Objective To compare the efficacy and safety of lauromacrogol injection sclerotherapy with ethanol injection sclerotherapy in treating simple liver cysts. Methods A total of 166 patients with simple liver cyst were randomly divided into the lauromacrogol group (study group, n=86) and the absolute alcohol group (control group, n=80). Under ultrasonographic guidance, puncture aspiration of liver cyst was carried out in all patients, which was followed by injection of lauromacrogol for patients in the study group or injection of ethanol for patients in the control group. The therapeutic effect and the side-effect were evaluated. The results were compared between the two groups. Results No serious complications such as bleeding or infection occurred in both groups. During the therapeutic course , 45 patients (56.3%) in the control group felt pain to some degree and 23 patients (28.8%) developed drunk-like symptoms, while no patient in the study group felt any obvious discomfort. One week after sclerotherapy , 20 patients (25%) in the control group complained of distending pain on the right upper abdomen, while only 9 patients (10.5%) in the study group complained of pain, and the difference was statistically significant (χ2= 6.073, P < 0.05). Six months after the treatment, the cure rate of the study group and the control group was 95.7%and 93.5%respectively, and the difference between the two groups was no significant (P > 0.05). Conclusion For the treatment of liver cysts, lauromacrogol injection is safe and effective. Therefore, this technique should be recommended in clinical practice.

Background and purpose:A variety of measures are taken preoperatively to reduce the tumor size of stageⅠb2 bulky cervical cancer before surgery. Which one is safer and more effective, currently, there is no consensus. This article compared the effect in 3 different treatment methods (neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy and operation) on patients with stageⅠb2 bulky cervical cancer, and provided evidence for clinical decision. Methods:Retrospective analysis the clinical date of 133Ⅰb2 bulky cervical cancer patients, who received preoperative neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy and direct operation from Apr. 2006 to Oct. 2010 in our hospital. Results: The effective rates of neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy group were 91.8% and 92.5%, respectively, there was no statistical difference(P>0.05). The tumor size got smaller after treatment compared with the size before treatment (P<0.05);The pathological efifciency rates were 95.56%and 97.30%, respectively, the difference was not statistically significant (P>0.05). The bleeding volume of neoadjuvant chemo radio therapy group was significantly higher than those in the other 2 groups (158.9±50.7 vs 116.8±45.5, 123.1±30.2;P<0.05), the infection of immediate surgery group was more severe than the other 2 groups (P<0.05). The pairwise comparison of average operation time in neoadjuvant chemotherapy group, neoadjuvant chemoradiotherapy group, and the immediate surgery group, pairwise comparisons of neoadjuvant chemotherapy group and the immediate surgery group in bleeding, comparion of neoadjuvant chemotherapy group and neoadjuvant chemoradiotherapy group on postoperative infection, and the comparison of the 3 groups on pelvic organ injury and lymphocele, had no statistical difference(P>0.05);Pathological examination showed that vascular invasion in surgery group had statistical differences than other 2 groups (P<0.05), there was no patient with positive margin in the 3 groups, and the lymph node metastasis rates also had no statistical difference (P>0.05);Besides, there were no statistical difference on vascular invasion between the 3 groups (P>0.05);And on 3-year overall survival, disease-free survival there was no statistical difference between the 3 groups (P>0.05). Conclusion:Neoadjuvant chemotherapy can effectively reduce tumor size for patients with stage Ⅰb2 bulky cervical cancer before operation, it is better than direct surgery or preoperative chemoradiotherapy in improving the resection rate, and reducing postoperative pathological positive rate, and infection. Neoadjuvant chemotherapy can improve the pathological complete remission rate. The combination of radiation and chemotherapy might produce synergistic effect on huge cervical tumor, but it can’t improve the survival rate. Therefore, neoadjuvant chemotherapy is the best choice for the stageⅠb2 cervical cancer patients. Therefore, a long-term follow-up or large sample randomized controlled trials is necessary to assess the prognosis of preoperative neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy.

