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1.
Journal of Clinical Hepatology ; (12): 375-379, 2021.
Article in Chinese | WPRIM | ID: wpr-873409

ABSTRACT

ObjectiveTo investigate the correlation between systemic immune-inflammation index (SII) and prognosis in patients with hepatic alveolar echinococcosis. MethodsA retrospective analysis was performed for the clinical data of 242 patients who were admitted to Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, from January 2015 to December 2018 and underwent surgery for hepatic alveolar echinococcosis, and SII was calculated. The chi-square test was used for comparison of categorical data between two groups, and a Spearman correlation analysis was performed. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of SII; the Kaplan-Meier method was used to plot survival curves and analyze overall survival time in the two groups, and the log-rank test was used for comparison of survival rates between the two groups; univariate and multivariate Cox regression analyses were used to identify the influencing factors for the prognosis of patients with hepatic alveolar echinococcosis. ResultsThe Spearman correlation analysis showed that SII was positively correlated with the postoperative fatality rate of patients with hepatic alveolar echinococcosis (r=0.267, P<0.001). The ROC curve showed that the optimal cut-off value of SII before surgery was 758.92, and based on this, 242 patients with hepatic alveolar echinococcosis were divided into low SII (SII ≤758.92) group with 126 patients and high SII (SII >758.92) group with 116 patients. The low SII group had 1-, 3-, and 5-year survival rates of 98.20%, 88.47%, and 6610%, respectively, and the high SII group had 1-, 3-, and 5-year survival rates of 90.80%, 53.05%, and 27.40%, respectively. The low SII group had a cumulative survival rate of >50% and a mean survival time of 55.584 months (95% confidence interval[CI]: 53550-57.617), while the high SII group had a cumulative survival rate of <50%, a mean survival time of 39.384 months (95% CI: 35.070-43.698), and a median survival time of 43 months (95% CI: 34.694-51.306). The low SII group had a significantly better survival rate than the high SII group, and there was a significant difference in overall survival rate between the two groups (χ2=46.979, P<005). The univariate analysis showed that SII >758.92 (hazard ratio [HR]=5.907, 95% CI: 3.386-10.306, P=0.001) was an influencing factor for the overall survival time of patients with hepatic alveolar echinococcosis, and the multivariate Cox regression analysis showed that preoperative peripheral blood SII (HR=3.507, 95% CI: 1.911-6.435, P=0.001) was an independent risk factor for the overall survival rate of patients with hepatic alveolar echinococcosis. ConclusionPreoperative SII level is clearly correlated with the prognosis of patients with hepatic alveolar echinococcosis and can thus be used as a clinical indicator to evaluate the prognosis of patients. The higher the peripheral blood SII before surgery, the worse the prognosis of patients.

2.
Article in Chinese | WPRIM | ID: wpr-908468

ABSTRACT

Hepatic alveolar echinococcosis is a zoonotic parasitic disease caused by echinococcus multilocularis infection. The growth pattern of the lesions of hepatic alveolar echinococcosis is similar to that of liver malignant tumor showing invasive growth. Hepatic alveolar echinococcosis can not only directly invade the adjacent tissue structure, but also metastasize through the lymphatic tracts and blood vessels. Hepatic alveolar echinococcosis with intraperitoneal implantable metastasis is extremely rare. The authors introduce the diagnosis and treatment of 1 patient who had hepatic alveolar echinococcosis with intraperitoneal implantable metastasis.

