Objective To explore the effects of selective external biliary drainage (SEBD) on the liver function of rats with obstructive jaundice. Methods The rates of right hepatic lobe weight against body weight of SD rats in SEBD group and total external biliary drainage (TEBD) group were calculated at day 0, 1, 4, 7, 10 after external biliary drainage. The mRNA and protein expressions of multidrug resistance-associated protein 2 (MRP2) and bile salt export pump (BSEP) were detected by RT-PCR and Western blot. Results Compared with TEBD group, the rate of right hepatic lobe weight against body weight and mRNA and protein expression of MRP2 and BSEP were significantly higher in SEBD group (t=15.569, P <0.05 ; t =4.485, 7.143, 9.169, 5.178, P <0.05). Conclusions SEBD improves the liver function of rats with obstructive jaundice, which may be related to the compensatory increase of remnant liver volume and elevation of expression per volume of membrane transport proteins.

Objective To systematically review the prognostic factors of intrahepatic cholangiocarcinoma (ICC) and clinical significance of abdominal lymphadenectomy.Methods PubMed was queried with the terms of intrahepatic cholangiocarcinoma,survival,surgery,lymph or vascular invasion to find all studies published from January 2005 to December 2015.Authors were contacted by letters for the publications that were initially ineligible due to insufficient information for data extraction,responses were received,so these publications were included.Data were analyzed and evaluated by 2 independent researchers.Prognostic factors of ICC (vascular invasion,bile duct invasion,lymphatic vessel invasion,lymph node metastasis and peripheral nerve invasion) and related-factors of surgical method (R0 resection and lymph node dissected) were analyzed.The 3-,5-year survival rate,tumor-free survival rate and effect of lymph node dissected for prognosis of patients were extracted.Heterogeneity was analyzed by the chi-squared test and I2 test.The hazard ratio (HR) and 95％ confidence interval (CI) were transformed to Log (HR) and standard errors (SE) Log (HR).HR and 95％ CI of clinical factors associated with outcomes were done using univariate COX regression models.Publication bias was evaluated by the Egger's method,visualizing with funnel plot.Results A total of 48 publications including 7 868 patients with ICC were eligible to be included in this analysis,12 of 48 publications were included in the Mata analysis.Of 7 868 patients with ICC,vascular invasion,bile duct invasion,lymphatic vessel invasion,lymph node metastasis,peripheral nerve invasion,R0 resection and lymph node dissected were detected in 30％ (5％-98％),40％ (11％-59％),45％ (35％-65％),28％ (9％-100％),25％ (7％-55％),79％ (35％-100％) and 64％ (9％-100％),respectively.The 3-,5-year survival rate and 3-,5-year tumor-free survival rate were 39％ (16％-65％),29％(5％-60％) and 34％ (3％-60％),23％ (0-52％),respectively.The results of meta-analysis showed that lymph node metastasis and vascular invasion were factors affecting the prognosis of patients with ICC (HR =2.30,1.92,95 ％ CI:1.94-2.73,1.64-2.25,P ＜ O.05).Among the patients without lymph node metastasis,5-year survival rate in patients with and without lymphadenectomy was 17％-64％ and 15％-64％,respectively,showing no statistically significant difference (P ＞ 0.05).Among the patients with lymph node metastasis,5-year survival rate in patients with and without lymphadenectomy was 48％ and 11％,respectively,showing a statistically significant difference (P＜0.05).Conclusions Lymph node metastasis and vascular invasion are the risk factors affecting the prognosis of patients with ICC.Routine lymphadenectomy for ICC cannot show survival benefit,while routine lymphadenectomy should be applied to patients with ICC and uncertain lymph node metastasis.

