ObjectiveTo summarize the application status and progress of indocyanine green fluorescence imaging in laparoscopic anatomic liver resection , and to analyze its advantages, limitations, and prospects.MethodThe literatures about indocyanine green fluorescence imaging in laparoscopic anatomic liver resection were reviewed.ResultsIndocyanine green fluorescence imaging had been preliminarily used in the operation of liver tumors and had shown its unique value in the anatomical liver resection, providing a new way to reduce the recurrence of liver cancer, improve the therapeutic effect, and prolong the survival time of patients.ConclusionsThe clinical application of indocyanine green fluorescence imaging in anatomic liver resection is still at the stage of development and popularization. Although it has unique advantages and development potential, it needs to be further improved in the aspects of tissue penetration, specificity, and staining success rate.
ObjectiveTo investigate the predictive value of preoperative red blood cell distribution width to platelet count ratio (RPR) and platelet-albumin-bilirubin (PALBI) scoring for postoperative complications after radical resection of hepatic alveolar echinococcosis (HAE). MethodsAccording to the inclusion and exclusion criteria, the clinicopathologic data of patients diagnosed with HAE and underwent radical hepatectomy in the Affiliated Hospital of Qinghai University from January 2018 to October 2022 were retrospectively collected. The risk factors affecting postoperative complications after radical hepatectomy for HAE were analyzed by univariate and multivariate unconditional logistic regression analysis, which were used to construct the nomogram. The receiver operating characteristic curve was used to evaluate the value in predicting postoperative complications by nomogram model. The discrimination of the nomogram was evaluated using Bootstrap internal 1 000 resampling and evaluated using a consistency index. The predicted postoperative complications probability by nomogram and actual postoperative complications probability were calculated by Kaplan-Meier method, and the calibration curve was drawn. The calibration ability of the nomogram model was evaluated by Hosmer-Lemeshow goodness-of-fit test. The decision curve analysis was used to evaluate clinical benefit of the nomogram model. ResultsA total of 160 patients with HAE radical hepatectomy were included, of which 105 had no postoperative complications and 55 had postoperative complications. The multivariate unconditional logistic regression analysis showed that the operation time ≥207 min, intraoperative bleeding ≥650 mL, and albumin ＜38 g/L, RPR ≥0.054, and higher PALBI grading (3 levels) were the risk factors affecting postoperative complications after HAE radical hepatectomy (OR＞1, P<0.05). Based on the risk factors, the nomogram was constructed. The area under the receiver operating characteristic curve (95%CI) predicted by the nomogram for the postoperative complications was 0.873 (0.808, 0.937), with an optimal cutoff value of 0.499. The consistency index was 0.855 for discriminating postoperative complications after HAE radical hepatectomy. The calibration curve was tested by Hosmer-Limeshow and showed a good fit between the predicted curve by the nomogram and actual curve (χ2=3.193, P=0.367), indicating that the nomogram had a good calibration ability. The decision curve analysis showed that there was a good clinical applicability within the range of 11% to 93% of the threshold probability. ConclusionsThe preoperative RPR and PALBI scoring are risk factors affecting postoperative complications after radical hepatectomy for HAE. The nomogram constructed with risk factors including RPR and PALBI has a good predictive value for postoperative complications after radical hepatectomy for HAE.
