BACKGROUND Given the current organ shortage crisis,split liver transplantation(SLT)has emerged as a promising alternative for select end-stage liver disease patients.AIM To introduce an ex-vivo liver graft splitting a...BACKGROUND Given the current organ shortage crisis,split liver transplantation(SLT)has emerged as a promising alternative for select end-stage liver disease patients.AIM To introduce an ex-vivo liver graft splitting approach and evaluate its safety and feasibility in SLT.METHODS A retrospective analysis was conducted on the liver transplantation data from cases performed at our center between April 1,2022,and May 31,2023.The study included 25 SLT cases and 81 whole liver transplantation(WLT)cases.Total ex-vivo liver splitting was employed for SLT graft procurement in three steps.Patient outcomes were determined,including liver function parameters,postoperative complications,and perioperative mortality.Group comparisons for categorical variables were performed using theχ²-test.RESULTS In the study,postoperative complications in the 25 SLT cases included hepatic artery thrombosis(n=1)and pulmonary infections(n=3),with no perioperative mortality.In contrast,among the 81 patients who underwent WLT,complications included perioperative mortality(n=1),postoperative pulmonary infections(n=8),abdominal infection(n=1),hepatic artery thromboses(n=3),portal vein thrombosis(n=1),and intra-abdominal bleeding(n=5).Comparative analysis demonstrated significant differences in alanine aminotransferase(176.0 vs 73.5,P=0.000)and aspartate aminotransferase(AST)(42.0 vs 29.0,P=0.004)at 1 wk postoperatively,and in total bilirubin(11.8 vs 20.8,P=0.003)and AST(41.5 vs 26.0,P=0.014)at 2 wk postoperatively.However,the overall incidence of complications was comparable between the two groups(P>0.05).CONCLUSION Our findings suggest that the total ex-vivo liver graft splitting technique is a safe and feasible approach,especially under the expertise of an experienced transplant center.The approach developed by our center can serve as a valuable reference for other transplantation centers.展开更多
Ex-vivo liver resection is a procedure in which the liver is completely removed, perfused and after bench surgery, the liver is autotransplanted to the original site. Ex vivo liver resection is an important treatment ...Ex-vivo liver resection is a procedure in which the liver is completely removed, perfused and after bench surgery, the liver is autotransplanted to the original site. Ex vivo liver resection is an important treatment for unresectable liver tumors. This surgical procedure requires long operation time, during which blood flow must be carefully maintained to avoid venous congestion. An effective veno-venous bypass (VVB) may meet this requirement. The present study was to test our new designed VVB device which comprised one heparinized polyvinylchloride tube and three magnetic rings The efficacy of this device was tested in five dogs. A VVB was established in 6-10 minutes. There was no leakage during the procedure. Hemodynamics was stable at anhepatic phase, which indicated that the bypass was successful. This newly-developed VVB device maintained circulation stability during ex-vivo liver resection in our dog model and thus, this VVB device significantly shortened the operation time.展开更多
AIM： Positioning of interventional devices in liver lesions is a challenging task if only CT is available. We investigated the potential benefit of combined PET/CT images for localization of interventional devices in...AIM： Positioning of interventional devices in liver lesions is a challenging task if only CT is available. We investigated the potential benefit of combined PET/CT images for localization of interventional devices in interventional liver studies. METHODS： Thirty lesions each of hyperdense, isodense and hypodense attenuation compared to normal liver parenchyma were injected into 15 ex-vivo pig livers. All lesions were composed of the same amounts of gelatine containing 0.5 MBq of ^18F-FDG. Following lesion insertion, an interventional needle was placed in each lesion under CT-guidance solely. After that, a PET/CT study was performed. The localization of the needle within the lesion was assessed for CT alone and PET/CT and the root mean square （RMS） was calculated. Results were compared with macroscopic measurements after lesion dissection serving as the standard of reference. RESULTS： In hypo- and isodense lesions PET/CT proved more accurate in defining the position of the interventional device when compared with CT alone. The mean RMS for CT and PET/CT differed significantly in isodense and hypodense lesions. No significant difference was found for hyperdense lesions. CONCLUSION： Combined FDG-PET/CT imaging provides more accurate information than CT alone concerning the needle position in FDG-PET positive liver lesions. Therefore combined PET/CT might be potentially beneficial not only for localization of an interventional device, but may also be beneficial for guidance in interventional liver procedures.展开更多
