Liver Tumors Research Articles

Comparison of laparoscopic liver resection for the ventral versus the dorsal areas of segment 8.

The technical difficulties of laparoscopic liver resection (LLR) are greatly associated with the location of liver tumors. Since segment 8 (S8) contains a wide area, the difficulty of LLR for S8 tumors may vary depending on the location within the segment, such as the ventral (S8v) and dorsal (S8d) area, but the difference is unclear. We retrospectively investigated 30 patients who underwent primary laparoscopic partial liver resection for liver tumors in S8 at Kobe University Hospital between January 2018 and June 2023. Thirteen and 17 patients underwent LLR for S8v and S8d, respectively. The operation time was significantly longer (S8v 203[135-259] vs. S8d 261[186-415] min, P = 0.002) and the amount of blood loss was significantly higher (10[10-150] vs. 10[10-200] mL, P = 0.034) in the S8d group than in the S8v group. No significant differences were observed in postoperative complications or postoperative length of hospital stay. Additionally, intraoperative findings revealed that the rate at which the case performed partial liver mobilization in the S8d group was higher (2[15.4%] vs. 8[47.1%], P = 0.060) and the median parenchymal transection time of the S8d group was longer (102[27-148] vs. 129[37-175] min, P = 0.097) than those in the S8v group, but there were no significant differences. The safety of LLR for the S8d was comparable to that of LLR for S8v, although LLR for S8d resulted in longer operative time and more blood loss. B230165 (approved at December 26, 2023).

Study of confluence of hepatic veins application in liver transplantation.

Liver has exceptional regeneration capacity which makes live donor liver transplantation a good surgical option for patients waiting for donors. Hepatic veins play major role in transplantation surgeries. Variations of hepatic veins can have great impact on surgical approach and outcome of the surgery. In the present study, total number of hepatic veins, presence and absence of accessory veins and confluence with its varied patterns were studied. We found maximum cases with 2 and 3 major hepatic veins which indicate presence of confluence. Confluence between left and middle hepatic veins was highest with 38% of total 54% of cases with confluence. We also found confluence between middle and accessory hepatic vein which is not mentioned in any present classifications. In addition, we have measured confluence length and diameter which holds significance in hepatic resection and anastomosis. The mean confluence length was 0.88±0.39 cm while mean confluence diameter was 0.57±0.20 cm. We found accessory hepatic veins in 15% of cases. The knowledge of this surgical anatomy and associated variations is of paramount importance in liver transplantation, radiological interventional procedures of liver and hepatic tumor resection procedures.

Development of cantharidin/baicalin co-delivery system based on mitochondrial targeting strategy for enhanced hepatocellular carcinoma therapy

Cantharidin (CTD) as a treatment for primary liver cancer are well known, and although structural alteration and nano-delivery are efficient in diminishing toxicity, its urinary and digestive toxicity has hindered its clinical application. Based on the synergistic effect of CTD and baicalin (BA) on proliferation inhibition of liver tumor cells, the highly expressed folic acid (FA) receptor of liver cancer cell membrane and the high negative membrane potential of tumor cell mitochondria, we synthesized CHEMS-FRFK and prepared a dual-ligand modified co-delivery liposomes (FA/FRFK-CTD/BA-Lips). Liposomes were spherical particles with uniform particle size, high encapsulation rate, good stability and no hemolysis. The results confirmed that FA/FRFK-CTD/BA-Lips had good targeting to mitochondria of tumor cells, and its target effect on mitochondria of HepG2 was better than that of Huh-7 cells. Compared with CTD, the cytotoxicity of liposomes on HepG2 is 7.0 times higher, while the cytotoxic effect on normal liver cells Thle-2 is 2.1 times lower. It may be related to increasing clathrin-mediated endocytosis, inhibiting tumor cell migration, arresting cell cycle in G1/G0 phase, and promoting mitochondria-mediated endogenous Bcl-2/Caspase 3 apoptosis pathway. Meanwhile, FA/FRFK-CTD/BA-Lips could alter the pharmacokinetic behavior of CTD and BA by increasing concentrations in vivo, slowing release and excretion, good anti-tumor with no obvious toxicity, and successfully delivered CTD/BA to liver tissue, tumor cells and mitochondria. Therefore, FA/FRFK-CTD/BA-Lips, as a delivery system targeting the mitochondria of liver cancer cells, has promising development potential, and could provide a new strategy for solving the problem of CTD toxicity and the treatment of hepatocellular carcinoma.

