Comparison of laparoscopic hepatectomy,percutaneous radiofrequency ablation and open hepatectomy in the treatment of small hepatocellular carcinoma

Objective

Three mainstream techniques—laparoscopic hepatectomy (LH), percutaneous radiofrequency ablation (pRFA), and open hepatectomy (OH)—were compared in this study, in terms of their efficacies in the treatment of small hepatocellular carcinoma (HCC).

Methods

A comparative study was performed within a total of 94 patients diagnosed with small HCC in our hospital from 2005 to 2010, who underwent LH (28), RFA (33), or OH (33). They had either a single tumor lesion of less than 5 cm or up to three nodules with diameters of less than 3 cm each. Outcomes were carefully evaluated throughout a 3-year follow-up interval and statistically interpreted.

Results

The pRFA group had a significantly lower disease-free survival rate compared with the two surgical groups (P=0.001) and significantly shorter overall survival (P=0.005), while the LH group and the OH group had no difference in survival results. For patients younger than 60 years old, surgical approaches offered a better long-term overall survival prognosis (P=0.008). There were no statistically significant differences among the three groups in overall survival for elderly patients (P=0.104).

Conclusions

Among patients with small HCC, LH may provide better curative effects than pRFA without increasing complication rates. pRFA leads to faster recurrence than surgical resections. LH has similar therapeutic effects to OH and causes less trauma. For patients younger than 60 years old, LH may be the best curative treatment. Elderly patients may choose either surgery or pRFA.

     

Ki-67在肝细胞肝癌中的表达及其临床意义

[目的]探讨抗增殖核蛋白的单克隆抗体(Ki-67)在肝细胞肝癌(HCC)中的表达情况及临床意义.[方法]采用免疫组织化学方法检测51例HCC病人术后存档的石蜡标本中Ki-67的表达情况.[结果]HCC中Ki-67阳性表达率58.8％.Ki-67表达阳性率与肿瘤大小、门脉癌栓和肿瘤分级相关,与肝硬化、病灶数目、包膜、AFP及HBsAg不相关,Ki-67阳性表达组HCC病人术后无瘤生存期均显著低于阴性表达组.[结论]Ki-67对HCC的浸润转移均起促进作用,是HCC预后的重要标志物.     

Prognostic significance of regulatory T lymphocytes in patients with hepatocellular carcinoma

We investigated the prognostic role of regulatory T cells (Tregs) in patients with hepatocellular carcinoma (HCC). Relevant evidence regarding prognostic significance of Tregs was systematically searched in MEDLINE and Embase databases. A meta-analysis was performed to compare survival in patients with high or low Tregs level (either in peripheral blood or tumor). Eighteen studies were identified that fulfilled for the eligibility criteria and were included for data synthesis. Our pooled hazard ratios (HRs) demonstrated that increased Tregs intratumoral accumulation was significantly associated with worse overall survival (HR=2.04, 95% confidence interval (CI): 1.72–2.42) and diseasefree survival (HR=1.82, 95% CI: 1.58–2.09). Three studies evaluated the role of Tregs in peripheral blood, and all of them showed that increased peripheral Tregs correlated with shortened disease-free and overall survival. Collectively, our results showed that the increased Tregs count is tightly associated with the shortened survivals. Its measurement in either primary tumor or even circulation might be a candidate marker of prognostic significance in HCC patients.     

评价宫颈癌预后生物学指标的最新进展

宫颈癌早期是以手术为主的综合治疗,中晚期是以放疗为主的综合治疗。尽管有多种治疗方法可供选择,具有复发高风险因素如巨块型、盆腔淋巴结转移、脉管淋巴转移等情况的宫颈癌,预后仍较差。了解评价宫颈癌预后的生物学指标,对宫颈癌患者治疗方案的选择、化疗及放疗的剂量调整等至关重要。本文从宫颈癌肿瘤内环境指标、与宫颈癌细胞生物学特性相关指标、离体标本相关指标、分子功能影像学方法四方面评价宫颈癌预后生物学指标的最新进展。     

