Objective To evaluate the safety of mesohepatectomy for centrally located large hepatic tumors.Methods The clinical data of 37 patients who underwent hepatectomy for centrally located large liver tumors in our hospital from October 2010 to August 2015 were retrospectively analyzed.During the operation,the left and right hemilivers were mobilized.Slings for the improved liver hanging maneuver and for selective hepatic vascular occlusion were placed.These slings were used when necessary in order to minimize occlusion and ischemia time to the residual liver,and to maximize the volume of functional liver remnant.Mesohepatectomy was carried out using a microwave hemostatic separator.The feasibility,its effects on preventing hemorrhage,the degree of liver damage and the postoperative complications were evaluated.Results The mean diameter of the neoplasms was (12.6 ± 7.2) cm.The vascular inflow occlusion time of the left and right hemilivers were (12.2 ±3.5) min and (18.5 ±7.1) min,respectively.The blood loss was (487 ± 352) ml.The amount of red blood cell transfusion was (2.7 ± 1.9) U.The operation time was (215 ± 72) min.TBIL,ALT and AST reached their peak levels on the 1 st day after operation and they were higher than before surgery (P ＜ 0.01).The levels were then significantly decreased on the 3rd day after operation.However,the TBIL (P ＜ 0.05),ALT (P ＜ 0.01) and AST (P ＜ 0.05) were higher than the preoperative level,and only returned to normal or were close to the preoperative value on the 7th day after operation (P ＞ 0.05).The initial increase in ALT was quick and then it slowed down,while the initial increase in AST was slow but it decreased quickly.Conclusions Mesohepatectomy for centrally located large hepatic tumors could safely be carried out using the liver hanging maneuver combined with selective hepatic vascular occlusion and a microwave hemostatic separator.This method has the advantages of causing less bleeding,liver damage and rapid recovery.

A rapid resolution liquid chromatography coupled with quadrupole-time-of-flight mass spectrometric (RRLC-Q-TOF-MS) method was established and optimized for the analysis of pharmacokinetic behavior of ginsenoside Rb2 in rats by intravenous injection administration.The metabolism of ginsenosides Rb2 in vivo rat was also explored.In the experiment,Agilent SB C18 column was selected for the sample separation with 0.1％ aqueous formic acid solution as mobile phase (A) and acetonitrile as mobile phase (B) at a flow rate of 0.2 mL/min,and the injection volume was set to 5 μL.Q-TOF-MS was carried out in electron pray ionization (ESI) negative ion mode.The limit of quantification (LOQ,S/N =10) and limit of detection (LOD,S/N=3) were 0.10 and 0.08 μg/mL,respectively,and the linear range was 0.1-1.26 μg/mL.The experiment results showed that the concentration-time profile of ginsenoside Rb2 conformed to a two-compartment pharmacokinetic model after intravenous administration for rats.The mean plasma elimination half-lives were (23.58±1.10) min (t1/2α),(1306.55±147.23) min (t1/2β) for Rb2.By analyzing the urine of rats after intravenous administration and the fecal samples after oral administration of ginsenoside Rb2,it was found that the metabolites were M6,M2 (CY),F2,and C-K.

Correspondinga uthor:Wan Chun, Email:mdchunwan@163.com
[Absrt act] Obj ective To summarize the clinical experience with isolated complete resection of he-patic caudate lobe in 14 patients. Mte hods The clinical data of 14patients with isolated complete resection of hepatic caudate lobe carried out in our hospital from December 2007 to March 2015 were retrospectively analyzed .During the operation , selective hepatic vascular occlusion slings , and supra-and infra-hepatic in-ferior vena cava slings were placed after full mobilization of the liver .Isolated complete resection of the he-patic caudate lobe was performed through the left and /or the right , the anterior liver-splitting or the retro-grade approaches .Results The mean operation time was (227 ±64) min.The mean amount of blood loss was (530 ±325) ml.The mean vascular occlusion time was (19.5 ±18.6) min.The mean diameter of ne-oplasm was (15 4.±9 .2) cm. All the operations were successfully carried out .There were no massive hem-orrhage, bile leakage or perioperative death .Hydrothorax occurred in 3 patients and ascites in 2.The mean stay in hospital was (21 ±9) days.All the patients were cured and discharged home .Conclusion Isolated complete resection of hepatic caudate lobe was feasible in clinical practice .