3.
Journal of Clinical Hepatology ; (12): 2813-2818, 2021.
Article in Chinese | WPRIM | ID: wpr-906868

ABSTRACT

Objective To investigate the association between serum macrophage polarization-related factors and liver fibrosis in patients with alveolar echinococcosis (AE). Methods A total of 120 patients with AE who attended Department of Hepatobiliary and Pancreatic Surgery in The Affiliated Hospital of Qinghai University from September 2018 to October 2020 were enrolled as AE group, and 33 healthy controls were enrolled as normal control group. The two groups and the patients with varying degrees of liver fibrosis were compared in terms of the levels of interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), and transforming growth factor-β1 (TGF-β1). Comparison of normally distributed continuous data between two groups was made by the independent samples t -test, while comparison of non-normally distributed continuous data was made by the Mann-Whitney U test or Kruskal-Wallis H test. Comparison of categorical data between groups was made by the chi-square test. Univariate and multivariate logistic regression analyses were used to investigate the association between serum macrophage polarization-related factors and liver fibrosis in patients with AE, and the receiver operating characteristic (ROC) curve was used to analyze the value of serological examination in the diagnosis of liver fibrosis in patients with AE. A Spearman correlation analysis was used to analyze the correlation of each index with HAI score and Metavir score. Results Compared with the normal control group, the AE group had significant increases in the serum levels of IL-6 [13.97 (9.64-23.62) pg/mL vs 1.30 (0.35-2.71) pg/mL, Z =-5.980, P < 0.001], TNF-α [2.26 (1.65-4.13) pg/mL vs 1.40 (1.04-2.10) pg/mL, Z =-3.114, P < 0.01], and TGF-β1 [3.64(2.71-5.72) pg/mL vs 2.91(2.20-3.35) pg/mL, Z =-2.594, P < 0.05], and increases in the serum levels of IL-6 (hazard ratio [ HR ]=2.721, 95% confidence interval [ CI ]: 1.730-4.280, P < 0.05) and TNF-α( HR =3.527, 95% CI : 1.158-10.747, P < 0.05) were independent risk factors for the onset of liver fibrosis in AE patients. The ROC curve analysis showed that hydatid IgG combined with the serum levels of IL-6 and TNF-α had a sensitivity of 88.4%, a specificity of 95.8%, and an area under the ROC curve of 0.951(95% CI : 0.937-0.964) in the diagnosis of liver fibrosis, which were significantly higher than those of IL-6, TNF-α, or hydatid IgG alone ( Z =-3.458, -4.011, and 2.379, all P < 0.05). The Spearman analysis showed that the serum levels of IL-6, TNF-α, and TGF-β1 were positively correlated with HAI score ( r =0.560, 0.644, and 0.465, all P < 0.001) and Metavir fibrosis score ( r =0.530, 0.758, and 0.567, all P < 0.001), and the serum level of IL-10 was negatively correlated with HAI score ( r =-0.232, P =0.011) and Metavir fibrosis score ( r =-0.288, P =0.001). Conclusion Macrophage polarization is often observed in patients with hepatic AE, and the levels of the macrophage polarization-related factors IL-6, TNF-α, and TGF-β1 are associated with the development and progression of liver fibrosis, which can provide certain reference information for predicting the onset of liver fibrosis.

4.
Journal of Clinical Hepatology ; (12): 2737-2741, 2021.
Article in Chinese | WPRIM | ID: wpr-905033

ABSTRACT

Benign biliary stricture (BBS) refers to complete or incomplete stricture of the biliary tract caused by a series of non-malignant diseases. BBS often has complex and diverse etiologies, and severe complications may occur if it is not adequately treated. Diagnostic methods currently used in clinical practice include imaging, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, and choledochoscopy, and treatment methods include balloon dilatation, stent implantation, percutaneous transhepatic biliary drainage, and surgical treatment. At present, endoscopic diagnosis and treatment of BBS has become the preferred method. However, there is still no clear classification of BBS, which needs further investigation. By consulting related literature in China and globally, this article summarizes the issues associated with the endoscopic diagnosis and treatment of BBS.

5.
Journal of Clinical Hepatology ; (12): 131-134, 2021.
Article in Chinese | WPRIM | ID: wpr-862557

ABSTRACT

ObjectiveTo investigate the influence of endoplasmic reticulum stress (ERS) on some inflammatory mediators during the progression of hepatic alveolar echinococcosis (HAE) and its clinical significance. MethodsA total of 15 patients with HAE who underwent partial liver resection in Qinghai University Affiliated Hospital from June 2018 to September 2019 were enrolled, and the marginal zone of HAE lesion was resected as AE group; 15 normal liver tissue samples collected during the same period of time were selected as control group. Western blot and qRT-PCR were used to measure the protein and mRNA expression of protein kinase R-like ER kinase (PERK), CCAAT/enhancer-binding protein homologous protein (CHOP), caspase-12, and glucose-regulated protein-78 (GRP-78), and q-PCR was used to measure the mRNA expression of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor (TNF). The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the t-test was used for comparison of normally distributed continuous data between two groups; a Pearson correlation analysis was performed to investigate the correlation between two variables. ResultsCompared with the control group, the AE group had significantly higher protein expression levels of PERK, CHOP, caspase-12, and GRP78 (U=4.165, 3.461, 2.577, and 3.344, all P<0.001) and their mRNA expression levels (t= 34003, 4.461, 53.573, and 55.224, all P<0.001). The AE group had significantly higher mRNA expression levels of IL-1β, IL-6, and TNF than the control group (t=6.090, 12.578, and 53.573, all P<0.001). The protein expression levels of PERK, CHOP, caspase-12, and GRP-78 were positively correlated with the mRNA expression levels of IL-1β, IL-6, and TNF (all r>0.700, all P≤0.05). ConclusionPositive correlation is observed between the activation of ERS and inflammatory mediators in HAE, and excessive activation of ERS can change the secretion of several inflammatory mediators to exacerbate liver injury, while further studies are needed to clarify the specific mechanism.

