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Objective:To analyze the clinical efficacy and safety of surgical excision of slings in the treatment of voiding dysfunction after the midurethral sling(MUS)procedure.Methods:A retrospective analysis was conducted on postoperative patients with voiding dysfunction after MUS from January 2016 to June 2021.The ages of the patients ranged from 47 to 73 years, with an average of(61.3±8.2)years.The patients were followed up for preoperative and postoperative urinary flow rates and PVR, and results from the ICI-Q-SF were collected from patients for statistical analysis.Results:The shortest time from the first sling procedure to the occurrence of voiding dysfunction was 2 months and the longest was 7 months, with an average of(3.8±1.8)months.The earliest surgical excision was performed 5 months after MUS and the latest was done 24 months after MUS, with an average of(12.3±6.6)months.Among the 12 patients, symptoms of 11 patients after surgical excision of slings were significantly improved, compared with pre-surgery data.The urinary flow rate was 9.3(3.7, 13.2)ml/s before surgery and 21.5(15.7, 34.2)ml/s after surgery, P=0.004; The residual urine volume before surgery: 315(200, 377)ml, after surgery: 0(0, 80)points, P<0.001, both with statistical significance; preoperative ICI-Q-SF: 0(0, 5)points, postoperative: 4(0, 8)points, There was no significant difference between before and after operation( P=0.348). Conclusions:Surgical excision of slings is safe and effective in the treatment of voiding dysfunction after MUS.
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Objective:To analyze the clinical efficacy and safety of the retropubic tension-free vaginal tape(TVT)procedure for postoperative recurrent urinary incontinence in women.Methods:Retrospective analysis was conducted on twenty-two patients who had developed recurrent urinary incontinence after mid-urethral sling(MUS)surgery and received the retropubic TVT procedure via the middle urethra from January 2016 to June 2020.Patients were between 44 and 74 years old, with a mean age of 61.2±10.2.They were initially treated with the TVT and inside-out trans-obturator(TVT-O)procedures and were followed up by using the International Consultation on Incontinence Questionnaire-Short Form(ICI-Q-SF). Then statistical analysis was performed.Results:No bladder or urethral puncture wounds were observed in the 22 patients during cystoscopy.No pain, sling, vaginal or urethral erosion, or postoperative sling infection was found in any of the patients during a long-term follow-up.Considerable improvement was achieved in frequency of leakage[pre-operation: 4(4, 5) vs.post-operation: 1(1, 2), P<0.001], urine leakage volume[pre-operation: 6(4, 6)ml vs.post-operation: 2(2, 2)ml, P<0.001], impact on quality of life[pre-operation: 10(8, 10) vs. post-operation: 2(1, 3), P<0.001]and ICI-Q-SF[pre-operation: 20(18, 21) vs. post-operation: 5(3, 7), P<0.001]after TVT. Conclusions:TVT is safe and effective for the treatment of recurrent urinary incontinence after MUS surgery.
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Objective:To analyze the learning effect of laparoscopic radical cystectomy(LRC)+ modified ileal conduit(MIC).Methods:From 2014 to 2019, 42 patients underwent MIC and their clinical data was retrospectively analyzed. 34 operations were performed by surgeon 1 and 8 operations by surgeon 2. We divided the 34 patients of surgeon 1 into three groups according to their surgical sequence (group A, 1st to 12th; group B, 13th to 23th; group C, 24 th to 34 th), the 8 cases of surgeon 2 was regarded as group D. The history of abdomen surgery in the 4 groups were 0, 1, 4, 3 cases, respectively ( P<0.05). There was no significant difference of the other baseline characteristics, such as age, BMI, American Society of Anesthesiologists. Then we compared several variables between the 4 groups like operation time, time of ileal conduit construction, blood loss, complication rate, lymph node yield, surgical margin, etc. The key steps of the MIC included isolating terminal ileum when the mesentery was transilluminated, performing end-to-end reflux ureterointestinal anastomosis after the efferent loop was fixed, closing the rent of the retroperitoneum. Results:All operations were performed intracorporeally with no transition to open surgery. The operative time for group A, B, C were 330.0(320.0, 360.0)min, 300.0(250.0, 308.0)min, 270.0(216.0, 324.0)min, respectively ( P =0.010). The time of ileal conduit construction of the 3 groups were 136.5(131.3, 147.5)min, 92.0(79.0, 119.0)min, 79.0(72.0, 115.0)min, respectively ( P <0.001). In addition, the difference of the two variables above between A and B, A and C groups separately reached statistical significance ( P<0.05), while the difference between B and C groups did not ( P>0.05). Other variables, such as blood loss, complication rate, lymph node yield, surgical margin, between the 3 groups reached no statistical significance ( P>0.05). The operative time of group D was 420.0(350.0, 450.0)min, and it reached statistical significance ( P<0.05) when compared with group A. There were no significant differences in other variables, such as blood loss, complication rate, lymph node yield, surgical margin, among the 2 groups ( P>0.05). Conclusions:The learning effect of LRC+ MIC was obvious. When surgeon volume increased, the operative time decreased significantly. Variables like estimated blood loss and complication rate of the 2 surgeons did not reached significant difference, which indicated reproductivity and safety of this procedure.
