Objective To investigate the location and ultrastructure of hepatic stem cells in adult rat. Methods Proliferation of hepatic oval cell of the rat was accomplished. Identification was made with immunohistochemistry with CK18, 19 and CD34 as markers. Ultrastructure of hepatic stem cells was observed with transmission electron microscope. Results The majority of hepatic oval cells were localized in the Hering channel, but some of them were distributed in the hepatic lobules. Electron microscopy revealed three types of oval cells. TypeⅠ cell was small, 7?m in size, with large nucleus but small amounts of cytoplasm and organelles. The cell was recognized as primitive oval cell. Type Ⅱ cell was larger, measuring 8?m in diameter, containing more cytoplasm and organelles. Type Ⅲ cells were larger than both of above cells, and they contained more organelles. Conclusion Hepatic oval cells in adult rat are localized in Hering channel, and they may be stem cells hepatocytes.

Objective To research the possibility of the rat mesenchymal stem cells (MSCs) to differentiate into hepatocyte-like with hepatocyte growth factor plus E growth factor in vitro. Methods (1) Bone marrow in the femurs of Wistar rat was collected by flushing under sterile condition. MSCs were separated and cultured according to the direct anchoring method, identified by using immunocytochemical methods and flow cytometry. After MSCs were induced by HGF (20mg/ml) and EGF (10mg/ml), mRNA expression level of AFP、Alb、CK-18 in the MSCs were detected by RT-PCR. In addition, ultrastructures in the cells induced were observed using electron microscope. Results Anchored MSCs is single or cell clone is developed. Cell is uniform in the configuration and converged long fusiform after 7-10 days. Cultured cells are certified to be MSCs in the immunocytochemistry and flow cytometry. Afer 21 days, cultured cells show Hepatocyte-like characters in the configuration. RT-PCR:On day 7 mRNA of AFP was detected; mRNA of Alb and CK-18 were detected at the beginning, then strengthen on 21 day. At the same time, induced cells in the electron microscope results coincided with hepatic cells. Conclusions MSCs can be isolated, cultured and expanded easily in vitro. MSCs induced by HGF plus EGF in vitro can differentiate into hepatocyte-like cells. As a result, it can provide a new therapeutic method for liver failure.

This study was designed to explore the treatment effect of imperatorin(Imp)on chronic endometritis(CE)and the possible mechanism.A rat model of CE was established by injecting phenol gel into the ovary and was grouped into CE group,Imp low dose group(ImpL group,5 mg?kg-1?d-1),Imp high dose group(ImppH group,10 mg?kg-1?d-1),and ImpH+lipopolysaccharide(LPS,10 mg/kg)groups,while sham-treated rats were grouped as control group(CT group).Uterine organ index of all groups were measured;hematoxylin eosin(HE)staining was applied to observe the pathological changes of uterine tissue;immunohistochemistry was applied to detect the expression of vascular endothelial growth factor(VEGF)in the endometrium;ELISA was used to measure the levels of serum IL-6 and TNF-α;RT-qPCR and Western blot were applied to verify the expression of IL-1β,nuclear factor-κB(NF-κB),NOD-like receptor protein 3(NLRP3),and matrix metalloproteinase(MMP)-9 in uterine tissue.Compared with the CT group,the uterus and vagina of the CE group were swollen and congested,and the expression of VEGF in the endometrium was decreased(P<0.05),the levels of IL-6 and TNF-α in serum and the expressions of IL-1β,p-NF-κB/NF-κB,NLRP3,and MMP-9 in uterine tissue were increased(P<0.05).Imp could reverse these pathological changes mentioned above in CE model,while LPS was able to partially suppress the improvement effect of ImpH on CE rats.In conclusion,Imp may have a certain therapeutic effect on CE by inhibiting the activation of NLRP3 inflammatory pathway.

