BACKGROUND: Liver surgery has gone through the phases of wedge liver resection, regular resection of hepatic lobes, irregular and local resection, extracorporeal hepatectomy, hemi-extracorporeal hepatectomy and Da Vin...BACKGROUND: Liver surgery has gone through the phases of wedge liver resection, regular resection of hepatic lobes, irregular and local resection, extracorporeal hepatectomy, hemi-extracorporeal hepatectomy and Da Vinci surgical system-assisted hepatectomy. Taking advantage of modern technologies, liver surgery is stepping into an age of precise liver resection. This review aimed to analyze the comprehensive application of modern technologies in precise liver resection. DATA SOURCE: PubMed search was carried out for English-language articles relevant to precise liver resection, liver anatomy, hepatic blood inflow blockage, parenchyma transection, and down-staging treatment. RESULTS: The 3D image system can imitate the liver operation procedures, conduct risk assessment, help to identify the operation feasibility and confirm the operation scheme. In addition, some techniques including puncture and injection of methylene blue into the target Glisson sheath help to precisely determine the resection. Alternative methods such as Pringle maneuver are helpful for hepatic blood inflow blockage in precise liver resection. Moreover, the use of exquisite equipment for liver parenchyma transection, such as cavitron ultrasonic surgical aspirator, ultrasonic scalpel, Ligasure and Tissue Link is also helpful to reduce hemorrhage in liver resection, or even operate exsanguinous liver resection without blocking hepatic blood flow. Furthermore, various down-staging therapies including transcatheter arterial chemoembolization and radio-frequency ablation were appropriate for unresectable cancer, which reverse the advanced tumor back to early phase by local or systemic treatment so that hepatectomy or liver transplantation is possible.CONCLUSIONS: Modern technologies mentioned in this paper are the key tool for achieving precise liver resection and can effectively lead to maximum preservation of anatomical structural integrity and functions of the remnant liver. In addition, large randomized trials are needed to evaluate the usefuln展开更多
Sometimes endometrial polyps,submucosal myomas,and endometrial cancer show similar findings under ultrasonography.The aim of this study was to assess the antidiastole value of blood flow parameters using three-dimensi...Sometimes endometrial polyps,submucosal myomas,and endometrial cancer show similar findings under ultrasonography.The aim of this study was to assess the antidiastole value of blood flow parameters using three-dimensional(3D)power Doppler ultrasonography angiography(PDA)between endometrial cancer and uterine parenchyma lumps.The data of the blood flow indices in 3D-PDA including the vascularization index(VI),flow index(FI),and vascularization flow index(VFI)in 40 patients with endometrial cancer and 41 patients with uterine parenchyma lumps(endometrial polyps and submucosal myomas)were retrospectively analysed and compared utilizing Virtual Organ Computer-aided AnaLysis(VOCAL)software.The results showed that all the blood flow parameters(VI,FI,VFI)were significantly higher in women with endometrial cancer than in those with uterine parenchyma lumps(P<0.001).The area under the curve of ROC of VI,FI,and VFI was 0.98,0.84,and 0.97,respectively.Thus,the best predictor of endometrial carcinoma was VI with a sensitivity of 97.0% and a specificity of 91.0%.The optimal cutoff value of VI was 4.06%.Our data demonstrated that all of the blood flow signal parameters(including VI,FI,and VFI)in 3D power Doppler ultrasonography had significant antidiastole values between endometrial cancer and uterine parenchyma lumps to assist clinicians in properly diagnosing patients.展开更多
To address the incomplete problem in pulmonary parenchyma segmentation based on the traditional methods, a novel automated segmentation method based on an eight- neighbor region growing algorithm with left-right scann...To address the incomplete problem in pulmonary parenchyma segmentation based on the traditional methods, a novel automated segmentation method based on an eight- neighbor region growing algorithm with left-right scanning and four-corner rotating and scanning is proposed in this pa- per. The proposed method consists of four main stages： image binarization, rough segmentation of lung, image denoising and lung contour refining. First, the binarization of images is done and the regions of interest are extracted. After that, the rough segmentation of lung is performed through a general region growing method. Then the improved eight-neighbor region growing is used to remove noise for the upper, mid- dle, and bottom region of lung. Finally, corrosion and ex- pansion operations are utilized to smooth the lung boundary. The proposed method was validated on chest positron emis- sion tomography-computed tomography （PET-CT） data of 30 cases from a hospital in Shanxi, China. Experimental results show that our method can achieve an average volume overlap ratio of 96.21 ± 0.39% with the manual segmentation results. Compared with the existing methods, the proposed algorithm segments the lung in PET-CT images more efficiently and ac- curately.展开更多
