RESUMO
Objective: To investigate the clinical significance of accurate assessment of "volume and quality" of functional liver in Autologous liver transplantation (ALT) in the treatment of the advanced hepatic alveolar echinococcosis (HAE). Methods: The clinical data of 12 patients with advanced HAE who underwent ALT at the First Affiliated Hospital of Xinjiang Medical University from May 2015 to July 2016 were retrospectively analyzed. Results: The preoperative hepatic functions of 12 patients were 8 Child-Pugh Grade A, 1 Grade B, and 3 Grade C. Three of the patients had moderate or severe jaundice. Three of the patients calculated functional liver graft volume (GV) and standard liver volume (SLV) ratio (GV/SLV) were <30%. After the protection of liver function, anti-infection, percutaneous transhepatic cholangiography drainage (PTCD), selective portal vein embolization (PVE), and staging liver resection, liver function Child-Pugh grade of 11 patients was raised to A grade, and the other patient was B grade, meanwhile the bilirubin was reduced to 2 times the normal value. The GV/SLV ratios of 3 patients with low GV/SLV ratio had reached 44.4%, 47.2% and 56.2% respectively. In this study, the GV/SLV ratios of the 12 patients were between 73.2% and 40.8% with an average of 55.6%. Operation time was 11.5-20.5 h, with an average of 12.3 h. Anhepatic phase time was 193-375 min with median 253.5 min. The red blood cell suspension was 0-6 U during the operation. The average hospitalization was 10-42 d, with the average 22.7 d. Total hospital costs were 121 600-434 800 Yuan, with the median cost of 174 400 Yuan. One patient died of septic shock a week after surgery. Conclusion: (1)ALT may provide feasibility for the advanced HAE. (2)Accurate assessment of functional liver "volume and quality" appeared as the key points to the ALT. (3)Precise surgery and individualized treatment could improve and protect the functional liver "volume and quality" .
Assuntos
Transplante de Fígado , Fígado , Bilirrubina , Drenagem , Equinococose , Embolização Terapêutica , Hepatectomia , Humanos , Estudos Retrospectivos , Transplante AutólogoRESUMO
Objective: To investigate the expression of Toll-like receptor 2ï¼TLR2ï¼ and TLR4 mRNA in peripheral blood mononuclear cells ï¼PBMCï¼ and in the liver of patients with hepatic alveolar echinococcosis (HAE), and their correlations with related cytokines in plasma. Methods: Twenty-eight HAE patients hospitalized in the First Affiliated Hospital of Xinjiang Medical University during January 2012 and June 2015 and 28 healthy volunteers as a control were enrolled in this study. Plasma levels of interferon-γ ï¼IFN-γï¼, interleukin-5 ï¼IL-5ï¼, IL-23, and IL-10 were measured by ELISA. qRT-PCR was performed to detect TLR2 and TLR4 mRNA levels in PBMCs and hepatic tissues. The percentage of peripheral blood eosinophil ï¼Eo%ï¼ was determined by a hematology analyzer. The correlations of TLR2 and TLR4 mRNA levels in PBMCs with levels of related cytokines and Eo% were analyzed with the Spearman Correlation method. Results: ELISA results showed that the plasma levels of IFN-γ, IL-5, IL-23, and IL-10 in the HAE group were ï¼301.100±47.290ï¼, ï¼43.420±11.380ï¼, ï¼86.580±31.990ï¼ and ï¼8.766±7.568ï¼ pg/ml respectively, which were higher than those in the controlï¼»ï¼301.100±67.790ï¼, ï¼40.970±6.310ï¼, ï¼46.770±15.490ï¼ and ï¼6.272±10.360ï¼ pg/mlï¼½ with a statistical significance for IL-23 ï¼P<0.01ï¼. Results of qRT-PCR showed that the expression level of TLR2 in the HAE group ï¼0.100±0.084ï¼ was significantly higher than that in the control ï¼0.055±0.040ï¼ ï¼P<0.05ï¼, while the expression level of TLR4 in the HAE group ï¼0.004±0.003ï¼ was comparable to that in the controlï¼0.003±0.002ï¼ï¼P>0.05ï¼. The expression of TLR2 and TLR4 mRNA in HAE lesions in the HAE groupï¼29.680±25.650 and 21.340±16.640, respectivelyï¼ were both significantly higher than that in para-lesion regionsï¼2.308±4.140 and 5.541±9.233ï¼ and that in tissues of the control ï¼1.112±1.431 and 1.100±1.734ï¼ï¼P<0.01ï¼. There was also a significant difference in Eo% between the HAEï¼0.448±0.240ï¼ and the controlï¼0.110±0.100ï¼ groups. Spearman correlation coefficients revealed a positive correlation of TLR2 mRNA in PBMCs with plasma IL-23 level and peripheral blood Eo% in HAE subjectsï¼r=0.368, r=0.382, respectivelyï¼. Conclusion: There are increases in TLR2 and TLR4 mNRA expression in PBMCs and in HAE lesions in HAE patients. The TLR2 mNRA expression in PBMCs positively correlates with plasma IL-23 level and peripheral Eo%.
Assuntos
Equinococose Hepática , Leucócitos Mononucleares , Citocinas , Ensaio de Imunoadsorção Enzimática , Eosinófilos , Humanos , Interferon gama , Interleucina-10 , Interleucina-5 , RNA Mensageiro , Receptor 2 Toll-Like , Receptor 4 Toll-Like , Receptores Toll-LikeRESUMO
Echinococcosis is an important communicable disease that has remarkable impacts on the global health. The disease is highly endemic in western China. In the last decades, achievements were obtained for the surgery and drug therapies for echinococcosis, as well as for studies on genomics, signaling pathways, and liver proliferation and injury of the intermediate hosts. Although steps have entered vaccine development, challenges remainin immunodiagnosis and drug treatment for intermediate hosts, and in vaccine development for definitive hosts. This paper gives an overview on the current achievements and challenges for echinococcosis control.
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Equinococose , China , Humanos , Controle de InfecçõesRESUMO
PURPOSE: Actual 5-year survival rates after resection of colorectal liver metastases (CLM) are 25-45%, whereas 10-year survival rates are extrapolated from survival curves. Few studies have reported long-term survivors with 10 years of actual follow-up. Therefore, no recurrences occurring after 10-plus years have been reported. The aim of our study was to analyze actual 10-year survival rates and prognostic factors. METHODS: Clinical data of patients with CLM who had undergone first liver resection in our center between January 1990 and December 2000 were retrospectively analyzed. RESULTS: Eighty-nine patients of mean age 64 years were studied. Three patients were excluded from the study: one because of postoperative death, and two from being lost to follow-up. All other subjects had a potential 10-year follow-up. Only 33% patients received perioperative chemotherapy. The actual 10-year overall and disease-free survival rate were 22 and 19%, respectively. Poor prognostic factors were disease-free interval less than 1 year, wedge liver resection, clinical risk score>2, segment 1 CLM location, and peritumoral lymphangitis. Good prognostic factors were tumors having mucinous components in primary tumor and CLM located in the right lobe. CONCLUSIONS: With actual long-term follow-up for 10 years, disease-free survival rate is 19% and mainly depends on surgical management. Recurrence continues to occur more than 5 years after liver resection for CLM; cure cannot be assumed at this time. Clinical risk score is a good predictor of cure and should be taken into account when choosing perioperative treatment.