This study was designed to explore the treatment effect of imperatorin(Imp)on chronic endometritis(CE)and the possible mechanism.A rat model of CE was established by injecting phenol gel into the ovary and was grouped into CE group,Imp low dose group(ImpL group,5 mg?kg-1?d-1),Imp high dose group(ImppH group,10 mg?kg-1?d-1),and ImpH+lipopolysaccharide(LPS,10 mg/kg)groups,while sham-treated rats were grouped as control group(CT group).Uterine organ index of all groups were measured;hematoxylin eosin(HE)staining was applied to observe the pathological changes of uterine tissue;immunohistochemistry was applied to detect the expression of vascular endothelial growth factor(VEGF)in the endometrium;ELISA was used to measure the levels of serum IL-6 and TNF-α;RT-qPCR and Western blot were applied to verify the expression of IL-1β,nuclear factor-κB(NF-κB),NOD-like receptor protein 3(NLRP3),and matrix metalloproteinase(MMP)-9 in uterine tissue.Compared with the CT group,the uterus and vagina of the CE group were swollen and congested,and the expression of VEGF in the endometrium was decreased(P<0.05),the levels of IL-6 and TNF-α in serum and the expressions of IL-1β,p-NF-κB/NF-κB,NLRP3,and MMP-9 in uterine tissue were increased(P<0.05).Imp could reverse these pathological changes mentioned above in CE model,while LPS was able to partially suppress the improvement effect of ImpH on CE rats.In conclusion,Imp may have a certain therapeutic effect on CE by inhibiting the activation of NLRP3 inflammatory pathway.

Objective:To investigate the application value of augmented reality navigation combined with indocyanine green(ICG) fluorescence imaging technology in laparoscopic anatomical segment 8 liver resection.Methods:Clinical and pathological data from 8 patients with hepatocellular carcinoma located in segment 8 of the liver admitted to the First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University from October 2021 to October 2022 were collected restrospectively. Among them,there were 5 males and 3 females,aged between 40 and 72 years. During the operation,the self-developed laparoscopic augmented reality surgical navigation system was used to integrate the three-dimensional liver model with the laparoscopic scene,and ICG fluorescence imaging technology was used to guide the anatomical liver resection of segment 8. The predicted liver resection volume and actual liver resection volume,related surgical indicators and postoperative complications were analyzed.Results:Among the 8 patients, 4 underwent laparoscopic anatomical segment 8 liver resection,1 underwent laparoscopic anatomical ventral subsegment of segment 8 liver resection,2 underwent laparoscopic anatomical ventral subsegment combined with medial subsegment of segment 8 liver resection, and 1 underwent laparoscopic anatomical dorsal subsegment of segment 8 liver resection. All operations were completed under the guidance of augmented reality navigation combined with ICG fluorescence imaging,without conversion to open surgery. The operation time was (276.3±54.8)minutes(range:200 to 360 minutes). Intraoperative blood loss was (75.0±35.4)ml(range:50 to 150 ml). No blood transfusion was performed during the operation. The length of postoperative hospital stay was (7.6±0.8)days(range:7 to 9 days). There were no deaths or postoperative complications such as bleeding or biliary fistula during the perioperative period.Conclusion:Augmented reality navigation combined with ICG fluorescence imaging technology can guide the implementation of laparoscopic anatomical segment 8 liver resection.

Objective:To investigate the application value of augmented reality navigation combined with indocyanine green(ICG) fluorescence imaging technology in laparoscopic anatomical segment 8 liver resection.Methods:Clinical and pathological data from 8 patients with hepatocellular carcinoma located in segment 8 of the liver admitted to the First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University from October 2021 to October 2022 were collected restrospectively. Among them,there were 5 males and 3 females,aged between 40 and 72 years. During the operation,the self-developed laparoscopic augmented reality surgical navigation system was used to integrate the three-dimensional liver model with the laparoscopic scene,and ICG fluorescence imaging technology was used to guide the anatomical liver resection of segment 8. The predicted liver resection volume and actual liver resection volume,related surgical indicators and postoperative complications were analyzed.Results:Among the 8 patients, 4 underwent laparoscopic anatomical segment 8 liver resection,1 underwent laparoscopic anatomical ventral subsegment of segment 8 liver resection,2 underwent laparoscopic anatomical ventral subsegment combined with medial subsegment of segment 8 liver resection, and 1 underwent laparoscopic anatomical dorsal subsegment of segment 8 liver resection. All operations were completed under the guidance of augmented reality navigation combined with ICG fluorescence imaging,without conversion to open surgery. The operation time was (276.3±54.8)minutes(range:200 to 360 minutes). Intraoperative blood loss was (75.0±35.4)ml(range:50 to 150 ml). No blood transfusion was performed during the operation. The length of postoperative hospital stay was (7.6±0.8)days(range:7 to 9 days). There were no deaths or postoperative complications such as bleeding or biliary fistula during the perioperative period.Conclusion:Augmented reality navigation combined with ICG fluorescence imaging technology can guide the implementation of laparoscopic anatomical segment 8 liver resection.

