Current status and prospect of surgical treatment of liver cancer / 中华外科杂志

With the rapid development of liver surgery,minimally invasive techniques have been widely used in liver surgery. Many challenging liver can be performed laparoscopically to decrease the surgical trauma. At the same time,the efficiency and accuracy of liver surgeries have been highly improved by the advanced assisted technology of liver surgery. The purpose of this article is to summarize the current situation of liver surgery as well as the future of liver surgery.

The new classifications of biliary tract diseases based on actual anatomy / 中华外科杂志

In order to facilitate the treatment strategies for biliary tract injury, hilar cholangiocarcinoma, bile duct tumor thrombus, cholangiocellular carcinoma and bile duct cystic dilatation, many classifications have been made, even more than 10 types for one disease. Each type is represented by numbers or English alphabet, which are not only confusing but also difficult to remember. The Academician Mengchao Wu divided the liver into five sections and four segments base on its anatomy, this classification is very direct and visual, thus had been using till now. In order to overcome those complicated problems, it is considered to develop a new classification based on actual anatomic location similar to that for liver cancer, which is easy to remember and to directly determine the treatment strategy. All kinds of classifications have their own characteristics and advantages and disadvantages. This practical classifications avoid the complexity and may be useful for clinicians.

Current status and controversy of laparoscopic technique in the diagnosis and treatment of gallbladder cancer / 中华外科杂志

This article introduces the current status and controversy of laparoscopic technique in the treatment of gallbladder carcinoma. Combined with the characteristics of incidental gallbladder carcinoma, the feasibility of laparoscopic techniques for the treatment of early gallbladder carcinoma is analyzed.In the era of minimally invasive medical, laparoscopic techniques should play a more important role in the management of gallbladder cancer, but the long-term prognosis of laparoscopic radical surgery for gallbladder cancer needs strict prospective and high-volume clinical research to validate.

Laparoscopic liver tumor resection under indocyanine green fluorescent navigation: A single center experience of 60 patients to study the optimal preoperative injection timing of indocyanine green / 中华肝胆外科杂志

Objective To study the optimal timing of preoperative injection of indocyanine green in laparoscopic liver tumor resection under indocyanine green fluorescent navigation to obtain the most satisfactory fluorescence imaging effects.Methods 60 patients with liver tumors who underwent laparoscopic hepatectomy from April 2017 to October 2018 were retrospectively studied on the intraoperative fluorescence imaging effects.A simple grading of the fluorescence imaging effects was developed.The ICG R15 and preoperative injection times of ICG were correlated with the intraoperative fluorescence imaging effects.Results Of 60 patients with liver tumors,59 patients underwent laparoscopic liver resection and one patient was converted to open surgery.The overall satisfaction rate of intraoperative fluorescence imaging was 73.4％ (44/60).In the patients with an ICG R15 rate ≤ 7％,it was easier to obtain good fluorescence imagings when the preoperative administration time was longer than 48 hours.Even when the preoperative administration time was longer than 5 days,satisfactory fluorescence imaging effect could still be obtained in these patients.In the patients with an ICG R15 rate ＞ 7％,intraoperative fluorescence imagings were unsatisfactory when the administration time was less than 6 days.Relative better imagings were obtained in these patients when the preoperative administration time was more than 6 days.Conclusions When the pre-operative ICG injection dose was not changed,the preoperative administration time should be adjusted according to the value of the ICG R15 to obtain better intraoperative fluorescence imaging effects of the liver tumors.The optimal timing needs to be further studied by a large case study.

Clinical effect of terminal branches portal vein embolization combined with transcatheter arterial chemoembolization on liver neoplasms / 中华外科杂志

