[Current status of lymph node dissection in pyloric-preserving gastrectomy for early gastric cancer].

With the gradual increase in the diagnosis rate of early gastric cancer, clinicians must consider prevention of gastric anatomical structure and physiological function while ensuring the radical treatment of the tumor. Pylorus-preserving gastrectomy is a function- preserving operation that preserves the pylorus, inferior pyloric vessel, and the vagus nerve in patients with early middle gastric cancer. One of the major controversies at present is the thoroughness of limited lymph node dissection for pyloric-preserving gastrectomy. Various studies have reported that the lymph node metastasis rate of early middle gastric cancer was low, especially in the suprapyloric region, inferior pylorus and the upper pancreatic region. Partial lymph node dissection is required for vascular and neurological protection, which is also safe and feasible in studies reported by major centers. Many clinical studies have been carried out in Japan and Korea, and postoperative follow-up has gradually increased evidence, providing the basis for the safety of lymph node dissection. In large case studies comparing pylorus- preserving gastrectomy with traditional distal gastrectomy, the incidence of postoperative morbidity, such as dumping syndrome, bile reflux esophagitis, weight loss, and malnutrition is low. Sentinel lymph node navigation technology is gradually applied to the diagnosis and treatment of early gastric cancer, and its clinical application value still needs further research.

Efficacy of continuous renal replacement on acute renal injury developed in severe sepsis.

Sepsis is a systemic inflammatory response that can further develop into severe sepsis (septic shock), which eventually leads to multiple organ dysfunction syndrome (MODS). This study aimed to assess the effects of continuous renal replacement therapy (CRRT) on acute renal injury caused by severe sepsis by monitoring biochemical parameters. A total of 60 patients with septic shock and acute kidney injury were included. The control group (30 cases) was treated with routine treatment and intermittent renal replacement therapy (IRRT). The experimental group (30 cases) was treated with routine treatment and continuous renal replacement therapy CRRT. The changes in inflammation and biochemical indexes and APACHE- II score were evaluated before the treatment and 1, 3, and 7days after the treatment. The inflammatory markers (neutrophil percentage, C-reactive protein (CRP) and procalcitonin (PCT) levels) in the experimental group decreased significantly after treatment. In the control group, the index of inflammation still increased one day after treatment and decreased on day 3 of treatment. After treatment, blood lactate, serum creatinine and urea nitrogen levels decreased, but the urine volume increased. After treatment, the vasoactive dose in the experimental group was significantly lower than that of the control group (P less than 0.05). CRRT is a good treatment for septic shock-related acute kidney injury, which improves biochemical indicators and protects kidney function.

Activation, isolation, identification and in vitro proliferation of oval cells from adult rat livers.

Oval cells, putative hepatic stem cells, could potentially provide a novel solution to the severe shortage of donor livers, because of their ability to proliferate and differentiate into functional hepatocytes. We have previously demonstrated that oval cells can be induced to differentiate into cells with morphologic, phenotypic, and functional characteristics of mature hepatocytes. In this study, we have established a new model combining ethionine treatment with partial hepatectomy to activate oval cells, then developed a procedure utilizing selective enzymatic digestion and density gradient centrifugation to isolate and purify such cells from heterogeneous liver cell population. We identified oval cells by their morphological characteristics and phenotypic properties, thereby providing definitive evidence of the presence of hepatic stem-like cells in adult rat livers. Viewed by transmission electron microscopy, they were small cells with ovoid nuclei, a high nucleus/cytoplasm ratio and few organelles, including mitochondria and endoplasmic reticulum. Flow cytometric assay showed that these cells highly expressed OV-6, cytokeratin-19 (CK-19) and albumin. Reverse transcriptase-polymerase chain reaction (RT-PCR) analysis displayed that the freshly isolated cells co-expressed albumin, cytokeratin-7 (CK-7) and CK-19 mRNA, indicating that they were essentially bipotential hepatic stem-like cells. Furthermore, we set up a culture system containing growth factors and a fibroblast feeder layer, to provide nourishment to these cells. Thus, we were able to culture them in vitro for more than 3 months, with the number of cells doubling 100 times. Gene expressions of albumin, CK-7 and CK-19 in the cells derived from the expanding colonies at day 95 were confirmed by RT-PCR analysis. These data suggested that the hepatic oval cells derived from adult rat livers possess a high potential to proliferate in vitro with a large increase in number, while maintaining the bipotential nature of hepatic stem cells.

