A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy.

BACKGROUND: blood loss during liver resection and the need for perioperative blood transfusions have negative impact on perioperative morbidity, mortality, and long-term outcomes. METHODS: a randomized controlled trial was performed on patients undergoing liver resection comparing hemihepatic vascular inflow occlusion, main portal vein inflow occlusion, and Pringle maneuver. The primary endpoints were intraoperative blood loss and postoperative liver injury. The secondary outcomes were operating time, morbidity, and mortality. RESULTS: a total of 180 patients were randomized into 3 groups according to the technique used for inflow occlusion during hepatectomy: the hemihepatic vascular inflow occlusion group (n = 60), the main portal vein inflow occlusion group (n = 60), and the Pringle maneuver group (n = 60). Only 1 patient in the hemihepatic vascular occlusion group required conversion to the Pringle maneuver because of technical difficulty. The Pringle maneuver group showed a significantly shorter operating time. There were no significant differences between the 3 groups in intraoperative blood loss and perioperative mortality. The degree of postoperative liver injury and complication rates were significantly higher in the Pringle maneuver group, resulting in a significantly longer hospital stay. CONCLUSIONS: all 3 vascular inflow occlusion techniques were safe and efficacious in reducing blood loss. Patients subjected to hemihepatic vascular inflow occlusion, or main portal vein inflow occlusion responded better than those with Pringle maneuver in terms of earlier recovery of postoperative liver function. As hemihepatic vascular inflow occlusion was technically easier than main portal vein inflow occlusion, it is recommended.

Sodium butyrate induces rat liver oval cells WB-F344 differentiating into billiary epithelium cells in vitro / 第二军医大学学报

Objective: To investigate the effect of sodium butytate (different concentrations) on the growth and proliferation of rat liver oval cell line WBF344, and to discuss the conditions and tules for sodium butyrate-inducd WB-F344 cells differentiation into biliary lineage in vitro. Methods: WB-F344 cells were treated with sodium butyrate (0.70, 2.25, 3.75, 4.5 mmol/L) and the cell growth and morphological changes were observed; routinely cultured WB-F344 cells were taken as control. The changes of CK19 protein expression were examined immunohistochemically after WB-F244 cells were treated with 3.75% sodium butyrate; and the expression of phenotypic markers, such as γ-glutamyltransferase (GGT), β4-integrin, CK19, AFP and ALB at toRNA level were determined by RT-PCR. Untreated WB-F344 cells were used as blank control. Results: We found that sodium butyrate inhibited the growth of WB-F344 cells. The optical densities were significantly decreased in 3.75 and 4.5 mmol/L groups compared with that in control group(P<0.01); but no significant difference was found between 0.75, 2.25 mmol/L groups with control group. WB-F344 cells treated with 3.75, 4.5 mmol/L sodium butyrate became larger and round, with increased nuclei and decreased nucleus to cytoplasm ratio; those treated with 0.75, 2.25 mmol/L had no obvious changes. Immunohistochemical results showed that sodium butyrate significantly increased CK19 expression compared with control group ([92.3±1.1]% vs [1.3±0.2]%, P<0.01). RT-PCR showed increased expression of β4-integrin in sodium butyrate treated groups, but not in control group; the expression of GGT and CK19 was higher than that of control group. Alpha-fetoprotein (AFP) expression was observed in blank control group, but not in sodium butyrate treated cells. Albumin expression was not detected in the 2 groups. Conclusion: Sodium butyrate at 3.75 mmol/L is suitable for inducing WB-F344 cells differentiate into the biliary lineage in vitro.

Effect of preoperative transcatheter arterial chemoembolization for treatment of resectable large hepatocellular carcinoma: A clinical randomized controlled trial / 第二军医大学学报

Objective: To evaluate the effect of preoperative transcatheter arterial chemoembolization (TACE) on liver function and survival of patients after resection of large hepatocellular carcinoma (HCC) by a randomized controlled approach. Methods: From July 2001 to December 2003, a total of 108 patients with resectable large HCC(≥ 5 cm) ,who met the inclusion criteria, were prospectively randomized into surgical resection group (OP group, n=56) or preoperative TACE group (TACE + OP group, n=52). Operative outcomes, resection rate, 1-,3-,and 5-year tumor-free survival rates and overall survival rate were compared between the two groups. Results: The preoperative baseline conditions were equivalent between the two groups. The γ-globulin level in TACE + OP group was significantly higher than that in the OP group(P = 0. 046) after chemoembolization. The prealbumin level was significantly lower than that of the OP group seven days after operation(P = 0. 031). Compared with TACE + OP group, OP group had a significantly higher resection rate (100% vs 89. 4% ,P=O. 017) ,a less average operative time (P=O. 042) ,and less metastases (2 vs 9,P=O. 018). There were no significant differences between the two groups in intraoperative blood loss, warm ischemic time, 1-,3-,and 5-year tumor-free survival rates,or overall survival rate. Conclusion: The preoperative TACE can not improve post-operative tumor-free and overall survival rates, and it may result in tumor metastasis or hepatic function damages.

Relationship between oxidized lipoprotein, angiogenesis and human coronary atherosclerotic plaque stabilization / 中华病理学杂志

<p><b>OBJECTIVES</b>To analyze the relationship between oxidized low density lipoprotein (oxLDL), angiogenesis and stabilization of atherosclerotic plaques in human coronary arteries; and to investigate the role of oxLDL in creating vulnerable sites in atherosclerotic plaques.</p><p><b>METHODS</b>Samples of coronary arteries were obtained at autopsies of 42 patients with acute coronary syndrome. Eighty randomly selected blocks were studied by immunohistochemistry using antibodies against oxLDL and endothelial cells (factor VIII). Computer-aided planimeter was used for quantitative analysis.</p><p><b>RESULTS</b>In unstable plaques, percentage of immunoreactive areas for oxLDL was significantly higher than that in stable plaques. Most of the oxLDL were located in shoulder region of these plaques, as compared to the fibrous cap and basal regions. The details of distribution of oxLDL were as follows: shoulder region (20.43 +/- 3.12 for unstable plaques and 17.65 +/- 4.22 for stable plaques), fibrous cap (4.77 +/- 2.03 for unstable plaque and 2.80 +/- 0.22 for stable plaques) and basal region (5.65 +/- 1.65 for unstable plaques and 3.22 +/- 1.02 for unstable plaques). OxLDL was also a main component in the lipid core. In the shoulder region, there was a significant positive correlation between neovascularization and oxLDL (r = 0.8247, P = 0.000).</p><p><b>CONCLUSIONS</b>The amount of oxLDL is significantly higher in unstable atherosclerotic plaques, especially over the shoulder region. OxLDL in coronary atherosclerotic plaques is thus an important factor in determining stabilization of the plaques. OxLDL may induce influx of inflammatory cells which subsequently leads to decreased plaque stabilization.</p>