Objective To study the distribution of genotypes of hepatitis C virus in Guizhou and its relationship between infec-tious route of genotype and age ,gender was analyzed .Methods Serum specimens in this study were obtained from 198 patients , whose anti-HCV and HCV RNA were positive .A reverse transcriptase PCR(RT nested-PCR)assay using conserved primers de-duced from the core-envelope 1(C-E1)region of the hepatitis C virus(HCV)genome was employed to amplify a 474-nucleotide-long fragment .Phylogenetic analysis of the C-E1 sequences was conducted by direct sequencing of the RT-PCR products and alignment with published HCV subtypes in GenBank .Subtypes of the samples were determined by nucleotide sequencing followed by composi-tion of a phylogenetic tree .Results Among the 198 patients surveyed ,genotype 1a was detected in 4 cases(2 .0% ) ,genotype 1b in 71 cases(35 .9% ) ,genotype 2a in 9 cases(4 .6% ) ,genotype 3a in 29 cases(14 .7% ) ,genotype 3b in 47 cases(23 .7% ) ,genotype 6 a in 37 cases(18 .7% )and genotype 6d in 1 cases(0 .5% ) .Genotype distribution on gender had no statistical significance(P>0 .05) , and its distribution on people with different ages had statistical significance(P<0 .05) ,and its distribution on patients with different infectious routes was significantly different(P<0 .05) .Conclusion The major genotypes of HCV are 1b ,3b ,6a and 3a in Guizhou , and genotype 1a is predominant .Genotypes 1a ,2a and 6d exist too .Genotypes of patients infected with HCV are related to their in-fectious routes ,and the HCV genotypes are in a great variety .

ObjectiveTo perform preoperative planning, virtual resection, and risk assessment for patients to be treated by hepatectomy using the liver hepatic image analysis system (IQQA-Liver) and to evaluate the effect and feasibility of three-dimensional (3D) image reconstruction in assisting liver surgery planning. MethodsA retrospective analysis was performed on 32 patients who underwent 3D imaging-assisted preoperative planning from July 2012 to July 2014. The full/residual liver volume was calculated; intrahepatic duct reconstruction was performed; the scheme and extent of surgical removal were simulated. The efficacy of reconstruction and the feasibility of surgical plan were evaluated. ResultsSurgery was completed according to the 3D imaging-assisted preoperative plan in 29 (90.63%) of the 32 patients. After operation, biliary fistula occurred in 1 case, pleural effusion in 3 cases, and ascites in 3 cases. All patients were discharged safely with a mean hospital stay of 13±4 d. ConclusionThe 3D image reconstruction of the liver contributes to individualized operation and improves the certainty of surgery though intuitive understanding of the location of the tumor and its anatomic relationship with surrounding vessels and bile ducts or virtual liver surgery.

Objective To screen and validate the prognostic biomarkers of patients with hepatocelluar carcinoma (HCC) based on reverse phase protein array (RPPA).Methods All public RPPA data (HCC patients) in TCGA database before December 2017 were enrolled in this study.Univariate and multivariate Cox analysis were used to screen the target proteins with prognostic value.From January 2013 to January 2014,121 HCC patients who were treated in the Affiliated Hospital of North Sichuan Medical College were enrolled in the study.Prognostic related proteins screened from RPPA data were detected in these patients' tumor specimen.Then,the correlations between the expression of the screened protein and prognosis was further analyzed.Results In the 218 protein,23 was related with HCC patient prognosis.Multivariate Cox regression analysis showed that high expression of NOTCH1 (HR=1.515,95％ CI:1.287～1.845,P＜0.05) and high expression of AKT1 (HR=1.119,95％ CI:1.033～ 1.203,P＜0.05) increased the risk of death,while high expression of NF2 (HR=0.865,95％ CI:0.783～0.956,P＜0.05) decreased the risk of death.The results of clinical data analysis indicated that there were significant differences of NOTCH1,AKT1 and NF2 level between HCC and adjacent tissue.Further survival analysis revealed that high expression of NOTCH1 and AKT1 were significantly associated with poor prognosis.The expression of NF2 was correlated with prognosis,but the difference was not statistically significant (P＞0.05).Conclusion RPPA,as a high throughput protein expression quantitative technique,can be used for screening prognostic markers,and the reliability of the screening results is higher in general.

