Purpose: To investigate the mechanism by which natural killer (NK) cells are compromised by infection with Echinococcus multilocularis in patients with alveolar echinococcosis (AE). Methods: NK cells from AE patients and healthy individuals were measured by flow cytometry and quantitative real-time polymerase chain reaction (PCR) to identify the frequency of different types of NK cells and assess their function. E. multilocularis cyst fluid (EMF) was applied to human monocytic leukaemia cells (THP-1 cells) to assess its effect on their differentiation. In a co-culture system with NK and EMF-THP-1 cells, the function of NK cells were analyzed by enzyme-linked immunosorbent assay (ELISA) with or without antibody against KIR2DL1. Results: Blood from AE patients had fewer CD56low NK cells (p < 0.01) with decreased production of IFN-γ and granzyme B due to the elevated expression of KIR2DL1 (p < 0.001). Treatment of THP-1 cells with EMF induced a tolerogenic phenotype upon activation. Incubation of these EMF-THP-1 cells with NK cells isolated from AE patients significantly impaired the cytotoxic function of NK cells, but this effect was largely blocked by an anti-KIR2DL1 antibody (p < 0.001). Conclusion: E. multilocularis modulates infection macrophages to induce NK cell dysfunction via interaction with KIR2DL1. These results provide a new insight into the mechanisms of parasitic infection-induced dysfunction of NK cells, and may be helpful for the development of therapeutic strategies for the treatment of alveolar echinococcosis.

This study evaluates the feasibility of retrohepatic inferior vena cava (RHIVC) resection without reconstruction in patients with end-stage hepatic alveolar echinococcosis (AE). Four hundred and fifty-seven patients diagnosed with hepatic AE and who underwent surgical resections between January 2010 and October 2018 were retrospectively analyzed. Nine patients receiving RHIVC resection without reconstruction were included in this study. Among the patients, 5 were male and 4 female. Mean follow-up time was 64.4 months (18-95). In this series, adequate collateral circulation was formed before operation in all patients, and 7 cases underwent ex vivo liver resection and autotransplantation (ELRA) and 2 cases underwent extended right hemi-hepatectomy. Average standard liver volume, graft volume, surgical time, and anhepatic phase in ELRA group patients was 1144 ± 127 cm 3 , 740 ± 235 cm 3 , 16.8 ± 4.1 hours, and 337.4 ± 108.65 minutes respectively. Average hospital stay time for all patients was 45 ± 36.4 days. There were no intraoperative deaths. The 30-day mortality rate was 11.1%, and total mortality rate was 22.2%. Postoperative complications occurred in 4 patients. During follow-up, no relapsed AE lesions were found. RHIVC resection without reconstruction is a feasible way for hepatic AE patients with adequate collateral circulation. Careful protection of collateral venous is the key factor for successful operation.

Human cystic echinococcosis is a zoonosis caused by the larval cestode Echinococcus granulosus. Clear cell renal carcinoma is the most common pathological type of renal cell carcinoma. Echinococcosis complicated with carcinoma is rarely reported. Here, we reported a female patient with echinococcal cyst of the liver accompanied with clear cell renal carcinoma. This 27-year-old woman was admitted for abdominal pain. The serological testing of hydatid cyst was positive and levels of tumor markers were within the normal range. The computed tomography and histological findings confirmed hepatic echinococcal cyst complicated with renal carcinoma of kidney. Preoperative liver function was grade A. The patient underwent pericystectomy of liver hydatid cyst and partial nephrectomy. No recurrence was found at 1 year of follow-up. Liver hydatid complicated with renal cell carcinoma is rare, which should be differentiated from liver metastasis of renal cancer. Surgical resection is the optimal treatment. This case may provide insight for the diagnosis and research on the co-occurrence of tumor and hydatid cyst.

