Objective To investigate the clinical value of enhanced recovery after surgery (ERAS) in radical resection of hepatocellular carcinoma (HCC).Methods The propensity score matching (PSM) and retrospective cohort study were conducted.The clinicopathological data of 116 patients with HCC who were admitted to the Fuzhou General Hospital of Nanjing Command of PLA from June 2014 to January 2016 were collected.Fifty-eight patients using pre-,intra-and post-operative ERAS managements were allocated into the ERAS group and 58 using traditional perioperative managements were allocated into the control group.Observation indicators:(1) operation situations;(2) postoperative recovery:postoperative recovery time of bowel sound,time to initial anal exsufflation,time of drainage-tube removal,levels of alanine transaminase (ALT),total bilirubin (TBil),C-reactive protein (CRP) at 1,3 and 7 days postoperatively,postoperative complications (vomiting,abdominal distension,wound infection,intra-abdominal infection and pulmonary infection),duration of postoperative hospital stay,hospital expenses and satisfaction degree of patients;(3) follow-up situation.Followup using outpatient examination and telephone interview was performed to detect survival of patients up to March 2016.Measurement data with normal distribution were described as x±s.The comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range).The comparison between groups was analyzed using the paried rank sum test.Repeated measurement data were evaluated by the repeated measures ANOVA.Results (1) Operation situations:all the patients underwent successful operations,without perioperative death.(2) Postoperative recovery:postoperative recovery time of bowel sound,time to initial anal exsufflation,time of drainage-tube removal,levels of ALT,TBil and CRP at 1,3 and 7 days postoperatively,duration of postoperative hospital stay,hospital expenses and satisfaction degree of patients were (49±10)hours,(60±10)hours,(3.3±0.7)days,(379±99)U/L,(222±65)U/L,(98±16)U/L,(20.4±4.7)μmol/L,(15.5±2.1)μmol/L,(13.4±1.8)μmol/L,(49±10)mg/L,(124±21)mg/L,(30± 5)mg/L,(9.7±0.9)days,(4.1±0.6) ×104 yuan,8.6±0.9 in the ERAS group and (53±5)hours,(64±7)hours,(6.2±1.6)days,(445± 114)U/L,(278±79) U/L,(116± 25) U/L,(18.6± 3.5) μmol/L,(17.0±2.7) μmol/L,(14.2±1.9)μmol/L,(53±11)mg/L,(135±35)mg/L,(34±6)mg/L,(10.0± 1.0) days,(4.3±0.5)x104 yuan,8.2±1.0 in the control group,respectively,with statistically significant differences between the 2 groups (t=2.537,2.479,2.065,F=20.075,14.357,13.460,t=2.060,2.197,2.370,P＜0.05).Number of patients with postoperative vomiting,abdominal distension,wound infection,intra-abdominal infection and pulmonary infection were 5,3,2,1,1 in the ERAS group and 6,6,7,5,3 in the control group,respectively,with no statistically significant difference between the 2 groups (x2=0.100,1.084,3.011,0.206,0.618,P＞ 0.05).(3) Follow-up situation:all the 116 patients were followed up for 1-20 months,with a median time of 11 months.During the follow-up,2 patients in the ERAS group died (1 dying of tumor recurrence and 1 dying of respiratory failure) and 3 in the control group died (1 dying of multiple organs metastasis,1 dying of lung metastasis of HCC and 1 dying of myocardial infarction).Conclusion ERAS in the perioperative management after radical resection of HCC is safe and effective,and it can quickly improve postoperative recovery of patients.

AIM: To investigate the effect of LY980503(a benflumetol derivative)on multidrug resistance of tumor cell line using DNA microarray. METHODS: Total RNA was extracted from multidrug resistant MCF/DOX cell line. cDNA microarray containing 320 cDNAs was used to detect the gene expression profile. RESULTS: 9 down-regulated genes and 1 up-regulated gene were identified after multidrug resistant MCF/DOX cells were treated with LY980503. CONCLUSION: LY980503 can effectively reverse the resistance of MCF/DOX to DOX in vitro by adjusting the expression of multi-genes.

