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2.
Anon Chotirosniramit Akkaphod Liwattanakun Sunhawit Junrungsee Wasana Ko-iam Trichak Sandhu Worakitti Lapisatepun 《肝胆外科与营养》2020,9(6):729
BackgroundHepatocellular carcinoma (HCC) presenting with macroscopic bile duct tumor thrombus (BDTT) is an uncommon event. The role of a curative hepatic resection and associated long-term outcomes remain controversial. In addition the necessity for bile duct resection is still unclear. The aim of this study was to evaluate outcomes of hepatectomy with a selective bile duct preservation approach for HCC with BDTT in comparison to outcomes without BDTT.MethodsA total of 22 HCC with BDTT patients who had undergone curative hepatic resection with a selective bile duct preservation approach at our institute were retrospectively reviewed. These were compared to group of 145 HCC without BDTT patients. The impact of curative surgical resection and BDTT on clinical outcomes and survival after surgical resection were analyzed.ResultsAll HCC with BDTT cases underwent major hepatectomy vs. 32.4% in the comparative group. Bile duct preservation rate was 56.5%. The 1-, 3- and 5-year survival rates of HCC with BDTT patients in comparison to the HCC without BDTT group were 81.8%, 52.8% and 52.8% vs. 73.6%, 55.6% and 40.7% (P=0.804) respectively. Positive resection margin, tumor size ≥5 cm and AFP ≥200 IU/mL were significant risk factors regarding overall survival. However, it is unclear whether presence of a bile duct tumor thrombus has an adverse impact on either recurrence free survival or overall survival.ConclusionsBile duct obstruction from tumor thrombus did not necessarily indicate an advanced form of disease. Tumor size and AFP had greater impact on long-term outcomes than bile duct tumor thrombus. Major liver resection with a selective bile duct preserving approach in HCC with BDTT can achieve favorable outcomes comparable to those of HCC without BDTT in selected patients. 相似文献
3.
Disthabanchong S Domrongkitchaiporn S Sirikulchayanonta V Stitchantrakul W Karnsombut P Rajatanavin R 《BONE》2004,35(3):604-613
Our previous report on bone histomorphometry in patients with distal renal tubular acidosis (dRTA) revealed decreased bone formation rate (BFR) when compared to healthy subjects. The abnormality improved significantly after alkaline therapy. The modest increase in osteoblastic surface, after correction of metabolic acidosis, could not explain the striking improvement in bone formation, suggesting additional influence of metabolic acidosis on osteoblast function and/or bone matrix mineralization. Osteoblasts and, to a lesser extent, osteoclasts synthesize and secrete bone matrix including type I collagen and various noncollagenous proteins (NCPs). Substantial evidence suggested diverse functions of NCPs related to bone formation, resorption, and mineralization. Metabolic acidosis, through its effect on bone cells, may result in an alteration in the production of NCPs. Our study examined bone histomorphometry with detailed analysis on the mineralization parameters and NCPs expression within the bone matrix of patients with dRTA before and after treatment with alkaline. Seven dRTA patients underwent bone biopsy at their initial diagnosis and again 12 months after alkaline therapy. Bone mineral density (BMD) and bone histomorphometry were obtained at baseline and after the treatment. The expression of NCPs was examined by immunohistochemistry, quantitated by digital image analysis, and reported as a percentage of area of positive staining or mineralized trabecular bone area. Alkaline therapy normalized the low serum phosphate and PTH during acidosis. The reduction in BMD at baseline improved significantly by the treatment. Bone histomorphometry demonstrated the increase in osteoid surface and volume without significant alteration after acidosis correction. In comparison to the normal subjects, osteoid thickness was slightly but insignificantly elevated. Osteoblast and osteoclast populations and their activities were suppressed. The reduction in mineral apposition rate and adjusted apposition rate were observed in conjunction with the prolongation of mineralization lag time. Alkaline therapy improved the mineralization parameters considerably. In addition to the increase in BFR relative osteoblast number after acidosis correction, osteocalcin expression in the bone matrix increased significantly from 16.7% to 22.3%. Six of seven patients had decreased osteopontin expression. In conclusion, the abnormal bone remodeling in dRTA is characterized by low turnover bone disease with some degree of defective mineralization. Alteration of NCPs expression suggested the effect of metabolic acidosis on bone cells. Alkaline therapy increased bone mass through the restoration of bone mineral balance and, perhaps, improved osteoblast function. 相似文献
4.
