Clinical characteristics of testicular torsion and factors influencing testicular salvage in children:A 12-year study in tertiary center

BACKGROUND Testicular torsion is the most common acute scrotum worldwide and mainly occurs in children and adolescents.Studies have demonstrated that the duration of symptoms and torsion grade lead to different outcomes in children diagnosed with testicular torsion.AIM To predict the possibility of testicular salvage(TS)in patients with testicular torsion in a tertiary center.METHODS We reviewed the charts of 75 pediatric patients with acute testicular torsion during a 12-year period from November 2011 to July 2023 at the Suzhou Hospital of Anhui Medical University.Univariate and multivariate logistic regression analyses were used to determine independent predictors of testicular torsion.The data included clinical findings,physical examinations,laboratory data,color Doppler ultrasound findings,operating results,age,presenting institution status,and follow-up results.RESULTS Our study included 75 patients.TS was possible in 57.3%of all patients;testicular torsion occurred mostly in winter,and teenagers aged 11-15 years old accounted for 60%.Univariate logistic regression analyses revealed that younger age(P=0.09),body mass index(P=0.004),torsion angle(P=0.013),red blood cell count(P=0.03),neutrophil-to-lymphocyte ratio(P=0.009),and initial presenting institution(P<0.001)were associated with orchiectomy.In multivariate analysis,only the initial presenting institution predicted TS(P<0.05).CONCLUSION The initial presenting institution has a predictive value for predicting TS in patients with testicular torsion.Children with scrotal pain should be admitted to a tertiary hospital as soon as possible.

Coupling relationship and genetic mechanisms of shelf-edge delta and deep-water fan source-to-sink:A case study in Paleogene Zhuhai Formation in south subsag of Baiyun Sag,Pearl River Mouth Basin,China

The coupling relationship between shelf-edge deltas and deep-water fan sand bodies is a hot and cutting-edge field of international sedimentology and deep-water oil and gas exploration.Based on the newly acquired high-resolution 3D seismic,logging and core data of Pearl River Mouth Basin(PRMB),this paper dissected the shelf-edge delta to deep-water fan(SEDDF)depositional system in the Oligocene Zhuhai Formation of Paleogene in south subsag of Baiyun Sag,and revealed the complex coupling relationship from the continental shelf edge to deep-water fan sedimentation and its genetic mechanisms.The results show that during the deposition of the fourth to first members of the Zhuhai Formation,the scale of the SEDDF depositional system in the study area showed a pattern of first increasing and then decreasing,with deep-water fan developed in the third to first members and the largest plane distribution scale developed in the late stage of the second member.Based on the development of SEDDF depositional system along the source direction,three types of coupling relationships are divided,namely,deltas that are linked downdip to fans,deltas that lack downdip fans and fans that lack updip coeval deltas,with different depositional characteristics and genetic mechanisms.(1)Deltas that are linked downdip to fans:with the development of shelf-edge deltas in the shelf area and deep-water fans in the downdip slope area,and the strong source supply and relative sea level decline are the two key factors which control the development of this type of source-to-sink(S2S).The development of channels on the continental shelf edge is conducive to the formation of this type of S2S system even with weak source supply and high sea level.(2)Deltas that lack downdip fans:with the development of shelf edge deltas in shelf area,while deep water fans are not developed in the downdip slope area.The lack of“sources”and“channels”,and fluid transformation are the three main reasons for the formation of this type of S2S system.(3)Fans that lack updip coeval deltas:with the development of deep-water fans in continental slope area and the absence of updip coeval shelf edge deltas,which is jointly controlled by the coupling of fluid transformation at the shelf edge and the“channels”in the continental slope area.

