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End stage liver disease is a serious threat to human health.Existing conventional therapies are far from ideal,and orthotopic liver transplantation is limited by the lack of donor liver.A new therapy,transplantation of hepatic stem cell,is a promising approach.Hepatic oval cells are hepatic stem/progenitor cells(HSC/HPC)during hepatic regeneration,and they are being referred to as hepatic precursor cells.It got its name because of its oval nucleus,high nuclear/cytoplasmic ratio and other morphological features.Research has shown increasingly importance in the knowledge of hepatic oval cells.There are many signaling pathways in hepatic oval cells activation and proliferation.As a branch of the Wnt signaling pathway,Wnt/β-catenin signaling pathway has a significant effect on hepatic oval cells activation and proliferation.However,the exact mechanisms of this process have not been completely elucidated.This review describes the role of Wnt/β-catenin signaling pathway in hepatic oval cell activation and proliferation.
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Objective To investigate the efficiency and safety of laparoscopic hepatectomy (LH) and open hepatectomy (OH) in patients with hepatocellular carcinoma (HCC). Methods A total of 45 HCC cases undergoing hepatectomy from January 2008 to December 2010 in our hospital were divided into LH group ( n =21 ) and OH group ( n =24 ).Their clinical efficiency and safety were compared and analyzed. Results The amount of intraoperative blood loss and blood transfusion in LH group were significantly higher than that of OH ( respectively x2 =3.973,x2 =4.862,all P ＜ 0.05 ).LH is associated with less postoperative complications and duration of hospital stay,compared with OH ( respectively x2 =4.746,t =-2.717,all P ＜0.05).Cumulative survival rates in both groups were not statistically significant ( x2 =0.172,P ＞ 0.05 ).However tumor-free survival rate in LH was significantly higher,superior to that of OH (x2 =4.543,P ＜ 0.05). Conclusions LH and OH are all safe and effective hepatectomy for HCC.LH has the advantage of less complication and shorter hospital stay.
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Objective To observe the blood biochemical and histological changes before and after pancreas freezing, to provide evidence for cryosurgery for pancreatic cancer. Methods Fifteen healthy pigs were divided into deep frozen group (n = 5), shallow frozen group (n = 5), non-frozen group (n = 3) and normal group (n = 2). After anesthesia and Iaparotomy, a probe of the Argon-Helium Surgical System was inserted into the pancreas, 100% and 10% argon output power were used in deep and shallow frozen group, respectively;and the temperature were - 130 ～ - 140℃ and - 110 ～ - 120℃, respectively;which results in an ice-ball with 15 ～ 20 mm in diameter. Then helium gas was inputted to increase the temperature to 10 ～ 20℃ for three minutes;then the whole process was repeated. A probe was inserted into the pancreas in the non-frozen group only and only laparotomy was performed in non-grozen group normal group and normal group. Serum amylase, IL-6, CRP levels before and after the experiment was determined;the pigs were sacrificed at day 7 and the pancreas was harvested for light microscope and electron microscope examination. Results The frozen pancreatic tissue became pitchy necrosis zone, and it could be distinguished from non-frozen tissue;there were obvious tissue necrosis in the center and para-center of frozen area, and the ultra-structure were destroyed and disappeared, mitochondria degranulation and rough endoplasmic reticulum degrannlation were observed. Serum amylase was elevated in 13 (86.7%) pigs and most returned to normal at 6th day. Serum IL-6 was slightly elevated in 5 (33.3%) pigs. There was no significant difference among all the groups in term of serum CRP. All the pigs were alive until the time of sacrifice. Conclusions Cryosurgery has affirmative fatal ablative effects on pancreatic tissue, and it is safe with no serious complications.
