Atualização das Recomendações da Sociedade Brasileira de Hepatologia para o Tratamento Sistêmico do Carcinoma Hepatocelular / Brazilian society of hepatology updated recommendations for systemic treatment of hepatocellular carcinoma

ABSTRACT Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2020 the updated recommendations for the diagnosis and treatment of HCC. Since then, new data have emerged in the literature, including new drugs approved for the systemic treatment of HCC that were not available at the time. The SBH board conducted an online single-topic meeting to discuss and review the recommendations on the systemic treatment of HCC. The invited experts were asked to conduct a systematic review of the literature on each topic related to systemic treatment and to present the summary data and recommendations during the meeting. All panelists gathered together for discussion of the topics and elaboration of the updated recommendations. The present document is the final version of the reviewed manuscript containing the recommendations of SBH and its aim is to assist healthcare professionals, policy-makers, and planners in Brazil and Latin America with systemic treatment decision-making of patients with HCC.

RESUMO O carcinoma hepatocelular (CHC) é uma das principais causas de mortalidade relacionada a câncer no Brasil e no mundo. A Sociedade Brasileira de Hepatologia (SBH) publicou em 2020 a atualização das recomendações da SBH para o diagnóstico e tratamento do CHC. Desde então, novas evidências científicas sobre o tratamento sistêmico do CHC foram relatadas na literatura médica, incluindo novos medicamentos aprovados que não estavam disponíveis na época do último consenso, levando a diretoria da SBH a promover uma reunião monotemática on-line para discutir e rever as recomendações sobre o tratamento sistêmico do CHC. Um grupo de experts foi convidado para realizar uma revisão sistemática da literatura e apresentar uma atualização, baseada em evidências científicas, sobre cada tópico relacionado ao tratamento sistêmico e a apresentar os dados e recomendações resumidas durante a reunião. Todos os painelistas se reuniram para discutir os tópicos e elaborar as recomendações atualizadas. O presente documento é a versão final do manuscrito revisado, contendo as recomendações da SBH, e seu objetivo é auxiliar os profissionais de saúde, formuladores de políticas e planejadores no Brasil e na América Latina na tomada de decisões sobre o tratamento sistêmico de pacientes com CHC.

Diagnostic value of contrast-enhanced ultrasound in hepatic epithelioid hemangioendothelioma / 中华肝脏病杂志

Objective: To investigate the features of contrast-enhanced ultrasound (CEUS) in hepatic epithelioid hemangioendothelioma (HEHE) in order to improve the preoperative diagnosis rate. Methods: CEUS images of 32 pathologically-proven cases of hepatic epithelioid hemangioendothelioma from January 2004 to August 2021 were collected. Lesions were analyzed to observe the features of enhancement mode, enhancement intensity, and distinct enhancement phases. Results: Among the 32 cases, one had a solitary lesion, 29 had multiple lesions, and two had diffuse-type lesions. Contrast-enhanced ultrasound revealed a total of 42 lesions in 32 cases. In terms of arterial phase enhancement, 18 lesions had overall enhancement, six lesions had uneven dendritic enhancement, 16 lesions had rim-like enhancement, and two lesions had just slight peripheral spot enhancement around the lesions. Among the three cases, there were multiple lesions that had overall enhancement and ring enhancement. In terms of the enhancement phase, 20 lesions showed "fast progression", 20 lesions showed "same progression", and two lesions showed "slow progression". During the late arterial or early portal venous phases with rapid washout, all lesions manifested as hypoechoic. With peaked enhanced intensity, 11 lesions had a lower enhancement intensity than the surrounding normal liver parenchyma; 11 lesions had the same enhancement degree as the surrounding normal liver parenchyma; and 20 lesions had a higher enhancement degree than the surrounding normal liver parenchyma. All 16 ring-enhancing lesions had marked hyperenhancement. In the typical enhancing lesions, four showed hyperenhancement, five showed low enhancement, and nine showed isoenhancement. In the dendrite-enhancing lesions, there were two isoenhancing and four hypoenhancing. Contrast-enhanced ultrasound delineated the boundaries of all lesions more clearly than two-dimensional ultrasound. Conclusion: Contrast-enhanced ultrasound has certain value in the diagnosis of hepatic epithelioid hemangioendothelioma.

