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Objective:To investigate characteristics of the 18F-flurodeoxyglucose ( 18F-FDG) uptake intensity and ranges in distinct hepatic alveolar echinococcosis lesions. Methods:The clinical data of 39 patients with position emission tomography during Jan 2017 to Dec 2019 in the First Affiliated Hospital of Xinjiang Medical University were enrolled. Among them, there were 17 males and 22 females, aging from 15 to 65 years (median 34 years). Lesions were classified into six groups based on heterogenic scales of calcification and liquefaction: A. non-calcified and non-liquefied ( n=7); B. obvious calcified and non-liquefied ( n=7); C. partial calcified and partial liquefied( n=10); D. obvious calcified and partial liquefied ( n=5); E. partial calcified and subtotal liquefied ( n=5); F. obvious calcified and subtotal liquefied ( n=5). Tumor to background ratio (TBR) and width (W) of lesion infiltrative boundary were measured and calculated. Statistical comparison using Mann-Whitney U test as well as correlation analysis was performed. Results:TBR values [ M( Q1, Q3)] for each group were 4.40(3.66, 7.03), 2.55(1.69, 3.60), 3.73(3.37, 5.21), 2.90(2.75, 3.60), 3.80(3.49, 6.36), 2.49(2.21, 3.97), among which A>B, A>D, A>F, C>B, E>B ( U=3.0, 4.0, 4.5, 11.0, 5.0, all P<0.05); From the perspective of the calcification in each group, it was found that the lighter the calcification was, the greater the TBR value was. W values [ M( Q1, Q3)] for each group were [12.5(10.0, 19.5), 11.2(10.5, 12.5), 12.2(10.9, 13.2), 7.8(7.3, 9.3), 10.0(7.3, 13.4), 7.3(6.8, 7.6)] mm, among which A>D, A>F, B>D, B>F, C>D, C>F (all U=0, all P<0.05); According to the degree of calcification and liquefaction of lesions in each group, the lighter the calcification was, the greater the W value was; The heavier the liquefaction was, the smaller the W value was. A mild strength linear correlation has been observed between the TBR value and W value ( r=0.4136, P<0.05). Conclusions:Less calcification and liquefaction implicated higher 18F-FDG uptake intensity and wider range. Radical resection margins and tissue sampling should be individualized based on different lesion features in surgical treatment.
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Human alveolar echinococcosis is a chronic infectious disease caused by Echinococcus multilocularis infection. It predominantly injuries the liver and grows like the malignant tumor. The therapeutic options and prognosis depend on types of human alveolar echinococcosis, clinical stages, biological activity, vascular invasion, pathological characteristics, and patient's immune status. However, despite of multiple classification methods, there are still lacking of comprehensive typing schemes. which leads to inappropriate diagnosis and therapy. This research systematically reviewed the recent studies on human alveolar echinococcosis at home and abroad and analyzed the classifications based on ultrasound, computer tomography, magnetic resonance imaging, positron emission computed tomography, serology and pathology, and some novel technologies and summarized the individual advantage and disadvantage for each classification Relationships and their advantages plus disadvantages have been assessed comprehensively. Meanwhile, the possible reference factors or theoretical basis for optimized future classification are proposed, in order to establish a unified classification system to provide guidance for clinical diagnosis and treatment.
