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Objective@#To investigate the application value of augmented reality (AR) technology in pancreatoduodenectomy (PD).@*Methods@#The retrospective and descriptive study was conducted. The clinicopathological data of 3 male patients who underwent PD in Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital from June 2018 to February 2019 were collected. The 3 patients were aged from 52 to 63 years, with a median age of 57 years. Digital imaging and communication standard format data of enhanced computed tomography (CT) scan were collected, the three-dimensional (3D) images of abdominal arteries, portal vein, descending duodenum, pancreatic body and tail, pancreatic head, common bile duct, and pancreatic duct were reconstructed. The results were imported into the AR software. Optical tracking based on two-dimensional codes and manual interactive rigid registration were adopted for intraoperative navigation. Observation indicators: (1) surgical and postoperative conditions; (2) postoperative pathological examination; (3) follow-up. Follow-up using outpatient examination or telephone interview was conducted to detect survival of patients and tumor metastasis and recurrence up to June 2019. The measurement data with skewed distribution were expressed as M (range). Count data were expressed as absolute numbers.@*Results@#(1) Surgical and postoperative conditions: all the 3 patients underwent PD with AR technology as intraoperative navigation successfully. The operation time, volume of intraoperative blood loss, and duration of postoperative hospital stay were 6 hours (range, 5-8 hours), 700 mL (range, 300-900 mL), 11 days (range, 9-12 days). There was no perioperative death or complication occured. After surgery, the patients who underwent PD combined with superior mesenteric vein (SMV) resection and reconstruction had patent SMV on the enhanced computed tomography examination. (2) Postoperative pathological examination: results of pathological examination showed 1 case of intraductal papillary mucinous neoplasm (IPMN) of the pancreas with invasive adenocarcinoma (neoplasm invading SMV), 1 case of insulinoma, and 1 case of periampullary neuroendocrine carcinoma, respectively. (3) Follow-up: 3 patients were followed up for 4-12 months, with a median follow-up time of 6 months. During the follow-up, the patient with IPMN of the pancreas and invasive adenocarcinoma had liver metastasis at 3 months after surgery, and received chemotherapy at other hospital. After 4 cycles of chemotherapy, the metastatic nodule shrank, and the patient was still in follow-up up to deadline of follow-up. Other 2 patients had no recurrence or metastasis.@*Conclusion@#AR technique assisted PD is safe and feasible, which is helpful to indentify vascular branches and tracks.
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Structure of biliary system is complex as well as various, making troubles for optimal surgical treatment of biliary disease. Remarkable imaging of biliary system helps surgeon evaluating patients and planning surgeries. There are several methods to obtain accurate anatomical information of biliary system, such as X-ray fluoroscopy, MRI and fluorescence-based imaging. Each has its own advantages and disadvantages. Combination of multi-model imaging technologies may improve visual result of anatomical information of biliary tract. More resolvable, legible, and sequential imaging technology of biliary system remains further study. This article reviews various cholangiography methods widely used in the clinical setting.
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Objective To investigate the application value of augmented reality (AR) technology in pancreatoduodenectomy (PD).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 3 male patients who underwent PD in Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital from June 2018 to February 2019 were collected.The 3 patients were aged from 52 to 63 years,with a median age of 57 years.Digital imaging and communication standard format data of enhanced computed tomography (CT) scan were collected,the three-dimensional (3D) images of abdominal arteries,portal vein,descending duodenum,pancreatic body and tail,pancreatic head,common bile duct,and pancreatic duct were reconstructed.The results were imported into the AR software.Optical tracking based on two-dimensional codes and manual interactive rigid registration were adopted for intraoperative navigation.Observation indicators:(1) surgical and postoperative conditions;(2) postoperative pathological examination;(3) follow-up.Follow-up using outpatient examination or telephone interview was conducted to detect survival of patients and tumor metastasis and recurrence up to June 2019.The measurement data with skewed distribution were expressed as M (range).Count data were expressed as absolute numbers.Results (1) Surgical and postoperative conditions:all the 3 patients underwent PD with AR technology as intraoperative navigation successfully.The operation time,volume of intraoperative blood loss,and duration of postoperative hospital stay were 6 hours (range,5-8 hours),700 mL (range,300-900 mL),11 days (range,9-12 days).There was no perioperative death or complication occured.After surgery,the patients who underwent PD combined with superior mesenteric vein (SMV) resection and reconstruction had patent SMV on the enhanced computed tomography examination.(2) Postoperative pathological examination:results of pathological examination showed 1 case of intraductal papillary mueinous neoplasm (IPMN) of the pancreas with invasive adenocarcinoma (neoplasm invading SMV),1 case of insulinoma,and 1 case of periampullary neuroendocrine carcinoma,respectively.(3) Follow-up:3 patients were followed up for 4-12 months,with a median follow-up time of 6 months.During the follow-up,the patient with IPMN of the pancreas and invasive adenocarcinoma had liver metastasis at 3 months after surgery,and received chemotherapy at other hospital.After 4 cycles of chemotherapy,the metastatic nodule shrank,and the patient was still in follow-up up to deadline of follow-up.Other 2 patients had no recurrence or metastasis.Conclusion AR technique assisted PD is safe and feasible,which is helpful to indentify vascular branches and tracks.
