ABSTRACT
Objective:To evaluate the outcome of laser coagulation under fetoscope for placental chorioangioma (CA).Methods:The clinical data of three pregnant women with giant CA treated by laser coagulation under fetoscope in Peking University Third Hospital from January 2018 to December 2020 were analyzed retrospectively. Relevant articles up to September 2022 were retrieved from Wanfang Database, China National Knowledge Infrastructure and PubMed, and the clinical data of all patients were retrospectively summarized. Indications and intervention effects of fetoscopic laser therapy were analyzed. Descriptive statistics was used to describe the data.Results:Thirteen patients were involved in this study including 10 cases retrieved from the databases. The average age of the pregnant women was (30.3±6.2) years old. There were 12 cases of single pregnancy and one case of twin pregnancy (monochorionic diamnionic twin pregnancy). Except for cases for which data were not available in the literatures, at the diagnosis of CA, the average gestational age was (19.9±4.5) weeks ( n=7) and the average maximum diameter of the mass was (6.1±4.1) cm ( n=6). The patients underwent fetoscopic laser therapy at an average gestational age of (25.0±2.0) weeks ( n=13) with the average maximum tumor diameter of (7.6±2.8) cm ( n=9). After treatment, the amniotic fluid volume of three cases decreased to normal. In one case, the amniotic fluid volume decreased but was still above the upper limit of the normal range. Moreover, the maximum tumor diameter decreased in four cases; the peak systolic velocity of the fetal middle cerebral artery decreased to normal in one case; fetal heart function became normal in two cases and fetal edema was relieved in one case. Among the three patients treated in our hospital, the blood supply of CA disappeared after treatment. Intrauterine fetal death occurred in two cases. The other 11 patients gave birth to live babies at the gestational age of (36.6±3.8) weeks with five through cesarean section (5/11), five through vaginal delivery (4/11) and two not reported. The birth weight of the neonates was (2 712±1 023) g and all of them survived. The gender of five neonates were reported and all were females, two of them were monochorionic diamnionic twins. No abnormality was found in the three neonates delivered in our hospital during a six-month follow-up. No abnormality was reported in the other neonates during ten days to six months of follow-up. Conclusions:Fetoscopic laser coagulation may help reduce the size of CA, decrease complications and improve pregnancy outcomes.
ABSTRACT
Objective:To analyze the labor progression characteristics of primiparous term singleton pregnant women with adenomyosis.Methods:From April 2014 to May 2021, pregnant women underwent regular antenatal examination in Peking University Third Hospital were enrolled in this retrospective study, 109 primiparous term pregnant women with adenomyosis who underwent singleton, primipara, cephalic and vaginal delivery were referred as the adenomyosis group, while 109 pregnant women without adenomyosis primiparous term pregnant women at the same time were referred as the control group. The general clinical information, labor process intervention, pregnancy outcomes and labor course time of the two groups were analyzed.Results:(1) General clinical conditions: the pre-pregnancy uterine volume of the adenomyosis group was larger than that of the control group [(66.8±23.7) vs (41.4±13.1) cm 3, P<0.05]. The proportion of assisted reproductive pregnancy and endometriosis in the adenomyosis group were higher than those in the control group [31.2% (34/109) vs 7.3% (8/109); 31.2% (34/109) vs 5.5% (6/109); all P<0.05]. There were no significant differences in maternal age, gestational age at delivery, pre-pregnancy body mass index, gestational weight gain, gravidity, incidence of pregnancy complications (gestational diabetes mellitus, pre-eclampsia and thyroid diseases) and premature rupture of membranes between the two groups (all P>0.05). (2) Labor process intervention and maternal and fetal outcomes: postpartum hemorrhage was higher in the adenomyosis group than the control group (median: 300 vs 260 ml, P=0.018). There were no significant differences in the proportion of labor onset, use of oxytocin, artificial rupture of membranes, perineal laceration Ⅲ and above, episiotomy, newborn weight and 1-minute Apgar score between the two groups (all P>0.05). (3) Time of labor process: there were no significant differences between the two groups in the time required for the first stage, third stage, total stage and cervical dilation 0-1, 1-2, 2-3, 3-4, 4-5, 5-6, 6-7 cm (all P>0.05). The time required for cervical dilation 7-8, 8-9, 9-10 cm and the second stage of labor in adenomyosis group (median: 20, 18, 15 and 12 minutes, respectively) were shorter than those of the control group (median: 23, 23, 23 and 26 minutes, respectively), and the differences were statistically significant (all P<0.05). (4) The effect of endometriosis on labor: there was no significant difference in the effect of endometriosis on labor in adenomyosis group ( P>0.05). Conclusions:The labor process of primiparous term pregnant women with adenomyosis is significantly accelerated after the cervical dilatation for 7 cm, which should be closely observed. The third stage of labor course is managed aggressively with drugs to prevent postpartum hemorrhage.
