Comparison of the application methods and effects of skin flaps in the repair of defects in different parts of the nose according to the concept of aesthetic nosesubunits / 中华耳鼻咽喉头颈外科杂志

Objective: To analyze the difference of application methods and effects of local flap in small and medium-sized defects of different aesthetic subunits of nose, in order to provide reference for clinical work. Methods: A retrospective analysis was made on 59 patients with external nasal masses and scars who underwent surgical treatment in the Department of Aesthetic Plastic Surgery of the Affiliated Hospital of Qingdao University from July 1, 2021 to January 30, 2022, including 27 females and 32 males, aged 15 to 69 years. Using Likert scale, the repair methods and effects of local flap for nasal soft tissue defects were evaluated and summarized from three aspects of texture, flatness and scar concealment. GraphPad Prism 5.0 software was used for data statistics and analysis. Results: The use of skin flaps to repair small and medium-sized areas of the nose could achieve satisfactory results. For patients with different subunits, in terms of skin flatness and scar concealment degree in the operation area, patients' satisfaction with the dorsal and lateral nasal areas was higher than that of the alar and tip areas, respectively (F=6.40, P=0.001; F=10.57, P<0.001). For patients with different skin flap repair methods, the satisfaction of patients with Z-plasty and Dufourmentel skin flap was higher than that of other skin flap repair methods (F=4.38, P=0.002), and the satisfaction of patients with Dufourmentel skin flap was the highest in the degree of scar concealment (F=2.57, P=0.038). Conclusions: In the small and medium-sized defects of the nose, the use of multiple local flaps can achieve good cosmetic effects and functional recovery. The operator should select the appropriate flap repair method according to the characteristics of different aesthetic subunits of the nose.

Primary cell culture and morphological observation of bulbar conjunctival fibroblasts in conjunctivochalasis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the growth status and morphological changes of primary cultured bulbar conjunctival fibroblasts in different stages of conjunctivochalasis(CCH), and to determine the best passage time, so as to obtain stable and consistent CCH bulbar conjunctival fibroblasts.METHODS: CCH primary bulbar conjunctival fibroblasts were obtained by tissue block adhesion method. The fibroblasts were purified by trypsin differential digestion method. The growth status and morphological changes of fibroblasts in different periods were observed and recorded under inverted microscope. The fibroblasts were identified by immunofluorescence cytochemical staining.RESULTS: After 24h of CCH conjunctival tissue adherent to the wall, a small number of cells would be seen crawling out around the tissue blocks. The logarithmic phase of cell growth was from the 2-7d. The cells grew fast, with vigorously proliferation, clear outline, uniform distribution, increas in numbers and clear nuclei. From the 9-15d, the cell growth entered the plateau stage, the tissue blocks gradually aged and lost activity. The cells grew slowly, arranged loosely, the volume became larger, the shape became flat, and a large number of granular substances and vesicles were produced in the cytoplasm. Some cells fell off from the bottom of the culture bottle, and large gaps appeared between the cells. After subculture and purification, the size and morphology of fibroblasts were basically the same. Through cell identification, fibroblasts were long spindle, flat star or multi-process spindle, wide in the middle, oval nucleus, relatively small at both ends, with 2-3 slender processes of different lengths extending outward.CONCLUSION: Primary CCH bulbar conjunctival fibroblasts can be successfully obtained by tissue block adhesion method. When the cells grow to the 8d, they can be digested and passaged to obtain stable and consistent CCH conjunctival fibroblasts.

Application of augmented reality and mixed reality navigation technology in laparoscopic limited right hepatectomy / 中华外科杂志

Objective: To investigate the application effect of augmented reality and mixed reality navigation technology in three-dimensional(3D) laparoscopic narrow right hepatectomy(LRH). Methods: A retrospective analysis was performed on the clinical data of 5 patients with hepatic malignancy admitted to the First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University from September 2020 to June 2021,all of whom were males,aged from 42 to 74 years.Preoperative evaluation was performed using the self-developed 3D abdominal medical image visualization system; if all the 5 patients were to receive right hemihepatectomy,the remnant liver volume would be insufficient,so LRH were planned.During the operation,the independently developed 3D laparoscopic augmented reality and mixed reality surgical navigation system was used to perform real-time multi-modal image fusion and interaction between the preoperative 3D model and 3D laparoscopic scene.Meanwhile,intraoperative ultrasound assisted indocyanine green fluorescence was used to determine the surgical path.In this way,the LRH under the guidance of augmented reality and mixed reality navigation was completed.The predicted liver resection volume was evaluated before surgery,actual resected liver volume,surgical indicators and postoperative complications were analyzed. Results: All the 5 patients completed LRH under the guidance of augmented reality and mixed reality navigation technology,with no conversion to laparotomy.The median operative time was 300 minutes(range:270 to 360 minutes),no intraoperative blood transfusion was performed,and the median postoperative hospital stay was 8 days(range:7 to 9 days).There were no perioperative deaths,or postoperative complications such as liver failure,bleeding,or biliary fistula. Conclusion: For patients who need to undergo LRH,the use of augmented and mixed reality navigation technology can safely and effectively guide the implementation of surgery,retain more functional liver volume,improve surgical safety,and reduce postoperative complications.

