Liver transplantation is an alternative treatment of hepatocellular carcinoma beyond the Milan criteria

Background

The decision to perform liver transplantation (LT) or liver resection (LR) for patients with hepatocellular carcinoma (HCC) who are beyond the Milan criteria remains controversial.

Methods

We retrospectively analyzed outcome data for 179 patients with HCC beyond the Milan criteria who were treated with LR (n = 135) or LT (n = 44). Univariate and multivariate Cox proportional hazard models were established. Kaplan-Meier survival curves were generated, and a log-rank test was performed to compare group survival status.

Results

Patients who underwent LR group were significantly older, had a lower TNM stage, and were more likely to have unilateral disease and noncirrhotic liver. Significantly more patients in the LR group had recurrence (53.3% vs 29.5%) or died (61.5% vs 43.2%) than patients in the LT group. Recurrence-free survival rates were 11.9% for the LR group and 61.5% for the LT group. The median overall survival duration showed no statistically difference between the LR group (28.0 months) and the LT group (50.0 months).

Conclusions

LT may be the better choice for patients with HCC beyond the Milan criteria.     

缺血性结肠炎的临床特征及转归

目的观察缺血性结肠炎（Ischemic colitis,IC）的临床特征及转归情况。方法回顾性分析39例IC患者的临床资料及内镜特征,并对其进行随访。结果 IC好发于中老年人,60岁以上患者占69.2%,多伴有相关基础疾病（82.1%,32/39）,包括高血压、心脑血管疾病及糖尿病等。临床主要表现为腹痛、便血等症状,病变多发生于左半结肠,呈节段性分布。多数患者预后良好,39例患者中5.1%（2/39）于住院期间死亡,1例患者于随访期间出现复发。结论结肠镜检查是诊断早期IC的主要方法,IC复发率低。     

Complex Pathophysiology of Abusive Head Trauma with Poor Neurological Outcome in Infants

Abusive head trauma (AHT) in infants, especially acute subdural hematoma, has an extremely poor outcome. The most decisive and important finding is the appearance of a widespread low-density area on head computed tomography. This phenomenon was traditionally thought to be caused by cerebral ischemia. However, many other pathophysiological abnormalities have been found to be intricately involved. Recent studies have found that status epilepticus and hyperperfusion injures are the major causes. Another serious problem associated with AHT is cardiopulmonary arrest (CPA). Many infants are reported to visit to the hospital with CPA, and its pathophysiology has not been fully elucidated. This paper examines the background of these pathological conditions and associated factors and elucidate the pathophysiological mechanisms resulting in poor outcomes in AHT. In addition to the intensity of assault on the head, the peculiar pathophysiological characteristics in infants, as well as the social background specific to child abuse, are found to be associated with poor outcome.     

广西汉族IL-10启动子区基因多态性与HBV易感性及感染转归的关系

目的探讨白细胞介素-10(IL-10)基因启动子区-592A/C、-1082G/A位点单核苷酸多态性与乙型肝炎病毒(HBV)易感性及后临床转归之间的关系。方法 256例慢性HBV感染者,其中乙型肝炎肝硬化59例,慢性乙型肝炎151例,慢性HBV携带46例,以52例健康体检者作为对照组。采用聚合酶链反应-限制性片段长度多态性分析(PCR-RFLP)技术,检测各组IL-10基因启动子区-592A/C、-1082G/A位点基因型及等位基因分布频率。结果肝硬化组、肝炎组、携带组与对照组的IL-10-592A/C位点AA、AC、CC基因型及A、C等位基因分布频率比较,差异均无统计学意义(P>0.05);IL-10-1082G/A位点GG、GA和AA基因型分布频率比较,差异有统计学意义(P<0.05),AA基因型频率分布依次为肝硬化组>肝炎组>携带组>对照组(P<0.05);各组IL-10-1082G/A位点G、A等位基因频率比较,差异有统计学意义(P<0.05),肝硬化组的A等位基因频率分布最高,其余依次为肝炎组、携带组及健康对照组(P<0.05)。不同HBV-DNA水平组的IL-10-592A/C、IL-10-1082G/A两位点基因型及等位基因分布频率比较,差异均无统计学意义(P>0.05)。结论IL-10-1082G/A位点AA基因型及A等位基因可能与广西汉族人群HBV易感性及其临床结局有关;而IL-10基因启动子区-592A/C、-1082G/A位点多态性可能与广西汉族人群感染HBV后的病毒复制水平无明显关系。     

159例前置胎盘妊娠结局的临床分析

目的探讨三种前置胎盘类型的病因、临床表现及妊娠结局。方法将10年间的159例前置胎盘按类型分为边缘性（80例）、部分性（32例）、完全性（47例）三组,并将临床资料进行回顾性比较分析。结果前置胎盘的发生率为1．98％,其中边缘性0．99％,部分性0．4％,完全性0．58％。高龄、多产、流产、剖宫产均为发生前置胎盘的高危因素,三组前置胎盘患者产前出血、输血、诊断孕周、分娩孕周、阴道分娩、早产、剖宫产率比较差异均有统计学显著意义（P〈0．05）;三组产后出血、失血性休克、切除子宫、急诊剖宫产、择期剖宫产、新生儿体重、窒息及围产儿死亡比较,差异均元统计学意义（P〉0．05）。完全性新生儿体重平均只有2470．2g。结论前置胎盘的临床表现、妊娠结局与其类型有关,完全性及部分性前置胎盘临床症状较重,母儿预后较差,早诊断、早治疗可降低并发症发生率。     

