ObjectiveTo summarize the application status and progress of indocyanine green fluorescence imaging in laparoscopic anatomic liver resection , and to analyze its advantages, limitations, and prospects.MethodThe literatures about indocyanine green fluorescence imaging in laparoscopic anatomic liver resection were reviewed.ResultsIndocyanine green fluorescence imaging had been preliminarily used in the operation of liver tumors and had shown its unique value in the anatomical liver resection, providing a new way to reduce the recurrence of liver cancer, improve the therapeutic effect, and prolong the survival time of patients.ConclusionsThe clinical application of indocyanine green fluorescence imaging in anatomic liver resection is still at the stage of development and popularization. Although it has unique advantages and development potential, it needs to be further improved in the aspects of tissue penetration, specificity, and staining success rate.
ObjectiveTo investigate the predictive value of preoperative red blood cell distribution width to platelet count ratio (RPR) and platelet-albumin-bilirubin (PALBI) scoring for postoperative complications after radical resection of hepatic alveolar echinococcosis (HAE). MethodsAccording to the inclusion and exclusion criteria, the clinicopathologic data of patients diagnosed with HAE and underwent radical hepatectomy in the Affiliated Hospital of Qinghai University from January 2018 to October 2022 were retrospectively collected. The risk factors affecting postoperative complications after radical hepatectomy for HAE were analyzed by univariate and multivariate unconditional logistic regression analysis, which were used to construct the nomogram. The receiver operating characteristic curve was used to evaluate the value in predicting postoperative complications by nomogram model. The discrimination of the nomogram was evaluated using Bootstrap internal 1 000 resampling and evaluated using a consistency index. The predicted postoperative complications probability by nomogram and actual postoperative complications probability were calculated by Kaplan-Meier method, and the calibration curve was drawn. The calibration ability of the nomogram model was evaluated by Hosmer-Lemeshow goodness-of-fit test. The decision curve analysis was used to evaluate clinical benefit of the nomogram model. ResultsA total of 160 patients with HAE radical hepatectomy were included, of which 105 had no postoperative complications and 55 had postoperative complications. The multivariate unconditional logistic regression analysis showed that the operation time ≥207 min, intraoperative bleeding ≥650 mL, and albumin ＜38 g/L, RPR ≥0.054, and higher PALBI grading (3 levels) were the risk factors affecting postoperative complications after HAE radical hepatectomy (OR＞1, P<0.05). Based on the risk factors, the nomogram was constructed. The area under the receiver operating characteristic curve (95%CI) predicted by the nomogram for the postoperative complications was 0.873 (0.808, 0.937), with an optimal cutoff value of 0.499. The consistency index was 0.855 for discriminating postoperative complications after HAE radical hepatectomy. The calibration curve was tested by Hosmer-Limeshow and showed a good fit between the predicted curve by the nomogram and actual curve (χ2=3.193, P=0.367), indicating that the nomogram had a good calibration ability. The decision curve analysis showed that there was a good clinical applicability within the range of 11% to 93% of the threshold probability. ConclusionsThe preoperative RPR and PALBI scoring are risk factors affecting postoperative complications after radical hepatectomy for HAE. The nomogram constructed with risk factors including RPR and PALBI has a good predictive value for postoperative complications after radical hepatectomy for HAE.
