ABSTRACT
El Adenoma Hepatocelular (AH) es un tumor hepático benigno, su diagnóstico ha avanzado gracias a los avances en los métodos moleculares, facilitaron dividirlos en subtipos, con diferentes pronósticos e indicaciones terapéuticas. Se presenta el caso clínico de una paciente, de 40 años con hallazgo ecográfico de tumor hepático, la Tomografía de Abdomen y Pelvis voluminosa lesión sólida heterogénea, en la Resonancia Magnética compatible con Adenoma esteatósico (asociado a mutación HNF1 alfa). Se decide tratamiento quirúrgico, con resección de los segmentos 6 y 7. La Anatomía patológica concluye: Compatible con el subtipo inflamatorio. Los Adenoma hepáticos (AH) son tumores raros, solitarios de estirpe epitelial, benignos. Se presentan en mujeres de edad fértil y asociado al consumo de anticonceptivos orales y estrógenos. Estos tumores predominan en hígado derecho, con proliferación de células parecidas a los hepatocitos normales, pero desorganizados y sin arquitectura lobular normal, sin ductos biliares ni tejido conectivo de sostén. Los AH así como el resto de los tumores hepáticos benignos, han aumentado su incidencia de la mano con el avance de la imagenología abdominal. La importancia de la diferenciación con el resto de los tumores hepáticos benignos surge del potencial maligno de éstos. Podemos clasificar a los pacientes según el perfil molecular asociado a marcadores inmunohistoquímicos. Los estudios de imagen son fundamentales para la diferenciación tumoral en diagnóstico y planear la terapéutica. El tratamiento será individualizado, determinada por la clínica, la variedad de subtipos, y la evolución. Debido a la complejidad de la enfermedad, el tratamiento de la HA es uno de los mejores ejemplos de abordaje individualizado en unidades hepatobiliares.
Hepatocellular adenoma (HA) is a benign liver tumor, its diagnosis has advanced thanks to advances in molecular methods, which facilitated its division into subtypes, with different prognoses and therapeutic indications. We present the clinical case of a 40-year-old patient with an ultrasound finding of a liver tumor, a voluminous heterogeneous solid lesion on a CT scan of the abdomen and pelvis, compatible with a steatotic adenoma on MRI (associated with HNF1 alpha mutation). Surgical treatment was decided, with resection of segments 6 and 7. The pathology concluded in short: Compatible with the inflammatory subtype. Hepatic adenomas (HA) are rare, solitary, benign epithelial tumors. They occur in women of childbearing age and associated with the consumption of oral contraceptives and estrogens. These tumors predominate in the right liver, with proliferation of cells similar to normal hepatocytes, but disorganized and without normal lobular architecture, without bile ducts or supporting connective tissue. HA, as well as the rest of the benign liver tumors, have increased their incidence in the hand with the advancement of abdominal imaging. The importance of differentiation with the rest of the benign liver tumors arises from the malignant potential of these. We can classify patients according to the molecular profile associated with immunohistochemical markers. Imaging studies are fundamental for tumor differentiation in diagnosis and therapeutic planning. The treatment will be individualized, determined by the clinic, the variety of subtypes, and the evolution. Due to the complexity of the disease, the treatment of AH is one of the best examples of an individualized approach in hepatobiliary units.
O adenoma hepatocelular (AH) éum tumor benigno do fígado, seu diagnóstico avançougraçasaosavanços dos métodos moleculares, que facilitaramsuadivisão em subtipos, com diferentes prognósticos e indicaçõesterapêuticas. Apresentamos o caso clínico de umadoente de 40 anoscomachadoultrassonográfico de tumor hepático, volumosalesão sólida heterogénea à TC de abdómen e pelve, compatívelcom adenoma esteatótico à RM (associado a mutação HNF1 alfa ). Optou-se por tratamentocirúrgico, comressecção dos segmentos 6 e 7. A patologiaconcluiu-se resumidamente: Compatívelcom o subtipo inflamatório. Os adenomas hepáticos (AH) são tumores epiteliais raros, solitários e benignos. Ocorrem em mulheres em idadereprodutiva e associadasao consumo de anticoncepcionaisorais e estrogênios. Esses tumores predominam no fígadodireito, comproliferação de células semelhantesaoshepatócitosnormais, porém desorganizados e semarquitetura lobular normal, sem ductos biliares outecido conjuntivo de sustentação. O HA, assim como os demais tumores hepáticos benignos, têm aumentado suaincidêncianamãocom o avanço da imagem abdominal. A importância da diferenciaçãocom os demais tumores hepáticos benignos decorre do potencial maligno destes. Podemos classificar os pacientes de acordocom o perfil molecular associado a marcadores imuno-histoquímicos. Os estudos de imagemsãofundamentais para a diferenciação tumoral no diagnóstico e planejamentoterapêutico. O tratamento será individualizado, determinado pela clínica, variedade de subtipos e evolução. Pela complexidade da doença, o tratamento da HA é um dos melhoresexemplos de abordagem individualizada nas unidades hepatobiliares.
