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Objective:To investigate the relationship between the positive surgical margin and clinical factors such as neoadjuvant hormonal therapy after robot-assisted laparoscopic radical prostatectomy (RARP) in high-risk patients with prostate cancer.Methods:The clinical data of 164 patients with high-risk prostate cancer being performed RARP by one surgeon were analyzed retrospectively in our hospital from January 2016 to January 2022. The mean patient’s age was (65.3±6.2) years old, mean body mass index (BMI) was (25.6±3.0) kg/m 2, the median value of total prostate specific antigen (tPSA) before operation was 18.6(11.3, 31.3)ng/ml, the median value of Gleason score before operation was 7 (7, 8), the median value of prostate volume was 29.3 (22.4, 40.2) ml, and the clinical stage was T 2aN 0M 0-T 4N 0M 0. 80 patients with prostate cancer were treated with neoadjuvant endocrine therapy. All of them were treated with complete androgen blockade with a median course of 3 months. Univariate analysis was used to analyze the correlation between age, BMI, prostate volume, neoadjuvant hormonal therapy, preoperative tPSA, clinical stage, Gleason score before operation and positive surgical margin. Then multivariate logistic regression was used to further analyze the independent risk factor of positive surgical margin after RARP. Results:The postoperative pathological diagnosis included pT 2 stage in 111 cases (67.7%), pT 3a stage in 15 cases (9.1%), pT 3b stage in 25 cases (15.2%), pT 4 stage in 13 cases (7.9%). No lymph node metastasis was noticed in all patients. The Gleason scores included 6 in 11 cases (6.7%), 3+ 4 in 26 cases (15.9%), 4+ 3 in 36 cases (22.0%), 8 in 17 cases (10.4%), 9-10 in 24 cases (14.6%), un-evaluation due to endocrine therapy in 50 (30.5%). The positive surgical margin of high-risk patients with prostate cancer was 44.5% (73/164). Univariate analysis showed that the neoadjuvant hormonal therapy, tPSA and clinical stage were correlated with positive surgical margin ( P<0.05). Multivariate logistic regression analysis showed that non-neoadjuvant hormonal therapy, preoperative tPSA>20ng/ml and clinical stage>T 2b were independent risk factors for positive surgical margin of high-risk patients with prostate cancer. Stratified analysis showed that when the preoperative tPSA was 10-20 ng/ml(21.1% vs.55.9%, P=0.014), the clinical stage was T 2c(29.6% vs.49.1%, P=0.040), the Gleason score before operation was 7(19.4% vs.54.1%, P=0.003), the positive surgical margin of high-risk patients in the neoadjuvant hormonal therapy group was significantly lower than that in the non-neoadjuvant hormonal therapy group ( P<0.05). Conclusions:Non-neoadjuvant hormonal therapy, preoperative tPSA>20 ng/ml and clinical stage>T 2b were independent risk factors for positive surgical margin of RARP in the high-risk patients with prostate cancer. For high-risk patients with preoperative tPSA of 10-20 ng/ml, clinical stage of T 2c and Gleason score before operation of 7, neoadjuvant hormonal therapy has important clinical significance in reducing the positive surgical margin of RARP.
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Objective:To analyze the characteristic of prenatal serological screening in fetus with X-linked ichthyosis (XLI), and to explore the relationship between unconjugated estriol (uE 3) levels and XLI. Methods:A total of 56 fetuses with Xp22.31 microdeletion indicated by prenatal diagnosis and 70 fetuses diagnosed with trisomy 21 and 26 fetuses with trisomy 18 in Henan Provincial People's Hospital and Affiliated Hospital of Weifang Medical College from September 2016 to June 2021 were collected. The multiples of median (MoM) values of uE 3, alpha-fetoprotein (AFP), and human chorionic gonadotropin (hCG) during the second trimester of pregnancy were retrospectively analyzed. Prenatal diagnosis was made by amniotic fluid karyotype analysis and genome copy number variant analysis, parent genetic verification and pathogenicity analysis were performed, and maternal and infant outcomes were followed up. Results:Of 56 pregnant women with fetal Xp22.31 microdeletion, 43 underwent serological screening during the second trimester of pregnancy, of which 42 were abnormal (39 male fetuses and 3 female fetuses). The median uE 3 MoM value of 39 male fetuses [0.06 (0.00-0.21)] was lower than the normal value and significantly lower than that of fetuses with trisomy 21 [0.71 (0.26-1.27)] and fetuses with trisomy 18 [0.36 (0.15-0.84)], the difference was statistically significant ( Z=99.96, P<0.001). While the MoM values of AFP and hCG were all within the normal range. Among the 56 fetuses carrying Xp22.31 microdeletion, 45 were male fetuses and 11 were female fetuses, and the deletion fragments all involved STS gene. Eighty-nine percent (50/56) were inherited from mother (49 cases) or father (1 case), and 11% (6/56) were de novo mutations. Follow-up showed 48 live births (38 males and 10 females) and 8 chose to terminate pregnancy (7 males and 1 female). Among the 38 male newborns, 37 presented with scaly skin changes from 1 to 3 months of age, and one had no clinical manifestations until 4 months after birth. Ten female newborns had no obvious clinical manifestations. Conclusions:The decrease levels of uE 3 MoM on maternal serological screening is closely related to the higher risk of XLI in male fetuses. For pregnant women with low uE 3 in serological screening or with family history of ichthyosis, in addition to chromosomal karyotype analysis, joint detection of genomic copy number variant analysis should be recommended.