This study aims to evaluate the clinic value of ultrasound, computed tomography (CT) and serological testing in the differentiation between hepatic Cystic Echinococcosis (CE) types 1 and simple hepatic cysts. Totally 50 patients with CE Types 1 and 50 patients with simple hepatic cysts were included. All patients examined by ultrasound, CT and serological testing respectively. The receiver operating characteristic (ROC) curve of diagnosis methods was drawn and their sensitivity, specificity, Youden index, positive likelihood ratio, negative likelihood ratio, positive predictive value and negative predictive value were compared. Pathology result was used as golden standard. The area under ROC curve of ultrasound was 0.97 and of CT and serological testing was 0.79 and 0.71 respectively. The sensitivity of ultrasound in the diagnosis of CE Types 1 was 96.00%, specificity was 98.00%, the positive likelihood ratio was 48.00, and negative likelihood ratio was 0.04. Disease prevalence was 50%, positive predictive value was 97.96%, and negative predictive value was 96.08%. The sensitivity of CT was 80.00%, specificity was 62.00%, positive likelihood ratio was 2.11, and negative likelihood ratio was 0.32. Disease prevalence was 50%, positive predictive value was 67.80%, and negative predictive value was 75.61%. The sensitivity of immunological test was 86.00%, specificity was 72.00%, positive likelihood ratio was 3.07, and negative likelihood ratio was 0.19. Disease prevalence was 50%, positive predictive value was 75.44%, and negative predictive value was 83.72%. Combined ultrasound and immunological test, the sensitivity and the specificity was 82% and 100% respectively. Combined CT and immunological test, the sensitivity the specificity was 70% and 82% respectively. In the differentiate diagnosis of CE Types 1 and simple hepatic cyst, ultrasound is better than CT with high sensitivity and specificity, therefore recommended. Immunological examination is an important complement to the imaging examination.

目的:探索CBL联合PBL教学模式在肝囊型包虫病教学中的应用效果.方法:共有60名学生,平均分为两组,在实验组中实施PBL联合CBL教学法,在对照组实施传统教学法,对总评成绩实行统计学分析.结果:CBL联合PBL教学模式明显优于传统教学方法.结论:PBL联合CBL教学法提高了教学效果,不仅对培养应用性医学人才有重要意义,而且还促使教师再学习提高健全自身知识体系.

肝泡型包虫病是临床上较为罕见的一种特殊类型的寄生虫病,该病在肝内呈浸润性生长,晚期似肝癌一样转移或侵害周围脏器,临床素有“寄生虫性肝癌”或“虫癌”之称[1].本文通过在临床实习生肝泡型包虫病临床实习中应用PBL教学模式,探讨如何提高肝泡型包虫病临床实习教学质量.本文总结了肝胆包虫外科实习教学中应用PBL教学的一些经验,对PBL教学方法的应用过程中的优势与问题进行分析,从而使PBL教学法更好地应用于肝脏疾病外科实习教学中.

OBJECTIVES:The present study aimed to investigate the difference in major adverse cardiac events (MACE) at 3 years after double-kissing (DK) crush versus culotte stenting for unprotected left main distal bifurcation lesions (LMDBLs).BACKGROUND:The multicenter and randomized DKCRUSH-III (Comparison of double kissing crush versus culotte stenting for unprotected distal left main bifurcation lesions: results from a multicenter, randomized, prospective study) showed that DK crush stenting was associated with fewer MACE at 1-year follow-up in patients with LMDBLs compared with culotte stenting. Here, we report the 3-year clinical outcome of the DKCRUSH-III study.METHODS:A total of 419 patients with LMDBLs who were randomly assigned to either the DK crush or culotte group in the DKCRUSH-III study were followed for 3 year. The primary endpoint was the occurrence of a MACE at 3 years. Stent thrombosis (ST) was the safety endpoint. Patients were classified by simple and complex LMDBLs according to the DEFINITION (Definition and Impact of Complex Bifurcation Lesions on Clinical Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents) study criteria.RESULTS:At 3 years, MACE occurred in 49 patients the culotte group and in 17 patients in the DK crush group (cumulative event rates of 23.7% and 8.2%, respectively; p < 0.001), mainly driven by increased myocardial infarction (8.2% vs. 3.4%, respectively; p = 0.037) and target-vessel revascularization (18.8% vs. 5.8%, respectively; p < 0.001) between groups. Definite ST rate was 3.4% in the culotte group and 0% in the DK crush group (p = 0.007). Complex LMDBLs were associated with a higher rate of MACE (35.3%) at 3 years compared with a rate of 8.1% in patients with simple LMDBLs (p < 0.001), with an extremely higher rate in the culotte group (51.5% vs. 15.1%, p < 0.001).CONCLUSIONS:Culotte stenting for LMDBLs was associated with significantly increased rates of MACE and ST. (Double Kissing [DK] Crush Versus Culotte Stenting for the Treatment of Unprotected Distal Left Main Bifurcation Lesions: DKCRUSH-III, a Multicenter Randomized Study Comparing Double-Stent Techniques; ChiCTR-TRC-11001877).

