Abstract:Abstract:Objective：To explore the safe technique of caudate lobectomy for liver cancer in candafe lobe(LCCL).
Methods ：The clinical data of 11 cases of primary liver cancer in caudate lobe who received hepatectomy successfully were retrospectively analyzed. four procedures were used in the operations:（1）selection of appropriate skin incision, so as to obtain excellent exposure of operative field;（2）adequate mobilization of the liver to allow the liver to be displaced upwards to the left or to the right;（3）preparatory placement of tapes for total hepatic vascular isolation,so that this procedure can be used when necessary;（4）selection of the ideal route for hepatectomy based on the condition of the tumor and, if necessary, the combined removal of multiple lobes. Among the 11 cases, simple occlusion of vessels of porta hepatis was used for candate lobectomy in 6 cases, while, in the other cases, the vessels were intermittently occluded several times or total hepatic vlascular isolation was used for the caudate lobectomy. combined partial right hepatectomy was done in 2 cases, combined left lateral lobectomy in 3 cases and caudate lobectomy alone in 6 cases.
Results：Operation was smooth and successful in all of the 11 cases, and there was no mortality.
Conclusions：Caudate lobectomy for LCCL can be safely performed when the above procedures are used.

Abstract:Abstract:Objective：To investigate the effects of TACE in preventing post-operative tumor recurrence and increasing survival rate for primary hepatocellular cancer patients.
Methods ：Forty two patients with primary hepatocellular cancer were studied in this research. Transcatheter arterial chemoembolization (TACE) was performed in 22 patients after operation but not in the other 20 patients. The post-operative recurrence rate of the tumors and the survival rate of the patients were compared between the two groups.
Results：In TACE group, the tumor recurrence rate within one year after operation was remarkably lower than that of the control group(P<0.05). But there was no significant difference in the tumor recurrence rate two years after operation between the two groups(P>0.05). The one-year survival rate (76.1％) and two-year survival rate(48.2％) of TACE group were both significantly higher than those of the control group(52.8％,23.6％)(P<0.05).
Conclusions：Transcatheter arterial chemoembolization after operation could remarkably decrease the tumor recurrence rate and increase post-operative survival rate.

Abstract:Abstract:Objective：To investigate the changes and significance of dendritic cells (DCs) in hepatocellular carcinoma （HCC） tissue and peripheral blood after transcatheter arterial chemoembolization （TACE）.
Methods ：Surgical specimens were obtained from 17 HCC patients who had been treated by operation after TACE and 30 patients operated on without TACE. The infiltration of DCs in HCC tissue was measured by immunohistochemistry method. Peripheral blood was obtained from 37 patients with HCC treated by TACE. The blood was obtained on the day before TACE, the first day , the 7th day and the 15th day after TACE respectively. The counts of DCs in peripheral blood were quantified by flow cytometry.
Results：The infiltration of DCs in HCC tissue which had been treated by oparation after TACE was lower than that of the groap not treated by TACE(P<0.05). On the 7th and 15th day after TACE, the counts of DCs in peripheral blood decreased significantly (P<0.05).
Conclusions：After TACE, the infiltration of DCs in HCC tissue decreased, and the counts of DCs in blood were also decreased. This could be one of the reasons why HCC can recurr and metastasize easily after TACE.

