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Objective:To investigate the prognosis of robotic pancreatoduodenectomy after the learning curve and open pancreatoduodenectomy for pancreatic cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 396 patients who underwent curative pancreatoduodenectomy for pancreatic duct adenocar-cinoma in Ruijin Hospital of Shanghai Jiaotong University School of Medicine from January 2017 to December 2018 were collected. There were 244 males and 152 females, aged 64(range, 36?92)years. Of 396 patients, 86 cases undergoing robotic pancreatoduodenectomy were divided into robotic group, 310 cases undergoing open pancreatoduodenectomy were divided into open group. Observa-tion indicators: (1) propensity score matching and comparison of general data between the two groups after matching; (2) follow-up and survival analysis. Follow-up was conducted by telephone interview or outpatient examinations including tumor markers and abdominal imaging examina-tions to detect survival of patients up to March 2022. Overall survival was defined as the time from the surgery date to death or the last follow-up. Disease-free survival was defined as the time from the surgery date to tumor recurrence or the last follow-up. The propensity score matching was conducted by 1∶1 matching using the nearest neighbor method. Normality of measurement data was examined using the Shapiro-Wilk test. Measurement data with skewed distribution were described as M(range), and comparison between groups was analyzed using the Mann-Whitney rank-sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test. Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-Rank test was used for survival analysis. An intent-to-treat analysis was performed in this study, patients who were converted to laparotomy from robotic surgery were still divided into the robotic group. Results:(1) Propensity score matching and comparison of general data between the two groups after matching: 164 of 396 patients had successful matching, including 82 cases in robotic group and open group, respectively. Before propensity score matching, the body mass index, cases in stage T1, T2, T3, T4, cases in N0, N1, N2 were 23.4(range, 21.4?25.3)kg/m 2,24, 41, 10, 11, 52, 27, 7 for the robotic group, versus 22.4(range,20.3?23.9)kg/m 2,57, 144, 22, 87, 131, 132, 47 for the open group, showing significant differences in the above indicators between the two groups ( Z=3.01, 2.63, 3.03, P<0.05). After propensity score matching, cases of males, age, body mass index, cases with American Society of Anesthesiologists (ASA) score as 1, 2, 3, CA19-9, cases with preoperative biliary drainage, cases with portal vein resection, cases with pancreatic resection margin <1 mm, cases in stage T1, T2, T3, T4, cases in stage N0, N1, N2, cases with nerve invasion, cases with tumor differentiation as high-medium differentiation, medium-low differentiation, low differentiation, cases with adjuvant chemotherapy were 51, 65(range, 59?69)years, 23.0(range, 21.0?25.2)kg/m 2, 32, 41, 9, 160.4(range, 46.7?377.2)U/mL, 21, 9, 8, 21, 40, 10, 11, 48, 27, 7, 76, 26, 47, 9, 53 for the robotic group, versus 58, 65(range, 58?69)years, 23.3(range, 21.4?25.3)kg/m 2, 35, 39, 8, 172.0(range, 69.7?402.9)U/mL, 26, 9, 10, 24, 40, 7, 11, 49, 28, 5, 76, 22, 49, 11, 57 for the open group, showing no significant difference in the above indicators between the two groups ( χ2=1.34, Z=0.18, 0.34, 0.49, 0.51, χ2=0.75, 0.00,0.25, Z=0.59, 0.27, χ2=0.00, Z=0.76, χ2=0.44, P>0.05). (2) Follow-up and survival analysis: after propensity score matching, 164 patients were followed up for 54(range, 1?67)months. The follow-up time of patients was 55(range, 51?59)months for the robotic group, versus 54(range, 50?58)months for the open group, respectively, showing no significant difference between the two groups ( Z=0.48, P>0.05). During the follow-up, the 1-year overall survival rate, 3-year overall survival rate, the median survival time, 1-year disease-free survival rate, 3-year disease-free survival rate, the median disease-free survival time, tumor recurrence rate, cases with recurrence pattern as local recurrence, liver recurrence, other distant recurrence, local and distant recurrence were 81.7%, 39.0%, 27 months(95% confidence interval as 19?33 months), 61.0%, 34.2%, 15 months(95% confidence interval as 12?18 months), 54.9%(45/82), 12, 16, 9, 8 for the robotic group. The above indicators were 79.3%, 36.0%, 24 months(95% confidence interval as 19?31 months), 59.8%, 27.5%, 15 months(95% confidence interval as 10?20 months), 58.5% (48/82), 10, 22, 6, 10 for the open group. There was no significant difference in overall survival or disease-free survival between the two groups ( χ2=0.39, 0.47, P>0.05). There was no significant difference in tumor recurrence rate or tumor recurrence site between the two groups either ( χ2=0.22, 1.86, P>0.05). Conclusion:After the learning curve, robotic pancreato-duodenectomy has non-inferior prognosis compared with open pancreatoduodenectomy.
