Solitary cavities of the lung: diagnostic implications of cavity wall thickness

Sixty-five solitary cavities of the lung were evaluated for wall thickness. All lesions in which the thickest part of the cavity wall was 1 mm were benign. Of the lesions whose thickest measurement was 4 mm or less, 92% were benign. Of cavities that were 5-15 mm in their thickest part, 51% were benign and 49% malignant. Of those over 15 mm thick, 95% were malignant. Measurement of the thickest part of te cavity wall gives a more reliable indication of benignancy or malignancy than measurement of the thinnest part.     

Single-Incision Laparoscopic Common Bile Duct Exploration with Conventional Instruments: an Innovative Technique and a Comparative Study

Background

Single-incision laparoscopic surgery developed rapidly in recent years. We introduce an innovative technique: single-incision laparoscopic common bile duct exploration (SILCBDE) with conventional instruments. A retrospective comparison between SILCBDE and standard laparoscopic common bile duct exploration (LCBDE) was analyzed.

Methods

Thirty-four patients who underwent LCBDE for choledocholithiasis in a period of 17 months were enrolled. Seventeen standard LCBDEs and 17 SILCBDEs were attempted. Simultaneous cholecystectomies were performed.

Results

The stone clearance rate was 94.1 % (16 patients) in the standard LCBDE group and 100 % in the SILCBDE group. There was no statistical difference in demographic distribution, clinical presentations, and operative results between the two groups, except the SILCBDE group had a higher rate of acute cholecystitis than the standard LCBDE group (76.5 vs. 35.3 %; p?<?0.05). One procedure (5.9 %) in the SILCBDE group was converted to a four-incision transcystic LCBDE. The complication rate was 11.8 % (two patients) in the standard LCBDE group and 5.9 % (one patient) in the SILCBDE group. The average follow-up period was 4.2 months.

Conclusion

SILCBDE is as safe and efficacious as standard LCBDE in experienced hands. Choledochoscope manipulation and bile duct repair are the key skills. Long-term follow-up and further prospective randomized trials are anticipated.     

The impact of spleen volume on the survival of metastatic pancreatic adenocarcinoma patients receiving nanoliposomal irinotecan

Nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil and leucovorin (NalFL) comprises the current standard for gemcitabine-failed metastatic pancreatic ductal adenocarcinoma (PDAC). As liposomes generally accumulate in the spleen, we evaluated the impact of spleen volume on prognosis. We enrolled patients with metastatic PDAC who failed gemcitabine-based therapy and were initiated on NalFL between August 2018 and November 2020. The spleen volume before NalFL administration was evaluated. They were stratified into dose subgroups (i.e. low, < 48 mg/m²; intermediate, 48 - < 64 mg/m²; high, ≥ 64 mg/m²) by the average nal-IRI dose during the entire treatment, and multivariate analysis of overall survival (OS) was performed. We included 547 patients with a median age of 63 years (range, 27-89 years) and a median of 1 (range, 0-7) palliative chemotherapy regimen. The median spleen volume was 245 mL (range, 82-817 mL). Among patients with splenomegaly (≥ 245 mL), the low-dose subgroup had the worst median time to treatment failure (TTF, 1.8 months vs. 2.5 months vs. 2.5 months, P = 0.020) and OS (3.3 months vs. 5.9 months vs. 6.6 months, P = 0.018) as against no prognostic impact in patients without splenomegaly. In the multivariate analysis of patients with splenomegaly, performance status (PS) ≥ 2, body surface area (BSA) < 1.6 m², prior fluoropyrimidine use, liver metastasis, and low-dose subgroup were independent poor prognostic factors. A low average nal-IRI dose was significantly associated with poor prognosis, especially among patients with splenomegaly. Further pharmacological studies should validate the relevance of spleen volume on the treatment outcomes of nal-IRI.     

Neuroprotective action of lithium in disorders of the central nervous system

Substantial in vitro and in vivo evidence of neurotrophic and neuroprotective effects of lithium suggests that it may also have considerable potential for the treatment of neurodegenerative conditions.Lithium's main mechanisms of action appear to stem from its ability to inhibit glycogen synthase kinase-3 activity and also to induce signaling mediated by brain-derived neurotrophic factor.This in turn alters a wide variety of downstream effectors,with the ultimate effect of enhancing pathways to cell surviva...     

