Table of Content

30 September 2022, Volume 9 Issue 3

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Original article

Bioinformatics analysis and validation of key genes in the pathogenesis and prognosis of hepatocellular carcinoma

Shi Wenwu, Chen Zhimin, Zhou Jinhua

2022, 9(3):  1-6. 

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Objective: To screen the key genes of hepatocellular carcinoma (HCC) and verify the prognostic genes of the key genes by bioinformatics.
Method: GSE112790 and GSE101685 data sets were downloaded from Gene Expression Omnibus (GEO) database to screen common differentially expressed genes in HCC tissues and paracancerous tissues. The biological processes and related signaling pathways of the differentially expressed genes (DEGs) were analyzed by gene ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment. Ten key genes were screened from the protein-protein interaction network constructed by DEGs through Cytoscape software, which were screened and verified involved in prognosis.
Result: A total of 344 DEGs were screened out in the two data sets, among which 104 were up-regulated and 240 were down-regulated. GO enrichment analysis showed that differentially expressed genes were mainly concentrated in cell cycle process, mitotic cell cycle process, organic acid metabolism process, carboxylic acid metabolism process and oxalic acid metabolism process. KEGG enrichment analysis showed that the differentially expressed genes were mainly concentrated in metabolism of xenobiotics by cytochrome P450, p53 signaling pathway, drug metabolism-cytochrome P450, metabolic pathways, linoleic acid metabolic pathway, CDK1, CCNB1, CCNA2, CCNB2, MAD2L1, AURKA, TTK, CDC20, NDC80 and BIRC5 may play a role in the development and progression of HCC. After tissue specimen verification, the mRNA expression levels of CDK1 and MAD2L1 in HCC tissues were higher than those in adjacent tissues, and the differences were statistically significant (P<0.001). Results of survival analysis showed that the survival time of CDK1 low expression group was significantly longer than that of the high expression group (P=0.030), and MAD2L1 was not correlated with the prognosis of HCC patients (P=0.481).
Conclusion: CDK1, CCNB1, CCNA2, CCNB2, MAD2L1, AURKA, TTK, CDC20, NDC80 and BIRC5 may play a role in the development and progression of HCC. CKD1 is associated with the prognosis of HCC and may become a new prognostic marker.

Perioperative safety and feasibility analysis of laparoscopic hepatectomy ofⅧ segment hepatocellular carcinoma

Song Zengfu, Zhao Liang, Xu Haitao, Zhao Haoran, Wang Peng, Wang Yunfeng, Zhang Yubao

2022, 9(3):  7-11. 

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Objective: To investigate the perioperative safety and feasibility of laparoscopic hepatectomy ofⅧ segment hepatocellular carcinoma.
Method: The data of 48 patients suffered fromⅧ segment hepatocellular carcinoma undergoing hepatectomy in Harbin Medical University Cancer Hospital from January 2019 to May 2022 were retrospectively analyzed, and they were divided into open group (27 cases) and laparoscopic group (21 cases). The basic clinical data, operative data and postoperative data of the two groups were compared.
Result: There were no significant differences in basic clinical data between the two groups (P>0.05). In intraoperative data, there were no significant differences in operative time, intraoperative blood loss, intraoperative blood transfusion rate and distance of tumor resection margin between the two groups (P>0.05). In postoperative data, there were no significant differences in liver function indexes of the 1st, 3rd and 5th day after surgery, postoperative complication rate, drainage tube removal time and postoperative hospital stay between the two groups (P>0.05). The blocking time of hepatic portal in the laparoscopic group was longer than that in the open group [(48.0±14.8)min vs. (38.5±13.1)min, P<0.05], and the time of taking food and out-of-bed mobilization after operation was shorter than that in the open group [(1.6±0.7)d vs. (2.2±0.6)d, (2.0±0.7)d vs. (2.4±0.5)d, P<0.05].
Conclusion: Laparoscopic hepatectomy ofⅧ segment hepatocellular carcinoma has obvious minimally invasive advantages, such as early postoperative food intake and early out-of-bed activity, without increasing the incidence of complications. After the accumulation of experience in laparoscopic surgery, laparoscopic hepatectomy ofⅧ segment hepatocellular carcinoma is safe and feasible.

Incidence and mortality of liver cancer in Beijing, 2003—2017

Cheng Yangyang, Li Huichao, Liu Shuo, Yang Lei, Zhang Xi, Li Qingyu, Li Haoxin, Wang Ning

2022, 9(3):  12-16. 

