Strict Selection Criteria Research Articles

Wait-and-see treatment strategies for rectal cancer patients with clinical complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis.

Wait-and-see treatment strategies may benefit rectal cancer patients who achieve a clinical complete response (cCR) after neoadjuvant chemoradiotherapy (NCRT). In this study, we analyzed data from 9 eligible trials to compare the oncologic outcomes of 251 rectal cancer patients achieving a cCR through nonsurgical management approaches with the outcomes of 344 patients achieving a pathologic complete response (pCR) through radical surgery. The two patient groups did not differ in distant metastasis rates or disease-free and overall survival, but the nonsurgical group had a higher risk of 1, 2, 3, and 5-year local recurrence. Hence, we concluded that for rectal cancer patients achieving a cCR after NCRT, a wait-and-see strategy with strict selection criteria, an appropriate follow-up schedule, and salvage treatments achieved outcomes at least as good as radical surgery. Long-term randomized and controlled trials with more uniform inclusion criteria and standardized follow-up schedules will help clarify the risks and benefits of wait-and-see treatment strategies for these patients.

Could careful patient selection for renal denervation warrant a positive effect on arterial stiffness and left ventricular mass reduction?

Aims After the sequence of Symplicity HTN trials, the impact of the procedure on lowering blood pressure (BP) and cardiovascular risk is still debatable. We present initial results of the multimodal pilot study that aimed at carefully selecting proper patients and investigating the effects of RASD on cardiac morphology and central haemodynamic parameters in 15 patients with resistant arterial hypertension prior and 6 months after RASD.Methods and results The multimodal (applanation tonometry, echocardiography and cardiac magnetic resonance (CMR)) study findings have shown a significant BP decrease (190/112 ± 23/12 to 153/91 ± 18/11 mm Hg, P< 0.002), a decrease of the arterial markers (carotid-femoral pulse wave velocity decreased from 11.46 ± 2.92 m/s to 9.17 ± 2.28 m/s and the augmentation index decreased from 25.47 ± 10.55 to 21 ± 12.19, P< 0.006), a significant left ventricular mass index decrease by 10% both by echocardiography (140.83 ± 38.46 to 115.26 ± 25.37 g/m2, n = 14, P< 0.001) and CMR (108.32 ± 39.02 to 97.25 ± 30.06 g/m2, n = 15, P= 0.003). A significant decrease of CMR retrograde flow volume in the ascending aorta non-dependent on BP was also found.Conclusions Our study is characterised by strict and extensive patient selection criteria for renal artery sympathetic denervation (RASD), which seem to warrant a positive effect of the procedure on BP, arterial stiffness and left ventricular mass 6 months after RASD, although it should be confirmed in larger controlled trials.

Domestic LPG interventions in South Africa: Challenges and lessons

A majority of grid-connected households in South Africa use electricity for cooking and heating tasks. This thermal intensive use of electricity has a high load factor and is a contributory factor of electricity demand outstripping supply at peak demand periods. The government has promoted liquefied petroleum gas (LPG) as an alternative thermal energy source for household cooking and heating. This study evaluates the long-term successes, challenges and social impacts of an LPG intervention project that was piloted in Atteridgeville Township, a typical low-income suburb. The data was gathered through one-on-one household interviews with a sample of the beneficiaries. The results indicate that seven years after the LPG intervention, about 70% of the beneficiaries continue to use LPG and report that the intervention has improved their welfare. Fast cooking is cited as the key tangible benefit of LPG technology in households, followed by saving on electricity bills. The project would have achieved more success through better community engagement, including strict beneficiary selection criteria; a long-term LPG distribution and maintenance plan; and inclusion of recurring monthly LPG subsidies for indigent households. The study discusses the subset of factors necessary for successful rollouts of similar energy projects.

American Thyroid Association Statement on Remote-Access Thyroid Surgery.

