Location and extent of cavernous transformation of the portal vein dictates different visceral side revascularization in Meso-Rex bypass.

BACKGROUND: As an emerging standard of care for portal vein cavernous transformation (PVCT), Meso-Rex bypass (MRB) has been complicated and variated. The study aim was to propose a new classification of PVCT to guide MRB operations. METHODS: Demographic data, the extent of extrahepatic PVCT, surgical methods for visceral side revascularization, intraoperative blood loss, operating time, changes in visceral venous pressure before and after MRB, postoperative complications and the condition of bypass vessels after MRB were extracted retrospectively from the medical records of 19 patients. RESULTS: The median age of the patients (13 males and 6 females) was 32.5 years, while two patients were underage. Causes of PVCT can be summarized as follows: thrombophilia such as dysfunction of antithrombin III or proteins C; secondary to abdominal surgeries; secondary to abdominal infection or traumatic intestinal obstruction, and unknown causes. Intraoperatively, the median operation time was 9.5 h (7-13 h), and the intraoperative blood loss was 300 mL (100-1,600 mL). Ten cases used autologous blood vessels while 10 used allogeneic blood vessels. The vascular anastomosis was divided into the following types according to the site and approach: Type (T) 1-PV pedicel type, T2-confluence type, T3-major visceral vascular type; and T4-collateral visceral vascular type. Furthermore, the visceral venous pressure before and after MRB dropped significantly from 36 cmH2O (28-44) to 24.5 cmH2O (15-31) (P < 0.01). Postoperatively, one patient had delayed wound healing, two developed biochemical pancreatic fistulae, one experienced lymphatic leakage, the former caused by heat damage of the pancreatic tissues, the latter by cutting lymphatic vessels in the mesentery or removing the local lymph nodes during the process of separating the superior mesenteric vein, and one was re-operated on for an intervening intestinal fistulae. Postoperative enhanced CT scans revealed a significant improvement in abdominal varix in the patients with patent bypass, and at the 1-year postoperative follow-up, enhanced CT scans of six patients showed that the long axis of the spleen was reduced by ≥ 2 cm. CONCLUSIONS: MRB can effectively reduce visceral venous pressure in patients with PVCT. It is feasible to determine the PVCT type according to the extent of involvement and to choose individualized visceral side revascularization performances.

Citric Acid and Poly-glutamic Acid Promote the Phytoextraction of Cadmium and Lead in Solanum nigrum L. Grown in Compound Cd-Pb Contaminated Soils.

Phytoextraction is an efficient strategy for remediating heavy metal-contaminated soil. Chelators can improve the bioavailability of heavy metals and increase phytoextraction efficiency. However, traditional chelators have gradually been replaced due to secondary pollution. In this study, a typical organic acid (citric acid, CA) and a novel biodegradable chelator (poly-glutamic acid, PGA), were investigated using pot experiments to compare the phytoextraction efficiency of Solanum nigrum L. (a Cd (hyper)accumulator) for cadmium (Cd) and lead (Pb) in contaminated soil. The results showed CA and PGA significantly improved plant growth, and total Cd and Pb amounts of S. nigrum, both CA and PGA significantly increased the shoot Cd and Pb concentrations. However, only PGA significantly increased the root Pb concentration. CA and PGA application promoted the bioavailability of Cd and Pb in rhizosphere soils and their translocations from roots to shoots in S. nigrum. Both CA and PGA increased the phytoextraction efficiency of Cd and Pb in S. nigrum plants, and the PGA for Cd and Pb phytoextraction was more effective than CA. Our findings demonstrate that the biodegradable chelator PGA has great potential for enhancing phytoextraction from compound Cd-Pb contaminated soils, suggesting that biodegradable chelator-assisted phytoextraction with (hyper)accumulator is strongly recommended in severely contaminated sites.

Comparison of survival benefit between salvage surgery after conversion therapy versus surgery alone for hepatocellular carcinoma with portal vein tumor thrombosis: a propensity score analysis.

