Effects of Rg_1 on LPS-induced apoptosis and autophagy of lung epithelial cells / 中国中药杂志

This paper aimed to study the protective effect of ginsenoside Rg_1 on endotoxin(LPS)-induced apoptosis of lung epithelial cells and its mechanism of action. Mouse lung epithelial cells(MLE-12) were first treated with LPS. The autophagy changes and apoptosis and the relationship with concentration and time of LPS were observed. Then,the level of autophagy in MLE-12 was regulated at a specific concentration and action time of LPS,and the changes of apoptosis were observed. Secondly,ginsenoside Rg_1 and autophagy inhibitor 3-MA were added respectively at the same concentration and action time of LPS. The lung epithelial cells were grouped to observe the effect of ginsenoside Rg_1 on LPS-induced apoptosis of lung epithelial cells and its mechanism. In the animal experiment,the mice were grouped and tested by apoptosis protein,lung injury score and HE staining section to verify whether ginsenoside Rg_1 has a protective effect on LPS-induced lung injury. The results showed that apoptosis and autophagy increased as the rise of concentration after treatment with LPS for 12 h. The apoptosis increased gradually,and the autophagy increased first and then decreased over time at the LPS concentration of 25 g·L-1. The apoptosis of LPS group was higher than that of control group,and LPS+3-MA group increased further,while apoptosis decreased significantly in LPS+RAM(rapamycin,autophagy promoter) group. The autophagy increased in LPS group,decreased in LPS+3-MA group and increased in LPS+RAM group. The apoptosis of LPS group was higher than that of control group,and the apoptosis of LPS+Rg_1 group decreased. The apoptosis of LPS+Rg_1+3-MA group increased again. The autophagy of LPS group further increased after administration of ginsenoside Rg_1,but decreased after administration of 3-MA. In the in vivo experiments in mice,the apoptosis of LPS group increased significantly compared with the control group,while LPS + ginsenoside Rg_1 group decreased. Lung injury score and HE staining also conformed to the above trend. LPS can induce the apoptosis of lung epithelial cells in a time-dependent and concentration-dependent manner. The autophagy of lung epithelial cells increases with the rise of LPS concentration. At the specific concentration of LPS,autophagy increases first and then decreases after 12-16 hours. Proper increase of autophagy in lung epithelial cells within a certain period of time can reduce the apoptosis induced by LPS,while inhibition of autophagy can increase apoptosis. Ginsenoside Rg_1 has a protective effect on lung cancer epithelial cell apoptosis induced by autophagy.

Significance of serum IgG4 and CA19-9 in diagnosis and antidiastole of IgG4 related cholangitis / 中国免疫学杂志

Objective:To investigate the value of autoantibodies and serum levels of IgG4 and CA19-9 in the diagnosis of IgG4 associated cholangitis (IgG4-SC).Methods:Detect the serum IgG4 and CA19-9 of 41 clinical cases of IgG4-SC patients,162 clinical cases of non IgG4-SC patients and 40 healthy human serum samples by immunoassay and direct chemiluminescence methods, also detect the antinuclear antibodies (ANA),anti neutrophil antibody (ANCA),anti smooth muscle antibody (SMA) and anti mitochondrial antibody (AMA) of the above serum samples by indirect immunofluorescence and analyze the detection results.Results:①The positive rates of ANA,ANCA,SMA and AMA in patients with IgG4-SC were 41.46%,7.32%,0 and 2.44%.Among them,the positive rate of ANA was significantly different from that of the normal control group(P<0.01),and the positive rate of SMA and AMA was significantly different from that of non IgG4-SC group(P<0.01),and so as the positive rate of ANCA do with that of PSC group.②The number of serum IgG4 and CA19-9 increased samples were significantly compared with the normal control group (P<0.01);the area under the ROC curve (AUC) was 0.979 and 0.646,respectively,and P<0.05.Conclusion:The high level of serum IgG4 and CA19-9 and autoantibody detection are of great accuracy and important clinical value in the differential diagnosis of IgG4-SC.

