Repetitive transcranial magnetic stimulation(r TMS)has been shown to effectively improve impaired swallowing in Parkinson's disease(PD)patients with dysphagia.However,little is known about how r TMS affects the co...Repetitive transcranial magnetic stimulation(r TMS)has been shown to effectively improve impaired swallowing in Parkinson's disease(PD)patients with dysphagia.However,little is known about how r TMS affects the corresponding brain regions in this patient group.In this casecontrol study,we examined data from 38 PD patients with dysphagia who received treatment at Beijing Rehabilitation Medicine Academy,Capital Medical University.The patients received high-frequency r TMS of the motor cortex once per day for 10 successive days.Changes in brain activation were compared via functional magnetic resonance imaging in PD patients with dysphagia and healthy controls.The results revealed that before treatment,PD patients with dysphagia showed greater activation in the precentral gyrus,supplementary motor area,and cerebellum compared with healthy controls,and this enhanced activation was weakened after treatment.Furthermore,before treatment,PD patients with dysphagia exhibited decreased activation in the parahippocampal gyrus,caudate nucleus,and left thalamus compared with healthy controls,and this activation increased after treatment.In addition,PD patients with dysphagia reported improved subjective swallowing sensations after r TMS.These findings suggest that swallowing function in PD patients with dysphagia improved after r TMS of the motor cortex.This may have been due to enhanced activation of the caudate nucleus and parahippocampal gyrus.The study protocol was approved by the Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University(approval No.2018 bkky017)on March 6,2018 and was registered with Chinese Clinical Trial Registry(registration No.Chi CTR 1800017207)on July 18,2018.展开更多
AIM:To investigate the effect of plasmapheresis via the portal vein for"small-for-size"syndrome(SFSS)aided by extracorporeal continuous portal diversion(ECPD).METHODS:Extensive or total hepatectomy in the pi...AIM:To investigate the effect of plasmapheresis via the portal vein for"small-for-size"syndrome(SFSS)aided by extracorporeal continuous portal diversion(ECPD).METHODS:Extensive or total hepatectomy in the pig is usually adopted as a postoperative liver failure(PLF)or SFSS model.In this study,animals which underwent85%-90%hepatectomy were randomized into either the Systemic group(n=7)or the Portal group(n=7).In the Systemic group,all pigs received temporal plasmapheresis(PP)via the extracorporeal catheter circuit(systemic to systemic circulation)from 24 to 30 h posthepatectomy(PH);in the Portal group,all pigs received ECPD to divert partial portal vein flow(PVF)to the systemic circulation after hepatectomy,then converted to temporal PP from 24 to 30 h PH,and subsequently converted to ECPD again until 48 h PH.In the Portal group,the PVF was preserved at 3.0-3.3 times that of the baseline value,similar to that following 70%hepatectomy,which was regarded as the optimal PVF to the hypertrophic liver remnant.At 48 h PH,all pigs were re-opened and the portal vein pressure(PVP),PVF,and HAF(hepatic artery flow)were measured,and then diversion of the portal venous flow was terminated.After1 h the PVP,PVF,and HAF were re-measured.The portal hemodynamic changes,liver injury,liver regeneration and bacterial/lipopolysaccharide(LPS)translocation were evaluated in the two groups.RESULTS:The PVP in the Portal group was significantly lower than that in the Systemic group during the time period from 2 to 49 h PH(P<0.05).Serum alanine aminotransferase(ALT),total bilirubin(TB)and ammonia were significantly reduced in the Portal group compared with the Systemic group from 24 to 48 h PH(P<0.05).The Portal group may have attenuated sinusoidal endothelial injury and decreased the level of HA compared with the Systemic group.In the Systemic group,there was significant sinusoidal dilation,hydropic changes in hepatocytes and hemorrhage into the hepatic parenchyma,and the sinusoidal endothelial lining was partially destroyed and detached into the sinusoidal space.CD31immunostaining revealed significant destruction of the endothelial lining.In the Portal group,there was no intraparenchymal hemorrhage and the sinusoidal endothelial cells and hepatocytes were well preserved.CD31immunostaining was mild which indicated less destruction of the endothelial lining.HA was significantly decreased in the Portal group compared with the Systemic group from 2 to 48 h PH.The rate of liver remnant regeneration was elevated,while apoptosis was attenuated in the Portal group compared with the Systemic group.Thymidine kinase activity was much higher in the Portal group than in the Systemic