• Calcitonin
• Carcinoembryonic antigen
• Medullary thyroid carcinoma
• Multiple endocrine neoplasia
• Somatic RET mutation
• Tyrosine kinase inhibitors

• Humans
• Thyroid Neoplasms/pathology
• Thyroid Neoplasms/therapy
• Thyroid Neoplasms/surgery
• Thyroid Neoplasms/diagnosis
• Carcinoma, Neuroendocrine/pathology
• Carcinoma, Neuroendocrine/surgery
• Carcinoma, Neuroendocrine/therapy
• Prognosis
• Follow-Up Studies
• Neoplasm Staging
• Thyroidectomy
• Biomarkers, Tumor

• Laparoscopic performance
• Minimally invasive surgery
• Mozart effect
• Rock music

• Clinical Competence
• Humans
• Laparoscopy/methods
• Music
• Operating Rooms
• Surgeons
• Task Performance and Analysis

• SEER program
• age
• lymph node metastasis
• lymph node ratio
• papillary thyroid carcinoma

• Crohn's disease
• Follow-up
• Ileocecal resection
• Postoperative recurrence

• EOB-MRI
• Functional liver volume
• Portal vein tumor thrombus
• Regional liver functional reserve

• career choice
• mentorship
• premedical education
• premedical vs medical
• surgical education
• surgical skills

• 21-Hydroxylase deficiency
• Acne
• CYP21A2 gene
• Congenital adrenal hyperplasia
• Heterozygosity
• Hirsutism

• Acne Vulgaris/epidemiology
• Acne Vulgaris/genetics
• Adrenal Hyperplasia, Congenital/epidemiology
• Adrenal Hyperplasia, Congenital/genetics
• Adult
• Female
• Heterozygote
• Hirsutism/epidemiology
• Hirsutism/genetics
• Humans
• Mutation
• Prevalence
• Steroid 21-Hydroxylase/genetics
• Young Adult

• 81270879 National Natural Science Foundation of China
• 81270879 National Natural Science Foundation of China
• 2016YFC0905100 National Key Research and Development Program of China
• 81971375 Innovative Research Group Project of the National Natural Science Foundation of China

• Clinically relevant postoperative pancreatic fistula (CR-POPF)
• external pancreatic duct stent
• pancreaticoduodenectomy
• prognosis
• systematic review and meta-analysis

• gastrointestinal stromal tumors of stomach
• laparoscopic surgery
• robotic surgery

• Abdomen
• Adhesions
• Computed tomography
• Magnetic resonance imaging
• Ultrasound
• Visceral slide

• Abdominal Wall/diagnostic imaging
• Humans
• Magnetic Resonance Imaging
• Postoperative Complications/diagnostic imaging
• Sensitivity and Specificity
• Tissue Adhesions/diagnostic imaging
• Tomography, X-Ray Computed
• Ultrasonography

Refractory pheochromocytoma and paraganglioma (PPGL) have a poor prognosis and the treatment strategy remains to be established. This multi-institutional phase I study was performed to determine the safety, dose-limiting toxicity (DLT), and efficacy of [¹³¹I]-meta-iodobenzylguanidine (¹³¹I-mIBG) therapy for refractory PPGLs. Twenty patients with refractory PPGL were enrolled in this study. We administered fixed doses of ¹³¹I-mIBG to all patients, delivering a second and third course of ¹³¹I-mIBG to eight and three patients, respectively. During the 20 weeks after ¹³¹I-mIBG injection, the authors surveyed the adverse events in accordance with the Common Terminology Criteria for Adverse Events. All patients experienced adverse events and adverse reactions, but none experienced a grade 4 adverse event. Twelve weeks after ¹³¹I-mIBG injection, examinations for the evaluation of therapeutic effects was performed in accordance with the Response Evaluation Criteria in Solid Tumours (RECIST). The best overall response rates (based on RECIST categories) were 10% (complete response), 65% (stable disease), 15% (progressive disease), and 10% (not all evaluated). The efficacy and safety of ¹³¹I-mIBG therapy was shown in patients with refractory PPGL, and DLT was observed in neither single nor repeated ¹³¹I-mIBG therapy, indicating a tolerability for ¹³¹I-mIBG therapy.

