Objective To investigate the severe complications after ultrasound- guided percutaneous microwave coagulation therapy( PMCT) for primary hepatic carcinoma( PHC) and measures for prevention and treatment. Methods A total of 652 patients with PHC who were admitted to department of hepatobiliary surgery in Air Force General Hospital,PLA from January 2012 to December 2014 were selected,and ultrasound- guided PMCT was performed for all the patients. The occurrence of post- PMCT complications was observed and compared between the years 2012,2013,and 2014. Measures for prevention and treatment were summarized. The chi- square test was applied for comparison of categorical data between groups. Results A total of 18 patients experienced severe PMCT- related complications,with an incidence rate of 2. 76%. These complications included intra- abdominal hemorrhage( n = 10),liver abscess( n = 2),intestinal fistula( n = 1),diaphragmatic rupture( n = 2),acute renal failure( n = 1),tumor implantation metastasis( n = 1),and cardiovascular and cerebrovascular diseases( n = 1). One patient died of the complications above,and the complication- related mortality was 5. 56%( 1 /18). The incidence of PMCT- related complications showed a significant difference between 2012,2013,and 2014( χ2= 11. 78,P = 0. 003). Conclusion Ultrasound- guided PMCT is generally safe,but the patients with liver tumors in special sites,severe liver cirrhosis,and other systemic diseases still have a high risk. The indications for PMCT should be followed strictly,and enhancement in preoperative prophylactic treatment,standard intraoperative procedure,and careful postoperative observation can significantly reduce the adverse outcome caused by PMCT- related complications.

Objective To investigate the effect of transcatheter arterial chemoembolization( TACE) combined with interferon( IFN) adjuvant therapy in the treatment of advanced primary liver cancer,and to provide new ideas for adjuvant therapies after TACE. Methods The databases including Cochrane Library,Pub Med,Medline,Embase,CNKI,Wanfang Data,and VIP were searched to obtain all articles published before January 2015,and the randomized controlled trials( RCTs) about the comparison between TACE combined with IFN and TACE alone published in journals at home and abroad were included. Quality assessment and data extraction were performed for these articles,and Revman 5. 1 software was applied for the meta- analysis. Results A total of 6 RCTs were included,consisting of 311 patients in the IFN adjuvant therapy group and 308 patients in the placebo group. The results of the meta- analysis showed that compared with the placebo group,the IFN adjuvant treatment group had significantly lower 1-,2-,and 3- year recurrence rates and a significantly higher 1- year survival rate( P = 0. 006,0. 002,0. 002,and 0. 030). Conclusion IFN adjuvant therapy can reduce the risk of liver cancer recurrence after TACE and improve the patients' survival rate.

Objective To investigate the prognostic factors for transcatheter arterial chemoembolization( TACE) in patients with advanced primary hepatocellular carcinoma( HCC). Methods The clinical data of 124 patients with advanced HCC who were admitted to Huaian No. 1 People's Hospital Affiliated to Nanjing Medical University and underwent TACE from May 2007 to May 2012 were analyzed retrospectively. The Kaplan- Meier method was used to calculated cumulative survival rates,and the log- rank test was used for survival difference analysis and univariate prognostic analysis; the Cox univariate analysis was applied to determine risk factors,and the Cox multivariate stepwise regression analysis was applied to determine independent risk factors. Results Follow- up visits were performed for all patients,and the time for follow- up visits was 3- 40 months. The 0. 5-,1-,2-,and 3- year cumulative survival rates of these patients were97. 6%,74. 2%,15. 5%,and 4. 1%,respectively,with a median survival time of 482 days. Univariate analysis showed that preoperative serum alpha- fetoprotein( AFP) level,tumor size,presence or absence of portal vein tumor thrombus,and tumor stage were the prognostic factors in patients with HCC undergoing TACE( all P < 0. 001); Cox multivariate stepwise regression analysis showed that tumor size,tumor stage,preoperative serum AFP level,and presence or absence of portal vein tumor thrombus were the independent prognostic factors( Wald values = 7. 428,7. 699,15. 235,and 5. 803,respectively,all P < 0. 05). Conclusion Tumor size,tumor stage,preoperative serum AFP level,and presence or absence of portal vein tumor thrombus are the independent prognostic factors in patients with HCC undergoing TACE,and can guide the prognosis and selection of therapeutic regimens in clinical practice.