Subject(s)
Humans , Female , Adult , Adenoma, Liver Cell/surgery , Adenoma, Liver Cell/diagnostic imaging , Liver Neoplasms , Magnetic Resonance Imaging , Ultrasonography , Treatment OutcomeABSTRACT
Background Long-term exposure to arsenic can cause liver injury of varying degrees. Mitochondrial damage may be an early key event of arsenic-induced liver injury. Silent mating type information regulation 2 homolog 1 (SIRT1)/ recombinant peroxisome proliferators-activated receptor gamma coactivator 1 alpha (PGC-1α) is an important pathway regulating mitochondrial mass and function. However, whether arsenic-induced liver injury is related to mitochondrial dysfunction mediated by SIRT1/PGC-1α pathway remains unclear. Objective To investigate potential effects of sodium arsenite (NaAsO2) on mitochondrial function and expressions of SIRT1/PGC-1α pathway-related proteins in human normal liver cell. Methods Human normal liver cells (MIHA cells) were used as the research object. MIHA cells were treated with different concentrations of NaAsO2 (0, 5, 10 and 20 μmol·L−1) for 24 h, and the cells were collected for study. The ultrastructure of mitochondria was observed by transmission electron microscopy, adenosine triphosphate (ATP) concentration by fluorescence method, mitochondrial membrane potential (MMP) level by flow cytometry, and SIRT1, PGC-1α and their downstream nuclear respiratory factor 1 (NRF1) and mitochondrial transcription factor A (TFAM) protein expression levels by Western blotting. One-way analysis of variance and trend test were used for data statistical analysis. Results The viability of MIHA cells decreased gradually with the increase of NaAsO2 concentration (F=6495.47, P<0.001). The transmission electron microscope observation showed that the size of mitochondria in the 10 μmol·L−1 NaAsO2 treatment group was different, and the mitochondria were swollen or elongated in a rod-like shape. The mitochondria in the 20 μmol·L−1 NaAsO2 treatment group swelled like air spheres or vacuoles. The ATP concentration and MMP level of MIHA cells gradually decreased with the increase of NaAsO2 concentration (Ftrend of ATP=172.28, Ftrend of MMP=59.91, both Ps<0.001). Compared with the control group, the protein expression levels of SIRT1, PGC-1α, NRF1, and TFAM were not significantly changed in the 5 μmol·L−1 NaAsO2 treatment group, while the protein expression levels of SIRT1, PGC-1α, and TFAM were decreased in the 10 μmol·L−1 NaAsO2 treatment group, and the protein expression levels of SIRT1, PGC-1α, and NRF1 were decreased in the 20 μmol·L−1 NaAsO2 treatment group. The results of trend test showed that the protein expression levels of SIRT1, PGC-1α, NRF1, and TFAM decreased gradually with the increase of NaAsO2 concentration (Ftrend of SIRT1=47.07, P<0.001; Ftrend of PGC-1α=15.17, P<0.01; Ftrend of NRF1=13.54, P<0.01; F trend of TFAM=4.20, P<0.05). Conclusion The down-regulation of SIRT1/PGC-1α and its downstream NRF1 and TFAM may be involved in NaAsO2-induced mitochondrial dysfunction in liver cells.
ABSTRACT
Introdução: O trabalho objetiva avaliar o perfil epidemiológico dos pacientes operados por adenoma hepático e os fatores de influência nas diferentes apresentações clínicas. Métodos: Estudo transversal descritivo com 21 pacientes operados por adenoma hepático. Dados de prontuário e laudos anatomopatológicos foram revisados a fim de estudar a relação entre perfil dos pacientes, apresentação clínica e características do tumor. Resultados: Sexo feminino foi predominante na amostra. A idade média dos pacientes foi de 32 anos e o IMC médio 25,9. Uso de anticoncepcional oral foi relatado em 93% dos casos, sendo 13 anos o tempo médio de uso. A presença de comorbidades teve associação com adenomas de maior tamanho, e diabetes mellitus foi doença mais frequente associada a este tumor. Houve associação clínica entre tamanho do adenoma e sintomatologia: pacientes com sinais e sintomas mais pronunciados apresentaram lesões de tamanho médio superior em comparação aos pacientes com sintomas inespecíficos ou ausentes. Conclusão: Os fatores já conhecidos associados ao Adenoma Hepático envolvem o sexo feminino, uso de contraceptivo oral de longa data, doenças do armazenamento do glicogênio, uso de anabolizantes e, menos comumente, gestação e diabetes mellitus. Neste trabalho evidenciamos o diabetes mellitus como a comorbidade mais frequente entre os pacientes com diagnóstico de Adenoma Hepático, relacionando-se a adenomas de maior tamanho na amostra deste estudo, o que sugere possível associação do diabetes mellitus na gênese dos adenomas hepáticos e também no prognóstico, visto que lesões maiores representam risco aumentado de complicações.