Risk of Calcium Oxalate Nephrolithiasis after Calcium or Combined Calcium and Calcitriol Supplementation in Postmenopausal Women 总被引:2,自引:0,他引:2
S. Domrongkitchaiporn B. Ongphiphadhanakul W. Stitchantrakul N. Piaseu S. Chansirikarn G. Puavilai R. Rajatanavin 《Osteoporosis international》2000,11(6):486-492
Although calcium supplementation can cause hypercalciuria, the risk of nephrolithiasis has been shown to decrease rather
than increase among subjects who had a higher calcium intake. Hypercalciuria is also a well-established side effect of calcitriol
administration. However, the risk of nephrolithiasis is not well defined. The present study was undertaken to prospectively
determine the effect of calcium with or without calcitriol on physicochemical risk factors associated with calcium oxalate
nephrolithiasis in Thai postmenopausal women with osteoporosis. Subjects consisted of 53 Thai women more than 10 years postmenopausal
who were randomly allocated to receive 750 mg of calcium carbonate supplement alone (n= 28) or 750 mg of calcium carbonate plus 0.5 mg calcitriol (n= 25) daily. Mean ± SEM for age was 65.3 ± 1.1 years, body weight 53.5 ± 1.3 kg. Urine samples for biochemical assays were
collected at baseline and 3 months after treatment. Supersaturation for calcium oxalate stone formation was assessed from
the 24 h urine constituents by the Tiselius’s index, AP(CaOx). Three months of calcium supplement alone resulted in a modest,
but not significant, increase in urinary calcium (baseline, 2.90 ± 0.43 mmol/day; after treatment 3.58 ± 0.54 mmol/day) with
no change in urinary oxalate, citrate or magnesium. In contrast, calcium together with calcitriol caused a significant increase
in urinary calcium (baseline, 2.87 ± 0.41 mmol/day; after treatment, 4.08 ± 0.57 mmol/day; p<0.05). No significant change in other urine constituents after treatment with calcium and calcitriol was detected. Therefore,
AP(CaOx) did not significantly increase either after calcium alone (baseline, 1.17 ± 0.39; after treatment, 1.36 ± 0.28) or
after calcium plus calcitriol (baseline, 1.09 ± 0.17; after treatment, 1.09 ± 0.19). However, after treatments, 12 subjects
(23%) – 6 receiving calcium supplement alone and 6 receiving calcium plus calcitriol supplement – had high AP(CaOx) values
(greater than the upper limit of 95% CI for AP(CaOx) derived from non-stone-forming Thai women). The post-treatment/baseline
ratio was 3.21 ± 0.74 for urinary calcium, 1.01 ± 0.19 for urinary oxalate, and 2.23 ± 0.42 (median 1.15) for AP(CaOx). The
post-treatment/baseline ratio of calcium, but not for urinary oxalate, had a significant correlation with the post-treatment/baseline
ratio of AP(CaOx). Our findings suggest that the alteration in the risk of calcium oxalate nephrolithiasis based on urinary
composition is related to the alteration in urinary calcium. The risk of calcium oxalate nephrolithiasis does not increase
significantly after calcium or combined calcium and calcitriol supplement in the majority of postmenopausal women with osteoporosis.
Received: 10 March 1999 / Accepted: 16 November 1999 相似文献
5.
Sandhu T Yamada S Ariyakachon V Chakrabandhu T Chongruksut W Ko-iam W 《Surgical endoscopy》2009,23(5):1044-1047
Background Post-laparoscopic pain syndrome is well recognized and characterized by abdominal and particularly shoulder tip pain; it occurs
frequently following laparoscopic cholecystectomy. The etiology of post-laparoscopic pain can be classified into three aspects:
visceral, incision, and shoulder. The origin of shoulder pain is only partly understood, but it is commonly assumed that the
cause is overstretching of the diaphragmatic muscle fibers owing to a high rate of insufflations. This study aimed to compare
the frequency and intensity of shoulder tip pain between low-pressure (7 mmHg) and standard-pressure (14 mmHg) in a prospective
randomized clinical trial.
Methods One hundred and forty consecutive patients undergoing elective laparoscopic cholecystectomy were randomized prospectively
to either high- or low-pressure pneumoperitoneum and blinded by research nurses who assessed the patients during the postoperative
period. The statistical analysis included sex, mean age, weight, American Society of Anesthesiologists (ASA) grade, operative
time, complication rate, duration of surgery, conversion rate, postoperative pain by using visual analogue scale, number of
analgesic injections, incidence and severity of shoulder tip pain, and postoperative hospital stay. p < 0.05 was considered indicative of significance.
Results The characteristics of the patients were similar in the two groups except for the predominance of males in the standard-pressure
group (controls). The procedure was successful in 68 of 70 patients in the low-pressure group compared with in 70 patients
in the standard group. Operative time, number of analgesic injections, visual analogue score, and length of postoperative
days were similar in both groups. Incidence of shoulder tip pain was higher in the standard-pressure group, but not statistically
significantly so (27.9% versus 44.3%) (p = 0.100).
