Background: Hemolymphangioma is a rare disease with congenital malformation of both vascular and lymphatic vessels characterized by cystic dilation. It mostly occurs in cutaneous localizations like head, neck during childhood. Only few cases of hemolymphangioma occur in the small intestine, pancreas, esophagus have been reported. Hemolymphangioma is usually asymptomatic or lack of typical symptoms and the diagnosis is often made as an incidental finding during endoscopy. On rare cases the initial symptoms can be chronic anemia due to gastrointestinal bleeding. They constitute an unusual manifestation and there is a low incidence of this type of tumor.

目的 探讨非酒精性脂肪性肝病(NAFLD)小鼠肝组织脂质代谢相关基因水平变化.方法 采用高脂饲料喂养20小鼠,构建小鼠NAFLD动物模型,观察小鼠肝组织病理学变化,检测血清总胆固醇(TCH)和甘油三酯(TG)含量,采用RT-PCR法检测小鼠肝组织胆固醇调节元件结合蛋白(SREBPs)、乙酰辅酶A羧化酶(ACC)和脂肪酸合成酶(fatty acid synthase,FAS)基因变化.结果 10只NAFLD模型小鼠肝细胞排列不整齐,肝细胞内出现大小不等的脂滴;NAFLD模型小鼠血清TG和TCH水平分别为(0.63±0.13) mmol/L和(7.23±0.7) mmol/L,显著高于10只对照组[(0.28±0.06) mmol/L和(2.78±0.6) mmol/L,P＜0.001];在实验24 w末,NAFLD组小鼠肝组织FAS和SREBP-1 mRNA水平分别为(3.9±1.1)和(1.8±0.7),对照组则分别为[(1.0±0.3)和(1.0±0.4),FAS:t=6.231,P＜0.001;SREBP-1:t=2.431,P =0.035],差异显著,而NAFLD组小鼠肝组织ACC mRNA水平为(1.2±0.5),与对照组[(1.0±0.4),t=0.765,P=0.462]比,无显著差异.结论 NAFLD模型小鼠肝组织与脂质代谢相关基因显著上调,为进一步研究NAFLD的发生发展机制奠定了基础.

*These authors contributed equally to this work Background: Signal transducer and activator of transcription (STAT) proteins are wellknown transcription factors that play an important role in the progression of cancer. However, the association between STAT family genes and hepatocellular carcinoma (HCC) remains unclear. This study investigates the expression level, the prognostic value and the potential mechanism of STAT family genes in HCC. Methods: Data from 365 HCC patients in The Cancer Genome Atlas (TCGA) database and 241 HCC patients in the Gene Expression Omnibus (GEO) database were used to investigate the diagnostic and prognostic values of STAT genes by survival analysis and nomogram. Gene set enrichment analysis (GSEA) was used to investigate the potential mechanism of the STAT genes in the development of HCC. Results: Our results showed that STAT4/5B mRNA expression levels in HCC tissues were lower than those in normal tissues. Importantly, our results indicated that high expression of STAT5A, STAT5B and STAT6 was associated with better overall survival in HCC patients. Joint effects analysis of STAT5A, STAT5B and STAT6 suggested that the prognosis difference for any combination of genes was more significant than that for any individual gene. Then, we developed a risk score model could predict HCC prognosis and the nomogram visualized gene expression and clinical factors of probability for HCC prognosis. The ROC and calibration curves showed good performance in survival prediction in both the TCGA and the GEO databases. GSEA suggested that high expression of STAT5A, STAT5B and STAT6 were involved in immune-related biological processes, drug metabolism cytochrome P450, JAK-STAT signalling pathway, and PPAR signalling pathways. Conclusion: Our data suggest that STAT5A, STAT5B and STAT6 expression may be potential prognostic markers of HCC and, in combination, have a better predictive value for HCC prognosis.

目的:探讨熊去氧胆酸胶囊对肝癌术后肝功能的保护作用.方法:30例肝细胞癌患者在行肝切除术后随机分为试验组和对照组,分别从术后第3天开始给予口服熊去氧胆酸胶囊及空白对照观察.结果:术后第7天较术后第3天试验组总胆红素、间接胆红素下降显著(P<0.05),术后第7天较术后第3天两组GGT前后变化不明显(P>0.05).结论:熊去氧胆酸胶囊可加速术后胆汁排泄,改善胆汁淤积,对肝切除术后肝功能恢复可能具有保护作用.