The objective of this research was to use abdominal computed tomography (CT) scans to non-invasively quantify anthropometrical data of the human stomach and to concomitantly create an anatomically correct and distensi...The objective of this research was to use abdominal computed tomography (CT) scans to non-invasively quantify anthropometrical data of the human stomach and to concomitantly create an anatomically correct and distensible ex-vivo gastric model. Thirty-three abdominal CT scans of human subjects were obtained and were imported into reconstruction software to generate 3D models of the stomachs. Anthropometrical data such as gastric wall thickness, gastric surface area and gastric volume were subsequently quantified. A representative 3D computer model was exported into a selective laser sintering (SLS) rapid prototyping machine to create an anatomically correct solid gastric model. Subsequently, a replica wax template of the SLS model was created. A negative mould was offset around the wax template such that the offset distance was equivalent to that of the gastric wall thickness. A silicone with similar mechanical properties to the human stomach was poured into the offset. The lost wax manufacturing technique was employed to create a hollow distensible stomach model. 3D computer gastric models were generated from the CT scans. A hollow distensible silicone ex-vivo gastric model with similar compliance to that of the human stomach was created. The anthropometrical data indicated that there is no significant relationship between BMI and gastric surface area or gastric volume. There were inter- and intra-group differences between groups with respect to gastric wall thickness. This study demonstrates that abdominal CT scans can be used to both non-invasively determine gastric anthropometrical data as well as create realistic ex-vivo stomach models.展开更多
Lung transplant is the standard of care for patients with end-stage lung disease refractory to medical management. There is currently a critical organ shortage for lung transplantation with only 17% of offered organs ...Lung transplant is the standard of care for patients with end-stage lung disease refractory to medical management. There is currently a critical organ shortage for lung transplantation with only 17% of offered organs being transplanted. Of those patients receiving a lung transplant, up to 25% will develop primary graft dysfunction, which is associated with an 8-fold increase in 30-d mortality. There are numerous mechanical lung assistance modalities that may be employed to help combat these challenges. We will discuss the use of mechanical lung assistance during lung transplantation, as a bridge to transplant, as a treatment for primary graft dysfunction, and finally as a means to remodel and evaluate organs deemed unsuitable for transplant, thus increasing the donor pool, improving survival to transplant, and improving overall patient survival.展开更多
Micro-computed tomography (MCT) encompasses two primary scanning options: ex-vivo and in-vivo imaging. Ex-vivo scanning involves the examination of extracted teeth or dental specimens, allowing for detailed analyses o...Micro-computed tomography (MCT) encompasses two primary scanning options: ex-vivo and in-vivo imaging. Ex-vivo scanning involves the examination of extracted teeth or dental specimens, allowing for detailed analyses of the microarchitecture of mineralized tissue. By analyzing the microarchitecture of dental tissues, MCT can provide valuable information about bone density, porosity, and microstructural changes, contributing to a better understanding of disease progression and treatment outcomes. Moreover, MCT facilitates the quantification of dental parameters, such as bone volume, trabecular thickness, and connectivity density, which are crucial for evaluating the efficacy of dental interventions. This present study aims to comprehensively review and explore the applications of MCT in dentistry and highlight its potential in advancing research and clinical practice. The results depicted that the quantitative approach of MCT enhances the precision and reliability of dental research. Researchers and clinicians can make evidence-based decisions regarding treatment strategies and patient management, relying on quantifiable data provided by MCT. The applications of MCT in dentistry extend beyond research, with potential clinical implications in fields such as dental implantology and endodontics. MCT is expected to play an increasingly significant role in enhancing our understanding of dental pathologies, improving treatment outcomes, and ultimately, benefiting patient care in the field of dentistry.展开更多
