ABSTRACT
Neoadjuvant therapy has become the first choice for locally advanced esophageal carcinoma. Patients with post-neoadjuvant positive lymph node staging (ypN+) have poor prognosis, and there is no effective adjuvant therapy. Programmed death protein-1 (PD-1) antibody can obtain better clinical efficacy in the treatment of advanced esophageal cancer. The authors designed a multicenter, prospective, randomized controlled clinical trial of Toripalimab (PD-1 antibody) adjuvant therapy on esophageal squamous cell carcinoma patients with ypN+ after the treatment of neoadjuvant chemotherapy combined with surgical resection, in order to provide clinical practices for the adjuvant treatment of ypN+ patients.
ABSTRACT
Compared with traditional cerebral angiography, magnetic resonance angiography has the advantages of non-invasive, convenient, and no adverse effects of contrast agents. In many cases, it can be used as an alternative examination or an important supplement to digital subtraction angiography. This article reviews the application progress of magnetic resonance angiography in the diagnosis and treatment of moyamoya disease.
ABSTRACT
Objective To investigate the clinical features, treatment strategies and outcomes of patients with Moyamoya disease and lenticulostriate artery (LSA) aneurysm rupture. Methods Patients with moyamoya disease and LSA aneurysm rupture admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medicine School from October 2012 to March 2015 were analyzed retrospectively. They were followed up for 1 year. The modified Rankin Scale (mRS) was used to evaluate the outcomes, and 0-2 was defined as good outcome. The demographic characteristics, image anatomical features, treatment schemes, and outcomes of the patients were summarized. The Pubmed database was used to retrieve other similar studies, which combined with this group of cases for analysis. Results A total of 10 patients were enrolled, 2 males and 8 females, aged 29-72 years, with an average of 43. 6 years. All cases were intracranial hemorrhage, including 3 cases of cerebral hemorrhage, 6 cases of ventricular hemorrhage, and 1 case of subarachnoid hemorrhage. At the time of admission, 7 patients had disturbance of consciousness, and 3 patients underwent emergency extraventricular drainage. Among them, 5 patients received endovascular embolization, 4 had good outcome, 1 had mild neurological deficit (mRS score 3); 2 received surgical treatment, all had good outcome; 3 received conservative treatment, all had re-bleeding, 2 died, and 1 had severe disability (mRS score 4). Fourteen eligible articles were included, and a total of 18 patients were included in the analysis: surgical treatment in 7 cases, endovascular treatment in 6 cases, and conservative treatment in 5 cases (self-healing in 1 case). According to the data of this group of patients and literature reports, the good outcome rate of the patients with early interventional embolization or craniotomy clipping treatment was significantly higher than that of conservative treatment (70. 6％vs. 22. 2％; P = 0. 038). Conclusion There is a certain risk of conservative treatment of Moyamoya disease complicated with LSA aneurysm rupture and requires active treatment. Interventional embolization of the parent artery or surgically clipping of aneurysm can effectively improve the clinical outcome of such patients. Interventional embolization of the parent artery and aneurysm can be selected simultaneously if the condition of the parent artery is allowed. Surgery can be selected when the condition of parent artery is poor and the aneurysm is located in the superficial part.
ABSTRACT
Objective To explore the value of CT radiomics model in predicting three-year survival time in patients with primary hepatocellular carcinoma (HCC). Methods Eighty one patients pathologically or clinically confirmed HCC and B stageof Barcelona clinical liver cancer before transcatheter arterial chemoembolization (TACE) in Zhejiang Cancer Hospitalwere retrospectively enrolled from January 2010 to June 2014.A primary cohort consisted of 64 patients and an independent validation cohort consisted of 17 patients. The patients were divided into survival group of 39 cases and death groupof 42 cases duringthree-year follow-up. All the patients underwentnon-enhanced and contrast-enhanced CTimages scan before TACE. Three hundered and seventy six quantization radiomics features were extracted from the arterial phase and portal phase CTimages of target lesion. LASSO regression model was used for data dimension reduction. Logistic regression was used to develop the prediction model. The predictive ability of the model was validated using the area under the curve (AUC) of receiver operating characteristic(ROC) analysis. Results The radiomics features selected from the arterial and portal phase were 8 and 5, respectively. The arterial prediction model showed AUC=0.833, sensitivity=83.9％(26/31), specificity=81.8％(27/33), accuracy=82.8％(53/64)in primary datasetand AUC=0.861, sensitivity=75.0％(6/8), specificity=100.0％(9/9), accuracy=88.2％(15/17)in independent validation dataset.The portal prediction model showed AUC=0.858, sensitivity=83.3％(25/30), specificity=85.3％(29/34), accuracy=84.4％(54/64)in primary dataset and AUC=0.750, sensitivity=75.0％(6/8), specificity=100.0％(9/9), accuracy=88.2(15/17)in independent validation dataset. Conclusion This study shows CT radiomics model can be conveniently used to facilitate the preoperative individualized prediction of three-year survival time in patients with HCC.