Translating contrast enhanced computed tomography images to liver radioembolization dose distribution for more comprehensively indicating patients

Objective. Contrast-enhanced computed tomography (CECT) is commonly used in the pre-treatment evaluation of liver Y-90 radioembolization feasibility. CECT provides detailed imaging of the liver and surrounding structures, allowing healthcare providers to assess the size, location, and characteristics of liver tumors prior to the treatment. Here we propose a method for translating CECT images to an expected dose distribution for tumor(s) and normal liver tissue. Approach. A pre-procedure CECT is used to obtain an iodine arterial-phase distribution by subtracting the non-contrast CT from the late arterial phase. The liver segments surrounding the targeted tumor are selected using Couinaud’s method. The resolution of the resulting images is then degraded to match the resolution of the positron emission tomography (PET) images, which can image the Y-90 activity distribution post-treatment. The resulting images are then used in the same way as PET images to compute doses using the local deposition method. CECT images from three patients were used to test this method retrospectively and were compared with Y-90 PET-based dose distributions through dose volume histograms. Main results. Results show a concordance between predicted and delivered Y-90 dose distributions with less than 10% difference in terms of mean dose, for doses greater than 10% of the 98th percentile (D2%). Significance. CECT-derived predictions of Y-90 radioembolization dose distributions seem promising as a supplementary tool for physicians when assessing treatment feasibility. This dosimetry prediction method could provide a more comprehensive pre-treatment evaluation—offering greater insights than a basic assessment of tumor opacification on CT images.

Visually communicating pathological changes: A case study on the effectiveness of phong versus outline shading

In this paper, we investigate the suitability of different visual representations of pathological growth and shrinkage using surface models of intracranial aneurysms and liver tumors. By presenting complex medical information in a visually accessible manner, audiences can better understand and comprehend the progression of pathological structures. Previous work in medical visualization provides an extensive design space for visualizing medical image data. However, determining which visualization techniques are appropriate for a general audience has not been thoroughly investigated.We conducted a user study (n = 40) to evaluate different visual representations in terms of their suitability for solving tasks and their aesthetics. We created surface models representing the evolution of pathological structures over multiple discrete time steps and visualized them using illumination-based and illustrative techniques. Our results indicate that users’ aesthetic preferences largely coincide with their preferred visualization technique for task-solving purposes. In general, the illumination-based technique has been preferred to the illustrative technique, but the latter offers great potential for increasing the accessibility of visualizations to users with color vision deficiencies.

Hepatitis B virus X protein differentially regulates the angiogenesis of Hepatocellular Carcinoma through p53-VEGF axis according to glucose levels

