Objective To compare the primary treatment efficacy of radiofrequency ablation and surgical resection in patients with solitary hepatocellular carcinoma (HCC) which the diameter is ≤5 cm.Methods Databases were searched for comparative studies on radiofrequency ablatiom vs surgical resection published from 2005 to 2012.A Meta-analysis was performed using a randomized or fixed effect model to compare the treatment efficacy between radiofrequency ablatiom and surgical resection.Results Five studies fulfilled the criteria and were included.For HCC patients whose single tumors' diameter is ≤5 cm,radiofrequency ablation was equivalent to surgical resection for 1-,3-and 5-year overall survivals (P ＞ 0.05).However,surgical resection was superior to radiofrequency ablation in 1-,3-and 5-year disease-free survivals and there' s significant difference (P ＜ 0.05).Higher local recurrence rate was associated with radiofrequency ablation than surgical resection.Conclusions For HCC patients whose single tumors' diameter is ≤5 cm,radiofrequency ablation can achieve comparable overall survival as surgical resection,though with higher recurrence rate and lower disease-free survival.

Objective To investigate how SDF-1α and c-MYC protein regulates TACRl-Tr expression. Methods c-myc shRNA vector was constructed, small interfering RNA was employed for silencing c-myc gene in MCF-7 breast cancer cell. SDF-1α neutralized antibody was used in c-myc+ cell group and c-myc- cell group, while other c-myc+ cell group and c-myc- cells group were cultured under normal condition. The mRNA level of TACRl-Tr was determined by real-time PCR. Results c-myc shRNA vector was constructed successfully, in the normal presence of SDF-la, the level of TACRl-Tr mRNA in c-myc- cell group were lower than that in c-myc+ cell group( P < 0.05). But in the presence of SDF-la neutralized antibody, TACRl-Tr mRNA level of c-myc- cell group was higher than that of c-myc+ cell group(P < 0.05). Conclusion In the normal culture condition, c-MYC protein may transactivate TACRl-Tr transcription in MCF-7 cell, in the presence of SDF-1α neutral antibody, c-MYC protein lost the activity of transactivating for TACRl-Tr transciption.

Objective To invcstigate the value of preoperative imaging morphologic classification in solitary small hepatocellular carcinoma treated by RFA.Methods The clinical data of 73 patients with small hepatocellular carcinoma who rcccivcd radiofrequency ablation at the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January 2008 to December 2012 were analyzed retrospectively.The lesions were classified into three types according to gross appearance in preoperative contrast-enhanced computed tomography (CT):single nodular type (type 1);single nodular with extranodular growth type or confluent multinodular type (type 2);infiltrating type (type 3).Thc clinicopathological features of patients with 3 types of tumors were compared by statistical methods.Patients were followed up via outpatient examination and telephone interview up to August 2014 or death.Results There were 24 cases of type 1,35 cases of type 2,14 cases of type 3,and the proportion were 20.2％,32.9％,47.9％,19.2％,respectively.The preoperative alpha-fetoprotein of type 3 was significantly higher than othcr types.The disease-free survival time of the three types were (37.2 ± 3.3) months,(20.9 ± 4.0) months,(14.4 ±4.9) months.The prognosis of the irregular types (type 2,type 3) is poor than the regular types (type 1).The overall survival time were (72.5 ± 4.7) months,(66.2 ± 7.3) months,(31.2 ± 5.3) months.The type 3 was the worst.The results of univariate analysis showed that morphologic classification,preoperative AFP,tumor size were related factors affecting the prognosis of patients (P ＜ 0.05).The results of multivariate analysis showed that morphologic classification was the independent risk factors affecting the prognosis of patients (P ＜ 0.05).Conclusion The preoperative imaging morphologic classification is the independent risk factors affecting the prognoses of patients with small HCC,which is help to choose the best treatment for patients with small hepatocellular.

Radiofrequency ablation (RFA) has been playing an important role in the treatment of hepatocellular carcinoma (HCC). It is minimally invasive, easily repeatable and potentially curative. Many centers now accept it to be the best therapeutic choice for patients with early-stage HCC when liver transplantation or surgical resection is not suitable. In this article, we reviewed the indications, techniques , and clinical results of RFA in the treatment of HCC.Suitable patient selection, good pre-treatment planning,complete ablation, and careful post-treatment follow up are important. Techniques, such as artificial pleural effusion and ascites, contrast-enhanced ultrasonography-guided RFA,laparoscopic or open surgical approaches have reduced complications and expanded the indications for RFA.