Introduction: This work aims to evaluate the epidemiological profile of patients who underwent surgery for liver adenoma and the factors that could influence different clinical presentations. Methods: Descriptive cross-sectional study with 21 patients with liver adenoma who underwent surgery. Medical records and pathological reports were reviewed to study the connection between patients' profile, clinical presentation, and features of the tumor. Results: Female sex predominated in the sample. The mean age of patients was 32 years and the mean BMI was 25.9. The use of oral contraceptives was reported in 93% of the cases, with an average usage time of 13 years. The presence of comorbidities was associated with larger adenomas, and diabetes mellitus was the most frequent comorbidity co-existing with this tumor. Clinical association between the size of adenomas and symptoms was identified: patients with more pronounced signs and symptoms had larger lesions compared with patients with nonspecific or absent symptoms. Conclusion: The known factors associated with Hepatic Adenoma involve female sex, long-term use of oral contraceptives, glycogen storage diseases, use of anabolic steroids, and, less commonly, pregnancy and diabetes mellitus. In this study, we highlight diabetes mellitus as the most frequent comorbidity among patients diagnosed with Hepatic Adenoma, relating to larger adenomas in this study sample, which suggests a possible association of diabetes mellitus in the genesis of liver adenomas and in the prognosis, since larger lesions represent an increased risk of complications.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Adenoma, Liver Cell/surgery , Adenoma, Liver Cell/epidemiology , Liver Neoplasms/epidemiologyABSTRACT
Objective:To explore the diagnosis and treatment of hepatocellular adenoma.Methods:The clinical data of 23 hepatocellular adenoma patients admitted to the Affiliated Hospital of Qingdao University from May 2013 to May 2020 were retrospectively analyzed.Results:Fifteen patients were female, the age ranged from 21 to 60. The maximum tumor diameter was from 2.5 cm to 15 cm.Most patients (15/23) were asymptomatic. There were 20 cases (87%) with single lesion and 3 cases (13%) with multiple lesions. Contrast-enhanced CT and MRI showed enhancement in the arterial phase, and de-enhancement in the portal phase as well as in the delayed phase. All cases underwent tumor resection. Hepatocellular adenoma was confirmed by pathology with partial canceration in one case and intratumoral hemorrhage in two cases. Sixteen cases were misdiagnosed preoperatively, 20 were followed up with the median follow-up time of 36 months. Recurrence was not found.Conclusion:Hepatocellular adenoma is uncommon and often misdiagnosed. Preoperative diagnosis is dependent on MRI.Given the fact of high rate misdiagnosis and a tendency of canceration,resection is recommended.
ABSTRACT
Objective:To study the protective effect and mechanism of Ranae Oviductus protein hydrolysate （ROPH） on the expression of pathway-related proteins in ethanol-induced L-02 cell injury. Method:The ROPH was prepared by compound enzymatic hydrolysis. L-02 cell injury model was induced with 400 mmol·L<sup>-1 </sup>ethanol. Cell viability was detected by cell counting kit-8 （CCK-8） assay. Cell cycle and apoptosis were examined by flow cytometry. JC-1/Hochest staining was employed for qualitative investigation. The expression of related proteins in apoptosis， mitogen-activated protein kinase （MAPK） signaling pathway， and pyroptosis in L-02 cells was detected by Western blot. Result:The results of the CCK-8 assay showed that 400 mmol·L<sup>-1 </sup>ethanol could induce L-02 cell injury within 12 hours. Compared with the blank group， the model group showed decreased viability of L-02 cells （<italic>P</italic><0.01）， elevated percentage of the cell cycle in the G<sub>0</sub>/G<sub>1</sub> phase （<italic>P</italic><0.01）， increased total cell apoptosis rate （<italic>P</italic><0.01）， reduced mitochondrial membrane potential （<italic>P</italic><0.01）， up-regulated expression of apoptosis-related proteins ［B-cell lymphoma-2 （Bcl-2）-associated X protein （Bax）， Cytochrome C （Cyt C）， and cysteine-dependent aspartate specific protease-3 （Caspase-3）］ （<italic>P</italic><0.05， <italic>P</italic><0.01） and MAPK signaling pathway-related proteins ［C-Jun amino-terminal kinase （JNK） and p38 MAPK］ （<italic>P</italic><0.05， <italic>P</italic><0.01）， and potentiated expression of pyrolysis-related proteins Caspase-1 and interleukin-1<italic>β </italic>（IL-1<italic>β</italic>） （<italic>P</italic><0.05）. Compared with the model group， the ROPH treatment group exhibited improved cell cycle arrest （<italic>P</italic><0.05， <italic>P</italic><0.01）， diminished total cell apoptosis rate （<italic>P</italic><0.01）， elevated mitochondrial membrane potential in a dose-dependent manner， down-regulated expression of Bax， Cyt C， and Caspase-3 proteins （<italic>P</italic><0.05， <italic>P</italic><0.01）， up-regulated expression of Bcl-2 protein （<italic>P</italic><0.05， <italic>P</italic><0.01）， and a downward trend in expression of proteins related to MAPK signaling pathway and pyrolysis （<italic>P</italic><0.05， <italic>P</italic><0.01）. Conclusion:ROPH could inhibit oxidative stress-triggered liver injury in ethanol-induced cells by improving mitochondrial membrane potential， reducing the expression of proteins in the mitochondria-mediated apoptosis pathway， and inhibiting the expression of proteins related to the MAPK signaling pathway and pyrolysis pathway to reduce the mitochondrial dysfunction and inflammatory response in ethanol-induced L-02 liver cells and inhibit oxidative stress， thereby exerting a therapeutic role in alcoholic liver injury.