Introduction and ObjectivesBlood glucose fluctuates severely in the diabetes(DM) and tumor microenvironment. Our previous works have found Hepatitis B virus X protein (HBx) differentially regulated metastasis and apoptosis of hepatoma cells depending on glucose concentration. We here aimed to explore whether HBx played dual roles in the angiogenesis of hepatocellular carcinoma varying on different glucose levels. Materials and MethodsWe collected conditioned medium from HBx-overexpressing cells cultured with two solubilities of glucose, and then applied to EA.hy926 cells. Alternatively, a co-culture cell system was established with hepatoma cells and EA.hy926 cells. We analyzed the angiogenesis of EA.hy926 cells with CCK8, wound-healing, transwell-migartion and tube formation experiment. ELISA was conducted to detect the secretion levels of angiogenesis-related factors. siRNAs were used to detect the P53-VEGF axis. ResultsHBx expressed in hepatoma cells suppressed VEGF secretion, and subsequently inhibited the proliferation, migration and tube formation of EA.hy926 cells in a high glucose condition, while attenuating these in the lower glucose condition. Furthermore, the p53-VEGF axis was required for the dual role of HBx in angiogenesis. Additionally, HBx mainly regulated the nuclear p53. ConclusionsThese data suggest that the dual roles of HBx confer hepatoma cells to remain in a glucose-rich environment and escape from the glucose-low milieu through tumor vessels, promoting liver tumor progression overall. We exclusively revealed the dual role of HBx on the angiogenesis of liver tumors, which may shed new light on the mechanism and management strategy of HBV- and DM-related hepatocellular carcinoma.

Binge drinking at time of bariatric surgery is associated with liver disease, suicides, and increases long-term mortality.

Alcohol use disorder has been reported in patients undergoing bariatric procedures, but the pattern of alcohol consumption has not been evaluated. We investigated the prevalence, risk factors, and impact of binge drinking (BD) at the time of surgery and during follow-up. A prospective, longitudinal study of subjects undergoing bariatric surgery was included in the LABS-2 registry between 2006 and 2009. Participants with AUDIT questionnaire at the time of surgery and a minimum of 12 months follow-up were included. BD was defined as consuming ≥5 drinks on at least 1 occasion in the previous month. Liver biopsies were obtained during bariatric procedures in not all cases. Survival analysis was performed with the adjusted Cox regression model and competing risk. A total of 2257 subjects were included, with a median follow-up of 79 months. The prevalence of BD at time of surgery was 12%, and it raised up to 23% during follow-up. Patients with BD predominantly had a binge eating disorder (OR=1.35 [95% CI: 1.04-1.76]), regularly consumed fast food [OR=1.4 (95% CI: 1.07-1.85)] and used other drugs (OR=2.65 [95% CI: 1.74-4.04]). Within liver biopsies evaluation, BD showed higher hepatic iron deposits (OR=3.00 [95% CI: 1.25-7.21]). BD at the time of surgery was associated with a higher risk of BD during follow-up (OR=10.49 [95% CI: 7.86-14.00]) and long-term mortality (HR: 3.21 [95% CI: 1.67-6.18]). Specific causes of death in these patients with BD were liver disease (p=0.020), suicide (p=0.015), neoplasms (p=0.034), and respiratory (p=0.025). The prevalence of BD in patients undergoing bariatric surgery is high and increases the risk of postoperative liver disease, suicides, and long-term mortality.

Spontaneous rupture of hepatic hemangioma: case report and literature review

Hepatic lesions represent a potential etiology of spontaneous hemoperitoneum. Among these, hepatic hemangiomas, characterized by congenital vascular malformations, stand out as the most likely benign liver neoplasms, frequently presenting as asymptomatic entities. However, spontaneous rupture constitutes the gravest complication associated with these lesions, underscoring the imperative of prompt diagnosis. Notably, the global mortality rate attributed to spontaneous rupture of hepatic hemangiomas remains elevated. Hence, achieving an accurate diagnosis of this condition is paramount for informing. Hepatic hemangioma stands as the prevailing benign hepatic neoplasm, with autopsy studies indicating a prevalence ranging between 3% and 20%. In a clinical scenario, a 64-year-old patient presented at Sant’Anna and S. Sebastian Hospital with severe abdominal pain, hypotension (blood pressure 70/40 mm Hg), tachycardia (heart rate 120 bpm), and abdominal muscle guarding upon physical examination. Ultrasound assessment revealed the presence of free intraperitoneal fluid. However, the ultrasound examination could not be completed due to the patient’s deteriorating hemodynamic status and manifestation of instability. Consequently, an urgent exploratory laparotomy was deemed necessary and promptly undertaken in the operating theater.

