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Objective:To investigate the influence of lymphadenectomy on efficacy of patients with intrahepatic cholangiocarcinoma (ICC) at different locations.Methods:The retro-spective cohort study was conducted. The clinicopathological data of 123 patients with ICC who were admitted to the Affiliated Hospital of North Sichuan Medical College from January 2015 to January 2022 were collected. There were 78 males and 45 females, aged 55(rage, 50?60)years. All patients underwent radical resection. Observation indicators: (1) clinical characteristics of patients with ICC; (2) follow-up; (3) surgical situations in ICC patients with different number of lymph nodes dissected. Measurement data with normal distribution were represented as Mean± SD, and compari-son between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Kaplan-Meier method was used to draw survival curve and Log-Rank test was used for survival analysis. Results:(1) Clinical characteristics of patients with ICC. Of the 123 patients, 81 cases had peripheral ICC and 42 cases had central ICC. The albumin-bilirubin grade (grade 1, grade 2?3), preoperative lymph node metastasis risk assessment (low risk, high risk), the number of lymph nodes dissected (<6, ≥6), lymph node metastasis (positive, negative) were 57, 24, 51, 30, 49, 32, 15, 66 in patients with peripheral ICC, versus 19, 23, 17, 25, 14, 28, 16, 26 in patients with central ICC, showing significant differences in the above indicators between them ( χ2=7.40, 5.66, 8.17, 5.62, P<0.05). (2) Follow-up. All the 123 patients were followed up for 28(range, 21?38)months. The 3-year overall survival rate was 57.8% in the 81 patients with peripheral ICC, versus 32.3% in the 42 patients with central ICC, showing a significant difference between them ( χ2=5.98, P<0.05). Of the 42 patients with central ICC, there were 25 cases with high risk of lymph node metastasis before surgery and 17 cases with low risk of lymph node metastasis before surgery. Of the 25 central ICC patients with high risk of lymph node metastasis before surgery, the 3-year overall survival rate was 28.9% in the 18 cases with the number of lymph nodes dissected ≥6, versus 14.3% in the 7 cases with the number of lymph nodes dissected <6, showing a significant difference between them ( χ2=8.90, P<0.05). (3) Surgical situa-tions in patients with the different number of lymph nodes dissected. Of the 123 patients, cases with the number of lymph nodes dissected <6 and ≥6 were 63 and 60, and there was no significant difference in the operation time, intraoperative blood transfusion, postoperative complications, bile leakage, liver insufficiency, pulmonary infection, pleural effusion, abdominal effusion, or lymphatic leakage between them ( P>0.05). One patient might have multiple complications. Conclusions:The prognosis of patients with peripheral ICC is better than that of patients with central ICC. For patients with central ICC who are at high risk of lymph node metastasis before surgery, adequate lymph node dissection may result in a better prognosis.
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ObjectiveTo understand the cooperative work and mechanism in the corona virus disease 2019 containment action by the support-to-Hebei epidemiological investigation group formed by five provinces， summarize the existing challenges， and discuss the relevant mechanism， so as to provide evidence for future support actions. MethodsA questionnaire survey was used to investigate the members from five provinces of the support-to-Hebei epidemiological investigation team. The content included basic information， work situation， problems in cooperative work， and suggestions in support mechanisms. ResultsA total of 104 questionnaires were issued， of which 101 valid questionnaires were collected with an effective response rate of 97.12%. The proportions of respondents who participated in the epidemic-related data preparation， case investigation， technical training， supervision of key venues， and specimen collection was 93.07%， 85.15%， 81.19%， 65.35%， and 44.55%， respectively. The respondents believed that information sharing channel of local epidemic situation was blocked （95.05%）， coordination mechanism among local departments was insufficient （84.16%）， communication and coordination mechanism among the dispatch institutions， support team， and local departments was unperfect （84.16%）， management of the dispatch institutions to the support team was relatively loose （79.21%）， dispatch institutions failed to make full use of professional advantages of the support team （72.28%）， and majority of the support team members engaged in a single profession （59.41%）. The respondents suggested that local departments should improve the information sharing mechanism （95.05%）， strengthen communication and coordination among the dispatch institutions， support team， and local departments （92.08%）， and dispatch institutions should clarify the tasks and responsibilities of the support team （91.09%）， formulate cross-regional emergency support plans （87.13%） and evaluation plans of support action （72.28%）. ConclusionIn order to ensure the efficiency and accuracy of future support actions， it is necessary to improve the mechanism of emergency coordination， communication and matching， response procedures， team management， and support evaluation.
