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Background:With the advancement of endoscopic techniques,the detection rate of duodenal lesions has increased,and the selection and curative effect of endoscopic resection of duodenal lesions need to be further explored.Aims:To evaluate the safety and efficacy of endoscopic treatment of duodenal tumors.Methods:A retrospective analysis was conducted on 32 patients with duodenal tumors treated with endoscopic resection from January 2017 to January 2022 at Taizhou People's Hospital Affiliated to Nanjing Medical University.The location,depth,treatment method,postoperative pathology,and complications of duodenal tumors were summarized.Results:Among the 32 patients,there were 21 males and 11 females.Two patients presented with melena,10 patients had abdominal pain,and 20 patients were asymptomatic.Twenty-eight tumors were located in descending part of duodenum,and 4 were located in duodenal bulb.One patient underwent endoscopic submucosal excavation,2 underwent cold snare polypectomy,12 underwent endoscopic submucosal dissection,and 17 underwent endoscopic mucosal resection.All lesions were completely resected.Among the 32 lesions,there were 21 tubular adenoma or tubulovillous adenoma,7 Brunner's gland adenoma,2 lipoma,1 neuroendocrine tumor,and 1 stromal tumor.One patient with duodenal tubulovillous adenoma had perforation during operation and was transferred to surgery for repair.The other patients did not have complications such as perforation and bleeding during operation.All patients had no recurrence after postoperative endoscopy.Conclusions:Endoscopic treatment for duodenal tumors is safe and effective,and has good clinical value.
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Sacral tumors are surgically challenging and at a high risk of complications. In recent years, robotic-assisted resection has been gradually applied in sacral tumors, but it is difficult to remove bone tissue by present robotic instruments, which limits the application of surgical robot in sacral tumor. The present study aimed to explore the application range and therapeutic effect of minimally invasive ultrasonic osteotome in robotic-assisted sacral tumor resection. Eighteen patients underwent robotic-assisted sacral tumor resection in the First Affiliated Hospital of Sun Yat-Sen University from May 2015 to March 2021 by the Da Vinci robotic surgical system. Among them three patients who underwent osteotomy with minimally invasive ultrasonic osteotome were enrolled. There were 2 males and 1 female, aged 24, 32, 71 years, respectively. The tumors included 2 schwannomas and 1 ganglioneuroma. The operation time, bleeding volume and postoperative hospitalization days were recorded. The recurrence and complications were evaluated during follow-up. The operative time of the 3 patients was 80, 240 and 300 minutes, and the intraoperative bleeding volume was 30, 30 and 100 ml. Complete resection was performed in 2 cases and intralesional resection in 1 case. The postoperative hospital stay was 5, 3 and 7 days respectively. The follow-up time was 58, 17 and 31 months respectively. No tumor recurrence was found during the follow-up. As regards complications, only one patient had left foot pain after operation, and there were no other intraoperative or postoperative complications. The therapeutic advantages of ultrasonic osteotome combined with the Da Vinci robotic surgical system can achieve precise osteotomy, reduce intraoperative bleeding and accelerate postoperative recovery for certain patients with sacral tumors.
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Objective:To analyze the clinical and laboratory characteristics of acute myeloid leukemia (AML) patients with NPM1 mutation, and to explore the prognostic factors.Methods:A total of 77 AML patients with NPM1 gene mutation admitted to Hebei Yanda Ludaopei Hospital from May 1st 2012 to December 31st 2021 were enrolled in the study, including 34 male and 43 female patients. The median age was 40 (3, 68) years old. Patients were selected and divided into 4 groups according to the morphological FAB classification. There were 29 cases (37.7%) of M1 type, 13 cases (16.9%) of M2 type, 23 cases (29.9%) of M4 type, and 12 cases (15.5%) of M5 type. The clinical characteristics, bone marrow/peripheral blood cell morphology, immunophenotype, cytogenetics, molecular biology and overall survival of different groups were retrospectively analyzed, and the risk factors affecting the prognosis of AML were also explored. Cox multivariate regression was used to analyze the clinical influencing factors of survival and prognosis.Results:The white blood cell counts were highest in M4 and M5 patients and lowest in M2 patients, while no significant difference in the red blood cell, hemoglobin, and platelet counts( P>0.05). Morphologically, there were significant differences in the percentage of blasts and blasts with cup-like nuclei on bone marrow (BM) and peripheral blood (PB). The proportion of blasts in BM and PB was the highest in M1 and the lowest in M2 ( P<0.001). The positive rate of blasts with cup-like nuclei was the highest in M1 and the lowest in M5 of BM ( P<0.001), while the highest in M2 and the lowest in M5 of PB ( P=0.006). The