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Objective:To evaluate the clinical value of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC) after surgical resection.Methods:A retrospective study was conducted on the clinical data of 156 patients who underwent surgery for ICC in Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University from November 2010 to December 2017, including 94 males and 62 females, aged (60.0±9.5) years. Curative surgery was performed in 114 cases. Of 64 cases were in stage Ⅰ according to American Joint Committee on Cancer (AJCC), including 38 cases of non-lymph node dissection (NLND) and 26 cases of LND; 21 cases were in AJCC stage Ⅱ, including 11 cases of NLND and 10 cases of LND; 22 cases were in AJCC stage Ⅲb, including 14 cases of LND and 8 cases of lymph node resection (LNR); 5 cases were in AJCC stage Ⅲa, 2 cases were in AJCC stage Ⅳ. Univariate and multivariate Cox regression analysis were used for the risk factors of ICC prognosis. The log-rank test compared the survival rates of the two groups.Results:Cox multivariate analysis indicated that lymph node metastasis was independent risk factors for prognosis in patients with ICC ( HR=1.96, 95% CI: 1.09-3.55, P=0.026). A total of 114 patients were included in the curative surgery group. The 1-, 3-, and 5-year overall survival (OS) rates of the negative lymph node group ( n=91) were 65.9%, 47.3% and 35.6%, respectively, which were significantly better than those of the positive lymph node group ( n=23) who had 1-, 3-, 5-year OS rates of 56.5%, 17.7% and 0, respectively (χ 2=8.11, P=0.004 ). In stage Ⅰ and Ⅱ patients, there were no significant differences in 1-, 3-, 5-year OS rates between the NLND group and the LND group (both P>0.05 ). In stage Ⅲb patients, the LND group had 1-, 3-, 5-year OS rates of 71.4%, 29.8% and 0, respectively, significantly better than those of the LNR group who had 1-, 3-, 5-year OS rates of 37.5%, 0 and 0, respectively (χ 2=6.45, P=0.011). Conclusions:Lymph node metastasis is an independent risk factor affecting the prognosis of ICC. Lymph node dissection should be performed cautiously in ICC with AJCC stage Ⅰ and Ⅱ, while routine lymph node dissection is recommended in ICC with AJCC stage Ⅲb.
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Objective:To investigate the effect of optimizing perioperative measures on reducing postoperative gastric emptying disorder in gastrointestinal reconstruction after pancreaticoduodenectomy.Methods:The clinical data of 146 patients who underwent pancreaticoduodenectomy from Jan 2019 to Dec 2020 at the Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital ,Anhui Medical University were analyzed retrospectively. Among them, 78 cases underwent traditional Billroth Ⅱ gastrojejunal anastomosis for gastrointestinal reconstruction, and 68 cases in the improvement group took optimization measures. The time to first postoperative flatus, time to oral intake, postoperative hospital stay and complications were observed.Results:The operation time in the control group was (351.4±71.6) min, less than that in the improved group (368.8±97.6) min, while the time [(9.9±6.5)d vs. (7.6±6.0)d] to first oral take and postoperative hospital stay [(20.7±8.6)d vs. (17.9±7.0)d] were significantly longer than those in the improved group. The incidence of postoperative gastric emptying disorder (19.2% vs. 7.4%) was significantly higher than that in the improved group ( P<0.05). There was no significant difference in postoperative time to first flatus and postoperative gastrointestinal bleeding between the two groups (all P>0.05). Conclusions:The measures of optimizing gastrointestinal reconstruction in the perioperative period of pancreaticoduodenectomy have obvious advantages in reducing gastric emptying disorder, promoting the recovery of gastrointestinal function and shortening the length of hospital stay.
