Exploration and practice of smart hospital based on new diagnosis and treatment model / 现代医院

As the state vigorously promotes the high-quality development of hospitals and improves people's medical ex-perience,the patient-centered hospital should make full use of technological resources such as the Internet,5 G and artificial in-telligence,vigorously develop mobile medical services and artificial intelligence services,transform and optimize the diagnosis and treatment process,and streamline all links before,during and after diagnosis so as to provide better data services to the pa-tient to ensure that they can get things done with greater ease.The patients'medical experience and hospital management effi-ciency can be greatly improved.In this study,specific measures to create a new diagnosis and treatment model through the con-struction of smart hospital platform were expounded in order to provide references for related research and policy formulation of other Chinese medical institutions.

Construction of digital intelligent minimally invasive research-oriented hepatobiliary and pancreatic surgery discipline / 中华消化外科杂志

The emergence and evolution of digital intelligent technology has profoundly influenced the development of minimally invasive research-oriented hepatobiliary and pancreatic surgery discipline. Over various periods, our team has always adhered to the principle of "being oriented by clinical issues and driven by clinical needs", continuously carried out innovative research across interdisciplinary boundaries, propelling the evolution of digital intelligent technology. Spanning over two decades, this journey includes the progression from digital virtual human, three-dimensional visualization, molecular fluorescence imaging, augmented reality and mixed reality, artificial intelligence, to the realm of human visualization meta-universe. This evolution facilitates the shift from two-dimensional empirical diagnoses of hepatobiliary and pancreatic surgical diseases to deep learning intelligent diagnostics, the transition from morphology-based tumor diagnoses to molecular imaging-based diagnostics, and from conventional empirical surgery to intelligent navigation surgery. The authors provide a comprehensive review of our developmental process and achievements within the realm of digital intelligent diagnostic and therapeutic technologies, with the aims to promote the development and application of digital intelligent medicine.

Construction and application of pre-job training program for new nurses based on transformative learning / 中华医学教育探索杂志

Objective:To construct a new nurse pre-job training program based on transformative learning and explore its preliminary application effect.Methods:A quasi-experimental study was conducted, and 52 new nurses enrolled in 2019 in a three-A hospital of Hangzhou were randomly divided into experimental group ( n=26) and control group ( n=26). The experimental group adopted transformative learning based pre-job training program for new nurses, while the control group adopted traditional pre-job training program for new nurses. SPSS 20.0 and Microsoft Excel 2010 were performed for data processing, and t test and Fisher's exact probability test were used for statistical analysis. Results:After the training, the comparison of two groups of new nurses showed that, the total score of clinical core competence of the experimental group (226.62±32.84) was higher than that of the control group (197.00±29.54), the total score of self-efficacy of the experimental group (28.46±4.94) was higher than that of the control group (24.31±4.76), the total score of the transition shock of the experimental group (77.23±14.13) was lower than that of the control group (91.27±17.98), and the mean value of clinical assessment of the experimental group (73.16±17.05) was higher than that of the control group (61.58±14.24), all with statistical significance ( P<0.05). Conclusion:The pre-job training program for new nurses based on transformative learning can improve the clinical ability and self-efficacy of new nurses, reduce the transition shock of new nurses, and have a profound impact on their career.

Application of augmented reality and mixed reality navigation technology in laparoscopic limited right hepatectomy / 中华外科杂志

Objective: To investigate the application effect of augmented reality and mixed reality navigation technology in three-dimensional(3D) laparoscopic narrow right hepatectomy(LRH). Methods: A retrospective analysis was performed on the clinical data of 5 patients with hepatic malignancy admitted to the First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University from September 2020 to June 2021,all of whom were males,aged from 42 to 74 years.Preoperative evaluation was performed using the self-developed 3D abdominal medical image visualization system; if all the 5 patients were to receive right hemihepatectomy,the remnant liver volume would be insufficient,so LRH were planned.During the operation,the independently developed 3D laparoscopic augmented reality and mixed reality surgical navigation system was used to perform real-time multi-modal image fusion and interaction between the preoperative 3D model and 3D laparoscopic scene.Meanwhile,intraoperative ultrasound assisted indocyanine green fluorescence was used to determine the surgical path.In this way,the LRH under the guidance of augmented reality and mixed reality navigation was completed.The predicted liver resection volume was evaluated before surgery,actual resected liver volume,surgical indicators and postoperative complications were analyzed. Results: All the 5 patients completed LRH under the guidance of augmented reality and mixed reality navigation technology,with no conversion to laparotomy.The median operative time was 300 minutes(range:270 to 360 minutes),no intraoperative blood transfusion was performed,and the median postoperative hospital stay was 8 days(range:7 to 9 days).There were no perioperative deaths,or postoperative complications such as liver failure,bleeding,or biliary fistula. Conclusion: For patients who need to undergo LRH,the use of augmented and mixed reality navigation technology can safely and effectively guide the implementation of surgery,retain more functional liver volume,improve surgical safety,and reduce postoperative complications.

