Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is used for patients with advanced hepatocellular carcinoma who cannot tolerate major hepatectomy due to an insufficient future liver remnant,but the morbidity and mortality rate in the perioperative period are still high.Available studies indicate that damage control surgery variations such as laparoscopic procedure and associating radiofrequency/microwave ablation/liver tourniquet and portal vein ligation could improve the morbidity and mortality associated with ALPPS,as could portal vein embolization.However,randomized controlled trials are needed to determine benefits in technical variations.

Precision medicine significantly promotes the diagnosis and treatment of various diseases,which also induces the revolution of evidence-based clinical practice guidelines,as well as multimodality therapy for hepatocellular carcinoma (HCC).In the application of the concept of precision medicine and evidence-based medicine,surgeons will concretize the precise surgery,establish an improved multimodality therapy for HCC,and ultimately achieve the goal of overall benefit.This is also a new task of surgeons in the precision medicine era.

Trypsin was purified from crude material of pig pancreas by AOT/isooctane reversed micellar system.The influence of the main operating parameters such as ethanol concentration in forward and backward extraction,pH,KCl and AOT concentration,temperature were investigated.Forward and backward extraction recovery of trypsin reached almost 90% and neared 100%,respectively.Finally,about 88% of total yield was obtained,and the specific activity of trypsin was increased to over 1800U/mg with purification factor of 5 folds more.In AOT-isooctane reverse micellar extraction system,denaturation or precipitation of proteins always occured due to strong electrostatic interaction between AOT-proteins molecules.It had been resolved by adding ethanol into reverse micellar system,and no denaturation was observed.Otherwise,the phase separation time was shortened significantly because of ethanol added.It was only 10 minutes or less to reach phases separation after forward and backward extraction.If this method can be applied in industry,efficiency will be greatly improved.

BACKGROUND: Phosphorylcholine-containing poly (L-lactide) (PLLA-PC) is a kind of novel amphiphilic copolymer with good biocompatibility and biodegradability. In the previous work, self-assembly micelles of PLLA-PC were prepared with film rehydration method. But it hardly formed micelle with film rehydretion method because the longer chains of LLA existed in the PLLA-PC copolymer. However, the mechanism of phosphotipid choline polymer with long hydrophobic chain forming micelle remains still unclear. OBJECTIVE: To prepare self-assembling nanoparticles of PLLA-PC using solvent evaporation method, and to explore the factors that affected the properties and stability of nanoparticles.METHOD: ① Nanoparticles were prepared with solvent evporation metod.PLLA-PC copolymer was dissolved into acetone, and the copolymer solution was added dropwise to distilled water with stirring to yield nanoparticles. The critical micelle concentration (CMC) was performed on the F-7000FL220-240V. The emission and excitation wavelength were 395 nm and 300 mm, respectively. Transmission electron microscopy (TEM) was carried out on a JEM-100CX electron microscope to observe the morphology of PLLA-PC nanoparticles. Dynamic light scattering measurements on nanoparticle solutions were performed on a NANOSIZE 3600 at room temperatire. ②Gel permeation chromatography(GPC)measurements were perfrmed on a Waters 717 apparatus equipped with an RI detector. THF was used as the mobile phase at a flow rate of 1.0 mlJmin. A 1 g/L solution (50 μL) was injected for each analysis. RESULTS AND CONCLUSION: TEM indicated that the PLLA-PC nanoparticles presented typical shell/core structure. The critical micelle concentration was determined by fluorescent probe method. The results showed that the CMCs were quite low ( 10~(-3) g/L) and were dependent on the LLA units in the copolymer. The size and size distribution of the nanoparticles were detected by dynamic light scattering. The results indicated that the size could be affected by the LLA units, concentration of the organic solution and the concentration of the aqueous solution of the nanoparticles. On the other hand, they hardly changed over the dilution with water, which was of great importance in venous injection. They degraded at 37℃. PLLA-PC nanoparticles with controllable sizes can be prepared with phase separation method and might serve as a novel material for drug delivery.