ObjectiveTo investigate the in vitro effect of pseudolaric acid B (PAB) on apoptosis of protoscolece cells and its regulatory effects on angiogenesis and cell apoptosis in the the lesion-host microenvironment tissue in vivo, as well as its possible mechanisms, in order to provide a basis for the clinical development of new alternative drugs for Echinococcus multilocularis. MethodsIn vitro experiments: the protoscoleces, vesicles, germinal cells, human foreskin fibroblasts (HFFs) and normal human liver cells were treated with different concentrations of PAB (0, 2.5, 5, 10, 20, 40, 80, 160 and 320 μmol/L) for 7, 5, 5, 5 and 5 days, then evaluated the survival rate of the protoscoleces, the release level of phosphoglucose isomerase (PGI) from the vesicles, the viability of the germinal cells, as well as the viability of HFFs and normal human liver cells. The protoscoleces and vesicles were fixed with 2.5% glutaraldehyde and used for scanning electron microscopy and transmission electron microscopy observation. Animal experiments: the protoscoleces were isolated from the abdominal lesions of the protected gerbils, and then infected 18 C57BL/6J mice by intraperitoneal injection to establish models, dividing into 3 groups with 6 mice in each group. The model group was given 0.3 mL of PBS by gavage daily, the albendazole (ABZ) group was given 0.3 mL ABZ (100 mg/kg) daily by gavage, the PAB group was given 0.3 mL of PAB (40 mg/kg) by gavage daily. After continuous gavage for 6 weeks, the lesion host microenvironment tissue was taken and ELISA was used to detect the expression levels of vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS) and cysteinyl aspartate specific proteinase3 (caspase3), the expression levels of nitric oxide (NO) was detected using a biochemical detection kit, Western blot was used to detect the expression levels of BCL2-associated X protein (Bax), B-cell lymphoma-2 (Bcl2), caspase3, cleaved-caspase3, VEGF, vascular endothelial growth factor receptor 2 (VEGFR2), phosphatidylinositol 3 kinase (PI3K), phosphorylated PI3K (p-PI3K), protein kinase B (AKT) and phosphorylated AKI (p-AKT) protein. ResultsIn vitro experiments: the protoscoleces of Echinococcus multilocularis were cultured with different concentrations of PAB for 7 days in vitro, the protoscoleces of 40, 80, 160 and 320 μmol/L group all died after 6, 4, 2 and 1 day, respectively; PAB exhibited a certain time and concentration dependence on the protoscoleces of Echinococcus multilocularis. After PAB treatment, the release of PGI in culture supernatant of Echinococcus multilocularis gradually increased with the increase of PAB concentration [concentration for 50% of maximal effect value was (24.40±1.42) μmol/L], the vitality of germinal cells was significantly inhibited [half maximal inhibitory concentration value was (15.94±2.55) μmol/L]. PAB had no significant toxicity to mammalian cells. When 20 μmol/L PAB intervention in the protoscoleces for 3 days, the expression levels of Bax and caspase3 proteins were upregulated, while the expression level of Bcl2 protein was downregulated. Animal experiments: compared with the model group, the wet weight of lesions in the PAB and ABZ groups decreased (P<0.01), and the inhibition rates of lesion growth in the PAB and ABZ groups were 91.03% and 74.44%, respectively. The expression of proliferation and angiogenesis indicators (Ki67, CD34, VEGF, VEGFR2, eNOS, NO) were downregulated in the lesion host microenvironment tissues of mice in the ABZ and PAB groups (P<0.05), while the expression of apoptosis related proteins (caspase3, cleaved-caspase3 and Bax) were upregulated and the expression of PI3K/AKT signaling pathway related proteins (p-PI3K and p-AKT) were downregulated (P<0.05). ConclusionPAB has a strong in vitro and in vivo effect against Echinococcus multilocularis, and its mechanism may be related to the inhibition of PI3K/AKT signaling pathway, leading to increased apoptosis and decreased angiogenesis.
We comprehensively outlined the application of imaging, immunology, and molecular biology techniques in the detection of hepatic echinococcosis (HE). Imaging techniques, represented by ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography, not only provided some critical information about the morphology, location, and characteristics of HE lesions, but also could be combined with artificial intelligence technologies to enhance the diagnostic capabilities and expand the application scenarios. These techniques were essential tools for the diagnosis, screening, and prevention of HE. Immunological techniques, such as the indirect hemagglutination assay, enzyme-linked immunosorbent assay, immunoblotting, and chemiluminescence immunoassay, aided in diagnosis and differential diagnosis by detecting the specific antibodies. Molecular biology techniques, such as polymerase chain reaction and high-throughput sequencing, provided a strong support for the diagnosis and pathogen identification of HE due to their high sensitivity and specificity. Based on these three major technologies, more sensitive, specific, convenient, and cost-effective detection techniques had emerged, offering more options for the detection and control of HE. Additionally, constructing comprehensive diagnostic models by combining the advantages of different detection technologies will aid to improve the diagnostic efficiency of HE.
