Currently, nuclear imaging such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) is increasingly used in the management of liver malignancy. <sup>18</sup>F-fluor...Currently, nuclear imaging such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) is increasingly used in the management of liver malignancy. <sup>18</sup>F-fluorodeoxyglucose (FDG)-PET is the most widely used nuclear imaging in liver malignancy as in other cancers, and has been reported to be effective in diagnosis, response monitoring, recurrence evaluation, and prognosis prediction. Other PET imaging such as <sup>11</sup>C-acetate PET is also used complementarily to FDG-PET in diagnosis of liver malignancy. Additionally, image-based evaluation of regional hepatic function can be performed using nuclear imaging. Those imaging modalities are also effective for candidate selection, treatment planning, and perioperative evaluation in liver surgery and transplantation. Recently, nuclear imaging has been actively adopted in the transarterial radioembolization therapy of liver malignancy, according to the concept of theragnosis. With the development of new hybrid imaging technologies such as PET/magnetic resonance imaging and SPECT/CT, nuclear imaging is expected to be more useful in the management of liver malignancy, particularly regarding liver surgery and transplantation. In this review, the efficacy and roles of nuclear imaging methods in diagnosis, transplantation and theragnosis are discussed.展开更多
Objective: to discuss the value of radiofrequency ablation in patients with malignant liver tumors. Methods: October 2010 and 150 liver tumor patients between October 2020 were included in the study, by randomized int...Objective: to discuss the value of radiofrequency ablation in patients with malignant liver tumors. Methods: October 2010 and 150 liver tumor patients between October 2020 were included in the study, by randomized into two groups: Control group (receiving arterial chemoembolization), observation group (receiving arterial chemoembolization ultrasonic radiofrequency ablation), compare the data results of the two groups after treatment. Results: the observation group had more advantages in the treatment efficiency, serum methyl fetal protein index, small hemorrhage rate, pleural effusion rate, liver function injury rate, nausea and vomiting rate than the control group, and the P-value was less than 0.05, with statistical differences. Conclusion: for patients with liver malignancy, the combined transarterial intervention and ultrasonic radiofrequency ablation have better treatment results and more effectively delay the disease progress, which is worth clinical promotion.展开更多
Despite its crucial role in interventional therapies for liver malignancy,cone-beam computed tomography(CBCT)has not yet been fully integrated into clinical practice due to several complicating factors,including nonst...Despite its crucial role in interventional therapies for liver malignancy,cone-beam computed tomography(CBCT)has not yet been fully integrated into clinical practice due to several complicating factors,including nonstandardized operations and limited recognition of CBCT among interventional radiologists.In response,the Chinese College of Interventionalists has released a consensus statement aimed at standardizing and promoting the application of CBCT in the interventional therapies for liver malignancy.This statement summarizes CBCT scanning techniques,and operational standards,and highlights its potential applications in clinical practice.展开更多
This letter critically evaluates Jiang et al's article on the differentiation of benign and malignant liver lesions using Emax and platelet count.Despite notable findings,significant methodological and interpretat...This letter critically evaluates Jiang et al's article on the differentiation of benign and malignant liver lesions using Emax and platelet count.Despite notable findings,significant methodological and interpretative limitations are identified.The study lacks detailed assay conditions for Emax measurement,employs inadequate statistical methods without robust multivariate analysis,and does not provide clinically relevant threshold values.The nomogram's reliance on Emax as a major diagnostic contributor is questionable due to attenuation in hepatocellular carcinoma patients with cirrhosis.Moreover,the study's limitations,such as selection bias and confounding factors,are not adequately addressed.Future research should adopt more rigorous methodologies,including prospective studies with larger cohorts and standardized protocols for biomarker measurement,to enhance validity and clinical applicability.展开更多
Pediatric liver masses encompass a diverse spectrum of benign and malignant lesions,with distinct patterns based on patient age.Optimal imaging is critical for timely diagnosis,management,and prognosis.This pictorial ...Pediatric liver masses encompass a diverse spectrum of benign and malignant lesions,with distinct patterns based on patient age.Optimal imaging is critical for timely diagnosis,management,and prognosis.This pictorial minireview cate-gorizes pediatric liver masses by age group to guide hepatology and radiology practice,with an emphasis on imaging characteristics.In children from birth to six years of age,the most common liver masses include hepatoblastoma,the most common primary hepatic malignancy in this age group;infantile hemangioma,a benign vascular tumor with a characteristic appearance on imaging;and mesen-chymal hamartoma,a rare developmental lesion.For children older than six years,liver masses are distinct,with hepatocellular carcinoma being the predo-minant malignant lesion.Benign masses such as focal nodular hyperplasia and hepatocellular adenoma also emerge in this age range,often linked to hormonal influences or metabolic disorders.The masses observed across all pediatric age groups include hepatic cysts,choledochal cysts,hydatid cysts,pyogenic and amebic abscesses,tuberculosis,lymphoma,and metastases,each presenting with unique imaging features essential for differential diagnosis.This minireview provides a comprehensive,age-based overview of pediatric liver masses,focusing on clinical presentation and key imaging findings to support accurate diagnosis and optimize management strategies in clinical hepatology,particularly in low resource settings.展开更多