Objective To investigate the effect of soothing liver and regulating the qi method on gastric Cajal interstitial cell apoptosis and its possible mechanism. Methods 120 Wistar rats were divided into three groups:control group,yangmingfushi syndrome group and soothing liv-er and regulating the qi method group. After the success of the model,the patients in the treatment group were treated with Chaihu Shugan San De-coction,and the rats in the control group and the control group were fed with the same amount of 0. 9％ Sodium chloride,continuous treatment for 5 d. After 20 days treatment,the survival rate of rats in each group was observed,and the average weight of the surviving rats was measured. Plas-ma substance P (SP)levels were measured by radioimmunoassay. The Cajal interstitial cells in the stomach of each group rats were separated,and the apoptosis of each group was detected by flow cytometry. The expression of apoptosis related proteins and PI3K/ PDK1 / Akt signaling pathway re-lated proteins in stomach Cajal cells of was detected by Western-blot. Results After 20 days,the survival rate,the average body weight and SP content of the rats in the yangmingfushi group were significantly lower than those in the control group (P < 0. 05). The survival rate,the average body weight and SP content of the rats treated with soothing liver and regulating qi method were significantly higher than those of the yangmingfushi Group (P < 0. 05). The apoptosis rate and Bax,Cleaved-caspase3,Cleaved-caspase9 protein expression in the soothing liver and regulating the qi method group were significantly higher than those in the control group,and the expression of Bcl-2,PI3K,PDK1,Akt and p-Akt protein was significantly lower than that in the control group (P < 0. 05);cell apoptosis rate and Bax,Cleaved-caspase3 and Cleaved-caspase9 protein expression in soothing liver and regulating the qi method group were significantly lower than that of yangmingfushi syndrome group,the expression of Bcl-2,PI3K,PDK1,Akt,p-Akt protein was significantly higher than yangmingfushi syndrome group (P < 0. 05). Conclusion Soothing liver and regulating the qi method may reduce the apoptosis of Cajal interstitial cells which induced by the yangmingfushi syndrome through the PI3K/ PDK1 / Akt signal pathway,and effectively improve the gastrointestinal function.

Angiogenesis is a fundamental part of the response to tissue injury, which is involved in the development of hepatic fibrosis. Vascular endothelial growth factor plays an important role in angiogenesis. The expression of VEGF is increased during hepatic fibrogenesis and correlates with the micro-vessel density. In this study, we investigated the effects of bevacizumab, an anti-angiogenetic drug, on the formation of hepatic fibrosis. We found that bevacizumab could attenuate the development of hepatic fibrosis and contribute to the protection of liver function. Bevacizumab was also found to downregulate the expression α-SMA and TGF-β1, which have been reported to be profibrogenic genes in vivo. We also observed that the expression of VEGF increased significantly during the development of hepatic fibrosis and CCl4 was found to induce hepatocytes to secrete VEGF, which led to the activation and proliferation of HSCs. Bevacizumab was also found to block the effects of the hepatocytes on the activation and proliferation of HSCs. Our results suggest that bevacizumab might alleviate liver fibrosis by blocking the effect of VEGF on HSCs. Bevacizumab might be suitable as a potential agent for hepatic fibrosis therapy.

Objective To explore the clinical value of total hemihepatic vascular exclusion (THHVE) in right hepatectomy for hepatocellular carcinoma (HCC). Methods One hundred and twenty-three consecutive patients who underwent right hepatectomy for HCC between February 2006 and December 2008 were studied retrospectively. THHVE was used in 58 patients (group A) and Pringle maneuver in 65 patients (group B). The patient's demographics,surgical procedure and outcome were collected and compared between the two groups.Results The tumor size was significantly bigger in group A than group B (7.69±3.70 cm vs.6.08±4.07 cm,P＜0.05).The vascular occlusion time in group A was significantly longer than groupB (28.55±8.67 min vs.19.85±6.71 min,P＜0.05). However, intraoperative blood loss in group A was significantly less than group B (304.31±270.36 ml vs.542.62±876.84 ml,P＜0.05),and the elevation of serum alanine aminotransferase (ALT) on day- 1,-3 and- 7 after operation in group A were significantly lower than group B (P＜0.05).The postoperative complication rate in group A was lower than group B (18.97％ vs.38.46％,P＜0.05).Conclusion THHVE was a safe and efficacious technique in right hepatectomy for HCC.It significantly decreased blood loss,alleviated liver injury and reduced postoperative morbidity and mortality.

