Abstract:Objective: To investigate a method of liver functional reserve estimation suitable for Chinese patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) before hepatectomy. Methods: The clinical data of 129 consecutive patients with HBV-related HCC undergoing partial hepatectomy were retrospectively analyzed, and then the specificities and sensitivities of three classical methods of liver functional reserve estimation for predicting posthepatectomy hepatic failure were compared. Results: Of the patients, 13 cases (10%) developed liver failure and one died in hospital. The proportion of patients undergoing major hepatectomy, age and indocyanine green retention rate at 15 min (ICGR15) of the group with liver failure were significantly higher than those in the other group with good recovery of liver function (all P<0.05). The Decision Tree and the ICGR15 method had significant value for liver functional reserve estimation (both P<0.01). The sensitivity, specificity, the positive predictive value and the negative predictive value of decision tree method were 95%, 84%, 64% and 98%, respectively, which were all better than those of ICGR15 method. Conclusion: The Decision Tree is a suitable method for liver functional reserve estimation before hepatectomy in patients with HBV-related HCC.

Abstract:Objective: To investigate the safety and efficacy of surgical treatment in hepatocellular carcinoma (HCC) combined with moderate/severe portal hypertension (PHT). Methods: From January 2005 to December 2011, 247 patients with HCC-PHT who met the criteria were designated to undergo simple hepatectomy (none, mild or moderate PHT) or undergo hepatectomy plus azygos-portal disconnection. The laboratory parameters and postoperative risk factors such as hepatic encephalopathy, ascites, gastric ulcer and recurrent bleeding between the two groups were compared and analyzed. Results: Compared with the simple hepatectomy group, the postoperative liver function recovery and the incidence of hepatic encephalopathy, ascites, gastric ulcer and recurrent bleeding in the combination surgery group showed no significant difference (all P>0.05), but the postoperative white blood cell (WBC) and platelet counts significantly increased, and the long-term risk of recurrent bleeding significantly decreased in the combination surgery group (all P<0.05). Conclusion: The synchronous operation is a safe and effective method for treatment of HCC with severe PHT. It can improve the quality of life in this subset of patients but does not increase the surgical mortality and postoperative complications.

Abstract:Objective: To evaluate the safety and efficacy of Glissonean pedicle transection method for anatomic mesohepatectomy. Methods: According to frequency-matching principle, 51 patients with central liver tumors were randomly designated to undergo liver resection with conventional procedure (n=30) or Glissonean pedicle transection method (n=21). The operative time, intraoperative blood loss, postoperative liver function, length of hospital stay, incidence of complications and outcomes between the two groups were compared. Results: By comparison with the conventional group, Glissonean pedicle transection group had decreased operative time [(2.7±0.839) h vs. (4.5±0.952) h], reduced intraoperative bleeding [ (406±33.182) mL vs. (793±29.677) mL], fast recovery of liver function [ALT value on postoperative day (POD) 7: (63.048±7.513) U/L vs. (323.667±12.939) U/L], and shortened length of hospital stay [(12.528±0.245) d vs. (16.733±0.338) d], as well as lowered incidence of postoperative complications (14.2% vs. 40%) and 1-year tumor recurrence rate [4.8% (1/21) vs. 26.7% (8/30) ]. All the differences between the two groups had statistical significance (all P<0.05). Conclusion: Glissonean pedicle transection method for anatomic mesohepatectomy is safe, effective, minimally invasive, and is recommended for general use.

