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Objective To explore the effect of fish oil fat emulsion as perioperative nutritional support on patients with liver cirrhosis and portal hypertension.Methods Randomized controlled clinical trial was performed between September 2011 and September 2017 in patients with liver cirrhosis and portal hypertension who underwent pericardial devascularization and splenectomy.Hypocaloric total parenteral nutritional support (TPN) started from the first day after the operation for 5 consecutive days.Patients were divided into experimental group and control group according to thetype of fat emulsion used.43 patients in experimental group were applied for fish oil fat emulsion injection (10％ Omegaven) + medium long chain structure fat emulsion (20％STG) and 42 patients in control group were applied for medium long chain structure fat emulsion (20％STG).Liver function (total bilirubin and alanine aminotransferase),nutrition index (serum albumin and prealbumin),inflammatory mediators (TNF-α,IL-6 and IL-10) were measured before and after the operation,and the clinical outcomes were observed.Results There was no statistically significant difference in liver function and nutritional indices between the experimental group and the control group (P＞0.05).The inflammatory mediators like TNF-u,IL-6 and IL-10 on the first day after surgery were significantly higher than those before surgery in both groups [experiment group:(225.54±54.78) vs.(61.49±16.47),(74.94±6.36) vs.(39.84±2.77),(77.53±11.4) vs.(46.05±6.13) ng/L;control group:(229.26±62.15) vs.(63.48±13.76),(77.23±7.83)vs.(40.64±3.34),(73.89±7.97)vs.(44.88±5.72) ng/L;P＜ 0.01].With the progress of time,the proinflammatory factors like TNF-α and IL-6 decreased after the operation and the range of decrease was higher in experiment group than in control group [d4-d 1:(-56.88± 31.63) vs.(-35.96±20.02),(-13.52±5.20) vs.(-6.38±2.84) ng/L;d7-d1:(-150.67±42.58) vs.(-132.79±53.35),(-27.04±8.97) vs.(-20.85±6.38) ng/L;P＜ 0.05].The range of increase in anti-inflammatory media IL-10 was higher in experiment group than in the control group (d4-d1:(14.22±13.08) vs.(5.64±3.58) ng/L;d7-d1:(17.78±5.58) vs.(-37.96±11.43) ng/L;P＜0.05).The incidence of grade Ⅲ complications and total complications (4.7％ vs.21.4％,23.3％ vs.45.2％) and hospitalization time [(10.12 ±1.48) vs.(12.33±2.04) d] in the experimental group were significantly lower than those in the control group (P＜0.05).Conclusions In patients with liver cirrhosis and portal hypertension,perioperative nutritional support of fish oil fat emulsion can reduce systemic inflammatory response and operative complications and promote rapid recovery through its two-way regulation of inflammatory mediators.
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Objective To investigate the molecular expression and clinical significance of Vimentin and E-cadherin during epithelial-mesenchymal transformation of hepatocellular carcinoma (HCC) tissues.Methods Hepatocellular carcinoma and paracancerous tissue were collected from 55 patients,while nonneoplastic nonnal liver tissue were collected from 20 patients without cancerous diseases as control group.Expressions of Vimentin and E-cadherin were examined by immunohistochemistry staining.Clinicopathological features of the relative expression of Vimentin and E-cadherin,and its influence on prognosis were discussed as well.Results Vimentin was positively expressed in 69.1％ cancer tissue,and was significantly higher than paracancerous tissues and normal liver tissues(P ＜ 0.05).E-cadherin was positively expressed in 27.3％ cancer tissue and was significantly lower compared with paracancerous tissues and normal liver tissues(P ＜0.05).The expression of Vimentin and E-cadherin was negatively correlated(r =-0.653,P ＜ 0.05).Vimentin expressions in subgroups of TNM stage Ⅲ-Ⅳ,poor differentiation,multiple tumor nodules,metastasis and recurrence were all significantly higher than the respective subgroups as TNM stage Ⅰ-Ⅱ] (x2 =7.267,P ＜ 0.05),moderate to well differentiation (x2 =4.045,P ＜ 0.05),single tumor node (x2=12.143,P ＜0.05),without metastasis or recurrence (x2 =7.267,P ＜ 0.05).On the contrary,Ecadherin showed higher expression in the subgroup of single tumor node compared with multiple tumor nodules(x2 =6.878,P ＜ 0.05).The follow-up of patients further demonstrated that patients with positive Vimentin expression had a significantly lower disease-free survival compared with the Vimentin negative group (P ＜0.05).Conclusions Vimentin and E-cadherin both participated in epithelial-mesenchymal transition process of hepatocellular carcinoma.High expression of Vimentin and low expression of E-cadherin were closely correlated with occurrence and development of HCC.Vimentin and E-cadherin may serve as impottant biomarkers in clinical diagnosis and prognosis prediction of HCC.
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0.05). All of the indexes in control group were lower on post-operative day 7 than those of pre-operation. The levels of pre-albumin,transferrin, fibronectin, IgG,IgM, CD~+_3, CD~+_4 T cells and nitrogen balance in the study group were significantly higher than those of control group.Negative nitrogen balance began to be positive in the study group on the post-operative day 7. However, the nitrogen balance in the control group was still negative on the post-operative day 10. The duration of hospitalization in the r-hGH group was shorter than that of the control group. The 1-year, 2-year and 3-year survival rates and recurrence rate were not different between two groups.(Conclusions) The post-operative short-term use of the r-hGH plus HPN in patients with excisable gastrointestinal cancer is safe, effective and benefit for the post-operative recovery.
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Objective To evaluate the effect of combination of growth hormone(GH),somatostatin(ST) with hypocaloric parenteral nutrition(HPN) on SAP patients with MOD. Methods forty one cases of SAP complicated with MOD were randomedly divided into control group (20 cases) and experiment group (21 cases). In experiment group ,total calories and nitrogen were given 62.9～83.9kJ/(kg?d) and 0.10～ 0.12g/(kg?d). lipid calorie was supplied in less than 40 percent of the total energy.GH was percutaneously injected for 7d and ST was intravenously injected for 7～14d. Control group was given TPN only.Serum albumin, pre albumin, transferring,CRP,total lymphocyte count(TLC), urea nitrogen, nitrogen balance and serum TNF ?, IL 1,IL 6 level were determined before treatment and on the day 7 after treatment. Results After treatment, serum albumin and pre albumin and transferring increased significantly (P