6.
Article in Chinese | WPRIM | ID: wpr-883229

ABSTRACT

Objective:To investigate the prognostic value of preoperative red blood cell distribution width (RDW) for hepatocellular carcinoma (HCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 1 025 HCC patients who were admitted to three medical centers (586 in the First Affiliated Hospital of Xi'an Jiaotong University, 248 in the Second Affiliated Hospital of Xi'an Jiaotong University and 191 in the Qinghai University Affiliated Hospital) between April 2002 and August 2017 were collected. There were 809 males and 216 females, aged (54±11)years, with a range from 16 to 83 years. The average coefficient of variation of RDW (RDW-CV) of 1 025 patients was 14.3%. Of 1 025 patients, 347 cases had high RDW of RDW-CV >14.3%, and 678 had low RDW of RDW-CV ≤14.3%. Observation indicators: (1) clinico-pathological data of HCC patients; (2) influencing factors for prognosis of HCC patients; (3) follow-up and survival. (4) stratified analysis of independent influencing factors. Follow-up was performed by outpatient examination, telephone interview or internet interview to detect postoperative survival of patients up to October 2017. Measurment data with normal distribution were represented as Mean±SD, and measurment data with skewed distribution were described as M (range). Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. The Graphpad Prism 7.0 was used to draw survival curves, and Log-rank test was used for survival analysis. Univariate and multivariate analyses were performed using the COX proportional hazard model. Results:(1) Clinicopathological data of HCC patients: cases with age ≤70 years or >70 years, cases without cirhhosis or with cirhhosis , cases of Child-Pugh grade A or Child-Pugh grade B or C, cases with the level of alpha fetoprotein (AFP) ≤200 μg/L or >200 μg/L, cases with single tumor or multiple tumors were 313, 34, 152, 186, 161, 53, 158, 143, 186, 109 for high RDW patients, versus 641, 37, 359, 310, 415, 48, 367, 227, 547, 131 for low RDW patients, respectively, showing significant differences in above indicators between the two groups ( χ2=6.709, 6.787, 23.906, 7.114, 34.375, P<0.05). (2) Influencing factors for prognosis of HCC patients: results of univariate analysis showed that age, Child-Pugh grade, AFP, RDW-CV, tumor diameter, the number of tumors were related factors for prognosis of patients ( hazard ratio=1.388, 1.432, 1.534, 1.455, 2.813, 1.505, 95% confidence interval as 1.004-1.920, 1.086-1.887, 1.263-1.864, 1.211-1.748, 2.293-3.450, 1.173-1.932, P<0.05 ). Results of multivariate analysis showed that age, RDW-CV, tumor diameter and the number of tumors were independent factors for prognosis of patients ( hazard ratio=1.020, 1.340, 2.427, 1.438, 95% confidence interval as 1.007-1.032, 1.027-1.749, 1.801-3.272, 1.057-1.956, P<0.05). (3) Follow-up and survival: 1 025 patients were followed up for 1-124 months, with a median follow-up time of 25 months. The median survival time was 23 months for high RDW patients, versus 44 months for low RDW patients, showing a significant difference in the overall survival between the two groups ( χ2=11.640, P<0.05). (4) Stratified analysis of independent influencing factors: the results of stratified analysis of 3 independent influencing factors including age, tumor diameter and the number of tumors showed that in the 954 patients with age ≤70 years, the median survival time was 25 months for high RDW patients, versus 48 months for low RDW patients, showing a significant difference in the overall survival between the two groups ( χ2=14.030, P<0.05). In the 71 patients with age >70 years, the median survival time was 11 months for high RDW patients, versus 29 months for low RDW patients, showing no significant difference in the overall survival between the two groups ( χ2=0.933, P>0.05). In the 459 patients with tumor diameter ≤5 cm, the median survival time was 44 months for high RDW patients, versus 76 months for low RDW patients, showing a significant difference in the overall survival between the two groups ( χ2=8.660, P<0.05). In the 487 patients with tumor diameter >5 cm, the median survival time was 14 months for high RDW patients, versus 18 months for low RDW patients, showing no significant difference in the overall survival between the two groups ( χ2=2.950, P>0.05). In the 733 patients with single tumor, the median survival time was 20 months for high RDW patients, versus 48 months for low RDW patients, showing a significant difference in the overall survival between the two groups ( χ2=13.530, P<0.05). In the 240 patients with multiple tumors, the median survival time was 15 months for high RDW patients, versus 20 months for low RDW patients, showing a significant difference in the overall survival between the two groups ( χ2=6.820, P<0.05). Conclusions:Preoperative RDW can be used as a predictive index for prognosis of HCC patients, and patients with high RDW have poorer prognosis. RDW have better predictive value in patients with age ≤70 years or tumor diameter ≤5 cm.

