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Ruze R, Jiang T, Zhang W, Zhang M, Zhang R, Guo Q, Aboduhelili A, Zhayier M, Mahmood A, Yu Z, Ye J, Shao Y, Aji T. Liver autotransplantation and atrial reconstruction on a patient with multiorgan alveolar echinococcosis: a case report. BMC Infect Dis 2024; 24:659. [PMID: 38956482 PMCID: PMC11218102 DOI: 10.1186/s12879-024-09545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/20/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Alveolar echinococcosis (AE) primarily affects the liver and potentially spreads to other organs. Managing recurrent AE poses significant challenges, especially when it involves critical structures and multiple major organs. CASE PRESENTATION We present a case of a 59-year-old female with recurrent AE affecting the liver, heart, and lungs following two previous hepatectomies, the hepatic lesions persisted, adhering to major veins, and imaging revealed additional diaphragmatic, cardiac, and pulmonary involvement. The ex vivo liver resection and autotransplantation (ELRA), first in human combined with right atrium (RA) reconstruction were performed utilizing cardiopulmonary bypass, and repairs of the pericardium and diaphragm. This approach aimed to offer a potentially curative solution for lesions previously considered inoperable without requiring a donor organ or immunosuppressants. The patient encountered multiple serious complications, including atrial fibrillation, deteriorated liver function, severe pulmonary infection, respiratory failure, and acute kidney injury (AKI). These complications necessitated intensive intraoperative and postoperative care, emphasizing the need for a comprehensive management strategy in such complicated high-risk surgeries. CONCLUSIONS The multidisciplinary collaboration in this case proved effective and yielded significant therapeutic outcomes for a rare case of advanced hepatic, cardiac, and pulmonary AE. The combined approach of ELRA and RA reconstruction under extracorporeal circulation demonstrated distinct advantages of ELRA in treating complex HAE. Meanwhile, assessing diaphragm function during the perioperative period, especially in patients at high risk of developing pulmonary complications and undergoing diaphragmectomy is vital to promote optimal postoperative recovery. For multi-resistant infection, it is imperative to take all possible measures to mitigate the risk of AKI if vancomycin administration is deemed necessary.
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Affiliation(s)
- Rexiati Ruze
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830011, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, 830011, China
| | - Tiemin Jiang
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830011, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, 830011, China
| | - Weimin Zhang
- Department of Cardiac Surgery, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830011, China
| | - Mingming Zhang
- Department of Cardiac Surgery, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830011, China
| | - Ruiqing Zhang
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830011, China
| | - Qiang Guo
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830011, China
| | - Aboduhaiwaier Aboduhelili
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830011, China
| | - Musitapa Zhayier
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830011, China
| | - Ahmad Mahmood
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830011, China
| | - Zhaoxia Yu
- Department of Critical Care Medicine, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830011, China
| | - Jianrong Ye
- Department of Anesthesia, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830011, China
| | - Yingmei Shao
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830011, China.
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, 830011, China.
| | - Tuerganaili Aji
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830011, China.
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, 830011, China.
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Khuroo MS, Khuroo NS, Rather AA. A Case Series and Literature Review of Alveolar Echinococcosis in Kashmir, India: An Emerging Endemic Zone for Echinococcus multilocularis. Life (Basel) 2024; 14:794. [PMID: 39063549 PMCID: PMC11277966 DOI: 10.3390/life14070794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
A prospective study on 110 patients with echinococcosis at Dr. Khuroo's Medical Clinic, Srinagar, Kashmir, India, from March 2019 to April 2024 identified 12 cases (4 males, 8 females; mean age of 46.58 ± 11.97 years) of Alveolar echinococcosis (AE). Two patients were detected through ultrasound examinations carried out for unrelated causes; one presented with features of liver abscess, and nine had pain in the right upper quadrant for a mean period of 2.2 ± 1.79 years. All had the liver as the primary organ involved, with 15 tumor masses of a mean maximum diameter of 9.22 ± 3.21 cm and volume of 426 ± 374.61 cm3. Tumors placed centrally had invaded vessels and the biliary tract in eight patients, and those placed peripherally had invaded the liver capsule and adjacent organs in nine patients. Histologic examination of liver biopsies or resected organs revealed necrotic lesions, calcifications, and granulomatous inflammation with slender, thin-walled vesicles of bizarre configuration that stained strongly eosinophilic with periodic acid Schiff. Two patients had segmental liver resections; one was treated with liver aspiration, while the other nine with advanced disease received chemotherapy with albendazole along with praziquantel. Patients showed clinical improvement on a median follow-up of 12 months (range 1 to 60 months); however, MRI T2-weighted images and 18F-FDG-PET-CECT scans in two patients showed active disease on follow-up at one and five years, respectively. A systematic review detected 146 cases of AE in India from 1980 to April 2024. Twenty cases were from foreign countries, mostly from Central Asian republics, and 118 (93.65%) of the remaining 126 Indian patients were permanent residents of Kashmir Valley. The disease affected a population of 79,197 residing in 22 villages from 5 border districts of the valley. These villages were either high in or adjacent to the Himalayan mountain range. Disease prevalence in the affected population was 146.47/105 (males 131.53/105 and females 163.18/105) and the incidence was 12.41/105/year (males 11.16/105/year and females 13.81/105/year). Possible causes of the emergence of AE are discussed, and future directions for research to face this challenge arebeen identified.
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Affiliation(s)
- Mohammad Sultan Khuroo
- Digestive Diseases Centre, Dr. Khuroo’s Medical Clinic, Kashmir, Srinagar 190010, India;
| | - Naira Sultan Khuroo
- Digestive Diseases Centre, Dr. Khuroo’s Medical Clinic, Kashmir, Srinagar 190010, India;
| | - Ajaz Ahmad Rather
- Department of Surgery and Registrar Academics, Sher-I-Kashmir Institute of Medical Sciences Medical College and Hospital, Bemina, Kashmir, Srinagar 190010, India;
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Lin X, Shao YM, Zhang RQ, Aji T. Applying LASSO logistic regression for the prediction of biliary complications after ex vivo liver resection and autotransplantation in patients with end-stage hepatic alveolar echinococcosis. Eur J Med Res 2024; 29:301. [PMID: 38812045 PMCID: PMC11134669 DOI: 10.1186/s40001-024-01898-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/21/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The purpose of this study was to explore the relevant risk factors associated with biliary complications (BCs) in patients with end-stage hepatic alveolar echinococcosis (HAE) following ex vivo liver resection and autotransplantation (ELRA) and to establish and visualize a nomogram model. METHODS This study retrospectively analysed patients with end-stage HAE who received ELRA treatment at the First Affiliated Hospital of Xinjiang Medical University between August 1, 2010 and May 10, 2023. The least absolute shrinkage and selection operator (LASSO) regression model was applied to optimize the feature variables for predicting the incidence of BCs following ELRA. Multivariate logistic regression analysis was used to develop a prognostic model by incorporating the selected feature variables from the LASSO regression model. The predictive ability, discrimination, consistency with the actual risk, and clinical utility of the candidate prediction model were evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Internal validation was performed by the bootstrapping method. RESULTS The candidate prediction nomogram included predictors such as age, hepatic bile duct dilation, portal hypertension, and regular resection based on hepatic segments. The model demonstrated good discrimination ability and a satisfactory calibration curve, with an area under the ROC curve (AUC) of 0.818 (95% CI 0.7417-0.8958). According to DCA, this prediction model can predict the risk of BCs occurrence within a probability threshold range of 9% to 85% to achieve clinical net benefit. CONCLUSIONS A prognostic nomogram with good discriminative ability and high accuracy was developed and validated to predict BCs after ELRA in patients with end-stage HAE.
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Affiliation(s)
- Xin Lin
- Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, 830000, Xinjiang, China
| | - Ying-Mei Shao
- Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, 830000, Xinjiang, China
| | - Rui-Qing Zhang
- Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, 830000, Xinjiang, China
| | - Tuerganaili Aji
- Centre of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, China.
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, 830000, Xinjiang, China.