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Objective To evaluate the efficacy of transarterial chemoembolization (TACE) and percutaneous cryosurgery sequential therapy for unresectable hepatocellular carcinoma (HCC).Methods Four hundred and twenty patients with unresectable HCC were divided into sequential TACE-cryosurgery sequential (sequential) group (n=290) and cryosurgery alone (cryoalone) group (n = 130). TACE was performed with the routine operation; the percutaneous cryosurgery was conducted 2 to 4 weeks after TACE. The patients were followed up at the first month and once every 2 to 3 month later. Liver ultrasound or both computer tomography and alpha fetal protein were examined during follow-up. Results During a mean follow-up of (42±17) months (range from 24 to 70 months), the local recurrence rate of ablated lesion was 17% for all the patients, 11% and 24% for patients in sequential group and cryoalone groups respectively (P=0. 001). The overall 1-, 2-, 3-, 4-and 5-year survival rate was 72%, 57%, 47%, 39% and 31%, respectively. The 1- and 2-year survival rates (71% and 61 % ) in sequential group were similar to those (73 % and 54 % ) in cryo-alone group (P=0.69 and 0. 147), while the 4- and 5-year survival rates were higher in sequential group (49 % and 39 % ) than those (29 % and 23 % ) in cryo-alone group (P= 0.001). Eighteen patients with large HCC (＞5 cm in diameter) in sequential group survived for more than 5 years while no one in cryo-alone group. Complication rate was 24% in all patients, 21% and 26% for the sequential and cryo-alone groups respectively (P=0. 06). The incidence of hepatic bleeding was higher in cryo-alone group than in sequential group (P=0. 02). Liver crack occurred in two patients of the cryoalone group. Conclusions Pre-cryosurgical TACE increased the cryoablation efficacy and decrease its complications, especially hepatic bleeding. TACE and cryosurgery sequential therapy may be a better treatment for unresectable HCC, especially for large HCC.
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Objective To analyze the CT staging and evaluate its role in assessing the resectability of the gallbladder carcinoma.Methods The CT scans of 47 patients who had pathologically confirmed gallbladder carcinoma were retrospectively reviewed and the CT stages of gallbladder carcinoma were used to evaluate the resectability.Results Before operation,three patients were in stage Ⅰ(6.4%,3/47),14stageⅡ(29.8%,14/47),10 stageⅢ(21.7%,3/47),20 stage Ⅳ(42.6%,20/47),however,after operation,three patients were in stage Ⅰ(6.4%,3/47),14 stageⅡ(29.8%,14/47),8 stage Ⅲ(17.0%%,8/47),22 stage Ⅳ(42.6%,20/47).The accurate rate of CT staging confirmed by operation was 91.5%(43/47).The treatment procedures of gallbladder carcinomas included radical operation,palliative excision and exploratory laparotomy.For 47 patients with gallbladder carcinomas,radical operation was performed in 30 cases(3 stage Ⅰ,14 stageⅡ,7 stage Ⅲ,6 stage Ⅳ),palliative excision 15 cases(1 stage Ⅲ,14 stage Ⅳ),exploratory laporatory 2 eases(2 stage Ⅳ).Conclusion The staging of gallbladder carcinoma with CT may provide definite value in evaluating respectability of gallbladder carcinoma.
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Objective To summarize the experience of adjuvant therapy for primary hepatocellular carcinoma. Methods 316 cases of operable hepatocellular carcinoma were divided into three groups. Only hepatectomy were performed in group one (21 8cases).Preopemtive adjuvant TACE were done in group two (52 cases). Preoperative adjuvant TACE and postoperative trans-portal vein chemotherapy were done in group three (46 cases), which was named hepatectomy sequencing two vessel therapy. Results 1, 3 and 5 year survival rote were 51.2 %, 30.0 % and 20.5 % respectively in group one, 57.2 %, 43.0 % and 31.5 % in group two, 84.0 %, 62.5 % and 51.0 % in group three. The postoperative disease-free survival rate in group three was significantly higher than that in group one and group two (P ＜0.05). Conclusion Hepatectomy sequencing two vessels therapy in perioperative period might improve the survival rate, which can prevent and delay the incidence of recurrence and may improve the effect of liver resection.
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Objective Shh and Ptch have been known to play critical roles in the hedgehog pathway and the hedgehog pathway activation occurs in the gastrointestinal cancers. This study was to detect the expression of Shh and Ptch in gallbladder carcinoma, and explore their correlation to gallbladder carcinoma. Methods The expression of Shh and Patch protein in 41 specimens of primary gallbladder carcinoma, 20 specimens of normal gallbladder and 21 specimens of adenoma tissue were assessed by immunohistochemistry.Results The positive expression rate of Shh and Ptch in gallbladder carcinoma was 75.6% (31/41) and 78.0% (32/40) respectively, in normal gallbladder mucous was 5% ( 1/20 ) and 5% ( 1/20 ) respectively,in gallbladder adenoma was 4.7% ( 1/21 ) and 9.6% (2/21) respectively, and there was significant differenee between the three groups in Shh and Patch expression values(P ＜0.001 ). However, there was no significant difference between age group, histological grade group, histologic type group, Nevin stage group,lymph node or distal organ metastasis group, and gallstone presence group in Shh and Ptch expression value (P ＞ 0.05, respectively). The expression of Shh was positively correlated to Ptch (r = 0.72, P ＜ 0.01 ).Conclusion These data support our hypothesis that Hh signaling is dysregulated in human gallbladder carcinognesis.
