OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicent...OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were randomly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis<30% with no 30-day major adverse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area product.RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6%).Both groups achieved 100% clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI group had a technical success rate of 100%.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator radiation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups.CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.展开更多
“The inferiority complex after being accused”is one of the typical cultural psychologies of some people currently in the judicial field at the grassroots society in China.It is mainly manifested in their reluctance ...“The inferiority complex after being accused”is one of the typical cultural psychologies of some people currently in the judicial field at the grassroots society in China.It is mainly manifested in their reluctance to be sued or cooperated with the investigation,and keep away from grass-roots judicial field as far as possible in terms of geographical location and behavior.Once someone else are called by the real judiciary or individuals or organizations pretending to the judiciary,it is easy to trigger the illusion that they may have done something wrong in past times,then they can easily fall into a state of depression and confusion,and even be deceived by other malicious people.Obviously,similar psychology is not conducive to the rule by law and modernization of grassroots society,and it is not conducive to the construction of a harmonious police-civilian relationship.Based on humanistic care and universal law,it is necessary to achieve fine justice based on the perspectives of language culture,costume culture,public psychology,etc.,and gradually guide the traditional people to correctly face the phenomenon of the“inferiority complex after being accused”,so it can help they integrate themselves into the modern society ruled by law smoothly.展开更多
Jane Eyre has been the focus of numerous critics and scholars since its publication in 1847 and they have made a great contribution to the study of Jane Eyre, exploring it from different perspectives. Most of critics ...Jane Eyre has been the focus of numerous critics and scholars since its publication in 1847 and they have made a great contribution to the study of Jane Eyre, exploring it from different perspectives. Most of critics and readers regard Jane Eyre as an independent and brave feminism fighter to challenge the tradition in Victorian period while they tend to pay less attention to the invisible side of Jane Eyre. Jane Eyre is not always so brave and strong and confident to face her life, which can be discovered from her language and behavior when she confronts conflicts. This is Jane Eyre's feeling of inferiority. From the perspective of Alfred Adler's individual psychology, this thesis studies Jane Eyre's feeling of inferiority at Gateshead.展开更多
Jane Eyre has been regarded as a self-esteemed woman.But actually she is one with inferiority complex.This essay will analyze this novel from her inferiority complex with Alfred Adler’s theory.The analysis will unfol...Jane Eyre has been regarded as a self-esteemed woman.But actually she is one with inferiority complex.This essay will analyze this novel from her inferiority complex with Alfred Adler’s theory.The analysis will unfold from her inferiority feelings,its reasons and how does she transcend these feelings.展开更多
The authors regret one of the author’s affiliations was mistakenly annotated in the manuscript.Hence,the authors of the below article were contacted after publication to request a correction of the author’s afflicti...The authors regret one of the author’s affiliations was mistakenly annotated in the manuscript.Hence,the authors of the below article were contacted after publication to request a correction of the author’s affliction and responded with the correct by the time this corrigendum is being published.展开更多
BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often lead...BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.展开更多
Inferior grains exhibit delayed developmental processes and reduced metabolic activities compared to superior grains,leading to unstable rice yield and quality.While significant advancements have been achieved in eluc...Inferior grains exhibit delayed developmental processes and reduced metabolic activities compared to superior grains,leading to unstable rice yield and quality.While significant advancements have been achieved in elucidating the physiology of endosperm filling in inferior grains,the role of the embryo remains underexplored and warrants comprehensive investigation.Two Wuyujing 3 mutants,DW024(relatively synchronous;syn-DW024)and DW179(significantly asynchronous;asyn-DW179),with different grain-filling patterns were used in this study.Samples