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 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 investigate the risk factors of gallbladder neoplastic polyps,to determine the proper surgical indications,and to understand more about the clinical characteristics of gallbladder adenoma.Methods The clinical data of 748 patients diagnosed to have polypoid lesion of gallbladder (PLG) and underwent cholecystectomy from January 1998 to December 2012 in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively reviewed.Results Among 748 patients,340 had abdominal symptoms.Postoperative histopathology showed non-neoplastic polyps (n =659),gallbladder adenoma (n =68),gallbladder cancer (n =15) and no polyps (n =6).The mean diameters of the nonneoplastic lesions and the neoplastic polyps were (9.38 ± 3.44) mm and (14.55 ± 5.71) mm,respectively (P ＜ 0.01).The average age of the patients with non-neoplastic lesions was (44.14 ± 11.42) years and (47.39 ± 12.82) years in those with neoplastic polyps (P ＜ 0.05).The proportion of solitary PLG was 41.4％ (253/611) and 59.59％ (47/79) for the non-neoplastic lesions and the neoplastic polyps respec tively (P ＜ 0.01).The size of PLG (13.34 ± 4.18 mm vs.20.07 ± 8.19 mm,P ＜ 0.05) and the age of the patient (45.78 ± 11.66 years vs.54.13 ± 15.82 years,P ＜0.05) between the gallbladder adenoma and gallbladder cancer groups were significantly different.Gallbladder adenoma or dysplasia was identified in 66.7％ (10/15) of gal1bladder cancer specimens.Conclusions Patients with PLG and with abdominal symptoms,large size (≥ 10 mm),old age (≥50 y) and solitary polyp are indications for cholecystectomy.Gallbladder adenoma may develop to gallbladder cancer within 10 years.

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: A method was established to obtain fingerprint and determination of six components in Glycyrrhizae Radix et Rhizoma Pieces (GRRP) based on HPLC-PDA, and samples with four kinds of softening methods (showering moistening, steaming, 70 ℃ decompression steaming, 85 ℃ decompression steaming) were analyzed. Methods: The content of total flavonoids and total saponins was determined by ultraviolet spectrophotometry with liquiritin and glycyrrhizic acid as reference materials. Simultaneous determination of six components of liquiritin, ononin, isoliquiritin, glycyrrhizin, echinatin, glycyrrhizic acid was performed based on HPLC. Changes of the components content in the samples which treated by different softening methods were compared. The similarity evaluation of samples with different softening methods was carried out by the chromatographic fingerprint similarity evaluation system of traditional Chinese medicine, and cluster analysis was also carried out. Results: The results showed that the content of total flavonoids and total saponins in untreated samples was the highest, and the content of total flavonoids and total saponins in samples treated by showering moistening was the lowest. The three treatment methods of atmospheric pressure steaming, steaming decompression at 70 ℃ and steaming decompression at 85 ℃ had little effect on the samples. The content determination showed that the content of isoliquiritin was decreased significantly after softening treatment. The difference among the different softening treatment groups was not significant. The samples with different softening methods of the three batches of samples were grouped together with their raw products. Different softening methods had no significant difference in the composition of the medicinal herbs. Conclusion: The established method can quickly and accurately determine the six components, and in particular, the content of isoglycyrrhizin should be monitored. Combining production efficiency, production cost and quality evaluation, steaming is the most feasible in the production process. This study provided theoretical guidance for the large-scale production of softening, which was conducive to further standardizing the production process of GRRP.