Abstract:Objective: To investigate the long-term efficacy of postoperative transcatheter hepatic artery embolization (TAE) in non-shock patients with spontaneously ruptured hepatocellular carcinoma (HCC). Methods: The clinicopathologic and follow-up data of 162 non-shock patients with spontaneously ruptured HCC undergoing surgical resection were collected. The factors affecting prognosis were determined by univariate and multivariate analysis. The patients were divided into two groups according to whether they received postoperative TAE or not, and the survival difference between the two groups were compared by Kaplan-Meier method. Results: Univariate analysis indicate that the tumor diameter (P=0.008), liver cirrhosis (P=0.03), tumor location (P=0.028) and treatment method (P=0.012) were related to the prognosis of the non-shock patients with spontaneously ruptured HCC. Multivariate analysis suggested that the tumor diameter (HR=1.954, 95%CI=1.691-5.526, P=0.007), liver cirrhosis (HR=1.544, 95%CI=1.003-2.000, P=0.041), tumor location (HR=1.785, 95%CI=1.023-3.114, P=0.026) and treatment method (HR=1.692, 95%CI=1.131-2.533, P=0.011) were independent risk factors affecting the prognosis of the non-shock patients with spontaneously ruptured HCC. Survival analysis demonstrated that the patients undergoing postoperative TAE had a better prognosis than that of the patients undergoing surgery only (P<0.001). Conclusion: Postoperative TAE can improve the prognosis of the non-shock patients with spontaneously ruptured HCC.

Abstract:Objective: To investigate the efficacy of B ultrasound-guided cryocycle microwave in adjuvant therapy for advanced liver cancer. Methods: One hundred and sixty-four consecutive patients with advanced liver cancer were randomly allocated either to study group or control group, with 82 cases in each group. Patients in both groups underwent embolization therapy, and then the patients in study group received, additionally, the B ultrasound-guided cryocycle microwave treatment. Results: Of the patients in study group, complete response was achieved in 12 cases, partial response was obtained in 40, stable disease was seen in 10 cases, progressive disease occurred in 20 cases, and overall response rate was 63.4% (52/82), while these parameters in control group occurred in 8, 22, 22, 30 cases and 36.6% (30/82), respectively. The efficacy in study group was better than that in control group and the overall rates between the two groups had statistical significance (χ2=5.760, P<0.05). The tumor deactivation rate was 97.6% in study group and 81.7% in control group, and the difference had statistical significance (χ2=6.852, P<0.05). All the patients had abdominal pain on the day after treatment, which disappeared without further special treatment, and no serious complications such as gastrointestinal perforation occurred in any of the patients. Conclusion: B ultrasound-guided cryocycle microwave combined with embolization therapy for advanced liver cancer is safe, effective and applicable, and deserves to be widely used.

Abstract:Objective: To investigate the diagnosis and treatment of hepatocellular carcinoma (HCC) with fever as main symptom. Methods: The clinical data of 10 HCC patients with fever as main symptom recently admitted to our hospital were retrospectively analyzed. Results: Of the 10 patients, 4 cases were diagnosed with HCC, but 6 cases had been misdiagnosed as liver abscess by other hospitals and were given anti-infective treatment for a long time. All of the patients received aggressive management and their temperatures were effectively controlled after admission. Six patients underwent transcatheter arterial chemoembolization (TACE) and 4 patients underwent surgical treatment. One patient died 2 weeks after surgery. The follow-up data suggested a poor general prognosis. The other 9 cases died between 2 months and 1 year after treatment. Conclusion: HCC with fever as main symptom should be differentiated from liver abscess, and surgical resection is the first choice for treatment of these patients.

Abstract:Objective: To analyze the degradome of extracellular proteins of hepatocellular carcinoma (HCC) cell line HCCLM3 through proteomic techniques, so as to screen a marker for HCC. Methods: Extracellular proteins of HCCLM3 were resolved by polyacylamide gel electrophoresis (PAGE), and were then identified by using Linear Ion Trap Quadrupole-Fourier Transform-Mass Spectrometry (LTQ-FT-MS/MS) after in-gel digestion. The degradome was analyzed through on-line database searching combined with molecular weight information. The osteopontin (OPN) expression in the plasma of healthy subjects, hepatitis B, hepatitis B-caused cirrhosis and HCC patients were quantified by Western blot method. Results: The HCCLM3 extracellular proteins were resolved into 51 bands and 1 405 non-redundant proteins were identified, Among which 474 proteins were degradated, and the secretory proteins had the highest degradation ratio (50%). The serum level of 20-kD fragment of OPN was significantly higher in HCC patients than that in other three populations. The receiver operating characteristic (ROC) showed the area under curve (AUC) of AFP for HCC diagnosis was 0.79 and 20-kD fragment of OPN was 0.68, respectively, and the combination of the two could raise the AUC to 0.89. Conclusion: The combination use of gel electrophoresis and MS is an effective and feasible approach to investigate the HCC degradome. The 20-kD fragment of OPN may be a potential marker for HCC diagnosis.