Objective:To investigate the application value of three-dimensional (3D) visualization combined with indocyanine green (ICG) fluorescence imaging in anatomical hepatectomy for hepatocellular carcinoma (HCC).Methods:Clinical data of 45 patients with HCC who underwent anatomical hepatectomy in the Department of Hepatobiliary Surgery, the 900th Hospital of Joint Logistic Support Force of People′s Liberation Army from September 2019 to December 2020 were retrospectively analyzed. Among them, 27 patients were males and 18 were females, aged from 28 to 73 years, aged (57.76±10.95) years on average. According to the different surgical methods, all patients were randomly divided into ICG group ( n=24) and control group ( n=21). In ICG group, 15 patients were males and 9 females, aged (58.21±11.81) years on average. Anatomical hepatectomy was performed using 3D visualization combined with ICG fluorescence imaging. In control group, 12 patients were male and 9 female, aged (57.24±11.35) years on average. Conventional anatomical hepatectomy was performed. The operation duration, bleeding volume, the numbers of cases underwent blood transfusion, occlusion durations, days of hospitalization, highest postoperative serum ALT and TBiL, duration of recovery of postoperative serum ALT and TBiL, and incidence of complications were observed. Measurement data with approximately normal distribution were represented by ( Mean± SD) and groups were compared using t test. Measurement data with skewed or uneven distribution were represented by M (rang) and groups were compared using Man-Whitney U test. Count date were compared using Fisher exact test. Results:All the patients underwent successful operations, without perioperative death. In ICG group, the operation duration was 110.50 (44.00-145.00) min and the occlusion durations was (15.17±2.14) min respectively, shorter than 122.00(80.00-255.00) min and (17.29±4.35) min in control group, the difference between the two groups were statistically significant ( Z=-2.002, -2.115; P<0.05). In ICG group, the numbers of cases underwent blood transfusion was 2 cases, less than 8 cases in control group, the difference between the two groups was statistically significant ( χ2=4.147, P<0.05). The bleeding volume, days of hospitalization, highest postoperative serum ALT and TBiL, duration of recovery of postoperative serum ALT and TBiL, postoperative complications between the two groups were not statistically different ( P>0.05). Conclusions:3D visualization combined with indocyanine green fluorescence imaging technique is a feasible surgical method for anatomical hepatectomy. It is helpful for liver surgeons to visualize and recognize the boundary between hepatic segments and improve the safety of anatomic hepatectomy.

BACKGROUND: The presence of ischemic penumbra in hypertensive cerebral hemorrhage is the hot spot and still controversial. The value of 4,9-diaza-2, 3, 10, 10-tetramethydodecan-2, 11-dione dioxime (HL91) tagged with 99Tcm on detecting the hypoxic brain tissue surrounding the hypertensive cerebral hemorrhage nidus, which represents the penumbra is still waited for confirmation.OBJECTIVE: To investigate the value of 99Tcm-HL91 single photon emission computed tomography (SPECT)/CT imaging on detecting hypoxic tissue in the patients with hypertensive cerebral hemorrhage.DESIGN: Control study.SETTING: Department of Neurology, Jiangmen Municipal Central Hospital, Guangdong Province.PARTICIPANTS: This series included 22 patients with hypertensive cerebral hemorrhage examined between March 2004 and March 2005 in Jiangmen Municipal Central Hospital. All cases revealed sudden onset of the disease, presented with the history of hypertension. These patients were diagnosed with hypertension after admission. The hemorrhage occurred in the anterior circulation territory in all cases and the volume of hemorrhage ranged from 10 mL to 63 mL. Minimally invasive stereotaxic aspiration was performed in 3 cases, craniotomy debridement in 1 case, and expectant treatment in the remaining cases. The period of time from the symptom onset to the examination was form 12 hours to 1.5 years, including more than 1 month in 5 cases. Control group consisted of 6 cases were clinically diagnosed with melancholia and anxiety disorders. Cerebral hemorrhage and acute cerebral infarction were ruled out by integrated CT scan in these 6 cases.METHODS: All 22 patients with hypertensive cerebral hemorrhage and 6 normal controls underwent 99Tcm-HL91 SPECT imaging and combined with CT scan.MAIN OUTCOME MEASURES: ① Identification of radioactive concentrations at one side of the peripheral zone of the lesions by visual analysis on two consecutive slices at two different axial directions were considered aspositive hypoxic imaging. ② The other was ROI semi-quantification measuring radiocounting ratio (R) between the region of visible radioactive concentrations, the center of the nidus, and their contralateral mirror region. R ＜ 0.8 or R ＞ 1.2 was considered to be abnormal. ③ Hypoxic region was defined by integrated CT fused imaging, and its volume was calculated using Xelerix workstation. The volume of the hypoxic tissue and hemorrhage was computed by Duotian formula: length of the maximum cross-section of the hemorrhage × width × slice number × 1/2.RESULTS: All 28 patients were involved in the final analysis. ① Perihemorrhagic radioactive concentrations which represented positive hypoxic imaging was revealed on 99Tcm-HL91 SPECT imaging in 18 cases out of 22 patients with cerebral hemorrhage, and positive rate was 77.78%. Bilateral cerebral hemisphere showed symmetric negative imaging in 6 cases of the control group. ② The fused SPECT/CT images revealed hypoxic region was around the intracerebral hemorrhage, small portion was within the nidus of hemorrhage with irregular shape. R value was 1.75±0.10 in perihemorrhagic hypoxic region in 18 cases with positive imaging, and R value was 1.05±0.11 in the basal ganglia in the control group. There was statistically significant difference between the two groups (P ＜ 0.01). ③ There was a positive linear correlation between maximum volume of hematom and hypoxia volume (correlation coefficient: r=0.7517, P ＜ 0.01).CONCLUSION: Relying on the mechanism about demonstrating the hypoxic tissue on fused SPECT/CT imaging, the hypoxic tissue would represent the penumbra may exist in the territories located around the cerebral hemorrhage. The positive territories may be reversible, I.e. The important portion of the penumbra. 99Tcm-HL91 SPECT/CT imaging can detect the hypoxic tissue surrounding the cerebral hemorrhage. The volume of hypoxic tissue is correlated with the hemorrhagic volume. The procedure is promising and could be applied in clinic.

