Treatment and prognosis of hepatic epithelioid hemangioendothelioma based on SEER data analysis from 1973 to 2014

Background: Hepatic epithelioid hemangioendothelioma (HEH) is a rare tumor of vascular origin with an unknown etiology, a low incidence, and a variable natural course. We evaluated the management and prognosis of HEH from the Surveillance, Epidemiology and End Results (SEER) program and changes in treatment modalities of HEH over 30 years. Methods: From 1973 to 2014 in the SEER database, we selected patients diagnosed with HEH. We analyzed the clinical characteristics, patterns of management, and clinical outcomes of patients with HEH. Results: We identi ed 79 patients with HEH (median age: 54.0 years;male to female ratio: 1:2.6). The initial extent of disease was local in 22 (27.8%) patients, regional metastasis in 22 (27.8%), distant metas-tasis in 31 (39.2%) and unknown in 4 (5.1%). The median size of primary tumor was 3.85 cm (interquartile range, 2.50 7.93 cm). Among 74 patients with available management data, the most common manage-ment was no treatment (29/74, 39.2%), followed by chemotherapy only (22/74, 29.7%), liver resection-based (13/74, 17.6%), and transplantation-based therapy (6/74, 8.1%). The 5-year cancer-speci c survival rate was 57.8%. Patients who underwent surgical treatment had signi cantly higher survival than those who underwent non-surgical treatment (5-year survival;88% vs. 49%, P=0.019). Multivariate analysis revealed that surgical therapy was the only independent prognostic factor for survival (hazard ratio: 0.20, P=0.040). Conclusions: Resection or liver transplantation is worth considering for treatment of patients with HEH.

Endoscopic papillary large balloon dilation for the removal of bile duct stones

Endoscopic papillary large balloon dilation(EPLBD)with endoscopic sphincterotomy(EST)has been widely used as the alternative to EST along with endoscopic mechanical lithotripsy(EML)for the removal of large or difficult bile duct stones.Furthermore,EPLBD without EST was recently introduced as its simplified alternative technique.Thus,we systematically searched PubMed,Medline,the Cochrane Library and EMBASE,and analyzed all gathered data of EPLBD with and without EST,respectively,by using a single standardized definition,reviewing relevant literatures,published between 2003and June 2013,where it was performed with largediameter balloons(12-20 mm).The outcomes,including the initial success rate,the rate of needs for EML,and the overall success rate,and adverse events were assessed in each and compared between both of two procedures:"EPLBD with EST"and"EPLBD without EST".A total of 2511 procedures from 30 published articles were included in EPLBD with EST,while a total of413 procedures from 3 published articles were included in EPLBD without EST.In the results of outcomes,the overall success rate was 96.5%in EPLBD with EST and97.2%in EPLBD without EST,showing no significant difference between both of them.The initial success rate(84.0%vs 76.2%,P<0.001)and the success rate of EPLBD without EML(83.2%vs 76.7%,P=0.001)was significantly higher,while the rate of use of EML was significantly lower(14.1%vs 21.6%,P<0.001),in EPLBD with EST.The rate of overall adverse events,pancreatitis,bleeding,perforation,other adverse events,surgery for adverse events,and fatal adverse events were 8.3%,2.4%,3.6%,0.6%,1.7%,0.2%and 0.2%in EPLBD with EST and 7.0%,3.9%,1.9%,0.5%,0.7%,0%and 0%in EPLBD without EST,respectively,showing no significant difference between both of them.In conclusion,recent accumulated results of EPLBD with or even without EST suggest that it is a safe and effective procedure for the removal of large or difficult bile duct stones without any additional risk of severe adverse events,when performed under appropriate guidelines.

Long-type double-balloon enteroscopy-assisted ERCP using hand-made accessories in Roux-en-Y hepaticojejunostomy(with video)

To the Editor:Short-type balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography(BE-ERCP)is becoming the procedure of choice for biliopancreatic disease treatment in patients with postoperative anatomy^([1,2]).However,it has not yet been available in many countries.Although a long-type balloon enteroscope with a200-cm working length has been widely used for small bowel endoscopy,its use for ERCP was limited by the lack of commercially available extra-long accessories^([3]).

Robotic cholecystectomy with new port sites

AIM:To introduce robotic cholecystectomy(RC) using new port sites on the low abdominal area.METHODS:From June 2010 to June 2011,a total of 178 RCs were performed at Ajou University Medical Center.We prospectively collected the set-up time(working time and docking time) and console time in all robotic procedures.RESULTS:Eighty-three patients were male and 95 female;the age ranged from 18 to 72 years of age(mean 54.6 ± 15.0 years).All robotic procedures were successfully completed.The mean operation time was 52.4 ± 17.1 min.The set-up time and console time were 11.9 ± 5.4 min(5-43 min) and 15.1 ± 8.0 min(4-50 min),respectively.The conversion rate to laparoscopic or open procedures was zero.The complication rate was 0.6%(n = 1,bleeding).There was no bile duct injury or mortality.The mean hospital stay was 1.4 ± 1.1 d.There was a significant correlation between the console time and white blood cell count(r = 0.033,P = 0.015).In addition,the higher the white blood cell count(more than 10000),the longer the console time.CONCLUSION:Robotic cholecystectomy using new port sites on the low abdominal area can be safely and efficiently performed,with sufficient patient satisfaction.

Flexible electronics based on one-dimensional and two-dimensional hybrid nanomaterials

Research on flexible or wearable electronics has been grown remarkably due to the advent of nanomaterials,such as metal nanowires,graphene,or transition metal dichalcogenides.Although each nanomaterial has mechanical and electrical characteristics that can be applied into flexible electronics,the limitations of each nanomaterial are also clear.In order to overcome the limitations of these nanomaterials,research on the hybrid structures of nanomaterials has been extensively conducted.In this study,we introduce the properties of one-dimensional nanomaterials,twodimensional nanomaterials,and their hybrid nanomaterials.And then,we provide information concerning various flexible electronics based on these nanomaterials.