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Objective To study the expression of chemokine stromal cell-derived factor-1 and its receptor CXCR4 in gallbladder carcinoma and evaluate the relationship between the expression of SDF-1 and CXCR4 protein and the clinicopathology,and lymph node metastasis of gallbladder carcinoma.Methods The expression of SDF-1 and CXCR4 protein in 41 cases of gallbladder adenoma carcinoma was examined by immunohistochemical technique(SP),and the relation of SDF-1/CXCR4 biology axis to clinicopathological parameter was also analyzed.Results The positive expression rate of SDF-1 and CXCR4 in gallbladder carcinoma was 68.3%(28/41)and 51.2%(21/41)respectively,in normal gallbladder mucous was 5%(1/20)and 5%(1/20)respectively,in cholecystitis and gallstone was 6.7%(6/90)and 5.6%(5/90)respectively,and there is significantly different among the three groups in SDF-1 and CXCR4 expression values(P＜0.001,P＜0.001,respectively).There is significant difference among histological grade group,Nevin stage group,histological differentiation,lymph node or distal organ metastasis group in SDF-1 and CXCR4 expression value(P＜0.05,respectively).However,there is no significant difference among sex group,age group,tumor size group,and gallstone presence group in SDF-1 and CXCR4 expression value(P＞0.05,respectively).The expression of SDF-1 was positively correlated to CXCR4(r=0.68,P＜0.01).Conclusion Up-regulated SDF-1 and CXCR4 is associated with the carcinogenesis and metastasis of gallbladder carcinoma.
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Objective To investigate the feasibility and security of omentum minus cavity xenotransloantation of alginic-polylysine-alginic(APA) microencapsulated neonatal swine islet cells by laparoscopic procedure. Methods 5 patients with IDDM received the xenotransloantation of APA microencapsulated neonatal pig islets in omentum minus cavity by laparoscopic procedure.The patients' general conditions,the change in fast blood glucose level,serum C-peptide and the dose of insulin used were observed before and after the xenotransplantation. Results No complications occurred during operation and after operation.The levels of serum C-peptide increased by 3 to 23 times respectively and the post-operative dose of insulin needed decreased obviously.Insulin independency was achieved in one recipient for up to 31 months. Conclusions Omentum minus cavity xenotransplantation of APA microencapsulated neonatal pig islets for the treatment of IDDM patients by laparoscopic technique is safe and practicable.
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Objective To explore the surgical treatment of the primary retroperitoneal tumor (PRT). Methods A retrospective clinical data analysis was made on the 59 cases of PRT who underwent operation. Results 59 cases were diagnosed by operation and pathologic examination.In 41 cases of malignancyt ( 69.49%),complete resection, partial resection, surgical exploration and biopsy were performed on 15 cases (36.6%), 8 cases (19.5%) and 18 case (43.9%) , respectively. The 3- and 5-year survival rates of maligment PRT with total resection were 53.3% and 26.7%,and with partial resection were 19.23% and 7.69% respectively.In 18 cases of benign tumor (30.5%),complete resection, partial resection, surgical exploration and biopsy were performed on 14 cases (77.8%), 3cases (16.7%) and 1case ( 5.6%) , respectively. The 3- and 5-year survival rates of benign PRT with total resection were 92.86% and 85.7%,and with non-completely resection were 75.0% and 50.0%, respectively. Conclusions Operation is the main treatment of PRT. Early diagnosis and radical resection are the keys in improving the prognosis of PRT.