How to change from traditional surgery to intelligent navigation surgery? / 中华外科杂志

After more than 20 years of multidisciplinary integration of medical science and technology,as well as research and practice in innovative diagnosis and treatment,digital medicine 4.0 has made a profound and important impact on the development of traditional surgery. To combine traditional surgery with digital medicine 4.0 technology is the direction of surgery development in the future.New technologies represented by digital intelligent navigation surgery have been deeply explored and widely applied in the diagnosis and treatment of many surgical diseases. With the innovative development and application of artificial intelligence,Big Data and mixed reality technology,the surgery will develop in ways similar to aerospace automatic and intelligent navigation,leading to the advent of digital medicine 5.0.

Effectiveness and safety of osteochondral allograft transplantation in the knee joint: A meta-analysis / 中国组织工程研究

BACKGROUND: Osteochondral allograft transplantation for the treatment of knee articular cartilage defects is one of the longest clinical methods. Although this method is widely used in clinical practice and is trusted by orthopedic surgeons, it still lacks evidence-based medicine support. OBJECTIVE: To investigate the efficacy of osteochondral allograft transplantation in the knee joint, systematic review and meta-analysis of all available data, and evaluate the efficacy and safety of osteochondral allograft as a transplant substitute in knee joint surgery. METHODS: Literature search was conducted in PubMed/Medline, EMBASE, Cochrane Collaboration Library, China National Knowledge Infrastructure and Wanfang Database. The application of osteochondral allograft in knee joint transplantation was searched and selected according to the literature inclusion criteria. Articles whose data can be extracted and meta-analyzable were mainly selected. RESULTS AND CONCLUSION: (1) Twenty-five studies met the inclusion criteria and were all case series studies. The patient reported that osteochondral allograft can be used as a graft material to repair knee joint defects. A total of 1 081 patients (1 111 knees) were included in the study. The age of onset was 11-75 years old, with an average age of 34.41 years. The proportion of women was about 40.81%. The follow-up period was 4-384 months, with an average of 76.8 months. (2) In these studies, donors received a minimum age of 10 years and a maximum of 65 years. According to the donor age range and number of studies, donors aged 15-45 were the primary targets. (3) The overall success rate after surgery was 74%, and the overall secondary operation rate was 17%. The success rate of unipolar surgery was 74.44% (501/673); the success rate of bipolar surgery was 50.94% (27/53). The success rate of unipolar surgery was significantly higher than that of bipolar surgery (χ2 =13.679, P < 0.05). (4) Treatment complications occurred in 67 patients (13.14%, 67/510). Common complications were persistent pain at the surgical site (15 cases), graft fracture or fragmentation (12 cases). (5) These results indicate that osteochondral allograft is an effective and safe substitute for knee joint transplantation. The overall success rate is 74% and the secondary operation rate is 17%. It is a treatment with high success rate and low risk of reoperation.

Dual pitch titanium-coated pedicle screws improve initial and early fixation in a polyetheretherketone rod semi-rigid fixation system in sheep / 中华医学杂志(英文版)

