AN ANALYSIS FOR DEATH CAUSES IN 45 CASES OF LIVER CANCER TREATED WITH TRADITIONAL CHINESE DRUGS

Among the 165 cases of late-stage liver cancer treated in our hospital,65(39.4%)died,with an average survival time of 8.1 months and a median survival time of 7 months.Among the 65 dead patients,45 were treated with traditional Chinese drugs and 20 withwestern medicine.The average survival time was 8.4 months in the former and 7.3months in the latter group.The direct causes of death for the 65 patients were hepaticcoma,severe hemorrhage of the upper digestive tract,Heyd’s syndrome,hepatorrhexis,respiratory failure,cardiac failure,etc.The incidence rates of hemorrhage of the upperdigestive tract and hepatorrhexis in the 45 patients treated with traditional Chinese drugswere obviously lower than those treated with western medicine.

载药微球联合TACE治疗原发性肝癌患者的效果观察

目的观察载药微球联合肝动脉化疗栓塞术(TACE)治疗原发性肝癌患者的效果。方法选取2021年6至12月收治的原发性肝癌患者60例,根据患者住院序号分为研究组和对照组各30例。研究组采用TACE联合CalliSpheres载药微球治疗,对照组接受传统TACE治疗。观察2组临床疗效、血常规、肝功能指标、甲胎蛋白(AFP)水平,并评估安全性。结果2组治疗后血红蛋白、血小板计数、白蛋白较治疗前降低,总胆红素、丙氨酸转氨酶、天冬氨酸转氨酶较治疗前升高(P<0.05);2组治疗后1周上述指标比较差异无统计学意义(P>0.05)。研究组治疗后AFP水平低于对照组(P<0.05)。研究组并发症及毒副反应发生率低于对照组(P<0.05)。研究组总有效率[86.67%(26/30)]高于对照组[63.33%(19/30)](P<0.05)。研究组术后1、2年的总体生存与局部控制率均高于对照组(P<0.05)。研究组满意度评分[(79.14±16.37)分]高于对照组[(64.35±17.22)分](P<0.01)。结论载药微球联合TACE治疗原发性肝癌效果较好,可有效延长患者生存时间,减轻并发症及毒副反应,提高生存质量。

中药调节肠道菌群缓解药物性肝损伤的研究进展

药物性肝损伤是由化学药物、膳食补充剂和草药产品等引起的肝脏损伤疾病,其极易发展为肝衰竭,且在其发生发展的同时常伴随肠道菌群的变化。中药多成分、多靶点的治疗特点可以通过调节肠道菌群、改善肠道屏障、降低炎症因子水平等减轻药物性肝损伤。对中药干预肠道菌群缓解药物性肝损伤的作用进行总结,以期对中药治疗药物性肝损伤的机制研究提供参考。

不同粒径载药微球序贯TACE用于治疗巨块型原发性肝癌伴肝静脉或门静脉癌栓

原发性肝癌(primary liver cancer,PLC)是我国最常见的消化系统恶性肿瘤,恶性程度高、预后差;其中约20%为巨块型,多伴明显坏死且包膜不完整,易侵犯脉管系统,常合并静脉癌栓或远隔转移等[1-2]。TACE是治疗不可切除PLC伴门静脉癌栓的主要方法。近年来,载药微球TACE(drug-eluting bead TACE,DEB-TACE)临床应用越来越广泛,且用于治疗PLC效果满意[3],但以DEB-TACE治疗PLC合并静脉癌栓的研究尚少,且单一粒径载药微球用于治疗具有不同肿瘤学特征的病灶存在不足。本研究采用不同粒径载药微球序贯TACE治疗6例巨块型PLC伴肝静脉或门静脉癌栓,以观察其价值。

中药活性成分调控糖代谢抗胆管癌的分子机制

胆管癌是一种高度异质性的肿瘤,其发病隐匿、病情凶险、恶性程度高、预后极差。葡萄糖是胆管癌增殖和转移的主要能量来源,胆管癌细胞在快速增殖过程中其糖代谢途径会被重新编辑,产生大量能量以满足自身需求。中医药在胆管癌治疗中具有独特优势,中药活性成分已被证明可以通过调控糖代谢抑制胆管癌的发生和发展。本文对胆管癌中的糖代谢特点和中药活性成分调控糖代谢抗胆管癌进行综述,为胆管癌的治疗提供新思路。