of superior and inferior grains were collected at intervals from 5 to 60 d after fertilization and subsequently dissected into subsamples of the embryo and endosperm.Histochemical staining,biochemical analysis,and RNA sequencing(RNA-seq)were combined to systematically compare developmental and physiological traits between superior and inferior grains.Combining hierarchical clustering of mRNA datasets revealed three developmental phases of the endosperm and embryo:morphogenesis,endosperm filling/embryo enlargement,and maturation.In both syn-DW024 and asyn-DW179,the duration of the endosperm/embryo morphogenesis phase was identical in superior and inferior grains.The inferior grains of asyn-DW179 exhibited a 10-day prolongation in the endosperm filling phase and a 20-day extension in the embryo enlargement phase compared to the superior grains.The endosperm of inferior grains exhibited higher contents of sugars and free amino acids,along with slower accumulation of storage compounds,which was associated with the down-regulation of genes for starch synthesis and ABA signaling.In addition,transporters for nutrient exchanges between endosperm and embryo were down-regulated,suggesting a potential role of the embryo in adjusting the endosperm filling process.Collectively,our results reveal that the prolonged phases of endosperm filling and embryo enlargement may underlie the impaired development of inferior grains,offering a new perspective for breeding or cultivating rice with uniform grain quality.展开更多
BACKGROUND Inferior mesenteric arteriovenous fistula(IMAVF)is an extremely rare condition characterized by abnormal communication between the inferior mesenteric artery and vein.IMAVF often mimics ischemic bowel disea...BACKGROUND Inferior mesenteric arteriovenous fistula(IMAVF)is an extremely rare condition characterized by abnormal communication between the inferior mesenteric artery and vein.IMAVF often mimics ischemic bowel disease and ulcerative colitis(UC),leading to diagnostic challenges and treatment failures.CASE SUMMARY Three consecutive cases presented with non-specific symptoms including perianal pain and bloody diarrhea were reported.Initial diagnosis included acute severe UC and ischemic colitis.Pathology suggested ischemic changes,and with further contrast-enhanced computed tomography together with digital subtraction angiography which confirmed the diagnosis of IMAVF.All three cases were treated by vascular embolization,and symptoms improved rapidly following treatment.CONCLUSION We presented the largest single center IMAVF series with detailed clinical characteristics,facilitating early diagnosis for similar cases in the future.展开更多
BACKGROUND Kidney transplantation is increasingly more common due to the ongoing shortage of deceased donors.However,anatomical challenges,such as a short renal artery,can complicate surgical procedures and increase c...BACKGROUND Kidney transplantation is increasingly more common due to the ongoing shortage of deceased donors.However,anatomical challenges,such as a short renal artery,can complicate surgical procedures and increase complication risk,including thrombosis and anastomotic stenosis.To address these issues and optimize graft outcomes,innovative surgical techniques are essential.CASE SUMMARY We present a case of kidney transplantation complicated by a short donor renal artery.To address the discrepancy between arterial length and diameter mismatch,the recipient’s inferior epigastric artery was used as a cuff interposition for arterial reconstruction.Following standard laparoscopic donor nephrectomy,vascular reconstruction was performed on the back table.The use of the inferior epigastric artery as a cuff allowed for successful elongation and size matching of the donor renal artery,enabling a tension-free anastomosis to the recipient’s external iliac artery.Postoperative Doppler ultrasound and angiography confirmed excellent graft perfusion.The patient experienced an uneventful recovery with immediate graft function and maintained stable renal function at 6 months post-transplant.To our knowledge,this is the first reported use of the inferior epigastric artery as a cuff interposition in renal artery reconstruction,offering a novel and effective technique for managing short renal arteries in kidney transplantation.CONCLUSION Interposition of the epigastric artery offers an innovative technique for managing short donor renal arteries,reducing the risk of early thrombosis and long-term complications as size mismatch and intimal hyperplasia.展开更多
