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It is not fully clear why there is a higher contribution of pluripotent stem cells (PSCs) to the chimera produced by injection of PSCs into 4-cell or 8-cell stage embryos compared with blastocyst injection. Here, we show that not only embryonic stem cells (ESCs) but also induced pluripotent stem cells (iPSCs) can generate F0 nearly 100% donor cell-derived mice by 4-cell stage embryo injection, and the approach has a "dose effect". Through an analysis of the PSC-secreted proteins, Activin A was found to impede epiblast (EPI) lineage development while promoting trophectoderm (TE) differentiation, resulting in replacement of the EPI lineage of host embryos with PSCs. Interestingly, the injection of ESCs into blastocysts cultured with Activin A (cultured from 4-cell stage to early blastocyst at E3.5) could increase the contribution of ESCs to the chimera. The results indicated that PSCs secrete protein Activin A to improve their EPI competency after injection into recipient embryos through influencing the development of mouse early embryos. This result is useful for optimizing the chimera production system and for a deep understanding of PSCs effects on early embryo development.
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Animals , Mice , Activins , Metabolism , Cells, Cultured , Embryonic Development , Germ Layers , Metabolism , Pluripotent Stem Cells , Cell Biology , MetabolismABSTRACT
Objective To compare laparoscopic appendectomy to conventional operation for the treatment of appendicitis.Methods In this study 1558 patients diagnosed as appendicitis were divided into group A(laparoscopic appendectomy)and group B(conventional operation)according to the random numbers.In group A,779 patients were treated with laparoscopic appendectomy.In group B,779 patients were treated with conventional open appendectomy.The inhospital data and that of followed-up were compared.Statistical analysis was carried out using SPSS11.5 for Windows.Comparisons between categorical variables and continuous variables were analyzed using the X~2 test and t test.Results The operation was successfully performed in all 1558 patients.The operating time in group A and B were(30±2.2)min versus(30±1.6)min(t=0.00,P>0.05),the blood loss were(15±2.9)ml versus(29±5.2)ml(t=65.62,P<0.05),the bed off activity time were(26±3.1)h versus(51±2.1)h(t=69.95,P<0.05),the bowels'move time were(29±1.6)h versus(52±4.6)h(t=10.92,P<0.05),the hospital stay were(3±0.9)d versus(7±1.2)d(t=74.42,P<0.05),the inhospital cost was (6591±41)yuan versus(4860±32)yuan(t=-12.19,P<0.05),the incision infection rate was 0 and 2.8%(X~2=25.40,P<0.05).Postoperative analgesics were needed in 3.8% and 31.4% (X~2=30.63,P<0.05).All the patients were followed-up from 4.5 years to 9.8 years(average 6.8 years).The development of incision hernia in group A and B was 0 versus 0.64% (X~2=5.01,P<0.05).Conclusions Laparoscopic appendectomy is a therapy of choice for patients with acute appendicitis with advantages of minimal invasion,early recovery,few complications and short hospital stay.
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Objective To evaluate the feasibility and efficacy of laparoscopic thyroidectomy in the treatment of thyroid carcinoma. Methods 12 patients with thyriod carcinoma treated with laparoscopic thyroidectomy from January 2003 to January 2006 in our hospital were analyzed retrospectively. Results All operations were successful and there were no surgical deaths. The postoperative complications included 2 cases of hoarseness, 1 extremity numbness and 1 temporary hypoparathyroidism. The number of dissected lymph nodes was from 0 to 13 with a mean of 7.6 nodes in each patient. Of the 12 patients, there was one patient with bilateral lymph nodes metastasis, 5 patients unilateral positive lymph nodes and 6 patients no lymph nodes involvement. The pathologic result of all 12 cases was papillary thyroid carcinoma. After 30 to 62 months' follow-up (average 50.4 months), all patient were still survive and no local recurrence or distance metastasis happened. Conclusion Laparoscopic thyroidectomy in the treatment of early papillary thyroid carcinoma is safe and feasible.
