This study aimed to induce the differentiation of isolated and purified adipose-derived stromal cells (ADSCs) into myoblasts, which may provide a new strategy for tissue engineering in patients with stress urinary incontinence (SUI). ADSCs, isolated and cultured ex vivo, were identified by flow cytometry and induced to differentiate into myoblasts in the presence of an induction solution consisting of DMEM supplemented with 5-azacytidine (5-aza), 5% FBS, and 5% horse serum. Cellular morphology was observed under an inverted microscope. Ultrastructural changes occurring during the differentiation were observed by transmission electron microscopy and confocal laser scanning microscopy. Cellular immunohistochemical staining was applied to determine the expression of desmin protein in cells with and without induced differentiation. Reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting were used to detect mRNA and protein expression, respectively, of sarcomeric and desmin smooth muscle proteins. The results showed that ADSCs were mainly of a spindle or polygon shape. Flow cytometry analysis revealed that ADSCs did not express CD34, CD45, and CD106 but high levels of CD44 and CD90, which confirmed that the cultured cells were indeed ADSCs. After induction with a 5-aza-containing solution, morphological changes in ADSCs, including irregular cell size, were observed. Cells gradually changed from long spindles to polygons and star-shaped cells with microvilli on the cell surface. Many organelles were observed and the cytoplasm was found to contain many mitochondria, rough endoplasmic reticulum (rER), and myofilament-like structures. Cell immunohistochemical staining revealed different levels of desmin expression in each phase of the induction process, with the highest expression level found on day 28 of induction. RT-PCR and Western blot results confirmed significantly higher desmin gene expression in induced cells compared with control cells, but no significant difference between the two groups of cells in sarcomeric protein expression. It was concluded that under specific induction setting, ADSCs can be induced to differentiate into myoblasts, providing a potential new option in stem cell transplantation therapy for SUI.

Objective To assess the outcome of liver transplantation in patients over sixty years of age,in order to attempt to expand the indications of liver transplantation. Methods From August,2000 to January,2002, the clinical data of 36 patients who underwent liver transplantation in our department were analysed retrospectively. Of the 36 cases, the data (operating time, the length of hospitalization, rejection rate and ICU stay days after operation) of 5 patients whose age were ≥60 years (elderly group) and the data of 31 patients whose age were under 60 years (

Objective To summarize the initial experience in application of mesohepatectomy for the treatment of central liver tumors while focusing on its indication, short-term and long-term prognosis and especially outlining its technical details. Methods The clinical data of 3 patients receiving mesohepatectomy from December 2007 to March 2009 in our hospital were retrospectively analyzed.The imaging characteristics were summarized to convey the indication details. The technique details of the operation were outlined so as to reduce blood loss or other complications during and after the operation. The post-operative course and follow-up data were also collected and analyzed. Results Two patients suffered from primary hepatocellular carcinoma with liver cirrhosis and the other from giant hemangioma. The tumors were located in Couinaud yegment Ⅳ and/or Ⅷ. The average blood loss and operative duration were 800 ml and 7 h, respectively. Blood liver function tests returned to normal within 7 days postoperatively and the patients were discharged after that. No complications occurred. The follow-up for 7-15 months showed that there was no recurrence. Conclusion Mesohepatectomy is the principal choice of treatment for centrally located liver tumors. For the safety and avoidance of complications, the doctor should abide by the concept of segment-oriented hepatectomy and apply the updated techniques such as CUSA (Cavitron ultrasonic surgical aspirator). For patients with compromised liver function, mesohepatectomy might be superior to extended bepatectomy. Thus, the application of mesohepatectomy should be expanded. Meanwhile, further investigation is needed for its full evaluation.

