Risk factors for long-term prognosis of hepatocellular carcinoma patients after anatomic hepatectomy

BACKGROUND The risk factors for patients with major postoperative complications immediately after liver resection have been identified;however,the intermediate and longterm prognoses for these patients have yet to be determined.AIM To evaluate the factors responsible for the long-term recurrence-free survival rate in patients with hepatocellular carcinoma(HCC)following anatomic hepatectomy.METHODS We performed a retrospective analysis of 74 patients with HCC who underwent precise anatomic hepatectomy at our institution from January 2013 to December 2015.The observational endpoints for this study were the tumor recurrence or death of the HCC patients.The overall follow-up duration was three years.The recurrence-free survival curves were plotted by the Kaplan-Meier method and were analyzed by the log-rank test.The value of each variable for predicting prognosis was assessed via multivariate Cox proportional hazards regression analysis.RESULTS The 1-year and 3-year recurrence-free survival rates of HCC patients were 68.92%and 55.41%,respectively,following anatomic liver resection.The results showed that the 3-year recurrence-free survival rate in HCC patients was closely related to preoperative cirrhosis,jaundice level,tumor stage,maximal tumor diameter,complications of diabetes mellitus,frequency of intraoperative hypotensive episodes,estimated blood loss(EBL),blood transfusion,fluid infusion,and postoperative infection(P<0.1).Based on multivariate analysis,preoperative cirrhosis,tumor stage,intraoperative hypotension,and EBL were identified to be predictors of 3-year recurrence-free survival in HCC patients undergoing anatomic hepatectomy(P<0.05).CONCLUSION Tumor stage and preoperative cirrhosis adversely affect the recurrence-free survival rate in HCC patients following anatomic hepatectomy.The long-term recurrence-free survival rate of patients with HCC is closely related to intraoperative hypotension and EBL.     

Effectiveness of surgical resection for complicated liver cancer and its influencing factors: A retrospective study

BACKGROUND Surgical resection is the preferred method for patients with complex liver cancer.But the tumor is in a special position,the surgery is highly risky,postoperative complications can easily occur,and the prognosis is not ideal.AIM To investigate the effectiveness of surgical resection for complex liver cancer and its influencing factors.METHODS Fifty-seven patients who had complicated liver cancer and underwent surgical resection at our hospital from August 2015 to August 2016 were enrolled in this study.All patients were followed for three years,and their postoperative complications,survival,and factors that impacted their survival were analyzed.RESULTS The total incidence of postoperative complications was 45.61%,and the incidence of pleural effusion was the highest at 28.07%.There were no correlations between the 2-year and 3-year survival rates and sex,age,and HbsAg of the patients(P>0.05).In terms of pathological parameters,the 2-year and 3-year survival rates were significantly different according to the presence of a tumor capsule,degree of liver cirrhosis,satellite or focal lesions,hepatic vein thrombosis,portal vein tumor thrombus,and intraoperative blood loss(P<0.05).CONCLUSION be affected by factors such as the presence of a tumor capsule,cirrhosis degree,satellite or focal lesions,hepatic vein embolization,portal vein tumor thrombus,and intraoperative blood loss.Therefore,these factors should be controlled and prevented during surgery to help improve patient survival after surgery.     

C反应蛋白在老年COPD急性加重期的临床意义

Objective To explore clinical value of C-reactive protein(CRP) in acute aggressive period old patients with COPD. Methods 210 old patients in acute aggressive period with COPD were selected,who used antibiotic ,cortin or febrifuge and anodyne before. CRP,WBC,ESR and temperature were detected before and after controlling infection. Results The positive rate of CRP, WBC, ESR and temperature was 92. 38%, 27.62% ,48.57% and 46.67% respectively. The level of CRP is significant over WBC,ESR and temperature( P <0.01). The level of CRP were 58. 66±15.20 and 8.26±1.24 respectively at before and after controlling in-fection(P<0.01). The level of WBC were 8.69±2.60 and 5.34±1.48 respectively at before and after can-trolling infection(P<0.01). The level of ESR were 36.81±14.23 and 24.52±14.61 respectively at before and after controlling infection (P<0.01). The level of temperature were 37.29±0.78℃ and 36.26±0.37℃ respectively at before and after controlling infection (P<0.01). Conclusion CRP is a good marker in acute aggressive period old patients with COPD and it isn't disturbed by antibiotic,cortin or febrifuge and anodyne.     