ObjectiveTo comprehend the current diagnosis status and new progress of hepatic echinococcosis (HE). MethodThe literature from domestic and foreign researchers relevant diagnosis of HE in recent years was searched and summarized. ResultsThe HE was widely distributed worldwide, with extremely high mortality and disability rates, posing a serious threat to local economic development and public health. At present, in addition to the traditional and widely recognized diagnostic methods based on epidemiological histories, clinical manifestations, routine imaging, and experimental examinations, many innovative technologies based on these traditional diagnostic methods had emerged in the field of HE diagnosis, such as diagnostic prediction models constructed based on ultrasound and other imaging data, artificial intelligence, three-dimensional visual reconstruction, and circulating free DNA testing, which significantly improved the diagnosis rate of the HE. ConclusionsIn recent years, with the continuous improvement of medical level, the in-depth and perfect exploration of HE has made remarkable progress, which not only provides a new possibility for the early diagnosis of the HE, but also provides an important basis for research in related fields and the formulation of prevention and control measures. Therefore, the further promotion and application of these new techniques will aid to promote the diagnosis progress of HE and reduce its impact on population health.
Objective To detect and analize the expressions and it’s clinical significance of apoptosis factors in hepatic alveolar echinococcosis tissues by using antibody chip technology. Methods The liver tissue specimens (including the edge of lesions and normal liver tissues) of surgical resection of 6 patients with hepatic alveolar echinococcosis in Affiliated Hospital of Qinghai University were collected. The tissue protein was extracted and the level of apoptosis was detected by antibody chip technology. The data were analyzed by AAH-APO-G1 software. Results The expression levels of 5 kinds of apoptosis factors (Bad, Fas, IGFBP-3, P21 and XIAP) in the liver tissues of the marginal zone of hepatic alveolar echinococcosis were compared with that of the normal liver tissues, and the difference was statistically significant (P<0.05). The expression levels of Bad, Fas, IGFBP-3 and P21 were up-regulated, and the expression level of XIAP was down regulated. Conclusions Apoptosis-related factors play a role in the progression of the hepatic alveolar echinococcosis, there may be contact with the immune escape mechanisms, while promote apoptosis factor and inhibitory apoptosis factor that may exist the function imbalance, so more in-depth exploration the mechanism of apoptosis factors on hepatic alveolar echinococcosis in diagnosis and treatment have important significance.
Objective To summarize the nutritional assessment methods for liver cancer patients and their development, and to provide reference for rationally nutritional assessment and nutritional support. Method Domestic and foreign literatures were searched to summarize the nutritional assessment methods for liver cancer patients and their development, in order to determine a practical and feasible assessment method. Results The evaluation validity of traditionally nutritional assessment methods which contained many individual indicators was low. But subjective global assessment (SGA), mini nutritional assessment (MNA), and nutritional risk screening 2002 (NRS-2002) had similar evaluation validity, this 3 kinds of nutritional assessment methods were more suitable for liver cancer patients compared with the traditionally nutritional assessment methods. Conclusion The clinician should simultaneously apply SGA, MNA, NRS-2002, and other comprehensively nutritional assessment methods, as well as related anthropometric and laboratory indexes, to get a more accurate assessment of the nutritional status for patients with liver cancer.