Objective:To investigate the value of quantitative electroencephalography (qEEG) in the evaluation of thrombolytic efficacy in acute cerebral infarction.Methods:A prospective cohort study was conducted. Ninety-four patients with acute cerebral infarction who received intravenous thrombolysis admitted to the department of emergency of Qinhuangdao First Hospital from October 2019 to September 2020 were enrolled. The relative energy values of δ, θ, α and β waves in qEEG before and 2 hours, 24 hours and 7 days after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis were dynamically monitored, and the power ratio index [DTABR, DTABR = (δ+θ)/(α+β)] was calculated. The National Institutes of Health stroke scale (NIHSS) score was also recorded. The reduction of NIHSS score ≥ 3 or the disappearance of neurological symptoms were regarded as effective thrombolytic therapy. The changes of DTABR before and after thrombolysis in patients with effective and ineffective thrombolysis were analyzed, and the correlation between DTABR and NIHSS score was analyzed by Pearson method.Results:A total of 94 patients were enrolled, including 64 males and 30 females. The average age was (61.71±10.11) years from 36 to 89 years old. Thrombolysis was effective in 57 cases and ineffective in 37 cases. Compared with before thrombolysis, DTABR of the effective group was significantly decreased at 2 hours, 24 hours and 7 days after thrombolysis (left cerebral infarction: 1.87±1.45, 1.59±0.88, 1.58±0.90 vs. 3.82±2.60; right cerebral infarction: 1.55±0.57, 1.41±0.50, 1.35±0.44 vs. 3.20±1.63, all P < 0.05). DTABR did not change or increase significantly at 2 hours, 24 hours and 7 days after thrombolysis compared with before thrombolysis (left cerebral infarction: 3.56±2.57, 3.48±2.19, 3.54±2.50 vs. 3.11±1.62; right cerebral infarction: 5.29±3.93, 5.33±3.94, 5.19±4.52 vs. 4.73±2.43, all P > 0.05). Pearson correlation analysis showed a significant positive correlation between DTABR and NIHSS score in patients with acute cerebral infarction (r = 0.691, P < 0.01).Conclusion:The quantitative index of qEEG, DTABR, can accurately and quickly monitor the process of thrombolysis in acute cerebral infarction, and can effectively evaluate the effect of thrombolysis in patients.

Background Current researches of choroidal structure changes primarily focus on macular choroidal thickness in adolescents and children,but there are few studies on peripapillary choroidal thickness in children with enhanced depth imaging (EDI)-OCT.In addition,the reliability of manual measurements to peripapillary choroidal thickness is an important factor for the estimation of EDI-OCT.Objective This study was to determine the repeatability and reproducibility of manual measurements of peripapillary choroidal thickness in children by EDI-OCT.Methods A reliability evaluation of diagnosis test was performed.EDI-OCT technology was used to image the peripapillary choroidal thickness in 49 children aged 7-14 years in Eye Hospital of Wenzhou Medical University from February to March 2015 under the informed consent of their custodians.An annular scanning was carried out surrounding optical disc by the same ophthalmologist with Spectralis OCT,and the peripapillary choroidal thickness was manually measured at global,temporal,superotemporal,superonasal,nasal,inferonasal and inferotemporal zones.The intraclass and interclass repeatability and reducibility of measuring values from intraobserver,inter-observer and intra-session were evaluated with intraclass correlation coefficients (ICC),and BlandAltman agreement analysis was used to assess the consistency of repeated measurements.Results The average age in the subjects was (9.9 ± 1.3) years.No significant difference was found in the mean difference of reduplicative measured peripapillary choroidal thickness at each zone (all at P＞0.05).The ICCs of intra-observer,inter-observer and intra-session were 0.971-0.993,0.827-0.952 and 0.974-0.991,respectively,and the 95％ limit of agreement of global peripapillary choroidal thickness were-12.4-9.7 μm,-15.2-11.6 μm and-16.3-19.1 μm,respectively.Conclusions The repeatability,reproducibility and consistency are favorable in manually measured values of peripapillary choroidal thickness from EDI-OCT image.EDI-OCT appears a good application in the assessment of peripapillary choroidal thickness in children.

