Evaluation of the therapeutic effects of lateral approach combined with anteromedial approach in the treatment of terrible triad of the elbow

OBJECTIVE

This study aims to evaluate the therapeutic effects of the lateral approach combined with anteromedial approach in the treatment of terrible triad of the elbow.

METHODS

Between June 2010 and January 2015, 334 patients suffering from terrible triad of the elbow, amongst whom 105 cases underwent lateral approaches combined with anteromedial approaches, 112 cases underwent lateral approaches, and 117 cases underwent anteromedial approaches were included in the study. The serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) were detected using enzyme-linked immunosorbent assay (ELISA) before operation and at 7 days and 3 months after operation. X-ray imaging was employed to examine the recovery condition of the elbow, and the joint motion and the forearm rotation of elbow were evaluated before and after the operation.

RESULTS

Excellent rate was obtained in accordance with the Mayo Elbow Performance Score (MEPS). The serum levels of CRP, IL-6, IL-8 and TNF-α gradually decreased to normal levels after the operation, and recovery was faster in patients undergoing lateral approach combined with anteromedial approach in comparison to those undergoing lateral and anteromedial approaches. The X-ray images showed good recovery of elbows in all patients, but the range of joint motion, forearm rotation degree, and MEPS were higher in patients undergoing lateral approach combined with anteromedial approach compared to those undergoing lateral and anteromedial approaches independently.

CONCLUSION

Taken together, these findings demonstrate lateral approach combined with anteromedial approach reveals better therapeutic effect than lateral approach and anteromedial approach in the treatment of terrible triad of the elbow.

Therapeutic effect of curcumin on experimental colitis mediated by inhibiting CD8+CD11c+ cells

AIM

To verify whether curcumin (Cur) can treat inflammatory bowel disease by regulating CD8⁺CD11c⁺ cells.

METHODS

We evaluated the suppressive effect of Cur on CD8⁺CD11c⁺ cells in spleen and Peyer’s patches (PPs) in colitis induced by trinitrobenzene sulfonic acid. Mice with colitis were treated by 200 mg/kg Cur for 7 d. On day 8, the therapeutic effect of Cur was evaluated by visual assessment and histological examination, while co-stimulatory molecules of CD8⁺CD11c⁺ cells in the spleen and PPs were measured by flow cytometry. The levels of interleukin (IL)-10, interferon (IFN)-γ and transforming growth factor (TGF)-β1 in spleen and colonic mucosa were determined by ELISA.

RESULTS

The disease activity index, colon weight, weight index of colon and histological score of experimental colitis were obviously decreased after Cur treatment, while the body weight and colon length recovered. After treatment with Cur, CD8⁺CD11c⁺ cells were decreased in the spleen and PPs, and the expression of major histocompatibility complex II, CD205, CD40, CD40L and intercellular adhesion molecule-1 was inhibited. IL-10, IFN-γ and TGF-β1 levels were increased compared with those in mice with untreated colitis.

CONCLUSION

Cur can effectively treat experimental colitis, which is realized by inhibiting CD8⁺CD11c⁺ cells.

Surgery Combined with Radiotherapy to Treat Spinal Tumors: A Review of Published Reports

Spinal tumors result in high morbidity and a high rate of lower limb paralysis. Both surgical therapy and radiation therapy (RT) are used to treat spinal tumors; however, how best to combine these two therapies to maximize the benefits and minimize the risks is still being debated. It is also difficult to decide the optimal timing, course and dose of RT, especially in pregnant women and children. The aim of this review is to assist surgeons who are dealing with spinal tumors by providing comprehensive information about advanced techniques for administering RT with greater precision and safety, and about the impact of various ways of combining surgery and RT on therapeutic outcomes. We here review published reports about treating spinal tumors with a combination of these two forms of therapy and attempt to draw appropriate conclusions concerning selection of optimal treatment protocols. Our conclusion is that postoperative radiotherapy, especially with high-precision, low-dose and multiple fractions, and brachytherapy are promising therapies to combined with surgery.

Integrated Chinese and Western medicine for treatment of cerebral hemorrhage with gastrointestinal hemorrhage: Curative effect and influence on prognosis

AIM

To observe the clinical effect of integrated Chinese and Western medicine in the treatment of cerebral hemorrhage with gastrointestinal hemorrhage and its influence on prognosis.

METHODS

Seventy patients with cerebral hemorrhage and gastrointestinal bleeding were randomly divided into a control group (n = 35) and an observation group (n = 35). Both groups were treated with hemocoagulase and omeprazole injection, and the observation group was additionally given Xijiao Dihuang decoction. Clinical curative effect and prognosis were compared between the two groups.

RESULTS

The duration of continued bleeding and intracranial hypertension, the amount of blood transfusion, NIHSS score, survival rate, and mortality rate were significantly lower in the observation group than in the control group (t = 17.935, 18.293, 16.386, and 20.915, χ² = 5.193, 7.012, P < 0.05). The hemoglobin level, MBI score, and improvement rate were significantly higher in the observation group than in the control group (t = 21.284, 19.841, χ² = 6.395, P < 0.05).

CONCLUSION

Hemocoagulase and omeprazole injection combined with Xijiao Dihuang decoction are effective in the treatment of cerebral hemorrhage with gastrointestinal bleeding.

Therapeutic effect of bilastine in Japanese cedar pollinosis using an artificial exposure chamber (OHIO Chamber)

BACKGROUND

Environmental exposure chambers have been used to expose subjects to aeroallergens to investigate the efficacy of prophylactic treatment with symptomatic agents in Japan. We first examined the therapeutic effect of bilastine (BIL), a novel non-sedative second-generation H₁-antihistamine, in subjects with Japanese cedar pollinosis using an artificial exposure chamber (OHIO Chamber).

METHODS

This was a randomized, double-blind, four-way crossover, placebo- and active-controlled phase II study (trial registration number JapicCTI-132213). Subjects were exposed to cedar pollen (8000 grains/m³) for 2 h on Day -1 and 4 h each on Day 1 and 2. BIL 10 or 20 mg, placebo, or fexofenadine hydrochloride (FEX) 60 mg was administered orally 1 h after the start of pollen exposure on Day 1. Placebo or FEX was administered 12 h after the first dosing. The primary efficacy endpoint was the sum of total nasal symptom score (TNSS) from 0 to 3 h after the Day 1 dosing.

RESULTS

We enrolled 136 subjects and the sum of TNSS on Day 1 of the three active treatments was significantly lower than that of placebo and was maintained up to 26 h after the first dosing (Day 2). The sum of TNSS or sneezing score on Day 1 after BIL 20 mg was more significantly decreased than after FEX. Moreover, BIL showed a faster onset of action than FEX.

CONCLUSIONS

We demonstrated the efficacy, rapid onset, and long duration of action of BIL in subjects with Japanese cedar pollinosis exposed to cedar pollen using the OHIO Chamber.

Clinical effects of Bifidobacterium triple viable tablets combined with montmorillonite in treatment of damp-heat diarrhea in children

AIM

To evaluate the clinical effects of Bifidobacterium triple viable tablets combined with montmorillonite in the treatment of damp-heat diarrhea in children and to explore the mechanism involved.

