ObjectiveTo understand the progress and problems of liver transplantation standard for hepatocellular carcinoma. MethodsThe related articles regarding transplant criteria of hepatocellular carcinoma were reviewed and analyzed. ResultsSince Milan criteria were proposed by Mazzaferro in 1996, a number of criteria were porposed by many transplant centers. These criteria expanded Milan criteria. Compared with Milan criteria, these criteria expanded tumor size and (or) tumor number, or combined with some biological variables, or combined with some immunological variables. However, there are still some issues should be clarified. ConclusionDespite there are many transplant criteria of hepatocellular carcinoma, but a number of issues should be further investigated.
The treatment of liver cancer is still a challenge in the world, and it is mainly refers to hepatocellular carcinoma (HCC). There are many factors affecting the overall survival rate of HCC; the recurrence of HCC is the main risk factor affecting the survival of patients, hence, it is urgent to explore the clinical treatment of recurrent HCC to obtain long-term survival of the patients. Up to now, surgical treatment is a radical treatment for HCC. Similarly, liver resection and liver transplantation are still the main therapy methods for recurrent HCC. In addition, radiofrequency ablation and transcatheter arterial chemoembolization and other local treatments still play an irresistible role. Therefore, emphasizing the postoperative follow-up of patients, diagnosing recurrent HCC in early stage, paying attention to the risk factors of HCC recurrence and selecting a suitable treatment plan for individuals are critical ways to prolong the survival of patients.
ObjectiveTo investigate the expression of IQ motif-containing GTPase activating protein 1 (IQGAP1) in hepatocellular carcinoma (HCC) tissues, and to analyze the relationship of IQGAP1 and patient's clinical characteristics and prognosis after liver resection. MethodsData of 79 patients who received liver resection between 2007 and 2009 in our hospital were collected. The expression of IQGAP1 was examined by immunohistochemical tests. The clinical characteristics and prognosis were compared. ResultsIQGAP1 was detected in 43 patients (54.4%). Patients with IQGAP1 expression had more poor differentiation and microvascular invasion. The cumulative recurrence-free rate and overall survival rate in 1-, 3-, and 5-year after operation of patients with IQGAP1 expression (cumulative recurrencefree rate:67.4%, 39.5%, and 23.3%; cumulative overall survival rate:97.7%, 71.5%, and 53.3%) were poor than patients without IQGAP1 expression (cumulative recurrence-free rate:100%, 94.4%, and 83.3%; cumulative overall survival rate:1007%, 97.2%, and 88.9%), P < 0.001. ConclusionsHCC patients with IQGAP1 expression had a poor prognosis after liver resection. IQGAP1 may be a prognostic indicator for hepatocellular carcinoma.
Objective To investigate the long-term effectiveness of Ni-Ti memory alloy tripod fixator in the treatment of Kienböck disease. Methods The clinical data of 22 patients with Kienböck disease who were treated with Ni-Ti memory alloy tripod fixator between January 2011 and September 2013 and followed up more than 10 years was retrospectively analyzed. There were 14 males and 8 females with an average age of 45 years (range, 20-64 years). The Lichtman staging was stage Ⅲb. According to AO/Association for the Study of Internal Fixation (AO/ASIF) classification, there were 6 cases of type B1, 2 cases of type B2, 10 cases of type B3, and 4 cases of type C2. The disease duration ranged from 18 to 50 months, with an average of 30.7 months. The operation time, intraoperative blood loss, and complications were recorded. Wrist height ratio and scapholunate angle were measured by wrist anteroposterior and lateral X-ray films before and after operation. The grip strength of bilateral hands was measured by Jamar dynamometer. The wrist pain was evaluated by visual analogue scale (VAS) score, and the wrist function was evaluated by Mayo score, and the radial deviation, ulnar deviation, dorsiflexion, and palmar flexion range of motion of wrist were measured. Results The operation time was 45-60 minutes, with an average of 52.21 minutes; the intraoperative blood loss was 50-60 mL, with an average of 58.63 mL. No nerve or blood vessel injury occurred during operation. All patients were followed up 10-13 years (mean, 11.3 years). X-ray films at 3 months after operation showed that the density of lunate bone was lower than that before operation. Satisfactory fusion of the scapho-trapezio-trapezoeid joint was achieved at 3-6 months after operation (mean, 4.5 months), and the wrist height ratio and the scapholunate angle after fusion significantly improved when compared with those before operation (P<0.05). Wrist pain relieved, scaphoid rotation and dislocation improved, and no radiocarpal joint degeneration was found during follow-up, and no internal fixator loosening, breakage, or lunate bone necrosis occurred. At last follow-up, the wrist radial deviation, ulnar deviation, dorsiflexion, and palmar flexion range of motion, VAS score, and grip strength of the affected side significantly improved when compared with those before operation (P<0.05); the grip strength of the affected side recovered to 99.00%±1.25% of the healthy side. Mayo score ranged from 72 to 93, with an average of 85; 14 cases were rated as excellent, 5 good, and 3 satisfactory, the excellent and good rate was 86.4%. ConclusionIn the treatment of stage Ⅲb Kienböck’s disease, the scapho-trapezio-trapezoeid joint usion using Ni-Ti memory alloy tripod fixator can effectively reduce pain, improve hand function, and prevent further deterioration, and achieve good long-term effectiveness.