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Objective To investigate the clinical efficacy of laparoscopic hepatectomy.Methods The clinical data of 258 patients who received laparoscopic hepatectomy at the First Affiliated Hospital of Fujian Medical University from March 2010 to January 2013 were retrospectively analyzed.There were 196 patients with primary hepatic cancer,45 with hepatic hemangioma,13 with hepatic focal nodular hyperplasia,2 with hepatic metastatic cancer,1 with carcinoma of gallbladder and 1 with hepatic hamartoma.All patients were followed up via phone call or out-patient examination till March 2013.Results A total of 142 patients received single hepatic segmentectomy,98 received multiple hepatic segmentectomy,18 received multiple lesions resection.Fifty-one patients received hepatic tumorectomy + cholecystectomy.All the operations were successfully done under laparoscope without conversion to the open surgery.The mean tumor diameter and the operation time were (5 ± 3) cm (range,1.0-11.5 cm) and (113 ± 56) minutes (range,50-310 minutes),respectively.Intraoperative hepatic portal occlusion was performed on 122 patients,and the time for hepatic portal occlusion was (15 ± 7)minutes.The volume of intraoperative blood loss was (211 ± 195)mL (range,10-650 mL),and blood transfusion was not needed.The capsule of the tumor was complete.The distance between the resection margin and the malignant tumor was above 1.5 cm,and there was no residual tumor in the resection margin.The hepatic function was back to the normal level in 1 week after the operation,and no patient had hepatic failure.The duration of postoperative hospital stay was (7.2 ± 1.3)days (range,5-10 days).One patient was complicated with bile leakage,6 with slight peritoneal effusion,and other patients had no postoperative complications.The rate of follow-up was 91.47％ (236/258),and the time of follow-up was (16 ± 10) months.A total of 199 patients with malignant hepatic tumors were followed up.During the follow-up,180 patients had tumor-free survival; 18 patients had postoperative tumor recurrence; 1 patient had omental metastasis and received surgical resection.Thirty-seven patients with benign hepatic tumor survived without complication during the follow-up.Conclusion Laparoscopic hepatectomy is effective for the treatment of hepatic tumors.Multiple hepatic inflow occlusion under laparoscope in a short time may improve the safety of surgery,without prolonging the recovery time of patients.

Objective To investigate the correlated factors of pulmonary metastasis of hepatocellular carcinoma (HCC),so as to provide theoretical evidences for the prevention and treatment.Methods The clinical data of 862 patients with HCC who were admitted to the First Affiliated Hospital of Fujian Medical University from January 2008 to March 2012 were retrospectively analyzed.There were 107 patients with pulmonary metastasis.Factors including serum alpha fetoprotein (AFP) level,serum gamma-glutamyl transpeptidase (GGT) level,hepatitis B virus (HBV) infection,presence and treatment of intrahepatic tumor were analyzed to screen out relevant factors of pulmonary infection of HCC.Univariate and multivariate COX regression model analysis were performed for data analysis.Results The results of univariate analysis showed that high level of AFP (≥400 μg/L),ultra-high level of GGT (≥ 150 U/L),presence of HBV infection,the number of intrahepatic tumors ≥2,no radical resection (or radiofrequency ablation) for intrahepatic tumors,combining with tumor thrombi in the vessels,lymph node metastasis were risk factors of pulmonary metastasis of HCC (RR =1.986,3.653,0.365,3.675,0.252,0.379,0.352,P ＜ 0.05).The results of multivariate analysis showed that high level of AFP (≥400 μg/L),HBV infection,the number of intrahepatic tumors ≥2,no radical resection (or radiofrequency ablation) for intrahepatic tumors,combining with tumor thrombi in the vessels were risk factors of pulmonary metastasis of HCC (RR =2.391,3.462,3.425,3.396,2.418,0.638,P ＜ 0.05).Conclusions AFP ≥400 μg/L,HBV infection,the number of intrahepatic tumors ≥ 2,no radical resection (or radiofrequency ablation),tumor thrombi in the vessels and lymph node metastasis are risk factors of pulmonary metastasis of HCC.Anti-hepatitis virus treatment and early treatment are helpful for the prevention and treatment.

