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1.
Chinese Journal of Urology ; (12): 830-834, 2022.
Article in Chinese | WPRIM | ID: wpr-993929

ABSTRACT

Objective:To compare the efficacy and safety of retroperitoneal laparoscopic adrenalectomy (RLA) and transperitoneal laparoscopic adrenalectomy (TLA) in the treatment of localized adrenocortical carcinoma (ACC).Methods:The data of 22 patients with stage Ⅰ/Ⅱ ACC underwent laparoscopic adrenalectomy in our institution from January 2009 to December 2018 were retrospectively analyzed. According to the different surgical approaches, these patients were divided into RLA and TLA groups. Eleven patients underwent RLA and 11 patients underwent TLA. There were no significant differences between the RLA group and the TLA group in terms of age at first diagnosis[44 (35, 54) vs. 46(41, 55) years, P= 0.793], sex (male/female: 3/8 vs. 4/7, P = 1.00), secreting tumor ratio (3/11 vs. 4/11, P = 1.00), tumor location (left/right: 6/6 vs. 7/4, P = 1.00), with hypertension or diabetes mellitus (4/11 vs. 3/11, P = 1.00). However, RLA has significantly smaller tumor size [3.0(2.5, 8.4) cm vs. 7.7(5.2, 8.4)cm, P= 0.001], and more stage Ⅰ patients [90.9%(10/11) vs. 18.2%(2/11), P=0.002], compared with those in TLA group. The perioperative indicators and oncology prognosis outcomes were collected and compared between the two groups. The Kaplan-Meier method was performed to calculate the overall survival (OS) and disease-free survival (DFS). Results:Compared with TLA, RLA had shorter operation time[90(70, 100) vs. 110 (90, 120) min, P = 0.005] and postoperative drainage tube removal time [2 (2, 3) vs. 3 (2, 6) day, P = 0.002), and the difference was statistically significant. In the TLA group, one patient was converted to open operation due to intraoperative tumor capsule rupture. For postoperative complications, one patient in the TLA group suffered with wound infection. There were no perioperative deaths in either group. All postoperative pathological examinations confirmed ACC, and there was no significant difference in Ki-67 index between the two groups [10%(3%, 35%) vs. 10%(9%, 25%), P = 0.484]. The median follow-up was similar in the two groups [48(26, 98) vs. 31(18, 49) months, P=0.237]. The local recurrence and metastasis rates were 36.4% for RLA group and 63.6% for TLA group ( P = 0.395). Survival analysis showed no statistically significant difference in DFS [5-year DFS rate: 33.6% vs. 73.2%, P = 0.118] between the two groups. The 5-year OS rates for RLA group versus TLA group were 58.3% vs. 45.5% ( P=0.485). Conclusions:For localized (stage Ⅰ/Ⅱ) ACC, both RLA and TLA seem safe and feasible, based on the similar long-term oncological prognosis. However, compared with TLA, RLA has the advantage of shorter operation time and postoperative drainage tube removal time. Due to the small number of cases included in this study, further multi-center, large-sample studies are required to demonstrate clear benefit of one surgical approach in the future.

2.
Article in Chinese | WPRIM | ID: wpr-787734

ABSTRACT

The aim of this study was to explore the clinical features, hearing prognosis and differential diagnosis of recurrent low frequency sensorineural hearing loss (RLFD) . The clinical characteristics, clinical manifestations, audiological examination and auxiliary examination of RLFD patients were retrospectively analyzed. We summarized clinical features, draw the pure tone audiometry curves, and analyze the diagnosis of RLFD. Forty-seven patients (53 ears) with RLFD had a hearing review time of 1-124 months. The course of disease ranged from 3 to 320 months with an average course of 29 months. ①The incidence of tinnitus in the accompanying symptoms was 93.6%(44 cases), and the ear suffocation was 83.0%(39 cases), 38.3% (18 cases) of the patients developed vestibular symptoms during the course of the disease. ②During the observation period, 27 cases(57.4%) were diagnosed with related diseases: 7 cases(14.9%) Meniere's disease, 6 cases(12.8%) vestibular migraine, 2 cases(4.3%) with Meniere's disease and migraine, and 1 case(2.1%) with idiopathic intracranial hypotension 11 cases(23.4%) were possible cochlear migraine; ③Migraine-related RLFD had a younger onset age, more common in women; ④83.0%(44 ears)of the affected ears had stable or improved low-frequency hearing during the observation period, 17.0%(9 ears)of the affected ears experienced low-frequency hearing; ⑤18.9%(10 ears)of the affected ears had high-frequency hearing loss; ⑥RLFD had 6 types of audiological outcomes: low-frequency improvement combined with high-frequency stability; low-frequency stability combined with high-frequency stability; low frequency progress combined with high frequency stability type; low frequency improvement combined with high frequency progress type; low frequency stability combined with high frequency progress type; low frequency progress combined with high frequency progress type; ⑦Rising type hearing curve low frequency hearing prognosis is good, mountain type and descending low frequency hearing prognosis is poor. Tinnitus and ear stuffiness are the early symptoms and the most disturbing symptoms in patients with RLFD. The mechanism of Migraine may play an important role in the pathogenesis of RLFD. The rare causes such as intracranial hypotension syndrome should not be ignored. Most of the patients with RLFD had stable or improved hearing after long-term fluctuation, but some patients with low or high frequency hearing might decline. The type of initial hearing curve was a prognostic factor. Long-term hearing follow-up is helpful for prognosis evaluation.

