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Ni C.Y.,Shanghai University | Ni C.Y.,Chinese University of Hong Kong | Yang Y.,Shanghai University | Yang Y.,Chinese University of Hong Kong | And 8 more authors.
European Journal of Surgical Oncology | Year: 2013

Background and aim Fast-track surgery (FTS), combining several techniques with evidence-based adjustments, has shown its effectiveness to accelerate recovery, reduce morbidity and shorten hospital stay in many operations. This randomized controlled study was carried out aiming to compare the short-term outcomes of partial hepatectomy for liver cancer managed with FTS or with conventional surgery (CS). Methods To compare the short-term effects between FTS and CS, a randomized controlled trial was carried out for liver cancer patients undergoing partial hepatectomy from September 2010 to June 2012. Results Patients with liver cancers before receiving partial hepatectomy were randomized into the FTS group (n = 80) and the CS group (n = 80). Compared with the CS group, the FTS group had significantly less complications (P < 0.05), shorter durations of nausea/vomiting, paralytic ileus and hospital stay, higher general comfort questionnaire measures (GCQ) by Kolcaba Line (all P < 0.05), and lower serum levels of C-reactive protein on postoperative days 1, 3, and 5. Conclusions FTS was safe and efficacious. It lessened postoperative stress reactions and accelerated recovery for patients undergoing partial hepatectomy for liver cancer. © 2013 Elsevier Ltd. All rights reserved. Source


Zhang J.,Shanghai University | Yang Y.,Shanghai University | Yang T.,Shanghai University | Yuan S.,Shanghai University | And 8 more authors.
Hepatology | Year: 2015

Growing evidence indicates that the aberrant expression of microRNAs (miRNAs) contributes to tumor development; however, the function of miRNAs in human hepatocellular carcinoma (HCC) remains largely undefined. In this study, we report that microRNA-422a (miR-422a) is significantly down-regulated in HCC tumor samples and cell lines compared with normal controls, and its expression level is negatively correlated with pathological grading, recurrence, and metastasis. The restoration of miR-422a expression in HCC tumor cells significantly inhibited cell proliferation and migration in vitro. At the same time, the overexpression of miR-422a in HCC tumor cells significantly inhibits tumor growth and liver metastasis in xenograft tumor models. A mechanistic study identified three genes, forkhead box G1 (FOXG1), FOXQ1, and FOXE1, as miR-422a targets in the regulation of HCC development. We also investigated the function of the three targets themselves in HCC tumorigenesis using RNAi manipulation and demonstrated that the knockdown of these targets led to significant inhibition of tumor cell proliferation and migration both in vitro and in vivo. More interestingly, a potential miR-422a promoter region was identified. Both the promoter activity and miR-422a expression were negatively regulated by the three targets, indicating that a double-negative feedback loop exists between miR-422a and its targets. Moreover, we explored the therapeutic potential of miR-422a in HCC treatment and found that the therapeutic delivery of miR-422a significantly inhibited tumor development in a xenograft tumor model and a diethylnitrosamine-induced primary HCC model. Conclusion: Our findings show the critical roles of miR-422a and its targets-FOXG1, FOXQ1, and FOXE1-in the regulation of HCC development and provide new potential candidates for HCC therapy. © 2014 by the American Association for the Study of Liver Diseases. Source


Yang Y.,Shanghai University | Zhao L.-H.,Shanghai University | Fu S.-Y.,Shanghai University | Lau W.Y.,Chinese University of Hong Kong | And 5 more authors.
American Surgeon | Year: 2014