7.
Journal of Clinical Hepatology ; (12): 1477-1480, 2021.
Article in Chinese | WPRIM | ID: wpr-877342

ABSTRACT

Autoimmune pancreatitis (AIP) is an autoimmune-mediated abnormal chronic inflammatory disorder and is often misdiagnosed as pancreatic neoplastic lesions. With in-depth studies of this disease in recent years, it has been taken seriously by hepatobiliary physicians and surgeons. This article summarizes the clinical features, diagnostic criteria, and treatment methods for autoimmune pancreatitis at the present stage, so as to provide clinicians with diagnosis and treatment experience to reduce clinical misdiagnosis.

8.
Journal of Clinical Hepatology ; (12): 977-981, 2021.
Article in Chinese | WPRIM | ID: wpr-875917

ABSTRACT

Immune checkpoint inhibitors (ICIs) therapy has shown broad prospects in the treatment of malignant tumors and infectious diseases, but problems encountered during application drive researchers to explore potential immune checkpoints. This article summarizes the research advances in the role of the new immune checkpoint lymphocyte activation gene-3 (LAG-3) in liver-related diseases, aiming to provide a reference for subsequent research. LAG-3 is expected to become the classic target of next-generation ICIs therapy and play a key role in immunotherapy for liver-related diseases.

9.
International Journal of Surgery ; (12): 77-81,f3, 2020.
Article in Chinese | WPRIM | ID: wpr-799704

ABSTRACT

Objective@#To analyze the effects of different N stages, surgical treatment, lymph node dissection and combined chemoradiotherapy on the prognosis of intrahepatic cholangiocarcinoma (ICC).@*Methods@#The clinical data and follow-up results of 4 555 ICCs in the SEER database were retrospectively analyzed. Including 3 710 patients with N0 phase and 845 patients with N1, all patients included complete TNM staging information, survival time and survival status information, surgical related information and radiotherapy and chemotherapy treatment information. The survival curve was described by Kaplan-Meier method. The survival of 120 months was described. The hypothesis test was performed by Log-rank test. The overall prognosis of patients with different N-stage ICCs was observed. Different surgical methods, lymph nodes were removed, and postoperatively. The effect of chemoradiotherapy on the prognosis of patients with different N-stage ICC. Measurement data with skewed distribution were expressed as medians, and count data were expressed as percentages.@*Results@#The median survival time of N1 patients was 12 months while 15 months in N0 patients. In N0 patients, the median survival time was 8 months of no operation performed patients, 26 months of local tumor destruction patients, and 45-59 months of surgical treatment performed patients. In N1 patients, the survival time was 9 months, 26 months and 14-22 months of no operation performed, local tumor destruction and surgical treatment performed patients, respectively. In the N0 stage, the median survival time was 37 months for lymph node dissection not performed patients, and the median survival time for lymph node dissection patients was 46-55 months. In N1 patients, the median survival time was 26 months and 18-20 months for without or with lymph node dissection patients. In the N0 stage, the median survival time was 41-42 months for without chemo- or radio-therapy, and it was 43-46 months for with chemo- or radio-therapy patients. In the N1 stage, the median survival time 10-17 months and 23 months for without or with chemo- or radio-therapy patients.@*Conclusions@#The prognosis of patients with N1 in ICC is significantly worse than that in patients with N0. Surgery is an effective method for the treatment of ICC. At the same time, routine lymphadenectomy should be recommended. Patients with N1 are recommended for radiotherapy and chemotherapy.

