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Objective:To explore the effect of pre-transplant immunotherapy on the prognosis of transplant recipients with hepatocellular carcinoma(HCC).Methods:From June 2018 to September 2021, retrospective analysis was conducted for clinical data of 19 HCC-liver transplant recipients receiving pre-transplant immunotherapy in affiliated Huashan Hospital of Fudan University. Pre-transplant immunotherapy regimen, adverse reactions, post-transplant acute rejection, tumor recurrence and metastasis and other complications were recorded. According to the preoperative tumor imaging and the changes of alpha-fetoprotein level, tumor change during recipient waiting period was judged by the mRECIST standard. According to whether or not there was partial tumor remission, they were divided into two groups of non-remission( n=13)and remission( n=6). Postoperative conditions of two groups were compared. Kaplan-Meier method was used for calculating the survival rate of recipients after transplantation and survival curve and Log-rank test utilized for comparing the recurrence-free and overall survival rates of recipients at 1 and 2 years post-operation. Results:A total of 19 liver transplant recipients received immunotherapy plus targeted and transcatheter arterial chemoembolization(TACE) before transplant. In non-remission group, tumor was stable( n=9)and progressive( n=4); 6 cases in remission group had tumor partial remission. Two recipients in non-remission group were pathologically confirmed by liver biopsy to have acute rejection(2/19, 10.5%)and both recovered after glucocorticoid + rATG and glucocorticoid therapy. In non-remission group, 2 patients died from septic shock post-operation. Among 3 patients of tumor recurrence and metastasis post-operation, 2 cases survived with tumor and 1 died after tumor recurrence and metastasis. In remission group( n=6), none had postoperative tumor recurrence and metastasis. The recurrence-free survival rates of non-remission group recipients at 1 and 2 years post-operation were 76.9% and 76.9% and recurrence-free survival rates in remission group were 100% and 100% respectively and inter-group difference in RFS was not statistically significant( χ2=1.468, P=0.226). The overall survival rates of recipients in non-remission group at 1 and 2 years post-operation were 76.9% and 76.9% respectively. And recipients in remission group were 100% and 100% respectively and no statistically significant inter-group difference existed in OS( χ2=1.292, P=0.256). Conclusions:Without a significantly higher risk of acute rejection after transplant, immunotherapy may be an effective option for bridging treatment before liver transplantation for HCC. And it remains necessary to expand the sample size for verifications and supports.
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Objective:To compare the prognoses of salvage liver transplantation fulfilling the Criteria of Milan, University of California San Francisco(UCSF)and Hangzhou.Methods:Clinical data were retrospectively reviewed for 256 patients with recurrent hepatocellular carcinoma(HCC)undergoing donation after citizen death(DCD)liver transplantation(LT)from January 2015 to October 2019.They were divided into two groups of primary(PLT, n=175)and salvage(SLT, n=81). General profiles, tumor pathological characteristics and postoperative complications of two groups were compared by T-test, rank-sum or χ2 test.Kaplan-Meier method and Log rank test were employed for comparing overall survival rate(OS)and recurrence-free survival rate(RFS)between two groups.In SLT group, 31 cases fulfilled Milan criteria, 45 cases UCSF criteria and 69 cases Hangzhou criteria.OS/RFS of three groups were compared.According to there was downstaging or bridging treatment pre-LT, SLT group was divided into downstaging group(n=32)and non-downstaging group(n=49). OS/RFS of two groups were compared.According to the Rescit1.1 criteria, downstaging group were divided into remission group(n=14)and non-remission group(n=18)and OS/RFS of two groups were compared. Results:The operative durations of PLT and SLT groups were(439.5±74.9)and(475.1±83.4)min respectively.There was significant inter-group difference( P<0.05); However, no significant inter-group difference existed in amount of intraoperative bleeding, blood transfusion, postoperative hospital stay or incidence of postoperative complications(all P>0.05). No significant difference existed in OS/RFS between PLT and SLT groups( P>0.05). No significant difference existed in OS at 1/3/5 years post-SLT among Milan, UCSF and Hangzhou criteria groups(all P>0.05); However, RFS in Milan criteria group at 1/3/5 years post-SLT were 93.5%, 81.7% and 81.7% respectively.They were significantly higher than 68.9%, 59.7% and 59.7% in UCSF criteria group and 78.3%, 58.8% and 55.5% in Hangzhou criteria group(all P<0.05). For patients on downstaging therapy, OS in the Remission group at 1, 3 and 5 years post-SLT were 100%, 73% and 73% respectively, which was significantly higher than 83.3%, 49.4% and 0 in non-Remission group( P=0.042). RFS in the Remission group at 1, 3 and 5 years post-SLT were 100%, 62.5% and 46.9% respectively, which was significantly higher than 52.9%, 0 and 0 in no-Remission group( P=0.001). Conclusions:The survival outcome of SLT recipients is similar to that of PLT recipients.The overall survival of SLT recipients shows no significant difference between Milan, UCSF and Hangzhou criteria.However, SLT recipients fulfilling Milan criteria have the longest recurrence-free time.The prognosis of patients with remission after preoperative descending treatment is superior to that of patients without remission.
