Safety and efficacy of the controlled first hepaticportal blood flow occlusion in hepatectomy / 中华肝胆外科杂志

Objective:To determine the safety and efficacy of controlled first hepaticportal blood flow occlusion in hepatectomy.Methods:Patients who underwent hepatectomy from 1 September 2018 to 1 September 2020 at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Anhui Medical University were studied. There were 133 males and 70 females, with age of (52.9±19.2) years old. They were prospectively randomized into three groups: the intermittent Pringle’s maneuver group ( n=72), the controlled first hepaticportal blood flow occlusion group ( n=66) and the selective portal vein occlusion group ( n=65). The clinical data of these three groups before, during and after operation were analysed. Results:The amount of intraoperative bleeding in the selective portal vein occlusion group was significantly more than the intermittent Pringle’s maneuver group [(226.7±117.9) vs. (115.7±84.2) ml, P<0.05] and the controlled first hepaticportal blood flow occlusion group [(226.7±117.9) vs. (128.1±103.6) ml, P<0.05]. The total duration of operation in the selective portal vein occlusion group was significantly longer than the intermittent Pringle’s maneuver group [(173.6±51.7) vs. (128.4±36.5) min, P<0.05] and the controlled first hepaticportal blood flow occlusion group [(173.6±51.7) vs. (136.1±40.7) min, P<0.05]. The postoperative data showed the AST indexes on day 1 after surgery to be significantly different between the intermittent Pringle’s maneuver group with the controlled first hepaticportal blood flow occlusion group [(587.5±189.2) vs. (361.2±158.3) U/L, P<0.05], and the selective portal vein occlusion group [(587.5±189.2) vs. (358.2±162.7) U/L, P<0.05]. The ALT indexes on day 1 after surgery were significantly different between the intermittent Pringle’s maneuver group with the controlled first hepaticportal blood flow occlusion group [(609.4±172.5) vs. (414.8±162.2) U/L, P<0.05], and the selective portal vein occlusion group[(609.4±172.5) vs. (395.6±158.7) U/L, P<0.05]. The AST and ALT indexes on day 3 after surgery were significantly different between the intermittent Pringle’s maneuver group the controlled first hepaticportal blood flow occlusion group, and the selective portal vein occlusion group. Other liver functions, postoperative complications and recovery indexes showed no significantly differences among the three groups. Conclusions:All the three methods of hepatic blood flow occlusion were safe and efficacious. The controlled first hepaticportal blood flow occlusion method was simple to use and it provided some protective effect in alleviating hepatic ischemia reperfusion injury.

Application of alternative hemihepatic vascular occlusion in anatomic mesohepatectomy / 局解手术学杂志

Objective To investigate the application and advantages of alternative vascular hemihepatic occlusion in anatomic mesohepatectomy.MethodsThe clinical data of 57 patients with liver cancer who underwent operation in hepatobiliary surgery of Fuzhou general hospital from January 2014 to December 2017 were retrospectively analyzed.According to the surgery method, the patients were divided into observation group and control group, 34 cases in observation group were performed anatomic mesohepatectomy with alternative hemihepatic occlusion, 23 cases in control group were treated with non-anatomical liver lobectomy.The clinical effect of two groups were compared.Results The observation group was significantly better than the control group in terms of operation time, intraoperative blood loss, length of hospital stay, hospitalization costs, ALB at 1, 3, 5 days after surgery, ALT and AST at 1, 3, 5, 7 days after surgery, the differences were significant (P＜0.05).There was no perioperative deaths in the two groups.ConclusionApplied alternative hemihepatic vascular occlusion in anatomic mesohepatectomy can achieve good short-term curative effect and high safety.