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Objective: To analyze the characteristics, diagnosis and treatment status of Takotsubo syndrome (TTS) of Chinese patients. Methods: Complete literature review was performed to summarize Chinese TTS cases between 2007 and 2018. Results: A total of 131 literatures were included including 160 TTS patients (age (58.3±14.7) years). There were 137 female patients (85.6%) in this cohort, the age was (59.6±14.0) years. There were 124 cases (77.5%) of stress-evoking factors, of which 83 cases (66.9%) were self-stress factors. There were 97 cases (60.6%) complained of chest pain and 15 cases (9.4%) with syncope. Forty-eight cases (30.0%) presented with cardiogenic shock. CK-MB and cTnT/I increased in 109 cases (80.1%). There were 124 cases (77.5%) presented with ST segment elevation on electrocardiogram, which were common in lead V2-V5. Echocardiography results were available in 128 cases (80.0%), reduced left ventricular ejection fraction (<50%) was reported in 78 cases (73.6%). Coronary angiography was performed in 133 patients (83.1%), of which 126 patients (94.7%) had normal coronary arteries or single non-significant stenosis. One hundred and thirty-eight patients (87.3%) were apical type. The misdiagnosis rate on admission was 96.9% (155/160), of which 141 cases (88.1%) were misdiagnosed as acute myocardial infarction. Nitroglycerin was used in 36 patients (30.3%). Angiotensin converting enzyme inhibitor or angiotensin Ⅱ receptor antagonist were used in 38 patients (31.9%). β blockers were used in 46 patients (38.7 %). Dopamine was used in 22 cases (18.5%) and norepinephrine was used in 12 cases (10.1%). Intra-aortic balloon counter pulsation was used in 5 cases (3.1%). Cardiopulmonary resuscitation was performed in 9 cases (5.6%). Cardiac function recovery time was 7 (6, 15) days. The average InterTAK diagnosis score was (51.5±18.1) points, and value was>70 points in 2 cases (1.3%). There were 92 patients in the high-risk group, and there were 3 recurrent TTS cases. Five patients died. Conclusions: TTS incidence tends to be young and dominates in female in China. The misdiagnosis rate is extremely high on admission. Most patients are treated with medication.
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Adult , Aged , Female , Humans , Middle Aged , Echocardiography , Electrocardiography , Stroke Volume/physiology , Takotsubo Cardiomyopathy/diagnosis , Ventricular Function, Left/physiologyABSTRACT
Objective:To investigate the effects of pregnancy and lactation nonylphenol (NP) exposure on the balance of Treg/Th17 cells in the brain of offspring mice and the related mechanisms.Methods:Thirty pregnant C57BL/6 mice were randomly divided into three groups: control group (drinking distilled water), and NP-treated groups (drinking 0.2 μg/ml or 2.0 μg/ml NP water solution). ELISA kit was used to analyze the levels of TNF-α, IFN-γ and IL-17, flow cytometry was used to analyze the frequency of Treg and Th17 cells in spleen, quantitative RT-PCR was used to analyze the RORγt, Foxp3 mRNA, Western blot was used to analyze the protein expression of RORγt, Foxp3 and PI3K/Akt/mTOR signal pathway, and immunofluorescence was used to analyze the expression of Iba1 in the brain tissue of offspring mice.Results:Compared with the control group, NP exposure increased the serum levels of IL-17 and TNF-α in male offspring mice ( P<0.05), and decreased the levels of IFN-γ( P<0.05). Flow cytometry analysis showed that the percentage of Th17 cells in the spleen of male offspring mice exposed to NP (0.2 μg/ml or 2.0 μg/ml) was significantly higher than that of the control group, while the percentage of Tregs cells was lower. Compared with the control group, the expression levels of Foxp3 proteins in the brain tissue of male offspring mice exposed to NP (0.2 μg/ml or 2.0 μg/ml) was significantly lower, accompanied by a dramatic increase in RORγt protein levels ( P<0.05). Similar mRNA expression was also observed in qRT-PCR analysis. The protein expression levels of mTOR (p-mTOR) and its upstream related regulators[PI3K, p-Akt (Ser473), p-Akt (Thr308)] in the brain of male offspring mice increased gradually during the period of exposure to NP( P<0.05). Immunofluorescence analysis showed that compared with the control group, the number of Iba1 positive cells in brain tissue of male offspring mice exposed to NP (0.2 μg/ml or 2.0 μg/ml) increased significantly ( P<0.05). Conclusions:Maternal exposure to NP during pregnancy and lactation may affect the development/function of neurons in offspring through neuroimmune axis, and increase the risk of neurodevelopmental disorders in offspring.
