[New advances in the diagnosis and treatment of intrahepatic cholangiocarcinoma].

Intrahepatic cholangiocarcinoma (ICC) is a type of primary liver cancer, which has shown an increasing trend in incidence and mortality in recent years, with a poor prognosis. The clinical diagnosis and treatment of ICC currently face the challenges of low detection rate, high mortality rate, poor treatment outcome, and urgently need more in-depth research to promote the improvement of clinical diagnosis and treatment level. In recent years, ICC diagnosis and treatment related research has made new progress in many aspects, and the knowledge about these new clinical diagnosis and treatment advances should be updated in a timely manner. This article reviewed the latest research results in recent years, summarized some new views on ICC typing, prevention and diagnosis staging that have been proposed recently, as well as the new progress made in surgical treatment and systemic treatment, and briefly discussed the potential of ICC individualized precision treatment and the occurrence of rare complications caused by combined treatment.

Microneedle fractional radiofrequency treatment of facial photoageing as assessed in a split-face model.

BACKGROUND: A new therapeutic device passes radiofrequency energy through microneedles to targeted tissue. Three-dimensional photography may be useful for evaluating the clinical efficacy of microneedle fractional radiofrequency (MFR) used on the appearance of rhytids and to improve facial laxity. AIM: To evaluate the efficacy and safety of MFR in the treatment of facial photoageing. METHODS: In total, participants with facial photoageing were enrolled in the study. All volunteers were randomized to receive split-face treatments with MFR 2 months apart. The participants self-evaluated at baseline, Days 1-7, and Months 1 and 3 after the final treatment. Objective evaluation was provided by a three-dimensional in vivo imaging system. In addition, skin melanin index, erythema index, immediate reactions, healing times and other adverse effects were evaluated. RESULTS: Compared with the untreated side, the treated side of most participants improved, based on clinical assessments at the 1- and 3-month follow-up visits after treatment. Both objective and participative assessments were satisfactory. The participants demonstrated a decrease of roughness parameter (Sa) value at each follow-up visit. Compared with pretreatment value, Sa decreased significantly at Months 1 and 3 on the treated side (P < 0.05). Minimal and reversible adverse effects and rapid healing were recorded. CONCLUSIONS: MFR appears to be an excellent treatment for photodamaged facial skin in Chinese patients.

[History, current situation and bottleneck of the diagnosis and treatment system of hepatic hilar cholangiocarcinoma in Japan].

Hilar cholangiocarcinoma is one of the most difficult malignant tumors to treat in the biliary system. In Japan, 5-year survival rate of the disease has increased from 32.5% to 67.1% during the past 30 years. The impressive progress reflects the solid efforts in preoperative endoscopic diagnosis, innovation in surgery such as PTPE as well as hepato-pancreatoduodenectomy and perioperative treatment including replacement of the bile and synbiotic treatment, which have finally formed a set of standardized diagnosis and treatment systems. The present review intends to report the history, current status and remaining bottlenecks of the diagnosis and treatment system of hilar cholangiocarcinoma in Japan as follows.

[Efficiency and influencing factors of ultrasound-guided radiofrequency ablation as treatment in hepatic malignant tumors].

