Laparoscopic hepatectomy is routinely used in the surgical treatment of hepatocellular carcinoma, and has formed a standardized operating procedure. Tumors located in the segments Ⅶ and Ⅷ of liver as well as the paracaval subsegment of caudate lobe are considered to be difficult sites for laparoscopic hepatectomy due to the deep anatomical location, proximity to important vascular structures, difficulty in exposing the visual field under laparoscopy, and limited operating space. Based on the experience of our team and related research reports, the authors analyzed and summarized countermeasures for the difficulties of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma in difficult sites. Adhering to the tumor-centered and margin-based principles, accurate preoperative assessment, selection of the correct surgical approach, designing liver resection plane guided by hepatic vena while taking into account portal vein territory, and giving preference to ananatomical hepatectomy while preserving functional liver parenchyma as much as possible are the prerequisites for ensuring minimally invasive and oncology benefits for patients with hepatocellular carcinoma in difficult sites.
ObjectiveTo investigate the expression of major histocompatibility complex, classⅡ, DQ alpha 1 (HLA-DQA1) in lung adenocarcinoma and its prognostic significance. MethodsThe prognostic significance of HLA-DQA1 in lung adenocarcinoma was determined by constructing receiver operating characteristic (ROC) curve and Kaplan-Meier curve, and functional analysis was performed using gene ontology (GO) enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway, and gene set enrichment analysis (GSEA). The association between the level of immune cell infiltration and HLA-DQA1 expression was evaluated using CIBERSORT and Spearman correlation analysis. Clinicopathological data of patients with lung adenocarcinoma who were hospitalized for surgical treatment at the North China University of Science and Technology Affiliated Hospital from 2022 to 2023 were collected, and the relationship between HLA-DQA1 expression and clinicopathological features of lung adenocarcinoma patients was analyzed using reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry in vitro experiments. ResultsA total of 30 patients were included in the study, including 17 females and 13 males, with 20 cases aged ≥60 years and 10 cases aged <60 years. Compared with normal tissue, the expression level of HLA-DQA1 in lung adenocarcinoma was significantly lower, as confirmed by quantitative real-time PCR (qRT-PCR) and immunohistochemistry in lung adenocarcinoma and normal lung tissue. CancerSEA, GO, and KEGG analyses indicated that HLA-DQA1 was closely related to the immune infiltration of tumor cells. Drug sensitivity analysis showed that patients with high HLA-DQA1 expression may be resistant to crizotinib treatment, while they are relatively sensitive to cisplatin, paclitaxel, docetaxel, and epidermal growth factor receptor inhibitors. ConclusionHLA-DQA1 is an important prognostic marker for patients with lung adenocarcinoma.
Objective To explore the effectiveness of the modified Lemaire procedure in anterior cruciate ligament reconstruction (ACLR) in patients with a highly positive pivot shift test. Methods The clinical data of 18 patients with anterior cruciate ligament (ACL) rupture and highly positive pivot shift test between April 2020 and September 2022 were retrospectively analyzed. There were 13 males and 5 females with an average age of 28.33 years (range, 17-41 years). Causes of injury: 11 cases of direct violence injury, including 6 cases of traffic accident injury, 4 cases of sports injury, 1 case of falling injury; 7 cases of indirect violence injury, all sports injury. All patients had complete ACL rupture, including 15 acute injuries and 3 old injuries. The preoperative pivot shift test was grade Ⅱ in 9 cases and grade Ⅲ in 9 cases. All patients were treated with ACLR combined with modified Lemaire procedure. The International Knee Documentation Committee (IKDC) score and Lysholm score were used to evaluate the effectiveness before operation and at 3, 6, 12 months after operation. KT-2000 arthrometer was used to measure the anterior stability of the knee joint, and the difference between the healthy and affected sides was recorded. Pivot shift test was used to evaluate the rotational stability of the knee joint. During the follow-up, X-ray films were taken to observe the bone tunnel and internal fixation, and MRI was used to examine the healing of ACL, anterolateral collateral ligament and fibular collateral ligament grafts. Results All patients completed the operation successfully without complications such as knee joint infection, vascular and nerve injury. All patients were followed up 12-19 months (mean, 13.22 months). After operation, the rotational stability of the knee joint recovered satisfactorily, and there was no adverse symptom such as knee instability and locking at last follow-up. X-ray film and MRI showed that the bone tunnel was anatomically located and healed well, the internal fixation was in good position, and the reconstructed ACL and iliotibial band were continuous and in good tension. The IKDC score, Lysholm score, and the difference of KT-2000 between the healthy and the affected side significantly improved at 3, 6, and 12 months after operation (P<0.05). All the indicators further improved with time after operation, except that there was no significant difference in IKDC score between 3 and 6 months after operation and in the difference of KT-2000 between 3 months and 6, 12 months after operation (P>0.05), and there was significant difference in other indicators between different time points (P<0.05). Pivot shift test was negative immediately after operation and at last follow-up. Conclusion In ACL injuries with a highly positive pivot shift test, ACLR combined with the modified Lemaire procedure can effectively restore anterolateral knee stability, leading to satisfactory knee stability and function in the early postoperative period.