ABSTRACT
To investigate the mechanism of Huanglian Wendan Decoction in intervening impaired glucose tolerance( IGT) rat insulin resistance( IR) based on the pyroptosis pathway of liver cells. The IGT rat model was established by high-fat diet( 20 weeks) combined with high temperature,humidity environment and inactive lifestyle. The experiment was divided into blank group,model group,metformin hydrochloride group( positive group)( 0. 05 g·kg~(-1)·d~(-1)) and Huanglian Wendan Decoction group( 7. 8 g·kg~(-1)·d~(-1)). After continuous intragastric administration for 4 weeks,the body weight,body length and abdominal circumferences of all the rats were measured,the Lee' s obesity indexes was calculated,and the levels of fasting plasma glucose( FPG) and 2-hour plasma glucose( 2 hPG) in each group were measured. Serum insulin levels( FINS) and tumour necrosis factor-α( TNF-α) levels were detected by ELISA,and insulin sensitivity index( ISI) and insulin resistance index( IRI) values were calculated. The expressions of cysteinyl aspartate specific proteinase-1( caspase-1),gasdermin D( GSDMD),interleukin-1β( IL-1β) and interleukin-18( IL-18) m RNA and proteins in liver tissues were detected by Real-time PCR and Western blot. Immunofluorescence was used to detect the expressions of caspase-1 and GSDMD protein in liver tissues. Huanglian Wendan Decoction could effectively reduce the weight of model rats,improve abdominal obesity,FINS,IRI and ISI indexes and correct 2 hPG levels. Compared with blank group,TNF-α levels in serum and caspase-1,GSDMD,IL-1β and IL-18 expressions in liver tissue of model control group were increased significantly. Huanglian Wendan Decoction could effectively reduce TNF-α level in serum,regulate the expressions of caspase-1,GSDMD,IL-1β and IL-18 genes and proteins in liver tissues of IGT rats. The above results showed that the occurrence and development of " obesity-IR-abnormal glucose metabolism-type 2 diabetes mellitus" was closely related to inflammatory response and the classical pyroptosis pathway mediated by caspase-1/GSDMD. The mechanism of Huanglian Wendan Decoction in improving IR may be correlated with reduction of the level of inflammatory factors and the alleviation of the state of pyroptosis,and thus reverse the course of IGT.
Subject(s)
Animals , Rats , Diabetes Mellitus, Type 2 , Drugs, Chinese Herbal , Liver , PyroptosisABSTRACT
RESUMO - RACIONAL: As principais indicações das hepatectomias video-laparoscópicas (HVL), inicialmente, eram nas lesões hepáticas benignas. À medida que a HVL se tornou mais popular, as indicações de doenças malignas superaram as de doenças benignas. Este estudo teve como objetivo discutir as indicações e resultados da HVL para o tratamento de tumores hepáticos benignos. MÉTODOS: De 445 HVL realizadas em um único centro, 100 (22,4%) foram para tumores benignos. Os autores discutem as indicações para ressecção e apresentam seus resultados perioperatórios. RESULTADOS: No total, 100 pacientes com tumores benignos foram avaliados, a saber: 66 casos de adenomas hepatocelulares; 14 de neoplasia mucinosa biliar; 13 de hiperplasia nodular focal; 4 de angiomiolipomas; e 3 de hemangiomas. O tamanho médio das lesões foi de 7,6 cm (3,1 a 19,6 cm). A taxa de morbidade total foi de 19%, sendo 9% classificados como Clavien-Dindo 3 ou 4 e não foi observada mortalidade. CONCLUSÃO: A HVL para tumores hepáticos benignos é segura e apresenta excelentes resultados. No entanto, as indicações para cirurgia são cada vez mais restritas, não sendo recomendável indicar a ressecção somente por se tratar de procedimento minimamente invasivo.
ABSTRACT - BACKGROUND: The main indications of the use of laparoscopic liver surgery (LLS), in the early days, were benign liver lesions. As LLS became more popular, indications for malignant diseases outnumbered those for benign ones. This study aims to rule out the indications and results of LLS for the treatment of benign liver tumors. METHODS: Out of 445 LLS performed in a single center, 100 (22.4%) were for benign tumors. The authors discuss the indications for resection and present their perioperative results. RESULTS: In total, 100 patients with benign tumors were evaluated. Specifically, these were as follows: 66 cases of hepatocellular adenomas; 14 cases of biliary mucinous neoplasm; 13 cases of focal nodular hyperplasia; 4 cases of angiomyolipomas; and 3 cases of hemangiomas with a mean size of 7.6 cm (ranging from 3.1 to 19.6 cm). The total morbidity rate was 19%, with 9% classified as Clavien-Dindo grades 3 or 4. No mortality was observed. CONCLUSION: LLS for benign liver tumors is safe and presents excellent results. However, indications for resection are increasingly restricted and should not be performed just because it is a minimally invasive procedure.