Background Artisan phakic intraocular lens (pIOL) implantation was demonstrated to be safe and effective for the correction of high myopia in short-term.However,long-term corneal endothelium status after operation should be concerned.Objective This study was to investigate the long-term changes of corneal endothelial cell density (ECD) and morphology following Artisan pIOL implantation for the correction of high myopia.Methods Fifty-one eyes of 27 patients who received Artisan PIOL implantation for high myopia from January 2005 to December 2008 were retrospectively analyzed.The central corneal ECDs were detected by corneal endothelial cell counter before surgery and 6 months and 1 year,2,3,4,5,6 years after surgery,and the coefficient of variation (CV) and standard deviation (SD) of cellular area were evaluated.ECD loss rate with time lapse was calculated ([preoperative ECD-postoperative ECD]/preoperative ECD× 100％).Results Six years after surgery,there were 34 eyes with BCVA ≥ 1.0,14 eyes with BCVA higher than preoperative and 8 eyes with BCVA lower than preoperative.The mean intraocular pressure was (14.23±2.14)mmHg 6 years postoperative.The preoperative mean ECD was (3 184.05±233.55)/mm2,and the ECD was gradually reduced over time with the cell loss 2.34％ in 6 months,5.32％ in 1 year,6.32％ in 2 years,8.06％ in 3 years,12.59％ in 4 years,15.63％ in 5 years and 19.49％ in 6 years after operation.Before surgery,The mean CV of cellular area was 37.17±7.12,and the SD of cellular area was 118.77±21.39,and those 6 years after surgery were 32.24 ±4.62 and 125.60± 18.49,respectively.The mean CV and SD of cellular area were significantly different among different time points (P =0.000,0.036).Eight eyes with localized iris depigmentation,6 eyes with IOL dyssymmetry,3 eyes with transient high intraocular pressure and 2 eyes with Macular hemorrhage were obtained after surgery.Conclusions Corneal endothelial cells appear obvious changes in both number and morphology after Artisan pIOL implantation in high myopia.ECD is gradually reduced with time lapse,and the shape of the cells occur remodeling during 6-year fellow-up duration.Overall,endothelial specular microscopy is mandatory before and after surgery for a long term.

Objective To investigate the effects of vascular endothelial growth factor receptor-1(VEGFR-1) in the invasion and metastasis of hepatocellular carcinoma(HCC)by detecting the expression of VEGFR-1 in HCC tissues.Methods Paraffin-embedded tissue which containing HCC tissues and adjacent tissues were prepared from patients(n=82)with HCC,then were analyzed by immunohistochemical technique for the expression of VEGFR-1,epithelial marker E-cadherin and mesenchymal marker Vimentin.The relationship between the expression of VEGFR-1 and pathological parameters,and the correlation between VEGFR-1 and E-cadherin,VEGFR-1 and Vimentin were analyzed.Results The expression rates of VEGFR-1 in HCC tissues and adjacent tissues were 89%(73/82)and 0,respectively.The difference of VEGFR-1 expression in portal vein tumor thrombus,tumor capsule,stage,size and differentiation grade of tumor had statistical significance(x2=22.192,15.934,16.751,20.154,6.487,P＜0.05).The expression of VEGFR-1 had effect on the 1-,2-year recurrence rate and 2-year survival rate (x2=0.983,0.958,0.847,P＜0.05),but not on 1-year survival rate(x2=0.359,P＞0.05).The expression of VEGFR-1 was negatively correlated with that of E-cadherin(r=0.765,P＜0.01)but positively with that of Vimentin (r=1.469,P＞0.05).Conclusions VEGFR-1 may play an important role in invasion and metastasis of HCC.Epithelial-mesenehymal transition that induced by VEGFR-1 may contribute to the invasion and metastasis of HCC.

Objective To observe the effects of hepatic artery reconstruction in rat with orthotopic liver transplantation(OLT)on ultrastructure changes of intrahepatic biliary epithelial cells after ischemia reperfusion iniury and postoperative biliary complications. Methods Male SD rats were divided into sham operation group (SO),OLT with hepatic artery reconstruction group(HA)and OLT without hepatic artery reconstruction group (NA).The liver tissue samples were collected at 0.5,3,6,12,24,36,48 hours after ischemia reperfusion in both HA grouD and NA group.The uhrastructure of intrahepatic biliary epithelial cells was observed by transmission electron microscope,and the morphometric analysis by the computer image analysis system.The postoperative biliary complications were also observed.Results In HA group and NA group,the injury of intrahepatic biliary epithelial cells aggravated gradually along with the reperfusion.The uhrastructure changes,such as enlarged mitochondria,blurred or disappeared cristae and decreased number of microvilli,were most significant at 24 hours and then recovered gradually.The mitochondrial average area and average perimeter were increased and the mitochondrial numerical densitv was decreased gradually along with the reperfusion.At 24,36,48 hours,the mitochondrial average area and average perimeter in NA group were significantly greater than those in HA group(t=-3.566,-7.780,-4.730,-4.610,-2.599,-5.730,P＜0.05).The average numerial density of mitochondia in NA group was significantly less than that in HA group at 36,48 hours(t=-4.619,4.000,P＜0.05).The incidence rate of biliary complications in HA group is significantly lower than that in NA group(x2=4.286,P＜0.05).Conclusions Hepatic artery reconstruction in rat with OLT has an protective effect on the uhrastructure of intrahepatic biliary epithelial cells after ischemia reperfusion.It is beneficial to the recovery of intrahepatic bile duct epithelial cells and can reduce the incidence rate of biliary complications.