Protective Mechanism of Banxia Houputang on Lipopolysaccharide-induced Neuroinflammatory Injury / 中国实验方剂学杂志

ObjectiveTo study the inhibitory effect of Banxia Houputang （BHT） on lipopolysaccharide （LPS）-induced inflammation of microglia （BV2） cells and the neuroprotective effect on human neuroblastoma （SH-SY5Y） cells. MethodAfter the neuroinflammatory model was constructed by LPS inducing BV2 cells， model group （LPS 100 µg·L-1）， administration groups （LPS+1 g·L-1 BHT， LPS+2 g·L-1 BHT， LPS+5 g·L-1 BHT， LPS+10 g·L-1 BHT）， and blank group were given DEME medium at the same volume. In addition， neuronal apoptosis model was established by co-culture of LPS-induced BV2 cell inflammation medium and SH-SY5Y cells （LPS-DMEM） and was administrated according to the above grouping. Cell viability was detected by Cell Counting Kit-8 （CCK-8） assay. The content of nitric oxide （NO） and that of tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， and interleukin-6 （IL-6） were determined by Griess aasay and enzyme-linked immunosorbent assay （ELISA）， respectively. The mRNA levels of TNF-α， IL-1β， interleukin-4 （IL-4）， nitric oxide synthase （iNOS）， and interleukin-10 （IL-10） were measured by real-time polymerase chain reaction （Real-rime PCR）. Western blot was used to detect the expression levels of signal transducer and activator of transcription 3 （STAT3）， Janus kinase 2 （JAK2） and nuclear factor kappa-B （NF-κB p65）， protein kinase B （Akt）， inhibitor of nuclear factor κB α （IκBα）， B-cell lymphoma-2 （Bcl-2）， and Bcl-2 associated X protein （Bax）. ResultCompared with blank group， LPS increased the NO release， levels of TNF-α， IL-1β， IL-6， and iNOS and protein expression of Akt， NF-κB p65， IκBα， JAK2 and STAT3， decreased the content of IL-4 and IL-10 in BV2 cells， and induced apoptosis of co-cultured SH-SY5Y cells （P<0.01）. Compared with model group， BHT reduced the content of NO， TNF-α， IL-1β， and iNOS （P<0.01） and protein expression of Akt， NF-κB p65， IκBα， JAK2 and STAT3 （P<0.01）， elevated the content of IL-4 and IL-10 （P<0.01）， and inhibited the apoptosis of SH-SY5Y cells induced by LPS-DMEM （P<0.01）. ConclusionThis experiment reveals that BHT inhibited LPS-induced inflammation in BV2 cells by regulating Akt/NF-κB/JAK2/STAT3 signaling pathway and showed neuroprotective effects on SH-SY5Y cells.

Therapeutic Mechanism of Huangqi Guizhi Wuwutang on Rheumatoid Arthritis / 中国实验方剂学杂志

ObjectiveTo reveal the mechanism of action of Huangqi Guizhi Wuwutang in the treatment of rheumatoid arthritis by pharmacological research based on its clinical application. MethodThe collagen-induced arthritis （CIA） rat model was established by injecting bovine type Ⅱ collagen and Freund's adjuvant at the tail， and was treated with different concentrations of Huangqi Guizhi Wuwutang. The rats were randomly divided into blank group， model group， methotrexate （0.9 mg·kg-1） group， and Huangqi Guizhi Wuwutang low- and high-dose （5.13， 20.52 g·kg-1·d-1） groups， with continuous intragastric administration for 4 weeks. The degree of joint swelling， weight， degree of foot swelling and arthritis index score were determined and the pathological changes of ankle joints were detected by hematoxylin and eosin （HE） staining to observe the therapeutic effect of Huangqi Guizhi Wuwutang on rheumatoid arthritis. In addition， enzyme-linked immunosorbent assay （ELISA） and Western blot were used to measure the expression of interleukin 1β （IL-1β）， interleukin 6 （IL-6）， interleukin 10 （IL-10） and tumor necrosis factor-α （TNF-α） in serum and the expression of nuclear factor kappa-B （NF-κB） pathway related proteins in synovial tissue， respectively to clarify the molecular mechanism of Huangqi Guizhi Wuwutang in the treatment of rheumatoid arthritis. ResultCompared with the conditions in blank group， the body weight and IL-10 level were decreased （P<0.01）， and the degree of foot swelling and arthritis index score， the levels of IL-1β， IL-6 and TNF-α， and the expression of NF-κB pathway related proteins were increased （P<0.01，） in the model group， with impaired morphology and function of the ankle joint. Additionally， compared with the model group， Huangqi Guizhi Wuwutang low- and high-dose groups had increased body weight of rats and IL-10 level （P<0.01）， and reduced degree of foot swelling and arthritis index score （P<0.05， P<0.01）， levels of IL-1β， IL-6 and TNF-α （P<0.01） and expression of NF-κB pathway related proteins （P<0.05， P<0.01）， with improved function and morphology of the ankle joint. ConclusionHuangqi Guizhi Wuwutang can significantly alleviate joint inflammatory injury by down-regulating NF-κB pathway and reducing the inflammatory response in CIA rats.

Optimization of polysaccharide extraction from Hippocampus by deep neural network and Box-Behnken design-response surface methodology / 中国中药杂志

In this paper, the extraction rate of crude polysaccharides and the yield of polysaccharides from Hippocampus served as test indicators. The comprehensive evaluation indicators were assigned by the R language combined with the entropy weight method. The Box-Behnken design-response surface methodology(BBD-RSM) and the deep neural network(DNN) were employed to screen the optimal parameters for the polysaccharide extraction from Hippocampus. These two modeling methods were compared and verified experimentally for the process optimization. This study provides a reference for the industrialization of effective component extraction from Chinese medicinals and achieves the effective combination of modern technology and traditional Chinese medicine.

