Abstract: Interventional treatment has become the first- line therapeutic method for intermediate- stage hepatocellular carcinoma( HCC).With the development of related techniques,drug- loaded microparticles and radioactive microspheres have been applied in clinical practice,with good therapeutic effect achieved. This paper analyzes and summarizes the existing interventional treatment methods and problems,and points out that HCC patients can achieve great benefits from combination therapy,and that standardized interventional therapy is a direction for future development.
Abstract: In recent years,hepatocellular carcinoma( HCC) has become the second leading cause of cancer- related death worldwide. Due to the insidious onset of this disease,only 20%- 30% of the patients with HCC have the opportunity for surgical resection or liver transplantation. At present,interventional therapy has become the first choice for patients with intermediate- stage HCC and some patients with late- stage HCC,and more and more scholars have realized the importance and necessity of comprehensive interventional therapy for HCC. The comprehensive interventional therapy of transcatheter arterial chemoembolization( TACE) in combination with various methods( TACE combined with local treatment,TACE sequential surgery,or TACE combined with systemic treatment) provides many therapeutic approaches and achieves good therapeutic effects. However,the indications,timing,and recurrence and metastasis after treatment for such combination therapies await further investigation.
Abstract: In recent years,more and more therapeutic methods have been applied for the treatment of primary liver cancer; however,since most lesions develop from progressive liver disease or liver cirrhosis,primary liver cancer is still a refractory malignant tumor. Although surgical resection and liver transplantation are radical therapeutic methods,they are not applicable to most patients due to complex issues related to transplantation and insidious onset of such disease. With the improvement in equipment and technology,the interventional therapies for primary liver cancer have been taken more seriously,especially transcatheter arterial chemoembolization and percutaneous radiofrequency ablation. This article investigates the effect and feasibility of the combination of these two therapies for primary liver cancer and introduces the research advances in interventional therapy for primary liver cancer.
Abstract: Hepatocellular carcinoma( HCC) is a common malignant tumor in the world,and surgical resection and liver transplantation are two radical treatment modalities,but only 10%- 20% of all patients can receive such treatments. In recent years,local therapies including radiofrequency ablation,microwave ablation,cryoablation,and the irreversible electroporation ablation which appeared recently have gradually become the alternative therapies for the patients who are unable to undergo surgery. In addition to local tumor growth control and improvement in survival outcomes,the ablation technology also helps to downgrade tumor for secondary resection. This article focuses on the research progress in radiofrequency ablation alone and in combination with other therapies in the treatment of HCC,compares radiofrequency ablation with other local ablative therapies,and briefly introduces the application of intelligent navigation technology in adjuvant ablation.With the development of medical imaging and progress in related fields,the ablation technology will be widely applied in clinical practice in the future.
Abstract: An early and accurate response evaluation is essential for clinicians to decide whether to continue the treatment with current therapeutic regimen or to make necessary changes. This article briefly introduces the development of response evaluation criteria for tumors,elaborates on the application of radiological evaluation criteria in local interventional therapy or sorafenib treatment of hepatocellular carcinoma( HCC),compares the four radiological evaluation criteria,i. e.,World Health Organization( WHO) criteria,Response Evaluation Criteria in Solid Tumors( RECIST),European Association for the Study of Liver( EASL) criteria,and the modified RECIST( mRECIST),and thinks that EASL criteria and mRECIST are better than WHO criteria and RECIST and can predict the prognosis of HCC patients at earlier time points.
Abstract: Hepatocellular carcinoma( HCC) originating from the caudate lobe is a special- site HCC,which is rare and difficult to treat.The major therapeutic method in the past was surgical resection. In recent years,interventional treatment for HCC originating from the caudate lobe has achieved significant progress,and good therapeutic effect has been obtained. This paper briefly introduces the anatomic features of the caudate lobe and the features of blood supply in HCC originating from the caudate lobe,reviews the research advances in the therapeutic methods of transcatheter arterial chemoembolization and local ablation for HCC originating from the caudate lobe,and points out that a combination of interventional therapies for HCC originating from the caudate lobe needs to be further investigated in clinical practice.
Objective To investigate the severe complications after ultrasound- guided percutaneous microwave coagulation therapy( PMCT) for primary hepatic carcinoma( PHC) and measures for prevention and treatment. Methods A total of 652 patients with PHC who were admitted to department of hepatobiliary surgery in Air Force General Hospital,PLA from January 2012 to December 2014 were selected,and ultrasound- guided PMCT was performed for all the patients. The occurrence of post- PMCT complications was observed and compared between the years 2012,2013,and 2014. Measures for prevention and treatment were summarized. The chi- square test was applied for comparison of categorical data between groups. Results A total of 18 patients experienced severe PMCT- related complications,with an incidence rate of 2. 76%. These complications included intra- abdominal hemorrhage( n = 10),liver abscess( n = 2),intestinal fistula( n = 1),diaphragmatic rupture( n = 2),acute renal failure( n = 1),tumor implantation metastasis( n = 1),and cardiovascular and cerebrovascular diseases( n = 1). One patient died of the complications above,and the complication- related mortality was 5. 56%( 1 /18). The incidence of PMCT- related complications showed a significant difference between 2012,2013,and 2014( χ2= 11. 78,P = 0. 003). Conclusion Ultrasound- guided PMCT is generally safe,but the patients with liver tumors in special sites,severe liver cirrhosis,and other systemic diseases still have a high risk. The indications for PMCT should be followed strictly,and enhancement in preoperative prophylactic treatment,standard intraoperative procedure,and careful postoperative observation can significantly reduce the adverse outcome caused by PMCT- related complications.