C反应蛋白在老年COPD急性加重期的临床意义

Objective To explore clinical value of C-reactive protein(CRP) in acute aggressive period old patients with COPD. Methods 210 old patients in acute aggressive period with COPD were selected,who used antibiotic ,cortin or febrifuge and anodyne before. CRP,WBC,ESR and temperature were detected before and after controlling infection. Results The positive rate of CRP, WBC, ESR and temperature was 92. 38%, 27.62% ,48.57% and 46.67% respectively. The level of CRP is significant over WBC,ESR and temperature( P <0.01). The level of CRP were 58. 66±15.20 and 8.26±1.24 respectively at before and after controlling in-fection(P<0.01). The level of WBC were 8.69±2.60 and 5.34±1.48 respectively at before and after can-trolling infection(P<0.01). The level of ESR were 36.81±14.23 and 24.52±14.61 respectively at before and after controlling infection (P<0.01). The level of temperature were 37.29±0.78℃ and 36.26±0.37℃ respectively at before and after controlling infection (P<0.01). Conclusion CRP is a good marker in acute aggressive period old patients with COPD and it isn't disturbed by antibiotic,cortin or febrifuge and anodyne.     

Long-term survival of two patients with recurrent pancreatic acinar cell carcinoma treated with radiofrequency ablation: A case report

BACKGROUND Pancreatic acinar cell carcinoma (PACC) is a rare type of malignant pancreatic cancer that represents approximately 1%of all pancreatic neoplasms.Due to its very low incidence,only a few retrospective studies are available.Although surgery is the first choice for treatment,most patients experience recurrence(mainly in the liver) and there are no clear recommendations for patients with advanced disease.CASE SUMMARY We report two patients with PACC treated with sturgery who experienced tumour recurrence in the liver.Patient 1 carried a germline mutation in the APC gene.Both patients were treated with gemcitabine plus oxaliplatin and gemcitabine plus capecitabine as first-and second-line therapies,respectively.After a favoturable response to chemotherapy,the patients underwent radiofrequency ablation of the remaining liver metastases.For patient 1,we documented a relapse in the liver after a disease-free period of 9 mo,and treatment with gemcitabine plus capecitabine was restarted.The patient achieved a complete response,and he remains alive without evidence of disease recurrence after six years.After radiofrequency ablation,patient 2 experienced disease-free survival for 21 mo,when peritoneal relapse was diagnosed and treated with chemotherapy.The patient achieved a stable disease state for nearly two years;nevertheless,further progressive disease was documented,and he died seven years after the first relapse.CONCLUSION PACC presents different biological behaviours than pancreatic adenocarcinoma.Multidisciplinary treatment involving local ablative therapies may be considered for PACC.     

血必净与低分子肝素对严重脓毒症患者凝血功能及预后的影响

Objective To compare between the impact of Xuebijing injectio (a Chinese herbal medicine preparation) and that of low molecular weight heparin (LMWH) on coagulation function and prognosis in patients with severe sepsis, so as to guide the treatment of sepsis. Method A total of 89 patients with severe sepsis were randomly(random number) divided into 3 groups, namely Xuebijing group (group A),LMWH group (group B) and routine group (group C). The patients of group C received a series of remedies according to the guideline for severe sepsis. The patients of group A were treated with Xuebijing injectio in addition to routine treatment. The patients of group B were treated with LMWH along with routine treatment.Data of blood coagulation function tests and APACHE Ⅱ score of patients in three groups before and after treatment were analyzed respectively. The 28-day mortality and length of hospital stay were compared among three groups. All data were analyzed by using t-test, Analysis of Variance, q-test, x2-test and rank sum treatment, all markers of the blood coagulation function tests in group A improved significantly after treatment (P＜0.01), while only some markers of the blood coagulation function tests improved in the other two groups ( P ＜ 0. 05 or P ＜ 0. 01 ); After treatment, the blood coagulation function in group A improved significantly more than that in other two groups ( P ＜ 0.05 ), while there were some markers of the blood coagulawith the data before treatment, the APACHE Ⅱ score in group A and group B decreased after treatment (P＜0.05). After treatment, the APACHE Ⅱ score of group A and group B decreased significantly more than that of group C ( P ＜ 0.05). But there was no significant difference between group A and group B ( P ＞Xuebijing obviously improves the blood coagulation function in patients with severe sepsis, while LMWH only improves some markers of the coagulation function tests. Both Xuebijing and LMWH reduce mortality and improve prognosis of patients with sepsis.     