Objective To investigate the therapeutic effect of transcatheter arterial chemoembolization( TACE) in patients with hepatocellular carcinoma( HCC) complicated by portal vein tumor thrombus,and to identify related prognostic factors. Methods The clinical data of152 HCC patients with portal vein tumor thrombus who were admitted to Xijing Hospital of Fourth Military Medical University and received TACE from January 2006 to December 2010 were analyzed retrospectively. The occurrence of post- TACE liver failure,upper gastrointestinal bleeding,and post- embolization syndrome was observed,and survival data and prognostic factors were analyzed. The Kaplan- Meier method was used to calculate cumulative survival rate,the log- rank test was used for univariate analysis,and the Cox proportional hazards model was used for multivariate analysis. Results The median survival time was 5. 0 months,and the 6-,12-,and 18- month cumulative survival rates were 37%,18%,and 9%,respectively. Univariate analysis showed that tumor size,tumor type,involvement of both liver lobes,distant metastasis,and Child- Pugh class were the prognostic factors for TACE in HCC patients with portal vein tumor thrombus( χ2= 5. 108,11. 542,6. 036,12. 319,and 22. 574,respectively,all P < 0. 05); multivariate analysis showed that tumor size,tumor type,distant metastasis,and Child- Pugh class were the independent prognostic factors( Wald values = 11. 243,5. 021,7. 651,and25. 876,respectively,all P < 0. 05); Child- Pugh class was the only influencing factor for liver failure in HCC patients with portal vein tumor thrombus( P = 0. 015). Conclusion TACE is safe and effective in HCC patients with portal vein thrombus and good liver function.Tumor size,tumor type,distant metastasis,and Child- Pugh class are the main factors influencing survival,which provides a basis for clinicians to select appropriate interventional therapies.

Objective To evaluate the effect of live combined Bacillus subtilis and Enterococcus faecium enteric- coated capsules in the prevention and treatment of adverse events and complications after transcatheter arterial chemoembolization( TACE). Methods A total of 239 patients who were diagnosed with hepatocellular carcinoma and treated with TACE from January 2012 to December 2013 were randomly divided into experimental group( n = 111) and control group( n = 128). The patients in the experimental group were orally given live combined Bacillus subtilis and Enterococcus faecium enteric- coated capsules 3 days before surgery,and the patients in the control group were given placebo with the same appearance. The adverse events,incidence of complications,and blood ammonia level after TACE were compared between the two groups. Independent- samples t- test was performed for comparison of continuous data between the two groups,and chi- square test was performed for comparison of categorical data. Results Compared with those in the control group,the patients in the experimental group had a significantly lower incidence of adverse events such as pyrexia,abdominal distension,and constipation( t = 2. 728,2. 561,and 2. 026,respectively; all P < 0. 05); meanwhile,the patients in the experimental group had a significantly lower incidence of postoperative complications such as liver abscess,ileus,spontaneous bacterial peritonitis,and hepatic encephalopathy than those in the control group( t = 1. 969,2. 312,2. 987,and 2. 826,respectively; all P < 0. 05). After treatment,the patients in the experimental group had a significantly lower blood ammonia level compared with those in the control group( t = 1. 97; P < 0. 05). Conclusion As a new kind of live bacterial preparation,Bacillus subtilis and Enterococcus faecium enteric- coated capsules can reduce abdominal discomfort and blood ammonia level after TACE,as well as the incidence of severe complications including liver abscesses,but related mechanisms need further studies.

Objective To investigate the effect of recombinant human endostatin( Endostar) combined with hepatic artery interventional therapy on the progression- free survival( PFS) of patients with advanced hepatocellular carcinoma( HCC). Methods A total of 86 patients with advanced HCC who were admitted to Fujian Provincial Tumor Hospital from March 2011 to May 2015 were selected and divided into treatment group and control group according to a matched pair design. The treatment group( 43 patients) was given Endostar combined with hepatic artery interventional therapy,and the control group( 43 patients) was given hepatic artery interventional therapy combined with oral administration of Ganfule. The chi- square test was applied for comparison of categorical data between the two groups,and the t- test was applied for comparison of continuous data between the two groups. The Kaplan- Meier method was applied for survival analysis,the Log- rank test was applied for univariate analysis,and Cox proportional hazards model was applied for multivariate analysis. Results The median PFS in the treatment group and the control group was 154 d [95% confidence interval( CI) : 94- 214 d]and 70 d( 95% CI: 39- 101d),respectively,with a significant difference between the two groups( χ2= 10. 741,P = 0. 001). Univariate analysis showed that the severity of liver cirrhosis,number of tumors,and main portal vein tumor thrombus / inferior vena cava tumor thrombus were the prognostic factors for patients with advanced HCC( χ2= 8. 182,9. 150,and 6. 565,P = 0. 004,0. 027,and 0. 038); multivariate analysis showed that the severity of liver cirrhosis and main portal vein tumor thrombus / inferior vena cava tumor thrombus were the independent prognostic factors for PFS in patients with advanced HCC who were treated with Endostar combined with hepatic artery interventional therapy( P = 0. 028 and 0.013). Conclusion Endostar can effectively prolong the PFS of patients with advanced HCC after hepatic artery interventional therapy,but it does not have a clear advantage in patients with severe liver cirrhosis or main portal vein tumor thrombus / inferior vena cava tumor thrombus.