ObjectiveTo investigate the in vitro effect of pseudolaric acid B (PAB) on apoptosis of protoscolece cells and its regulatory effects on angiogenesis and cell apoptosis in the the lesion-host microenvironment tissue in vivo, as well as its possible mechanisms, in order to provide a basis for the clinical development of new alternative drugs for Echinococcus multilocularis. MethodsIn vitro experiments: the protoscoleces, vesicles, germinal cells, human foreskin fibroblasts (HFFs) and normal human liver cells were treated with different concentrations of PAB (0, 2.5, 5, 10, 20, 40, 80, 160 and 320 μmol/L) for 7, 5, 5, 5 and 5 days, then evaluated the survival rate of the protoscoleces, the release level of phosphoglucose isomerase (PGI) from the vesicles, the viability of the germinal cells, as well as the viability of HFFs and normal human liver cells. The protoscoleces and vesicles were fixed with 2.5% glutaraldehyde and used for scanning electron microscopy and transmission electron microscopy observation. Animal experiments: the protoscoleces were isolated from the abdominal lesions of the protected gerbils, and then infected 18 C57BL/6J mice by intraperitoneal injection to establish models, dividing into 3 groups with 6 mice in each group. The model group was given 0.3 mL of PBS by gavage daily, the albendazole (ABZ) group was given 0.3 mL ABZ (100 mg/kg) daily by gavage, the PAB group was given 0.3 mL of PAB (40 mg/kg) by gavage daily. After continuous gavage for 6 weeks, the lesion host microenvironment tissue was taken and ELISA was used to detect the expression levels of vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS) and cysteinyl aspartate specific proteinase3 (caspase3), the expression levels of nitric oxide (NO) was detected using a biochemical detection kit, Western blot was used to detect the expression levels of BCL2-associated X protein (Bax), B-cell lymphoma-2 (Bcl2), caspase3, cleaved-caspase3, VEGF, vascular endothelial growth factor receptor 2 (VEGFR2), phosphatidylinositol 3 kinase (PI3K), phosphorylated PI3K (p-PI3K), protein kinase B (AKT) and phosphorylated AKI (p-AKT) protein. ResultsIn vitro experiments: the protoscoleces of Echinococcus multilocularis were cultured with different concentrations of PAB for 7 days in vitro, the protoscoleces of 40, 80, 160 and 320 μmol/L group all died after 6, 4, 2 and 1 day, respectively; PAB exhibited a certain time and concentration dependence on the protoscoleces of Echinococcus multilocularis. After PAB treatment, the release of PGI in culture supernatant of Echinococcus multilocularis gradually increased with the increase of PAB concentration [concentration for 50% of maximal effect value was (24.40±1.42) μmol/L], the vitality of germinal cells was significantly inhibited [half maximal inhibitory concentration value was (15.94±2.55) μmol/L]. PAB had no significant toxicity to mammalian cells. When 20 μmol/L PAB intervention in the protoscoleces for 3 days, the expression levels of Bax and caspase3 proteins were upregulated, while the expression level of Bcl2 protein was downregulated. Animal experiments: compared with the model group, the wet weight of lesions in the PAB and ABZ groups decreased (P<0.01), and the inhibition rates of lesion growth in the PAB and ABZ groups were 91.03% and 74.44%, respectively. The expression of proliferation and angiogenesis indicators (Ki67, CD34, VEGF, VEGFR2, eNOS, NO) were downregulated in the lesion host microenvironment tissues of mice in the ABZ and PAB groups (P<0.05), while the expression of apoptosis related proteins (caspase3, cleaved-caspase3 and Bax) were upregulated and the expression of PI3K/AKT signaling pathway related proteins (p-PI3K and p-AKT) were downregulated (P<0.05). ConclusionPAB has a strong in vitro and in vivo effect against Echinococcus multilocularis, and its mechanism may be related to the inhibition of PI3K/AKT signaling pathway, leading to increased apoptosis and decreased angiogenesis.
