Ex vivo liver resection and auto-transplantation as an alternative for the treatment of liver malignancies: Progress and challenges

Hepatectomy is still the major curative treatment for patients with liver malignancies.However,it is still a big challenge to remove the tumors in the central posterior area,especially if their location involves the retrohepatic inferior vena cava and hepatic veins.Ex vivo liver resection and auto-transplantation(ELRA),a hybrid technique of the traditional liver resection and transplantation,has brought new hope to these patients and therefore becomes a valid alternative to liver transplantation.Due to its technical difficulty,ELRA is still concentrated in a few hepatobiliary centers that have experienced surgeons in both liver resection and liver transplantation.The efficacy and safety of this technique has already been demonstrated in the treatment of benign liver diseases,especially in the advanced alveolar echinococcosis.Recently,the application of ELRA for liver malignances has gained more attention.However,standardization of clinical practice norms and international consensus are still lacking.The prognostic impact in these oncologic patients also needs further evaluation.In this review,we summarized the principles and recent progresses on ELRA.

Ex vivo liver resection and auto-transplantation and special systemic therapy in perihilar cholangiocarcinoma treatment

This editorial contains comments on the article“Systematic sequential therapy for ex vivo liver resection and autotransplantation:A case report and review of li-terature”in the recent issue of World Journal of Gastrointestinal Surgery.It points out the actuality and importance of the article and focuses primarily on the role and place of ex vivo liver resection and autotransplantation(ELRAT)and systemic therapy,underlying molecular mechanisms for targeted therapy in perihilar cho-langiocarcinoma(pCCA)management.pCCA is a tough malignancy with a high proportion of advanced disease at the time of diagnosis.The only curative option is radical surgery.Surgical excision and reconstruction become extremely com-plicated and not always could be performed even in localized disease.On the other hand,ELRAT takes its place among surgical options for carefully selected pCCA patients.In advanced disease,systemic therapy becomes a viable option to prolong survival.This editorial describes current possibilities in chemotherapy and reveals underlying mechanisms and projections in targeted therapy with ki-nase inhibitors and immunotherapy in both palliative and adjuvant settings.Fi-broblast grow factor and fibroblast grow factor receptor,human epidermal grow-th factor receptor 2,isocitrate dehydrogenase,and protein kinase cAMP activated catalytic subunit alpha(PRKACA)and beta(PRKACB)pathways have been ac-tively investigated in CCA in last years.Several agents were introduced and approved by the Food and Drug Administration.They all demonstrated mean-ingful activity in CCA patients with no global change in outcomes.That is why every successfully treated patient counts,especially those with advanced disease.In conclusion,pCCA is still hard to treat due to late diagnosis and extremely complicated surgical options.ELRAT also brings some hope,but it could be performed in very carefully selected patients.Advanced disease requires systemic anticancer treatment,which is supposed to be individualized according to the genetic and molecular features of cancer cells.Targeted therapy in combination with chemo-immunotherapy could be effective in susceptible patients.

870 EX型涡流纺纱机优势分析及应用

为了探索新型涡流纺纱设备的优势,从数字技术、机械与电气自动化、自动接头装置、质量检测和分析系统等方面介绍870 EX型涡流纺纱机的技术创新点,从条干、毛羽、重量不匀率水平3方面分析其工艺优势;详述应用870 EX型涡流纺纱机纺R 19.7 tex麻灰纱的原料选用、工艺参数、测试仪器及标准,并与环锭纺和转杯纺进行成纱质量对比。指出:870 EX型涡流纺纱机技术先进,具有高产、高效、高速的工艺优势;纺R 19.7 tex麻灰纱的纱线毛羽少、抗起毛起球性好,满足针织用纱质量要求;纺纱速度达转杯纺的4倍以上,环锭纺的30倍以上,生产效率高且成纱质量稳定。

瓦里安Clinac 23EX医用直线加速器故障维修1例

介绍了瓦里安Clinac 23EX医用直线加速器在开机晨检中出现的FLOW联锁故障,分析了故障产生的原因,提出了具体的故障排除思路与维修方法,为同行维修类似故障提供了参考。