Objective To explore the clinical application value of three-dimensional visualization of blood vessels as the axis and virtual reality technology in giant liver cancer.Methods Thin-layer CT image data of 13 patients who were diagnosed as giant primary liver cancer were collected for three-dimensional reconstruction,and then transformed into VR model.The anatomical relationship between the tumor and its surrounding important structures was analyzed.The preoperative evaluation,classification and surgical planning based on blood vessels as the axis were carried out to guide intraoperative navigation.The consistency was verified by the intraoperative rapid pathological examination.Results 13 patients successfully achieved 3D reconstruction and VR model transformation.According to the 3D visualization classification of blood vessels as the axis.There were three cases of type Ⅰ a grade 1,two cases of type Ⅰa grade 2;one case of type Ⅱ a grade 2;one case of type Ⅱ b grade 3;two cases of type Ⅱ c grade 3;four cases of type Ⅱ a grade 3.Conclusions Three-dimensional visualization and VR technology can provide comprehensive information on the anatomical structure of liver cancer lesions and blood vessels,which is of great value in the application of giant liver cancer surgery.

Objective To investigate the clinical efficacy of three-dimensional visualization technique (3DVT) combined with enhanced recovery after surgery (ERAS) in the treatment of hepatolithiasis.Methods The retrospective cohort study was conducted.The clinicopathological data of 64 patients with hepatolithiasis who were admitted to Zhujiang Hospital of Southern Medical University from November 2015 to August 2018 were collected.There were 17 males and 47 females,aged from 30 to 82 years,with a median age of 55 years.Of the 64 patients,23 who completed preoperative assessment and planning using 3DVT,and furthermore received ERAS for perioperative management were divided into 3DVT + ERAS group,and 41 who received preoperative assessment merely under the guidance of 3DVT,combined with conventional perioperative management were divided into 3DVT + conventional group.Observation indicators:(1) preoperative CT and 3DVT assessment;(2) perioperative conditions;(3) follow-up.The follow-up was conducted by outpatient service,e-mail or telephone interview to detect the postoperative recurrence of hepatolithiasis up to March 2019.The measurement data with normal distribution were expressed as Mean±SD,and the t test was used for comparison between groups.The measurement data with skewed distribution were expressed as M (P25,P75),and the Mann-Whitney U test was used for comparison between groups.The count data were expressed as absolute numbers or percentages,and the comparison between groups was pedormed using the chi-square test or Fisher exact probability.Results (1) Preoperative CT and 3DVT assessment:23 patients in the 3DVT + ERAS group underwent preoperative CT examination and 3DVT assessment,the consistency between CT results and intraoperative findings was 91.3％ (21/23),and the consistency between 3DVT results and intraoperative findings was 95.7％(22/23).Fourty-one patients in the 3DVT + conventional group underwent preoperative CT examination and 3DVT assessment,the consistency between CT results and intraoperative findings was 90.2％ (37/41),and the consistency between 3DVT results and intraoperative findings was 95.1％ (39/41).(2) Perioperative conditions:the volume of intraoperative blood loss,duration of postoperative hospital stay,postoperative total bilirubin,postoperative direct bilirubin,postoperative albumin,postoperative alanine aminotransferase,postoperative aspartate aminotransferase and postoperative hemoglobin were 50 mL (10 mL,100 mL),8 days (7 days,9 days),12 μmol/L (9 μmol/L,16 μmoL/L),6 μmol/L (4 μmoL/L,8 μmol/L),(37±4)g/L,44 U/L (18 U/L,85 U/L),32 U/L (20 U/L,65 U/L),(117±18)g/L in the 3DVT + ERAS group,and 100 mL (50 mL,300 mL),13 days (10 days,16 days),17 μmol/L (12 μmoL/L,33 μmoL/L),11 μmoL/L (7 μmoL/L,21 μmol/L),(29±6)g/L,78 U/L (43 U/L,122 U/L),121 U/L (72 U/L,176 U/L),(106±13)g/L in the 3DVT + conventional group,respectively;there were significant differences between two groups (Z =-3.084,-4.827,-2.953,-3.632,t =5.261,Z=-2.960,-4.625,t =2.773,P＜0.05).Two patients had pulmonary infection and 2 had pleural effusion in the 3DVT + ERAS group,and all the 4 patients were cured after treatment.One case of biliary fistula,4 cases of pulmonary infection and 5 cases of pleural effusion occurred in the 3DVT + conventional group,and these patients were cured by adequate abdominal drainage,antibiotic therapy and thoracocentesis,respectively.There was no perioperative death in either group.(3) Follow-up:64 patients were followed up for 6-36 months,with a median time of 23 months.During the follow-up,no recurrent hepatolithiasis in the 3DVT + ERAS group,and 1 case of recurrent hepatolithiasis was confirmed by ultrasound in the 3DVT + conventional group.No cholangiocarcinoma occurred in either group.Conclusion The combination of 3DVT and ERAS is effective,safe and feasible in the management of hepatolithiasis,which can accelerate the postoperative recovery of liver function,thus enhancing perioperative recovery and improving the prognosis of patients simultaneously.

