OBJECTIVETo investigate the significance of three dimensional visualization and virtual surgery system in living related donor liver transplantation surgery.

METHODSTwo patients suffered biliary calculi were scanned by 64 slice helical computer tomography (CT) on livers and the data were imported into medical image proceeding system (MIPS) for sequence. Man-made segmentation and true-up on the image from the data were carried out. Three dimensional (3D) models of the liver and the intrahepatic vessels were reconstructed by VTK software respectively. The models were exported with format STL from it and then were imported into the FreeForm Modeling System for smoothing and modifying. At last, living related donor liver transplantation were simulated with the force-feedback equipment (PHANToM).

RESULTSIt had great verisimilar image for the reconstructed 3D liver models with artery, hepatic vein, portal vein and bile duct. By seeing through liver, it had high fidelity and strong 3D effect for the intrahepatic artery, hepatic vein, portal vein and bile duct, and their spatial disposition and course and co-relationship were shown clearly. In the virtual surgery system, the virtual scalpel could be manipulated on 3D liver model with PHANToM. The simulating effect was the same as the clinic operation for living related donor liver transplantation.

CONCLUSIONSThe visualized liver model reconstructed is 3D and verisimilar, and it is helpful to design reasonable scheme for liver transplantation. It can improve the surgical effect, decrease the surgical risk, reduce the complication, enhance the communication between doctor and patient through designing surgical plan and demonstrating visualized operation before surgery.

Adult ; Computer Simulation ; Female ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Liver ; diagnostic imaging ; Liver Transplantation ; Living Donors ; Models, Anatomic ; Tomography, Spiral Computed ; User-Computer Interface

OBJECTIVETo assess the feasibility of visual-reality technique for simulating surgical resection of pancreatic tail carcinoma using a 3-dimensional pancreas model reconstructed on the basis of the CT data.

METHODSThe original image data of 64-slice spiral CT was obtained from a patient with pancreatic tail carcinoma. Using adaptive region growing algorithm, the serial CT images were segmented and automatically extracted for 3-dimensional reconstruction of the pancreas and the anatomically related structures with a self-designed program. The model was then processed with Freeform Modeling System for image modification and smoothing. With the assistance of GHST SDK and PHANTOM software systems, preoperative simulation of surgical resection of the carcinoma was performed on the basis of the established pancreatic model.

RESULTSThe reconstructed 3-dimensional pancreatic model with the related structures clearly visualized the 3-dimensional structures of the pancreas, the pancreatic tail compromised by the carcinoma, and the adjacent organs, displaying also the distribution, courses and the anatomical relations of the ductal systems including the main pancreatic duct, abdominal aorta, portal vein system, and the biliary tract. During simulated surgery for pancreatic tail carcinoma resection, the GHOST SDK system allowed effective application of the virtual surgical instruments, and the use of PHANTOM software produced a surgical experience with high resemblance of that from an actual operation.

CONCLUSIONThe serial CT data-based reconstruction of 3-dimensional pancreas model and simulated operation on this model using virtual-reality technique has great potentials for application in individualized surgical planning and surgical risk assessment in cases of pancreatic tail carcinoma, and also facilitates clinical training of the surgeons.

Computer Simulation ; Female ; Humans ; Imaging, Three-Dimensional ; methods ; Middle Aged ; Models, Biological ; Pancreatic Neoplasms ; diagnostic imaging ; surgery ; Tomography, Spiral Computed ; User-Computer Interface

OBJECTIVETo study the clinical value of 3-dimensional (3D) reconstruction of the liver and its ductal structures using 64-slice spiral CT data in hepatobiliary surgery.

METHODSThe image data of 64-slice spiral CT scanning was obtained from patients with biliary calculi. Image segmentation was performed both using computer programs and manually, and 3D reconstruction of the liver was carried out using Mimics software. The reconstructed model of the liver and the ductal system was exported in STL format, and then into the FreeForm Modeling System for modification and smoothing, followed by image registration of the liver with the ductal system and the calculi.

RESULTSThe reconstructed liver model accurately represented the actual size of the liver and its anatomic landmarks, and by adjusting the transparency of the liver, the hepatic and intrahepatic arteries, veins, the portal vein, some abdominal vessels and the biliary system with the calculi were clearly visualized. The calculi in the intrahepatic and extrahepatic bile ducts were distinct in terms of the location and number, and dilation and stenosis of the intrahepatic and extrahepatic bile ducts were also clearly observed. The model presented with realistic profile of the liver that allowed vivid 3D observation. The model also allowed zooming and rotation for observation in full views.