Objective To investigate the effect of transcatheter arterial chemoembolization( TACE) combined with interferon( IFN) adjuvant therapy in the treatment of advanced primary liver cancer,and to provide new ideas for adjuvant therapies after TACE. Methods The databases including Cochrane Library,Pub Med,Medline,Embase,CNKI,Wanfang Data,and VIP were searched to obtain all articles published before January 2015,and the randomized controlled trials( RCTs) about the comparison between TACE combined with IFN and TACE alone published in journals at home and abroad were included. Quality assessment and data extraction were performed for these articles,and Revman 5. 1 software was applied for the meta- analysis. Results A total of 6 RCTs were included,consisting of 311 patients in the IFN adjuvant therapy group and 308 patients in the placebo group. The results of the meta- analysis showed that compared with the placebo group,the IFN adjuvant treatment group had significantly lower 1-,2-,and 3- year recurrence rates and a significantly higher 1- year survival rate( P = 0. 006,0. 002,0. 002,and 0. 030). Conclusion IFN adjuvant therapy can reduce the risk of liver cancer recurrence after TACE and improve the patients' survival rate.
Objective To investigate the prognostic factors for transcatheter arterial chemoembolization( TACE) in patients with advanced primary hepatocellular carcinoma( HCC). Methods The clinical data of 124 patients with advanced HCC who were admitted to Huaian No. 1 People's Hospital Affiliated to Nanjing Medical University and underwent TACE from May 2007 to May 2012 were analyzed retrospectively. The Kaplan- Meier method was used to calculated cumulative survival rates,and the log- rank test was used for survival difference analysis and univariate prognostic analysis; the Cox univariate analysis was applied to determine risk factors,and the Cox multivariate stepwise regression analysis was applied to determine independent risk factors. Results Follow- up visits were performed for all patients,and the time for follow- up visits was 3- 40 months. The 0. 5-,1-,2-,and 3- year cumulative survival rates of these patients were97. 6%,74. 2%,15. 5%,and 4. 1%,respectively,with a median survival time of 482 days. Univariate analysis showed that preoperative serum alpha- fetoprotein( AFP) level,tumor size,presence or absence of portal vein tumor thrombus,and tumor stage were the prognostic factors in patients with HCC undergoing TACE( all P < 0. 001); Cox multivariate stepwise regression analysis showed that tumor size,tumor stage,preoperative serum AFP level,and presence or absence of portal vein tumor thrombus were the independent prognostic factors( Wald values = 7. 428,7. 699,15. 235,and 5. 803,respectively,all P < 0. 05). Conclusion Tumor size,tumor stage,preoperative serum AFP level,and presence or absence of portal vein tumor thrombus are the independent prognostic factors in patients with HCC undergoing TACE,and can guide the prognosis and selection of therapeutic regimens in clinical practice.
Objective To investigate the therapeutic effect of transcatheter arterial chemoembolization( TACE) in patients with hepatocellular carcinoma( HCC) complicated by portal vein tumor thrombus,and to identify related prognostic factors. Methods The clinical data of152 HCC patients with portal vein tumor thrombus who were admitted to Xijing Hospital of Fourth Military Medical University and received TACE from January 2006 to December 2010 were analyzed retrospectively. The occurrence of post- TACE liver failure,upper gastrointestinal bleeding,and post- embolization syndrome was observed,and survival data and prognostic factors were analyzed. The Kaplan- Meier method was used to calculate cumulative survival rate,the log- rank test was used for univariate analysis,and the Cox proportional hazards model was used for multivariate analysis. Results The median survival time was 5. 0 months,and the 6-,12-,and 18- month cumulative survival rates were 37%,18%,and 9%,respectively. Univariate analysis showed that tumor size,tumor type,involvement of both liver lobes,distant metastasis,and Child- Pugh class were the prognostic factors for TACE in HCC patients with portal vein tumor thrombus( χ2= 5. 108,11. 542,6. 036,12. 319,and 22. 574,respectively,all P < 0. 05); multivariate analysis showed that tumor size,tumor type,distant metastasis,and Child- Pugh class were the independent prognostic factors( Wald values = 11. 243,5. 021,7. 651,and25. 876,respectively,all P < 0. 05); Child- Pugh class was the only influencing factor for liver failure in HCC patients with portal vein tumor thrombus( P = 0. 015). Conclusion TACE is safe and effective in HCC patients with portal vein thrombus and good liver function.Tumor size,tumor type,distant metastasis,and Child- Pugh class are the main factors influencing survival,which provides a basis for clinicians to select appropriate interventional therapies.
