C entral venous cannulation (CVC) is commonly used for many well-known indications, with the internal jugular, subclavian, and femoral veins the most common sites for CVC. In some patients, CVC may be extremely complicated, unsafe, or fatal. Use of ultrasound techniques to facilitate CVC may reduce these risks of misplacement and complications. Real-time 2-dimensional ultrasound (RTUS) has become more popular because it can visualize arteries, veins, and surrounding structures by their relative positions. This meta-analysis was undertaken to investigate the effects of RTUS on the clinical outcomes of patients receiving CVC.Several databases were searched for randomized controlled trials (RCTs) that compared outcomes in patients undergoing CVC with either RTUS or the anatomic landmark technique without any ultrasound guidance. Data were extracted from fulltext articles. The principal end points for the analysis were cannulation failure, arterial puncture, hematoma, pneumothorax, and hemothorax.Twenty-five of 1542 potentially relevant articles were included in the analysis. One report had 2 RCTs, giving a total of 26 RCTs with 4185 CVC procedures. Real-time 2-dimensional ultrasound substantially reduced the risk of cannulation failure (relative risk [RR] = 0.18) and reduced the risk of arterial puncture, hematoma, pneumothorax, and hemothorax (RRs = 0.25, 0.30, 0.21, and 0.10, respectively). Heterogeneity was low between studies. Sensitivity analyses indicated that the overall risk estimates for cannulation failure, arterial puncture, and hematoma were not modified by any single study, with RRs ranging from 0.17 to 0.20 for cannulation failure, from 0.22 to 0.28 for arterial puncture, and from 0.24 to 0.35 for hematoma. The superiority of RTUS for risk of cannulation failure was statistically significant in adult patients but not in pediatric patients (RRs = 0.18 and 0.26, respectively). Based on limited data, RTUS was not associated with a reduced risk of arterial puncture, hematoma, pneumothorax, and hemothorax in pediatric patients (RRs = 0.34, 0.13, 0.40, and 0.40, respectively). In addition, high heterogeneity was found in the data for pediatric patients for the risks of cannulation failure and arterial puncture.The pooled results showed that RTUS compared with anatomic landmark led to statistically significant reductions in the incidence of cannulation failure and the risks for accidental arterial puncture, hematoma, pneumothorax, and hemothorax. Because more data in the pediatric population are required, well-designed RCTs for this patient group are needed to clarify the role of RTUS in children.

BackgroundA totally implantable venous access device (TIVAD) provides reliable, long-term vascular access and improves patients’ quality of life. The wide use of TIVADs is associated with important complications. A meta-analysis was undertaken to compare the internal jugular vein (IJV) with the subclavian vein (SCV) as the percutaneous access site for TIVAD to determine whether IJV has any advantages.MethodsAll randomized controlled trials (RCTs) and cohort studies assessing the two access sites, IJV and SCV, were retrieved from PubMed, Web of Science, Embase, and OVID EMB Reviews from their inception to December 2015. Random-effects models were used in all analyses. The endpoints evaluated included TIVAD-related infections, catheter-related thrombotic complications, and major mechanical complications.ResultsTwelve studies including 3905 patients published between 2008 and 2015, were included. Our meta-analysis showed that incidences of TIVAD-related infections (odds ratio [OR] 0.71, 95 % confidence interval [CI] 0.48–1.04, P = 0.081) and catheter-related thrombotic complications (OR 0.76, 95 % CI 0.38–1.51, P = 0.433) were not significantly different between the two groups. However, compared with SCV, IJV was associated with reduced risks of total major mechanical complications (OR 0.38, 95 % CI 0.24–0.61, P < 0.001). More specifically, catheter dislocation (OR 0.43, 95 % CI 0.22–0.84, P = 0.013) and malfunction (OR 0.42, 95 % CI 0.28–0.62, P < 0.001) were more prevalent in the SCV than in the IJV group; however, the risk of catheter fracture (OR 0.47, 95 % CI 0.21–1.05, P = 0.065) were not significantly different between the two groups. Sensitivity analyses using fixed-effects models showed a decreased risk of catheter fracture in the IJV group.ConclusionThe IJV seems to be a safer alternative to the SCV with lower risks of total major mechanical complications, catheter dislocation, and malfunction. However, a large-scale and well-designed RCT comparing the complications of each access site is warranted before the IJV site can be unequivocally recommended as a first choice for percutaneous implantation of a TIVAD.

