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Objective:To investigate the influencing of portal vein embolization (PVE) and PVE combined with transcatheter arterial chemoembolization (TACE) on secondary hepatectomy and prognosis of patients with initially unresectable hepatocellular carcinoma (HCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 102 patients with initially unresectable HCC who were admitted to the Third Affiliated Hospital of Naval Medical University from October 26,2015 to December 31,2022 were collected. There were 82 males and 20 females, aged 52(range,25?73)years. Of 102 patients, 72 cases undergoing PVE combined with TACE were set as the PVE+TACE group, and 30 cases undergoing PVE were set as the PVE group. Observation indicators: (1) surgical resection rate of secondary hepatectomy and increase of future liver remnant (FLR); (2) situations of secondary hepatectomy; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the Mann-Whitney U test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and Log-Rank test was used for survival analysis. Results:(1) Surgical resection rate of secondary hepatectomy and increase of FLR. The surgical resection rate of secondary hepatectomy in the PVE+TACE group and the PVE group were 72.2%(52/72) and 53.3%(16/30), respectively, showing no significant difference between the two groups ( χ2=3.400, P>0.05). The surgical waiting time, increasing volume of FLR, growth rate of FLR in the 52 patients of PVE+TACE group receiving secon-dary hepatectomy were 20(range, 14?140)days, 140(range, 62?424)mL, 9.8(range, 1.5?26.5)mL/day, respectively. The above indicators in the 16 patients of PVE group receiving secondary hepatectomy were 16(range, 12?35)days, 160(range, 95?408)mL, 10.5(range, 1.2?28.0)mL/day, respectively. There was no significant difference in the above indicators between the 52 patients of PVE+TACE group and the 16 patients of PVE group ( Z=1.830, 1.498, 1.266, P>0.05). (2) Situations of secondary hepatectomy. The operation time, rate of tumor necrosis (>90%, 60%?90%,<60%), cases with complications ≥ grade Ⅲa in the 52 patients of PVE+TACE group receiving secondary hepatectomy were 200(range, 125?420)minutes, 8, 4, 40, 28, respectively. The above indicators in the 16 patients of PVE group receiving secondary hepatectomy were 170(range, 105?320)minutes, 0, 0, 16, 4, respectively. There were significant differences in the above indicators between the 52 patients of PVE+TACE group and the 16 patients of PVE group ( Z=2.132, ?2.093, χ2=4.087, P<0.05). (3) Follow-up. Sixty-eight patients who completed the surgery were followed up for 40(range, 10?84)months. The 1-, 3-, 5-year recurrence free survival rate in the 52 patients of PVE+TACE group receiving secondary hepatectomy were 73.0%, 53.3%, 35.4%, respectively. The above indicators in the 16 patients of PVE group were 62.5%, 37.5%, 18.8%, respectively. There was a significant difference in the recurrence free survival rate between the 52 patients of PVE+TACE group and the 16 patients of PVE group ( χ2=4.035, P<0.05). The 1-, 3-, 5-year overall survival rate in the 52 patients of PVE+TACE group receiving secondary hepatectomy were 82.5%, 61.2%, 36.6%, respectively. The above indica-tors in the 16 patients of PVE group receiving secondary hepatectomy were 68.8%, 41.7%,20.8%, respectively. There was a significant difference in the overall survival rate between the 52 patients of PVE+TACE group and the 16 patients of PVE group ( χ2=4.767, P<0.05). Conclusion:Compared with PVE, PVE+TACE as stage Ⅰ surgery can increase the surgical resection rate of secondary hepatec-tomy and the recurrence free survival rate of patients with initially unresectable HCC, prolong the long-term survival time, but not influence the growth rate of FLR.
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BACKGROUND: Traditional Chinese medicine has proposed the theory of “treatment for flaccidity aims at Yangming meridian” in the Internal Canon of Medicine. However, there have been relatively few reports on electroacupuncture at the stomach channel of Foot Yangming in the treatment of spinal cord injury. OBJECTIVE: To investigate the effect of electroacupuncture stimulation of Zusanli and Futu on Caspase-3 expression in injured segments of spinal cord injury rats. METHODS: Sixty-four Sprague-Dawley female rats, SPF grade, were randomly divided into four groups, i.e., control group, pre-labeling group, post-injury labeling group and electroacupuncture group, with 16 rats in each group. The control group and the pre-labeling group were intraperitoneally given Brdu (50 mg/kg) for 10 days before the operation. The control group was given a bite to remove the lamina on the 11th day, which did not damage the spinal cord. A model of spinal cord injury was made in the pre-labeling group on the 11th day. The post-injury labeling group and the electroacupuncture group were injected intraperitoneally with Brdu for 10 days after the spinal cord injury was made, and the post-injury labeling group was not treated. The electroacupuncture group started electroacupuncture at Zusanli and Futu acupoints on the 3rd day after the model was established. Spinal cord specimens were taken at 3, 10, 17, and 24 days after injury in each group, and the changes in the number of neurons were observed by hematoxylin-eosin staining. The expression of Brdu positive cells was observed by immunohistochemistry. The changes in Caspase-3 mRNA and protein expression were detected by qRT-PCR and western blot, respectively. The study protocol was approved by the Animal Ethic Committee of Guangxi Medical University, with an approval No. 201712001. RESULTS AND CONCLUSION: The expression of Caspase-3 mRNA and protein after spinal cord injury was higher than that of the control group without spinal cord injury, and the number of neurons after spinal cord injury was significantly lower than that of the control group. With the passage of time, the mRNA and protein expression of Caspase-3 gene in the pre-labeling, post-injury labeling and electroacupuncture groups increased first and then decreased, while the Caspase-3 expression in the electroacupuncture group decreased significantly, which was significantly different from that in the pre-labeling and post-injury labeling groups (P < 0.05). Hematoxylin-eosin staining results showed that the number of neurons in the electroacupuncture group was significantly higher than that in pre-labeling and post-injury labeling groups, and gradually approached the number of neurons in the control group on the 24th day. Immunohistochemical results showed that the positive protein expression in the electroacupuncture group increased first and then decreased, reaching the highest on the 17th day and the lowest on the 24th day. The overall positive protein expression was significantly higher than that in the other groups (P < 0.05). To conclude, electroacupuncture stimulation of Zusanli and Futu acupoints can reduce the expression of Caspase-3 mRNA and protein, reduce the apoptosis of nerve cells, and promote the number of neurons, thus promoting the regeneration and repair of nerve cells.