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Microscopic extension (subclinical lesion) is the key factor for defining clinical target volume in radiotherapy. In this article, the research progresses on microscopic extension or extracapsular extension in esophageal cancer, lung cancer, hepatocellular carcinoma, prostate cancer, bladder cancer, rectal cancer, breast cancer, non-melanoma skin cancer and metastatic lymph nodes were reviewed. These results provide important basis for the definition of clinical target volume. However, a series of questions remain to be properly resolved.
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The measurement of portal vein pressure (PVP) is important for the evaluation of therapeutic efficacy and prognosis in patients with liver cirrhosis.Aims: To investigate a non-invasive method for evaluating PVP in model of liver cirrhosis in rats.Methods: Liver cirrhosis model in rats was induced by intraperitoneal injection with thioacetamide.Magnetic resonance imaging with TOF sequence was used to measure portal vein diameter (PVD).PVP was detected directly by transvenous catheterization of portal vein.Body weight, liver weight, spleen weight, liver volume and spleen volume were determined.The hydroxyproline content in liver was determined by alkaline hydrolysis assay, proportion of collagen area in liver was detected by Sirius red staining.Results: Liver cirrhosis model in rats was successfully established after intraperitoneal injection for 20 weeks.Compared with control group, mean PVP, liver weight, liver volume, spleen weight, PVD, liver volume/body weight (LV/BW) ratio, spleen volume/body weight (SV/BW) ratio, hydroxyproline content and proportion of collagen area were significantly increased in model group (P<0.05), and body weight was significantly decreased (P<0.001).PVP was positively correlated with LV/BW ratio and proportion of collagen area (P<0.05).Conclusions: LV/BW and proportion of collagen area can indirectly reflect the PVP, and may provide a non-invasive approach for evaluation of portal hypertension.
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Objective To analyze the incidence rate and the perioperative risk factors associated with delirium after cardiac surgery.Methods We enrolled 622 patients between October 2014 and March 2015 in the department of cardiovascular surgery in Henan Provincial People's Hospital who were allocated to group PD and non-PD according to the Confusion Assessment Method(CAM) after the cardiac operation.Baseline demographics,perioperative data,and postoperative outcomes of these patients were recorded and analyzed via chi-square test and multivariate logistic regression analysis to determine the risk factors of postoperative delirium.Results Postoperative delirium was detected in 102 patients according to CAM criteria.The incidence was 16.4％.Multivariate logistic regression analysis revealed that age (OR =3.456;95％ CI:2.431-4.569),preoperative atrial fibrillation (OR =1.987;95％ CI:3.562-7.862),prolonged surgery duration (OR =1.246;95％ CI:3.164-5.982),postoperative pain (OR =5.356;95 ％ CI:1.386-9.374)were independently associated with postoperative delirium after cardiac surgery.Conclusions Delirium is a frequent complication,age,preoperative atrial fibrillation,prolonged surgery duration,postoperative pain are independent risk factors for delirium following cardiac surgery.Management according to potential risk factors may be associated with preferable therapeutic outcomes.
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Objective To discuss the clinical epidemiology features and change trend of aortic dissection (AD) in Henan Province.Methods Retrospective analysis of consecutive 906 patients with AD over 10 years in Henan Provincial People' s Hospital,the First Affiliated Hospital of Zhengzhou University and Henan Provincial Chest Hospital.Hospital records and prognosis were compared between two five-year periods.Results 906 cases with AD were hospitalized during the past 10years.The mean age was (50.2 ± 9.8) years.The male/female ratio was 3.49 ∶ 1.Hypertension was present in 60.3 ％ of all patients.Heavy smoking history was elicited in 32.2％ of all patients.Type A dissection were identified in 57.8％ of all the cases,and type B in 42.2％.In-hospital mortality of acute type A dissection was 21.8％,acute type B dissection 6.8％.In two five-year periods,the total number of cases increased by 216％,among which type A was the fastest,increased by 294％,Changes of mean age and male/female ratio were not significant.For acute AD,changes of prognosis in one year improved,and reach statistical significance (P ＜ 0.05).Conclusion This study provides insight into current regional profiles of AD.The number of hospitalized patients with AD is increasing dramatically.The mean age of the first-attack is much younger and the male ration is much higher than that reported by other regional researchers.These data support the urgent need for further improvement in prevention and treatment of AD.
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Objective To investigate whether Tumor Necrosis Factor-alpha (TNFα) is capable of activating Rho kinase pathway which leads to smooth muscle cell proliferation and the intervention function of Rosuvastatin, and clarify the mechanism and intervention manner of anti-atherosclerosis by Rosuvastatin. Methods Wistar neonate rat smooth muscle cells were cultured, and the activity of cell proliferation was determined by methyl thiazolyl tetrazolium (MTT). The expression of Rho kinase genes after the stimulation of TNFα was evaluated by RT-PCR. Western blot method was used to measure the protein expression of proliferating cell nuclear antigen (PCNA) after TNFα stimulation and Rosuvastatin intervention in smooth muscle cell. Results The TNFα stimulation significantly enhanced the expression of Rho kinase and increased the expression of PCNA protein in smooth muscle cells (P < 0.05). These effects were positively correlated with prolonged treatment whereas additional Rosuvastatin administration inhibited the above-mentioned effects (P < 0.05). Conclusions The activation of TNFα mediated Rho kinase signaling pathway can significantly promote smooth muscle cell proliferation, and Rosuvastatin can not only inhibit this pathway but also the induced proliferation.