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Objective To establish the diagnostic model based on detection of serum biomarkers in pancreatic cancer (PC) associated diabetes.Methods From June 2013 to July 2014, at Ruijin Hospital, School of Medicine , Shanghai Jiao Tong University , 30 patients diagnosed with PC companied with new onset diabetic mellitus and 30 patients with new onset type 2 diabetic mellitus , were enrolled .Serum samples were examined by liquid chromatography-mass spectrometry ( LC-MS) for metabolomics analysis .Orthogonal partial least square ( OPLS ) was performed for raw data analysis to obtain the differentially expressed metabolites between two groups .The first 15 cases of each group were taken as training samples and the left as validation samples.The model was established using logistic regression via stepwise differentially expressed metabolites and clinical data input in training samples .The diagnostic efficiency of the model was verified in validating samples . Results Ten differentially expressed metabolites were identified in PC companied with new onset diabetic mellitus group and new onset type 2 diabetic mellitus group .The differentially expressed metabolites identified in positive ion mode were 3-ketosphingosine , arachidonoyl dopamine , phosphatidylethanolamine ( 18 :2 ) , ubiquinone-1 and valine .The differentially expressed metabolites identified in negative ion mode were C 16 sphingosine-1-phosphate, keto palmitic acid, isoleucine, N-succinyl-L-diaminopimelic acid and uridine.The diagnostic model was established in training samples:p=e(Xβ)/(1+e(Xβ)), ( Xβ) =-158.975-1.891 (age) +0.309 ( phosphatidylethanolamine 18:2 ) +1.035 ( C16 sphingosine-1-phosphate ) +0.084 (isoleucine) +1.1145 ( N-succinyl-L-diaminopimelic acid ).The area under curve ( AUC) of receiver operating characteristic (ROC) of this model was 0.982 in validation samples, the sensitivity and specificity were both 93.3％.Conclusion Serum metabolomics-based diagnostic approach is a promising method for screening PC from new onset diabetic mellitus .
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Pancreaticoduodenectomy (PD) is a standard surgical method for periampullary cancer.The hemorrhage is a dangerous complication after PD,how to effectively prevent and treat hemorrhage is a difficult point of pancreatic surgery,and also a key for reducing postoperative mortality.Four famous experts and their teams in surgical fiell explored prevention and treatment of the hemorrhage after PD from different angles based on clinical experiences.Professor Shen Boyong has conducted a discussion on early and Date hemorrhage after PD combined with previous successful experiences and prospective research data.Professor Chen Yajin suggested preventing hemorrhage in the aspects of anatomical resection,anastomosis and reconstruction,peritoneal drainage-tube placement and postoperative management based on different causes of hemorrhage.Professor Peng Bing paid attention to hemorrhage after laparoscopic PD,and supposed that intraoperative careful hemostasis,precise anastomosis,reasonable peritoneal drainage-tube placement and optimal perioperative management can reduce incidences of postoperative pancreatic fistula,biliary fistula and intra-abdominal infection,thereby lowering the incidence of hemorrhage.Professor Tan Guang respectively proposed processing strategies of hemorrhagc for grading A (mild at early stage),B (severe at early stage and mild at late stage) and C (severe at late stage).