Remote-access techniques have been described over the recent years as a method of removing the thyroid gland without an incision in the neck. However, there is confusion related to the number of techniques available and the ideal patient selection criteria for a given technique. The aims of this review were to develop a simple classification of these approaches, describe the optimal patient selection criteria, evaluate the outcomes objectively, and define the barriers to adoption. A review of the literature was performed to identify the described techniques. A simple classification was developed. Technical details, outcomes, and the learning curve were described. Expert opinion consensus was formulated regarding recommendations for patient selection and performance of remote-access thyroid surgery. Remote-access thyroid procedures can be categorized into endoscopic or robotic breast, bilateral axillo-breast, axillary, and facelift approaches. The experience in the United States involves the latter two techniques. The limited data in the literature suggest long operative times, a steep learning curve, and higher costs with remote-access thyroid surgery compared with conventional thyroidectomy. Nevertheless, a consensus was reached that, in appropriate hands, it can be a viable option for patients with unilateral small nodules who wish to avoid a neck incision. Remote-access thyroidectomy has a role in a small group of patients who fit strict selection criteria. These approaches require an additional level of expertise, and therefore should be done by surgeons performing a high volume of thyroid and robotic surgery.

Sero - Prevalence of Viral Transfusion-transmissible Infections amongst voluntary Blood donors

This study aimed to determine the Sero-prevalence of viral transfusion-transmissible Infectious diseases among blood donors, namely immunodeficiency virus, hepatitis B and C transmissible infections (TTIs like HBV, HCV.) HIV (Human immune viruses.). sero-prevalence of viral transmissible infections. The donated blood for specific antibodies for infections agents. Can largely reduce the risk of TTIs, virus among blood donors. The study was carried out in the blood bank at Khartoum Teaching Hospital, centre, Sudan. Screening of blood samples for hepatitis B surface Antigen (HBsAg), Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) Antibodies were done using (ELISA) enzyme link immunoassay. The study included (1184) voluntary Blood donors, all were males. The overall prevalence of viral transfusion transmissible Infections were (11.84%). The sero-prevalence for antibody against HIV (6) and hepatitis C Virus was positive in 8 (0.06) and (0.08%) donors respectively while HBsAg was detected in 98 (9.8%) donors. situation that need for strict criteria for selection of blood donors and also methods of laboratory assays. Services are high in Sudan due to the endemicity of infections like malaria, nutritional problem and obstetrical emergencies associated with blood loss. Little is known about the level of these infections in Sudan so; this study was conducted to investigate the sero-prevalence of transfusion transmissible viral infectious diseases in particular human B and hepatitis Immunodeficiency, hepatitis C viruses. The mode of transmission for HIV, HBV and HCV is the same and includes unsafe Sexual sharp materials Contact, using contaminated with body fluid, mother to Child and transfusion of blood and blood Products.

The primordial deuterium abundance: subDLA system atzabs = 2.437 towards the QSO J 1444+2919

We report a new detection of neutral deuterium in the sub Damped Lyman Alpha system with low metallicity [O/H]\,=\,$-2.042 \pm 0.005$ at $z_{\rm abs}=2.437$ towards QSO~J\,1444$+$2919. The hydrogen column density in this system is log$N$(H\,{\sc i})~$=19.983\pm0.010$ and the measured value of deuterium abundance is log(D/H)~$=-4.706\pm0.007_{\rm stat}\pm0.067_{\rm syst}$. This system meets the set of strict selection criteria stated recently by Cooke et al. and, therefore, widens the {\it Precision Sample} of D/H. However, possible underestimation of systematic errors can bring bias into the mean D/H value (especially if use a weighted mean). Hence, it might be reasonable to relax these selection criteria and, thus, increase the number of acceptable absorption systems with measured D/H values. In addition, an unweighted mean value might be more appropriate to describe the primordial deuterium abundance. The unweighted mean value of the whole D/H data sample available to date (15 measurements) gives a conservative value of the primordial deuterium abundance (D/H)$_{\rm p}=(2.55\pm 0.19)\times10^{-5}$ which is in good agreement with the prediction of analysis of the cosmic microwave background radiation for the standard Big Bang nucleosynthesis. By means of the derived (D/H)$_{\rm p}$ value the baryon density of the Universe $\Omega_{\rm b}h^2=0.0222\pm0.0013$ and the baryon-to-photon ratio $\eta_{10} = 6.09\pm 0.36$ have been deduced. These values have confident intervals which are less stringent than that obtained for the {\it Precision Sample} and, thus, leave a broader window for new physics. The latter is particularly important in the light of the lithium problem.