BACKGROUND: Salvage surgery after conversion therapy with a combination of tyrosine kinase inhibitor and anti-programmed death-1 antibody has shown improved survival benefits in patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). We aimed to compare the survival benefits in a retrospective cohort of patients with HCC with PVTT who underwent salvage surgery after conversion therapy and surgery alone. METHODS: From January 2015 to October 2021, we selected patients diagnosed with HCC with PVTT who underwent liver resection at Chinese PLA General Hospital. The primary endpoint in the comparison of survival benefits between conversion therapy and surgery-alone groups was recurrence-free survival. Propensity score matching was applied to reduce any potential bias in the study. RESULTS: The 6-, 12-, and 24-month recurrence-free survival rates in the conversion and surgery alone groups were 80.3% vs 36.5%, 65.4% vs 29.4%, and 56% vs 21%, respectively. On multivariable Cox regression analyses, conversion therapy significantly reduced HCC-related mortality and HCC recurrence rates compared with surgery alone. CONCLUSIONS: For patients with HCC with PVTT, surgery after conversion therapy is in relationship with increased survival in comparison with surgery alone.

Towards Universal Screening for Postpartum Depression in China: Lessons Learned from a Comprehensive Prevention Programme in Shenzhen.

PURPOSE: This study was conducted to assess the real-world efficacy of a universal programme for the prevention of postpartum depression (PPD) in Shenzhen. Given the lack of evidence on routine PPD screening and intervention in China, it sought to provide insights for programme planning and implementation, particularly in relation to achievement of the targets set by the first national guidelines for PPD prevention and treatment. METHODS: Using routine health information system data, the PPD screening, referral and intervention rates for 2015-2019 were calculated and compared to the programmes targets. Trends of variables were tested by using trend χ2. RESULTS: The programme screened 137,761 to 178,857 women for PPD every year with the coverage among all postpartum women increased steadily from 71.1% to 82. 5% (χ2 = 10145.251, p < 0.001). The PPD-positive rate maintained between 4.06% and 4.89%. However, although referral messages were given to an increased percentage of PPD-positive women (χ2 = 1090.908, p < 0.001), the intervention rate (i.e., referral uptake) were far lower than the programme target of 80%. CONCLUSIONS: This study demonstrated high efficacy of Shenzhen's comprehensive PPD prevention programme initiated in 2013. The resultant rise in the screening rate among all postpartum women, together with a high referral rate of those screened positive, have contributed to the city's relatively low PPD prevalence. PPD screening and intervention should be included as part of basic public health services to ensure universal coverage and specific strategies should be adopted to ensure referral uptake.

Laparoscopic anatomical liver resection guided by real-time indocyanine green fluorescence imaging: experience and lessons learned from the initial series in a single center.

BACKGROUND: Anatomical liver resection is an established procedure for primary hepatic tumors. Laparoscopic anatomical hepatectomy has been proven to be technically achievable from S1 to S8 in experienced hands. The indocyanine green (ICG) fluorescence imaging technique offers a novel tool of intraoperative visualization in hepatobiliary surgery. This study aims to investigate the feasibility of laparoscopic anatomical liver resection based on segmental staining using real-time ICG fluorescence. METHODS: From December 2015 to October 2017, 36 patients in our institute underwent lap-ALR using real-time ICG fluorescence mapping of the tumor-bearing portal territory. The procedural and perioperative data were collected and analyzed. RESULTS: In our case series, we successfully performed the fashion of positive staining mostly in segmentectomy or sub-segmentectomy by individually injecting 5-10 ml of ICG (0.025 mg/ml) into its feeding portal branch guided by intraoperative ultrasound, and the negative staining mainly for sectionectomy, hemihepatectomy and multi-segmentectomy by interrupting the Glissonean pedicle serving the tumor-bearing segments and systemically injecting 1 ml of ICG (2.5 mg/ml). Our total successful rate of staining is 53%. No conversion to laparotomy, Clavien III-IV complication or 90-day mortality occurred. Valuable technical feedback, experience and lessons are learned from this initial practice. CONCLUSIONS: Real-time ICG fluorescence imaging adds much precision to laparoscopic anatomical hepatectomy. The success of segmental staining requires a high proficiency of IOUS and skillful interpretation of preoperative 3D simulation. Decision-making on the fashions of positive and negative staining have been initially recommended. Multi-centered practice and technical modification are necessary to standardize its application.

