Treatment of Cavernous Transformation of Portal Vein Caused by Hepatic Cystic Echinococcosis Using Ex Vivo Liver Resection and Autotransplantation.

BACKGROUND Hepatic cystic echinococcosis (HCE) is a frequently overlooked parasitic liver disease, for which the commonly recommended treatment is radical resection. However, this approach is often associated with severe comorbidities such as HBV/HCV, cirrhosis, and hepatic carcinoma, among others. CASE REPORT In this report, we present a case successfully managed by ex vivo liver resection and autologous liver transplantation (ELRA). In the described case, ex vivo resection was not feasible due to recurrent lesions and infections invading the portal vein, which resulted in portal vein cavernous transformation. CONCLUSIONS Through this paper, we aim to detail the treatment process, showcasing the feasibility and advantages of ELRA. Additionally, we propose a novel approach for the treatment of this disease, while emphasizing the importance of radical resection surgery to prevent long-term complications.

Application value of endoscopic retrograde biliary drainage for acute obstructive suppurative cholangitis in the elderly / 中华消化内镜杂志

Objective:To evaluate the safety and efficacy of endoscopic retrograde biliary drainage (ERBD) for acute obstructive suppurative cholangitis (AOSC) in the elderly.Methods:A retrospective analysis was performed on the clinical data of AOSC patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2018 to January 2020. Patients aged 75 years and over ( n=49) were assigned to the elderly group and patients under 75 years old were assigned to the control group ( n=63). General data, American Society of Anesthesiologists (ASA) grading, procedure-related indicators, incidence of postoperative complications and mortality were compared. Results:There were significant differences in age (82.6±5.1 years VS 64.6±4.5 years, t=19.98, P<0.001), albumin levels (29.1±5.9 g/L VS 34.6±8.8 g/L, t=-3.94, P<0.001) and ASA grade ( χ2=8.37, P=0.015) in the elderly group and the control group . The elderly group were accompanied by more basic diseases, i.e. hypertension [57.14% (28/49) VS 34.9% (22/63), χ2=5.51, P=0.019], coronary heart disease [55.1% (27/49) VS 27.0% (17/63), χ2=9.14, P=0.003], chronic obstructive pulmonary diseases/asthma [24.5% (12/49) VS 6.3% (4/63), χ2=7.41, P=0.006]. There were no significant differences in the operation time (31.4±8.1 min VS 30.4±8.0 min, t=-0.61, P=0.543) or hospital stay (6.1±1.7 days VS 5.7±1.4 days, t=1.35, P=0.182). The incidences of postoperative complications were 14.3% (7/49) in the elderly group and 12.7% (8/63) in the control group, showing no significant difference ( χ2=0.06, P=0.807). No ERBD-related death was observed in either group during hospital stay. Conclusion:For elderly patients with AOSC over 75 years old, emergency ERBD, which can quickly relieve the disease, is safe and effective. Advanced age is not an absolute contraindication for emergency ERBD.

Current status of research on laparoscopic treatment of hepatic cystic echinococcosis / 临床肝胆病杂志

Echinococcosis is a common type of parasitic disease in pastoral areas, and hepatic cystic echinococcosis is mainly observed in clinical practice, with surgical resection as the main treatment method. With the continuous development of endoscopic technology and the advantages of little trauma, clear visual field, and rapid postoperative recovery, it has gradually been applied in the treatment of hepatic cystic echinococcosis and has achieved a good treatment effect. Since laparoscopic endocystectomy and subtotal pericystectomy have high incidence rates of residual cavity complications and recurrence in clinical practice, they are not recommended for the treatment of hepatic cystic echinococcosis, and meanwhile, laparoscopic partial hepatectomy and total pericystectomy have the advantages of little trauma, few complications, and good safety in radical resection of lesion. With reference to related articles in China and foreign countries, this article summarizes and elaborates on the indications, precautions, and complications of laparoscopic partial hepatectomy and total pericystectomy, so as to provide a reference for minimally invasive treatment of hepatic cystic echinococcosis.

