AIM： To study the association between host immunity and hepatitis B virus （HBV） recurrence after liver transplantation. METHODS： Peripheral blood mononuclear cells （PBMC） were isolated from 40 patients with hepa...AIM： To study the association between host immunity and hepatitis B virus （HBV） recurrence after liver transplantation. METHODS： Peripheral blood mononuclear cells （PBMC） were isolated from 40 patients with hepatitis B and underwent orthotopic liver transplantation （OLT） before and 2, 4, 8 wk after surgery. After being cultured in vitro for 72 h, the levels of INF-γ and TNF-α in culture supematants were detected with ELISA. At the same time, the quantities of HBV DNA in serum and PBMCs were measured by real time PCR. RESULTS： The levels of INF-γ and TNF-α in PBMC culture supernatants decreased before and 2, 4 wk after surgery in turns （INF-γ 155.52±72.32 ng/L vs 14.76±9.88 ng/L vs 13.22±10.35 ng/L, F= 6.946, P= 0.027〈0.05; TNF-α 80.839±46.75 ng/L vs18.59±17.29 ng/L vs9.758±7.96 ng/L, F= 22.61, P = 0.0001〈0.05）. The levels of INF-γ and TNF-α were higher in groups with phytohemagglutinin （PHA） than in those without PHA before surgery. However, the difference disappeared following OLT. Furthermore, INF-γ and TNF-α could not be detected in most patients at wk 4 and none at wk 8 after OLT. The HBV detection rate and virus load in PBMC before and 2, 4 wk after surgery were fluctuated （HBV detected rate： 51.4%, 13.3%, 50% respectively; HBV DNA： 3.55±0.674 log（10） copies/mL vs 3.00±0.329 log（10） copies/mL vs 4.608±1.344 log（10） copies/mL, F= 7.582, P= 0.002〈0.05）. HBV DNA in serum was 4.48±1.463 log（10） copies/mL before surgery and 〈 10^3 copies/mL after OLT except for one with 5.72×10^6 copies/mL 4 wk after OLT who was diagnosed as HBV recurrence. The levels of INF-γ and TNF-α were lower in patients with a high HBV load than in those with a low HBV load （HBV DNA detected/undetected in PBMCs： IFN-γ 138.08±72.44 ng/L vs 164.24±72.07 ng/L, t = 1.065, P= 0.297〉0.05, TNF-α 80.75±47.30 ng/L vs 74.10±49.70 ng/L, t= 0.407, P= 0.686〉 0.05; HBV DNA positive/negative： IFN-γ 136.77±70.04 ng/L vs 175.27±71.50 ng/L, t= 1.702, P= 0.097〉0.05; TNF-α 75.37±43.02 ng/L vs 81.53±52.46 ng/L, t = 0.402, P = 0.690〉0.05）. CONCLUSION： The yielding of INF-γ and TNF-α from PBMCs is inhibited significantly by immunosuppressive agents following OLT with HBV load increased, indicating that the impaired immunity of host is associated with HBV recurrence after OLT.展开更多
BACKGROUND:Many studies have confirmed that serum total cholesterol(sTC) concentrations were associated with underlying liver damage and the synthesis capacity of liver.However, the role of postoperative sTC level on ...BACKGROUND:Many studies have confirmed that serum total cholesterol(sTC) concentrations were associated with underlying liver damage and the synthesis capacity of liver.However, the role of postoperative sTC level on evaluating graft function and predicting survival of recipients who underwent liver transplantation has not been discussed.METHODS:Clinical data of 231 living donor liver transplantation recipients from May 2003 to January 2015 were retrospectively collected. Patients were stratified into the low sTC group(sTC <1.42 mmol/L, 57 recipients) and high sTC group(sTC ≥1.42 mmol/L, 174 recipients) according the sTC level on postoperative day 3 based on receiver-operating characteristic curve analysis. The clinical characteristics and postoperative short-and long-term outcomes were compared between the two groups.RESULTS:Recipients with sTC <1.42 mmol/L experienced more severe preoperative disease conditions, a higher incidence of postoperative early allograft dysfunction(38.6% vs 10.3%, P<0.001), 90-day mortality(28.1% vs 10.9%, P=0.002)and severe complications(29.8% vs 17.2%, P=0.041) compared to recipients with sTC ≥1.42 mmol/L. The multivariate analysis demonstrated that sT C <1.42 mmol/L had a 4.08-fold(95% CI:1.83-9.11, P=0.001) and 2.72-fold(95% CI:1.23-6.00,P=0.013) greater risk of developing allograft dysfunction and 90-day mortality, and patients with sTC <1.42 mmol/L had poorer overall recipient and graft survival rates at 1-, 3-, and 5-year than those with sTC ≥1.42 mmol/L(67%, 61% and 61% vs 83%, 71% and 69%, P=0.025; 65%, 59% and 59% vs 81%,68% and 66%, P=0.026, respectively). Cox multivariate anal-ysis showed that sTC <1.42 mmol/L was an independent predicting factor for total recipient survival(HR=2.043; 95% CI:1.173-3.560; P=0.012) and graft survival(HR=1.905; 95% CI:1.115-3.255; P=0.018).CONCLUSIONS:sTC <1.42 mmol/L on postoperative day 3 was an independent risk factor of postoperative early allograft dysfunction, 90-day mortality, recipient and graft survival, which can be used as a marker for predicting postoperative short-and long-term outcomes.展开更多
Hepatic venous stenosis may be a cause of graft failure in living donor liver transplantation （LDLT）. Balloon dilation and metallic frame approaches have been used successfully to treat hepatic venous stenosis. Here...Hepatic venous stenosis may be a cause of graft failure in living donor liver transplantation （LDLT）. Balloon dilation and metallic frame approaches have been used successfully to treat hepatic venous stenosis. Here, we report the effect of transfemoral venous balloon dilation for treating a child with hepatic venous stenosis after LDLT .展开更多