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Objective To study the efficacy of laparoscopic hepatectomy combined with Iodine-125 and radiofrequency ablation(RFA)in the treatment of metastatic hepatic carcinoma.Methods There were 124 patients diagnosed as hepatic metastasis detected by CT or MR scan, and were divided into two treatment groups. Group A(combined group of 41 cases)with laparoscopic excision,RFA and iodine-125 treatment and group B(control group of 83 cases)with transhepatic artery chemoembolization(TACE)and systematic chemotherapy.Results Nine new hepatic metastatic foci were found by laparoscopic ulstrasound during the operation in group A,and in this group,18 hepatic metastatic lesions located on the surface in 13 patients were removed,then RAF applied to the hepatic metastases,and iodine-125 planted in place,altogether 59 foci near to the porta hepatis or large vessels were treated by laparoscopic RFA and iodine-125 implantation.All patients were followed-up from 26 to 45 months(average 35.4 months).The total relief rate was 90.2% and 30.1 % in group A and B respectively(x~2=39.68,P＜0.05＝.The median survival time was 19 and 11 months in group A and B respectively(t=-9.74,P＜0.05＝.The survival rate at 1-,2-and 3-years was 80.5%,48.8%,24.4% and 54.2%,28.9%,9.6% in group A and B respectively (x~2=8.11,4.73,4.81,P＜0.05＝.Conclusions Laparoscopic excision,Iodine-125 implantation and radiofrequency ablation in the treatment of metastatic liver carcinoma is safe、effective,and this approach prolongs the patient's survival time.
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Objective To study the efficiency of iaparoscopic inguinal hernia repair without the use of a mesh. Methods We used laparoscopic hernia repair without the use of a mesh in 92 cases of inguinal hernia. Results were compared with that of total extraperitoneal laparoscopic inguinal hernioplasty(TEP) in 91 cases from January 2001 to March 2004. Results The laparoscopic procedures were successfully performed in all the patients. In mesh-free and TEP group respectively the operating time was (21±4) min vs. (70±16) min (t=28. 01, P<0.05), hospital stay was (3.5±1.0) d vs. (4.8±1.2) d (t=7.96, P<0.05), average time off-bed was (1.0±0.5) d vs. (1.8±0.7) d (t=8.90, P<0.05), duration of pain was (1.0±0.5) d vs. (2.5±0.7) d (t=16.69, P<0.05), the expense was (4500±500) RMB yuan vs. (8000±820) RM B yuan(t=34.89, P<0.05), subcutaneous hematoma rate was 0% vs. 8.7% (χ~2=6.48, P<0.05). The 48 hour C-reaction protein level after the operation was (3.9±0.3) mg/dl and (8.8±0.5) mg/dl (t=80.48, P<0.05). All the difference was statistically significant between the two groups. All patients were followed up for 56.9±6.2 months. The recurrence rate was 0 and 2.1% (χ~2=0.51,P>0.05) respectively. Conclusions Mesh-free laparoseopie inguinal hernia repair is safe, cost-effective, as well as of much lower hernia recurrence.
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Objective To study the safety and efficacy of laparoseopic subtotal thyroidectomy for primary hyperthyroidism.Methods From January 2003 to January 2007,seventy-five patients with primary hyperthyroisism underwent subtotal thyroidectomy,among which thirty patients by laparoscopic procedure and forty-five patients by open surgery.The clinical data were retrospectively analyzed.Results All the surgery were Successful.No patient in the endoscopic group was converted to open surgery.The mean operative times of endoscopic group and open surgery group were(110.5±12.3)min vs(98.8±15.5)min(t=3.46,P<0.05),the mean blood loss were(45.5±11.5)ml vs(65.8±12.6)ml(t=7.07,P<0.05),the inhospital fee were(11128.5±358.8)RMB yuan vs(6500.9±231.9)RMB yuan(t=67.92,P<0.05),the amount of drainage were(125.9±10.7)ml vs(46.5±9.4)ml(t=33.90,P<0.05),the days of drainage were(2.98±0.5)d vs(1.75±0.3)d(t=13.31,P<0.05),tlle use of analgeties was in 20.0%(6/30)vs 42.2%(19/45)(χ~2=4.00,P<0.05),the rate of temporary hoarseness wag 6.6%(2/30)vs 8.8%(4/45)(χ~2=0.12,P>0.05).There were 1 hypothyroidism and 1 recurrent hyperthyroidism in endoscopic group while 1 hypothyroidism and 2 recurrent hyperthyroidism in open surgery group after a 47.8 month's follow-up. Conclusions Endoscopic subtotal thyroideetomy for hyperthyroidism patients is safe,effective and presents a significant cosmetic advantage.