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Objective To establish a canine model of fulminate hepatic failure ( FHF) and study the treatment of FHF by partial orthotopic liver transplatation(POLT).Methods Carbon tetrachloride (CCL4) mixed with the same amount of peanut oil in the dosage of 0.9 ml per kilogram of body weight was injected intraperitoneally to canines. ALT,tolal bilirubine(TB), PT, NH 4,and blood suger(BG) were monitored. The pathological changes were observed when the canine died,remain alived animal were killed on 7th day and 14th day respectively. EEG was performed on 3rd day after the model eslablished. Results After CCl 4 was injected, the canine showed progressive hepatic failure, ALT, TB and NH rose persistantly, PT prolonged, and BG decreased (P
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Objective To evaluate the value of ERCP in treating hepatocellular carcinoma complicated with tumor thrombi in bile duct.Methods To analyze retrospectively the results of 15 cases of hepatocellular carcinoma with tumor thrombi in the bile duct including ERBD 8 cases and ENBD 7cases,EMBE after ENBD 4 cases, EST with clearance of tumor thrombi and cytological brush 12 cases, ERCP conjugated with other compositive treatments 9 cases.Results The common feature of cholangiography is filling defect in the bile duct as the so called "tennis bat" sign and "flocculation" sign, 13 cases have got drainage successfully after ERCP with the effective rate 86 7%, Satisfactory results were obtained in patients received ERCP conjugated with other compositive treatments.Conclusion ERCP is very important treatment of hepatocellular carcinoma with tumor thrombi in the bile duct; the "tennis bat" sign and "flocculation" sign were the very important evidences of tumor thrombi in the bile duct. If combined with other compositive treatment such as surgery and TAE, ERCP is very effective treatment for the releasing symptoms, improving living quality and prolonging life span in these patients, even in some patients radical cure could be obtained.
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Objective To evaluate the effect and result of xenotransplantation with alginic polylysine alginic(APA) microencapsulated neonatal swine islets for the treatment of IDDM patients.[WT5”HZ] Method [WT5”BZ] The neonatal pig islets were microencapsulated with APA technique and cultured in vitro. The secretion of insulin, glucose stimulated insulin release test and histological examination between the microencapsulated and unmicroencapsulated neonatal pig islets were compared. 3 patients with IDDM received a xenotransplantation of microencapsulated neonatal pig islets by laparoscopic procedure. The change in blood glucose level, C peptide and the dose of insulin used were observed before and after the xenotransplantation. [WT5”HZ]Results [WT5”BZ] No significant difference was found between microencapsulated and unmicroencapsulated neonatal pig islets in vitro in terms of biological activity of the islets. The levels of serum C peptide in two of the 3 recipients increased by 11 and 23 times respectively, the postoperative dose of insulin needed decreased by 63% in one, insulin independency was achieved in the other recipient.In these two cases,the microencapsulated islets have functioned effectively for up to 80 ds.[WT5”HZ] Conclusion [WT5”BZ] APA microencapsulated neonatal pig islets have good biological activity and survived while transplanted into IDDM recipients. Omentum minus cavity xenotransplantation of microencapsulated neonatal pig islets by laparoscopic technique is safe, capable of repeated transplantation.
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ObjectiveTo evaluate the feasibility of angioscopically external valve suture repair. MethodAngioscope was introduced through the terminal great sapherous to the first venous valve of superficial femoral vein. With general femoral vein, deep femoral vein, superficial femoral vein blocked, heparin-contained NS was used to establish water column, and video-guided angioscopy demonstrates the valve′s shape and its degree of defect and deformation. Twelve patients with primary deep venous insufficiency underwent video-valvuloplasty.ResultsPostoperative phlebography showed disappearance of reflux in 9 cases, and significantly reduced reflux in 3 cases. There was no morbidity postoperatively. Conclusion Angioscopic external suture valve repair is safe and effective in the treatment of femoral superficial venous insufficiency.
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Objective To analyze the major causes of reoperation for abdominal injuries and explore the effective preventive measures so as to enhance operation quality for abdominal injuries. Methods The data of 33 patients undergoing relaparotomy for abdominal injuries during the last 10 years was analyzed retrospectively. Results There were 25 closed injuries and 8 stab penetrating injuries in this group. The causes of reoperation were mainly missed injuries in initial laprotomy 10 cases,inappropriate surgical procedures 8 cases, postoperative complications 13 cases, and negative relaparotomy 2 cases. In these 33 patients, 40 times of reoperation were performed, and among them 2 patients sustained 3 times of laparotomy respectively. Overall mortality rate was 12%(4/33). The main causes of death were MODS resulted from consumption coagulopathy and/or severe septic complication after reoperation. Conclusions The effective preventive steps to decrease the incidence of reoperation in patients with abdominal injuries include complete interventional exploration, right operational methods and sufficient drainage in initial laparotomy for a surgeon.