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Objective:To clarify the anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava during laparoscopic surgery.Methods:In December 2018, two frozen and two fresh adult cadavers were dissected. The chest of the frozen cadavers was opened along the bilateral midline of the clavicle, the anterior pericardial wall was opened, and the superior vena cava and the inferior vena cava was dissected. The abdominal cavity was opened along the midline of the abdomen, the left and right hepatic lobes were turned over, the inferior vena cava and the second hilum of the posterior segment of the liver were exposed, and the hiatus of the inferior vena cava was opened and entered the pericardium.The anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava were observed, and the length of the superior segment of the inferior vena cava was measured. The fresh frozen cadaver patients underwent laparoscopic surgery.Five 12 mm trocars were placed at the side of umbilicus, right rectus abdominis about 4 cm from umbilicus, midline of abdomen about 6 cm above umbilicus, right axillary front about 2 cm below inferior edge of liver, left midline of clavicle about 2 cm below inferior edge of liver. Laparoscopic-assisted turning of the left and right hepatic lobes, exposing the posterior inferior vena cava and the second hilum of the liver, opening of the vena cava hiatus into the pericardium.The anatomical characteristics and adjacent relationship of the upper diaphragmatic segment of the inferior vena cava were observed.Results:In two autopsies, the inferior vena cava entered the chest through the cava sulcus of the liver and the phrenic foramen cava, and then through the fibrous pericardium into the right atrium. The length from the diaphragm of inferior vena cava to the right atrium was 1.67 cm, 2.57 cm. In laparoscopic operation, the diaphragm entrance of the posterior segment of the liver inferior vena cava, the second hepatic portal and the inferior vena cava could be well exposed.The diaphragm could be opened along the hole of the vena cava with a relatively non vascular anatomical layer of adipose tissue.There was a large anatomical gap between the pericardium and the right atrium, and the inferior vena cava, the superior vena cava and the right atrium could be well exposed, and the whole diaphragm could be completely and continuously exposed from the bottom to the inferior vena cava at the entrance segment of the right atrium.Conclusions:There was a relatively avascular anatomical layer beside the inferior vena cava. During laparoscopic operation, opening the diaphragm through the abdominal cavity could safely enter the pericardium and expose the inferior vena cava, the superior vena cava and the right atrium, which provides a possibility for the removal of Mayo Ⅳ grade inferior vena cava tumor thrombus through this approach.
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Objective:To investigate the technical points and clinical effect of thulium fiber laser lobes-enucleation of the prostate (ThuLLEP).Methods:A total of 90 patients underwent ThuLLEP and plasmakinetic enucleation of prostate (PKEP) in our hospital from November 2018 to December 2020 were collected. The age of patients in the two groups was (67.7±6.8) years and (65.7±7.1) years, the prostate volume was 56.0 (46.0-83.5) ml and 61.0 (53.5-79.5) ml, the serum PSA was 3.6 (2.2-6.0) ng/ml and 4.4 (1.8-7.3) ng/ml, the international prostate symptom score (IPSS) was 27 (22-31) and 28 (23-30), the quality of life score (QOL) was 5 (5-6) and 5 (5-6), the maximum urinary flow rate (Q max) was (8.5±5.7) ml/s and (7.8±3.8) ml/s, the post-void residual volume (PVR) was 127 (47-250) ml and 100 (27-209) ml. The differences had no statistical significance ( P>0.05). The glands were bluntly dissected to establish the surgical capsule plane on both sides of the verumontanum after the verumontanum being located. And then the middle lobe was removed. The glands formed grooves at 12 o'clock after vaporization, which served as anatomical marker. The left and right lobes were removed step by step. Finally, tissue crushing was performed. The PKEP group was enucleated by three lobes enucleation. Perioperative indicators were compared between the two groups. Results:All the operations were completed successfully. The median operative time in ThuLLEP and PKEP groups was 60 (50-73) minutes and 75 (60-100) minutes, the postoperative bladder irrigation time was 2.8 (2.3-3.6) d and 3.8 (2.6-4.7) d, the catheter indwelling time was 4.1 (3.7-4.9) d and 4.9 (4.7-6.0) d, the postoperative hospital stay was 5 (4-6) d and 6 (5-7) d. The decreased hemoglobin was 8.0 (1.5-14.5) g/L and 15.0 (6.5-21.0) g/L. The differences had statistical significance ( P<0.05). Follow-up was performed for 6 months after surgery. The median IPSS score of the two groups was 5 (2-11) and 6 (3-9), the QOL score was 1 (1-2) and 1 (1-2) respectively, which had statistical significance compared with the preoperative parameters ( P<0.05), but no statistical significance between the two groups ( P>0.05). The ThuLLEP group had 1 case of postoperative blood transfusion, 1 case of transient urinary incontinence and 2 cases of urethral stricture. The PKEP group had 1 case of fever and blood transfusion, 3 cases of transient urinary incontinence and 3 cases of urethral stricture. Conclusions:ThuLLEP has definite clinical effect because of less bleeding, quicker recovery and fewer complications. The relatively simple operation steps are beneficial for beginners to master.
