ABSTRACT
Objective:To preliminarily study the feasibility, safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with selective portal vein embolization (SPVE) before surgical resection in the treatment of large liver cancer.Methods:A retrospective study was conducted on the clinical data of 17 patients with large liver cancer treated with TACE combined with SPVE from January 2016 to December 2019 at the Department of Hepatobiliary Surgery, the Sixth Medical Center of PLA General Hospital. The study included 15 males and 2 females, aged (59.17±10.30) years. The levels of alanine aminotransferase, tumor changes and patient survival were analyzed before operation, after TACE, and after SPVE.Results:Among the 17 patients, the levels of alanine aminotransferase on the 1st and 3rd day after SPVE was significantly higher than those after TACE [191.4 (30.5-1966.4) IU/L vs 125.3 (35.7-846.2) IU/L on the first day, and 298.5 (24.6-1334.2) IU/L vs 208.6 (21.6-775.6) IU/L on the 3rd day], all P<0.05. One month after the two combined embolism, among the 6 patients with a tumor diameter of 5-10 cm, 2 patients (33.3%) had complete remission, 3 patients (50.0%) had partial remission, and 1 patients (16.6%) had stable disease. For the tumor’s longest diameter, among the 11 patients with tumors >10 cm, 1 patient had complete remission (9.1%), 4 patients had partial remission (36.4%), 5 patients had stable diseases (45.5%), and 1 patient had disease progression (9.1%). Eventually, 11 patients underwent surgical exploration. The median residual liver volume before treatment was 329.5 (284.9-365.7) ml, and after the combined procedure 415.6 (354.7-718.8) ml. The median hyperplasia ratio was 28.1% (14.1%-51.3%). Eight patients finally underwent surgical resection. There was no death in the perioperative periods. The median tumor-free survival time was 17 (7-42) months, and the median survival time was 27 (7-42) months. Conclusion:For patients with large liver cancer with insufficient remnant liver volume, preoperative TACE+ SPVE has certain value in controlling tumor progression, promoting remnant liver hyperplasia, increasing surgical resection rate and improving prognosis.
ABSTRACT
Objective To explore the expression of liver fatty acid binding protein (L-FABP) in tissues of hilar cholangiocarcinoma and the relationship between expression of L-FABP and clinicopathological factors and prognosis of the patients.Methods The retrospective case-control study was conducted.The clinicopathological data of 132 patients with hilar cholangiocarcinoma who were admitted to the Navy General Hospital between January 2003 and January 2013 were collected.The expression of L-FABP in tumor tissues and adjacent tissues of hilar cholangiocarcinoma and normal bile duct tissues were respectively detected by immunohistochemistry.Observation indicators:(1) expression of L-FABP by immunohistochemistry;(2) relationship between clinicopathological factors of patients and expression of L-FABP in tumor tissues;(3) follow-up and survival situations;(4) prognostic analysis of patients after radical resection of hilar cholangiocarcinoma.Follow-up using outpatient examination and telephone interview was performed to detect postoperative overall survival time up to June 2017.Count data were described as percentage and compared using the chi-square test.The survival time was calculated by the Kaplan-Meier method.Measurement data with skewed distribution were described as M (range).The univariate analysis and multivariate analysis were respectively done using the nonparametric test and COX regression model.Results (1) Expression of L-FABP by immunohistochemistry:the positive expressions of L-FABP were located in the cytoplasm.The low,moderate and high expression rates of L-FABP in tumor tissues were respectively 11.36％ (15/132),71.97％ (95/132) and 16.67％ (22/132),and positive-staining cells showed platy and / or diffuse distribution;the low,moderate and high expression rates of L-FABP in adjacent tissues of hilar cholangiocarcinoma were respectively 77.27％ (102/132),7.58％ (10/132) and 15.15％ (20/132),and positive-staining cells showed scattered or platy distribution,with a weaker staining intensity compared with tumor tissues;there was no positive expression in normal bile duct tissues.There was a statistically significant difference in expressions of L-FABP among tumor tissues and adjacent tissues of hilar cholangiocarcinoma and normal bile duct tissues (x2=5.423,P ＜ 0.05).(2) Relationship between clinicopathological factors of patients and expression of L-FABP in tumor tissues:cases with low,moderate and high expressions of L-FABP in tumor tissues were respectively 10,30,5 in 45 patients with tumor diameter ＜ 3 cm and 4,29,9 in 42 patients with 3 cm ≤ tumor diameter ≤ 5 cm and 1,36,8 in 45 patients with tumor diameter ＞ 5 cm,with a statistically significant difference (x2 =10.171,P＜ 0.05).(3) Follow-up and survival situations:132 patients were followed up for 5-90 months,with a median time of 33 months.During the followup,postoperative overall median survival time of 132 patients was 31 months.(4) Prognostic analysis of patients after radical resection of hilar cholangiocarcinoma:results of univariate analysis showed that tumor differentiation,lymph node metastasis and expressions of L-FABP in tumor tissues were related factors affecting prognosis of patients after radical resection of hilar cholangiocarcinoma (Z =1.845,3.156,1.243,P＜0.05).Results of multivariate analysis showed that tumor differentiation,lymph node metastasis and expressions of L-FABP in tumor tissues were independent factors affecting prognosis of patients after radical resection of hilar cholangiocarcinoma (odds ratio =0.431,1.806,3.692,95％ confidence interval:0.292-0.693,0.974-2.973,1.875-11.364,P＜0.05).Conclusions The high expression of L-FABP in tumor tissues is significantly correlated with the tumor diameter.Tumor differentiation,lymph node metastasis and expressions of L-FABP in tumor tissues are independent factors affecting prognosis of patients after radical resection of hilar cholangiocarcinoma.