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Objective:To investigate the changes of natural killer (NK) cells, natural killer T (NKT) cells and T lymphocytes in the peripheral blood after nanosecond pulse ablation of hepatic vesicular hydatid in rats with different energy levels.Methods:A total of 32 SD rats were randomly divided into hepatic vesicular hydatid model group, low voltage group (1 000 V), medium voltage group (1 500 V) and high voltage group (2 000 V). The hydatid model of rats was established by selective injection of 100 μl of echinococcosis head suspension with concentration of 500/100 μl into the left hepatic portal vein in all the 4 groups. After 3 months, nanosecond pulse therapy was applied to the left lobe vesicular hydatid lesions in the low voltage group, medium voltage group and high voltage group. On the third day after treatment, flow detector was used to calculate the ratio of CD 4+ T to CD 8+ T in peripheral blood of four groups by CD 3+ T, CD 4+ T, CD 8+ T, NK cells and NKT cells. Results:CD 3+ T was expressed in the high voltage group with (62.08±2.75)%, the medium voltage group with (63.84±7.73)%, the low voltage group with (55.19±8.55)% and the control group with (54.76±8.28)% ( P<0.05). CD 4+ T number was larger in high voltage group (43.7±6.51)% than medium voltage group (38.82±5.47)%, low voltage group (37.31±6.96)% and model group (38.12±3.04)% ( P<0.05). CD 8+ T ratio in the high voltage group was (20.03±2.40)%, the medium voltage group was (21.22±1.74)%, the low voltage group was (19.00±3.06)%, and the model group (20.56±3.98)%, with no statistically significant difference ( P>0.05). NK cells ratio in high voltage group was (6.49±1.60)%, medium voltage group was (3.02±0.32)%, low voltage group was (3.42±0.91)% and model group was (3.44±0.55)% ( P<0.05). NKT cells ratio in high voltage group was (1.53±0.16)%, medium voltage group was (0.82±0.09)%, in low voltage group was (0.70±0.17)% and model group (0.78±0.10)% ( P<0.05). CD 4+ T/CD 8+ T high voltage group was (2.26±0.65), medium voltage group was (1.90±0.40), low voltage group was (1.98±0.37) and model group was (2.06±0.35) ( P<0.05). Conclusion:High voltage (2 000 V) increased number of T, NK and NKT cells in peripheral blood compared with medium voltage (1 500 V) and low voltage (1 000 V), which may be the immune response of the body caused by nanosecond pulse ablation of hepatic vesicular hydatid in rats.
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Objective:To explore the curative effect of laparoscopic surgery for hepatic cysticercosis.Methods:Search the literature from February 2010 to February 2020 on literature platforms such as Wanfang Data, VIP, CNKI, Pubmed, ScienceDirect, Web of Science, etc. the key words were "肝囊型包虫病" , "细粒棘球蚴" , "手术" , "开腹手术" , "腹腔镜" , "微创手术" , " echinococcosis " , " liver or hepatic " , " laparoscopic or minimal invasive " . Data on intraoperative indicators (e.g., operation time, bleeding volume), postoperative complications, hospital stay, recurrence rate, etc. in the literature included in the study were extracted and meta-analyzed.Results:A total of 9 articles were included, including 2 prospective studies and 7 retrospective case-control studies. A total of 1031 patients were enrolled, including 272 in the laparoscopic group and 759 in the laparotomy group. The results of the meta-analysis showed that the total postoperative complication rate in the laparoscopic group was lower than that in the laparotomy group ( OR=1.64, 95% CI: 1.10-2.45, P<0.05). Incision-related complications in the laparoscopy group and laparotomy group the difference was statistically significant ( OR=2.81, 95% CI: 1.03-7.70, P<0.05), and the hospital stay in the laparoscopic group was shorter ( SMD=1.21, 95% CI: 0.47-1.96, P<0.05). There was no significant difference between the two groups in operation time, postoperative bile leakage, residual cavity infection and effusion, and postoperative recurrence rate ( P>0.05). Conclusions:Under the premise of strictly grasping the indication of laparoscopic surgery, the incidence of complications after laparoscopic surgery is low, the hospitalization time is short.
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ObjectiveTo investigate the role of transforming growth factor (TGF-β1) in hepatic fibrosis induced by echinococcus multilocular infection and its possible mechanisms in this process.Methods Forty-five C57BL/6 mice were randomly divided into the model group（30）and the control group (15). Protoscolece suspension of echinococcus multilocular was infused through portal vein in the model group (4000/each). Mice in the control group was injected the same volume of normal saline solution. Six mice in the model group and 3 mice in the control group were sacrificed at 1, 2, 4, 8 and 12 weeks after infection. The liver tissues were observed the histopathological changes by using hematoxylin-eosin (H&E) staining. The fibrosis degree and glycogen synthesis function of liver tissue were observed by Sirius-red staining and Periodic acid schiff (PAS), respectively. The expression levels of TGF-β1 and a-smooth muscle actin (α-SMA) were measured by immunohistochemical staining.ResultsThe obvious abnormal changes were not observed in 1 week after model setup. The diffuse distribution of multiple white spots began to appear at 2 weeks, but the amount of white plaques decreased after 8 weeks. Meanwhile, forming small lesions were not obviously observed the boundary with the surrounding normal liver tissue. Clear echinococcal vesicles were seen at week 12. H&E staining showed that hepatic tissue structure of control group was normal. In the model group, the number of lesions with worms decreased gradually and amount of granulomas were increased. The inflammatory lesions did not change significantly. Sirius-red staining demonstrated that collagen deposition in the control group was mainly around the bile duct and blood vessels. However, the deposition in the model group was mainly around the lesion and the degree of fibrosis became more serious with time. PAS staining displayed that the content of glycogen in the liver tissues of the control group was rich, evenly distributed and stained uniformly. However, the glycogen staining positive area decreased with the time of infection and the staining became lighter in the model group. Immunohistochemical staining indicated that the positive expression of α-SMA and TGF- β1 in the control group were mainly found in the bile ducts and perivascular areas. The positive areas in the model group were mostly granulomatous areas around the metacercariae and fibroblasts. Expression of α-SMA and TGF- β1 increased over time after infection with the expression peak at 12 weeks(16.80±2.09、4.10±2.14).ConclusionThe degree of fibrosis in liver tissues at different time points was consistent with the expression trend of TGF- β1 and α-SMA. TGF-β1 may promote collagen deposition and lead to fibrosis by activating hepatic stellate cells.