脑实质内神经鞘瘤并文献复习

目的初步探讨脑实质内神经鞘瘤发病机制,影像学表现,病理学特征,提高诊断率。方法通过对1例脑内神经鞘瘤,并结合文献复习进行分析。结果本例患者术前诊断胶质瘤,术中见肿瘤与脑组织无浸润,手术全切,术后病理及免疫组化证实为神经鞘瘤,痊愈后出院。结论脑实质内神经鞘瘤极为罕见,其发病性质不明,易误诊,确诊有赖于病理及免疫组化。     

The role of central venous pressure and type of vascular control in blood loss during major liver resections

BACKGROUND: Blood loss during liver resection constitutes the primary determinant of the postoperative outcome. Various techniques of vascular control and maintenance of a low central vein pressure (CVP) have been used in order to prevent intraoperative blood loss and postoperative complications. Our study aims at assessing the effects of different levels of CVP in relation to type of vascular control on perioperative blood loss and patient outcome. METHODS: The records of 102 consecutive patients who underwent a major hepatectomy were retrospectively analyzed. Forty-two patients were operated on with a CVP of 6 mm Hg or more and 60 patients had a CVP of 5 mm Hg or less. The Pringle maneuver was used in 45 patients and selective hepatic vascular exclusion (SHVE) in 57 patients. Blood loss, complications, and mortality were analyzed comparing the two CVP groups in relation to type of vascular control. RESULTS: The Pringle maneuver is associated with more blood loss when CVP is 6 mm Hg or more compared with CVP 5 mm Hg or less (1,250 mL [250 to 2,850] versus 780 mL [150 to 3,100]; P <0.05). Conversely, blood loss during SHVE is independent of the CVP levels. A significant difference in blood loss between the Pringle maneuver and SHVE was observed, only when CVP was 6 mm Hg or more (1,250 mL [250 to 2,850] versus 680 mL [150 to 1,260]; P <0.05). Hospital stay was also significantly longer in patients operated on with CVP 6 mm Hg or more (15 days [4 to 38] than in patients with CVP 5 mm Hg or less (10 days [4 to 32]; P <0.05). CONCLUSIONS: Elevated CVP during major liver resections results in greater blood loss and a longer hospital stay. The Pringle maneuver with CVP 5 mm Hg or less is associated with blood loss not significantly different from that with SHVE. The latter, though, has been shown not to be affected by CVP levels and should be used whenever CVP remains high despite adequate anesthetic management.     

足月儿和近足月儿的临床近期预后对比研究

目的 对比分析足月儿与近足月儿(34周≤胎龄<7周)近期预后情况. 方法 2005年8月-2008年7月我院出生足月儿25 212例和近足月儿1 075例,从中随机抽取足月儿180例和近足月儿130例,收集包括母亲的孕期并发症、分娩方式、羊水情况、新生儿出生体质量和阿普伽新生儿(Apgar)评分等临床资料,比较近足月儿和足月儿的临床近期预后(呼吸困难、体温不稳定、低血糖、黄疸、呼吸暂停及住院天数)有无差异. 结果 足月儿与近足月儿呼吸困难发生率(分别为13.9%与47.7%)、体温不稳定发生率(分别为5.6%与29.2%)、低血糖发生率(分别为5.0%与16.2%)、高胆红素血症发生率(分别为35.6%与58.5%)、呼吸暂停发生率(分别为1.1%与22.3%)比较,差异均有统计学意义(P<0.05).足月儿与近足月儿平均住院时间(分别为4与9 d)比较,差异有统计学意义(P<0.05). 结论 与足月儿相比,近足月儿临床近期并发症的发生率更高,住院时间长,近期预后较差,因此临床上需要对近足月儿的护理及治疗加以重视.     

Routine outcomes monitoring as part of children and young people's Improving Access to Psychological Therapies (CYP IAPT) – improving care or unhelpful burden?

This brief commentary article considers the implications of intensive outcome monitoring which is central to children and young people's Improving Access to Psychological Therapies (CYP IAPT) in England and Wales. Services are being provided with a range of free software solutions to enable data collection, and guidance on interpretation of the measures, but there will still be some burden of data entry and collation for already overstretched services. It may be that the utility of the feedback will go some way to offset the sense of burden but this remains to be seen. Whether commissioners and others will rise to the challenge of supporting this aspect may prove crucial to the success or otherwise of such intensive ROM use. Many aspects of the CYP IAPT approach are new and whilst drawing on experience from earlier pilots of session by session monitoring in CAMHS both in the UK and abroad, and from Adult IAPT, there is likely to be much for us to learn. Time will tell whether the approach helps to improve the care children and young people receive but we are cautiously optimistic.     

Do Poison Center Guidelines Adversely Affect Patient Outcomes as Triage Referral Values Increase?

Abstract

Background.?The purpose of this study was to determine whether patient outcomes were adversely affected as healthcare referral values increased for two common poisonings: acute, unintentional acetaminophen (APAP) poisonings and acute, unintentional iron (Fe) poisonings. We hypothesized that symptom rates would increase with high referral values. Methods.?Qualifying 1997 exposures were separated by substance (APAP or Fe) and then further stratified into three healthcare referral value ranges. Symptomatic and asymptomatic patients were totaled for each stratum. Expected vs. observed distributions of symptomatic and asymptomatic patients across triage referral strata for a given substance and treatment location were compared using chi‐square test for independence. The Wilcoxon–Mann–Whitney test was used to compare the distribution of patients across referral strata for home vs. healthcare facility locations for a specific substance. Results.?There were no statistically significant differences in the distribution of symptomatic patients within referral value strata for APAP or for Fe. There was also no difference in distribution of symptomatic patients across strata when comparing home vs. healthcare facility for APAP and Fe. Conclusion.?Referral values as high as 201 mg/kg for APAP and 61 mg/kg for Fe do not appear to adversely affect patient outcomes.