Novel compound heterozygous mutations in the hemojuvelin gene in a juvenile hemochromatosis patient:A case report

BACKGROUND Juvenile hemochromatosis(JH)is an early-onset,rare autosomal recessive disorder of iron overload observed worldwide that leads to damage in multiple organs.Pathogenic mutations in the hemojuvelin(HJV)gene are the major cause of JH.CASE SUMMARY A 34-year-old male Chinese patient presented with liver fibrosis,diabetes,hypogonadotropic hypogonadism,hypophysis hypothyroidism,and skin hyperpigmentation.Biochemical test revealed a markedly elevated serum ferritin level of 4329μg/L and a transferrin saturation rate of 95.4%.Targeted exome sequencing and Sanger sequencing revealed that the proband had a novel mutation c.863G>A(p.R288Q)in the HJV gene which was transmitted from his father,and two known mutations,c.18G>C(p.Q6H)and c.962_963delGCinsAA(p.C321*)in cis,which were inherited from his mother.The p.R288W mutation was previously reported to be pathogenic for hemochromatosis,which strongly supported the pathogenicity of p.R288Q reported for the first time in this case.After 72 wk of intensive phlebotomy therapy,the patient achieved a reduction in serum ferritin to 160.5μg/L.The patient's clinical symptoms demonstrated a notable improvement.CONCLUSION This study highlights the importance of screening for hemochromatosis in patients with diabetes and hypogonadotropic hypogonadism.It also suggests that long-term active phlebotomy could efficiently improve the prognosis in severe JH.

Treatment of choice for malignant gastric outlet obstruction: More than clearing the road

In this editorial,we comment on the in-press article in the World Journal of Gas-trointestinal Endoscopy concerning the treatment of malignant gastric outlet obstruction(mGOO).The original theory of treatment involves bypassing the obstruction or reenabling the patency of the passage.Conventional surgical gastroenterostomy provides long-term relief of symptoms in selected patients,with substantial morbidity and a considerable rate of delayed gastric emptying.Endoscopic stenting was introduced as an alternative minimally invasive proce-dure with less procedural morbidity and rapid clinical improvement;however,it presented a high rate of long-term recurrence.Therefore,challenges remain in the treatment of mGOO patients to improve clinical outcomes.Endoscopic ultra-sound-guided gastroenterostomy has recently emerged as a promising method because of the combined effects of surgery and endoscopy,whereas stomach-partitioning gastrojejunostomy has been reported as a modified surgical proce-dure to reduce the rate of delayed gastric emptying.In decision-making regarding the treatment of choice,it should be taken into account that mGOO might be accompanied by a variety of pathological conditions,including cancer cachexia,anorexia,malabsorption,and etc.,all of which can also lead to the characteristic symptoms and poor nutritional status of mGOO.The treatment plan should consider comprehensive aspects of patients to achieve practical improve-ments in prognosis and the quality of life.

International experts consensus guidelines on robotic liver resection in 2023

The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Based on the foundation of the previous consensus statement,this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice.The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine(EBM).Relevant literature was reviewed and analyzed by the evidence evaluation group.According to the WHO Handbook for Guideline Development,the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022,a total of 14 recommendations were generated.Among them were 8 recommendations formulated by the GRADE method,and the remaining 6 recommendations were formulated based on literature review and experts’opinion due to insufficient EBM results.This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.

Molecular dynamics study of interactions between edge dislocation and irradiation-induced defects in Fe–10Ni–20Cr alloy

Irradiation-induced defects frequently impede the slip of dislocations, resulting in a sharp decline in the performance of nuclear reactor structural materials, particularly core structural materials. In the present work, molecular dynamics method is used to investigate the interactions between edge dislocations and three typical irradiation-induced defects(void,Frank loop, and stacking fault tetrahedron) with the sizes of 3 nm, 5 nm, and 7 nm at different temperatures in Fe–10Ni–20Cr alloy. The critical resolved shear stresses(CRSSs) are compared among different defect types after interacting with edge dislocations. The results show that the CRSS decreases with temperature increasing and defect size decreasing for each defect type during the interaction with edge dislocations, except for the case of 3-nm Frank loops at 900 K. According to a comparison, the CRSS in Frank loop is significantly higher than that of others of the same size, which is due to the occurrence of unfaulting and formation of superjog or stacking-fault complex during the interaction. The atomic evolution of irradiation-induced defects after interacting with dislocations can provide a novel insight into the design of new structural materials.

