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End-stage liver disease score and future liver remnant volume predict post-hepatectomy liver failure in hepatocellular carcinoma

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World Journal of Clinical Cases 2019年第22期7卷 3734-3741页

作者： Fan-Hua Kong Xiong-Ying Miao Heng Zou Li Xiong Yu Wen Bo Chen Xi Liu Jiang-Jiao Zhou Department of General Surgery The Second Xiangya Hospital Central South University

BACKGROUND Hepatocellular carcinoma(HCC)is the world’s sixth most common malignant tumor and the third cause of cancer death.Although great progress has been made in hepatectomy,it is still associated with a certain degree of risk of posthepatectomy liver failure(PHLF),which extends the length of hospital stay and remains the leading cause of postoperative death.Studies have shown that assessment of hepatic functional reserve before hepatectomy is beneficial for reducing the incidence of PHLF.AIM To assess the value of model for end-stage liver disease(MELD)score combined with standardized future liver remnant(sFLR)volume in predicting PHLF in patients undergoing hepatectomy for HCC.METHODS This study was attended by 238 patients with HCC who underwent hepatectomy between January 2015 and January 2018.Discrimination of sFLR volume,MELD score,and sFLR/MELD ratio to predict PHLF was evaluated according to the area under the receiver operating characteristic curve.RESULTS The patients were divided into two groups according to whether PHLF occurred after hepatectomy.The incidence of PHLF was 8.4%in our research.The incidence of PHLF increased with the decrease in sFLR volume and the increase in MELD score.Both sFLR volume and MELD score were considered independent predictive factors for PHLF.Moreover,the cut-off value of the sFLR/MELD score to predict PHLF was 0.078(P<0.001).This suggests that an sFLR/MELD≥0.078 indicates a higher incidence of PHLF than an sFLR/MELD<0.078.CONCLUSION MELD combined with sFLR is a reliable and effective PHLF predictor,which is superior to MELD score or sFLR volume alone.

关键词： Post-hepatectomy liver failure Hepatocellular carcinoma Hepatectomy Model for end-stage liver disease Standardized future liver remnant Hepatitis B virus

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Simulation of recovery of upper remnant coal pillar while mining the ultra-close lower panel using longwall top coal caving

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International Journal of Mining Science and Technology 2020年第1期30卷 55-61页

作者： Guorui Feng Pengfei Wang College of Mining Engineering Taiyuan University of TechnologyTaiyuan 030024China

With the depletion of easily minable coal seams,less favorable reserves under adverse conditions have to be mined out to meet the market demand.Due to some historical reasons,large amount of remnant coal was left unrecovered.One such case history occurred with the remnant rectangular stripe coal pillars using partial extraction method at Guandi Mine,Shanxi Province,China.The challenge that the coal mine was facing was that there is an ultra-close coal seam right under it with an only 0.8–1.5 m sandstone dirt band in between.The simulation study was carried out to investigate the simultaneous recovery of upper remnant coal pillars while mining the ultra-close lower panel using longwall top coal caving(LTCC).The remnant coal pillar was induced to cave in as top coal in LTCC system.Physical modelling shows that the coal pillars are the abutments of the stress arch structure formed within the overburden strata.The stability of overhanging roof strata highly depends on the stability of the remnant coal pillars.And the gob development(roof strata cave-in)is intermittent with the cave-in of these coal pillars and the sandstone dirt band.FLAC3D numerical modelling shows that the multi-seam interaction has a significant influence on mining-induced stress environment for mining of lower panels.The pattern of the stress evolution on the coal pillars with the advance of the lower working face was found.It is demonstrated that the stress relief of a remnant coal pillar enhances the caveability of the pillars and sandstone dirt band below.

关键词： Simulation remnant coal pillars Ultra-close Dirt band Longwall top coal caving

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Current controversies in treating remnant gastric cancer: Are minimally invasive approaches feasible?