3-D Quantum-Inspired Self-Supervised Tensor Network for Volumetric Segmentation of Medical Images.

This article introduces a novel shallow 3-D self-supervised tensor neural network in quantum formalism for volumetric segmentation of medical images with merits of obviating training and supervision. The proposed network is referred to as the 3-D quantum-inspired self-supervised tensor neural network (3-D-QNet). The underlying architecture of 3-D-QNet is composed of a trinity of volumetric layers, viz., input, intermediate, and output layers interconnected using an S -connected third-order neighborhood-based topology for voxelwise processing of 3-D medical image data, suitable for semantic segmentation. Each of the volumetric layers contains quantum neurons designated by qubits or quantum bits. The incorporation of tensor decomposition in quantum formalism leads to faster convergence of network operations to preclude the inherent slow convergence problems faced by the classical supervised and self-supervised networks. The segmented volumes are obtained once the network converges. The suggested 3-D-QNet is tailored and tested on the BRATS 2019 Brain MR image dataset and the Liver Tumor Segmentation Challenge (LiTS17) dataset extensively in our experiments. The 3-D-QNet has achieved promising dice similarity (DS) as compared with the time-intensive supervised convolutional neural network (CNN)-based models, such as 3-D-UNet, voxelwise residual network (VoxResNet), Dense-Res-Inception Net (DRINet), and 3-D-ESPNet, thereby showing a potential advantage of our self-supervised shallow network on facilitating semantic segmentation.

Microspheres-mediated magnetic thermal ablation combined with immune checkpoint blockade therapy for liver cancer

Hepatocellular carcinoma (HCC) are some of the most difficult malignant tumors to treat, due to their high rates of metastasis and recurrence. Image-guided percutaneous ablation, which serves as an important means in HCC treatment. However, drawbacks such as puncture injury, metastasis, and a limited ablation range still exist. Therefore, A highly effective and non-invasive magnetic thermal ablation (MTA) scheme for HCC was proposed by precisely embolizing magnetic microspheres into tumor-feeding arteries. In this study, polyacrylamide (PAM) and ferric oxide (Fe3O4) were utilized to prepare uniformly sized PAM@Fe3O4 microspheres with excellent eddy current heating effects. Additionally, a combined approach of MTA and immunotherapy was suggested. MTA combined with immune checkpoint blockade therapy efficiently ablated primary tumors and inhibited simulated metastatic tumors in mice. Further arterial embolization experiments in rabbit ears and renal arteries demonstrated the effective retention of PAM@Fe3O4 microspheres in blood vessels for MTA. Finally, we successfully applied PAM@Fe3O4 microspheres for efficient MTA therapy in a rabbit VX2 in situ liver tumor model. The aim of research is to provide new strategies for clinical HCC treatment, promoting the transition from image-guided percutaneous minimally invasive ablation to noninvasive ablation. This significant transition holds the potential for clinical applicability.

IMPDH2 suppression impedes cell proliferation by instigating cell cycle arrest and stimulates apoptosis in pediatric hepatoblastoma