Application of fluid modulus inversion to complex lithology reservoirs in deep-water areas

It has been a challenge to distinguish between seismic anomalies caused by complex lithology and hydrocarbon reservoirs using conventional fluid identification techniques,leading to difficulties in accurately predicting hydrocarbon-bearing properties and determining oil-water contacts in reservoirs.In this study,we built a petrophysical model tailored to the deep-water area of the Baiyun Sag in the eastern South China Sea based on seismic data and explored the feasibility of the tri-parameter direct inversion method in the fluid identification of complex lithology reservoirs,offering a more precise alternative to conventional techniques.Our research found that the fluid modulus can successfully eliminate seismic amplitude anomalies caused by lithological variations.Furthermore,the seismic databased direct inversion for fluid modulus can remove the cumulative errors caused by indirect inversion and the influence of porosity.We discovered that traditional methods using seismic amplitude anomalies were ineffective in detecting fluids,determining gas-water contacts,or delineating high-quality reservoirs.However,the fluid factor Kf,derived from solid-liquid decoupling,proved to be sensitive to the identification of hydrocarbon-bearing properties,distinguishing between high-quality and poor-quality gas zones.Our findings confirm the value of the fluid modulus in fluid identification and demonstrate that the tri-parameter direct inversion method can significantly enhance hydrocarbon exploration in deep-water areas,reducing associated risks.

Salvage the Bones and The Not Yet: Environmental Crisis Writing of Post-Katrina Literature

After Hurricane Katrina in 2005,literary works related to such a crisis sprouted the southern America,which are known as Post-Katrina Literature.This thesis,taking Salvage the Bones and The Not Yet as examples,scrutinizes how writers respond to the Post-Katrina environmental crisis in different ways.In Salvage the Bones,Jesmyn Ward employs a biographical genre to record the Katrina disaster,thereby,writings serving as a way of healing the psychic trauma of the writer herself;and in The Not Yet,Moira Crone presents a post-natural world by the employment of the Cli-Fi genre.Both writers enrich the tradition of Southern literature as well as American eco-literature.

Structural characteristics and deep-water hydrocarbon accumulation model of the Scotian Basin, Eastern Canada

Commercial hydrocarbon reservoirs have been discovered in shallow-water areas of the Scotian Basin, Eastern Canada. However, knowledge about the structure and hydrocarbon accumulation characteristics of the basin is still insufficient, which constrains the oil and gas exploration in deep-water areas. Based on comprehensive data of magnetic anomalies, seismic survey, and drilling, this study determines the structure characteristics of the Scotian Basin and its hydrocarbon accumulation conditions in deep waters and evaluates the deep-water hydrocarbon exploration potential. The transform faults and basement structures in the northern basin control the sedimentary framework showing thick strata in east and thin strata in west of the basin. The bowl-shaped depression formed by thermal subsidence during the transitional phase and the confined environment (micro basins) caused by salt tectonics provide favorable conditions for the development of source rocks during the depression stage (also referred to as the depression period sequence) of the basin. The progradation of large shelf-margin deltas during the drift phase and steep continental slope provide favorable conditions for the deposition of slope-floor fans on continental margins of the basin. Moreover, the source-reservoir assemblage comprising the source rocks within the depression stage and the turbidite sandstones on the continental margin in the deep waters may form large deep-water turbidite sandstone reservoirs. This study will provide a valuable reference for the deep-water hydrocarbon exploration in the Scotian Basin.

Sedimentary elements,evolutions and controlling factors of the Miocene channel system:a case study of the deep-water Taranaki Basin in New Zealand

Deep-water channel systems are important petroleum reservoirs,and many have been discovered worldwide.Understanding deep-water channel sedimentary elements and evolution is helpful for deep-sea petroleum exploration and development.Based on high-resolution 3D seismic data,the Miocene channel system in the deep-water Taranaki Basin,New Zealand,was analyzed by using seismic interpretation techniques such as interlayer attribute extraction and strata slicing.The channel system was divided into five composite channels(CC-I to CC-V)according to four secondary level channel boundaries,and sedimentary elements such as channels,slump deposits,inner levees,mass transport deposits,and hemipelagic drape deposits were identified in the channel system.The morphological characteristics of several composite channels exhibited stark variances,and the overall morphology of the composite channels changed from relatively straight to highly sinuous to relatively straight.The evolution of the composite channels involved a gradual and repeated process of erosion and filling,and the composite channels could be divided into three evolutionary stages:initial erosion-filling,later erosion-filling(multistage),and channel abandonment.The middle Miocene channel system may have formed as a consequence of combined regional tectonic activity and global climatic change,and its intricate morphological alterations may have been influenced by the channel's ability to self-regulate and gravity flow properties.When studying the sedimentary evolution of a large-scale deep-water channel system in the Taranaki Basin during the Oligocene-Miocene,which transitioned from a passive margin to plate convergence,it can be understood how tectonic activity affected the channel and can also provide a theoretical reference for the evolution of the deepwater channels in areas with similar tectonic conversion environments around the world.