BACKGROUND Laparoscopic liver resection(LLR)has become a safe surgical procedure that needs additional summarization.AIM To review 4 years of total LLR surgeries,exceeding 1000 cases,which were performed at a single c...BACKGROUND Laparoscopic liver resection(LLR)has become a safe surgical procedure that needs additional summarization.AIM To review 4 years of total LLR surgeries,exceeding 1000 cases,which were performed at a single center.METHODS Patients who underwent LLR at West China Hospital of Sichuan University between January 2015 and December 2018 were identified.Surgical details,including the interventional year,category of liver disease,and malignant liver tumors prognosis,were evaluated.The learning curve for LLR was evaluated using the cumulative sum method.The Kaplan-Meier method was used to perform survival analysis.RESULTS Ultimately,1098 patients were identified.Hepatocellular carcinoma(HCC)was the most common disease that led to the need for LLR at the center(n=462,42.08%).The average operation time was 216.94±98.51 min.The conversion rate was 1.82%(20/1098).The complication rate was 9.20%(from grade II to V).The 1-year and 3-year overall survival rates of HCC patients were 89.7%and 81.9%,respectively.The learning curve was grouped into two phases for local resection(cases 1-106 and 107-373),three phases for anatomical segmentectomy(cases 1-44,45-74 and 75-120),and three phases for hemihepatectomy(cases 1-17,18-48 and CONCLUSION LLR may be considered a first-line surgical intervention for liver resection that can be performed safely for a variety of primary,secondary,and recurrent liver tumors and for benign diseases once technical competence is proficiently attained.展开更多
The Author Reply:We thank Dr.Fu-Shan Xue et al.for the opportunity to discuss the article we recently published in Hepatobiliary Pancreat Dis Int[1].They claim that the study setting is not strong enough to prove the ...The Author Reply:We thank Dr.Fu-Shan Xue et al.for the opportunity to discuss the article we recently published in Hepatobiliary Pancreat Dis Int[1].They claim that the study setting is not strong enough to prove the statistical association between a low postoperative s TC and increased postoperative adverse outcome.展开更多
Mammalian target of rapamycin(m TOR) inhibitor as an attractive drug target with promising antitumor effects has been widely investigated. High quality clinical trial has been conducted in liver transplant(LT) recipie...Mammalian target of rapamycin(m TOR) inhibitor as an attractive drug target with promising antitumor effects has been widely investigated. High quality clinical trial has been conducted in liver transplant(LT) recipients in Western countries. However, the pertinent studies in Eastern world are paucity. Therefore, we designed a clinical trial to test whether sirolimus can improve recurrence-free survival(RFS) in hepatocellular carcinoma(HCC) patients beyond the Milan criteria after LT. This is an open-labeled, single-arm, prospective, multicenter, and real-world study aiming to evaluate the clinical outcomes of early switch to sirolimus-based regimens in HCC patients after LT. Patients with a histologically proven HCC and beyond the Milan criteria will be enrolled. The initial immunosuppressant regimens are center-specifc for the frst 4-6 weeks. The following regimens integrated sirolimus into the regimens as a combination therapy with reduced calcineurin inhibitors based on the condition of patients and centers. The study is planned for 4 years in total with a 2-year enrollment period and a 2-year follow-up. We predict that sirolimus conversion regimen will provide survival benefts for patients particular in the key indicator RFS as well as better quality of life. If the trial is conducted successfully, we will have a continued monitoring over a longer follow-up time to estimate indicator of overall survival. We hope that the outcome will provide better evidence for clinical decision-making and revising treatment guidelines based on Chinese population data.展开更多
A previous study has shown that liver or combined liver-kidney transplantation can be a valuable surgical technique for the treatment of polycystic liver disease. Herein, we present the case of a 35-year-old woman wit...A previous study has shown that liver or combined liver-kidney transplantation can be a valuable surgical technique for the treatment of polycystic liver disease. Herein, we present the case of a 35-year-old woman with polycystic liver disease, who underwent orthotopic liver transplantation (OLT) on November 11, 2008. The whole-size graft was taken from a deceased donor (a 51-year-old man who died of a heart attack). Resection in a patient with massive hepatomegaly is very difficult. Thus, after intercepting the portal hepatic vein, left hepatectomy was performed, then the vena cava was intercepted, the second and third porta hepatic isolated, and fi nally, right hepatectomy was performed. OLT was performed successfully. The recipient did well after transplantation. This case suggested that OLT is an effective therapeutic option for polycystic liver disease and left hepatectomy can be performed fi rst during OLT if the liver is over enlarged.展开更多