Objective: To evaluate the effect of levonorgestrel-releasing intrauterine system (LNG-IUS) plus oral megestrol acetate (MA) as fertility-preserving treatment in patients with early-stage endometrial cancer (EEC). Methods: In this single-center, phase II study with open-label, randomized and controlled design, young patients (18–45 years) diagnosed with primary EEC were screened, who strongly required fertility-preserving treatment. Patients were randomly assigned (1:1) into MA group (160 mg oral daily) or MA (160 mg oral daily) plus LNG-IUS group. Pathologic evaluation on endometrium retrieved by hysteroscopy was performed every 3 months. The primary endpoint was complete response (CR) rate within 16 weeks of treatment. The secondary endpoints were CR rate within 32 weeks of treatment, adverse events, recurrent and pregnancy rate. Results: Between July 2017 and June 2020, 63 patients were enrolled and randomly assigned. Totally 56 patients (26 in MA group; 28 in MA + LNG-IUS group) were included into primary-endpoint analyses. The median follow-up was 31.6 months (range, 3.1–94.0). No significant difference in 16-week CR rate were found between MA and MA + LNG-IUS groups (19.2% vs. 25.0%, p=0.610; odds ratio=1.40; 95% confidence interval=0.38–5.12), while the 32-week CR rates were also similar (57.1% and 61.5%, p=0.743), accordingly. More women in MA + LNG-IUS group experienced vaginal hemorrhage (46.4% vs. 16.1%; p=0.012) compared with MA group. No intergroup difference was found regarding recurrence or pregnancy rate. Conclusion Compared with MA alone, the addition of LNG-IUS may not improve the early CR rate for EEC, and may produce more adverse events instead.

Objective:To analyze the hemodynamic changes of different types of unruptured intracranial aneurysms before and after flow diverter (FD) treatment with computational fluid dynamics (CFD), and lay research foundation for precision treatment and prognosis evaluation for unruptured intracranial aneurysms.Methods:Four patients with different types of unruptured intracranial aneurysms, admitted to Department of Neurosurgery, First Affiliated Hospital of Air Force Medical University from January 2022 to March 2022, were chosen. Digital subtraction angiography (DSA) data of the patients before and immediately after surgery were collected. Morphological and hemodynamic parameters of the aneurysms were calculated by 3D reconstruction, finite element simulation, and CFD methods: ostium ratio (OsR), neck ratio (NR), area ratio (ArR), volume ratio (VoR), wall shear stress (WSS), normalized wall shell stress (NWSS), blood inflow, relative inflow, aneurysm average velocity, parent artery average velocity, normalized velocity, residual flow volume (RFV), and inflow concentration index (ICI); differences of these indexes before and after treatment were compared.Results:The OsR of 6 aneurysms was 0.225, 0.267, 0.265, 0.389, 1.000, 1.000, respectively; NR was 1.220, 0.274, 1.090, 1.587, 2.809, and 4.019, respectively; ArR was 0.608 and 0.224, 0.623, 3.462, 1.225 and 1.784, respectively; and VoR was 0.386, 0.052, 0.212, 3.462, 0.422 and 1.882, respectively. The parameters of WSS, NWSS, blood inflow, relative inflow, aneurysm average velocity, parent artery average velocity, normalized velocity, RFV, and ICI decreased obviously after FD implantation.Conclusion:On the basis of 3D reconstruction combined with FD/coil virtual implantation, CFD-based hemodynamic analysis can obtain accurate parameters of different types of intracranial aneurysms before and after FD treatment.

Objective:To summarize the experience of surgical treatment of primary liver cancer.Methods:The clinical data of 10 966 surgically managed cases with primary liver cancer, from January 1986 to December 2019 at Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University, were retrospectively analyzed. The life table method was used to calculate the survival rate and postoperative recurrence rate. Log‐rank test was used to compare the survival process of different groups, and the Cox regression model was used for multivariate analysis. In addition, 2 884 cases of hepatocellular carcinoma(HCC) with more detailed follow‐up data from 2009 to 2019 were selected for survival analysis. Among 2 549 patients treated with hepatectomy, there were 2 107 males and 442 females, with an age of (56.6±11.1) years (range: 20 to 86 years). Among 335 patients treated with liver transplantation, there were 292 males and 43 females, with an age of (51.0±9.7) years (range: 21 to 73 years). The outcomes of hepatectomy versus liver transplantation, anatomic versus non-anatomic hepatectomy were compared, respectively.Results:Of the 10 966 patients with primary liver cancer, 10 331 patients underwent hepatectomy and 635 patients underwent liver transplantation. Patients with liver resection were categorized into three groups: 1986－1995(712 cases), 1996－2008(3 988 cases), 2009?2019(5 631 cases). The 5‐year overall survival rate was 32.9% in the first