group at 48 h PH.The PCNA index was significantly increased and the apoptotic index was significantly decreased in the Portal group compared with the Systemic group.Bacterial translocation and endotoxin,as well as the inflammatory response,were significantly attenuated in the Portal group compared with the Systemic group.LPS,tumor necrosis factor-and interleukin-6 levels were all significantly decreased in the Portal group compared with the Systemic group from 24 to48 h PH,while bacterial DNA level was significantly decreased from 2 to 48 h PH.CONCLUSION:PP plus ECPD via the portal vein can attenuate toxic load and hyperperfusion injury,and should be undertaken instead of PP via the systemic circulation in SFSS or PLF.展开更多
AIM:To investigate the feasibility of temporary extracorporeal continuous porta-caval diversion(ECPD) to relieve portal hyperperfusion in "small-for-size" syndrome following massive hepatectomy in pigs.METHO...AIM:To investigate the feasibility of temporary extracorporeal continuous porta-caval diversion(ECPD) to relieve portal hyperperfusion in "small-for-size" syndrome following massive hepatectomy in pigs.METHODS:Fourteen pigs underwent 85%-90% liver resection and were then randomly divided into thecontrol group(n = 7) and diversion group(n = 7).In the diversion group,portal venous blood was aspirated through the portal catheter and into a tube connected to a centrifugal pump.After filtration,the blood was returned to the pig through a double-lumen catheter inserted into the internal jugular or subclavian vein.With the conversion pump,portal venous inflow was partially diverted to the inferior vena cava through a catheter inserted via the gastroduodenal vein at 100-130 m L/min.Portal hemodynamics,injury,and regeneration in the liver remnant were compared between the two groups.RESULTS:Compared to the control group,porta-caval diversion via ECPD significantly mitigated excessive portal venous flow and portal vein pressure(PVP); the portal vein flow(PVF),hepatic artery flow(HAF),and PVP in the two groups were not significantly different at baseline; however,the PVF(431.8 ± 36.6 vs 238.8 ± 29.3,P < 0.01; 210.3 ± 23.4 vs 122.3 ± 20.6,P < 0.01) and PVP(13.8 ± 2.6 vs 8.7 ± 1.4,P < 0.01; 15.6 ± 2.1 vs 10.1 ± 1.3,P < 0.05) in the control group were significantly higher than those in the diversion group,respectively.The HAF in the control group was significantly lower than that in the diversion group at 2 h and 48 h post hepatectomy,and ECPD significantly attenuated injury to the sinusoidal lining and hepatocytes,increased the regeneration index of the liver remnant,and relieved damage that the liver remnant suffered due to endotoxin and bacterial translocation.CONCLUSION:ECPD,which can dynamically modulate portal inflow,can reduce injury to the liver remnant and facilitate liver regeneration,and therefore should replace permanent meso/porta-caval shunts in "smallfor-size" syndrome.展开更多
BACKGROUND In recent years,we created and employed a new anastomosis method,“bridging”pancreaticogastrostomy,to treat patients with extremely severe pancreatic injury.This surgery has advantages such as short length...BACKGROUND In recent years,we created and employed a new anastomosis method,“bridging”pancreaticogastrostomy,to treat patients with extremely severe pancreatic injury.This surgery has advantages such as short length of surgery,low secondary trauma,rapid construction of shunts for pancreatic fluid,preventing second surgeries,and achieving good treatment outcomes in clinical practice.However,due to the limited number of clinical cases,there is a lack of strong evidence to support the feasibility and safety of this surgical procedure.Therefore,we carried out animal experiments to examine this procedure,which is reported here.AIM To examine the feasibility and safety of a new rapid method of pancreaticogastrostomy,“bridging”pancreaticogastrostomy.METHODS Ten Landrace pigs were randomized into the experimental and control groups,with five pigs in each group.“Bridging”pancreaticogastrostomy was performed in the experimental group,while routine mucosa-to-mucosa pancreaticogastrostomy was performed in the control group.After surgery,the general condition,amylase levels in drainage fluid on Days 1,3,5,and 7,fasting and 2-h postprandial blood glucose 6 mo after surgery,fasting,2-h postprandial peripheral blood insulin,and portal vein blood insulin 6 mo after surgery were assessed.Resurgery was carried out at 1 and 6 mo after the former one to examine the condition of the abdominal cavity and firmness and tightness of the pancreaticogastric anastomosis and pancreas.RESULTS After surgery,the general condition of the animals was good.One in the control group did not gain weight 6 mo after surgery,whereas significant weight gain was present in the others.There were significant differences on Days 1 and 3 after surgery between the two groups but no differences on Days 5 and 7.There were no differences in fasting and 2-h postprandial blood glucose and fasting and 2-h insulin values of postprandial peripheral blood and portal vein blood 6 mo after surgery between the two groups.One month after surgery,the sinus tract orifice/anastomosis was patent in the two groups.Six months after surgery,the sinus tract orifice/anastomosis was sealed,and pancreases in both groups presented with chronic pancreatitis.CONCLUSION“Bridging”pancreaticogastrostomy is a feasible and safe a means of damage control surgery during the early stage of pancreatic injury.展开更多
