Parenchymal neurocysticercosis is the most common form of neurocysticercosis in the central nervous system(CNS),which mainly causes epilepsy and usually responses well to routine medications.However,there are apprecia...Parenchymal neurocysticercosis is the most common form of neurocysticercosis in the central nervous system(CNS),which mainly causes epilepsy and usually responses well to routine medications.However,there are appreciable cases of relapses refractory to medical treatment.We investigated microsurgical treatment of epilepsy with parenchymal neurocysticercosis.Nine cases of epilepsy caused by parenchymal neurocysticercosis from 2002 to 2018 were analyzed retrospectively.Cysts in 7 cases were completely removed.No case died of operation and no new dysfunction of the nervous system was observed after surgery.Among the other 9 cases,8 cases became seizure-free or controlled by medicine according to the postoperative followup for 6 months to 9 years.One case was lost for followup.It was suggested that epilepsy with parenchymal neurocysticercosis can usually be controlled after routine medications.However,surgery is still indicated in some cases and careful microsurgery is associated with satisfactory clinical outcomes in appropriately selected cases.展开更多
Background Liver resection involves surgical removal of a portion of the liver.It is used to treat liver tumors and liver injuries.The complexity and high-risk nature of this surgery prevents novice doctors from pract...Background Liver resection involves surgical removal of a portion of the liver.It is used to treat liver tumors and liver injuries.The complexity and high-risk nature of this surgery prevents novice doctors from practicing it on real patients.Virtual surgery simulation was developed to simulate surgical procedures to enable medical professionals to be trained without requiring a patient,a cadaver,or an animal.Therefore,there is a strong need for the development of a liver resection surgery simulation system.We propose a real-time simulation system that provides realistic visual and tactile feedback for hepatic parenchymal transection.Methods The tetrahedron structure and cluster-based shape matching are used for physical model construction,topology update of a three-dimensional liver model soft deformation simulation,and haptic rendering acceleration.During the liver parenchyma separation simulation,a tetrahedral mesh is used for surface triangle subdivision and surface generation of the surgical wound.The shape-matching cluster is separated via component detection on an undirected graph constructed using the tetrahedral mesh.Results In our system,cluster-based shape matching is implemented on a GPU,whereas haptic rendering and topology updates are implemented on a CPU.Experimental results show that haptic rendering can be performed at a high frequency(>900Hz),whereas mesh skinning and graphics rendering can be performed at 45fps.The topology update can be executed at an interactive rate(>10Hz)on a single CPU thread.Conclusions We propose an interactive hepatic parenchymal transection simulation method based on a tetrahedral structure.The tetrahedral mesh simultaneously supports physical model construction,topology update,and haptic rendering acceleration.展开更多
Pineal apoplexy is a rare clinical presentation of pineal parenchymal tumors. We report the curative treatment of a case of pineal parenchymal tumor of intermediate differentiation with spontaneous apoplectic hemorrha...Pineal apoplexy is a rare clinical presentation of pineal parenchymal tumors. We report the curative treatment of a case of pineal parenchymal tumor of intermediate differentiation with spontaneous apoplectic hemorrhage. This case is shown through computed tomography and magnetic resonance imaging of the brain, and is confirmed via histopathological studies. Recurrent upward gaze paresis was observed after the stereotactic biopsy. The paresis required an expeditious tumor resection. The mechanism of the pineal apoplectic hemorrhage remains unclear although it has been observed in different pineal region lesions. Clinical and radiological evidence of the cure 5 years post-surgery is available.展开更多
Objective: We investigated the correlations between background parenchymal enhancement (BPE) and MRI interpretations with respect to short-interval follow-ups and biopsy rates. Methods: All accessible MRI examinations...Objective: We investigated the correlations between background parenchymal enhancement (BPE) and MRI interpretations with respect to short-interval follow-ups and biopsy rates. Methods: All accessible MRI examinations from 128 women during a limited time period in 2016 were evaluated. A blinded radiologist visually categorized BPE as minimal, mild, moderate, or marked. A BI-RADS category was also assigned. We used descriptive statistics to report the findings and chi-square and Fisher’s exact tests to compare categories. Results: Prevalence of minimal, mild, moderate, and marked BPE was 14.1%, 43.0%, 32.0%, and 10.9%, respectively. The short-interval follow-up rates were 22.2%, 27.3%, 26.8%, and 7.1% in women with minimal, mild, moderate, and marked BPE, respectively. BPE was not associated with the short-interval follow-up rate (p-value = 0.477). Biopsy rates were 22.2%, 27.3%, 22.0%, and 57.1% in women with minimal, mild, moderate, and marked BPE, respectively. Although there was no significant relationship between biopsy rates and BPE levels (p-value = 0.095) in the total population, these two factors were significantly associated in premenopausal women (p-value = 0.023) and in women of 30 - 39 years (p-value = 0.001). Conclusion: Higher BPE does not correlate with short-interval follow-up rates, but appears to be related to biopsy rate, thus causing false-positives and unnecessary biopsy recommendations, particularly in younger, premenopausal women.展开更多
