Blooding Research Articles

Minor liver resection for hilar cholangiocarcinoma of Bismuth-Corlette type Ⅲ and Ⅳ

Objective: To explore the clinical effect and safety of minor liver resection for hilar cholangiocarcinoma (HC) of Bismuth-Corlette type Ⅲ and Ⅳ. Methods: From May 2007 to May 2017, the clinical data of 108 patients with Bismuth-Corlette type Ⅲ and Ⅳ HC underwent hepatectomy were collected and analyzed retrospectively.There were 56 males and 52 females, aged (57.2±5.3) years (ranged 48-76 years) .Among the 108 cases, there were 51 cases of type Ⅲa, 40 cases of type Ⅲb and 17 cases of type Ⅳ. Small-scale hepatectomy (≤3 hepatectomy) was performed in 70 cases, including 8 cases of 4b segment resection, 28 cases of 4b segment+5 segment resection, and 34 cases of partial 4 segment+partial 7 segment+partial 1 segment resection. Large-scale hepatectomy was performed in 38 cases (>3 segments) , of which 30 cases were treated with 2 segments+3 segments+4 segments+1 segment, and 8 cases were treated with 5 segments+7 segments+8 segments+1 segment. t' test was used to analyze the data which did not conform to the normal distribution, and χ(2) test was used to calculate the incidence of postoperative complications and the 1, 3, and 5-year cumulative overall survival rate. Results: (1) The operation time of minor liver resection group ((180±25)minutes) was shorter than that of major liver resection group ((210±35)minutes) (t'=4.676, P<0.05) , the amount of blooding operation time of minor liver resection group ((310±80)ml) was less than that of major liver resection group ((500±110)ml)in the operation (t'=9.385, P<0.05) , and the difference was statistically significant. (2) The incidence of complications was lower in minor liver resection group and major liver resection group, and the difference was statistically significant (χ(2)=5.230, P<0.05) . (3) The actual 1-, 3- and 5-year survival rates were 87.1%, 58.4%, 30.0% and 84.2%, 57.9%,31.6%, respectively. There were no significant differences in survival rates in two groups in 1-, 3- and 5-year survival rates (χ(2)=0.177, P=0.674; χ(2)=0.005, P=0.946; χ(2)=0.029, P=0.865) . Conclusions: Compared to patients with major liver resection, Minor liver resection for selected patients with HC of Bismuth-Corlette Ⅲ and Ⅳaccording to our criteria achieved better long-term outcomes. Chen's biliojejunostomy is a simple, effective and safe method, which can be widely used when there are multiple biliary intestinal anastomosese.

Establishment of experimental model for saphenous artery perforator flap in mini pig

Objective To investigate the anatomy characteristics of saphenous artery(SA) and its perforator vessels in mini pig, and to provide a new perforator flap animal model. Methods Between May, 2018 and August, 2018, 6 7-months-old mini pigs weight 25 kilograms were sacrificed by blooding under general anesthesia. The bilateral external iliac arteries were injected with a mixture of latex-lead oxide mixture and underwent CT-scanning to provide 3-dimensional reconstruction. The origin, diameter, courses and distribution of the SA and perforators of both hind limbs were observed. Results One of the hind limbs was abandoned due to the leakage of perfusion fluid. The other 11 hind limbs were available. The femoral artery passed through the medial femoral muscle and sartorius muscle in the middle of thigh, and run between the medial femoral muscle and gracilis muscle above the knee. Below the knee, it run on the surface of the medial leg muscles. A number of small branches were distributed in the tarsal joint and calcaneus at the medial malleolus, and there were abundant communicating branches with the posterior tibial artery. The average length of SA was (14.86±0.76) mm. The outer diameters of SA at initiative, medial tibial condyle and medial malleolus were(1.73±0.15) mm, (1.50±0.12) mm and (1.30±0.13) mm, respectively. There were a total of 79 perforators which were identified, with a mean of (7.09±1.16) perforators per hind limbs. And the average outer diameter was 0.10-0.78 (0.40±0.13) mm. Conclusion The SA constantly exist with good outer diameter. The number of perforator is abundant. SA can be used as a reliable animal model for studying and training of perforator flap. Key words: Saphenous artery; Perforator flap; Mini pig; Animal model

Cap-assisted endoscopic sclerotherapy for hemorrhoids: a prospective study (with video)

