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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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Will artificial intelligence widen the therapeutic gap between children and adults?

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Pediatric Investigation 2024年第1期8卷 1-6页

作者： Matthew Nagy Bryan Sisk Albert lai eric Kodish Cleveland Clinic Lerner College of Medicine Case Western Reserve UniversityClevelandOhioUSA Department of Pediatrics Division of Hematology/OncologyWashington University School of MedicineSt.LouisMissouriUSA Department of Medicine Bioethics Research CenterWashington University School of MedicineSt.LouisMissouriUSA Institute for Informatics Washington University School of MedicineSt.LouisMissouriUSA Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation Cleveland Clinic Children’sClevelandOhioUSA

The impending rise of artificial intelligence(AI)-powered healthcare offers exciting hope for improved care and outcomes in children with serious illnesses.1 The historical precedent in healthcare,however,suggests that advancements in adult care do not necessarily result in proportional progress in *** disparity was first noted in the mid-20th century when tragedies that involved drugs with well-studied and known adult safety profiles,such as sulfonamide elixir and thalidomide,resulted in harm to children due to limited pediatric clinical trial inclusion.2 As a result,legislation in 1962 required drug companies to include package labels that restricted or dissuaded the use of medications in children that were not properly studied in this population.2 Subsequently,physicians became reluctant to prescribe many medications,and pharmaceutical companies had little incentive to enroll children in trials as an unfavorable result could negatively impact sales in the adult market,and a successful outcome would only marginally increase the market pool.3 This lack of access led *** Shirkey to describe children as"therapeutic orphans"in 1968.2 After more than half a century of legislation aimed at increasing pediatric representation in research and drug development(Figure 1),enrollment of children in clinical trials remains disproportionately low,4 with children included in as few as 12%of trials for diseases with a burden equal to,or greater in,the pediatric versus adult population.

关键词： companies Figure properly

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Publication scope and priorities of FESE in an evolving world: An editorial update and perspective

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Frontiers of Environmental Science & Engineering 2024年第1期18卷 169-171页

作者： Deng Shubo Jin Rencun Liang Sai Liu Fudong Liu, Jinyong Lyu lai Ning Daliang Pan Bingcai van Hullebusch eric Wang, Bin Wen Xianghua Kang, Xiao Xu, Elvis Genbo Yang, Hong Qi, Ying Zhan Xinmin Zhao Dongye

Frontiers of Environmental Science&Engineering(FESE)is one of the flagship journals of the chinese Academy of *** is an international peer-reviewed journal that publishes cutting-edge scientific work in all aspects of environmental *** 2007,FESE has been an important platform for communicating the cutting-edge progress of theories,methods,technologies,and policies in environmental science and *** authors and readers involve scientists,engineers,and policymakers that are important stakeholders in dealing with environmental *** authors are encouraged to review recent issues of FESE to gain a deep understanding of the topics that are of great interest to the journal’s *** the cover letter,please clearly state the relevance to the journal’s publication scope and *** particular,prospective authors are directed to the following instructions for further details on the scope,novelty and quality expectations,and minimum requirements.

关键词： journal please dealing

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音高控制游戏:周文中晚期音乐中的可变调

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音乐探索 2024年第2期 47-57页

作者：黎昭纲贝勒大学美国布鲁克纳研究会理事会

《霞光》是周文中创作生涯中的一座里程碑。在这部作品的创作中,周文中除了运用中国的书法原则和自1960年以来在他音乐中标志性的可变调系统外,还从东西方绘画中汲取灵感。尤其是中国17世纪早期绘画中的水墨艺术和19世纪中期纽约哈德逊... 详细信息

《霞光》是周文中创作生涯中的一座里程碑。在这部作品的创作中,周文中除了运用中国的书法原则和自1960年以来在他音乐中标志性的可变调系统外,还从东西方绘画中汲取灵感。尤其是中国17世纪早期绘画中的水墨艺术和19世纪中期纽约哈德逊河画派的作品,启发作曲家创作了暗喻大自然的色彩、光线、空间,和动感的声音景观。与此同样重要的是《霞光》在周文中作品中所占的重要地位,因为这是一部连接了他所谓的创作“成熟期”和创作晚期的过渡性作品,预示了周文中生命最后十年的创作,开启了他创作发展的新里程。

