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Hydrochloric acid enhanced radiofrequency ablation for treatment of large hepatocellular carcinoma in the caudate Lobe:Report of three cases

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World Journal of Clinical Cases 2019年第4期7卷 508-515页

作者： Han-Xia Deng Jin-Hua Huang Wan Yee Lau Fei Ai Min-Shan Chen Zhi-Mei Huang Tian-Qi Zhang Meng-Xuan Zuo Department of Minimally Invasive Interventional Therapy Cancer Centre of Sun Yat-sen University State Key Laboratory of Oncology in Southern China Department of Hepatobiliary Surgery Cancer Centre of Sun Yat-sen University Faculty of Medicine The Chinese University of Hong Kong Prince of Wales Hospital

BACKGROUND To report on the use of percutaneous hydrochloric acid(HCl) enhanced radiofrequency ablation(HRFA) for the treatment of large(maximum diameter ≥5 cm) hepatocellular carcinoma(HCC) in the caudate Lobe.CASE SUMMARY Between August 2013 and June 2016, three patients with a large HCC(maximum diameter: 5.0, 5.7, and 8.1 cm) in the caudate Lobe were treated by transarterial chemoembolization followed by computer tomography(CT) guided RFA using a monopolar perfusion RF electrode, which was enhanced by local infusion of 10%HCl at 0.2 mL/min(total volume, 3 to 12 mL). The output power of HRFA reached 100 W, and the average ablation time was 39 min(range, 15 to 60 min).Two patients each underwent one session of HRFA and one patient two sessions.After treatment, CT/magnetic resonance imaging showed that all the three lesions were completely ablated. There was no major complication. Two patients had asymptomatic bile duct dilatation. One patient died of tongue cancer 24 mo after ablation. The remaining two patients were alive and no area of enhancement is detected in the caudate Lobe at 28 and 60 mo after ablation, respectively.CONCLUSION Percutaneous CT-guided HRFA is safe and efficacious in treating large HCC in the caudate Lobe.

关键词： Hydrochloric acid Radiofrequency ablation Hydrochloric acid enhanced radiofrequency ablation Caudate Lobe Large hepatocellular carcinoma Case report

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Middle hepatic vein reconstruction in adult right Lobe living donor liver transplantation improves recipient survival

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Hepatobiliary & Pancreatic Diseases International 2019年第2期18卷 125-131页

作者： Hai-Jun Guo Kun Wang Kang-Chen Chen Zhi-Kun Liu Abdulahad Al-Ameri Yan Shen Xiao Xu Shu-Sen Zheng Division of Hepatobiliary and Pancreatic Surgery First Affiliated Hospital Zhejiang University School of Medicine Key Laboratory of Combined Multi-organ Transplantation Ministry of Public Health First Affiliated Hospital Zhejiang University School of Medicine

Background: The efficacy and necessity of middle hepatic vein(MHV) reconstruction in adult-to-adult right Lobe living donor liver transplantation(LDLT) remain controversial. The present study aimed to evaluate the survival beneficiary of MHV reconstructions in LDLT. Methods: We compared the clinical outcomes of liver recipients with MHV reconstruction( n = 101) and without MHV reconstruction( n = 43) who underwent LDLT using right Lobe grafts at our institution from January 2006 to May 2017. Results: The overall survival(OS) rate of recipients with MHV reconstruction was significantly higher than that of those without MHV reconstruction in liver transplantation( P = 0.022; 5-yr OS: 76.2% vs 58.1%). The survival of two segments(segments 5 and 8) hepatic vein reconstruction was better than that of the only one segment(segment 5 or segment 8) hepatic vein reconstruction( P = 0.034; 5-yr OS: 83.6% vs 67.4%). The survival of using two straight vascular reconstructions was better than that using Y-shaped vascular reconstruction in liver transplantation with two segments hepatic vein reconstruction( P = 0.020; 5-yr OS: 100% vs 75.0%). The multivariate analysis demonstrated that MHV tributary reconstructions were an independent beneficiary prognostic factor for OS(hazard ratio = 0.519, 95% CI: 0.282–0.954, P = 0.035). Biliary complications were significantly increased in recipients with MHV reconstruction(28.7% vs 11.6%, P = 0.027). Conclusions: MHV reconstruction ensured excellent outflow drainage and favored recipient outcome. The MHV tributaries(segments 5 and 8) should be reconstructed as much as possible to enlarge the hepatic vein anastomosis and reduce congestion.