Objective To explore the strategies of using psychological crisis intervention in public emergencies.Methods In the early stage,psychological crisis intervention concepts and behavioral responses were formed through literature research and qualitative research methods.Use three rounds of Delphi for expert advice.Three indexes including positive coefficient,authority and coordination were used to test the reliability of expert consultation.Results Overall,it passed 239 out of 269 entries.The first round passed item 210,modified item 18,no consensus item 41;In the second round,8 new entries were added,and 22 entries were deleted through 24 entries.In the third round,there were 5 entries and 16 entries were deleted.The authority coefficient was 0.859,indicating that the experts were very familiar with the items.The coordination coefficient of three rounds of consultations were 0.464,0.696,and 0.407 (P＜0.001)respectively,showing that the coordination degree of experts was excellent,the credibility of feedback was high,and results were highly reliable.Conclusions The strategies of field psychological crisis intervention for public emergencies developed in this study received the consensus by domestic psychological crisis intervention experts,it is will provide a basis for systematic,comprehensive and effective guidance for this work.

Objective To explore the application value of three-dimensional visualization technology in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Methods Clinical data of one patient with hepatocellular carcinoma (HCC) undergoing ALPPS using three-dimensional visualization technology were analyzed retrospectively. The patient was female, aged 44 years, was hospitalized due to transaminase elevation for 3 months and solid hepatic lesion for 3 d. She had a history of hepatitis B. She was diagnosed with massive HCC in the right liver lobe. The informed consents of the patient was obtained and the local ethical committee approval was received. Preoperative evaluation and surgical planning were performed using computer tomography (CT) scan and medical imaging three-dimensional visualization system (MI-3DVS). Results Total liver volume was 1 033 ml and the left lobe volume was 195 ml, accounting for 16%of the standard liver volume measured by three-dimensional visualization technology before the ifrst-stage surgery. The right branch of portal vein was ligated and the left and right liver lobes were separated. Total liver volume was 1 048 ml and the left lobe volume was 394 ml, accounting for 33%of the standard liver volume measured by three-dimensional visualization technology 3 weeks after surgery. Right hemihepatectomy was performed during the second stage. The ifndings of preoperative three-dimensional visualization technology were consistent with intraoperative observation. Preoperative surgical planning was in accordance with intraoperative procedures. No apparent complication was observed after surgery. Conclusion Three-dimensional visualization technology is a favorable supplementary option for ALPPS in making the preoperative precise diagnosis and detailed surgical planning.