Validation of a treatment algorithm for orthopaedic implant-related infections with device-retention—results from a prospective observational cohort study

Success rates for treatment regimens involving retention of an infected implant are conflicting and failure rates of up to 80% have been reported. We aimed to validate a proposed treatment algorithm, based on strict selection criteria, by assessing long-term outcome of treatment for orthopaedic device-related infection (ODRI) with retention. From January 1999 to December 2009, all patients diagnosed with ODRI at the University Hospital Basel, Switzerland were eligible for treatment with open surgical debridement, implant-retention and antibiotics, if duration of clinical symptoms was ≤3 weeks, the implant was stable, the soft-tissue had no abscess or sinus tract, and the causative pathogen was susceptible to antimicrobial agents with activity against surface-adhering microorganisms. Antimicrobial treatment was administered according to a predefined algorithm. The primary outcome was treatment failure after 2-year follow up. A total of 455 patients were diagnosed with an ODRI, of whom 233 (51.2%) patients were eligible for treatment involving implant-retention. Causative pathogens were mainly Staphylococcus aureus (41.6%) and coagulase-negative staphylococci (33.9%). Among patients with ODRIs related to prostheses, failure was documented in 10.8% (12/111) and in patients with ODRIs related to osteosyntheses, failure occurred in 9.8% (12/122) after 2 years of follow up. In all, 90% of ODRIs were successfully cured with surgical debridement and implant-retention in addition to long-term antimicrobial therapy according to a predefined treatment algorithm: if patients fulfilled strict selection criteria and there was susceptibility to rifampin for Gram-positive pathogens and ciprofloxacin for Gram-negative pathogens.

Prostate capsule sparing radical cystectomy - a safe procedure for few.

The authors present a four-year experience with prostate capsule sparing (PCS) laparoscopic radical cystectomy (RC) [1]. First, these authors should be commended for their execution of a technically challenging procedure. Although this is a small series, the perioperative outcomes (operative time, blood loss, length of stay (LOS)) are similar to published data for the robotic-assisted procedure [2]. Of note, this paper once again shows that hospital LOS is not shortened with a minimally invasive approach, questioning the benefit to patients (the addition of PSC does not contribute to the perioperative convalescence). The authors present impressive potency (90%) and continence (90% day, 85% night) results, showcasing the quality of life (QOL) benefits of PCS. These numbers are consistent with other centers of excellence [3]. This leaves the oncologic outcomes as the controversial aspect of this procedure. There are two cancers to be considered: urothelial carcinoma of the prostate (UCP) and prostate adenocarcinoma (PC). As the authors point out, local recurrence rates of UCP are low with this technique (none in the present report). Similarly, Mertens et al. found UCP recurrence of <1% in 120 patients undergoing PCS RC [3]. In our opinion, this is the most important aspect of avoiding a total prostate resection. Lest we forget that the basis for en bloc prostate removal is to reduce the amount of urothelium left behind. With strict selection criteria such as that in this study, missed ductal or stromal invasion is unlikely. Tumor at or distal to the trigone and the presence of carcinoma in-situ are known risk factors for UCP at time of RC [4, 5], providing guidance for patient selection. Regarding the missed diagnosis of PC, we would contend that this is a substantially over-argued point. If the argument is related to the difficulty treating PC after one has undergone orthotopic neobladder creation, then consider the extremely low likelihood of requiring PC treatment after PCS RC in the literature (<1%). RC can be performed on patients who have previously undergone prostatectomy without added morbidity, so in the rare event of an occurrence of clinically significant PC, subsequent prostatectomy would likely be feasible. Given the significant QOL improvement associated with PCS, the criteria for prostate removal during RC should be based on preoperative clinical concern for PC, including biopsies as indicated. The continence and potency benefits of a PCS RC may both be realized with an orthotopic neobladder, a minority of urinary diversions (30–50% at high volume centers) [6]. However, the more commonly performed cutaneous diversion would see less benefit. Combine this fact with the average age of patients with bladder cancer requiring a RC (over 65, most with poor baseline potency) as well as the pathologic selection criteria, and you realize that PCS RC may be a great procedure, but only for a select few.