关键词： Living donor liver transplantation Right Lobe graft MHV reconstruction Survival Complications

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Feasibility of laparoscopic isolated caudate Lobe resection for rare hepatic mesenchymal neoplasms

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World Journal of Clinical Cases 2019年第20期7卷 3194-3201页

作者： Yang Li Kai-Ning Zeng Dan-Yun Ruan Jia Yao Yang Yang Gui-Hua Chen Gen-Shu Wang Department of Liver Surgery and Liver Transplantation Guangzhou Clinical Research and Translation Center for Liver DiseaseThe Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510630Guangdong ProvinceChina Department of Medical Oncology The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510630Guangdong ProvinceChina

BACKGROUND Mesenchymal tumors such as perivascular epithelioid cell neoplasm(PEComa)and inflammatory pseudotumor-like follicular dendritic cell sarcoma(IPT-like FDC sarcoma)are relatively uncommon in the liver and are particularly rare in the caudate Lobe.The clinical manifestations and available imaging tests lack specificity for hepatic mesenchymal tumors.To the best of our knowledge,no caudate PEComa or IPT-like FDC sarcoma has been completely resected by laparoscopy.The standard laparoscopic technique,surgical approaches,and tumor margins for potentially malignant or malignant caudate mesenchymal tumors are still being explored.AIM To assess both the safety and feasibility of laparoscopic resection for rare caudate mesenchymal neoplasms.METHODS Eleven patients who underwent isolated caudate Lobe resection from 2003 to 2017 were identified from a prospective database.Three consecutive patients with rare caudate mesenchymal tumors underwent laparoscopic resection.Patient demographic data,intraoperative parameters,and postoperative outcomes were assessed and compared with the open surgery group.RESULTS All procedures for the three resection patients with caudate mesenchymal tumors were completed using a total laparoscopic technique by two different approaches.The average operative time was 226 min,and the estimated blood loss was 133 mL.The average length of postoperative hospital stay was 6.3±0.3 d for the laparoscopy group and 15.5±2.3 d for the open surgery group(PLobe resection for rare mesenchymal neoplasms is a feasible and curative surgical option in selected patients.

关键词： Laparoscopic liver resection Caudate Lobe Perivascular epithelioid cell neoplasm Inflammatory pseudotumor-like follicular dendritic cell sarcoma

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Effect of Swirl Preset Vorticity on Combustion Performance of Lobe Nozzle Combustor Chamber

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Transactions of Nanjing University of Aeronautics and Astronautics 2019年第5期36卷 828-837页

作者： WANG Lijun JIANG Jintao YUAN Weiwei MEN Kuo XU Yijun College of Energy and Environment ShenyangShenyang Aerospace University

To improve the combustor performance of multi-point injection combustion,Lobe nozzle design was applied to the aero-engine model combustor,by presetting the swirl through a certain twisted angle of the edge of the Lobe outlet.Numerical simulation in combination with modelling test is used in this paper.The effects of swirl vorticity presetting onto the vortex structure,the characteristics of combustion temperature field,the combustor exit temperature field quality,the combustion efficiency,and the NOx emissions of multi-point injection combustion chamber are investigated.Compared with the conventional vortex flow at the Lobe outlet edge,the results of numerical simulation and water modelling test of the swirl vorticity presetting show that the swirl presetting can efficiently enhance the range and intensity of the Lobe-induced vorticities.Besides,it can improve the uniformity of the combustion temperature in the combustor chamber,together with the reduced emissions of the pollutant NOx.Moreover,compared with the conventional Lobe nozzle chamber,the swirl vortex presetting can effectively improve its combustion performance.The flow simulation test results demonstrate the fluid vortex structure in the combustion chamber and validate the simulation results.