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Li J, Zhao H, Lv G, Aimulajiang K, Li L, Lin R, Aji T. Phenotype and function of MAIT cells in patients with alveolar echinococcosis. Front Immunol 2024; 15:1343567. [PMID: 38550591 PMCID: PMC10973110 DOI: 10.3389/fimmu.2024.1343567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
Mucosal-associated invariant T (MAIT) cells are a subpopulation of unconventional T cells widely involved in chronic liver diseases. However, the potential role and regulating factors of MAIT cells in alveolar echinococcosis (AE), a zoonotic parasitic disease by Echinococcus multilocularis (E. multilocularis) larvae chronically parasitizing liver organs, has not yet been studied. Blood samples (n=29) and liver specimens (n=10) from AE patients were enrolled. The frequency, phenotype, and function of MAIT cells in peripheral blood and liver tissues of AE patients were detected by flow cytometry. The morphology and fibrosis of liver tissue were examined by histopathology and immunohistochemistry. The correlation between peripheral MAIT cell frequency and serologic markers was assessed by collecting clinicopathologic characteristics of AE patients. And the effect of in vitro stimulation with E. multilocularis antigen (Emp) on MAIT cells. In this study, MAIT cells are decreased in peripheral blood and increased in the close-to-lesion liver tissues, especially in areas of fibrosis. Circulating MAIT exhibited activation and exhaustion phenotypes, and intrahepatic MAIT cells showed increased activation phenotypes with increased IFN-γ and IL-17A, and high expression of CXCR5 chemokine receptor. Furthermore, the frequency of circulating MAIT cells was correlated with the size of the lesions and liver function in patients with AE. After excision of the lesion site, circulating MAIT cells returned to normal levels, and the serum cytokines IL-8, IL-12, and IL-18, associated with MAIT cell activation and apoptosis, were altered. Our results demonstrate the status of MAIT cell distribution, functional phenotype, and migration in peripheral blood and tissues of AE patients, highlighting their potential as biomarkers and therapeutic targets.
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Affiliation(s)
- Jintian Li
- School of Public Healthy, Xinjiang Medical University, Urumqi, China
- State Key Laboratory of Pathogenesis, Prevention, and Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hanyue Zhao
- State Key Laboratory of Pathogenesis, Prevention, and Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary & Hydatid Disease, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Guodong Lv
- State Key Laboratory of Pathogenesis, Prevention, and Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Kalibixiati Aimulajiang
- State Key Laboratory of Pathogenesis, Prevention, and Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Liang Li
- State Key Laboratory of Pathogenesis, Prevention, and Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Renyong Lin
- State Key Laboratory of Pathogenesis, Prevention, and Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary & Hydatid Disease, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Tuerganaili Aji
- School of Public Healthy, Xinjiang Medical University, Urumqi, China
- State Key Laboratory of Pathogenesis, Prevention, and Treatment of Central Asian High Incidence Diseases, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary & Hydatid Disease, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Eren S, Aydın S, Kantarci M, Kızılgöz V, Levent A, Şenbil DC, Akhan O. Percutaneous management in hepatic alveolar echinococcosis: A sum of single center experiences and a brief overview of the literature. World J Gastrointest Surg 2023; 15:398-407. [PMID: 37032805 PMCID: PMC10080597 DOI: 10.4240/wjgs.v15.i3.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/18/2022] [Accepted: 02/14/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Hepatic alveolar echinococcosis (HAE) is a serious zoonotic infection that affects humans. It may have a tumor-like appearance at times. Percutaneous treatment of HAE patients is extremely relaxing for them. HAE is a significant human zoonotic infection caused by the fox tapeworm Echinococcus Multilocularis larvae. It possesses the characteristics of an invasive tumor-like lesion due to its infiltrative growth pattern and protracted incubation period. The disease is endemic over central Europe, Asia, and North America.
AIM To characterize HAE patients who were treated percutaneously, their outcomes, and the major technical features of percutaneous treatment in HAE.
METHODS Patients who were treated with percutaneous cyst drainage and/or percutaneous biliary drainage were included in the study. Uncorrected abnormal coagulation values and solid or non-infected HAE with minor necrotic change were excluded.
RESULTS Thirty-two patients underwent percutaneous cyst drainage, two patients underwent percutaneous biliary drainage, and four patients underwent percutaneous biliary drainage alone. Interventional radiology is utilized to drain echinococcal necrosis and abscesses within/without the liver, as well as diseased and clogged bile ducts.
CONCLUSION Percutaneous drainage of cyst contents and/or biliary channels using a minimally invasive technique is a very beneficial. Percutaneous cyst drainage with albendazole therapy improves quality of life in patients who are unable to undergo surgery, even when the mass resolves with long-term treatment.
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Affiliation(s)
- Suat Eren
- Department of Radiology, Faculty of Medicine, Atatürk University, Erzurum 25100, Turkey
| | - Sonay Aydın
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24100, Turkey
| | - Mecit Kantarci
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24100, Turkey
| | - Volkan Kızılgöz
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24100, Turkey
| | - Akın Levent
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24100, Turkey
| | - Düzgün Can Şenbil
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24100, Turkey
| | - Okan Akhan
- Department of Radiology, Hacettepe University, Ankara 06090, Turkey
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Zhang G, Mou Y, Fan H, Li W, Cao Y, Bao H. 7T Small Animal MRI Research for Hepatic Alveolar Echinococcosis. Top Magn Reson Imaging 2022; 31:53-59. [PMID: 36469640 DOI: 10.1097/rmr.0000000000000297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/28/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES 7T small animal magnetic resonance imaging (MRI) was used to analyze the growth characteristics of hepatic alveolar echinococcosis (HAE). METHODS A mouse model of HAE was established by intraperitoneal injection of alveolar Echinococcus tissue suspension. Ten mouse models successfully inoculated by ultrasound screening were selected. The mouse model was scanned with T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and diffusion-weighted imaging (DWI) sequence by 7T small animal MRI. Size, morphology, boundary, signal, and relationship with surrounding tissues of the lesions were recorded as characteristic alterations. Mice were killed at the end of the experiment, and the pathological specimens were taken for routine hematoxylin and eosin staining. RESULTS Lesions were mainly located in the right lobe of the liver. The multivesicular structure is the characteristic manifestation of this disease. In the liver, lesions invaded the portal vein and were mainly distributed at the hepatic hilum. The left branch of the portal vein was mainly invaded. The mean diameter of the lesions in the left lobe of the liver was larger than in other parts of the liver. The mean diameter of the cystic solid lesions was greater than the multilocular cystic lesions. HAE showed hypointense on T1WI, hyperintense on T2WI, and hypointense on DWI; the marginal zone of the lesion showed hyperintensity on DWI and grew toward the hilum. The MRI features of intraperitoneal lesions were similar to those of intrahepatic lesions. Intraperitoneal lesions increased faster than intrahepatic lesions in the same period. CONCLUSION Polyvesicular structure is a characteristic manifestation of hepatic alveolar echinococcosis in mice. The noninvasive monitoring of liver HAE in mice by 7T small animal MRI provides a visual basis for the diagnosis and treatment integration of HAE.
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Affiliation(s)
- Guanmi Zhang
- Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China; and
| | - Yalin Mou
- Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China; and
| | - Haining Fan
- Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Weixia Li
- Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China; and
| | - Yuntai Cao
- Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China; and
| | - Haihua Bao
- Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China; and
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Aydin F, Yalcin A, Karaman A, Sade R, Ozturk G, Alper F. Diagnostic and Management Perspectives in Alveolar Echinococcosis: Review of Literature. Eurasian J Med 2022; 54:10-15. [PMID: 36655439 PMCID: PMC11163348 DOI: 10.5152/eurasianjmed.2022.22308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/27/2022] [Indexed: 01/19/2023] Open
Abstract
Alveolar echinococcosis is a life-threatening zoonotic disease caused by Echinococcus multilocularis. The disease usually primarily involves the liver and shows tumor-like growth. Early diagnosis of alveolar echinococcosis is difficult because the disease is usually asymptomatic in the early stages. Untreated cases are fatal and result in death within 10 years of liver involvement. In the diagnosis of alveolar echinococcosis, the patient's medical history, radiological imaging findings, and serological and histopathological tests are used together. Radiological imaging methods are very important for early diagnosis and differential diagnosis of the disease. In this article, we wanted to review the diagnosis and treatment of alveolar echinococcosis and emphasize the importance of keeping it in mind, especially in cystic lesions of the liver, and the importance of early diagnosis of the disease.