Delineation of contaminant plume for an inorganic contaminated site using electrical resistivity tomography: comparison with direct-push technique.

Precise delineation of contaminant plume distribution is essential for effective remediation of contaminated sites. Traditional in situ investigation methods like direct-push (DP) sampling are accurate, but are usually intrusive and costly. Electrical resistivity tomography (ERT) method, as a non-invasive geophysical technique to map spatiotemporal changes in resistivity of the subsurface, is becoming increasingly popular in environmental science. However, the resolution of ERT for delineation of contaminant plumes still remains controversial. In this study, ERT and DP technique were both conducted at a real inorganic contaminated site. The reliability of the ERT method was validated by the direct comparisons of their investigation results that the resistivity acquired by ERT method is in accordance with the total dissolved solid concentration in groundwater and the overall variation of the total iron content in soil obtained by DP technique. After testifying the applicability of ERT method for contaminant identification, the extension of contaminant plume at the study site was revealed by supplementary ERT surveys conducted subsequently in the surrounding area of the contaminant source zone.

Delayed introduction of immunosuppressive regimens in critically ill patients after liver transplantation.

BACKGROUND: The manipulation of immunosuppression therapy remains challenging in patients who develop infectious diseases or multiple organ dysfunction after liver transplantation. We evaluated the outcomes of delayed introduction of immunosuppression in the patients after liver transplantation under immune monitoring with ImmuKnow assay. METHODS: From March 2009 to February 2014, 225 consecutive liver recipients in our institute were included. The delayed administration of immunosuppressive regimens was attempted in 11 liver recipients with multiple severe comorbidities. RESULTS: The median duration of non-immunosuppression was 12 days (range 5-58). Due to the infectious complications, the serial ImmuKnow assay showed a significantly low ATP level of 64±35 ng/mL in the early period after transplantation. With the development of comorbidities, the ImmuKnow value significantly increased. However, the acute allograft rejection developed when a continuous distinct elevation of both ATP and glutamyltranspeptidase levels was detected. The average ATP level measured just before the development of acute rejection was 271±115 ng/mL. CONCLUSIONS: The delayed introduction of immunosuppressive regimens is safe and effective in management of critically ill patients after liver transplantation. The serial ImmuKnow assay could provide a reliable depiction of the dynamics of functional immunity throughout the clinical course of a given patient.

Traditional surgical planning of liver surgery is modified by 3D interactive quantitative surgical planning approach: a single-center experience with 305 patients.

BACKGROUND: Decision making and surgical planning are to achieve the precise balance of maximal removal of target lesion, maximal sparing of functional liver remnant volume, and minimal surgical invasiveness and therefore, crucial in liver surgery. The aim of this prospective study was to validate the accuracy and predictability of 3D interactive quantitative surgical planning approach (IQSP), and to evaluate the impact of IQSP on traditional surgical plans based on 2D images. METHODS: A total of 305 consecutive patients undergoing hepatectomy were included in this study. Surgical plans were created by traditional 2D approach using picture archiving and communication system (PACS) and 3D approach using IQSP respectively by two groups of physicians who did not know the surgical plans of the other group. The two surgical plans were submitted to the chief surgeon for selection before operation. The specimens were weighed. The two surgical plans were compared and analyzed retrospectively based on the operation results. RESULTS: The two surgical plans were successfully developed in all 305 patients and all the 3D IQSP surgical plans were selected as the final decision. Total 278 patients successfully underwent surgery, including 147 uncomplex hepatectomy and 131 complex hepatectomy. Twenty-seven patients were withdrawn from hepatectomy. In the uncomplex group, the two surgical plans were the same in all 147 patients and no statistically significant difference was found among 2D calculated resection volume (2D-RV), 3D IQSP calculated resection volume (IQSP-RV) and the specimen volume. In the complex group, the two surgical plans were different in 49 patients (49/131, 37.4%). According to the significance of differences, the 49 different patients were classified into three grades. No statistically significant difference was found between IQSP-RV and specimen volume. The coincidence rate of territory analysis of IQSP with operation was 92.1% (93/101) for 101 patients of anatomic hepatectomy. CONCLUSIONS: The accuracy and predictability of 3D IQSP were validated. Compared with traditional surgical planning, 3D IQSP can provide more quantitative information of anatomic structure. With the assistance of 3D IQSP, traditional surgical plans were modified to be more radical and safe.