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World Journal of Clinical Cases 2019年第21期7卷 3384-3393页

作者： Fu-Hai Ma Hao Liu Shuai Ma Yang Li Yan-Tao Tian Department of Pancreatic and Gastric Surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College

The incidence of remnant gastric cancer(RGC)is still increasing.Minimally invasive approaches including endoscopic resection,laparoscopic and robotic approaches,and function-preserving gastrectomy have been utilized as curative treatment methods for primary gastric cancer.However,adhesions and anatomical alterations due to previous gastrectomy make the use of minimally invasive approaches complicated and difficult for RGC.Application of these approaches for the treatment of RGC is still controversial.Endoscopic submucosal dissection is a favorable alternative therapy for the resection of early gastric cancer that occurs in the remnant stomach and can prevent unnecessary complications.The majority of retrospective studies have shown that endoscopic submucosal dissection is an effective and oncologically safe treatment modality for RGC.Subtotal gastrectomy could serve as a function-preserving gastrectomy for patients with early RGC and improve postoperative late-phase function.However,there are only two studies that demonstrate the feasibility and oncological efficacy of subtotal gastrectomy for RGC.The non-randomized controlled trials showed that compared to open gastrectomy,laparoscopic gastrectomy for RGC led to better short-term outcomes and similar oncologic results.Because of the rarity of RGC,future multicenter studies are required to determine the indications of minimally invasive treatment for RGC.

关键词： remnant gastric cancer Minimally invasive approaches Endoscopic submucosal dissection Subtotal gastrectomy Laparoscopic gastrectomy

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Gastric cancer arising from the remnant stomach after distal gastrectomy:A review

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World Journal of Gastroenterology 2014年第38期20卷 13734-13740页

作者： Shinsuke Takeno Tatsuya Hashimoto Kenji Maki Ryosuke Shibata Hironari Shiwaku Ippei Yamana Risako Yamashita Yuichi Yamashita Department of Gastroenterological Surgery Fukuoka University Faculty of Medicine

Gastric stump carcinoma was initially reported by Balfore in 1922,and many reports of this disease have since been published. We herein review previous reports of gastric stump carcinoma with respect to epidemiology,carcinogenesis,Helicobacter pylori(H. pylori) infection,Epstein-Barr virus infection,clinicopathologic characteristics and endoscopic treatment. In particular,it is noteworthy that no prognostic differences are observed between gastric stump carcinoma and primary upper third gastric cancer. In addition,endoscopic submucosal dissection has recently been used to treat gastric stump carcinoma in the early stage. In contrast,many issues concerning gastric stump carcinoma remain to be clarified,including molecular biological characteristics and the carcinogenesis of H.pylori infection.We herein review the previous pertinent literature and summarize the characteristics of gastric stump carcinoma reported to date.

关键词： remnant gastric cancer Distal gastrec-tomy Carcino

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Impact of mesocaval shunt on safe minimal liver remnant:Porcine model

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World Journal of Gastroenterology 2013年第31期19卷 5076-5084页

作者： Yu-Liang Tu Xuan Wang Da-Dong Wang Zi-Man Zhu Jing-Wang Tan Department of Hepatobiliary Surgery the First Affiliated Hospital Chinese PLA General Hospital Department of Hepatobiliary Surgery Chinese PLA No. 81 Hospital

AIM: To investigate the capacity of shunts to relieve portal hypertension and decrease the safe minimal liver remnant in pigs.METHODS: A subtotal hepatectomy with < 60 mL blood loss and without hepatic pedicle occlusion was performed.The mesenteric venous inflow was diverted through a mesocaval shunt(MCS) constructed using the prepared left renal vein with an end-to-side running suture of 5-0 proline.All 21 animals that underwent subtotal hepatectomy and/or MCS were divided into three groups.In the 15% group,the residual volume was 14%-19% of total liver volume(TLV);in the 15%+ S group,the residual volume was also 14%-19% of TLV with a mesocaval shunt(MCS);and in the 10%+ S group,the residual volume was 8%-13% of TLV with an MCS.In the three groups,the intraoperative portal vein pressure(PVP) and portal vein flow(PVF) were monitored and compared at laparotomy and 1 h posthepatectomy.The survival rate,sinusoidal endothelial damage,tissue analysis,and serum analysis were investigated among the three groups.RESULTS: The percentage residual liver volume was 15.9%,16.1% and 11.8% in the 15%,15%+ S,10%+ S groups,respectively.After hepatectomy,PVF and portal-to-arterial flow ratio in the 15%+ S group significantly decreased and hepatic artery flow(HAF) per unit volume significantly increased,compared to those in the 15% group.The PVP in the 15%+ S group and 10%+ S group increased slightly from that measured at laparotomy;however,in the 15% group,the PVP increased immediately and significantly above that observed in the other two groups.The 14-d survival rates were 28.5%,85.6%,and 14.2% in the 15%,15%+ S,and 10%+ S groups,respectively.In the 15%+ S group,the shunts effectively attenuated injury to the sinusoidal endothelium,and the changes in the serum and tissue analysis results were significantly reduced compared to those in the 15% and 10%+ S groups.CONCLUSION: MCS can decompress the portal vein and so attenuate liver injury from hyperperfusion,and make extreme or marginal hepatectomy safer.