Consistency analysis of aneurysm morphological parameters measurements by different experienced physicians / 中国脑血管病杂志

Objective: To investigate the consistency among different experienced physicians in the measurement of morphological parameters of intracranial aneurysms. Methods: From April 1,2017 to April 30,2017, DSA data of 27 aneurysms from 24 consecutive patients in Department of Neurosurgery, Xuanwu Hospital, Capital Medical University were retrospectively collected. Morphological measurement of these aneurysms was performed after three-dimensional reconstruction (morphological parameters:diameter, height,width,neck widui and aneurysm inflow-angle).The measurement physicians were three interventional neuroradiologists who were engaged in cerebrovascular diseases for less than 5 years (3 years),5 to 10 years (9 years) and more than 10 years (13 years),and they were blinded to each other. The intraclass correlation coefficient (ICC) was used to compare the consistency of measurements among the three physicians,and the Kruskal-Wallis rank sum test was used to compare the statistical differences. Results: The ICC values were consistent in morphological parameters of aneurysm diameter,width,height and neck width among the three different experienced physicians (ICC = 0. 936 -0. 995). However, in terms of the inflowangle measurement, there was moderately consistent (ICC = 0. 561) between the physician within 5 years and the one experienced 5 to 10 years, and both of them were poorly consistent with the physician over 10years (ICC =0.465 and ICC = 0. 284, respectively). There were no statistically significant differences among the three different experienced physicians in measuring morphological parameters of length (diameter, height,width and neck width;H values were 0.881,0.743,1.651 and 0. 160;all P value >0.05),but the difference in inflow-angle was statistically significant (H = 1.391, P =0.006). Conclusion Length parameters have good consistency among different experienced physicians in clinical measurement, but the measurement of angle parameters has poor consistency and is not reliable enough.

Application of inflow reverse recovery sequence in MR portal vein imaging after liver transplantation / 中国医学影像技术

Objective: To explore the application value of inflow reversal recovery (IFIR) sequence in portal vein imaging after liver transplantation. Methods IFIR sequence imaging and contrast-enhanced MRA (CE-MRA) were performed successively on the upper abdomen in 26 patients after liver transplantation. The portal vein display quality of 2 kinds of images was scored and compared independently by 2 radiologists. The diameter of anastomotic stoma was measured and compared, and the consistency of image quality scores and anastomotic diameters were evaluated between the 2 radiologists. Results Both IFIR sequence and CE-MRA could show the main portal vein and the proximal left and right branches of the portal vein in 26 patients, and the image quality score ≥3 points was 92.31% (24/26) and 96.15% (25/26), respectively. There was no significant difference of image quality score of IFIR sequence and CE-MRA evaluated by 2 radiologists (radiologist 1: Z=-1.077, P=0.282; radiologist 2: Z=-0.629, P=0.529), nor of the measured diameter of anastomosis between IFIR sequence and CE-MRA (radiologist 1: t=0.369, P=0.546; radiologist 2: t=0.020, P=0.889). The consistency of image quality scores and anastomotic diameters evaluated by the 2 radiologists was good. Conclusion IFIR sequence can be used as an effective method to evaluate portal vein after liver transplantation.

Anatomy and clinical significance of hilar plate / 中国实用外科杂志

The concept of hepatic hilar plate was first proposed by Couinaud in 1957. After more than 60 years of exploration and clinical practice, the related techniques of hepatic hilar plate exposure, including lowering hepatic hilar plate technique, extra-glissonean pedicle approach technique,have been used in hepatic vascular inflow occlussion of open and laparoscopic anatomical hepatectomy, resection of hepatic hilar complex tumors, management of hepatolithiasis and traumatic benign stricture of high bile duct. Hilar plate detachment and glissonean pedicle approach technique are more and more widely used, which have become a compulsory course for hepatobiliary surgeons to reduce the difficulty of perihilar surgery and increase the safety of liver surgery.

