Objective To analyze the effect of different doses of esketamine and different time in-tervals on reducing propofol injection pain(PIP)before intravenous propofol using factorial design.Methods A total of 360 elective general anesthesia surgical patients,167 males and 193 females,aged 18-64 years,BMI 18-30 kg/m2,ASA physical status Ⅰ-Ⅲ were selected.Randomized numerical table method was used to divide the patients into three groups:esketamine 0.05 mg/kg(group A),esketamine 0.075 mg/kg(group B),and esketamine 0.1 mg/kg(group C),120 cases in each group.Each group was further randomly divided into 3 subgroups with 40 cases in each.Groups A1,A2,and A3 received intrave-nous propofol after induction of anesthesia with intravenous esketamine 0.05 mg/kg at intervals of 30 sec-onds,45 seconds,and 1 minute respectively.Groups B1,B2,and B3 received intravenous propofol after induction of anesthesia with intravenous esketamine 0.075 mg/kg at intervals of 30 seconds,45 seconds,and 1 minute respectively.Groups C1,C2,and C3 received intravenous propofol after induction of anesthe-sia with intravenous esketamine 0.1 mg/kg at intervals of 30 seconds,45 seconds,and 1 minute respective-ly.The McCririck scale was used to evaluate the occurrence of PIP.The induced dose of propofol,postoper-ative nausea and vomiting,respiratory amnesia,irritability,confusion,depressed and other adverse reactions were recorded.Results Comparison of the use of different doses of esketamine or different time intervals on the reduction of PIP showed a statistically significant difference respectively(P＜0.05).There was an interaction between different doses of esketamine and different intervals(P＜0.05).There were no significant differences in propofol induction dose and adverse reactions such as,postoperative nausea and vomiting,respiratory amnesia,irritability,confusion,depressed in nine groups of patients.Conclusion Compared with esketamine 0.05 and 0.1 mg/kg and intervals of 30 seconds and 1 minute,the use of esket-amine 0.075 mg/kg and intervals of 45 seconds followed by intravenous propofol is effective in suppressing PIP without the occurrence of significant adverse effects.

Conversion therapy has become the core in the treatment of borderline resectable or unresectable liver cancer, which provides resectable opportunities for more advanced liver cancer patients. In accordance with the first-choice treatment regimen recommended by the guidelines, the authors reported a successful case of Atezolizumab and Bevacizumab (T+A regimen) conversion therapy. The patient with initially borderline resectable advanced liver cancer was performed liver segment resection sucessfully after conversion therapy, and non-tumor recurrence was observed at postoperative 9 months. Postoperative pathological examination showed combined hepatocellular-cholangiocarcinoma, which also indicated the important value of T+A regimen in the conversion therapy of combined hepatocellular-cholangiocarcinoma.

Objective:To analyze the clinical features and prognosis of liver perivascular epithelioid cell neoplasms (PEComa).Methods:The clinical data of 12 patients with liver PEComa diagnosed by pathology at the First Affiliated Hospital of Xi 'an Jiaotong University from October 2011 to November 2021 were retrospectively analyzed. There were 1 male and 11 females, with a median age of 44 (range 20 to 63) years old. The clinical manifestations, laboratory examinations, imaging features, treatment methods, postoperative pathological features and treatment outcomes of these patients were collected and analysed. Postoperative follow-up by telephone or patient's follow-up records.Results:Among the 12 patients with hepatic PEComa, 8 patients (66.7%) were asymptomatic and 11 patients (91.7%) had a single lesion. All patients underwent surgical treatment, including local tumor resection in 10 patients (83.3%) and extended hemihepatectomy in 2 patients (16.7%). Enhanced CT showed the lesion to be a quasi-round homogeneous low-density mass, enhanced in arterial phase with hepatic artery branches in the lesion, and decrease in enhancement degrees in portal vein phase and delayed phase. Postoperative pathology of the lesions in all the 12 patients was benign. Immunohistochemical results showed that the positive rates of melanoma cell markers HMB45, Melan-A and smooth muscle actin were 100.0%(12/12), 83.3%(10/12) and 91.7%(11/12) respectively. The median follow-up period was 27 months, and no recurrence or metastasis was found.Conclusion:Hepatic PEComa occurred commonly in women with obscure symptoms. The lesion was mainly single and it had no correlation with hepatitis. It is easily confused with primary liver cancer and liver metastasis on medical imagings. PEComa expressed markers of both melanocyte and smooth muscle cell, and radical surgical resection resulted in good results.