METHODS

Sixty pediatric patients with damp-heat diarrhea were randomly divided into either a control group (n = 30) or an observation group (n = 30). The control group was treated with montmorillonite alone, and the observation group was treated with Bifidobacterium triple viable tablets plus montmorillonite. Clinical efficacy was compared between the two groups. The possible immune mechanism involved was explored by detecting different subsets of T cells. The rate of adverse drug reactions was also compared between the two groups.

RESULTS

The times to recovery of normal body temperature, normal stool, and remission of vomiting and abdominal pain were significantly shorter in the observation group than in the control group (P < 0.05). Before treatment, there were no significant differences in CD3⁺ cells, CD4⁺ cells, or CD4⁺/CD8⁺ ratio between the two groups (P > 0.05); however, these indexes were significantly higher in the observation group than in the control group 5 d after treatment (P < 0.05). The rate of adverse drug reactions between the two groups had no statistical significance (P > 0.05).

CONCLUSION

Bifidobacterium triple viable tablets combined with montmorillonite is more effective than montmorillonite alone in children with damp-heat diarrhea, and it can regulate the body's immunity.

Atropine combined with omeprazole for treatment of acute gastritis: Efficacy and influence on inflammatory factors

AIM

To investigate the clinical effects of atropine plus omeprazole in patients with acute gastritis and their influence on inflammatory factors.

METHODS

From April 2015 to July 2016, 100 patients with acute gastritis were randomly divided into either a control group (n = 50) or an observation group (n = 50). The control group was given anisodamine plus omeprazole, and the observation group was given atropine plus omeprazole. Clinical efficacy was compared between the two groups, and the changes in inflammatory factors were recorded.

RESULTS

Compared with the control group, clinical symptoms such as nausea, vomiting, abdominal pain, and diarrhea were significantly milder, hospitalization time was significantly shorter (P < 0.05), and the levels of inflammatory cytokines Interferon-β, tumor necrosis factor-α and interleukin-6 were significantly lower (P < 0.05) in the observation group. The rate of adverse drug reactions was was significantly lower in the observation group than in the control group (6.00% vs 16.00%, P < 0.05).

CONCLUSION

Treatment with atropine plus omeprazole can achieve satisfactory effects, inhibit inflammation, and improve symptoms in patients with acute gastritis.

Dynamic contrast-enhanced perfusion area-detector CT assessed with various mathematical models: Its capability for therapeutic outcome prediction for non-small cell lung cancer patients with chemoradiotherapy as compared with that of FDG-PET/CT

PURPOSE

To directly compare the capability of dynamic first-pass contrast-enhanced (CE-) perfusion area-detector CT (ADCT) and PET/CT for early prediction of treatment response, disease progression and overall survival of non-small cell carcinoma (NSCLC) patients treated with chemoradiotherapy.

MATERIALS AND METHODS

Fifty-three consecutive Stage IIIB NSCLC patients who had undergone PET/CT, dynamic first-pass CE-perfusion ADCT, chemoradiotherapy, and follow-up examination were enrolled in this study. They were divided into two groups: 1) complete or partial response (CR+PR) and 2) stable or progressive disease (SD+PD). Pulmonary arterial and systemic arterial perfusions and total perfusion were assessed at targeted lesions with the dual-input maximum slope method, permeability surface and distribution volume with the Patlak plot method, tumor perfusion with the single-input maximum slope method, and SUV_max, and results were averaged to determine final values for each patient. Next, step-wise regression analysis was used to determine which indices were the most useful for predicting therapeutic effect. Finally, overall survival of responders and non-responders assessed by using the indices that had a significant effect on prediction of therapeutic outcome was statistically compared.

RESULTS

The step-wise regression test showed that therapeutic effect (r²=0.63, p=0.01) was significantly affected by the following three factors in order of magnitude of impact: systemic arterial perfusion, total perfusion, and SUV_max. Mean overall survival showed a significant difference for total perfusion (p=0.003) and systemic arterial perfusion (p=0.04).

CONCLUSION

Dynamic first-pass CE-perfusion ADCT as well as PET/CT are useful for treatment response prediction in NSCLC patients treated with chemoradiotherapy.

Therapeutic effect of Mahaenggamseok-tang on neutrophilic lung inflammation is associated with NF-κB suppression and Nrf2 activation

ETHNOPHARMACOLOGICAL RELEVANCE

Mahaenggamseok-tang (MHGST), an herbal formula in traditional Asian medicine, has been used to treat patients with various pulmonary diseases including common cold and influenza. However, the potential therapeutic effect of MHGST on acute lung injury (ALI), a leading cause of death worldwide, and the anti-inflammatory mechanisms of MHGST remained less understood.

MATERIALS AND METHODS

The methanol extract of MHGST was prepared and fingerprinted by HPLC. For the induction of ALI, C57BL/6 mice (n=5/group) received a single intraperitoneal (i.p.) injection of LPS. Referring to the dose for patients, two different amounts of MHGST were delivered in an aerosol to mouse lungs via trachea 2h after the i.p. LPS administration. Lung histology, bronchoalveolar lavage fluid, myeloperoxidase (MPO) activity, and the expression of inflammatory and Nrf2-dependent genes were analyzed to determine the effect of MHGST on lung inflammation. For mechanistic studies, western blotting and semi-quantitative RT-PCR were conducted using RAW 264.7 cells.

RESULTS

When administered 2h after the onset of ALI, MHGST relieved lung pathology characteristic to ALI, with decreases of neutrophil infiltration and MPO activity. While suppressing the expression of inflammatory genes, MHGST increased the expression of Nrf2-dependent genes in ALI mouse lungs. Concordantly, MHGST activated Nrf2 activity while suppressing NF-κB in RAW 264.7 cells.

CONCLUSION

MHGST suppressed neutrophilic lung inflammation, a hallmark of ALI, which was associated with the activation of anti-inflammatory Nrf2 and the suppression of pro-inflammatory NF-κB. Our results suggest that MHGST has a therapeutic potential against ALI.

Octreotide acetate combined with propranolol hydrochloride for treatment of digestive tract hemorrhage: Efficacy and influence on quality of life

AIM

To observe the efficacy of octreotide acetate combined with propranolol hydrochloride in the treatment of patients with gastrointestinal bleeding and its impact on quality of life (QOL).

METHODS

One hundred patients with gastrointestinal bleeding treated from January 2015 to July 2016 at our hospital were divided into either a control group (n = 50) or an observation group (n = 50). The control group was treated with octreotide acetate injection alone, and the observation group was treated with octreotide acetate injection combined with propranolol hydrochloride. QOL was assessed using the QOL scale. Clinical efficacy and QOL were compared between the two groups.

RESULTS

After treatment, central venous pressure was significantly higher in the observation group than in the control group (P < 0.05); time to hemostasis, heart rate, blood transfusion, portal vein blood flow, splenic vein blood flow, serum alanine transaminase and aspartate transaminase levels were significantly lower in the observation group than in the control group (P < 0.05); physical function, role function, cognitive function, emotional function, social function, and the overall QOL score were significantly higher in the observation group than in the control group (P < 0.05).

