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Laparoscopic hepatectomy has the advantages of little trauma, mild stress response, and rapid postoperative recovery. Due to the deep location and complex structure, tumors located in the upper right posterior areas of the liver (Ⅶ, Ⅷ, and Ⅳa segments) and the caudate lobe have limited surgical field and difficult exposure under laparoscopy, which brings great risk to surgical operation, and these locations are considered difficult locations in laparoscopic liver surgery. In recent years, with the improvement in the technology and concept of laparoscopic liver surgery, the upgrading of surgical instruments and equipment and the application of three-dimensional visualization technology have made it possible to remove liver tumors in difficult locations under laparoscopy. With reference to the authors’ own experience, this article summarizes the key technical points of laparoscopic liver surgery in difficult locations, including adequate preoperative assessment, reasonable surgical planning, full exposure of surgical field through body position and trocar distribution, and prediction and prevention of the risk of bleeding. Various new techniques can be used to precisely locate the tumor and guide the partition of liver parenchyma, and with the help of a well-trained surgical anesthesia team, it is possible to ensure the safety and effectiveness of laparoscopic hepatectomy in difficult locations.
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Objective To study the clinical use of indocyanine green (ICG) fluorescence imaging in laparoscopic liver surgery.Methods The clinical and pathological data of 68 patients who underwent laparoscopic hepatectomy using the ICG fluorescence imaging technique during the study period from September 2016 to October 2018 in Zhongnan Hospital,Wuhan University were retrospectively analyzed.Analysis was carried out on the surgical methods,fluorescence navigation methods,ICG injection time and dose,tumor characteristics,and pathological studies of the resected specimens.Results Of 68 patients,3 patients were converted to open surgery,and the remaining 65 patients completed the ICG fluorescence laparoscopic hepatectomy.Thirty-two of these 65 patients underwent ICG fluorescent guided laparoscopic anatomical resection of lower hepatic segment / hepatic hemilivers (positive staining in 17 patients,negative staining in 15 patients),with 19 patients successfully staining with ICG(19 / 32,59.4％).Postoperative histopathology showed primary hepatic solid tumors (n=31),secondary liver tumors (n=12),hepatic cysts (n=4),hepatic hemangiomas (n =5),hepatolithiasis (n =12) and hepatic focal nodular hyperplasia (n =1).These lesions were combined with hepatitis B liver fibrosis in 29 patients.Conclusions ICG fluorescence imaging positively impacted on laparoscopic liver surgery.Proper preoperative ICG injection was helpful for the identification,localization and intraoperative surgical guidance of tumors,especially for patients with deep-seated and central tumors.As a consequence,oncological and surgical safety of laparoscopic liver surgery was improved.Targeted visualization of liver segments and surgical navigation using intraoperative ICG injections facilitated accurate and precise resection of anatomical liver segments or hemi-hepatectomies.The use of intraoperative ICG fluorescence technology for hepatic hemangioma,hepatic cyst,intrahepatic bile duct stones and other benign liver lesions,helped to improve safety of surgery.