Differentiation of putative hepatic stem cells derived from adult rats into mature hepatocytes in the presence of epidermal growth factor and hepatocyte growth factor.

Oval cells, putative hepatic stem cells, can differentiate into a wide range of cell types including hepatocytes, bile epithelial cells, pancreatic cells and intestinal epithelial cells. In this study, we used different growth factor combinations to induce oval cells to differentiate into mature hepatocytes. We isolated and purified oval cells utilizing selective enzymatic digestion and density gradient centrifugation. Oval cells were identified by their morphological characteristics and the strong expressions of OV-6, albumin, cytokeratin (CK)-19 and CK-7. Using a 2-step induction protocol, we demonstrated that oval cells first changed into small hepatocytes, then differentiated into mature hepatocytes. Small hepatocytes were distinguished from oval cells by their morphological features (e.g. round shape and nuclei) and the lack of CK-19 mRNA expression. Mature hepatocytes were identified by their ultrastructural traits and their expressions of albumin, CK-18, tyrosine aminotransferase (TAT), and alpha-1-antitrypsin (alpha-1-AT). Differentiated cells acquired the functional attributes of hepatocytes in that they secreted albumin and synthesized urea at a high level throughout differentiation. Oval cells can thus differentiate into cells with the morphological, phenotypic and functional characteristics of hepatocytes. This 2-step induction procedure could provide an abundant source of hepatocytes for cell transplantation and tissue engineering.

[Higher lint percent and drought tolerant cotton line selected by radiation breeding].

The Gossypium hirsutum cv. Liaomian No. 9 were mutagenized by 60Co gamma ray, from which the mutant line Zhonghuzhi PI 935 (be called "PI 935" for short) was bred by family selection method. The PI 935 not only has some good traits (growing period, drought tolerance, lint color and fiber quality) similar to the original cultivar, but also has higher lint outturn and lint yield than that of the Liaomian No. 9. The PI 935 has been identified and regional tested in nine places times for four years in the southern Xinjiang Weiwuer autonomous region. It was shown that the PI 935 had the higher lint outtrn for the average 47.3% was ten-point percentage more than that of the check cultivars (Junmian No. 1 or Xinluzhong No. 5), the similar lint yield by and large and the growing period by five days later than that of the checks. The PI 935 was collected in the National Bank of Crop Germplasm (unified No. ZM 114274 and named "Zhonghuzhi PI 935").

Analysis of the arterial supply of the extrahepatic bile ducts and its clinical significance.

The purpose of this study is to describe the arterial supply of the entire extrahepatic bile duct system. The cross-sectional area of all arteries that supply the ducts is measured under an operating microscope in 50 adult cadavers injected with red latex through the aorta. The extrahepatic bile duct system is divided into four topographic portions: cystic duct and gallbladder, right and left hepatic ducts, bile (common) duct and including its supra-retroduodenal parts, and the pancreatic and intraduodenal portions. The arterial supply to each portion is carefully detailed. The ducts are supplied by more than seven arteries, of which the major arteries are the cystic artery, posterior superior pancreaticoduodenal artery, right hepatic artery, and retroportal artery. Collectively they provide 94.5% of the blood supply to the ducts. Arteries form three types of anastomotic patterns on the walls of the ducts, suggesting that ductal incisions can be made in ways that least disturb the blood supply. The patterns are: a network, a longitudinal anastomotic chain, and an arterial circle. These data emphasize the importance of the arterial supply in biliary surgery and especially the treatment of hemobilia.