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Objective:To explore the application of different reconstruction methods of retrohepatic inferior vena cava (RHIVC) in the ex-vivo liver resection and auto-transplantation(ELRA)for hepatic alveolar echinococcosis (AE).Methods:The 88 patients with end-stage hepatic AE treated by ELRA from August 2010 to December 2018 were divided into 3 groups according to the different methods of RHIVC reconstruction, respectively , group A, autologous vascular repair and reconstruction group (n=50); group B, RHIVC replacement group (n=31); group C, RHIVC resection without reconstruction group (n=7), and the clinical data were analyzed and followed up.Results:The average operation time of group A, B and C was 16.32±3.20 h, 15.99±3.32 h, 16.86±4.18 h ( P>0.05), The average anhepatic phase was398.48±104.12 min, 389.41±135.25 min, 337.43±108.65 min( P>0.05), The differences were not statistically significant. The average hospital stays after surgery in the three groups were 30.64±18.54 d, 25.94±16.37 d, 51.29±29.43 d ( P<0.05), There were significant statistical differences, and the results showed that the group B was significantly less than other two groups. The incidence of IVC related complications in group A and B was 20.0% and 9.7%. Among all the subjects, RHIVC stenosis was found in 9 patients and thrombus was formed in 4 patients in postoperative. Conclusions:RHIVC reconstruction methods can be selected appropriately according to the defect degree of lumen after resection.
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Objective:To investigate the risk factors related to choledocholithiasis in gallstone patients.Methods:The clinical data of 140 patients with gallstones or gallstones complicated with choledocholithiasis treated at our hospital from Jan 2017 to Dec 2019 were analyzed retrospectively.Results:The results showed gallstones≥ 10 mm (χ 2=7.896, P=0.019), parapapillary diverticulum (χ 2=10.849, P=0.013), the number of gallstones (single vs. multiple) (χ 2=9.760, P=0.080), age ( t=2.767, P=0.006), diameter of common bile duct ( t=8.068, P=0.000), total bilirubin level ( t=2.372, P=0.019), alkaline phosphatase ( t=2.448, P=0.016), significantly related to the formation of common bile duct stones. Logistic regression analysis showed that gallstone ≥ 10 mm, common bile duct dilatation, parapapillary diverticulum and multiple gallstones were all independent risk factors for choledocholithiasis in gallstone patients. Conclusion:A variety of risk factors were responsible for the formation of choledocholithiasis in gallstone patients.
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Objective:To analyze the treatment and the impact of brain metastases on patients with hepatic alveolar hydatid disease.Methods:The data of 11 patients with hepatic alveolar hydatidosis with brain metastases treated at the First Affiliated Hospital of Xinjiang Medical University from January 2014 to December 2019 were retrospectively analyzed. There were 7 males and 4 females. The age range was 19~49 years, with an average of 34 years. Of 11 patients, 7 were treated with surgery combined with drugs and 4 with drugs only. Analyze the treatment and results of patients.Results:Of the 7 patients who were treated with surgery and drugs, 2 patients underwent hepatectomy. They were treated with regular postoperative oral medication and were well on follow-up. Three patients underwent only brain surgery. On follow-up from 1 to 3 years, one patient developed pneumonia with atelectasis, another patient developed ascites and jaundice with physical decline. The third patient was stable and had an independent life. Two patients underwent partial hepatectomy and hydatidectomy, with one patient requiring repeated hydatidectomies. On follow-up for one of these 2 patients for 5 years, the patient was home bound and could not take care of himself. The other patient was followed up for 3 years and was stable, alive and able of self-care. Four patients were treated with albendazole liposome, including one patient who developed ascites, a second one with weight loss, physical decline, limb edema and a third one with pleural effusion, pelvic effusion and pneumonia. These patients were still alive with improvement of symptoms on supportive treatment.Conclusion:The treatment of hepatic alveolar hydatidosis with brain metastases is still mainly surgery and anti-hydatid drugs. The prognosis of most patients was poor. The surgical principle is neurosurgery first, followed by surgery on liver, lung, spleen and other organs involved by hydatid disease.
