Survival of patients with hepatobiliary tract and duodenal cancer sites in Germany and the United States in the early 21st century

Hepatobiliary tract cancers (HBTCs) are a heterogeneous group of cancers with high mortality. Because most of these cancers, with the exception of hepatocellular carcinoma (HCC), are rare, few data are available concerning the population level survival expectations of patients with HBTC. Here, we describe survival of patients with HBTC in Germany with comparison to survival in the US. Therefore, data were extracted from 12 databases in Germany and the Surveillance, Epidemiology and End Results (SEER13) database in the US. Period analysis and modeled period analysis were used to calculate 5‐year relative survival estimates for patients with HBTC diagnosed from 1997 to 2013. HCC was the most common HBTC in each database, accounting for over 1/3 of HBTC in Germany and about half of cases in the US. Overall age adjusted 5‐year relative survival for HBTC in 2006‐2013 was 19.1% in Germany and 20.6% in the US. Five‐year relative survival increased by 3.8% units in Germany and 4.5% units in the US between 2002–2005 and 2010–2013. Five‐year relative survival for individual types of HBTC ranged from 9.8% in Germany and 2.9% in the US for not otherwise specified biliary tract cancers to 44.4% and 50.1%, respectively, in Germany and the US for duodenal cancers. In conclusion, survival for HBTC remains poor in both Germany and the US, although a small increase in survival in the past decade was observed. Further work to find better treatment options for HBTC is needed to improve survival.     

A naive Bayes algorithm for tissue origin diagnosis (TOD‐Bayes) of synchronous multifocal tumors in the hepatobiliary and pancreatic system

Synchronous multifocal tumors are common in the hepatobiliary and pancreatic system but because of similarities in their histological features, oncologists have difficulty in identifying their precise tissue clonal origin through routine histopathological methods. To address this problem and assist in more precise diagnosis, we developed a computational approach for tissue origin diagnosis based on naive Bayes algorithm (TOD‐Bayes) using ubiquitous RNA‐Seq data. Massive tissue‐specific RNA‐Seq data sets were first obtained from The Cancer Genome Atlas (TCGA) and ～1,000 feature genes were used to train and validate the TOD‐Bayes algorithm. The accuracy of the model was >95% based on tenfold cross validation by the data from TCGA. A total of 18 clinical cancer samples (including six negative controls) with definitive tissue origin were subsequently used for external validation and 17 of the 18 samples were classified correctly in our study (94.4%). Furthermore, we included as cases studies seven tumor samples, taken from two individuals who suffered from synchronous multifocal tumors across tissues, where the efforts to make a definitive primary cancer diagnosis by traditional diagnostic methods had failed. Using our TOD‐Bayes analysis, the two clinical test cases were successfully diagnosed as pancreatic cancer (PC) and cholangiocarcinoma (CC), respectively, in agreement with their clinical outcomes. Based on our findings, we believe that the TOD‐Bayes algorithm is a powerful novel methodology to accurately identify the tissue origin of synchronous multifocal tumors of unknown primary cancers using RNA‐Seq data and an important step toward more precision‐based medicine in cancer diagnosis and treatment.     

Primary sclerosing cholangitis in children

Primary sclerosing cholangitis (PSC), a chronic inflammatory process affecting the extrahepatic and/or medium to large bile ducts, is not rare in children. It has features suggesting an autoimmune pathogenesis, although the mechanism of tissue damage remains unknown. The clinical presentation of childhood primary sclerosing cholangitis is highly variable and frequently without obvious features of cholestasis. Clinical similarity to autoimmune hepatitis is common. Association with chronic colitis is less common than in adults. Cholangiography is essential for the diagnosis and examination of the medium to large intrahepatic ducts is mandatory, as 40% of children lack extrahepatic duct involvement. Histological findings may help to distinguish childhood PSC from autoimmune hepatitis. In children, sclerosing cholangitis may also develop secondary to other disease processes, notably Langerhans histiocytosis, congenital immunodeficiencies and cystic fibrosis. Neonatal sclerosing cholangitis is chronic inflammatory disease of bile ducts which presents initially with neonatal cholestasis; its pathogenesis remains uncertain and may not be the same as for primary sclerosing cholangitis. Effective treatment modalities for childhood PSC remain undetermined. Liver transplantation is required for children who progress to biliary cirrhosis and hepatic decompensation.     

个性化护理联合心理行为干预在肝胆外科围术期中的应用效果

目的分析个性化护理联合心理行为干预在肝胆外科围术期中的应用效果。方法选取2017年12月至2019年12月于我院行肝胆外科手术的88例患者作为研究对象,按照随机数字表法将其分为对照组(44例,常规护理)和观察组(44例,个性化护理联合心理行为干预)。比较两组的护理效果。结果观察组的PQRS各项评分均显著高于对照组(P<0.05)。观察组术后2、12、24 h的VAS评分均显著低于对照组(P<0.05)。护理后,两组的各项心理状态评分均显著改善,且观察组优于对照组(P<0.05)。观察组的术后并发症总发生率显著低于对照组(P<0.05)。结论个性化护理联合心理行为干预应用于肝胆外科围术期能够显著改善患者的心理状态,提高患者术后恢复质量,值得临床推广应用。     

Risk of malignancies in autoimmune hepatitis type 1 patients with a long‐term follow‐up in Japan

Aim

The risk of malignancies in autoimmune diseases is high and is regarded to be due to immunological abnormalities, the use of immunosuppressive agents, and/or chronic inflammation. The aim of this study was to investigate the incidence and risk of malignancies in patients with autoimmune hepatitis (AIH) type 1 in Japan.

