Tumor Size Does Not Independently Affect Long-Term Survival after Curative Resection of Solitary Hepatocellular Carcinoma Without Macroscopic Vascular Invasion

Objective

The aim of this study was to investigate the prognostic value of tumor size alone on long-term survival and recurrence after curative resection for solitary hepatocellular carcinoma (HCC) without macroscopic vascular invasion.

Methods

A single-center cohort of 615 patients with solitary HCC (a single tumor, without macroscopic vascular invasion or distant metastasis) undergoing curative hepatic resection from 2002 to 2010 was retrospectively studied. Using 2.0, 3.0, 4.0, 5.0, 8.0, and 10.0 cm as cut-off values of tumor size, the overall survival (OS) and recurrence-free survival (RFS) rates were compared between the groups of patients with tumor size up to a certain cut-off value and the groups of patients with tumor size above that cut-off value. Thus, multiple comparisons were done. The prognostic factors of OS and RFS were evaluated using univariate and multivariate analyses.

Results

The median tumor size of all HCCs was 4.0 cm (range 0.9–22.0 cm). The in-hospital mortality rate was 1.0 %, and the overall morbidity rate was 22.3 %. The 1-, 3-, and 5-year OS rates were 96.0, 79.8, and 69.9 %, and the corresponding RFS rates were 83.6, 72.7, and 57.2 %, respectively. On univariate analyses, the 1-, 3-, and 5-year OS and RFS rates were significantly different between the individual two groups of patients as divided by the aforementioned different cut-off values of tumor sizes (all p < 0.05). However, when tumor size was put as a continuous variable into multivariate analysis, it was no longer an independent prognostic factor of OS or RFS after curative resection.

Conclusions

Tumor size did not independently affect long-term survival and recurrence after curative resection of solitary HCC without macroscopic vascular invasion. Therefore, there is no size limit that precludes hepatic resection for solitary HCC, provided the tumor is resectable.     

Establishing a central zone in scaphoid surgery: a computational approach

Purpose

Scaphoid fractures are commonly fixed with headless cannulated screws positioned centrally in the scaphoid. Judgement of central placement of the screw may be difficult. We generated a central zone using computer analysis of 3D reconstructions of computed tomography (CT) images. As long as the screw axis is completely contained within this central zone, the screw would be considered as centrally placed.

Methods

Thirty cases of 3D CT reconstructions of normal scaphoids in a computerised operation planning and simulation system (Vxwork software) were obtained. The central zone was established after some distance shrinkage of the original scaphoid surface reconstruction model using the function “erode” in the software. The shape of the central zone was evaluated, and the width of the central zone in the proximal pole, waist portion and distal pole was measured. We also established the long axis of the scaphoid to see whether it stays in the central zone.

Results

All central zones could be divided into distal, waist and proximal portions according to the corresponding irregular shape of the scaphoid. As the geometry of the central zone was so irregular and its width very narrow, it was possible to completely contain the screw axis either in the proximal portion alone, waist alone or distal central zone alone.

Conclusions

Establishing the central zone of scaphoid 3D CT images provided a baseline for discussion of central placement of a scaphoid screw. The geometry of the scaphoid central zone determined that the screw could hardly be inserted through entire scaphoid central area during surgery.     

Effects of aescin on testicular repairment in rats with experimentally induced varicocele

This study was conducted to investigate the effects of aescin treatment in a rodent model treated with an experimentally induced varicocele. Experimental varicocele was induced by partial ligation of the left renal vein of rats. Aescin administration was performed daily for 4 weeks after the varicocele induction. Seven weeks later, a contrast‐enhanced ultrasound was performed of the rats' testis to assess testicular blood flow. The animals were sacrificed, and H&E staining was then used to evaluate testicular pathological changes and polymorphonuclear leucocytes density. Cauda epididymal sperm counts and motility were evaluated. Blood was collected for the measurement of follicle‐stimulating hormone, luteinising hormone and testosterone. Contrast‐enhanced ultrasound showed that there were significant decreases in testicular blood flow in the aescin‐treated groups compared with those in control varicocele group. Testicular oedema was detected in those rats treated with a varicocele but without aescin, while no oedema was found in the experimental group. H&E staining showed dysfunctional spermatogenesis in both cohorts; however, polymorphonuclear leucocytes density was significantly reduced in aescin‐treated groups. There was an increase in sperm counts of the aescin‐treated groups. Our study demonstrated that aescin could exert therapeutical effects on reversal of testicular lesions in varicocele rats.     

New bone formation enhanced by ADSCs overexpressing hRunx2 during mandibular distraction osteogenesis in osteoporotic rabbits

Promoting new bone formation during distraction osteogenesis (DO) in elderly patients with osteoporosis is still a challenge. In this study, we investigated the effect of gene therapy using local Runt‐related gene 2 on new bone formation during osteoporotic mandibular DO in rabbits. First, we successfully established a mandibular osteoporotic animal model by ovariectomizing rabbits. Second, the right mandibles of the osteoporotic rabbits were distracted after corticotomy. The distraction gap of the rabbits in Group A2 and B2 were injected with Adv‐hRunx2‐GFP‐transfected adipose‐derived stromal cells (ADSCs) and Adv‐GFP‐transfected ADSCs, respectively. Rabbits in Groups C2 (ovariectomized control) and D2 (sham surgery control) were injected with physiologic saline. New‐generation bone tissue in the distraction gap was analyzed via plain radiographic examinations, micro‐computed tomography, histological examinations, and biomechanical testing at weeks 3, 6, and 9 of the consolidation period. Results of above examinations showed that no ideal new bone formation was observed in Groups B2 and C2, but obvious ideal new bone formation was observed in Group A2 and D2. The results suggested that gene therapy using rhRunx2‐modified ADSCs promoted new bone formation during osteoporotic mandibular DO and effectively compensated for the detrimental effects of systemic osteoporosis on new bone formation. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:709–720, 2014.     

Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a randomized clinical trial

Objective

To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP), for treatment of benign prostatic hyperplasia (BPH).

Methods

A total of 164 cases of BPH were selected from patients who were hospitalized between January 2010 and December 2011. Patients had received either HoLEP or TURP treatment. Clinical data were collected from the perioperative period, 1 month after surgery, and 12 months after surgery.

Results

There was no significant difference between the two groups in the maximum urinary flow rate (Q _max), postvoid residual volume (PVR), international prostate symptom score (IPSS), or quality-of-life score (QOL score) at 1 month after surgery (p = 0.56, p = 0.346, p = 0.536 and p = 0.145, respectively). However, after 12 months, patients from the HoLEP group demonstrated better scores in Q _max, PVR, IPSS, and QOL than those from the TURP group (p = 0.037, p = 0.003, p < 0.001 and p = 0.019, respectively). The two groups had comparable operation time (p = 0.105), catheterization time (p = 0.173), and length of hospital stay (p = 0.395), but were statistically different in the weight of resected prostate tissue (p < 0.001), bladder irrigation time (p < 0.001), hemoglobin levels (p = 0.011), and blood sodium levels (p = 0.002) after surgery.

Conclusions

Compared to TURP, HoLEP was safer and had better long-term efficacy as assessed by multiple quantitative measures. Therefore, HoLEP may present a better option in the treatment of BPH.     

非酒精性脂肪性肝病联合用药临床研究进展

非酒精性脂肪性肝病（NAFLD）是临床上最常见的慢性肝病,全球发病率约为25%,NAFLD可进展为肝纤维化、肝硬化和肝细胞癌,严重威胁人类健康。目前我国尚未批准任何治疗药物上市,新药研发迫在眉睫。NAFLD发病机制复杂,单一用药很难取得好的疗效。几种不同作用机制的药物联合使用是未来治疗NAFLD的必然趋势。通过联合用药可能降低药物的不良反应,发挥协同作用产生更好的疗效。本文综述了NAFLD联合用药的最新临床研究进展,以期为后续NAFLD新药开发和临床合理用药提供参考。     

Robotic Versus Laparoscopic Colorectal Surgery

Background:

Robotic approaches have become increasingly used for colorectal surgery. The aim of this study is to examine the safety and efficacy of robotic colorectal procedures in an adult population.

Study Design:

A systematic review of articles in both PubMed and Embase comparing laparoscopic and robotic colorectal procedures was performed. Clinical trials and observational studies in an adult population were included. Approaches were evaluated in terms of operative time, length of stay, estimated blood loss, number of lymph nodes harvested, and perioperative complications. Mean net differences and odds ratios were calculated to examine treatment effect of each group.

Results:

Two hundred eighteen articles were identified, and 17 met the inclusion criteria, representing 4,342 patients: 920 robotic and 3,422 in the laparoscopic group. Operative time for the robotic approach was 38.849 minutes longer (95% confidence interval: 17.944 to 59.755). The robotic group had lower estimated blood loss (14.17 mL; 95% confidence interval: –27.63 to –1.60), and patients were 1.78 times more likely to be converted to an open procedure (95% confidence interval: 1.24 to 2.55). There was no difference between groups with respect to number of lymph nodes harvested, length of stay, readmission rate, or perioperative complication rate.

Conclusions:

The robotic approach to colorectal surgery is as safe and efficacious as conventional laparoscopic surgery. However, it is associated with longer operative time and an increased rate of conversion to laparotomy. Further prospective randomized controlled trials are warranted to examine the cost-effectiveness of robotic colorectal surgery before it can be adopted as the new standard of care.     

Major Hepatectomy Is a Safe Modality for the Treatment of Intrahepatic Cholangiocarcinoma in Selected Patients Complicated with Cirrhosis

Objective

The objective of this paper is to evaluate the perioperative outcomes of major hepatectomy for intrahepatic cholangiocarcinoma (ICC) in patients with cirrhosis.

Methods

We retrospectively evaluated the preoperative, intraoperative, and postoperative findings in 42 consecutive patients with cirrhosis and in 102 patients with normal livers who underwent major hepatectomy for ICC.

Results

Preoperative liver function was worse in patients with cirrhosis compared to patients without cirrhosis. Cirrhotic patients had significantly higher intraoperative blood loss, longer operation time, and longer hospital stay than non-cirrhotic patients. However, the two groups had similar overall morbidity and hospital mortality rates and similar rates of liver failure or other complications. Their R0 resection rates, resection margin widths and disease-free survival rates were also similar.

Conclusions

Major hepatectomy for ICC can be performed in selected cirrhotic patients with acceptable morbidity and mortality rates, as compared to patients without cirrhosis.