Optimization of Extraction Technology for Yangxin Anshen Granules with Orthogonal Test / 中国中医药信息杂志

Objective To optimize the extraction technology for Yangxin Anshen Granules. Methods With yield of volatile oil as index, single factor tests were adopted to investigate effects of water, soaking time and distillation time on extraction technology of volatile oil. Using water amount, extraction time and extraction times as factors, the contents of paeoniflorin and total solid as indexes, orthogonal test was employed to optimize the extraction technology of Yangxin Anshen Granules. Results The optimical extraction technology conditions were as follows:Cinnamomi Ramulus, Saposhkoviae Radix, and Citri Sarcodactylis Fructus were extracted to get volatile oil with eight-folds amount water of herbs for 6 hours; other herbs were boiled with eight-folds amount water of herbs and extrancted for two times, 1 h each time. Conclusion This extraction process is reasonable and practical, and can well guarantee the quality of preparation.

Forensic Validation of the Goldeneye™ DNA ID 25A Kit / 法医学杂志

OBJECTIVE@#To test and estimate the forensic application of Goldeneye™ DNA ID 25A Kit.@*METHODS@#The kit was validated by a series of tests for accuracy, sensitivity, consistency, peak height balance, stability, and mixed samples through measured blood samples and other samples in routine casework.@*RESULTS@#The peak height balance of the different loci was ≥ 42%. The genotyping results of the positive control DNA was accurate. The complete STR genotyping result could be obtained from 0.125 ng positive control DNA.@*CONCLUSION@#Goldeneye™ DNA ID 25A Kit is suitable for criminal cases and DNA database in forensic practice.

Expression of pGSK-3α/β Tyr279/216 and XIAP proteins in cholangiocarcinoma and their clinical significance / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the expressions of the active form of glycogen synthase kinase-3(GSK-3)-pGSK-3α/β (Tyr279/216) and its downstream moleculor X-linked inhibitor of apoptosis protein (XIAP) in cholangiocarcinoma and to analyze their correlation with clinicopathological and survival significance.</p><p><b>METHODS</b>Immunohistoehemistry was used to detect the expressions of the active form of GSK-3- pGSK-3α/β (Tyr279/216) and its downstream moleculor XIAP proteins in 50 cholangiocarcinoma tissues and 20 normal bile duct tissues.</p><p><b>RESULTS</b>The positive rates of pGSK-3α/β (Tyr279/216) and XIAP were 62.0% and 68.0% in cholangiocarcinoma, and 10.0% and 25.0% in normal bile duct tissues, respectively. The intensity of pGSK-3α/β (Tyr279/216) and XIAP expressions in cholangiocarcinoma were significantly higher than that in the normal bile duct tissues (P < 0.001), and there was a significant correlation between pGSK-3α/β (Tyr279/216) and XIAP expressions (r = 0.544, P < 0.001). The expression of pGSK-3α/β(Tyr279/216) protein in cholangiocarcinoma was associated with TNM stage (P = 0.042), histological grade (P = 0.031), whereas the expression of XIAP protein in cholangiocarcinoma was correlated with CEA level (P = 0.006). Patients with positive expression of pGSK-3α/β (Tyr279/216) and XIAP demonstrate a significantly worse prognosis than that of patients with negative expression of pGSK-3α/β (Tyr279/216) and XIAP for overall survival (P = 0.002, P = 0.018). Multivariate survival analysis revealed that positive pGSK-3α/β (Tyr279/216) expression provided significant independent prognostic value for overall survival (P = 0.002).</p><p><b>CONCLUSIONS</b>The expressions of pGSK-3α/β(Tyr279/216) and XIAP proteins were significantly associated with the development and progression of cholangiocarcinoma. pGSK-3α/β(Tyr279/216) may be an important prognostic factor for survival of patients with cholangiocarcinoma.</p>

Study on the correlation between contrast-enhanced ultrasonographic characteristics and microvessel density in breast cancer / 中华医学超声杂志（电子版）