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Objective:To investigate the risk factors for delayed gastrointestinal hemorrhage after pancreaticoduodenectomy (PD).Methods:The retrospective case-control study was conducted. The clinicopathological data of 173 patients who underwent PD in the First Affiliated Hospital of Anhui Medical University from November 2017 to May 2020 were collected. There were 107 males and 66 females, aged (61±11)years. All patients underwent PD and patients with gastrointestinal hemorrhage after surgery were treated with non-surgical or surgical treatments. Observation indicators: (1) gastrointestinal hemorrhage after PD and treatment situations; (2) influencing factors for delayed gastrointestinal hemorrhage after PD. Measurement data with normal distribution were expressed by Mean±SD, and count data were expressed by absolute numbers or percentages. Univariate analysis was performed using the chi-square test, and multivariate analysis was performed using the Logistic regression model. Results:(1) Gastrointestinal hemorrhage after PD and treatment situations: of 173 patients, 15 cases had gastrointestinal hemorrhage after PD, including 2 cases with early gastrointestinal hemorrhage and 13 cases with delayed gastrointestinal hemorrhage. Among the 13 cases with delayed gastrointestinal hemorrhage, 3 cases were mild hemorrhage, 10 cases were severe hemorrhage, 4 cases were gastric mucosal hemorrhage, 3 cases were gastric ulcer hemorrhage, 3 cases were gastrointestinal anastomotic hemorrhage, 2 cases were cholangio-jejunal anastomotic hemorrhage, 1 case was biliary arteriovenous fistula hemorrhage. Of the 13 patients with delayed gastrointestinal hemorrhage, 4 cases were treated only with conservative treatment, 4 cases were treated with interventional treatment, 3 cases were treated with endoscopic treatment and 2 cases were treated with surgical treatment. Of the 13 patients with delayed gastrointestinal hemorrhage, 12 were cured and 1 died. (2) Influencing factors for delayed gastrointestinal hemorrhage after PD: results of univariate analysis showed that albumin, total bilirubin, pancreatic fistula and history of gastric ulcer were the influencing factors for delayed gastrointestinal hemorrhage after PD ( χ2=7.888, 6.555, 4.252, 6.253, P<0.05). Results of multivariate analysis showed that total bilirubin >200 μmol/ L, pancreatic fistula and history of gastric ulcer were independent risk factors for delayed gastrointestinal hemorrhage after PD ( odds ratio=4.122, 4.290, 5.267, 95% confidence interval as 1.009-16.844, 1.149-16.022, 1.195-23.221, P<0.05). Conclusion:Total bilirubin >200 μmol/L, pancreatic fistula and history of gastric ulcer are independent risk factors for delayed gastrointestinal hemorrhage after PD.
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Objective:To explore the clinicopathological characteristics of the primary hepatic adenosquamous carcinoma(ASC).Methods:A retrospective analysis was performed on the clinical data of 5 ASC patients admitted to the First Affiliated Hospital of Anhui Medical University from 2006 to 2019 who underwent surgical resection and were pathologically confirmed.Results:Among the 5 ASC cases, there were 4 males and 1 female. The age ranged from 48 to 73 years. As for the initial symptoms, there were 5 cases complaining upper abdominal pain, 2 cases presenting fever, 1 case presenting weight loss and 1 case presenting jaundice. CA19-9 was significantly higher than normal in 4 cases, while AFP was normal in all. None had definite preoperative diagnosis.All the 5 patients underwent surgical resection with pathology proved primary hepatic ASC. Lymph node metastasis was found in 4 cases and nerve invasion in 2 cases. There were 4 cases at TNM stage ⅣA, one at stage ⅠB. The median disease-free survival (DFS) was 5 months and the overall survival (OS) was 9 months.Conclusions:Primary hepatic adenosquamous carcinoma is a rare type of liver malignant tumor with an extremely poor prognosis. Surgical resection helps little in improving the prognosis.
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Chronic liver disease (CLD) is one of the major public health problems,and liver fibrosis is a common feature of CLD.To date,there is no noninvasive method with high sensitivity and specificity for diagnosing and monitoring liver fibrosis in clinical practice.MRI T1ρ,a new technology developed in recent years,is sensitive to macromolecular (such as protein) composition and proton exchange between water and macromolecules,and therefore may be sensitive for the evaluation of liver fibrosis.This review introduces the principle and state of the art of liver MRI T1ρ technology,and summarizes the applications of MRI T1ρ for evaluation of liver fibrosis.