OBJECTIVE: To evaluate the efficiency and influencing factors of ultrasound-guided percutaneous radiofrequency ablation (RFA) as treatment of hepatic malignant tumors. METHODS: Clinical data and follow-up radiographic images of patients with hepatic malignant tumors who had undergone treatment with ultrasound-guided percutaneous RFA at our hospital between March 2012 and March 2014 were reviewed. Rates of incomplete ablation, recurrence, and tumor progression were calculated, and the factors affecting each were analyzed. RESULTS: Four hundred and twelve lesions were ablated in a total of 392 ultrasound-guided percutaneous RFA procedures applied to 360 patients. The average tumor size was 2.51±1.10 cm. During at least 3 months of follow-up, the complete ablation rate was 86.11% (310/360), the recurrence rate was 7.78% (28/360), and the progression rate was 6.1% (22/360). Tumors with vessel-proximal location, size of ≥ 3 cm and ≥ 3 month presence had significantly higher rates of residual lesions after ablation (χ(2) = 4.431, 10.889 and 8.000, respectively; p<0.05). Tumors with ≥ 3 month presence had significantly higher rates of recurrence and progression (χ(2) = 29.032 and 22.092, P < 0.05). CONCLUSION: Ultrasound-guided percutaneous RFA can effectively control local progression of hepatic malignant tumors. Tumor size, length of presence, and vessel-proximal location are influencing factors of complete ablation rate, while length of presence is also an influencing factor for the recurrence and progression rates.

APC2 Cullin protein and APC11 RING protein comprise the minimal ubiquitin ligase module of the anaphase-promoting complex.

In mitosis, the anaphase-promoting complex (APC) regulates the onset of sister-chromatid separation and exit from mitosis by mediating the ubiquitination and degradation of the securin protein and mitotic cyclins. With the use of a baculoviral expression system, we have reconstituted the ubiquitin ligase activity of human APC. In combination with Ubc4 or UbcH10, a heterodimeric complex of APC2 and APC11 is sufficient to catalyze the ubiquitination of human securin and cyclin B1. However, the minimal APC2/11 ubiquitin ligase module does not possess substrate specificity, because it also ubiquitinates the destruction box deletion mutants of securin and cyclin B1. Both APC11 and UbcH10 bind to the C-terminal cullin homology domain of APC2, whereas Ubc4 interacts with APC11 directly. Zn(2+)-binding and mutagenesis experiments indicate that APC11 binds Zn(2+) at a 1:3 M ratio. Unlike the two Zn(2+) ions of the canonical RING-finger motif, the third Zn(2+) ion of APC11 is not essential for its ligase activity. Surprisingly, with Ubc4 as the E2 enzyme, Zn(2+) ions alone are sufficient to catalyze the ubiquitination of cyclin B1. Therefore, the Zn(2+) ions of the RING finger family of ubiquitin ligases may be directly involved in catalysis.

Reevaluation of limited side-to-side portacaval shunt.

Although the results of limited side-to-side portacaval shunt were better than those of other shunts, postoperative encephalopathy still occurred in 10.2% of the patients. To determine the relationship between the diameter of anastomotic stoma and the development of postoperative encephalopathy, animal experiments and clinical observations were carried out. In 4 of 8 dogs in 3 months after limited side-to-side portacaval shunt and in 6 patients with postoperative encephalopathy, there was significant augmentation of the diameter of anastomotic stoma. To prevent the widening of anastomotic stoma caused by blood flow under high pressure, a limiting ring of 10 mm in diameter was put around the anastomotic site during operation in 21 patients with portal hypertension. Follow-up for 3-15 months (average 6 months) showed that there was no evidence of postoperative encephalopathy and rebleeding. A ring of same kind was put around the dilated anastomotic stoma during exploration in the 6 patients, and all their cerebral symptoms and signs disappeared completely soon after the second operation.

[Diagnosis and treatment of bile duct tumor thrombus in patients with hepatocellular carcinoma].

OBJECTIVE: Tumor thrombus in the bile duct (BDT) is very rare in patients with hepatocellular carcinoma (HCC). The prognosis of the patients with BDT is very poor. To improve the prognosis, HCC patients with BDT were retrospectively reviewed. METHODS: Retrospective study was performed in 16 cases of HCC with BDT found in authors' institute from July 1987 to Oct. 1998. Factors affecting prognosis were analyzed. RESULTS: The occurrence rate of BDT as 0.76% (16/2100). Removal of BDT and HCC was performed in all but one patients. Fourteen patients were followed-up for over 1 year after operation. The 1-year survival and recurrence rate was 71.4% (10/14) and 57.1% (8/14), respectively. Three female patients survived over 4, 6, and 12 years, respectively. CONCLUSIONS: Early detection and diagnosis, surgical removal of primary tumors and BDT are the key points to prolong the survival time of patients.