【Objective】 To detect the expressions of microRNA（miR）-362 and histone deacetylase 6 （HDAC6） in bone cancer pain （BCP） rats and investigate the analgesic effect of miR-362 and its potential analgesic mechanism. 【Methods】 The BCP model was developed by injecting Walker 256 mammary gland carcinoma cells into bone marrow cavity. Plasmid transfection was used to regulate the expressions of miR-362 and HDAC6. The Van Frey filaments and radiant heat instrument were used to detect the paw withdrawal threshold （PWT） and paw withdrawal latency （PWL）. qRT-PCR was used to detect mRNA expression levels of miR-362 and HDAC6， and Western blotting was used to detect protein expression of HDAC6 and nuclear factor kappa-B p65 （NF-κB p65）. ELISA assay was used to detect the protein levels of interleukin （IL）-1β， IL-6 and tumor necrosis factor α （TNF-α）. Luciferase activity assay was used to determine the relationship between miR-362 and HDAC6. 【Results】 Compared to sham group， the significant decrease of PWT and PWL， decrease of miR-362 and the increase of HDAC6 mRNA and protein in the spinal were detected in BCP group （P<0.05）. Compared to BCP group， the significantly increase of PWT and PWL and decrease of HDAC6 mRNA and protein in the spinal were detected in BCP+LV-miR-362 group （P<0.05）. Compared to BCP+LV-miR-362 group， PWT and PWL significantly decreased in BCP+LV-miR-362+LV-HDAC6 group （P<0.05）. In addition， compared to BCP group， significant decreases of NF-κB p65， IL-1β， IL-6 and TNF-α in spinal were detected in BCP+LV-HDAC6 siRNA group （P<0.05）. Moreover， compared to mimic miR-362+HDAC6 3’UTR^MUT group， the luciferase activity significantly decreased in mimic miR-362+HDAC6 3’UTR^WT group （P<0.05）. 【Conclusion】 As a key factor regulating the mechanism of BCP through “HDAC6-NF-κB p65” signal pathway in rats， targeting miR-362 may be a novel therapeutic method for BCP.

Objective To explore the application value of three-dimensional visual (3DV) assessment and virtual reality (VR) study of type Ⅲ and Ⅳ hilar cholangiocarcinoma with portal vein as the axis.Methods The CT image data of 10 patients who were diagnosed as Bismuth type Ⅲ and Ⅳ hilar cholangiocarcinoma by B-ultrasound and CT in Zhujiang Hospital,Southern Medical University were imported into 3D visualization system (3DVS) for 3D image reconstruction,and the portal vein was used as the axis for 3DV analysis and evaluation.The 3D data were then imported into the VR development engine to perform VR research,so as to help the operation planning.Both of the image data were taken into the operation room for intraoperative navigation.Results 10 patients completed 3D visualization reconstruction and VR model transformation.According to the 3D visualization of hepatic hilar hepatocarcinoma,there were 1 case of type Ⅱ,2 cases of type Ⅲa,5 cases of type Ⅲb,1 case of type Ⅳa and 1 case of type Ⅳb.The portal vein was classified according to Cheng type:6 cases of type Ⅰ,3 cases of type Ⅱ,and 1 case of type Ⅲ.The hepatic artery was classified according to Michels type:5 cases of type Ⅰ,1 case of type Ⅱ,3 cases of type Ⅲ,and 1 case of type Ⅸ.The 3DV assessment and VR study were almost consistent with the intraoperative findings.No liver failure or death occurred during the perioperative period.Conclusion The 3DV assessment and VR study with the portal vein as the axis have potential application for the surgical treatment of type Ⅲ and Ⅳ hilar cholangiocarcinoma.