• Education
• Laparoscopic skills
• Laparoscopic training practice
• Training
• Visual motor coordination
• Visual-spatial discordant

• Adhesions
• Small bowel obstruction
• Trends

• Gamma-probe technique
• Lymphoscintigraphy
• Sentinel lymph node biopsy
• Thyroid carcinoma
• Vital blue dye technique

• Humans
• Incidence
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Predictive Value of Tests
• Sentinel Lymph Node Biopsy/methods
• Sentinel Lymph Node Biopsy/statistics & numerical data
• Thyroid Cancer, Papillary/epidemiology
• Thyroid Cancer, Papillary/pathology
• Tumor Burden

Background: Undifferentiated pleomorphic sarcoma (UPS) of the maxillary sinus is an extremely rare malignancy of the head and neck. Surgery is the mainstay of treatment for UPS; however, proximity to vital structures makes it challenging to achieve negative surgical margins. Adjuvant therapy including radiation therapy with or without chemotherapy is generally indicated. Despite advances in multimodality treatment, objective response rates to available therapies and prognosis of metastatic UPS remain dismal. Immunotherapy has become a fourth cornerstone of cancer therapy and checkpoint blockade immunotherapy is a standard of care for recurrent or metastatic cisplatin-refractory head and neck squamous cell carcinoma. Checkpoint blockade immunotherapy is being studied in metastatic sarcoma, including UPS, and while initial results are promising, objective response rates remain below 20%. However, adding radiation therapy to checkpoint blockade immunotherapy has been shown, in both preclinical and retrospective clinical studies, to have combinatorial effects on both local and metastatic disease. Thus, further investigation into the effects of radiation therapy combined with immunotherapy in head and neck sarcomas is warranted.

Case Presentation: We present a case of metastatic, chemotherapy-refractory, UPS of the maxillary sinus in a 55-year-old male treated with checkpoint blockade immunotherapy combined with radiation, which resulted in a complete response.

Conclusions: This is the first report to our knowledge of metastatic UPS treated with a combination of radiation and dual agent checkpoint blockade immunotherapy. Further investigation is warranted to study the effects of this combination in patients with metastatic UPS that fail to respond to currently available therapies.

• checkpoint blockade
• head and neck cancer
• immunotherapy
• radiation
• sarcoma
• stereotactic radiotherapy

• Fluid balance
• Pancreaticoduodenectomy
• Postoperative pancreatic fistula
• Whipple

• Aged
• Female
• Fluid Therapy/adverse effects
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Pancreatic Fistula/etiology
• Pancreatic Fistula/prevention & control
• Pancreaticoduodenectomy/adverse effects
• Postoperative Complications/etiology
• Retrospective Studies
• Risk Factors
• Water-Electrolyte Balance

• Laparoscopic training
• Mentoring
• Skill transfer
• Virtual reality simulator

• Benign multicystic mesothelioma
• Inflammatory cysts of the peritoneum
• Peritoneal inclusion cyst
• Peritoneal mesothelial cysts
• Postoperative peritoneal cyst
• Young female

• NWLE
• PHAT
• Recurrence
• WLE

Microenvironmental properties are thought to be responsible for feto-maternal tolerance. Speculatively, ectopic expression of placental gene programs might also be related to cancer cells’ ability to escape from immune vigilance mechanisms during carcinogenesis and cancer progression. Recently, we published the first human genomic evidence of similar immune related gene expression profiles in both placenta (placenta and decidual tissue) and cancer (both primary and metastatic) in the same patient with lymph-node positive breast carcinoma during pregnancy. Here we report the first epigenomic analysis of these tissue samples and describe their main findings, with respect to immune related genes regulation (over or under expressed) in cancer cells with regards placental tissues. We confirm significant similarities, and hierarchical clustering (both unsupervised and supervised), in CpG island methylation patterns between decidual/placental and cancer microenvironments, which cannot be easily explained by simple models or unique pathways. Several different cell types are probably involved in these complex immune regulation mechanisms. Cancers may somehow “hijack” gene programs evolved over millions of years to allow for feto-maternal tolerance in placental mammals in order to escape from immune vigilance and spread locally or to distant sites.

• cancer microenvironment
• carcinogenesis
• immune vigilance
• materno-fetal tolerance
• placental microenvironment

• Latero-cervical lymph node metastases
• Papillary thyroid cancer
• Thyroid cancer
• Thyroid cancer metastases
• Thyroid cancer outcome

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Papillary/secondary
• Carcinoma, Papillary/surgery
• Child
• Female
• Follow-Up Studies
• Humans
• Lymph Nodes/pathology
• Lymph Nodes/surgery
• Lymphatic Metastasis
• Male
• Middle Aged
• Neck Dissection
• Prognosis
• Retrospective Studies
• Risk Factors
• Thyroid Neoplasms/pathology
• Thyroid Neoplasms/surgery
• Young Adult

To investigate potential biomarkers for predicting postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD).

