Augmented reality technology for preoperative planning and intraoperative navigation during hepatobiliary surgery: A review of current methods.

BACKGROUND: Augmented reality (AR) technology is used to reconstruct three-dimensional (3D) images of hepatic and biliary structures from computed tomography and magnetic resonance imaging data, and to superimpose the virtual images onto a view of the surgical field. In liver surgery, these superimposed virtual images help the surgeon to visualize intrahepatic structures and therefore, to operate precisely and to improve clinical outcomes. DATA SOURCES: The keywords "augmented reality", "liver", "laparoscopic" and "hepatectomy" were used for searching publications in the PubMed database. The primary source of literatures was from peer-reviewed journals up to December 2016. Additional articles were identified by manual search of references found in the key articles. RESULTS: In general, AR technology mainly includes 3D reconstruction, display, registration as well as tracking techniques and has recently been adopted gradually for liver surgeries including laparoscopy and laparotomy with video-based AR assisted laparoscopic resection as the main technical application. By applying AR technology, blood vessels and tumor structures in the liver can be displayed during surgery, which permits precise navigation during complex surgical procedures. Liver transformation and registration errors during surgery were the main factors that limit the application of AR technology. CONCLUSIONS: With recent advances, AR technologies have the potential to improve hepatobiliary surgical procedures. However, additional clinical studies will be required to evaluate AR as a tool for reducing postoperative morbidity and mortality and for the improvement of long-term clinical outcomes. Future research is needed in the fusion of multiple imaging modalities, improving biomechanical liver modeling, and enhancing image data processing and tracking technologies to increase the accuracy of current AR methods.

A minimally invasive medial patellofemoral ligament arthroscopic reconstruction.

The medial patellofemoral ligament reconstruction is recognized as a good choice for patients with recurrent patellar dislocation. Most techniques of the medial patellofemoral ligament reconstruction are open surgeries. Recently, we present a minimally invasive medial patellofemoral ligament arthroscopic reconstruction technique as a possible alternative method for recurrent patellar dislocation. The aim of the study was to describe a safe and effective technique to perform medial patellofemoral ligament reconstruction. The graft was prepared in shape to "Y." Two 5-mm incisions were made in the skin above the medial edge of the patella. Two docking bone tunnels were drilled from medial edge to the center of the patella, mimicking the wide patellar insertion of the medial patellofemoral ligament, and a bone tunnel was made at the femoral insertion site. Two free ends of the graft were fixed into the patellar tunnels by lateral cortical suspension, and the folded end was fixed into the femoral tunnel by bioabsorbable interference screw. Average patellar tilt and the congruence angle were 30.7° ± 7.5° and 52.7° ± 7.3° and were reduced to 12.8° ± 0.9° and 2.3° ± 11.5° after treatment. The Kujala score was increased from 63.0 ± 9.0 to 91.0 ± 7.0. The minimally invasive medial patellofemoral ligament arthroscopic reconstruction in this paper seems to be helpful to increase safe of operation and treatment effect and reduce complications.

Medial retinaculum plasty versus medial patellofemoral ligament reconstruction for recurrent patellar instability in adults: a randomized controlled trial.