BACKGROUND Sigmoid colon cancer faces challenges due to anatomical diversity,including variable inferior mesenteric artery(IMA)branching and tumor localization complexities,which increase intraoperative risks.AIM To c...BACKGROUND Sigmoid colon cancer faces challenges due to anatomical diversity,including variable inferior mesenteric artery(IMA)branching and tumor localization complexities,which increase intraoperative risks.AIM To comprehensively evaluate the impact of three-dimensional(3D)visualization technology on enhancing surgical precision and safety,as well as optimizing perioperative outcomes in laparoscopic sigmoid cancer resection.METHODS A prospective cohort of 106 patients(January 2023 to December 2024)undergoing laparoscopic sigmoid cancer resection was divided into the 3D(n=55)group and the control(n=51)group.The 3D group underwent preoperative enhanced computed tomography reconstruction(3D Slicer 5.2.2&Mimics 19.0).3D reconstruction visualization navigation intraoperatively guided the following key steps:Tumor location,Toldt’s space dissection,IMA ligation level selection,regional lymph node dissection,and marginal artery preservation.Outcomes included operative parameters,lymph node yield,and recovery metrics.RESULTS The 3D group demonstrated a significantly shorter operative time(172.91±20.69 minutes vs 190.29±32.29 minutes;P=0.002),reduced blood loss(31.5±11.8 mL vs 44.1±23.4 mL,P=0.001),earlier postoperative flatus(2.23±0.54 days vs 2.53±0.61 days;P=0.013),shorter hospital length of stay(13.47±1.74 days vs 16.20±7.71 days;P=0.013),shorter postoperative length of stay(8.6±2.6 days vs 10.5±4.9 days;P=0.014),and earlier postoperative exhaust time(2.23±0.54 days vs 2.53±0.61 days;P=0.013).Furthermore,the 3D group exhibited a higher mean number of lymph nodes harvested(16.91±5.74 vs 14.45±5.66;P=0.030).CONCLUSION The 3D visualization technology effectively addresses sigmoid colon anatomical complexity through surgical navigation,improving procedural safety and efficiency.展开更多
BACKGROUND Inferior vena cava(IVC)leiomyosarcomas are rare and aggressive tumors.Complete cure depends on achieving R0 resection,which often requires circumferential resection and reconstruction.Synthetic grafts have ...BACKGROUND Inferior vena cava(IVC)leiomyosarcomas are rare and aggressive tumors.Complete cure depends on achieving R0 resection,which often requires circumferential resection and reconstruction.Synthetic grafts have traditionally been used when venous continuity must be restored.However,the use of cadaveric IVC grafts for reconstruction has not been widely reported.CASE SUMMARY Herein,we present the case of a 64-year-old woman diagnosed with an intrahepatic IVC leiomyosarcoma with local invasion.The patient responded favorably to chemotherapy and subsequently underwent an en bloc right hepatectomy,retrohepatic IVC resection,and reconstruction with an interpositional cadaveric IVC graft.Serial imaging follow-ups until 2 years after the operation showed persistent patency of the graft and no graft-related complications.CONCLUSION Cadaveric IVC grafts are an alternative to synthetic grafts for reconstruction,with acceptable outcomes.Larger,long-term studies are necessary to validate these findings.展开更多
Various approaches to laparoscopic anatomic liver resection have been described.In this paper,the authors present a technique that utilizes the ventral avascular areas above the inferior vena cava.While many liver sur...Various approaches to laparoscopic anatomic liver resection have been described.In this paper,the authors present a technique that utilizes the ventral avascular areas above the inferior vena cava.While many liver surgeons partially adopt this elements of this method,few employ it to the full extent outlined here.Main-taining low central venous pressure during anesthesia is critical to this approach,as demonstrated by the operative images showing collapsed hepatic veins.This technique is particularly advantageous when the patient’s body mass index is low,the tumor is small(or large but deeply embedded within the liver parenchy-ma),and the overlying liver tissue is not excessively bulky or heavy.Nonetheless,following the conventional course along the Glissonean pedicle can be beneficial.The authors demonstrate notable skill in completing these procedures laparosco-pically.However,concerns over margin positivity and tumor recurrence remain,and follow up studies are needed to further validate the approach.展开更多
BACKGROUND A 56-year-old female presented with acute abdominal pain due to a ruptured pseudoaneurysm associated with median arcuate ligament syndrome(MALS),a rare condition caused by the compression of the celiac arte...BACKGROUND A 56-year-old female presented with acute abdominal pain due to a ruptured pseudoaneurysm associated with median arcuate ligament syndrome(MALS),a rare condition caused by the compression of the celiac artery by the median arcuate ligament(MAL),potentially leading to ischemia,aneurysm formation,and rupture.CASE SUMMARY Computed tomography revealed a retroperitoneal hematoma,celiac artery stenosis,and two aneurysms in the inferior pancreaticoduodenal artery.Hemo-stasis was achieved using transcatheter arterial embolization.However,15 days after embolization,the patient developed duodenal stenosis,manifesting as gastric distension and nausea without abdominal pain.Endoscopy revealed mucosal edema and luminal narrowing of the duodenum.Conservative treatment was ineffective,and the patient underwent MAL transection and gastrojejun-ostomy.She recovered uneventfully,and follow-up at 4 months showed complete resolution of duodenal stenosis and no recurrence.CONCLUSION This case highlights the importance of the early diagnosis and multidisciplinary management of MALS.展开更多