ObjectiveTo analyze findings of 3.0 T diffusion weighted magnetic resonance (MR) in hepatic alveolar echinococcosis and evaluate potential role of apparent diffusion coefficients (ADC) in hepatic alveolar echinococcosis. MethodsThe clinical data of 26 patients with hepatic alveolar echinococcosis from November 2013 to January 2015 in this hospital were analyzed retrospectively. Hepatic MR scannings with diffusion weighted imaging (DWI) sequences (b-value=0, 600, 1 000, and 1 200 s/mm2) were performed in 26 patients with hepatic alveolar echinococcosis. The data of all the patients were stored to the PACS. The lesion features including type, size, distribution, location, and calcification (on the CT) were assessed by two deputy radiologists. TheADCvalues of marginal area, centre area, surrounding area of liver parenchyma tissue were measured at different b values (0, 600, 1 000, and 1 200 s/mm2) and compared. Results①There were 26 patients with a total of 29 lesions, of which involved multiple liver segments, 21 (72%) lesions located in the right lobe, 4 lesions involved simultaneously the left and right lobes. Twenty-four lesions invaded the hepatic vein or portal vein, 20 lesions invaded the intrahepatic bile duct, 10 lesions invaded the right adrenal gland. Seven patients occurred hilar and retroperitoneal lymph nodes metastases, 5 patients occurred pulmonary metastasis, 3 patients occurred brain metastasis, while 3 patients occurred lung and brain metastases simultaneously. ②There were 20 liquefied necrotic lesions, of which 5 lesions marginal area had multiple small round cysts in T2WI, 15 were only solid and without small cyst; The DWI of the centre area in 12 lesions showed a high signal, 8 lesions showed a low signal. There were 9 solid lesions, of which 2 lesions marginal area had multiple small round cysts in T2WI, 7 lesions marginal area were only solid and without cyst in T2WI. The DWI of the solid lesions showed a low signal, there was a "ring" high signal in the edge of lesions. ③At the same b value, theADCvalue of the centre area in the liquefied necrosis lesions were significantly higher than that in the solid lesions (P<0.01). At different b values, theADCvalue of the surrounding liver parenchyma tissue was significantly lower than that of the marginal area (P<0.01) and the centre area (P<0.01) in the liquefied necrosis lesions; theADCvalue of the centre area was significantly higher than that of the marginal area or surrounding liver parenchyma tissue (P<0.05, P<0.01) in the solid lesions. ConclusionsDWI could clearly distinguish structure and composition of hepatic alveolar echinococcosis and has a higher value in distinguishing from other liver dieases. The averageADCvalue of centre area in liquefied necrotic lesions is higher than that in solid lesions.
We comprehensively outlined the application of imaging, immunology, and molecular biology techniques in the detection of hepatic echinococcosis (HE). Imaging techniques, represented by ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography, not only provided some critical information about the morphology, location, and characteristics of HE lesions, but also could be combined with artificial intelligence technologies to enhance the diagnostic capabilities and expand the application scenarios. These techniques were essential tools for the diagnosis, screening, and prevention of HE. Immunological techniques, such as the indirect hemagglutination assay, enzyme-linked immunosorbent assay, immunoblotting, and chemiluminescence immunoassay, aided in diagnosis and differential diagnosis by detecting the specific antibodies. Molecular biology techniques, such as polymerase chain reaction and high-throughput sequencing, provided a strong support for the diagnosis and pathogen identification of HE due to their high sensitivity and specificity. Based on these three major technologies, more sensitive, specific, convenient, and cost-effective detection techniques had emerged, offering more options for the detection and control of HE. Additionally, constructing comprehensive diagnostic models by combining the advantages of different detection technologies will aid to improve the diagnostic efficiency of HE.
ObjectiveTo evaluate roles and advantages of magnetic resonance imaging (MRI) and compute.tomography (CT) in preoperative assessment for hepatic alveolar echinococcosis. MethodMRI and CT scan imaging data of 60 patients with hepatic alveolar echinococcosis underwent radical surgery were retrospectively analyzed. ResultsMRI scanning could accurately identify the peripheral zone and marginal zone of hepatic alveolar echinococcosis lesions, and CT could not accurately show the above structures. In assessment of anatomic relation between vascular and lesions, MRI findings of 52 cases were in full compliance with corresponding intraoperative findings, and 8 cases were partial compliant. However, CT findings of 35 cases were in full compliance with corresponding intraoperative findings, 13 cases were partial compliant, and 12 cases were not compliant at all. In assessment of anatomic relation between biliary and lesions, MRCP could clearly show the bile duct, bile duct stenosis location and degree; CT scanning could only show widened bile duct, but could not accurately judge bile duct dilatation. ConclusionsMRI exerts some obvious advantages in preoperative evaluation of hepatic alveolar echinococcosis, and could accurately find relation between lesions and vascular or biliary system. MRI should be used as routine examination for patients with hepatic alveolar echinococcosis.