Aplicação de técnicas de redes neurais e modelagem atmosférica para elaboração de previsões de vazão na Bacia do Rio Grande (MG) / Application of neural networks techniques and atmospheric modeling to elaborate inflow forecasts in the Rio Grande Basin (MG), Brazil

RESUMO Neste estudo foi proposta a elaboração de um modelo de previsão de vazões no horizonte de dez dias para a Usina Hidrelétrica de Furnas, localizada na Bacia do Rio Grande, Minas Gerais, a partir da aplicação de redes neurais artificiais (RNA), informações de vazão natural e precipitação observada e prevista. O modelo foi desenvolvido utilizando o software Matlab(r) Neural Network Toolbox. Escolheu-se uma rede neural do tipo perceptron multicamadas (MLP), treinada com algoritmo supervisionado de retropropagação Levenberg-Marquardt. As previsões de precipitação foram obtidas a partir do modelo ETA/Centro de Previsão do Tempo e Estudos Climáticos (CPTEC), e utilizadas com e sem tratamento matemático. Foram realizados três experimentos, dividindo-se o histórico de dados em três períodos, sendo o primeiro para a calibração do modelo, o segundo para a validação e o terceiro para os testes. Em cada experimento foi variado o conjunto de dados de entrada, sendo utilizada, no primeiro experimento, somente a vazão passada para prever os dez dias de vazão futura. No segundo foi adicionada a precipitação observada e, no terceiro, a previsão de precipitação. Os resultados da modelagem chuva-vazão obtidos com a previsão de precipitaçãodo modelo ETA não apresentaram melhorias estatísticas em comparação com os experimentos que só utilizaram informações passadas. No entanto, quando se utilizou a previsão de precipitação corrigida matematicamente, observou-se uma melhora sensível tanto nos índices estatísticos quanto na representação da previsão simulada no hidrograma, ficando o desempenho da modelagem proposta neste estudo semelhante à encontrada em modelos conceituais do tipo chuva-vazão.

ABSTRACT The purpose of this study was to elaborate a ten-year runoff forecast model for the Furnas hydroelectric plant. The facility is located in the Rio Grande Basin in the state of Minas Gerais, Brazil. Artificial neural networks were used to determine natural flow as well as observed and predicted precipitation. The model was created using the Matlab(r) Neural Network Toolbox software, and the multi-layers perceptron (MLP) was trained with supervised learning algorithm Levenberg-Marquardt. Precipitation forecasts derived from ETA/Centro de Previsão do Tempo e Estudos Climáticos (CPTEC) model, and both raw and mathematical adjusted data were used. Historical data was separated in three different periods in order to calibrate, validate and test the model. The first share was used for calibration, the second portion was used for validation and the third one to test the model. In each experiment the input data was modified; thus, in the first experiment, to forecast the ten day runoff, only the past runoff data was considered. In the second experiment, observed precipitation was added; and in the third one, the forecast precipitation was added. The rainfall-runoff modeling results did not show any significant improvement in the statistics when ETA input data is compared with the experiments that only used past information as input. Nevertheless, when forecast precipitation was used with mathematical adjustment, a mild improvement was shown for the statistics index and for the forecast hydrogram simulation. As a result, the modeling performance proposed in this study is similar to that found in conceptual models of rainfall-runoff type.

Problems of precision hepatic surgery in nowadays / 中华消化外科杂志

With the era of precision hepatic surgery coming,the hepatic surgery has been promoted to brand-new level,which would be more accurate and meticulous.However,all those advances,such as super-thin computed tomography scan,three-dimensional imaging and the technology of threedimensional printing,have not promoted the clinic results for patients overtly.The optimal curative effect could be attained,if there is a perfect combination of operators' experience and those advanced imaging.For two issues,the time of vascular inflow occlusion and residual hepatic volume,operators could flexiblely use of clinic existing researches with surgical team and instruments according to the medical condition of patients.Precision hepatic surgery could be promoted to a higher level through constantly clinical research and innovations.