关键词：周文中《霞光》可变调书法及绘画与音乐

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Effects of SARS-CoV-2 infection on incidence and treatment strategies of hepatocellular carcinoma in people with chronic liver disease

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World Journal of Hepatology 2024年第2期16卷 211-228页

作者： Lung-Yi Mak Matthew Shing Hin chung Xue Li Francisco Tsz Tsun lai eric Yuk Fai Wan Celine Sze Ling chui Franco Wing Tak cheng Esther Wai Yin chan ching Lung cheung Ivan chi Ho Au Xi Xiong Wai-Kay Seto Man-Fung Yuen Carlos King Ho Wong Ian chi Kei Wong Department of Medicine The University of Hong KongHong KongChina State Key Laboratory of Liver Research The University of Hong KongHong KongChina Department of Pharmacology and Pharmacy The University of Hong KongHong KongChina Laboratory of Data Discovery for Health(D24H) Hong Kong Science and Technology ParkHong KongChina Department of Family Medicine and Primary Care The University of Hong KongHong KongChina School of Nursing The University of Hong KongHong KongChina School of Public Health The University of Hong KongHong KongChina Research Department of Practice and Policy University College LondonLondon WC1E 6BTUnited Kingdom Aston School of Pharmacy Aston UniversityBirmingham B47ETUnited Kingdom

BACKGROUND chronic liver disease(CLD)was associated with adverse clinical outcomes among people with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)*** To determine the effects of SARS-CoV-2 infection on the incidence and treatment strategy of hepatocellular carcinoma(HCC)among patients with *** A retrospective,territory-wide cohort of CLD patients was identified from an electronic health database in Hong *** with confirmed SARS-CoV-2 infection[coronavirus disease 2019(COVID-19)+CLD]between January 1,2020 and October 25,2022 were identified and matched 1:1 by propensity-score with those without(COVID-19-CLD).Each patient was followed up until death,outcome event,or November 15,*** outcome was incidence of *** outcomes included all-cause mortality,adverse hepatic outcomes,and different treatment strategies to HCC(curative,non-curative treatment,and palliative care).Analyses were further stratified by acute(within 20 d)and post-acute(21 d or beyond)phases of SARS-CoV-2 *** rate ratios(IRRs)were estimated by Poisson regression *** Of 193589 CLD patients(>95%non-cirrhotic)in the cohort,55163 patients with COVID-19+CLD and 55163 patients with COVID-19-CLD were included after 1:1 propensity-score *** 249-d median follow-up,COVID-19+CLD was not associated with increased risk of incident HCC(IRR:1.19,95%CI:0.99-1.42,P=0.06),but higher risks of receiving palliative care for HCC(IRR:1.60,95%CI:1.46-1.75,P<0.001),compared to *** both acute and post-acute phases of infection,COVID-19+CLD were associated with increased risks of allcause mortality(acute:IRR:7.06,95%CI:5.78-8.63,P<0.001;post-acute:IRR:1.24,95%CI:1.14-1.36,P<0.001)and adverse hepatic outcomes(acute:IRR:1.98,95%CI:1.79-2.18,P<0.001;post-acute:IRR:1.24,95%CI:1.13-1.35,P<0.001),compared to *** Although CLD patients with SARS-CoV-2 infection were not associated with increased risk of HCC,they

关键词： SARS-CoV-2 infection chronic liver disease Long COVID Post-COVID-19 syndrome Cirrhosis Hepatocellular carcinoma

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A step forward in laparoscopic hepatectomy:comments on“Expert Consensus on Laparoscopic Hepatectomy(2013 Version)by National Hepatic Surgery Group,Society of Surgery,chinese Medical Association”

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Frontiers of Medicine 2013年第4期7卷 520-522页

作者： eric C.H.lai Department of Surgery Pamela Youde Nethersole Eastern HospitalChai WanHong KongChina

I read with great interest the consensus and guideline of laparoscopic hepatectomy,which was originated from the experts in china[1].This is a significant step forward in minimally invasive liver *** development of minimally invasive liver surgery over the last 2 decades has a great impact on the surgical practice in china,and the other parts of the *** potential advantages of laparoscopic hepatectomy are those of minimal access surgery(Table 1).

关键词： Surgery hepatectomy surgery

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