[Comparison of the Predictive Values of Eight Staging Systems for Primary Liver Cancer in Prognosis of Combined Hepatocellular-cholangiocellular Carcinoma Patients after Surgery].

OBJECTIVE: To compare the predictive values of eight staging systems for primary liver cancer in the prognosis of combined hepatocellular-cholangiocellular carcinoma (cHCC-CC) patients after surgery. METHODS: The clinical data of 54 cHCC-CC patients who underwent hepatectomy or liver transplantation from May 2005 to Augest 2013 in Chinese PLA General Hospital were collected. We evaluated the prognostic value of the Okuda staging system, Cancer of the Liver Italian Program (CLIP) score, French staging system, Barcelona Clinic Liver Cancer (BCLC) staging system, 7th edition of tumour-node-metastasis (TNM) staging system for hepatocellular carcinoma and intrahepatic cholangiocarcinoma (ICC), Japan Integrated Staging (JIS) score, and Chinese University Prognostic Index. The distribution, Kaplan-Meier method, Log-rank test, and area under a receiver operating characteristic curve were used to compare the prognosis-predicting ability of these different staging systems in 54 cHCC-CC patients after surgery. RESULTS: The TNM staging system for ICC and JIS score had a better distribution of cases. The 12-and 24-month survivals of the entire cohort were 65.5% and 56.3%, respectively. A Log-rank test showed that there was a significant difference existing in the cumulative survival rates of different stage patients when using TNM staging system for ICC (stage 1 vs. stage 2, P=0.012; stage 2 vs. stage 3-4, P=0.002), Okuda staging system (stage 1 vs. stage 2, P=0.025), and French staging system (stage A and stage B, P=0.045). The 12-and 24-month area under curve of TNM staging system for ICC, BCLC staging system, JIS score, and CLIP score were 0.836 and 0.847, 0.744 and 0.780, 0.723 and 0.764, and 0.710 and 0.786, respectively. CONCLUSION: The 7th edition of TNM staging system for ICC has superior prognostic value to other seven staging systems in cHCC-CC patients undergoing surgical treatment.

[Clinical application of precise liver surgery techniques for donor hepatectomy in living donor liver transplantation].

OBJECTIVE: To evaluate the effect of techniques of precise liver surgery for donor hepatectomy in living donor liver transplantation. METHODS: Eighty-nine donors aged from 19 to 57 years were performed by the same surgical team from June 2006 to December 2013 in Chinese People's Liberation Army General Hospital.Individualized surgical program were developed according to preoperative imaging examination and hepatic functional reserve examination. The evaluation included liver function, liver volume, vascular anatomy and bile duct anatomy. According to the results after the operation, preoperative evaluation accuracy, postoperative donor liver function and postoperative complications were analyzed. ANOVA analysis was used to compare the difference of graft volume by two-dimensional, three-dimensional calculation method and actual postoperative graft weight. Pearson correlation test and linear regression analysis were used to verify the correlation between the estimated graft volume each method and actual graft postoperative weight. RESULTS: All the 89 cases operation protocol as following, there were 5 cases with left lateral lobe graft, 10 cases with left lobe liver graft, 74 cases with right lobe graft. There were 59 cases with middle hepatic vein (MHV) harvested, and 30 cases without MHV. The mean graft volume by two-dimensional, three-dimensional calculation method and actual postoperative graft weight were (656.2±134.1) ml, (631.7±143.2) ml and (614.5±137.7) ml respectively. ANOVA analysis results showed that there were no statistically significant difference in the three methods (P>0.05). Compared to the actual postoperative graft weight, the average error rate of the two methods were 7.9% and 5.3% respectively. Pearson correlation test showed the graft volume calculated by two-dimensional and three-dimensional methods had a significantly positive correlation with actual graft weight (r=0.821, 0.890, P<0.01) and linear regression analyze showed the R2 were 0.674 and 0.792, respectively. The accuracy rate of preoperative evaluation about portal vein, hepatic vein, hepatic artery and bile duct were 100%, 100%, 97.8% and 95.5%, respectively. The preoperative plan and postoperative practical scheme coincidence rate was 95.5%. Overall donor complication rate was 7.4%. All donors were alive. Sixteen donors received right lobe hepatectomy with gallbladder preserved had a good liver function and gallbladder function. CONCLUSION: Through the precise preoperative evaluation, surgical planning, fine operation and excellent postoperative management, precise liver surgery technique can ensure the safety of donor in living donor liver transplantation.