Abnormalities, Multiple ; diagnosis ; Adolescent ; Humans ; Male ; Spleen ; abnormalities ; Testis ; abnormalities

OBJECTIVE: To review classification and synthesis of amphiphilic polymers containing polyethylene glycol and the application as drug carriers.DATA SOURCE: A computer-based research was conducted in SCI-Expanded, El Compendex and China Journal Full-text Database for articles concerning classification and synthesis of amphiphilic polymers containing polyethylene glycol and their micelles application as drug carriers published from January 2000 to July 2009.DATA SELECTION: A total of 616 articles were primarily obtained. Following reading titles and abstract, articles addressing detail classification and synthesis of amphiphilic polymers containing polyethylene glycol and representative micellar influencing factor were included. Totally 31 English and Chinese literatures were collected for further analysis.MAIN OUTCOME MEASURES: Classification, synthesis and drug vector mechanism of amphiphilic polymers containing polyethylene glycol and the micellar application as drug carriers were measured.RESULTS: Star-shaped copolymer could elevate micellar stability, but there were many arm numbers, whicti might induced a decrease in drug carrier volume. Special group introduced in copolymer contributed to the combination of drug and carrier. To connect target group could provide target transport property. The length and density of polyethylene glycol chain in copolymer was related to micellar function. Changed the length and density of polyethylene glycol could obtain polymer micelles that circulated in vivo for a long time.CONCLUSION: Amphiphilic polymers containing polyethylene glycol has outstanding potential in medical drug carrier field and isolation technique.

Objective To evaluate the efficacy of a self-expandable metal stent coated with autologous endothelial progenitor cells(EPCs)for prevention of restenosis in transjugular intrahepatic portosystemic shunt(TIPS)in a swiue model.Methods EPCs were coated on the metal stents using fibrin gel before TIPS procedure.TIPS was performed in 15 young adult pigs,using an autologous EPC-seeded stent(treatment group,n=9)or a conventional bare metal stent(control group,n=6).All pigs were sacrificed at 2 weeks after TIPS procedure.Portography was performed immediately before the euthanasia.Gross and microscopic pathological exams and immunohistochemical exams of the TIPS track specimens were performed.Fisher test and t test were used to analyse the data.Results TIPS was performed successfully in all the 15 swine.On day 14 of follow-up,direct portography and necropsy demonstrated that 5 shunts remained patent,2 shunts stenosed,and the remaining 2 shunts occluded in the treatment group(n=9);while 5 shunts were occluded and one shunt was stenotic in the control group(n=6).The patency rate was 56%vs 0(P=0.03)between the two groups.Histological analyses showed a greater pseudo-intimal hyperplasia in the TIPS track of the control group than that of the treatment group(pseudointimal thickness at hepatic vein,hepatic parenchyma and portal vein site was(1.2±0.4),(1.3±0.5),(1.5±0.4)mmvs(1.0±0.6),(0.9±0.5),(1.0±0.4)mm respectively(P＜0.05).Conclusion The EPC-coated metal stent is feasibly constructed in vitro and improves the patency in TIPS in a porcine model.