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Objective:To explore the relationship between CD24 expression in preoperative peripheral blood as well as cancer tissue and clinical parameters and prognosis in patients with hepatocellular carcinoma (HCC) after liver transplantation (LT).Methods:From November 2018 to November 2019, clinical data were collected for 65 HCC patients and 41 patients with benign liver disease.The preoperative peripheral blood level of CD24 was detected by enzyme-linked immunosorbent assay (ELISA) and the expression of CD24 in cancerous foci and adjacent tissues examined by immunohistochemistry.Kaplan-Meier survival curves of differential CD24 expression were plotted and survival differences compared by Log-rank method.One-way ANOVA was utilized for examining the relationship between the expression level of CD24 and various clinicopathological parameters and multivariate Cox analysis for screening independent risk factors affecting patient prognosis.Results:The concentration of CD24 in preoperative peripheral blood (p-CD24) of HCC patients (6.51±2.33 μg/L) was significantly higher than that of patients with benign liver disease (4.10±0.91) μg/L, P<0.05.The positive rate of CD24 was obviously higher in cancerous tissues than that in adjacent tissues (87.7% vs. 4.6%, P<0.05). The peripheral blood level of CD24 was positively correlated with the expression intensity of CD24 in tumor tissues (t-CD24, r=0.570, P<0.001). The expression of CD24 (both in blood and cancer foci) was significantly correlated with preoperative level of gamma-glutamyl transferase (GGT), maximal tumor diameter, microvascular invasion, portal vein tumor thrombus, vessel carcinoma embolus and satellite focus ( P<0.05). The expression of CD24 in patients exceeding the Milan/UCSF criteria was higher than those fulfilling the criteria ( P<0.005). Patients with a higher expression of CD24 had worse overall survival and recurrence-free survival rates as compared to those a lower expression of CD24 ( P<0.05). Multivariate Cox analysis indicated that t-CD24 [OS: HR=3.661(1.005-13.333)], P=0.049; recurrence-free survival (RFS): [HR=4.331(1.887-9.942), P=0.001] and preoperative level of alpha fetoprotein (AFP) [OS: HR=4.900(1.590-15.097), P=0.006]; RFS: [HR=3.414(1.614-7.221), P=0.001] were independent risk factors for overall survival and recurrence-free survival in HCC patients undergoing LT. Conclusions:The preoperative peripheral blood level of CD24 in HCC patients undergoing LT indirectly reflects the expression of CD24 in cancerous tissues to a certain extent.And the expression of CD24 in cancerous tissue is one of the independent risk factors affecting OS and RFS of LT patients.
