Portal vein embolization combined with ex vivo liver resection and autotransplantation: A novel treatment strategy for end-stage and metastatic hepatic alveolar echinococcosis

Alveolar echinococcosis(AE)is a lethal parasitic disease caused by Echinococcus multilocularis larvae,and more than 90%of pri-mary AE lesions occur in the liver.Most of the affected individ-uals remain asymptomatic and the disease is often diagnosed at an advanced stage.The infection may spread to organs adjacent to the liver or distant locations,eventually causing end-stage multi-ple organ AE.Brain metastasis of AE is the most fatal with an inci-dence rate of 0.2%[1].

Main controlling factors and enrichment area evaluation of shale gas of the Lower Paleozoic marine strata in south China

The Lower Paleozoic shale in south China has a very high maturity and experienced strong tectonic defor- mation. This character is quite different from the North America shale and has inhibited the shale gas evaluation and exploration in this area. The present paper reports a com- prehensive investigation of maturity, reservoir properties, fluid pressure, gas content, preservation conditions, and other relevant aspects of the Lower Paleozoic shale from the Sichuan Basin and its surrounding areas. It is found that within the main maturity range （2.5 % 〈 EqRo 〈 3.5 %） of the shale, its porosity develops well, having a positive cor- relation with the TOC content, and its gas content is con- trolled mainly by the preservation conditions related to the tectonic deformation, but shale with a super high maturity （EqRo 〉 3.5 %） is considered a high risk for shale gas exploration. Taking the southern area of the Sichuan Basin and the southeastern area of Chongqing as examples of uplifted/folded and faulted/folded areas, respectively, geo- logical models of shale gas content and loss were proposed. For the uplifted/folded area with a simple tectonic defor- mation, the shale system （with a depth 〉 2000 m） has lar- gely retained overpressure during uplifting without a great loss of gas, and an industrial shale gas potential is generally possible. However, for the faulted/folded area with a strong tectonic deformation, the sealing condition of the shale system was usually destroyed to a certain degree with a great loss of free gas, which decreased the pressure coefficient and resulted in a low production capacity. It is predicted that the deeply buried shale （〉3000 m） has a greater gas potential and will become the focus for further exploration and development in most of the south China region （outside the Sichuan Basin）.

Approaches to reconstruction of inferior vena cava by ex vivo liver resection and autotransplantation in 114 patients with hepatic alveolar echinococcosis

BACKGROUND Hepatic alveolar echinococcosis(AE)is most commonly found in retrohepatic inferior vena cava(RHIVC).Ex vivo liver resection and autotransplantation(ELRA)can better realize the radical resection of end-stage hepatic AE with severely compromised hepatocaval confluences,and reconstruction of the affected vessels.Currently,there is a scarcity of information regarding RHIVC reconstruction in ELRA.AIM To propose reasonable RHICV reconstruction strategies for ex vivo liver resection and autotransplantation.METHODS We retrospectively summarized the clinical data of 114 patients diagnosed with hepatic AE who treated by ELRA in our department.A total of 114 patients were divided into three groups according to the different reconstruction methods of RHIVC:Group A with original RHIVC being repaired and reconstructed(n=64),group B with RHIVC being replaced(n=43),and group C with RHIVC being resected without reconstruction(n=7).The clinical data of patients,including the operation time,anhepatic phase,intraoperative blood loss,complications and postoperative hospital stay,were analyzed and the patients were routinely followed up.The normally distributed continuous variables were expressed as means±SD,whereas the abnormally distributed ones were expressed as median and analyzed by analysis of variance.Survival curve was plotted by the Kaplan-Meier method.RESULTS All patients were routinely followed up for a median duration of 52(range,12-125)mo.The 30 d mortality rate was 7.0%(8/114)and 7 patients died within 90 d.Among all subjects,the inferior vena cava(IVC)-related complication rates were 17.5%(11/63)in group A and 16.3%(7/43)in group B.IVC stenosis was found in 12 patients(10.5%),whereas thrombus was formed in 6 patients(5.3%).Twenty-two patients had grade III or higher complications,with the complication rates being 17.2%,16.3%,and 57.1%in the three groups.The average postoperative hospital stay in the three groups was 32.3±19.8,26.7±18.2,and 51.3±29.4 d(P=0.03),respectively.CONCLUSION ELRA can be considered a safe and feasible option for end-stage hepatic AE patients with RHIVC infiltration.The RHIVC reconstruction methods should be selected appropriately depending on the defect degree of AE lesions in IVC lumen.The RHIVC resection without any reconstruction method should be considered with caution.