Objectives The present study aimed to investigate the association between periprocedural myocardial infarction (PMI), defined by creatine kinase (CK)‐MB or troponin I (TNI) level elevations >5 times the 99th percentile of the upper reference limit (URL) within 48 hr after implantation of a drug‐eluting stent (DES), and one‐year mortality in patients with coronary bifurcation. Background PMI is reported to be associated with increased one‐year mortality after DES implantation. However, the prevalence and association of PMI with mortality after stenting bifurcation lesions remains unclear. Methods We prospectively followed 1,971 patients with true coronary bifurcations who underwent DES implantation as part of the multicenter DEFINITION study. These patients were grouped into categories based on PMI outcome: Non‐PMI, CKMB‐PMI, TNI‐PMI, and CKMB/TNI‐PMI. The primary endpoint was the rate of all‐cause mortality at one year. Results PMI occurred in 11.4% of patients by CKMB criteria and 41.3% of patients by TNI criteria. At one‐year follow‐up, the mortality rate was 2.3% in the entire patient population. However, mortality was significantly higher in the CKMB‐PMI (6.4%) and CKMB/TNI‐PMI (6.1%) groups compared to the Non‐PMI (1.7%) and TNI‐PMI (2.1%) groups (all P < 0.05). A 10‐fold increase in TNI levels resulted in similar PMI rate (5.2%) and mortality risk (adjusted HR 2.7, 95% CI 3.0–5.2) as a fivefold increase in CKMB levels. Conclusions PMI, as defined by CKMB elevations following coronary bifurcation lesion stenting, was associated with increased one‐year mortality. Additionally, to attain an equal frequency of PMI, the elevation in TNI levels needed to be twice as high as the elevation in CKMB levels. © 2015 Wiley Periodicals, Inc.

OBJECTIVES:The present study established criteria to differentiate simple from complex bifurcation lesions and compared 1-year outcomes stratified by lesion complexity after provisional stenting (PS) and 2-stent techniques using drug-eluting stents. BACKGROUND:Currently, no criterion can distinguish between simple and complex coronary bifurcation lesions. Comparisons of PS and 2-stent strategies stratified by lesion complexity have also not been reported previously. METHODS:Criteria of bifurcation complexity in 1,500 patients were externally tested in another 3,660 true bifurcation lesions after placement of drug-eluting stents. The primary endpoint was the occurrence of a major adverse cardiac event (MACE) at 12 months. The secondary endpoint was the rate of stent thrombosis (ST). RESULTS:Complex (n = 1,108) bifurcation lesions were associated with a higher 1-year rate of MACE (16.8%) compared with simple (n = 2,552) bifurcation lesions (8.9%) (p < 0.001). The in-hospital ST and 1-year target lesion revascularization rates after 2-stent techniques in the simple group (1.0% and 5.6%, respectively) were significantly different from those after PS (0.2% [p = 0.007] and 3.2% [p = 0.009], respectively); however, 1-year MACE rates were not significantly different between the 2 groups. For complex bifurcation lesions, 2-stent techniques had lower rates of 1-year cardiac death (2.8%) and in-hospital MACE (5.0%) compared with PS (5.3%, p = 0.047; 8.4%, p = 0.031). CONCLUSIONS:Complex bifurcation lesions had higher rates of 1-year MACE and ST. The 2-stent and PS techniques were overall equivalent in 1-year MACE. However, 2-stent techniques for complex lesions elicited a lower rate of cardiac death and in-hospital MACE but higher rates of in-hospital ST and revascularization at 1 year for simple lesions.

Background First generation drug-eluting stents (DES) were associated with a high incidence of late stent thrombosis (ST), mainly due to delayed healing and re-endothelization by the durable polymer coating. This study sought to assess the safety and efficacy of the Nano polymer-free sirolimus-eluting stent (SES) in the treatment of patients with de novo coronary artery lesions. Methods The Nano trial is the first randomized trial designed to compare the safety and efficacy of the Nano polymer-free SES and Partner durable-polymer SES (Lepu Medical Technology, Beijing, China) in the treatment of patients with de novo native coronary lesions. The primary endpoint was in-stent late lumen loss (LLL) at 9-month follow-up. The secondary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction or target lesion revascularization. Results A total of 291 patients (Nano group: n =143, Partner group: n =148) were enrolled in this trial from 19 Chinese centers. The Nano polymer-free SES was non-inferior to the Partner durable-polymer DES at the primary endpoint of 9 months ( P <0.001). The 9-month in-segment LLL of the polymer-free Nano SES was comparable to the Partner SES (0.34±0.42) mm vs. (0.30±0.48) mm, P =0.21). The incidence of MACE in the Nano group were 7.6% compared to the Partner group of 5.9% ( P =0.75) at 2 years follow-up. The frequency of cardiac death and stent thrombosis was low for both Nano and Partner SES (0.8% vs. 0.7%, 0.8% vs. 1.5%, both P =1.00). Conclusions In this multicenter randomized Nano trial, the Nano polymer-free SES showed similar safety and efficacy compared with the Partner SES in the treatment of patients with de novo coronary artery lesions. Trials in patients with complex lesions and longer term follow-up are necessary to confirm the clinical performance of this novel Nano polymer-free SES.