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Objective To explore the effect of fish oil fat emulsion as perioperative nutritional support on patients with liver cirrhosis and portal hypertension.Methods Randomized controlled clinical trial was performed between September 2011 and September 2017 in patients with liver cirrhosis and portal hypertension who underwent pericardial devascularization and splenectomy.Hypocaloric total parenteral nutritional support (TPN) started from the first day after the operation for 5 consecutive days.Patients were divided into experimental group and control group according to thetype of fat emulsion used.43 patients in experimental group were applied for fish oil fat emulsion injection (10％ Omegaven) + medium long chain structure fat emulsion (20％STG) and 42 patients in control group were applied for medium long chain structure fat emulsion (20％STG).Liver function (total bilirubin and alanine aminotransferase),nutrition index (serum albumin and prealbumin),inflammatory mediators (TNF-α,IL-6 and IL-10) were measured before and after the operation,and the clinical outcomes were observed.Results There was no statistically significant difference in liver function and nutritional indices between the experimental group and the control group (P＞0.05).The inflammatory mediators like TNF-u,IL-6 and IL-10 on the first day after surgery were significantly higher than those before surgery in both groups [experiment group:(225.54±54.78) vs.(61.49±16.47),(74.94±6.36) vs.(39.84±2.77),(77.53±11.4) vs.(46.05±6.13) ng/L;control group:(229.26±62.15) vs.(63.48±13.76),(77.23±7.83)vs.(40.64±3.34),(73.89±7.97)vs.(44.88±5.72) ng/L;P＜ 0.01].With the progress of time,the proinflammatory factors like TNF-α and IL-6 decreased after the operation and the range of decrease was higher in experiment group than in control group [d4-d 1:(-56.88± 31.63) vs.(-35.96±20.02),(-13.52±5.20) vs.(-6.38±2.84) ng/L;d7-d1:(-150.67±42.58) vs.(-132.79±53.35),(-27.04±8.97) vs.(-20.85±6.38) ng/L;P＜ 0.05].The range of increase in anti-inflammatory media IL-10 was higher in experiment group than in the control group (d4-d1:(14.22±13.08) vs.(5.64±3.58) ng/L;d7-d1:(17.78±5.58) vs.(-37.96±11.43) ng/L;P＜0.05).The incidence of grade Ⅲ complications and total complications (4.7％ vs.21.4％,23.3％ vs.45.2％) and hospitalization time [(10.12 ±1.48) vs.(12.33±2.04) d] in the experimental group were significantly lower than those in the control group (P＜0.05).Conclusions In patients with liver cirrhosis and portal hypertension,perioperative nutritional support of fish oil fat emulsion can reduce systemic inflammatory response and operative complications and promote rapid recovery through its two-way regulation of inflammatory mediators.
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Objective To investigate the molecular expression and clinical significance of Vimentin and E-cadherin during epithelial-mesenchymal transformation of hepatocellular carcinoma (HCC) tissues.Methods Hepatocellular carcinoma and paracancerous tissue were collected from 55 patients,while nonneoplastic nonnal liver tissue were collected from 20 patients without cancerous diseases as control group.Expressions of Vimentin and E-cadherin were examined by immunohistochemistry staining.Clinicopathological features of the relative expression of Vimentin and E-cadherin,and its influence on prognosis were discussed as well.Results Vimentin was positively expressed in 69.1％ cancer tissue,and was significantly higher than paracancerous tissues and normal liver tissues(P ＜ 0.05).E-cadherin was positively expressed in 27.3％ cancer tissue and was significantly lower compared with paracancerous tissues and normal liver tissues(P ＜0.05).The expression of Vimentin and E-cadherin was negatively correlated(r =-0.653,P ＜ 0.05).Vimentin expressions in subgroups of TNM stage Ⅲ-Ⅳ,poor differentiation,multiple tumor nodules,metastasis and recurrence were all significantly higher than the respective subgroups as TNM stage Ⅰ-Ⅱ] (x2 =7.267,P ＜ 0.05),moderate to well differentiation (x2 =4.045,P ＜ 0.05),single tumor node (x2=12.143,P ＜0.05),without metastasis or recurrence (x2 =7.267,P ＜ 0.05).On the contrary,Ecadherin showed higher expression in the subgroup of single tumor node compared with multiple tumor nodules(x2 =6.878,P ＜ 0.05).The follow-up of patients further demonstrated that patients with positive Vimentin expression had a significantly lower disease-free survival compared with the Vimentin negative group (P ＜0.05).Conclusions Vimentin and E-cadherin both participated in epithelial-mesenchymal transition process of hepatocellular carcinoma.High expression of Vimentin and low expression of E-cadherin were closely correlated with occurrence and development of HCC.Vimentin and E-cadherin may serve as impottant biomarkers in clinical diagnosis and prognosis prediction of HCC.