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Chylous fistula is a postoperative complication following pancreatic surgery,it is mainly diagnosed according to the nature of the patient's drainage fluid (≥3 days after surgery,triglyceride concentration ≥ 1.2 mmol/L).The mechanism of occurrence includes obstruction,injury and exudation of the lymph-vessels.Risk factors can be concluded into 3 aspects:clinicopathological features,surgical procedure and postoperative management.Most of the chylorrhea can be cured by conservative treatment like modified dietary measures and somatostatin,while severe cases still requires intervention and surgical treatment.This article reviewed the risk factors and treatment approaches of postoperative chylous fistula,and elucidated relative mechanisms,hoping to provide guidance in clinical prevention,diagnosis and treatment of chylous fistula.
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Objective·To prepare chitosan-gelatin porous microspheres by high voltage electrostatic method combined with freeze-drying and ionic cross-linking method and investigate the factors that influence the formation of porous medium.Methods·Porous chitosan microspheres and chitosangelatin porous microspheres were prepared using high voltage electrostatic method combined with freeze-drying and ionic cross-linking method,with sodium tripolyphosphate (STPP) as crosslinking agent.Factors that affect the porous structure and pore size of porous microspheres were compared,such as different chitosan-gelatin ratio,freezing temperature,curing time with saturated STPP in 85％ ethanol solution.The morphology,surface and internal structure,particle size of the porous chitosan microspheres and chitosan-gelatin porous microspheres were observe by using light microscope,scanning electron microscope and hematoxylin-eosin staining.Results·Microspheres prepared by freeze-drying with an electrostatic and ionic cross-linking method have open,interconnected and highly macroporous,with good spherical surface.Saturated STPP ethanol solution (85％ ethanol) was chosen as the crosslinking agent to prevent destruction of the porous structure.The order of freeze and crosslinking,cross-linking time and the second freezing temperature,can influence the pore size of porous microspheres.Gelatin and chitosan can form polyelectrolyte complexes,and can also be used as porogen in porous structure.Conclusion·The preparation of porous chitosan-gelatin microspheres via this method has a large pore size (diameter 100-200 μm),suitable for cell growth and the migration.
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With the continuous improvement of the diagnosis rate of benign pancreatic disease and the younger age of disease onset,the demand for minimally invasive pancreatic surgery is increasing,meanwhile,how to keep the normal pancreatic tissue as much as possible to reduce the impact on the patients' life has gained surgeons' thinking.The Da Vinci robotic surgical system,providing a clearer 3D vision and more accurate operation,makes some difficult minimally invasive pancreatic surgery such as pancreaticoduodenectomy can be carried out extensively.Based on clinical experiences and related literatures,this paper will analyze the present situation of Da Vinci robot-assisted pancreatic surgery and give prospects.
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Objective To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 310 patients who received pancreaticoduodenectomy at the Ruijin Hospital of Shanghai Jiaotong University from January 2005 to May 2013 were retrospectively analyzed.The risk factors associated with the interoperative pancreatic fistula were analyzed.The univariate and multivariate analysis were done using the Pearson chi-square test and non-conditional Logistic regression model.Results A total of 134 patients had postoperative complications,including 103 (33.23％) with pancreatic fistula,among them 40 patients developed additional complications.The results of univariate analysis showed that preoperative levels of hemoglobin,total bilirubin,diameter of the pancreatic duct and postoperative level of albumin were risk factors of pancreatic fistula after pancreaticoduodenectomy (x2 ＝ 4.543,6.087,6.265,5.311,P ＜ 0.05).The results of multivariate analysis showed that preoperative level of total bilirubin equal to or above 34.2 μmol/L,the diameter of the pancreatic duct under 3 mm and the level of postoperative albumin under 28 g/L were the independent risk factors of pancreatic fistula (OR =1.806,1.936,1.780; 95％ confidence interval:1.107-2.948,1.170-3.206,1.002-3.165,P ＜ 0.05).Conclusion Preoperative jaundice (the level of total bilirubin ≥ 34.2 umol/L),pancreatic duct diameter ＜ 3 mm and postoperative malnutrition (albumin ＜ 28 g/L) indicate a higher incidence of postoperative pancreatic fistula.
