Risk factors for hypercoagulability after laparoscopic hepatic haemangioma resection

Background: Laparoscopic hepatectomy with a small incision, light abdominal wall trauma and rapid postoperative recovery has been widely used in the surgical treatment of benign liver diseases. However, the occurrence of complications, such as deep-vein thrombosis, associated with laparoscopic techniques has raised concerns. This study aimed to investigate the factors influencing the development of a hypercoagulable state in patients following laparoscopic hepatic haemangioma resection. Materials and Methods: Between 2017 and 2019, 78 patients to be treated by laparoscopic hepatic haemangioma resection were selected prospectively for the study. The differences in relevant clinical factors between patients with and without blood hypercoagulability at 24 h after surgery were compared, and the factors influencing the development of blood hypercoagulability after surgery were analysed. Results: The study included 78 patients, split into the hypercoagulable group (n = 27) and nonhypercoagulable group (n = 51). Compared with patients who did not develop blood hypercoagulability, patients who did had significantly higher preoperative levels of fibrinogen (Fib), D-dimer (D-Di), fibrinogen degradation products (FDP), platelet count (PLT), low-density lipoprotein cholesterol (LDL-C) and history of hyperlipidaemia whereas high-density lipoprotein cholesterol (HDL-C) levels were significantly lower (P < 0.05.) in hypercoagulable group. Univariate and multifactorial logistic regression analyses showed that a history of hyperlipidaemia, Fib ≥3.83 g/L, D-Di ≥9.12 μg/ml, FDP ≥14.64 μg/ml, PLT ≥292 × 109/L, HDL-C ≥1.25 mmol/L and LDL-C ≥2.03 mmol/L was the most common independent risk factors for the development of a hypercoagulable state of blood in patients after laparoscopic hepatic haemangioma resection (P < 0.05). Conclusion: For patients undergoing laparoscopic hepatic haemangioma resection, attention should be paid to the development of a hypercoagulable state in those with the risk factors described in this study

Synergistic Effect of Activated Carbon, NiO and Al₂O₃ on Improving the Thermal Stability and Flame Retardancy of Polypropylene Composites

It is difficult to enhance the char yields of polypropylene (PP) due to the preferential complete combustion. Successful formation of abundant char layer structure of PP upon flammability was obtained due to the synergistic effect of NiO, Al2O3 and activated carbon (AC). From characterization of scanning electron microscopy (SEM) and transmission electron microscopy (TEM), it was revealed that the microstructure of residual char contained large amount of carbon nanotubes. Compared to the modification of AC, NiO and Al2O3 alone, the combination of AC, NiO and Al2O3 dramatically promotes the charring ability of PP. In the case of AC and NiO, NiO plays a role of dehydrogenation, resulting in the degradation product, while AC mainly acts as carbonization promoter. The addition of Al2O3 results in higher dispersion and smaller particle size of NiO, leading to greater exposure of active sites of NiO and higher dehydrogenation and carbonization activity. Compared to the neat PP, the decomposition temperature of the PP modified by combined AC, NiO and Al2O3 was increased by 90 ℃. The yield of residual char of AC-5Ni-Al-PP reached as high as 44.6%. From the cone calorimeter test, the heat release rate per unit area (HRR) and total heat release per unit area (THR) of PP composite follows the order AC-5Ni-Al-PP < AC-10Ni-Al-PP < AC-Ni-PP < AC-15Ni-Al-PP < AC-1Ni-Al-PP. Compared to the neat PP, the peak of HRR declined by 73.8%, 72.7%, 71.3%, 67.6% and 62.5%, respectively

Expert consensus on resection of chest wall tumors and chest wall reconstruction.

