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Objective:To study the survival outcomes in patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) treated with sorafenib combined with transcatheter arterial chemoembolization (TACE) versus sorafenib alone.Methods:The data of 92 patients with BCLC stage C HCC at Tianjin Medical University Cancer Institute& Hospital from January 2008 to December 2015 were retrospectively studied. There were 82 males and 10 females. The average age was 56.3 years. Classified according to whether there were vascular invasion and/or distant metastasis, patients were divided into the vascular invasion group ( n=24), the metastasis group ( n=48), and the vascular invasion combined with metastasis group ( n=20). All patients were treated with sorafenib, but some patients received combined treatment with TACE. The survival data of these patients on follow-up was collected. The Kaplan-Meier method was used for survival analysis, and the survival rates were compared by the log-rank test. Univariate and multivariate Cox analyses were used to determine the prognostic factors of patients’ survival. Results:There were no significant differences in the baseline clinical data among the three groups (all P>0.05). Multivariate Cox regression analysis showed that pre-treatment alpha fetal protein >20 μg/L ( HR=1.90, 95% CI: 1.13-3.12), alkaline phosphatase >125 U/L ( HR=1.60, 95% CI: 1.03-2.49) and sorafenib alone ( HR=2.11, 95% CI: 1.23-3.54) were independent risk factors of survival for these patients. There were no significant differences in the cumulative survival rates among the three groups ( P>0.05). In the vascular invasion group, the cumulative survival rates of patients treated with combined sorafenib and TACE ( n=4) were significantly higher than those treated with sorafenib alone ( n=20) ( P<0.05). Conclusion:Compared with sorafenib alone, sorafenib combined with TACE resulted in better prognosis for patients with BCLC stage C HCC. Subgroup analysis showed that patients with vascular invasion had significantly better survival treated with combined sorafenib and TACE than sorafenib alone.
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Objective To compare the efficacy of radiofrequency ablation versus surgical resection in treatment of colorectal liver metastases with a maximum diameter ≤ 3 cm and a number ≤ 3, and to analyze the risk factors of recurrence. Methods The data of 97 patients with colorectal liver metastases from January 2012 to June 2016 treated at Tianjin Medical University Cancer Institute and Hospital were analyzed retrospectively. There were 66 males and 31 females. The patients were divided into the radiofre-quency ablation group (23 patients) and the surgical resection group ( 74 patients). The patients were followed up. The clinicopathological features of the two groups before treatment were compared. Kaplan-Meier curves were drawn, and the recurrence-free survival curve and overall survival curve of the two groups were compared by log-rank test. Univariate and multivariate Cox regression analysis was used to analyze the risk factors of recurrence. Results There were no significant differences in age, location of primary tumor, number and size of liver metastases, and preoperative carcinoembryonic antigen level between the two groups (P＞0. 05). On the date this study was censored, there were 50 patients who had developed recurrence in the surgical resection group and 22 patients in the ablation group, (67. 6% vs. 95. 7% ). The difference was significant (P＜0. 05). The 1-and 2-year recurrence-free survival rates were 54. 6% and 39. 0% in the surgical resection group and 39. 1% and 8. 7% in the radiofrequency ablation group, respectively. The difference was significant (P＜0. 05). There was no local recurrence in either of the two groups. There was no significant difference in the overall survival curves between the two groups (P＞0. 05). Univariate and multivariate analysis showed that N 1 ～2 staging (HR=1. 908, 95% CI: 1. 094～3. 325), simultaneous liver metastasis (HR=1. 662, 95% CI: 1. 024～2. 695) and radiofrequency ablation (HR=2. 708, 95% CI: 1. 589～4. 617) were independent risk factors of recurrence for colorectal liver metastasis. Conclusions Radiofrequency ablation can achieve complete ablation in patients with colorectal liver metastases with maximum diameter ≤3 cm and number≤3, but the recurrence rate of radiofrequency ablation is significantly higher than that of surgical resection. N 1 ～2 staging, simultaneous liver metastasis and radiofrequency ablation were independent risk factors for recurrence of colorectal liver metastasis.
