Comparative efficacy and safety of immunotherapy for patients with advanced or metastatic esophageal squamous cell carcinoma: a systematic review and network Meta-analysis.

BACKGROUND: The study aimed to compare efficacy and safety of various immune checkpoint inhibitors for patients with advanced or metastatic esophageal squamous cell carcinoma (ESCC). METHODS: We searched Medline, Web of Science, Cochrane Central Register of Controlled Trials, Embase, Clinical Trials.gov and several international conference databases from January 1, 2000 to December 19, 2021. We conducted Bayesian network meta-analysis to assess the relative effects among treatments. Outcomes included overall survival (OS), progression-free survival (PFS), overall response rate and adverse events. RESULTS: Ten eligible trials with 5250 patients were included. Toripalimab and Camrelizumab plus chemotherapy were preferred to rank first on OS (probability, 61%) and PFS (probability, 37%) in the first-line setting, respectively. In refractory patients, Sintilimab and Camrlizumab were most likely to be ranked first on OS (probability, 37%) and PFS (probability, 94%). The toxicity related to immunotherapy was manageable in clinical trials. Camrelizumab and Nivolumab had the less adverse events of grade 3 or higher in the first and refractory setting, respectively. CONCLUSIONS: This study found that Toripalimab and Camrelizumab plus chemotherapy were likely to be the best option in terms of OS and PFS in the first-line setting for patients with advanced or metastatic ESCC respectively. Sintilimab and Camrelizumab were the preferred options for OS and PFS in refractory patients respectively. The toxicity of immunotherapy was different from conventional chemotherapy, but manageable in patients with ESCC. TRIAL REGISTRATION: PROSPERO registration number: (CRD 42021261554).

Gut microbiota homeostasis restoration may become a novel therapy for breast cancer.

Breast cancer is the most diagnosed cancer in women. It significantly impairs a patient's physical and mental health. Gut microbiota comprise the bacteria residing in a host's gastrointestinal tract. Through studies over the last decade, we now know that alterations in the composition of the gut microbiome are associated with protection against colonization by pathogens and other diseases, such as diabetes and cancer. This review focuses on how gut microbiota can affect breast cancer development through estrogen activity and discusses the types of bacteria that may be involved in the onset and the progression of breast cancer. We also describe potential therapies to curtail the risk of breast cancer by restoring gut microbiota homeostasis and reducing systemic estrogen levels. This review will further explore the relationship between intestinal microbes and breast cancer and propose a method to treat breast cancer by improving intestinal microbes. We aimed at discovering new methods to prevent or treat BC by changing intestinal microorganisms.

Natural history of pathologically confirmed pulmonary subsolid nodules with deep learning-assisted nodule segmentation.

OBJECTIVE: To explore the natural history of pulmonary subsolid nodules (SSNs) with different pathological types by deep learning-assisted nodule segmentation. METHODS: Between June 2012 and June 2019, 95 resected SSNs with preoperative long-term follow-up were enrolled in this retrospective study. SSN detection and segmentation were performed on preoperative follow-up CTs using the deep learning-based Dr. Wise system. SSNs were categorized into invasive adenocarcinoma (IAC, n = 47) and non-IAC (n = 48) groups; according to the interval change during the preoperative follow-up, SSNs were divided into growth (n = 68), nongrowth (n = 22), and new emergence (n = 5) groups. We analyzed the cumulative percentages and pattern of SSN growth and identified significant factors for IAC diagnosis and SSN growth. RESULTS: The mean preoperative follow-up was 42.1 ± 17.0 months. More SSNs showed growth or new emergence in the IAC than in the non-IAC group (89.4% vs. 64.6%, p = 0.009). Volume doubling time was non-significantly shorter for IACs than for non-IACs (1436.0 ± 1188.2 vs. 2087.5 ± 1799.7 days, p = 0.077). Median mass doubling time was significantly shorter for IACs than for non-IACs (821.7 vs. 1944.1 days, p = 0.001). Lobulated sign (p = 0.002) and SSN mass (p = 0.004) were significant factors for differentiating IACs. IACs showed significantly higher cumulative growth percentages than non-IACs in the first 70 months of follow-up. The growth pattern of SSNs may conform to the exponential model. The initial volume (p = 0.042) was a predictor for SSN growth. CONCLUSIONS: IACs appearing as SSNs showed an indolent course. The mean growth rate was larger for IACs than for non-IACs. SSNs with larger initial volume are more likely to grow. KEY POINTS: • Invasive adenocarcinomas (IACs) appearing as subsolid nodules (SSNs), with a mean volume doubling time (VDT) of 1436.0 ± 1188.2 days and median mass doubling time (MDT) of 821.7 days, showed an indolent course. • The VDT was shorter for IACs than for non-IACs (1436.0 ± 1188.2 vs. 2087.5 ± 1799.7 days), but the difference was not significant (p = 0.077). The median MDT was significantly shorter for IACs than for non-IACs (821.7 vs. 1944.1 days, p = 0.001). • SSNs with lobulated sign and larger mass (> 390.5 mg) may very likely be IACs. SSNs with larger initial volume are more likely to grow.

