IntroductionIn most instances, liver transplantation (LT) is the only available treatment for end‐stage liver diseases. However, LT could also induce serious liver diseases or injury, and the underlying mechanisms of LT-induced complications remain largely unknown, especially the mechanisms of the dysfunction of the immune system mediated by long noncoding RNAs (lncRNAs).MethodsIn this study, we globally analyzed the proportion of immune cells by using the transcriptome sequencing data (RNA-seq) of needle-core liver biopsies from pre- and post-transplantation recipients. Dysregulated lncRNAs were found to be correlated with the altered fractions of immune cells. We finally explored the potential targets of dysregulated lncRNAs and analyzed their functions in LT.ResultsWe found that in the samples, some immune cells changed significantly after LT, including CD4 T cells, NK cells and mast cells. The proportion of macrophages in different polarization states also changed significantly, with M0 macrophages increasing and M2 macrophages decreasing. Through weighted gene co-expression network analysis (WGCNA), 7 gene expression modules related to LT were identified. These modules were related to changes in the proportion of different immune cells. The functions of these modules represent the response modes of different functional genes after LT. Among these modules, MEtan and MEyellow modules were primarily enriched in apoptosis and inflammatory pathways. Twelve immunity-related lncRNAs were identified for the first time, and the regulatory network co-changing with immune cells was also identified. The co-expressed genes of these lncRNAs were highly enriched in apoptosis-related pathways. Many apoptosis-related genes were found to be up-regulated after LT.DiscussionIn summary, we speculated that the expression and regulation of these apoptotic genes may be related to the changes in the proportion of immune cells. Some of these lncRNAs and apoptosis-related genes have been reported to be related to cell proliferation and apoptosis. They are also potential biomarkers or therapeutic targets.

The treatment of end-stage hepatic alveolar echinococcosis is extremely difficult and complicated. As the lesion of hepatic echinococcosis can infiltrate into the surrounding area in the early stage, the biliary tract, liver, and inferior vena cava are often involved in the end stage, and even worse, metastases to the retroperitoneum and distant organs such as the brain and lung occur via lymphatic and blood vessels. As a result, conventional surgical treatment cannot achieve the goal of curative or radical resection. Most patients often have cachexia at initial diagnosis, which seriously affects their survival period and quality of life after surgery. At present, the main treatment methods include radical resection, liver transplantation, reduced volume resection of lesions, palliative resection combined with drug therapy, drug therapy, radiofrequency, and microwave ablation. Among all the current treatment measures, surgery is still the first choice, which can provide patients with a chance to cure. Based on recent literature reports and clinical practice in our hospital, we review the present situation of treatment of end-stage hepatic vesicular echinococcosis in this paper.

Objectives Liver echinococcosis is a severe zoonotic disease caused by Echinococcus (tapeworm) infection, which is epidemic in the Qinghai region of China. Here, we aimed to explore biomarkers and establish a predictive model for the diagnosis of liver echinococcosis. Methods Microarray profiling followed by Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis was performed in liver tissue from patients with liver hydatid disease and from healthy controls from the Qinghai region of China. A protein–protein interaction (PPI) network and random forest model were established to identify potential biomarkers and predict the occurrence of liver echinococcosis, respectively. Results Microarray profiling identified 1152 differentially expressed genes (DEGs), including 936 upregulated genes and 216 downregulated genes. Several previously unreported biological processes and signaling pathways were identified. The FCGR2B and CTLA4 proteins were identified by the PPI networks and random forest model. The random forest model based on FCGR2B and CTLA4 reliably predicted the occurrence of liver hydatid disease, with an area under the receiver operator characteristic curve of 0.921. Conclusion Our findings give new insight into gene expression in patients with liver echinococcosis from the Qinghai region of China, improving our understanding of hepatic hydatid disease.

目的 总结肝减体积式病灶切除联合药物治疗对终末期肝泡型包虫病的疗效及其临床意义.方法 回顾性收集青海省人民医院普外科于2013年3月至2019年10月期间收治的行肝减体积式病灶切除联合药物治疗的46例终末期肝泡型包虫病患者的临床资料.结果 46例患者术后失访3例,获访43例,随访时间3～79个月,中位数为40个月.随访期间死亡15例,其中5例因合并脑包虫病于术后16～36个月出现癫痫急性发作、脑水肿而死亡;4例患者因全身多发转移于术后9～36个月出现多脏器功能衰竭而死亡;2例术前合并肺包虫转移的患者因术后出现急性肺栓塞而死亡;4例因反复胆道感染于术后2年内死亡,余患者随访期间均存活,未发现远处脏器转移.结论 肝减体积式病灶切除联合药物治疗终末期肝泡型包虫病,可提高患者的生存质量,降低患者住院费用,减少术后并发症的发生,缩短住院时间.