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Objective To measure the reliability and validity of the Chinese version of the compre-hensive assessment of ACT processes(CompACT)in financial staffs. Methods A total of 3 735 valid ques-tionnaires were obtained from financial staffs.The valid questionnaires were randomly allocated into two groups,of which one subset(n=1 873)was used for exploratory factor analysis(EPA),and the other(n=1 845)for confirmatory factor analysis(CFA).Criterion and convergent validity were tested by Pearson corre-lation respectively.Incremental validity was tested by hierarchical regression analysis. Results The EFA suggested theoretically-coherent three-factor structure for a 15-itemed version of the CompACT.The three fac-tors named as acceptance and cognitive defusion,mindfulness and self as context,value and committed ac-tion,and explained 73.75% of the total variance and factor loadings ranged from 0.67 to 0.90.The CFA con-firmed the hypothesized three-factor mode(χ2/df=5.91,CFI=0.98,TLI=0.98,RMSEA=0.05). Conclu-sion The research suggests that the Chinese version of the CompACT has acceptable psychometric in prop-erties,so it can be applied in the assessment of the psychological flexibility and mental health in China.
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Hepatocellular carcinoma (HCC) is the world's fifth common malignant tumor,ranks as the second and sixth leading causes of cancer death in nale and female.In a majority of the cases,HCC is diagnosed in advanced stage of disease when curative treatment options are not applicable.In 2007,sorafenib was approved for the first-line treatment of advanced HCC.Targeted therapy,which could improve the overall survival and qualities of life,brought a new hope for patients with advanced HCC.Unfortunately,in the past 10 years,various drugs tested in numerous different trials failed to denonstrate any benefit.Recent studies have demonstrated the efficacy of two molecular targeted agents,the second-line agent regorafenib and the first-line agent lenvatinib.Furthermore,preliminary results of immune checkpoint inhibitors such as anti-PD-1/PD-L1 or CTLA-4 antibodies were quite encouraging.These new drugs brought dawn of targeted therapy of HCC.
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Objectives To analyze prognosis and risk factors of Barcelona Clinical Liver Cancer (BCLC) stage B hepatocellular carcinoma patients treated with hepatectomy.Methods Clinical data of 162 BCLC stage B patients who underwent hepatectomy at Tianjin Medical University Cancer Institute & Hospital and the Second Hospital of Tianjin Medical University from June 2007 to December 2013 were retrospectively studied.The correlations between factors (age,gender) and long-term outcome were analyzed to determine independent risk factors.Subsequently,subgroup analysis of BCLC stage B hepatocellular carcinoma was performed.Results Multiple tumors,maximum tumor diameter ＞ 10 cm and AFP ＞ 100 μg/L were con firmed as independent risk factors of overall survival in postoperative BCLC B patients.Based on the risk factors,patients were divided into two groups,namely low-risk subgroup (≤ 1 risk factor) and high-risk subgroup (≥ 2 risk factors).In low-risk subgroup,1,3 and 5-year overall survival (OS) rates were 91.6％,65.5％,61.9％ respectively,and mean OS was 72 months.By contrast,1,3 and 5-year OS rates in high-risk subgroup were 67.4％,25.6％,10.8％ respectively,and mean OS was 29 months.Further more,1,3 and 5-year OS rates of all patients were 85.2％,54.9％,48.0％ respectively,and mean OS was 61 months.Conclusions Relatively favorable long-term outcomes could be yielded in BCLC stage B hepatocellular carcinoma patients treated with liver resection.The independent risk factors including multiple tumors,maximum tumor diameter ＞ 10 cm and AFP ＞ 100 μg/L were closely correlated with overall survival.BCLC stage B hepatocellular carcinoma patients could be divided into low-risk and high-risk subgroups based on the risk factors mentioned above.Survival rates in low-risk subgroup are remarkably superior to those in high-risk subgroup.