We prospectively recruited 83 patients to this study. All patients underwent PD (Child’s procedure) at the Division of Hepatobiliary and Pancreas Surgery at the First Bethune Hospital of Jilin University between June 2011 and April 2015. Data pertaining to demographic variables, clinical characteristics, texture of pancreas, surgical approach, histopathological results, white blood cell count, amylase and choline levels in the serum, pancreatic/gastric drainage fluid, and choline and amylase levels in abdominal drainage fluid were included in the analysis. Potential correlations between these parameters and postoperative complications such as, POPF, acute pancreatitis, hemorrhage, delayed gastric emptying, and biliary fistula, were assessed.

Twenty-eight out of the 83 (33.7%) patients developed POPF. The severity of POPF was classified as Grade A in 8 (28%) patients, grade B in 16 (58%), and grade C in 4 (14%), according to the pancreatic fistula criteria. On univariate and multivariate logistic regression analyses, higher amylase level in the abdominal drainage fluid on postoperative day (POD)1 and higher serum amylase levels on POD4 showed a significant correlation with POPF (P < 0.05). On receiver operating characteristic curve analysis, amylase cut-off level of 2365.5 U/L in the abdominal drainage fluid was associated with a 78.6% sensitivity and 80% specificity [area under the curve (AUC): 0.844; P = 0.009]. A cut-off serum amylase level of 44.2 U/L was associated with a 78.6% sensitivity and 70.9% specificity (AUC: 0.784; P = 0.05).

Amylase level in the abdominal drainage fluid on POD1 and serum amylase level on POD4 represent novel biomarkers associated with POPF development.

• Pancreaticoduodenectomy
• Complication
• Amylase
• Pancreatic fistula

• Abdominal Cavity/surgery
• Amylases/blood
• Biomarkers/analysis
• Drainage
• Feasibility Studies
• Female
• Humans
• Male
• Middle Aged
• Pancreas/pathology
• Pancreas/surgery
• Pancreatic Fistula/blood
• Pancreatic Fistula/epidemiology
• Pancreatic Fistula/etiology
• Pancreaticoduodenectomy/adverse effects
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Period
• Predictive Value of Tests
• Prospective Studies
• Risk Assessment/methods
• Risk Factors
• Severity of Illness Index

Concordance between mutations in the primary papillary thyroid carcinoma (PTC) and the paired x lymph node metastasis may elucidate the potential role of molecular targeted therapy in advanced stages. BRAF and NRAS mutations in primary PTC (n = 253) with corresponding metastatic lymph node (n = 46) were analyzed utilizing StripAssays (ViennaLab Diagnostics). Statistical analysis was performed using (SPSS, Inc.), version 24.0 with a p-value of <0.05, and concordance via kappa agreement. BRAF mutation frequency in conventional PTC (cPTC): 56.8%, papillary thyroid microcarcinoma (PTMC): 36.5%, PTMC-FV: 2.7% and PTC-FV: 4.1%. NRAS mutation frequency in PTC-FV: 28.6%, PTMC: 28.6%, PTMC-FV: 23.8%, and cPTC: 19.0%. BRAF mutation correlation with older age in cPTC (42.6 versus 33.6) years (p < 0.001) was the only significant clinicopathologic parameter. BRAF mutations were concordant in the primary and its corresponding lymph node deposits in PTC with a kappa of 0.77 (p-value < 0.0001). BRAF mutations are predominant in cPTC and PTMC while NRAS mutations in PTC-FV. BRAF mutation is conserved in metastatic lymph node deposits, thus BRAF is an early mutational pathogenetic driver. Therefore, targeted therapy is potential in recurrent and advanced stage disease.

Focal hepatic venous outflow obstruction frequently occurs after extended liver resection and leads to a portal hypertension, arterial hypoperfusion and parenchymal necrosis.

In this study, we investigated the pharmacological modulation of liver perfusion and hepatic damage in a surgical model of hepatic outflow obstruction after extended liver resection by administration of 5 different drugs in comparison to an operative intervention, splenectomy.