The effects of local wet hyperthermia combined with microwave ablation on tumor growth and serum levels of interferon-β and interleukine-12 in mouse models of mammary carcinoma

Objective To investigate the effects of local wet hyperthermia combined with microwave ablationon tumor growth and serum levels of interferon-β(IFN-β)and interleukine-12(IL-12).Methods An experimental mouse model beating mammary carcinoma was established in Balb/c mice and then treated with microwave ablation after 14 d.Seven d after ablation,local wet hyperthermia was administered once weekly for 2 weeks.Tumor growth and lung metastasis,as well as the survival of bearing tumor mice were observed.The serum levels of IFN-β and IL-12 were detected with enzyme-linked immuno sorbent assay(ELISA). Results When local wet hyperthermia was combined with microwave ablation tumor growth and lung metastasis were significantly less than when microwave ablation or local wet hyperthermia was used alone(P＜0.05).Furthermore,the survival of bearing tumor mice in combined therapy group prolonged significantly compared with those receiving either therapy alone(P＜0.05).Serum levels of IFN-β and IL-12 were also significantly higher in combined therapy group compared with the other groups (P＜0.05). Conclusions Local wet hyperthermia combined with microwave ablation is more effective than either local wet hyperthermia or microwave ablation alone in retarding tumor growth,which may be related to the enhanced immune response.     

Significance of 125I radioactive seed implantation on growth differentiation factor and programmed death receptor-1 during treatment of oral cancer

BACKGROUND Oral cancer(OC)is the most common malignant tumor in the oral cavity,and is mainly seen in middle-aged and elderly men.At present,OC is mainly treated clinically by surgery or combined with radiotherapy and chemotherapy;but recently,more and more studies have shown that the stress trauma caused by surgery and the side effects of radiotherapy and chemotherapy seriously affect the prognosis of patients.AIM To determine the significance of 125I radioactive seed implantation on growth differentiation factor 11(GDF11)and programmed death receptor-1(PD-1)during treatment of OC.METHODS A total of 184 OC patients admitted to The Second Affiliated Hospital of Jiamusi University from May 2015 to May 2017 were selected as the research subjects for prospective analysis.Of these patients,89 who received 125I radioactive seed implantation therapy were regarded as the research group(RG)and 95 patients who received surgical treatment were regarded as the control group(CG).The clinical efficacy,incidence of adverse reactions and changes in GDF11 and PD-1 before treatment(T0),2 wk after treatment(T1),4 wk after treatment(T2)and 6 wk after treatment(T3)were compared between the two groups.RESULTS The efficacy and recurrence rate in the RG were better than those in the CG(P<0.05),while the incidence of adverse reactions and survival rate were not different.There was no difference in GDF11 and PD-1 between the two groups at T0 and T1,but these factors were lower in the RG than in the CG at T2 and T3(P<0.05).Using receiver operating characteristic(ROC)curve analysis,GDF11 and PD-1 had good predictive value for efficacy and recurrence(P<0.001).CONCLUSION 125I radioactive seed implantation has clinical efficacy and can reduce the recurrence rate in patients with OC.This therapy has marked potential in clinical application.The detection of GDF11 and PD-1 in patients during treatment showed good predictive value for treatment efficacy and recurrence in OC patients,and may be potential targets for future OC treatment.     

Early changes in white blood cell,C-reactive protein and procalcitonin levels in children with severe multiple trauma

BACKGROUND: To analyze early changes in white blood cells(WBCs), C-reactive protein(CRP) and procalcitonin(PCT) in children with multiple trauma, before secondary inflammation develops. METHODS: This single-center retrospective study collected data from patients with blunt traumatic injury admitted to the pediatric intensive care unit(PICU). According to the prognostic outcome of 28 d after admission to the PICU, patients were divided into survival group(n=141) and non-survival group(n=36). Char...     