Objective: The objective of this study was to assess the sonographic findings in renal parenchymal diseases using gray-scale ultrasound in order to classify these diseases. The study design was a cross-sectional one. ...Objective: The objective of this study was to assess the sonographic findings in renal parenchymal diseases using gray-scale ultrasound in order to classify these diseases. The study design was a cross-sectional one. There were 204 patients who were suspected with renal diseases. They had been scanned with ultrasound to assess the kidneys. The echogenicity, renal cortex and paren-chyma, and cortico-medullary differentiation had been evaluated. Results: The study revealed that the echogenicity of renal parenchyma and cortex increased in all types of renal parenchymal diseases. The cortico-medullary differentiation was mainly disturbed in acute parenchymal disease (69.04%), loss in chronic end-stage parenchymal disease (85%);and there was significant difference (p-value = 0.0001). Conclusion: Ultrasound provided useful and accurate diagnosis of renal parenchymal diseases. In this study, renal parenchymal diseases had been classified into acute, chronic and end-stage renal parenchymal diseases.展开更多
Motor impairment of cerebral origin is a syndrome that induces a reduction in activity, the origin of which is brain injury or a non-progressive and definitive abnormality occurring in a developing immature brain. Mot...Motor impairment of cerebral origin is a syndrome that induces a reduction in activity, the origin of which is brain injury or a non-progressive and definitive abnormality occurring in a developing immature brain. Motor disability, spastic, dyskinetic or ataxic, is often associated with sensory, cognitive, sensory and behavioral disorders with or without epileptic disease. View of accidental discoveries of corpus callosum abnormalities, most often asymptomatic or associated with psychomotor retardation, epilepsy, neurological disorders or cardiomyopathy, a high technical platform must be available for its diagnosis. We report in this article the case of a 7-year-old boy followed at the neuropsychiatric center Joseph Guislain of the Brothers of Charity of Lubumbashi in Congo (DRC) since 2016 for generalized tonic-clonic seizures, in whom the diagnosis of cerebral palsy on cyst of corpus callosum and in the right parietal lobe, as well as cardiopathy was posed during its consultation in September 2017. This case was published with parental consent.展开更多
Objective To evaluate the value of renal parenchymal volume and thickness by non-contrast spiral CT in evaluating the differential glomerular filtration rate ( GFR) for chronic obstructed kidneys,and to compare the co...Objective To evaluate the value of renal parenchymal volume and thickness by non-contrast spiral CT in evaluating the differential glomerular filtration rate ( GFR) for chronic obstructed kidneys,and to compare the correlations between two morphologic indices of renal parenchyma and GFR for chronic obstructed kidneys.展开更多
Objective To study the clinical feature,image,treatment and prognosis of supratentorial parenchymalependymomas.Methods14cases of patients sufferedfrom supratentorial parenchymal ependymomas were treated.There were10ep...Objective To study the clinical feature,image,treatment and prognosis of supratentorial parenchymalependymomas.Methods14cases of patients sufferedfrom supratentorial parenchymal ependymomas were treated.There were10ependymomas and4malignantependymomas.Tumor located in frontal lobe in4cases,展开更多
Laparoscopic liver surgery has gained wide acceptance resulting in a paradigm shift of liver surgery.Technical innovations and accumulation of surgeon’s experience have allowed laparoscopic liver resection(LLR)to bec...Laparoscopic liver surgery has gained wide acceptance resulting in a paradigm shift of liver surgery.Technical innovations and accumulation of surgeon’s experience have allowed laparoscopic liver resection(LLR)to become an effective procedure with favorable peri-and post-operative outcomes.Through the overall process of LLR,liver parenchymal transection remains the most critical step with the aim of minimizing blood loss and secures the appropriate cutting line,i.e.,securing major vessels and obtaining adequate surgical margin clearance for malignancies.Multiple preoperative imaging modalities and intraoperative ultrasonography findings may contribute to the best determination of the appropriate cutting line during the LLR;however,technical expertise in minimizing and controlling bleeding during liver parenchymal transection is still a challenge for safe LLR,and therefore represents a major concern for hepatobiliary surgeons.Along with the historical fact that the technique of liver parenchymal transection itself is chosen according to surgeon’s preference and"savoir-faire",the best technical modality in laparoscopic liver parenchymal transection remains to be determined.However,better understanding the technical issue may serve a contribution to the standardization of LLR.This review article therefore focuses on the technical aspects of the laparoscopic liver parenchymal transection.展开更多
The rationale of the performance of anatomic resection(AR)of the liver in case of hepatocellular carcinoma(HCC)is the removal of portal pedicle feeding the tumor because of the tumor’s tendency to invade the portal v...The rationale of the performance of anatomic resection(AR)of the liver in case of hepatocellular carcinoma(HCC)is the removal of portal pedicle feeding the tumor because of the tumor’s tendency to invade the portal veins(1).This technical approach is expected to be effective from an oncological perspective for a disease such as HCC,which is associated with a high rate of intrahepatic recurrence(2,3).In the eighties,Makuuchi et al.proposed the systematic subsegmentectomy(4)reporting excellent results(5),and later some other authors reported new techniques to identify the portal territory of a given HCC and perform a true AR of the liver(5-7).展开更多
Hepatitis C virus(HCV) infection is associated with increased thrombotic risk. Several mechanisms are involved including direct endothelial damage by the HCV virus, with activation of tissue factor, altered fibrinolys...Hepatitis C virus(HCV) infection is associated with increased thrombotic risk. Several mechanisms are involved including direct endothelial damage by the HCV virus, with activation of tissue factor, altered fibrinolysis and increased platelet aggregation and activation. In advanced stages, chronic HCV infection may evolve to liver cirrhosis, a condition in which alterations in the portal microcirculation may also ultimately lead to thrombin activation, platelet aggregation, and clot formation. Therefore in advanced HCV liver disease there is an increased prevalence of thrombotic phenomena in portal vein radicles. Increased thrombin formation may activate hepatic stellate cells and promote liver fibrosis. In addition, ischemic changes derived from vascular occlusion by microthrombi favor the so called parenchymal extinction, a process that promotes collapse of hepatocytes and the formation of gross fibrous tracts. These reasons may explain why advanced HCV infection may evolve more rapidly to end-stage liver disease than other forms of cirrhosis.展开更多
AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/<sup>99m</sup>Tc-galactosyl-human serum albumin (GSA) single-photon emission com...AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/<sup>99m</sup>Tc-galactosyl-human serum albumin (GSA) single-photon emission computed tomography (SPECT) fusion imaging for surgical decision making.METHODS: We enrolled 57 patients who underwent bi- or trisectionectomy at our institution between October 2013 and March 2015. Of these, 26 patients presented with hepatocellular carcinoma, 12 with hilar cholangiocarcinoma, six with intrahepatic cholangiocarcinoma, four with liver metastasis, and nine with other diseases. All patients preoperatively underwent three-phase dynamic multidetector CT and <sup>99m</sup>Tc-GSA scintigraphy. We compared the parenchymal hepatic resection rate (PHRR) with the FHRR, which was defined as the resection volume counts per total liver volume counts on 3D CT/<sup>99m</sup>Tc-GSA SPECT fusion images.RESULTS: In total, 50 patients underwent bisectionectomy and seven underwent trisectionectomy. Biliary reconstruction was performed in 15 patients, including hepatopancreatoduodenectomy in two. FHRR and PHRR were 38.6 ± 19.9 and 44.5 ± 16.0, respectively; FHRR was strongly correlated with PHRR. The regression coefficient for FHRR on PHRR was 1.16 (P < 0.0001). The ratio of FHRR to PHRR for patients with preoperative therapies (transcatheter arterial chemoembolization, radiation, radiofrequency ablation, etc.), large tumors with a volume of > 1000 mL, and/or macroscopic vascular invasion was significantly smaller than that for patients without these factors (0.73 ± 0.19 vs 0.82 ± 0.18, P < 0.05). Postoperative hyperbilirubinemia was observed in six patients. Major morbidities (Clavien-Dindo grade ≥ 3) occurred in 17 patients (29.8%). There was no case of surgery-related death.CONCLUSION: Our results suggest that FHRR is an important deciding factor for major hepatectomy, because FHRR and PHRR may be discrepant owing to insufficient hepatic inflow and congestion in patients with preoperative therapies, macroscopic vascular invasion, and/or a tumor volume of > 1000 mL.展开更多
Endoscopic ultrasound guided liver biopsy(EUS-LB)has emerged as a minimally-invasive alternative to the traditional(percutaneous or transjugular)liver biopsy techniques for the diagnosis of liver parenchymal diseases....Endoscopic ultrasound guided liver biopsy(EUS-LB)has emerged as a minimally-invasive alternative to the traditional(percutaneous or transjugular)liver biopsy techniques for the diagnosis of liver parenchymal diseases.Potentially,EUS-LB combines the advantages of percutaneous and transjugular liver biopsy in addressing focused sampling in addition to measuring portal pressure.Additionally,EUS-LB facilitates access to both the lobes of the liver which is not considered with the traditional percutaneous liver biopsy.Multiple studies have compared EUS-LB with conventional liver biopsy and reported comparable diagnostic yield,increased acquisition of complete portal tracts,and longer specimen length as compared to the traditional approaches.EUS-LB is associated with lesser post-procedural pain and shorter recovery time,while providing lower risk of complications when compared to traditional liver biopsy.Innovations in needle types,needle sizes and suction techniques have aimed at further optimizing the EUS-LB technique.This review article updates current literature with focus on the variations in the technique and equipment used for EUS-LB,and compares EUS-LB with traditional methods of liver biopsy.展开更多
An isolated parenchymal gastric metastasis from ovarian carcinoma without any other sites of recurrence is extremely rare. Only two cases have been reported, both of which were symptomatic. We herein report such a cas...An isolated parenchymal gastric metastasis from ovarian carcinoma without any other sites of recurrence is extremely rare. Only two cases have been reported, both of which were symptomatic. We herein report such a case without any symptoms. A 61-year-old woman presented with a high cancer antigen-125 level without any other clinical manifestation. A subsequent 18 F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography scan revealed a submucosal mass with hypermetabolism of 18F-FDG (standardized uptake value:5.36) in the gastric antrum. The final pathology after gastric antrectomy showed a metastatic gastric tumor from a primary ovarian carcinoma. We also performed an extensive literature review about gastric metastasis from ovarian carcinoma published until recently, and this is the first case of an isolated parenchymal gastric metastasis from ovarian carcinoma without any symptoms.展开更多
BACKGROUND Several methods,such as finger fracture,Pean crush,cavitron ultrasonic surgical aspirator(CUSA),and water jet(WJ),are used for hepatic parenchymal dissection in liver surgery.CUSA is the conventional method...BACKGROUND Several methods,such as finger fracture,Pean crush,cavitron ultrasonic surgical aspirator(CUSA),and water jet(WJ),are used for hepatic parenchymal dissection in liver surgery.CUSA is the conventional method in Japan.WJ is a relatively novel method for parenchymal dissection.Although it has several advantages,such as lower volume of blood loss and shorter operative time,the effect of the WJ system for hepatic dissection on the remnant liver has not yet been investigated.AIM To investigate and compare the effect of the WJ method vs CUSA on the remnant liver cut surface.METHODS This observational study compared the two types of parenchymal transection methods(WJ vs CUSA)in liver surgery.In total,24 and 40 patients who underwent hepatectomy using the WJ method and CUSA,respectively,were included in the analysis.Accordingly,the clinicopathological characteristics and clinical outcomes of 24 and 40 patients were compared.Furthermore,postoperative contrast-enhanced computed tomography(CT)scan was performed to assess the cut surface length of the remnant liver and the degenerative thickness of the areas with a reduced contrast effect in the dissected plane.Then,the two groups were compared.RESULTS On CT scan,the median areas of denaturation in the liver dissection planes were 522(range:109.5-1242)mm^(2) in the CUSA group and 324(range:93.6-1529)mm^(2) in the WJ group.The area did not significantly differ between the two groups;however,the denaturation thickness of the WJ group was significantly lower than that of the CUSA group[5.8(range:0.7-11.1)mm vs 3.3(range:1.7-10.4)mm,P<0.001].CONCLUSION The WJ group had significantly thinner contrast-enhanced areas in the post hepatectomy detached section than the CUSA group.展开更多