Epidemiological characteristics and temporal-spatial clustering of pulmonary tuberculosis and its social influence factors in immigration city / 中国人兽共患病学报

We investigated the epidemiological characteristics and temporal-spatial clustering of pulmonary tuberculosis (PTB),and analyzed its social influence factors in immigration city.Descriptive epidemiological analysis was conducted on PTB cases data extracted from the National Disease Reporting System of Chinese Center for Disease Control and Prevention between 2013 and 2015.Kulldorff scan statistics was applied to community based and town-based incidence data by SaTScan 9.1.1.The results were visualized by ArcMap10.2.A total of 12 109 PTB cases were reported in Ningbo with a decreasing trend in incidence rate and an increasing trend in proportion of floating population from 2013 to 2015.The male to female ratio was 2.07 ∶ 1 (8 162/3 947).All age groups were affected by PTB,but the incidence in 15-34 years age group and 65+ years age group were higher.Patients aged between 15 and 54 years accounted for 73.95 ％ of all cases.Most cases were farmers,housekeepers or unemployed,migrants and workers.There were six temporal-spatial clusters,of which the most likely clusters were in downtown and its surrounding areas,and the second likely clusters were in industrial parks.Compared with non cluster areas,proportion of floating population (t =2.88,P=0.01) especially immigrants from other provinces (t=7.46,P =0.00),and population density (t=3.37,P=0.00) in cluster areas were higher,while per capita green area was lower (t =-2.39,P 0.03).The downtown and its surrounding areas,industrial parks could be the future PTB combating regions.High population density and immigrants are associated with PTB clustering.

Epidemiological characteristics and temporal-spatial clustering of pulmonary tuberculosis and its social influence factors in immigration city / 中国人兽共患病学报

We investigated the epidemiological characteristics and temporal-spatial clustering of pulmonary tuberculosis (PTB),and analyzed its social influence factors in immigration city.Descriptive epidemiological analysis was conducted on PTB cases data extracted from the National Disease Reporting System of Chinese Center for Disease Control and Prevention between 2013 and 2015.Kulldorff scan statistics was applied to community based and town-based incidence data by SaTScan 9.1.1.The results were visualized by ArcMap10.2.A total of 12 109 PTB cases were reported in Ningbo with a decreasing trend in incidence rate and an increasing trend in proportion of floating population from 2013 to 2015.The male to female ratio was 2.07 ∶ 1 (8 162/3 947).All age groups were affected by PTB,but the incidence in 15-34 years age group and 65+ years age group were higher.Patients aged between 15 and 54 years accounted for 73.95 ％ of all cases.Most cases were farmers,housekeepers or unemployed,migrants and workers.There were six temporal-spatial clusters,of which the most likely clusters were in downtown and its surrounding areas,and the second likely clusters were in industrial parks.Compared with non cluster areas,proportion of floating population (t =2.88,P=0.01) especially immigrants from other provinces (t=7.46,P =0.00),and population density (t=3.37,P=0.00) in cluster areas were higher,while per capita green area was lower (t =-2.39,P 0.03).The downtown and its surrounding areas,industrial parks could be the future PTB combating regions.High population density and immigrants are associated with PTB clustering.

The study to estimate the floating population in Seoul, Korea

Traffic-related pollutants have been reported to increase the morbidity of respiratory diseases. In order to apply management policies related to motor vehicles, studies of the floating population living in cities are important. The rate of metro rail transit system use by passengers residing in Seoul is about 54% of total public transportation use. Through the rate of metro use, the people-flow ratios in each administrative area were calculated. By applying a people-flow ratio based on the official census count, the floating population in 25 regions was calculated. The reduced level of deaths among the floating population in 14 regions having the roadside monitoring station was calculated as assuming a 20% reduction of mobile emission based on the policy. The hourly floating population size was calculated by applying the hourly population ratio to the regional population size as specified in the official census count. The number of people moving from 5 a.m. to next day 1 a.m. could not be precisely calculated when the population size was applied, but no issue was observed that would trigger a sizable shift in the rate of population change. The three patterns of increase, decrease, and no change of population in work hours were analyzed. When the concentration of particulate matter less than 10 μm in aerodynamic diameter was reduced by 20%, the number of excess deaths varied according to the difference of the floating population. The effective establishment of directions to manage the pollutants in cities should be carried out by considering the floating population. Although the number of people using the metro system is only an estimate, this disadvantage was supplemented by calculating inflow and outflow ratio of metro users per time in the total floating population in each region. Especially, 54% of metro usage in public transport causes high reliability in application.