Subject(s)
Humans , Laparoscopy , Liver Neoplasms/surgery , Retrospective Studies , HepatectomyABSTRACT
Objective::To investigate the protective effect of salvianolic acid B on HepaRG hepatocyte injury induced by arsenic trioxide (As2O3 ) and its mechanism. Method::HepaRG cells were incubated with 5μmol·L-1 As2O3 for 24 h to induce hepatocyte injury. The cells were divided into control group, model group, salvianolic acid B 10 μmol·L-1 group, salvianolic acid B 10 μmol·L-1+ As2O3 group, salvianolic acid B 5 μmol·L-1+ As2O3 group, and salvianolic acid B 2.5 μmol·L-1+ As2O3 group. HepaRG cells were preincubated with salvianolic acid B for 2 h and then incubated with As2O3 for 24 h. At the end of the incubation, cell viability was detected by thiazolyl blue tetrazolium bromide assay, apoptosis was observed by Hoechst33342 fluorescence staining, apoptosis rate was detected by annexin V-FITC/propidium iodide double staining flow cytometry, and mitochondrial membrane was observed by JC-1 fluorescence staining. Western blot was used to detect the protective effect of expressions of relevant proteins Bcl-2, Bax, Akt, p-Akt on salvianolic acid B in the liver. Result::As2O3 concentration-dependently reduced the survival rate of HepaRG cells(P<0.01), salvianolic acid B had no effect on normal cell viability for 2 h, pre-incubation with salvianolic acid B(5, 10 μmol·L-1) for 2 h significantly increased the decreased cell survival rate caused by As2O3 (P<0.01). As2O3 significantly increased hepatocytes apoptosis rate(P<0.01), while pre-incubation with salvianolic acid B(10 μmol·L-1) deceased apoptosis rate(P<0.01). Incubation with As2O3 for 24 h caused decrease of mitochondrial membrane potential, pre-incubation with salvianolic acid B maintained mitochondrial membrane potential, indicating that the anti-apoptotic effect of salvianolic acid B were related to the mitochondrial pathway modulation. Western blot analysis showed that salvianolic acid B promoted the ratio of Bcl-2/Bax and promoted p-Akt/Akt compared with As2O3 group(P<0.01). Conclusion::Salvianolic acid B has a protective effect on hepatocyte injury induced by As2O3, and its mechanism is related to maintenance of mitochondrial function and inhibition of hepatocyte apoptosis.
ABSTRACT
OBJECTIVE: To investigate the effect of nickel sulfate on cell survival rate and apoptosis of normal human liver L02 cells. METHODS: i) L02 cells in logarithmic growth phase were divided into 9 groups, each with 6 wells. L02 cells in each group were treated with 0, 100, 200, 300, 400, 500, 600, 700 and 800 μmol/L nickel sulfate. The survival rate of L02 cells was determined by CCK-8 assay after cells were treated for 0, 6, 12, 24, 48 and 72 hours. The nickel sulfate exposure dose and exposure time for subsequent experiments were selected based on the results of CCK-8 assay. ii) L02 cells in logarithmic growth phase were divided into control group, 100 and 300 μmol/L dose groups, and were exposed to 0, 100 and 300 μmol/L nickel sulfate for 12 hours, respectively. Western blot was used to detect the relative protein expression of B cell lymphoma/leukemia 2(BCL-2), Bcl-2 related protein X(BAX), caspase-3, phosphorylated RNA-dependent protein kinase-like endoplasmic reticulum kinase(p-PERK), phosphorylated eukaryotic translation initiation factor 2α(p-eIF2α), CCAAT/enhancer-binding protein homologous protein(CHOP) and glucose regulatory protein 78(GRP78). RESULTS: i) After treatment with nickel sulfate, the survival rate of cells decreased with the increase of dose and the prolongation of exposure time(all P values were <0.01). According to the half inhibitory concentration of nickel sulfate on L02 cells, the nickel sulfate exposure time in subsequent experiments was selected as 12 hours, and the exposure concentration was 100 and 300 μmol/L. ii) Compared with the control group, the relative expression of BCL-2 protein in L02 cells in the 100 and 300 μmol/L dose groups decreased(all P values were <0.05), while the relative protein expression of BAX, caspase-3 protein and ratio BAX/BCL-2 increased(all P values were <0.05). Compared with 100 μmol/L dose group, the relative expression of BCL-2 protein in L02 cells of 300 μmol/L dose group decreased(P<0.05), while the relative expression of BAX and caspase-3 protein and the ratio of BAX/BCL-2 increased(all P values were <0.05). Compared with the control group, the relative expression levels of p-PERK, p-eIF2α, CHOP and GRP78 protein in L02 cells were increased in 100 and 300 μmol/L dose groups(all P values were P<0.05). Compared with 100 μmol/L dose group, the relative expression levels of p-eIF2α, CHOP and GRP78 protein in 300 μmol/L dose group were increased(all P values were<0.05).CONCLUSION: Nickel sulfate can regulate the expression of apoptosis related proteins and PERK signaling pathway related proteins in L02 cells, aggravate apoptosis of L02 cells and decrease the cell survival rate.