group(1986－1995). The 5‐year overall survival rate of resected primary liver cancer was 51.7% in the third group(2009‐2019), among which the 5‐year overal survival rates of hepatocellular carcinoma, intrahepatic cholangiocarcinoma and mixed liver cancer were 57.4%, 26.6% and 50.6%, respectively. Further analysis was performed on 2 549 HCC patients with primary hepatectomy. The 1‐, 3‐, 5‐, and 10‐year overall survival rates were 88.1%, 71.9%, 60.0%, and 41.0%, respectively, and the perioperative mortality rate was 1.0%. Two hundred and forty‐seven HCC patients underwent primary liver transplantation, with 1‐, 3‐, 5‐, and 10‐year overall survival rates of 84.0%, 64.8%, 61.9%, and 57.6%, respectively. Eighty‐eight HCC patients underwent salvage liver transplantation, with the 1‐, 3‐, 5‐, and 10‐year overall survival rates of 86.8%, 65.2%, 52.5%, and 52.5%, respectively. There was no significant difference in survival rates between the two groups with liver transplantation ( P>0.05). Comparing the overall survival rates and recurrence rates of primary hepatectomy (2 549 cases) with primary liver transplantation (247 cases), the 1‐, 3‐, 5‐, and 10‐year overall survival rates in patients within Milan criteria treated with hepatectomy and transplantation were 96.3%, 87.1%, 76.9%, 54.7%, and 95.4%, 79.4%, 77.4%, 71.7%, respectively ( P=0.754). The 1‐, 3‐, 5‐year recurrence rates were 16.3%, 35.9%, 47.6% and 8.1%, 11.7%, 13.9%, respectively( P<0.01). The 1‐, 3‐, 5‐, 10‐year overall survival rates in patients with no large vessels invasion beyond the Milan criteria treated with liver resection and transplantation were 87.2%, 65.9%, 53.0%, 33.0% and 87.6%, 71.8%, 71.8%, 69.3%, respectively( P=0.003); the 1‐, 3‐, 5‐year recurrence rate were 39.2%, 57.8%, 69.7% and 29.7%, 36.7%, 36.7%, respectively ( P<0.01). The 1‐, 3‐, 5‐, and 10‐year overall survival rates in patients with large vessels invasion treated with liver resection and transplantation were 62.1%, 36.1%, 22.2%, 15.0% and 62.9%, 31.8%,19.9%, 0, respectively ( P=0.387); the 1‐, 3‐, 5‐year recurrence rates were 61.5%, 74.7%, 80.8% and 59.7%, 82.9%, 87.2%, respectively( P=0.909). Independent prognostic factors for both overall survival and recurrence‐free survival rates of HCC patients treated with liver resection included gender, neoadjuvant therapy, symptoms, AST, intraoperative or postoperative blood transfusion, tumor number, tumor size, cirrhosis, macrovascular invasion, microvascular invasion, and pathological differentiation. Propensity score matching analysis of 443 pairs further showed that there was no significant difference in overall survival rate between anatomical liver resection and non‐anatomical liver resection( P=0.895), but the recurrence rate of non‐anatomical liver resection was higher than that of anatomical liver resection( P=0.035). Conclusions:In the past decade, the overall survival rate of HCC undergoing surgical treatment is significantly higher than before. For HCC patients with good liver function reservation, surgical resection can be performed first, and salvage liver transplantation can be performed after recurrence. The effect of salvage liver transplantation is comparable to that of primary liver transplantation. As for the choice of liver resection approaches, non‐anatomical resection can reserve more liver tissue and can be selected as long as the negative margin is guaranteed.

Objective:To summarize the experience of surgical treatment of primary liver cancer.Methods:The clinical data of 10 966 surgically managed cases with primary liver cancer, from January 1986 to December 2019 at Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University, were retrospectively analyzed. The life table method was used to calculate the survival rate and postoperative recurrence rate. Log‐rank test was used to compare the survival process of different groups, and the Cox regression model was used for multivariate analysis. In addition, 2 884 cases of hepatocellular carcinoma(HCC) with more detailed follow‐up data from 2009 to 2019 were selected for survival analysis. Among 2 549 patients treated with hepatectomy, there were 2 107 males and 442 females, with an age of (56.6±11.1) years (range: 20 to 86 years). Among 335 patients treated with liver transplantation, there were 292 males and 43 females, with an age of (51.0±9.7) years (range: 21 to 73 years). The outcomes of hepatectomy versus liver transplantation, anatomic versus non-anatomic hepatectomy were compared, respectively.Results:Of the 10 966 patients with primary liver cancer, 10 331 patients underwent hepatectomy and 635 patients underwent liver transplantation. Patients with liver resection were categorized into three groups: 1986－1995(712 cases), 1996－2008(3 988 cases), 2009?2019(5 631 cases). The 5‐year overall survival rate was 32.9% in the first group(1986－1995). The 5‐year overall survival rate of resected primary liver cancer was 51.7% in the third group(2009‐2019), among which the 5‐year overal survival rates