Objective To investigate the relation of contrast-enhanced ultrasound ( CEUS ) characteristics and microvessel density ( MVD ) in the breast cancer .Methods From October 2010 to February 2012, 45 cases of patients with breast cancer were studied in Yantai Yuhuangding Hospital , Affiliated to Qingdao University Medical College .All lesions were examined by CEUS before surgery .The blood perfusion parameters such as rising time (RT),peak intensity(PI),time to peak(TTP),wash-in slope (WIS) and mean transit time ( MTT) were obtained by time-intensity curve ( TIC).Immunohistochemical staining for anti-factor CD34 was performed on surgery specimen and the MVD was evaluated .The CEUS characteristics and blood perfusion parameters between different MVD groups of breast cancer were compared.Results In 45 cases of breast cancer,mean MVD was(47.6 ±14.2)/high power field(HPD). Twenty-one cases(46.7%) were classified as high MVD group(MVD>48/HPD) and 24 cases(53.3%) were classified as lower MVD group ( MVD≤48/HPD) .Besides two cases without contrast agent perfusion in CEUS imaging, blood perfusion was observed in 43 cases (95.6%).Heterogeneous enhancement was observed in 25 cases(55.6%).Local blood perfusion defect was observed in 27 cases(60.0%).Irregular shape was observed in 37 cases(82.2%).Centripetal enhancement was observed in 25 cases(55.6%). Penetrating surrounding vessels was observed in 32 cases(71.1%).Poorly-defined margin was observed in 34 cases(75.6%).Compared with the surrounding normal breast tissue ,RT and TTP of center region of neoplasms was shorter[(9.3 ±3.3)s vs (11.1 ±3.7)s and (25.3 ±5.9)s vs (27.5 ±6.4)s],PI was higher[(12.1 ±4.6)dB vs (9.2 ±2.8)dB],WIS was higher(1.0 ±0.4 vs 0.8 ±0.3) and differences were significant(t =-3.001, -4.785,6.987 and 5.438,all P 0.05).Conclusion CEUS characteristics of breast lesions were associated with MVD ,which may reflect the microvessel distributional characteristics of neoplasm and may be one of bases used to evaluate neoplasm angiogenesis .

Binding pancreatic duct to mucosa anastomosis / 中华外科杂志

<p><b>OBJECTIVE</b>To study the feasibility of binding pancreatic duct to mucosa anastomosis (BDM)-a complementary procedure to both binding pancreaticojejunostomy and binding pancreaticogastrostomy.</p><p><b>METHODS</b>(1) Animal experimental study:gastrostomy and jejunostomy were performed on six adult New Zealand rabbits. The gastrostomy and jejunostomy shared a same stent (rubber urethral catheter, silicone tube or plastic infusion tube). Both ends of the stent were placed in gastric and enteric cavity. Purse-string suture was performed around the stent before the jejunum and the stomach were brought together for fixation by few stitches. And to observe whether the purse-string suture around a plastic tube, rubber tube or silicon tube inserted into jejunum and/or stomach can prevent leaking out of the jejunal or gastric content to cause peritonitis. (2) Clinically 7 patients were performed with BDM anastomosis. The procedure was consisted of five steps: preparation of the pancreatic stump;preparation of the jejunum; preparation of the fixing sutures between the pancreatic stump and the jejunum; implementation of the anastomosis; lastly, fixation of the jejunum beside the pancreas stump. Post-operative periodic examination of the blood amylase and the amylase in the abdominal drainage. Pancreatic fistula was classified in to two categories: parenchymal fistula (pancreatic cut surface fistula) and anastomotic leakage.</p><p><b>RESULTS</b>Animal experiment did not show any leakage around the plastic tube or silicon tube inserted into jejunum and(or) stomach. There was no anastomotic leak in all the patients. There was transient increase of amylase in two cases, but the volume of drainage did not exceed 50 ml/d and the recovery of the patients was not affected.</p><p><b>CONCLUSIONS</b>BDM is a simple, safe and easy procedure to perform. It provides to the surgeons with a new option in different situations to achieve the most ideal surgical result.</p>