Male inbred Lewis rats (Lew/Crl) were subjected to right median hepatic vein ligation + 70% partial hepatectomy. Treatment consisted of a splenectomy or the application of saline, carvedilol or isosorbide-5-mononitrate (ISMN) (5 mg · kg⁻¹ respectively 7,2 mg · kg⁻¹ per gavage 12 h⁻¹). The splenectomy was performed during operation. The effect of the treatments on hepatic hemodynamics were measured in non-operated animals, immediately after operation (n = 4/group) and 24 h after operation (n = 5/group). Assessment of hepatic damage (liver enzymes, histology) and liver cell proliferation (BrdU-immunohistochemistry) was performed 24 h after operation. Furthermore sildenafil (10 μg · kg⁻¹ i.p. 12h⁻¹), terlipressin (0.05 mg · kg⁻¹ i.v. 12 h⁻¹) and octreotide (10 μg · kg⁻¹ s.c. 12 h⁻¹) were investigated regarding their effect on hepatic hemodynamics and hepatic damage 24 h after operation (n = 4/group).

Carvedilol and ISMN significantly decreased the portal pressure in normal non-operated rats from 11,1 ± 1,1 mmHg (normal rats) to 8,4 ± 0,3 mmHg (carvedilol) respectively 7,4 ± 1,8 mmHg (ISMN). ISMN substantially reduced surgery-induced portal hypertension from 15,4 ± 4,4 mmHg to 9,6 ± 2,3 mmHg. Only splenectomy reduced the portal flow immediately after operation by approximately 25%. No treatment had an immediate effect on the hepatic arterial perfusion. In all treatment groups, portal flow increased by approximately 3-fold within 24 h after operation, whereas hepatic arterial flow decreased substantially. Neither treatment reduced hepatic damage as assessed 24 h after operation. The distribution of proliferating cells appeared very similar in all drug treated groups and the splenectomy group.

Transient relative reduction of portal pressure did not result in a reduction of hepatic damage. This might be explained by the development of portal hyperperfusion which was accompanied by arterial hypoperfusion.

The online version of this article (doi:10.1186/s40360-017-0155-4) contains supplementary material, which is available to authorized users.

• Liver resection
• Portal hypertension
• Splenectomy
• Vasoactive drugs

To investigate whether circulating cytokeratin-positive (CK⁺) cells in the mesenteric blood of resected colorectal specimens are prognostic and correlate with tumor budding.

Fifty-six colorectal specimens were collected between 9/2007 and 7/2008. Blood from the mesenteric vein was drawn immediately after receiving the fresh and unfixed specimens in the pathology department. After separation of the mononuclear cells by Ficoll-Hypaque density-gradient centrifugation, cytological smears were immunocytochemically stained for CK18. Tumor budding was evaluated on slides stained for pan-cytokeratin. The identification of ≥ 30 buds/1.3 mm² was defined as high grade budding.

CK⁺ cells and clusters were identified in 29 (48%) and 14 (25%) of the samples, respectively. Two cells were identified in one of three non-malignant cases. Clusters were found exclusively in malignant cases. The occurrence of CK⁺ cells or clusters was not associated with any of the evaluated clinicopathological factors, including surgical technique and tumor budding. Moreover, the occurrence of CK⁺ cells or clusters had no influence on the cancer-specific survival [75 mo (CI: 61; 88) vs 83 mo (CI: 72; 95) and 80 mo (CI: 63; 98) vs 79 mo (CI: 69; 89), respectively].

CK⁺ cells and showed neither prognostic significance nor an association with tumor budding. It is very likely that CK18-staining is not specific enough to identify the relevant cells.

• Colorectal cancer
• Circulating cells
• Tumor budding
• Peripheral blood
• Survival

Minimally invasive surgery has been replacing the open standard technique in several procedures. Similar or even better postoperative outcomes have been described in laparoscopic or robot-assisted procedures when compared to open surgery. Moreover, minimally invasive surgery has been providing less postoperative pain, shorter hospitalization, and thus a faster return to daily activities. However, the learning curve required to obtain laparoscopic expertise has been a barrier in laparoscopic spreading. Laparoscopic surgery training laboratory has been developed to aid surgeons to overcome the challenging learning curve. It may include tutorials, inanimate model skills training (box models and virtual reality simulators), animal laboratory, and operating room observation. Several different laparoscopic courses are available with specific characteristics and goals. Herein, we aim to describe the activities performed in a dry and animal-model training laboratory and to evaluate the impact of different kinds of laparoscopic surgery training courses on surgeon’s performance. Several tasks are performed in dry and animal laboratory to reproduce a real surgery. A short period of training can improve laparoscopic surgical skills, although most of times it is not enough to confer laparoscopic expertise for participants. Nevertheless, this short period of training is able to increase the laparoscopic practice of surgeons in their communities. Full laparoscopic training in medical residence or fellowship programs is the best way of stimulating laparoscopic dissemination.

