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Objective: To observe the protective effect of Xuebijing injection pretreatment on hepatic ischemia reperfusion (I/R) injury and coagulopathy in liver cancer patients undergoing excision of hepatic cancer after occlusion of hepatic blood flow., Methods: A prospective randomly controlled study was conducted. Sixty patients with liver cancer classified as Child-Pugh class A undergoing hepatectomy in the Department of Hepatobiliary Surgery of Sun Yat-sen University Cancer Center from October 2011 to March 2013 were enrolled. The patients were randomized into control group and Xuebijing group (each patient received 100 mL Xuebijing injection added to 0.9% saline as a preoperative treatment for 3 days). Complete blood count, coagulation function, hepatic function, serum pro-inflammatory cytokines and alpha-fetoprotein (AFP) levels were determined before and after operation., Results: Forty-five out of 60 patients were enrolled eventually, with 23 patients in control group and 22 in Xuebijing group, and among them 43 patients were positive for hepatitis B surface antigen (HBsAg) at admission. Compared with those before operation, the postoperative levels of alanine transaminase (ALT), aspartate transaminase (AST) and lactate dehydrogenase (LDH) in control and Xuebijing groups were significantly elevated, prothrombin time (PT) and activated partial prothrombin time (AfYIT) were significantly prolonged, and white blood cells (WBC) , proportion of neutrophils (N) and C-reactive protein (CRP) were significantly increased (P<0.05 or P<0.01 ). Although the above indexes in Xuebijing group after operation were lower than those in control group in different degrees [ALT (U/L): 213.1 (80.4-796.6) vs. 265.8 (15.6-882.3), AST (UIL): 194.1 (65.4-914.2) vs. 264.3 (15.4-475.9), LDH (lg,U/L): 5.69 ± 0.72 vs. 5.71 ± 0.72, PT (s): 15.24 ± 2.16 vs. 14.41 ± 1.33, AfYIT (s): 31.51 ± 7.04 vs. 29.47 ± 4.90, WBC (x 109/L) : 13.4 7 ± 4.66 vs. 14.58 ± 4.40, N: 0.87 ± 0.06 vs. 0.87 ± 0.04, CRP (mg/L): 40.64 (16.93-189.59) vs. 45.64 ( 1.65-349.40) J, no statistical significance was found between the groups (all P>0.05 ). The preoperative levels of tumor necrosis factor-a (TNF -a) and interleukin-6 OL-6) were both less than 1.0 ng/L, and the postoperative levels of TNF-a showed no significant change, and IL-6 was increased to 485.10 (104.00-837.50) ng/L and 193.26 (95.10-385.20) ng/L in control and Xuebijing groups respectively (P<0.01). The serum high mobility group box-1 ( HMGB1 ) protein levels after operation were higher than those of preoperative in both groups (both P<0.01), but the postoperative HMGB1 in Xuebijing group were significantly lower than those in control group (j.Lg/L: 268.73 ± 5.56 vs. 277.12 ± 2.92, P<0.01). Acute physiology and chronic health evaluation ll (APACHE ll) score in Xuebijing group was significantly lower than that in control group (4.18 ± 3.75 vs. 4.53 ± 2.34, t=5.328, P=0.027), and the first passage of flatus and defecation after operation in Xuebijing group were significantly earlier than those in control group [exhaust time (days): 3 (2-4) vs. 3 (2-4), U=-2.023, P=0.043; defecation time (days): 4 (2-6) vs. 5 (3-8), U =-2.926, P=0.003 J. However, no difference was found between two groups in the postoperative and total hospital days. Spearman rank correlation analysis showed there were positive correlations between hepatitis B virus (HBV)-DNA levels and preoperative ALT (r=0.414, P=0.044) and AST (r=0.405, P=0.024) in 33 HBV-DNA positive patients, but there was no significant correlation between HBV -DNA levels or other preoperative liver function indicators., Conclusions: Hepatic I/R injury and coagulopathy may occur in liver cancer patients undergoing resection of cancer with occlusion of hepatic blood flow. Xuebijing injection may inhibit the release of serum pro-inflammatory cytokines, thereby alleviate hepatic I/R injury and promote the recovery of intestinal function. But it does not offer protective effect on coagulopathy.

Background & Objective: Osteopontin (OPN), a secretory phosphorylated glycoprotein and integrin-binding protein, has been involved in tumorigenesis, progression, invasion, and metastasis. OPN is over-expressed in a variety of human tumors. This study was to evaluate the value of OPN detection in forecasting the postoperative metastasis and recurrence of hepatocellular carcinoma (HCC)., Methods: Plasma OPN level of 56 patients with HCC was detected before operation by enzyme-linked immunosorbent assay (ELISA), and plasma samples of 23 healthy volunteers were also analyzed as control group. The correlation of plasma OPN level to metastasis and recurrence of HCC was analyzed., Results: Plasma OPN level was significantly higher in HCC group than in control group [(864.4+/-391.9) microg/L vs. (382.5+/-169.4) microg/L, P<0.001]. During the follow-up, 25 patients had tumor recurred. Plasma OPN level was significantly higher in the patients with early HCC recurrence than in those without recurrence [(961.0+/-411.6) microg/L vs. (744.6+/-323.9) microg/L, P=0.039]. Cox multivariate analysis showed that plasma OPN level, cirrhosis, and tumor size were independent predictors for HCC recurrence and metastasis., Conclusion: Plasma OPN level may be a potential diagnostic marker for predicting metastasis and recurrence of HCC.

