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Gadoxetate magnetic resonance imaging (MRI) is widely used in clinical practice for liver imaging. For optimal use, we must understand both its advantages and limitations. This article is the outcome of an online advisory board meeting and subsequent discussions by a multidisciplinary group of experts on liver diseases across the Asia-Pacific region, first held on September 28, 2020. Here, we review the technical considerations for the use of gadoxetate, its current role in the management of patients with hepatocellular carcinoma (HCC), and its relevance in consensus guidelines for HCC imaging diagnosis. In the latter part of this review, we examine recent evidence evaluating the impact of gadoxetate on clinical outcomes on a continuum from diagnosis to treatment decision-making and follow-up. In conclusion, we outline the potential future roles of gadoxetate MRI based on an evolving understanding of the clinical utility of this contrast agent in the management of patients at risk of, or with, HCC.
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Objective:To explore the risk factors influencing the prognosis for patients with hepatocellular carcinoma (HCC) recurrence after liver transplantation and summarize the relevant diagnostic and therapeutic experiences.Methods:The clinicopathological features with diagnosis and treatment plan of 102 recurrent HCC patients fulfilling the Fudan Criteria were compared for survival rate (univariate analysis) and independent prognostic indicators were obtained by Cox multivariate analysis.Results:The 1/3/5-year overall survival rates were 92.2%, 48.6% and 34.6% and the 1/3/5-year survival rates with tumor were 63.2%, 31.0% and 16.7% respectively. Cox regression analysis indicated that patient age, whether tumor can be surgically resected or not and personalized diagnostic & therapeutic plan based upon targeted therapy were independent prognostic factors affecting the overall survival rates and survival rates with tumor.Conclusions:Although HCC recurrence and metastasis after liver transplantation seriously influence patient prognosis, satisfactory outcomes may be obtained for some patients through active, effective and precise managements.
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Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in clinical practice and has the features of high incidence rate, poor prognosis, and high mortality rate, and its incidence rate and mortality rate rank among the top malignant tumors in the world. High heterogeneity of HCC affects the evolution and therapeutic response of HCC. Since most HCC patients are in the advanced stage at the time of diagnosis, systemic treatment has become the main treatment option. In recent years, remarkable achievements have been made in molecular targeted therapy and immunotherapy for HCC, and the latest NCCN guidelines for the systemic treatment of HCC show that sorafenib, lenvatinib, and atezolizumab combined with bevacizumab are recommended as the first-line treatment of HCC, and regorafenib, cabozantinib, nivolumab, pembrolizumab, and ramucirumab are the second-line treatment options for HCC. In the era of precision medicine, how to select the optimal individualized systemic treatment regimen is the key problem in the systemic treatment of HCC. This article reviews the advances in the systemic treatment of HCC in the era of precision medicine and discusses the development direction of HCC treatment in the future.
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Liver fibrosis is a pathophysiological process characterized by abnormal accumulation of connective tissues in the liver caused by chronic liver injuries, in which the activation and migration of hepatic stellate cells (HSCs) play a central role. Extracellular vesicles (EVs) are a class of nanoscale, bilayer lipid enveloped vesicles secreted by almost all cells. EVs are of great interest in liver pathology because they have been found to mediate the communication between cells and regulate cellular microenvironment via horizontal transfer of their cargoes. EVs carry bioactive cargoes including proteins, lipids and RNA molecules, and are involved in the activation of HSCs during liver fibrogenesis.
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Liver transplantation is the most effective treatment for patients with hepatocellular carcinoma (HCC),however,postoperative tumor recurrence severely hampers its efficacy.With the development of precision medicine and liquid biopsy,the diagnosis and treatment of patients undergoing liver transplantation for liver cancer might be updated.On the basis of "safety,effectiveness and precision",investigating the novel recurrence-related prognostic factors,improving the current indications of liver transplantation for patients with HCC,selecting optimal local regional treatments preoperatively and providing effective interventions for recurrent liver cancer after liver transplantation,may improve the long-term survival and therapeutic results of liver transplantation in patients with HCC.
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Objective To master the dynamics of schistosomiasis endemic situation and influencing factors in Mianyang City,so as to provide the evidence for making the control and prevention measures. Methods Six villages of six schistosomia?sis heavy endemic counties were selected as survey sites according to the national surveillance protocol(Revision in 2014)in Mianyang City. The surveys of the incidences of schistosomiasis in population and livestock as well as the prevalence of Oncome?lania hupensis snails were conducted in the 6 national surveillance sites. Results The serum positive rates of local residents and migrant people were 2.12%and 1.71%,respectively. The infection rate of cattle was 0. The area with snails was 9.344 8 hm2. The mean density of living snails was 0.25/0.1 m2. The occurrence rate of frames with snails was 7.07%,and no infected snails were found. Conclusions The infection rates of schistosome in human and livestock are low and the prevalence of O. hu?pensis snails is stable in the national surveillance sites in Mianyang City. However,the schistosomiasis transmission risk still ex?ists,therefore,we should strengthen the control measures to prevent the rebound of the endemic.