ImportanceSialic acid–binding immunoglobulin-like lectin 15 (Siglec-15) is a novel immune checkpoint molecule that is highly homologous to programmed cell death ligand 1 (PD-L1), but information remains limited about its role in esophageal squamous cell carcinoma (ESCC).ObjectiveTo explore the expression pattern and association of Siglec-15 with outcomes among patients with ESCC who received neoadjuvant chemoradiotherapy (CRT).Design, Setting, and ParticipantsThis retrospective cohort study was conducted at an academic institution in China. Participants included patients with ESCC who underwent neoadjuvant CRT and esophagectomy between June 2002 and December 2018. Multiplexed immunofluorescence staining was used to evaluate the expression of Siglec-15 and PD-L1 in tumor cells (TCs) or tumor-associated macrophages based on pre-CRT biopsies. Different immune phenotypes have been proposed and further validated in an independent cohort. Data analysis was conducted from January to May 2021.ExposuresSiglec-15 or PD-L1 positivity vs negativity.Main Outcomes and MeasuresPathologic complete response (pCR), overall survival (OS), and recurrence-free survival (RFS).ResultsOf 130 participants (median [range] age, 56 [42-73] years; 108 [83.1%] male participants) in the primary cohort, 58 patients (44.6%) achieved a pCR after neoadjuvant CRT. Siglec-15 and PD-L1 were detected in both TCs and macrophages. The percentage of Siglec-15–positive macrophages was notably higher than that of Siglec-15–positive TCs (median [IQR]: 34.4% [12.7%-64.3%] vs 4.8% [0.7%-25.6%]; P &amp;lt; .001). TC–Siglec-15 expression was significantly and positively associated with macrophage–Siglec-15 expression (r = 0.78; P &amp;lt; .001). Siglec-15 positivity was significantly associated with a higher rate of pCR (37 of 70 [52.9%] vs 21 of 60 [35.0%]; P = .04), more favorable OS (hazard ratio [HR], 0.46; 95% CI, 0.25-0.85; P = .01), and RFS (HR, 0.48; 95% CI, 0.26–0.88; P = .02). However, PD-L1 positivity in TCs was negatively associated with survival. Stratification analysis further revealed that patients with combined Siglec-15 positivity and PD-L1 negativity had better survival than those with other phenotypes. Major findings were reproducible in a validation cohort with 55 patients.Conclusions and RelevanceIn this cohort study of patients with ESCC receiving neoadjuvant CRT, Siglec-15 positivity was associated with a better pathological response and more favorable survival. Siglec-15 could serve as a novel biomarker to identify potential candidates that may benefit from immunotherapy combined with CRT.

BackgroundLiver cancer is one of the most deadly and prevalent cancers. A routine follow‐up plan for liver cancer is crucial but limited. In the present study, we aimed to disclose possible risk factors and critical survival time windows for primary liver cancer.MethodsWe enrolled 692 liver cancer patients from Sun Yat‐sen University Cancer Center (SYSUCC). Univariate and multivariate logistic regression analyses of cirrhosis and recurrence were conducted. A meta‐analysis was utilized to validate an indication of creatinine (CRE) in recurrence. Conditional survival analysis was performed using the Kaplan–Meier method. The results were further verified by the SYSUCC validation cohort and Surveillance, Epidemiology, and End Results (SEER) validation cohort.ResultsOur results indicated that A/G, history of hepatitis, history of alcohol consumption and platelet (PLT) might be potential prognostic factors for cirrhosis in liver cancer patients. CRE was significantly correlated with recurrence due to various therapies, especially after transarterial embolization. Moreover, 1.5 years to 2 years may be a critical time window for deterioration in survival rate based on the conditional survival analysis.ConclusionA/G, history of hepatitis, alcohol consumption and PLT may be potential prognostic factors for cirrhosis in liver cancer patients. More attention should be focused on the renal function when treating the patients due to the significant role of CRE. 1.5 years to 2 years is a critical time window for deterioration in survival rate for liver cancer patients that contributes to determining the optimal follow‐up plan in the future.

Background Curcumin has attracted much attention due to its wide range of therapeutic effects. In this study, we used serum collected from patients undergoing one-lung ventilation (OLV) to establish an in vitro acute lung injury (ALI) model to explore the potential protective mechanism of curcumin on ALI. Our study provides a new reference for the prevention and treatment of ALI induced by OLV. Methods A549 cells were treated with 20% serum from patients undergoing OLV to establish an in vitro ALI model. Curcumin, at a dose of 40 μg/ml, was administered two hours prior to this model. The levels of inflammation and oxidative stress markers were observed by Western blot, qRT–PCR, ELISA and reactive oxygen species assay. Additionally, the expression of peroxiredoxin 6 (Prdx6) and proteins involved in the NF-κB signaling pathway was evaluated. Results Twenty percent of serum collected from patients undergoing OLV downregulated the expression of Prdx6, leading to the activation of the NF-κB signaling pathway, which was associated with the subsequent overproduction of inflammatory cytokines and reactive oxygen species. Pretreatment with curcumin restored Prdx6 downregulation and inhibited NF-κB pathway activation by suppressing the nuclear translocation of P65, eventually reducing inflammation and oxidative stress damage in A549 cells. Conclusions Prdx6 mediated the protective function of curcumin by inhibiting the activation of the NF-κB pathway in ALI in vitro.