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Objective:To explore the feasibility and safty of robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy in treatment of Ⅳa grade tumor thrombus without cardiopulmonary bypass and thoracotomy.Methods:The clinical data of 4 patients with renal cell carcinoma and Ⅳa grade tumor thrombus by robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy from January 2013 to June 2019 were retrospectively analyzed. The median age was 53.5 (53-70) years. The average body mass index was 23.25 (20.7-26.3) kg/m 2. The tumors were located on the right side in 2 cases. The average maximum diameter of the tumor was 8.1 (3.6-11.2) cm.Preoperative tumor thrombus of all patients was classified as Ⅳa. The average preoperative length of tumor thrombus in vena cava was 12.3 (11.8-18.0) cm. All the operations were performed under multidisciplinary cooperation of urology, hepatobiliary, cardiovascular, ultrasound and anesthesiologist team. Surgical procedure: Robot assisted liver mobilization was used to expose the inferior vena cava. Under the guidance of intraoperative ultrasound, the central tendon and pericardium of diaphragm were dissected until the inferior vena cava and right atrium in the superior pericardium were exposed. The first porta hepatis and inferior vena cava were blocked in turn.The vena cava thrombectomy and inferior vena cava reconstruction were performed. Results:All the operations were completed without conversion. The median operation time was 553.5 (338-642) minutes, and the median time of the first porta hepatis occlusion was 18.1 (14-32)minutes. The median blood loss was 1 900(1 000-2 600)ml. All patients were transferred to ICU after operation. The median length of stay in ICU was 7(4-8) days, and the median time of indwelling drainage tube was 8(4-12) days. The average postoperative hospital stay was 13(11-20) days. There were 1 case of grade Ⅱ and 3 cases of grade Ⅲ complications (Clavien classification). One case had paroxysmal supraventricular tachycardia, one case had lymphatic fistula, one case had pleural effusion with atelectasis, and one case had hepatic and renal insufficiency and lymphatic fistula. The complications were improved after treatment. There was no perioperative death.Conclusions:Robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy is an alternative method for the treatment of Ⅳa grade inferior vena cava tumor thrombus. Using this method, Ⅳa grade tumor thrombus can be treated without cardiopulmonary bypass and thoracotomy, with controllable complications and zero perioperative mortality.
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Objective:To explore the curative effect of robotic intracorporeal studer orthotopic neobladder (RISON).Methods:The clinical data of 40 patients who underwent RISON in our hospital from April 2018 to March 2020 were analyzed retrospectively, including 39 males and 1 female with an average age of (56.4±9.9)years, an average body mass index of (25.5±3.1) kg/m 2. Four patients received preoperative neoadjuvant chemotherapy. Comorbidity component index score was 0-2 points in 6 cases, 3-5 points in 33 cases, 6-8 points in 1 case. All patients had definite pathological diagnosis for the high grade urothelial carcinoma or recurrent bladder tumors, and the tumor staging forecast within T 2 stage. Biopsy of the posterior urethra and bladder neck revealed negative result of tumor invasion. The patients had normal kidney function and without any clear bowel disease history. All patients underwent robotic radical intracorporeal studer orthotopic neobladders and standard lymphadenectomy. About 30 to 40 cm from terminal ileum was selected as the new bladder neck and 50 cm ileum as neobladder. Restore intestinal continuity with EndoGIA. The intestinal canal was cut off along the offside of mesentery except for proximal 10 cm. After U-shape suture of the new bladder back wall, the new anterior bladder wall was sutured with barbs line further in pulp muscularis. "Wallace" was performed bilateral ureteral anastomosis and closing the proximal end of the anterior wall of the new bladder. Further follow-up results were also collected to evaluate the clinical treatment effect, including pathological results of tumor, bladder capacity, urine control (usage of pads), sexual function, short-term(≤30 d) and long-term(>30 d) complications. Results:All the RISONs were successfully performed without conversion to open operation. Median operation time was 360(300.0, 442.5) min, blood loss was 200(200.0, 337.5) ml, indwelling time of gastric tube was 3(3, 4)d, full tolerance time was 3(3, 5)d, and postoperative hospital stay was 9(8, 10)d. Postoperative pathological results showed 39(97.5%) cases were no more than T 2N 0M 0, 1 case was confirmed T 3aN 0M 0 pathologically, 1 case was positive in surgical margin, 1 case was diagnosed as incidental prostate cancer, 15(12, 20) lymph nodes were dissected and no lymph node metastasis was found. Short-term (within 30 days) complications occurred in 12 patients, including Clavien grade Ⅰ 7 cases, Clavien grade Ⅱ 5 cases. Long-term (out of 30 days) complications occurred in 18 patients, including Clavien grade Ⅰ 10 cases, Clavien grade Ⅱ 7 cases, Clavien grade Ⅲ 1 case. And the follow-up time was 1 to 24 months. The median bladder volume 300 (0, 400)ml of 25 patients who were followed up for more than one year and 1 in 34 female patient developed incontinence. Other 33 patients had continence rate of 93.9% (0 pad) during the day, and needed regular urination at night (1-3 times), with an average of 2 pads. All 11 patients with nerve-sparing achieved satisfactory erectile function after operation, with an average IIEF-6 score of (21.5±2.7). No tumor recurrence or death occurred in all patients during the follow-up period. Conclusions:Robotic intracorporeal studer orthotopic neobladder is a safe and feasible urinary diversion operation. The patients achieved good clinical efficacy in tumor control, bladder volume, daytime and nighttime continence, sexual function recovery.
