Objective To review the important points in the preoperative assessment and the surgical technique in precise hepatic pedicle dissection in anatomical hepatic segmentectomy.Methods 104 patients who underwent anatomical hepatic segmentectomy were divided into two groups according to the different surgical approaches adopted in a prospective and non-randomized manner:the precise hepatic pedicle dissection group (the precise group,n=44) and the conventional hepatectomy group (the conventional group,n=60).The perioperative and follow-up data were analyzed.Patients who had primary liver cancer,including hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma,were analyzed separately.Results (1) There was no perioperative death in the two groups.There was no significant differences in blood loss and transfusion between the 2 groups of patients (P=0.069,0.208; t=1.844,1.266).There was a significantly higher rate of vascular inflow occlusion (P=0.001).There were significantly longer periods of vascular inflow occlusion and operative time (P=0.001,0.001; t=3.849,3.574) in the precise group.There was no significant difference in postoperative complications (P=0.988) and the duration of postoperative hospital stay (P=0.509;t=0.662) between the two groups.(2) In patients with primary liver cancer,there were no significant differences between the precise group (n=29) and the conventional group (n=41) in tumor margin positivity,vascular invasion and pathological staging (P=0.985,0.630,0.769).(3) All patients were followed up for two years.When compared with the conventional group,the disease-free survival (P=0.012),overall survival (P =0.006),and median survival (16.5 ± 4.5mo vs.7.8 ± 3.8mo)were significantly longer in the precise group.Conclusion Precise hepatic pedicle dissection had the same safety and efficacy as conventional method in partial hepatectomy.For primary liver cancer,precise hepatic pedicle dissection had better survival compared to the conventional method when the surgical margin was negative.

Objective To explore the feasibility of constructing three-dimensional model after the unicompartmental knee arthroplasty using the point-to-point image registration technology,so as to provide experimental basis for further application and optimization.Methods Patients of medial compartment knee osteoarthritis undergoing UKA were chosen and their postoperative three-dimensional knee models were established based on the MRI and CT scans.The virtual prosthetic replacement and finite element models were constructed using point-to-point image registration technology,and the kinematic changes were analyzed.Results The complete postoperative three-dimensional knee models of UKA were established,and the kinematic charateristics were similar to those conducted in traditional methods.Conclusion The virtual surgery can be performed using the point-to-point image registration technology,and it is both easier and more convenient than the traditional methods.

Objective:To analyze the MRI features of hepatic epithelioid hemangioendothelioma (HEHE).Methods:The data of patients with HEHE managed in the Wenzhou People's Hospital of Zhejiang Province and the First Affiliated Hospital of Wenzhou Medical University from April 2000 to April 2019 were retrospectively analyzed. Among the 26 patients with HEHE, there were 12 males and 14 females, aged from 23 to 65 years (average 44.4 years). The quantity, size, shape and type of the lesions were observed and the MRI features were analyzed.Results:Of the 382 nodules detected by MRI in the 26 patients, the size varied from 0.5cm to 12.0 cm, with 16 nodules being more than 5.0 cm in diameter (average of 2.2 cm). Four patients with a single nodular type presented with low signal on T 1 weighted imaging (T 1WI), high signal on T 2 weighted imaging (T 2WI), high signal on diffused weighted imaging (DWI), and high central signal and low peripheral annular signal on apparent diffusion coefficient (ADC). After enhancement, the lesions presented with annular centripetal enhancement or continuous annular enhancement. Fourteen patients with multiple nodules had a total of 147 lesions, presenting with low signal on T 1WI, high signal on T 2WI, high signal on DWI, and high central signal and low peripheral annular signal on ADC. After enhancement, the lesions presented with annular centripetal enhancement and continuous annular enhancement. There were 24 lesions in 6 patients who had a " double-ring sign" , 21 lesions in 7 patients who had a capsule " shriveled sign" , 16 lesions in 7 patients who had a " lollipop sign" and 18 lesions in 5 patients who had an " intravascular sign" . There were 231 lesions in 8 patients of the fusion type. The lesions showed low signal on T 1WI, high signal on T 2WI , high signal on DWI, and high central signal and low peripheral signal on ADC. After enhancement, the lesions presented with flocculent or annular centripetal enhancement. In 8 patients, 87 lesions had a " target sign" , 55 lesions had a " lollipop sign" and 42 lesions had a capsule " shriveled sign" , and 36 lesions in 5 patients had an " intravascular sign" . Conclusion:MRI signs of HEHE have certain characteristics, such as lesions being distributed near the capsule, and fusing with each other; a " target sign" on T 2WI; a capsule " shriveled sign " ; and a " double-ring sign" , a " lollipop sign" , an " intravascular sign" in the portal phase. These features are helpful in diagnosing HEHE.

