Hepatocellular carcinoma presenting as an extrahepatic mass:A case report and review of literature

BACKGROUND Hepatocellular carcinoma(HCC)is a primary liver tumor generally diagnosed based on radiographic findings.Metastatic disease is typically associated with increased tumor diameter,multifocality,and vascular invasion.We report a case of a patient who presented with extrahepatic HCC metastasis to a portocaval lymph node with occult hepatic primary on computed tomography(CT).We review the literature for cases of extrahepatic HCC presentation without known hepatic lesions and discuss strategies to differentiate between metastatic and ectopic HCC.CASE SUMMARY A 67-year-old male with remotely treated hepatis C was referred for evaluation of an enlarging portocaval,mixed cystic-solid mass.Serial CT evaluations demonstrated steatosis,but no cirrhosis or liver lesions.Endoscopic ultrasound demonstrated a normal-appearing pancreas,biliary tree,and liver.Fine needle aspiration yielded atypical cells.The differential diagnosis included duodenal or pancreatic cyst,lymphoproliferative cyst,stromal or mesenchymal lesions,nodal involvement from gastrointestinal or hematologic malignancy,or duodenal gastrointestinal stromal tumor.After review by a multidisciplinary tumor board,the patient underwent open surgical resection of a 5.2 cm×5.5 cm retroperitoneal mass with pathology consistent with moderately-differentiated HCC.Magnetic resonance imaging(MRI)subsequently demonstrated a 1.2 cm segment VIII hepatic lesion with late arterial enhancement,fatty sparing,and intrinsic T1 hyperintensity.Alpha fetoprotein was 23.3 ng/mL.The patient was diagnosed with HCC with portocaval nodal involvement.Review:We surveyed the literature for HCC presenting as extrahepatic masses without history of concurrent or prior intrahepatic HCC.We identified 18 cases of extrahepatic HCC ultimately found to represent metastatic lesions,and 30 cases of extrahepatic HCC found to be primary,ectopic HCC.CONCLUSION Hepatocellular carcinoma can seldomly present with extrahepatic metastasis in the setting of occult primary.In patients with risk factors for HCC and lesions suspicious for metastatic disease,MRI may be integral to identifying small hepatic lesions and differentiating from ectopic HCC.Tumor markers may also have utility in establishing the diagnosis.

Navigating emotional challenges:A journey with patients undergoing chemotherapy

A recent article reported that cancer patients with subthreshold depression are more likely to develop major depression within a year.Multivariate regression analysis revealed that regular exercise was a protective factor against cancerrelated fatigue,whereas advanced age,radiotherapy,pain,and low hemoglobin were risk factors for cancer-related fatigue.A limitation of this study was the lack of methodological details about leukemia patients receiving depressive treatment at a specific hospital.Professional assessment,behavioral modification plans,communication,destressing techniques,and educational plans may help chemotherapy patients manage emotional issues and reduce anxiety.Furthermore,these strategies can inspire patients to create,facilitate their treatment,and help them to remain healthy.

Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery

AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODS This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy(RG), laparoscopic gastrectomy(LG), open gastrectomy(OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients(RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery(P = 0.42) and stage of the disease(P = 0.16). Intraoperative blood loss was significantly lower in the LG(95.93 ± 119.22) and RG(117.91 ± 68.11) groups compared to the OG(127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG(27.78 ± 11.45), LG(24.58 ± 13.56) and OG(25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P < 0.0001). A similar complications rate was found(P = 0.13). The leakage rate was not different(P = 0.78) between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.