肝泡型棘球蚴病是由多房棘球绦虫幼虫寄生于宿主体内所引起的一种慢性人兽共患寄生虫病.根治性手术切除是肝泡型棘球蚴病首选的治疗方法.近年来,随着一些微创外科治疗方法在外科系统各领域的普及,微创外科技术逐渐开始应用于肝泡型棘球蚴病的临床治疗.本文就肝泡型棘球蚴病的微创外科治疗现状及进展进行综述.

ObjectiveTo investigate the postoperative complications of ex vivo liver resection combined with autologous liver transplantation in the treatment of end-stage hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies. MethodsSurgical data and follow-up data were collected from 11 patients with end-stage hepatic alveolar echinococcosis who underwent autologous liver transplantation in Qinghai People’s Hospital from January 2013 to March 2019, and intraoperative and postoperative conditions were analyzed. ResultsAll 11 patients underwent autologous liver transplantation successfully, without intraoperative death, among whom 2(18.18%) underwent hemi-extracorporeal hepatectomy and 9 (81.82%) underwent total extracorporeal hepatectomy. For the reconstruction of the retrohepatic inferior vena cava, 2 patients (18.18%) underwent reconstruction with the autologous great saphenous vein, 4 patients (36.36%) underwent reconstruction with artificial vessels, and the autologous retrohepatic inferior vena cava was preserved in 5 patients (45.45%). For biliary reconstruction, 8 patients (72.73%) underwent choledochoenterostomy and 3 (27.27%) underwent choledochocholedochostomy. The main postoperative complications of the 11 patients included bleeding in 2 patients (18.18%), bile leakage and abdominal infection in 4 patients (36.36%), bilioenteric anastomotic stenosis in 1 patient (9.09%), thrombus in 2 patients (1818%), pulmonary infection and pleural effusion in 2 patients (18.18%), and echinococcosis recurrence in 1 patient (9.09%). Of all 11 patients, 2 (18.18%) died during the perioperative period, and the other 9 patients (81.82%) were improved and discharged. Conclusion Bleeding, biliary complications, and infection are the main causes of death in patients undergoing autologous liver transplantation at high altitude. An accurate understanding of surgical indication, careful multidisciplinary evaluation before surgery, superb operation during surgery, standardized surgical procedures, and fine perioperative management are the key to reducing perioperative mortality, avoiding and reducing postoperative complications, and achieving good long-term survival in patients undergoing autologous liver transplantation.

Morbidity of mixed cystic and alveolar echinococcosis (CE and AE) is exceptionally rare. Less literature retrieved from a database on the internet detailed the content, including radiography, pathology, and therapeutics data. Such a case of co-occurrence of the different Echinococcus species was diagnosed and treated at our hospital center from Nov 2019 to Feb 2020. A 30 yr old female from the pastoral area in Qinghai Province, China, was diagnosed with a case of echinococcosis and diagnosis was confirmed after image studies, immunoassaying of hydatid enzymes, life history and pathology result. The patient underwent hepatectomy along with excision of the internal capsule. Post-operative pathology was done, and it confirmed a mixed infection of both CE and AE. The patient recovered well without complications after liver-protecting and tissue repair treatment for 15 days. Knowing about infective mode and immune method of the case might be vital for research on variation for Echinococcus infection.

The long-term use of benzimidazoles for the treatment of echinococcosis may cause multiple adverse reactions and low compliance. A search for novel agents, as an alternative of benzimidazoles, is therefore of great significance for the treatment of echinococcosis. This review focuses on the progress of researches on non-benzimidazoles for the clinical treatment of echinococcosis, including anti-parasitic agents, anti-proliferative agents and plant extracts, so as to provide insights into the further development of non-benzimidazoles.