Clinical effect of rhinoplasty with ear cartilage and silicone prosthesis: a three-dimensional scanning study / 中华医学美学美容杂志

Objective:To use three-dimensional (3D) scanning to measure the preoperative and postoperative nasal parameters of the patients received rhinoplasty with ear cartilage and silicone prosthesis, and to evaluate the clinical effect of the surgery.Methods:Sixteen female patients with an average age of 28.3 years, ranged from 21 to 35 years, received rhinoplasty with ear cartilage and silicone prosthesis in Wuhan Tongji Hospital from June 2018 to February 2019. Preoperative and postoperative 3D scanning was performed to measure nasal parameters, including linear length, angle, and proportional index.Results:All patients were satisfied with the postoperative outcomes. The postoperative nasal length, nasal height, and nasal depth increased significantly, and the postoperative nasal width and nasal tip width decreased. The postoperative nasolabial angle and nasofrontal angle were statistically improved, while the preoperative and postoperative data of columellar facial angle, nasal tip angle, and nasal column-lobular angle were not significantly different. The ratios of nasal depth and nasal width, nasal index and nasal tip protrusion were improved after surgery, while the postoperative ratios of nasal columella and nasal lobules length were not statistically improved.Conclusions:The 3D scanning allows for comprehensive and accurate measurement of the nasal parameters. The rhinoplasty with ear cartilage and silicone prosthesis is more effective in improving the overall contour of the nose, but less effective in improving the aesthetics of the nasal tip.

Application of 3D visualization and 3D printing in individualized precision surgery for Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma / 南方医科大学学报

OBJECTIVE@#To explore the application of 3D visualization and 3D printing in individualized precision surgical treatment of Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma.@*METHODS@#We retrospectively analyzed the data of 10 patients with hilar cholangiocarcinoma undergoing surgeries under the guidance of 3D visualization and 3D printing in the Department of Hepatobiliary Surgery, Zhujiang Hospital from May 2016 to March 2019. Thin-section CT data of the patients were collected for 3D reconstruction and 3D printing, and the 3D printed models were used for observing the 3D relationship of tumor with the intrahepatic bile duct, hepatic artery, portal vein and hepatic vein system and for performing preoperative simulated surgery and surgical planning. The 3D printed models were subsequently used for real-time intraoperative navigation to guide surgeries in the operating room.@*RESULTS@#3D visualization models were successfully reconstructed for all the 10 patients and printed into 3D models. The 3D visualization types in Bismuth-Corlette classification included type Ⅲa (4 cases), type Ⅲb (4 cases), and type Ⅳ (2 cases); 4 patients showed portal vein variation, 3 had hepatic artery variation, and 2 had both portal vein and hepatic artery variations. Two patients were found to have trifurcation type of portal vein variation, one had "I-shaped" variation, and one showed the absence of the right anterior branch of the portal vein; 3 patients had hepatic artery variations with the left hepatic artery originating from the left gastric artery (1 case) and the right hepatic artery originating from the superior mesenteric artery (2 cases). Four patients with type Ⅲb underwent left hepatectomy; 4 with type Ⅲa received right hepatectomy; 1 patient with of type Ⅳ received peripheral hepatic resection and another underwent left hepatectomy. The results of preoperative 3D reconstruction, 3D printed model and preoperative planning were consistent with the intraoperative findings. The operative time was 452±75.12 min with a mean intraoperative blood loss of 356±62.35 mL and a mean hospital stay of 15 ± 4.61 days in these cases. One patient had bile leakage and 3 patients had pleural effusion postoperatively, and they were discharged after drainage and medications. No liver failure or death occurred in these cases perioperatively.@*CONCLUSIONS@#3D visualization and 3D printing can facilitate accurate preoperative assessment, surgical planning and surgical procedure optimization for Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma to improve surgical safety and reduce surgical risks especially in cases of intrahepatic vascular variations.

Application value of multimodal image fusion technology in the diagnosis and treatment of intrahepatic cholangiocarcinoma / 中华消化外科杂志

