[Minor liver resection for hilar cholangiocarcinoma of Bismuth-Corlette type â ¢ and â £].

Objective: To explore the clinical effect and safety of minor liver resection for hilar cholangiocarcinoma (HC) of Bismuth-Corlette type Ⅲ and Ⅳ. Methods: From May 2007 to May 2017, the clinical data of 108 patients with Bismuth-Corlette type Ⅲ and Ⅳ HC underwent hepatectomy were collected and analyzed retrospectively.There were 56 males and 52 females, aged (57.2±5.3) years (ranged 48-76 years) .Among the 108 cases, there were 51 cases of type Ⅲa, 40 cases of type Ⅲb and 17 cases of type Ⅳ. Small-scale hepatectomy (≤3 hepatectomy) was performed in 70 cases, including 8 cases of 4b segment resection, 28 cases of 4b segment+5 segment resection, and 34 cases of partial 4 segment+partial 7 segment+partial 1 segment resection. Large-scale hepatectomy was performed in 38 cases (>3 segments) , of which 30 cases were treated with 2 segments+3 segments+4 segments+1 segment, and 8 cases were treated with 5 segments+7 segments+8 segments+1 segment. t' test was used to analyze the data which did not conform to the normal distribution, and χ(2) test was used to calculate the incidence of postoperative complications and the 1, 3, and 5-year cumulative overall survival rate. Results: (1) The operation time of minor liver resection group ((180±25)minutes) was shorter than that of major liver resection group ((210±35)minutes) (t'=4.676, P<0.05) , the amount of blooding operation time of minor liver resection group ((310±80)ml) was less than that of major liver resection group ((500±110)ml)in the operation (t'=9.385, P<0.05) , and the difference was statistically significant. (2) The incidence of complications was lower in minor liver resection group and major liver resection group, and the difference was statistically significant (χ(2)=5.230, P<0.05) . (3) The actual 1-, 3- and 5-year survival rates were 87.1%, 58.4%, 30.0% and 84.2%, 57.9%,31.6%, respectively. There were no significant differences in survival rates in two groups in 1-, 3- and 5-year survival rates (χ(2)=0.177, P=0.674; χ(2)=0.005, P=0.946; χ(2)=0.029, P=0.865) . Conclusions: Compared to patients with major liver resection, Minor liver resection for selected patients with HC of Bismuth-Corlette Ⅲ and Ⅳaccording to our criteria achieved better long-term outcomes. Chen's biliojejunostomy is a simple, effective and safe method, which can be widely used when there are multiple biliary intestinal anastomosese.

[Magnetic-activated cell sorting (MACS) versus density gradient centrifugation (DGC) for the selection of human sperm in assisted reproductive techniques].

Objective: To investigate whether the assisted reproductive techniques (ART) outcomes can be improved by using magnetic-activated cell sorting combined isolate density gradient centrifugation (MACS-DGC), and to compare the results with the conventional isolate density gradient centrifugation (DGC) method. Methods: In the period from January to December 2014, patients who attended the andrology laboratory for sperm DNA fragmentation analysis and underwent the in vitro fertilization and embryo transfer (IVF-ET) treatment were divided into 3 groups, and each group has two subgroups according to the way of fertilization : in vitro fertilization (IVF) as subgroup 1 and intracytoplasmic sperm injection (ICSI) as subgroup 2. Group A (A1, A2 ): DNA fragmentation index(DFI)≥20 and using MACs; Group B (B1, B2): DFI≥20 and using isolate method; Group C (C1, C2): DFI<20 and using isolate method. The fertilization rate, good-quality embryos, implantation rate, pregnancy rate and live-birth rate of each group were analyzed. Results: Similar results were obtained among groups for all the parameters compared: On IVF cycles no significant difference was observed in fertilization rate, percentage of good-quality embryos on day 3, implantation rate, positive beta-hCG tests, and live-birth rate among the three subgroups (A1 vs B1 vs C1). Between the subgroups of ICSI cycles (A2 vs B2 vs C2) the percentage of high-quality embryos, pregnancy rate, implantation rate and live-birth rate were all significantly higher in the MACS-DGC (A2) group compared to DGC alone (B2). Conclusion: Based on the results, MACS as a part of sperm preparation technique will not improve sperm fertilizing potential, embryos quality, implantation rate, pregnancy rate or live-birth rate of IVF, but it may help select the most fertile sperm and to improve clinical outcomes of ICSI.