Objective To explore the application value of three-dimensional visual (3DV) assessment and virtual reality (VR) study of type Ⅲ and Ⅳ hilar cholangiocarcinoma with portal vein as the axis.Methods The CT image data of 10 patients who were diagnosed as Bismuth type Ⅲ and Ⅳ hilar cholangiocarcinoma by B-ultrasound and CT in Zhujiang Hospital,Southern Medical University were imported into 3D visualization system (3DVS) for 3D image reconstruction,and the portal vein was used as the axis for 3DV analysis and evaluation.The 3D data were then imported into the VR development engine to perform VR research,so as to help the operation planning.Both of the image data were taken into the operation room for intraoperative navigation.Results 10 patients completed 3D visualization reconstruction and VR model transformation.According to the 3D visualization of hepatic hilar hepatocarcinoma,there were 1 case of type Ⅱ,2 cases of type Ⅲa,5 cases of type Ⅲb,1 case of type Ⅳa and 1 case of type Ⅳb.The portal vein was classified according to Cheng type:6 cases of type Ⅰ,3 cases of type Ⅱ,and 1 case of type Ⅲ.The hepatic artery was classified according to Michels type:5 cases of type Ⅰ,1 case of type Ⅱ,3 cases of type Ⅲ,and 1 case of type Ⅸ.The 3DV assessment and VR study were almost consistent with the intraoperative findings.No liver failure or death occurred during the perioperative period.Conclusion The 3DV assessment and VR study with the portal vein as the axis have potential application for the surgical treatment of type Ⅲ and Ⅳ hilar cholangiocarcinoma.

Objective: To explore a novel method for preoperative precision assessment of centrally located hepatocellular carcinoma(HCC) with blood vessel as axis based on three-dimensional(3D) visualization and virtual reality(VR) technology and its application values. Methods: High-quality thin-layer enhanced CT data were collected from 20 patients with centrally located HCC who treated at First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University from March 2017 to August 2018 diagnosed by preoperative examination. There were 18 males and 2 females, aged 28 to 69 years, all of Child-Pugh grade A. First of all, 3D reconstruction was performed by a 3D visualization software; then, the reconstructed 3D image was imported into VR development engine for VR research; afterwards, the analysis and evaluation system with blood vessel as axis was established based on 3D visualization classification of centrally located HCC; therefore, the relationship of the tumor to its major peripheral blood vessels was accurately judged and the surgical planning was formulated. Two images were brought into the operating room for navigation in surgery. The assessments results of preoperative data (CT and (or) MRI) and three-dimensional visualization of blood vessels in VR environment were compared; the values of the preoperative and postoperative hemoglobin, serum albumin and bilirubin were recorded and compared. Chi-square test, t-test and non-parametric test were used for the analysis of counting data, continuous measurement data and non-normal distribution measurement data, respectively. Results: 3D visualization modeling was completed in all of the 20 patients with centrally located HCC. According to the results of 3D visualization classification of centrally located HCC, there were 3 cases of type Ⅰ,1 case of type Ⅱ,4 cases of type Ⅲ,7 cases of type Ⅳ and 5 cases of type Ⅴ; according to the assessment and classification based on blood vessel as the axis, there were 6 cases of type Ⅰa,2 cases of type Ⅰb,2 cases of type Ⅱa,9 cases of type Ⅱb and 1 case of type Ⅱc. All patients underwent successful resection of tumor under the guidance of 3D visualization and VR technology. There were 15 cases whose assessment results based on preoperative CT/MRI were consistent with intraoperative findings, with a coincidence rate of 75.0%(15/20); while in VR environment, the assessment results of 3D visualization with blood vessel as axis were all consistent with the intraoperative findings, with coincidence rate of 100%(20/20). There was a statistically significant difference between the groups (χ²=5.714, P=0.017). There was no red blood cell transfusion in all patients during the operation. The preoperative hemoglobin was (128.8±14.9)g/L, and it was (119.8±12.5)g/L on postoperative day 1. There was no significant difference between these two sets of data (t=2.07, P=0.054). No death during the perioperative period and no complications such as hepatic failure, hemorrhage and biliary fistula after operation occurred. Conclusion Preoperative evaluation based on 3D visualization and VR technology with blood vessel as the axis has significant clinical value for preoperative planning and surgical navigation of centrally located HCC.