CONCLUSIONSThe reconstructed model of the liver and its ductal system can be useful for preoperative planning and intraoperative complete removal of the calculi from the bile duct, and for the bile duct dilation and stenosis detected in the model, appropriate measures should be taken to reduce the residual calculi and prevent reoccurrence.

Bile Ducts, Extrahepatic ; diagnostic imaging ; surgery ; Bile Ducts, Intrahepatic ; diagnostic imaging ; surgery ; Female ; Gallstones ; diagnostic imaging ; surgery ; Humans ; Imaging, Three-Dimensional ; methods ; Middle Aged ; Models, Anatomic ; Tomography, Spiral Computed ; methods

OBJECTIVETo study the two-dimensional (2D) image segmentation, three-dimensional (3D) reconstruction and virtual surgery of cholecystectomy based on the 2D image data of the liver, biliary track and cholecystolithiasis obtained by 64-slice spiral CT.

METHODSThe image data of the liver, biliary track and cholecystolithiasis were obtained by 64-slice spiral CT scanning. Segmentation and automatic extraction of the images were performed using auto-adapting region growing algorithm. 3D reconstruction of the segmented data was carried out using MIMICS10.0 and self-designed software, and the data of the 3D model of the liver with the billiary tract were imported into FreeForm Modeling System for registration and smoothing. Virtual surgery of cholecystotomy for calculus removal and cholecystectomy were performed with Phantom.

RESULTSThe auto-adapting region growing algorithm allowed rapid image segmentation, and the 3D model of the liver based on the segmentation data clearly displayed vivid 3D structures of the liver. Virtual operations of cholecystectomy could be performed in the FreeForm Modeling System.

CONCLUSIONThe algorithm we proposed can correctly and rapidly complete image segmentation and 3D reconstruction of cholecystolithiasis from the data 64-slice spiral CT, and allows virtual operations on the gallbladder.

Cholecystectomy ; Cholecystolithiasis ; diagnostic imaging ; surgery ; Cholecystostomy ; Computer Simulation ; Computer-Assisted Instruction ; methods ; Humans ; Imaging, Three-Dimensional ; methods ; Surgery, Computer-Assisted ; methods ; Tomography, Spiral Computed ; User-Computer Interface

To explore the clinical distribution and drug resistance characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP), in order to provide reference for the prevention and treatment of CRKP infection. Retrospective analysis was performed on 510 clinical isolates of CRKP from January 2017 to December 2021, and strain identification and drug sensitivity tests were conducted by MALDI-TOF mass spectrometer and VITEK-2 Compact microbial drug sensitivity analyzer. The carbapenemase phenotype of CRKP strain was detected by carbapenemase inhibitor enhancement test. The CRKP strain was further categorized by immunochromogenic method and polymerase chain reaction (PCR) was used for gene detection. The results showed that 302 strains (59.2%) were derived from sputum, 127 strains (24.9%) from urine and 47 strains (9.2%) from blood. 231 (45.3%) were mainly distributed in intensive care, followed by 108 (21.2%) in respiratory medicine and 79 (15.5%) in neurosurgery. Drug susceptibility test result shows that the resistant rate of tigecycline increased from 1.0% in 2017 to 10.1% in 2021, the difference was statistically significant (χ²=14.444,P<0.05). The results of carbapenemase inhibitor enhancement test showed that 461 carbapenemase strains (90.4%) of 510 CRKP strains, including 450 serinase strains (88.2%), 9 metalloenzyme strains (1.8%), and 2 strains (0.4%) produced both serine and metalloenzyme. 49 strains (9.6%) did not produce enzymes. Further typing by immunochromogenic assay showed that 461 CRKP strains were KPC 450 (97.6%) and IMP 2 (0.4%). 7 NDM (1.5%); 2 strains of KPC+NDM (0.4%); PCR results were as follows: 450 strains of blaKPC (97.6%), 2 strains of blaIMP (0.4%), 7 strains of blaNDM (1.5%), and 2 strains of blaKPC+NDM (0.4%). In conclusion, CRKP strains mainly originated from sputum specimens and distributed in intensive care department, and the drug resistance characteristics were mainly KPC type in carbapenemase production. Clinical microbiology laboratory should strengthen the monitoring of CRKP strains, so as to provide reference for preventing CRKP infection and reducing the production of bacterial drug resistance.
Anti-Bacterial Agents/pharmacology* ; Carbapenems/pharmacology* ; Klebsiella pneumoniae/genetics* ; Hospital Distribution Systems ; Retrospective Studies ; Microbial Sensitivity Tests ; beta-Lactamases/genetics* ; Bacterial Proteins/genetics* ; Drug Resistance, Bacterial/genetics*

