Primary liver cancer (PLC) includes hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (CC).In recent years, the incidence of PLC has increased significantly in the world.At present, the therapy for liver cancer tends to diversify, but surgical resection is still the first choice and the most effective treatment for HCC in general.As the biomedical, evidence-based medicine, and medical humanities are proposed, to achieve the best therapeutic effect and minimize the trauma has become the goal of modem surgery.Moreover, this could promote the transformation of surgical model from traditional experiential surgery to precision surgery.Besides, as the critical techniques of treating HCC in preoperative evaluation,operative procedures, perioperative management and the innovation of surgical instruments develop fast, precise liver resection has come into being.And now this concept is getting more and more attention from hepatobiliary surgeons.In this paper, the progress on the application of precise liver resection in the treatment of PLC is reviewed based on the preoperative evaluation and intraoperative procedures.

Objective:To establish the alcoholic fatty liver(AFL) animal models,and to explore the protective effect of Zhi Zi Da Huang Tang (ZZDHT) on the rats with AFL and its dosage.Methods:A total of 54 SD rats were divided into normal control group (n=10) and model control group (n=44).The rats in model control group were given alcohol by lavage (50% ethanol solution 6.0 mL·kg-1) combined with high-fat feed to establish the rat models of AFL.After 4 weeks,the rats in model control group were randomly divided into model group(treated with water),simvastatin group (10 mg·kg-1),low and high doses (5.0 and 10.0 g·kg-1) of ZZDHT groups,and there were 10 rats in each group.Every 2 weeks during the process,the body weights and levels of serum total cholesterol (TC),triglyceride (TG),aspertate aminotransferase (AST),and alanine aminotransferase (ALT) were detected.After 4 weeks,the body weights and liver weights of the rats were detected;the levels of TC,TG,AST,ALT,alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) in serum and liver tissue of the rats of were detected;the levels of tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6) and interleukin-1β(IL-1β) in serum of the rats were detected;the morphology of liver tissue was observed by HE staining and the pathological examination was performed.Results:Compared with normal control group,the levels of serum TC,AST,ALT,TG,TNF-α,IL-6,and IL-1β of the rats in model group 4 weeks after administration were significantly increased (P<0.05 or P<0.01).Compared with model group,the levels of serum TC,TG,AST,and ALT of the rats in low and high doses of ZZDHT groups 4 weeks after administration were decreased (P<0.05 or P<0.01);the levels of serum TNF-α and IL-6,IL-1β of the rats in high dose of ZZDHT group were decreased (P<0.01);the levels of serum TNF-α and IL-1β of the rats in low dose of ZZDHT group were decreased (P<0.01);the levels of serum ADH and ALDH in liver tissue of the rats in low and high doses of ZZDHT groups and simvastatin group were decreased(P<0.05 or P<0.01).The HE staining result showed that compared with model group,the pathological conditions of the liver tissue of the AFL rats in ZZDHT groups were significantly improved.Conclusion:ZZDHT can significantly improve the liver injury caused by high fat diet combined with alcohol and fat liver lesions.

Objective:To investigate the effects of chronic exposure to low concentration sevoflurance on hippocampus in SD fetal rats.Methods:Totally sixty female SD rats at clean grade weighing 240-260 g were randomly divided into four groups , the control group and sevoflurane groups (n=15).The three experimental groups were respectively treated with 30 mg· L-1(parts permillion1 × 10 -6), 100 mg· L-1 and 300 mg· L-1 sevoflurane with 6-hour inhalation, qd for 2 weeks, while the control group breathed fresh air with the same volume .After mating conception , the rats inhaled the same concentration sevoflurane or air till scarification on the 19 th day.Half of brain in the fetal rats was withdrawn to prepare the paraffin specimens , and immunohistochemistry was used to detect the apoptosis in hippocampal CA 1 region associated with protein Bcl-2 and Bax.The hippocampus was stripped from the other half of brain and 10%homogenate was prepared, and the activity level of superoxide dismutase (SOD) and the content of malondialdehyde (MDA) were detected.Results:Bcl-2 in hippocampus CA1 region in 300 mg· L-1 group was lower than that in the control group , while Bax was higher than that in the control group (P<0.05);SOD was lower in 300mg· L-1 group than that in the control group , and MDA was higher than that in control group (P <0.05) .The other two sevoflurane groups had no differences when compared with the con-trol group (P >0.05).Conclusion:Low concentration inhalation of sevoflurane above 300mg· L-1 can enhance the cell apoptosis in hippocampus through increasing the oxidative stress reaction in embryonic brain of SD rat resulting in excessive MDA and reduced SOD.