Surgical treatment of huge hepatocarcinoma with invasion or severe adhesion of diaphragm using the technique of orthotopic liver resection.

BACKGROUND/AIMS: To explore the clinical application and significance of the technique of orthotopic liver resection. METHODOLOGY: From January 2004 to December 2011, five patients with huge hepatocellular carcinoma with invasion or severe adhesion of diaphragm were undergone right semi-liver resection using the technique of orthotopic liver resection. The right hemi-liver was isolated from the first liver portal, second liver portal and third liver portal, then isolated from the normal liver, finally the tumor and the invaded diaphragm were resected or removed from the severe adhesion. The approach to hepatic resection involved routine use of Peng's multifunctional operative dissector, selective control of in and out-flow of liver, control of inferior vena cava (IVC) and liver hanging maneuver, anterior approach, etc. RESULTS: The operations were successfully performed in 5 patients. Operative time was 120, 180, 150, 150 and 160 min, respectively. The amount of blood loss were 350, 350, 400, 450, 600 ml, respectively. Postoperative complications were pleural effusion in 3 cases, and other 2 cases recovered without complications. CONCLUSIONS: Although the technique of orthotopic liver resection has a high technical requirement for surgeons, it provides a surgical method and operative opportunity for the patients whose tumor has invaded diaphragm or has been severe adhesion with diaphragm and conventional liver resection cannot be performed.

Neuroprotective capabilities of TSA against cerebral ischemia/reperfusion injury via PI3K/Akt signaling pathway in rats.

BACKGROUND: Hundreds of previous studies demonstrated the cytoprotective effect of trichostatin-A (TSA), a kind of histone deacetylases inhibitors (HDACIs), against cerebral ischemia/reperfusion insult. Meanwhile, phosphatidylinositol-3 kinase/Akt (PI3K/Akt) is a well-known, important signaling pathway that mediates neuroprotection. However, it should be remains unclear whether the neuroprotective capabilities of TSA against cerebral ischemia/reperfusion is mediated by activation of the PI3K/Akt signaling pathway. METHODS: Five groups rats (n = 12 each), with middle cerebral artery occlusion (MCAO) except sham group, were used to investigate the neuroprotective effect of certain concentration (0.05 mg/kg) of TSA, and whether the neuroprotective effect of TSA is associated with activation of the PI3K/Akt signaling pathway through using of wortmannin (0.25 mg/kg). RESULTS: TSA significantly increased the expression of p-Akt protein, reduced infarct volume, and attenuated neurological deficit in rats with transient MCAO, wortmannin weakened such effect of TSA dramatically. CONCLUSIONS: TSA could significantly decrease the neurological deficit scores and reduce the cerebral infarct volume during cerebral ischemia/reperfusion injury, which was achieved partly by activation of the PI3K/Akt signaling pathway via upgrading of p-Akt protein.

Meshless method with operator splitting technique for transient nonlinear bioheat transfer in two-dimensional skin tissues.

A meshless numerical scheme combining the operator splitting method (OSM), the radial basis function (RBF) interpolation, and the method of fundamental solutions (MFS) is developed for solving transient nonlinear bioheat problems in two-dimensional (2D) skin tissues. In the numerical scheme, the nonlinearity caused by linear and exponential relationships of temperature-dependent blood perfusion rate (TDBPR) is taken into consideration. In the analysis, the OSM is used first to separate the Laplacian operator and the nonlinear source term, and then the second-order time-stepping schemes are employed for approximating two splitting operators to convert the original governing equation into a linear nonhomogeneous Helmholtz-type governing equation (NHGE) at each time step. Subsequently, the RBF interpolation and the MFS involving the fundamental solution of the Laplace equation are respectively employed to obtain approximated particular and homogeneous solutions of the nonhomogeneous Helmholtz-type governing equation. Finally, the full fields consisting of the particular and homogeneous solutions are enforced to fit the NHGE at interpolation points and the boundary conditions at boundary collocations for determining unknowns at each time step. The proposed method is verified by comparison of other methods. Furthermore, the sensitivity of the coefficients in the cases of a linear and an exponential relationship of TDBPR is investigated to reveal their bioheat effect on the skin tissue.

