A meta-analysis and systematic review of the comparison of laparoscopic ablation to percutaneous ablation for hepatic malignancies.

BACKGROUND: The optimal access for thermal ablation of the liver has not been evaluated in the literature for the laparoscopic versus percutaneous techniques. The aim of this manuscript was to determine the optimal ablation technique and patient selection for hepatic malignancies by comparing the efficacy and recurrence-free survival of laparoscopic and percutaneous thermal ablation. METHODS: A detailed literature search was made in PubMed, Web of Science, Google scholar, and EMBASE for related research publications. The data were extracted and assessed by two reviewers independently. Analysis of pooled data was performed, and Odds Ratio (OR) or Hazard Ratio (HR) with corresponding confidence intervals (CIs) was calculated and summarized respectively. RESULTS: A total of 10 articles were included with 1916 ablation patients. Laparoscopic ablation success (Median 100%) was found to be higher than percutaneous ablation success (median 89.4%) (p = ns). There was a higher percentage of both local and non-local hepatic recurrence in the patients treated with percutaneous ablation versus laparoscopic ablation. Meta-analysis indicated no difference in the adjusted hazard rate of recurrence by procedure type (p = 0.94). Laparoscopic ablation had a higher percentage of complications compared to percutaneous ablation (median lap 14.5% vs. perc 3.3%). CONCLUSIONS: While laparoscopic and percutaneous ablation are both effective interventions for hepatic malignancies, laparoscopic ablation was found to have improved ablation success and less local and non-local hepatic recurrence compared to percutaneous ablation.

Laparoscopic microwave ablation versus percutaneous microwave ablation of hepatic malignancies: Efficacy and recurrence-free survival outcomes in patients.

BACKGROUND: Hepatic thermal ablation has been found to be effective and equivalent to resection in certain liver histologies. Of the 16,000 annual liver ablations performed in the United States, only 13% (2,080 ablations) are performed laparoscopically. The laparoscopic technique remains underused even with the benefits of improved staging and better access to tumors. The purpose of this study is to compare laparoscopic microwave ablation versus percutaneous microwave ablation in terms of efficacy and recurrence-free survival outcomes in patients with hepatic malignancies. METHODS: A comparative analysis was performed on 275 patients (289 ablation procedures) who underwent laparoscopic microwave ablation or percutaneous microwave ablation between February 2011 and May 2021. Ablation success was confirmed postprocedure and recurrence was monitored at follow-up via contrast-enhanced computed tomography/magnetic resonance imaging and/or computed tomography/positron emission tomography. RESULTS: The groups were similar for sex, age, body mass index, location of tumor, size of tumor, and number of tumors. Ablation success was 100% in both groups. Local recurrence was significant (5%: laparoscopic microwave ablation vs 22%: percutaneous microwave ablation, P = .002) and same-lobe recurrence (21%: laparoscopic microwave ablation vs 24%: percutaneous microwave ablation) was lower in the laparoscopic microwave ablation group. Median recurrence-free survival was 15.8 months for the laparoscopic microwave ablation group and 5.6 months for the percutaneous microwave ablation group (P = .0002). Overall, 90-day complications were lower in the laparoscopic microwave ablation group (11%) compared with the percutaneous microwave ablation group (21%) (P = .11). CONCLUSION: Laparoscopic surgical ablation is a critical surgical skill that must be taught in fellowship. Laparoscopic microwave ablation leads to better tumor specific outcomes and oncologic outcomes demonstrating clinical efficacy in the treatment of hepatic malignancies compared with percutaneous microwave ablation.

Designing Beyond the Americans With Disabilities Act (ADA): Creating an Autism-Friendly Vocational Center.