关键词： Hepatectomy Safe minimal remnant volume Mesocaval shunt Pigs

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Effects of anthropogenic disturbances on vegetation diversity and structure:a case study in the remnant forests surrounding the village ecosystems of Tripura,Northeast India

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Chinese Journal of Population,Resources and Environment 2015年第4期13卷 332-340页

作者： Koushik Majumdar B.K.Datta Plant Taxonomy and Biodiversity Laboratory Department of BotanyTripura University

The types,frequency,and intensity of human interference with forests markedly affect the vegetation dynamics.Assessment of the impact of anthropogenic disturbances on forest diversity and structure is one of the central issues related to human behaviour and forest ecosystems and management.Both species diversity and density are very sensitive to local anthropogenic disturbance,which can be reduced depending on land-use systems.We used 10 line transects of 500 x 10 m to record and measure all plants >10 cm girth in some of the remaining forests surrounding villages in Tripura,Northeast India.To predict the effects of anthropogenic pressure on species richness and forest structure,we recorded and scored all ongoing disturbances in all transects of the forests.Although our study did not show any significant effects on the mean number of species,all diversity indices were significantly affected by disturbance.Total stem density(F = 128.60,p < 0.0001) and basal area(F = 65.30,p < 0.0001) of the forest stands were significantly affected by disturbance.Disturbance significantly(F= 84.81,p < 0.0001) impacts the abundance of mature voluminous trees removed by extensive illegal logging.Further,stem density at the middle(F= 10.01,p < 0.05) and upper(F= 131.70,p < 0.0001) canopy stories was also reduced by high disturbance intensity.The present analysis will be useful to policy-makers and planners for implementation of sustainable forest management at both the local and regional scale.

关键词： impact of human influence remnant village forests vegetation diversity and density

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Role of urban remnant evergreen broad-leaved forests on natural restoration of artificial forests in Chongqing metropolis

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Journal of Central South University 2009年第S1期16卷 276-281页

作者：杨永川李楠 Key Laboratory of Three Gorges Reservoir Region's Eco-Environment Ministry of EducationChongqing University Faculty of Urban Construction and Environmental Engineering Chongqing University

The effects of urban remnant natural evergreen broad-leaved forest (EBLF) on the restoration of artificial pine forests surrounding it were studied with reference to species composition,biodiversity,dominant species and stand structure on Mt. Tieshanping in Chongqing metropolis,Southwest China. The seeds from the remnant EBLF naturally facilitate the restoration process of artificial Pinus massoniana forests near it. The similarity of species composition between the artificial Pinus massoniana forests and the remnant EBLF and biodiversity index of the artificial Pinus massoniana forests decrease as the distance from the remnant EBLF increases. Castanopsis carlesii var. spinusa is the dominant species in the ground vegetation,shrub layer and sub-tree layer of the Pinus massoniana forests near the remnant EBLF. However,the natural restoration processes of those farther away from the remnant EBLF are restricted for the absence of seed source of the inherent components of the remnant EBLF,and the anthropogenic measures should be taken to facilitate the restoration process.