ABSTRACT
Background: Yellow phosphorus containing rodenticide poisoning are common in Adult critical care. They cause coagulopathy and liver cell failure in humans. Till date, only liver transplants had been advocated as the final treatment of fulminant liver failure occurring as a complication of rodenticide poisoning. In this study, an innovative Treatment approach was given to liver cell failure cases who had consumed yellow phosphorus paste.Methods: Retrospective analysis of case records of liver cell failure cases due to the consumption of phosphorus containing Rodenticide poisonings, were analysed for a period of 1 year from January 2018 to January 2019 in a public hospital. Medical case records were obtained from records department and Postmortem registers. Symptoms, signs, investigations, treatments, complications, and outcomes were tabulated.Results: Total 11 cases were studied. 8 cases of liver cell failure and coagulopathy in whom therapeutic heparin free plasmapheresis was given, recovered completely from liver cell failure. A significant drop in Haemoglobin, platelet count, PT INR Ratio and rise in serum alkaline phosphatase, were the predictable factors used for the intervention of therapy with 5 cycles of heparin free plasmapheresis to eliminate toxic effects of phosphorus on liver cells and in the blood. A comparative analysis of untreated cases (n=3) vs treated with plasmapheresis (n=8), showed a significant statistical difference (P <0.005) in outcomes with a degree of freedom=2.Conclusions: Plasmapheresis can be a therapeutic treatment for liver cell failure caused due to the consumption of yellow phosphorus. Predictable factors for impending liver cell failure in whom plasmapheresis will be of benefit are dependent upon prothrombin time, INR ratio, Liver enzymes and time interval between consumption and onset of liver cell failure.
ABSTRACT
Objective To evaluate the clinical value of CT combined with MRI in the qualitative diagnosis of hepatic lesions.Methods From August 2015 to March 2018,100 patients with liver diseases were selected from Zhoushan Hospital.CT,MRI and combined examination were performed respectively.The results of diagnosis of liver diseases in three different ways were compared and analyzed.Results A total of 96 lesions were detected by CT,the detectable rate was 88.89% ,97 lesions were detected by MRI,and the detectable rate was 89.81%. A total of 105 lesions were detected by CT and MRI,and the detectable rate was 97.22%.The detection rate and number of detected lesions of combined test were significantly higher than those of single test (χ2 =8.25,6.22,all P<0.05), but there were no statistically significant differences in the detection rate and the number of lesions between CT and MRI (all P>0.05).Conclusion The diagnosis of benign and malignant lesions by the combination of CT and MRI is very good.The diagnostic effect is relatively small and the safety factor is high.It is worth widely used in clinical diagnosis of patients.
ABSTRACT
Objective@#To evaluate the clinical value of CT combined with MRI in the qualitative diagnosis of hepatic lesions.@*Methods@#From August 2015 to March 2018, 100 patients with liver diseases were selected from Zhoushan Hospital.CT, MRI and combined examination were performed respectively.The results of diagnosis of liver diseases in three different ways were compared and analyzed.@*Results@#A total of 96 lesions were detected by CT, the detectable rate was 88.89%, 97 lesions were detected by MRI, and the detectable rate was 89.81%.A total of 105 lesions were detected by CT and MRI, and the detectable rate was 97.22%.The detection rate and number of detected lesions of combined test were significantly higher than those of single test (χ2=8.25, 6.22, all P<0.05), but there were no statistically significant differences in the detection rate and the number of lesions between CT and MRI (all P>0.05).@*Conclusion@#The diagnosis of benign and malignant lesions by the combination of CT and MRI is very good.The diagnostic effect is relatively small and the safety factor is high.It is worth widely used in clinical diagnosis of patients.
ABSTRACT
OBJECTIVE： To study the effects of cimetidine on low dose rate irradiation-induced liver cell apoptosis in Beagle dogs. METHODS： Healthy male Beagle dogs were randomly divided into normal control group， model control group， positive drug group （lentinan， 21.33 mg/kg） and cimetidine low-dose， medium-dose and high-dose groups （5.33， 10.67， 21.33 mg/kg）， with 4 Beagle dogs each. Except for normal control group， other groups were given 60Co-γ accumulative irradiation （dosage rate： 0.040 8 mGy/min） for 23 d； the medication groups were given relevant medicine orally before irradiation， once a day. Twenty-four hours after stopping irradiation， TUNEL method was used to detect the apoptosis of liver cells in Beagle dogs. The percentage of apoptotic cells was calculated. The expression level of apoptosis-related proteins （Bax， Bcl-2， Caspase-3， p53） in liver tissue was detected by immunohistochemistry. RESULTS： Compared with normal control group， apoptotic cells and Bax， Caspase-3， p53 positive cells were increased significantly in liver tissue of Beagle dogs in model control group； the percentage of apoptotic cells， protein expression levels of Bax， Caspase-3 and p53 were increased significantly； Bcl-2 positive cells were decreased significantly， and its protein expression level was decreased significantly （P＜0.05 or P＜0.01）. Compared with model control group， above positive cells of liver tissue in Beagle dogs were changed to different extents in medication groups； the percentage of apoptotic cells and protein expression levels of p53 in medication groups， protein expression levels of Bax in positive drug group， cimetidine low-dose and high-dose groups as well as protein expression levels of Caspase-3 in cimetidine groups were decreased significantly； protein expression levels of Bcl-2 were increased significantly in cimetidine groups. The percentage of apoptotic cells in cimetidine medium-dose and high-dose groups as well as protein expression levels of Caspase-3 in cimetidine groups were all lower than positive control group. Protein expression level of p53 in cimetidine low-dose group was significantly higher than positive drug group （P＜0.05 or P＜0.01）. CONCLUSIONS： Cimetidine can inhibit the low dose rate irradiation-induced apoptosis of liver cells in Beagle dogs， and certainly protect liver cells against irradiation. The mechanism of it may be associated with up-regulating the protein expression of Bcl-2 and down-regulating the protein expression of Bax， Caspase-3 and p53 in liver cells.
