Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach

BACKGROUND： With advances in technology, laparoscopic liver resection is widely accepted. Laparoscopic liver resection under hemihepatic vascular inflow occlusion has advantages over the conventional total hepatic inflow occlusion using the Pringle＇s maneuver, especially in patients with cirrhosis.METHOD： From November 2011 to August 2012, eight consecutive patients underwent laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach with biliary bougie assistance.RESULTS： The types of liver resection included right hepatectomy（n1）, right posterior sectionectomy（n1）, left hepatectomy and common bile duct exploration（n1）, segment 4b resection（n1）, left lateral sectionectomy（n2）, and wedge resection（n2）. Four patients underwent right and 4 left hemihepatic vascular inflow occlusion. Four patients had cirrhosis. The mean operation time was 176.3 minutes. The mean time taken to achieve hemihepatic vascular inflow occlusion was 24.3minutes. The mean duration of vascular inflow occlusion was54.5 minutes. The mean intraoperative blood loss was 361 mL.No patient required blood transfusion. Postoperatively, one patient developed bile leak which healed with conservative treatment. No postoperative liver failure and mortality occurred. The mean hospital stay of the patients was 7 days.CONCLUSION： Our technique of hemihepatic vascular inflow vascular occlusion using the lowering of hilar plate approachwas safe, and it improved laparoscopic liver resection by minimizing blood loss during liver parenchymal transection.

Severe community-acquired pneumonia caused by Leptospira interrogans:A case report and review of literature

BACKGROUND Leptospira is an uncommon pathogen for adult severe community-acquired pneumonia and its nonspecific manifestations and limited diagnostic tests make it difficult to identify.Although conventional penicillin remains efficacious to treat leptospirosis,failure in early diagnosis and treatment can lead to progression into a deadly syndrome with multiple organ dysfunction.Next generation sequencing is of great value to understand cases with infection of unknown cause,which could help in the diagnosis of uncertain Leptospira infection.CASE SUMMARY We recently managed a patient with fever,cough and dyspnea on admission that progressed into persistent adult respiratory distress syndrome,hemoptysis and hematuria after admission.In this case,the rare Leptospira infection was clouded by the positive influenza tests at admission,delaying early Leptospira-targeted antibiotics administration.Next generation sequencing,a novel molecular diagnostic tool,provided a key hint to uncover the crucial pathogen,Leptospira interrogans,further supported by the possible occupational exposure history.Subsequent conventional penicillin and mechanical respiratory support were administrated to cure the patient successfully without any sequela.CONCLUSION Clinicians must pay attention to possible exposure history and keep uncommon Leptospira in mind when managing pneumonia with unknown causes.

A direct observation of aqueous humour flow in vivo after implantable collamer lens with a central hole implantation

Dear Editor,We present the reported case of the aqueous humour flow observed in vivo after implantable collamer lens(ICL)with a central hole implantation surgery.ICL,a phakic intraocular lens which is located in the posterior chamber,is an effective treatment to correct moderate-tohigh myopia^([1-2]).

Multi-stimuli-responsive aggregation-induced emission copper iodide cluster

Stimuli-responsive luminescent materials have attracted significant attention in the development of smart photoactive materials for both fundamental research and technological applications.In this work,a new copper iodide cluster(1)with aggregationinduced emission(AIE)characteristic,was obtained combining Cu_(4)I_(4) core with rhodamine B derivative ligand.1 has reversible and distinct multi-stimuli-responsive luminescence for external temperature,volatile organic compound,and mechanical force.Significantly,1 exhibited unusual large blue shift(84 nm)after being ground,which originated from the change of intermolecular interactions.Moreover,1 exhibits high oxygen quenching efficiency for 82.2% at 1 bar.Mechanistic studies showed that the multi-stimuli-responsive luminescence properties of 1 can be attributed to the regulation of cluster-centered luminescence process,metal-to-ligand charge transfer process,halide-to-metal charge transfer luminescence process and aggregationinduced barrier to oxygen process.This work not only reports an AIE copper iodide cluster,but also provides a new strategy to develop multi-stimuli-responsive luminescence materials.

Association of handgrip strength with semen characteristics:a study with repeated measurements among healthy Chinese men

Accumulating epidemiological evidence shows that handgrip strength provides predictive potential in physical,mental,and reproductive health status.However,the associations between handgrip strength and semen characteristics have not been explored.We recruited 1382 eligible men at the Hubei Province Human Sperm Bank(Wuhan,China)who had their handgrip strength measured at recruitment and provided 6458 repeated semen specimens within a 6-month period.Semen characteristics,including semen volume,sperm motility parameters(immotility,nonprogressive motility,and progressive motility),and sperm concentration,were assessed.Mixed-effect models and restricted cubic spline functions were applied to investigate the relationship of handgrip strength with repeated measurements of semen characteristics.After adjusting for confounding factors,the mixed-effect models revealed that handgrip strength was positively associated with semen volume,sperm concentration,progressive motility,total motility,and total count(all P for trend<0.05).Compared to men in the lowest quartile,those in the highest quartile of handgrip strength had higher semen volume,sperm concentration,progressive motility,total motility,and total count,with measurements of 14.2%(95%confidence interval[CI]:5.9%-23.2%),19.5%(95%CI:7.3%-33.1%),9.5%(95%CI:3.4%-15.9%),8.8%(95%CI:3.2%-14.6%),and 36.4%(95%CI:18.9%-56.5%),respectively.These positive dose-response relationships were further confirmed in restricted cubic splines,where handgrip strength was modeled as a continuous variable.Handgrip strength,as an indicator of muscular function and strength,was positively associated with semen characteristics in a dose-dependentmanner.