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It is well known that Tokyo University Hospital (TUH) is one of the most famous medical centers around the world in Japan. Among several departments in TUH, the Department of Hepatobiliary-Pancreatic Surgery and Artificial Organ and Transplantation Division are representative predominant divisions, which have high-quality diagnostic and treatment service systems being at the leading position in the world. The authors visit the Department of Hepatobiliary-Pancreatic Surgery and Artificial Organ and Transplantation Division in 2022. When studying and working in TUH, the authors make a multi-angle comparisons of the development status and technical levels of hepatobiliary and pancreatic surgery among TUH, western countries and China. It aims to share and exchange with fellow surgeons at home and abroad, and bring benefits or enlightenment to the professional advancement of them.
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Intrahepatic cholangiocarcinoma (ICC) is the second most common human liver malignancy and its incidence rate has been gradually increasing worldwide over the past decades. Surgical resection (R0 resection) is the preferred potentially curative treatment for ICC patients. However, due to its conceal clinical features and high invasiveness, most patients have lost the opportunity for surgical resection at the time of diagnosis. In recent years, with the rapid development of targeted therapy and immunotherapy, which is represented by immune checkpoint inhibitors, clinicians are expected to provide more effective treatment options for patients with mid-stage or advanced ICC. At present, there are still controversial opinions on different guidelines regarding preoperative biliary drainage, the extent of hepatectomy, the definition of R0 resection, the width of the resection margin, lymph node dissection, postoperative recurrence, adjuvant therapy, etc. In this review, 12 guidelines or expert consensus published worldwide from 2012 to 2022 (including 4 Chinese guidelines, 4 European guidelines, 2 American guidelines and 2 Japanese guidelines) were retrieved. Focusing on sorting and comparing the current views on clinical management of ICC in different guidelines, this review aims to provide reference information for ICC clinical management and decision-making.
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The tumor microenvironment of hepatocellular carcinoma (HCC) is complex, leading to the high heterogeneity, occurrence and development of HCC. Exosomes are one of the most important components of HCC tumor microenvironment. Exosomes are membranous vesicles with the diameter about 40~160 nm, consisting with protein, nucleic acid and other substances, and can carry out signal transmission between cells. The information regulation of HCC-derived exosomes in the tumor microenvironment has a significant impact on the malignant biological behavior of HCC. In recent years, studies on the role of exosomes in the detection, treatment and prognosis of HCC have been made in-depth. This review focused on the role of exosomes in the biological process of HCC microenvironment, and discusses the research progress of exosomes in the HCC angiogenesis, metastasis, epithelial-mesenchymal transformation and immune regulation and so on.
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Purpose@#Laparoscopy is being increasingly accepted for pancreaticoduodenectomy. Stapled anastomosis (SA) is used extensively to facilitate laparoscopic pancreaticoduodenectomy (LPD); however, the incidence of anastomotic bleeding after stapled gastrointestinal anastomosis is still high. @*Methods@#One hundred and thirty-nine patients who underwent LPD using Whipple method were enrolled in our study. We performed the SA with our reinforced method (n = 68, R method) and without the method (n = 71, NR method). We compared the clinical characteristics and anastomosis methods of patients with or without gastrointestinal-anastomotic hemorrhage (GAH), and operative parameters were also compared between the anastomotic methods. @*Results@#Of the 139 patients undergoing LPD, 15 of them developed GAH. The clinical characteristics of patients with or without GAH were not significantly different except in the anastomotic method (P < 0.001). In the univariate logistic regression analyses, only the anastomotic method was associated with GAH. Furthermore, patients with the NR method had significantly higher incidences of GAH (P < 0.001) and Clavien-Dindo grade ≥ III complications (P < 0.001). @*Conclusion@#Our retrospective analysis showed that the SA performed with reinforced method might be a reform of SA without the reinforcement, as indicated by the lower incidence of GAH. However, further research is necessary to evaluate the utility of this reinforced method.
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Hepatocellular carcinoma cells interact with tumor microenvironment, and exhibits There are temporal and spatial heterogeneity of hepatocellular carcinoma which interacts with tumor microinvironment. In this paper, we summarized the characteristics of hepatocellular carcinoma heterogeneity, the mechanism of heterogeneity, and the impact of hepatocellular carcinoma heterogeneity on diagnosis and treatment, so as to provide a new thinking direction for the diagnosis and treatment of hepatocellular carcinoma.