Objective To explore the effects of combined infusion of Treg cells from recipient rats and imDCs from donor rats prolonging the survival time of rats undergoing allogeneic orthotopic liver transplantation.Methods One hundred cases of rat allogeneic orthotopic liver transplantation were performed by using modified two-cuff method: DA rats served as donors,and Lewis rats as recipients,which were divided into 5 groups: acute rejection group,mDC group,imDC group,Treg group,co-infusion group (imDC-Treg group).2 × 106 imDC,2 × 106 mDC and 1 × 107 Treg cells were respectively injected to Lewis rats in every group via caudal vein before transplantation.Four Lewis rats from each group were randomly sacrificed on the day 3,7 and 10 after transplantation.Liver function (ALT and TBIL) and changes of cytokines (IL-10,IL-2 and TGF-β) were evaluated in peripheral blood.The pathological changes of the liver graft were observed.The DNA fragmentation characteristics of apoptosis in the liver were detected by using TUNEL staining.Survival analysis was performed on remnant rats.Results The liver function in imDC-Treg group had reverted to normal faster than that in the control groups.ELISA revealed that at day 7,the serum levels of IL-10 and TGF-β were higher,and the serum levels of IL-2 were lower in imDC-Treg group.Liver pathology demonstrated that there was only a slight number of mononuclear cell infiltration in hepatic graft afterorthotopic liver transplantation in co-infusion group (imDC-Treg group),which belonged to a nonidentified or slight type of acute rejection,and the liver graft showed regeneration of hepatocytes along with a small number of neutrophile granulocyte infiltration at the day 10.TUNEL staining indicated that the number of apoptotic T cells was much less in control groups than in imDC-Treg groups.The survival time of recipients in Treg-imDC group was 37 days,significantly longer than in irnDC group (23 days) and Treg group (15 days).Conclusion Infusion of imDC from donor rats or Treg from recipient rats alone couldn't induce long-term allograft survival of recipients after allogeneic rat liver transplantation.The co-infusion of Treg and imDC significantly prolonged the survival time of rats subject to allogeneic liver transplantation.

Objective To calculate the residoal liver volume using a virtaal liver surgery planning system,and to investigate the value of standardized estimated liver remnant volume ratio (STELR) in prcdicting hepatic dysfunction after hepatectomy.MethodsThe clinical data of 76 patients with primary liver cancer who were admitted to the First Affiliated Hospital of Fujian Medical University from April 2007 to October 2011 were retrospectivcly analyzed.The virtual resection and residual liver volume measurements were carried out using Liv 1.0 software.The value of STELR in predicting hepatic dysfunction was assessed using receiver operator characteristic (ROC) curves.Effects of different risk factors on postoperative hepatic dysfunction were analyzed using univariate analysis of variance and multivariate Logistic regression models. Results The mean residual liver volumes predicted by the software and resected during operation were (489 ± 206)ml and (459 ± 199 )ml,respectively,with a positive correlation between predicted and actual resection volumes (r =0.916,P ＜ 0.05).Of the 76 patients,48 had mild hepatic dysfunction,19 had moderate hepatic dysfunction and 9 had severe hepatic dysfunction.A critical STELR of 53％ was associated with severe hepatic dysfunction.Severe hepatic dysfunction was detected in 2 out of 59 (3％) patients with STELR ≥ 53％ and 7 out of 17 (41％) patients with STELR ＜ 53％,which represented a significant difference ( x2 =5.085,P ＜ 0.05 ).The result of univariate analysis revealed that STEL,R,operating time,intraoperative blood loss were significant prognostic indicators for severe hepatic dysfunction ( F =7.227,8.630,13.809,P ＜0.05).Multivariate Logistic regession revealed that STELR was a significant independent predictor of severe hepatic dysfunction ( Wald =6.675,P ＜ 0.05 ).Conclusion The likelihood of severe hepatic dysfunction after hepatectomy can be predicted by STELR.