AIM:To assess the validity of the Milan and University of California San Francisco(UCSF) criteria and examine the long-term outcome of orthotopic liver transplantation(OLT) in patients with hepatocellular carcinoma(HC...AIM:To assess the validity of the Milan and University of California San Francisco(UCSF) criteria and examine the long-term outcome of orthotopic liver transplantation(OLT) in patients with hepatocellular carcinoma(HCC) in a single-center study.METHODS:This study is a retrospective review of prospectively collected data.Between 1998 and 2009,56 of 356 OLTs were performed in patients with HCC.Based on pathological examination of liver explants,patients were retrospectively categorized into 3 groups:Milan +(n = 34),Milan-/UCSF +(n = 7) and UCSF-(n = 14).RESULTS:Median follow-up period was 39.5(1-124) mo.The 5-year overall survival rates in the Milan +,Milan-/UCSF + and UCSF-groups were 87.7%,53.6% and 33.3%,respectively(P < 0.000).Within these groups,tumor recurrence was determined in 5.8%,14.3% and 40% of patients,respectively(P < 0.011).Additionally,the presence of microvascular invasion within the explanted liver had a negative effect on the 5-year disease free survival(74.7% vs 46.7%,P < 0.044).CONCLUSION:The Milan criteria are reliable in the selection of suitable candidates for OLT for the treatment of HCC.For cases of OLT involving living donors,the UCSF criteria may be applied.展开更多
EH （Epithelioid hemangioendothelioma） is a rare vascular malignant neoplasm. Only 434 cases had been reported until 2006. Symptoms may be nonspecific, but it atso can involve hepatic veins resulting in Budd-Chiari s...EH （Epithelioid hemangioendothelioma） is a rare vascular malignant neoplasm. Only 434 cases had been reported until 2006. Symptoms may be nonspecific, but it atso can involve hepatic veins resulting in Budd-Chiari syndrome. The main differential diagnosis is cholangiocarcinoma, sometimes only distinguishable through immunohistochemistry study. We report a case of a young woman diagnosed with hepatic EH and listed for liver transplantation.展开更多
Hepatectomy is still the major curative treatment for patients with liver malignancies.However,it is still a big challenge to remove the tumors in the central posterior area,especially if their location involves the r...Hepatectomy is still the major curative treatment for patients with liver malignancies.However,it is still a big challenge to remove the tumors in the central posterior area,especially if their location involves the retrohepatic inferior vena cava and hepatic veins.Ex vivo liver resection and auto-transplantation(ELRA),a hybrid technique of the traditional liver resection and transplantation,has brought new hope to these patients and therefore becomes a valid alternative to liver transplantation.Due to its technical difficulty,ELRA is still concentrated in a few hepatobiliary centers that have experienced surgeons in both liver resection and liver transplantation.The efficacy and safety of this technique has already been demonstrated in the treatment of benign liver diseases,especially in the advanced alveolar echinococcosis.Recently,the application of ELRA for liver malignances has gained more attention.However,standardization of clinical practice norms and international consensus are still lacking.The prognostic impact in these oncologic patients also needs further evaluation.In this review,we summarized the principles and recent progresses on ELRA.展开更多
Transarterial radioembolization or selective internal radiation therapy(SIRT)has emerged as a minimally invasive approach for the treatment of tumors.This percutaneous technique involves the local,intra-arterial deliv...Transarterial radioembolization or selective internal radiation therapy(SIRT)has emerged as a minimally invasive approach for the treatment of tumors.This percutaneous technique involves the local,intra-arterial delivery of radioactive microspheres directly into the tumor.Historically employed as a palliative measure for liver malignancies,SIRT has gained traction over the past decade as a potential curative option,mirroring the increasing role of radiation segmentectomy.The latest update of the BCLC hepatocellular carcinoma guidelines recognizes SIRT as an effective treatment modality comparable to other local ablative methods,particularly well-suited for patients where surgical resection or ablation is not feasible.Radiation segmentectomy is a more selective approach,aiming to deliver high-dose radiation to one to three specific hepatic segments,while minimizing damage to surrounding healthy tissue.Future research efforts in radiation segmentectomy should prioritize optimizing radiation dosimetry and refining the technique for super-selective administration of radiospheres within the designated hepatic segments.展开更多
BACKGROUND Solitary fibrous tumor of the liver (SFTL) is a rare occurrence with a low number of cases reported in literature. SFTL is usually benign but, 10%-20% cases are reported to be malignant with a tendency to m...BACKGROUND Solitary fibrous tumor of the liver (SFTL) is a rare occurrence with a low number of cases reported in literature. SFTL is usually benign but, 10%-20% cases are reported to be malignant with a tendency to metastasize. The majority of malignant SFTL cases are associated with a paraneoplastic hypoglycaemia defined as Doege-Potter syndrome. Surgery is the best therapeutic treatment, however, long- life follow-up is recommended. CASE SUMMARY A 74-year-old man, was admitted to the emergency department after a syncopal episode with detection of hypoglycaemia resistant to medical treatment. The computed tomography revealed a solid mass measuring 15 cm of the left liver. An open left hepatectomy was performed with complete resection of tumor. Histopathological analyses confirmed a malignant SFTL. CONCLUSION Large series with long-term follow-up have not been published neither have clinical trials been undertaken. Consequently, the methodical long-term followup of surgically treated SFTLs is strongly recommended.展开更多