Medical aspects of terrorist bombings: A focus on damage control surgery and damage control resuscitation

Although terrorist bombings have tormented the world for a long time, currently they have reached unprecedented levels and become a continuous threat without borders, race or age. Almost all of them are caused by improvised explosive devices. The unpredictability of the terrorist bombings, leading to simultaneous generation of a large number of casualties and severe "multidimensional" blast trauma require a constant vigilance and preparedness of every hospital worldwide. Approximately 1.0%-2.6% of all trauma patients and 7% of the combat casualties require a massive blood transfusion. Coagulopathy is presented in 65% of them with mortality exceeding 50%. Damage control resuscitation is a novel approach, developed in the military practice for treatment of this subgroup of trauma patients. The comparison with the conventional approach revealed mortality reduction with 40%-74%, lower frequency of abdominal compartment syndrome(8% vs 16%), sepsis(9% vs 20%), multiorgan failure(16% vs 37%) and a significant reduction of resuscitation volumes, both crystalloids and blood products. Damage control surgery(DCS) and damage control resuscitation(DCR) are promising new approaches, contributing for the mortality reduction among the most severely wounded patients. Despite the lack of consensus about the optimal ratio of the blood products and the possible influence of the survival bias, we think that DCR carries survival benefit and recommend it in trauma patients with exsanguinating bleeding.

Parathyroid Surgery Outcome at King Salman Armed Forces Hospital

Introduction: The aim of this study is to review the surgical outcome of parathyroidectomy at one institution over nine years in form of methods of diagnosis, type of surgery, postoperative complications and histopathology findings. Methods: This is a retrospective study from a single institution (King Salman North West Armed Forced Hospital (KSAFH), Tabuk, Saudi Arabia). All cases underwent parathyroidectomy from 1/1/2010 until 31/12/2018 were retrieved from the archives of the department of surgery. Data were extracted from the patients’ charts. They included demographical data, presence of comorbidities, laboratory and radiological investigations, type of surgery, postoperative complications and histopathology findings. Inclusion criteria include patients older than 13 years old. Exclusion criteria include patients younger than 13 years old, hyperparathyroidism cured with medication, patients unwilling to give informed consent and patients with serious underlying medical conditions that restrict diagnostic testing or therapy such as congestive cardiac failure. Results: A total of 30 patients underwent parathyroidectomy at KSAFH. 20 out of 30 patients were female (66.7%). The mean age was 35 - 45 years old. Diabetes mellitus was found in 5 patients (16.7%), while hypertension was seen in 10 patients (33.3%). 6 patients (20%) had end stage renal disease (ESRD). The data showed 24 patients with primary hyperparathyroidism (80%), 5 patients with secondary hyperparathyroisim (16.7%) and one patient with tertiary hyperparathyroidism (3.3%). Our study demonstrated that 23 patients underwent partial parathyroidectomy (76.6%), while 7 patients underwent total parathyroidectomy (23.3%). According to the method used for diagnosis of hyperparathyroidism, blood tests were used in 27 patients (90%), Sestamibi parathyroid scan in 26 patients (86.6%), ultrasound scanning in 28 patients (93.3%) and bone scan in 9 patients (30%). Sensitivity of Sestamibi scan in primary hyperparathyroidism (91.7%) and (66%) for secondary hyperparathyroidism. Mean operative time was 79 minutes. Mean hospital stay was 4 days. Postoperative ccomplications included hypocalcemia in 9 patients (30%), wound infection was (0%), hematoma formation in 2 patients (6.67%), seroma formation in 1 patient (3.33%), vascular injury (0%) and recurrence rate in 2 patients (6.67%). Histopathology findings included parathyroid adenoma in 22 patients (73.3%), parathyroid hyperplasia in 6 patients (20%) and parathyroid carcinoma in 2 patients (6.7%). Rate of cure was 93.3%. Conclusions: Hyper-parathyroidism is more common in female patients than male patients. High sensitivity for sestamibi scan in primary hyperparathyroidism. ESRD is the most common cause of secondary hyperparathyroidism. Most common complication is hypocalcemia. High rate of cure following parathyroid surgery.