none75siChest wall tumors are a relatively uncommon disease in clinical practice. Most of the published studies about chest wall tumors are usually single-center retrospective studies, involving few patients. Therefore, evidences regarding clinical conclusions about chest wall tumors are lacking, and some controversial issues have still to be agreed upon. In January 2019, 73 experts in thoracic surgery, plastic surgery, science, and engineering jointly released the Chinese Expert Consensus on Chest Wall Tumor Resection and Chest Wall Reconstruction (2018 edition). After that, numerous experts put forward new perspectives on some academic issues in this version of the consensus, pointing out the necessity to further discuss the points of contention. Thus, we conducted a survey through the administration of a questionnaire among 85 experts in the world. Consensus has been reached on some major points as follows. (I) Wide excision should be performed for desmoid tumor (DT) of chest wall. After excluding the distant metastasis by multi-disciplinary team, solitary sternal plasmacytoma can be treated with extensive resection and adjuvant radiotherapy. (II) Wide excision with above 2 cm margin distance should be attempted to obtain R0 resection margin for chest wall tumor unless the tumor involves vital organs or structures, including the great vessels, heart, trachea, joints, and spine. (III) For patients with chest wall tumors undergoing unplanned excision (UE) for the first time, it is necessary to carry out wide excision as soon as possible within 1–3 months following the previous surgery. (IV) Current Tumor Node Metastasis staging criteria (American Joint Committee on Cancer) of bone tumor and soft tissue sarcoma are not suitable for chest wall sarcomas. (V) It is necessary to use rigid implants for chest wall reconstruction once the maximum diameter of the chest wall defect exceeds 5 cm in adults and adolescents. (VI) For non-small cell lung cancer (NSCLC) invading the chest wall, wide excision with neoadjuvant and/or adjuvant therapy are recommended for patients with stage T3-4N0-1M0. As clear guidelines are lacking, these consensus statements on controversial issues on chest wall tumors and resection could possibly serve as further guidance in clinical practice during the upcoming years.openLei Wang , Xiaolong Yan, Jinbo Zhao, Chang Chen, Chun Chen, Jun Chen, Ke-Neng Chen, Tiesheng Cao, Ming-Wu Chen, Hongbin Duan, Junqiang Fan, Junke Fu, Shugeng Gao, Hui Guo, Shiping Guo, Wei Guo, Yongtao Han , Ge-Ning Jiang , Hongjing Jiang, Wen-Jie Jiao, Mingqiang Kang, Xuefeng Leng, He-Cheng Li, Jing Li, Jian Li, Shao-Min Li, Shuben Li, Zhigang Li, Zhongcheng Li, Chaoyang Liang, Nai-Quan Mao, Hong Mei, Daqiang Sun, Dong Wang, Luming Wang, Qun Wang, Shumin Wang, Tianhu Wang, Lunxu Liu, Gaoming Xiao, Shidong Xu, Jinliang Yang, Ting Ye, Guangjian Zhang, Linyou Zhang, Guofang Zhao, Jun Zhao, Wen-Zhao Zhong, Yuming Zhu, Karel W E Hulsewé, Yvonne L J Vissers, Erik R de Loos, Jin Yong Jeong, Giuseppe Marulli, Alberto Sandri, Zsolt Sziklavari , Jacopo Vannucci, Luca Ampollini, Yuichiro Ueda , Chaozong Liu , Andrea Bille , Masatsugu Hamaji, Beatrice Aramini, Ilhan Inci , Cecilia Pompili, Hans Van Veer, Alfonso Fiorelli, Ricciardi Sara, Inderpal S Sarkaria, Fabio Davoli, Hiroaki Kuroda, Servet Bölükbas, Xiao-Fei Li, Lijun Huang , Tao Jiang Affiliations expandLei Wang , Xiaolong Yan, Jinbo Zhao, Chang Chen, Chun Chen, Jun Chen, Ke-Neng Chen, Tiesheng Cao, Ming-Wu Chen, Hongbin Duan, Junqiang Fan, Junke Fu, Shugeng Gao, Hui Guo, Shiping Guo, Wei Guo, Yongtao Han , Ge-Ning Jiang , Hongjing Jiang, Wen-Jie Jiao, Mingqiang Kang, Xuefeng Leng, He-Cheng Li, Jing Li, Jian Li, Shao-Min Li, Shuben Li, Zhigang Li, Zhongcheng Li, Chaoyang Liang, Nai-Quan Mao, Hong Mei, Daqiang Sun, Dong Wang, Luming Wang, Qun Wang, Shumin Wang, Tianhu Wang, Lunxu Liu, Gaoming Xiao, Shidong Xu, Jinliang Yang, Ting Ye, Guangjian Zhang, Linyou Zhang, Guofang Zhao, Jun Zhao, Wen-Zhao Zhong, Yuming Zhu, Karel W E Hulsewé, Yvonne L J Vissers, Erik R de Loos, Jin Yong Jeong, Giuseppe Marulli, Alberto Sandri, Zsolt Sziklavari , Jacopo Vannucci, Luca Ampollini, Yuichiro Ueda , Chaozong Liu , Andrea Bille , Masatsugu Hamaji, Beatrice Aramini, Ilhan Inci , Cecilia Pompili, Hans Van Veer, Alfonso Fiorelli, Ricciardi Sara, Inderpal S Sarkaria, Fabio Davoli, Hiroaki Kuroda, Servet Bölükbas, Xiao-Fei Li, Lijun Huang , Tao Jiang Affiliations expan

Causal association between snoring and stroke: a Mendelian randomization study in a Chinese populationResearch in context

Summary: Background: Previous observational studies established a positive relationship between snoring and stroke. We aimed to investigate the causal effect of snoring on stroke. Methods: Based on 82,339 unrelated individuals with qualified genotyping data of Asian descent from the China Kadoorie Biobank (CKB), we conducted a Mendelian randomization (MR) analysis of snoring and stroke. Genetic variants identified in the genome-wide association analysis (GWAS) of snoring in CKB and UK Biobank (UKB) were selected for constructing genetic risk scores (GRS). A two-stage method was applied to estimate the associations of the genetically predicted snoring with stroke and its subtypes. Besides, MR analysis among the non-obese group (body mass index, BMI <24.0 kg/m2), as well as multivariable MR (MVMR), were performed to control for potential pleiotropy from BMI. In addition, the inverse-variance weighted (IVW) method was applied to estimate the causal association with genetic variants identified in CKB GWAS. Findings: Positive associations were found between snoring and total stroke, hemorrhagic stroke (HS), and ischemic stroke (IS). With GRS of CKB, the corresponding HRs (95% CIs) were 1.56 (1.15, 2.12), 1.50 (0.84, 2.69), 2.02 (1.36, 3.01), and the corresponding HRs (95% CIs) using GRS of UKB were 1.78 (1.30, 2.43), 1.94 (1.07, 3.52), and 1.74 (1.16, 2.61). The associations remained stable in the MR among the non-obese group, MVMR analysis, and MR analysis using the IVW method. Interpretation: This study suggests that, among Chinese adults, genetically predicted snoring could increase the risk of total stroke, IS, and HS, and the causal effect was independent of BMI. Funding: National Natural Science Foundation of China, Kadoorie Charitable Foundation Hong Kong, UK Wellcome Trust, National Key R&D Program of China, Chinese Ministry of Science and Technology