Mg alloys have mechanical properties compatible with human bones.However,their rapid degradation and associated foreign body reactions in vivo significantly limit their application for human implants.In this study,thr...Mg alloys have mechanical properties compatible with human bones.However,their rapid degradation and associated foreign body reactions in vivo significantly limit their application for human implants.In this study,three differently processed Mg alloys,pure Mg(PM),cold extruded Mg alloy AZ31(CE AZ31),and fully annealed AZ31 Mg alloy(FA AZ31)were comparatively investigated for their potential as implants using a rat model.All three implanted Mg alloys do not show any impact on hepato-and renal function,nor any signs of observable changes to vital organs.Proteomics analysis of tissues directly contacting the implants 2.5 months post implantation revealed that FA AZ31 activates very few inflammation and immune associated signaling pathways;while the CE AZ31 and PM produce more significant inflammatory responses as confirmed by cytokine array analyses.Further,FA AZ31 activated pathways for cell organization and development that may improve the recovery of injured tissues.Structurally,EBSD analysis reveals that the FA AZ31 alloy has a higher ratio of first-order pyramidal orientated(10–11){10–1–2}grain texture with a value of 0.25,while PM and CE AZ31 alloys have lower ratios of first-order pyramidal orientated texture with the values of 0.16 and 0.17,respectively.This is associated with recovery and recrystallisation during annealing which promotes grain texture which exhibits enhanced degradation behaviours and induces a more limited immune response in vivo.In conclusion,the FA AZ31 demonstrated better biocompatibility and corrosion resistance and is a promising candidate for metal-based degradable implants which warrants further investigation.展开更多
Portal vein tumor thrombosis(PVTT) is a common phenomenon in hepatocellular carcinoma(HCC). Compared to HCC without PVTT, HCC with PVTT is characterized by an aggressive disease course, worse hepatic function, a highe...Portal vein tumor thrombosis(PVTT) is a common phenomenon in hepatocellular carcinoma(HCC). Compared to HCC without PVTT, HCC with PVTT is characterized by an aggressive disease course, worse hepatic function, a higher chance of complications related to portal hypertension and poorer tolerance to treatment. Conventionally, HCC with PVTT is grouped together with metastatic HCC during the planning of its management, and most patients are offered palliative treatment with sorafenib or other systemic agents. As a result, most data on the management of HCC with PVTT comes from subgroup analyses or retrospective series. In the past few years, there have been several updates on management of HCC with PVTT. First, it is evident that HCC with PVTT consists of heterogeneous subgroups with different prognoses. Different classifications have been proposed to stage the degree of portal vein invasion/thrombosis, suggesting that different treatment modalities may be individualized to patients with different risks. Second, more studies indicate that more aggressive treatment, including surgical resection or locoregional treatment, may benefit select HCC patients with PVTT. In this review, we aim to discussthe recent conceptual changes and summarize the data on the management of HCC with PVTT.展开更多
AIM:To evaluate the adequacy of surgical treatment of T2 gallbladder carcinoma(GBCa)according to tumor spread in the subserosal layer. METHODS:A series of 84 patients with GBCa were treated at Saga University Hospital...AIM:To evaluate the adequacy of surgical treatment of T2 gallbladder carcinoma(GBCa)according to tumor spread in the subserosal layer. METHODS:A series of 84 patients with GBCa were treated at Saga University Hospital,Japan between April 1989 and October 2008.The tumor stage was graded according to the TNM staging for GBCa from the American Joint Committee on Cancer Manual 6th edition. Tumor staging revealed 30 patients with T2 tumors.T2 GBCa was divided into three groups histologically by the extent of tumor spread in the subserosal layer,using a score of ss minimum(ss min),ss medium(ss med)or ss massive(ss mas). RESULTS:For ss min GBCa,there was no positive pathological factor and patient survival was satisfactory with simple cholecystectomy,with or without extra-he- patic bile duct resection.For ss med GBCa,some pathological factors,h-inf(hepatic infiltration),ly(lymphatic invasion)and n(lymph node metastasis),were positive. For ss mas GBCa,there was a high incidence of positive pathological factors.The patient group with extra-hepatic bile duct resection with D2 lymph node dissection (BDR with D2)and those with S4a5 hepatectomy had significantly better survival rates.CONCLUSION:We suggest that radical surgery is not necessary for ss min GBCa,and partial hepatectomy and BDR are necessary for both ss med and ss mas GBCa.展开更多