ABSTRACT
Objective:To analyze fetoscopic cord laser therapy for management of monochorionic monoamniotic (MCMA) twin pregnancies.Methods:The clinical data of fetoscopic cord laser therapy, including cord occlusion, transection, and disentanglement in three pairs of MCMA twins from January 2020 to January 2021 in Peking University Third Hospital were summarized. Literature on cord occlusion and/or transection in MCMA twins were retrieved from Cochrane Library, PubMed, EMBASE, CBM, WanFang, and CNKI from the time at establishment to December 2020. The clinical conditions, surgical indications and methods, disease progression, and maternal and infant prognosis were analyzed.Results:Three cases of MCMA twins in this study period received fetoscopic cord laser therapy between 17-24 weeks, among which two cases gave birth at full-term without any maternal or infant complications, and one was terminated due to fetal malformation. Seven English articles including 29 MCMA twin pregnancies were retrieved. In addition to the three cases reported in this article, a total of 32 cases were analyzed. The indication of cord occlusion and/or transection included twin-reversed arterial perfusion sequence (21.9%, 7/32), fetal malformation (46.9%, 15/32), selective fetal growth restriction (sFGR) (21.9%, 7/32), twin-to-twin transfusion syndrome (TTTS) (3.1%, 1/32), TTTS combined with sFGR (3.1%, 1/32), single intrauterine death (3.1%, 1/32). Gestational age at surgery was between 14 +1 to 27 +3 weeks. No maternal complication due to the operation was reported. After exclusion of two cases who did not receive cord transection and one case was terminated due to fetal malformation, all the other 29 co-twins were born alive at the gestational age between 24 +3 to 40 weeks and birth weight between 800-3 800 g. Among the 29 live born babies, four died soon after birth with unclarified reasons in the literature and one was born with multiple malformations which were detected prenatally, and the other 24 neonates were healthy during the follow-up from 1 month to 9 years old. Conclusions:For MCMA twin pregnant women with umbilical cord entanglement or other indications for fetal reduction, cord occlusion, transection, and disentanglement using fetoscopic cord laser is safe and effective for protecting the surviving fetus.
ABSTRACT
Objective To systematically explore the efficacy of four intervention regiments including desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs in the treatment of monosymptomatic nocturnal enuresis in children by network meta-analysis. Methods The databases of PubMed, Cochrance Library, EMBase and Web of Science were systematically searched and retrieved upto August 1, 2017. Included were the randomized controlled trials (RCTs) which had any two or more of four intervention regiments (desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs) for treatment of monosymptomatic nocturnal enuresis in children. The literature was screened according to the established inclusion and exclusion criteria, and the data extraction and quality evaluation were performed for the final inclusion of RCT. Software R 3.3.2 and STATA 14.0 were used for data analysis. Results Fifteen RCTs were included with a total of 1505 children. Network meta-analysis showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were higher than those of desmopressin (complete reaction rate: OR=2.8, 95％ CI :1.5～5.4; success rate: OR=3.5, 95％ CI :1.7～7.5) and alarm (complete response rate: OR=2.7, 95％ CI :1.1～6.6; success rate: OR=3.8, 95％ CI: 1.6～9.0. The success rate of desmopressin combined with alarm was higher than that of alarm (OR=1.9, 95％CI: 1.1～3.4) . The recurrence rate of alarm after treatment was significantly lower than that of desmopressin (OR=0.15, 95％CI: 0.03～0.53) . The ranking results showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were the best. The desmopressin combined with alarm can minimize the number of bed-wetting episodes per week and the recurrence rate of alarm was the lowest among the four regiments. Conclusion The effect of desmopressin combined with anticholinergic drugs is significantly better than that of alarm or desmopressin alone. The combination of desmopressin and alarm has a slight advantage or similar effect to that of single alarm or desmopressin treatment. The effect of desmopressin is similar to that of alarm. Alarm treatment has the lowest recurrence rate.
