Radiofrequency ablation for single hepatocellular carcinoma 3 cm or less as first-line treatment

AIM:To evaluate long-term outcomes of radiofrequency(RF) ablation as first-line therapy for single hepatocellular carcinoma(HCC) ≤ 3 cm and to determine survival and prognostic factors.METHODS:We included all 184 patients who underwent RF ablation as a first-line treatment for single HCC ≤ 3 cm between April 2005 and December 2013.According to the criteria of Livraghi,the 184 patients were divided into two groups:those suitable for surgical resection(84 cases) and those unsuitable for surgical resection(100 cases).The primary endpoints were the overall survival(OS) rate and safety;the secondary endpoints were primary technique effectiveness and recurrence rate.RESULTS:There were 19(10.3%) cases of ablation related minor complications.The complete tumor ablation rate after one RF session was 97.8%(180/184).The rate of local tumor progression,extrahepatic metastases and intrahepatic distant recurrence were 4.9%(9/184),9.8%(18/184) and 37.5%(69/184),respectively.In the 184 patients,the 1-,3-,and 5-year OS rates were 99.5%,81.0%,and 62.5%,respectively.The 1-,3-,and 5-year OS rates were 100%,86.9%,and 71.4%,respectively,in those suitable for surgical resection and 99.0%,76.0%,and 55.0%,respectively,in those unsuitable for surgical resection(P = 0.021).On univariate and multivariate analyses,poorer OS was associated with Child-Pugh B class and portal hypertension(P < 0.05).CONCLUSION:RF ablation is a safe and effective treatment for single HCC ≤ 3 cm.The OS rate of patients suitable for surgical resection was similar to those reported in surgical series.

Anisodamine accelerates spontaneous passage of single symptomatic bile duct stones ≤ 10 mm

AIM:To investigate the rate of spontaneous passage of single and symptomatic common bile duct(CBD)stones≤10 mm in diameter in 4 wk with or without a2-wk course of anisodamine.METHODS:A multicenter,randomized,placebocontrolled trial was undertaken.A total of 197 patients who met the inclusion criteria were enrolled.Ninetyseven patients were assigned randomly to the control group and the other 100 to the anisodamine group.The anisodamine group received intravenous infusions of anisodamine(10 mg every 8 h)for 2 wk.The control group received the same volume of 0.9%isotonic saline for 2 wk.Patients underwent imaging studies and liver-function tests every week for 4 wk.The rate of spontaneous passage of CBD stones was analyzed.RESULTS:The rate of spontaneous passage of CBD stones was significantly higher in the anisodamine group than that in the control group(47.0%vs 22.7%).Most(87.2%,41/47)stone passages in the anisodamine group occurred in the first 2 wk,and passages in the control group occurred at a comparable rate each week.Factors significantly increasing the possibility of spontaneous passage by univariate logistic regression analyses were stone diameter(<5 mm vs≥5 mm and≤10 mm)and anisodamine therapy.Multivariate logistic regression analyses revealed that these two factors were significantly associated with spontaneous passage.CONCLUSION:Two weeks of anisodamine administration can safely accelerate spontaneous passage of single and symptomatic CBD stones≤10 mm in diameter,especially for stones<5 mm.

Laparoscopic vs computerized tomography-guided radiofrequency ablation for large hepatic hemangiomas abutting the diaphragm

AIM: To compare safety and therapeutic efficacy of laparoscopic radiofrequency(RF) ablation vs computed tomography(CT)-guided RF ablation for large hepatic hemangiomas abutting the diaphragm.METHODS: We retrospectively reviewed our sequential experience of treating 51 large hepatic hemangiomas abutting the diaphragm in 51 patients by CT-guided or laparoscopic RF ablation due to either the presence of symptoms and/or the enlargement of hemangioma.Altogether, 24 hemangiomas were ablated via a CTguided percutaneous approach(CT-guided ablation group), and 27 hemangiomas were treated via a laparoscopic approach(laparoscopic ablation group).RESULTS: The mean diameter of the 51 hemangiomas was 9.6 ± 1.8 cm(range, 6.0-12.0 cm). There was nodifference in the diameter of hemangiomas between the two groups(P > 0.05). RF ablation was performed successfully in all patients. There was no difference in ablation times between groups(P > 0.05). There were 23 thoracic complications in 17 patients: 15(62.5%, 15/24) in the CT-guided ablation group and2(7.4%, 2/27) in the laparoscopic ablation group(P< 0.05). According to the Dindo-Clavien classification,two complications(pleural effusion and diaphragmatic rupture grade Ⅲ) were major in two patients. All others were minor(grade Ⅰ). Both major complications occurred in the CT-guided ablation group. The minor complications were treated successfully with conservative measures, and the two major complications underwent treatment by chest tube drainage and thoracoscopic surgery, respectively. Complete ablation was achieved in 91.7%(22/24) and 96.3%(26/27) in the CT-guided and the laparoscopic ablation groups,respectively(P > 0.05).CONCLUSION: Laparoscopic RF ablation therapy should be used as the first-line treatment option for large hepatic hemangiomas abutting the diaphragm.It avoids thermal injury to the diaphragm and reduces thoracic complications.

