Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a breakthrough in the field of hepatobiliary surgery.The remnant liver regeneration was stimulated during the first stage of the operation,and the radical resection of the tumor could be successfully carried out during the second stage of the operation.ALPPS is a new approach for patients with tumor which is previously considered unresectable during one hospital stay.In April 2014,a patient with hepatocellular carcinoma (HCC) in the right liver and liver cirrhosis was admitted to the Southwest Hospital.Preoperative examination confirmed that the ratio of the remnant liver volume to the standard liver volume was 26.9％,which indicated that the patient was inappropriate to receive radical resection of HCC.Therefore,totally laparoscopic ALPPS was applied.In the first stage of the operation,the portal vein ligation associated with liver hanging tape placement and in situ splitting of liver were carried out after hanging the Glisson's pedicle under the laparoscope.Thirteen days after the first stage of the operation,the ratio of the remnant liver volume to the standard liver volume was 40.6％.The second stage of the operation was carried out 14 days after the first stage of the operation.The right hepatic pedicle and right hepatic vein were transected with a stapler.The tumor was removed after full mobilization of the right liver.The distance between the resection margin to the tumor was 1.5 cm.No complications were detected after the first stage of the operation,while the patient was complicated with pleural effusion after the second stage of the operation and was cured by pleural puncture and drainage.The patient was discharged at postoperative day 9 and followed up at postoperative month 1.The results of follow-up confirmed that the hepatic function was normal,and no mass occupying lesions and pleural effusion were detected.Totally laparoscopic ALPPS is safe and feasible with satisfactory short-term efficacy.

Objective To observe the effect of intravesical chemotherapy in papillary urothelial neoplasm of low malignant potential (PUNLMP) urinary bladder after transurethral resection of bladder tumor (TUR-Bt). Methods 44 cases of PUNLMP confirmed by pathological examination from Jan 2004 to Dec 2013 were retrospectively analyzed. Clinical manifestation: 24 asymptomatic, 19 gross hematuria and 1 abdominal discomfort. All cases were treated by TUR-Bt and immediately administered by intravesical instillation of 40 mg HCPT once, then 32 cases (A group) underwent additional intravesical instillation of HCPT once, and 12 cases (B group) underwent instillation qw for 8 times. Results PUNLMP cases accouted for 2.28 %(44/1 926) of bladder neoplasms admitted during the same period. There were 32 males and 12 females. 39 patients had multiple tumors, and 5 had single. All of cases were followed up with the medial follow-up time of 82 months (16-136 months), only one case in B group recurred after 14 months, and postoperatively without pathological progression. The difference of recurrence rates between two groups had no statistical significance (P=0.273). Conclusions PUNLMP has low incidence rate and is more common among middle-aging males. Doctors should consider PUNLMP when patients with bladder neoplasm are asymptomatically detected. Immediate instillation combined with additional one postoperatively could reduce the recurrence rate of PUNLMP obviously with satisfying prognosis. However, maintenance instillation does not enhance effect.

Objective To explore the effects of lycopene on interleukin-6 (IL-6) expression and motor function after spinal cord injury in rats. Methods 36 healthy adult Sprague-Dawley rats were randomly divided into control group (A), methylprednisolone sodium succinate (MP) treatment group (B) and lycopene treatment group (C) with 12 rats in each group, and spinal cord injury model at T9 was established with modified Allen's technique (10 g×25 mm). 30 minutes after modeling, group A received no treatment, group B was injected MP 30 mg/ kg, group C was given lycopene 20 mg/kg. They were tested with inclined plate test 1 day, 3 days and 7 days after injury. The expression of IL-6 was examined with immunohistochemistry, then. Results The inclined plate test scores were higher in the group C than in the group A 1 day and 7 days after injury (P<0.05), and in the group B than in the group A 1 day, 3 days and 7 days after injury (P<0.05). The expression of IL-6 was significantly lower in the groups B and C than in the group A 1 day, 3 days, 7 days after injury (P<0.001). Conclusion Lycopene can inhibit the expression of IL-6 in acute spinal cord injury to reduce the inflammation and facilitate the recovery of nerve and motor function.