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The hepatotoxicity of gefitinib is an important factor limiting its clinical application. In order to control the toxicity, we conducted this study to find the gene variation that can explain and predict the occurrence and severity of hepatotoxicity of gefitinib. Ninety patients with non-small cell lung cancer were included in the retrospective clinical study. Detailed hepatotoxicity induced by gefitinib and epidemiological characteristics were recorded. Twenty-six candidate single-nucleotide polymorphisms of molecular targets, metabolic enzymes, transporters and chemokines were genotyped by matrix-assisted laser desorption/ionization time-of-flight platform. Various confounding factors, such as age, gender and smoking status, were included in the follow-up analysis and variability in the extent of hepatotoxicity was best explained by a multivariate logistic regression model incorporating. The severity of hepatotoxicity was associated with mitogen-activated protein kinase 1 rs13515 (OR=9.467, P=0.074). The research about pharmacogenomic of gefitinib identified the determinants of the drug-induced liver injury. These findings provide a basis to design clinical trials targeting a particular toxicity of gefitinib or similarly targeted agents to benefit patients on long-term gefitinib treatment.
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Objective To evaluate the clinical value of a new optic puncture needle designed by our department for renal calculi treatment. Methods There were 8 patients undergoing micro-PCNL with the new device from June 2016 to February 2017. Values of basic demographic data ,operation time ,pain score ,drop in hemoglobin and complications were recorded. Results The mean stone size,operation time,pain score,drop in hemoglobin,and in-hospital time was(21.9 ± 7.3)mm,(43.6 ± 13.6)min,2.8 ± 1.3,7.0 g/L[(133.2 ± 10.3 g/L vs.(123.2 ± 13.9)g/L,P>0.05]and(3.1 ± 1.0)d,respectively. No patient required blood transfusion. Stone-free rate at 1 and 3 months post-operation were 87.5%(7/8)and 100%(8/8),respectively. One suffered urinary tract infections( ClavienⅠ)and was treated with antibiotics. There were no major complications. Conclusion The new device for treatment of renal calculi is feasible and effective.
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Objective To evaluate the clinical value of a new optic puncture needle designed by our department for renal calculi treatment. Methods There were 8 patients undergoing micro-PCNL with the new device from June 2016 to February 2017. Values of basic demographic data ,operation time ,pain score ,drop in hemoglobin and complications were recorded. Results The mean stone size,operation time,pain score,drop in hemoglobin,and in-hospital time was(21.9 ± 7.3)mm,(43.6 ± 13.6)min,2.8 ± 1.3,7.0 g/L[(133.2 ± 10.3 g/L vs.(123.2 ± 13.9)g/L,P>0.05]and(3.1 ± 1.0)d,respectively. No patient required blood transfusion. Stone-free rate at 1 and 3 months post-operation were 87.5%(7/8)and 100%(8/8),respectively. One suffered urinary tract infections( ClavienⅠ)and was treated with antibiotics. There were no major complications. Conclusion The new device for treatment of renal calculi is feasible and effective.