Objective To evaluate the clinical effect of regulating expiratory airway pressure of noninvasive ventilation(NIV)to treat overlap syndrome(OS)with respiratory failure by pressure titration in monitor during sleep.Method Individuals who met the following criteria were selected for the study:(1)OS with respiratory failure confiemed by polysomnogram(PSC)and pulmonary function tests;(2)ability to tolerate PSG tests all night;(3)lucid consciousness and spontaneous breathing upon awaken and(4)ability to tolerate NIV.The criteria of exclusion were:(1)frequent expectoration of blood or hemoptysis;(2)spontaneous pneumothorax;(3)severe prosopo-trauma or facial ulcer and(4)large amount of secretion in the airway.From August 2005 to Decentber 2008,27 patients were selected with two patients excluded.The remaining 25 patients treated with noninvasive bi-level positive airway pressure(BiPAP)were randomly assigned to titration group or control group.During sleep,the patients of titration group were put under the optimal expiratory airway pressure[EPAP,(8.8 ± 0.5)cmH2O]which was got from titration by AutoCPAP ventilator and the EPAP decreased immediately to 5 cmH2O when the patients wake up next day.In the patients of control group,the EPAP was maintained at 5 cm H2O round the clock.The degree of apnoea and the hypopnea index(AHI),the results of arterial blood gas analysis(pH,PaO2,PaCO2)in the morning,the lowest pulse oxygen saturation(SPO2LOW)and the arterial blood gas level at 10 am before and after ventilation,duration of taking off ventilator at night,complications of NIV,incidence of air leakage and invasive ventilation after NIV were comparatively analyzed between the two groups.Results Compared with the control group,the titration group showed a notably increase in the value of SPO2LOW[(25.9± 11.3)%vs.(14.9±8.4)%;P＜0.05].The PaO2 level was significantly higher in the titration group(29.4±4.4)mmHg than that in the control group(22.6 ± 2.1)mmHg(P＜0.0001);however,the PaCO2 level in the titration group(16.8 ±7.3)mmHg was not significant different from that in the control group(20.0±6.3)mmHg(P＞0.05).The PaO2 level at 10am in the titration group(28.9 ± 6.7)mmHg was not significant different from that in the control group(31.3 ± 7.7)mmHg(P＞0.05);however,the PaCO2 level in the titration group(23.3 ±5.7)mmHg was higher than that in the control group(18.2 ±5.0)mmHg(P＜0.05).Conclusions Regulating EPAP of NIV to treat overlap syndrome with respiratory failure by pressure titration in monitor during sleep was more effective at improving hypoxemia and carbon dioxide retention than traditional methods without adjusting the EPAP to the optimal level.The optimal didn't increase carbon dioxide retention at night,confirming that the method was safe.

BACKGROUND: Studies have shown that propofol enables a reduction in the number of adult rat mesenchymal stem cells, while the cell differentiation is also significantly inhibited. OBJECTIVE: To explore whether liver X receptors (LXRs) can reverse the inhibitory effects of propofol on bone marrow mesenchymal stem cells. METHODS: Fifteen healthy C57/BL6 mice were randomized into three groups, 5 of which served as blank control group (intraperitoneally treated with normal saline), 5 as propofol treatment group (intraperitoneally treated with 60 mg/kg propofol), and 5 as propofol + LXRs agonist treatment group (intraperitoneally injected with 10 μL/g LXRs at the 1st day, and then injected with 60 mg/kg propofol at the 2nd day). The mice in the three groups were killed at 1-3 hours after treatment to isolate and culture bone marrow mesenchymal stem cells. Cell counting kit-8 and cloneformation assay were used to evaluate the abilities of cell proliferation and self-renewal; induced differentiation experiments in vitro were used to evaluate the differentiation ability of cells into adipocytes, osteoblasts and chondrocytes; real-time quantitative PCR was used to detect the expression of differentiation related molecules andNotch signal. RESULTS AND CONCLUSION: In the propofol-treated mice, cell viability and clone forming ability as well as adipogenic, osteogenic and chondrogenic differentiation of cells decreased significantly compared with the blank control group (P <0.05), while LXR agonists could reverse these effects significantly (P < 0.05). Notch signal expressions showed no difference among three groups prior to induced differentiation. The expression levels differentiation related molecules downregulated significantly after propofol treatment (P < 0.05), but upregulated significantly after treatment with LXR agonists (P < 0.05). Notch signaling inhibitor treatment could significantly inhibit the multi-directional differentiation of bone marrow mesenchymal stem cells in the three groups. All these findings indicate that activated LXRs can reverse the inhibitory effects of propofol on bone marrow mesenchymal stem cells.