Objective To explore the application value of multimodal image fusion technology in the diagnosis and treatment of intrahepatic cholangiocarcinoma (ICC).Methods The retrospective descriptive study was conducted.The clinicopathological data of 11 patients with ICC who were admitted to Zhujiang Hospital of Southern Medical University between January and September 2018 were collected.There were 5 males and 6 females,aged (55 ± 12)years,with a range from 30 to 74 years.The data of contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) with gadoxetate disodium (Gd-EOB-DTPA) of the upper abdomen were respectively collected,and three-dimensional(3D) model of liver was constructed based on CT-MRI fusion images.The preoperative evaluation and surgical planning were carried out based on the different modal imaging examination technologies.The indocyanine green (ICG) molecular fluorescence imaging system and augmented reality navigation system were used to guide hepatectomy.Observation indicators:(1) preoperative evaluation;(2) intraoperative situations;(3) comparison between surgical planning based on the different model imaging technologies and actual surgical method;(4) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications up to November 2018.Measurement data with normal distribution were represented as Mean ± SD,measurement data with skewed distribution were represented as M (range).Count data were described as absolute number or percentage and comparisons were analyzed using the paired chi-square test.Results (1) Preoperative evaluation:the proportions of grade 3 and above branch vessels of the portal vein and hepatic vein system and tumor margin by enhanced CT examination and enhanced MRI examination were respectively 11/11,4/11 and 5/11,11/11,with statistically significant differences in above indicators (x2 =4.16,5.14,P＜0.05).The enhanced CT showed 11 liver cancer lesions and enhanced MRI showed 13 lesions (including 2 lesions not demonstrated by enhanced CT,with a maximum diameter ≤ 10 mm).The 3D model of liver based on CT-MRI fusion image:location,number,infiltrating range (tumor boundary),intrahepatic vascular distribution,variation and its spatial relationship with lesions could be stereoscopically,intuitively and comprehensively displayed.(2) Intraoperative situations:of 11 patients,11 lesions were explored with naked eyes;13 lesions were detected by ICG molecular fluorescence imaging system,including 2 lesions showing low uptake lesions in liver and gallbladder specific period by preoperative MRI examinations and intrahepatic metastasis cancer by pathologic examination.Of 11 patients,6 had naked-eye ischemia boundaries around related vessels of hepatic portal ligation;10 with anatomical hepatectomy had hepatic segments or hemihepatic boundary by ICG molecular fluorescence imaging system,including 2 using positive staining and 8 using anti-staining.Among 11 patients,3 (1 combined with local resection of hepatic segment Ⅷ metastases),2,2,1,1,1 and 1 underwent respectively left hepatectomy,left lateral lobectomy of liver,right hepatectomy,extended right hepatectomy,right lobectomy of liver,resection of partial hepatic segment Ⅷ and mesohepatectomy.Seven of 11 patients received regional lymph node dissection and 4 received simple lymph node biopsy.Of 11 patients,1 diagnosed as with bile leakage of liver section underwent suture and ligation treatment with 4-0 Prolene;10 didn't occurred bile leakage.The surgical margin of 11 patients was negative.The operation time,volume of intraoperative blood loss and duration of hospital stay were (240± 118)minutes,(275±249)mL and (13 ± 8) days,respectively.There was no blood transfusion in the perioperative period.(3) Comparison between surgical planning based on the different model imaging technologies and actual surgical method:surgical planning of 3D model based on CT,MRI and CT-MRI fusion image in 6,9 and 11 patients was respectively consistent with actual surgical method.(4) Follow-up:11 patients were followed up for 2-10 months,with a median time of 6 months.Three patients had postoperative complications,2 of which were found in Clavien-Dindo Ⅰ and Ⅱ,including 1 with pleural effusion + peritoneal effusion and 1 with pleural effusion,they were improved after conservative treatment;1 with complication of Clavien-Dindo Ⅲ (postoperative intra-abdominal bleeding) was improved by selective arterial embolization using percutaneous femoral artery puncture.There was no postoperative bile leakage,hepatic failure and death.Conclusion Multimodal image fusion technique is helpful to optimize the preoperative surgical planning,which can assist the recognition of important vessels and real-time navigation of hepatectomy during operation,and improve the safety of operation.

Regulation mechanism of E2F1 transcription factor on M2 macrophages in full-thickness skin defect wounds of mice / 中华烧伤杂志

Objective@#To explore the regulatory mechanism of E2F1 transcription factor on M2 macrophages in full-thickness skin defect wounds of mice.@*Methods@#E2F1 gene knockout heterozygotes C57BL/6 mice and wild-type C57BL/6 mice were introduced and self-reproduced. Two weeks after birth, E2F1 gene knockout homozygotes mice and wild-type mice were identified by polymerase chain reaction (PCR). Twelve identified 6-8 weeks old male E2F1 gene knockout homozygotes C57BL/6 mice and wild-type C57BL/6 mice were selected respectively according to the random number table and set as E2F1 gene knockout group and wild-type group. A full-thickness skin defect wound was made on the back of each mouse. On post injury day (PID) 2 and 7, 6 mice in each group were selected according to the random number table and sacrificed, and the wound tissue was excised. The expression of CD68 and CD206 double positive M2 macrophages was observed by immunofluorescence method, and the percentage of CD206 positive cells was calculated. The protein expression of CD206 was detected by Western blotting. The mRNA expression of arginase 1 was detected by real-time fluorescent quantitative reverse transcription PCR (RT-PCR). Wound tissue specimens of the two groups on PID 7 were obtained, and the protein and mRNA expressions of peroxisome proliferator-activated receptor gamma (PPAR-γ) were detected by Western blotting and real-time fluorescent quantitative RT-PCR respectively. The above-mentioned experiments were repeated four times. Three specimens of wound tissue of mice in wild-type group on PID 7 were obtained to detect the relationship between E2F1 and PPAR-γ by co-immunoprecipitation and Western blotting, and this experiment was repeated two times. Data were processed with unpaired t test.@*Results@#The size of PCR products of E2F1 gene knockout homozygotes C57BL/6 mice and wild-type C57BL/6 mice were 227 and 172 bp respectively, which were the same as those of the designed DNA fragments. On PID 2 and 7, the number of CD68 and CD206 double positive M2 macrophages in the wound tissue of mice in E2F1 gene knockout group was more than that of wild-type group, and the percentages of CD206 positive cells in the wound tissue of mice in E2F1 gene knockout group were (0.234±0.032)% and (0.584±0.023)% respectively, which were significantly higher than (0.129±0.017)% and (0.282±0.071)% of wild-type group (t=3.29, 3.54, P<0.05). On PID 2 and 7, the protein expression of CD206 in the wound tissue of mice in E2F1 gene knockout group were 1.00±0.23 and 1.63±0.26 respectively, which were significantly higher than 0.43±0.06 and 0.97±0.08 of wild-type group (t=2.41, 2.45, P<0.05). On PID 2 and 7, the mRNA expressions of arginase 1 in the wound tissue of mice in E2F1 gene knockout group were 0.482±0.105 and 0.195±0.031 respectively, which were significantly higher than 0.163±0.026 and 0.108±0.017 of wild-type group (t=3.04, 2.86, P<0.05). On PID 7, the protein and mRNA expressions of PPAR-γ in the wound tissue of mice in E2F1 gene knockout group were 0.61±0.12 and 0.51±0.13 respectively, which were significantly higher than 0.20±0.04 and 0.20±0.04 of wild-type group (t=3.36, 2.86, P<0.05). On PID 7, detection of the wound tissue of mice in wild-type group showed that PPAR-γ had unidirectional effect on E2F1.@*Conclusions@#E2F1 transcription factor affects the polarization of M2 macrophages by inhibiting the expression of PPAR-γ, thereby inhibiting the healing process of full-thickness skin defect wounds in mice.

