Objective:Microvascular invasion(MVI)is an important risk factor for early recurrence after hepatectomy for hepatocellular carcinoma(HCC).However,it lacks the systemic evidence of the tissue sampling protocol for effi...Objective:Microvascular invasion(MVI)is an important risk factor for early recurrence after hepatectomy for hepatocellular carcinoma(HCC).However,it lacks the systemic evidence of the tissue sampling protocol for efficient MVI detection.This study aims to explore the relationship between the number of sampling sites(NuSS)crossing the tumor interface,the paracancerous parenchyma,and the positive rate of MVI.展开更多
Fifteen percent to forty percent of patients present with persistent disabling neck pain or radicular pain after cervical spine surgery. Persistent pain after cervical surgery is called cervical post-surgery syndrome(...Fifteen percent to forty percent of patients present with persistent disabling neck pain or radicular pain after cervical spine surgery. Persistent pain after cervical surgery is called cervical post-surgery syndrome(CPSS). This review investigates the literature about interventional pain therapy for these patients. Because different interventions with different anatomical targets exist, it is important to find the possible pain source. There has to be a distinction between radicular symptoms(radicular pain or radiculopathy) or axial pain(neck pain) and between persistent pain and a new onset of pain after surgery. In the case of radicular symptoms, inadequate decompression or nerve root adherence because of perineural scarring are possible pain causes. Multiple structures in the cervical spine are able to cause neck pain. Hereby, the type of surgery and also the number of segments treated is relevant. After fusion surgery, the so-called adjacent level syndrome is a possible pain source. After arthroplasty, the load of the facet joints in the index segment increases and can cause pain. Further, degenerative alterations progress. In general, two fundamentally different therapeutic approaches for interventional pain therapy for the cervical spine exist: Treatment of facet joint pain with radiofrequency denervation or facet nerve blocks, and epidural injections either via a transforaminal or via an interlaminar approach. The literature about interventions in CPSS is limited to single studies with a small number of patients. However, some evidence exists for these procedures. Interventional pain therapies are eligible as a target-specific therapy option. However, the risk of theses procedures(especially transforaminal epidural injections) must be weighed against the benefit.展开更多
Background/Objectives: Global ageing is associated with an increase in the frequency of peripheral arterial disease (PAD), which is often complex to manage postoperatively. The aim of this study was to describe postop...Background/Objectives: Global ageing is associated with an increase in the frequency of peripheral arterial disease (PAD), which is often complex to manage postoperatively. The aim of this study was to describe postoperative complications of Lower limb arteriopathy in geriatric units. Materials and Methods: This was a retrospective, descriptive study from July 2019 to June 2022 of patients aged at least 65 years hospitalized in the geriatric unit of the FANN hospital for postoperative management of a Lower limb arteriopathy. Sociodemographic, clinical and evolutionary characteristics were collected and analyzed using Epi info version 7.2.6 software. Results: Forty patients met the criteria, representing 7.69% of hospital admissions. The average age was 77.5 years, with women in majority (75%). The mean time to geriatric admission after surgery was 9 ± 3 days. Poly pathologies (≥3 comorbidities) were present in 55% of patients. Cardiovascular risk factors were dominated by high blood pressure (85%), followed by mellitus diabetes (52.5%) and dyslipidemia (12.5%). Other associated comorbidities were dominated by heart disease (40%), followed by ischemic stroke (27.5%) and major cognitive impairment (27.5%). Excessive chronic arterial disease of the limbs was the predominant vascular diagnosis (80%) and amputation was the most common surgical procedure (62.5%), especially of the thigh (42.4%). Symptoms included refusal to eat (70%) and mental confusion (70%). The geriatric syndromes were mainly acute loss of functional independence (97.5%) and malnutrition (77.5%). The average number of acute diagnoses on admission was 4 ± 1, represented mainly by infectious diseases (31.5%), dominated by superinfection of the amputation stump (55%) and pulmonary infection (25%). Mortality rate was 22.5%. Conclusion: Post-surgical complications are frequent in the geriatric population, with a high mortality rate. Prior geriatric assessment would optimize postoperative results.展开更多
