Extended criteria for living donor liver transplantation in patients with advanced hepatocellular carcinoma

Background

The purpose of this study was to evaluate the possibility of expanding the selection criteria in living donor liver transplantation (LDLT) to treat hepatocellular carcinoma (HCC).

Methods

From October 2000 to December 2010, we retrospectively analyzed 71 patients who had undergone LDLT beyond the Milan criteria (MC), among the entire cohort of 199 HCC patients. We evaluated the tumor biology as well as overall and disease-free survival (DFS), seeking to identify risk factors for recurrence. The median follow-up was 37 months (range 5-124).

Results

Among the 71 patients beyond the MC were 18 recurrences and 30 deaths. Their 5-year overall and DFS rates were 52.3% and 67.7%, respectively. On multivariate analysis, tumor diameter, tumor number, and E-S grade significantly influenced overall and DFS. According to our new criteria (size ≤7 cm, number ≤7), 86% of our patients would be included compared with 64% using MC. Five-year DFS and overall survival rates according to our criteria were comparable with the MC: 86.8% and 72.3% versus 86.8% and 73.4%, respectively.

Conclusion

Our criteria appear to achieve useful cut-off values beyond the MC.     

短信息在2型糖尿病患者健康教育中的应用

目的探讨短信息在糖尿病患者院外健康教育中的应用效果。方法将初次诊断为2型糖尿病的100例患者随机分为两组各50例,两组患者住院期间进行相同的健康教育,出院后对照组接受电话随访,观察组利用计算机网络发送已编辑好的相应内容进行健康教育与随访互动。于出院时、出院后1、3、6、12个月评价自我管理能力、代谢指标及血压。结果两组自我管理能力评分逐渐下降,观察组下降程度显著慢于对照组(均P<0.05);FBG、PBG 2h、HbA1c值及收缩压均呈逐渐升高趋势,观察组各项指标中除收缩压外均显著优于对照组(均P<0.05)。结论短信息随访用于患者出院后的连续性教育中,效果优于电话随访,有利于巩固住院的健康教育效果。     

Factors associated with non-orthotopic urinary diversion after radical cystectomy

Introduction

Preoperative factors favoring the performance of non-orthotopic bladder substitution (OBS) after radical cystectomy for muscle-invasive bladder cancer were identified.

Patients and methods

We retrospectively reviewed the medical records of 730 patients who underwent radical cystectomy for urothelial carcinoma of the bladder. After excluding 75 patients who were unable to undergo OBS due to the tumor location or elevated serum creatinine level, we assessed the preoperative factors in the remaining 655 patients. Multivariate logistic regression analysis was performed to identify the independent preoperative predictors of type of urinary diversion.

Results

Of the 655 patients, 171 (26.1%) underwent non-OBS. Patients who underwent non-OBS were more likely to be older and females, to have a lower educational status, non-organ confined disease, more comorbid medical conditions, more impaired performance status, lower body mass index, anemia, azotemia, and hypoalbuminemia, and to be treated by less-experienced surgeons (P?<?0.05 each). After adjusting for provider-based factors, multivariate analysis showed that factors independently associated with non-OBS included advanced age (odds ratio [OR] 4.10, P?<?0.001), female gender (OR 2.08, P?=?0.027), ECOG performance status (??1 vs 0, OR 5.20, P?<?0.001), low educational status (OR 1.59, P?=?0.042), clinically node-positive disease (OR 2.36, P?=?0.003), anemia (OR 1.67, P?=?0.041), azotemia (OR 3.97, P?<?0.001), and hypoalbuminemia (OR 1.84, P?=?0.046).

Conclusion

Several patient-based as well as provider-based factors were associated with the type of urinary diversion after radical cystectomy. Advanced age, female gender, low performance status, low education level, clinically node-positive disease, anemia, hypoalbuminemia, and azotemia were associated with non-OBS, as surgery was performed by relatively inexperienced surgeons.     

Treatment of diabetic foot ulcers using cultured allogeneic keratinocytes—A pilot study

Diabetic foot ulcers often pose a difficult treatment problem. Repeated applications of cell‐based products have been reported to result in acceleration of diabetic wound healing. The purpose of this clinical trial study was to report preliminary findings of the efficacy and safety of the cultured allogeneic keratinocyte sheets in the treatment of diabetic foot ulcers. Fifty‐nine patients with diabetic foot ulcers were randomized to either the keratinocyte treatment group (n = 27) or the control group treated with vaseline gauze (n = 32). Except for the application of keratinocytes, treatment of study ulcers was identical for patients in both groups. Either keratinocyte sheet or vaseline gauze was applied at the beginning of the study and weekly thereafter for a maximum of 11 weeks. The maximum follow‐up period for each patient was 12 weeks. Complete ulcer healing was achieved in 100% of the treatment group and 69% of the control group (p < 0.05). The Kaplan–Meier median times to complete closure were 35 and 57 days for the keratinocyte and control groups, respectively. No adverse events related to the treatment occurred. These results indicate that cultured allogeneic keratinocytes may offer a safe and effective treatment for diabetic foot ulcers.     