Abstract:Objective: To observe the homing of mesenchymal stem cells (MSCs) transfected with adenovirus containing mouse CXCR4 gene to the injured liver. Methods: The mouse MSCs were isolated, expanded in vitro and then identified. The target CXCR4 gene was obtained from mouse liver, and the adenovirus vector Ad-mCXCR4 was constructed by homologous recombination and identified. MSCs were transfected with Ad-mCXCR4, with the MSCs transfected with empty vector Ad-vector or without transfection serving as controls, and the CXCR4 protein expression in each cell group was determined by Western blot analysis. Mice were randomly divided into three groups after the establishment of CCl4-induced liver damage, and then, the Ad-mCXCR4 transfected MSCs, Ad-vector transfected MSCs or non-transfected MSCs were injected into the mice through tail vein, respectively. At 48 h after injection, the MSCs homing signals from the injured liver tissues of each group were detected by laser confocal microscopy. Results: Recombinant adenovirus vector Ad-mCXCR4 was constructed successfully. The MSCs transfected with Ad-mCXCR4 presented a strong CXCR4 expression, while the MSCs transfected with Ad-vector or without transfection had no CXCR4 expression. No green fluorescent protein-positive cells were noted in the liver of mice injected with non-transfected MSCs, and the number of green fluorescent protein-positive cells in the liver of mice injected with Ad-mCXCR4-MSCs was significantly higher than that of mice injected with Ad-vector-MSCs [(21.25±1.56) vs. (5.42±0.81)] (P<0.01). Conclusion: CXCR4 expression can be elevated in MSCs by gene modification technique and the homing of CXCR4-overexpressing MSCs to the injured liver is enhanced.

Abstract:Objective: To observe the epithelial-mesenchymal transition (EMT) and alterations in invasive and metastatic ability of hepatocellular carcinoma (HCC) cells under hypoxic conditions. Methods: Two human HCC cell lines with different invasive and metastatic ability (SMMC-7721 and HepG2) were selected to establish the physical hypoxia models through hypoxic cultures (1% O2). The morphological changes of both cells under hypoxic condition were monitored. After hypoxia treatment, the expression of epithelial-specific protein E-cadherin and mesenchymal-specific protein vimentin in the both types of HCC cells were measured by Western blot method, and the migratory and invasive abilities of the both types of HCC cells were assessed by using Transwell chamber. Results: Under hypoxic condition, both types of HCC cells changed from initially confluent epithelioid to scattered spindle pattern; Western blot showed that the expression levels of E-cadherin in both types of cells were significantly decreased (both P<0.01) while their vimentin levels were significantly increased (both P<0.01); Transwell chamber results indicated that the migratory and invasive abilities of both types of HCC cells were significantly enhanced under hypoxic system (all P<0.01); and all the above changes were more evident in SMMC-7721 cells than those in HepG2 cells (all P<0.01). Conclusion: Hypoxia can induce EMT process in HCC cells and enhance their invasive and migratory ability.

Abstract:Objective: To investigate the therapeutic effect of in vitro amplified bone marrow c-Kit+Lin? (CD117) cells transplantation on hepatic fibrosis in mice. Methods: The bone marrow c-kit+Lin? cells of mice were isolated and purified by using magnetic-activated cell sorting (MACS), and then the cells were cultured and expanded in the serum-free medium supplemented with hepatocyte growth factor (HGF), stem cell factor (SCF), FLt-3 ligand (FL), thrombopoietin (TPO) and leukemia inhibitory factor (LIF). The models of alcohol induced hepatic fibrosis were created in mice of the same strain, and the model mice were treated with CD117 cells (transplantation group) or buffer solution of the same volume (model group) by tail vein injection respectively, and the normal mice were used as control (normal group). Thirty days later, the pathological changes of liver and the parameters concerning liver function and hepatic fibrosis of each group were assessed. Results: The CD117 cells were effectively expanded in the serum-free medium supplemented with the above mentioned factors. No pathological alteration was noted in the liver of normal mice, while the liver of model group presented remarkable hepatocyte degeneration and fibrotic changes, and these alterations were obviously alleviated in transplantation group compared with model group. In both model and transplantation groups, the serum levels of alanine transaminase (ALT), aspartate transaminase (AST), hyaluronic acid (HA) and laminin (LN) increased, and albumin (ALB) decreased with varying degrees compared with normal group, but the alterations of the above parameters in transplantation group were all milder than those in model group, and all differences had statistical significances (all P<0.05). Conclusion: CD117 cells can be effectively expanded in vitro by the proper combination of cytokins (HGF, SCF, FL, TPO and LIF). CD117 cells transplantation has therapeutic effect on hepatic fibrosis in mice.