Inflammatory bowel disease(IBD)includes Crohn’s disease(CD),ulcerative colitis and unclassified entities.CD commonly involves the terminal ileum and colon but at the time of diagnosis it can be confined to the small ...Inflammatory bowel disease(IBD)includes Crohn’s disease(CD),ulcerative colitis and unclassified entities.CD commonly involves the terminal ileum and colon but at the time of diagnosis it can be confined to the small bowel(SB)in about 30%of the patients,especially in the young ones.Management of isolated SB-CD can be challenging and objective evaluation of the SB mucosa is essential in differentiating CD from other enteropathies to achieve therapeutic decisions and to plan the follow-up.The introduction of cross-sectional imaging techniques and capsule endoscopy(CE)have significantly expanded the ability to diagnose SB diseases providing a non-invasive test for the visualization of the entire SB mucosa.The main CE limitations are the low specificity,the lack of therapeutic capabilities and the impossibility to take biopsies.Device assisted enteroscopy(DAE)enables histological confirmation when traditional endoscopy,capsule endoscopy and cross-sectional imaging are inconclusive and also allows therapeutic interventions such as balloon stricture dilation,intralesional steroid injection,capsule retrieval and more recently stent insertion.In the current review we will discuss technical aspect,indications and safety profile of DAE in children and adults with IBD.展开更多
Background:Although several prediction models for the occurrence of postoperative pancreatic fistula(POPF)after pancreatoduodenectomy(PD)exist,all were established using Western cohorts.Large-scale external validation...Background:Although several prediction models for the occurrence of postoperative pancreatic fistula(POPF)after pancreatoduodenectomy(PD)exist,all were established using Western cohorts.Large-scale external validation studies in Eastern cohorts that consider demographic variables including lower body mass index(BMI)are scarce.The purpose of this study was to externally validate POPF prediction models using nationwide large-scale Korean cohorts.Methods:Nine tertiary university hospitals in the Republic of Korea participated.Patients'preoperative characteristics,intraoperative factors,and pathologic findings were evaluated.POPF grades were determined according to the 2016 International Study Group on Pancreatic Surgery definition.Three POPF risk models(Callery,Roberts,and Mungroop)were selected for external validation.Results:A total of 1,898 PD patients were enrolled.A non-pancreatic disease diagnosis[hazard ratio(HR),1.856;95%confidence interval(CI),1.223–2.817;P=0.004),higher preoperative BMI(HR,1.069;95%CI,1.019–1.121;P=0.006),and soft pancreatic texture(HR,1.859;95%CI,1.264–2.735;P=0.002)were independent risk factors for clinically relevant POPF(CR-POPF).The area under the receiver operating characteristic curve(AUC)values were 0.61,0.64,and 0.63 on the Callery,Roberts,and Mungroop models,respectively;all were lower than those published in each external validation study.Conclusions:Western POPF prediction models performed less well when applied to Korean cohorts.Thus,a large-scale Eastern-specific and externally validated POPF prediction model is needed.展开更多
基金supported in part by JSPS research grant(No.P16718)Natural Science Foundation of Guangdong Province(No.2020A1515010855)+2 种基金National Science Foundation of China(31971355)Genecology MCR Seed Funding of University of the Sunshine CoastDeng Feng Project of Foshan First People’s Hospital(2019A008)。
文摘Mg alloys have mechanical properties compatible with human bones.However,their rapid degradation and associated foreign body reactions in vivo significantly limit their application for human implants.In this study,three differently processed Mg alloys,pure Mg(PM),cold extruded Mg alloy AZ31(CE AZ31),and fully annealed AZ31 Mg alloy(FA AZ31)were comparatively investigated for their potential as implants using a rat model.All three implanted Mg alloys do not show any impact on hepato-and renal function,nor any signs of observable changes to vital organs.Proteomics analysis of tissues directly contacting the implants 2.5 months post implantation revealed that FA AZ31 activates very few inflammation and immune associated signaling pathways;while the CE AZ31 and PM produce more significant inflammatory responses as confirmed by cytokine array analyses.Further,FA AZ31 activated pathways for cell organization and development that may improve the recovery of injured tissues.Structurally,EBSD analysis reveals that the FA AZ31 alloy has a higher ratio of first-order pyramidal orientated(10–11){10–1–2}grain texture with a value of 0.25,while PM and CE AZ31 alloys have lower ratios of first-order pyramidal orientated texture with the values of 0.16 and 0.17,respectively.This is associated with recovery and recrystallisation during annealing which promotes grain texture which exhibits enhanced degradation behaviours and induces a more limited immune response in vivo.In conclusion,the FA AZ31 demonstrated better biocompatibility and corrosion resistance and is a promising candidate for metal-based degradable implants which warrants further investigation.