ORGAN SAVING TREATMENT OF RECTAL CANCER

Objective : to evaluate the results of “watch and wait” approach for rectal cancer patients with complete clinical response after neoadjuvant chemoradiotherapy (CRT) followed by consolidation chemotherapy. Materials and methods . Between 2013 and 2016, 130 patients who were diagnosed with stage T2N0–1M0–T3(CRM+)–4N0–2M0 middle and low rectal cancer were treated by CRT (single dose 2 Gy to a total dose 50–54 Gy with concominant capecitabine 850 mg/m2 /day of radiotherapy) with consolidation chemotherapy (CapOx) (capecitabine 2000 mg/m2 14 days and oxaliplatin 130 mg/m2 intravenous once in 3 weeks). Results . 21 patient showed complete clinical response. During the time of observation (median 14.6 month) all patients alive without signs of recurrence and progression. Conclusion . Preliminary results showed that organ saving treatment for rectal cancer patients with a complete clinical response is oncologically safe when followed by strict selection criteria and active follow-up, including endoscopy and magnetic resonance imagin. Future investigation is needed to justify this statement. Probability of complete response is higher for early stages of rectal cancer.

Does length of common limb influence remission of diabetes? Short-term results.

BACKGROUND:Despite strict patient selection criteria, diabetes remission is not seen in all patients after gastric bypass. Can length of the common limb influence diabetes remission?AIM:To find if any correlation exists between the length of the common limb and remission of diabetes.STUDY DESIGN:Prospective study.MATERIALS AND METHODS:Twenty-five consecutive patients with Type II diabetes mellitus and a fasting C-peptide >1 ng/ml who underwent laparoscopic Roux-en-y gastric bypass were included. All patients had standard limb lengths and length of the common limb was measured in all patients. Patients were followed up and glycated haemoglobin (HbA1c) was repeated at 6 months postoperatively. Pre- and postoperative HbA1c were then correlated with the lengths of common limb to look for any relation.STATISTICAL ANALYSIS:Descriptive and inferential statistical analysis, analysis of variance (ANOVA).RESULTS:Of the 25 patients, 15 were females and 10 were males. The mean age was 44.16 years and the mean body mass index (BMI) was 43.96 kg/m2. Preoperative HbA1c varied from 5.8 to 12.3%. Length of the common limb varied from 210 to 790 cm (mean 470.4 cm). HbA1c at 6 months ranged from 4.8 to 7.7% (mean 5.81%). On comparison of preoperative and 6 months postoperative HbA1c and correlating with the length of common limb, we found that patients with a common limb of length <600 cm had a statistically significant improvement in HbA1c compared to those with >600 cm length (P = 0.004).CONCLUSION:A shorter common limb does appear to have better chances of resolution of Type II diabetes mellitus in our study, thus paving the way for further studies.

Patterns of Early Rejection in Renal Retransplantation: A Single-Center Experience.

It has been reported that kidney retransplant patients had high rates of early acute rejection due to previous sensitization. In addition to the acute antibody-mediated rejection (ABMR) that has received widespread attention, the early acute T-cell-mediated rejection (TCMR) may be another important issue in renal retransplantation. In the current single-center retrospective study, we included 33 retransplant patients and 90 first transplant patients with similar protocols of induction and maintenance therapy. Analysis focused particularly on the incidence and patterns of early acute rejection episodes, as well as one-year graft and patient survival. Excellent short-term clinical outcomes were obtained in both groups, with one-year graft and patient survival rates of 93.9%/100% in the retransplant group and 92.2%/95.6% in the first transplant group. Impressively, with our strict immunological selection and desensitization criteria, the retransplant patients had a very low incidence of early acute ABMR (6.1%), which was similar to that in the first transplant patients (4.4%). However, a much higher rate of early acute TCMR was observed in the retransplant group than in the first transplant group (30.3% versus 5.6%, P < 0.001). Acute TCMR that develops early after retransplantation should be monitored in order to obtain better transplant outcomes.

Is current clinical practice modified about intraoperative breast irradiation?