A rare case of mixed adult Hepatoblastoma mimicking as Hepatocellular Carcinoma

@#Hepatoblastoma (HB) is a rare pediatric malignant tumor of the liver. Most of these tumors arise in the embryo and this is usually discernible in the first 3 years of life; thus, its occurrence in the adult population seems to be unusual. We present this case due to its rarity and its potential to mimic other primary liver tumors in adults such as HCC. To the best of our knowledge with literature review, there are only 40 cases of adult HB reported worldwide. In this paper, we report a case of a 49-year-old female, diagnosed with Chronic Hepatitis B, admitted due to abdominal pain. Physical examination revealed hepatomegaly. Liver function test was unremarkable. AFP was elevated at >50,000ng/mI. Triphasic CT scan revealed a hypodense mass in the right lobe of the liver measuring approximately 11 × 11 × 13cm suggestive of HCC. Subsequently, patient underwent right hepatectomy. Pathological examination, however, demonstrated that the tumor showed a malignant neoplasm with epithelial and mesenchymal components consistent with adult HB, mixed type. Since treatment of adult HB is not yet established, studies have suggested that it is logical to follow the treatment protocol for childhood HB. Hence, this patient underwent chemotherapy with Cisplatin, Vincristine and 5-Fluorouracil. The low incidence of HB in adults presents a diagnostic challenge, requiring a high index of suspicion and a thorough evaluation. Since prognosis could be improved with early detection and treatment, it is important for clinicians not to overlook HB.

Effects of Dexmedetomidine on Postoperative Delirium in Liver Tumor Resection Elderly Patients with Sleep Disorders / 中国药房

OBJECTIVE：To investigate the effects of d exmedetomidine on postoperative delirium （POD） in liver tumor resection elderly patients with sleep disorder （SD）. METHODS ：Totally 80 patients undergoing liver tumor resection with preoperative Pittsburgh sleep quality index （PSQI）score ≥7 were selected from the Affiliated Cancer Hospital of Zhengzhou University from Jan. 1st，2020 to Oct. 31st，2020. They were randomly divided into group SD and group Dex according random number table ，with 40 cases in each group. At the same time ，40 patients with preoperative PSQI score ＜7 were selected as group C. Thirty min before anesthesia induction ，Dexmedetomidine hydrochloride injection 0.4 μg/kg was injected intravenously in group Dex. Etomidate emulsion injection ，Sufentanil citrate injection and Rocuronium bromide injection were used for anesthesia induction in 3 groups，and Ropofol medium/long chain fat emulsion injection + Remifentanil hydrochloride for injection was used to maintain anesthesia. The drug use ，operation time ，PACU stay time and postoperative hospital stay were recorded in 3 groups. The cognitive function was evaluated 2 h before operation and 1，3，5，7 days after operation. The occurrence of POD was observed. The plasma levels of IL- 6 and S 100β were measured 2 h before operation ，2 h after operation ，1，3，5 days after operation. The occurrence of ADR was recorded. RESULTS ：There was no statisti cal significance in intraoperativ e drug use and operation time among 3 groups （P＞0.05）. The PACU stay time ， the incidence of POD and the duration of POD in group SD an d lixxi18@126.com group Dex were significantly higher or longer than group C ， while the Dex group was significantly lower or shorter thangroup SD （P＜0.05）. The postoperative hospitalization stay ofgroup SD was significantly longer than group C and group Dex （P＜0.05），and there was no statistical significance between group Dex and group C （P＞0.05）. Before operation ，there was no statistical significance in MMSE scores or plasma levels of IL- 6 and S100β among 3 groups（P＞0.05）. MMSE scores of group C 1，3 days after operation ，those of group SD and group Dex 1，3，5 and 7 days after operation were significantly lower than those before operation. MMSE scores of group SD and group Dex 1，3，5 and 7 days after operation were significantly lower than group C at corresponding period ；the group Dex was significantly higher than the group SD at corresponding period （P＜0.05）. The plasma levels of IL- 6 and S 100 β at different time points were significantly higher than before operation ，and the group SD and group Dex were significantly higher than the group C ，and the group Dex was significantly lower than group SD at corresponding period （P＜0.05）. There was no statistical significance in the total incidence of ADR among 3 groups（P＞0.05）. CONCLUSIONS ：SD can promote the occurrence of POD in liver tumor resection elderly patients. Dexmetomidine can reduce the incidence of POD in elderly patients with preoperative SD ，the mechanism of which may be associated with the inhibition of IL- 6 and S 100β expression and the alleviation of brain injury with good safety.