Abstract:

Objective: To investigate the protective effects of two different preconditioning methods, namely the classical ischemic preconditioning (IPC) and limb ischemic preconditioning (LIPC), on liver ischemia/reperfusion injury in rabbits with cirrhosis and their possible mechanisms. Methods: Rabbit model of liver cirrhosis was induced by subcutaneous injection of CCl4-olive oil solution. Subsequently, the cirrhotic rabbits were randomly divided into the sham operation group, hepatic I/R group (I/R group), IPC + hepatic I/R group (IPC group) and LIPC + hepatic I/R group (LIPC group), with 7 rabbits in each group. The hepatic I/R model was produced by occlusion of hepatic inflow for 30 min and then reperfusion for 2 h, IPC was induced by a 10-min hepatic occlusion and 10-min reperfusion just before I/R procedure, and LIPC was elicited by 3 cycles of 5-min occlusion and 5-min reperfusion of the unilateral hind limb using a tourniquet 24 h before I/R. The liver samples of each group were obtained after 2-h reperfusion, then histopathological examination was performed, and level of endotholin 1 (ET-1) and expression of heat shock protein 70 (HSP70) in the liver tissues were detected by ELISA and Western blot, respectively. Results: Compared with sham operation group, all other groups presented degeneration, hydrops and inflammatory cell infiltration of varying degrees on the basis of cirrhosis, but these pathological changes in both IPC and LIPC groups were obviously milder than those in I/R group, and were similar between IPC and LIPC group. Compared with sham operation group, the ET-1 levels and HSP70 expressions in liver tissues of other groups all significantly increased (all P<0.05), but in both IPC and LIPC groups, the ET-1 levels were significantly lower and the HSP70 expression were significantly higher than that in I/R group (all P<0.05), while these two indexes had no significant differences between IPC and LIPC group (both P<0.05). Conclusion: Both LIPC and IPC have protective effect against I/R injury of the cirrhotic liver. There is no significant difference in the protective intensity of the 2 methods.LIPC may have a high potential for clinical application because of its non-invasiveness

Abstract:Objective: To investigate the influence of S-ademetionine on albumin (ALB) mRNA expression in rat liver after ischemia-reperfusion injury. Methods: Seventy-two male SD rats were equally randomized into sham operation group, hepatic ischemia-reperfusion group (IR group), and hepatic ischemia-reperfusion plus S-ademetionine treatment group (SAM group). The animal models were induced by 20 min hepatic ischemia and subsequent reperfusion in IR group and SAM group. One hour after surgery, rats of SAM group were given S-ademetionine [100 mg/(kg?d)] by intraperitoneal injection, and rats of sham operation group and IR group were given normal saline at the same volume instead. Six rats from each group were sacrificed on postoperative day (POD) 1, 4, 7 and 10, respectively, and the ALB mRNA expressions in the liver tissues were detected by quantitative real-time RT-PCR. Results: On POD 1, the relative expression levels of ALB mRNA in SAM group and IR group were significantly lower than that of sham operation group (both P<0.05), but no significant difference was noted between themselves (P>0.05). The relative expression levels of ALB mRNA of SAM group began to increase from POD 4 compared with IR group (all P<0.05), and were even higher than that of sham operation group on POD 10 (P<0.05). Conclusion: S-ademethionine can increase ALB mRNA expression in rat liver after ischemia-reperfusion injury, and boost liver synthetical function.