After the results obtained in the two randomized clinical trial, the ELIOT trial and the TARGIT-A trial, a heated debate is going on concerning the question of applying intraoperative radiotherapy (IORT) instead of postoperative whole breast irradiation (WBI) after breast conservative treatment. Currently, many centers are applying the IORT following the strict selection criteria dictated by the working groups American Society for Radiation Oncology (ASTRO) and Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) and monitoring the oncological outcome together with radiation toxicity on breast tissue. The clinical experience of the Geneva University Hospital regarding the use of the Intrabeam system is evaluated and compared with current evidences.

A comparison of timed artificial insemination and automated activity monitoring with hormone intervention in 3 commercial dairy herds

The objective of this study was to compare the reproductive performance of cows inseminated based on automated activity monitoring with hormone intervention (AAM) to cows from the same herds inseminated using only an intensive timed artificial insemination (TAI) program. Cows (n=523) from 3 commercial dairy herds participated in this study. To be considered eligible for participation, cows must have been classified with a body condition score of at least 2.50, but no more than 3.50, passed a reproductive tract examination, and experienced no incidences of clinical, recorded metabolic diseases in the current lactation. Within each herd, cows were balanced for parity and predicted milk yield, then randomly assigned to 1 of 2 treatments: TAI or AAM. Cows assigned to the TAI group were subjected to an ovulation synchronization protocol consisting of presynchronization, Ovsynch, and Resynch for up to 3 inseminations. Cows assigned to the AAM treatment were fitted with a leg-mounted accelerometer (AfiAct Pedometer Plus, Afimilk, Kibbutz Afikim, Israel) at least 10d before the end of the herd voluntary waiting period (VWP). Cows in the AAM treatment were inseminated at times indicated by the automated alert system for up to 90d after the VWP. If an open cow experienced no AAM alert for a 39±7-d period (beginning at the end of the VWP), hormone intervention in the form of a single injection of either PGF2α or GnRH (no TAI) was permitted as directed by the herd veterinarian. Subsequent to hormone intervention, cows were inseminated when alerted in estrus by the AAM system. Pregnancy was diagnosed by ultrasound 33 to 46d after insemination. Pregnancy loss was determined via a second ultrasound after 60d pregnant. Timed artificial insemination cows experienced a median 11.0d shorter time to first service. Automated activity-monitored cows experienced a median 17.5-d shorter service interval. No treatment difference in probability of pregnancy to first AI, probability of pregnancy to repeat AI, pregnancy loss, time to pregnancy, or proportion of pregnant cows at 90d past the VWP existed. Based on these results, inseminating cows using AAM with hormone intervention can achieve a level of reproductive performance comparable to TAI. Considering the strict cow selection criteria used in this study, interpretation of results for on-farm implementation should be performed cautiously; the results cannot be directly extrapolated to whole herds of cows.

Effectiveness of decoronation technique in the treatment of ankylosis: A systematic review.

Dentoalveolar ankylosis in growing patients is complex leading to continuing root replacement resorption, tooth infra-position, or may even affect the development of alveolar ridge and adjacent teeth. While extraction of ankylosed teeth might be associated with bone loss, decoronation of the offending tooth (removal of crown portion and instrumentation of pulp canal to stimulate bleeding) has been suggested as a more conservative approach of bone preservation until definitive implant placement is planned. To primarily assess the efficacy of bone width and height preservation around ankylosed permanent teeth following decoronation. Pubmed, Embase, Ovid Medline, Thomson's ISI Web of Science and Cochrane library were searched from the year 1984 up to May 2015. Two authors conducted the data extraction. To eliminate publication bias, Open Grey literature and Pro-quest Dissertation Abstracts and Thesis database was also consulted. Through our strict selection criteria, only 12 articles were considered for eligibility. No randomized controlled trials were identified. Only one retrospective cohort study, four case series and seven case reports, were analyzed. Following decoronation, preservation of ridge height and ridge width were both noted. To maximize the benefits of decoronation, a timely and wellmonitored intervention is required. Treatment in patients, who have surpassed pubertal growth peaks, may not yield maximum effective treatment outcomes.

