Focus problems in diagnosis and treatment of recurrent hepatocellular carcinom / 中国实用外科杂志

Recurrent hepatocellular carcinoma(HCC) is acommon problem in the treatment of HCC patients. At present,there is a lack of staging and treatment system for recurrenthepatocellular carcinoma,and a lack of high-level clinicalresearch. Therefore,there is much controversy in the treatmentof recurrent hepatocellular carcinoma. The controversy ismainly focused on whether it is proper to take aggressivelyrepeated surgical resection or liver transplantation. For recurrent tumors of polyclonal origin,clinical treatmentdecisions are basically based on the staging and treatmentsystem of primary hepatocellular carcinoma,and the prognosisis not inferior to that of primary tumors. For recurrent tumorsof monoclonal origin,it tends to be less invasive,such asinterventional,ablation,radiotherapy or targeted drugs. Thetreatment strategy for hepatocellular carcinoma must considermany factors, such as trauma,safety,effectiveness and cost. Itis similar to and still a little different from that of primaryhepatocellular carcinoma. Therefore,the treatment of recurrenthepatocellular carcinoma cannot fully refer to the treatmentsystem of primary hepatocellular carcinoma.

Hepatic vein occlusion with Satinsky clamp in hepatectomy for complicated liver tumor / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the application of an improved method of hepatic vein occlusion with Satinsky clamp when resecting the liver tumor involving second hepatic portal.</p><p><b>METHODS</b>From January 2003 to December 2010, there were totally 330 patients with liver tumor admitted, who underwent liver resection with Pringle maneuver plus hepatic vein occlusion with Satinsky clamp. Data regarding the intra-operative and post-operative course of the patients were analyzed. There were 245 male and 85 female patients, with a mean age of (50 ± 11) years. The diameter of tumor was (9 ± 6) cm. Among the 330 patients, there were 271 patients with viral hepatitis B, 215 patients with liver cirrhosis; 321 patients were in Child class A of liver function and 9 in class B. Pringle maneuver plus hepatic vein occlusion with Satinsky clamp was used to occlude the blood flow in the liver resection. The liver transection was performed with clamp-crushing technique.</p><p><b>RESULTS</b>Hepatic vein occlusion with Satinsky clamp was successful in all 330 patients. The operation time was (132 ± 29) minutes, while (7 ± 3) minutes for dissecting hepatic vein and (22 ± 7) minutes for inflow blood occlusion. The blood loss in operation was (480 ± 265) ml, with 20% of patients receiving blood transfusion. No patient had large hemorrhage and air embolism due to hepatic vein laceration. No patient died in the perioperative period. The complications included 31 patients of pleural effusion, 14 patients of seroperitoneum, 10 patients of biliary fistula, 2 patients of massive blood loss during liver resection and 2 patients of re-bleeding after operation.</p><p><b>CONCLUSION</b>The method of hepatic vein occlusion with Satinsky clamp was safe and effective.</p>

Influence of obesity on short-term surgical outcome in patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the influence of obesity on surgical procedure and short-term surgical outcome in patients with gastric carcinoma.</p><p><b>METHODS</b>A total of 426 patients with gastric carcinoma underwent laparotomy in our hospital during January 2006 and June 2008. All the patients were divided into obesity group and non-obesity group according to body mass index (BMI). The thickness of subcutaneous fat (SCF), abdominal anterior-posterior diameter (APD) and transverse diameter (TD) at the umbilicus level were measured by abdominal CT. Furthermore, the surgical data and postoperative conditions including short-term outcome were reviewed and compared between two groups.</p><p><b>RESULTS</b>The incidence of obesity was 29.8% in gastric carcinoma patients. Mean values of SCF thickness, APD and TD in obesity group and non-obesity group were (21.8+/-7.1) mm vs (14.4+/-7.5) mm, (223.2+/-24.6) mm vs (181.8+/-23.5) mm and (323.6+/-23.8) mm vs (285.8+/-24.4) mm (P=0.000). Longer operative time (P=0.007) and less amount of dissected lymph nodes were found in obesity group as compared to non-obesity group (P=0.000). Also, obesity group lasted a longer postoperative period of fever (P=0.000) and experienced more post-operative complications (P=0.005) than non-obesity group did.</p><p><b>CONCLUSIONS</b>Abdominal CT scan may display the abdominal shape of gastric carcinoma patients, hence, it is useful to evaluate the difficulty of surgical procedure. These patients may involve in complicated surgical procedure and worse short-term outcome due to obese abdominal shape. Therefore, perioperative management should be emphasized for these patients.</p>

