Prealbumin is predictive for postoperative liver insufficiency in patients undergoing liver resection

AIM:To investigate the risk factors for postoperative liver insufficiency in patients with Child-Pugh class A liver function undergoing liver resection.METHODS:A total of 427 consecutive patients undergoing partial hepatectomy from October 2007 to April 2011 at a single center(Department of Hepatic SurgeryⅠ,Eastern Hepatobiliary Surgery Hospital,Shanghai,China) were included in the study.All the patients had preoperative liver function of Child-Pugh class A and were diagnosed as having primary liver cancer by postoperative histopathology.Surgery was performed by the same team and hepatic resection was carried out by a clamp crushing method.A clamp/unclamp time of 15 min/5 min was adopted for hepatic inflow occlusion.Patients' records of demographic variables,intraoperative parameters,pathological findings and laboratory test results were reviewed.Postoperative liver insufficiency and failure were defined as prolonged hyperbilirubinemia unrelated to biliary obstruction or leak,clinically apparent ascites,prolonged coagulopathy requiring frozen fresh plasma,and/or hepatic encephalopathy.The incidence of postoperative liver insufficiency or liver failure was observed and the attributing risk factors were analyzed.A multivariate analysis was conducted to determine the independent predictive factors.RESULTS:Among the 427 patients,there were 362 males and 65 females,with a mean age of 51.1 ± 10.4 years.Most patients(86.4%) had a background of viral hepatitis and 234(54.8%) patients had liver cirrhosis.Indications for partial hepatectomy included hepatocellular carcinoma(391 patients),intrahepatic cholangiocarcinoma(31 patients) and a combination of both(5 patients).Hepatic resections of ≤ 3 and ≥ 4 liver segments were performed in 358(83.8%) and 69(16.2%) patients,respectively.Seventeen(4.0%) patients developed liver insufficiency after hepatectomy,of whom 10 patients manifested as prolonged hyperbilirubinemia unrelated to biliary obstruction or leak,6 patients had clinically apparent ascites and prolonged coagulopathy,1 patient had hepatic encephalopathy and died on day 21 after surgery.On univariate analysis,age ≥ 60 years and prealbumin < 170 mg/dL were found to be significantly correlated with postoperative liver insufficiency(P = 0.045 and P = 0.009,respectively).There was no statistical difference in postoperative liver insufficiency between patients with or without hepatitis,liver cirrhosis and esophagogastric varices.Intraoperative parameters(type of resection,inflow blood occlusion time,blood loss and blood transfusion) and laboratory test results were not associated with postoperative liver insufficiency either.Age ≥ 60 years and prealbumin < 170 mg/dL were selected on multivariate analysis,and only prealbumin < 170 mg/dL remained predictive(hazard ratio,3.192;95%CI:1.185-8.601,P = 0.022).CONCLUSION:Prealbumin serum level is a predictive factor for postoperative liver insufficiency in patients with liver function of Child-Pugh class A undergoing hepatectomy.Since prealbumin is a good marker of nutritional status,the improved nutritional status may decrease the incidence of liver insufficiency.

Risk factors and surgical outcomes for spontaneous rupture of BCLC stages A and B hepatocellular carcinoma: A case-control study

AIM: To investigate the risk factors and surgical outcomes for spontaneous rupture of Barcelona Clinic Liver Cancer (BCLC) stages A and B hepatocellular carcinoma (HCC).

Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma

AIM:To determine the risk factors for hepatocellular carcinoma(HCC) rupture,and report the management and long-term survival results of patients with spontaneous rupture of HCC.METHODS:Among 4209 patients with HCC who were diagnosed at Eastern Hepatobiliary Surgery Hospital from April 2002 to November 2006,200(4.8%) patients with ruptured HCC(case group) were studied retrospectively in term of their clinical characteristics and prognostic factors.The one-stage therapeutic approach to manage ruptured HCC consisted of initial management by conservative treatment,transarterial embolization(TACE) or hepatic resection.Results of various treatments in the case group were evaluated and compared with the control group(202 patients) without ruptured HCC during the same study period.Continuous data were expressed as mean ± SD or me-dian(range) where appropriate and compared using the unpaired t test.Categorical variables were compared using the Chi-square test with Yates correction or the Fisher exact test where appropriate.The overall survival rate in each group was determined using the Kaplan-Meier method and a log-rank test.RESULTS:Compared with the control group,more patients in the case group had underlying diseases of hypertension(7.5% vs 3.0%,P =0.041) and liver cirrhosis(87.5% vs 56.4%,P < 0.001),tumor size >5 cm(83.0% vs 57.4%,P < 0.001),tumor protrusion from the liver surface(66.0% vs 44.6%,P < 0.001),vascular thrombus(30.5% vs 8.9%,P < 0.001) and extrahepatic invasion(36.5% vs 12.4%,P < 0.001).On multivariate logistic regression analysis,underlying diseases of hypertension(P = 0.002) and liver cirrhosis(P < 0.001),tumor size > 5 cm(P < 0.001),vascular thrombus(P = 0.002) and extrahepatic invasion(P < 0.001) were predictive for spontaneous rupture of HCC.Among the 200 patients with spontaneous rupture of HCC,105 patients underwent hepatic resection,33 received TACE,and 62 were managed with conservative treatment.The median survival time(MST) of all patients with spontaneous rupture of HCC was 6 mo(range,1-72 mo),and the overall survival at 1,3 and 5 years were 32.5%,10% and 4%,respectively.The MST was 12 mo(range,1-72 mo) in the surgical group,4 mo(range,1-30 mo) in the TACE group and 1 mo(range,1-19 mo) in the conservative group.Ninety-eight patients in the control group underwent hepatic resection,and the MST and median diseasefree survival time were 46 mo(range,6-93 mo) and 23 mo(range,3-39 mo) respectively,which were much longer than that of patients with spontaneous rupture of HCC undergoing hepatic resection(P < 0.001).The 1-,3-,and 5-year overall survival rates and the 1-,3-and 5-year disease-free survival rates in patients with ruptured HCC undergoing hepatectomy were 57.1%,19.0% and 7.6%,27.6%,14.3% and 3.8%,respectively,compared with those of 77.1%,59.8% and 41.2%,57.1%,40.6% and 32.9% in 98 patients with-CONCLUSION:Prolonged survival can be achieved in selected patients undergoing one-stage hepatectomy,although the survival results were inferior to those of the patients without ruptured HCC.

Patients with advanced primary hepatocellular carcinoma treated by melatonin and transcatheter arterial chemoembolization: a prospective study

Objective: To observe the clinical efficacy of tran- scatheter arterial chemoembolization (TACE) and TACE+MLT (melatonin) on inoperable advanced primary hepatocellular carcinoma. Methods: From January 1997 to January 1998, one hundred patients with inoperable advanced primary hepatocellular carcinoma were treated separately by TACE (50) and TACE+MLT (20 mg/d at 8:00 PM orally, 7 days before TACE) (50). Results: The effective rates (WHO standards) of TACE and TACE+MLT were 16% and 28% respec- tively (P<0.05). After TACE or TACE+MLT, the resection rate at two-stage of TACE was 4% or 14% (P<0. 01). The 0.5-, 1- and 2-year survival rates in the TACE group were 82%, 54% and 26% respectively; in the TACE+MLT group 100%, 68% and 40% respectively. The results were significantly better in the TACE+MLT group than in the TACE group. MLT could protect liver function from the damage caused by TACE. The IL-2 levels of all pa- tients significantly increased, whereas sIL-2R expres- sions decreased after TACE+MLT as compared with the TACE group (P<0.01). Conclusions: With definite protection and treatment effect on the liver function damage caused by TACE, MLT can enhance the immunological activities of pa- tients. It also can improve the effect of TACE by in- creasing the survival and resection rate after two- stage operation.

Effects of dezocine on postoperative stress response and immune function in patients with breast cancer

Objective: To investigate the effects of dezocine on postoperative stress response and immune function in patients with breast cancer. Methods: According to random data table method, a total of 80 patients who were scheduled for breast cancer radical surgery from September 2016 to May 2017 were divided into observation group and the control group, 40 cases in each group. The observation group gave intravenous injection of dezocine as an advanced analgesia 15 min before anesthesia induction, the control group given the same amount of sodium chloride injection. The levels of serum inflammatory factors and immune function were measured and compared between the two groups before and after operation. Results: The levels of angiotensin Ⅱ, renin, cortisol, aldosterone, CD3+, CD4+, CD8+and CD4+/CD8+ in the two groups before treatment were not statistically significant. The levels of angiotensin Ⅱ, renin, cortisol, aldosterone in the two groups were increased at first and then decreased, which were significantly higher than those in the same group before operation at 1 d and 3 d;and the levels of angiotensin Ⅱ, renin, cortisol, aldosterone in the observation group were significantly lower than those in the control group after 1 d and 3 d, the difference was statistically significant. The levels of serum CD3+, CD4+ and CD4+/CD8+ in the two groups were decreased at first and then increased, which were significantly lower than those in the same group before operation at 1 d and 3 d;and the observation group levels were significantly higher than those in the control group after 1 d and 3 d, the above indicators were compared with the difference was statistically significant. The levels of serum CD8+ in the two groups were increased at first and decreased subquently, which were significantly higher than those in the same group before operation at 1 d and 3 d and the observation group levels were significantly lower than those in the control group after 1 d and 3 d, the above indicators were compared with the difference was statistically significant. The above indicators have restore to preoperative levels after 5 d. Conclusion: Dezocine can reduce the stress response in patients with perioperative breast cancer, improve the immune function of patients, which has important clinical value, so it is worth promoting.

