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Clinical studies had demonstrated that early diagnosis of lesion could significantly reduce the risk of cancer. Magneto-acoustic-electrical tomography (MAET) is expected to become a new detection method due to its advantages of high resolution and high contrast. Based on thinking of modular design, a low-cost, digital magneto-acoustic conductivity detection system was designed and implemented in this study. The theory of MAET using chirp continuous wave excitation was introduced. The results of homogeneous phantom experiment with 0.5% NaCl clearly showed that the conductivity curve of homogeneous phantom was highly consistent with the actual physical size, which indicated that the chirp excitation theory in our proposed system was correct and feasible. Besides, the resolution obtained by 1 000 μs sweep time was better than that obtained by 500 μs and 1 500 μs, which means that sweep time is an important factor affecting the detection resolution of the conductivity. The same result was obtained in the experiments carried out on homogeneous phantoms with different concentrations of NaCl, which demonstrated the repeatability of our proposed MAET system.
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Objective To evaluate the value of acoustic radiation force impulse (ARFI) elastography in assessment of nonalcoholic fatty liver disease (NAFLD) and hepatic fibrosis in rats.Methods Models with various degrees of NAFLD severity were conducted in 110 rats by feeding high fat emulsion.The right liver lobe of rat models were processed and embedded in a fabricated gelatin solution to measure the shear wave velocity (SWV) by ARFI.And the other liver lobes were used for histologic assessment.Based on NAFLD activity score (NAS),the final pathologic NAFLD diagnosis were considered as normal group (NAS=0),simple steatosis (SS) group (1≤NAS≤2),borderline (3≤NAS≤4) group and nonalcoholic steatohepatitis (NASH) group (NAS≥5).The diagnostic accuracy of the SWV parameters in evaluating NAFLD severity and fibrosis stages was studied using ROC curves.Results The difference of SWV values among normal group,SS group,borderline group and NASH group was statistically significant (F=31.53,P＜0.001).Taking SWV≥ 2.54 m/s as the diagnostic standard to differentiate normal rats from rats with SS,and SWV≥2.90 m/s to differentiate SS from NASH in rats,the area under ROC curve (AUC) was 0.922 (95％CI [0.871,0.973],P＜0.001) and 0.882 (95％ CI [0.807,0.956],P＜0.001) respectively.The sensitivity and specificity were 93.5 ％ and 100 ％ for differentiating normal and SS groups,83.3 ％ and 84.2 ％ for differentiating SS and NASH groups.Taking SWV≥3.48 m/s as cutoff to predict fibrosis (≥F2 stage),the AUC was 0.963 (95％CI [0.909,1.000],P＜0.001),the sensitivity was 92.9％ and the specificity was 97.6％.Taking SWV≥3.61 m/s as cutoff to predict severe fibrosis (≥F3 stage),the AUC was 0.997 (95％CI [0.990,1.000],P＜0.001),sensitivity was 100％ and specificity was 98.9％.The same high validity was maintained as in the prediction of cirrhosis (F4 stage) with the cutoff as SWV≥4.50 m/s,and the AUC was 0.993 (95％CI [0.982,1.000],P＜0.001),the sensitivity was 100 ％ and the specificity was 96.8％.Conclusion ARFI elastography is a promising method for differentiating the different severity of NAFLD and staging the degree of hepatic fibrosis with NAFLD in rat models.
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<p><b>OBJECTIVE</b>To compare the outcomes of hand-assisted laparoscopic liver surgery (HALS) and pure laparoscopic liver surgery (PLS).</p><p><b>METHODS</b>The clinical data were analyzed for 64 patients undergoing major hepatectomy with HALH (23 cases) and PLS (41 cases) between January, 2010 and December, 2012.</p><p><b>RESULTS</b>The general data of the two groups were comparable. Compared with PLS, HALS was associated with a significantly shorter operative time (240 vs 191 min), less intraoperative blood loss (430 vs 220 ml, P<0.05), and a lower cost (P<0.05). There was no significant difference between the two groups in postoperative hospital stay, complication rates or recurrence rate of hepatocellular carcinoma.</p><p><b>CONCLUSION</b>HALS is safe for major liver resection with such advantages over PLS as causing less trauma and a lower cost.</p>
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Humans , Blood Loss, Surgical , Carcinoma, Hepatocellular , General Surgery , Hepatectomy , Methods , Laparoscopy , Methods , Length of Stay , Liver Neoplasms , General Surgery , Neoplasm Recurrence, LocalABSTRACT
Objective To review our experience in the diagnosis and management of paralysis of the right hemidiaphragm after liver transplantation. Methods 60 adult patients received liver transplantation from February 2001 to March 2007 in Sun Yat-sen Memorial Hospital were retrospectively analyzed. The pathophysiologic changes, clinical progress, and management of serious respiratory complications caused by post-transplant paralysis of the right hemidiaphragm were studied. Results Among 60 patients, 40 developed postoperative respiratory complications, and 5 were due to paralysis of the right hemidiaphragm. The 5 patients presented with paradoxical respiration and the ventilator supporting times were 14, 16, 34, 45, and 60 days, respectively. Tracheostomy was performed in 4. These patients developed pneumonia in 5, atelectasis in 4, acute respiratory distress syndrome (ARDS) in 4, hepatopulmonary syndrome in 4, and pulmonay interstitial edema in 3. Among the 5 patients, 4 patients survived and 1 patient died of ARDS and multiple organs failure 31 days after the transplantation. Conclusions After liver transplantation, strict monitoring of the respiratory function and timely use of a respirator for patients with the paralysis of the hemidiaphragm is very important. For patients with suspicious hemidiaphragm paralysis, tracheostomy should be decisively performed.