Objective To analyze the association of postnatal weight gain proportion of very low birth weight (BW) preterm babies and the onset of severe retinopathy of prematurity,and investigate the optimal cut-off points and predictive ability of postnatal weight gain (WG) proportion for the onset of retinopathy of prematurity (ROP).Methods A retrospective cohort study.257 preterm infants underwent screening whose weight was less than 1500 g were enrolled in this study.Risk factors include BW,gestational age (GA),history of oxygen inhalation,need for blood transfusions,Apgar score in 1 to 10 minutes,embryo number,delivery mode,in vitro fertilization infants,and WG proportion within 6 weeks after birth and other systemic diseases were recorded.Their correlation with severe ROP is analyzed.Clinical outcomes were divided into severe ROP group (patients who suffered from ROP and required treatment) and mild and no ROP group (patients who suffered from ROP but do not require treatment and-patient without ROP).The severe ROP group included 18 patients and mild and no ROP group included 239 patients.Multiple logistic regression and receiver operating characteristic (ROC) curve were used to determine if the WG proportion was independently related to severe ROP development and if it was capable of predicting severe ROP.This study determines the predict value by comparing the area under the ROC curve (AUC) of independent risk factors.Results GA (t=-4.835,P＜0.001),BW(t=-5.192,P＜0.001),history of oxygen inhalation (x2=6.001,P=0.009),proportion of infants who had oxygen inhalation for more than 10 days(x2 =10.019,P=0.002),postnatal WG proportion at 1 week(t =-3.663,P＜ 0.001),postnatal WG proportion at 2 weeks(t=-3.425,P=0.001) had significant difference between two groups.Multiple logistic regression analysis revealed that GA (β =-0.858,P =0.008),BW (β =-0.005,P =0.010),postnatal WG proportion at 2 weeks (β=-8.745,P =0.035) were correlated to severe ROP significantly.And their area under the ROC were 0.836[95％ confidence interval (CI):0.752-0.920],0.826 (95％CI:0.947-0.903),0.744 (95％CI:0.598-0.891) respectively.The optimal cut-off points of GA,BW,and postnatal WG proportion at 2 weeks were 28.41 weeks,1241.96 g,12.80％ respectively.Conclusion Low WG proportion at 2 weeks of very low BW preterm babies is an important and independent risk factor for severe ROP and has certain predictive value of the onset of severe ROP.

This paper discussed the main point specifically from the three aspects which are the certainty and uncertainty of technological function , the predictability and unpredictability of technological efficiency , and“should do”or“not should do”of technological application .It presented an ethics argument of medical technology clinical admittance restriction and defends the standpoint -what we can do does not mean what we should do , aiming to provide moral theoretical support of ethical review of medical technology application .

Objective To investigate the mechanism of hearing loss after focal cerebral ischemia-reperfusion injury in rats.Methods A total of 60 healthy male adult SD rats were included in this study and randomly divided into 2 groups, ischemia-reperfusion(I/R) group and sham operated control, with 30 rats in each group.The rats in I/R group were operated for suture-occluded method to establish middle cerebral artery occlusion(MCAO)model, with ischemia for 60 mins followed by reperfusion for 24 hrs.The control group was only to be isolated cervical vessels, with no thread embolism inserted.The auditory brainstem response (ABR) was tested before operation and at 24 hrs post-operation respectively.At 24 hrs post-operation, we scored neurological functions, measured the changes of water content in the brain using the dry-wet weight method, and determined the infarct volume through TTC method.We also evaluated the integrity of blood-brain barrier(BBB) by viewing the exudation of Evans blue and observed the apoptosis of neurocyte by TUNEL method to conclude apoptotic index(AI).The expression of MMP-9,Claudin-5,Occludin and CX-43 were detected by Western blot.Results Compared with the sham group,the neurological function scores,the infarct volume and water content of the brain increased, with the elevated thresholds of ABR significantly and AI went up in I/R group.The expression levels of MMP-9 and CX-43 were significantly up-regulated,but the expressions of Claudin-5 and Occludin were obviously down-regulated.All of the differences above had statistical significances.Conclusion The mechanism of hearing loss after focal cerebral ischemia-reperfusion injury in rats is possibly related to MMPs activation,neurocyte apoptosis,BBB breakage and gap junction damage.