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Purpose@#Whether craniospinal irradiation (CSI) could be replaced by limited-field radiation in non-metastatic bifocal germinoma remains controversial. We addressed the issue based on the data from our series and the literature. @*Methods@#Data from 49 patients diagnosed with non-metastatic bifocal germinoma at our hospital during the last 10 years were collected. The Pediatric Quality of Life Inventory 4.0 was used to evaluate health-related quality of life (HRQOL). Additionally, 81 patients identified from the literature were also analyzed independently. @*Results@#In our cohort, 34 patients had tumors in the sellar/suprasellar (S/SS) plus pineal gland (PG) regions and 15 in the S/SS plus basal ganglia/thalamus (BG/T) regions. The median follow-up period was 52 months (range, 10 to 134 months). Our survival analysis showed that patients treated with CSI (n=12) or whole-brain radiotherapy (WBRT; n=34) had comparable disease-free survival (DFS; p=0.540), but better DFS than those treated with focal radiotherapy (FR; n=3, p=0.016). All 81 patients from the literature had tumors in the S/SS+PG regions. Relapses were documented in 4/45 patients treated with FR, 2/17 treated with whole-ventricle irradiation, 0/4 treated with WBRT, and 1/15 treated with CSI. Survival analysis did not reveal DFS differences between the types of radiation field (p=0.785). HRQOL analysis (n=44) in our cohort found that, compared with S/SS+PG germinoma, patients with BG/T involvement had significantly lower scores in social and school domains. However, HRQOL difference between patients treated with CSI and those not treated with CSI was not significant. @*Conclusion@#In patients with non-metastatic bifocal germinoma, it is rational that CSI could be replaced by limited-field radiation. HRQOL in patients with BG/T involvement was poorer.
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Objective@#To explore the clinical efficacies of applying aged marginal donor liver.@*Methods@#From January 2015 to June 2018, clinical data were retrospectively analyzed for 199 adult liver transplantation donors and recipients. They were divided into two groups of aged (≥60 years) and appropriate age (<60 years). The prognosis of two groups was compared after a follow-up period of 1 year. And the aged group was further assigned into lower and higher fat infiltration groups according to the degree of fat infiltration in donor liver and compared the prognosis of two groups.@*Results@#No significant differences existed in initial, peak value and recovery time of transaminase (AST/ALT), peak value and recovery time of total bilirubin, glutamyl transpeptidase, alkaline phosphatase, international normalized ratio (INR), peak value of lactate, postoperative hospital stay, graft dysfunction, biliary/vascular complications, acute/chronic rejection or graft survival rate between aged and appropriate age groups post-transplantation. The aged group was further divided into lower and higher fat infiltration groups according to the fat infiltration rate (<20%, ≥20%). And significant inter-group differences existed in peak value and recovery time of AST/ALT, peak value of total bilirubin, glutamyl transpeptidase, lactate, postoperative hospital stay and graft dysfunction. The above parameters were significantly worse in higher fat infiltration group. Also the rejection rate was higher in high group at 1 year post-operation and no significant inter-group difference existed in biliary/vascular complications. In higher group, 4 patients showed graft dysfunctions during perioperative period. Two of them were discharged successfully after secondary transplantation and another 2 patients died.@*Conclusions@#On the premise of comprehensive evaluations of donor liver status and reasonable matching of recipients, aged marginal donor liver can be safely applied with excellent clinical outcomes. Severe fatty donor liver should be employed with caution. Hypertensive drugs, high serum sodium and long period of cold ischemia are also important influencing factors for aged donors.
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Objective To explore the clinical efficacies of applying aged marginal donor liver . Methods From January 2015 to June 2018 ,clinical data were retrospectively analyzed for 199 adult liver transplantation donors and recipients .They were divided into two groups of aged (≥60 years) and appropriate age (<60 years) .The prognosis of two groups was compared after a follow-up period of 1 year .And the aged group was further assigned into lower and higher fat infiltration groups according to the degree of fat infiltration in donor liver and compared the prognosis of two groups . Results No significant differences existed in initial ,peak value and recovery time of transaminase (AST/ALT ) , peak value and recovery time of total bilirubin , glutamyl transpeptidase , alkaline phosphatase ,international normalized ratio (INR) ,peak value of lactate ,postoperative hospital stay , graft dysfunction , biliary/vascular complications , acute/chronic rejection or graft survival rate between aged and appropriate age groups post-transplantation .The aged group was further divided into lower and higher fat infiltration groups according to the fat infiltration rate (< 20％ ,≥20％ ) . And significant inter-group differences existed in peak value and recovery time of AST /ALT ,peak value of total bilirubin , glutamyl transpeptidase , lactate , postoperative hospital stay and graft dysfunction .The above parameters were significantly worse in higher fat infiltration group .Also the rejection rate was higher in high group at 1 year post-operation and no significant inter-group difference existed in biliary/vascular complications . In higher group , 4 patients showed graft dysfunctions during perioperative period .Two of them were discharged successfully after secondary transplantation and another 2 patients died .Conclusions On the premise of comprehensive evaluations of donor liver status and reasonable matching of recipients ,aged marginal donor liver can be safely applied with excellent clinical outcomes .Severe fatty donor liver should be employed with caution . Hypertensive drugs ,high serum sodium and long period of cold ischemia are also important influencing factors for aged donors .