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Objective:To investigate the effect of pregnancy on endothelial progenitor cells (EPCs) in patients with rheumatoid arthritis (RA) and its mechanism.Methods:The newly treated RA patients in our hospital from January 2016 to June 2018, were included in this study. According to pregnancy or not, patients were divided into simple RA group and RA pregnancy group. They were all female patients, 30 in each group. Immunohistochemical staining was used to detect the number of lymphocyte common antigen (LCA) + lymphocytes and CD68 + macrophages in synovial tissue, flow cytometry was used to detect the proportion of EPC and endothelial cells, and enzyme-linked immunosorbent assay(ELISA) was used to detect the concentrations of vascular endothelial growth factor (VEGF), stromal cell derived factor (SDF-1), interleukin (IL)-6 and IL-10 in EPC supernatant. T-test was used for the comprarison between the two groups, and single factor analysis of variancewas used for the comparison between multiple groups. Results:Immunohistoche-mical results showed that the number of CD68 + macrophages and LCA + lymphocytes in synovium of RA with pregnancy group was significantly lower than that of non-pregnant RA group. The results of ELISA showed that the concentration of human leucocyte antigen-G (HLA-G) in peripheral blood was (8.9±1.7) pg/ml in non- pregnant RA group and (396.7±89.6) pg/ml in RA pregnancy group, the difference beween the two groups was statistically significant ( t=4.329, P<0.01). The results of flow cytometry showed that the proportion of EPC in lymphocytes was (0.13±0.03)% in non-pregnant RA group and (0.76±0.09)% in RA with pregnancy group, the difference beween the two groups was statisti-cally significant ( t=6.671, P<0.01). The results of correlation analysis showed that the proportion of EPC in peripheral blood was positively correlated with HLA-G concentration ( r=0.886 1, P<0.01). In vitro experiments showed that HLA-G could promote the recovery of EPC paracrine and differentiation function in RA patients. Conclusion:Pregnancy can improve the number and biological function of EPC in patients with RA. HLA-G may play an important role in this process.
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We report a case of fetal cardiac diverticulum diagnosed by ultrasound in the second trimester in a patient who finally had an induced abortion. The 28-year-old pregnant woman went to the Department of Obstetrics of Henan Provincial People's Hospital due to a fetal cardiac abnormality found by ultrasound in a local hospital at 25 +3 gestational weeks. At 25 +4 gestational weeks, fetal echocardiography showed a suspected fetal pericardial cyst, and further MRI showed a left ventricular structure disorder. Fetal echocardiography performed at 25 +5 weeks of gestation identified a cystic echo in the pericardial cavity in the fetus's left-ventricular side, communicating with the left ventricle. A weakened pulsation of the left ventricle and fetal edema were also found. Intraamniotic injection of ethacridine was performed for induced abortion due to suspected fetal cardiac diverticulum at 26 weeks of gestation, and fetal left ventricular diverticulum was diagnosed by pathological examination. Copy number variation analysis showed a 744 kb duplication in p15.3p15.2 region of chromosome 11 with unidentified pathogenicity.
