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The purpose of this study was to conduct a comprehensive study of the clinical correlation between the alpha-fetoprotein (AFP) level at diagnosis and pathological grades, progression, and survival of patients with hepatocellular carcinoma (HCC). A total of 78,743 patients in Surveillance, Epidemiology, and End Results Program (SEER)-registered HCC was analyzed. The AFP test results for patients with HCC were mainly recorded as AFP-negative and AFP-positive. Logistic regression analysis revealed that the AFP level at diagnosis was an independent risk factor of pathological grade (odds ratio [OR], 2.559; 95% confidence interval [CI], 2.075–3.157; P P P P P

Background and Objectives: Patients undergoing synchronous open splenectomy and hepatectomy (OSH) for concurrent hepatocellular carcinoma (HCC) and hypersplenism usually have major surgical trauma caused by the long abdominal incision. Surgical procedures that contribute to rapid recovery with the least possible impairment are desired by both surgeons and patients. The objective of this study was to explore outcomes in patients treated with simultaneous laparoscopic or open splenectomy and hepatectomy for hepatocellular carcinoma (HCC) with hypersplenism. Methods: We retrospectively evaluated the treatment outcomes in 23 patients with cirrhosis, HCC, and hypersplenism, who underwent simultaneous laparoscopic splenectomy and hepatectomy (LSH; n = 12) or open splenectomy and hepatectomy (OSH; n = 11) from January 2012 through December 2015. Their perioperative variables were compared. Results: LSH was successful in all patients. There were nonsignificant similarities between the 2 groups in duration of operation, estimated blood loss, and volume of blood transfused (P > .05 each). Compared with OSH, LSH had a significantly shorter postoperative visual analog scale pain score (P < .001); shorter time to first oral intake (P < .001), passage of flatus (P < .05) and off-bed activity (P < .001); shorter postoperative duration of hospitalization (P < .001); fewer days of postoperative temperature >38.0°C (P < .01); fewer postoperative complications (P < .05); and better liver and renal function on postoperative days 7 (P < .05 each). Conclusions: Simultaneous LSH is safe for selected patients with HCC and hypersplenism associated with liver cirrhosis.

To investigate the effects and technical points of several individualized laparoscopic therapies for patients suffering from cirrhotic portal hypertension.In total, 385 cirrhotic patients who underwent the treatment of individualized laparoscopic therapy from February 2012 to December 2015 at the Clinical Medical College of Yangzhou University were enrolled in this study. We retrospectively analyzed the clinical data and the key technical points.Individualized laparoscopic therapies were successfully performed on 379 of 385 cases. Six cases were converted to a laparotomy (the rate of conversion to laparotomy was 1.6%). Modified laparoscopic splenectomy (MLS) for cirrhotic patients with hypersplenism was successfully performed on 103 of 105 cases. Laparoscopic azygoportal disconnection for cirrhotic patients with esophagogastric variceal bleeding (EGVB) or F3 varices was successfully performed on 61 of 62 cases, and modified laparoscopic splenectomy and azygoportal disconnection (MLSD) for cirrhotic patients with hypersplenism and EGVB or F3 varices was successfully performed on 196 of 201 cases. Synchronous MLS and laparoscopic partial hepatectomy (SLSH) for cirrhotic patients with hypersplenism and hepatocellular carcinoma (HCC) and synchronous MLSD and laparoscopic partial hepatectomy (SLSDH) for cirrhotic patients with hypersplenism, EGVB or F3 varices and HCC were all successfully implemented on 12 and 5 patients, respectively. From May 2013, we used the intraoperative autologous cell salvage during each individualized laparoscopic procedure.An individualized laparoscopic therapy was beneficial for different state of selected cirrhotic patients with portal hypertension with or without HCC.

Introduction Laparoscopic splenectomy and azygoportal disconnection (LSD) has been reported to be safe, feasible, and minimally invasive for cirrhotic patients with portal hypertension. There is still controversy as to whether it is necessary to perform synchronous splenectomy for patients with moderate hypersplenism who undergo azygoportal disconnection for esophagogastric variceal hemorrhage (EGVB). Methods We retrospectively evaluated the outcomes in 51 cirrhotic patients with EGVB and moderate hypersplenism (PLT ≥50 × 10 9 /L) who underwent LSD (n = 28) or laparoscopic azygoportal disconnection (LD) (n = 23) between January 2014 and October 2015. Their demographic, intraoperative, and postoperative variables were compared. Results LSD and LD were successful in all the patients. When compared with LSD, LD had a significantly shorter operation time, less intraoperative blood loss, shorter postoperative hospital stay, fewer days of postoperative body temperature >38.0 °C, lower rate of fever postoperatively, and lower C-reactive protein concentration and procalcitonin concentration on postoperative day (POD) 7 (all P P + and CD8 + and the CD4+/CD8+ ratio (all P Conclusions LD is safe and effective for EGVB with moderate hypersplenism secondary to portal hypertension in selected patients.

