The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Base...The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Based on the foundation of the previous consensus statement,this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice.The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine(EBM).Relevant literature was reviewed and analyzed by the evidence evaluation group.According to the WHO Handbook for Guideline Development,the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022,a total of 14 recommendations were generated.Among them were 8 recommendations formulated by the GRADE method,and the remaining 6 recommendations were formulated based on literature review and experts’opinion due to insufficient EBM results.This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.展开更多
Background: Creating a tunnel between the pancreas and splenic vessels followed by pancreatic parenchyma transection(“tunnel-first” strategy) has long been used in spleen-preserving distal pancreatectomy(SPDP) with ...Background: Creating a tunnel between the pancreas and splenic vessels followed by pancreatic parenchyma transection(“tunnel-first” strategy) has long been used in spleen-preserving distal pancreatectomy(SPDP) with splenic vessel preservation(Kimura’s procedure). However, the operation space is limited in the tunnel, leading to the risks of bleeding and difficulties in suturing. We adopted the pancreatic “parenchyma transection-first” strategy to optimize Kimura’s procedure. Methods: The clinical data of consecutive patients who underwent robotic SPDP with Kimura’s procedure between January 2017 and September 2022 at our center were retrieved. The cohort was classified into a “parenchyma transection-first” strategy(P-F) group and a “tunnel-first” strategy(T-F) group and analyzed. Results: A total of 91 patients were enrolled in this cohort, with 49 in the T-F group and 42 in the P-F group. Compared with the T-F group, the P-F group had significantly shorter operative time(146.1 ± 39.2 min vs. 174.9 ± 46.6 min, P < 0.01) and lower estimated blood loss [40.0(20.0–55.0) m L vs. 50.0(20.0–100.0) m L, P = 0.03]. Failure of splenic vessel preservation occurred in 10.2% patients in the TF group and 2.4% in the P-F group( P = 0.14). The grade 3/4 complications were similar between the two groups( P = 0.57). No differences in postoperative pancreatic fistula, abdominal infection or hemorrhage were observed between the two groups. Conclusions: The pancreatic “parenchyma transection-first” strategy is safe and feasible compared with traditional “tunnel-first strategy” in SPDP with Kimura’s procedure.展开更多
Objective Compared to portal vein ligation(PVL),simultaneous bile duct and portal vein ligation(BPL)can significantly enhance hypertrophy of the intact liver.This study aimed to investigate whether BPL could improve s...Objective Compared to portal vein ligation(PVL),simultaneous bile duct and portal vein ligation(BPL)can significantly enhance hypertrophy of the intact liver.This study aimed to investigate whether BPL could improve survival after extended hepatectomy independently of an increased remnant liver.Methods We adopted rat models of 90%BPL or 90%PVL.To investigate the role of bile acids(BAs)the BA pools in the PVL and BPL groups were altered by the diet.Staged resection preserving 10%of the estimated liver weight was performed 3 days after BPL;PVL;or sham operation.Histology,canalicular network(CN)continuity;and hepatocyte polarity were evaluated.Results At 3 days after BPL;PVL;or sham operation when the volumetric difference of the intended liver remained insignificant,the survival rates after extended hepatectomy were 86.7%,47%,and 23.3%,respectively(P<0.01).BPL induced faster restoration of canalicular integrity along with an intensive but transient BA overload.Staged hepatectomy after BPL shortened the duration of the bile CN disturbance and limited BA retention.Decreasing the BA pools in the rats that underwent BPL could compromise these effects,whereas increasing the BA pools of rats that underwent PVL could induce similar effects.The changes in CN restoration were associated with activation of LKB1.Conclusion In addition to increasing the future remnant liver,BPL shortened the duration of the spatial disturbance of the CN and could significantly improve the tolerance of the hypertrophied liver to staged resection.BPL may be a safe and efficient future option for patients with an insufficient remnant liver.展开更多
Hepatocellular carcinoma(HCC)is the third most common cause for cancer-related death worldwide,especially in China[1].Hepatectomy is considered one of the most potentially curative therapies for HCC[2].As HCC is capab...Hepatocellular carcinoma(HCC)is the third most common cause for cancer-related death worldwide,especially in China[1].Hepatectomy is considered one of the most potentially curative therapies for HCC[2].As HCC is capable of vascular invasion and metastasis via the portal venous system,anatomical resection is often performed to reduce tumor recurrence.This process involves resecting the tumor-bearing portal branches and the corresponding hepatic parenchyma[3].Certain comparative studies have demonstrated better overall survival and disease-free survival with the use of anatomical resection when compared with nonanatomical resection[4–6].展开更多
Background:The high incidence of gallstone recurrence was a major concern for laparoscopic gallbladderpreserving surgery.This study aimed to investigate the risk factors for gallstone recurrence after gallbladder-pres...Background:The high incidence of gallstone recurrence was a major concern for laparoscopic gallbladderpreserving surgery.This study aimed to investigate the risk factors for gallstone recurrence after gallbladder-preserving surgery and to establish an individualized nomogram model to predict the risk of gallstone recurrence.Methods:The clinicopathological and follow-up data of 183 patients who were initially diagnosed with gallstones and treated with gallbladder-preserving surgery at our hospital from January 2012 to January 2019 were retrospectively collected.The independent predictive factors for gallstone recurrence following gallbladder-preserving surgery were identified by multivariate logistic regression analysis.A nomogram model for the prediction of gallstone recurrence was constructed based on the selected variables.The C-index,receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the