OBJECTIVE:To analyze the sequences of the cytochrome C oxidase subunit I (Cox1) gene of various Echinococcus granulosus genotypes that are currently recorded in the GenBank database, so as to investigate the genetic variation and differentiation of the E. granulosus genotypes across the world.METHODS:The sequences of the Cox1 gene of various E. granulosus genotypes that are currently recorded in the GenBank database were collected, and the same sequences of the Cox1 gene identified from a region were excluded. The mutation sites among the Cox1 gene sequences were identified and a phylogenetic tree was created based on the Cox1 gene.RESULTS:Transversion mutation was the predominant type of mutation in the Cox1 gene of E. granulosus. The same Cox1 gene sequence was found in E. granulosus G1, G6 and G7 genotypes isolated from various geographical locations across the world, with the corresponding GenBank accession numbers of KY766891, MH300971 and MH301007, respectively. Phylogenetic analysis revealed that E. granulosus G10 genotype had a remarkable geographical aggregation.CONCLUSIONS:E. granulosus G1, G6 and G7 genotypes have primitive Cox1 gene sequences. There is a geographical aggregation of the E. granulosus G10 genotype in the phylogenetic tree, which has a tendency towards reproductive isolation.

Objective:To compare the different methods of hepatic blood flow occlusion in hepatectomy for hepatic alveolar echinococcosis.Methods:A total of 49 patients with hepatic alveolar echinococcosis who underwent radical hepatectomy from January 2018 to January 2019 in Department of General Surgery, Qinghai Provincial People's Hospital were retrospectively studied. There were 22 males and 27 females, aged 10-62 years. The patients were divided into the Glisson group ( n=22) and the Pringle group ( n=27) according to the method used for hepatic blood flow occlusion during operation. For the Glisson group, intrahepatic blood flow was occluded at the Glisson pedicle. For the Pringle group, intrahepatic blood flow was occluded using the Pringle’s maneuvre. Intraoperative blood loss, operation time, postoperative liver function and postoperative complications were compared between the two groups. Results:There were no significant differences between the two groups in operation time, intraoperative blood loss and intraoperative blood transfusion (all P>0.05). The vascular occlusion time of blood flow in the Pringle group was 35 (30, 45) min, which was significantly longer than that of 20 (15, 26) min in the Glisson group ( P<0.05). The drainage tube in the Pringle group was removed after 8 (7, 12) d, which was significantly longer than that of 7 (6, 9) d in the Glisson group ( P<0.05). After operation, alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin in the Glisson group were significantly better than those in the Pringle group (all P<0.05). Postoperative complications occurred in 9 patients (40.9%, 9/22) in the Glisson group and 15 patients (55.6%, 15/27) in the Pringle group ( P>0.05). Conclusion:The liver function, and time of removal of abdominal drainage tube after Glisson pedicle hepatic blood flow occlusion in patients who underwent hepatectomy for hepatic alveolar echinococcosis were significantly better than the Pringle method.

Alveolar echinococcosis is a parasitic zoonosis that severely damages human health. Currently, radical surgical resection is the first choice for hepatic alveolar echinococcosis. For the advanced hepatic echinococcosis patients with refractory radical resection, the palliative surgery combined with chemotherapy, liver transplantation, drug therapy, and radiofrequency microwave ablation may provide comprehensive tools. This article reviews the current situation and progress of comprehensive treatments for hepatic alveolar echinococcosis.

目的 探讨急性结石性胆囊炎患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中转开腹的危险因素.方法 通过青海省人民医院医院管理信息系统(hospital management information system,HIS)收集青海省人民医院普外科2018年1月至2019年12月急性结石性胆囊炎行LC患者的临床资料,探讨LC中转开腹的独立危险因素,行单因素分析和二元多因素Logistic回归分析影响因素.结果 共收集156例急性结石性胆囊炎患者基本资料及临床资料,其中完全行LC者共120例,由腹腔镜中转开腹手术胆囊切除术有36例,纳入研究影响因素中性别(χ2=0.414,P=0.520)、年龄(χ2=0.309,P=0.578),体质指数(χ2=0.001,P=0.977)、高血压病(χ2=1.256,P=0.262)差异均无显著性;胆囊壁厚度(χ2=15.230,P<0.001)、胆囊炎急性发作时间(χ2=6.984,P=0.008)、白细胞计数(Z=-2.533,P=0.011)、总胆红素水平(Z=-2.311,P=0.021)和纤维蛋白原(Z=-2.490,P=0.013)差异均有显著性.行二元多因素Logistic回归结果表明,胆囊壁厚度≥5mm、胆囊炎急性发作时间≥72h是急性结石性胆囊炎LC术中转开腹的独立危险因素.结论 LC术前准确把握手术适应证,术中规范、细致的操作可有效降低LC中转开腹率,而当患者术前超声提示胆囊壁显著增厚或胆囊炎急性发作时间较长应提前做好中转开腹的准备,以降低手术时间.