Abstract:Abstract:Objective：To study expression of CD147 in rabbit VX2 tumor tissues after transarterial embolization with hydroxyapatite nanoparticles loaded with lipiodol.
Methods ：Thirty rabbits implanted with tumor tissue of cell line VX2 were divided into three groups: control group, lipiodol group, and hydroxyapatite nanoparticles loaded with lipiodol group. The transarterial embolization was performed superselectively via gastroduodenal artery of rabbits, and each rabbit in control group was infused with 1ml normal saline, that in lipiodol group was infused with 0.3ml lipiodol per kg, and o.3ml hydroxyapatite nanoparticles loaded with lipiodol per kg for that in the last group.Results of treatment were detected by using CT on day 3 after operation. After two weeks, three-step Immunohistochemical technique(S-P) and Western blot technique were used to investigate the expression of CD147 in tumor tissues of the 3 groaps. Results：Immunohistochemical results showed that CD147 was expressed on membrane of tumor cells in all three groups. The positive ratios of CD147 in three groups were （31.33±5.88）%,（75.63±4.44）%, and （80.03±5.59）% respectively, while the expression of CD147 in tumor tissues in control group was significantly different from others（P<0.01）, but for the other two groups, there was no difference between them（P＞0.05）. Protein half-quantitation detecting of CD147 with Western blot technique displayed that expression of CD147 in tumor tissues increased after embolization in last two groups as compared to that of control group（P<0.05）.Conclusions：There was an increasing tendency expression of CD147 in tumor tissues after transarterial embolization with hydroxyapatite nanoparticles loaded with lipiodol or only with lipiodol, and it may be one of the important factors for the high recurrence rate of hepatocellular carcinoma after embolization treatment.

Abstract:Abstract:Objective：To investigate the inhibitory effect of octreotide on transforming growth factor-alpha (TGF-α)-induced cell proliferation of human hepatocellular carcinoma cells and its possible mechanism.
Methods ：The effect of octreotide on TGF-α-induced cell proliferation of the liver cancer cells (LCC) was evaluated by immunohistochemistry method. The effect of octreotide on TGF-α secretion and epidermal growth factor receptor(EGFR) expression in the cells was determined by reverse-transcriptase polymerase chain reaction(RT-PCR). The effect of octreotide on extracellular signal-regulated protein kinase (ERK) expression in the cells was measured by Western-blot and immunohistochemistry method.
Results：The TGF-α-induced expressions of proliferating cell nuclear antigen (PCNA) in nucleus were obviously increased by TGF-α. TGF-αmRNA index of hepatocellular carcinoma cells was decreased by octreotide. Octreotide inhibited significantly the expressions of EGFR mRNA induced by TGF-α. Octreotide inhibited significantly the expressions of ERK protein induced by TGF-α. There was intense staining in the nucleus of the cells by TGF-α and weak staining in the nucleus of the cells treated simultaneously by octreotide and TGF-α.
Conclusions：Octreotide can inhibit the secretion of TGF-α, the expression of EGFR, and the signal transduction of EGFR of LCC, and consequently exerts an inhibitory effect on TGF-α-induced hepatocellular carcinoma cells proliferation.

Abstract:Abstract:Objective：To study the effect of reconstructed hepatic blood flow after partial portal vein arterialization on hepatic microvasculature and histology.
Methods ：Experimental model of partial portal vein arterialization was established in rats. The changes of hepatic microvasculature and histology in the rat model were observed.
Results：One month after arterio-portal shunt, the hepatic tissues showed no significant abnormality. However, corrosive cast samples showed that hepatic sinusoids were slightly thicker and their filling was more obvious than normal, but were not obviously deformed, and were distributed around the central vein in a radial form. Ink perfusion samples showed that hepatic sinusoids were regular and slightly wider. Their colour was homogeneous and slightly deeper.
Conclusions：Partial portal vein arterialization has no early effect on hepatic microvasculature and histologic structure.

Abstract:Abstract:Objective：To explore the effect of hepatic intra-arterial injection of emulsions of lipidol and pingyangmycin (EL+P) on normal hepatic tissues.
Methods ：Forteen big-ear white rabbits were divided into three groups: sham-operation group, A group (low dose of EL+P),and B group(high dose of EL+P). Laparotomy was performed, and various doses of EL+P were perfused into the hepatic artery. Biopsy specimens were obtained on the 1st, 2nd, 4th, and 6th week respectively after the operation. Hematoxylin-eosin stain, immunohistochemistry stain of platelet derived growth factor B(PDGF-B) and quantitative analysis were performed.
Results：The main manifestation of A group was transient hepatocyte hydropic degeneration; in group B the degeneration of hepatocytes was most severe in the 2nd week. Fibrosis appeared in the 4th week,and obvious pseudolobules were formed in some parts of the liver in the 6th week. The expression of PDGF-B was mainly concentrated on the membrane of hepatocytes and fibrotic septum.
Conclusions：Hepatic intra-arterial injection of EL+P can result in damage of normal hepatic tissue. PDGF-B participated in the process of hepatic fibrosis.