10.
Journal of Clinical Hepatology ; (12): 2045-2049, 2020.
Article in Chinese | WPRIM | ID: wpr-829174

ABSTRACT

ObjectiveTo investigate the expression of exosome microRNAs (miRNAs) in bile of hepatic alveolar echinococcosis (HAE) patients with biliary tract invasion and the regulatory mechanism of differentially expressed miRNAs on target genes. MethodsBile samples were collected from 12 HAE patients who attended Qinghai University Affiliated Hospital from August 2017 to October 2018, with 6 patients in observation group (with the manifestation of biliary tract invasion) and 6 in control group (without the manifestation of biliary tract invasion). Ultracentrifugation extraction and Western blot were used to identify the structure of exosomes, the Trizol method was used to extract total RNA in exosomes, and miRNA expression profile microarray was used to identify differentially expressed miRNAs. The pathway enrichment analysis was performed to predict the target genes of biliary tract invasion based on differentially expressed miRNAs. ResultsA total of 74 differentially expressed miRNAs were identified between the observation group and the control group, among which 9 were upregulated and 65 were downregulated (|Fold Change|>2). The pathway analysis showed that the target genes were mainly enriched in the pathways for tumorigenesis, phosphatidylinositol signaling system, and PTEN (FDR<0.05). The GO annotation and enrichment analysis showed that the target genes were mainly enriched in the biological processes such as positive regulation of gene repression and regulation of cell differentiation (FDR<0.05). ConclusionThe established expression profile of differentially expressed exosome miRNAs in bile of HAE patients with biliary tract invasion can be used as biomarkers for biliary tract invasion of HAE and preliminarily elaborate on the regulatory mechanism of differentially expressed miRNAs on target genes after HAE invades the biliary tract.

11.
Journal of Clinical Hepatology ; (12): 464-467, 2020.
Article in Chinese | WPRIM | ID: wpr-820990

ABSTRACT

Endoplasmic reticulum stress (ERS) manifests as the aggregation of misfolded and unfolded proteins in the endoplasmic reticulum lumen and disorder of calcium balance and can activate the signaling pathways involved in unfolded protein response, endoplasmic reticulum overload reaction, and sterol regulatory cascade response. ERS can not only exert a protective effect by inducing the expression of endoplasmic reticulum molecular chaperones such as glucose-regulated protein 78 and glucose-regulated protein 94, but also induce cell apoptosis. At present, there is still no systematic understanding of ERS involvement in the development and progression of liver diseases. This article summarizes the research advances in ERS-related signaling pathways and related liver diseases and elaborates on the role of ERS-mediated cell apoptosis in liver diseases. The intervention of ERS signaling pathways may provide a reference for the research and treatment of liver diseases in the future.

12.
Article in Chinese | WPRIM | ID: wpr-868902

ABSTRACT

Objective:To investigate the expression level and clinical significance of NLRP3 inflammasome associated protein and inflammatory factors in hepatic alveolar echinococcosis (HAE).Methods:A total of 21 HAE patients (case group) and 40 healthy subjects (health group) who underwent surgical treatment in the Affiliated Hospital of Qinghai University from January 2018 to August 2018 were selected and separated into case group and healthy group. In the case group, 12 were males and 9 were females, aged (35.20±7.50) years; in the healthy group, there were 24 males and 16 females, aged (35.19±14.48) years old. The expression of NLRP3, Caspase-1, IL-1β, IL-18 and IL-33 in normal liver tissues and the nodule tissues were detected by immunohistochemistry. The expression of IL-1β, IL-18 and IL-33 was detected in the serum of patients by ELISA. Statistical method was used to analyze the difference of each test index between the two groups.Results:The positivity and intensity of NLRP3, Caspase-1, IL-1β and IL-33 in marginal lesion tissue were more than normal liver tissue, while IL-18 was weaker. The differences were significant ( P<0.05). ELISA assay showed that the expression level of IL-33 in the case group was higher than that in the healthy group [177.88(168.87, 192.92) pg/ml vs 171.78(161.80, 181.93) pg/ml] with significant differences ( P<0.05). There were no significant differences in the levels of IL-1β and IL-18 in serum between case group and healthy group ( P>0.05). Conclusion:The abnormal expression of NLRP3 inflammasome associated protein and inflammatory factor in HAE suggested that the inflammatory body may be involved in the progression of the disease.