AIM: To assess how the application of different types of markers affects the tracking accuracy of Cyber Knife's.METHODS: Fifteen patients were recruited and subjected to the ultrasound-guided placement of markers....AIM: To assess how the application of different types of markers affects the tracking accuracy of Cyber Knife's.METHODS: Fifteen patients were recruited and subjected to the ultrasound-guided placement of markers. Two different type of needles 25 gauge(G) and 17 G containing two different fiducial marker, gold notched flexible anchor wire 0.28 mm × 10 mm(25 G needle) and gold cylindrical grain 1 mm × 4 mm(17 G), were used. Seven days after the procedure, a Cyber Knife planning computed tomography(CT) for the simulation of radiation treatment was performed on all patients.A binary CT score was assigned to the fiducial markers visualization. Also, the CT number was calculated for each fiducial and the values compared with a specific threshold.RESULTS: For each patient from 1 to 5, intra-hepatic markers were placed(one in 2 patients, three in 8 patients, four in 3 patients, and five in 2 patients). A total of 48 needles were used(thirty-two 17 G and sixteen 25 G) and 48 gold markers were placed(32 Grain shaped markers and 16 Gold Anchor). The result showed that the CT visualization of the grain markers was better than the anchor markers(P = 5 × 10^(-9)). Furthermore, the grain markers were shown to present minor late complications(P = 3 × 10^(-6)), and the best CT threshold number(P = 0.0005). CONCLUSION: The study revealed that the Gold Anchor fiducial marker is correlated with a greater number of late minor complications and low visualization by the CT.展开更多
Objective:To study the influences of LncRNA H19(H19)on malignant liver tumor cells and elucidate the underlying molecular mechanisms.Methods:H19 expression in liver tumor tissues,matched normal liver tissues,human liv...Objective:To study the influences of LncRNA H19(H19)on malignant liver tumor cells and elucidate the underlying molecular mechanisms.Methods:H19 expression in liver tumor tissues,matched normal liver tissues,human liver malignant tumor cell lines and the human hepatocyte line LO2 was assessed via quantitative RT-PCR.Cell viability analysis and Matrigel invasion analysis were performed to evaluate the effects of H19 on cell proliferation and invasion.Luciferase reporter analysis was carried out to assess the interaction between miR-140-5p and SOS Ras/Rac guanine nucleotide exchange factor 1(SOS1).The influence of H19 on the Ras-MAPK signalling pathway was evaluated by detecting key protein levels via active Ras pull-down analysis and Western blot analysis.Results:H19 expression was lower in liver cancer samples than in matched normal liver tissue samples.H19 overexpression enhanced the proliferation and invasion of HepG2 and SMMC-7721 cells.H19 overexpression increased the level of activated Ras.The expression levels of phosphorylated Raf,phosphorylated ERK and phosphorylated MEK were increased by H19 overexpression.H19 knockdown had the opposite effect.Treatment with a MAPK inhibitor significantly reversed the influence of H19 overexpression on liver malignant tumor cell growth and invasion.The MAPK activator reversed the opposing effects of H19 silencing.H19 overexpression increased the protein level of SOS1,and miR-140-5p directly targeted SOS1.Conclusion:H19 can activate the Ras-MAPK signalling pathway via the miR-140-5p/SOS1 axis in malignant liver tumour cells.展开更多
To the Editor:Laparoscopic liver resection(LLR)is widely used as a standard procedure for liver malignancies and benign diseases.Consensus guidelines stated that LLR may be feasible and safe in experienced centers.Evi...To the Editor:Laparoscopic liver resection(LLR)is widely used as a standard procedure for liver malignancies and benign diseases.Consensus guidelines stated that LLR may be feasible and safe in experienced centers.Evidence has shown that LLR is less invasive and has bet-ter patient prognosis than conventional procedures[1].However,laparoscopic anatomic liver resection(LALR)such as segment 8(S8)resection is still challenging due to difficulties in segmental mapping and surgical techniques[2,3].Liver S8 is in a deep-seated area surrounded by the ribs and the diaphragm,and closely con-nected to the right and middle hepatic veins and inferior vena cava.Furthermore,the Glissonean pedicle of segment 8(G8)is lo-cated deep in the liver parenchyma,lacking anatomical landmarks,and making forceps manipulation difficult.Therefore,LALR-S8 has been described as the most challenging procedure[4].展开更多
BACKGROUND Previous nomograms for hepatocellular carcinoma(HCC)did not include the neutrophil-to-lymphocyte ratio(NLR)or platelet-to-lymphocyte ratio(PLR).This study aimed to establish an effective nomogram capable of...BACKGROUND Previous nomograms for hepatocellular carcinoma(HCC)did not include the neutrophil-to-lymphocyte ratio(NLR)or platelet-to-lymphocyte ratio(PLR).This study aimed to establish an effective nomogram capable of estimating the association between preoperative inflammatory factors and overall survival(OS)of HCC patients after hepatectomy.AIM To analyse the factors affecting the prognosis of HCC and establish a nomogram.METHODS A total of 626 HCC patients(410 training set patients from the First Affiliated Hospital of Anhui Medical University and 216 validation set patients from the First Affiliated Hospital of University of Science and Technology of China)underwent hepatectomy from January 2014 to December 2017 and were followed up every 3–6 mo.The nomogram was based on OS-related independent risk factors identified by Cox regression analysis.The C-index,calibration curve,and area under the curve(AUC)were used to evaluate the nomogram’s accuracy.RESULTS The 1-,2-and 3-year OS rates were 79.0%,68.0%and 45.4%in the training cohort(median OS=34 mo)and 92.1%,73.9%and 51.2%in the validation cohort(median OS=38 mo).Higherα-fetoprotein[hazard ratio(HR)=1.812,95%confidence interval(CI):1.343–2.444],NLR(HR=2.480,95%CI:1.856–3.312)and PLR(HR=1.974,95%CI:1.490–2.616),tumour size≥5 cm(HR=1.323,95%CI:1.002–1.747),and poor differentiation(HR=3.207,95%CI:1.944–5.290)were significantly associated with shortened OS.The developed nomogram integrating these variables showed good reliability in both the training(C-index=0.71)and validation cohorts(C-index=0.75).For predicting 1-,2-and 3-year OS,the nomogram had AUCs of 0.781,0.743 and 0.706 in the training cohort and 0.789,0.815 and 0.813 in the validation cohort.The nomogram was more accurate in predicting prognosis than the AJCC TNM staging system.CONCLUSION The prognostic nomogram combining pathological characteristics and inflammation indicators could provide a more accurate individualized risk estimate for the OS of HCC patients with hepatectomy.展开更多