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Objective To investigate the expression and role of regulatory plasma cells in gravidas with systemic lupus erythematosus ( SLE) . Methods Gravidas with SLE were enrolled in Henan Provincial People's Hospital from April 2013 to April 2018. They were divided into three groups including pregnancy control group, SLE stable group and SLE deterioration group. The ratio of CD3-LAG-3+CD138high regulatory plasma cells was detected by flow cytometry. The concentrations of soluble human leukocyte antigen-G ( sHLA-G) and anti-nuclear antibody Ig were detected by ELISA. Lymphocytes in peripheral blood of SLE deterioration group were isolated, and then cultured in RPMI1640 medium containing 10％ fetal bovine ser-um and stimulated with HLA-G. Results Flow cytometry showed that the proportion of regulatory plasma cells in SLE stable group was (2. 483±0. 1318)％ and that in SLE deteriorating group was (1. 662± 0. 1304)％. There was a significant difference between the two groups (t=4. 431, P=0. 0013). The con-centrations of sHLA-G in SLE stable group and SLE deteriorating group were (36. 50±3. 510) ng/ml and (16. 50±2. 405) ng/ml, and the difference between the two groups was statistically significant (t=4. 701, P=0. 0008). Correlation analysis showed that the concentration of sHLA-G was positively correlated with the proportion of regulatory plasma cells (r=0. 7471, P=0. 0009). The results of in vitro experiment showed that the proportions of B cells and regulatory plasma cells were ( 7. 573 ± 0. 6539 )％ and ( 1. 593 ± 0.1879)％ in SLE deterioration group and (3. 732±0. 7178)％ and (2. 503±0. 2921)％ in HLA-G group with statistical differences between the two groups (t=3. 957, P=0. 0027;t=2. 620, P=0. 0256). Conclusions The proportion of regulatory plasma cells and the concentration of sHLA-G were significantly decreased in pregnant patients with SLE, which was closely related to disease severity. HLA-G played an important role in promoting the proliferation of regulatory plasma cells.
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Objective To confirm the noninferiority of mesorectal excision (ME) alone to ME combined with lateral lymph node dissection (LLND) in terms of efficacy. Methods Eligibility criteria included histologically proven rectal cancer at clinical stageⅡ/Ⅲ; main lesion located in the rectum. Patients were intra-operatively allocated to undergo ME combined with LLND or ME alone in a randomized manner. The primary endpoint was relapse-free survival, with a noninferiority margin for the hazard ratio of 1.34. Secondary end points included overall survival and local-recurrence-free survival. Results In total, 502 patients from November 11, 2010 to October 1, 2017 were randomized to the ME combined with LLND (252 patients) and ME alone (250 patients) groups. The 5-year relapse-free survival in the ME combined with LLND and ME alone groups were 73.4% and 73.3%, respectively (hazard ratio:1.07, 90.9% CI 0.84— 1.36), with one sided P value for noninferiority of 0.0547. The 5-year overall survival, and 5-year local-recurrence-free survival in the ME combined with LLND and ME alone groups were 92.6% and 90.2% , and 87.7% and 82.4% , respectively. The numbers of patients with local recurrence were 21 cases (8.3%) and 43 cases (17.2%) in the ME combined with LLND group and ME alone group (P=0.024). Conclusions The noninferiority of ME alone to ME combined with LLND is not confirmed in the intent-to-treat analysis. ME combined with LLND has a lower local recurrence, especially in the lateral pelvis, compared to ME alone.
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Objective To explore the feasibility of robot-assisted laparoscopic inferior vena cava (IVC) thrombectomy in treating renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava thrombus.Methods From November 2014 to January 2017,5 cases of renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava tumor thrombus were treated with robot-assisted surgery.There were 4 males and 1 female with the median age of 59 years (range 54-71 years).Four cases had the renal tumor on the right side and one on the left side.The mean tumor size was 6.8 cm (range 5-9 cm) with 3 cases of T3b and 2 cases of T3c.There were 4 cases of level Ⅲ and 1 case of level Ⅳ inferior vena cava thrombus with the median length of 9 cm (range 7-11 cm).The surgical procedure for Mayo level Ⅲ inferior vena cava thrombus included mobilization of both left and right robes of liver,subsequently controlling the suprahepatic infradiaphramatic IVC and first porta hepatis simultaneously.The surgical procedure for Mayo level Ⅳ inferior vena cava thrombus included cardiopulmonary bypass by multi-disciplinary cooperation among urologists,hepatobiliary and cardiovascular surgeons.The procedures included live mobilization,control of the superior vena cava and first porta hepatis and remove thrombus in the atrium and IVC respectively.Results All operations were completed successfully.The median operative time was 440 min (320-630 min).The blood recovery device was used and the intraoperative estimated blood loss was 2 500 ml (500-6 000 ml) and all cases required intraoperative blood transfusion.The median time of intraoperative occlusion of IVC was 35 min (25-50 min).All patients were transferred to the intensive care unit for median of 4 days (2-8 days) after surgery.The median time to remove the postoperative drainage tube was 9 days (7-12 days).Postoperative pathological diagnosis revealed 5 cases of clear cell carcinoma.Postoperative renal dysfunction occurred in 3 patients and liver dysfunction occurred in 2 patients who improved after medical therapy.During median 19.6 months (12-48 months) of follow-up,1 patient died and 1 patient progressed.Conclusions Despite the high risk of surgery,robot-assisted laparoscopic IVC thrombectomy for renal tumor with Mayo level Ⅲ-Ⅳ thrombus is feasible for experienced surgeons in selected patients.However,the oncological outcomes need further investigation.