瓦里安23EX医用直线加速器多叶准直器故障维修实例研究

随着医疗领域的快速发展,医用直线加速器多叶准直器成为医用加速器治疗直准器的重要配置,为医疗临床放疗提供重要的设备。同时,在医用直线加速器照射旋转期间,可以结合实际情况,利用多叶准直器对射野形状进行调节,并且根据靶区的头型形状,利用计算机对多叶准直器的运行进行严格控制,从而实况多动态放射治疗。但是,多叶准直器在长期运行中,难免会产生一些故障,所以本文立足瓦里安23EX医用直线加速器,对多叶准直器故障进行总结,有针对性进行维修,确保多叶准直器可以正常运行,满足医疗放射治疗需求,也给相关研究工作提供一定参考。

5EX模型指导下的《创意纸电路》课程活动设计

跨学科项目学习是培养学生核心素养的主要教学方式之一,而创意纸电路课程能够整合科学、劳动、数学、信息科技及艺术等多门学科知识,具有很强的实践性与综合性,非常适合作为开展跨学科学习项目的载体。本文基于华南师范大学李克东教授的5EX设计模型理论,以紧密联系生活实际的“光控路灯”为主题,通过提出问题、制订计划、需求分析、设计搭建、编程实现、创意路演、评价反思7个教学活动环节,将科学实验、信息科技的算法实现与艺术设计和动手制作紧密融通,完成“光控路灯”项目的创作与展示,全面促进学生的综合能力发展。

Systematic sequential therapy for ex vivo liver resection and autotransplantation: A case report and review of literature

BACKGROUND Perihilar cholangiocarcinoma(pCCA)is a highly malignant tumor arising from the biliary tree.Radical surgery is the only treatment offering a chance of long-term survival.However,limited by the tumor’s anatomic location and peri-vascular invasion,most patients lose the chance for curative treatment.Therefore,more methods to increase the resectability of tumors as well as to improve outcomes are needed.CASE SUMMARY A 68-year-old female patient had a hepatic hilar mass without obvious symptoms.Laboratory results showed hepatitis B positivity.Magnetic resonance imaging indicated that the mass(maximum diameter:41 mm)invaded the left and right branches of the main portal vein,as well as the middle,left and right hepatic veins;enlarged lymph nodes were also detected in the hilum.The patient was diagnosed with pCCA,and the clinical stage was determined to be T4N1M0(stage IIIC).Considering the tumor’s anatomic location and vascular invasion,systematic conversion therapy followed by ex vivo liver resection and autotrans-plantation(ELRA)was determined as personalized treatment for this patient.Our original systemic sequential therapeutic strategy(lenvatinib and tislelizumab in combination with gemcitabine and cisplatin)was successfully adopted as conversion therapy because she achieved partial response after three cycles of treatment,without severe toxicity.ELRA,anastomotic reconstruction of the middle hepatic vein,right hepatic vein,root of portal vein,inferior vena cava and right hepatic artery,and lymph node dissection were performed at one month after systemic therapy.Pathological and immunohistochemical examination confirmed the diagnosis of pCCA with lymph node metastasis.Although the middle hepatic vein was partially obstructed four months later,hepatic vein stent implantation successfully addressed this problem.The patient has survived for 22 mo after the diagnosis,with no evidence of recurrence or metastasis.CONCLUSION An effective therapeutic strategy for conversion therapy greatly increases the feasibility and efficiency of ELRA.

瓦里安23EX直线加速器维修案例分析

本文通过分析3个典型的瓦里安23EX直线加速器故障案例,阐述了医用直线加速器的结构、工作原理及维修的重要性。本文分析了HWFA联锁、AIR联锁和FLOW/PUMP联锁故障,探讨了故障原因及解决方案。直线加速器的正常运行对肿瘤放射治疗非常重要,维修工作能确保设备有效运行,避免治疗延误。定期维护和及时维修是保障设备性能的关键。

深度学习下吊装作业工人防护装备及吊钩检测方法

为解决危大工程中吊装作业安全管理的问题,基于深度学习构建目标检测算法(You Only Look Once version 5,YOLOv5)网络模型,针对进入吊装作业区域内人员的防护装备进行多目标融合检测,并对吊钩在施工过程中的状态进行检测。在原始的检测网络模型中引入4种注意力机制,并通过5种训练模型的结果对比分析,进而选择卷积块注意力模块(Convolutional Block Attention Module,CBAM)最优模型。优化后的检测模型对安全帽的平均识别精度达86.5%,对反光衣的平均识别精度达83.0%,对吊钩的状态识别精度达92.0%。将训练好的人员检测模型和吊钩检测模型打包成exe执行文件,应用到施工安全管理人员的中控平台,可帮助管理人员更好地判断吊装作业的工作情况,进而及时进行风险管控。