13.
Chinese Journal of Trauma ; (12): 143-147, 2020.
Article in Chinese | WPRIM | ID: wpr-867686

ABSTRACT

Objective:To investigate the value of high-resolution 3T MRI in the detection of triangular fibrocartilage complex (TFCC) injuries through a diagnostic test.Methods:A retrospective case series analysis was performed in 133 patients with ulnar wrist pain admitted in Beijing Jishuitan Hospital from January 2013 to April 2018. There were 68 males and 65 females, aged 14-69 years (mean 32.6 years). The patients was examined with the wrist MRI with consistent parameters and then received wrist arthroscopic detection or treatment. The TFCC injuries were classified as central injury, namely triangular fibrocartilage disc injury and peripheral injury, namely the tear of ulnar attachment, radial attachment, distal radioulnar ligaments and ulnocarpal ligaments. Take the results of wrist arthroscopy as the gold standard, the MRI and arthroscopic findings were compared and the sensitivity, specificity, positive/negative predictive value and positive/negative likelihood ratio were determined.Results:Wrist arthroscopy confirmed TFCC injuries in 122 patients, among which 72 patients were with central injury and 102 with peripheral injury. Meanwhile, TFCC injuries were diagnosed with MRI in 124 patients, among which 75 patients were central injury and 111 cases were peripheral injury. As for central injury, the sensitivity/specificity, positive/negative predictive value and positive/negative likelihood ratio of MRI were 0.972/0.918, 0.933/0.966 and 11.85/0.03, respectively; when the target pathology was peripheral injury, the sensitivity/specificity, positive/negative predictive value and positive/negative likelihood ratio of MRI were 0.882/0.323, 0.811/0.45 and 1.30/0.37, respectively.Conclusions:High-resolution 3T MRI is accurate in detection of central injury of TFCC, no matter the injury is traumatic or degenerated. In the diagnosis of peripheral injury of the TFCC, MRI can provide some help for its high sensitivity. However, the positive findings of MRI on peripheral structures should be cautious because of the poor specificity, and hence the results of history, physical examination and MRI should be considered together to attain an accurate diagnosis.

14.
International Journal of Surgery ; (12): 77-81,封3, 2020.
Article in Chinese | WPRIM | ID: wpr-863276

ABSTRACT

Objective To analyze the effects of different N stages,surgical treatment,lymph node dissection and combined chemoradiotherapy on the prognosis of intrahepatic cholangiocarcinoma (ICC).Methods The clinical data and follow-up results of 4 555 ICCs in the SEER database were retrospectively analyzed.Including 3 710 patients with N0 phase and 845 patients with N1,all patients included complete TNM staging information,survival time and survival status information,surgical related information and radiotherapy and chemotherapy treatment information.The survival curve was described by Kaplan-Meier method.The survival of 120 months was described.The hypothesis test was performed by Log-rank test.The overall prognosis of patients with different Nstage ICCs was observed.Different surgical methods,lymph nodes were removed,and postoperatively.The effect of chemoradiotherapy on the prognosis of patients with different N-stage ICC.Measurement data with skewed distribution were expressed as medians,and count data were expressed as percentages.Results The median survival time of N1 patients was 12 months while 15 months in N0 patients.In N0 patients,the median survival time was 8 months of no operation performed patients,26 months of local tumor destruction patients,and 45-59 months of surgical treatment performed patients.In N1 patients,the survival time was 9 months,26 months and 14-22 months of no operation performed,local tumor destruction and surgical treatment performed patients,respectively.In the N0 stage,the median survival time was 37 months for lymph node dissection not performed patients,and the median survival time for lymph node dissection patients was 46-55 months.In N1 patients,the median survival time was 26 months and 18-20 months for without or with lymph node dissection patients.In the N0 stage,the median survival time was 41-42 months for without chemo-or radio-therapy,and it was 43-46 months for with chemo-or radio-therapy patients.In the N1 stage,the median survival time 10-17 months and 23 months for without or with chemo-or radio-therapy patients.Conclusions The prognosis of patients with N1 in ICC is significantly worse than that in patients with N0.Surgery is an effective method for the treatment of ICC.At the same time,routine lymphadenectomy should be recommended.Patients with N1 are recommended for radiotherapy and chemotherapy.

15.
Article in Chinese | WPRIM | ID: wpr-745341

ABSTRACT

Objective To preliminarily study the use of indocyanine green in hepatic alveolar echinococcosis surgery.Methods The data of 13 patients with hepatic alveolar ecbinococcosis treated at the Affiliated Hospital of Qinghai University from May 2017 to May 2018 with laparotomy and intraoperative indocyanine green injection were retrospectively studied.Images were collected by the fluorescence acquisition system.Results There were 7 females and 6 males,with an average age of (37.9±14.7) years.The mean weight was (57.4±11.3) kg.Except for one patient of Han nationality,the rest were Tibetans.The lesions were not visualized but normal liver tissues emitted green fluorescence.One patient had a slightly enhanced fluorescence circle around the lesion.The fluorescence intensity of some areas were between normal liver tissues and the lesion,which were suspected to be the marginal zone (which needed to be confirmed by pathology).Three patients (23.1%,3/13) had small lesions on the liver surface,2 were not found by imaging examination,and 1 showed strip calcification on CT.No residual lesions in the liver (except for the microwave ablated lesions) were found after resection.No postoperative complications occurred in all the patients.Seven patients were followed up and no recurrence was found.Conclusions Fluorescence imaging of indocyanine green has the advantages of detecting small and residual lesions in surgery carried out for hepatic alveolar echinococcosis.More studies are needed to confirm the findings.