Objective To evaluate the effect of live combined Bacillus subtilis and Enterococcus faecium enteric- coated capsules in the prevention and treatment of adverse events and complications after transcatheter arterial chemoembolization( TACE). Methods A total of 239 patients who were diagnosed with hepatocellular carcinoma and treated with TACE from January 2012 to December 2013 were randomly divided into experimental group( n = 111) and control group( n = 128). The patients in the experimental group were orally given live combined Bacillus subtilis and Enterococcus faecium enteric- coated capsules 3 days before surgery,and the patients in the control group were given placebo with the same appearance. The adverse events,incidence of complications,and blood ammonia level after TACE were compared between the two groups. Independent- samples t- test was performed for comparison of continuous data between the two groups,and chi- square test was performed for comparison of categorical data. Results Compared with those in the control group,the patients in the experimental group had a significantly lower incidence of adverse events such as pyrexia,abdominal distension,and constipation( t = 2. 728,2. 561,and 2. 026,respectively; all P < 0. 05); meanwhile,the patients in the experimental group had a significantly lower incidence of postoperative complications such as liver abscess,ileus,spontaneous bacterial peritonitis,and hepatic encephalopathy than those in the control group( t = 1. 969,2. 312,2. 987,and 2. 826,respectively; all P < 0. 05). After treatment,the patients in the experimental group had a significantly lower blood ammonia level compared with those in the control group( t = 1. 97; P < 0. 05). Conclusion As a new kind of live bacterial preparation,Bacillus subtilis and Enterococcus faecium enteric- coated capsules can reduce abdominal discomfort and blood ammonia level after TACE,as well as the incidence of severe complications including liver abscesses,but related mechanisms need further studies.
Objective To investigate the effect of recombinant human endostatin( Endostar) combined with hepatic artery interventional therapy on the progression- free survival( PFS) of patients with advanced hepatocellular carcinoma( HCC). Methods A total of 86 patients with advanced HCC who were admitted to Fujian Provincial Tumor Hospital from March 2011 to May 2015 were selected and divided into treatment group and control group according to a matched pair design. The treatment group( 43 patients) was given Endostar combined with hepatic artery interventional therapy,and the control group( 43 patients) was given hepatic artery interventional therapy combined with oral administration of Ganfule. The chi- square test was applied for comparison of categorical data between the two groups,and the t- test was applied for comparison of continuous data between the two groups. The Kaplan- Meier method was applied for survival analysis,the Log- rank test was applied for univariate analysis,and Cox proportional hazards model was applied for multivariate analysis. Results The median PFS in the treatment group and the control group was 154 d [95% confidence interval( CI) : 94- 214 d]and 70 d( 95% CI: 39- 101d),respectively,with a significant difference between the two groups( χ2= 10. 741,P = 0. 001). Univariate analysis showed that the severity of liver cirrhosis,number of tumors,and main portal vein tumor thrombus / inferior vena cava tumor thrombus were the prognostic factors for patients with advanced HCC( χ2= 8. 182,9. 150,and 6. 565,P = 0. 004,0. 027,and 0. 038); multivariate analysis showed that the severity of liver cirrhosis and main portal vein tumor thrombus / inferior vena cava tumor thrombus were the independent prognostic factors for PFS in patients with advanced HCC who were treated with Endostar combined with hepatic artery interventional therapy( P = 0. 028 and 0.013). Conclusion Endostar can effectively prolong the PFS of patients with advanced HCC after hepatic artery interventional therapy,but it does not have a clear advantage in patients with severe liver cirrhosis or main portal vein tumor thrombus / inferior vena cava tumor thrombus.
Objective To investigate the clinical effect of systemic chemotherapy combined with transcatheter arterial chemoembolization( TACE) in the treatment of breast cancer with liver metastases. Methods A total of 86 female breast cancer patients with liver metastases who were treated in the Affiliated Hospital of Shandong Academy of Medical Sciences from December 2012 to December 2014 were selected and equally divided into experimental group and control group. The patients in the control group received systemic chemotherapy,and those in the experimental group received systemic chemotherapy combined with TACE. The clinical effect,changes in lesions,and patients' quality of life( QOL) scores after treatment were compared between two groups. The t- test was applied for comparison of continuous data between the two groups,and the chi- square test was applied for comparison of categorical data between the two groups. Results The experimental group had a significantly higher overall response rate than the control group( 90. 70% vs 58. 14%,χ2= 13. 07,P = 0. 001). Compared with the control group,the experimental group had significantly smaller diameters of tumors and lymph nodes after treatment( t = 4. 26 and 4. 63,both P < 0. 001),as well as significantly higher QOL scores at 3 and 6 months after treatment( t = 6. 30 and 3. 89,both P <0. 001). Conclusion Systemic chemotherapy combined with TACE has a significant therapeutic effect in breast cancer patients with liver metastases,and can improve patients' symptoms,reduce adverse drug reactions,and improve QOL. As a safe and reliable therapeutic method,it is worthy of clinical application.