Use of Non-Verbal Representations to Define Concept of Pulse Conditions in Traditional Chinese Medicine Standards

The standardization of terms and definitions is fundamental to all activities in the domain of traditional Chinese medicine(TCM).For decades,definitions of TCM terminology relied on conventional verbal representations to differentiate between related concepts.However,the ancient Chinese is obscure and comprises a massive volume of information,making it difficult to convey the definition accurately in other languages.This article proposes a potential solution that the definition for pulse terminology can be supplemented by modern means of non-verbal representation,i.e.,using pulse waveform graphs and parameters to complete the definition of each pulse.A discussion of the challenges of obtaining reliable data is also included.

Effects of dexmedetomidine on inflammatory response and oxidative stress in laparoscopic hysterectomy patients

Objective: To investigate the effect of dexmedetomidine on inflammatory response and oxidative stress in patients with laparoscopic total hysterectomy. Methods: Ninety patients with laparoscopic hysterectomy under general anesthesia were selected in our hospital from January 2015 to December 2016, and randomly divided into control group and observation group, Each group of 45 cases. The observation group was given dexmedetomidine, intravenous pump injection, The control group was given the same amount of saline in the same manner, followed by anesthesia induction. The hemodynamics, inflammatory factors and oxidative stress were monitored before anesthesia (T0), 30 min after the end of pneumoperitoneum (T1), after operation (T2) and at the end of 24 h (T3). Results: Compared with T0, T1, T2 and T3, the observation group of patients with MAP and HR levels were no significant difference;T3, the control group MAP and HR levels were not significantly different;T1 and T2, MAP and HR levels in the control group were significantly increased, And significantly higher than the observation group;Compared with T0, the levels of CRP, TNF-α and IL-1β in patients were significantly increased in T1, T2 and T3, but the levels of CRP, TNF-α and IL-1β in the observation group were significantly lower than those in the control group;Compared with T0, both groups of patients with H2O2 and MDA levels were significantly increased, TAS levels were significantly reduced, the difference was statistically significant, However, the levels of H2O2 and MDA in the observation group were significantly lower than those in the control group, the level of TAS was significantly higher than the control group. Conclusion:Laparoscopic hysterectomy increases the inflammatory response and oxidative stress in patients, while the use of dexmedetomidine can maintain hemodynamic stability in a certain extent, reduce the inflammatory response and reduce oxidative stress injury;it is worth of further clinical application.

Arterial blood supply of hepatocellular carcinoma is associated with efficacy of sorafenib therapy

Aim:There are some previous reports concerning the relationship between prognosis of patients treated with sorafenib and parameters of computed tomography(CT)and magnetic resonance imaging(MRI).This study presents monocentric experience with sorafenib in the treatment of hepatocellular carcinoma(HCC)patients and will try to identify predictive factors for survival based on the correlation of results from imaging and survival.Methods:A total of 38 HCC patients treated from April 2009 to December 2010 with sorafenib were included in this study.HCCs were classified as good arterial supply and poor arterial supply according to the enhancement intensity on CT scan or MRI.Clinical data were collected and survival time was analyzed by Kaplan-Meier method.A Cox’s regression model was performed to reveal predictive factors for survival.Results:Among the 38 patients treated with sorafenib,mean age was 53.3±11.1 years and 35(92.1%)were males.Tumors in 17 patients were classified as good arterial supply,while the remaining 21 patients belonged to poor arterial supply.The median survival time(MST)was 10.7 months[95%confidence interval(CI),8.7-12.7]and the 1-year overall survival(OS)was 41.0%.The MST and 1-year OS in patients with a good arterial supply of tumors were 12 months(range:4-20 months)and 52.9%,compared with that of 7 months(range:1-16 months)and 23.8%in patients with a poor arterial supply of tumors(P=0.002).Patients who had tumors at Barcelona Clinic Liver Cancer(BCLC)stage B had longer MST and higher OS than those who had tumors at BCLC stage C,but there was no statistical difference between these two stages.On multivariate analysis,only arterial supply of the tumors remained statistically predictive for OS(hazard ratios 0.22,95%CI,0.07-0.67,P=0.008).Conclusion:Arterial blood supply is an independent predictor for survival in patients treated with sorafenib,and patients with a good arterial supply of tumors benefit more than those with a poor arterial supply of tumors.