Case Letter Severe trauma has high morbidity and mortality rates,being the leading cause of death in young adults.Among all traumas,tra ffi c injuries are particularly lethal.^([1-2]) The injury severity score(ISS) ca...Case Letter Severe trauma has high morbidity and mortality rates,being the leading cause of death in young adults.Among all traumas,tra ffi c injuries are particularly lethal.^([1-2]) The injury severity score(ISS) can be used to assess trauma severity,with ISS of<9,9–15,16–24,and≥25 indicating minor,moderate,severe,and critical trauma,respectively.The ISS is correlated with mortality,morbidity,and hospitalization duration after injury.^([3-4]) Here,we report one patient who was admitted to our emergency intensive care unit(EICU) due to traumatic liver rupture and traumatic myocardial infarction complicated with inferior vena cava(IVC) thrombosis.展开更多
BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical di...BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical difficulty.This case report aimed to introduce a novel treatment strategy combining negative pressure wound therapy(NPWT)with a fenestrated Penrose drain to manage refractory seroma in patients with a history of ischial pressure ulcers.CASE SUMMARY A 63-year-old woman presented with soft tissue defects on the left ischium and right trochanter.After surgical debridement,an inferior gluteal artery perforator(IGAP)flap was used to reconstruct the left ischium.NPWT was applied at a setting of 75 mmHg on postoperative day 3 owing to the development of seroma,combined with a fenestrated Penrose drain to facilitate effective drainage of serous fluid.A 54-year-old man presented with a 4 cm×2 cm ulcer on the left ischium after previous excision and flap coverage.After thorough debridement,the IGAP flap was elevated,and NPWT with a fenestrated Penrose drain was implemented immediately postoperatively at 75 mmHg to promote drainage.Both patients achieved a stable recovery without complications.CONCLUSION NPWT combined with a fenestrated Penrose drain placement is a promising strategy for addressing refractory seromas in cases of complex pressure ulcers.展开更多
BACKGROUND Acute pulmonary thromboembolism is a complication of venous thrombosis.Extracorporeal membrane oxygenation(ECMO),an effective rescue measure for rapid hemodynamic recovery,can be used in patients for whom t...BACKGROUND Acute pulmonary thromboembolism is a complication of venous thrombosis.Extracorporeal membrane oxygenation(ECMO),an effective rescue measure for rapid hemodynamic recovery,can be used in patients for whom thrombolysis therapy has failed.CASE SUMMARY This case report describes an extreme rescue process for a patient with a preset inferior vena cava(IVC)filter in a relatively economically underdeveloped area with an insufficient supply of consumables.In an emergency,veno-arterial ECMO was successfully initiated by intubation through the IVC filter to the right atrial opening without displacement of the filter during the entire process.CONCLUSION This study demonstrates that in resource-limited settings,femoral vein cannulation for veno-arterial ECMO is a feasible and safe option for patients with preimplanted IVC filters.展开更多
Current breast reconstruction evaluations mostly focus on static cosmetic analysis as a measure of the clinical outcomes.Moreover,it is essential to consider the dynamic changes in the reconstructed breast alongside a...Current breast reconstruction evaluations mostly focus on static cosmetic analysis as a measure of the clinical outcomes.Moreover,it is essential to consider the dynamic changes in the reconstructed breast alongside assessments of aesthetic symmetry,functional restoration,complication rates,and long-term stability of the reconstruction.This study aimed to assess the mobility of the reconstructed breast following various breast reconstruction techniques,specifically by comparing deep inferior epigastric perforator(DIEP) flaps and pedicled transverse rectus abdominis musculocutaneous(TRAM) flaps.We conducted a longitudinal case study to investigate the changes in breast movement resulting from different surgical interventions.The comparison showed that DIEP flap reconstruction was more likely to achieve superior breast mobility outcomes than TRAM flap reconstruction.For a better breast aesthetic outcome,it is fundamental to improve the awareness of the dynamic evaluation of the reconstructed breast at the surgical strategy level.展开更多
基金supported by the National Key Research and Development Program of China(No.2022YFC3602500)Beijing High-level Public Health Technical Talents Construction Project(Discipline Leader-03-24)Beijing Hospitals Authority’s Ascent Plan(DFL20240601).