Axillary Recurrences after Sentinel Node Surgery—Results over Ten Years in a University Hospital

Background: Sentinel node biopsy (SNB) was introduced at Ullevaal University Hospital in 2000. This article presents results from the first ten years use of the method. Material and Methods: A prospective registration of 2762 patients was made from 2000 through 2009. Results: The median follow-up time was 51 months. The overall detection rate was 93%. 36% of the patients with positive SNs had non-sentinel metastases. These were significantly associated with a macrometastatic SN and a primary tumour>20 mm. 18% of patients with sentinel metastasis≤2 mm had non-sentinel metastases. 14 patients with negative SN (0.7%) developed axillary recurrence. 32% with a preoperative diagnosis of ductal carcinoma in situ (DCIS) were upstaged to infiltrating carcinoma on final histology. None of the patients with pure DCIS had positive SNs. Conclusion: Few late events (0.7%) in SN negative axillas demonstrate the safety of the technique.

Embedding aligned nanofibrous architectures within 3D-printed polycaprolactone scaffolds for directed cellular infiltration and tissue regeneration

Three-dimensional(3D) printing provides a promising way to fabricate biodegradable scaffolds with designer architectures for the regeneration of various tissues.However,the existing3D-printed scaffolds commonly suffer from weak cell-scaffold interactions and insufficient cell organizations due to the limited resolution of the 3D-printed features.Here,composite scaffolds with mechanically-robust frameworks and aligned nanofibrous architectures are presented and hybrid manufactured by combining techniques of 3D printing,electrospinning,and unidirectional freeze-casting.It was found that the composite scaffolds provided volume-stable environments and enabled directed cellular infiltration for tissue regeneration.In particular,the nanofibrous architectures with aligned micropores served as artificial extracellular matrix materials and improved the attachment,proliferation,and infiltration of cells.The proposed scaffolds can also support the adipogenic maturation of adipose-derived stem cells(ADSCs)in vitro.Moreover,the composite scaffolds were found to guide directed tissue infiltration and promote nearby neovascularization when implanted into a subcutaneous model of rats,and the addition of ADSCs further enhanced their adipogenic potential.The presented hybrid manufacturing strategy might provide a promising way to produce additional topological cues within 3D-printed scaffolds for better tissue regeneration.

Prognostic-related genes for pancreatic cancer typing and immunotherapy response prediction based on single-cell sequencing data and bulk sequencing data

Pancreatic cancer is associated with high mortality and is one of the most aggressive of malignancies,but studies have not fully evaluated its molecular subtypes,prognosis and response to immunotherapy of different subtypes.The purpose of this study was to explore the molecular subtypes and the key genes associated with the prognosis of pancreas cancer patients and study the clinical phenotype,prognosis and response to immunotherapy using single-cell seq data and bulk RNA seq data,and data retrieved from GEO and TCGA databases.Methods:Single-cell seq data and bioinformatics methods were used in this study.Pancreatic cancer data were retrieved from GEO and TCGA databases,the molecular subtypes of pancreatic cancer were determined using the six cGAS-STING related pathways,and the clinical phenotype,mutation,immunological characteristics and pathways related to pancreatic cancer were evaluated.Results:Pancreatic cancer was classified into 3 molecular subtypes,and survival analysis revealed that patients in Cluster3(C3)had the worst prognosis,whereas Cluster1(C1)had the best prognosis.The clinical phenotype and gene mutation were statistically different among the three molecular subtypes.Analysis of immunotherapy response revealed that most immune checkpoint genes were differentially expressed in the three subtypes.A lower risk of immune escape was observed in Cluster1(C1),indicating higher sensitivity to immunotherapeutic drugs and subjects in this Cluster are more likely to benefit from immunotherapy.The pathways related to pancreatic cancer were differentially enriched among the three subtypes.Five genes,namely SFRP1,GIPR,EMP1,COL17A and CXCL11 were selected to construct a prognostic signature.Conclusions:Single-cell seq data were to classify pancreatic cancer into three molecular subtypes based on differences in clinical phenotype,mutation,immune characteristics and differentially enriched pathways.Five prognosis-related genes were identified for prediction of survival of pancreatic cancer patients and to evaluate the efficacy of immunotherapy in various subtypes.

