Minimally invasive ablation is one of the most effective therapy methods for liver tumor. Eastern Hepatobiliary Surgery Hospital, Second Military Medical University is responsible for the training of refresher physicians in liver tumor minimally invasive ablation. However, due to the different professional background of the refresher physician, the conventional teaching method is not enough. Through the train-ing of clinical thinking, image reading ability, ultrasound guide operation and the management of intraop-erative and postoperative complications in many aspects targeted teaching, reaching the purpose of training, increasing the experience of popularities of minimally invasive ablation technology, and providing a reference basis for future refresher physician teaching in liver tumor minimally invasive ablation.

[Summary] In the treatment of very-early stage hepatocellular carcinoma ( HCC) , several therapies have their own strengths . Liver transplantation, surgical resection, and percutaneous ablation are the most effective procedures for very-early stage HCC.Liver transplantation is difficult to carry out due to lack of donors .Surgical resection and percutaneous ablation are the most commonly used methods with ideal effects .Compared with surgical resection , percutaneous ablation has its obvious advantages in patients with small HCC and senile patients , but the recurrence rate is relatively high .When the above mentioned three methods are not feasible , transarterial chemoembolization is a remedial treatment .Combined use of local therapy is superior to topical therapy alone and suitable for patients with unresectable lesions .Theobserving therapystill needs more clinical studies to confirm its safety and effectiveness .

Colorectal liver metastases (CRLM) are one of the main causes of death among the patients with colorectal cancer,yet most patients with CRLM are unable to get radical resection.Fortunately,thermal ablation can yield long-term survival efficacy in this population of CRLM patients.Currently,thermal ablation is the first-line treatment among other ablation technologies,including radiofrequency ablation and microwave ablation (MWA).However,recent advancements in microwave ablation techniques increase consideration of this method in the treatment of CRLM,such as:reliable,fast,efficient and rarely affected by heat-sink effect.This article aims to review the mechanism,efficacy,complications of MWA in treating CRLM.

The gene encoding thermostable lactate dehydrogenase (Tm-LDH) was cloned into the plasmid pHsh from Thermotoga maritima, and expressed in Escherichia coli JM 109. The recombinant protein was purified to homogeneity by a simple step, heat treatment. The recombinant enzyme had a molecular mass of 33 kDa. The optimal temperature and pH of Tm-LDH were observed 95 degrees C and 7.0. The purified enzyme had a half-life of 2 h at 90 degrees C, and exhibited better stability over a pH range from 5.5 to 8.0. The K(m) and V(max) values were 1.7 mmol/L, 3.8 x 10(4) U/mg of protein for pyruvate, and 7.2 mmol/L and 1.1 x 10(5) U/mg for NADH, respectively. The expression of Tm-LDH in T7 system could not obtain high efficiency, but it has been soluble over-expression in pHsh system and reached 340 mg/L. The superior stability and productivity of Tm-LDH will lay the foundation of its industrial-scale fermentation and application in the NAD regeneration.
Cloning, Molecular ; Enzyme Stability ; Escherichia coli ; metabolism ; L-Lactate Dehydrogenase ; biosynthesis ; Molecular Weight ; Recombinant Proteins ; biosynthesis ; Temperature ; Thermotoga maritima ; enzymology

Objective To investigate the efficiency and prognostic factors for the patients with hepatocel-lular carcinoma (HCC) at unresectable early stage when treated with percutaneous microwave ablation. Methods From January 2007 to January 2010 , 105 cases of at unresectable early stage were treated with percutaneous microwave ablation. Complete response rate, major complication rate, overall survival rates, disease-free survival rate were observed and prognostic risk factors were analyzed. Results The complete response rate was 95.7%. The major complication ratewas 3.8%. The 1-, 3-, and 5-year overall survival rates were 97.1%, 66.7%, 46.7%, and the corresponding disease-free survival rates were 82.9%, 48.6%, 31.4%, respectively. Age > 65 year and tumor size > 3 cm were independent risks for disease-free survival. Age > 65 year and recurrence were independent risks for overall survival. Conclusions Percutaneous microwave ablation is a safe and efficient ther-apy for HCC at unresectable early stage.