ABSTRACT
Objective To compare the effect of two procedures,named "mucosa to mucosal "and "end-inside" anastomosis for cholangiojejunostomy,and analyze its applicable scope.Methods A retrospective analysis was performed on the clinical data of 340 patients who underwent choledochojejunostomy from May 2012 to May 2017 in the Navy General Hospital.These patients were divided into two groups according to the procedure they received,including " mucosa to mucosal" anastomosis (n =249) and " end-inside"anastomosis (n =91).Two anastomotic methods of intraoperative state and postoperative complications were compared respectively under normal bile duct condition and cholangiectasis condition.Results When the common bile duct was not dilated,time spent for anastomoting in "end-inside" anastomosis was significantly shorten than that in "mucosa to mucosal" anastomosis (12.7 ± 1.2) min vs.(25.2 ± 5.8) min,and incidences of anastomotic leakage,bile duct infection,liver abscess,blie duct stricture postoperation (1.6％ vs.9.7％) in "end-inside" anastomosis were significantly lower than those in "mucosa to mucosal" anastomosis (P ＜ 0.05).Whether the common bile duct was dilated or not,the shrinking extents of stoma in " end-inside" anastomosis were lower than those in " mucosa to mucosal" anastomosis (1.4 ± 0.4) mm vs.(3.6 ± 1.2),(2.9 ± 0.6) mm vs.(4.2 ± 1.2) mm with statistical significances (P ＜ 0.05).There was no significant differences between two procedures when common bile duct was dilated.Conclusion Compared to the mucosa to mucosal anastomosis,the end-inside anastomosis had the advantage of easy operating and low postoperative complications when the bile duct was not dilated.
ABSTRACT
Objective Toexplore the expression and significance of microRNA-155 (miR-155) in psoriasis vulgaris. Methods Areal-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) method with TaqMan probe technology was performed to detect miR-155 expression in skin lesion area and nonskinlesionalarea of 35 patients with psoriasis vulgaris , compared with that of 30 normal controls. The correlations among miR-155 expression, psoriasis area and severity index (PASI) score and Interleukin-17A(IL-17A)expression were studied. Results The expressions of miR-155 and IL-17A in lesional and non-lesionalgroups were higher than that of control group (all P < 0.01). Also expressions in lesional skin were higher than non-lesional skin (both P < 0.01). In skin lesion group, significant positive correlations existed betweenmiR-155 or IL-17A expression and PASI score as well as miR-155 and IL-17A expression (all P < 0.05). Conclusions Up-expression of miR-155 was relevant to psoriasis development , which is related withthe hyperfunctionof Th17 cells in psoriasis.
ABSTRACT
Objective To explore the expression alteration and significance of inteleukin (IL)-37 in pso-riasis valguris (PV) patients. Methods Patients with PV had been treated with oral acitretin for 8 weeks. PASI score, ELISA and qRT-PCR were used to exam the data of 38 patients (PV group) and 32 controls (control group). Results IL-37 in PV group was significantly higher than that in control group (P 0.05) but decreased obviously after 8 weeks(P < 0.001). Signif-icant correlations existed among PASI scores, IL-37, IFN-γ and IL-17, as well as among IL-37 and IFN-γ, IL-17 (P < 0.05). Conclusions The increase of IL-37 is relevant to PV development and is associated with pa-tients’ conditions, IFN-γ and IL-17 but the alteration of IL-37 is not related with IL-4.
ABSTRACT
Objective: To build up rabbit models of hepatic cirrhosis in through common bile duct partial ligation (CBDPL). Methods: Male New Zealand rabbits were subjected to CBDPL to induce hepatic cirrhosis. The liver biopsies were performed during the surgery and after sacrifice to evaluate hepatic fibrosis. The serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), total protein (TP) and albumin (ALB) were determined at week 0, 1, 2, 4 and 11 following the occlusion. Results: There were two kinds of morphological and histological manifestations after CBDPL, the one was inconspicuous hepatic fibrosis coexisted with sacculation-like bile ductal dilation and muddy stone; the other is remarkable hepatic fibrosis and cirrhosis along with uneven bile ductal dilation. The serum levels of ALT, AST, TBIL and DBIL were significantly higher after one week of operation. The levels of ALT, AST, TP and ALB decreased after two-week of operation, and the levels of TBIL and DBIL were returned to the normal level after two-week of operation. Conclusion: The animal models of hepatic cirrhosis can be built up through CBDPL in rabbits.
ABSTRACT
ObjectiveTo investigate the hemodynamic changes after multiple firearm injuries in a swine model. Methods Twelve pigs were divided into 2 groups randomly, with control group ( n =6) subjected to catheterization only. Multiple trauma group ( n =6) was subjected to tangential fracture of parietal bone and comminuted fractures of bilateral femora (ISS≥16) using 5 8 mm bullets. The hemodynamic changes, including MAP, PAP, PAWP, CO, SVRI and portal vein blood flow, were observed at different time intervals up to 72 h after trauma or catheterization. At the same time, gastric pHi was measured as well. Results Compared with control group pigs in multiple trauma group suffered a hyperdynamic circulation developed at 48～72 hours. The cardiac output rose and vascular resistance declined obviously. The pulmonary artery pressure and pulmonary capillary wedge pressure elevated significantly. Mean artery pressure, portal vein blood flow and gastric pHi declined significantly. Conclusion Without severe blood loss and hemorrhagic shock, the decrease of portal vein blood flow and viscera underperfusion still took place after multiple firearm injuries.