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Objective To investigate the therapeutic effectiveness of residue liver embedding of iodine-125 on recurrence after hepatectomy in hepatocellular carcinoma patients. Methods In this study, 85 cases with resectable hepatocellular carcinoma were collected and divided into two groups randomly: intrahepatic embedding of iodine-125 group and control group. The serum values of T lymphocyte phenotypes (CD3 + CD4 + ,CD8 +), NK cells,TB IL, ALT, AST, AFP and MMP-9 were measured in all patients 1 day before and 7, 30 days after the operation respectively; B ultrasonic and CT were used to detect for intrahepatic dissemination and recurrence of HCC after hepateetomy. All patients were followed-up from 16 to 55 months (average 35.4 months). Results Surgery were successful in all cases. There were no difference in T lymphocyte phenotypes, NK cells, TBIL, ALT and AST between the two groups (P＞0.05). The serum values of AFP and MMP-9 were much lower in the intrahepatic embedding of iodine-125 group than the control group(P<0.05). In iodine-125 embedding group, the 0.5-, 1-year recurrent rates were 2.3%、6.9%, respectively, compared with 14.2% and 26.1%, respectively, in control group (all P<0.05). Conclusions Intrahepatic embedding of iodine-125 in HCC patients after hepatectomy decreases values of AFP, MMP-9 and local cancer recurrence rate in HCC patients after hepatectomy.
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Objective To evaluate the clinic efficacy of laparoscopic totally extraperitoneal technique in complex inguinal hernia repair. Methods Totally 42 patients with complex inguinal hernia were repaired by laparoscopic totally extraperitoneal technique in our hospital during July 2004 to June 2008. Among the cases,18 patients had bilateral indirect inguinal hernia,8 had unilateral indirect and direct inguinal hernia,5 suffered from indirect inguinal hernia at one side and direct inguinal hernia in the other side,4 patients showed bilateral direct inguinal,3 showed bilateral indirect inguinal hernia and unilateral direct inguinal hernia,2 had bilateral direct inguinal hernia and unilateral indirect inguinal hernia,1 patient showed indirect inguinal hernia complicated with femoral hernia at the same side,and 1 patient had indirect and direct inguinal hernia at the both sides.During the operation,a 10-mm incision was made at 15 mm below the umbilicus reaching the Hunter's line,to place the laparoscope and separate the extraperitoneal space.Afterwards,two 5-mm trocars were inserted and then extraperitoneal pneumorperitoneum was established involving the retropublic space extending up to the anterior superior spine,so that to return the complex hernias.A polypropylene patch was then used to cover the pubic foramen and Hesselbach triangle. Results TEP was successfully completed in all of the 42 patients with a mean operation time of 85-165 min (mean,107.3 min) and estimated intraoperative blood loss of 10-20 ml. Scrotum aerocele was detected in all of the cases during the operation. The patients received normal diet in 2 days postoperation. They were discharged from our hospital in 7 to 9 days (mean,7.6 days). Follow-up was achieved for 3 to 32 months (mean,15.3 months) in all of the patients,during the period,2 patients showed recurrent direct inguinal hernia,and 5 had mild paraesthesia in the lower abdominal wall. Conclusions TEP is safe and effective for complex inguinal hernia.
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Objective To study the efficacy of laparoscopic pull through proctectomy for the treatment of rectal cancer. Methods There were 60 patients colonoscopically diagnosed as having rectal cancer (3~12 cm from the anal margin). Laparoscopic pull through proctectomy was performed. The distal tumor-free margin was about 2 cm. Results All the operations were performed successfully, without conversions to open surgery. The operating time was 89~179 min (120?25 min), the blood loss was 48~147 ml (75?26 ml), the length of hospital stay was 5~12 d (8.3?1.5 d), and the hospitalization expenditure was 8 680~15 800 yuan (9 900?750 yuan). Follow-up observations in the 60 patients for 12~25 months (mean, 22.3 months) showed no intraabdominal hemorrhage, anal stenosis, or intestinal leakage. Fecal incontinence was not seen at 2 postoperative month. One patient was found local recurrence after 12 months and underwent a second laparoscopic resection. Conclusions Laparoscopic pull through proctectomy for rectal cancer is safe, effective, and minimally invasive.