ObjectiveTo comprehend the current diagnosis status and new progress of hepatic echinococcosis (HE). MethodThe literature from domestic and foreign researchers relevant diagnosis of HE in recent years was searched and summarized. ResultsThe HE was widely distributed worldwide, with extremely high mortality and disability rates, posing a serious threat to local economic development and public health. At present, in addition to the traditional and widely recognized diagnostic methods based on epidemiological histories, clinical manifestations, routine imaging, and experimental examinations, many innovative technologies based on these traditional diagnostic methods had emerged in the field of HE diagnosis, such as diagnostic prediction models constructed based on ultrasound and other imaging data, artificial intelligence, three-dimensional visual reconstruction, and circulating free DNA testing, which significantly improved the diagnosis rate of the HE. ConclusionsIn recent years, with the continuous improvement of medical level, the in-depth and perfect exploration of HE has made remarkable progress, which not only provides a new possibility for the early diagnosis of the HE, but also provides an important basis for research in related fields and the formulation of prevention and control measures. Therefore, the further promotion and application of these new techniques will aid to promote the diagnosis progress of HE and reduce its impact on population health.
ObjectiveTo observe effect of echinococcus cyst fluid on proliferation and cell cycle progression of rat hepatic stellate cells (HSC-T6), and to preliminarily reveal a new mechanisms of pro-fibrogenic effect of alveolar echinococcosis. MethodsHSC-T6 cells were treated with different concentrations (0.00-0.90 mg/mL) of echinococcus cyst fluid. Then, the morphological changes were observed under the inverted microscope, the impacts on proliferation and cell cycle were tested by the CCK-8 assay and flow cytometry respectively. ResultsAfter treated by echinococcus cyst fluids with different concentrations (0.00-0.90 mg/mL) for 24 h, the most cells shrinked fusiform shape with more slender synapses, and the proliferation activities were increased with the concentration of echinococcus cyst fluid increasing when it was higher than 0.05 mg/mL (P<0.05), the proportion of G0/G1 was decreased (P<0.05) and those of S and G2/M were increased (P<0.05) with the concentration of echinococcus cyst fluid increasing. ConclusionsEchinococcus cyst fluid could promote proliferation of HSC-T6 cells in a dose-dependent manner, which might due to its impact on cell cycle progression. Therefore, alveolar echinococcosis might promote hepatic fibrosis through regulating hepatic stellate cells, but further research on detail needs to be done in future.
ObjectiveTo explore potential value of three-dimensional reconstruction technique for preoperative evaluation of hepatic alveolar echinococcosis. MethodsTwenty-one cases of hepatic alveolar echinococcosis proved by postoperative pathological examination in Affiliated Hospital of Qinghai University from October 2013 to March 2014 were analyzed retrospectively. The three periods of patients’ liver dynamic thin layerCTscan images were collected and imported in three-dimensional reconstruction software by DICOM format. The volume of the virtual resected liver tissue was calculated by software, and then was compared with the actual resected liver tissue volume. ResultsThe resected liver volume was (761.94±505.77) mL and (756.19±501.78) mL in the virtual surgery and in the veritable surgery, respectively. The proportion of resected liver in the total liver was (39.27±18.75)% and (38.95±16.99)% in the virtual surgery and in the veritable surgery, respectively. The resected liver volume had no significant difference between the virtual surgery and veritable surgery (P>0.05), which a positive relation (r=0.989, P<0.001). ConclusionThe limited preliminary data in this study show that three-dimensional reconstruction technique and virtual planning system for surgery could accurately guide resection of lesion and provide preoperative guidance of accurate liver resection for hepatic alveolar echinococcosis.
ObjectiveTo summarize clinical treatments of hepatic alveolar echinococcosis in recent years and provide a new basis for guiding clinical practice. MethodsThe relevant literatures about treating hepatic alveolar echinococcosis at home and abroad were reviewed. The clinical curative effect and advantages or disadvantages among various treatments were analyzed. ResultsThe radical surgery was still the primary treatment of hepatic alveolar echinococcosis, liver transplantation was more used in the treatment of the late hepatic alveolar echinococcosis. surgery combined with chemical therapy had an obvously clinical curative effect. ConclusionsWith a high incidence and poor prognosis of hepatic alveolar echinococcosis, it is difficult to cure. Radical surgery, liver transplantation, chemotherapy and radiation therapy have been used in clinical treatment of hepatic alveolar echinococcosis. It is essential to fully acknowledge indications of various treatments. At the same time, if occurrence and development of this disease could be further researched, it might bring us a new hope of curing hepatic alveolar echinococcosis.