BackgroundLaparoscopic central bisectionectomy (Couinaud's segment IV, V, and VIII) needs exposure of the RHV and MHV on the surface of the remnant and the resecting side, respectively. Avoiding venous injury is mandatory and laparoscopy-specific cranio-caudal approach to hepatic veins might be helpful [1]. We present this procedure in performing laparoscopic central bisectionectomy.PatientA 45-year-old female was admitted to our hospital with a 6 cm HCC in the segment VIII and IV. Her comorbid disease was non-cirrhotic HBV hepatitis (Child-Pugh grade A) and diabetes (untreated).MethodAfter cholecystectomy, G4 branches were dissected and cut by extra- or intra-hepatic approach. Hilar plate was dissected and the Gant was encircled and occluded by a vascular clip. Afterwards, exposure of the MHV was started at its root on IVC [2,3] and extended in cranio-caudal direction [1]. After sufficient space was obtained around the Gant, the Gant and the MHV were cut. Parenchymal transection between right anterior and right posterior sections was also started form the root of the RHV to its cranio-caudal direction. Liver resection was finished with full exposure of the RHV.ResultsThe operating time was 380 minutes, and the blood loss volume was 30 ml. Postoperative CT image showed exposure of the RHV and umbilical portion of Glissonean branch, and no fluid retention.ConclusionLaparoscopy-specific cranio-caudal approach to hepatic veins may be useful to avoid split injury of venous branches [4], especially if the hepatectomy requires complete exposure of hepatic vein, such as central bisectionectomy. 相似文献
In the Netherlands, safe and sufficient drinking water is provided to the general population by ten drinking water companies. To guarantee safe drinking water the World Health Organization (WHO) developed a Water Safety Plan (WSP), a Risk Assessment and a Risk Management (RA/RM) framework. The objective of the study was to identify legally required RA approaches, to document application of RA/RM activities at Dutch drinking water companies and to determine to what extent these RA/RM activities as a whole cover all the elements of the WHO WSP approach. This study could be of interest to both managers of large water utilities and decision makers.The assessment was performed by means of a policy review and interviews with two to four staff members involved in RA/RM from all ten Dutch drinking water companies combined with a joint workshop. The drinking water companies are well aware of the potential hazards and risks that can influence the drinking water quality. To guarantee the supply of safe and sufficient drinking water, the Dutch drinking water sector uses six different legally required RA/RM approaches. This study shows that by using the six legally required RA/RM approaches, all WSP steps are covered. WSP entails a generic risk assessment for identifying all hazards and hazardous events from source to tap, whereas the six legally required RA/RM each focus on specific risks at an advanced level. Each risk assessment provides information on specific hazards and hazardous events covering a part of the water supply chain. These legal requirements are complemented with additional RA/RM activities at sector and water company level such as codes of practices and standard operating procedures. The outcomes of all RA/RM approaches combined provide information from source to tap. When using multiple RA/RM approaches, it is crucial to share and combine information derived from the different activities. 相似文献
Background: The importance of conversation partners (CPs) for persons with aphasia (PwA) was recently highlighted. Trained CPs are shown to increase communicative access and improve quality of life. The Kagan scales, i.e., “Measure of skills in Supported Conversation” and “Measure of Participation in Conversation” (the MSC-MPC scales), between PwA and their CPs were designed to assess the communication dyad. The MSC-MPC scales were translated and adapted to Italian in 2015.
Aim: To validate the Italian version of the MSC-MPC scales (I-MSC/MPC) by assessing intra- and inter-rater reliability and concurrent validity.
Methods & Procedures: Thirty-two couples formed by 16 PwA and two CPs (one trained and one untrained) for each PwA were enrolled in the study. Aphasia severity was staged by the Therapy Outcome Measures “Dysphasia” impairment scale. Functional communication and pragmatic abilities were assessed with the I-ASHA-FACS and the Pragmatic Protocol, respectively. The PwA were videotaped while communicating both with trained and untrained CPs. All videotapes were assessed using the I-MSC/MPC scales by one expert speech and language therapist and two trainee speech and language therapists. The Intraclass Correlation Coefficient (ICC) was used to calculate inter- and intra-rater reliability. Correlations between the I-MSC/MPC scales and the aphasia severity, the I-ASHA-FACS, and the Pragmatic Protocol results were calculated by the Spearman’s test. The Mann-Whitney test was used to separate the I-MSC/MPC results obtained by the trained CPs from the untrained CPs.