Abstract:Objective: To observe the protective effect of pirinixic acid on cold storage injury to rat liver. Methods: Sixty SD rats were equally randomized into pirinixic acid pretreatment group and control group. Rats in pirinixic acid pretreatment group were given pirinixic acid [3 mg/(kg·d)] at 2 d, 1 d and 1 h before surgery by tail vein injection, and rats in control group were given vehicle at the same volume instead. The livers were then removed from rats of the two groups and preserved in 4 oC℃ Ringer’s solution. Liver specimens of the two groups were studied after cold preservation for 0 (before cold preservation), 2, 4, 6 and 8 h respectively, and 6 specimens were obtained in each group at each time point. The mRNA and protein expression levels of peroxisome proliferator-activated receptors α (PPARα) were detected by RT-PCR and Western blot, respectively. The activities of nuclear factor-κB (NF-κB) in hepatic cells were measured by using immunohistochemical staining, and pathological examinations were also performed. Results: With prolongation of the preservation time, the expression levels of mRNA and protein of PPARα in the liver tissues were decreased, and the pathological scores of liver increased gradually in both groups, but in the same time points, the expression levels of mRNA and protein of PPARα in pirinixic acid pretreatment group were higher than those in control group, and the pathological score of pirinixic acid pretreatment group was lower than that of control group, and all the differences had statistical significances (all P<0.05). Except for the control group at 8 h time point, the activities of NF-κB in hepatocytes of the both groups were increased gradually with the extension of the preservation time, and NF-κB activity of pirinixic acid pretreatment group was significantly lower than that of control group at the same time points (all P<0.05). Conclusion: Pirinixic acid has protective effect against cold preservation injury of liver in rats, and its mechanism is probably associated with up-regulating PPARα expression and inhibiting NF-κB activation.

Abstract:Objective: To evaluate the pathological changes of normal liver tissues surrounding the ablation zone after radiofrequency ablation (RFA) combined with hepatic blood inflow occlusion. Methods: VX2 liver tumor transplantation models were established in rabbits, and then they were assigned to undergo RFA alone (RFA group) or RFA plus hepatic blood inflow occlusion (RFA + hepatic occlusion group). RFA was performed using a cool-tip radiofrequency electrode (radiofrequency parameters setting: 30 W, 8 min), and hepatic blood inflow occlusion was done with the Pringle maneuver. The animals were sacrificed one week later and the pathological changes in liver tissues around the ablation zone were examined by using H&E staining. Results: Compared with RFA group, the surrounding liver tissues in RFA + hepatic occlusion group showed a larger number of inflammatory cells accumulating in the areas around central veins and Glisson’s sheaths, and other pathological changes such as liver cell swelling, expansion of portal vein and central vein, proliferation of bile duct epithelial cells were all more evident in RFA + hepatic occlusion group (all P<0.05). Conclusion: RFA plus hepatic blood inflow occlusion exerts more severe pathological damage in the liver tissues surrounding the ablation zone than RFA alone.

Abstract:Objective: To investigate the gene mutation patterns at hepatitis B virus (HBV) polymerase region in patients with lamivudine-resistant hepatitis B. Methods: The serum samples from 94 hepatitis B patients who underwent lamivudine treatment and developed resistance and another 50 hepatitis B patients without lamivudine resistance were collected. The resistant mutations at HBV polymerase gene region were detected by direct sequencing of PCR products. Results: Of the 94 lamivudine-resistant patients, 80 cases were found with lamivudine-resistant mutations at HBV polymerase gene region, among which the single mutation at RtM204I was 30.4% (24/80), and the alliance mutation of rtLl80M+rtM204V was 25.0% (20/80), rtLl80M + rtM204I was 22.5% (18/80) and rtVl73L + rtV180M + rtM204V was 8.3% (7/80), respectively. Only 2 cases of the 50 non-resistant patients had the HBV polymerase gene mutations. Conclusion: The lamivudine resistance-related mutations at HBV polymerase gene region are diverse and complex. Thus, multi-loci detection should be performed so as to find the drug resistance strains early and then adjust treatment plan accordingly.

