INTRODUCTIONWe describe the natural history of Asian adult soft tissue sarcomas (STSs) in the extremities and predict prognosticative factors for local recurrence, metastasis and tumour-related death.

MATERIALS AND METHODSBetween January 1999 and May 2009, 67 adult patients with first presentation STSs of extremity sites underwent surgical treatment at a single institution. The associations between patient demographics and pathological features with local recurrence, metastasis and mortality were studied using univariate and multivariate analysis.

RESULTSThe mean age of our patients was 52.4 years with most presentations occurring in the thigh. Majority of Asian STSs were high grade (61.3%) and large tumours with 81.0% being >5 cm. Stages Ia, Ib, IIa, IIb, IIc, III and IV accounted for 6.6%, 6.6%, 26.2%, 11.5%, 3.3%, 42.6% and 3.3% of presentations, respectively. Patients were followed-up for a mean period of 45.9 months. On univariate analysis, high tumour grade and advanced stage (IIc to IV) were predictive of local recurrence and metastasis. Deep lesions were more likely to recur but not metastasise or cause death. Age, sex, size, and margin positivity were not predictive for all end-points. On multivariate testing, only pathological high grade was associated adversely with local recurrence [odds ratio (OR) = 10.0, 95% CI, 1.2 to 84.9, P = 0.035], metastasis (OR = 12.7, 95% CI, 2.46 to 65.2, P = 0.002) and mortality (OR = 16.2, 95% CI, 1.95 to 135.0, P = 0.010).

CONCLUSIONSAsian adult extremity soft tissue sarcomas present late and are most commonly found in the thigh. High pathological grade is a consistent independent predictor for local failure, distant spread and tumour-related death. Our results reaffirm the current thinking that tumour biology is of primary importance in determining patient outcomes.

Adult ; Aged ; Aged, 80 and over ; Asia ; epidemiology ; Extremities ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Sarcoma ; classification ; ethnology ; mortality ; pathology ; surgery ; Soft Tissue Neoplasms ; classification ; ethnology ; mortality ; pathology ; surgery

INTRODUCTION: The use of periarticular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) TXA have not been well explored in the literature. This retrospective cohort study aimed to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate postoperative pain relief and functional outcomes in patients after unilateral primary total knee arthroplasty (TKA). METHODS: A total of 63 patients underwent TKA, and they were divided into the IA TXA delivery group ( n = 42) and PA TXA delivery group ( n = 21). All patients were administered 1 g of TXA. They also received pericapsular infiltration consisting of 0.5 mL of adrenaline, 0.4 mL of morphine, 1 g of vancomycin, 1 mL of ketorolac and 15 mL of ropivacaine. Outcomes for blood loss and surrogate markers for immediate functional recovery were measured. RESULTS: Of the 63 patients, 54% were female and 46% male. The mean drop in postoperative haemoglobin levels in the PA and IA groups was 2.0 g/dL and 1.6 g/dL, respectively, and this was not statistically significant ( P = 0.10). The mean haematocrit drop in the PA and IA groups was 6.1% and 5.3%, respectively, and this was also not statistically significant ( P = 0.58). The postoperative day (POD) 1 and discharge day flexion angles, POD 1 and POD 2 visual analogue scale (VAS) scores, gait distance on discharge and length of hospitalisation stay were largely similar in the two groups. CONCLUSION Our study showed that both IA and PA TXA with analgesic components were equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes.
Humans ; Male ; Female ; Tranexamic Acid/adverse effects* ; Arthroplasty, Replacement, Knee/adverse effects* ; Antifibrinolytic Agents/adverse effects* ; Retrospective Studies ; Postoperative Hemorrhage ; Blood Loss, Surgical/prevention & control* ; Administration, Intravenous ; Analgesia ; Analgesics/therapeutic use* ; Pain, Postoperative/drug therapy* ; Injections, Intra-Articular

Primary bile acids were reported to augment secretion of chemokine (C‒X‒C motif) ligand 16 (CXCL16) from liver sinusoidal endothelial cells (LSECs) and trigger natural killer T (NKT) cell-based immunotherapy for liver cancer. However, abundant expression of receptors for primary bile acids across the gastrointestinal tract overwhelms the possibility of using agonists against these receptors for liver cancer control. Taking advantage of the intrinsic property of LSECs in capturing circulating nanoparticles in the circulation, we proposed a strategy using nanoemulsion-loaded obeticholic acid (OCA), a clinically approved selective farnesoid X receptor (FXR) agonist, for precisely manipulating LSECs for triggering NKT cell-mediated liver cancer immunotherapy. The OCA-nanoemulsion (OCA-NE) was prepared