PURPOSE: The purpose of this study was to evaluate the clinical results of medial retinaculum plasty (MRP) and medial patellofemoral ligament reconstruction (MPFLR) with concomitant lateral retinacular release with respect to imaging and functional results. METHODS: Seventy patients with recurrent patellar instability were randomly divided into 2 groups based on their birth years (even/odd), receiving either MRP or MPFLR. Lateral retinacular release was also performed in all patients. Preoperatively, all patients received magnetic resonance imaging to evaluate the injury to the medial patellofemoral ligament. Computed tomography was performed before surgery and at follow-up. The subjective symptoms and functional outcome were evaluated preoperatively and postoperatively with the Kujala score, the Tegner activity score, and a subjective questionnaire. The physical apprehension test was examined, and redislocation was recorded. RESULTS: Patients were followed up for a mean period of 40 months (range, 24 to 55 months). The measurement results for the congruence angle, patellar tilt angle, and patellar lateral shift decreased significantly from the pretreatment measurements to the normal range at the latest follow-up, without a statistically significant difference between the 2 groups (P > .05). The median Kujala score had significantly improved after surgery. However, no statistically significant difference was found between the 2 groups at the latest follow-up (P > .05). In 6 cases in the MRP group (19%) and 3 in the MPFLR group (9%), we found patellar lateral shift that exceeded 1.5 cm but was less than 2.0 cm with a firm endpoint for the apprehension test, without a significant difference between the 2 groups. CONCLUSIONS: This prospective randomized study showed that MPFLR for recurrent patellar instability could achieve good clinical results, with a good congruous patellofemoral joint and good knee function. MRP could yield similar results to MPFLR for recurrent patellar instability in adults with medial patellofemoral ligament injuries from the patella or midsubstance portions. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Double-bundle anatomical versus single-bundle isometric medial patellofemoral ligament reconstruction for patellar dislocation.

PURPOSE: The purpose of this study was to evaluate reconstruction of the medial patellofemoral ligament (MPFL) using the double-bundle anatomical or single-bundle isometric procedure with respect to the patients' clinical outcomes. METHODS: In this retrospective study, we evaluated the clinical outcome of double-bundle anatomical versus single-bundle isometric reconstruction of the MPFL for patellar dislocation patients. Sixty-three patients were included in this study from August 2004 to January 2008. From August 2004 to September 2006, MPFL reconstruction using a single-bundle isometric technique was performed in 21 patients (26 knees). Since October 2006, the double-bundle anatomical reconstruction of the MPFL has been used as the routine surgical procedure. It was performed in 37 patients (44 knees). Fifty-eight patients (70 knees) could be followed up. According to the different techniques, we divided the patients into two groups: group D with double-bundle anatomical reconstruction (37 patients) and group S with single-bundle isometric reconstruction (21 patients). Clinical evaluation consisted of the number with a patellar re-dislocation, patellar apprehension sign, Kujala score, subjective questionnaire score, the patella lateral shift rate and patellar tilt angle measured by cross-sectional CT scan. RESULTS: According to the Kujala score and the subjective questionnaire score, the outcome of the double-bundle group was better than the outcome of the single-bundle group especially in the long-term. Patellar re-dislocation occurred in three patients in the group S, while no re-dislocation occurred in the group D. In total, 26.9 % of group S was considered to have patellar instability, compared to 4.54 % of the group D. After operation, the patellar tilt angle (PTA) and the patella lateral shift rate (PLSR) were restored to the normal range, with statistical significance (P < 0.05) compared to the preoperative state. CONCLUSION: Single- and double-bundle reconstruction of the MPFL can both effectively restore patella stability and improve knee function. However, outcomes in the follow-up period showed that the double-bundle surgery procedure was much better than in single-bundle surgery.

Medial patellar retinaculum plasty versus medial capsule reefing for patellar dislocation in children and adolescents.

