AIM:To develop a novel 3-dimensional(3D) virtual hepatectomy simulation software,Liversim,to visualize the real-time deformation of the liver.METHODS:We developed a novel real-time virtual hepatectomy simulation softw...AIM:To develop a novel 3-dimensional(3D) virtual hepatectomy simulation software,Liversim,to visualize the real-time deformation of the liver.METHODS:We developed a novel real-time virtual hepatectomy simulation software program called Liversim. The software provides 4 basic functions:viewing 3D models from arbitrary directions,changing the colors and opacities of the models,deforming the models based on user interaction,and incising the liver parenchyma and intrahepatic vessels based on user operations. From April 2010 through 2013,99 patients underwent virtual hepatectomies that used the conventional software program SYNAPSE VINCENT preoperatively. Between April 2012 and October 2013,11 patients received virtual hepatectomies using the novel software program Liversim; these hepatectomies were performed both preoperatively and at the same that the actual hepatectomy was performed in an operating room. The perioperative outcomes were analyzed between the patients for whom SYNAPSE VINCENT was used and those for whom Liversim wasused. Furthermore,medical students and surgical residents were asked to complete questionnaires regarding the new software.RESULTS:There were no obvious discrepancies(i.e.,the emergence of branches in the portal vein or hepatic vein or the depth and direction of the resection line) between our simulation and the actual surgery during the resection process. The median operating time was 304 min(range,110 to 846) in the VINCENT group and 397 min(range,232 to 497) in the Liversim group(P = 0.30). The median amount of intraoperative bleeding was 510 m L(range,18 to 5120) in the VINCENT group and 470 m L(range,130 to 1600) in the Liversim group(P = 0.44). The median postoperative stay was 12 d(range,6 to 100) in the VINCENT group and 13 d(range,9 to 21) in the Liversim group(P = 0.36). There were no significant differences in the preoperative outcomes between the two groups. Liversim was not found to be clinically inferior to SYNAPSE VINCENT. Both students and surgical residents reported that the Liversim image was almost the same as the actual hepatectomy.CONCLUSION:Virtual hepatectomy with real-time deformation of the liver using Liversim is useful for the safe performance of hepatectomies and for surgical education.展开更多
BACKGROUND Several studies have demonstrated the feasibility and effectiveness of using ultrasound elastography to assess liver tissue stiffness.Virtual touch imaging quantification(VTIQ)based on acoustic radiation fo...BACKGROUND Several studies have demonstrated the feasibility and effectiveness of using ultrasound elastography to assess liver tissue stiffness.Virtual touch imaging quantification(VTIQ)based on acoustic radiation force impulse imaging has been developed as a latest and noninvasive method for assessing liver stiffness in children.AIM To determine the standard value in healthy children,and to identify possible factors that might influence the VTIQ measurement.METHODS With the ethical approval,202 children between 1 month and 15 years old were included in this study.None of them had any liver or systematic diseases.All children had a normal ultrasound scan and normal body mass index(BMI)range.The subjects were divided into four age and BMI groups.The effects of gender,age,liver lobe,measurement depth,and BMI on liver elasticity were investigated.RESULTS A significant correlation was found between age and shear wave velocity(SWV)value.At measurement depths of 1.5 cm and 2.0 cm in the left lobe,there were significant differences among the age groups.SWV values were significantly negatively correlated with the measurement depth.Gender,liver lobe,and BMI showed no significant effect on the SWV values.Age and BMI may influence the quality of the elastogram.CONCLUSION VTIQ is a noninvasive technique that is feasible to measure liver stiffness in children.The afore-mentioned velocity value obtained utilizing VTIQ method could be used as reference value for normal liver stiffness in children.展开更多