Objective@#To analyze the efficacy of branches portal vein embolization (TBPVE) combined with transcatheter arterial chemoembolization (TACE) on liver neoplasms.@*Methods@#From August 2016 to May 2017, there were 13 patients including 11 males and 2 females with primary hepatocellular carcinoma who underwent TBPVE+ TACE , among whom there were 11 cases with a history of HBV infection.Average age of the 13 patients was (60.8±6.2)years. The live function of all patients were Child-Pugh A classification.The CT or MRI images of each patient was reconstructed and the standard liver volume(SLV) before TBPVE+ TACE was (1 181.2±49.3)ml, estimated future liver remnant(FLR) was (326.1±72.1)ml and FLR/SLV was (27.6±6.0)%.The puncture site for TBPVE was determined by the three-dimensional reconstruction of portal vein.CT scan or MRI, AFP and liver function test were repeated after one and two weeks after TBPVE+ TACE.FLR and FLR/SLV were calculated respectively.Hepatectomy would be performed if the patients agreed.The postoperative complications were analyzed.@*Results@#On the 7thday after TBPVE+ TACE, the FLR/SLV was(42.6±8.0)% and the FLR increasement was(56.0±24.6)%.The level of AFP decreased from(87.9±81.8)μg/L to (29.7±20.9)μg/L.On the 14thday after TBPVE+ TACE, the FLR/SLV was(45.8±6.2)% and the FLR increasement was(71.8±29.0)%.Four patients underwent surgery which including 2 right hepatectomies and 2 right trisegmentectomies in 2 weeks after TBPVE+ TACE.Nine patients were performed with targeting intratumoral lactic acidosis TACE (TILA-TACE). No severe complication occurred in all patients.@*Conclusions@#TBPVE could induce a rapid growth of the liver remnant but still with the concern of inducing the growth of neoplasms at the same time.To combine TACE in TBPVE therapy not also can the growth of neoplasms be prevented but also inducing its shrinking.This method might be a new mode for the treatment of hepatocellular carcinoma.

Clinical efficacy and experiences of laparoscopic hepatectomy for segment Ⅶ and Ⅷ liver tumors / 中华消化外科杂志

Objective To investigate the clinical efficacy and experiences of laparoscopic hepatectomy (LH) for segment Ⅶ and Ⅷ liver tumors.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 94 patients who underwent LH for segment lⅦ or Ⅷ liver tumors in the Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from June 2010 to August 2016 were collected.The operating space for operation was built under laparoscopy.According to liver cirrhosis grading,tumor size,adjacent relationship with major blood vessels and residual liver volume,non-anatomical and anatomical hepatectomies were selected by patients.During the operation,tumors were precisely pinpointed and plane of liver resection was determined,and then proper instruments of liver partition and techniques of hepatic inflow occlusion were selected.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival situation.Follow-up using outpatient examination and telephone interview was performed to detect the patients' survival up to July 2017.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (interquartile range).Survival rate was caculated by the Kaplan-Meier method.Results (1) Surgical and postoperative recovery situations:all 94 patients received successful operations,without perioperative death,including 73undergoing non-anatomical hepatectomy and 21 undergoing anatomical hepatectomy.Fourteen patients had conversion to open surgery and 27 received hepatic inflow occlusion.The median operation time,median volume of intraoperative blood loss and cases with intraoperative blood transfusion were respectively 187.5 minutes (75.0minutes),200 mL (200 mL) and 15.Eighteen patients had postoperative complications,including 6 with pleural effusion,6 with abdominal effusion,1 with wound infection,1 with abdominal infection,1 with venous thrombosis,1 with bleeding,1 with coagulation disorders and 1 with hepatic insufficiency.Clavien-Dindo classification of complications:11,1,5 and 1 patients were detected in grade Ⅰ,lⅡ,Ⅲ and Ⅳ,respectively.All complications were improved by symptomatic treatment.The median duration of hospital stay was 7 days (6 days).(2) Postoperative pathological examination:results of tumor pathological examination showed that 45,5,9 and 35 patients were respectively confirmed as hepatocellular carcinoma,cholangiocarcinoma,metastatic hepatic carcinoma and benign liver tumor.(3) Follow-up and survival situation:59 patients with malignant tumors were followed up for 6.0-52.0 months,with a median time of 42.6 months.Postoperative 1-and 3-year overall survival rates of 59 patients with malignant tumors were 98.3％ and 84.7％,respectively.Conclusions LH for segment Ⅶ and Ⅷ liver tumors which is conducted in experienced medical center is safe and feasible,with definite effects.Building operating space for operation under laparoscopy,determining precise positioning of the tumor and plane of liver resection,and selecting proper instruments of liver partition and techniques of hepatic inflow occlusion are the key points of successful operation.

Present and future for associating liver partition and portal vein ligation for staged hepatectomy / 中华消化外科杂志

Compared to portal vein embolization and traditional two-stage hepatectomy,associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can induce the proliferation of liver rapidly,concomitantly with high incidence of complications and mortality in the perioperative period.The feasibility and safety have been improved gradually as the improvement of technology and the accumulation of experience.But it is still controversial on its efficacy for malignant tumors,especially with insufficiency of medium-and long-term out-comes.The mechanism of rapid proliferation induced by ALPPS needs more studies with further steps.