BackgroundHepatoblastoma (HB) is the most common pediatric liver tumor, presenting significant therapeutic challenges due to its high rates of recurrence and metastasis. While Inosine Monophosphate Dehydrogenase 2(IMPDH2) has been associated with cancer progression, its specific role and clinical implications in HB have not been fully elucidated.MethodsThis study utilized Quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) and Tissue Microarray (TMA) for validation. Following this, IMPDH2 was suppressed, and a series of in vitro assays were conducted. Flow cytometry was employed to assess apoptosis and cell cycle arrest. Additionally, the study explored the synergistic therapeutic effects of mycophenolate mofetil (MMF) and doxorubicin (DOX) on HB cell lines.ResultsThe study identified a marked overexpression of IMPDH2 in HB tissues, which was strongly correlated with reduced Overall Survival (OS) and Event-Free Survival (EFS). IMPDH2 upregulation was also found to be associated with key clinical-pathological features, including pre-chemotherapy alpha-fetoprotein (AFP) levels, presence of preoperative metastasis, and the pre-treatment extent of tumor (PRETEXT) staging system. Knockdown of IMPDH2 significantly inhibited HB cell proliferation and tumorigenicity, inducing cell cycle arrest at the G0/G1 phase. Notably, the combination of MMF, identified as a specific IMPDH2 inhibitor, with DOX, substantially enhanced the therapeutic response.ConclusionThe overexpression of IMPDH2 was closely linked to adverse outcomes in HB patients and appeared to accelerate cell cycle progression. These findings suggest that IMPDH2 may serve as a valuable prognostic indicator and a potential therapeutic target for HB.ImpactThe present study unveiled a significant overexpression of inosine monophosphate dehydrogenase 2 (IMPDH2) in hepatoblastoma (HB) tissues, particularly in association with metastasis and recurrence of the disease. The pronounced upregulation of IMPDH2 was found to be intimately correlated with adverse outcomes in HB patients. This overexpression appears to accelerate the progression of the cell cycle, suggesting that IMPDH2 may serve as a promising candidate for both a prognostic marker and a therapeutic target in the context of HB.

The efficacy and safety of computed tomography-guided percutaneous cryoablation for malignant liver tumors at high-risk sites

Objective: To assess the efficacy and safety of computed tomography (CT)-guided percutaneous cryoablation in treating malignant liver tumors located explicitly at high-risk sites. Methods: Data were collected retrospectively from patients with malignant liver tumors undergoing percutaneous cryoablation at Tianjin Medical University Cancer Hospital between January 2018 and December 2021. In all, 46 patients with malignant liver tumors at non-high-risk sites were matched 1∶1 according to the maximum tumor diameter. Technical success rate, complete ablation rate, and complications at 12 and 24 months post-surgery were evaluated. A statistical analysis of the ablation effect difference between the high-risk site and non-high-risk site groups was conducted. Univariate and multivariate logistic regression analyses were performed to identify risk factors. Results: Both groups demonstrated a 100% intraoperative technical success rate, and no major complications related to cryoablation were observed. The complete ablation rate was 82.6% (38/46) and 71.7% (33/46) in the high-risk group and 84.8% (39/46) and 73.9% (34/46) in the non-high-risk group at 12 and 24 months, respectively. There was no significant difference in complete ablation rates between the two groups (P>0.05). Multivariate analysis identified the distance between the tumor edge and high-risk site ≤5 mm and preoperative trans-arterial chemoembolization (TACE) treatment as independent risk factors for cryoablation effect. Conclusion: CT-guided percutaneous cryoablation is a safe and effective approach for patients with malignant liver tumor at high-risk sites. Our results emphasize the importance of proper preoperative planning and intraoperative manipulation.

Precision and Robust Models on Healthcare Institution Federated Learning for Predicting HCC on Portal Venous CT Images.

Hepatocellular carcinoma (HCC), the most common type of liver cancer, poses significant challenges in detection and diagnosis. Medical imaging, especially computed tomography (CT), is pivotal in non-invasively identifying this disease, requiring substantial expertise for interpretation. This research introduces an innovative strategy that integrates two-dimensional (2D) and three-dimensional (3D) deep learning models within a federated learning (FL) framework for precise segmentation of liver and tumor regions in medical images. The study utilized 131 CT scans from the Liver Tumor Segmentation (LiTS) challenge and demonstrated the superior efficiency and accuracy of the proposed Hybrid-ResUNet model with a Dice score of 0.9433 and an AUC of 0.9965 compared to ResNet and EfficientNet models. This FL approach is beneficial for conducting large-scale clinical trials while safeguarding patient privacy across healthcare settings. It facilitates active engagement in problem-solving, data collection, model development, and refinement. The study also addresses data imbalances in the FL context, showing resilience and highlighting local models' robust performance. Future research will concentrate on refining federated learning algorithms and their incorporation into the continuous implementation and deployment (CI/CD) processes in AI system operations, emphasizing the dynamic involvement of clients. We recommend a collaborative human-AI endeavor to enhance feature extraction and knowledge transfer. These improvements are intended to boost equitable and efficient data collaboration across various sectors in practical scenarios, offering a crucial guide for forthcoming research in medical AI.

