The use of laparoscopic liver resections for benign and malignant diseases has spread worldwide.As in open liver surgery,anatomical orientation and the ability to control intraoperative challenges as bleeding have to be combined with expertise in advanced laparoscopic techniques.We provide an overview regarding the literature on laparoscopic liver resection for benign and malignant liver tumors with the aim to discuss the current standards and define remaining challenges.Laparoscopic liver resection is feasible and safe in selected patients and experienced hands.The minimal invasive approach offers benefits in perioperative shortterm outcome without compromising oncological outcomes compared to open liver resections.Further randomized trials are needed to formally prove these statements and to define the optimal indication and techniques for the individual patient.

Objective To observe the clinical efficacy of traditional Chinese medicine foot bath combined with Xueshuantong injection in the treatment of diabetic peripheral neuropathy.Methods Sixty patients with diabetic peripheral neuropathy(DPN)were randomly divided into two groups.According to the patients' condition,oral hypoglycemic drugs or insulin were used to control blood glucose.The control group was treated with Xueshuantong injection on routine nutrition nerve program.In the conventional nutrition nerve program based on the use of traditional Chinese medicine foot bath combined with Xueshuantong injection treatment,2 groups were treated after 10 days to evaluate the efficacy.Results The total effective rate of the observation group and the control group was 90％and 66.7％respectively.The sensory and motor function of the observation group were significantly improved after the treatment group,and the blood rheology and serum endothelin level were significantly decreased.Conclusion Chinese medicine foot bath combined with Xueshuantong injection for the treatment of diabetic peripheral neuropathy.

Objective To evaluate the biomechanical effect of cortical screw support technique in fixation of the femoral neck fractures. Methods The models of subcapital femoral neck fracture were made in eight matched pairs of embamled cadaver femurs and decided into experiment group and control group (four pairs per group). The side of experiment group was fixed using three cannulated compression screws with cortical screw support and that of control group with conventional screw placement. The speci-mens in two groups were tested in aspects of torsion and axial loading. Results In axial load test at load of 600 N and 800 N, the displacements in cortical screw support group were (0.677±0.135) mm and (0.907±0.132) mm respectively, while those of femoral head in conventional screw placement group were (0.899±0.160) mm and (1.202±0.152) nun respectively (P <0.05). There was signifi-cant difference between the two groups (P < 0.05). The maximal vertical loading for failure of the fixa-tion was (2 782±228) N in cortical screw support group and (1 950±281) N in conventional screw placement group (P < 0.01). In torsibility test at 4° and 6° torsibility, the torque-moments of cortical screw support group were (10.406±1.515) Nm and (15.328 ±1.471) Nm respectively and those of conventional screw placement group (6.628±1.163) Nm and (9.072±1.570) Nm respectively, with statistical difference between two groups (P <0.01). The maximal torque-moment for failure of the fixa-tion was (25.437±5.213) Nm in cortical screw support group and (13.235±3.012) Nm in conven-tional screw placement group (P < 0.01). Conclusion Fixation of femoral neck fractures by using cortical screw support can significantly enhance anti-torsion and anti-compression of internal fixation.

OBJECTIVETo investigate the role of natural killer T cells (NKT) in the pathogenesis and staging of endometriosis (EMT).

METHODSSixty EMT cases of stages I to IV were enrolled as the observation group, and 20 healthy volunteers served as the control group. NKT percentages in the peripheral blood and peritoneal effusions were detected by flow cytometry, and the levels of interferon-γ (IFN-γ) and interleukin-4 (IL-4) were examined using ELISA.

RESULTSCompared with the control group, EMT group showed significantly lowered NKT percentages and IFN-γ and IL-4 levels in both the peripheral blood and peritoneal effusions (P<0.05). In EMT patients, NKT percentages, IFN-γ and IL-4 levels all increased significantly with the stage of EMT in the order of I>II>III>IV (P<0.05). Spearman correlation analysis showed that NKT, IFN-γ and IL-4 were all inversely correlated with the stage of EMT (r>0.06, P<0.05).

CONCLUSIONAs a protective factor against EMT, NKT, together with its cytokines IFN-γ and IL-4, play an important role in EMT and is closely correlated with EMT staging.