关键词： Lobe nozzle vortex structure multi-point injection combustor chamber combustion performance combustion characteristics

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Gastric duplication cyst communicating to accessory pancreatic Lobe: A case report and review of the literature

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World Journal of Clinical Cases 2018年第16期6卷 1182-1188页

作者： Michael Rousek David Kachlik Andrej Nikov Jirina Pintova Miroslav Ryska Department of Surgery 2~(nd) Faculty of Medicine Charles University and Central Military Hospital Department of Anatomy 2~(nd) Faculty of Medicine Charles University Department of gastroenterology Jablonec nad Nisou Hospital

Background The combination of a gastric duplication cyst and duplicated part of the pancreas is an extremely rare developmental defect. The incidence in the population, or the clinical impact thereof, has not been uncovered. Symptoms are unspecific. Surgery is the treatment of choice. Timely diagnostics are of utmost importance, albeit they might be challenging at times. Being so rare, case reports are currently the only relevant source of information about the condition. Therefore each published finding is of a clinical impact.case summary Our work describes the case of a 22 year-old patient, who developed idiopathic acute pancreatitis. A computed tomography scan discovered liquid collection between the antrum of the stomach and the head of the pancreas. Initially, the collection was thought to be a pancreatic pseudocyst. Endoscopic ultrasoundguided transgastric drainage showed to have only a temporary therapeutic effect. Magnetic resonance cholangiopancreatography showed an accessory pancreatic Lobe with a separate duct system. The accessory pancreatic Lobe exited the body of the pancreas andwas in contact with the cystic collection. The patient was indicated for surgical resection. Within the surgery, an en bloc resection of the accessory pancreatic Lobe was performed with the antrum of the stomach containing the gastric duplication cyst. No complications were observed in the surgery or thereafter. In the five months follow-up period, the patient was completely symptom free. Histopathological findings confirmed the gastric duplication cyst communicating to accessory pancreatic Lobe.conclusion This developmental defect is extremely rare. It can cause recurrent acute pancreatitis. Diagnostics are challenging. Surgery is treatment of choice.

关键词： Pancreatic resection Accessory pancreatic Lobe Acute pancreatitis Developmental defect Gastric duplication cyst Case report

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Brain-wide Mapping of Mono-synaptic Afferents to Different Cell Types in the Laterodorsal Tegmentum

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Neuroscience Bulletin 2019年第5期35卷 781-790页

作者： Xiaomeng Wang Hongbin Yang Libiao Pan Sijia Hao Xiaotong Wu Li Zhan Yijun Liu Fan Meng Huifang Lou Ying Shen Shumin Duan Hao Wang Department of Neurobiology and Department of Neurosurgery of The Second Affiliated Hospital Key Laboratory of Medical Neurobiology of the Ministry of Health of ChinaNHC and CAMS Key Laboratory of Medical NeurobiologyZhejiang University School of Medicine

The laterodorsal tegmentum(LDT) is a brain structure involved in distinct behaviors including arousal,reward, and innate fear. How environmental stimuli and top-down control from high-order sensory and limbic cortical areas converge and coordinate in this region to modulate diverse behavioral outputs remains unclear.Using a modified rabies virus, we applied monosynaptic retrograde tracing to the whole brain to examine the LDT cell type specific upstream nuclei. The LDT received very strong midbrain and hindbrain afferents and moderate cortical and hypothalamic innervation but weak connections to the thalamus. The main projection neurons from cortical areas were restricted to the limbic Lobe, including the ventral orbital cortex(VO), prelimbic, and cingulate cortices. Although different cell populations received qualitatively similar inputs, primarily via afferents from the periaqueductal gray area, superior colliculus, and the LDT itself, parvalbumin-positive(PV?) GABAergic cells received preferential projections from local LDT neurons.With regard to the different subtypes of GABAergic cells, aconsiderable number of nuclei, including those of the ventral tegmental area, central amygdaloid nucleus, and VO, made significantly greater inputs to somatostatinpositive cells than to PV?cells. Diverse inputs to the LDT on a system-wide level were revealed.