Outcomes of EC-MPS combined with low-dose tacrolimus in DCD kidney transplantation for high-risk DGF recipients

Effective use of immunosuppressive agents to avoid the occurrence of nephrotoxicity and rejection in recipients with delayed graft function (DGF) is a concern for physicians. We investigated the outcomes of treatment with enteric-coated mycophenolate sodium (EC-MPS) in combination with a low-dose of tacrolimus (Tac) in renal transplantation for recipients with a high risk of DGF. We conducted a retrospective study of 61 recipients with a high risk of DGF who were treated with EC-MPS and low-dose Tac. The recipients were separated into a no-DGF group and a DGF group, based on whether DGF actually occurred. The results showed that although EC-MPS and Tac doses were similar in both groups, the percentage of recipients whose mycophenolic acid area under the curve 0–12 h (MPA-AUC_{0–12 h}) was below 30 (mg·h)/L was significantly higher and the Tac trough concentration significantly lower in the DGF group one week after transplantation. Notably, a higher incidence of biopsy-proven acute rejection (BPAR) was found in the DGF group and among all recipients whose MPA-AUC_{0–12 h} was less than 30 (mg·h)/L at one week after transplantation. One-year graft survival, patient survival, allograft function, and the incidence of the most common adverse events were similar in the two groups. In conclusion, the immunosuppressive regime is applicable to Chinese kidney transplant recipients, and early low exposure to EC-MPS was related to acute rejection in the recipients at a high risk of DGF.     

CHOP及GRP78在复发性多形性胶质母细胞瘤患者表达显著增加

目的:研究CHOP及GRP78与复发性GBM的相关性。方法:采用Western blot检测CHOP及GRP78在初发及复发GBM组织中的表达;Real-time PCR检测GRP78在初发以及复发GBM组织中的表达。结果:CHOP及GRP78在初发GBM中表达上调,而在经过原发性肿瘤切除后接受放疗和替莫唑胺化疗的复发性GBM中增加尤为显著。结论:CHOP及GRP78在GBM发病机制中起重要作用,该分子有望成为GMB潜在的诊断及预后评估标志物。     

Advanced primary peritoneal carcinoma： clinicopathological and prognostic factor analyses

Objective: To investigate the factors favoring a positive prognosis for advanced primary peritoneal carcinoma (PPC). Methods: Twenty-four cases meeting the criteria for PPC were analyzed retrospectively for the clinicopathologic profiles. Immunohistochemistry was used to determine the expressions of p53, Top2α, Ki-67 and Her-2/neu. Then all these clinicopathological factors and molecular markers were correlated with the prognosis. Results: There were 15 cases of primary peritoneal serous papillary carcinoma (PPSPC), 6 cases of mixed epithelial carcinoma (MEC) and 3 cases of malignant mixed Mullerian tumor (MMMT). All patients underwent cytoreductive surgery with optimal debulking achieved in 3 cases. Among those receiving first-line chemotherapy, 13 patients received the TP regimen (paclitaxel-cisplatin or carboplatin) and 7 patients received the PAC regimen (cisplatin-doxorubicin-cyclophosphamide). The median overall survival of all patients was 42 months, while the breakdown for survival time for patients with PPSPC, MMT and MEC was 44, 13 and 19 months, respectively. The expressions of p53, Top2a and Ki-67 were all demonstrated in 11 cases respectively. None showed the expression of Her-2/neu. There were significant differences in the median survival between patients with PPSPC and those with MMMT (44 months vs 13 months, P<0.05), also between patients receiving TP combination and those receiving the PAC regimen (75 months vs 28 months, P<0.05). Another significant difference in the median progression-free survival (PFS) was identified between patients with positive p53 immunostaining and those with negative p53 immunostaining (15 months vs 47 months, P<0.05), whereas age, menopausal status, residual tumor size and the other molecular factors did not significantly impact survival. Conclusion: Patients with PPC should be treated with a comprehensive management plan including appropriate cytoreductive surgery and responsive chemotherapy. Overestimating an optimal debulking surgery may not benefit survival. The pathologic subtype, chemotherapy regimen and p53 overexpression were significant prognostic factors.     

