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<p><b>BACKGROUND</b>Liver transplantation has become the treatment of choice for patients with end-stage acute or chronic hepatic disease. Bile duct complications are common events after liver transplantation. The aim of this study was to evaluate the blood supply of the human bile duct and identify the underlying mechanisms of bile duct complications after liver transplantation.</p><p><b>METHODS</b>The duct supply branches from gastroduodenal artery and blood supply of extrahepatic bile duct system were re-evaluated through selective hepatic angiography from 600 patients. In addition, 33 cadavers were injected with latex casting material into the common hepatic artery, then the extrahepatic bile duct and the branches from the common hepatic artery were carefully dissected to visualize the gastroduodenal artery and its branching to the extrahepatic bile duct.</p><p><b>RESULTS</b>The bile duct artery arose from the branch of the gastroduodenal artery in 8.1% (49/600). Of these 49 individuals, the bile duct artery was supplied by the gastroduodenal artery (61.22%, 30/49), the proper hepatic artery (14.29%, 7/49), or both the gastroduodenal artery and the proper hepatic artery (24.49%, 12/49). In our study of 33 cadavers, the percentage that the bile duct artery arose from the gastroduodenal artery was 27.27%. The blood supply to the bile extrahepatic bile ducts was divided into different segments and formed longitudinal and arterial network anastomosed on the walls of the duct.</p><p><b>CONCLUSIONS</b>There is a close relationship between the duct supply branches from gastroduodenal artery and the blood supplying patterns of the extrahepatic bile duct system. In liver transplant surgery, the initial part of the gastroduodenal artery is preferred to be preserved in the donor liver. It is of great significance to improve the success rate of operation and reduce complications.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Angiography , Bile Ducts, Extrahepatic , Diagnostic Imaging , Hepatic Artery , Diagnostic Imaging , Liver TransplantationABSTRACT
Whether the type of culture media utilized in assisted reproductive technology has impacts on laboratory outcomes and birth weight of newborns in in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) was investigated. A total of 673 patients undergoing IVF/ICSI and giving birth to live singletons after fresh embryo transfer on day 3 from Jan. 1, 2010 to Dec. 31, 2012 were included. Three types of culture media were used during this period: Quinn's Advantage (QA), Single Step Medium (SSM), and Continuous Single Culture medium (CSC). Fertilization rate (FR), normal fertilization rate (NFR), cleavage rate (CR), normal cleavage rate (NCR), good-quality embryo rate (GQER) and neonatal birth weight were compared using one-way ANOVA and χ (2) tests. Multiple linear regression analysis was performed to determine the impact of culture media on laboratory outcomes and birth weight. In IVF cycles, GQER was significantly decreased in SSM medium group as compared with QA or CSC media groups (63.6% vs. 69.0% in QA; vs. 71.3% in CSC, P=0.011). In ICSI cycles, FR, NFR and CR were significantly lower in CSC medium group than in other two media groups. No significant difference was observed in neonatal birthweight among the three groups (P=0.759). Multiple linear regression analyses confirmed that the type of culture medium was correlated with FR, NFR, CR and GQER, but not with neonatal birth weight. The type of culture media had potential influences on laboratory outcomes but did not exhibit an impact on the birth weight of singletons in ART.
Subject(s)
Female , Humans , Infant, Newborn , Male , Pregnancy , Birth Weight , Culture Media , Fertilization in Vitro , Pregnancy OutcomeABSTRACT
Objective To analyze and compare hemodynamic features of two different options for modified B-T shunt (MBTS) surgery, namely end-to-side(ETS) and side-to-side (STS), so as to provide references for clinical treatment of single ventricle heart defect syndrome. MethodsThe real geometric model was reconstructed by medical images obtained from a patient with hypoplastic left heart syndrome (HLHS); MBTS surgery was simulated through virtual operations; a lumped parameter model (LPM) was constructed based on physiological data of the patient; the post-operational boundary conditions of computational fluid dynamics (CFD) models (namely STS model and ETS model) were predicted based on the LPM; numerical simulation was conducted on two CFD models by using finite volume method. Results Flow details and wall shear stress distributions were all obtained for two models. The mean oscillatory shear index (OSI) of ETS model and STS model in part of pulmonary arteries was 3.058×10-3 and 13.624×10-3, respectively, while the energy loss was 116.5 and 94.8 mW, respectively, and blood flow rate ratios of left pulmonary artery to right pulmonary artery (RRPA/LPA) were 0.8 and 1.72, respectively. Conclusions There were nearly no differences between two CFD models in energy loss, which led to a relatively small impact on the surgery. The STS model had a more balanced pulmonary artery blood perfusion and a smaller mean OSI in part of pulmonary arteries, therefore, the STS model was superior to the ETS model. This study provides an important theoretical support and reference for treating patients with HLHS.