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PURPOSE: This study was designed to investigate the relationship between molecular subtype and locoregional recurrence (LRR) in patients with early-stage breast cancer with 1-3 positive axillary lymph nodes (ALNs) and improve the individualized indications for postmastectomy radiotherapy (PMRT). METHODS: The records of 701 patients with pT1-2N1M0 breast cancer who did not undergo PMRT were retrospectively analyzed. Tumors were subclassified as follows: luminal A, luminal B, human epidermal growth factor receptor 2 (HER2)-enriched, and basal-like subtypes. Multivariate Cox analysis was used to determine the risk of LRR associated with the different subtypes and to adjust for clinicopathologic factors. RESULTS: Luminal A, luminal B, HER2-enriched, and basal-like subtypes accounted for 51.2%, 28.0%, 8.1%, and 12.7% of cases, respectively. The median follow-up duration was 67 months (range, 9-156 months). Univariate analysis revealed that, compared with the luminal A subtype, the HER2-enriched and basal-like subtypes were associated with significantly higher 5-year LRR rates (5.6% vs. 21.6% and vs.15.7% respectively; p=0.002 each), lower 5-year LRR-free survival (LRFS) rates (90.6% vs. 73.8% and 78.5%, respectively; p=0.001 each), and poorer 5-year breast cancer-specific survival (BCSS) rates (93.7% vs. 82.2% [p=0.002] and 84.9% [p=0.001], respectively). Multivariate analysis revealed that the HER2-enriched and basal-like subtypes, age ≤35 years, a medial tumor, and pT2 stage were poor prognostic factors for LRR and LRFS; furthermore, 2 to 3 positive ALNs represented an independent prognostic factor affecting LRR. The 10-year LRR rates of patients with 0, 1, 2, 3, and 4 risk factors were 1.0%, 6.9%, 14.3%, 30.4%, and 54.3%, respectively (p<0.001); the 10-year BCSS rates were 86.6%, 88.5%, 84.4%, 79.7%, and 38.8%, respectively (p<0.001). CONCLUSION: Molecular subtyping allows for individualized evaluation of LRR risk in patients with pT1-2N1M0 breast cancer. PMRT should be recommended for patients with ≥3 LRR risk factors.
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Humans , Breast Neoplasms , Breast , Follow-Up Studies , Lymph Nodes , Molecular Typing , Multivariate Analysis , Neoplasm Recurrence, Local , Phenobarbital , Prognosis , Radiotherapy , ErbB Receptors , Recurrence , Retrospective Studies , Risk FactorsABSTRACT
Through random sampling,a total of 300 residents of Beijing Changping Ming Tombs Town were selected for home-based questionnaires.The smoking rate of interviewed residents was 21.4％ (53/248).The rate in men (42/125,33.6％ ) was bigber than that in women ( 11/123,8.9％ ).The rate in those with higher education was lower than that in those with lower educational level ( x2 =27.12,P ＜ 0.05 ).The population awareness of tobacco hazards was 80.6％ (200/248).Awareness in smokers was lower than the average awareness of ex-smokers and nonsmokers ( x2 =5.07,P ＜ 0.05 ).The higher the education level,the higher the awareness of tobacco health hazards ( x2 ≈ 19.72,P ＜ 0.05 ).There were differences in awareness among different age groups (x2 =13.37,P ＜ 0.05 ).
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<p><b>BACKGROUND</b>A growing number of studies worldwide have advocated the replacement of whole-breast irradiation with accelerated partial breast irradiation using three-dimensional conformal external-beam radiation (APBI-3DCRT) for early-stage breast cancer. But APBI can be only used in selected population of patients with early-staged breast cancer. It is not replacing the whole breast radiotherapy. This study aimed to examine the feasibility and acute normal tissue toxicity of the APBI-3DCRT technique in Chinese female patients who generally have smaller breasts compared to their Western counterparts.</p><p><b>METHODS</b>From May 2006 to December 2009, a total of 48 Chinese female patients (with early-stage breast cancer who met the inclusion criteria) received APBI-3DCRT after breast-conserving surgery at Sun Yat-sen University Cancer Center. The total dosage from APBI-3DCRT was 34 Gy, delivered in 3.4 Gy per fractions, twice per day at intervals of at least six hours. The radiation dose, volume of the target area and volume of irradiated normal tissues were calculated. Acute toxicity was evaluated according to the Common Toxicity Criteria (CTC) 3.0.