TGF-ß1 signaling activates hepatic stellate cells through Notch pathway.

Hepatic stellate cells (HSCs), as the most important stromal cells in the liver microenvironment, play crucial roles in hepatic fibrosis, hepatocellular carcinoma, liver regeneration and fetal liver development after transdifferentiating into myofibroblasts (MFs). Transforming growth factor ß1 (TGF-ß1), as an important polyergic cytokine, is involved in HSCs activation process. However, the specific mechanisms of HSCs transdifferentiation process are not clearly demonstrated. Here we added exogenous recombinant TGF-ß1 protein and transforming growth factor ß receptor 1 (TGF-ßR1) inhibitor SB431542 into mouse HSCs to detect the detailed impact of TGF-ß1 signaling on HSCs activation. TGF-ß1 signaling significantly increased phosphorylated (P)-Smad2/3 level and promoted Smad2/3 translocation from the cytoplasm to the nucleus, which also caused transdifferentiation of HSCs into MFs. Importantly, TGF-ß1 signaling also resulted in high expression of Notch pathway markers Notch1, Jagged1, Hes1 in HSCs. In contrast, expression of those above markers in mouse HSCs were obviously decreased after hampering TGF-ß1 signaling via TGF-ßR1 inhibitor SB431542. To further examine the effect of Notch pathway on HSCs activation process, TGF-ß1-stimulated HSCs and control HSCs were treated with or without LY450139, a specific inhibitor of Notch pathway. LY450139 evidently decreased the expression of Notch1 and MFs marker α-smooth muscle actin (α-SMA) expression in HSCs. These above results may provide a novel insight that TGF-ß1 signaling controls HSCs activation process through regulating the expression of Notch pathway markers.

Differential diagnosis for hepatic cyst diseases / 中华普通外科杂志

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 antiEgCF antibody (x2 =4.26,P ＜ 0.05) and EgB antibody (x2 =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.

Application of enhanced recovery after surgery in ambulatory laparoscopic appendectomy / 中华全科医师杂志

Objective To assess the safety and feasibility of ambulatory laparoscopic appendectomy (ALA) with the concept of enhanced recovery after surgery (ERAS).Methods The clinical data of patients with appendicitis undergoing surgical treatment in the First Affiliated Hospital of Xinjiang Medical University from August 2017 to August 2018 were retrospectively analyzed.Among 196 patients,100 cases received ambulatory laparoscopic appendectomy with ERAS (ERAS group) and 96 cases received conventional laparoscopic appendectomy (control group).The average length of hospital stay,hospitalization expenses,NRS pain score at 6 h,12 h,24 h after surgery,patient satisfaction,time of postoperative off-bed activity,time of gastrointestinal function recovery,and postoperative complications were compared between two groups.Results There were significant differences in average length of hospital stay [(36.5± 1.3) h vs.(74.5±4.4) h,t=80.986),hospitalization expenses[(9 617.5±637.5) Yuan vs.(13 740.1±640.6) Yuan,t=45.150],6 h NRS pain score[(3.4± 1.4) vs.(4.1±1.3),t=3.360],12 h NRS pain score(2.0±1.3 vs.2.5±1.1,t=-2.929),time of postoperative off-bed activity[(5.7 ± 0.9) h vs.(11.5 ± 2.0) h,t=26.237],time of gastrointestinal function recovery(6.8± 1.1) h vs.(12.2±2.3) h,t=20.341]and patient satisfaction [(95.6±3.0) vs.(90.5±4.9),t=-8.644]between ERAS group and control group (all P＜0.05).There was no significant difference in the NRS pain score at 24 h(1.0±0.7 vs.1.0±0.8,t=0.287)and postoperative complications (x2=0.025)between the two groups (P＞0.05).Conclusion The ambulatory laparoscopic appendectomy with enhanced recovery after surgery is safe and feasible,with the advantages of low hospitalization cost,short hospitalization time,and high patient satisfaction.

[The clinical practice of improvement the "Volume and Quality" of functional liver in autologous liver transplantation for the patients with alveolar echinococcosis].

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" .