ABSTRACT
Hepatocellular adenoma is a rare type of benign tumor in the liver. It has high risk of rupture and low risk of malignant transform. Recently the incidence of hepatocellular adenoma malignant transforming has been increasing. The malignant progress of hepatocellular adenoma develop to hepatocellular carcinoma has the transition state. This course not only relyes on the CTNNB1 gene exon 3 mutations, but also depends on TERT gene promoter mutation. This article will elaborate the hepatocellular adenoma malignant transforming in molecule mechanism, pathological diagnosis and therapies.
ABSTRACT
Hepatocellular adenoma is a rare type of benign tumor in the liver. It has high risk of rupture and low risk of malignant transform. Recently the incidence of hepatocellular adenoma malignant transforming has been increasing. The malignant progress of hepatocellular adenoma develop to hepatocellular carcinoma has the transition state. This course not only relyes on the CTNNB1 gene exon 3 mutations, but also depends on TERT gene promoter mutation. This article will elaborate the hepatocellular adenoma malignant transforming in molecule mechanism, pathological diagnosis and therapies.
ABSTRACT
Primary hepatocytes are widely used in drug metabolism and toxicity assessment. As the culture of primary hepatocytes in vitro is a process of dedifferentiation, hepatocytes lose normal metabolic detoxification function gradually. The mechanism of hepatocyte dedifferentiation has been not clear so far. TFs play an important role in the dedifferentiation and non-parenchymal cells can maintain the function of hepatocytes in vitro. However, the current methods cannot be used in effective identification and quantitative analysis of a large number of TFs. In this paper, the mo-culture system (only primary hepatocytes) and co-culture system (primary hepatocytes and non-parenchymal cells) were established. The cells were cultured for 24 h, 48 h, 72 h as monolayer. The changes of TFs during the culture were obtained by TOT (Transcription factor response elements on tip) transcription factor enrichment method and mass spectrometry. A total of 219 TFs were identified in three individual replicates. The result revealed that up-regulated TFs were enriched in cell proliferation, death and immune response pathways, and down-regulated TFs were involved in metabolism pathway. The establishment of such culture-TFs identification system is of great significance to reveal the mechanism of primary hepatocyte dedifferentiation and crosstalk between hepatocytes and non-parenchymal cells.
ABSTRACT
<p><b>OBJECTIVE</b>To observe the effect of crocetin on autophagy in rat hepatocytes exposed to lipopolysaccharide (LPS) and D-galactosamine (D-gal) and explore the mechanism.</p><p><b>METHODS</b>Cultured rat hepatocytes were exposed to LPS (1 mg/L) and Dgal (60 mg/L) to induce cell injury and treated with crocetin, 3MA, or crocetin+3MA. Twelve hours after the treatments, the cells were examined for levels of ALT, AST and LDH in the supernatant using ELISA. LC3 fluorescence in the cells following immunofluorescence staining was observed using fluorescence microscopy. Autophagosomes in the cells were observed by transmission electron microscopy, and the cellular expressions of LC3, p62 and SIRT1 were detected using Western blotting.</p><p><b>RESULTS</b>The levels of ALT, AST and LDH in the hepatocytes were elevated after LPS- and D-gal-induced injury, reached the highest levels after 3MA treatment, but were decreased significantly by crocetin treatment. LC3 fluorescence increased obviously in the injured hepatoctyes, and the increment was the most obvious in crocetin-treated cells; LC3 fluorescence was decreased significantly after 3MA treatment. Cell injury induced obvious increase in autophagy in the hepatocytes, and the number of autophagosomes increased significantly after crocetin treatment but was reduced significantly after 3MA treatment. The cell injury caused an obvious up-regulation of LC3 and SIRT1 expression and down-regulated p62 expression. LC3 and SIRT1 expression levels were the highest and the expression of p62 was the lowest in cells with crocetin treatment. 3MA treatment significantly reduced the expression of LC3 and SIRT1 and increased the expression of p62 in the injured cells.</p><p><b>CONCLUSIONS</b>Autophagy is increased in injured rat hepatocytes, and crocetin can promote autophagy in the injured cells to reduce further cell injury.</p>
ABSTRACT
Objective To explore the expression and role of programmed cell death ligand-1 (PD-L1) in sorafenib-resistant human hepatocellular carcinoma cells. Methods Sorafenib-resistant human hepatocellular carcinoma cell lines (Hep3B-SR, HepG2-SR) were established by the procedure of stepwise increase in sorafenib concentrations. CCK-8 assay was used to detect half inhibition concentration (IC50). The expressions of P-glycoprotein (P-gp), multidrug resistance-associated protein 1 (MRP1) and PD-L1 were examined by Western blotting and qPCR. The expression of PD-L1 was silenced by transfecting siRNA into the drug-resistant cells, and the silencing efficiency was tested. After silencing the expression of PD-L1 in the drug-resistant cells, CCK-8 assay was used to detect IC50, the drug-resistance index was calculated, and the expressions of P-gp and MRP1 were examined. Then cell proliferation assay, wound healing assay, colony formation assay and flow cytometry were applied to examine cell proliferation, migration, clone formation and apoptosis, respectively. Results The drug-resistance indexes of Hep3B-SR and HepG2-SR were 5.4 and 5.2, respectively. The expressions of P-gp, MRP1 and PD-L1 in the drug-resistant cells were significantly up-regulated in comparison with the parental cells (all P0.01). After inhibiting the expression of PD-L1, the drug-resistance indexes of Hep3B-SR and HepG2-SR decreased to 1.8 and 1.5, respectively, and the expressions of P-gp and MRP1 were down-regulated (all P0.01). Silencing the PD-L1 expression could significantly inhibit the proliferation, migration and colony formation of drug-resistant cells, and could significantly promote the apoptosis (all P0.01); and these effects were strengthened by combining sorafenib. Conclusion PD-L1 is highly expressed in sorafenib-resistant hepatocellular carcinoma cells. Inhibition of PD-L1 expression can partially reverse the drug-resistance of the cells and significantly enhance the anticancer effect of sorafenib. Inhibiting the expression of PD-L1 can effectively repress the growth of sorafenib-resistant hepatocellular carcinoma cells, which is more if combining with sorafenib.