Scientific Hepatectomy for Hepatocellular Carcinoma

With advances in imaging technology and surgical instruments,hepatectomy can be perfectly performed with technical precision for hepatocellular carcinoma(HCC).However,the 5-year tumor recurrence rates remain greater than 70%.Thus,the strategy for hepatectomy needs to be reappraised based on insights of scientific advances.Scientific evidence has suggested that the main causes of recurrence after hepatectomy for HCC are mainly related to underlying cirrhosis and the vascular spread of tumor cells that basically cannot be eradicated by hepatectomy.Liver transplantation and systemic therapy could be the solution to prevent postoperative recurrence in this regard.Therefore,determining the severity of liver cirrhosis for choosing the appropriate surgical modality,such as liver transplantation or hepatectomy,for HCC and integrating newly emerging immune-related adjuvant and/or neoadjuvant therapy into the strategy of hepatectomy for HCC have become new aspects of exploration to optimize the strategy of hepatectomy.In this new area,hepatectomy for HCC has evolved from a pure technical concept emphasizing anatomic resection into a scientific concept embracing technical considerations and scientific advances in underlying liver cirrhosis,vascular invasion,and systemic therapy.By introducing the concept of scientific hepatectomy,the indications,timing,and surgical techniques of hepatectomy will be further scientifically optimized for individual patients,and recurrence rates will be decreased and long-term survival will be further prolonged.

Correlation between immune-related adverse events and long-term outcomes in pembrolizumab-treated patients with unresectable hepatocellular carcinoma:A retrospective study

BACKGROUND Although immune checkpoint inhibitor(ICI)therapy has improved the prognosis of unresectable hepatocellular carcinoma(HCC),it has also resulted in unique immune-related adverse events(irAEs).The relationship between irAE and treatment outcomes in ICI-treated unresectable HCC patients remains unknown.AIM To elucidate the correlation between immune-related toxic effects and prognosis in patients with unresectable HCC treated with pembrolizumab.METHODS From March 2019 to February 2021,a total of 190 unresectable HCC(Barcelona Clinic Liver Cancer C)patients receiving pembrolizumab treatment were retrospectively reviewed.Overall survival(OS)was the primary endpoint,while objective response rate(ORR),disease control rate(DCR),and time to progression(TTP)were secondary evaluation indexes.We assessed demographics,irAEs,and outcomes by retrospective review.RESULTS One hundred and forty-three males and 47 females were included in the study.The ORR and DCR were 12.1%(23/190)and 52.1%(99/190),respectively.The median OS was 376 d[95%confidence interval(CI):340-411 d]and the median TTP was 98 d(95%CI:75-124 d).The overall incidence of treatment-related adverse events was 72.6%(138/190)and 10.0%of them were severe irAEs(grade≥3).Child-Pugh B class,portal vein tumor thrombus,extrahepatic metastasis,and hypothyroidism were the independent risk factors for survival.Patients with hypothyroidism showed a longer OS[517 d(95%CI:423-562)vs 431 d(95%CI:412-485),P=0.011]and TTP[125 d(95%CI:89-154)vs 87 d(95%CI:61-98),P=0.004]than those without irAEs.CONCLUSION Pembrolizumab-treated patients with unresectable HCC who experienced hypothyroidism have promising ORR and durable response.Hypothyroidism,an irAE,may be used as a clinical evaluation parameter of response to ICIs in unresectable HCC.

