ObjectiveTo elucidate the mechanism of multiple organs dysfunction (MOD) during acute obstructive cholangitis (AOC). MethodsThe reports about MOD and AOC in recent 10 years were collected and reviewed.ResultsApplicable animal models of AOC were established. During AOC, the decrease of Kupffer cells (KCs) phagocytic function and clearance function, hepatocyte mitochondrion damage, the effect of KCs on protein synthesis of hepatocytes and activation of KCs by endotoxin played an important role in the pathogenesis of MOD. ConclusionThe mechanism of pathogenesis of MOD during AOC is complicated and the changes of KCs functions is one of major factors.
Objective To summarize the role of costimulatory molecules in inducing immune tolerance of organ transplantation. Methods Domestic and international publications online involving costimulatory molecules and immune tolerance in recent years were collected and reviewed. Results The relationship between costimulatory pathways and transplantation immunity has already been clarified in recent years. The main costimulatory molecules alreadly found mainly include B7-CD28/CTLA4, CD40-CD154, 4-1BB/4-1BBL, and ICOS-B7h, etc. Costimulatory pathways com-inhibition or combining with other immunosuppression methods could obtain stable and long lasting immune tolerance. Conclusions With the development of immunology and molecular biology, costimulatory pathways of T lymphocyte activation will be further interpreted. Other new costimulatory molecules will be discovered in the future, which will afford theory evidence for inducing immune tolerance.
ObjectiveCombined with long non-coding RNA (lncRNA) to find a regression model that can be used to predict the survival rate of patients with colon cancer before operation.MethodsThe clinical information and gene expression information of patients with colon cancer were downloaded by using TCGA database. The differentially expressed lncRNAs in tumor and paracancerous tissues were screened out, and then combined with the clinical information of patients to construct Cox proportional hazard regression model.ResultsA total of 26 kinds of lncRNAs with statistical difference in gene expression between paracancerous tissues and tumor tissues were selected (P<0.05). Through repeated screening and comparison of prediction efficiency, the prediction model was finally selected, which was constructed by patients’ age, M stage, N stage, and three kinds of lncRNAs (ZFAS1, SNHG25, and SNHG7) gene expression level: age [HR=4.00, 95%CI: (1.48, 10.84), P=0.006], M stage [HR=3.96, 95%CI: (2.23, 7.04), P<0.001], N stage [HR=1.87, 95%CI: (1.24, 2.84), P=0.003], ZFAS1 gene expression level [HR=0.60, 95%CI: (0.41, 0.86), P=0.006], SNHG25 gene expression level [HR=0.85, 95%CI: (0.73, 1.00), P=0.045], and SNHG7 gene expression level [HR=2.32, 95%CI: (1.53, 3.52), P<0.001] were all independent risk factors for postoperative survival of patients with colon cancer. The area under the ROC curves for predicting 1, 3, and 5-year overall survival were 0.802, 0.828, and 0.771, respectiely, which had a good prediction ability.ConclusionThe predictive model constructed by the combination of ZFAS1, SNHG25, SNHG7 genes expression level with M stage, N stage, and age can better predict the overall survival rate of patients before operation, which can effectively guide clinical decision-making and choose the most suitable treatment method for patients.
ObjectiveTo explore the effect of La-related protein 6 (LARP6) gene on the survival of postoperative patients with gastric cancer, and to explore its relationship with immune cell infiltration.MethodsThe clinical survival information and gene expression information of gastric cancer patients were downloaded from The Cancer Genome Atlas (TCGA) database. The relationship between LARP6 gene expression and clinical characteristics of patients were analyzed. Cox proportion hazard regression model was used to find out the prognostic risk factors of gastric cancer patients, and then Kaplan-Meier plotter database was used to verify. Then the correlation between LARP6 gene expression and immunity was proved by Tumor IMmune Estimation Resource (TIMER) immune database.ResultsIn gastric cancer patients, the expression of LARP6 gene was related to pathological stage, T stage, and N stage (P<0.05), but not related to M stage and sex (P>0.05). Multivariate Cox proportion hazard regression analysis showed that age [HR=2.022, 95%CI was (1.287, 3.176), P=0.002] and LARP6 gene expression [HR=1.176, 95%CI was (1.070, 1.293), P<0.001] were prognostic factors. Further verified by Kaplan Meier plotter database, the results also showed that the overall survival (OS) and progression-free survival (PFS) of gastric cancer patients with high expression of LAPR6 gene were worse than those with low expression of LARP6 gene (P<0.001). TIMER database was used to explore the correlation between the expression level of LARP6 gene and immune cell infiltration in patients with gastric cancer, and the results showed that the expression level of LARP6 gene in gastric cancer patients was positively correlated with the infiltration number of CD4+ T cells and macrophage cell (P<0.001). Log-rank results showed that infiltration number of macrophage cell and LARP6 gene expression were risk factors for clinical prognosis of gastric cancer patients (P<0.05).ConclusionsMacrophage cell andcell and LARP6 gene expression are risk factors for gastric cancer patients. LARP6 may be a new target for the treatment of gastric cancer.