A multivariate risk prediction model of malignant partially cystic thyroid nodules / 中华内分泌外科杂志

Objective To develop a multivariate logistic regression model , and to predict the risk of ma-lignant partially cystic thyroid nodules .Methods 470 patients(662 nodules)treated with surgery and confirmed by pathological diagnosis were screened out .Their ultrasonographic morphology and vascularity of thyroid nod-ules, thyroid stimulating hormone(TSH)and clinical information were collected and analyzed retrospectively .The model was developed to calculate the individual risk and ROC curve was used to evaluate the predictive index . Results The regression model was:Z=-3.60+1.40X2+2.47X3+1.05X4+0.57X9+0.07X10+1.02X12 ( X2 represents eccentric acute-angle configuration , X3 represents microcalcification , X4 represents cystic-solid margin,X9 represents echogenecity of solid portion , X10 represents TSH,X12 represents gender );M=eZ/1+eZ (M represents probability of malignancy , e represents natural constant 2.72).When applied the model to the ver-ification group, the accuracy, sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, negative likeli-hood ratio(LR-)and positive likelihood ratio(LR+)was 96.95%,100%, 96.68%, 3.32%, 0%, 0 and 30.12 respectively.The largest area under the receiver-operating characteristics curve (AUC)was 0.88,which proved the model has high diagnostic value .Conclusions The model has high accuracy to predict the risk of malignan-cy.M is closely related to malignant risk of partially cystic thyroid nodules .

Changes of the colonic physiologic functions after colonic anastomosis with a degradable stent in a porcine model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A new procedure of colonic anastomosis with a degradable stent has already been proven to be simple, feasible, and safe in our porcine model. In this study, we evaluated its impact on the colonic physiologic functions.</p><p><b>METHODS</b>A total of 20 pigs were assigned randomly to either a stent anastomosis group (SA, n = 10) or a conventional anastomosis group (CA, n = 10). Colonic anastomosis with a degradable stent was performed in the SA group, and conventional hand-sewn anastomosis was performed in the CA group. Body weight, fecal weight, total colonic transit time, immunohistochemistry staining of interstitial cells of Cajal (ICC), plasma diamine oxidases (DAO) levels, and Western blotting analysis of occludin were evaluated before and after anastomosis.</p><p><b>RESULTS</b>No obvious diarrhea or constipation was observed in all pigs. No significant difference in body weight between the groups was detected at any time. Yet, the fecal weight was less in the CA group compared with the SA group on postoperative day (POD) 7. No observable colonic paralysis or retention occurred. For total colonic transit time, there was no significant difference between the two groups at any time or among different time points in the same group. The integrated optical density of ICC showed no significant difference on either POD 14 or 30. The plasma DAO levels were remarkably elevated after surgery, and began to decrease since POD 3. However, there was no significant difference between both two groups in plasma DAO levels at any time either. For both groups, the expression of occludin was not significantly different from their pre-surgery level on either POD 14 or 30.</p><p><b>CONCLUSIONS</b>According to these results, this procedure with a degradable stent was supposed to be the same as the conventional hand-sewn procedure in their impact on the colonic physiologic functions.</p>

Decorin prevents the development of CCl₄-induced liver fibrosis in mice / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Liver fibrosis normally progresses to cirrhosis and destroys the normal architecture of the liver, resulting in liver dysfunction and irreversible cirrhosis. The aim of this study was to investigate the anti-fibrosis effect and the possible underlying mechanisms of decorin.</p><p><b>METHODS</b>The mice model of liver fibrosis was induced by intraperitoneal injection of 50% (v/v) of carbon tetrachloride (CCl4) diluted in olive oil (1 ml/kg body weight) once every 2 days for 5 weeks. Three weeks after injecting CCl4 intraperitoneally, mice were randomly divided into normal control with vehicles only (olive oil), mouse model given CCl4 only, and CCl4 plus decorin (DCN, 250 µg/kg). Two weeks later, all the mice were sacrificed and their liver tissues were analyzed for the expressions of genes related to liver fibrosis and under hematoxylin-eosin staining, Masson staining, and immunohistochemical staining of all groups. Aspartate transaminase, alanine transaminase, and total bilirubin of the serum were determined for evaluation of the liver function.</p><p><b>RESULTS</b>Exogenous protein decorin could reduce liver fibrosis induced by CCl4 in mice. The degree of fibrosis in the experimental group was alleviated, and the contents of collagen fibers were lower in the experimental group than those of the control group. In addition, expressions of transforming growth factor β1 and α-smooth muscle actin decreased in the experimental group.</p><p><b>CONCLUSIONS</b>Taking liver fibrosis model of mouse as the experimental target and by injecting exogenous protein decorin into the model, we confirmed that decorin could inhibit the expression of proteins related to fibrosis and reduce the formation of liver fibrosis in mice.</p>