Hepatocellular carcinoma is the fifth most common malignancy and the third most common cause of cancer-related mortality worldwide. From the wide variety of treatment options, surgical resection and liver transplantat...Hepatocellular carcinoma is the fifth most common malignancy and the third most common cause of cancer-related mortality worldwide. From the wide variety of treatment options, surgical resection and liver transplantation are the only therapeutic ones. However, due to shortage of liver grafts, surgical resection is the most common therapeutic modality implemented. Owing to rapid technological development, minimally invasive approaches have been incorporated in liver surgery. Liver laparoscopic resection has been evaluated in comparison to the open technique and has been shown to be superior because of the reported decrease in surgical incision length and trauma, blood loss, operating theatre time, postsurgical pain and complications, R0 resection, length of stay, time to recovery and oral intake. It has been reported that laparoscopic excision is a safe and feasible approach with near zero mortality and oncologic outcomes similar to open resection. Nevertheless, current indications include solid tumors in the periphery < 5 cm, especially in segments Ⅱ through Ⅵ, while according to the consensus laparoscopic major hepatectomy should only be performed by surgeons with high expertise in laparoscopic and hepatobiliary surgery in tertiary centers. It is necessary for a surgeon to surpass the 60-cases learning curve observed in order to accomplish the desirable outcomes and preserve patient safety. In this review, our aim is to thoroughly describe the general principles and current status of laparoscopic liver resection for hepatocellular carcinoma, as well as future prospects.展开更多
Objective:To investigate the safety of relieving bed restriction in hepatic arterial infusion chemotherapy(HAIC)and its effects on patient comfort.Methods:A prospective study was conducted.Patients with malignant live...Objective:To investigate the safety of relieving bed restriction in hepatic arterial infusion chemotherapy(HAIC)and its effects on patient comfort.Methods:A prospective study was conducted.Patients with malignant liver tumors,who met the enrollment criteria,were randomly divided into experimental and control groups.During HAIC treatment,the patients in the experimental group,who were not confined to bed and could get out of bed,used electronic injection pumps to infuse chemotherapy drugs.The patients in the control group,who were strictly confined to bed and prohibited from getting out of bed,used infusion pumps to infuse chemotherapy drugs.The complications of the two groups were observed.The Christenson standard improved method was used to evaluate the bleeding and hematoma of limbs on the operation side.The Kolcaba General Comfort Questionnaire(GCQ)and Barthel Index(BI)were used to evaluate the two groups.Results:Ninety patients with malignant liver tumors were enrolled,including 53 with primary liver cancer and 37 with colorectal liver metastasis.There were 70 males and 20 females,aged 41-81 years old,with an average age of 61.6±9.248 years old.There were 60 patients in the experimental group and 30 patients in the control group.All patients underwent HAIC.The study showed that,during the treatment period,there were 3 cases of postoperative puncture point hematoma formation in the two groups,including 2 cases in the experimental group(2/60,3.3%)and 1 case in the control group(1/30,3.3%).The difference was not statistically significant(p>0.05).There were 5 cases of postoperative puncture point bleeding,including 4 cases in the experimental group(4/60,6.7%)and 1 case in the control group(1/30,3.3%),and the difference was not statistically significant(p>0.05).A total of 23 cases,with 6 cases in the experimental group(6/60,10%)and 17 cases in the control group(17/30,56.7%),complained of back pain after the operation,and the difference was statistically significant(p<0.05).Twenty-one cases complained of poor defecation after the operation,including 10 cases in the experimental group(10/60,16.7%)and 11 cases in the control group(11/30,36.7%).The difference was statistically significant(p<0.05).During the period of infusion chemotherapy,the two groups of patients had there was a significant difference between the two groups in terms of comfort status(GCQ)(88.78±6.705,78.47±9.519,p<0.001)and self-care ability(BI)(74.25±9.152,66.83±6.628,p<0.001).Conclusion:During HAIC treatment,getting out of bed is safe and reliable and can increase the patients’comfort and self-care ability.Hence,it merits clinical application.展开更多
Trillions of microbes have evolved with and continue to live on and within human beings. A variety of environmental factors can affect intestinal microbial imbalance, which has a close relationship with human health a...Trillions of microbes have evolved with and continue to live on and within human beings. A variety of environmental factors can affect intestinal microbial imbalance, which has a close relationship with human health and disease. Here, we focus on the interactions between the human microbiota and the host in order to provide an overview of the microbial role in basic biological processes and in the development and progression of major human diseases such as infectious diseases, liver diseases, gastrointestinal cancers, metabolic diseases, respiratory diseases, mental or psychological diseases, and autoimmune diseases. We also review important advances in techniques associated with microbial research, such as DNA sequencing, metabonomics, and proteomics combined with computation-based bioinformatics.Current research on the human microbiota has become much more sophisticated and more comprehensive.Therefore, we propose that research should focus on the host-microbe interaction and on causeeffect mechanisms, which could pave the way to an understanding of the role of gut microbiota in health and disease, and provide new therapeutic targets and treatment approaches in clinical practice.展开更多