Background@#Reports on the efficacy of modifications to the thread design of pedicle screws are scarce. The aim of the study was to investigate initial and early fixation of pedicle screws with a plasma-sprayed titanium coating and dual pitch in the pedicle region (dual pitch titanium-coated pedicle screw [DPTCPS]) in a polyetheretherketone (PEEK) rod semi-rigid fixation system.@*Methods@#Fifty-four sheep spine specimens and 64 sheep were used to investigate initial ( "0-week" controls) and early (postoperative 6 months) fixation, respectively. Sheep were divided into dual pitch pedicle screw (DPPS), standard pitch pedicle screw (SPPS), DPTCPS, and standard pitch titanium-coated pedicle screw (SPTCPS) groups. Specimens/sheep were instrumented with four screws and two rods. Biomechanical evaluations were performed, and histology at the implant-bone interface was investigated.@*Results@#At 0-week, mean axial pull-out strength was significantly higher for the DPTCPS and SPTCPS than the SPPS (557.0 ± 25.2 vs. 459.1 ± 19.1 N, t = 3.61, P < 0.05; 622.6 ± 25.2 vs. 459.1 ± 19.1 N, t = 3.43, P < 0.05). On toggle-testing, the DPTCPS was significantly more resistant than the SPPS and SPTCPS (343.4 ± 16.5 vs. 237.5 ± 12.9 N, t = 3.52, P < 0.05; 343.4 ± 16.5 vs. 289.9 ± 12.8 N, t = 3.12, P < 0.05; 124.7 ± 13.5 vs. 41.9 ± 4.3 cycles, t = 2.18, P < 0.05; 124.7 ± 13.5 vs.79.5 ± 11.8 cycles, t = 2.76, P < 0.05). On cyclic loading, maximum displacement was significantly lower for the DPTCPS than the SPPS and SPTCPS (1.8 ± 0.13 vs. 3.76 ± 0.19 mm, t = 2.29, P < 0.05; 1.8 ± 0.13 vs. 2.46 ± 10.20 mm, t = 2.69, P < 0.05). At post-operative 6 months, mean axial pull-out strength was significantly higher for the DPTCPS and SPTCPS than the SPPS (908.4 ± 33.6 vs. 646.5 ± 59.4 N, t = 3.34, P < 0.05; 925.9 ± 53.9 vs. 646.5 ± 59.4 N, t = 3.37, P < 0.05). On toggle-testing, the DPTCPS was significantly more resistant than the SPPS and SPTCPS (496.9 ± 17.9 vs. 370.3 ± 16.4 N, t = 2.86, P < 0.05; 496.9 ± 17.9 vs. 414.1 ± 12.8 N, t = 2.74, P < 0.05; 249.1 ± 11.0 vs.149.9 ± 11.1 cycles, t = 2.54, P < 0.05; 249.1 ± 11.0 vs.199.8 ± 7.2 cycles, t = 2.61, P < 0.05). On cyclic loading, maximum displacement was significantly lower for the DPTCPS than the SPPS and SPTCPS (0.96 ± 0.11 vs. 2.39 ± 0.14 mm, t = 2.57, P < 0.05; 0.96 ± 0.11 vs. 1.82 ± 0.12 mm, t = 2.73, P < 0.05). Resistance to toggle testing (370.3 ± 16.4 vs. 414.1 ± 12.8 N, t = 3.29, P < 0.05; 149.9 ± 11.1 vs.199.8 ± 7.2 cycles, t = 2.97, P < 0.05) was significantly lower and maximum displacement in cyclic loading (2.39 ± 0.14 vs.1.82 ± 0.12 mm; t = 3.06, P < 0.05) was significantly higher for the SPTCPS than the DPTCPS. Bone-to-implant contact was significantly increased for the DPTCPS compared to the SPPS (58.3% ± 7.0% vs. 36.5% ± 4.4%, t = 2.74, P < 0.05); there was no inflammatory reaction or degradation of coated particles.@*Conclusion@#DPTCPSs might have stronger initial and early fixation in a PEEK rod semi-rigid fixation system.

Dual pitch titanium-coated pedicle screws improve initial and early fixation in a polyetheretherketone rod semi-rigid fixation system in sheep / 中华医学杂志(英文版)