Schwannoma quístico del porta hepatis / Cystic Schwannoma of Porta Hepatis

Resumen Introducción: Los Schwannomas de la vía biliar corresponden a una entidad extremadamente infrecuente, habiéndose reportado solo escasos casos en la literatura. Caso Clínico: El presente paciente corresponde a un hombre de 45 años, a quien durante examen rutinario se le pesquisa una lesión quística hepática. La resonancia magnética confirmó la lesión, y la biopsia de la pieza resecada diagnosticó la existencia de un Schwannoma benigno con marcadores positivos para vimentina y proteína S-100.

Introduction: Bile duct schwannoma is an extremely rare condition. We report a 45 years old male patient in whom during a rutinary ultrasound exam a liver cyst was detected. Magnetic resonance confirmed lesión and the histopathology of the resected specimen was a benign schwannoma proven by positive inmunoreaction to vimentina.

Tumores hepáticos fetales, a propósito de un caso de hemangioendotelioma gigante / Fetal hepatic tumors, apropos of a case of giant hemangioendothelioma

RESUMEN Se comunica el caso de una tumoración hepática fetal gigante diagnosticada en el tercer trimestre de embarazo, que cursó con signos de inminencia de falla cardiaca. Las pruebas posnatales confirmaron la sospecha de hemangioma hepático. Actualmente, se encuentra en manejo expectante con evolución hacia la regresión. Adicionalmente, revisamos las características de los principales tumores hepáticos primarios fetales.

ABSTRACT Case report of a giant fetal hepatic tumor diagnosed in the third trimester of pregnancy that presented signs of imminent cardiac failure. Postnatal tests confirmed the suspicion of hepatic hemangioma. Currently, the patient is under expectant management, evolving towards regression. We review the characteristics of the main fetal primary liver tumors.

Hemangioendotelioma hepático infantil multifocal / Multifocal hepatic hemangioendothelioma

INTRODUCCIÓN: El hemangioendotelioma hepático (HEH) es un tumor benigno, raro en niños, que se presenta frecuentemente en el primer año de vida. La presentación clínica es variable y su diagnóstico se realiza en base a la sospecha clínica, estudios de laboratorio y de imagen. El objetivo fue describir un caso de hemangioendotelioma hepático multifocal. CASO CLÍNICO: Niña de 3 meses que presentó hepatomegalia sin elementos de falla hepática ni cardiaca. Se realizó ecografía y tomografía de ab domen que orientaron al diagnóstico de HEH que se confirmó con la angioresonancia de abdomen. Recibió glucocorticoides a altas dosis en forma prolongada. Al año y medio de iniciado el tratamiento se evidenció remisión del tumor. Presentó efectos secundarios por el tratamiento instaurado. CONCLUSIONES: La presencia de una hepatomegalia aislada en un lactante asintomático debe hacer pensar en una probable patología tumoral, orientándonos por la clínica e imagenología al diagnóstico nosológico de la misma. Siempre se debe sospesar las posibles complicaciones con los riesgos de los tratamientos a realizar. En este caso la extensión del tumor y sus probables complicaciones justificó el uso de corticoterapia prologada a altas dosis a pesar de sus efectos adversos.