Assessment of ¹⁸⁸Re marked anti MHC class II antibody by peripheral blood mononuclear cells stimulated by donor alloantigen / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Previous studies showed that anti MHC-II monoclone antibody (MAb) only had partial inhibiting effect of alloreactive mixed lymphocyte reaction (MLR) in vitro and it was unsteady and non-persistent. The aim of this research was to determine whether radioactive isotope (188)Re marked MHC-II antibody could benefit the allograft acceptance in transplantation as compared to normal MHC-II antibody.</p><p><b>METHODS</b>188Re was incorporated to 2E9/13F (ab')(2) which is against swine MHC class II antigen (MAb-(188)Re). Porcine peripheral blood mononuclear (PBMC) cells were examined for proliferation and cytokine mRNA expression after stimulation with MHC-II MAb or MAb-(188)Re.</p><p><b>RESULTS</b>The proliferative response of recipient PBMCs in mixed lymphocyte reaction (MLR) to donor alloantigen showed that the stimulation index of MAb-(188)Re group was significantly lower than the MHC-II MAb group and control (P < 0.05). mRNA expression of interleukin 2, interferon Υ and tumor necrosis factor α (type 1 cytokines) was lower in MAb-(188)Re group than the MHC-II MAb group, while interleukin 10 (type 2 cytokines) was higher in MAb-(188)Re group in the first 24 hours.</p><p><b>CONCLUSION</b>MAb-(188)Re could help the graft acceptance by inhibiting T cell proliferation, lowering the expression of type 1 cytokines and elevating the type 2 cytokines produced by PBMC.</p>

Role of dissection of secondary branches of splenic pedicle in portal hypertension cases undergoing splenectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It is well known that conventional splenectomy, which requires careful handling and ligation of tissue of the splenic hilum, can easily cause complications such as splenic fever and pancreatic fistula. Here, we use the technique of dissection of the secondary branches of the splenic pedicle to handle the hilum in the portal hypertension patients who are subjected to splenectomy.</p><p><b>METHODS</b>We retrospectively compared and analyzed the complications, postoperative hospital stay, operative time, and occurrence of hemorrhage in 121 patients with portal hypertension undergoing splenectomy and devascularization of the gastric cardia from January 1999 to December 2007. The selected cases consisted of 51 patients undergoing conventional splenectomy and 70 patients undergoing dissection of secondary branches of the splenic pedicle. In addition, we analyzed the relationship between size of the spleen and occurrence of complications.</p><p><b>RESULTS</b>The incidence of pancreatic fistula and splenic fever (0/70 and 9/70) was lower in patients undergoing dissection of secondary branches of the splenic pedicle as compared with that of the conventional group (5/51 and 18/51 respectively). In addition, there was no significant difference in operative time and volume of blood loss between two groups. The spleen thickness of those patients who had pancreatic fistula and splenic fever was significantly greater than those without complications.</p><p><b>CONCLUSIONS</b>These results indicate that dissection of secondary branches of the splenic pedicle in portal hypertension patients undergoing splenectomy can decrease the incidence of splenic fever and pancreatic fistula, and shorten the postoperative hospital stay, especially in the patients with a large spleen. So dissection of secondary branches of the splenic pedicle is a valuable technique for splenectomy.</p>

Congenital choledochal cysts in adults: twenty-five-year experience / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Choledochal cyst is rare in western countries. The relatively high incidence of coexistent hepatobiliary disease increases the difficulty of the surgical management of choledochal cyst. Here we analyze the diagnosis and treatment of congenital bile duct cyst in 122 Chinese adults.</p><p><b>METHODS</b>The clinical data of 122 patients with congenital choledochal cysts admitted from 1981 to 2006 were analyzed.</p><p><b>RESULTS</b>Clinical symptoms in most cases were nonspecific, resulting in delayed diagnosis. Sixty-one patients (50%) had coexistent pancreatobiliary disease. Among the 122 patients, 119 patients underwent ultrasonic examination; ERCP/MRCP was performed in 63 cases and CT in 102 cases. Abnormal pancreatobiliary duct junction was found in 48 patients. Sixteen patients had malignant lesions in the bile duct, arising in 11 of them from incomplete choledochal cyst that underwent various operations including cystenterostomy or cystojejunostomy. There was significant difference between the patients who underwent incomplete cyst resection and complete cyst resection in malignancy rate of bile duct (Chi square test, P = 0.000; odds ratio, 7.800; 95% confidence interval, 2.450 to 24.836).</p><p><b>CONCLUSIONS</b>ERCP, CT and MRCP had proved their great values in the classification of the disease. Cyst excision with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice for patients with type I or type IV cysts. For type V cyst (Caroli's disease) with recurrent cholangitis, liver transplantation should be considered.</p>

Progress in gut-derived mechanism of multiple organ dysfunction syndrome after burns and trauma / 中华烧伤杂志

Multiple organ dysfunction syndrome (MODS) is a serious complication with higher mortality in patients with burns and trauma. It is important to study the mechanism of MODS for prevention and control of it. Mesenteric lymph mechanism of MODS is a new viewpoint of gut-derived mechanism of MODS in recent years. In this review, we elucidate the mechanism of gut-derived origin of MODS and role of mesenteric lymph path in development of MODS after burns and trauma injury.

