Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

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EDITORIAL
REVIEW
In vivo imaging of hematopoietic stem cell development in the zebrafish
Panpan Zhang, Feng Liu
Front Med. 2011, 5 (3): 239-247.  
https://doi.org/10.1007/s11684-011-0123-0

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In vivo imaging is crucial for developmental biology and can further help to follow cell development/differentiation in normal and pathological conditions. Recent advances in optical imaging techniques has facilitated tracing of the developmental dynamics of a specific organ, tissue, or even a single cell. The zebrafish is an excellent model for imaging of hematopoiesis due to its transparent embryo at early stage; moreover, different zebrafish hematopoietic stem cells (HSCs) transgenic lines have been demonstrated as very useful tools for illustrating the details of the HSC developmental process. In this review, we summarize recent studies related to the non-invasive in vivo imaging of HSC transgenics, to show that zebrafish transgenic lines are powerful tools for developmental biology and disease. At the end of the review, the perspective and some open questions in this field will be discussed.

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Mechanism of arterial remodeling in chronic allograft vasculopathy
Qichang Zheng, Shanglong Liu, Zifang Song
Front Med. 2011, 5 (3): 248-253.  
https://doi.org/10.1007/s11684-011-0149-3

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Chronic allograft vasculopathy (CAV) remains a major obstacle for long-term survival of grafts even though therapeutic strategies have improved considerably in recent years. CAV is characterized by concentric and diffuse neointimal formation, medial apoptosis, infiltration of lymphocyte or inflammatory cells, and deposition of extracellular matrix both in arteries and veins. Recent studies have shown that stem cells derived from the recipient contribute to neointimal formation under the regulation of chemokines and cytokines. Arterial remodeling in allografts eventually causes ischemic graft failure. The pathogenesis is multi-factorial with both immunologic and non-immunological factors being involved. The immunological factors have been discussed extensively in other articles. This review focuses mainly on the arterial remodeling that occurs in 3 layers of vessel walls including intimal injury, accumulation of smooth muscle-like cells in the neointimal, medial smooth muscle cell apoptosis, adventitial fibrosis, and deposition of extracellular matrix.

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Multislice computed tomography angiography in the diagnosis of cardiovascular disease: 3D visualizations
Zhonghua Sun
Front Med. 2011, 5 (3): 254-270.  
https://doi.org/10.1007/s11684-011-0153-7

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Multislice computed tomography (CT) has been widely used in clinical practice for the diagnosis of cardiovascular disease due to its reduced invasiveness and high spatial and temporal resolution. As a reliable alternative to conventional angiography, multislice CT angiography has been recognized as the method of choice for detecting and diagnosing head and neck vascular disease, abdominal aortic aneurysm, aortic dissection, and pulmonary embolism. In patients with suspected coronary artery disease, although invasive coronary angiography still remains as the gold standard technique, multislice CT angiography demonstrates high diagnostic accuracy; in selected patients, it is considered as the first-line technique. The imaging diagnosis of cardiovascular disease is based on a combination of two-dimensional (2D) and three-dimensional (3D) visualization tools to enhance the diagnostic value. This is facilitated by reconstructed visualizations which provide additional information about the extent of the disease, an accurate assessment of the spatial relationship between normal structures and pathological changes, and pre-operative planning and post-procedure follow-up. The aim of the present article is to present an overview of the diagnostic performance of various 2D and 3D CT visualizations in cardiovascular disease, including multiplanar reformation, maximum intensity projection, volume rendering, and virtual intravascular endoscopy. The recognition of the potential value of these visualizations will assist clinicians in efficiently using the multislice CT imaging modality for the diagnostic management of patients with cardiovascular disease.

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Towards the optimization of management of hepatocellular carcinoma
Xi Feng, Madhava Pai, Malkhaz Mizandari, Tinatin Chikovani, Duncan Spalding, Long Jiao, Nagy Habib
Front Med. 2011, 5 (3): 271-276.  
https://doi.org/10.1007/s11684-011-0148-4

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Hepatocellular carcinoma (HCC) is the fifth most common neoplasm in the world, closely correlated with viral hepatitis and liver cirrhosis. The vast majority of HCC patients present at a late stage and are unsuitable for surgery due to limited liver functional reserve. Tumors can involve major vessels or hilar structures, necessitating major liver resection and/or rendering liver resection unfeasible. A series of new technologies have been developed to optimise HCC management. Stem cell therapy improves impaired liver functional reserve prior to liver resection. Intravascular radiofrequency ablation recanalises the portal vein invaded by tumour thrombus and endobiliary radiofrequency ablation restores and extends biliary patency of the bile duct invaded by malignancy. Laparoscopic radiofrequency assisted liver resection minimizes blood loss and avoids liver warm ischemia, while increasing parenchymal sparing. These benefits combined maximize the safety of liver resection.