Quantitative morphometric analysis of a deep-water channel in the Taranaki Basin, New Zealand

The morphological changes of deep-water channels have an important influence on the distributions of channel sand reservoirs,so it is important to explore the morphological change process of deep-water channel for the exploration and development of deep-water oil and gas.Based on a typical sinuous Quaternary channel(Channel I)in the Taranaki Basin,New Zealand,a variety of seismic interpretation techniques were applied to quantitatively characterize the morphological characteristics of the Channel I,and the relationships between the quantitative parameters and the morphological changes of the Channel I,as well as the controlling factors affecting those morphological changes,were discussed.The results are as follows:(1)in the quantitative analysis,six parameters were selected:the channel depth,width,sinuosity,and aspect ratio(width/depth),the channel swing amplitude(λ)and the channel bend frequency(ω);(2)according to the quantitative morphological parameters of the channel(mainly including three parameters such as channel sinuosity,ωandλ),the Channel I was divided into three types:the low-sinuous channel(LSC),the high-sinuous channel(HSC),the moderate-sinuous channel(MSC).U-shaped channel cross-sections developed in the LSC,V-shaped channel cross-sections developed in the HSC,including inclined-V and symmetric-V cross-sections,and dish-shaped channel cross-sections developed in the MSC;(3)the morphological characteristics of the LSC and MSC were related to their widths and depths,while the morphology of the HSC was greatly affected by the channel width,a change in depth did not affect the HSC morphology;(4)the morphological changes of the Channel I were controlled mainly by the slope gradient,the restricted capacity of the channel and the differential in fluid properties.

Repeat peroral endoscopic myotomy with simultaneous submucosal and muscle dissection as a salvage option for recurrent achalasia

BACKGROUND For recurrent achalasia after initial peroral endoscopic myotomy(POEM)failure,repeat POEM(Re-POEM)has been reported as a treatment option.However,severe esophageal interlayer adhesions caused by previous procedures impede the successful establishment of a submucosal tunnel and lead to aborted Re-POEM procedures.Our team previously described POEM with simultaneous submucosal and muscle dissection(POEM-SSMD)as a feasible solution for achalasia with severe interlayer adhesions.AIM To investigate the effectiveness and safety of Re-POEM with simultaneous submucosal and muscle dissection(Re-POEM-SSMD).METHODS A total of 1049 patients with achalasia who underwent successful endoscopic myotomy at the Digestive Endoscopic Center of Chinese PLA General Hospital from December 2014 to May 2022 were reviewed.Patients with recurrent achalasia who experienced initial POEM clinical failure were retrospectively included in this study.The primary endpoint was retreatment clinical success,defined as an Eckardt score≤3 during the postretreatment follow-up and no need for additional treatment.Procedure-related adverse events,changes in manometric lower esophageal sphincter(LES)pressure and reflux complications,as well as procedure-related parameters,were recorded.RESULTS Sixteen patients underwent Re-POEM(9 patients)or Re-POEM-SSMD(7 patients)successfully at a median of 45.5 mo(range,4-95 mo)after initial POEM.During a median followup period of 31 mo(range,7-96 mo),clinical success(Eckardt score≤3)was achieved in 8(88.9%)and 6(85.7%)patients after Re-POEM and Re-POEM-SSMD,respectively(P=0.849).The median Eckardt score dropped from 4(range,3-8)at preretreatment to 1(range,0-5)at postretreatment in the Re-POEM group(P=0.025)and from 5(range,2-8)to 2(range,0-4)in the Re-POEM-SSMD group(P<0.001).The mean manometric LES pressure decreased from 23.78±9.04 mmHg to 11.45±5.37 mmHg after Re-POEM(P<0.001)and from 26.80±7.48 mmHg to 11.05±4.38 mmHg after Re-POEM-SSMD(P<0.001).No serious adverse events were recorded in both groups.CONCLUSION In conclusion,Re-POEM-SSMD appears to be a safe and effective salvage therapy for recurrent achalasia with severe interlayer adhesions.