基金Supported by the Hong Kong Research Grants Council General Research Fund Scheme,No.462013
文摘Portal vein tumor thrombosis(PVTT) is a common phenomenon in hepatocellular carcinoma(HCC). Compared to HCC without PVTT, HCC with PVTT is characterized by an aggressive disease course, worse hepatic function, a higher chance of complications related to portal hypertension and poorer tolerance to treatment. Conventionally, HCC with PVTT is grouped together with metastatic HCC during the planning of its management, and most patients are offered palliative treatment with sorafenib or other systemic agents. As a result, most data on the management of HCC with PVTT comes from subgroup analyses or retrospective series. In the past few years, there have been several updates on management of HCC with PVTT. First, it is evident that HCC with PVTT consists of heterogeneous subgroups with different prognoses. Different classifications have been proposed to stage the degree of portal vein invasion/thrombosis, suggesting that different treatment modalities may be individualized to patients with different risks. Second, more studies indicate that more aggressive treatment, including surgical resection or locoregional treatment, may benefit select HCC patients with PVTT. In this review, we aim to discussthe recent conceptual changes and summarize the data on the management of HCC with PVTT.
文摘AIM:To evaluate the adequacy of surgical treatment of T2 gallbladder carcinoma(GBCa)according to tumor spread in the subserosal layer. METHODS:A series of 84 patients with GBCa were treated at Saga University Hospital,Japan between April 1989 and October 2008.The tumor stage was graded according to the TNM staging for GBCa from the American Joint Committee on Cancer Manual 6th edition. Tumor staging revealed 30 patients with T2 tumors.T2 GBCa was divided into three groups histologically by the extent of tumor spread in the subserosal layer,using a score of ss minimum(ss min),ss medium(ss med)or ss massive(ss mas). RESULTS:For ss min GBCa,there was no positive pathological factor and patient survival was satisfactory with simple cholecystectomy,with or without extra-he- patic bile duct resection.For ss med GBCa,some pathological factors,h-inf(hepatic infiltration),ly(lymphatic invasion)and n(lymph node metastasis),were positive. For ss mas GBCa,there was a high incidence of positive pathological factors.The patient group with extra-hepatic bile duct resection with D2 lymph node dissection (BDR with D2)and those with S4a5 hepatectomy had significantly better survival rates.CONCLUSION:We suggest that radical surgery is not necessary for ss min GBCa,and partial hepatectomy and BDR are necessary for both ss med and ss mas GBCa.
文摘Inflammatory bowel disease(IBD)includes Crohn’s disease(CD),ulcerative colitis and unclassified entities.CD commonly involves the terminal ileum and colon but at the time of diagnosis it can be confined to the small bowel(SB)in about 30%of the patients,especially in the young ones.Management of isolated SB-CD can be challenging and objective evaluation of the SB mucosa is essential in differentiating CD from other enteropathies to achieve therapeutic decisions and to plan the follow-up.The introduction of cross-sectional imaging techniques and capsule endoscopy(CE)have significantly expanded the ability to diagnose SB diseases providing a non-invasive test for the visualization of the entire SB mucosa.The main CE limitations are the low specificity,the lack of therapeutic capabilities and the impossibility to take biopsies.Device assisted enteroscopy(DAE)enables histological confirmation when traditional endoscopy,capsule endoscopy and cross-sectional imaging are inconclusive and also allows therapeutic interventions such as balloon stricture dilation,intralesional steroid injection,capsule retrieval and more recently stent insertion.In the current review we will discuss technical aspect,indications and safety profile of DAE in children and adults with IBD.
基金This study was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institutefunded by the Ministry of Health&Welfare,Republic of Korea(grant number:HI16C2037)by the Collaborative Genome Program for Fostering New Post-Genome Industry of the National Research Foundation funded by the Ministry of Science and ICT(NRF-2017M3C9A5031591).
文摘Background:Although several prediction models for the occurrence of postoperative pancreatic fistula(POPF)after pancreatoduodenectomy(PD)exist,all were established using Western cohorts.Large-scale external validation studies in Eastern cohorts that consider demographic variables including lower body mass index(BMI)are scarce.The purpose of this study was to externally validate POPF prediction models using nationwide large-scale Korean cohorts.Methods:Nine tertiary university hospitals in the Republic of Korea participated.Patients'preoperative characteristics,intraoperative factors,and pathologic findings were evaluated.POPF grades were determined according to the 2016 International Study Group on Pancreatic Surgery definition.Three POPF risk models(Callery,Roberts,and Mungroop)were selected for external validation.Results:A total of 1,898 PD patients were enrolled.A non-pancreatic disease diagnosis[hazard ratio(HR),1.856;95%confidence interval(CI),1.223–2.817;P=0.004),higher preoperative BMI(HR,1.069;95%CI,1.019–1.121;P=0.006),and soft pancreatic texture(HR,1.859;95%CI,1.264–2.735;P=0.002)were independent risk factors for clinically relevant POPF(CR-POPF).The area under the receiver operating characteristic curve(AUC)values were 0.61,0.64,and 0.63 on the Callery,Roberts,and Mungroop models,respectively;all were lower than those published in each external validation study.Conclusions:Western POPF prediction models performed less well when applied to Korean cohorts.Thus,a large-scale Eastern-specific and externally validated POPF prediction model is needed.
