AIM： To evaluate the clinical outcomes of patients undergoing hepatectomy with hemihepatic vascular occlusion （HHO） compared with total hepatic inflow occlusion （THO）. METHODS： Randomized controlled trials （RCT...AIM： To evaluate the clinical outcomes of patients undergoing hepatectomy with hemihepatic vascular occlusion （HHO） compared with total hepatic inflow occlusion （THO）. METHODS： Randomized controlled trials （RCTs） co- mparing hemihepatic vascular occlusion and total he- patic inflow occlusion were included by a systematic literature search. Two authors independently assessed the trials for inclusion and extracted the data. A meta- analysis was conducted to estimate blood loss, transfu- sion requirement, and liver injury based on the levels of aspartate aminotransferase （AST） and alanine arni- notransferase （ALT）. Either the fixed effects model or random effects model was used. RESULTS- Four RCTs including 338 patients met the predefined inclusion criteria. A total of 167 patients were treated with THO and 171 with HHO. Metaanalysis of AST levels on postoperative day 1 indicated higher levels in the THO group with weighted mean dif- ference （WMD） 342.27; 95% confidence intervals （CI） 217.28-467.26; P = 0.00001; I2 = 16%. Meta-analysis showed no significant difference between THO group and HHO group on blood loss, transfusion requirement, mortality, morbidity, operating time, ischemic duration, hospital stay, ALT levels on postoperative day 1, 3 and 7 and AST levels on postoperative day 3 and 7. CONCLUSION： Hemihepatic vascular occlusion does not offer satisfying benefit to the patients undergoing hepatic resection. However, they have less liver injury after liver resections.展开更多
Laparoscopic hepatectomy seems to be difficult because of the ease of bleeding from the liver parachyma during resection. This is not easily controlled under the laparoscope, especially during right or left hemihepate...Laparoscopic hepatectomy seems to be difficult because of the ease of bleeding from the liver parachyma during resection. This is not easily controlled under the laparoscope, especially during right or left hemihepatectomy, except for resection of the peripheral liver or left lateral segment when porta hepatis dissection is not indicated. Although both inflow and outflow control seems to be ideal in laparoscopic left hepatectomy, there have not been many reports of this. In addition to the high technical demands and the time required, any injury of the main hepatic veins or vena cava during the procedure will cause catastrophic bleeding and air embolism. Recently, we succeeded in achieving inflow and outflow occlusion during laparoscopic left hemihepatectomy in four cases, with satisfactory results.展开更多
目的研究动脉溶栓联合机械辅助治疗前后循环大动脉急性闭塞性脑梗死患者的有效性和安全性。方法 42例大动脉闭塞性脑梗死患者行动脉溶栓联合机械辅助治疗,分为前循环组(24例)、后循环组(18例),评估不同组别治疗前后的NIHSS评分(National...目的研究动脉溶栓联合机械辅助治疗前后循环大动脉急性闭塞性脑梗死患者的有效性和安全性。方法 42例大动脉闭塞性脑梗死患者行动脉溶栓联合机械辅助治疗,分为前循环组(24例)、后循环组(18例),评估不同组别治疗前后的NIHSS评分(National Institute of Health stroke scale)、GCS评分(Glasgow comascore,GCS)及治疗后血管再通率、BI(Barthel Index)优率、症状性颅内出血率、死亡率。结果前循环组卒中病因分型以心源性栓塞为主(15/24,62.5%),后循环组以动脉粥样硬化性血栓形成为主(5/18,72.2%),两组间比较,差异有统计学差异(P=0.026);前、后循环组患者,治疗后的NIHSS评分(8.3±4.9 vs.8.1±5.7)较治疗前(15.1±5.3vs.16.8±7.8)明显降低(P=0.001 vs.P=0.001)、GCS评分(13.9±4.4 vs.12.8±4.2)较治疗前(9.5±3.8 vs.9.6±3.7)明显提高(P=0.001 vs.P=0.021),后循环血管再通率(15/18,83.3%)有高于前循环(14/24,58.3%)趋势(P=0.830),前循环组患者颅内出血发生率(5/24,20.8%)明显高于后循环组(0,0%)(P=0.039),两组患者死亡率相似。结论动脉溶栓联合机械辅助治疗脑梗死能改善神经功能缺损,血管再通率高,更适用于后循环脑梗死的治疗。展开更多
血管性认知障碍(vascular cognitive impairment,VCI)是近年来医学研究的热点之一,该疾病病因较复杂,临床表现为多认知领域障碍、记忆力受损、以及痴呆等,严重影响患者生存质量。成功建立慢性脑缺血性血管性认知障碍的动物模型,是医学...血管性认知障碍(vascular cognitive impairment,VCI)是近年来医学研究的热点之一,该疾病病因较复杂,临床表现为多认知领域障碍、记忆力受损、以及痴呆等,严重影响患者生存质量。成功建立慢性脑缺血性血管性认知障碍的动物模型,是医学研究其发病机制、提供治疗并攻克此疾病的第一步。经过发展,现存在多种VCI动物建模方法,其中以啮齿类动物居多,针对大鼠有四血管闭塞法(4-vessel occlusion,4-VO)法、改良4-VO法、3期4-VO法、两血管闭塞法(2-vessel occlusion,2-VO)法、改良2-VO法、以及一侧颈总动脉闭塞一侧颈总动脉狭窄改良法(modified common carotid artery occlusion,mCCAO)等;针对小鼠有颈总动脉狭窄(bilateral CCA stenosis,BCAS)和不对称颈动脉手术(asymmetric CCA surgery,ACAS)等。根据所采用的手术建模方法不同,动物在术后的病理损伤部位、损伤程度、生存率、动物行为学表现、都存在一定的差异。本文将对上述8种啮齿鼠类动物血管性痴呆模型的手术构建方法、表型、评价指标、优缺点等进行系统的回顾,以期望能够为研究者在相关动物模型的选择上提供一些指导和帮助。展开更多