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The study of hemodynamics, which refers to dynamics inside the blood circulation, mainly includes the flow rate, flow resistance, pressure, shear stress, disturbed flow, as well as their associations in between. Therefore, with its important significance in the clinical treatments of vessel curvature, arterial stenosis or occlusion, pathological artery branches and aneurism, study about hemodynamics is essential to human health. Currently, extensive researches on hemodynamics have been conducted with respect to artery bypass, coronary arterial stenosis, abdominal aortic aneurysm, atherosclerosis, cerebral aneurysm and swirling flow. With the development of such research on hemodynamics, surgical planning and interventional therapy have improved rapidly. The influence mechanism of hemodynamic parameters, including pressure, flow resistance, flow rate, wall shear stress, blood viscosity, flow separation, turbulent flow, vortex on the post-operation complications could be deeply explored with the help of more and more clinical apparatus and have gained some achievements.
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Objective Based on time-coupled multiscale coupling algorithm, to simulate the hemodynamics after systemic-pulmonary shunt procedure on single ventricular patient so as to obtain the local three-dimensional (3D) fluid field and global hemodynamic information before and after surgery. MethodsFirstly, the 0D-3D coupled multiscale hemodynamic model of systemic-pulmonary shunt procedure was established based on the lumped parameter model (0D) before surgery and the shunt model (3D), then the 0D-3D interface coupling condition and the time coupling algorithm were discussed. Secondly, the multiscale simulation of 3D CFD (computational fluid dynamics) model coupled with 0D lumped parameter model was realized based on lattice Boltzmann method. Finally, the multiscale simulation results were compared with patient’s 0D simulation results to study the hemodynamic changes before and after surgery. Results The global hemodynamic change and local 3D flow pattern were obtained by this multiscale simulation. The pulmonary blood flow distribution ratio was increased from 32.21% to 57.8%. Conclusions The systemic-pulmonary shunt procedure can effectively increase the blood supply of pulmonary circulation by implanting the shunt between the systematic circulation and pulmonary circulation. The geometrical multiscale method can effectively simulate both the coarse global and detailed local cardiovascular hemodynamic changes, which is of great significance in pre-operation planning of cardiovascular surgery.
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Objective In order to improve the local hemodynamics of coronary artery bypass graft and reduce the incidence of restenosis, a double-bypass-graft design was proposed to alleviate artery stenosis. Methods Based on finite element method, the hemodynamics of the conventional bypass graft model and the double-bypass-graft model was adopted for numerical simulation. The distributions of hemodynamics such as flow field and wall shear stress in the vicinity of anastomosis were calculated. Results This new design provided better hemodynamics near the main anastomosis region, eliminated the vortex and flow stagnation, and increased the wall shear stress at the artery floor. The axial length of vortex near the assistant bypass graft by this new design was only 3 mm, which was shorter than that of 4.5 mm in the conventional design. Nearly 36% of the total blood was directed into the assistant bypass graft. Conclusions The new design could help to reduce the incidence of intimal hyperplasia.
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Objective To conduct the operation of capture and deformation in virtual three-dimensional (3D) environment with force feedback device and simulate the coronary artery bypass operation. Methods Based on data collected from real CT images of the patient with heart disease, digitized visual model of the heart was reconstructed. Then the bypass vessel was built and the vessel model was sculptured by force feedback device to simulate the bypass surgery from pulmonary artery to ventriculus dexter in Fontan operation. Results Space structure of the heart was shown in the virtual 3D reconstructed environment. Bypass vessel with any diameter and angle was transformed to simulate the coronary artery bypass operation. Heart patch with any size was built to repair the heart model. The satisfactory model and parameters of the postoperative model were finally achieved. Conclusions The application of force feedback device in virtual coronary artery bypass operation sets the stage for cardiovascular surgery planning system with mechanical characteristics to simulate multiple modalities of such operation.
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Objective To predict the influence of connecting position between left superior vena cava (LSVC) and pulmonary artery on bilateral bidirectional Glenn (BBDG) shunt by numerical simulation. Methods Firstly, a 3D anatomical geometrical model was reconstructed by the medical images of a hypoplastic left heart syndrome (HLHS) patient with LSVC. Secondly, based on haptic deformations, several computational models were virtually generated, and computational fluid dynamics (CFD) numerical simulations were conducted using finite volume method. Finally, hemodynamic parameters were analyzed and evaluated. Results Flow recirculation was observed in the pulmonary artery between the LSVC and right superior vena cava (RSVC). The diameter of RSVC was defined as D. Varying the distance between LSVC and RSVC from 2D to 3.5D resulted in the least energy dissipation at 3D and the most at 2D. The blood flow rate ratios of left pulmonary artery to right pulmonary artery (LPA/RPA) ranged from 0.65-1.11. Conclusions Too close distance between LSVC and RSVC would bring out unfavorable hemodynamic distributions and consume more energy in the treatment of BBDG shunt. This study is of significance for surgeons to evaluate the optimal Fontan options in the treatment of HLHS accompanied by LSVC.