ObjectiveTo construct a new model for predicting the overall survival rate of gastric cancer and to guide the clinical work.MethodsThe clinical information and gene expression information of patients with gastric cancer were downloaded through The Cancer Genome Atlas (TCGA) database. The clinicopathologic characteristics and gene expression information affecting the overall survival rate of gastric cancer patients were screened by univariate COX regression and Lasson regression, then the predictive model was constructed by multiple COX regression model, and the predictive model was tested by receiver operating characteristic curve, calibration curve and decision curve analysis curve. The effect of genes included in the predictive model on the overall survival rate of patients with gastric cancer was discussed, and the predictive model diagram was drawn.ResultsThrough repeated screening and comparison of the model, the patient’s age, T stage, N stage, M stage and 12 genes (INCENP, IGHD3-16, ITFG1-AS1, NEK5, MATN3, YWHABP2, SYT12, LINC01210, ZNF385C, LINC01980, CYMP-AS1 and FAT3) were included in the predictive model. The prediction ability of this model was close to or more than 80%, which was significantly higher than that of the traditional TNM staging prediction system. All the indexes included in the model were significantly different by univariate and multivariate COX regression analysis（P<0.05）, and the 12 genes included were the risk factors affecting the overall survival rate of gastric cancer.ConclusionThe gastric cancer prediction model constructed by combining clinical characteristics and genomics has good predictive ability and can guide clinical work.
【Abstract】Objective To study the characteristics, diagnosis, treatment and prophylaxis of cytomegalovirus (CMV) infection after liver transplantation. Methods The literatures of recent 10 years were collected and reviewed. ResultsThe infection rate of CMV after liver transplantation was high, and it was frequently complicated with other types of infectious diseases. There was no specificity in the clinical features of CMV infection, and no effective measures were taken for early diagnosis, prevention and therapy.Conclusion CMV is the primary opportunistic pathogen after liver transplantation. Monitoring the status of CMV infection in recipients preoperatively and postoperatively, early prophylaxis and treatment are very important and useful to prevent and treat this disease.
Objective To evaluate the role of endoscopic retrograde cholangio-pancreatography(ERCP)in diagnosis of anomalous converge of the cystic duct and prevention of bile duct injuries during laparoscopic cholecystectomy(LC). Methods From July, 1992 to June, 1999, LCs were performed in 4 500 patients with gallbladder stone or cholecystitis at our center. Preoperative ERCPs were performed in 780 of all patients (14.50%). Anomalous junctions of the cystic duct with common hepatic duct were investigated and the length and caliber of these cystic duct were measured and compared with 100 control cases. Results An overall anomalous converges of the cystic duct were found in 125(16.03%) of the 780 patients undergoing ERCP. Of 780 patients undergoing LC, 35 cases were converted to open cholecystectomy(4.5%), and various complications occurred in 6 cases (0.77%), but no death and biliary duct injuries occurred. Conclusion Various types of anomalous junctions of the cystic duct could be diagnosed precisely by ERCP before LC and the preoperative examination of ERCP may be helpful in prevention of bile duct injuries and other biliary complications in the laparoscopic time.
Objective To investigate the feasibility of elective laparoscopic hepatectomy in the treatment of ruptured hepatocellular carcinoma. Methods We tried to perform an elective laparoscopic hepatectomy for a middle-aged man who had a ruptured hepatocellular carcinoma without active hemorrhage. The data of this patient was summarized. Results The patient received the elective laparoscopic hepatectomy, and the liver lesions were completely removed. The operation was successful. Operative time was 300 min and intraoperative bleeding was 500 mL. Postoperative recovery of this patient was good and no complication occurred. The abdominal drainage tube was removed on 4 days after operation, and he discharged on 8 days after operation. The pathology confirmed that the hepatocellular carcinoma was moderately differentiated and ruptured. Conclusion Elective laparoscopic hepatectomy is safe and feasible in the treatment of ruptured hepatocellular carcinoma for specific patient, but this operation needs to be performed by experienced surgeons with laparoscopic skills.
Objective To explore the opportunity of surgery after transarterial chemoembolization therapy for patient with primary hepatocellular carcinoma in Barcelona Clinic Liver Cancer (BCLC) B stage. Methods Multi- disciplinary team (MDT) carried out for a BCLC B stage patient in October 2017 in the Second Affiliated Hospital of Chongqing Medical University. The patient diagnosed with massive primary hepatocellular carcinoma in right lobe of the liver accompanied by para-tumor satellite nodules and metastatic nodules in quadrate lobe (BCLC B stage) in 2 months ago and received twice TACE therapies in the first 2 months. The MDT group developed anterior approach in right hepatectomy and tumor enucleation in the left medial segment. Results The experts group of MDT agreed on the patient undergone twice TACE therapies, whose tumor in right lobe had shrinked and left lobe enlarged, and the patient acquired the opportunity for surgery. By elaborately devised perioperative care and surgery risk control, the patient undergone operation successfully and recovered without any operative complications. Conclusions A proportion of BCLC B stage patients with hepatocellular carcinoma can acquire the opportunity of a second stage operation for removal of the tumor. We should manage this portion of patients well and strive for the best therapeutic effect.
ObjectiveTo summarize the research progress of KRAS mutation in pancreatic tumorigenesis and therapy.MethodThe research progress of KRAS mutation in pancreatic tumorigenesis and therapy were summarized by reading the domestic and international literatures published in recent years.ResultsPancreatic cancer had the title of " king of cancer”. More than 90% of pancreatic cancer patients had KRAS mutation. KRAS had a complex relationship with pancreatic cancer through downstream signaling pathways, including Raf (rapidly accelerated fibrosarcoma)-mitogen-activated protein kinase kinase (MEK)-extracellular signal-regulated kinase (ERK), phosphatidylinositol-4, 5-bisphosphate 3-kinase (PI3K)-protein kinase B (AKT), and RalGDS-Ral. Although basic research on pancreatic cancer was deepening, there was still a lack of effective molecular targeted drugs.ConclusionsKRASgene plays an important role in the occurrence of pancreatic cancer. The treatment associated with KRAS mutation provides a more effective prognostic possibility for pancreatic cancer patients.