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The da Vinci robotic surgical system has the advantages of three-dimensional vision and high degree of accuracy,flexibility and repeatability,which makes surgical procedures such as digestive tract anastomosis easier to conduct under minimally invasive conditions.In this article,the feasibility and principle of digestive tract anastomosis and the procedures of pancreaticojejunostomy and pancreaticogastrostomy by the da Vinci robotic surgical system are introduced,so as to improve the quality of anastomosis and reduce the incidences of postoperative complications.Compared with traditional laparotomy,da Vinci robotic surgical system simplified the surgical procedures and reduced the trauma,which is suitable for digestive tract anastomosis in pancreatic surgery.The method of pancreatic anastomosis should be selected in consideration of the condition of patients,surgical procedure and the experience of surgeons.
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Objective To identify the role of p53 in the induction of growth arrest DNA damage-inducible gene 45β (GADD45β) in HCC cells by Oxaliplatin.Methods A Hep3B+p53 clone was established by transfection of the full-length p53 sequence to Hep3B.Following oxaliplatin administration,quantitative real-time PCR was employed to validate the expression changes of GADD45β.pGL3 basic luciferase plasmids including promoter fragments were synthesized in vitro and transfected into cells.The effects on promoter activity,cell growth and the cleavage of Caspase-3 were further focused on.Results Hep3B+p53 expressed p53 protein stably.The transfection of p553 enhanced the induction of GADD45β in Hep3B by Oxaliplatin.The promoter activity of fragments constructed NF-κB and E2F-1 binding sites was induced about 1.5 and 0.8 folds by transfection of p53.The colony formation and DNA syntheses were inhibited apparently in Hep3B+p53 with p53 by Oxaliplatin (30.41％ and 75.60％ by 100 μmol/L Oxaliplatin,respectively).Moreover,p53 transfection triggered cleavage of Caspase-3 more rapidly.Conclusion p53 played a role in the induction of GADD45β in Hep3B by Oxaliplatin.
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Objective To investigate the efficacy of pancreaticoduodenectomy by using the da Vinci robotic system.Methods The clinical data of 10 patients who received pancreaticoduodenectomy (PD) by the da Vinci robotic surgical system at the Ruijin Hospital from March 2010 to March 2011 were retrospectively analyzed.The perioperative condition of the patients,incidence of complications and postoperative survival were observed.Results Operations were successfully performed on all the patients,and there was no conversion to open surgery.Nine patients received pancreaticojejunostomy,and 1 received pancreaticogastrostomy.The mean operation time,operative blood loss and postoperative duration of hospital stay were 449.5 minutes (range,405-510 minutes),614 ml (range,340-1100 ml) and 22.7 days (range,14-39 days),respectively.One patient developed pancreatic obstruction which was alleviated by operation.Two patients developed pancreatic fistula and were cured by conservative treatment.One patient developed anastomotic bleeding and was cured by conservative treatment.The results of pathological examination confirmed that 3 patients were diagnosed as with pancreatic ductal adenocarcinoma,2 with duodenal papillary adenocarcinoma,1 with ampullary adenocarcinoma,2 with serous cystadenocarcinoma,1 with carcinoid tumor and 1 with pancreatic duct stone and inflammatory mass.All patients were followed up for 6-12 months.The prognosis of the 9 patients was good,except for 1 patient who had tumor recurrence at the sixth month after operation.No mortality was observed.Conclusion PD performed with the da Vinci robotic surgical system is safe,and its efficacy is comparable to that of open surgery.
