Pancreatic ductal adenocarcinoma(PDAC)is a global health challenge and remains one of the most lethal malignancies;there are only a few therapeutic options.However,significant efforts have led to the identification of...Pancreatic ductal adenocarcinoma(PDAC)is a global health challenge and remains one of the most lethal malignancies;there are only a few therapeutic options.However,significant efforts have led to the identification of major genetic factors that drive the progression and pathogenesis of PDAC.Notably,the research and application of molecular targeted therapies and immunotherapies have rapidly increased and facilitated great progress in the treatment of many malignant tumors,additional targeted therapies and immunotherapy based on next-generation sequencing results provide new opportunities for the diagnosis and treatment of pancreatic tumors.Immune checkpoint inhibitors are also now being incorporated as PDAC therapies,and combinations of molecularly targeted therapies with immunotherapies are emerging as strategies for boosting the immune response.The investigation of biomarkers of a response or primary resistance to immunotherapies is also an emerging research area.Herein,we further discuss the recent technological advances that continue to expand our understanding of PDAC complexity.We discuss the advancements expected in the near future,including biomarker-driven treatments and immunotherapies.We presume that the clinical translation of these research efforts will improve the survival outcomes of this challenging disease,which are currently dismal.展开更多
BACKGROUND Patients with middle and advanced hepatocellular carcinoma(HCC)frequently experience significant anxiety and depression,severely affecting their quality of life.AIM To examine the anxiety and depression sta...BACKGROUND Patients with middle and advanced hepatocellular carcinoma(HCC)frequently experience significant anxiety and depression,severely affecting their quality of life.AIM To examine the anxiety and depression status of patients with middle and advanced HCC,the influencing factors,and the correlation between these psychological factors and quality of life.METHODS We collected baseline data from 100 patients with HCC,assessing anxiety and depression levels using the Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD).Quality of life was evaluated with the Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire.Multivariate logistic regression analyzed clinical and psychosocial factors affecting anxiety and depression,while Pearson correlation assessed relationships among HAMA,HAMD,and Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire scores.RESULTS Results indicated that 64%of patients exhibited anxiety and 65%showed depression symptoms.Key influencing factors included Barcelona Clinic Liver Cancer C stage,multiple tumors,social support,prior treatments(such as liver resection and transcatheter arterial chemoembolization/hepatic artery infusion chemotherapy),as well as HAMA and HAMD scores.Anxiety and depression correlated negatively with quality of life,with coefficients of-0.671 and-0.575 for HAMA and HAMD,respectively.CONCLUSION Anxiety and depression are prevalent among patients with middle and advanced HCC,impacting quality of life.This underscores the need for psychological health considerations in liver cancer treatment and establishing psychological interventions is essential.展开更多
AIM: To prospectively evaluate the effectiveness and safety of continuous wound infiltration(CWI) for pain management after open gastrectomy. METHODS: Seventy-five adult patients with American Society of Anesthesiolog...AIM: To prospectively evaluate the effectiveness and safety of continuous wound infiltration(CWI) for pain management after open gastrectomy. METHODS: Seventy-five adult patients with American Society of Anesthesiologists(ASA) Physical Status Classification System(ASA) grade 1-3 undergoing open gastrectomy were randomized to three groups. Group 1 patients received CWI with 0.3% ropivacaine(group CWI). Group 2 patients received 0.5 mg/m L morphine intravenously by a patient-controlled analgesia pump(PCIA)(group PCIA). Group 3 patients received epidural analgesia(EA) with 0.12% ropivacaine and 20 μg/m L morphine with an infusion at 6-8 m L/h for 48 h(group EA). A standard general anesthetic technique was used for all three groups. Rescue analgesia(2 mg bolus of morphine, intravenous) was given when the visual analogue scale(VAS) score was ≥ 4. The outcomes measured over 48 h after the operation were VAS scores both at rest and during mobilization, total morphine consumption, relative side effects, and basic vital signs. Further results including time to extubation, recovery of bowel function, surgical wound healing,mean length of hospitalization after surgery, and the patient's satisfaction were also recorded.RESULTS: All three groups had similar VAS scores during the first 48 h after surgery. Group CWI and group EA, compared with group PCIA, had lower morphine consumption(P < 0.001), less postoperative nausea and vomiting(1.20 ± 0.41 vs 1.96 ± 0.67, 1.32 ± 0.56 vs 1.96 ± 0.67, respectively, P < 0.001), earlier extubation(16.56 ± 5.24 min vs 19.76 ± 5.75 min, P < 0.05, 15.48 ± 4.59 min vs 19.76 ± 5.75 min, P < 0.01), and earlier recovery of bowel function(2.96 ± 1.17 d vs 3.60 ± 1.04 d, 2.80 ± 1.38 d vs 3.60 ± 1.04 d, respectively, P < 0.05). The mean length of hospitalization after surgery was reduced in groups CWI(8.20 ± 2.58 d vs 10.08 ± 3.15 d, P < 0.05) and EA(7.96 ± 2.30 d vs 10.08 ± 3.15 d, P < 0.01) compared with group PCIA. All three groups had similar patient satisfaction and wound healing, but group PCIA was prone to higher sedation scores when compared with groups CWI and EA, especially during the first 12 h after surgery. Group EA had a lower mean arterial pressure within the first postoperative 12 h compared with the other two groups.CONCLUSION : CWI with ropivacaine yields a satisfactory analgesic effect within the first 48 h after open gastrectomy, with lower morphine consumption and accelerated recovery.展开更多
Objective: To investigate the early effects of hypertonic and isotonic saline solutions on apoptosis of intestinal mucosa in rats with hemorrhagic shock. Methods: A model of rat with severe hemorrhagic shock was estab...Objective: To investigate the early effects of hypertonic and isotonic saline solutions on apoptosis of intestinal mucosa in rats with hemorrhagic shock. Methods: A model of rat with severe hemorrhagic shock was established in 21 Sprague-Dawley (SD) rats. The rats were randomly divided into the sham group, normal saline resuscitation (NS) group, and hypertonic saline resuscitation (HTS) group, with 7 in each group. We detected and compared the apoptosis in small intestinal mucosa of rats after hemorrhagic shock and resuscitation by terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL), FITC (fluo- rescein-iso-thiocyanate)-Annexin V/PI (propidium iodide) double staining method, and flow cytometry. Results: In the early stage of hemorrhagic shock and resuscitation, marked apoptosis of small intestinal mucosa in the rats of both NS and HTS groups was observed. The numbers of apoptotic cells in these two groups were significantly greater than that in the sham group (P<0.01). In the HTS group, the apoptic cells significantly decreased, compared with the NS group (P<0.01). Conclusion: In this rat model of severe hemorrhagic shock, the HTS resuscitation of small volume is more effective than the NS resuscitation in reducing apoptosis of intestinal mucosa in rats, which may improve the prognosis of trauma.展开更多
Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) has been recently demonstrated as a method to induce rapid and extensive hypertrophy within a short time and has been employed for a v...Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) has been recently demonstrated as a method to induce rapid and extensive hypertrophy within a short time and has been employed for a variety of primary and metastatic liver tumors. However, controversies remain due to its high morbidity and mortality. To enable safer surgery, liver surgeons have searched for better technical modifications, such as partial ALPPS, mini-ALPPS, minimally invasive ALPPS, and Terminal branches portal vein Embolization Liver Partition for Planned hepatectomy(TELPP). It seems that TELPP is very promising, because it has the main advantage of ALPPS-the rapid increase of future liver remnant volume, but the morbidity and mortality are much lower because only one surgical operation is required.展开更多
AIM:To provide long-term survival results of operable duodenal gastrointestinal stromal tumors(DGISTs)in a tertiary center in China.METHODS:In this retrospective study,the pathological data of 28 patients with DGISTs ...AIM:To provide long-term survival results of operable duodenal gastrointestinal stromal tumors(DGISTs)in a tertiary center in China.METHODS:In this retrospective study,the pathological data of 28 patients with DGISTs who had been treated surgically at the Second Department of General Surgery,Sir Run Run Shaw Hospital(SRRSH)from June1998 to December 2006 were reviewed.All pathological slides were examined by a single pathologist to confirm the diagnosis.In patients whose diagnosis was not confirmed by immunohistochemistry at the time of resection,representative paraffin blocks were reassembled,and sections were studied using antibodies against CD117(c-kit),CD34,smooth muscle actin(SMA),vimentin,S-100,actin(HHF35),and desmin.Operative procedures were classified as wedge resection(WR,local resection with pure closure,without duodenal transection or anastomosis),segmental resection[SR,duodenal transection with Roux-Y or BillrothⅡgastrojejunostomy(G-J),end-to-end duodenoduodenostomy(D-D),end-to-end or end-to-side duodenojejunostomy(D-J)],and pancreaticoduodenectomy(PD,Whipple operation with pancreatojejunostomy).R0 resection was pursued in all cases,and at least R1 resection was achieved.Regional lymphadenectomy was not performed.Clinical manifestations,surgery,medical treatment and follow-up data were retrospectively analyzed.Related studies in the literature were reviewed.RESULTS:There were 12 males and 16 females patients,with a median age of 53 years(20-76 years).Their major complaints were"gastrointestinal bleeding"(57.2%)and"nonspecific discomfort"(32.1%).About14.3%,60.7%,17.9%,and 7.1%of the tumors originated in the first to fourth portion,respectively,with a median size of 5.8 cm(1.6-20 cm).Treatment was by WR in 5 cases(17.9%),SR in 13 cases(46.4%),and by PD in 10 cases(35.7%).The morbidity and mortality rates were 35.7%and 3.6%,respectively.The median post-operative stay was 14.5 d(5-47 d).During a follow-up of 61(23-164)mo,the 2-year and 5-year relapse-free survival was 83.3%and 50%,respectively.Eighty-four related articles were reviewed.CONCLUSION:Surgeons can choose to perform limited resection or PD for operable DGISTs if clear surgical margins are achieved.Comprehensive treatment is necessary.展开更多
Objective： Three mainstream techniques-laparoscopic hepatectomy （LH）, percutaneous radiofrequency ablation （pRFA）, and open hepatectomy （OH）--were compared in this study, in terms of their efficacies in the tre...Objective： Three mainstream techniques-laparoscopic hepatectomy （LH）, percutaneous radiofrequency ablation （pRFA）, and open hepatectomy （OH）--were compared in this study, in terms of their efficacies in the treat- ment of small hepatocellular carcinoma （HCC）. Methods： A comparative study was performed within a total of 94 patients diagnosed with small HCC in our hospital from 2005 to 2010, who underwent LH （28）, RFA （33）, or OH （33）. They had either a single tumor lesion of less than 5 cm or up to three nodules with diameters of less than 3 cm each. Outcomes were carefully evaluated throughout a 3-year follow-up interval and statistically interpreted. Results： The pRFA group had a significantly lower disease-free survival rate compared with the two surgical groups （P=0.001） and significantly shorter overall survival （P=-0.005）, while the LH group and the OH group had no difference in survival results. For patients younger than 60 years old, surgical approaches offered a better long-term overall survival prognosis （P=0.008）. There were no statistically significant differences among the three groups in overall survival for elderly patients （P=0.104）. Conclusions： Among patients with small HCC, LH may provide better curative effects than pRFA without increasing complication rates, pRFA leads to faster recurrence than surgical resections. LH has similar therapeutic effects to OH and causes less trauma. For patients younger than 60 years old, LH may be the best curative treatment. Elderly patients may choose either surgery or pRFA.展开更多
AIM： To introduce and evaluate a new method to re- pair bile duct defect with a degradable stent and au- tologous tissues. METHODS： Eight Ba-Ma mini-pigs were used in this study, Experimental models with common bile...AIM： To introduce and evaluate a new method to re- pair bile duct defect with a degradable stent and au- tologous tissues. METHODS： Eight Ba-Ma mini-pigs were used in this study, Experimental models with common bile duct （CBD） defect （0,5-1,0 cm segment of CBD resected） were established and then CBD was reconstructed by duct to duct anastomosis with a novel degradable stent made of poly [sebacic acid-co-（1,3-propanediol）-co- （1,2-propanediol）]. In addition, a vascularized greater omentum was placed around the stent and both ends of CBD. Cholangiography via gall bladder was per- formed for each pig at postoperative months 1 and 3 to rule out stent translocation and bile duct stricture. Complete blood count was examined pre- and post- operatively to estimate the inflammatory reaction. Liver enzymes and serum bilirubin were examined pre- and post-operatively to evaluate the liver function. Five pigs were sacrificed at month 3 to evaluate the healing of anastomosis. The other three pigs were raised for one year for long-term observation. RESULTS： All the animals underwent surgery success- fully. There was no intraoperative mortality and no bile leakage during the observation period, The white blood cell counts were only slightly increased on day 14 and month 3 postoperatively compared with that before operation, the difference was not statistically significant （P = 0.652）. The plasma level of alanine aminotrans- ferase on day 14 and month 3 postoperatively was also not significantly elevated compared with that before operation （P = 0.810）. Nevertheless, the plasma level of y-glutamyl transferase was increased after opera- tion in both groups （P = 0.004）, especially 2 wk after operation. The level of serum total bilirubin after opera- tion was not significantly elevated compared with that before operation （P = 0.227）, so did the serum direct bilirubin （P = 0.759）. By cholangiography yia gall blad- der, we found that the stent maintained its integrity of shape and was stillin situ at month 1, and it disap- peared completely at month 3. No severe CBD dilation and stricture were observed at both months 1 and 3. No pig died during the 3-too postoperative observation period. No sign of necrosis, bile duct stricture, bile leak- age or abdominal abscess was found at reoperation at month 3 postoperatively. Pigs had neither fragments of stent nor stones formed in the CBD. Collagen deposit was observed in the anastomosis by hematoxylin and eosin （HE） and Masson＇s trichrome stains. No severe cholestasis was observed in liver parenchyma by HE staining. Intestinal obstruction was found in a pig 4 mo after operation, and no bile leakage, bile duct stricture or biliary obstruction were observed in laparotomy. No sign of bile duct stricture or bile leakage was observed in the other two pigs. CONCLUSION： The novel method for repairing bile duct defect yielded a good short-term effect without postoperative bile duct stricture. However, the long- term effect should be further studied.展开更多