离体肝切除和自体肝移植术(ex-vivo liver resection and autotransplantation,ELRA)是肝脏外科中的一种复杂术式。ELRA适合于侵犯下腔静脉、门静脉与肝静脉及它们分支的复杂病灶的切除。近几年,经过众多学者对ELRA进行大量的手术实践...离体肝切除和自体肝移植术(ex-vivo liver resection and autotransplantation,ELRA)是肝脏外科中的一种复杂术式。ELRA适合于侵犯下腔静脉、门静脉与肝静脉及它们分支的复杂病灶的切除。近几年,经过众多学者对ELRA进行大量的手术实践与研究分析后,ELRA迅速发展。在疾病的适应证中,ELRA着重于晚期肝恶性肿瘤与终末期肝泡型棘球蚴病的治疗。最新的研究中,肝脏Child-Pugh评分B级和残余肝脏体积与标准肝脏体积之比为0.35~0.40的病人也能满足ELRA的肝脏要求。另外,体内临时的门腔静脉分流技术也因其术后死亡率低于过去的体外静脉-静脉转流技术而成为术中首选。术中的血管重建,重点围绕肝后下腔静脉重建方式的选择。对于需重建肝后下腔静脉的病人,则根据病灶切除后肝后下腔静脉壁缺损的程度,采用直接缝合、使用补片、使用人工血管的方式进行重建。现结合文献,对上述领域进行综述。展开更多
Despite significant improvements in outcomes after liver trans-plantation,many patients continue to die on the waiting list,while awaiting an available organ for transplantation.Organ shortage is not only due to an in...Despite significant improvements in outcomes after liver trans-plantation,many patients continue to die on the waiting list,while awaiting an available organ for transplantation.Organ shortage is not only due to an inadequate number of available organs,but also the inability to adequately assess and evaluate these organs prior to transplantation.Over the last few decades,ex-vivo perfusion of the liver has emerged as a useful technique for both improved organ preservation and assessment of organs prior to transplantation.Large animal studies have shown the superiority of ex-vivo perfusion over cold static storage.However,these studies have not,necessa-rily,been translatable to human livers.Small animal studies have been essential in understanding and improving this tech-nology.Similarly,these results have yet to be translated into clinical use.A few Phase 1 clinical trials have shown promise and confirmed the viability of this technology.However,more robust studies are needed before ex-vivo liver perfusion can be widely accepted as the new clinical standard of organ preser-vation.Here,we aimed to review al relevant large and smal animal research,as well as human liver studies on normother-mic ex-vivo perfusion,and to identify areas of deficiency and opportunities for future research endeavors.展开更多
The evaluation of the corneal biomechanical behaviour has important clinical applications.To name a few,the accuracy of the intraocular pressure measurement,the study of corneal ectatic diseases and the assessment and...The evaluation of the corneal biomechanical behaviour has important clinical applications.To name a few,the accuracy of the intraocular pressure measurement,the study of corneal ectatic diseases and the assessment and optimisation of corneal surgical procedures are all highly influenced by corneal biomechanics.Over the last 45 years different ex-vivo methods were developed to study corneal biomechanical behaviour.Different tissue maintenance,support,loading systems,as well as different monitoring strategies of corneal deformations were employed.In this review,the most important and commonly used methods are outlined,including strip extensiometry,inflation,compression,indentation and tissue separation testing.Their particularities,applications,pros and cons and main applications are discussed.展开更多
基金Supported by the Shenzhen Science and Technology Research and Development Fund,No.JCYJ20220530163011026.
文摘BACKGROUND Given the current organ shortage crisis,split liver transplantation(SLT)has emerged as a promising alternative for select end-stage liver disease patients.AIM To introduce an ex-vivo liver graft splitting approach and evaluate its safety and feasibility in SLT.METHODS A retrospective analysis was conducted on the liver transplantation data from cases performed at our center between April 1,2022,and May 31,2023.The study included 25 SLT cases and 81 whole liver transplantation(WLT)cases.Total ex-vivo liver splitting was employed for SLT graft procurement in three steps.Patient outcomes were determined,including liver function parameters,postoperative complications,and perioperative mortality.Group comparisons for categorical variables were performed using theχ²-test.RESULTS In the study,postoperative complications in the 25 SLT cases included hepatic artery thrombosis(n=1)and pulmonary infections(n=3),with no perioperative mortality.In contrast,among the 81 patients who underwent WLT,complications included perioperative mortality(n=1),postoperative pulmonary infections(n=8),abdominal infection(n=1),hepatic artery thromboses(n=3),portal vein thrombosis(n=1),and intra-abdominal bleeding(n=5).Comparative analysis demonstrated significant differences in alanine aminotransferase(176.0 vs 73.5,P=0.000)and aspartate aminotransferase(AST)(42.0 vs 29.0,P=0.004)at 1 wk postoperatively,and in total bilirubin(11.8 vs 20.8,P=0.003)and AST(41.5 vs 26.0,P=0.014)at 2 wk postoperatively.However,the overall incidence of complications was comparable between the two groups(P>0.05).CONCLUSION Our findings suggest that the total ex-vivo liver graft splitting technique is a safe and feasible approach,especially under the expertise of an experienced transplant center.The approach developed by our center can serve as a valuable reference for other transplantation centers.
