Both techniques of vascular control were equally safe, efficacious, and feasible for patients undergoing laparoscopic left-sided liver resection. The tourniquet method gave a wider safety margin for patients with chronic liver disease with a compromised hepatic reserve by causing less ischemia-reperfusion injury to the remnant liver.

Background and Objectives:In the past, right hepatectomy via the anterior approach has been regarded as one of the many standard approaches for hepatectomy. However, total laparoscopic right hepatectomy from the anterior approach has been regarded as technically challenging. We report our experience in using the anterior approach in total laparoscopic right hepatectomy for hepatocellular carcinoma (HCC).Methods:From June 2013 through December 2015, five consecutive patients underwent total laparoscopic right hepatectomy using the anterior approach, but without the hanging maneuver.Results:The mean operative time was 360 (range, 300–480) minutes, and the mean blood loss was 340 (110–600) mL. No patient needed any blood transfusion. There was no conversion to open surgery. Ascites, pleural effusion, and bile leakage occurred in 2, 1, and 1 patients, respectively. No patients expired as a result of the surgery or liver failure. The mean hospital stay was 7 (4–15) days. All patients had R0 resection. After a mean follow-up of 22 (8–33) months, no patients experienced recurrence of disease.Conclusion:Total laparoscopic right hepatectomy using the anterior approach is feasible and safe.

Background/Aims: This study aimed to explore whether the adoptive transfusion of autologous CD4+CD25+ regulatory T cells (CD4+CD25+ Tregs) has a therapeutic effect on Experimental autoimmune neuritis (EAN) model rats, and it provides new experimental and theoretical bases for the immunotherapy of Guillain-Barre syndrome (GBS). Methods: CD4+CD25+ Tregs were sorted from the spleens of rats using immunomagnetic bead separation techniques combined with flow cytometry. Their in vitro inhibitory function was determined using a lymphocyte proliferation inhibition test, and their purity was confirmed by flow cytometry. Cells were stimulated using CD3/CD28 monoclonal antibodies and were cultured in culture medium containing interleukin 2 (IL-2), transforming growth factor-β (TGF-β) and rapamycin. After 15 days of amplification, CD4+CD25+ Tregs were collected and transfused into EAN model rats. Changes in the pathology and electron microscopical morphology of rat sciatic nerves in the normal group, untreated group, low-dose group (2 × 10⁷) and high-dose group (4 × 10⁷) were observed, and the expression of CD4+CD25+FOXP3 in peripheral blood in the four groups of rats was detected by flow cytometry. Results: Compared with rats in the untreated group, rats in the treatment groups had significantly reduced infiltration of inflammatory cells in the sciatic nerve, as well as myelin and axonal damage. Additionally, the CD4+CD25+ Tregs levels in peripheral blood were significantly higher than those in the untreated group (P< 0. 05). Moreover, the therapeutic effect became more significant with an increase in the dose of adoptive transfusion. Conclusion: Adoptive transfusion of CD4+CD25+ Tregs into EAN model rats has significant therapeutic effects.

Although garlic has been used in Chinese traditional medicine for its medical properties for thousands of years, investigations into its mode of action are relatively recent. The purpose of this study was to evaluate the in vitro anti-fungal efficacy of the active principle of garlic, pure allicin and polybutylcyanoacrylate (PBCA) nanoparticles (NPs) loaded with allicin. Pure allicin was prepared by reacting synthetic alliin with a stabilized process of the garlic enzyme alliinase. PBCA NPs were prepared by emulsion polymerization method and pure allicin was wrapped into it. The in vitro efficacy of pure allicin and PBCA-allicin NPs to Candida albicans, Cryputococcus neoformans, Trichophyton rubum, Microsporum gypseum, M. canis and Epidermophyton floccosum was examined and evaluated by MIC and MFC. The MIC of PBCA-allicin NPs to C. albicans (2.93 x 10(-2)mg/ml), T. rubum (1.46 x 10(-2)mg/ml) and E. floccosum (1.46 x 10(-2)mg/ml) was significantly lower than that of pure allicin (5.86 x 10(-2)mg/ml, 2.93 x 10(-2)mg/ml, 2.93 x 10(-2)mg/ml, respectively); accordingly, the MFC of PBCA-allicin NPs to C. albicans (5.86 x 10(-2)mg/ml), T. rubum (2.93 x 10(-2)mg/ml), E. floccosum (2.93 x 10(-2)mg/ml) and M. canis (2.93 x 10(-2)mg/ml) also decreased dramatically. These favourable results indicated that pure allicin has stronger in vitro anti-fungal efficacy to six tested fungi than alliinase and alliin. Moreover, it has improved significantly after pure allicin being wrapped into PBCA NP, which may be due to the NP's good prolonged release effect and nano-scale dimensions.

Background: Open right anterior sectionectomy, which involves resection of liver segments 5 and 8, has been reported to have similar postoperative mortality rates as right hepatectomy, but it has a decreased risk in developing posthepatectomy liver failure. Totally laparoscopic right anterior sectionectomy is technically demanding and has rarely been reported in hepatocellular carcinoma (HCC) patients with cirrhosis. Methods: Our experience in carrying out totally laparoscopic right anterior sectionectomy on four consecutive HCC patients with cirrhosis from November 2016 to August 2017 using the extraglissonian approach formed the basis of this report. Results: All four patients had hepatitis B–related HCC. The mean operation time was 502 ± 55 minutes. All patients underwent intermittent Pringle's Maneuver with cycles of clamp/unclamp times of 15/5 minutes for the left-sided liver transection plane, and intermittent right hemihepatic vascular inflow occlusion with cycles of clamp/unclamp times of 30/5 minutes for the right-sided liver transection plane. The mean Pringle's Maneuver time was 58.8 ± 11.4 minutes and the mean right hemihepatic vascular inflow occlusion time was 66.3 ± 11.1 minutes. The mean intraoperative blood loss was 512 ± 301 mL. No patients required any blood transfusion. There was no conversion to open surgery. Postoperative complications included intra-abdominal bleeding requiring reoperation for hemostasis (n = 1), intra-abdominal collection requiring percutaneous drainage (n = 1), and right pleural effusion requiring percutaneous drainage (n = 1). There was no 90-day postoperative mortality. The mean hospital stay was 10.7 ± 2.9 days. After a median follow-up of 10 (range, 6–16) months, one patient developed HCC recurrence in the liver remnant. Conclusion: Totally laparoscopic right anterior sectionectomy using the extraglissonian approach was technically feasible and safe in expert hands. More data are needed to assess the long-term oncological survival outcomes.

The preliminary results of this 5-steps stapling technique for right hepatectomy using the liver hanging maneuver are encouraging as the technique resulted in little intraoperative blood loss and short operation time, and it caused no major complications and mortality.

Encouraging results were obtained with the use of the closed suction irrigation method for infected laparotomy wounds. The closed suction irrigation method decreased hospital stay and allowed early rehabilitation. The findings of our study need to be substantiated in large-scale randomized controlled trials.