ABSTRACT
Objective To study the occurrence of acute gastrointestinal injury under different critical status in Pediatric Intensive Care Unit,and to assess the connection between citrulline and acute gastrointestinal injury.To ana-lyze the correlation among serum citrulline and C-reaction protein(CRP),procalcitonin(PCT),creatinine,urea nitro-gen,bilirubin,lactate,albumin.To study the role of citrulline in evaluating the children condition,prognosis and changes in critically ill children.Methods Ninety-six pediatric patients who were critically ill at the Pediatric Intensive Care Unit of the Second Hospital of Lanzhou University were selected,excluding those with primary gastrointestinal diseases and chronic kidney disease.Clinical features were recorded and CRP,PCT,creatinine,urea nitrogen,bilirubin,lactate, and albumin were measured.Serum citrulline concentrations were measured by high performance liquid chromatography in 65 patients with gastrointestinal injury,and sensitivity,specificity and area under the receiver operating characteristic (ROC)curve were calculated.Results The incidence of acute gastrointestinal injuries in non-critical group,critical group,reorganization critical group were 47.06%(16/34 cases),75.00%(36/48 cases),92.86%(13/14 cases) (χ2=11.848,P=0.003).The serum citrulline concentrations of gastrointestinal injury group and non- gastrointesti-nal injury group were(14.655 ± 8.231)μmol/L,(23.522 ± 11.079)μmol/L(t=4.398,P<0.05).The area under ROC of citrulline was 0.079 8.Serum citrulline concentrations increased significantly in infants with very severe gastro-intestinal injury after 3 days of treatment compared with admission[(26. 40 ± 16. 10)μmol/L vs.(14. 40 ± 6.82)μmol/L,t=5.524,P=0.029].The lower serum citrulline levels the children had,the higher mortality was. There were negative correlations among serum citrullin and CRP,PCT and length of hospital stay(r = -0. 319,-0.299,-0.364,P=0.003,0.006,0.001).There were no correlations among serum citrullin and blood urea nitro-gen,lactic acid,albumin,and bilirubin levels.Conclusion The more critically ill children have a higher incidence of acute gastrointestinal injury and the worse the prognosis.Serum citrulline levels may well reflect the extent of acute gas-trointestinal injury and the outcome.Perhaps it can be one of the reliable markers to evaluate the function of gastrointes-tinal and participate in assessing critical condition and prognosis in critical ill children ness.
ABSTRACT
Objective To evaluate the prognostic value of the extracapsular spread (ECS) of regional lymph nodes in nasopharyngeal carcinoma (NPC) based on magnetic resonance imaging.Methods A retrospective review was performed for 477 previously untreated patients with NPC who were treated in Yuebei People′s Hospital from January 2009 to December 2013.Univariate and multivariate survival analyses were performed to identify the prognostic value of ECS in NPC.Results There were 216 patients with ECS and 261 patients without ECS,and the median survival of the two groups of patients was 38.5 months and 39.0 months,respectively.The 3-year overall survival (OS),progression-free survival (PFS),local recurrence-free survival (LRFS),and distant metastasis-free survival (DMFS) rates of the patients with ECS versus those without ECS were 81.9% versus 90.7%,65.8% versus 85.0%,87.8% versus 95.8%,and 80.3% versus 92.9%,respectively (all P=0.000).The univariate analysis showed that N stage and ECS were important prognostic factors for OS,PFS,LRFS,and DMFS in NPC patients (P=0.000-0.004),and T stage and TNM stage were associated with OS,PFS,and DMFS (all P=0.000).The multivariate analysis using the Cox regression model showed that T stage was an independent prognostic factor for the survival of NPC patients,and ECS was an important prognostic factor for PFS,LRFS,and DMFS.Conclusion ECS of regional lymph nodes is a risk factor for local recurrence or distant metastasis in patients with NPC.
ABSTRACT
Objective:To investigate the effects of 5-aza-2′deoxycytidine(5-aza-dC),a DNA methyltransferase (DNMT)inhibitor, on the methylation status of the RECK gene and the invasion of salivary adenoid cystic carcinoma cell lines.Methods:Methylation-specific PCR,Western blot analysis and quantitative real-time PCR were used to investigate the methylation status of RECK gene and the expression of RECK mRNA and protein in SACC cell lines.The invasive ability of SACC cells was examined by transwell assay. Results:Promoter methylation was only found in ACC-Mcell line and not in ACC-2 cell line.Treatment of ACC-Mcells with 5-aza-dC partially reversed the hypermethylation status of the RECK gene and significantly enhanced the expression level of mRNA and pro-tein of RECK,suppressed ACC-Mcell invasive ability.Conclusion:5-aza-dC can inhibit ACC-Mcell invasion by reversal of hyperm-ethylation status of RECK gene.
ABSTRACT
Objective:To explore the effect of family history of cancer on clinical features and prognostic factors in nasopharyngeal car-cinoma (NPC) patients. Methods:The clinical data of 89 NPC patients with a family history of cancer and 388 NPC patients without a family history of cancer were retrospectively reviewed. Univariate and multivariate survival analyses were performed to identify possi-ble prognostic factors. Results:The clinical characteristics of NPC patients with and without family history of cancer were compared. The gender, age, TNM stage, pathological type, and hemoglobin radiotherapy concentration before treatment did not significantly dif-fer between the two groups (P>0.05). NPC patients with a family history of cancer had better 3-year overall survival than those with-out family history of cancer (91.6%vs. 85.5%), but no statistically significant difference was observed (P=0.211). Both univariate and multivariate analyses showed that T, N, and TNM stages were the important prognosis factors affecting 3-year overall survival (OS), progression free survival (PFS), and distant metastasis-free survival (DMFS) of NPC (P0.05). Conclusion:NPC patients with family history of cancer had better 3-year OS than those without family history of cancer, but no statistically significant observation was found. Large T stage or high lymph node stage contributed to poor survival of NPC. Family history of cancer had no significant in-fluence on the survival of NPC patients.
