[Efficacy of three-dimensional visualization technology in the precision diagnosis and treatment for primary liver cancer: a retrospective multicenter study of 1 665 cases in China].

Objective: To evaluate the efficacy of three-dimensional(3D) visualization technology in the precision diagnosis and treatment for primary liver cancer. Methods: A total of 1 665 patients with primary liver cancer who admitted to seven medical centers in China between January 2009 to January 2019, diagnosed and treated by 3D visualization protocol were analyzed, and their clinical data were retrospectively reviewed. There were 1 255 males(75.4%) and 410 females(24.6%), with age of (52.9±11.9) years (range: 18 to 86 years). The acquisition of high-quality CT images with submillimeter spatial resolution were conducted using a quality control system. By means of homogenization methods, 3D reconstruction and 3D visualization analysis were performed. Postoperative observation: pathology reports, microvascular invasion, perioperative complications and follow-up. SPSS 25.0 statistical software was used for statistical description and analysis of clinical data. Kaplan-Meier curve was used to calculate overall survival and disease-free survival rate. Results: (1)In the sample of 1 265 patients, 3D reconstructed models clearly displayed as follows. tumor size: ≤2 cm in 155 cases (9.31%), >2 cm to 5 cm in 551 cases (33.09%), >5 cm to 10 cm in 636 cases (38.20%), >10 cm in 323 cases (19.40%). (2) Classification of hepatic blood vessels. Hepatic artery: type Ⅰ(normal type) in 1 494 cases(89.73%),variant hepatic artery in 171 cases (10.27%), including type Ⅱ in 35 cases, type Ⅲ in 38 cases, and other types in 98 cases. Hepatic vein: type Ⅰ (normal) in 1 195 cases (71.77%),variant hepatic veins in 470 cases(28.23%), including type Ⅱ in 376 cases and type Ⅲ in 94 cases. Portal vein:normal type in 1 315 cases (78.98%), variant portal veins in 350 cases (21.02%), including type Ⅰ in 189 cases, type Ⅱin 103 cases, type Ⅲ in 50 cases, type Ⅳ in 8 cases. Hepatic artery variation coexisting with portal vein variation in 24 cases (1.44%). Hepatic vein variation coexisting with portal vein variation in 113 cases (6.79%). Three types of vascular variation in 4 cases (0.24%), including coexistence of type Ⅱ hepatic artery variation or type Ⅰ portal vein variation with type Ⅲ hepatic vein variation in 2 cases,coexistence of type Ⅲ hepatic artery variation or type Ⅲ portal vein variation with type Ⅱ hepatic vein variation in 2 cases. (3) Preoperative liver volume calculation:1 499.3 (514.4)ml (range:641.7 to 6 637.0 ml) of total liver volume, including 479.1 (460.1) ml (range:10.5 to 2 086.8 ml) for liver resection and 959.9 (460.4)ml (range:306.1 to 5 638.0 ml) for residual function. (4)Operative methods: anatomical hepatectomy in 1 458 cases (87.57%); non-anatomic hepatectomy in 207 cases (12.43%). (5)the median operation time was 285(165)minutes (range: 40 to720 minutes). (6)The median intraoperative blood loss was 200(250)ml (range:10 to 4 200 ml) and 346 cases (20.78%) had intraoperative transfusion. (7)Pathology reports: hepatocellular carcinoma in 1 371 cases (82.34%), cholangiocarcinoma in 260 cases (15.62%) and mixed hepatocellular carcinoma in 34 cases (2.04%). Microvascular invasion: M0 in 199 cases, M1 in 64 cases, and M2 in 27 cases. (8)Postoperative complications in 207 cases (12.43%), including Clavien-Dindo grade Ⅰ or Ⅱ in 57 cases, grade Ⅲ or Ⅳ in 147 cases and grade Ⅴ in 3 cases.There were 13 cases (0.78%) of liver failure and 3 cases (0.18%) of perioperative death. (9) The follow-up time was 3.0 to 96.0 months, with a median time of 21.0(17.8) years. The overall 3-year survival and disease-free survival rates were 80.0% and 56.5%, respectively. The overall 5-year survival and disease-free survival rates were 59.7% and 30.0%, respectively. Conclusion: 3D visualization technology plays an important role in realizing accurate diagnosis of anatomical location and morphology of primary liver cancer, improving the success rate of surgery and reducing the incidence of complications.