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Objective:To study the impact of selective occlusion of hepatic arterial blood flow in external capsule excision for hepatic cystic echinococcosis.Methods:A retrospective analysis was conducted on the data of 80 patients with hepatic cystic echinococcosis who underwent surgical treatment from January 2017 to January 2019 in the First Affiliated Hospital of Xinjiang Medical University. There were 36 males and 44 females, with an average age of 47 years. All patients underwent external capsule excision of hepatic cystic echinococcosis. According to the type of intraoperative blood flow occlusion, the patients were divided into: group A ( n=42), selective occlusion of hepatic artery; group B ( n=38), Pringle’s maneuvre. The hospitalization stay, intraoperative blood loss, postoperative ventilation time and complications were compared between the two groups. The postoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, and total bilirubin were compared between the two groups. Results:The intraoperative blood loss (215.7±29.6) ml, postoperative ventilation time (2.3±0.1)d, and hospital stay (11.6±1.0) d in group A were better than those in group B (254.8±20.6) ml, (3.2±0.2) d, (12.7±0.7) d, the differences were significant (all P<0.05). There were 4 patients (9.5%) who developed postoperative complications in group A and 5 patients (13.2%) in group B. There was no significant difference between the two groups ( P>0.05). Group A had better ALT, AST, albumin, and total bilirubin on day 3 after operation, and the differences were significant (all P<0.05). The ALT (62.8±5.2) U/L, AST (32.7±2.6) U/L, albumin (39.1±0.3) g/L, total bilirubin (12.1±0.5) μmol/L in Group A were better than group B (121.9±5.6) U/L, (53.9±8.0) U/L, (32.2±0.6) g/L, (19.3±0.9) μmol/L on day 5 after operation, the differences were significant (all P<0.05). Conclusion:Selective occlusion of the hepatic artery in external capsule excision for hepatic cystic echinococcosis was superior to the traditional Pringle’s maneuver in controlling intraoperative bleeding and postoperative liver function recovery.
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Objective@#To investigate the feasibility and safety of the concept of enhanced recovery after surgery (ERAS) in the perioperative application of ambulatory laparoscopic cholecystectomy (ALC).@*Methods@#A retrospective analysis was made on 168 patients (ALC group) undergoing ALC in the daytime ward from Aug 2017 to Aug 2018 in our hospital vs conventional laparoscopic cholecystectomy CLC in the general ward in 165 patients (CLC group) . Clinical data, operation time, intraoperative blood loss, conversion to laparotomy, postoperative complication, readmission, pain score after 6h, patient satisfaction, first postoperative anal exhaust, average length of hospital stay, and hospitalization expenses were compared between the two groups.@*Results@#In the ALC group, the pain score, the first anal exhaust time, the average length of hospital stay, and the hospitalization cost were significantly lower than those in the CLC group. Compared with the CLC group, the satisfaction of patients in the ALC group was significantly improved. There was no significant difference in the incidence of postoperative complications (biliary leakage, postoperative bleeding, bile duct injury, infection of the incision) and readmission rate.@*Conclusion@#Use of enhanced recovery after surgery in laparoscopic cholecystectomy in day surgery is safe and feasible. It has many advantages such as reducing hospitalization costs and postoperative pain and accelerating postoperative recovery.
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Objective@#To study the clinical outcomes using laparoscopic complete dissection of cysts, subtotal cystectomy and partial hepatectomy in the treatment of hepatic cystic echinococcosis.@*Methods@#A retrospective study was conducted on 40 patients with hepatic cystic echinococcosis treated by laparoscopic surgery from January 2014 to June 2018 at the First Affiliated Hospital of Xinjiang Medical University. According to the different surgical methods, these patients were divided into three groups: group A (n=14): the laparoscopic complete capsulectomy group, group B (n=14): the laparoscopic subtotal capsulectomy group, group C (n=12): the laparoscopic partial hepatectomy group. The operation time, intraoperative blood loss, time to pass first flatus, duration of drainage tube placement, days of hospitalization after operation, hospitalization expenses, complications of the residual cavity and local recurrence were compared among the 3 groups.@*Results@#In this study, all the 40 patients with hepatic cystic hydatidosis were cured, and no death occurred during the perioperative period. The intraoperative blood loss, postoperative duration of drainage tube placement, and hospitalization cost of the three groups were significantly the highest in group C (all P<0.05). The operative time and the time to pass first flatus in group C were both significantly greater than group B (P<0.05). The length of postoperative hospitalization in group A was significantly less than in group C (P<0.05). Postoperative recurrence and complications in group B were significantly worse than those in group A and group C (all P<0.05).@*Conclusion@#Laparoscopic complete dissection of the external capsule turned out to be the best laparoscopic treatment of hepatic cystic echinococcosis, followed by laparoscopic partial hepatectomy. Open surgery should be considered in patients with lesions which are evaluated preoperatively to have difficulty in carrying out laparoscopic complete dissection of capsule or partial hepatectomy.
