Application of real-time virtual sonography surgical navigation combined with indocyanine green fluorescence imaging technology during anatomical liver resection / 中华肝胆外科杂志

Objective:To analyze the clinical effect of real-time virtual sonography (RVS) surgical navigation combined with indocyanine green fluorescence imaging technology in the anatomical liver segmentectomy for hepatocellular carcinoma (HCC).Methods:The clinical data of 35 patients who underwent anatomical liver segmentectomy using RVS surgical navigation combined with indocyanine green fluorescence imaging technology in the Department of Hepatobiliary Surgery of Peking University International Hospital from January 2020 to January 2022 were retrospectively analyzed. There were 22 males and 13 females, aged (60.0±10.0) years. RVS is real-time virtual sonography, which fuses real-time intraoperative ultrasound images with corresponding preoperative CT or MRI images to guide the surgical plane. Methods of operation, time of operation, intraoperative blood loss, operative margin, hospital stay and postoperative complications were analyzed. Postoperative complications were graded by Clavien-Dindo system. The 1-year overall survival and tumor-free survival rates of patients were followed up by outpatient or telephone review.Results:Anatomical liver segmentectomy was performed on 36 patients, including 1 patient (2.9%) of segment Ⅱ, 1 patient (2.9%) of segment Ⅲ, 5 patients (14.3%) of segment Ⅳ, 6 patients (17.1%) of segment Ⅴ, 10 patients (28.6%) of segment Ⅵ, 7 patients (20.0%) of segment Ⅶ, 4 patients (11.4%) of segment Ⅷ, and 1 patient (2.9%) of segments Ⅴ+ Ⅷ. The operation time of 35 patients was (310.2±81.6) min, with an intraoperative blood loss of [ M( Q1, Q3)] 390.0(250.0, 500.0) ml. The hospital stay was (11.6±2.1) d. There was no postoperative death. Postoperative complications occurred in 3 cases (8.6%), of which 2 cases (5.7%) were ascites, Clavien-Dindo grade Ⅰ; Postoperative hemorrhage occurred in 1 case (2.9%), Clavien-Dindo grade Ⅱ. HCC was confirmed by pathology in all cases, and the operative margins were negative. The median follow-up time was 14 months (12 to 20 months). The 1-year overall survival rate after surgery was 100.0%(35/35), three patients (8.6%) had tumor recurrence, and the 1-year tumor-free survival rate was 91.4% (32/35). Conclusion:RVS surgical navigation combined with indocyanine green fluorescence imaging technology could be feasible in anatomical segmental hepatectomy for HCC.

Research advances in the role of gastrointestinal microbe in pancreatic cancer / 中华肝胆外科杂志

In recent years, there have been increasing studies on the role of microorganisms in pancreatic cancer which show that bacteria and fungi are closely associated with pancreatic cancer. In the past, the pancreas has usually been considered as a sterile organ. Recent studies, however, show that microbiome exists in the pancreas. Bacteria can migrate from the intestine to the pancreas. Changing the composition of the microbiome may have positive effects on treatment of pancreatic cancer. This article reviews the relationship between gastrointestinal microbiome and pancreatic cancer.

Clinical diagnosis and treatment of metastatic liver leiomyosarcoma in 5 cases / 中华普通外科杂志

Objective:To investigate the clinical features, treatment methods of metastatic liver leiomyosarcoma (MLL).Methods:The characteristics of 5 cases of MLL were reviewed and summarized. Among them, 4 cases were derived from retroperitoneal leiomyosarcoma and 1 case was derived from uterine leiomyosarcoma. In terms of metastasis time, 1 case was simultaneous liver metastasis and 4 cases were heterochronous liver metastases, all of which were more than 2 years away from the primary tumor resection.Results:One patient died within 2 years after the diagnosis of MLL, and this patient had not undergone surgical treatment for liver metastases. Of the 4 patients who had had the metastasis resection, 2 patients died within 3 years. Currently, 2 patients are alive, 1 patient after 36 months, and 1 patient after 29 months.Conclusion:MLL occurs mostly years after the primary tumor is removed. Currently, surgical treatment is considered to be the main treatment method for MLL, which can significantly prolong the patients survival.

Research progress of gastric schwannoma / 国际外科学杂志

Gastric schwannoma is a tumor originating from mesenchymal tissue. The clinical incidence is relatively rare, accounting for 6.3% of all gastric stromal tumors. The tumor is more likely to occur in the body of the stomach and usually originates from the gastric submucosal nerve. Most gastric schwannomas do not have any clinical symptoms. Imaging examination can play a diagnostic role, but the diagnosis still requires pathological examination, especially S-100 protein which is the gold standard for the diagnosis of gastric schwannomas. Gastric schwannoma usually needs to be distinguished from gastrointestinal stromal tumors and gastrointestinal autonomic nerve tumors. In terms of treatment, complete surgical resection is the first choice.

