ObjectiveTo understand the progress and problems of liver transplantation standard for hepatocellular carcinoma. MethodsThe related articles regarding transplant criteria of hepatocellular carcinoma were reviewed and analyzed. ResultsSince Milan criteria were proposed by Mazzaferro in 1996, a number of criteria were porposed by many transplant centers. These criteria expanded Milan criteria. Compared with Milan criteria, these criteria expanded tumor size and (or) tumor number, or combined with some biological variables, or combined with some immunological variables. However, there are still some issues should be clarified. ConclusionDespite there are many transplant criteria of hepatocellular carcinoma, but a number of issues should be further investigated.
ObjectiveTo review the development and clinical application of ankle prosthesis.MethodsThe recent literature on ankle prosthesis design and clinical application was reviewed and analyzed. ResultsCompared with the hip and knee prostheses, the ankle prosthesis develops slowly and has been developed to the third generation. The ankle joint has a special structure of multi-axis movement. The design of the first and second generations of prostheses is not conformed to the biomechanics of the ankle. The third generation of prosthesis is more conform to the characteristics of ankle biomechanics, with high postoperative survival rate and satisfactory clinical outcome. ConclusionAt present, the survival rate of ankle prosthesis is low, and there is still much room for improvement in biomechanics, materials, and other aspects.
ObjectiveTo summarize the clinical and imaging features of hepatic adrenal rest tumor and to explore its tissue source, diagnosis, differential diagnosis and treatment.MethodsThe clinical data of patient with hepatic adrenal rest tumor in the West China Hospital of Sichuan University were analyzed retrospectively. The diagnostic methods of liver adrenal junction were summarized by consulting relevant literatures.ResultsThe patient was admitted to the hospital with right hepatic lesions. The preoperative imaging examination showed that it was the imaging features of hepatocellular carcinoma. The right hemihepatectomy was proposed. During the operation, it was found that the lesions were not from the liver, but from the retroperitoneum (The possibility of adrenal origin was very high). Then, the retroperitoneal occupying lesions was completely resected via urology surgery consultation. The pathological results showed that the tumor was adrenocortical carcinoma.ConclusionsIt is very difficult to accurately diagnose nature of hepatic adrenal rest tumor before operation only by results of cross-sectional imaging, especially for some adrenal tumor. It needs to fully be evaluated and even to perform multidisciplinary discussion if necessary for patients who have hepatic adrenal rest tumor before operation, so as to avoid misdiagnosis to a certain extent.
ObjectiveTo investigate the predictive value of the preoperative peripheral blood neutrophil percentage-to-albumin ratio (NPAR) for survival after radical resection of hepatocellular carcinoma (HCC) and to construct a nomogram prediction model based on NPAR. MethodsAccording to inclusion and exclusion criteria, the HCC patients with China Liver Cancer Staging (CNLC) stage Ⅰa–Ⅱa who underwent radical hepatectomy at West China Hospital of Sichuan University from January 2010 to December 2020 were retrospectively collected and then randomly divided into a training set and a validation set with a 7∶3 ratio. The optimal cutoff value for NPAR was determined using X-tile. Cox proportional hazards regression model was used to identify the independent risk factors for overall survival (OS) in HCC patients and then construct a nomogram model. The predictive performance of the model was evaluated using the C-index, receiver operating characteristic (ROC) curve, and calibration curve, as well as validated in the validation set. ResultsA total of 3 423 HCC patients with CNLC stage Ⅰa–Ⅱa were enrolled in this study, with 2 397 in the training set and 1 026 in the validation set. There were no statistically significant differences in baseline characteristics between the training and validation sets (P>0.05). The optimal cutoff value for NPAR was 17.0, and patients with NPAR ≤17.0 (2 124 cases) had significantly better OS and relapse-free survival (RFS) than those with NPAR>17.0 (273 cases). The multivariate Cox proportional hazards regression model analysis showed that the alpha-fetal protein>400 μg/L, NPAR>17.0, multiple tumors, tumor diameter >5 cm, poor tumor differentiation, capsular invasion, microvascular invasion, and satellite lesions were the independent risk factors affecting postoperative OS in HCC patients (RR>1, P<0.05). The nomogram constructed based on these risk factors demonstrated good discriminations for OS and RFS (C-indexes of 0.708 and 0.709, respectively) and predictive performance in both the training and validation sets. ConclusionsPreoperative high NPAR (>17.0) in HCC patients with CNLC Ⅰa–Ⅱa stages is associated with significantly worse OS compared to those with low NPAR (≤17.0). The nomogram prediction model based on NPAR can effectively predict postoperative survival.