Lysosome-targeted ruthenium(II) complexes induce both apoptosis and autophagy in HeLa cells.

Ruthenium complexes with good biological properties have attracted increasing attention in recent decades. In this work, three ruthenium polypyridine complexes containing 5-fluorouracil derivatives as ligands, [Ru(bpy)2(L)]2+ (Ru1), [Ru(phen)2(L)]2+ (Ru2), [Ru(dip)2(L)]2+ (Ru3) (L = 1-((1,10-phenanthroline-5-amino) pentyl)-5-fluorouracil; bpy = 2,2'-bipyridine; phen =1,10-phenanthroline; dip = 4,7-diphenyl-1,10-phenanthroline), were synthesized and characterized. Based on in vitro cytotoxicity tests, Ru3 (IC50 = 7.35 ± 0.39 µM) showed the best anticancer activity among three compounds in the selected cell lines. It is worth noting that Ru3 also exerts less cytotoxicity on LO2 cell lines, with an IC50 value 5 times higher than that on HeLa cells, indicating its selective activity. Mechanism studies revealed that Ru3 can specifically target lysosomes and induce cell apoptosis in a caspase-dependent manner. Specifically, Ru3 can arrest cell cycle at the G0/G1 phase, increase the intracellular reactive oxygen species (ROS) level, and then damage DNA. In short, Ru3 can eventually cause cell death through the synergy of inducing apoptosis and autophagy, which was further proven by western blot assay results.

Progress in Research on Antitumor Drugs and Dynamic Changes in Skeletal Muscles.

Objective: To review the research progress of reltionship between antitumor drugs and the dynamic changes of the skeletal muscles during treatment phase. Background: Sarcopenia is a common disease in patients with tumors, and it has been agreed that patients with tumors and sarcopenia experience more serious adverse reactions and have a shorter long-term survival after antitumor therapy than patients without sarcopenia. Antitumor drugs whilst beneficial for tumor regression, interferes and synergizes with cancer-induced muscle wasting/sarcopenia, induced myodemia or intramuscular fat and the two conditions often overlap making it difficult to drive conclusions. In recent years, increasing attention has been paid to the dynamic changes in skeletal muscles during antitumor drug therapy. Dynamic changes refer not only measurement skeletal muscle quantity at baseline level, but give more emphasis on the increasing or decreasing level during or end of the whole treatment course. Methods: We retrievaled published English-language original research articles via pubmed, those studies mainly focused on repeated measurements of skeletal muscle index using computed tomography (CT) in cancer patients who received antitumor drug treatment but not received interventions that produced muscle mass change (such as exercise and nutritional interventions). Conclusion: This article will summarize the research progress to date. Most of antineoplastic drug cause skeletal muscle loss during the treatment course, loss of L3 skeletal muscle index is always associated with poor clinical outcomes.

[Evaluation of detection and analysis of chromosome 22q11.2 microdeletion by multiple ligation-dependent probe amplification assay].

OBJECTIVE: To evaluate multiplex ligation-dependent probe amplification (MLPA) assay detection in analysis of chromosome 22q11.2 microdeletion. METHODS: Between March 2008 and September 2009, thirty-two patients including 10 males and 16 females aged between years (3.6±3.1) were selected and evaluated by history, physical examination and medical records. Of these patients, sixteen patients who were previous diagnostic as 22q11.2 microdeletion were in positive control group, the other 16 healthy children were in negative control group. All the patients were detected by MLPA and fluorescence in situ hybridization (FISH) for the presence of a 22q11.2 microdeletion after informed consent. Diagnostic efficacy was assessed by sensitivity, specificity and Kappa analysis. RESULTS: We have applied the two assays of detection of chromosome 22q11.2 microdeletion in 32 patients. Sixteen patients in positive control group were found to have a 22q11.2 deletion and, with the deletion size of 3-Mb. However, as expected, chromosome 22q11.2 deletion was not found in negative control group. The MLPA results were in good agreement with that by FISH. Therefore, MLPA has high sensitivity and specificity. CONCLUSION: MLPA is a rapid, reliable, high-throughput and relatively economical alternative to FISH technology for the diagnosis of 22q11.2 microdeletion. It can provide reliable and helpful information for clinical diagnosis of 22q11.2 microdeletion syndrome.