Minimal invasive techniques have allowed for major surgical advances.We report our initial experience of performing total laparoscopic left hepatectomy(segmentsⅡ-Ⅳ)with the Lotus(laparoscopic operation by torsional ...Minimal invasive techniques have allowed for major surgical advances.We report our initial experience of performing total laparoscopic left hepatectomy(segmentsⅡ-Ⅳ)with the Lotus(laparoscopic operation by torsional ultrasound)Ultrasonic Scalpel.The perioperative and postoperative courses of the young female patient were uneventful and she is in a good general condition without complaints 18 mo after surgery.To the best of our knowledge,this is the first total laparoscopic hemihepatectomy to be performed in Greece,as well as the first laparoscopic liver resection using Lotus shears.展开更多
A new species of gymnospermous fossil wood, Protophyllocladoxylon jingyuanense sp. nov., is described from the lower part of the Tsingyuan Formation （Serpukhovian/Late Mississippian）, near the coal mine of Ciyao, Ga...A new species of gymnospermous fossil wood, Protophyllocladoxylon jingyuanense sp. nov., is described from the lower part of the Tsingyuan Formation （Serpukhovian/Late Mississippian）, near the coal mine of Ciyao, Gansu, northwestern China. The specimen is preserved only in silicified secondary xylem, while growth rings are absent. Pits in radial tracheidal walls are araucaroid in type, uniseriate, occasionally biseriate. Xylem rays are homogeneous, uniseriate, occasionally biseriate. Cross-field pits are simple, large, one to two in number. Axial parenchyma is absent. The anatomical characters and geographic distribution of Protophyllocladoxylon woods through geological ages are documented. Those species with axial parenchyma and without growth rings live in warm climate, whereas the species without axial parenchyma and with growth rings are present either in warm or cool climate. The ideal living climate for Protophyllocladoxylon woods is warm and wet. Our new species, as a fossil wood of Early Carboniferous, is likely the earliest known species of Protophyllocladoxylon.展开更多
BACKGROUND Primary squamous cell carcinoma(SCC)of the renal parenchyma is extremely rare,with only nine cases reported.CASE SUMMARY This study reports a 51-year-old man with primary SCC of the renal parenchyma.The pat...BACKGROUND Primary squamous cell carcinoma(SCC)of the renal parenchyma is extremely rare,with only nine cases reported.CASE SUMMARY This study reports a 51-year-old man with primary SCC of the renal parenchyma.The patient was admitted with recurrent dull pain and discomfort in the right lumbar region,which had worsened over 2 weeks,accompanied by painful gross hematuria.SCC antigen(SCCA)levels were elevated,and imaging revealed a renal mass with associated calculi.The patient underwent laparoscopic unilateral nephrectomy and lymph node dissection.Postoperative pathology confirmed highly differentiated SCC with necrosis in the right renal parenchyma,with negative renal pelvis and ureter.The pathological stage was Pt3aN1M0.Four months after surgery,the tumor recurred with involvement of the liver,right psoas major muscle,and inferior vena cava.The patient refused chemotherapy and succumbed to the disease 6 months postoperatively due to disease progression.CONCLUSION We report a case of primary SCC of the renal parenchyma,a rare renal malignancy.The clinical symptoms,laboratory tests,and imaging findings are nonspecific,making accurate and timely diagnosis challenging.According to the literature,for patients with renal calculi accompanied by a renal mass,elevated serum SCCA levels,and magnetic resonance imaging showing cystic or cystic-solid masses within the kidney with pseudocapsules and heterogeneous mild enhancement,the possibility of this disease should be considered.展开更多