Objective To investigate the influence of simvastatin treatment on Toll-like receptor 4 (TLR4) in monocytes of peripheral blood in patients with sepsis and severe sepsis and its significance. Methods A prospective randomized controlled trial was conducted. 106 patients with sepsis and 92 patients with severe sepsis admitted to Department of Critical Care Medicine of Henan Provincial People's Hospital from August 2013 to June 2015 were enrolled. These two groups of patients were randomized into conventional treatment group and simvastatin group. All patients received treatment according to the 2012 International Sepsis Treatment Guidelines, including anti-infection drugs, nutritional support, and palliative treatment, and the patients with severe sepsis were given early goal-directed therapy (EGDT). The patients in simvastatin group received simvastatin 40 mg daily orally for at least 15 days. The peripheral blood was collected and the monocytes were isolated at 1, 5, 10, 15 days after intensive care unit (ICU) admission. TLR4 expression on the surface of TLR4/CD14+ double positive monocytes was determined by flow cytometry, and adverse reaction was observed during treatment. Results TLR4 expression on the surface of monocytes showed a tendency of decreasing with prolongation of simvastatin treatment in the simvastatin group in patients with sepsis (n = 59) or severe sepsis (n = 54). However, in patients with sepsis, TLR4 level was significantly decreased from 10 days in simvastatin group as compared with that of conventional therapy group (n = 47), and it was decreased up to 15 days [mean fluorescence intensity (MFI): 21 (19, 28) vs. 27 (25, 33) at 10 days, Z = 2.198, P = 0.021; 16 (15, 21) vs. 26 (23, 34) at 15 days, Z = 4.611, P = 0.002]. In patients with severe sepsis, there was no significant difference in TLR4 level at different time points between simvastatin group and conventional treatment group (n = 38) [MFI: 55 (52, 63) vs. 56 (48, 65) at 1 day, Z = 0.313, P = 0.692; 47 (42, 56) vs. 49 (41, 58) at 5 days, Z = 0.827, P = 0.533; 40 (35, 42) vs. 42 (37, 45) at 10 days, Z = 1.012, P = 0.301; 33 (30, 38) vs. 38 (35, 41) at 15 days, Z = 0.539, P = 0.571]. No adverse reaction related with simvastatin was found during treatment in patients with sepsis or severe sepsis. Conclusions Statins could significantly down-regulate the TLR4 expression on peripheral blood monocytes in septic patients, while it showed no significant influence on TLR4 expression in patients with severe sepsis. A different effect of statins on TLR4 expression and the downstream inflammation process in sepsis and severe sepsis patients might partially explain the discrepancy in previous reports about the therapeutic effect of statins therapy in sepsis and severe sepsis patients.