Objective To investigate the application of diffusion- weighted magnetic resonance imaging( DW- MRI) for the evaluation of the therapeutic effect of percutaneous ethanol injection( PEI) and its effect on micro- angiogenesis in residual tumor in a rabbit VX2 liver tumor model. Methods A total of 26 rabbits with VX2 liver tumor were randomly divided into experimental group and control group,with13 rabbits in each group. CT- guided PEI was performed for the experimental group,and no treatment was performed for the control group.DW- MRI was performed at 1 week after operation. Apparent diffusion coefficient( ADC) ADCtotalin the active tumor areas and necrosis areas were compared within the experimental group,ADCperfand microvascular density( MVD) count in the active tumor areas were compared between the two groups,and the correlation between ADCperfand MVD count was analyzed. The Shapiro- Wilk test was applied for normality analysis,the Wilcoxon rank sum test was applied for comparison of continuous data between the two groups,and the correlation between ADCperfand MVD count was analyzed by the Pearson correlation coefficient. Results In the experimental group,ADCtotalshowed a significant difference between the necrosis areas and the active tumor areas( [1. 674( 1. 340- 2. 571) ] × 10- 3mm2/ s vs [1. 296( 1. 120-1. 972) ]× 10- 3mm2/ s; Z = 2. 052,P = 0. 040). ADCperfand MDV count in the active tumor areas showed no significant differences between the experimental group and the control group [0. 568( 0. 381- 1. 873) ]× 10- 3mm2/ s vs [0. 947( 0. 518- 1. 476) ]× 10- 3mm2/ s,Z =0. 487,P = 0. 626; 23. 641 ± 6. 138 vs 23. 487 ± 3. 466; Z =- 0. 128,P = 0. 898). In both groups,ADCperfin the active tumor areas was positively correlated with MDV count( r = 0. 583 and 0. 593,P = 0. 037 and 0. 033). Conclusion DW- MRI can accurately assess the therapeutic effect of PEI and reflect the condition of micro- angiogenesis in a rabbit VX2 liver tumor model. At 1 week after PEI,PEI has no obvious effect on micro- angiogenesis in residual tumor.
Abstract: Objective To investigate the values of aspartate aminotransferase to platelet ratio index( APRI) and alanine aminotransferase to platelet ratio index( BPRI) for the prediction of pathological changes in liver tissue in patients with chronic hepatitis B( CHB). Methods A total of 167 CHB patients who visited the People's Hospital of Liuzhou from February 2004 to February 2014 were collected. Liver biopsy,routine blood test,and liver function test were performed,and then the correlation between APRI / BPRI and liver pathology was analyzed.The Mann- Whitney U test was applied for comparison of continuous data between groups,and the receiver operating characteristic( ROC)curve was used to evaluate the predictive values of APRI and BPRI for liver pathological staging. Results APRI was compared between G0,G1,G2,G3,and G4 groups with different liver inflammation grades,and the G1 group had a significantly different APRI value than the G2 and G3 groups( both P < 0. 05); the G0- 1 group had a significantly different APRI value than the G2- 4 group( P < 0. 05). BPRI was also compared between these groups,and it differed significantly between the G0 group and G4 group and between the G1 group and G2 group( both P < 0. 05); the G0- 1 group had a significantly different BPRI value than the G2- 4 group( P < 0. 05). APRI and BPRI were compared between each two of S0,S1,S2,S3,and S4 groups,and they showed significant differences between the S2 and S3 groups( P <0. 05). The areas under the ROC curve of APRI and BPRI for predicting liver inflammation G2- 4 were 0. 748 and 0. 736,respectively( 95% CI: 0. 669- 0. 827 and 0. 653- 0. 819,respectively; both P < 0. 000 1); the optimal cut- off values for APRI and BPRI to predict liver inflammation G2- 4 were 0. 601 and 0. 630,respectively,with sensitivity,specificity,and Youden index of 63. 6% /82. 7%,74. 5% /59. 6%,and 39. 0% /42. 4%,respectively. Conclusion APRI and BPRI can be used to predict liver inflammatory activity in CHB patients.