INTRODUCTION: Hepatic hemangioendothelioma is a rare benign tumor in children, which frequently occurs in the first year of life. The clinical presentation is variable and the diagnosis is based on clinical suspicion, and laboratory and imaging studies. The objective was to describe a case of multifocal hepa tic hemangioendothelioma. CLINICAL REPORT: 3-month-old girl who presented hepatomegaly without elements of hepatic or heart failure. Abdominal ultrasound and CT scan were used to diagnose hepatic hemangioendothelioma, which was confirmed by CT abdominal angiography. The patient received glucocorticoid treatment at high doses for a prolonged period. A year and a half after treatment, there was evidence of tumor remission. She had side effects from the established treatment. CONCLUSIONS: In asymptomatic patients with isolated hepatomegaly, it should be considered a probable tumor patho logy, considering the clinic and imaging studies. Possible complications and treatments risks must always be assessed. In this case, the tumor extension and its probable complications justified the use of prolonged corticosteroid therapy at high doses despite its adverse effects.

Transauricular arterial access for hepatic artery embolization in rabbit VX2 liver tumor

Purpose: The purpose of this study is to evaluate the feasibility of percutaneous transauricular artery access for hepatic artery catheterization using a peripherally inserted central catheter (PICC) device and hepatic artery catheterization through auricular approach. Methods: Ten New Zealand White rabbits were used to establish a VX2 liver tumor model. Hepatic artery angiography and embolization were performed 3 weeks after inoculation. The rabbits were restrained in supine position under anesthesia. Intra-arterial access was accomplished with percutaneous Seldinger technique through the auricular artery using a PICC device. The hepatic artery catheterization was performed with a microcatheter and guide wire. The rate of technical success and procedure time was investigated. Results: Two rabbits failed initial percutaneous transauricular arterial access, with success in a contralateral attempt. Thus, percutaneous transauricular arterial access was achieved in 10 of 12 auricular arteries, with a technical success rate of 83.3%. The time needed to obtain intra-auricular access was 7.2 ± 3.1 min. Hepatic artery catheterization, angiography, and embolization were accomplished through the auricular approach in all 10 rabbits. Conclusion: Arterial access in rabbits can be achieved through the auricular artery. Hepatic artery catheterization, angiography, and embolization can be performed through auricular arterial access

Guidelines for application of computer-assisted indocyanine green molecular fluorescence imaging in diagnosis and surgical navigation of liver tumors (2019) / 南方医科大学学报

Computer-assisted combined indocyanine green (ICG) molecular fluorescence imaging technology can be used for preoperative planning and intraoperative detection from three-dimensional (3D) morphological anatomy and level of cellular function to guide the anatomical, functional and radical hepatectomy of liver tumor. This technology has received wide acceptance and has shown important diagnostic and therapeutic value. This guideline is intended to standardize the application of computer-assisted combined ICG molecular fluorescence imaging for accurate diagnosis and treatment of liver tumors in the following aspects: (1) the workflow of 3D visualization technology; (2) the mechanism and application flow of ICG molecular fluorescence imaging; (3) clinical application of 3D visualization technology and virtual reality technology; and (4) clinical application of ICG molecular fluorescence imaging. ICG molecular fluorescence imaging can help to define tumor boundary, determine hepatic segment and hepatic lobectomy tangent at the molecular and cellular level, and detect small lesions or metastases. According to the fluorescence signal characteristics of liver tumors and combined with rapid frozen pathological examination during operation, the differentiation degree of liver space-occupying lesions (such as primary liver cancer) can be preliminarily determined, and residual tumors and biliary leakage on the hepatic section can be detected after hepatectomy. Computer-assisted ICG molecular fluorescence imaging in the diagnosis and surgical navigation of liver tumors provides a new approach to digital diagnosis and treatment of liver tumors. With its development in clinical practice and the technological innovation, this technology will be further improved to allow more accurate diagnosis and treatment of liver tumors.

The efficacy of radiofrequency ablation combined with splenectomy in treatment of hepatocellular carcinoma with liver cirrhosis and hypersplenism / 中华肝胆外科杂志