Objective To investigate feasibility and clinical application value of improved percutaneous transhepatic biliary internal-external drainage (PTBIED).Methods Consecutive patients from April 2007 to April 2010 with malignant obstructive jaundice were diagnosed by medical imaging or pathological confirmation whenever possible.The patients with proximal malignant biliary obstruction and intact inferior common bile ducts ＞ 3 cm in length,and a bilirubin of 70 μmol/L or higher,were included in the experimental group.The control group included patients with low malignant biliary obstruction,and those who met the criteria for the experimental group but refused to receive the altered method of PTBIED.The patients underwent traditional PTBIED in control group.The patients in the experimental group received the procedure as following:according to percutaneous transhepatic cholangiography,a biliary external drainage catheter was modified by adding side-holes.Then under fluoroscopic guidance,the loop tip of the modified biliary drainage catheter was positioned in the inferior common hepatic duct/common bile duct,while the additional side-holes were located in the expanded hepatic duct.Technical success rate,complications,hepatic function and white cell count (WBC) were recorded pre- and post-procedure.All patients were followed-up until death.A t-test was used to compare continuous variable data changes,the Chi-square test was used to compare categorical variable data in two groups,and survival time was assessed using the Kaplan-Meier method.Results Forty-six patients were included in the study,with 21 in the experimental group and 25 in the control group.The procedures were successfully performed in all patients in the two groups.There was no procedure-related death in the two groups.Symptoms were improved similarly after procedures in the two groups.The mean quantity of drained bile per day [experimental group (521 +136) ml/d,control group (606 + 159 ) ml/d,t =1.930,P ＞ 0.05],decrease of the serum total bilirubin after the procedures [ experimental group (87 ± 51 ) μmol/L,control group( 105 ± 66 ) μmol/L ( t =1.061,P ＞ 0.05 ) ] and the median survival time ( experimental group 7.7 months,control group 6.9 months,x2 =0.610,P ＞0.05 ) of the patients showed no statistically significant difference between two groups.The mean WBC amount of patients was higher after the traditional procedure [ ( 10.9 ±5.2) × 109/L] than before the procedure [ (7.8 ±2.9) × 109/L] in the control group ( t =3.606,P ＜ 0.05 ),but the converse change occurred in the experimental group [ pre-procedure (8.2 ± 3.4) × 109/L ],post-procedure [ (7.4 ± 2.6) × 109/L] ( t =2.649,P ＜ 0.05 ).No reflux of duodenal juice was observed in all patients of the experimental group,and 1 patient had infection of biliary tract.The reflux was observed in 11 patients of the control group after conventional PTBIED.Of them,8 patients had infection of biliary tract.Incidence rate of infection of biliary tract in the control group was higher than that in the experimental group( x2 =5.381,P ＜ 0.05 ).Conclusions Improved PTBIED is convenient and feasible,and compared with traditional PTBIED,it can reduce the complications of infection of biliary tract.

Hilar cholangiocarcinoma(HCCA) is a hotpot and a difficult point in the field of hepatobiliary surgery. HCCA is the most common type of cholangiocarcinoma and is characterized by atypical early clinical manifestations, rapid progression and poor prognosis. There is no specific marker for HCCA and its preoperative diagnosis and evaluation mainly relies on imaging examination. Surgical treatment is still the main treatment, but most patients have lost the opportunity of surgical resection by the time of treatment. In recent years, a large number of studies have been conducted on the diagnosis and treatment of HCCA at home and abroad, and the efficacy of HCCA has been improved. Perioperative management, including the selection of preoperative drainage and perioperative chemoradiotherapy and others, improved postoperative survival. Among them, the application of preoperative radiotherapy and chemotherapy in the field of liver transplantation has achieved quite good results. Targeted therapy and immunotherapy have provided new treatment methods for HCCA. This paper reviews the diagnosis and multimodal treatment of HCCA.

Objective To study the clinical value of the conventional liver function tests in liver reserve function assessment for large hepatocellular carcinoma.Methods The clinicopathological data of 113 patients with ChildPugh A hepatocellular carcinoma who underwent radical resection with large hepatocellular carcinoma in the Department of Hepatobiliary Surgery of Fuzhou General Hospital of People's Liberation Army from January 2014 to December 2016 were retrospectively analyzed.The patients were divided into two groups according to the recovery of postoperative liver function,which 105 patients recovered well and 8 patients had hepatic decompensation among them.The liver function index of two groups were analyzed.Measurement data with approximately normal distribution were represented by and groups were compared using t test;measurement data with skewed or uneven disstribution were represented by M (range)and group werecompared using Man-Whitney U test;count data were compared using Fisher exact test;risk factors for postoperative liver dysfunction were analyzed using Logistic single factor and multivariate and ROC curve were drawn.Results Preoperative prothrombin time,international standardization ratio,platelet,prealbumin,total bilirubin,alkaline phosphatase,γ-glutamyl transpeptidase comparison between the two groups were statistically significant (Z =-1.983,-2.180,-2.608,-2.007,-3.577,-2.228,-2.575,P ＜ 0.05).Logistic univariate analysis showed that platelet,total bilirubin and prealbumin were the risk factors for the recovery of liver function of radical resection hepatic decompensation with large hepatocellular carcinoma.Logistic multivariate regression analysis showed that preoperative high total bilirubin and low preabumin were independent risk factors of radical resection hepatic decompensation with large hepatocellular carcinoma.Logistic univariate analysis showed that preoperative high total bilirubin and low prealbumin were not risk factors of radical resection liver failure with large hepatocellular carcinoma.The area under the curve of total bilirubin was 0.880,P =0.000,95％ CI:0.808-0.953,the sensitivity was 87.5％,specificity was 84.8％ and the area under prealbumin curve was 0.769,P =0.011,95％ CI:0.648-0.891,sensitivity was 75.2％,specificity was 77.5％ by the ROC curve.The best threshold of total bilirubin and prealbumin after radical resection with large hepatocellular carcinoma were 17.55 μmol/L and 0.18 g/L respectively by the ROC curve.Conclusion The Child-Pugh A patients in radical resection hepatic decompensation with large hepatocellular carcinoma recover well when the preoperative liver function is as follows:total bilirubin ＜ 17.55 μmol/L and prealbumin ≥0.18 g/L.