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Objective To study the effect and value of the application of the median umbilical fold in laparoscopic treatment for indirect inguinal hernia in children.Methods A total of 105 cases of pediatric indirect inguinal hernia(including 32 cases of incarcerated hernia, 25 cases of bilateral hernia,and 6 cases of recurrent hernia after open surgery) was treated with laparoscopic high ligation of the hernia sac and repair with the median umbilical fold from January 2004 to August 2005.The operation was performed through two or three trocars.Under laparoscopic visualization,the internal ring was identified for a purse-string suture.Then the median umbilical fold was sutured on the internal ring to repair the defect.Results The operation was successfully performed under laparoscope in all the 105 cases.The operative time was 10~25 min(mean,15 min) for unilateral hernia and 20~35 min(mean,25 min) for bilateral hernia.The intraoperative blood loss was hardly seen.The length of hospital stay was 2~3 days.The postoperative recovery was uneventful,without intestinal adhesion,infection,or hematoma of the scrotum.Follow-up observations in the 105 cases for 5~24 months(mean,18 months) found no recurrence.Conclusions Laparoscopic high ligation of the hernia sac and repair with the median umbilical fold is safe and effect for pediatric indirect inguinal hernia,with advantages of mini-invasion,simple performance,short operation time,low complication rate,and quick recovery.
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Objective To investigate the clinical value of two kinds of endoscopic thyroidectomy for thyroid diseases.Methods Endoscopic thyroidectomy via breast approach or axillary approach was performed in 98 cases from December 2003 to August 2005.The subcutaneous space beneath the breast area and the subplatysmal space in the neck were bluntly dissected through a 5-mm incision.The CO_2 was insufflated at the pressure of 8~10 mm Hg to create an operative space.Three trocars were inserted.The dissection of the thyroid parenchyma and vessels was performed endoscopically by using an ultrasonically activated scalpel.The recurrent laryngeal nerve,the superior laryngeal nerve,and the parathyroid glands were preserved carefully.There were 1 case of lobectomy on one side and partial thyroidectomy on the other side,18 cases of unilateral lobectomy,12 cases of bilateral subtotal thyroidectomy,46 cases of unilateral subtotal lobectomy,and 21 cases of resection of thyroid mass. Results The operation was successfully completed in all the 98 cases,without conversions to open surgery.No complications were noted.The operative time was 69.1?29.0 min,the estimated blood loss was 37.9?10.6 ml,and the postoperative hospital stay was 3.5?0.7 days.The drainage tube was removed at 24~36 hours after operation.Two cases of thyroid cancer were followed for 24 months without recurrence.The remaining 96 cases were followed for 6~28 months(mean,16 months) without recurrence.Conclusions Endoscopic thyroidectomy via breast or axillary approach is feasible and safe,giving patients satisfactory cosmetic results.
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Objective To evaluate the value and clinical efficacy of amputation of secondary structures of the spleen pedicel for laparoscopic splenectomy(LS).Methods Twenty-one cases of idiopathic thrombocytopenic purpura(ITP) and 1 case of splenic cyst were given a 4-port laparoscopic splenectomy.After the spleen was mobilized,a non-traumatic forceps was used to clip the pedicel at the site 3~5 cm from the hilus of spleen for the control of hemorrhage.The serosa on the spleen pedicel was opened by using a harmonic scalpel.Then secondary structures of the splenic arteries and veins,one by one,were disconnected from without upward,double ligated with the Hem-o-lok clips,and severed with the harmonic scalpel.The spleen was placed into an extraction bag,broken into small pieces,and removed from the extraction incision.Results The laparoscopic splenectomy was successfully completed in all the 22 cases.The operative time was 75~180 min(mean,117 min),and the estimated intraoperative blood loss was 20~280 ml(mean,87 ml).All the patients got out of bed and began to take food at 1~2 days after operation. The length of postoperative hospitalization was 5~11 d(mean,5.6 d).There were 1 case of incisional subcutaneous hematoma and 1 case of subcutaneous emphysema.Follow-up for 1.5～52 months(mean,19.3 months) in the 22 cases revealed no surgery-related complications.Conclusions The amputation of secondary structures of the spleen pedicel is a relatively safe and effective measure for completing laparoscopic splenectomy.