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Objective To study the processing method,extraction technology and quality evaluation analysis of Paeonialactiflora Pall, so as to provide reference for selecting the best method and improving its quality .Methods One year and 3 years Chinese herbal medicine Paeonialactiflora Pall was used.The use of raw materials and cooked products for processing methods to paeoniflorinas the representative , and the content was determined by high performance liquid chromatography.With the optimization of orthogonal test, the methods for the determination of effective components of radix paeoniaealba were summarized and the quality control methods were analyzed .Results The content of paeoniflorin in raw paeonialactiflora pall was (6.33 ±0.52)%,and the content of paeoniflorinin cooked Paeonialactiflora Pall was (5.74 ±0.45)%, which was with statistical significance(P <0.05).The content of paeoniflorin in raw paeonialactiflora pall was (5.90 ±0.38)%,and 4.85 ±0.45% in three years cooked paeonialactiflora pall, and the differenceswere with statistical significance(P<0.05).Extracted three times with 70% ethanol, time 65 min, 6 times the amount of solvent,the paeoniflorin high cream rate was highest.By means of induction, several active ingredients should be screened out to control the content of paeonialactiflora pall to publish multiple indicatorsquality control methods .Conclusion The preparation method of Chinese herb paeonialactiflora pall has showed that the active ingredient content is morein raw herb.To establish quality control method of multiple indicators of paeonialactiflora pall based on raw herb,gradually improve the quality of more comprehensive paeonialactiflora pall quality control model.To optimize the extraction of Chinese herbal medicine,provide scientific reference for the sustainable utilization and industrial production of paeonialactiflorapall.
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AIM To investigate the tissue distribution of brucine-loaded solid lipid nanoparticles in mice in vivo.METHODS Mice were intravenously injected with suspension of prepared brucine-loaded solid lipid nanoparticles and marked by fluorescein isothiocyanate (FITC).The in vivo tissue distribution of nanoparticles was analyzed by having the brucine contents in various tissues (heart,liver,spleen,lung,kidney and bone) determined by HPLC,after which fluorescence confocal laser endomicroscopy was used for further detection.RESULTS Brucine had its the highest (1.64) relative intake efficiency (Re) in mice liver,and the nanoparticles shared all over one value of targeting efficiencies (Te) in various tissues,manifesting a much stronger selectivity to liver than that of brucine solution.With the extension of time,the FITC-narked nanoparticles displayed a rich extracellular to intracellular distribution indicating a positive correlation.CONCLUSION Brucine's increased distribution in the liver tissue of mice due to its solid lipid nanoparticle form shows obvious for liver targeting.
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Experiments were conducted to investigate the suitability of the multistage in-situ reaction analyzer based on a micro fluidized bed ( MFB-MIRA) for measuring the rapid change of the gas concentration during gas-solid reactions. The results showed that the control performance of capillary temperature had a great impact on the stability of on-line measurement. Based on the observed regular patterns, the capillary temperature control system was equipped with a precision temperature controller. The control precision of capillary temperature reached ± 0 . 2℃, which guaranteed the high stabilities of the sampling flow rate and the chamber vacuum. The measured results of the modified gas monitoring system showed the periodic fluctuations of the on-line measurement were eliminated. The stability of measurement was significantly improved. The fluctuating range and relative standard deviation of the measured response to O2 in air changed from 1. 9% and 0. 5% to 1. 4% and 0. 2%, respectively. A pressure regulating device was also developed to control the absolute pressure at the gas sampling point. The control precision reached ± 0. 02 kPa. The measured results showed that the response of the process mass spectrometer was positively correlated with the absolute pressure at the sampling point, indicating the necessity of the pressure regulating device. The accuracy and repeatability of process mass spectrometer were improved. This study has enhanced the suitability of MFB-MIRA for studying rapid gas-solid reactions and broadened the scope of reliable applications of MFB-MIRA and process mass spectrometer.
