Objective To study the anatomy and variations of hepatic veins draining into inferior vena cava （IVC）， and to classify the surgical techniques of piggyback liver transplantation （PBLT） based on the view of hepatic veins anatomy with IQQA liver image analysis system so as to provide the important basis for the perioperative clinical decision making. Methods Two hundred and forty-eight cases of PBLT were preformed in the Zhongnan Hospital of Wuhan University and the 3rd Xiangya Hospital of Central South University from May 2000 to August 2007， the types of hepatic veins were summarized according to the anatomy of hepatic veins and short hepatic veins draining into IVC at the second and third hepatic hilars. Forty cases of PBLT were preformed in the Zhongnan Hospital of Wuhan University from March 2010 to April 2013， and the anatomy of hepatic veins was reviewed with IQQA liver image analysis system. The anatomy of hepatic veins and technological type of liver transplantation were recorded respectively. Results Of these 248 livers studied in our center， type Ⅰ（the left and middle hepatic vein joined as one trunk ） was found in 142 cases （57.25%）， type Ⅱ （the right and middle hepatic vein joined as one trunk） was 54 cases （21.77%）， type Ⅲ （three hepatic veins joined as one trunk） in 14 cases （5.64%）， type Ⅳ （the left， middle， and right hepatic veins were all unique）in 34 cases （13.71%）， and type Ⅴ （no hepatic veins but short hepatic veins） in 4 cases （1.61%）. The data of 40 cases of PBLT from IQQA liver image analysis system showed that type Ⅰwere found in 24 cases （60.00%）， type Ⅱin 9 cases（22.50%）， type Ⅲ in 2 cases （5.00%）， type Ⅳ in 4 cases （10.00%）， and type Ⅴ in 1 case （2.50%）， which were matched with hepatic vein classification standard of the author. Conclusions Studying the anatomy and variations of hepatic veins draining into IVC with IQQA liver image analysis system and classifying the surgical techniques of PBLT （type Ⅰ，Ⅱ，Ⅲ，andⅣA patients can be performed classical PBLT；Type ⅣB and Ⅴ patients can only be performed ameliorative PBLT） could provide an important basis for clinical preoperative decision.
ObjectiveTo investigate the value of computer assisted radiology and surgery solutions system (IQQA-Liver) in surgical planning for precise hepatectomy. MethodsThe clinical data of 95 cases performed precise hepatec-tomy from January 1, 2012 to June 30, 2013 in our hospital were retrospectively analyzed, and the computer assisted radiology and surgery solutions system was used for three dimensional quantitative analysis, volume measurement and designing for liver resection in all the cases before operation. ResultsThe intuitive and clear three dimensional images of all the 95 cases were obtained by using the computer assisted radiology and surgery solutions system, which could show the precise anatomical relationship of the liver, tumor, and main hepatic vascular.The three dimensional images could be observed at any angle and rotated freely, and could show the involved and needed to be resected vascular away from the tumor margin for 2 mm, 5 mm, 10 mm, and 20 mm and the liver volume dominated by this vascular.Of all the 95 cases, the total liver volume was (1 776.4±998.5) cm3, the proposed removed liver volume was (1 026.2±811.5) cm3, the functional residual liver volume was (795.3±522.6) cm3.The ratio of functional residual liver volume to the standard total liver volume was (58.2±25.1)%, which the ratio of patients without cirrhosis was > 30% and with cirrhosis was > 40%.All the 95 cases were implemented precise operation.The operation plan was designed based on a combination of factors such as the amount of functional residual liver volume and function.The surgery programs were changed for 13 cases, in which 9 cases were narrowed the scope of resection and 4 cases were expanded the scope of resection.No patients died perioperation. ConclusionBy using the computer assisted radiology and surgery solutions system (IQQA-Liver), we could precisely locate liver tumor, calculate the functional residual liver volume, identify the relationship between tumor and adjacent vascular, and ultimately help to design the optimal surgical plan.
Comparison among multiple interventions has been realized due to the development of network meta-analysis and so far many studies have reported its implementation process. However, its results are rarely interpreted in domestic studies at present. This article interprets the results of trace plots, density plots, Brooks-Gelman-Rubin diagnosis plots, rankogram, surface under the cumulative ranking, and network plots, to provide references and assistance for further research regarding network meta-analysis.
ObjectiveTo interpret ROBIS, a new tool to evaluate the risk of bias in systematic reviews, to promote the comprehension of it and its proper application. MethodsWe explained each item of ROBIS tool, used it to evaluate the risk of bias of a selected intervention review whose title was Cyclophosphamide for Primary Nephrotic Syndrome of Children: A Systematic Review, and judged the risk of bias in the review. ResultsThe selected systematic review as a whole was rated as “high risk of bias”, because there existed high risk of bias in domain 2 to 4, namely identification and selection of studies, data collection and study appraisal, synthesis and findings. The risk of bias in domain 1 (study eligibility criteria) was low. The relevance of identified studies and the review’s research question was appropriately considered and the reviewers avoided emphasizing results on the basis of their statistical significance. ConclusionROBIS is a new tool worthy of being recommended to evaluate risk of bias in systematic reviews. Reviewers should use ROBIS items as standards to conduct and produce high quality systematic reviews.
In order to help Chinese guideline developers, clinicians, health policy makers and other relevant researchers fully understand and make appropriate use of World Health Organization (WHO) guidelines, Chinese GRADE Center and Guidelines Review Committee of World Health Organization (WHO-GRC) have written a series of papers about development methods, review principles and the structure and content of WHO guidelines. This is the third (also last) paper which interpreted Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection and Guidelines for the Screening, Care and Treatment of Persons with Hepatitis C Infection as examples with the process and steps of WHO guideline development.
Dose-response meta-analysis (DRMA) is one of the branches of meta-analysis, which has provided important evidence for clinical research. Since introducing into China, it has gained great attention. In order to improve the reporting quality of DRMA, Dr. Chang Xu et al. developed the reporting guideline for DAMA——G-Dose Checklist. It was published in Chinese Jouranl of Evidence-based Medicine in 2016. This paper interprets the checklists so as to promote the understanding and use of it.