Abstract: Objective To investigate the occurrence of liver injury and related risk factors for hepatitis B virus( HBV) reactivation after chemotherapy in HBsAg- positive patients with malignant tumors. Methods A total of 150 HBsAg- positive patients with malignant tumors who received chemotherapy in Shantou Central Hospital from January 2011 to December 2013 were collected; 43 patients received prophylactic antiviral therapy,i. e.,the application of antiviral therapy before,during,and within half a year after chemotherapy( experiment group),and 107 patients did not receive prophylactic antiviral therapy( control group). The occurrence of liver injury after chemotherapy in both groups was analyzed retrospectively. Chi- square test was applied for comparison of categorical data between the two groups,and logistic regression analysis was used to investigate the related factors for HBV reactivation after chemotherapy. Results Of all,64 patients( 42. 0%) experienced liver injury after chemotherapy,including 13 grade Ⅰ cases( 8. 7%),29 grade Ⅱ cases( 19. 3%),15 grade Ⅲcases( 10. 0%),and 6 grade Ⅳ cases( 4. 0%),and the liver injury grade differed significantly between the two groups( χ2= 19. 498,P = 0. 001). The experiment group had a significantly lower incidence of liver injury than the control group( 18. 6% [8 cases] vs 52. 3%[56 cases]; χ2= 25. 864,P < 0. 001). The univariate logistic regression analysis showed that there were significant differences in six parameters of hepatitis B before chemotherapy,HBV quantification,application of hormones,and application of prophylactic antiviral therapy between the two groups. The multivariate logistic regression analysis of these four factors showed that they were all independent influencing factors for HBV reactivation after chemotherapy,and prophylactic antiviral therapy was the only protective factor. Conclusion HBsAg-positive patients with malignant tumors have a high incidence of liver injury after chemotherapy,and prophylactic antiviral therapy can effectively reduce the incidence of HBV reactivation and liver injury after chemotherapy in HBsAg- positive patients.
Abstract: Objective To investigate the differences between carvedilol and propranolol in the degree of hepatic venous pressure gradient( HVPG) reduction,response rate,and adverse events in patients with cirrhotic portal hypertension,and to evaluate the efficacy and safety of carvedilol in reducing portal vein pressure. Methods Sixty- four patients with cirrhotic portal hypertension who were diagnosed and treated in Shandong Provincial Hospital from October 2010 to January 2012 were selected and randomized into propranolol group( n = 33) and carvedilol group( n = 31). The dose of drugs was adjusted according to blood pressure and heart rate,and the course of treatment was 7 days. Measurements of HVPG and liver and renal function indices were performed before and after treatment,and the degree of HVPG reduction and response rate were compared between the two groups. The incidence of adverse events such as hypotension,ascites,and renal injury in the two groups was observed. Comparison of continuous data between the two groups was made by t test,and comparison of categorical data was made by chi- square test or Fisher's exact. Results HVPG was reduced significantly in both carvedilol group and propranolol group,with degrees of( 28. 30 ±22. 19) % and( 12. 38 ± 24. 09) %,respectively,and the reduction in the carvedilol group was significantly greater / higher / larger( t =0. 223 4,P = 0. 032). The response rate was 56. 7%( 17 /30) and 41. 9%( 13 /31) in the carvedilol group and propranolol group,respectively,with no significant difference between the two groups( χ2= 1. 324,P = 0. 250). The carvedilol group had a significantly more reduction in mean arterial pressure( MAP) than the propranolol group( t = 2. 338,P = 0. 024),but the patients did not experience the adverse event of hypotension. The levels of bilirubin,serum creatinine,and urea nitrogen did not change significantly before and after treatment,and there was no tendency of ascites formation or aggravation. Conclusion This randomized study suggests that within a short period of time,carvedilol is more effective than propranolol in reducing HVPG and has no obvious adverse effects. Carvedilol is safe and effective in the treatment of cirrhotic portal hypertension.
Abstract: Objective To investigate the risk factors for the development of post- endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia( PEPH) after endoscopic retrograde cholangiopancreatography( ERCP). Methods The clinical data of 233 patients who underwent therapeutic ERCP from January 2012 to December 2014 in our hospital and met the inclusion criteria were analyzed retrospectively. Basic information including age,sex,drinking history,single stone,triglyceride,and nationality was extracted,and detailed information on intraoperative procedure,intraoperative diagnosis,and complications for ERCP was carefully recorded. Chi- square test was applied for comparison of categorical data between groups,and Logistic regression analysis were applied to determine the risk factors for the development of PEPH. Results The incidence of PEPH was 26. 6%( 62 /233). Univariate analysis showed that female sex( χ2= 3. 320,P= 0. 045),drinking history( χ2= 6. 108,P = 0. 010),common bile duct stenosis( χ2= 5. 767,P = 0. 012),single stone( χ2= 9. 121,P= 0. 020),juxta- ampullary duodenal diverticula( χ2= 28. 170,P < 0. 001),and abnormal triglyceride( χ2= 54. 717,P < 0. 001) might be the risk factors for PEPH,and these factors differed significantly between the two groups. Multivariate analysis showed that female sex( OR = 1. 616,P = 0. 025) drinking history( OR = 2. 360,P = 0. 010),common bile duct stenosis( OR = 2. 163,P = 0. 012),juxta- ampullary duodenal diverticula( OR = 5. 502,P < 0. 001),and abnormal triglyceride( OR = 12. 924,P < 0. 001) were independent risk factors for PEPH. Conclusion Female sex,drinking history,common bile duct stenosis,juxta- ampullary duodenal diverticula,and abnormal triglyceride are independent risk factors for PEPH,and targeted preventive measures for such high- risk populations can effectively reduce the incidence of PEPH.
