Objective To evaluate the hemostatic effect of selective artery embolization in treatment for traumatic hepatic rupture bleeding. Methods The clinical data of 63 patients with traumatic hepatic rupture treated in this hospital from Jan. 2004 to Jun. 2011 were analyzed retrospectively. With Seldinger technique， a catheter was introduced into the liver artery via the right femoral artery for angiography. Once the bleeding site was identified， microcatheter was placed into the hemorrhagic vessels to control the bleeding with polyvinyl alcohol or gelatin sponges. Results The hepatic arteriography was successfully performed in 63 cases， the results showed hepatic left-artery bleeding in 8 cases， hepatic right-artery bleeding in 39 cases， and hepatic left- and right-artery bleeding in 10 cases. Fifty-seven cases received selective arterial embolization and successful hemostasia， including one embolization in 36 cases， two embolizations in 11 cases， and more than two embolizations in 10 cases. Six patients without obvious hemorrhage didn’t receive selective arterial embolization. There was no bleeding again case and no dead case. The hemoglobin and hematocrit returned to normal in one week after embolization. No hemorrhage or other complications happened during follow-up for 0.5 to 1 year. Conclusion The selective arterial embolization is an effective， safe and minimally invasive method for hemostasia of patients with traumatic hepatic rupture.
【Abstract】ObjectiveTo explore the appropriate surgical management of the primary hepatocellular carcinoma with hypersplenism. MethodsOf 67 patients who has primary hepatocellular carcinoma with hypersplenism, 17 cases had hepatectomy combined with splenectomy, 7 cases had hepatectomy only, and the other 43 patients were treated with hepatic artery embolization and splenic artery embolization. ResultsThe symptoms of hypersplenism disappeared and the hemogram became normal 30 d after operation in 17 patients who had hepatectomy combined with splenectomy, but worsened in 7 patients who only had simple hepatectomy and 6 cases of those patients were treated with splenic artery embolization 3-7 months after operation. In 43 patients treated with hepatic artery embolization and splenic artery embolization, 79%（34/43）had improved hypersplenism symptoms and the hemogram became normal. ConclusionThe treatment of primary hepatocellular carcinoma with hypersplenism should be strived for hepatectomy combined with splenectomy. If the liver mass cannot be resected, hepatic artery embolization and splenic artery embolization should be chosen.
Objective To prepare Pluronic F-127 composite gel loaded with transforming growth factor β3 (TGF-β3) and bone marrow mesenchymal stem cells (BMSCs) and observe its osteogenesis and angiogenesis effects in vivo and in vitro. Methods BMSCs were isolated from the tibial and femoral bone marrow of New Zealand white rabbits and passaged, and the 3rd generation cells were used for subsequent experiments after identification of osteogenic and adipogenic induction. Pluronic F-127 powder and TGF-β3 were dissolved in L-DMEM medium to prepare Pluronic F-127 gel, TGF-β3+Pluronic F-127 gel, BMSCs+Pluronic F-127 gel, and TGF-β3+BMSCs+Pluronic F-127 gel. The 3rd generation of BMSCs were cultured with L-DMEM medium (group A), osteogenic induction medium (group B), osteogenic induction medium containing Pluronic F-127 gel (group C), and osteogenic induction medium containing TGF-β3+Pluronic F-127 gel (group D), respectively. After 14 days of culturing, alkaline phosphatase (ALP) staining and Alizarin red staining were used to observe the osteogenesis. In addition, the BMSCs were cultured with L-DMEM medium containing Pluronic F-127 gel (experimental group) and L-DMEM medium (control group) for 1, 2, 3, and 4 days, respectively. And the cell proliferation was detected by MTT assay. Ten New Zealand white rabbits were taken to prepare the maxillary sinus lift models, and Pluronic F-127 gel (group A), TGF-β3+Pluronic F-127 gel (group B), BMSCs+Pluronic F-127 gel (group C), and TGF-β3+BMSCs+Pluronic F-127 gel (group D) were injected into the bone defects, respectively. On the 8th week, imaging examination and HE staining were used to observe the formation of new bone, immunohistochemical staining was used to observe the expression of vascular endothelial growth factor (VEGF) and bone morphogenetic protein 2 (BMP-2) in bone tissue, and Western blot was used to detect the relative expressions of VEGF, oncostatin M (OSM), and BMP-4 proteins in bone tissue. Results Osteogenic and adipogenic induction identified the isolated and cultured cells as BMSCs. In vitro staining showed that ALP activity and Alizarin red concentration in group D were significantly higher than those in other groups (P<0.05). MTT assay showed that the absorbency (A) value of the two groups increased gradually, and there was no significant difference between the groups at each time point (P>0.05). In vivo experimental imaging examination showed that the bone mineral density and osteogenic continuity of group D were the best, and the proportion of new bone volume was superior to other groups (P<0.05). HE staining showed that compared with other groups, bone trabeculae in group D were dense and arranged regularly, on which a large number of osteoblasts and osteoclasts were distributed, and a large number of new bone formation could be seen. Immunohistochemical staining showed the strong positive expressions of BMP-2 and VEGF in group D (P<0.05); Western blot detection showed that the relative expressions of VEGF, OSM, and BMP-4 proteins in group D were significantly higher than those in other groups (P<0.05). Conclusion The BMSCs in Pluronic F-127 composite gel loaded with TGF-β3 and BMSCs can be induced to differentiate into osteoblasts, and the composite gel has no toxic effect on cells, and has obvious osteogenesis and angiogenesis in the maxillary sinus of rabbits.
Objective To summarize and further investigate the initial experience of organ procurement process for organ donation after cardiac death （DCD）. Methods The clinical data，the selected standard，and the organ procurement process of 28 cases of DCD from July 2009 to January 2012 in the liver transplantation center of Guangzhou General Hospital were reviewed and analyzed. Results Twenty-eight cases of DCD all had donated organs successfully. Among these cases，there were 3 cases （10.7%） of the Maastricht Ⅲ， and one case （3.6%） of the Maastricht Ⅳ，and 24 cases （85.7%） of the organ donation after brain death plus cardiac death （DBCD）．Three cases of the Maastricht Ⅲ were practiced the organ procurement process of DCD．One case of the Maastricht Ⅳ was practiced the organ procurement process of DBCD without the extracorporeal membrane oxygenation （ECMO）．Twenty-four cases of DBCD were practiced the organ procurement process of DBCD with the ECMO．The donator warm ischemic time was zero min in DBCD，18 min in Maastricht Ⅳ，and mean 25 min （22-28 min） in MaastrichtⅢ．All the donated organs included 28 livers，40 kidneys，and 2 hearts．And all these organs had been practiced the liver transplantation，the kidney transplantation，and the heart transplantation. Conclusions The organ procurement process for organ DCD includes the DCD process and the DBCD process in China，and the later includes the organ procurement process with the ECMO and without the ECMO．The ECMO could well control the warm ischemia for protecting the donors just without ethics dispute. So，the using of the ECMO for the organ DCD of citizen in China has a very important contribution．