Sirolimus-Based Immunosuppression Therapy in Liver Transplantation for Patients With Hepatocellular Carcinoma Exceeding the Milan Criteria

Aim

Sirolimus (SRL) acts as a primary immunosuppressant or antitumor agent. The aim of the present study was to evaluate the influence of SRL on the recurrence rate and survival of patients after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) exceeding the Milan criteria.

Materials and Methods

We retrospectively examined 73 consecutive patients who underwent OLT for HCC exceeding the Milan criteria from March 2004 through December 2005. Among them, 27 patients were treated with SRL-based immunosuppressive protocols after OLT, and 46 patients by an FK506-based protocol. Statistical analysis was based on the intent-to-treat method.

Results

The 2 groups were comparable in all clinicopathologic parameters. The mean overall survival was 594 ± 35 days in the SRL group and 480 ± 42 days in the FK506 group (P = .011); the mean disease-free survival period was 519 ± 43 days in the SRL group and 477 ± 48 days in the FK506 group (P = .234). Multivariate analysis revealed Child's status (P = .004) and immunosuppressive protocol (P = .015) were the significant factors affecting overall survival. Only microvascular invasion (P = .004) was significantly associated with disease-free survival. Among 24 surviving patient in the SRL group, 2 patients had SRL discontinued for toxicity; 10 had SRL monotherapy immunosuppression.

Conclusion

The SRL-based immunosuppressive protocol improved the overall survival of patients after OLT for HCC exceeding the Milan criteria, probably by postponing recurrence and with better tolerability.     

“过渡钉”复位在Sextant经皮椎弓根螺钉治疗胸腰椎骨折中的应用

目的探讨"过渡钉"复位在Sextant经皮椎弓根螺钉治疗胸腰椎骨折中的临床效果。方法回顾分析2011年3月—2012年7月手术治疗的67例无神经症状胸腰椎骨折患者,其中,Sextant经皮椎弓根螺钉治疗35例(A组),Sextant经皮椎弓根螺钉联合"过渡钉"复位治疗32例(B组)。纳入标准:椎管占位但无神经症状,无需减压的胸腰椎骨折。分别比较两组的手术时间、术中出血量、术后引流量、切口长度、手术前后疼痛视觉模拟评分(VAS),以及术前、术后1周、术后1年骨折椎体前缘压缩程度和后凸Cobb角改善情况。结果所有患者随访12~26个月,平均14个月。Sextant经皮椎弓根螺钉联合"过渡钉"复位治疗胸腰椎骨折较传统Sextant经皮椎弓根螺钉组在手术时间、术中出血量、术后引流量、切口长度、术后3个月VAS评分无统计学意义(P>0.05);而在骨折椎体前缘压缩程度以及后凸Cobb角改善情况有统计学意义(P<0.05)。结论与单纯Sextant经皮椎弓根螺钉技术相比,Sextant经皮椎弓根螺钉联合"过渡钉"复位治疗胸腰椎骨折具有出血少、手术时间短、恢复快等优点,尤其对伤椎畸形矫正较传统Sextant经皮椎弓根螺钉优势明显。     

68Ga标记的SSR靶向多肽PET/CT显像的研究进展及其在神经内分泌肿瘤中的初步应用

近年来,68Ga标记的多肽PET/CT显像为神经内分泌肿瘤（NET）的诊断提供了新的方法和视角。68Ge/68Ga发生器已经商业化,容易获得,并且68Ga标记过程简单方便,显像剂稳定性好。在此基础上,越来越多的研究比较了68Ga标记的多肽PET/CT与传统的形态学显像方法（CT、MRI）及生长抑素受体扫描对NET病灶的诊断效能,发现68Ga标记的多肽PET/CT远远优于后者。此外,68Ga标记的多肽PET/CT显像还能为患者治疗方案的选择、辐射剂量的调整甚至预后效果的评估提供多种重要信息,其有望成为NET患者肿瘤显像的临床首选。笔者就近年来68Ga标记的多肽PET/CT显像在临床上的初步应用研究作一综述。     

持续床旁血液净化联合削痂治疗重度烧伤并发ARF

目的观察持续床旁血液净化联合早期削痂植皮对重度烧伤并发急性肾功能衰竭(ARF)的治疗疗效。方法以我院2011年1月~2013年12月收治的23例重度烧伤并发ARF患者为研究对象,入院后给予积极补液抗休克、纠正电解质紊乱、抗感染、早期削痂植皮及持续床旁静脉-静脉血液透析滤过等综合治疗。检测患者治疗前,治疗后1、3、7、14、21 d血生化指标、炎症因子的变化及治疗疗效。结果治疗后3 d开始,患者Hb、WBC、Scr、ALT、AST、血钾、TNF-α及IL-6与治疗前相比明显降低,尿量明显增多(P<0.05);治疗后7 d开始,BUN及m ALB与治疗前相比也明显降低(P<0.05),IL-10与治疗前相比明显增高(P<0.05)。所有患者经过积极综合治疗无死亡病例,早期削痂植皮存活率为(96.1±3.8)%,患者住院时间(31.5±8.2)d。治疗后5~20 d进入多尿期,平均(10.2±5.0)d,肾功能均恢复正常。结论持续床旁血液净化联合早期削痂植皮等综合治疗,可有效纠正重度烧伤并发ARF患者的内环境紊乱,恢复肾功能,临床疗效确切。     