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Primary liver cancer is one of the common malignant tumors and its mortality ranks third in the world. Because there are no obvious symptoms in the early stage of liver cancer, most patients are diagnosed as advanced stage, without the opportunity of surgical resection. The authors report a case of hepatocellular carcinoma with portal vein tumor thrombus, which reduced significantly after hepatic artery infusion chemotherapy combined with bevacizumab and atezolizumab, showing the safety and efficacy.
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Objective To study the association between ratio of peritumoral hepatic stellate cells to γδ T cells ratio (SGR) and prognosis of patients with hepatocellular carcinoma (HCC) after curative resection.Methods From January 2011 to December 2013,the clinical data of 320 patients with HCC who underwent curative resection at the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Chongqing Medical University were collected and analyzed retrospectively.Immunohistochemistry was used to calculate the SGR in adjacent cancer tissues.Survival was estimated by Kaplan-Meier method.Prognosis of HCC patients was analyzed by univariate and multivariate analyses.Results Multivariate analysis revealed multiple tumors (HR =1.895,95％ CI:1.155-3.108),microvascular invasion (HR =1.665,95％ CI:1.104-2.512),tumor size ＞ 5 cm (HR =2.400,95％ CI:1.603-3.594) and peritumoral SGR ＞ 18 (HR =1.880,95％ CI:1.257-2.810) were independent risk factors of the overall survival rate in HCC patients.Preoperative AFP ＞ 20 μg/L (HR =1.631,95％ CI:1.151-2.311),microvascular invasion (HR =2.145,95％ CI:1.536-2.994),tumor size ＞ 5 cm (HR =1.866,95％ CI:1.342-2.592) and peritumoral SGR ＞ 18 (HR =1.517,95％ CI:1.084-2.122) were independent risk factors of the tumor-free survival rate in HCC patients.Patients were then divided into the low SGR (ratio≤ 18,n =222) and high SGR groups (ratio ＞ 18,n =98) using SGR in adjacent cancer tissues.The overall survival and tumor-free survival rates of the low SGR group were significantly better than the high SGR group (P ＜ 0.05).Conclusion Peritumoral SGR was an independent prognostic factor of patients with HCC following radical resection.The prognosis of patients with low SGR was better.
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Objective :To observe influence of Ginkgo ketone ester dropping pills (GKE) combined atorvastatin on vascular endothelial function ,serum levels of omentin-1 and homocysteine (Hcy) in hypertensive patients with ca-rotid arteriosclerosis (CAS).Methods : A total of 120 hypertensive patients with CAS treated in our hospital were selected ,randomly and equally divided into atorvastatin group and combined treatment group (received GKE com-bined atorvastatin ) ,both groups received corresponding therapy based on health education ,diet and exercise etc for 12 weeks.Blood pressure ,blood lipids ,carotid intima-media thickness (IMT ) ,plaque size ,levels of endothelin (ET)-1 ,nitric oxide (NO) ,serum omentin-1 and Hcy were compared between two groups before and after treat- ment .Results : Compared with before treatment ,there were significant reductions in blood pressure ,blood lipids (except significant rise in HDL-C) ,serum levels of ET-1 and Hcy ,IMT and plaque size ,and significant rise in ser-um levels of NO and omentin-1 in two groups after treatment , P＜0-01 all.Compared with atorvastatin group after treatment ,there were significant reductions in blood pressure ,blood lipids (except significant rise in HDL-C) ,ser-um levels of ET-1 [ (136-42 ± 15-57) μg／ml vs.(116-57 ± 13-28) μg／ml] and Hcy [ (15-46 ± 3-25 ) μmol／L vs. (10-58 ± 3-11) μmol／L] ,IMT [ (1-43 ± 0-21) mm vs.(1-26 ± 0-19) mm] and plaque size [ (22-53 ± 1-28) mm2 vs.(20-67 ± 1-14 ) mm2 ] ,and significant rise in serum levels of NO [ (102-43 ± 12-37) μmol／L vs.(129-84 ± 13-36) μmol／L] and omentin-1 [ (176-57 ± 45-20 ) μg／ml vs.(198-73 ± 45-38) μg／ml] in combined treatment group , P＜0-05 or ＜0-01- Conclusion : Ginkgo ketone ester dropping pills combined atorvastatin can significantly improve vascular endothelial function and arteriosclerosis while reducing blood pressure and blood lipids in hyperten-sive patients with carotid arteriosclerosis .