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Objective@#To analyze the changes of local immune cells in liver of mice caused by nanosecond pulse therapy for hepatocellular carcinoma.@*Methods@#Forty C57BL-6J of mice were randomly divided into four groups: negative control group (n=10), tumor group (n=10), surgical resection group (n=10) and nanosecond pulse group (n=10). Hepa 1-6 cells were injected into the left hepatic lobe of mice in tumor group, resection group and nanosecond pulse group to construct the orthotopic xenograft tumor model. Left hepatic lobectomy was performed in the surgical excision group and nanosecond pulse was performed in the nanosecond pulse group 7 days after the construction. All mice were sacrificed 7 days after the treatment. CD3＋ was detected by flow cytometry in the left hepatic lobe lesion, the nanosecond pulse group and the normal liver tissue of the right hepatic lobe in the liver and tumor groups of the blank control group. T, CD4＋T, CD8＋T, regulatory T cells (Treg), myeloid-derived suppressor cells (MDSC), natural killer cells (NK), B cells, and the ratio of CD4＋T to CD8＋T.@*Results@#In the blank control group, the tumor group the number of lesion in the mice and the pulse area of the nanosecond pulse group CD4＋T cells in blank control group (normal liver)>nanosecond pulse group>tumor group [(25.77±3.76)% vs. (15.72±2.70)% vs. (12.68±3.13)%, P<0.05]; CD8＋T cell tumor group>blank control group>nanosecond pulse group [(14.01±2.75)% vs. (13.99±1.41)% vs. (8.42±2.21)%, P<0.05]. The ratio of CD4＋T to CD8＋T in nanosecond pulse group > blank control group > tumor group [(1.90±0.17) vs. (1.86±0.32) vs. (0.93±0.21), P<0.05]; B cell nanosecond pulse group> blank control group > tumor group [(47.65±3.77)% vs. (33.74±3.91)% vs. (15.94±6.10)%, P<0.05]; MDSC cell tumor group > nanosecond pulse group > blank control group [(18.49±2.74)% vs. (8.41±3.05)% vs. (2.15±0.69)%, P<0.05]. However, CD3＋T cells, NK cells and Treg cells showed no statistical significance among the three groups (all P>0.05). Normal liver tissue in right lobe of liver in 4 groups the ratio of CD4＋T to CD8＋T in blank control group >nanosecond pulse group >surgical resection group >tumor group [(1.86±0.32) vs. (1.85±0.43) vs. (1.52±0.16) vs. (1.36±0.29), P<0.05]; B cell nanosecond pulse group >surgical resection group >blank control group> Tumor group [(46.85±8.30)% vs. (34.23±6.17)% vs. (33.74±3.91)% vs. (27.64±2.20)%, P<0.05]; Treg cell tumor group >resection group>nanosecond pulse group>blank control group [(26.34±6.23)% vs. (7.01±2.04)% vs. (3.63±1.59)% vs. (3.19±1.50)% , P<0.05]; MDSC in tumor group >resection group>nanosecond pulse group>blank control group [(12.22±2.02)% vs. (5.00±0.73)% vs. (2.87±0.96)% vs. (2.15±0.69)%, P<0.05]. However, there were no statistically significant differences in CD3＋T, CD4＋T, CD8＋T and NK cells among the four groups (all P>0.05).@*Conclusion@#Nanosecond pulse ablation of primary hepatocellular carcinoma of mice can induce immune response in ablation area and other hepatic lobes, which may be due to the anti-tumor immunity induced by nanosecond pulse.
