Application of persistent methylene blue dyeing method for anatomic hepatectomy of hepatocellular carcinoma with bile duct tumor thrombi / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the role of anatomic hepatectomy of hepatocellular carcinoma with bile duct tumor thrombi by application of persistent methylene blue dyeing method.</p><p><b>METHODS</b>From January 2009 to February 2011, 11 hepatocellular carcinoma patients with bile duct tumor thrombi underwent anatomic hepatectomy with removal of the biliary tumor thrombus. There were 10 male and 1 female patients. The average age was 49 years (ranging from 31 to 67 years). The initial symptom of 9 out of the 11 patients was jaundice. After anatomy and ligation of Glissonean pedicle of pre-resection segment, methylene blue was injected into its far-end portal vein in order to dye the segment.</p><p><b>RESULTS</b>Persistent methylene blue dyeing method was successful in all patients. Primary foci were found in all patients. Hepatectomy were performed, including 4 patients of segmentectomy, 3 patients of subsegmentectomy, 2 patients of hemihepatectomy, and 2 patients of hepatic sectionectomy. The mean operation time and blood loss was 137 minutes and 246 ml respectively. Severe complications such as liver function failure and sub-diaphragm abscess was avoided in all patients. No perioperative death. Post-operation radiotherapy was performed on 2 patients . Over a mean follow-up time of 14.6 months, liver cancer recurrence occurred in 2 patients, abdomen seeding metastasis in 1 patient, bile duct tumor thrombi recurrence in 1 case, and 2 patients died.</p><p><b>CONCLUSIONS</b>Anatomic hepatectomy of hepatocellular carcinoma with bile duct tumor thrombi by application of persistent methylene blue dyeing method can make resection more precise and improve curative effect.</p>

Three-dimensional reconstruction of digitized human liver: based on Chinese Visible Human / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Comparing with two dimensional (2D) imaging, both in diagnosis and treatment, three dimensional (3D) imaging has many advantages in clinical medicine. 3D reconstruction makes the target easier to identify and reveals the volume and shape of the organ much better than 2D imaging. A 3D digitized visible model of the liver was built to provide anatomical structure for planing of hepatic operation and for realizing accurate simulation of the liver on the computer.</p><p><b>METHODS</b>Transverse sections of abdomen were chosen from the Chinese Visible Human dataset. And Amira software was selected to segment and reconstruct the structures of the liver. The liver was reconstructed in three-dimensions with both surface and volume rendering reconstruction.</p><p><b>RESULTS</b>Accurately segmented images of the main structures of the liver were completed. The reconstructed structures can be displayed singly, in small groups or as a whole and can be continuously rotated in 3D space at different velocities.</p><p><b>CONCLUSIONS</b>The reconstructed liver is realistic, which demonstrates the natural shape and exact position of liver structures. It provides an accurate model for the automated segmentation algorithmic study and a digitized anatomical mode of viewing the liver.</p>

Clinical application of precise liver resection techniques in patients with complicated liver space-occupying lesions / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the early results of precise liver resection.</p><p><b>METHODS</b>Between May 2006 and June 2009, 65 patients with complicated liver space-occupying lesions were included in the study. Fifty-one patients underwent curative liver resection. Liver resections performed included 16 trisectionectomies, 11 hemihepatectomy, 5 meso hepatectomies, 3 combined segmentectomies, 5 caudate lobectomies and 11 irregular local resections.</p><p><b>RESULTS</b>Patients undergoing resection had no mortality with a major morbidity of 9.8%. Nineteen vascular repairs and reconstructions were patent at last follow-up. The postoperative 1-year survival rate was 100% in 10 patients with benign lesions and 92.7% in 41 patients with malignant tumors. The 1-year survival rate was zero in patients with malignant tumors, who underwent no liver resection.</p><p><b>CONCLUSIONS</b>Precise liver resection, as an aggressive surgical approach, offers hope for these patients, who would otherwise have a dismal prognosis.</p>

Development and clinical application of 3D operative planning system of live in virtual reality environments / 中华外科杂志

<p><b>OBJECTIVE</b>To explore and develop three-dimension (3D) virtual reality (VR) liver model and convert computed tomography data into a fully 3D VR environment for display, measure and manipulation.</p><p><b>METHODS</b>3D-reconstruction of liver was restored from spiral computed tomography (CT) data by using LiVirtue software. Dextrobeam was used to view the 3D model in the VR environment. The liver and its anatomic structure were reconstructed to illuminate the location of the tumor and its related vessels.</p><p><b>RESULTS</b>3D models of liver, tumor and their relative vessels were reconstructed successfully. These models could be viewed and manipulated in the VR environment on personal computer.38 patients underwent liver resection, including 21 right hemihepatectomy, 14 left hemihepatectomy and 3 extended right hemihepatectomy. The intraoperative contrast with preoperative simulation confirmed the reliability of our 3D operative planning system.</p><p><b>CONCLUSIONS</b>The preoperative simulation in 3D VR facilitated liver resection by the ability to view tumor and its relative vessels. This preoperative estimation from 3D model of liver benefits a lot to complicated liver resection.</p>

Relationship between sinusoidal endothelial cell apoptosis and hepatocyte injury after their transplantation into rats / 中华肝脏病杂志