Effect of IL-6 C-572G polymorphism on idiopathic membranous nephropathy risk in a Han Chinese population

Membranous glomerulonephritis (MGN) is viewed as an immune-mediated glomerular disease, with immunologic expression occurring in genetically susceptible persons. The cytokine interleukin-6 (IL-6) gene polymorphism is known to impair intracellular signaling pathways following adaptive immune response. Our study gauged the effects of IL-6 C-572G (rs1800796) single nucleotide polymorphism (SNP) on MGN among Taiwan's Han Chinese population, as analyzed in 265 controls and 106 MGN patients. Genotyping for IL-6 C-572G SNP was performed by restriction fragment length polymorphism assay. Data showed stark differences in genotype and allele frequency distributions at IL-6 C-572G SNP between MGN patients and controls (p = 1.6E-04 and 1.7E-04, respectively). People with C allele or with CC genotype at IL-6 C-572G SNP showed higher risk of MGN (odds ratio = 2.42 and 2.71, respectively; 95% confidence interval = 1.51-3.87 and 1.60-4.60, respectively). These point to IL-6 C-572G polymorphism as the underlying cause of MGN; polymorphism merits further investigation.     

Ⅰ、Ⅱ级肝门区域阻断肝叶(段)切除的初步体会

目的 总结区域阻断肝叶、肝段的入肝血管分支,施行各种类型肝切除的经验.方法 回顾性分析2006年～2007年间湖南省人民医院肝胆科行肝门区域血管阻断肝部分切除的319例临床资料.左肝外叶切除127例,左半肝切除(含Ⅰ段切除)89例,右肝前叶切除15例,右肝后叶切除34例,右半肝切除(含Ⅸ段切除)32例,肝血管瘤剥除/肝局部切除19例,肝囊肿剥除/肝局部切除3例.结果 全组无手术死亡,失血量平均(70±15)mL,术后5～7 d复查肝功能无明显损害,未出现肝坏死、胆漏、出血等并发症.结论 区域血管阻断肝叶(段)切除避免了保留肝叶的缺血再灌注损伤,使手术从容不迫的进行,减少了大量失血及肝功能衰竭的发生,是一种安全、有效的切肝手术方法.     

Oxidation Behavior Characterization of Zircaloy-4 Cladding with Different Hydrogen Concentrations at 500–800 °C in an Ambient Atmosphere

This study simulated the after-burned zirconium cladding oxidation in air at temperatures between 500 and 800 °C. The weight changes of Zircaloy-4 cladding with hydrogen contents of 100–1000 ppm continuously measured through thermogravimetric analysis (TGA) during oxidation tests at different temperatures in an air atmosphere. The TGA results indicate a transition of oxidation kinetics from a parabolic rate law to a linear rate law for as-received and hydrided Zircaloy-4 cladding. The hydrogen concentration of Zircaloy-4 had a marked effect on its pre-transition oxidation in air between 500 and 800 °C. For all samples, the linear oxidation (post transition stage) at 650 °C, which is the critical oxidation temperature, displays a similar trend. In addition, scanning electron microscopy and transmission electron micros-copy examinations indicated the presence of a few and numerous discontinuous micro-cracks in the oxide layer in the pre-transition and post-transition stages, respectively.     

Growth rate of asymptomatic hepatocellular carcinoma and its clinical implications

The growth rate of 31 asymptomatic hepatocellular carcinomas (diameter less than or equal to 5 cm) discovered in 28 patients by a prospective screening program was determined by real-time ultrasonography over 36-860 days. Except for one tumor that shrank on follow-up, the doubling time ranged from 29 to 398 days, with a median of 117 days, an arithmetic mean of 136 days, and a geometric mean of 110 days. In 17 tumors with more than two measurements, the growth rate remained exponential in nine, declined in growth in seven, and showed an initial lag period in one. Doubling time correlated with initial tumor diameter but was independent of the patient's age, sex, hepatitis B surface antigen status, tumor location, liver function tests, stage of liver cirrhosis, histologic type, or grade of malignancy. Although initial alpha-fetoprotein levels did not correlate well with growth rate, in 14 patients with an exponential increase of serum alpha-fetoprotein, the alpha-fetoprotein doubling time was closely related to the tumor doubling time. Based on the above data, the median detectable subclinical period of hepatocellular carcinoma was deduced to be 3.2 yr, and the suitable screening interval for its early detection in our area was 4-5 mo.     

Ondansetron versus placebo for the control of nausea and vomiting during Caesarean section under spinal anaesthesia

This prospective, randomised, placebo-controlled, double-blind study was performed to evaluate the effects of ondansetron on nausea and vomiting during elective Caesarean section under spinal anaesthesia. Seventy-four full-term parturients were studied. After umbilical-cord clamping, ondansetron 4 mg or 0.9% saline was injected intravenously and the study period continued for 2 h. The severity of nausea was graded from 0 = none to 10 = maximum, while that of vomiting was graded from single = once per min to continuous = multiple per min. The incidence of vomiting was lower following ondansetron (36%) compared with the control group (58%, p < 0.028). Neither the severity of vomiting nor the incidence of nausea was influenced by ondansetron. However, for those who experienced nausea, ondansetron reduced its severity (p = 0.05). We conclude that the intra-operative administration of 4 mg ondansetron intravenously during Caesarean section under spinal anaesthesia significantly reduces the incidence of vomiting and the severity of nausea.