Preoperative prediction of survival in resectable gallbladder cancer by a combined utilization of CA 19-9 and carcinoembryonic antigen / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Currently, all frequently used staging systems in gallbladder cancer (GBC) are based on postoperative pathological examinations. In patients undergoing curative operation, there is no effective method to predict survival preoperatively. In this study, we explored whether a combined utilization of two tumor biomarkers, namely carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA), could give a preoperative prediction of survival in resectable GBC.</p><p><b>METHODS</b>Seventy-three patients who underwent radical resection for GBC were included in this study. A retrospective analysis of clinical-pathological data was conducted.</p><p><b>RESULTS</b>By multivariate analysis, CA 19-9 elevation (P < 0.05) and CEA elevation (P < 0.001) were discovered as two individual factors for postoperative survival. By a combined utilization, patients were divided into three groups: patients with elevation of CEA (group I), patients with elevation of CA 19-9 but without CEA (group II), and patients with nonelevations of either CA 19-9 or CEA (group III). The cumulative 5-year survival rates in groups I, II, and III were 0, 14.0%, and 42.8%, respectively (P < 0.05).</p><p><b>CONCLUSIONS</b>By a combined utilization of CA 19-9 and CEA, individualized prediction of survival is available in resectable GBC before operation. Extended radical operation brings the most prognostic benefits in patients with nonelevations of either CA 19-9 or CEA. However, if operation would be in a larger-scale destructive manner, careful consideration of surgical decisions should be made in patients with elevation of tumor biomarkers, especially CEA.</p>

Perioperative outcomes of laparoscopic versus open splenectomy for nontraumatic diseases: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Surgical treatment has become the standard treatment for nontraumatic diseases of the spleen. This meta-analysis compared the relative merits of laparoscopic splenectomy (LS) with open splenectomy (OS) for nontraumatic splenic diseases.</p><p><b>METHODS</b>A literature search was performed to identify studies comparing perioperative outcomes in patients who underwent LS or OS for nontraumatic diseases. Pooled odds ratios (ORs) and weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using a fixed- or random-effects model.</p><p><b>RESULTS</b>Thirty-five studies matched the selection criteria. Of the 7 269 patients included 3 981 underwent LS and 3 288 underwent OS for nontraumatic diseases. OS was associated with shorter operation time (WMD = 42.65, 95% CI: 25.58-59.73), whereas LS was associated with reduced operative blood loss (WMD = -133.95, 95% CI: -229.02 to -38.88), need for blood transfusion requirement (OR = 0.53, 95% CI: 0.39-0.72), overall postoperative morbidity rate (OR = 0.44, 95% CI: 0.38-0.51), postoperative mortality rate (OR = 0.38, 95% CI: 0.24-0.59), and length of hospital stay (WMD = -2.73, 95% CI: -3.34 to -2.12).</p><p><b>CONCLUSIONS</b>LS is superior to OS for nontraumatic diseases, with reduced operative blood loss, need for blood transfusion, postoperative morbidity and mortality rates, and length of hospital stay, although OS is associated with reduced operation time. LS may be a good alternative to OS for patients with nontraumatic splenic diseases.</p>