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Affiliation(s)
- Fahri Aydin
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
| | - Ahmet Yalcin
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
| | - Adem Karaman
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
| | - Recep Sade
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
| | - Gurkan Ozturk
- Ataturk University, Faculty of Medicine, Department of General Surgery, Erzurum, Turkey
| | - Fatih Alper
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
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A J, Chai J, Shao Z, Zhao S, Wang H, A X, Yang J. Comparison of local ablation with Albendazole or laparoscopic hepatectomy combined with Albendazole in the treatment of early hepatic alveolar echinococcosis. Front Public Health 2022; 10:960635. [PMID: 36276387 PMCID: PMC9580460 DOI: 10.3389/fpubh.2022.960635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
Background Echinococcosis (E) is a zoonotic parasitic disease caused by the larval morphology of echinococcosis tapeworms. Among the recognized species, two are of medical importance-E. granulosus and E. multilocularis-causing cystic echinococcosis (CE) and alveolar echinococcosis (AE) in humans, respectively. Diagnosis of AE is based on clinical manifestation and epidemiological data, imaging techniques, histopathology and/or nucleic acid detection, and serology. At present, WHO guidelines suggest that benzimidazoles (BMZ) are mandatory in all AE patients, temporarily after complete resection of the lesions and for life in all other AE cases. Interventional procedures should be preferred to palliative surgery whenever possible, and radical surgery is the first choice in all cases suitable for total resection of the lesion. However, some research centers have proposed that local ablation (LA) including radiofrequency ablation (RFA) and microwave ablation (MWA) is no less effective than radical surgery or better than simple medication in the early stage hepatic AE (WHO-IWGE PNM classification of AE: P1N0M0). This study attempted to compare the real efficacy of the above treatment methods, so as to find the best treatment for this kind of patient. Methods The data of patients with hepatic AE who underwent laparoscopic hepatectomy (LH), RFA, and MWA in Qinghai Provincial People's Hospital from January 2015 to January 2021 were collected. At the same time, the cases treated with Albendazole (ABZ) were collected together with the institution for disease control and prevention. According to the treatment methods, the above cases were divided into LH group, RFA group, MWA group, and medication group. The basic data and postoperative recovery indices of the four groups were compared, respectively. Results A total of 199 patients with hepatic AE were enrolled in this study, including 90 males and 109 females. The youngest was 5 years old and the oldest was 66 years old, with an average of 33.41±14.64 years old. 20.6% of the patients had hepatitis B (41/ 199). A total of 45 patients underwent ultrasound-guided RFA, 47 patients underwent ultrasound-guided MWA, 51 patients were treated with ABZ, and 56 patients underwent LH. There were no significant differences in baseline characteristics among the four groups (p > 0.05). The RFA group and MWA group were more advantageous than the LH group regarding operation time and incidence of postoperative complications (p < 0.05). But recurrence rate of the lesion in the LH group was significantly lower than the RFA group, MWA group, and medication group. However, there was no significant difference in recurrence-free survival time among the four groups (p >0.05). Conclusion LH has a significant effect in the treatment of early-stage hepatic AE, especially in terms of recurrence which is significantly better than LA and medication alone. Follow-up and adherence to ABZ therapy are essential if conservative treatment is to achieve better outcomes.
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Affiliation(s)
- Jide A
- Department of Hepatic Hydatidosis, Qinghai Provincial People's Hospital, Xining, China
| | - Jinping Chai
- Department of Internal Medicine-Cardiovascular, Qinghai Provincial People's Hospital, Xining, China
| | - Zongping Shao
- Department of Anesthesiology, The First People's Hospital of Kashi Prefecture, Kashi, China
| | - Shunyun Zhao
- Department of Hepatic Hydatidosis, Qinghai Provincial People's Hospital, Xining, China
| | - Hao Wang
- Intensive Care Unit, Qinghai Provincial People's Hospital, Xining, China
| | - Xiangren A
- Department of Clinical Laboratory, Qinghai Provincial People's Hospital, Xining, China
- Department of Clinical Laboratory, Qinghai Province Key Laboratory of Laboratory Medicine, Xining, China
- Department of Clinical Laboratory, Qinghai Clinical Medical Research Center, Xining, China
| | - Jinyu Yang
- Department of Hepatic Hydatidosis, Qinghai Provincial People's Hospital, Xining, China
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Comparative genomic analysis of Echinococcus multilocularis with other tapeworms. Biologia (Bratisl) 2022. [DOI: 10.1007/s11756-022-01120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Primary Infection by E. multilocularis Induces Distinct Patterns of Cross Talk between Hepatic Natural Killer T Cells and Regulatory T Cells in Mice. Infect Immun 2022; 90:e0017422. [PMID: 35862712 PMCID: PMC9387288 DOI: 10.1128/iai.00174-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The larval stage of the helminthic cestode Echinococcus multilocularis can inflict tumor-like hepatic lesions that cause the parasitic disease alveolar echinococcosis in humans, with high mortality in untreated patients. Opportunistic properties of the disease have been established based on the increased incidence in immunocompromised patients and mouse models, indicating that an appropriate adaptive immune response is required for the control of the disease. However, cellular interactions and the kinetics of the local hepatic immune responses during the different stages of infection with E. multilocularis remain unknown. In a mouse model of oral infection that mimics the normal infection route in human patients, the networks of the hepatic immune response were assessed using single-cell RNA sequencing (scRNA-seq) of isolated hepatic CD3+ T cells at different infection stages. We observed an early and sustained significant increase in natural killer T (NKT) cells and regulatory T cells (Tregs). Early tumor necrosis factor (TNF)- and integrin-dependent interactions between these two cell types promote the formation of hepatic lesions. At late time points, downregulation of programmed cell death protein 1 (PD-1) and ectonucleoside triphosphate diphosphohydrolase 1 (ENTPD1)-dependent signaling suppress the resolution of parasite-induced pathology. The obtained data provide fresh insight into the adaptive immune responses and local regulatory pathways at different infection stages of E. multilocularis in mice.
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Laparoscopic Treatment Strategies for Liver Echinococcosis. Infect Dis Ther 2022; 11:1415-1426. [PMID: 35751754 PMCID: PMC9334471 DOI: 10.1007/s40121-022-00664-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 05/31/2022] [Indexed: 12/13/2022] Open
Abstract
Liver echinococcosis is clinically mainly composed of hepatic cystic echinococcosis (CE) and hepatic alveolar echinococcosis (AE). At present, laparoscopy has been comprehensively applied in the treatment of two types of liver echinococcosis. For hepatic CE treatment, both laparoscopic total pericystectomy and laparoscopic hepatectomy can achieve radical results, but the former is considered the first choice owing to its being more minimally invasive; laparoscopic subtotal pericystectomy and laparoscopic partial pericystectomy can be accepted as complementary options, considering the presence of complicated cysts and the level of laparoscopic technique in remote hospitals; laparoscopic cystectomy is simple, but it is not currently recommended for treatment of hepatic CE owing to poor efficacy and high risk of postoperative complications. For hepatic AE treatment, laparoscopy not only achieves the same radical effect as open surgery in selected patients, but also is more minimally invasive, so it has a better prospect.
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12
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Yamamoto Y, Sakamoto Y, Kamiyama T, Nagatsu A, Asahi Y, Orimo T, Kakisaka T, Kamachi H, Otsuka T, Mitsuhashi T, Taketomi A. A case of alveolar echinococcosis in the liver that ruptured into the pericardium treated by a combination of hepatectomy and albendazole. Surg Case Rep 2022; 8:63. [PMID: 35394220 PMCID: PMC8993950 DOI: 10.1186/s40792-022-01417-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Alveolar echinococcosis (AE) is a rare parasitic disease caused by the larva of Echinococcus multilocularis. It nearly always occurs in the liver, and cardiac involvement is extremely rare. Liver resection is the most effective intervention for AE because the only potentially curative treatment is removal of the lesion. Even when complete resection is not performed, long-term survival can be expected after surgical removal of most of the lesion with lifelong administration of albendazole (ABZ). Case presentation A 64-year-old man who lived in Hokkaido was referred to our hospital due to abnormalities in biliary enzymes. According to the findings from enhanced computed tomography and magnetic resource imaging of the abdomen, transthoracic echocardiography and serologic tests, he was diagnosed with hepatic AE with rupture into the pericardium. He underwent extended left hemi-hepatectomy with reconstruction of the inferior vena cava and opening of the pericardium with drainage as reduction surgery. Pathological examination revealed echinococcal infection in the pericardium as well as the liver. He started chemotherapy with 400 mg ABZ per Day 67 days after surgery. Although the surgical margin was positive in the pathological findings, he was alive 19 months later with no regrowth of the echinococcal lesion. Conclusion AE with cardiac involvement is extremely rare. Even if the complete removal of cardiac-involved AE is not possible, surgical debulking with lifelong ABZ treatment can successfully manage the disease.
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Affiliation(s)
- Yoichi Yamamoto
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan.
| | - Yuzuru Sakamoto
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan.
| | - Toshiya Kamiyama
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan
| | - Akihisa Nagatsu
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan
| | - Yoh Asahi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan
| | - Tatsuya Orimo
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan
| | - Tatsuhiko Kakisaka
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan
| | - Hirofumi Kamachi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan
| | - Takuya Otsuka
- Department of Surgical Pathology, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan
| | - Tomoko Mitsuhashi
- Department of Surgical Pathology, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan
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13
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Deng X, Wang JJ, Huang HS, Zhang LQ, Wang ZX, Wang KQ, Yang XZ, He SS, Li Z, Gao Y, Wang HJ, Fan HN, Cairang Y. Analysis of the efficacy of microwave ablation in the treatment of early hepatic alveolar echinococcosis: A propensity score matching based study. Acta Trop 2022; 228:106307. [PMID: 35016884 DOI: 10.1016/j.actatropica.2022.106307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/28/2021] [Accepted: 01/06/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND To explore the efficacy of microwave ablation (MWA) in the treatment of hepatic alveolar echinococcosis (HAE) with a diameter of ≤5 cm. METHOD From June 2014 to January 2020, patients diagnosed with HAE were retrospectively analyzed. After balancing the confounding factors by propensity score matching (PSM) , the patients were divided into MWA group (n = 20) and radical operation group (n = 20) by 1:1 matching. The safety and effectiveness of MWA were assessed by comparing the differences between the two groups in terms of postoperative general laboratory indices, grading of postoperative complications, length of postoperative hospitalization, the outcome of treatment, and disease recurrence. RESULT After PSM, all confounders were not statistically different (P>0.05) . Compared with the radical surgery group, patients in the MWA group had lower postoperative ALT and WBC elevations (P<0.001) , shorter postoperative hospital stay (P<0.001) ) , lower hospital costs (P<0.001) . The effective rate of the two groups was 100%. There was no statistical difference in the incidence of postoperative complications and recurrence rate (P>0.05). CONCLUSION MWA is a safe and effective means of treating HAE ≤ 5 cm in diameter.