BACKGROUND@#Reports on the efficacy of modifications to the thread design of pedicle screws are scarce. The aim of the study was to investigate initial and early fixation of pedicle screws with a plasma-sprayed titanium coating and dual pitch in the pedicle region (dual pitch titanium-coated pedicle screw [DPTCPS]) in a polyetheretherketone (PEEK) rod semi-rigid fixation system.@*METHODS@#Fifty-four sheep spine specimens and 64 sheep were used to investigate initial ("0-week" controls) and early (post-operative 6 months) fixation, respectively. Sheep were divided into dual pitch pedicle screw (DPPS), standard pitch pedicle screw (SPPS), DPTCPS, and standard pitch titanium-coated pedicle screw (SPTCPS) groups. Specimens/sheep were instrumented with four screws and two rods. Biomechanical evaluations were performed, and histology at the implant-bone interface was investigated.@*RESULTS@#At 0-week, mean axial pull-out strength was significantly higher for the DPTCPS and SPTCPS than the SPPS (557.0 ± 25.2 vs. 459.1 ± 19.1 N, t = 3.61, P < 0.05; 622.6 ± 25.2 vs. 459.1 ± 19.1 N, t = 3.43, P < 0.05). On toggle-testing, the DPTCPS was significantly more resistant than the SPPS and SPTCPS (343.4 ± 16.5 vs. 237.5 ± 12.9 N, t = 3.52, P < 0.05; 343.4 ± 16.5 vs. 289.9 ± 12.8 N, t = 3.12, P < 0.05; 124.7 ± 13.5 vs. 41.9 ± 4.3 cycles, t = 2.18, P < 0.05; 124.7 ± 13.5 vs.79.5 ± 11.8 cycles, t = 2.76, P < 0.05). On cyclic loading, maximum displacement was significantly lower for the DPTCPS than the SPPS and SPTCPS (1.8 ± 0.13 vs. 3.76 ± 0.19 mm, t = 2.29, P < 0.05; 1.8 ± 0.13 vs. 2.46 ± 10.20 mm, t = 2.69, P < 0.05). At post-operative 6 months, mean axial pull-out strength was significantly higher for the DPTCPS and SPTCPS than the SPPS (908.4 ± 33.6 vs. 646.5 ± 59.4 N, t = 3.34, P < 0.05; 925.9 ± 53.9 vs. 646.5 ± 59.4 N, t = 3.37, P < 0.05). On toggle-testing, the DPTCPS was significantly more resistant than the SPPS and SPTCPS (496.9 ± 17.9 vs. 370.3 ± 16.4 N, t = 2.86, P < 0.05; 496.9 ± 17.9 vs. 414.1 ± 12.8 N, t = 2.74, P < 0.05; 249.1 ± 11.0 vs.149.9 ± 11.1 cycles, t = 2.54, P < 0.05; 249.1 ± 11.0 vs.199.8 ± 7.2 cycles, t = 2.61, P < 0.05). On cyclic loading, maximum displacement was significantly lower for the DPTCPS than the SPPS and SPTCPS (0.96 ± 0.11 vs. 2.39 ± 0.14 mm, t = 2.57, P < 0.05; 0.96 ± 0.11 vs. 1.82 ± 0.12 mm, t = 2.73, P < 0.05). Resistance to toggle testing (370.3 ± 16.4 vs. 414.1 ± 12.8 N, t = 3.29, P < 0.05; 149.9 ± 11.1 vs.199.8 ± 7.2 cycles, t = 2.97, P < 0.05) was significantly lower and maximum displacement in cyclic loading (2.39 ± 0.14 vs.1.82 ± 0.12 mm; t = 3.06, P < 0.05) was significantly higher for the SPTCPS than the DPTCPS. Bone-to-implant contact was significantly increased for the DPTCPS compared to the SPPS (58.3% ± 7.0% vs. 36.5% ± 4.4%, t = 2.74, P < 0.05); there was no inflammatory reaction or degradation of coated particles.@*CONCLUSION@#DPTCPSs might have stronger initial and early fixation in a PEEK rod semi-rigid fixation system.

Application of fusion indocyanine green fluorescence imaging in the surgical treatment of recurrent hepatocellular carcinoma in 12 cases / 中国实用外科杂志

OBJECTIVE: To investigate the application value of fusion indocyanine green fluorescence imaging(FIGFI)in the surgical treatment of recurrent hepatocellular carcinoma.METHODS: From January 2015 to January 2018,theclinical data of 12 patients with recurrent hepatocellular carcinoma who received surgical treatment guided by three-dimensional visualization technology combined with FIGFI at Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University were analyzed. High-quality thin-slice CT data were collected for three-dimensionalvisualization and reconstruction,individualized liver segmentation and preoperative surgical planning. FIGFI was used todefine the demarcation of tumors,to determine the extent of hepatectomy,and to detect small hepatocellular carcinomaand metastases during the operation. The use of FIGFI in combination with three-dimensional visualization imagesguided the precision hepatectomy. postoperative efficacy was observed by follow-up.RESULTS: All the 12 patientsunderwent successful three-dimensional reconstruction and liver resection. Preoperative CT revealed 12 lesions(80%);intraoperative FIGFI detected 15 lesions(100%);of the three newly discovered lesions,2 were hepatocellular carcinomaand 1 was cirrhosis nodule. The operation time was 267.5(183,345)minutes and the amount of bleeding was 287.5(62.5,513.5)m L. No severe complications such as abdominal hemorrhage,abdominal infection,bile leakage and liverfailure occurred postoperatively. No death occurred during the perioperative period. The median follow-up period was 29 (3-36)months; during the follow-up period, 1 casewas lost and 4 cases had metastasis or recurrence.All the patients were alive at the end of the follow-up.CONCLUSION: FIGFI is helpful to achieveanatomical, functional and radical hepatectomy inthe treatment of recurrent hepatocellular carcinoma.

