Thought and practice of long-term management for hepatobiliary and pancreatic malignant tumors / 中华肝胆外科杂志

Radical resection is the only measurement to cure patients of hepatobiliary and pancreatic tumors. The comprehensive application of endoscopy, interventional therapy, radiotherapy and systemic therapy can not only significantly improve the early diagnosis rate of the disease, and successfully transform some borderline resectable tumors into radical resectable states, but also reduce the recurrence rate of tumors after surgery, thus prolonging the survival time of patients. In recent years, the continuous emergence of new systemic therapeutic drugs has brought new opportunities for patients with hepatobiliary and pancreatic malignancies, but the number of doctors participating in diagnosis and treatment has also increased accordingly. Therefore, the contradiction between the division system based on treatment methods and the orderly and standardized treatment is becoming more and more prominent. According to the latest progress of hepatobiliary and pancreatic cancer research at home and abroad, and combined with our clinical experience, we proposed a long-term management concept based on hepatobiliary and pancreatic comprehensive multi-technical team. Based on this concept, we have carried out new thought and practice on the diagnosis and treatment of patients with hepatobiliary and pancreatic malignant tumors.

Discussion of issues related to Budd-Chiari syndrome / 国际外科学杂志

Budd-Chiari syndrome (B-CS) is a rare disease caused by hepatic vein outflow obstruction, and its etiology is complex and inconclusive. Current studies suggest that vascular dysplasia, gut microbiota and trace element imbalance may be related to the pathogenesis of B-CS, and the development of high-throughput sequencing technology may help to clarify the exact pathogenesis of B-CS. The symptoms of B-CS are not specific and rely mainly on imaging methods to establish the diagnosis, so there is an urgent need to find new noninvasive biological diagnostic markers. In addition, there are many pathological types and different criteria of B-CS, which mostly can′t fully reflect the pathophysiological changes of B-CS patients and guide clinical treatment. Therefore, we recommend pathophysiological classification according to the hemodynamic changes and collateral circulation compensation of B-CS, and then develop personalized treatment strategies for stratified management different from the traditional early diagnosis and treatment protocols. This article summarizes and discusses the above contents.

Reflection and practice of long-term management of hepatocellular carcinoma / 中华消化外科杂志

The treatment of hepatocellular carcinoma (HCC) has always been a hot spot of medical research worldwide. At present, surgical resection is the main therapy for HCC, supplemen-ted by interventional therapy, chemotherapy, radiotherapy, etc. Although the overall survival of HCC has been significantly improved in recent years, the overall effect is still unsatisfactory. New systemic therapeutic drugs are constantly emerging and applied to clinical practice, which bring new opportunities and challenges for the treatment of HCC. However, too many diagnosis and treatment topics bring obvious contradiction between the division system and the orderly and standardized HCC treatment. In the future, how to realize unified and standardized homogeneous diagnosis and treatment is the key problem to be solved urgently. The authors summarize the current status of diagnosis and treatment of HCC and propose the long-term management concept for HCC according to their own clinical experience and the current advances of the diagnosis and treatment at home and abroad, and carry out new practice and investigation on the patients with HCC by constructing a hepatobiliary multi-technical team.

Differentially expressed mRNA involved in the resistance of liver cancer to anlotinib / 临床肝胆病杂志

ObjectiveTo screen out the mRNAs involved in the resistance of hepatoma cells to anlotinib using ceRNA microarray. MethodsHigh-dose shock combined with low-dose induction was used to culture hepatoma cells resistant to anlotinib, and CCK8 assay was used to verify the difference in the proliferation of drug-resistant hepatoma cells treated by anlotinib. The ceRNA microarray was used to screen out the differentially expressed genes between drug-resistant hepatoma cells and normal hepatoma cells, and real-time PCR was used to verify the differentially expressed genes detected by some microarrays. the independent samples t-test was used for comparison of continuous data between two groups, and the Kaplan-Meier method was used to analyze the overall survival of hepatoma cells samples, and the log-rank test was used to compare survival rates. Fisher’s exact test was used for chip screening. ResultsThere was a significant difference in gene expression between drug-resistant hepatoma cells and normal hepatoma cells, and 10 genes with the greatest difference were screened out for analysis by reducing the range. There were 4 genes associated with drug resistance and tumor growth, i.e., BIRC2, BIRC7, ABCC2, and MAPK8. There were significant reductions in the expression levels of BIRC2, ABCC2, and MAPK8 (P=0001 4, 0001 2, and 0.011 8), and there was a significant increase in the expression of BIRC7 (P＜0.001). The results of real-time PCR were consistent with those of microarray (t=10.74,32.65,18.34, and 2.80; P=0.000 4, 0.000 1, 0.000 1, and 0.044 8). The high expression of BIRC7 and the low expression of MAPK8 were associated with the significant reduction in survival time (P=0.022 0 and 0.005 6). ConclusionBIRC2, BIRC7, ABCC2, and MAPK8 are differentially expressed between anlotinib-resistant hepatoma cells and normal hepatoma cells and may be involved in the resistance of hepatoma cells to anlotinib.