Objective:To explore the difficulties and surgical decision of laparoscopic technique in patients with complicated hepatolithiasis.Methods:The clinical data of 13 patients with complicated hepatolithiasis who underwent laparoscopic hepatectomy at Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College from December 2019 to December 2020 were collected. There were 3 males and 10 females with average age of 50.8 years (range: 14 to 67 years). All patients had upper abdominal pain and a history of cholecystectomy, 4 of them had fever.Seven cases underwent laparoscopic left hemihepatectomy+bile duct exploration, 2 cases underwent laparoscopic right hemihepatectomy+bile duct exploration, 2 cases underwent laparoscopic quadrate hepatectomy (liver 4B+Part 5)+hilar cholangioplasty+bile duct exploration, 2 cases underwent laparoscopic quadrate lobe resection (liver 4B+Part 5)+cholangioplasty+cholangiojejunostomy. All patients were re-examined with abdominal ultrasound and choledochoscope 3 months after operation.Results:The median operation time was 5.2 hours (range: 3.6-6.5 hours), blood loss was 278 ml (range: 120-580 ml). During the operation, 1 case had duodenal bulb injury, and the defect area was about 1.0 cm × 1.2 cm. After timely detection, the defect area was carefully evaluated and trimmed. Absorbable suture was used to suture duodenal bulb, and gastrojejunostomy was performed after repair. One case had small intestinal serosa injury, which was intermittently sutured and embedded with absorbable suture. All the patients recovered smoothly without death. Three months after the operation, 12 patients completed abdominal ultrasound and T-tube sinus choledochoscopy. Residual stones were found in 3 patients, stones were removed in 2 patients by T-tube sinus choledochoscopy 3 months after the operation, 1 patient was still in the recovery period (within 3 months after surgery). No residual stones were found in the remaining 10 patients.Conclusion:The three key laparoscopic techniques in operation of complex hepatolithiasis: adhesiolysis and porta hepatis exposure, laparoscopic hepatectomy, and laparoscopic choledochojejunostomy are very important.

Objective:To explore the difficulties and surgical decision of laparoscopic technique in patients with complicated hepatolithiasis.Methods:The clinical data of 13 patients with complicated hepatolithiasis who underwent laparoscopic hepatectomy at Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College from December 2019 to December 2020 were collected. There were 3 males and 10 females with average age of 50.8 years (range: 14 to 67 years). All patients had upper abdominal pain and a history of cholecystectomy, 4 of them had fever.Seven cases underwent laparoscopic left hemihepatectomy+bile duct exploration, 2 cases underwent laparoscopic right hemihepatectomy+bile duct exploration, 2 cases underwent laparoscopic quadrate hepatectomy (liver 4B+Part 5)+hilar cholangioplasty+bile duct exploration, 2 cases underwent laparoscopic quadrate lobe resection (liver 4B+Part 5)+cholangioplasty+cholangiojejunostomy. All patients were re-examined with abdominal ultrasound and choledochoscope 3 months after operation.Results:The median operation time was 5.2 hours (range: 3.6-6.5 hours), blood loss was 278 ml (range: 120-580 ml). During the operation, 1 case had duodenal bulb injury, and the defect area was about 1.0 cm × 1.2 cm. After timely detection, the defect area was carefully evaluated and trimmed. Absorbable suture was used to suture duodenal bulb, and gastrojejunostomy was performed after repair. One case had small intestinal serosa injury, which was intermittently sutured and embedded with absorbable suture. All the patients recovered smoothly without death. Three months after the operation, 12 patients completed abdominal ultrasound and T-tube sinus choledochoscopy. Residual stones were found in 3 patients, stones were removed in 2 patients by T-tube sinus choledochoscopy 3 months after the operation, 1 patient was still in the recovery period (within 3 months after surgery). No residual stones were found in the remaining 10 patients.Conclusion:The three key laparoscopic techniques in operation of complex hepatolithiasis: adhesiolysis and porta hepatis exposure, laparoscopic hepatectomy, and laparoscopic choledochojejunostomy are very important.