Sustained-release fluorouracil (FU) implants have been extensively used in peritoneal interstitial chemotherapy, and during surgery for gastrointestinal tumors, breast cancer and hepatic tumors. Currently, studies regarding the complications associated with sustained-release FU implants are rare. The present study describes the case of a 61-year-old male who presented with a space-occupying lesion of the left lobe of the liver six months after undergoing a radical total gastrectomy. Thus, laparoscopic exploration was performed to remove the tumor. Postoperative histological examination demonstrated that the lesion in the left lobe comprised of necrotic tissue with granulation tissue hyperplasia. Based on the surgical and postoperative histological findings, the mass was proposed to be due to a high concentration of local sustained-release FU implants. Furthermore, the drug was partially surrounded and had been insufficiently metabolized over a long time period, which was proposed to have caused necrosis, proliferation and fibrillation, and induced granuloma. In conclusion, local high concentrations of sustained-release FU implants may be associated with granuloma and this finding may enable improved management of sustained-release FU implants during surgery.

As a fish farmed widely in the tropical and subtropical regions where aflatoxin contamination has been generally detected, tilapia has been studied for aflatoxicosis evaluation in Asia. However, relatively short-term aflatoxin B1 (AFB1) exposure in previous studies resulted in some contradictory conclusions. Therefore, this work was designed to investigate the toxic effects and residue of AFB1 in tilapia during a long-term trial of 20 weeks, during which the tilapia obtained more than 1900% weight gain and grew to a commercial size (around 500 g). Tilapia were fed six diets containing different levels of AFB1 (19, 85, 245, 638, 793 and 1641 μg/kg), which were prepared with AFB1-contaminated peanut meal. AFB1-related physiological and toxicological properties in fish were determined during the 20-week period. The results indicated that dietary AFB1 led to aflatoxicosis effects in tilapia in a dose- and duration-dependent manner. No toxic effects of AFB1 were found during the first 10 weeks, but by 20 weeks, the diet with 245 μg AFB1/kg or higher doses reduced the growth and induced hepatic disorder, resulting in decreased lipid content, hepatosomatic index, cytochrome P450 A1 activity, elevated plasma alanine aminotransferase activity and abnormal hepatic morphology, but such dietary AFB1 doses did not affect the survival rate of experimental fish. The AFB1 residue was only detected in liver, in a dose-dependent manner, but not in edible flesh. Taken together, under good culture conditions, tilapia is a rather tolerant species for dietary AFB1 exposure up to 1641 μg/kg diet during 20 weeks. Long-term exposure for more than 15 weeks is necessary to evaluate aflatoxicosis in tilapia. Consuming only tilapia flesh would not increase the risk of exposure to AFB1 for human consumers.

The effects of different ratios of dietary raw to pre-gelatinized starch on the growth performance, feed utilization and body composition of juvenile yellowfin seabream (Sparus latus) were evaluated during a 10-week growth trial. Five isonitrogenous, semi-purified diets containing 200 g kg−1 starch comprising different ratios of raw to pre-gelatinized starch [(in g kg−1)100:100 (diet 1), 150:50 (diet 2), 50:150 (diet 3), 200:0 (diet 4), 0:200 (diet 5), raw:pre-gelatinized] were prepared and fed to triplicate groups of juvenile S. latus. Our results showed that fish fed diet 4 (200 g kg−1 raw starch) had the highest weight gain and specific growth rate, followed by those fed diet 2, diet 1, diet 3 and diet 5. Feed efficiency, protein efficiency ratio and protein productive value in the fish on diets 4 and diet 2, respectively, were significantly higher than those on diets 3 and diet 5, respectively. Body and muscle compositions were unaffected by the different dietary raw to pre-gelatinized starch ratios. Values of hepatosomatic index, intraperitoneal fat ratio, viscerosomatic index and condition factor did not vary among experimental treatments. Plasma indices showed variations, but these were not relative to dietary treatments. In conclusion, the partial or total replacement of raw starch by pre-gelatinized starch in diets for yellowfin seabream did not improve its growth performance and feed utilization.