Three-dimensional visualization technology for precise diagnosis and treatment of primary liver cancer: A Meta-analysis / 中国实用外科杂志

OBJECTIVE: To systematically review the effectiveness and safety of three-dimensional visualization technology(3 DVT) for precise diagnosis and treatment of primary liver cancer(PLC). METHODS: The cohort studies regarding using3 DVT in precise diagnosis and treatment of PLC were collected by searching several national and international online databases. The retrieval time was from inception of the database to June 2019. Two reviewers independently screened the literatures, extracted data and evaluated the methodological quality of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. RESULTS: A total of 8 studies were finally included involving 533 patients, with 263 cases in 3 DVT group and 270 in two-dimensional(2D) imaging group. The results of meta-analysis showed that in 3 DVT group, compared with 2 D imaging group, the intraoperative blood loss was reduced(MD=-76.00, 95%CI-127.25—-24.74, P=0.004);the operative time was shortened(MD=-44.81, 95%CI-64.64—-24.98, P0.05). CONCLUSION: The application of3 DVT in precise diagnosis and treatment of PLC is safe and effective, and it can effectively reduce the intraoperative blood loss and the incidence of postoperative complications, accelerate the recovery of postoperative liver function, shorten the operation time and hospitalization time, and reduce the recurrence rate of liver cancer in short-term follow-up.

Indocyanine green fluorescence imaging for precise diagnosis and treatment of liver neoplasms:A Meta-analysis / 中国实用外科杂志

OBJECTIVE: To systematically review the safety and effectiveness of indocyanine green(ICG) fluorescence imaging for precise diagnosis and treatment of liver neoplasms.METHODS: PubMed,EMbase,The Cochrane Library,CNKI,WanFang Data and VIP databases were electronically searched to collect cohort Studies which involved ICG fluorescence imaging for precise diagnosis and treatment of liver neoplasms. The retrieval time was from inception of the database to June 2019. Screened the literatures,extracted data,and Meta-analysis was performed by using RevMan 5.3 software.RESULTS: 10 studies were finally included involving 803 patients,with 328 cases in ICG molecular fluorescence imaging group and 475 patients in the control group. The results of meta-analysis showed that in ICG fluorescence imaging group,compared with the control group,the blood transfusion rate was decreased(OR=0.42,95%CI0.22～0.80,P=0.008),the rate of negative incision margin was increased(OR=3.22,95%CI 1.09～9.51,P=0.03),the incidence of postoperative complications was decreased(OR=0.49,95%CI 0.28～0.85,P=0.01). However,there was no statistical differences between the two groups in terms of perioperative blood loss,operation time or hospitalization time(all P>0.05).CONCLUSION: The application of ICG fluorescence imaging in precise diagnosis and treatment of liver neoplasms can effectively reduce the incidence of blood transfusion,the incidence of postoperative complications,and increase the rate of negative incision margin.

Application of digital intelligent diagnostic and treatment technology in anatomical hepatectomy / 中国实用外科杂志

Digital intelligent diagnostic and treatment technology refers to a novel technology which is based by associating digitalized and intelligent high-tech with modern science to form a multi-knowledge and multi-disciplinary domain; it includes three-dimensional visualization,3 D printing,molecular fluorescence imaging,mixed reality,photoacoustic imaging,artificial intelligence-radiomis and real-time multimodal image surgical navigation.It plays a significant role in precision diagnosis,preoperative planning and intraoperative navigation of diseases.The authors' team,combining digital intelligent technology with the actual vascular distribution of patients,has been committed to the realization of individualized liver segmentation,volume calculation,simulation surgery,preoperative planning,mixed reality,tumor boundary definition and real-time image fusion for navigation in liver surgery.The research results were applied clinically,and achieved anatomical,functional,and radical hepatectomy for liver tumors.