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Objective To compare effects between laparoscopic appendectomy(LA) and open appendectomy(OA) for acute appendicitis in children.Methods A total of 95 children with acute appendicitis from July 2000 to July 2005 were given either LA(LA Group,n=50) or OA(OA Group,n=45).The surgical outcomes and curative effects were compared between the two groups.Results The operation was successfully completed in both of the groups.No bleeding,intestinal fistula,or stump appendicitis was seen.There was no difference in the operation time between the LA Group(38.8?17.4 min) and the OA Group(41.9?15.8 min)(t=-0.905,P=0.368).The time to first defecation was significantly shorter in the LA Group(26.4?7.2 h) than in the OA Group(39.7?8.8 h)(t=-8.094,P=0.000).Appendiceal perforation was found in 29 children in the LA Group and 26 children in the OA Group,without significant difference(?~2=1.633,P=0.983),but the incidence of wound infection was significantly higher in the OA Group(11 children) than in the LA Group(2 children)(?~2=8.381,P=0.004).A drainage placement was required in 3 children in the LA Group and 9 children in the OA Group,with significant difference(?~2=4.206,P=0.040).The LA Group had significantly shorter time to normal temperature(55.4?16.2 h) than the OA Group(77.8?30.6 h)(t=-4.522,P=0.000),shorter hospital stay(5.4?1.3 d) than the OA Group(13.4?6.5 d)(t=-8.520,P=0.000),but higher hospitalization costs(6 117.9?836.5 yuan) than the OA Group(4 528.6?527.1 yuan)(t=10.937,P=0.000).Conclusions Laparoscopic appendectomy is superior to open surgery for acute appendicitis in children because of its advantages of minimal invasion,little pain,early recovery,good cosmetic appearance,low complication rate,and short hospital stay.
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90 Gy . Tumor irradiation dose, the umber of tumor and liver cirrhosis were identified by Cox-regression analysis as independent predictors for survival. Two patients experienced CTC grade 1 acute hepatic toxicity and three patients experienced grade 3 acute hepatic toxicity. Two patients developed RILD. Nine patients experienced RTOG grade 1 acute gastrointestinal complication and one patient experienced acute gastrointestinal bleeding. Five patients experienced RTOG grade 1 leucopenia and five patients experienced grade 2 leucopenia. Conclusion Iodine-125 seed local radiotherapy combined with TACE is safe and effective for HCC. It is worth of further dose escalation study.
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Objective To study the feasibility of laparoscopic high ligation and median umbilical fold onlay for the treatment of adult inguinal hernia.Methods Laparoscopic high ligation and median umbilical fold onlay was performed in 35 cases of adult inguinal hernia(including 5 cases of incarcerated hernia,12 cases of bilateral hernia,and 8 cases of recurrent hernia)from Janaury 2003 to August 2005.Surgical outcomes ad follow-up records were compared with those from another 30 cases of inguinal hernia treated by conventional surgery.Results The laparoscopic operation was successfully performed in all the 35 cases.As compared with conventional surgery,laparoscopic operation presented a shorter operation time(20.8?8.8 min vs 53.5?12.6 min;t=-12.262,P=0.000)and postoperative hospital stay(5.5?1.8 d vs 8.5?1.9 d;t=-6.529,P=0.000).Edema of scrotum was not found in laparoscopic cases but occurred in 11 out of 30 conventional cases(36.7%;?2=15.448,P=0.000).Follow-up examinations for 18.6?8.9 months found 2 cases of recurrence after conventional surgery and no recurrence after laparoscopic operation(?2=0.691,P=0.406).Conclusions Laparoscopic high ligation and median umbilical fold onlay is safe and feasible in the treatment of adult inguinal hernia.