维拉帕米二甲双胍联合用药对高血压合并Ⅱ型糖尿病患者降压及降糖作用临床观察

Objective To observe blood pressure lowering effect and the blood glucose lowering effect on the combination of Verapamil and Metformin therapy for hypertensive patients with type 2 diabetes mellitus (diabetes mellitus, DM). Methods 129 cases of hypertension in patients with type 2 DM were divided into two groups, Verapamil treatment group, 98 cases in the control group 31 cases. (1) Verapamil treatment groups: Verapamil hydrochloride sustained-release capsules 180 mg/d, Metformin 750 ～ 1500 mg/d,Valsartan 80 ～ 160 mg/d, A Division horses Lin 100 mg/d, (2) control group, Valsartan 80 ～ 160 mg/d, Verapamil hydrochloride sustained-release capsules 180 mg/d, Aspirin 100 mg/d. (3) Blood pressure observation: Subjects in patients as early as 7: 00 and 22: 00 evening, measured two times a day and record systolic blood pressure blood pressure decreased significantly compared with those before treatment,4,6 weeks after the blood pressure weeks treatment their difference was significant (P<0.01), but the blood pressure has not dropped to normal ment review TC, TG, LDL decreased significantly after treatment, the difference was significant (P<0.05),HDL increased after treatment of (2.73±0.17), after treatment there was significant difference between improved (P<0.05), Verapamil treatment group was significantly better than the control group. Conclusion The combination of Verapamil and Metformin therapy for hypertensive patients with type 2 diabetes mellitus (DM) patients has good blood pressure lowering effect and blood glucose lowering effect.     

Feasibility of High-Intensity Focused Ultrasound for Hepatocellular Carcinoma after Stereotactic Body Radiation Therapy: Initial Experience

The purpose of this initial clinical observation was to investigate the safety and effect of high-intensity focused ultrasound (HIFU) for patients with hepatocellular carcinoma (HCC) after stereotactic body radiation therapy (SBRT). Twenty patients who had been treated with SBRT, with 24 local residuals, received HIFU ablation. The changes of periphery blood cell count and serum biochemistry were observed before HIFU and 1 week after. Contrast-enhanced magnetic resonance imaging before HIFU and 2 weeks after was performed to assess the effect of HIFU. All patients received follow-up. The mean ± standard deviation follow-up time was 19.3 ± 18.0 mo. The median survival time and 1-y survival rate were 21 mo and 76.2%. Seventeen residual lesions (70.8%) received complete ablation and seven received partial ablation, with a mean ablation ratio of 75.8% ± 18.2%. No significant differences were found in periphery blood cell counts or serum biochemistry 1 week after HIFU compared with before HIFU. No severe adverse reactions related to HIFU were observed. Thus, we believe that HIFU can safely and effectively ablate residual HCC after SBRT, which may be a feasible option for patients with HCC who have local residuals after SBRT.     

高强度聚焦超声治疗放疗后肝癌的早期MRI表现

目的探讨MRI评估高强度聚焦超声(HIFU)治疗放射疗法(放疗)后肝癌早期疗效的可行性。方法 16例原发性肝癌19个肿瘤病灶先放疗后HIFU。HIFU前、后2周行MRI常规平扫和增强扫描,并观察各序列信号变化。结果与HIFU前比较,HIFU后57.9%病灶T2WI信号降低,63.2%病灶T1WI信号增加,84.2%病灶T1WI增强肿瘤血液灌注消失。结论 MRI可能是早期评价HIFU治疗放疗后肝癌疗效的一种可行的影像学方法之一。常规平扫结合增强扫描可能提高早期疗效评价的准确率。     

