Objective To analyze the pathogenesis of cystoid macular edema (CME) secondary to exudative age-related macular degeneration (AMD). Methods From October 2000 to December 2003, OCT images of 171 eyes of 140 patients with exudative AMD were evaluated. The CNV types were classified according to its location (above or below the RPE), and the correlation between the types of CNV and the development of CME were analyzed. Results Of the 171 eyes with AMD, 89 eyes (52.0%) had CME, and 82 eyes (48.0%) had no CME. Among the 89 eyes with CME, 76 eyes (85.4% ) had an active CNV lesion, and 13 eyes (14.6%) had a disciform scar. Among the 82 eyes without CME, 69 eyes (84.1%) had an active CNV lesion, and 13 eyes (15.9 %) had a disciform scar. In the 76 eyes with both CME and active CNV, 75 eyes (9 8.7%) had a subretinal CNV, which included 61 eyes (80.3%)with a combined CNV complex and 14 eyes (18.4%) with a Gass 2 type CNV, only 1 eye (1.3%) had a Gass 1 type CNV. Whereas, in the 69 eyes with active CNV but without CME, 57 eyes (82.6%) had a Gass 1 type CNV, only 12 eyes (17.4%) had a subretinal CNV. There was a significant difference in the incidence of subretinal CNV between eyes with or without CME (χ2=99.5838, P=0.0000). Conclusions CME formation was highly corre lated with the invasion of CNV into the subretinal space. Subretinal CNV might be the direct cause of CME secondary to exudative AMD.(Chin J Ocul Fundus Dis，2004，20：299-302)
Objective To evaluate the correlation between retinal-choroidal anastomosis (RCA) and pigment epithelium detachment (PED) secondary to exudative age-related macular degeneration (AMD). Methods From October 2000 to December 2003,75 eyes of 70 patients with active exudative AMD underwent OCT, fluorecein and/or indocyanine green angiography (FA/ICGA) examinations were analyzed to ascertain whether there was RCA. The correlations between RCA and PED were evaluated. Results Of 75 eyes with exudative AMD, 34 eyes (45.3%) had RCA, 41 eyes (54.7%) had no RCA. Among the eyes with RCA, 30 eyes (88.2%) had PED, the remaining 4 eyes (11.8%) had no PED. Among the eyes without RCA, 33 eyes (80.5%) had PED, and 8 eyes (19.5%) had no PED. There was no significant difference in the incidence of PED between eyes with or without RCA (χ2=0.83, P=0.5290). PED tear was found in 17 eyes (51.5%)out of 33 eyes with PED and without RCA, but in 26 eyes (86.7% ) out of 30 eyes with both PED and RCA. There was a significant difference in the incidence of PED tear between eyes with or without RCA (χ2=8.9612, P=0.0030). Conclusions RCA is not uncommon in exudative AMD. It often coexisted with PED, but there is no direct correlation between them. PED tear is highly correlated with RCA formation. (Chin J Ocul Fundus Dis，2004，20：295-298)
ObjectiveTo understand the latest progress of enrichment technology of circulating tumor cells (CTCs), and summarize the principle, advantages and disadvantages of various enrichment technologies and their applications in primary liver cancer (PLC). MethodThe literature relevant to the enrichment methods of CTCs in the PLC was reviewed and summarized. ResultsThe clinical significances of CTCs in the early diagnosis and staging, hierarchical diagnosis and treatment, and efficacy monitoring of patients with PLC had been recognized. There were many separation and enrichment technologies for CTC, which were mainly based on the differences of physical and biochemical characteristics, as well as the combination of enrichment methods with various principles. Each enrichment method had corresponding advantages and disadvantages, and few enrichment methods for CTC was applied to PLC. ConclusionsAlthough many problems need to be solved in enrichment method of CTCs at present, it is believed that the existing problems will be solved one by one with continuous improvement of technology. And CTC detection is expected to apply in clinical, so as to provide more efficient diagnosis and treatment methods for patients with PLC.
