简介：AIM:Toassessthevalueofgemstonespectralimaging(GSI)inefficacyevaluationinhepatocellularcancer(HCC)aftertranscatheterarterialchemoembolization(TACE)treatment.METHODS:ThirtypatientswithHCCunderwentGSI,includingnonenhanced,arterial,portalvenousanddelayedphasescans,afterTACEtreatment.ArterialphaseimageswereacquiredwithGSIforreconstructionofvirtualnonenhancedimagesandcoloroverlayimages.Digitalsubtractionangiography(DSA)wasperformedinallthesepatients.Twoblindedandindependentreadersevaluatedthedataintworeadingsessions;standardnonenhanced,arterial,portalvenous,anddelayedphaseimageswerereadinsessionA,andtheoptimalmonochromaticimages,iodine/waterbasedimagesandspectrumfeatureswerereadinsessionB.SensitivityandspecificitywerecalculatedwiththeDSAdataasthereferencestandard.Thesensitivityandspecificitywerecomparedusingtheχ2test.RESULTS:DSArevealed154lesionsin30patients,and100ofthemhadbloodsupply.Overallsensitivityandspecificitywere72%(72/100)and77.8%(42/54)forsessionA,and97%(97/100)and94.4%(51/54)forsessionB,respectively.Thesensitivityandspecificityofthetworeadingsessionsweresignificantlydifferent(χ2=23.04,χ2=7.11,P<0.05).CONCLUSION:ComparedwithconventionalCT,GSIcouldsignificantlyimprovethedetectionofsmallandmultiplelesionswithoutincreasingtheradiationdose.Basedonspectrumfeatures,GSIcouldassesstumorhomogeneityandmoreaccuratelyidentifyresidualtumorsandrecurrentormetastaticlesionsduringefficacyevaluationandfollow-upinHCCafterTACEtreatment.

简介：AIMToprovideanupdatedassessmentofthesafetyandefficacyofenhancedrecoveryaftersurgery(ERAS)protocolsinelectivegastriccancer(GC)surgery.METHODSPubMed,Medline,EMBASE,WorldHealthOrganizationInternationalTrialRegister,andCochraneLibraryweresearcheduptoJune2017forallavailablerandomizedcontrolledtrials(RCTs)comparingERASprotocolsandstandardcare(SC)inGCsurgery.ThirteenRCTs,withatotalof1092participants,wereanalyzedinthisstudy,ofwhom545underwentERASprotocolsand547receivedSCtreatment.RESULTSNosignificantdifferencewasobservedbetweenERASandcontrolgroupsregardingtotalcomplications(P=0.88),mortality(P=0.50)andreoperation(P=0.49).Theincidenceofpulmonaryinfectionwassignificantlyreduced(P=0.03)followinggastrectomy.However,thereadmissionrateafterGCsurgerynearlytripledunderERAS(P=0.009).ERASprotocolssignificantlydecreasedthelengthofpostoperativehospitalstay(P<0.00001)andmedicalcosts(P<0.00001),andacceleratedbowelfunctionrecovery,asmeasuredbyearliertimetothefirstflatus(P=0.0004)andthefirstdefecation(P<0.0001).Moreover,ERASprotocolswereassociatedwithalowerlevelofseruminflammatoryresponse,higherserumalbumin,andsuperiorshorttermqualityoflife(QOL).CONCLUSIONCollectively,ERASresultsinacceleratedconvalescence,reductionofsurgicalstressandmedicalcosts,improvednutritionalstatus,andbetterQOLforGCpatients.However,high-qualitymulticenterRCTswithlargesamplesandlong-termfollow-upareneededtomorepreciselyevaluateERASinradicalgastrectomy.