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Objective@#To invastigate how to differentiate the single cystic hepatic hydatidosis from single hepatic cysts.@*Methods@#From Apr 2014 to Aug 2018 at the First Affiliated Hospital of Xinjiang Medical University, 30 cases of liver single cystic diseases were misdiagnosed·Relevant clinical data were compared including medical history, imaging features, immunological examination etc.@*Results@#18 cases of echinococcosis were misdiagnosed as hepatic cysts before operation, and 12 patients with hepatic cysts were misdiagnosed as hepatic cystic echinococcosis before operation.There were no significant differences between the two groups in eosinophil count (Eo#)(t=1.35, P>0.05), albumin (t=0.38, P>0.05), aspartate aminotransferase (t=0.99, P>0.05), and CT values(t=0.85, P>0.05). The results suggest that anti-EgCF antibody(χ2=4.26, P<0.05) and EgB antibody (χ2=7.26, P<0.05) are of significantly differential value in the identification of the two diseases.@*Conclusion@#Levels of anti-EgB and anti-EgCF antibodies to hepatic cystic echinococcosis are higher than that to single hepatic cysts.
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Objective To analyze the changes of local immune cells in liver of mice caused by nanosecond pulse therapy for hepatocellular carcinoma. Methods Forty C57BL-6J of mice were randomly divided into four groups:negative control group ( n=10 ) , tumor group ( n=10 ) , surgical resection group (n=10) and nanosecond pulse group (n=10). Hepa 1-6 cells were injected into the left hepatic lobe of mice in tumor group, resection group and nanosecond pulse group to construct the orthotopic xenograft tumor model. Left hepatic lobectomy was performed in the surgical excision group and nanosecond pulse was performed in the nanosecond pulse group 7 days after the construction. All mice were sacrificed 7 days after the treatment. CD3+ was detected by flow cytometry in the left hepatic lobe lesion, the nanosecond pulse group and the normal liver tissue of the right hepatic lobe in the liver and tumor groups of the blank control group. T, CD4+T, CD8+T, regulatory T cells (Treg), myeloid-derived suppressor cells (MDSC), natural killer cells (NK), B cells, and the ratio of CD4+T to CD8+T. Results In the blank control group, the tumor group the number of lesion in the mice and the pulse area of the nanosecond pulse group CD4+T cells in blank control group (normal liver) >nanosecond pulse group >tumor group [(25. 77 ± 3. 76)％ vs. (15. 72 ± 2. 70)％ vs. (12. 68 ± 3. 13)％, P<0. 05]; CD8+T cell tumor group>blank control group>nanosecond pulse group [(14. 01 ± 2. 75)％ vs. (13. 99 ± 1. 41)％ vs. (8. 42 ± 2. 21)％, P<0. 05]. The ratio of CD4+T to CD8+T in nanosecond pulse group > blank control group > tumor group [ ( 1. 90 ± 0. 17) vs. (1. 86 ± 0. 32) vs. (0. 93 ± 0. 21), P<0. 05];B cell nanosecond pulse group> blank control group > tumor group [(47. 65 ± 3. 77)％ vs. (33. 74 ± 3. 91)％ vs. (15. 94 ± 6. 10)％, P<0. 05];MDSC cell tumor group > nanosecond pulse group > blank control group [(18. 49 ± 2. 74)％ vs. (8. 41 ± 3. 05)％ vs. (2. 15 ± 0. 69)％, P<0. 05]. However, CD3+T cells, NK cells and Treg cells showed no statistical significance among the three groups (all P>0. 05). Normal liver tissue in right lobe of liver in 4 groups the ratio of CD4+T to CD8+T in blank control group >nanosecond pulse group >surgical resection group >tumor group [(1. 86 ± 0. 32) vs. (1. 85 ± 0. 43) vs. (1. 52 ± 0. 16) vs. (1. 36 ± 0. 29), P<0. 05]; B cell nanosecond pulse group >surgical resection group >blank control group > Tumor group [(46. 85 ± 8. 30)％ vs. (34. 23 ± 6. 17)％ vs. (33. 74 ± 3. 91)％ vs. (27. 64 ± 2. 20)％, P<0. 05];Treg cell tumor group >resection group>nanosecond pulse group>blank control group [(26. 34 ± 6. 23)％vs. (7. 01 ± 2. 04)％ vs. (3. 63 ± 1. 59)％ vs. (3. 19 ± 1. 50)％ , P<0. 05]; MDSC in tumor group>resection group > nanosecond pulse group > blank control group [ ( 12. 22 ± 2. 02 )％ vs. ( 5. 00 ± 0. 73)％ vs. (2. 87 ± 0. 96)％ vs. (2. 15 ± 0. 69)％,P <0. 05]. However, there were no statistically significant differences in CD3+T, CD4+T, CD8+T and NK cells among the four groups ( all P >0. 05 ) . Conclusion Nanosecond pulse ablation of primary hepatocellular carcinoma of mice can induce immune response in ablation area and other hepatic lobes, which may be due to the anti-tumor immunity induced by nanosecond pulse.