Hepatocellular carcinoma (HCC) is one of the few cancers whose incidence has been continually increasing over recent years. Resection of HCC offers the only hope for cure. However, recurrences are common in patients who have undergone resection. In our opinion, the effectiveness with which transarterial chemoembolization (TACE) as a neoadjuvant therapy for resectable HCC prevents recurrence and prolongs survival has not been conclusively demonstrated. All published meta-analyses have consistently failed to demonstrate that preoperative TACE improves the prognosis of resectable HCC. We believe that these published articles have several limitations and have our own views about the results of meta-analyses. It is very important that the scientific community shed more light on the pathogenesis of HCC and relate this to choice of therapy. This review mainly concerns our understanding of preoperative TACE for resectable HCC and briefly addresses desirable directions for future studies.

Background and objectives Given the technical difficulty of laparoscopic splenectomy and azygoportal disconnection (LSD), data are limited that compare the laparoscopic to the open procedure. As the technique becomes more widespread, questions regarding its safety, feasibility, and reproducibility must be addressed. This review assesses the current status of LSD. Methods We conducted our literature review with a search of the PubMed database. All published series of 5 or more laparoscopic splenectomy and azygoportal disconnection procedures were examined. The demographic, intraoperative, and postoperative data analyzed included number of ports, conversion rate, operative duration, estimated intraoperative blood loss, postoperative hospital stay, and complications. Results Fifteen articles met the review criteria. Of 412 laparoscopic procedures, traditional laparoscopic splenectomy and azygoportal disconnection (TLSD) was used in 322 patients (78.2%), a modified laparoscopic procedure (MLSD) in 79 (19.2%), and a single-incision laparoscopic procedure (SLSD) in 11 (2.7%). Compared with the traditional and single-incision laparoscopic procedures, the MLSD procedure was associated with shorter operative duration and less blood loss. Furthermore, although the incidence of postoperative portal vein system thrombosis was higher in the laparoscopic than in the open splenectomy with azygoportal disconnection (OSD) procedure, the LSD procedure was associated with less pulmonary infection and pleural effusion and fewer incisional and overall complications than the open procedure. The rate of conversion to an open procedure was 5.4%. Conclusions LSD is feasible and safe for selected patients when performed by an expert laparoscopic surgeon. It has perioperative advantages over OSD, but studies with longer follow-up periods and larger samples of patients are needed.

Laparoscopic hepatectomy (LH) using many different surgical techniques has become increasingly popular for the management of hepatic tumors. The performance of surgical procedures involving the least possible impairment is expected increasingly more often by both surgeons and patients. We herein describe a clinical cohort of ten patients with hepatic cavernous hemangioma (HCH) who underwent modified LH (MLH) with a new technique. We herein present the advantages of the low level of impairment during performance of this modified procedure and compare the outcomes of MLH with those of traditional LH (TLH) for HCH.We retrospectively evaluated the treatment outcomes in 24 patients with HCH who underwent MLH (n = 10) or TLH (n = 14) from February 2008 to January 2013. Their demographic, intraoperative, and postoperative variables were compared.MLH was successful in all patients. An electromechanical morcellator allowed for easy extraction of the entire HCH without the use of a cumbersome retrieval bag, enlarged incision, or hand-assisted incision. There was no conversion to an open operation or significant perioperative complications. The operation time (P = 0.037), time to removal of the HCH (P 0.0001), visual analog scale pain score on the first postoperative day (P = 0.012), time to off-bed activity (P = 0.036), and postoperative hospital stay (P = 0.048) were significantly lower in the MLH group than in the TLH group.MLH involving the use of an electromechanical morcellator provides expedient recovery and minimal postoperative pain and scarring. It is a feasible, effective, and safe surgical procedure and embodies all of the benefits of minimally invasive surgery for patients with HCH.

To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy or open splenectomy and azygoportal disconnection for portal hypertension.This study included 44 patients who underwent modified laparoscopic splenectomy and azygoportal disconnection (MLSD) and 71 who underwent open procedures for portal hypertension. Blood samples were collected before surgery and on days 1, 3, and 7 after surgery. Markers of liver and renal function, C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) were measured, and perioperative variables were compared between the two groups.The modified laparoscopic group showed significantly better and faster recovery, better liver and renal function, and fewer complications than the open group. CRP, IL-6, and PCT concentrations on postoperative days 1, 3, and 7 were significantly lower in the modified laparoscopic group than in the open group.MLSD was associated with lower inflammatory immune responses, less impairment of liver and renal function, and faster and better recovery.