【Objective】 To evaluate the safety and efficacy of rivaroxaban in preventing portal vein system thrombosis （PVST） in patients with liver cirrhosis after splenectomy and pericardial devascularization. 【Methods】 Totally 76 cirrhotic patients underwent splenectomy and pericardial devascularization were randomly assigned to rivaroxaban treatment group （n=38） or low-molecular weight heparin （LMWH） plus warfarin treatment group （n=38）. The experimental group was given rivaroxaban 10 mg orally， once a day， for 30 days. The control group was given subcutaneous injection of 5000 IU low molecular weight heparin （LMWH） twice a day for 5 days and warfarin （initial dose 2.5 mg） orally once a day for 30 days. Both groups were followed up for 1 year. We compared the two groups in the incidence of PVST， recovery of liver function and coagulation function， decompensation of liver function， incidence of liver cancer， and active bleeding. 【Results】 Totally 18 patients （47.4%） in rivaroxaban group developed PVST， compared with 29 patients （76.3%） in LMWH plus warfarin group （P=0.024）. The incidence of PVST during the first year after operation was significantly lower in rivaroxaban group than in LMWH plus warfarin group （F=7.852， P=0.007）. The intra-group comparisons versus baseline showed that the liver function improved from POD 21 to POM 1， and coagulation function improved from POM 2 in rivaroxaban group. In contrast， the liver function improved from POM 1 to POM 2， and coagulation function improved from POM 4 in LMWH plus warfarin group. The two groups did not significantly differ in liver function decompensation， incidence of liver cancer， or active bleeding （all P>0.05）. 【Conclusion】 The prophylactic use of rivaroxaban significantly decreases the incidence of PVST after splenectomy and pericardial devascularization in cirrhotic patients compared to LMWH plus warfarin treatment. Besides， rivaroxaban treatment is safe and effective and is associated with improved liver and coagulation functions than LMWH plus warfarin treatment.

OBJECTIVE:To study the influence of calcineurin gene polymorphism on the efficacy of cyclosporine A (CsA). METHODS:The blood samples of patients treated with CsA were collected. The trough blood concentration of CsA was detected by EMIT. The genotype of PPP3CA and PPP3CB was assayed by RFLP-PCR method. The expression of NFAT-regulated gene IL-2, IFN-γand GM-CSF were measured by RT-qPCR,which were used to define the index of indirect efficacy of CsA. The relationship of gene polymorphism with CsA efficacy was study by relationship analysis and multiple factor regression method,etc. RESULTS:A to-tal of 100 blood samples were collected. There was no significant correlation between the expression of CsA efficacy-related NFAT-reg-ulated gene GM-CSF and trough concentration of CsA(rGM-CSF=-0.04,P=0.238);the expression of IL-2 and IFN-γ were negatively correlated with trough concentration of CsA significantly(rIL-2=-0.384 3,P<0.001;rIFN-γ=-0.335 4,P<0.001). Using the average value of mRNA expression of IL-2 and IFN-γas indirect efficacy index,the polymorphism of PPP3CB rs3763679 site significantly in-fluenced the efficacy of CsA(P<0.05),but PPP3CA rs3804358 had no any effect on it(P>0.05). Stratified analysis showed that among patients with immune disease underwent renal transplantation,efficacy of patients with PPP3CB rs3763679 genovariation(TC+TT) were better than those with wild-type gene (CC)(P<0.05). After the efficacy was normalized by CsA trough concentration, multivariate analysis showed that normalized efficacy of CsA was negatively correlated with gender,PPP3CB rs3763679,lactate dehy-drogenase and creatinine significantly,but positively correlated with PPP3CA rs3804358,leucocyte count,usea nitrogen,glycerin trilaurate,etc. CONCLUSIONS:PPP3CB rs3763679 gene polymorphism influence the efficacy of CsA;among patients with immune disease underwent renal transplantation,efficacy of patients with PPP3CB rs3763679 TT+TC is better than that of CC type. At the same time,gender,PPP3CA rs3804358,leucocyte count,usea nitrogen,glycerin trilaurate and other factors all can influence the nor-malized efficacy of CsA to different extent. Multiple factors should be considered when using CsA.