Objective To identify the types,frequency and risk factors of major complications using microwave ablation (MWA) to treat liver malignancies in a single center.Methods Using the electronic medical record system,patients with liver cancer who were treated with MWA from January 2010 to November 2015 were retrospectively studied,and the risk factors of severe complications were analyzed.Results Of the 7 403 patients who were treated with MWA (12 558 ablations).96 cases experienced severe complications (1.3％) and 5 patients died (0.07％).The complications included liver abscess (n ＝ 34,0.46％),pleural effusion (n ＝ 20,0.27％),bile duct injury (n ＝ 15,0.20％),hemorrhage (n ＝ 6,0.08％),liver failure (n ＝ 6,0.08％),extrahepa-tic organ injuries (n ＝ 5,0.07％),cancerous cells implantation of abdominal walls (n ＝ 2),cardiac arrest (n ＝ 1),vascular thrombosis (n ＝ 1),renal insufficiency (n ＝ 1),and patients with other associated diseases which developed after the MWA therapy (n ＝2).Metastatic liver cancer and earlier treatment of MWA sessions were associated with a higher major complication rate (P ＜ 0.05).Conclnsions MWA is a well-tolerated local treatment for liver cancer,with an acceptably low incidence of severe complications.Liver abscess was the most common postoperative severe complication.The surgeons＇ experience and tumor type were associated with the incidence of severe complications,however,not relavant with the frequency of preoperative ablations.Appropriate measures can be taken to effectively reduce the risk of serious complications.

Objective:To explore the role of reactive oxygen species(ROS,i.e,H_2O_2 and O_2-) in regulation of respiratory rhythm in the medial area of nucleus retrofacialis(mNRF).Methods: Medullary slices of neonatal SD rats,including hypoglossal nerve(Ⅻn) and mNRF,were made according to Suzue's method.Simultaneous recording of the Ⅻn respiratory rhythmic activity(RRA) with suction electrode and the respiratory neuronal discharge were performed with whole cell patch in the mNRF on the brainstem slice in vitro.The effect of t-butyl hydroperoxide(tBHP) and ?-lipoic acid(?-LA) on the respiratory pacemaker neurons and respiratory rhythm in the mNRF were observed.Results: tBHP significantly decreased respiratory cycle(RC) and increased respiratory amplitude;?-LA significantly increased RC and decreased its amplitude.Meanwhile,?-LA significantly prolonged the action potential of the respiratory cadmium-insensitive pacemaker neurons and reduced its amplitude,but it had no significant effect on the cadmium-sensitive respiratory pacemaker neurons.Voltage steps and ramps showed that ?-LA inhibited both the transient and persistent sodium current of cadmium-insensitive pacemaker neurons.Conclusion: ROS has an excitatory effect on the respiratory rhythm and the cadmium-insensitive respiratory pacemaker neurons through modulating sodium current.

Objective To study the prevention and treatment of severe complications of percutaneous radiofrequency ablation(PRFA)for hepatic malignancy. Methods A series of 939 patients with primary hepatic carcinoma or hepatic metastasis confirmed by pathological examinations or clinical manifestations underwent 1098 treatments of PRFA between January 2006 and December 2009. All the patients were followed up to study the short-or long-term complications related to PRFA. Results Complications developed in 9 patients: bile duct injury (4 patients), hemothorax (2 patients), and intra-abdominal hemorrhage (3 patients). The incidence of complication was 0.82% (9/1098) and the complication-related mortality was 11.1% (1/9). Conclusions Although PRFA which is minimally invasive, is a safe and effective treatment, there were still risks for this procedure, especially when the tumor is located at the portahepatic region or the patient has coagulopathy. Some serious complications can be prevented. It is important to observe the strict indications for RFA and to carry out the procedure carefully. Early detection of complication is important.

Objective To investigate the value of microwave ablation in the treatment of hepatocellular carcinoma in the caudate lobe.Methods We retrospectively analyzed the data of patients with hepatocellular carcinoma in the caudate lobe treated primarily by microwave ablation from January 2011 to May 2016 in our department,and explore the safety,efficacy of microwave ablation (MWA).Results The 11 patients had been treated with microwave ablation procedure in 13 lesions,through caudate lobe epigastric puncture in 9 cases and intercostal puncture in 2 cases.A total of 2 cases did not reach the technical success due to one case treated by radiation therapy,and the other treated by repeated MWA.However,the repeated MWA of that patient failed to reach the technical success.And the effective rate of treatment was 81.8％ (9/11).Following up to October 2016,the average follow-up time was (31.5±15.4) months.There were 1 patient with extrahepatic metastasis and 4 cases of patients with intrahepatic distant recurrence,among which 3 cases underwent MWA treatment again and 1 case underwent radiotherapy.Conclusion Microwave ablation is a safe and effective therapy option for the Caudate Lobe tumor.

Objective To investigate the risk factors of hepatitis B virus (HBV) reactivation after microwave ablation (MWA) and its prevention.Methods 72 patients who met the inclusion criteria were enrolled into the study.30 patients were in the control group and 42 patients in the prophylactic antivirus group.Results 8.3％ (6/72) patients developed HBV reactivation.A high HBV DNA load and no prophylactic antivirus therapy were independent risk factors of viral reactivation.Conclusion Prophylactic antivirus therapy can prevent HBV reactivation.