基金supported by agrant from the National Natural Science Foundation of China(30830099)
文摘Ex-vivo liver resection is a procedure in which the liver is completely removed, perfused and after bench surgery, the liver is autotransplanted to the original site. Ex vivo liver resection is an important treatment for unresectable liver tumors. This surgical procedure requires long operation time, during which blood flow must be carefully maintained to avoid venous congestion. An effective veno-venous bypass (VVB) may meet this requirement. The present study was to test our new designed VVB device which comprised one heparinized polyvinylchloride tube and three magnetic rings The efficacy of this device was tested in five dogs. A VVB was established in 6-10 minutes. There was no leakage during the procedure. Hemodynamics was stable at anhepatic phase, which indicated that the bypass was successful. This newly-developed VVB device maintained circulation stability during ex-vivo liver resection in our dog model and thus, this VVB device significantly shortened the operation time.
文摘AIM： Positioning of interventional devices in liver lesions is a challenging task if only CT is available. We investigated the potential benefit of combined PET/CT images for localization of interventional devices in interventional liver studies. METHODS： Thirty lesions each of hyperdense, isodense and hypodense attenuation compared to normal liver parenchyma were injected into 15 ex-vivo pig livers. All lesions were composed of the same amounts of gelatine containing 0.5 MBq of ^18F-FDG. Following lesion insertion, an interventional needle was placed in each lesion under CT-guidance solely. After that, a PET/CT study was performed. The localization of the needle within the lesion was assessed for CT alone and PET/CT and the root mean square （RMS） was calculated. Results were compared with macroscopic measurements after lesion dissection serving as the standard of reference. RESULTS： In hypo- and isodense lesions PET/CT proved more accurate in defining the position of the interventional device when compared with CT alone. The mean RMS for CT and PET/CT differed significantly in isodense and hypodense lesions. No significant difference was found for hyperdense lesions. CONCLUSION： Combined FDG-PET/CT imaging provides more accurate information than CT alone concerning the needle position in FDG-PET positive liver lesions. Therefore combined PET/CT might be potentially beneficial not only for localization of an interventional device, but may also be beneficial for guidance in interventional liver procedures.
基金Supported by the Irish Research Council for Science Engineering and Technology and by the National Development Plan
文摘The objective of this research was to use abdominal computed tomography (CT) scans to non-invasively quantify anthropometrical data of the human stomach and to concomitantly create an anatomically correct and distensible ex-vivo gastric model. Thirty-three abdominal CT scans of human subjects were obtained and were imported into reconstruction software to generate 3D models of the stomachs. Anthropometrical data such as gastric wall thickness, gastric surface area and gastric volume were subsequently quantified. A representative 3D computer model was exported into a selective laser sintering (SLS) rapid prototyping machine to create an anatomically correct solid gastric model. Subsequently, a replica wax template of the SLS model was created. A negative mould was offset around the wax template such that the offset distance was equivalent to that of the gastric wall thickness. A silicone with similar mechanical properties to the human stomach was poured into the offset. The lost wax manufacturing technique was employed to create a hollow distensible stomach model. 3D computer gastric models were generated from the CT scans. A hollow distensible silicone ex-vivo gastric model with similar compliance to that of the human stomach was created. The anthropometrical data indicated that there is no significant relationship between BMI and gastric surface area or gastric volume. There were inter- and intra-group differences between groups with respect to gastric wall thickness. This study demonstrates that abdominal CT scans can be used to both non-invasively determine gastric anthropometrical data as well as create realistic ex-vivo stomach models.
文摘Lung transplant is the standard of care for patients with end-stage lung disease refractory to medical management. There is currently a critical organ shortage for lung transplantation with only 17% of offered organs being transplanted. Of those patients receiving a lung transplant, up to 25% will develop primary graft dysfunction, which is associated with an 8-fold increase in 30-d mortality. There are numerous mechanical lung assistance modalities that may be employed to help combat these challenges. We will discuss the use of mechanical lung assistance during lung transplantation, as a bridge to transplant, as a treatment for primary graft dysfunction, and finally as a means to remodel and evaluate organs deemed unsuitable for transplant, thus increasing the donor pool, improving survival to transplant, and improving overall patient survival.