AIM: To investigate the capacity of shunts to relieve portal hypertension and decrease the safe minimal liver remnant in pigs.METHODS: A subtotal hepatectomy with < 60 mL blood loss and without hepatic pedicle occl...AIM: To investigate the capacity of shunts to relieve portal hypertension and decrease the safe minimal liver remnant in pigs.METHODS: A subtotal hepatectomy with < 60 mL blood loss and without hepatic pedicle occlusion was performed.The mesenteric venous inflow was diverted through a mesocaval shunt(MCS) constructed using the prepared left renal vein with an end-to-side running suture of 5-0 proline.All 21 animals that underwent subtotal hepatectomy and/or MCS were divided into three groups.In the 15% group,the residual volume was 14%-19% of total liver volume(TLV);in the 15%+ S group,the residual volume was also 14%-19% of TLV with a mesocaval shunt(MCS);and in the 10%+ S group,the residual volume was 8%-13% of TLV with an MCS.In the three groups,the intraoperative portal vein pressure(PVP) and portal vein flow(PVF) were monitored and compared at laparotomy and 1 h posthepatectomy.The survival rate,sinusoidal endothelial damage,tissue analysis,and serum analysis were investigated among the three groups.RESULTS: The percentage residual liver volume was 15.9%,16.1% and 11.8% in the 15%,15%+ S,10%+ S groups,respectively.After hepatectomy,PVF and portal-to-arterial flow ratio in the 15%+ S group significantly decreased and hepatic artery flow(HAF) per unit volume significantly increased,compared to those in the 15% group.The PVP in the 15%+ S group and 10%+ S group increased slightly from that measured at laparotomy;however,in the 15% group,the PVP increased immediately and significantly above that observed in the other two groups.The 14-d survival rates were 28.5%,85.6%,and 14.2% in the 15%,15%+ S,and 10%+ S groups,respectively.In the 15%+ S group,the shunts effectively attenuated injury to the sinusoidal endothelium,and the changes in the serum and tissue analysis results were significantly reduced compared to those in the 15% and 10%+ S groups.CONCLUSION: MCS can decompress the portal vein and so attenuate liver injury from hyperperfusion,and make extreme or marginal hepatectomy safer.展开更多
基金supported by the Beijing Municipal Science and Technology Commission Capital Clinical Feature Applied Research Project of China,No.Z181100001718205(to WJG and PLH)。
文摘Repetitive transcranial magnetic stimulation(r TMS)has been shown to effectively improve impaired swallowing in Parkinson's disease(PD)patients with dysphagia.However,little is known about how r TMS affects the corresponding brain regions in this patient group.In this casecontrol study,we examined data from 38 PD patients with dysphagia who received treatment at Beijing Rehabilitation Medicine Academy,Capital Medical University.The patients received high-frequency r TMS of the motor cortex once per day for 10 successive days.Changes in brain activation were compared via functional magnetic resonance imaging in PD patients with dysphagia and healthy controls.The results revealed that before treatment,PD patients with dysphagia showed greater activation in the precentral gyrus,supplementary motor area,and cerebellum compared with healthy controls,and this enhanced activation was weakened after treatment.Furthermore,before treatment,PD patients with dysphagia exhibited decreased activation in the parahippocampal gyrus,caudate nucleus,and left thalamus compared with healthy controls,and this activation increased after treatment.In addition,PD patients with dysphagia reported improved subjective swallowing sensations after r TMS.These findings suggest that swallowing function in PD patients with dysphagia improved after r TMS of the motor cortex.This may have been due to enhanced activation of the caudate nucleus and parahippocampal gyrus.The study protocol was approved by the Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University(approval No.2018 bkky017)on March 6,2018 and was registered with Chinese Clinical Trial Registry(registration No.Chi CTR 1800017207)on July 18,2018.