Prevention of metastasis to liver by using 5-FU intraperitoneal chemotherapy in nude mice inoculated with human colonic cancer cells

AIMS Using a new approach of regional adjuvant chemotherapy to prevent cancer cells hepatic metasta- sis after radical surgery of large bowel cancer. METHODS A model of liver with metastasis of hu- man colonic cancer (HCC) cells in nude mice was used to observe the effect in prevention of metastasis of HCC cells inoculated via spleen applied with early postoper- ative intraperitoneal (IP) chemotherapy using large dose of 5-FU. RESULTS The incidence of metastasis to liver was decreased by 40%,the mean number of metastatic liv- er nodules in each animal was reduced by 50.89% and the mean survival times of each animal was prolonged by 48.21% by using 5-FU 40 mg/NS 40 ml/kg IP for two consecutive days as compared with the controls. CONCLUSIONS IP is a new and more effective re- gional adjuvant chemotheraputic approach in the pre- vention of liver metastasis HCC cells after radical surgery of large bowel cancer.

The value of postoperative hepatic regional chemotherapy in prevention of recurrence after radical resection of primary liver cancer

INTRODUCTIONIn China,primary liver cancer (PLC) ranks secondin cancer mortality since the 1990s.In the field ofPLC treatment,surgical resection remains the best,which includes large PLC resection,small PLCresection,re-resection of subclinical recurrence,aswell as cytoreduction and sequential resection forunresectable PLC.However,recurrence

Liver-first approach of colorectal cancer with synchronous hepatic metastases: A reverse strategy

Recently, there has been a change in the strategy of how synchronous colorectal hepatic metastases are attributed to the development of more valuable protocols of chemotherapy and radiotherapy for neoadjuvant treatment of colorectal neoplasms and their hepatic metastases. There is a consensus that patients with synchronous colorectal hepatic metastases have lower survival than those with metachronous colorectal hepatic metastases. Currently, controversy remains concerning the best approach is sequence in a patient with colorectal cancer and synchronous hepatic metastases resection. To obtain a better patient selection, the authors have suggested the initial realization of systemic chemotherapy in the circumstance of patients with colorectal tumor stage Ⅳ, since these patients have a systemic disease. The rationale behind this liver-first strategy is initially the control of synchronous hepatic metastases of colorectal carcinoma, which can optimize a potentially curative hepatic resection and longstanding survival. The liver-first strategy procedure is indicated for patients with colorectal hepatic metastases who require downstaging therapy to make a curative liver resection possible. Thus, the liver-first strategy is considered an option in cases of rectal carcinoma in the early stage and with limited or advanced synchronous colorectal hepatic metastases or in case of patients with asymptomatic colorectal carcinoma, but with extensive liver metastases. Patients undergoing systemic chemotherapy and with progression of neoplastic disease should not undergo hepatic resection, because it does not change the prognosis and may even make it worse. To date, there have been no randomized controlled trials on surgical approach of colorectal synchronous hepatic metastases, despite the relatively high number of available manuscripts on this subject. All of these published studies are observational, usually retrospective, and often non-comparative. The patient selection criteria for the liver-first strategy should be individualized, and the approach of these patients should be performed by a multidisciplinary team so its benefits will be fully realized.

Anemia and iron deficiency in gastrointestinal and liver conditions

Iron deficiency anemia(IDA) is associated with a number of pathological gastrointestinal conditions other than inflammatory bowel disease, and also with liver disorders. Different factors such as chronic bleeding, malabsorption and inflammation may contribute to IDA. Although patients with symptoms of anemia are frequently referred to gastroenterologists, the approach to diagnosis and selection of treatment as well as follow-up measures is not standardized and suboptimal. Iron deficiency, even without anemia, can substantially impact physical and cognitive function and reduce quality of life. Therefore, regular iron status assessment and awareness of the clinical consequences of impaired iron status are critical. While the range of options for treatment of IDA is increasing due to the availability of effective and well-tolerated parenteral iron preparations, a comprehensive overview of IDA and its therapy in patients with gastrointestinal conditions is currently lacking. Furthermore, definitions and assessment of iron status lack harmonization and there is a paucity of expert guidelines on this topic. This review summarizes current thinking concerning IDA as a common co-morbidity in specific gastrointestinal and liver disorders, and thus encourages a more unified treatment approach to anemia and iron deficiency, while offering gastroenterologists guidance on treatment options for IDA in everyday clinical practice.