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Objective To investigate the protective effect of polymyxin B (PMB) to the liver graft after liver transplantation and the underlying mechanism in rats.Methods Male SD rats were selected as the donors and recipients.Non-artery whole liver transplantation model was established in rats according to Kamada's two-cuff method.The rats were divided into two groups by the way of random number table method:control group (normal saline,0.5 ml) and PMB group (PMB,1 mg/ml,0.4 mg/kg+ normal saline 0.5 ml).The levels of portal vein plasma endtotoxin (EU/ml)were determined by endotoxin-analyzing machine of BET-24A. ALT,BUN,and TNF-α,IL-6 in serum were measured by using machine of Automatic Analyzer and ELISA,respectively.The CD14,TLR4,NFκB and AP-1 in the grafts were measured by RT-PCR and Western blotting,and pathological changes were observed. Results PMB decreased the levels of portal vein plasma endotoxin 1 h after reperfusion in PMB group as compared with control group (P＜0.05),and the levels of portal vein plasma endotoxin returned to the normal levels 6 h after reperfusion in both two groups (P＞0.05).After operation,the levels of ALT,TNFα and IL-6 in serum were significantly reduced (P＜0.05),the expression of CD14 and TLR4 mRNA in the grafts was significantly decreased (P＜0.05),the expression of Hsp60 protein and mRNA,and NF-κB and AP1 proteins in the grafts were reduced (P＜0.05),and the pathological damage to the grafts was significantly alleviated in PMB group as compared with control group.Conclusion PMB reduced the levels of portal vein plasma endotoxin after reperfusion in liver transplantation in rats.PMB improved liver function,reduced the injury of inflammatory response,decreased the levels of endotoxin signal pathway markers and alleviated the pathological damage to the grafts.
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Objective To study the relationship between hepatic arterial buffer response (HABR),recovery of liver function,early biliary complications and small-for-size syndrome (SFSS).Methods Early hepatic hemodynamic parameters (including hepatic arterial flow (HAF),portal venous flow (PVF) were measured using duplex Doppler sonography in 34 patients who received living donor liver transplantation (preoperatively n＝26,intraoperatively n=26) and on postoperative days 1,2,3,and 7.Alanine aminotransferase (ALT),aspartate aminotransferase (AST) and total bilirubin (TBIL) level were measured preoperatively and on postoperative days 1,2,3,7,14,21,and 28.If TBIL level was elevated,we used B ultrasonography or CT and even ERCP to diagnose early biliary complications.The days taken for AST,AI T and TBIL to recover and the number of patients with early (＜60 days) biliary complications (bile leakage or bile stricture) and with small-for-size syndrome (SFSS) were recorded.Results Passive hepatic artery buffer response (HABR) was present in 11 patients early after living donor liver transplantation (group 1) and it disappeared in 23 patients (group 2).The recovery in days taken for normalization of AST (10.6± 8.8),AIT (11.6±9.0) and TBlL (average of 29) in group 1 were shorter than in group 2.However,the differences did not reach statistics difference (P＞0.05).The overall incidences of early biliary complications and small-for-size syndrome (SFSS) in group 1 were significantly lower than in group 2 (P=0.04).The survival rate in group 1 was 82 ％,compared with 74 ％ in group 2.Conclusions Passive hepatic arterial buffer response (HABR) disappeared in some patients early after living donor liver transplantation.There were high incidences of early biliary complications and small-for-size syndrome (SFSS) in these patients.Measurcment of hepatic buffer response in the early stage after living donor liver tranaplanta tion is valuable for predition of early biliary complications and small-for-size syndrome (SFSS),thus helping to prevent failure in transplantation.