CONCLUSION

Octreotide acetate combined with propranolol hydrochloride for patients with gastrointestinal bleeding has better clinical efficacy and can improve QOL compared with octreotide acetate alone.

Tumor-suppressive effects of atelocollagen-conjugated hsa-miR-520d-5p on un-differentiated cancer cells in a mouse xenograft model

Background

We previously demonstrated that hsa-miR-520d-5p can convert cancer cells into induced pluripotent stem cells (iPSCs) or mesenchymal stem cells (MSCs) via a demethylation process and p53 upregulation in vivo. Additionally, we have reported the non-tumorigenic effect of miR-520d-5p on normal human cells, including fibroblasts.

Methods

We used atelocollagen-conjugated miR-520d-5p (520d/atelocollagen) to confirm the possibility of a therapeutic effect on cancer cells. We traced the size and signal intensity of GFP-expressing tumors in mice each week, beginning 4 weeks after subcutaneous inoculation.

Results

520d/atelocollagen treatment suppressed tumor growth by greater than 80 % each week relative to controls and resulted in an approximately 30 % disappearance of tumors. In mice whose tumors disappeared, the existence of human genomic material at the injection site was examined by quantitative Alu-PCR, and we confirmed the co-existence of both species-derived cells. In every site where a tumor disappeared in immunodeficient mice, GFP protein was expressed in the connective tissues, and approximately 0.1 % of the extracted DNA contained human genomic material. We could not identify any adverse effects in vivo.

Conclusions

This is the first report to confirm an inhibitory effect of 520d/atelocollagen on cancer cells in vivo. The development of optimized modifications of this carrier is expected to enhance the efficiency of entry into tumor cells and the induction of its inhibitory effect.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-016-2467-y) contains supplementary material, which is available to authorized users.

Acquired hemophilia A in patients after surgery for congenital choledochal cysts: Report of two cases and review of the literature

Acquired hemophilia (AH) is an uncommon severe autoimmune disease caused by the deficiency of clotting factor Ⅷ due to the presence of autoimmune response antibody. Most of AH cases are secondary, with bleeding manifestations similar to those of hemophilia A. Here we report two cases of young patients with HA developing after surgery for congenital choledochal cysts. We also performed a literature review to summarize the pathogenesis, mechanism, clinical features, diagnosis and treatment of this condition.

Effects of whole protein enteral nutrient in malnourished patients with liver cirrhosis

AIM: To investigate the effect of whole protein enteral nutrient in malnourished patients with liver cirrhosis.

METHODS: The study introduced random control study and the self-control study. A total of 189 malnourished patients with liver cirrhosis screened by subject global assessment were divided randomly into either a study group (n = 90) or a control group (n = 89). The control group was treated with a routine diet, and the study group received nutritional support treatment with a whole protein enteral nutrient between two meals or at night on the basis of a routine diet. Changes in body mass index, arm circumference, triceps skin fold, calf circumference, prothrombin activity, albumin, prealbumin, total lymphocyte count, edema, abdomen ascites and Child-Pugh classification were assessed and compared between the two groups before treatment and two weeks after the treatment.

RESULTS: After nutritional treatment, the study group showed significantly increased albumin and improved edema and abdomen ascites compared with the control group (P < 0.05). Body mass index, prothrombin activity, albumin, prealbumin, total lymphocyte count, edema, abdomen ascites and Child-Pugh classification were significantly improved in the study group after treatment compared with before treatment (P < 0.05).

CONCLUSION: Nutritional support treatment with a whole protein enteral nutrient can significantly correct malnutrition and improve liver function in malnourished patients with liver cirrhosis.

Dynamic contrast-enhanced perfusion area detector CT for non-small cell lung cancer patients: Influence of mathematical models on early prediction capabilities for treatment response and recurrence after chemoradiotherapy

PURPOSE

To determine the capability and influence of the mathematical method on dynamic contrast-enhanced (CE-) perfusion area detector CT (ADCT) for early prediction of treatment response as well as progression free and overall survival (PFS and OS) of non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy.

MATERIALS AND METHODS

Sixty-six consecutive stage III NSCLC patients underwent dynamic CE-perfusion ADCT examinations, chemoradiotherapy and follow-up examinations. Response Evaluation Criteria in Solid Tumors (RECIST) criteria were used to divide all patients into responders and non-responders. Differences in each of the indices for all targeted lesions between measurements obtained 2 weeks prior to the first and the third course of chemotherapy were determined for all patients. ROC analyses were employed to determine the capability of perfusion indices as markers for distinguishing RECIST responders from non-responders. To evaluate their capability for early prediction of therapeutic effect, OS of perfusion index-based responders and non-responders were compared by using the Kaplan-Meier method followed by log-rank test.

RESULTS

Area under the curve (Az) for total perfusion by means of the dual-input maximum slope method was significantly larger than that of pulmonary arterial perfusion using the same method (p=0.007) and of perfusion with the single-input maximum slope method (p=0.007). Mean OS demonstrated significantly difference between responder- and non-responder groups for total perfusion (p=0.02).

CONCLUSION

Mathematical models have significant influence on assessment for early prediction of treatment response, disease progression and overall survival using dynamic CE-perfusion ADCT for NSCLC patients treated with chemoradiotherapy.

Correlation between uterine fibroids with various magnetic resonance imaging features and therapeutic effects of high-intensity focused ultrasound ablation

Objective:

To explore the correlation between magnetic resonance imaging (MRI) features of uterine fibroids (UFs) and therapeutic effects of high-intensity focused ultrasound ablation (HIFUA), and to provide evidence for UFs diagnosis with MRI in clinical practice.

Methods:

Forty-three UFs patients who were treated in our hospital from April 2012 to June 2014 were selected, including 72 UFs (48 multiple and 24 single UFs). Transverse, sagittal and coronal MRI scanning was performed one week before and after HIFUA to record UF number, location, type (intramural fibroid, submucosal fibroid and subserosal fibroid), mean diameter, hemoperfusion state, volume and ablation rate. The patients were followed up in the postoperative 1st, 2nd and 3rd months.

Results:

HIFUA exerted the best ablative effect on fibroids on the anterior uterine wall (F=26.763, P=0.036). Various types of fibroids were ablated significantly differently (F=3.406, P<0.05) by HIFUA that was most effective for ablating the subserosal ones. Having significantly different ablative effects on UFs with different radial line lengths (F=29.94, P<0.05), HIFUA ablated those with radial line lengths of 3-5 cm most effectively. For UFs with different T2WI signal intensities, HIFUA also functioned significantly differently (F=3.179, P=0. 03).

Conclusion:

HIFUA exerted significantly different ablative effects on UFs with various MRI features. Therefore, these features were well correlated with the therapeutic effects of HIFUA, allowing MRI as a promising diagnostic protocol.