Case-Control Studies ; Endometriosis ; metabolism ; pathology ; Female ; Flow Cytometry ; Humans ; Interferon-gamma ; blood ; Interleukin-4 ; blood ; Natural Killer T-Cells ; metabolism

The percutaneous transhepatic portal approach is the most commonly used technique for islet transplantation, largely owing to its safety and minimally invasive characteristic. Bleeding complications after islet transplantation are rare. A case of type 1 diabetes mellitus (T1DM) was treated in Tianjin First Center Hospital, who had a massive intra-abdominal hemorrhage after percutaneous transhepatic portal vein catheterization for islet transplantation. Through the review of the overall development of the case, we aim to improve the awareness of the complications of islet transplantation, to reduce the incidence of complications after percutaneous transhepatic portal vein transplantation, and to provide experience.

Objective To study the clinical treatment and prognosis of de novo liver cancer following renal transplantation.Methods The clinical data of 15 patients who developed de novo liver cancer after renal transplantation carried out prior to treatment of liver cancer at the First Center Hospital of Tianjin between June 2006 and June 2016 were retrospectively studied.These patients were diagnosed to have liver cancer ranging from 23 to 98 months after renal transplantations,with an average of (42.5 ± 29.7) months.Two patients were diagnosed within 2 years,7 within 5 years,and 6 over 5 years after renal transplantation.Results Three patients underwent transcatheter arterial chemoembolization (TACE) and 12 patients underwent surgical resection which included right/left hemihepatectomy (n =5),hepatic segment resection (n =4),and tumor enucleation (n =3).Postoperative histopathology confirmed hepatocellular carcinoma in 8 patients,cholangiocarcinoma in 1 patient,and mixed liver cancer in 3 patients.Among the 12 patients who initially underwent'curative'surgery,3 patients died from recurrent cancer 8,16,25 months after surgery,respectively.The remaining 9 patients were still alive with a follow-up which ranged from 0.6 to 65-month.The 3 patients who underwent TACE were alive for 4,7 and 13 months,respectively.Conclusions De novo liver cancer were usually asymptomatic and had a rapid onset.The optimal clinical management which includes early diagnosis,appropriate therapy with immunosuppression and renal function preservation can result in good long-term survival.

Objective To probe the correlation between preoperative pulmonary dysfunction and postoperative pulmonary complications in patients of orthotopic liver transplantation. Methods From August 2008 to June 2009, 71 orthotopic liver transplantation patients were studied. Preoperative pulmonary function and its relationship with postoperative pulmonary complications were analyzed.Results Preoperatively 65 out of 71 patients had abnormal lung functions, suffering from pulmonary diffusing capacity reduction (65 cases, 91.5% ), followed by reduction of restrictive ventilation function (30 cases, 42. 2% ), small airway function reduction ( 28 cases, 39.4% ), and obstructive ventilatory function reduction (21 cases, 29. 6% ). The incidence of postoperative pulmonary complications was 56. 3% including: pulmonary atelectasis, pneumonia, acute respiratory failure. The incidence of posttransplantation pulmonary complications in patients with pulmonary restrictive or obstructive ventilation function reduction was higher than in normal group (x2 = 6.703, P= 0.010; x2 = 4.768, P = 0.029), and there was significant difference in pulmonary complication rate between groups of moderate and severe diffusing capacity reduction and mild reduction and normal range (x2 = 8.478, P = 0.004 ).Conclusions Preoperative pulmonary function abnormality in patients before liver transplantation such as pulmonary ventilatory function reduction (VCmax ＜ 80% or FEV1.0 ＜ 80% ) and moderate to severe pulmonary diffusing capacity reduction (TLCOSB ＜ 60% ) predicts higher incidence of postoperative pulmonary complications.

OBJECTIVETo study the therapeutic effects of Qianggan Capsule (QC) combined Lamivudine on hepatic fibrosis in patients with chronic hepatitis B.

METHODSEighty-five patients were randomly divided into two groups, group A (40 cases) were treated with QC and Lamivudine and group B (45 cases) were treated with QC alone both for 6 months. Hepatic fibrosis related indexes and pathologic examination of liver biopsy were performed within 3 months before treatment and in 1 month after treatment.

RESULTSSerum levels of hyaluronic acid, collagen N and laminin decreased markedly after treatment in both groups (P < 0.05). Hepatic histopathological examination showed that the total effective rate of impovement in activity of inflammation-necrosis and fibrosis was 80.0% and 70.0% in group A, 57.8% and 75.6% in group B, respectively, the combined treatment showed a better effect in improving the activity of inflammation-necrosis than QC alone (P < 0.05), but with no significant difference to the latter in improving fibrosis.