ABSTRACT
Objective@#To discuss the effect and safety of continuous pumping for home enteral nutrition after esophagectomy.@*Methods@#The current study retrospectively analyzed the esophageal cancer patients who underwent transthoracic esophagectomy between January 2017 and November 2017 at First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute. There were totally 108 cases, including 88 males and 20 females, with an average age of 62 years. The patients were divided into pump feeding group (n=56) and traditional tube feeding group (n=52). The postoperative short-term safety, weight maintenance, enteral nutrition tolerance and nutritional support complete rate of the 2 groups were compared by χ2 test, Fisher exact test and t test, respectively.@*Results@#Compared with traditional tube feeding group, the patient safety in pumping feeding group was significantly better, with complications within 2 months after discharge were 11/52 and 4/56 respectively (χ2=2.393, P=0.035); the weight maintenance was significantly better, the weight loss within 4 weeks after discharge were 3.90 kg and 0.13 kg, respectively (t=7.720, P=0.000); the general enteral complications were significantly lower (26/52 vs. 5/56, χ2=22.225, P=0.000), the nutritional support complete rate was significantly higher (23/52 vs. 55/56, χ2=39.167, P=0.000).@*Conclusions@#Continuous pump feeding enteral nutrition support after discharge postoperatively could help improve patient safety after discharge, which is better for weight maintenance of the patients. Pump feeding could also enhance tolerability of tube feeding and ensure the effective accomplishment of nutritional support.
ABSTRACT
BACKGROUND@#Currently, there is no consensus on the follow-up strategy (follow-up time interval and content) of non-small cell lung cancer (NSCLC) in the world, and the relevant clinical evidence is also very limited. In this study, we aimed to summarize the recurrence/metastasis sites and timings of stage I NSCLC patients based on their follow-up data, aiming to provide a basis of follow-up time interval and content for this group of patients.@*METHODS@#We retrospectively analyzed the 416 stage I NSCLC patients that underwent continuous anatomic lobectomy between Jan. 2000 to Oct. 2013 in our prospective lung cancer database. According to the recurrence/metastasis sites and timings, the long term follow-up time interval and content were explored.@*RESULTS@#The 5-yr disease free survival (DFS) and overall survival (OS) in the whole group were 82.4% and 85.4%, respectively. There were 76 cases (18.3%) had recurrence/metastasis during follow-up, among which the most frequent site was pulmonary metastasis (21 cases, 5.0%), followed by brain metastasis (20 cases, 4.8%), bone metastasis (12 cases, 2.9%), and mediastinal lymph node metastasis (12 cases, 2.9%). Among the factors that could influence recurrence/metastasis, patients with pT2a suffered from a higher recurrence/metastasis rate compared to patients with pT1 (P=0.006), with 5-yr DFS being 73.8% and 87.3%, respectively (P=0.002), and the 5-yr OS being 77.7% and 90.3%, respectively (P=0.011).@*CONCLUSIONS@#The commonest recurrence/metastasis sites of stage I NSCLC after anatomic lobectomy are lung, brain and mediastinal lymph nodes, the risk of recurrence/metastasis within 2 years were equal to that between 3 years and 5 years. The follow-up frequencies and content within 2 years could be adjusted according to T stages.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Carcinoma, Non-Small-Cell Lung , Mortality , Pathology , General Surgery , Follow-Up Studies , Lung Neoplasms , Mortality , Pathology , General Surgery , Lymph Nodes , General Surgery , Lymphatic Metastasis , Neoplasm Staging , Pneumonectomy , Prospective Studies , Retrospective StudiesABSTRACT