Decorin accelerates the liver regeneration after partial hepatectomy in fibrotic mice / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Considering the existence of a large number of liver cell degeneration and necrosis in fibrotic liver, liver function was damaged severely and could not effectively regenerate after partial hepatectomy (PHx). The aim of this study was to investigate whether decorin (DCN) could promote the liver regeneration after PHx in fibrotic mice.</p><p><b>METHODS</b>Forty mice (5-week-old, Balb/c) were injected with CCl4 intraperitoneally and liver fibrosis model was established after 5 weeks. The survival mice were randomly divided into two groups: control group and DCN group. Then, we performed 70% PHx on all these mice and injected DCN or phosphate-buffered saline plus normal saline (NS) to each group, respectively, after surgery. Liver body weight ratio (LBR), quantitative real-time polymerase chain reaction, and immunohistochemistry were used to analyze liver regeneration and fibrosis degree in both groups, and to find out whether exogenous protein DCN could promote the regeneration of fibrosis liver after PHx.</p><p><b>RESULTS</b>Expressions of a-smooth muscle actin (SMA) mRNA and LBR had significant increases in the DCN group at postoperative Day 3 (POD 3, P < 0.05). The protein expressions of CD31, a-SMA, and tumor necrosis factor (TNF)-a were higher in the DCN group than those in the control group by immunohistochemistry at POD 3 (P < 0.05).</p><p><b>CONCLUSION</b>Exogenous protein DCN could promote liver regeneration after PHx in fibrotic mice.</p>

The effect of a biodegradable paclitaxel-eluting stent on bile duct healing after trauma in a porcine model / 中华普通外科杂志

Objective To evaluate the effect of a biodegradable paclitaxel-eluting biliary stent on bile duct scar formation and biliary stricture by observing the healing process after stent placement in a porcine billiary model.Methods A novel biodegradable paclitaxel-eluting biliary polylactide stent was manufactured by immersion method.The efficacy of drug release for paclitaxel-eluting biliary stent was investigated by HPLC.Paclitaxel-eluting stent were surgically inserted in the bile duct of fifteen swines in experimental group while stent without paclitaxel were placed in other fifteen swines in control group.Animals were sacrificed after 1,3,6 months.The anastomic healing of the common bile duct was observed.The size of anastomosis was measured and compared between the two groups.Result A novel biodegradable paclitaxel-eluting biliary stent was manufactured.The total amount of paclitaxel released was about 281 pg (30.4％) over a month as determined with HPLC methods.There was no death,no leakage.The diameter of anastomosis in the experimental group was significantly larger than that in control group.Cholangiography did not show obvious bile duct dilatation in experimental group.Histologic examination showed less hyperplasia of the bile duct wall in the experimental group than that in control group.Conclusion Release of paclitaxel via a biodegradable stent relieves billiary stricture in porcine model and have no obvious negative influence on wound healing of the common bile duct.

Prevention and management of injuries to right accessory hepatic duct and right hepatic duct during laparoscopic cholecystectomy / 中华普通外科杂志

Objective To summarize our experience in the prevention and treatment of right accessory hepatic duct and right hepatic duct injury during laparoscopic cholecystectomy. Methods The clinical data of 21 cases with right accessory hepatic duct or right hepatic duct during laparoscopic cholecystectomy were reviewed retrospectively. Result According to anatomy identified by preoperative work-up and selective cholangiography during the operation, 18 cases had the right accessory hepatic duct,eleven of them were confirmed intraoperatively. The accessory hepatic ducts were conserved in 3 cases and clipped without biliary leaks postoperativly in 7 cases; One case had biliary leaks postoperatively with the duct sutured intraoperatively, and recovered well conservative therapy. Accessory hepatic ducts were accidentally injuried in 7 cases, two patients were transferred to open surgery; three cases were confirmed to be injuried and clipped by second laparoscopic exploration because of biliary leaks postoperatively. Three cases had a low confluence of the right and left hepatic duct with the gallbladder duct joining the right bile duct, the ducts were conserved in 2 cases and injuried in one. Postoperatively all these 21 cases were followed up for 2 years, without jaundice or liver dysfunction. Conclusions To prevent injury of right accessory hepatic duct and right hepatic duct. High vigilance and familiarity with the anatomic variants of the biliary tree and intraoperative cholangiography in selective cases are fundmental.

Establishment of a hepatic stem cell line stably expressing human interleukin-2 / 中国免疫学杂志

Objective:Establishing the hepatic stem cell(WB-F344)line that expresses human interleukin-2 stably and effectively.Methods: We constructed the retroviral vector Plpcx-il-2 containing human interleukin-2 gene, and transfected it into PT67 packaging cells.The infectious viruses were used to infect the hepatic stem cell WB-F344,then the puromycin resistant clones were acquired after puromycin selection.The expression of IL-2 was detected using RT-PCR,immunocytochemistry, Western blot and indirect immunofluorescence, respectively.Results: The retroviral vector containing human IL-2 gene was constructed.The titer of virus in the supernatant reached 10~5 CFU/ml after transfecting PT67 packeting cells.The puromycin resistant clones were acquired after infection of WB-F344 and the cell line WB-F344/Plpcx-IL-2 expressing human interleukin-2 stably was established.Conclusion: By retroviral-mediated transfecting human interleukin-2 gene, the hepatic stem cell stably and effectively expressing interleukin-2 are obtained.This provides a good basis for further research on immuno-gene therapy of liver cancer.