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14
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Özdemir S, Aksungur N, Altundaş N, Kara S, Korkut E, Özkaraca M, Sefa Mendil A, Öztürk G. Genome-wide profiling of the expression of serum derived exosomal circRNAs in patients with hepatic alveolar echinococcosis. Gene 2022; 814:146161. [PMID: 34995736 DOI: 10.1016/j.gene.2021.146161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/30/2021] [Accepted: 12/06/2021] [Indexed: 01/22/2023]
Abstract
The patients with hepatic alveolar echinococcosis is poorly detected due to invasive and slow growth. Thus, early diagnosis of hepatic alveolar echinococcosis is so important for patients. Circular RNAs are crucial types of the non-coding RNA. Recent studies have provided serum-derived exosomal circRNAs as potential biomarkers for detection of various diseases. The clinical importance of exosomal circRNAs in hepatic alveolar echinococcosis have never been explored before. Here, we investigated the serum-derived exosomal circRNAs in the diagnosis of hepatic alveolar echinococcosis. Firstly, High-throughput Sequencing was performed using 9 hepatic alveolar echinococcosis and 9 control samples to detect hepatic alveolar echinococcosis related circRNAs. Afterwards, bioinformatic analyzes were performed to identify differentially expressed circRNAs and pathway analyzes were performed. Finally, validation of the determined circRNAs was performed using RT-PCR. The sequencing data indicated that 59 differentially expressed circRNAs; 31 up-regulated and 28 down-regulated circRNA in hepatic alveolar echinococcosis patients. The top 5 up-regulated and down-regulated circRNAs were selected for validation by RT-qPCR assay. As a result of the verification, circRNAs that were significantly up- and down-regulated showed an expression profile consistent with the results obtained. Importantly, our findings suggested that identified exosomal circRNAs could be a potential biomarker for the detection of hepatic alveolar echinococcosis serum and may help to understand the pathogenesis of hepatic alveolar echinococcosis.
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Affiliation(s)
- Selçuk Özdemir
- Atatürk University, Faculty of Veterinary Medicine, Department of Genetics, Erzurum, Turkey; Heinrich Heine University, Faculty of Medicine, Department of Gastroenterology, Hepatology and Infection, Düsseldorf, Germany.
| | - Nurhak Aksungur
- Atatürk University, Faculty of Medicine, Department of General Surgery, Erzurum, Turkey
| | - Necip Altundaş
- Atatürk University, Faculty of Medicine, Department of General Surgery, Erzurum, Turkey
| | - Salih Kara
- Atatürk University, Faculty of Medicine, Department of General Surgery, Erzurum, Turkey
| | - Ercan Korkut
- Atatürk University, Faculty of Medicine, Department of General Surgery, Erzurum, Turkey
| | - Mustafa Özkaraca
- Sivas Cumhuriyet University, Faculty of Veterinary Medicine, Department of Pathology, Sivas, Turkey
| | - Ali Sefa Mendil
- Erciyes University, Faculty of Veterinary Medicine, Department of Pathology, Kayseri, Turkey
| | - Gürkan Öztürk
- Atatürk University, Faculty of Medicine, Department of General Surgery, Erzurum, Turkey
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15
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Hotz JF, Peters L, Kapp-Schwörer S, Theis F, Eberhardt N, Essig A, Grüner B, Hagemann JB. Evaluation of Serological Markers in Alveolar Echinococcosis Emphasizing the Correlation of PET-CTI Tracer Uptake with RecEm18 and Echinococcus-Specific IgG. Pathogens 2022; 11:pathogens11020239. [PMID: 35215182 PMCID: PMC8880252 DOI: 10.3390/pathogens11020239] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 02/05/2023] Open
Abstract
Human alveolar echinococcosis (AE), which is caused by the cestode Echinococcus (E.) multilocularis, is an epidemiologically relevant issue in modern medicine and still poses a diagnostic and therapeutic challenge. Since diagnosis mainly relies on imaging procedures and serological testing, we retrospectively and comparatively analyzed the performance of an Echinococcus IgG screening ELISA, whole serum IgE, and two specific confirmatory ELISA platforms using the defined E. multilocularis antigens Em2-Em18 (Em2+) and recombinant Em18 (recEm18). With special emphasis on the clinical usefulness of recEm18, we correlated the laboratory results with clinical characteristics and imaging findings in a large and well-characterized cohort of N = 124 AE patients, who were followed over several years after either surgical plus subsequent pharmacological treatment or pharmacotherapy alone. All patients had routinely received PET-CTI every two years. Our data reveal strong correlations for both Echinococcus IgG and recEm18 with tracer uptake in PET-CTI and parasitic lesion size and number, suggesting additional clinical usefulness of recEm18 for certain constellations only, while IgG and Em2+ still appear reasonable and sensitive screening methods for initial diagnosis of AE. With this study, we aim to contribute to further optimizing medical care of AE patients. For instance, it might be reasonable to consider the replacement of some PET-CTI follow-ups by imaging procedures with less radiation exposure or serological means alone. Further studies that clarify the correlation of serological markers with ultrasound criteria might be particularly useful, and further retrospective as well as prospective investigations are justified in this context.
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Affiliation(s)
- Julian Frederic Hotz
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, A-1090 Vienna, Austria
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
- Correspondence: (J.F.H.); (B.G.); (J.B.H.)
| | - Lynn Peters
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
| | - Silke Kapp-Schwörer
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
| | - Frauke Theis
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
| | - Nina Eberhardt
- Department of Nuclear Medicine, Ulm University Hospital, D-89081 Ulm, Germany;
| | - Andreas Essig
- Institute of Medical Microbiology and Hygiene, Ulm University Hospital, D-89081 Ulm, Germany;
| | - Beate Grüner
- Division of Infectious Diseases, Department of Internal Medicine III, Ulm University Hospital, D-89081 Ulm, Germany; (L.P.); (S.K.-S.); (F.T.)
- Correspondence: (J.F.H.); (B.G.); (J.B.H.)
| | - Jürgen Benjamin Hagemann
- Institute of Medical Microbiology and Hygiene, Ulm University Hospital, D-89081 Ulm, Germany;
- Correspondence: (J.F.H.); (B.G.); (J.B.H.)
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16
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Deng X, Wang JJ, Wang ZX, Fan HN, Wang HJ, Huang HS, Wang KQ, Yang XZ, Han JW, Cairang Y. Effectiveness and safety of ultrasound-guided percutaneous microwave ablation for hepatic alveolar echinococcosis. BMC Med Imaging 2022; 22:27. [PMID: 35151256 PMCID: PMC8841114 DOI: 10.1186/s12880-022-00752-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background Microwave ablation (MWA) is a popular therapy for liver malignant tumor in recent years. Few studies have been conducted on its use in the treatment of hepatic alveolar echinococcosis (HAE). The study aims to evaluate the efficacy and safety of MWA in the treatment of HAE. Methods This study analyzed the data of 45 patients (mean age, 38 ± 2 years; 24 males) diagnosed with HAE and underwent MWA treatment between June 2014 to December 2019. The patients after MWA were examined by CT or MRI [follow-up: 32 months (IQR 23–48.5)] to determine whether the lesions were relapsed and to evaluate the therapeutic effect of MWA. The safety of MWA was evaluated by monitoring postoperative complications. Clinical data, such as patient demographics, imaging features of the lesions, relevant findings of laboratory tests before and after ablation, and information related to ablation, were collected and analyzed. Paired-sample t tests and paired-sample Wilcoxon signed-rank tests were used to compare relevant laboratory indicators before and after MWA. Results MWA was applied to 57 HAE lesions in 45 patients. The median size of lesions was 3.42 cm (IQR2.85–4.41). The rate of complete ablation was 100% (57/57). The median follow-up time was 32 months (IQR 23–48.5). The recurrence rate was 13% (6/45), and the median time of recurrence was 22 months. The rate of minor complications was 11.1% (5/45), and there were no major complications and deaths. Compared to preoperative, ALB, RBC, HBG, and PLT were decreased (p < 0.001); ALT, TB, DB, and WBC were increased (p < 0.001); and no statistically difference in PT, APTT, and INR (p > 0.05). Conclusions MWA might be a safe and effective way to cure HAE. Meanwhile, it provides a new option and a new way of thinking about treatment for patients with HAE.
