Experience of laparoscopic ultrasound-guided ablation of diaphragmatic liver tumors

Objective·To investigate the safety and effectiveness of laparoscopic ultrasound-guided microwave ablation for phrenic surface liver tumors, as well as the specific experience of its use.Methods·A retrospective analysis was performed on 13 cases of diaphragmatic liver tumor who received laparoscopic ultrasound-guided microwave ablation in Zhejiang University of Traditional Chinese Medicine Affiliated Wenzhou Hospital from November 2019 to April 2021. The falciform ligament, coronal ligament and deltoid ligament were severed according to the need, and gauze pads were filled on the diaphragmatic surface or visceral of the liver. Laparoscopic ultrasound scan of the liver was performed to determine the location of the tumor and whether there were new tumors. Meanwhile, ultrasound contrast agent was used to perform multi-point and multi-angle ablation of the tumor after biopsy. During the process of needle withdrawal, laparoscopic direct observation was performed to observe whether there was bleeding, and needle path ablation was performed. After ablation, contrast-enhanced ultrasound was repeated and additional ablation was performed if necessary. Perioperative complications were observed and preoperative and postoperative blood biochemical indexes, white blood cells level and postoperative MRI manifestations were compared.Results·All the 13 patients were successfully treated with laparoscopic ultrasound-guided microwave ablation. There were no serious complications such as diaphragm injury, arrhythmia, pneumonia, pneumothorax, massive bleeding, biliary fistula and intestinal injury. The white blood cells before surgery [(4.9±1.0)×109/L] and day 2 after surgery [(8.7±2.5)×109/L] were significantly different (P=0.000). The glutamic-pyruvic transaminase [15.0 (22.0, 77.5) U/L] before surgery and day 2 after surgery [69.0 (135.0, 371.0) U/L] were significantly different (P=0.013). One month after the operation, MRI enhancement confirmed that the total necrosis rate of the lesion was 100%.Conclusion·Laparoscopic ultrasound-guided hepatic tumor ablation, which is first performed under laparoscopy, forms a safe isolation zone around the liver through the establishment of pneumoperitoneum, severed ligament, gauze isolation and other methods. Then, under the direct vision of laparoscopic ultrasound probe, the diaphragmatic liver tumors are ablated to achieve a safer and more effective method

A Study on Liver Damage Induced by Photodynamic Therapy

目的　研究光动力作用对活体肝组织的损伤 ,探讨光动力治疗肝癌的可行性 ,为临床治疗提供实验依据。方法　动物实验 :将小鼠分成光动力疗法 (PDT)组、单血卟啉衍生物 (HpD)组、激光组和空白对照组。光敏药物选用血卟啉衍生物 ,给药量每公斤体重 10mg ,药物用 1ml生理盐水稀释 ,于实验前 48h将药物注射入PDT组和HpD组小鼠腹腔内 ,避光饲养。将PDT组和激光组小鼠固定于实验板上。麻醉后 ,剖腹暴露右肝前叶 ,激光直接投照于肝脏表面 ,光斑直径 5mm ,照射 2min。激光器为氩离子泵浦染料激光器系统 ,光波长 6 30nm ,输出功率 10 0mW ,每一照射区能量累积约 6 0J ,照光后关腹 ,回笼饲养观察。于照光后 1、2 4、72、12 0h处死各组小鼠 ,剖腹取肝组织置于 4%福尔马林液中固定 ,常规石蜡包埋切片 ,HE染色 ,光镜观察。临床治疗 :经病理确诊的肝癌患者 ,于治疗前 48h做皮肤划痕试验 ,阴性者按每公斤体重 5mg静脉给药。治疗时 ,在B超引导下 ,用 18G肝穿针经皮穿刺 ,将石英光纤导入肝肿瘤内。激光波长 6 30nm ,输出功率 35 0mW ,每一照射点能量累积2 2 0J。治疗 1个月后行二期切除术。标本用 4%福尔马林固定 ,常规石蜡包埋切片 ,HE染色 ,光镜观察。结果　动物实验光镜观察结果显示 :PDT组于照光后 2 4h出现照光区肝细Objective To investigate the liver damage induced by photodynamic therapy(PDT) and provide an experimental basis for PDT treatment for liver cancers. Methods 96 normal mice were divided into 4 groups: PDT group, laser group, HpD group and control group. The photosensitizer used in this study was hematoporphyrin derivative (HpD), diluted in 5% glucose and injected into the peritoneal cavity at a dose of 10 mg/kg body weight 48 h before light irradiation. The mice were kept from sunlight exposure. After anesthesia the abdomen was opened and the right front lobe of the liver was exposed. An argon laser pumped dye laser system was used. The liver surface was directly irradiated by the 630 nm laser beam at a power of 100 mW for 2 minutes. The spot size was 5 mm in diameter and the energy density was 60 J/cm 2. The mice were killed at 1, 24, 72 and 120 hours after laser irradiation, respectively. Samples were embedded in paraffin and HE stained sections were examined underlight microscope. Besides, a 46-years old male patient with liver cancer was also included in this study. He received HpD in a dose of 5 mg/kg body weight, i.v. injected 48 h prior to laser irradiation. Ultrasound-guided liver puncture was performed and optical fibers were inserted into and evenly distributed in the tumor. The 630 nm laser irradiation was carried out at a power of 350 mW, energy density of 250 J/cm 2 per each spot. The patient was operated one month later and specimens were taken for histopathological examination. Results Animal experiment: Large necrotic areas were observed in livers of mice 24 hours after PDT. There was a clear demarcation between irradiated and non-irradiated areas observed by both gross and microscopic examination. Fibrous proliferation was seen in the surrounding tissues 120 hours after PDT. Swelling of hepatocytes was observed at 1 h after laser irradiation alone, but returned to normal at 72 h after irradiation. No damage to hepatocytes was observed in livers of both HpD alone and control groups. Clinical case: Wide-spread necrotic areas were present in the PDT irradiated tumor tissue. Normal hepatocytes were observed in the non-irradiated surrounding tissue. There were numerous lymphocytes and macrophages infiltrating in the surrounding areas. Conclusions Selective and sharply demarcated photodamage to liver tissue can be induced by selective laser irradiation after HpD administration. It is suggested that photodamage to surrounding normal tissues can be avoided by carefully controlled laser irradiation during photodynamic therapy of liver cancers.福建省“95”重点科技项

