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Modifications of ALPPS–from complex to more complex or from complex to less complex operations

Hepatobiliary & Pancreatic Diseases International 2017年第4期16卷 346-352页

作者： Wan Yee Lau Eric ch lai Faculty of Medicine The Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina Department of Surgery Pamela Youde Nethersole Eastern HospitalHong Kong SARChina

BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently been developed to induce rapid liver hypertrophy to reduce the chance of post-hepatectomy liver failure in patients with borderline or insufficient future liver remnant. ALPPS is still in an early developmental stage and its techniques have not been standardized. This study aimed to review the technical modifications of the conventional ALPPS procedure. DATA SOURCES: Studies were identified by searching MEDLINE and PubMed for articles published from January 2007 to December 2016 using the keywords 'associating liver partition and portal vein ligation for staged hepatectomy' and 'ALPPS'. Additional articles were identified by a manual search of references from key articles. RESULTS: There have been a lot of modifications of the conventional ALPPS. These are classified as: (1) modifications aiming to improve surgical results; (2) modifications aiming to expand surgical indications; (3) salvage ALPPS; (4) ALPPS using the minimally invasive approach. Some of these modifications have made the conventional ALPPS procedure to become even more complex, although there have also been other attempts to make the procedure less complex. The results of most of these modifications have been reported in small case series or case reports. We need better well-designed studies to establish the true roles of these modifications. However, it is interesting to see how this conventional ALPPS procedure has evolved since its introduction. CONCLUSIONS: There is a trend for the use of minimally invasive procedure in the phase 1 or 2 of the conventional ALPPS procedure. Some of these modifications have expanded the use of ALPPS in patients who have been considered to have unresectable liver tumors. The long-term oncological outcomes of these modifications are still unknown.

关键词： associating liver partition and portal vein ligation for stage hepatectomy hepatocellular carcinoma hepatectomy liver metastasis portal vein embolization

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Hemodynamics and oxygen transport dynamics during hepatic resection at different central venous pressures in a pig model

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Hepatobiliary & Pancreatic Diseases International 2011年第5期10卷 516-520页

作者： Wan-Yee Lau Eric ch lai Department of Hepatic and Biliary Surgery First Affiliated Hospital Guangxi Medical University Faculty of Medicine the Chinese University of Hong Kong Shatin New Territories Hongkong SAR China

BACKGROUND: Although low central venous pressure (CVP) has been used to minimize blood loss during hepatectomy the impact of variations of CVP on the rate of blood loss and on the perfusion of end-organs has not been evaluated This animal study aimed to evaluate the hemodynamics and oxygen transport changes during hepatic resection at different CVP levels. METHODS: Forty-eight anesthetized Bama miniature pigs were divided into 8 groups with CVP during hepatic resection controlled at 0 to <1, 1 to <2, 2 to <3, 3 to <4, 4 to <5, 5 to <6, 6 to <7, and 7 to <8 cmH 2 O. Intergroup comparisons were made for hemodynamic parameters, oxygen transport dynamics, and the rate of blood loss. RESULTS: The rate of blood loss and the hepatic venous pressure during hepatic resection were almost linearly related to the CVP. A significant drop in the mean arterial pressure cardiac output, and cardiac index occurred between CVP ≥2 and <2 cmH 2 O. Oxygen delivery (DO 2 ), oxygen consumption (VO 2 ) and oxygen extraction ratio (ERO 2 ) remained relatively constant between CVPs of 2 to <8 cmH 2 O. There was a significant drop in DO 2 when the CVP was <2 cmH 2 O. There was also a significant drop in VO 2 and ExO 2 when the CVP was <1 cmH 2 ***: The optimal CVP for hepatic resection is 2to 3 cmH2O.