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Objective To summarize and analyze the pathological characteristics of solid pseudopapillary tumor of pancreas (SPTs).Methods The clinical data of 51 cases of SPTs were retrospectively analyzed.The immunohistochemical localizations of different markers (HSE,SYN,CD_(56),CD_(10),Nestin,Vim,a1-ACT,EMA,AE1/AE3 and CK19) on 39 SPTs were studied.Results Pathological features included a combination of solid and cystic components with pseudopapillae formation and degenerative regions without glands.Among the 39 cases of SPTs,the expression rate of NSE was 97.4%,the expression rate of CD_(56),CD_(10) was 84.6%,the expression rate of Nestin and Vim was 64% and 87%,the expression rate of S100 was 79.5%,the expression rate of a1-ACT and a1-AT was 82.1% and 79.5%,while the expression rate of SYN was 12.8%;however there was low expression and weak positive reaction of EMA,AE1/AE3 and CK19.Conclusions The typical pathological characteristics of SPTs may result from gradual degenerative changes induced anoxemia in some SPT's areas.The heterogeneity of SPTs on different antibody markers showed that the SPTs may be originated from pancreatic embryonic stem cells,and result from immature differentiation of the pluripotential stem cells during pancreatic genesis.
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Objective To verify the diagnosis of the bacterial infections and to identify the pathogens, by PCR detection and bacterial endotoxin limulus test. Methods This study enrolled 50 patients receiving liver al-lografts from October 2005 to October 2007 in Ruijin Hospital. Peripheral blood samples were taken on DO, D1, D7 and D14. After preparation of the samples, PCR detection, bacterial endotoxin limulus test were performed. Results The sensitivity, specificity, and accuracy in the diagnosis was 66.7% ,95.0%, and 78.0% for the PCR, and 84.2%,83.9%,and 84.0% for limulus test respectively. It took 3 hours on average for the accomplishment of all these tests. Conclusions Positive PCR test plus negative limulus test suggest G+ infection, which may need the drugs targeting on G+ bacteria;positive PCR test plus positive limulus test, suggest G-infection or mixed infection, which may need drugs against the G-bacteria;negative PCR test, suggests the lack of severe infection. PCR test and limulus test were both remarkably faster than traditional cultural methods in diagnosis.
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OBJECTIVE:To create an in vitro harvesting method of culturing a large number of adult bone marrow MSCs(BMSCs) DESIGN,TIME AND SETTlNG:The randomized, controlled study was performed at the Shanghai Institute of Digestive Surgery (Key Laboratory of Education Committee of Shanghai City),as well as Department of General Surgery and Organ Transplantation Center,Ruijin Hospital,Medical College.Shanghai Jiao Tong University from September 2005 to April 2006.MATERIALS:Bone marrow samples were collected from normal persons.who did bone marrow examination at the Department of Hematology,Ruijin Hospital,Medical College.Shanghai Jiao Tong University.Donors were volunteers who signed the informed consent.METHODS:Human BMSCs were harvested using Pemoll gradient centrifugation and adherence method.and then incubated in microcarrier cytodex3.Common monolayer polystyrene was incubated as controls.Cell phenotype and proliferative activity were tested utilizing flow cytometry and MTT.MAIN OUTCOME MEASURES:Collection.incubation,morphology of human BMSCs.and prolireration and cell cycle of human BMSCs on the cytodex 3 were measured.RESULlTS:Flow cytometry detection showed that the surface marker of human BMSCs on the cytodex3 was ldentical to that on the common monolayer polystyrene;BMSCs were positive for CD29,CD44 and CD105.but negative for CD14,CD34,CD45,VLA-1 and HLA-DR.MTT detection demonstrated that human BMSCs were in the adaptive phase at days 1-3.and entered logarithmic phase frOm day 3.No significant difference was detected in human BMSCs on the monolayer polystyrene and cytodex3(P＞0.05).On the monolayer polystyrene,human BMSCs entered degenerating stage from day 6,whereas on the cytodex3,human BMSCs were still in the logarithmic growth phase at day 9(P＜0.05).Flow cytometry detection confirmed that the cell cycle of human BMSCs was the same both on the monolayer polystyrene and cytodex3 (P＞0.05). CONCLUSION:Using cytodex3 culture technique,a large amount of human BMSCs can be obtained,and the proliferative activity of these BMSCs is good.