Abstract:Abstract:Objective：To investigate the significance of activation of nuclear factor-κB(NF-κB) and expression of tumor necrosis factor-alpha(TNF-α)mRNA in hepatocellular carcinoma.
Methods ：Chemoluminescent electrophoretic mobility shift assay(EMSA) was used to detect the activity of NF-κB in normal liver tissues, hemangiomas of liver, HCC tissues and tissues adjacent to cancer; and expression of TNF-α mRNA in each group was detected by RT-PCR analysis.
Results：Expression of TNF-α mRNA in tissues adjacent to cancer and HCC tissues groups was 0.36±0.16 and 0.68±0.21,respectively, significantly higher than that in normal liver tissues and hemangiomas of liver 0.24±0.12 and 0.21±0.10 (all P<0.05). The activity of NF-κB in tissues adjacent to cancer and HCC tissues was significantly higher than that in normal liver tissues and hemangiomas of liver (P<0.05),and the expression of TNF-α mRNA in tissues adjacent to cancer and HCC tissues had a significant positive correlation with the activity of NF-κB(r=0.773,P<0.05; r=0.838,P<0.05, respectively).
Conclusions：Abnormal activation of NF-κB signal transduction pathway and TNF-α was related to development and progression of HCC.

Abstract:Abstract:Objective：To investigate how to prevent injury to non-heart-beating donor (NHBD) in rat orthotopic liver transplantation and improve the success rate of operation.
Methods：Male SD rats were divided into non-heart-beating time 30min (N-30) and non-heart-beating time 45min (N-45) group randomly.Thirty liver transplants were performed in each group. Meanwhile,a routine operation group and a modified operation group were also set up according to the surgical procedure of donor operation.
Results：(1) In routine operation and modified operation group cold ischemia time was (70.04±1.48) and (70.36±1.42)min(P>0.05) respectively,but anhepatic phase, IVC clamping time and recipient operation time in both groups was (70.32±1.53)min, (16.40±0.73)min,(22.75±1.16)min and(90.58±3.76)min, respectively; (2) In N-30 and N-45 groups, there were 5 and 9 recipients who died of primary graft non-function(PGN) in normal group,but only 1 and 2 recipients, respectively, died of PGN in modified operation group(40% Vs 12%,P<0.05).(3)In N-30 and N-45 groups, 5 and 7,2 and 2,2 and 1 recipients,respectively, died of grafted liver bleeding after reperfusion ,deep anesthesia, and prolongation of anhepatic phase. (4) One-week survival rate was 50% and 30% in N-30 and N-45 group respectively(P<0.05).
Conclusions：The key to improve the success rate of rat orthotopic liver transplantation is to prevent these factors,including injury in donor removal, grafted liver bleeding after reperfusion,deep anesthesia, and prolongation of anhepatic phase.

Abstract:Abstract:Objective：To investigate the protective effect and mechanism of warm ischemic preconditioning of on liver cold ischemic-reperfusion injury of donor liver in rats.
Methods ：Male Sprague Dawley rats were used as donors and recipients of orthotopic liver transplantation, the cold ischemia period and anhepatic phase was 120 min and 16~20 min respectively. Rats were randomly divided into 3 groups: sham-operation group, liver transplantation group, and ischemic pre-conditioning（IP） group. IP was performed with 5-min ischemia followed by 5-min reperfusion.
Results：After operation, the serum levels of ALT and superoxide were significantly higher in the groups of liver transplantation and IP group than in the sham-operation group(P﹤0.05), and they were lower in IP group than those in liver transplantation group(P﹤0.05), but activity of anti-oxidase was higher in IP group（P﹤0.05）.Plasma NO concentrations were marked higher in the groups of liver transplantation and IP at 2h, 4h, 24h and 72 h after operation than those in sham-operation group (P﹤0.05), and at 72 h were higher in liver transplantation than those in IP and sham-operation group, and higher in IP group than in sham-operation group. Serum TNF-α levels were obviously increased in liver transplantation than those in IP and sham-operation groups （P﹤0.05）.
Conclusions：Warm IP for donor liver could obviously protect rat liver graft from cold ischemic-reperfusion injury, its mechanism might be that IP can rapidly increase serum NO level, maintain a steady level of serum NO, decrease TNF-α generation from inflammatory cells and thus diminish cellular injury of liver graft.