BACKGROUND@#Thoracoscopic surgery has gradually become the major procedure for lung cancer surgery in our department. Its characteristics are minimal trauma and quick recovery, which make approximately 90% of patients discharge from the hospital after surgery. However, the postoperative complications still happen now and then. We analyzed the patients who had been hospitalized for longer than 7 days after thoracoscopic lung cancer surgery, aiming to summarize the types and risk factors of complications, and improve postoperative safety of patients.@*METHODS@#The data were come from the prospective database of Thoracic Surgery Unit One in Peking Cancer Hospital, and patients that underwent thoracoscopic pulmonary surgery between Jan. 2010 and Dec. 2014 with length of stay more than 7 days were included in the study. The classifications of the complications were investigated and graded as mild or severe complications according to modified Claviengrading, the relationship between clinical factors and degrees of complications was also analyzed.@*RESULTS@#The hospitalization of 115 cases were longer than 7 days after surgery, accounting for 10.3% (115/1,112) of the whole patients that underwent surgery during the same period. Eighty-one cases had mild complications, accounting for 7.3% (81/1,112) of the whole cases that underwent surgery during the same period and 70.4% (81/115) of the cases with prolonged length of stay; the proportions of severe complications in both groups were 3.1% (34/1,112) and 29.6% (34/115), respectively; and the proportions of complications that caused perioperative deaths were 0.18% (2/1112) and 1.7% (2/115), respectively. Among all the postoperative complications, the most common was air leakage for more than 5 days after surgery, with a total of 20 cases (1.8% and 17.4%). The other common complications were: atelectasis (19 cases, 1.7% and 16.5%), pulmonary infection (18 cases, 1.6% and 15.7%), etc. The less common complications was bronchopleural fistula (4 cases, 0.36% and 3.5%) with very high risk, and 2 cases died perioperatively due to the combination of acute respiratory distresssyndrome (ARDS). In the clinical factors, only preoperative low pulmonary function (FEV1%<70%) was the potential risk factor for postoperative severe complications (45.8% vs 23.6%, P=0.038). There was no significant difference either regarding the 5 year disease free survival or the 5 year overall survival between mild complication group and severe complication group, with 5 year DFS being 52.2% and 51.9%, respectively (P=0.894) , and 5 year overall survival being 64.0% and 53.5%, respectively (P=0.673).@*CONCLUSIONS@#Continuous postoperative air leakage, atelectasis and pulmonary infections were the major causes for prolonged hospitalization after thoracoscopic surgery for lung cancer, and bronchopleural fistula was the most perilous complications. Patients with low preoperative pulmonary function were more likely to have severe postoperative complication, however, this would not influence the long term survival of the patients.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Hospitalization , Length of Stay , Lung Neoplasms , General Surgery , Therapeutics , Postoperative Complications , Epidemiology , Postoperative Period , Prospective Studies , Thoracic Surgery, Video-AssistedABSTRACT
Objective To discuss the application of routine CT three-phase perfusion parameter,that is arterial enhancement fraction (AEF) value,in evaluating the curative effect of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Methods The clinical data of a total of 30 patients with pathologically proved HCC were enrolled in this study.Routine CT three-phase perfusion scan was performed 1-3 days before as well as 30-40 days after TACE in all patients.AEF value was calculated by using CT Kinetics software (GE Healthcare).The formula for calculating AEF value was as follows:AEF value=(arterial phase CT value-plain scan CT value)÷(portal phase CT value-plain scan CT value).The results were statistically analyzed.Results Effective treatment group had 17 patients,and ineffective treatment group had 13 patients.The postoperative AEF values in the effective treatment group and the ineffective treatment group were (0.351±0.090) and (0.438±0.050) respectively,the difference between the two groups was statistically significant (P＜0.05).Taking postoperative AEF value of 0.392 as the critical value to predict the postoperative effect of TACE,the sensitivity and specificity were 86.7％ and 73.2％ respectively,and the area under the curve was 0.876 (P＜0.001).Conclusion The routine CT three-phase perfusion parameter (AEF) can quantitatively reflect the hemodynamic changes of HCC after TACE,which is helpful for making early evaluation of TACE effect,meanwhile,no additional radiation dose will be added.