[Chromosome 22q11.2 microdeletion and phenotype analysis of patients with non-syndromic tetralogy of Fallot].

OBJECTIVE: To investigate the frequency and clinical phenotypes of 22q11.2 microdeletion in patients with non-syndromic tetralogy of Fallot (TOF). METHODS: Six-eight non-syndromic TOF patients (38 males and 30 females, aged 0-11 years) were selected and evaluated by history, physical examination and review of medical records. After informed consent was obtained, peripheral blood was drawn for genomic DNA extraction. Chromosome 22q11.2 microdeletion was screened by multiplex ligation-dependent probe amplification (MLPA). Suspected cases were confirmed with fluorescence in situ hybridization (FISH). Data was analyzed with SPSS 11.5 software. Phenotype-genotype correlations were assessed using Fisher's exact test. P values less than 0.05 on a 2-sided test were considered to be significant. RESULTS: Six-eight non-syndromic TOF children were screened for a 22q11.2 deletion, among which 59 (86.8%) presented pulmonary stenosis (PS) and 9 (13.2%) presented pulmonary atresia (PA). Seven patients (10.3%) were found to have carried a deletion. Among these, four had TOF-PS, three had TOF-PA. The frequency of 22q11.2 deletion in patients with TOF-PA (3/9, 33.3%) is much higher than that of TOF-PS (4/59, 6.80%) (P< 0.05). CONCLUSION: 22q11.2 microdeletion is present in approximately 10.3% of patients with non-syndromic TOF. The deletion tends to have a higher prevalence in patients with TOF-PA. 22q11.2 deletion should be screened in non-syndromic TOF children and genetic counselling may be provided.

[Anatomic variations and corresponding surgical techniques of total anomalous pulmonary venous connection].

OBJECTIVE: To describe the anatomic variations of total anomalous pulmonary venous connection (TAPVC) and its corresponding surgical techniques. METHODS: A total of 143 TAPVC subjects were hospitalized from April 1981 to July 2010. Those patients with other complex congenital heart diseases, such as transposition of great artery and single ventricle, were excluded. A pathological diagnosis was made by echocardiography, magnetic resonance imaging, computed tomography, catheterization and intra-operative findings. The specific types of TAPVC were as follows:supra-cardiac (49.7%, 71/143), cardiac (40.6%, 58/143), infra-cardiac (4.2%, 6/143) and mixed (5.6%, 8/143). The subtypes were classified by the pathway of common confluence, distribution of pulmonary vein and their orifice site. The techniques of surgical repairs included modified Warden procedure and pulmonary vein transplantation. RESULTS: The patients with supra-cardiac type were further divided into 4 subtypes according to the course of vertical veins and their orifice site: right and left veins forming a common confluence, then draining into vertical and innominate veins (n = 65); common confluence of pulmonary vein drainage into superior vena cava through a short vertical vein at the right pulmonary hilus (n = 3); right and left pulmonary veins separately draining into superior vena cava (n = 2); common confluence draining into innominate vein through a right path beside trachea (n = 1). Cardiac types were further divided into 3 subtypes: coronary sinus (n = 20), right atrium (n = 37) and right atrium & sinus (n = 1). Infra-cardiac type had no subtype. Mixed type was more complex and it was further divided into 3 subtypes: bilateral & symmetrical connection (right 2 + left 2, n = 5); bilateral & asymmetrical connection (3 + 1, n = 3). Surgical repairs were performed on 135 patients. The surgical mortality of TAPVC was 5.9% (8/135). And there was no late death. The major causes of death were pulmonary infection and low cardiac output syndrome. CONCLUSION: A detailed classification of TAPVC is of great importance for surgical approaches and methodological designs. And an individualized surgical plan yields excellent patient outcomes.

[Efficacy of arterial duct stenting in neonatal pulmonary atresia with intact ventricular septum].