Objective To assess the influence of hepatic artery ligation on survival, hepatocyte apoptosis and regeneration of rats with obstructive jaundice. Methods Eighty adult male Wistar rats were divided into four groups: group A, suffered 70% hepatectomy+hepatic artery ligation+biliary drainage after 3 days of establishing obstructive jaundice model; group B, suffered 70% of hepatectomy+biliary drainage after 3 days of establishing obstructive jaundice model; group C, suffered 70% of hepatectomy+hepatic artery ligation after 3 days of sham operation; group D, suffered 70% of hepatectomy after 3 days of sham operation. Five rats of each group were sacrificed on 1, 2, 3, and 6 days after second operation. Liver function, hepatocyte apoptosis and liver regeneration were detected. Results Postoperative survival rates were not significantly different between group A and group B, similarly between group C and group D (allP＞0.05). There was no significantly different in liver function of group Aversus group B, and group Cversus group D (P＞0.05), but the synthesis of album on 1 d or 3 d after operation were significant difference (group Aversus group B,P＜0.05; group Cversus group D,P＜0.05). Both of the group A, group B and group C had the highest apoptotic index on 1 d after operation, whereas the group D had the lowest hepatic apoptotic index among four group after the surgery. The regeneration indexes were as follow: group D＞group C＞group B＞group A (allP＜0.05). On y 6 d after operation, the regeneration indexes of group A and group B did not increase, while those of group C and group D decreased remarkably. However, the regeneration indexes of four groups were lower than the mean level. Conclusions Hepatic artery ligation will increase hepatocyte apoptosis and weaken liver regeneration. However, for rats with obstructive jaundice, hepatic artery ligation didn't increase the risk of postoperative mortality.
ObjectiveTo investigate the expression of forkhead box A2 (FXOA2) in intrahepatic cholangiocarcinoma (ICC), and to analyze the relationship between expression of FOXA2 and patient's prognosis after liver resection. MethodsData of 85 patients with ICC who underwent liver resection between 2009 and 2013 in our hospital were collected retrospectively. The expression of FOXA2 was examined by immunohistochemical method, and then the relationship between expression of FOXA2 and patient's prognosis/clinical characteristics was expplored. ResultsAmong the 85 patients, low expression of FOXA2 was detected in 50 patients, whereas high expression was observed in 35 patients. More advanced tumor (Ⅲ+Ⅳ staging) was found in patients with low expression of FOXA2 than patients with high expression of FOXA2 (P < 0.050). The median follow-up time was 15-month (3-73 months). During the follow-up period, 65 patients suffered from recurrence, whereas 64 patients died. The multivariate analysis suggested that, postoperative recurrence was associated with low expression of FOXA2, evaluated preoperative CA19-9, and presence of satellite nodes (P < 0.050). Low expression of FOXA2, evaluated preoperative CA19-9, nerves invasion, and presence of satellite nodes were predictive factors for postoperative prognosis (P < 0.050). ConclusionLow expression of FOXA2 was associated with poor prognosis for patients with ICC after liver resection, and FOXA2 may be a prognostic factor for ICC.
ObjectiveTo review the development and clinical application of ankle prosthesis.MethodsThe recent literature on ankle prosthesis design and clinical application was reviewed and analyzed. ResultsCompared with the hip and knee prostheses, the ankle prosthesis develops slowly and has been developed to the third generation. The ankle joint has a special structure of multi-axis movement. The design of the first and second generations of prostheses is not conformed to the biomechanics of the ankle. The third generation of prosthesis is more conform to the characteristics of ankle biomechanics, with high postoperative survival rate and satisfactory clinical outcome. ConclusionAt present, the survival rate of ankle prosthesis is low, and there is still much room for improvement in biomechanics, materials, and other aspects.
ObjectiveTo summarize the clinical and imaging features of hepatic adrenal rest tumor and to explore its tissue source, diagnosis, differential diagnosis and treatment.MethodsThe clinical data of patient with hepatic adrenal rest tumor in the West China Hospital of Sichuan University were analyzed retrospectively. The diagnostic methods of liver adrenal junction were summarized by consulting relevant literatures.ResultsThe patient was admitted to the hospital with right hepatic lesions. The preoperative imaging examination showed that it was the imaging features of hepatocellular carcinoma. The right hemihepatectomy was proposed. During the operation, it was found that the lesions were not from the liver, but from the retroperitoneum (The possibility of adrenal origin was very high). Then, the retroperitoneal occupying lesions was completely resected via urology surgery consultation. The pathological results showed that the tumor was adrenocortical carcinoma.ConclusionsIt is very difficult to accurately diagnose nature of hepatic adrenal rest tumor before operation only by results of cross-sectional imaging, especially for some adrenal tumor. It needs to fully be evaluated and even to perform multidisciplinary discussion if necessary for patients who have hepatic adrenal rest tumor before operation, so as to avoid misdiagnosis to a certain extent.
ObjectiveTo summarize the research progress in artificial metacarpophalangeal joint and interphalangeal joint prostheses.MethodsThe research literature on artificial metacarpophalangeal joint and interphalangeal joint prostheses at home and abroad was reviewed and summarized from anatomy, prosthesis design, and material development.ResultsThe artificial joint replacement can correct deformity, relieve pain, and improve function immediately. In the past 50 years, many researches have focused on the design and material of prostheses and surgical technique of joint replacement. There are three types of prostheses, including hinged limit-type-prosthesis, semi-limit-type-prosthesis, and non-limit-type-prosthesis. The prostheses have their own advantages and disadvantages, the long-term effectiveness of joint replacement is not ideal.ConclusionThe metacarpophalangeal joint and interphalangeal joint prostheses with more anatomical structure and biocompatible materials are needed.