文摘AIM:To investigate the effect of plasmapheresis via the portal vein for"small-for-size"syndrome(SFSS)aided by extracorporeal continuous portal diversion(ECPD).METHODS:Extensive or total hepatectomy in the pig is usually adopted as a postoperative liver failure(PLF)or SFSS model.In this study,animals which underwent85%-90%hepatectomy were randomized into either the Systemic group(n=7)or the Portal group(n=7).In the Systemic group,all pigs received temporal plasmapheresis(PP)via the extracorporeal catheter circuit(systemic to systemic circulation)from 24 to 30 h posthepatectomy(PH);in the Portal group,all pigs received ECPD to divert partial portal vein flow(PVF)to the systemic circulation after hepatectomy,then converted to temporal PP from 24 to 30 h PH,and subsequently converted to ECPD again until 48 h PH.In the Portal group,the PVF was preserved at 3.0-3.3 times that of the baseline value,similar to that following 70%hepatectomy,which was regarded as the optimal PVF to the hypertrophic liver remnant.At 48 h PH,all pigs were re-opened and the portal vein pressure(PVP),PVF,and HAF(hepatic artery flow)were measured,and then diversion of the portal venous flow was terminated.After1 h the PVP,PVF,and HAF were re-measured.The portal hemodynamic changes,liver injury,liver regeneration and bacterial/lipopolysaccharide(LPS)translocation were evaluated in the two groups.RESULTS:The PVP in the Portal group was significantly lower than that in the Systemic group during the time period from 2 to 49 h PH(P<0.05).Serum alanine aminotransferase(ALT),total bilirubin(TB)and ammonia were significantly reduced in the Portal group compared with the Systemic group from 24 to 48 h PH(P<0.05).The Portal group may have attenuated sinusoidal endothelial injury and decreased the level of HA compared with the Systemic group.In the Systemic group,there was significant sinusoidal dilation,hydropic changes in hepatocytes and hemorrhage into the hepatic parenchyma,and the sinusoidal endothelial lining was partially destroyed and detached into the sinusoidal space.CD31immunostaining revealed significant destruction of the endothelial lining.In the Portal group,there was no intraparenchymal hemorrhage and the sinusoidal endothelial cells and hepatocytes were well preserved.CD31immunostaining was mild which indicated less destruction of the endothelial lining.HA was significantly decreased in the Portal group compared with the Systemic group from 2 to 48 h PH.The rate of liver remnant regeneration was elevated,while apoptosis was attenuated in the Portal group compared with the Systemic group.Thymidine kinase activity was much higher in the Portal group than in the Systemic group at 48 h PH.The PCNA index was significantly increased and the apoptotic index was significantly decreased in the Portal group compared with the Systemic group.Bacterial translocation and endotoxin,as well as the inflammatory response,were significantly attenuated in the Portal group compared with the Systemic group.LPS,tumor necrosis factor-and interleukin-6 levels were all significantly decreased in the Portal group compared with the Systemic group from 24 to48 h PH,while bacterial DNA level was significantly decreased from 2 to 48 h PH.CONCLUSION:PP plus ECPD via the portal vein can attenuate toxic load and hyperperfusion injury,and should be undertaken instead of PP via the systemic circulation in SFSS or PLF.
文摘AIM:To investigate the feasibility of temporary extracorporeal continuous porta-caval diversion(ECPD) to relieve portal hyperperfusion in "small-for-size" syndrome following massive hepatectomy in pigs.METHODS:Fourteen pigs underwent 85%-90% liver resection and were then randomly divided into thecontrol group(n = 7) and diversion group(n = 7).In the diversion group,portal venous blood was aspirated through the portal catheter and into a tube connected to a centrifugal pump.After filtration,the blood was returned to the pig through a double-lumen catheter inserted into the internal jugular or subclavian vein.With the conversion pump,portal venous inflow was partially diverted to the inferior vena cava through a catheter inserted via the gastroduodenal vein at 100-130 m L/min.Portal hemodynamics,injury,and regeneration in the liver remnant were compared between the two groups.RESULTS:Compared to the control group,porta-caval diversion via ECPD significantly mitigated excessive portal venous flow and portal vein pressure(PVP); the portal vein flow(PVF),hepatic artery flow(HAF),and PVP in the two groups were not significantly different at baseline; however,the PVF(431.8 ± 36.6 vs 238.8 ± 29.3,P < 0.01; 210.3 ± 23.4 vs 122.3 ± 20.6,P < 0.01) and PVP(13.8 ± 2.6 vs 8.7 ± 1.4,P < 0.01; 15.6 ± 2.1 vs 10.1 ± 1.3,P < 0.05) in the control group were significantly higher than those in the diversion group,respectively.The HAF in the control group was significantly lower than that in the diversion group at 2 h and 48 h post hepatectomy,and ECPD significantly attenuated injury to the sinusoidal lining and hepatocytes,increased the regeneration index of the liver remnant,and relieved damage that the liver remnant suffered due to endotoxin and bacterial translocation.CONCLUSION:ECPD,which can dynamically modulate portal inflow,can reduce injury to the liver remnant and facilitate liver regeneration,and therefore should replace permanent meso/porta-caval shunts in "smallfor-size" syndrome.