Salvage locoregional therapies for recurrent hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is the second most common cause of cancerrelated death worldwide.Despite the advent of screening efforts and algorithms to stratify patients into appropriate treatment strategies,recurrence rates remain high.In contrast to first-line treatment for HCC,which relies on several factors,including clinical staging,tumor burden,and liver function,there is no consensus or general treatment recommendations for recurrent HCC(R-HCC).Locoregional therapies include a spectrum of minimally invasive liver-directed treatments which can be used as either curative or neoadjuvant therapy for HCC.Herein,we provide a comprehensive review of recent evidence using salvage loco-regional therapies for R-HCC after failed curative-intent.

Rotationplasty type BIIIb as an effective alternative to limb salvage procedure in adults:Two case reports

BACKGROUND Rotationplasty is often performed for malignant tumors,but type BIIIb rotationplasty is rarely reported,and there needs to be more evidence of the procedure and treatment.The purpose of this case study was to report a new direction in the use of type BIIIb rotationplasty in treating patients with limb salvage and longterm non-healing infections.CASE SUMMARY Case 1:A 47-year-old man underwent radiotherapy for hemangioendothelioma in his left thigh,resulting in a femoral fracture.Despite the use of plates,intramedullary nailing,and external fixators,the femoral bone failed to unite due to infectious nonunion.Multiple operations were unable to control the infection,leaving the patient immobile.We performed a modified tibia-pelvic-constrained hip rotationplasty,utilizing a constrained prosthetic hip between the tibia and pelvis following a femur resection.Two years post-surgery,the patient was able to walk with the prosthetic device without any signs of recurring infection.The corresponding functional scores were 72 points for the Musculoskeletal Tumor Society(MSTS),53 for the Functional Mobility Assessment(FMA),93 for the Toronto Extremity Salvage Score(TESS),and 56 for the MOS 36-item short form health survey(SF-36).Case 2:A 59-year-old woman presented with liposarcoma in her left thigh.Magnetic resonance imaging revealed tumors in the medial,anterior,and posterior femur muscles,encircling the femoral vessels and nerves.Fortunately,there were no symptoms of sciatic dysfunction,and the tumor had not invaded the sciatic nucleus.After one year of follow-up,the patient expressed satisfaction with limb preservation post-type BIIIb rotationplasty.The corresponding functional scores were 63 points for the MSTS,47 for the FMA,88 for the TESS,and 52 for the SF-36.CONCLUSION Our study suggests that type BIIIb rotationplasty may be an alternative to amputation in patients with incurable infections.For malignant tumors of the lower extremities without invasion of the sciatic nerve,type BIIIb rotationplasty remains an excellent alternative to amputation.This surgical method may prevent amputation,improve functional outcomes,and facilitate biological reconstruction.

Theoretical and technical progress in exploration practice of the deep-water large oil fields, Santos Basin, Brazil

The history and results of petroleum exploration in the Santos Basin, Brazil are reviewed. The regularity of hydrocarbon enrichment and the key exploration technologies are summarized and analyzed using the seismic, gravity, magnetic and drilling data. It is proposed that the Santos Basin had a structural pattern of two uplifts and three depressions and the Aram-Uirapuru uplift belt controlled the hydrocarbon accumulation. It is believed that the main hydrocarbon source kitchen in the rift period controlled the hydrocarbon-enriched zones, paleo-structures controlled the scale and quality of lacustrine carbonate reservoirs, and continuous thick salt rocks controlled the hydrocarbon formation and preservation. The process and mechanism of reservoirs being transformed by CO_(2)charging were revealed. Five key exploration technologies were developed,including the variable-velocity mapping for layer-controlled facies-controlled pre-salt structures, the prediction of lacustrine carbonate reservoirs, the prediction of intrusive/effusive rock distribution, the detection of hydrocarbons in lacustrine carbonates, and the logging identification of supercritical CO_(2)fluid. These theoretical recognitions and exploration technologies have contributed to the discovery of deep-water super-large reservoirs under CNODC projects in Brazil, and will guide the further exploration of deep-water large reservoirs in the Santos Basin and other similar regions.

