Use of an autologous liver round ligament flap zeros postoperative bile leak after curative resection of hilar cholangiocarcinoma.

BACKGROUND: Postoperative bile leak is a major surgical morbidity after curative resection with hepaticojejunostomy for hilar cholangiocarcinoma, especially in Bismuth-Corlette types III and IV. This retrospective study assessed the effectiveness and safety of an autologous hepatic round ligament flap (AHRLF) for reducing bile leak after hilar hepaticojejunostomy. METHODS: Nine type III and IV hilar cholangiocarcinoma patients were consecutively hospitalized for elective perihilar partial hepatectomy with hilar hepaticojejunostomy using an AHRLF between October 2009 and September 2013. The AHRLF was harvested to reinforce the perihilar hepaticojejunostomy. Main outcome measures included operative time, blood loss, postoperative recovery times, morbidity, bile leak, R0 resection rate, and overall survival. RESULTS: All patients underwent uneventful R0 resection with hilar hepaticojejunostomy. No patient experienced postoperative bile leak. CONCLUSIONS: The AHRLF was associated with lack of bile leak after curative perihilar hepatectomy with hepaticojejunostomy for hilar cholangiocarcinoma, without compromising oncologic safety, and is recommended in selected patients.

Clinical analysis of thyroid carcinoma showing thymus-like differentiation: report of 8 cases.

Thyroid carcinoma showing thymus-like differentiation (CASTLE) is a kind of rare neoplasm of the thyroid gland. Because thyroid CASTLE is rare and difficult to diagnose, its clinicopathologic features have not been well defined, and no universally accepted treatment recommendation is available. We analyzed retrospectively the clinicopathologic data of 8 patients with thyroid CASTLE who underwent surgery and radiotherapy at the Shengjing Hospital of China Medical University between December 2008 and June 2012. All patients accepted radical surgery. All patients accepted postoperative radiotherapy, except one 79-year-old patient. There was no evidence of recurrence or metastasis during the follow-up period. The pattern of immunohistochemical staining was similar to that of thymic carcinoma. Six of 8 CASTLE cases expressed CD5. All 8 CASTLE patients were negatively expressed in thyroglobulin, thyroid transcription factor 1, and calcitonin. Patients with thyroid CASTLE have good outcomes after radical resection and postoperative radiotherapy. Positive CD5 immunoreactivity can contribute to diagnosis of this disease.

Expression of stromal cell-derived factor 1 and CXCR7 in papillary thyroid carcinoma.

Stromal cell-derived factor 1 (SDF-1) is a chemokine that is expressed in some cancer cells and is involved in tumor cell migration and metastasis. CXCR7, a novel receptor for SDF-1, has been identified recently. Researches demonstrated that interaction between SDF-1 and CXCR7 could play an important role in cancer progression. In this study, we aimed to investigate the expressions of SDF-1 and CXCR7 and the relationship between their expressions and clinicopathological characteristics in papillary thyroid carcinoma (PTC). Expressions of SDF-1 and CXCR7 in 33 cases of thyroid benign lesion tissue and 79 cases of PTC tissue and peritumoral non-malignant tissue were detected by immunohistochemical staining. Expressions of SDF-1 and CXCR7 were negative in peritumoral non-malignant tissues. Respectively, positive expression rates of SDF-1 and CXCR7 were 69.6 and 65.8 % in PTC, 12.1 and 30.3 % in thyroid benign tissue. The expression of SDF-1 and CXCR7 were positively correlated with lymph node metastasis. SDF-1 and CXCR7 expressions were related with the lymph nodes metastasis of PTC.

Nanoparticle-mediated local delivery of an antisense TGF-ß1 construct inhibits intimal hyperplasia in autogenous vein grafts in rats.

BACKGROUND: Intimal hyperplasia is one of the most important causes of vascular graft failure. Numerous studies have correlated transforming growth factor-ß1 (TGF-ß1) with extracellular matrix (ECM) deposition, a hallmark of intimal thickening. PRINCIPAL FINDINGS: In the present study, we performed immunohistochemistry, RT-PCR, and Western blot to examine the dynamic expression of TGF-ß1, TGF-ß1 receptor type I (TGF-ß RI), matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) during intimal hyperplasia in grafted veins of a rat model generated by grafting a portion of the right internal jugular vein to the ipisiliary carotid artery. Additionally, we determined whether nanoparticle-mediated delivery of a TGF-ß1 antisense-expressing construct prevented TGF-ß1 expression and intimal hyperplasia in grafted veins. In grafted veins, the expression of TGF-ß1 significantly increased on day 3 after transplantation, peaked on day 7, slightly decreased on day 14, and returned to baseline levels on day 28. The positive expression of TGF-ß RI in grafted veins remarkably increased on day 7, peaked on day 14, and decreased thereafter. MMP-1 expression decreased significantly, while TIMP-1 expression increased, significantly on days 14 and 28. Nanoparticle-mediated delivery of a TGF-ß1 antisense-expressing construct down-regulated TGF-ß1 expression and inhibited intimal hyperplasia in grafted veins. CONCLUSIONS: Our findings provide further evidence that TGF-ß1 plays an integral role in the development of intimal hyperplasia after vascular injury. Nanoparticle-mediated delivery of a TGF-ß1 antisense-expressing construct is a feasible strategy to target TGF-ß1-induced intimal thickening.

[The best concentration ratio of propofol controlled-infusion combined with sevoflurane in anesthesia for patients undergoing laparoscopy].

OBJECTIVE: To investigate the best concentration ratio of propofol controlled-infusion combined with sevoflurane in anesthesia for patients undergoing laparoscopy. METHODS: One hundred patients undergoing cholecystectomy under laparoscopy were randomly divided into 5 equal groups treated with propofol controlled plasma at the concentrations of 1, 2, 3, 4, and 5 microg/ml respectively (Group 1-5). Bispectral index (BIS) was maintained at a range of 50 +/- 5 by adjusting sevoflurane inhalation. The end-tidal concentration of sevoflurane (ETsevo), systolic pressure, diastolic pressure, recovery time, awareness, and post-operative nausea and vomiting (PONV) within 24 h after operation were recorded. The best concentration ratio of propofol controlled-infusion combined with sevoflurane with the definition as the highest ETsevo without PONV decrease along with the increase of propofol concentration. RESULTS: ETsevo was negatively correlated with and propofol concentration. There were nit significant differences in the systolic pressure, diastolic pressure, and recovery time among different groups. No incidence of intra-operative awareness was found. The PONV rates of Group 1 and 2 were both 60%, significantly higher than those of the other 3 groups (all P < 0.05) without significant differences in PONV rate among Group 3 - 5. The best concentration ratio of propofol controlled-infusion combined with sevoflurane was propofol controlled-infusion at the concentration of 1 microg/ml with ETsevo at the concentration as 1 minimal alveolar concentration (MAC). CONCLUSION: Propofol controlled-infusion at the concentration of 1 microg/ml with ETsevo at the concentration as 1 MAC is the best concentration ratio with low PONV rate and a possibility to prevent intra-operative awareness.