Massive blood loss remains a problem during resection for giant liver hemangioma. This present study was designed to compare selective hepatic vascular exclusion (SHVE) versus Pringle maneuver in surgery for liver hemangioma compressing the major (right, middle, or left) hepatic veins. From January 2003 to December 2011, 589 consecutive patients with hemangioma underwent liver resection in our department, and 273 patients had their tumors compressing at least one of the three major hepatic veins (right, middle, or left). Either SHVE (n 5 120 patients) or Pringle maneuver (n 5 153 patients) was used to minimize blood loss during resection. Data regarding the intraoperative and postoperative courses of these patients were retrospectively analyzed. There was no significant difference between the two groups of patients regarding age, sex, tumor size, types of hepatectomy, and extent of tumor involvement of the major hepatic veins. Intraoperative blood loss, transfusion requirements, and transfusion volume were significantly less in the SHVE group (P < 0.01). For the Pringle group, major hepatic veins were lacerated in 19 patients during hepatic parenchymal transection. For the SHVE group, a major hepatic vein was lacerated during extrahepatic dissection of the hepatic vein in two patients and during hepatic parenchymal transection in 14 patients. SHVE was more efficacious in minimizing intraoperative bleeding during liver resection for hemangiomas compressing the major hepatic veins. It prevented intraoperative major bleeding and air embolism and significantly decreased postoperative liver failure and in-hospital mortality. Source


Hu Z.,Nanjing Medical University | Liu Y.,Nanjing Medical University | Zhai X.,U.S. Center for Disease Control and Prevention | Dai J.,Nanjing Medical University | And 25 more authors.
Nature Genetics | Year: 2013

Chronic hepatitis B virus (HBV) infection is a challenging global health problem. To identify genetic loci involved in chronic HBV infection, we designed a three-phase genome-wide association study in Han Chinese populations. The discovery phase included 951 HBV carriers (cases) and 937 individuals who had naturally cleared HBV infection (controls) and was followed by independent replications with a total of 2,248 cases and 3,051 controls and additional replications with 1,982 HBV carriers and 2,622 controls from the general population. We identified two new loci associated with chronic HBV infection: rs3130542 at 6p21.33 (near HLA-C, odds ratio (OR) = 1.33, P = 9.49 × 10-14) and rs4821116 at 22q11.21 (in UBE2L3, OR = 0.82, P = 1.71 × 10-12). Additionally, we replicated the previously identified associations of HLA-DP and HLA-DQ variants at 6p21.32 with chronic HBV infection. These findings highlight the importance of HLA-C and UBE2L3 in the clearance of HBV infection in addition to HLA-DP and HLA-DQ. Source


Huang G.,Shanghai Alliance | Chen X.,East China Normal University | Chen X.,Nanjing Political Academy | Lau W.Y.,Shanghai Alliance | And 6 more authors.
British Journal of Surgery | Year: 2014

Background Health-related quality of life (HRQL) is an important outcome measure in studies of cancer therapy. This study aimed to investigate HRQL and survival in patients with small hepatocellular carcinoma (HCC) treated with either surgical resection or percutaneous radiofrequency ablation (RFA). Methods Between January 2006 and June 2009, patients with newly diagnosed solitary, small (3 cm or less) HCC were invited to participate in this non-randomized prospective parallel cohort study. The Functional Assessment of Cancer Therapy - Hepatobiliary (FACT-Hep) instrument was used for assessing HRQL. HRQL and survival were compared between the two treatment groups. Results A total of 389 patients were enrolled. Questionnaires were completed fully by 99·7 per cent of invited participants (388 of 389) at baseline, 98·7 per cent (383 of 388) at 3 months, 99·0 per cent (379 of 383) at 6 months, 98·4 per cent (365 of 371) at 1 year, 96·6 per cent (336 of 348) at 2 years and 95·1 per cent (289 of 304) at 3 years. There were no significant differences in disease-free and overall survival between the two groups. Patients treated with percutaneous RFA had significantly better HRQL total scores after 3, 6, 12, 24 and 36 months than those who had surgical resection (P < 0·001, P < 0·001, P = 0·001, P = 0·003 and P = 0·025 respectively). On multivariable analysis, the presence of concomitant disease, cirrhosis and surgical resection were significant risk factors associated with a worse HRQL score after treatment. Conclusion Percutaneous RFA produced better post-treatment HRQL than surgical resection for patients with solitary small (no more than 3 cm) HCC. Radiofrequency ablation is a good alternative for surgery © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd. Source

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