Objective: This study evaluated two surgical procedures, total splenectomy and spleen-preserving surgery, for the treatment of spleen cystic echinococcosis (CE). Methods: A total of 21 patients who underwent surgery for removal of spleen CE were evaluated retrospectively. Patients were divided into two groups, those who received a total splenectomy (n = 7) and those who underwent spleen-preserving surgery (n = 14). Results: Total splenectomy surgery took 127.1 ± 11.1 min and spleen-preserving surgery took 104.3 ± 25.3 min (p < 0.05). The length of hospital stay was the same for both patient groups (10.6 days on average). No patient suffered from recurrence during follow-up and all of the patients made a good recovery. No patient developed post-splenectomy sepsis or serious infectious complications. No patient suffered recurrence. Conclusions: The spleen-saving approach is likely an effective method for the removal of CE spleen cysts given that it is a quick procedure and preserves the function of the spleen. Total splenectomy procedures may be performed particularly for larger, centrally located cysts.

OBJECTIVES:The study aimed to investigate the difference in major adverse cardiac event (MACE) at 1-year after double kissing (DK) crush versus Culotte stenting for unprotected left main coronary artery (UPLMCA) distal bifurcation lesions. BACKGROUND:DK crush and Culotte stenting were reported to be effective for treatment of coronary bifurcation lesions. However, their comparative performance in UPLMCA bifurcation lesions is not known. METHODS:A total of 419 patients with UPLMCA bifurcation lesions were randomly assigned to DK (n = 210) or Culotte (n = 209) treatment. The primary endpoint was the occurrence of a MACE at 1 year, including cardiac death, myocardial infarction, and target vessel revascularization (TVR). In-stent restenosis (ISR) at 8 months was secondary endpoint, and stent thrombosis (ST) served as a safety endpoint. Patients were stratified by SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) and NERS (New Risk Stratification) scores. RESULTS:Patients in the Culotte group had significant higher 1-year MACE rate (16.3%), mainly driven by increased TVR (11.0%), compared with the DK group (6.2% and 4.3%, respectively; all p < 0.05). ISR rate in side branch was 12.6% in the Culotte group and 6.8% in the DK group (p = 0.037). Definite ST rate was 1.0% in the Culotte group and 0% in the DK group (p = 0.248). Among patients with bifurcation angle ≥70°, NERS score ≥20, and SYNTAX score ≥23, the 1-year MACE rate in the DK group (3.8%, 9.2%, and 7.1%, respectively) was significantly different to those in the Culotte group(16.5%, 20.4%, and 18.9%, respectively; all p < 0.05). CONCLUSIONS:Culotte stenting for UPLMCA bifurcation lesions was associated with significantly increased MACEs, mainly due to the increased TVR. (Double Kissing [DK] Crush Versus Culotte Stenting for the Treatment of Unprotected Distal Left Main Bifurcation Lesions: DKCRUSH-III, a Multicenter Randomized Study Comparing Double-Stent Techniques; ChiCTR-TRC-00000151).

Background Diabetes mellitus is an independent predictor of adverse clinical events after drug‐eluting stent implantation. Objectives The objective of this study is to evaluate the long‐term clinical efficacy and safety of biodegradable polymer‐based sirolimus‐eluting stents in diabetic versus non‐diabetic patients. Methods A total of 2077 “all comers,” including 440 (21.2%) diabetic patients and 1637 (78.8%) non‐diabetic patients, were prospectively enrolled in the CREATE study at 59 centers in four countries. The recommended antiplatelet regimen was clopidogrel and aspirin for 6 months followed by chronic aspirin therapy. The primary outcome was the rate of major adverse cardiac events (MACE), defined as a composite of cardiac death, non‐fatal myocardial infarction (MI), and target lesion revascularization (TLR). Results Diabetic patients had higher risks of all‐cause death (8.2% vs. 3.4%, P < 0.001) and cardiac death (4.1% vs. 1.4%, P < 0.001) compared with non‐diabetic patients at 4 years. The rates of non‐fatal MI (0.2% vs. 0.9%, P = 0.218), TLR (2.0% vs. 2.8%, P = 0.357), MACE (5.9% vs. 4.4%, P = 0.227), and overall stent thrombosis (1.6% vs. 1.6%, P = 0.932) were not significantly different between diabetic and non‐diabetic patients. A landmark analysis showed that prolonged clopidogrel therapy (>6 months) was not beneficial in reducing the cumulative hazards of MACE either in diabetic or non‐diabetic patients (log rank P = 0.810). Conclusions Biodegradable polymer‐based sirolimus‐eluting stents for the treatment of diabetic patients had a similar clinical event rate at 4 years compared with non‐diabetic patients, except for a higher mortality rate. © 2012 Wiley Periodicals, Inc.