Objective To evaluate whether adjuvant transchatheter arterial chemoembolization(TACE) can reduce early recurrence of small hepatocellular carcinoma(SHCC) patients after surgical treatment using randomized controlled trial.Methods A total of 117 patients,who underwent radical hepatectomy from Sept.2008 to Dec.2009,were randomly divided into 2 groups.Fifty-nine patients(group A or TACE group) received adjuvant TACE one month after hepatectomy,and 58(group B or control group) did not receive any adjuvant therapies.Follow-up was done regularly.The disease-free survival(DFS) time and recurrence rate within the following two years were analyzed.Results The median follow-up duration was 29 months in our study.Twenty-two recurrences happened within one year and all recurrences happened within two years.The mean DFS periods were(28.93±1.40) months(range: 5-29 months) and(26.94±1.62) months(range: 3-35 months)(P=0.443) in group A and B,respectively.The half-year,1-year and 2-year recurrence rates of group A vs group B were 10.2% vs 13.8%,20.3% vs 20.7%,25.7% vs 31.2%(P=0.443),respectively.Univariate analysis showed that infection of HBV DNA,blood transfusion,Edmondson-Steiner grade and tumor diameter(3 cm as cut-off point) were correlated with tumor recurrence(P0.05).Multivariate COX regression analysis indicated that HBV DNA,blood transfusion,and tumor diameter(3 cm as cut-off point) were independent factors of early recurrence.Conclusion Adjuvant TACE can not reduce early recurrence of SHCC with a low risk of recurrence,so it is not recommended as a routine therapy to prevent early tumor recurrence.Further study is needed to verify whether TACE can benefit the long-term recurrence and overall survival of patients.

Objective To evaluate the clinical value of postoperative adjuvant transcatheter arterial chemoembolization(TACE) on the prognosis of hepatocellular carcinoma(HCC) patients after radical hepatectomy using a prospective cohort study.Methods A total of 220 HCC patients underwent radical hepatectomy from Jan.2008 to Dec.2008 and 104 were recruited in the present study.Fifty-six patients(TACE group) received adjuvant TACE one month after hepatectomy,and 48(control group) did not receive any adjuvant therapies.Follow-up was done regularly.The disease-free survival(DFS) time and total survival(TS) were statistically analyzed.Results The median DFS time in TACE group was significantly shorter than that in the control group(11 months vs 13 months,P=0.005).The 1-year,2-year and 3-year recurrence rates were 50%,85.7%,and 89.3% in TACE group and 46.8%,58.3%,and 62.5% in the control group(P=0.005),respectively.Multivariate COX regression analysis indicated that TACE,AFP,intact tumor peplos,liver cirrhosis,vascular invasion and tumor Edmondson-Steiner grade were the risk factors for recurrence(P0.05).The median TS time periods in TACE group and control group were 29(4-41) months and 24(5-59) months(P=0.789),respectively.The 1-year,2-year and 3-year survival rates were 85.6%,59.5%,and 36.5% in TACE group and 75%,50%,and 41.7% in the control group(P=0.789),respectively.Multivariate COX regression analysis indicated that AFP,intact tumor peplos and tumor Edmondson-Steiner grade were correlated with the total survival of patients(P0.05).Conclusion Adjuvant TACE can not improve DFS and TS of HCC patients after radical hepatectomy,and it may even contribute to a poor prognosis.Therefore more attention should be paid in choosing treatment strategy.