Objective:To explore the effect of humanistic care on the quality of life and the negative emotion of patients with liver cancer operation. Methods: A total of 577 patients with liver cancer surgery were selected to participate in this study from January 2014 to December 2015 . From January 2014 to December 2014 , 288 cases of liver cancer patients were given routine nursing care as the control group. From January 2015 to December 2015, 289 patients were given humanistic care nursing as experimental group. The emotion of depression and anxiety were evaluated using Self-rating Depression Scale and Self-rating Anxiety Scale, the quality of life was evaluated with the core scale of life quality measurement system for cancer patients, while sleep quality with the Pittsburgh Sleep Quality Index. Results:Both depression and anxiety score of the subjects in experimental group were lower than those in the control group(P<0. 05). Physical function, cognitive function, social function, emotional function, role function, and overall health status of the subjects in the experimental group were higher than those in the con-trol group (P<0. 05), while pain, tiredness, nausea, vomiting, shortness of breath, insomnia, diarrhea, loss of appetite, constipation, economic difficulties and other score were statistically lower than those in the control group (P<0. 05). The subjects′quality of life of in the experimental group was better than those in the control group(P<0 . 05 ) , but the sleep index score was lower in the experimental group ( P<0 . 05 ) . Conclusion: Humanistic care nursing can effectively reduce the negative emotions of patients with liver cancer surgery, and thus to improve the quality of life.

OBJECTIVETo investigate the expression of mucin 15 (MUC15) in hepatocellular carcinoma and explore its association with the prognosis of patients.

METHODSThe expression of MUC15 was detected by quantitative RT-PCR and Western blotting in liver cell line L02, liver cancer cell lines HepG2, MHCC-97H, and SMMC-7721, and in 122 HCC and corresponding adjacent non-tumor liver tissues. The association of MUC15 expression in HCC tissues with the clinical parameters and the patients' survival was analyzed.

RESULTSThe 1iver cell line L02 showed significantly higher MUC15 expression level than the liver cancer cell lines HepG2, MHCC-97H, and SMMC-7721 (P<0.05). The expression level of MUC15 was markedly lower in the HCC tissues than in the adjacent non-tumor liver tissues (P<0.05). MUC15 expression in the HCC tissues was significantly correlated with the tumor TNM stage, intrahepatic or lymphatic metastasis, portal vein thrombosis and tumor differentiation (P<0.05). Kaplan-Meier survival analysis suggested that a low MUC15 expression was associated with a poor clinical prognosis of the patients.

CONCLUSIONThe expression of MUC15 is correlated with the clinicopathological features and prognosis of HCC patients, and may potentially serve as a novel prognostic marker for HCC.

Carcinoma, Hepatocellular ; metabolism ; Cell Line, Tumor ; Hep G2 Cells ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms ; metabolism ; Lymphatic Metastasis ; Mucins ; metabolism ; Neoplasm Staging ; Prognosis

Objective To investigate the expression of mucin 15 (MUC15) in hepatocellular carcinoma and explore its association with the prognosis of patients. Methods The expression of MUC15 was detected by quantitative RT-PCR and Western blotting in liver cell line L02, liver cancer cell lines HepG2, MHCC-97H, and SMMC-7721, and in 122 HCC and corresponding adjacent non-tumor liver tissues. The association of MUC15 expression in HCC tissues with the clinical parameters and the patients' survival was analyzed. Results The 1iver cell line L02 showed significantly higher MUC15 expression level than the liver cancer cell lines HepG2, MHCC-97H, and SMMC-7721 (P<0.05). The expression level of MUC15 was markedly lower in the HCC tissues than in the adjacent non-tumor liver tissues (P<0.05). MUC15 expression in the HCC tissues was significantly correlated with the tumor TNM stage, intrahepatic or lymphatic metastasis, portal vein thrombosis and tumor differentiation (P<0.05). Kaplan-Meier survival analysis suggested that a low MUC15 expression was associated with a poor clinical prognosis of the patients. Conclusion The expression of MUC15 is correlated with the clinicopathological features and prognosis of HCC patients, and may potentially serve as a novel prognostic marker for HCC.