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Objective: To analyze the incidence and mortality of liver cancer in Beijing from 2013 to 2017, to provide scientific strategy for liver cancer prevention and treatment.
Method: The data from Beijing cancer registry during 2003—2017 were collected and qualified to calculate the crude incidence and mortality rate, age-standardized rate, cumulative rate (0-74 years) and annual percentage change (APC).
Result: There were 37 459 cases diagnosed as liver cancer during 2003—2017 with a crude incidence rate of 19.92/105. The age-standardized incidence rate by Chinese standard population (ASR China) in 2000 and world standard population (ASR World) of liver cancer were 11.42/105 and 11.29/105, respectively. The male to female incidence ratio of ASR world was 3.07:1. The incidence in urban areas was lower than that in rural area with a ratio of 0.79:1. The cases of liver cancer deaths were about 30 945, with a crude mortality rate of 16.46/105. The ASR China and ASR World mortality rate were 9.15/105 and 9.04/105. The male to female mortality ratio of ASR world was 3.09:1. The mortality in urban areas was lower than that in rural area with a ratio of 0.77:1. The APC of ASR World for incidence of liver cancer was -2.33% (95%CI: -3.3%--1.3%, P<0.001), the APC of ASR World for mortality of liver cancer was -1.53% (95%CI: -2.5%--0.5%, P=0.005). The incidence rate and the mortality rate peaked in the age group of 80-84 years and 85+ years, respectively.
Conclusion: The incidence and mortality rates of liver cancer in Beijing were decreasing in the past 15 years, the rates were still higher than the average level of world. The disease burden can not be ignored. The incidence and mortality rates of liver cancer in Beijing were higher for male than those in female, and higher in rural area than that in urban area, suggesting the prevention and treatment of liver cancer should continue to be strengthened in the middle-aged and elderly men and rural people.

Analysis of postoperative pain score and risk of lung infection after liver resection based on propensity score matching

Huang Yongchu, Cai Ruiqiang, Liu Nian, Zhou Fengsheng, Mao Xianshuang

2022, 9(3):  17-21. 

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Objective: To investigate the relationship between postoperative pain score and pulmonary infection after liver resection for liver cancer.
Method: A retrospective selection of 270 patients with liver cancer who underwent hepatectomy in Hezhou People's Hospital from March 2015 to October 2020 was used as the research object. Numerical rating scal (NRS) was used to enter the ward within 24 hours after anesthesia consciously. The patients were scored for pain, and patients with NRS≤3 points were included in the low NRS group (n=175), and patients with NRS>3 points were included in the high NRS group (n=95). Use the propensity score matching method to match the NRS low group with the NRS high group at a ratio of 1:1. The matching factors include age, history of cerebrovascular accident, past history of lung disease, preoperative deep vein puncture, preoperative hospital stay, Operation time, intraoperative blood loss, postoperative ventilator use, nasogastric tube indwelling time, abdominal drainage tube indwelling time, and preoperative white blood cell, procalcitonin (PCT), C-reactive protein (CRP) levels. Compare the baseline data of the low NRS group and the high NRS group before and after matching, and the incidence of postoperative lung infection.
Results: Before matching, there were significant differences in some baseline data between the two groups (P<0.05), and there was no significant difference in the incidence of lung infection between the low NRS group and the high NRS group (P>0.05). After matching, the differences in the matching variables between the two groups were not statistically significant (P>0.05). The incidence of postoperative lung infection in the low NRS group (8.1%) was significantly lower than that in the high NRS group (21.0%) (P<0.05) .
Conclusion: There is a certain correlation between postoperative pain score and pulmonary infection after hepatectomy for liver cancer. Severe postoperative pain may increase the risk of pulmonary infection after hepatectomy. Therefore, clinically, patients are actively evaluated for postoperative pain, and analgesic interventions are given as early as possible to eliminate or alleviate patients' pain and reduce the risk of postoperative lung infection.

Nursing field

Investigation and influencing factors of postoperative fatigue in patients with hepatocellular carcinoma after liver transplantation

Wei Wei, Cui Chen, Liu Xiulian, Han Guijie, Pan Jing, Gao Yanping, Zhang Jingjing, Wang Yuan

2022, 9(3):  22-26. 