Three-dimensional visual assessment and virtual reality study of centrally located hepatocellular carcinoma on the axis of blood vessels / 中华外科杂志

Objective@#To explore a novel method for preoperative precision assessment of centrally located hepatocellular carcinoma(HCC) with blood vessel as axis based on three-dimensional(3D) visualization and virtual reality(VR) technology and its application values.@*Methods@#High-quality thin-layer enhanced CT data were collected from 20 patients with centrally located HCC who treated at First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University from March 2017 to August 2018 diagnosed by preoperative examination. There were 18 males and 2 females, aged 28 to 69 years, all of Child-Pugh grade A. First of all, 3D reconstruction was performed by a 3D visualization software; then, the reconstructed 3D image was imported into VR development engine for VR research; afterwards, the analysis and evaluation system with blood vessel as axis was established based on 3D visualization classification of centrally located HCC; therefore, the relationship of the tumor to its major peripheral blood vessels was accurately judged and the surgical planning was formulated. Two images were brought into the operating room for navigation in surgery. The assessments results of preoperative data (CT and (or) MRI) and three-dimensional visualization of blood vessels in VR environment were compared; the values of the preoperative and postoperative hemoglobin, serum albumin and bilirubin were recorded and compared. Chi-square test, t-test and non-parametric test were used for the analysis of counting data, continuous measurement data and non-normal distribution measurement data, respectively.@*Results@#3D visualization modeling was completed in all of the 20 patients with centrally located HCC. According to the results of 3D visualization classification of centrally located HCC, there were 3 cases of type Ⅰ,1 case of type Ⅱ,4 cases of type Ⅲ,7 cases of type Ⅳ and 5 cases of type Ⅴ; according to the assessment and classification based on blood vessel as the axis, there were 6 cases of type Ⅰa,2 cases of type Ⅰb,2 cases of type Ⅱa,9 cases of type Ⅱb and 1 case of type Ⅱc. All patients underwent successful resection of tumor under the guidance of 3D visualization and VR technology. There were 15 cases whose assessment results based on preoperative CT/MRI were consistent with intraoperative findings, with a coincidence rate of 75.0%(15/20); while in VR environment, the assessment results of 3D visualization with blood vessel as axis were all consistent with the intraoperative findings, with coincidence rate of 100%(20/20). There was a statistically significant difference between the groups (χ2=5.714, P=0.017). There was no red blood cell transfusion in all patients during the operation. The preoperative hemoglobin was (128.8±14.9)g/L, and it was (119.8±12.5)g/L on postoperative day 1. There was no significant difference between these two sets of data (t=2.07, P=0.054). No death during the perioperative period and no complications such as hepatic failure, hemorrhage and biliary fistula after operation occurred.@*Conclusion@#Preoperative evaluation based on 3D visualization and VR technology with blood vessel as the axis has significant clinical value for preoperative planning and surgical navigation of centrally located HCC.

Clinical efficacy of three-dimensional visualization technique combined with enhanced recovery after surgery in the treatment of hepatolithiasis / 中华消化外科杂志