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The relationship between inflammation and cancer has long been the focus of the medical research direction,the infiltration of inflammatory cells is always accompanied by the evolution process of malignant tumor,a lot of inflammatory cells and tumor cells are mutually induced,and lead to a inflammation cascade reaction,finally gradually form an immune network of inflammatory tumor,which not only involves in the occurrence and development of tumor,but also affects the prognosis of patients.In recent years,clinical studies have confirmed that the detection of peripheral blood related inflammatory immune cells can accurately predict the prognosis of hepatocellular carcinoma.Based on the collection of related information at home and abroad,a summary was made to clarify the effects of inflammatory immune cells on the prognosis of hepatocellular carcinoma.
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Objective@#To investigate the correlation between Ishak inflammation score and the clinicopathological characteristics and recurrence of patients with hepatocellular carcinoma (HCC) after curative resection, and then set up a recurrence nomogram for HCC.@*Methods@#A total of 326 patients with HCC after curative resection from January 2006 to December 2009 were studied retrospectively as training cohort and 110 HCC patients after surgery from January 2010 to December 2012 were used as validation cohort.Clinical follow-up data and peritumoral Ishak inflammation score in training cohort were used to set up a nomogram predicting recurrence of HCC, which was verified by validation cohort. Kaplan-Meier and Cox proportional hazard regression model were used to analyzed accuracy of model prediction.@*Results@#According to Ishak inflammation score, patients were divided into four subgroups: Grade Ⅰ(1-4 scores), Grade Ⅱ(5-8 scores), Grade Ⅲ (9-12 scores) and Grade Ⅳ(13-18 scores). Ishak inflammation score were associated with aspartate transaminase(median 36.0 U/L, P=0.011), γ-glutamyl transpeptidase(median 54.5 U/L, P=0.005), HBV-DNA load(20.5%>106 copies/ml, P=0.015) and microvascular invasion(26.7% positive, P=0.021). Multivariate analysis showed that Ishak inflammation score(P=0.007), HBV-DNA load(P<0.01), tumor size(P=0.001) and microvascular invasion(P=0.001) were related with the recurrence of HCC patients.These four risk factors were incorporated into the nomogram.Calibration curves of the nomogram had good agreement between prediction and observation in the probability of recurrence.Both C-indexes and receiver operating characteristic curve analyses revealed that this nomogram had better predictive abilities than those of the AJCC and Barcelona Clinic Liver Cancer (BCLC) stage systems.These results were verified by the validation cohort.@*Conclusion@#A nomogram based on Ishak inflammation score could accurately predict the recurrence of HCC and contribute to HCC relapse surveillance after curative hepatectomy.
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[Objective]To investigate the effect of pellino-1 gene overexpression by lentivirus vector on the ubiquitin of tumor necrosis factor receptor-associated factors 3 (TRAF3) and the activation of mitogen-activated protein kinases (MAPK) signaling pathway in endotoxin-tolerant kupffer cells (KCs).[Methods]Isolated KCs of C57BL/6 mouse were randomly divided into two groups:control group,which transfected with control lentivirus vector for 48 h,then pretreated with 10 ng/mL lipopolysaccharide (LPS)for 24 h,and next treated with 300 ng/mL LPS;overexpression group,which transfected with pellino-1 gene overexpression lentivirus vector for 48 h,then pretreated with 10 ng/mL lipopolysaccharide(LPS)for 24 h,and next treated with 300 ng/mL LPS. The protein expressions of pellino-1,K48-Ub,TRAF3,p38,p-p38,c-Jun N-terminal kinase(JNK)and p-JNK were analyzed by Western blot. The level of interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)and interleukin-10(IL-10)in superna-tants were measured by enzyme linked immunosorbent assay(ELISA).[Results]Compared with control group,the protein expres-sions of pellino-1,K48-Ub,p-JNK and p-p38 and the levels of IL-1β(P < 0.05),TNF-α(P < 0.05)in supernatants was in-creased in overexpression group,while the protein levels of TRAF3 and the levels of IL-10(P < 0.05)in supernatants were de-creased.[Conclusion]Overexpression of pellino-1 can promote TRAF3 K48 ubiquitination degradation,decrease the protein expres-sion of TRAF3,activate the downstream MAPK signaling pathway,and thus impair the formulation of endotoxin tolerance.
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The paper discusses the acquisition and utilization of APP medical resources from medical literature,medical information,evidence-based medicine,medical community,and other specialized and various supporting tools,so as to provide references for continuous education and learning of medical staffs.