Mesenchymal stem cells: In vivo therapeutic application ameliorates carbon tetrachloride induced liver fibrosis in rats

BACKGROUND

Egypt has the highest prevalence of hepatitis C virus in the world with infection rate up to 60%, for which liver fibrosis or hepatic carcinoma is the final outcome. Stem cell therapy provides a new hope for hepatic repair instead of traditional treatment, liver transplantation, as it is safer, gives long term engraftment and avoid expensive immunosuppressive drugs and unexpected hazardous effects.

AIM

This work aimed at determining the therapeutic potential of mesenchymal stem cells (MSC) in hepatic repair as a new line of therapy for liver fibrosis.

METHODS

33 female albino rats were divided into three groups: Group I: 10 rats injected subcutaneously with olive oil, Group II: 13 rats injected with carbon tetrachloride (CCl4) and Group III: 10 rats injected with CCl4 then bone marrow derived MSC from male rats. Blood and liver tissue samples were taken from all rats for biochemical and histological study.

RESULTS

Liver functions for group II rats showed significant deterioration in response to CCl4 in addition to significant histological changes in liver lobules and portal areas. Those parameters tend to be normal in MSC-treated group. Group III rats revealed normalized liver function and histological picture. Meanwhile, most of the pathological lesions were still detected in rats of second group.

CONCLUSION

Undifferentiated MSCs have the ability to ameliorate CCl4 induced liver injury in albino rats in terms of liver functions and histological features. So, stem cell therapy can be considered clinically to offer a hope for patients suffering from liver fibrosis.

Matrine derivative WM130 inhibits hepatocellular carcinoma by suppressing EGFR/ERK/MMP-2 and PTEN/AKT signaling pathways

Matrine, a sophora alkaloid, has been demonstrated to exert antitumor effects on many types of cancer. However, its bioactivity is weak and its potential druggability is low. We modified the structure of matrine and obtained a new matrine derivative, WM130 (C30N4H40SO5F), which exhibited better pharmacological activities than matrine. In this study, we investigated the antitumor activity and the underlying mechanisms of WM130 on hepatocellular carcinoma (HCC) cells in vitro and in vivo, and found that WM130 inhibited the proliferation, invasion, migration and induced apoptosis of HCC cells in a dose-dependent manner. Furthermore, after treatment with WM130, the expressions of p-EGFR, p-ERK, p-AKT, MMP-2 and the ratio of Bcl-2/Bax were significantly down-regulated, whereas the expression of PTEN was increased in HCC cells. Moreover, WM130 inhibited Huh-7 xenograft tumor growth in a dose-dependent manner after intravenous administration. Immunohistochemistry results demonstrated that WM130 treatment resulted in down-regulation of p-EGFR, MMP-2, and Ki67 and up-regulation of PTEN. The findings indicated that WM130 could inhibit cell proliferation, invasion, migration and induced apoptosis in HCC cells by suppressing EGFR/ERK/MMP-2 and PTEN/AKT signaling pathways and may be a novel effective candidate for HCC treatment.

Immuno-Modulatory Effect and Therapeutic Potential of Brugia malayi Cystatin in Experimentally Induced Arthritis

Helminths are known to modulate host's immune system and understanding this modulation can help in identification of novel therapeutic agents for autoimmune diseases. In this study, we have assessed the immune-modulatory activity and the therapeutic effect of Brugia malayi recombinant cystatin (rBmCys) in methylated BSA (mBSA) induced arthritis using rodent model. Administration of rBmCys has suppressed the severity of mBSA-arthritis in mastomys by reducing paw swelling and other clinical disease parameters as evident from significantly decreased arthritic index. The anti-arthritic effect of rBmCys was also confirmed by decreased histopathological score for synovitis, bone erosion and fibrosis in the tissue sections of paws. Further, this therapeutic effect of cystatin was found to be associated with significantly decreased production of IFN-γ and TNF-α and increased release of IL-4 and IL-10 cytokines. These results implied that rBmCys treatment has alleviated mBSA-induced arthritis and thus can be a promising alternative agent for the treatment of arthritis.

Effect of selective and non-selective serotonin receptor activation on L-DOPA-induced therapeutic efficacy and dyskinesia in parkinsonian rats

Selective activation of 5-HT1 receptors has been shown to produce near to full suppression of L-DOPA-induced dyskinesia (LID) in animal models of Parkinson's disease; however, a reduction of the therapeutic effect of L-DOPA has been reported in several studies. Conversely, we recently found that increasing the serotonergic tone with chronic administration of the serotonin precursor 5-hydroxy-tryptophan (5-HTP) can reduce LID in 6-OHDA-lesioned rats, without affecting L-DOPA efficacy. To directly compare the effects of selective versus non-selective serotonin receptor activation, here we first tested different acute doses of the 5-HT1A/1B receptor agonist eltoprazine and 5-HTP on LID in order to identify doses of the individual compounds showing similar anti-dyskinetic efficacy in L-DOPA-primed dyskinetic rats. About 50% reduction of LID was observed with 0.1 mg/kg and 24 mg/kg of eltoprazine and 5-HTP, respectively; we then compared the effect of the two drugs, individually and in combination, on L-DOPA-induced stepping test in L-DOPA-naïve parkinsonian animals and LID over three weeks of L-DOPA treatment. Results showed that eltoprazine induced significant worsening of L-DOPA-mediated performance in the stepping test, while 5-HTP did not. Interestingly, combination of 5-HTP with eltoprazine prevented the reduction in the forelimb use induced by eltoprazine. Moreover, 5-HTP and eltoprazine given individually showed similar efficacy also upon chronic treatment, and had additive effect in dampening the appearance of LID when given in combination. Finally, chronic administration of eltoprazine and/or 5-HTP did not affect striatal serotonin innervation, compared to l-DOPA alone, as measured by serotonin transporter expression.

Laparoscopic versus open left hemihepatectomy for hepatolithiasis. J Surg Res. 2015;199:402-406. [PMID: 26169034 DOI: 10.1016/j.jss.2015.06.021]

BACKGROUND

Partial hepatectomy is the most definitive treatment for hepatolithiasis. Laparoscopic liver resection, however, presents unique technical challenges. The objectives of this study were to evaluate and compare the safety and perioperative and long-term outcomes of laparoscopic left hemihepatectomy (LLH) versus open left hemihepatectomy (OLH) for left intrahepatic duct stones.

METHODS

From March 2009-October 2014, 97 consecutive patients with left intrahepatic duct stones who underwent LLH (n = 46) or OLH (n = 51) were evaluated. We retrospectively reviewed the clinical outcomes and the stone clearance rates of the 97 patients in this study.

RESULTS

The median surgical procedure times were 254 min (188-396 min) in the LLH group and 236 min (192-395 min) in the OLH group. No significant difference was found in the surgical procedure times between the two groups. The intraoperative blood loss of the LLH group was less than the OLH group (332 mL [247-914 mL] versus 369 mL [221-996 mL], P = 0.13), but there was no statistical significance. A shorter length of postoperative hospital stay was noticed in laparoscopy group (11 d [8-21 d] versus 12 d [9-24 d], P = 0.01). Postoperative complications were observed in six of the 46 patients (13.0%) after LLH and in 11 of the 51 patients (21.6%) after OLH (P = 0.27). Laparoscopy was comparable with laparotomy in the effectiveness of stone clearance during the first attempt (93.5% versus 94.1%, P = 1.00).