AIM: To analyze the virtual touch tissue quantification(VTTQ) and virtual touch imaging quantification(VTIQ) techniques, and identify possible factors that may influence VTTQ and VTIQ measurements.METHODS: One hundred...AIM: To analyze the virtual touch tissue quantification(VTTQ) and virtual touch imaging quantification(VTIQ) techniques, and identify possible factors that may influence VTTQ and VTIQ measurements.METHODS: One hundred and eighty-six(104 women/82 men) of 323 subjects met the inclusion criteria(age > 18 years, no history of chronic or gastrointestinal disease, body-mass index(BMI) < 30 kg/m2, a fasting period of at least three hours, no history of hepatotoxic pharmaceuticals, alcohol consumption < 24 g/d in men and < 12 g/d in women, and normal findings upon ultrasound examination of the abdomen). Measurements were taken at depths of 50 mm with VTTQ, 15 mm and 25 mm with VTIQ in the right hepatic lobe, and at 15 mm with only VTIQ in the left hepatic lobe. The examiner acquired six measurements per position, thereby giving 24 measurements in total.RESULTS: The 95% confidence intervals of mean were1.23-1.29 m/s for VTTQ and 1.29-1.37 m/s, 1.17-1.23 m/s, and 1.48-1.57 m/s for VTIQ in a depth of 15 mm and 25 mm in the right hepatic lobe and 15 mm in the left hepatic lobe. Only superficial measurements in the right hepatic lobe with the VTIQ method exhibited an effect of age on shear wave velocity. Measurements acquired using the 6C1 probe with the VTTQ method showed no dependence on BMI. By comparison, BMI influenced measurements taken with the VTIQ method using the 9L4 probe in the superficial and deep areas of the right hepatic lobe, as well as in the left hepatic lobe(P = 0.0160, P = 0.0019, P = 0.0173, respectively). Gender influenced measurements at depths of 50 mm with VTTQ and 25 mm with VTIQ in the right hepatic lobe(P = 0.0001, P = 0.0269). Significant differences were found between measurements with the 6C1(VTTQ) and 9L4 probes(VTIQ)(P = 0.0067), between superficial and deep measurements(P < 0.0001), and between the right and left lobes of the liver(P < 0.0001). CONCLUSION: Measurements in the right lobe and deep regions are preferable. Gender differences must be considered. BMI must be considered when assessing VTIQ technology.展开更多
基于多靶点虚拟筛选、网络药理学分析和体外实验,探讨强肝胶囊(QGC)治疗非酒精性脂肪性肝病(NAFLD)的潜在作用机制。利用基于PPARα/γ、FXR及sEH的多靶点虚拟筛选选出QGC中具有治疗NAFLD的活性成分,运用网络药理学预测活性成分靶点、...基于多靶点虚拟筛选、网络药理学分析和体外实验,探讨强肝胶囊(QGC)治疗非酒精性脂肪性肝病(NAFLD)的潜在作用机制。利用基于PPARα/γ、FXR及sEH的多靶点虚拟筛选选出QGC中具有治疗NAFLD的活性成分,运用网络药理学预测活性成分靶点、疾病相关靶点,筛选调控疾病的关键靶点,通过Discovery Studio 2020软件和Gromacs软件对关键活性成分和关键靶点进行分子对接和分子动力学模拟分析。最后,通过实验验证QGC中的关键活性成分对肝细胞脂肪变性的改善作用。多靶点虚拟筛选得到235个QGC活性成分,网络药理学分析得到320个成分-疾病共同靶点。分子对接结果表明,芹菜素、异鼠李素、迷迭香酸、大黄素甲醚、木犀草素与关键靶点PTPN1、PPARα、PPARγ、AR具有良好的结合能力。分子动力学模拟进一步验证了迷迭香酸、大黄素甲醚等化合物与关键靶点具有良好的结合稳定性。体外实验结果显示,5个关键活性成分均能改善HepG2细胞的脂肪变性,其中异鼠李素、迷迭香酸、大黄素甲醚改善细胞脂肪变性模型的效果最佳。本研究通过多层面探讨,为QGC在NAFLD治疗中的开发和应用提供理论依据。展开更多
Preoperative assessment of the liver volume and function of the remnant liver is a mandatory prerequisite before performing major hepatectomy. The aim of this work is to develop and test a software application for eva...Preoperative assessment of the liver volume and function of the remnant liver is a mandatory prerequisite before performing major hepatectomy. The aim of this work is to develop and test a software application for evaluation of the residual function of the liver prior to the intervention of the surgeons. For this purpose, a complete software platform consisting of three basic modules: liver volume segmentation, visualization, and virtual cutting, was developed and tested. Liver volume segmentation is based on a patient examination with non-contrast abdominal Computed Tomography (CT). The basis of the segmentation is a multiple seeded region growing algorithm adapted for use with CT images without contrast-enhancement. Virtual tumor resection is performed interactively by outlining the liver region on the CT images. The software application then processes the results to produce a three-dimensional (3D) image of the “resected” region. Finally, 3D rendering module provides possibility for easy and fast interpretation of the segmentation results. The visual outputs are accompanied with quantitative measures that further provide estimation of the residual liver function and based on them the surgeons could make a better decision. The developed system was tested and verified with twenty abdominal CT patient sets consisting of different numbers of tomographic images. Volumes, obtained by manual tracing of two surgeon experts, showed a mean relative difference of 4.5%. The application was used in a study that demonstrates the need and the added value of such a tool in practice and in education.展开更多
