[Effects of E-selectin and their ligands on the adhesive metastasis of hepatocellular carcinoma].

OBJECTIVES: To explore the effects of E-selectin, ICAM-1 and their ligands on the adhesive metastasis of hepatocellular carcinoma (HCC), and to select possible anti-adhesion drugs for hepatocellular carcinoma metastasis. METHODS: 78 HCC patients were analyzed with the correlation of clinical features to the expression levels of E-selectin, sLeX, sLeA and CD44v6 in the tumor tissue. The adhesion between HepG2 and endothelial cell lines was examined by solid phase adhesion assay in vitro. Two kinds of drugs were accessed for their anti-adhesion ability. RESULTS: The positive rate of E-selectin in vascular endothelia cells adjacent to cancer nest is 70.51%, and which of sLeX, sLeA, CD44v6 within tumor cells is 64.10%, 69.23%, 62.90% respectively. The patients' life span is closely related with the positive expression of sLeX, sLeA, CD44v6 (P = 0.008, 0.001, 0.022). The positive expression of E-selectin, sLeX and sLeA is significantly correlated to portal vein tumor thrombus (PVTT), preoperative extrahepatic metastasis, and satellite foci, but not to the size of tumor and AFP. The level of CD44v6 expression is significantly correlated to patient's survival time. The expression levels of E-selectin and ICAM-1 are remarkably higher after ED25 and ECV304 cell lines be activated. Meanwhile the adhesive ability of HepG2 to endothelial cell is mediated. Dexamethasone, tanshinone IIA are able to block this adhesion at low concentration. CONCLUSION: The expression levels of E-selectin, sLeX, sLeA and CD44v6 are closely correlated with clinical features. E-selectin, ICAM-1 and their ligands are important molecules of hepatocellular carcinoma and endothelial cells to tumor adhesive metastasis. Dexamethasone, tanshinone II A can be hopefully used as anti-adhesion drugs.

[Study of surgical procedures of abdominal organ cluster transplantation].

OBJECTIVE: To evaluate the surgical procedures and therapeutic effect of organ cluster transplantation in treating abdominal multiple organ malignant tumors. METHODS: Two patients with abdominal multiple organ malignant tumors received organ cluster transplantation in May and August 2004. The excised specimen included liver, pancreas, duodenum, stomach, spleen, mesenteric and epigastric lymph nodes. The transplanted organs included liver, pancreas, duodenum. Superior mesenteric artery was involved in the malignancy in one case and was transected and anastomosed to right common iliac artery. RESULTS: The patients waked up 4 and 5 hours post operation and began recovering 3 and 5 days after. Dynamic examinations showed that the functions of grafted liver, pancreas and duodenum obtained normal function in 10 days post the transplantation. One patient survived for 12 months postoperatively and died of recurrence of cancer; The other recovered uneventfully after transplantation, and discharged automatically 20 days after. CONCLUSIONS: Abdominal organ cluster transplantation is technically feasible and effective for patients with abdominal multiple organ malignant tumors.

[Study of embryonic stem cells induced to express hepatic cell functions in vitro in a pathologic niche containing cholestatic serum].

OBJECTIVE: To study the role of a pathologic niche inducing mouse embryonic stem cells (ESC) to express hepatic cell functions in vitro. METHODS: Embryoid bodies were developed from 5 to 7 day hanging-drop culture of mouse ESC, and their dissociated cells were planted in three differential systems: nothing added; with 20 ng/ml hepatocyte growth factor (HGF); and 5% rat cholestatic serum plus 20 ng/ml HGF added. Their differentiation was observed with inverted microscopes daily, and their hepatic functions were analyzed against their synthesis of glycogen, triglycerides, albumin, and urea nitrogen, and by their staining of indocyanine green (ICG) and fluorescein diacetate (FDA). RESULTS: ESC spontaneous differentiation was hardly being controlled to form three germ layers. HGF prompted the ESC to develop further into visceral endoderm and mesoderm (myocardium), but both of them only expressed a low level of hepatocyte-specific metabolic functions. With cholestatic serum added into the HGF-induced system, differentiated cells grew into similar angular cells, and had a higher level synthesis of glycogen, triglycerides, albumin and urea nitrogen with positive ICG and FDA staining. CONCLUSIONS: Spontaneous or HGF-induced ESC differentiation has only limited hepatic functions expressed. A pathologic niche in vitro induces ESC to develop into hepatic lineages, with a higher level of hepatic metabolic functions.

[Digestive tract reconstruction and postoperative management of upper abdominal multivisceral transplantation].

OBJECTIVE: To explore the method of digestive tract reconstruction and postoperative management in the upper abdominal multivisceral transplantation (MVT). METHODS: The data of a pancreatic cancer patient with multiple liver metastases, undergone the first upper abdominal MVT in Asia on May 2004, was investigated retrospectively. RESULTS: During the operation, liver, gall bladder, pancreas, duodenum, part of jejunum, total stomach, greater and lesser omentum, and spleen were all resected from the recipient. Roux-en-Y procedure was adopted for the reconstruction of digestive tract, including closing the proximal end of donor duodenum, anastomosing recipient jejunum with horizontal part of donor duodenum, transecting the jejunum 35 cm from the anastomosis, end-to-side anastomosing the distal cut end of jejunum with the end of esophagus, and end-to-side anastomosing proximal cut jejunum with jejunum 50 cm away from esophageal anastomosis. Drainage tube was left inside duodenum and jejunum stoma was made for nutrient canal.The endocrine of pancreas was suppressed by the use of somatostatin postoperatively. Removing of nasogastric tube and duodenum draining tube were delayed. Bowel function recovered 4 days postoperatively and gradually resumed ordinary diet. One month after operation, the patient had no other complications except diarrhea. CONCLUSION: The success of upper abdominal MVT supplies precious experience in digestive tract construction and postoperative management.