AIM: To elucidate the role of fibulin-5(FBLN-5) as a suppressor of hepatocellular carcinoma(HCC) cell metastasis via integrin.METHODS: The expression of FBLN-5 was determined by immunohistochemistry in 140 HCC samples...AIM: To elucidate the role of fibulin-5(FBLN-5) as a suppressor of hepatocellular carcinoma(HCC) cell metastasis via integrin.METHODS: The expression of FBLN-5 was determined by immunohistochemistry in 140 HCC samples and matched normal tissues, and was further confirmed by RT-PCR and Western blot analyses in various cell lines. Recombinant FBLN-5 was expressed in Escherichia coli BL21(DE3), purified and used in cell attachment assays. Expression of a specific plasmid or a specific si RNA in HCC cells resulted in the overexpression or knockdown of FBLN-5, respectively. Further, the migration and invasion of HCC cells were investigated using the Boyden chamber and transwell assays. The concentration of secreted matrix metalloproteinase 7(MMP-7) was determined using ELISA. RESULTS: FBLN-5 expression was found to be downregulated in HCC. Its expression was significantly correlated with advanced tumor metastasis; this was indicative of poor 5-year overall survival. Recombinant full-length human FBLN-5 promoted the attachment of HCC cells via integrins: it inhibited HCC cell adhesionand migration to fibronectin in a concentrationdependent manner. It also inhibited HCC cell migration and invasion through an integrin-binding arginineglycine-aspartic acid(RGD) motif by downregulating MMP-7. CONCLUSION: These results suggest that lower FBLN-5 expression is an important indicator of poor survival and that FBLN-5 inhibits HCC motility via an integrin-dependent mechanism. RGD-dependent suppression of MMP-7 by FBLN-5 might contribute to the development of new therapeutic strategies for HCC.展开更多
Originally proposed by John McCarthy in 1955,artificial intelligence(AI)has achieved a breakthrough and revolutionized the processing methods of clinical medicine with the increasing workloads of medical records and d...Originally proposed by John McCarthy in 1955,artificial intelligence(AI)has achieved a breakthrough and revolutionized the processing methods of clinical medicine with the increasing workloads of medical records and digital images.Doctors are paying attention to AI technologies for various diseases in the fields of gastroenterology and hepatology.This review will illustrate AI technology procedures for medical image analysis,including data processing,model establishment,and model validation.Furthermore,we will summarize AI applications in endoscopy,radiology,and pathology,such as detecting and evaluating lesions,facilitating treatment,and predicting treatment response and prognosis with excellent model performance.The current challenges for AI in clinical application include potential inherent bias in retrospective studies that requires larger samples for validation,ethics and legal concerns,and the incomprehensibility of the output results.Therefore,doctors and researchers should cooperate to address the current challenges and carry out further investigations to develop more accurate AI tools for improved clinical applications.展开更多
BACKGROUND Primary hepatic leiomyosarcoma is rare and reported sporadically, with less than40 such cases have been reported in the English-language literature. Although it is reported to be associated with acquired im...BACKGROUND Primary hepatic leiomyosarcoma is rare and reported sporadically, with less than40 such cases have been reported in the English-language literature. Although it is reported to be associated with acquired immune deficiency syndrome, EpsteinBarr virus infection, Hodgkin's lymphoma, immunosuppression after organ transplantation, and hepatitis C virus-related liver cirrhosis, the precise steps leading to leiomyosarcoma have not been fully identified. Therapeutic strategies include liver wedge resection or lobectomy, chemotherapy, radiotherapy and liver transplantation; however, the prognosis of primary hepatic leiomyosarcoma is dismal.CASE SUMMARY We describe here the first case of primary hepatic leiomyosarcoma successfully treated by transcatheter arterial chemoembolization(TACE). The patient was a 68-year-old woman who presented with right upper quadrant pain and weight loss over the past 5 wk before admission. Abdominal computed tomography(commonly known as CT) and ultrasonography showed a mixed echoic mass measuring about 10 cm × 7 cm occupying the right lobe of the liver. Exploratory laparotomy was performed 1 wk after admission. The tumor was unresectable and biopsy was performed. Based on rapid frozen-section and histopathological examination, a final diagnosis of primary hepatic leiomyosarcoma was established. TACE was performed 2 wk later. The postoperative course was uneventful and the patient was discharged on day 7 after the operation. Contrastenhanced CT showed that the tumor significantly shrunk with satisfactory lipiodol deposition. The patient has been followed up for 82 mo until now, and no progressive enlargement of the tumor or distal metastasis was observed.CONCLUSION TACE is a safe and effective treatment for primary hepatic leiomyosarcoma. The therapeutic effect of TACE combined with surgical resection should be further assessed.展开更多
Correction to:Tong YF,Meng N,Chen MQ,Ying HN,Xu M,Lu B,Hong JJ,Wang YF,Cai XJ.Maturity of associating liver partition and portal vein ligation for staged hepatectomy-derived liver regeneration in a rat model(World J G...Correction to:Tong YF,Meng N,Chen MQ,Ying HN,Xu M,Lu B,Hong JJ,Wang YF,Cai XJ.Maturity of associating liver partition and portal vein ligation for staged hepatectomy-derived liver regeneration in a rat model(World J Gastroenterol 2017;24(10):1107-1119)[1].Erratum:In the“Conclusion of Abstract”,“Core tip”,“Discussion”and“Research perspectives”,the description regarding the relationship between the volumetric and functional proliferation during ALPPS-derived liver regeneration should be revised.Specifically,the sentence that reads“as the ALPPS-derived proliferation in volume lags behind the functional regeneration”should be revised to“as the ALPPS-derived functional regeneration lags behind the proliferation in volume”.展开更多
BACKGROUND Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC).However,the prognostic and predictive factors rem...BACKGROUND Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC).However,the prognostic and predictive factors remain unclear.AIM To assess the prognostic factors and the predictors of PA-TACE benefit for OS in patients with resected HCC.METHODS Univariate and multivariate analyses were performed to identify the potential prognostic factors for OS.In order to assess the predictive factors of PA-TACE benefit,the interaction variables between treatments for each subgroup were evaluated using the Cox proportional hazards regression model.RESULTS A total of 378 patients (PA-TACE vs surgery alone,189:189) from three centerswere included after a propensity-score 1:1 matching analysis.Compared to the group receiving surgery alone,PA-TACE prolonged the OS rate in patients with resected HCC (P <0.001).The Barcelona Clinic Liver Cancer system and ferritinto-hemoglobin ratio (FHR) were used as the prognostic factors for OS in both groups.Age (P=0.023) and microscopic vascular invasion (MVI)(P=0.002) were also identified in the PA-TACE group,while gender (P=0.027),hepatitis B virus(P=0.034) and albumin-bilirubin grade (P=0.027) were also selected in the surgery alone group.In addition,PA-TACE resulted in longer OS than surgery alone across subgroups [all hazard ratios (PA-TACE-to-surgery alone)<1].Notably,a significantly prolonged OS following PA-TACE was observed in patients with high FHR (P=0.038) and without MVI (P=0.048).CONCLUSION FHR and Barcelona Clinic Liver Cancer stages were regarded as prognostic factors for OS.Moreover,high FHR and the absence of MVI were important predictive factors,which can be used to assist clinicians in selecting which patients could achieve a better OS with PA-TACE.展开更多