经皮穿刺注射无水乙醇治疗高强度聚焦超声治疗后残留肝癌的疗效观察

目的探讨经皮穿刺注射无水乙醇治疗高强度聚焦超声(HIFU)后残留肝癌的疗效及其影响因素。方法对HIFU治疗肝癌术后的83例残留病灶进行无水乙醇注射(PEI)治疗。观察治疗前后患者临床症状、肿瘤标记物的变化,并用彩色多普勒血流显像(CDFI)定期随访肿瘤变化。结果79例患者临床症状明显改善。6个月和1、2年生存率分别为95.5%、82.5%、60.5%。CDFI随访,所有患者治疗区病灶回声增强,血供减少或消失,其中77例(92.8%)病灶体积缩小。51例AFP阳性患者中,46例(90.2%)AFP下降。结论HIFU联合无水乙醇能有效破坏肿瘤血供,灭活肿瘤,延长患者的生存期和提高生存质量,是肝癌非手术治疗的一种有效方法。     

高强度聚焦超声治疗原发性肝癌术后10年门诊随访现状

目的分析高强度聚焦超声(HIFU)治疗原发性肝癌术后10年的随访现状,探讨HIFU无创治疗技术的术后随访新医学模式。方法对1999~2009年HIFU治疗的原发性肝癌患者进行术后定期随访,通过术后临床症状、实验室检查、影像学检查观察HIFU治疗的效果。结果治疗后2周经磁共振复查提示病灶已凝固坏死,肝癌标志物甲胎蛋白(AFP)下降率为83.12%(192/231),1年生存率为78.16%,2年生存率为59.54%,3年生存率为38.95%,随访率84.30%,失访率15.70%。结论持续开展术后定期门诊随访,对于观察HIFU的治疗效果具有非常重要的意义,可以及时、定期了解肝癌病情的发展变化,从而有效地延长患者生存期限。     

高强度聚焦超声治疗靠近心脏肝癌后心肌酶谱和肌钙蛋白Ⅰ的变化

目的 探讨高强度聚焦超声(HIFU)治疗靠近心脏肝癌对心脏的影响.方法 分别于HIFU治疗前和HIFU治疗后1、3、7 d检测34例靠近心脏肝癌患者外周血谷草转氨酶(AST)、肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)、α-羟丁酸脱氢酶(α-HBDH)、乳酸脱氢酶(LDH)、肌红蛋白(Myo)和肌钙蛋白I(cTnI),同时监测心电图.结果 AST、CK、CK-MB、α-HBDH、LDH、Myo HIFU后1 d明显升高,差异有统计学意义(P<0.05);HIFU后3 d、7 d明显下降,与HIFU前比较,差异均无统计学意义(P>0.05).HIFU前后cTnI和心电图均正常.结论 HIFU治疗靠近心脏肝癌对心肌无明显损伤.cTnI是评价HIFU对心肌损伤的重要特异性指标.     

射频消融联合无水酒精局部注射对原发性肝癌的生命质量及预后的影响

目的分析射频消融联合无水酒精局部注射对原发性肝癌的生命质量及预后的影响。方法纳入该院2011年1月-2014年12月射频消融联合无水酒精局部注射治疗的204例原发性肝癌患者进行分析,采用随机数字表法分为对照组104例,治疗组100例,对照组给予超声引导下经皮无水酒精注射治疗,治疗组给予射频消融联合无水酒精局部注射治疗,治疗观察周期为3个月。观察两组治疗前后的肝功能、甲胎蛋白(AFP)的变化;使用欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)评价患者生命质量的改变;观察复发率及生存期,采用Logistic回归分析预后的危险因素。结果治疗前,对照组与治疗组患者丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素、清蛋白、AFP水平比较,差异均无统计学意义(P0.05);治疗后,治疗组患者ALT、AST、总胆红素和AFP水平较对照组降低,差异均有统计学意义(P0.05)。治疗前,对照组与治疗组患者EORTC QLQ-C30总体健康情况、躯体功能、社会功能、恶心和呕吐、疼痛、疲倦、失眠、腹泻和食欲减退评分比较,差异均无统计学意义(P0.05);治疗后,治疗组患者EORTC QLQ-C30总体健康情况、躯体功能、社会功能评分较对照组升高,恶心和呕吐、疼痛、疲倦、失眠、腹泻和食欲减退评分较对照组降低,差异均有统计学意义(P0.05)。随访时间截至2015年6月30日,共随访了190例患者,随访率为93.14%,健在的患者有108例,死亡的患者有82例。多因素Logistic回归分析结果显示,发病位置、治疗前ALT、AFP水平、术中输血、手术方式、肿瘤复发与射频消融联合无水酒精局部注射治疗原发性肝癌后预后相关(P0.05)。结论射频消融联合无水酒精局部注射是一种有效的治疗原发性肝癌的方法,原发性肝癌预后与发病位置、治疗前ALT、AFP水平、术中输血、手术方式和肿瘤复发相关。     

