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Purpose@#Oxidized cellulose is available in many forms, but manufactured using either a regenerated or non-regenerated process. In this study, we evaluated the effects of 2 different hemostatic agents for the treatment of local bleeding in patients undergoing hepatic resection. @*Methods@#This was a monocentric, parallel-group, randomized, and controlled clinical trial to compare oxidized regenerated cellulose gauze (ORCG) with oxidized non-regenerated cellulose gauze (ONRCG) in patients undergoing hepatectomy. The primary endpoint was the time to hemostasis at the target bleeding site. The secondary endpoints were the postoperative drainage volume on the first 2 days after surgery and the hospital stay. @*Results@#There was no significant difference between the ORCG and ONRCG groups in time to hemostasis from column analysis (238.8 ± 121.6 seconds vs. 193.7 ± 85.3 seconds, P = 0.068), and there were no differences in the rates of hemostatic success between the 2 groups at 120 seconds (18.4% vs. 24.3%; odds ratio [OR], 0.703; 95% confidence interval [CI], 0.231–2.136) and 300 seconds (71.1% vs. 89.2%; OR, 0.298; 95% CI, 0.085–1.041). However, the ONRCG group was superior to the ORCG group in hemostasis according to the survival analysis (log-rank test, P = 0.044). Moreover, there were also no significant differences between the 2 groups in postoperative drainage volume on the first 2 days (P = 0.436, P = 0.381) and hospital stay (P = 0.537, P = 0.200). @*Conclusion@#ONRCG was not inferior to ORCG as a hemostatic agent in patients undergoing liver resection.
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Purpose@#Oxidized cellulose is available in many forms, but manufactured using either a regenerated or non-regenerated process. In this study, we evaluated the effects of 2 different hemostatic agents for the treatment of local bleeding in patients undergoing hepatic resection. @*Methods@#This was a monocentric, parallel-group, randomized, and controlled clinical trial to compare oxidized regenerated cellulose gauze (ORCG) with oxidized non-regenerated cellulose gauze (ONRCG) in patients undergoing hepatectomy. The primary endpoint was the time to hemostasis at the target bleeding site. The secondary endpoints were the postoperative drainage volume on the first 2 days after surgery and the hospital stay. @*Results@#There was no significant difference between the ORCG and ONRCG groups in time to hemostasis from column analysis (238.8 ± 121.6 seconds vs. 193.7 ± 85.3 seconds, P = 0.068), and there were no differences in the rates of hemostatic success between the 2 groups at 120 seconds (18.4% vs. 24.3%; odds ratio [OR], 0.703; 95% confidence interval [CI], 0.231–2.136) and 300 seconds (71.1% vs. 89.2%; OR, 0.298; 95% CI, 0.085–1.041). However, the ONRCG group was superior to the ORCG group in hemostasis according to the survival analysis (log-rank test, P = 0.044). Moreover, there were also no significant differences between the 2 groups in postoperative drainage volume on the first 2 days (P = 0.436, P = 0.381) and hospital stay (P = 0.537, P = 0.200). @*Conclusion@#ONRCG was not inferior to ORCG as a hemostatic agent in patients undergoing liver resection.
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Liver cancer is an aggressive malignant tumor. At present, microvascular invasion (MVI) is considered to be an independent risk factor for early recurrence and metastasis of liver cancer, and it is also an important indicator for liver transplant recipient selection. Therefore, preoperative prediction of MVI has important clinical value. It is currently predicted that MVI mainly passes specific serum markers such as des-gamma-carboxyprothrombin and preoperative imaging features. This article reviews the diagnosis, occurrence, preoperative prediction, impact on prognosis and corresponding treatment methods of MVI.