AIM: To explore the feasibility and safety of laparoscopic colonic anastomosis using a degradable stent in a porcine model.METHODS: Twenty Bama mini-pigs were randomly assigned to a stent group(n = 10) and control gro...AIM: To explore the feasibility and safety of laparoscopic colonic anastomosis using a degradable stent in a porcine model.METHODS: Twenty Bama mini-pigs were randomly assigned to a stent group(n = 10) and control group(hand-sewn anastomosis, n = 10). The anastomotic completion and operation times were recorded, along with histological examination, postoperative general condition, complications, mortality, bursting pressure, and the average anastomotic circumference(AC).RESULTS: All pigs survived postoperatively except for one in the stent group that died from ileus at 11 wk postoperatively. The operation and anastomotic completion times of the stent group were significantly shorter than those of the control group(P = 0.004 and P = 0.001, respectively). There were no significant differences in bursting pressure between the groups(P = 0.751). No obvious difference was found between the AC and normal circumference in the stent group, but AC was significantly less than normal circumferencein the control group(P = 0.047, P < 0.05). No intestinal leakage and luminal stenosis occurred in the stent group. Histological examination revealed that the stent group presented with lower general inflammation and better healing.CONCLUSION: Laparoscopic colonic anastomosis with a degradable stent is a simple, rapid, and safe procedure in this porcine model.展开更多
BACKGROUND Despite significant advances in multimodality treatments,hepatocellular carcinoma(HCC)remains one of the most common malignant tumors.Identification of novel prognostic biomarkers and molecular targets is u...BACKGROUND Despite significant advances in multimodality treatments,hepatocellular carcinoma(HCC)remains one of the most common malignant tumors.Identification of novel prognostic biomarkers and molecular targets is urgently needed.AIM To identify potential key genes associated with tumor microenvironments and the prognosis of HCC.METHODS The infiltration levels of immune cells and stromal cells were calculated and quantified based on the ESTIMATE algorithm.Differentially expressed genes(DEGs)between high and low groups according to immune or stromal scores were screened using the gene expression profile of HCC patients in The Cancer Genome Atlas and were further linked to the prognosis of HCC.These genes were validated in four independent HCC cohorts.Survival-related key genes were identified by a LASSO Cox regression model.RESULTS HCC patients with a high immune/stromal score had better survival benefits than patients with a low score.A total of 899 DEGs were identified and found to be involved in immune responses and extracellular matrices,147 of which were associated with overall survival.Subsequently,52 of 147 survival-related DEGs were validated in additional cohorts.Finally,ten key genes(STSL2,TMC5,DOK5,RASGRP2,NLRC3,KLRB1,CD5L,CFHR3,ADH1C,and UGT2B15)were selected and used to construct a prognostic gene signature,which presented a good performance in predicting overall survival.CONCLUSION This study extracted a list of genes associated with tumor microenvironments and the prognosis of HCC,thereby providing several valuable directions for the prognostic prediction and molecular targeted therapy of HCC in the future.展开更多
Objective： The liver hanging maneuver （LHM） is rarely applied in laparoscopic right hepatectomy （LRH） because of the difficulty encountered in retrohepatic tunnel （RT） dissection and tape positioning. Thus far ...Objective： The liver hanging maneuver （LHM） is rarely applied in laparoscopic right hepatectomy （LRH） because of the difficulty encountered in retrohepatic tunnel （RT） dissection and tape positioning. Thus far no report has detailed how to quickly and easily establish RT for laparoscopic LHM in LRH, nor has employment of the Goldfinger dissector to create a total RT been reported. This study＇s aim was to evaluate the safety and feasibility of establishing RT for laparoscopic LHM using the Goldfinger dissector in LRH. Methods： Between March 2015 and July 2015, five consecutive patients underwent LRH via the caudal approach with laparoscopic LHM. A five-step strategy using the Goldfinger dissector to establish RT for laparoscopic LHM was adopted. Perioperative data were analyzed. Results： The median age of patients was 58 （range, 51-65） years. Surgery was performed for one intrahepatic lithiasis and four hepatocellular carcinomas with a median size of 90 （40-150） mm. The median operative time was 320 （282-358） min with a median blood loss of 200 （200-600） ml. Laparoscopic LHM was achieved in a median of 31 （21-62） min, and the median postoperative hospital stay was 14 （9-16） d. No transfusion or conversion was required, and no severe liver-related morbidity or death was observed. Conclusions： The Goldfinger dissector is a useful instrument for the establishment of RT. A five-step strategy using the Goldfinger dissector can quickly and easily facilitate an RT for a laparoscopic LHM in LRH.展开更多
BACKGROUND There is a controversy as to whether laparoscopic surgery leads to a poor prognosis compared to the open approach for early gallbladder carcinoma (GBC)We hypothesized that the laparoscopic approach is an al...BACKGROUND There is a controversy as to whether laparoscopic surgery leads to a poor prognosis compared to the open approach for early gallbladder carcinoma (GBC)We hypothesized that the laparoscopic approach is an alternative for early GBC.AIM To identify and evaluate the safety and feasibility of laparoscopic surgery in the treatment of early GBC.METHODS A comprehensive search of online databases,including MEDLINE (PubMed),Cochrane libraries,and Web of Science,was performed to identify noncomparative studies reporting the outcomes of laparoscopic surgery and comparative studies involving laparoscopic surgery and open surgery in early GBC from January 2009 to October 2019.A fixed-effects meta-analysis was performed for 1-and 5-year overall survival and postoperative complications,while 3-year overall survival,operation time,blood loss,the number of lymph node dissected,and postoperative hospital stay were analyzed by random-effects models.RESULTS The review identified 7 comparative studies and 8 non-comparative studies.1068 patients (laparoscopic surgery:613;open surgery:455) were included in the meta-analysis of 1-,3-,and 5-year overall survival with no significant differences observed [(HR=0.54;95%CI:0.29-1.00;12=0.0%;P=0.051),(HR=0.75;95%CI:0.34-1.65;I^2=60.7%;P=0.474),(HR=0.71;95%CI:0.47-1.08;I^2=49.6%;P=0.107),respectively].There were no significant differences in operation time[weighted mean difference (WMD)=18.69;95%CI:-19.98-57.36;I^2=81.4%;P=0.343],intraoperative blood loss (WMD=-169.14;95%CI:-377.86-39.57;I2=89.5%;P=0.112),the number of lymph nodes resected (WMD=0.12;95%CI:-2.95-3.18;I^2=73.4%;P=0.940),and the complication rate (OR=0.69;95%CI:0.30-1.58;I2=0.0%;P=0.377) between the two groups,while patients who underwent laparoscopic surgery had a reduced length of hospital stay (WMD=-5.09;95%CI:-8.74--1.45;I2=91.0%;P=0.006).CONCLUSION This systematic review and meta-analysis confirms that laparoscopic surgery is a safe and feasible alternative to open surgery with comparable survival and operation-related outcomes for early GBC.展开更多
AIM: To explore risk factors of lymphatic metastasis (LM) in gallbladder cancer, and their potential to complement unsatisfactory radiological detection.