Multivariate analysis of the incidence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt / 中国综合临床

Objective To analyze the correlation between the clinical characteristics and the incidence of postoperative hepatic encephalopathy in patients with cirrhosis who received transjugular intrahepatic portosystemic shunt ( TIPS) . Methods The clinical data of 80 patients with liver cirrhosis hospitalized in the Fifth Medical Center of PLA General Hospital from March 2015 to March 2017 were retrospectively analyzed. The related factors of hepatic encephalopathy complications after TIPS treatment were analyzed. Results The cumulative incidence of hepatic encephalopathy was about 23. 75%(19／80) in one year after TIPS operation. Through single factor analysis and multi factor Logistic regression analysis,it was found that the two factors of preoperative platelet level and the location of tips blood shunt were closely related to the occurrence of hepatic encephalopathy after TIPS operation. The ROC curve suggested that the AUC of preoperative platelet level and the location of tips blood shunt were 0. 657 and 0. 668, respectively. The sensitivity and specificity of the former were 70. 0%,52. 6% and the cutoff value was 51 ×109／L, respectively, while those of the latter were 70. 5% and 63. 2%, respectively. Conclusion Preoperative platelets level＞51×109／L or shunting of the left branches of the portal vein may indicate a lower incidence of hepatic encephalopathy.

Depression evaluation in before and after first time hemodialysis in patients with uremia and related factors analysis / 重庆医学

Objective To investigate the depression status and its influencing factors in the patients with uremia before and after the first time hemodialysis.Methods A total of 177 patients with uremia conducted the questionnaire investigation by using the Hamilton Depression Scale and self-made general information questionnaire.Meanwhile,the laboratory indexes were detected and analyzed.Results At one week before dialysis,35% of the patients had different degrees of depression symptoms,11.9% of the patients had depressive symptoms at 1 week after dialysis;the depression scores before and after dialysis were(14.96 ± 8.37) points and(6.52 ± 3.81)points respectively,the difference was statistically significant(t=16.267,P<0.01).The depression score had statistical difference between the patients with complications and patients without complications(t= -2.528,P=0.013);while the depression scores had no statistical difference among the patients with different sexes,ages,cultural levels,types of original dis-eases,whether smoking and drinking(P<0.01).The Spearman correlation analysis showed that the levels of GLU,Cr and BUN were positively correlated with the depression score,while the levels of TC and Alb were negatively correlated with the depression score,the difference was statistically significant(P< 0.01).Conclusion The evaluation of depression status in hemodialysis pa-tients should be emphasized.

Intraoperative ultrasonography for repeated hepatic resections for hepatocellular carcinoma / 中华肝胆外科杂志

Objective To evaluate the efficacy of intraopèrative ultrasonography (IOUS) on primary and repeated hepatectomies for hepatocellular carcinoma (HCC).Methods 430 patients underwent 555 operations for HCC.New tumors detected by IOUS at the primary and repeated hepatectomies were retrospectively analyzed.The long-term outcomes were also studied.Results IOUS had the highest sensitivity in the routinely used imaging examinations.The detection rate by each imaging modality decreased slightly but uniformly at the second hepatectomy.IOUS detected 56 new tumors in 30 patients (7.1％) at the primary hepatectomy and 13 new tumors in 8 (7.3％) at the second.The average size of tumor detected was 8.7±3.8 and 9.0±5.2 mm at the primary and second resections,respectively.The preoperative surgical plan was changed due to the IOUS findings alone in 24 patients (5.6％) at the primary hepatectomy,and in 7 (6.4％) at the second.Although recurrence was frequent in patients with new tumors detected at the primary hepatectomy,long-term survival after appropriate treatment for recurrence was similar to those patients without new tumors detected.Conlusions Despite recent progress in imaging modalities,IOUS is still the most sensitive examination.The same degree of precaution is necessary to detect new tumors using IOUS in repeated hepatectomy.Patients with new tumors detected by IOUS are at high risk for recurrence so that regular check-up is important to improve patient survival.

