ObjectiveTo understand the progress and problems of liver transplantation standard for hepatocellular carcinoma.
MethodsThe related articles regarding transplant criteria of hepatocellular carcinoma were reviewed and analyzed.
ResultsSince Milan criteria were proposed by Mazzaferro in 1996, a number of criteria were porposed by many transplant centers. These criteria expanded Milan criteria. Compared with Milan criteria, these criteria expanded tumor size and (or) tumor number, or combined with some biological variables, or combined with some immunological variables. However, there are still some issues should be clarified.
ConclusionDespite there are many transplant criteria of hepatocellular carcinoma, but a number of issues should be further investigated.
ObjectiveTo summarize the effectiveness of nitinol memory alloy two foot fixator with autologous cancellous bone grafting in treating old scaphoid fracture and nonunion.MethodsBetween January 2013 and January 2017, 11 patients of old scaphoid fracture and nonunion were treated with nitinol memory alloy two foot fixator and autologous cancellous bone grafting. All patients were male with an average age of 26.1 years (range, 18-42 years). The fractures were caused by sport in 3 cases, falling in 7 cases, and a crashing object in 1 case. The interval between injury and operation was 6-18 months (mean, 8.9 months). Postoperative outcome measures included operation time, fracture healing time, grip strength, range of motion (ROM) of flexion, extension, ulnar deviation, and radial deviation, Mayo score, visual analogue scale (VAS) score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe operation time was 35-63 minutes (mean, 48 minutes). All incisions had primary healing with no infection and loosening or breakage of internal fixator. All patients were followed up 12-30 months (mean, 20.7 months). X-ray films showed that fracture healing was achieved in all patients with an average time of 15 weeks (range, 12-25 weeks). All internal fixators were removed after 10-12 months of operation (mean, 11.2 months). At last follow-up, the grip strength, ROMs of flexion, ulnar deviation, and radial deviation were superior to those before operation (P<0.05), no significant difference was found in ROM of extension between pre- and post-operation (t=0.229, P=0.824). There were significant differences in above indexes between affected and normal sides (P<0.05). At last follow-up, the Mayo, VAS, DASH scores were also significantly superior to those before operation (P<0.05).ConclusionFor the old scaphoid fracture and nonunion, Ni-Ti arched shape-memory alloy fixator and autologous cancellous bone grafting can obtain good effectiveness, which is an effective treatment.
Objective To assess the influence of hepatic artery ligation on survival, hepatocyte apoptosis and regeneration of rats with obstructive jaundice. Methods Eighty adult male Wistar rats were divided into four groups: group A, suffered 70% hepatectomy+hepatic artery ligation+biliary drainage after 3 days of establishing obstructive jaundice model; group B, suffered 70% of hepatectomy+biliary drainage after 3 days of establishing obstructive jaundice model; group C, suffered 70% of hepatectomy+hepatic artery ligation after 3 days of sham operation; group D, suffered 70% of hepatectomy after 3 days of sham operation. Five rats of each group were sacrificed on 1, 2, 3, and 6 days after second operation. Liver function, hepatocyte apoptosis and liver regeneration were detected. Results Postoperative survival rates were not significantly different between group A and group B, similarly between group C and group D (allP＞0.05). There was no significantly different in liver function of group Aversus group B, and group Cversus group D (P＞0.05), but the synthesis of album on 1 d or 3 d after operation were significant difference (group Aversus group B,P＜0.05; group Cversus group D,P＜0.05). Both of the group A, group B and group C had the highest apoptotic index on 1 d after operation, whereas the group D had the lowest hepatic apoptotic index among four group after the surgery. The regeneration indexes were as follow: group D＞group C＞group B＞group A (allP＜0.05). On y 6 d after operation, the regeneration indexes of group A and group B did not increase, while those of group C and group D decreased remarkably. However, the regeneration indexes of four groups were lower than the mean level. Conclusions Hepatic artery ligation will increase hepatocyte apoptosis and weaken liver regeneration. However, for rats with obstructive jaundice, hepatic artery ligation didn't increase the risk of postoperative mortality.