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Objective To explore the safety and effectiveness of laparoscopic hepatectomy in the treatment of recurrent hepatolithiasis.Methods The clinical data of recurrent hepatolithiasis patients treated by laparoscopic hepatectomy were studied.Results Among the 17 patients of recurrent hepatolithiasis patients,5 received hepatic segmentectomy (lobectomy),12 cases received hepatic segmenteetomy (lobectomy),exploration of the comnon bile duct and T-tube drainage,1 case received hepatic segmenteetomy (lobectomy) plus exploration of the common bile duct.The mean operation time and operative blood loss were (236 ± 86) min and (430 ± 101) ml,respectively.The time of gastrointestinal function recovery and postoperative hospital stay were (2.5 ± 0.9) d and (12.3 ± 3.9) d.Postoperative complications included postoperative sub-phrenic hydrops in 3 cases,liver margin infection in 2 cases,incision infection in 1 case,residual stone in 2 cases,bile leak in 2 cases,the pulmonary infection in 2 cases pleural effusion in 3 cases.All were cured by non-surgical treatment.Postoperatively 15 were followed up for 2-24 months.Conclusions It is safe and feasible for laparoscopic hepatectomy to treat recurrent hepatolithiasis.
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Objective To evaluate the therapeutic effects of postoperative TACE (transarterial chemoembolization) in patients with hepatocellular carcinoma after liver resection.Methods The search was conducted on China biomedical literature database,Chinese CNKI,VIP,Wanfang and PubMed,OVID,Embase and Cochrane library.All the literatures were searched till the end of January 2016.The quality of the included studies were evaluated using the modified Jadad score for randomized controlled trials and the Newcastle-Ottawa Scale for case controlled studies.The trials were analyzed by Stata12.0.Results A total of 2184 patients from 1 randomized controlled trial (RCT) and 14 case-control studies were included.These patients were divided into two groups based on the treatment method.469 patients were included into the hepatic resection only group and 1087 patients were into the postoperative TACE group.The results showed that postoperative TACE improved the 1-year survival for hepatocellular carcinoma.Subgroup analyses were conducted on the risk factor group (tumor diameter greater than 5cm;multiple nodules and blood vessel invasion) and the no risk factor group.Postoperative TACE played an important role in the risk factor group (subgroup analysis for the no risk factor group:RR =1.10,95％ CI:0.97,1.25,P ＞0.05;subgroup analysis for the risk factor group:RR =1.16,95％ CI:1.02,1.32,P ＜ 0.05).Postoperative TACE significantly improved the 3 year survival rate in the postoperative TACE group (RR =1.33,95％ CI:1.15,1.53,P ＜0.05),but the five-year survival rate showed no significant difference between the two groups (RR=1.21,95％CI:0.95,1.15,P＞0.05).Conclusions Postoperative TACE prolonged the survival rate of patients with hepatocellular carcinoma,especially those who had the following risk factors:tumor diameter greater than 5 cm;multiple nodules;blood vessel invasion.Postoperative TACE can be recommended as a routine treatment.
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Objective To evaluate the therapeutic effects of preoperative prophylactic TACE for resectable primary hepatocellular carcinoma patients by mata analysis.Methods The research was conducted by retrieving China biomedical literature database,Chinese CNKI,VIP,Wanfang and PubMed,OVID,Embase,Cochrane library.Randomized controlled trials were evaluated by using the modified Jadad score and the case-control study were evaluated by using the Newcastle-Ottawa Scale respectively.All trials involved were analyzed by Stata12.0.Results 2 316 patients came from 3 randomized controlled trials (RCT) and 8 case-control articles including 752 patients in preoperative prophylactic TACE groups and 1 564 patients from liver resection only group.There was no significant difference in the operation time and blood loss between the two groups (operation time:SMD =0.058,95 ％ CI:-0.166-0.050,P =0.290;the amount of bleeding:SMD =-0.098,95 ％ CI:-0.204--0.08,P =0.070).The hospital stay was slightly prolonged in the preoperative prophylactic TACE groups (SMD =-0.86,95％ CI:-1.57--0.14,P =0.02).There was no significant difference between two groups in the 3-year overall survival and 5-year overall survival (the 3-year overall survival:RR =1.039,95％ CI:0.964-1.121,P =0.314;the 5-year overall survival:RR =0.96,95％ CI:0.86-1.08,P =0.505).Conclusion The Preoperative TACE fails to reduce the operation time and intraoperative blood loss,only prolonging the length of hospital stay.While the long-term survival rate remained unimproved.