Teaching Organisational Theory in Undergraduate Management Programmes: An exercise in facilitated theory testing for active experimentation

Significant attention has been paid in recent years to student attrition, and rightly so, since rates are rising and need diagnosing. Little attention seems to have been paid to the converse--the successful student. It is widely believed among academics that high school grades--in the UK, A-levels--are poor indicators of final performance, although we persist in using them as entry criteria in the absence of any other index into a student's potential. This study, conducted in parallel in two traditional (pre-1992) UK universities, focuses on one discipline that has peculiar characteristics in intake, student expectation and entry criteria. We confirm some widely held beliefs, and scotch some others. As with all such studies, the number of confounding factors is large, but we draw conclusions where possible that are of relevance to all disciplines, and discuss how we mean to proceed.     

The Relationship between Different Criteria for Admission to Medical School and Student Success

The relevance of admission policy for educational outcome in medical schools is demonstrated by means of longitudinal data on the total population of several cohorts of students admitted to the German medical schools on the basis of a variety of criteria (n = 28,000 students). The correlations between the quantitative criteria for admission and performance on the First Medical Examination (which takes place after 2–3 years of study) were calculated. Secondly, the mean total scores on this examination that have been achieved at first attempt by groups of students admitted according to different selection criteria were compared. Thirdly, the rates of success on the medical examination at first attempt after two years of study were compared for the above‐mentioned groups of students. The most striking result is the large difference between the groups under comparison in terms of their success rates in the First Medical Examination. The highest pass rates (80%) are achieved by students selected on the basis of a combination of the average mark in the secondary school leaving certificate and the total score on the ‘Test for Medical Studies’, an aptitude test. Had the students been admitted at random, they would only have attained a pass rate of 48% (base rate). For those admitted on the basis of the result of an interview or on the basis of ‘waiting‐time’ (i.e. the number of semesters they had spent queuing) the pass rates are 49 and 45%. The results are interpreted in the light of different political and educational goals that are or can be envisaged when decisions on admission strategies are made.     

Estrogen receptor expression in adrenocortical carcinoma

Objective: Adrenocortical carcinoma (ACC) is a rare but highly malignant tumor, and its diagnosis is mostly delayed and prognosis is poor. We report estrogen receptor (ER) expression in this tumor and our clinical experiences with 17 ACC cases. Methods: The data of the 17 patients (9 females and 8 males, age range from 16 to 69 years, mean age of 42.6 years) with ACC were reviewed, and symptoms, diagnostic procedures, treatment, and results of follow-up were evaluated. Immunohistochemistry was used to detect ER expression in tumor samples from the 17 patients. Results: At the time of diagnosis, 4 tumors were classified as Stage Ⅰ, 4 as Stage Ⅱ, 3 as Stage Ⅲ, and 6 as Stage Ⅳ. Eight patients demonstrated positive nuclear immunostaining of ER. The prognosis of patients with ER positive was significantly better (P<0.05) than that of patients with ER negative, with 1- and 5-year survival rates at 86% and 60% for ER-positive patients, and 38% and 0% for ER-negative patients, respectively. Conclusion: ER-positivity may be one of the factors associated with a worse prognosis of ACC.     

From research to reality: Australian evidence-based practice in autism education

Many teachers are sporadic in using evidence-based practice (EBP) concerning students with autism spectrum disorder (ASD). Numerous reasons have been posited for this. However, no single study has worked to understand the relative importance of identified criteria in the EBP decision-making processes of teachers. Through the development of a new survey tool, the Evidence-Based Practice Innovation Survey (EBPIAS), an exploration of the decision-making process of Australian teachers in their adoption and cessation of EBP was undertaken. Teachers rated the perception that an EBP would meet the needs of their students as the most important criteria in determining their use of EBP. Conversely, the judgement that an EBP did not meet the needs of their student was the most important criteria in their decision to cease use. In comparing the relevant importance of identified criteria, teachers rated the perception of training as the second-lowest consideration in their decision to adopt and cease using EBP. Consequently, there may need to be greater promotion of, or information concerning, the training required by teachers for effective implementation supporting a more balanced and holistic approach in assessing criteria impacting the adoption of EBP by teachers in the first instance, potentially lowering cessation rates.     