Methods

Two hundred and fifty‐six patients diagnosed with AIH were enrolled. A person‐year calculation was carried out for AIH patients, and the numbers of expected events were clarified using data from “The Monitoring of Cancer Incidence in Japan Project” in order to examine the standard incident rate (SIR) of each type of malignancy. Biochemical data regarding carcinogenesis and its background factors were also examined.

Results

Twenty‐seven patients (10.5%) developed malignancies; 11 (4.3%) with hepatobiliary cancer and 16 (6.3%) with extrahepatic malignancies. The overall SIR for malignancies in AIH was significantly high at 2.04 (95% confidence interval [CI], 1.34–2.96), and was high among female patients at 2.49 (95% CI, 1.60–3.71). The SIR for hepatobiliary cancer was 14.14 (95% CI, 7.05–25.30), and was markedly high for female patients at 21.83 (95% CI, 10.45–40.16). The SIR for oral/pharyngeal cancer was significantly high for female patients at 14.61 (95% CI, 1.64–52.77). The risk factors for hepatobiliary cancer at the diagnosis of AIH were low levels of alanine aminotransferase (P = 0.0226), low platelet counts (P < 0.0001), and cirrhosis (P = 0.0004). The risk factor for extrahepatic malignancy was relapse of AIH (P = 0.0485).

Conclusion

The risk of malignancies was generally high among AIH patients. Those with the risk factors of malignancies should be carefully followed up.     

柴胡在黄疸治疗中的作用探讨

柴胡味苦、辛,性微寒,归肝胆经。通过对黄疸历代文献的梳理,发现柴胡在黄疸治疗中主要取其和解少阳、疏肝去血结、解表开郁之功,黄疸病机亦与肝气郁结、肝胆经气不利、肝胆郁热等有关。故黄疸辨治不应忽视肝胆。     

Endoscopic nasojejunal feeding tube placement in patients with severe hepatopancreatobiliary diseases:a retrospective study of 184 patients

BACKGROUND:Total parenteral nutrition (TPN) has been recognized as the mainstay of nutritional support in patients with severe hepatopancreatobiliary (HPB) diseases for decades.However,recent studies advocate the utilization of endoscopic nasojejunal feeding tube placement (ENFTP),rather than the conventional approach.This study was designed to compare the clinical value of ENFTP and TPN in patients with severe HPB diseases.METHODS:Two groups of patients with severe HPB diseases were analyzed retrospectivel...     

Ultrasound study of liver disease caused by Schistosoma mansoni in rural Zambian schoolchildren

Objective: To evaluate the prevalence of Schistosoma mansoni‐related liver disease in school‐age children who live beside the Zambezi River in the Chitokoloki district, North Western Province, Zambia. Methods: Liver ultrasounds of school students from the Chitokoloki day school, grades 1–12, were performed. Liver patterns, periportal branch wall thickening and portal hypertension were assessed to evaluate the presence of liver fibrosis due to S. mansoni infection. To obtain incidence rates of acute disease, stool specimens were examined from a subgroup for the presence of S. mansoni eggs using the formol detergent sedimentation technique. Results: Of 976 enrolled students, 764 (78.2%) were examined by ultrasound. Of those, 284 (37.2%) had findings indicative of periportal fibrosis on ultrasound. Stool specimen were collected from 414 (54%) students of which six (1.5%) were positive for S. mansoni eggs. Conclusion: School students living along the Zambezi River, Zambia have a relatively high prevalence of S. mansoni‐related liver disease. These findings suggest that all schoolchildren in this area should receive treatment against S. mansoni.     

肝胆手术手术部位感染相关危险因素研究

目的探讨肝胆手术手术部位感染(surgical site infection,SSI)的危险因素,为制定SSI的控制措施提供依据。方法采用目标性监测的方法,研究肝胆手术SSI的发生情况,并对其相关危险因素:术前住院日、有无糖尿病、外周血血浆清蛋白、手术持续时间、手术方式、ASA评分、切口方向、切口长度、术中失血量、术后引流管留置天数及有无术后并发症等24个变量进行单因素和多因素Logistic回归分析。结果肝胆手术SSI发生率为11.74%(35/298),其中住院期问感染24例(68.57%),出院后随访发现感染11例(31.43%)。Logistic回归分析结果显示,术后出现脂肪液化和切口裂开等并发症、手术持续时间及术后引流天数是SSI的独立危险因素。结论肝胆手术SSI的发生是多因素共同作用的结果,必须采取综合性的预防措施才能有效地降低SSI的发生率。