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Objective To investigate the therapeutic effects of presurgical TMT on the heights and levels of inferior vena cava(IVC)thrombi,and to assess its impact on surgical strategy.Methods We retrospectively reviewed data of 18 patients with renal cell carcinoma(RCC)involving IVC tumor thrombi who were treated at our hospital with presurgical TMT followed by an IVC thrombectomy.Data from 18 patients(16 men and 2 women)were included in the analysis.The median age was 53.5 years(range:33-75 years),and the mean BMI was 24.7kg/m2(rrange:18.1 -30.4 kg/m2).4 cases of tumors located in the left kidney,14 cases were right.The changes in heights and levels of the IVC thrombi were compared using computed tomography or magnetic resonance imaging.The IVC tumor thrombus level was evaluated according to the Mayo classification.Results The tumor thrombus levels before TMT were stage Ⅰ in 1 patient,Ⅱ in 1 2 patients,Ⅲ in 4 patients,and Ⅳ in 1 patient.The presurgical TMT was sorafenib in 6 patients(33.3%),sunitinib in 9(50.0%),and axitinib in 3(16.7%).After a median of 2 treatment cycles(range:1-6 cycles),three patients experienced grade 3 adverse events.One patient stopped treatment after 6 weeks owing to intolerable skin reactions and difficulty walking.The tumor thrombus height decreased measurably in 11 patients(61.1%).The thrombus height remained stable in 5 patients(27.8%)and was enlarged in 2(11.1%).The median reduction of tumor thrombus height was -0.53 cm (range:-4.23 to 1.21 cm).The median change in the maximum diameter of the thrombus was -0.30 cm (range:-1.23 to 0.29 cm).Down-staging of the thrombus level occurred in 4 patients(22.2%);the surgical strategy was modified in 3 patients(level≥Ⅲ)to avoid cardiopulmonary bypass and complicated liver mobilization under robot-assisted laparoscopy.Conclusions Our data suggest a limited influence of presurgical TMT,with a positive benefit in RCC patients with level Ⅲ and Ⅳ thrombus.Thrombus-level regression may potentially alter the surgical strategy,especially robotic surgery.Additionally,preoperative targeted therapy did not significantly increase perioperative mortality and risk of serious complications.
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BACKGROUND:Compared with the cone stem,short stem holds good matching with femoral canal,and remarkably reduces the risk of prosthesis loosening.OBJECTIVE:To further investigate the clinical efficacy of Accolade Ⅱ stem for Crowe type Ⅰ developmental dysplasia of the hip.METHODS:Clinical data of 16 patients with Crowe type Ⅰ developmental dysplasia of the hip undergoing total hip arthroplasty using Accolade Ⅱ stem were collected,the length of both lower limbs before and after surgery was compared,and the Visual Analogue Scale,functional recovery of the hip and general conditions were observed at 12 weeks postoperatively.RESULTS AND CONCLUSION:(1) The change in length of both lower limbs before and after surgery had significant difference (P ＜ 0.05),and 10 patients (62％) with the same length of both lower limbs before surgery,and 15 cases (94％) after surgery.(2) The postoperative acetablar abducent angle was 41°-54° (average 46.9°).(3) The Visual Analogue Scale and Harris hip scores after surgery were significantly improved compared with baseline (P ＜ 0.05).(4) The intraoperative blood loss was 147 mL on average,the mean operation time was 72 minutes,and the hospitalization time was 7.2 days.(5) All patients recovered well and no complications occurred at 3 months postoperatively.(6) To conclude,Accolade Ⅱ stem is safe and reliable for Crowe type Ⅰ developmental dysplasia of the hip,and exhibits good functional recovery of the hip.
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A comprehensive physician authorization management system has been established at Renmin Hospital of Wuhan University in its effort of promoting the clinical standardization.This system covers authorization of prescription,disposition,surgery,and medical report among others,adhering to the principle of clear,complete quantitative competence-based,authorization.The training and assessment of physicians in parallel canimprove physicians' competence and quality of care.
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Objective To evaluate the multi-spiral CT(MSCT)imaging features and classification of renal pelvis carcinoma.Meth-ods 76 patients of renal pelvis carcinoma proved pathologically were analyzed retrospectively,and divided into different types ac-cording to the MSCT features.The MSCT differences for different types were analyzed.Results Most of the tumors showed iso-density or slight hyperdensity (95%)on un-enhanced images,and persistent mild-to-moderate enhancement (91%)in enhanced im-ages.All cases were divided into three types:pelvic mass type in 30 cases (39%),substance invasion type in 25 cases (33%),wall thickening type in 21 cases (28%).All cases were also divided into two types:substance invasion type(25 cases,33%)and renal pelvis type(5 1 cases,67%).The occurrence rate of local low enhancement,whole kidney low enhancement,hydronephrosis,lymph node metastasis and vein tumor thrombus were 80%,20%,48%,52%,1 6% in substance invasion type cases,and 4%,42%, 75%,4%,6% in the renal pelvis type cases,respectivily.Conclusion MSCT multiphase enhancement scanning shows important valuation in the diagnosis and classification of renal pelvis carcinoma.Obvious differences of CT features are showed for different types.The diagnosis accuracy may be improved by the knowledge of substance invasion type.