关键词： hepatectomy hemorrhage central venous pressure tissue oxygenation hemodynamics

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Associating liver partition and portal vein ligation for staged hepatectomy： the current role and development

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Hepatobiliary & Pancreatic Diseases International 2017年第1期16卷 17-26页

作者： Wan Yee Lau Eric ch lai Stephanie HY Lau Faculty of Medicine The Chinese University of Hong Kong Shatin New Territories Department of Surgery Pamela Youde Nethersole Eastern Hospital Department of Surgery Queen Elizabeth Hospital Hong Kong China

BACKGROUND： Associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） has recently been developed to induce rapid liver hypertrophy and reduce posthepatectomy liver failure in patients with insufficient future liver remnant （FLR）. ALPPS is still considered to be in an early developmental phase because surgical indications and techniques have not been standardized. This article aimed to review the current role and future developments of ALPPS. DATA SOURCES： Studies were identified by searching MED- LINE and PubMed for articles from January 2007 to October 2016 using the keywords ＂associating liver partition and portal vein ligation for staged hepatectomy＂ and ＂ALPPS＂ Addi- tional papers were identified by a manual search of references from key articles. RESULTS： ALPPS induces more hypertrophy of the FLR in less time than portal vein embolization or portal vein ligation. The benefits of ALPPS include rapid hypertrophy 47%-110% of the liver over a median of 6-16.4 days, and 95%-100% com- pletion rate of the second stage of ALPPS. The main criticisms of ALPPS are centered on its high morbidity and mortality rates. Morbidity rates after ALPPS have been reported to be 15.3%-100%, with ≥ the Clavien-Dindo grade III morbidity of 13.6%-44%. Mortality rates have been reported to be 0%-29%. The important questions to ask even if oncologic long-term results are acceptable are： whether the gain in quality and quantity of life can be off balance by the substantial risks of morbidity and mortality, and whether stimulation of rapid liver hypertrophy also accelerates rapid tumor progression and spread. Up till now, the documentations of the ALPPS procedure come mainly from case series, and most of these series include heterogeneous groups of malignancies. The numbers are also too small to separately evaluate survival for different tumor etiologies. CONCLUSIONS： Currently, knowledge on ALPPS is limited, and prospective randomized studies are lacking. From th

关键词： associating liver partition and portal vein ligation for staged hepatectomy portal vein embolization laparoscopy colorectal liver metastases hepatocellular carcinoma

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Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2013年第5期12卷 520-524页

作者： cheng-Xin Lin Ya Guo Wan Yee Lau Guang-Ying Zhang Yi-Ting Huang Wen-Zheng He Eric ch lai Department of Anesthesiology First Affiliated Hospital of Guangxi Medical University Department of Hepatic and Biliary Surgery First Affiliated Hospital of Guangxi Medical University Faculty of Medicine The Chinese University of Hong Kong

BACKGROUND:Low central venous pressure(CVP) affects hemodynamic stability and tissue *** prospective study aimed to evaluate the optimal CVP during partial hepatectomy for hepatocellular carcinoma(HCC).METHODS:Ninety-seven patients who underwent partial hepatectomy for HCC had their CVP controlled at a level of 0 to 5 mmHg during hepatic parenchymal *** systolic blood pressure(SBP) was maintained,if possible,at 90 mmHg or *** B surface antigen was positive in 90 patients(92.8%) and cirrhosis in 84 patients(86.6%).Pringle maneuver was used routinely in these patients with clamp/unclamp cycles of 15/5 *** average clamp time was 21.4±8.0 *** patients were divided into 5 groups based on the CVP:group A:0-1 mmHg;B:1.1-2 mmHg;C:2.1-3 mmHg;D:3.1-4 mmHg and E:4.1-5 *** blood loss per transection area during hepatic parenchymal transection and the arterial blood gas before and after liver transection were ***:With active fluid load,a constant SBP ≥90 mmHg which was considered as optimal was maintained in 18.6% in group A(95% CI:10.8%-26.3%);39.2% in group B(95% CI:29.5%-48.9%);72.2% in group C(95% CI:63.2%-81.1%);89.7% in group D(95% CI:83.6%-95.7%);and 100% in group E(95% CI:100%-100%).The blood loss per transection area during hepatic parenchymal transection decreased with a decrease in *** to groups D and E,blood loss in groups A,B and C was significantly less(analysis of variance test,P<0.05).Compared with the baseline,the blood oxygenation decreased significantly when the CVP was *** excess and HCO 3-in groups A and B were significantly decreased compared with those in groups C,D and E(P<0.05).CONCLUSION:In consideration of blood loss,SBP,base excess and HCO 3-,a CVP of 2.1-3 mmHg was optimal in patients undergoing partial hepatectomy for HCC.