Conclusions Low-pressure pneumoperitoneum tended to be better than standard-pressure pneumoperitoneum in terms of lower incidence of shoulder
tip pain, but this difference did not reach statistical significance following elective laparoscopic cholecystectomy. 相似文献
6.
7.
Kongmee M Boonyuan W Achee NL Prabaripai A Lerdthusnee K Chareonviriyaphap T 《Journal of the American Mosquito Control Association》2012,28(1):20-29
Feeding responses of Anopheles harrisoni and An. minimus were evaluated following exposure to 2 pyrethroid insecticides, bifenthrin or deltamethrin, using an excito-repellency test system in the presence and absence of live host cues. The results demonstrated that contact irritancy was the primary action of bifenthrin or deltamethrin in both mosquito species. There was no noncontact repellency effect elicited by either insecticide. Anopheles minimus showed rapid escape response with high mortality rates following direct contact with deltamethrin in the absence of a host and delayed escape responses when a host was present. Similarly, exposure of An. minimus to bifenthrin also elicited a delayed escape response in the presence of a host but with lower mortality rates. In experiments using An. harrisoni, the presence or absence of a host had no significant effect on behavioral responses to either insecticide (P > 0.05). We conclude that deltamethrin elicited stronger irritant chemical effects than bifenthrin but that behavioral responses in vector populations are dampened in the presence of an available host. This information is useful for estimating probability of pathogen transmission when using irritant chemicals in proximity to a blood-meal source. 相似文献
8.
Prasitsuebsai W Cressey TR Capparelli E Vanprapar N Lapphra K Chokephaibulkit K 《The Pediatric infectious disease journal》2012,31(4):389-391
We assessed the pharmacokinetics of nevirapine in HIV and tuberculosis-coinfected children while they were receiving nevirapine-containing fixed-dose combination tablets with rifampicin-based tuberculosis treatment and after discontinuation. The median age (range) was 9.7 (4.4-11.7) years. The nevirapine area under the concentration versus time curve from 0 to 12 hours and trough concentration with rifampicin were 85.3 (40.5-170.7) mg.h/mL and 6.4 (3.00-13.27) mg/mL, respectively, providing adequate exposure. 相似文献
9.
10.
Bunupuradah T Ananworanich J Pancharoen C Petoumenos K Prasitsuebsai W Wongngam W Ubolyam S Sriheara C Lange J Phanuphak P Puthanakit T 《Vaccine》2011,29(16):2962-2967
HIV infected individuals have poorer response to hepatitis B vaccine (HBV) compared to normal host. Intradermal administration (ID) facilitates the exposure of antigen to antigen-presenting cells compared to intramuscular administration (IM).HIV-infected children aged 1-18 years with CD4% ≥ 15% or 200 cells/mm3 who had negative HBs Ag, antiHBs, and antiHBc were randomized to receive 3-dose of HBV via ID (2 μg/dose) or IM (10 μg/dose) route at months 0, 2, and 6. AntiHBs titers were measured at months 2, 6 and 7 after first HBV. AntiHBs ≥ 10 mIU/mL was considered protective and AntiHBs > 100 mIU/mL was considered good response.Participants included 41 in ID and 39 in IM arms. 64% had completed 3-doses HBV during infancy. The mean (SD) of age, nadir CD4% and current CD4% were 12 (3.3) years, 10.6 (7.9)% and 28 (8.0)% respectively. 91% were on HAART and 84% had undetectable HIV-RNA.Proportion of children with protective antiHBs in ID vs. IM group were 19.5% vs. 25.6% at month 2, 56.1% vs. 76.9% at month 6, and 90.2% vs. 92.3% at month 7 (NS, all). The geometric mean (95% confidence interval) of antiHBs titer in ID vs. IM group were 112.5 (34.4-367.6) vs. 141.2 (49.4-404.1) mIU/mL at month 2 (p = 0.74), 70.4 (39.8-124.4) vs. 132.1 (79.4-219.8) mIU/mL at month 6 (p = 0.10), and 157.0 (103.0-239.3) vs. 458.9 (324.0-647.0) mIU/mL at month 7 (p < 0.001). However, only 56.1% of the ID arm had good response to HBV compared to 82.1% in the IM arm (p = 0.01). The predictors for being a good responder to HBV were IM administration [OR 4.0, 95%CI 1.4-11.8, p = 0.012] and body weight <35 kg at baseline [OR 3.8, 95%CI 1.3-10.8, p = 0.013]. No adverse events grade 3/4 occurred.In conclusion, HIV-infected children without severe immune suppression, both ID and IM routes of HBV resulted in similar rates of protective antibody titers. However, high antibody titers to HBV were more common with IM; therefore, IM administration is preferred. 相似文献