Small-for-size syndrome secondary to outflow block of the segments V and VIII anastomoses--successful treatment with trans-splenic artery embolization: a case report

Despite the rapid expansion of living donor liver transplantation (LDLT) in the adult population over the last few years, small-for-size syndrome (SFSS) has emerged as an important clinical problem. We have herein reported a patient who developed clinical evidence of prolonged cholestasis and intractable ascites after a small-for-size right lobe LDLT. The SFSS was attributed to outflow block of segments V and VIII anastomoses with severe portal overperfusion injury. It was successfully treated by reduction of portal pressure and blood flow after trans-splenic arterial ligation. We recommend that trans-splenic artery embolization, a technically simple procedure, be applied to treat portal overperfusion injury in SFSS.

Photochemical cross-linking for collagen-based scaffolds: a study on optical properties, mechanical properties, stability, and hematocompatibility

Collagen presents an attractive biomaterial for tissue engineering because of its excellent biocompatibility and negligible immunogenicity. However, some intrinsic features related to the mechanical stability and thrombogenicity limit its applications in orthopedic and vascular tissue engineering. Photochemical cross-linking is an emerging technique able to stabilize tissue grafts and improve the physicochemical properties of collagen-based structures. However, other important properties of collagen-based structures and the effect of processing parameters on these properties have not been explored. In this study, we aim to investigate the dose dependence of tensile and swelling properties on two parameters, namely, laser energy fluence and rose Bengal photosensitizer concentration. We also study the compression properties using cyclic compression test, long-term stability using subcutaneous implantation, and hematocompatibility using platelets adhesion test, of cross-linked collagen structures. Moreover, because limited optical penetration in turbid media is the major obstacle for light-based techniques, we also characterize the optical properties, which partially determine the effective optical penetration depth in collagen gel samples, during photochemical cross-linking. Laser energy fluence and rose Bengal concentration are important parameters affecting the cross-linking efficiency, which was characterized as the mechanical and the swelling properties, in a dose-dependent manner. Under the experimental conditions in this study, the peak fluence was 12.5 J/cm2 and the minimal rose Bengal concentration for effective cross-linking was >0.00008% (0.786 micromol). Photochemical cross-linking also enhanced the compression strength and long-term stability of collagen structures without compromising the tissue compatibility. Furthermore, photochemical cross-linking reduced platelet adhesion and abolished fibrin mesh formation, thereby improving the hematocompatibility of collagen structures. These results suggest the feasibility of using the photochemically cross-linked collagen structures for orthopedic and vascular tissue engineering. Finally, the effective optical penetration depth in collagen gel samples is wavelength and rose Bengal concentration dependent, and was approximately 12 mm at 514 nm at 0.001% (9.825 micromol), the rose Bengal concentration mostly used in this study.

Randomized trial of acupuncture versus sham control for prevention of myelosuppression in patients with gynecologic malignancies

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Background: CIM is a significant toxicity that is treated with cytokine growth factors, dose reductions and/or delays. Preliminary uncontrolled Chinese studies suggest that acupuncture lessens CIM. Methods: Patients (pts) with newly diagnosed or recurrent gyn cancers receiving chemotherapy were eligible. Trial design was a double blinded, randomized trial of active acupuncture or sham for 5 weeks (administered 3x per week). Primary endpoints were first nadir WBC and ANC levels at chemo cycle 2; other endpoints were recovering counts following the cycle 2 nadir, QOL, G-CSF levels, and feasibility. Results: >460 patients were screened. 21 pts were randomized to either active acupuncture (n=11) or sham control (n=10). Median age of the pts was 55 yrs (range: 28–81). 15 pts have completed the acupuncture treatment to provide the baseline and nadir WBC and ANC. Toxicities related to either sham or active acupuncture were minimal. The active pts group showed higher baseline WBC (median: 3,600 vs. 2,600, NS) and ANC (median: 2,269 vs. 1,922, NS) values. The nadir WBC was higher in the pts receiving acupuncture (median 3,600 vs. 2,300) but the difference was not statistically significant after adjusting for the baseline difference (p=0.16). Nadir ANC was higher among the pts receiving acupuncture (median: 2,424 vs. 1,274) but the difference was not statistically significant after adjusting for the baseline difference (p=0.1107). Recovering WBC in the pts receiving acupuncture was higher (median: 8,600 vs. 4,400) after adjusting for the baseline difference (p=0.045). The recovering ANC in the pts receiving acupuncture was higher (median: 6,530 vs. 4,038) but this difference was not statistically significant after adjusting for the baseline difference (p=0.0919). QOL and G-CSF data will be presented at ASCO. Conclusions: Although a larger randomized trial is necessary to determine the effects of acupuncture on CIM, there were consistent trends, and recovering WBC counts were significantly higher in patients receiving acupuncture. Formal evaluation of CAM is vital to confirm potentially clinically meaningful benefits.

No significant financial relationships to disclose.

The nonsynonymous single nucleotide polymorphisms of DNA repair geneXRCC1and susceptibility to the development of cervical carcinoma and high-risk human papillomavirus infection

To evaluate contribution of single nucleotide polymorphisms (SNPs) of X-ray repair cross-complementing group 1 (XRCC1) gene to the risk of cervical carcinoma, we conducted a case-control study of 1012 patients including 539 carcinoma and 473 cervical intraepithelial neoplasia (CIN) and 800 normal women controls and genotyped three XRCC1 SNPs (Arg194Trp, Arg280His, and Arg399Gln). We found that compared with the Arg399Gln (GG), subjects carrying the homozygous Gln399Gln (AA) genotype had a significantly 2.32-fold increased risk of cervical carcinoma (95% CI 1.47-3.65), heterozygous Arg399Gln (GA) genotype were also associated with a significantly increased risk of cervical carcinoma, with the adjusted odds ratio (OR) being 1.58 (95% CI 1.24-2.00). Similarly, compared with Arg194Arg (CC) wild-type genotype, elevated risks were associated with the Trp194Trp (TT) for carcinoma (ORs and 95% CIs being 2.09 [1.45-3.02]) but not for heterozygote Arg194Trp (CT). In addition, three common haplotypes were found to be associated with an increased risk of cervical carcinoma. Using 194Arg-280Arg-399Arg as the reference, the OR and 95% confidence interval for 194Arg-280Arg-399Gln, 194Arg-280His-399Arg, 194Trp-280Arg-399Arg were 2.30 (1.86-2.85), 1.85 (1.41-2.41), 1.98 (1.62-2.40), respectively. The significantly increased risk associated with the haplotypes was also observed in squamous cell carcinoma (SCC) for all three common haplotypes using 194Arg-280Arg-399Arg as the reference. Neither difference was found for adenocarcinoma and CIN. All three SNPs and haplotypes did not confer more risk of high-risk human papillomavirus infection in carcinoma, CIN, and normal subgroup. Our findings suggest that XRCC1 polymorphisms including genotypes and haplotypes contribute to susceptibility to the development of cervical SCC, and the increased susceptibility is probably not through increasing susceptibility to human papillomavirus infection.

Primary cervical choriocarcinoma: report of four cases and literature review

Primary cervical choriocarcinoma is very rare. So far, approximately 82 authenticated cases have been reported in the literature. We present additional four cases of primary cervical choriocarcinoma; the clinical features, differential diagnosis, and appropriate management are reported. Up to January 2005, all the four patients survived.