predictive power of the nomogram model for gallstone recurrence.Results:During the follow-up period,a total of 65 patients experienced gallstone recurrence,and the recurrence rate was 35.5%.Multivariate logistic regression analysis revealed that the course of gallstones>2 years[odds ratio(OR)=2.567,95%confidence interval(CI):1.270-5.187,P=0.009],symptomatic gallstones(OR=2.589,95%CI:1.059-6.329,P=0.037),multiple gallstones(OR=2.436,95%CI:1.133-5.237,P=0.023),history of acute cholecystitis(OR=2.778,95%CI:1.178-6.549,P=0.020)and a greasy diet(OR=2.319,95%CI:1.186-4.535,P=0.014)were independent risk factors for gallstone recurrence after gallbladder-preserving surgery.A nomogram model for predicting the recurrence of gallstones was established based on the above five variables.The results showed that the C-index of the nomogram model was 0.692,suggesting it was valuable to predict gallstone recurrence.Moreover,the calibration curve showed good consistency between the predicted probability and actual probability.Conclusions:The nomogram model for the prediction of gallstone recurrence might help clinicians develop a proper treatment strategy for patients with gallstones.Gallbladder-preserving surgery should be cautiously considered for patients with high recurrence risks.展开更多
BACKGROUND Glycolysis caused by hypoxia-induced abnormal activation of hypoxia inducible factor-1α(HIF-1α)in the immune microenvironment promotes the progression of hepatocellular carcinoma(HCC),leading to enhanced ...BACKGROUND Glycolysis caused by hypoxia-induced abnormal activation of hypoxia inducible factor-1α(HIF-1α)in the immune microenvironment promotes the progression of hepatocellular carcinoma(HCC),leading to enhanced drug resistance in cancer cells.Therefore,altering the immunosuppressive microenvironment by improving the hypoxic state is a new goal in improving cancer treatment.AIM To analyse the role of HIF-1α,which is closely related to tumour proliferation,invasion,metastasis,and angiogenesis,in the proliferation and invasion of liver cancer,and to explore the HIF-1αpathway-mediated anti-cancer mechanism of sirolimus(SRL)combined with Huai Er.METHODS Previous studies on HCC tissues identified the importance of HIF-1α,glucose transporter 1(GLUT1),and lactate dehydrogenase A(LDHA)expression.In this study,HepG2 and Huh7 cell lines were treated,under hypoxic and normoxic conditions,with a combination of SRL and Huai Er.The effects on proliferation,invasion,cell cycle,and apoptosis were analysed.Proteomics and genomics techniques were used to analyze the HIF-1α-related signalling pathway during SRL combined with Huai Er treatment and its inhibition of the proliferation of HCC cells.RESULTS High levels of HIF-1α,LDHA,and GLUT-1 were found in poorly differentiated HCC,with lower patient survival rates.Hypoxia promoted the proliferation of HepG2 and Huh7 cells and weakened the apoptosis and cell cycle blocking effects of the SRL/Huai Er treatment.This was achieved by activation of HIF-1αand glycolysis in HCC,leading to the upregulation of LDHA,GLUT-1,Akt/mammalian target of rapamycin(mTOR),vascular endothelial growth factor(VEGF),and Forkhead box P3 and downregulation of phosphatase and tensin homolog deleted on chromosome ten(PTEN)and p27.The hypoxia-induced activation of HIF-1αshowed the greatest attenuation in the SRL/Huai Er(S50+H8)group compared to the drug treatments alone(P<0.001).The S50+H8 treatment significantly downregulated the expression of mTOR and HIF-1α,and significantly reduced the expression of VEGF mRNA.Meanwhile,the combined blocking of mTOR and HIF-1αenhanced the downregulation of Akt/mTOR,HIF-1α,LDHA,and GLUT-1 mRNA and resulted in the downregulation of PTEN,p27,and VEGF mRNA(P<0.001).CONCLUSION SRL increases the anti-cancer effect of Huai Er,which reduces the promotion of hypoxia-induced HIF-1αon the Warburg effect by inhibition of the PI3K/Akt/mTOR-HIF-1αand HIF-1α-PTEN signalling pathways in HCC.展开更多
BACKGROUND Irreversible electroporation(IRE)is a local non-thermal ablative technique which has been suggested as a potential cancer therapy.However,the specific anatomic characteristics of the pancreatic head make it...BACKGROUND Irreversible electroporation(IRE)is a local non-thermal ablative technique which has been suggested as a potential cancer therapy.However,the specific anatomic characteristics of the pancreatic head make it challenging to perform any local ablation in this region.Therefore,the safety and feasibility of IRE in the pancreatic head region should be further explored.AIM To evaluate the safety of IRE in pancreatic head region including its effects on pancreatic ducts,vessels,and adjacent gastrointestinal organs.METHODS Eight landrace miniature pigs underwent IRE of pancreatic head tissue successfully,with a total of 16 lesions created.Laboratory testing including white blood cell(WBC)count and serum amylase before IRE with follow-up laboratory analysis and pathological examination at 1,7,14,and 28 d postablation were performed.RESULTS All pigs tolerated the ablation procedure without serious perioperative complications.Transiently elevated WBC count and amylase were observed at 24 h post-IRE,suggesting an acute pancreatic tissue damage which was confirmed by pathological observations.Vascular endothelial cells and pancreatic duct epithelial cells in ablation zone were also positive in terminal deoxynucleotidyl transferase dUTP nick end labeling staining.There was extensive duodenum mucosa damage with local hemorrhage 24 h after ablation,while regeneration of new villous structures were observed at 7 and 28 d post-IRE.Masson’s trichromatic staining showed that the extracellular matrix was still intact in vessels and pancreatic ducts,and even in the duodenum.CONCLUSION IRE ablation to the pancreatic head may be safe and feasible without long-term damage to the surrounding vital structures.However,risks of stress injuries in acute phase should be taken into consideration to prevent severe perioperative complications.展开更多
BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is the second most common primary liver cancer in humans after hepatocellular carcinoma and a rare epithelial malignancy that results in a poor prognosis.According to the...BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is the second most common primary liver cancer in humans after hepatocellular carcinoma and a rare epithelial malignancy that results in a poor prognosis.According to the Liver Cancer Study Group of Japan classification,ICC can be divided into three types:Mass-forming(MF)type,periductal-infiltrating(PI)type,and intraductal-growth type.The MF type is the most common,accounting for 57.1-83.6%of ICCs.Nevertheless,little is known about the epidemiology and treatment of MF ICC.AIM To examine the prognostic factors for patients with MF ICC.METHODS We carried out a retrospective analysis of consecutive patients with MF ICC treated at the Faculty of Hepato-Pancreato-Biliary Surgery of Chinese PLA General Hospital between January 2008 and December 2018.According to the treatment received,the patients were divided into either a resection group or an exploration group.RESULTS The pooled 1-,3-,and 5-year survival rates in the 68 patients with MF ICC were 66.5%,36.3%,and 9.3%,respectively.Univariate analysis revealed that surgical resection(P<0.001),nodal metastasis(P<0.001),tumor location(P=0.039),vascular invasion(P<0.001),ascites(P<0.001),and differentiation(P=0.009)were significantly associated with the prognosis and survival of MF ICC.Multivariate analysis revealed that ascites(hazard ratio[HR]=5.6,95%confidence interval[CI]:1.6-18.9,P=0.006)and vascular invasion(HR=2.5,95%CI:1.0-6.1,P=0.045)were independent risk factors for MF ICC.The pooled 1-,3-,and 5-year survival rates in the 19 patients of the exploration group were 5.3%,5.3%,and 0,respectively.Among the 49 patients who underwent surgical resection,the pooled 1-,3-,and 5-year survival rates were 93.5%,49.7%,and 14.4%,respectively.Univariate and multivariate analyses revealed that vascular invasion(HR=3.1,95%CI:1.2-8.5,P=0.024)and nodal metastasis(HR=3.2,95%CI:1.4-7.6,P=0.008)were independent prognostic risk factors for surgical resection patients.CONCLUSION The prognosis of MF ICC patients is dismal,especially those with ascites or vascular invasion.Surgical resection is a key factor in improving overall survival in patients with MF ICC,and vascular invasion and lymph node metastasis affect the efficacy of surgical resection.展开更多
BACKGROUND Gastric cancer(GC)is one of the most prevalent malignant tumors that endangers human health.Early diagnosis is essential for improving the prognosis and survival rate of GC patients.Ring finger protein 180(...BACKGROUND Gastric cancer(GC)is one of the most prevalent malignant tumors that endangers human health.Early diagnosis is essential for improving the prognosis and survival rate of GC patients.Ring finger protein 180(RNF180)is involved in the regulation of cell differentiation,proliferation,apoptosis,and tumorigenesis,and aberrant hypermethylation of CpG islands in the promoter is strongly associated with the occurrence and development of GC.Thus,methylated RNF180 can be used as a potential biomarker for GC diagnosis.AIM To use droplet digital polymerase chain reaction(ddPCR)to quantify the methylation level of the RN180 gene.A reproducible ddPCR assay to detect methylated RNF180 from trace DNA was designed and optimized.METHODS The primer and probe were designed and selected,the conversion time of bisulfite was optimized,the ddPCR system was adjusted by primer concentration,amplification temperature and amplification cycles,and the detection limit of ddPCR was determined.RESULTS The best conversion time for blood DNA was 2 h 10 min,and that for plasma DNA was 2 h 10 min and 2 h 30 min.The results of ddPCR were better when the amplification temperature was 56°C and the number of amplification cycles was 50.Primer concentrations showed little effect on the assay outcome.Therefore,the primer concentration could be adjusted according to the reaction system and DNA input.The assay required at least 0.1 ng of input DNA.CONCLUSION In summary,a ddPCR assay was established to detect methylated RNF180,which is expected to be a new diagnostic biomarker for GC.展开更多
HMGN2 have functions in inflammatory response.However,the role of HMGN2 in severe acute pancreatitis(SAP)remains unclear.Here,our study was to discuss the role and regulatory mechanism ofHMGN2 in SAP.In this study,the...HMGN2 have functions in inflammatory response.However,the role of HMGN2 in severe acute pancreatitis(SAP)remains unclear.Here,our study was to discuss the role and regulatory mechanism ofHMGN2 in SAP.In this study,the SAP cell model of AR42J was used to study the function and mechanism of HMGN2 in SAP.The protein expression in cells and serums were examined by western blot and ELISA assay.qPCR was used to test the transcriptional RNA level.Cell viability were examined by MTT assay.Luciferase assay was used to evaluate the interaction between gene and gene.Our results showed that HMGN2 was significantly upregulated in SAP patients.The database predicted and luciferase assay data indicated the HMGN2 was directly binding with miR-590-3p.ELISA,MTT and western blot experiments showed that the HMGN2 were promoted the cell proliferation,reduced the inflammation,and repressed the cell autophagy.Mechanism studies showed that the pseudogene HMGN2P46 level was positively correlated with HMGN2 and upregulated HMGN2 expression by competing for miR-590-3p in SAP.Taken together,all over these results showed upregulation of HMGN2 alleviates SAP,this process was regulated by HMGN2P46 competitively binding with miR-590-3p,which may provide a new insight for the treatment and intervention in SAP.Pseudogene HMGN2P46 was a miRNA sponge to regulate HMGN2 level by competing for miR-590-3p to alleviate the process of SAP.It provided a novel strategy for the diagnosis and treatment of severe acute pancreatitis.展开更多
