Laparoscopic Anatomical Liver Resection of Segment VIII by Using ICG Fluorescence Positive Staining Under the Guidance of Laparoscopic Ultrasonography.

BACKGROUND: Anatomical segmentectomy is a surgical procedure that completely removes a territory (or territories) of the third-order portal venous branches of a Couinaud segment (Wakabayashi et al. in J Hepatobil Pancreat Sci 29(1):82-98, 2022. https://doi.org/10.1002/jhbp.899 ). Laparoscopic segmentectomy of S8 is considered technically challenging because of the Precise dissection of the Glissonean pedicle of S8, and exposure of the middle and right hepatic veins are required (Ome et al. in J Am Coll Surg 230(3):e13-e20, 2020; Wakabayashi et al. in Ann Surg 261(4):619-29, 2015. https://doi.org/10.1097/sla.0000000000001184 ; Monden et al. in J Hepatobil Pancreat Sci 29(1):66-81, 2022. https://doi.org/10.1002/jhbp.898 ). This report describes a new approach, which can reduce unwanted damage to normal tissues and complications. METHODS: A 53-year-old man who has suffered from hepatitis B for 10 years was admitted for the treatment of two nodular tumors located in segment VIII. The surgical procedure began with the percutaneous injection of 5 mL, 0.025 mg/mL of ICG into the S8 portal branch by using an 18G PTCD needle under the guidance of laparoscopic ultrasound (Xu et al. in Surg Endosc 34(10):4683-4691, 2020. https://doi.org/10.1007/s00464-020-07691-5 ; Wang et al. in Ann Surg 274(1):97-106, 2021. https://doi.org/10.1097/sla.0000000000004718 ; Aoki et al. in J Am Coll Surg 230(3):e7-e12, 2020. https://doi.org/10.1016/j.jamcollsurg.2019.11.004 ), followed by liver transection on the cranial side of the liver, which used the ICG fluorescence images for exposing the roots of the middle and right hepatic veins and dissecting and ligating S8 portal pedicle. The excision specimen was sent for histopathological diagnosis. RESULTS: It took 200 min for the operation and 60 min for the total Pringle maneuver. The estimate of blood loss was 110 mL. The final histopathologic results of the two nodules were hepatocellular carcinoma (HCC). The patient was discharged on postoperative Day 6 with no complications. CONCLUSIONS: Laparoscopic anatomical liver resection of S8 has been demonstrated to be feasible. Under the guidance of laparoscopic ultrasonography, ICG positive staining was proven to be optimal for Anatomical segmentectomy.

Efficacy and safety of sequential therapy with sorafenib and regorafenib for advanced hepatocellular carcinoma: a two-center study in China.

Background: Regorafenib is a standard 2nd-line treatment for patients with advanced hepatocellular carcinoma (HCC), but the efficacy and safety of sequential therapy with sorafenib and regorafenib among advanced HCC patients in China is not clear. Methods: This was a retrospective, two-center, cohort study of advanced HCC patients who received sequential therapy of sorafenib and regorafenib from October 2018 to April 2020 at 2 Chinese institutions. The patients were converted directly to regorafenib after failing to respond to sorafenib monotherapy. The patients underwent evaluations every 4-6 weeks to determine the efficacy and safety of the treatment according to physiological, laboratory, and radiological results. A radiological evaluation using computed tomography or magnetic resonance imaging scans was conducted. The outcomes included overall survival (OS) and progression-free survival (PFS). Results: A total of 43 patients received regorafenib as a 2nd-line treatment after sorafenib progression. Of these patients, 26 (60.5%) and 17 (39.5%) were diagnosed with Barcelona Clinic Liver Cancer (BCLC) stages B and C, respectively. The median PFS was 11.0 [95% confidence interval (CI): 5.8-16.2] months, and the median OS was 17.0 (95% CI: 12.8-21.2) months. Conversely, the most common toxicities were hand-foot skin reaction (48.8%), diarrhea (32.6%), and hypertension (14%). The most common grade 3-4 toxicities were hypoalbuminemia (4.7%), anemia (4.7%), and thrombocytopenia (4.7%). Alpha-fetoprotein (AFP) ≥400, alanine transaminase (ALT) ≥60 IU/L, and aspartate aminotransferase (AST) ≥60 IU/L before 2nd-line treatment were associated with PFS in the univariable analyses. The Cox proportional-hazards regression analysis showed that AFP [hazard ratio (HR) =0.225; 95% CI: 0.073-0.688; P=0.009], ALT (HR =0.195; 95% CI: 0.051-0.741; P=0.016), AST (HR =0.209; 95% CI: 0.063-0.697; P=0.011), and presence of extrahepatic metastasis (HR =0.074; 95% CI: 0.009-0.608; P=0.015) before 2nd-line treatment were independently associated with PFS. Conclusions: The sequential therapy of sorafenib and regorafenib is well-tolerated and effective in advanced HCC patients after sorafenib progression based on our two-center real-world data. Patients with good liver function reserve and a high level of AFP before 2nd-line treatment may benefit from sequential treatment. These results still need further validation.