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<p><b>OBJECTIVE</b>To evaluate the preliminary curative effect of interspinous injections for the diagnosis and treatment of back pain caused by lumbar kissing spine (Baastrup's disease) under fluoroscopically guiding.</p><p><b>METHODS</b>From November 2011 to March 2013,17 patients with back pain caused by Baastrup's disease were treated with fluoroscopically-guided interspinous injections, including 7 males and 10 females with an average age of 49.6 years old ranging from 40 to 71 years old; the duration of the disease ranged from 2 to 5 years with a mean of 3.7 years. The visual analogue scale (VAS) and the lumbar segments range of motion (ROM) was analyzed at pre-operation, 2 days, 3 months and final followed-up after operation, the effects were evaluated with modified Macnab standard.</p><p><b>RESULTS</b>All patients were follow-up from 6 to 10 months with an average of 7.6 months. The pre-operative VAS was 6.41 +/- 0.94, the postoperative VAS at different time points improved significantly comparing with pre-operation,and the differences were statistically significant (P < 0.01). There was no significant difference in VAS at different time points after operation (P > 0.05). The ROM of operated segment and adjacent segment was (4.88 +/- 0.86) degrees and (6.82 +/- 0.73) degrees respectively at pre-operation. The postoperative operated segment ROM at different time points improved significantly comparing with pre-operation, and the differences were statistically significant (P < 0.05). Compared with pre-operation, there was no significant difference in adjacent segment ROM at different time points after operation (P > 0.05). According to modified Macnab, the result was excellent in 6 cases, good in 7 cases, fair in 3 cases and poor in 1 case.</p><p><b>CONCLUSION</b>Fluoroscopically-guided interspinous injections is an effective method for the diagnosis and treatment of Baastrup's disease. The method has advantages of simple operation, minimal invasion and safety, satisfactory short-term and medium-term therapeutic effect; it can also effectively lessen the pain of lumbar and back.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Anesthetics, Local , Low Back Pain , Diagnosis , Diagnostic Imaging , Drug Therapy , Lumbar Vertebrae , Diagnostic Imaging , Nerve Block , Spinal Diseases , Diagnosis , Diagnostic Imaging , Drug Therapy , Tomography, X-Ray ComputedABSTRACT
<p><b>OBJECTIVE</b>To evaluate the liability of sentinel node biopsy in the treatment of early stage oral tongue carcinoma with clinically negative neck.</p><p><b>METHODS</b>Eighteen patients with T1 or T2 oral tongue carcinoma were enrolled in the prospective study. Preoperative lymphoscintigraphy and intra-operative hand-held gamma probe techniques were used to detect the sentinel lymph nodes. The sentinel lymph node biopsies were sent to frozen section pathology and the results were compared with specimen of routine selective neck dissection (I ∼ III or I ∼ IV). The accuracy of cervical metastasis prediction was compared between sentinel node biopsy and tumor thickness.</p><p><b>RESULTS</b>Sentinel lymph nodes were identified in all 18 cases. The numbers of sentinel lymph nodes of level Ib, IIa and III were 6, 22 and 2, respectively. In this series, positive sentinel lymph nodes were revealed in 4 cases, which were also positive in the postoperative routine histology.In other cases, both sentinel lymph nodes and routine histology were negative. Both the sensitivity and specificity were 100%. Sentinel lymph node biopsy obviously improved the specificity of predicting cervical metastasis comparing with the tumor thickness. (100% vs. 36.4%).</p><p><b>CONCLUSION</b>Sentinel node biopsy is effective and reliable in the treatment of early stage oral tongue cancer, and deserves clinical application.</p>
Subject(s)
Humans , Lymph Nodes , General Surgery , Mouth Neoplasms , Diagnosis , Prospective Studies , Sentinel Lymph Node Biopsy , Methods , Tongue Neoplasms , DiagnosisABSTRACT
<p><b>OBJECTIVE</b>To discuss the radical treatment of cervical giant cystic lymphangioma in Children and cosmetic result.</p><p><b>METHODS</b>Twenty-five children with cervical giant cystic lymphangioma were retrospectively analyzed. The diameter of all the tumors was more than 10 cm. 24 cases underwent resection. The complication, therapeutic effect and cosmetic result were recorded.</p><p><b>RESULTS</b>The tumors were all removed radically in all the cases. The patients were followed up for 1-5 years with no recurrence. Cosmetic result was satisfactory in 22 cases. Secondary operation was performed in 2 cases with satisfactory result. Complications included 5 cases of lymph leakage, 2 cases of poor wound healing, 1 case of infection and 2 cases of tongue edema.</p><p><b>CONCLUSIONS</b>The cervical giant cystic lymphangioma in children can be resected radically with satisfactory result.</p>