Abstract: Objective To observe the clinical effect and efficacy of prostaglandin E1( PGE1),the drug for microcirculation improvement,in the treatment of acute pancreatitis( AP). Methods A total of 80 patients with mild- to- moderate AP who were hospitalized and treated in Second Department of Hepatobiliary and Pancreatic Surgery of the First Hospital of Jilin University from May 2014 to January 2015 were enrolled and randomized into two groups. Forty- four patients in control group received the conventional comprehensive therapy for AP,and36 patients in experiment group received PGE1 in addition to the conventional therapy. The time to disappearance of abdominal symptoms and the time for serum and urine levels of amylase and serum levels of lipase,C- reactive protein( CRP),and procalcitonin( PCT) to return to normal were compared between the two groups. The independent- samples t- test was applied for comparison of continuous data between the two groups,and the chi- square test or Fisher's exact test was applied for comparison of categorical data between the two groups.Results The two groups had significant differences in the time for serum levels of amylase and CRP and percentage of neutrophils to return to normal and hospital costs( P = 0. 041,0. 030,0. 012,and 0. 026,respectively). PGE1 quickly relieved abdominal pain and distention,reduced the serum level of amylase,shortened the length of hospital stay,and reduced hospital costs. Conclusion PGE1 has good clinical effect and safety in the treatment of AP,and can be applied as an adjuvant drug in the comprehensive therapy for AP.
Abstract: Objective To investigate the clinical features of recurrent biliary pancreatitis and related predisposing factors. Methods A total of 272 patients with biliary pancreatitis who were admitted and treated in Jiangbei District People's Hospital from January 2008 to December 2014 were enrolled and divided into recurrence group( 56 patients with recurrent biliary pancreatitis) and primary group( 216 patients with primary biliary pancreatitis). Clinical features and predisposing factors were compared between the two groups. Comparison of continuous data between the two groups was made by t test and comparison of categorical date was made by chi- square test. Results There were no significant differences in age and mortality between the two groups( both P > 0. 05). Compared with the primary group,the recurrence group had a significantly higher proportion of males,a significantly increased APACHE- Ⅱ score,significantly increased incidence rates of moderate- to- severe pancreatitis and common bile duct stones,significantly higher rates of stenosis of the common bile duct orifice and hyperlipidemia,and a significantly higher rate of surgical treatment( all P < 0. 05). In the recurrence group,the type of pancreatitis differed significantly between patients with 2 times of recurrence and those with > 2 times of recurrence( recurrence for more than 2 times)( P =0. 040). Compared with the primary group,the recurrence group had a significantly higher proportion of patients with known predisposing factors( 80. 36% vs 58. 33%,P = 0. 002),as well as significantly higher rates of high- fat diet and drinking( both P < 0. 05). However,the rates of biliary tract infection and oral administration of drugs showed no significant differences between the two groups( both P > 0. 05).Conclusion Recurrent biliary pancreatitis is common and severe in males,and is often complicated by common bile duct stones,stenosis of the common bile duct orifice,and hyperlipidemia,with a high rate of surgical treatment. High- fat diet and drinking are important predisposing factors for recurrent biliary pancreatitis.
Abstract: Objective To evaluate the value of combined determination of various indices in the clinical diagnosis of acute pancreatitis( AP) through dynamic measurements of the levels of peripheral serum C- reactive protein( CRP),lipase( LPS),interleukin- 1β( IL-1β),and intercellular adhesion molecule 1( ICAM- 1),as well as changes in their levels,in patients with AP. Methods A total of 86 patients with AP who were treated in Fourth Affiliated Hospital of China Medical University from January 2010 to December 2012 were selected,among whom there were 39 patients with severe acute pancreatitis( SAP) and 47 patients with mild acute pancreatitis( MAP). Serum samples were collected from these patients on days 1,3,5,and 7 of admission. Twelve healthy subjects were selected as controls. Enzyme- linked immunosorbent assay was applied to measure the levels of CRP,IL- 1β,and ICAM- 1,and the dry slides method was applied to measure the concentration of serum LPS. The t test and χ2test were applied for comparison of continuous data and categorical data between groups,respectively. Results On day 1 of admission,the patients in MAP group had significantly higher levels of CRP,IL- 1β,and LPS than those in control group( t =- 74. 126,- 60. 135,and- 364. 153,respectively; all P < 0. 001); on day 1 of admission,the patients in SAP group had significantly higher levels of CRP,ICAM- 1,IL- 1β,and LPS than those in control group( t =- 121. 355,- 25. 728,- 89. 422,and- 415. 840,respectively; all P < 0. 001). The peak concentration of each index appeared on day 1 or 3 of admission,and decreased progressively in the course of therapy. The patients in SAP group had significantly higher levels of serum CRP,LPS,IL- 1β,and ICAM- 1 than those in MAP group( all P < 0. 05). Conclusion Combined determination of serum CRP,LPS,IL- 1β,and ICAM- 1levels has a certain clinical value in early identification of severity of AP.