Postprandial glucagon-like peptide 1 secretion is associated with urinary albumin excretion in newly diagnosed type 2 diabetes patients

BACKGROUND Microalbuminuria is an early and informative marker of diabetic nephropathy.Our study found that microalbuminuria developed in patients with newly diagnosed type 2 diabetes mellitus(T2DM).AIM To investigate the association between glucagon-like peptide 1(GLP-1)and microalbuminuria in newly diagnosed T2DM patients.METHODS In total,760 patients were recruited for this cross-sectional study.The GLP-1 levels during a standard meal test and urinary albumin-creatinine ratio(UACR)were determined.RESULTS Patients with microalbuminuria exhibited lower GLP-1 levels at 30 min and 120 min during a standard meal test than patients with normal albuminuria(30 min GLP-1,16.7±13.3 pmol vs 19.9±15.6 pmol,P=0.007;120 min GLP-1,16.0±14.1 pmol vs 18.4±13.8 pmol,P=0.037).The corresponding area under the curve for active GLP-1(AUCGLP-1)was also lower in microalbuminuria patients(2257,1585 to 3506 vs 2896,1763 to 4726,pmol×min,P=0.003).Postprandial GLP-1 levels at 30 min and 120 min and AUCGLP-1 were negatively correlated with the UACR(r=0.159,r=0.132,r=0.206,respectively,P<0.001).The prevalence of microalbuminuria in patients with newly diagnosed T2DM was 21.7%,which decreased with increasing quartiles of AUCGLP-1 levels(27.4%,25.3%,18.9%and 15.8%).After logistic regression analysis adjusted for sex,age,hemoglobin A1c,body mass index,systolic blood pressure,estimated glomerular filtration rate,homeostasis model assessment of insulin resistance,AUC_(glucose)and AUC_(glucagon)patients in quartile 4 of the AUCGLP-1 presented a lower risk of microalbuminuria compared with the patients in quartile 1(odds ratio=0.547,95%confidence interval:0.325-0.920,P=0.01).A consistent association was also found between 30 min GLP-1 or 120 min GLP-1 and microalbuminuria.CONCLUSION Postprandial GLP-1 levels were independently associated with microalbuminuria in newly diagnosed Chinese T2DM patients.

Proposal of a modified classification for hilar cholangiocarcinoma

Hilar cholangiocarcinoma is a malignant tumor that originates from the left and right hepatic ducts and their confluence.It is highly malignant and associated with a poor prognosis.Surgical resection is the only available curative treatment option.A scientific classification system can aid in the preoperative assessment of resectability and guide the development of appropriate surgical strategies.Several classification systems are available,with the Bismuth-Corlette(BC)classification being the earliest and most widely used.Similar to many other classifications,the BC classification relies on the secondary branching of the bile ducts as an important anatomical landmark,making it unsuitable for cases with variations in the bile duct anatomy.With advances in understanding the hepatic plate and anatomical structures at the hilum,the secondary bile ducts are no longer considered important anatomical landmarks.Therefore,modifications to the BC classification are needed to align with modern anatomical improvements and advancements in surgical techniques.Herein,we propose a modification to the BC classification.In this new system,the boundary of the hilar plate is considered as limit of the proximal ductal margin and used as an anatomical landmark,rather than the concept of“secondary bile ducts”in the BC classification.

