Objective To explore application value of photodynamic therapy (PDT) in treatment of unresectable hilar cholangiocarcinoma. Method The literatures about PDT in the treatment of the unresectable hilar cholangiocarcinoma in the PubMed, MedLine, Embase, CNKI, and Wanfang databases were reviewed. Results The PDT combined with stent or chemotherapy was the main method in the treatment of the unresectable hilar cholangiocarcinoma, which could make the tumor down-staging, obviously reduce the jaundice, improve the quality of life, improve the survival rate, prolong the stent patency and be treated repeatedly. Especially, it was suitable for the patients with elderly, poor health, intolerance of surgery, could partly replace the R1 or R2 operation of hilar cholangiocarcinoma and avoid the risk of surgery and postoperative complications. The therapeutic effective of the PDT was related to the early therapy and times of therapy. However, the shortcomes of the PDT were that the depth of killing tumor was not enough and there was a certain incidence of adverse reaction. Conclusions Therapeutic effect of PDT combine with stent or chemotherapy for unresectable hilar cholangiocarcinoma is better than that of single therapy. It is expected to be a first-line scheme of palliative treatment for unresectable hilar cholangiocarcinoma.
Objective To evaluate safety and long-term efficacy of fully covered self-expandable mental stent (FCSEMS) in treatment of biliary stricture after liver transplantation (LT). Methods From January 2010 to June 2018, the data of patients with the biliary stricture after the LT underwent the endoscopic retrograde cholangiagraphy (ERCP) at the First Hospital of Lanzhou University were collected retrospectively. The therapeutic effect of the FCSEMS was evaluated. Results A total of 21 patients with the biliary stricture after the LT were treated. The success rate of the stent placement was 100%. The FCSEMSs were used in 7 cases and the only multiple plastic stents (MPSs) were used in 14 cases. There were no significant differences in the gender, age, time of biliary stricture, frequency of ERCP, recurrence time of biliary stricture, cure time of biliary stricture, curative effect, recurrence of biliary stricture, and incidence of complications between the patients treated with the FCSEMS and the MPS (P>0.050), but the number of plastic stents in the patients treated with the FCSEMS was significantly less than that in the patients treated only with the plastic stents (P<0.050), while the duration of stent retention was longer than that in the patients treated only with the plastic stents (P<0.050). Six patients were cured, 1 was remitted, and 2 were relapsed by the FCSEMS. Eight were cured, 3 were remitted, 3 were ineffective, and 5 were relapsed by the MPS alone. Conclusions FCSEMS might be an safe effective alternative to plastic stent in treatment of biliary stricture after LT, resulting in a longer duration placement, less number of plastic stent use. It is necessary to further accumulate cases to validate cure rate and recurrence rate of biliary stricture.
ObjectiveTo analyze factors affecting post-hepatectomy liver failure (PHLF) of patients with hepatocellular carcinoma (HCC) and explore value of combining albumin-bilirubin (ALBI) score with standardized future liver remnant (sFLR) in prediction of PHLF.MethodsThe clinical data of patients with HCC underwent curative hepatectomy in the Second and the Fifth Departments of General Surgery of the First Hospital of Lanzhou University from January 2016 to June 2018 were retrospectively reviewed. The risk factors of PHLF were identified through the logistic regression, the area under the receiver operating characteristic curve (AUC) was used to analyze the predictive value of the ALBI score, sFLR, or ALBI score×sFLR.ResultsA total of 72 patients with HCC were enrolled, all of them were the Child-Pugh A grade. The incidence of PHLF was 27.78% (20/72) in these 72 patients with HCC, which was 12.96% (7/54) and 72.22% (13/18) in the 54 patients with ALBI- Ⅰ grade and 18 patients with ALBI- Ⅱ grade respectively, the difference was statistically significant (P<0.001). The results of multivariable analysis of PHLF showed that the PLT (OR=0.030, P=0.018), ALBI grade (OR=11.758, P=0.020), and sFLR (OR=0.835, P=0.003) were identified as the independent predictors of PHLF. The AUC for the ALBI score×sFLR in predicting the PHLF was 0.892, it was greater than that of the ALBI score (AUC=0.799) or the sFLR (AUC=0.773).ConclusionCompared with Child-pugh grade, ALBI grade is more accurate in predicting PHLF of HCC patients, and combining ALBI score with sFLR is better than sFLR or ALBI score alone in predicting PHLF of patients with HCC.