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BACKGROUND: Presently, there is not an optimal cryopreservation protocol of the microcapsules, which has restrained the application of the microcapsules. OBJECTIVE: To investigate the characteristics of ice crystal and the morphology of alginate-chitosan-alginate (ACA) microcapsules cryopreserved at different solutions and different cooling rates, and to explore the optimal cryopreservationprotocol for ACA microcapsules. DESIGN, TIME AND SETTING: An observational study was performed at the Laboratory of Cryomicroecope in Shanghai University of Science and Technology (China) from February to April in 2008. MATERIALS: The high-voltage pulsing microcapsule shaping device was used to prepare ACA microcapsules.METHODS: The ACA microcapsules were preserved at different cooling rates (1 ℃/minute, 10 ℃/minute, 30 ℃/minute and 100 ℃/minute) by the cryomicroscopy system and then rawarmed at 50 ℃/minute. The protocols were repeated after the supplement of 10% dimethyl sulphoxide. MAIN OUTCOME MEASURES: The growth of ice crystals and the morphology of ACA microcapsules were checked at different cooling rates and in different solutions. The changes of forms and the rates of damage were checked after the microcapsules were rewarmed.RESULTS: The ice crystals grew into big crystals at the freezing process when the cooling rate was low than 10 ℃/minute and cryoprotector was not used. The growth of ice crystals would result in the distortion of microcapsules. It also could reduce the cryodamage of the microcapsules. The size of the ice crystals would grow down when raising the cooling rate and using thecryoprotector. The post-thaw ACA microcapsules were intact when dimethyl sulphoxide was used at a concentration of 10% and the cooling rate was higher than 30 ℃/minute (P ＜ 0.05). CONCLUSION: Mechanical damage occurs mainly during the growing of ice crystals at the time of microcapsules cryopreservation process. The growth of the ice could be restrained effectively by raising the cooling rate and using the cryoprotector.
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Objective To assess the volumetric variation of liver and spleen in early diagnosis of liver fibrosis and cirrhosis.Methods One hundred and thirty-seven subjects underwent dynamic enhanced examination of liver and spleen using multi-slice CT(MSCT).Forty potential living liver donors were served as controls.Sixty-three histologically proved fibrotic patients were divided into slight liver fibrosis(F≤2,n=44)and advanced liver fibrosis(F≥3,n=19)according to the Ishak system.Liver cirrhosis group consisted of 34 patients diagnosed clinically and radiologically.The measurement of total liver volume(TLV),right liver lobe volume(RV),left lateral liver segment volume(LLV),left medial liver segment volume(LMV),eaudate lobe volume(CV)and spleen volume(SV)were obtained bv MSCT.The ratios of segmental liver and SV to TLV were also calculated.Results The values of liver volumes(TLV,RV and LMV)reduced gradually among control(1470.38 cm3,933.34 cm3,216.20 cm3,respectively),slight liver fibrosis(1239.99 cm3,799.74 cm3,184.69 cm3,respectively),advanced liver fibrosis(1219.76 cm3,765.22 cm3,179.44 cm3,respectively)and cirrhosis(1078.21 cm3,543.73 cm3,163.12 cm3,respectively) groups.The volume of SV and the ratios of CV/TLV and SV/TLV increased gradually among control (256.29 cm3,3.09%,17.53%),slight liver fibrosis(284.41 cm3,3.20%,22.91%),advanced liver fibrosis(343.13 cm3,3.58%,28.80%)and cirrhosis(863.38 cm3,4.16%,82.91%)groups.There was significant difference among control,liver fibrosis and cirrhosis group in TLV,RV,LMV and SV/TLV(P＜0.05),but there was no significant difference in all parameters between the slight liver fibrosis group and the advanced liver fibrosis group(P＞0.05).There was significant correlation of TLV,LMV,SV,RV,CV/TLV,SV/TLV,RV/TLV and LLV/TLV with liver cirrhosis and its staging.Conclusion Variations in liver and spleen volume,the ratios of segmental liver and SV/TLV are correlated with the extent of liver fibrosis and cirrhosis.which will be helpful in early detection of liver fibrosis and cirrhosis.