文摘OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were randomly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis<30% with no 30-day major adverse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area product.RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6%).Both groups achieved 100% clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI group had a technical success rate of 100%.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator radiation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups.CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.
文摘“The inferiority complex after being accused”is one of the typical cultural psychologies of some people currently in the judicial field at the grassroots society in China.It is mainly manifested in their reluctance to be sued or cooperated with the investigation,and keep away from grass-roots judicial field as far as possible in terms of geographical location and behavior.Once someone else are called by the real judiciary or individuals or organizations pretending to the judiciary,it is easy to trigger the illusion that they may have done something wrong in past times,then they can easily fall into a state of depression and confusion,and even be deceived by other malicious people.Obviously,similar psychology is not conducive to the rule by law and modernization of grassroots society,and it is not conducive to the construction of a harmonious police-civilian relationship.Based on humanistic care and universal law,it is necessary to achieve fine justice based on the perspectives of language culture,costume culture,public psychology,etc.,and gradually guide the traditional people to correctly face the phenomenon of the“inferiority complex after being accused”,so it can help they integrate themselves into the modern society ruled by law smoothly.
文摘Jane Eyre has been the focus of numerous critics and scholars since its publication in 1847 and they have made a great contribution to the study of Jane Eyre, exploring it from different perspectives. Most of critics and readers regard Jane Eyre as an independent and brave feminism fighter to challenge the tradition in Victorian period while they tend to pay less attention to the invisible side of Jane Eyre. Jane Eyre is not always so brave and strong and confident to face her life, which can be discovered from her language and behavior when she confronts conflicts. This is Jane Eyre's feeling of inferiority. From the perspective of Alfred Adler's individual psychology, this thesis studies Jane Eyre's feeling of inferiority at Gateshead.
文摘Jane Eyre has been regarded as a self-esteemed woman.But actually she is one with inferiority complex.This essay will analyze this novel from her inferiority complex with Alfred Adler’s theory.The analysis will unfold from her inferiority feelings,its reasons and how does she transcend these feelings.
文摘The authors regret one of the author’s affiliations was mistakenly annotated in the manuscript.Hence,the authors of the below article were contacted after publication to request a correction of the author’s affliction and responded with the correct by the time this corrigendum is being published.
基金Supported by the General Project of the Natural Science Foundation of Chongqing,No.cstc2021jcyj-msxmX0604.
文摘BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.
基金supported by the National Key Research and Development Program of China(2022YFD2300700)the National Natural Science Foundation of China(32201894)+1 种基金Hainan Provincial Natural Science Foundation of China(323QN193)Rothamsted Research receives strategic funding from the Biotechnological and Biological Sciences Research Council of the UK.Matthew J.Paul acknowledges funding from the Delivering Sustainable Wheat(BB/X011003/1)Strategic Program.