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In recent years,the morbidity of colorectal cancer (CRC) has gradually increased,and trends to be younger.There are 1.2 million new patients suffering from CRC in the worldwide each year.Even undergoing radical mastectomy,there are still 25％ ～ 40％ of patients complicated with heterochronic liver metastasis simultaneously.The colorectal cancer liver metastasis (CRLM) has become one of the difficulties and the major cause of death,which is diagnosed in 20％ of patients at the same time of initial diagnosis.At present,the primary and metastatic cancer on liver resection is recognized as the only way to cure CRLM.In recent years,with the development of surgical technology,the normative use of peri-operative drugs,the collaboration of the mode of multidisciplinary team (MDT) and the development of the technology of targeted therapy,the survival rate of patients has been improved significantly.But the recurrence rate within 1 year is nearly 50 ％ after hepatectomy.Nearly 80 ％ of patients with CRLM missed opportunity for surgery when they were first diagnosed.Facing a huge group of CRLM,how to combine the patients' individual characteristics,the periodization of liver metastasis,the preoperative prognosis evaluation,the peri-operative adjuvant therapy and the directional treatment method etc.to form a systematic and effective therapeutic schedule has become the present focus attention,which still contains some outstanding issues.This article reviews the relevant progress.
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Objective To summarize the clinical experience of harvesting and using the kidneys from donation after cardiac death (DCD) donors.Methods Fourteen kidney transplantations were successfully performed on 14 patients with end-stage renal diseases.The kidneys were harvested from 7 volunteer donors (age 30～53 years) diagnosed with cardiac death,who were scored 19～23according to the University of Wisconsin donation after cardiac death evaluation.Primary diseases of the donors were cerebral hemorrhage,brain injury,ischemic cerebral vascular disease and brain tumor.Warm ischemia time ranged from 5 to 45 min,and cold ischemia time was 4.5 ～ 12.5 h.Results After transplantation,three patients had delayed graft function (DGF),one had primary non-function (PNF),and two patients developed acute rejection.In the patient with PNF,the transplanted kidney was removed one day after operation and the patient went back to hemodialysis.One patient with DGF was still in recovery with serum creatine 149 μmnol/L (within 3 months after operation).The above two cases both utilized the kidneys with 45 min of warm ischemia time.The rest 12 patients were discharged with normal renal function.Conclusion Under the condition of our country,kidneys strictly harvested from DCD donors can be used as one of the main sources of kidney grafts for kidney transplantation.
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Objective To summarize our experience in the liver transplantation from the donation after cardiac death (DCD).Methods The livers from three DCD donors (2 cases of brain trauma and 1 case of cerebral hemorrhage) were harvested according to the Guidelines for Donation after Cardiac Death in China.These grafts were orthotopically transplanted into three recipients including 2 cases of decompensative hepatic cirrhosis and 1 case of primary liver cancer.The warm ischemic time ranged from 7.5 to 10 min and the cold ischemic time was 4.5,8.2 and 6.5 h respectively.Postoperative immunosuppressive regimens included prednisone,FK506 and mycophenolate mofetil (MMF).Antibiotics and anticoagulatants were used accordingly.Results All of the 3 recipients obtained normal liver function within 3 weeks since the grafts were implanted without PNF,thrombosis and rejection.No postoperative complications occurred in 3 recipients during the follow-up period of 2 to 9 months with normal liver function.Conclusion The liver transplant from DCD donor showed good results in our center.Chinese group Ⅲ of DCD donor,UW score above the middle level and the short warm ischemic time are three keys ensuring the success of the liver transplant from DCD donors.
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Objective To investigate the effect of inducible nitric oxide synthase(iNOS) inhibitor aminoguanidine on pancreas islets cultured with cytokines TNF-? and IL-1? in rats.Methods Islets isolated from Wistar rats were purified and cultured.According to whether cytokines TNF-?,IL-1? and aminoguanidine were added into the medium respectively or not,islets were divided into 4 groups: cultured with islet only was taken as blank control group,cultured with TNF-?+IL-1? as cytokine group,cultured with aminoguanidine as aminoguanidine group,and cultured with TNF-?+IL-1? and aminoguanidine as aminoguanidine+cytokine group.NO level in culture medium and iNOS activity in islets tissue(Test Kit),apoptosis(TUNEL method) and viability of islets cell(acridine orange/ethidium bromide stain),and the function of islets(insulin release test) were measured.Results Compared with blank control group,the activity of iNOS in islet tissue and level of NO in culture medium increased,and the mass mortality and apoptosis appeared in islet cells,while insulin secretion decreased in cytokine group(P