目的 探讨加速康复外科理念在肝囊型包虫病患者围手术期应用的安全性、有效性.方法 回顾性分析2017年1月至2018年1月青海省人民医院包虫病诊疗中心行根治性手术治疗的92例肝囊型包虫病患者临床资料.按围手术期处理方法分为加速康复组(n=42)和传统康复组(n=50),比较两组患者术中出血量、术中输血量、术后并发症发生情况、首次通气时间、拔除腹腔引流管时间及术后住院时间等指标.结果 与传统康复组相比,加速康复组手术并发症发生率[23.8％(10/42)vs 82.0％(41/50),χ2=30.35,P=0.001]更低,术后首次通气时间[15(12,20)h vs 35.5(27,45)h,Z=-7.728,P<0.001]更早,术后住院时间[4(3,5)d vs 15(12,18)d,Z=-8.254,P<0.001]更短,差异均具有统计学意义.结论 加速康复外科理念在肝囊型包虫病患者围手术期的应用安全有效,不仅可有效降低手术并发症发生率,而且可明显缩短患者的术后住院时间.

目的 总结泡型棘球蚴的浸润生长、免疫逃逸、转移机制方面的最新研究进展,为泡型棘球蚴病的免疫诊断和治疗等研究提供思路.方法 通过查阅国内外关于泡型棘球蚴的生长增殖、免疫逃逸和转移的相关文献,对可能参与其免疫逃逸的相关机制进行分析总结.结果 天然屏障、免疫耐受、细胞因子、血管新生等在泡球蚴的致病过程中发挥着重要的作用,但由于各个因素相互作用影响使得这一过程错综复杂.结论 目前就泡型棘球蚴的生长、转移、免疫逃逸等机理的研究文献仍然较少,但目前主流的研究方向有免疫逃逸、细胞因子、血管新生,随着医疗技术的发展和大量相关研究的进行,对泡型棘球蚴的致病和免疫逃逸机制这一过程或将进一步明确.

探讨保留肝后下腔静脉的离体肝切除、自体肝移植术在治疗终末期肝泡型包虫病中的疗效.回顾性分析青海省人民医院包虫诊疗中心自2017年1月至2019年3月收治的3例行保留肝后下腔静脉的离体肝切除、自体肝移植术的肝泡型包虫患者临床资料.术中2例患者肝后下腔静脉从包虫病灶完整剥离,未行肝后下腔静脉搭桥、重建.1例患者在离体包虫病灶切除时完整保留肝后下腔静脉,未行人工血管重建肝后下腔静脉.术后3例患者出现不同类型并发症,经积极处理后顺利出院.出院后随访2～18个月,3例患者均无血栓并发症,其中1例患者健肝再发包虫,2例患者肝再生良好、无包虫复发.保留肝后下腔静脉的离体肝切除、自体肝移植术在治疗终末期肝泡型包虫病在本研究中疗效较好.

Objective To investigate whether the expression of metal matrix protease-9 (MMp-9) changes with altitude in severe acute pancreatitis (SAP) lung injury by establishing SAP model in rats.The related indexes of pancreas and lung injury and MMp-9 were measured.Methods 280 SPF male Wistar rats were randomly assigned to different altitude groups to establish SAP model,then the serum amylase (AMY) content of each group were detected.The degree of pancreatic injury and pancreatic pathological score were observed under light microscope.The expression level of MMP-9 in lung tissues was measured and analyzed by statistical methods.Results (1) At the same altitude,the expression of MMP-9 in each time group increased with time,with statistically significant difference (P ≤ 0.05).(2) AMY value,pathological score of pancreas and expression of MMP-9 in lung tissue increased with the altitude in the same time group at different altitudes,with statistically significant difference (P ≤ 0.05).Conclusions The higher the altitude,the more severe the damage of SAP and lung,and the higher the expression level of MMP-9.