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Objective To compare the two liver volume measurements using multi-slice spiral CT (MSCT)for clinical reference.Methods Twenty-four patients with hepatic disease awaiting orthotopic liver transplantation underwent muhiphase MSCT of the upper abdomen.Liver volumes using two measurements(manual volume measurement and semi-automated volume measurement)before transplantation were compared with the actual liver volume(ALV)measured during transplantation by means of water displacement.Both measurements were timed.Correlation coefficient.one way ANOVA and Bland-Altman tests were used for statistical analysis.Results The mean liver volume estimated with the manual method and the semi-automated method were(1360±157)cm3 and(1345±152)cm3.respectively.The actual liver volume was(1307±153)cm3.There was no significant diffierence between the volumes measured using the three methods(F=0.032,P＞0.05).For all the patients,there Was significant correlation between liver volume measured by MSCT and the actual liver volume.There was a good correlation between the liver volume measured by manual method and the actual liver volume(r=0.976,P＜0.05),so did the correlation between the liver volume measured by semi-automated method and the actual liver volume (r=0.987,P＜0.05).And the semi-automated method took much shorter time[(9.2±1.8)min]compared with the manual method [(23.2±5.8)min ].Conclusion Semi-automated method provided acceptable measurements for liver volume.
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Objective To study the clinical characteristics and diagnosis of the solid-psendopapillary tumor of pancreas (SPT).Methods The clinical data of 40 SPT from January 1996 to January 2008 were retrospectively analyzed. The average age was (32.9 + 13.6 )years. The average clinical course was (8.6±0.1) months.Clinical symptoms usually included distensible pains and secret anguish in abdomen (60.0%).No jaundice appeared in any case.Results The surgical resection was favorable for the treatment of SPT,which had excellent prognosis.No tumor recurrence were found in those following-up patients. Grossly,the cut surface showed areas of solid and papillary tissue,cystic degeneration,hemorrhage,and necrosis.Pathological features included a combination of solid and cystic components with pseudopapillae formation and degenerative regions without glands.Conclusions SPT has its uniquely clinical and pathological characteristics.Its main diagnosed points are helpful for clinical doctors to make timely diagnosis and reduce the rate of misdiagnosis and mistreatment.
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BACKGROUND: Hepatocyte/polymer interface with good biocompatibility is the key factor in bioreactor design andconstruction, however, bioreactor used in the clinical practice currently is not an ideal one.OBJECTIVE: To establish human hepatocyte compatible polypropylene interface and to lay a foundation for establishingbioartificial liver reactor with polypropylene hollow fiber.DESIGN, TIME AND SETTING: The comparative observation, cell compatibility experiment was performed betweenFebruary and October 2003 at Shanghai Jiao Tong University, Shanghai, China.MATERIALS: Polypropylene Photochemical graft polymerization modification technique was used to graft hydrophilicacrylamide groups on the surface of polypropylene membrane by chemical bonds to form modified polypropylenemembrane.METHODS: L02 human hepatoeytes were seeded on polypropylene membrane, modified polypropylene membrane andpolystyrene membrane, and polystyrene membrane was used as normal control.MAIN OUTCOME MEASURES: Static water contact angle of polypropylene membrane before and after graftmodification; morphology, adherent rate and proliferation activity of L02 human hepatocytes on different material surfaces.RESULTS: Static water contact angle after polypropylene membrane graft modification was smaller than that before graftmodification (P < 0.05). The adherent rate of L02 human hepatocytes on the surface of modified polypropylene membranewas 0, and the proliferation activity of them, which grew as spherical aggregates, was markedly higher than that of cells onpolystyrene membrane and polypropylene membrane without graft modification.CONCLUSION: Grafting polyacrylamide on the surface of polypropylene can establish good interface of L02 humanhepatocytes/polypropylene and form hepatocyte spherical aggregates through simple static culture.