Background Reconstruction of damaged tissues requires both surface hemostasis and tissue bridging.Tissues with damage resulting from physical trauma or surgical treatments may have arbitrary surface topographies,makin...Background Reconstruction of damaged tissues requires both surface hemostasis and tissue bridging.Tissues with damage resulting from physical trauma or surgical treatments may have arbitrary surface topographies,making tissue bridging challenging.Methods This study proposes a tissue adhesive in the form of adhesive cryogel particles(ACPs) made from chitosan,acrylic acid,1-ethyl-3-(3-dimethylaminopropyl) carbodiimide(EDC) and N-hydroxysuccinimide(NHS).The adhesion performance was examined by the 180-degree peel test to a collection of tissues including porcine heart,intestine,liver,muscle,and stomach.Cytotoxicity of ACPs was evaluated by cell proliferation of human normal liver cells(LO2)and human intestinal epithelial cells(Caco-2).The degree of inflammation and biodegradability were examined in dorsal subcutaneous rat models.The ability of ACPs to bridge irregular tissue defects was assessed using porcine heart,liver,and kidney as the ex vivo models.Furthermore,a model of repairing liver rupture in rats and an intestinal anastomosis in rabbits were established to verify the effectiveness,biocompatibility,and applicability in clinical surgery.Results ACPs are applicable to confined and irregular tissue defects,such as deep herringbone grooves in the parenchyma organs and annular sections in the cavernous organs.ACPs formed tough adhesion between tissues[(670.9±50.1) J/m^(2) for the heart,(607.6±30.0) J/m^(2) for the intestine,(473.7±37.0) J/m^(2) for the liver,(186.1±13.3) J/m^(2) for the muscle,and(579.3±32.3) J/m^(2) for the stomach].ACPs showed considerable cytocompatibility in vitro study,with a high level of cell viability for 3 d[(98.8±1.2)%for LO2 and(98.3±1.6)%for Caco-2].It has comparable inflammation repair in a ruptured rat liver(P=0.58 compared with suture closure),the same with intestinal anastomosis in rabbits(P=0.40 compared with suture anastomosis).Additionally,ACP-based intestinal anastomosis(less than 30 s) was remarkably faster than the conventional suturing process(more than 10 min).When ACPs degrade after surgery,the tissues heal across the adhesion interface.Conclusions ACPs are promising as the adhesive for clinical operations and battlefield rescue,with the capability to bridge irregular tissue defects rapidly.展开更多
文摘Pancreatic ductal adenocarcinoma(PDAC)is a global health challenge and remains one of the most lethal malignancies;there are only a few therapeutic options.However,significant efforts have led to the identification of major genetic factors that drive the progression and pathogenesis of PDAC.Notably,the research and application of molecular targeted therapies and immunotherapies have rapidly increased and facilitated great progress in the treatment of many malignant tumors,additional targeted therapies and immunotherapy based on next-generation sequencing results provide new opportunities for the diagnosis and treatment of pancreatic tumors.Immune checkpoint inhibitors are also now being incorporated as PDAC therapies,and combinations of molecularly targeted therapies with immunotherapies are emerging as strategies for boosting the immune response.The investigation of biomarkers of a response or primary resistance to immunotherapies is also an emerging research area.Herein,we further discuss the recent technological advances that continue to expand our understanding of PDAC complexity.We discuss the advancements expected in the near future,including biomarker-driven treatments and immunotherapies.We presume that the clinical translation of these research efforts will improve the survival outcomes of this challenging disease,which are currently dismal.
文摘BACKGROUND Patients with middle and advanced hepatocellular carcinoma(HCC)frequently experience significant anxiety and depression,severely affecting their quality of life.AIM To examine the anxiety and depression status of patients with middle and advanced HCC,the influencing factors,and the correlation between these psychological factors and quality of life.METHODS We collected baseline data from 100 patients with HCC,assessing anxiety and depression levels using the Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD).Quality of life was evaluated with the Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire.Multivariate logistic regression analyzed clinical and psychosocial factors affecting anxiety and depression,while Pearson correlation assessed relationships among HAMA,HAMD,and Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire scores.RESULTS Results indicated that 64%of patients exhibited anxiety and 65%showed depression symptoms.Key influencing factors included Barcelona Clinic Liver Cancer C stage,multiple tumors,social support,prior treatments(such as liver resection and transcatheter arterial chemoembolization/hepatic artery infusion chemotherapy),as well as HAMA and HAMD scores.Anxiety and depression correlated negatively with quality of life,with coefficients of-0.671 and-0.575 for HAMA and HAMD,respectively.CONCLUSION Anxiety and depression are prevalent among patients with middle and advanced HCC,impacting quality of life.This underscores the need for psychological health considerations in liver cancer treatment and establishing psychological interventions is essential.
基金Supported by Foundation of Health Department of Zhejiang ProvinceChina+3 种基金No.2011RCA207Foundation of Education Department of Zhejiang ProvinceChinaNo.Y201431914
文摘AIM: To prospectively evaluate the effectiveness and safety of continuous wound infiltration(CWI) for pain management after open gastrectomy. METHODS: Seventy-five adult patients with American Society of Anesthesiologists(ASA) Physical Status Classification System(ASA) grade 1-3 undergoing open gastrectomy were randomized to three groups. Group 1 patients received CWI with 0.3% ropivacaine(group CWI). Group 2 patients received 0.5 mg/m L morphine intravenously by a patient-controlled analgesia pump(PCIA)(group PCIA). Group 3 patients received epidural analgesia(EA) with 0.12% ropivacaine and 20 μg/m L morphine with an infusion at 6-8 m L/h for 48 h(group EA). A standard general anesthetic technique was used for all three groups. Rescue analgesia(2 mg bolus of morphine, intravenous) was given when the visual analogue scale(VAS) score was ≥ 4. The outcomes measured over 48 h after the operation were VAS scores both at rest and during mobilization, total morphine consumption, relative side effects, and basic vital signs. Further results including time to extubation, recovery of bowel function, surgical wound healing,mean length of hospitalization after surgery, and the patient's satisfaction were also recorded.RESULTS: All three groups had similar VAS scores during the first 48 h after surgery. Group CWI and group EA, compared with group PCIA, had lower morphine consumption(P < 0.001), less postoperative nausea and vomiting(1.20 ± 0.41 vs 1.96 ± 0.67, 1.32 ± 0.56 vs 1.96 ± 0.67, respectively, P < 0.001), earlier extubation(16.56 ± 5.24 min vs 19.76 ± 5.75 min, P < 0.05, 15.48 ± 4.59 min vs 19.76 ± 5.75 min, P < 0.01), and earlier recovery of bowel function(2.96 ± 1.17 d vs 3.60 ± 1.04 d, 2.80 ± 1.38 d vs 3.60 ± 1.04 d, respectively, P < 0.05). The mean length of hospitalization after surgery was reduced in groups CWI(8.20 ± 2.58 d vs 10.08 ± 3.15 d, P < 0.05) and EA(7.96 ± 2.30 d vs 10.08 ± 3.15 d, P < 0.01) compared with group PCIA. All three groups had similar patient satisfaction and wound healing, but group PCIA was prone to higher sedation scores when compared with groups CWI and EA, especially during the first 12 h after surgery. Group EA had a lower mean arterial pressure within the first postoperative 12 h compared with the other two groups.CONCLUSION : CWI with ropivacaine yields a satisfactory analgesic effect within the first 48 h after open gastrectomy, with lower morphine consumption and accelerated recovery.
基金Project (No. 20061420) supported by the Education and Research Foundation of Zhejiang Province, China
文摘Objective: To investigate the early effects of hypertonic and isotonic saline solutions on apoptosis of intestinal mucosa in rats with hemorrhagic shock. Methods: A model of rat with severe hemorrhagic shock was established in 21 Sprague-Dawley (SD) rats. The rats were randomly divided into the sham group, normal saline resuscitation (NS) group, and hypertonic saline resuscitation (HTS) group, with 7 in each group. We detected and compared the apoptosis in small intestinal mucosa of rats after hemorrhagic shock and resuscitation by terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL), FITC (fluo- rescein-iso-thiocyanate)-Annexin V/PI (propidium iodide) double staining method, and flow cytometry. Results: In the early stage of hemorrhagic shock and resuscitation, marked apoptosis of small intestinal mucosa in the rats of both NS and HTS groups was observed. The numbers of apoptotic cells in these two groups were significantly greater than that in the sham group (P<0.01). In the HTS group, the apoptic cells significantly decreased, compared with the NS group (P<0.01). Conclusion: In this rat model of severe hemorrhagic shock, the HTS resuscitation of small volume is more effective than the NS resuscitation in reducing apoptosis of intestinal mucosa in rats, which may improve the prognosis of trauma.
基金Supported by the National Natural Science Foundation of China,No.81570559 and No.81272673
文摘Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) has been recently demonstrated as a method to induce rapid and extensive hypertrophy within a short time and has been employed for a variety of primary and metastatic liver tumors. However, controversies remain due to its high morbidity and mortality. To enable safer surgery, liver surgeons have searched for better technical modifications, such as partial ALPPS, mini-ALPPS, minimally invasive ALPPS, and Terminal branches portal vein Embolization Liver Partition for Planned hepatectomy(TELPP). It seems that TELPP is very promising, because it has the main advantage of ALPPS-the rapid increase of future liver remnant volume, but the morbidity and mortality are much lower because only one surgical operation is required.
