Objective:This article aimed to systematically evaluate the safety, feasibility and short-term outcomes of laparoscopic versus open radical resection for hilar cholangiocarcinoma.Methods:Relevant medical literatures published before November 30, 2021 were searched using PubMed, EMbase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, CBM databases. Based on predetermined inclusion and exclusion criteria, articles were selected, and RevMan5.4 software was used to conduct the meta-analysis of this study.Results:Twelve comparative cohort articles were enrolled, which included 634 patients. There were 275 patients who underwent laparoscopic radical resection for hilar cholangiocarcinoma in the laparoscopic group, and 359 patients who underwent open radical resection for hilar cholangiocarcinoma in the open group. Meta-analysis showed that when compared with the open group, operation time of the laparoscopic group was significantly longer ( MD=58.36, 95% CI:13.54-103.18). However, intraoperative blood loss ( MD=-79.70, 95% CI:-90.01--69.39), hospital stay ( MD=-3.37, 95% CI:-4.29--2.45) and incision-related complications ( OR=0.36, 95% CI:0.16-0.80) were all significantly less (all P<0.05). The number of lymph node harvested, R 0 resection rates, postoperative bile leakage, intraperitoneal infection and effusion, total complication rates, and perioperative mortality and 1-year survival rates after operation between the two groups were not significantly different (all P>0.05). Conclusion:Laparoscopic radical resection for hilar cholangiocarcinoma was feasible and safe in selected patients carried out in an experienced hepatobiliary surgery center.

Three-dimensional finite element model of elbow was established to study the effect of medial collateral ligament (MCL) in maintaining the stability of elbow joint. In the present study a three-dimensional geometric model of elbow joint was established by reverse engineering method based on the computed tomography (CT) image of healthy human elbow. In the finite element pre-processing software, the ligament and articular cartilage were constructed according to the anatomical structure, and the materials and contacts properties were given to the model. In the neutral forearm rotation position and 0° flexion angle, by comparing the simulation data of the elbow joint with the experimental data, the validity of the model is verified. The stress value and stress distribution of medial collateral ligaments were calculated at the flexion angles of elbow position in 15°, 30°, 45°, 60°, 75°, 90°, 105°, 120°, 135°, respectively. The result shows that when the elbow joint loaded at different flexion angles, the anterior bundle has the largest stress, followed by the posterior bundle, transverse bundle has the least, and the stress value of transverse bundle is trending to 0. Therefore, the anterior bundle plays leading role in maintaining the stability of the elbow, the posterior bundle plays supplementary role, and the transverse bundle does little. Furthermore, the present study will provide theoretical basis for clinical recognizing and therapy of elbow instability caused by medial collateral ligament injury.
Biomechanical Phenomena ; Cadaver ; Collateral Ligaments ; physiology ; Elbow Joint ; physiology ; Finite Element Analysis ; Humans ; Range of Motion, Articular ; Tomography, X-Ray Computed

Objective To analyze the effects of rapid rehabilitation surgical procedures on recovery and stress response in patients undergoing hepatectomy.Methods Retrospective analysis of 60 patients with liver resection in Zhujiang Hospital of Southern Medical University from January 2012 to December 2015,40 males and 20 females.According to the rehabilitation method,it was divided into intervention group (n=30) and control group (n=30).The operation time,intraoperative blood loss,postoperative complications,and interleukin-6 (IL-6),C-reactive protein (CRP),and white blood cell count (WBC) on days 1st,3rd,and 5 th before and after surgery were compared between the two groups.Results Both groups completed the operation successfully.There was no significant difference in intraoperative blood loss and operation time between the two groups (P＞0.05).The duration of postoperative ventilation and postoperative hospitalization in the intervention group was less than that in the control group,and the incidence of postoperative complications (23.3％ vs.50.0％) and the first and second day after surgery were lower than those in the control group,with statistically significant differences (P＜0.05).On the first,third and fifth days after surgery,IL-6 and CRP in the intervention group were lower than those in the control group,respectively (64.96± 24.10) μg/L vs.(286.74±67.98) μg/L,(60.52±18.31)μg/L vs.(162.33±52.62) μg/L,(31.61± 9.42) μg/L vs.(77.44±24.54)μg/L and (24.64±17.45) mg/L vs.(41.46±20.79) mg/L,(81.11± 36.58) mg/L vs.(117.23±44.80) mg/L,(44.90±22.31) mg/L vs.(65.27±38.05) mg/L,the differences were statistically significant (P＜0.05).Conclusion The concept of rapid rehabilitation surgery applied to patients with hepatectomy can reduce postoperative stress response,reduce postoperative complications,and accelerate the recovery process.

OBJECTIVETo investigate the effect of galectin-3 in inducing the differentiation of rat bone marrow mesenchymal stem cells (BMSCs) into hepatocyte- like cells and explore the involvement of the signaling pathways in the induced cell differentiation.