Abstract:Objective: To compare the safety and clinical feasibility between anterior liver hanging maneuver (ALH) and conventional approach for right hepatectomy. Methods: From January 2008 to June 2011, 40 patients scheduled to undergo right hepatectomy were randomly allocated to using ALH or conventional approach, with 20 cases in each group. The preoperative conditions, scope of hepatic resection, intraoperative events, postoperative complications, and alterations in biochemical parameters between the two groups were compared. Results: The preoperative data and scope of liver resection of the two groups were comparable. The incidences of intraopeative massive bleeding of two groups had no significant difference (P>0.05), but the intraoperative blood loss and blood transfusion volume in ALH group were significantly less than those in conventional approach group [(340.0±241.4) mL vs. (725.0±386.6) mL; (290.0±397.2) mL vs. (615.0±722.7) mL, both P<0.05], and the proportion of patients without any blood transfusion in ALH group was significantly higher than that in conventional approach group (16/20 vs. 10/20, P<0.05). The length of postoperative ICU stay and hospital stay, and the incidences of postoperative complications between the two groups had no significant differences (all P>0.05). The liver function parameters [including total bilirubin (TBIL), alanine transaminase (ALT), aspartate transaminase (AST), proalbmin (PA) and prothrombin time (PT)] had no statistical significances between the two groups before operation and on postoperative day (POD) 1 (all P>0.05). In ALH group, the C-reactive protein (CRP) level was significantly increased on POD 1, while the TBIL, ALT, AST and PT were significantly increased and PA was significantly decreased from POD 3 to 7 compared with conventional approach group (all P<0.05). No significant differences were noted in the renal function parameters [including blood urea nitrogen (BUN) and creatinine] between the two groups before and after operation (all P>0.05). Conclusion: Anterior liver hanging maneuver is associated with higher intraoperative safety, and better protection of postoperative liver function than conventional procedure for right hepatectomy.

Abstract:Objective: To investigate the efficacy of selective hemihepatic vascular occlusion in hepatectomy for cavernous hemangioma. Methods: The clinical data of 104 patients with hepatic cavernous hemangioma undergoing surgical resection from January 2006 to January 2011 were retrospectively analyzed. Of the patients, selective hemihepatic vascular occlusion was performed in 26 cases (group A), and the Pringle maneuver was performed in 78 patients (group B). The influence of the two approaches on the parameters that included intraoperative conditions, postoperative liver function and incidence of complications were compared and analyzed. Results: Operations were successfully performed in all the 104 patients. There were no statistical differences in intraoperative bleeding, blood transfusion volume, hepatic inflow occlusion time, blood oxygen saturation, time to intestinal function recovery and incidence of complication between the two groups (all P>0.05), but the alterations of peripheral blood pressure and arterial pulse in group B were more evident than those in group A (both P<0.01). The postoperative changes of liver function parameters such as ALT, AST, ALB and TBIL in group B were more favorable than those in group A, and all the differences had statistical significance (P<0.05 or P<0.01). Conclusion: Using selective hemihepatic vascular occlusion in hepatic resection of cavernous hemangiom can effectively reduce the impact of hepatic blood flow occlusion on systemic hemodynamics, alleviate hepatic ischemia–reperfusion injury, and thereby facilitate recovery of postoperative liver function.

Abstract:Objective: To compare the clinical efficacies between two methods of selective hepatic vascular exclusion in laparoscopic hepatectomy (LH). Methods: The clinical data of 28 patients undergoing LH from May 2005 to June 2011 were retrospectively analyzed. According to the procedures of selective hepatic vascular exclusion, the patients were divided into group A (exclusion through Glisson's capsule, n=14) and group B (exclusion through separated blood vessels after Glisson's capsule dissection, n=14). The perioperative parameters (operative time, intraoperative blood loss and blood transfusion volume), postoperative indexes (routine blood tests, liver function parameters, postoperative complications and hospital stay) and clinical outcomes (recurrence and survival rate) between the two groups were compared. Results: There were no significant differences in the operative time, bleeding, and transfusion volume between the two groups (all P>0.05). No significant differences were noted in parameters of liver function and routine blood tests on each postoperative time point, as well as in length of postoperative hospitalization and complications between the two groups (all P>0.05). The follow-up results showed that there were no significant differences in 1- and 2-year recurrent rate as well as 2- and 3-year survival rate between the two groups (all P>0.05). Conclusion: The two methods of selective vascular exclusion have no significant difference for LH, and the selection is on the surgeon's practice profile and surgical procedures.