Surgical treatment of biliary ductal stricture complicating localized left hepatolithiasis.

AIM: To summarize the experience in the clinical treatment of biliary duct strictures complicating localized left hepatolithiasis in the last two decades. METHODS: A retrospective analysis of 67 cases of biliary duct strictures complicating localized left hepatolithiasis treated in our center in the last two decades was made with regards to each patient's age, gender, results of various preoperative examinations, operative findings, treatment and postoperative courses. RESULTS: The incidence of left hepatic duct (LHD) stricture was 59.8% and that of a left external hepatic duct (LEHD) stricture was 84.0 % and 84.8% respectively, in which a severe degree dominated. Among the operative procedures used in the treatment of LHD strictures, plastic operation plus biliary enteric anastomosis ranks first in frequency (52.2%), with a re-stricture rate of 17.1%. Left lobectomy ranks third (19.4%) with no re-stricture. Simple plastic performance or dilation had a high occurrence rate of re-stricture and usually needed subsequent surgery. Most LEHD strictures were eradicated by lateral segmentectomy or lobectomy, whereas most LMHD strictures were just the opposite. The rate of preoperative diagnosis of LMHD by endoscopic retrograde cholangiography, percutaneous transhepatic cholangiography, computed tomography or intraoperative and postoperative trans-T-tube cholangiography was much lower than that of LEHD or extrahepatic duct. CONCLUSION: Too much attention paid to LEHD disorders in the treatment of localized left hepatolithiasis potentially results in negligence or omission in LMHD disorders. Malpractice treatments of LHD strictures are important factors affecting the long term results of localized left hepatolithiasis, for which left lobectomy is usually the therapy of choice.

[Changes in gut hormones after Roux-en-Y cholangio-jejunostomy].

In order to explore the mechanism of secondary gastric acid hypersecretion after Roux-en-Y Cholangio-jejunostomy (CJR-Y), we studied the changes of gastric acid secretion and determined the levels of somatostatin (SS), gastrin (Gn), neurotensin (NT), beta-endorphin (beta-EP) in serum, gastric juice and pyloric antrum in patients with CJR-Y. The results showed that gastric hypersecretion developed, levels of SS in those specimens decreased significantly and the content of Gn increased obviously after CJR-Y; whereas the content of NT and beta-EP did not change significantly. We concluded that the decreased level of SS plays a role in the mechanism.

[Surgical treatment for hilar bile duct stricture].

474 patients suffering from hilar bile duct strictures were treated from 1975 to 1992. 74.7% of the patients had a history of biliary surgery for 1-5 times. Causes of strictures were of iatrogenic in 10.9%, of primary in 71.7%, and of suppurative in 7.1%. Site of strictures: LHD in 37.6%, LHD+RHD+CHD in 17.4%, RHD in 9.6%, CHD in 14.7%, and LHD+RHD in 11.5%. The inferior end of the CBD were of spasmodic or flaccid in 23.6% and 48.3%, respectively. Treatment included cholangioplasty in 56.5%, dilatation and stent in 15.2%, lobectomy and segmetectomy of involued liver in 48%, repairing in 11.4%, bilio-enterostomy in 60.7%, and portal vein decompression in 6.3%.

[Induction of differentiation of human gastric cancer cell line by retinoic acid].

The growth rate and weight of transplanted tumor of SGC7901 gastric cancer cell line, treated with 10 mumol/L retinoic acid (RA) in nude mice, were significantly reduced in comparison with those of control cells. The morphology of RA-treated cells was changed from ellipse shape with meandering margin of a large nucleus to shuttle shape with smooth margin of a small nucleus. With flow cytometry, it was found that G/O Phase markedly increased after the RA treatment, whereas S and G2 + M phase decreased. Especially the S phase fraction was lower than that of control cells. The above results indicated that RA could reverse biological and morphological phenotypes of the human gastric cancer cells in vitro and could induce differentiation of gastric cancer cells to a certain extent.