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Objective To evaluate the molluscicidal effect of Rongbao in schistosomiasis endemic areas in Mianyang City. Methods Three Oncomelania hupensis snail habitats with the similar snail status were selected and sprayed with Rongbao,ni-closamide,and fresh water,respectively. Then the snail status in the three fields was surveyed before the spraying and 7,15,30 and 60 days after the spraying,and the molluscicidal effects of different molluscicides were compared. Results The reducing rates of densities of living snails in the field sprayed with Rongbao were 94.4%,95.9%,98.2%and 98.8%,7,15,30 and 60 days after the spraying,respectively. The reducing rates of the densities of living snails in the other field sprayed with niclosamide were 94.0%,94.0%,89.9%and 92.2%in above-mentioned days,respectively. In the 30 days and 60 days after the spraying,the reducing rates of densities of living snails in the field sprayed with Rongbao were significantly higher than those sprayed with ni-closamide(χ230 d=8.18,χ260 d=3.97,Both P<0.05). Conclusion The short-term molluscicidal effect of Rongbao is similar to that of niclosamide,but the long-term effect of Rongbao is better than that of niclosamide.
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Surgical resection is the treatment of choice for patients with colorectal liver metastases.The criteria for hepatic resection of colorectal liver metastases have been extended.Patients who were expected to have complete tumor resection,negative resection margin and adequate remnant liver volume could receive surgical resection.Surgical resection combined with local ablation can expand the resectability of liver metastases.There is no significant difference of long-term survival between simultaneous and staged resection for colorectal and liver tumors.Laparoscopic surgery has been proved as safe and feasible for colorectal liver metastases.The survival benefits of adjuvant chemotherapy during perioperative period is unclear,and neo-adjuvant chemotherapy might not benefit all the patients with colorectal liver metastases.
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Primary liver cancer is the third most common cause of death from cancer worldwide, and it is the second cause of cancer death in China. A variety of molecular markers and signaling pathways associated with hepatocarcinogenesis and tumor progression have been discovered in basic research in the recent decade. However, the 5 year survival of patients has not been remarkably improved, due in a large part to the late diagnosis and the limited treatment options. It seems that translational medicine should be accelerated to addres this problem. Translational medicine has been shown to bridge basic research and clinical practice in a B2B model: from bench to the bedside and bedside to the bench. It goes from the bench to bedside where theories emerging from preclinical experimentation are tested on patients, and from bedside to the bench, where information obtained from preliminary clinical sciences is used to refine the understanding of the biological principles. In liver cancer, diagnostic markers screening, development of molecular classification, and stratifying patients for targeted therapy are considered as exciting fields of translational medicine. The integration of basic and clinical sciences by translational medicine will improve not only the understanding of the underlying molecular mechanisms, but also the clinical outcomes in patients with primary liver cancer.
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Cancer metastasis is considered as a complex process involving a series of sequential steps and a variety of molecalar signal transduction pathways.Tumor recurrence and metastasis are major obstacles for long-term survival of Liver cancer patients.Although the prognosis after recurrence and metastasis is dismal,the advancement of molecular researches of metastasis of liver cancer seems promising.In studies of origins of metastasis of liver cancer,the primary cancer cell and corresponding metastatic liver cancer cells share similar gene signature,which indicates that genes favoring metastasis progression are initiated in the primary tumors.The metastasis of liver cancer may be an early event in hepatic carcinogenesis and progression.Some molecular signatures have been developed to classify the metastatic potential of liver cancer.Furthermore,a variety of studies demonstrate that the tumor microenvironment instead of tumor cells plays a more important role in liver cancer metastasis.The pre-metastatic niche composed of non-tumoral cells may promote the cancer cell sedimentation and progression.The theory of cancer stem cell speculates that cancer stem cells were the real source of recurrent or metastatic tumors.Cancer stem cells will be one of the main targets of liver cancer treatment.The prevention and treatment of liver cancer recurrence or metastasis are quite difficult because liver cancer is resistant to traditional chemotherapy.Targeting the molecules involved in the metastasis of liver cancer WOuld be promising to cure those diseases.
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The incidence of hepatocellular carcinoma (HCC) has increased worldwide over the past two decades. Surgical resection and liver transplantation have been demonstrated as potentially curative treatment options, which could be considered in 30% -40% of HCC patients. Recent advancements of surgical treatment have focused not only on the surgical techpiques, but also the hepatic functional reserve evaluation, resectability assessment and the effects of biological characteristics of tumor on prognosis. There is no single variable to evaluate the hepatic functional reserve accurately. Combined Child-Pugh classification, ICGI5, portal vein pressure detection and remanent liver volume measurement are required prior to liver resection. The 5-year survival rate after liver resection for HCC is about 50%. The results are acceptable for some selected patients that underwent tumor resection with thrombectomy, including HCC with portal vein tumor thrombus or bile duct thrombosis. The choice of local resection or regular hepatectomy is still controversial although the former is commonly performed to treat HCC with cirrhosis, and the latter is applied to HCC patients without liver cirrhosis. The results of liver transplanta-tion for HCC are better than liver resection, and the Milan criteria is generally accepted. Any attempts to expand the selection criteria should be cautious because of organ shortage. Salvage transplantation for intrabepatic recurrence after liver resection may be a good choice in some resectable HCC. The recurrence and metastasis after surgical treatment are the main obstacles to achieve better results. Identification of predictive factors could be helpful to develop prevention strategies. Due to the importance of biological characteristics in tumor recurrence and metastasis, a molecular classification to predict prognosis of HCC patients will lead to a more personalized medicine. Targeting key molecules of biological pathways could optimize the therapeutic modality in HCC.