ABSTRACT
<p><b>BACKGROUND</b>The effectiveness and influence of surgery followed by adjuvant chemoradiotherapy (CRT) on the survival of patients with resectable esophageal carcinoma are still under debate. The outcomes of clinical trials have not been consistent. This study aimed to perform a meta-analysis of eligible published clinical trials to compare CRT with surgery without adjuvant chemoradiotherapy (non-CRT) for resectable esophageal carcinoma.</p><p><b>METHODS</b>Computerized bibliographic and manual searches were undertaken to identify all eligible literature between 1990 and 2012. PubMed, EMBASE, Chinese National Knowledge Infrastructure, and Wanfang databases were our primary sources for published clinical trials. The quality of the methodology and reliability of the data from all of the clinical trials were assessed. All data were extracted by three independent researchers.</p><p><b>RESULTS</b>Seven studies that included a total of 523 patients were selected. It was found that CRT significantly improved survival. The odds ratio (OR) in comparing CRT and non-CRT groups was 1.75 (95% confidence intervals (CI): 1.17 - 2.60, P = 0.006) for 1-year survival, 2.07 (95%CI: 1.45 - 2.96, P < 0.0001) for 3-year survival, and 2.17 (95%CI: 1.45 - 3.26, P = 0.0002) for 5-year survival. There have been no CRT treatment-related deaths reported in the literature. The incidence of related complications was high in the cases with CRT. Patients treated with CRT had a lower incidence of local-regional cancer recurrence (OR: 0.49, 95%CI: 0.31 - 0.76, P = 0.002) and a similar incidence of distant cancer recurrence (OR: 0.90, 95%CI: 0.60 - 1.34, P = 0.60).</p><p><b>CONCLUSIONS</b>It was found that patients with resectable esophageal carcinoma could gain a survival benefit from CRT. However, CRT was associated with a high incidence of related complications.</p>
Subject(s)
Humans , Carcinoma , General Surgery , Therapeutics , Chemoradiotherapy, Adjuvant , Methods , Esophageal Neoplasms , General Surgery , TherapeuticsABSTRACT
Objective To discuss the combined value of gray-scale ultrasound ( GSUS) and contrast-enhanced ultrasound (CEUS) in the diagnosis of benign and malignant thyroid lesions and to explore the optimal diagnostic point of scoring method .Methods Ultrasound images of 178 thyroid lesions confirmed by pathology were synthetically reviewed by scoring 5 GSUS indicators including shape , orientation, interior echogenicity, halo sign, microcalcification and 6 CEUS indicators including relative arrival time of microbubbles in the periphery and interior, peak periphery and interior echogenicity, peripheral ring-enhancement, and homogeneity of enhancement .One positive indicator scored one point .The optimal diagnostic points and their clinical value were explored according to ROC curves .Results Scores of GSUS, CEUS and the combination of GSUS and CEUS were significantly different (Z =10.188,9.843,10.705,all P <0.001). Areas under ROC curves of GSUS, CEUS and the combination of GSUS and CEUS were 0.936, 0.919 and 0.964, respectively.Three or more positive GSUS indicators of five in a thyroid lesion predicted that the thyroid lesion was malignant , with the sensitivity of 79.6% and the specificity of 91.2%.Two or more positive CEUS indicators of six in a thyroid lesion predicted that the thyroid lesion was malignant , with the sensitivity of 91.8% and the specificity of 81.2%.Five or more positive GSUS and CEUS indicators of eleven in a thyroid lesion predicted that the thyroid lesion was malignant , with the sensitivity of 93.6%and the specificity of 92.3%.The areas under the ROC curve of GSUS and CEUS were 0.936 and 0.919.The area under the ROC curve of the combination of GSUS and CEUS was 0.964, larger than the areas under the GSUS ROC curve and the CEUS ROC curve.Conclusion Ultrasound is valuable in the differential diagnosis of benign and malignant thyroid lesions , and the combination of GSUS and CEUS is the most valuable with 5 points as the optimal diagnostic scoring method .
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the early diagnostic value of contrast-enhanced ultrasound (CEUS) in acute renal failure (ARF) of rabbit.</p><p><b>METHODS</b>The rabbit model of ARF was established by intramuscular injection of 50% glycerin (12 ml/kg) into the hind legs of 18 New Zealand rabbits. CEUS was performed for both kidneys before injection and 6 hours after the injection. The slope rate of ascending curve (A), the slope rate of descending curve (alpha), area under curve (AUC), derived peak intensity (DPI), and time to peak (TTP) were measured in renal cortex of rabbits using Q-lab software package. Blood serum urea nitrogen (BUN) and serum creatinine (SCr) were measured.</p><p><b>RESULTS</b>The values of A and alpha before the injection of glycerin were (3.07 +/- 1.83) dB/s and (0.19 +/- 0.15)/s, respectively, which were significantly higher than the values after injection [ (2.76 +/- 1.31) dB/s and (0.09 +/- 0.02)/s, respectively] (P < 0.05). The values of AUC and TTP before the injection of glycerin were (137.4 +/- 68.4) dB s and (6.33 +/- 3.71) s, which were significantly lower than the values after injection [(309.5 +/- 88.9) dB s and (8.61 +/- 3.97) s, respectively] (P < 0.01). No significant change of DPI, BUN or SCr was found.</p><p><b>CONCLUSIONS</b>CEUS can precisely display the hemodynamic change of ARF model of rabbit in the early stage, with superior sensitivity than BUN and SCr. It may be a promising imaging method for the early diagnosis of ARF.</p>