[ Objective] This study aimed to investigate pathological changes in various organs of piglets infected with classical swine fever and provide reliable basis for accurate diagnosis of classical swine fever. [ Method] ...[ Objective] This study aimed to investigate pathological changes in various organs of piglets infected with classical swine fever and provide reliable basis for accurate diagnosis of classical swine fever. [ Method] By using paraffin embedding, section slicing and HE staining, histopathological changes in the heart, liver, spleen, lung, kidney and small intestine tissues of five diseased piglets were observed. C Result] Classical swine fever virus could lead to multiple visceral and mueosal hemorrhages, inflammatory cell infiltration, necrosis and other pathological changes. [ Conclusion ] Classical swine fever virus can further cause progressive degeneration and necrosis of different cells, resulting in immune injury.展开更多
Pulmonary amyloidosis is uncommon and is usually associated with systemic amyloidosis. Localized pulmonary involvement in amyloidosis without systemic amyloidosis is even rarer; it is generally tracheobronchial or par...Pulmonary amyloidosis is uncommon and is usually associated with systemic amyloidosis. Localized pulmonary involvement in amyloidosis without systemic amyloidosis is even rarer; it is generally tracheobronchial or parenchymal in location. Parenchymal pulmonary amyloidosis is generally asymptomatic and an incidental finding, presenting as nodules varying in size and number, unilateral or bilateral. We present an unusual case of primary bilateral pulmonary nodular amyloidosis in an elderly female.展开更多
Background： Laparoscopic liver resection （LLR） has been considered to be safe and feasible. However, few studies focused on the comparison between the anatomic and nonanatomic LLR. Therefore, the purpose of this st...Background： Laparoscopic liver resection （LLR） has been considered to be safe and feasible. However, few studies focused on the comparison between the anatomic and nonanatomic LLR. Therefore, the purpose of this study was to compare the perioperative factors and outcomes of the anatomic and nonanatomic LLR, especially the area of liver parenchymal transection and blood loss per unit area. Methods： In this study, surgical and oncological data of patients underwent pure LLR procedures for malignant liver tumor were prospectively collected. Blood loss per unit area of liver parenchymal transection was measured and considered as an important parameter. All procedures were conducted by a single surgeon. Results： During nearly 5 years, 84 patients with malignant liver tumor received a pure LLR procedure were included. Among them, 34 patients received anatomic LLR and 50 received nonanatomic LLR, respectively. Patients of the two groups were similar in terms of demographic features and tumor characteristics, despite the tumor size was significantly larger in the anatomic LLR group than that in the nonanatomic LLR group （4.77 ± 2.57 vs. 2.87 ± 2.10 cm, P = 0.001）. Patients who underwent anatomic resection had longer operation time （364.09 ± 131.22 vs. 252.00±135.21 min, P 〈 0.001） but less blood loss per unit area （7.85 ± 7.17 vs. 14.17 ± 10.43 ml/cm2, P = 0.018）. Nonanatomic LLR was associated with more blood loss when the area of parenchymal transection was equal to the anatomic LLR. No mortality occurred during the hospital stay and 30 days alter the operation. Moreover, there was no difference in the incidence of postoperative complications. The disease-free and overall survival rates showed no significant differences between the anatomic LLR and nonanatomic LLR groups. Conclusions： Both anatomic and nonanatomic pure LLR are safe and feasible. Measuring the area of parenchymal transection is a simple and effective method to estimate the outcomes of the liver resection surgery＇. Blood loss per unit area is an important parameter which is comparable between the anatomic LLR and nonanatomic LLR groups.展开更多
Successful regenerative medicine strategies of xenogeneic extracellular matrix need a synergistic balance among inflammation,fibrosis,and remodeling process.Adaptive macrophage subsets have been identified to modulate...Successful regenerative medicine strategies of xenogeneic extracellular matrix need a synergistic balance among inflammation,fibrosis,and remodeling process.Adaptive macrophage subsets have been identified to modulate inflammation and orchestrate the repair of neighboring parenchymal tissues.This study fabricated PPARγ-primed CD68+CD206+M2 phenotype(M2γ),and firstly verified their anti-inflammatory and tissue-regenerating roles in xenogeneic bioengineered organ regeneration.Our results showed that Th1-type CD3^(+)CD8^(+)T cell response to xenogeneic-dentin matrix-based bioengineered root complex(xeno-complex)was significantly inhibited by M2γmacrophage in vitro.PPARγactivation also timely recruited CD68^(+)CD206^(+)tissue macrophage polarization to xeno-complex in vivo.These subsets alleviated proinflammatory cytokines(TNF-α,IFN-γ)at the inflammation site and decreased CD3^(+)CD8^(+)T lymphocytes in the periphery system.When translated to an orthotopic nonhuman primate model,PPARγ-primed M2 macrophages immunosuppressed IL-1β,IL-6,TNF-α,MMPs to enable xeno-complex to effectively escape immune-mediated rejection and initiate graft-host synergistic integrity.These collective activities promoted the differentiation of odontoblast-like and periodontal-like cells to guide pulp-dentin and cementum-PDLs-bone regeneration and rescued partially injured odontogenesis such as DSPP and periostin expression.Finally,the regenerated root showed structure-biomechanical and functional equivalency to the native tooth.The timely conversion of M1-to-M2 macrophage mainly orchestrated odontogenesis,fibrogenesis,and osteogenesis,which represents a potential modulator for intact parenchymal-stromal tissue regeneration of targeted organs.展开更多
基金Hubei Province Natural Science Foundation of China(No.2017CFB643).