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Objective: To investigate and analyze the incidence of fatigue in patients with hepatocellular carcinoma after liver transplantation, evaluate the applicability of multidimensional fatigue symptom inventory (MFSI) for patients and further analyze the factors affecting fatigue.
Method: The patients with hepatocellular carcinoma after liver transplantation who were followed up in the hepatobiliary surgery outpatient department of Beijing Chaoyang Hospital during December 2021 were selected for questionnaire survey. The fatigue of patients was evaluated by MFSI, the reliability and validity of the scale were evaluated, and the influencing factors of fatigue were further analyzed by multiple linear regression.
Result: The total MFSI score of patients with hepatocellular carcinoma after liver transplantation was 12.5±7.0, including general fatigue was 5.3±2.6, physical fatigue was 7(6, 9), emotional fatigue was 3(0, 5), psychological fatigue was 4(2, 5) and vitality was 6.7±3.2. The Cronbach's α coefficient of MFSI total score is 0.803 and the Kaiser-Meyer-Olkin (KMO) coefficient is 0.808. The results of regression analysis showed that the years after transplantation, rejection and tumor recurrence were the significant influencing factors of fatigue in patients with hepatocellular carcinoma after liver transplantation (P<0.05).
Conclusion: MFSI has good reliability and validity, and is helpful to comprehensively evaluate the fatigue status of patients with hepatocellular carcinoma after liver transplantation. Years after transplantation, rejection and tumor recurrence are the significant influencing factors of fatigue in patients with hepatocellular carcinoma after liver transplantation.

Prediction of pain intensity after transarterial chemoembolization in patients with hepatocellular carcinoma by neutrophil to lymphocyte ratio-platelet to lymphocyte ratio score

Liang Qianjing, Wu Deping, Wang Shengjie, Yan Kangming, Deng Lili, Han Shanshan

2022, 9(3):  27-35. 

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Objective: The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) was combined to construct a comprehensive inflammatory response score (named NLR-PLRs), followed by a nomogram model to predict the intensity of pain after transcatheter arterial chemoembolization (TACE).
Method: Totally 170 patients with unresectable hepatocellular carcinoma (HCC) treated in the Affiliated Hospital of Wanxi Health Vocational College operating room from January 2017 to December 2021 were selected. These patients were randomly divided into test set (n=102) and validation set (n=68) according to the ratio of 1.5:1. NLR-PLRs was constructed based on the receiver operator characteristic (ROC) curve analysis results for NLR and PLR predicting moderate or severe pain after TACE. Risk factors for moderate or severe pain after TACE were analyzed in the test set using multifactorial Logistic regression, and then a nomogram model was constructed. The predictive performance of the nomogram model was evaluated using test set and validation set data.
Result: In the test set, both NLR and PLR were higher in patients with moderate or severe pain after TACE than in patients with no or mild pain after TACE, and all differences were statistically significant (P<0.05). The ROC curves showed that the area under the curve (AUC) for NLR and PLR to predict moderate or severe pain after TACE was 0.700 and 0.764, with optimal cut-off values of 3.27 and 173.79, respectively. Age, maximum tumor diameter, number of tumors, portal venous tumor thrombus (PVTT), and NLR-PLRs were independent risk factors for moderate or severe pain after TACE (all P<0.05). In the test set, the consistency index (C-index) was 0.847 (95%CI: 0.738-0.911) and the AUC was 0.866 (95%CI: 0.784-0.925). The nomogram model provided a significant additional net clinical benefit over the individual predictor results. Similarly, C-index was 0.749 (95%CI: 0.629-0.847), and the AUC was 0.749 (95%CI: 0.629-0.847) in the validation set, while the nomogram model provided a significant additional net clinical benefit over the individual predictor results.
Conclusion: NLR-PLRs was associated with moderate or severe pain after TACE. The nomogram model based on NLR-PLRs may inform the timing of pain care management procedure initiation.

Medical education

Design and implementation of a teaching system of liver imaging learning and operation simulation based on internet and 3D visualization technology

Zhang Yefan, Wang Qiang, Zhang Chengshuo, Chen Xiao, Huang Zhen, Li Zhiyu, Bi Xinyu, Cai Jianqiang

2022, 9(3):  40-45. 

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It is the basic skills for hepatobiliary surgeons to formulate reasonable and accurate surgical plans based on computed tomography (CT)/ magnetic resonance imaging (MRI) images. This requires doctors to establish the three-dimensional structure of organs and lesions in their minds by reading the images, however the training for this ability is difficult in clinical teaching. The three-dimensional visualization technology can help medical students have a better sense for liver anatomy and liver surgery, and greatly improve learning efficiency. Based on clinical teaching requirements, we designed and established a liver image and surgery simulation teaching system based on the Internet and three-dimensions visualization technology. In this article, we introduced the system architecture, functional modules and personal computer (PC)/mobile terminal realization of the system.