文摘Inferior grains exhibit delayed developmental processes and reduced metabolic activities compared to superior grains,leading to unstable rice yield and quality.While significant advancements have been achieved in elucidating the physiology of endosperm filling in inferior grains,the role of the embryo remains underexplored and warrants comprehensive investigation.Two Wuyujing 3 mutants,DW024(relatively synchronous;syn-DW024)and DW179(significantly asynchronous;asyn-DW179),with different grain-filling patterns were used in this study.Samples of superior and inferior grains were collected at intervals from 5 to 60 d after fertilization and subsequently dissected into subsamples of the embryo and endosperm.Histochemical staining,biochemical analysis,and RNA sequencing(RNA-seq)were combined to systematically compare developmental and physiological traits between superior and inferior grains.Combining hierarchical clustering of mRNA datasets revealed three developmental phases of the endosperm and embryo:morphogenesis,endosperm filling/embryo enlargement,and maturation.In both syn-DW024 and asyn-DW179,the duration of the endosperm/embryo morphogenesis phase was identical in superior and inferior grains.The inferior grains of asyn-DW179 exhibited a 10-day prolongation in the endosperm filling phase and a 20-day extension in the embryo enlargement phase compared to the superior grains.The endosperm of inferior grains exhibited higher contents of sugars and free amino acids,along with slower accumulation of storage compounds,which was associated with the down-regulation of genes for starch synthesis and ABA signaling.In addition,transporters for nutrient exchanges between endosperm and embryo were down-regulated,suggesting a potential role of the embryo in adjusting the endosperm filling process.Collectively,our results reveal that the prolonged phases of endosperm filling and embryo enlargement may underlie the impaired development of inferior grains,offering a new perspective for breeding or cultivating rice with uniform grain quality.
文摘BACKGROUND Inferior mesenteric arteriovenous fistula(IMAVF)is an extremely rare condition characterized by abnormal communication between the inferior mesenteric artery and vein.IMAVF often mimics ischemic bowel disease and ulcerative colitis(UC),leading to diagnostic challenges and treatment failures.CASE SUMMARY Three consecutive cases presented with non-specific symptoms including perianal pain and bloody diarrhea were reported.Initial diagnosis included acute severe UC and ischemic colitis.Pathology suggested ischemic changes,and with further contrast-enhanced computed tomography together with digital subtraction angiography which confirmed the diagnosis of IMAVF.All three cases were treated by vascular embolization,and symptoms improved rapidly following treatment.CONCLUSION We presented the largest single center IMAVF series with detailed clinical characteristics,facilitating early diagnosis for similar cases in the future.
文摘BACKGROUND Kidney transplantation is increasingly more common due to the ongoing shortage of deceased donors.However,anatomical challenges,such as a short renal artery,can complicate surgical procedures and increase complication risk,including thrombosis and anastomotic stenosis.To address these issues and optimize graft outcomes,innovative surgical techniques are essential.CASE SUMMARY We present a case of kidney transplantation complicated by a short donor renal artery.To address the discrepancy between arterial length and diameter mismatch,the recipient’s inferior epigastric artery was used as a cuff interposition for arterial reconstruction.Following standard laparoscopic donor nephrectomy,vascular reconstruction was performed on the back table.The use of the inferior epigastric artery as a cuff allowed for successful elongation and size matching of the donor renal artery,enabling a tension-free anastomosis to the recipient’s external iliac artery.Postoperative Doppler ultrasound and angiography confirmed excellent graft perfusion.The patient experienced an uneventful recovery with immediate graft function and maintained stable renal function at 6 months post-transplant.To our knowledge,this is the first reported use of the inferior epigastric artery as a cuff interposition in renal artery reconstruction,offering a novel and effective technique for managing short renal arteries in kidney transplantation.CONCLUSION Interposition of the epigastric artery offers an innovative technique for managing short donor renal arteries,reducing the risk of early thrombosis and long-term complications as size mismatch and intimal hyperplasia.
基金Supported by the Health Commission of Fuyang City,Anhui,China,No.FY2023-45Fuyang Municipal Science and Technology Bureau,Anhui,China,No.FK20245505+1 种基金Anhui Provincial Health Commission,No.AHWJ2023Baa20164Bengbu Medical University,No.2023byzd215.