BACKGROUND: Nerve growth factor (NGF) is characterized by poor stability both in vitro and in vivo, and liable to lose its bioactivity.OBJECTIVE: To study the stability of liposome-encapsulated NGF injection preserved under various conditions.DESIGN: A controlled study of liposome-encapsulated NGF.SETTING: Department of Surgery of the First Affiliated Hospital of Nanjing Medical University.MATERIALS: This study was carried out at the Central Laboratory of the First Affiliated Hospital of Nanjing Medical University between July 2002and March 2004. NGF from rat submaxillary gland was purified, encapsulated by liposome, and prepared into lyophilized dosage form before preserved under different conditions (at 4 ℃, room temperature, 40 ℃ or 40 ℃ with saturated humidity, respectively).METHODS: Chicken embryo dorsal root ganglion cultured in serum-free medium was used to evaluation the bioactivity of NGF in vitro. The dorsal root ganglion from 8-day-old chicken embryo was inoculated in a polylysine-coated 24-well culture plate and cultured in Dulbecco modified Ea-gle medium (DMEM) containing different testing samples. Only DMEM was used for culture in the negative control group, while DMEM containing NGF at different concentrations used in the positive control group. The ganglion was cultured at 37 ℃ with 50 mL/L CO2 and saturated humidity for 24 hours, and the growth of the nerve fibers was observed under an inverted microscope. The bioactivity of NGF was also evaluated in simulated condition in vivo by adding lyophilized liposome-encapsulated NGF and positive control NGF specimen into 0.5 mL rat serum, which, along with the blank control serum, was added into 2.5 mL DMEM at 0.5, 1, 2, 3, 4,6 hours and thoroughly mixed. The bioactivity of NGF was assessed accord-ing to the length and density of the dorsal root ganglion and graded the prominences (recorded as "++" or "+++ "), and very long and dense growth of the prominences (++++).MAIN OUTCOME MEASURES: In vitro bioactivity of NGF preserved for 10, 30, 60, and 90 days by testing the growth of cultured chick embryo dorsal root ganglion in serum-free DMEM and in test of rats serum containing NGF added at 0, 0.5, 1, 2, 3, 4, and 6 hours into DMEM.RESULTS: Lyophilized liposome-encapsulated NGF exhibited stable bioactivity (+++) after preservation at 4℃ and room temperature for 10-90days; at 40 ℃ for 10-60 days, the it retained its the bioactivity (+++),which, however, slightly decreased by 90 days (++); its bioactivity was preserved (+++) at 40 ℃ with saturated humidity for 10 days (+++), slightly decreased at 30-60 days (++) and noticeably lowered (+) at 90 days. When preserved for 0, 0.5, 1, 2, and 3 hours in rat seum, the NGF preparation retained stable bioactivity (++++ or +++), which slightly decreased at 4 hours and 6 hours (++).CONCLUSION: Liposome-encapsulated NGF has stable bioactivity but its preservation at relatively high temperature with high humidity is difficult.Lyophilized liposome-encapsulated NGF exhibits better bioactivity than NGF-liposome suspension after preservation under various conditions.

Objective To screen the genes related with signal transducers and activators of transcription 3 (STAT3) regulating pancreatic cancer invasion and metastasis by gene chips.Methods Human pancreatic cancer cell line SW1990 stably expressing low level of Stat3 was established by lentivirus transfection,while cells transfected with mock plasmid and cells without transfection served as control groups.The differences of invasion and metastasis related genes expression among the three groups were screened by gene chips.STAT3 mRNA and protein expression was measured by real-time PCR and Western blot.Three differentially expressed genes (MMP-7,IL-1β and IgTα7) were verified.ResultsThe expression level of STAT3 mRNA was 0.391 ± 0.037 after pancreatic cancer SW1990 cell trarsfected with STAT3 targeted lentivirus,which was significantly lower than those in mock plasmid group (1.002 ± 0.015) and nontransfected group ( 1.206 ± 0.042,P ＜ 0.05 ) ; the expression level of STAT3 protein was 182.38 ± 65.32,which was significantly lower than those in mock plasmid group (223.40 ±58.40) and non-transfected group (212.33 ±53.69).Eight invasion and metastasis related genes of SW1990 lowly expressing Stat3 were upregulated,while 3 genes were down-regulated.By verification,the mRNA level of MMP-7 and IL-1β were lower than in control group transfected with mook plassmid(0.287 ± 0.115 vs 1.010 ± 0.124,t =19.45,P =0.000;0.490 ± 0.10 vs 1.002 ± 0.002,t =13.83,P =0.000),but the mRNA level of IgTα7 was not decreased (1.173 ±0.280 vs 0.998 ±0.003,t =4.236,P =0.094).Meanwhile,the protein level of MMP-7 was significantly down-regulated when Stat3 was knocked down.ConclusionsStat3 causes changes of expressions of many invasion and metastasis-related genes of SW1990,and MMP-7 may be the main target gene regulated by Stat3.

Objective To explore the dose rate response characterization of four kinds of dosimeters for clinical application.Methods Within the range of 100-600 cGy/min,the dose rate responses of the PTW 0.6 cm3 ion chamber,0.015 cm3 ion chamber,Matrixx Evolution 2D diode array and MapCHECK 2D diode array under the same measuring conditions were measured.The dose rate response of the PTW 0.6 cm3 ion chamber under different energy and working voltage were analyzed.Results All ionization chambe.r types of measured equipment showed certain dose rate dependence for 6 MV X-rays.All the differences were below 1％.The dose rate dependence disappeared for 15 MV X-rays.The 2D diode array had strong dose rate dependence and the response difference was about 2％.Conclusions It is necessary to test and analyze the dose rate response of the measured equipment in treatment technology with dose rate varying,in order to ensure the precision of daily calibration and dose verification.