Application of multimode imaging technology in real time navigation in anatomical liver resections / 中国实用外科杂志

OBJECTIVE:To explore the value of three dimensional(3 D) visualization combined with indocyanine green(ICG) fluorescent imaging and virtual reality(VR) technique in real-time navigation in anatomical liver resections.METHODS:Data of 64 patients with liver neoplasms were collected from January 2016 to June 2018 in Hapatobiliary Surgery,Zhujiang Hospital,Southern Medical University. Pre-operative 64-slice CT or 256-slice CT examination was performed.Thin-slice CT image data were imported into MI-3 DVS to perform 3 D reconstruction of liver, intrahepatic vessels and tumors. The 3 D reconstruction model was then imported into a VR development engine to transform into a VR model, so as to instruct preoperative planning and decision-making; intraoperative Pinpoint fluorescence imager was used to detect liver and tumor, and 3 DV and VR techniques were combined to assist the hepatectomy.During the period of this research,RESULTS: four patients with MI-3 DVS 3 D reconstruction showed clear liver, tumor, and intrahepatic vascular structures.The manipulator with a head-mounted display and a sensor for capturing hand and finger movement was integrated into a 3 D-VR environment to visualize the immersion, spatial and stereoscopic sensation of the pre-3 DV model. FIGFI could be used to define the tumor boundary and the hepatic margin, as well as to detect the small liver cancer and the residual lesion of the liver margin. In the group of 64 patients, left lateral loberesection was performed in 4 cases, left hepatectomy in 16 cases, right anterior resection of the liver in 5 cases, right hepatic resection in 5 cases, right lobe resection in 17 cases, middle hepatectomy in 5 cases and hepatic segmentectomy in11 cases(5 segments, 3 cases, 6 segments, 6 cases, 7 segments, 1 case, 8 segments, 1 case) and caudate lobectomy in 1 case. The actual operation procedure was consistent with the preoperative planning. No severe complications such as intraperitoneal hemorrhage, bile leakage, liver failure, death occurred after operation.CONCLUSION:Multimode imaging technique has important application value in preoperative accurate imaging diagnosis and intraoperative anatomic, functional and radical hepatectomy.

Significance of digital intelligent medical technology in preoperative evaluation of perihepatic hilar biliary tract diseases / 中国实用外科杂志

The digital intelligent medical technology such as three dimensional visualization, three dimensional printing,enhanced/virtual reality technology, indocyanine green molecular imaging are widely used in the clinical diagnosis and treatment of hepatobiliary and pancreatic diseases and showed a booming trend. Perihepatic hilar biliary tract diseases with complex anatomical structure, special physiological pathology character and lower efficiency of diagnosis and treatment are the major and difficult disease in the field of surgery. Efficient preoperative evaluation is the key to improve the efficiency of diagnosis and treatment. The digital intelligent medical technology can be used to obtain the comprehensive, individualized image diagnostic information,and comprehensive analysis the anatomy relations of the hepatic artery, portal vein, bile duct and lesions, and quantitatively measure the liver volume, formulate the reasonable operation scheme, determine the best approach of surgery, predict intraoperative injury risk and improve the surgical treatment effect.

Application of 3D visualization technique in breast cancer surgery with immediate breast reconstruction using laparoscopically harvested pedicled latissimus dorsi muscle flap / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the value of 3D visualization technique in breast-preserving surgery for breast cancer with immediate breast reconstruction using laparoscopically harvested pedicled latissimus dorsi muscle flap.</p><p><b>METHODS</b>From January, 2015 to May, 2016, 30 patients with breast cancer underwent breast-preserving surgery with immediate breast reconstruction using pedicled latissimus dorsi muscle flap. The CT data of the arterial phase and venous phase were collected preoperatively and imported into the self-developed medical image 3D visualization system for image segmentation and 3D reconstruction. The 3D models were imported into the simulation surgery platform for virtual surgery to prepare for subsequent surgeries. The cosmetic outcomes of the patients were evaluated 6 months after the surgery. Another 18 patients with breast cancer who underwent laparoscopic latissimus dorsi muscle breast reconstruction without using 3D visualization technique from January to December, 2014 served as the control group. The data of the operative time, intraoperative blood loss and postoperative appearance of the breasts were analyzed.</p><p><b>RESULTS</b>The reconstructed 3D model clearly displayed the anatomical structures of the breast, armpit, latissimus dorsi muscle and vessels and their anatomical relationship in all the 30 cases. Immediate breast reconstruction was performed successfully in all the cases with median operation time of 226 min (range, 210 to 420 min), a median blood loss of 95 mL (range, 73 to 132 mL). Evaluation of the appearance of the breast showed excellent results in 22 cases, good appearance in 6 cases and acceptable appearance in 2 cases. In the control group, the median operation time was 283 min (range, 256 to 313 min) and the median blood loss was 107 mL (range, 79 to 147 mL) with excellent appearance of the breasts in 10 cases, good appearance in 4 cases and acceptable appearance in 4 cases.</p><p><b>CONCLUSION</b>3D reconstruction technique can clearly display the morphology of the latissimus dorsi and the thoracic dorsal artery, allows calculation of the volume of the breast and the latissimus dorsi, and helps in defining the scope of resection of the latissimus dorsi to avoid injuries of the pedicled vessels. This technique also helps to shorten the operation time, reduce intraoperative bleeding, and improve the appearance of the reconstructed breast using pedicled latissimus dorsi muscle flap.</p>

