Shall we take a second thought before applying radiofrequency ablation for resectable HCC ≤2 cm?

Hepatocellular carcinoma (HCC), a disease with poor survival rates unless recognized and treated early, ranks as the fifth most common cancer worldwide. Previous researches has led some authors to choose radiofrequency ablation (RFA) as the primary treatment even the tumor is resectable. Dr. Roayaie’s study retrospectively analyzed the surgical outcome of HCC ≤2 cm. The results obtained in the studies indicate that anatomic resection may achieve better survival for patients with well-preserved liver function, and without liver cirrhosis. This research also revealed the presence of satellite lesions and microvascular invasion were evident in such early tumors, as the benefit of anatomic resection is unique and cannot be duplicated by ablation. Further RCTs with large sample sizes and long-term follow-up are still required to clarify which should be the best treatment of choice.     

幼龄成骨细胞移植促进骨质疏松性骨折愈合中不同类型一氧化氮合酶的动态表达

目的:追踪观察移植细胞在骨折愈合不同时间点的神经型一氧化氮合酶、诱导型一氧化氮合酶与内皮型一氧化氮合酶动态表达的生物学意义。方法:实验于1999-01/2004-02在中山大学动物试验中心、中山大学病理教研室完成、中山大学肿瘤防治中心完成。选择SD清洁级大鼠96只,按配对原则分为实验组48只,对照组48只;SD清洁级乳鼠20只进行成骨细胞原代培养。建立SD大鼠老龄骨质疏松骨折的动物模型,实验组将SD乳鼠颅骨体外培养的成骨细胞移植到SD雌性大鼠骨质疏松性骨折部位,对照组注入等量无血清培养液。手术后3,7,10,14,21,28,56,84d处死,每组每个时间点6只。用免疫组化检测骨折愈合不同时相的标本诱导型一氧化氮合酶、内皮型一氧化氮合酶和神经元型一氧化氮合酶的动态表达情况。结果:96只大鼠均进入结果分析。实验组:诱导型一氧化氮合酶在3d左右可见较多阳性表达的细胞,7d有表达高峰。内皮型一氧化氮合酶在3d左右可见少量阳性细胞,14d有表达高峰。神经元型一氧化氮合酶在10d左右可见少量阳性细胞,14～21d表达稍有增高,整个实验过程中神经元型一氧化氮合酶表达较弱,表达高峰不明显。而对照组诱导型一氧化氮合酶、内皮型一氧化氮合酶均有较弱表达,表达峰低平,而神经元型一氧化氮合酶表达很弱,未见明显表达高峰。结论:诱导型一氧化氮合酶、内皮型一氧化氮合酶在成骨细胞移植促进老年骨质疏松性骨折愈合的表达具有时效性,且表达的定位细胞不同,表达的量有差别,提示骨折部位一氧化氮合酶的释放可能对促进骨质疏松性骨折愈合有意义。神经元型一氧化氮合酶在成骨细胞移植促进老年骨质疏松性骨折愈合过程中的作用不明显。     

腋下Muscle-sparing剖胸切口在临床中的应用

目的：探讨腋下Muscle—Sparing剖胸切口在临床中的应用及其优、缺点。方法：对35例行Muscle—Sparing剖胸术病例进行回顾性分析。结果：Muscle—Sparing剖胸切口手术时显露较差．操作较困难，但术后肺功能影响小，疼痛轻，胸壁肌肉保留完整，伤侧上肢、肩关节活动受限轻、恢复快。结论：对适当病例Muscle—Sparing剖胸术是一种损伤较小的开胸术。     

Phenotypic plasticity of mesenchymal stem cells is crucial for mesangial repair in a model of immunoglobulin light chain-associated mesangial damage

Mesangiopathies produced by glomerulopathic monoclonal immunoglobulin light chains (GLCs) acting on the glomerular mesangium produce two characteristic lesions: AL-amyloidosis (AL-Am) and light chain deposition disease (LCDD). In both cases, the pathology is centered in the mesangium, where initial and progressive damage occurs. In AL-Am the mesangial matrix is destroyed and replaced by amyloid fibrils and in LCDD, the mesangial matrix is increased and remodeled. The collagen IV rich matrix is replaced by tenascin. In both conditions, mesangial cells (MCs) become apoptotic as a direct effect of the GLCs.

MCs were incubated in-vitro with GLCs and animal kidneys were perfused ex-vivo via the renal artery with GLCs, producing expected lesions, and then mesenchymal stem cells (MSCs) were added to both platforms. Each of the two platforms provided unique information that when put together created a comprehensive evaluation of the processes involved. A “cocktail” with growth and differentiating factors was used to study its effect on mesangial repair.

MSCs displayed remarkable phenotypic plasticity during the repair process. The first role of the MSCs after migrating to the affected areas was to dispose of the amyloid fibrils (in AL-Am), the altered mesangial matrix (in LCDD) and apoptotic MCs/debris. To accomplish this task, MSCs transformed into facultative macrophages acquiring an abundance of lysosomes and endocytotic capabilities required to engage in phagocytic functions. Once the mesangial cleaning was completed, MSCs transformed into functional MCs restoring the mesangium to normal. “Cocktail” made the repair process more efficient.