Objective To investigate the mechanism of mastoparan-1 (MP-1) antagonizing lipopolysaecharide (LPS) in vitro. Methods The affinity of MP-1 for lipid A was assayed by biosensor, and the neutralization of MP-1 on LPS (2 μg/L) was detected by kinetic turbidimetric limulus test. After exposing fluorescin isothiecyanate (FITC) labeled LPS (FITC-LPS) to MP-1 at different concentrations (5, 10, 20, 40 μmol/L), the binding of FITC-LPS to murine RAW264.7 cells was analyzed by laser scanning confocal microscopy. The influence of MP-1 on TLR4 expression in RAW264.7 cells stimulated by LPS (100 μg/L) was detected by immunoeytochemieal staining. The expressions of TLR4, TNF-α and IL-6 at the gene and protein level were detected by RT-PCR and ELISA after exposing LPS (100 μg/ L) stimulated RAW264.7 cells to MP-1 at different concentrations. The effect of MP-1 on the viability of RAW264.7 cells was detected by MTT assay. Results MP-1 had high affinity to lipid A and could neutralize LPS. MP-1 at 10 μmol/L significantly inhibited not only binding of FITC-LPS to RAW264.7 (P < 0.05), but also protein and gene expressions of TLR4, TNF-α and IL-6 in LPS stimulated RAW264.7 cells in a dose-dependent manner (P < 0.05). No toxic effect of MP-1 on the viability of RAW264.7 cells was found (P > 0.05). Conclusions MP-1 inhibits cell viability mediated by LPS, which may be related to its neutralization of LPS and inhibition of binding of LPS to RAW264.7 cell membrane receptors.

BACKGROUND:Large-scale expansion of undifferentiated and multipotential adipose-derived stem cells using serum-free culture system is a difficult issue to be resolved. OBJECTIVE:To establish an in vitro culture system combined with the extracellular matrix in order to investigate the efficiency, effectiveness and security of extracellular matrix on expanding adipose-derived stem cells. METHODS:In vitro isolated adipose-derived stem cells were seeded in traditional two-dimensional plastic plates and extracellular matrix-coated plates supplemented with serum-free medium respectively. After in vitro expansion, total cellnumber, expression of cellsurface markers, cellsenescence degree and multipotent differentiation ability (adipogenic, osteoblastic and chondrogenic differentiation) of adipose-derived stem cells cultured under both conditions were detected and compared. Moreover, the clinical safety of adipose-derived stem cells expanded in extracellular matrix-coated plates was investigated. RESULTS AND CONCLUSION:Total cellnumber of passage 5 adipose-derived stem cells cultured in extracellular matrix-coated plates was 10 times more than that in traditional two-dimensional plastic plates. Flow-cytometric analysis showed that adipose-derived stem cells cultured with extracellular matrix expressed stem cellsurface markers. cellular senescence examination showed that almost al of passage 15 adipose-derived stem cells cultured with extracellular matrix showed no aging, while most passage 5 adipose-derived stem cells cultured by the two-dimensional system aged and lost their proliferation ability. Multidirectional induction of adipose-derived stem cells showed that passage 15 adipose-derived stem cells cultured with extracellular matrix could stil differentiate into adipocytes, osteoblasts and chondrocytes as passage 5 adipose-derived stem cells did, which performed much better than the induced differentiations of passage 5 adipose-derived stem cells cultured by the two-dimensional system. Karyotype analysis and in vivo invasion experiment insured the clinical safety of adipose-derived stem cells expanded with extracellular matrix. Al above results suggest a safe and more efficient expansion system of extracellular matrix for clinical application using the serum-free culture system combined with extracellular matrix.

Biopsy ; Histological Techniques ; instrumentation ; methods ; Humans ; Indicators and Reagents ; Paraffin Embedding ; Ultrasonics

Objective To investigate the clinical features and LRRK2 gene mutation in patients with autosomal dominant familial Parkinson's disease (PD). Methods The clinical features of 16 autosomal dominant familial PD probands were analyzed in terms of age at onset, onset symptoms, UPDRS scores, response to the levodopa treatment and drug-induced dyskinesia. The LRRK2 gene exons 5,13,31,32,35,37,41 and 48 of 16 probands were sequenced after polymerase chain reaction. The novel mutation was further screened in 24D sporadic PD patients and 214 controls using PCR-RFLP for the genotypo frequency analysis. Results Clinically, most of 16 probands had late-onset age. Resting tremor (9patients, 56. 25%,t=0.558,P=0.679)and bradykinesia (9 patients,56.25%,t=0.369,P=0.454)were common onset symptoms followed by rigidity(6 patients,37.50%,t=1.324,P=0.735)and postural instability(5 patients,31.25%,t=2.369,P=0.956).Majority of them had good response to levedopa treatment and rare occurrence of drug-induced dyskinesia. Among the 16 autosomal dominant familial PD probands,6 variants were identified:c.457 T＞C(Leu153Leu),c.1432 G＞T(Asp478Tyr),c.5457 T＞C(Gly1819Gly),c.7153 G＞A(Gly2385Arg),IVS31+28 T＞G and IVS37+162 T＞C. The c.1432G＞T(Asp478Tyr)variant was a novel mutation and it was not detected in 240 sporadic PD patients and 214 controls. The reported mutations associated with the PD, such as Arg1441 Cys/Gly/His, Arg1514Gln, Tyr1699Cys, Ile2012Thr, Gly2019Ser and Ile2020Thr,were not found in our study. Conclusions The autosomal dominant familial PD patients present with classical symptoms of PD and bear the LRRK2 variantsAsp478Tyr and Gly2385Arg.