文摘Parenchymal neurocysticercosis is the most common form of neurocysticercosis in the central nervous system(CNS),which mainly causes epilepsy and usually responses well to routine medications.However,there are appreciable cases of relapses refractory to medical treatment.We investigated microsurgical treatment of epilepsy with parenchymal neurocysticercosis.Nine cases of epilepsy caused by parenchymal neurocysticercosis from 2002 to 2018 were analyzed retrospectively.Cysts in 7 cases were completely removed.No case died of operation and no new dysfunction of the nervous system was observed after surgery.Among the other 9 cases,8 cases became seizure-free or controlled by medicine according to the postoperative followup for 6 months to 9 years.One case was lost for followup.It was suggested that epilepsy with parenchymal neurocysticercosis can usually be controlled after routine medications.However,surgery is still indicated in some cases and careful microsurgery is associated with satisfactory clinical outcomes in appropriately selected cases.
基金NSFC(61902014)Research Unit of Virtual Human and Virtual Surgery,Chinese Academy of Medical Sciences(2019RU004)Medical Innovation Research Project of PLA General Hospital(CX19032).
文摘Background Liver resection involves surgical removal of a portion of the liver.It is used to treat liver tumors and liver injuries.The complexity and high-risk nature of this surgery prevents novice doctors from practicing it on real patients.Virtual surgery simulation was developed to simulate surgical procedures to enable medical professionals to be trained without requiring a patient,a cadaver,or an animal.Therefore,there is a strong need for the development of a liver resection surgery simulation system.We propose a real-time simulation system that provides realistic visual and tactile feedback for hepatic parenchymal transection.Methods The tetrahedron structure and cluster-based shape matching are used for physical model construction,topology update of a three-dimensional liver model soft deformation simulation,and haptic rendering acceleration.During the liver parenchyma separation simulation,a tetrahedral mesh is used for surface triangle subdivision and surface generation of the surgical wound.The shape-matching cluster is separated via component detection on an undirected graph constructed using the tetrahedral mesh.Results In our system,cluster-based shape matching is implemented on a GPU,whereas haptic rendering and topology updates are implemented on a CPU.Experimental results show that haptic rendering can be performed at a high frequency(>900Hz),whereas mesh skinning and graphics rendering can be performed at 45fps.The topology update can be executed at an interactive rate(>10Hz)on a single CPU thread.Conclusions We propose an interactive hepatic parenchymal transection simulation method based on a tetrahedral structure.The tetrahedral mesh simultaneously supports physical model construction,topology update,and haptic rendering acceleration.
文摘Pineal apoplexy is a rare clinical presentation of pineal parenchymal tumors. We report the curative treatment of a case of pineal parenchymal tumor of intermediate differentiation with spontaneous apoplectic hemorrhage. This case is shown through computed tomography and magnetic resonance imaging of the brain, and is confirmed via histopathological studies. Recurrent upward gaze paresis was observed after the stereotactic biopsy. The paresis required an expeditious tumor resection. The mechanism of the pineal apoplectic hemorrhage remains unclear although it has been observed in different pineal region lesions. Clinical and radiological evidence of the cure 5 years post-surgery is available.
文摘Objective: We investigated the correlations between background parenchymal enhancement (BPE) and MRI interpretations with respect to short-interval follow-ups and biopsy rates. Methods: All accessible MRI examinations from 128 women during a limited time period in 2016 were evaluated. A blinded radiologist visually categorized BPE as minimal, mild, moderate, or marked. A BI-RADS category was also assigned. We used descriptive statistics to report the findings and chi-square and Fisher’s exact tests to compare categories. Results: Prevalence of minimal, mild, moderate, and marked BPE was 14.1%, 43.0%, 32.0%, and 10.9%, respectively. The short-interval follow-up rates were 22.2%, 27.3%, 26.8%, and 7.1% in women with minimal, mild, moderate, and marked BPE, respectively. BPE was not associated with the short-interval follow-up rate (p-value = 0.477). Biopsy rates were 22.2%, 27.3%, 22.0%, and 57.1% in women with minimal, mild, moderate, and marked BPE, respectively. Although there was no significant relationship between biopsy rates and BPE levels (p-value = 0.095) in the total population, these two factors were significantly associated in premenopausal women (p-value = 0.023) and in women of 30 - 39 years (p-value = 0.001). Conclusion: Higher BPE does not correlate with short-interval follow-up rates, but appears to be related to biopsy rate, thus causing false-positives and unnecessary biopsy recommendations, particularly in younger, premenopausal women.