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Objective To evaluate the clinical effectiveness of laparoscopic (LDP) versus open distal pancreatectomy (ODP) using meta-analysis.Methods Comprehensive literature search was conducted on articles only in English published from 2006 to 2012 on MEDLINE,EMbase,Cochrane Central Registry of Controlled Trials to compare LDP with ODP for Pancreatic disease.Data were extracted and evaluated by two reviewers independently.The quality of the included trials was evaluated.Meta-analyses were conducted using the Cochrane Collaboration's RevMan 5.1 software.Results Fourteen controlled clinical trials (n=1417) were included.The LDP group was significantly longer than the ODP group in operation time,and was significantly larger in the number of patients with spleen preservation [(MD-273.10,95％ CI-354.39-191.081,P＜0.01),(OR 2.42,95％ CI 1.78-3.30,P＜0.01) respectively].The LDP group was significantly less than the ODP group in intraoperative blood loss,time to oral intake,and length of hospital stay [(MD-273.10,95％ CI -354.39-191.81,P＜0.01),(MD-1.78,95％ CI-2.36-1.20,P＜0.01),(MD-3.15,95％ CI-3.97-2.33,P＜0.01) respectively].There were no significant differences in blood transfusion,pancreatic fistula rate,and mortality between the two groups.Conclusions LDP is feasible and safe in treating pancreatic disease.When compared with ODP,LDP has the advantages of having less intraoperative blood loss,quicker recovery and more patients with spleen preservation.
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Objective To detect aberrant methylation in the promoter of FHIT and RASSF1A genes in peripheral plasma and tumor tissues from patients with hepatocellular carcinoma (HCC) and to determine its clinical significance.Methods The methylation status of FHIT and RASSF1A genes in peripheral plasma and tumor tissues from 36 patients with HCC were detected by methylation-specific polymerase chain reaction(MSP).The correlation between methylation status in plasma and clinicopathological features was analyzed.Results The frequency of promoter methylation of FHIT in tissues was 75％ (27/36) and in plasma 52.8％ (19/36),and the correlation coefficient was r=0.482 (P=0.003).The frequency of promoter methylation of RASSF1A in tumor tissues was 83.3％ (30/36) and in plasma 61.1％ (22/36),and the correlation coefficient was r=0.561 (P=0.0004).Aberrant methylation of FHIT,RASSF1A gene in the plasma and tissues had no correlation with the patients' clinicopathological features such as gender,age,HBV/HCV infection,hepatic cirrhosis,tumor size,alpha-fetoprotein (AFP) level,pathological grade,staging,vascular tumour thrombus and recurrence.The sensitivity of AFP ≥400 μg/L was 44.4％,and AFP ≥20 μg/L 69.4％.The sensitivity of FHIT and RASSF1A gene promoter hypermethylation in 36 HCC patients was 72.2％.In 20 patients whose AFP ＜400 μg/L,the frequency of hypermethylation of the two genes together was 80％.When AFP ＜20 μg/L,the frequency of hypermethylation of the two genes together was 54.5 ％.Conclusions There was a significant concordance between plasma and tumor tissue methylation profiles.The methylation status in plasma and tumor tissues had no correlation with the patients' clinicopathological features.Combining promoter methylation of FHIT and RASSF1A genes was superior to AFP in the diagnosis of HCC.
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Objective To study the diagnosis,surgical indications, and results of surgical treatment for hepatic hemangioma. Methods The data of 37 patients with hepatic hemangioma treated by hepatectomy in our department from July 2005 to July 2008 were analyzed retrospectively. The diagnoses were made by ultrasound, enhanced CT and MRI. Surgical indications included: (1) diameter >5 cm, located at the left lateral section or the lower edge of the liver with symptoms. (2) diameter >10 cm or recent rapid growth. The hemangioma were located in the left liver in 10 patients, right liver in 17, caudate lobe in 3, middle hepatic lobe in 2, multiple tumors in left and right livers in 5.The preoperative liver function was grade A in all patients. Results Five patients underwent right hepatectomy, 2 underwent left hepatectomy, 10 underwent left lateral sectionectomy, 3 underwent caudate lobectomy, 5 underwent central hepatectomy, 8 underwent right anterior sectionectomy, 4 underwent combined hepatic resections and 2 underwent prophylactic exploration of the common bile duct. Pringle's maneuver was applied in 28 patients, and total hepatic vascular exclusion in 7. The occlusion time ranged from 8-36 and 10-40 minutes (average: 22.2±14.3 min and 21.6±12.1 min),respectively. 400 ml of intraoperative blood transfusion was given to 4 patients each. All operations were successfully carried out. The specimens measured 5-20 cm. There was no peri-operative death.The postoperative complications were: pleural effusion (n=4); subphrenic (n=2). Histologic diagnosis confirmed hepatic cavernous hemangioma in all patients. All patients were regularly followed-up (ranged 6 months-4 years), and no recurrence was detected. Conclusion In carefully selected patients, liver resection for hepatic hemangioma is safe and effective.