Laparoscopic radical resection of gastric carcinoma:a report of 15 cases / 中华普通外科杂志

Objective To evaluate the feasibility,safety and therapeutic efficacy of laparoscopic radical resection for gastric carcinoma. Method In this study,15 patients with gastric carcinoma underwent laparoscopic radical resection from May 2005 to Aug 2006,clinical parameters including surgical procedures,operation time,blood loss,time for passage of flatus,complications and pathological findings were recorded. Result All operations were successful.Five cases received laparoscopic radical distal gastrectomy,5 cases received hand-assisted laparoscopic radical distal gastrectomy,laparoscopic total gastrectomy was performed in 4 cases,laparoscopic proximal gastrectomy was performed in 1 case.The operation time ranged from 195 to 350 min,the blood loss was 100 to 600 ml.The average time of intestinal function recovery was(2.9 ± 0.8)days.The average number of lymph nodes dissected were(28±6).There was no major postoperative complications.Postoperative follow-up were 24 months in 15 cases,there were no metastasis and tumor recurrence.Conclusion Laparoscopie radical gastrectomy is a feasible and safe surgical procedure for patients of gastric carcinoma.

Human errors in medical practice and the prevention / 中华医院管理杂志

Human errors are errors found in planning or implementation, and those found in medical practice are often major causes of mishaps.To name a few, wrong-site surgery, medication error, wrong treatment, and inadvertent equipment operation.Errors of this category can be prevented by learning from experiences and achievement worldwide.Preventive measures include those taken in human aspect and system aspect, reinforced education and training, process optimization, and hardware redesign.These measures can be aided by multiple safety steps in risky technical operations, in an effort to break the accident chain.For example, pre-operative surgical site marking, multi-department co-operated patient identification, bar-coded medication delivery, read-back during verbal communication, and observation of clinical pathway.Continuous quality improvement may be achieved when both the management and staff see medical errors in the correct sense, and frontline staff are willing to report their errors.

Relationship of neutrophil apoptosis and caspase-3 activity with multiple organ dysfunction syn-drome after multiple injury / 中华创伤杂志

Objective To investigate apoptosis of polymorphonuclear neutrophil and activity of caspase-3 in the peripheral blood and discuss their correlation with development of multiple organ dysfunc- tion syndrome (MODS) after multiple injury. Methods A total of 55 patients with multiple injury were included in the prospective study, and divided into two groups, ie, MODS group (multiple injury patients who developed MODS,) and non-MODS group (multiple injury patients who were free from MODS). The activity of caspase-3 was detected by flow cytometry and the serum levels of IL-6 and IL-10 were detected by ELISA. Then, we evaluated whether the neutrophil apoptesis was correlated with the ser- um levels of IL-6 and IL-10 in patients with MODS. Results Compared with non-MODS group, neu- trophil apoptesis was significantly reduced and activated caspase-3 decreased significantly in MODS group (P <0.05). In MODS group, serum IL-6 was increased significantly while serum IL-10 was decreased significantly compared with non-MODS group. The apoptosis of neutrophil in multiple injury patients with MODS had a negative correlation with IL-6 levels but a positive correlation with IL-10 levels. Conclu- sions The delayed apoptosis of neutrophil due to decreased activated caspase-3 may play partial roles in the development of MODS after multiple injury. IL-6 and IL-10 may contribute to the apoptotic changes.

The advance and limitation of microencapsulated grafts transplantation / 生物医学工程学杂志

Microencapsulation of cells or tissue fragments represents a potentially effective method to prevent graft rejection in allotransplantation and xenotransplantation without the need of immunosuppression, but the functional survival of all trial grafts is still limited. Usually, graft failure is mainly interpreted as the consequence of the progressive fibrotic overgrowth of capsules, the insufficient supply of oxygen and nutrition to the encapsulated graft, and the dysfunction of the encapsulated graft induced by small proinflammatory factors. These detrimental factors are interrelatd with the microcapsules, the implanted graft, and the transplantation site. This article reviews and summarizes the advance and the limitation of microencapsulated grafts transplantation in the above-mentioned aspects.