CONCLUSIONS

In left-sided hepatolithiasis, LLH was safe and effective: it resulted in low postoperative morbidity, no mortality, and a high stone clearance rate. The potential benefit of LLH was a shorter hospital stay. If consideration is given to the appropriate indication criteria, including the extent of hepatectomy and the location and distribution of lesions, LLH may be an excellent choice for treatment of left-sided hepatolithiasis.

Validation of a Quantitative Single-Subject Based Evaluation for Rehabilitation-Induced Improvement Assessment

The foreseen outcome of a rehabilitation treatment is a stable improvement on the functional outcomes, which can be longitudinally assessed through multiple measures to help clinicians in functional evaluation. In this study, we propose an automatic comprehensive method of combining multiple measures in order to assess a functional improvement. As test-bed, a functional electrical stimulation based treatment for foot drop correction performed with chronic post-stroke participants is presented. Patients were assessed on five relevant outcome measures before, after intervention, and at a follow-up time-point. A novel algorithm based on variables minimum detectable change is proposed and implemented in a custom-made software, combining the outcome measures to obtain a unique parameter: capacity score. The difference between capacity scores at different timing is three holded to obtain improvement evaluation. Ten clinicians evaluated patients on the Improvement Clinical Global Impression scale. Eleven patients underwent the treatment, and five resulted to achieve a stable functional improvement, as assessed by the proposed algorithm. A statistically significant agreement between intra-clinicians and algorithm-clinicians evaluations was demonstrated. The proposed method evaluates functional improvement on a single-subject yes/no base by merging different measures (e.g., kinematic, muscular) and it is validated against clinical evaluation.

Great efficacy of sulfachloropyrazine-sodium against acute murine toxoplasmosis

OBJECTIVE

To identify more effective and less toxic drugs to treat animal toxoplasmosis.

METHODS

Efficacy of seven kinds of sulfonamides against Toxoplasma gondii (T. gondii) in an acute murine model was evaluated. The mice used throughout the study were randomly assigned to many groups (10 mice each), which either remained uninfected or were infected intraperitoneally with tachyzoites of T. gondii (strains RH and CN). All groups were then treated with different sulfonamides and the optimal treatment protocol was determined candidates. Sulfadiazine-sodium (SD) was used for comparison.

RESULTS

The optimal therapy involved gavaging mice twice per day with 250 mg/kg bw of sulfachloropyrazine-sodium (SPZ) for five days. Using this protocol, the average survival time and the time-point of 50% fatalities were prolonged significantly compared with SD treatment. Treatment with SPZ protected 40% of mice from death, and the heart and kidney tissue of these animals was parasite-free, as determined by nested-PCR. SPZ showed excellent therapeutic effects in the treatment of T. gondii in an acute murine model and is therefore a promising drug candidate for the treatment and prevention of T. gondii in animals.

CONCLUSIONS

It can be concluded that the effective drug sulfachloropyrazine may be the new therapeutic options against animal toxoplasmosis.

Jianpi Hewei decoction combined with Jianwei Xiaoshi oral liquid for treatment of functional dyspepsia

AIM: To assess the therapeutic effect of Jianpi Hewei decoction combined with Jianwei Xiaoshi oral liquid for functional dyspepsia (FD).

METHODS: One hundred and eighty patients with FD were randomly divided into two groups: a treatment group (n = 120) and a control group (n = 60). Both groups of patients were given Jianpi Hewei decoction, and the treatment group was additionally given Jianwei Xiaoshi oral liquid. After 3 wk of treatment, the therapeutic effect was compared between the two groups.

RESULTS: The total effective rate in the treatment group was significantly better than that in the control group (93.3% vs 83.3%, P < 0.05). The total symptom score improvement was also significantly better in the treatment group than in the control group (P < 0.05). The scores of abdominal distention, anorexia, indigestion, fatigue and other symptoms were significantly decreased in both groups (P < 0.05), and the decrease was more significant in the treatment group (P < 0.05).

CONCLUSION: Jianpi Hewei decoction combined with Jianwei Xiaoshi oral liquid has a significant curative effect on FD.

Clinical therapeutic effects of AO/ASIF clavicle hook plate on distal clavicle fractures and acromioclavicular joint dislocations

Objective: The aim of this study was to evaluate the security and effectiveness of AO/ASIF clavicle hook plate in the treatment of distal clavicle fractures and acromioclavicular joint dislocations.

Methods: One hundred patients with distal clavicle fractures and acromioclavicular joint dislocations who were admitted in our hospital from January 2012 to January 2013 were selected as the study subjects. They were then randomly divided into a control group and an observation group (n=50). The observation group was treated with AO/ASIF clavicle hook plates, and the control group was treated with Kirschner-wire tension bands. The outcomes were recorded and compared.

Results: The JOA scores of the two groups were similar before surgery (P>0.05). The two groups both had obviously increased JOA scores in the postoperative 6th and 12th weeks, and the score in the postoperative 12th week was higher. There were statistically significant intra-group differences (P<0.05). The postoperative 6th-week and 12th-week JOA scores of the observation group were (83.2±1.8) and (97.4±1.5) respectively, and those of the control group were (71.6±2.2) and (82.3±2.6) respectively, with statistically significant inter-group differences (P<0.05). Significantly more patients in the observation group (100%) were evaluated as excellent or good outcomes after fixation than those in the control group (60%). After removal of the surgical apparatus, the recurrence rates of bone fracture and joint dislocation in the observation group were significantly lower than those of the control group (P<0.05).

Conclusion: AO/ASIF clavicle hook plate functioned more effectively than Kirschner-wire tension band in clinical treatment of distal clavicle fractures and acromioclavicular joint dislocations. The former protocol enjoyed small incisions, firm fixation and early shoulder mobility. Therefore, it is a safe and effective surgical method that is worthy of being widely applied in clinical practice.

Nucleolin-targeting liposomes guided by aptamer AS1411 for the delivery of siRNA for the treatment of malignant melanomas

BRAF gene mutation is found in more than 60% of malignant melanomas, which are difficult to treat. In this study, a new tumor-targeting liposome was developed to deliver anti-BRAF siRNA (siBraf) for the treatment of melanomas. Nucleolin is overexpressed on the surface of cancer cells. AS1411, an aptamer showing specific binding to nucleolin, was conjugated to PEGylated cationic liposome as the targeting probe ASLP (AS1411-PEG-liposome). The ASLP/siRNA complex was formed through electrostatic interaction between ASLP and siRNA. The binding of AS1411 to the surface of PEGylated liposomes was confirmed by gel electrophoresis and capillary electrophoresis. Real-time PCR and Western blot analysis showed that ASLP/siBraf exhibited strong silencing activity of BRAF gene. The much higher accumulation of the siRNA in tumor cells comparing with normal cells indicated that ASLP displayed excellent tumor-targeting capability. Notably, ASLP/siBraf showed significant silencing activity in A375 tumor xenograft mice and inhibited the melanoma growth. These results suggested that the new nucleolin-targeted siRNA delivery system by AS1411 may have the potential for the treatment of melanoma.