METHODSThe third passage of cultured rat femoral BMSCs were treated with 0.5 μg/mL galectin-3, 20 ng/mL hepatocyte growth factor (HGF) or both to induce their differentiation, with untreated rat BMSCs and hepatocytes as controls. At 7, 14, 21 and 28 days of induction, the cells were examined for morphological changes followed by glycogen staining, quantitative real-time PCR and Western blotting. Gene microarray technique was used to examine the mRNA expression profile of the BMSCs induced with galectin-3. The BMSCs were also induced with galectin-3 in combination with XMU-MP-1, a Hippo signaling pathway inhibitor, after which Western blotting was performed to detect the expressions of YAP, P-YAP, ALB, AFP and CK-18 in the cells.

RESULTSThe cells isolated from the femoral bone marrow of SD rats showed a consistent surface marker phenotype with the BMSCs. Induction with galectin-3, HGF, or both all resulted in gradual morphological changes of the BMSCs into hepatocyte-like cells, and the cells with a combined induction for 28 days showed the highest morphological similarity with hepatocytes. The cells induced with galectin-3, HGF, or their combination for 28 days all showed increased positivity rate of glycogen staining, which was the highest in the cells with combined induction ( < 0.05) without significant difference between the cells induced with galectin-3 and HGF alone ( > 0.05). Induction with galectin-3 and HGF alone both increased the expressions of AFP, ALB and CK-18 mRNAs in the cells, and their expression levels were similar between the cells at 28 days ( > 0.05). Galectin-3 and HGF did not show an interactive effect on the mRNA expressions of AFP (=0.236, =0.640) or ALB (=50.639, =0.000), but had a synergistic effect on CK-18 mRNA expression (=50.639, =0.000). The protein expressions of AFP, ALB and CK18 were also increased in the induced cells but not detected in the cells without induction. Gene microarray results revealed 27 up-regulated genes and 62 down-regulated genes in galectin-3-induced BMSCs involving TGF-β, PI3K-Akt and Hippo signal pathways. Induction with galectin-3 and galectin-3+XMU-MP-1 increased YAP expression in the cells, and galectin-3+XMU-MP-1 was more efficient to induce the differentiation of the BMSCs.

CONCLUSIONSGalectin-3 can induce the differentiation of rat BMSCs into hepatocyte-like cells, and the combination with HGF increases the efficiency of induced differentiation of the cells. TGF-β, PI3K-Akt and Hippo pathways are involved in the induced differentiation of the BMSCs, and inhibiting Hippo pathway can improve the induction efficiency.

Ductular reaction is a kind of repair response to biliary and hepatocellular injury, and the pathological changes include lobular bile duct hyperplasia, matrix change and inflammatory cell infiltrations. In human liver, a ductular reaction originates from the activation and proliferation of hepatic progenitor cells. The activated hepatic progenitor cells, the intermediate hepatocytes and the reactive small bile duct cells together form the cell complex of ductular reaction, which has the dual characteristics of hepatobiliary system and co-expresses the hepatocyte and cholangiocyte antigen. Ductular reaction appears in all kinds of acute and chronic hepatobiliary injury, and plays an important role in liver regeneration and repair, fibrogenesis, cirrhosis formation, and hepatobiliary cancer occurrence and development. Understanding the pathological features and pathophysiological mechanisms of ductular reaction in various clinical hepatobiliary diseases and their role in liver regeneration can provide important suggestion for further exploring new-targeted treatment approach.

Objective To study the correlation between the clinical characteristics of HCC patients with different phenotype circulating tumor cells in the peripheral blood.Methods 77 patients with HCC and 21 patients with benign liver diseases treated at Zhujiang Hospital of Southern Medical University from April 2015 to December 2016 were retrospectively studied.The CanPatrolTM System was adoptedto detect epithelial-mesenchymal phenotype CTCs in the peripheral blood.This study aimed to clarify whether the epithelial-mesenchymal phenotype CTCs were specifically originated from the tumorand to investigate the correlation between CTCs and the clinical features of the patients.Results Using epithelial and mesenchymal markers,the CTCs were divided into three subtypes:epithelial,mesenchymal and mixed CTCs.No epithelial-mesenchymal phenotype CTCs were detected in patients with benign liver diseases.The positivity rates of epithelial,mixed and mesenchymal CTCs in the peripheral blood of 77 patients with HCC were 37.7％ (29/77),74.0％ (57/77) and 50.6％ (39/77),respectively.The positivity rates of epithelial-mesenchymal phenotype CTCs in patients with HCC were significantly higher than the group of patients with benign liver diseases (P ＜ 0.05).The positivity rates of epithelial CTCs were significantly correlated with AFP,number of tumor and portal vein tumor thrombus (P ＜ 0.05).The positivity rates of mixed CTCs were significantly correlated with portal vein tumor thrombus,tumor differentiation and BCLC stage (P ＜ 0.05).The positivity rates of mesenchymal CTCs were significantly correlated with tumor size,portal vein tumor thrombus,tumor differentiation and BCLC stage (P ＜ 0.05).Conclusions The positivity rates of epithelial,mixed and mesenchymal CTCs were closely related to different aspects of clinical characteristics of patients with HCC.These CTCs may serve as indicatorsto evaluatethe progress of HCC.