Factors associated with child protection recurrence in Australia

The aim of the current research was to advance understanding of child protection in Australia by examining the factors associated with recurrence of child protection notifications to the formal child protection system. Extant research has been primarily undertaken in the USA and it is important to understand whether similar factors associated with recurrence actually hold in the Australian context. Administrative data were obtained for a sample of 9608 children first subject to a screened-in report in 2011–12. Children were followed for 12 months. Cox Proportional Hazard models were used to measure associations between 26 independent variables and four types of recurrence: subsequent reports, subsequent investigations, subsequent substantiations, and subsequent intervention. Factors associated with recurrence in Australia were broadly similar to those identified in other jurisdictions, including reports and substantiation for neglect, younger age, prior child protection involvement in the household, and parental characteristics including drug use, mental health problems, and history of maltreatment as a child. As in previous studies, post-investigative service provision was positively associated with recurrence. In prior US research, race did not predict recurrence. However, in the present study, Indigenous Australian children were significantly more likely to be subject to all types of recurrence measured. Future research on recurrence should aim to disentangle the complex relationships between child protection recurrence, child maltreatment, and service delivery. Recurrence is not a good proxy indicator of child safety. The findings have implications for the equity of recurrence-based risk assessment tools as they are applied to indigenous populations.     

Mutants of Escherichia coli heat-labile enterotoxin and cholera toxin as mucosal adjuvants

Heat-labile enterotoxin(LT) and cholera toxin(CT) are highly homologous (82 % at the amino acid level), they are the causative factors of travelers diarrhea and cholera respectively[1]. When co-stimulating the surface of the mucosal with antigens, these toxins induce significantly immunological reaction [2]. Because of this character, LT and CT are widely used as mucosal adjuvants in non-human animal models. But the high toxicity and allergenicity caused by IgE antibody (Ab) responded to b…     

Exploring regional and institutional factors of international students' dropout: The South Korea case

With an increasing number of international students in South Korea, the issue of retaining these students and reducing their dropout rates has become important. This study explores the multilevel factors that affect the institutional dropout rate among international students in Korea. The research questions are as follows: (a) to what extent do international students drop out from undergraduate or short‐term programmes in Korean universities?; (b) what are the regional and institutional factors that determine international students' dropout rates? This study uses the panel data on educational institutions as found in the Higher Education in Korea report, which has been updated annually by the Ministry of Education since 2013. According to the pooled ordinary least square and panel analyses, the results indicate that a range of institutional factors (such as type, size, tuition and research performance of academics) and regional factors (such as regional gross domestic product, inflation and the numbers of foreigners in the region) are all associated with the dropout rates of international students. This study suggests that we need to consider various factors to improve the international students' learning experiences both inside and outside of the campus.     

黑木相思种源耐寒性的地理变异

以12个黑木相思种源的一年生枝条为材料,测定不同低温处理下叶片的相对电导率,利用Logistic方程计算各种源的半致死温度(LT50),应用相关分析和主成分回归分析法研究耐寒性的地理变异。结果表明:种源耐寒能力大小依次为M5(NSW)>3(SA)>7(NSW)>2(VIC)>M4(QLD)>16(NSW)>M2(QLD)>M1(QLD)>M6(QLD)>M3(NSW)>1(QLD)>6(NSW),LT50随纬度升高而降低,影响LT50大小的最主要因素是温度(一月均温、年均温、七月均温)及相对湿度。通过聚类分析,将12个种源按LT50大小分成南北两大类群。     