Open vascular reconstructions(OVR),including bypass grafts and dialysis access,are standard treatments for cardiovascular and renal diseases.Unfortunately,OVR often fail largely due to intimal hyperplasia(IH),and ther...Open vascular reconstructions(OVR),including bypass grafts and dialysis access,are standard treatments for cardiovascular and renal diseases.Unfortunately,OVR often fail largely due to intimal hyperplasia(IH),and there are no clinical methods to prevent this complication.Perivascular drug administration during OVR presents a promising strategy for IH suppression.However,durations of drug release from carriers are generally short whereas sustained efficacy is essential for clinical success.This raises a critical question in clinical translation:can IH suppression be realistically maintained long-term(e.g.,over 6 months)with short-term perivascular interventions?To address this question,we modified a rat vein-graft model to prolong IH progression.We then applied Pericelle,a nanoparticle/hydrogel hybrid system that we developed for perivascular delivery of rapa-mycin,an established IH-inhibitory drug.Surprisingly,despite short(~3-month)drug release,Pericelle demonstrated IH suppression throughout 3,6,and 9 months with IH reduced from 115.58±27.89 to 40.34±5.18 at 9 months(P<0.05,n=6 rats),as indicated by morphometric analysis.Live animal ultrasonography showed the same trend.Consistently,histone-3 lysine-27 trimethylation,an epigenetic mark associated with IH progression,was decreased at 6 months after Pericelle treatment.Moreover,Pericelle exhibited promising ef-ficacy in mitigating IH in a porcine model of arteriovenous fistula that mimics dialysis access.These results suggest that Pericelle-mediated suppression of IH in rat vein-grafts extends much beyond drug release,offering potential solutions to longstanding translational challenges in reducing OVR failure.展开更多
Primary liver cancer is the sixth most prevalent malignancy worldwide and the third leading cause of cancer-related death.According to the latest data from the National Cancer Center of China,its mortality rate has ri...Primary liver cancer is the sixth most prevalent malignancy worldwide and the third leading cause of cancer-related death.According to the latest data from the National Cancer Center of China,its mortality rate has risen,making it the country’s second-deadliest tumor.Hepatocellular carcinoma(HCC),the predo-minant histological subtype,remains a substantial therapeutic challenge.Hepa-tectomy is the treatment of choice for HCC;however,because of its insidious onset and aggressive progression,the global 5-year survival rate is only 14.1%,and up to 70%of patients experience recurrence within five years after surgery.Consequently,reducing postoperative recurrence and prolonging survival have become critical research priorities.Currently,no consensus or guidelines exist regarding the clinical efficacy or potential synergistic effects of diagnostic and therapeutic strategies to prevent postoperative recurrence.In recent years,interest has grown in systemic therapies and combined local modalities-particularly targeted agents and immune checkpoint inhibitors,as adjuvant treatments.This review synthesizes recent advances in targeted and immunotherapeutic adjuvant therapies for postoperative HCC to inform clinical practice and improve patient outcomes.展开更多
文摘Objective:Microvascular invasion(MVI)is an important risk factor for early recurrence after hepatectomy for hepatocellular carcinoma(HCC).However,it lacks the systemic evidence of the tissue sampling protocol for efficient MVI detection.This study aims to explore the relationship between the number of sampling sites(NuSS)crossing the tumor interface,the paracancerous parenchyma,and the positive rate of MVI.
文摘Fifteen percent to forty percent of patients present with persistent disabling neck pain or radicular pain after cervical spine surgery. Persistent pain after cervical surgery is called cervical post-surgery syndrome(CPSS). This review investigates the literature about interventional pain therapy for these patients. Because different interventions with different anatomical targets exist, it is important to find the possible pain source. There has to be a distinction between radicular symptoms(radicular pain or radiculopathy) or axial pain(neck pain) and between persistent pain and a new onset of pain after surgery. In the case of radicular symptoms, inadequate decompression or nerve root adherence because of perineural scarring are possible pain causes. Multiple structures in the cervical spine are able to cause neck pain. Hereby, the type of surgery and also the number of segments treated is relevant. After fusion surgery, the so-called adjacent level syndrome is a possible pain source. After arthroplasty, the load of the facet joints in the index segment increases and can cause pain. Further, degenerative alterations progress. In general, two fundamentally different therapeutic approaches for interventional pain therapy for the cervical spine exist: Treatment of facet joint pain with radiofrequency denervation or facet nerve blocks, and epidural injections either via a transforaminal or via an interlaminar approach. The literature about interventions in CPSS is limited to single studies with a small number of patients. However, some evidence exists for these procedures. Interventional pain therapies are eligible as a target-specific therapy option. However, the risk of theses procedures(especially transforaminal epidural injections) must be weighed against the benefit.