Congenital mitral valve stenosis in a Chinchilla cat

A one-year-old, 3.25 kg intact male Chinchilla cat presented with acute right hind limb paralysis. Diagnostic imaging studies found cardiomegaly with interstitial lung pattern, abnormal mitral valve leaflets without maximum opening at the end of the ventricular diastole and during atrial systole and severe mitral inflow obstruction. Based on these findings and its young age, the case was diagnosed as congenital mitral valve stenosis. Treatment was directed to stabilize clinical conditions related to heart failure, to prevent further formation of thrombus and to relieve pain associated with thromboembolism. After one month of therapy, hind limb motor function was fully recovered.

Value of in-flow inversion recovery sequence in diagnosis of Budd-Chiari syndrome / 实用放射学杂志

Objective To explore the feasibility of in-flow inversion recovery (IFIR)sequence of magnetic resonance imaging (MRI)at 1.5T in diagnosis of Budd-Chiari syndrome (BCS).Methods A total of 45 patients with Budd-Chiari syndrome diagnosed by surgery or interventional surgery in our institution were enrolled.The prerequisite of the study was that all medical imaging data including MRI and digital subtraction angiography (DSA)should be integrated.Then,the diagnostic accuracy rates between IFIR sequence and DSA were analyzed and compared.Results Of all 45 patients with BCS,40 (88.9%)were diagnosed accurately by IF-IR sequence,including typeⅠa in 10,typeⅠb in 14,typeⅡ in 10 and type Ⅲ in 6.Meanwhile,41 (91.1%)were diagnosed accu-rately by DSA,including typeⅠa in 8,typeⅠb in 14,typeⅡ in 13 and type Ⅲ in 6.No significant difference was showed in diag-nostic accuracy between two imaging methods (P >0.05).Spearman rank correlation analysis revealed that the diagnostic accuracy of IFIR sequence was highly consistent with that of DSA(r =0.853,P <0.001 ).However,there existed significant difference be-tween two methods in accurate diagnosis of typeⅠa and typeⅡ BCS (P <0.05).Conclusion MRI IFIR sequence at 1.5T is highly consistent with DSA in diagnosis and classification of BCS,which can be used as a reliable method of preoperative screening for BCS diagnosis.

Scan parameter optimization of renal artery with inflow-sensitive inversion recovery magnetic resonance angiography / 医学研究生学报

Objective Non-contrast enhanced magnetic resonance angiography ( MRA) has become the focus of research at home and abroad .The aim of the article was to optimize the scan parameters of renal artery with inflow-sensitive inversion recovery ( IF-IR) MRA. Methods 30 cases of renal artery patients into two groups were collected from December 2013 to May 2014 in our hospi-tal.They were divided into stenosis group(n=12) and non-stenosis group(n=48).IFIR-MRA sequences were carried out on each patient by using various BSP-TI with 1200,1300 and 1400 ms, all other parameters were identical .The image signal to noise ratio, a renal artery branch and venous artifact were evaluated by two experienced radiologists , and the best BSP-TI was obtained from different groups. Results BSP-TI=1400 ms was optimal for renal artery stenosis group while 1200 ms was the most suitable for non-stenosis group. Conclusion IFIR-MRA of renal artery can achieve better image quality of renal artery and its branches and it is feasible in clinical routine practice , especially for those patients with renal insufficiency .

The use of the right hepatic pedicle to guide classification of liver neoplasms on medical imaging and precise liver resection / 中华肝胆外科杂志