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Objective: To investigate the correlation between FIB-4 and the clinicopathological characteristics and prognosis of patients with hepatocellular carcinoma (HCC) after curative resection. Methods: From January 2009 to December 2012, the clinicopathological and follow-up data of 245 patients with HCC after curative resection were retrospectively studied. Their survival was calculated using the Kaplan-Meier method. The Cox proportional hazard regression model was used for the multivariate analysis. Results: According to FIB-4 index, patients were divided into two subgroups: FIB-4Ⅰ(≤3.25) and FIB-4Ⅱ(>3.25). FIB-4 could predict liver cirrhosis severity (Ishak grade, Grade 1-5 vs. Grad 6, r=0.681, P<0.001). It was associated with liver function such as:aspartate transaminase (P<0.001)、total bilirubin (P=0.009)、albumin (P=0.001) and platelet count (P<0.001) other than tumor clinicopathologic features. Both univariate and multivariate analysis showed FIB-4 could predict the prognosis of HCC patients (Overall survival: P=0.037 and 0.011; Recurrencefree survival: P=0.027 and P=0.043, respectively). Conclusion: The preoperative FIB-4 index could be used as a prognostic marker for the prognosis of HCC after curative hepatectomy.
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The National Natural Science Foundation-supported papers in the field of epidemiological methods and health statistics since 1987 were analyzed by trend analysis in order to have a better understanding of the development,current situation and history in the field of epidemiological methods and health statistics,and provide reference for the selection of topics,approval of projects and optimization of supporting structure in the field of epidemiological methods and health statistics.
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Objective To explore the current status of sexual education and real needs of college freshmen in Kunming.Methods By applying random sampling,350 students from three universities in Kunming were investigated by seff-administered questionnaire,and 310 valid questionnaires were recovered.Fesults 23.9％ students confirmed that the schools do not provide courses related to sexual health,and 22.9％ of the surveyed students claimed that they even did not heard any sexual education courses in their schools.The main sources of students to acquire information in terms of sexuality and sexual health are network television,video magazines,friends and classmates.Both male and female students are more acceptable to carry out sex education lectures.There were significant differences between male and female students in the form of obtaining sexual education,the content of sexual education and the demand of sexual education in three aspects (P＜0.05).Girls tend to carry out sexual education in the form of major courses,but boys tend to the form of playing video or distributing books and periodicals (P＜0.05).Girls tend to obtain the courses on sexually disease,AIDS,heterosexual intercourse,or love psychology,but boys tend to contraceptive knowledge and skilIs,or Sexual value orientation (P＜0.05).Girls are more likely to acquire the knowledge of masturbation,sexual health,or sexual health,but boys prefer to the knowledge of sexual psychology,parasexuality,or homosexuality (P＜0.05).Conclusion As a main body of educational institute for young people,all universities should provide training courses related to sexuality and sexual health at the early stage of higher education in order to equip college students with essential knowledge and skills to have safer and positive impact on their college studies.
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Objective To investigate the effect of heat stress on organ indices, intestinal morphology, gastric mu-cosal HSP70 mRNA expression and glucose metabolic hormones in mice.Methods A single-factor experiment was de-signed for the present research.Eighteen KM mice of the similar age and weight were randomly divided into control group and heat stress group.The weight of the heart, liver, spleen, lung and kidney, as well as the expression of HSP70 mRNA in the mouse gastric mucosa were measured.The plasma concentration of insulin and glucagon, the villus height and crypt depth of the duodenum and jejunum were detected.The histological changes of the liver, duodenum and jejunum were also examined.Results There was no effect of heat stress on the organ indices.It significantly increased the expression of HSP70 mRNA in the gastric mucosa, reduced the plasma insulin level and caused serious injury to the liver, duodenum and jejunum in the mice.Conclusions Heat stress does not significantly affect the organ indices in mice, but can significantly increase the expression of HSP70 mRNA in the gastric mucosa, cause apparent damages in the liver, duodenum and jeju-num, reduce the villus height, crypt depth and villus height/crypt depth ratio of the duodenum and jejunum, and also de-crease the blood insulin concentration in the mice.