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Objective To explore the relationship among experiential avoidance,cognitive fusion and type D personality in pregnant women.Methods 309 pregnant women were assessed with self-made general information questionnaire,acceptance and action questionnaire-2nd edition (AAQ-Ⅱ),cognitive fusion questionnaire(CFQ) and type D personality scale(DS14).Results Average score of AAQ-Ⅱ and CFQ of 309 pregnant women were (16.41±7.55) and (24.24± 10.90),respectively.According to the type D personality questionnaire scores,the subjects were divided into four groups.Average score of each group on AAQ-Ⅱ and CFQ was respectively (21.25 ± 8.18) and (31.12± 10.99) for type D personality group (Group 1),(19.80±6.14) and (27.67±9.76) for negative emotion group(Group 2),(15.12±6.40) and (22.16±9.56)for social inhibition group (group 3) and (14.02±6.61) and (21.18±10.03) for group without negative emotions and social inhibition (group 4).The differences between groups were statistically significant (F=19.44,17.372,all P＜0.01).Correlation analysis revealed that AAQ-Ⅱ and CFQ were positively related to NA and SI (r=0.484,0.251,0.477,0.302,P＜0.05).NA and SI all entered the AAQ-Ⅱ regression equation and CFQ regression equation respectively:Y1 =4.655+ 1.032X1 + 0.836X2,Y2 =8.013+ 1.233X1 + 0.745X2 (Y1 as AAQ-Ⅱ,Y2 as CFQ,X1 as NA,X2 as SI).Conclusion Pregnant women with type D personality have the worst psychological flexibility.The two demensions of type D personality are predictive to experiential avoidance and cognitive fusion.
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Objective To investigate the diagnosis and treatment of autoimmune pancreatitis (AIP).Methods The clinical data of 25 patients with AIP who were admitted to the Cancer Hospital of Tianjin Medical University between January 2009 and December 2013 were retrospectively analyzed.Patients received the test of serum γ-globulin and IgG4 and abdominal imaging examination.The revised HISORt or results of postoperative pathological examination were performed as diagnostic criteria.Patients who were unable to tolerate surgery were treated by oral prednisone.The focal masses were apparent in the pancreas by imaging examination,which cannot exclude the possibility of malignancy because of ambiguous pathologic characters of masses.Patients who received ineffective hormonal therapy and were able to tolerate surgery underwent surgery.All the patients were followed up by outpatient examination and telephone interview up to December 2014.Results Primary symptoms:jaundice was detected in 16 patients,obvious weight loss (weight loss ＞ 10％ standard body mass) in 4 patients,chronic diarrhea (duration of diarrhea ＞ 2 months or 2 weeks ＜ duration of intermittent diarrhea ＜ 4 weeks) in 3 patients and abdominal pain in 2 patients.Abnormal level of serum γ-globulin and increasing level of IgG4 were detected in 13 and 1 pateints.The results of imaging examinations showed that pancreatic masses,stenosis of bile duct and extrapancreactic organ involvement were detected in 19,6 and 11 patients.Of 25 patients with AIP,10 underwent conservative treatment without adverse reaction and 15 underwent surgical treatment,including 13 of 15 patients undergoing pancreaticoduodenectomy and 2 of 15 patients undergoing resection of the body and tail of the pancreas + splenectomy.The operation time,volume of intraoperative blood loss and postoperative recovery time of gastrointestinal function in 15 patients undergoing surgery were (271 ±59) minutes,(268 ± 109) mL and (3.8 ± 1.2)days.After operation,2 patients were complicated with abdominal infection and had remission of symptoms by symptomatic treatment,including 1 with pancreatic fistula and 1 with delayed gastric emptying.The duration of hospital stay of 15 patients undergoing surgery was (11.5 ± 2.9)days.The results of postoperative pathological examination showed that there were central acinar atrophy,extensive fibrosis,lymphoplasmacytic cell infiltration,nerve tissue surrounded by the plasma cell lymphoma and obstructive phlebitis.The absolute value of positive cells of IgG4 was more than 50 high power field and number of positive cells of IgG4 was more than positive cells of 40％ IgG.Twenty-five patients were followed up for a median time of 27 months (range,6-47months).Nineteen patients had remission of symptoms at month 6 after treatment with normal level of serum γ-globulin and IgG4 and without recurrence of pancreatic masses,including 7 receiving conservative treatment and 12 receiving surgical treatment.Conclusions The clinical signs of AIP are jaundice,abnormal serum γglobulin and pancreatic masses which are found by imaging examination.Surgery is safe and effective for the treatment of AIP,while surgical indications should be strictly followed because of the surgical trauma.