Objective To evaluate the efficacy and safety of reduced volume hepatectomy in treat-ment of advanced hepatic alveolar echinococcosis. Methods The clinical data of 90 patients with advanced hepatic alveolar echinococcosis treated at the Qinghai Provincial People's Hospital from January 2017 to Janu-ary 2019 were retrospectively analyzed. There were 41 males and 49 females, with an average age of 32 ( range 11 to 58 ) years. The locations of the lesions, operations, complications and follow-up were analyzed. Results 90 patients were treated with reduced volume focal hepatectomy, 38 with radical resec-tion and 52 with quasi radical resection. The operation time was ( 361 ± 22 ) min. The hospital stay was (22 ± 2) day, and the blood loss was (781 ± 37) ml. Red blood cells were transfused in 19 patients and plasma in 39 patients. Pringle' s maneuver was used in 12 patients, regional hepatic blood flow occlusion in 42 patients, and Glisson sheath occlusion in 26 patients. The total bilirubin, alanine aminotransferase and aspartate aminotransferase returned to normal in 3 to 14 days after operation. There were 12 patients who developed bile leakage, 41 pleural effusion and 26 effusion in the operation sites. A total of ninety patients were followed up for 2 to 24 months. There was no recurrence of echinococcosis after radical resection and no enlargement of residual lesions after quasi-radical resection. Conclusion Reduced-volume hepatectomy reduced the risk and difficulty of operation. The follow-up results were good. This approach provides a feasi-ble scheme for treatment of advanced hepatic alveolar echinococcosis.

目的 探讨颈动脉支架植入术对脑梗死患者认知功能的影响.方法 选取青海省人民医院自2011年1月至2015年1月收治的1 10例行颈动脉支架置入术患者为研究对象.术后1、3、6个月应用蒙特利尔认知评价量表(MMSE)以及MoCA量表对患者的认知功能进行评定,采用连线测验(TMT)A、B部分对患者进行认知功能评分.结果 与治疗前及治疗后1个月比较,治疗后3、6个月,患者MMSE及MoCA评分逐渐升高,差异均有统计学意义(P＜0.05).与治疗前比较,治疗后1个月TMT-A及TMT-B所需时间明显缩短,治疗后3、6个月检测所需时间进一步缩短,差异均有统计学意义(P＜0.05).治疗后,患者的MoCA各子项得分均有改善,但抽象、回忆以及执行功能的改善较快(P＜0.05);定向功能的改善较慢.结论 颈动脉支架置入术可以改善无症状性颈动脉狭窄患者的认知功能.

OBJECTIVE:To amplify and sequence Coxl and Nadl genes in Echinococcus multilocularis isolates from Qinghai Province, and to create phylogenetic trees and molecular clocks, so as to provide evidence for estimating the evolutionary relationships and origins of E. multilocularis in Qinghai Province.METHODS:Twenty-two post-surgical specimens of patients with hepatic alveolar echinococcosis were sampled from Qinghai Provincial People's Hospital in 2017. The Coxl and Nadl genes were amplified from E. multilocularis samples and sequenced. Then, the gene sequences were aligned to the Coxl and Nadl genes of Echinococcus species in GenBank database. The intra-species variation was observed, and the phylogenetic tree and molecular clock were created.RESULTS:All E. multilocularis samples shared more than 99% genetic homology with the sequences of Coxl and Nadl genes from the E. multilocularis Asian strain in the GenBank database. A total of 6 genotypes were identified, including 2 isolates that had no 100% homology with the sequences of known genes in the GenBank database. Phylogenetic tree analysis revealed remarkable clustering of the E. multilocularis samples with the E. multilocularis Asian strain, and the E. multilocularis isolates from Qinghai Province were estimated to date back to 94 000 years ago by the molecular clock.CONCLUSIONS:The present study characterizes 6 E. multilocularis genotypes in Qinghai Province, including 2 novel genotypes. Asian strain is the predominant strain of E. multilocularis in Qinghai Province, and the E. multilocularis isolates from Qinghai Province date back to 94 000 years ago.

The hepatic echinococcosis is an anthropozoonosis and caused by the larva of . The main pathogenic type of in China is and , which cause cystic echinococcosis and alveolar echinococcosis respectively. At present, the treatment of hepatic echinococcosis has made great progress, but there are still some difficulties in the treatment of complex echinococcosis, especially of the cases existing one or more complications, and the focus of infection encroaching the hepatic portal, important vessels and bile vessel. This paper based on the literature reports and clinical experiences in recent years, puts forward the surgical treatment strategy for complex hepatic echinococcosis.