BACKGROUND Studies have validated the potential of methylated cell-free DNA as a biomarker in various tumors,and methylated DNA in plasma may be a potential biomarker for cancer.AIM To evaluate the diagnostic value of...BACKGROUND Studies have validated the potential of methylated cell-free DNA as a biomarker in various tumors,and methylated DNA in plasma may be a potential biomarker for cancer.AIM To evaluate the diagnostic value of RASSF1A methylation in plasma for colorectal cancer(CRC)and hepatocellular carcinoma(HCC).METHODS A total of 92 CRC patients,67 colorectal polyp(CRP)patients,63 HCC patients,and 66 liver cirrhosis(LC)patients were enrolled.The plasma DNA was subjected to DNA extraction,double-strand DNA concentration determination,bisulfite conversion,purification,single-strand DNA concentration determination,and digital polymerase chain reaction(PCR)detection.The methylation rate was calculated.The diagnostic value was evaluated by the area under the curve(AUC).RESULTS The age and sex in the CRC and CRP groups and the HCC and LC groups were also matched.The DNA methylation rate of RASSF1A in plasma in the CRC group was 2.87±1.80,and that in the CRP group was 1.50±0.64.DNA methylation of RASSF1A in plasma showed a significant difference between the CRC and CRP groups.The AUC of RASSF1A methylation for discriminating the CRC and CRP groups was 0.82(0.76-0.88).The AUCs of T1,T2,T3 and T4 CRC and CRP were 0.83(0.72-0.95),0.87(0.78-0.95),0.86(0.77-0.95),and 0.75(0.64-0.85),respectively.The DNA methylation rate of RASSF1A in plasma in the HCC group was 4.45±2.93,and that in the LC group was 2.46±2.07.DNA methylation of RASSF1A in plasma for the HCC and LC groups showed a significant difference.The AUC of RASSF1A methylation for discriminating the HCC and LC groups was 0.70(0.60-0.79).The AUCs of T1,T2,T3 and T4 HCC and LC were 0.80(0.61,1.00),0.74(0.59-0.88),0.60(0.42-0.79),and 0.68(0.53-0.82),respectively.CONCLUSION RASSF1A methylation in plasma detected by digital PCR may be a potential biomarker for CRC and HCC.展开更多
BACKGROUND In recent years,we created and employed a new anastomosis method,“bridging”pancreaticogastrostomy,to treat patients with extremely severe pancreatic injury.This surgery has advantages such as short length...BACKGROUND In recent years,we created and employed a new anastomosis method,“bridging”pancreaticogastrostomy,to treat patients with extremely severe pancreatic injury.This surgery has advantages such as short length of surgery,low secondary trauma,rapid construction of shunts for pancreatic fluid,preventing second surgeries,and achieving good treatment outcomes in clinical practice.However,due to the limited number of clinical cases,there is a lack of strong evidence to support the feasibility and safety of this surgical procedure.Therefore,we carried out animal experiments to examine this procedure,which is reported here.AIM To examine the feasibility and safety of a new rapid method of pancreaticogastrostomy,“bridging”pancreaticogastrostomy.METHODS Ten Landrace pigs were randomized into the experimental and control groups,with five pigs in each group.“Bridging”pancreaticogastrostomy was performed in the experimental group,while routine mucosa-to-mucosa pancreaticogastrostomy was performed in the control group.After surgery,the general condition,amylase levels in drainage fluid on Days 1,3,5,and 7,fasting and 2-h postprandial blood glucose 6 mo after surgery,fasting,2-h postprandial peripheral blood insulin,and portal vein blood insulin 6 mo after surgery were assessed.Resurgery was carried out at 1 and 6 mo after the former one to examine the condition of the abdominal cavity and firmness and tightness of the pancreaticogastric anastomosis and pancreas.RESULTS After surgery,the general condition of the animals was good.One in the control group did not gain weight 6 mo after surgery,whereas significant weight gain was present in the others.There were significant differences on Days 1 and 3 after surgery between the two groups but no differences on Days 5 and 7.There were no differences in fasting and 2-h postprandial blood glucose and fasting and 2-h insulin values of postprandial peripheral blood and portal vein blood 6 mo after surgery between the two groups.One month after surgery,the sinus tract orifice/anastomosis was patent in the two groups.Six months after surgery,the sinus tract orifice/anastomosis was sealed,and pancreases in both groups presented with chronic pancreatitis.CONCLUSION“Bridging”pancreaticogastrostomy is a feasible and safe a means of damage control surgery during the early stage of pancreatic injury.展开更多
Background:A new staging system for patients with hepatocellular carcinoma(HCC)associated with portal vein tumor thrombus(PVTT)was developed by incorporating the good points of the BCLC classification of HCC,and by im...Background:A new staging system for patients with hepatocellular carcinoma(HCC)associated with portal vein tumor thrombus(PVTT)was developed by incorporating the good points of the BCLC classification of HCC,and by improving on the currently existing classifications of HCC associated with PVTT.Methods:Univariate and multivariate analysis with Waldχ2 test were used to determinate the clinical prognostic factors for overall survival(OS)in patients with HCC and PVTT in the training cohort.Then the conditional inference trees analysis was applied to establish a new staging system.Results:A training cohort of 2,179 patients from the Eastern Hepatobiliary Surgery Hospital and a validation cohort of 1,550 patients from four major liver centers in China were enrolled into establishing and validating a new staging system.The system was established by incorporating liver function,general health status,tumor resectability,extrahepatic metastasis and extent of PVTT.This staging system had a good discriminatory ability to separate patients into different stages and substages.The median OS for the two cohorts were 57.1(37.2-76.9),12.1(11.0-13.2),5.7(5.1-6.2),4.0(3.3-4.6)and 2.5(1.7-3.3)months for the stages 0 to IV,respectively(P<0.001)in the training cohort.The corresponding figures for the validation cohort were 6.4(4.9-7.9),2.8(1.3-4.4),10.8(9.3-12.4),and 1.5(1.3-1.7)months for the stages II to IV,respectively(P<0.001).The mean survival for stage 0 to 1 were 37.6(35.9-39.2)and 30.4(27.4-33.4),respectively(P<0.001).Conclusions:A new staging system was established which provided a good discriminatory ability to separate patients into different stages and substages after treatment.It can be used to supplement the other HCC staging systems.展开更多
文摘The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Based on the foundation of the previous consensus statement,this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice.The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine(EBM).Relevant literature was reviewed and analyzed by the evidence evaluation group.According to the WHO Handbook for Guideline Development,the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022,a total of 14 recommendations were generated.Among them were 8 recommendations formulated by the GRADE method,and the remaining 6 recommendations were formulated based on literature review and experts’opinion due to insufficient EBM results.This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.