Purification, identification and molecular mechanism of dipeptidyl peptidase IV inhibitory peptides from discarded shrimp (Penaeus vannamei) head.

DPP-IV plays a key role for regulation of glucose metabolism in the body. The object of this study was to obtain DPP-IV inhibitors from discarded but protein-rich Penaeus vannamei (P. vannamei) head, and to explore the potential mechanism between DPP-IV and its inhibitors. P. vannamei head protein was hydrolyzed by five food grade proteases, respectively. The animal protease hydrolysate showed the highest inhibitory active. Then the hydrolysate was sequentially separated by ultrafiltration, gel filtration chromatography and reversed phase high-performance liquid chromatography (RP-HPLC), the peptides sequences were identified by LC-MS/MS and four potential peptides YPGE, VPW, HPLY, YATP showed superior DPP-IV inhibitory activity. Meanwhile, molecular docking effectively explored their mechanism through formed hydrogen bonds and hydrophobic regions. The four peptides showed better DPP-IV inhibitory activity stability with heating treatment, pH (1-10) treatment, and in vitro gastrointestinal digestion. Our results demonstrated that the protein hydrolysate from discarded P. vannamei head can be considered as a promising natural source of DPP-IV inhibitor for helping to improve glycaemic control in Type 2 diabetes.

Purification, identification, and molecular mechanism of DPP-IV inhibitory peptides from defatted Antarctic krill powder.

Dipeptidyl peptidase-IV (DPP-IV) inhibitors can reduce the blood sugar levels of diabetic patients by preventing the rapid decomposition of incretin hormone and prolonging its physiological effects. In this study, DPP-IV inhibitory peptides FAGDDAPR and LAPPRGSL were isolated from defatted Antarctic krill powder (DAKP) protein by the sequential purification of ultrafiltration, gel filtration chromatography, and RP-HPLC, and IC50 values of the two peptides were 349.70 ± 3.66 µM and 461.14 ± 0.87 µM, respectively. The FAGDDAPR and LAPPRGSL were identified by LC-MS/MS method, and the molecular models of DPP-IV and the two peptides were further constructed by AutoDock Vina software, the results revealed that the inhibition activity of FAGDDAPR and LAPPRGSL was mainly attributed to the formation of strong hydrophobic interactions and hydrogen bonds with amino acids of DPP-IV. PRACTICAL APPLICATIONS: DAKP is an economical by-product produced in the production of krill oil and contains high-quality protein, but these products were mainly used as fish feed and had low utility value in the past. DPP-IV inhibitors are an efficacious drug employed in the treatment of hyperglycemia processes. However, these drugs can cause undesirable side effects. Thus, the development of new natural hypoglycemic drugs with low side effects is a valuable strategy to be applied in therapeutic interventions.