ABSTRACT
Objective To discuss the value of diagnosing gastrointestinal dysfunction in.critically ill children.Methods Seventy-six critically ill patients were reviewed,48 cases combined with gastrointestinal dysfunction.Plasma D-lactate,intestinal fatty acid binding protein(IFABP)of serum and urine were performed in all patients,detected the sensitivity and specificity,ealculated the area under the ROC curve (AUC).Results Plasma D-Iactate level≥9.63 mg/L had a sensitivity of 85.2%,specificity of 70.9%,and AUC of 0.822 for diagnosing gastrointestinal dysfunction.Serum IFABP level≥0.129μg/L had a sensitivity of 65.2%,specificity of 63.8%,and AUC of 0.744 for diagnosing gastrointestinal dysfunction.Urine IFABP ≥0.330μg/Lhad a sensitivity of 78.3%,specificity of 72.3%,and AUC of 0.820 for diagnosing gastrointestinal dysfunction.There was no significant difference in AUC between plasma and urine IFABP(P＞0.05),there was no significant difference in AUC between serum D-lactate and serum IFABP(P＞0.05).Conclusions Plasma D-Lactgte,serum and urine WABP may be useful markers as warning gastrointestinal dysfunction of critically ill children.Plasma D-lactate and urine IFABP level may be more sensitively,but they need to be further studied.
ABSTRACT
Objective The results and side effects of nasopharyngeal carcinoma treated by combined external radiotherapy and Californium -252 neutron after loading intracavitary radiotherapy. Methods From November 2005 to March 2007, 30 nasopharyngeal carcinoma patients with staged T1 and T2 by 1992 Fuzhou staging system, were treated by external beam radiotherapy combined with Californium-252 neutron after loading intraeavitary radiotherapy. Results All patients were followed up for 2 years. 2 cases recurred in the nasopharynx. 4 cases developed distant metastases. 2 cases developed trismus. No perforations in hand and soft palate occurred. Conclusion External beam radiotherapy combined with Californian-252 neutron after loading intracavitary radiotherapy for nasopharyngeal carcinoma is indicated for boosting the dose to the nasopharyngeal cavity; reducing the dose for external irradiation. It can improve local control rate of nasopharyngeal carcinoma and reduce occur rate for the trismus.
ABSTRACT
Objective To evaluated the treatment results of late-course accelerated hyperfractionated radiotherapy combined with chemotherapy for advanced esophageal carcinoma. Methods 72 patients with advanced esophageal cancer were randomized into two groups. The late-course accelerated hyperfractionated radiotherapy combined with chemotherapy(LCAF+CT)group received the induction chemotherapy for two cycles, followed by conventional fractionation radiotherapy to a dose of 36 Gy, then changed into accelerated hyperfractionated radiotherapy to a total dose of 60 ~ 66 Gy. The conventional fractionation radiotherapy combined with chemotherapy(CF+CT)group received the chemotherapy that it was similar to LCAF+CT group, and used the conventional fractionation radiotherapy to a total dose of 60 ~ 66 Gy. Results The 1-, 3- and 5-year survival rates were 82.3 %, 51.6 %, 38.2 % in the LCAF+CT group, and 73.8 %, 31.5 %, 18.6 % in the CF+CT group. The differences of 3- and 5-year survival rates were statistically significant (P 0.05). Conclusion Late-coures accelerated hyperfractionated radiotherapy combined with chemotherapy might improve the treatment efficacy of advanced esophageal cancer and lengthen the suvival time. The toxic and side effects of LCAF+CT group were more severe than those of CF+CT group, but they were well tolerable.
ABSTRACT
The treatment results of radiofrequency ablation (m) were analyzed in l5 patients with the complicated Supraventricular tachycardia(SVT)． The causes of SVT were dual accessory pathway(AP) in 9 patients, single M with slow-fast atrioventricular junctional reentrant tachycardio (AVJRT) in 5 patients and single AP with slow fast/fast-slow AVJRT in l patient． Results: 24 APs and 6 slow pathways of atrioventricular node were abl a ted． All patients were successful． During the follow-up of 6～48 months, there were no recurrence in l5 patients, also there were no occurrence of atrioventricular block and other complications． Conclusion: Using the proper methods of m of the complicated SVT would have a h igher successful rate, a lower recurrent rate and lower complications．