The Research of Three-dimensional Visualization of Liver Pipeline Structure in Medical Image Processing

肝内管道系统是一个相互间联系紧密并且解剖结构复杂多变的多层次的结构整体。正是这种复杂的管道系统及其生理和病理变异，决定了肝脏外科手术的难度。 移动立方体（MC）算法是三维重建的一种经典算法。本文针对MC算法所存在的算法效率低下等缺点分析其根本原因，提出了一种基于6邻面的表面追踪算法来对该算法的运行效率进行改进，并实现肝脏门静脉的三维可视化。实验结果表明，改进的MC方法在保证三维重建效果的前提下，算法的效率得到了明显的提高。 MC算法重建出的血管的表面比较粗糙，本文提出了一种几何模拟的血管三维可视化方法，利用小圆台拼接拟合血管，实现了肝脏管道的三维可视化。实验结果表明，该方法的显示结果视觉质...Intrahepatic pipeline system is a whole structure that closely linked to each other, within complex changing anatomical structure. It is this complex piping system and its physiological and pathological variation, determine the difficulty of liver surgery. Marching Cubes (MC) algorithm is a classical three-dimensional reconstruction algorithm. This paper analyzed the root causes of defects of the...学位：工学硕士院系专业：信息科学与技术学院计算机科学系_计算机应用技术学号：2302008115326

Ultrasound Guided Percutaneous PDT For Advanced Liver Cancer A Report of 30 Cases

为探讨治疗中晚期肝癌的理想方法，扩大和发展光动力疗法，自1994年6月起，我们应用光动力疗法（PdT）治疗中晚期肝癌30例，其中肝细胞癌28例、腺癌2例。肿瘤直径7~10CM的13例、10CM以上至16CM的17例。伴肺转移5例、骨转移5例、门静脉或腔静脉浸润4例。首次治疗19例、其他方法治疗无效或复发者11例。本研究采用氩激光泵浦染料激光器系统，获得630nM波长的连续波治疗光。光敏剂选用血卟啉衍生物（HPd）。治疗时通过b超引导经皮肝穿，将光纤导入肿瘤组织中布点照射。治疗后未见肝功能明显损伤，未出现肝穿出血、腹膜炎等严重并发症，没有一个月内病情恶化者。有14例患者只作一次治疗，其中5例出院后失访；另9例肿瘤部分缓解率为22%。16例患者接受二、三次治疗，肿瘤部分缓解率达到62%。随访病例中有8例已存活1年以上。patients with advanced liver cancer were treated by interstitial photodynamic therapy (PDT).These included 28 hepatocellular carcinoma and two adenocarcinoma, 19 primary tumors and 11 recurred Following other treatments.The diameter of tumors were 7 10 cm in 13 cases and 10 16 cm in 17 cases.In this study, an argon laser pumped dye laser system was used to give a CW laser beam at 630 nm which was split and coupled into three optical Fibers.The patients received injection of photosensitizer of hematoporphyrin derivative (HpD) i.v.at a dose of 5 mg/kg body weight 48 h prior to laser irradiation.Then the Fibers were inserted into tumor by ultrasonic visualization guided percutaneous liver puncture.The inserted irradiation points were spaced in entire tumor volume and the tumor was irradiated with a light output power of 300 mW For 12 minuts per point.Totally 52 treatments were perFormed in 30 patients.Among them, 14 cases were treated by only one time and 16 cases 2 or 3 times.The Follow up were carried out in 25 cases For 3 18 months.The results show that signiFicant remission was 22% (2/9) in those patients by only one treatment and 62% (10/16) in those by 2 or 3 treatments.The reduction rate of tumor size was over 90% in Five out of six cases aFter 3 treatments.8 patients have been surviving over one year.No obvious change was Found in all patients examined by liver Function test, renal Function test and blood routine examination.The level of AFP depicted a descending tendency aFter PDT.Our Findings indicate that PDT is eFFective and saFe For the treatment of large liver cancers including those recurred Following hepatic resection and those Failed in hepatic artery inFusion embolic chemotherapy.福建省“八五”攻关资

