The Bigger the Better? Analysis of Surgical Complications and Outcome of the Retrosigmoid Approach in 449 Oncological Cases.

Introduction: Exposure of the posterior skull base and the cerebellopontine angle is challenging due to important neurovascular structures. The retrosigmoid approach (RSA) has become the standard method used in surgery. We report our experiences with RSAs regarding technical obstacles, complications, and approach-related outcomes. Materials and Methods: We performed a retrospective chart review at a tertiary neurosurgical center between January 2007 and September 2020. We included all patients undergoing surgery for oncologic lesions through RSAs, concentrating on surgical technique, postoperative outcome, and complications. Results: A total of 449 RSAs were included. The median age at the time of surgery was 58 years; 168 (37.4%) were male and 281 (62.6%) were female. The median approach surface was 7.8 cm2. The median tumor volume was 5.9 cm3. The median Clavien-Dindo grade was 2, the total complication rate was 28.7%, and gross total resection (GTR) was 78.8%. Findings revealed that tumor volume had no significant impact on postoperative complications in general (p = 0.086) but had a significant impact on postoperative hemorrhage (p = 0.037) and hydrocephalus (p = 0.019). Tumor volume was significant for several preoperative symptoms (p < 0.001). The extent of the approach had no significant impact on complications in general (p = 0.120) but was significant regarding postoperative cerebrospinal fluid (CSF) leaks (p = 0.008). Craniotomy size was not significant regarding GTR (p = 0.178); GTR rate just missed significant correlation with tumor volume (p = 0.056). However, in the case of vestibular schwannomas, the size of craniotomy was important for GTR (p = 0.041). Conclusion: Tumor volume has an important impact on preoperative symptoms as well as on postoperative complications. Although the extent of the craniotomy barely missed significance regarding GTR, a correlation can be assumed. Thus, the extent of craniotomy should be taken into presurgical consideration, especially in the case of postoperative CSF leaks. Regarding vestibular schwannomas, craniotomy size plays an important role in achieving satisfactory oncological outcomes. Different approaches should be selected where necessary regarding superior resection rates.

Environmental impacts and optimizing strategies of municipal sludge treatment and disposal routes in China based on life cycle analysis.

The management and utilization of sludge in a sustainable approach require a systematic analysis of the environmental impacts generated from diverse sludge treatment and disposal processes. This study systematically assessed 12 common sludge treatment and disposal routes based on the existing operating and construction conditions of representative sludge disposal projects in China. We evaluated their environmental impacts using a life cycle assessment following the International Organization for Standardization (ISO 14040 and ISO 14044), and found that the routes of co-incineration, mono-incineration, and anaerobic digestion with or without thermal hydrolysis may be useful in terms of simultaneously controlling environmental pollution and carbon emissions in China. Therein, the route of co-incineration was recommended as the best one because its human toxicity potential (-152.31 kg dichlorobenzene (1,4-DB) eq/ton dry solid (t DS)), freshwater ecotoxicity potential (FEP, -127.40 kg 1,4-DB eq/t DS), terrestrial ecotoxicity potential (TEP, -0.81 kg 1,4-DB eq/t DS), and global warming potential (-27.26 kg CO2 eq/t DS) were all negative (environmental benefits). Furthermore, the toxicity impacts of the mono-incineration route were also negative, but it still needed to further enhance energy recovery to reduce carbon emissions. Despite the routes of anaerobic digestion and thermal hydrolysis in combination with anaerobic digestion had the excellent negative carbon emission attributes (-572.44 kg CO2 eq/t DS, -474.92 kg CO2 eq/t DS), they showed serious FEP and TEP owing to the heavy metals pollution caused by subsequent land use of anaerobic digested sludge. Overall, this study selected the most suitable sludge treatment and disposal routes to simultaneously satisfy the requirements of carbon emission reduction and pollution control in China and proposed optimizing suggestions for future technical improvement and development.

Multivisceral Transplantation for Diffuse Portomesenteric Thrombosis: Lessons Learned for Surgical Optimization.