ObjectiveTo investigate the expression of forkhead box A2 (FXOA2) in intrahepatic cholangiocarcinoma (ICC), and to analyze the relationship between expression of FOXA2 and patient's prognosis after liver resection. MethodsData of 85 patients with ICC who underwent liver resection between 2009 and 2013 in our hospital were collected retrospectively. The expression of FOXA2 was examined by immunohistochemical method, and then the relationship between expression of FOXA2 and patient's prognosis/clinical characteristics was expplored. ResultsAmong the 85 patients, low expression of FOXA2 was detected in 50 patients, whereas high expression was observed in 35 patients. More advanced tumor (Ⅲ+Ⅳ staging) was found in patients with low expression of FOXA2 than patients with high expression of FOXA2 (P < 0.050). The median follow-up time was 15-month (3-73 months). During the follow-up period, 65 patients suffered from recurrence, whereas 64 patients died. The multivariate analysis suggested that, postoperative recurrence was associated with low expression of FOXA2, evaluated preoperative CA19-9, and presence of satellite nodes (P < 0.050). Low expression of FOXA2, evaluated preoperative CA19-9, nerves invasion, and presence of satellite nodes were predictive factors for postoperative prognosis (P < 0.050). ConclusionLow expression of FOXA2 was associated with poor prognosis for patients with ICC after liver resection, and FOXA2 may be a prognostic factor for ICC.
ObjectiveTo summarize the effectiveness of nitinol memory alloy two foot fixator with autologous cancellous bone grafting in treating old scaphoid fracture and nonunion.MethodsBetween January 2013 and January 2017, 11 patients of old scaphoid fracture and nonunion were treated with nitinol memory alloy two foot fixator and autologous cancellous bone grafting. All patients were male with an average age of 26.1 years (range, 18-42 years). The fractures were caused by sport in 3 cases, falling in 7 cases, and a crashing object in 1 case. The interval between injury and operation was 6-18 months (mean, 8.9 months). Postoperative outcome measures included operation time, fracture healing time, grip strength, range of motion (ROM) of flexion, extension, ulnar deviation, and radial deviation, Mayo score, visual analogue scale (VAS) score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe operation time was 35-63 minutes (mean, 48 minutes). All incisions had primary healing with no infection and loosening or breakage of internal fixator. All patients were followed up 12-30 months (mean, 20.7 months). X-ray films showed that fracture healing was achieved in all patients with an average time of 15 weeks (range, 12-25 weeks). All internal fixators were removed after 10-12 months of operation (mean, 11.2 months). At last follow-up, the grip strength, ROMs of flexion, ulnar deviation, and radial deviation were superior to those before operation (P<0.05), no significant difference was found in ROM of extension between pre- and post-operation (t=0.229, P=0.824). There were significant differences in above indexes between affected and normal sides (P<0.05). At last follow-up, the Mayo, VAS, DASH scores were also significantly superior to those before operation (P<0.05).ConclusionFor the old scaphoid fracture and nonunion, Ni-Ti arched shape-memory alloy fixator and autologous cancellous bone grafting can obtain good effectiveness, which is an effective treatment.
The treatment of liver cancer is still a challenge in the world, and it is mainly refers to hepatocellular carcinoma (HCC). There are many factors affecting the overall survival rate of HCC; the recurrence of HCC is the main risk factor affecting the survival of patients, hence, it is urgent to explore the clinical treatment of recurrent HCC to obtain long-term survival of the patients. Up to now, surgical treatment is a radical treatment for HCC. Similarly, liver resection and liver transplantation are still the main therapy methods for recurrent HCC. In addition, radiofrequency ablation and transcatheter arterial chemoembolization and other local treatments still play an irresistible role. Therefore, emphasizing the postoperative follow-up of patients, diagnosing recurrent HCC in early stage, paying attention to the risk factors of HCC recurrence and selecting a suitable treatment plan for individuals are critical ways to prolong the survival of patients.
ObjectiveTo summarize the research progress in artificial metacarpophalangeal joint and interphalangeal joint prostheses.MethodsThe research literature on artificial metacarpophalangeal joint and interphalangeal joint prostheses at home and abroad was reviewed and summarized from anatomy, prosthesis design, and material development.ResultsThe artificial joint replacement can correct deformity, relieve pain, and improve function immediately. In the past 50 years, many researches have focused on the design and material of prostheses and surgical technique of joint replacement. There are three types of prostheses, including hinged limit-type-prosthesis, semi-limit-type-prosthesis, and non-limit-type-prosthesis. The prostheses have their own advantages and disadvantages, the long-term effectiveness of joint replacement is not ideal.ConclusionThe metacarpophalangeal joint and interphalangeal joint prostheses with more anatomical structure and biocompatible materials are needed.