<p><b>OBJECTIVES</b>To investigate the relationship between the apoptosis of sinusoidal endothelial cells (SEC) and the hepatocyte injury of the livers after their transplantation into rats.</p><p><b>METHODS</b>Male SD rats were divided into three groups randomly: sham group, UW1h group and UW12 h group. Orthotopic liver transplantations were performed using the technique described by Kamada with a modification. A survival rate curve was made using the Kaplan-Meier method. Liver tissue specimens and blood samples were collected at different time points after the surgeries. Six animals were sacrificed at each time-point. The liver injury was evaluated by serum ALT and HA levels. The incidence of apoptosis in SECs was measured using the Tunel method. Additionally, the typical morphology indication of apoptosis was observed by transmission electron microscopy.</p><p><b>RESULTS</b>The survival rate at 168 h in the UW12 h group was significantly lower than that in the UW1h group (F = 6.39, P<0.05). The levels of serum ALT and HA were significantly higher in UW12 h group than those in UW1h group (F = 3.99, P<0.05; F = 12.43, P<0.05). The serum ALT level reached its peak at 6 h after transplantation in both groups. The AI of SEC was significantly higher in the UW12 h group than those in the UW1h group and sham group (F = 63.58, P<0.01; F = 86.58, P<0.01). The apoptosis index (AI) in the UW1h group and in the UW12 h group both reached their peak at 6 h postoperatively and the AI of SEC of each group was positively correlated with their serum ALT levels significantly (r = 1.0, P,0.01; r = 0.962, P<0.05).</p><p><b>CONCLUSION</b>The increase of apoptosis of SEC is significantly correlated with the dysfunction of the livers after transplantation in rats, and the dysfunction was mainly caused by the process of cold preservation/reperfusion injury.</p>

Cyclosporine microemulsion C2 monitoring in Chinese adult liver transplant recipients: a preliminary randomized control trial / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and reliability of cyclosporine microemulsion (CsA-ME) C(2) monitoring and to determine the target level of C(2) in Chinese adult liver transplant recipients.</p><p><b>METHODS</b>53 Chinese adult liver transplant recipients were randomly divided into three groups (group C(0), n = 17; group high level C(2), n = 18; group low level C(2), n = 18). Blood chemistry reflecting heart, liver and renal function and CsA level were examined at certain interval during follow-up. The change of immune status and episodes of rejection were also observed closely.</p><p><b>RESULTS</b>The group low level C(2) had the lowest CsA oral dose (2.51 +/- 0.37 mg/kg/d), and had significant difference compared with the other groups (P < 0.01). The best liver, heart and renal function was observed in group low level C(2). The CD(4)(+)/CD(8)(+) ratio of group low level C(2) was 1.04 +/- 0.68, which had no significant difference with C(0) group. The rejection incidence of the three groups had no significant difference. group low level C(2) had highest clinical benefit ratio (72.22%), while the clinical benefit of group high level C(2) is the lowest (11.11%).</p><p><b>CONCLUSIONS</b>With rational target level, C(2) monitoring can show us the proper oral dose of CsA which can decrease the side effects remarkably without rejection episodes increasing. The target level of C(2) in Chinese adult liver transplant recipients might be: 600-800 ng/ml 1 to 6 months posttransplant, 400-600 ng/ml 7-12 months posttransplant.</p>

Detection of alpha-fetoproteins mRNA and melanoma antigen-1 mRNA in peripheral blood of patients with hepatocellular carcinoma and its clinical significance / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility of alpha-fetoproteins (alpha-FP) mRNA and melanoma antigen-1 (MAGE-1) mRNA as 2 markers of micrometastasis in hepatocellular carcinoma (HCC) patients' peripheral blood.</p><p><b>METHODS</b>Subjects were divided into five groups: patients with HCC (n=65); patients with hepatitisB and liver cirrhosis (n=22); patients with metastatic liver cancer (n=12); patients with hepatic hemangioma (n=12); and healthy volunteers (n=20). alpha-FP mRNA and MAGE-1 mRNA in peripheral blood were tested by nested reverse transcription polymerase chain reaction (RT-PCR).</p><p><b>RESULTS</b>MAGE-1 mRNA and alpha-FP mRNA were detected in 27 (42%) and 35 (54%) of 65 HCC patients respectively, while 42 (65%) HCC patients were positive for at least 1 marker. The frequency of alpha-FP mRNA and MAGE-1 mRNA positivity strongly correlated with portal thrombosis, intrahepatic metastatic nodules, tumor diameter and TNM stage (P <0.05). With regard to controls, 4 of 12 (33%) samples from patients with metastatic liver cancer showed MAGE-1 mRNA in their peripheral blood, but groups of hepatitis and cirrhosis, hepatic hemangioma, healthy volunteers did not. And 3 of 22 samples (14%) from group hepatitis and cirrhosis showed alpha-FP mRNA, but none of samples from other control group showed alpha-FP mRNA.</p><p><b>CONCLUSIONS</b>Nested RT-PCR is a sensitive and reliable method for detecting circulating HCC cells. Two-marker RT-PCR assay with a liver-specific alpha-FP marker in combination with a cancer-specific MAGE-1 marker may be a promising tool for detecting micrometastases with better sensitivity and specificity than one marker RT-PCR.</p>

Isolation and Identification of a Lipopeptide / 微生物学通报

A lipopeptide compound was isolated from the culture of Bacillus subtilis HSO121 by methods of acidic precipitation, solvent extract, fractional precipitation, adsorption and prepared thin-layer chromatography; and its molecular structure was determined by by ninhydrin assay and IR methods following the Amino analysis, MS-MS and ESI-MS. It shows that the isolated lipopeptide consists of two homologues with molecular mass 1,022D and 1,036D and bearing a cyclic structure with the amino acid sequence Leu-Leu-Asp-Val-Leu-Leu-Glu in the peptide chain, which indicates that the isolated lipopeptide falls into the analogs of surfactin.