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OBJECTIVE:To explore the role of clinical pharmacists in therapy for patient with interstitial lung disease (ILD) induced by erlotinib. METHODS:Clinical pharmacists participated in the therapy for ILD in a patient receiving erlotinib target treat-ment after thoracic vertebra and lumbar radiation,analyzed the cause of ILD and suggested to stop taking imipenem and cilastatin sodium,fluconazol and erlotinib according to lab indexes and patient’s symptom;took prednisone 30 mg,po,qd,for anti-inflam-mation instead of methylprednisolone;adjusted the dose of prednisone to 40 mg/d,and additionally took Carbocisteine oral solution 10 ml,tid,for improving respiratory symptom;panipenem betamipron 1 g,ivgtt,bid,instead of piperacillin sodium and sulbactam sodium. RESULTS:Physicians adopted the suggestions of clinical pharmacists,and the symptom of anhelation and double pneumo-nia recovered;discharged medication plan was erlotinib 150 mg,po,qd. CONCLUSIONS:The patient with radiation history easily suffers from ILD when using erlotinib,and should use erlotinib carefully in the clinic. Clinical pharmacists participated in drug ther-apy and promote safe and rational use of drugs in the clinic.
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Pathological neural activity in subthalamic nucleus (STN) is closely related to the symptoms of Parkinson' s disease. Local field potentials (LFPs) recordings from subthalamic nucleus show that power spectral peaks exist at tremor, double tremor and tripble tremor frequencies, respectively. The interaction between these components in the multi-frequency tremor may be related to the generation of tremor. To study the linear and nonlinear relationship between those components, we analyzed STN LFPs from 9 Parkinson's disease patients using time frequency, cross correlation, Granger casuality and bi-spectral analysis. Results of the time-frequency analysis and cross-frequency correlation analysis demonstrated that the power density of those components significantly decreased as the alleviation of tremor and cross-correlation (0.18-0.50) exists during tremor period. Granger causality of the time-variant amplitude showed stronger contribution from tremor to double tremor components, and contributions from both tremor and double tremor components to triple tremor component. Quadratic phase couplings among these three components were detected by the bispectral approaches. The linear and nonlinear relationships existed among the multi-components and certainly confirmed that the dependence cross those frequencies and neurological mechanism of tremor involved complicate neural processes.
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Humans , Action Potentials , Electromyography , Parkinson Disease , Subthalamic Nucleus , TremorABSTRACT
Objective To evaluate the impact of the Blumgart anastomosis in pancreaticojejunostomy on the incidence of postoperative pancreatic fistula (POPF) after pancreaticoduodeneetomy (PD),and to study its safety and efficacy.Methods A total of 205 patients who underwent PD between January 2011 and February 2013 were retrospectively studied.The patients were divided into three groups depending on the pancreaticoenteric reconstruction:the Blumgart anastomosis group (n=37),the duct-to-mucosa anastomosis group (n =39) and the traditional invagination group (n=129).Postoperative morbidity were analyzed.Results The incidences of POPF after the Blumgart anastomosis (8.1％) was significantly lower than the duct-to-mucosa anastomosis group (23.1％ ; P=0.037) and the traditional invagination anastomosis group (30.2％ ; P=0.012).Multivariate analysis revealed soft pancreatic texture,pancreatic duct diameter ＜3 mm and non-Blumgart anastomosis were independent risk factors of POPF.On subgroup analysis,the Blumgart anastomosis was superior to the duct-to-mucosa anastomosis in patients with pancreatic duct diameter ＜ 3 mm (P=0.038),and showed advantages over the traditional invagination anastomosis in patients with soft pancreatic texture (P =0.001),as well as in patients with pancreatic duct diameter ＜ 3 mm (P=0.011).Conclusions The Blumgart anastomosis is a safe technique,and it could significantly reduced the rate of POPF.It should be routinely used for pancreatoenteric reconstruction after PD.
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Aim An HPLC method was established for the study on pharmacokinetics and bioequivalence of oxaprozin enteric tablet in healthy volunteers.Methods The oxaprozin in plasma was determined using HPLC method following a single oral dose of 400 mg of oxaprozin given respectively to 18 healthy male volunteers in an open randomized crossover design.The pharmacokinetic parameters and relative bioavailability were calculated to evaluate the bioequivalence of 2 preparations.Results AUC_(0-240 h) of oxaprozin tested tablet and reference tablet were(2852.86?871.00)and (2992.84?854.02)?g?L~(-1)?h,C_(max) were(33.48?11.36)and (32.70?7.30)?g?L~(-1),T_(max) were(12.1?5.7)and(13.8?5.8)h,T_(1[]2ke) were(57.11?8.51)and(60.98?7.97)h,respectively.These main pharmacokinetic parameters obtained showed no statistically significant difference between the 2 products.Conclusion The method is simple and sensitive.Both preparations are bioequivalent.