Osteoarthritis, a disorder characterized by articular cartilage deterioration, varying degrees of inflammation, and chondrocyte apoptosis, is the most common chronic joint disease. To slow or reverse its progression, ...Osteoarthritis, a disorder characterized by articular cartilage deterioration, varying degrees of inflammation, and chondrocyte apoptosis, is the most common chronic joint disease. To slow or reverse its progression, inflammation should be inhibited, and chondrocyte proliferation should be promoted. Tetrahedral framework nucleic acids can be internalized by chondrocytes(even inflammatory chondrocytes) and can enhance their proliferation and migration. Wogonin, a naturally occurring flavonoid,suppresses oxidative stress and inhibits inflammation. In this study, tetrahedral framework nucleic acids were successfully selfassembled and used to load wogonin. We confirmed the effective formation of tetrahedral framework nucleic acid/wogonin complexes by dynamic light scattering, zeta potential analysis, transmission electron microscopy, and fluorescence spectrophotometry. Tetrahedral framework nucleic acids, wogonin, and especially tetrahedral framework nucleic acid/wogonin complexes effectively alleviated inflammation in vitro and in vivo and prevented cartilage destruction. In addition, these materials remarkably downregulated the expression of inflammatory mediators and matrix metalloproteinases, upregulated chondrogenic markers, and promoted tissue inhibitor of metalloproteinase 1 and B-cell lymphoma 2 expression. In vivo, after treatment with tetrahedral framework nucleic acid/wogonin complexes, the bone mineral density in regenerated tissues was much higher than that found in the untreated groups. Histologically, the complexes enhanced new tissue regeneration, significantly suppressed chondrocyte apoptosis, and promoted chondrogenic marker expression. They also inhibited cell apoptosis, increased chondrogenic marker expression, and suppressed the expression of inflammatory mediators in osteoarthritis. Therefore, we believe that tetrahedral framework nucleic acid/wogonin complexes can be used as an injectable form of therapy for osteoarthritis.展开更多
Background:Apoptosis,also called programmed cell death,is a genetically controlled process against hyperproliferation and malignancy.The Fas-Fas ligand(FasL)system is considered a major pathway for apoptosis in cells ...Background:Apoptosis,also called programmed cell death,is a genetically controlled process against hyperproliferation and malignancy.The Fas-Fas ligand(FasL)system is considered a major pathway for apoptosis in cells and tissues.Thus,this study aimed to investigate whether single nucleotide polymor-phisms(SNPs)in Fas and FasL gene may have effects on the recurrence and survival of patients with hepatocellular carcinoma(HCC)after curative hepatectomy.Methods:We investigated the relationship between Fas rs1800682,rs2234767 and FasL rs763110 poly-morphisms and recurrence-free survival(RFS)as well as overall survival(OS)in 117 Chinese Han patients with HCC who underwent hepatectomy.Results:In Kaplan-Meier survival analysis,only Fas rs1800682(-670 A/G)was associated with RFS and OS.Compared with AA genotype,the AG/GG genotype was significantly associated with better RFS(P=0.008)and OS(P=0.020).Moreover,multivariate Cox regression analysis showed that Fas rs1800682 remained as a significant independent predictor of RFS for HCC patients with hepatectomy[AG/GG vs.AA:adjusted hazard ratio=0.464,95%confidence interval:0.275-0.782,P=0.004],but was not an independent predictor of OS(P=0.395).Conclusions:This study demonstrated that Fas-670 G allele may play a protective role in the recurrence and survival of HCC patients with hepatectomy.Furthermore,Fas rs1800682 polymorphism might be a promising biomarker for HCC patients after hepatectomy.展开更多
Background:There are few detailed consensus and guidelines on perioperative clinical characteristicsof liver transplantation(LT)in patients with methylmalonic acidemia(MMA).This retrospective studyinvestigated details...Background:There are few detailed consensus and guidelines on perioperative clinical characteristicsof liver transplantation(LT)in patients with methylmalonic acidemia(MMA).This retrospective studyinvestigated details of the clinical course and individualized treatment plan of the center with largestexperience in China.Methods:A total of 7 MMA patients undergoing LT in Beijing Friendship Hospital from June 2013 toDecember 2017 were enrolled in the study,whose clinical data(clinical characteristics,laboratory findings,chronological changes in urine MMA levels,treatment,etc.)during perioperative period were analyzedretrospectively.All the patients received strict postoperative management.Results:All the 7 cases were confirmed to have isolated MMA,among which,3 cases received livingdonor liver transplantation(LDLT),4 cases received deceased donor liver transplantation(DDLT).A wildfluctuate of metabolic condition was observed within the first few days after surgery and two weeks afterLT,the mean base excess of blood value(BE-B)restored to normal whereas plasma bicarbonate(HCO3-)was still below normal value even with intermittent sodium bicarbonate correction.It also showed markedreduction in propionylcarnitine(C3)and C3/C2 level and the mean urine MMA by gas chromatographymassspectrometry(GC-MS)was reduced by 81.7%(P<0.01)but remained>72×higher than upper limitof normal.The metabolism-correcting medications were administered as before.The renal function ofone case with renal insufficiency before LT(serum creatinine rising)maintained stable by adjusting theimmunosuppressive regimen during the observation period.All patients survive to date.Conclusions:LT is an effective treatment to prevent metabolic crisis,but patients with MMA tend to bemetabolically fragile even after surgery.During perioperative period,close monitoring should be given foracidosis episodes so as to implement sodium bicarbonate correction.Metabolism-correcting medications arestill needed.Special immunosuppressive regimen is an effective way of maintaining renal function for thosewith kidney dysfunction.展开更多