BACKGROUND Synchronous combined hepatocellular-cholangiocarcinoma(CHC)and hepatocellular carcinoma(HCC)is very rare,with few literature reports and poor clinical outcomes associated with the disorder.Surgical resectio...BACKGROUND Synchronous combined hepatocellular-cholangiocarcinoma(CHC)and hepatocellular carcinoma(HCC)is very rare,with few literature reports and poor clinical outcomes associated with the disorder.Surgical resection is the main treatment,which makes the preoperative diagnosis very important.However,due to imaging manifestations overlapping with HCC,diagnosis of this type of synchronous cancer is challenging and it tends to be misdiagnosed as multiple HCC.Herein,we report the contrast-enhanced ultrasound(CEUS)manifestations of a case of synchronous CHC and HCC,aiming at adding to the understanding of this disease.CEUS displayed exquisite vascularity and tissue perfusion in real time with good spatial and temporal resolution and more accurately reflect tumor washin and washout times than contrast-enhanced computed tomography(CT)in this case.CASE SUMMARY The patient was a 69-year-old female with a 20-year history of chronic hepatitis B.Due to months of epigastric pain and anorexia,she reffered to our hospital for treatment.Five days before hospitalization,abdominal magnetic resonance imaging performed at another hospital detected a space-occupying lesion in the liver.After her hospitalization,laboratory tests showed elevated alpha-fetoprotein and carbohydrate antigen 19-9 level.Two suspicious liver lesions located in S4 and S6,respectively,were identified in a cirrhotic background by abdominal contrast-enhanced CT(CECT).Furthermore,the lesion in S4 and S6 were detected by CEUS and assigned to CEUS LI-RADS 5 and M categories,respectively.The patient underwent tumor radical resections.Post-operative pathology confirmed the S4 and S6 lesions to be HCC and CHC,respectively.A newly-found suspicious liver nodule with potential malignancy was detected in liver S1 by both CEUS and CECT 7 mo after operation.CONCLUSION The CEUS characteristics of CHC and HCC are different.CEUS features in combination with clinical information could help in effective diagnosis,clinical decision-making and better prognosis.展开更多
文摘Currently, nuclear imaging such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) is increasingly used in the management of liver malignancy. <sup>18</sup>F-fluorodeoxyglucose (FDG)-PET is the most widely used nuclear imaging in liver malignancy as in other cancers, and has been reported to be effective in diagnosis, response monitoring, recurrence evaluation, and prognosis prediction. Other PET imaging such as <sup>11</sup>C-acetate PET is also used complementarily to FDG-PET in diagnosis of liver malignancy. Additionally, image-based evaluation of regional hepatic function can be performed using nuclear imaging. Those imaging modalities are also effective for candidate selection, treatment planning, and perioperative evaluation in liver surgery and transplantation. Recently, nuclear imaging has been actively adopted in the transarterial radioembolization therapy of liver malignancy, according to the concept of theragnosis. With the development of new hybrid imaging technologies such as PET/magnetic resonance imaging and SPECT/CT, nuclear imaging is expected to be more useful in the management of liver malignancy, particularly regarding liver surgery and transplantation. In this review, the efficacy and roles of nuclear imaging methods in diagnosis, transplantation and theragnosis are discussed.
文摘Objective: to discuss the value of radiofrequency ablation in patients with malignant liver tumors. Methods: October 2010 and 150 liver tumor patients between October 2020 were included in the study, by randomized into two groups: Control group (receiving arterial chemoembolization), observation group (receiving arterial chemoembolization ultrasonic radiofrequency ablation), compare the data results of the two groups after treatment. Results: the observation group had more advantages in the treatment efficiency, serum methyl fetal protein index, small hemorrhage rate, pleural effusion rate, liver function injury rate, nausea and vomiting rate than the control group, and the P-value was less than 0.05, with statistical differences. Conclusion: for patients with liver malignancy, the combined transarterial intervention and ultrasonic radiofrequency ablation have better treatment results and more effectively delay the disease progress, which is worth clinical promotion.
文摘Despite its crucial role in interventional therapies for liver malignancy,cone-beam computed tomography(CBCT)has not yet been fully integrated into clinical practice due to several complicating factors,including nonstandardized operations and limited recognition of CBCT among interventional radiologists.In response,the Chinese College of Interventionalists has released a consensus statement aimed at standardizing and promoting the application of CBCT in the interventional therapies for liver malignancy.This statement summarizes CBCT scanning techniques,and operational standards,and highlights its potential applications in clinical practice.
文摘This letter critically evaluates Jiang et al's article on the differentiation of benign and malignant liver lesions using Emax and platelet count.Despite notable findings,significant methodological and interpretative limitations are identified.The study lacks detailed assay conditions for Emax measurement,employs inadequate statistical methods without robust multivariate analysis,and does not provide clinically relevant threshold values.The nomogram's reliance on Emax as a major diagnostic contributor is questionable due to attenuation in hepatocellular carcinoma patients with cirrhosis.Moreover,the study's limitations,such as selection bias and confounding factors,are not adequately addressed.Future research should adopt more rigorous methodologies,including prospective studies with larger cohorts and standardized protocols for biomarker measurement,to enhance validity and clinical applicability.
文摘Pediatric liver masses encompass a diverse spectrum of benign and malignant lesions,with distinct patterns based on patient age.Optimal imaging is critical for timely diagnosis,management,and prognosis.This pictorial minireview cate-gorizes pediatric liver masses by age group to guide hepatology and radiology practice,with an emphasis on imaging characteristics.In children from birth to six years of age,the most common liver masses include hepatoblastoma,the most common primary hepatic malignancy in this age group;infantile hemangioma,a benign vascular tumor with a characteristic appearance on imaging;and mesen-chymal hamartoma,a rare developmental lesion.For children older than six years,liver masses are distinct,with hepatocellular carcinoma being the predo-minant malignant lesion.Benign masses such as focal nodular hyperplasia and hepatocellular adenoma also emerge in this age range,often linked to hormonal influences or metabolic disorders.The masses observed across all pediatric age groups include hepatic cysts,choledochal cysts,hydatid cysts,pyogenic and amebic abscesses,tuberculosis,lymphoma,and metastases,each presenting with unique imaging features essential for differential diagnosis.This minireview provides a comprehensive,age-based overview of pediatric liver masses,focusing on clinical presentation and key imaging findings to support accurate diagnosis and optimize management strategies in clinical hepatology,particularly in low resource settings.