基金Supported by Grants from Science and Technology Departmentof Zhejiang Province,No.2012C13020-2
文摘AIM:To provide long-term survival results of operable duodenal gastrointestinal stromal tumors(DGISTs)in a tertiary center in China.METHODS:In this retrospective study,the pathological data of 28 patients with DGISTs who had been treated surgically at the Second Department of General Surgery,Sir Run Run Shaw Hospital(SRRSH)from June1998 to December 2006 were reviewed.All pathological slides were examined by a single pathologist to confirm the diagnosis.In patients whose diagnosis was not confirmed by immunohistochemistry at the time of resection,representative paraffin blocks were reassembled,and sections were studied using antibodies against CD117(c-kit),CD34,smooth muscle actin(SMA),vimentin,S-100,actin(HHF35),and desmin.Operative procedures were classified as wedge resection(WR,local resection with pure closure,without duodenal transection or anastomosis),segmental resection[SR,duodenal transection with Roux-Y or BillrothⅡgastrojejunostomy(G-J),end-to-end duodenoduodenostomy(D-D),end-to-end or end-to-side duodenojejunostomy(D-J)],and pancreaticoduodenectomy(PD,Whipple operation with pancreatojejunostomy).R0 resection was pursued in all cases,and at least R1 resection was achieved.Regional lymphadenectomy was not performed.Clinical manifestations,surgery,medical treatment and follow-up data were retrospectively analyzed.Related studies in the literature were reviewed.RESULTS:There were 12 males and 16 females patients,with a median age of 53 years(20-76 years).Their major complaints were"gastrointestinal bleeding"(57.2%)and"nonspecific discomfort"(32.1%).About14.3%,60.7%,17.9%,and 7.1%of the tumors originated in the first to fourth portion,respectively,with a median size of 5.8 cm(1.6-20 cm).Treatment was by WR in 5 cases(17.9%),SR in 13 cases(46.4%),and by PD in 10 cases(35.7%).The morbidity and mortality rates were 35.7%and 3.6%,respectively.The median post-operative stay was 14.5 d(5-47 d).During a follow-up of 61(23-164)mo,the 2-year and 5-year relapse-free survival was 83.3%and 50%,respectively.Eighty-four related articles were reviewed.CONCLUSION:Surgeons can choose to perform limited resection or PD for operable DGISTs if clear surgical margins are achieved.Comprehensive treatment is necessary.
文摘Objective： Three mainstream techniques-laparoscopic hepatectomy （LH）, percutaneous radiofrequency ablation （pRFA）, and open hepatectomy （OH）--were compared in this study, in terms of their efficacies in the treat- ment of small hepatocellular carcinoma （HCC）. Methods： A comparative study was performed within a total of 94 patients diagnosed with small HCC in our hospital from 2005 to 2010, who underwent LH （28）, RFA （33）, or OH （33）. They had either a single tumor lesion of less than 5 cm or up to three nodules with diameters of less than 3 cm each. Outcomes were carefully evaluated throughout a 3-year follow-up interval and statistically interpreted. Results： The pRFA group had a significantly lower disease-free survival rate compared with the two surgical groups （P=0.001） and significantly shorter overall survival （P=-0.005）, while the LH group and the OH group had no difference in survival results. For patients younger than 60 years old, surgical approaches offered a better long-term overall survival prognosis （P=0.008）. There were no statistically significant differences among the three groups in overall survival for elderly patients （P=0.104）. Conclusions： Among patients with small HCC, LH may provide better curative effects than pRFA without increasing complication rates, pRFA leads to faster recurrence than surgical resections. LH has similar therapeutic effects to OH and causes less trauma. For patients younger than 60 years old, LH may be the best curative treatment. Elderly patients may choose either surgery or pRFA.
基金Supported by Grants from Science and Technology Department of Zhejiang Province, No. 2009C33027 and No. 2009R50040
文摘AIM： To introduce and evaluate a new method to re- pair bile duct defect with a degradable stent and au- tologous tissues. METHODS： Eight Ba-Ma mini-pigs were used in this study, Experimental models with common bile duct （CBD） defect （0,5-1,0 cm segment of CBD resected） were established and then CBD was reconstructed by duct to duct anastomosis with a novel degradable stent made of poly [sebacic acid-co-（1,3-propanediol）-co- （1,2-propanediol）]. In addition, a vascularized greater omentum was placed around the stent and both ends of CBD. Cholangiography via gall bladder was per- formed for each pig at postoperative months 1 and 3 to rule out stent translocation and bile duct stricture. Complete blood count was examined pre- and post- operatively to estimate the inflammatory reaction. Liver enzymes and serum bilirubin were examined pre- and post-operatively to evaluate the liver function. Five pigs were sacrificed at month 3 to evaluate the healing of anastomosis. The other three pigs were raised for one year for long-term observation. RESULTS： All the animals underwent surgery success- fully. There was no intraoperative mortality and no bile leakage during the observation period, The white blood cell counts were only slightly increased on day 14 and month 3 postoperatively compared with that before operation, the difference was not statistically significant （P = 0.652）. The plasma level of alanine aminotrans- ferase on day 14 and month 3 postoperatively was also not significantly elevated compared with that before operation （P = 0.810）. Nevertheless, the plasma level of y-glutamyl transferase was increased after opera- tion in both groups （P = 0.004）, especially 2 wk after operation. The level of serum total bilirubin after opera- tion was not significantly elevated compared with that before operation （P = 0.227）, so did the serum direct bilirubin （P = 0.759）. By cholangiography yia gall blad- der, we found that the stent maintained its integrity of shape and was stillin situ at month 1, and it disap- peared completely at month 3. No severe CBD dilation and stricture were observed at both months 1 and 3. No pig died during the 3-too postoperative observation period. No sign of necrosis, bile duct stricture, bile leak- age or abdominal abscess was found at reoperation at month 3 postoperatively. Pigs had neither fragments of stent nor stones formed in the CBD. Collagen deposit was observed in the anastomosis by hematoxylin and eosin （HE） and Masson＇s trichrome stains. No severe cholestasis was observed in liver parenchyma by HE staining. Intestinal obstruction was found in a pig 4 mo after operation, and no bile leakage, bile duct stricture or biliary obstruction were observed in laparotomy. No sign of bile duct stricture or bile leakage was observed in the other two pigs. CONCLUSION： The novel method for repairing bile duct defect yielded a good short-term effect without postoperative bile duct stricture. However, the long- term effect should be further studied.
基金Zhejiang Provincial Natural Science Foundation of China,No.LY13H180001Education Bureau of Zhejiang Province,No.N20130416
文摘AIM: To elucidate the role of fibulin-5(FBLN-5) as a suppressor of hepatocellular carcinoma(HCC) cell metastasis via integrin.METHODS: The expression of FBLN-5 was determined by immunohistochemistry in 140 HCC samples and matched normal tissues, and was further confirmed by RT-PCR and Western blot analyses in various cell lines. Recombinant FBLN-5 was expressed in Escherichia coli BL21(DE3), purified and used in cell attachment assays. Expression of a specific plasmid or a specific si RNA in HCC cells resulted in the overexpression or knockdown of FBLN-5, respectively. Further, the migration and invasion of HCC cells were investigated using the Boyden chamber and transwell assays. The concentration of secreted matrix metalloproteinase 7(MMP-7) was determined using ELISA. RESULTS: FBLN-5 expression was found to be downregulated in HCC. Its expression was significantly correlated with advanced tumor metastasis; this was indicative of poor 5-year overall survival. Recombinant full-length human FBLN-5 promoted the attachment of HCC cells via integrins: it inhibited HCC cell adhesionand migration to fibronectin in a concentrationdependent manner. It also inhibited HCC cell migration and invasion through an integrin-binding arginineglycine-aspartic acid(RGD) motif by downregulating MMP-7. CONCLUSION: These results suggest that lower FBLN-5 expression is an important indicator of poor survival and that FBLN-5 inhibits HCC motility via an integrin-dependent mechanism. RGD-dependent suppression of MMP-7 by FBLN-5 might contribute to the development of new therapeutic strategies for HCC.