Objective To observe the clinical effects of arthroscopic reconstruction for anterior cruciate ligament ( ACL ) tear using tension-relieving technique and enhanced recovery after surgery ( ERAS ) . Methods Between May 2014 and June 2016, 80 patients with ACL tear were randomly di-vided into 2 equal groups. The experimental group was treated with arthroscopic reconstruction using hamstring tendon autograft and tension-relieving technique followed by ERAS; the control group was treated with arthroscopic reconstruction using hamstring tendon autograft only followed by conventional postoperative re-covery. The 2 groups were compared in terms of knee flexion angles at postoperative 2nd, 4th and 8th weeks, and the IKDC ( International Knee Documentation Committee ) , HSS ( Hospital for Special Surgery ) , and Lysholm scores at postoperative 3rd, 6th and 12th months. Results The 80 patients obtained an average follow-up of 12. 3 ± 1. 7 months. Arthroscopy one year postoperation revealed fine ACL growth without laxity or other complications in the experimental group. Joint stiffness appeared in one case at 2 months postoperation and ACL laxity was observed in 3 cases by arthroscopy at 12 months postoperation in the control group. The knee flexion angles at postoperative 2nd, 4th and 8th weeks, and the IKDC, HSS and Lysholm scores at postoperative 3rd, 6th and 12th months in the experimental group were significantly better than those in the control group ( P <0. 05 ) . In both groups, the IKDC, HSS and Lysholm scores at postoperative 3rd, 6th and 12th months and the knee flexion angles at postoperative 2nd, 4th and 8th weeks were all significantly im-proved than the preoperative values ( P <0. 05 ) . Conclusion In arthroscopic reconstruction for ACL tear, tension-relieving technique combined with ERAS can promote functional recovery of the knee and reduce postoperative complications, facilitating early recovery of sports function.

Objective To investigate the effect of interaction between serum neutrophil gelatinase-associat-ed lipid carrier protein(NGAL)and complications after percutaneous coronary intervention(PCI)on poor prognosis in patients with ST-segment elevation myocardial infarction(STEMI),and to provide reference for improving prognosis.Methods From January 2017 to January 2020,a total of 400 STEMI patients admitted to this hospital were selected and divided into good prognosis group(n=378)and poor prognosis group(n=22)according to their 2-year prognosis.Logistic regression equations were used to analyze the prognostic fac-tors of STEMI patients,and multiplicative and additive effects were established to analyze the effect of the in-teraction between serum NGAL and post-PCI complications on poor prognosis.Results Gender,age,heart rate,Gensini score,number of lesions ≥2,Killip grade,complications after PCI and NGAL level after PCI were associated with poor prognosis in STEMI patients(P＜0.05).Gender(female),age,heart rate,Gensini score,number of lesions ≥2,Killip grade,complications after PCI and NGAL level after PCI were all inde-pendent influencing factors of poor prognosis in STEMI patients(P＜0.05).There was interaction between serum NGAL after PCI and complications after PCI,both of which had an adverse effect on the prognosis of STEMI patients(P＜0.05).There was no multiplicative interaction between serum NGAL and complications after PCI(P＞0.05).When serum NGAL and complications after PCI were exposed at the same time,the risk of poor prognosis in STEMI patients was higher than the sum of the two exposures alone,and the interaction was 2.611 times the sum of the effects of the two exposures alone.Conclusion Serum NGAL and postopera-tive complications after PCI are independent factors influencing poor prognosis in STEMI patients.There is a additive interaction between the two factors,and exposure can increase the risk of poor prognosis.