AIM To investigate the inhibitory effect of paeonol on hydrogen peroxide(H2O2)-induced apoptosis in PC12 cells. METHODS The injury model in PC12 cells was generated by H2O2 treatment. The cell viability was determined using methylthiazolyl tetrazolium reduction assay. Apoptotic cells and reactive oxygen species (ROS) were measured by flow cytometry. Lactate dehydrogenase (LDH) activity and malonyldialdehyde (MDA) content were measured by spectroscope respectively. RESULTS After PC12 cells were treated with H2O2 (100 μmol*L-1) for 10 h,its viability obviously decreased, and apoptotic cells, LDH release into the culture media, ROS and MDA contents in PC12 cells significantly increased. When the cells were pretreated with paeonol (12, 25 and 50 μmol*L-1)for 1 h prior to incubation with H2O2, its viability was greatly increased, and apoptotic cells, LDH release, ROS and MDA contents significantly decreased. CONCLUSION Paeonol protects PC12 cells from H2O2-induced apoptosis and this effect is probably achieved through its antioxidative action.

Objective To investigate the expression of soluble triggering receptors expressed on myeloid cells-1 ( sTREM-1 ) in intraperitoneal drainage fluid of patients with abdorminal trauma and its predictive value for post-traumatic sepsis. Methods A total of 80 abdominal trauma patients were served as the trauma group and 25 patients treated with subtotal gastrectomy as the control group.Intraperitoneal drainage fluid sTREM-1,serum sTREM-1,procalcitonin (PCT) and C-reactive protein (CRP)at 0,24,48,72 hours after admission were determined in two groups for assessing their value in early prediction of post-traumatic sepsis. Results The levels of drainage fluid sTREM-1,serum sTREM-1,PCT and CRP in the trauma group were significantly higher than those in the control group (P ＜ 0.05 ).Drainage fluid sTREM-1 showed the area under the receiver operating characteristic (ROC) curve,sensitivity and specificity for 0.84,77％,and 83％ in the prediction of post-traumatic sepsis,which was superior to the serum sTREM-1,PCT and CRP. Conclusion Intraperitoneal drainage fluid sTREM-1 has high accuracy in predicting the sepsis in abdominal trauma patients.

Objective To investigate the expression of adiponectin in placenta and its correlation with preeclampsia.Methods Placental tissues were collected from normal term pregnancies(normal pregnancy group,n=20),mild preeclampsia(mild preeclampsia group,n=12)and severe preeclampsia (severe preeclampsia group,n=22).The expression of adiponectin protein and the intensity of its mRNA in placenta were detected using immunohistochemistry and RT-PCR,respectively.Integral optical density (IOD)which represents the expression level of adiponectin protein,and the ratio of adiponectin cDNA PCR products to β-actin cDNA PCR products which represents the intensity of transcription of adiponectin mRNA in placenta were analyzed.Results (1)The expression of adiponectin protein was observed in cytoplasm of placental cytotrophoblasts and syncytiotrophoblasts among three groups.There was no significant difference in adiponectin protein expression between maternal side and fetal side of placenta in three groups(all P＞0.05);(2)The expression of adiponectin protein in placenta in severe preeclampsia group(30 984 ±14 604)was significantly lower than that of mild preeclampsia group(58 360±8910,P＜0.01)and of normal pregnancy group(53 246±17 554,P＜0.01).There was also no significant difference in the expression of adiponeclln protein in placenta between term delivery and preterm delivery in severe preeclampsia group(38 890±20 386 vs 29 319±8997,P＞0.05),however,the expression of adiponectin protein in placenta in term delivery of severe preeclampsia group was significantly lower than that ofterm delivery of normlal pregnancy group(38 890±20 386 vs 53 246±17 554,P＜0.05);(3)The expression of adiponectin mRNA was detected in placental tissues among three groups also.The intensity of transcription of adiponectin in placenta in severe preeclampsia group(1.0±0.2)was markedly lower than that of mild preeclampsia group(2.9±0.8,P＜0.05)and normal pregnancy group(3.3±1.1,P=0.000).Conclusion The expression of adiponectin decreases in placenta tissues of severe preeclampsia,indicating that the abnormal expression of adiponectin may be involved in the pathogenesis of preeclampsia.