关键词： central venous pressure hepatectomy blood loss

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Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach

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Hepatobiliary & Pancreatic Diseases International 2014年第5期13卷 508-512页

作者： Ying-Jun chen Zuo-Jun Zhen Huan-Wei chen Eric ch lai Fei-Wen Deng Qing-Han Li Wan Yee Lau Department of Liver Surgery The First People's Hospital of Foshan Faculty of Medicine The Chinese University of Hong Kong

BACKGROUND： With advances in technology, laparoscopic liver resection is widely accepted. Laparoscopic liver resection under hemihepatic vascular inflow occlusion has advantages over the conventional total hepatic inflow occlusion using the Pringle＇s maneuver, especially in patients with ***： From November 2011 to August 2012, eight consecutive patients underwent laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach with biliary bougie ***： The types of liver resection included right hepatectomy（n1）, right posterior sectionectomy（n1）, left hepatectomy and common bile duct exploration（n1）, segment 4b resection（n1）, left lateral sectionectomy（n2）, and wedge resection（n2）. Four patients underwent right and 4 left hemihepatic vascular inflow occlusion. Four patients had cirrhosis. The mean operation time was 176.3 minutes. The mean time taken to achieve hemihepatic vascular inflow occlusion was 24.3minutes. The mean duration of vascular inflow occlusion was54.5 minutes. The mean intraoperative blood loss was 361 *** patient required blood transfusion. Postoperatively, one patient developed bile leak which healed with conservative treatment. No postoperative liver failure and mortality occurred. The mean hospital stay of the patients was 7 ***： Our technique of hemihepatic vascular inflow vascular occlusion using the lowering of hilar plate approachwas safe, and it improved laparoscopic liver resection by minimizing blood loss during liver parenchymal transection.

关键词： laparoscopic liver resection hepatectomy vascular control liver neoplasm hilar plate

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What are the ten new commandments in severe polytrauma management？

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World Journal of Emergency Medicine 2010年第2期1卷 85-92页

作者： CW Kam ch lai SK Lam FL So CL Lau KH cheung Accident ＆ Emergency Department Tuen Mun Hospital Hong Kong China

This review aims to provide a concise overview of the trauma management evolution in the past decade. 1） Trauma care priorities have incorporated staff protection against infection and early decision making in addition to the conventional ABCDE. 2） Five stratified levels for DAM have replaced the non-specific conventional Plans A ＆ B. 3） CT scanning can be the tunnel to death for the hemodynamically unstable patient. 4） DPL has virtually been replaced by the FAST USG. 5） Direct whole-body MDCT provides rapid imaging diagnosis ＆ expedites the definitive treatment but carries high radiation hazards. 6） The dynamic shock assessment by fluid resuscitation response provides more outcome-specific evaluation than the static blood volume loss model. 7） DCR comprising of permissive hypotension, hemostatic resuscitation ＆ DCS aims to overcome the lethal triad of trauma. Early transfusion of blood components of FFP ＆ platelet concentrates improves the outcome in massive blood transfusion. 8） DCS aims to rectify the deranged physiology and not to fully restore the damaged anatomy. 9） A pre-defined protocol for major pelvic fracture can be life-saving and the novel Pre-PPP （pre-peritoneal pelvic packing） may further reduce mortality coupled with the necessary TCAE. 10） Injury prevention is equally important if not more than the trauma resuscitation ＆ operation.

关键词： Polytrauma Priorities DAM CT MDCT DPL FAST Fluid resuscitation responder DCR DCS Pre-PPP Injury prevention

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Power Flow Analytical Solutions and Multi-dimensional Voltage Stability Boundaries Based on Multivariate Quotient-difference Method

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CSEE Journal of Power and Energy Systems 2024年第3期10卷 1168-1178页

作者： chengxi Liu Qiupin lai School of Electrical Engineering and Automation Wuhan UniversityWuhan 430072China Hubei Engineering and Technology Research Center for AC/DC Intelligent Distribution Network Wuhan 430072China IEEE

This paper proposes a novel Multivariate Quotient-Difference(MQD)method to obtain the approximate analytical solution for AC power flow ***,in the online environment,the power flow solutions covering different operating conditions can be directly obtained by plugging values into multiple symbolic variables,such that the power injections and consumptions of selected buses or areas can be independently *** method first derives a power flow solution through a Multivariate Power Series(MPS).Next,the MQD method is applied to transform the obtained MPS to a Multivariate Pad´e Approximants(MPA)to expand the Radius of Convergence(ROC),so that the accuracy of the derived analytical solution can be significantly *** addition,the hypersurface of the voltage stability boundary can be identified by an analytical formula obtained from the coefficients of *** direct method for power flow solutions and voltage stability boundaries is fast for many online applications,since such analytical solutions can be derived offline and evaluated online by only plugging values into the symbolic variables according to the actual operating *** proposed method is validated in detail on New England 39-bus and IEEE 118-bus systems with independent load variations in multi-regions.