大鼠腓总神经“π”式桥接于胫神经后再生神经的电生理溯源

目的 研究大鼠胫神经原位桥接切断的腓总神经，观察腓总神经再生程度、神经纤维的来源等。方法 将断裂的腓总神经近端和远端分别就近与胫神经施行端侧吻合，存活18个月后，电生理检测再生神经纤维的动作电位传导，取腓总神经远段行光镜及电镜观察神经纤维再生数量及状态。结果 远段腓总神经有明显的神经纤维再生，远段腓总神经通过邻近神经的桥接与近段腓总神经之间有动作电位传导。结论 断裂腓总神经“π”式桥接于胫神经，部分再生神经纤维可能来源于原腓总神经近段，部分来自胫神经。     

Mortality,Morbidity, and Costs of Ruptured and Elective Abdominal Aortic Aneurysm Repairs in Nova Scotia,Canada

Ruptured abdominal aortic aneurysms (RAAA) have a 78-94% mortality rate. If cost-effectiveness of screening programs for abdominal aortic aneurysms (AAA) are to be assessed, direct costs for RAAA repairs and elective AAA (EAAA) repairs are required. This study reports mortality, morbidity, and direct costs for RAAA and EAAA repairs in Nova Scotia in 1997-1998 and also compares Nova Scotia and U.S. costs. We performed a retrospective study of 41 consecutive RAAA and 48 randomly selected EAAA patients. Average total costs for RAAA repair were significantly greater than those for EAAA repair (direct costs: $15,854 vs. $9673; direct plus overhead costs: $18,899 vs. $12,324 [pricing in 1998 Canadian dollars]). Intensive care unit length of stay and blood product usage were the most substantial direct cost differentials ($3593 and $2106). Direct cost for preoperative testing and surveillance was greater in the EAAA group ($839 vs. $33). Estimates of U.S. in-hospital RAAA and EAAA repair costs are more than 1.5 times Nova Scotia costs. Direct in-hospital RAAA repair costs are $6181 more than EAAA repair costs. These in-hospital cost data are key cost elements required to assess the cost-effectiveness of various screening strategies for earlier detection and monitoring of AAA within high-risk populations in Canada. Further studies are required to estimate cost per quality-adjusted-life-year gained for various AAA screening and monitoring strategies in Canada.     

A case of lung cancer with hypercalcemia which was incidentally complicated with primary hyperparathyroidism due to parathyroid adenoma.

In lung cancer patients, hypercalcemia is a fairly common metabolic problem associated with malignancy. However, the occurrence of hypercalcemia in lung cancer patients means an ominous prognostic sign. As hypercalcemia often causes early death, quick diagnosis and treatment for hypercalcemia are required. A 69-year-old woman was admitted to our hospital with anorexia caused by hypercalcemia. On admission, serum level of PTH was elevated and PTHrP was normal. From the results of CT findings and transbronchial lung biopsy, the cause of the hypercalcemia was determined as lung cancer incidentally complicated with primary hyperparathyroidism. First, serum calcium level was returned to normal through hydration with saline and bisphosphonates. Next, left hemithyroidectomy for primary hyperparathyroidism was performed. Histologically, the tumor was diagnosed as parathyroid adenoma. Fifteen days later, left lower lobectomy for primary lung cancer was performed under a video-assisted thoracoscopic approach. Histologically, the tumor was diagnosed as a moderately differentiated adenocarcinoma. Four years and three months after the operation, the patient is alive and well with no sign of recurrence. When a lung cancer patient is complicated with hypercalcemia, we need to consider that primary hyperparathyroidism is a possible cause of the hypercalcemia.     

Bridging mandibular continuity defects with miniplates: an experimental study.

Various miniplate fixation techniques were studied in dogs to determine whether the use of miniplate fixation provides sufficient stability in mandibular continuity defects. Continuity resections measuring 15 mm were made on the mandibles of 16 dogs and were bridged using 4 miniplate fixation techniques, each replicated 4 times. All dogs were placed on a normal diet throughout the postoperative period. Clinical and radiological examinations were carried out 6 weeks later. We found that the group with both double miniplates and bicortical screws was stable, whereas the groups utilizing either a single miniplate or monocortical screws were not. The results of this study indicate that using a combination of double miniplates and bicortical screws to bridge defects after mandibular resection produces stable and predictable results.     

关节镜在儿童髋关节疾患中的应用

目的探讨关节镜在诊断和治疗儿童髋关节疾患中的应用价值。方法对24例(36髋)儿童髋关节疾患进行关节镜手术。先天性髋关节脱位12例(20髋)在关节镜下行真臼清理、关节囊修整,直视下引导复位术;股骨头骨骺缺血性坏死8例(12髋)在关节镜监视下行钻孔减压和滑膜刨削清理术;化脓性髋关节炎4例(4髋)在关节镜下行清创、灌洗、引流术。结果所有病例均获随访,随访时间8~44个月。12例先天性髋关节脱位均获成功治疗,术后再脱位1例,经手法整复复位。无1例出现股骨头骨骺缺血性坏死、髋关节运动受限或关节僵硬等并发症。股骨头骨骺缺血性坏死和化脓性髋关节炎12例术后疼痛消失,关节活动范围恢复正常。结论关节镜对儿童髋关节疾患具有重要的诊断和治疗价值。     

ICU医护合作与护士职业获益感的相关性研究

目的调查ICU医护合作关系及ICU护士职业获益感,分析医护合作对护士职业获益感的影响。方法采用医护合作量表、护士职业获益感量表对230名ICU护士进行调查。结果医护合作量表总分为(90.60±14.48)分,条目均分为(3.62±0.58)分;护士职业获益感总分为(133.39±17.11)分,条目均分为(4.04±0.52)分。回归分析显示,护士和医生的关系、患者信息的交流能力及职称是护士职业获益感的主要影响因素(调整R2=0.428)。结论ICU医护合作和护士职业获益感较高,且医护合作是护士职业获益感的重要影响因素,管理者应重视医护合作关系的建设,提升护士的积极职业认知。