Some thoughts on the construction of medical characteristic disciplines in local medical colleges and universities / 中华医学科研管理杂志

Objective This paper expounds the present situation of the construction and probes into the development path of the medical characteristic disciplines,so as to provide guidance for the development of the characteristic disciplines of local medical colleges and universities.Methods According to the general characteristics of the discipline construction of the local medical colleges and universities,through the analysis of the current situation of the objective development and the restriction of the bottleneck,to analyze the new methods and new ways for the development of the characteristic disciplines in local medical colleges and universities.Results Medical characteristic disciplineconstruction should pursue sustainable development,mining subject characteristics;concise direction of research,enhance the level of scientific research;focus on academic exchanges,build talent echelon;integrate all kinds of resources,construction of subject group;building performance evaluation,pioneering achievement innovation.Conclusions Local educational institutions and medical colleges and universities should fully understand the importance of characteristic disciplines to meet the needs of local development and create brand culture.The characteristic disciplines with prominent advantages,reasonable structure and sustainable development should be established.

[Application of three-dimensional visualization technology in surgical treatment for patients with hepatic alveolar echinococcosis].

OBJECTIVE: To determine the clinical value of three-dimensional(3D) visualization technology in pre-operative assessment and surgical planning for patients with hepatic alveolar echinococcosis. METHODS: Eighty-five hepatic alveolar echinococcosis patients received surgical treatment in the First Affiliated Hospital of Xinjiang Medical University between May 2011 and May 2015.3D reconstruction and virtual surgeries were performed on diseased livers using a 3D visualization reconstruction system for liver, which based on the data set of 64-slice CT from those patients and indicated the feasibility and safety of liver resection. The pre-operative measurement results were compared with intra-operative conditions to verify the accuracy of pre-operative evaluation. RESULTS: All surgical strategies of patients underwent surgical treatment(59 of 85 received traditional liver resection and 26 of 85 received liver auto-transplantation)were consistent with pre-operative surgical planning in 3D reconstruction. Furthermore, the pre-operative resection liver volume((751±510)cm(3)) estimated by 3D calculation method was positively correlated with the actual weight((777±567)g) after the surgery(r=0.990), and the error rate was 4.7%; the pre-operative remaining liver volume((829±157)cm(3)) estimated by 3D calculation method was positively correlated with the actual weight((770±206) g) after the surgery(r=0.978). Patients were followed for 6-46 months after the surgery, and 3 post-operative death and 2 recurrence (one case received secondary surgery and one case received drug therapy) were reported during the follow-up period. CONCLUSIONS: A liver 3D visualization technology has application value in the pre-assessment and surgical planning.When it combined with ultrasound, CT and MRI, traditional examinations, the liver 3D visualization technology can effectively improve the success rate of operation, reduce the risks of surgery.

[Living donor liver transplantation for the treatment complicated hepatic cystic echinococcosis: first case report from China].

OBJECTIVE: To report the first clinical experience of living donor liver transplantation(LDLT) in patient with complicated hepatic cystic echinococcosis in China. METHODS: First Affiliated Hospital of Xinjiang Medical University successfully implemented LDLT in the treatment of one patient with complicated hepatic cystic echinococcosis after four times liver surgery and secondary congestive cirrhosis on May 9, 2015. The clinical data of the patient has been retrospectively analyzed. RESULTS: LDLT procedure was successfully performed in a patient with four previous liver intervention due to his recurrence. The patient was lack of right lobe, while with significant hypertrophy in left lobe. The reoccurred lesion compressed the retrohepatic vena cava, left hepatic vein, portal vein, that led to the stricture of retrohepatic vena cava, left hepatic vein orifice. The phlebography displayed remarkable stricture in retrohepatic vena cava and rich collateral circulation by which the venous blood flow back to the right atrium via paravertebral vein. The orifice of left hepatic vein shaped as hair-like so that the stenting was impossibly. After the multi-disciplinary team discussion, the liver transplantation was proposed, while the autotransplantation was considered as first line option, and with the backup of living related donor. The laparotomy showed the hugely enlarged liver with nodular changes. The frozen section was tested twice and showed as spotty necrosis with pseudo-lobe formation. Although the enlarged left lobe about 2 000 g weight, the liver colored as grey with cotton-like texture, the plan for autotransplantation was abandoned regarding the high risk for post-operative liver failure. Therefore, LDLT was performed. The donor was her brother who donated right lobe with 685 g weight. The operation time was 1 005 min with anhepatic time 335 min. Total of 12 units red blood cell suspension was transfused. The coagulating function was back to normal in 3 days after operation. The patient was discharged at 30 days after operation, while the routine blood test and biochemical markers had back to normal levels. The patient had taken tacrolimus and methylprednisolone with normal life. The liver functions of transplanted liver were normal in 90 days after surgery. The patient was able to self-activity and regular outpatient follow-up. CONCLUSION: Hepatic CE is an infectious disease, and liver transplantation could be the last choice for complicated case, especially in combination with severe complications, like Budd-Chiari syndrome.