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17
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A J, Zhang J, Chai J, Zhao S, Wang H, A X, Yang J. Comparison of the Efficacy of Anatomic and Non-anatomic Hepatectomy for Hepatic Alveolar Echinococcosis: Clinical Experience of 240 Cases in a Single Center. Front Public Health 2022; 9:816704. [PMID: 35211454 PMCID: PMC8863048 DOI: 10.3389/fpubh.2021.816704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hepatic alveolar echinococcosis (AE) is a zoonotic parasitic disease. There are more than 16,000 new cases each year, approximately 60 million people are threatened, and the annual direct economic loss is RMB 3 billion. The prevalence of AE in some areas of the Qinghai–Tibet Plateau is as high as 6.0%. Radical resection, including anatomic and non-anatomic hepatectomy, for advanced AE can significantly prolong the survival time of patients. However, there is no literature compared the efficacy of anatomic and non-anatomic hepatectomy. Therefore, by comparing various clinical evaluation indices between anatomic and non-anatomic hepatectomy, this study explored the short-term and long-term efficacy of these two surgical methods for AE. Methods The clinical data of patients with AE who underwent radical hepatectomy at Qinghai Provincial People's Hospital from January 2015 to January 2021 were retrospectively analyzed. The patients were divided into two groups by surgical method, that were, non-anatomic hepatectomy group and anatomic hepatectomy group. We compared these two groups focusing on basic preoperative data, such as age, sex, lesion size, and liver function parameters; main intraoperative evaluation indices, such as operation time, intraoperative porta hepatis occlusion time, intraoperative blood loss, and blood transfusion; and postoperative recovery evaluation indicators, such as postoperative liver function, incidence of surgical complications, and AE recurrence. Results A total of 240 patients were enrolled in this study, including 123 in anatomic hepatectomy group and 117 in non-anatomic hepatectomy group. There were no significant differences (P > 0.05) between baseline characteristics. Anatomic hepatectomy group was advantageous than non-anatomic hepatectomy group regarding intraoperative blood loss (P < 0.001), blood transfusion (P < 0.001), and porta hepatis occlusion time (P < 0.001). There were statistically significant differences in postoperative liver function (aspartate aminotransferase: P < 0.001; alanine aminotransferase: P < 0.001), surgical complications (P < 0.001), and AE recurrence rate (P = 0.003). The median survival of patients in the anatomic hepatectomy group was 66 months, compared to 65 months in the non-anatomic hepatectomy group (χ2 = 4.662, P = 0.031). Conclusions Anatomic hepatectomy was not only safe for AE but also showed better short-term and long-term superiority than non-anatomic hepatectomy.
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Affiliation(s)
- Jide A
- Medical College of Soochow University, Suzhou, China
- Department of Hepatic Hydatidosis, Qinghai Provincial People's Hospital, Xining, China
| | - Jingni Zhang
- Department of Hepatic Hydatidosis, Qinghai Provincial People's Hospital, Xining, China
| | - Jinping Chai
- Department of Internal Medicine-Cardiovascular, Qinghai Provincial People's Hospital, Xining, China
| | - Shunyun Zhao
- Department of Hepatic Hydatidosis, Qinghai Provincial People's Hospital, Xining, China
| | - Hao Wang
- Intensive Care Unit, Qinghai Provincial People's Hospital, Xining, China
| | - Xiangren A
- Department of Clinical Laboratory, Qinghai Province Key Laboratory of Laboratory Medicine, Qinghai Clinical Medical Research Center, Qinghai Provincial People's Hospital, Xining, China
- Xiangren A
| | - Jinyu Yang
- Department of Hepatic Hydatidosis, Qinghai Provincial People's Hospital, Xining, China
- *Correspondence: Jinyu Yang
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18
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Yang HC, Xing ZK, Shao H, Tan XW, Wang EQ, Liao Y, Chen HJ, Wu XW, Chen XL, Zhang SJ. The expression of cytokeratin and apoptosis-related molecules in echinococcosis related liver injury. Mol Biochem Parasitol 2022; 248:111455. [PMID: 35016896 DOI: 10.1016/j.molbiopara.2022.111455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/29/2021] [Accepted: 01/06/2022] [Indexed: 10/25/2022]
Abstract
The study aimed to investigate the expression of cytokeratin and apoptosis-related molecules in the livers of two types of hepatic echinococcosis mice models and to preliminarily explore the relationship between the expression of cytokeratin and apoptosis in echinococcosis related liver injury. We established a mouse model infected by Echinococcus granulosus and Echinococcus multilocularis and observed the expression of cytokeratin and apoptosis related proteins in the two types of hepatic echinococcosis tissues during different stages by immunohistochemical staining. A co-culture model was established using normal hepatocytes and different concentrations of E. granulosus and E. multilocularis protoscoleces. Cell Counting Kit-8 was used to detect cell proliferation, flow cytometry was used to detect hepatocyte apoptosis, and western blot was used to quantify cytokeratin and apoptosis-related proteins, such as caspase3, caspase9, Bcl-2, and Bax. Surgical specimens were obtained from patients with hepatic echinococcosis to analyze the expressions of cytokeratin, caspase3, caspase9, Bcl-2, and Bax by western blot. The expressions of cytokeratin and caspase3 were analyzed by immunohistochemistry. The qRT-PCR method was used to determine the expression of CK8 and CK18 in the liver tissues. In vivo experiments showed that compared to that in the control group, the cytokeratin and caspase3 proteins in the liver tissues of the two types of hepatic echinococcosis were strongly expressed around the lesions of liver echinococcosis; there was a difference between cytokeratin expression of the two different echinococcosis parasites in the liver. Echinococcus granulosus and Echinococcus multilocularis in the co-culture model in vitro could promote the expression of CK, caspase3, caspase9, and Bax protein, decrease the expression of Bcl-2, promote hepatocyte apoptosis, and inhibit cell proliferation; in clinical samples, we found that compared with that in the normal tissues, the expression of cytokeratin, caspase3, caspase9, and Bax in echinococcus tissues was high, but that in Bcl-2 was low. Furthermore, the expression of CK8 and CK18 mRNA were higher in echinococcus tissues than that in the normal tissues and immunohistochemistry analysis also showed that cytokeratin and caspase3 levels were higher in echinococcus tissues than that in the normal tissues. The expression of cytokeratin and apoptosis-related molecules, reflecting liver damage, is high in the liver and is caused due to hepatic echinococcosis. This study provides the first evidence of cytokeratin could be useful for evaluating liver tissue damage caused by echinococcus infection.
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Affiliation(s)
- H C Yang
- School of Medicine, Shihezi University, Shihezi, 832008, Xinjiang, China; Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832008, Xinjiang, China
| | - Z K Xing
- School of Medicine, Shihezi University, Shihezi, 832008, Xinjiang, China; Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832008, Xinjiang, China
| | - H Shao
- School of Medicine, Shihezi University, Shihezi, 832008, Xinjiang, China
| | - X W Tan
- School of Medicine, Shihezi University, Shihezi, 832008, Xinjiang, China
| | - E Q Wang
- School of Medicine, Shihezi University, Shihezi, 832008, Xinjiang, China
| | - Y Liao
- School of Medicine, Shihezi University, Shihezi, 832008, Xinjiang, China
| | - H J Chen
- School of Medicine, Shihezi University, Shihezi, 832008, Xinjiang, China
| | - X W Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832008, Xinjiang, China
| | - X L Chen
- Department of Immunology, School of Medicine, Shihezi University, Shihezi, 832002, Xinjiang, China
| | - S J Zhang
- Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832008, Xinjiang, China.
