Application of 3D reconstruction through CT to measure the abdominal cavity volume in the treatment of external abdominal hernia.

OBJECTIVE: To evaluate 3D reconstruction through CT in the measurement of abdominal cavity volume. METHODS: From January 1, 2019 to December 31, 2019, 61 patients diagnosed as external abdominal hernia were included in this prospective study. Multislice computed tomography (MSCT) was applied to patients scanning, and the images were transferred to post-processing workstation for further analysis. We measured the abdominal cavity volumes using volume rendering (VR) method and diameter rendering (DR) method, and the results were used to test whether there is a correlation between them. In addition, the time required for the measurement was recorded and analyzed. RESULTS: In this study, we found that there was no significant difference in the abdominal cavity volumes between these two groups (VR vs. DR = 7857.316 ± 2035.786 cm3 vs. 7967.268 ± 2925.792 cm3, P > 0.05). Besides, the correlation analysis between the measured values of VR method and DR method showed there was a significant positive correlation (r = 0.922, P < 0.01). The linear regression equation based on the scatter plot was established as follows: y = 0.6417x + 2745, R2 = 0.8504. Furthermore, this regression equation was simplified as follows: y = 0.64x + 2800, R2 = 0.8499. Meanwhile, the time required for measurement of VR was significantly longer than that of DR (VR vs. DR = 64.3 ± 7.1 min vs. 2.6 ± 0.6 min, P < 0.01). CONCLUSION: In conclusion, the DR method can quickly measure and calculate the abdominal cavity volume, and its accuracy can more suitable for clinical requirement.

In vivo reflectance confocal microscopy in daily practice: Image features correlated to histopathology.

BACKGROUND: In vivo reflectance confocal microscopy (RCM) represents a promising technique for noninvasive visualization of skin lesions. In the clinical daily practice, doctors want to know the relationship between the RCM images and the skin pathological changes. OBJECTIVE: The aim of this study was to identify the basic skin pathological changes under RCM, and use RCM terminology to describe these pathological changes. METHODS: A total of 100 patients were recruited and were evaluated both by RCM and histopathologic examination. Ten healthy volunteers were also recruited as control. RCM examinations were done and biopsies of the lesions at the same site of RCM examination were performed for histopathology analysis. RESULTS: The pathological changes including hyperkeratosis, parakeratosis, acanthosis, papilloma, spongiosis, pustule, vacuolar degeneration, hyperpigmentation, changes of collagen fibers, and vascular changes can be imaged by RCM and corresponded well to their histopathology. RCM failed to find the atypical keratinocytes in two squamous cell carcinoma cases because of the hyperkeratosis and failed to find the vascular changes in one port wine stain cases because of the limitation of detecting depth. CONCLUSION: Features correlating well to histopathology are observed on RCM. RCM can be used as an auxiliary diagnosis tool for the clinical diagnosis.

Randomized clinical trial of chemoembolization plus radiofrequency ablation versus partial hepatectomy for hepatocellular carcinoma within the Milan criteria.

BACKGROUND: This study aimed to compare sequential treatment by transcatheter arterial chemoembolization (TACE) and percutaneous radiofrequency ablation (RFA) with partial hepatectomy for hepatocellular carcinoma (HCC) within the Milan criteria. METHODS: In a randomized clinical trial, patients with HCC within the Milan criteria were included and randomized 1 : 1 to the partial hepatectomy group or the TACE + RFA group. The primary outcome was overall survival and the secondary outcome was recurrence-free survival. RESULTS: Two hundred patients were enrolled. The 1-, 3- and 5-year overall survival rates were 97·0, 83·7 and 61·9 per cent for the partial hepatectomy group, and 96·0, 67·2 and 45·7 per cent for the TACE + RFA group (P = 0·007). The 1-, 3- and 5-year recurrence-free survival rates were 94·0, 68·2 and 48·4 per cent, and 83·0, 44·9 and 35·5 per cent respectively (P = 0·026). On Cox proportional hazard regression analysis, HBV-DNA (hazard ratio (HR) 1·76; P = 0·006), platelet count (HR 1·00; P = 0·017) and tumour size (HR 1·90; P < 0·001) were independent prognostic factors for recurrence-free survival, and HBV-DNA (HR 1·61; P = 0·036) was a risk factor for overall survival. The incidence of complications in the partial hepatectomy group was higher than in the TACE + RFA group (23·0 versus 11·0 per cent respectively; P = 0·024). CONCLUSION: For patients with HCC within the Milan criteria, partial hepatectomy was associated with better overall and recurrence-free survival than sequential treatment with TACE and RFA. REGISTRATION NUMBER: ACTRN12611000770965 (http://www.anzctr.org.au/).

Analysis and clinical significance of microRNA-499 expression levels in serum of patients with acute myocardial infarction.

The aim of this study was to investigate the expression level of microRNA-499 and its clinical significance in serum of patients with acute myocardial infarction (AMI). We recruited 59 patients with AMI and 60 healthy individuals undergoing physical examination in our hospital during the same period as controls. Peripheral blood was drawn in the morning on the same day of microRNA extraction. The expression level of microRNA-499 was analyzed by real-time fluorescent quantitative polymerase chain reaction (qPCR). The sensitivity and specificity of the clinical diagnosis of AMI were analyzed by a receiver operating characteristic (ROC) curve. Fluorescent qPCR analysis showed that the expression of microRNA-499 in serum of patients with AMI was significantly higher than in controls (P < 0.05). MicroRNA-499 was detected in blood serum 3 h post-AMI, reaching a peak after 12 h and declining after 15 h. The area under the ROC curve (AUC) for the gold standard cardiac troponin I (cTnI) was 0.971 [95% confidence interval (CI): 0.951-1.000], and for the microRNA-499, AUC = 0.915 (95%CI: 0.826-1.000). When the microRNA-499 levels in patient and control (> 1.5) sera were compared, the sensitivity of microRNA-499 in judging AMI was found to be 86.37% and the specificity was 93.47%. Our results demonstrated that the expression levels of microRNA-499 in serum of patients with AMI were abnormal. Its high sensitivity and specificity for the diagnosis of AMI suggest that it would be useful as an auxiliary index for clinical diagnosis of AMI.

Liver resection under total vascular exclusion with or without preceding Pringle manoeuvre.

BACKGROUND: Adequate control of bleeding is crucial during liver resection. This study analysed the safety and efficacy of hepatectomy under total hepatic vascular exclusion (THVE) in patients with tumours encroaching or infiltrating the hepatic veins and/or the inferior vena cava (IVC). METHODS: All patients undergoing liver resection with THVE between January 2000 and July 2006 were identified from a prospectively collected database containing 2400 patients. Data on patient demographics, surgical procedure and outcome were collected. RESULTS: A total of 87 patients scheduled for liver resection under THVE were identified, 77 with malignant tumours and ten with benign disease. THVE could not be used in two patients (2 per cent) owing to haemodynamic intolerance during trial clamping. Seventeen patients received simultaneous clamping of the portal triad and vena cava, and 68 had portal triad clamping followed by concomitant portal and vena cava clamping. The mean(s.d.) duration of THVE was 28.3(7.5) and 18.7(5.2) min respectively. Overall postoperative complication and operative mortality rates were 53 and 2 per cent respectively. Mean(s.d.) hospital stay was 16.8(4.7) days. CONCLUSION: Major hepatic resection for tumours encroaching on the hepatic veins or IVC can be carried out under THVE with reasonable morbidity and mortality.