OBJECTIVE: To evaluate the feasibility and efficacy of arterial duct stenting in neonates with pulmonary atresia and intact ventricular septum. METHODS: Eleven neonatal pulmonary atresia with intact ventricular septum patients received arterial duct stenting in our hospital from December 2007 to September 2010 were involved in this study. The average age was (8.20 +/- 2.90) days (ranged from 3 to 13 days). The average weight was (3.41 +/- 0.29) kg (ranged from 3.00 to 3.88 kg). The stents were selected according to digital subtracted angiography measurements. After checking for correct position by angiography, the balloon was inflated to expand the stent to desired diameter. Oxygen saturation was monitored, echocardiography was measured and stent diameter and location were observed by chest Xray. Patients were followed up at 1, 3, 6 and 12 months post procedure. RESULTS: Stents were successfully implanted in all 11 patients. The preoperative peripheral oxygen saturation was (63.27 +/- 8.47)%, while increased to (82.73 +/- 5.59)% after alprostadil application and to (86.18 +/- 3.19)% after operation (all P < 0.01). After the operation, the peripheral oxygen saturation was higher than alprostadil application (P < 0.05). The intraoperative narrowest diameter of patent ductus arteriosus was (1.69 +/- 0.37) mm, the length was (16.72 +/- 2.37) mm. The internal diameter of implant stents was 4 mm, the length was (20.18 +/- 3.40) mm. After the operation, surgical B-T shunt operation was performed in one patient due to stent shift and pulse oxygen saturation decrease. One patient died post operation with unknown reason, another patient received stent balloon dilatation due to pulse oxygen saturation decrease at 4 months after the surgery. Pulmonary atresia with intact ventricular septum surgeries were performed in 2 patients at 5 and 7 months after stent implantation. CONCLUSION: The neonatal pulmonary atresia with intact ventricular septum arterial stent implantation was a feasible and effective procedure and this method could be used as preferred treatment in pulmonary atresia and intact ventricular septum for neonates.

Prognosis of pentalogy of Cantrell depends mainly on the severity of the intracardiac anomalies and associated malformations.

We believe the paper may be of particular interest to the readers of your journal. It is a commentary on van Hoorn et al: Pentalogy of Cantrell: two patients and a review to determine prognostic factors for optimal approach (Eur J Pediatr (2008) 167:29-35). The correct definition of pentalogy of Cantrell and ectopia cordis was described in the text and the determinant factor that affects the prognosis of pentalogy of Cantrell was discussed.

[An analysis on prognostic factors of hilar cholangiocarcinoma].

OBJECTIVE: To investigate the influencing factors on the prognosis of hilar cholangiocarcinoma. METHODS: The clinical data were retrospectively analyzed in 86 cases of hilar cholangiocarcinoma admitted into our hospital from Jan. 2004 to July. 2008. RESULTS: Of 86 cases with hilar cholangiocarcinoma, the mean survival time was 13.7 +/- 2.3 months, 1-year survival 57.3% and 3-year survival 29.7%. The mean survival time in patients with resection operation (19.4 +/- 2.2 months) was significantly longer than those with no operation (7.2 +/- 1.2 months) (P < 0.05). The mean survival time in patients with non-vascular resection group (23.4 +/- 2.1 months) was significantly longer than those with portal vein resection alone group (15.3 +/- 1.4 months) and hepatic artery resection group (9.3 +/- 0.9 month) (P < 0.05). Cox regression analysis showed that staging, tumor diameter and operative were the dependent prognosis factors while pathologic type, vascular resection and age not the dependent prognosis factors. CONCLUSION: The prognosis of hilar cholangiocarcinoma correlates with operative approach, clinical stage and tumor diameter. A surgeon must be cautious to choose the surgical approach for treatment.

[Transesophageal echocardiography-guided hybrid therapy for ventricular septal defects in children].

OBJECTIVE: To evaluate transesophageal echocardiography (TEE)-guided periventricular device closure for treatment of ventricular septal defects (VSD) in children. METHODS: The Amplatzer device was applied, the size of which was 1 or 2 mm larger than the VSD size assessed by TEE. Via a small lower sternotomy, the device was introduced through right ventricular surface to close the VSD under continuous TEE guidance without cardiopulmonary bypass. RESULT: The procedures were successful in 6 cases, including 4 cases with muscular VSD and 2 cases with perimembranous VSD. The diameter of VSD was 3 mm to 10 mm and one case had pulmonary hypertension. One case of multi-muscular VSD with transposition of the great arteries failed to the treatment because the mitral open was interfered by the device. One case had bundle branch block in ICU stay and returned to normal without special therapy. The average operation time was 30 min and blood loss was 5 approximately 20 ml, no patients required blood transfusion; the average length of ICU stay was 24 h. Patients were discharged 1 to 2 d postoperatively. At a median follow-up for 12 months, all patients were asymptomatic and had no residual ventricular shunts. CONCLUSION: With the guide of TEE, intra-operative hybrid therapy is a safe and effective method for closure of muscular and perimembranous VSD without cardiopulmonary bypass in children.