INTRODUCTION: The purpose of this study was to evaluate the clinical effect of medial patellar retinaculum plasty for children and adolescent patients with patellar dislocation. MATERIALS AND METHODS: A prospective study was performed between October 2005 and December 2009. Sixty-one cases of children and adolescent patients with patellar dislocation were admitted to our study. Twenty-nine patients received medial capsule reefing, of which 13 patients also received lateral retinacular release (LRR) (Group I). Thirty-two patients received medial patellar retinaculum plasty, of which 12 patients also received LRR (Group II). Preoperatively, all patients received magnetic resonance imaging (MRI) to evaluate the injury of medial patellofemoral ligament. And all patients received computed tomography (CT) scans on which the congruence angle (CA) and patellar lateral shift (PLS) could be evaluated with 30° knee flexion. Physical apprehension tests were examined and the redislocation was recorded. In addition, knee function was evaluated using the Kujala score and subjective questionnaires. RESULTS: Patients were followed up for a mean period of 50 months (25-75 months). For the comparison between the preoperative and postoperative results, the Kujala score improved significantly from 52.3 ± 2.9 to 78.1 ± 3.6 in Group I and from 53.5 ± 3.4 to 82.2 ± 3.4 in Group II (P < 0.05). There was significant difference of CA on CT scans and PLS with a statistical difference between the two groups (P < 0.05). Results of the apprehension test showed that nine patients had patellar lateral shift exceeding 1.5 cm with a soft end point in Group I and two patients had patellar lateral shift exceeding 1.5 cm with a hard end point in Group II (P < 0.05). Moreover, the subjective questionnaire revealed a significant difference of subjective effects between two groups (P < 0.05), including 7 excellent, 10 good and 12 fair in Group I and 18 excellent, 9 good, and 5 fair in Group II. CONCLUSION: The medial retinaculum plasty was better than medial capsule reefing in improving the subjective effects and decreasing the rate of patellar instability postoperatively in children and adolescent patients.

[Short-term clinical efficacies of esophageal carcinoma treated surgically by Ivor-Lewis approach].

OBJECTIVE: To explore the short-term clinical efficacies of treating esophageal carcinoma surgically by Ivor-Lewis approach so as to summarize the characteristics of lymph node metastasis of esophageal cancer and evaluate the safety and effectiveness of surgical treatment of middle and lower esophagus. METHODS: Our hospital started the Ivor-Lewis approach of esophageal cancer from 2005. During the period of 2007 - 2010, a total of 404 patients underwent the Ivor-Lewis approach for esophageal cancer. And the AJCC software was used for the probability statistical analysis. RESULTS: None of them died. But 89/101 patients (22.0%) had the occurrences of postoperative complications. And while still within the original stage of T1, tumor probably metastasized. CONCLUSION: Esophageal cancer has an early tendency of metastasis. Based upon the anatomic locations of metastatic lymph nodes, it is better to predict the prognosis of patients. Thus the combined regimen of Ivor-Lewis surgery plus two-field lymphadenectomy is both safe and efficacious for esophageal carcinoma in the middle and lower segments.

Cinobufacini Inhibits the Development of Pancreatic Cancer Cells through the TGFß/Smads Pathway of Pancreatic Stellate Cells.

This study aimed to test cinobufacini therapeutic potential for pancreatic cancer, verify its potential molecular mechanism, and evaluate the cinobufacini impact on pancreatic cancer microenvironment. First, the effect of cinobufacini-treated pancreatic stellate cells (PSCs) supernatant on the value-added ability of pancreatic cancer (PCCs) was tested. The results show that cinobufacini can effectively reduce the ability of PSCs supernatant to promote the value-added PCCs. Further results show that cinobufacini can effectively reduce the concentration of TGFß in the supernatant of PSCs. Subsequently, the impact of cinobufacini on the transcription and translation levels of key genes in the TGFß/Smads pathway was examined. The results showed that the impact of cinobufacini on the transcription levels of Smad2, Smad3, and Smad7 was in a concentration-dependent manner, while the transcriptional activity of collagen I mRNA was decreased with the increase of cinobufacini concentration. The results of protein expression showed that cinobufacini could upregulate the expression of inhibitory protein Smad7, inhibit the phosphorylation level of p-Smad2/3, and then suppress the expression of type I collagen (collagen I). On the one hand, this study shows that cinobufacini can inhibit the promotion of PSCs on the proliferation of PCCs. On the other hand, cinobufacini can upregulate the expression of the inhibitory molecule, Smad7, through the TGFß/Smads pathway and reduce the phosphorylation level of p-Smad2/3, thereby inhibiting the expression of collagen I and pancreatic fibrosis. cinobufacin can inhibit the proliferation of SW1900 cells by blocking the TGFß/Smads pathway of pancreatic stellate cells. These results provide a clinical basis for the treatment of pancreatic cancer.