Background: and Purpose This study aimed to investigate early changes in interstitial fluid (ISF) flow in patients with severe carotid stenosis after carotid angioplasty and stenting (CAS). Methods: We prospectively recruited participants with carotid stenosis ≥80% undergoing CAS at our institute between October 2019 and March 2023. Magnetic resonance imaging (MRI), including diffusion tensor imaging (DTI), and the Mini-Mental State Examination (MMSE) were performed 3 days before CAS. MRI with DTI and MMSE were conducted within 24 hours and 2 months after CAS, respectively. The diffusion tensor image analysis along the perivascular space (DTI-ALPS) index was calculated from the DTI data to determine the ISF status. Increments were defined as the ratio of the difference between post- and preprocedural values to preprocedural values. Results: In total, 102 participants (age: 67.1±8.9 years; stenosis: 89.5%±5.7%) with longitudinal data were evaluated. The DTI-ALPS index increased after CAS (0.85±0.15; 0.85 [0.22] vs. 0.86±0.14; 0.86 [0.21]; P=0.022), as did the MMSE score (25.9±3.7; 24.0 [4.0] vs. 26.9±3.4; 26.0 [3.0]; P<0.001). Positive correlations between increments in the DTI-ALPS index and MMSE score were found in all patients (rs=0.468; P<0.001). Conclusion An increased 24-hour post-CAS DTI-ALPS index suggests early improvement in ISF flow efficiency. The positive correlation between the 24-hour DTI-ALPS index and 2-month MMSE score increments suggests that early ISF flow improvement may contribute to long-term cognitive improvement after CAS.

Background: and Purpose This study aimed to investigate early changes in interstitial fluid (ISF) flow in patients with severe carotid stenosis after carotid angioplasty and stenting (CAS). Methods: We prospectively recruited participants with carotid stenosis ≥80% undergoing CAS at our institute between October 2019 and March 2023. Magnetic resonance imaging (MRI), including diffusion tensor imaging (DTI), and the Mini-Mental State Examination (MMSE) were performed 3 days before CAS. MRI with DTI and MMSE were conducted within 24 hours and 2 months after CAS, respectively. The diffusion tensor image analysis along the perivascular space (DTI-ALPS) index was calculated from the DTI data to determine the ISF status. Increments were defined as the ratio of the difference between post- and preprocedural values to preprocedural values. Results: In total, 102 participants (age: 67.1±8.9 years; stenosis: 89.5%±5.7%) with longitudinal data were evaluated. The DTI-ALPS index increased after CAS (0.85±0.15; 0.85 [0.22] vs. 0.86±0.14; 0.86 [0.21]; P=0.022), as did the MMSE score (25.9±3.7; 24.0 [4.0] vs. 26.9±3.4; 26.0 [3.0]; P<0.001). Positive correlations between increments in the DTI-ALPS index and MMSE score were found in all patients (rs=0.468; P<0.001). Conclusion An increased 24-hour post-CAS DTI-ALPS index suggests early improvement in ISF flow efficiency. The positive correlation between the 24-hour DTI-ALPS index and 2-month MMSE score increments suggests that early ISF flow improvement may contribute to long-term cognitive improvement after CAS.