Objective To study the efficacy and safety of radiofrequency ablation combined with splenectomy in treatment of primary liver cancer with liver cirrhosis and hypersplenism.Methods Thirty patients with hepatocellular carcinoma complicated with liver cirrhosis and hypersplenism were treated in Fuyang People's Hospital from January 2016 to December 2017.These patients were randomly divided into the observation group (n =15) and the control group (n =15).Surgical liver resection combined with splenectomy was performed in the control group,and radiofrequency ablation combined with splenectomy was performed in the observation group.The time of thermal ischemia,operation time,intraoperative blood loss,blood transfusion volume,length of hospital stay,platelet level and liver function 1 week after surgery,and the incidences of postoperative complications and the overall survival rates 2 years after surgery were compared between the two groups.Results The operation times of the observation group and the control group were (89.1 ± 18.4 vs.118.9 ± 33.6) rin,blood loss (228.4 ± 120.5 vs.362.2 ± 159.5) ml,blood transfusion (192.3±112.4 vs.503.8±196.2) ml,and length of hospital stay (13.5±6.0 vs.21.9±11.6) d (all P＜0.05).After a week of operation,the indicators in the observation group were significantly better than the control group (all P＜0.05).The postoperative two-years complication rate in the observation group was 13.3％,which was significantly lower than the control group (46.7％,P＜0.05).There was no significant difference in the survival rates between the two groups two years after surgery.Conclusions Radiofrequency ablation combined with splenectomy for treatment of liver cancer with cirrhosis and hypersplenism effectively reduced postoperative complications,preserved liver function,increased platelet levels,improved hypersplenism,and was safer.It is a surgical method worthy of generalization.

Radio technician operation specification of multi b value DWI technique applied to liver tumor detection / 医疗卫生装备

Objective To enhance the standardized operation of multi b value DWI technique when the radio technician detects liver tumors.Methods The operation specifications of multi b value DWI technique applied to liver benign tumors diagnosis were analyzed for MRI conventional examination,MR-DWI scan,MR-DWI image processing.Considerations were also taken on unified detection standard,supervision system,management mechanism and etc.Results Radio technician was improved in operation specification when used multi b value DWI technique to detect liver tumors. Conclusion Radio technician operation specification of multi b value DWI technique has to be strengthened to enhance the clinical efficacy.

The clinical features and treatment of liver abscess formation after TACE for metastatic liver tumors / 介入放射学杂志

Objective To investigate the clinical features,related risk factors,the efficacy and safety of clinical management about liver abscess formation occurring after transcatheter arterial chemoembolization (TACE) for metastatic liver cancer.Methods Among 1812 patients with metastatic liver tumors who were receiving TACE,23 patients developed liver abscess.The clinical features and risk factors for abscess formation were retrospectively analyzed.The curative effects and safety of percutaneous puncture cavity drainage (PCD),or combined with percutaneous transhepatic cholangiography and drainage (PTCD) were analyzed.Results The incidence of liver abscess after TACE for metastatic liver tumors was 1.3％ (23/1812).Postoperative high fever,chill,elevated white blood cell count and increased neutrophil proportion were the main clinical features of liver abscess.The mean time before the diagnosis of liver abscess was confirmed was (11.3±3.7) days after TACE.The hepatic metastatic malignancy originated from the malignant tumor of digestive tract was seen in 73.9％ of patients,18 patients (78.3％) had a history of gastroenteric surgery,and 12 patients (52.2％) had a history of diabetes mellitus.The number of hepatic metastatic lesions was more than 3 in 19 patients (82.6％).After the formation of liver abscess,the liver functions became worse in all patients (P=0.024).In 19 patients (82.6％),angiography showed that the metastases were hypovascular lesions.Blood and pus cultures revealed that E.coli was the main infectious bacteria of liver abscess.The mean time of using anti-infective drugs before hepatic abscess developed liquefaction was (10.4±3.3) days,and the mean time of abscess liquefaction was (15.9±3.7) days.The mean value of the maximum diameters of abscesses was (9.2±2.0) cm.PCD was employed in all patients,the average times of PCD procedure was (3.7±1.7) times.PCD followed by PTCD was performed in 7 patients as they had biloma associated with obstructive jaundice.The average drainage time for liver abscess was (3.1 ±1.7) months.No infectious peritonitis,tumor rupture,or tumor implantation at puncture point was observed.The median survival time of 23 patients with liver abscess was (8.0±0.7) months.The median survival time in patients who received PCD procedure only was (9.0±1.0) months,while it was (5.0±0.7) months in patients who received PCD together with PTCD,and statistically significant difference in the median survival time existed between the above two groups (P=0.041).Conclusion The risk factors of liver abscess formation after TACE in patients with metastatic liver tumors include the site of primary tumor and gastrointestinal surgery.Diabetes may be one of the risk factors.Clinically,the lesions of liver abscess are usually multiple and they often occur in hypovascular lesions with central necrosis,The nain infectious bacteria are from digestive tract,and biloma is easy to develop.Active and effective antibiotic treatment plus puncture drainage of abscess cavity,or combined with PTCD,are effective treatment measures for this kind of liver abscess.