文摘BACKGROUND Sigmoid colon cancer faces challenges due to anatomical diversity,including variable inferior mesenteric artery(IMA)branching and tumor localization complexities,which increase intraoperative risks.AIM To comprehensively evaluate the impact of three-dimensional(3D)visualization technology on enhancing surgical precision and safety,as well as optimizing perioperative outcomes in laparoscopic sigmoid cancer resection.METHODS A prospective cohort of 106 patients(January 2023 to December 2024)undergoing laparoscopic sigmoid cancer resection was divided into the 3D(n=55)group and the control(n=51)group.The 3D group underwent preoperative enhanced computed tomography reconstruction(3D Slicer 5.2.2&Mimics 19.0).3D reconstruction visualization navigation intraoperatively guided the following key steps:Tumor location,Toldt’s space dissection,IMA ligation level selection,regional lymph node dissection,and marginal artery preservation.Outcomes included operative parameters,lymph node yield,and recovery metrics.RESULTS The 3D group demonstrated a significantly shorter operative time(172.91±20.69 minutes vs 190.29±32.29 minutes;P=0.002),reduced blood loss(31.5±11.8 mL vs 44.1±23.4 mL,P=0.001),earlier postoperative flatus(2.23±0.54 days vs 2.53±0.61 days;P=0.013),shorter hospital length of stay(13.47±1.74 days vs 16.20±7.71 days;P=0.013),shorter postoperative length of stay(8.6±2.6 days vs 10.5±4.9 days;P=0.014),and earlier postoperative exhaust time(2.23±0.54 days vs 2.53±0.61 days;P=0.013).Furthermore,the 3D group exhibited a higher mean number of lymph nodes harvested(16.91±5.74 vs 14.45±5.66;P=0.030).CONCLUSION The 3D visualization technology effectively addresses sigmoid colon anatomical complexity through surgical navigation,improving procedural safety and efficiency.
文摘BACKGROUND Inferior vena cava(IVC)leiomyosarcomas are rare and aggressive tumors.Complete cure depends on achieving R0 resection,which often requires circumferential resection and reconstruction.Synthetic grafts have traditionally been used when venous continuity must be restored.However,the use of cadaveric IVC grafts for reconstruction has not been widely reported.CASE SUMMARY Herein,we present the case of a 64-year-old woman diagnosed with an intrahepatic IVC leiomyosarcoma with local invasion.The patient responded favorably to chemotherapy and subsequently underwent an en bloc right hepatectomy,retrohepatic IVC resection,and reconstruction with an interpositional cadaveric IVC graft.Serial imaging follow-ups until 2 years after the operation showed persistent patency of the graft and no graft-related complications.CONCLUSION Cadaveric IVC grafts are an alternative to synthetic grafts for reconstruction,with acceptable outcomes.Larger,long-term studies are necessary to validate these findings.
文摘Various approaches to laparoscopic anatomic liver resection have been described.In this paper,the authors present a technique that utilizes the ventral avascular areas above the inferior vena cava.While many liver surgeons partially adopt this elements of this method,few employ it to the full extent outlined here.Main-taining low central venous pressure during anesthesia is critical to this approach,as demonstrated by the operative images showing collapsed hepatic veins.This technique is particularly advantageous when the patient’s body mass index is low,the tumor is small(or large but deeply embedded within the liver parenchy-ma),and the overlying liver tissue is not excessively bulky or heavy.Nonetheless,following the conventional course along the Glissonean pedicle can be beneficial.The authors demonstrate notable skill in completing these procedures laparosco-pically.However,concerns over margin positivity and tumor recurrence remain,and follow up studies are needed to further validate the approach.