关键词： Laterodorsal tegmentum Rabies virus retrograde tracing Limbic Lobe Mice

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Alterations of Cerebral Functional Connectivity in Patients with Frontal Lobe Epilepsy:A Graph Theory Study

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Transactions of Nanjing University of Aeronautics and Astronautics 2019年第3期36卷 527-536页

作者： CAO Xinzhi QIAN Zhiyu XU Qiang ZHANG Zhiqiang SHEN Junshu LU Guangming College of Automation Engineering Nanjing University of Aeronautics and AstronauticsNanjing 211106P.R.China Department of Information Jiangsu Province Academy of Traditional Chinese MedicineJiangsu Province Hospital on Integration of Chinese and Western MedicineNanjing 210028P.R.China Department of Medical Imaging Jinling HospitalMedical School of Nanjing UniversityNanjing 210002P.R.China Department of Equipment Jiangsu Province Academy of Traditional Chinese MedicineJiangsu Province Hospital on Integration of Chinese and Western MedicineNanjing 210028P.R.China

The aim of the present study is to investigate the brain functional network changes of patients with frontal Lobe epilepsy(FLE)by resting-state functional magnetic resonance imaging(rsfMRI)and graph theoretical analysis.rsfMRI is performed in 46 adult patients with FLE and 46 age matched healthy controls(HCs).A functional network is built from these subjects,and the topological properties of such network are analyzed quantitatively using graph theoretical methods.According to the results,both FLE patients and HCs exhibit prominent small world features.Compared with HCs,FLE shows a decrease in local efficiency(Eloc),clustering coefficient,nodal efficiency as well as nodal degree.Furthermore,FLE(seven)has fewer hubs than HCs(ten).The functional abnormalities in the network organization suggest functional disturbances in patients with FLE.This study helps to gain new insights into the functional disorder in patients with FLE.The networks built here can also be a set of potential biomarkers for the diagnosis,monitoring and the treatment of FLE.

关键词： functional MRI graph theory frontal Lobe epilepsy small world

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Split liver transplantation: Current developments

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World Journal of Gastroenterology 2018年第47期24卷 5312-5321页

作者： Christina Hackl Katharina M Schmidt Caner Süsal Bernd Dohler Martin Zidek Hans J Schlitt Department of Surgery University Hospital RegensburgRegensburg 93053Germany Collaborative Transplant Study (CTS) Institute of ImmunologyHeidelberg UniversityHeidelberg 69120Germany

In 1988, Rudolf Pichlmayr pioneered split liver transplantation(SLT), enabling the transplantation of one donor liver into two recipients-one pediatric and one adult patient. In the same year, Henri Bismuth and colleagues performed the first full right/full left split procedure with two adult recipients. Both splitting techniques were rapidly adopted within the transplant community. However, a SLT is technically demanding, may cause increased perioperative complications, and may potentially transform an excellent deceased donor organ into two marginal quality grafts. Thus, crucial evaluation of donor organs suitable for splitting and careful screening of potential SLT recipients is warranted. Furthermore, the logistic background of the splitting procedure as well as the organ allocation policy must be adapted to further increase the number and the safety of SLT. Under defined circumstances, in selected patients and at experienced transplant centers, SLT outcomes can be similar to those obtained in full organ LT. Thus, SLT is an important tool to reduce the donor organ shortage and waitlist mortality, especially for pediatric patients and small adults. The present review gives an overview of technical aspects, current developments, and clinical outcomes of SLT.