基金the Ethics Committee of Chinese PLA General Hospital(S2022-530-01).
文摘Background: Creating a tunnel between the pancreas and splenic vessels followed by pancreatic parenchyma transection(“tunnel-first” strategy) has long been used in spleen-preserving distal pancreatectomy(SPDP) with splenic vessel preservation(Kimura’s procedure). However, the operation space is limited in the tunnel, leading to the risks of bleeding and difficulties in suturing. We adopted the pancreatic “parenchyma transection-first” strategy to optimize Kimura’s procedure. Methods: The clinical data of consecutive patients who underwent robotic SPDP with Kimura’s procedure between January 2017 and September 2022 at our center were retrieved. The cohort was classified into a “parenchyma transection-first” strategy(P-F) group and a “tunnel-first” strategy(T-F) group and analyzed. Results: A total of 91 patients were enrolled in this cohort, with 49 in the T-F group and 42 in the P-F group. Compared with the T-F group, the P-F group had significantly shorter operative time(146.1 ± 39.2 min vs. 174.9 ± 46.6 min, P < 0.01) and lower estimated blood loss [40.0(20.0–55.0) m L vs. 50.0(20.0–100.0) m L, P = 0.03]. Failure of splenic vessel preservation occurred in 10.2% patients in the TF group and 2.4% in the P-F group( P = 0.14). The grade 3/4 complications were similar between the two groups( P = 0.57). No differences in postoperative pancreatic fistula, abdominal infection or hemorrhage were observed between the two groups. Conclusions: The pancreatic “parenchyma transection-first” strategy is safe and feasible compared with traditional “tunnel-first strategy” in SPDP with Kimura’s procedure.
基金supported by the Natural Science Foundation of Beijing Municipality(No.7194317).
文摘Objective Compared to portal vein ligation(PVL),simultaneous bile duct and portal vein ligation(BPL)can significantly enhance hypertrophy of the intact liver.This study aimed to investigate whether BPL could improve survival after extended hepatectomy independently of an increased remnant liver.Methods We adopted rat models of 90%BPL or 90%PVL.To investigate the role of bile acids(BAs)the BA pools in the PVL and BPL groups were altered by the diet.Staged resection preserving 10%of the estimated liver weight was performed 3 days after BPL;PVL;or sham operation.Histology,canalicular network(CN)continuity;and hepatocyte polarity were evaluated.Results At 3 days after BPL;PVL;or sham operation when the volumetric difference of the intended liver remained insignificant,the survival rates after extended hepatectomy were 86.7%,47%,and 23.3%,respectively(P<0.01).BPL induced faster restoration of canalicular integrity along with an intensive but transient BA overload.Staged hepatectomy after BPL shortened the duration of the bile CN disturbance and limited BA retention.Decreasing the BA pools in the rats that underwent BPL could compromise these effects,whereas increasing the BA pools of rats that underwent PVL could induce similar effects.The changes in CN restoration were associated with activation of LKB1.Conclusion In addition to increasing the future remnant liver,BPL shortened the duration of the spatial disturbance of the CN and could significantly improve the tolerance of the hypertrophied liver to staged resection.BPL may be a safe and efficient future option for patients with an insufficient remnant liver.
基金This study was supported by a grant from the National Natural Science Foundation of China(82102861).
文摘Hepatocellular carcinoma(HCC)is the third most common cause for cancer-related death worldwide,especially in China[1].Hepatectomy is considered one of the most potentially curative therapies for HCC[2].As HCC is capable of vascular invasion and metastasis via the portal venous system,anatomical resection is often performed to reduce tumor recurrence.This process involves resecting the tumor-bearing portal branches and the corresponding hepatic parenchyma[3].Certain comparative studies have demonstrated better overall survival and disease-free survival with the use of anatomical resection when compared with nonanatomical resection[4–6].