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Objective To explore the anti-inflammatory effect of erythropoietin (EPO) on hepatic ischemia reperfusion (IR) injury in fatty liver rats.Methods A total of 100 male SD rats were fed with high-fat diet for 12 weeks.After the model was successfully established,the fatty liver rats were randomly divided into sham-operation (SHAM),the ischemia-reperfusion (IR) and EPO preconditioning group.Serum ALT and AST as well as hepatic histopathological changes were measured.Xanthine oxidase method was used to detect the liver tissue SOD.Thiobarbituric acid method was used to detect the MDA.Enzyme-linked immunosorbent adsorption assay (ELISA) was used to detect the plasma tumor necrosis factor alpha (TNFαt) and interleukin 1 (IL-1).Results In the EPO preconditioning groups the swelling hepatocytes was observed,but the inflammatory cell infiltration was significantly decreased and no necrosis of hepatocytes was found.ALT and AST in the EPO preconditioning groups were significantly lower than those in IR group (P ＜ 0.05).The levels of SOD activity in the EPO preconditioning groups were significantly higher,but MDA were significantly lower than that in IR group (P ＜ 0.05).The TNF-α and IL-1 in the EPO preconditioning groups were significantly lower than those in IR group (P ＜0.05).The values of ALT,AST,TNF-α,IL-1 and MDA in the EPO groups were:EPO-1 ＞ EPO-2 ＞ EPO-3 (P ＜ 0.05);but the values of SOD in the EPO groups were:EPO-1 ＜ EPO-2 ＜ EPO-3 (P ＜ 0.05).Conclusions EPO preconditioning has a protective effect against hepatic IR injury in fatty liver rats,possibly through inhibiting the inflammatory reaction to prevent the IR injury.The anti-inflammatory effect of high-dose EPO is better than that of low-dose EPO.
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OBJECTIVE:To establish a method for determining the main contents and entrapment efficiency in the bruc-ine nanostructured lipid carrier(NLC). METHODS:HPLC was adopted to determine the main content,sephadex gel filtration meth-od was employed to separate free drug in brucine NLC to determine the entrapment efficiency. The column was Dikma C18 with the mobile phase of mobile phase A(methanol)-mobile phase B [water-acetic acid-triethylamine(230∶2.4∶0.3,V/V/V)](30∶70,V/V)at the flow rate of 1 ml/min,the detection wavelength was 265 nm,volume was 10 μl and temperature was 30 ℃. RESULTS:The linear range of brucine was 4.00-80.00μg/ml(r=0.999 9);RSDs of precision,stability and reproducibility tests were≤1.67%;av-erage recoveries of content determination and sephadex gel filtration method were respectively 99.66%(RSD=0.45%,n=9) and 99.75%(RSD=1.74%,n=9);and the average entrapment efficiency was 69.92%. CONCLUSIONS:The method is simple,re-producible and efficient,and can be used for the determination of main contents and entrapment efficiency in brucine NLC.
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Poly(β-amino esters) (PBAE) are used for drug carrier and have many advantages, such as pH-sensitivity, low toxicity, structural diversity and the synthetic method of PBAE is easy. Therefore they are possessed broad application prospect in tumor-targeted drugs delivery systems. In this paper, the structural features and target drugs delivery property of PBAE are reviewed. The application forms of PBAE and different anti-cancer drugs loaded in the copolymer for tumor-targeted drugs delivery systems are introduced particularly.
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Objective To study the process of hydroxypropyl-β-cyclodextrin (HP-β-CD) inclusion techniques for osthol. Methods The inclusion complex of osthol and HP-β-CD was prepared by unsaturated water solution and freeze-drying technique. Inclusion techniques were selected by screening on quadratic orthogonal rotation combination design method, and the entrapment efficiency was identified by HPLC. Results The optimal technical conditions were as follows:the ratio of HP-β-CD and drug was 4.5∶1;temperature for electric mixer was 35 ℃;the stirring time for thermostatic waterbath was 210 min. Conclusion This method is reasonable and it may have a prosperous future of development and application.