Background: Multivisceral transplantation entails the en-bloc transplantation of stomach, duodenum, pancreas, liver and bowel following resection of the native organs. Diffuse portomesenteric thrombosis, defined as the complete occlusion of the portal system, can lead to life-threatening gastrointestinal bleeding, malnutrition and can be associated with liver and intestinal failure. Multivisceral transplantation is the only procedure that offers a definitive solution by completely replacing the portal system. However, this procedure is technically challenging in this setting. The aim of this study is to describe our experience, highlight the challenges and propose technical solutions. Materials and Methods: We performed a retrospective analysis of our cohort undergoing multivisceral transplantation for diffuse portomesenteric thrombosis at our institution from 2000 to 2020. Donor and recipient demographics and surgical strategies were reviewed in detail and posttransplant complications and survival were analyzed. Results: Five patients underwent MVTx. Median age was 47 years (23-62). All had diffuse portomesenteric thrombosis with life-threatening variceal bleeding. Major blood loss during exenteration was avoided by combining two techniques: embolization of the native organs followed by a novel, staged extraction. This prevented major perioperative blood loss [median intra-operative transfusion of 3 packed red blood cell units (0-5)]. Median CIT was 330 min (316-416). There was no perioperative death. One patient died due to invasive aspergillosis. Four others are alive and well with a median follow-up of 4.1 years (0.3-5.9). Conclusions: Multivisceral transplantation should be considered in patients with diffuse portomesenteric thrombosis that cannot be treated by any other means. We propose a standardized surgical approach to limit the operative risk and improve the outcome.

[Analysis of metabolomics and proteomics based on capillary electrophoresis-mass spectrometry].

Capillary electrophoresis-mass spectrometry (CE-MS) has the advantages of higher sensitivity, higher efficiency, and less sample consumption. Moreover, it possesses obvious advantages during the analysis of strongly charged and highly polar samples. CE-MS has been widely applied in life sciences, medicine, and pharmacology. In the past ten years, the main factors affecting its application were system stability, reproducibility, and data accuracy. In order to solve the existing problems of CE-MS, researchers have invested significant effort in technology innovation to further expand CE-MS application. In the fields of medicine and analytical chemistry, substantial research indicates that CE-MS is superior compared to other metabolomic and proteomic approaches. This study aims at reviewing the latest methods and applications developed in the fields of medicine and analytical chemistry since 2015. Furthermore, it also aims at enhancing the technology development-related application value of CE-MS and serving as a reference for future development. Further development of the CE-MS technology is discussed from the aspects of coating-sample interaction, interface types, and data processing methods. Concerning the coating types, neutral coatings had been applied extensively in CE-MS and there should be no limitation to the charge of the analyte. The coating decreased sample adsorption on the inner wall by covering the surface charge, greatly reducing the electroosmotic flow (EOF). A charged capillary coating could modify such an EOF direction. The cationic coating could reduce the hydrophobic interaction between the sample and the capillary column, resulting in higher EOF. If it is applied to the sheathless interface, the resolution could be improved by extending the capillary length. Anionic coatings are predominant among the anionic compounds, shortening the separation time by reducing the interaction between the anionic compounds and the capillary. The coating type should be chosen relative to the analyte characteristics. Concerning the interface technology, all interfaces should be simple, practical, and non-dependent on sheath liquid and background electrolytes. As far as data processing methods are concerned, it is necessary to design and develop a practical method for span space data comparison and processing. The optimized experimental conditions have effectively improved separation efficiency and data comparison analysis. Furthermore, they established a solid foundation for its application development. CE-MS analysis of complex samples in the fields of metabolomics and proteomics (e. g., of tissues, cells, body fluids, etc.) could provide a visualization method for future clinical analysis. It contributes to the development of cancer pathological analysis, drug development, disease surveillance, etc. The characteristic analysis of small molecule metabolites and protein biomarkers directly reflects on enzymatic activity in the biological systems. It could be associated with the development of various diseases/complications. Omics analysis also has an important directive to disease detection and surveillance with obvious advantages in disease diagnosis, staged treatment, drug development, and patient treatment progress. CE-MS is useful in detecting complications and promoting personalized medicine. It provides technical support for future clinical developments. In addition to a comprehensive review of the recent advances of CE-MS research, this paper also indicates the development directions of CE-MS. In order to avoid the problem of omics analysis and obtain the optimized analysis results, future analysis should be improved from the following three aspects:(i) The analysis conditions should be optimized concerning sample preparation methods and separation techniques. (ii) The analytic techniques should be supported to adjust to capillary coating and interface technology. (iii) New ideas should be developed in the fields of clinical research and statistical analysis.