[Retrograde partial hepatectomy: report of 11 patients].

OBJECTIVE: To study a new approach to hepatectomy for liver tumors resected difficulty by typical method. METHOD: The operative order is retrograde as compared with typical hepatectomy, namely, transection of the liver is performed first, isolating adhesions between the tumor and the diaphragm or partial invaded phrenectomy is performed second, and then after cutting corresponding ligaments, liver tumor is removed. If the surrounding organs were invaded or adhered by tumor too tightly to be separated. They were resected with the tumor. RESULT: The approach was used in 11 patients with malignant tumors of liver from June 1994 to January 1996. Operation time was 192 min (150 - 250 min) and estimated blood loss during operation was 1460 ml (800 - 4, 200 ml). No operative mortality was found and all of the patients recovered uneventfully. CONCLUSION: The retrograde partial hepatectomy is a good method for resection of liver tumors resected difficulty by typical hepatectomy.

Implants placed simultaneously with maxillary sinus floor augmentations in the presence of antral pseudocysts: a case report.

An antral pseudocyst on the maxillary sinus has previously been a contraindication for sinus augmentation. The authors report the case of a patient with an antral pseudocyst (16.7 mm × 27.6 mm) in his left sinus, who was referred for dental implant treatment. The surgical plan was to perform the sinus augmentation after removing the cyst whilest simultaneously placing implants. During the operation the cyst could not be found in the left sinus. The sinus augmentation was carried out successfully without sinus membrane perforation and the implants were placed according to plan. Three mouths later, the cyst was still present and good osseointegration of the implants was achieved. After the implants had been in place for a year, a CT scan showed that the cyst had decreased in size. The authors conclude that it is may not be necessary to remove a sinus cyst before sinus augmentation or during the sinus augmentation operation if the patient does not have any symptoms and the cyst is not large. In cases with large lesions or an unclear diagnosis, further evaluation is needed before surgical intervention.

Treatment of hepatocellular carcinoma.

Treatment of hepatocellular carcinoma (HCC) remains a critical issue particularly in the endemic areas. This paper summarizes the literature in the recent 4 years and the author's data. Substantial progress has been found in the treatment of HCC during the recent decades, which was mainly a result of advances in medical imaging, aggressive surgical approach, regional cancer therapies and multidisciplinary approach. Surgical approaches that resulted in significant prolonged survival included: resection (particularly small HCC resection), re-resection for subclinical recurrence, cytoreduction and sequential resection for initially unresectable HCC, and liver transplantation for small HCC. In nonsurgery, regional cancer therapy has been a new trend, which includes transcatheter arterial chemoembolization, percutaneous ethanol injection for small HCC, and others. As a result of multimodality combination treatment and changing concepts in surgical oncology, the role of surgery in the treatment of HCC has become bigger. However, the inadequacy of regional cancer therapies, its multicentric origin and tumor invasiveness remain major targets to be studied for a curative treatment.

[Clinical study on preventing endodontic interappointment pain with dexamethasone].

OBJECTIVE: To investigate the effect decreasing of the incidence of endodontic interappointment pain(EIP) by local injection of 5 mg dexamethasone. METHODS: 5 mg dexamethasone was injected submucosally at apical region of 80 teeth with asymtomatic pulp necrosis after root canal therapy, then observing the incidence of EIP and compared with control group. RESULTS: The clinical observation revealed that the incidence of EIP of dexamethasone group (10.00%) was lower than that of control group (33.75%), P < 0.01, and the level of pain was decreased. Ordinal logistic regression revealed that EIP was related to tooth location, fistula, and root canal therapy. CONCLUSION: The incidence of EIP can be reduced after 5 mg dexamethasone local injected.