Modified arterioportal shunting in radical resection of hilar cholangiocarcinoma.

BACKGROUND/AIMS: The resection and reconstruction of hepatic artery is often required in radical surgery for hilar cholangiocarcinoma. In this study, we reported our experience in performing the arterioportal shunting with restriction of the arterial caliber as an alternative for the arterial reconstruction on the basis of our experiment when reconstruction of hepatic artery is impossible. METHODOLOGY: Eight patients with hilar cholangiocarcinoma underwent extended left hepatectomy and caudate lobectomy combined with en bloc resection of hepatic artery and arterioportal shunting with restriction of the arterial caliber. The efficacy of arterioportal shunting and restriction of the arterial caliber in preventing complications of arterioportal shunting were assessed by computed tomography angiography (CTA) perioperational period and 2 years follow-up after the operation. RESULTS: Eight patients recovered uneventfully without any complication. CTA showed a patent shunt and normal liver regeneration. No signs of portal hypertension were found in two years of follow-up. CONCLUSIONS: Arterioportal shunting with restriction of the arterial caliber appears to be a feasible and safe alternative for the microvascular reconstruction after hepatic artery resection in radical surgery for hilar cholangiocarcinoma.

Graft cholangiopathy: etiology, diagnosis, and therapeutic strategies.

BACKGROUND: Graft cholangiopathy has been recognized as a significant cause of morbidity, graft loss, and even mortality in patients after orthotopic liver transplantation. The aim of this review is to analyze the etiology, pathogenesis, diagnosis and therapeutic strategies of graft cholangiopathy after liver transplantation. DATA SOURCE: A PubMed database search was performed to identify articles relevant to liver transplantation, biliary complications and cholangiopathy. RESULTS: Several risk factors for graft cholangiopathy after liver transplantation have been identified, including ischemia/reperfusion injury, cytomegalovirus infection, immunological injury and bile salt toxicity. A number of strategies have been attempted to prevent the development of graft cholangiopathy, but their efficacy needs to be evaluated in large clinical studies. Non-surgical approaches may offer good results in patients with extrahepatic lesions. For most patients with complex hilar and intrahepatic biliary abnormalities, however, surgical repair or re-transplantation may be required. CONCLUSIONS: The pathogenesis of graft cholangiopathy after liver transplantation is multifactorial. In the future, more efforts should be devoted to the development of more effective preventative and therapeutic strategies against graft cholangiopathy.

[Liver transplantation for irresectable hilar cholangiocarcinoma].

OBJECTIVE: To evaluate the outcome of patients with irresectable hilar cholangiocarcinoma undergoing orthotopic liver transplantation (OLT) and to identify the prognostic factors that could influence survival. METHODS: The data of 18 patients who underwent OLT for irresectable hilar cholangiocarcinoma between June 2003 and October 2010 were analyzed retrospectively. There were 12 male and 6 female cases with median of 52 years(range from 34 to 65 years).Fifteen patients underwent modified piggyback liver transplantation, 2 patients underwent classical orthotopic liver transplantation and 1 patient underwent living donor liver transplantation. Data were evaluated regarding tumor size, pathologic stage, overall survival, recurrence rates and prognostic factors. RESULTS: OLT with lymphadenectomy was received by 18 patients with hilar cholangiocarcinoma. Median time until tumor recurrence was 20.5 months(range from 6.0 to 33.0 months). Seventeen patients died during follow-up.Of these, 14 patients died from recurrent or metastatic diseases, 2 patients died from multiple organ dysfunction syndrome during peri-operative period, and one patient died from other cause. The median survival time was 29.5 months(range from 3.0 to 84.0 months). The overall survival rate and recurrence-free survival rate at 1, 3, and 5 year were 16/18, 8/18, 1/18 and 13/18, 2/18, 1/18, respectively.Lymph node metastases had a statistically significant negative impact on overall survival. The 1, 3, and 5 year survival rates were 6/7, 1/7,0 and 10/11, 7/11, 1/11 (P < 0.05) in lymph node-positive and lymph node-negative patients. CONCLUSIONS: Acceptable survival rates can be achieved by OLT for irresectable hilar cholangiocarcinoma without lymph node metastases.Strict patient selection plus multimodal chemoradiation therapy prior to OLT are recommend for patients with lymph node metastases.