试论生态旅游认证体系的建立和作用

在传统旅游业面临严峻的绿色环保批判的形势下,可持续旅游和生态旅游产品市场应运而生,认证体系作为一种对可持续旅游或生态旅游能清楚定位并提供有效运作的方法,具有提高企业形象和促进市场影响力的“双赢”性,已经被众多的旅游部门、组织、机构自愿或竞争性地接受。针对目前国内外生态旅游发展状况,本文对5个主要生态旅游认证机构（Green Globe21,Certificate for Sustainable Tourism,Green Deal,Smart Voyager,and Fair Trade Tourism in South Africa）在发展中国家的发展情况进行简单对比分析。     

The Doctorate in the Nordic Countries

This article gives an overview of the research training systems in Denmark, Finland, Norway and Sweden with emphasis on the structure, organisation, time span of the degree, completion rates, labour market and internationalisation of postgraduate education. Even though the various national research training systems in the Nordic countries seem to be becoming more similar, there are still differences in their organisational models. In addition, the article compares the Nordic doctoral systems with those of the USA, the UK, Germany and France-the four countries which traditionally have been the most important recipients of Nordic students seeking research training abroad. The model of the US 'graduate school' has been the inspiration and basis for many European initiatives to improve doctoral degree education. In all these countries such schools have been introduced, but often in a modified form and to a limited extent. The main conclusion is that the trend is towards a common international PhD where the content, breadth, length and quality are equivalent.     

Determining the Number of Latent Classes in Single- and Multiphase Growth Mixture Models

Stage-sequential (or multiphase) growth mixture models are useful for delineating potentially different growth processes across multiple phases over time and for determining whether latent subgroups exist within a population. These models are increasingly important as social behavioral scientists are interested in better understanding change processes across distinctively different phases, such as before and after an intervention. One of the less understood issues related to the use of growth mixture models is how to decide on the optimal number of latent classes. The performance of several traditionally used information criteria for determining the number of classes is examined through a Monte Carlo simulation study in single- and multiphase growth mixture models. For thorough examination, the simulation was carried out in 2 perspectives: the models and the factors. The simulation in terms of the models was carried out to see the overall performance of the information criteria within and across the models, whereas the simulation in terms of the factors was carried out to see the effect of each simulation factor on the performance of the information criteria holding the other factors constant. The findings not only support that sample size adjusted Bayesian Information Criterion would be a good choice under more realistic conditions, such as low class separation, smaller sample size, or missing data, but also increase understanding of the performance of information criteria in single- and multiphase growth mixture models.     

磁共振弥散加权成像对索拉菲尼治疗肝细胞癌的疗效评估(英文)

研究目的:应用磁共振弥散加权成像(DWI)监测荷瘤裸鼠肝细胞性肝癌表观弥散系数(ADC)的变化,探讨ADC对索拉菲尼治疗肝细胞性肝癌的疗效预测。创新要点:探讨磁共振DWI对索拉菲尼治疗肝癌疗效的早期评估,期望能够指导临床合理用药。研究方法:荷瘤裸鼠分成两组(治疗组和对照组)共40只,使用GE 3.0T磁共振成像系统和小动物线圈,分别于服药前后1、10、14和18天(40 mg/kg,一天两次)进行T1加权成像(T1WI)、T2加权成像(T2WI)和DWI扫描。在弥散加权图像上进行ADC测量,对比不同区域和不同时间点的差异。重要结论:索拉菲尼治疗10天后,伴随肝癌肿瘤的缩小,肿瘤内部ADC值明显上升,病理切片显示治疗组瘤体中心小血管闭塞,凋亡细胞可见,此时瘤体内坏死细胞并未大量显现,说明ADC值的改变可以反映索拉菲尼的疗效。     

Evaluating admission criteria effects for under-represented groups

The effects that admission criteria may have for under-represented groups are an important concern for programs seeking to improve access to post-secondary education. Using data from a large preservice teacher education program in the Canadian province of Ontario, we demonstrate two approaches to evaluating the effects of admission criteria. The first approach uses survival analysis to compare the effects of minimum admission criteria for determining the admissibility of applicants. The second approach compares the actual admission decisions with the decisions that would have been made using eight alternative sets of rules with varying emphases on academic preparation, ratings of applicants’ essays and applicants’ demographic information. Both approaches offer insights into the roles of specific admission criteria in addressing under-representation.