Background:Hemodialysis(HD) per se is a risk factor for thrombosis.Considering the growing body of evidence on blood-flow restriction(BFR) exercise in HD patients,identification of possible risk factors related to the...Background:Hemodialysis(HD) per se is a risk factor for thrombosis.Considering the growing body of evidence on blood-flow restriction(BFR) exercise in HD patients,identification of possible risk factors related to the prothrombotic agent D-dimer is required for the safety and feasibility of this training model.The aim of the present study was to identify risk factors associated with higher D-dimer levels and to determine the acute effect of resistance exercise(RE) with BFR on this molecule.Methods:Two hundred and six HD patients volunteered for this study(all with a glomerular filtration rate of <15 mL/min/1.73 m2).The RE+BFR session consisted of 50% arterial occlusion pressure during 50 min sessions of HD(intradialytic exercise).RE repetitions included concentric and eccentric lifting phases(each lasting 2 s) and were supervised by a strength and conditioning specialist.Results:Several variables were associated with elevated levels of D-dimer,including higher blood glucose,citrate use,recent cardiovascular events,recent intercurrents,higher inflammatory status,catheter as vascular access,older patients(>70 years old),and HD vintage.Furthermore,RE+BFR significantly increases D-dimer after 4 h.Patients with borderline baseline D-dimer levels(400-490 ng/mL) displayed increased risk of elevating D-dimer over the normal range(≥500 ng/mL).Conclusion:These results identified factors associated with a heightened prothrombotic state and may assist in the screening process for HD patients who wish to undergo RE+BFR.D-dimer and/or other fibrinolysis factors should be assessed at baseline and throughout the protocol as a precautionary measure to maximize safety during RE+BFR.展开更多
文摘AIM： To evaluate the clinical outcomes of patients undergoing hepatectomy with hemihepatic vascular occlusion （HHO） compared with total hepatic inflow occlusion （THO）. METHODS： Randomized controlled trials （RCTs） co- mparing hemihepatic vascular occlusion and total he- patic inflow occlusion were included by a systematic literature search. Two authors independently assessed the trials for inclusion and extracted the data. A meta- analysis was conducted to estimate blood loss, transfu- sion requirement, and liver injury based on the levels of aspartate aminotransferase （AST） and alanine arni- notransferase （ALT）. Either the fixed effects model or random effects model was used. RESULTS- Four RCTs including 338 patients met the predefined inclusion criteria. A total of 167 patients were treated with THO and 171 with HHO. Metaanalysis of AST levels on postoperative day 1 indicated higher levels in the THO group with weighted mean dif- ference （WMD） 342.27; 95% confidence intervals （CI） 217.28-467.26; P = 0.00001; I2 = 16%. Meta-analysis showed no significant difference between THO group and HHO group on blood loss, transfusion requirement, mortality, morbidity, operating time, ischemic duration, hospital stay, ALT levels on postoperative day 1, 3 and 7 and AST levels on postoperative day 3 and 7. CONCLUSION： Hemihepatic vascular occlusion does not offer satisfying benefit to the patients undergoing hepatic resection. However, they have less liver injury after liver resections.
文摘Laparoscopic hepatectomy seems to be difficult because of the ease of bleeding from the liver parachyma during resection. This is not easily controlled under the laparoscope, especially during right or left hemihepatectomy, except for resection of the peripheral liver or left lateral segment when porta hepatis dissection is not indicated. Although both inflow and outflow control seems to be ideal in laparoscopic left hepatectomy, there have not been many reports of this. In addition to the high technical demands and the time required, any injury of the main hepatic veins or vena cava during the procedure will cause catastrophic bleeding and air embolism. Recently, we succeeded in achieving inflow and outflow occlusion during laparoscopic left hemihepatectomy in four cases, with satisfactory results.