3.
Article in Chinese | WPRIM | ID: wpr-821516

ABSTRACT

Objective@#The aim of this study was to explore the clinical features, hearing prognosis and differential diagnosis of recurrent low frequency sensorineural hearing loss (RLFD) . @*Method@#The clinical characteristics, clinical manifestations, audiological examination and auxiliary examination of RLFD patients were retrospectively analyzed. We summarized clinical features, draw the pure tone audiometry curves, and analyze the diagnosis of RLFD. @*Result@#Forty-seven patients (53 ears) with RLFD had a hearing review time of 1-124 months. The course of disease ranged from 3 to 320 months with an average course of 29 months. ①The incidence of tinnitus in the accompanying symptoms was 93.6%(44 cases), and the ear suffocation was 83.0%(39 cases), 38.3% (18 cases) of the patients developed vestibular symptoms during the course of the disease. ②During the observation period, 27 cases(57.4%) were diagnosed with related diseases: 7 cases(14.9%) Meniere's disease, 6 cases(12.8%) vestibular migraine, 2 cases(4.3%) with Meniere's disease and migraine, and 1 case(2.1%) with idiopathic intracranial hypotension 11 cases(23.4%) were possible cochlear migraine; ③Migraine-related RLFD had a younger onset age, more common in women; ④83.0%(44 ears)of the affected ears had stable or improved low-frequency hearing during the observation period, 17.0%(9 ears)of the affected ears experienced low-frequency hearing; ⑤18.9%(10 ears)of the affected ears had high-frequency hearing loss; ⑥RLFD had 6 types of audiological outcomes: low-frequency improvement combined with high-frequency stability; low-frequency stability combined with high-frequency stability; low frequency progress combined with high frequency stability type; low frequency improvement combined with high frequency progress type; low frequency stability combined with high frequency progress type; low frequency progress combined with high frequency progress type; ⑦Rising type hearing curve low frequency hearing prognosis is good, mountain type and descending low frequency hearing prognosis is poor. @*Conclusion@#Tinnitus and ear stuffiness are the early symptoms and the most disturbing symptoms in patients with RLFD. The mechanism of Migraine may play an important role in the pathogenesis of RLFD. The rare causes such as intracranial hypotension syndrome should not be ignored. Most of the patients with RLFD had stable or improved hearing after long-term fluctuation, but some patients with low or high frequency hearing might decline. The type of initial hearing curve was a prognostic factor. Long-term hearing follow-up is helpful for prognosis evaluation.