Abstract:Abstract:Objective：To investigate the mechanism of alternation of PKC activify in liver ischemia preconditioning(IP).
Methods ：After establishment of rat liver IP model, PKC inhibitor and activator were utilized to analyze the phosphorylation of PKC and P44/42MAPKs and HSP expression, and cellular structure was also observed. All of the data were statistically analyzed.
Results：Compared with the control group without IP, the phosphorylation of PKC was significantly increased in IP treated models and PKC activated group(P< 0.01), and P44/42 MAPKs and expression of HSP 70 were also obviously increased, but with little change of hepatic cellular structure. In contrast, opposite changes were found in PKC inhibited groups, the phosphorylation PKC was decreased in PKC inhibited group(P< 0.01) and marked changes in hepatic cellular structure.
Conclusions：The IP model has shown that PKC activation plays a pivotal role in the activation of P44/42 MAPKs pathway that participates in the preservation of liver cells. At the same time, HSP expression is regulated by signals in P44/42 MAPKs pathway.

Abstract:Abstract:Objective：To determine the delayed protective effect of diazoxide(DE), as an ischemic preconditioning (IPC) simulator, on inhibition of ischemia/reperfusion induced hepatocyte apoptosis in rats.
Methods ：Four groups of SD rats (n=8 each) were pretreated with: (1) 5-min period of liver ischemia (IPC group); (2) DE 5mg/kg iv (DE group), (3) DE plus 5-hydroxydecanoate (DE+5-HD group), and (4) with saline(control or C group). Twenty-four hours later, the pretreated rats were subjected to 60-min sustained liver ischemia followed by 180-min reperfusion. All rats were only subjected to 70% liver ischemia. An additional fifth (S)group of rats (sham group) was set up, in which only anesthesia and laparotomy were performed twice. Finally, liver samples were obtained to determine apoptotic cells by TUNEL, and the expressions of Bcl-2 protein by immunohistochemical technique, and pathology.
Results：Apoptosis index were higher in C group than those in S group (P<0.01). There were also severe morphologic damages in C group. The levels of expression of Bcl-2 protein were increased (P<0.01) and apoptosis index were decreased (P<0.05) in IPC group and DE group compared with C group. DE+5-HD group had the opposite changes, contrasted to DE group (P<0.05,P<0.01).
Conclusions：DE can mimic the delayed protective effects of IPC, and induce delayed protection against hepatocyte apoptosis, possibly due to increased expression of the Bcl-2 protein.

Abstract:Abstract:Objective： To explore the regulating mechanism of inducible nitric oxide synthase(iNOS) in hepatic injury of obstructive jaundice (OJ) in vivo and in vitro experiments. Methods：(1) Rat hepatocytes were isolated by in situ collagenase perfusion and primary culture. Hepatocytes were pretreated with various concentrations of iNOS inhibitor SMT for 20 min. After pretreatment, 50μM GCDC was added for an additional 24hr. Cells were next detected by FCM and TUNEL.(2) Experimental obstructive jaundice (BDL) was induced by double ligation of the bile duct in rats. After BDL for 3d、7d、14d、and 21d, the apoptotic status in liver of all rats were determined with TUNEL, and iNOS protein in liver of OJ was ditermined with immunohistochemistry method. Results：(1) SMT decreased GCDC-induced apoptosis in a concentration - dependent manner. (2) The apoptotic rate of liver was related to length of time of OJ. Apoptosis index (AI) was highest from rats with 14d bile duct ligation. The stronger the iNOS expression, the higher was the number of apoptotic cells that was found in OJ. Conclusions：iNOS is involved in the regulation and the occurrence and progression of hepatic injury of obstructive jaundice.