Abstract:Objective: To investigate the clinical value and therapeutic effect of reduced-size hepatectomy on advanced huge hepatic alveolar echinococcosis (HAE). Methods: The clinical data of 4 patients with advanced giant HAE and with difficulty to achieve radical resection who underwent reduced-size liver resection from August 2010 to February 2011 were analyzed. For all patients, comprehensive assessments were made before operation, indications and timing for operation were strictly controlled, accurate and precise procedures were performed during operation, and anti-echinococcosis therapy was initiated postoperatively with oral administration of albendazole (ABZ). Results: Operations were successfully performed in all the 4 patients. The median operative time was 267.5 min (210–320 min), median intraoperative blood loss was 737.5 mL (600–950 mL) and the median red blood cell transfusion requirement was 4.0 U (2–6 U), respectively. The mean follow-up was 10 months (8–14 months), during which 1 case developed biliary fistula of the residual hydatid cavity, and 1 case had residual cavity hydrops. The previous obstructive jaundice and lower extremity edema of the patients were all relieved, and no intrahepatic dissemination or death occurred. Conclusion: Reduced-size liver resection provides a feasible technical approach for treatment of advanced giant HAE when it is difficult to implement radical treatment. Strict adherence to surgical indications and timing as well as regular administration of anti-echinococcosis drugs are effective measures to prevent the recurrence and dissemination of HAE.

Abstract:Objective: To assess the application value of the medical imaging software (SurgiCase 5.0) in liver surgery. Methods: The 128-slice spiral CT images of 10 patients with primary liver cancer admitted to our hospital over the past half year were collected. First, the data of slice-images were imported into SurgiCase 5.0 software for 3D remodeling. Then, these 3D models were used for planning of the surgical procedures, which were finally compared with the intraoperative findings. Results: The 10 3D models had better visualization, could be rotated and viewed from different angles, and clearly displayed the lesions as well as their spatial relationship with the intrahepatic vessels. The virtual models basically matched the actual intraoperative findings. The average volume of the resected liver of the 10 patients estimated by the software was (490.1±185.9) mL and the average volume actually resected was (464.4±169.5) mL with error rate of 7.1%, and there was a significant positive correlation between them (r=0.993, P<0.01). Conclusion: SurgiCase 5.0 can provide a reference for complex hepatic resections, and help in choosing the correct surgical procedure and decrease surgical risk.

Abstract:A variety of tumor markers have been identified over the past years, among which, epithelial cell adhesion molecule (EpCAM) is expected to become a new diagnostic factor for improving the detection rate of liver cancer. Based on reports in the literature, this paper summarizes the biological characteristics of EpCAM and its expression characteristics in liver development and liver cancer, as well as the current status and prospects of its application in clinical diagnosis.

Abstract:Ischemia-reperfusion injury is often encountered in surgical practice. Numerous studies have shown that limb ischemic preconditioning (LIPC) can protect organs from ischemia-reperfusion injury during surgery. In view of the accumulating evidence of this phenomenon, this paper addresses the progresses associated with LIPC that include the LIPC target organs and their underlying protective mechanisms.

Abstract:

With the rapid development of minimally invasive surgery, laparoscopic techniques have been widely applied in clinical practice. Use of laparoscopic surgery for hepatobiliary diseases has become increasingly popular, and continues to develop and improve. Its surgical indications are gradually expanding, operative trauma is progressively decreasing, and esthetic outcome is consistently improving. This paper, based on the recent literature and our own experience, is intended to provide an overview of the current state and advances of the application of laparoscopic techniques in hepatobiliary surgery.

Abstract:Epithelial-mesenchymal transition (EMT) is closely related to cancer progression such as local invasion and distal metastases. The down-regulation of epithelial marker (E-cadherins) and up-regulation of mesenchymal markers (vimentin and N-cadherin) in the cell surface is the main feature of EMT process. This paper addresses the recent progress in investigating the mechanism underlying cancer EMT.