【Abstract】ObjectiveTo measure the expressions of Fas/FasL mRNA in normal liver, adjacent non-cancerous liver parenchyma and hepatocarcinoma, and to explore the relationship between the expressions of Fas/FasL mRNA in those tissues and the hepatocellular carcinogenesis. MethodsSemi-quantity reverse transcript-ploymerase chain reaction(QRTPCR) were performed to measure the relative quantity of the Fas and FasL mRNA expressions in normal liver (n=25), adjacent noncancerous liver parenchyma(n=40) and hepatocarcinoma(n=40). ResultsThe relative quantity of Fas and FasL mRNA expressed in normal liver, adjacent non-cancerous liver parenchyma and hepatocarcinoma were 0.792±0.039 vs 0.245±0.043，0.857±0.031 vs 0.429±0.035 and 0.473±0.047 vs 0.185±0.041, respectively. The relative quantity of Fas mRNA expression in hepatocarcinoma was lower than that of normal liver tissue and adjacent non-cancerous liver parenchyrna (P＜0.05). The relative quantity of FasL mRNA expression in hepatocarcinoma was also lower than that of normal liver tissue (P＜0.05) and adjacent non-cancerous liver parenchyma (P＜0.01), but its expression in adjacent non-cancerous liver parenchyma was higher than that of normal liver tissue (P＜0.05).ConclusionHepatorcarcinoma may escape the immune surveillance of the host, not only by means of reducing Fas expression, but also through adjacent non-cancerous liver parenchyma’s increasing expression of FasL to induce apoptosis of contact lymphocyte which highly expresses Fas.
One hundred and five hepatic resection were performed from 1984 to 1994. Six of these patients complicated with subphrenic infection after hepatectomy, of whom two patients died of liver failure. Subphrenic dropsy occureeed in nine cases. Subphrenic infection is easy to occur in: right or extend lobectomy, massive blood loss at operation, and in postoperative bleeding which subjects to laparotomy for lemostasis. Seecure hemostasis, avoidence of hepatic tissue devitalization during operation and effective subphenic drainage aree essential to reduce the incidencee of subphrenic infection, and routine bacterial culture of subphrenic drainage fluid will help to select propre antibiotic.
ObjectiveTo explore the protective effect of low-molecular-weight heparin calcium (LHC) combined with trimetazidine on intestinal smooth muscle of intestinal acute mesangial vein thrombosis (AMVT) in rats and it's mechanism of effect.
MethodsA total of 120 SD male rats were randomly divided into three groups, with 40 rats in each group. LHC group: after the AMVT model established, rats were subcutaneous injection the LHC (30 U/100 g) per 12 h until 72 h after surgery. LHC+trimetazidine group (LHCT group): after the AMVT model established, rats were subcutaneous injection the LHC (30 U/100 g) and tail vein injection the trimetazidine (10 mg/kg) per 12 h until 72 h after surgery. Normal saline group (NS group): after the AMVT model established, rats were subcutaneous injection the NS (0.2 mL/100 g) per 12 h until 72 after surgery. The AMVT model were established by blocking superior mesenteric vein of 8 cm and the edge vein arch. Vena cava blood samples and intestinal segments were collected sequentially at 6 h, 12 h, 24 h, 48 h and 72 h afrer surgery. The levels of malondialdehyde (MDA) and creatine kinase (CK) in the blood, and the level of ATP in the intestinal tissue samples were measured with ELISA. Intestinal tissue were taken from the rats for inestinal tissue section, stained with hematoxylin and eosin, examined under light microscopy and evaluated histopathologically using mesemeche scoring system at different time.
ResultsCompared with the LHC group and NS group, the levels of MDA and CK in blood and histopathology score of intestinal tissues in rats were significantly decreased, and the level of ATP significantly increased in LHCT group at different time point (P < 0.05).
ConclusionTrimetazidine can improve intestinal smooth muscle energy metabolism in the AMVT disease, comined with LHC early can avoid intestinal smooth muscle wall permeability coagulation necrosis and reduce the intestinal smooth muscle damage.