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Objective To explore the efficacy of laparoscopic hepatectomy in combination with radiofrequency ablation and Iodine-125 brachytherapy in the treatment of hepatic carcinoma.Methods The study included 26 cases of hepatic carcinoma(left-sided,12 cases;right-sided,11 cases,both-sided,3 cases).There were 34 tumor lesions,with a maximum diameter of 2.8～13.0 cm.All the patients underwent laparoscopic hepatectomy in combination with radiofrequency ablation and Iodine-125 brachytherapy.Results The combination operation was successfully completed in all the cases,without conversions to open surgery.During the operation,2 new tumor lesions were founded by laparoscopic ulstrasound.Among the 36 lesions,only harmonic scalpel vaporization and Iodine-125 seeds implantation was performed in 8 cases of posterior right lobe lesions,and laparoscopic hepatectomy in combination with radiofrequency ablation and Iodine-125 seeds implantation was conducted in 28 cases of margin lesions.Follow-up checkups for 12～25 months(mean,22.3 months)showed a 1-year survival rate of 92.3%(24/26).Local tumor recurrence was seen in 3 out of 36 lesions.No severe complications occurred.Conclusions Combination of laparoscopic hepatectomy,radiofrequency ablation,and Iodine-125 brachytherapy for treating hepatic carcinoma is safe and minimally invasive,with a rapid recovery and a high survival rate.
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Objective To explore the feasibility of mastoscopic resection of benign mammary gland tumors. Methods A total of 68 cases were diagnosed as having benign mammary gland tumors(42 cases of fibroma and 26 cases of cystic adenoma) by using molybdenum target X-ray examinations.The tumor was located at lower outer quadrant in 26 cases,upper inner quadrant in 16 cases,lower inner quadrant in 14 cases,and upper outer quadrant in 12 cases,respectively.The operation was conducted via a transaxillary approach.A specially-designed flap dissector was utilized to establish a tunnel underneath the breast skin,where the air was inflated to build a surgical space.Then the tumor was resected by using an electrotome or harmonic scalpel. Frozen-section examination was routinely carried out during operation. Results The operation was successfully completed in all the 68 cases,without intraoperative complications.The operation time was 28~45 min(mean,35 min).The drainage tube was indwelled for 1~2 d.Subcutaneous effusion occurred in 1 case.Postoperative recovery was uneventful without skin necrosis or other complications.The length of postoperative hospital stay was 2~5 d(3.0?1.5 d).Follow-up checkups in the 68 cases for 3~36 months(mean,12 months) revealed good cosmetic outcomes. Conclusions Transaxillary mastoscopic resection of benign mammary gland tumors is safe and feasible,with good cosmetic results.
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Objective To evaluate the effect of duodenal shunt procedures for the treatment of cholangitis caused by peripapi llary duodenal diverticulum. Methods Three types of shunt procedure were adopted i.e. Roux-en-Y gastrojejunost omy (14 cases), Billroth-Ⅱ operation (24 cases), duodenojejunostomy (4 cases). Results There was no severe co mplication nor recurrent cholangitis postoperatively in 42 patients at a follow up of 1～10 years. Four patients suffering from moderate delayed empting wer e relieved by conservative measures.Conclusion Duodenal shunt procedures are effective for the treatment of ch olangitis caused by peripapillary duodenal diverticulam.
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Objective To study the efficacy of laparoscopic tumor resection combined with iodine-125 and radiofrequency ablation in the treatment of rectal carcinoma with synchronous hepatic metastasis. Methods There were 30 patients diagnosed as rectal carcinoma with synchronous hepatic metastasis detected by CT scan. Hepatic metastases were confirmed by needle biopsy under laparoscopy. Laparoscopic radical resection of rectal carcinoma and metastatic hepatic tumors was performed. Those metastatic tumors that could not be resected were managed by RAF. Iodine-125 was planted in the tumors' site. Results Seven new hepatic metastases were found by the laparoscopic ulstrasound during the operation. 8 hepatic metastatic lesions were removed, 25 tumors located in the right liver were managed by RAF. All patients were followed-up from 12 to 25 months(average 22. 3 months), Local recurrence was found in 6 patients, the 1-year survival rate was 73% (22/30). Conclusions Laparoscopic excision, Iodine-125 and radiofrequency ablation in the treatment of rectal carcinoma with synchronous hepatic metastasis is safe、effective、minimally invasive.