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Objective:To investigate the effect of multi line therapy for lung adenocarcinoma transformed into small cell lung cancer (SCLC), and review and discuss the related literature.Methods:Combined with the clinical examples of lung adenocarcinoma transformed SCLC after treatment with anti epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs), the diagnostic process and multi line treatment plan of transformed SCLC were analyzed, and the therapeutic effect was evaluated by imaging. At the same time, it was reviewed and discussed in combination with relevant literature.Results:Serological tumor markers were significant for the diagnosis of transformed SCLC after EGFR-TKI treatment of lung adenocarcinoma, and pathology was still the gold standard for its diagnosis. The multiline therapy of SCLC has certain effect on transformed small cell lung cancer.Conclusion:The overall prognosis of lung adenocarcinoma transformed into SCLC after EGFR TKIs treatment is poor, so it is necessary to diagnose and treat it as early as possible, evaluate the effect of imaging in time, and make treatment adjustment quickly.
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Objective:To investigate the effect of thrombus burden on the clinical outcome of endovascular recanalization in large vessel occlusive stroke.Methods:Patients with acute anterior circulation occlusion who underwent endovascular treatment within 24 hours after onset in Zhengzhou University People′s Hospital from January 2018 to December 2019 were retrospectively collected. According to the clot burden score (CBS) of DSA, total objectives were divided into CBS≥6 group (24 cases) and CBS<6 group (38 cases). Clinical data of the two groups were collected and the modified Rankin scale (mRS) was used to evaluate the clinical outcome at 90 days after surgery. Independent sample t-test, Wilcoxon rank sum test and χ 2 test were used to compare the clinical data between the two groups. Independent risk factors affecting the clinical outcome were analyzed by binary logistic regression. Results:There were no statistically significant differences in basic demographic data, stroke risk factors and other factors between the CBS≥6 group and CBS<6 group ( P>0.05).The proportion of using tirofiban after surgery in the CBS≥6 group (63.2%, 24/38) was lower than that in the CBS<6 group (87.5%, 21/24) (χ2=4.380, P=0.044). The discharge NIHSS score of the CBS≥6 group was [5.0 (3.3, 7.8) points] lower than CBS<6 group [8.5 (1.8, 14.5) points] ( Z=5.221, P=0.022). The proportion of postoperative mRS 0-2 was (91.7%, 22/24) in the CBS≥6 group higher than CBS<6 group(39.5%, 15/38) (χ2=20.486, P=0.001), there were no statistically significant differences between the two groups ( P<0.05). The results of binary logistics regression analysis showed the CBS groups (OR=0.042, 95%CI 0.007-0.244 , P=0.001) was an independent risk factor affecting good outcome. Subgroup analysis of whether tirofiban was used or not showed there was no statistically significant difference in clinical prognosis between the two groups ( P>0.05). Conclusions:The clinical outcome of CBS≥6 group is significantly better than that of CBS<6 group, and patients with small thrombus burden are more likely to get a good clinical outcome of 90 days.
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OBJECTIVE@#To investigate the expression of RNA methyltransferase METTL14 in hepatocellular carcinoma (HCC) and its clinical significance.@*METHODS@#Immunohistochemical staining was used to detect the expression of METTL14 in 147 pairs of HCC and adjacent hepatic tissues. According to the scores rated by pathologists, the 147 cases of HCC were divided into high and low METTL14 expression groups. The correlation between the expression of METTL14 and clinicopathological parameters was analyzed, and Kaplan-Meier method was used to analyze the relationship between the expression of METTL14 and the prognosis and survival (including the overall survival and disease-free survival) of the patients with HCC after operation. Univariate analysis and multivariate analysis were carried out to assess the impact of METTL14 expression level on the overall survival and tumor-free survival of the patients after operation using a COX regression model and explore whether METTL14 expression level is an independent prognostic risk factor of the postoperative patients.@*RESULTS@#The expression of METTL14 was significantly lower in HCC tissues than in the adjacent tissues ( < 0.001). METTL14 expression in HCC tissues was significantly correlated with the tumor size (=0.044) and TNM stage (=0.046). A low expression of METTL14 in HCC tissues was significantly correlated with a poor prognosis and a significantly shortened overall survival time and disease-free survival time of the patients ( < 0.05), and was an independent risk factor affecting the overall survival and disease-free survival of HCC patients.@*CONCLUSIONS@#METTL14 may be a new prognostic marker for patients with HCC after hepatectomy.