</p><p><b>RESULTS</b>Among the 48 patients, the planning target volume for evaluation (PTVE) was (90.42 ± 9.26) cm³, the ipsilateral breast volume (IBV) was (421.74 ± 28.53) cm³, and the ratio between the two was (20.74 ± 5.86)%. Evaluation of the dosimetric characteristics of the PTVE revealed excellent dosimetric results in 14 patients and acceptable results in 34 patients. The dose delivered to the PTVE ranged from 93% to 110% of the prescribed dose. The average ratio of the volume of PTVE receiving 95% of the prescription dose (V95) was (99.26 ± 0.37)%. The habituation index (HI) and the conformity index (CI) were 1.08 ± 0.01 and 0.72 ± 0.02, respectively, suggesting good homogeneity and conformity of the dose delivered to the target field. The radiation dose to normal tissues and organs was within the dose limitation. Subjects experienced mild acute toxicity. The main manifestations were breast edema in 22 patients, breast pain in 7, skin erythema in 25, general malaise in 22 and cytopenia in 8. No acute radiological cardiac or pulmonary injury was found.</p><p><b>CONCLUSIONS</b>The results of our short-term follow-up showed that it is feasible to perform APBI-3DCRT for early-stage breast cancer after breast-conserving surgery in Chinese female patients with smaller breasts. However, further studies are required to elucidate its efficacy and long-term side effects.</p>
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Adult , Female , Humans , Middle Aged , Asian People , Breast Neoplasms , Radiotherapy , General Surgery , Radiotherapy, ConformalABSTRACT
<p><b>OBJECTIVE</b>To evaluate the dosimetric advantages of postmastectomy electron-beam chest-wall irradiation after left mastectomy in patients with breast cancer.</p><p><b>METHODS</b>Electron-beam chest-wall irradiation and tangential field irradiation were planned using Pinnacle7.4f planning systems for 42 patients with left breast cancer after mastectomy. The total prescribed dose for both plans was 5000 cGy/25 fractions. The dose volume histogram was used to compare the dosimetry of the clinical target volume (CTV) and the organs at risk such as the heart and ipsilateral lung.</p><p><b>RESULTS</b>The maximum dose (Dmax) of the CTV of electron beam chest-wall irradiation plans was significantly higher than that of tangential field irradiation plans (5562±61 vs 5402±82 cGy, t=6.10, P<0.05). The CTV of the electron beam chest-wall irradiation plans showed better heterogeneity than that of the tangential field irradiation plans, with heterogeneity index of 1.18±0.03 and 1.13±0.18, respectively (t=6.50, P<0.05). Electron beam chest-wall irradiation plans had also a better conformal index of the CTV than tangential field irradiation plans (0.77±0.17 vs 0.57±0.17, t=3.49, P<0.05). The V40 of the ipsilateral lung, the maximum dose of the heart, V30 and V40 of the heart in the electron beam chest-wall irradiation plans were smaller than those of the tangential field irradiation plans [(5.86±3.68)% vs (8.73±3.26)%, t=-2.27, P<0.05; 4839±388 cGy vs 5095±176 cGy, t=-2.32, P<0.05; (2.58±1.50)% vs (7.20±2.62)%, t=-4.70, P<0.05; (1.74±1.23)% vs (4.20±2.51)%, t=-3.50, P<0.05].</p><p><b>CONCLUSION</b>Compared with the tangential field irradiation plans, electron-beam chest-wall irradiation has better coverage index of the CTV and can decrease the high-dose volume of the normal tissue, but shows a poorer habituation index of the CTV.</p>
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Adult , Female , Humans , Middle Aged , Breast Neoplasms , Radiotherapy , General Surgery , Mastectomy , Postoperative Period , Radiometry , Radiotherapy Dosage , Thoracic Wall , Radiation EffectsABSTRACT
<p><b>BACKGROUND AND OBJECTIVE</b>The role of postmastectomy radiotherapy (PMRT) in breast cancer patients with T1-T2 tumors and 1-3 positive axillary nodes is still uncertain. This study investigated the value of PMRT for these patients.</p><p><b>METHODS</b>In the retrospective data of 488 eligible patients, survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using a log-rank test and the Cox proportional hazards model, respectively.</p><p><b>RESULTS</b>The median observation time was 54 months. The 5- and 10-year locoregional recurrence-free survival (LRFS) rates were 90.8% and 86.9%, respectively. The 5- and 10-year disease-free survival (DFS) rates were 82.0% and 74.3%, respectively. The 5- and 10-year overall survival (OS) rates were 90.7% and 82.7%, respectively. For the 412 patients without PMRT, T2 classification, 2-3 positive nodes, and hormone (estrogen and progesterone) receptor-negative were risk factors for locoregional recurrence in the multivariate analysis. On the basis of these 3 risk factors, the group with 2-3 factors had a 10-year LRFS rate of 63.1% compared with 96.1% for the group with 0-1 factors (P < 0.001). For the group with 2-3 risk factors, LRFS and DFS were significantly improved by PMRT, with the 5- and 10-year LRFS rates without PMRT of 82.4% and 63.1%, respectively, and, with PMRT, of 98.1% at both 5 years and 10 years (P = 0.002). The 5- and 10-year DFS rates without PMRT were 72.0% and 57.6%, respectively, and, with PMRT, the 5- and 10-year DFS rates were 89.4% and 81.7%, respectively (P = 0.007). There was no significant difference in the 10-year OS rates between patients with and without PMRT. However, there is the potential benefit of 15.3% (87.1% vs. 71.8%, P = 0.072). Conversely, the group with 0-1 factors of PMRT had no effect on prognosis.