Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is introduced as a modified two staged hepatectomy for advanced liver malignancies,which requires extended hepatectomy with very small future remnant liver volume.It is characterized by rapid and large growth of future remnant liver and potential of widening the indication of curative resection with extended major hepatectomy for liver malignancies.However,it showed much higher morbidity of complications and mortality than extended hepatectomy after portal vein embolization.The development of ALPPS is often controversial.In this article,the development and problems of ALPPS are retrospected and summarized,in order to reflect the role of ALPPS in Japan where zero mortality after hepatectomy is highly expected.

The beta-glucans derived from yeast cell walls have been reported for having many immunomodulatory activities in vivo and in vitro. In this study, Aureobasidium-derived soluble branched (1,3-1,6) beta-glucan (Sophy beta-glucan) was checked for natural killer (NK) activity and for the production of IFN-gamma and IL-4 in Leishmania amazonensis infection. The main experiment was performed with a group of female C57BL/6 and BALB/c mice, orally supplemented with 5% of Sophy beta-glucan and infected with promastogotes of L. amazonensis (1 x 10(7)) into the footpad. Increase in the footpad thickness with time was observed in BALB/c mice in spite of the oral Sophy beta-glucan supplement, but it was less in C57BL/6 mice. The difference in overall mean footpad thickness between 'infection only' versus 'infection + glucan' groups was statistically significant (P < 0.001). High NK activity in C57BL/6 than BALB/c mice was observed in 'glucan only' group compared to the control group and also in 'infection + glucan' group compared to 'infection only' group. The difference in the NK activity among these groups was significant (P < 0.05). The IFN-gamma level increased at weeks 7 and 8 post-infection in C57BL/6 mice and was significantly high in 'infection + glucan' group compared to the 'infection only' group (P < 0.05). IL-4 levels did not increase up to detectable levels throughout the study. The results led a conclusion that Sophy beta-glucan enhances NK activity and cellular immunity in L. amazonensis-infected mice.
Administration, Oral ; Animals ; Ascomycota/*chemistry ; Cytotoxicity Tests, Immunologic ; Female ; Foot/pathology ; Glucans/administration & dosage/*isolation & purification/pharmacology/*therapeutic use ; Immunologic Factors/administration & dosage/*isolation & purification/pharmacology/*therapeutic use ; Interferon-gamma/biosynthesis ; Interleukin-4/biosynthesis ; Killer Cells, Natural/drug effects/*immunology ; Leishmania mexicana/*immunology ; Leishmaniasis, Cutaneous/*drug therapy/immunology/pathology ; Mice ; Mice, Inbred BALB C ; Mice, Inbred C57BL ; Severity of Illness Index ; Time Factors