Pancreaticoduodenectomy for advanced gastric cancer with pancreaticoduodenal region involvement.

AIM: To characterize the factors of the improved survival following combined pancreaticoduodenectomy (PD) and gastrectomy for the treatment of advanced gastric cancer with pancreaticoduodenal region involvement. METHODS: From 1995 to 2004, 53 patients with primary gastric cancer were diagnosed with synchronous (n = 44) or metachronous (n = 9) pancreaticoduodenal region involvement. Of these, 17 patients (32%) underwent total gastrectomy (TG) or distal subtotal gastrectomy (SG) combined with PD simultaneously. The preoperative demographic, clinical information, clinicopathologic features and the surgical results of these 17 patients were considered as factors influencing survival and were analyzed by the Kaplan-Meier method with log-rank comparison. RESULTS: The actual 1- and 3-year survival rates of these 17 patients after resection were 77% and 34%, respectively, and three patients survived for more than 5 years after surgery. The tumor-free resection margin (P = 0.0174) and a well-differentiated histologic type (P = 0.0011) were significant prognostic factors on univariate analysis. No mortality occurred within one mo after operation, postoperative weight loss of different degree was present in all the patients with TG and 12 cases had other complications. There were 9 (53%) cases of recurrence in 5-48 mo after operation. The survival rate in the palliative and explorative group was significantly (P = 0.0064) lower than in the combined PD group. CONCLUSION: Judicious use of en bloc PD and gastrectomy and strictly preventing postoperative complications may improve the long-term survival for advanced gastric cancer patients with pancreaticoduodenal region involvement. Well-differentiated histology and negative resection margin are the most important predictors of long survival.

[The role of vascular resection and reconstruction in the treatment of hilar cholangiocarcinoma].

OBJECTIVE: To evaluate the role of vascular resection and reconstruction in the treatment of hilar cholangiocarcinoma. METHODS: 117 patients with potentially resectable hilar cholangiocarcinoma underwent exploration. Twenty-one patients had exploration or drainage only due to distant metastases, and the other 96 patients received surgical resection. Thirty-one of those had vascular resection and reconstruction, including portal vein resection alone in 21 patients, combined hepatic artery and portal vein resection in 2 and hepatic artery resection alone in 8. Therefore, the patients were divided into four groups: non-surgical resection (21), portal vain resection (21), hepatic artery resection (10) and non-vascular resection (65) and their clinical data were reviewed retrospectively. RESULTS: The hepatic artery resection group had significantly higher perioperative morbidity and mortality rate (80.0% and 20.0%) than non-vascular resection group (16.9% and 1.5%), respectively, (P < 0.05), while no significant difference was found between the portal vein resection alone group and the non-vascular resection group (P > 0.05). Of all resected vessel specimens, vascular wall invasion beyond the adventitia was pathologically confirmed in 82.6% of the portal veins and 50.0% of the hepatic arteries. The 1-, 3- and 5-year survival rates were 59.0%, 34.0%, and 16.0% in the non-vascular resection group, versus 44.0%, 23.0% and 11.0% in the portal vein resection alone group (P < 0.05) and 18.0%, 0 and 0 in the hepatic artery resection group (P < 0.01), respectively, with a significant difference among the three groups. The 1-, 3- and 5-year survival rates in the non-surgical resection group were 13.0%, 0 and 0, respectively, which were similar to those in the hepatic artery resection group. Though a significant difference in survival rates existed between the portal vein resection alone group and non-resected group (P < 0.001), no significant difference was found between the hepatic artery resection group and non-resected group (P > 0.05). CONCLUSION: Both portal vein and hepatic artery resection can improve resection rate for hilar cholangiocarcinoma, and portal vein resection may improve the prognosis in selected patients. However, hepatic artery resection can not improve survival and may even lead to an increase of perioperative morbidity and mortality.