ObjectiveThe present study was to investigate the value of multi-disciplinary team (MDT) model in patient with primary giant liver cancer.MethodsThe MDT model was carried out for a BCLC B stage patient who admitted in the Second Affiliated Hospital of Chongqing Medical University in July 2018. The associated references were reviewed and the treatment methods were discussed about primary giant liver cancer.ResultsAn elder man who was diagnosed as primary hepatocellular carcinoma (minor cancer) in right lobe of the liver in three years ago and took Chinese medicine orally. When the patient subsequent visited this time, the liver cancer increased about 10 cm. After discussed by MDT, the treatment method was draw up to transarterial chemoembolization (TACE) plus surgery. After received twice TACE therapies in the later 14 weeks, the tumor in right lobe had significantly shrinked and left lobe enlarged. The patient underwent laparoscopic right liver hepatectomy after the second MDT discussion in 5 months later. The patient underwent operation successfully. The operation lasted for 270 minutes, and the intraoperative blood loss was about 500 mL. The suspended red blood cells (400 mL) was infused. The patient underwent transient liver failure and recovered through hepatoprotective and symptomatic supportive treatment, and discharged on 12 days after operation. A retrospective examination of abdominal CT at 4 months postoperatively revealed a significant hyperplasia of the left lobe of the liver, and there was no sign of recurrent tumor. The patient was continue to followed up.ConclusionsThepatient with primary giant hepatocellular carcinoma who cannot underwent surgery at the first time can received TACE, and a few patients could be underwent radical operation later. MDT should be applied flexibly in the treatment of patients with huge hepatocellular carcinoma from beginning to end, so the best treatment plan should be carried out for patients.
Objective To investigate the current situation of randomized controlled trials or clinical controlled trial (RCT/CCT) on chronic hepatitis B and whether to offer reliable evidence for clinical practice in China. Methods RCT/CCT identified from six Chinese clinical journals were searched manually and assessed according to international standard of evidence-based medicine. Results 308 issues containing 212 therapeutic articles and 88 RCT/CCT on chronic hepatitis B were identified and analyzed. Conclusion the quantity and quality of RCT/CCT of chronic hepatitis B did not meet the need of clinical practice.
【摘要】 目的 探討老年肝門膽管癌的圍手術期處理方法。 方法 回顧性分析1992年6月-2004年10月收治的60歲以上的肝門膽管癌患者臨床資料。 結果 78例患者合并有多臟器儲備功能改變，施行手術切除12例，外引流手術11例，內引流手術55例。17例出現并發癥，以肺部感染、肝腎功能衰竭和吻合口瘺為多見。根治性切除、 姑息性切除和姑息性引流組手術后中位生存時間分別為12、8、5個月。 結論 肝門膽管癌的手術復雜，創傷大，對老年患者更容易產生心肺功能異常及各種并發癥；但通過圍手術期內合理、充分的綜合治療措施，仍能取得較好的治療效果。【Abstract】 Objective To investigate the perioperative therapy for the elder patients with hilar cholangiocarcinoma. Methods The clinical data of over 60 years old patients with hilar cholangiocarcinoma who were treated in the hospital from June 1992 to October 2004 were retrospectively analyzed. Result Seventy-eight patients with multiple organs liver functional changes, 12 patients received surgical excision, 11 patients received external drainage surgery, 55 patients received internal drainage surgery. Postoperative complications occurred in 17 patients, wost of which were lung infection, liver and kidney failure and anastomotic leakage. The median survival time were 12, eight and five months for the patients who received radical resection, palliative resection and drainage, respectively. Conclusions The surgical treatment for hilar cholangiocarcinoma is complicated with major surgical trauma. The postoperative complication and the cardio-pulmonary dysfunetion are easily happened especially in the aged patients. Intensive supportive therapy is needed all over the course.
Objectives
To systematically review the association between TM6SF2 (transmembrane six superfamily member 2- rs58592426) polymorphism and liver lesion and the severity of liver fibrosis.
Methods
We electronically searched databases including PubMed, CNKI, WanFang Data and CBM from inception to January 27, 2016, to collect cross-sectional studies about the association between the TM6SF2 polymorphism and the liver lesion and the severity of liver fibrosis. Two reviewers independently screened literature, extracted data and assessed the methodological quality included studies. Then, meta-analysis was performed using Stata 12.0 software.
Results
A total of 23 studies including 96 594 patients were included. The results of meta-analysis showed that: TM6SF2 polymorphism was associated with increased risk of the severity of liver fibrosis, the levels of TG, TC and LDL-C (all P values < 0.05). Carriers of the T allele showed lower levels of TG, TC, and LDL-C. Carriers of the T allele revealed higher levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) when compared with homozygous EE.
Conclusion
TM6SF2 polymorphism is associated with lipid traits in different population, the variants shows lower levels of lipid traits in blood serum and increases the risk of the severity of liver fibrosis and liver lesion.