Preliminary Investigation on Regulating Effects of Different TCM Treatments on Transcription of the Correlated Genes of Liver Cancer in Rats

The regulating effects of TCM treatments including clearing away heat and toxic materials,promoting blood circulation and removing blood stasis,and strengthening the spleen and regulating qi on the oncogene transcription were observed in the liver cancer model rats.The preliminary results indicated that the mRNA levels of H-ras N-ras and K-ras,and signal molecules correlated with the ras/MAPK signal transduction pathway were down-regulated by the different TCM treatments in varying degrees.Also,the regulating effects of the treatments on differently-displayed genes were discrepant.It is suggested that the molecular mechanisms of the TCM treatments for liver cancer was complex with different target genes.

Adeno-associated virus mediated endostatin gene therapy in combination with topoisomerase inhibitor effectively controls liver tumor in mouse model

AIM:rAAV mediated endostatin gene therapy has been examined as a new method for treating cancer.However, a sustained and high protein delivery is required to achieve the desired therapeutic effects.We evaluated the impact of topoisomerase inhibitors in rAAV delivered endostatin gene therapy in a liver tumor model. METHODS:rAAV containing endostatin expression cassettes were transduced into hepatoma cell lines.To test whether the topoisomerase inhibitor pretreatment increased the expression of endostatin,Western blotting and ELISA were performed.The biologic activity of endostatin was confirmed by endothelial cell proliferation and tube formation assays. The anti-tumor effects of the rAAV-endostatin vector combined with a topoisomerase inhibitor,etoposide,were evaluated in a mouse liver tumor model. RESULTS:Topoisomerase inhibitors,including camptothecin and etoposide,were found to increase the endostatin exPression level in vitro.The over-expressed endostatin, as a result of pretreatment with a topoisomerase inhibitor, was also biologically active.In animal experiments,the combined therapy of topoisomerase inhibitor,etoposide with the rAAV-endostatin vector had the best tumor- suppressive effect and tumor foci were barely observed in livers of the treated mice.Pretreatment with an etoposide increased the level of endostatin in the liver and serum of rAAV-endostatin treated mice.Finally,the mice treated With rAAV-endostatin in combination with etoposide showed the longest survival among the experimental models. CONCLUSION:rAAV delivered endostatin gene therapy in combination with a topoisomerase inhibitor pretreatment is an effective modality for anticancer gene therapy.

Atypical onset of bicalutamide-induced liver injury

Anti-androgen therapy is the leading treatment for advanced prostate cancer and is commonly used for neoadjuvant or adjuvant treatment. Bicalutamide is a non-steroidal anti-androgen, used during the initiation of androgen deprivation therapy along with a luteinizing hormone-releasing hormone agonist to reduce the symptoms of tumor-related flares in patients with advanced prostate cancer. As side effects, bicalutamide can cause fatigue, gynecomastia, and decreased libido through competitive androgen receptor blockade. Additionally, although not as common, drug-induced liver injury has also been reported. Herein, we report a case of hepatotoxicity secondary to bicalutamide use. Typically, bicalutamideinduced hepatotoxicity develops after a few days; however, in this case, hepatic injury occurred 5 mo after treatment initiation. Based on this rare case of delayed liver injury, we recommend careful monitoring of liver function throughout bicalutamide treatment for prostate cancer.

Heat shock protein 72 normothermic ischemia,and the impact of congested portal blood reperfusion on rat liver

INTRODUCTIONFrom the technical aspect of liver surgery ,control of bleeding during hepatic parenchymal resection is one of the most important procedures in hepatectomy .Pringle,s maneuver ,a temporary cross-clamping of the hepatoduodnal ligament ,has often been used for this purpose[1],This is the simplest and userul technique to reduce intraoperative blood loss .