Background: and Purpose This study aimed to investigate early changes in interstitial fluid (ISF) flow in patients with severe carotid stenosis after carotid angioplasty and stenting (CAS). Methods: We prospectively recruited participants with carotid stenosis ≥80% undergoing CAS at our institute between October 2019 and March 2023. Magnetic resonance imaging (MRI), including diffusion tensor imaging (DTI), and the Mini-Mental State Examination (MMSE) were performed 3 days before CAS. MRI with DTI and MMSE were conducted within 24 hours and 2 months after CAS, respectively. The diffusion tensor image analysis along the perivascular space (DTI-ALPS) index was calculated from the DTI data to determine the ISF status. Increments were defined as the ratio of the difference between post- and preprocedural values to preprocedural values. Results: In total, 102 participants (age: 67.1±8.9 years; stenosis: 89.5%±5.7%) with longitudinal data were evaluated. The DTI-ALPS index increased after CAS (0.85±0.15; 0.85 [0.22] vs. 0.86±0.14; 0.86 [0.21]; P=0.022), as did the MMSE score (25.9±3.7; 24.0 [4.0] vs. 26.9±3.4; 26.0 [3.0]; P<0.001). Positive correlations between increments in the DTI-ALPS index and MMSE score were found in all patients (rs=0.468; P<0.001). Conclusion An increased 24-hour post-CAS DTI-ALPS index suggests early improvement in ISF flow efficiency. The positive correlation between the 24-hour DTI-ALPS index and 2-month MMSE score increments suggests that early ISF flow improvement may contribute to long-term cognitive improvement after CAS.

Background: and Purpose This study aimed to investigate early changes in interstitial fluid (ISF) flow in patients with severe carotid stenosis after carotid angioplasty and stenting (CAS). Methods: We prospectively recruited participants with carotid stenosis ≥80% undergoing CAS at our institute between October 2019 and March 2023. Magnetic resonance imaging (MRI), including diffusion tensor imaging (DTI), and the Mini-Mental State Examination (MMSE) were performed 3 days before CAS. MRI with DTI and MMSE were conducted within 24 hours and 2 months after CAS, respectively. The diffusion tensor image analysis along the perivascular space (DTI-ALPS) index was calculated from the DTI data to determine the ISF status. Increments were defined as the ratio of the difference between post- and preprocedural values to preprocedural values. Results: In total, 102 participants (age: 67.1±8.9 years; stenosis: 89.5%±5.7%) with longitudinal data were evaluated. The DTI-ALPS index increased after CAS (0.85±0.15; 0.85 [0.22] vs. 0.86±0.14; 0.86 [0.21]; P=0.022), as did the MMSE score (25.9±3.7; 24.0 [4.0] vs. 26.9±3.4; 26.0 [3.0]; P<0.001). Positive correlations between increments in the DTI-ALPS index and MMSE score were found in all patients (rs=0.468; P<0.001). Conclusion An increased 24-hour post-CAS DTI-ALPS index suggests early improvement in ISF flow efficiency. The positive correlation between the 24-hour DTI-ALPS index and 2-month MMSE score increments suggests that early ISF flow improvement may contribute to long-term cognitive improvement after CAS.

This study was aimed to explore the immunoregulatory function and capability supporting the angiogenesis of exosomes secreted by bone marrow mesenchymal stem cells (BMMSC) from healthy persons. Supernatant of BMMSC (P4-P6) was collected for exosome purification. Transmission electron microscopy (TEM) and Western blot were used to identify the quality of isolated exosomes. The amount of exosomes was quantified through bicinchoninic acid (BCA) protein assay. Human peripheral blood mononuclear cells (PBMNC) were isolated from healthy donor and added with isolating exosomes. After co-cultured for 72 h, IFN-γ from the co-culture system was detected by ELISA. The expression of miRNA-associated with immunity were detected by real-time reverse transcription polymerase chain reaction (Real-time RT-PCR). The interactions between exosomes and human umbilical vein endothelial cells (HUVEC) were observed with confocal microscopy. Subconfluent HUVEC were harvested and treated with the indicated concentration of exosomes. Nude mice were injected subcutaneously with exosomes or PBS as control to verify the ability of angiogenesis. The results showed that diameter range of exosomes was range from 40 to 160 nm. The isolated exosomes expressed the CD9. There was approximately linear relation between the secretion of exosomes and cell density. The exosomes suppressed the production of IFN-γ from PBMNC, and contained miRNA associated with immune regulation such as miR301, miR22 and miR-let-7a. Exosomes induced vascular tube formation in vitro and vascularization of Matrigel plugs in vivo. It is concluded that the BMMSC-derived exosomes can regulate immunity and support vascularization.
Adult ; Animals ; Bone Marrow Cells ; cytology ; metabolism ; Cells, Cultured ; Exosomes ; immunology ; metabolism ; Female ; Humans ; Interferon-gamma ; metabolism ; Leukocytes, Mononuclear ; cytology ; Male ; Mesenchymal Stromal Cells ; cytology ; metabolism ; Mice, Nude ; Middle Aged ; Neovascularization, Physiologic