文摘Objective: The objective of this study was to assess the sonographic findings in renal parenchymal diseases using gray-scale ultrasound in order to classify these diseases. The study design was a cross-sectional one. There were 204 patients who were suspected with renal diseases. They had been scanned with ultrasound to assess the kidneys. The echogenicity, renal cortex and paren-chyma, and cortico-medullary differentiation had been evaluated. Results: The study revealed that the echogenicity of renal parenchyma and cortex increased in all types of renal parenchymal diseases. The cortico-medullary differentiation was mainly disturbed in acute parenchymal disease (69.04%), loss in chronic end-stage parenchymal disease (85%);and there was significant difference (p-value = 0.0001). Conclusion: Ultrasound provided useful and accurate diagnosis of renal parenchymal diseases. In this study, renal parenchymal diseases had been classified into acute, chronic and end-stage renal parenchymal diseases.
文摘Motor impairment of cerebral origin is a syndrome that induces a reduction in activity, the origin of which is brain injury or a non-progressive and definitive abnormality occurring in a developing immature brain. Motor disability, spastic, dyskinetic or ataxic, is often associated with sensory, cognitive, sensory and behavioral disorders with or without epileptic disease. View of accidental discoveries of corpus callosum abnormalities, most often asymptomatic or associated with psychomotor retardation, epilepsy, neurological disorders or cardiomyopathy, a high technical platform must be available for its diagnosis. We report in this article the case of a 7-year-old boy followed at the neuropsychiatric center Joseph Guislain of the Brothers of Charity of Lubumbashi in Congo (DRC) since 2016 for generalized tonic-clonic seizures, in whom the diagnosis of cerebral palsy on cyst of corpus callosum and in the right parietal lobe, as well as cardiopathy was posed during its consultation in September 2017. This case was published with parental consent.
文摘Objective To evaluate the value of renal parenchymal volume and thickness by non-contrast spiral CT in evaluating the differential glomerular filtration rate ( GFR) for chronic obstructed kidneys,and to compare the correlations between two morphologic indices of renal parenchyma and GFR for chronic obstructed kidneys.
文摘Objective To study the clinical feature,image,treatment and prognosis of supratentorial parenchymalependymomas.Methods14cases of patients sufferedfrom supratentorial parenchymal ependymomas were treated.There were10ependymomas and4malignantependymomas.Tumor located in frontal lobe in4cases,
文摘Laparoscopic liver surgery has gained wide acceptance resulting in a paradigm shift of liver surgery.Technical innovations and accumulation of surgeon’s experience have allowed laparoscopic liver resection(LLR)to become an effective procedure with favorable peri-and post-operative outcomes.Through the overall process of LLR,liver parenchymal transection remains the most critical step with the aim of minimizing blood loss and secures the appropriate cutting line,i.e.,securing major vessels and obtaining adequate surgical margin clearance for malignancies.Multiple preoperative imaging modalities and intraoperative ultrasonography findings may contribute to the best determination of the appropriate cutting line during the LLR;however,technical expertise in minimizing and controlling bleeding during liver parenchymal transection is still a challenge for safe LLR,and therefore represents a major concern for hepatobiliary surgeons.Along with the historical fact that the technique of liver parenchymal transection itself is chosen according to surgeon’s preference and"savoir-faire",the best technical modality in laparoscopic liver parenchymal transection remains to be determined.However,better understanding the technical issue may serve a contribution to the standardization of LLR.This review article therefore focuses on the technical aspects of the laparoscopic liver parenchymal transection.
文摘The rationale of the performance of anatomic resection(AR)of the liver in case of hepatocellular carcinoma(HCC)is the removal of portal pedicle feeding the tumor because of the tumor’s tendency to invade the portal veins(1).This technical approach is expected to be effective from an oncological perspective for a disease such as HCC,which is associated with a high rate of intrahepatic recurrence(2,3).In the eighties,Makuuchi et al.proposed the systematic subsegmentectomy(4)reporting excellent results(5),and later some other authors reported new techniques to identify the portal territory of a given HCC and perform a true AR of the liver(5-7).
文摘Hepatitis C virus(HCV) infection is associated with increased thrombotic risk. Several mechanisms are involved including direct endothelial damage by the HCV virus, with activation of tissue factor, altered fibrinolysis and increased platelet aggregation and activation. In advanced stages, chronic HCV infection may evolve to liver cirrhosis, a condition in which alterations in the portal microcirculation may also ultimately lead to thrombin activation, platelet aggregation, and clot formation. Therefore in advanced HCV liver disease there is an increased prevalence of thrombotic phenomena in portal vein radicles. Increased thrombin formation may activate hepatic stellate cells and promote liver fibrosis. In addition, ischemic changes derived from vascular occlusion by microthrombi favor the so called parenchymal extinction, a process that promotes collapse of hepatocytes and the formation of gross fibrous tracts. These reasons may explain why advanced HCV infection may evolve more rapidly to end-stage liver disease than other forms of cirrhosis.