The Americans with Disabilities Act (ADA) has been effective in establishing building standards that create accessible spaces for people with physical impairments. These guidelines have not addressed the needs of people with mental, emotional, and/or developmental disabilities. With the increase in autism diagnosis, designers/architects need to expand their planning to include more universal solutions. The purpose is to demonstrate ways of designing beyond ADA to address needs of people with autism spectrum disorder (ASD). To design effectively, designers/architects must identify sensory issues that influence these children in establishing a regulatory state enabling effective interaction with neurotypical peers. Design is also important for teachers, therapists, and parents of children with ASD to enable more successful interactions. If the environment is overstimulating for a child with ASD, then a parent/caregiver/therapist will struggle to achieve their goals. Mostafa recommended seven design criteria known as ASPECTSS™: Acoustics, Spatial sequencing, Escape spaces, Compartmentalization, Transition spaces, Sensory zoning, and Safety, when designing for people with ASD. These classifications lay the groundwork for the established guidelines. As designers/architects, we have a responsibility to create inclusive environments. To help, the authors highlighted a vocational center showing one plan that meets ADA guidelines and another that illustrates additional environmental features addressing the needs of people with ASD. These criteria originated from evidence-based solutions derived from a literature review and personal interview. These recommendations demonstrate that sensitivity to the needs of people with autism creates a solution that is better for all people.

Lactoferrin supplementation to dairy calves.

Twenty-one Holstein calves (12 bulls, 9 heifers) were used to evaluate the effects of supplemental lactoferrin (0, 1, and 10 g/d) added to colostrum, milk, and milk replacer in a 56-d study. Calves fed lactoferrin (LF) weighed more during wk 2, 3, 4, 5, and 6 than control calves. Calves fed LF had increased preweaning daily weight gains and heart girth gains compared with calves not fed lactoferrin. Calves fed 1 g/d LF had a greater preweaning average daily gain than calves fed 10 g/d of lactoferrin. Hematocrit and serum Fe were unaffected by treatments. Calves were weaned when they had consumed 0.7 kg of calf starter grain for 2 consecutive d and were at least 28 d of age. All calves were weaned by 35 d of age, regardless of starter intake. Calves fed LF consumed more calf starter grain during the preweaning period and met weaning criteria at a younger age. This study indicates that supplementing calf diets with LF is advantageous to calf performance.

Concordant in situ and in vitro data show that maternal cigarette smoking negatively regulates placental cytotrophoblast passage through the cell cycle.

Maternal cigarette smoking is associated with fetal growth restriction and other pregnancy complications. To investigate possible mechanisms involving the placenta, we studied the morphology of first trimester chorionic villi from mothers who smoked. In mothers who smoked > 20 cigarettes/day, floating villi showed focal defects including an absence of cytotrophoblast stem cells and an abnormal thinning of the syncytium. Anchoring villi displayed a striking increase in the number of cytotrophoblast columns that failed to reach the uterus or degenerated in the intervillous space. Many samples showed a significant reduction in the number of anchoring villi. Also, the number of Ki67-positive cytotrophoblasts was dramatically decreased, indicating that fewer cells were in S phase of the mitotic cycle. Together, these results suggested premature depletion of the cytotrophoblast stem cell population. To test this hypothesis, we exposed anchoring villi from nonsmokers to nicotine in vitro and analyzed the effects on cytotrophoblast passage through the cell cycle. Nicotine (0.23 to 6.0 microM) negatively affected the expression of a number of cell cycle regulators/markers and BrdU incorporation, without discernable effects on apoptosis. These results link abnormal placental development secondary to maternal cigarette smoking to a substantial decrease in the mitotic potential of cytotrophoblasts.

Hypoxia alters early gestation human cytotrophoblast differentiation/invasion in vitro and models the placental defects that occur in preeclampsia.