Patients with gallbladder carcinoma can present with a variety of paraneoplastic syndromes,including Cushing's syndrome,hypercalcemia,acanthosis nigricans,bullous pemphigoid,dermatomyositis and the sign of Leser-T...Patients with gallbladder carcinoma can present with a variety of paraneoplastic syndromes,including Cushing's syndrome,hypercalcemia,acanthosis nigricans,bullous pemphigoid,dermatomyositis and the sign of Leser-Trélat.Surgical resection of the primary tumor results in resolution of these paraneoplastic syndromes.We present a 67-year old female with facial and cervical erythema who was initially diagnosed with dermatomyositis.However,an abdominal computed tomography(CT)and positron emission tomographyCT scan was suspicious for gallbladder carcinoma with lymph node metastasis.After surgical resection,her dermatomyositis was resolved.This case demonstrates that dermatomyositis may be a manifestation of preexisting gallbladder carcinoma.展开更多
BACKGROUND Combined penetrating trauma involving the chest, pericardium, abdomen, and thigh is rare and lethal. It is difficult to quickly rescue patients with penetrating injuries from long steel bars.CASE SUMMARY A ...BACKGROUND Combined penetrating trauma involving the chest, pericardium, abdomen, and thigh is rare and lethal. It is difficult to quickly rescue patients with penetrating injuries from long steel bars.CASE SUMMARY A previously healthy 56-year-old male worker presented with a length of rebar that penetrated the chest-abdomen-pelvic cavity and was palpable on the anterior side of the neck and thigh. On radiological imaging, the left chest wall-left chest cavity-mediastinum-abdominal cavity-right groin area-right thigh demonstrated a strip-like density shadow, about 1.5 cm thick, with the heart, stomach wall, and part of the intestine involved. There was a left-sided pleural effusion, left lung compression of about 50%-60%, and a small amount of left pleural effusion/blood accumulation;possible perforation of hollow organs;and double multiple ribs fractures on the side. An emergency green channel was opened to provide a rescue process for smooth and timely diagnostic and treatment to save the patient's life. The patient was followed at 4 mo after discharge and showed good recovery.CONCLUSION For pre-hospital emergency treatment in locations that are not fully prepared for surgery, we do not recommend cutting the steel bars outside the body. We advocate pulling out foreign bodies intact to reduce secondary injuries.展开更多
Intrahepatic cholangiocarcinoma(iCCA)can originate from the large bile duct group(segment bile ducts and area bile ducts),small bile duct group(septal bile ducts and interlobular bile ducts),and terminal bile duct gro...Intrahepatic cholangiocarcinoma(iCCA)can originate from the large bile duct group(segment bile ducts and area bile ducts),small bile duct group(septal bile ducts and interlobular bile ducts),and terminal bile duct group(bile ductules and canals of Hering)of the intrahepatic biliary tree,which can be histopathological corresponding to large duct type iCCA,small duct type iCCA and iCCA with ductal plate malformation pattern,and cholangiolocarcinoma,respectively.The challenge in pathological diagnosis of above subtypes of iCCA falls in the distinction of cellular morphologies,tissue structures,growth patterns,invasive behaviors,immunophenotypes,molecular mutations,and surgical prognoses.For these reasons,this expert consensus provides nine recommendations as a reference for standardizing and refining the diagnosis of pathological subtypes of iCCA,mainly based on the 5th edition of the World Health Organization Classification of Tumours of the Digestive System.展开更多
With technological advances in laparoscopic hepatectomy and new navigation devices,such as flexible laparoscopic ultrasound probes,indocyanine green(ICG)-fluorescent imaging and three-dimensional imaging,laparoscopic ...With technological advances in laparoscopic hepatectomy and new navigation devices,such as flexible laparoscopic ultrasound probes,indocyanine green(ICG)-fluorescent imaging and three-dimensional imaging,laparoscopic segmentectomy(LS),which maximizes the preservation of the functional hepatic reserve and the possibility for future repeat hepatectomy while ensuring adequate surgical margins,has become a feasible alternative to hemihepatectomy for addressing hepatocellular carcinoma(HCC).展开更多
Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected pa...Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection,a‘conversion therapy’strategy.However,conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed.Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review:Many research centers in China have accumulated significant experience implementing HCC conversion therapy.Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC;however,there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields.In order to summarize and learn from past experience and review current challenges,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition)was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice.Sixteen consensus statements on the implementation of conversion therapy for HCC were developed.The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.展开更多
基金Supported by the Technology Program of Guangdong Province, No. 2004B35001001
文摘AIM： To study the association between host immunity and hepatitis B virus （HBV） recurrence after liver transplantation. METHODS： Peripheral blood mononuclear cells （PBMC） were isolated from 40 patients with hepatitis B and underwent orthotopic liver transplantation （OLT） before and 2, 4, 8 wk after surgery. After being cultured in vitro for 72 h, the levels of INF-γ and TNF-α in culture supematants were detected with ELISA. At the same time, the quantities of HBV DNA in serum and PBMCs were measured by real time PCR. RESULTS： The levels of INF-γ and TNF-α in PBMC culture supernatants decreased before and 2, 4 wk after surgery in turns （INF-γ 155.52±72.32 ng/L vs 14.76±9.88 ng/L vs 13.22±10.35 ng/L, F= 6.946, P= 0.027〈0.05; TNF-α 80.839±46.75 ng/L vs18.59±17.29 ng/L vs9.758±7.96 ng/L, F= 22.61, P = 0.0001〈0.05）. The levels of INF-γ and TNF-α were higher in groups with phytohemagglutinin （PHA） than in those without PHA before surgery. However, the difference disappeared following OLT. Furthermore, INF-γ and TNF-α could not be detected in most patients at wk 4 and none at wk 8 after OLT. The HBV detection rate and virus load in PBMC before and 2, 4 wk after surgery were fluctuated （HBV detected rate： 51.4%, 13.3%, 50% respectively; HBV DNA： 3.55±0.674 log（10） copies/mL vs 3.00±0.329 log（10） copies/mL vs 4.608±1.344 log（10） copies/mL, F= 7.582, P= 0.002〈0.05）. HBV DNA in serum was 4.48±1.463 log（10） copies/mL before surgery and 〈 10^3 copies/mL after OLT except for one with 5.72×10^6 copies/mL 4 wk after OLT who was diagnosed as HBV recurrence. The levels of INF-γ and TNF-α were lower in patients with a high HBV load than in those with a low HBV load （HBV DNA detected/undetected in PBMCs： IFN-γ 138.08±72.44 ng/L vs 164.24±72.07 ng/L, t = 1.065, P= 0.297〉0.05, TNF-α 80.75±47.30 ng/L vs 74.10±49.70 ng/L, t= 0.407, P= 0.686〉 0.05; HBV DNA positive/negative： IFN-γ 136.77±70.04 ng/L vs 175.27±71.50 ng/L, t= 1.702, P= 0.097〉0.05; TNF-α 75.37±43.02 ng/L vs 81.53±52.46 ng/L, t = 0.402, P = 0.690〉0.05）. CONCLUSION： The yielding of INF-γ and TNF-α from PBMCs is inhibited significantly by immunosuppressive agents following OLT with HBV load increased, indicating that the impaired immunity of host is associated with HBV recurrence after OLT.
基金supported by grants from the National Science and Technology Major Project of China(2012ZX10002-016 and 2012ZX10002-017)
文摘BACKGROUND:Many studies have confirmed that serum total cholesterol(sTC) concentrations were associated with underlying liver damage and the synthesis capacity of liver.However, the role of postoperative sTC level on evaluating graft function and predicting survival of recipients who underwent liver transplantation has not been discussed.METHODS:Clinical data of 231 living donor liver transplantation recipients from May 2003 to January 2015 were retrospectively collected. Patients were stratified into the low sTC group(sTC <1.42 mmol/L, 57 recipients) and high sTC group(sTC ≥1.42 mmol/L, 174 recipients) according the sTC level on postoperative day 3 based on receiver-operating characteristic curve analysis. The clinical characteristics and postoperative short-and long-term outcomes were compared between the two groups.RESULTS:Recipients with sTC <1.42 mmol/L experienced more severe preoperative disease conditions, a higher incidence of postoperative early allograft dysfunction(38.6% vs 10.3%, P<0.001), 90-day mortality(28.1% vs 10.9%, P=0.002)and severe complications(29.8% vs 17.2%, P=0.041) compared to recipients with sTC ≥1.42 mmol/L. The multivariate analysis demonstrated that sT C <1.42 mmol/L had a 4.08-fold(95% CI:1.83-9.11, P=0.001) and 2.72-fold(95% CI:1.23-6.00,P=0.013) greater risk of developing allograft dysfunction and 90-day mortality, and patients with sTC <1.42 mmol/L had poorer overall recipient and graft survival rates at 1-, 3-, and 5-year than those with sTC ≥1.42 mmol/L(67%, 61% and 61% vs 83%, 71% and 69%, P=0.025; 65%, 59% and 59% vs 81%,68% and 66%, P=0.026, respectively). Cox multivariate anal-ysis showed that sTC <1.42 mmol/L was an independent predicting factor for total recipient survival(HR=2.043; 95% CI:1.173-3.560; P=0.012) and graft survival(HR=1.905; 95% CI:1.115-3.255; P=0.018).CONCLUSIONS:sTC <1.42 mmol/L on postoperative day 3 was an independent risk factor of postoperative early allograft dysfunction, 90-day mortality, recipient and graft survival, which can be used as a marker for predicting postoperative short-and long-term outcomes.