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Objective To explore the clinical features and risk factors associated with intrahepatic and hilar cholangiocarcinoma after liver transplantation .Methods Retrospective analysis of clinical data was performed for 20 hospitalized patients with intrahepatic and hilar cholangiocarcinoma from June 25 ,2014 to October 31 ,2018 .Treatments and follow-up outcomes were analyzed .The survival rate was calculated by the Kaplan-Meier method and the survival curve plotted .Cox regression model was employed for analyzing the prognostic factors .Results The cumulative recurrence rate of patients with AJCC stage Ⅰ /Ⅱ was significantly lower than that in AJCC stage Ⅲ/Ⅳ .And the cumulative recurrence rate of stageⅠ/Ⅱ Patients was 0 and that of stage Ⅲ/Ⅳ 76％ (P=0 .042) .Cox regression model showed that CA19-9 was the only prognostic factor .An elevated level of CA19-9 was associated with high recurrence post-transplantation (HR=1 .001;95％ CI:1 .000～1 .001;P=0 .035) .Conclusions During progressive stage ,the recurrence rate is higher with a worse prognosis .And an elevation of CA19-9 is an independent poor prognostic factor after intrahepatic and hilar cholangiocarcinoma transplantation .
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Objective To explore the relationships of subjective well-being with personality trait and self-efficacy in policemen.Methods Totally 329 policemen from 3 prisons were assessed with General Well-Being Schedule (GWBS),Eysenck Personality Questionnaire (EPQ) and General Self-Efficacy Scale (GSES).The relationship between subjective well-being and personality traits,self-efficacy of policemen was analyzed using correlation analysis,variance analysis,regression analysis and structural equation modeling.Results The personality of extroverted stability had the highest score in GSE (2.74 ± 0.56) and GWB (88.89±11.90),while the introverted instability had the lowest(GSE:(2.19±0.46);GWB:(67.38±13.79)).Psychoticism(2.45± 1.72) was negatively correlated with GWB (78.24± 15.32) (r=-0.19,P＜0.01),neuroticism(5.07±3.31) was negatively correlated with GSE (2.50±0.57) and GWB (r=-0.38,-0.60,all P＜0.0l),while introversion-extroversion(8.13±2.86) was positively correlated with GSE and WGB (r=0.26,0.29,all P＜0.01).Structural equation model showed that neuroticism negatively influenced GWB (γ =-0.610,P＜0.01),and introversion-extroversion positively influenced GWB (γ=0.169,P＜0.05).Self-efficacy had partial mediating effect on relationship between neuroticism and GWB as well as the relationship between introversion-extroversion and GWB.Conclusions There is a high correlation between neuroticism and GWB.Self-efficacy plays a mediating role on relationship between personality trait and GWB.It can promote GWB of policemen by enhancing their self-efficacy.
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Objective To investigate the clinical efficacy and therapeutic progress of orthotopic liver transplantation for the treatment of hepatic epithelioid hemangioendotheliom(a EHE). Methods Clinical data of 2 patients diagnosed with hepatic EHE were retrospectively analyzed. One patien(t case 1) was diagnosed with multiple hepatic EHE complicated with multiple infarction lesions of the spleen, and underwent orthotopic liver transplantation combined with splenectomy. The other cas(e case 2) was diagnosed with multiple hepatic EHE and received orthotopci liver transplantation alone. Literature review was performed. Pathological characteristics, clinical efficacy of liver transplantation and clinical prognosis of hepatic EHE patients were analyzed. Results Two patients successfully underwent surgery and were discharged postoperatively. The diagnosis of hepatic EHE was confirmed by pathological examinaiton and case 1 was complicated with EHE of the spleen . For case 1, tacrolimus was replaced by sirolimus at postoperavtie 1 month. At postoperative 4 months, capecitabine was orall y administered( chemotherapy) for EHE recurrence. At 6 months after surgery, the patient wa sdiagnosed with recurrent hepatic EHE complicated with multiple bone metastases, and waso rally administered with sorafenib. At postoperative 7 months, the patient died from cachexia and liver failure. Case 2 was followed up until the submission date( 8 months after surgery). No postoperative complications and tumor recurrence were observed. Previous studies had demonstrated that surgical resection was the primary therapy of hepatic EHE. Liver transplantation was highly recommended for patients with multiple unresectable hepatic EHE and extra-hepatic lesions. Moreover, chemotherapy, percutaneous puncture combined with transcatheter arterial chemoembolization and anti-angiogenesis treatment exerted certain clinical efficacy.C onclusions Surgical resection remains the primary therapy of hepatic EHE. For patients with multiple intrahepatic EHE, liver transplantation is considered as the optimal treatment. Much attention should be diverted to the prevention and treatment o f recurrent hepatic EHE following liver transplantation, aiming to improve the clinical efficacy.