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19
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Fakhar M, Keighobadi M, Hezarjaribi HZ, Montazeri M, Banimostafavi ES, Sayyadi S, Ghaffari Hamadani MM, Sharifpour A, Tabaripour R, Asadi S, Soosaraei M, Khasseh AA. Two decades of echinococcosis/hydatidosis research: Bibliometric analysis based on the web of science core collection databases (2000-2019). Food Waterborne Parasitol 2021; 25:e00137. [PMID: 34849415 PMCID: PMC8608866 DOI: 10.1016/j.fawpar.2021.e00137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/31/2021] [Accepted: 11/07/2021] [Indexed: 11/29/2022] Open
Abstract
Echinococcus granulosus sensu lato and Echinococcus multilocularis are responsible for serious health and economic implications for humans and animals. This study was designed to conduct a bibliometric analysis of global research on echinococcosis/hydatidosis included in the Web of Science Core Collection databases from 2000 to 2019. A total of 7066 relevant articles between 2000 and 2019 were identified. Most articles were published in 2015 (502 articles), 2017 (492 articles) and 2018 (493 articles), with the Veterinary Parasitology journal publishing the largest number of articles (237). Researchers from Xinjiang Medical University, China authored the most articles (388) in the field. Authors Craig, P.S. and Deplazes, P. were the most active in publishing143 and 126 hydatid cyst research papers, respectively. The most echinococcosis/hydatidosis publications originated from Turkey, China and Iran, with 1210, 708 and 531 articles, respectively. The highest levels of research collaboration were evident between China- England, China-France, England-France, China-Australia, and China-Japan. Also, the top researchers in this field had relatively extensive collaborations with each other. Our bibliometric analysis provides a picture of the scientific research into the echinococcosis/hydatidosis field. Further multi-national collaborative research efforts in this field should show promising progress in the future.
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Affiliation(s)
- Mahdi Fakhar
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Iranian National Registry Center for Hydatid Cyst (INRCHC), Department of Radiology, Imam Khomeini Hospital, Mazandaran Branch, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoud Keighobadi
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hajar Ziaei Hezarjaribi
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Corresponding authors at: Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, School of Medicine, Mazandaran University of Medical Sciences, Farah-Abad Road, PO Box: 48471-91971, Sari, Iran.
| | - Mahbobeh Montazeri
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Corresponding authors at: Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, School of Medicine, Mazandaran University of Medical Sciences, Farah-Abad Road, PO Box: 48471-91971, Sari, Iran.
| | - Elham S. Banimostafavi
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Iranian National Registry Center for Hydatid Cyst (INRCHC), Department of Radiology, Imam Khomeini Hospital, Mazandaran Branch, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahram Sayyadi
- Iranian National Registry Center for Hydatid Cyst (INRCHC), Department of Surgery, Mazandaran Branch, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad M. Ghaffari Hamadani
- Iranian National Registry Center for Hydatid Cyst (INRCHC), Department of Surgery, Mazandaran Branch, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Sharifpour
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Iranian National Registry Center for Hydatid Cyst (INRCHC), Department of Radiology, Imam Khomeini Hospital, Mazandaran Branch, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rabeeh Tabaripour
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Samira Asadi
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoud Soosaraei
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali A. Khasseh
- Department of Knowledge and Information Sciences, Payame Noor University, Tehran, Iran
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20
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Maca against Echinococcosis?-A Reverse Approach from Patient to In Vitro Testing. Pathogens 2021; 10:pathogens10101335. [PMID: 34684284 PMCID: PMC8537204 DOI: 10.3390/pathogens10101335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
Drug-based treatment of alveolar echinococcosis (AE) with benzimidazoles is in most cases non-curative, thus has to be taken lifelong. Here, we report on a 56-year-old male AE patient who received standard benzimidazole treatment and biliary plastic stents, and additionally self-medicated himself with the Peruvian plant extract Maca (Lepidium meyenii). After 42 months, viable parasite tissue had disappeared. Based on this striking observation, the anti-echinococcal activity of Maca was investigated in vitro and in mice experimentally infected with Echinococcus multilocularis metacestodes. Albendazole (ABZ)-treated mice and mice treated with an ABZ+Maca combination exhibited a significantly reduced parasite burden compared to untreated or Maca-treated mice. As shown by a newly established UHPLC-MS/MS-based measurement of ABZ-metabolites, the presence of Maca during the treatment did not alter ABZ plasma levels. In vitro assays corroborated these findings, as exposure to Maca had no notable effect on E. multilocularis metacestodes, and in cultures of germinal layer cells, possibly unspecific, cytotoxic effects of Maca were observed. However, in the combined treatments, Maca inhibited the activity of ABZ in vitro. While Maca had no direct anti-parasitic activity, it induced in vitro proliferation of murine spleen cells, suggesting that immunomodulatory properties could have contributed to the curative effect seen in the patient.
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21
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Abstract
Hepatic alveolar echinococcosis (HAE) is a rare but severe zoonosis caused by the pseudotumoral intrahepatic development of the larval stage of the tapeworm Echinococcus multilocularis. HAE is present only in the Northern Hemisphere, predominantly in China. Currently, there is a significant resurgence of cases in historically endemic areas associated with emergence of HAE in countries not previously concerned. Today, in European countries, HAE is often discovered by chance; however, clinicians should be made aware of opportunistic infections that progressively emerged recently as a result of therapeutic or pathological immunosuppression. Ultrasonography is the key first-line diagnostic procedure, with specific serology providing confirmation in 95% of the cases. Albendazole, only parasitostatic, is the mainstay for treatment. Surgical resection, if feasible, is the gold standard for treatment, and more patients are currently eligible for this option because of an earlier diagnosis. The prognosis has considerably improved but remains poor in countries where access to care is less favorable.
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Affiliation(s)
- Solange Bresson-Hadni
- Gastroenterology and Hepatology, Faculty of Medicine, University Hospitals of Geneva, Switzerland.,Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University Hospitals of Geneva, Faculty of Medicine, Switzerland.,Laboratory of Parasitology-Mycology, National Reference Center for Echinococcosis, University Hospital of Besançon, Besançon, France
| | - Laurent Spahr
- Gastroenterology and Hepatology, Faculty of Medicine, University Hospitals of Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University Hospitals of Geneva, Faculty of Medicine, Switzerland
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22
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Aini A, Yimingjiang M, Yasen A, Ran B, Jiang T, Li X, Wang J, Abulizi A, Li Z, Shao Y, Aji T, Wen H. Quantitative evaluation of range and metabolic activity of hepatic alveolar echinococcosis lesion microenvironment using PET/CT and multi-site sampling method. BMC Infect Dis 2021; 21:702. [PMID: 34301188 PMCID: PMC8299608 DOI: 10.1186/s12879-021-06366-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/28/2021] [Indexed: 02/07/2023] Open
Abstract
Background Alveolar echinococcosis (AE) lesion microenvironment (LME) is crucial site where parasite-host interactions happen and of great significance during surgery and obtaining liver samples for basic research. However, little is known about quantification of LME range and its’ metabolic activity regarding different lesion characteristics. Methods A prospective and retrospective analysis of LME from surgical AE patients was performed. Patients (n = 75) received abdominal computed tomography (CT) and position emission tomography/computed tomography using 18F-fluodeoxyglucose (18F-FDG-PET/CT) within 1 week prior to surgery. Semiquantitatively, calcification was clustered with 0%, < 50% and ≥ 50% degrees at lesion periphery; liquefaction was clustered with 0%, < 50%, 50 ~ 75%, ≥75% degrees at lesion center using volumetric ratio. Tumor to background ratio (TBR) of 18F-FDG standard uptake value (SUV, n = 75) was calculated, and range of 18F-FDG uptake area was measured; Multi-site sampling method (MSS, n = 35) was introduced to obtain histological slides to evaluate immune cell infiltrative ranges. Results Altogether six major lesion groups have been identified (A: 0% calcified, 0% liquefied; B: ≥50% calcified, 0% liquefied; C: < 50% calcified, < 50% liquefied; D: ≥50% calcified, < 50% liquefied; E: < 50% calcified, 50 ~ 75% liquefied; F: ≥50% calcified, ≥75% liquefied). Statistically, TBR values respectively were 5.1 ± 1.9, 2.7 ± 1.2, 4.2 ± 1.2, 2.7 ± 0.7, 4.6 ± 1.2, 2.9 ± 1.1 in groups A ~ F, and comparisons showed A > B, A > D, A > F, E > B, E > D, E > F, C > B, C > D, C > F (P < 0.05); LME ranges indicated by PET/CT respectively were 14.9 ± 3.9, 10.6 ± 1.5, 12.3 ± 1.1, 7.8 ± 1.6, 11.1 ± 2.3, 7.0 ± 0.4 mm in groups A ~ F, and comparisons showed A > B, A > D, A > F, A > E, C > B, C > D, C > F, E > D, E > F, B > D, B > F (P < 0.05); LME ranges indicated by MSS respectively were 17.9 ± 4.9, 13.0 ± 2.7, 11.9 ± 2.6, 6.0 ± 2.2, 11.0 ± 4.1, 6.0 ± 2.2 mm in groups A ~ F, and comparisons showed A > C, A > D, A > F, B > D, B > F, C > D, C > F (P < 0.05). Generally, less calcifications indicated higher TBR values and wider LME ranges; and, severer liquefactions indicated smaller LME ranges. Additionally, patients with previous medication history had lower TBR values. Conclusions PET/CT and MSS method showed distinct TBRs and LME ranges for different calcifications and liquefactions. This study would be able to provide references for both surgical resections of lesions and more accurate sample acquisitions for basic research targeted to immunology. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06366-3.