Objective To observe the revascularization process of chemically extracted acellular allogeneous nerve graft in repairing rat sciatic nerve defect. Methods Eighty adult male SD rats were selected. The sciatic nerve trunks from ischial tuberosity to the ramus of tibiofibular nerve of 16 SD rats were obtained and were prepared into acellular nerve stents by chemical reagent. Sixty-four SD rats were used to prepare the models of sciatic nerve defect (1.0 cm) and thereafter were randomized into two groups (n=32): experimental group in which acellular allogeneous nerve grafts were adopted and control group in which orthotopic transplantation of autologous nerve grafts were adopted. Postoperatively, the general conditions of all rats were observed, and the gross and ALP staining observation were conducted at 5, 7, 10, 14, 21, 28 days and 2, 3 months, respectively. Results All the incisions were healed by first intention. Trail ing status and toe’s dysfunction in extension happened to the right hindl imb of rats in two groups and were improved 6 weeks after operation. General observation showed that the grafts of two groups connected well to the nerves, with appearances similar to that of normal nerve. ALP staining demonstrated that the experimental group had no ingrowth of microvessel but the control group had ingrowth of microvessel 5 days after operation; the experimental group had ingrowth of microvessel but both groups had no microvessel 7 days after operation; few longitudinal microvessel throughout the grafts were observed in both groups 10, 14 and 21 days after operation; no obvious difference in capillary network of grafts was observed between two groups 28 days after operation; and the microvascular architecture of grafts in both groups were similar to that of normal nerve 2 and 3 months after operation. Conclusion When the chemically extracted allogeneous nerve graft is adopted to repair the peripheral nerve defect, new blood microvessels can grow into grafts timely and effectively.
Objective To study the human optic canal and its inner structures, and provide anatomic knowledge of this area for optic nerve decompression and further study in pathologic mechanisms of indirect optic nerve injury. Methods Serial sections of the 18 optic canals of adults were made at orbital, middle and cranial parts. Quantitative measurements of the canal wall thickness, canal transverse area, dural sheath transverse area, optic nerve transverse area, and subarachnoid space transverse area were done by means of IMAGEPRO morphometric analysis system. Subarachnoid space transverse area to canal transverse area ratio (SSTA/CTA) and subarachnoid space transverse area to dural sheath transverse area ratio (SSTA/DSTA) were calculated. Results The middle portion of medial wall is the thinnest part of the canal (0.35plusmn;0.48)mm. The middle part of the optic canal was the narrowest part and the transverse area was (17.54plusmn;2.12)mm2. From cranial end to orbital end, SSTA/CTA, SSTA/DSTA and the subarachnoid space transverse area became smaller and smaller. Conclusion Since the potential space is limited, even a tiny amount of blood or sweling of the nerve may cause optic compression. Due to the potential space gradually decreases from cranial end to orbital end and the narrowest portion of the canal is in the middle part, the middle part and the anterior part of the optic canal are critical in optic narve decompression. (Chin J Ocul Fundus Dis,1999,15:24-26)
Objective Compare and analyze the value of β-hydroxybutyrate from two kinds of blood ketone instruments (Optium Xceed blood ketone body instrument from American Abbott laboratories and TBS-1 blood ketone body instrument from Beijing Yicheng company), and provide instructions for clinical applications. Methods Select 7 children patients with epilepsy which have a response to ketogenic diet. The two kinds of blood ketone instruments were used to test blood ketone value of whole blood synchronously in five different periods, and compare the 70 results. Results The measuring results obtained from these two kinds of blood ketone body instruments have statistical difference significantly. The value acquired from TBS-1 blood ketone body instrument is lower than that from Optium Xceed blood ketone body instrument. Measurements using a paired t test, the value of t=12.14, P<0.01. The results from two kinds of blood ketone body instruments are statistically significant. Conclusion The values from 2 kinds of blood ketone instruments are different, which would influence the clinical judgment. At present, the key problem is that there is lack of special blood ketone measure technology for patients with ketogenic diet. How to improve the measure accuracy of high-level blood ketone value remains the future work.