Laparoscopic splenectomy and azygoportal disconnection has been reported safe, feasible and minimally invasive for patients with portal hypertension. We have developed an even less invasive technique, modified laparoscopic splenectomy and azygoportal disconnection, and compared outcomes of modified laparoscopic splenectomy and azygoportal disconnection and open splenectomy and azygoportal disconnection in patients with portal hypertension.We retrospectively evaluated outcomes in 107 cirrhotic patients with portal hypertensive bleeding and secondary hypersplenism who underwent modified laparoscopic splenectomy and azygoportal disconnection (n = 37) or open splenectomy and azygoportal disconnection (n = 70) between January 2010 and February 2013. Their demographic, intraoperative, and postoperative variables were compared.Modified laparoscopic splenectomy and azygoportal disconnection was successful in all patients, with none requiring conversion to open surgery or having significant perioperative complications. Operation time was significantly longer for modified laparoscopic splenectomy and azygoportal disconnection than open splenectomy and azygoportal disconnection (P0.0001), but estimated intraoperative blood loss (P = 0.0004); volume of intraoperative blood transfusion (P0.05); visual analog scale pain score on the first postoperative day (P0.0001); times to first oral intake (P0.0001), passage of flatus (P = 0.0004), and off-bed activity (P0.0001); postoperative hospital stay (P0.0001); postoperative days of temperature38.0 °C (P = 0.002); white blood cell counts on postoperative days 1 (P0.0001) and 7 (P0.05) were significantly reduced in the modified laparoscopic splenectomy and azygoportal disconnection group. The percentage of patients experiencing postoperative complications was significantly lower in the modified laparoscopic splenectomy and azygoportal disconnection group than in the open splenectomy and azygoportal disconnection group (13.5 % [5/37] vs. 35.7 % [25/70], P0.05).The less invasive modified laparoscopic splenectomy and azygoportal disconnection group is a feasible, effective, and safe surgical procedure for liver cirrhosis patients with portal hypertensive bleeding and hypersplenism.

Background. Laparoscopic splenectomy and azygoportal disconnection (LSD) using many different surgical techniques has become increasingly popular for treatment of cirrhotic patients with bleeding portal hypertension and secondary hypersplenism. Surgical procedures with the least possible impairment are consistently expected by both surgeons and patients. Here, we report a clinical cohort of 10 patients who underwent LSD with a new technique and present the advantages of less impairment during performance of this new technique. Methods. A cohort of 10 cirrhotic patients with bleeding portal hypertension and secondary hypersplenism treated with LSD were studied. During the procedure, an electromechanical morcellator allowed for easy extraction of the entire massive splenic tissue without a cumbersome intracorporeal bag, enlarged incision, or hand-assisted incision. Various perioperative data were recorded. Results. LSD was successful in all patients. There was no conversion to open operations or significant perioperative complications. The operative time was 288.0 ± 53.9 minutes, the spleen removal time was 39.3 ± 15.1 minutes, and blood loss was 240.0 ± 217.1 mL. Conclusions. This new technique involving the use of an electromechanical morcellator provides expedient recovery and minimal postoperative pain and scarring. LSD with this technique is a feasible, effective, and safe surgical procedure, and embodies all the benefits of minimally invasive surgery for cirrhotic patients with bleeding portal hypertension and hypersplenism.

To study the active immunity response of liver transplant patients for HBV-related diseases after hepatitis B virus (HBV) vaccine immunization and to investigate the factors that influence the effectiveness of the vaccination in order to find measures to increase its success.Thirteen patients who had liver transplants because of HBV-related end-stage liver diseases received hepatitis B virus immunoglobulin and lamivudine for an average of 38 months (range 27-77 months). They received double intramuscular doses (40 microg) of a recombinant vaccine at months 0, 1, 2 and 6. The anti-HBs titers were tested regularly at months 1, 2, 3, 6 and 7.Seven of the 13 patients (53.8%) developed higher serum titers of anti-HBs compared with their titers prior to the vaccinations, 2 patients of the 13 (15.4%) developed an increase by 100 U/L and in 4 patients (30.8%) their base levels were doubled. Those responding patients were followed-up for another 8 months after the fourth vaccination, and only 1 patient among them had a decrease of the anti-HBs titers below the level prior to the vaccination.Hepatitis B vaccine immunization can be used to enhance the active immunity against HBV in patients who had liver transplants for HBV-related diseases.

