Objective To explore the effect and safety of combination of hemihepatectomy and hepatic artery resection for Bismuth Ⅲ,Ⅳ hilar cholangiocarcinoma.Methods A retrospective analysis was made on 43 cases operated from May 2003 to June 2012,including right hemihepatectomy in 12 cases,lefi liver resection in 28 cases,left trisegmentectomy in 3 cases,combined caudate lobe resection in 19 cases,all were with proper hepatic arterectomy,in those cases portal vein resection and reconstruction was carried out in 5 cases,hepatic artery reconstruction in 2 cases.Preoperative PTCD was performed in 5 cases in whom age ＞ 70 and bilirubin ＞ 300 μmol/L.Results Radical resection rate was 58.1％(25/43),5 cases were well-differentiated adenocarcinoma,13 cases of moderately differentiated adenocarcinoma,poorly differentiated adenocarcinoma in 18 cases,papillary carcinoma in 2 cases,mucous adenocarcinoma in 4 cases,sclerosing adenocarcinoma in 1 case,the incidence of postoperative complications was 39.5％ (17/43) including hepatic abscess (3 cases),biliary fistula (4 cases),hepatic insufficiency and massive ascites in 4 cases,portal vein stenosis after reconstruction in 2 cases,hepatic artery obliteration after reconstruction in 1 case,gastric paralysis in 3 cases.There was no inhospital death.1,3,5 year survival rates were 93.0％ (40/43),39.5％ (17/43),and27.9％ (12/43).Conclusions In Bismuth Ⅲ,Ⅳ hilar cholangiocarcinoma,in whom hepatic artery obliteration is common,hepatic arterectomy is safe and feasible,however,concurrent hepatic artery reconstruction is mandatory in those with the reconstruction of the portal vein.
Key words:
Bile duct neoplasms ; Hepatectomy ; Hepatic artery ; Vascular resection
Gene editing nucleases, represented by CRISPR-associated protein 9 (Cas9), are becoming mainstream tools in biomedical research. Successful delivery of CRISPR/Cas9 elements into the target cells by transfection is a prerequisite for efficient gene editing. This protocol demonstrates that tube electroporation (TE) machine-mediated delivery of CRISPR/Cas9 ribonucleoprotein (RNP), along with single-stranded oligodeoxynucleotide (ssODN) donor templates to different types of mammalian cells, leads to robust precise gene editing events. First, TE was applied to deliver CRISPR/Cas9 RNP and ssODNs to induce disease-causing mutations in the interleukin 2 receptor subunit gamma (IL2RG) gene and sepiapterin reductase (SPR) gene in rabbit fibroblast cells. Precise mutation rates of 3.57%-20% were achieved as determined by bacterial TA cloning sequencing. The same strategy was then used in human iPSCs on several clinically relevant genes including epidermal growth factor receptor (EGFR), myosin binding protein C, cardiac (Mybpc3), and hemoglobin subunit beta (HBB). Consistently, highly precise mutation rates were achieved (11.65%-37.92%) as determined by deep sequencing (DeepSeq). The present work demonstrates that tube electroporation of CRISPR/Cas9 RNP represents an efficient transfection protocol for gene editing in mammalian cells.
With the method of social investigation and statistical analysis, this paper investigates and analyzes the online shopping behavior of college students in several universities in Chongqing The prevalence of Internet shopping addiction among college students was measured.The study found that the current college students' Internet shopping addiction has been initially formed, the level of addiction is in the Middle Range, and needs the attention of students' family and school education and other relevant parties, and to formulate appropriate intervention and counseling measures.
Objective To evaluate the surgical treatment strategy of concomitance of cholelithiasis and bile duct varicosity.Methods The surgical treatment experience of 17 cases with concomitance of cholelithiasis and bile duct varicosity was retrospective analyzed.Results All these patients were recovered.16 cases were followed-up from 3～10 years.2 cases were died in hepatoma and upper gastrointestinal bleeding.14 cases had satisfactory curative effect by followed up for average 9 years.Conclusion To adopt the different surgical countermeasures according to the different types of the patient's conditions,it could have satisfactory results.
Charity crowdfunding has become one of the most important donation channels in the Internet age. Faced with complex personality traits, can charity crowdfunding platforms attract a wide range of people to make donations? By integrating personality theory with cognitivist learning theory (SOR), and with the help of 449 questionnaire data, this paper examines the psychological mechanisms of altruistic and egoistic personality traits participating in crowdfunding donations and reveals the mediating role of media cognition and donation cognition. The study found that individuals with both altruistic and egoistic personality characteristics have the intention to donate in the context of crowdfunding platforms, and the formation of the intention to donate depends on the individual's cognition of crowdfunding donations, including the cognition of crowdfunding (media trust perception) and perception of donation (donation motivation), specifically, in the relationship between personality characteristics and donation intention, the three media trusts (donation platform trust perception, project initiator trust perception, and project text content trust perception) and three kinds of donation motivations (sympathy, guilt, and satisfaction) play an important mediating role, and the mediating mechanisms of altruistic and egoistic personality are slightly different. The research results have certain implications for the development of philanthropy in the Internet context.