Abstract:Abstract:Objective：To evaluate the effect of perioperative enteral immunotrition(IMPACT) on liver regeneration in cirrhotic rats with hepatectomy.
Methods ：Forty-eight cirrhotic rats were randomly divided into two groups: Group A, perioperative standard enteral nutrition group(n=24), receiving standard enteral nutrient NUTRISON during hepatectomy. Group B, perioperative enteral immunonutrition group(n=24), receiving enteral immunonutrient IMPACT after hepatectomy. According to the different time of taking specimens, each group was separated into four subgroups, each subgroup had six rats. The rats in the two groups received equal daily nutritional supplement intragastrically, which was 690kJ/kg per day. Before the 68% hepatectomy, the rats were fed with enteral nutrient for 8 days, and after operation were fed until the day of taking specimens. On the day before hepatectomy and 1st, 4th and 8th postoperative day(POD), MI (mitotic index) of liver cell and PCNA (proliferating cell nuclear antigen) labeling index of hepatocyte were determined.
Results：MI increased significantly in both group on 4th and 8th postoperative day(P<0.05), with the maximal value on 4th day after hepatectomy. The values of MI in B3 and B4 subgroups were significantly higher than those in A3 and A4 subgroups(P<0.05). PCNA labeling index increased significantly in both groups on 1st, 4th and 8th day(P<0.05), with the maximal value on 1st day after hepatectomy. The values of PCNA labeling index in B3 and B4 subgroups were significantly higher than those in A3 and A4 subgroups(P<0.05).
Conclusions：Compared with perioperative standard enteral nutrition, perioperative enteral immunonutrition can enhance the regeneration capacity of the remnant liver and maintain a high ability of regeneration for a longer time after resection of cirrhotic liver of rats.

Abstract:Abstract:Objective：To study the method of preparation of donor liver in liver transplantation.
Methods ：The methods and skills of donor liver preparation and the anomaly artery reconstruction of graft in 64 cases of orthotopic liver transplantation (OLT) were retrospectively analyzed.
Results：All allografts had preparation and were suitable for clinical transplantation. Thirteen cases with hepatic artery anatomy variation were found. Among the 13 cases, 5 cases were reconstructed. Splenic artery (3/5) and gastro-duodenal artery (2/5) were typically used for anastomosis of the variant hepatic arteries. No complications resulted from donor liver preparation.
Conclusions：Correct preparation of the donor hepatic artery and biliary tracts, can decrease the incidence of hepatic artery and biliary tract complications after liver transplantation, and is the key to ensure successful donor liver preparation.

Abstract:Abstract:Objective：To investigate the effects of placing medical collagen sponge on the wound surface for severe rupture of liver.
Methods ：In 132 patients with severe hepatic trauma , 68 cases were randomly enrolled in collgan spong treatment group, in which the hepatic wound was treated with collagen sponge,while the 64cases in control group were treated with commonly used gelatin sponge.
Results：The therapeutic results of collagan spong group were better than those of control group in the hemostatic time ［(19.65±1.28)min vs (34.3±1.2)min］, hemorrhagic volume ［(301.57±56.8)mL vs (642.3±61.8)mL］, abdominal cavity drainage volume［(380.45±12.34)mL vs (693.2±219.4)mL］, recovery time of hepatic tissue ［(30.30±6.42)d vs (62.1±7.2)d］, postoperation complications (re-bleeding , and hepatobiliary leakage) ［11.5% and 3.0% vs 6.3% and 9.5%］, and hospital time stay ［(24.01±4.89)d vs (35.8±5.9)d］ (all with P<0.05 ).
Conclusions：The collagen sponge has stronger effect than gelatin sponge for hemostasis of liver wound. It can closely adhere to surface of wound, the postoperative complications were few and postoperative recovery was fast . Collagen sponge is an excellent and safe biologic material for hepatic trauma.