基金Zhejiang Medical and Health Science and Technology Project,No.2019321842National Natural Science Foundation of China,No.81827804Zhejiang Clinical Research Center of Minimally Invasive Diagnosis and Treatment of Abdominal Diseases,No.2018E50003.
文摘Originally proposed by John McCarthy in 1955,artificial intelligence(AI)has achieved a breakthrough and revolutionized the processing methods of clinical medicine with the increasing workloads of medical records and digital images.Doctors are paying attention to AI technologies for various diseases in the fields of gastroenterology and hepatology.This review will illustrate AI technology procedures for medical image analysis,including data processing,model establishment,and model validation.Furthermore,we will summarize AI applications in endoscopy,radiology,and pathology,such as detecting and evaluating lesions,facilitating treatment,and predicting treatment response and prognosis with excellent model performance.The current challenges for AI in clinical application include potential inherent bias in retrospective studies that requires larger samples for validation,ethics and legal concerns,and the incomprehensibility of the output results.Therefore,doctors and researchers should cooperate to address the current challenges and carry out further investigations to develop more accurate AI tools for improved clinical applications.
基金Yinzhou Young Investigator Award,NO.Yin Ren She 2017-133Ministry of Science of Yinzhou District,No.Yin Ke 2017-110
文摘BACKGROUND Primary hepatic leiomyosarcoma is rare and reported sporadically, with less than40 such cases have been reported in the English-language literature. Although it is reported to be associated with acquired immune deficiency syndrome, EpsteinBarr virus infection, Hodgkin's lymphoma, immunosuppression after organ transplantation, and hepatitis C virus-related liver cirrhosis, the precise steps leading to leiomyosarcoma have not been fully identified. Therapeutic strategies include liver wedge resection or lobectomy, chemotherapy, radiotherapy and liver transplantation; however, the prognosis of primary hepatic leiomyosarcoma is dismal.CASE SUMMARY We describe here the first case of primary hepatic leiomyosarcoma successfully treated by transcatheter arterial chemoembolization(TACE). The patient was a 68-year-old woman who presented with right upper quadrant pain and weight loss over the past 5 wk before admission. Abdominal computed tomography(commonly known as CT) and ultrasonography showed a mixed echoic mass measuring about 10 cm × 7 cm occupying the right lobe of the liver. Exploratory laparotomy was performed 1 wk after admission. The tumor was unresectable and biopsy was performed. Based on rapid frozen-section and histopathological examination, a final diagnosis of primary hepatic leiomyosarcoma was established. TACE was performed 2 wk later. The postoperative course was uneventful and the patient was discharged on day 7 after the operation. Contrastenhanced CT showed that the tumor significantly shrunk with satisfactory lipiodol deposition. The patient has been followed up for 82 mo until now, and no progressive enlargement of the tumor or distal metastasis was observed.CONCLUSION TACE is a safe and effective treatment for primary hepatic leiomyosarcoma. The therapeutic effect of TACE combined with surgical resection should be further assessed.
文摘Correction to:Tong YF,Meng N,Chen MQ,Ying HN,Xu M,Lu B,Hong JJ,Wang YF,Cai XJ.Maturity of associating liver partition and portal vein ligation for staged hepatectomy-derived liver regeneration in a rat model(World J Gastroenterol 2017;24(10):1107-1119)[1].Erratum:In the“Conclusion of Abstract”,“Core tip”,“Discussion”and“Research perspectives”,the description regarding the relationship between the volumetric and functional proliferation during ALPPS-derived liver regeneration should be revised.Specifically,the sentence that reads“as the ALPPS-derived proliferation in volume lags behind the functional regeneration”should be revised to“as the ALPPS-derived functional regeneration lags behind the proliferation in volume”.
基金Supported by Opening Fund of Engineering Research Center of Cognitive Healthcare of Zhejiang Province,No.2018KFJJ09National Natural Science Foundation of China,No.81827804
文摘BACKGROUND Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC).However,the prognostic and predictive factors remain unclear.AIM To assess the prognostic factors and the predictors of PA-TACE benefit for OS in patients with resected HCC.METHODS Univariate and multivariate analyses were performed to identify the potential prognostic factors for OS.In order to assess the predictive factors of PA-TACE benefit,the interaction variables between treatments for each subgroup were evaluated using the Cox proportional hazards regression model.RESULTS A total of 378 patients (PA-TACE vs surgery alone,189:189) from three centerswere included after a propensity-score 1:1 matching analysis.Compared to the group receiving surgery alone,PA-TACE prolonged the OS rate in patients with resected HCC (P <0.001).The Barcelona Clinic Liver Cancer system and ferritinto-hemoglobin ratio (FHR) were used as the prognostic factors for OS in both groups.Age (P=0.023) and microscopic vascular invasion (MVI)(P=0.002) were also identified in the PA-TACE group,while gender (P=0.027),hepatitis B virus(P=0.034) and albumin-bilirubin grade (P=0.027) were also selected in the surgery alone group.In addition,PA-TACE resulted in longer OS than surgery alone across subgroups [all hazard ratios (PA-TACE-to-surgery alone)<1].Notably,a significantly prolonged OS following PA-TACE was observed in patients with high FHR (P=0.038) and without MVI (P=0.048).CONCLUSION FHR and Barcelona Clinic Liver Cancer stages were regarded as prognostic factors for OS.Moreover,high FHR and the absence of MVI were important predictive factors,which can be used to assist clinicians in selecting which patients could achieve a better OS with PA-TACE.
文摘AIM: To explore the feasibility and safety of laparoscopic colonic anastomosis using a degradable stent in a porcine model.METHODS: Twenty Bama mini-pigs were randomly assigned to a stent group(n = 10) and control group(hand-sewn anastomosis, n = 10). The anastomotic completion and operation times were recorded, along with histological examination, postoperative general condition, complications, mortality, bursting pressure, and the average anastomotic circumference(AC).RESULTS: All pigs survived postoperatively except for one in the stent group that died from ileus at 11 wk postoperatively. The operation and anastomotic completion times of the stent group were significantly shorter than those of the control group(P = 0.004 and P = 0.001, respectively). There were no significant differences in bursting pressure between the groups(P = 0.751). No obvious difference was found between the AC and normal circumference in the stent group, but AC was significantly less than normal circumferencein the control group(P = 0.047, P < 0.05). No intestinal leakage and luminal stenosis occurred in the stent group. Histological examination revealed that the stent group presented with lower general inflammation and better healing.CONCLUSION: Laparoscopic colonic anastomosis with a degradable stent is a simple, rapid, and safe procedure in this porcine model.