文摘Micro-computed tomography (MCT) encompasses two primary scanning options: ex-vivo and in-vivo imaging. Ex-vivo scanning involves the examination of extracted teeth or dental specimens, allowing for detailed analyses of the microarchitecture of mineralized tissue. By analyzing the microarchitecture of dental tissues, MCT can provide valuable information about bone density, porosity, and microstructural changes, contributing to a better understanding of disease progression and treatment outcomes. Moreover, MCT facilitates the quantification of dental parameters, such as bone volume, trabecular thickness, and connectivity density, which are crucial for evaluating the efficacy of dental interventions. This present study aims to comprehensively review and explore the applications of MCT in dentistry and highlight its potential in advancing research and clinical practice. The results depicted that the quantitative approach of MCT enhances the precision and reliability of dental research. Researchers and clinicians can make evidence-based decisions regarding treatment strategies and patient management, relying on quantifiable data provided by MCT. The applications of MCT in dentistry extend beyond research, with potential clinical implications in fields such as dental implantology and endodontics. MCT is expected to play an increasingly significant role in enhancing our understanding of dental pathologies, improving treatment outcomes, and ultimately, benefiting patient care in the field of dentistry.
文摘离体肝切除和自体肝移植术(ex-vivo liver resection and autotransplantation,ELRA)是肝脏外科中的一种复杂术式。ELRA适合于侵犯下腔静脉、门静脉与肝静脉及它们分支的复杂病灶的切除。近几年,经过众多学者对ELRA进行大量的手术实践与研究分析后,ELRA迅速发展。在疾病的适应证中,ELRA着重于晚期肝恶性肿瘤与终末期肝泡型棘球蚴病的治疗。最新的研究中,肝脏Child-Pugh评分B级和残余肝脏体积与标准肝脏体积之比为0.35~0.40的病人也能满足ELRA的肝脏要求。另外,体内临时的门腔静脉分流技术也因其术后死亡率低于过去的体外静脉-静脉转流技术而成为术中首选。术中的血管重建,重点围绕肝后下腔静脉重建方式的选择。对于需重建肝后下腔静脉的病人,则根据病灶切除后肝后下腔静脉壁缺损的程度,采用直接缝合、使用补片、使用人工血管的方式进行重建。现结合文献,对上述领域进行综述。
文摘Despite significant improvements in outcomes after liver trans-plantation,many patients continue to die on the waiting list,while awaiting an available organ for transplantation.Organ shortage is not only due to an inadequate number of available organs,but also the inability to adequately assess and evaluate these organs prior to transplantation.Over the last few decades,ex-vivo perfusion of the liver has emerged as a useful technique for both improved organ preservation and assessment of organs prior to transplantation.Large animal studies have shown the superiority of ex-vivo perfusion over cold static storage.However,these studies have not,necessa-rily,been translatable to human livers.Small animal studies have been essential in understanding and improving this tech-nology.Similarly,these results have yet to be translated into clinical use.A few Phase 1 clinical trials have shown promise and confirmed the viability of this technology.However,more robust studies are needed before ex-vivo liver perfusion can be widely accepted as the new clinical standard of organ preser-vation.Here,we aimed to review al relevant large and smal animal research,as well as human liver studies on normother-mic ex-vivo perfusion,and to identify areas of deficiency and opportunities for future research endeavors.
基金This study was supported by the Zhejiang Provincial Natural Science Foundation of China under Grant(LY20H120001,LQ20A020008)the National Natural Science Foundation of China(82001924).
文摘The evaluation of the corneal biomechanical behaviour has important clinical applications.To name a few,the accuracy of the intraocular pressure measurement,the study of corneal ectatic diseases and the assessment and optimisation of corneal surgical procedures are all highly influenced by corneal biomechanics.Over the last 45 years different ex-vivo methods were developed to study corneal biomechanical behaviour.Different tissue maintenance,support,loading systems,as well as different monitoring strategies of corneal deformations were employed.In this review,the most important and commonly used methods are outlined,including strip extensiometry,inflation,compression,indentation and tissue separation testing.Their particularities,applications,pros and cons and main applications are discussed.