模拟失重对成年小鼠闪光视网膜电图和视网膜微循环的影响

目的:小鼠通过悬尾来模拟失重状态下体液头向重分布,然后观察视网膜电图(ERG)和视网膜微循环的变化。方法:正常成年雄性C57BL/6J小鼠随机分到3个实验组和3个对照组,最终每组6只。具体分组如下:实验1组(尾悬15d),实验2组(尾悬30d),实验3组(悬吊30d后恢复体位30d);对照1组(正常饲养15d),对照2组(正常饲养30d),对照3组(正常饲养60d)。时间满足后马上检测暗适应闪光ERG,记录混合反应和振荡电位(OPs),并进行荧光素眼底血管造影(FFA)。然后提取视网膜组织,用免疫组化法检测感光细胞视色素或视蛋白的表达,用TUNEL试剂盒检测视网膜组织细胞的凋亡情况。结果:悬吊15d组,暗适应ERG的混合反应,b波较大而OPs振幅明显降低,后者第二个子波(O 2)幅值197±33μV,15d未悬吊组336±47μV(t=-5.938,P<0.001)。悬吊30d组,小鼠ERG恢复,O 2幅值264±39μV,与30d未悬吊组308±41μV无差异(t=-1.887,P>0.05)。悬吊15d组FFA,视网膜微血管较对照组更密集,呈迂曲扩张的表现,其他实验组基本正常。各实验组感光细胞视色素或视蛋白的表达未见明显异常,视网膜未见凋亡阳性细胞。结论:模拟失重状态下体液头向重分布,短期内小鼠ERG和视网膜微循环可能受到影响,但未对视网膜产生明显的永久性损伤。

International consensus statement on robotic hepatectomy surgery in 2018

The robotic surgical system has been applied in liver surgery. However,controversies concerns exist regarding a variety of factors including the safety,feasibility, efficacy, and cost-effectiveness of robotic surgery. To promote the development of robotic hepatectomy, this study aimed to evaluate the current status of robotic hepatectomy and provide sixty experts' consensus and recommendations to promote its development. Based on the World Health Organization Handbook for Guideline Development, a Consensus Steering Group and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 22 topics were prepared analyzed and widely discussed during the 4 meetings. Based on the published articles and expert panel opinion, 7 recommendations were generated by the GRADE method using an evidence-based method, which focused on the safety, feasibility, indication,techniques and cost-effectiveness of hepatectomy. Given that the current evidences were low to very low as evaluated by the GRADE method, further randomized-controlled trials are needed in the future to validate these recommendations.

Changes of immune function in patients with liver cirrhosis after splenectomy combined with resection of hepatocellular carcinoma

OBJECTIVE: To study the changes of immune function in liver cirrhosis patients after splenectomy combined with resection of hepatocellular carcinoma (HCC). METHODS: Sixteen patients with HCC associated with liver cirrhosis were divided into two groups: splenectomy combined with hepatectomy (splenectomy group n=7) and hepatectomy (non-splenectomy group, n=9). T lymphocyte subsets such as CD4, CD8, CD4/CD8 and Th lymphocyte cytokines such as interferon γ (IFN-γ), IL-2, IL-10 in 7 ml peripheral venous blood before operation and 2 months after operation were examined and compared between the two groups. RESULTS: There was no significant difference in pre-operative CD4, CD8, CD4/CD8, IL-2, IFN-γ, IL-10 levels in the two groups. Two months after operation, the levels of CD4 (38.2%±3.7%), CD4/CD8 (1.7±0.3), IFN-γ (104.4±14.9 pg/ml), 1L-2 (98.6±18.6 pg/ml) were increased and those of CD8 (23.7±3.7 pg/ml), IL-10 (55.5±11.2 pg/ml) levels were decreased in the splenectomy group. The levels of CD4 (32.5%±4.0%), CD4/CD8 (1.1±0.1), IFN-γ(70.5±12.6 pg/ml), IL-2(80.9±13.5 pg/ml) in the non-splenectomy group were much lower than those in the splenectomy group, but the levels of CD8 (29.4%±4.0%), IL-10 (89.4±10.0 pg/ml) in the non-splenectomy group were significantly higher than those in the splenectomy group (P<0.05). CONCLUSIONS: Splenectomy combined with hepatectomy for HCC patients associated with liver cirrhosis does not decrease but promote the recovery of T lymphocyte subsets and Th1/Th2 cytokines from imbalance and improve anti-tumor immune function of the patients.