文摘BACKGROUND A 56-year-old female presented with acute abdominal pain due to a ruptured pseudoaneurysm associated with median arcuate ligament syndrome(MALS),a rare condition caused by the compression of the celiac artery by the median arcuate ligament(MAL),potentially leading to ischemia,aneurysm formation,and rupture.CASE SUMMARY Computed tomography revealed a retroperitoneal hematoma,celiac artery stenosis,and two aneurysms in the inferior pancreaticoduodenal artery.Hemo-stasis was achieved using transcatheter arterial embolization.However,15 days after embolization,the patient developed duodenal stenosis,manifesting as gastric distension and nausea without abdominal pain.Endoscopy revealed mucosal edema and luminal narrowing of the duodenum.Conservative treatment was ineffective,and the patient underwent MAL transection and gastrojejun-ostomy.She recovered uneventfully,and follow-up at 4 months showed complete resolution of duodenal stenosis and no recurrence.CONCLUSION This case highlights the importance of the early diagnosis and multidisciplinary management of MALS.
文摘Case Letter Severe trauma has high morbidity and mortality rates,being the leading cause of death in young adults.Among all traumas,tra ffi c injuries are particularly lethal.^([1-2]) The injury severity score(ISS) can be used to assess trauma severity,with ISS of<9,9–15,16–24,and≥25 indicating minor,moderate,severe,and critical trauma,respectively.The ISS is correlated with mortality,morbidity,and hospitalization duration after injury.^([3-4]) Here,we report one patient who was admitted to our emergency intensive care unit(EICU) due to traumatic liver rupture and traumatic myocardial infarction complicated with inferior vena cava(IVC) thrombosis.
基金Supported by Research fund of Dankook University in 2023,No.R202300627.
文摘BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical difficulty.This case report aimed to introduce a novel treatment strategy combining negative pressure wound therapy(NPWT)with a fenestrated Penrose drain to manage refractory seroma in patients with a history of ischial pressure ulcers.CASE SUMMARY A 63-year-old woman presented with soft tissue defects on the left ischium and right trochanter.After surgical debridement,an inferior gluteal artery perforator(IGAP)flap was used to reconstruct the left ischium.NPWT was applied at a setting of 75 mmHg on postoperative day 3 owing to the development of seroma,combined with a fenestrated Penrose drain to facilitate effective drainage of serous fluid.A 54-year-old man presented with a 4 cm×2 cm ulcer on the left ischium after previous excision and flap coverage.After thorough debridement,the IGAP flap was elevated,and NPWT with a fenestrated Penrose drain was implemented immediately postoperatively at 75 mmHg to promote drainage.Both patients achieved a stable recovery without complications.CONCLUSION NPWT combined with a fenestrated Penrose drain placement is a promising strategy for addressing refractory seromas in cases of complex pressure ulcers.
文摘BACKGROUND Acute pulmonary thromboembolism is a complication of venous thrombosis.Extracorporeal membrane oxygenation(ECMO),an effective rescue measure for rapid hemodynamic recovery,can be used in patients for whom thrombolysis therapy has failed.CASE SUMMARY This case report describes an extreme rescue process for a patient with a preset inferior vena cava(IVC)filter in a relatively economically underdeveloped area with an insufficient supply of consumables.In an emergency,veno-arterial ECMO was successfully initiated by intubation through the IVC filter to the right atrial opening without displacement of the filter during the entire process.CONCLUSION This study demonstrates that in resource-limited settings,femoral vein cannulation for veno-arterial ECMO is a feasible and safe option for patients with preimplanted IVC filters.
文摘Current breast reconstruction evaluations mostly focus on static cosmetic analysis as a measure of the clinical outcomes.Moreover,it is essential to consider the dynamic changes in the reconstructed breast alongside assessments of aesthetic symmetry,functional restoration,complication rates,and long-term stability of the reconstruction.This study aimed to assess the mobility of the reconstructed breast following various breast reconstruction techniques,specifically by comparing deep inferior epigastric perforator(DIEP) flaps and pedicled transverse rectus abdominis musculocutaneous(TRAM) flaps.We conducted a longitudinal case study to investigate the changes in breast movement resulting from different surgical interventions.The comparison showed that DIEP flap reconstruction was more likely to achieve superior breast mobility outcomes than TRAM flap reconstruction.For a better breast aesthetic outcome,it is fundamental to improve the awareness of the dynamic evaluation of the reconstructed breast at the surgical strategy level.
