No-touch isolation technique in emergency pancreaticoduodenectomy for neoplastic hemorrhage: Two case reports and review of literature

BACKGROUND Emergency pancreaticoduodenectomy(EPD)is a rare event for complex periam-pullary etiology.Increased intraoperative blood loss is correlated with poor post-operative outcomes.CASE SUMMARY Two patients underwent EPD using a no-touch isolation technique,in which all arteries supplying the pancreatic head region were ligated and divided before manipulation of the pancreatic head and duodenum.The operative times were 220 and 239 min,and the blood loss was 70 and 270 g,respectively.The patients were discharged on the 14^(th) and 10^(th) postoperative day,respectively.Thirty-two patients underwent EPD for the treatment of neoplastic bleeding.The mean operative time was 361.6 min,and the mean blood loss was 747.3 g.The comp-lication rate was 37.5%.The in-hospital mortality rate was 9.38%.CONCLUSION The no-touch isolation technique is feasible,safe,and effective for reducing intraoperative blood loss in EPD.

An effective technique for isolating adult activated Schwann cells

BACKGROUND： Schwann cells （SCs） are neuroglial cells of peripheral nerve and play a key role in repairing peripheral nerve injury; therefore, it provides an important evidence for transplantation of SCs which are characterized by active proliferation and adult high-purity in vitro after nerve injury in clinic, and also develops a new therapeutic way for nerve injury.OBJECTEVE： To investigate an effective technique for isolating adult activated Schwann cells,DESIGN： Controlled observational study.SETTING： Mudanjiang Medical College.MATERIALS： The experiment was completed at the Department of Medical Genetics of Harbin Medical University from March 2003 to April 2005. Health female Wistar rats, aged 2 months, weighting 150-160 g, were randomly divided into 3 groups with 5 in each group.METHODS： The right sciatic nerves from 15 Wistar rats were exposed and transected at the mid thigh under pentobarbital anesthesia （4 mg/kg, Lp）. Seven days later, the distal segments of the predegenerated nerves were removed and used to produce adult Schwann cell cultures. The distal segment of the predegenerated nerve, 20 mm in length, was resected. The nerve was cut into pieces 1 mm in length and incubated for 3 hours under CO2 at 37 ℃ with an enzyme mixture of 0.05% collagenase/dispase. Rats were divided into 3 groups： ① Group 1： The nerve fragments were explanted in poly-L-lysine and laminin-coated dishes with BS medium from the 1st to the 6th day, On the 6^th day, the fragments were removed into a new poly-L-lysine-laminin-coated dish and the BS medium was changed to BS with 10% FBS, The nerve fragments were replaced repeatedly in the same way in new dishes on the 12^th and the 18th days. ② Group 2： For the first 3 days, the nerve fragments were fed with BS with 10% FBS. This medium was changed to BS medium on the third day. The nerve fragments were removed to another dish on day 6 and BS medium was changed to BS with 25 mI.JL FBS. Hereafter the culture method was the same as for group 1. ③ Group 3： For the first 6 days, nerve fragments were incubated in a dish not coated with poly-L-lysine and laminin, in BS medium supplemented with 8×10^7 U/L of penicillin-streptomycin. On the 6th day, the nerve fragments were removed to a poly-L-lysine-laminin-coated dish and cultured in BS with 25 mI.JL FBS, On the 12th day, the nerve fragments were explanted a second dish and fed with BS containing 100 mL/L FBS. On the 18^th day, they were explanted to a third poly-L-lysine-laminin-coated dish, SCs were obtained from all 3 dishes on the 21st day, Finally, purity and density of SCs were identified and proliferation index was calculated at the same time.MAIN OUTCOME MEASURES ： Purity and density of SCs cultured with various methods in the three groups for 21 days.RESULTS ： ① Isolation and proliferation of SCs： In the group 1, they increased in number after 4 days and both purity and density of cultured SCs were significantly higher than those from group 2. In the group 2, there were few fibroblasts. In the group 3, both purity and density of cultured SCs were remarkably higher than in those from groups 1 or 2. Then optimal proliferation was soon seen and the rapid expansion of SC populations suppressed the development of contaminating fibroblasts. On the 21st day, SCs proliferated to achieve maximal density and were too crowded to be counted. With Chi-square test, the data of the purity and the density were analyzed from groups 1 to 3, the result indicated X^2=430.47, P 〈 0.05. ② Characterization and proliferation rate of SCs： Immunostaining for S100 protein was evident in the cell soma and the processes of all three groups in cultures of SCs. SCs in vitro demonstrated typical bior tri-polar morphology, had oval nuclei, and stained brightly for $100. The proliferation rate of SCs was assessed with double fluorescence staining for BrdU and S100 on the 21^st day of all three groups in cultures. About 40%-50% of the total SCs in the each group showed BrdU incorporation.CONCLUSION： The method is to use predegeneration in vivo, differential speed culture supplemented with the penicillin-streptomycin in low concentration, and changing of the concentration of FBS in the BS medium from 0 to 100 mL/L. This method allows remarkable suppression of fibroblast growth and attainment of SC proliferation and purity, in a short time, from adult nerves.

3D-printed “fistula stent” designed for management of enterocutaneous fistula: An advanced strategy

Enterocutaneous fistulas(ECFs) are great challenges during the open abdomen. The loss of digestive juice, water-electrolyte imbalance and malnutrition are intractable issues during management of ECF. Techniques such as "fistula patch" and vacuumassisted closure therapy have been applied to prevent contamination of open abdominal wounds by intestinal fistula drainage. However, failures are encountered due to high-output fistula and anatomical complexity. Here, we report 3 D-printed patient-personalized fistula stent for ECF treatment based on 3 D reconstruction of the fistula image. Subsequent follow-up demonstrated that this stent was well-implanted and effective to reduce the volume of enteric fistula effluent.

A Compact Self-Isolated MIMO Antenna System for 5G Mobile Terminals

A compact self-isolated Multi Input Multi Output (MIMO) antennaarray is presented for 5G mobile phone devices. The proposed antenna systemis operating at the 3.5 GHz band (3400–3600 MHz) and consists of eight antennaelements placed along two side edges of a mobile device, which meets the currenttrend requirements of full-screen smartphone devices. Each antenna element isdivided into two parts, a front part and back part. The front part consists of anI-shaped feeding line and a modified Hilbert fractal monopole antenna, whereasthe back part is an L-shaped element shorted to the system ground by a0.5 mm short stub. A desirable compactness can be obtained by utilizing the Hilbert space-filling property where the antenna element’s overall planar size printedon the side-edge frame is just (9.57 mm × 5.99 mm). The proposed MIMO antenna system has been simulated, analyzed, fabricated and tested. Based on the selfisolated property, good isolation (better than 15 dB) is attained without employingadditional decoupling elements and/or isolation techniques, which increases system complexity and reduces the antenna efficiency. The scattering parameters,antenna efficiencies, antenna gains, and antenna radiation characteristics areinvestigated to assess the proposed antenna performance. For evaluating the proposed antenna array system performance, the Envelope Correlation Coefficients(ECCs), Mean Effective Gains (MEGs) and channel capacity are calculated.Desirable antenna and MIMO performances are evaluated to confirm the suitability of the proposed MIMO antenna system for 5G mobile terminals.