Primary combined hepatocellular-cholangiocellular sarcoma:An unusual case

Primary liver carcinosarcoma is rare. Here we report an unusual case of liver carcinosarcoma containing combined hepatocellular cholangiocarcinoma. A mass in the right liver lobe of a 45-year-old man was accidentally discovered by ultrasonic inspection and computed tomography(CT) scan. Surgical resection was performed following a diagnosis of primary liver cancer. Micropathologically, both carcinomatous and sarcomatous elements were present, and diagnosis of liver carcinosarcoma was confirmed. The carcinomatous element consisted of hepatocellular carcinoma and foci of cholangiocellular carcinoma. The sarcomatous element was composed of spindle cells and bizarre cells,as well as foci of osteosarcoma and chondrosarcoma.Hepatocellular carcinoma cells diffusely expressed both hepatocyte specific markers cytokeratin(CK)8/18 and cholangiocyte specific markers CK19, and sarcoma cells were positive for vimentin. Interestingly,both carcinomatous and sarcomatous cells expressed epithelial membrane antigen. CD117-positive ductular reactions and small undifferentiated cells were observed.A liver progenitor cell origin of the liver carcinosarcoma was proposed.

模拟失重条件下小鼠视网膜坏死和凋亡的变化

目的:探索模拟失重环境与视网膜损伤的关系。方法:采用尾吊小鼠试验模拟失重,应用光镜和透射电镜观察视网膜组织形态学变化;应用免疫组织化学和Western blot检测与分析相关的分子变化。结果:光镜和透射电镜显示:与对照组相比,尾吊组小鼠视网膜神经节层和内核层细胞中均可见更多死亡细胞,相关通路中的TNF-α和caspase-3蛋白表达上调。结论:在模拟失重环境下小鼠视网膜会产生明显的病理损伤。

Combined Laparoscopic Splenectomy and Esophagogastric Devascularization versus Open Splenectomy and Esophagogastric Devascularization for Portal Hypertension due to Liver Cirrhosis

This study was conducted to compare the feasibility,safety and effectiveness of the combined-laparoscopic splenectomy and esophagogastric devascularization(C-LSED)with open splenectomy and esophagogastric devascularization surgery(OSED)in patients with portal hypertension due to liver cirrhosis.From February 2014 to June 2018,68 patients with portal hypertension were diagnosed as having serious gastroesophageal varices and/or hypersplenism in our center.Thirty patients underwent C-LSED and 38 patients received OSED.Results and outcomes were compared retrospectively.No patients of C-LSED group required an intraoperative conversion to open surgery.Significantly shorter operating time,less blood loss,lower transfusion rates,shorter postoperative hospital stay,lower rates of complications were found in C-LSED group than in C-LSED group(P<0.05).No death and rebleeding were documented in both groups during the follow-up periods of one year Postoperative endoscopy revealed that varices in the patients of both groups were alleviated significantly from severe to mild,and in a part of cases,the varices disappeared.The final results suggest that the C-LSED technique is superior to open procedure,due to slightly invasive,simplified operative procedure,significantly shorter operating time,less intraoperative bleeding and lower post-operative complication rates.And C-LSED offers comparable long-term effects to open surgery.

Decreased fragile histidine triad expression in colorectal cancer and its association with apoptosis inhibition