文摘AIM:To assess the validity of the Milan and University of California San Francisco(UCSF) criteria and examine the long-term outcome of orthotopic liver transplantation(OLT) in patients with hepatocellular carcinoma(HCC) in a single-center study.METHODS:This study is a retrospective review of prospectively collected data.Between 1998 and 2009,56 of 356 OLTs were performed in patients with HCC.Based on pathological examination of liver explants,patients were retrospectively categorized into 3 groups:Milan +(n = 34),Milan-/UCSF +(n = 7) and UCSF-(n = 14).RESULTS:Median follow-up period was 39.5(1-124) mo.The 5-year overall survival rates in the Milan +,Milan-/UCSF + and UCSF-groups were 87.7%,53.6% and 33.3%,respectively(P < 0.000).Within these groups,tumor recurrence was determined in 5.8%,14.3% and 40% of patients,respectively(P < 0.011).Additionally,the presence of microvascular invasion within the explanted liver had a negative effect on the 5-year disease free survival(74.7% vs 46.7%,P < 0.044).CONCLUSION:The Milan criteria are reliable in the selection of suitable candidates for OLT for the treatment of HCC.For cases of OLT involving living donors,the UCSF criteria may be applied.
文摘EH （Epithelioid hemangioendothelioma） is a rare vascular malignant neoplasm. Only 434 cases had been reported until 2006. Symptoms may be nonspecific, but it atso can involve hepatic veins resulting in Budd-Chiari syndrome. The main differential diagnosis is cholangiocarcinoma, sometimes only distinguishable through immunohistochemistry study. We report a case of a young woman diagnosed with hepatic EH and listed for liver transplantation.
文摘Hepatectomy is still the major curative treatment for patients with liver malignancies.However,it is still a big challenge to remove the tumors in the central posterior area,especially if their location involves the retrohepatic inferior vena cava and hepatic veins.Ex vivo liver resection and auto-transplantation(ELRA),a hybrid technique of the traditional liver resection and transplantation,has brought new hope to these patients and therefore becomes a valid alternative to liver transplantation.Due to its technical difficulty,ELRA is still concentrated in a few hepatobiliary centers that have experienced surgeons in both liver resection and liver transplantation.The efficacy and safety of this technique has already been demonstrated in the treatment of benign liver diseases,especially in the advanced alveolar echinococcosis.Recently,the application of ELRA for liver malignances has gained more attention.However,standardization of clinical practice norms and international consensus are still lacking.The prognostic impact in these oncologic patients also needs further evaluation.In this review,we summarized the principles and recent progresses on ELRA.
文摘Transarterial radioembolization or selective internal radiation therapy(SIRT)has emerged as a minimally invasive approach for the treatment of tumors.This percutaneous technique involves the local,intra-arterial delivery of radioactive microspheres directly into the tumor.Historically employed as a palliative measure for liver malignancies,SIRT has gained traction over the past decade as a potential curative option,mirroring the increasing role of radiation segmentectomy.The latest update of the BCLC hepatocellular carcinoma guidelines recognizes SIRT as an effective treatment modality comparable to other local ablative methods,particularly well-suited for patients where surgical resection or ablation is not feasible.Radiation segmentectomy is a more selective approach,aiming to deliver high-dose radiation to one to three specific hepatic segments,while minimizing damage to surrounding healthy tissue.Future research efforts in radiation segmentectomy should prioritize optimizing radiation dosimetry and refining the technique for super-selective administration of radiospheres within the designated hepatic segments.
文摘BACKGROUND Solitary fibrous tumor of the liver (SFTL) is a rare occurrence with a low number of cases reported in literature. SFTL is usually benign but, 10%-20% cases are reported to be malignant with a tendency to metastasize. The majority of malignant SFTL cases are associated with a paraneoplastic hypoglycaemia defined as Doege-Potter syndrome. Surgery is the best therapeutic treatment, however, long- life follow-up is recommended. CASE SUMMARY A 74-year-old man, was admitted to the emergency department after a syncopal episode with detection of hypoglycaemia resistant to medical treatment. The computed tomography revealed a solid mass measuring 15 cm of the left liver. An open left hepatectomy was performed with complete resection of tumor. Histopathological analyses confirmed a malignant SFTL. CONCLUSION Large series with long-term follow-up have not been published neither have clinical trials been undertaken. Consequently, the methodical long-term followup of surgically treated SFTLs is strongly recommended.
文摘AIM: To assess how the application of different types of markers affects the tracking accuracy of Cyber Knife's.METHODS: Fifteen patients were recruited and subjected to the ultrasound-guided placement of markers. Two different type of needles 25 gauge(G) and 17 G containing two different fiducial marker, gold notched flexible anchor wire 0.28 mm × 10 mm(25 G needle) and gold cylindrical grain 1 mm × 4 mm(17 G), were used. Seven days after the procedure, a Cyber Knife planning computed tomography(CT) for the simulation of radiation treatment was performed on all patients.A binary CT score was assigned to the fiducial markers visualization. Also, the CT number was calculated for each fiducial and the values compared with a specific threshold.RESULTS: For each patient from 1 to 5, intra-hepatic markers were placed(one in 2 patients, three in 8 patients, four in 3 patients, and five in 2 patients). A total of 48 needles were used(thirty-two 17 G and sixteen 25 G) and 48 gold markers were placed(32 Grain shaped markers and 16 Gold Anchor). The result showed that the CT visualization of the grain markers was better than the anchor markers(P = 5 × 10^(-9)). Furthermore, the grain markers were shown to present minor late complications(P = 3 × 10^(-6)), and the best CT threshold number(P = 0.0005). CONCLUSION: The study revealed that the Gold Anchor fiducial marker is correlated with a greater number of late minor complications and low visualization by the CT.
基金supported by grants from Guangxi Nanning Qingxiu District Key Research and Development Program of Science and Technology Plan(No.2020050)Guangxi Medical and Health Appropriate Technology Development,Promotion and Application Project(No.S2021097)+1 种基金Guangxi Key Research and Development Program(No.AB22080064)Guangxi Natural Science Foundation(No.2017GXNSFAA198126,No.2022GXNSFAA035509).