Objective To investigate the clinical effect of systemic chemotherapy combined with transcatheter arterial chemoembolization( TACE) in the treatment of breast cancer with liver metastases. Methods A total of 86 female breast cancer patients with liver metastases who were treated in the Affiliated Hospital of Shandong Academy of Medical Sciences from December 2012 to December 2014 were selected and equally divided into experimental group and control group. The patients in the control group received systemic chemotherapy,and those in the experimental group received systemic chemotherapy combined with TACE. The clinical effect,changes in lesions,and patients' quality of life( QOL) scores after treatment were compared between two groups. The t- test was applied for comparison of continuous data between the two groups,and the chi- square test was applied for comparison of categorical data between the two groups. Results The experimental group had a significantly higher overall response rate than the control group( 90. 70% vs 58. 14%,χ2= 13. 07,P = 0. 001). Compared with the control group,the experimental group had significantly smaller diameters of tumors and lymph nodes after treatment( t = 4. 26 and 4. 63,both P < 0. 001),as well as significantly higher QOL scores at 3 and 6 months after treatment( t = 6. 30 and 3. 89,both P <0. 001). Conclusion Systemic chemotherapy combined with TACE has a significant therapeutic effect in breast cancer patients with liver metastases,and can improve patients' symptoms,reduce adverse drug reactions,and improve QOL. As a safe and reliable therapeutic method,it is worthy of clinical application.

Objective To investigate the application of diffusion- weighted magnetic resonance imaging( DW- MRI) for the evaluation of the therapeutic effect of percutaneous ethanol injection( PEI) and its effect on micro- angiogenesis in residual tumor in a rabbit VX2 liver tumor model. Methods A total of 26 rabbits with VX2 liver tumor were randomly divided into experimental group and control group,with13 rabbits in each group. CT- guided PEI was performed for the experimental group,and no treatment was performed for the control group.DW- MRI was performed at 1 week after operation. Apparent diffusion coefficient( ADC) ADCtotalin the active tumor areas and necrosis areas were compared within the experimental group,ADCperfand microvascular density( MVD) count in the active tumor areas were compared between the two groups,and the correlation between ADCperfand MVD count was analyzed. The Shapiro- Wilk test was applied for normality analysis,the Wilcoxon rank sum test was applied for comparison of continuous data between the two groups,and the correlation between ADCperfand MVD count was analyzed by the Pearson correlation coefficient. Results In the experimental group,ADCtotalshowed a significant difference between the necrosis areas and the active tumor areas( [1. 674( 1. 340- 2. 571) ] × 10- 3mm2/ s vs [1. 296( 1. 120-1. 972) ]× 10- 3mm2/ s; Z = 2. 052,P = 0. 040). ADCperfand MDV count in the active tumor areas showed no significant differences between the experimental group and the control group [0. 568( 0. 381- 1. 873) ]× 10- 3mm2/ s vs [0. 947( 0. 518- 1. 476) ]× 10- 3mm2/ s,Z =0. 487,P = 0. 626; 23. 641 ± 6. 138 vs 23. 487 ± 3. 466; Z =- 0. 128,P = 0. 898). In both groups,ADCperfin the active tumor areas was positively correlated with MDV count( r = 0. 583 and 0. 593,P = 0. 037 and 0. 033). Conclusion DW- MRI can accurately assess the therapeutic effect of PEI and reflect the condition of micro- angiogenesis in a rabbit VX2 liver tumor model. At 1 week after PEI,PEI has no obvious effect on micro- angiogenesis in residual tumor.

Objective To analyze the prognostic risk factors for hepatic encephalopathy( HE),and to explore the risk factors for prognosis.Methods A total of 385 patients with HE who were treated in Liaocheng People's Hospital from January 2006 to June 2014 were enrolled in this study and analyzed retrospectively. These patients were divided into improved group( n = 125) and deteriorated group( n = 260). A total of 25 clinical indices were selected,and non- conditional binary logistic regression analysis was performed for related data with SPSS.Results Univariate analysis showed that HE stage,upper gastrointestinal hemorrhage,hepatorenal syndrome( HRS),total bilirubin( TBil),and international normalized ratio( INR) were risk factors affecting the prognosis of HE( P = 0. 000,0. 009,0. 047,0. 002,and0. 027,respectively). Multivariate logistic regression analysis was further performed for the variables with statistical significance and the results showed that HE stage,upper gastrointestinal hemorrhage,HRS,TBil,and INR were independent risk factors affecting the prognosis of HE( P = 0. 000,0. 009,0. 000,0. 000,and 0. 008,respectively; OR( 95% CI) = 4. 388( 2. 997- 6. 424),2. 805( 1. 300- 6. 050),4. 036( 2. 018- 8. 072),1. 005( 1. 003- 1. 007),and 1. 446( 1. 099- 1. 901),respectively). Conclusion HE stage,upper gastrointestinal hemorrhage,HRS,TBil,and INR are risk factors affecting the prognosis of HE,and advanced HE stages,a high level of bilirubin,high INR,and presence of upper gastrointestinal hemorrhage and HRS indicate poor prognosis. The patient's HE stage,upper gastrointestinal hemorrhage,HRS,TBil,and INR are applied as the indices for prognosis of HE,and the equation based on the these indices may have a reference value in clinical practice.