ObjectiveTo review the role of intestinal flora on the tumor microenvironment and the effect of both on the development of hepatocellular carcinoma (HCC), with a view to providing new ideas on the causes of HCC development and progression. MethodRelevant articles in the direction of intestinal flora and tumor microenvironment and HCC as well as the relationship between intestinal flora and tumor microenvironment in recent years were searched and summarized. ResultsThe tumor microenvironment played an important role in the occurrence, development and postoperative recurrence of HCC. The intestinal flora, as one of the important regulators of tumor microenvironment, could induce HCC by affecting the tumor microenvironment in addition to interacting with the liver through the gut-liver axis. ConclusionIntestinal flora can influence to HCC by regulating the tumor microenvironment, and its specific mechanism of action still needs to be further investigated, which can be a new direction for HCC research.
【Abstract】Objective To study the correlation between focal adhesion kinase (FAK) expression and biological behavior of invasion and metastasis in gastric carcinoma. MethodsThe immunoreactivity of FAK was revealed by immunohistochemical method in gastric carcinoma tissues,canceradjacent tissues, normal gastric mucosa,and 200 regional lymph nodes in 50 collected specimens when radical resection of gastric carcinoma were carried out. ResultsThe percentage of FAK bly positive immunoreactivity were 10.0%（5/50）， 20.0%（10/50） and 78.0%（39/50） in normal gastric mucosa， cancer-adjacent tissues and gastric carcinoma tissues respectively. The b immunoreactivity was obviously higher in gastric carcinoma tissues than that in normal gastric mucosa or canceradjacent tissues (P＜0.01). There were no difference between normal gastric mucosa and canceradjacent tissues (Pgt;0.05). The percentage of bly positive immunoreactivity of FAK were 68.8%（22/32） and 33.3%（6/18） in cases with metastasis and without metastasis of lymph node respectively. The immunoreactivity of FAK in cases with metastasis of lymph node was significantly higher than that without metastasis of lymph node (P＜0.05).The b immunoreactivity of FAK were 87.2%（136/156） and 40.9%(18/44) in withmetastatic lymph node and withoutmetastatic lymph node. The immunoreactivity of FAK in withmetastatic lymph node was significantly higher than that withoutmetastatic lymph node （P＜0.01）. The percentage of FAK bly positive immunoreactivity showed correlation with the cellular differentiation and depth of infiltration of gastric carcinoma. The deeper infiltration and lower differentiation, the ber expression rate was obtained (P＜0.05), which showed no correlation with Borrmann type, location and size of tumor (Pgt;0.05). ConclusionIncreased immunoreactivity of FAK is an important role of invasion and metastasis for gastric carcinoma cells. Detection of FAK expression in cancer tissues can be helpful to understand the carcinogenic biological behavior of gastric carcinoma as well as to make judgment and treatment of prognosis of patients.
【Abstract】ObjectiveTo investigate the risk factors for acute lung injury(ALI) after orthotopic liver transplantation(OLT) and to explore the prevention and cure scheme.MethodsThe risk factors responsible for ALI in 4 patients undergoing OLT were analyzed with retrospective investigation.ResultsPortal pulmonary hypertension, longterm mechanical ventilation, severe infection, SIRS, hypercoagulability, overdose transfusion and kidney dysfunction were risk factors for ALI.ConclusionALI frequently occurred after OLT. Reducing and diminishing the risk factors is very important to avoid ALI after OLT.
ObjectiveTo study the expression of cyclooxygenase2 (COX2) and its clinical significance in gastric carcinoma. MethodsThe expression of COX2 in 47 cases of gastric carcinoma and 16 cases of normal gastric tissue were detected by SP immunohistochemical technique. Helicobacter pylori (H.pylori) infection was diagnosed by urease experiment and Giemsa staining.ResultsThere was no positive signal of COX2 detected in normal gastric tissue. The positive expression rate of COX2 was 63.8%(30/47) in gastric carcinoma.The expression of COX2 was correlated with TNM stage, lymph node metastasis and H.pylori infection（P＜0.01）. Positive COX2 expression rate in H.pylori infection group was 72.4%(21/29), significantly higher than that in the group without H.pylori infection.Conclusion COX2 expression is involved in the carcinogenesis and malignant progression of gastric carcinoma.The examination of COX2 may be helpful to judge biological behavior of gastric carcinoma.
