Successful totally laparoscopic right trihepatectomy following conversion therapy for hepatocellular carcinoma:A case report

BACKGROUND About 20%-30%of newly diagnosed hepatocellular carcinoma(HCC)patients are surgically feasible due to a variety of reasons.Active conversion therapy may provide opportunities of surgery for these patients.Nevertheless,the choice of surgical procedure is controversial after successful conversion therapy.We report a patient with HCC who underwent successful laparoscopic right trisectionectomy after conversion therapy with portal vein embolization and transarterial chemoembolization.CASE SUMMARY A 67-year-old male patient presented to our hospital with epigastric distention/discomfort and nausea/vomiting for more than 1 mo.Contrast-enhanced computed tomography scan of the abdomen demonstrated multiple tumors(the largest was≥10 cm in diameter)located in the right liver and left medial lobe,and the left lateral lobe was normal.The future remnant liver(FRL)of the left lateral lobe accounted for only 18%of total liver volume after virtual resection on the three-dimensional liver model.Conversion therapy was adopted after orally administered entecavir for antiviral treatment.First,the right portal vein was embolized.Then tumor embolization was performed via the variant hepatic arteries.After 3 wk,the FRL of the left lateral lobe accounted for nearly 30%of the total liver volume.Totally laparoscopic right trisectionectomy was performed under combined epidural and general anesthesia.The in situ resection was performed via an anterior approach.The operating time was 240 min.No clamping was required during the surgery,and the intraoperative blood loss was 300 mL.There were no postoperative complications such as bile leakage,and the incision healed well.The patient was discharged on the 8th postoperative day.During the 3-mo follow-up,there was no recurrence and obvious hyperplasia of residual liver was observed.Alpha-fetoprotein decreased significantly and tended to be normal.CONCLUSION Due to the different biological characteristics of the liver cancer and the pathophysiological features of the liver from other organs,the conversion treatment should take into account both the feasibility of tumor downstaging and the volume and function of the remnant liver.Our case provides a reference for clinicians in terms of both conversion therapy and laparoscopic right trisectionectomy.

The Description of Pancreatic Cancer Death in Inner Mongolia 2008-2014

Objective: The study aimed to assess the characteristics of pancreatic cancer deaths and the relationship between socio-demographic status and mortality risk of pancreatic cancer in Inner Mongolia. Method: We obtained our data for 2008-2014 from the Death Registry System of Inner Mongolia. We calculated the mortality rate, potential years of life lost (PYLL) and average years of life lost (AYLL) for men and women. We collected socio-demographic characteristics including education level, ethnicity, region, and occupation. Logistic regression models were employed to analyze risk factors of pancreatic cancer. Results: The average mortality rate of pancreatic cancer was 4.42/100,000 in Inner Mongolia during 2008 to 2014. Mortality rate in men was higher in all age groups compared with those in women. The highest mortality rate was 1.3 times than the lowest mortality rate for men and 1.6 times for women during seven years. Average AYLL in women were more than 3.4 years compared with that in men. PYLLR in women was fluctuated from 0.41 to 0.63 per thousand during 2008 to 2014. In eastern region, no occupation and high education level had a higher risk of pancreatic cancer. Conclusion: In Inner Mongolia, the mortality rate associated with pancreatic cancer was higher in men compared with in women. More than 65 years old groups had high death risk for pancreatic cancer. Average years of life lost for women were significantly higher than that for men. We should pay more attention to the older men.

Association of rs1137101 with hypertension and type 2 diabetes mellitus of Mongolian and Han Chinese

BACKGROUND Hypertension(HTN)and type 2 diabetes mellitus(T2DM)are often coincident,and each condition is considered a risk factor for the other.Both occur frequently in the Inner Mongolia region of China.The reasons for differences in risk between Han and Mongolian ethnic groups are not known.The LEPR gene and its polymorphism,rs1137101(Gln223Arg),are both considered risk factors for HTN and T2DM,but any role of rs1137101 in the occurrence of HTN+T2DM remains unclear for Mongolian and Han populations in the Inner Mongolia region.AIM To investigate the relationship between rs1137101 and the occurrence of HTN with T2DM in Mongolian and Han populations in Inner Mongolia METHODS A total of 2652 subjects of Han and Mongolian ethnic origins were enrolled in the current study,including 908 healthy controls,1061 HTN patients and 683 HTN patients with T2DM.RESULTS The association between the rs1137101 polymorphism and HTN with T2DM was analyzed,and differences between Han and Mongolian individuals assessed.There was a significant correlation between rs1137101 and HTN(co-dominant,dominant,over-dominant and log-additive models)and HTN+T2DM(co-dominant,dominant,over-dominant and log-additive models)after adjustment for sex and age in individuals of Mongolian origin.rs1137101 was significantly associated with HTN(co-dominant,recessive and log-additive models)and HTN+T2DM(codominant,dominant,over-dominant and log-additive models)in the Han Chinese population.CONCLUSION Mongolian and Han subjects from Inner Mongolia with HTN who had rs1137101 were protected against the development of T2DM.Allele A has the opposite impact on the occurrence of HTN in Mongolian and Han Chinese populations.

Study on clinical effects of pedicle screw combined with immobilized implantation bone by wirerope and hallow compression screw immobilization in treating spondylolysis of lumbar vertebra of multiple segments of adults

Objective:To observe clinical effects of pedicle screw fixation combined with cable wires and bone graft and cannulated compression screws on adult multi-segment lumbar spondylolysis.Methods:70 cases of patients with multi-segment lumbar spondylolysis were selected in our hospital.According to different surgical schemes,these patients were divided into the observation group(35 cases)and the control group(35 cases).The observation group received pedicle screw fixation combined with cable wires and bone graft and the control group received cannulated compression screw fixation.Macnab criteria were adopted to implement a therapeutic evaluation of two groups of patients to make an observation and comparison of the excellent and good rate of surgery and a series of indicators including perioperative clinical effects,intraoperative blood loss,duration of surgery,hospital length of stay(HLOS),visual analogue scale(VAS),Oswestry disability index and Japanese Orthopaedic Association(JOA)score.Results:The excellent and good rate of the observation group was 97.14%,and that of the control group was 82.86%,the difference between two groups was statistically significant(χ^(2)=6.248,p=0.012).The differences in intraoperative blood loss,duration of surgery and HLOS between two groups were statistically significant(t=-4.55,t=-4.55,t=-4.55;p<0.05).Oswestry index,VAS score and JOA score of the observation group were(2.4±0.9),(28.5±6.4)and(27.1±3.1)respectively,and these of the control group were(3.5±1.2),(37.1±7.8)and(21.3±2.7)respectively,the differences between two groups were statistically significant(t=4.338,t=5.043,t=8.347,p<0.05).Conclusions:Pedicle screw combined with immobilized implantation bone by wirerope has an excellent clinical effect on the treatment of adult multi-segment lumbar spondylolysis,and it has a series of advantages such as fast postoperative recovery,small surgical trauma and so on.In addition,this technique can also restore the stability of spinal segments and relieve pains to a greater degree.