AIM:To investigate the features of crush thoracic trauma in Sichuan earthquake victims using chest digital radiography(CDR).METHODS:We retrospectively reviewed 772 CDR of 417 females and 355 males who had suffered cru...AIM:To investigate the features of crush thoracic trauma in Sichuan earthquake victims using chest digital radiography(CDR).METHODS:We retrospectively reviewed 772 CDR of 417 females and 355 males who had suffered crush thoracic trauma in the Sichuan earthquake.Patient age ranged from 0.5 to 103 years.CDR was performed between May 12,2008 and June 7,2008.We looked for injury to the thoracic cage,pulmonary parenchyma and the pleura.obtained in 349 patients,the remaining 423 patients underwent only AP CDR.Thoracic cage fractures,pulmonary contusion and pleural injuries were noted in 331(42.9%;95% CI:39.4%-46.4%),67 and 135 patients,respectively.Of the 256 patients with rib fractures,the mean number of fractured ribs per patient was 3.Rib fractures were mostly distributed from the 3rd through to the 8th ribs and the vast majority involved posterior and lateral locations along the rib.Rib fractures had a significant positive association with non-rib thoracic fractures,pulmonary contusion and pleural injuries(P < 0.001).The number of rib fractures and pulmonary contusions were significant factors associated with patient death.CONCLUSION:Earthquake-related crush thoracic trauma has the potential for multiple fractures.The high number of fractured ribs and pulmonary contusions were significant factors which needed appropriate medical treatment.展开更多
BACKGROUND An ependymoma is a glial tumor that usually occurs in or near the ventricle,close to the ependyma.It rarely occurs exclusively in the brain parenchyma without being associated with the ventricle.CASE SUMMAR...BACKGROUND An ependymoma is a glial tumor that usually occurs in or near the ventricle,close to the ependyma.It rarely occurs exclusively in the brain parenchyma without being associated with the ventricle.CASE SUMMARY Here,we report a rare case of a cerebellar ependymoma completely located in the brain parenchyma.A previously healthy 32-year-old female with a 1-month history of dizziness was admitted to our hospital.During hospitalization,magnetic resonance imaging of the brain revealed a space-occupying lesion measuring 57 mm×41 mm×51 mm in the right cerebellar hemisphere and inferior cerebellar vermis.The patient underwent surgical resection for the right cerebellar mass.Postoperative pathological examination revealed an ependymoma.At 1 year follow-up,the patient was doing well and showed no recurrence.CONCLUSION We conducted a literature review and summarized three theories regarding ependymomas located exclusively in the brain parenchyma,which are key to the diagnosis of intraparenchymal cerebellar ependymomas.Surgery and postoperative radiotherapy are the primary treatment options for ependymomas.展开更多
基金supported by grants from the National Natural Science Foundation of China (81172095, 81171135 and 81200324)Bureau of Health Medical Scientific Research Foundation of Hainan Province (Qiongwei 2012 PT-70)China Postdoctoral Science Foundation funded project (2012m521875)
文摘BACKGROUND: Liver surgery has gone through the phases of wedge liver resection, regular resection of hepatic lobes, irregular and local resection, extracorporeal hepatectomy, hemi-extracorporeal hepatectomy and Da Vinci surgical system-assisted hepatectomy. Taking advantage of modern technologies, liver surgery is stepping into an age of precise liver resection. This review aimed to analyze the comprehensive application of modern technologies in precise liver resection. DATA SOURCE: PubMed search was carried out for English-language articles relevant to precise liver resection, liver anatomy, hepatic blood inflow blockage, parenchyma transection, and down-staging treatment. RESULTS: The 3D image system can imitate the liver operation procedures, conduct risk assessment, help to identify the operation feasibility and confirm the operation scheme. In addition, some techniques including puncture and injection of methylene blue into the target Glisson sheath help to precisely determine the resection. Alternative methods such as Pringle maneuver are helpful for hepatic blood inflow blockage in precise liver resection. Moreover, the use of exquisite equipment for liver parenchyma transection, such as cavitron ultrasonic surgical aspirator, ultrasonic scalpel, Ligasure and Tissue Link is also helpful to reduce hemorrhage in liver resection, or even operate exsanguinous liver resection without blocking hepatic blood flow. Furthermore, various down-staging therapies including transcatheter arterial chemoembolization and radio-frequency ablation were appropriate for unresectable cancer, which reverse the advanced tumor back to early phase by local or systemic treatment so that hepatectomy or liver transplantation is possible.CONCLUSIONS: Modern technologies mentioned in this paper are the key tool for achieving precise liver resection and can effectively lead to maximum preservation of anatomical structural integrity and functions of the remnant liver. In addition, large randomized trials are needed to evaluate the usefuln
基金This research was supported by grants from the National Natural Science Foundation of China(No.81501530)Hubei Province Health and Family Planning Scientific Research Project(No.WJ2019M130).