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Objective To study the functions of peroxisome proliferator-activated receptorγ(PPARγ), retinoic acid X receptor α (RXRα) and cyclooxygenase 2 (COX-2) in the carcinogenesis of cervical squamous cell carcinoma (SCC). Methods The expressions of PPARγ, RXRα and COX-2 in 17 cases of normal cervical epithelium (NCE), 72 cases of squamous intraepithelial lesion (SIL) and 42 cases of cervical SCC were detected with immunohistochemical method respectively. Results The positive expression rates of PPARγ in the NCE, SIL and cervical SCC group were 23.5 % (4/17), 58.3 % (42/72) and 83.3 % (35/42) respectively; the positive expression rates of RXRα in the NCE, SIL and cervical SCC group were 29.4 %(5/17), 54.2 % (39/72) and 90.5 % (38/42) respectively. No significant expression of COX-2 was found in the NCE, while the positive expression rates of COX-2 in SIL and cervical SCC were 36.1 % (26/72) and 57.1 %(24/42) respectively. The positive expression rates of PPARγ, RXRαand COX-2 in high-grade SIL group were higher than those in low-grade SIL group (all P<0.05). In cervical SCC group, the positive expression rate of COX-2 with lymph node metastasis was higher than that without lymph node metastasis (χ2= 3.98, P= 0.04). Conclusion PPARγ, RXRαand COX-2 might be all involved in the carcinogenesis of SCC.
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Objective To study the functions of peroxisome proliferator-activated receptorγ(PPARγ), retinoic acid X receptor α (RXRα) and cyclooxygenase 2 (COX-2) in the carcinogenesis of cervical squamous cell carcinoma (SCC). Methods The expressions of PPARγ, RXRα and COX-2 in 17 cases of normal cervical epithelium (NCE), 72 cases of squamous intraepithelial lesion (SIL) and 42 cases of cervical SCC were detected with immunohistochemical method respectively. Results The positive expression rates of PPARγ in the NCE, SIL and cervical SCC group were 23.5 % (4/17), 58.3 % (42/72) and 83.3 % (35/42) respectively; the positive expression rates of RXRα in the NCE, SIL and cervical SCC group were 29.4 %(5/17), 54.2 % (39/72) and 90.5 % (38/42) respectively. No significant expression of COX-2 was found in the NCE, while the positive expression rates of COX-2 in SIL and cervical SCC were 36.1 % (26/72) and 57.1 %(24/42) respectively. The positive expression rates of PPARγ, RXRαand COX-2 in high-grade SIL group were higher than those in low-grade SIL group (all P<0.05). In cervical SCC group, the positive expression rate of COX-2 with lymph node metastasis was higher than that without lymph node metastasis (χ2= 3.98, P= 0.04). Conclusion PPARγ, RXRαand COX-2 might be all involved in the carcinogenesis of SCC.
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@#ObjectiveTo investigate the strategy and effect of microsurgical treatment for pediatric cerebellar astrocytoma. Methods93 cases of pediatric cerebellar astrocytoma were reviewed who received microsurgical operation. ResultsTotal removal was achieved in 85 cases while subtotal in 8 cases. Pre-operatively, tumor capsule puncture was performed in 21 cases, lateral ventricle puncture and draining in 9 cases and ventricle-peritoneal shunt in 23 cases. Post-operative radiotherapy was performed in 8 cases. They were followed up for 26 months to 5 years with 8 cases lost. There was no death and recurrence. Scores of Karnofsky Performance Status (KPS) was more than 90 in all cases followed up. ConclusionPediatric cerebellar astrocytoma can be treated satisfactorily with microsurgery. By improving surgical removal rate, reasonable peri-operative treatment and early rehabilitation, children with cerebellar astrocytoma can achieve long and excellent living status.