Objective To explore the application value of multimodal image fusion technology in the diagnosis and treatment of intrahepatic cholangiocarcinoma (ICC).Methods The retrospective descriptive study was conducted.The clinicopathological data of 11 patients with ICC who were admitted to Zhujiang Hospital of Southern Medical University between January and September 2018 were collected.There were 5 males and 6 females,aged (55 ± 12)years,with a range from 30 to 74 years.The data of contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) with gadoxetate disodium (Gd-EOB-DTPA) of the upper abdomen were respectively collected,and three-dimensional(3D) model of liver was constructed based on CT-MRI fusion images.The preoperative evaluation and surgical planning were carried out based on the different modal imaging examination technologies.The indocyanine green (ICG) molecular fluorescence imaging system and augmented reality navigation system were used to guide hepatectomy.Observation indicators:(1) preoperative evaluation;(2) intraoperative situations;(3) comparison between surgical planning based on the different model imaging technologies and actual surgical method;(4) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications up to November 2018.Measurement data with normal distribution were represented as Mean ± SD,measurement data with skewed distribution were represented as M (range).Count data were described as absolute number or percentage and comparisons were analyzed using the paired chi-square test.Results (1) Preoperative evaluation:the proportions of grade 3 and above branch vessels of the portal vein and hepatic vein system and tumor margin by enhanced CT examination and enhanced MRI examination were respectively 11/11,4/11 and 5/11,11/11,with statistically significant differences in above indicators (x2 =4.16,5.14,P＜0.05).The enhanced CT showed 11 liver cancer lesions and enhanced MRI showed 13 lesions (including 2 lesions not demonstrated by enhanced CT,with a maximum diameter ≤ 10 mm).The 3D model of liver based on CT-MRI fusion image:location,number,infiltrating range (tumor boundary),intrahepatic vascular distribution,variation and its spatial relationship with lesions could be stereoscopically,intuitively and comprehensively displayed.(2) Intraoperative situations:of 11 patients,11 lesions were explored with naked eyes;13 lesions were detected by ICG molecular fluorescence imaging system,including 2 lesions showing low uptake lesions in liver and gallbladder specific period by preoperative MRI examinations and intrahepatic metastasis cancer by pathologic examination.Of 11 patients,6 had naked-eye ischemia boundaries around related vessels of hepatic portal ligation;10 with anatomical hepatectomy had hepatic segments or hemihepatic boundary by ICG molecular fluorescence imaging system,including 2 using positive staining and 8 using anti-staining.Among 11 patients,3 (1 combined with local resection of hepatic segment Ⅷ metastases),2,2,1,1,1 and 1 underwent respectively left hepatectomy,left lateral lobectomy of liver,right hepatectomy,extended right hepatectomy,right lobectomy of liver,resection of partial hepatic segment Ⅷ and mesohepatectomy.Seven of 11 patients received regional lymph node dissection and 4 received simple lymph node biopsy.Of 11 patients,1 diagnosed as with bile leakage of liver section underwent suture and ligation treatment with 4-0 Prolene;10 didn't occurred bile leakage.The surgical margin of 11 patients was negative.The operation time,volume of intraoperative blood loss and duration of hospital stay were (240± 118)minutes,(275±249)mL and (13 ± 8) days,respectively.There was no blood transfusion in the perioperative period.(3) Comparison between surgical planning based on the different model imaging technologies and actual surgical method:surgical planning of 3D model based on CT,MRI and CT-MRI fusion image in 6,9 and 11 patients was respectively consistent with actual surgical method.(4) Follow-up:11 patients were followed up for 2-10 months,with a median time of 6 months.Three patients had postoperative complications,2 of which were found in Clavien-Dindo Ⅰ and Ⅱ,including 1 with pleural effusion + peritoneal effusion and 1 with pleural effusion,they were improved after conservative treatment;1 with complication of Clavien-Dindo Ⅲ (postoperative intra-abdominal bleeding) was improved by selective arterial embolization using percutaneous femoral artery puncture.There was no postoperative bile leakage,hepatic failure and death.Conclusion Multimodal image fusion technique is helpful to optimize the preoperative surgical planning,which can assist the recognition of important vessels and real-time navigation of hepatectomy during operation,and improve the safety of operation.