文摘AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/<sup>99m</sup>Tc-galactosyl-human serum albumin (GSA) single-photon emission computed tomography (SPECT) fusion imaging for surgical decision making.METHODS: We enrolled 57 patients who underwent bi- or trisectionectomy at our institution between October 2013 and March 2015. Of these, 26 patients presented with hepatocellular carcinoma, 12 with hilar cholangiocarcinoma, six with intrahepatic cholangiocarcinoma, four with liver metastasis, and nine with other diseases. All patients preoperatively underwent three-phase dynamic multidetector CT and <sup>99m</sup>Tc-GSA scintigraphy. We compared the parenchymal hepatic resection rate (PHRR) with the FHRR, which was defined as the resection volume counts per total liver volume counts on 3D CT/<sup>99m</sup>Tc-GSA SPECT fusion images.RESULTS: In total, 50 patients underwent bisectionectomy and seven underwent trisectionectomy. Biliary reconstruction was performed in 15 patients, including hepatopancreatoduodenectomy in two. FHRR and PHRR were 38.6 ± 19.9 and 44.5 ± 16.0, respectively; FHRR was strongly correlated with PHRR. The regression coefficient for FHRR on PHRR was 1.16 (P < 0.0001). The ratio of FHRR to PHRR for patients with preoperative therapies (transcatheter arterial chemoembolization, radiation, radiofrequency ablation, etc.), large tumors with a volume of > 1000 mL, and/or macroscopic vascular invasion was significantly smaller than that for patients without these factors (0.73 ± 0.19 vs 0.82 ± 0.18, P < 0.05). Postoperative hyperbilirubinemia was observed in six patients. Major morbidities (Clavien-Dindo grade ≥ 3) occurred in 17 patients (29.8%). There was no case of surgery-related death.CONCLUSION: Our results suggest that FHRR is an important deciding factor for major hepatectomy, because FHRR and PHRR may be discrepant owing to insufficient hepatic inflow and congestion in patients with preoperative therapies, macroscopic vascular invasion, and/or a tumor volume of > 1000 mL.
文摘Endoscopic ultrasound guided liver biopsy(EUS-LB)has emerged as a minimally-invasive alternative to the traditional(percutaneous or transjugular)liver biopsy techniques for the diagnosis of liver parenchymal diseases.Potentially,EUS-LB combines the advantages of percutaneous and transjugular liver biopsy in addressing focused sampling in addition to measuring portal pressure.Additionally,EUS-LB facilitates access to both the lobes of the liver which is not considered with the traditional percutaneous liver biopsy.Multiple studies have compared EUS-LB with conventional liver biopsy and reported comparable diagnostic yield,increased acquisition of complete portal tracts,and longer specimen length as compared to the traditional approaches.EUS-LB is associated with lesser post-procedural pain and shorter recovery time,while providing lower risk of complications when compared to traditional liver biopsy.Innovations in needle types,needle sizes and suction techniques have aimed at further optimizing the EUS-LB technique.This review article updates current literature with focus on the variations in the technique and equipment used for EUS-LB,and compares EUS-LB with traditional methods of liver biopsy.
文摘An isolated parenchymal gastric metastasis from ovarian carcinoma without any other sites of recurrence is extremely rare. Only two cases have been reported, both of which were symptomatic. We herein report such a case without any symptoms. A 61-year-old woman presented with a high cancer antigen-125 level without any other clinical manifestation. A subsequent 18 F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography scan revealed a submucosal mass with hypermetabolism of 18F-FDG (standardized uptake value:5.36) in the gastric antrum. The final pathology after gastric antrectomy showed a metastatic gastric tumor from a primary ovarian carcinoma. We also performed an extensive literature review about gastric metastasis from ovarian carcinoma published until recently, and this is the first case of an isolated parenchymal gastric metastasis from ovarian carcinoma without any symptoms.
文摘BACKGROUND Several methods,such as finger fracture,Pean crush,cavitron ultrasonic surgical aspirator(CUSA),and water jet(WJ),are used for hepatic parenchymal dissection in liver surgery.CUSA is the conventional method in Japan.WJ is a relatively novel method for parenchymal dissection.Although it has several advantages,such as lower volume of blood loss and shorter operative time,the effect of the WJ system for hepatic dissection on the remnant liver has not yet been investigated.AIM To investigate and compare the effect of the WJ method vs CUSA on the remnant liver cut surface.METHODS This observational study compared the two types of parenchymal transection methods(WJ vs CUSA)in liver surgery.In total,24 and 40 patients who underwent hepatectomy using the WJ method and CUSA,respectively,were included in the analysis.Accordingly,the clinicopathological characteristics and clinical outcomes of 24 and 40 patients were compared.Furthermore,postoperative contrast-enhanced computed tomography(CT)scan was performed to assess the cut surface length of the remnant liver and the degenerative thickness of the areas with a reduced contrast effect in the dissected plane.Then,the two groups were compared.RESULTS On CT scan,the median areas of denaturation in the liver dissection planes were 522(range:109.5-1242)mm^(2) in the CUSA group and 324(range:93.6-1529)mm^(2) in the WJ group.The area did not significantly differ between the two groups;however,the denaturation thickness of the WJ group was significantly lower than that of the CUSA group[5.8(range:0.7-11.1)mm vs 3.3(range:1.7-10.4)mm,P<0.001].CONCLUSION The WJ group had significantly thinner contrast-enhanced areas in the post hepatectomy detached section than the CUSA group.