Objective To evaluate the value of fast track surgery (FTS) in laparoscopic hepatectomy.Methods The clinical data of 142 patients undergoing laparoscopic liver resection from January 2014 to January 2016 were analyzed retrospectively.74 patients received fast track surgery treatment (FTS group) and 68 patients received traditional treatment methods (control group).Results Compared with control group,FTS group had a shorter operative time and less blood lose (t =2.279,t =2.432,P ＜0.05),quicker postoperative intestinal function recovery (t =3.548,P ＜ 0.05),a shorter postoperative hospitalization time (t =2.821,P ＜ 0.05),a lower hospitalization cost (t =2.507,P ＜ 0.05),a lower postoperative VAS scores (t =3.394,t =3.176,t =7.079,P ＜ 0.05) in 3 post-op successive days.There were 3 patients with major post-op complications in FTS group (4.05％,3/74) compared with 4 cases in control group (5.88％,4/68) (x2 =0.253,P ＞ 0.05).Conclusion The application of fast track surgery in laparoscopic liver resection is safe and effective,and helpful in reducing patients' inhospital cost.

Objective To estimate the safety,feasibility and generalization of three point single-incision laparoscopic cholecystectomy (SILC).Methods The clinical data of 1 126 patients who underwent three-point SILC at the second department of Hepatobiliary Surgery of Zhu Jiang Hospital,Southern Medical University From January 1,2011 to December 30,2015 was analyzed retrospectively.The patient who were indicated for conventional laparoscopic cholecystectomy were included,but those suspected malignant diseases of gallbladder were excluded.Results Of the 1126 patients,the surgery was performed successfully in 923 patients,and 192 patients need extra ports due to the adhesion and difficulty of exposing the Calots triangle,and 11 were converted to open surgery due to severe adhesion,with the success rate being 81.9％.The operating time was (29.5 ± 12.2) min (from the entrance of laparoscope to the removing of gallbladder),the blood loss was (8.7 ± 7) ml,and the hospital stay time was (1.4 ± 0.7) d (after surgery).There were three cases of bile duct injury:two of them were bile leak of aberrant duct,one of them was bile leak of cystic duct damaged by heat.And there was one case of injury of duodenum,22 cases of umbilicus hematoma,13 cases of hematoma of thorax,and 2 cases of thoracic hemorrhage who required surgery.There were no hernia,aerothorax and so on.Conclusion Three point SILC is a technology that is safe,maneuverable and suitable for being carried out in clinical practice.

Transarterial chemoembolization (TACE) combined the embolization with chemotherapy,whose efficacy has been verified in the treatment of hepatocellular carcinoma.Factors like the incomplete embolism,the formation of collateral circulation,neoangiogenesis and the like greatly weaken the clinical efficacy of TACE in the long term.Thus,the improvement of TACE efficacy depends on the comprehensive treatment.This paper reviewed the present application status and the progress on the treatment of hepatocellular carcinoma with TACE.

Objective To investigate the measurement , feasibility and clinic effect of hyperthermic intraperitoneal chemotherapy (HIPEC) guided by B ultrasound in the treatment of malignant ascites from peritoneal carcinomatosis. Methods From July 2011 to June 2013, B ultrasound-guided approach was used to perform HIPEC on 36 patients affected by malignant ascites secondary to peritoneal carcinomatosis. Every patient underwent HIPEC for three times , by way of continuous circulatory perfusion into peritoneal cavity with saline at 400 ~ 600 mL/min and intraperitoneal perfusion with 5-FU mitomycin-C and cisplatin for 90 minutes with an inflow temperature of (43 ± 0.2)℃. These patients were followed up for a long term. Results Intraoperative course was uneventful in all cases. Complete clinical regression of ascites and related symptoms was achieved in all the 26 patients, partial regression achieved in 8 patients, and no curative effect achieved in 2 cases. The acquired total clinic effectiveness was 94.44%. No postoperative deaths and complication related to the procedure occurred in this study. The KPS grades of patients rose (P < 0.001), the level of tumor markers decreased, including CA199 (P < 0.001), CEA (P < 0.001), CA125 (P = 0.003). Conclusion HIPEC guided by B ultrasound appears to be a safe, feasible and effective procedure for the treatment of debilitating malignant ascites from unresectable peritoneal carcinomatosis , which would have a clinic good perspective in future.