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Objective To explore the relationship between postpartum depression and experiential avoidance of parturient and to provide empirical evidences for acceptance and commitment therapy in mental treatment of postpartum depression.Methods 309 pregnant women were assessed with self-made general information questionnaire,self-rating depression scale (SDS) and acceptance and action questionnaire-2nd edition (AAQ-Ⅱ) in predelivery periods and 3-7 days after childbirth respectively.Results AAQ-Ⅱ scores in the predelivery or postpartum depression group ((18.54±8.25),(19.07±7.82)) were higher than that in the normal group((15.47±7.03),(14.57±6.57)),and the difference was statistically significant(t=-3.15,-5.07,all P＜0.01).It was found that the predelivery or postpartum AAQ-Ⅱ scores were positively associated with the SDS scores of predelivery periods and postpartum periods respectively(r=0.34,0.34,0.24,0.42,all P＜0.01).Hierarchical multiple regression analyses were then conducted.In the first block,neonatal exceptional conditions and the predelivery SDS significantly explained variance in postpartum depression(β=0.09,0.62,all P＜0.01).In the second block,the predelivery AAQ-Ⅱ still had a significant effect on postpartum depression (β=0.13,P=0.006,△R2=0.01,P=0.006),despite control the age of parturient women,postpartum complication,neonatal exceptional conditions and the predelivery SDS.Conclusion A function to predict the occurrence of maternal postpartum depression is obtained from the experiential avoidance which is attributed to the risk of maternal postpartum depression.
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Objective:To investigate the effect of pancreaticojejunostomy on the occurrence of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy. Methods:Data from 145 patients with periampullary tumor who underwent pancreaticoduode-nectomy in Tianjin Medical University Cancer Institute and Hospital between October 2008 and August 2013 were reviewed. Factors potentially associated with POPF were analyzed by Pearson chi-square test and Logistic regression analysis. Results:Among the 145 patients, 27 were diagnosed with POPF, including 5 grade A, 17 grade B and 5 grade C. Neither duct to mucosa nor Blumgart pancreati-cojejunostomy was correlated with POPF in grade C. The univariate analysis showed that gender, pancreatic cancer, portal vein involve-ment, type of pancreaticojejunostomy, texture of pancreas, and diameter of the main pancreatic duct were closely correlated with POPF. The multivariate analysis using Logistic regression showed that different pancreaticojejunal anastomoses and genders were independent predictors of POPF. Conclusion:Different types of pancreatic anastomoses are a risk factor for POPF after pancreaticoduodenectomy.
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Objective:To discusse the clinical features of sarcomatoid hepatocellular carcinoma to improve the understanding of diagnosis and treatment for sarcomatoid hepatocellular carcinoma. Methods:Data including clinical features and follow-up from 8 pa-tients admitted in Tianjin Medical University Cancer Institute and Hospital from January 2009 to April 2014 were retrospectively ana-lyzed. Results: The average age of all patients was 56.6 years old, and the male-to-female ratio was 3:1. Preoperative CT or MRI showed specific characteristics but it was difficult to confirm diagnosis. Pathological and immunohistochemical examination revealed an expressed epithelial-like phenotype. All 8 patients had advanced local tumor invasion and high lymph node metastasis rates. These patients received surgery, and the median survival time was 10.8 months (3 months to 35 months). Conclusion:Diagnosis of sarcoma-toid hepatocellular carcinoma mainly depended on postoperative pathological examination. Immunohistochemistry was beneficial for sarcomatoid hepatocellular carcinoma diagnosis and differential diagnosis. Surgical treatment prolonged survival time, but the overall prognosis remained poor.