Objective To explore the use of the right hepatic pedicle to guide classification of liver neoplasms on medical imaging and the type of liver resection.Methods From January 2009 to December 2012,32 patients with a single liver neoplasm surrounding the right hepatic pedicle,including 17 patients with primary liver cancer and 15 patients with cavernous hemangioma of liver,were recruited into this study in our hospital.Using the position of the neoplasm in relation to the right hepatic pedicle on CT or MRI,these liver neoplasms were divided into 4 types:type A neoplasms which infiltrated or surrounded the right hepatic pedicle; type B neoplasms which were in the front of the right hepatic pedicle; type C neoplasms which were at the back of the right hepatic pedicle,and type D neoplasms which were between the two branches of the right hepatic pedicle.Before surgery,a simulated plan was designed on the different hepatic vascular inflow obstruction and types of hepatectomy based on the classification in medical imaging.Results The locations of the liver neoplasm were completely in line with the preoperative imaging classification.Boththe vascular flow obstruction and the types of hepatectomy correlated with the preoperative surgery simulation planning.Five patients with type A neoplasms underwent right hemihepatectomy or extended right hepatectomy; 8 with type B tumors underwent right anterior sectionectomy or mesohepatectomy; 9 with type C neoplasms underwent segment Ⅴ,Ⅵ resection; 10 with type D tumors underwent right anterior or right posterior sectionectomy.Pringle maneuver,total hepatic blood inflow obstruction and selective right hepatic blood inflow obstruction were applied according to the operation and the regional anatomical structures.All operations were smoothly carried out with an average operation time of 145 min.The average blood loss was 320 ml and 18 patients required intraoperative blood transfusion with an average blood transfusion amount of 460 ml.Postoperative complications included bile leakage (n =3),right pleural effusion (n =2) and hemorrhage (n =1).They all responded to conservative treatment.Conclusion This classification using preoperative medical imaging of the right hepatic pedical could provide important information for liver resection,and it is helpful for formulating more refined operation scheme.

Response Characteristics of the Perdido and Wolf Bay System to Inflows and Sea Level Rise.

The Perdido and Wolf Bay system in Alabama, USA, is an estuarine system linking the freshwater from the Perdido and Wolf Bay watersheds and the tidal saltwater from the Gulf of Mexico through Perdido Pass, Dolphin Pass, and the Gulf Intracoastal Waterway. A three dimensional hydrodynamic model using Environmental Fluid Dynamics Code (EFDC) was developed and used to analyze complex and dynamic flow, salinity, and temperature distributions in the system. The external driving forces for the model include the river discharges from natural and urban watersheds, atmospheric winds, and astronomical tidal elevations at the open boundaries where flow exchange takes place. Simulated water surface elevation, temperature, and salinity were compared against the field data at several observation stations in 2008 and 2009 with good agreement (coefficient of determination R2 = 0.92 between the measured and the modeled water surface elevations). The calibrated EFDC model was used to examine responses of the system to high, mean, and low inflows from streams and the sea level rise in the open boundaries under climate change. The concept of the age of water was applied to understand pollutant transport in the system. The age of water reveals dynamic and complex interactions between tides from the Gulf of Mexico and inflows from the streams. The age of water is less than 20 days under the 2-year high inflows and up to 160 days under 7Q10 low inflows. Under mean inflow conditions, the age of the tracer released from Wolf Bay is 50–70 days in the lower Perdido Bay and larger than that in the upper Perdido Bay, indicating a strong interaction between tides and inflows, which results in recirculation of flow and pollutants. The age of water is projected to increase up to 60 days under estimated sea level rise scenarios.

Regional hepatic vascular inflow occlusion in laparoscopic hepatectomies / 中华肝胆外科杂志

Objective To explore the feasibility and safety of regional hepatic vascular inflow occlusion in laparoscopic hepatectomies.Methods 35 patients with liver lesions received laparoscopic hepatectomy using regional hepatic vascular inflow occlusion.The mean age was 46.1 ± 3.5 years.The relevant branches of portal vein and hepatic artery were isolated with sharp and blunt dissections and were then occluded regionally.Results Laparoscopic regional hepatic vascular inflow occlusion and hepatectomies were successfully carried out in 35 patients.The mean operative time was 60.6±15.2 minutes.The mean blood loss was 230.8±56.5 ml.The mean postoperative hospital stay was 6.6±1.3 days.Conclusions Regional hepatic vascular inflow occlusion is a safe and feasible method in laparoscopic hepatectomies.