Objective To investigate the expression of mucin 15 (MUC15) in hepatocellular carcinoma and explore its association with the prognosis of patients. Methods The expression of MUC15 was detected by quantitative RT-PCR and Western blotting in liver cell line L02, liver cancer cell lines HepG2, MHCC-97H, and SMMC-7721, and in 122 HCC and corresponding adjacent non-tumor liver tissues. The association of MUC15 expression in HCC tissues with the clinical parameters and the patients' survival was analyzed. Results The 1iver cell line L02 showed significantly higher MUC15 expression level than the liver cancer cell lines HepG2, MHCC-97H, and SMMC-7721 (P<0.05). The expression level of MUC15 was markedly lower in the HCC tissues than in the adjacent non-tumor liver tissues (P<0.05). MUC15 expression in the HCC tissues was significantly correlated with the tumor TNM stage, intrahepatic or lymphatic metastasis, portal vein thrombosis and tumor differentiation (P<0.05). Kaplan-Meier survival analysis suggested that a low MUC15 expression was associated with a poor clinical prognosis of the patients. Conclusion The expression of MUC15 is correlated with the clinicopathological features and prognosis of HCC patients, and may potentially serve as a novel prognostic marker for HCC.

Objective To investigate the efficacy of concomitant precise hemihepateetomy for the treatment of hilar cholangiocarcinoma.Methods The clinical data of 38 patients with hilar cholangiocarcinoma who received concomitant precise hemihepatectomy at the First Affiliated Hospital of Xi'an Jiaotong University from January 2009 to October 2012 were retrospectively analyzed.All patients were examined by B ultrasonography,computed tomography (CT),magnetic resonance cholangiopancreatography (MRCP) and CT angiography (CTA)preoperatively.The hepatic function was tested before operation.Of the 7 patients with obstructive jaundice,5 received percutaneous transhepatic cholangial drainage,and 2 received endoscopic nosalbiliary drainage.Surgical procedures were determined according to the results of imaging examination.The resection of hilar cholangiocarcinoma,postoperative histopathological examination,pre-and postoperative hepatic function and prognostic indicators were analyzed.The count data and measurement data were analyzed using the chi-square test and t test,respectively; the survival curve was drawn by Kaplan-Meier method,and the survival rate was analyzed using the Log-rank test.COX proportion hazards model was used for multivariate analysis.Results The positive rates of B ultrasonography,CT and MRCP were 65.8％ (25/38),71.1％ (27/38) and 89.5％ (34/38),respectively.The results of 5 patients who received CTA were positive.Concomitant left hemihepatectomy was performed on 28 patients,concomitant right hemihepatectomy on 10 patients; concomitant caudate lobectomy on 22 patients,concomitant resection and reconstruction of portal vein on 4 patients (including 1 patient who received left hepatic vein repair),concomitant hepatic artery resection on 12 patients (including 3 patients who received hepatic artery reconstruction).Of the 38 patients,R0 resection was performed on 32 patients,R1 resection on 4 patients,R2 resection on 2 patients.Hepatic function indicators including total bilirubin,direct bilirubin,alkaline phosphatase,gamma-glutamyl-transferase,alanine aminotransferase and aspartate aminotransferase were significantly decreased after operation (t =7.799,8.445,5.697,6.633,4.469,4.140,P ＜ 0.05).Two patients died perioperatively,with the mortality rate of 5.3％ (2/38).The main postoperative complications included bile leakage and hepatic function insufficiency,with the incidences of 28.9％ (11/38) and 21.1％ (8/38),respectively.Postoperative histopathological findings included 31 patients with invasive adenocarcinoma,5 patients with nodular adenocarcinoma,1 patient with mucinous adenocarcinoma and 1 patient with adenosquamous carcinoma.The overall 1-,2-,3-year survival rates were 66％,37％ and 21％,and the median survival time was 22.0 months.There were significant differences in the survival rates between patients who received R0 resection and those with R1/R2 resection,and between patients with N0 and N1/N2 stage (x2 =4.516,10.397,P ＜ 0.05).The results of multivariate analysis showed that positive margin and lymph node metastasis were prognostic indicators.Conclusions Concomitant precise hemihepatectomy has significantly improved the radical resection rate and the efficacy of treatment for hilar cholangiocarcinoma.Comprehensive preoperative imaging examination and hepatic function test are important for the assessment for resectability of hilar cholangiocarcinoma.Selective preoperative biliary drainage are key points to decrease postoperative morbidity and morality.