Mobilization of monocytic myeloid-derived suppressor cells is regulated by PTH1R activation in bone marrow stromal cells

Myeloid-derived suppressor cells(MDSCs)are bone marrow(BM)-derived immunosuppressive cells in the tumor microenvironment,but the mechanism of MDSC mobilization from the BM remains unclear.We investigated how BM stromal cell activation by PTH1R contributes to MDSC mobilization.PTH1R activation by parathyroid hormone(PTH)or PTH-related peptide(PTHrP),a tumor-derived counterpart,mobilized monocytic(M-)MDSCs from murine BM without increasing immunosuppressive activity.In vitro cell-binding assays demonstrated thatα4β1 integrin and vascular cell adhesion molecule(VCAM)-1,expressed on M-MDSCs and osteoblasts,respectively,are key to M-MDSC binding to osteoblasts.Upon PTH1R activation,osteoblasts express VEGF-A and IL6,leading to Src family kinase phosphorylation in M-MDSCs.Src inhibitors suppressed PTHrP-induced MDSC mobilization,and Src activation in M-MDSCs upregulated two proteases,ADAM-17 and MMP7,leading to VCAM1 shedding and subsequent disruption of M-MDSC tethering to osteoblasts.Collectively,our data provide the molecular mechanism of M-MDSC mobilization in the bones of tumor hosts.

单孔腹腔镜手术:内镜手术的新进展

目的单孔腹腔镜手术在世界上引起了广泛的兴趣和关注。本文结合临床资料介绍我们自己的经验。材料与方法对2008年1月～2009年8月100例单孔胆囊切除资料进行分析,评估这种手术的技术要点、学习曲线、常见问题和解决方法。结果本组实验所有病人均经过术前评估,单孔腹腔镜手术均成功实施。经过50例手术后,平均手术时间与常规腹腔镜手术基本相同。术中常见的问题包括器械之间的冲突、腹腔镜与光纤之间的冲突、器官显露困难。单孔腹腔镜手术不仅具有传统腹腔镜手术的优点,而且其良好的美容效果是传统腔镜手术不具备的。结论单孔腹腔镜手术在世界上逐渐流行。一旦掌握其基本要点,学习曲线可能会缩短。与病人良好的交流以及手术组的密切配合是其成功的基本保证。我们的研究还只是在探索时期,随着技术不断成熟,必然会得到广泛应用。

Heparin improves organ microcirculatory disturbances in caerulein-induced acute pancreatitis in rats

AIM:Microcirculatory disturbances are important early pathophysiological events in various organs during acute pancreatitis.The aim of the study was to evaluate changes in microperfusion of the pancreas,liver,kidney,stomach, colon,skeletal muscle,and to investigate the influence of heparin on the organ microcirculation in caerulein-induced experimental acute pancreatitis. METHODS:Acute pancreatitis was induced by 4 intraperitoneal injections of caerulein(Cn)(15 μg/kg).The organ microcirculation was measured by laser Doppler flowmetry.Serum interleukin 6 and hematocrit levels were analysed. RESULTS:Acute pancreatitis resulted in a significant drop of microperfusion in all examined organs.Heparin administration(2×2.5 mg/kg)improved the microcirculation in pancreas(36.9±4% vs 75.9±10%),liver(56.6±6% vs 75.2±16%),kidney (45.1±6% vs 79.3±5%),stomach (65.2±8% vs 78.1±19%),colon(69.8±6% vs 102.5±19%), and skeletal muscle (59.2±6% vs 77.9±13%).Heparin treatment lowered IL-6(359.0±66 U/mL vs 288.5±58 U/mL) and hematocrit level(53±4% vs 46±3%). CONCLUSION:Heparin administration has a positive influence on organ microcirculatory disturbances accompanying experimental Cn-induced acute pancreatitis.