Study of induction of tumor specific cytotoxic T lymphocyte by using tumor-derived exosome / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To investigate whether the exosomes derived from Tca8113 could induce production of tumor-specific T cells when pulsed onto dendritic cells.</p><p><b>METHODS</b>Tca8113 cell was cultured with RPIM1640, isolated and purified the tumor-derived exosomes from the culture supernatants by ultrafiltration with Millipore centrifual filter devices; frozen and thawed Tca8113 cells to get frozen tumor antigens (FTA). The exosomes and FTA was pulsed onto DC generated from normal human peripheral blood mononuclear cell (PBMC) in vitro. The DC pulsed with FAP or exosomes cocultured with the peripheral blood lymphocytes to transform T cell into specific CTL. To observe the killing and wounding activity of CTL, the CTL and Tca8113 cells were mixed at a ratio of 20 to 1, SPCA-1 cells and 95-D cells was evaluated as control group.</p><p><b>RESULTS</b>The CTL induced by DC pulsed with FAP or exosomes had significant activity killing Tca8113 (P < 0.01); Moreover the CTL induced by DC pulsed with exosomes could also kill SPCA-1 cells (P < 0.05), but the CTL induced by DC pulsed with FTA had not this function.</p><p><b>CONCLUSION</b>Exosomes derived from tumour accumulate in culture supernatants. Exosomes are a natural and new source of tumour-rejection antigens, opening up new avenues for immunotherapy against oral cancers. The exosome-specific CTL could kill another kind of tumor, so tumor-derived exosomes may contain shared tumor-rejection antigens.</p>

Expression of stromal CD34 and alpha-smooth muscle actin in oral invasive cancer / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To observe the expression of stromal CD34 and alpha-smooth muscle actin (alpha-SMA) in oral invasive cancer.</p><p><b>METHODS</b>The distribution and expression of stromal CD34 and alpha-SMA in 60 patients with invasive oral squamous cell cancer and 20 resections with tumor-free margins from 60 patients with invasive oral squamous cell cancer were examined by immunohistochemistry SP method.</p><p><b>RESULTS</b>Twenty cases of resections of mucosa with tumor-free margins exhibited CD34 expression in fibrocytes cytoplasm in the vicinity of vessels, mucosa and submucosa but were free of alpha-SMA expression, only the walls of muscularized vessels stained positive for alpha-SMA in the stroma. Sixty invasive oral squamous cell carcinomas were free of stromal CD34 expression, only the endothelia of small vessels stained positive for CD34, of which 53 invasive oral squamous cell carcinomas expressed stromal alpha-SMA in myofibroblasts cytoplasm.</p><p><b>CONCLUSIONS</b>The detection of CD34 and alpha-SMA is an adjunctive tool in judging oral cancer invasion in small oral mucosa biopsy specimens based on the absence of CD34 expression paralleled by the gain of alpha-SMA in the stroma of oral invasive cancer.</p>

Some malpractices in application of computed radiography / 中华放射学杂志

Objective To improve the CR image quality and to promote the digital image standard constitution by analyzing the common problems and malpractiees in application of computed radiography. Methods Phenomenon and reasons of 107 CR junk-films from nine three-"A"-hospitals were analyzed, discussed,recorded,and statistised by 20 radiologists,radiographers and engineers.Results Among 107 junk fihns,there are 36 cases(33.64%)of incorrect operations,29 cases(27.10%)of artifacts in reading and transferring the data of IP,15 cases(14.02%)of artifacts in IP system,and 13 cases (12.15%)of selection of inappropriate radiographic parameters,and 9 eases(8.41%)of printer-failures, and 5 eases(4.67%)of inappropriate post-processing techniques.By analyzing the reasons of 107 junk films we found that 60.74% were due to less responsibilities and incorrect operations,and 35.51% were due to new problems in CR techniques,and other were due to inappropriate post-processing techniques. Conclusion Responsibilities,operation regulations,digital image quality standards,studying of new techniques and appropriate use of the post-processing techniques are the key points for improving the CR image quality and the diagnosis level.