文摘BACKGROUND Despite significant advances in multimodality treatments,hepatocellular carcinoma(HCC)remains one of the most common malignant tumors.Identification of novel prognostic biomarkers and molecular targets is urgently needed.AIM To identify potential key genes associated with tumor microenvironments and the prognosis of HCC.METHODS The infiltration levels of immune cells and stromal cells were calculated and quantified based on the ESTIMATE algorithm.Differentially expressed genes(DEGs)between high and low groups according to immune or stromal scores were screened using the gene expression profile of HCC patients in The Cancer Genome Atlas and were further linked to the prognosis of HCC.These genes were validated in four independent HCC cohorts.Survival-related key genes were identified by a LASSO Cox regression model.RESULTS HCC patients with a high immune/stromal score had better survival benefits than patients with a low score.A total of 899 DEGs were identified and found to be involved in immune responses and extracellular matrices,147 of which were associated with overall survival.Subsequently,52 of 147 survival-related DEGs were validated in additional cohorts.Finally,ten key genes(STSL2,TMC5,DOK5,RASGRP2,NLRC3,KLRB1,CD5L,CFHR3,ADH1C,and UGT2B15)were selected and used to construct a prognostic gene signature,which presented a good performance in predicting overall survival.CONCLUSION This study extracted a list of genes associated with tumor microenvironments and the prognosis of HCC,thereby providing several valuable directions for the prognostic prediction and molecular targeted therapy of HCC in the future.
文摘AIM: To conduct a meta-analysis to evaluate the prognostic role of hypoxia inducible factor-1α (HIF-1α) expression in gastric cancer.
基金Project supported by the General Research Project of Medicine and Science of Zhejiang Province(Nos.2014KYB119 and 2015KYB221),China
文摘Objective： The liver hanging maneuver （LHM） is rarely applied in laparoscopic right hepatectomy （LRH） because of the difficulty encountered in retrohepatic tunnel （RT） dissection and tape positioning. Thus far no report has detailed how to quickly and easily establish RT for laparoscopic LHM in LRH, nor has employment of the Goldfinger dissector to create a total RT been reported. This study＇s aim was to evaluate the safety and feasibility of establishing RT for laparoscopic LHM using the Goldfinger dissector in LRH. Methods： Between March 2015 and July 2015, five consecutive patients underwent LRH via the caudal approach with laparoscopic LHM. A five-step strategy using the Goldfinger dissector to establish RT for laparoscopic LHM was adopted. Perioperative data were analyzed. Results： The median age of patients was 58 （range, 51-65） years. Surgery was performed for one intrahepatic lithiasis and four hepatocellular carcinomas with a median size of 90 （40-150） mm. The median operative time was 320 （282-358） min with a median blood loss of 200 （200-600） ml. Laparoscopic LHM was achieved in a median of 31 （21-62） min, and the median postoperative hospital stay was 14 （9-16） d. No transfusion or conversion was required, and no severe liver-related morbidity or death was observed. Conclusions： The Goldfinger dissector is a useful instrument for the establishment of RT. A five-step strategy using the Goldfinger dissector can quickly and easily facilitate an RT for a laparoscopic LHM in LRH.
基金the Zhejiang Medical Health Science and Technology Project,No.2016133597 and No.2019321842Natural Science Foundation of Zhejiang Province,No.LQ18H160003.
文摘BACKGROUND There is a controversy as to whether laparoscopic surgery leads to a poor prognosis compared to the open approach for early gallbladder carcinoma (GBC)We hypothesized that the laparoscopic approach is an alternative for early GBC.AIM To identify and evaluate the safety and feasibility of laparoscopic surgery in the treatment of early GBC.METHODS A comprehensive search of online databases,including MEDLINE (PubMed),Cochrane libraries,and Web of Science,was performed to identify noncomparative studies reporting the outcomes of laparoscopic surgery and comparative studies involving laparoscopic surgery and open surgery in early GBC from January 2009 to October 2019.A fixed-effects meta-analysis was performed for 1-and 5-year overall survival and postoperative complications,while 3-year overall survival,operation time,blood loss,the number of lymph node dissected,and postoperative hospital stay were analyzed by random-effects models.RESULTS The review identified 7 comparative studies and 8 non-comparative studies.1068 patients (laparoscopic surgery:613;open surgery:455) were included in the meta-analysis of 1-,3-,and 5-year overall survival with no significant differences observed [(HR=0.54;95%CI:0.29-1.00;12=0.0%;P=0.051),(HR=0.75;95%CI:0.34-1.65;I^2=60.7%;P=0.474),(HR=0.71;95%CI:0.47-1.08;I^2=49.6%;P=0.107),respectively].There were no significant differences in operation time[weighted mean difference (WMD)=18.69;95%CI:-19.98-57.36;I^2=81.4%;P=0.343],intraoperative blood loss (WMD=-169.14;95%CI:-377.86-39.57;I2=89.5%;P=0.112),the number of lymph nodes resected (WMD=0.12;95%CI:-2.95-3.18;I^2=73.4%;P=0.940),and the complication rate (OR=0.69;95%CI:0.30-1.58;I2=0.0%;P=0.377) between the two groups,while patients who underwent laparoscopic surgery had a reduced length of hospital stay (WMD=-5.09;95%CI:-8.74--1.45;I2=91.0%;P=0.006).CONCLUSION This systematic review and meta-analysis confirms that laparoscopic surgery is a safe and feasible alternative to open surgery with comparable survival and operation-related outcomes for early GBC.
文摘AIM: To explore risk factors of lymphatic metastasis (LM) in gallbladder cancer, and their potential to complement unsatisfactory radiological detection.
基金supported by the National Natural Science Foundation of China (12102388, T2125009, 92048302)the National Key Research and Development Program of China 2017 (YFA0701100)the Fundamental Research Funds for the Central Universities (226-2022-00141, 2022QZJH52)。
文摘Background Reconstruction of damaged tissues requires both surface hemostasis and tissue bridging.Tissues with damage resulting from physical trauma or surgical treatments may have arbitrary surface topographies,making tissue bridging challenging.Methods This study proposes a tissue adhesive in the form of adhesive cryogel particles(ACPs) made from chitosan,acrylic acid,1-ethyl-3-(3-dimethylaminopropyl) carbodiimide(EDC) and N-hydroxysuccinimide(NHS).The adhesion performance was examined by the 180-degree peel test to a collection of tissues including porcine heart,intestine,liver,muscle,and stomach.Cytotoxicity of ACPs was evaluated by cell proliferation of human normal liver cells(LO2)and human intestinal epithelial cells(Caco-2).The degree of inflammation and biodegradability were examined in dorsal subcutaneous rat models.The ability of ACPs to bridge irregular tissue defects was assessed using porcine heart,liver,and kidney as the ex vivo models.Furthermore,a model of repairing liver rupture in rats and an intestinal anastomosis in rabbits were established to verify the effectiveness,biocompatibility,and applicability in clinical surgery.Results ACPs are applicable to confined and irregular tissue defects,such as deep herringbone grooves in the parenchyma organs and annular sections in the cavernous organs.ACPs formed tough adhesion between tissues[(670.9±50.1) J/m^(2) for the heart,(607.6±30.0) J/m^(2) for the intestine,(473.7±37.0) J/m^(2) for the liver,(186.1±13.3) J/m^(2) for the muscle,and(579.3±32.3) J/m^(2) for the stomach].ACPs showed considerable cytocompatibility in vitro study,with a high level of cell viability for 3 d[(98.8±1.2)%for LO2 and(98.3±1.6)%for Caco-2].It has comparable inflammation repair in a ruptured rat liver(P=0.58 compared with suture closure),the same with intestinal anastomosis in rabbits(P=0.40 compared with suture anastomosis).Additionally,ACP-based intestinal anastomosis(less than 30 s) was remarkably faster than the conventional suturing process(more than 10 min).When ACPs degrade after surgery,the tissues heal across the adhesion interface.Conclusions ACPs are promising as the adhesive for clinical operations and battlefield rescue,with the capability to bridge irregular tissue defects rapidly.