Discoid medial meniscus of both knees: A case report.

BACKGROUND: Discoid meniscus is a congenital anomaly that typically affects the lateral meniscus. The appearance of the discoid medial meniscus in both knees is extremely rare, with an incidence of only 0.012%. CASE SUMMARY: Our patient was a 30-year-old female. Under no obvious predisposing causes, she began to experience pain in both knees, which worsened while walking and squatting. The pain was aggravated after exercise, and joint flexion and extension activities were accompanied by knee snapping. Apley's test was positive on physical examination, and there was a pressing pain in the medial articular space. Plain radiographs of both knees revealed no obvious abnormalities in the bilateral knee joint space. Partial meniscectomy as well as menisci reformation were performed on both knees under arthroscopy. Under the guidance of rehabilitation, the patient's range of motion in both knees returned to normal without pain and knee snapping. CONCLUSION: This study showed that the clinical manifestations of the discoid medial meniscus injury are identical to those of the conventional medial meniscus injury, and arthroscopic surgery is effective.

[Functional reconstruction of the medial collateral ligament with double-bundle allograft technique].

OBJECTIVE: To discuss a new technique about reconstruction of medial collateral ligament (MCL) with double bundle allograft and to evaluate the short-term clinical efficacy. METHODS: All 53 patients who suffered from valgus instability of the knee were selected. All cases were diagnosed of MCL injury because the medial gap of the knee widened more than 5 mm compared with collateral knee by the stress X-ray, MRI displayed discontinuity of MCL and valgus stress test was positive. All patients were accepted arthroscopic evaluation through inferomedial and inferolateral arthroscopy portal incisions to ascertain whether there were intra-articular injuries. An 8 cm incision was made from 1 cm superior adductor tubercle to 5 cm proximal medial tibia joint line in a longitudinal fashion. The anterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 45 mm under the medial tibia joint line. The posterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 20 mm under the medial tibia joint line. We used 5 mm or 6 mm reamer to drill the tibia tunnel along with guide pin, and then drill the femur tunnel with 6 mm or 7 mm drill in the top of the adductor tubercle about 25 mm or 30 mm length. The allograft was pulled into the tunnel from tibia to the femur and fixed with absorbable interference screw. Patients carried out active rehabilitation program after operation. One year after the operation, IKDC score, Lysholm score were used to evaluate the clinical effect. RESULTS: The IKDC score (A or B, 86.78% vs. 0), Lysholm scores (89.7 ± 3.4 vs. 51.8 ± 4.9, t = -79.724, P < 0.05) were significantly improved compared with preoperative in all patients. Medial joint widened gap decreased from (10.4 ± 2.4) mm preoperative to (2.8 ± 1.5) mm postoperative from X ray and the differences were significant (t = 41.727, P < 0.05). Among these patients, the medial joint widened gap of 46 cases were less than 3 mm, 7 cases were from 3 mm to 5 mm. The range of motion was 135.4° ± 2.5° preoperative and 132.7° ± 3.7° postoperative. The 9 patients still had medial tenderness 1 year after operation. CONCLUSION: Application double bundle allograft technique to reconstruct MCL can significantly improve the stability of the knee and the short-term clinical efficacy was sure.

Effects of miR-145 on the inhibition of chondrocyte proliferation and fibrosis by targeting TNFRSF11B in human osteoarthritis.