Outpatient Treatment of Compensated Cuff Arthropathy Using Inlay Arthroplasty With Subscapularis Preservation

Management of the rotator cuff–deficient shoulder remains challenging particularly for younger patients with higher functional demands. Patients presenting with signs and symptoms of cuff tear arthropathy (CTA) are frequently treated with reverse, total, or hemishoulder arthroplasty. Life expectancy must be taken into consideration when deciding on the treatment path for high-demand patients, particularly in light of significant complication rates and poor revision strategies for reverse shoulder arthroplasty. Subsets of patients presenting with early CTA stage IA (Seebauer Classification, Burkhart type I) are suitable candidates for a less-invasive approach. Intact fulcrum kinematics provide a compensated, deltoid-driven functional improvement when primary and secondary pain generators are addressed. Over the past 7 years, we have followed strict stage-specific selection criteria and treated these patients with a humeroacromial inlay arthroplasty (HemiCAP), which preserves the congruity of the articular surface with minimal bone resection and leaves a clinical exit strategy into total shoulder arthroplasty or hemishoulder arthroplasty if necessary. The procedure allows for a deltoid-splitting approach leaving the subscapularis untouched. This has positive implications for postoperative recovery and prevents possible approach-related complications associated with a subscapularis tenotomy. Patient selection, technical aspects, and adjuvant procedures play an important role and make superior humeral head inlay arthroplasty a safe, effective, and reproducible joint-preserving solution for early-stage compensated CTA.

The causes of total knee arthroplasty failure: Avoiding your next revision

This article is a personal retrospective of the author׳s more than 35 years of experience as an arthroplasty surgeon and specifically addresses how to avoid revision total knee arthroplasty.1.Avoid revision surgery if the patient is satisfied, unless imminent danger of prosthetic failure appears.2.Use proper technique at the primary arthroplasty to avoid the problems of aseptic loosening, instability, malalignment, and infection that force most revisions. Scrupulous attention to detail in patient selection and operative technique at the primary surgery will help avert revision surgery.3.Remember that surgical technique is prosthesis specific. Understanding the design and insertion philosophy of each implant is crucial to success; every implant system is different.4.Strive to understand the underlying reason that an arthroplasty has failed to make a patient satisfied and fix the problem at revision. If the reason for revision is unclear, it is unlikely that surgery will make the patient better.5.Avoid revision surgery if the problem is pain with no identifiable, surgically correctable problem.6.Maintain strict selection criteria for obese patients, who have higher prevalence of problems that can lead to total knee revision. Surgeons who operate on obese patients likely will have more revision cases. Often, however, obese patients have gratifying results in terms of pain relief and improved function.

Survival after mesenchymal stromal cell therapy in steroid-refractory acute graft-versus-host disease: systematic review and meta-analysis

Graft-versus-host disease (GVHD) is the major limitation of allogeneic haemopoietic stem-cell transplantation (HSCT), for which no approved treatments are available. Use of mesenchymal stromal cells (MSCs) has become standard practice in some European countries, but controversy exists for their benefit. The aim of this meta-analysis was to analyse available evidence for the benefit of MSC treatments in steroid-resistant acute GVHD. We did a systematic review and meta-analysis to assess response to and survival after MSC treatment in patients with steroid-refractory acute GVHD. We searched MEDLINE, Embase, Ovid, and Cochrane Central databases for published studies, and we used ClinicalTrials.gov and other websites to find unpublished studies and conference abstracts. We included prospective and retrospective studies in which MSCs were administered to patients with steroid-refractory acute GVHD. Data were extracted independently by two investigators based on strict selection criteria. A random-effects model was used to pool outcomes across studies because of anticipated heterogeneity. Our primary outcome was survival at 6 months from the first infusion of MSCs. We identified 628 citations with our search, of which 610 were excluded after review and a further five did not contain pertinent data. Thus, our meta-analysis included 13 non-randomised studies at moderate risk of bias, comprising a total of 336 patients. Six studies provided data for the primary outcome analysis (119 patients). Survival at 6 months after MSC treatment was 63% (95% CI 50-74; I(2)=41%). Survival did not differ with respect to age, MSC culture medium, or dose of MSCs delivered. Available evidence suggests that infusion of MSCs could be an acceptable treatment for patients with steroid-refractory acute GVHD. Randomised clinical trials are needed urgently to assess different treatment modalities for steroid-refractory acute GVHD. None.