文摘AIM:To develop a novel 3-dimensional(3D) virtual hepatectomy simulation software,Liversim,to visualize the real-time deformation of the liver.METHODS:We developed a novel real-time virtual hepatectomy simulation software program called Liversim. The software provides 4 basic functions:viewing 3D models from arbitrary directions,changing the colors and opacities of the models,deforming the models based on user interaction,and incising the liver parenchyma and intrahepatic vessels based on user operations. From April 2010 through 2013,99 patients underwent virtual hepatectomies that used the conventional software program SYNAPSE VINCENT preoperatively. Between April 2012 and October 2013,11 patients received virtual hepatectomies using the novel software program Liversim; these hepatectomies were performed both preoperatively and at the same that the actual hepatectomy was performed in an operating room. The perioperative outcomes were analyzed between the patients for whom SYNAPSE VINCENT was used and those for whom Liversim wasused. Furthermore,medical students and surgical residents were asked to complete questionnaires regarding the new software.RESULTS:There were no obvious discrepancies(i.e.,the emergence of branches in the portal vein or hepatic vein or the depth and direction of the resection line) between our simulation and the actual surgery during the resection process. The median operating time was 304 min(range,110 to 846) in the VINCENT group and 397 min(range,232 to 497) in the Liversim group(P = 0.30). The median amount of intraoperative bleeding was 510 m L(range,18 to 5120) in the VINCENT group and 470 m L(range,130 to 1600) in the Liversim group(P = 0.44). The median postoperative stay was 12 d(range,6 to 100) in the VINCENT group and 13 d(range,9 to 21) in the Liversim group(P = 0.36). There were no significant differences in the preoperative outcomes between the two groups. Liversim was not found to be clinically inferior to SYNAPSE VINCENT. Both students and surgical residents reported that the Liversim image was almost the same as the actual hepatectomy.CONCLUSION:Virtual hepatectomy with real-time deformation of the liver using Liversim is useful for the safe performance of hepatectomies and for surgical education.
基金Supported by Science and Technology Foundation of Pudong New District,No.PKJ2015-Y05)Medical and Industrial Interdisciplinary Fund of Shanghai Jiao Tong University,No.YG2016MS30+1 种基金General Program of Shanghai Health and Family Planning Commission,No.201740095Guiding Project of Shanghai Science and Technology Commission,No.19411965400
文摘BACKGROUND Several studies have demonstrated the feasibility and effectiveness of using ultrasound elastography to assess liver tissue stiffness.Virtual touch imaging quantification(VTIQ)based on acoustic radiation force impulse imaging has been developed as a latest and noninvasive method for assessing liver stiffness in children.AIM To determine the standard value in healthy children,and to identify possible factors that might influence the VTIQ measurement.METHODS With the ethical approval,202 children between 1 month and 15 years old were included in this study.None of them had any liver or systematic diseases.All children had a normal ultrasound scan and normal body mass index(BMI)range.The subjects were divided into four age and BMI groups.The effects of gender,age,liver lobe,measurement depth,and BMI on liver elasticity were investigated.RESULTS A significant correlation was found between age and shear wave velocity(SWV)value.At measurement depths of 1.5 cm and 2.0 cm in the left lobe,there were significant differences among the age groups.SWV values were significantly negatively correlated with the measurement depth.Gender,liver lobe,and BMI showed no significant effect on the SWV values.Age and BMI may influence the quality of the elastogram.CONCLUSION VTIQ is a noninvasive technique that is feasible to measure liver stiffness in children.The afore-mentioned velocity value obtained utilizing VTIQ method could be used as reference value for normal liver stiffness in children.