Objective To analyze the prognostic risk factors for hepatic encephalopathy( HE),and to explore the risk factors for prognosis.Methods A total of 385 patients with HE who were treated in Liaocheng People's Hospital from January 2006 to June 2014 were enrolled in this study and analyzed retrospectively. These patients were divided into improved group( n = 125) and deteriorated group( n = 260). A total of 25 clinical indices were selected,and non- conditional binary logistic regression analysis was performed for related data with SPSS.Results Univariate analysis showed that HE stage,upper gastrointestinal hemorrhage,hepatorenal syndrome( HRS),total bilirubin( TBil),and international normalized ratio( INR) were risk factors affecting the prognosis of HE( P = 0. 000,0. 009,0. 047,0. 002,and0. 027,respectively). Multivariate logistic regression analysis was further performed for the variables with statistical significance and the results showed that HE stage,upper gastrointestinal hemorrhage,HRS,TBil,and INR were independent risk factors affecting the prognosis of HE( P = 0. 000,0. 009,0. 000,0. 000,and 0. 008,respectively; OR( 95% CI) = 4. 388( 2. 997- 6. 424),2. 805( 1. 300- 6. 050),4. 036( 2. 018- 8. 072),1. 005( 1. 003- 1. 007),and 1. 446( 1. 099- 1. 901),respectively). Conclusion HE stage,upper gastrointestinal hemorrhage,HRS,TBil,and INR are risk factors affecting the prognosis of HE,and advanced HE stages,a high level of bilirubin,high INR,and presence of upper gastrointestinal hemorrhage and HRS indicate poor prognosis. The patient's HE stage,upper gastrointestinal hemorrhage,HRS,TBil,and INR are applied as the indices for prognosis of HE,and the equation based on the these indices may have a reference value in clinical practice.
Objective To analyze and compare the serum metabolite profiling of healthy volunteers and patients with minimal hepatic encephalopathy( MHE),identify the specific biomarkers of MHE,and explore the method for early diagnosis of MHE. Methods Twenty-nine patients with MHE caused by hepatitis B cirrhosis who were admitted to First Affiliated Hospital of Guangxi University of Chinese Medicine( MHE group) from October 2013 to October 2014,as well as 50 healthy volunteers who received physical examinations in this hospital( NC group) during the same period,were collected. Gas chromatography and time- of- flight mass spectrometry( GC- TOFMS) and ultra- high- pressure liquid chromatography- quadrupole- time- of- flight mass spectrometry( UPLC- QTOFMS) were applied to determine the metabolites in serum samples. Principal component analysis( PCA) and orthogonal partial least squares- discriminant analysis( OPLS-DA) were applied for multivariate statistical analysis,and univariate t test was applied for comparison between the two groups,so as to determine the biomarkers for MHE. Results In combination of the modeling analysis with PCA and OPLS- DA,the results from univariate t test,and vasoactive intestinal peptide( VIP) value in the models,a total of 27 possible specific biomarkers for MHE were found in serum in the two groups. According to the fold change between MHE group and NC group in OPLS- DA model,there were 9 down- regulated metabolites and 18 up- regulated metabolites in the patients with MHE compared with healthy volunteers. Conclusion Serum metabolomics analytical platforms such as GC- TOFMS and UPLC- QTOFMS can detect a variety of metabolites in serum,which can be of help to explore the pathogenesis of MHE. In addition,the diagnostic model OPLS- DA established in this study can differentiate between the normal population and patients with MHE,which may be applied for early diagnosis of MHE.
Objective To evaluate the compatible stability of magnesium isoglycyrrhizinate( MgIG) injection and reduced glutathione( GSH) for injection at room temperature. Methods High- performance liquid chromatography was applied to measure the changes in the content of MgIG and reduced GSH after MgIG injection and reduced GSH for injection were mixed with 5% or 10% glucose solution. Results There were no significant changes in the content of MgIG and reduced GSH within 0,0. 5,1,1. 5,2,and 4 h after MgIG injection and reduced GSH for injection were mixed with 5% or 10% glucose solution. Conclusion MgIG injection and reduced GSH for injection are compatible in 5% and 10% glucose solutions,but the mixed solution should be used within 4 h.