Objective To evaluate the effects of different selection criteria on the prognosis of hepatocellular carcinoma(HCC)patients undergoing liver transplantation(LT)and to evaluate a new criterion.Methods A retrospective analysis was performed on 81 consecutive patients with HCC who underwent LT.The survival rates of the patients who met different criteria such as Milan.UCSF(University of California San Francisco UCSF).and Pittsburgh(Pitt)modified TNM criteria were calculated by KaplanMeier method,and the value of different criteria was evaluated.The Long-Rank test and COX proportional hazards regression model were performed to analyze the prognostic factors.the model of criteria was established according the most important prognostic factors.Using the Kaplan-Meier method,the suitable cut-offs of every variable ifl the model were found by comparing the survival and the number of the patients who met the cut-off,and considering the significant difference between the patients who met and exceed the cut-off at the same time.Resuits The 1,2,3-year accumulative survival rates of the 19 patients who met Milan criteria were 87.7%,87.7%,and 52.6%respectively:the 1,2,3-year disease free survival rates of them were 88.9%,72.7%,and 72.7%respectively.The 1,2.3-year accumulative survival rates of the 26 patients who met UCSF criteria were 87.2%,80.5%,and 55.2%respectively;the 1,2,3-year disease free survival rates of them were 84.1%,68.4%,and 68.4%respectively.With our new expanded criterion as of solitary tumor≤8 cm in diameter.or no more than 3 tumors,with the largest≤6 am,and a total tumor diameter≤10 cm.there was no significant difierence in 1,2,3-year sunrival rates and disease free survival rates(89.0%,81.8%,71.8%,and 81.9%,72.4%,72.4%.)as compared with Milan or UCSF criteria.but with this new criterion more patients(a=41)would be eligible for transplantation with a comparable long term survival.and the difference of the accumulative survival rates and disease free survival rates of the patients who met and exceed the new criteria was significant(P＜0.05).Conclusion The new indication is acceptable because the criteria does not adversely impact survival.

Objective To summarize the experience in the diagnosis and treatment of elastofibroma dorsi,focusing on the clinical features,the specific radiological characteristics,and the typical pathological alterations.Methods Clinical data of 10 cases of pathologically confirmed elastofibroma dorsi from January 1997 to April 2008 were retrospectively reviewed.Results Most patients were female(8/10)in this series.All the lesions were located within the muscles in the subscapular region.There were 13 lesions in 10 cases(3 cases with bilateral involvement).Seven patients complained of pain and feeling of foreign body,and three were asymptomatic.The size of the masses was between 4 centimeters to 12 centimeters,averaging at(7.46 ±2.70)centimeters.Except for the early 3 cases,accurate diagnosis was made in all the other 7 cases before the histological exams solely based on the physical examination and imaging findings.Marginal excision was done for all the cases under general anesthesia.Fluid accumulation,as the only kind of complication was found in 3 cases which was resolved by repeated paracentesis.No recurrence was found during the follow-up period(4 months to 125 months,median 11 months).Conclusion Elastofibroma dorsi is a rare,pseudotumoral lesion usually found in elderly women.It is a very special type of soft tissue tumors that its diagnosis can usually be made solely on the basis of unique imaging characteristics and physical examination before the histological exam.Surgical marginal excision is the choice of treatment with good short-term and long-term results.

Objective To observe the changes in hypersplenism after orthotopic liver transplantation(OLT) and investigate the effect of OLT on hypersplenism. Methods Based on the clinical data of 14 eligible OLT patients operated on in our hospital during two and a half years, an analysis of the pre operative values of the thickness of the spleen, blood WBC and PLT count was made,and the postoperative pattern of changes of portal flow velocity was observed. Results Blood WBC and PLT count returned to normal 1 month after the operation, and the thickness of spleen reduced about 17.0% in the first month , but had no additional change at 1 year later. Portal flow velocity increased significantly 1 month after operation , then decreased slowly in the first year. Portal flow velocity , blood WBC and PLT count were all significantly related to the thickness of the spleen. Conclusions The high velocity of portal flow after OLT was mostly attributed to increased flow from the splenic vein; the main cause of the decrease in the level of blood WBC and PLT in hypersplenism before operation is augmentation of splenic volume; the recuperation of hypersplenism after OLT relies on the extent of reversion of splenic volume. It is not necessary to perform splenectomy in patients with hypersplenism when they receive OLT.