Protective effect of portal vein occlusion without hepatic artery inflow control on cirrhotic rat liver / 中华肝胆外科杂志

Objective In order to improve cirrhotic liver management,each aspect of the liver's complex blood flow must be understood.This study investigates the protective effect of portal vein occlusion,with hepatic artery preservation,on cirrhotic liver after ischemia and reperfusion.Methods Carbon tetrachlorideand induced cirrhotic rats and normal rats were randomly assigned into 4 groups:normal sham operation (N-SO),cirrotic sham operation (C-SO),portal triad clamping (PTC),and portal vein clamping without hepatic artery inflow control (PVC).During the occlusion,the total 3-minute blood loss from the liver surface cut was weighed.At 1,6,and 24 hours post reperfusion,the serum alapine amino transferas (ALT),the adenosine triphosphate (ATP) of liver tissue,the malonolialdehgde (MDA) of liver tissue,and the morphological changes were evaluated.Result The amount of hemorrhage between the groups ranked as follows:PTC ＜ PVC ＜ N-SO ＜ C-SO (P＜0.05).At 1,6,and 24 hours post reperfusion.the ALT and MDA levels of the groups ranked as follows:PTC ＞ PVC ＞ C-SO ＞ N-SO (P＜0.05).Additionally,each group's ATP level ranked as follows:PTC ＜ PVC ＜ C-SO ＜ N-SO (P＜0.05).With histopathological examination,the hepatic injuries of the PTC and PVC group were more severe than those of the C-SO group,especially in the PTC group.Conclusion Therefore,the technique of portal vein clamping and hepatic artery inflow control can reduce the ischemic reperfusion injury of the cirrhotic rats' liver.

Non-contrast-enhanced Magnetic Resonance Angiography of the Hepatic Portal Vein at 3.0 Tesla / 中国医学影像学杂志

Purpose To explore the methods of selectively visualizing hepatic portal vein by using three-dimensional fast imaging employing steady state acquisition combined with in-flow inversion recovery labeling pulse at 3.0 Tesla. Materials and Methods Ten healthy volunteers were examined under different TI (1200, 1400, 1600, 1800 ms), and the vessel-to-liver contrast ratio of the main portal vein, right portal vein, and left portal vein were measured. Results Non-contrast-enhanced MRA images of portal vein were obtained successfully in all ten volunteers. The signal intensity of peripheral portal branches gradually increased when TI increased from 1200 ms to 1600 ms, and the highest vessel-to-liver contrast ratio occurred when TI was 1400 ms. Conclusion Non-contrast enhanced magnetic resonance angiography of the hepatic portal vein can be successfully achieved at 3.0T high field MRI. A fixed TI of 1400 ms is preferable.

The impact of different hepatic vascular occlusion methods on hepatic parenchymal function in partial hepatectomy / 中华肝胆外科杂志

Objective To investigate the impact of different hepatic vascular inflow occlusion methods on hepatic parenchymal function in partial hepatectomy.Methods Between 2009 and 2010,62 hepatocellular carcinoma (HCC) patients underwent partial hepatectomy.In 13 patients,partial hepatectomy was carried out without using any inflow occlusion (group A).In 29 patients intermittent Pringle's maneuver (group B) while in 20 patients selective hepatic inflow occlusion (group C) were used.Intraoperative indocyanine green retention rate at 15 minutes (ICGR15) was measured using pulse spectrophotometry before and during hepatectomy. Results (1) Blood loss in group A was greater than group B and C (P=0.016,P=0.001).(2) There was no significant difference in the preoperative ICGR15 values among group A,B and C.The intraoperative ICGR15 for group B was significantly higher than group A and C (P=0.011,P=0.030).(3) A significant correlation was found between the level of ICGR15 and total inflow clamp time (r =0.484,P =0.001) and blood loss (r=0.349,P=0.005),respectively.(4) Compared with group A and B,postoperative liver function recovered significantly faster in group C.Conclusion Selective hepatic inflow occlusion was useful in controlling blood loss and it was beneficial to the hepatic functional reserve in the liver remnant.