ABSTRACT
<p><b>OBJECTIVE</b>To summarize the mortality of esophagectomy in our series and compare the different mortalities based on 30-day deaths and 90-day deaths postoperatively.</p><p><b>METHODS</b>A total of 954 patients undergoing esophagectomy by single-surgeon-team between January 2000 and December 2012 from our prospective database were enrolled. The mortalities based on 30-day and 90-day deaths postoperatively were compared, and the causes of deaths within 30 days and 90 days were analyzed.</p><p><b>RESULTS</b>Among all these 954 patients, a total of 20 postoperative deaths(2.1%) were observed: 11 within 30 days(1.1%) and 9 between 30 and 90 days after surgery(1.0%). The reasons for deaths within 30 days were as follows: 3 for respiratory failure related to anastomotic leakage,1 for bleeding after stenting due to anastomotic fistula, 1 for sepsis, 3 for respiratory failure from presenting preoperative respiratory morbidities, 2 for cardiac arrest caused by preoperative heart disorder, and 1 for multiple organ failure caused by early adjuvant chemotoxicity. The reasons for deaths between 30 and 90 days were as follows: 1 for respiratory failure related to anastomotic leakage, 1 for cardiac arrest from preoperative heart disorder, 1 for cerebrovascular accident, 1 for liver failure from liver cirrhosis presenting preoperatively, 1 for renal failure after operation, 1 for tumor progression and 2 for unknown reasons.</p><p><b>CONCLUSION</b>Since postoperative mortality calculated based on 30 days deaths postoperatively may underestimate the risk of esophagectomy, mortality calculated based on 90 days may be a better option.</p>
Subject(s)
Humans , Anastomotic Leak , Cause of Death , Esophageal Neoplasms , General Surgery , Esophagectomy , Mortality , Postoperative Period , Prospective Studies , Risk Factors , StentsABSTRACT
Objective To investigate the strategy and efficacy of enteral nutrition support of patients with spontaneous intraventricular hemorrhage-induced coma.Methods 139 patients were randomly divided into study group (treated with enteral nutrition mixed suspension,n =67) and control group (treated with normal full nutritional homogenized product,n =72) with a random number generating software.Enteral nutrition support was administered in 6-48 hours after admission.The total daily intake of enteral nutrition preparation was 1 000 ml (4 186.8 kJ),supplemented by liquid food.Body weight,serum albumin,serum total protein,hemoglobin,lymphocyte count,incidence of infection,level of consciousness and incidence of complications were compared between the two groups.Results In the third week after onset,the serum albumin [(32.1 ± 3.3) g/Lvs.(30.5±2.3) g/L,P=0.041],total protein [(62.2±3.2) g/Lvs.(56.9±2.7) g/L,P=0.039],and hemoglobin [(125.5 ±5.7) g/Lvs.(120.7 ±6.4) g/L,P=0.027] were significantly higher in the study group than in the control group.The Glasgow score in the second week in the study group was 13.1 ± 1.9,significantly higher than that in the control group (11.0 ±2.3) (P =0.037);the incidence of nosocomial infection was significantly lower in the study group than in the control group [17.9％ (12/67) vs.29.2％ (21/72),P =0.021];the proportion of patients with abnormal blood test results and that of patients having fever for more than 7 consecutive days were both significantly lower in the study group than in the control group [31.3％ (21/67) vs.38.8％ (28/72),P=0.042;37.3％ (25/67) vs.41.7％ (30/72),P =0.047].The two groups showed no significant difference in the incidence of intracranial infection after external ventricular drainage (P =0.235).Conclusion For patients with spontaneous intraventricular hemorrhage-induced brain dysfunction,enteral nutrition support with enteral nutrition suspension could effectively improve nutritional status,reduce complications,therefore conducive to recovery.
ABSTRACT
Moyamoya disease may cause subarachnoid hemorrhage because of its feature of spontaneous occlusion of the circle of Willis with vascular network abnormal hyperplasia on the base of the brain.This article reviews the disease characteristics of moyamoya disease-related subarachnoid hemorrhage,the correlations between bleeding mechanisms,disease progression and bleeding,as well as its therapeutic measures.