Habitat evaluation for target species following deep-water channel project in the Yangtze River

In order to optimize the design of a 12.5 m deepwater channel project and protect the ecological environment, it is necessary to study the habitat evaluation of species in the engineered area. A coupled eco-hydrodynamic model, which combines a hydrodynamic model （ADCIRC） and a habitat suitability index （HSI） model is developed for target fish （Coilia nasus） and benthos （Corbicula fluminea） in the Yangtze River in order to predict the ecological changes and optimize the regulation scheme. Based on the existing research concerning the characteristics of Coilia nasus and Corbicula fluminea, the relationship between the target species and water environment factors is established. The verification results of tidal level, velocity and biological density show that the proposed coupling model performs well when predicting ecological suitability in the studied region. The results indicate a slight improvement in the potential habitat availability for the two species studied as the natural hydraulic conditions change after the deep-water channel regulation works.

Precut sphincterotomy:A reliable salvage for difficult biliary cannulation

Even experienced endoscopists have 90% success in achieving deep biliary cannulation with standard methods. Biliary cannulation may become difficult in 10%-15% of patients with biliary obstruction and pre- cut (access) sphincterotomy is frequently chosen as a rescue treatment in these cases. Generally, precut sphincterotomy ensures a rate of 90%-100% success- ful deep biliary cannulation. The precut technique has been performed as either a fistulotomy with a needle knife sphincterotome or as a transpapillary septotomy with a standard sphincterotome. Both methods have similar efficacy and complication rates when adminis- tered to the proper patient. Although precut sphincter- otomy ensures over 90% success of biliary cannula- tion, it has been characterized as an independent risk factor for pancreatitis. The complications of the precut technique are not limited to pancreatitis. Two more important ones, bleeding and perforation, are also re- ported in some publications as being observed more commonly than during standard sphincterotomy. It is also reported that precut sphincterotomy increases morbidity when performed in patients without dilata- tion of their biliary tract. Nevertheless, precut sphinc- terotomy is a good alternative as a rescue method in the setting of a failed standard cannulation method. This paper discusses the technical details, timing, ef- ficacy and potential complications of precut sphincter- otomy.

Conversion therapy and suitable timing for subsequent salvage surgery for initially unresectable hepatocellular carcinoma: What is new?

AIM To review the conversion therapy for initially unre-sectable hepatocellular carcinoma(HCC) patients and the suitable timing for subsequent salvage surgery. METHODS A Pub Med search was undertaken from 1987 to 2017 to identify articles using the keywords including "unresectable" "hepatocellular carcinoma", "hepate-ctomy", "conversion therapy", "resection", "salvage surgery" and "downstaging". Additional studies were investigated through a manual search of the references from the articles. The exclusion criteria were duplicates, case reports, case series, videos, contents unrelated to the topic, comments, and editorial essays. The main and widely used conversion therapies and the suitable timing for subsequent salvage surgery were discussed in detail. Two members of our group independently performed the literature search and data extraction. RESULTS Liver volume measurements [future liver remnant(FLR)/total liver volume or residual liver volume/bodyweight ratio] and function tests(scoring systems and liver stiffness) were often performed in order to justify whether patients were suitable candidates for surgery. Successful conversion therapy was usually defined as downstaging the tumor, increasing FLR and providing subsequent salvage surgery, without increasing com-plications, morbidity or mortality. The requirementsfor performing salvage surgery after transcatheter arterial chemoembolization were the achievement of a partial remission in radiology, the disappearance of the portal vein thrombosis, and the lack of extrahepatic metastasis. Patients with a standardized FLR(sF LR) > 20% were good candidates for surgery after portal vein embolization, while other predictive parameters like growth rate, kinetic growth rate were treated as an effective supplementary. There was probably not enough evidence to provide a standard operation time after associating liver partition and portal vein ligation for staged hepatectomy or yttrium-90 microsphere radioembolization. The indications of any combinations of conversion therapies and the subsequent salvage surgery time still need to be carefully and comprehen-sively evaluated. CONCLUSION Conversion therapy is recommended for the treatment of initially unresectable HCC, and the suitable subse-quent salvage surgery time should be reappraised and is closely related to its previous therapeutic effect.