Objective:To evaluate the effects of pegylated interferon (Peg-IFN) alfa-2b combined with nucleotide analogues (NAs) on the recurrence of hepatitis B-related liver cancer after resection, and to explore the changes of HBsAg and HBV DNA in patients with chronic hepatitis B liver cancer during postoperative treatment.Methods:The prospective study was conducted. Clinical data of 43 patients with hepatitis B-related liver cancer who underwent radical resection treated in 900th Hospital of People′s Liberation Army were prospectively analyzed from January 2020 to December 2021. Among 43 patients, there were 39 males and 4 females, the age was 30-76 years. According to different treatment methods they were divided into two groups, the patients treated by Peg-IFN alfa-2b combined with NAs were devided into the IFN group( n=10), and those treated by NAs alone into the NAs group( n=33). Two-pair semi-quantitative were collected every 3 months after operation. The recurrence-free survival rate, recurrence time after 2 years in the two groups, the clearance rate and the negative rate of HBsAg and HBV DNA in the two groups. Peg-IFN alfa-2b was evaluated in improving the prognosis of hepatitis B-related liver cancer. The measurement data of normal distribution were expressed by mean±standard deviation ( ± s), and t-test was used for comparison between the two groups. Chi-square test was used for comparison between the two groups of count data. Repeated analysis of measurement variance was used for analysis HBsAg and HBV DNA changes of the interferon group overall survival time and recurrence-free surrival time of patients was estimated using Kaplan-Meier method and the difference between groups was assessed using Log-rank test. Results:HBsAg and HBV DNA: The HBsAg clearance rate at 24 weeks and that at 48 weeks in the IFN group were 24.6% and 59.0% respectively. The HBsAg negative rate at 48 weeks was 16.7%. The HBV DNA clearance rate at 24 weeks and that at 48 weeks were 33.9% and 53.8% respectively. The HBV DNA negative rate was 0 at 48 weeks. The levels of HBsAg and HBV DNA in the IFN group decreased gradually with time. There were statistically differences between the levels of HBsAg and HBV DNA at 0 weeks, 24 weeks and 48 weeks( P<0.05). The 2-year overall survival rates of IFN group and NAs group were 100% and 90.9% respectively. The 2-year recurrence-free survival rates were 90.0% and 63.6% respectively. There were no significant statistical differences in the overall survival rate and recurrence-free survival rate between the groups ( P>0.05). The postoperative recurrence time of the IFN group and the NAs group were (15.00±7.07) months and (5.78±3.39) months respectively. The difference between the two groups was statistically significant ( t=3.160, P<0.01). Conclusion:Long-term antiviral therapy of Peg-IFN alfa-2b combined with NAs can prolong the recurrence time of liver cancer, reduce the levels of HBsAg and HBV DNA in serum, and potentially improve the survival rate of the patients compared with therapy of NAs alone.

Three patients received surgical treatment in Department of Hepatobiliary Surgery of Mengchao Hepatobiliary Hospital from December 2020 to February 2022. Ceftriaxone sodium was given prophylactically before and after operation,and gallbladder silt stones were found by imaging examination on the 3rd, 3rd and 2nd after surgery in 3 patients, respectively. No special treatment was given,after the withdrawal of ceftriaxone sodium for 28, 38 and 48 d,radiographic examination showed that calculi disappeared spontaneously. It is suggested that the pseudolithiasis may be related to administration of ceftriaxone sodium.