Objective To investigate the clinical efficacy of three-dimensional visualization technique (3DVT) combined with enhanced recovery after surgery (ERAS) in the treatment of hepatolithiasis.Methods The retrospective cohort study was conducted.The clinicopathological data of 64 patients with hepatolithiasis who were admitted to Zhujiang Hospital of Southern Medical University from November 2015 to August 2018 were collected.There were 17 males and 47 females,aged from 30 to 82 years,with a median age of 55 years.Of the 64 patients,23 who completed preoperative assessment and planning using 3DVT,and furthermore received ERAS for perioperative management were divided into 3DVT + ERAS group,and 41 who received preoperative assessment merely under the guidance of 3DVT,combined with conventional perioperative management were divided into 3DVT + conventional group.Observation indicators:(1) preoperative CT and 3DVT assessment;(2) perioperative conditions;(3) follow-up.The follow-up was conducted by outpatient service,e-mail or telephone interview to detect the postoperative recurrence of hepatolithiasis up to March 2019.The measurement data with normal distribution were expressed as Mean±SD,and the t test was used for comparison between groups.The measurement data with skewed distribution were expressed as M (P25,P75),and the Mann-Whitney U test was used for comparison between groups.The count data were expressed as absolute numbers or percentages,and the comparison between groups was pedormed using the chi-square test or Fisher exact probability.Results (1) Preoperative CT and 3DVT assessment:23 patients in the 3DVT + ERAS group underwent preoperative CT examination and 3DVT assessment,the consistency between CT results and intraoperative findings was 91.3％ (21/23),and the consistency between 3DVT results and intraoperative findings was 95.7％(22/23).Fourty-one patients in the 3DVT + conventional group underwent preoperative CT examination and 3DVT assessment,the consistency between CT results and intraoperative findings was 90.2％ (37/41),and the consistency between 3DVT results and intraoperative findings was 95.1％ (39/41).(2) Perioperative conditions:the volume of intraoperative blood loss,duration of postoperative hospital stay,postoperative total bilirubin,postoperative direct bilirubin,postoperative albumin,postoperative alanine aminotransferase,postoperative aspartate aminotransferase and postoperative hemoglobin were 50 mL (10 mL,100 mL),8 days (7 days,9 days),12 μmol/L (9 μmol/L,16 μmoL/L),6 μmol/L (4 μmoL/L,8 μmol/L),(37±4)g/L,44 U/L (18 U/L,85 U/L),32 U/L (20 U/L,65 U/L),(117±18)g/L in the 3DVT + ERAS group,and 100 mL (50 mL,300 mL),13 days (10 days,16 days),17 μmol/L (12 μmoL/L,33 μmoL/L),11 μmoL/L (7 μmoL/L,21 μmol/L),(29±6)g/L,78 U/L (43 U/L,122 U/L),121 U/L (72 U/L,176 U/L),(106±13)g/L in the 3DVT + conventional group,respectively;there were significant differences between two groups (Z =-3.084,-4.827,-2.953,-3.632,t =5.261,Z=-2.960,-4.625,t =2.773,P＜0.05).Two patients had pulmonary infection and 2 had pleural effusion in the 3DVT + ERAS group,and all the 4 patients were cured after treatment.One case of biliary fistula,4 cases of pulmonary infection and 5 cases of pleural effusion occurred in the 3DVT + conventional group,and these patients were cured by adequate abdominal drainage,antibiotic therapy and thoracocentesis,respectively.There was no perioperative death in either group.(3) Follow-up:64 patients were followed up for 6-36 months,with a median time of 23 months.During the follow-up,no recurrent hepatolithiasis in the 3DVT + ERAS group,and 1 case of recurrent hepatolithiasis was confirmed by ultrasound in the 3DVT + conventional group.No cholangiocarcinoma occurred in either group.Conclusion The combination of 3DVT and ERAS is effective,safe and feasible in the management of hepatolithiasis,which can accelerate the postoperative recovery of liver function,thus enhancing perioperative recovery and improving the prognosis of patients simultaneously.

Three-dimensional visualization combined with indocyanine green fluorescence imaging in diagnosis and treatment of primary hepatocellular carcinoma / 南方医科大学学报

OBJECTIVE@#To explore the value of three-dimensional visualization technology (3DVT) combined with indocyanine green (ICG) fluorescence imaging in the diagnosis and treatment of primary hepatocellular carcinoma (HCC).@*METHODS@#We retrospectively analyzed the clinical data of 154 patients with HCC admitted to the Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University between January, 2016 and November, 2018. In 57 of the patients (3DVT group), preoperative CT and Gd-EOB-DTPA-enhanced MRI were performed and 3D visualization and surgical planning was carried out before the operation; intraoperative ICG florescence imaging was performed for real-time detection of the tumor location and demarcation, intrahepatic satellite lesions and metastases. According to the intraoperative fluorescent signals and 3D visualization-based surgical planning, the final surgical plan was determined. In the other 97 patients (control group), conventional surgical assessment and surgical resection of the tumor was carried out. The preoperative imaging findings, intraoperative tumor detection, postoperative laboratory results, pathological reports, and follow-up data of the patients were analyzed.@*RESULTS@#In 3DVT group, 63 and 70 lesions were detected by preoperative CT and MRI, respectively; compared with CT examination, intraoperative ICG florescence imaging revealed additional 17 lesions, among which 10 were pathologically confirmed as HCC and 7 as cirrhosis nodules. The median volume of bleeding was 300 mL in 3DVT group, significantly less than that in the control group (400 mL; Z=2.291, =0.022). In both groups, serious complications or perioperative death occurred in none of the patients. The incidence of postoperative complications was significantly lowed in 3DVT group than in the control group [21% (12/57) 48.4% (47/97); =11.406, =0.001]. The overall disease-free survival rate at 2 years after the operation was significantly higher in 3DVT group than in the control group (74.9% 28.9%, =0.022).@*CONCLUSIONS@#3DVT combined with ICG fluorescence imaging allows precise preoperative diagnosis, surgical planning and implementation, intraoperative detection of small liver cancers and precise navigation for HCC treatment, thereby helping to reduce postoperative complications and improve the disease-free survival rate of the patients.