OBJECTIVE:To observe clinical efficacy and safety of Brucea javanica oil combined with gemcitabine and cisplat-in in the treatment of advanced non small cell lung cancer(NSCLC). METHODS:Totally 131 advanced NSCLC patients selected from Huanggang Hospital of TCM during Feb. 2014 to Jan. 2016 were divided into observation group(71 cases)and control group (60 cases)according to random number table. Control group was given Gemcitabine for injection(1st and 8th day)+Cisplatin injec-tion (2nd day),every 21 days,twice as a treatment course. Observation group was additionally given Breucea javanica oil oral emulsion 20 mL,po,2-3 times/d,for consecutive 14 d (3 days before chemotherapy). Both groups received treatment for 87 d and followed up until Jul. 1,2016. Clinical efficacy,the levels of T cell subsets (CD3+,CD4+,CD8+),survival time were ob-served in 2 groups. Single factor and multiple factor analysis was conducted for survival time. The occurrence of ADR was record-ed. RESULTS:The total response rate of observation group (32.39%) was higher than that of control group (25.00%),without statistical significance(P>0.05). Before treatment,there was no statistical significance in the levels of CD3+,CD4+ and CD8+ be-tween 2 groups(P>0.05). After treatment,the levels of CD3+ and CD4+ in observation group were increased significantly,while CD8+ level was decreased significantly;there was statistical significance compared to control group at corresponding period (P<0.05). Four patients withdrew from the study in observation group and 3 patients in control group. The survival time of observation group [(14.02 ± 4.10) months] was longer than control group [(13.21 ± 5.22) months],without statistical significance (P>0.05). Single factor analysis showed that the survival time of patients aged <70 were significantly longer than those of patients aged ≥70;those of patients with pleural effusion were significantly shorter than those of patients without pleural effusion;there was statis-tical significance (P<0.05). Multiple factor analysis showed that with or without pleural effusion,age were influential fac-tors for survival time of patients with advanced NSCLC(OR=1.685 and 0.647,P=0.012 and 0.043). There was no statistical significance in the incidence of ADR between observation group (50.70%) and control group (53.33%)(P>0.05). CONCLU-SIONS:Brucea javanica oil combined with gemcitabine and cisplatin in the treatment of advanced NSCLC patients,although not significantly improve the therapeutic effect,but can significantly improve the cellular immune function. With or without pleural effu-sion and age are infuential facters for survival time of advanced NSCLC patients.

Objective: To discuss the application of three dimentional(3D)visualization technologies in treatment plan of hepatic malignant tumor. Methods: The clinical data of 300 patients with liver malignant tumor who received treatment from January 2016 to January 2017 in the Third Department of Hepatic Surgery of Eastern Hepatobiliary Surgery Hospital was retrospectively analyzed in this study, including 221 male and 79 female patients aged from 7 to 76 years with median age of 54 years. The median height was 168 cm (115-183 cm), the median weight was 65 kg (20-105 kg) and the median tumor volume was 142 ml (23-2 493 ml). Three-dimensional visualization technology was used in all patients to reconstruct liver three-dimensional graphics. Also, two and three-dimensional methods were taken respectively to evaluate patients and develop treatment strategy. The change of treatment strategy caused by 3D evaluation, actual surgical plan, operation time, time of hepatic vascular occlusion, intraoperative blood loss, volumes of blood transfusion and postoperative complications was observed. Results: After three-dimensional visualization technology was applied, 75(25%) of 300 patients′ treatment strategies had been changed. The range of hepatectomy was extended in 25 patients. And 7 of them were due to hepatic venous variation, which resulted in increasing drainage area. In other 4 patients, liver resections were extended due to lack of perfusion of the liver parenchyma after the removal of portal vein. And hepatectomy was expanded in 14 patients in order to increase the surgical margin. The range of hepatectomy was reduced in 8 patients, 4 of which were due to hepatic venous variation, such as hepatic vein of segment 4 or lower right posterior hepatic vein. The remaining 4 cases were because of insufficient residual liver volume.The surgical resection was performed in 278 cases, 257 of which received operation directly. Left hepatectomy was performed in 24 patients and right hepatectomy was performed in 33 patients. Left trisectionectomy was carried out in 12 patients and right trisectionectomy was carried out in 11 patients. Caudate lobectomy was applied in 10 patients. There were 18 cases of left lateral sectionectomy, 7 cases of right anterior sectionectomy, 25 cases of right posterior sectionectomy and 18 cases of mesohepatectomy. Single or multi segment resection was performed in 99 patients. The treatment strategy of thirty-six patients was converted to staged hepatectomy (ALPPS 11 cases and portal vein embolization 25 cases). The median operation time was 130 minutes (90-360 minutes) and the median inflow blood occlusion time was 20 minutes (0-75 minutes). Median blood loss volume was 200 ml (20-1 600 ml). Thirty-seven of 278 patients received transfusions, and the average red blood transfusion volume was (4.4±1.7)units (0-8 units). Median hepatic resection volume was 530 ml(30-2 600 ml). There were 117 cases of pleural effusion after operation, including 3 patients needing invasive therapy. Ascites occurred in 23 patients, 6 of whom needed invasive therapy. Biliary leakage was observed in 30 patients. Eight patients occurred hepatic cutting surface hemorrhage, 6 of whom received blood transfusion, and 4 of whom underwent laparotomy to stop bleeding. Three patients had pulmonary infection after surgery and 3 patients appeared biliary obstruction. Deep vein thrombosis took place in 2 patients and portal vein thrombosis was observed in 4 patients. No postoperative liver failure and death ever happened in our study group. Conclusion Three-dimensional visualization technique can optimize the treatment strategy of patients with liver malignant tumor, improve surgical safety.

