Tumor necrosis as a poor prognostic predictor on postoperative survival of patients with solitary small hepatocellular carcinoma.

BACKGROUND: Small hepatocellular carcinoma (sHCC) is a special subtype of HCC with the maximum tumor diameter ≤ 3 cm and excellent long-term outcomes. Surgical resection or radiofrequency ablation provides the greatest chance for cure; however, many patients still undergo tumor recurrence after primary treatment. To date, there is no clinical applicable method to assess biological aggressiveness in solitary sHCC. METHODS: In the current study, we retrospectively evaluated tumor necrosis of 335 patients with solitary sHCC treated with hepatectomy between December 1998 and 2010 from Sun Yat-sen University Cancer Center. RESULTS: The presence of tumor necrosis was observed in 157 of 335 (46.9%) sHCC patients. Further correlation analysis showed that tumor necrosis was significantly correlated with tumor size and vascular invasion (P = 0.026, 0.003, respectively). The presence of tumor necrosis was associated closely with poorer cancer-specific overall survival (OS) and recurrence-free survival (RFS) as evidenced by univariate (P <  0.001; hazard ratio, 2.821; 95% CI, 1.643-4.842) and multivariate analysis (P = 0.005; hazard ratio, 2.208; 95% CI, 1.272-3.833). Notably, the combined model by tumor necrosis, vascular invasion and tumor size can significantly stratify the risk for RFS and OS and improve the ability to discriminate sHCC patients' outcomes (P <  0.0001 for both). CONCLUSIONS: Our results provide evidence that tumor necrosis has the potential to be a parameter for cancer aggressiveness in solitary sHCC. The combined prognostic model may be a useful tool to identify solitary sHCC patients with worse outcomes.

Efficacy and Safety of Citalopram for the Treatment of Poststroke Depression: A Meta-Analysis.

OBJECTIVE: To objectively evaluate the efficacy and safety of citalopram versus other antidepressant drugs in poststroke depression (PSD) treatment. METHODS: We searched randomized controlled trials (RCTs) that compared citalopram with other Selective serotonin reuptake inhibitors (SSRIs) and Serotonin norepinephrine reuptake inhibitor (SNRIs) on PSD treatment. The methodological quality of RCTs was assessed according to the Cochrane risk of bias tool. Meta-analysis was conducted using RevMan 5.3 software with standard mean difference (SMD) or Relative risk (RR) and their 95% confidence interval (CI). RESULTS: A total of 20 studies involving 1485 patients were included .The RR of efficacy index compared to other SSRIs was 1.04 [95% CI: .98-1.09, P = .17], and to SNRIs was 1.01 [95% CI: .93-1.09, P = .83]. The RR of cure index compared to other SSRIs was .99 [95% CI: .82-1.19, P = .88], and to SNRIs was .95 [95% CI: .71-1.27, P = .74]. Significant decreases on Hamilton Depression Scale scores were observed in favor of citalopram when compared to other SSRIs after 4-, 6-week treatment [SMD = -.44, 95% CI: -.85 to -.03, P = .03; SMD = -.50, 95% CI: -.98 to -.02, P = .04], and no significant difference was found with SNRIs in any week [P > .05]. The rate of adverse effects also showed no significant difference between citalopram and other antidepressants [P > .05]. CONCLUSIONS: This meta-analysis indicates that the efficacy of citalopram is similar to that of other SSRIs and SNRIs, but citalopram takes action faster than other SSRIs. The adverse effects of citalopram have no significant difference compared to other antidepressants and those adverse effects are less and mild.

Therapeutic hypothermia (different depths, durations, and rewarming speeds) for acute ischemic stroke: a meta-analysis.

OBJECTIVES: Whether therapeutic hypothermia benefits patients with acute ischemic stroke (AIS) remains controversial. The aim of this study was to evaluate the efficacy and safety of the different depths, durations, and rewarming speeds of therapeutic hypothermia for AIS. METHODS: The MEDLINE (OVID), EMBASE, and Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials (RCTs) of therapeutic hypothermia for AIS from the inception of the databases to October 2013. After data extraction and quality assessment, a meta-analysis was performed using RevMan 5.1. RESULTS: A total of 6 RCTs involving 252 AIS patients were eligible for the meta-analysis. Subanalyses stratified by depth, duration, and rewarming speed of therapeutic hypothermia were also performed. Our results showed that therapeutic hypothermia was associated with an increased risk of pneumonia (risk ratio = 3.30, 95% CI 1.48-7.34; P = .003, P for heterogeneity = .91, I(2) = 0%). No significant difference was observed between the 2 groups in terms of neurologic outcomes, mortality, and other complications including symptomatic or fatal intracranial hemorrhage, deep vein thrombosis, and atrial fibrillation. CONCLUSIONS: These limited data suggest that therapeutic hypothermia does not significantly improve stroke outcomes and may lead to higher rates of pneumonia. Multicenter RCTs with larger samples are needed to confirm the current findings.