ObjectiveTo investigate the effect of jejunostomy combined with Ivor-Lewis or McKeown operation on the treatment of middle and lower esophageal cancer.MethodsThe clinical data of 127 patients with middle and lower esophageal cancer admitted to our hospital from June 2018 to October 2019 were retrospectively analyzed, including 89 males and 38 females, aged 62.82±8.65 years. The patients were divided into an Ivor-Lewis group (IL group, 72 patients) and a McKeown group (MK group, 55 patients) according to surgical methods. Patients in the IL group received jejunostomy combined with Ivor-Lewis operation, and patients in the MK group received jejunostomy combined with McKeown operation. The operation time, postoperative bedside electrical impedance tomography (EIT) parameters, postoperative inflammatory factor levels, postoperative complications and rehabilitation of the two groups were compared.ResultsThe operation time (262.65±49.78 min vs. 303.04±60.13 min), postoperative eating time (10.54±2.22 d vs. 11.47±2.49 d) and postoperative hospital stay (14.78±2.47 d vs.15.72±2.36 d) in the IL group were significantly shorter than those in the MK group (P<0.05). The blood loss (156.13±52.43 mL vs. 158.87±48.47 mL) and the number of lymph node dissection (29.47±8.88 vs. 30.17±9.80) in the IL group were less than those in the MK group, but the differences were not statistically significant (P>0.05). The repeated measurement analysis of variance showed that the time point could significantly affect tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-8 levels (Ftime point=520.543, 272.379, 147.688, all P<0.05), but the surgical methods and the interactive effect of time point and surgical methods did not affect the levels of TNF-α, IL-6 and IL-8 (P>0.05). Postoperative bedside EIT image parameters were statistically different on the postoperative 1 d, 3 d, 5 d and 7 d between the two groups (P<0.05). Compared with the MK group, the incidences of recurrent laryngeal nerve injury, arrhythmia, pulmonary infection and atelectasis, anastomotic leakage, gastric wall necrosis and stump fistula, secondary thoracotomy and abdominal hemostasis, and intestinal obstruction were lower, but the differences were not statistically different (P>0.05). The recurrence rate of patients in the IL group within 6 months was lower than that in the MK group, but the difference was not statistically significant (8.33% vs. 9.09%, P>0.05).ConclusionJejunostomy combined with Ivor-Lewis or McKeown surgery have equivalent effects on patients with middle and lower esophageal cancer.
ObjectiveTo investigate the clinical feasibility and value of laparoscopic precise segment Ⅳ hepatectomy by guiding of indocyanine green (ICG) fluorescence imaging via ligamenta teres hepatis. MethodThe clinicopathologic data of patients with liver cancer treated in the Department of Liver Surgery of West China Hospital of Sichuan University from January 2017 to December 2021 who underwent precise segment Ⅳ hepatectomy by the guidance of ICG fluorescence imaging through the ligamenta teres hepatis were collected retrospectively. ResultsA total of 6 patients were collected, including 5 males and 1 female. The age ranged from 42 to 78 years. All 6 patients were successfully completed using laparoscopic precise segment Ⅳ hepatectomy by guiding of ICG fluorescence imaging via ligamenta teres hepatis. The operation time was (200±30) min, the intraoperative bleeding was (100±20) mL, and there were no intraoperative blood transfusion, postoperative liver failure, postoperative pneumonia, incision infection, bile leakage, postoperative bleeding, and other complications. The postoperative hospital stay was (7±2) d. One patient with positive microvascular invasion was found after operation and recurred at 38 months after operation, then treated by radiofrequency ablation and didn’t recur. No patient died during the follow-up period in 6 patients. ConclusionFrom results of limited cases in this study, laparoscopic precise segment Ⅳ hepatectomy by guiding of ICG fluorescence imaging via ligamenta teres hepatis is safe, feasible, and effective.
Large-for-size syndrome (LFSS) is a fatal complication of abdominal and thoracic organ compression due to mismatch of the size of the graft and recipient abdominal cavity. In recent years, with the increased prevalence of obesity epidemic among the donor pool, the incidence of LFSS tends to increase in adult liver transplantation. However, it is still unclear how to effectively prevent LFSS after adult death after citizen death (DCD) liver transplantation. Almost all transplantation centers rely on experience to deal with it, and there is no objective prevention strategy. This article summarizes the current problems in preventing LFSS after adult DCD liver transplantation, and our team’s exploration of the existing problems.
Objective To explore feasibility and effectiveness of three-dimensional (3D) printing technology in precise hepatectomy. Methods The patient was a 60-year-old woman with diagnosis of liver malignancy. The liver model was reconstructed using the IQQA Liver System (EDDA Technology, Inc. USA) based on the CT scan data. The volumes of the liver and the lesion were measured and recorded. The CT data were further digitally reconstructed by means of cloud computing and storage with RevoCloud (V1.0) Medical Imaging System. The best surgical plan was determined by the repeated virtual surgical resection with the reconstruction system, based on the corresponding resected liver volume and the remaining liver volume. Results The reconstruction of liver clearly showed that the tumor invaded the right hepatic and middle hepatic veins, as well as the anterior branch of right portal vein, which was consistent with the conclusion of CT scan. In the other hand, the right posterior branch of the portal vein was completely distributed in the segment Ⅴ and Ⅵ, while a relatively large right posterior inferior vena presented and drained segment Ⅴ and Ⅵ. The anatomic resection of segment Ⅶ, Ⅷ , and Ⅳa was completed according to the preoperative plan. The liver function kept recovering, and the patient discharged a week later. Conclusion Results of this patient show that 3D printing technology can accurately assess anatomic construction of liver and determine relationship between lesion and its surrounding tissue, which can be effectively used in precise hepatectomy.