Objective To explore the hepatic artery variations encountered in laparoscopic pancreaticoduodenectomy (LPD) surgery and its significance. Methods The clinical datas of 26 patients who underwent LPD from January 2020 to January 2023 were retrospectively collected. Preoperative evaluation of hepatic artery variability and its types based on relevant clinical and imaging data, as well as targeted measures taken during surgery, and patients’ prognosis were analyzed. Results According to preoperative abdominal enhanced CT, arterial computer tomography angiography imaging and intraoperative skeletonization of the hepatoduodenal ligament, hepatic artery variation was found in 9 of 26 patients undergoing LPD. The left hepatic artery was substituted in 1 case, the right hepatic artery was substituted in 2 cases, 2 cases were the left accessory hepatic artery, and the common hepatic artery originated from the superior mesenteric artery in 3 cases. There was 1 case, right hepatic artery coming from the abdominal aorta, whose arterial variation was not included in the traditional typing. The variant hepatic artery from superior mesenteric artery was separated by posterior approach during operation, and the variant hepatic artery from left gastric artery was separated by anterior approach during operation. Nine patients with hepatic artery variation recovered well after operation, and no serious complications occurred. Conclusions Various hepatic artery variations during LPD need to be carefully evaluated before surgery. During surgery, it should be determined whether to retain the mutated blood vessel based on its diameter and changes in liver blood flow after occlusion, so that reasonable operation can be performed during the operation to avoid hepatic artery damage.
【Abstract】ObjectiveTo develop a new singletube polymerase chain reaction amplification (ST Amp) protocol for the efficient sequencing-based typing (SBT) of human leukocyte antigen DRB1（HLA-DRB1）.MethodsA set of 7 group-specific exonic 5′ amplification primers and a single generic 3′ primer were included together in a single PCR mix to facilitate a single PCR amplification per sample for HLA-DRB1 typing.ResultsAll samples were successfully typed, the typing result was accurate and repeatable.ConclusionST Amp technique has resulted in the ability to perform high-resolution, high-specificity and high-throughput HLA-DRB1 typing by DNA sequencing.
Objective To apply rapid prototyping (RP) technology on pre-fabricating nasoalveolar molding (NAM) appliances, and compare clinical outcomes and complications with traditional NAM appliances. Methods Between June 2014 and September 2016, 39 children with unilateral cleft lip and palate were included in study. Seventeen children (test group) had received novel NAM protocol by pre-fabricating NAM appliances using RP technology, and the other 22 children (control group) had received traditional NAM protocol. There was no significant difference in gender, age, the side of cleft lip and palate, and the width of the alveolar cleft gap before treatment between 2 groups (P>0.05). The change of width of the alveolar cleft gap, number of clinic visit, treatment time, and complications were compared between 2 groups. Results The number of clinic visit was less in test group than in control group (P<0.05). There was no significant difference in treatment time between 2 groups (P>0.05). During treatment, there was 16 children (72.2%) of skin irritation, 3 (13.6%) of mucosal ulceration, 1 (4.5%) of intraoral bleeding, 1 (4.5%) of alveolar arch T-shap asymmetry in control group. And there were 11 children (64.7%) of skin irritation, 3 (17.6%) of mucosal ulceration in test group. There was no significant difference in the incidence of complications between 2 groups (P>0.05). After treatment, the anterior alveolar cleft width, horizontal cleft width, sagittal cleft width, antero-medial alveolar ridges angle of the healthy side, angle between anterior alveolar and posterior alveolar baseline of the healthy side, perpendicular distance from buccal frenum point to sagittal line were significantly reduced when compared with the values before treatment (P<0.05). The angle between the anterior segments of two sides, angle between buccal frenum point and posterior baseline were significant increased when compared with the values before treatment (P<0.05). There was no significant difference in the differences between pre- and post-treatment of above indexes between 2 groups (P>0.05). There also was no significant difference in posterior alveolar width, the width between the middle parts of alveolar, vertical cleft width, antero-medial alveolar ridges angle of the affected side, and angle between anterior alveolar and posterior alveolar baseline of the affected side between pre- and post-treatment in each group (P>0.05). Conclusion Clinical outcome of novel approach was equivalent to traditional protocol; however, the number of clinic visit decreased. With improving of RP technology, it would provide a more consistency and convenient way for sequential treatment with cleft lip and palate.