Objective To analyze and compare the serum metabolite profiling of healthy volunteers and patients with minimal hepatic encephalopathy( MHE),identify the specific biomarkers of MHE,and explore the method for early diagnosis of MHE. Methods Twenty-nine patients with MHE caused by hepatitis B cirrhosis who were admitted to First Affiliated Hospital of Guangxi University of Chinese Medicine( MHE group) from October 2013 to October 2014,as well as 50 healthy volunteers who received physical examinations in this hospital( NC group) during the same period,were collected. Gas chromatography and time- of- flight mass spectrometry( GC- TOFMS) and ultra- high- pressure liquid chromatography- quadrupole- time- of- flight mass spectrometry( UPLC- QTOFMS) were applied to determine the metabolites in serum samples. Principal component analysis( PCA) and orthogonal partial least squares- discriminant analysis( OPLS-DA) were applied for multivariate statistical analysis,and univariate t test was applied for comparison between the two groups,so as to determine the biomarkers for MHE. Results In combination of the modeling analysis with PCA and OPLS- DA,the results from univariate t test,and vasoactive intestinal peptide( VIP) value in the models,a total of 27 possible specific biomarkers for MHE were found in serum in the two groups. According to the fold change between MHE group and NC group in OPLS- DA model,there were 9 down- regulated metabolites and 18 up- regulated metabolites in the patients with MHE compared with healthy volunteers. Conclusion Serum metabolomics analytical platforms such as GC- TOFMS and UPLC- QTOFMS can detect a variety of metabolites in serum,which can be of help to explore the pathogenesis of MHE. In addition,the diagnostic model OPLS- DA established in this study can differentiate between the normal population and patients with MHE,which may be applied for early diagnosis of MHE.

Objective To evaluate the compatible stability of magnesium isoglycyrrhizinate( MgIG) injection and reduced glutathione( GSH) for injection at room temperature. Methods High- performance liquid chromatography was applied to measure the changes in the content of MgIG and reduced GSH after MgIG injection and reduced GSH for injection were mixed with 5% or 10% glucose solution. Results There were no significant changes in the content of MgIG and reduced GSH within 0,0. 5,1,1. 5,2,and 4 h after MgIG injection and reduced GSH for injection were mixed with 5% or 10% glucose solution. Conclusion MgIG injection and reduced GSH for injection are compatible in 5% and 10% glucose solutions,but the mixed solution should be used within 4 h.

Objective To investigate the changes in serum asymmetric dimethylarginine( ADMA) levels in the progression of liver inflammation in a rat model of nonalcoholic fatty liver disease( NAFLD). Methods The rat model of NAFLD was established through high- fat cream by gavage and these rats were considered the experimental group( group M),and the rats in the normal control group( group C) were given normal saline by gavage within the same period of time. Liver samples and serum samples were collected from these rats. Serum alanine aminotransferase( ALT) and ADMA levels and the content of nitric oxide( NO) in liver tissue homogenate were measured at 4,8,and 12 weeks for group M( M4,M8,and M12) and 12 weeks for group C( C12),and NAFLD activity score( NAS) was evaluated for both groups at the same time point. As for the data that were normally distributed and had homogeneity of variance,one- way analysis of variance was applied for comparison between multiple groups,and the least significant difference( LSD) t- test was applied for comparison within the same group; as for the data that were normally distributed and had heterogeneity of variance,Kruskal- Wallis H test was applied for comparison between multiple groups. Pearson correlation analysis was applied for correlation analysis. Results Compared with the C12 group,the M12 group had significantly increased serum ADMA and ALT levels and content of NO in liver tissue homogenate( P = 0. 010,P < 0. 001,and P < 0. 001,respectively). Serum ADMA level was not significantly correlated with serum ALT level( r = 0. 195,P = 0. 228),and was positively correlated with the content of NO in liver tissue homogenate and NAS in rats( r = 0. 631,P < 0. 001; r = 0. 782,P < 0. 001).Conclusion In rats with NAFLD,serum ADMA level gradually increases with the progression of liver inflammation,and is positively correlated with the content of NO and NAS. The role of ADMA as a new inflammatory factor for evaluating the grade of chronic liver inflammation in NAFLD needs to be further investigated.