ABSTRACT
Objective To compare the value of diffusion kurtosis imaging (DKI) mode and mono-exponential mode in predicting the response to neoadjuvant chemotherapy (NAC) for locally advanced breast carcinoma using DWI.Methods From January 1,2013 to December 31,2016,eighty patients with locally advanced breast carcinoma were enrolled into this prospective clinical study.The diagnosis was confirmed on the basis of histopathological results.The clinical stage stayed at Ⅱ or Ⅲ.The patients would receive breast-conserving surgery after NAC.All the patients underwent DWI examination by using both mono-exponential mode and DKI mode before chemotherapy was initiated.The parameters included ADC,mean diffusivity (MD) and mean kurtosis (MK).Within 1 to 3 days before or after MRI examination,the patients underwent aspiration biopsy,received 4 to 8 cycles of NAC and followed by surgery.According to histologic grading before NAC,the patients were classified into well-differentiated and poor-differentiated group.According to the comparison between pathological results acquired from biopsy before NAC and specimen acquired after surgery,the patients were classified into pathologic complete response (pCR) and pathologic non-complete response (non-pCR) according to treatment effect.The imaging parameters were compared between the pCR and the non-pCR group using t test.The predicting ability of two imaging modes was compared and analyzed with ROC analysis.The relationships between multiple imaging parameters,pathologic,clinical characteristics of tumor and treatment effect were analyzed using logistic multi-variate regression analysis,and further analyzed using Wald test.Results There were 30 cases of pCR and 50 cases of non-pCR.The ADC and MD values were lower in the pCR group than in the non-pCR group (P＜0.05).MK value was higher in the pCR group than in the non-pCR group (P＜0.05).ROC analysis showed that the area under ROC curve of ADC,MD and MK in predicting treatment effect were 0.732,0.866 and 0.683 respectively.Logistic regression analysis showed that,according to predicting ability,MD,ADC and MK successively were the independent predictors for the early response to chemotherapy.Conclusion Compared with mono-exponential mode,DKI mode can reflect the real micro-environment and water diffusion restriction within the tumor area more reliably and accurately,and is more suitable to serve as an imaging technique for predicting the response to NAC for locally advanced breast carcinoma.
ABSTRACT
Objective To investigate the influence of the pain management path on the postherpetic neuralgia patients. Methods Ninety patients with postherpetic neuralgia were divided into two groups by random digits table method:the control group and the experimental group, 45 cases in each group. The patients in the control group accepted conventional nursing care, the patients in the experimental group accepted the pain management path nursing care. The scores of pain and the overall satisfaction were assessed, the incidence of common adverse reactions at 5 and 10 days after the treatment, hospitalization expenses and hospitalization days were recorded. Results The gender, age, course of disease and degree of pain had no significant difference between the experimental group and the control group at admission (P>0.05). After 5 and 10 days treatment, the scores of pain in the experimental group were (3.07±1.34) , (1.09±0.90) points, and these were (4.29±1.74), (2.27±1.32) points in the control group, the differences were statistically significant (t=3.74, 4.94, all P<0.01). After 5 and 10 days treatment, the scores of the overall satisfaction in the experimental group were (5.50 ± 1.71), (7.96 ± 1.30) points, and these were (4.50 ± 1.60), (7.00 ± 1.50) points in the control group, the differences were statistically significant (t=-2.89,-3.37, all P<0.01). After 10 days treatment, the incidence of constipation was 26.67% (12/45) and 53.33% (24/45) in the experimental group and the control group respectively, the difference was statistically significant between the two groups (χ2=6.667, P<0.05). The hospitalization days were (13.71 ± 3.05) d and (15.76 ± 3.54) d in the experimental group and the control group respectively, the difference was statistically significant between the two groups (t=2.934, P<0.01). The hospitalization expenses were (11798.38 ± 3312.33) yuan and (13972.24 ± 3726.66) yuan respectively, there was significant difference between the two groups (t=2.925, P < 0.01). Conclusions The application of the pain management path for the pain management in patients with postherpetic neuralgia, can relieve the pain, reduce the incidence of adverse effects, hospitalization expenses and days, improve the overall satisfaction of the patients.
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Objective To evaluate the efficacy of radiofrequency thermocoagulation guided by three-dimensional computer tomography(3-D CT)for the treatment of severe recurrent glossopharyngeal neuralgia(GPN). Methods Twenty-nine patients of both sexes with recurrent intractable GPN, aged 42-75 yr, with recurrent course of 1-8 yr, of Barrow Neurological Institute(BNI)Pain Scale(BNI-P) class Ⅳ or Ⅴ, were enrolled in this study. Percutaneous radiofrequency thermocoagulation was applied to the middle and lower segment of the styloid process of the glossopharyngeal nerve under 3D CT guidance. Before operation and at 72 h, 6 months and 1 year after operation, BNI-P class and BNI Numbness Scale scores were recorded, and effective treatment and operation-related complications were also recorded. Re-sults Nineteen patients underwent one operation, 8 patients underwent two operations, and 2 patients un-derwent three operations. BNI-P class was significantly lower at each time point after operation than before operation(P<0.05). The rate of effective treatment was 100% at 72 h and 6 months after operation and 97% at 1 yr after operation. Different degrees of dysesthesias at the posterior part of the tongue on the affect-ed side occurred after operation and disappeared at 1 yr after operation. Operation-related nausea and vomi-ting, facial nerve damage, accessory nerve damage and fatality were not observed. Conclusion 3D CT-guided radiofrequency thermocoagulation of the glossopharyngeal nerve provides reliable efficacy and higher safety for the patients with severe recurrent GPN.