Non-fluoroscopic percutaneous transcatheter closure of atrial septal defects in children under transesophageal echocardiographic guidance.

BACKGROUND: This study sought to investigate the feasibility, safety and effectiveness of transcatheter closure of atrial septal defects (ASDs) under the guidance of transesophageal echocardiography (TEE) in children. METHODS: We reviewed the medical records of patients who underwent percutaneous ASD closure at our center from August 2016 to December 2017. For a total of 88 patients who were identified as having a single-hole defect and were undergoing percutaneous transcatheter ASD closure, a procedure completely guided by TEE was performed. There were 31 male patients and 57 female patients. The patients' mean age was 60.09 ± 36.42 months (13-182 months), and their mean body weight was 20.16 ± 10.04 kg (9-77 kg). Patients were followed up by performing transthoracic echocardiography and obtaining chest X-rays and electrocardiograms. RESULTS: The transcatheter closure of ASDs was successful in all patients. The mean ASD size was 11.58 ± 5.31 mm (3-28 mm), and the mean size of the occlusion device was 16.07 ± 5.29 mm (6-36 mm). The mean procedural times were 13.33 ± 2.82 minutes (6-16 minutes). The mean hospitalization costs were 27,259.66 ± 2507.04 RMB (25,200.00-33,911.45 RMB). The mean postoperative hospital stay was 3.22 ± 0.53 days (3-5 days). Residual shunt, occlusion device shedding or displacement, and pericardial effusion were not observed during or after the operation. CONCLUSION: Percutaneous transcatheter ASD closure completely guided by TEE is a feasible, safe, non-invasive and easy procedure.

[Surgical treatment for ventricular septal defect in infants under 5 kg of body weight].

OBJECTIVE: To review the indication and timing of surgery,surgical techniques and perioperative management of ventricular septal defect (VSD) repair on infants under 5 kg of body weight. METHODS: From January, 2000 to December, 2005, 134 children patients with VSD and associated anomalies, who were under 5 kg of body weight and aged (3.9+/-1.9) months, were diagnosed and treated in our department. RESULTS: One case died of arrhythmia and heart failure in the early stage of postoperation (mortality 0.7%). The most common postoperative complications were pneumonia (14), pulmonary hypertensive crisis (6), arrhythmia (4), low cardiac output (4), dropsy of thoracic cavity(1). Followed up for 6 m-6 y, the development of all 133 cases was well. Two children with residual shunt got a spontaneous closure confirmed by echocardiography one year postoperatively. CONCLUSION: The clinical results of operations on VSD infants with low body weight are satisfactory with attention to the indication and timing of surgery, proper CPB management, rational operations and perioperative management.

[Effect of cardiopulmonary bypass on CD11/CD18 expression of neutrophils in children undergoing cardiac surgery].

OBJECTIVE: To investigate the changes in perioperative expression level of CD11/CD18 of neutrophils in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). METHODS: Thirty children patients with congenital heart disease underwent cardiac surgery with CPB (CPB group) and the control group consisted of 20 children who received thoracic or general surgery without CPB. Blood samples were drawn at the following time points: pre-surgery, 15 min after onset of CPB, immediately after CPB, 2 h after surgery and on the 1st, 2nd, 3rd postoperative day. D11/CD18 expression on neutrophils and serum concentration of IL-6 and IL-8 were analyzed by flow cytometry and enzyme-linked immunosorbent assay, respectively. RESULT: In CPB group plasma levels of IL-6 and IL-8 increased significantly and peaked at 2 h after initiation of CPB (P<0.05), and descended to the after-anesthesia level at 3rd day after operation. In non-CPB group there was a similar trend of changes in IL-6 and IL-8, but to a much lesser extent. The level of CD11b/CD18 in CPB group began to increase significantly and peaked at 15 min after initiation of CPB (P <0.05), and descended to the after-anesthesia level at 2 h after operation. There was no significant changes of CD11b/CD18 in control group (P >0.05). No significant differences were detected at any time points with respect to expression of CD11a/CD18 and CD11c/CD18 in both groups (P >0.05). CONCLUSION: CPB surgery of children can cause increasing of the CD11b/CD18 expression level of neutrophil but has no significant effect on CD11a/CD18 and CD11c/CD18. CD11b/CD18 may play an important role in the systemic inflammation induced by CPB.