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Laparoscopic surgery for pancreatic lesions: current status and future
Taiping Zhang, Xiao Du, Yupei Zhao
Front Med. 2011, 5 (3): 277-282.  
https://doi.org/10.1007/s11684-011-0147-5

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Laparoscopic pancreatic surgery has been gaining increasing recognition in recent years, and its practice has increased despite its highly complex procedure and longer learning curve compared with surgeries for other abdominal organs. Laparoscopic distal pancreatectomy and tumor enucleation are two of the fastest-growing techniques and are currently in wide use because of their comparable technical simplicity. Literature review showed that laparoscopic distal pancreatectomy and enucleation are safe and efficient approaches for benign and low-degree malignant tumors; however, the indication for malignant tumors remains controversial. Laparoscopic pancreaticoduodenectomy is practiced in a limited number of surgical centers and presented as case reports or in small series. Although its feasibility was demonstrated by many surgeons, whether the laparoscopic procedure can achieve benefits comparable to or even more prominent than those of an open procedure has not been clinically proven. Prospective, randomized, controlled trials of laparoscopic operation versus open pancreatic surgery are necessary to justify the wide application and routine practice of the laparoscopic procedure for pancreatic lesions.

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Single incision laparoscopic cholecystectomy using the one-incision three-trocar technique with all straight instruments: how I do it?
Hongyi Cui
Front Med. 2011, 5 (3): 283-287.  
https://doi.org/10.1007/s11684-011-0151-9

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Single incision laparoscopic surgery (SILS) is a novel minimally invasive surgical technique that is gaining popularity around the world. One of the most commonly performed procedures is single incision laparoscopic cholecystectomy (SILC). Most reported techniques utilize special purpose-made access port and articulating instruments, rendering the procedure costly and difficult to learn. This article provides a stepwise description of SILC technique using all straight instruments without the need for a special port. It aims to shorten the learning curve for surgeons wishing to adopt a safe and cost-effective SILC technique to their practice.

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RESEARCH ARTICLE
Type 2 diabetic patients with non-alcoholic fatty liver disease exhibit significant haemorheological abnormalities
Hui Dong, Fu’er Lu, Nan Wang, Xin Zou, Jingjing Rao
Front Med. 2011, 5 (3): 288-293.  
https://doi.org/10.1007/s11684-011-0127-9

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Haemorheological abnormalities have been described in diabetes mellitus, as well as in non-alcoholic fatty liver disease (NAFLD). However, the relationship between the changes in liver fat content and haemorheology is unknown. The current study aims to show the correlation between haemorheological parameters and intrahepatic lipid content (IHLC) in patients with type 2 diabetes. The serum biochemical markers, such as fasting plasma glucose (FPG), haemoglobin A1c (HbA1c), liver enzymes, lipid profiles, and haemorheological properties, were examined. IHLC was quantified using proton magnetic resonance spectroscopy (1H-MRS) scanning of the liver. A significant correlation was observed between IHLC and whole blood viscosity at high, middle, and low shear rates. IHLC also positively correlated with haematocrit, the reduced whole blood viscosity at low and middle shear rates, and the erythrocyte aggregation index. Diabetic patients with NAFLD exhibited significant haemorheological abnormalities compared with patients without NAFLD. In summary, haemorheological disorders are linked to non-alcoholic fatty liver in type 2 diabetes.

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c-Fos expression in rat brainstem following intake of sucrose or saccharin
Ke Chen, Jianqun Yan, Jinrong Li, Bo Lv, Xiaolin Zhao
Front Med. 2011, 5 (3): 294-301.  
https://doi.org/10.1007/s11684-011-0144-8

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To examine whether the activation of brainstem neurons during intake of a sweet tastant is due to orosensory signals or post-ingestive factors, we compared the distribution of c-Fos-like immunoreactivity (c-FLI) in the nucleus of the solitary tract (NST) and parabrachial nucleus (PBN) of brainstem following ingestion of 0.25 M sucrose or 0.005 M saccharin solutions. Immunopositive neurons were localized mainly in the middle zone of the PBN and four rostral-caudal subregions of the NST. Intake of sucrose increased the number of FLI neurons in almost every subnucleus of the PBN (F(2,13) = 7.610, P = 0.023), in addition to the caudal NST at the level of the area postrema (F(2,13) = 10.777, P = 0.003) and the NST intermediate zone (F(2,13) = 7.193, P = 0.014). No significant increase in the number of c-Fos positive neurons was detected in response to saccharin ingestion, although there was a trend towards a modest increase in a few select NST and PBN nuclei. These results suggest that the PBN and NST may be involved in sweet taste perception and modulation of sweet tastant intake, but the significantly enhanced intensity of Fos expression induced by sucrose indicates that PBN/NST neuronal activity is driven by the integrated effects of sweet taste sensation and post-ingestive signals.