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Affiliation(s)
- Abudusalamu Aini
- Hepatobiliary and Echinococcosis Surgery Department, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, China
| | - Maiweilidan Yimingjiang
- Department of Pathology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Aimaiti Yasen
- Hepatobiliary and Echinococcosis Surgery Department, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, China
| | - Bo Ran
- Hepatobiliary and Echinococcosis Surgery Department, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Tiemin Jiang
- Hepatobiliary and Echinococcosis Surgery Department, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaohong Li
- Department of Nuclear Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jian Wang
- Radiology Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abuduaini Abulizi
- Hepatobiliary and Echinococcosis Surgery Department, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhide Li
- Hepatobiliary and Echinococcosis Surgery Department, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yingmei Shao
- Hepatobiliary and Echinococcosis Surgery Department, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,WHO Collaboration Center on Prevention and Management of Echinococcosis, Clinical Medical Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Tuerganaili Aji
- Hepatobiliary and Echinococcosis Surgery Department, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China. .,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China. .,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China. .,WHO Collaboration Center on Prevention and Management of Echinococcosis, Clinical Medical Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Hao Wen
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, China. .,WHO Collaboration Center on Prevention and Management of Echinococcosis, Clinical Medical Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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23
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Sun T, He Y, Shen S, Wang W. Two-stage hepatectomy combined with middle hepatic vein reconstruction in a patient with complicated hepatic alveolar echinococcosis. Asian J Surg 2021; 44:1405-1406. [PMID: 34312050 DOI: 10.1016/j.asjsur.2021.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/08/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Ting Sun
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, PR China
| | - Yang He
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, PR China
| | - Shu Shen
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, PR China
| | - Wentao Wang
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, PR China.
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24
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Liu C, Fan H, Ge RL. A Case of Human Hepatic Alveolar Echinococcosis Accompanied by Lung and Brain Metastases. THE KOREAN JOURNAL OF PARASITOLOGY 2021; 59:291-296. [PMID: 34218601 PMCID: PMC8255489 DOI: 10.3347/kjp.2021.59.3.291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/09/2021] [Indexed: 01/14/2023]
Abstract
Alveolar echinococcosis (AE) is considered as a fatal zoonosis caused by the larvae of Echinococcus multilocularis. The lungs and brain are the most common metastatic organs. We report a human case of hepatic alveolar echinococcosis accompanied by lung and brain metastasis. In particular, the patient had a history of tuberculosis and the lung lesions were easily misdiagnosed as lung abscesses. The lesions of liver and lung underwent radical resection and confirmed as alveolar echinococcosis by pathological examination. The patient had no surgical complications after operation and was discharged after symptomatic treatment. Unfortunately, the patient later developed multiple intracerebral AE metastases. We required the patient to take albendazole orally for life and follow up.
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Affiliation(s)
- Chuanchuan Liu
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai 810001, China.,Qinghai University Affiliated Hospital, Xining, Qinghai 810001, China.,Qinghai Key Laboratory for Echinococcosis, Xining, Qinghai 810001, China
| | - Haining Fan
- Qinghai University Affiliated Hospital, Xining, Qinghai 810001, China.,Qinghai Key Laboratory for Echinococcosis, Xining, Qinghai 810001, China
| | - Ri-Li Ge
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai 810001, China.,Qinghai University Affiliated Hospital, Xining, Qinghai 810001, China.,Qinghai Key Laboratory for Echinococcosis, Xining, Qinghai 810001, China
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25
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Wan L, Ran B, Aji T, Shao Y, Jiang T, Wen H. Laparoscopic or open treatment for hepatic alveolar echinococcosis: A single-institution experience. Int J Infect Dis 2021; 107:182-187. [PMID: 33862206 DOI: 10.1016/j.ijid.2021.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and efficacy of laparoscopy in the treatment of hepatic alveolar echinococcosis (AE). METHODS Between January 2018 and December 2019, 213 hepatic AE patients were admitted to the authors' institution. Among them, 165 patients (77.46%, 165/213) underwent surgery. Of 13 patients who underwent laparoscopic treatment, two required conversion to open surgery. The remaining 11 patients (group 1) were analyzed. During the same period, 154 patients underwent open surgery, but only 14 records were compatible with the criteria for the laparoscopic approach and were reviewed retrospectively (group 2). RESULTS Conversion to open surgery occurred in two cases. Both groups were basically consistent in terms of detailed demographic data, characteristics of the lesions, and surgical strategy (P > 0.05). The laparoscopic group not only achieved the same R0 resection as the open group, but the results were also significantly superior to those of the open group in terms of postoperative complications, postoperative catheterization time, and postoperative hospital stay (P = 0.042, P = 0.046, and P = 0.045, respectively). No recurrences were observed in either group during this period. CONCLUSIONS Laparoscopic surgery provides a safe and efficacious approach for hepatic AE in selected patients. Large, prospective, randomized trials are needed to confirm its superiority.
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Affiliation(s)
- Li Wan
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China; Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China
| | - Bo Ran
- Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China; Xinjiang Hydatid and Hepatobiliary Surgery Medical Centre, Urumqi 830054, PR China
| | - Tuerganaili Aji
- Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China; Xinjiang Hydatid and Hepatobiliary Surgery Medical Centre, Urumqi 830054, PR China
| | - Yingmei Shao
- Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China; Xinjiang Hydatid and Hepatobiliary Surgery Medical Centre, Urumqi 830054, PR China
| | - Tiemin Jiang
- Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China; Xinjiang Hydatid and Hepatobiliary Surgery Medical Centre, Urumqi 830054, PR China
| | - Hao Wen
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China; Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China.
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26
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Ren B, Wang J, Miao Z, Xia Y, Liu W, Zhang T, Aikebaier A. Hepatic Alveolar Echinococcosis: Predictive Biological Activity Based on Radiomics of MRI. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6681092. [PMID: 33997041 PMCID: PMC8108638 DOI: 10.1155/2021/6681092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/06/2021] [Accepted: 03/17/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND To evaluate the role of radiomics based on magnetic resonance imaging (MRI) in the biological activity of hepatic alveolar echinococcosis (HAE). METHODS In this study, 90 active and 46 inactive cases of HAE patients were analyzed retrospectively. All the subjects underwent MRI and positron emission tomography computed tomography (PET-CT) before surgery. A total of 1409 three-dimensional radiomics features were extracted from the T2-weighted MR images (T2WI). The inactive group in the training cohort was balanced via the synthetic minority oversampling technique (SMOTE) method. The least absolute shrinkage and selection operator (LASSO) regression method was used for feature selection. The machine learning (ML) classifiers were logistic regression (LR), multilayer perceptron (MLP), and support vector machine (SVM). We used a fivefold cross-validation strategy in the training cohorts. The classification performance of the radiomics signature was evaluated using receiver operating characteristic curve (ROC) analysis in the training and test cohorts. RESULTS The radiomics features were significantly associated with the biological activity, and 10 features were selected to construct the radiomics model. The best performance of the radiomics model for the biological activity prediction was obtained by MLP (AUC = 0.830 ± 0.053; accuracy = 0.817; sensitivity = 0.822; specificity = 0.811). CONCLUSIONS We developed and validated a radiomics model as an adjunct tool to predict the HAE biological activity by combining T2WI images, which achieved results nearly equal to the PET-CT findings.
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Affiliation(s)
- Bo Ren
- Department of Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Li Yu Shan Road, No. 137 Urumqi City 830054, China
| | - Jian Wang
- Department of Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Li Yu Shan Road, No. 137 Urumqi City 830054, China
| | - Zhoulin Miao
- Department of Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Li Yu Shan Road, No. 137 Urumqi City 830054, China
| | - Yuwei Xia
- Huiying Medical Technology Co., Ltd., Room A206, B2, Dongsheng Science and Technology Park, HaiDian District, Beijing City 100192, China
| | - Wenya Liu
- Department of Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Li Yu Shan Road, No. 137 Urumqi City 830054, China
| | - Tieliang Zhang
- Department of Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Li Yu Shan Road, No. 137 Urumqi City 830054, China
| | - Aierken Aikebaier
- Department of Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Li Yu Shan Road, No. 137 Urumqi City 830054, China
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27
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Golriz M, Flossmann V, Ramouz A, Majlesara A, Kulu Y, Stojkovic M, Mehrabi A. Case Report: Successful DaVinci-Assisted Major Liver Resection for Alveolar Echinococcosis. Front Surg 2021; 8:639304. [PMID: 33748182 PMCID: PMC7969883 DOI: 10.3389/fsurg.2021.639304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/03/2021] [Indexed: 12/02/2022] Open
Abstract
We report a case of successful robot-assisted major liver resection in a patient with liver alveolar echinococcosis (AE). A 62-year-old male patient was incidentally diagnosed with a large infiltrative lesion in the right liver lobe suspicious for AE. A radical surgical resection as a right-sided hemihepatectomy was indicated. The operation was carried out via a robotic-assisted procedure using the DaVinci Xi Surgical System. The tumor measured 12.4 × 8.8 cm and was successfully resected through a suprapubic incision of 13 cm. The patient was free of pain after the second post-operative day. A fluid collection near the resection plate was easily drained without bile leakage. The patient had no surgical complications. Radical resection is inevitable for adequate curative therapy of AE and provides clear margins. Robotic surgery is a relatively new and safe option for curative resection of AE lesions, with remarkable advantages for patients and surgeons.