Treatment Strategy and Research Progress of Immune Microenvironment for Liver Metastasis of Non-small Cell Lung Cancer

Liver is the common site for metastasis and spread of non-small cell lung cancer (NSCLC). Lung cancer patients with liver metastasis have poor prognosis, which may be related to liver-specific microenvironment composition. The metastasis of lung cancer to the liver is regulated by various pathophysiological factors, including the liver immune microenvironment, related cells, proteins, signaling molecules, and gene changes. These factors will affect the consistent disease process and subsequent treatment strategies. Immune checkpoint inhibitors (ICIs) have made breakthroughs in treatment of patients with advanced NSCLC. However, NSCLC patients with liver metastasis, a unique population of advanced lung cancer, are characterized by poor immunotherapeutic effect. This paper reviews the related mechanisms of the immune microenvironment in affecting the occurrence and development of liver metastases and summarizes the achievements and prospects of anti-tumor immunotherapy in liver metastases of NSCLC

Automatic Generation of Electronic Medical Record Based on GPT2 Model

Writing Electronic Medical Records (EMR) as one of daily major tasks of doctors, consumes a lot of time and effort from doctors. This paper reports our efforts to generate electronic medical records using the language model. Through the training of massive real-world EMR data, the CMedGPT2 model provided by us can achieve the ideal Chinese electronic medical record generation. The experimental results prove that the generated electronic medical record text can be applied to the auxiliary medical record work to reduce the burden on the compose and provide a fast and accurate reference for composing work

Long-term Follow-up Results of 70 Liver Cancer Cases Received Ultrasound Guided Percutaneous PDT

目的　分析光动力治疗肝癌的临床表现和远期疗效 ,探讨疗效影响因素和治疗适应证 ,为临床推广应用提供参考数据。方法　肝癌患者 70例 ,其中小肝癌 2例 ,大肝癌 6 8例。均经B超、CT定位 ,甲胎蛋白 (AFP)定量 ,病理组织学确诊。治疗前 48h ,患者行血卟啉衍生物 (HpD)皮试 ,阴性者按每公斤体重 5mg静脉给药。治疗时 ,在B超引导下 ,用 18G肝穿针经皮穿刺将石英光纤引导入肝肿瘤内进行光辐照。激光器为氩离子激光泵浦染料激光器系统 ,激光波长 6 30nm ,光纤末端为 1cm长柱状弥散头 ,输出功率 30 0～ 35 0mW ,每一照射点能量累积约 2 2 0J,肿瘤内实行多点照射。治疗后 1周 ,检查血常规、肝功能、AFP及B超 ,一个月后 ,行肝穿活检。多次治疗间歇时间为 1个月。结果　 70例肝癌行 170次治疗 ,其中接受 1次治疗 30例 ,多次治疗 40例。 1次治疗组 1年生存率 10 % ,无生存 2年者 ;2次治疗组 1年生存率 5 0 % ,2年以上生存率 8% ;3次以上治疗组 1年生存率 82 % ,2年生存率 5 0 % ,3年生存率 32 % ,其中 3例存活5年以上。全组只有 18%的患者出现治疗后短期内一过性ALT、AST轻度升高 (<5 0U)和TBIL轻度升高 ,余未见明显异常。随访患者 1～ 5年 ,未见肝功能远期受损。病人接受治疗后 ,只有 17%出现低热 3～ 4天 ,30 %的Objective To investigate the long-term follow-up results of ultrasound-guided percutaneous PDT for liver cancer and to evaluate the efficacy and safety of this technique. Methods 70 patients with liver cancers, including 2 small tumors and 68 large tumors, were examined by ultrasound, CT, AFP assay, and diagnosed by histopatholopy of needle biopsy. The patients received injection of hematoporphyrin derivative(HPD) i.v. in a dose of 5 mg/kg body weight 48 h prior to laser irradiation. An argon laser pumped dye laser system was used to give a CW laser beam at 630 nm. The light beam was split and coupled into three optical fibers. An ultrasound-guided percutaneous liver puncture was performed and optical fibers were inserted into the tumors via 18G needles. Efforts were made to ensure that irradiation points were distributed in entire tumor volume and a light output of 300～350 mW for 12 minutes per point was used. The patients were examined with routine blood test, liver functions, AFP assay and USG at one week after treatment. A month later they were reexamined by needle biopsy and received next PDT treatment. Results Total 170 treatments were performed in the 70 patients. Among them 30 cases were treated for only once, 12 cases twice, 12 cases 3 times, and 16 cases 4 times or more. All 70 cases were followed up for 1-5 years. The results showed that multiple treatment is more effective than single treatment. The 1-, 2-and 3-years survival rate was 10%, 0, 0 in the group by single treatment, respectively, 50%, 8% and 8% in the group treated twice, and 82%, 50% and 30% in the group treated by 3 or more time, respectively. Three patients from the last group have already been surviving for longer than 5 years. Slight increase of ALT, AST and total bilirubin occurred in only 18%, and mild fever occurred in 17% of the 70 cases for 3-4 days shortly after PDT treatment. No severe complications due to PDT such as severe hemorrhage after liver puncture, hepatic failure, biliary peritonitis or long-lasting liver dysfunctions were observed in our group. Conclusions Photodynamic therapy is effective and safe for the treatment of liver cancers including those following hepatic resection or those failed after embolic chemotherapy by hepatic artery infusion. However, we would suggest that single PDT treatment is not enough and repeated PDT treatments are recommended in order to obtain a significant therapeutic effect to patients with large liver cancers.福建省“95”重点科技项

