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Hepatocellular carcinoma has a low early diagnostic rate, and there is a lack of highly sensitive and specific tumor markers. In recent years, fluid biopsy technique, represented by circulating free DNA (cfDNA), has become an auxiliary method for the diagnosis of cancer and has attracted more and more attention due to its advantages of noninvasiveness, convenience, and repeatability. With reference to the recent studies in China and foreign countries, this article summarizes and analyzes the advances in cfDNA in the diagnosis and treatment of hepatocellular carcinoma from the aspects of biological characteristics, detection techniques, and clinical application, so as to provide a basis for clinical diagnosis and treatment.
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Objective To investigate a new clinical classification of hepatolithiasis based on biliary anatomy and pathology in order to guide clinical decision-making.Methods The cases of hepatolithiasis admitted to our hospital from Mar 2015 to Aug 2018 were classified into six types and an additional type according to biliary anatomy,stone site and extent,liver pathological changes,and Oddi sphincter function.Results Of the214 cases of hepatolithiasis,5 cases (2.3％) were type Ⅰ;41 cases (19.2％) were type Ⅱ;76 cases (35.5％) were type Ⅲ;17 cases (7.9％) were type Ⅳ;29 cases (13.5％) were type Ⅴ;46 cases (21.5％) of type Ⅵ.The most common complication was incision infection (28 cases,13.1％),liver failure 0,and perioperative death 0.During the follow-up from 3 months to 3 years,there were 14cases of stone recurrence,the recurrence rate was 7.6％.Conclusion This classification scheme and the "individualized precise anatomical combined hepatectomy or segmental hepatectomy" based on this classification is safe and effective while enhancing the cure rate.
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Objective To explore the use of CA199,CEA,CA50 and ALP combined with magnetic resonance imaging (MRI) in diagnosis of intrahepatic bile duct stones with early bile duct carcinoma.Methods The clinical diagnosis of 36 cases of patients with hepatolithasis-associated intrahepatic cholangiocarcinoma (HICC) and 118 cases with intrahepatic duct stone (IHDS) were analyzed retrospectively.Serum CA199,CEA,CA50,ALP and magnetic resonance (MRI,MRCP) were performed and the results were analyzed.Results Abdominal pain discomfort in Hepatolithasis-associated intrahepatic cholangiocarcinoma showed multiple symptoms.Three typical Charcot syndromes were rare.On the gender distribution,intrahepatic bile duct stones was frequently found in women,on the contrary,Hepatolithasis-associated intrahepatic cholangiocarcinoma was frequently more found in men (P ＜0.05) Abdominal pain and fever in patients of Hepatolithasis-associated intrahepatic cholangiocarcinoma was more than that of patients with Intrahepatic bile duct stone (P＜0.05) When alkaline phosphatase (ALP) was more than 169 U/L,significant difference was seen between two groups (P＜ 0.05) According to the diagnosis of HICC,the accuracy of CA199,CEA,CA50 combined with ALP was 88.6％,the accuracy of magnetic resonance examination alone was 90.2％,and the accuracy of multiple serological markers and magnetic resonance was 95.5％.Conclusion MRI combined with serum CA199,CEA,CA50 and ALP can effectively improve the HICC preoperative diagnosis rate.
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It has been shown, however, that in terms of immune function, a transitional stage of dendritic cell maturation exists between immature myeloid dendritic cells (imDCs) and mature dendritic cells (DCs), which were named semimature dendritic cells (smDCs). Therefore, the theory that DCs can be classified as imDCs and mDCs has been challenged because of finding smDCs. SmDCs and imDCs are regarded as tolerogenic dendritc cells while what concrete mechanism taken by smDCs and imDCs in transplantation immunity has yet to know. The authors analyzed the important roles and the advanced molecular mechanism of smDCs and imDCs in transplantation immunity in order to update and widen understand underlying tolerogenic dendritic cells.