Objective To systematically review the effectiveness of perioperative oral probiotics in hepatic resection patients,and provide evidence-based clinical evidence.Methods PubMed,Cochrane Library,Web of Science,EMbase,SinoMed,WanFang Data,CNKI and VIP databases were electronically searched to collect randomized controlled trials(RCTs)on perioperative oral probiotics in hepatectomized patients from inception to June 30,2023.Two reviewers independently screened literature,extracted data and assessed the risk of bias of the included studies.Meta-analysis was performed by RevMan 5.4 software.Results A total of 10 RCTs were included,including 715 patients.The Meta-analysis showed that compared to placebo or blank controls,the incidence of postoperative infections in oral probiotic patients(RR=0.60,95％CI 0.48 to 0.74,P＜0.001),serum endotoxin levels(MD=-0.88,95％CI-1.53 to-0.22,P=0.009),cumulative antibiotic use(MD=-1.48,95％CI-2.17 to-0.78,P＜0.001),AST levels(MD=-9.68,95％CI-11.36 to-8.01,P＜0.001),ALT levels(MD=-21.24,95％CI-34.81 to-7.68,P=0.002),TBiL levels(SMD=-0.70,95％CI-0.95 to-0.45,P＜0.001),CRP levels(SMD=-0.52,95％CI-0.91 to-0.13,P=0.009),procalcitonin levels(MD=-0.19,95％CI-0.32 to-0.05,P=0.006),IL-6 levels(MD=-7.30,95％CI-14.26 to-0.33,P=0.04),and the first flatus time(MD=-1.16,95％CI-1.51 to-0.82,P＜0.001),hospital stay(MD=-0.62,95％CI-0.83 to-0.41,P＜0.001),hospitalisation costs(SMD=-0.65,95％CI-0.95 to-0.34,P＜0.001)were lower.Conclusion Current evidence shows that perioperative oral probiotics can significantly reduce the postoperative infection rate and decrease the release of inflammatory factors in liver resection patients,promote the recovery of postoperative hepatic and gastrointestinal functions,and shorten the length of hospital stay and costs.Due to the limited quality and quantity of the included studies,more high quality studies are needed to verify the above conclusion.

Patients with end-stage liver disease after liver transplantation constantly suffer from malnutrition due to primary diseases and transplantation-related factors. Malnutrition will worsen clinical condition of the patients, increase the incidence of complication, length of hospital stay and medical expense after transplantation, and lower the survival rate. Sufficient nutritional support at all stages of liver transplantation is of significance. Accurate assessment of nutritional status and timely intervention are prerequisites for perioperative nutritional treatment in liver transplantation. In this article, the latest nutritional risk screening indexes and evaluation tools, nutritional support methods and other perioperative nutritional intervention measures for liver transplantation were reviewed, aiming to deepen the understanding and cognition of perioperative nutritional therapy for liver transplantation and provide reference for improving nutritional status and clinical prognosis of liver transplant recipients.

Objective:To explore the regulation of macrophage polarization and its effects on liver cancer invasion, metastasis and apoptosis by CCAAT/enhancer binding protein δ (CEBPD).Methods:THP-1 stable transfected cells with knockdown CEBPD (shCEBPD) and negative control shNC were constructed by lentviral transfection technique. THP-1 transfected cells were induced into macrophages, lipopolysaccharide (LPS) and interferon γ(IFNγ) by phorbol 12-tetradecanoate 13-acetate (PMA), and then the polarized macrophages were further induced to M1 type. The quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect M1 type macrophage related interleukin 1β (IL-1β) genes, IL-6, tumor necrosis factor α (TNFα), and inducible nitric oxide synthase (iNOS) mRNA expression level. Flow cytometry was used to detect M1 macrophage-specific surface marker CD80 expression levels. M1-induced macrophages were co-cultured with liver cancer MHCC97H cells using Transwell non-contact small sized co-culture dishes. MHCC97H cells invasion and metastasis were detected by Transwell and scratch assay under co-culture conditions, and the MHCC97H cells apoptosis was detected by flow cytometry.Results:The mRNA expression levels of M1 macrophage marker genes iNOS, TNFα, IL-6 and IL-1β in THP-1 derived macrophages were decreased after CEBPD knockdown. M1 macrophage-specific surface marker CD80 expression levels were decreased (23.7% ± 2.1% and 62.5% ± 2.0%, t = 9.58, P < 0.05). THP-1 were co-cultured with MHCC97H in shCEBPD and shNC group, respectively. Compared with shNC group, the invasion [(158.0 ± 3.5) and (75.0 ± 4.5), t = 39.87, P < 0.01] and metastatic ability (54.6% ± 1.5% and 24.3% ± 1.0%, P < 0.01) of MHCC97H cells co-cultured in shCEBPD group were stronger and the apoptosis rate was reduced [(9.4% ± 1.0%) vs. (23.7% ± 1.2%), t = 12.68, P < 0.01]. Conclusion:CEBPD can inhibit the invasion and metastasis and increase the apoptosis by amplifying M1 type macrophages polarization in liver cancer cells.