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Affiliation(s)
- Mohammad Golriz
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Viktoria Flossmann
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ali Ramouz
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ali Majlesara
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Yakup Kulu
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Marija Stojkovic
- Department of Clinical Tropical Medicine, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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28
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Calame P, Doussot A, Turco C, Colpart P, Heyd B, Delabrousse E. Local invasion of hepatic alveolar echinococcosis should not be underestimated: Lessons learned from imaging-pathologic correlation. Diagn Interv Imaging 2021; 102:189-192. [PMID: 33500218 DOI: 10.1016/j.diii.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Paul Calame
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030 Besançon, France.
| | - Alexandre Doussot
- Department of Digestive Surgery, University of Bourgogne Franche-Comté, CHRU Besançon, 25030 Besançon, France
| | - Celia Turco
- Department of Digestive Surgery, University of Bourgogne Franche-Comté, CHRU Besançon, 25030 Besançon, France
| | - Prudence Colpart
- Department of Pathology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030 Besançon, France
| | - Bruno Heyd
- Department of Digestive Surgery, University of Bourgogne Franche-Comté, CHRU Besançon, 25030 Besançon, France
| | - Eric Delabrousse
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030 Besançon, France; EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Bourgogne Franche-Comté, 25030 Besançon, France
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29
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Wan L, Ran B, Aji T, Shalayiadang P, Jiang T, Shao Y, Wen H. Laparoscopic hepatectomy for the treatment of hepatic alveolar echinococcosis. ACTA ACUST UNITED AC 2021; 28:5. [PMID: 33439119 PMCID: PMC7805388 DOI: 10.1051/parasite/2021001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/04/2021] [Indexed: 12/25/2022]
Abstract
Background: At present, laparoscopy is relatively mature as a minimally invasive technique, but there are few reports on this approach for the radical treatment of hepatic alveolar echinococcosis (AE). In this study, we aimed to evaluate the safety and feasibility of laparoscopic hepatectomy (LH) for AE treatment. Results: A retrospective review of medical records obtained from 13 patients diagnosed with AE between January 2018 and December 2019 and treated with laparoscopic hepatectomy was conducted at the First Affiliated Hospital of Xinjiang Medical University. All patients (n = 13) underwent hepatic resection using laparoscopy and none were transferred to open surgery. The average duration of surgery was 285 min (145–580 min). Intraoperative bleeding was 305 mL (20–2000 mL). The mean duration of postoperative catheterization was 6.9 days (3–21 days), and postoperative hospital stay was 7.2 days (4–14 days). No complication of Clavien-Dindo grade III or above occurred, except for the second patient with acute liver failure post-surgically. No recurrences or deaths were observed at 9–30 months of follow-up. Conclusions: Laparoscopic hepatectomy appears to be safe and effective in selected AE patients. The advantages of this technique for AE treatment need to be further compared with the classical open approach.
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Affiliation(s)
- Li Wan
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, PR China - State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, 830011 Urumqi, PR China
| | - Bo Ran
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, PR China - Xinjiang Hydatid & Hepatobiliary Surgery Medical Centre, 830054 Urumqi, PR China
| | - Tuerganaili Aji
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, PR China - Xinjiang Hydatid & Hepatobiliary Surgery Medical Centre, 830054 Urumqi, PR China
| | - Paizula Shalayiadang
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, PR China - Xinjiang Hydatid & Hepatobiliary Surgery Medical Centre, 830054 Urumqi, PR China
| | - Tiemin Jiang
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, PR China - Xinjiang Hydatid & Hepatobiliary Surgery Medical Centre, 830054 Urumqi, PR China
| | - Yingmei Shao
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, PR China - Xinjiang Hydatid & Hepatobiliary Surgery Medical Centre, 830054 Urumqi, PR China
| | - Hao Wen
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, PR China - State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, 830011 Urumqi, PR China
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Kaliyeva D, Yukhnevich Y, Abatov N, Nurbekov A. Difficulties in diagnosing the alveolar echinococcosis (case report). Int J Surg Case Rep 2020; 75:258-260. [PMID: 32977148 PMCID: PMC7516185 DOI: 10.1016/j.ijscr.2020.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023] Open
Abstract
Alveolar echinococcosis is asymptomatic usually and detected an advanced stage. Differential diagnosis is difficult due to similarities with tumor and metastasis to the different organs. The cystic mass size can be very large. The resection and albendazole is beneficial.
Introduction Alveolar echinococcosis is dangerous parasitic zoonose with the large endemic area. This disease has a high prevalence in Kazakhstan. Presentation of case We report on a 45-year woman suffering from alveolar echinococcosis with a huge cystic mass and difficulty of differential diagnosis. She was hospitalized for surgery with primary diagnosis of hydatid disease. The liver carcinoma was suspected during surgery due to the huge size and structure of the mass. This mass was totally removed. The alveolar echinococcosis was confirmed by histopathological examination. Discussion Essential features of this case are the large size of the lesion with a dense consistency and the germination of blood vessels, which unusual for alveolar echinococcosis. Total resection and Albendazole therapy was successful for patient, she didn't have a relapse during the follow-up examination. Conclusion This report may provide new aspects of visualization of alveolar echinococcosis and highlight the necessity for the upgrade of the diagnosis tactic.
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Affiliation(s)
- Dinar Kaliyeva
- Department of Surgical Diseases, Karaganda Medical University, 40, Gogolia str, Karaganda 10017, Kazakhstan
| | - Yekaterina Yukhnevich
- Department of Clinical Pharmacology and Evidence-Based Medicine, Karaganda Medical University, 40, Gogolia str, Karaganda 10017, Kazakhstan.
| | - Nurkassi Abatov
- Department of Surgical Diseases, Karaganda Medical University, 40, Gogolia str, Karaganda 10017, Kazakhstan
| | - Aydin Nurbekov
- Department of Surgical Diseases, Karaganda Medical University, 40, Gogolia str, Karaganda 10017, Kazakhstan
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Lundström-Stadelmann B, Rufener R, Hemphill A. Drug repurposing applied: Activity of the anti-malarial mefloquine against Echinococcus multilocularis. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2020; 13:121-129. [PMID: 32636148 PMCID: PMC7389337 DOI: 10.1016/j.ijpddr.2020.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
The current chemotherapeutical treatment against alveolar echinococcosis relies exclusively on benzimidazoles, which are not parasiticidal and can induce severe toxicity. There are no alternative treatment options. To identify novel drugs with activity against Echinococcus multilocularis metacestodes, researchers have studied potentially interesting drug targets (e.g. the parasite's energy metabolism), and/or adopted drug repurposing approaches by undertaking whole organism screenings. We here focus on drug screening approaches, which utilize an in vitro screening cascade that includes assessment of the drug-induced physical damage of metacestodes, the impact on metacestode viability and the viability of isolated parasite stem cells, structure-activity relationship (SAR) analysis of compound derivatives, and the mode of action. Finally, once in vitro data are indicative for a therapeutic window, the efficacy of selected compounds is assessed in experimentally infected mice. Using this screening cascade, we found that the anti-malarial mefloquine was active against E. multilocularis metacestodes in vitro and in vivo. To shed more light into the mode of action of mefloquine, SAR analysis on mefloquine analogues was performed. E. multilocularis ferritin was identified as a mefloquine-binding protein, but its precise role as a drug target remains to be elucidated. In mice that were infected either intraperitoneally with metacestodes or orally with eggs, oral treatment with mefloquine led to a significant reduction of parasite growth compared to the standard treatment with albendazole. However, mefloquine was not acting parasiticidally. Assessment of mefloquine plasma concentrations in treated mice showed that levels were reached which are close to serum concentrations that are achieved in humans during long-term malaria prophylaxis. Mefloquine might be applied in human AE patients as a salvage treatment. Future studies should focus on other repurposed anti-infective compounds (MMV665807, niclosamide, atovaquone), which showed stronger in vitro activity against E. multilocularis than mefloquine.
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Affiliation(s)
- Britta Lundström-Stadelmann
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Längggassstrasse 122, 3012, Bern, Switzerland.
| | - Reto Rufener
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Längggassstrasse 122, 3012, Bern, Switzerland
| | - Andrew Hemphill
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Längggassstrasse 122, 3012, Bern, Switzerland
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