Objective:To investigate the common reasons,clinical features and the strategy of management with postoperative bleeding in thorax and abdominal cavity in orthotopic liver transplantation(OLT).Methods:Data based on the 12 cases undergoing OLT in our hospital from August 2000 to January 2002 were collected and analyzed.Results:The most common reason for bleeding post OLT was staxis in abdominal cavity(n=5),then was as followed:the abdominal bleeding caused by hepatic artery thrombolytic therapy(n=3),liver biopsy(n=2),Tipps(n=1),surgical technical reason(n=1).In all 12 cases,re operation of laparotomy was needed in 6 because of the massive bleeding.Acute renal failure happened in 5,and 3 needed hemodialysis.Four patients died postoperatively from massive abdominal bleeding,and 3 caused directly by the acute renal failure.Conclusion:Bleeding in the thorax and abdominal cavity happens frequently after OLT,and staxis in abdominal is the most common reason.The correct management for bleeding is the key thing to prevent complications.It is important to pay close attention to perioperative improvement of coagulative capacity,control of massive bleeding and prevention of renal failure.

Objective:To investigate the risk and prognosis of orthotopic liver transplantation (OLT)for patients with advanced hepatocellular carcinoma(HCC)and those without liver tumor.Methods:The risk and prognosis of 21 cases of orthotopic liver transplantation for patients with HCC were retrospectively reviewed and the comparison was made between such patients and 19 others with non tumor caused end stage failures whose OLT procedures have been done at the same period.Results:Compared with the non tumor OLT recipients,the HCC patients have a better preoperative coagulation function.In accordance with this,the blood lose,the required transfusion and the total infusion during the operation were also less than those of non tumor OLT patients.The duration of hypotension induced by bleeding in HCC patients were also shorter than that in non tumor patients.There were more patients in HCC group with uneventful postoperative course than that in non tumor group.The perioperative mortality was also lower in HCC group.Although the recurrence of malignance affected the long term survival of HCC patients,the whole survival rate was similar to that of non tumor OLT patients.Conclusion:OLT remains an effective alternative for the advanced HCC patients for whom there was no other better choice.It is possible that some patients can get a long term survival and are free of the recurrence of the HCC after OLT treatment.

Amygdala ; drug effects ; metabolism ; Animals ; Conditioning (Psychology) ; Morphine ; adverse effects ; Rats ; Receptors, Opioid, kappa ; metabolism

OBJECTIVETo study the efficacy of stenting followed by laparoscopic surgery in the treatment of obstructing left-sided colon cancer.

METHODSForty-nine patients with obstructing left-sided colon cancer were prospectively randomized into two groups. Twenty patients received emergent open surgery, while 15 underwent laparoscopic surgery 3 days after placement of the self-expanding metal stent (SEMS) and 14 of them received laparoscopic surgery 10 days after placement of SEMS. Outcomes evaluated included 1-stage operation rate, conversion rate, operative time, length of hospital stay, blood loss, postoperative pain score and use of analgesics, rates of permanent stoma, and postoperative complications.

RESULTSCompared with emergent open surgery, patients undergoing laparoscopic surgery had significantly less blood loss(P=0.000), lower permanent stoma rate (P=0.024), less pain(P=0.000), and lower incidence of postoperative complications. Laparoscopic surgery was associated with a significantly higher rate of 1-stage operation(P=0.004). Compared with patients undergoing laparoscopic surgery 3 days after SEMS placement, patients who underwent laparoscopic surgery 10 days after SEMS placement had a significantly higher 1-stage operation rate(P=0.001) and a lower conversion rate(P=0.046).

CONCLUSIONSSelf-expanding metal stenting is a safe and effective bridge to laparoscopic surgery in patients with obstructing left-sided colon cancer. Laparoscopic surgery 10 days after SEMS placement may be more appropriate.

Adult ; Aged ; Colonic Neoplasms ; complications ; surgery ; Female ; Humans ; Intestinal Obstruction ; etiology ; surgery ; Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Stents ; Treatment Outcome