Tangcao pill is commonly applied in adjuvant and even alternative therapy for patients with AIDS. However, the herb contains complex ingredients, but with unknown effect against anti-HIV drug and unknown function. Because CYP450 emzyme is the main metabolic enzymes of the drug, it is of important significance to study the regulation of CYP450 enzymes before and after the combined administration of Tangcao pill and EFV. Proteomics, due to its high throughout and high sensitivity, has been widely applied in CYP450 enzyme study. In this paper, liver microsomes were separated through differential centrifugation. Their proteins were separated through SDS-PAGE. The three protein bands that CYP450 enzymes were located were cut and identified by liquid chromatography tandem mass spectrometry. Totally 16 CYP450 isoenzymes were identified. Furthermore, in order to make a quantitative analysis on the effect of tang herb on CYP450 emzyme, the multiple reaction monitoring (MRM) technology based on MS was adopted. The CYP2C11 was selected based on the results of the mass spectrum identification of proteins. The characteristic polypeptides were obtained through searching Expasy blast database. The m/z of the fragment ions was less than 800. In the paper, the m/z of ion pairs of CYP2C11 were 711.5/232.1, 711.5/319.2, 711.5/466.2 and 711.5/595.3, and the m/z of ESAT-6 (internal standard, IS) were 735.5/215.3, 735.5/389.3, 735.5/460.3 and 735.5/524.3. The relative peak (analyte/IS) area was adopted for the relative quantitative analysis. Compared with the EFV single administration group, the EFV and Tangcao pill combined administration group showed a 1.6-fold increase in CYP2C11. The results of the paper indicated that Tangcao pill may affect drug metabolism by regulating metabolic enzymes such as CYP2C11, but the specific mechanism still unknown.
Animals ; Cytochrome P-450 Enzyme System ; chemistry ; genetics ; metabolism ; Drugs, Chinese Herbal ; administration & dosage ; Electrophoresis, Polyacrylamide Gel ; Male ; Microsomes, Liver ; chemistry ; drug effects ; enzymology ; Proteomics ; Rats ; Rats, Sprague-Dawley

Objective To investigate the protective role of FDP to STZ induced islest apoptosis and the potential mechanisms.Methods The pancreases of the rats were treated to collect islets cells.The cells were incubated with STZ with/or FDP.Cell morphology,insulin secretion,HO-1 activity,CO content,SOD activity,GSH-px activity,iNOS activity were examined.No conetent and apoptotic percentage was detected.Results HO-1 activity and CO content of the normal control group were low.STZ induced a significant decrease of cell activity and insulin release,flow cytometry analysis showed that apoptotic percentage of islet cells remarkably increased following the addition of STZ,FDP obviously improved the islets cellular activity damaged by STZ,basic amount of insulin secretion and stimulated by high glucose were improved(P

Objective To evaluate the curative effect of microwave ablation (MWA) for solitary hepatocellular carcinoma (HCC) sized less than 5 cm,and to discuss the prognosis and its influence factors.Methods The clinical data of 603 HCC patients,who were admitted to authors' hospital during the period from 2011 to 2013 to receive MWA,were retrospectively analyzed.The patients were followed up till March 2016.Results According to the inclusion criteria,a total of 603 patients were enrolled in this study.Complete ablation of HCC lesions was obtained in 5.8％ of patients (35/603).No statistically significant difference in complete ablation rate existed between each other among groups of different tumor diameter (P=0.056).The incidence of severe complications was 1.7％ (10/603).The median survival time was (59.6±1.9)months,while the 1-,2-and 3-year overall survival rates were 94.7％,81.9％ and 71.8％ respectively.In terms of overall survival rate,no statistically significant difference existed between groups of different age as well as between groups of different tumor diameter (P=0.225 and P=0.777 respectively),but statistically significant difference existed between groups of different sex as well as between groups of different recurrence interval (P=0.029 and P＜0.001 respectively).Univariate and multivariate analysis showed that gender,preoperative albumin level and recurrence interval were the factors influencing overall survival rate (P=0.035,P=0.006 and P＜0.001 respectively).Conclusion For the treatment of solitary HCC sized less than 5 cm,MWA has reliable curative effect,it is a safe and minimally-invasive therapy for HCC.The overall survival rate between patients with different age or between patients with different HCC size is not obviously different.The gender,preoperative albumin level and recurrence interval are independent factors that affect the overall survival rate.