[Level and trend of cardiovascular disease mortality in China from 2002 to 2016].

Objective: To investigate the level and trend of cardiovascular disease mortality in China from 2002 to 2016. Methods: Using data of China Health Statistics Yearbook (2003-2012) and China's Health and Family Planning Statistical Yearbook (2013-2017),we calculated the age-standardized mortality rates (ASMR) in China. Joinpoint regression model was employed to estimate the annual percent change (APC) and average annual percent change (AAPC) of cardiovascular disease ASMR. Results: (1)The ASMR of cardiovascular disease were 225.65/100 thousands, 242.74/100 thousands, 214.63/100 thousands, 240.97/100 thousands, 195.24/100 thousands, 201.50/100 thousands, 208.83/100 thousands, 248.44/100 thousands, 261.38/100 thousands, 231.98/100 thousands, 210.25/100 thousands, 237.80/100 thousands, 235.21/100 thousands, 237.58/100 thousands,and 237.25/100 thousands from 2002 to 2016, and there was no significant difference in ASMR of cardiovascular disease (AAPC=0.2%, P>0.05) . The ASMR of chronic rheumatic heart disease decreased significantly (AAPC=-4.5%,P<0.05). There were no significant differences in ASMR of cerebrovascular disease, hypertensive heart disease, and ischemic heart disease (AAPC=0, P>0.05; AAPC=2.0%, P>0.05; AAPC=4.3%, P>0.05, respectively). (2) There were no significant differences in ASMR of cardiovascular disease from 2002 to 2016 in city and country (AAPC=-0.7%, P>0.05; AAPC=0.8%, P>0.05, respectively). The ASMR of chronic rheumatic heart disease decreased significantly in city and rural area (AAPC=-4.4%, P<0.05; AAPC=-4.6%, P<0.05, respectively). (3) There were no significant differences in ASMR of cardiovascular disease from 2002 to 2016 in male and female (AAPC=-0.3%,P>0.05; AAPC=-0.2%,P>0.05,respectively). The ASMR of chronic rheumatic heart disease decreased significantly in female (AAPC=-4.2%, P<0.05). The ASMR of ischemic heart disease increased significantly in male and female (AAPC=4.7%,P<0.05; AAPC=5.2%,P<0.05,respectively). (4) The ASMR of cardiovascular disease showed a significant upward trend in residents aged 15 to 34 from 2002 to 2016 (AAPC=3.1, P<0.05). There were no significant differences in ASMR of cardiovascular disease in residents aged 35 to 64 and ≥65 (AAPC=-0.1%, P>0.05; AAPC=-0.2%, P>0.05, respectively). Conclusion: The ASMR of cardiovascular disease in China remains stable during 2002 to 2016, and the ASMR of cardiovascular disease shows upward trend among young people.

Cerebral and renal abscess and retino-choroiditis secondary to Candida albicans in preterm infants: eight case retrospective study.

OBJECTIVES: To assess the tissues and organs commonly involved and the clinical features in the invasive fungal infection (IFI) of Candida albicans in the preterm infants. MATERIALS AND METHODS: Eight preterm infants who developed IFI with positive blood culture for Candida albicans were retrospectively studied. All infants received selected clinical and laboratory parameters evaluation, such as blood culture, cerebral magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) biochemical test, routine urine test, urine culture, renal ultrasonography, renal computer tomography (CT), and fundus examination. The re-examinations were performed after one to two months follow-up. RESULTS: Cerebral abscesses were detected in six infants. Five cases developed renal systemic fungal infection, among which one had renal abscess. Three cases were complicated with fungal retino-choroiditis. CONCLUSIONS: Preterm infants, especially very-low-birthweight (VLBW) and extremely-low-birth-weight (ELBW) infants are susceptible to fungi. The majority of preterm late-onset fungal infections are due to Candida albicans. The organs commonly involved in the IFI of Candida albicans are central nervous system (CNS), kidney and fundus, among which renal systemic fungal infection are prone to recur, calling for a prolonged anti-fungi treatment course.