高强度聚焦超声治疗106例肝癌临床疗效的初步研究

目的观察高强度聚焦超声（HIFU）治疗肝癌的临床疗效。方法HIFU治疗肝癌106例,比较患者治疗前后瘤体体积、临床症状、甲胎蛋白、CT检查结果,并追踪生存时间。结果HIFU治疗后,肝脏肿瘤体积缩小（P〈0．01）,CT显示治疗靶区坏死明确,周围邻近脏器未见明显损伤,治疗区CT值降低（P〈0．01）,动脉期、门脉期无强化或强化减弱。临床症状明显改善,甲胎蛋白转阴或明显降低（P〈0．01）。患者的生存期明显延长。结论HIFU是一有效的无创性治疗肝癌的新方法。     

磁共振血氧水平依赖成像观察原发性肝细胞癌高强度聚焦超声治疗前后氧摄取变化特点

目的 通过观察原发性肝细胞癌(HCC)高强度聚焦超声(HIFU)治疗前后氧摄取变化特点,探讨BOLD MRI评估HIFU治疗原发性HCC疗效的潜在价值。方法 16例原发性HCC患者于HIFU治疗前及治疗后2周内接受常规MRI、BOLD MRI及动态增强扫描。BOLD MRI采用梯度回波序列。将BOLD图像数据传输至工作站,采用R2^*软件对图像进行后处理生成R2^*图及T2^*图。在病灶中心、周围正常肝组织以及背部肌肉设置ROI,测量R2^*值、T2^*值及信号强度(SI)。对3个ROI R2^*值、T2^*值及SI在HIFU治疗前后的差异进行比较。结果 与治疗前比较,HCC R2^*值在HIFU治疗后2周内明显升高 ,而T2^*值、SI值在HIFU治疗后2周内明显降低 。周围肝组织及背部肌肉R2^*值、T2^*值及SI值在HIFU治疗前后的无明显变化(P＞0.05)。结论 BOLD MRI在评价原发性肝细胞癌缺氧及HIFU疗效方面有一定潜力。     

超声介入冷循环微波消融治疗肝癌的临床价值研究

目的 观察超声引导下冷循环微波消融治疗肝癌的临床价值.方法 在超声引导下对不能行常规手术治疗的45例肝癌患者进行冷循环微波消融治疗.治疗后定期对所有患者进行超声造影、CT增强和肝脏功能血清学指标(丙氨酸转氨酶和总胆红素)及肝癌血清学指标甲胎蛋白(AFP)变化情况检测,并随访观察1年以上.结果 45例患者肝癌病灶微波消融...     

Follow-up of high-intensity focused ultrasound treatment for patients with hepatocellular carcinoma

Nonsurgical therapies have become treatment options for hepatocellular carcinoma (HCC). This study was to evaluate the efficacy and complications of high-intensity focused ultrasound (HIFU) treatment for patients with HCC. Between May 2001 and May 2005, 145 patients with HCC were enrolled for treatments using a HIFU tumor therapeutic system. Clinical symptoms, hepatic functions and values of serum α-fetoprotein (AFP) were tested before and after HIFU treatment. The changes in computerized tomography (CT) and magnetic resonance imaging (MRI), complications and survival time after HIFU were also obtained for further analysis. Symptoms improved or pain was relieved in 84.8% of the 145 patients and the rate of serum AFP decrease was 71.7%. The size of the target tumor shrank by various degrees. The 2-year survival rate was 80% in patients with stage Ib HCC, 51.4% in stage IIa and 46.5% in stage IIIa. During HIFU treatment, complications included body temperature increase and abnormal cardiac rhythm. After HIFU procedures, there were skin burns of different grades. In conclusion, HIFU is safe and effective for patients with hepatocellular carcinoma; HIFU can improve the survival quality of patients with HCC.