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Objective Portal hypertension and ischemia/reperfusion (I/R) have been implicated in small-for-size liver graft dysfunction. Matrix metalloproteinases-2 (MMP-2) and MMP-9 are critically involved in hepatic I/R injury. The goal of this study was to investigate the role of MMP-2 and MMP-9 in acute small-for-size graft injury. Methods 108 rats were divided into three groups:100 % (full-size), 50 % (half-size) and 25 % (quarter-size) liver transplantation groups. Blood and liver samples were collected to assess liver function, hepatic malondialdehyde (MDA) content, tissue myeloperoxidase (MPO) activity and histological changes. ELISA, real-time PCR, gelatin zymography, and immunohistochemistry were used to determine the expression pattern of MMP-2 and MMP-9 in liver grafts. Results The expression levels of MMP-9 were significantly higher in quarter-size and half-size grafts than those in full-size liver grafts 6, 12, and 24 h after reperfusioa And theelevated levels of MMP-9 were related to graft size inversely. However, MMP-2 was expressed and remained in all groups invariably. MMP-9 overexpression was accompanied by extensive liver I/R injury, as evidenced by significant increases in hepatic microscopic damage scores, MDA content,MPO activity and liver function levels. Furthermore, MMP-9 was found mainly to locate around periportal area. The presence of the active form of MMP-9 was significantly higher in small-for-size grafts, which was correlated with sinusoidal dilatation, congestion and hemorrhage. Conclusion These results support critical function of MMP-9 in acute small-for-size liver graft injury. Moreover,portal hypertension may be a crucial trigger for expression and activation of MMP-9.
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Objective To understand the prevalence of alcohol dependence in individuals living in Guangxi Zhuang Autonomous Region,China. Methods From July 2007 to December 2007,21290 subjects aged more than 15 were randomly selected for 6 Prefecture-level cities and 10 counties by stratified multi-stage cluster sampling method. All subjects were investigated by face to face interview. The Chinese version of Composite International Diagnostic Interview (CIDI3.0) Provided by the Chinese Center for Disease Control And Prevention was used as the screening tool and the diagnoses were made with the 10th edition of international classification of Disease Criteria. Results 18 219 subjects completed the screening,the Completion rate was 85.58‰. The general point prevalence and the general lifetime prevalence of alcohol dependence in individuals living in Guangxi was both 4.50‰. The general lifetime prevalence was higher in rural (6.17‰) than in urban (1.85‰) ( RR =0.31,95% CI =0. 17 ～0.57, P=0. 000) ,higher in men (8.59‰) than in women (0. 33‰) ( RR =0.04,95% CI =0. 01 ～ 0.13, P = 0.000 ) and higher in Zhuang (9.63‰) than in Han(1.95‰) ( RR = 5. 01,95% CI = 3.02 ～8.34, P = 0.000). The lifetime prevalence of alcohol dependence tends upwards as age increasing (P＜0.05 ) and it differs in different marital status,higher in divorce groups (P ＜ 0.05). Conclusion Schizophrenia, Depression disorder, Alcohol dependence disorder are the most common mental disorders and have become the public health problem in Guangxi. To do this,it is necessary to carry out targeted research in prevention and rehabilitation.
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@#Objective To investigate the clinical features, therapeutic strategy and prognosis of pediatric benign cerebellar astrocytomas (BCAs). Methods 101 children with BCAs diagnosed histopathologically were analyzed retrospectively and followed up. Results There were 50 boys and 51 girls with a median age of 9.8 years old. The sizes of tumors were 3～7.5 cm. 46 cases were with solid-tumor, 24 with the tumor in the cyst, 31 with the cysty in the tumor. 39 cases were located in cerebellum vermis, 58 cases were in the cerebellar hemisphere and 9 cases were adhesive with brain stem located in the forth ventricle. 92 cases were total removed and 9 cases were subtotal removed. 87 patients were followed up for 1～5 years, and all of them has survived, without radiotherapy or chemotherapy. Conclusion Pediatric benign cerebellar astrocytomas mostly grows in cerebellar hemisphere， also in vermis frequently. Neuroimaging and pathology may conduce to the diagnosis. Microsurgical resection may result in optimal outcome.