16.
Article in Chinese | WPRIM | ID: wpr-745088

ABSTRACT

Objective To evaluate conventional wrist physical examination in detecting injury to the triangular fibrocartilage complex (TFCC).Methods A retrospective study was conducted of the 118 patients (119 wrists) who had been admitted from January 2013 to October 2017 to Hand Surgery Department,Beijing Jishuitan Hospital for wrist arthroscopic surgery.All of them underwent wrist physical examination preoperatively for conventional index tests for TFCC injury like ulnar fovea sign,piano-key test,distal ulnar ballottement test and ulnocarpal stress test.They were 68 males and 50 females with a mean age of 32 years.The results of physical examination were compared with the arthroscopic findings to calculate the sensitivity,specificity,positive/negative predictive value (PPV/NPV) and +/-likelihood ratio (LR) of each index test.In addition,we combined the results of any 2 tests to increase the capability of detecting peripheral TFCC injury.Results The diagnostic values of each index test were achieved by comparison between the results of physical examination and the arthroscopic findings:(1) ulnar fovea sign:sensitivity =0.648,specificity =0.742;(2) piano key test:sensitivity =0.817,specificity =0.735;(3) distal ulnar ballottement test:sensitivity =0.927,specificity =0.647;(4) ulnocarpal stress test:sensitivity =0.825,specificity =0.500.The combination of any 2 tests produced 3 new index tests,of which the most valuable combination was ulnar fovea sign & distal ulna ballottement test,with a sensitivity of 0.598,a specificity of 0.941,a PPV of 0.961and a + LR of 10.14,Conclusions The signs elicited in physical examination and special tests can be helpful in the diagnosis of TFCC injuries.However,as the value of any single test is not enough,we should clinically combine the results of ulna fovea sign and distal ulna ballottement test to increase the capability of detecting peripheral TFCC injury.

17.
Chinese Journal of Trauma ; (12): 241-246, 2019.
Article in Chinese | WPRIM | ID: wpr-745048

ABSTRACT

Objective To investigate the clinical efficacy of dry arthroscopy in the treatment of wrist joint injury. Methods A retrospective case series study was conducted to analyze the clinical data of 59 patients with wrist joint injuries admitted from January 2013 to January 2016. There were 48 males and 11 females, aged 15-69 years, with an average age of 34 years. Among the patients, there were 32 patients with old scaphoid fractures ( including delayed diagnosis and treatment of scaphoid fractures or scaphoid fracture nonunion) , 23 patients with intra articular fractures of distal radius, and four patients with chronic instability of lower ulnar radial joint. All patients were treated with dry arthroscopic surgery. During the operation, the operation time of bone grafting and the swelling degree of soft tissue around the joint which needed simultaneous incision were observed. Fracture healing, and joint stability were recorded after operation, and wrist function was evaluated by Mayo wrist function score. Results The average operation time of scaphoid bone grafting was 7 minutes. In patients with distal radius fractures requiring simultaneous incision and reconstruction of the lower ulnar radial ligament, there was no significant periarticular swelling, with normal anatomical layer and clear visual field. All patients were followed up for 6-28 months ( average 9 months) . All the old scaphoid fractures were healed, with the average healing time of 12. 6 weeks. All distal radius fractures were anatomically repositioned during operation. All patients with chronic instability of the lower ulnar radial joint were seen stable recovery of the joint, with negative impact test of the lower ulnar and radial joints. The Mayo wrist function score of all patients averaged 95 points. Conclusion Dry arthroscopic technique can improve the efficiency of bone grafting under wrist arthroscopy, reduce the swelling of soft tissue around the joint, maintain clear anatomical layers of soft tissue, promote fracture healing and improve wrist function, especially applicable for wrist arthroscopy with minimally invasive bone grafting and wrist incision at the same time.

18.
Article in Chinese | WPRIM | ID: wpr-754734

ABSTRACT

Objective To explore the effectiveness of wide awake local anesthesia no tourniquet (WALANT) in arthroscopy for diagnosis and treatment of wrist injuries and conditions.Methods Between January 2012 and January 2016,WALANT approach was used in wrist arthroscopy for 22 patients with wrist injury or condition at Department of Hand Surgery,Beijing Jishuitan Hospital.They were 10 males and 12 females,aged from 19 to 56 years(average,34 years).Arthroscopic exploration was conducted in 7 cases,arthroscopic synovectomy in 6,dorsal wrist ganglionectomy in 3,triangular fibrocartilage complex (TFCC) debridement in 5 and TFCC repair in one.All the patients were anesthetized using portal site local anesthesia (PSLA) technique.Additional local infiltration around ulnar-sided wrist incisions was performed in 2 TFCC repairs.Bupivacaine was used for both techniques.The effects were evaluated using a ten-point visual analogue scale (VAS).Results Desired objectives were achieved in all patients.No operative complication was observed.Mild pain was noted in all the patients when local anesthetic was injected to the portal sites,with an average VAS score of 2.5 points (from 1 to 3 points).In the following arthroscopic procedures,most of the patients did not report any discomfort.Only one patient undergoing TFCC repair reported mild pain (VAS score of 3 points) during ulnar-carpal suture procedure.Conclusion The new WALANT technique is safe,time-saving,economical and capable of pain control during arthroscopy for numerous wrist injuries and conditions.