Analysis of therapeutic effect and safety of target-dose metoprolol in the treatment of patients with diabetes mellitus with chronic heart failure

Objective: To explore the therapeutic effect and safety of target-dose metoprolol in treating chronic heart failure (CHF) patients complicated with diabetes mellitus (DM).

Methods: One hundred and fifty-four elderly patients were randomly divided into an observation group and a control group (n=77), which were treated with target-dose metoprolol and conventional therapy, and routinely treated respectively. The New York Heart Association (NYHA) classification, left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), 6-min walking distance and medication safety of the two groups were compared.

Results: Compared with the results before treatment, the NYHA classification, LVESD, LVEDD, LVEF and 6-minutes walking distance of both groups were significantly improved (P<0.05), with significantly better results in the observation group than those in the control group after treatment (P<0.05). In the 6 months of follow-up, the incidence of cardiac events in the observation group (3.90%) was significantly lower than that of the control group (14.29%) (P<0.05). The levels of average fasting blood sugar and glycosylated hemoglobin in the groups showed no significant differences (P>0.05).

Conclusion: Treating CHF patients complicated with DM with target-dose metoprolol can obviously boost the cardiac function and exercise tolerance, leading to satisfactory clinical therapeutic effect, high security and moderate tolerance.

Carthami Flos suppresses neutrophilic lung inflammation in mice, for which nuclear factor-erythroid 2-related factor-1 is required

Carthami Flos (CF) is used in traditional Asian medicine to treat blood stagnation and its associated diseases in patients. While the underlying mechanism for this effect remains unknown, CF has been reported to activate Nrf2, a transcription factor that is critical in protecting from various inflammatory lung diseases including acute lung injury (ALI). Here, we examined whether CF has a therapeutic effect on lung inflammation and assessed the impact of Nrf2 on the effect of CF using an ALI mouse model. Treatment of bone marrow derived macrophages with standardized aqueous extract of CF (AECF) activated Nrf2, resulting in the expression of Nrf2 dependent genes including GCLC, NQO-1 and HO-1. While intranasal LPS treatment of wild type mice resulted in neutrophilic infiltration and a concomitant expression of pro-inflammatory cytokine genes in the lung, the hallmarks of ALI, an intratracheal spraying of AECF to the lung 2h after LPS treatment suppressed the inflammatory response. By contrast, similar treatment in nrf2(-/-) mice with AECF failed to attenuate the inflammatory response. Thus, our results show that AECF attenuated neutrophilic lung inflammation in mice, which required Nrf2. Since AECF administration abrogates lung inflammation after LPS treatment, we propose CF as a potential therapeutics in the management of ALI.

Salvage thoracic surgery in patients with primary lung cancer

BACKGROUND

Patients with advanced non-small cell lung cancer (NSCLC) continue to have a poor prognosis. The majority of patients are not indicated for surgery for a radical cure, and systemic chemotherapy is the mainstay of treatment. However, long-term survival is rare due to the resistance to therapy. On the other hand, surgery is performed only under certain conditions for colon cancer and esophageal cancer. Few reports are available about salvage thoracic surgery in patients with primary lung cancer. The purpose of this study was to show the outcomes of salvage surgery for lung cancer, and we discuss possible future treatment strategies based on our findings.

METHODS

Three hundred and fifty-two patients with primary lung cancer underwent surgical resection, and we evaluated those who underwent salvage operations. We also examined the relationships between the performance of a salvage operation and the clinicopathological characteristics of the patients. The clinical outcomes of salvage surgery for lung cancer were assessed.

RESULTS

Salvage thoracic operations were performed in eight (2.3%) of the 352 patients. The surgical procedures were lobectomy in four patients, segmentectomy in two, and pneumonectomy and wedge resection were each performed in one patient. There was no postoperative mortality. All patients were alive at the time of the analysis. The mean follow-up period for the salvage operation cases was 14.0 months. No significant correlation was identified between the incidence of salvage surgery and the age, gender, histology, postoperative stay or hospital stay. The incidence of advanced stage disease was higher in the salvage cases than in the overall cases.

CONCLUSIONS

Salvage thoracic surgery was possible, and moderately improved the prognosis, without prolongation of the postoperative stay or hospital stay. A salvage operation might be considered a reasonable and proper treatment for carefully selected patients.

Clinical effects and complications of TIPS for portal hypertension due to cirrhosis: A single center

AIM: To determine the clinical effects and complications of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension due to cirrhosis.

METHODS: Two hundred and eighty patients with portal hypertension due to cirrhosis who underwent TIPS were retrospectively evaluated. Portal trunk pressure was measured before and after surgery. The changes in hemodynamics and the condition of the stent were assessed by ultrasound and the esophageal and fundic veins observed endoscopically.

RESULTS: The success rate of TIPS was 99.3%. The portal trunk pressure was 26.8 ± 3.6 cmH₂O after surgery and 46.5 ± 3.4 cmH₂O before surgery (P < 0.01). The velocity of blood flow in the portal vein increased. The internal diameters of the portal and splenic veins were reduced. The short-term hemostasis rate was 100%. Esophageal varices disappeared completely in 68% of patients and were obviously reduced in 32%. Varices of the stomach fundus disappeared completely in 80% and were obviously reduced in 20% of patients. Ascites disappeared in 62%, were markedly reduced in 24%, but were still apparent in 14% of patients. The total effective rate of ascites reduction was 86%. Hydrothorax completely disappeared in 100% of patients. The incidence of post-operative stent stenosis was 24% at 12 mo and 34% at 24 mo. The incidence of post-operative hepatic encephalopathy was 12% at 3 mo, 17% at 6 mo and 19% at 12 mo. The incidence of post-operative recurrent hemorrhage was 9% at 12 mo, 19% at 24 mo and 35% at 36 mo. The cumulative survival rate was 86% at 12 mo, 81% at 24 mo, 75% at 36 mo, 57% at 48 mo and 45% at 60 mo.

CONCLUSION: TIPS can effectively lower portal hypertension due to cirrhosis. It is significantly effective for hemorrhage of the digestive tract due to rupture of esophageal and fundic veins and for ascites and hydrothorax caused by portal hypertension.

MDCT angiography to evaluate the therapeutic effect of PTVE for esophageal varices

AIM: To evaluate the role of multi-detector row computed tomography (MDCT) angiography for assessing the therapeutic effects of percutaneous transhepatic variceal embolization (PTVE) for esophageal varices (EVs).

METHODS: The subjects of this prospective study were 156 patients who underwent PTVE with cyanoacrylate for EVs. Patients were divided into three groups according to the filling range of cyanoacrylate in EVs and their feeding vessels: (1) group A, complete obliteration, with at least 3 cm of the lower EVs and peri-/EVs, as well as the adventitial plexus of the gastric cardia and fundus filled with cyanoacrylate; (2) group B, partial obliteration of varices surrounding the gastric cardia and fundus, with their feeding vessels being obliterated with cyanoacrylate, but without reaching lower EVs; and (3) group C, trunk obliteration, with the main branch of the left gastric vein being filled with cyanoacrylate, but without reaching varices surrounding the gastric cardia or fundus. We performed chart reviews and a prospective follow-up using MDCT images, angiography, and gastrointestinal endoscopy.