4.
Chinese Journal of Urology ; (12): 257-261, 2019.
Article in Chinese | WPRIM | ID: wpr-745580

ABSTRACT

Objective To investigate the effects of preoperative 8 am plasma total cortisol level (PTC) on the prognosis of adrenocortical carcinoma (ACC).Methods A total of 44 patients from January 2009 to October 2017 with ACC were included,PTC level within one week before surgery,clinical and pathological data were collected.The mean age of the patients was (45.2 ± 15.2) years.There were 27 females and 17 males.The mean tumor diameter was (63.6 ± 20.7) mm.There were 20 cases with functional ACC,in which 18 patients presented symptoms associated with Cushing syndrome.According to ENSAT stage,9 patients were staged as stage Ⅰ,and 35 were staged as stage Ⅱ.The median pre-operative 8 am PTC was 572.6 nmol/L,range from 89.3 to 1 118.7 nmol/L.Open adrenalectomy was employed in 23 patients and laparoscopic approach in 21 patients.The optimal cut-off value of pre-operative PTC was determined by receiver operating characteristic curve (ROC) and patients were divided into two groups with high PTC and low PTC values.Kaplan-Meier method was used to draw the survival curve,univariate and multivariate Cox regression were used to explore factors influencing the prognosis of ACC patients.Results The median follow-up duration was 42 months,range from 3-104 months.The optimal cut-off value was determined as 476.2 nmol/L,baseline and clinic-pathologic characteristics differences between two groups were not statistical significant (P > 0.05).The overall survival (OS) in the high PTC group was shorter than that in the low PTC group [median 18months (20-104 months) vs.40 months (5-98 months),P =0.014],and the recurrence free survival (RFS) of patients in the high PTC group was also shorter than that in the low PTC [median 26 months (0-104 months) vs.50 months (5-98 months),P =0.028).In univariate analysis,age,gender,tumor stage,preoperative PTC,and symptoms were correlated with postoperative OS and RFS (P < 0.05).After adjusting for age,gender,tumor stage,symptoms,multivariate Cox regression showed that pre-operative high PTC was an independent prognostic factor associated with a decreased OS (HR =2.086,95 % CI 1.495-2.287,P =0.014) and decreased RFS (HR =2.234,95% CI 1.546-2.334,P =0.045).Conclusion The preoperative morning PTC is an independent risk factor for the prognosis of ACC.

5.
Article in Chinese | WPRIM | ID: wpr-754986

ABSTRACT

Objective To evaluate the difference of set-up errors between thermoplastic mask and breast bracket in patients receiving intensity-modulated radiotherapy after breast conserving surgery,and the impact of clinical factors associated with set-up errors.Methods A total of 34 patients treated with intensity-modulated radiotherapy after breast conserving surgery from January 2016 to June 2018 were reviewed.Eighteen patients were fixed with thermoplastic mask,and sixteen were with breast bracket.Weekly CBCT scan records were used to analyze set-up errors,and group systematic and random errors were computed.The influence of clinical factors on set-up errors was also analyzed.Results The immobilization technique with thermoplastic mask showed great superior in comparison with breast bracket;however,only in the Ty(translation) and Ry(rotation),the differences had significance.Based on group systematic and random errors,PTV margins in Tx,Ty and Tzwere 2.65,4.36 and 2.87 mm in thermoplastic mask group,as well as 5.71,6.07 and 4.20 mm in breast bracket group,respectively.Multi-factor regression analysis showed that BMI was independent factors affecting set-up errors.Conclusions Compared with breast bracket,the immobilization technique with thermoplastic mask has the potential of reducing set-up errors and PTV margins in patients receiving intensity-modulated radiotherapy after breast conserving surgery,especially in patients with high BMI.

6.
Article in Chinese | WPRIM | ID: wpr-708330

ABSTRACT

Microwave radiation plays an important role in the diagnosis and treatment of malignant tumors. Whether microwave radiation can improve the effect of chemotherapy on intracranial carcinoma through improving the permeability of blood brain barrier is a hot topic at present. Blood-brain barrier permeability can be increased by microwave radiation though thermal effect and non thermal effect,and the mechanism may be related to the regulation of vascular endothelial growth factor,Occludin,aquaporin 4 and adhesion molecule-1.However, there are still questions on the physical parameters, include temperature, microwave frequency,specific absorption rate and exposure time.