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Objective To identify the prognostic factors for patients with intrahepatic cholangiocarcinoma.Methods The clinical data of 99 patients with intrahepatic cholangiocarcinoma who received surgical treatment at the Cancer Hospital of Tianjin Medical University from January 2000 to January 2010 were analyzed retrospectively.Lymph nodes at the hepatic portal and group 12,13 and 8 lymph nodes were resected.The range of hepatectomy was decided according to the size,location,number of tumor and the hepatic function.Patients were followed up every month within the first 6 months after operation,every 3 months at 6 months later,and they were followed up every half year at 2 years later.Patients who were suspected as with tumor recurrence or progression were followed up every month.All the patients were followed up till death or March of 2013.The survival was analyzed using the Log-rank test,and multivariate analysis was done using the COX regression model.Results Forty patients received hemi-hepatectomy,27 received extended hemi-hepatectomy,20 received segmentectomy,and 12 received hemi-hepatectomy + wedge resection.All the patients were followed up and the median time of follow-up was 33 months (range 21.1-44.9 months).The 1-,3-,5-year recurrence-free survival rates and total survival rates of the 99 patients were 64.6％,29.2％,22.7％ and 78.8％,46.4％ and 30.3％,respectively.The results of univariate analysis showed that hepatitis B or C virus infection,preoperative CA19-9 level,TNM staging,lymph node metastasis,microvascular invasion,number of nodules and Ro resection were risk factors influencing the recurrence-free survival time (Log-rank value =5.048,5.982,20.128,13.148,29.632,32.488,50.574,P ＜0.05).The peroperative CA19-9 level,TNM staging,lymph node metastasis,microvascular invasion,number of nodules and R0 resection were risk factors influencing the total survival rate (Log-rank value =4.302,17.267,11.756,23.840,36.411,47.126,P ＜0.05).There were significant differences in the recurrence-free survival time and total survival time between patients in different TNM stages (20 patients in stage Ⅰ,44 in stage Ⅱ,8 in stage Ⅲ and 27 in stage Ⅳ) (Log-rank value =20.128,17.267,P ＜0.05).There were significant difference in the recurrence-free survival time between patients in stage Ⅰ and Ⅲ,patients in stage Ⅰ and Ⅳ,and between patients in stage Ⅱ and Ⅳ (Log-rank value =10.807,19.368,6.347,P ＜ 0.05).There were significant difference in the total survival time between patients in stage Ⅰ and Ⅱ,patients in stage Ⅰ and Ⅲ,patients in stage Ⅰ and Ⅳ and between patients in stage Ⅱ and Ⅳ (Log-rank value =6.119,4.015,16.282,4.929,P＜0.05).There was no significant difference in the survival time between patients in other TNM stages (P ＞ 0.05).The results of multivariate analysis showed that TNM stage Ⅲ and Ⅳ,microvascular invasion,multiple nodules and R0 resection were independent risk factors influencing the recurrence-free survival time (RR =1.413,3.073,2.737,3.916,95％ confidence interval:1.119-1.784,1.837-5.140,1.338-4.207,1.849-8.291,P＜0.05) ; lymph node metastasis,microvascular invasion,multiple tumors and R0 resection were the independent risk factors influencing the total survival time (RR =2.025,2.948,0.327,3.494,95％ confidence interval:1.215-3.374,1.774-4.900,0.183-0.583,1.670-7.310,P ＜ 0.05).Conclusions TNM stage Ⅲ and Ⅳ,lymph node metastasis,microvascular invasion,multiple nodules,non-R0 resection shorten the recurrence-free survival time and total survival time of patients who received surgical resection for intrahepatic cholangiocarcinoma,and they are the main factors influencing the prognosis.R0 resection could improve the survival of patients with intrahepatic cholangiocarcinoma.
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Objective To investigate the clinical and pathological characteristics,surgical treatment strategy and prognosis of primary malignant neoplasms of the appendix.Methods The clinical data of 74 patients with primary malignant neoplasms of the appendix in our hospital from January 1982 to December 2012 were retrospectively studied.Results Among the 74 cases of primary malignant neoplasms of the appendix,carcinoids were the most common accounting for approximately 70％,adenocarcinoma accounting for 22％ and lymphoma accounting for 8％.The prognosis of primary malignant neoplasms of the appendix is rather poor,nainly because of patients' later presentetion.The overall 1,3,5-year survival rate is respectively 95％,74％,60％,the prognosis of carcinoid is good,while that of adenocarcinoma is poor.Conclusions The incidence of primary malignant neoplasms of the appendix is relatively low.It is difficult to diagnose preoperatively,and the diagnosis relies mainly on rapid intraoperative frozen section and postoperative pathology.