基金supported by a grant from Jiangsu Health Department of China (RC2007058)
文摘Hepatic venous stenosis may be a cause of graft failure in living donor liver transplantation （LDLT）. Balloon dilation and metallic frame approaches have been used successfully to treat hepatic venous stenosis. Here, we report the effect of transfemoral venous balloon dilation for treating a child with hepatic venous stenosis after LDLT .
基金Supported by Sichuan Provincial Key Project-Science and Technology Project Plan,No.2019yfs0372.
文摘BACKGROUND Laparoscopic liver resection(LLR)has become a safe surgical procedure that needs additional summarization.AIM To review 4 years of total LLR surgeries,exceeding 1000 cases,which were performed at a single center.METHODS Patients who underwent LLR at West China Hospital of Sichuan University between January 2015 and December 2018 were identified.Surgical details,including the interventional year,category of liver disease,and malignant liver tumors prognosis,were evaluated.The learning curve for LLR was evaluated using the cumulative sum method.The Kaplan-Meier method was used to perform survival analysis.RESULTS Ultimately,1098 patients were identified.Hepatocellular carcinoma(HCC)was the most common disease that led to the need for LLR at the center(n=462,42.08%).The average operation time was 216.94±98.51 min.The conversion rate was 1.82%(20/1098).The complication rate was 9.20%(from grade II to V).The 1-year and 3-year overall survival rates of HCC patients were 89.7%and 81.9%,respectively.The learning curve was grouped into two phases for local resection(cases 1-106 and 107-373),three phases for anatomical segmentectomy(cases 1-44,45-74 and 75-120),and three phases for hemihepatectomy(cases 1-17,18-48 and CONCLUSION LLR may be considered a first-line surgical intervention for liver resection that can be performed safely for a variety of primary,secondary,and recurrent liver tumors and for benign diseases once technical competence is proficiently attained.
文摘The Author Reply:We thank Dr.Fu-Shan Xue et al.for the opportunity to discuss the article we recently published in Hepatobiliary Pancreat Dis Int[1].They claim that the study setting is not strong enough to prove the statistical association between a low postoperative s TC and increased postoperative adverse outcome.
基金supported by grants from the National S&T Major Project (2017ZX10203205)Key Program,National Natural Science Foundation of China (81930016)Zhejiang Provincial Natural Science Foundation of China (LY21H160026)。
文摘Mammalian target of rapamycin(m TOR) inhibitor as an attractive drug target with promising antitumor effects has been widely investigated. High quality clinical trial has been conducted in liver transplant(LT) recipients in Western countries. However, the pertinent studies in Eastern world are paucity. Therefore, we designed a clinical trial to test whether sirolimus can improve recurrence-free survival(RFS) in hepatocellular carcinoma(HCC) patients beyond the Milan criteria after LT. This is an open-labeled, single-arm, prospective, multicenter, and real-world study aiming to evaluate the clinical outcomes of early switch to sirolimus-based regimens in HCC patients after LT. Patients with a histologically proven HCC and beyond the Milan criteria will be enrolled. The initial immunosuppressant regimens are center-specifc for the frst 4-6 weeks. The following regimens integrated sirolimus into the regimens as a combination therapy with reduced calcineurin inhibitors based on the condition of patients and centers. The study is planned for 4 years in total with a 2-year enrollment period and a 2-year follow-up. We predict that sirolimus conversion regimen will provide survival benefts for patients particular in the key indicator RFS as well as better quality of life. If the trial is conducted successfully, we will have a continued monitoring over a longer follow-up time to estimate indicator of overall survival. We hope that the outcome will provide better evidence for clinical decision-making and revising treatment guidelines based on Chinese population data.
文摘A previous study has shown that liver or combined liver-kidney transplantation can be a valuable surgical technique for the treatment of polycystic liver disease. Herein, we present the case of a 35-year-old woman with polycystic liver disease, who underwent orthotopic liver transplantation (OLT) on November 11, 2008. The whole-size graft was taken from a deceased donor (a 51-year-old man who died of a heart attack). Resection in a patient with massive hepatomegaly is very difficult. Thus, after intercepting the portal hepatic vein, left hepatectomy was performed, then the vena cava was intercepted, the second and third porta hepatic isolated, and fi nally, right hepatectomy was performed. OLT was performed successfully. The recipient did well after transplantation. This case suggested that OLT is an effective therapeutic option for polycystic liver disease and left hepatectomy can be performed fi rst during OLT if the liver is over enlarged.