RESULTS: The median follow-up period was 34 mo. The rate of eradication of varices for all patients was 56.4% (88/156) and the rate of relapse was 31.3% (41/131). The rates of variceal eradication at 1, 3, and 5 years after PTVE were 90.2%, 84.1% and 81.7%, respectively, for the complete group; 61.2%, 49% and 42.9%, respectively, for the partial group; with no varices disappearing in the trunk group. The relapse-free rates at 1, 3 and 5 years after PTVE were 91.5%, 86.6% and 81.7%, respectively, for the complete group; 71.1%, 55.6% and 51.1%, respectively, for the partial group; and all EVs recurred in the trunk group. Kaplan-Meier analysis showed P values of 0.000 and 0.000, and odds ratios of 3.824 and 3.603 for the rates of variceal eradication and relapse free rates, respectively. Cyanoacrylate in EVs disappeared with time, but those in the EVs and other feeding vessels remained permanently in the vessels without a decrease with time, which is important for the continued obliteration of the feeding vessels and prevention of EV relapse.

CONCLUSION: MDCT provides excellent visualization of cyanoacrylate obliteration in EV and their feeding veins after PTVE. It confirms that PTVE is effective for treating EVs.

Comparison of Two brands of Methylphenidate (Stimdate(®) vs. Ritalin(®)) in Children and Adolescents with Attention Deficit Hyperactivity Disorder: A Double-Blind, Randomized Clinical Trial

OBJECTIVE

To compare the effectiveness and safety of the methylphenidate produced in Iran (Stimdate®) with its original brand (Ritalin®) in children with Attention deficit hyperactivity disorder (ADHD).

METHODS

In this double-blinded randomized clinical trial, 30 patients with ADHD who were 6 to 16 years old, were divided into two groups: 15 in Stimdate® and 15 in Ritalin® group. The two groups were compared for side effects profile, Conner's Parent's Rating Scale-Persion version (CPRS-R), Child Symptom Inventory-4 (CSI-4), Clinical Global Impressions (CGI), and Children's Global Assessment Scale (CGAS), at baseline and at the 4(th) and 6(th) weeks.

RESULTS

The subjects showed significant decreases in the CPRS-Rand CSI-4 scores and significant increase of CGAS scores during the follow-up, but there were no significant difference between Stimdate® and Ritalin® group, regarding the pattern of changes observed. The mean therapeutic dose and the number of side effects were not significantly different between the two studied groups.

CONCLUSIONS

Both Stimdate® and Ritalin® had comparable clinical efficacy and safety in children with ADHD.

Comparison of laparoscopic and open surgery for pyogenic liver abscess with biliary pathology

AIM: To investigate the feasibility and therapeutic effect of laparoscopic surgery for pyogenic liver abscess (PLA) with biliary pathology.

METHODS: From January 2004 to October 2010, 31 patients with PLA combined with biliary pathology meeting entry criteria received surgical management in our hospital. Of the 31 patients, 13 underwent laparoscopic surgery (LS group) and 18 underwent open surgery (OS group). Clinical data including operation time, intraoperative blood loss, postoperative complication rate, length of postoperative hospital stay, and abscess recurrence rate were retrospectively analyzed and compared between the two groups.

RESULTS: All patients received systemic antibiotic therapy. Four patients underwent ultrasound-guided percutaneous catheter drainage before operation. Postoperative complications occurred in 5 patients (16.1%, 5/31) including 2 in the LS group and 3 in the OS group. One patient had retained calculus in the common bile duct and another had liver abscess recurrence in the OS group. No retained calculus and liver abscess recurrence occurred in the LS group. In the two groups, there was no mortality during the perioperative period. There were no significant differences in operation time, intraoperative blood loss and transfusion, postoperative complication rate and abscess recurrence rate between the two groups. Oral intake was earlier (1.9 ± 0.4 d vs 3.1 ± 0.7 d, P < 0.05) and length of postoperative hospital stay was shorter (11.3 ± 2.9 d vs 14.5 ± 3.7 d, P < 0.05) in the LS group than in the OS group.

CONCLUSION: Laparoscopic surgery for simultaneous treatment of PLA and biliary pathology is feasible in selected patients and the therapeutic effect is similar to that of open surgery.

Assessment of Therapeutic Effect of Sunitinib by (11)C-Acetate PET Compared with FDG PET Imaging in a Patient with Metastatic Renal Cell Carcinoma

Although sunitinib shows a high response rate in patients with untreated metastatic renal cell carcinoma (mRCC), quite a few patients show no therapeutic effect. Therefore, it is crucial to distinguish the patients who respond to sunitinib from those who do not as early as possible after the administration of the therapy. We herein report a case of mRCC in which (11)C-acetate (AC) positron emission tomography (PET) showed an early therapeutic effect of sunitinib treatment 4 weeks after its administration.

Therapeutic effects of fistular onion stalk extract on nonalcoholic fatty liver in rats

AIM: To investigate the therapeutic effects of fistular onion stalk extract on nonalcoholic fatty liver (NAFL) in rats.

METHODS: Sixty-four Wistar rats were randomly divided into two groups: blank control group (n = 8) and fat milk group (n = 56). The fat milk group was intragastrically given fat milk once a day to induce NAFL. After induction of NAFL, eight rats from each group were killed. The remaining rats of the fat milk group were further randomly divided into six subgroups: model control subgroup, Jiaogulan subgroup, polyene phosphatidylcholine subgroup, and low-, medium- and high-dose fistular onion stalk extract subgroups. Except the model control subgroup, each of the other subgroups was given the corresponding drug. After 8 weeks, all the animals were sacrificed. The contents of plasma total triglyceride (TG), cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were determined. The levels of malondialdehyde (MDA) and superoxide dismutase (SOD) in liver tissue were measured by spectrophotometry. Enzyme-linked immunosorbent assay (ELISA) was used to determined the changes in the content of TNF-α in the liver.

RESULTS: Compared with the model control subgroup, serum lipid levels showed different degrees of improvement in the low-, medium- and high-dose fistular onion stalk extract, Jiaogulan and polyene phosphatidylcholine subgroups: the levels of TG, TC and LDL decreased significantly (TG: 0.57 mmol/L ± 0.05 mmol/L, 0.51 mmol/L ± 0.04 mmol/L, 0.58 mmol/L ± 0.05 mmol/L, 0.52 mmol/L ± 0.05 mmol/L and 0.50 mmol/L ± 0.03 mmol/L vs 0.73 mmol/L ± 0.06 mmol/L, all P < 0.01; TC: 2.04 mmol/L ± 0.18 mmol/L, 1.69 mmol/L ± 0.15 mmol/L, 2.03 mmol/L ± 0.41 mmol/L, 1.88 mmol/L ± 0.18 mmol/L and 1.70 mmol/L ± 0.39 mmol/L vs 3.42 mmol/L ± 0.42 mmol/L, all P < 0.01; LDL: 0.41 mmol/L ± 0.05 mmol/L, 0.36 mmol/L ± 0.12 mmol/L, 0.46 mmol/L ± 0.13 mmol/L and 0.40 mmol/L ± 0.15 mmol/L vs 0.81 mmol/L ± 0.24 mmol/L, all P < 0.01); the levels of MDA and TNF-α were reduced significantly (all P < 0.01); and SOD activity increased (61.79 U/mg ± 5.72 U/mg, 83.03 U/mg ± 7.47 U/mg, 70.51 U/mg ± 4.84 U/mg, 66.66 U/mg ± 9.23 U/mg and 73.12 ± 4.87 U/mg vs 49.50 U/mg ± 9.31 U/mg, all P < 0.01).