Background & Objective: Focal nodular hyperplasia (FNH) is a rare benign hepatic tumor, and its diagnosis and treatment remain controversial. This study was to summarize the clinical features of FNH, and explore its diagnosis and treatment principles., Methods: Clinical data of 38 FNH patients, treated in our hospital from Jul. 1997 to Jul. 2004, were studied retrospectively with literature review to summarize the clinical feature, diagnosis, and treatment of FNH. All the patients were followed up till Jul. 2004., Results: Among the 38 patients, 30 (78.9%) were under 40 years old, 26 (68.4%) were asymptomatic, 32 (84.2%) had normal liver function, and alpha fetoprotein (AFP) was negative in all the patients. Correct diagnosis rates were 5.3% (2/38) for B ultrasonography, 45.5% (5/11) for color Doppler ultrasound, 100% (2/2) for contrast-enhanced ultrasound, and 36.8% (14/34) for double-phase helical CT scan. Of the 38 patients, 34 (89.5%) underwent hepatic resection without any complication, 1 underwent biopsy and transcatheter arterial embolization (TAE), 2 underwent biopsy and percutaneous ethanol injection (PEI), 1 only underwent biopsy. The size of lesions didn't change after TAE or PEI. HCC appeared in 2 patients with hepatitis 69 and 32 months after the resection of FNH lesions. At the end of follow-up, 37 patients were survival, and the other one died of other disease 1 year after PEI., Conclusions: The patients with FNH usually have no clinical symptoms with good prognosis. The combination of multiple imaging measures is of help to the diagnosis of FNH. We recommend close observation for patients with confirmed diagnosis of FNH and without clinical symptoms, and recommend surgical resection for those with equivocal diagnosis, symptoms, lesion enlargement, or accompanied with hepatitis or cirrhosis.

Background & Objective: The TNM staging system for hepatocellular carcinoma (HCC) was revised by the International Union Against Cancer (UICC) from the 5th edition (TNM5) to the 6th edition (TNM6) in 2002. This study was to evaluate the prognostic value of TNM6 staging in a large cohort study of HCC patients who underwent hepatectomy, and investigate its feasibility and applicability in China., Methods: Clinical and follow-up data of 478 HCC patients, who underwent hepatectomy in our center from Jan. 1993 to Dec. 1998, were reviewed retrospectively. Survival rates of the patients were compared according to TNM5 staging and TNM6 staging. The advantages and disadvantages of TNM6 staging were analyzed., Results: According to TNM5 staging, 12 (2.5%) patients were in stage I, 224 (46.8%) in stage II, 95 (19.9%) in stage IIIA, 8 (1.7%) in stage IIIB, and 139 (29.1%) in stage IVA. The 5-year survival rates were 81.8%, 41.5%, 17.0%, 0%, and 10.2%, respectively; there were significant differences in survival rate between stage II and IIIA, between stage II and IIIB, and between stage IIIA and IIIB, but no significant differences were observed between stage I and II, or between stage IIIB and IVA. According to TNM6 staging, 234 (48.9%) patients were in stage I, 41 (8.6%) in stage II, 96 (20.1%) in stage IIIA, 88 (18.4%) in stage IIIB, and 19 (4.0%) in stage IIIC. The 5-year survival rates were 43.3%, 20.2%, 13.1%, 13.0%, and 0, respectively; there was significant difference in survival rate between stage I and II, but no significant differences were found between stage II and IIIA, between stage II and IIIB, and between stage IIIA and IIIB., Conclusions: TNM6 staging has important improvement, and is simpler than TNM5 staging. But TNM6 staging still has limitation, which is not very accurate to predict the prognosis in clinical practice, and is not suitable for Chinese HCC patients who were usually accompanied with cirrhosis.

Background & Objective: Most cases of hepatocellular carcinoma (HCC) are unresectable even without extra-hepatic metastasis. In addition, about 80%-90% patients in China are accompanied with cirrhosis. Liver transplantation is probably more proper for these patients than other treatments. This study was to explore the value of liver transplantation for treatment of advanced HCC without extra-hepatic metastasis, and to summarize the experience of liver transplantation performed in Cancer Center of Sun Yat-sen University., Methods: Ten patients with advanced HCC without extra-hepatic metastasis who underwent liver transplantation in Sun Yat-sen University Cancer Center from Sept. 2003 to Apr. 2004 were followed up to May 2004, and their clinical records were reviewed retrospectively., Results: The mortality within 1 month after operation was 0.0% for 10 cases of liver transplantation. One patient was alive for 7 month with tumor recurrence, and the remaining 9 patients were alive for 1-6 months without recurrence. Alpha fetoprotein (AFP) decreased to normal range within 2 months in 2 cases with macro tumor thrombus in the trunk of portal vein, and the left branch of portal vein, respectively., Conclusion: Advanced HCC without extra-hepatic metastasis, even with macro tumor thrombus in portal vein, is still indicated for liver transplantation.