文摘Objective:To study the influences of LncRNA H19(H19)on malignant liver tumor cells and elucidate the underlying molecular mechanisms.Methods:H19 expression in liver tumor tissues,matched normal liver tissues,human liver malignant tumor cell lines and the human hepatocyte line LO2 was assessed via quantitative RT-PCR.Cell viability analysis and Matrigel invasion analysis were performed to evaluate the effects of H19 on cell proliferation and invasion.Luciferase reporter analysis was carried out to assess the interaction between miR-140-5p and SOS Ras/Rac guanine nucleotide exchange factor 1(SOS1).The influence of H19 on the Ras-MAPK signalling pathway was evaluated by detecting key protein levels via active Ras pull-down analysis and Western blot analysis.Results:H19 expression was lower in liver cancer samples than in matched normal liver tissue samples.H19 overexpression enhanced the proliferation and invasion of HepG2 and SMMC-7721 cells.H19 overexpression increased the level of activated Ras.The expression levels of phosphorylated Raf,phosphorylated ERK and phosphorylated MEK were increased by H19 overexpression.H19 knockdown had the opposite effect.Treatment with a MAPK inhibitor significantly reversed the influence of H19 overexpression on liver malignant tumor cell growth and invasion.The MAPK activator reversed the opposing effects of H19 silencing.H19 overexpression increased the protein level of SOS1,and miR-140-5p directly targeted SOS1.Conclusion:H19 can activate the Ras-MAPK signalling pathway via the miR-140-5p/SOS1 axis in malignant liver tumour cells.
文摘To the Editor:Laparoscopic liver resection(LLR)is widely used as a standard procedure for liver malignancies and benign diseases.Consensus guidelines stated that LLR may be feasible and safe in experienced centers.Evidence has shown that LLR is less invasive and has bet-ter patient prognosis than conventional procedures[1].However,laparoscopic anatomic liver resection(LALR)such as segment 8(S8)resection is still challenging due to difficulties in segmental mapping and surgical techniques[2,3].Liver S8 is in a deep-seated area surrounded by the ribs and the diaphragm,and closely con-nected to the right and middle hepatic veins and inferior vena cava.Furthermore,the Glissonean pedicle of segment 8(G8)is lo-cated deep in the liver parenchyma,lacking anatomical landmarks,and making forceps manipulation difficult.Therefore,LALR-S8 has been described as the most challenging procedure[4].
基金Key Research and Development Plan of Anhui Province,No.1804h08020239(Dr.Liu FB).
文摘BACKGROUND Previous nomograms for hepatocellular carcinoma(HCC)did not include the neutrophil-to-lymphocyte ratio(NLR)or platelet-to-lymphocyte ratio(PLR).This study aimed to establish an effective nomogram capable of estimating the association between preoperative inflammatory factors and overall survival(OS)of HCC patients after hepatectomy.AIM To analyse the factors affecting the prognosis of HCC and establish a nomogram.METHODS A total of 626 HCC patients(410 training set patients from the First Affiliated Hospital of Anhui Medical University and 216 validation set patients from the First Affiliated Hospital of University of Science and Technology of China)underwent hepatectomy from January 2014 to December 2017 and were followed up every 3–6 mo.The nomogram was based on OS-related independent risk factors identified by Cox regression analysis.The C-index,calibration curve,and area under the curve(AUC)were used to evaluate the nomogram’s accuracy.RESULTS The 1-,2-and 3-year OS rates were 79.0%,68.0%and 45.4%in the training cohort(median OS=34 mo)and 92.1%,73.9%and 51.2%in the validation cohort(median OS=38 mo).Higherα-fetoprotein[hazard ratio(HR)=1.812,95%confidence interval(CI):1.343–2.444],NLR(HR=2.480,95%CI:1.856–3.312)and PLR(HR=1.974,95%CI:1.490–2.616),tumour size≥5 cm(HR=1.323,95%CI:1.002–1.747),and poor differentiation(HR=3.207,95%CI:1.944–5.290)were significantly associated with shortened OS.The developed nomogram integrating these variables showed good reliability in both the training(C-index=0.71)and validation cohorts(C-index=0.75).For predicting 1-,2-and 3-year OS,the nomogram had AUCs of 0.781,0.743 and 0.706 in the training cohort and 0.789,0.815 and 0.813 in the validation cohort.The nomogram was more accurate in predicting prognosis than the AJCC TNM staging system.CONCLUSION The prognostic nomogram combining pathological characteristics and inflammation indicators could provide a more accurate individualized risk estimate for the OS of HCC patients with hepatectomy.
文摘Hepatocellular carcinoma is the fifth most common malignancy and the third most common cause of cancer-related mortality worldwide. From the wide variety of treatment options, surgical resection and liver transplantation are the only therapeutic ones. However, due to shortage of liver grafts, surgical resection is the most common therapeutic modality implemented. Owing to rapid technological development, minimally invasive approaches have been incorporated in liver surgery. Liver laparoscopic resection has been evaluated in comparison to the open technique and has been shown to be superior because of the reported decrease in surgical incision length and trauma, blood loss, operating theatre time, postsurgical pain and complications, R0 resection, length of stay, time to recovery and oral intake. It has been reported that laparoscopic excision is a safe and feasible approach with near zero mortality and oncologic outcomes similar to open resection. Nevertheless, current indications include solid tumors in the periphery < 5 cm, especially in segments Ⅱ through Ⅵ, while according to the consensus laparoscopic major hepatectomy should only be performed by surgeons with high expertise in laparoscopic and hepatobiliary surgery in tertiary centers. It is necessary for a surgeon to surpass the 60-cases learning curve observed in order to accomplish the desirable outcomes and preserve patient safety. In this review, our aim is to thoroughly describe the general principles and current status of laparoscopic liver resection for hepatocellular carcinoma, as well as future prospects.