CONCLUSION: Fistular onion stalk extract may exert a protective effect on liver function by decreasing the levels of TG and TC and the activity of MDA and increasing the activity of SOD.

Laparoscopic vs open left hepatectomy for hepatolithiasis

AIM: To explore the feasibility and therapeutic effect of total laparoscopic left hepatectomy (LLH) for hepatolithiasis.

METHODS: From June 2006 to October 2009, 61 consecutive patients with hepatolithiasis who met the inclusion criteria for LLH were treated in our institute. Of the 61 patients with hepatolithiasis, 28 underwent LLH (LLH group) and 33 underwent open left hepatectomy (OLH group). Clinical data including operation time, intraoperative blood loss, postoperative complication rate, postoperative hospital stay time, stone clearance and recurrence rate were retrospectively analyzed and compared between the two groups.

RESULTS: LLH was successfully performed in 28 patients. The operation time of LLH group was longer than that of OLH group (158 ± 43 min vs 132 ± 39 min, P < 0.05) and the hospital stay time of LLH group was shorter than that of OLH group (6.8 ± 2.8 d vs 10.2 ± 3.4 d, P < 0.01). No difference was found in intraoperative blood loss (180 ± 56 mL vs 184 ± 50 mL), postoperative complication rate (14.2% vs 15.2%), and stone residual rate (intermediate rate 17.9% vs 12.1% and final rate 0% vs 0%) between the two groups. No perioperative death occurred in either group. Fifty-seven patients (93.4%) were followed up for 2-40 mo (mean 17 mo), including 27 in LLH group and 30 in OLH group. Stone recurrence occurred in 1 patient of each group.

CONCLUSION: LLH for hepatolithiasis is feasible and safe in selected patients with an equal therapeutic effect to that of traditional open hepatectomy.

Treatment of severe hepatitis by HA neutral macroporous resin hemoperfusion: an analysis of 40 cases

AIM: To investigate the efficacy of hemo-perfusion with HA neutral macroporous resin in the treatment of severe hepatitis, and to find out the important nursing points to get better results.

METHODS: A total of 40 severe hepatitis patients were treated by HA neutral macroporous resin (HA330-Ⅱ) hemoperfusion (96 times in total). The symptoms, signs, liver function, renal function, prothrombin activity (PTA), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) levels were analyzed before and after treatment. Venous cannula or venepuncture was used to set up blood circulation.

RESULTS: After hemoperfusion, the symptoms and signs were improved to different extents in most of the patients; the levels of ALT, TBIL, DBIL were decreased significantly (92.3 ± 53.1 IU/L vs 176.8 ± 120.2 IU/L; 283.2 ± 90.2 µmol/L vs 363.0 ± 140.3 µmol/L; 122.8 ± 71.7 µmol/L vs 247.5 ± 106.4 µmol/L; all P < 0.01); PTA was increazed (39.6% ± 12.5% vs 29.2% ± 14.8%, P < 0.01). Meanwhile, the levels of IL-6 and TNF-α were decreased (27.6 ± 22.5 ng/L vs 88.5 ± 32.8 ng/L, 0.47 ± 0.4 µg/L vs 0.83 ± 0.6 µg/L; both P < 0.01) after hemoperfusion. Of the 40 patients, 29 cases recovered (72.5%); 3 cases were found without improvements and discharged from hospital (7.5%); 8 cases died (20%). Thirty-six patients (90%) finished hemoperfusion by venepuncture and 4 patients (10%) by venous cannula.

CONCLUSION: HA resin hemoperfusion is able to remove toxins in patients with severe hepatitis, and improve the clinical symptoms and signs to some extent. Full preparation, skillful techniques, close observation and timely treatment of side effects contribute to a favorable efficacy.

Percutaneous ethanol injection, radiofrequency and their combination in treatment of hepatocellular carcinoma

AIM: To evaluate the therapeutic effect and the indication of percutaneous ethanol injection (PEI), radiofrequency ablation (RFA) and their combination in treatment of hepatocellular carcinoma (HCC).

METHODS: Two hundred and fifty-five patients with HCC received treatment of PEI, RFA or their combination. Group1 (< 3 cm in diameter, n=85) was treated with PEI, group2 (< 3 cm in diameter, n=153) with RFA. Group3 (>3 cm in diameter, n=86) was divided into two groups. Group 3a (n=34) was treated with RFA, while group 3b (n=52) was treated with RFA for 2 wk after transcatheter arterial chemoembolization or PEI. Contrast-enhanced sonography was performed for 61 patients before and after RFA. Liver function and serum alpha-fetoprotein (AFP) were measured for all patients. Changes of the lesions on ultrasound and contrast-enhanced CT/MRI were evaluated for assessing the therapeutic responses. The 1-, 2-, 3- and 5-year survival rates were recorded after treatment.

RESULTS: In group 1, the complete necrosis rate of lesions after 1 mo was 77.6% (66/85). The level of AFP declined conspicuously after 1 mo. The 1-, 2-, 3- and 5-year survival rate after treatment was 80.0% (52/65), 60.4% (32/53), 52.5% (21/40) and 33.3% (7/21), respectively. In group 2, the complete necrosis rate of lesions after 1 moh was 92.2% (141/153). The level of AFP decreased conspicuously after 1 mo. The 1-, 2-, 3- and 5-year survival rate after treatment was 94.6% (88/93), 73.2% (52/71), 63.5% (33/52) and 46.4% (13/28), respectively. In group 3a, the complete necrosis rate of lesions after 1 mo was 23.5% (8/34). AFP dropped down to the normal level in only one patient after 1 mo. The 1-, 2- and 3-year survival rate after treatment was 47.6% (10/21), 42.9% (6/14) and 27.3% (3/11), respectively. Only one patient was still alive after 5 years. In group 3b, the complete necrosis rate of lesions after 1 mo was 57.7% (30/52). The level of AFP decreased after 1 mo. The 1-, 2-, 3- and 5-year survival rate after treatment was 68.6% (24/35), 46.2% (12/26), 36.8% (7/19) and 27.3% (3/11), respectively.

CONCLUSION: The therapeutic effect of RFA on small HCC is better than that of PEI. Small HCC is the optimal indication of RFA. For recurrent HCC (diameter>3 cm), the combined treatment of RFA and PEI/ACE should be used.