ObjectiveTo investigate the predictive value of the preoperative peripheral blood neutrophil percentage-to-albumin ratio (NPAR) for survival after radical resection of hepatocellular carcinoma (HCC) and to construct a nomogram prediction model based on NPAR. MethodsAccording to inclusion and exclusion criteria, the HCC patients with China Liver Cancer Staging (CNLC) stage Ⅰa–Ⅱa who underwent radical hepatectomy at West China Hospital of Sichuan University from January 2010 to December 2020 were retrospectively collected and then randomly divided into a training set and a validation set with a 7∶3 ratio. The optimal cutoff value for NPAR was determined using X-tile. Cox proportional hazards regression model was used to identify the independent risk factors for overall survival (OS) in HCC patients and then construct a nomogram model. The predictive performance of the model was evaluated using the C-index, receiver operating characteristic (ROC) curve, and calibration curve, as well as validated in the validation set. ResultsA total of 3 423 HCC patients with CNLC stage Ⅰa–Ⅱa were enrolled in this study, with 2 397 in the training set and 1 026 in the validation set. There were no statistically significant differences in baseline characteristics between the training and validation sets (P>0.05). The optimal cutoff value for NPAR was 17.0, and patients with NPAR ≤17.0 (2 124 cases) had significantly better OS and relapse-free survival (RFS) than those with NPAR>17.0 (273 cases). The multivariate Cox proportional hazards regression model analysis showed that the alpha-fetal protein>400 μg/L, NPAR>17.0, multiple tumors, tumor diameter >5 cm, poor tumor differentiation, capsular invasion, microvascular invasion, and satellite lesions were the independent risk factors affecting postoperative OS in HCC patients (RR>1, P<0.05). The nomogram constructed based on these risk factors demonstrated good discriminations for OS and RFS (C-indexes of 0.708 and 0.709, respectively) and predictive performance in both the training and validation sets. ConclusionsPreoperative high NPAR (>17.0) in HCC patients with CNLC Ⅰa–Ⅱa stages is associated with significantly worse OS compared to those with low NPAR (≤17.0). The nomogram prediction model based on NPAR can effectively predict postoperative survival.
ObjectiveTo investigate the expression of forkhead box A2 (FXOA2) in intrahepatic cholangiocarcinoma (ICC), and to analyze the relationship between expression of FOXA2 and patient's prognosis after liver resection.
MethodsData of 85 patients with ICC who underwent liver resection between 2009 and 2013 in our hospital were collected retrospectively. The expression of FOXA2 was examined by immunohistochemical method, and then the relationship between expression of FOXA2 and patient's prognosis/clinical characteristics was expplored.
ResultsAmong the 85 patients, low expression of FOXA2 was detected in 50 patients, whereas high expression was observed in 35 patients. More advanced tumor (Ⅲ+Ⅳ staging) was found in patients with low expression of FOXA2 than patients with high expression of FOXA2 (P < 0.050). The median follow-up time was 15-month (3-73 months). During the follow-up period, 65 patients suffered from recurrence, whereas 64 patients died. The multivariate analysis suggested that, postoperative recurrence was associated with low expression of FOXA2, evaluated preoperative CA19-9, and presence of satellite nodes (P < 0.050). Low expression of FOXA2, evaluated preoperative CA19-9, nerves invasion, and presence of satellite nodes were predictive factors for postoperative prognosis (P < 0.050).
ConclusionLow expression of FOXA2 was associated with poor prognosis for patients with ICC after liver resection, and FOXA2 may be a prognostic factor for ICC.
ObjectiveTo investigate the expression of IQ motif-containing GTPase activating protein 1 (IQGAP1) in hepatocellular carcinoma (HCC) tissues, and to analyze the relationship of IQGAP1 and patient's clinical characteristics and prognosis after liver resection.
MethodsData of 79 patients who received liver resection between 2007 and 2009 in our hospital were collected. The expression of IQGAP1 was examined by immunohistochemical tests. The clinical characteristics and prognosis were compared.