Genotyping ex situ trees of Abies nebrodensis translocated from the original Sicilian population to enrich the gene pool

As a dynamic ex situ conservation strategy,a clonal seed orchard was started in a nursery in Pomaio(POM)in central Italy in 1993 for an assisted migration experiment of Abies nebrodensis(Lojac.)Mattei.Two artifi cial ex situ populations were planted with this gene pool:a seedling arboretum in Pieve Santo Stefano(PSS)and a small dendrological collection in Papiano(PAP),both originating from the Sicilian relict population.Here,using AFLP markers,we estimated the relatedness among the relocated genotypes of the three collections to check whether the three collections had suffi cient genetic variability to be considered as additional sources of variability to the original gene pool for the assisted migration strategy.High individual genetic variability was found in the collections;each plant had a diff erent genotype and was confi rmed to belong to its population of origin.PAP and PSS trees were shown to be only from the original population of A.nebrodensis species and were derived from a limited set of maternal fertile genotypes.Based on the Sicilian fi r population inventory,nursery production in Sicily,and structure clustering analysis,close genetic relationships among POM,PAP and several PSS trees(1–35)were evident.Similarly,the PSS group(36–78)was genetically close to tree 1 of POM and in a lesser proportion to plants 7 and 9 of POM.The sampling of seedlings used to form batches in the nursery might have infl uenced the structure of the resultant plantations.All genotypes will be useful for enriching the original gene pool.

Chemical components and protective effects of Atractylodes japonica Koidz.ex Kitam against acetic acid-induced gastric ulcer in rats

BACKGROUND Atractylodes japonica Koidz.ex Kitam.(A.japonica,Chinese name:Guan-Cangzhu,Japanese name:Byaku-jutsu),a perennial herb,which is mainly distributed in northeast area of China,it’s often used to treat digestive system diseases such as gastric ulcer(GU).However,the mechanism of its potential protective effects against GU remains unclear.AIM To investigate the protective effects of A.japonica on acetic acid-induced GU rats.METHODS The chemical constituents of A.japonica were determined by ultra performance liquid chromatography tandem mass spectrometry(UPLC-MS/MS)analysis.The rat model of GU was simulated by acetic acid method.The pathological changes of gastric tissues were evaluated by hematoxylin-eosin stain,the levels of epidermal growth factor(EGF),EGF receptor(EGFR),nuclear factor kappa-B(NF-κB),interleukin-1β(IL-1β),IL-10,Na^(+)-K^(+)-ATPase(NKA)in serum and gastric tissues were determined by enzyme-linked immunosorbent assay,and the mRNA expressions of EGFR,NF-κBp65,IkappaBalpha(IκBα)and Zonula Occludens-1(ZO-1)in gastric tissues were determined by real-time reverse transcription polymerase chain reaction,and the efficacy was observed.Then,plasma metabolomic analysis was performed by UPLC-MS/MS to screen the specific potential biomarkers,metabolic pathways and to explore the possible mechani-sms.RESULTS 48 chemical constituents were identified.Many of them have strong pharmacological activity,the results also revealed that A.japonica significantly improved the pathological damage of gastric tissues,increased the expression levels of IL-10,IκBαrelated to anti-inflammatory factors,decreased the expression levels of IL-1β,NF-κB,NF-κBp65,related to proinflammatory factors,restored the levels of factors about EGF,EGFR,ZO-1 associated with ulcer healing and the levels of factors about NKA associated with energy metabolism.Metabolomic analysis identified 10 potential differential metabolites and enriched 7 related metabolic pathways.CONCLUSION These findings contribute to the understanding of the potential mechanism of A.japonica to improve acetic acidinduced GU,and will be of great importance for the development and clinical application of natural drugs related to A.japonica.