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Objective To explore the effect and intracellular signal transduction pathway of insulin-like growth factor 1 (IGF-1) on the expression of stem cell factor (SCF) in spesis rats colonic smooth muscle cells (SMC).Methods The model of spesis rats was established,colonic SMC from spesis rats were cultured by enzymolysis and identified by α-actin immunofluoresence methods.Colonic SMC incubated with different concentrations (0,50,100 and 150 μg/L) of IGF-1 for different durations (0,12,24,36 and 48 h),and another SMC were pretreated with specific mitogen-activated protein kinase (MEK) inhibitor PD-98059 and phosphatidylinostiol 3-kinase(PI 3-kinase) inhibitor LY-294002 before IGF-1 induced.The expression of SCF in colonic SMC was examined by Western blot and quantitative reverse transcription polymerase chain reaction.Results (1) A very low level of SCF was expressed in colonic SMC cultured in bovine serum free medium.The protein and mRNA were 0.223 ± 0.047 and 0.149 ± 0.023 respectively.The expression of SCF protein and mRNA from SMC was increased to 0.398±0.033 and 0.243±0.013(P＜0.05) when concentration of IGF-1 was 50 μg/L.The final effective concentration of IGF-1 in vitro was 100 μg/L,the levels of SCF protein and mRNA were increased to 0.719±0.017 and 0.360±0.006(P＜0.05).(2) For the time point induced the SCF expression by IGF-1,the expression level of protein and mRNA in 0 h were 0.347±0.031 and 0.092 ±0.018 respectively.The time point of SCF peak level occurred at the 24 h,the expression level of SCF protein and mRNA were increased to 0.893 ± 0.049 and 0.396 ± 0.048 (P ＜ 0.05).(3) The IGF-1-induced SCF expression was reduced significantly by a pretreatment of PD-98059 (SCF protein and mRNA were reduced 37％ and 45％,P＜0.05),and LY-294002 had no effect on the expression of SCF (P＞0.05).Conclusion The expression of SCF from colon SMC in sepsis rat is stimulated by IGF-1 in both dose and time-dependent manners,in which ERKMAPK signal transduction may play an important role.
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Objective To evaluate the effects of iron dextran or iron sucrose on the stability of fat emulsion in total nutrient admixture (TNA) in pediatric settings.Methods TNA with different intravenous doses of iron sucrose or iron dextran (0.25,0.5,0.75,or 1.00 mg) were prepared,and each dose was prepared 10 bags.The TNAs were stored at 25 ℃ for 3 days,and the stability of fat emulsion was observed by electron scanning microscopy.Meanwhile,the pH and osmolality were also measured.Results The particle sizes of fat emulsions in TNA with different concentrations of iron sucrose or iron dextran at different time points were not significantly different (F =0.32,P =0.7836 ; F =1.73,P =0.1321,respectively).The mean particle size of the fat emulsion in each group was ＜ 0.5 μm within 72 hours.For TNA containing different concentrations of iron,the percentage of particles ＞ 0.5 μm,pH,and osmotic pressure showed no significant difference at different time points (percentage:F =1.47,P =0.3467 ; F =1.04,P =0.4758.pH:F =0.63,P =0.5942 ; F =0.46,P =0.6825.osmotic pressure:F =1.37,P =0.3648 ; F =0.65,P =0.6023).Conclusion The TNA addeded with iron sucrose or iron dextran with an concentrations of ＜ 1％ is stable.
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Mesenchymal stem cells (MSCs) have a strong self-renewal capacity and multi-differentiation potential,which make them become ideal seed cells of tissue repair and target cells of gene therapy.However,the labeling and tracing method of MSCs transplanted in vivo is the hot spot and difficult problem of the current research.At present,the commonly used tracer methods of MSCs include fluorescence dye labeling,molecular marker,imaging marker technology.This paper summarized the advantages and disadvantages of these tracer methods.