Intraoperative cell salvage with autologous transfusion in liver transplantation

Liver transplant(LT) is the primary treatment for patients with end-stage liver disease. About 25000 LTs are performed annually in the world. The potential for intraoperative bleeding is quite variable. However, massive bleeding is common and requires blood transfusion. Allogeneic blood transfusion has an immunosuppressive effect and an impact on recipient survival, in addition to the risk of transmission of viral infections and transfusion errors, among others.Techniques to prevent excessive bleeding or to use autologous blood have been proposed to minimize the negative effects of allogeneic blood transfusion.Intraoperative reinfusion of autologous blood is possible through previous selfdonation or blood collected during the operation. However, LT does not normally allow autologous transfusion by prior self-donation. Hence, using autologous blood collected intraoperatively is the most feasible option. The use of intraoperative blood salvage autotransfusion(IBSA) minimizes the perioperative use of allogeneic blood, preventing negative transfusion effects without negatively impacting other clinical outcomes. The use of IBSA in patients with cancer is still a matter of debate due to the theoretical risk of reinfusion of tumor cells. However, studies have demonstrated the safety of IBSA in several surgical procedures, including LT for hepatocellular carcinoma. Considering the literature available to date, we can state that IBSA should be routinely used in LT, both in patients with cancer and in patients with benign diseases.

Deep-water Fan Systems and Petroleum Resources on the Northern Slope of the South China Sea

The shallow shelf delta/strand arenaceous-pelitic deposit region in the north of the Pearl River mouth basin, sitting on the northern continental shelf of the South China Sea, has already become an important oil production base in China. Recent researched has revealed that a great deal of deep-water fans of great petroleum potentiality exist on the Baiyun deep-water slope below the big paleo Pearl River and its large delta. Based on a mass of exploration wells and 2-D seismic data of the shallow shelf region, a interpretation of sequence stratigraphy confirmed the existence of deep-water fans. The cyclic falling of sea level, abundant detrital matter from the paleo Pearl River and the persistent geothermal subsidence in the Baiyun sag are the three prerequisites for the formation and development of deep-water fans. There are many in common between the deep-water shelf depositional system of the northern South China Sea and the exploration hotspots region on the two banks of the Atlantic. For example, both are located on passive continent margins, and persistent secular thermal subsidence and large paleo rivers have supplied abundant material sources and organic matter. More recently, the discovery of the big gas pool on the northern slope of the Baiyun sag confirms that the Lower Tertiary lacustrine facies in the Baiyun sag has a great potentiality of source rocks. The fans overlying the Lower Tertiary source rocks should become the main exploration areas for oil and gas resources.

Wave Motion Compensation Scheme and Its Model Tests for the Salvage of An Ancient Sunken Boat

The application of the vertical hoisting jack and wave motion compensation techniques to the salvage of an ancient sunken boat is introduced. The boat is wooden, loaded with cultural relics. It has been immersed at the bottom of the South China Sea for more than 800 years. In order to protect the structure of the boat and the cultural relics inside to the largest extent, an open caisson is used to hold the sunken beat and the silts around before they are raised from the seabed all together as a whole. In the paper, first, the seakeeping model test of the system of the salvage barge and the open caisson is done to determine some important wave response parameters. And then a further experimental study of the ap- plication of the vertical hoisting jack and wave motion compensation scheme to the salvage of the sunken boat is carried out. In the model tests, the techniques of the integrative mechanic-electronic-hydraulic control, wave motion forecast and wave motion compensation are used to minimize the heave motion of the open caisson. The results of the model tests show that the heave motion of the open caisson can be reduced effectively by the use of the present method.

PhaseⅠ/Ⅱtrial evaluating concurrent carbon-ion radiotherapy plus chemotherapy for salvage treatment of locally recurrent nasopharyngeal carcinoma