Application of digital 3D technique combined with nanocarbon-aided navigation in endoscopic sentinel lymph node biopsy for breast cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the clinical value of digital 3D technique combined with nanocarbon-aided navigation in endoscopic sentinel lymph node biopsy for breast cancer.</p><p><b>METHODS</b>Thirty-nine female patients with stage I/II breast cancer admitted in our hospital between September 2014 and September 2015 were recruited. CT lymphography data of the patients were segmented to reconstruct digital 3D models, which were imported into FreeForm Modeling Surgical System Platform for visual simulation surgery before operation. Endoscopic sentinel lymph node biopsy and endoscopic axillary lymph node dissection were then carried out, and the accuracy and clinical value of digital 3D technique in endoscopic sentinel lymph node biopsy were analyzed.</p><p><b>RESULTS</b>s The 3D models faithfully represented the surgical anatomy of the patients and clearly displayed the 3D relationship among the sentinel lymph nodes, axillary lymph nodes, axillary vein, pectoralis major, pectoralis minor muscle and latissimus dorsi. In the biopsy, the detection rate of sentinel lymph nodes was 100% in the patients with a coincidence rate of 87.18% (34/39), a sensitivity of 91.67% (11/12), and a false negative rate of 8.33% (1/12). Complications such as limb pain, swelling, wound infection, and subcutaneouseroma were not found in these patients 6 months after the operation.</p><p><b>CONCLUSION</b>Endoscopic sentinel lymph node biopsy assisted by digital 3D technique and nanocarbon-aided navigation allows a high detection rate of sentinel lymph nodes with a high sensitivity and a low false negative rate and can serve as a new method for sentinel lymph node biopsy for breast cancer.</p>

Application of digitalized minimally invasive technique in treatment of hepatolithiasis based on MI-3DVS / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the clinical value of digitalized minimally invasive technique in the treatment of the hepatolithiasis.</p><p><b>METHODS</b>The 64-slice spiral CT data were acquired from 4 hepatolithiasis patients for three-dimensional reconstruction and simulation operation using abdominal medical image-3D visualization system (MI-3DVS). Three-dimensional reconstruction was performed for the liver, hepatic arteries, hepatic veins, portal veins, intrahepatic bile ducts and calculi. Based on the size and position of the calculi and the distribution of the dilated or stenotic biliary ducts, several simulation operations such as partial hepatectomy and hepaticojejunstomy were performed. With guidance by the findings in the simulation operation, the actual minimally invasive operation was performed.</p><p><b>RESULTS</b>The three-dimensional models of the liver, hepatic arteries, hepatic veins, portal veins, intrahepatic bile ducts and calculi were reconstructed successfully, which clearly visualized the site and the number of calculi and the condition of the involved intrahepatic bile ducts. Guided by the three-dimensional models and the simulation operations, partial hepatectomy and hepaticojejunstomy were performed and the calculi were removed completely in all the 4 cases with maximum preservation of the residual liver volume.</p><p><b>CONCLUSION</b>Three-dimensional reconstruction and simulation operation allows digital minimally invasive treatment of hepatolithiasis, which can be a new approach to hepatobiliary surgery.</p>