Clinical analysis of severe trauma in the elderly / 中华老年医学杂志

Objective To evaluate the causes and prognosis of severe trauma in the elderly.Methods The 168 patients in elderly group (aged 60 to 91 years), 517 in middle-aged group (aged 36to 59 years) and 405 in young group (aged 18 to 35 years) were evaluated using an abbreviated injury scale (AIS2005) and injury severity score (ISS). All patients with ISS ≥ 16 were selected during a seven-year period. The injury severity, injury site number, cause of injury, injury site, emergency operation, diseases before injury, secondary infection after injury, development of multiple organ dysfunction, number of patients with Intensive Care Unit (ICU) stay, length of stay in ICU and prognosis were compared among three groups. Results The main cause of injury was accident (64patients, 38.1%), followed by traffic accident (63 patients, 37.5%) in elderly group. The traffic accident was major cause of injury in middle-aged and young group (246 patients, 47.6%; 153patients, 37.8%, respectively), followed by fall from high places (128 patients, 24.8%; 102 patients, 25.2%, respectively). The main injury sites were head and chest in elderly, middle-aged and young group (155 patients, 92.3%; 411 patients, 79.5%; 321 patients, 79.3%, respectively).There were significant differences among three groups in injury site number, emergency operation,pre-injury diseases, secondary infection after injury, number of patients with ICU stay and length of stay in ICU (F=8. 299, P＜0.01; x2= 14.88, P=0.001; x2=254.6, P＜0.01; x2=10. 54, P=0. 005; x2 = 15.62, P＜0.01; F= 5.760, P= 0.005, respectively ). In spite of injury severity (F=2.950, P= 0.053), there were significant differences between elderly group and middle-aged or young group (t=2.325, P=0.021; t=2.128, P=0.034, respectively). The incidence of multiple organ dysfunction had no significant difference among the three groups (x2 = 1.142, P= 0.565). The cure rate and unhealed automatically discharged patients had significant differences (x2 = 13.77, P= 0. 001;x2 =6.025, P= 0.049, respectively). The mortalities were similar (x2 = 1.397, P= 0.497). The leading cause of death among three groups was a serious head injury. Conclusions For elderly patients, it is important to reduce accidental injuries and traffic accidents, to improve the cure rate,and to reduce the unhealed and mortality rate.

Expression and significance of KL-6 mucin in the tissue and serum of hepatoma / 中华消化外科杂志

Objective To detect the expression of KL-6 mucin in the tissue and serum of hepatoma in different hepatoma patients,and to investigate the value of KL-6 mucin as a tumor marker in the diagnosis of hepatoma.Methods The expression of KL-6 mucin in the hepatoma tissues of 81 patients with hepatocellular carcinoma(HCC),21 patients with cholangiocarcinoma(CC),12 patients with combined hepatocellular and cholangiocarcinoma(HCC-CC)and 56 patients with metastatic liver cancer(MLC)was detected by immunohistochemical analysis.The expression of KL-6 mucin in the serums of 34 HCC patients,8 CC patients,30 MLC patients and 19 healthy individuals was detected by enzyme-linked immunosorbent assay,and all the data were analyzed by t test.Results Expression of KL-6 mucin was detected in the cholangiocarcinoma tissues in all CCand HCC-CC patients.In several hepatoma cells and partial hepatoma tissues of patients with MLC,the expression of KL-6 mucin was detected.No expression of KL-6 mucin was detected in the hepatocellular carcinoma tissuesand non-cancerous tissues of patients with HCC or HCC-CC.The serum levels of KL-6 mucin expression in CC patients were signifcantly higher than those in healthy individuals,HCC and MLC patients(t=5.58,5.34,4.00.P＜0.01).The difference of the serum levels of KL-6 mucin expression between MLC patients and healthy individuals had statistical significance(t=2.77,P＜0.01).However,no significant difference in serum levels of KL-6 mucin expression was found between HCC patients and healthy individuals and between HCC patients and MLC patients(t=2.03,1.89,P＞0.05).Conclusion The expression of KL-6 inucin in CC patients is significantly higher than in patients with other types of hepatoma in both tissue and serum levels.Thus,KL-6 may be a usetul new tmnor marker for distinguishing CC from other types of hepatoma.

Relation of BMI, WC and WHR to cardiovascular diseases in middle and elderly patients / 肠外与肠内营养

Objective:To investigate the effect of body mass index(BMI), waist circumference(WC) and waist hip ratio (WHR) on blood pressure, serum lipids, renal function, protein and lymphocyte. Methods:175 middle and elderly patients were measured. Results:Compared to normal weight cases, SBP and uric-acid were significantly higher in over-weight cases. Triglyceride, SBP and DBP were all significantly higher in obesity cases. When waist circumference was beyond 85 cm in women, triglyceride, lymphocyte and DBP were all significantly higher than those in normal weight women. When waist circumference was beyond 90 cm in men, triglyceride was significantly higher than that in normal weight men. Conclusion:When BMI increases, triglyceride and blood pressure will increase accordingly. When WC is higher than normal, triglyceride in male and female will be higher. Control of obesity, is helpful to prevent cardiovascular diseases.

A SELENIUM-HEALTH DATABASE IN CHINA AND ITS STUDIES ON NUTRIOLOGY / 营养学报

A selenium-health database, in which data were compiled only from Chinese literatures, has been realized. For data processing the rnulti-variate analysis software package involved pattern recognitions as the main part has been developed. Based upon such a computation, we hare discussed the following objects; the Se-contents of Chinese foods, the relation between trace element Se and some of the endemic diseases, and the Se-ecological food's chain in China.