Establishment of Budd-Chiari syndrome models and related research advances / 临床肝胆病杂志

Budd-Chiari syndrome (BCS) is a clinical syndrome of portal hypertension caused by the occlusion of the hepatic vein or the inferior vena cava, with or without inferior vena cava hypertension, and the formation of inferior vena cava diaphragm and/or hepatic venous obstruction are the main features in the Chinese population. At present, little is known about the etiology and pathogenesis of BCS, and most of the studies are clinical studies of diagnosis and treatment strategies. There is a lack of experimental exploration and research on the pathogenesis of BCS, and stable models are a necessary condition for the research on pathogenesis. This article reviews and analyzes the methods for establishing BCS models, the features of each model, and related research advances, in order to provide a reliable experimental basis for the research on the etiology and pathogenesis of BCS.

Isolation, cultivation, and identification of human fibroblasts from cirrhotic liver / 国际外科学杂志

Objective To establish a method for isolating and culturing fibroblasts from cirrhotic liver in vitro,observe the biological characteristics of fibroblasts.Methods Human fibroblasts from cirrhotic liver were isolated and cultured by adhering to the culture plastic.The morphologic and growth characteristics of the acquired cells were observed by microscopy imaging and cell counting.The expression of FSP-1 and Vimentin of fibroblasts was detected through immunofluorescence and western blotting.Results The tissue blocks were well-adherent to the culture plastic within 2 hours.Hepatocyte-like cells were observed surrounding the blocks within about 1 week,and spindle-shaped fibroblasts were observed within about 2 weeks.After a series of passage,the attached cells became proliferated quickly.The growth curves of the passage 3,4 and 5 were quite similar.The result of immunofluorescence showed the expression of FSP1 and Vimentin was positive.The positive rate was respectively (90.6 ± 1.0) ％ and (91.2-± 4.1) ％.Conclusions Human fibroblasts from cirrhotic liver can be cultured successfully through adherent property.The method for isolation and culture of fibroblasts from cirrhotic liver is convenient,efficient,stable and cultured cells remain naive biological characteristics.

RNA interference targeting actin-associated protein Transgelin inhibits human pancreatic carcinoma xenograft in nude mice / 中华普通外科杂志

Objective To investigate the in vivo effect of silenced actin-associated protein Transgelin on the growth of human pancreatic carcinoma xenograft in nude mice.Methods Human pancreatic cancer cell line BxPC3 were transfected with small hairpin RNA (shRNA) eukaryotic expression vector targeting Transgelin gene.RT-PCR and Western blot were used to analyze Transgelin expression after transfection.24 animal models were randomly divided into three groups with 8 in each:Experimental group (transplanted BxPC3/Transgelin shRNA),negative control group (transplanted BxPC3/Neo) and untreated group (transplanted BxPC3).Tumor size was measured weekly.All mice were sacrificed after 28 days.Tumor volume was calculated,inhibitory effect was analyzed.Immunohistochemical staining of paraffin sections for Transgelin and proliferating cell nuclear antigen (PCNA) proteins were performed.Results Tumors varied in sizes among 3 groups (all P ＜ 0.05).On day 21 and 28 tumor was significantly smaller in experimental group than those in control groups.Tumor weighed(0.74 ±0.21) g in experimental group,lower than that in negative control group(1.42 ± 0.28) g and untreated group(1.59 ± 0.24) g (all P ＜ 0.05).The inhibitory effect was 53.5％ in experimental group.The PCNA index was significantly lower in experimental group than those in control groups (all P ＜ 0.05).Conclusions Deletion of Transgelin gene can significantly inhibit the proliferation and tumor growth of BxPC3 cells in nude mice.

Imaging diagnosis of hepatic nodules in patients with Budd-Chiari syndrome / 中华消化外科杂志

Hepatic nodules in patients with Budd-Chiari syndrome (B-CS) are identified in clinical work and the differentiating diagnosis is very important for making the treatment strategy.Most B-CS patients with hepatic nodules have nonspecific clinical manifestations.Ultrasonography,computed tomography and magnetic resonance imaging are often used for differentiating diagnosis.According to the results of retrospective study on clinical and imaging data of 51 B-CS patients with hepatic nodules,we draw a conclusion that the differentiating diagnosis of hepatic nodules in patients with B-CS depends on imaging characteristics.Different treatment strategies are adopted according to the comprehensive analysis of these imaging data and satisfactory results can be achieved.