1,8-cineole ameliorates colon injury by downregulating macrophage M1 polarization via inhibiting the HSP90-NLRP3-SGT1 complex

Ulcerative colitis(UC)is characterized by chronic relapsing intestinal inflammation.Currently,there is no effective treatment for the disease.According to our preliminary data,1,8-cineole,which is the main active compound of Amomum compactum Sol.ex Maton volatile oil and an effective drug for the treatment of pneumonia,showed remarkable anti-inflammatory effects on colitis pathogenesis.However,its mechanism of action and direct targets remain unclear.This study investigated the direct targets and mechanism through which 1,8-cineole exerts its anti-inflammatory effects using a dextran sulfate sodium salt-induced colitis mouse model.The effects of 1,8-cineole on macrophage polarization were investigated using activated bone marrow-derived macrophages and RAW264.7 cells.In addition,1,8-cineole targets were revealed by drug affinity responsive target stability,thermal shift assay,cellular thermal shift assay,and heat shock protein 90(HSP90)adenosine triphosphatases(ATPase)activity assays.The results showed that 1,8-cineole exhibited powerful anti-inflammatory properties in vitro and in vivo by inhibiting the macrophage M1 polarization and protecting intestinal barrier function.Mechanistically,1,8-cineole directly interacted with HSP90 and decreased its ATPase activity,also inhibited nucleotide-binding and oligomerization domain-,leucine rich repeat-,and pyrin domain-containing 3(NLRP3)binding to HSP90 and suppressor of G-two allele of SKP1(SGT1)and suppressed NLRP3 inflammasome activation in macrophages.These results demonstrated that 1,8-cineole is a potential drug candidate for UC treatment.

珠江磨刀门河口百年来沉积速率变化与环境变迁——沉积物粒度及^(210)Pb_(ex)约束

磨刀门作为珠江三角洲河流水系重要的入海口之一,是研究人类活动对河口岸沉积环境影响的理想区域。然而,由于沉积物年龄难以确定,使得相关研究十分匮乏。因此,本文通过^(210)Pb同位素重建了磨刀门河口浅滩沉积柱的年龄框架,并结合粒度特征和粒度端元分析,讨论了百年来的沉积环境演变及控制机制。结果表明,区域的沉积主要源自西江径流来砂和外海潮流再输入泥沙,受近岸颗粒输入影响。在20世纪70年代前后,该区域沉积环境发生了显著的变化,磨刀门河口沉积速率由0.53 cm/a(70年代前)突然增加到1.68 cm/a(70年代后),且伴随沉积物粒度各组分及参数变异系数增大,粗粒物质增加,潮流物源输入减少,径流及近岸物源输入增加。这可能与西江输沙量变化和磨刀门区域1970年以来发生的围填海等人类活动增强有关。

Complex inferior vena cava reconstruction during ex vivo liver resection and autotransplantation:A case report

BACKGROUND Ex vivo liver resection and autotransplantation(ELRA)is an essential approach for treating patients with end-stage hepatic alveolar echinococcosis(AE),and its surgical indications involve severe invasion of important hepatic vessels,which makes in vivo resection impossible.Revascularization is a major step in the process of ELRA,which is extremely challenging when the invaded vessels have huge defects.CASE SUMMARY Herein,we have reported the case of a 26-year-old patient with hepatic AE in an autologous liver graft who underwent complex inferior vena cava(IVC)reconstruction using disease-free IVC,autologous portal vein fragments,and umbilical vein within the ligamentum teres hepatis.The patient showed good surgical recovery without vascular-related complications during the long-term follow-up.CONCLUSION We reviewed three studies that have reported complex revascularization of the IVC.This case report and systematic review showed that the use of autologous perihepatic vessels prevents donor-area trauma,immune rejection,and other adverse reactions.When the blood vessel is severely invaded and a single vascular material cannot repair and reconstruct the defect,ELRA may provide a safe and feasible surgical approach,which has good prospects for clinical application.