Objective To investigate the incidence rate, molecular epidemiology and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infection. Methods A total of 119 Staphylococcus aureus strains isolated from January 2016 to December 2020 in general surgery of this hospital were collected retrospectively and divided into MRSA group and methicillin-sensitive Staphylococcus aureus group according to whether or not resistant to oxacillin. The clinical data of all patients infected with Staphylococcus aureus and drug sensitivity of Staphylococcus aureus were collected. Molecular typing was performed by multilocus sequence typing (MLST), resistance gene, virulence gene and biofilm gene were detected by polymerase chain reaction (PCR) method, and a case-control study was used to identify risk factors for MRSA infection. ResultsThe detection rate of MRSA was 57.98% (69/119), mainly was from pus specimens (80.67%, 96/119). The results of MLST showed that the dominant clone types were ST88 (37.68%, 26/69), ST951 (27.54%, 19/69) and ST59 (18.84%, 13/69). The results of PCR showed that the detection rates of mecA, mecC, Aac (6′ )/Aph (2′ ′ ), Aph (3)-Ⅲ, ant (4′ )- Ⅰ a, tetM, qnrA, panton-valentine leukocidin, fibronectin-binding protein A, staphylococcal enterotoxin A, staphylococcal enterotoxin B, α-hemolysins, intracellular adhesion A, staphylococcal accessory regulators A, and fibronectin-binding protein B in 69 strains of MRSA were 100%, 0.00%, 27.54%, 34.78%, 18.84%, 14.49%, 1.45%, 8.70%, 98.55%, 11.59%, 91.30%, 94.20%, 92.75%, 97.10% and 86.96%, respectively. Multivariate analysis showed that hospital transfer, wound infection, catheter related infection, drainage tube and history of cephalosporin using were risk factors for MRSA infection. ConclusionsThe detection rate of MRSA in general surgery of this hospital is high. ST88 is the most common clone type. The carrying rates of resistant-, virulence- and biofilm-related genes are high. Hospital transfer, wound infection, drainage tube, history of cephalosporin using etc. are high risk factors for MRSA infection. It is advised that invasive operation should be reduced, antibiotics should be used rationally, hand hygiene should be paid attention to, environmental sanitation disinfection should be carried out regularly, and the monitoring of MRSA bacteria should be strengthened, so as to reduce and control the infection and spread of MRSA.
Objective To design a new custom-made artificial semi-knee joint based on rapid prototyping(RP) technique and to explore a method to solve necroses of allocartilage in hemi-joint allotransplantation. Methods Based on the extracted 3D contour image of the articular cartilage of femoral condyle, the custom-made artificial semi-knee joint was designed with Surfacer 9.0 image processingsoftware. The artificial semi-knee joint design used the femoral condylar 3D contour of the patient as the outer face and the subchondral bone 3D contour of allograft bone as inner face. One dado for medullary nailand two for special designing cages which were used to fix the cartilage into the allograft were added on the inner face. After being converted into RP data format, the computerassisted design was imported into the LPS600 rapid prototyping machine, and the prototype was achieved. Furthermore, the prototype could be modified by hand according to the design. Then the RP model was used as a positive mould to build up a silica gel negativemould, and the negative mould was sent to the factory to manufacture Ti-6Al-4V alloy articular cartilage through ordinary mould-melted founding process. Finally, the whole metal cartilage was completed after melting two special cages on it andpolishing it. Results A new custom-made artificial semi-knee joint was made ad used to treat a 14-year old patient. The custom-made artificial semi-knee joint and the subchondral bone were a perfect match. The operative result was satisfactory. The patient could walk 5 weeks after operation. The bone healing of the auto-bone and allo-bone was achieved 6 months later. A follow-up period lasting 1 yearshowed that the knee joint played a good function. Conclusion The artificial semi-knee joint is a good match for the allograft boneand a good idea to solve necroses of allocartilage in hemijoint allotransplantation.
Mycobacterium tuberculosis is the causative agent of human tuberculosis. Through the genotyping of Mycobacterium tuberculosis, we can find the epidemic situation and characteristics of tuberculosis in time, analyze the transmission chain between patients in different jurisdictions, and formulate effective intervention measures in time, to provide a strong basis for clinical diagnosis and treatment. At present, several genotyping techniques for Mycobacterium tuberculosis have their advantages and disadvantages in application. This article reviews the genotyping technology, population genetics and genotyping naming rules of Mycobacterium tuberculosis.
Objective To investigate the clinical typing and their relevant surgical treatment principle and method of pressure sore. Methods From January 1983 to April 2006, 122 patients with 179 pressure sores were treated. There were 93 males and29 females, aging 1568 years. The pressure sores were located at sacrococcygeus (54 lesions), petrochanteric region (37 lesions), ischial tuberosity (30 lesions), heel (17 lesions), olecranon (15 lesions), scapula (9 lesions), lateral malleolar (7 lesions), caput fibulace (4 lesions), pretibial (3 lesions), and lumbar region (3 lesims)respectivly. The disease course was from 2 months to 11 years. The areas of pressure sores were from 1.5 cm× 1.0 cm to 20.0 cm×18.0 cm. According to the wound characteristics, the pressure sores were divided into three types：sinus type（12/179）, ulcer type （74/179） and mixed type（93/179）.Aimed at different types of pressure sore, skin grafting, skin flap and myocutaneous flap were employed to repair wound. The areas of flaps were from 5.0 cm×3.5 cm to 26.0 cm×14.5 cm. The areas of skin grafting were from 7 cm×5 cm to 23 cm×12 cm. Results All wounds of sinus type healed by firstintention except one; and all flaps survived. All wounds of uler type healed byfirst intention; and the flaps survived completely except two which had a partial necrosis. All flaps which harvested to repair 93 pressure sores of mixed typewere survived. But one or two sinus occurred in 8 cases. Two healed by operation, and the others healed by dressing exchange. The wounds healed by first intention. The donor sites healed by first intention. The routine followup in 73 patients after 6 months showed that the recurrence appeared in 4 mixed type. The recurrence rate was 55% and the other patients had good outcome. Conclusion Clinical typing of pressure sore is helpful to select the suitable operation method and improve the rate of success.