CT技术诊断下肢动脉硬化闭塞症的应用进展

CT血管成像技术(CTA)在下肢动脉硬化闭塞症诊断中的应用日益广泛。该技术相对其他方法来说具有无创、简便等明显优势。数字减影血管造影以往被认为是诊断动脉硬化性疾病的唯一可靠方法, 而目前CTA技术对这个老的“金标准”提出了挑战。多源CT的应用使全动脉树形结构的无创成像成为可能, 该技术的优化令动脉硬化性疾病的诊断更加精准。对比剂的应用和仪器参数的优化, 使CTA检查的照射剂量明显降低。今后, 随着CT技术的快速发展, CTA技术必将成为诊断下肢动脉闭塞疾病的理想方法。     

3.0 T磁共振T2弛豫时间图技术在评估兔坐骨神经放射性损伤的价值

目的探讨使用磁共振T₂弛豫时间图（T₂ mapping）技术评估兔坐骨神经放射性损伤的可行性和准确性。方法选取21只新西兰大白兔,随机选取一侧后肢坐骨神经行单次立体定向照射,照射剂量35 Gy,照射中心位于神经层面距腓肠肌后缘3 cm,照射野直径1 cm,照射体积约0.79 cm³,对侧为对照侧。所有兔于照射前、照射后1 d、1个月、2个月、3个月、4个月评价肢体功能变化,并行T₂多回波及T₂WI/SPIR序列扫描。扫描完成后于上述各时间点随机处死2只兔,取照射段坐骨神经行电镜检查。结果照射后1 d,照射段神经T₂值明显升高,神经肿胀、T₂WI/SPIR信号稍增高;照射后1个月T₂值较1 d降低,接近正常水平,T₂WI/SPIR上信号未见升高;照射后2个月起T₂值进行性升高,并至4个月达高峰,T₂WI/SPIR上2个月起神经及周围肌间隙出现小片长T₂信号影,3、4个月异常信号逐渐加重并出现条索状短T₂信号影。结论 T₂值能较好地反映周围神经放射性损伤的急性改变,但它对于评价放射性损伤时神经的细微改变可能并不敏感。     

Novel SLA-DQ alleles and their recombinant molecules in xenogeneic stimulation of human T cells

MHC class II antigens DR and DQ are essential for graft rejection both in allo- and xeno-transplantation. The antigens, especially the DQA and DQB gene-coencoded DQ molecules, are also involved in transplantation tolerance induced by activation of regulatory T cells. Here we report six novel DQ alleles from three properly inbred Chinese pig strains Gz, Bm and Yn. In our study, cDNA of swine leukocyte antigen (SLA)-DQA and -DQB were amplified by RT-PCR and sequenced for each strain. The ORF-containing SLA-DQA and -DQB genes are composed of 768 (or 765) and 786 nucleotides, encoding antigen molecules of 255 (or 254) and 261 amino acid residues, respectively. Sequences of both SLA-DQA and -DQB alleles showed disparities when compared either among the three pig strains or with available SLA data, which allows our novel alleles receiving their accession numbers from GenBank. The sequence analysis further revealed a phylogenic connection of our SLA-DQ alleles with SLA-DQ(c) haplotype. In addition, the homologies of MHC DQ or DQ-like molecules between Chinese pigs (SLA) and human (HLA) are higher than those between pigs and mice (H-2). By co-transfection of Bm pig DQA and DQB genes into L929 cells, the Bm-DQ heterodimer-expressed cells could effectively stimulate the human lymphoproliferation in presence of human APCs with a mean stimulation index (SI) 9.9+/-1.4. This functional assay indicated that our recombinant DQ antigens are capable of initiating human lymphoproliferation in a xeno-MLR.     

Reliability of classification systems for intertrochanteric fractures of the proximal femur in experienced orthopaedic surgeons

INTRODUCTION: The aim of this study was to determine the reliability of currently used classification systems for intertrochanteric fractures of the proximal femur, and to determine the reliability of these systems in experienced orthopaedic surgeons. MATERIALS AND METHODS: Forty intertrochanteric fractures of the proximal femur were classified independently by five experienced observers using the AO, Evans, Kyle, and Boyd classification systems on two separate occasions 3 months apart. The interobserver and intraobserver variation was assessed using kappa statistics. RESULTS: The level of agreement for classification into AO groups was almost perfect or substantial, and higher than other classification systems. When the fractures were further classified using the AO classification with subgroups, reliability became worse. CONCLUSIONS: The current study suggests that the AO classification system with groups can be used more reliably to measure intertrochanteric fractures of the proximal femur than Evans, Kyle, and Boyd classification systems. However, the reliability of the AO classification with subgroups is not satisfactory.     

Clinical experience and results of lumbar microendoscopic discectomy: a study with a five‐year follow‐up

Objective: To investigate the efficacy of microendoscopic discectomy (MED) for the treatment of lumbar disc herniation over a five‐year follow‐up period. Methods: Between January 2000 and December 2002, 275 patients were accepted for MED in our hospital. A retrospective review was carried out on 151 of these cases with a mean of five years follow‐up. The study helped us to assess the efficacy of this technique in the treatment of lumbar disc diseases. Modified MacNab criteria were used to assess the clinical outcome, and the disc‐height ratio was assessed radiographically according to the Mochida's method. Results: According to the modified MacNab criteria, 78.8% of patients were rated as excellent, 13.2% as good, 4.6% as fair, and 3.3% as poor. Complications included five revision surgeries due to recurrence of herniation, five dural lacerations during operation, and three cases of vertebral/disc infection. The average disc‐height ratio was 76.25%. Approximately 57% of the patients maintained their primary engagement. Conclusion: MED is both feasible and efficacious for the management of lumbar disc disease. On the basis of the present study it is concluded that MED is better than open discectomy (OD).