Cloning and expression of Oreochromis aurea gonadotropin-releasing hormone cDNA in Escherichia coli and its immunogenicity for mice / 生物工程学报

To study the function of the GnRH protein, the recombinant pMAL-GnRH was constructed and expressed in TB1 E. coli. The cDNA encoding gonadotropin-releasing hormone (GnRH) and GnRH associated peptide (GAP) was amplified from total RNA of O. aurea pituitary glands by reverse transcription polymerase chain reaction (RT-PCR), and then blasted against other GnRH cDNA sequences in the GenBank. The analysis of the sequence data indicated that the coding region of the cDNA fragment, which encoded 89 amino acid residues, was about 400 bp in size. The amplified cDNA fragment was cloned into the prokaryotic expression vector, pMAL-c2x, to produce the expression vector pMAL-GnRH. The recombinant plasmid was transformed into E. coli TB1. GnRH-MBP fusion protein was obtained after the addition of IPTG into the growth media. SDS-PAGE analysis revealed that the GnRH-MBP was expressed after induction with IPTG for 4 h. A protein band of 56 kD appeared on SDS-PAGE gel and was proved by Western blot. The mass production of the recombinant protein was about 41.6% of total bacteria protein. After purification and cleavage of the fusion protein purified GnRH protein could be obtained. Then the fusion protein was used to immunise some ICR mice to produce anti-GnRH antibody. This fusion protein could significantly elicit specific antibody response in immunized mice compared with the blank groups, and the titers against GnRH reached peak 0.707 +/- 0.320 at the 5th week after immunization. These results demonstrated that recombinant protein could induce high GnRH antibody responses in laboratory animals.

Surgical treatments of preoperative unsuspected gallbladder carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the surgical treatment of preoperative unsuspected gallbladder carcinoma (UGC) and its prognosis.</p><p><b>METHODS</b>Eighteen patients of UGC admitted in our hospital from January 1996 to December 2003 were analyzed retrospectively. The clinicopathological characters and surgical treatment of UGC patients were compared with the preoperative diagnosed gallbladder carcinoma (DGC) patients admitted in the same period. The cumulative survival rate of the patients received radical resection in two groups was analyzed by Kaplan-Meier method.</p><p><b>RESULTS</b>The serous layer was not invaded by tumor in 10 patients of UGC group (55.5%, 10/18), while the serous layer invaded and regional lymph node metastasis were detected in 39 patients of DGC group (90.7%, 39/43). Radical resection rate was 72.2% (13/18) in UGC group and 39.5% (17/43) in DGC group, and 5-year survival rates in those with radical resection were 54.6% and 23.5%, respectively (chi(L)(2) = 16.33, P < 0.01). Compared with the patients underwent palliative operation, the patients with radical resection has a longer median survival time (43.3 months vs 10.5 months, chi(L)(2) = 31.10, P < 0.01).</p><p><b>CONCLUSIONS</b>The prognosis of UGC is better than that of DGC generally. Reoperation for UGC should be performed as soon as possible, and the prognosis can be improved by radical resection.</p>