Multisciplinary management of patients with liver metastasis from colorectal cancer

Colorectal cancer(CRC) is one of the leading causes of cancer-related death. Surgery, radiotherapy and chemotherapy have been till now the main therapeutic strategies for disease control and improvement of the overall survival. Twenty-five per cent(25%) of CRC patients have clinically detectable liver metastases at the initial diagnosis and approximately 50% develop liver metastases during their disease course. Twentythirty per cent(20%-30%) are CRC patients with metastases confined to the liver. Some years ago various studies showed a curative potential for liver metastases resection. For this reason some authors proposed the conversion of unresectable liver metastases to resectable to achieve cure. Since those results were published, a lot of regimens have been studied for resectability potential. Better results could be obtained by the combination of chemotherapy with targeted drugs, such as anti-VEGF and antiEGFR monoclonal antibodies. However an accurate selection for patients to treat with these regimens and to operate for liver metastases is mandatory to reduce the risk of complications. A multidisciplinary team approach represents the best way for a proper patient management. The team needs to include surgeons, oncologists, diagnostic and interventional radiologists with expertise in hepatobiliary disease, molecular pathologists, and clinical nurse specialists. This review summarizes the most important findings on surgery and systemic treatment of CRC-related liver metastases.

Vascular complications following liver transplantation:Aliterature review of advances in 2015

Although vascular complications(VCs) following orthotopic liver transplantation(OLT) seldom occur, they are the most feared complications with a high incidence of both graft loss and mortality, as they compromise the blood flow of the transplant(either inflow or outflow). Diagnosis and therapeutic management of VCs constitute a major challenge in terms of increasing the success rate of liver transplantation. While surgical treatment used to be considered the first choice for management, advances in endovascular intervention have increased to make this a viable therapeutic option. Considering VC as a rare but a major and dreadful issue in OLT history, and in view of the continuing and rapid progress in recent years, an update on these uncommon conditions seemed necessary. In this sense, this review comprehensively discusses the important features(epidemiological, clinical, paraclinical, prognostic and therapeutic) of VCs following OLT.

Treatment of hepatoma with liposome-encapsulated adriamycin administered into hepatic artery of rats

AIM： To observe the therapeutic effects of liposomeencapsulated adriamycin （LADM） on hepatoma in comparison with adriamycin solution （FADM） and adriarnycin plus blank liposome （ADM ＋ BL） administered into the hepatic artery of rats. METHODS： LADM was prepared by pH gradient-driven method. Normal saline, FADM （2 mg/kg）, ADM＋BL （2 mg/kg）, and LADM （2 mg/kg） were injected via the hepatic artery in rats bearing liver W256 carcinosarcoma, which were divided into four groups randomly. The therapeutic effects were evaluated in terms of survival time, tumor enlargement ratio, and tumor necrosis degree. The difference was determined with ANOVA and Dunnett test and log rank test. RESULTS： Compared to FADM or ADM ＋ BL, LADM produced a more significant tumor inhibition （tumor volume ratio： 1.243±0.523 vs 1.883±0.708, 1.847±0.661, P 〈 0.01）, and more extensive tumor necrosis. The increased life span was prolonged significantly in rats receiving LADM compared with FADM or ADM＋BL （231.48 vs 74.66, 94.70） （P 〈 0.05）. CONCLUSION： The anticancer efficacies of adriamycin on hepatoma can be strongly improved by liposomal encapsulation through hepatic arterial administration.

Updates on gastric electrical stimulation to treat obesity: Systematic review and future perspectives

AIM: To evaluate the current state-of-the-art of gastric electrical stimulation to treat obesity. METHODS: Systematic reviews of all studies have been conducted to evaluate the effect of different types of gastric electrical stimulation(GES) on obesity.RESULTS: Thirty-one studies consisting of a total of 33 different trials were included in the systematic review for data analysis. Weight loss was achieved in most studies, especially during the first 12 mo, but only very few studies had a follow-up period longer than 1 year. Among those that had a longer follow-up period, many were from the Transcend(Implantable Gastric Stimulation) device group and maintained significant weight loss. Other significant results included changes in appetite/satiety, gastric emptying rate, blood pressure and neurohormone levels or biochemical markers such as ghrelin or HbA1 c respectively. CONCLUSION: GES holds great promises to be an effective obesity treatment. However, stronger evidence is required through more studies with a standardized way of carrying out trials and reporting outcomes, to determine the long-term effect of GES on obesity.

