Objective
To evaluate the impact of obesity and spleen length on laparoscopic splenectomy combined with pericardial devascularization.
Methods
We retrospectively analyzed 121 patients with portal hypertension who underwent laparoscopic splenectomy combined with pericardial devascularization in our hospital. Using BMI, these patients were classified as the obesity and the non-obesity groups. Using length of the spleen, the patients were divided into two subgroups: spleen AC diameter >20 cm and spleen AC diameter ≤20 cm.
Results
(1) For the Obesity group, the operation time, the rate of conversion to open operation and the complication rate after operation were higher than the non-obesity group [(184.0±49.0) min vs (142.0±39.0) min, 26.1% vs 8.0%, 26.1% vs 6.7%, respectively, P 0.05). (2) For obesity patients, the spleen AC diameter >20 cm group had a longer operation time and a higher rate of conversion to open operation [(224.0±42.0) min vs (152.0±44.0) min, 42.9% vs 12.0%, respectively, P 0.05).
Conclusions
Obesity extended the operation time and increased the rates of conversion to open operation and complication after operation. The spleen length had a major impact on the rates of conversion to open operation and complication after operation for the groups of obesity patients.
Key words:
Laparoscopic splenectomy; Splenectomy combined with pericardial devascularization; Obesity; Length of spleen
The present study retrospectively analyzed 170 patients diagnosed with paraquat (PQ) poisoning with the aim of clarifying whether the arterial lactate-time (arterial lactate concentration × time between ingestion and arterial lactate measurement) was a good predictor of mortality in patients with acute PQ poisoning. The results indicated that there was a positive correlation between the arterial lactate-time and PQ concentration-time (ρ=0.485). In addition, the arterial lactate-time data exhibited a similar discriminative power to the plasma PQ concentration-time data (z=0.712; P=0.864). For the receiver operating characteristic curve analysis, the lactate-time data had an area of 0.782 with a cut-off value of 11.95 mmol/l.h (sensitivity, 64.52%; specificity, 84.42%). To calculate the predicted probability of survival for any specified time and initial arterial lactate concentration, the following formula was derived based on the logistic regression coefficients: Logit(p) = 3.066 - 0.139 × (time lag following PQ ingestion) - 0.177 × (initial arterial lactate concentration); where the probability of survivors = 1/1 + e-logit(p). Therefore, the arterial lactate-time data exhibited a good predictive power for evaluating the prognosis of patients with acute PQ poisoning.
The process of in situ tumors developing into malignant tumors and exhibiting invasive behavior is extremely complicated . From a biophysical point of view, it is a phase change process affected by many factors, including cell-to-cell, cell-to-chemical material, cell-to-environment interaction, etc . In this study, we constructed spheroids based on green fluorescence metastatic breast cancer cells MDA-MB-231 to simulate malignant tumors in vitro , while constructed a three-dimensional (3D) biochip to simulate a micro-environment for the growth and invasion of spheroids. In the experiment, the 3D spheroid was implanted into the chip, and the oriented collagen fibers controlled by collagen concentration and injection rate could guide the MDA-MB-231 cells in the spheroid to undergo directional invasion. The experiment showed that the oriented fibers greatly accelerated the invasion speed of MDA-MB-231 cells compared with the traditional uniform tumor micro-environment, namely obvious invasive branches appeared on the spheroids within 24 hours. In order to analyze this interesting phenomenon, we have developed a quantitative analyzing approach to explore strong angle correlation between the orientation of collagen fibers and invasive direction of cancer cell. The results showed that the oriented collagen fibers produced by the chip can greatly stimulate the invasion potential of cancer cells. This biochip is not only conducive to modeling cancer cell metastasis and studying cell invasion mechanisms, but also has the potential to build a quantitative evaluation platform that can be used in future chemical drug treatments.
Cell migration is an indispensable physiological and pathological process for normal tissue development and cancer metastasis, which is greatly regulated by intracellular signal pathways and extracellular microenvironment (ECM). However, there is a lack of adequate tools to analyze the time-varying cell migration characteristics because of the effects of some factors, i.e., the ECM including the time-dependent local stiffness due to microstructural remodeling by migrating cells. Here, we develop an approach to derive the time-dependent motility parameters from cellular trajectories, based on the time-varying persistent random walk model. In particular, we employ the wavelet denoising and wavelet transform to investigate cell migration velocities and obtain the wavelet power spectrum. The time-dependent motility parameters are subsequently derived via Lorentzian power spectrum. Our analysis shows that the combination of wavelet denoising, wavelet transform and Lorentzian power spectrum provides a powerful tool to derive accurately the time-dependent motility parameters, which reflects the time-varying microenvironment characteristics to some extent.