Objective To explore the influence on the expressions of vascular endothelial growth factor (VEGF) gene and matrix metalloproteinase-2 (MMP-2) gene in hepatocellular carcinoma of SMMC-7721 cells with RNA interference (RNAi) silencing the expression of hypoxia inducible factor-1α (HIF-1α) gene. Methods Firstly, constructed short hairpin RNA (shRNA) targeting for HIF-1α gene, and then transfected it to SMMC-7721 cells after combining with plasmid. The SMMC-7721 cells were divided into three groups, silencing group, negative control group, and blank control group, which were transfected with HIF-1α-shRNA-pGenesil-1 recombinant vector, shRNA-HK-pGenesil-1 recombinant vector, and pGenesil-1 vector respectively. Transfection cells were screened by the concentration of 500 μg/mL G418, and then positive and negative cell clones with transfection recombination carrier were obtained. Detected the expressions of HIF-1α mRNA, VEGF mRNA, and MMP-2 mRNA in the 3 groups with real time PCR (RT-PCR) technology, under the condition of hypoxic training 6 h, 12 h, and 24 h, as well as conventional oxygen training. Results There was no expression of HIF-1α mRNA at conventional oxygen condition in the 3 groups, and there was no significant difference in expressions of VEGF mRNA and MMP-2 mRNA among the 3 groups (P>0.05) at the condition of conventional oxygen training. The expressions of HIF-1α mRNA, VEGF mRNA, and MMP-2 mRNA in the silencing group, compared with the the negative control group and the blank control group, were obviously decreased (P<0.05) under the condition of hypoxic training (6, 12, and 24 h), while there was no significant difference between the negative control group and the blank control group at each time point (P>0.05), but the expressions of HIF-1α mRNA, VEGF mRNA, and MMP-2 mRNA in the 3 groups under every condition of hypoxic training were all higher than those of conventional oxygen condition (P<0.05). Under the condition of hypoxic training, the expressions of HIF-1α mRNA, VEGF mRNA, and MMP-2 mRNA in the 3 groups decreased over time, and there was significant difference between any 2 time points in each group (P<0.05). Conclusion RNAi technique can effectively silence the expression of HIF-1α mRNA of SMMC-7721 cells, and then silence the expressions of VEGF and MMP-2 mRNA, to inhibit the invasion and metastasis of hepatocellular carcinoma.
Objective To analyze the clinical manifestations, diagnosis, treatment and prognosis of bone hydatid disease in China by literature review. Methods We searched the databases of China National Knowledge Infrastructure and Wanfang for case reports of bone hydatid disease published from 2000 to 2015 in China. Data were extracted by using a standardized form and a retrospective clinical analysis was performed. Results A total of 21 relevant literatures published from 2000 to 2015 were included, including 87 cases of bone hydatid disease treated from 1975 to 2015. The regional distribution of bone hydatid disease was mainly concentrated in the animal husbandry areas in China. In terms of diagnosis basis, imaging examination was mentioned in 54 cases (62.1%), laboratory examination was mentioned in 32 cases (36.8%), and pathologic examination was mentioned in 8 cases (9.2%), etc. Surgical treatment was the main treatment, and some treatments were combined with chemotherapy. The outcomes of bone hydatid disease were relatively poor. In the 44 cases whose outcomes were reported, 26 cases (59.1%) had recurrence, 18 cases were cured (40.9%), 10 cases (22.7%) underwent re-operation, and 2 cases (4.5%) died. Conclusions Bone hydatid disease is rare. Surgical treatment is still the main method for treating bone hydatid disease. The rate of recurrence of bone hydatidosis is relatively high, so it is very important to explore new methods for diagnosis and treatment of bone hydatid disease.
Objective To investigate safety and therapeutic effect of total pancreatectomy plus splenectomy for patient with pancreatic cancer. Methods The preoperative clinical data, surgical treatment, and postoperative conditions of 1 patient with pancreatic cancer who underwent the total pancreatectomy plus splenectomy in the Affiliated Hospital of Qinghai University in January 2018 were retrospectively analyzed. Results Combination of the patient clinical history, physical examination, laboratory and radiologic results, the patient was diagnosed with the pancreatic cancer. Then the patient underwent the Whipple procedure. During the operation, it was found that the texture of the pancreas was hard, and the spleen arteriovenous were considered to be invaded, and the multiple frozen section analysis during the operation showed that the surgical margin was positive. Eventually, the total pancreatectomy plus splenectomy was performed. The postoperative pathological analysis results revealed to the well-moderately differentiated tubular adenocarcinoma. When the condition of patient became stable, the pancreatin and insulin were required for long time. No severe complications occurred. The patient survived well after the surgery and no recurrence was observed for following-up of 3 months. Conclusion With improvement of surgical techniques and enhancement of postoperative management, total pancreatectomy can be used as a treatment for pancreatic cancer and it is still safe and feasible.