Insertion/deletion polymorphism in intron 16 of ACE gene in idiopathic recurrent spontaneous abortion: case-control study, systematic review and meta-analysis

The insertion/deletion (I/D) polymorphism in intron 16 of the angiotensin I-converting enzyme gene (ACE) has been extensively studied as a predisposing factor for idiopathic recurrent spontaneous abortion (IRSA). A case-control study including 149 women with ≥3 spontaneous abortions and 149 controls was performed to test the association of ACE I/D polymorphism with IRSA. A systematic review was conducted of previous case-control studies, with strict selection criteria for meta-analyses. We also aimed to evaluate the potential differences in summary estimates between studies defining IRSA as ≥2 and ≥3 spontaneous abortions. Genotyping was performed by PCR, and systematic review conducted using PubMed and Scopus. There was no association of the polymorphism with IRSA in Slovenian women. Sixteen case-control studies, showing substantial differences regarding IRSA definition and selection criteria for women were identified. Meta-analysis was performed and included four studies defining IRSA as ≥2 spontaneous abortions and the current study, which defined IRSA as ≥3 spontaneous abortions. Based on random effects model, meta-analysis conducted on 1192 patients and 736 controls showed no association with IRSA under dominant(DD+IDvsII) and recessive(DDvsID+II) genetic models. Well-designed studies are needed to evaluate the role of ACE I/D polymorphism in IRSA defined as ≥3 spontaneous abortions.

Wait-and-see or radical surgery for rectal cancer patients with a clinical complete response after neoadjuvant chemoradiotherapy: a cohort study.

A wait-and-see policy might be considered instead of surgery for rectal cancer patients with no residual tumor or involved lymph nodes on imaging or endoscopy after neoadjuvant chemoradiotherapy (clinical complete response, cCR). In this cohort study, we compared the oncologic outcomes of rectal cancer patients with a cCR who were managed according to a wait-and-see policy (observation group) or with surgery (surgery group). In the observation group, follow-up was performed every 3 months for the first year and consisted of MRI, endoscopy with biopsy, computed tomography and transrectal ultrasonography. In the surgery group, patients received radical surgery. Long-term oncologic outcomes were estimated using Kaplan-Meier curves. Thirty patients were enrolled in the observation group (median follow-up, 60 months; range, 18-100 months), and 92 patients were enrolled in the surgery group (median follow-up, 58 months; range, 18-109 months). The 5-year disease free survival and overall survival rates were similar in the two groups: 90.0% vs. 94.3% (P = 0.932) and 100.0% vs. 95.6% (P = 0.912), respectively. We conclude that for rectal cancer patients with a cCR after neoadjuvant chemoradiotherapy, a wait-and-see policy with strict selection criteria, follow-up and salvage treatments achieves outcomes at least as good as radical surgery. Additionally, we declare that the pCR (pathologic complete regression) and non-pCR subgroups of patients with a cCR have similar long-term failure (local recurrence and/or distant metastasis) rate.

A review of current status of living donor liver transplantation.

Living donor liver transplantation (LDLT) has become an inevitable procedure in Asia due to its shortage of deceased donor under the influence of the religion and native cultures. Through a broad variety of experience, LDLT has been evolved and extended its indication. Although there have been many surgical and ethical efforts to prevent donor risk, concerns of donor's safety still are remaining questions due to its strict selection criteria. Therefore, dual grafts LDLT or ABO incompatible (ABO-I) LDLT may be effective means in its application and safety aspect. Many Asian LDLT centers have pointed out the useful extended criteria of LDLT for hepatocellular carcinoma (HCC), but the applicability of extended criteria should be validated and standardized by worldwide prospective studies based on the Milan criteria. Recent struggling efforts have been reported to surmount extensive portal vein thrombosis and Budd-Chiari syndrome which were previously contraindicated to LDLT. There is no doubt that LDLT is a surely complicated therapy to be performed successfully and requires devoted efforts by surgeons and co-workers. Nonetheless, comprehensive increasing understandings of partial graft LT and improvements of surgical techniques with challenges to obstacles in LDLT will make its prosperity with satisfactory outcomes.