Application of three-dimensional visualization technology in precise diagnosis and treatment for hepatolithiasis / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the value of three-dimensional (3D) visualization technique in preoperative diagnosis, preoperative evaluation and surgical guidance for hepatolithiasis.</p><p><b>METHODS</b>The 64-slice spiral CT data of 30 hepatolithiasis cases were imported in a self-designed medical image processing system for 3D reconstruction of the intrahepatic bile duct. The preoperative diagnosis and pathological classification were derived from the reconstructed model, with which the feasibility and safety of the surgical plan were assessed by simulation of the surgical procedures. The consistency between the simulated procedure and the actual operation was evaluated, and the residual stones were detected using cholangiography with a T-shaped tube.</p><p><b>RESULTS</b>When the model setting was configured to render the liver translucent, the system clearly displayed the site and number of the bile duct calculi as well as the expansion or narrowing of the intrahepatic bile duct. A total consistency (100%) was found between the surgical findings and the preoperative findings based on the 3D model, and also between the actual surgical procedures and the preoperative simulation in 30 cases. The consistency rate between the actual surgical protocols and the preoperative surgical plan was 90%. Follow-up of 27 of the patients for 6 months showed a recurrence rate of 7.4% (2/27) after the operation.</p><p><b>CONCLUSION</b>The 3D visualization system allows accurate preoperative diagnosis and precise surgical operation to reduce the postoperative recurrence rate, and can be of value as a new diagnostic and treatment modality in biliary surgery.</p>

Clinical application of digitized three-dimensional image reconstruction for surgical simulation in living-related kidney transplantation / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the application of digitized three-dimensional (3D) image reconstruction in living-related kidney transplantation.</p><p><b>METHODS</b>The image data of 16-slice spiral CT in 5 cases of living-related kidney transplantation were collected to reconstruct the 3D model of the donor and recipient, which were then imported in the FreeForm Modeling System. The optimal surgical approach for each individual case was planned and simulated for verification. During the actual surgeries, the surgical findings were compared against the reconstructed model and the results of simulated surgery.</p><p><b>RESULTS</b>The 3D model clearly displayed the anatomy of the kidney and the variation of the related vessels. The optimal surgical approaches were planned through the simulated surgery. The anatomy of the kidney and the related vessels found in the actual surgeries were consistent with that displayed by the reconstructed 3D model. All the operations were completed successfully according to the surgical plan, and the patients recovered uneventfully without obvious complications.</p><p><b>CONCLUSION</b>Three-dimensional reconstruction and simulated surgery allow optimization of the surgical approaches of living-related kidney transplantation to ensure successful operation and minimize the surgical risks.</p>

Effects of SiRNA-EGFR on the expression of hyaluronidase gene EGFR in human breast cancer cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the effect of SiRNA-EGFR on the expression of hyaluronidase gene in human breast cancer cells.</p><p><b>METHODS</b>Reverse transcription-polymerse chain reaction was used to detect the changes in the expression of EGFR mRNA in human breast cancer cell lines MDA-MB-231, MDA-MB-435S, ZR-75 and ZR-75-30 after transfection by SiRNA-EGFR.</p><p><b>RESULTS</b>After transfection with SiRNA-EGFR, the expression levels of EGFR were significantly inhibited in MDA-MB-231, MDA-MB-435S, ZR-75 and ZR-75-30 cells (P<0.05).</p><p><b>CONCLUSION</b>Transfection by SiRNA-EGFR can inhibit the expression of EGFR mRNA in human breast cancer cells.</p>

Study on the clinical application of abdominal medical image proceeding system in extended hepatectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To study the applied value of abdominal medical image proceeding system (AMIPS) in extended hepatectomy.</p><p><b>METHODS</b>Sixty-four-slice spiral computer tomography (CT) scan data of 32 cases treated from September 2007 to July 2009 (15 male, 17 female; mean age 52 years old) with liver tumor was collected, among which there were 9 cases with huge liver tumor. The data was imported into AMIPS for sequence segmenting and three-dimensional (3D) reconstruction. The reconstructed models were imported into virtual system of AMIPS for digital hepatic segment partition and extended hepatectomy analysis for huge liver tumor of 9 cases. According to the calculated data, suitable modus operandi were selected.</p><p><b>RESULTS</b>In the AMIPS, the 3D models could show the relationships between the lesions to the surrounding tissue more intuitively and the type of blood supply. Digital hepatic segment partition made localize lesions more exactly. It was possible to hepatic segmentectomy and analysis of extended hepatectomy by calculating the relative volume of hepatic segment of huge liver tumor. Huge liver tumor of 9 cases performed different modus operandi, including two cases with right hemi hepatectomies, five cases with hepatic segmentectomy of S6 and S7, two cases with hepatic segmentectomy of S5-7 and part of the S8. There were margin-free tumor cells and no complications such as liver failure in all cases. The average hospitalization time was 21 d.</p><p><b>CONCLUSION</b>AMIPS is helpful in the diagnosis of hepatic disease and in the optimizing surgical plans which can decrease surgical risk and help prevent postoperative hepatic failure.</p>