关键词： remnant vegetation evergreen broad-leaved forest seed effect natural restoration

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Current status in remnant gastric cancer after distal gastrectomy

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World Journal of Gastroenterology 2016年第8期22卷 2424-2433页

作者： Masaichi Ohira Takahiro Toyokawa Katsunobu Sakurai Naoshi Kubo Hiroaki Tanaka Kazuya Muguruma Masakazu Yashiro Naoyoshi Onoda Kosei Hirakawa Department of Surgical Oncology Osaka City University Graduate School of Medicine

remnant gastric cancer(RGC) and gastric stump cancer after distal gastrectomy(DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori(H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis.

关键词： remnant gastric cancer Helicobacter pylori endoscopic treatment Surveillance laparoscopic surgery

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Esophageal reconstruction with remnant stomach:A case report and review of literature

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World Journal of Gastroenterology 2013年第20期19卷 3169-3172页

作者： Song-Ping Xie Guo-Hua Fan Gan-Jun Kang Qing Geng Jie Huang Bang-Chang Cheng Department of Thoracic Surgery Renmin Hospital of Wuhan University

The number of patients developing esophageal cancer after gastrectomy has increased.However,gastric remnant is very rarely used for reconstruction in esophageal cancer surgery because of the risk of anastomotic leakage resulting from insufficient blood flow.We present a case of esophageal cancer using gastric remnant for esophageal substitution after distal gastrectomy in a 57-year-old man who presented with a 1-month history of mild dysphagia and a background history of alcohol abuse.Gastroscopy showed a 1.2 cm × 1.0 cm bulge tumor of the lower third esophagus with the upper margin located 39 cm from the dental arcade.Computed tomography of the chest showed lower third esophageal wall thickening.The patient underwent en bloc radical esophagectomy with a two-field lymph node dissection of the upper abdomen and mediastinum via a left-sided posterolateral thoracotomy through the seventh intercostal space.The upper end of the esophagus was resected 5 cm above the tumor.The gastric remnant was used for reconstruction of the esophago-gastrostomy and placed in the left thoracic cavity.The patient started a liquid diet on postoperative day 8 and was discharged on the 10 th postoperative day without complications.In this report,we demonstrate that the gastric remnant may be used for reconstruction in patients with esophageal cancer as a substitute organ after distal gastrectomy.

关键词： Gastric remnant Distal Gastrectomy Esophageal cancer Substitution

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肥胖儿童non-HDL-C、remnant cholesterol与亚临床动脉粥样硬化的关系

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天津医科大学学报 2014年第1期20卷 25-28页

作者：焦朝艳刘戈力鲍鹏丽魏莹杨箐岩郑荣秀赵菁天津医科大学总医院儿科天津300052

目的:了解non-HDL-C和remnant cholesterol与肥胖儿童亚临床动脉粥样硬化(AS)的关系。方法:根据甘油三酯(TG)水平将65例肥胖儿童(肥胖组)分为I组(TG≥2.3 mmol/L)32例,II组(TG<2.3 mmol/L)33例,与肥胖组儿童性别年龄相匹配的正常体质量... 详细信息

目的:了解non-HDL-C和remnant cholesterol与肥胖儿童亚临床动脉粥样硬化(AS)的关系。方法:根据甘油三酯(TG)水平将65例肥胖儿童(肥胖组)分为I组(TG≥2.3 mmol/L)32例,II组(TGremnant cholesterol、AIP均较对照组升高,高密度脂蛋白胆固醇(HDL-C)较对照组降低,且I组的remnant cholesterol、AIP均较II组升高。肥胖组儿童AIP与TG、non-HDL-C、remnant cholesterol呈正相关,与HDL-C呈负相关。37例行颈动脉超声检查的肥胖儿童的c-IMT较正常儿童的增厚。结论:non-HDL-C、remnant cholesterol在肥胖儿童亚临床AS中有重要作用,在肥胖儿童血脂异常的治疗中应关注non-HDL-C、remnant cholesterol的变化。

关键词：儿童肥胖亚临床动脉粥样硬化 non—HDL—C remnant cholesterol 血浆致动脉粥样硬化指数颈动脉内膜-中层厚度

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