文摘Sometimes endometrial polyps,submucosal myomas,and endometrial cancer show similar findings under ultrasonography.The aim of this study was to assess the antidiastole value of blood flow parameters using three-dimensional(3D)power Doppler ultrasonography angiography(PDA)between endometrial cancer and uterine parenchyma lumps.The data of the blood flow indices in 3D-PDA including the vascularization index(VI),flow index(FI),and vascularization flow index(VFI)in 40 patients with endometrial cancer and 41 patients with uterine parenchyma lumps(endometrial polyps and submucosal myomas)were retrospectively analysed and compared utilizing Virtual Organ Computer-aided AnaLysis(VOCAL)software.The results showed that all the blood flow parameters(VI,FI,VFI)were significantly higher in women with endometrial cancer than in those with uterine parenchyma lumps(P<0.001).The area under the curve of ROC of VI,FI,and VFI was 0.98,0.84,and 0.97,respectively.Thus,the best predictor of endometrial carcinoma was VI with a sensitivity of 97.0% and a specificity of 91.0%.The optimal cutoff value of VI was 4.06%.Our data demonstrated that all of the blood flow signal parameters(including VI,FI,and VFI)in 3D power Doppler ultrasonography had significant antidiastole values between endometrial cancer and uterine parenchyma lumps to assist clinicians in properly diagnosing patients.
文摘To address the incomplete problem in pulmonary parenchyma segmentation based on the traditional methods, a novel automated segmentation method based on an eight- neighbor region growing algorithm with left-right scanning and four-corner rotating and scanning is proposed in this pa- per. The proposed method consists of four main stages： image binarization, rough segmentation of lung, image denoising and lung contour refining. First, the binarization of images is done and the regions of interest are extracted. After that, the rough segmentation of lung is performed through a general region growing method. Then the improved eight-neighbor region growing is used to remove noise for the upper, mid- dle, and bottom region of lung. Finally, corrosion and ex- pansion operations are utilized to smooth the lung boundary. The proposed method was validated on chest positron emis- sion tomography-computed tomography （PET-CT） data of 30 cases from a hospital in Shanxi, China. Experimental results show that our method can achieve an average volume overlap ratio of 96.21 ± 0.39% with the manual segmentation results. Compared with the existing methods, the proposed algorithm segments the lung in PET-CT images more efficiently and ac- curately.
文摘Minimal invasive techniques have allowed for major surgical advances.We report our initial experience of performing total laparoscopic left hepatectomy(segmentsⅡ-Ⅳ)with the Lotus(laparoscopic operation by torsional ultrasound)Ultrasonic Scalpel.The perioperative and postoperative courses of the young female patient were uneventful and she is in a good general condition without complaints 18 mo after surgery.To the best of our knowledge,this is the first total laparoscopic hemihepatectomy to be performed in Greece,as well as the first laparoscopic liver resection using Lotus shears.
基金the Project 111 of China (B06008)the Project No.KZCX2-YW-105 of CAS, China+1 种基金the NSFC Projects Nos.40872027,40621062, 40672015the Major Basic Research Project(No. 2006CB806400) of MOST of China
文摘A new species of gymnospermous fossil wood, Protophyllocladoxylon jingyuanense sp. nov., is described from the lower part of the Tsingyuan Formation （Serpukhovian/Late Mississippian）, near the coal mine of Ciyao, Gansu, northwestern China. The specimen is preserved only in silicified secondary xylem, while growth rings are absent. Pits in radial tracheidal walls are araucaroid in type, uniseriate, occasionally biseriate. Xylem rays are homogeneous, uniseriate, occasionally biseriate. Cross-field pits are simple, large, one to two in number. Axial parenchyma is absent. The anatomical characters and geographic distribution of Protophyllocladoxylon woods through geological ages are documented. Those species with axial parenchyma and without growth rings live in warm climate, whereas the species without axial parenchyma and with growth rings are present either in warm or cool climate. The ideal living climate for Protophyllocladoxylon woods is warm and wet. Our new species, as a fossil wood of Early Carboniferous, is likely the earliest known species of Protophyllocladoxylon.