Bibliometric Analysis of Traditional Medicine for Liver Tumor Based on PubMed / 世界科学技术-中医药现代化

In order to provide reference for treatment of liver tumors using traditional Chinese medicine, we analyzed the research status of liver tumor treatment with traditional Chinese Medicine based on PubMed. By the bibliography information concurrence mining system (BICOMB 2013), the literature were collected and analyzed from PubMed database from the day of establishment to 31 October 2017. CytoScape3.6.1 software was used to draw the Co-occurrence analysis chart of high-frequency subject headings and the subheadings, and SPSS17 statistical software was used to cluster the high frequency subject headings. 365 literatures were collected in total. The amount of published articles is increasing year by year. The literatures were mainly in English. From the literature indicating the author's country, we found that 70％ of the top 10 countries and regions which published the most papers were from Asia. Among them, Chinese scholars ranked first. The top 5 of the high-frequency subject headings and the subheadings were Humans, Male, Animals, Liver Neoplasms/drug therapy and Carcinoma, and Hepatocellular/drug therapy. The research focused on the following 9 aspects: metabolism of liver cells, neoplasms, liver cancer pathology, pharmacological efficacy of liver cancer, relationship between cell proliferation and apoptosis and efficacy; xenograft model antitumor assays in mice, pharmacology of antitumor Chinese herbal medicine or phytogenic drugs, the effects of dose-response relationship, cellular activity and signal transduction on drug efficacy, therapeutic uses of traditional and phytotherapy and the outcome and mortality of liver tumor. By the bibliometric analysis in the field of traditional medicine for liver tumor, we can understand the research direction and development status of this field, which can be reference for prevention and treatment of liver cancer with TCM.

Quantitative assessment of angiogenesis of rabbit liver tumors by using fiat detector CT in the angiography suite / 介入放射学杂志

Objective To investigate the feasibility of quantitatively evaluating angiogenesis in liver tumors by using flat detector computed tomography (FDCT) in the angiography suite.Methods The VX2 liver tumor model was established in 25 rabbits,and then FDCT examination was performed for each animal.After reconstructing the blood volume (BV) perfusion map,BV values of the hepatic tumor and parenchyma were measured respectively.All experimental rabbits were sacrificed after FDCT,and the corresponding tumor specimens were collected for measuring microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression level.The relationships of BV values with MVD and VEGF expression in liver tumors were analyzed.Results Of the 25 experimental rabbits,FDCT examination was successfully accomplished in 22(88.0％).Both the hepatic parenchyma and tumor lesions could be clearly visualized on BV perfusion map.The hepatic tumor was characterized by a hyperperfusion rim with a hypoperfusion center,known as rim-like enhancement pattern,on BV perfusion map.BV values bore a close relationship to both MVD grade and VEGF grade (P＜0.05 in both),while MVD grade had a parallel relationship with VEGF grade (r=0.504,P＜ 0.001).Conclusion It is feasible to use FDCT in the angiography suite to quantitatively assess the angiogenesis of liver tumors.It may be helpful for interventional treatment of liver tumors.

