Twist Expression in Circulating Hepatocellular Carcinoma Cells Predicts Metastasis and Prognoses.

Hepatocellular carcinoma (HCC) is one of the leading malignancies worldwide. Enumeration of circulating tumor cells (CTCs) has been demonstrated to be a prognostic indicator in HCC. Twist plays a critical role in metastasis and has been proposed as a biomarker for epithelial-mesenchymal transition (EMT). However, links between the expression of Twist in CTCs and HCC clinical parameters are still unclear. This study aims to evaluate the relationship between Twist expression in CTCs and clinicohistopathological risk factors of HCC. Between June 2015 and July 2017, 80 HCC patients and 10 healthy volunteers were enrolled in this study. CTCs were isolated and analyzed by the optimized CanPatrol™ CTC-enrichment technique. Our analysis showed that Twist+ CTCs were detected in 54 of the 80 (67.5%) HCC patients. The positive ratios of Twist+ CTCs correlated with portal vein tumor thrombi, TNM staging, AFP, cirrhosis, tumor number, tumor size, and microvascular invasion. Meanwhile, the follow-up results of the 33 HCC patients who underwent hepatectomy showed that the positive ratios of Twist+ CTCs were closely correlated with the rate of metastasis or recurrence and the mortality rate. The ROC curve analyses suggested that the prognostic evaluation of Twist+ CTCs outperforms CTCs alone. Twist+ CTCs showed higher expression in Glypican-3 protein. In conclusion, Twist expression in CTCs could serve as a biomarker for evaluating HCC metastasis and prognosis.

[Diagnosis and treatment of biliary complications after liver transplantation: analysis of 258 cases].

OBJECTIVE: To investigate the approaches to diagnosis, treatment and prevention of the biliary complications after orthotopic liver transplantation (OLT). METHODS: The clinical data were collected from 258 adult patients receiving orthotopic liver transplantation between August, 2004 and December, 2011, among whom 56 patients with biliary complications were identified to analyze the diagnosis and treatment of the complications. RESULTS: The incidence of biliary complication was 22.13% in the 258 recipients of secondary liver transplantation. Of the 56 patients with biliary complication, 32 (57.14%) had biliary stricture and 24 (42.86%) had bile leakage; 36 (64.29%) patients presented a simple type of biliary complication and 20 (35.71%) had a composite type, including bile leakage, biliary obstruction, biliary calculi, biliary tract infections, biliary sludge formation, and biliary tract bleeding. Thirty-one patients (55.36%) underwent routine endoscopic retrograde cholangiopancreato- graphy (ERCP), percutaneous transhepatic cholangiography (PTC) and other endoscopic or interventional treatments, and 23 (74.19%) were cured or showed improvement, while 3 died due to multiple organ dysfunction syndrome (MODS). CONCLUSION: Appropriate surgical approaches and skills in bile duct anastomosis are crucial to reduce the incidence of biliary complications following liver transplantation. Non-surgical treatment (including ERCP) is the primary option, followed by surgical bile duct exploration, for the management of biliary complications; liver retransplantation is the most effective life-saving means for patients with liver graft non-function. But still, prevention of biliary complications is of pivotal importance to improve the outcome of liver transplantation.

Detection of urinary metabolomics before and after Pringle maneuver-induced liver ischemia and reperfusion injury in rats using gas chromatography-mass spectrometry.

BACKGROUND: Metabolomics studies can quantitatively detect the dynamic metabolic response of living systems. OBJECTIVE: To detect urinary metabolomics after hepatic ischemia/reperfusion (I/R) injury induced by the Pringle maneuver using gas chromatography-mass spectrometry (GC-MS). METHODS: Male Sprague-Dawley rats (N = 80) were randomly divided into 4 groups (n = 20/group): sham operation, day 1, day 3, and day 5. Rats in the day 1, day 3, and day 5 groups underwent the Pringle maneuver. Serum alanine transaminase (ALT) and total bilirubin (TBIL) were measured, and hematoxylin and eosin (HE) staining of the liver tissue was performed. GC-MS was used to detect urinary metabolomics. RESULTS: Compared with the sham group, the serum ALT and TBIL levels at day 1 were significantly elevated (P < 0.01) and then decreased and reached close to normal levels at day 5. GC-MS detected 7 metabolites which had similar changes as those of liver tissue revealed by histological examination. Significant differences in lactic acid, pyruvic acid, alanine, serine, and glycerol-3-phosphate were found among the groups (P < 0.001). Principle component analysis showed that 7 metabolites distinguished the day 1 and day 3 groups from the sham group. CONCLUSIONS: Noninvasive urinary metabolomic analysis is a potential means for the early detection and diagnosis of hepatic I/R injury.