ABSTRACT
Hepatocellular adenoma (HCA) is the most common type of benign liver tumor, and its major complication is malignant transformation to hepatocellular carcinoma (HCC). Here, we report a case of HCC arising in HCA with bone marrow metaplasia in a 24-year-old Korean woman who presented with abdominal discomfort. A huge liver mass was found on abdominal ultrasonography. She underwent surgical hepatic resection, and the resected specimen was entirely involved by a 20-cm-sized tumor. Histological review revealed a well differentiated HCC arising from inflammatory HCA with β-catenin nuclear positivity and bone marrow metaplasia that contained hematopoietic cells. This case was unique because malignant transformation, inflammatory type HCA, β-catenin nuclear staining, and bone marrow metaplasia were simultaneously observed. Additionally, it should be noted that a large HCA with β-catenin activation can undergo malignant transformation and should be surgically resected in a timely manner.
Subject(s)
Female , Humans , Young Adult , Adenoma, Liver Cell , Bone Marrow , Carcinoma, Hepatocellular , Liver , Metaplasia , UltrasonographyABSTRACT
ABSTRACT Background: The hypervascular liver lesions represent a diagnostic challenge. Aim: To identify risk factors for cancer in patients with non-hemangiomatous hypervascular hepatic lesions in radiologically normal liver. Method: This prospective study included patients with hypervascular liver lesions in radiologically normal liver. The diagnosis was made by biopsy or was presumed on the basis of radiologic stability in follow-up period of one year. Cirrhosis or patients with typical imaging characteristics of haemangioma were excluded. Results: Eighty-eight patients were included. The average age was 42.4. The lesions were unique and were between 2-5 cm in size in most cases. Liver biopsy was performed in approximately 1/3 of cases. The lesions were benign or most likely benign in 81.8%, while cancer was diagnosed in 12.5% of cases. Univariate analysis showed that age >45 years (p< 0.001), personal history of cancer (p=0.020), presence of >3 nodules (p=0.003) and elevated alkaline phosphatase (p=0.013) were significant risk factors for cancer. Conclusion: It is safe to observe hypervascular liver lesions in normal liver in patients up to 45 years, normal alanine aminotransaminase, up to three nodules and no personal history of cancer. Lesion biopsies are safe in patients with atypical lesions and define the treatment to be established for most of these patients.
RESUMO Racional: As lesões hepáticas hipervasculares representam um desafio diagnóstico. Objetivo: Identificar fatores de risco para câncer em pacientes portadores de lesão hepática hipervascular não-hemangiomatosa em fígado radiologicamente normal. Método: Estudo prospectivo que incluiu pacientes com lesões hepáticas hipervasculares em que o diagnóstico final foi obtido por exame anatomopatológico ou, presumido a partir de seguimento mínimo de um ano. Diagnóstico prévio de cirrose ou radiológico de hemangioma foram considerados critérios de exclusão. Resultados: Oitenta e oito pacientes foram incluídos. A relação mulher/homem foi de 5,3/1. A idade média foi de 42,4 anos. Na maior parte das vezes as lesões hepáticas foram únicas e com tamanho entre 2-5 cm. Em aproximadamente 1/3 dos casos foi realizada biópsia hepática. Em 81,8% dos casos as lesões eram benignas ou provavelmente benignas enquanto que em 12,5% dos casos o diagnóstico foi de câncer. A análise univariada mostrou que idade superior a 45 anos (p<0,001), antecedente familiar pessoal de câncer (p=0,020), presença de mais de três nódulos (p=0,003) e elevação da alanina aminotransaminase (p=0,013) foram fatores de risco relevantes para o câncer. Conclusões: È indicado observar lesões hepáticas hipervasculares em fígado normal em pacientes com até 45 anos, alanina aminotransaminase normal, com até três nódulos e sem antecedente pessoal de câncer. Para os demais com lesões atípicas, a biópsia da lesão é segura e define na maior parte dos pacientes o tratamento a ser instituído.