The significance of liver hanging maneuver in liver-splitting anterior approach for hepatectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the feasibility of developing a tunnel between inferior vena cava (IVC) and caudate lobe before passing a tape through it, and to explore the significance of liver hanging maneuver in liver-splitting anterior approach for hepatectomy.</p><p><b>METHODS</b>Blunt dissection was used to develop the tunnel before a tape was passed through. A hemostatic plate was placed on the surface of liver parenchyma if needed. In the procedure of hepatectomy, the tape was pulled up to create an interspace between liver parenchyma and IVC so that the IVC can be protected during transection.</p><p><b>RESULTS</b>Liver hanging maneuver was performed successfully in 47 cases. There were no severe complications related to the procedure in these cases. The procedure was terminated in 1 case because of severe bleeding.</p><p><b>CONCLUSIONS</b>1. Liver hanging maneuver is feasible in terms of anatomy and technique. 2. With liver hanging maneuver, IVC can be protected safely and the intrahepatic vessels and ductal system at the transaction line can be exposed clearly. It also makes anterior approach for hepatectomy safer and easier.</p>

Influence of CO2 pneumoperitoneum on intracellular pH and signal transduction in cancer cells / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECT</b>The authors studied the influence of CO(2) pneumoperitoneum on intracellular pH and signal transduction arising from cancer cell multiplication in laparoscopic tumor operation.</p><p><b>METHOD</b>They set up a simulation of pneumoperitoneum under different CO(2) pressure, and then measured the variation of intracellular pH (pHi) at different time and the activity of protein kinase C (PKC) and protein phosphatase 2a (PP2a) at the end of the pneumoperitoneum. After 1 week, the concentration of cancer cells in the culture medium was calculated.</p><p><b>RESULT</b>When the pressure of CO(2) pneumoperitoneum was 0, 10, 20, 30 mmHg respectively, the average pHi was 7.273, 7.075, 6.783, 6.693 at the end of the pneumoperitoneum; PKC activity was 159.4, 168.5, 178.0, 181.6 nmol/(g.min) and PP2a was 4158.3, 4066.9, 3984.0, 3878.5 nmol/(g.min) respectively. After 1 week, the cancer cells concentration was 2.15 x 10(5), 2.03 x 10(5), 2.20 x 10(5), 2.18 x 10(5) L(-1).</p><p><b>CONCLUSION</b>CO(2) pneumoperitoneum could promote acidosis in cancer cells, inducing the activation of protein kinase C and deactivation of protein phosphatase 2a, but it could not accelerate the mitosis rate of the cancer cells.</p>

Surgical treatment of hepatocellular carcinoma originating from caudate lobe / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the significance of surgical treatment of HCC originating from caudate lobe.</p><p><b>METHODS</b>From 1995 to 2003, caudate lobectomy, including 19 cases of isolated lobectomy and 20 cases of combined lobectomy, were performed in 39 patients with HCC originating from caudate lobe, and the factors that might influence postoperative liver function were compared between the two groups.</p><p><b>RESULTS</b>All tumors were resected successfully. One patient died of postoperative renal failure. Hydrothorax occurred in 3 patients, ascites in 4 patients, and bile leakage in 1 patient. The survival rates of 1, 3, 5 year were 53%, 50%, 39% respectively.</p><p><b>CONCLUSIONS</b>Caudate lobectomy is a effective method for HCC originating from caudate lobe.</p>

Research on telerobotic laparoscopic surgery and its applications / 中国医疗器械杂志

A general review is here presented on the development, composition, existing problems and prospects of telerobotic laparoscopic surgery systems, based on the related literatures and informations in recent years.

Role and significance of extrahepatic control of hepatic vein and inferior vena cava in difficult hepatectomies for patients with liver tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the role of extrahepatic control on blood flow of hepatic vein and inferior vena cava in hepatectomy, and observe its effect on minimizing hemorrhage.</p><p><b>METHODS</b>From 2001 to April 2003, 33 patients who had liver tumors involving segment IV, VII, VIII or half liver underwent major hepatectomies that required exposure of the inferior vena cava and main trunks of hepatic veins, during which the major hepatic veins and inferior vena cava were isolated and taped to control blood flow when necessary.</p><p><b>RESULTS</b>In 33 attempts, 32 were successful and all tumors were resected successfully. The placement of occlusion tape was unsuccessful in 1 case. 7 cases did not need blood transfusion during operation. The amount of blood transfusion for other cases were form 0 to 1 600 ml. there was no operative mortality.</p><p><b>CONCLUSIONS</b>Appropriate control of main truck of hepatic vein and inferior vena cava is effective in reducing blood loss during hepatectomies. It is also very helpful for performing difficult hepatectomies.</p>