Pure laparoscopic living donor liver transplantation: Dreams come true

Minimally invasive approaches are increasingly being applied in surgeries and have recently been used in living donor hepatectomy. We have developed a safe and reproducible method for minimally invasive living donor liver transplantation, which consists of pure laparoscopic explant hepatectomy and pure laparoscopic implantation of the graft, which was inserted through a suprapubic incision. Pure laparoscopic explant hepatectomy without liver fragmentation was performed in a 60-year-old man with alcoholic liver cirrhosis and hepatocellular carcinoma. The explanted liver was retrieved through a suprapubic incision. A modified right liver graft, procured from his 24-year-old son using the pure laparoscopic method, was inserted through a suprapubic incision, and implantation was performed intracorporeally throughout the procedure. The time required to remove the liver was 369 min, and the total operative time was 960 min. No complications occurred during or after the surgery. The patient recovered well, and his hospital stay was of 11 days. Pure laparoscopic living donor liver transplantation from explant hepatectomy to implantation was performed successfully. It is a feasible procedure when performed by a highly experienced surgeon and transplantation team. Further studies with larger sample sizes are needed to confirm its safety and feasibility.

     

MCI的情志病机及疏肝法干预的可行性探讨＊

轻度认知障碍（Mild cognition impairment， MCI）是尚未达到阿尔兹海默病（Alzheimer’s disease， AD）的诊断标准且可逆转为正常脑老化状态的最佳窗口期。情志异常、肝失疏泄（肝失疏泄日久致肝郁）已被证实为MCI的重要情志病机，且“长期负性情绪积累肝失疏泄致衰加速脑老化”的科学假说已在本课题组前期研究中得到初步证实，疏肝法干预肝郁型MCI患者疗效显著，但以上作用机制尚未得到完全阐述。因此本研究系统总结了中医学对MCI的认识，长期情绪不调肝失疏泄对MCI的影响及可能机制，疏肝解郁方药及其成分改善肝郁型MCI的可行性，并提出使用无束缚性设计的眼动技术以探索疏肝法改善肝郁型MCI的可行性，为MCI的中医药干预及其神经机制探讨提供新思路，为中医情志衰老学说增添新内涵。     

情绪释放技术对乳腺癌术后化疗患者预期性悲伤的影响

目的 探讨情绪释放技术对改善乳腺癌术后化疗患者预期性悲伤的效果。方法 采用便利抽样法选取乳腺癌术后化疗患者60例为研究对象,采用随机数字表法将其分为对照组和干预组,各30例。对照组给予常规护理,干预组在对照组的基础上实施情绪释放干预疗法。比较干预前后2组心理痛苦程度和预期性悲伤得分水平。结果 干预后,干预组心理痛苦程度低于对照组(t=-17.930,P＜0.001);预期性悲伤总分及各维度得分均低于对照组(P＜0.001)。结论 对乳腺癌术后化疗患者应用情绪释放技术进行护理干预,可以减轻患者心理痛苦程度,降低患者预期性悲伤,值得临床推广应用。     

Carcinosarcoma arising from high-grade serous carcinoma of the ovary without estrogen receptor,WT-1, and PAX8 immunoreactivity

ObjectiveWe encountered a case of high-grade serous carcinoma (HGSC) of the ovary which recurred as carcinosarcoma of the sigmoid colon. Tumor cells of both the primary carcinoma and the secondary carcinosarcoma were negative for estrogen receptor (ER), WT-1, and PAX8. It is well known that most ovarian carcinomas arising from the Müllerian duct are immunoreactive for these biologic parameters. To our knowledge, this is the first case report that provides the results of immunohistochemical analysis of WT-1 and PAX8 for a primary carcinoma and recurrent carcinosarcoma.Case reportA 61-year-old woman had an advanced right ovarian HGSC. After a primary debulking surgery (hysterectomy, bilateral salpingo-oophorectomy and omentectomy) and adjuvant chemotherapy, complete remission was achieved. However, four and a half years later, a tumor arising beside the sigmoid colon was detected. A tumorectomy was performed through combined partial resection of the ileum and sigmoid colon. Microscopically, the tumor was diagnosed as carcinosarcoma of the sigmoid colon, which had originated from HGSC of the ovary. Interestingly, the malignant cells of the primary carcinoma and epithelial components of the recurrent carcinosarcoma were negative for ER, WT-1, and PAX8. These immunohistochemical features were unusual. Three cycles of chemotherapy with the previously used regimen and three additional cycles of doxorubicin and ifosfamide combination chemotherapy were administered. Currently, 3 years after the final chemotherapy was administered, the patient remains healthy.ConclusionHGSC of the ovary can recur as carcinosarcoma. Tumor cells of the primary HGSC without ER, WT-1, and PAX8 expression may have dedifferentiated and recurred as carcinosarcoma.