To make a portable apparatus for the patient self-doing joint voluntarily exercise that is keeping with the training demand of human body potential and muscle strong. Different kinds of spring belts are used for joint exercise apparatus according to the needs of joint exercise. Though active joint extension and flexion by using the method of Chinese physical and breathing exercises, the exercise was done by drawing the spring belt. The extremity multifunctional training box is easy for carrying and sutble for each mussel be trained. Because of the wide range of back spring power, it is easy to reach the best training mount and to do the continually training under the biggest training mount. It is beneficial to the joint active function improvement. From June 2006 to February 2008, this kind of apparatus was used in 30 patients with footdrop at the Beijing Tongren Hospital, Capital Medical University. The design of the extremity multifunctional training box is reasonable, and it is easy for carrying and operating. It is also helpful for the patient to do muscle exercise themselves, and the joint function can be persisted and improved by continual exercise using this apparatus.

BACKGROUND:Tranexamic acid is a synthetic anti-fibrinolytic drug, and can effectively control blood loss after total knee arthroplasty through vein. OBJECTIVE:To evaluate the effectiveness and safety of tranexamic acid in reducing blood loss after primary unilateral total knee arthroplasty. METHODS:From 2014 to 2015, 100 patients from the Department of Lower Limb, Sichuan Orthopaedic Hospital underwent primary unilateral total knee arthroplasty, and randomly divided into test group which used tranexamic acid and control group which used tranexamic acid, with 50 cases in each group. 1 g tranexamic acid was infused into the vein at 10 minutes before total knee arthroplasty in the test group, but tranexamic acid was not given in the control group. RESULTS AND CONCLUSION:The amount of total blood loss, postoperative wound drainage in 24 hours, and the amount of blood transfusion were significantly less in the test group than in the control group (P < 0.05). No significant differences in intraoperative blood loss and the number of patients receiving blood transfusion were found between the test and control groups. No significant difference in preoperative hemoglobin levels was detected before surgery, but hemoglobin levels were decreased after surgery between the two groups. Postoperative hemoglobin levels were apparently higher in the test group than in the control group after surgery. At 24 hours after surgery, no significant difference in coagulation was detectable between the two groups. At 6 days, double lower limb vein color Doppler ultrasound examination did not reveal deep vein thrombosis in both groups. These findings verify that treatment with tranexamic acid in the vein before primary unilateral total knee arthroplasty can evidently diminish the amount of perioperative blood loss and blood transfusion, reduce the risk and cost of blood transfusion, which is good for rehabilitation and does not increase the risk of deep vein thrombosis.

Purpose To explore the value of 320 row dynamic volume CT angiography in the preoperative assessment of juvenile nasopharyngeal angiofibroma (JNA) and in determining feeding arteries.Materials and Methods The imaging data of 18 cases with JNA proved by surgery and pathology and examined by 320 row dynamic volume CT were analyzed retrospectively.The imaging staging and feeding artery of tumors were determined.Results Most tumors (17/18) showed heterogeneous enhancement in the early stage of enhancement.With the extension of time,the enhancement scope of lesions expended.The time-density curve (TDC) of 11 cases demonstrated rapid ascending and rapid descending after injecting contrast,while 7 cases showed continuous increasing.The blood supply of all tumors included the external carotid artery system of the affected side and showed a close relationship with tumor staging.With the increase of tumor stage,the number of feeding arteries increased (r=0.858,P＜0.05).The feeding arteries of stage Ⅱc and stage Ⅲ tumors included ipsilateral maxillary artery and ascending pharyngeal artery.Besides,the effective radiation dose of 320 row CT angiography for searching arteries [(3.30±0.08) mSv]was less than that of DSA [(7.62±2.39) mSv] (t=-7.98,P＜0.05).Conclusion The 320 row dynamic volume CT imaging of JNA has certain characteristics,which can display the blood supply artery and accurate staging of tumors,thus it has important value in preoperative evaluation of JNA.