关键词： Liver transplantation organ shortage in situ split extended right Lobe left lateral Lobe living donor

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Vibration suppression of thin-walled workpiece machining considering external damping properties based on magnetorheological fluids flexible fixture

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Chinese Journal of Aeronautics 2016年第4期29卷 1074-1083页

作者： Ma Junjin Zhang Dinghua Wu Baohai Luo Ming Chen Bing Key Laboratory of Contemporary Design and Integrated Manufacturing Technology Ministry of EducationNorthwestern Polytechnical University

Milling of the thin-walled workpiece in the aerospace industry is a critical process due to the high flexibility of the workpiece. In this paper, a flexible fixture based on the magnetorheological(MR) fluids is designed to investigate the regenerative chatter suppression during the machining.Based on the analysis of typical structural components in the aerospace industry, a general complex thin-walled workpiece with fixture and damping constraint can be equivalent as a rectangular cantilever beam. On the basis of the equivalent models, natural frequency and mode shape function of the thin-walled workpiece is obtained according to the Euler–Bernoulli beam assumptions. Then,the displacement response function of the bending vibration of the beam is represented by the product of all the mode shape function and the generalized coordinate. Furthermore, a dynamic equation of the workpiece-fixture system considering the external damping factor is proposed using the Lagrangian method in terms of all the mode shape function and the generalized coordinate, and the response of system under the dynamic cutting force is calculated to evaluate the stability of the milling process under damping control. Finally, the feasibility and effectiveness of the proposed approach are validated by the impact hammer experiments and several machining tests.

关键词： Chatter Machining vibration sup pression Milling Stability Lobe diagram Thin-walled workpiece

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Prognostic factors in the surgical treatment of caudate Lobe hepatocellular carcinoma

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World Journal of Gastroenterology 2010年第9期16卷 1123-1128页

作者： Peng Liu,Jia-Mei Yang,Wen-Yang Niu,Tong Kan,Feng Xie,Dian-Qi Li,Ye Wang,Yan-Ming Zhou,Department of Special Treatment and Liver Transplantation,Eastern Hepatobiliary Surgery Hospital,Second Military Medical University,Shanghai 200438,China Peng Liu,Department of Hepatobiliary Surgery,Navy General Hospital,Beijing 100037,China Department of Special Treatment and Liver Transplantation Eastern Hepatobiliary Surgery Hospital Second Military Medical University Shanghai 200438 China.

AIM:To evaluate the short-and long-term outcomes of liver resection for caudate Lobe hepatocellular carcinoma (HCC).METHODS:We retrospectively analyzed 114 consecutive patients with HCC,originating from the caudate Lobe,who underwent resection between January 2001 and January 2007.Univariate and multivariate analyses were performed on several clinicopathologic variables to determine the factors affecting long-term outcome and intrahepatic recurrence.RESULTS:Overall mortality and morbidity were 0% and 18%,respectively.After a median follow-up of 31 mo (interquartile range,11-66 mo),tumor recurrence had occurred in 76 patients (66.7%).The 1-,3-,and 5-year disease-free survival rates were 65.7%,38.1%,and 18.4%,respectively.The 1-,3-,and 5-year overall survival rates were 76.1%,54.7%,and 31.8%,respectively.Univariate analysis showed that subsegmental location of the tumor (45.7% vs 16.2%,P=0.01),liver cirrhosis (12.3% vs 47.9%,P=0.03),surgical margin (18.5% vs 54.6%,P=0.04),vascular invasion (37.9% vs 23.2%,P=0.04) and extended caudate resection (42.1% vs 15.4%,P=0.04) were related to poorer long-term survival.Multivariate analysis showed that only subsegmental location of the tumor,liver cirrhosis and surgical margin were significant independent prognostic factors.CONCLUSION:Hepatectomy was an effective treatment for HCC in the caudate Lobe.The subsegmental location of the tumor,liver cirrhosis and surgical margin affected long-term survival.

关键词： Hepatectomy Hepatocellular carcinoma Caudate Lobe Prognostic factors

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