Objective To investigate the changes in serum asymmetric dimethylarginine( ADMA) levels in the progression of liver inflammation in a rat model of nonalcoholic fatty liver disease( NAFLD). Methods The rat model of NAFLD was established through high- fat cream by gavage and these rats were considered the experimental group( group M),and the rats in the normal control group( group C) were given normal saline by gavage within the same period of time. Liver samples and serum samples were collected from these rats. Serum alanine aminotransferase( ALT) and ADMA levels and the content of nitric oxide( NO) in liver tissue homogenate were measured at 4,8,and 12 weeks for group M( M4,M8,and M12) and 12 weeks for group C( C12),and NAFLD activity score( NAS) was evaluated for both groups at the same time point. As for the data that were normally distributed and had homogeneity of variance,one- way analysis of variance was applied for comparison between multiple groups,and the least significant difference( LSD) t- test was applied for comparison within the same group; as for the data that were normally distributed and had heterogeneity of variance,Kruskal- Wallis H test was applied for comparison between multiple groups. Pearson correlation analysis was applied for correlation analysis. Results Compared with the C12 group,the M12 group had significantly increased serum ADMA and ALT levels and content of NO in liver tissue homogenate( P = 0. 010,P < 0. 001,and P < 0. 001,respectively). Serum ADMA level was not significantly correlated with serum ALT level( r = 0. 195,P = 0. 228),and was positively correlated with the content of NO in liver tissue homogenate and NAS in rats( r = 0. 631,P < 0. 001; r = 0. 782,P < 0. 001).Conclusion In rats with NAFLD,serum ADMA level gradually increases with the progression of liver inflammation,and is positively correlated with the content of NO and NAS. The role of ADMA as a new inflammatory factor for evaluating the grade of chronic liver inflammation in NAFLD needs to be further investigated.
Abstract: Hepatitis B virus( HBV) is a great threat to human health,but due to its strong species specificity,there are still no ideal animal models at present to clarify the pathogenesis of HBV infection. At present,the research on HBV infection models mainly concentrates on mice,and great progress has been achieved / made. This review focuses on the advantages and disadvantages of HBV transgenic mouse model,HBV- transfected mouse model,and human- mouse chimeric liver HBV mouse model,and suggests that rational application of these models helps to clarify the pathogenesis of HBV.
Abstract: There are about 150 million people around the world with chronic hepatitis C virus( HCV) infection currently,of whom 20%will ultimately progress to cirrhosis and eventually die of end- stage liver disease and hepatocellular carcinoma. Interferon( IFN) has long been recognized as the cornerstone of the treatment of chronic hepatitis C because of its role in sustained virologic response and prevention of disease progression. However,it has limited efficacy and multiple adverse effects. In recent years,direct- acting antiviral agents( DAAs)have shown good efficacy. This review summarizes the recent advances in IFN- free anti- HCV therapeutic regimens based on DAAs. We believe that,with the emergence of DAAs,IFN- free therapies will develop rapidly and display better prospects.
Abstract: Primary liver cancer is a common malignant tumor in the digestive system. Most patients are in the advanced stage when a confirmed diagnosis has been made,and prognosis is often unfavorable. Traditional Chinese medicine( TCM) has unique advantages in the prevention and treatment of primary liver cancer. This article briefly introduces the etiology and pathogenesis of primary liver cancer,as well as syndrome differentiation and treatment of liver cancer with TCM,and summarizes the advances in multimodality therapies including TCM combined with transcatheter arterial chemoembolization,radical surgery for liver cancer,chemoradiotherapy,and molecular- targeted therapy,in order to provide a reference for the clinical treatment and improvement in the prognosis of primary liver cancer.
Abstract: Hepatic encephalopathy is one of the most common complications of liver failure and has a high incidence in hospitalized patients.Most patients with hepatic encephalopathy have varying degrees of malnutrition. In recent years,more and more clinical trials have confirmed that the nutritional support therapy is beneficial to patients with hepatic encephalopathy,and more attention has been paid to nutritional therapy. This paper introduces the pathogenesis of malnutrition in hepatic encephalopathy,and reviews the methods for nutrition evaluation and nutritional therapy in patients with hepatic encephalopathy.
Abstract: Endotoxin,which is also called lipopolysaccharide( LPS),is a unique element of Gram- negative bacteria. Liver is the main site for removing bacteria and endotoxin. Meanwhile,it is also the most vulnerable organ. Liver injury initially occurs in the hepatic sinusoids. This article mainly introduces the impact of LPS on Kupffer cells,hepatic sinusoidal endothelial cells,oxidant / antioxidant balance in the hepatic sinusoids,and liver blood flow. It is believed that the function of hepatic sinusoids in LPS- induced liver injury should not be ignored,and the hepatic sinusoids would play an important role in the prevention and treatment of LPS- induced liver injury.
Abstract: To date,the clustered regularly interspaced short palindromic repeat( CRISPR) / Cas9 system has been widely used to edit the genome in many species and cells. The system is the third generation of artificial endonuclease,which can edit DNA by recognizing short DNA sequences. This paper reviews the structural features of the system and its application in virus research,such as the functional studies of virus- related genes and the exploration of antiviral therapies( including HIV,HBV,and EB virus),looking forward to the future direction of virus research.