7.
Chinese Journal of Epidemiology ; (12): 1272-1276, 2016.
Article in Chinese | WPRIM | ID: wpr-736090

ABSTRACT

Objective To investigate the prevalence of the loss of basic activities of daily living (ADL) and instrumental ADL (IADL) influencing factors in the elderly population in China and provide evidence for the effective keeping and improvement of the elderly daily living.Methods The information about demographic characteristics and activities of daily living of elderly Chinese aged ≥ 60 years were collected by using the data of 2013 China Health and Retirement Longitudinal Study.The elderly's ADL of taking bath,eating,getting in and out of bed,dressing,toilet use,and defecating and the IADL of doing housework,cooking,making phone call,taking medicine,shopping and money managing were evaluated.The differences in loss of ADL among different populations were compared by x2 test and logistic regression analysis was conducted to identify influencing factors for the loss of ADL and IADL.Results The overall ADL loss rate was 23.8% and the overall IADL loss rate was 35.4% in elderly Chinese.The proportion of having trouble in toilet use was highest among all ADL items,followed by bathing and getting in and out of bed.The proportion of having trouble in making phone call was highest among all IADL items,followed by doing housework and money managing.Female,older age,low educational level,living in central and western China,chronic diseases and disability were factors associated with ADL loss and IADL loss;the divorced or separated,widowed were more likely to have ADL loss;people living in rural area were more likely to have IADL loss.Conclusion It is necessary to take comprehensive measures to delay and reduce the ADL and IADL loss in elderly Chinese and provide timely and appropriate health care for the elderly with ADL or IADL loss.

8.
Chinese Journal of Epidemiology ; (12): 1272-1276, 2016.
Article in Chinese | WPRIM | ID: wpr-737558

ABSTRACT

Objective To investigate the prevalence of the loss of basic activities of daily living (ADL) and instrumental ADL (IADL) influencing factors in the elderly population in China and provide evidence for the effective keeping and improvement of the elderly daily living.Methods The information about demographic characteristics and activities of daily living of elderly Chinese aged ≥ 60 years were collected by using the data of 2013 China Health and Retirement Longitudinal Study.The elderly's ADL of taking bath,eating,getting in and out of bed,dressing,toilet use,and defecating and the IADL of doing housework,cooking,making phone call,taking medicine,shopping and money managing were evaluated.The differences in loss of ADL among different populations were compared by x2 test and logistic regression analysis was conducted to identify influencing factors for the loss of ADL and IADL.Results The overall ADL loss rate was 23.8% and the overall IADL loss rate was 35.4% in elderly Chinese.The proportion of having trouble in toilet use was highest among all ADL items,followed by bathing and getting in and out of bed.The proportion of having trouble in making phone call was highest among all IADL items,followed by doing housework and money managing.Female,older age,low educational level,living in central and western China,chronic diseases and disability were factors associated with ADL loss and IADL loss;the divorced or separated,widowed were more likely to have ADL loss;people living in rural area were more likely to have IADL loss.Conclusion It is necessary to take comprehensive measures to delay and reduce the ADL and IADL loss in elderly Chinese and provide timely and appropriate health care for the elderly with ADL or IADL loss.

9.
Article in Chinese | WPRIM | ID: wpr-485155

ABSTRACT

Lung cancer is the main cause of cancer-related death worldwide. Non-small cell lung cancer (NSCLC) accounts for about 80% of lung cancer cases, but only 25%-30% of initially diagnosed patients have the option of radical surgery because of the lack of effective measures for early diagnosis. For locally advanced and advanced NSCLC, radiotherapy alone or comprehensive treatment with chemoradiotherapy is the main treatment method; however, the curative effect is unsatisfactory. Recently, increasing evidence sug-gests that targeted drugs, such as epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), combined with radiotherapy/chemoradiotherapy represent a promising treatment modality for NSCLC. This review will discuss the research status of EGFR-TKIs and radiotherapy for locally advanced and advanced NSCLC.

10.
Chinese Journal of Dermatology ; (12): 727-729, 2015.
Article in Chinese | WPRIM | ID: wpr-479913

ABSTRACT

Objective To better characterize the clinical and histopathological manifestations, diagnosis and differential diagnosis of epithelioid sarcoma (ES).Methods Clinical data were collected from nine patients with ES diagnosed and treated at the Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College from 2000 to 2014.The clinical and histopathological manifestations, immunophenotype, treatment and prognosis of ES were reviewed retrospectively.Results The median age at onset of ES was 34.5 years in these patients, and the average disease duration was 8.3 years.Lesions began on the extremities in 8 patients, and manifested as nodules,ulceration and lymphedema.Histopathological examination showed that tumor cells mainly consisted of spindle cells and epithelioid cells, some of which were in a palisade arrangement with central necrosis.Cytokeratin, epithelial membrane antigen (EMA) and vimentin were coexpressed by tumor cells.Recurrence was observed at the original site in 6 patients after lesion resection, and pulmonary metastasis occurred in 4 patients.Five patients were followed up and two of them died of pulmonary metastasis.Conclusions Local recurrence is frequent in patients with ES after lesion removal.Lymph node and pulmonary metastases of ES are common, and pulmonary metastasis is usually associated with a poor prognosis.

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