文摘Background:The high incidence of gallstone recurrence was a major concern for laparoscopic gallbladderpreserving surgery.This study aimed to investigate the risk factors for gallstone recurrence after gallbladder-preserving surgery and to establish an individualized nomogram model to predict the risk of gallstone recurrence.Methods:The clinicopathological and follow-up data of 183 patients who were initially diagnosed with gallstones and treated with gallbladder-preserving surgery at our hospital from January 2012 to January 2019 were retrospectively collected.The independent predictive factors for gallstone recurrence following gallbladder-preserving surgery were identified by multivariate logistic regression analysis.A nomogram model for the prediction of gallstone recurrence was constructed based on the selected variables.The C-index,receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the predictive power of the nomogram model for gallstone recurrence.Results:During the follow-up period,a total of 65 patients experienced gallstone recurrence,and the recurrence rate was 35.5%.Multivariate logistic regression analysis revealed that the course of gallstones>2 years[odds ratio(OR)=2.567,95%confidence interval(CI):1.270-5.187,P=0.009],symptomatic gallstones(OR=2.589,95%CI:1.059-6.329,P=0.037),multiple gallstones(OR=2.436,95%CI:1.133-5.237,P=0.023),history of acute cholecystitis(OR=2.778,95%CI:1.178-6.549,P=0.020)and a greasy diet(OR=2.319,95%CI:1.186-4.535,P=0.014)were independent risk factors for gallstone recurrence after gallbladder-preserving surgery.A nomogram model for predicting the recurrence of gallstones was established based on the above five variables.The results showed that the C-index of the nomogram model was 0.692,suggesting it was valuable to predict gallstone recurrence.Moreover,the calibration curve showed good consistency between the predicted probability and actual probability.Conclusions:The nomogram model for the prediction of gallstone recurrence might help clinicians develop a proper treatment strategy for patients with gallstones.Gallbladder-preserving surgery should be cautiously considered for patients with high recurrence risks.
基金Supported by the Natural Science Foundation of Capital Medical University,No.PYZ20014 and No.PYZ21074。
文摘BACKGROUND Glycolysis caused by hypoxia-induced abnormal activation of hypoxia inducible factor-1α(HIF-1α)in the immune microenvironment promotes the progression of hepatocellular carcinoma(HCC),leading to enhanced drug resistance in cancer cells.Therefore,altering the immunosuppressive microenvironment by improving the hypoxic state is a new goal in improving cancer treatment.AIM To analyse the role of HIF-1α,which is closely related to tumour proliferation,invasion,metastasis,and angiogenesis,in the proliferation and invasion of liver cancer,and to explore the HIF-1αpathway-mediated anti-cancer mechanism of sirolimus(SRL)combined with Huai Er.METHODS Previous studies on HCC tissues identified the importance of HIF-1α,glucose transporter 1(GLUT1),and lactate dehydrogenase A(LDHA)expression.In this study,HepG2 and Huh7 cell lines were treated,under hypoxic and normoxic conditions,with a combination of SRL and Huai Er.The effects on proliferation,invasion,cell cycle,and apoptosis were analysed.Proteomics and genomics techniques were used to analyze the HIF-1α-related signalling pathway during SRL combined with Huai Er treatment and its inhibition of the proliferation of HCC cells.RESULTS High levels of HIF-1α,LDHA,and GLUT-1 were found in poorly differentiated HCC,with lower patient survival rates.Hypoxia promoted the proliferation of HepG2 and Huh7 cells and weakened the apoptosis and cell cycle blocking effects of the SRL/Huai Er treatment.This was achieved by activation of HIF-1αand glycolysis in HCC,leading to the upregulation of LDHA,GLUT-1,Akt/mammalian target of rapamycin(mTOR),vascular endothelial growth factor(VEGF),and Forkhead box P3 and downregulation of phosphatase and tensin homolog deleted on chromosome ten(PTEN)and p27.The hypoxia-induced activation of HIF-1αshowed the greatest attenuation in the SRL/Huai Er(S50+H8)group compared to the drug treatments alone(P<0.001).The S50+H8 treatment significantly downregulated the expression of mTOR and HIF-1α,and significantly reduced the expression of VEGF mRNA.Meanwhile,the combined blocking of mTOR and HIF-1αenhanced the downregulation of Akt/mTOR,HIF-1α,LDHA,and GLUT-1 mRNA and resulted in the downregulation of PTEN,p27,and VEGF mRNA(P<0.001).CONCLUSION SRL increases the anti-cancer effect of Huai Er,which reduces the promotion of hypoxia-induced HIF-1αon the Warburg effect by inhibition of the PI3K/Akt/mTOR-HIF-1αand HIF-1α-PTEN signalling pathways in HCC.
文摘BACKGROUND Irreversible electroporation(IRE)is a local non-thermal ablative technique which has been suggested as a potential cancer therapy.However,the specific anatomic characteristics of the pancreatic head make it challenging to perform any local ablation in this region.Therefore,the safety and feasibility of IRE in the pancreatic head region should be further explored.AIM To evaluate the safety of IRE in pancreatic head region including its effects on pancreatic ducts,vessels,and adjacent gastrointestinal organs.METHODS Eight landrace miniature pigs underwent IRE of pancreatic head tissue successfully,with a total of 16 lesions created.Laboratory testing including white blood cell(WBC)count and serum amylase before IRE with follow-up laboratory analysis and pathological examination at 1,7,14,and 28 d postablation were performed.RESULTS All pigs tolerated the ablation procedure without serious perioperative complications.Transiently elevated WBC count and amylase were observed at 24 h post-IRE,suggesting an acute pancreatic tissue damage which was confirmed by pathological observations.Vascular endothelial cells and pancreatic duct epithelial cells in ablation zone were also positive in terminal deoxynucleotidyl transferase dUTP nick end labeling staining.There was extensive duodenum mucosa damage with local hemorrhage 24 h after ablation,while regeneration of new villous structures were observed at 7 and 28 d post-IRE.Masson’s trichromatic staining showed that the extracellular matrix was still intact in vessels and pancreatic ducts,and even in the duodenum.CONCLUSION IRE ablation to the pancreatic head may be safe and feasible without long-term damage to the surrounding vital structures.However,risks of stress injuries in acute phase should be taken into consideration to prevent severe perioperative complications.