Objective To explore the different effects of three wound treatment after liver resection in patients with primary liver cancer.Methods 965 cases of liver resection were treated with omentum covering method(group A of 63 patients),suture on the rope(group B of 565 cases),fibrin glue spray coagulation(group C of 337 cases) respectively.We deserved postoperative abdominal drainage,fever days and complication rate in the three groups.Results Peritoneal drainage volume in group B and C was less than in group A.The three approaches to liver wounds were no difference in heat days and complication rate.Conclusions The formation of the three methods is in the long process of clinical practice.But each has its own advantages and disadvantages.In the application process,they should be flexibility,but also in combination.

Objective Ultimate hepatectomy(trihepatectomy) is a high-risk surgical operation with high mortality and high rate of complication.Therefore,we should carefully make decision for such operation.When and how to perform ultimate hepatectomy is our focus of this study.Methods 30 patients accepted ultimate hepatectomy from Oct.2008 to Jun.2010.There were 28 hepatocellular carcinoma with 23 liver cirrhosis caused by viral hepatitis and 2 hemangioma among these patients.All the patients had an A grade of Child-Pugh score.Right trihepatectomy ware performed in 22 patients and 8 were left trihepatectomy.Results Median bleeding volum was 2148.42 mL(220～6 000 mL);median blood transfusion volum was 2126.32 mL(0～8 500 mL).Mean postoperative hospital stay was 11.26+2.58d(8～17 d).No death and serious complication such as liver failure occurred.Main complications were postoperative bleeding(1 case) and bile leakage(2 cases).Conclusions Although ultimate hepatectomy is a high-risk operation,satisfied outcome would be acquired with serious selection of patient,well-versed liver resection skill and sufficient perioperative management.

A 49-year-old male patient received transcatheter arterial chemoembolizaion(TACE) under local anesthesia in the treatment of primary liver cancer.Result of iodine allergy test before surgery was negative.The patient was given 30 mL of iopromide injection and 3 mL of lipiodol by high pressure injector.About 2 minutes later,the patient appeared dysthesia,chest stuffiness,anhelation,and his blood pressure could not be measured,with heart rate of 110 beats per minute,oxyhemoglobin saturation of 59%.Such medicines as dexamethasone sodium phosphate,adrenaline hydrochloride,hydrocortisone sodium succinate were given immediately for symptomatic treatment.One and a half hours later,the patient's symptoms improved.

1临床资料 例1:患者,女,67岁,于2006年9月因"反复中上腹胀痛1个月余"入院.反复中上腹疼痛呈牵拉痛,与饮食无关,当时无远处放射.实验室检查AFP 3.2 μg/L,CEA 17.32 μg/L,CA19-9>1 000 U/ml,CA125 369 U/ml.B超提示:肝脏多发占位性病变,胰腺低回声病变.

Carcinosarcoma is a rare biphasic malignancy consisting of intermixed epithelial and mesenchymal elements. Carcinosarcoma is particularly rare among children. We accepted a 7 year old patient with retroperitoneal carcinosarcoma. The tumor was totally resected and no recurrence is found 11 months after operation. Literatures has been reviewed and there are few reports of primary retroperitoneal carcinosarcoma in children up to date. So we report the patient's clinical character, surgical resection, pathological and immunohistochemical analysis.

BACKGROUND:Primary hepatic neuroendocrine carcinoma (PHNEC) is extremely rare, and fewer than 300 cases have been reported in the English/Chinese-language literature, therefore it is difficult to make a proper diagnosis and determine a therapeutic approach.METHODS:Eleven PHNEC patients were admitted to our hospital between January 1996 and May 2008. Laboratory examination, digestive endoscopy, B-ultrasonography, CT, MRI, or PET-CT were performed on the patients for preoperative diagnosis. All patients received liver resection. Some patients received transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection treatment (PEIT), or octreotide injection when a recurrence was found. The patients' clinical data were recorded and all patients were followed up.RESULTS:The patients were confirmed pathologically as having PHNEC . Their median follow-up time was 33 months (12-107 months). All patients survived, and the longest post-operative survival time was 107 months, the longest disease-free survival time was 98 months, the 1-year survival rate was 100%, and the 1-year recurrence rate was 45.5% (5/11).CONCLUSIONS:Since PHNEC is easy to confuse with hepatocellular carcinoma, careful screening of symptoms is needed to avoid misdiagnosis. Resection is the first choice of treatment for PHNEC and provides the most favorable outcomes including long-term survival. Other treatment such as TACE and PEIT can be considered as well, especially when a tumor recurs.