Radiofrequency ablation for hepatic hemangiomas: A consensus from a Chinese panel of experts

Recent studies have shown that radiofrequency(RF) ablation therapy is a safe, feasible, and effective procedure for hepatic hemangiomas, even huge hepatic hemangiomas. RF ablation has the following advantages in the treatment of hepatic hemangiomas: minimal invasiveness, definite efficacy, high safety, fast recovery, relatively simple operation, and wide applicability. It is necessary to formulate a widely accepted consensus among the experts in China who have extensive expertise and experience in the treatment of hepatic hemangiomas using RF ablation, which is important to standardize the application of RF ablation for the management of hepatic hemangiomas, regarding the selection of patients with suitable indications to receive RF ablation treatment, the technical details of the techniques, therapeutic effect evaluations, management of complications, etc. A final consensus by a Chinese panel of experts who have the expertise of using RF ablation to treat hepatic hemangiomas was reached by means of literature review, comprehensive discussion, and draft approval.

An In-depth Discourse Analysis of One Radio Interview From the Perspective of Cohesion

As a major criterion for textuality and a prominent term in discourse analysis, discourse cohesion is used on the one hand, to identify the linguistic features that cause the sentences to ＂cohere＂, and on the other hand, is to make the sentences in the discourse display some kind of mutual dependence. The paper has intensively analyzed the radio interview between Edward Heath and an interviewer from the perspective of discourse cohesion. After an in-depth analysis, the paper concludes that the interview is quite structurally cohesive by adopting several grammatical cohesive devices or ties, such as the verbal form, the time relator, the conjunction, the reference, the substitution, and the ellipsis, especially the reference and conjunction

Observation on the Effect of Acupoint Injection plus Massage Therapy on Primary Dysmenorrhea

Objective： To observe the clinical effects of acupoint injection therapy plus massage on primary dysmenorrhea （PD）. Methods： Ninety patients with PD were randomly divided into a treatment group or a control group, 45 cases in each group. The treatment group was treated by injection of Vitamin K3into Sanyinjiao （SP 6） plus massage on Diji （SP 8）. The control group was treated by oral administration of Ibuprofen sustained-release capsule. Before and after the treatment, visual analogue scale （VAS） was adopted to assess pain degree of the patients. The therapeutic effects were observed after continuous treatment of three cycles of menstruation. Results： After treatment, VAS scores were obviously decreased in both groups and the differences were statistically significant （allP＆lt;0.05）. The difference in VAS score after treatment was more significantin the treatment group than that in the control group （P＆lt;0.01）. The total effective rate was significantl higher in the treatment group than that in the control group （P＆lt;0.05）. Conclusion： Acupoint injection therapy plus massage for PD is effective and better than simple oral administration of Ibuprofen sustained-release capsule.

Optimization of microwave-assisted extraction of polysaccharides in the flower of Platycodon grandiflorum by response surface methodology

Platycodon grandiflorum polysaccharides(PGPs)are naturally occurring compounds derived from the flowers of platycodon grandiflorum.the microwave assisted extraction(MAE)of PGPs was studied.A three-level and three-factor Box-Behnken design was used to optimize MAE conditions,and the effects of operating conditions including microwave power(180-540 W),extraction time(20-60 s)and liquid to solid ratio(20-30 v/w)on the extraction yield of PGPs were studied through response surface methodology(RSM).The results showed that the highest yield of PGPs reached 8.35 g/(100 g)at 360 W microwave power,40 s extraction time and 25.2 v/w liquid to solid ratio.The extraction yield of PGPs was significantly affected by liquid to solid ratio(P<0.01),microwave power and extraction time(P<0.05).Compared with the conventional solvent extraction,MAE is more efficient and rapid due to the disruption of the flower tissue microstructure as a result of microwave acoustic cavitation as observed with the scanning electron microscopy(SEM).A macroporous resin,HPD400,was found to be effective for purifying the PGPs extract.