基金supported by National Key R&D Program of China (2019YFA0110600)National Natural Science Foundation of China (81970986, 81771125)
文摘Osteoarthritis, a disorder characterized by articular cartilage deterioration, varying degrees of inflammation, and chondrocyte apoptosis, is the most common chronic joint disease. To slow or reverse its progression, inflammation should be inhibited, and chondrocyte proliferation should be promoted. Tetrahedral framework nucleic acids can be internalized by chondrocytes(even inflammatory chondrocytes) and can enhance their proliferation and migration. Wogonin, a naturally occurring flavonoid,suppresses oxidative stress and inhibits inflammation. In this study, tetrahedral framework nucleic acids were successfully selfassembled and used to load wogonin. We confirmed the effective formation of tetrahedral framework nucleic acid/wogonin complexes by dynamic light scattering, zeta potential analysis, transmission electron microscopy, and fluorescence spectrophotometry. Tetrahedral framework nucleic acids, wogonin, and especially tetrahedral framework nucleic acid/wogonin complexes effectively alleviated inflammation in vitro and in vivo and prevented cartilage destruction. In addition, these materials remarkably downregulated the expression of inflammatory mediators and matrix metalloproteinases, upregulated chondrogenic markers, and promoted tissue inhibitor of metalloproteinase 1 and B-cell lymphoma 2 expression. In vivo, after treatment with tetrahedral framework nucleic acid/wogonin complexes, the bone mineral density in regenerated tissues was much higher than that found in the untreated groups. Histologically, the complexes enhanced new tissue regeneration, significantly suppressed chondrocyte apoptosis, and promoted chondrogenic marker expression. They also inhibited cell apoptosis, increased chondrogenic marker expression, and suppressed the expression of inflammatory mediators in osteoarthritis. Therefore, we believe that tetrahedral framework nucleic acid/wogonin complexes can be used as an injectable form of therapy for osteoarthritis.
基金supported by grants from the Sichuan Sci-ence and Technology Program(2019YFS0370)National Univer-sity Student Innovation and Entrepreneurship Training Programs(C2019104465).
文摘Background:Apoptosis,also called programmed cell death,is a genetically controlled process against hyperproliferation and malignancy.The Fas-Fas ligand(FasL)system is considered a major pathway for apoptosis in cells and tissues.Thus,this study aimed to investigate whether single nucleotide polymor-phisms(SNPs)in Fas and FasL gene may have effects on the recurrence and survival of patients with hepatocellular carcinoma(HCC)after curative hepatectomy.Methods:We investigated the relationship between Fas rs1800682,rs2234767 and FasL rs763110 poly-morphisms and recurrence-free survival(RFS)as well as overall survival(OS)in 117 Chinese Han patients with HCC who underwent hepatectomy.Results:In Kaplan-Meier survival analysis,only Fas rs1800682(-670 A/G)was associated with RFS and OS.Compared with AA genotype,the AG/GG genotype was significantly associated with better RFS(P=0.008)and OS(P=0.020).Moreover,multivariate Cox regression analysis showed that Fas rs1800682 remained as a significant independent predictor of RFS for HCC patients with hepatectomy[AG/GG vs.AA:adjusted hazard ratio=0.464,95%confidence interval:0.275-0.782,P=0.004],but was not an independent predictor of OS(P=0.395).Conclusions:This study demonstrated that Fas-670 G allele may play a protective role in the recurrence and survival of HCC patients with hepatectomy.Furthermore,Fas rs1800682 polymorphism might be a promising biomarker for HCC patients after hepatectomy.
基金This work was supported by The Capital Health Research and Development of Special(No.2016-1-2021)and Beijing Municipal Administration of Hospitals Ascent Plan(Code:DFL20150101).
文摘Background:There are few detailed consensus and guidelines on perioperative clinical characteristicsof liver transplantation(LT)in patients with methylmalonic acidemia(MMA).This retrospective studyinvestigated details of the clinical course and individualized treatment plan of the center with largestexperience in China.Methods:A total of 7 MMA patients undergoing LT in Beijing Friendship Hospital from June 2013 toDecember 2017 were enrolled in the study,whose clinical data(clinical characteristics,laboratory findings,chronological changes in urine MMA levels,treatment,etc.)during perioperative period were analyzedretrospectively.All the patients received strict postoperative management.Results:All the 7 cases were confirmed to have isolated MMA,among which,3 cases received livingdonor liver transplantation(LDLT),4 cases received deceased donor liver transplantation(DDLT).A wildfluctuate of metabolic condition was observed within the first few days after surgery and two weeks afterLT,the mean base excess of blood value(BE-B)restored to normal whereas plasma bicarbonate(HCO3-)was still below normal value even with intermittent sodium bicarbonate correction.It also showed markedreduction in propionylcarnitine(C3)and C3/C2 level and the mean urine MMA by gas chromatographymassspectrometry(GC-MS)was reduced by 81.7%(P<0.01)but remained>72×higher than upper limitof normal.The metabolism-correcting medications were administered as before.The renal function ofone case with renal insufficiency before LT(serum creatinine rising)maintained stable by adjusting theimmunosuppressive regimen during the observation period.All patients survive to date.Conclusions:LT is an effective treatment to prevent metabolic crisis,but patients with MMA tend to bemetabolically fragile even after surgery.During perioperative period,close monitoring should be given foracidosis episodes so as to implement sodium bicarbonate correction.Metabolism-correcting medications arestill needed.Special immunosuppressive regimen is an effective way of maintaining renal function for thosewith kidney dysfunction.