OBJECTIVETo analyse the genetic polymorphism of Arg-gingipainB (rgpB), a virulent factors of Porphyromonas gingivalis (P.gingivalis) and discuss the role of the different genotypes in the genesis and progress of chronic periodontitis.

METHODSA total of 104 subgingival plaque samples were included in this study. The extracted DNA was amplified with the primers designed to obtain the gene encoding the catalytic domain of rgpB (rgpB-cd), P.gingivalis was typed into four genotypes by restriction fragment length polymorphism (RFLP).

RESULTSIn lesion site, the detection rate of type IV was the highest (52.78%), which was higher than those of type I and III (P < 0.05 or P < 0.01). While in non-lesion site, The detection rate of type II was the highest (75.86%), which was higher than those of other types (P < 0.01).

CONCLUSIONSThe polymorphism of rgpB-cd gene may influence the virulence of P.gingivalis. P.gingivalis type IV may be well related to periodontitis, while type II may be a indigenous flora.

Adhesins, Bacterial ; genetics ; Adult ; Aged ; Chronic Periodontitis ; microbiology ; Cysteine Endopeptidases ; genetics ; Dental Plaque ; microbiology ; Female ; Humans ; Male ; Middle Aged ; Polymorphism, Genetic ; Porphyromonas gingivalis ; genetics ; pathogenicity

Objective To evaluate the clinical value of combining irreversible electroporation (IRE) with a biliary composite stent implantation in the treatment of unresectable hilar cholangiocarcinoma.Methods A total of sixteen patients with unresectable hilar cholangiocarcinoma were treated in the Fifth Affiliated Hospital of Zhengzhou University,from April 2016 to July 2018 with combined IRE ablation with a 125I particle biliary composite stent implantation.A comparative analysis was conducted on the clinical data including total bilirubin,ALT,AST,myocardial enzymes before and after surgery.Results All patients underwent successful operation and the hemodynamics were stable during the operations.In 16 patients,the myocardial enzymes increased on the first day after surgery and fell to normal within 5 days.A total of thirteen patients had a progressive reduction of CA19-9,1 patient had no significant change in CA19-9,and 2 patients had CA19-9 in the normal range before and after treatment.Total bilirubin,AST,and ALT decreased gradually after surgery in all the patients.Postoperative complications included biliary bleeding (1 patient),and ascites (1 patient).All patients were able to have the PTCD tube removed after treatment.The median time to PTCD removal was 46 days (range 11 ～ 123 days),and the median catheter-free time before requiring another PTCD tube replacement was 184 days (range 43 ～365 days).Conclusions IRE ablation combined with a biliary composite stent in the treatment of unresectable hilar cholangiocarcinoma was safe.The treatment had good short-term outcomes and it significantly improved the quality of life of the patients.

Objective To evaluate the safety and curative effect of nanoknife ablation in the treatment of unresectable hilar cholangiocarcinoma.Methods 15 patients with unresectable hilar cholangiocarcinoma received nanoknife ablation treatment from March 2016 to May 2017.The clinical variables of the patients before and after operation were analyzed.Results The operations in all the patients carred out successfully.Cardiac arrhythmia occurred in some patients during the operation accidentally.The level of CA19-9 increased significantly on postoperative day 1,3 and then gradually decreased in 13 patients;one patient had no significant change of CA19-9,and the data for another patient was always in the normal range.The liver function of all patients gradually improved after operation,and the level of total bilirubin,AST and ALT showed a downward trend.The myocardial enzyme in all the patients increased on postoperative day 1,then returned to normal within the following 5 days.Postoperative complications included atrial fibrillation (1 case),upper gastrointestinal bleeding (1 case).The recanalization rates of the bile duct at 2 weeks,1 month,and 2 months after surgery were 66.6％,86.6％,and 93.3％,respectively.Conclusion Nanoknife ablation has superior safety,noteworthy efficacy and less complications in the treatment of the unresectable hilar cholangiocarcinoma in the short term.