Elevated muscle enzymes and muscle biopsy in idiopathic hypoparathyroidism patients.

OBJECTIVE: To study idiopathic hypoparathyroidism (IHP) myopathy and its pathogenesis by histology method. METHODS: We retrospectively analyzed the clinical data of nine IHP patients during the years 2006-2010. RESULTS: We found that: 1) there was an inverse relationship between the decreased serum calcium level and the elevated muscle enzymes level; 2) the IHP patients had mild-to-moderate muscle cells vacuolar degeneration and focal hyaline degeneration by hematoxylin-eosin (HE) staining; 3) except for 2 patients, the others' muscles striations were undetectable by phosphotungstic acid hematoxylin staining; 4) 2 patients with extremely high level of creatine kinase and relatively longer disease duration had muscle atrophy, multiple focal muscle fiber hyaline degeneration and sarcolemma cells hyperplasia by HE staining; 5) all patients had different degree of immune complex deposition along the muscle cell membranes by immunofluorescence staining. CONCLUSION: The patients with IHP had some histological changes in skeletal muscles but with no specificity. The changes in muscles and the elevated serum muscle enzymes were related to hypocalcemia. The severity of changes in muscles was related to the duration of hypocalcemia and not only to its degree.

Prognostic value of PUMA expression in patients with HBV-related hepatocellular carcinoma.

OBJECTIVE: The p53 upregulated modulator of apoptosis (PUMA) is a potent apoptosis inducer that is downexpressed in various tumor types. The aim of this study was to explore the prognostic significance of PUMA expression in patients with hepatitis B virus-related hepatocellular carcinoma (HCC). MATERIALS AND METHODS: PUMA expressions were examined in 80 pairs of tissues to compare its expression between cancer tissues and paired noncancerous liver tissues using immunohistochemistry (IHC). Relationship between the PUMA expression level and clinicopathological characteristics and clinic outcomes was analyzed. RESULTS: PUMA protein was all positive in paired non-tumor tissue samples. PUMA were downregulated in 61.25% (49/80) of tumor tissues compared with non-tumor tissues. PUMA levels in cancer tissues were significantly lower than non-tumor in patients with recurrence-related factors and patients at higher stage (stage II, III) (p < 0.05). In addition, the expressions level in tumor tissues showed a significant correlation with advanced TNM stage (p = 0.013) and present of recurrence-related factors (p = 0.002). Furthermore, Kaplan-Meier survival analysis revealed that weak PUMA expression was associated with poor 3-year disease-free survival (DFS) and overall survival (OS) in HCC patients. Finally, multivariate analyses identified that PUMA was an independent poor-prognostic predictor for DFS and OS in patients with HBV-related HCC. CONCLUSIONS: Our results suggest that PUMA expression is a novel prognostic indicator in HBV-related HCC and may be a potential target for diagnosis and gene therapy.

[Studies on the synthesis and bioactivity of alpha-alkylaminobenzyl-phosphonic acids].

AIM: To search for some substituted benzyl phosphonic acids as leading compounds with inhibiting effect on osteoclast formation. METHODS: Target compounds were prepared from aromatic aldehydes, primary amine and phosphorous acid using tetramethylenesulfone as solvent via Arbuzov type reaction. The effect on inhibiting the formation of osteoclast-like cells (OLC) of related compounds was studied by incubating the extract of rat femur marrow. RESULTS: Ten compounds of alpha-alkylaminobenzyl phosphonic acids have been synthesized and identified by MS or 1HNMR analysis. Three (2, 8 and 9) of them were found to have notable effect on the inhibition of OLC formation (P < 0.01). CONCLUSION: Among the present substituted benzyl phosphonic acids, the increased aromaticity and hydrophobicity (such as compound 9) can remarkably enhance the ability to inhibit OLC formation.

Parathyroid hormone regulates osterix and Runx2 mRNA expression predominantly through protein kinase A signaling in osteoblast-like cells.