Adult cavernous transformation of the portal vein / 中华普通外科杂志

Objective To set up a standard for surgical classification of cavernous transformation of the portal vein (CTPV) and their management strategy according to the classification.Methods The clinical data of 63 CTPV cases were analyzed retrospectively,the classification and the corresponding treatment strategy were evaluated.Results According to the imaging examination,surgical treatment and long-term follow-up,CTPV was classified into four types:Type Ⅰ:cavernous transformation involving main trunk of the portal vein and intrahepatic branches.Portasystemic shunt (mesocaval and splenocaval shunt)(or plus port-azygous devascularization) were used for this type;Type Ⅱ:cavernous transformation in the main trunk and proximal SV or SMV.Portasystemic shunt (mesocaval and splenocaval shunt) or plus portazygous devascularization were applied;Type Ⅲ:cavernous transformation involving the whole portal system.Portopulmonary shunt (splenopneumopexy) or inferior mesenteric-caval shunt plus port-azygous devascularization were suggested;Type Ⅳ:any types aforementioned accompanied by biliary and /or pancreatic abnormalities.The treatment should focus on main symptoms and two-stage operation.Conclusions Doppler ultrasound and multi-slice spiral CT (MSCT) three dimensional (3D) reconstruction are the mainstay for the diagnosis of CTPV;Correct diagnosis,classification as well as individualized management are of great importance in the treatment of adult CTPV.

Stage management of Budd-Chiari syndrome / 中华普通外科杂志

Objective To investigate the indication,feasibility and clinical effectiveness of stage management of Budd-Chiari syndrome(B-CS). Methods From Feb 2007 to June 2009,32 cases of Budd-Chiari syndrome(9 cases of type Ⅰ,17 cases of type Ⅲa,6 cases of type Ⅲ b)were admitted.Inferior vena cava hypertension(IVCHT)and portal hypertension(PHT)co-existed in all the patients.According to the clinicopathologic classification and hemodynamic compensation,these patients underwent single stage treatment(snrglcal procedure or radioactive intervention)or two-stage management(one.stagesurgical procedure/radioactive intervention plus two-stage surgical procedure/radioactive intervemion).Results Recovery was achieved in all patients without mortality.The main complications were Dleural effusion in 3 cases,acute heart failure in 2 cases and celiac lymphatic leakage in 1 case respectively.which were cured after medical treatment.In 4 months to 2 years follow-up,no recurrent cases were identified and all the patients were in good condition. Condusions Stage management of Budd.Chiari svndrome canalleviate the perioperative risk and clinical effectiveness can be achieved.The hemodynamic compensation is the basis on which stage management is adopted.

Treatment of Irritable Bowel Syndrome with Modified TongXieYaoFang: A 83 Cases Study / 国际中医中药杂志

Objective To study the effects of treating irritable bowel syndrome (IBS) with modified TongXieYaoFang. Methods 83 IBS patients were randomly recruited into a treatment group (45 patients) and a control group (38 patients). In the control group, Trimebutine, 200mg, and Bifid triple viable capsule, 420mg, 3 times/day was given orally to the patients, while on the basis of that, the treatment group was administrated with modified TongXieYaoFang in addition. Both groups were treated for one course of 4 weeks. Results The total effective rate of the treatment group and the control group was 93.3% and 71.1% respectively, showing significant difference between the two groups (X2=7.2938, P<0.01 ). Conclusion TongXieYaoFang combined with western medicine is effective in treating IBS.

Establishment of CEAP system for the diagnosis of portal hypertension / 中国普通外科杂志

Objective To set up CEAP system for the diagnosis of portal hypertention.Methods Based on CEAP system from American Venous Forum,the clinical and pathologic classification of Budd-Chiari syndrome from Xu,the clinical and pathologic data of 251 cases of portal hypertension were analyzed retrospectively.Results According to the results of imaging examination [(Doppler ultrasound,percutaneous splenoportography,selective angiography of mesenteric artery,multi-slice spiral CT(MSCT) three dimensional(3D) reconstruction],clinical and pathological data,CEAP system for the diagnosis of portal hypertention was defined as follows: Clinical manifestation(C) including mild and severe types;Etiology(E)(congenital,primary,secondary);Anatomy(A) consists of liver,inferior vena cava,hepatic veins,and portal vein system;Pathophysiology(P) could have liver fibrosis/cirrhosis,obstruction,thrombosis,intrahepatic collateral circulation and tumors.Conclusions CEAP system for correct diagnosis,classification as well as the individual treatment is of great practical importance,and could be wide application.