文摘Patients with gallbladder carcinoma can present with a variety of paraneoplastic syndromes,including Cushing's syndrome,hypercalcemia,acanthosis nigricans,bullous pemphigoid,dermatomyositis and the sign of Leser-Trélat.Surgical resection of the primary tumor results in resolution of these paraneoplastic syndromes.We present a 67-year old female with facial and cervical erythema who was initially diagnosed with dermatomyositis.However,an abdominal computed tomography(CT)and positron emission tomographyCT scan was suspicious for gallbladder carcinoma with lymph node metastasis.After surgical resection,her dermatomyositis was resolved.This case demonstrates that dermatomyositis may be a manifestation of preexisting gallbladder carcinoma.
基金the Science and Technology Program of Sichuan Science and Technology Department,Nos.2019YFS0029and 2019YFS0529the National Natural Science Foundation of China,No.81770566。
文摘BACKGROUND Combined penetrating trauma involving the chest, pericardium, abdomen, and thigh is rare and lethal. It is difficult to quickly rescue patients with penetrating injuries from long steel bars.CASE SUMMARY A previously healthy 56-year-old male worker presented with a length of rebar that penetrated the chest-abdomen-pelvic cavity and was palpable on the anterior side of the neck and thigh. On radiological imaging, the left chest wall-left chest cavity-mediastinum-abdominal cavity-right groin area-right thigh demonstrated a strip-like density shadow, about 1.5 cm thick, with the heart, stomach wall, and part of the intestine involved. There was a left-sided pleural effusion, left lung compression of about 50%-60%, and a small amount of left pleural effusion/blood accumulation;possible perforation of hollow organs;and double multiple ribs fractures on the side. An emergency green channel was opened to provide a rescue process for smooth and timely diagnostic and treatment to save the patient's life. The patient was followed at 4 mo after discharge and showed good recovery.CONCLUSION For pre-hospital emergency treatment in locations that are not fully prepared for surgery, we do not recommend cutting the steel bars outside the body. We advocate pulling out foreign bodies intact to reduce secondary injuries.
基金Shanghai Municipal Key Clinical Specialty(shslczdzk01302)Shanghai Shenkang Hospital Development Center Clinical Science and Technology Innovation Project(SHDC12021109).
文摘Intrahepatic cholangiocarcinoma(iCCA)can originate from the large bile duct group(segment bile ducts and area bile ducts),small bile duct group(septal bile ducts and interlobular bile ducts),and terminal bile duct group(bile ductules and canals of Hering)of the intrahepatic biliary tree,which can be histopathological corresponding to large duct type iCCA,small duct type iCCA and iCCA with ductal plate malformation pattern,and cholangiolocarcinoma,respectively.The challenge in pathological diagnosis of above subtypes of iCCA falls in the distinction of cellular morphologies,tissue structures,growth patterns,invasive behaviors,immunophenotypes,molecular mutations,and surgical prognoses.For these reasons,this expert consensus provides nine recommendations as a reference for standardizing and refining the diagnosis of pathological subtypes of iCCA,mainly based on the 5th edition of the World Health Organization Classification of Tumours of the Digestive System.
基金National Natural Science Foundation of China(No. 81400636)Sichuan Province Key Research and Development Project(No. 2019YFS0203)Key Project of Clinical Research Incubation in West China Hospital of Sichuan University(No. 2020HXFH028)
文摘With technological advances in laparoscopic hepatectomy and new navigation devices,such as flexible laparoscopic ultrasound probes,indocyanine green(ICG)-fluorescent imaging and three-dimensional imaging,laparoscopic segmentectomy(LS),which maximizes the preservation of the functional hepatic reserve and the possibility for future repeat hepatectomy while ensuring adequate surgical margins,has become a feasible alternative to hemihepatectomy for addressing hepatocellular carcinoma(HCC).
文摘Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection,a‘conversion therapy’strategy.However,conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed.Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review:Many research centers in China have accumulated significant experience implementing HCC conversion therapy.Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC;however,there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields.In order to summarize and learn from past experience and review current challenges,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition)was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice.Sixteen consensus statements on the implementation of conversion therapy for HCC were developed.The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.