Runt-related transcription factor 2 (Runx2) and osterix are osteoblast-specific transcription factors essential for the development of osteoblastic cells and bone formation. PTH given intermittently has anabolic effects on bone; however, the exact role remains to be understood completely. The purpose of this study was both to investigate whether PTH regulates Runx2 as well as osterix expression and to identify the signaling used. Using RT-PCR, we confirmed that PTH (1-34) regulated Runx2 and osterix mRNA expression, in rat osteoblast-like cell line UMR 106, in a dose- and time-dependent manner. PTH in low concentrations stimulated both Runx2 and osterix mRNA expression while that in high concentrations did not. Forskolin, an adenylate cyclase activator, also enhanced Runx2 and osterix transcription, and the stimulatory effects of PTH and forskolin were blocked by the pre-treatment of the cells with H-89, a protein kinase A (PKA) inhibitor. In contrast, the protein kinase C (PKC) activator phorbol 12-myristate 13-acetate (PMA) had no effect on Runx2 transcription, but induced an increase in osterix mRNA level at the concentration of 500 nM at 12 h after treatment. Moreover, pre-treatment of the cells with calphostin C, a PKC-specific inhibitor, reduced the increase in osterix transcripts enhanced by PTH and PMA 12 h after treatment. However, these inhibitory effects were not sustained for longer terms. These observations demonstrate that PTH stimulates Runx2 and osterix expression in vitro, at least in part, at transcriptional level. Induction of Runx2 mRNA is mediated through the activation of cAMP/PKA signal transduction. In the case of osterix, although the increase in mRNA level is predominantly mediated via cAMP/PKA signaling, PKC activation might also be involved in this process.

Historical evolution of hypothermic liver surgery.

The clinical application of hypothermia dates back to the surgical treatment of blue babies (1949) and the early days of open heart surgery (1952), when generalized cooling was employed. The induction of hepatic hypothermia began with whole-body cooling in experimental models in 1953 and clinically in 1961. It was designed to minimize the ischemia-reperfusion injury associated with hepatic inflow occlusion. Body surface cooling and cooling via an extracorporeal circuit, however, were not widely accepted for hepatic surgery because of the adverse effects on the extrahepatic organs. Consequently, with the introduction of improved venovenous bypass techniques, in situ cold hepatic perfusion has been used in selected patients since 1971. In situ hypothermic hemihepatic perfusion, introduced in 1995, prevents an ischemic insult to the contralateral hepatic lobe. Topical cooling using ice slush under total or hemihepatic inflow occlusion was reported in 1993. This technique does not require cumbersome hypothermic perfusion equipment. In attempts to minimize intraoperative bleeding by vascular occlusion, the liver surgeon must consider the benefits and technical demands of hepatic hypothermia.

Heat shock protein 72 production in liver tissue after experimental total hepatic inflow occlusion.

BACKGROUND: The pathogenesis of hepatic ischaemia-reperfusion injury is incompletely understood. This study examined the effects of reperfusion with congested portal blood on ischaemia-reperfusion injury of the liver following Pringle's manoeuvre, as monitored by heat shock protein (HSP) 72 production in rat liver tissue. METHODS: Rats were randomized to three groups. In group 1 hepatic ischaemia with portal congestion was induced by Pringle's manoeuvre for 15 min; in group 2 Pringle's manoeuvre was applied for 15 min with an extracorporeal portasystemic shunt; and in group 3 the superior mesenteric vein was occluded for 15 min. The production of HSP72 in liver tissue was measured by Western blotting at 48 h after each intervention. Conventional parameters for hepatic function were examined at 1, 3 and 48 h after reperfusion. RESULTS: There was marked HSP72 expression in group 1, but not in group 2 or 3, showing that a combination of liver ischaemia and reperfusion of congested portal blood is required to induce strong expression of HSP72 in the tissue. On the other hand, biochemical parameters were raised equally in both groups 1 and 2, reflecting a similar degree of ischaemic hepatocyte injury. CONCLUSION: The additional stress impact of temporary portal occlusion upon ischaemia-reperfusion injury of the liver was clearly detected by in situ hepatic HSP72 production in this study.