Epidemiology and molecular genetics of congenital cataracts

Congenital cataract is a crystallin severe blinding disease and genetic factors in disease development are important. Crystallin growth is under a combination of genes and their products in time and space to complete the coordination role of the guidance. Congenital cataract-related genes, included crystallin protein gene (CRYAA, CRYAB, CRYBA1/A3, CRYBA4, CRYBB1, CRYBB2, CRYBB3, CRYGC, CRYGD, CRYGS), gap junction channel protein gene (GJA1, GJA3, GJA8), membrane protein gene (GJA3, GJA8, MIP, LIM2), cytoskeletal protein gene (BF-SP2), transcription factor genes (HSF4, MAF, PITX3, PAX6), ferritin light chain gene (FTL), fibroblast growth factor (FGF) and so on. Currently, there are about 39 genetic loci isolated to which primary cataracts have been mapped, although the number is constantly increasing and depends to some extent on definition. We summarized the recent advances on epidemiology and genetic locations of congenital cataract in this review.

Splenectomy in living donor liver transplantation and risk factors of portal vein thrombosis

Background:Graft inflow modulation(GIM)during adult-to-adult living donor liver transplantation(LDLT)is a common strategy to avoid small-for-size syndrome,and some transplant surgeons attempt small size graft strategy with frequent GIM procedures,which are mostly performed by splenectomy,in LDLT.However,splenectomy can cause serious complications such as portal vein thrombosis and overwhelming postsplenectomy infection.Methods:Forty-eight adult-to-adult LDLT recipients were enrolled in this study and retrospectively reviewed.We applied the graft selection criteria,which routinely fulfill graft-to-recipient weight ratio≥0.8%,and consider GIM as a backup strategy for high portal venous pressure(PVP).Results:In our current strategy of LDLT,splenectomy was performed mostly due to hepatitis C and splenic arterial aneurysms,but splenectomy for GIM was intended to only one patient(2.1%).The final PVP values≤20 mmHg were achieved in all recipients,and no significant difference was observed in patient survival or postoperative clinical course based on whether splenectomy was performed or not.However,6 of 18 patients with splenectomy(33.3%)developed postsplenectomy portal vein thrombosis(PVT),while none of the 30 patients without splenectomy developed PVT after LDLT.Splenectomy was identified as a risk factor of PVT in this study(P<0.001).Our study revealed that a lower final PVP could be risk factor of postsplenectomy PVT.Conclusions:Using sufficient size grafts was one of the direct solutions to control PVP,and allowed GIM to be reserved as a backup procedure.Splenectomy should be avoided as much as possible during LDLT because splenectomy was found to be a definite risk factor of PVT.In splenectomy cases with a lower final PVP,a close follow-up is required for early detection and treatment of PVT.

Development of biomedical publications on ametropia research in PubMed from 1845 to 2010:a bibliometric analysis

We have carried out a bibliometric analysis on the development of ametropia literature to determine its growth rule and tendency, and to provide the basis for the problems related to ametropia research. Literatures that contained the descriptors of ametropia in title or paper published before Nov. 10, 2010 in PubMed databases (www.ncbi.nlm.nih.gov/Pubmed) were selected. As bibliometric indicators of ametropia, biomedical journals referring to ophthalmology by ISSN were calculated. The principal bibliometric indicators: Price's and Bradford's laws were applied on the increase or dispersion of scientific literature, the participation index of languages and the journals. By means of manual coding, literatures were classified according to documents study and statistical analysis. The literatures cited in ametropia, astigmatism, myopia and hypermetropia had accumulated to 26475, which consists of Review (n =1560), Randomized Controlled Trial (n =776), Practice Guideline (n =10), Meta-Analysis (n=23), Letter (n=1222), Editorial (n =328), Clinical Trial ( n =1726) and Others (n=20830); and Humans (n=23073), Animals (n=1434) and Others ( n=1968). 1136 literatures were included in PubMed Central, 22384 in MEDLINE and 2955 in others. The ametropia literatures rose every 5 years which of the ametropia-year cumulated amount of the literatures had three periods: before 1900, slowly increasing from 1901 to 1950, rapidly rising from 1951 to 2010 (increased approximate exponentiation exponent). Sixty kinds of languages were listed in PubMed databases, of which English was dominant for aborting to ametropia research documents before 2010 (77.32%, 20471/26475). The document language of top eight accounted for 95.58% (English, German, French, Japanese, Russian, Italian, Spanish, Chinese), and others for 4.42% (1171/26475). The SCI database includes 48 ophthalmologic journals and the impact factor of 39 journals is >= 1 on Thomson-Reuters in 2010. Of 48 ophthalmologic journals, there were 14785 documents (55.85%) of ametropia, astigmatism, myopia, and hypermetropia. Others were without exception. The bibliometric analysis results show that ametropia literature are increased progressively, approximate exponentiation Exponent during 1951-2010. In addition, ametropia research has become more popular since nearly half century.