文摘BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is the second most common primary liver cancer in humans after hepatocellular carcinoma and a rare epithelial malignancy that results in a poor prognosis.According to the Liver Cancer Study Group of Japan classification,ICC can be divided into three types:Mass-forming(MF)type,periductal-infiltrating(PI)type,and intraductal-growth type.The MF type is the most common,accounting for 57.1-83.6%of ICCs.Nevertheless,little is known about the epidemiology and treatment of MF ICC.AIM To examine the prognostic factors for patients with MF ICC.METHODS We carried out a retrospective analysis of consecutive patients with MF ICC treated at the Faculty of Hepato-Pancreato-Biliary Surgery of Chinese PLA General Hospital between January 2008 and December 2018.According to the treatment received,the patients were divided into either a resection group or an exploration group.RESULTS The pooled 1-,3-,and 5-year survival rates in the 68 patients with MF ICC were 66.5%,36.3%,and 9.3%,respectively.Univariate analysis revealed that surgical resection(P<0.001),nodal metastasis(P<0.001),tumor location(P=0.039),vascular invasion(P<0.001),ascites(P<0.001),and differentiation(P=0.009)were significantly associated with the prognosis and survival of MF ICC.Multivariate analysis revealed that ascites(hazard ratio[HR]=5.6,95%confidence interval[CI]:1.6-18.9,P=0.006)and vascular invasion(HR=2.5,95%CI:1.0-6.1,P=0.045)were independent risk factors for MF ICC.The pooled 1-,3-,and 5-year survival rates in the 19 patients of the exploration group were 5.3%,5.3%,and 0,respectively.Among the 49 patients who underwent surgical resection,the pooled 1-,3-,and 5-year survival rates were 93.5%,49.7%,and 14.4%,respectively.Univariate and multivariate analyses revealed that vascular invasion(HR=3.1,95%CI:1.2-8.5,P=0.024)and nodal metastasis(HR=3.2,95%CI:1.4-7.6,P=0.008)were independent prognostic risk factors for surgical resection patients.CONCLUSION The prognosis of MF ICC patients is dismal,especially those with ascites or vascular invasion.Surgical resection is a key factor in improving overall survival in patients with MF ICC,and vascular invasion and lymph node metastasis affect the efficacy of surgical resection.
基金Supported by the National Key Research and Development Program of China,No.2020YFC2002700the National Natural Science Foundation of China,No.81972010+1 种基金the CAMS Initiative for Innovative Medicine,No.2016-I2M-1-007the Science Developing Funds of Navy General Hospital,No.CXPY201810.
文摘BACKGROUND Gastric cancer(GC)is one of the most prevalent malignant tumors that endangers human health.Early diagnosis is essential for improving the prognosis and survival rate of GC patients.Ring finger protein 180(RNF180)is involved in the regulation of cell differentiation,proliferation,apoptosis,and tumorigenesis,and aberrant hypermethylation of CpG islands in the promoter is strongly associated with the occurrence and development of GC.Thus,methylated RNF180 can be used as a potential biomarker for GC diagnosis.AIM To use droplet digital polymerase chain reaction(ddPCR)to quantify the methylation level of the RN180 gene.A reproducible ddPCR assay to detect methylated RNF180 from trace DNA was designed and optimized.METHODS The primer and probe were designed and selected,the conversion time of bisulfite was optimized,the ddPCR system was adjusted by primer concentration,amplification temperature and amplification cycles,and the detection limit of ddPCR was determined.RESULTS The best conversion time for blood DNA was 2 h 10 min,and that for plasma DNA was 2 h 10 min and 2 h 30 min.The results of ddPCR were better when the amplification temperature was 56°C and the number of amplification cycles was 50.Primer concentrations showed little effect on the assay outcome.Therefore,the primer concentration could be adjusted according to the reaction system and DNA input.The assay required at least 0.1 ng of input DNA.CONCLUSION In summary,a ddPCR assay was established to detect methylated RNF180,which is expected to be a new diagnostic biomarker for GC.
基金This work was supported by National Natural Science Foundation of China[81901957]China Postdoctoral Science Foundation[2018M633723].
文摘HMGN2 have functions in inflammatory response.However,the role of HMGN2 in severe acute pancreatitis(SAP)remains unclear.Here,our study was to discuss the role and regulatory mechanism ofHMGN2 in SAP.In this study,the SAP cell model of AR42J was used to study the function and mechanism of HMGN2 in SAP.The protein expression in cells and serums were examined by western blot and ELISA assay.qPCR was used to test the transcriptional RNA level.Cell viability were examined by MTT assay.Luciferase assay was used to evaluate the interaction between gene and gene.Our results showed that HMGN2 was significantly upregulated in SAP patients.The database predicted and luciferase assay data indicated the HMGN2 was directly binding with miR-590-3p.ELISA,MTT and western blot experiments showed that the HMGN2 were promoted the cell proliferation,reduced the inflammation,and repressed the cell autophagy.Mechanism studies showed that the pseudogene HMGN2P46 level was positively correlated with HMGN2 and upregulated HMGN2 expression by competing for miR-590-3p in SAP.Taken together,all over these results showed upregulation of HMGN2 alleviates SAP,this process was regulated by HMGN2P46 competitively binding with miR-590-3p,which may provide a new insight for the treatment and intervention in SAP.Pseudogene HMGN2P46 was a miRNA sponge to regulate HMGN2 level by competing for miR-590-3p to alleviate the process of SAP.It provided a novel strategy for the diagnosis and treatment of severe acute pancreatitis.