HPV testing for cervical cancer screening: technical improvement of laboratory logistics and good clinical performance of the cobas 6800 in comparison to the 4800 system.

BACKGROUND: European guidelines for cervical cancer screening now recommend the use of clinically validated assays for high-risk HPV-DNA sequences as primary test in women older than 30 years, performed in centralized laboratories, and run on systems providing automated solutions for all steps. METHODS: We conducted a comparison study, according to the international guidelines, nested within the organized population-based cervical screening program, between the cobas 4800 and 6800 systems (Roche Diagnostics), to evaluate accuracy and reproducibility of HPV test results and laboratory workflow. In Italy implementation of HPV cervical screening is under way on a regional basis; in Veneto it started in June 2015, following a piloting phase; the assay in use in the three centralized laboratories is the cobas 4800 HPV test, run on the cobas 4800 system. Comparison of HPV results with a new version of the assay (cobas 6800/8800 HPV) run on the cobas 6800 system, and intra- and inter-reproducibility analyses have been conducted in samples collected in PreservCyt medium (Hologic) from women without and with a subsequent diagnosis of high-grade lesion. RESULTS: Samples from women older than 30 years attending organized cervical cancer screening were used. Clinical sensitivity and specificity were evaluated on 60 cases and 925 controls, respectively; intra-laboratory reproducibility and inter-laboratory agreement by the 6800 system were evaluated on 593 and 460 specimens, respectively. Our results showed a very high agreement (> 98%) for overall qualitative results between the two systems; clinical sensitivity and specificity of the HPV assay run on 6800 were non-inferior to those of the HPV assay run on 4800 (p = 0,0157 and p = 0,0056, respectively, at the recommended thresholds of 90 and 98%); kappa values of 0.967 and 0.969 were obtained for intra- and inter-laboratory reproducibility analyses in the 6800 system. The 6800 platform displayed several technological improvements over the 4800 system, with higher throughput and laboratory productivity, and lower operator's hands-on time. CONCLUSIONS: The new cobas 6800/8800 HPV assay run on the 6800 instrument is suitable for use in large centralized laboratories included within population-based cervical cancer screening programs.

Distributed corporeality: Anatomy, knowledge and the technological reconfiguration of bodies in ballet.

Various specialist cultures configure bodies as complex technological devices. We know little about how exactly this is done. I focus on one of these cultures, classical ballet, to praxeologically reconstruct the conceptual, situational and material configuration of bodies as particular instruments. The technologization of the body is closely intertwined with the scientification of the practice - its ladenness with scientific knowledge about the body and an elaborate apparatus for the production of bodies. When anatomical knowledge and didactics intertwine in ballet class, this facilitates an opening of the black box 'body' for technical improvement. 'A body' becomes a plurality of (in this case, anatomically distinguished) actants. This distributed corporeality suggests that 'the body' is an assemblage that becomes apparent as such in moments of its modification. The empirical case as well as the analytical approach here give reason to reconsider the distinction between humans and non-humans that still prevails in actor-network theory and elsewhere.

Liver resection for non-colorectal metastases.

Whereas liver resection for colorectal metastasis has become standard of care, hepatectomy in patients with non-colorectal metastases remains controversial, mainly due to a heterogeneous tumor biology and missing data from prospective trials. This review aims at giving an overview about the indications and limits of liver surgery in patients with an advanced disease of a non-colorectal malignancy. Even though prospective trials are largely missing, results from retrospective studies indicate a survival benefit for liver resection in selected patients. Thus, in metastasized patients, treatment strategies should be developed in a multidisciplinary tumor board including an experienced liver surgeon.

Technical improvement of bronchoalveolar lavage in mice / 中国比较医学杂志

Objective To improve the preparation of bronchoalveolar lavage fluid(BALF)in mice. Methods BALB/c mice were divided into 3 groups. In the first and second groups, the whole lung lavage was performed with the traditional method,using a vein detained needle and lavaged with sterile saline. The mice in the third group got whole lung lavage by the improved method, namely, using a self-made plastic rigid pipe connected with a syringe. Each mouse was lavaged for 3 times,with 0.5 mL of sterile saline for each time, and the time consumption was recorded. The collected BALF was centrifuged,the supernatant was separated and its volume was measured accurately. Results The time spent for BALF collection in each mouse in the third group was(4 ± 0.62)min, significantly shorter than that of(10 ± 0.75) and(12 ± 0.88)min,respectively in the first and second groups(P< 0.05). The volume of BALF collected in each mouse of the third group was(1.34 ± 0.16)mL,significantly higher than that of(1.03 ± 0.25)and(1.13 ± 0.22)mL, respectively in the first and second groups(P< 0.05). Conclusions The improved method of BALF collection described in our study is simple,economical and efficient,and is useful for beginners especially.