AIM： To detect the expression of fragile histidine triad （FHIT） in normal colorectal tissue, colorectal adenoma and colorectal cancer （CRC） tissue, and to analyze its relationship with the clinicopathological features of CRC, and apoptosis-associatecl proteins （Bcl-2, Bax, survivin） and apoptosis in colorectal cancer. METHODS： FHIT mRNA analysis was performed by nested reverse transcription-polymerase chain reaction （RT-PCR） assay. Tissue microarray （TMA） was established to detect the expression of FHIT, Bcl-2, Bax and survivin genes in 80 CRC tissue specimens, 16 colorectal adenoma tissue specimens and 16 hemorrhoid （PPH） tissue specimens during the same period of time as the control. Citrate-microwave-SP was used as immunohistochemical method. The relationship between clinicopathological factors, such as differentiation grades and 5-year survival rate was observed. TUNEL assay was used to detect the apoptosis index in 80 CRC tissue specimens. RESULTS： Ten out of 26 （38.5%） CRC tissue specimens expressed aberrant FHIT transcripts, none of the aberrant FHIT transcripts was observed in the matchednormal tissue and colorectal adenoma tissue by nested RT-PCR assay. The positive rate of FHIT gene expression in normal colorectal tissue, colorectal adenoma and carcinoma tissue was 93.75%, 68.75% and 46.25%, respectively. Clinicopathological analysis of patients showed that the decreased FHIT gene expression was not associated with age, sex, serum CEA levels, tumor site and size, histological classification. However, the expression of FHIT was correlated with differentiation grades, pathological stages, lymph node metastases and 5-year survival rate after operation. The positive rate of apoptosis-associated proteins （Bax, Bcl-2 and survivin） in CRC tissue was 72.50%, 51.25% and 77.50%, respectively. The expression of these apoptosisassociated proteins in CRC tissue was correlated with the expression of FHIT. The mean apoptosis index in FHIT negative tumors was significantly lower than that in FHIT- positive tumors （5.41 ± 0.23 vs 0.56 ± 0.10, P 〈 0.01）. CONCLUSION： The FHIT gene plays an important role in the regulation of apoptosis and decreased FHIT expression plays a key role in the initiation and progression of colorectal carcinoma.

Keeping the right time in space: importance of circadian clock and sleep for physiology and performance of astronauts

The circadian clock and sleep are essential for human physiology and behavior; deregulation of circadian rhythms impairs health and performance. Circadian clocks and sleep evolved to adapt to Earth's environment, which is characterized by a 24-hour light–dark cycle. Changes in gravity load, lighting and work schedules during spaceflight missions can impact circadian clocks and disrupt sleep, in turn jeopardizing the mood, cognition and performance of orbiting astronauts. In this review, we summarize our understanding of both the influence of the space environment on the circadian timing system and sleep and the impact of these changes on astronaut physiology and performance.

Anatomic resection improved the long-term outcome of hepatocellular carcinoma patients with microvascular invasion:A prospective cohort study

BACKGROUND The long-term effect of anatomic resection(AR)is better than that of nonanatomic resection(NAR).At present,there is no study on microvascular invasion(MVI)and liver resection types.AIM To explore whether AR improves long-term survival in patients with hepatocellular carcinoma(HCC)by removing the peritumoral MVI.METHODS A total of 217 patients diagnosed with HCC were enrolled in the study.The surgical margin was routinely measured.According to the stratification of different tumor diameters,patients were divided into the following groups:≤2 cm group,2-5 cm group,and>5 cm group.RESULTS In the 2-5 cm diameter group,the overall survival(OS)of MVI positive patients was significantly better than that of MVI negative patients(P=0.031).For the MVI positive patients,there was a statistically significant difference between AR and NAR(P=0.027).AR leads to a wider surgical margin than NAR(2.0±2.3 cm vs 0.7±0.5 cm,P<0.001).In the groups with tumor diameters<2 cm,both AR and NAR can obtain a wide surgical margin,and the surgical margins of AR are wider than that of NAR(3.5±5.8 cm vs 1.6±0.5 cm,P=0.048).In the groups with tumor diameters>5 cm,both AR and NAR fail to obtain wide surgical margin(0.6±1.0 cm vs 0.7±0.4 cm,P=0.491).CONCLUSION For patients with a tumor diameter of 2-5 cm,AR can achieve the removal of peritumoral MVI by obtaining a wide incision margin,reduce postoperative recurrence,and improve prognosis.

Olfactory ensheathing cells promote nerve regeneration and functional recovery after facial nerve defects