Reversal of HCC Drug Resistance by Using Hammerhead Ribozymes against Multidrug Resistance 1 Gene

To reverse multidrug resistance（MDR） of HepG2 by anti-MDR1 hammerhead ribozyme, an anti-MDR1 hammerhead ribozyme was developed and delivered to P-gp-overproducing human hepatocarcinoma cell line HepG2 by a retroviral vector containing RNA polymerase Ⅲ promoter. The expression of mdrl/Pgp and Rz was detected in HepG2, HepG2 muhidrug-resistant cell line and HepG2 Rz-transfected cells by semi-quantitative RT-PCR and Western blot methods. Moreover, MTT assay was employed to detect the sensitivity of these ribozyme-transfected cells, and Rhodamine123 （Rh123） was used to test the function of Pgp. The Rz- transfected HepG2 cells became doxorubicin-sensitive, which was concomitant with the decreased MDR1 expression. The study showed that the retrovirus vector encoding the anti-MDR1 ribozyme may be applicable to the treatment of MDR cells.

Advances in the Researches on the Blocking Effect of Chinese Drugs on Tumors

Malignant tumors are caused by multiple carcinogenic factors undergoing several stages. The occurrence and development of tumors may be prevented and blocked if some effective interference factors are brought into play.1 At present, there are two main subjects for the researches, that is, blocking the precancerous lesions and blocking the develop-ment of tumors. The former focuses on the removing of carcinogenic factors and on the chemoprophylaxis of cancer, while the latter on the inhibition of cancer cell infiltration and cancerometastasis. These are summarized as follows.

亮菌口服溶液对肝癌术后患者免疫功能、肝功能及炎性因子的影响

目的 探讨亮菌口服溶液对肝癌术后患者免疫功能、肝功能及炎性因子的影响。方法 选取2019年2月—2020年3月收治的原发性肝癌94例,根据术后应用药物的不同均分为观察组和对照组。对照组在术后常规抗感染、护肝基础上加用恩替卡韦治疗,研究组在对照组基础上联合亮菌口服溶液治疗。比较2组临床疗效,治疗前后免疫功能指标、炎性因子、肝功能指标变化,治疗期间不良反应及无进展生存期(PFS)、总生存时间(OS)。结果 研究组治疗总有效率为95.74%(45/47)明显高于对照组的82.98%(39/47)(P<0.05)。治疗后2组CD3+、CD4+、CD8+、CD4+/CD8+及白蛋白水平均明显升高,且研究组较对照组明显升高(P<0.05,P<0.01)。治疗后2组C反应蛋白、白细胞介素-1、肿瘤坏死因子-α、白细胞介素-6及总胆红素、丙氨酸转氨酶、天冬氨酸转氨酶水平均降低,且研究组较对照组降低明显(P<0.05,P<0.01)。研究组不良反应总发生率明显低于对照组(P<0.05)。研究组PFS和OS均长于对照组(P<0.01)。结论 亮菌口服溶液可调节肝癌术后患者免疫功能,抗炎、抗肿瘤效果显著,并可有效促进患者肝功能恢复、延长患者生存期。

Immunotherapy for recurrent hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is presented frequently in late stages that are not amenable for curative treatment.Even for patients who can undergo resection for curative treatment of HCC,up to 50%recur.For patients who were not exposed to systemic therapy prior to recurrence,recurrence frequently cannot be subjected to curative therapy or local treatments.Such patients have several options of immunotherapy(IO).This includes programmed cell death protein 1(PD-1)and cytotoxic T-lymphocyte associated protein 4 treatment,combination of PD-1 and vascular endothelial growth factor inhibitor or single agent PD-1 therapy when all other options are deemed inappropriate.There are also investigational therapies in this area that explore either PD-1 and tyrosine kinase inhibitors or a novel agent in addition to PD-1 with vascular endothelial growth factor inhibitors.This minireview explored IO options for patients with recurrent HCC who were not exposed to systemic therapy at the initial diagnosis.We also discussed potential IO options for patients with recurrent HCC who were exposed to first-line therapy with curative intent at diagnosis.