Osteoarthritis (OA) is a common cause of functional deterioration in older adults, and altered chondrogenesis is the most common pathophysiological process involved in the development of OA. MicroRNA­145 (miR­145) has been shown to regulate chondrocyte homeostasis. However, the function of miR­145 in OA remains to be elucidated. In the present study, the expression levels of miR­145 were examined in cartilage specimens from 25 patients with knee OA using reverse transcription­quantitative polymerase chain reaction analysis. The effects of miR­145 on the proliferation and fibrosis of the C­20/A4 and CH8 cell lines were also investigated using 3-(4,5-dimethylth-iazol-2-yl)-2,5-diphenyltetrazolium bromide and western blot assays in vitro. The results revealed that the expression of miR-145 was decreased in the OA cartilage tissues, compared with normal cartilage tissues. The overexpression of miR­145 by transfection of cells with miR­145 mimics significantly inhibited C­20/A4 and CH8 cell proliferation and fibrosis. Furthermore, tumor necrosis factor receptor superfamily, member 11b (TNFRSF11B) was identified as a direct target of miR­145 in chondrocytes, which was confirmed using a dual­luciferase reporter assay. The expression level of TNFRSF11B was markedly upregulated in the patients with OA, and the ectopic expression of miR­145 was capable of suppressing the expression of TNFRSF11B. In addition, the knock down of TNFRSF11B using specific small interfering RNA also inhibited the proliferation and fibrosis of C­20/A4 and CH8 cells in vitro. These data provide the first evidence, to the best of our knowledge, to suggest the critical function of miR­145 in regulating the expression of TNFRSF11B, which may have important implications on the regulation of chondrocyte proliferation and fibrosis in OA.

[Comparison of mini-probe endoscopic ultrasonography with computed tomography in preoperative staging of esophageal cancer].

OBJECTIVE: To compare mini-probe endoscopic ultrasonography (MCUS) with computed tomography (CT) in preoperative T and N staging of esophageal cancer, and to find out the MCUS parameters to judge lymph node metastasis for esophageal cancer. METHODS: Thirty-five patients received both MCUS and CT preoperatively, on both of which the T and N stages were determined. The accuracy, sensitivity, specificity, positive predicting value and negative predicting value were compared with the postoperative pathological results. RESULTS: The accuracy of MCUS was 85.7% in T staging and 85.7% and 80.0% in N staging by the two different methods, which were 45.7% and 74.3%, respectively, by CT. CONCLUSION: MCUS is better than CT in preoperative staging for esophageal cancer. The ratio of short to long axis (S/L) combined with short axis is a useful way to determine lymph node metastasis.

Naringin protects human adipose-derived mesenchymal stem cells against hydrogen peroxide-induced inhibition of osteogenic differentiation.

Extensive evidence indicates that oxidative stress plays a pivotal role in the development of osteoporosis. We show that naringin, a natural antioxidant and anti-inflammatory compound, effectively protects human adipose-derived mesenchymal stem cells (hADMSCs) against hydrogen peroxide (H2O2)-induced inhibition of osteogenic differentiation. Naringin increased viability of hAMDSCs and attenuated H2O2-induced cytotoxicity. Naringin also reversed H2O2-induced oxidative stress. Oxidative stress induced by H2O2 inhibits osteogenic differentiation by decreasing alkaline phosphatase (ALP) activity, calcium content and mRNA expression levels of osteogenesis marker genes RUNX2 and OSX in hADMSCs. However, addition of naringin leads to a significant recovery, suggesting the protective effects of naringin against H2O2-induced inhibition of osteogenic differentiation. Furthermore, the H2O2-induced decrease of protein expressions of ß-catenin and clyclin D1, two important transcriptional regulators of Wnt-signaling, was successfully rescued by naringin treatment. Also, in the presence of Wnt inhibitor DKK-1, naringin is no longer effective in stimulating ALP activity, increasing calcium content and mRNA expression levels of RUNX2 and OSX in H2O2-exposed hADMSCs. These data clearly demonstrates that naringin protects hADMSCs against oxidative stress-induced inhibition of osteogenic differentiation, which may involve Wnt signaling pathway. Our work suggests that naringin may be a useful addition to the treatment armamentarium for osteoporosis and activation of Wnt signaling may represent attractive therapeutic strategy for the treatment of degenerative disease of bone tissue.

Medial and lateral retinaculum plasty for congenital patellar dislocation due to small patella syndrome.