ResultsIQGAP1 was detected in 43 patients (54.4%). Patients with IQGAP1 expression had more poor differentiation and microvascular invasion. The cumulative recurrence-free rate and overall survival rate in 1-, 3-, and 5-year after operation of patients with IQGAP1 expression (cumulative recurrencefree rate:67.4%, 39.5%, and 23.3%; cumulative overall survival rate:97.7%, 71.5%, and 53.3%) were poor than patients without IQGAP1 expression (cumulative recurrence-free rate:100%, 94.4%, and 83.3%; cumulative overall survival rate:1007%, 97.2%, and 88.9%), P < 0.001.
ConclusionsHCC patients with IQGAP1 expression had a poor prognosis after liver resection. IQGAP1 may be a prognostic indicator for hepatocellular carcinoma.
The treatment of liver cancer is still a challenge in the world, and it is mainly refers to hepatocellular carcinoma (HCC). There are many factors affecting the overall survival rate of HCC; the recurrence of HCC is the main risk factor affecting the survival of patients, hence, it is urgent to explore the clinical treatment of recurrent HCC to obtain long-term survival of the patients. Up to now, surgical treatment is a radical treatment for HCC. Similarly, liver resection and liver transplantation are still the main therapy methods for recurrent HCC. In addition, radiofrequency ablation and transcatheter arterial chemoembolization and other local treatments still play an irresistible role. Therefore, emphasizing the postoperative follow-up of patients, diagnosing recurrent HCC in early stage, paying attention to the risk factors of HCC recurrence and selecting a suitable treatment plan for individuals are critical ways to prolong the survival of patients.
ObjectiveTo summarize the research progress in artificial metacarpophalangeal joint and interphalangeal joint prostheses.MethodsThe research literature on artificial metacarpophalangeal joint and interphalangeal joint prostheses at home and abroad was reviewed and summarized from anatomy, prosthesis design, and material development.ResultsThe artificial joint replacement can correct deformity, relieve pain, and improve function immediately. In the past 50 years, many researches have focused on the design and material of prostheses and surgical technique of joint replacement. There are three types of prostheses, including hinged limit-type-prosthesis, semi-limit-type-prosthesis, and non-limit-type-prosthesis. The prostheses have their own advantages and disadvantages, the long-term effectiveness of joint replacement is not ideal.ConclusionThe metacarpophalangeal joint and interphalangeal joint prostheses with more anatomical structure and biocompatible materials are needed.
ObjectiveTo analyse the outcomes of patients with Child-Pugh A class cirrhosis and a single hepatocellular carcinoma (HCC) up to 5 cm in diameter who underwent liver transplantation versus resection.
MethodsDuring 2007 to 2011, 263 Child-Pugh A class cirrhotic patients with a single HCC up to 5 cm in diameter either underwent liver resection (n=227) or received liver transplantation (n=36) in our centre. Patients and tumour characteristics and outcomes were analysed.
ResultsThe 1-, 3-, and 5-year recurrence-free survival rates of patients who received liver transplantation and liver resection were 91.7%, 85.3%, 81.0% and 80.6%, 59.8%, 50.8%, respectively (P=0.003). The 1-, 3-, and 5-year overall survival rates of patients who underwent liver transplantation were 100%, 87.5%, and 83.1% versus 96.9%, 83.8%, and 76.1% for patients received liver resection (P=0.391). The 1-, 3-, and 5-year recurrence-free survival rates for patients with a diameter of HCC < 3 cm underwent liver transplantation were 92.3%, 92.3%, and 92.3% versus 80.2%, 62.5%, and 50.5% for live resection group (P=0.019). The 1-, 3-, and 5-year overall survival rates for patients with a diameter of HCC < 3 cm underwent liver transplantation and liver resection were 100%, 91.7%, 91.7% and 97.7%, 87.5%, 79.5%, respectively (P=0.470).
ConclusionsAlthough more recurrences are observed in Child A class cirrhotic patients with a single HCC up to 5 cm in diameter after liver resection, but overall survival rates for patients with a single HCC up to 5 cm in diameter are similar after liver resection and transplantation.