文摘Background/Objectives: Global ageing is associated with an increase in the frequency of peripheral arterial disease (PAD), which is often complex to manage postoperatively. The aim of this study was to describe postoperative complications of Lower limb arteriopathy in geriatric units. Materials and Methods: This was a retrospective, descriptive study from July 2019 to June 2022 of patients aged at least 65 years hospitalized in the geriatric unit of the FANN hospital for postoperative management of a Lower limb arteriopathy. Sociodemographic, clinical and evolutionary characteristics were collected and analyzed using Epi info version 7.2.6 software. Results: Forty patients met the criteria, representing 7.69% of hospital admissions. The average age was 77.5 years, with women in majority (75%). The mean time to geriatric admission after surgery was 9 ± 3 days. Poly pathologies (≥3 comorbidities) were present in 55% of patients. Cardiovascular risk factors were dominated by high blood pressure (85%), followed by mellitus diabetes (52.5%) and dyslipidemia (12.5%). Other associated comorbidities were dominated by heart disease (40%), followed by ischemic stroke (27.5%) and major cognitive impairment (27.5%). Excessive chronic arterial disease of the limbs was the predominant vascular diagnosis (80%) and amputation was the most common surgical procedure (62.5%), especially of the thigh (42.4%). Symptoms included refusal to eat (70%) and mental confusion (70%). The geriatric syndromes were mainly acute loss of functional independence (97.5%) and malnutrition (77.5%). The average number of acute diagnoses on admission was 4 ± 1, represented mainly by infectious diseases (31.5%), dominated by superinfection of the amputation stump (55%) and pulmonary infection (25%). Mortality rate was 22.5%. Conclusion: Post-surgical complications are frequent in the geriatric population, with a high mortality rate. Prior geriatric assessment would optimize postoperative results.
基金supported by the NIH Center for Accelerated Innovations-Cleveland Clinic(NCAI-CC)award 1UH54HL119810-06(1118-SUB)to K.C.K.and L.-W.G.The Ohio State University Accelerator award(ECG20170069)to K.C.K.and L.-W.G.+2 种基金the Ohio Development Services Agency fund(GRT00051721)to L.-W.GThis research also partially involved funding support from NIH awards R01HL129785(to K.C.K.,S.G.,and L.-W.G.)R01HL168405(to L.-W.G.,K.C.K.,and S.G.).
文摘Open vascular reconstructions(OVR),including bypass grafts and dialysis access,are standard treatments for cardiovascular and renal diseases.Unfortunately,OVR often fail largely due to intimal hyperplasia(IH),and there are no clinical methods to prevent this complication.Perivascular drug administration during OVR presents a promising strategy for IH suppression.However,durations of drug release from carriers are generally short whereas sustained efficacy is essential for clinical success.This raises a critical question in clinical translation:can IH suppression be realistically maintained long-term(e.g.,over 6 months)with short-term perivascular interventions?To address this question,we modified a rat vein-graft model to prolong IH progression.We then applied Pericelle,a nanoparticle/hydrogel hybrid system that we developed for perivascular delivery of rapa-mycin,an established IH-inhibitory drug.Surprisingly,despite short(~3-month)drug release,Pericelle demonstrated IH suppression throughout 3,6,and 9 months with IH reduced from 115.58±27.89 to 40.34±5.18 at 9 months(P<0.05,n=6 rats),as indicated by morphometric analysis.Live animal ultrasonography showed the same trend.Consistently,histone-3 lysine-27 trimethylation,an epigenetic mark associated with IH progression,was decreased at 6 months after Pericelle treatment.Moreover,Pericelle exhibited promising ef-ficacy in mitigating IH in a porcine model of arteriovenous fistula that mimics dialysis access.These results suggest that Pericelle-mediated suppression of IH in rat vein-grafts extends much beyond drug release,offering potential solutions to longstanding translational challenges in reducing OVR failure.
基金Supported by the Lianyungang Comprehensive Cancer Management and Technology Advancement Project,No.QN202302the First People’s Hospital of Lianyungang Young Talent Development Initiative,No.QN2212Jiangsu Society of Research Hospital Translational Medicine Research Grant,No.2024-GDZXKT-01-07.
文摘Primary liver cancer is the sixth most prevalent malignancy worldwide and the third leading cause of cancer-related death.According to the latest data from the National Cancer Center of China,its mortality rate has risen,making it the country’s second-deadliest tumor.Hepatocellular carcinoma(HCC),the predo-minant histological subtype,remains a substantial therapeutic challenge.Hepa-tectomy is the treatment of choice for HCC;however,because of its insidious onset and aggressive progression,the global 5-year survival rate is only 14.1%,and up to 70%of patients experience recurrence within five years after surgery.Consequently,reducing postoperative recurrence and prolonging survival have become critical research priorities.Currently,no consensus or guidelines exist regarding the clinical efficacy or potential synergistic effects of diagnostic and therapeutic strategies to prevent postoperative recurrence.In recent years,interest has grown in systemic therapies and combined local modalities-particularly targeted agents and immune checkpoint inhibitors,as adjuvant treatments.This review synthesizes recent advances in targeted and immunotherapeutic adjuvant therapies for postoperative HCC to inform clinical practice and improve patient outcomes.