No optimal prophylactic protocol of hepatitis B immunoglobulin (HBIG) combined with nucleos(t)ide analogue for HBV recurrence has been established yet. By investigating the alterations of HBV markers in HBV related liver disease patients, recipients of a liver transplant, under lamivudine or/and HBIG prophylaxis, we aim to explore the possible HBV recurrence mechanism involved and to find a new option in the prophylaxis of HBV recurrence and to tailor individualized therapy.Serial liver biopsy specimens and sera were obtained intraoperationally and at definite time points during follow-up. ELISA and chemiluminescent microparticle immunoassay, HBV DNA fluorescent quantification, immunohistochemistry staining and HBV DNA in situ hybridization were performed. Alterations of HBV markers in specimens of 96 liver transplant recipients were investigated retrospectively.All 17 cases had HBV recurrence (median 37 months) which occurred in the follow-up period after liver transplantation. The overall actual HBV recurrence rate at 2 years was 22% with a significant difference between that of the active and inactive groups (P0.05); 82.4% HBV recurrence took place within the first 3 years after the operation, and the recurrence ratio of first 3 years to 3 years later after transplantation was 4.7 (P0.01). The HBV DNA positive patients accounted for 78.6% of the total number of recurrences within the first 3 years. HBcAb and HBeAb positive rates went down with time, but their positivity remained.HBV recurrence happens after liver transplantation. In inactive HBV replicative patients with strictly combined prophylaxis and availability of other medications and using 3 years after liver transplantation as a point of time, we think that tapering down the dosage of HBIG and tailoring individualized treatment methods based on virological and immunological situations of each recipient are worth trying.

To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy and azygoportal disconnection (MLSD) with intraoperative autologous cell salvage.We retrospectively evaluated outcomes in 79 patients admitted to the Clinical Medical College of Yangzhou University with cirrhosis, portal hypertensive bleeding and secondary hypersplenism who underwent MLSD without (n = 46) or with intraoperative cell salvage and autologous blood transfusion, including splenic blood and operative hemorrhage (n = 33), between February 2012 and January 2014. Their intraoperative and postoperative variables were compared. These variables mainly included: operation time; estimated intraoperative blood loss; volume of allogeneic blood transfused; visual analog scale for pain on the first postoperative day; time to first oral intake; initial passage of flatus and off-bed activity; perioperative hemoglobin (Hb) concentration; and red blood cell concentration.There were no significant differences between the groups in terms of duration of surgery, estimated intraoperative blood loss and overall perioperative complication rate. In those receiving salvaged autologous blood, Hb concentration increased by an average of 11.2 ± 4.8 g/L (P0.05) from preoperative levels by the first postoperative day, but it had fallen by 9.8 ± 6.45 g/L (P0.05) in the group in which cell salvage was not used. Preoperative Hb was similar in the two groups (P0.05), but Hb on the first postoperative day was significantly higher in the autologous blood transfusion group (118.5 ± 15.8 g/L vs 102.7 ± 15.6 g/L, P0.05). The autologous blood transfusion group experienced significantly fewer postoperative days of temperature38.0°C (P0.05).Intraoperative cell salvage during MLSD is feasible and safe and may become the gold standard for liver cirrhosis with portal hypertensive bleeding and hypersplenism.

Background Patients with cirrhosis-associated hepatocellular carcinoma (HCC) rarely present with acute pancreatitis (AP) and obstructive jaundice as the main clinical features. AP with obstructive jaundice caused by common bile duct embolism (CBDE) is very rare. Case presentation A 54-year-old man with CBDE was misdiagnosed with common bile duct stones three times over a 7-month period. Investigations during this time did not identify CBDE. Surgical exploration was performed because of AP, obstructive jaundice, and a tumor in the left lobe of the liver. CBDE from the hepatic tumor was diagnosed by intraoperative biopsy and frozen section examination. The patient underwent left hemihepatectomy, cholecystectomy, and bile duct exploration. Conclusion Preoperative diagnosis of CBDE is difficult because of the rarity of the condition, lack of physician awareness, and easy misdiagnosis on imaging examinations. Early and accurate diagnosis of this condition is important.

We report a case of double primary liver cancer comprising hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). A 58-year-old Chinese man without obvious liver cirrhosis was diagnosed with multiple HCC in segment V (SV) and segment VIII (SVIII) of the liver. Preoperative abdominal magnetic resonance imaging revealed two solid masses in SV and SVIII. We performed hepatic resection of both segments. The tumors in SV and SVIII were pathologically diagnosed as HCC and ICC, respectively. Immunohistochemically, the HCC in SV was positive for carcinoembryonic antigen and negative for α-fetoprotein (AFP) and cytokeratin (CK), while the ICC in SVIII was negative for both AFP and CK. These observations confirmed the diagnosis of double primary liver cancer (HCC and ICC). Double primary liver cancer is extremely rare. We herein review previous reports of patients with a histological diagnosis of double primary liver cancer. Based on the findings of this case and the literature review, we speculate that the imaging findings of double primary hepatic cancer conform to the pathologic findings.