[Research Achievements and Challenges for Echinococcosis Control].

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.

Effect of echinococcus granulosus antigen B on streptozotocin induced diabetes mellitus in mice / 中华普通外科杂志

Objective To investigate the effect of echinococcus granulosus antigen B on the severity of streptozotocin induced diabetes mellitus.Methods Thirty male BALB/c mice were randomly divided into 3 groups:echinococcus granulosus antigen B group (group A,n =10),normal saline group (group B,n =10),control group (group C,n =10).Mouse in group A was injected by echinococcus granulosus antigen B and mouse in group B was given normal saline,Type 1 diabetes was induced.After 3 weeks,mice were executed and pancreases were scored on insulitis by HE staining.Serum IFN-γ and IL-4 levels were measured by ELISA.Results After 3 weeks of the establishment of diabetes model mouse body weight in group B and C decreased significantly compared with that in group A.Mouse mean blood glucose level in group A was significantly lower than that in group B and C.There were less than 40％ of islets with lymphocytic infiltration in group A,compared with 80％ in group B.The average Ridit was 0.423,0.519,and 0.561 in group A,B and C respectively,P ＜ 0.05.IL-4 level in group A was significantly higher than that in group B and group C [(71.6 ± 12.4) ng/ml,(12.6 ± 5.6) ng/ml,(14.2 ± 7.2) ng/ml,P ＜ 0.05].IFN-γ level in group B and group C were higher than that in group A [(276.1 ± 41.7) ng/ml,(352.2 ± 52.2) ng/ml,(358.1 ± 53.4) ng/ml,P ＜ 0.05].Conclusions Type 1 diabetes is organ specific T lymphocyte mediated autoimmune disease.Echinococcus granulosus antigen B has protective effects on diabetes mellitus in mice couteracting autoimmune injury to the islets by streptozotocin,probably by a mechanism related to immune deviation of Th1 to Th2.

Surgical treatment for hepatic alveolar echinococcosis: report of 50 cases.

BACKGROUND/AIMS: The purpose of this study is to present the surgical treatment of hepatic alveolar echinococcosis and evaluate the treatment outcomes. METHODOLOGY: A retrospective analysis was made on 50 patients admitted between 2000 and 2008. All the patients were divided into two groups, 26 patients for the radical surgery group and 24 for the palliative surgery group. RESULTS: In the palliative surgery group, 10 patients died during the follow-up period, 2 patients presented with brain metastasis and 4 patients with lung metastasis, 1 patient had multiple lesions in the liver, 1 patient who received left hepatectomy had a new lesion in caudate lobe of the liver, 4 patients had postoperative jaundice, 3 had cholangitis and 4 patients had biliary leaks. There were also 3 patients lost in the follow-up period. In the radical surgery group, 22 patients were alive and asymptomatic without recurrence during the follow-up period, 3 patients had recurrent cholangitis and 4 patients had biliary leaks. Three patients were lost during the followup period in this group. CONCLUSIONS: Radical resection appears to be best treatment of hepatic alveolar echinococcosis and palliative operation may cause a series of severe complications leading to death.