Olfactory ensheathing cells from the olfactory bulb and olfactory mucosa have been tbund to increase axonal sprouting and pathfinding and promote the recovery of vibrissae motor performance in facial nerve transection injured rats. However, it is not yet clear whether olfactory ensheathing cells promote the reparation of facial nerve defects in rats. In this study, a collagen sponge and silicone tube neural conduit was implanted into the 6-mm defect of the buccal branch of the facial nerve in adult rats. Olfactory ensheathing cells isolated from the olfactory bulb of newborn Sprague-Dawley rats were injected into the neural conduits connecting the ends of tile broken nerves, the morphology and function of the regenerated nerves were compared between the rats implanted with olfactory ensheathing cells with the rats injected with saline. Facial paralysis was assessed. Nerve electrography was used to measure facial nerve-induced action potentials. Visual inspection, anatomical microscopy and hematoxylin-eosin staining were used to assess the histomorphology around the trans planted neural conduit and the morphology of the regenerated nerve. Using fluorogold retrograde tracing, toluidine blue staining and lead uranyl acetate staining, we also measured the number of neurons in the anterior exterior lateral f：acial nerve motor nucleus, the number of myelinated nerve fibers, and nerve fiber diameter and myelin sheath thickness, respectively. After surgery, olfactory ensheathing cells de- creased facial paralysis and the latency of the facial nerve-induced action potentials. There were no differences in the general morphology of the regenerating nerves between the rats implanted with olfactory ensheathing cells and the rats injected with saline. Between-group results showed that olfactory ensheathing cell treatment increased the number of regenerated neurons, improved nerve fiber morphology, and increased the number of myelinated nerve fibers, nerve fiber diameter, and myelin sheath thickness. In conclusion, implantation of olfactory ensheathing cells can promote regeneration and functional recovery after facial nerve damage in rats.

A New Grasping Mode Based on a Sucked-type Underactuated Hand

Robot hands have been developing during the last few decades. There are many mechanical structures and analyti?cal methods for di erent hands. But many tough problems still limit robot hands to apply in homelike environment. The ability of grasping objects covering a large range of sizes and various shapes is fundamental for a home service robot to serve people better. In this paper, a new grasping mode based on a novel sucked?type underactuated(STU) hand is proposed. By combining the flexibility of soft material and the e ect of suction cups, the STU hand can grasp objects with a wide range of sizes, shapes and materials. Moreover, the new grasping mode is suitable for some situations where the force closure is failure. In this paper, we deduce the e ective range of sizes of objects which our hand using the new grasping mode can grasp. Thanks to the new grasping mode, the ratio of grasping size between the biggest object and the smallest is beyond 40, which makes it possible for our robot hand to grasp diverse objects in our daily life. For example, the STU hand can grasp a soccer(220 mm diameter, 420 g) and a fountain pen(9 mm diameter, 9 g). What’s more, we use the rigid body equilibrium conditions to analysis the force condition. Experiment evaluates the high load capacity, stability of the new grasping mode and displays the versatility of the STU hand. The STU hand has a wide range of applications especially in unstructured environment.

Solitary hepatic lymphangioma mimicking liver malignancy: A case report and literature review

BACKGROUND Hepatic lymphangioma,a malformation of the liver lymphatic system,is a rare benign neoplasm and usually coexists with other visceral lymphangiomas.Solitary hepatic lymphangioma is much more rarely seen and could cause a clinical misinterpretation as malignancy.CASE SUMMARY A 50-year-old woman with a liver mass of approximately 3.5 cm was initially diagnosed with hepatocellular carcinoma given the risk factors for liver cancer that she presented with,including Schistosome japonicum infection and jaundice,and also together with imaging results,which showed the mass enhanced quickly in the arterial phase and faded fast in the venous phase.The patient did not have the surgery first but received three rounds of transarterial chemoembolization because of her anxiety and fears for operation.Finally,the patient underwent laparoscopic liver segment 4b resection and cholecystectomy and was discharged from the hospital only 10 d after the operation.The pathological examination indicated the mass as hepatic lymphangioma.The patient has been followed up for 30 mo without recurrence.To raise the awareness of this misdiagnosed case and to better diagnose and treat this rare disease in future,we reviewed the published literature of solitary hepatic lymphangioma for its clinical symptoms,imaging presentation,operative techniques,histology features and prognosis.CONCLUSION Solitary hepatic lymphangioma mimicking malignancy makes diagnosis difficult.Complete surgical resection is the first choice to treat solitary hepatic lymphangioma.