Application of augmented-reality surgical navigation technology combined with ICG molecular fluorescence imaging in laparoscopic hepatectomy / 中华外科杂志

Objective@#To study the application value of augmented-reality (AR) surgical navigation technology combined with indocyanine green (ICG) molecular fluorescence imaging in three-dimensional (3D) laparoscopic hepatectomy.@*Methods@#The clinical data of forty-eight patients who had undergone 3D laparoscopic hepatectomy for hepatocellular carcinoma at First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University from January 2018 to April 2019 were retrospectively analyzed.The patients were divided into two groups: the group of 3D laparoscopic hepatectomy navigated by augment reality technology combined with ICG molecular fluorescence imaging (Group A) , and group of conventional 3D laparoscopic hepatectomy (Group B) . Patients in Group A (n=23) underwent 3D laparoscopic hepatectomy using augmented-reality technology combined with ICG molecular fluorescence imaging. In this group, the self-developed three-dimensional laparoscopic augmented-reality surgical navigation system (No. 2018SR840555) was operated to project the preoperative three-dimensional model to the surgical field, and the use of this system in combination with ICG molecular fluorescence imaging navigated laparoscopic hepatectomy. No surgical navigation technology was applied in Group B (n=25) . All patients signed the informed consent, which were in accordance with the requirements of medical ethics (Ethics No.: 2018-GDYK-003) . The preoperative data, surgical indicators and postoperative complications between the two groups were compared and analyzed.@*Results@#The median amount of intraoperative blood loss of Group A was 250 (200) ml (M (QR) ) , which was significantly lower than that of Group B (300 (150) ml) (Z=-2.307, P=0.021) .The transfusion rate of Group A was 13.0% (3/23) , which was significantly lower than that of Group B (40.0%, 10/25) (χ2=4.408, P=0.036) .The median postoperative hospitalization time of Group A was 8 (2) d, which was significantly shorter than that of Group B (11 (6.5) d) (Z=-2.694, P=0.007) . There were no serious complications and perioperative death in both groups.The incidence of postoperative complications in Group A was 17.4% (4/23) , which was not significantly different from that in group B (28%, 7/25) (χ2=0.763, P=0.382) .@*Conclusion@#Augmented-reality surgical navigation technology combined with ICG molecular fluorescence imaging has better effect in 3D laparoscopic hepatectomy.

Clinical efficacy and key points of individualized breast augmentation via inframammary fold incision / 中华医学美学美容杂志

Objective To explore the key points of surgical techniques in individualized breast augmentation via inframammary fold (IMF) incision.Methods Fifty-six patients of our department from March 2014 to March 2017 in this group were followed up for 3-18 months,with average 12 months.According to the patients' characteristics to determine the size and dimensions of the implant and the exact position of new IMF,via IMF incision we inserted an implant part under the pectoralis major muscle and part posterior to the breast after precisely stripping and forming the implant pocket,which were the dual-plane augmentation mammoplasty.Results Compared with traditional endoscope-assisted breast augmentation via axillary incision,the breast augmentation via inframammary fold incision was more accurate,the operation time was shortened by an average of one hour,the intraoperative hemorrhage decreased by about 20 ml on average,the postoperative drainage fluid was reduced by about 70 ml on average,the hospitalization time was shortened by about 3 days,the postoperative breast shape was naturally upright,and the incision was hidden at the new inframammary fold.No hematoma,infection,significant hypertrophic scar,capsule contracture and other complications were noted.Conclusions The individualized dual-plane augmentation mammoplasty via IMF incision can hide the incision in the inframammary fold.The operation under direct vision and no use of special equipments make it an ideal breast augmentation surgery.

A retrograde island flap pedicled on the frontal branch of superficial temporal artery with additional vein anastomosis for reconstruction of peri-auricular defects / 中华整形外科杂志

Objective@#To investigate an effective method for solving the venous stasis in reverse peri-auricular flap pedicled on the frontal branch of superficial temporal artery(STA).@*Methods@#From October 2013 to May 2016, 5 patients with peri-orbital defects were reconstructed with a retrograde flap pedicled on the frontal branch of STA that incorporated additional venous anastomosis. The additional venous anastomosis was created between the parietal branch of STV (superficial temporal vein) and the middle temporal vein. The defects at donor sites were directly sutured.@*Results@#The size of flaps ranged from 2 cm×2 cm to 2 cm×8 cm. All flaps survived without venous stasis. Color and texture match of the flap were excellent .In three cases, flaps were thinned in secondary operation. During the follow-up period(6 months to 2 years, average of 12.4 months), flaps survived well on early period. Excellent color and tissue match with peri-orbital tissue were achieved on later stage. The scar at the donor site was inconspicuous.@*Conclusions@#Retrograde island flaps pedicled on the frontal branch of superficial temporal artery with vein anastomosis has the advantages of robust blood supply, good texture, and color match, and acceptable donor mobidity, while avoiding the venous stasis and flap necrosis.

Application of three-dimensional laparoscopic cholecystectomy for complicated gallstone disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the clinical value of three-dimensional (3D) laparoscopic cholecystectomy in the treatment of complicated gallstone disease.</p><p><b>METHODS</b>From March 2014 to March 2015, 46 patients underwent cholecystectomy for complicated gallstone disease under 3D laparoscopy (3D group) and 43 received 2D laparoscopic cholecystectomy (2D group). The surgical data including the operative time, intraoperative blood loss, the rate of conversion to open laparotomy, recovery time of postoperative bowel motion and hospital stay were compared between the 2 groups.</p><p><b>RESULTS</b>Laparoscopic cholecystectomy was successfully completed in 43 patients in 3D group and in 39 patients in 2D group, and the rates of conversion to open laparotomy were similar between the two groups (P>0.05). The median operation time was significantly shorter in 3D group than in 2D group (50.5∓15.2 vs 65.4∓18.1 min, P<0.05), and the median volume of intraoperative blood loss was significantly smaller in 3D group (34.1∓13.6 vs 44.5∓22.3 mL, P>0.05). No significant differences were found in the recovery time of postoperative bowel motion and postoperative hospital stays between the two groups (P>0.05).</p><p><b>CONCLUSION</b>3D laparoscopy, which provides three-dimensional vision with a good sense of depth to allow precise surgical manipulation, can shorten the operation time and reduce the rate of conversion to open laparotomy for patients undergoing 3D laparoscopic cholecystectomy for complicated gallstone disease.</p>