Multi-View disentanglement-based bidirectional generalized distillation for diagnosis of liver cancers with ultrasound images

B-mode ultrasound (BUS) mainly reflects the tissue structural, morphological, and echo characteristics of liver tumors, and contrast-enhanced ultrasound (CEUS) offers supplementary information on the dynamic blood perfusion pattern to promote diagnostic accuracy. Transfer learning (TL) is capable of improving the performance of BUS-based computer-aided diagnosis (CAD) for liver cancer by transferring information from CEUS. However, most multi-view TL algorithms cannot fully capture the view-common together with the view-unique information of three CEUS phase images in the source domain to further promote knowledge transfer. To this end, a multi-view disentanglement-based bidirectional generalized distillation (MD-BGD) algorithm is proposed to explore and learn more potential knowledge from three typical CEUS phase images for multi-view transfer. MD-BGD consists of the multi-view feature disentanglement module and the bidirectional distillation module. The former explores more potential and transferable privileged information by disentangling three CEUS phase image features in the source domain into view-common and view-unique components. The latter develops a bidirectional generalized distillation algorithm to enhance the multi-view knowledge transfer between the source and the target domains, guided by shared labels. Therefore, the BUS-based CAD model is significantly improved by our proposed MD-BGD. MD-BGD is evaluated on the bi-modal ultrasound imaging dataset. It gains the best results of 90.75±2.20 %, 89.50±3.49 %, and 91.89±3.78 %, on accuracy, sensitivity, and specificity, respectively. These results indicate the effectiveness of MD-BGD in the diagnosis of liver cancer.

Targeting the Hippo/YAP1 signaling pathway in hepatocellular carcinoma: From mechanisms to therapeutic drugs (Review).

The Hippo signaling pathway plays a pivotal role in regulating cell growth and organ size. Its regulatory effects on hepatocellular carcinoma (HCC) encompass diverse aspects, including cell proliferation, invasion and metastasis, tumor drug resistance, metabolic reprogramming, immunomodulatory effects and autophagy. Yes‑associated protein 1 (YAP1), a potent transcriptional coactivator and a major downstream target tightly controlled by the Hippo pathway, is influenced by various molecules and pathways. The expression of YAP1 in different cell types within the liver tumor microenvironment exerts varying effects on tumor outcomes, warranting careful consideration. Therefore, research on YAP1‑targeted therapies merits attention. This review discusses the composition and regulation mechanism of the Hippo/YAP1 signaling pathway and its relationship with HCC, offering insights for future research and cancer prevention strategies.

SOX12 Facilitates Hepatocellular Carcinoma Progression and Metastasis through Promoting Regulatory T-Cells Infiltration and Immunosuppression.