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Humans , Biomarkers, Tumor , Carcinoma, Hepatocellular , Disease-Free Survival , Hepatectomy , Kaplan-Meier Estimate , Liver Neoplasms , Methyltransferases , PrognosisABSTRACT
Objective:To investigate the efficacy and safety of endovascular recanalization treatment for acute vertebral basilar artery occlusion (AVBAO) underlying intracranial atherosclerotic disease (ICAD) using a balloon-mounted stent.Methods:A total of 16 cases of consecutive AVBAO patients who underwent endovascular treatment with the balloon-mounted stent within 24 h after onset were retrospectively enrolled in Henan Provincial People′s Hospital from February 2017 to August 2019. And the recanalization rate, operation-related complications, symptomatic intracranial hemorrhage, the improvement of 1 week National Institutes of Health Stroke Scale (NIHSS) score and 3 months modified Rankin Scale (mRS) after treatment were recorded.Results:In all of the 16 patients, 4 patients underwent direct stenting angioplasty, 12 patients received salvage stenting. Stent placement was successful in all 16 patients. Balloon-mounted stent were implanted in basilar artery of 4 cases, in intracranial segment of vertebral artery of 8 cases, and in origination segment of vertebral artery of 4 cases. Recanalization was successful (thrombolysis in cerebral infarction grade 2b and 3) in 15 patients. The time between arterial puncture and recanalization was 79.0 (72.3, 109.3) min. One patient experienced distal thrombosis during surgery. Two patients suffered symptomatic intracranial hemorrhage within 48 h after surgery. The scores of the NIHSS were improved more than 4 points at 1 week after operation in 8 patients. At 3 months follow-up, 9 patients had a good outcome (mRS 0-3 points) and 4 patients died.Conclusion:Selective stenting angioplasty treatment with a balloon-mounted stent seems to be feasible and safe for AVBAO patients underlying ICAD.
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Objective To evaluate the safety and efficacy of stent implantation used as a rescue measure for acute ischemic stroke.Methods The clinical data of 13 patients with acute ischemic stroke caused by large artery occlusion of anterior c erebral circulation that occurred within 8 hours before clinical visit,who had received rescue stent implantation at authors' hospital,were retrospectively analyzed.Before stent implantation,all patients failed to respond to other recanalization treatments,including intravenous thrombolysis,intra-arterial thrombolysis,mechanical thrombec tomy with Penumbra device,and Solitaire stent thrombectomy.Angiography was performed immediately after stent implantation.Vascular recanalization condition was evaluated with blood flow grading that was based on thrombolysis in cerebral infarction (TICI) criterion.Perioperative bleeding and complications were recorded.National Institutes of Health Stroke Scale (NIHSS) score was used to assess the improvement of neurological function at one week after operation.Modified Rankin scale (mRS) score was used to evaluate the prognosis at 3 months after operation.Results A total of 16 stents were implanted in 13 patients.Before stent implantation,thrombectomy by using Solitaire retrievable stent was employed in 10 patients,mechanical thrombectomy with Penumbra device was adopted in 3 patients,intravenous thrombolysis with urokinase was used in one patient,and intra-arterial thrombolysis with urokinase was conducted in one patient.After stent implantation,partial or complete recanalization was achieved in 12 patients (TICI≥2b/3).NIHSS score was improved from preoperative (16.15±5.81) points to postoperative (8.08±5.61) points,the difference was statistically significant (P＜0.05).Three months after stenting treatment,good prognosis (mRS ≤2) was obtained in 7 patients (53.8％) and 2 patients died.Intracranial hemorrhage occurred in 2 patients and procedure-related embolism was observed in 3 patients.Conclusion For the treatment of acute ischemic stroke,intracranial stenting angioplasty,used as a rescue measure for thrombolytic therapy with different combinations of drugs,is safe and effective.
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Along with the continuous publication of a series of large-scale clinical trials results,endovascular thrombolytic therapy (or combined with intravenous thrombolysis) has been recommended as the treatment of first choice for acute ischemic stroke caused by large intracranial artery occlusion.Nevertheless,there are a variety of factors that may affect the clinical outcome of endovascular recanalization procedure.This article aims to make a comprehensive review about the factors that may affect the prognosis of patients with acute ischemic stroke who are receiving endovascular treatment.