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BACKGROUND: Extensive liver resection or liver transplantation operated on patients with combined hepatic cirrhosis and other complications correlates with high morbidity and mortality.Child-Turcotte-Pugh scoring system is now widely used in the assessment of liver function.This classification scheme includes three clinical indicators and two biochemical indices;however,it seems difficulty on directly evaluating functional status of hepatocytes.OBJECTIVE: To explore the practicability of bioluminescence adenosine triphosphate (ATP) determination assay to assess the functional reserve of residual hepatocytes,DESIGN,TIME AND SETTING: Case contrast study,which was carried out in the Second Affiliated Hospital,Sun Yat-sen University from January 2005 to March 2006.PARTICIPANTS: Thirty-two patients who underwent major extra-and intra hepatic surgery including liver transplantation were randomly divided into three groups based on hepatic cirrhosis grading standard,including normal group (n=7),macronodular cirrhosis group (n=9),and micronodular cirrhosis group (n=16).METHODS: Routine examination and biochemical indexes of liver were performed preoperatively,including glutamic oxalacetic transaminase (GOT) and total bilirubin (TBIL).Liver specimens were delivered by aseptic technique during operation and enzymatic digested.Cell suspension was cultured and centrifuged.Hepatocytes were counted and dispensed cell suspension to be used for ATP extraction and measurement.MAIN OUTCOME MEASURES: ATP content,preoperative biochemical parameters of liver function,and correlation between biochemical parameters and ATP content.RESULTS: The ATP content in the macronodular cirrhosis group was significantly higher than that in the micronodular cirrhosis group and normal group (P=0.000 1,0.004).While,the ATP content in the micronodular cirrhosis group was also significantly higher than that in the normal group (P=0.004).ATP content (mole/cell) wassignificantly positively correlated with serum glutamic oxalacetic transarninase (r=-0.609 3,P=0.000 2) and TBIL (r=0.614 5,P=0.000 2).CONCLUSION: ATP assay can directly evaluate functional reserve of liver parenchyma and reflect high operative risk status (HORS) and course of postoperative recovery in major hepatic resection.
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Objective To investigate the feasibility of differentiating human umbilical cord blood stem cells into hepatocytes. Methods Thirty-six BALB/c nude mice were randomly divided into experimental group and control group(18 in each of the group), and experimental group was again randomly divided into group A, B and C (six in each of the group). The mice in experimental group and control group were exposed to 350 cGy radiation produced by 60Co. After 3 h, karyocytes at different concentrations in the fresh human umbilical cord blood were injected into the mice in experimental group A, B, C via their tail veins, and the equal volume of normal sodium (NS) was also injected into control group via tail veins. After one month, carbon tetrachloride (CCl4) was injected into experimental group A, B and control group via abdominal cavity, and the equal volume of normal sodium was injected into experimental group C. After two months, immunohistochemistry and reverse transcriptase polymerase chain reaction (RT-PCR) were used to detect the expressions of human cytokeratin-18 (CK18), cytokeratin-19 (CK19) and albumin (ALB) in liver tissues of all mice. Results The expressions of CK18, CK19 and ALB in injured liver tissues were all positive, and the expressions of experimental group B were higher than those of experimental group A (P
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Objective To explore the effect of surgical treatment of metastatic hepatic cancer. Methods Two hundred and eight patients with metastatic hepatic cancer received surgical treatment in our department during the past seven years, and their information were analyzed retrospectively in this paper. The ages of these patients ranged from 19 years to 82 years, and 133 of them were male, 75 of them were female. Two of them were complicated with hepatocirrhosis, and 5 with polycystic liver. The metastatic cancer originated from gastrointestinal tract in 121 cases (58.2%), and from other parts of the body in 87 cases (41.8%). One hundred and sixteen of the patients received resection treatment (resection group), and 92 of them received non-resecton treatment (non-resection group). The survival rates of the two groups were compared through Chi square test.Results The 1-, 3- and 5-year survival rates for all patients were 56.3%,23.1% and 13.0%, respectively. The 1-, 3- and 5-year survival rates were 74.1 %,39.7% and 23.3% in the resection group respectively and 33.7%, 2.2% and 0 in the non-resection group, respectively. Resection group had a higher survival rate than that of the non-resection group ( P