Evaluation and Exploration of Citrus Germplasm Resources in the Origin of Shatangju(Citrus flamea Hort.ex Tseng Shiyueju)

[Objectives]To protect the local rare citrus germplasm resources and further develop and cultivate new citrus varieties.[Methods]The germplasm resources of Shatangju(Citrus flamea Hort.Ex Tseng Shiyueju)in Sihui City of Guangdong Province and other 8 citrus varieties from the same origin were evaluated.The appearance characteristics of tree shape,the length and thickness of shoot at each shoot stage,the appearance characteristics of leaves and the fruit quality of each variety were investigated.[Results]Through the comparison of various citrus varieties grafted with sour mandarin,the results showed that the overall advantages of the length and thickness of the shoots of Shatang tangerine in summer and autumn were more prominent,which was conducive to fruit setting.The sprouting time of the three shoots of each variety was different,and there were sporadic sprouting phenomena in different seasons,so the growth was different,and the length and thickness of the shoots were different in different seasons.There were significant differences in shoot length and diameter among different varieties in the same season.The coefficient of variation of Shatangju's leaves was low,and the traits were stable;leaf shape,leaf base shape,leaf margin and other indicators among the three shoots of the same variety and the differences among the same shoots of different varieties were compared.All varieties had strong flavor,separately sweet and sour,sweet and sweet taste.Shatangju has many segments,orange pericarp,rough texture,easy peeling,and high oblate fruit shape.The orange pericarp was favored by the participants,while the rough and thick peel was not favored by the participants.[Conclusions]Based on the improvement of local varieties,it is recommended to improve the smoothness of pericarp,reducing the thickness of pericarp and improving the flavor of fruit will be conducive to increasing sales.In the cultivation process of various quality resources,especially in the period of fruit growth and development,the plan of nutrition and fertilization should be formulated according to the rules of fruit growth and development,the rules of yield formation and the rules of quality composition,so as to establish the integrated nutrient management system of various varieties.

5EX模型支持下的小学定格动画项目活动设计与实践——以“黎明”主题作品为例

跨学科项目学习是培养学生核心素养的主要教学方式之一,而定格动画制作活动能够整合科学、技术、数学、工程及艺术等多门学科知识,具有很强的实践性与综合性,非常适合作为开展跨学科学习项目的载体。本研究基于5EX设计模型理论,以倡导人与自然和谐共生的环保主题“黎明”为定格动画制作实践案例,通过构建进入情境、初探项目,提出问题、制订计划,自主探究、脚本编写,积木搭建、数学应用,工程设计、动画制作,知识拓展、创意路演,评价反思、修改作品7个教学活动环节,将探究实践与动手制作紧密融通,完成定格动画项目的创作与展示,全面促进学生的综合能力发展。

EX2100e型励磁控制系统存在的问题和处理措施

EX2100e型励磁控制系统为美国GE公司生产,无论在原理上还是应用上,与国产励磁控制系统都存在差异化。文章对EX2100e型励磁控制系统自从投产后发生的故障和问题进行了分析,提出了解决方案并予以实施,从而有效降低了机组运行中发生事故停机的风险。

EX3600中盘弯梁整体更换工艺

国家能源准能集团公司黑岱沟露天煤矿所运行EX-3600反铲主要任务是剥离装岩石。设备使用10年,随着产量逐年增加,设备材料开始老化板材力学性能下降,再加上点检不到位,导致中盘座架弯板断裂严重,设备无法安全正常工作,大大影响剥离的产量。根据座架弯板的损坏情况,以往的方法是焊修开裂处或者依靠国外制造厂家的技术指导进行维修,维修周期长、成本高、检修效果也不尽如人意。

基于ESP8266EX的电视开关控制系统设计

如今,电视已在城乡普及,很多少年儿童因沉迷电视导致视力变差,近视率持续上升,越来越成为一个家庭问题和社会问题。对此,设计一种基于ESP8266EX芯片的电视开关控制系统,选用无线网络芯片ESP8266EX作为主控芯片,利用中国移动物联网开放平台ONENET云平台实现主控芯片与微信小程序间的数据交换,达到远程控制电视机开关的目的,使得家长能对少年儿童沉迷电视进行有效监管。详细介绍系统的硬件原理和软件设计。

EX3600-6型液压反铲液压系统油液污染与治理技术分析

本文以EX3600-6型液压反铲液压系统为例,分析了其存在的油液污染现象,并对此提出了相应的处理办法。找出影响油液质量的因素,并通过探究和分析液压油在液压系统中污染的原因,制定出相应的解决办法。本文主要介绍了液压系统油液污染的成因、污染种类、检测手段及其治理方法,为液压系统长期稳定运行提供了一定参考。