Objective To explore the application value of three-dimensional visualization technology in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Methods Clinical data of one patient with hepatocellular carcinoma (HCC) undergoing ALPPS using three-dimensional visualization technology were analyzed retrospectively. The patient was female, aged 44 years, was hospitalized due to transaminase elevation for 3 months and solid hepatic lesion for 3 d. She had a history of hepatitis B. She was diagnosed with massive HCC in the right liver lobe. The informed consents of the patient was obtained and the local ethical committee approval was received. Preoperative evaluation and surgical planning were performed using computer tomography (CT) scan and medical imaging three-dimensional visualization system (MI-3DVS). Results Total liver volume was 1 033 ml and the left lobe volume was 195 ml, accounting for 16%of the standard liver volume measured by three-dimensional visualization technology before the ifrst-stage surgery. The right branch of portal vein was ligated and the left and right liver lobes were separated. Total liver volume was 1 048 ml and the left lobe volume was 394 ml, accounting for 33%of the standard liver volume measured by three-dimensional visualization technology 3 weeks after surgery. Right hemihepatectomy was performed during the second stage. The ifndings of preoperative three-dimensional visualization technology were consistent with intraoperative observation. Preoperative surgical planning was in accordance with intraoperative procedures. No apparent complication was observed after surgery. Conclusion Three-dimensional visualization technology is a favorable supplementary option for ALPPS in making the preoperative precise diagnosis and detailed surgical planning.

OBJECTIVETo explore the application value of the MI-3DVS in patients with hepatic artery variation receiving duodenopancreatectomy.

METHODSA total of 114 patients who had undergone pancreatoduodenectomy were retrospectively summarized and analyzed during January 2010 to July 2012. The clinical data of 64-slice multidetector CT angiography (64-MDCTA) scanning was introduced into MI-3DVS for procedural segmentation, registration and 3-dimensional reconstruction. Based on the reconstructed 3-dimensional model, the origination and bifurcations of variant hepatic artery was observed. And its anatomical relationships with abdominal organs and vessels were also observed. Thereafter, preoperative procedures planning was formulated. The findings were compared to those found during the operation and by postoperative digital subtraction angiography (DSA) of coeliac artery.

RESULTSThe abdominal 3D models can clearly display the size and shape of tumor, the origin and course of the blood vessels, as well as the 3D anatomic relationship between tumors and organs, blood vessels. A total of 14 cases (12.3%, 14/114) were found with variant, including 9 cases (7.9%) with replaced right hepatic artery arising from superior mesenteric artery, 3 cases (2.6%) with replaced common hepatic artery arising from superior mesenteric artery, 2 cases (1.8%) with replaced left hepatic artery arising from left gastric artery. The 14 patients all received standard procedures of duodenopancreatectomy. Compared to the intraoperative findings and postoperative DSA examination, the sensitivity, specificity and accuracy of MI-3DVS to variant hepatic artery is 100%. The preoperative planning guided by MI-3DVS is in line with the intraoperative findings.No postoperative complications occurred in all 14 patients, including hepatic abscesses, biliary fistula and liver failure.

CONCLUSIONSMI-3DVS can accurately diagnose hepatic artery variation before duodenopancreatectomy. Therefore, it contributes to the formulation of preoperative surgical plans.It also increases the success rate of the surgical operations and decreases the occurrence of postoperative complications.

Adult ; Aged ; Aged, 80 and over ; Female ; Hepatic Artery ; abnormalities ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Pancreaticoduodenectomy ; instrumentation ; Retrospective Studies ; Tomography, Spiral Computed ; Young Adult