Precision in liver surgery.

Continuous theoretical and technological progress in the face of increasing expectations for quality health care has transformed the surgical paradigm. The authors systematically review these historical trends and propose the novel paradigm of "precision surgery," featuring certainty-based practice to ensure the best result for each patient with multiobjective optimization of therapeutic effectiveness, surgical safety, and minimal invasiveness. The main characteristics of precision surgery may be summarized as determinacy, predictability, controllability, integration, standardization, and individualization. The strategy of precision in liver surgery is to seek a balance of maximizing the removal of the target lesion, while maximizing the functional liver remnant and minimizing surgical invasiveness. In this article, the authors demonstrate the application of precision approaches in specific settings in complex liver surgery. They propose that the concept of precision surgery should be considered for wider application in liver surgery and other fields as a step toward the ultimate goal of perfect surgery.

Aggressive hepatectomy for the curative treatment of bilobar involvement of type IV-A bile duct cyst.

OBJECTIVE: To analyze the risk and benefit of aggressive hepatectomy for the curative treatment of bilobar bile duct cysts (BDCs) of type IV-A. BACKGROUND: Conventional surgical treatment of bilobar BDCs of type IV-A is extrahepatic cyst excision, followed by biliodigestive anastomosis. The role of hepatectomy in the treatment of bilobar BDCs remains unclear. METHODS: Between January 2006 and December 2011, a total of 28 patients with bilobar BDCs who underwent an aggressive hepatectomy were identified from a prospective database. Perioperative and long-term outcomes in these patients were compared with 18 patients with bilobar BDCs who received conventional surgical treatment. RESULTS: Patient characteristics such as age, sex, and clinical presentation were similar in both groups. Cystic dilatation of bile ducts was curatively resected in all 28 patients undergoing aggressive hepatectomy. Postoperative morbidity (57.1% vs 22.2%, P = 0.020), but not mortality (3.6% vs 0%, P = 1.000), in patients who underwent aggressive hepatectomy was significantly increased when compared with those who received conventional surgical treatment. Clearance rate of intrahepatic stones was significantly higher after aggressive hepatectomy than that after conventional surgical treatment (100.0% vs 45.5%, P < 0.001). Twenty-seven of 28 patients (96.4%), except 1 patient who met in-hospital death, achieved a symptom-free status after aggressive hepatectomy during a mean follow-up of 31 months. In contrast, during a mean follow-up of 37 months, 7 patients (38.9%, 7/18) remained free of biliary symptoms after conventional surgical treatment. The long-term outcomes between aggressive hepatectomy and conventional surgical treatment were significantly different (P < 0.001). In addition, no malignant transformation occurred after aggressive hepatectomy. However, intrahepatic cholangiocarcinoma has developed in the remnant BDC in 2 of 18 patients (11.1%) receiving conventional surgical treatment during follow-up. CONCLUSIONS: Aggressive hepatectomy, a challenging procedure, provides an efficient treatment option for some selected patients with bilobar BDCs of type IV-A. The role of aggressive hepatectomy in the curative treatment of bilobar BDCs of type IV-A should be paid particular attention in the future.

Validation of the laparoscopically stapled approach as a standard technique for left lateral segment liver resection.

