Survival Analysis of Re-resection Versus Radiofrequency Ablation for Intrahepatic Recurrence After Hepatectomy for Hepatocellular Carcinoma

Background  

Tumor recurrence after resection of hepatocellular carcinoma is a common phenomenon. Re-resection and radiofrequency ablation (RFA) are good options for treating recurrent HCC. This study compared the efficacy of these two modalities in the treatment of intrahepatic HCC recurrence after hepatectomy.     

Versatile use of the muscle and nerve sparing latissimus dorsi flap

In this report, we describe the technique of muscle and nerve sparing latissimus dorsi (LD) flap and evaluate the outcomes of reconstruction of various defects with 12 free and 2 pedicled muscle and nerve sparing LD flaps in 14 patients. The LD muscle functions at operated and nonoperated muscles were evaluated clinically and with electroneuromyography. All flaps survived completely but one which had a partial necrosis. The mean follow-up time was 12.3 months. Adduction and extention ranges of the shoulders were the same bilaterally in all patients. In electroneuromyography, no significant difference was available statistically between the sides. This muscle and nerve sparing latissimus dorsi flap has advantages of thinness, muscle preservation and reliability, and thus can be a good option to other fasciocutaneous flaps in reconstruction surgery.     

The outcome of prostaglandin-E1 and dextran-40 compared to no antithrombotic therapy in head and neck free tissue transfer: analysis of 1,351 cases in a single center

Free tissue transfer has become a popular technique for soft tissue defect reconstruction in head and neck cancer ablation. Although high success rates and good reliability of free flaps are proven, microvascular thrombosis is still the most critical issue for microsurgeons. Pharmacological antithrombotic agents are widely used but their efficacy is still debated. In this study, we analyzed whether prostaglandin-E1 (PGE1) and dextran-40 can improve the outcomes compared to no antithrombotic therapy at all. We retrospectively reviewed 1,351 free flaps performed for head and neck reconstruction after cancer ablation. Three groups defined were 232 flaps received PGE1, 283 flaps received dextran-40, and 836 received no antithrombotic therapy. The demographics of these three groups indicated no statistical differences. The results showed that flap survival revealed no significant difference among PGE1, dextran-40, and control group (P = 0.734). There was a tendency to hematomas in PGE1 group (P = 0.056) when compared with other two groups. Dextran-40 significantly increased flap failure rate in high-risk patients with diabetes mellitus (P = 0.006) or hypertension (P = 0.003), when compared with PGE1 and control group. These results revealed antithrombotic therapy with PGE1 and dextran-40 do not determine a significant improvement in flap survival.     

标准血清学法,单克隆抗体法和 NA法行HLA—A抗原分型的比较

目的：双盲比较研究血清学方法、单克隆抗体（单抗）方法和ＤＮＡ方法用于中国汉族人群ＨＬＡ－Ａ抗原分型的精确性。方法：研究样本２９６份,包括１４３名无关供者和１５３例等待肾移植受者。血清学方法为二步法微量淋巴细胞毒分型技术;单抗法为一步法单抗分型技术;ＤＮＡ方法采用顺序特异引物聚合酶反应（ＰＣＲ－ＳＳＰ）技术。结果：所有样本ＤＮＡ分型匀获得成功,重复率１００％,分型结果经标准ＤＮＡ验证和美国加州大学配     

Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized

BackgroundThe clinical syndrome of frailty identified through the assessment of weight loss, gait speed, grip strength, physical activity, and physical exhaustion has been used to identify patients with reduced reserves. We hypothesized that frailty is useful in predicting adverse outcomes in optimized elective elderly colorectal surgery patients.MethodsA prospective study was conducted at 2 centers (Singapore and Japan). All patients over 75 years of age undergoing colorectal resection were assessed for the presence of the syndrome of frailty. All these patients had already had their comorbidities optimized for surgery. The outcome measure was postoperative major complications (defined as Clavien-Dindo type II and above complications).ResultsEighty-three patients were studied from February 2008 to April 2010. The mean age was 81.5 years (range 75–93 years). The mean comorbidity index was 3.37 (range 0–11). Twenty-six (31.3%) patients were an American Society of Anesthesiologists (ASA) score of 3 and above. Chi-square analysis revealed that the odds ratio of postoperative major complications was 4.083 (95% confidence interval, 1.433–11.638) when the patient satisfied the criteria for frailty. Albumin <35, ASA >3, comorbidity index >5, and Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scores were not predictive of postoperative major complications.ConclusionsPreliminary findings show that frailty is a potent adjunctive tool of predicting postoperative morbidity. Frailty can be used to identify elderly patients needing further optimization before major surgery.     

Closed‐loop double‐vasopressor automated system to treat hypotension during spinal anaesthesia for caesarean section: a preliminary study

Hypotension occurs in most caesarean sections under spinal anaesthesia, necessitating vasopressor administration. However, the optimal dosing regimen remains unclear. We have developed a novel vasopressor delivery system that automatically administers phenylephrine or ephedrine based on continuous non‐invasive blood pressure monitoring. This prospective cohort study recruited 55 healthy women under standardised spinal anaesthesia with 2.2 ml hyperbaric bupivacaine 0.5%, 15 μg fentanyl and 100 μg morphine. A 50‐μg phenylephrine bolus was given at 1‐min intervals when systolic blood pressure fell below 90% of baseline, and a 4‐mg ephedrine bolus was given when hypotension developed with bradycardia (heart rate <60 beats.min^?1). Systolic blood pressure was within 20% of baseline in 88% of all measurements. Six patients (11%) had one or more measurements above 120% of baseline (1% of all measurements), whereas 36 (65%) had at least one reading below 80% of baseline (11% of total measurements). The system maintained systolic blood pressure at a mean (SD) of ?9.1 (7.0)% below baseline, with 5.4 (2.5)% fluctuation. Two patients (4%) experienced pre‐delivery nausea. All 5‐min Apgar scores were 9.     

The pre‐emptive analgesic effect of a cyclooxygenase‐2 inhibitor in a rat model of acute postoperative pain

We examined the pre‐emptive analgesic effect of a cyclooxygenase (COX)‐2 inhibitor in a rat surgical pain model and characterised the changes in cutaneous COX‐2 around a surgical site. Thermal hyperalgesia and mechanical allodynia were tested in the rats for three days after incision and skin tissues were collected for analysis of COX‐2. There was decreased expression of cutaneous COX‐2 one day after surgical incision. Pre‐incision injection of the COX‐2 inhibitor significantly inhibited expression of COX‐2 and also reduced thermal hyperalgesia (but not mechanical allodynia) compared with the post‐incision COX‐2‐inhibitor injection group, one day after incision.     

区域性大型活动卫生保障二次供水风险评价指标及模型的建立

目的探讨区域性大型活动卫生保障二次供水风险评价指标,建立风险评价模型,为区域性大型活动接待单位的事先遴选和开展二次供水卫生保障工作提供科学依据。方法采用Delphi专家咨询法方法研究确定二次供水风险评价指标体系及其权重;采用综合指数法建立线形风险评价模型。结果 30名咨询专家的平均专业工作经历为20.63±5.80年,两轮的应答率均为100%,权威系数分别为0.86±0.06、0.89±0.06,Kendall协调系数分别为0.761(X2=292.348,P<0.01),0.906(X2=363.588,P<0.01),经卡方检验均具有统计学意义;确定了区域性大型活动卫生保障二次供水风险评价的一级指标3项、二级指标10项,以及各项指标的权重,其中一级指标卫生管理、设施管理、水质管理的平均权重分别为2.02、3.94和4.04;建立了线形风险评价模型。结论区域性大型活动卫生保障二次供水线形风险评价模型的建立可为二次供水卫生保障工作提供科学依据,具有推广应用价值。