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Objective To analyze the risk factors for neurodevelopmental impairment of infants with tetralogy of Fallot (TOF).Methods Neurodevelopment of infants aged 0-3 years and undergoiong tetralogy of Fallot surgic operations in NanJing Children Hospital between October 2010 and October 2011 were assessed with Bayley Scales of Infant Development test (BSID).On the basis of assessment results,infants with 90 piont or more were devided into the normal group,and the rest less than 90 point were devided into the abnormal group.Compare the difference of birh weight,age,weight transcutaneous oxygen saturation (SPO2),hematokrit (HCT),McGoon index and left ventricular end-diastolic capacity index(LVEDI) at surgery between the two groups with t-test.And to identify risk factors for neurodevelopmental impairment of infants with tetralogy of Fallot with multivariate linear regression analysis.P ＜ 0.05 was statistically significant.Results All of 83 infants with 55 males and 28 females were admitted into this prospective study.There was no statistical significance in mental development index (MDI) and psychological development index (PDI) between the sexes.For MDI:normal 67 (80.7％),abnormal 16 (18.3％).With t-test,McGoon index,left ventricular end-diastolic capacity index and birth weight had significant difference between the two groups (P ＜ 0.05).Multivariate linear regression analysis showed that McGoon index,left ventricular end-diastolic capacity index and age at surgry were risk factors for MDI decrease,beta was 21.41,0.59 and-0.31,respectively (P＜ 0.05).Age at surgry was connected with MDI nagetively,McGoon index affected mostly.For PDI:normal 61 (73.5％),abnormal 22(26.5％).With t-test,MaGoon index and left ventricular end-diastolic capacity index had statistical significance between the two groups(P ＜ 0.05).Multivariate linear regression analysis showed that McGoon index and left ventricular end-diastolic capacity index were risk factors for PDI decrease,beta was 23.88 and 0.49,respectively (P =0.000).McGoon index influenced greatly.Conclusion McGoon index,left ventricular end-diastolic capacity index and age at surgry are influence factors for MDI decrease.McGoon index,left ventricular end-diastolic capacity index are risk factors for PDI decrease.McGoon index affects neurodevelopment of infants with tetralogy of Fallot mostly.
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<p><b>BACKGROUND</b>Lung cancer invading left atrium or base of pulmonary vein belongs to locally advanced lung cancer (T4). The prognosis of treatment without surgery is poor. The aim of this study is to explore the feasibility and the value of surgical method in the treatment of this disease.</p><p><b>METHODS</b>From April, 1993 to April, 2005, lobectomy or pneumonectomy combined with extended resection of left atrium were carried out in 46 patients with locally advanced lung cancer. The operations included left low lobectomy in 20 cases, left pneumonectomy in 6 cases, right middle and low lobectomy in 12 cases, right low lobectomy in 3 cases and right pueumonectomy in 5 cases respectively. The base of the pulmonary vein was invaded by the tumor in 34 patients, while left atriums were invaded obviously in 12 patients. Two patients were operated using extracoporeal circulation because of main pulmonary artery and left atrium being invaded. The Kaplan-Meier method (Log rank test) and a COX model were used to analyse the survival and the prognosis.</p><p><b>RESULTS</b>There was no operative mortality in this series, 15 patients had operative complication, including arrhythmia in 13 cases, pneumonia in 8 cases and heart failure in 1 case. The median survival was 35 months. The 1-, 3-, 5-year survival rates were 84.2%, 43.7%, 30.5% respectively. The survival of patients with N0/1 was better than that of patients with N2 disease, the median survival of them were 38 months and 19 months respectively (P=0.002). Using a Cox model analysis, lymph node stage (N0/1 or N2) was independent prognostic factor, while preoperative chemotherapy, sex, age and the pathologic type were not independent prognostic factors.</p><p><b>CONCLUSIONS</b>Surgical treatment for lung cancer invading the left atrium or the base of pulmonary vein is feasible, especially for N0 patients.</p>
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The hospital the authors work with started to implement a personnel mechanism based on employment under contract. The organizational structure was delimited scientifically and the posts were set up rationally. The employees had to compete for the posts and were appointed according to their merits. As a result, their work enthusiasm and initiative were aroused, their awareness of competition and sense of crisis were enhanced, and the allocation of personnel was optimized. When implementing the competition for the posts system, it is imperative to adhere to such principles as the combination of democracy and centralism, the combination of competition for the posts and comprehensive assessment, and the combination of competition and unity and cooperation.