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Objective To study the clinical outcomes using laparoscopic complete dissection of cysts,subtotal cystectomy and partial hepatectomy in the treatment of hepatic cystic echinococcosis.Methods A retrospective study was conducted on 40 patients with hepatic cystic echinococcosis treated by laparoscopic surgery from January 2014 to June 2018 at the First Affiliated Hospital of Xinjiang Medical University.According to the different surgical methods,these patients were divided into three groups:group A (n =14):the laparoscopic complete capsulectomy group,group B (n =14):the laparoscopic subtotal capsulectomy group,group C (n =12):the laparoscopic partial hepatectomy group.The operation time,intraoperative blood loss,time to pass first flatus,duration of drainage tube placement,days of hospitalization after operation,hospitalization expenses,complications of the residual cavity and local recurrence were compared among the 3 groups.Results In this study,all the 40 patients with hepatic cystic hydatidosis were cured,and no death occurred during the perioperative period.The intraoperative blood loss,postoperative duration of drainage tube placement,and hospitalization cost of the three groups were significantly the highest in group C (all P ＜ 0.05).The operative time and the time to pass first flatus in group C were both significantly greater than group B (P ＜ 0.05).The length of postoperative hospitalization in group A was significantly less than in group C (P ＜ 0.05).Postoperative recurrence and complications in group B were significantly worse than those in group A and group C (all P ＜ 0.05).Conclusion Laparoscopic complete dissection of the external capsule turned out to be the best laparoscopic treatment of hepatic cystic echinococcosis,followed by laparoscopic partial hepatectomy.Open surgery should be considered in patients with lesions which are evaluated preoperatively to have difficulty in carrying out laparoscopic complete dissection of capsule or partial hepatectomy.
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Objective To investigate the feasibility and safety of the concept of enhanced recovery after surgery (ERAS) in the perioperative application of ambulatory laparoscopic cholecystectomy (ALC).Methods A retrospective analysis was made on 168 patients (ALC group) undergoing ALC in the daytime ward from Aug 2017 to Aug 2018 in our hospital vs conventional laparoscopic cholecystectomy CLC in the general ward in 165 patients (CLC group).Clinical data,operation time,intraoperative blood loss,conversion to laparotomy,postoperative complication,readmission,pain score after 6h,patient satisfaction,first postoperative anal exhaust,average length of hospital stay,and hospitalization expenses were compared between the two groups.Results In the ALC group,the pain score,the first anal exhaust time,the average length of hospital stay,and the hospitalization cost were significandy lower than those in the CLC group.Compared with the CLC group,the satisfaction of patients in the ALC group was significantly improved.There was no significant difference in the incidence of postoperative complications (biliary leakage,postoperative bleeding,bile duct injury,infection of the incision) and readmission rate.Conclusion Use of enhanced recovery after surgery in laparoscopic cholecystectomy in day surgery is safe and feasible.It has many advantages such as reducing hospitalization costs and postoperative pain and accelerating postoperative recovery.
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Objective To evaluate the application value of preoperative computed tomography (CT) and three-dimensional reconstruction (3DR) of major vessels regarding lesion infiltration severity,vascular morphology & function and predict vascular surgeries during ex vivo liver resection and autotransplantation (ELRA) for end-stage hepatic alveolar echinocoecosis (AE).Methods Preoperative radiological & angiographical,intraoperative photographic and pathological materials were retrospectively collected in 40 consecutive patients undergoing ELRA for end-stage hepatic alveolar echinococcosis from January 2017 to January 2019.Severity of lesion infiltration,morphological & functional status as well as predictive value for surgical planning of hepatic venous system (HVs),inferior vena cava (IVC),portal venous system (PVs) and hepatic arterial supply system (HAs) were estimated,then compared with those built golden standards:angiography,intraoperative diagnosis and pathological examinationss.Results Evaluation accuracy of CT and 3DR for lesion infiltration severity,vascular morphology & function and predicting vascular surgeries respectively were 68.1％,71.9％,78.9％ and 57.5％,89.2％,71.1％ and all paired data had statistical significance (all P＜0.05).Furthermore,CT had a higher certainty of predicting the use of vascular prosthesis during surgery than 3DR (77.5％ and 70.0％,P＜0.05).Conclusions Pre-ELRA CT is recommended for evaluating lesion infiltration severity and predicting corresponding vascular surgery.However,3DR has more certainty in evaluating vascular morphology & function.Furthermore,CT is more reliable than 3DR in predicting vascular prosthesis during ELRA.However,optional better solutions should be studied for higher assurance.