The objective of this study was to explore the clinical effect of medial and lateral retinaculum plasty for congenital patellar dislocation due to small patella syndrome. Twelve patients with congenital patellar dislocation due to small patella syndrome treated at the authors' hospital between January 2005 and February 2010 were enrolled in the study. The study group comprised 4 men (4 knees) and 8 women (8 knees) with an average age of 10.58±6.91 years. All patients underwent medial and lateral retinaculum plasty. Clinical evaluation included the number of patellar redislocations, patellar apprehension sign, Kujala score, subjective questionnaire score, and patella lateral shift and patellar tilt angle measured using a cross-sectional computed tomography scan. All patients were followed up, and the shortest follow-up time was 2 years. Kujala scores improved from 49.20±6.20 preoperatively to 80.10±5.80 postoperatively. Subjective questionnaire scores indicated that the excellent and good rate was 75%. In addition, a significant difference existed in the patellar tilt angle and patella lateral shift between pre- and postoperative results (P<.05). Medial and lateral retinaculum plasty for patients with congenital patellar dislocation due to small patella syndrome can be effective to correct the tracking of the patellofemoral joint and improve knee function.

Medial patellar retinaculum plasty versus medial capsule reefing for patellar subluxation in adult.

OBJECTIVE: The purpose of this study was to evaluate the clinical and functional results of surgical treatment for patellar subluxation. METHODS: A retrospective study was undertaken between October 2004 and April 2009 of 78 cases of patellar subluxation: 40 cases with medial capsule reefing, of which 15 cases had the combination of lateral retinacular release (Group A); and 38 cases with medial patellar retinaculum plasty, of which 12 cases had the combination of lateral retinacular release (Group B). All patients had CT scans available for reviewing congruence angle (CA) with knee flexion at 30 degrees. In addition, knee function was evaluated using the Kujala score and subjective questionnaires. RESULTS: Patients were followed up for a mean 60 months (33-87 months). The Kujala score improved significantly from 78.3 ± 1.0 to 88.3 ± 1.6 in Group A and from 77.8 ± 0.9 to 91.2 ± 1.7 in Group B (P < 0.05). Postoperatively, the CA on CT scan had a statistical difference between the two groups (P < 0.05). The subjective questionnaire revealed a significant difference (P < 0.05), including 12 excellent, 20 good and eight fair in Group A, and 25 excellent, and 13 good in Group B. CONCLUSION: The medial retinaculum plasty was better than medial capsule reefing in improving the subjective effects and decreasing the patellar subluxation rate.

[Characteristics and risk factors of lymph node metastases in esophageal carcinoma].

OBJECTIVE: To investigate the status of lymph node metastases (LNM) of esophageal carcinoma and to identify the risk factors. METHODS: Clinical data of 308 patients who underwent esophagectomy with three-field lymphadenectomy during January 2006 and December 2010 were reviewed. Characteristics of LNM were studied. RESULTS: The average number of dissected lymph nodes was 35.6 ± 14.5 in 308 patients. There were 197 patients(64%) had LNM. Logistic regression analysis showed that lymphatic vessel invasion(P=0.019) and deep tumor invasion(P<0.001) were risk factors of LNM. The highest LNM site was paratracheal node(25.0%). The incidence of cervical LNM was 14.1% in the middle thoracic carcinoma, higher than that of upper thoracic (7.3%) and lower thoracic (8.3%). Rate of LNM was lower in upper thoracic carcinomas than that in middle or lower ones(P=0.001). No significant difference of LNM was found among upper, middle and lower thoracic carcinoma for cervical or thoracic nodes. Lymphatic vessel invasion(P<0.001) and metastases in paratracheal lymph nodes (P=0.014) were risk factors for cervical LNM. CONCLUSIONS: LNM of esophageal carcinoma can be found in both directions vertically and skipped metastasis. Paratracheal lymph nodes involvement is an indicator for cervical lymphadenectomy in thoracic esophageal carcinoma.