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Objective To investigate the intracellular signal transduction pathway of insulin promoting stem cell factor (SCF) expression in colonic smooth muscle cells (SMCs).Methods Colonic SMCs from SD rats were isolated and cultured, which were identified by α-actin immunofluorescence cytochemistry staining.SMCs were divided into 3 groups for experiment. ①Insulin concentration gradient group:Adding different insulin concentrations (0,2.5,5,20,40 and 80 mg/L) into SMCs culture and cultured for 16 hours; ② Insulin time point group:SMCs were cultured with insulin (40 mg/L) for different time durations (0,8,16,24 hours); ③ Signal pathway blocking group:SMCs were pretreated with LY-294002 or PD-98059,and then induced with insulin (40 mg/L) for 16 h.The proliferation of SMCs was examined by MTT method.The change of SCF expression was determined by Western blot and RT-PCR.Results ① Insulin at concentration of 5 mg/L remarkably promoted SMCs proliferation,and there was no significant difference in its effect with insulin concentrations at 20,40,80 mg/L (all P＜0.05).② Compared with no insulin adding group,low and medium dose of insulin (2.5,5,20 mg/L) already had a role in promoting SCF mRNA and SCF protein expression (all P ＜ 0.05). It reached maxium effect when insulin concentration was at 40 mg/L(P＜0.05),and there was no significant difference between insulin concentration at 40 mg/L and 80 mg/L (P＞0.05).③ Compared with time 0 hour,the expression of SCF increased after insulin worked on SMC (40 mg/L) for 8 hours (P＜0.05),and reached the peak after 16 hours (P＜0.05),and there was no significant difference between 24 hours and 16 hours (P＞0.05).④ Compared with blank control group and solvent control group,both insulin-induced SCF expression reduced after pretreated with LY-294002 or PD-98059 (all P＜0.05).Conclusions Insulin can promote SMCs proliferation,and in certain range the induction of SCF synthesis in colon SMCs is in dose and time dependent manners.The effect may be related to PI3K and MAPK signal pathway.
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Objective To investigate the relationship between hypoxia inducible factor-1?、angiopoietin2 and vascular endothelial growth factor and angiogenesis in hepatocellular carcinoma(HCC).Methods The(expression) of hypoxia inducible factor-1?、angiopoietin2 and vascular endothelial growth factor mRNA was(detected) in 52 HCC surgical specimens.And microvessel density(MVD) in tissue specimens of patients with coexpression of the parameters was examined.Results Of the 52 surgical specimens,36 cases had over(expression) of HIF-?、angiopoietin and VEGF protein,and coexpression of HIF-? and angiopoietin and VEGF mRNA in 38 of 52 cases.The expression of HIF-?、angiopoietin was related with the expression of VEGF(r_1= 0.783,P
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ObjectiveTo study the early diagnosis and prevention of fungal infection in severe acute pancreatitis(SAP). Method 1.SAP patients from July 1998 to June 2002 were prospectively randomized into 3 groups: garlicin prevention group, fluconazole (low dosage) prevention group and control group, the incidence of fungal infection in SAP was compared between the groups. For fungal infection patients, the fungal clearance and mortality rate were observed. 2.Clinical data of SAP patients with fungal infection and with simple bacterial infection was compared by multivariate logistic regression, and clinical characters and risk factors of fungal infection were evaluated. Results 1.There were lower incidences of fungal infection in garlicin group (16% vs. 30%,P
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Objective To determine the prevention and therapy of fungal infection in patients with severe acute pancreatitis (SAP). Methods Seventy patients with SAP admitted from July,1998 to June,2002 were randomly divided into 3 groups: garlicin prevention group, fluconazole (low dosage) prevention group and control group.The incidence of fungal infection, the fungal clearance and mortality after the treatment were compared. Results The incidence of fungal infection in garlicin group and fluconazole group was lower than that in control group. (16%∶30%,P
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Objective To investigate the diagnosis and treatment of malignant fibrous histiocytoma (MFH) in abdominal cavity. Methods The clinical manifestations, imaging examination, pathology, methodology, effect of treatment and prognosis of 28 MFH patients were retrospectively analyzed. Results Tumors were in the retroperitoneal space in 17 cases, within abdominal cavity in 6, in mesentery in 3 cases, and in the abdominal wall in 2 cases. The clinical symptoms were body weight loss, abdominal pain and mass. B ultrasonography and CT scanning showed mass in the abdomen. 24 cases were with multiplefoci,4 cases were with a single mass. Seventeen cases underwent complete tumor resection,11 cases with partial resection, 16 cases received postoperative chemotherapy and 14 cases with postoperative radiotherapy. The overall survival rate of 1-, 3- and 5- year was 76.9%,26.9% and 3.9%,respectively. Conclusion MFH is most often located in retroperitoneal space, surgical resection was the treatment of choice. The prognosis in patients with MFH might be improved by complete resection combined with chemotherapy or/ and radiotherapy.