文摘Objective:To investigate the safety of relieving bed restriction in hepatic arterial infusion chemotherapy(HAIC)and its effects on patient comfort.Methods:A prospective study was conducted.Patients with malignant liver tumors,who met the enrollment criteria,were randomly divided into experimental and control groups.During HAIC treatment,the patients in the experimental group,who were not confined to bed and could get out of bed,used electronic injection pumps to infuse chemotherapy drugs.The patients in the control group,who were strictly confined to bed and prohibited from getting out of bed,used infusion pumps to infuse chemotherapy drugs.The complications of the two groups were observed.The Christenson standard improved method was used to evaluate the bleeding and hematoma of limbs on the operation side.The Kolcaba General Comfort Questionnaire(GCQ)and Barthel Index(BI)were used to evaluate the two groups.Results:Ninety patients with malignant liver tumors were enrolled,including 53 with primary liver cancer and 37 with colorectal liver metastasis.There were 70 males and 20 females,aged 41-81 years old,with an average age of 61.6±9.248 years old.There were 60 patients in the experimental group and 30 patients in the control group.All patients underwent HAIC.The study showed that,during the treatment period,there were 3 cases of postoperative puncture point hematoma formation in the two groups,including 2 cases in the experimental group(2/60,3.3%)and 1 case in the control group(1/30,3.3%).The difference was not statistically significant(p>0.05).There were 5 cases of postoperative puncture point bleeding,including 4 cases in the experimental group(4/60,6.7%)and 1 case in the control group(1/30,3.3%),and the difference was not statistically significant(p>0.05).A total of 23 cases,with 6 cases in the experimental group(6/60,10%)and 17 cases in the control group(17/30,56.7%),complained of back pain after the operation,and the difference was statistically significant(p<0.05).Twenty-one cases complained of poor defecation after the operation,including 10 cases in the experimental group(10/60,16.7%)and 11 cases in the control group(11/30,36.7%).The difference was statistically significant(p<0.05).During the period of infusion chemotherapy,the two groups of patients had there was a significant difference between the two groups in terms of comfort status(GCQ)(88.78±6.705,78.47±9.519,p<0.001)and self-care ability(BI)(74.25±9.152,66.83±6.628,p<0.001).Conclusion:During HAIC treatment,getting out of bed is safe and reliable and can increase the patients’comfort and self-care ability.Hence,it merits clinical application.
基金This study was supported by grants from the National Basic Research Program of China （973 Program, 2013CB531401）, the Major Science and Technology Program of Zhejiang Province （2014C03039）, and the Natural Science Foundation of Zhejiang Province （R16H260001）. We acknowledge Doctors Chunlei Chen, Bo Li, Jing Guo, Ding Shi, Qiongling Bao, Silan Gu, Yanfei Chen, Kai Zhou, Qixiang Luo, Ruiqi Tang, and Xiangyang Jiang for the literature search and the preparation for the manuscript. We also thank the reviewers for their thoughtful and helpful comments.
文摘Trillions of microbes have evolved with and continue to live on and within human beings. A variety of environmental factors can affect intestinal microbial imbalance, which has a close relationship with human health and disease. Here, we focus on the interactions between the human microbiota and the host in order to provide an overview of the microbial role in basic biological processes and in the development and progression of major human diseases such as infectious diseases, liver diseases, gastrointestinal cancers, metabolic diseases, respiratory diseases, mental or psychological diseases, and autoimmune diseases. We also review important advances in techniques associated with microbial research, such as DNA sequencing, metabonomics, and proteomics combined with computation-based bioinformatics.Current research on the human microbiota has become much more sophisticated and more comprehensive.Therefore, we propose that research should focus on the host-microbe interaction and on causeeffect mechanisms, which could pave the way to an understanding of the role of gut microbiota in health and disease, and provide new therapeutic targets and treatment approaches in clinical practice.
文摘BACKGROUND Synchronous combined hepatocellular-cholangiocarcinoma(CHC)and hepatocellular carcinoma(HCC)is very rare,with few literature reports and poor clinical outcomes associated with the disorder.Surgical resection is the main treatment,which makes the preoperative diagnosis very important.However,due to imaging manifestations overlapping with HCC,diagnosis of this type of synchronous cancer is challenging and it tends to be misdiagnosed as multiple HCC.Herein,we report the contrast-enhanced ultrasound(CEUS)manifestations of a case of synchronous CHC and HCC,aiming at adding to the understanding of this disease.CEUS displayed exquisite vascularity and tissue perfusion in real time with good spatial and temporal resolution and more accurately reflect tumor washin and washout times than contrast-enhanced computed tomography(CT)in this case.CASE SUMMARY The patient was a 69-year-old female with a 20-year history of chronic hepatitis B.Due to months of epigastric pain and anorexia,she reffered to our hospital for treatment.Five days before hospitalization,abdominal magnetic resonance imaging performed at another hospital detected a space-occupying lesion in the liver.After her hospitalization,laboratory tests showed elevated alpha-fetoprotein and carbohydrate antigen 19-9 level.Two suspicious liver lesions located in S4 and S6,respectively,were identified in a cirrhotic background by abdominal contrast-enhanced CT(CECT).Furthermore,the lesion in S4 and S6 were detected by CEUS and assigned to CEUS LI-RADS 5 and M categories,respectively.The patient underwent tumor radical resections.Post-operative pathology confirmed the S4 and S6 lesions to be HCC and CHC,respectively.A newly-found suspicious liver nodule with potential malignancy was detected in liver S1 by both CEUS and CECT 7 mo after operation.CONCLUSION The CEUS characteristics of CHC and HCC are different.CEUS features in combination with clinical information could help in effective diagnosis,clinical decision-making and better prognosis.
