Objective To explore application value of photodynamic therapy (PDT) in treatment of unresectable hilar cholangiocarcinoma. Method The literatures about PDT in the treatment of the unresectable hilar cholangiocarcinoma in the PubMed, MedLine, Embase, CNKI, and Wanfang databases were reviewed. Results The PDT combined with stent or chemotherapy was the main method in the treatment of the unresectable hilar cholangiocarcinoma, which could make the tumor down-staging, obviously reduce the jaundice, improve the quality of life, improve the survival rate, prolong the stent patency and be treated repeatedly. Especially, it was suitable for the patients with elderly, poor health, intolerance of surgery, could partly replace the R1 or R2 operation of hilar cholangiocarcinoma and avoid the risk of surgery and postoperative complications. The therapeutic effective of the PDT was related to the early therapy and times of therapy. However, the shortcomes of the PDT were that the depth of killing tumor was not enough and there was a certain incidence of adverse reaction. Conclusions Therapeutic effect of PDT combine with stent or chemotherapy for unresectable hilar cholangiocarcinoma is better than that of single therapy. It is expected to be a first-line scheme of palliative treatment for unresectable hilar cholangiocarcinoma.
ObjectiveTo review the role of intestinal flora on the tumor microenvironment and the effect of both on the development of hepatocellular carcinoma (HCC), with a view to providing new ideas on the causes of HCC development and progression. MethodRelevant articles in the direction of intestinal flora and tumor microenvironment and HCC as well as the relationship between intestinal flora and tumor microenvironment in recent years were searched and summarized. ResultsThe tumor microenvironment played an important role in the occurrence, development and postoperative recurrence of HCC. The intestinal flora, as one of the important regulators of tumor microenvironment, could induce HCC by affecting the tumor microenvironment in addition to interacting with the liver through the gut-liver axis. ConclusionIntestinal flora can influence to HCC by regulating the tumor microenvironment, and its specific mechanism of action still needs to be further investigated, which can be a new direction for HCC research.
ObjectiveTo analyze factors affecting post-hepatectomy liver failure (PHLF) of patients with hepatocellular carcinoma (HCC) and explore value of combining albumin-bilirubin (ALBI) score with standardized future liver remnant (sFLR) in prediction of PHLF.MethodsThe clinical data of patients with HCC underwent curative hepatectomy in the Second and the Fifth Departments of General Surgery of the First Hospital of Lanzhou University from January 2016 to June 2018 were retrospectively reviewed. The risk factors of PHLF were identified through the logistic regression, the area under the receiver operating characteristic curve (AUC) was used to analyze the predictive value of the ALBI score, sFLR, or ALBI score×sFLR.ResultsA total of 72 patients with HCC were enrolled, all of them were the Child-Pugh A grade. The incidence of PHLF was 27.78% (20/72) in these 72 patients with HCC, which was 12.96% (7/54) and 72.22% (13/18) in the 54 patients with ALBI- Ⅰ grade and 18 patients with ALBI- Ⅱ grade respectively, the difference was statistically significant (P<0.001). The results of multivariable analysis of PHLF showed that the PLT (OR=0.030, P=0.018), ALBI grade (OR=11.758, P=0.020), and sFLR (OR=0.835, P=0.003) were identified as the independent predictors of PHLF. The AUC for the ALBI score×sFLR in predicting the PHLF was 0.892, it was greater than that of the ALBI score (AUC=0.799) or the sFLR (AUC=0.773).ConclusionCompared with Child-pugh grade, ALBI grade is more accurate in predicting PHLF of HCC patients, and combining ALBI score with sFLR is better than sFLR or ALBI score alone in predicting PHLF of patients with HCC.
Objective To evaluate safety and long-term efficacy of fully covered self-expandable mental stent (FCSEMS) in treatment of biliary stricture after liver transplantation (LT). Methods From January 2010 to June 2018, the data of patients with the biliary stricture after the LT underwent the endoscopic retrograde cholangiagraphy (ERCP) at the First Hospital of Lanzhou University were collected retrospectively. The therapeutic effect of the FCSEMS was evaluated. Results A total of 21 patients with the biliary stricture after the LT were treated. The success rate of the stent placement was 100%. The FCSEMSs were used in 7 cases and the only multiple plastic stents (MPSs) were used in 14 cases. There were no significant differences in the gender, age, time of biliary stricture, frequency of ERCP, recurrence time of biliary stricture, cure time of biliary stricture, curative effect, recurrence of biliary stricture, and incidence of complications between the patients treated with the FCSEMS and the MPS (P>0.050), but the number of plastic stents in the patients treated with the FCSEMS was significantly less than that in the patients treated only with the plastic stents (P<0.050), while the duration of stent retention was longer than that in the patients treated only with the plastic stents (P<0.050). Six patients were cured, 1 was remitted, and 2 were relapsed by the FCSEMS. Eight were cured, 3 were remitted, 3 were ineffective, and 5 were relapsed by the MPS alone. Conclusions FCSEMS might be an safe effective alternative to plastic stent in treatment of biliary stricture after LT, resulting in a longer duration placement, less number of plastic stent use. It is necessary to further accumulate cases to validate cure rate and recurrence rate of biliary stricture.