文摘BACKGROUND In recent years,we created and employed a new anastomosis method,“bridging”pancreaticogastrostomy,to treat patients with extremely severe pancreatic injury.This surgery has advantages such as short length of surgery,low secondary trauma,rapid construction of shunts for pancreatic fluid,preventing second surgeries,and achieving good treatment outcomes in clinical practice.However,due to the limited number of clinical cases,there is a lack of strong evidence to support the feasibility and safety of this surgical procedure.Therefore,we carried out animal experiments to examine this procedure,which is reported here.AIM To examine the feasibility and safety of a new rapid method of pancreaticogastrostomy,“bridging”pancreaticogastrostomy.METHODS Ten Landrace pigs were randomized into the experimental and control groups,with five pigs in each group.“Bridging”pancreaticogastrostomy was performed in the experimental group,while routine mucosa-to-mucosa pancreaticogastrostomy was performed in the control group.After surgery,the general condition,amylase levels in drainage fluid on Days 1,3,5,and 7,fasting and 2-h postprandial blood glucose 6 mo after surgery,fasting,2-h postprandial peripheral blood insulin,and portal vein blood insulin 6 mo after surgery were assessed.Resurgery was carried out at 1 and 6 mo after the former one to examine the condition of the abdominal cavity and firmness and tightness of the pancreaticogastric anastomosis and pancreas.RESULTS After surgery,the general condition of the animals was good.One in the control group did not gain weight 6 mo after surgery,whereas significant weight gain was present in the others.There were significant differences on Days 1 and 3 after surgery between the two groups but no differences on Days 5 and 7.There were no differences in fasting and 2-h postprandial blood glucose and fasting and 2-h insulin values of postprandial peripheral blood and portal vein blood 6 mo after surgery between the two groups.One month after surgery,the sinus tract orifice/anastomosis was patent in the two groups.Six months after surgery,the sinus tract orifice/anastomosis was sealed,and pancreases in both groups presented with chronic pancreatitis.CONCLUSION“Bridging”pancreaticogastrostomy is a feasible and safe a means of damage control surgery during the early stage of pancreatic injury.
文摘AIM: To investigate the capacity of shunts to relieve portal hypertension and decrease the safe minimal liver remnant in pigs.METHODS: A subtotal hepatectomy with < 60 mL blood loss and without hepatic pedicle occlusion was performed.The mesenteric venous inflow was diverted through a mesocaval shunt(MCS) constructed using the prepared left renal vein with an end-to-side running suture of 5-0 proline.All 21 animals that underwent subtotal hepatectomy and/or MCS were divided into three groups.In the 15% group,the residual volume was 14%-19% of total liver volume(TLV);in the 15%+ S group,the residual volume was also 14%-19% of TLV with a mesocaval shunt(MCS);and in the 10%+ S group,the residual volume was 8%-13% of TLV with an MCS.In the three groups,the intraoperative portal vein pressure(PVP) and portal vein flow(PVF) were monitored and compared at laparotomy and 1 h posthepatectomy.The survival rate,sinusoidal endothelial damage,tissue analysis,and serum analysis were investigated among the three groups.RESULTS: The percentage residual liver volume was 15.9%,16.1% and 11.8% in the 15%,15%+ S,10%+ S groups,respectively.After hepatectomy,PVF and portal-to-arterial flow ratio in the 15%+ S group significantly decreased and hepatic artery flow(HAF) per unit volume significantly increased,compared to those in the 15% group.The PVP in the 15%+ S group and 10%+ S group increased slightly from that measured at laparotomy;however,in the 15% group,the PVP increased immediately and significantly above that observed in the other two groups.The 14-d survival rates were 28.5%,85.6%,and 14.2% in the 15%,15%+ S,and 10%+ S groups,respectively.In the 15%+ S group,the shunts effectively attenuated injury to the sinusoidal endothelium,and the changes in the serum and tissue analysis results were significantly reduced compared to those in the 15% and 10%+ S groups.CONCLUSION: MCS can decompress the portal vein and so attenuate liver injury from hyperperfusion,and make extreme or marginal hepatectomy safer.
