I125 irradiation stent for treatment of hepatocellular carcinoma with portal vein thrombosis: A meta-analysis

PurposeA meta-analysis aimed to systematically evaluate the safety and efficiency of I¹²⁵ irradiation stent placement for patients with hepatocellular carcinoma (HCC) combined with portal vein tumor thrombosis (PVTT).Materials and methodsThe Cochrane library, PubMed/Medline, EMBASE, CNKI, Wanfang Data and CQVIP were systematically screened out from the earliest to December 2019. The qualities of all included studies were assessed. The primary endpoints were the 6-month, 12-month stent cumulative patency rate and 6-month, 12-month, 24-month overall survival rate while the secondary endpoints were the objective response rate of PVTT, main portal venous pressure changes and treatment-related adverse events. Our meta-analysis was conducted using Stata 12.0 software.ResultsTotally seven studies with 1018 patients were included in the final analysis, in which 602 patients received TACE and I¹²⁵ irradiation stent placement, and 416 patients in control group underwent TACE and stent placement without endovascular brachytherapy (EVBT). Meta-analysis showed that the I¹²⁵ irradiation stent improved the cumulative stent patency rates in 6 months [OR = 1.65, 95% CI (1.32–2.05), P < 0.001] and 12 months [OR = 2.55, 95% CI (1.90–3.42), P < 0.001] and the survival rates in 6 months [OR = 1.77, 95% CI (1.41–2.22), P < 0.001], 12 months [OR = 3.14, 95% CI (2.24–4.40), P < 0.001] and 24 months [OR = 7.39, 95% CI (3.55–15.41), P < 0.001]. However, there was no difference in the objective response rate of PVTT [OR = 1.13, 95% CI (0.87–1.48), P = 0.365], main portal venous pressure and the occurrence adverse event [OR = 0.88, CI = 0.72–1.08, P = 0.212] between two groups.ConclusionI¹²⁵ irradiation stent seems to be more effective in treating hepatocellular carcinoma with portal vein tumor thrombosis. The usage of portal vein stent combined endovascular brachytherapy has the potential to act as an alternative therapy for HCC with PVTT. On account of the limitation of studies included, more studies with high-level evidence, such as RCTs, are requisite to support the above promising results.     

Immediate implant placement and provisionalisation in the aesthetic zone

The aim of this retrospective study was to assess the outcome of immediate single‐tooth implant placement and provisionalisation in the aesthetic zone regarding hard and soft peri‐implant tissue parameters and patient‐related outcome measures in a private practice. All consecutively treated patients with single‐tooth immediate implant placement and provisionalisation between the period 1 January 2006 and 1 April 2013 in a referral practice in Amsterdam, the Netherlands, were included in the study. Fifty‐one patients of a total of 64 could be examined at follow‐up (T_follow‐up). Radiographs were present from implant placement (T_placement), after definitive crown placement (T_definitive), and new radiographs were taken at the follow‐up appointment (T_follow‐up). Next to this, soft tissue parameters, patients’ satisfaction and professionals’ aesthetic scores were measured at T_follow‐up. Implant survival was 96·9% after a mean follow‐up period of 4 years following implant placement. At definitive crown placement, mean marginal bone‐level loss was 0·25 mm (SD 0·19). Mean marginal bone‐level loss following definitive crown placement was 0·06 mm (SD 0·10) (T_definitive to T_follow‐up) after a mean follow‐up period of 4 years. Plaque index, bleeding index and gingival index scores were low. Patients’ satisfaction was rated very high: 9·0 (SD 0·7). Professionals aesthetic score was 16·49 (SD 1·86). From this study can be concluded that immediate placement of implants followed by immediate provisionalisation resulted in a high survival rate, minimum peri‐implant bone loss, very good aesthetics and satisfied patients after a mean follow‐up period of 4 years.     

Participatory action research: Involving students in parent education

Competition for scarce clinical placements has increased requiring new and innovative models to be developed to meet the growing need. A participatory action research project was used to provide a community nursing clinical experience of involvement in parent education. Nine Hong Kong nursing students self-selected to participate in the project to implement a parenting program called Parenting Young Children in a Digital World. Three project cycles were used: needs identification, skills development and program implementation. Students were fully involved in each cycle's planning, action and reflection phase. Qualitative and quantitative data were collected to inform the project. The overall outcome of the project was the provision of a rich and viable clinical placement experience that created significant learning opportunities for the students and researchers. This paper will explore the student's participation in this PAR project as an innovative clinical practice opportunity.     

Minimizing Ports During Robotic Partial Nephrectomy

Methods:Data on 11 robot-assisted laparoscopic partial nephrectomies performed by using our technique from February 2015 through June 2015 were retrospectively analyzed. The robotic platform used was DaVinci Xi (Intuitive Surgical, Inc., Sunnyvale, California, USA) with a 3-arm setup. The AirSeal system (SurgiQuest, Milford, Connecticut, USA) was used as a port allowing simultaneous introduction of 2 instruments for the bedside surgeon, obviating the need for an additional (fourth) robotic arm. A long suction-and-irrigation device and atraumatic grasping forceps were used. Both instruments were introduced through the trocar of the AirSeal system, making simultaneous introduction and use possible. We preferred the long suction-and-irrigation device, because it minimizes collision of the instruments.Results:Mean age and BMI of the patients were 55 ±14.6 y and 29.18 ± 6.85, respectively. Seven tumors were on the right side and 4 were on the left. The mean size of the tumors was 32.45 mm (± 11.31). Surgical time was 132.2 minutes (±37.17), with an estimated blood loss and ischemia time of 103.63 mL (±65.92) and 16.72 minutes (±9.52), respectively. One patient had postoperative bleeding that was resolved without transfusion. The median hospitalization period was 3.9 d (±0.53). Loss of intra-abdominal pressure was not observed, and pressure was stable at 10 mm Hg.Conclusion:The AirSeal System and its valveless trocar eliminated the need for an additional port placement in our series. The technique is feasible, safe, and reproducible; therefore, it may be implemented in selected cases of robot-assisted partial nephrectomies.     

Le Rotablator : un outil d’angioplastie indispensable

Rotational atherectomy is the treatment of choice for calcified coronary lesions. It should not be used routinely but only in some appropriate cases, especially when the successful deployment of a stent may be uncertain. Complications are rare but serious. Several cases of “off label” use, however, have been reported in the literature without additional complications.