【Abstract】ObjectiveTo investigate the risk factors for acute lung injury(ALI) after orthotopic liver transplantation(OLT) and to explore the prevention and cure scheme.MethodsThe risk factors responsible for ALI in 4 patients undergoing OLT were analyzed with retrospective investigation.ResultsPortal pulmonary hypertension, longterm mechanical ventilation, severe infection, SIRS, hypercoagulability, overdose transfusion and kidney dysfunction were risk factors for ALI.ConclusionALI frequently occurred after OLT. Reducing and diminishing the risk factors is very important to avoid ALI after OLT.
目的 探讨胰腺恶性纤维组织细胞瘤的诊断及治疗。方法 对兰州大学第一医院收治的1例胰腺恶性纤维组织细胞瘤患者，结合国、内外文献对其临床特点，影像学、病理学及免疫组化特征、治疗和预后进行分析。结果 行胰腺肿瘤切除，术后医用直线加速器采取三维适形精确放疗，随访9个月，未见肿瘤复发。结论 胰腺恶性纤维组织细胞瘤恶性度高，易复发、转移，生存率低，诊断主要依靠病理和免疫组化检查。外科手术联合放射治疗可延长生存时间和延缓肿瘤的复发。
ObjectiveTo explore the expression of genes related to hepatocellular carcinoma (HCC) stem cells and their prognostic correlation by using weighted gene co-expression network analysis (WGCNA).MethodsFirstly, the transcriptome sequencing (RNA-seq) and clinical data of HCC were downloaded from the public database the Cancer Genome Atlas (TCGA), and the mRNA expression-based stiffness index (mRNAsi) table of cancer stem cells was downloaded and sorted out to analyze the relationship between mRNAsi and pathological grade and prognosis of HCC. The mRNAsi of HCC was downloaded and the prognostic value of mRNAsi was discussed. Then we used WGCNA to screen the key modules related to liver cancer stem cells (LSCS). Gene Ontology and the Kyoto Encyclopedia of Genes and Genomes were used for the functional and pathway enrichment analysis. The online database STRING was used to construct hub genes coding proteins interaction (PPI) network and screen key genes. Finally, the key genes were analyzed for expression differences and expression correlations. The online database Kaplan-Meier plotter was used for survival analysis and verified.ResultsmRNAsi was significantly upregulated in cancer tissues (P<0.001), and increased with the increase of pathological grade of HCC (P=0.001). The mortality rate of the higher mRNAsi group was higher than that of the lower mRNAsi group (P=0.006). GO analysis found that hub genes were mainly involved in biological processes, such as mitosis and DNA replication, and KEGG showed that hub genes were enriched in cell cycle, DNA mismatch repair, oocyte meiosis, and other signaling pathways. We screened 10 key genes (included CCNB1, CDC20, CDCA8, NDC80, KIF20A, TTK, CDC45, KIF15, MCM2, and NCAPG) related to mRNAsi of HCC based on WGCNA. The key genes were highly expressed in the tumor samples compared to the normal samples. In addition, there was a strong interaction between proteins of these key genes (P<0.05), a strong co-expression relationship at the transcriptional level, and all related to prognosis of HCC.ConclusionsmRNAsi plays an important role in the occurrence and development of HCC. Ten key genes related to LSCS were screened, which may act as therapeutic targets for inhibiting the stem cell characteristics of HCC.
【Abstract】Objective To study the correlation between focal adhesion kinase (FAK) expression and biological behavior of invasion and metastasis in gastric carcinoma. MethodsThe immunoreactivity of FAK was revealed by immunohistochemical method in gastric carcinoma tissues,canceradjacent tissues, normal gastric mucosa,and 200 regional lymph nodes in 50 collected specimens when radical resection of gastric carcinoma were carried out. ResultsThe percentage of FAK bly positive immunoreactivity were 10.0%（5/50）， 20.0%（10/50） and 78.0%（39/50） in normal gastric mucosa， cancer-adjacent tissues and gastric carcinoma tissues respectively. The b immunoreactivity was obviously higher in gastric carcinoma tissues than that in normal gastric mucosa or canceradjacent tissues (P＜0.01). There were no difference between normal gastric mucosa and canceradjacent tissues (Pgt;0.05). The percentage of bly positive immunoreactivity of FAK were 68.8%（22/32） and 33.3%（6/18） in cases with metastasis and without metastasis of lymph node respectively. The immunoreactivity of FAK in cases with metastasis of lymph node was significantly higher than that without metastasis of lymph node (P＜0.05).The b immunoreactivity of FAK were 87.2%（136/156） and 40.9%(18/44) in withmetastatic lymph node and withoutmetastatic lymph node. The immunoreactivity of FAK in withmetastatic lymph node was significantly higher than that withoutmetastatic lymph node （P＜0.01）. The percentage of FAK bly positive immunoreactivity showed correlation with the cellular differentiation and depth of infiltration of gastric carcinoma. The deeper infiltration and lower differentiation, the ber expression rate was obtained (P＜0.05), which showed no correlation with Borrmann type, location and size of tumor (Pgt;0.05). ConclusionIncreased immunoreactivity of FAK is an important role of invasion and metastasis for gastric carcinoma cells. Detection of FAK expression in cancer tissues can be helpful to understand the carcinogenic biological behavior of gastric carcinoma as well as to make judgment and treatment of prognosis of patients.