BACKGROUND: Left lateral sectionectomy (LLS) is the most common type of anatomic laparoscopic liver resection performed, accounting for 20 % of all laparoscopic hepatectomies. Because there has been no standardized surgical technique for laparoscopic left lateral sectionectomy (LLLS), we offer an established operation: laparoscopically stapled left lateral sectionectomy (LSLLS). Our aim was to perform a case-controlled study of LSLLS with traditional (without vascular staplers) laparoscopic left lateral sectionectomy (TLLLS), validating the standardization and reproducibility of LSLLS. METHODS: From February 2009 to December 2011, a total of 49 LSLLSs were performed. The results were compared with 33 cohort-matched TLLLSs from an earlier time period. Ordered sample cluster analysis was used to determine the learning curve of LSLLS based on the operating time and blood loss. RESULTS: All LSLLS were performed successfully. There were no conversions to laparotomy or hand-assisted laparoscopic resection. Two endoscopic linear staplers were used in each case. Despite a higher hospital cost ($10,892 ± $944 vs. $8,962 ± $943, p < 0.05), LSLLS compared favorably with TLLLS regarding operating time (103 ± 21 vs. 151 ± 32 min, p < 0.05) and blood loss (70.8 ± 41.6 vs. 173.3 ± 131.1 ml, p < 0.05). No specific complications related to laparoscopy were observed. Ordered sample cluster analysis demonstrated a learning curve of 18 cases for LSLLS. CONCLUSIONS: This study demonstrates the standardization and reproducibility of LSLLS. We therefore propose LSLLS as the standard technique for lesions located in the left lateral section of the liver.

[Assessment of hepatic reserve function of cirrhosis liver using dynamic SPECT (99m)Tc-galactosyl human serum albumin scintigraphy].

OBJECTIVE: To evaluate the effectiveness of dynamic SPECT (99m)Tc-galactosyl human serum albumin (GSA) scintigraphy on the assessment of reserve function of cirrhosis liver. METHODS: From January 2010 to December 2011, 55 patients with cirrhosis liver were enrolled in this study. The case numbers of male and female were 43 and 12 respectively and the age was (51 ± 9) years (ranging from 35 to 69 years). After routine biochemistry test, CT scan and (99m)Tc-GSA dynamic SPECT scan were performed in turn using a juxtaposed SPECT/CT system. Then the morphologic volume of liver parenchyma (MLV), functional liver volume (FLV) and the hepatic cell absorption rate constant (GSA-K) were calculated. The correlations between GSA-K and routine biochemistry test, Child-Pugh score, indocyanine green clearance rate (ICG-K) were analyzed. The patients were further divided into 3 groups according to whether there was occlusion or stenosis in the main branch of left portal vein (group 1, n = 5), right portal vein (group 2, n = 13) or not (group 3, n = 37) and the regional hepatic functions index of the 3 groups were compared. RESULTS: The value of FLV of the whole, left and right liver was (594 ± 152) ml, (244 ± 119) ml and (356 ± 171) ml, respectively. There were correlations between GSA-K and total bilirubin, prothrombintime, Child-Pugh score and ICG-K (r = -0.730--0.298, P < 0.05). The FLV and MLV ratios of involved hemiliver to uninvolved hemiliver were 0.09 ± 0.06 and 0.30 ± 0.14 in group 1, 0.57 ± 0.43 and 1.08 ± 0.63 in group 2, 0.71 ± 0.30 and 0.71 ± 0.48 in group 3. The difference in MLV-FLV ratio was signifcant between group 1 and group 3, between group 2 and group 3 (P = 0.000). CONCLUSIONS: The dynamic SPCECT (99m)Tc-GSA scintigraphy can not only assess the whole liver function of cirrhosis liver effectively, but also evaluate the variation of regional liver function accurately.

Beneficial effects of arbuscular mycorrhizae on Cu detoxification in Mimosa pudica L. grown in Cu-polluted soils.