去甲斑蝥素-泊洛沙姆407缓释剂和无水乙醇的肝癌瘤内注射疗效比较

目的 :观察去甲斑蝥素 -泊洛沙姆 40 7(NCTD- P40 7)缓释剂瘤内注射治疗中晚期肝癌的疗效。方法 :将 5 6例癌灶最大直径为 6～ 12 cm的中晚期肝癌患者随机分为 2组 ,治疗组 (2 9例 )在超声引导下经皮肝穿刺瘤内注射 NCTD- P40 7缓释剂和对照组 (2 7例 )瘤内注射无水乙醇 ,进行临床疗效观察比较研究。结果 :在生活质量、实体瘤变化及实验室指标变化方面 ,两组疗效比较无显著性差异 (P>0 .0 5 ) ;在生存期方面 ,12个月生存率治疗组为 31.0 % ,对照组为 2 2 .2 % ,有显著性差异 (P<0 .0 5 )。在毒副反应方面 ,两组均未出现明显的毒副作用。 结论 :NCTD- P40 7缓释剂局部瘤内注射治疗可高浓度长时间作用于瘤体 ,对较大的中晚期肝癌具有一定疗效 ,且综合疗效优于无水乙醇瘤内注射。

体外化疗药物敏感实验对指导原发性肝癌个体化疗的临床意义

背景与目的:肝细胞癌(肝癌)化学治疗效果差。为了提高化疗效果,本研究采用体外化疗敏感实验——三磷酸腺苷肿瘤化疗药物敏感实验(adenosinetriphosphatetumorchemosensitivityassay,ATP鄄TCA)系统评估化疗药物,并利用该系统指导肝癌患者临床个体化疗。方法:获取50个原发性肝癌手术标本,采用ATP鄄TCA系统评估5鄄氟尿嘧啶(5鄄fluorouracil,5鄄FU)、丝裂霉素(mitomycin,MMC)、顺铂(cisplatin,DDP)、草酸铂(oxaliplatin,OXA)、表阿霉素(epirubicin,EPI)、健择(gemcitabine,GEM)、伊立替康(irinotecan,CPT鄄11)、足叶乙甙(etoposide,VP鄄16)和泰素(paclitaxel,PTX)等化疗药物;23例肝癌患者术后接受ATP鄄TCA系统指导临床化疗,同时以20例接受手术及常规治疗的肝癌患者作为对照,观察162周临床疗效。结果:ATP鄄TCA系统结果可评估率为90.8%。肝癌细胞对各种化疗药物中鄄高度敏感率分别为:泰素46%、伊立替康44%、健择36%、丝裂霉素14%、表阿霉素12%、顺铂8%、足叶乙甙6%、草酸铂6%以及5鄄氟尿嘧啶4%;临床结果:临床研究观察终点ATP鄄TCA组与对照组比较,PR、CR、SD及观察期内患者死亡率两组之间无显著性差异;然而对照组有较高病情进展发生率(60.00%vs.13.04%,P=0.003);ATP鄄TCA组较对照组在总病情缓解率(60.86%vs.30.00%,P=0.043)、平均手术后总生存期(78.91周vs.27.21周,P=0.006)及手术后无疾病进展生存期(30.52周vs.4.78周,P=0.005)方面表现出明显优势。结论:ATP鄄TCA系统可以成功用于评估肝癌标本。泰素、伊立替康和健择有较高的体外抗肝癌活性。ATP鄄TCA系统指导肝癌个体化疗有可能提高患者无疾病进展生存期和总生存期。

五个疏肝复方对胃肠运动功能影响的比较研究

目的:观察五个疏肝复方对小鼠胃排空、小肠推进及大鼠肠收缩幅度和频率的影响,以探明五个疏肝复方有无促胃肠动力作用。方法:通过正常小鼠胃内葡聚糖蓝-2000残留量、小肠内葡聚糖蓝-2000推进率来研究五个疏肝复方对小鼠胃排空、小肠推进的影响;采用正常大鼠肠道气囊法,记录五个疏肝复方对正常大鼠肠收缩幅度和频率的影响。结果:除逍遥散组外,其余4组与阳性对照组小鼠胃内色素残留量显著降低,小肠推进率明显增高;大鼠肠收缩频率加快,收缩波幅升高,与空白对照组比较差异有显著性(P<0.01)。结论:除逍遥散外,其余4个疏肝复方可以加快胃排空,促进小肠推进,并增加肠收缩幅度与频率。