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<p><b>OBJECTIVE</b>To explore different opinions in different people about Chinese patent medicine, Xiaoke pill, in post-marketing surveillance.</p><p><b>METHOD</b>Effectiveness, safety and cost of Xiaoke pill treating diabetes were investigated by clinical experts, clinical professionals and patients about mellitus.</p><p><b>RESULT</b>Both consensus and different views were found in the three subgroups.</p><p><b>CONCLUSION</b>Xiaoke pill has a good effectiveness with few adverse reactions. However compared with other advanced anti-diabetes mellitus, Xiaoke pill is now earning a big market in hospital in small cities and population with low income. Hence it is necessary to re-evaluate post-marketing Xiaoke pill for more evidences about effectiveness and safety.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Diabetes Mellitus, Type 2 , Drug Therapy , Drugs, Chinese Herbal , Product Surveillance, PostmarketingABSTRACT
Objective To sum up our experience on the diagnosis and treatment of rare hepatic tumors. Methods The data of 25 patients with rare liver tumors admitted in our hospital from May 2005 to January 2010 were analyzed retrospectively. Results The final pathologic diagnosis of focal nodular hyperplasia was made in 6 cases, and the diagnosis of vascular leiomyoma, hilar neurilemoma, intrahepatic aneurysm, biliary cystadenoma, hepatic hamartoma, biliary villous adenoma, and hepatic diffuse large B-cell lymphoma was established in one each case, respectively. The diagnosis of angiomyolipoma in 2patients, primary liver gastroimestinal stromal tumor in 2 patients, hepatoblastoma in 5 patients and liver undifferentiated sarcoma in 3 patients was established. Preoperative ultrasonography, CT and MRI were performed in 24, 22 and 6 patients respectively. Preoperative tentative diagnosis was finally confirmed by pathology in only 3 (16.7%) cases, all by CT report. Preoperative diagnosis was consistent with postoperative pathology in 5 patients (20%); All patients underwent liver resection including hemihepatectomy in 7 patients, hepatic lobectomy in 7 patients, segmentectomy in 9 patients and tumor enucleation in 2 patients; There was no recurrence after resection of benign, low malignant tumors and hepatic diffuse large B-cell lymphoma; Postoperative follow-up was made for all the 5 cases of malignant tumours, and there was recurrence in 3 cases. These 3 eases underwent second resection and there were no recurrences after reoperation. The two recurrent patients died with a mean survival of 4 months.Conclusions The preoperative correct imaging diagnostic rate for rare hepatic tumors is low. Surgery is the most effective therapy and reoperation should always be attempted for tumor recurrence in order to prolong survival.
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Objective To investigate the effect of postoperative prophylactic transcatheter arterial Chemoembolization(TACE) on preventing recurrence in 54 high-risk patients with hepatocellular carcinoma.Methods These 54 HCC cases were greded as high risk for recurrence and put on close follow up after radical resection.Risk factors included tumor thrombus,cancer satellite or multiple cancer nodules,postoperative high AFP level.Among them 42 cage (target group) received TACE,in which liver function was of Child A,and hepatitis virus replication was controlled in 1000 copies/ml.12 cases(centrol group) didn't receive TACE.The recurrent rate of HCC was compared between the cases with prophylactic TACE and those without through two years of follow-up. Result The recurrence rate of HCC was significantly lower in the cases with prophylactic TACE(19.O%) than those without(50%) within 1 year after the radical operation,and 2 years (52.3% vs 83.3%). Conclusion Postoperative TACE contributes to reducing the short-term HCC recurrence rate.