Objective To evaluate the methodology, feasibility, safety and efficacy of cap-assisted endoscopic sclerotherapy (CAES) for hemorrhoids. Methods Patients with grade Ⅰ to Ⅲ internal hemorrhoids underwent CAES from September 2014 to May 2016. According to the methodology of CAES, reasons for blooding were identified and polypectomy and excision of anal papilla fibroma was performed. Efficacy, intraoperative and postoperative complications and patient satisfaction were evaluated during and after CAES. The follow-up was more than three months. Results A total of 48 patients with grade Ⅰ to Ⅲ internal hemorrhoids underwent CAES, including 25(52.1%) patients with grade Ⅰ, 21(43.8%) patients with grade Ⅱ, and 2(4.2%) grade Ⅲ. During the whole procedure of CAES, colon and terminal ileum examination was performed in 48(100.0%) patients, polypectomy was performed in 14(29.2%) patients, excision of anal papilla fibroma was performed in 1(2.1%) patient, excision of external hemorrhoids was performed in 1(2.1%) patient, biopsy for the polyps on dentate line was performed in 2(4.2%) patients, and sclerotherapy for rectal mucosal prolapse was performed in 2(4.2%) patients. No bleeding was observed during and after CAES. Infection occurred in one (2.1%) patient, who recovered with a one-week anti-infective therapy. One (2.1%) patient claimed mild tenesmus within four days after CAES. No complications were observed within the three-month follow-up. All patients (100.0%) were satisfied with this novel procedure. Conclusion CAES, as a novel endoscopic sclerotherapy, is a safe and effective endoscopic therapy with high patient satisfaction for internal hemorrhoids. Key words: Hemorrhoids; Cap-assisted endoscopic sclerotherapy; Colonoscopy

Ultrasound guided closed reduction and pinning for adult phalangeal fractures

Objective To evaluate the value of ultrasound in adults phalangeal fractures, analysze clinical efficacy of ultrasound-assisted closed reduction and pinned fixation of adult phalangeal fracture. Methods A total of 23 phalanx fractures in 20 adult cases were recruited, including shaft fractures 4 fingers, the bottom fracture 13 fingers, and condylar fracture 6 fingers. All cases were examined by preoperative ultrasound and X-ray, intraoperative ultrasound assisted reset, and ultrasound-guided closed reduction were performed. Clinical evaluation included operative time, blooding, fluoroscopy times, the success rate of reduction inoperative, postoperative x-rays, total active motion (TAM) and grip strength. Results The postoperative follow-up ranged from 6 to 24 months, with an average of 16 months. Seventeen fingers were successful by ultrasound-guided closed reduction, and 6 fingers was reduced by C-arm fluoroscopy. The average healing time was (6.21±2.10) weeks. According to the functional evaluation criteria based on TAM, the results were rated as excellent in 14 cases (60.9%), good in 5 cases (21.7%), fair and poor in 4 cases(17.3%), the total excellent and good rates was 82.7%. Grip strength was (32.5±7.8)kg in affected side and (34.5±9.9)kg in opposite side, there was no significant difference(t=0.351, P=0.726). No nonunion occurred. Conclusions The position can be observed by ultrasound-guided percutaneous pinning of phalangeal fractures.It′s advantages are the less trauma, less blooding, and less X-ray exposure. But for some types of fractures, such as the bottom fracture and condylar fracture, the effects should be further studied. Key words: Ultrasonography; Phalangeal fractures; Fracture fixation, internal

Retinal morphologic change and related factor analysis in rats with early stage of diabetes mellitus

Background The pathological foundation of diabetic retinopathy is the breakdown of the bloodretina barrier induced by multifactors.Objective This study was to investigate the retinal morphologic change and the levels of serum vascular endothelial growth factor(VEGF),endothelin(ET)and nitric oxide(NO)in diabetic rats.Methods Forty healthy female SD rats were randomly divided into experimental group and control group and 20 rats for each group.Acute diabetes models were established by the intraperitoneal injection of 60 mg/kg streptozotocin in experimental group and the equal volume of buffer solution was injected at the same way in the control group.The serum VEGF level,ET level and NO concentration of diabetic and control rats were detected using ELISA double antibody sandwich method,125I radioimmune method and nitrate reduction method respectively at 2,4,6 and 8 weeks after injection.The eyeballs of rats were enucleated at the eighth week for retinal pathologic examination.This experiment followed the Measures for the administration of experimental animals of Shanghai City.Results The retinal structure was normal throughout the experimental duration in the control group.However,retinal edema and cellular disorganization appeared at 4 months and retinal blooding could be seen with the extending of diabetes course.The levels of serum VEGF and ET in each experimental group were significantly higher than those in control groups(P＜0.05).The levels of serum NO elevated in 2-month experimental group compared with same-phase control group(Z =-2.193,P＜0.05),and those in 6-and 8-month experimental groups were significantly lower than in corresponding control groups(Z =-2.449,Z =-2.236,P＜0.05).With the progression of the disease,the levels of VEGF and ET increased gradually,but the levels of NO decreased gradually,showing statistically significant differences(P＜0.05).The level of serum VEGF showed a positive correlation with serum ET level and a negative correlation with the serum NO concentration(r=-0.814,r=-0.803,P＜0.01)in the experimental group.A negative leaner relation was also found between serum ET level and serum NO concentration(r=0.821,P＜0.01).Conclusions The serum VEGF,ET and NO levels are closely associated with the degree of retinal lesion in early diabetic models.These results suggest that serum VEGF,ET and NO levels may be the important indexes predicting the course of retinal disease in diabetic rats. Key words: Diabetes mellitus; Retina; Vascular endothelial growth factor; Endothelin; Nitric oxide