基金Supported by Project of Agricultural Science and Technology Achievement Transformation of the Ministry of Science and Technology of China(2012GB2A200045)Major Project for Cultivation of New Varieties of Genetically Modified Organisms of the Ministry of Agriculture(2011ZX08006001)Science and Technology Development Project of Qinghuangdao City(NO.201101A181)
文摘[ Objective] This study aimed to investigate pathological changes in various organs of piglets infected with classical swine fever and provide reliable basis for accurate diagnosis of classical swine fever. [ Method] By using paraffin embedding, section slicing and HE staining, histopathological changes in the heart, liver, spleen, lung, kidney and small intestine tissues of five diseased piglets were observed. C Result] Classical swine fever virus could lead to multiple visceral and mueosal hemorrhages, inflammatory cell infiltration, necrosis and other pathological changes. [ Conclusion ] Classical swine fever virus can further cause progressive degeneration and necrosis of different cells, resulting in immune injury.
文摘Pulmonary amyloidosis is uncommon and is usually associated with systemic amyloidosis. Localized pulmonary involvement in amyloidosis without systemic amyloidosis is even rarer; it is generally tracheobronchial or parenchymal in location. Parenchymal pulmonary amyloidosis is generally asymptomatic and an incidental finding, presenting as nodules varying in size and number, unilateral or bilateral. We present an unusual case of primary bilateral pulmonary nodular amyloidosis in an elderly female.
文摘Background： Laparoscopic liver resection （LLR） has been considered to be safe and feasible. However, few studies focused on the comparison between the anatomic and nonanatomic LLR. Therefore, the purpose of this study was to compare the perioperative factors and outcomes of the anatomic and nonanatomic LLR, especially the area of liver parenchymal transection and blood loss per unit area. Methods： In this study, surgical and oncological data of patients underwent pure LLR procedures for malignant liver tumor were prospectively collected. Blood loss per unit area of liver parenchymal transection was measured and considered as an important parameter. All procedures were conducted by a single surgeon. Results： During nearly 5 years, 84 patients with malignant liver tumor received a pure LLR procedure were included. Among them, 34 patients received anatomic LLR and 50 received nonanatomic LLR, respectively. Patients of the two groups were similar in terms of demographic features and tumor characteristics, despite the tumor size was significantly larger in the anatomic LLR group than that in the nonanatomic LLR group （4.77 ± 2.57 vs. 2.87 ± 2.10 cm, P = 0.001）. Patients who underwent anatomic resection had longer operation time （364.09 ± 131.22 vs. 252.00±135.21 min, P 〈 0.001） but less blood loss per unit area （7.85 ± 7.17 vs. 14.17 ± 10.43 ml/cm2, P = 0.018）. Nonanatomic LLR was associated with more blood loss when the area of parenchymal transection was equal to the anatomic LLR. No mortality occurred during the hospital stay and 30 days alter the operation. Moreover, there was no difference in the incidence of postoperative complications. The disease-free and overall survival rates showed no significant differences between the anatomic LLR and nonanatomic LLR groups. Conclusions： Both anatomic and nonanatomic pure LLR are safe and feasible. Measuring the area of parenchymal transection is a simple and effective method to estimate the outcomes of the liver resection surgery＇. Blood loss per unit area is an important parameter which is comparable between the anatomic LLR and nonanatomic LLR groups.
基金This work was supported by the National Key Research and Development Program of China(Nos.2017YFA0104800),Nature Science Foundation of China(31771062,31971281,81901001),Key Research and Development Program of Sichuan Province(2017SZ0031).
文摘Successful regenerative medicine strategies of xenogeneic extracellular matrix need a synergistic balance among inflammation,fibrosis,and remodeling process.Adaptive macrophage subsets have been identified to modulate inflammation and orchestrate the repair of neighboring parenchymal tissues.This study fabricated PPARγ-primed CD68+CD206+M2 phenotype(M2γ),and firstly verified their anti-inflammatory and tissue-regenerating roles in xenogeneic bioengineered organ regeneration.Our results showed that Th1-type CD3^(+)CD8^(+)T cell response to xenogeneic-dentin matrix-based bioengineered root complex(xeno-complex)was significantly inhibited by M2γmacrophage in vitro.PPARγactivation also timely recruited CD68^(+)CD206^(+)tissue macrophage polarization to xeno-complex in vivo.These subsets alleviated proinflammatory cytokines(TNF-α,IFN-γ)at the inflammation site and decreased CD3^(+)CD8^(+)T lymphocytes in the periphery system.When translated to an orthotopic nonhuman primate model,PPARγ-primed M2 macrophages immunosuppressed IL-1β,IL-6,TNF-α,MMPs to enable xeno-complex to effectively escape immune-mediated rejection and initiate graft-host synergistic integrity.These collective activities promoted the differentiation of odontoblast-like and periodontal-like cells to guide pulp-dentin and cementum-PDLs-bone regeneration and rescued partially injured odontogenesis such as DSPP and periostin expression.Finally,the regenerated root showed structure-biomechanical and functional equivalency to the native tooth.The timely conversion of M1-to-M2 macrophage mainly orchestrated odontogenesis,fibrogenesis,and osteogenesis,which represents a potential modulator for intact parenchymal-stromal tissue regeneration of targeted organs.