Establishing improved rabbit model bearing VX2 liver tumor and application of hepatic artery and portal vein catheterization / 中国介入影像与治疗学

Objective To establish rabbit model bearing VX2 liver tumor using improved technique,and to analyze the relevant impact factors of hepatic artery and portal vein catheterization.Methods Transplanted liver tumors of 60 healthy New Zealand white rabbits were established through open abdominal puncture and hepatic artery and portal vein catheterization.The rabbits were divided into A group (survival) and B group (death) according to whether a short-term (within 7 days after surgery) death occurred or not.The univariate analysis of the factors which could lead to the death of rabbits were analyzed.The Logistic regression models were established with parameters which were significantly different between the 2 groups,and independent risk factors which could lead to the failure of the experiment were analyzed.Results VX2 tumors were successfully implanted in the liver to all 60 rabbits.Nine (9/60,15.00 ％) rabbits died within 7 days,while 51 (51/60,85.00％) rabbits survived,weight ＜ 2.5 kg,additional intraoperative anesthesia,operation time ≥60 min,length of incision ≥5 cm and blood loss of operation ≥25 ml were impact factors (all P＜0.05).Weight ＜ 2.5 kg,additional intraoperative anesthesia and the blood loss of operation ≥25 ml were independent risk factors for death (P＜0.01).Conclusion Relative high success rate of building rabbit models bearing VX2 liver tumor may achieved using hepatic artery and portal vein catheterization.Larger weight of rabbits,training of surgical skills,less intraoperative blood loss are helpful to avoid intraoperative additional anesthesia,thus reducing mortality of rabbits.

Immunotherapy experimental study of γδT cells from human peripheral blood on human liver cell nude mouse xenograft in vivo / 中国免疫学杂志

Objective:To study the immunotherapy effects of different doses of human peripheral blood γδT cells on human hepatoma cells (SMMC-7721) xenograft model.Methods: (1)The nude mouse model of liver cancer was established by inoculated BALB/c mouse subcutaneous with human hepatoma cell line (SMMC-7721).(2)The mononuclear cells in healthy human were extracted from peripheral blood,and specific amplification γδT cells in vitro.(3) The nude mouse model divided into 5 groups by random.The positive control group was 5-Fu,negative control group was normal saline(NS).The treatment group was injected different doses of γδT cells(1×105,5×105 and 25×105)by nude mice tail vein.The positive control group injected 5-Fu by enterocoelia,negative control group injected NS by tail veins.The inhibition effect of different dose γδT cells on tumor was observed,including weight,food intake and growth conditions,etc.and the changes of tumor volume (TV),relative tumor volume (RTV)and relative tumor appreciation rate[T/C(%)] were compared with positive control group and negative control group.Results: Different dose of γδT cells had different degree of inhibition on nude mouse xenograft growth.RTV compared with saline negative control group was statistically significant (P<0.05).Compared with the positive control group of 5-Fu,the TV growth was significantly lower than the 5-Fu,degree of inhibition was similar in RTV each dose group,and all slightly higher than the 5-Fu positive control group.The each dose group of T/C (%)was slightly lower than the relative tumor proliferation rate of the control group of 5-Fu,but had no significant difference.Conclusion: The γδT cells from peripheral blood had significant inhibitory effect on nude mice transplanted liver tumor and it may be used as a new treatment for liver cancer immunotherapy provide experimental data.

Risk factors of massive blood loss during resection of giant liver hemangioma / 中华肝胆外科杂志

Objective To evaluate the risk factors of massive blood loss in resection of giant liver hemangioma.Method The clinical data of 141 patients who underwent giant liver hemangioma resection were retrospectively studied.These data included general physical condition,laboratory tests,radiologic findings,and various surgical parameters.The patients were divided into the massive blood loss group (＞ 1 000 ml,n =27) and the minor blood loss group (≤1 000 ml,n =114).Logistic regression was performed to determine the risk factors of intraoperative massive blood loss.Results The average diameter of the liver hemangioma was significantly greater in the massive blood loss group than that in the minor blood loss group [(21.7 ± 8.5) cm vs.(14.1 ± 5.3) cm,P ＜ 0.05].The incidences of preoperative leukopenia,anemia,thrombocytopenia and prolonged prothrombin time were higher in the massive blood loss group than that in the minor blood loss group (48.1％ vs.16.7％,37.0％ vs.11.4％,25.9％ vs.3.5％,22.2％ vs.3.5％,respectively,all P ＜ 0.05).Hepatic hemangioma with compressed hepatic veins,inferior vena cava and porta hepatis were more frequently found in the massive blood loss group than in the minor blood group (55.6％ vs.14.9％,44.4％ vs.14.0％,55.6％ vs.12.3％,respectively,all P＜0.05).Logistic regression analysis demonstrated a diameter of hemangioma greater than 15 cm was a risk factor of intraoperative massive blood loss during surgical resection.Conclusions Giant hepatic hemangioma may cause disorders in the hematological and coagulation systems.Compression of major hepatic vessels raised technical difficulty and risks in surgery.Hemangioma with a diameter greater than 15 cm was recognized as a high-risk factor of intraoperative massive blood loss.