ObjectiveTo investigate the effectiveness and safety of nanoknife ablation guided by real-time virtual sonography (RVS) in the treatment of locally advanced pancreatic cancer (LAPC). MethodsA retrospective analysis was performed for the clinical data of 27 patients with LAPC who attended The Fifth Affiliated Hospital of Zhengzhou University from April 2018 to October 2019, and according to the treatment method, the patients were divided into combination group (12 patients treated with IRE combined with chemotherapy) and control group (15 patients treated with chemotherapy alone). The chemotherapy regimen was gemcitabine combined with tegafur, gimeracil and oteracil potassium for both groups. Adverse reactions and complications were observed for the combination group during the perioperative period, and the two groups were compared in terms of the changes in myocardial enzymes, blood amylase, and carbohydrate antigen 19-9 (CA19-9) before treatment and at different time points after treatment, as well as remission rate (RR) and disease control rate (DCR) at 3 months after treatment and survival status during follow-up. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups, and the Wilcoxon test was used for comparison within each group; the Fisher’s exact test was used for comparison of categorical data between groups; the Kaplan-Meier method was used to analyze the survival status during follow-up. ResultsIn the combination group, there were 12 cases of adverse reactions and mild complications during the perioperative period, i.e., 9 Clavien-Dindo grade I cases and 3 grade II cases. All patients in the combination group experienced a transient increase in myocardial enzymes, which returned to normal within 7 days, and there were no significant changes in creatine kinase and lactate dehydrogenase on day 7 after treatment (P＞0.05); 9 patients had a significant increase in blood amylase on day 1 after surgery, which significantly decreased on day 7 after surgery and basically returned to normal on day 14 after surgery, and there was no significant change in blood amylase on days 7、14， and 1 month after surgery (P＞0.05). Before treatment, the level of CA19-9 was higher than the normal value in both groups, and the combination group had a significant reduction in CA19-9 at 1, 2, and 3 months after treatment (all P＜005); in the control group, the level of CA19-9 firstly decreased for a short time and then increased, while there was no significant change in CA19-9 at 1, 2, and 3 months after treatment (all P＞0.05). At 3 months after treatment, the combination group had significantly higher RR and DCR than the control group (RR: 75.0% vs 26.7%, P=0.021; DCR: 91.6% vs 53.3%, P=0043). During the median follow-up time of 13 months, compared with the control group, the combination group had significantly higher median progression-free survival time (10 months vs 5 months, P=0.014) and median overall survival time (18 months vs 10 months, P=0.034). ConclusionRVS-guided percutaneous nanoknife ablation has marked clinical effect and high safety in the treatment of LAPC and can be used as a new treatment option for patients who refuse or cannot tolerate laparotomy for ablation therapy.

As more and more people are becoming aged in China and many of them tend to suffer from chronic cardiac problems, the long-term dynamic cardiac monitoring for freely moving patients becomes essential. A new design for continuous ECG recording on the freely moving patients at home and/or at work is proposed here. It is miniature in size, using digital technologies of the low gain amplifier, the high resolution analog to digital converter and the real-time digital filter that features > 100dB input signal dynamic range (ISDR), > 100dB common-mode rejection ratio (CMRR), and < 5microV (RMS) internal noise. The device works continuously more than 24 hours with a pair of AAA batteries, and is capable of storing the recorded data into a storage card. The preliminary tests showed that the P-QRS-T waveforms were captured and displayed smoothly in resting, walking, and activities, making the device useful in monitoring and analyzing for the patients on the move.
Electrocardiography, Ambulatory ; instrumentation ; methods ; Equipment Design ; Humans ; Signal Processing, Computer-Assisted ; Software