Arbuscular mycorrhizal (AM) fungi are known to have beneficial effects on host plants growing on contaminated soils. The present study aimed at investigating the influence of two different AM fungi (Rhizophagus intraradices and Funneliformis mosseae) on the growth of plants and Cu uptake by Mimosa pudica L. grown in polluted soils containing various levels of Cu (Control, 400, 500, or 600 mg kg-l soil) in pot experiments. Mycorrhizal colonisation rates by the two AM fungi decreased markedly with the increasing Cu levels in soils. This inhibition was more pronounced to F. mosseae than R. intraradices, indicating that R. intraradices was more tolerant to Cu than F. mosseae. Compared with non-mycorrhizal plants, R. intraradices inoculation increased plant growth (including shoot height, numbers of compound leaves and leaflets, and dry biomass) and P concentrations in the shoots and roots of M. pudica at all levels of Cu. Meanwhile, F. mosseae displayed a capability of growth promotion to M. pudica much later and lower than R. intraradices. F. mosseae and R. intraradices markedly decreased Cu concentration in shoots at 400-600 mg kg-1 Cu levels. However, R. intraradices was more efficient than F. mosseae in decreasing the shoot Cu concentrations. As for the increasing Cu tolerance by R. intraradices, possibly it was reached though the improvement of phosphorus nutrition and the decline of Cu transport from roots to shoots of M. pudica. R. intraradices showed a good potential for improving medicinal plants growth and declining toxic effects in Cu-contaminated soils.

Preparation of esterified biomass waste hydrogels and their removal of Pb2+, Cu2+ and Cd2+ from aqueous solution.

The treatment of polluted water is a serious environmental problem in the world. Biomass is easily modified and can be prepared into adsorbent materials, which is expected to solve the problem of heavy metal ion adsorption in sewage. In this paper, esterified tobacco straw based hydrogels (ETS-PAA) were synthesized from waste tobacco straw biomass. The structure and thermal stability of these hydrogels were characterized by FTIR, SEM, EDS, XPS and TG. The adsorption of metal ions by the hydrogel was measured by ICP-MS. The effects of initial ion concentration, adsorption time, pH, and temperature on the heavy metal adsorption were investigated. The results showed that ETS-PAA possessed more pores, which led to a better adsorption capacity. The maximum adsorption amounts of Pb2+, Cu2+ and Cd2+ were 2.41 mmol·g-1, 1.93 mmol·g-1 and 1.77 mmol·g-1, respectively. Finally, the adsorption mechanism and kinetics were analyzed. The adsorption was mainly accomplished by ion exchange of -COOK on the monomer chain with heavy metal ions, coordination of -OH and -CONH with heavy metal ions and interaction of ester bond, -COOH with heavy metal ions. The adsorption process was in accordance with the pseudo-second-order kinetic model and Freundlich model. The adsorption process belonged to multilayer chemisorption. This work shows that ETS-PAA was a promising material for the removal of heavy metal pollutants from aqueous solution.

Preparation of biomass-based hydrogels and their efficient heavy metal removal from aqueous solution.

In this work, a porous tobacco straw-based polyacrylic acid hydrogel STS-PAA with high adsorption performance was prepared by polymerizing pretreated waste tobacco straw (TS) with acrylic acid/potassium acrylate by UV radiation initiation. The adsorption performance of metal ions was investigated. The effects of different temperatures (25°C, 35°C, and 45°C), adsorption times (1-420 min), pH values (2.0-6.0) and initial concentrations (0.25-4.0 mmol L-1) of metal ions on the adsorption amount of heavy metal ions were investigated. The results showed that the hydrogel had a high removal rate of Pb2+, Cd2+ and Hg2+ in aqueous solution. The adsorption of Pb2+ was particularly effective. When C0 = 4.0 mmol L-1, pH = 6, the equilibrium adsorption amount of Pb2+, Cd2+ and Hg2+ reached 1.49 mmol g-1, 1.02 mmol L-1 and 0.94 mmol g-1, respectively. The chemical structure and morphology of the hydrogels were characterized by FT-IR, EDS, SEM and XPS. The Langmuir model fits well with the adsorption system. The kinetic data suggest the adsorption of Pb2+, Cd2+ and Hg2+ follow the pseudo-first-order model. This indicates that STS-PAA adsorption of three heavy metal ions is monolayer physical adsorption. Thermodynamic analysis shows that the adsorption of Pb2+, Cd2+ and Hg2+ by STS-PAA is an endothermic (ΔH>0) entropy increase (ΔS>0) non-spontaneous reaction.