Objective To study the therapeutic effect of Roux-en-Y gastric bypass （RYGB） on type 2 diabetes mellitus （T2DM） rats and explore the possible mechanism of vaspin in RYGB on T2DM. Methods Twenty SD rats with T2DM and 20 age- and sex-matched normal SD rats were randomly divided into 4 groups according to the random digits table：T2DM-RYGB group， T2DM-sham operation （SO） group，RYGB group，and SO group，10 rats in each group. Fasting plasma glucose （FPG） level，serum insulin （INS） level，vaspin level，and homeostasis model of insulin resistance （HOMA-IR） were determined before operation and on week 4，8 after operation，respectively．At the same time，the correlation between vaspin and the indicators （FPG，INS，or HOMA-IR） was analyzed．Results Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not significantly different between the T2DM-RYGB group and T2DM-SO group （P＞0.05） or between the RYGB group and SO group （P＞0.05），but the FPG level，INS level，vaspin level，and HOMA-IR in the T2DM-RYGB group and T2DM-SO group were significantly higher than those in the RYGB group （P＜0.05） and SO group （P＜0.05），respectively. On week 4 after operation，the FPG level，INS level，vaspin level，and HOMA-IR decreased in the T2DM-RYGB group，except for the FPG level，the other indexes had no significant differences as compared with the values before operation. On week 8 after operation，the FPG level，INS level，vaspin level，and HOMA-IR further decreased in the T2DM-RYGB group，there were significant differences of these indicators between before operation and on week 8 after operation. Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not statistically significant （P＞0.05） in the T2DM-SO group，RYGB group，or SO group. The changes in serum vaspin level correlated positively with those in INS and HOMA-IR before operaion and on week 4，8 after operaion in the T2DM-RYGB group and T2DM SO group rats （P＜0.05），respectively. Conclusions RYGB surgery has a therapeutic effect on T2DM rats，and serum vaspin level decreases and insulin resistance is improved after RYGB surgery，which may be one of the mechanisms of the treatment for T2DM.
Objective To investigate the expressions of Ki67 and PTEN protein in human gastric atypical hyperplasia and carcinoma, and to explore their relations with gastric canceration and the possibility of being early biological markers. Methods The expressions Ki67 and PTEN protein were detected by using immunohistochemical staining SP method in 22 cases of normal gastric tissues and 80 cases of atypical hyperplasia and 60 cases of gastric carcinoma. Results The positive expression level of PTEN in normal gastric tissue was higher than that in atypical hyperplasia tissue, with the lowest level in gastric carcinoma, whereas, it was opposite for the expressions of Ki67 in these samples. The positive expression rates of PTEN and Ki67 were both well related with pathological grading of gastric tissues (r=-0.461 and 0.301， respectively， P＜0.01). The expression of PTEN was not obviously related with Lauren type, infiltration degree and differentiation level of gastric carcinoma, but it was associated with lymph node metastasis. For Ki67, it was found that there were correlations between the expression of Ki67 and Lauren type， lymph node metastasis， but not with infiltration degree， differentiation level of gastric carcinoma. Negative correlation was found between the expressions of PTEN and Ki67 protein in gastric carcinoma (r=-0.316， P＜0.05). Conclusion Abnormal expressions of Ki67 and PTEN protein were associated with canceration in stomach. Therefore, both of them may act as useful biomarkers for early detection of gastric carcinoma.
【Abstract】Objective To investigate the detection and significance of micrometastasis in lymph nodes of periampullary carcinoma. MethodsThe immunoreactivity of CK19, CK7 and CK18 in 220 lymph nodes from 60 patients who had been carried out radical resection of periampullary carcinoma were revealed by immunohistochemical method. Combining with clinical data and the followup result discussion and analysis were made. All the lymph nodes collected from January 1997 to August 2004 in this hospital were examined to be nonlymphonodus metastasis by histological HE stain. The criterion of positive CK was established and micrometastasis will be diagnosed if CKs revealed to be positive combining with the morphological changes of lymph node tissue through the observation of microscope. ResultsFortythree of 220 lymph nodes of periampullary carcinoma had been micro metastasized. The detection rates of micrometastasis were 19.55%（43/220）， 14.55%（32/220）and 11.36%（25/220） with CK19，CK7 and CK18 antibody, respectively, which meant that CK19 were better than CK18 for detection of micrometastasis. Detection rates of CK7， CK19 were higher in Ⅲ， Ⅳ stage than inⅠ， Ⅱ（P＜0.05）, whereas it had no relationship with gender, age and tumor differentiation degree. The oneyear survival rate for micrometastasis patients was lower than nonmicrometastasis patients’ (P＜0.05). Conclusion Micrometastasis of periampullary carcinoma may be the early stage of tumor metastasia. The CK antibodies are significant levels to detect micrometastasis of periampullary carcinoma and to guide the clinical treatment and prognostic judgment.