ObjectiveTo estimate the value of the methed of MMC injected through greater omentum majus vein after the resection of tumor during the operation to prevent the recurrence of small HCC. MethodsA retrospective analysis of 127 patients was done. All of them received liver resection of HCC from 2002 Jan. to 2004 Dec. Group A include 67 patients who was injected MMC through greater omentum majus vein after the liver tumor was resected 60 patients who was not injected MMC was recruited into group B. All patients had a single tumor ≤5 cm without visible vessel invasion. ResultsThere was significant difference between two group of the period of disease-free survival (DFS), and median period of DFS of group A vs. group B was 48 months vs 21 months after the first operation (P =0.0043). Postoperative tumor recurrence rate was significant difference at the 24th month. COX regression showed that the DFS time was significantly affected by MMC, and hazard ratio was 0.528 (P =0.006). Conclusion Injection of MMC through greater majus omentum vein after the liver tumor was resected is a valuable method to prevent the recurrence of small HCC. We need more trial to prove its therapeutic effect in bigger tumor, mutiple tumor and tumor with visible vessel invasion.

<正>结核病的死亡居各种死因第9位[1]。在肺外结核病中,肝结核在临床上相对少见,尤其是肝以外无结核病灶的原发性肝结核临床上更为少见[2],由于其缺乏典型的临床表现,易被临床医师所忽视,甚至被误诊为肝恶性肿瘤而通过术

患者 女,22岁,因产前体检发现"胰头部肿块50 d"入院,无症状及阳性体征,血癌胚抗原、CA19-9均正常.钡餐检查见十二指肠框明显扩大,十二指肠固定,肠腔狭窄.CT提示:胰头部和钩突部一直径8.5 cm囊实性肿物,实性肿块内可见斑片状钙化,肿瘤边界清楚,包膜较完整(图1);MRI血管成像见肿瘤侵犯肠系膜上静脉,形成约5 cm狭窄段;CT三维重建图像可见肿瘤自前、后、右压迫肠系膜上静脉(SMV)(图2).术前诊断为胰腺黏液性囊腺瘤.

Objective To evaluate the inhibitory effects of sustained-release 5-fluorouracil(5-FU)micmparticles on the growth of HepG2 eels.Methods The inhibitory effects of sustained-releage 5-FU micropartides,5-FU microparticles and poly L-lactic acid on HepG2 cells were detected by MTT assay.The HepG2 cell apoptosis was demonstrated by flow cytomerry after Hoehest staining.Results The survival rate of HepG2 cells in sustained-release 5-FU microparticles group decreased as time passed by.The survival rate of HepG2 cells in 5-FU microparticles group wag the lowest on the first day,and then it increased gradually.The survival rates of HepG2 ceHs in 5-FU microparticles group on day 21 and 28 were hJigher than those in sustained-release 5-FU microparticles group.The survival rate of HepG2 cells in poly L-lactic acid group WSB higher than that in the other two groups.The difference upon survival rate among the 3 groups had statistical significance(F=3163.52,128.47.P＜0.01).Conclusions The sustained-release 5-FU micropartieles could keep on inhibiting tlle growth and inducing apoptosis of HepG2 cells in time-dependant manner.The inhibitory effect of sustained-release 5-FU is better than that of 5-FU microparticles.

> 1.临床资料:病人,女,67岁,于2006年9月因主诉"反复中上腹胀痛1个月余"入院。反复中上腹疼痛,呈牵拉痛,与饮食无关,当时无远处放射,偶有嗳气,无反酸,不伴发热,无恶心呕吐,无腹胀腹泻,无呕血黑便,无黄疸及陶土便。实验室检查,AFP:3.2μg/L,CEA:17.32μg/L,CA 19-9 :>1000 U/ml,CA 125 ;369 U/ml。B 超提示:肝脏多发占位性