Long term recurrence,pain and patient satisfaction after ventral hernia mesh repair

AIM: To compare long term outcomes of laparoscopic and open ventral hernia mesh repair with respect to recurrence, pain and satisfaction.METHODS: We conducted a single-centre follow-up study of 194 consecutive patients after laparoscopic and open ventral hernia mesh repair between March 2000 and June 2010. Of these, 27 patients(13.9%) died and 12(6.2%) failed to attend their follow-up appointment. One hundred and fifty-three(78.9%) patients attended for follow-up and two patients(1.0%) were interviewed by telephone. Of those who attended the follow-up appointment, 82(52.9%) patients had received laparoscopic ventral hernia mesh repair(LVHR) while 73(47.1%) patients had undergone open ventral hernia mesh repair(OVHR), including 11 conversions. The follow-up study included analyses of medical records, clinical interviews, examination of hernia recurrence and assessment of pain using a 100 mm visual analogue scale(VAS) ruler anchored by word descriptors. Overall patient satisfaction was also determined. Patients with signs of recurrence were examined by magnetic resonance imaging or computed tomography scan.RESULTS: Median time from hernia mesh repair to follow-up was 48 and 52 mo after LVHR and OVHR respectively. Overall recurrence rates were 17.1% after LVHR and 23.3% after OVHR. Recurrence after LVHR was associated with higher body mass index. Smoking was associated with recurrence after OVHR. Chronic pain(VAS > 30 mm) was reported by 23.5% in the laparoscopic cohort and by 27.8% in the open surgery cohort. Recurrence and late complications were predictors of chronic pain after LVHR. Smoking was associated with chronic pain after OVHR. Sixty point five percent were satisfied with the outcome after LVHR and 49.3% after OVHR. Predictors for satisfaction were absence of chronic pain and recurrence. Old age and short time to follow-up also predicted satisfaction after LVHR.CONCLUSION: LVHR and OVHR give similar long term results for recurrence, pain and overall satisfaction. Chronic pain is frequent and is therefore important for explaining dissatisfaction.

WWOX suppresses KLF5 expression and breast cancer cell growth

The WW domain-containing oxidoreductase（WWOX） is a tumor suppressor in a variety of cancers, including breast cancer. Reduced WWOX expression is associated with the basal-like subtype and a relatively poor disease-free survival rate among breast cancer patients. Though several WWOX partners have been identified, the functional mechanisms of WWOX＇s role in cancers have not been fully addressed to date. In the current study, we found WWOX suppresses expression of KLF5—an oncogenic transcription factor—at protein level, and suppresses cancer cell proliferation in both bladder and breast cancer cell lines. Furthermore, we demonstrated that WWOX physically interacts with KLF5 via the former＇s WW domains and the latter＇s PY motifs. Interestingly, we found the expression of WWOX negatively correlates with KLF5 expression in a panel of breast cancer cell lines. Taken together, we conjecture that WWOX may suppress cancer cell proliferation partially by reducing the expression of KLF5.