Objective To investigate the methods of establishing 3-dimensional skull model using electron beam CT(EBCT) data rapid prototyping technique, andto discuss its application in repairing crainomaxillofacial trauma. Methods The data were obtained by EBCTcontinuous volumetric scanning with 1.0 mm slice at thickness. The data were transferred to workstation for 3-dimensional surface reconstruction by computeraided design software and the images were saved as STL file. The data can be usedto control a laser rapid-prototyping device(AFS-320QZ) to construct geometricmodel. The material for the model construction is a kind of laser-sensitive resinpower, which will become a mass when scanned by laser beam .The design and simulation of operation can be done on the model. The image data were transferred to the device slice by slice. Thus a geometric model is constructed according to the image data by repeating this process. Preoperative analysis, surgery simulation and implant of bone defect could be done on this computer-aided manufacture d3D model. One case of craniomaxillofacial bone defect resulting from trauma wasreconstructed with this method. The EBCT scanning showed that the defect area was 4 cm×6 cm. The nose was flat and deviated to left. Results The -3dimensional -skull was reconstructed with EBCT data and rapid prototyping technique. The model can display the structure of 3-dimenstional anatomyand their relationship.The prefabricated implant by 3-dimensional model was well-matched with defect .The deformities of flat and deviated nose were corrected. The clinical result wassatisfactory after a follow-up of 17 months. Conclusion The 3-dimensional model of skull can replicate the prototype of disease and play an important role in the diagnosis and simulation of operation for repairing craniomaxillofacial trauma.
ObjectiveTo investigate the relationship between the CYP3A5 genotyping and the drug metabolism of tacrolimus after operation in adult liver transplantation.MethodsNinety-eight adult patients with liver transplantation in Tianjin First Center Hospital were selected as subjects. The blood samples of liver transplantation recipients and donor were collected before operation, and then tested the CYP3A5 genotyping by PCR method. The weekly body mass, tacrolimus dose, and drug valley concentration of the patients were monitored in 1, 2, 3, and 4 weeks after operation, to calculate the tacrolimus concentration/dose ratio. And then compared the effects of different genotyping of donor and receptors on tacrolimus concentration/dose ratio.ResultsIn the CYP3A5 genotyping of 98 patients with liver transplantation and the corresponding donors, GG type was the most and AA type was the least, the distribution of alleles was in accordance with the genetic law, and the difference was not statistically significant (P>0.05). According to the donor genotype, the results showed that there was a significant correlation between tacrolimus concentration/dose ratio and donor or recipients CYP3A5 genotype at 1, 2, 3, and 4 weeks after liver transplantation, and there was significant difference among the three groups (P<0.05): GG>AG>AA. According to the combined grouping of donor and receptor genotype, the results showed that there was significant difference in tacrolimus concentration/dose ratio among A*/A*, A*/GG, GG/A*, and GG/GG group (P<0.05), while there was significant difference in tacrolimus concentration/dose ratio between GG/GG and A*/A* group (P<0.01), the tacrolimus concentration/dose ratio was highest in GG/GG group and lowest in A*/A* group.ConclusionsThe CYP3A5 genotyping of the recipient and donor can affect the blood concentration of tacrolimus after liver transplantation, and the CYP3A5 GG genotype is more likely to reach the target plasma concentration than the other genotypes, that the detection of donor and recipient CYP3A5 genotype in patients with liver transplantation can provide a reference for individualized treatment of tacrolimus after liver transplantation.
Objective To introduce the recent advances of the application of computer technology in tissue engineering. Methods The recent original articlesrelated to computer technology, medical image technology, computer-aided design, the advanced manufacture technology were summarized and systematically analyzed.Results Computer-aided tissue engineering is a new fieldon tissue engineering. It is the future direction of tissue engineering study. This article reviews recent development of medical CT/MRI scanning, three-dimensional reconstruction, anatomical modeling, computeraided design, computer-aided manufacturing, rapid prototyping， RP manufacturing of tissue engineering scaffolds and computeraided implantation.Conclusion Computer-aided tissue engineering can be used in scaffolds design and fabrication, computer-aided artificial tissue implantation. It is a new field on tissue engineering.