Objective To investigate the correlation between immediate postoperative platelet count with liver failure after partial hepatectomy in patients with hepatocellular carcinoma.Methods The clinical data of 71 patients with hepatocellular carcinoma who underwent liver resection at the Hepatopancreatobiliary Surgery Department of Nanjing Drum Tower Hospital from July 2013 to August 2015 were retrospectively analyzed.The clinical diagnosis was confirmed by pathology of the resected specimens.Based on postoperative platelet count within 2 h,the patients were divided into the low platelet count (PLT ＜ 100 × 109/L) group (n =24,33.8％) and the normal platelet count (PLT ≥ 100 × 109/L) group (n =47,66.2％).The correlations between immediate postoperative platelet count with serum indexes including serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil) and direct bilirubin (DBil) were analyzed,and the incidences of posthepatectomy liver failure was also evaluated in these two groups.Results There was no re-operation and perioperative death in this study.Among the 71 patients,25 patients (35.2％) developed postoperative complications (grade Ⅰ to Ⅲ),and 8 patients (11.3％) suffered from postoperative liver failure (grade A).When compared with the normal platelet count group,the low platelet count group had significantly increased risks of postoperative liver failure (29.2％ vs 2.1％,X2 =11.618,P ＜ 0.05),increased postoperative peaks of ALT,AST,TBil and DBil levels [(462.5 ±135.7)U/L vs (307.9 ± 192.6) U/L,(440.0 ± 163.3) U/L vs (265.8 ± 155.8) U/L,(29.5 ±9.1) μmol/L vs (17.9 ±8.8) μ mol/L,t =3.507,4.385,5.129,P ＜0.05,respectively] and longer normalization time of liver function.Multiple Logistic regression analyses revealed that an immediate postoperative low platelet count was an independent risk factor of posthepatectomy liver failure.Conclusions The platelet count was associated with the incidence of postoperative liver failure after partial liver resection in patients with hepatocellular carcinoma.Patients with an immediate postoperative low platelet count suffered from a high incidence of posthepatectomy liver failure and delayed liver function recovery.

Objective To evaluate the viability of residual tumor after insufficient thermal ablation of rabbit VX2 liver tumor and investigated the efficacy of sorafenib as an adjuvant therapy.Methods Twenty-one rabbits were implanted with VX2 tumor to establish orthotopic liver tumor models.They were allocated randomly into 3 groups:control (n =7),ablation (n =7),and combination treatment (n =7).Microwave coagulation therapy was conducted with 20 W for 1 min and viable tumor tissue remained at the periphery.A laparotomy was performed in the control group.Sorafenib was given at 20 mg/kg/d during the following 10 days in the combination treatment group,and saline was given to the control and ablation group.Tumor volume was recorded before and after treatment,immunohistochemistry detected CD31 and proliferating cell nuclear antigen (PCNA) expression,and the micro-vessel density (MVD) and proliferation index (PI) were calculated accordingly.Results Ten days after insufficient ablation,tumor volume of the ablation group was larger than that of the control group (P ＜0.05).The MVD and PI of residual tumor were higher compared with those of the control group (P ＜ 0.05).With adjuvant therapy of sorafenib after insufficient ablation,tumor volume showed a decrease on the 10th day compared with tumors undergoing insurfficient ablation alone (P ＜ 0.05).The MVD and PI of residual tumor were lower than those of the ablation group (P ＜0.05).Conclusion Insufficient thermal ablation promotes residual tumor progression,but adjuvant therapy of sorafenib serves as an effective way to suppress the overgrowth and neovasculation of the residual tumor.

Objective To review the important points in the preoperative assessment and the surgical technique in precise hepatic pedicle dissection in anatomical hepatic segmentectomy.Methods 104 patients who underwent anatomical hepatic segmentectomy were divided into two groups according to the different surgical approaches adopted in a prospective and non-randomized manner:the precise hepatic pedicle dissection group (the precise group,n=44) and the conventional hepatectomy group (the conventional group,n=60).The perioperative and follow-up data were analyzed.Patients who had primary liver cancer,including hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma,were analyzed separately.Results (1) There was no perioperative death in the two groups.There was no significant differences in blood loss and transfusion between the 2 groups of patients (P=0.069,0.208; t=1.844,1.266).There was a significantly higher rate of vascular inflow occlusion (P=0.001).There were significantly longer periods of vascular inflow occlusion and operative time (P=0.001,0.001; t=3.849,3.574) in the precise group.There was no significant difference in postoperative complications (P=0.988) and the duration of postoperative hospital stay (P=0.509;t=0.662) between the two groups.(2) In patients with primary liver cancer,there were no significant differences between the precise group (n=29) and the conventional group (n=41) in tumor margin positivity,vascular invasion and pathological staging (P=0.985,0.630,0.769).(3) All patients were followed up for two years.When compared with the conventional group,the disease-free survival (P=0.012),overall survival (P =0.006),and median survival (16.5 ± 4.5mo vs.7.8 ± 3.8mo)were significantly longer in the precise group.Conclusion Precise hepatic pedicle dissection had the same safety and efficacy as conventional method in partial hepatectomy.For primary liver cancer,precise hepatic pedicle dissection had better survival compared to the conventional method when the surgical margin was negative.