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Objective To investigate the risk factors for heart failure in pregnant women with heart disease. Methods A retrospective analysis was made from 340 cases of pregnant women with heart disease in our hospital from January 2008 to December 2013. The pregnant women who presented heart failure were categorized in the observation group (n=65), and others were in the control group (n=275). Data was used to analyze by univariate and multivariate logistic regression for heart failure in pregnant women with heart disease. Results The total 340 cases of heart disease included 132(38.8%) of congenital heart disease, 86(25.3%) of rheumatic heart disease, 63(18.5%) of arrhythmia, 33(9.7%) of hypertensive heart disease and 26(7.6%) of peripartum cardiomyopathy. 65 cases (65/340, 19.1%) presented with heart failure, there were 4 cases resulted in death (1.2%). Multivariate logistic regression analysis showed that age≥35, the baseline parameters of New York Heart Academy (NYHA)≥Ⅱ, pulmonary artery pressure>50 mmHg (1 mmHg=0.133 kPa), baseline heart rate>100 bpm, cardiac events occurred before pregnancy were the independent risk factors for heart failure. Prenatal counseling and antenatal examination were the protective factors for heart failure. Conclusions There are a variety of influencing factors for the heart failure in pregnant women with heart disease. It is necessary to take targeted intervention measures in response to the influencing factors so as to reduce the development of heart failure.
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The rate of complete surgical resection is still low in hilar cholangiocarcinoma,which greatly affects the curative effect.Radiotherapy,one kind of treatment for tumors,has not been widely adopted in the past years.In recent years,with the development of radiotherapy technology,research of treating hilar cholangiocarcinoma through radiotherapy has become a spot.Many studies have shown that radiotherapy,as an adjuvant therapy for surgery and non-surgical treatment,can be the major means for treatment,and it could bring benefit for patients' survival extension and improvement of life quality.
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<p><b>OBJECTIVE</b>To evaluate the value of cone beam CT (CBCT) in the treatment of jaw bone cyst.</p><p><b>METHODS</b>Twenty-five patients with jaw bone cyst were included, which were examined by CBCT as an addition of panoramic radiography. Through CBCT, the information about the three-dimensional location, the bone wall of cyst and the relationship between cyst, teeth and some other important anatomical structures were studied, surgical preparations and treatments followed accordingly.</p><p><b>RESULTS</b>The CBCT images clearly demonstrated detailed information about the cyst, which was verified in the operation and helpful to the surgical preparation and treatment.</p><p><b>CONCLUSION</b>CBCT is more advantageous in the diagnosis and treatment of the jaw bone cyst than traditional panoramic radiography and periapical film.</p>
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Humanos , Quistes Óseos , Huesos , Tomografía Computarizada de Haz Cónico , Quistes , Enfermedades Mandibulares , Radiografía Panorámica , DienteRESUMEN
Objective To summarize the strategies of treatment and investigate the risk factors affecting the survival of patients with hepatic cancer recurrence and metastasis after liver transplantation.Methods The clinical data of 99 patients with hepatic cancer recurrence and metastasis after liver transplantation who were admitted to the Southwest Hospital of Third Military Medical University from January 1999 to September 2011 were retrospectively analyzed.Of the 99 patients,7 patients who did not meet the criteria were excluded from the study,and 92 patients were enrolled in the study.All patients were divided into single therapy group (18 patients) and combined therapy group (74 patients).The study was reviewed by the ethics committee,and all the patients signed the informed consent form.The survival time of the 2 groups was compared,and the risk factors affecting the survival time was analyzed.All data were analyzed using the t test,chi-square test or by calculating the Fisher exact probability.The survival curve was drawn using the Kaplan-Meier method,and the survival time was compared by the Log-rank test.Factors influencing the prognosis were analyzed using the multivariate linear regression analysis.Results The survival time of patients in the single therapy group and the combined therapy group after hepatic cancer recurrence and metastasis were (5.5 ± 1.1) months and (8.5 ± 1.6) months,respectively,with a significant difference between the 2 groups (Log-rank value =7.489,P ＜ 0.05).The survival time were (7.9 ± 1.5) months for patients in TNM Ⅱ and Ⅲ A,and (7.0 ± 1.3) months for patients in TNM Ⅲ B and ⅣA,with significant difference between the 2 groups (Log-rank value =2.567,P ＜0.05).The survival time of patients with moderately or well differentiated tumors after tumor recurrence and metastasis was (8.1 ± 1.5) months,which was significantly longer than (7.2 ± 1.4)months of patients with poorly differentiated tumor (Log-rank value =2.749,P ＜ 0.05).TNM stage,tumor differentiation,Milan criteria,great vessel invasion were independent factors affecting the survival of patients with hepatic cancer recurrence and metastasis (t =2.610,3.132,4.378,2.258,P ＜ 0.05).Conclusions Combined therapy can significantly prolong the survival time of patients with hepatic cancer recurrence and metastasis.Earlier hepatic cancer recurrence and metastasis after liver transplantation result in a shorter survival time.TNM stage,tumor differentiation,great vessel invasion and Milan criteria are risk factors affecting the survival of patients with hepatic cancer recurrence and metastasis after liver transplantation.