Background: After deinitive chemoradiotherapy for non-metastatic nasopharyngeal carcinoma(NPC), more than 10% of patients will experience a local recurrence. Salvage treatments present signiicant challenges for locally recurrent NPC. Surgery, stereotactic ablative body radiotherapy, and brachytherapy have been used to treat locally recurrent NPC. However, only patients with small-volume tumors can beneit from these treatments. Re-irradiation with X-ray—based intensity-modulated radiotherapy(IMXT) has been more widely used for salvage treatment of locally recurrent NPC with a large tumor burden, but over-irradiation to the surrounding normal tissues has been shown to cause frequent and severe toxicities. Furthermore, locally recurrent NPC represents a clinical entity that is more radioresistant than its primary counterpart. Due to the inherent physical advantages of heavy-particle therapy, precise dose delivery to the target volume(s), without exposing the surrounding organs at risk to extra doses, is highly feasible with carbon-ion radiotherapy(CIRT). In addition, CIRT is a high linear energy transfer(LET) radiation and provides an increased relative biological efectiveness compared with photon and proton radiotherapy. Our prior work showed that CIRT alone to 57.5 Gy E(gray equivalent), at 2.5 Gy E per daily fraction, was well tolerated in patients who were previously treated for NPC with a deinitive dose of IMXT. The short-term response rates at 3–6 months were also acceptable. However, no patients were treated with concurrent chemotherapy. Whether the addition of concurrent chemotherapy to CIRT can beneit locally recurrent NPC patients over CIRT alone has never been addressed. It is possible that the beneits of high-LET CIRT may make radiosensitizing chemotherapy unnecessary. We therefore implemented a phase I/II clinical trial to address these questions and present our methodology and results.Methods and design: The maximal tolerated dose(MTD) of re-treatment using raster-scanning CIRT plus concurrent cisplatin will be determined in the phase I, dose-escalating stage of this study. CIRT dose escalation from 52.5 to 65 Gy E(2.5 Gy E × 21–26 fractions) will be delivered, with the primary endpoints being acute and subacute toxicities. Eicacy in terms of overall survival(OS) and local progression-free survival of patients after concurrent chemotherapy plus CIRT at the determined MTD will then be studied in the phase II stage of the trial. We hypothesize that CIRT plus chemotherapy can improve the 2-year OS rate from the historical 50% to at least 70%.Conclusions: Re-treatment of locally recurrent NPC using photon radiation techniques, including IMXT, provides moderate eicacy but causes potentially severe toxicities. Improved outcomes in terms of eicacy and toxicity proile are expected with CIRT plus chemotherapy. However, the MTD of CIRT used concurrently with cisplatin-based chemotherapy for locally recurrent NPC remains to be determined. In addition, whether the addition of chemotherapy to CIRT is needed remains unknown. These questions will be evaluated in the dose-escalating phase I and randomized phase II trials.

Controversy over the use of intraoperative blood salvage autotransfusion during liver transplantation for hepatocellular carcinoma patients

Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. The critical points include whether tumor cells can be cleared by IBSA, whether IBSA increases the risk of recurrence or metastasis, and what are the indications for IBSA. Moreover, is it warranted to take the risk of tumor dissemination by using IBSA to avoid allogeneic blood transfusion? Do the remaining tumor cells after additional filtration by leukocyte depletion filters still possess potential tumorigenicity? Does IBSA always work well? We have reviewed the literature and tried to address these questions. The available data indicate that IBSA is safe in LT for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.

Clinical outcomes following salvage Gamma Knife radiosurgery for recurrent glioblastoma

Glioblastoma multiforme(GBM) is the most common malignant primary brain tumor with a survival prognosis of 14-16 mo for the highest functioning patients. Despite aggressive, multimodal upfront therapies, the majority of GBMs will recur in approximately six months. Salvage therapy options for recurrent GBM(r GBM) are an area of intense research. This study compares recent survival and quality of life outcomes following Gamma Knife radiosurgery(GKRS) salvage therapy. Following a Pub Med search for studies usingGKRS as salvage therapy for malignant gliomas, nine articles from 2005 to July 2013 were identified which evaluated rG BM treatment. In this review, we compare overall survival following diagnosis, overall survival following salvage treatment, progression-free survival, time to recurrence, local tumor control, and adverse radiation effects. This report discusses results for rG BM patient populations alone, not for mixed populations with other tumor histology grades. All nine studies reported median overall survival rates(from diagnosis, range:16.7-33.2 mo; from salvage, range:9-17.9 mo). Three studies identified median progression-free survival(range:4.6-14.9 mo). Two showed median time to recurrence of GBM. Two discussed local tumor control. Six studies reported adverse radiation effects(range:0%-46% of patients). The greatest survival advantages were seen in patients who received GKRS salvage along with other treatments, like resection or bevacizumab, suggesting that appropriately tailored multimodal therapy should be considered with each rG BM patient. However, there needs to be a randomized clinical trial to test GKRS for rG BM before the possibility of selection bias can be dismissed.