During normal human pregnancy a subpopulation of fetal cytotrophoblast stem cells differentiate and invade the uterus and its arterioles. In the pregnancy disease preeclampsia, cytotrophoblast differentiation is abnormal and invasion is shallow. Thus, the placenta is relatively hypoxic. We investigated whether lowering oxygen tension affects cytotrophoblast differentiation and invasion. Previously we showed that when early gestation cytotrophoblast stem cells are cultured under standard conditions (20% O2) they differentiate/invade, replicating many aspects of the in vivo process. Specifically, the cells proliferate at a low rate and rapidly invade extracellular matrix (ECM) substrates, a phenomenon that requires switching their repertoire of integrin cell-ECM receptors, which are stage-specific antigens that mark specific transitions in the differentiation process. In this study we found that lowering oxygen tension to 2% did not change many of the cells' basic processes. However, there was a marked increase in their incorporation of [3H]thymidine and 5-bromo-2'-deoxyuridine (BrdU). Moreover, they failed to invade ECM substrates, due at least in part to their inability to completely switch their integrin repertoire. These changes mimic many of the alterations in cytotrophoblast differentiation/invasion that occur in preeclampsia, suggesting that oxygen tension plays an important role in regulating these processes in vivo.

Maternal smoking inhibits early human cytotrophoblast differentiation.

Differentiation of the specialized epithelial cells of the placenta, termed cytotrophoblasts, is a particularly important aspect of placental development during the first trimester of pregnancy. During this process cytotrophoblast stem cells either fuse to form the syncytium or aggregate to form cell columns that adhere to, then invade the uterus. We found that chorionic villi from early gestation placentas of mothers who smoke showed a marked reduction in cell columns, a defect that could not be corrected by placing them in culture. We used two different in vitro models to determine if nicotine plays a role in the etiology of this defect. Exposing early gestation chorionic villi from nonsmoking women to nicotine inhibited subsequent cell column formation in vitro. Nicotine also inhibited normal first trimester cytotrophoblast invasion, apparently by reducing the ability of treated cells to synthesize and activate the 92 kDa type IV collagenase, an important mediator of invasion in vitro. These results suggest that maternal cigarette smoking inhibits the trophoblast differentiation pathway that leads to column formation and uterine invasion. This effect, which is due at least in part to the effects of nicotine, may contribute to the growth retardation observed in fetuses of mothers who smoke during pregnancy.

Comparative bioavailability and pharmacokinetics of hydrochlorothiazide from oral tablet dosage forms, determined by plasma level and urinary excretion methods.

The bioavailability and pharmacokinetics of two hydrochlorothiazide products were compared following single 50 mg oral doses to 20 healthy male volunteers. Plasma and urine were assayed for hydrochlorothiazide by a specific and sensitive HPLC method. Plasma profiles of hydrochlorothiazide were adequately described by a triexponential function. The bioavailability of hydrochlorothiazide from the two brands did not differ significantly as judged by the values of Cmax, tmax, AUC0 leads to infinity, mean residence time, variance of residence time, and urinary excretion of unchanged drug. Close similarity was observed between urinary excretion rates and concentrations of drug in plasma.

Correlation between dissolution characteristics and absorption of methaqualone from solid dosage forms.

A methaqualone tablet in two strengths, 150 and 300 mg, was developed. The dissolution rate of an experimental formulation in pH 7.0 phosphate buffer, measured by the resin flask method, was shown to correlate with bioavailability in humans. The dissolution rate criterion was used to develop the final tablet formulation. Bioavailability of this formulation in two strengths was compared with a commercial capsule formulation and a slowly dissolving tablet formulation. Correlation between dissolution rate and bioavailability was shown in freshly prepared methaqualone tablet formulations. Bioavailability of tablets under accelerated stability testing conditions remained unaltered, whereas the dissolution rates in pH 7 phosphate buffer decreased, using the resin flask method. A rotating-flask method was developed, and dissolution in 0.1 N HCl at 2 rpm correlated with the bioavailability of both new and aged tablet formulations.

Effect of flavoring oils on preservative concentrations in oral liquid dosage forms.

The partitioning of methyl-, ethyl-, propyl-, and butylparabens into flavoring oils from aqueous systems was studied. The partitioning is dependent on the concentration of the flavoring oil, the pH of the aqueous medium, and the nature and concentration of additives to the aqueous medium.