Objective To investigate the clinical effect of transhepatic arterial chemoembolization(TACE)combined with tyrosine kinase inhibitors(TKIs)and programmed death receptors-1(PD-1)inhibitors(TACE+TKIs+PD-1 antibody)in the treatment of moderate advanced unresectable hepatocellular carcinoma(HCC).Methods The clinical data of 65 patients with moderate advanced unresectable hepatocellular carcinoma admitted to the Affiliated Hospital of North Sichuan Medical College from January 2020 to January 2022 were analyzed retrospectively.65 patients were treated with TACE+TKIs+PD-1 antibody.The observation indexes were tumor response,objective response rate(ORR),disease control rate(DCR),total survival time,progression free survival time,conversion operation rate and adverse drug reaction.Results The ORR of 65 p-atients with hepatocellular carcinoma was 49.2％(32/65),and the DCR was 89.2％(58/65).Among them,there were 2 patients with complete remission(CR),30 patients with partial remission(PR),26 patients with stable disease(SD),and 7 patients with progression disease(PD).Among 65 patients with hepatocellular carcinoma,18 patients were transformed into resectable hepatocell-ular carcinoma and underwent RO surgery.The conversion rate was 27.6％(18/65).65 patients were followed up for 3 to 22.4 months,The median follow-up time was 16.5 months.The median overall survival time and median disease progression free survival time of 65 patients were 14.5 months(95％CI:12.3～16.6 months)and 8.8 months(95％CI:6.9～10.6 months),respectively.After treatment,65 patients all had post embolism syndrome(abdominal pain,fever,nausea,vomiting and other symptoms),and some patients had transient abnormal liver function.Adverse drug reactions below grade 3 recovered within a few days.Some patients were associated with multiple adverse drug reactions.1 patient(1.5％)stopped using TACE because of stubborn vomiting,and 5 patients(7.6％)stopped using Lenvatinib because of severe liver function damage during treatment,2 patients(3％)stopped using Camrelizumab because of severe reactive capillary hyperplasia,one patient(1.5％)stopped using Tislelizumab because of severe hypothyroidism,one patient(1.5％)stopped the treatment of Lenvatinib and Sintilimab due to severe gastrointestinal bleeding.The adverse drug reactions of grade 3～4 occurred in other patients were alleviated after drug reduction,symptomatic treatment and hormone treatment.Conclusion TACE+TKIs+PD-1 antibody can obtain reliable clinical efficacy and anti-tumor activity in the treatment of moderate advanced unresectable hepatocellular carcinoma.

Objective:To investigate the influence of lymphadenectomy on efficacy of patients with intrahepatic cholangiocarcinoma (ICC) at different locations.Methods:The retro-spective cohort study was conducted. The clinicopathological data of 123 patients with ICC who were admitted to the Affiliated Hospital of North Sichuan Medical College from January 2015 to January 2022 were collected. There were 78 males and 45 females, aged 55(rage, 50?60)years. All patients underwent radical resection. Observation indicators: (1) clinical characteristics of patients with ICC; (2) follow-up; (3) surgical situations in ICC patients with different number of lymph nodes dissected. Measurement data with normal distribution were represented as Mean± SD, and compari-son between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Kaplan-Meier method was used to draw survival curve and Log-Rank test was used for survival analysis. Results:(1) Clinical characteristics of patients with ICC. Of the 123 patients, 81 cases had peripheral ICC and 42 cases had central ICC. The albumin-bilirubin grade (grade 1, grade 2?3), preoperative lymph node metastasis risk assessment (low risk, high risk), the number of lymph nodes dissected (<6, ≥6), lymph node metastasis (positive, negative) were 57, 24, 51, 30, 49, 32, 15, 66 in patients with peripheral ICC, versus 19, 23, 17, 25, 14, 28, 16, 26 in patients with central ICC, showing significant differences in the above indicators between them ( χ2=7.40, 5.66, 8.17, 5.62, P<0.05). (2) Follow-up. All the 123 patients were followed up for 28(range, 21?38)months. The 3-year overall survival rate was 57.8% in the 81 patients with peripheral ICC, versus 32.3% in the 42 patients with central ICC, showing a significant difference between them ( χ2=5.98, P<0.05). Of the 42 patients with central ICC, there were 25 cases with high risk of lymph node metastasis before surgery and 17 cases with low risk of lymph node metastasis before surgery. Of the 25 central ICC patients with high risk of lymph node metastasis before surgery, the 3-year overall survival rate was 28.9% in the 18 cases with the number of lymph nodes dissected ≥6, versus 14.3% in the 7 cases with the number of lymph nodes dissected <6, showing a significant difference between them ( χ2=8.90, P<0.05). (3) Surgical situa-tions in patients with the different number of lymph nodes dissected. Of the 123 patients, cases with the number of lymph nodes dissected <6 and ≥6 were 63 and 60, and there was no significant difference in the operation time, intraoperative blood transfusion, postoperative complications, bile leakage, liver insufficiency, pulmonary infection, pleural effusion, abdominal effusion, or lymphatic leakage between them ( P>0.05). One patient might have multiple complications. Conclusions:The prognosis of patients with peripheral ICC is better than that of patients with central ICC. For patients with central ICC who are at high risk of lymph node metastasis before surgery, adequate lymph node dissection may result in a better prognosis.