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Treatment of severe acute pancreatitis through retroperitoneal laparoscopic drainage
Chun Tang, Baolin Wang, Bing Xie, Hongming Liu, Ping Chen
Front Med. 2011, 5 (3): 302-305.  
https://doi.org/10.1007/s11684-011-0145-7

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A treatment method based on drainage via retroperitoneal laparoscopy was adopted for 15 severe acute pancreatitis (SAP) patients to investigate the feasibility of the method. Ten patients received only drainage via retroperitoneal laparoscopy, four patients received drainage via both retroperitoneal and preperitoneal laparoscopy, and one patient received drainage via conversion to laparotomy. Thirteen patients exhibited a good drainage effect and were successfully cured without any other surgical treatment. Two patients had encapsulated effusions or pancreatic pseudocysts after surgery, but were successfully cured after lavage and B ultrasound-guided percutaneous catheter drainage. SAP treatment via retroperitoneal laparoscopic drainage is an effective surgical method, resulting in minor injury.

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“Fast Track” nasogastric decompression of rectal cancer surgery
Ka Li, Zongguang Zhou, Zengrong Chen, Yi Zhang, Cun Wang
Front Med. 2011, 5 (3): 306-309.  
https://doi.org/10.1007/s11684-011-0154-6

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This study evaluates the application of fast track (FT) nasogastric decompression in patients who underwent anterior resection of rectal cancer. A randomized control trial was performed comparing the group with the fast track treatment (n =β57) and the group with traditional nasogastric decompression (n =β84). Preoperative characteristics and postoperative recovery indices were recorded and analyzed. The results indicate no significant differences in gender (P =β0.614), age (P =β0.653), tumor location (P =β0.113), and TNM stages (P =β0.054) were observed between the 2 groups. The differences in the type of resection, anastomosis, and adoption of protective colostomy were all not significant between the FT and the traditional group. During the first 24 hours after surgery, the volume of nasogastric drainage averaged 197 ml in the FT group and 155 ml in the traditional group (P =β0.197). The initiation of test-meal (P =β0.000), semiliquid diet (P =β0.002), and ordinary diet (P =β0.008) were all significantly shorter in the FT group. Furthermore, compared with the other group, the patients in the FT group enjoyed earlier removal of the abdominal drainage, urinary catheter, and shorter hospital stays (P =β0.000). Based on a correlation test, the duration of nasogastric decompression is related to the time of test-meal and semiliquid diet. The routine usage of nasogastric decompression in rectal surgery is unnecessary. The fast track procedure might help in facilitating postoperative functional and diet recovery, reducing the time of catheterization, and shortening hospital stay.

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Fertility outcome analysis after modified laparoscopic microsurgical tubal anastomosis
Jihui Ai, Pei Zhang, Lei Jin, Yufeng Li, Jing Yue, Ding Ma, Hanwang Zhang
Front Med. 2011, 5 (3): 310-314.  
https://doi.org/10.1007/s11684-011-0152-8

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Modified laparoscopic microsurgical tubal anastomosis is an alternative for microsurgical anastomosis via laparotomy to reverse sterilization in women with renewed child wish. The current study aims to evaluate the fertility outcome after modified laparoscopic microsurgical tubal anastomosis. A retrospective study was performed. Fifty-eight women who underwent modified laparoscopic microsurgical tubal anastomosis were monitored to investigate the fertility outcome and characteristics of this new technology. Of the 58 patients, the cumulative pregnancy rate (PR) in the 42 patients with follow-up data was 23.8% (10/42), 57.1% (24/42), 66.7% (28/42), and 73.8% (31/42) within 6, 12, 24, and 36 months after surgery, respectively. The intrauterine PR was 69.0% (29/42). Two patients (4.8%) had ectopic pregnancies that occurred within 24 months of surgery; three cases ended in spontaneous abortion. The delivery rate was 83.9% (26/31). The length of operating time was 1.2±0.3 h, with a range of 1.0–2.5 h (60–145 min), and the mean time was approximately 75 min. The blood loss was relatively small, between 10 and 50 ml with an average amount of 22 ml. Thus, the modified laparoscopic tubal anastomosis is a highly successful procedure and a viable alternative to open abdominal microsurgical approaches. Compared with the traditional laparoscopic tubal sterilization reversal, this modified approach has three advantages: (1) less invasive approach via a trocar reduction; (2) remodeling of tube is better performing tied together after 3–4 sutures; and (3) faster operating time.

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COMMENTARY
Translating evidence into policy in China: opportunities and challenges
Jiyao Wang, Xuejuan Jin
Front Med. 2011, 5 (3): 315-320.  
https://doi.org/10.1007/s11684-011-0146-6

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Research and evidence are critical for the formulation of policies and practices in support of health care. In the past two decades, the Chinese Clinical Epidemiology Network has been promoting evidence-based policy making in China. Evidence-based policy has become a major part of the government’s approach to policy making. The current article addresses the translation of evidence into health policies based on the expansion of evidence-based medicine in China. It also discusses the opportunities and challenges for certain evidence to be considered in policy making and practice in the future.

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ERRATUM
14 articles