A microchamber array with composite ECM device enables the construction of a more realistic model for investigating cancer migration mechanisms and has potential to serve as a platform for personalized medicine screening.
Objective
To discuss the modified method and clinical effect of free hallux toe nail flap for reconstruction of composite tissue defect at finger tip and repair of its donor site.
Methods
Partial nail bed at fibular side of hallux was cut and combined with toe tip skin to form hallux toe nail flap. The reconstruction of finger tip defects was achieved by free hallux toe nail flap transplantation. The donor site of hallux was sutured directly. Nail bed wound was healed by itself without skin graft or flap repair. From May 2013 to April 2015, 13 cases (15 fingers) had partial nail bed and skin defects at finger tip and no obvious distal phalanx defects, which were repaired by this method.
Results
All the patients were follow-up for 3 to 12 months. All the free hallux toe nail flap graft survived. The finger tip appearance and nail growth were close to normal. The function of interphalangeal joint was good. Hallux nail was nearly complete with good appearance and without obvious defect. No local pain, ulceration, and sensory disorder occurred at hallux donor site.
Conclusion
Hallux toe nail flap is an ideal method for reconstruction of composite tissue defect at finger tip. The improvement of donor site repair method can make better appearance of toe tip and nail without obvious sequelae.
Key words:
Finger injuries; Surgical flaps; Free tissue flaps; Fingertip defects
To examine the impact of continuous plasma perfusion on plasma PQ concentration (PPQ) in acute PQ-poisoning patients for the estimation of its PQ clearance effect.21 PQ-poisoned patients admitted to our poisoning center within 24 hours after the ingestion were prospectively enrolled. Continuous plasma perfusion (flow rate 180 ml/min) was performed, with plasma/blood separation at 40 ml/min and routine cartridges change every 3 hours. Urinary PQ (UPQ), urine flow rate (UFR), and PPQ level at inlet/outlet of the cartridge were obtained right before, and 1.5 hours after the start of each perfusion session for calculation of renal and plasma PQ excretion.In all 8 rounds (108 sessions) of plasma perfusion on the 21 patients, PQ elimination rate (ml/min) by plasma perfusion was found always higher than the renal value: [1st (21 cases) 11.14±6.13 vs. 5.33±4.33; 2nd (21 cases) 18.36±11.32 vs. 4.85±3.15; 3rd (21 cases) 16.13±10.05 vs. 0.84±0.80; 4th (17 cases) 12.86 (6.72, 17.47) vs. 0.28 (0.09, 0.60); 5th (11 cases) 14.12 (10.48, 35.20) vs. 0.10 (0.03, 0.73); 6th (7 cases) 16.47 (11.82; 20.69) vs. 0.13 (0.03, 0.40); 7th (5 cases) 13.33 (9.71, 18.75) vs. 0.33 (0.24, 0.47); 8th (5 cases) 11.27 (9.21, 16.02) vs. 0.32 (0.10, 1.22), P< 0.05 or P< 0.01]. In the study, PPQ was found negatively correlated to PQ elimination by plasma perfusion (r = - 0.4799, P< 0.0001), and positively correlated to the renal elimination ( r = 0.5060, P< 0.0001). The survivors (10 cases) showed a higher PPQ reduction rate (mg×L(-1)×h(-1)) than the non-survivors (11 cases, 0.57± 0.03 vs. 0.47±0.06,P< 0.05).Continuous plasma perfusion may be a promising therapeutic tool for its significant PPQ reduction effect, and plasma perfusion should be made available early for patients with acute PQ intoxication.
ObjectiveTo probe into the relationship between The hepatolithiasis and the intrahepatic cholangiocarcinoma,and to summarize the experiences of diagnosis and treatment of these diseases.Methods
To investigate and evaluate different surgical methods applied in living-donor liver transplantation (LDLT).Fifty patients with end-stage liver disease received LDLT in our department between January 1995 and March 2006. The data were analyzed on a retrospective basis. The choice of different surgical methods, strategies applied to ensure the safety of donors and indications of LDLT in the series were reviewed.All donors recovered uneventfully. Among the 50 patients, 47 recipients presented with end-stage cirrhosis, 3 patients suffered from malignant tumor. To date, 6 recipients died after LDLT, among them, 3 recipients died of the operation and the other 3 recipients died of long-term complications. Resected donor livers included 9 cases of segments V, VI, VII and VIII (not including the middle hepatic veins) and 1 case of segments V, VI, VII and VIII (including the middle hepatic veins), 36 cases of segments II, III and IV (including the middle hepatic veins) and 4 cases of segments II, III, and part of IV (not including middle hepatic veins).LDLT helps tackle the problem of donor shortage in the world. The process is complicated, and it is very important to choose appropriate surgical methods for the improvement of surgical achievement and donor safety.
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