</p><p><b>CONCLUSIONS</b>In patients receiving mastectomy with T1-T2 breast cancer with 1-3 positive nodes, for the group with 2-3 risk factors, PMRT significantly improved LRFS and DFS and has potential benefit in OS.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Young Adult , Antineoplastic Combined Chemotherapy Protocols , Therapeutic Uses , Breast Neoplasms , Drug Therapy , Pathology , Radiotherapy , General Surgery , Carcinoma, Ductal, Breast , Drug Therapy , Pathology , Radiotherapy , General Surgery , Carcinoma, Lobular , Drug Therapy , Pathology , Radiotherapy , General Surgery , Chemotherapy, Adjuvant , Disease-Free Survival , Lymphatic Metastasis , Mastectomy , Neoplasm Recurrence, Local , Neoplasm Staging , Radiotherapy, Adjuvant , Radiotherapy, High-Energy , Receptors, Estrogen , Metabolism , Receptors, Progesterone , Metabolism , Retrospective Studies , Risk Factors , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To investigate the correlation of prolactin receptor (PRL-R) expression to estrogen receptor (ER) and progesterone receptor (PR) expressions in primary breast cancer.</p><p><b>METHODS</b>For 130 female patients with breast cancer (median age 46 years), PRL-R expression in the primary tumor was detected by immunohistochemistry, and the correlation between PRL-R and ER/PR expressions was analyzed statistically.</p><p><b>RESULTS</b>PRL-R positivity in the primary tumor was found in 89 of the patients (68.5%), and the positivity rate for PRL-R was positively correlated to ER expression (P<0.05). Further stratification of the patients according to the CerbB-2 status revealed such a correlation only in CerbB-2-positive patients (P<0.05). In the patient cohort, no significant correlation was found in the positivity rate between PRL-R and PR expressions (P>0.05), but in CerbB-2-positive patients, the positivity rate of PRL-R showed a positive correlation to PR expression (P<0.05).</p><p><b>CONCLUSION</b>The positive correlations in positivity rate between the PRL-R and ER/PR expressions are found only in CerbB-2 positive patients with breast cancer, and the expressional status of CerbB-2 affects the correlation between PRL-R and ER/PR expression in breast cancer.</p>
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Adult , Aged , Female , Humans , Middle Aged , Breast Neoplasms , Metabolism , Receptor, ErbB-2 , Genetics , Metabolism , Receptors, Estrogen , Metabolism , Receptors, Progesterone , Metabolism , Receptors, Prolactin , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To evaluate the radiosensitivity and toxicity of sodium glycididazole and cisplatin in concurrent chemoradiotherapy for local advanced nasopharyngeal carcinoma (NPC).</p><p><b>METHODS</b>Sixty patients with local advanced NPC (T3-4N2-3M0) were randomly divided into chemoradiotherapy group (n=30) and chemoradiotherapy plus sodium glycididazole group (n=30). All the patients received radiotherapy with (60)Co or 6-8 MV linear accelerator and concurrent injection of cisplatin at a weekly dose of 20 mg/m square. In sodium glycididazole group, the patients received injections of sodium glycididazole at 800 mg/m square prior to the radiotherapy 3 times a week.</p><p><b>RESULTS</b>At the end of the therapy and 3 month after the radiotherapy, a response rate of 100% was achieved in both of the groups. But at the end of the therapy, the chemoradiotherapy plus sodium glycididazole group showed a significantly higher rate of complete tumor remission than the chemoradiotherapy group (93.3% vs 73.33%, chi(2)=4.32, P=0.038). The patients in the two groups showed similar tolerance of the therapy during the observation.</p><p><b>CONCLUSION</b>Sodium glycididazole plus cisplatin can accelerate the tumor remission and improve the complete remission rate in patients with local advanced NPC without causing severe toxicity.</p>
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Adult , Female , Humans , Male , Middle Aged , Antineoplastic Combined Chemotherapy Protocols , Therapeutic Uses , Carcinoma , Drug Therapy , Radiotherapy , Cisplatin , Cobalt Radioisotopes , Therapeutic Uses , Combined Modality Therapy , Metronidazole , Therapeutic Uses , Nasopharyngeal Neoplasms , Drug Therapy , Radiotherapy , Radiation-Sensitizing Agents , Therapeutic UsesABSTRACT
50 days),whereas third party skin grafts were vigorously rejected.Conclusion Blockade of CD28-B7 and CD40-CD40 ligand interactions resulted in long-term allograft survival and donor-specific tolerance in mouse cardiac transplantation without chronic rejection.