Despite the success of immunotherapy in treating hepatocellular carcinoma (HCC), HCC remains a severe threat to health. Here, a crucial transcription factor, SOX12, is revealed that induces the immunosuppression of liver tumor microenvironment. Overexpressing SOX12 in HCC syngeneic models increases intratumoral regulatory T-cell (Treg) infiltration, decreases CD8+T-cell infiltration, and hastens HCC metastasis. Hepatocyte-specific SOX12 knockout attenuates DEN/CCl4-induced HCC progression and metastasis, whereas hepatocyte-specific SOX12 knock-in accelerates these effects. Mechanistically, SOX12 transcriptionally activates C-C motif chemokine ligand 22 (CCL22) expression to promote the recruitment and suppressive activity of Tregs. Moreover, SOX12 transcriptionally upregulates CD274 expression to suppress CD8+T-cell infiltration. Either knockdown of CCL22 or PD-L1 dampens SOX12-mediated HCC metastasis. Blocking of CC chemokine receptor 4 (CCR4), a receptor for CCL22, by inhibitor C-021 or Treg-specific knockout of CCR4 inhibits SOX12-mediated HCC metastasis. Transforming growth factor-β1 (TGF-β1)/TGFβR1-Smad2/3/4 is identified as a key upstream signaling for SOX12 overexpression in HCC cells. Combining C-021 or TGFβR1 inhibitor galunisertib with anti-PD-L1 exhibits an enhanced antitumor effect in two HCC models. Collectively, the findings demonstrate that SOX12 contributes to HCC immunosuppression through the CCL22/CCR4-Treg and PD-L1-CD8+T axes. Blocking of CCR4 or TGFβR1 improves the efficacy of anti-PD-L1 in SOX12-mediated HCC.

99mTc-HYNIC-Annexin V detection of apoptosis in the rabbit model of liver cancer.

To investigate the feasibility of detection of apoptosis in vivo by 99mTc-HYNIC-Annexin V, Annexin V was labeled with 99mTc through HYNIC. 18 New Zealand rabbits implanted VX-2 were randomly divided into control (n = 8) and paclitaxel (PAC, n = 10) groups, given 2 mL/kg of normal saline or 2.4 mg/kg of PAC intravenously. The liver tumor imaging was detected by SPECT through intravenous injection of 99mTc-HYNIC-Annexin V before treatment, 24 hours and 48 hours after treatment respectively. Tumor radioactive count proportion to non-tumor sites was calculated. When the last imaging was finished, the rabbits were sacrificed. The tumor was taken out and divided into two pieces, one for TUNEL immunohistochemical analysis and the other for flow cytometry (FCM). We found that the rate of Annexin V labeled with 99mTc through HYNIC was more than 95%, and radiochemical purity was above 95%. The SPECT showed that two groups had no significant tumor imaging before the treatment. There is no significant tumor imaging in control group, while the PAC group 24 h and 48 h after treatment showed significant accumulation. The Tumor/non-Tumor (T/NT) in PAC group at 24 h and 48 h after chemotherapy was significantly different from that in the control group and PAC group prior to treatment. There was no significant difference between 24 h and 48 h in PAC group. The TUNEL-positive cells detected by immunohistochemistry and apoptotic rate detected by FCM in PAC group were significant different from those in control group. The T/NT was significantly correlated to TUNEL-positive cells and apoptotic rate of the tumor. PAC can induce apoptosis of rabbit VX-2 liver cancer cells. 24-48 h after paclitaxel chemotherapy is a window time for apoptosis detection. Apoptotic cells in vivo can be detected by SPECT through 99mTc-HYNIC-Annexin V.

Role of liver augmentation prior to hepatic resection – a survey on standards, procedures, and indications in Germany, Switzerland, and Austria

PurposeFor primary and secondary liver tumors oncological resection remains a chance of cure. Augmentation of functional liver tissue may be necessary to preserve sufficient future liver remnant (FLR). Clinical decision-making on liver augmentation techniques and indications may differ internationally. Thus, this study aims to identify standards of liver augmentation in hepato-pancreatico-biliary (HPB) centers in Germany, Switzerland, and Austria.MethodsUsing a web-based survey, 48 hospitals in Germany, Switzerland, and Austria were invited to report their surgical indication, standard procedures, and results of liver augmentation.ResultsForty (83.3%) of the hospitals invited participated. Most of the hospitals were certified liver centers (55%), performing complex surgeries such as liver transplantation (57.5%) and ALPPS (80%). The standard liver augmentation technique in all countries was portal vein embolization (PVE; 56%), followed by ALPPS (32.1%) in Germany or PVE with hepatic vein embolization (33.3%) in Switzerland and Austria. Standard procedure for liver augmentation did not correlate with certification as liver center, performance of liver transplantation or ALPPS. Surgical indication for PVE varied depending on tumor entity. Most hospitals rated the importance of PVE before resection of cholangiocarcinoma or colorectal metastases as high, while PVE for hepatocellular carcinoma was rated as low.ConclusionThe survey gives an overview of the clinical routine in HPB centers in Germany, Austria, and Switzerland. PVE seems to dominate as standard technique to increase the FLR. However, there is a variety in the main indication for liver augmentation. Further studies are necessary evaluating the differing PVE techniques for liver augmentation.