文摘目的研究动脉溶栓联合机械辅助治疗前后循环大动脉急性闭塞性脑梗死患者的有效性和安全性。方法 42例大动脉闭塞性脑梗死患者行动脉溶栓联合机械辅助治疗,分为前循环组(24例)、后循环组(18例),评估不同组别治疗前后的NIHSS评分(National Institute of Health stroke scale)、GCS评分(Glasgow comascore,GCS)及治疗后血管再通率、BI(Barthel Index)优率、症状性颅内出血率、死亡率。结果前循环组卒中病因分型以心源性栓塞为主(15/24,62.5%),后循环组以动脉粥样硬化性血栓形成为主(5/18,72.2%),两组间比较,差异有统计学差异(P=0.026);前、后循环组患者,治疗后的NIHSS评分(8.3±4.9 vs.8.1±5.7)较治疗前(15.1±5.3vs.16.8±7.8)明显降低(P=0.001 vs.P=0.001)、GCS评分(13.9±4.4 vs.12.8±4.2)较治疗前(9.5±3.8 vs.9.6±3.7)明显提高(P=0.001 vs.P=0.021),后循环血管再通率(15/18,83.3%)有高于前循环(14/24,58.3%)趋势(P=0.830),前循环组患者颅内出血发生率(5/24,20.8%)明显高于后循环组(0,0%)(P=0.039),两组患者死亡率相似。结论动脉溶栓联合机械辅助治疗脑梗死能改善神经功能缺损,血管再通率高,更适用于后循环脑梗死的治疗。
文摘血管性认知障碍(vascular cognitive impairment,VCI)是近年来医学研究的热点之一,该疾病病因较复杂,临床表现为多认知领域障碍、记忆力受损、以及痴呆等,严重影响患者生存质量。成功建立慢性脑缺血性血管性认知障碍的动物模型,是医学研究其发病机制、提供治疗并攻克此疾病的第一步。经过发展,现存在多种VCI动物建模方法,其中以啮齿类动物居多,针对大鼠有四血管闭塞法(4-vessel occlusion,4-VO)法、改良4-VO法、3期4-VO法、两血管闭塞法(2-vessel occlusion,2-VO)法、改良2-VO法、以及一侧颈总动脉闭塞一侧颈总动脉狭窄改良法(modified common carotid artery occlusion,mCCAO)等;针对小鼠有颈总动脉狭窄(bilateral CCA stenosis,BCAS)和不对称颈动脉手术(asymmetric CCA surgery,ACAS)等。根据所采用的手术建模方法不同,动物在术后的病理损伤部位、损伤程度、生存率、动物行为学表现、都存在一定的差异。本文将对上述8种啮齿鼠类动物血管性痴呆模型的手术构建方法、表型、评价指标、优缺点等进行系统的回顾,以期望能够为研究者在相关动物模型的选择上提供一些指导和帮助。
基金supported by a grant provided by the Coordenacao de Aperfeicoamento de Pessoal de Nível Superior-Brazil-Finance Code 001 and National Council for Scientific and Technological Developmentfinanced in part by the Conselho Nacional de Desenvolvimento Científico e Tecnológico and Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior-Brasil--Finance Code 001funded by the Fundacao de Apoio à Pesquisa do Distrito Federal with grants from demanda espontanea-Edital 09/2022
文摘Background:Hemodialysis(HD) per se is a risk factor for thrombosis.Considering the growing body of evidence on blood-flow restriction(BFR) exercise in HD patients,identification of possible risk factors related to the prothrombotic agent D-dimer is required for the safety and feasibility of this training model.The aim of the present study was to identify risk factors associated with higher D-dimer levels and to determine the acute effect of resistance exercise(RE) with BFR on this molecule.Methods:Two hundred and six HD patients volunteered for this study(all with a glomerular filtration rate of <15 mL/min/1.73 m2).The RE+BFR session consisted of 50% arterial occlusion pressure during 50 min sessions of HD(intradialytic exercise).RE repetitions included concentric and eccentric lifting phases(each lasting 2 s) and were supervised by a strength and conditioning specialist.Results:Several variables were associated with elevated levels of D-dimer,including higher blood glucose,citrate use,recent cardiovascular events,recent intercurrents,higher inflammatory status,catheter as vascular access,older patients(>70 years old),and HD vintage.Furthermore,RE+BFR significantly increases D-dimer after 4 h.Patients with borderline baseline D-dimer levels(400-490 ng/mL) displayed increased risk of elevating D-dimer over the normal range(≥500 ng/mL).Conclusion:These results identified factors associated with a heightened prothrombotic state and may assist in the screening process for HD patients who wish to undergo RE+BFR.D-dimer and/or other fibrinolysis factors should be assessed at baseline and throughout the protocol as a precautionary measure to maximize safety during RE+BFR.