Outcomes & Results: Inter-rater and intra-rater reliability ICC results were highly significant and strong (ICC > .906, ICC > .978, p < .001, respectively). Significant correlations between the aphasia severity and the I-MSC/MPC scales ranged from moderate to strong (Spearman rho>.487, p < .005). Correlations between the I-MSC and the I-ASHA-FACS domains ranged from moderate to strong (rho >.458, p < .008). Correlation between the I-MPC and the I-ASHA-FACS domains were generally strong (rho > .569, p < .001) while correlations between the I-MSC and the I-ASHA-FACS domains ranged from moderate to strong (rho > .458, p = .008). Pragmatic aspects were shown to be mostly preserved in the PwA. All correlations between the I-MSC/MPC scales and the Pragmatic Protocol were strong (rho >.635, p < .008). The Mann-Whitney test showed significant results for the I-MSC scale (p < .026).
Conclusions: The I-MSC-MPC scales proved to be a valid and reliable instrument to assess the communicative dyad. The I-MSC scale was also used to distinguish trained from untrained CPs. The use of I-MSC-MPC scales is recommended in clinical practice. 相似文献
BackgroundEnthusiasm for anterior-based approaches for total hip arthroplasty (THA) continues to increase but there is concern for increased complications during the learning curve period associated. This study aimed to investigate if there was a difference in perioperative variables, intraoperative and immediate postoperative complications, or patient-reported outcomes when transitioning from a mini-posterior approach (mPA) to an anterior-based muscle-sparing (ABMS) approach for THA.MethodsRetrospective cohort study on the first 100 primary THA cases (n = 96 patients) of the senior author (August 2016 to August 2017) using the ABMS approach. These cases were compared to primary THA cases done the year prior (July 2015 to July 2016, n = 91 cases in 89 patients) using an mPA. Data were extracted and analyzed via gamma regression with robust standard errors and using generalized estimating equation regression.ResultsWe found no difference in the estimated blood loss (P = .452) and surgical time (P = .564) between the cohorts. The ABMS cases had a slightly shorter length of stay (P = .001) with an adjusted mean length of stay of 1.53 days (95% confidence interval 1.4-1.6) compared to 1.85 days (95% confidence interval 1.8-1.9) in the mPA cases. There was no difference in the frequency of immediate postoperative complications (all, P > .05). There was no difference in the adjusted mean change in patient-reported outcomes (all P > .05). In the ABMS group, there was no difference in surgical time or physical function computerized adaptive test between the first 20 cases (reference) and each subsequent group of 20 cases (all P > .05).ConclusionThis study demonstrates no associated learning curve for an experienced senior surgeon when switching routine THA approach from mPA to ABMS. We advise careful interpretation of our results, as they may not apply to all surgeons and practices.Level of EvidenceLevel III Therapeutic Study: retrospective comparative study. 相似文献
This study aimed at evaluating how encapsulation in a regular nanocarrier (NC) (providing extended circulation time) or in a brain-targeting NC (providing prolonged circulation time and increased brain uptake) may influence the therapeutic index compared with the unformulated drug and to explore the key parameters affecting therapeutic performance using a model-based approach. Pharmacokinetic (PK) models were built with chosen PK parameters. For a scenario where central effect depends on area under the unbound brain concentration curve and peripheral toxicity relates to peak unbound plasma concentration, dose-effect and drug-side effect curves were constructed, and the therapeutic index was evaluated. Regular NC improved the therapeutic index compared with the unformulated drug due to reduced peripheral toxicity, while brain-targeting NC enhanced the therapeutic index by lowering peripheral toxicity and increasing central effect. Decreasing drug release rate or systemic clearance of NC with drug still encapsulated could increase the therapeutic index. Also, a drug with shorter half-life would therapeutically benefit more from a NC encapsulation. This work provides insights into how a NC for brain delivery should be optimized to maximize the therapeutic performance and is helpful to predict if and to what extent a drug with certain PK properties would obtain therapeutic benefit from nanoencapsulation. 相似文献