Histopathologic study on endoscopic cyclophotocoagulation and trans-scleral cyclophotocoagulation in rabbit eyes

Background Endoscopic cyclophotocoagulation(ECP) is a new approach to treat refractory glaucoma.But,the histopathological change of ciliary body after ECP has not been reported yet.ObjectivePurpose of the present study is to explore the histopathologic change of ciliary body after ECP and investigate the mechanism of lowing intraocular pressure(IOP) of ECP and compared with trans-scleral cyclophotocoagulation (TSCP).MethodECP was performed on the right eyes of 30 adult pigmented rabbits and TSCP was taken in the fellow eyes.Other two normal pigmented rabbits were as control group.The clinical examinations were performed in day 1,3,5,7,14,28,42 and 56 after operation under the slim lamp to evaluate the inflammatory reactions of conjunctiva,sclera and cornea,and the IOP was detected in the same time points.The animals were sacrificed and the eyeballs were extracted for the examination of structure of ciliary body under the light microscope in day 7,14,28,42 and 56 after surgery respectively.ResultsThe mild inflammatory response and local opacity of lens were seen under the slim lamp in the eyes after ECP,and severe inflammatory reaction was in the eyes received TSCP.No opacity of lens was found after TSCP through the observing period.The lowing-IOP extent was significantly higher in ECP group than TSCP group after operation(P＜0.01).The structure of ciliary body epithelium was normal in normal rabbit eyes.The disruption of ciliary body epithelium,especially for non-pigment epithelial layer,edema of ciliary process were seen in the early period after ECP.Fourty-two days later,the irregulation of ciliary body epithelium and atrophy of ciliary process were exhibited under the light microscope.In TSCP group,the edema,blooding and damage of ciliary process were seen,but slight inflammatory response was in the ciliary epithelium.After 42 days of surgery,atrophy of ciliary body,irregular proliferation of pigmental and non-pigmental epithelial cells,thinness of sclera and scarring of ciliary stroma were revealed.ConclusionCompared with TSCP,ECP can selectively destroy ciliary epithelium effectively and thoroughly and therefore reduce IOP.The adverse effect of ECP is the opacity of lens.Less damage of adjacent tissue is found in ECP compared with TSCP. Key words: endoscope; cyclophotocoagulation; trans-scleral cyclophotocoagulation; ciliary body; intraocular pressure

D-dimer testing in suspected venous thromboembolism: an update.

Fibrin is the main thrombus component. Its production being definitely lower in in-patients than in outpatients. is followed by activation of the fibrinolytic system, resulting in plasmin generation and subsequent fibrin lysis (Figure 1). Dissolution of crosslinked fibrin leads to formation of specific degradation products, includMethods for measuring DD in blood ing D-dimer (DD),1 which can be easily detected and The advantages and disadvantages of the various measured in both whole blood and plasma using methods that measure DD in blood are displayed in monoclonal antibodies directed against epitopes Table 1. For clinical use in emergency situations, located in the DD fragment. In the past decade, DD rapid tests are mandatory. Among them, a whole testing has been established as a useful aid in the blood latex test (Simplired, Agen) that gives a diagnosis of venous thromboembolism (VTE).2 The present review updates experience on the use of DD testing for diagnosis of deep-vein thrombosis (DVT) of the lower limbs and pulmonary embolism (PE). Briefly, DD was found in the late 1980s and early 1990s to be highly sensitive (but non-specific) to the presence of VTE where clinically suspected in outpatients. In this population, the negative predictive value of a plasma DD concentration below a certain cutoff (usually about 500 mg/l) was more than 95%, thereby allowing one to rule out the disease in a substantial proportion (about one third) of patients. However, the diagnostic performances were strongly Figure 1. Generation of D-dimer (DD) fragments. Activation of blood coagulation leads to thrombin generadependent upon the assay used, latex tests being tion. Thrombin binds to the fibrinogen central domain definitely less sensitive than the more cumbersome and liberates fibrinopeptides A and B, resulting in fibrin enzyme-linked immunosorbent assays (ELISA), which monomers and polymer formation. The fibrin network is in turn were not suited for emergency use.2 Moreover, subsequently stabilized (‘cross-linked’) under the effect of this heterogeneity of tests raised uncertainty among activated coagulation factor XIII. Plasmin induces lysis of clinicians, who called for rigorous evaluation and cross-linked (X-linked) fibrin, resulting in formation of standardization of the various assays.3 Lastly, the various X-linked fibrin degradation products (FDPs) includutility of the measurement was dependent on the ing D-dimer (DD) and fragments containing the DD epitope. population to which it was applied, the specificity

"Blooding a Witch."

"Blooding a Witch."