CONCLUSIONQC combined Lamivudine could markedly reduce the activity of hepatic inflammation-necrosis, QC alone could also improve hepatic fibrosis.

Adult ; Capsules ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hepatitis B, Chronic ; complications ; drug therapy ; Humans ; Lamivudine ; therapeutic use ; Liver ; drug effects ; pathology ; virology ; Liver Cirrhosis ; drug therapy ; etiology ; Male ; Middle Aged ; Phytotherapy ; Reverse Transcriptase Inhibitors ; therapeutic use ; Treatment Outcome

OBJECTIVETo study the therapeutic efficacy of Qianggan Capsule (QC) in treating patients Seventy pa-with chronic hepatitis B fibrosis from the pathological aspect and serum fibrosis markers.

METHODSpatients with chronic hepatitis B were randomly assigned to two groups, the treated group (45 cases) and the control group (25 cases). QC was given to patients in the treated group, while glucurone and compound vitamin B were given to those in the control group. The therapeutic course for both groups was 6 months. The therapeutic effect was assessed by determination of fibrosis markers including serum levels of platelet-derived growth factor-BB (PDGF-BB), transforming growth factor beta 1 (TGF-beta1), matrix metalloproteinases-1 (MMP-1), tissue inhibitors of metalloproteinases-1 (TIMP-1) and serum levels of alanine transaminase (ALT), total bilirubin (TBIL), albumin (ALB), and prothrombin time (PT) were completed 1 month before treatment and at the end of the trial respectively.

RESULTS(1) Serum levels of ALT, TBIL, PT decreased obviously and the serum ALB level obviously increased in both groups (all P<0.05), showing no significant difference between the two groups (P>0.05). (2) Hepatic fibrosis markers: Serum levels of PDGF-BB, TGF-1P3, and TIMP-1 significantly decreased, and serum MMP-1 level markedly increased in the treated group more than before treatment (all P<0.05). No significant difference was shown between before and after treatment in each index of the control group (P>0.05). Serum levels of PDGF-BB, TGF-beta1, and TIMP-1 were obviously lower and the serum MMP-1 level was obviously higher in the treated group than in the control group after treatment (all P<0.05). (3) Hepatic histopathological results: The hepatic inflammatory necrosis activity and the hepatic fibrosis degree in the treated group were significantly improved (P<0.05), with the total effective rate of the hepatic necrosis activity improvement being 40.00% and that of the hepatic fibrosis degree being 57.78%. But there was no obvious improvement in the hepatic inflammatory necrosis activity or the hepatic fibrosis degree in the control group (P>0.05).

CONCLUSIONSQC could effectively improve serological indices and pathological indices of chronic hepatitis B fibrosis patients, showing better therapeutic effect in reversing hepatic fibrosis and alleviating hepatic inflammatory necrosis.

Adolescent ; Adult ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Hepatitis B, Chronic ; blood ; drug therapy ; pathology ; Humans ; Male ; Matrix Metalloproteinase 1 ; blood ; Middle Aged ; Phytotherapy ; Proto-Oncogene Proteins c-sis ; blood ; Tissue Inhibitor of Metalloproteinase-1 ; blood ; Transforming Growth Factor beta1 ; blood ; Young Adult

Objective To evaluate the indications and results of liver transplantation ior benign liver tumors.Methods From Jan 2001 to Dec 2014,16 patients of inoperable severely symptomatic benign liver tumors underwent liver transplantation in our department.There were 10 cases of polycystic liver disease,2 cases of hepatic epithelioid hemangioendothelioma,1 case of hepatic cavernous hemangioma,1case of liver mesenchymal hamartoma,1 case of hilar bile duct mucinous cystadenoma,1 case of hepatic adenoma.Results 3 cases were dead in the perioperative period.The remaining patients were alive and discharged with normal perioperative liver and kidney function.One case of polycystic liver lost to follow-up,the remaining 12 patients were all alive at the end of a follow-up of 17 to 161 months,with fully active life style.Conclusions Liver transplantation is an effective and sometimes the only treatment option for unresectable and symptomatic benign liver lesion.