Fracturing roofs to maintain entry (FRME) is a novel longwall mining method, which has been widely used in China, leading a new mining revolution. In order to research the change law of side abutment pressure and movement law of overlying strata when using the FRME, a new abutment pressure monitoring device, namely, the flexible detection unit (FDU), is developed and is applied in the field. The monitoring results show that compared with the head entry (also called the non-splitting entry), the peak value of the lateral abutment pressure in the tail entry (also termed the splitting entry) is reduced by 17.2% on average, and the fluctuation degree becomes smaller. Then, finite difference software FLAC3D is used to simulate the stress change of the solid coal on both sides of the panel. The simulation results show that the side abutment pressure of the tail entry decreases obviously, which is consistent with the measured results. Comprehensive analysis points out that after splitting and cutting the roof, the fissures can change the motion state of the overlying strata, causing the weight of the overburden borne by the solid coal to reduce; therefore, the side abutment pressure is mitigated.
Objective To investigate the diagnosis and management of acute bowel obstruction in ptients with colon cancer. Methods 40 cases of acute bowel obstruction in patients with colon cancer were analyzed retrospectively. All patients were treated by surgical management. Results 37 cases were succeeded. 3 cases were dead within postoperative period:two cases died from pulmonry infection and cardiac failure,one case died from anasto-mosis fistula,sepsis and infective shock. Postoperative complications were found in 21 cases,8 cases with pulmonary infection,4 cases with incision infetion and heart-lung-liver functional defect respectively,2 cases with anastomosis fistula and disruption wound respectively,1 case with abdominal infection. Conclusion Prior to operation,we should carry ouintegrated judgment,grasp operative indications and methods,and attach importance to the managemen of perioperative period.
Objective To investigate the causes and prevention measures for patients with portal hypertension hypersplenism undergone splenectomy plus pericardial devascularization and post-operative portal vein thrombosis (portal vein thrombogenesis,PVT).Methods 178 cases of splenectomy plus devascularization from July 2013 to May 1994 in Cangzhou Central Hospital of Hebei Province,including 102 cases of early postoperative application of low molecular heparin anticoagulant for the prevention group,76 cases without anticoagulant medicine as control group.33 cases with PVT found by B ultrasound or CT scan,were treated with urokinase body intravenous thrombolysis,hepatic artery catheterization thrombolysis,intestinal resection of + Fogarty catheter embolectomy vein stump treatment respectively.Results The total incidence of thrombosis was 18.5％ (33/178),prevention group was 8.8％ (9/102),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ thrombus,in 1 cases,no intestine necrosis.The control group thrombosis rate was 31.6％ (24/76),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ,thrombosis in 17 cases,5 cases of intestine necrosis,two groups of thrombosis rate were significantly differences (x2 =14.932,P =0.000).Thrombus disappeared completely in 7 cases,the thrombus grading decreased in 2 cases in the preventive group after thrombolysis,and thrombus disappeared completely in 6 cases,11 cases of thrombosis degraded in the control group after treatment of thrombolysis,1 case cured by TIPS with thrombolysis and thrombectomy,1 case died of sudden digestive tract bleeding,Among 5 cases of intestinal necrosis,4 cases died and 1 case undergone abdominal exploration being found with intestine & colon necrosis.Conclusions There are a variety of factors causing PVT after splenectomy and devascularization.Early anticoagulation can significantly reduce the incidence of PVT,early discovery and treatment can prevent severe outcome.
Key words:
Hypertension, portal vein; Splenectomy; Venous thrombosis ; Heparin
Objective To explore the reasons and preventive measures for biliary complications in post-operation of the hilar cholangiocarcinoma (HCC).Methods From September 1998 to September 2013,we have performed operations for 130 cases of hilar bile duct carcinoma,who were classified into Ⅰ type 11 cases,Ⅱ type 33 cases,Ⅲ type a 36 cases,Ⅲ type b 42 cases,Ⅳ type 8 cases by Bismuth classification.Surgical procedure types included the basic operation type difined as excision with gallbladder,hilar and common bile duct,hepatoduodenal ligament “skeletonized”,and hilar bile duct-jejunum Roux-en-y anastomosis,with or without liver resection.Results The total incidence of biliary complications was 26.2％ (34/130),21 cases of biliary leakage,after drainage of the 19 cases healed in 2 weeks,4 weeks after healing in 2 cases; 7 cases of biliary tract infection,use of antibiotics and cholagogue recovered drug; Stenosis in 3 patients,including 2 cases of reoperation cured,1 case of intrahepatic bile duct after puncture drainage with tube discharge; Gallstone liver abscess (3 cases),after intervention drainage of the whole.This group of 2 cases of death from liver failure,MODS,1 case death.The mortality was 2.3％ (3/130).Conclusions Biliary leakage ranked first in the incidence among biliary complications in post-operation of HCC,and drainage is the best solution for the treatment of biliary leakage.
Key words:
Bile duct cancer; Surgical procedures; Complications; Bile leakage
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