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Objective To evaluate the impact of the Blumgart anastomosis in pancreaticojejunostomy on the incidence of postoperative pancreatic fistula (POPF) after pancreaticoduodeneetomy (PD),and to study its safety and efficacy.Methods A total of 205 patients who underwent PD between January 2011 and February 2013 were retrospectively studied.The patients were divided into three groups depending on the pancreaticoenteric reconstruction:the Blumgart anastomosis group (n=37),the duct-to-mucosa anastomosis group (n =39) and the traditional invagination group (n=129).Postoperative morbidity were analyzed.Results The incidences of POPF after the Blumgart anastomosis (8.1％) was significantly lower than the duct-to-mucosa anastomosis group (23.1％ ; P=0.037) and the traditional invagination anastomosis group (30.2％ ; P=0.012).Multivariate analysis revealed soft pancreatic texture,pancreatic duct diameter ＜3 mm and non-Blumgart anastomosis were independent risk factors of POPF.On subgroup analysis,the Blumgart anastomosis was superior to the duct-to-mucosa anastomosis in patients with pancreatic duct diameter ＜ 3 mm (P=0.038),and showed advantages over the traditional invagination anastomosis in patients with soft pancreatic texture (P =0.001),as well as in patients with pancreatic duct diameter ＜ 3 mm (P=0.011).Conclusions The Blumgart anastomosis is a safe technique,and it could significantly reduced the rate of POPF.It should be routinely used for pancreatoenteric reconstruction after PD.
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Objective To investigate the clinical and pathological prognostic factors of the carcinoma of the body and tail of the pancreas.Methods The clinical data of 64 patients with the carcinoma of the body and tail of the pancreas who received radical resection at the Cancer Hospital of Tianjin Medical University from January 1998 to December 2008 were retrospectively analyzed.Abdominal ultrasound,computed tomography and tumor markers detection were carried out preoperatively to learn the condition of the patients.No patient received neoadjuvant therapy before operation,and chemotherapy,biotherapy and radiotherapy were applied to all the patients after radical resection.Indicators including the gender,age,onset of back pain,site,diameter and differentiation of tumors,operative procedure,lymph node metastasis,metastatic rate of lymph nodes,extra-and intra-pancreatic neural invasion,splenic artery invasion,splenic vein invasion,retroperitoneal soft tissue infiltration,venulae infiltration and TNM staging were collected.The survival curve was drawn by Kaplan-Meier method,and the survival was analyzed by Log-rank test.Univariate and multivariate analysis were carried out by chi-square test and COX proportional hazards model,respectively.Results All patients received R0 resection,and the mean number of lymph node resected was 15 (range,12-22).There were 5 patients with pancreatic leakage,3 with delayed gastric emptying,1 with peritoneal infection,and 1 with deep venous thrombosis,no perioperative mortality was detected.All the 64 patients were with ductal adenocarcinoma and cystadenocarcinoma,and 9 patients were with high differentiated tumor,35 with moderate differentiated tumor and 20 with low differentiated tumor.There were 4 patients with tumor in the TNM IA stage,9 in the TNM IB stage,17 in the TNM Ⅱ A stage and 34 in the TNM Ⅱ B stage.Twenty-six patients died of tumor local recurrence and 18 died of tumor distal metastasis.The 1-,3-,5-year survival rates were 42.2％,17.2％ and 15.6％,respectively,and the median survival time was 19.0 months.The result of univariate analysis showed that back pain,maximum tumor diameter,differentiation,lymph node metastasis,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion and TNM staging were factors affecting prognosis (x2=10.658,8.371,18.910,6.605,28.382,14.571,19.476,32.155,P ＜0.05).The result of multivariate analysis showed that tumor differentiation,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion,TNM staging were the independent factors affecting prognosis (RR =2.509,2.107,6.692,5.109,4.784,P ＜ 0.05).Conclusion Tumor differentiation,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion and TNM staging are the risk factors affecting the prognosis of carcinoma of the body and tail of the pancreas.