文摘AIM: To analyze the virtual touch tissue quantification(VTTQ) and virtual touch imaging quantification(VTIQ) techniques, and identify possible factors that may influence VTTQ and VTIQ measurements.METHODS: One hundred and eighty-six(104 women/82 men) of 323 subjects met the inclusion criteria(age > 18 years, no history of chronic or gastrointestinal disease, body-mass index(BMI) < 30 kg/m2, a fasting period of at least three hours, no history of hepatotoxic pharmaceuticals, alcohol consumption < 24 g/d in men and < 12 g/d in women, and normal findings upon ultrasound examination of the abdomen). Measurements were taken at depths of 50 mm with VTTQ, 15 mm and 25 mm with VTIQ in the right hepatic lobe, and at 15 mm with only VTIQ in the left hepatic lobe. The examiner acquired six measurements per position, thereby giving 24 measurements in total.RESULTS: The 95% confidence intervals of mean were1.23-1.29 m/s for VTTQ and 1.29-1.37 m/s, 1.17-1.23 m/s, and 1.48-1.57 m/s for VTIQ in a depth of 15 mm and 25 mm in the right hepatic lobe and 15 mm in the left hepatic lobe. Only superficial measurements in the right hepatic lobe with the VTIQ method exhibited an effect of age on shear wave velocity. Measurements acquired using the 6C1 probe with the VTTQ method showed no dependence on BMI. By comparison, BMI influenced measurements taken with the VTIQ method using the 9L4 probe in the superficial and deep areas of the right hepatic lobe, as well as in the left hepatic lobe(P = 0.0160, P = 0.0019, P = 0.0173, respectively). Gender influenced measurements at depths of 50 mm with VTTQ and 25 mm with VTIQ in the right hepatic lobe(P = 0.0001, P = 0.0269). Significant differences were found between measurements with the 6C1(VTTQ) and 9L4 probes(VTIQ)(P = 0.0067), between superficial and deep measurements(P < 0.0001), and between the right and left lobes of the liver(P < 0.0001). CONCLUSION: Measurements in the right lobe and deep regions are preferable. Gender differences must be considered. BMI must be considered when assessing VTIQ technology.
文摘基于多靶点虚拟筛选、网络药理学分析和体外实验,探讨强肝胶囊(QGC)治疗非酒精性脂肪性肝病(NAFLD)的潜在作用机制。利用基于PPARα/γ、FXR及sEH的多靶点虚拟筛选选出QGC中具有治疗NAFLD的活性成分,运用网络药理学预测活性成分靶点、疾病相关靶点,筛选调控疾病的关键靶点,通过Discovery Studio 2020软件和Gromacs软件对关键活性成分和关键靶点进行分子对接和分子动力学模拟分析。最后,通过实验验证QGC中的关键活性成分对肝细胞脂肪变性的改善作用。多靶点虚拟筛选得到235个QGC活性成分,网络药理学分析得到320个成分-疾病共同靶点。分子对接结果表明,芹菜素、异鼠李素、迷迭香酸、大黄素甲醚、木犀草素与关键靶点PTPN1、PPARα、PPARγ、AR具有良好的结合能力。分子动力学模拟进一步验证了迷迭香酸、大黄素甲醚等化合物与关键靶点具有良好的结合稳定性。体外实验结果显示,5个关键活性成分均能改善HepG2细胞的脂肪变性,其中异鼠李素、迷迭香酸、大黄素甲醚改善细胞脂肪变性模型的效果最佳。本研究通过多层面探讨,为QGC在NAFLD治疗中的开发和应用提供理论依据。
文摘Preoperative assessment of the liver volume and function of the remnant liver is a mandatory prerequisite before performing major hepatectomy. The aim of this work is to develop and test a software application for evaluation of the residual function of the liver prior to the intervention of the surgeons. For this purpose, a complete software platform consisting of three basic modules: liver volume segmentation, visualization, and virtual cutting, was developed and tested. Liver volume segmentation is based on a patient examination with non-contrast abdominal Computed Tomography (CT). The basis of the segmentation is a multiple seeded region growing algorithm adapted for use with CT images without contrast-enhancement. Virtual tumor resection is performed interactively by outlining the liver region on the CT images. The software application then processes the results to produce a three-dimensional (3D) image of the “resected” region. Finally, 3D rendering module provides possibility for easy and fast interpretation of the segmentation results. The visual outputs are accompanied with quantitative measures that further provide estimation of the residual liver function and based on them the surgeons could make a better decision. The developed system was tested and verified with twenty abdominal CT patient sets consisting of different numbers of tomographic images. Volumes, obtained by manual tracing of two surgeon experts, showed a mean relative difference of 4.5%. The application was used in a study that demonstrates the need and the added value of such a tool in practice and in education.
