov. 30,2011,there were 62 cases with the survival time more than seven years.The clinical data and follow up examination results of these 62 cases were retrospectively,including weight,blood pressure,blood sugar,blood lipids,and liver and kidney functions. The incidence of long-term complications was statistically tested.Results Postoperative metabolic complications including overweight or obese occurred in 21 cases (33.9％), new onset diabetes in18 patients (29％), hyperlipidemia in 17 cases (27.4％),hypertension in 9 cases ( 14.5 ％ ),and kidney dysfunction in 12 patients ( 19.4％ ).The incidence of diabetes and hyperlipidemia in the patients with overweight and diabetes (respectively 52.4％ and 42.9％) was significantly higher than in the normal weight group (respectively 17.1 ％ and 19.5 ％)(P＜0.05).In 58 recipients with primary diseases of hepatitis B-related liver diseases,one case had hepatitis B virus reinfection. In 17 recipients with primary disease of primary liver cancer,tumor recurrence occurred in 2 cases.During the follow up period,4 patients received liver re-transplantation due to hepatic artery stenosis (1 case) or biliary complications-induced loss of the transplanted liver function (3 cases).Conclusion The major complications of the long term survival recipients after liver transplantation are metabolic complications and primary disease relapse. Postoperative long-term follow up and monitoring of recipients is recommended to prevent and treat a variety of long-term complications.