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Objective To evaluate precise hepatectomy for liver metastases of colorectal cancer. Methods The clinical data of 85 patients with liver metastases of colorectal cancer who were admitted to the Cancer Hospital of Tianjin Medical University from October 2006 to October 2009 were retrospectively analyzed. Forty-two patients received precise hepatectomy(precise group) and 43 received routine hepatectomy (routine group). Evaluation of the hepatic and renal functions and detection of the tumors' condition were done before carrying out anatomical liver resection for patients in the routine group. Hepatic functional reserve of patients in the precise group was detected by indocyanine green excretion test. Hepatic artery, hepatic vein and portal vein were three-dimensionally reconstructed according to the data of computed tomography. The liver volume and residual liver volume of the patients were calculated. Hepatic resection was guided by intra-operative ultrasound in the precise group. Periand postoperative conditions and the results of follow-up of patients in the two groups were compared. All data were analyzed using the t test or chi-square test. Results No perioperative mortality was observed in the two groups.Time of hepatic blood flow occlusion and blood loss were (35±25)minutes and (685 ± 524) ml in the routine group, and (64±39) minutes and (486±360) ml in the precise group, respectively, with a significant difference between the two groups(t=4.116,-2.033, P＜0.05). The volumes of blood transfusion of the routine group and the precise group were (228±398) ml and (160±330)ml, respectively, with no significant difference between the two groups (t=-0.861, P＞0.05). The postoperaive levels of alanine transaminase at day 1 and day 7 were (672±284)U/L and (332±161)U/L in the routine group, and (344±158)U/L and (125 ±93) U/L in the precise group, respectively, with a significant difference between the two groups (t=-6.541,-7.232,P＜0.05). The length of hospital stay and postoperative mobidity were (18±10)days and 26% (11/43) in the routine group, and (12±6)days and 7%(3/42) in the precise group, respectively, with a significant difference between the two groups (t=- 3.915, x2=5.251, P＜0.05). The 1-year tumor recurrence rate and 1-year survival rate were 37% (16/43) and 88% (38/43) in the routine group, and 21% (9/42) and 93% (39/42) in the precise group, with no significant difference between the two groups (x2= 0.110, 0. 501, P＞0.05). Conclusion Precise hepatectomy is superior to routine hepatectomy in aspect of minimal trauma, quick recovery, efficacy and safety.
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Objective To explore the differential diagnostic significance of clone analysis for multicentric occurrence (MO) and intrahepatic metastasis (IM) in hepatocellular carcinomas (HCCs).Methods Loss of heterozygosity (LOH) and microsatellite instability (MSI) were analyzed by microsatellite polymorphism test and the integration sites of HBV were assessed by Southern blot in each nodule of the HCCs. The clonalities were then compared between each nodule of the same patient and the diagnosis of MO or IM was concluded. Finally, the results based on clonality analysis were compared with those according to clinicopathological and imaging data. Results According to the results of LOH and MSI in 79 nodules and nontumorous tissue from 35 cases of mutiple HCCs, 5 (14.3%)and 29 cases (82.9 %) were divided into MO and IM, respectively. Both MO and IM presented simultaneously in 1 patient (2.9%). The integration sites of HBV could be analyzed in 77 nodules from 34 multiple HCCs. Among them, 6 (17. 6%) and 27 cases (79.4%) were divided into MO and IM, respectively. Both MO and IM presented simultaneously in 1 patient (2.9%). The classification results of microsatellite polymorphism test and HBV integration sites analysis demonstrated a significant positive correlation (rs = 0.909, P＜0.001). Nevertheless, neither the classification of microsatellite polymorphism test nor that of HBV integrate sites analysis was correlated with the discrimination according to clinicopathologic and imaging data (rs=0. 133, P=0. 468, rs =0. 262, P=0. 155, respectively). Recurrence in patients in the MO group occurred significantly later than that in IM cases who were diagnosed by clonality analyses (P=0. 001). Conclusion The clonality analysis based on the results of LOH and MSI or assessments of HBV integrate sites is useful for the differential diagnosis of MO and IM and their treatment and prognosis.
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Objective: To discuss the surgical treatment of carcinoma of the pancreas with superior mesenteric artery (SMA) invasion. Methods: Vascular resection and reconstruction of the portal vein and hepatic artery were performed in 2 cases. Results: The portal vein (PV), superior mesenteric vein (SMV) and superior mesenteric artery (SMA) were involved. During surgery, the invaded superior mesenteric vessels were localized. Case 1 underwent pancreaticoduodenectomy with vascular resection, SMA partial resection and reconstruction. Case 2 was submitted to total pancreatic resection with simultaneous vascular resection of spleen artery and SMA reconstruction. No perioperative mortality occurred. Conclusion: Regional pancreaticoduodenectomy with superior mesenteric artery resection is a safe and effective surgical treatment for pancreatic carcinoma.
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The effect of Ultraviolet (UV) rays on the activity of parasporal crystal of Bacillus thuringiensis, var. Kurstaki HD-1 strain was studied by SEM, SDS-PAGE, bioassay and other methods. It was found that the morphology and surface structure of PC were damaged ,and its solubility in alkaline solution or silkworm gut juice was decreased after being irradiated by UV, the solubility was lost completely after a long time irradiation over 5 hours, so the processed PC could not be degraded into protoxin with insecticidal activity and was denatured.