The feasibility of breath control management guided stereotactic ablation body radiotherapy of liver tumors by volumetric modulated arc therapy / 中华放射医学与防护杂志

Objective To investigate the feasibility and plan quality of the image-guided volumetric modulated arc therapy (VMAT) based voluntary deep exhale breath-holding technique in the stereotactic ablative body radiotherapy (SABR) for liver tumors.Methods Fifteen patients with liver tumors were involved in this study.All patients were immobilized with voluntary deep exhale breath hold (vDEBH) combined with real-time position management (RPM) respiratory gating system.Treatment was planned using VMAT with 2 modified partial arc and re-planned using intensity modulated radiation therapy (IMRT) technique for comparison.Dosimetric parameters were calculated for plan quality assessment.Quality assurance studies included absolute dose and multiple planar dose verifications,total monitor units and delivery time analysis.Daily cone beam computed tomography imaging was used to verify the motions.Results There were no significant dosimetric differences between VMAT and conventional IMRT plans (P ＞0.05).Both techniques were able to minimize doses to organs at risk including normal liver,kidneys,spinal cord,and stomach.However,the average monitor units with VMAT were significantly lower 28.1％ than those with IMRT(t =3.064,P ＜0.05).The average beam-on time in VMAT plans was 31.6％ shorter than that in IMRT plans(t =2.278,P ＜ 0.05).Conclusions The utilization of VMAT in the treatment planning of SABR for liver tumors under breath control mode has better dosimetrics.In comparison to conventional IMRT plans,VMAT plans have higher efficiency and feasibility.

Application of intraoprerative ultrasound in malignant liver tumor / 中华肝胆外科杂志

Intraoperative ultrasonography (US) is the very important tool for liver surgery which not only provides the operating surgeon with useful real-time diagnostic and staging information that may result in an alteration in the planned surgical approach,but also provides the guidance for hepatectomy,vessel patency and intraoperative tumor ablation procedures.The indications,equipment,techniques and the benefits and limitations as well as future expectations are discussed.

Effect of Shenqi Fuzheng injection on invasion of MHCC97L cells based on RNA interference technology / 中国现代普通外科进展

Objective:To investigate the inhibitory effect of Shenqi Fuzheng injection on the expression of VEGF gene in human hepatocellular carcinoma cell line MHCC97L,and to elucidate the effect of Shenqi Fuzheng injection on tumor invasiveness,and to validate it through siRNA technology.Methods:After 24 hours of addition of Shenqi Fuzheng Injection (MHC) in the culture system of MHCC97L,Real-time PCR and Western-blot were used to detect the expression of MMP-9 and MMP-9 in the control group (Shenqi Fuzheng),negative control group (NaCI) And the expression of VEGF and RNA in the blank control group,and to determine the effect of Shenqi Fuzheng injection on the expression of VEGF and RNA.The effect of Shenqi Fuzheng Injection on the invasiveness of MHCC97L cells was detected by Transwell assay.The lentiviral vectors of MHCC97L cells were transfected into 293T cells and transfected into MHCC97L cells.The transfected cells were transfected into 293T cells by Lipofectamine 2000,and transfected into MHCC97L cells.The Effect of Shenqi Fuzheng Injection on the Invasion of VEGFi Tumor by Transwell.Results:Shenqi Fuzheng injection could significantly decrease the expression of VEGF mRNA and protein in normal MHCC97L cells (P＜0.05),and decrease the invasiveness of tumor cells (P＜0.05).VEGF RNA interference was successful.After intervention,Shenqi Fuzheng injection could not decrease the invasiveness of MHCC97L tumor (P＞0.05).Conclusion:Shenqi Fuzheng injection can reduce the invasion of MHCC97L cells by inhibiting the expression of VEGF gene.