A review of laboratory and clinical data supporting the safety and efficacy of cyclosporin A in traumatic brain injury

For decades, cyclosporin A (CsA) has proved to be safe and effective for use in transplantation. In the past 10 years, this agent has shown neuroprotective effects in animal models of traumatic brain injury (TBI). This review article provides a critical overview of the literature on CsA neuroprotective effects in animal studies and current findings of clinical trials in the treatment of TBI with an emphasis on the possible CsA molecular mechanism of action. Animal data provide compelling evidence of the therapeutic benefits of CsA in TBI, but the outcome indices are heterogeneous with respect to the animal model of TBI as well as the route, dose, and timing of CsA administration. Similarly, clinical studies (phase II trials) adapting almost identical patient inclusion criteria have demonstrated the safety of CsA use in TBI, but the clinical trials are also heterogeneous based on study design, especially with regard to the variable timing of CsA administration after TBI. In view of the translational shortcomings of the preclinical studies and the rather pilot nature of the limited clinical trials that recently reached phase III, we offer guidance on the future directions of laboratory investigations on CsA that could improve the safety and efficacy of this agent in subsequent larger clinical trials.     

High tibial osteotomy using polycaprolactone-tricalcium phosphate polymer wedge in a micro pig model

Medial open-wedge high tibial osteotomy has been gaining popularity in recent years, but adequate supporting material is required in the osteotomy gap for early weight-bearing and rapid union. The purpose of this study was to investigate whether the implantation of a polycaprolactone-tricalcium phosphate composite scaffold wedge would enhance healing of the osteotomy in a micro pig model. We carried out open-wedge high tibial osteotomies in 12 micro pigs aged from 12 to 16 months. A scaffold wedge was inserted into six of the osteotomies while the other six were left open. Bone healing was evaluated after three and six months using plain radiographs, CT scans, measurement of the bone mineral density and histological examination. Complete bone union was obtained at six months in both groups. There was no collapse at the osteotomy site, loss of correction or failure of fixation in either group. Staining with haematoxylin and eosin demonstrated that there was infiltration of new bone tissue into the macropores and along the periphery of the implanted scaffold in the scaffold group. The CT scans and measurement of the bone mineral density showed that at six months specimens in the scaffold group had a higher bone mineral density than in the control group, although the implantation of the polycaprolactone-tricalcium phosphate composite scaffold wedge did not enhance healing of the osteotomy.     

Does Total Mesorectal Excision Require a Learning Curve? Analysis from the Database of a Single Surgeon’s Experience

Background  

The procedure of total mesorectal excision (TME) is the gold standard in the treatment of rectal cancer. However, quality control of TME is still under debate. The present study was conducted to determine whether TME requires a learning curve to allow the surgeon to grasp the necessary technical expertise.     

Comparison of costs for video-assisted thoracic surgery lobectomy and open lobectomy for non-small cell lung cancer

Background  

To promote the broad use of video-assisted thoracic surgery (VATS) for lobectomy (VATSL) in the management of lung cancer, it should be proved cost-effective, especially in the current cost-sensitive climate. This study evaluated and compared the costs of VATSL and open lobectomy (OL) and analyzed how the surgeon’s experience level with VATSL affected the cost.     

Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach: our early experiences

Background  

Various endoscopic thyroidectomy procedures have been designed to minimize visible scarring. However, endoscopic thyroidectomies have some limitations in obtaining adequate surgical views and in the precise manipulations of the endoscopic instrument. Recently, robotic technology has been applied to thyroid surgery. The aim of this study was to determine the technical feasibility, intraoperative safety, and efficacy of robotic thyroidectomy.