关键词： Analytical power flow solution multivariate power series multivariate Padéapproximants multivariate quotient-difference multi-dimensional voltage stability boundary

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Preface to the Special Issue:Additive Manufacturing—Expanding Production Horizon

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Acta Metallurgica Sinica(English Letters) 2024年第1期37卷 1-2页

作者： lai-chang Zhang Centre for Advanced Materials and Manufacturing School of EngineeringEdith Cowan University270 Joondalup DriveJoondalupPerthWA6027Australia

Additive manufacturing(AM),commonly known as 3D printing,has become a transformative technology that has a profound impact on various industrial *** encompasses a set of techniques for building objects layer by layer from digital *** conventional subtractive manufacturing methods that involve removing material from large blocks,AM adds material incrementally,providing unprecedented design flexibility and efficiency.

关键词： removing printing Expanding

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Remote sensing image encryption algorithm utilizing 2D Logistic memristive hyperchaotic map and SHA-512

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Science china(Technological Sciences) 2024年第5期67卷 1553-1566页

作者： lai Qiang LIU Yuan YANG Liang School of Electrical and Automation Engineering East China Jiaotong UniversityNanchang330013China

The two-dimensional Logistic memristive hyperchaotic map(2D-LMHM)and the secure hash SHA-512 are the foundations of the unique remote sensing image encryption algorithm(RS-IEA)suggested in this *** proposed map is formed from the improved Logistic map and the memristor,which has wide phase space and hyperchaotic range and is exceptionally excellent to be utilized in specific *** proposed image algorithm uses the permutation-assignment-diffusion *** generates two position matrices in a progressive manner to achieve an efficient random exchange of pixel positions,assignment is carried through on the image pixels of the permutated image to entirely remove the original image information,strengthening the relationship between permutation and diffusion,and loop diffusion in two different directions can use subtle changes of pixels to affect the whole *** random key and plain-image SHA-512 hash values are used to produce an additional key,which is then utilized to figure out the permutation parameters and the initial value of a chaotic *** experimental results with the average NPCR=99.6094%(NPCR:number of pixels change rate),average UACI=33.4638%(UACI:unified average changing intensity),100%pass rate of the targets in the test set,the average correlation coefficient is 0.00075,and the local information entropy is 7.9025,which shows that the algorithm is able to defend against a variety of illegal attacks and provide more trustworthy protection than some of the existing state-of-the-art algorithms.

关键词： chaos memristive hyperchaotic map remote sensing SHA-512 image encryption RS-IEA

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Supercoiled DNA Minicircles under Double-strand Breaks

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chinese Journal of Polymer Science 2024年第9期42卷 1353-1359,I0007页

作者： Ye-Peng Qiao chun-lai Ren National Laboratory of Solid State Microstructures and Department of Physics Collaborative Innovation Center of Advanced MicrostructuresNanjing UniversityNanjing210093China

Understanding how supercoiled DNA releases intramolecular stress is essential for its functional ***,the molecular mechanism underlying the relaxation process remains insufficiently *** we employed MD simulations based on the oxDNA2 model to investigate the relaxation process of a 336-base pair supercoiled minicircular DNA under double-strand breaks with two fixed *** simulations show that the conformational changes in the DNA occur continuously,with intramolecular stress release happening abruptly only when the DNA chain traverses the breakage *** relaxation process is influenced not only by the separation distance between the fixed ends but also their ***,we observe an inhibitory effect on the relaxation characterized by small angles,where short terminal loops impede DNA conformational adjustments,preserving the supercoiled *** findings elucidate the intricate interplay between DNA conformational change,DNA motion and intramolecular stress release,shedding light on the mechanisms governing the relaxation of supercoiled DNA at the molecular level.

关键词： Supercoiled DNA DNA minicircle DNA relaxation oxDNA model MD simulation

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