This study is to investigate the effects of aqueous extract of Schisandra chinensis Baill (WWZ), kadsurin, schisandrin A, schisandrin B and schisandrol B on rat hepatic CYP3A. Rats received a daily gavage of aqueous extract of WWZ for different times. The livers were harvested after gavage and subjected to microsome preparation. Microsomal CYP3A activity was determined by measuring the amount of the metabolite of testosterone (6 beta-hydroxytestosterone) with HPLC. Aqueous extract of WWZ, kadsurin and schisandrin A were incubated with microsomes obtained from rat. Microsomal CYP3A activity was determined by HPLC. Primary hepatocytes were separated and extracted from rat, then were treated with aqueous extract of WWZ, schisandrin A, schisandrin B and schisandrol B. Then, the expression of CYP3A1 mRNA was analyzed by RT-PCR. As for the in vivo assay, aqueous extract of WWZ significantly inhibited the enzyme activity of CYP3A after 12 h gavage. The inhibitory effect was converted to inductive effect after 3-day gavage. Aqueous extract of WWZ could induce the enzyme activity of CYP3A after 6-day gavage. Aqueous extract of WWZ and kadsurin showed a dose-dependent inhibition of CYP3A (IC50 of 487.8 microg mL(-1) and 6.2 micromol L(-1), separately). In rat primary hepatocytes, aqueous extract of WWZ (2.5 mg mL(-1)), schisandrin A (0.1 micromol L(-1)), schisandrin B (0.1 micromol L(-1)) and schisandrol B (10 micromol L(-1)) increased significantly the expression of CYP3A1 mRNA by 23%, 55%, 42% and 27%, respectively. Aqueous extract of WWZ could show dual effect on the enzyme activity of CYP3A in rat in vivo. Meanwhile, kadsurin showed a dose-dependent inhibition of the enzyme activity of hepatic CYP3A in vitro. And schisandrin A, schisandrin B and schisandrol B showed significant inductive effect on the expression of rat CYP3A1 mRNA.
Animals ; Cyclooctanes ; administration & dosage ; isolation & purification ; pharmacology ; Cytochrome P-450 CYP3A ; genetics ; metabolism ; Dioxoles ; administration & dosage ; isolation & purification ; pharmacology ; Dose-Response Relationship, Drug ; Drugs, Chinese Herbal ; administration & dosage ; isolation & purification ; pharmacology ; Hepatocytes ; drug effects ; enzymology ; Inhibitory Concentration 50 ; Lignans ; administration & dosage ; isolation & purification ; pharmacology ; Male ; Microsomes, Liver ; enzymology ; Plants, Medicinal ; chemistry ; Polycyclic Compounds ; administration & dosage ; isolation & purification ; pharmacology ; RNA, Messenger ; metabolism ; Rats ; Rats, Sprague-Dawley ; Schisandra ; chemistry

Background: Percutaneous radiofrequency ablation (RFA) is a first-line treatment for very-early-stage hepatocellular carcinoma (HCC), whereas the efficacy of percutaneous microwave ablation (MWA) for very-early-stage HCC remains unclear. The purpose of this study was to clarify this issue by comparing the safety and efficacy of percutaneous MWA with percutaneous RFA in treating very-early-stage HCC. Methods: Clinical data of 460 patients who were diagnosed with very-early-stage HCC and treated with percutane-ous MWA or RFA between January 2007 and July 2012 at the Eastern Hepatobiliary Surgery Hospital, The Second Mili-tary Medical University, in Shanghai, China were retrospectively analyzed. Of these 460 patients, 159 received RFA, 301 received MWA. Overall survival (OS), recurrence-free survival (RFS), local tumor progression (LTP), complete ablation, and complication occurrence rates were compared between the two groups, and the prognostic factors associated with survival were analyzed. Results: No significant differences were observed between the two groups in terms of the 1-, 3-, or 5-year OS rates (99.3%, 90.4%, and 78.3% for MWA vs. 98.7%, 86.8%, and 73.3% for RFA, respectively;P= 0.331). Furthermore, no signif-icant differences were observed between the two groups in terms of the corresponding RFS rates (94.4%, 71.8%, and 46.9% for MWA vs. 89.9%, 67.3%, and 54.9% for RFA, respectively;P= 0.309), the LTP rates (9.6% vs. 10.1%,P= 0.883), the complete ablation rates (98.3% vs. 98.1%,P= 0.860), or the occurrence rates of major complications (0.7% vs. 0.6%,P= 0.691). By multivariate analysis, LTP, antiviral therapy, and treatment of recurrence were independent risk fac-tors for OS (P < 0.001), and the alpha-fetoprotein level was an independent prognostic factor for RFS (P= 0.002). Conclusions: MWA is as safe and effective as RFA in treating very-early-stage HCC, supporting MWA as a first-line treatment option for this disease.