ObjectiveTo summarize the research progress of hepatocellular carcinoma (HCC) based on tumor microenvironment immunophenotyping.MethodThe related literatures of basic and clinical studies on HCC immunophenotyping in the recent years were reviewed.ResultsHCC could be divided into different immunophenotypes based on tumor microenvironment, and it showed different immune molecular characteristics, immune cell infiltration characteristics, and anti-tumor ability. At the same time, the HCC immunophenotype was significantly associated with patients’ survival and had been proved to be able to better evaluate the prognosis of HCC patients. According to the relevant molecular characteristics in the HCC immune microenvironment, it could provide guidance for the drug regimen of immunotherapy.ConclusionHCC immunophenotyping is still in the early stage of research, and its clinical application value has been preliminarily shown for the evaluation of patients’ prognosis and immunotherapy decision-making, which is a new idea of individualized treatment of HCC in the future.
Objective To investigate the expression of vascular endothelial growth factor-A （VEGF-A） and the phenotypic transition after the activation of fibroblasts by the supernatant of cultured tumor cells．Methods The growth tendency of fibroblasts was tested by the MTT assay．The expressions of alpha-smooth muscle actin （α-SMA） and VEGF-A mRNA were tested by RT-PCR．The expressions of α-SMA and VEGF-A protein were tested by immunohistochemistry and Western blot．Results The MTT assay indicated that the conditional medium which contained tumor cells supernatant could obviously promote the growth of the fibroblasts． RT-PCR and Western blot manifested that α-SMA expressed by the fibroblasts which cultured by normal medium reached its peak on day 5，then decreased to a low level on day 7．When the medium contained 2 ng/ml transforming growth factor-β1 （TGF-β1），the fibroblasts could steadily express more α-SMA．But the above two mediums could not make the fibroblasts express the VEGF-A. When using the conditional medium，the α-SMA peak advanced on the third day and maintained at a high level，so as the expression of the VEGF-A．Conclusions The results suggested that fibroblasts can be activated to be myofibroblasts when using the conditional medium．The best activation time of the fibroblasts is consistent with the time of the VEGF-A expression at the highest level by the activated fibroblasts．The fibroblasts which activated at the best time are expected to become a kind of cells which can be used for promoting revascularization．
Objective To evaluate the effect of minimally invasive dynamic hip screws (MIDHS) in treating aged intertrochanteric fractures. Methods From April 2006 to March 2008, 49 aged patients with intertrochanteric fractures were treated with MIDHS. There were 22 males and 27 females, aged 65-78 years (average 70.2 years). Frature was caused by trafficaccident in 7 cases, by fall ing from height in 3 cases, and by injury from fall in 39 cases. The time from injury to operation was 2-12 days (average 5.5 days). According to Evans classification, there were 28 cases of types I, II (stable fracture) and 21 cases of types III, IV (unstable fracture). If the Singh index≤3 was defined as osteoporosis, the osteoporotic rate was 71.4% (35/49). All patients were on a radiolucent fracture traction table and their fractures had satisfactory closed reduction. After the guide wire was inserted and reamed under fluoroscopy, the lag screw and side plate were introduced through the small incision. In all unstable fractures, an additional, antirotational and large cancellous bone screw was used cranial to the DHS. Results The average operation time was 65.2 minutes. The average blood loss was 189.3 mL. All patients had satisfactory reduction and 79.6% (39/49) had adequate lag screw positions. The average postoperative hospital ization days was 5.8 days (3-12 days). All incision healed at stage I. There was no postoperative complications. Forty-nine patients were followed up 12 to 30 months (average 19.8 months). Fractures healed within 16 weeks in 47 patients and the average healing time was 13.1 weeks (12-16 weeks). The average Harris scoring was 90.8 (75-95). Implant failure and nonunion occurred in 2 cases, no serious compl ication occurred in other patients. Conclusion The MIDHS is a simple, safe and effective method for treatment of aged intertrochanteric fractures.
ObjectiveTo investigate the clinical effect of “Double R” pancreatojejunostomy in laparoscopic pancreaticoduodenectomy (LPD).MethodsThe clinical data of 20 patients underwent “Double R” pancreaticojejunostomy in the LPD from November 2018 to December 2019 in this hospital were collected retrospectively. The duration of pancreaticojejunostomy, incidence of postoperative pancreatic fistula, incidence of other complications, mortality, length of stay, and other clinical outcomes were analyzed.ResultsThere were 5 males and 6 females. The age was (56±10) years old. The body mass index was (22.6±4.4) kg/m2. The LPDs were successfully performed in all 20 patients, no patient transferred to the laparotomy, and no patient died within 30 d. There were 6 patients with papillary adenocarcinoma of the duodenum, 5 patients with adenocarcinoma of the lower part of the common bile duct, 2 patients with adenocarcinoma of the pancreatic duct, 3 patients with serous cystadenoma of the pancreatic head, 2 patients with intraductal papillary myxoma of the main pancreatic duct of the pancreatic head, 1 patient with duodenal adenoma with high grade intraepithelial neoplasia, 1 patient with metastatic renal clear cell carcinoma of the pancreatic head, 5 patients with soft pancreas, 12 patients with medium texture, 3 patients with hard texture. The diameter of distal pancreatic duct was (2.1±1.7) mm. The operative time was (380±69) min, the duration of pancreaticojejunostomy was (29±15) min, the intraoperative blood loss was (180±150) mL, the postoperative time of anal exhaust (2.2±0.8) d, postoperative time of fluid intake (3.5±1.1) d, postoperative time of half fluid intake (5.5±0.7) d, postoperative time of hospitalization (14±10) d. There were 3 complications in 2 patients, one of which suffered the pulmonary infection, the other suffered the delayed gastric emptying and gastrointestinal anastomosis bleeding, no bile leakage and abdominal hemorrhage happened. There were 2 cases of pancreatic fistula after the operation, all of them were biochemical pancreatic fistula.Conclusions“Double R” pancreaticojejunostomy method has some advantages of convenient operation, short operation time, and low incidence of pancreatic fistula. However, due to the limited sample size, its safety and feasibility still need to be verified by larger samples and more institutions.