• Education
• Laboratories
• Laparoscopy
• Robotics
• Surgery

• Adenocarcinoma/therapy
• Gastric Mucosa/surgery
• Gastrointestinal Stromal Tumors/therapy
• Humans
• Intestinal Neoplasms/therapy
• Lymph Node Excision
• Stomach Neoplasms/therapy

Anastomotic complications occur more frequently in patients with Crohn’s disease leading to postoperative intra-abdominal septic complications (IASC). Patients with IASC often require re-operation or drainage to control the sepsis and have an increased frequency of disease recurrence. The aim of this article was to examine the factors affecting postoperative IASC in Crohn’s disease after anastomoses, since some risk factors remain controversial. Studies investigating IASC in Crohn’s operations were included, and all risk factors associated with IASC were evaluated: nutritional status, presence of abdominal sepsis, medication use, Crohn’s disease type, duration of disease, prior operations for Crohn’s, anastomotic technique, extent of resection, operative timing, operative length, and perioperative bleeding. In this review, the factors associated with an increased risk of IASC are preoperative weight loss, abdominal abscess present at time of surgery, prior operation, and steroid use. To prevent IASC in Crohn’s patients, preoperative optimization with nutritional supplementation or drainage of abscess should be performed, or a diverting stoma should be considered for patients with multiple risk factors.

• Crohn’s disease
• Risk factors
• Complications
• Resection
• Postoperative septic complications
• Anastomosis

We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation and measured the total spleen and ablated volumes with contrast-enhanced computed tomography and volumetry. No major complications occurred, thrombocytopenia was resolved, and platelet levels remained stable, which allowed for early treatment of the patient’s underlying disease. Previous work has shown that splenic radiofrequency ablation is an attractive alternative treatment for hypersplenism induced by liver cirrhosis. We aimed to contribute to the currently sparse literature evaluating the role of radiofrequency ablation (RFA) in the management of hypersplenism. We conclude that splenic RFA appears to be a viable and promising option for the treatment of hypersplenism.

• Portal hypertension
• Thrombocytopenia
• Hypersplenism
• Percutaneous radiofrequency ablation
• Splenic ablation

• Catheter Ablation
• Contrast Media
• Humans
• Hypersplenism/diagnosis
• Hypersplenism/parasitology
• Hypersplenism/surgery
• Hypertension, Portal/diagnosis
• Hypertension, Portal/parasitology
• Liver Diseases, Parasitic/complications
• Liver Diseases, Parasitic/diagnosis
• Liver Diseases, Parasitic/parasitology
• Male
• Middle Aged
• Platelet Count
• Predictive Value of Tests
• Schistosomiasis mansoni/complications
• Schistosomiasis mansoni/diagnosis
• Schistosomiasis mansoni/parasitology
• Thrombocytopenia/diagnosis
• Thrombocytopenia/parasitology
• Thrombocytopenia/surgery
• Tomography, X-Ray Computed
• Treatment Outcome

Ligation of splenic artery (LSA) is used for the treatment of liver cirrhosis with hypersplenism. However, hypersplenism is not significantly improved following LSA treatment in some cases, and there are few reports of retreatment of hypersplenism after LSA. We report the case of a 47-year-old man with liver cirrhosis and hypersplenism who underwent LSA treatment, but did not significantly improve. Laboratory tests revealed severe leukocytopenia and thrombocytopenia. Celiac computed tomography arteriogram and digital subtraction angiography revealed two compensatory arteries connected to the hilar splenic artery from the left gastro-epiploic artery and from the dorsal pancreatic artery. Partial splenic embolization (PSE) was performed through the compensatory arteries. As a result, the patient achieved partial splenic ischemic infarction, and white blood cell and platelet counts rose and remained in the normal range. PSE is an effective therapeutic modality for the retreatment of hypersplenism when other modalities have failed.

• Hypersplenism
• Partial splenic embolization
• Splenic artery ligation
• Liver cirrhosis
• Leukocytopenia
• Thrombocytopenia

• Angiography, Digital Subtraction
• Collateral Circulation
• Embolization, Therapeutic/methods
• Humans
• Hypersplenism/diagnosis
• Hypersplenism/etiology
• Hypersplenism/surgery
• Hypersplenism/therapy
• Ligation
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnosis
• Male
• Middle Aged
• Regional Blood Flow
• Splenic Artery/diagnostic imaging
• Splenic Artery/surgery
• Tomography, X-Ray Computed
• Treatment Failure

• Career
• Gender
• Medical students
• Specialty

• image-guided surgery
• image-to-patient registration accuracy
• mechatronic surgical tools
• medical robotics