Efficacy of three dimensional visualization technique assisted hepatectomy for the treatment of primary liver cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical efficacy of three dimensional visualization technique assisted hepatectomy for the treatment of primary liver cancer.</p><p><b>METHODS</b>A total of 108 primary liver cancer patients who had been admitted to Zhujiang Hospital of Southern Medical University from September 2013 to December 2014 were assigned to three dimensional visualization technique assisted hepatectomy group (n = 55) and routine hepatectomy group (n = 53) according to different methods of hepatectomy. The observed variable in two groups as fellow: the operative time, intraoperative blood loss, intraoperative blood transfusion, the change of postoperative liver function and biochemical indicators in 1, 3, 5 days, postoperative complication. The patients were followed up via-return visit or telephone.A student's t test was used to compare continuous parametric variables, and the Mann-Whitney U test was used to compare non-parametric or discrete variables, as appropriate. Categorical data were compared using the Chi-square test or Fisher's exact test.</p><p><b>RESULTS</b>In 3D group and routine hepatectomy group, the patients' intraoperative blood transfusion volume were 300 ml (200-600 ml) and 400 ml (300-700 ml) (χ² = -2.609, P = 0.009) respectively, intraoperative blood loss volume were 400 ml (250-600 ml) and 550 ml (400-800 ml) (χ² = -2.277, P = 0.023), the operative time were (247 ± 57) min and (262 ± 53) min (χ² = -1.787, P = 0.074), the deterioration of the mainly liver function indicators peak in routine hepatectomy group were higher than that in 3D group (P < 0.05). The ALT, AST, TBIL in 3D group were lower than that in routine group on postoperative day 1, 3, 5, respectively (χ² = -5.740- -0.692, all P < 0.05). The ALB in 3D group was higher than that in routine group on postoperative day 3, 5 ((33.0 ± 5.6) g/L vs. (31.2 ± 4.1) g/L, (36.7 ± 4.4) g/L vs. (34.7 ± 4.2) g/L) (t = 1.922-2.573, both P < 0.05). In 3D group and routine hepatectomy group, the incidence of postoperative complications were 10.9% and 30.1% (χ² = 6.185, P = 0.013), the length of postoperative hospital day were (12.6 ± 3.6) days and (14.4 ± 3.5) days (χ² = -3.384, P = 0.031), the positive rate of resection margin were 0 and 9.4% respectively (Fisher test: P = 0.026), the 1-year tumor recurrence rate were 22.2% and 37.5% (P > 0.05), 1-year survival rate was 82.2% and 77.5% (P > 0.05). No perioperative mortality was occured in the two groups.</p><p><b>CONCLUSION</b>Three dimensional visualization technique assisted hepatectomy for the treatment of primary liver cancer could reduce surgical injury, lower the rate of postoperative complications, improve the safety and the efficacy of the operation and achieve a good prognosis.</p>

Applied rigid choledochoscope and pneumatic lithotripsy in targeting treatment of hepatolithiasis guided by three-dimensional visualization technology / 中华外科杂志

<p><b>OBJECTIVE</b>To study the value of rigid choledochoscope and pneumatic lithotripsy in targeting treatment of hepatolithiasis under the guidance of three-dimensional visualization technology.</p><p><b>METHODS</b>The 26 patients with hepatolithiasis from February 2012 to June 2013 were analyzed. There were 11 male and 15 female patients with a median age of 55.2 years (range 31-75 years old). The image data of CT scanning of hepatolithiasis were introduced into medical image three-dimensional visualization system (MI-3DVS) for three-dimensional reconstruction, 3D classifications of hepatolithiasis were obtained based on it. Applied rigid choledochoscope and pneumatic lithotripsy in targeting treatment of hepatolithiasis guided by three-dimensional visualization technology.</p><p><b>RESULTS</b>The 26 patients (29 times) experienced targeting treatment of rigid choledochoscope and pneumatic lithotripsy under the guidance of three-dimensional visualization technology, including:19 cases (4 cases of type IIc) through percutaneous biliary tract sinus, laparoscopic surgery 3 cases, laparotomy 4 cases. Three patients underwent surgery twice. The final stone clearance rate was 100%.One case confirmed combined with cholangiocarcinoma and transfer to radical resection.Intraoperative blood loss was (41.7 ± 8.5) ml, operating time was (100.8 ± 7.6) minutes, and postoperative hospital stay was (7.0 ± 0.6) days. A patient suffered postoperative biliary tract bleeding.Without bile duct injury, bleeding, bile leakage and other complications were occurred.</p><p><b>CONCLUSION</b>Rigid choledochoscope and pneumatic lithotripsy in the treatment of hepatolithiasis under the guidance of three-dimensional visualization technology achieved digital minimally invasive treatment of hepatolithiasis, which can be a new approach to hepatobiliary surgery.</p>