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Hepatic alveolar echinococcosis(HAE)is a parasitic disease characterized by invasive growth. Major treatment methods include pharmacotherapy and surgical treatment,and surgical treatment mainly includes radical hepatectomy and palliative surgery. Radical hepatec-tomy is the first choice,and palliative surgery is mainly used to alleviate disease conditions and complications. Pharmacotherapy also plays an important role in the delay and control of HAE. In recent years,autologous liver transplantation has been used in the treatment of HAE and has become an effective therapy for end-stage HAE patients who cannot be cured by routine surgery. This article introduces the indica-tions and advantages/disadvantages of radical hepatectomy and palliative surgery,as well as the experience in the application of multidisci-plinary treatment,the concept of fast-track surgery,and autologous liver transplantation in the treatment of HAE patients,in order to pro-vide a reference for the treatment of HAE.
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Liver cancer still threatens human health nowadays, so it is urgent to explore new minimally invasive methods for the treatment of liver cancer. This article reviews the general status of liver cancer in China and describes local ablation and immunotherapy for liver cancer. This article also introduces the basic principle of nanosecond pulse in the treatment of liver cancer and the mechanism of action of heat shock protein 70 (HSP70) in antitumor immunity and points out that as an exogenous electrical stimulation, nanosecond pulse can increase the expression of HSP70 in the body to strengthen the body′s anti-tumor immunity. This article perfects the immunological mechanism of nanosecond pulse in the treatment of liver cancer and provides new thoughts for immunotherapy for liver cancer.
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Objective To analyze the use of multidisciplinary team approach (MDT) for advanced and refractory hepatic alveolar echinococcosis in individualized treatment.Methods A retrospective study was conducted on the use of multidisciplinary team approach in individualized diagnosis and treatment for 137 patients with advanced and refractory hepatic alveolar echinococcosis (with invasion of major blood vessels and bile ducts,and/or with lung and brain metastasis) in our hospital from January 2005 to December 2013.The patients were divided into two groups:The MDT group (n =49) and the non-MDT group (n =88).The MDT group was further divided into two subgroups:subgroup A was the surgical treatment group (n =26),and subgroup B was the non-surgical treatment group (n =26).In the subgroup B,13 patients underwent late radical surgery.The non-MDT group was also further divided into two subgroups:subgroup a was the surgical treatment group (n =61),and subgroup b was the non-surgical treatment group (n =27).In subgroup b,5 patients underwent late radical surgery.The time taken to confirm the diagnosis,perioperative hospital stay,operation time,blood loss,postoperative drainage time,postoperative hospital stay,early postoperative complications (pleural and peritoneal effusions,bile leak,anastomotic leak),late postoperative complications (jaundice,anastomotic stenosis,recurrence),and rates of radical surgery were compared between subgroup A and subgroup a.The rates of late radical resection were compared between subgroup B with subgroup b.All data were analyzed using the Mann-Whitney rank sum test or the Chi-square test.Results Subgroup A had significantly shorter perioperative hospital stay,postoperative hospital stay,and total length of hospital stay than subgroup a (P ＜ 0.05).The incidence of late postoperative complications (jaundice,anastomotic stenosis,recurrence) was also significantly less than subgroup a (P ＜ 0.05),and the radical surgery rate was significantly higher than subgroup a (P ＜ 0.05).There was no significant difference in the time taken to confirm the diagnosis,operation time,blood loss,postoperative drainage time,early postoperative complications (pleural and peritoneal effusions,bile leak,anastomotic leak) (P ＜ 0.05) between subgroup A and subgroup a.The ratio of subgroup B receiving chemotherapy alone or drainage + chemotherapy,and the rate of late implement of radical resection were significantly higher than subgroup b (P ＜0.05).Conclusions A multidisciplinary team approach in individualized treatment comprehensively combined the advantages of the effects of drugs,intervention,surgery and systemic nutritional support.The best individualized treatment plan could be used which improved the rates of radical surgery in advanced and refractory hepatic alveolar echinococcosis,reduced postoperative complications,improved quality of life,and offered chances of radical resection in the patients who had lost the opportunities for surgery.