ABSTRACT
Objective To screen and identify protein interacted with enterovirus 71 (EV71)3A protein by means of T7-phage display system.Methods The prokaryotic expression vector of 3A protein was constructed for expressing and purifying 3A pro-tein.With 3A protein as the target protein,the T7-phage display system was adopted to screen the human hepatocyte cDNA library. The screened products were performed the DNA sequence analysis and the homologous research.Results 3A protein was expressed and purified,after 4 rounds of biopanning,37 positive clones were selected.The inserted fragments were amplified by PCR using specific T7 primer.The products were sequenced,2 proteins were identified to interact with 3A protein by homologous analysis. Conclusion Trough the T7 phage display system,two proteins interacted with 3A are obtained.The possible function of 3A protein can be speculated by researching the function of these two proteins,which lays the foundation for the further studying the pathogen-ic mechanism of EV71.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the cause and the management of treatment and prevention of reoperation following esophagectomy.</p><p><b>METHODS</b>Clinical data of 946 cases with esophageal cancer undergoing esophagectomy from January 2000 to December 2012 by the same surgical team in the Beijing Cancer Hospital were retrospectively analyzed. Among them, 19 patients underwent reoperation after esophagectomy because of serious complications. Clinical features and treatment course of these 19 cases were summarized.</p><p><b>RESULTS</b>The indications and procedures of reoperation included thoracotomy for hemorrhage (n=4), diaphragmatic hernia repair (n=4), thoracic duct ligation for chylothorax (n= 4), re-suturing for incision dehiscence (n=4), re-laparotomy and re-thoracotomy for drainage of traumatic pancreatitis (n=1), re-laparotomy for intestinal obstruction (n=1), and tracheotomy for bilateral recurrent laryngeal nerve paralysis (n=1). All the 19 patients were successfully cured without perioperative deaths and further complications.</p><p><b>CONCLUSIONS</b>The indications of reoperation following esophagectomy include postoperative bleeding, diaphragmatic hernia, chylothorax and abdominal incision dehiscence.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Esophageal Neoplasms , General Surgery , Postoperative Complications , Reoperation , Retrospective StudiesABSTRACT
Objective To investigate efficacy and effect on liver function of the experimental therapy with balloon catheter to block the main artery temporarily and then pressurize chemoembolization to treat hypovascular liver cancer. Methods Eighty patients with hypovascular liver cancer requiring interventional therapy were randomly divided into two groups.The experimental group was treated with the new therapy and the control group was treated with traditional therapy. The lipiodol-filling status and maximum diameter of the tumor was analyzed for a midterm outcome,and the change of AFP and liver function were evaluated.Mann-Whitney test was used for data between two groups,Friedman test was used for data of each group,and Spearman nonparameter relevant analysis was used for efficacy indexes.Results ( 1 ) All Patients have confirmed diagnosis of hypocvascular liver cancer and got balanced baseline. ( 2 ) Lipiodol-filling status:the clinical efficacy and benefit rates of patients from experimental group were higher than that from control group and showed statistically significant difference in 1,3,12 months (Z =-2.135,- 2.939,- 2.686 ; P =0.034,0.004,0.007 ),but no statistically significant difference in 6 month ( Z =- 1.170,P =0.242 ).The status of lipiodol-filling of experimental group ( x2 =2.593,P =0.459 ) was more stable than control group ( x2 =10.886,P =0.012).(3) Maximum diameter of the tumor:the clinical efficacy and benefit rates of patients from experimental group were higher than that from control group and showed statistically significant difference in 3,12 months ( Z =- 2.734,- 2.733 ; P =0.006,0.006),but no statistically significant difference in 1,6 month ( Z =- 1.692,- 1.895 ;P =0.091,0.058). But neither of two groups showed statistically significant difference in change of maximum diameter of the tumor ( x2 =5.500,P =0.139 ; x2 =6.509,P =0.089 ).Relation between lipiodol-filling and maximum diameter showed positive correlation in 3 month ( r =0.257,P =0.035 ). (4) Stratified analysis was used for data of AFP according to AFP value before therapy,and two groups showed no statistically significant difference for patients belonging to 20-1000 μg/L by Pearson Chi-square test. (5)Two groups showed no statistically significant difference for data of liver function before therapy and in 1,3,6months ( Z =- 1.073,- 1.314,-0.518,-0.549;P=0.308,0.189,0.604,0.583).Conclusions According to the midterm result of this experiment,the experimental therapy increased lipiodol-filling and decreased maximum diameter of the tumor significantly in 3 and 12 months correspondingly,but no significant difference was observed in AFP and liver function between groups yet. So the long-term efficacy and its influence to lung metastasis and survival rate need further research.
ABSTRACT
<p><b>BACKGROUND AND OBJECTIVE</b>Atelectasis is a common complication after thoracotomy, and it may threaten patients' life if it was not treated correctly and properly. The aim of this article is to explore and discuss the prevention and treatment for atelectasis during the perioperative period, and also to explore new methods for reducing the perioperative mortality due to atelectasis after thoracotomy.</p><p><b>METHODS</b>We retrospectively reviewed the medical records of 374 lung cancer patients who underwent thoracotomy in our department between Jan 2007 and Nov 2009.</p><p><b>RESULTS</b>Atelectasis occurred in 14 patients among all the 374 lung cancer patients who underwent thoracotomy. All the atelectasis returned to reexpansion after treatment.</p><p><b>CONCLUSION</b>The incidence of atelectasis in these series is relatively low compared with the reports in literatures. Good perioperative preparation and perioperative treatment can remarkably decrease the incidence and mortality of atelectasis after thoracotomy in the treatment of lung cancer.</p>