Rescuer fatigue during simulated neonatal cardiopulmonary resuscitation.

OBJECTIVE: To assess development of fatigue during chest compressions (CCs) in simulated neonatal cardiopulmonary resuscitation (CPR). STUDY DESIGN: Prospective randomized manikin crossover study. Thirty neonatal healthcare professionals who successfully completed the Neonatal Resuscitation Program performed CPR using (i) 3:1 compression:ventilation (C:V) ratio, (ii) continuous CC with asynchronous ventilation (CCaV) at a rate of 90 CC per min and (iii) CCaV at 120 CC per min for a duration of 10 min on a neonatal manikin. Changes in peak pressure (a surrogate of fatigue) and CC rate were continuously recorded and fatigue among groups was compared. Participants were blinded to pressure tracings and asked to rate their level of comfort and fatigue for each CPR trial. RESULT: Compared with baseline, a significant decrease in peak pressure was observed after 72, 96 and 156 s in group CCaV-120, CCaV-90 and 3:1 C:V, respectively. CC depth decreased by 50% within the first 3 min during CCaV-120, 30% during CCaV-90 and 20% during 3:1 C:V. Moreover, 3:1 C:V and CCaV were similarly preferred by healthcare professionals. CONCLUSION: Similarly, 3:1 C:V and CCaV CPR were also fatiguing. We recommend that rescuers should switch after every second cycle of heart rate assessment during neonatal CPR.

Complex chemical composition of colored surface films formed from reactions of propanal in sulfuric acid at upper troposphere/lower stratosphere aerosol acidities.

Particles in the upper troposphere and lower stratosphere (UT/LS) consist mostly of concentrated sulfuric acid (40-80 wt %) in water. However, airborne measurements have shown that these particles also contain a significant fraction of organic compounds of unknown chemical composition. Acid-catalyzed reactions of carbonyl species are believed to be responsible for significant transfer of gas phase organic species into tropospheric aerosols and are potentially more important at the high acidities characteristic of UT/LS particles. In this study, experiments combining sulfuric acid (H2SO4) with propanal and with mixtures of propanal with glyoxal and/or methylglyoxal at acidities typical of UT/LS aerosols produced highly colored surface films (and solutions) that may have implications for aerosol properties. In order to identify the chemical processes responsible for the formation of the surface films, attenuated total reflectance-Fourier transform infrared (ATR-FTIR) and 1H nuclear magnetic resonance (NMR) spectroscopies were used to analyze the chemical composition of the films. Films formed from propanal were a complex mixture of aldol condensation products, acetals and propanal itself. The major aldol condensation products were the dimer (2-methyl-2-pentenal) and 1,3,5-trimethylbenzene that was formed by cyclization of the linear aldol condensation trimer. Additionally, the strong visible absorption of the films indicates that higher-order aldol condensation products must also be present as minor species. The major acetal species were 2,4,6-triethyl-1,3,5-trioxane and longer-chain linear polyacetals which are likely to separate from the aqueous phase. Films formed on mixtures of propanal with glyoxal and/or methylglyoxal also showed evidence of products of cross-reactions. Since cross-reactions would be more likely than self-reactions under atmospheric conditions, similar reactions of aldehydes like propanal with common aerosol organic species like glyoxal and methylglyoxal have the potential to produce significant organic aerosol mass and therefore could potentially impact chemical, optical and/or cloud-forming properties of aerosols, especially if the products partition to the aerosol surface.

[A computerized Chinese classification of diseases and coding system].

The historical review and the necessity of establishment of the Chinese Classification of Diseases (CCD) and Coding System are described. The content, terms used for unified and standardized nomenclatures, coding system including diagnostic terms of traditional Chinese medicine and other codings are introduced. The utility of the CCD system in medical record face sheet management, national native medical statistics, consultative retrieval from terms and codes of diseases, the development and practical trial of ICD-9 CCD is also discussed. Finally, the position and prospect of CCD system in international informatics communication is emphasized.