Reliability of indocyanine green retention and clearance rates at 15 minutes calculated by dye-dilution cardiac output flowmetry in comparison to blood sampling in patients undergoing hepatic resection

Relationship of Immunonutritional factor with Changes in Liver Volume after Portal Vein Embolization

Background

To identify predictors of changes in hepatic volumes after portal vein embolization, we examined the relationship with preoperative nutritional and immunological parameters.

Patients and Methods

Ninety-three patients who underwent portal vein embolization were included. The control group comprised 13 patients who underwent right hepatectomy without portal vein embolization. Computed tomographic volumetric parameter was measured for changes in embolized and nonembolized liver. Correlation with various candidates of immunonutritional parameters was examined.

Results

Difference in increased liver ratio was 9.1%. C-reactive protein levels significantly increased after portal vein embolization (P < .01), whereas albumin and total cholesterol levels significantly decreased, respectively (P < .01). The C-reactive protein/albumin ratio, prognostic nutritional index, Controlling Nutritional Status score, and modified Glasgow Prognostic Score were significantly different, respectively (P < .01). Prothrombin activity and total cholesterol level significantly correlated with the increased change in nonembolized liver (P < .05). The C-reactive protein and C-reactive protein/albumin ratio after portal vein embolization negatively correlated with hypertrophic ratio (P < .05). By comparing posthepatectomy outcomes between 64 patients undergoing portal vein embolization and 13 who did not, the prevalence of severe complications and mortality in the portal vein embolization group was not different from that in the non–portal vein embolization group. Liver activity at 15 minutes > 0.92 and increased liver volume ≥ 10% tended to correlate with lower prevalence of severe complications. Only increased intraoperative blood loss ≥ 1,500 mL was significantly associated with morbidity and mortality (P < .05).

Conclusion

Contrary to our hypothesis, immunonutritional parameters, except C-reactive protein and C-reactive protein/albumin ratio, did not reflect hypertrophy after portal vein embolization. Although it is difficult to predict the hypertrophic degree, the strategy of scheduled hepatectomy should be switched in case of impaired inflammatory status after portal vein embolization.

Hydroxyethyl starch-new indocyanine green conjugates for enhanced cancer photodynamic therapy

In the present work, hydroxyethyl starch-new indocyanine green (HES-IR-820) conjugates were developed for enhanced cancer photodynamic therapy. HES-IR-820 conjugates were prepared by the condensation reaction between IR-820 and amino groups modified HES. HES-IR-820 conjugates with IR-820 loading content of 2.0% (HES-IR-8202.0) and 3.2% (HES-IR-8203.2) were prepared and characterized by 1H NMR, FT-IR, HPLC, and UV-Vis. HES-IR-8202.0 and HES-IR-8203.2 are monomolecular nanosized particles with hydrodynamic diameters of around 10 nm. HES-IR-8202.0 and HES-IR-8203.2 exhibit significantly enhanced stability in pH 7.4 PBS buffer and pH 7.4 PBS buffer containing 10% fetal bovine serum as compared to free IR-820. HES-IR-8202.0 and HES-IR-8203.2 show limited drug release in pH 7.4 and pH 5.0 PBS buffer. HES-IR-8202.0 and HES-IR-8203.2 exhibit enhanced singlet oxygen generation under 808 nm laser irradiation and reduced cellular uptake amount as compared to free IR-820. The cellular uptake pathway study reveals that the lipid raft-mediated endocytosis and macropinocytosis are involved in the cellular uptake of HES-IR-8202.0 and HES-IR-8203.2. Compared to free IR-820, HES-IR-8202.0 and HES-IR-8203.2 show reduced cytotoxicity, enhanced in vitro antitumor effect under 0.3 W/cm2 808 nm laser irradiation, and similar in vitro antitumor effect under 0.6 W/cm2 808 nm laser irradiation. HES-IR-820 conjugates show significant potential for cancer photodynamic therapy.