Objective To evaluate effects of Lycium barbarum polysaccharide (LBP) on expression of vascular endothelial growth factor (VEGF) and hypoxia inducible factor-1α (HIF-1α) in ultraviolet B (UVB)-radiated HaCaT cells.Methods Conventionally cultured HaCaT cells were divided into control group and LBP groups,which were firstly treated with DMEM,12.5,25.0,50.0 and 100 μg/ml LBP solution respectively for 4 hours,and then were irradiated by UVB at different intensity of 0,20,40,60 mJ/cm2 separately.After 24-hour continuing culture,CCK-8 assay was performed to determine the cell survival rate,and an enzymatic-biochemical method to estimate the activity of superoxide dismutase (SOD).RT-PCR and Western blot analysis were conducted to measure the mRNA and protein expression of HIF-1α and VEGF respectively.Results Compared with the control group at the same UVB radiation dose,the 12.5-,25.0-and 100.0-μ,g/ml LBP groups showed different extents of increase in survival rates of UVB-radiated cells (P ＜ 0.05),and the 50.0-μg/ml LBP group showed the highest cell survival rate (P ＜ 0.01).Among all the LBP groups,SOD activity was highest in the 50.0-μg/ml LBP group (P ＜ 0.01).Along with the increase of UVB radiation dose,the mRNA and protein expression of HIF-1α and VEGF all gradually increased.Compared with the control group,the 50.0-μg/ml LBP group could effectively reduce the mRNA and protein expression of HIF-1α and VEGF in HaCaT cells (all P ＜ 0.05).Conclusion LBP may play a role in protecting cells from UVB radiation-mediated damage,likely by influencing the mRNA and protein expression of HIF-1α and VEGF in HaCaT cells.

Objective To investigate the nutritional status,body composition,and energy metabolism of hepatocarcinoma patients undergoing surgical treatment and explore the relationships of the nutritional status with body composition and energy metabolism.Methods Totally 112 hospitalized hepatocarcinoma patients undergoing surgical treatment met the inclusion and exclusion criteria were enrolled as the intervention group,and another 100 patients with cholelithiasis during the the same period were enrolled as the control group.Their general clinical data including body mass index(BMI),arm circumference,grip,albumin,prealbumin,energy expenditure,and body composition were collected.The nutritional status was assessed by the scored patient-generated subjective global assessment(PG-SGA).The relationships of the nutritional status with body composition and between energy metabolism were analyzed.All the data were analysed by SPSS 16.0 software package.Results The arm circumference [(23.9±3.6)cm vs.(25.3±4.5)cm,t=2.57,P=0.014],hand grip[(31.7±6.0)kg vs.(39.2±7.6)kg,t=8.19,P<0.001],serum albumin[(32.5±4.7)g/L vs.(36.5±7.2)g/L,t=4.92,P=0.007] and prealbumin[(0.172±0.052)g/L vs.(0.263±0.077)g/L,t=10.3,P=0.004] of the intervention group were significantly lower than the control group.The total malnutrition rate of the intervention group was 37.5％(42 cases at levels B and C),and that of the control group was 14.4％(14 cases at levels B and C)(X2=19.73,P<0.001).The extracellular water significantly increased in the intervention group compared with that of the control group[(15.35±2.21)L vs.(13.51±2.73)L,t=5.54,P<0.001];however,the somatic cell mass [(27.54±4.42)kg vs.(29.03±4.38)kg,t=2.53,P=0.012],fat mass[(13.44±4.23)kg vs.(17.36±5.21)kg,t=6.18,P<0.001],and muscle mass[(43.11±6.27)kg vs.(48.17±7.13)kg,t=5.63,P<0.001] had significantly decreased compared with the control group.The measured value of rest energy expenditure(mREE)[(6 581.62±1 201.70)kJ/d vs.(6 290.73±1 071.68)kJ/d,t=1.98,P=0.042] of the intervention group was significantly higher than the control group(P=0.042),and the respiratory quotient(RQ)was also significantly higher(0.87±0.10 vs.0.85±0.06,t=2.72,P=0.027).The extracellular fluid(PG-SGA A vs.B P=0.035;A vs.C P<0.001;B vs.C P=0.042)were significantly increased,and the number of somatic cells(A vs.B P=0.015;A vs.C P=0.001;B vs.C P=0.022),fat(A vs.B P=0.026;A vs.C P=0.003;B vs.C P=0.022)and muscle mass(A vs.B P=0.029;A vs.C P=0.011;B vs.C P=0.036)were decreased with the deterioration of nutritional status,resting energy expenditure(A vs.B P=0.023;A vs.C P=0.002;B vs.C P=0.032),and RQ(A vs.C P=0.004;B vs.C P=0.012)were also increased with the deterioration of nutritional status,and there was significant difference among three groups.Conclusions The incidence of malnutrition is high in hepatocarcinoma patients undergoing surgical treatment.The patients can have lower lean body mass,more water retention,and higher energy metabolism,which may worsen along with the deterioration of nutritional status.