基金Supported by National Natural Science Foundation of China,No.81972010Science Developing Funds of Navy General Hospital,No.CXPY201810。
文摘BACKGROUND Studies have validated the potential of methylated cell-free DNA as a biomarker in various tumors,and methylated DNA in plasma may be a potential biomarker for cancer.AIM To evaluate the diagnostic value of RASSF1A methylation in plasma for colorectal cancer(CRC)and hepatocellular carcinoma(HCC).METHODS A total of 92 CRC patients,67 colorectal polyp(CRP)patients,63 HCC patients,and 66 liver cirrhosis(LC)patients were enrolled.The plasma DNA was subjected to DNA extraction,double-strand DNA concentration determination,bisulfite conversion,purification,single-strand DNA concentration determination,and digital polymerase chain reaction(PCR)detection.The methylation rate was calculated.The diagnostic value was evaluated by the area under the curve(AUC).RESULTS The age and sex in the CRC and CRP groups and the HCC and LC groups were also matched.The DNA methylation rate of RASSF1A in plasma in the CRC group was 2.87±1.80,and that in the CRP group was 1.50±0.64.DNA methylation of RASSF1A in plasma showed a significant difference between the CRC and CRP groups.The AUC of RASSF1A methylation for discriminating the CRC and CRP groups was 0.82(0.76-0.88).The AUCs of T1,T2,T3 and T4 CRC and CRP were 0.83(0.72-0.95),0.87(0.78-0.95),0.86(0.77-0.95),and 0.75(0.64-0.85),respectively.The DNA methylation rate of RASSF1A in plasma in the HCC group was 4.45±2.93,and that in the LC group was 2.46±2.07.DNA methylation of RASSF1A in plasma for the HCC and LC groups showed a significant difference.The AUC of RASSF1A methylation for discriminating the HCC and LC groups was 0.70(0.60-0.79).The AUCs of T1,T2,T3 and T4 HCC and LC were 0.80(0.61,1.00),0.74(0.59-0.88),0.60(0.42-0.79),and 0.68(0.53-0.82),respectively.CONCLUSION RASSF1A methylation in plasma detected by digital PCR may be a potential biomarker for CRC and HCC.
文摘BACKGROUND In recent years,we created and employed a new anastomosis method,“bridging”pancreaticogastrostomy,to treat patients with extremely severe pancreatic injury.This surgery has advantages such as short length of surgery,low secondary trauma,rapid construction of shunts for pancreatic fluid,preventing second surgeries,and achieving good treatment outcomes in clinical practice.However,due to the limited number of clinical cases,there is a lack of strong evidence to support the feasibility and safety of this surgical procedure.Therefore,we carried out animal experiments to examine this procedure,which is reported here.AIM To examine the feasibility and safety of a new rapid method of pancreaticogastrostomy,“bridging”pancreaticogastrostomy.METHODS Ten Landrace pigs were randomized into the experimental and control groups,with five pigs in each group.“Bridging”pancreaticogastrostomy was performed in the experimental group,while routine mucosa-to-mucosa pancreaticogastrostomy was performed in the control group.After surgery,the general condition,amylase levels in drainage fluid on Days 1,3,5,and 7,fasting and 2-h postprandial blood glucose 6 mo after surgery,fasting,2-h postprandial peripheral blood insulin,and portal vein blood insulin 6 mo after surgery were assessed.Resurgery was carried out at 1 and 6 mo after the former one to examine the condition of the abdominal cavity and firmness and tightness of the pancreaticogastric anastomosis and pancreas.RESULTS After surgery,the general condition of the animals was good.One in the control group did not gain weight 6 mo after surgery,whereas significant weight gain was present in the others.There were significant differences on Days 1 and 3 after surgery between the two groups but no differences on Days 5 and 7.There were no differences in fasting and 2-h postprandial blood glucose and fasting and 2-h insulin values of postprandial peripheral blood and portal vein blood 6 mo after surgery between the two groups.One month after surgery,the sinus tract orifice/anastomosis was patent in the two groups.Six months after surgery,the sinus tract orifice/anastomosis was sealed,and pancreases in both groups presented with chronic pancreatitis.CONCLUSION“Bridging”pancreaticogastrostomy is a feasible and safe a means of damage control surgery during the early stage of pancreatic injury.
文摘Background:A new staging system for patients with hepatocellular carcinoma(HCC)associated with portal vein tumor thrombus(PVTT)was developed by incorporating the good points of the BCLC classification of HCC,and by improving on the currently existing classifications of HCC associated with PVTT.Methods:Univariate and multivariate analysis with Waldχ2 test were used to determinate the clinical prognostic factors for overall survival(OS)in patients with HCC and PVTT in the training cohort.Then the conditional inference trees analysis was applied to establish a new staging system.Results:A training cohort of 2,179 patients from the Eastern Hepatobiliary Surgery Hospital and a validation cohort of 1,550 patients from four major liver centers in China were enrolled into establishing and validating a new staging system.The system was established by incorporating liver function,general health status,tumor resectability,extrahepatic metastasis and extent of PVTT.This staging system had a good discriminatory ability to separate patients into different stages and substages.The median OS for the two cohorts were 57.1(37.2-76.9),12.1(11.0-13.2),5.7(5.1-6.2),4.0(3.3-4.6)and 2.5(1.7-3.3)months for the stages 0 to IV,respectively(P<0.001)in the training cohort.The corresponding figures for the validation cohort were 6.4(4.9-7.9),2.8(1.3-4.4),10.8(9.3-12.4),and 1.5(1.3-1.7)months for the stages II to IV,respectively(P<0.001).The mean survival for stage 0 to 1 were 37.6(35.9-39.2)and 30.4(27.4-33.4),respectively(P<0.001).Conclusions:A new staging system was established which provided a good discriminatory ability to separate patients into different stages and substages after treatment.It can be used to supplement the other HCC staging systems.