BACKGROUND:Alveolar echinococcosis located in the adrenal gland can be considered a rare and aggressive infestation that radiologically and macroscopically mimics a malignant neoplasm. Its pathogenesis is poorly understood. This paper describes its clinical and radiological aspects and discusses its proper management.METHODS:The records of two patients with adrenal gland alveolar echinococcosis who were diagnosed and treated in our center in 2009 were evaluated.RESULTS:Neither patient showed any signs of recurrence following radical surgical treatment and postoperative oral anthelmintic therapy.CONCLUSION:Radical surgery can be a feasible, effective management option that results in a good prospective outcome.

BackgroundThe effects of intravascular ultrasound (IVUS)‐guided complex approaches using drug‐eluting stents (DES) for coronary bifurcation lesions on clinical outcomes has not yet been studied in detail.ObjectiveOur objective was to analyze the difference in 1‐year outcomes following two‐stent techniques involving implantation of DES for coronary bifurcation lesions between IVUS‐guided and angiography‐guided groups.MethodsFrom May 26, 2007 to March 24, 2010, 628 patients received two‐stent techniques (324 in the IVUS‐guided group and 304 angiography‐guided) and were prospectively studied. We compared major adverse cardiac events (MACE, including cardiac death, stent thrombosis [ST], myocardial infarction [MI] and target lesion/vessel revascularization) at 12‐months follow‐up, before and after adjusting for propensity score matching.ResultsAt 12‐months after the indexed procedure, patients in the angiography‐guided group had significantly increased in‐stent restenosis. Compared to the angiography‐guided group, the IVUS‐guided group had a significantly lower overall unadjusted ST rate (1.2% vs. 6.9%, P < 0.001), definite ST (0.6% vs. 5.3%, P < 0.001), late ST (0.6% vs. 4.3%, P = 0.003), MI (4.6% vs. 8.9%, P = 0.038) and cardiac death (0.9% vs. 3.3%, P = 0.049). By propensity score matching, 123 paired patients were matched. The late ST at 12‐months follow‐up was 0% in the IVUS‐guided group versus 4.9% in the angiography‐guided group (P = 0.029), resulting in significant differences in ST‐elevation MI between the two groups (2.4% vs. 9.8%, P = 0.030).ConclusionsThe IVUS‐guided two‐stent technique was associated with significantly reduced late stent thrombosis, with a resultant reduction in ST‐elevation MI. © 2012 Wiley Periodicals, Inc.

OBJECTIVES:This study sought to evaluate the safety and efficacy of a biodegradable polymer-coated sirolimus-eluting stent (Excel, JW Medical System, Weihai, China) with 6-month dual antiplatelet therapy in daily practice.BACKGROUND:It has been hypothesized that persistent presence of polymer may compromise the safety of drug-eluting stents, and that therefore biodegradable polymer coatings might reduce late adverse events.METHODS:Between June and November 2006, 2,077 patients, exclusively treated with Excel stents at 59 centers from 4 countries, were enrolled in this prospective, multicenter registry. Recommended antiplatelet regimen included clopidogrel and aspirin for 6 months followed by chronic aspirin therapy.RESULTS:The average duration of clopidogrel treatment was 199.8 +/- 52.7 days and 80.5% of discharged patients discontinued clopidogrel at 6 months. The cumulative rates of major adverse cardiac events were 0.9% at 30 days, 2.7% at 1 year, and 3.1% at 18 months. Overall rate of stent thrombosis was 0.87% at 18 months. The rates of acute, subacute, late, and very late stent thrombosis were 0.1%, 0.38%, 0.34%, and 0.05%, respectively. Angiographic follow-up, performed in 974 (31.6%) lesions from 653 patients (31.7%), revealed a mean in-stent late lumen loss of 0.21 +/- 0.39 mm. Binary restenosis rates were 3.8% in-stent and 6.7% in-segment.CONCLUSIONS:This multicenter registry documents satisfactory safety and efficacy profiles, as evidenced by low rates of major adverse cardiac events and stent thrombosis up to 18 months, for the Excel biodegradable polymer-based sirolimus-eluting stent when used with 6 months of dual antiplatelet therapy in a "real-world" setting. (Multi-Center Registry Trial of EXCEL Biodegradable Polymer Drug-Eluting Stent [CREATE]; NCT00331578).