文摘BACKGROUND Primary squamous cell carcinoma(SCC)of the renal parenchyma is extremely rare,with only nine cases reported.CASE SUMMARY This study reports a 51-year-old man with primary SCC of the renal parenchyma.The patient was admitted with recurrent dull pain and discomfort in the right lumbar region,which had worsened over 2 weeks,accompanied by painful gross hematuria.SCC antigen(SCCA)levels were elevated,and imaging revealed a renal mass with associated calculi.The patient underwent laparoscopic unilateral nephrectomy and lymph node dissection.Postoperative pathology confirmed highly differentiated SCC with necrosis in the right renal parenchyma,with negative renal pelvis and ureter.The pathological stage was Pt3aN1M0.Four months after surgery,the tumor recurred with involvement of the liver,right psoas major muscle,and inferior vena cava.The patient refused chemotherapy and succumbed to the disease 6 months postoperatively due to disease progression.CONCLUSION We report a case of primary SCC of the renal parenchyma,a rare renal malignancy.The clinical symptoms,laboratory tests,and imaging findings are nonspecific,making accurate and timely diagnosis challenging.According to the literature,for patients with renal calculi accompanied by a renal mass,elevated serum SCCA levels,and magnetic resonance imaging showing cystic or cystic-solid masses within the kidney with pseudocapsules and heterogeneous mild enhancement,the possibility of this disease should be considered.
基金Supported by National Nature Sciences Foundation of China,No.30970820 and 30870688Science Foundation for Distinguished Young Scholars of Sichuan Province,No. 2010JQ0039
文摘AIM:To investigate the features of crush thoracic trauma in Sichuan earthquake victims using chest digital radiography(CDR).METHODS:We retrospectively reviewed 772 CDR of 417 females and 355 males who had suffered crush thoracic trauma in the Sichuan earthquake.Patient age ranged from 0.5 to 103 years.CDR was performed between May 12,2008 and June 7,2008.We looked for injury to the thoracic cage,pulmonary parenchyma and the pleura.obtained in 349 patients,the remaining 423 patients underwent only AP CDR.Thoracic cage fractures,pulmonary contusion and pleural injuries were noted in 331(42.9%;95% CI:39.4%-46.4%),67 and 135 patients,respectively.Of the 256 patients with rib fractures,the mean number of fractured ribs per patient was 3.Rib fractures were mostly distributed from the 3rd through to the 8th ribs and the vast majority involved posterior and lateral locations along the rib.Rib fractures had a significant positive association with non-rib thoracic fractures,pulmonary contusion and pleural injuries(P < 0.001).The number of rib fractures and pulmonary contusions were significant factors associated with patient death.CONCLUSION:Earthquake-related crush thoracic trauma has the potential for multiple fractures.The high number of fractured ribs and pulmonary contusions were significant factors which needed appropriate medical treatment.
基金Supported by The Sichuan Medical Youth Innovation Research Project,No.Q22044.
文摘BACKGROUND An ependymoma is a glial tumor that usually occurs in or near the ventricle,close to the ependyma.It rarely occurs exclusively in the brain parenchyma without being associated with the ventricle.CASE SUMMARY Here,we report a rare case of a cerebellar ependymoma completely located in the brain parenchyma.A previously healthy 32-year-old female with a 1-month history of dizziness was admitted to our hospital.During hospitalization,magnetic resonance imaging of the brain revealed a space-occupying lesion measuring 57 mm×41 mm×51 mm in the right cerebellar hemisphere and inferior cerebellar vermis.The patient underwent surgical resection for the right cerebellar mass.Postoperative pathological examination revealed an ependymoma.At 1 year follow-up,the patient was doing well and showed no recurrence.CONCLUSION We conducted a literature review and summarized three theories regarding ependymomas located exclusively in the brain parenchyma,which are key to the diagnosis of intraparenchymal cerebellar ependymomas.Surgery and postoperative radiotherapy are the primary treatment options for ependymomas.
