Background: There is currently no consensus on the ideal plane for implant placement in breast reconstruction. The study compares the clinical efficacy and safety between prepectoral and subpectoral implant-based breast reconstruction. Methods: PubMed, Web of Sciences, EMBASE, and Cochrane databases were systematically searched following the PRISMA guidelines. Inclusion criteria were articles describing implant-based breast reconstructions with implant placed either prepectorally or subpectorally. Primary outcomes were postoperative complications, pain score, and patients' quality of life. Results: There were 15 studies including a total of 1868 patients. Overall complication rates were comparable between the prepectoral and subpectoral groups (odds ratio [OR], 0.79; confidence interval [CI], 0.57–1.10). The capsular contracture rate was reduced in the prepectoral group (OR, 0.45; CI, 0.27–0.73), whereas no significant difference was observed in terms of skin necrosis (OR, 0.72; CI, 0.45–1.17), implant loss (OR, 0.85; CI, 0.56–1.30), and patients' quality of life (standardised mean difference, 0.25; CI, −0.51 to 1.00). Conclusion: The prepectoral implant-based breast reconstruction is a good alternative to subpectoral implant-based breast reconstruction for a certain group of patients, eliminating animation deformity without increasing complications.

The past century has witnessed the rapid development of operation technique, surgical instruments, and knowledge of the diseases in orthopedics. In the academic history, a number of classic papers boosted the advancement for surgery. In this paper, we performed a bibliometric analysis, aiming to determine the most influential studies within the field. Articles were searched from the publication year of 1900 to 2016 according to the Science Citation Index Expanded database of the Clarivate Analytics Web of Science Core Collection database. Two citation indicators TCyear and Cyear were employed to characterize the classic articles and the articles were identified and analyzed. A total of 30 classic articles with TC2016 ≥ 1000 in Web of Science category of orthopedics were identified, all written in English between 1961 and 2007 by nine countries. The minimal value of TC2016 was 1010; the maximum 3570; and the average 1591. Thirty classic articles were published in eight journals that were listed in the Web of Science category of orthopedics in 2016, and in two other orthopedics journals that were no longer tracked by Web of Science category of orthopedics as of 2016. Among the top 10 cited articles in both TC2016 and C2016, five articles barely received attention in the first few years after their publication, while they became cited more and more frequently in the last decade. This study evaluated the development and trend of orthopedics research by adopting bibliometric analysis. It serves as a guide for investigators in the future research.

Portal hypertension is a serious symptom of chronic liver diseases, which can lead to many critical complications, such as the formation of varices related to upper digestive bleeding, ascites, infection, hepatic encephalopathy, renal failure, and even death. As a result, portal pressure monitoring has important prognostic and clinical implications. The hepatic venous pressure gradient measurement, a gold-standard method applied to monitor portal pressure, is invasive and only available in experienced centers. Over the past decade, noninvasive methods aimed at monitoring the portal pressure have been increasingly investigated, including serum markers, radiological features, ultrasound elastography, doppler and contrast-enhanced ultrasonography. In this study, we focused on both invasive and noninvasive methods for portal pressure monitoring and explored their roles in clinical setting. The advantages and limitations of various techniques for future research are also discussed.

1. Background: Recently, immune checkpoint blockade has emerged as one of the most potential treatments for solid tumors. Programmed cell death ligand 1(PD-L1), a member of the B7 family of molecules, plays a crucial role in tumor immunobiology. However, the prognostic significance of PD-L1 in cholangiocarcinoma (CCA) patients remains controversial. The objective of this study was to inquire into the prognostic and clinicopathological significance of PD-L1 in CCA via a meta-analysis. 2. Methods: We searched PubMed, Embase, the Cochrane Library, Web of Science and Google Scholar up to April 2019, regardless of the region or language, for studies on the correlation between prognosis or clinicopathology and PD-L1 in patients with CCA. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to investigate the prognostic significance of PD-L1 expression in cholangiocarcinoma. The odds ratios (ORs) were also calculated to explore the association between PD-L1 expression and clinicopathological features. 3. Results: Eleven studies including 1,066 patients were included in our meta-analysis. The meta-analysis of these studies showed a trend that high PD-L1 expression indicated a poor OS, but the result was not statistically significant (HR=1.62, 95% CI[0.98-2.68], p=0.063). For DFS, although the pooled result is not statistically significant, it trends toward being significant that high PD-L1 expression indicated improved DFS (HR=0.80, 95% CI[0.62, 1.04], p =0.092). In subgroup analyses, the results were not consistent across the subgroups that were divided based on the publication year (before 2018: HR=1.92, 95% CI[1.34-2.75], p< 0.001; after 2018: HR=1.42, 95% CI[0.70-2.89], p=0.335). Moreover, PD-L1 expression in TCs was significantly correlated with the AJCC TNM stage of CCA (OR=0.52, 95% CI[0.27, 0.99], p=0.09). 4. Conclusion Our meta-analyses revealed that PD-L1 expressed in TCs was significantly correlated with the AJCC TNM stage of CCA. Based on the included studies, we found that PD-L1 indeed expressed in both TCs and ICs in CCA patients, raising the possibility of the use of anti-PD-1/PD-L1 therapy for CCA patients. In contrast, expression of PD-L1 did not seem to be associated with patient outcome in our study. The prognostic role of PD-L1 in CCA demands further investigation.