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Objective To analyze and estimate, the treatment of patients with histologically confirmed subependymal giant-cell astroeytoma (SEGCA). Methods The data from 23 patients with SEG-CA who were diagnosed between February 1995 and February 2008 were retrospectively evaluated. Various combinations of surgery and radiotherapy had been used for treatment. Results Total resection was 16 cases, subtotal resection was 7 cases, radiotherapy was 17 cases. The average follow-up time was 53 months.One postoperative SEGCA recurrence. Epilepsy was totally disappeared in 17.6% (3/17), partly disappeared in 47.1%(8/17). All cases survived. Conclusions The key of treatment is total resection. The significance of radiotherapy is not sure. The overall prognosis of SEGCA is favorable.
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Objective To explore the clinical characteristics of epidural hematoma in children. Methods A total of 120 children with epidural hematomas within recent three years were reviewed. Results The main cause of injury in infants and preschool children was falling or sliping, but traffic accident was the predominant cause in children over seven years old. About 65.8% children were complicated by skull fractures, with average Glasgow Coma Scale (GCS) score of 13.6. Except for acute hematoma treated with emergency surgical operation, the other hematoma was rechecked with CT scan at days 1 and 3 or so after it was found for the first time. Patients receiving operation accounted for 57.5% and those with hematoma due to diploe bleeding for 43.9%. Conclusions The primary cerebral injury is not severe relatively in children with epidural hematoma, in which the incidence of skull fracture is lower than that in adults. The main cause for hematoma formation is diploe bleeding. Sound prognosis can be obtained through recheck of CT scan and suitable therapy.
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Objective:To understand suicide prevention knowledge, suicide attitude and related factors among undergraduates in Changsha.Methods:Using multistage stratified cluster sampling, a total of 1664 undergraduates from six universities in Changsha were tested with Suicide Awareness Questionnaire, Suicide Attitude Questionnaire (QSA), Adolescent Self-Rating Life Events Check List (ASLEC), Social Support Questionnaire (SSQ) and Symptom Checklist 90 (SCL-90). Results:The mean score of suicide awareness among undergraduates was 10.8?0.9 and the correct response rate was 54.5%. The result of suicide awareness score showed, female undergraduates had a lower score than males (9.2?0.8, 12.3?0.8;t=2.33, P=0.020), medical undergraduates had a higher score than ones of humanities and social science or engineering (13.9?0.8, 10.0?1.0, 9.7?0.7;F=10.47, P=0.000), undergraduates from one-child families had a higher score than ones from non-one-child families (11.9?0.7, 9.1?0.9;t=3.25, P=0.034), and college students from nuclear family had a higher score than ones from extended families or one-parent families (14.0?0.9, 10.3?0.8, 9.4?0.7;F=7.49, P=0.000). The major factors related to suicide awareness were gender, specialty and family type (?=0.087, 0.342 and 0.084, respectively). And the major factors related to attitude towards attributes of suicide behaviors were specialty, gender, suicide ideation and mental health status (?=0.688, -0.055, 0.810 and 0.731, respectively). Conclusions:College students in Changsha have severe misunderstands about suicide prevention. It is necessary to pay more attention to the education of suicide knowledge and to cultivate the correct suicide attitude among college students.
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Objective To evaluate the efficiency of microsurgical methods for treatment of hypothalamic gliomas in children and the management of postoperative complications Methods Twenty-one tumors were classified into two types according to their location, size and extensive direction The tumors were removed with microsurgical technique by various approaches, such as transcallosal-interforniceal or translongitudinal fissure, transubfrontal methods Results Twenty-one cases of hypothalamic gliomas were verified by surgery and pathology The total and subtotal removal was 18 cases Partial removal was 3 cases There was no mortality in this series Major neurological complications included diabetes insipidus, electrolyte disorder and hyperthermia Surgical complications included subdural fluid collections, hydrocephalus, epilepsy Seventeen cases were followed up, and showed satisfying results Conclusion Microsurgical operations through appropriate approaches and reasonable management of complications are important methods for improving the outcome of hypothalamic gliomas in children