Application of laparoscopy to recurrent inguinal hernia in children / 中华实用儿科临床杂志

Objective To explore the value of laparoscopy in the diagnosis and treatment of recurrent inguinal hernia in children.Methods The clinical data of 67 cases receiving laparoscopic treatment for recurrent inguinal hernia in children at the Department of General Surgery,Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science & Technology were retrospectively analyzed,including the type of hernia recurrence,operation time,intraoperative and postoperative complications,such as short-term hydrocele formation and testicular atrophy and so on.Results In 67 cases,there were 65 males and 2 females.Open repair surgery and laparoscopic surgery were respectively performed in 48 cases and 19 cases for the first operation and the hernia defects were found after operation.Contralateral patent vaginal process deformities were found in 11 sides in the reoperation.Among 67 cases of recurrent inguinal hernia,incomplete ligation of hernia sac was found in 21 cases,low level ligation of hernia sac in 17 cases,no ligation of hernia sac in 14 cases,omissive direct inguinal hernia in 4 cases,loose ligation of hernia sac in 4 cases,overlarge inner ring in 4 cases,weak abdominal muscles in 2 cases,and increased abdominal pressure (long-term constipation,asthma) in 1 case.All the patients were treated by laparoscopic hernia repair and no serious complications occurred during the operation.The average time of unilateral operation was (15.0±2.2) minutes (13-25 minutes),and bilateral operation was (27.0±4.3) minutes (18-41 minutes).All patients were discharged on the second day.Two patients showed short-term postoperative hydrocele and were cured with conservative treatment.During the follow-up time of (23±2) months (9-39 months),no recurrence or testicular atrophy was found.Conclusions Laparoscopy can confirm the type of recurrent inguinal hernia and contribute to reduce postoperative recurrence.Laparoscopic management of recurrent inguinal hernia in children is safe and feasible,which is expected to replace open hernia repair.

Improvements of Surgical Technique in Establishment of Rat Orthotopic Pulmonary Transplantation Model Using Cuffs / 华中科技大学学报（医学）（英德文版）

In order to establish more simple and effective rat orthotopic lung transplantation models, 20 rats were divided into donor and recipient groups. Rat lung transplantation models were established by using improved cuff technique. All the 10 operations were accomplished successfully.The mean operative time of recipients was 45±4 min. The survival time was over 30 days after lung transplantation. The checks of X-ray were almost ncrmal. There was no significant difference in the blood gas analysis before and after clipping the right hilum (P＞. 05). This method is more simple,applicable and requires less time.

Technical Improvement of the Gastrointestinal Anastomosis After Gastrectomy / 中国医师杂志

Objective To summarize the experience of using anastomotic apparatus and ring in the reconstruction of alimentary tract after gastrectomy. Methods Anastomotic apparatus or anastomotic ring was used to reconstruct alimentary tract after total or partial gastrectomy including esophagojejunostomy, esophagogastrostomy, gastroduodenostomy, gastrojejunostomy and jejunojejunostomy. Results The reconstruction of alimentary tract after gastrectomy using anastomotic apparatus and ring was successfully completed once in 182 cases. There were not anastomotic leakage, bleeding and infection after operation. During the follow-up period of 3～12 months, gastroscope or barium meal examinations showed that only 3 cases had the stricture of anastomotic entrance, and the other patients recovered well. Conclusion Compared with using traditional manual anastomosis to reconstruct alimentary tract after gastrectomy, anastomotic apparatus and ring had the advantages of convenience, simplicity, rapidity and reliability, and could raise operative efficiency greatly, shorten operative time and prevent the complications of post-operation such as the leakage and striture of anastomotic entrance. Using anastomotic apparatus and ring was recommended in the reconstruction of alimentary tract.