19.
Chinese Journal of Microsurgery ; (6): 423-428, 2019.
Article in Chinese | WPRIM | ID: wpr-792080

ABSTRACT

To introduce the surgical procedure of orthopaedic robot-assisted vascularised fibular grafting for the treatment of ANFH and report the short-term result. Methods From September, 2016 to November, 2018, 17 patients (21 hips) with ANFH had undergone robot-assisted free fibular grafting. There were 14 males and 3 females, of which, 8 cases were associated with the right side, 5 cases the left side, and 4 cases with both sides. The average age was 35 (ranged from 17 to 55) years. There were 7 patients suffered from idiopathic ischemic necrosis of femoral head, 4 patients who had cannulated screws fixed after a femoral neck fracture, 4 patients who had a history of alcohol consumption, 1 patient who had taken corticosteroids for 6 months to treat nephritis, and 1 patient who had a history of alcohol consumption and had also taken corticosteroids. Seventeen hips were in Ficat stage II, and 4 hips were in Ficat stage III. The orthopaedic surgical robot workstation was used to plan the entry point and target of the guide pin during the operation, to place a cannula in the optimal position. Then a bone window was created and the fibula was placed into the bone tunnel.Using fluoroscopy to monitor each step of the procedure and verify the position of the fibula. Finally, the vessels were anastomosed. The patient remain in bed completely for a week with the use of vasodilator. The follow-up was accomplished with phone call and outpatient clinic, and Harris score was evaluated. Results All 21 surgical procedures were successful. The guide pins and fibula were accurately placed according to the robot’s plan, and the tips of the fibula were placed at the centre of the load-bearing region of the femoral heads, 4 to 6 mm from the articular surface. Conventional anticoagulant, anti-infective therapy was performed after the pro-cedure. Ten patients were followed-up postoperatively more than 1 year, with an average of 15 (from 12 to 24) months. The function of the hip joint recovered smoothly for 9 patients.Frontal and lateral X-ray and CT scans showed that the tips of the fibula were placed at the centre of the load-bearing region, 4 to 6 mm from the articular surface.One patient suffered from bilateral femoral head necrosis and the right side recovered smoothly after operation.However, joint move-ment was restricted for the left hip and the pain was significant.An arthroscopic examination was performed 1 month after the operation and did not identify any problems such as intraarticular incular infection or articular surface of the femoral head was protruded by the tip of the fibula.The symptoms were alleviated after removing the osteophytes at the rim of the acetabulum.The Harris score was 62.4±13.6 before operation, and 84.5±4.5 at the last time of followed-up after opera-tion.The difference in Harris scores was statisticly significant (P<0.05). Conclusion With the assistance of an or-thopaedic robot system, the guide pin can be accurately positioned, thereby allowing the tip of the fibula to be inserted in-to the optimal anatomical position and maximising its mechanical efficacy.In theory, it is the best choice for performing fibular bone transplantation in ANFH.And the early effect of treatment is good.

20.
Journal of Clinical Hepatology ; (12): 672-676, 2019.
Article in Chinese | WPRIM | ID: wpr-778876

ABSTRACT

Programmed death-1 (PD-1) is an important immunosuppressive molecule which interacts with its ligand programmed death-ligand 1 (PD-L1) and plays an important role in central/peripheral immune tolerance, transplantation immunity, tumor immune escape, and autoimmune disease. At present, there is still no systematic understanding of the role of the PD-1/PD-L1 pathway in the development and progression of liver diseases. This article summarizes related studies on the role of the PD-1/PD-L1 pathway in the progression of liver diseases and reviews the immunoregulatory function of the PD-1/PD-L1 pathway and its role in liver diseases. It is pointed out that the PD-1/PD-L1 pathway is involved in immunoregulatory function of the liver and plays an important role in the development and progression of liver inflammation, autoimmune liver diseases, viral liver diseases, tumor immune escape, transplantation rejection reaction, induced immune response, and autoimmune tolerance. Intervention of the PD-1/PD-L1 pathway may provide new strategies and directions for the prevention and treatment of liver disease.

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