Effects of all trans relinoic acid on the liver metastatic model of gastric cancer cells, BGC-823 and MKN-45

目的　研究全反式视黄酸 (ATRA)对胃癌细胞实验性肝转移能力的影响。方法　将胃癌细胞BGC 82 3和MKN 45注射于裸小鼠脾包膜下 ,隔日给裸小鼠灌服ATRA。术后 6周处死裸小鼠 ,解剖脾脏及肝脏肿瘤并用免疫组织化学方法测定其肿瘤血管密度 ;以放射免疫法测定血清癌胚抗原 (CEA)。结果　ATRA抑制胃癌细胞脾包膜下移植瘤的生长及其肝转移 ,抑制率分别为 5 0 .0 %(BGC 82 3)和 33.3% (MKN 45 ) ;使脾移植瘤和肝转移瘤的肿瘤血管密度降低。ATRA还可使肝转移模型鼠血清CEA含量分别下降 5 0 .2 4% (BCG 82 3)和 48.10 % (MKN 45 )。结论　ATRA能有效抑制胃癌细胞的实验性肝转移 ,从而抑制胃癌细胞分泌CEA以及抑制肿瘤血管的形成。 【英文摘要】 Objective To investigate the effects of all trans retinoic acid (ATRA) on experimental liver metastatic ability of gastric cancer cells. Methods BGC 823 and MKN 45 cells were injected into spleen subcapsule of nude mice, who were administrated ATRA every other day after operation. Six weeks after operation, the nude mice were executed. Tumors in spleen and liver were examined pathologically and microtumor vessel density (MVD) was measured by using immunohistochemical method and serum carcino embryonic ..

Aldose reductase regulates IRS-1 and LKB1-AMPKa signaling to promote insulin resistance, obesity and NAFLD

多元醇糖代谢支路（thepolyolpathway,PP）是糖酵解-三羧酸循环以及戊糖磷酸循环之外细胞葡萄糖代谢的第三个最重要的途径。醛糖还原酶（aldosereductase,AR）是PP的第一个和限速酶，它负责将葡萄糖还原为山梨醇，后者在山梨醇脱氢酶（sorbitoldehydrogenase,SDH）的作用下生成果糖。AR/PP在细胞代谢、炎症反应、免疫应答等生命活动中扮演重要角色，AR/PP的异常调控与糖尿病和糖尿病并发症的发生发展紧密相关。同时，AR/PP的过度激活产生的果糖与肝脂肪化或非酒精性脂肪肝（NAFLD）有着紧密的联系。另一方面，果糖代谢不受肝能量水平（AMP/ATP）的调...The polyol pathway (PP) is the third most important pathway of glucose metabolism besides the glycolysis - tricarboxylic acid cycle and the pentose phosphate pathway. Aldose reductase (AR) is the first and rate-limited enzyme of PP, it catalyzes glucose reduction to sorbitol, and the latter generates fructose with the aid of sorbitol dehydrogenase (SDH). AR/PP plays an important role in cell metab...学位：理学博士院系专业：生命科学学院_细胞生物学学号：2162012015379