of hepatocellular carcinoma, intrahepatic cholangiocarcinoma and mixed liver cancer were 57.4%, 26.6% and 50.6%, respectively. Further analysis was performed on 2 549 HCC patients with primary hepatectomy. The 1‐, 3‐, 5‐, and 10‐year overall survival rates were 88.1%, 71.9%, 60.0%, and 41.0%, respectively, and the perioperative mortality rate was 1.0%. Two hundred and forty‐seven HCC patients underwent primary liver transplantation, with 1‐, 3‐, 5‐, and 10‐year overall survival rates of 84.0%, 64.8%, 61.9%, and 57.6%, respectively. Eighty‐eight HCC patients underwent salvage liver transplantation, with the 1‐, 3‐, 5‐, and 10‐year overall survival rates of 86.8%, 65.2%, 52.5%, and 52.5%, respectively. There was no significant difference in survival rates between the two groups with liver transplantation ( P>0.05). Comparing the overall survival rates and recurrence rates of primary hepatectomy (2 549 cases) with primary liver transplantation (247 cases), the 1‐, 3‐, 5‐, and 10‐year overall survival rates in patients within Milan criteria treated with hepatectomy and transplantation were 96.3%, 87.1%, 76.9%, 54.7%, and 95.4%, 79.4%, 77.4%, 71.7%, respectively ( P=0.754). The 1‐, 3‐, 5‐year recurrence rates were 16.3%, 35.9%, 47.6% and 8.1%, 11.7%, 13.9%, respectively( P<0.01). The 1‐, 3‐, 5‐, 10‐year overall survival rates in patients with no large vessels invasion beyond the Milan criteria treated with liver resection and transplantation were 87.2%, 65.9%, 53.0%, 33.0% and 87.6%, 71.8%, 71.8%, 69.3%, respectively( P=0.003); the 1‐, 3‐, 5‐year recurrence rate were 39.2%, 57.8%, 69.7% and 29.7%, 36.7%, 36.7%, respectively ( P<0.01). The 1‐, 3‐, 5‐, and 10‐year overall survival rates in patients with large vessels invasion treated with liver resection and transplantation were 62.1%, 36.1%, 22.2%, 15.0% and 62.9%, 31.8%,19.9%, 0, respectively ( P=0.387); the 1‐, 3‐, 5‐year recurrence rates were 61.5%, 74.7%, 80.8% and 59.7%, 82.9%, 87.2%, respectively( P=0.909). Independent prognostic factors for both overall survival and recurrence‐free survival rates of HCC patients treated with liver resection included gender, neoadjuvant therapy, symptoms, AST, intraoperative or postoperative blood transfusion, tumor number, tumor size, cirrhosis, macrovascular invasion, microvascular invasion, and pathological differentiation. Propensity score matching analysis of 443 pairs further showed that there was no significant difference in overall survival rate between anatomical liver resection and non‐anatomical liver resection( P=0.895), but the recurrence rate of non‐anatomical liver resection was higher than that of anatomical liver resection( P=0.035). Conclusions:In the past decade, the overall survival rate of HCC undergoing surgical treatment is significantly higher than before. For HCC patients with good liver function reservation, surgical resection can be performed first, and salvage liver transplantation can be performed after recurrence. The effect of salvage liver transplantation is comparable to that of primary liver transplantation. As for the choice of liver resection approaches, non‐anatomical resection can reserve more liver tissue and can be selected as long as the negative margin is guaranteed.

Monoacylglycerol lipase (MAGL) is a pivotal enzyme in the endocannabinoid system, which metabolizes 2-arachidonoylglycerol (2-AG) into the proinflammatory eicosanoid precursor arachidonic acid (AA). MAGL and other endogenous cannabinoid (EC) degrading enzymes are involved in the fibrogenic signaling pathways that induce hepatic stellate cell (HSC) activation and ECM accumulation during chronic liver disease. Our group recently developed an ¹⁸F-labeled MAGL inhibitor ([¹⁸F]MAGL-4-11) for PET imaging and demonstrated highly specific binding in vitro and in vivo. In this study, we determined [¹⁸F]MAGL-4-11 PET enabled imaging MAGL levels in the bile duct ligation (BDL) and carbon tetrachloride (CCl₄) models of liver cirrhosis; we also assessed the hepatic gene expression of the enzymes involved with EC system including MAGL, NAPE-PLD, FAAH and DAGL that as a function of disease severity in these models; [¹⁸F]MAGL-4-11 autoradiography was performed to assess tracer binding in frozen liver sections both in animal and human. [¹⁸F]MAGL-4-11 demonstrated reduced PET signals in early stages of fibrosis and further significantly decreased with disease progression compared with control mice. We confirmed MAGL and FAAH expression decreases with fibrosis severity, while its levels in normal liver tissue are high; in contrast, the EC synthetic enzymes NAPE-PLD and DAGL are enhanced in these different fibrosis models. In vitro autoradiography further supported that [¹⁸F]MAGL-4-11 bound specifically to MAGL in both animal and human fibrotic liver tissues. Our PET ligand [¹⁸F]MAGL-4-11 shows excellent sensitivity and specificity for MAGL visualization in vivo and accurately reflects the histological stages of liver fibrosis in preclinical models and human liver tissues.