Regional Differences in Hepatitis C-Related Hospitalization Rates, United States, 2012-2019.

In the United States, hepatitis C is the most commonly reported bloodborne infection. It is a leading cause of liver cancer and death from liver disease and imposes a substantial burden of hospitalization. We sought to describe regional differences in hepatitis C virus (HCV)-related hospitalizations during 2012 through 2019 to guide planning for hepatitis C elimination. We analyzed discharge data from the National Inpatient Sample for 2012 through 2019. We considered hospitalizations to be HCV-related if (1) hepatitis C was the primary diagnosis or (2) hepatitis C was any secondary diagnosis and the primary diagnosis was a liver disease-related condition. We analyzed demographic and clinical characteristics of HCV-related hospitalizations and modeled the annual percentage change in HCV-related hospitalization rates, nationally and according to the 9 US Census Bureau geographic divisions. During 2012-2019, an estimated 553 900 HCV-related hospitalizations occurred in the United States. The highest hospitalization rate (34.7 per 100 000 population) was in the West South Central region, while the lowest (17.6 per 100 000 population) was in the West North Central region. During 2012-2019, annual hospitalization rates decreased in each region, with decreases ranging from 15.3% in the East South Central region to 48.8% in the Pacific region. By type of health insurance, Medicaid had the highest hospitalization rate nationally and in all but 1 geographic region. HCV-related hospitalization rates decreased nationally and in each geographic region during 2012-2019; however, decreases were not uniform. Expanded access to direct-acting antiviral treatment in early-stage hepatitis C would reduce future hospitalizations related to advanced liver disease and interrupt HCV transmission.

Preoperatively suspected gallbladder cancer improves survival compared with incidental gallbladder cancer in pT3 patients.

The aim was to compare survival for incidental gallbladder cancer (IGBC), respectively, preoperatively suspected gallbladder cancer (GBC), subjected to surgery for different pathological tumour (pT) stages and in different treatment groups in a national cohort. Data were collected and crosslinked from two national quality registers, SweLiv (2009-2019) and GallRiks (2009-2016). Survival was estimated using Kaplan-Meier analysis. The log-rank test and Cox regression analyses were used to compare groups. In total, 466 IGBC patients, including 225 who only underwent simple cholecystectomy (SC), and 477 GBC patients were included. Most patients were female, with small differences in mean age between groups. In all IGBC patients compared with GBC patients, an improved 5-year overall survival in pT3 GBC undergoing surgery (GBC 13% vs all IGBC 8%, p < 0.001), was seen. GBC was shown to be an independent predictor for improved survival in pT3 patients (hazard ratio (HR): 0.6; 95% confidence interval (CI): 0.4-0.8, p < 0.001). In addition, in GBC with curative reresection compared with IGBC SC and IGBC with curative resection, an improved 5-year overall survival in pT3 GBC was shown (GBC 20% vs all IGBC 10%, p < 0.001). GBC was an independent predictor for improved survival in pT3 patients with curative resection (HR: 0.4; 95% CI: 0.3-0.7, p < 0.001). GBC was shown to be an independent predictor for improved survival in pT3 patients, and patients with GBC may benefit from one-stage resection. It is, therefore, reasonable to recommend that radiological suspicion of malignancy should be evaluated at a liver tumour centre to optimize patient outcomes.