scores of myeloperoxidase and chloroacetate esterase were all the highest in M1 and the lowest in M5 ( P<0.001, 0.001, respectively). In terms of molecular biology, the occurence rate of blasts combined with DNMT3A mutation was the highest in M4 and the lowest in M2 ( P=0.044), while those combined with FLT3-ITD mutation was the highest in M4 and the lowest in M5 ( P=0.002). In immunophenotype, there were significant differences in the expression positivities of seven antigens including HLA-DR, CD56, CD11c, CD15, CD14, CD96 and cMPO ( P<0.05). Multivariate COX regression analysis showed that no recurrence after treatment ( P<0.001), complete remission after treatment ( P=0.015) and transplantation ( P<0.001) were correlated with overall survival (OS). No recurrence after treatment ( P=0.033), transplantation ( P=0.027), no mutation of FLT3-ITD ( P=0.040), and hemoglobin concentration ( P=0.023) were associated with relapse-free survival (RFS). Survival analysis by Kaplan-Meier curve showed that there was no significant difference in survival time between the M1, M2, M4 and M5 groups in OS and RFS. Conclusion:There were significant differences in the white blood count, the percentage of blasts and blasts with cup-like nuclear morphology, cytochemical staining (MPO integration, CE integration and percentage of NAS-DCE), gene mutation (DNMT3A and FLT3-ITD) and immunophenotypes (HLA-DR, CD56, CD11c, CD15, CD14, CD96 and cMPO) between the four groups. The multivariate analysis revealed that no recurrence after treatment and transplantation were independent prognostic factors in NPM1 mut AML patients. On the other hand, FLT3-ITD mutation and hemoglobin concentration were associated with RFS and complete remission after treatment was associated with OS in the entire NPM1 mut cohort.
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Background: The revised Atlanta classification (RAC) and determinant-based classification (DBC) are widely used in assessing the severity of acute pancreatitis (AP). However, studies on comparison between RAC and DBC are scarce. Aims: To explore the accuracy of RAC and DBC in the assessment of AP severity. Methods: The clinical data of 481 AP patients from September 2015 to September 2019 at Taizhou People's Hospital were collected and severity were stratified according to RAC and DBC. The treatment and prognosis of each subgroup were compared. Results: On the basis of RAC, 269 (55.9%), 174 (36.2%) and 38 (7.9%) patients were classified as mild AP (MAP), moderate severe AP (MSAP) and severe AP (SAP), respectively. There were significant differences in mortality, ICU monitoring rate, ICU stay, operation rate and hospital stay among the above groups (P<0.05). On the basis of DBC, 319 (66.3%), 117 (24.3%), 34 (7.1%) and 11 (2.3%) patients were classified as MAP, MSAP, SAP and critical AP (CAP), respectively. There were significant differences in mortality, ICU monitoring rate, ICU stay, operation rate and hospital stay among the above groups (P<0.05). The ICU monitoring rate (100% vs. 63.2%, P=0.014), median ICU stay (35 days vs. 15 days, P=0.001), hospital stay [(50.36±21.54) days vs. (22.78±14.56) days, P=0.038] were significantly increased in CAP patients (classified by DBC) than those in SAP patients (classified by RAC), however, no significant differences in mortality and operation rate were found between the two groups (P=0.136; P=0.202). Conclusions: Both RAC and DBC can accurately stratify the severity of AP. SAP patients (classified by RAC) complicated with infected necrosis should be further classified into CAP.
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Objective To evaluate the effect and safety of stone extraction via endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) in elderly cases over 90 years old with gallstones in common bile duct (CBD). Methods Retrospective clinical data analysis was performed in 37 elderly cases treated by endoscopic stone extraction via ERC and EST.Results The gallstones of 30 cases were successfully extracted with only one trying. The multiple stones of another 4 cases were not totally extracted, they underwent endoscopic naso-biliary drainage (ENBD) for 5 days, and then the stones were successfully extracted. The successful rate of stone extraction was 91.9% (34/37). Giant stones in 2 cases were minimized and extracted 6 months later with help of endoscopic retrograde biliary drainage (ERBD). In one case stone extraction failed,because of huge diverticulum. Bleeding complication during operation was observed in one case (2.7%). Duodenal perforation and acute pancreatitis were not documented in this group.Conclusions EST and ERBD are minor invasive, effective, safe and practical for stones extraction in elderly patients over 90 years old with gallstones in CBD.
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Objective To evaluate the role of Lugol’s s taining in detecting early esophageal cancer.Methods 2% Lugol’s solution was adopted to stain esophageal m ucosa in 111 cases with esophageal superficial lesions. And multiple biopsies we re taken for pathological study.Results Among the 111 cases with Lugol’s staining, the results in normal, light, deep and non-stained were 4, 68,11 and 28 cases respectively . Pathology result: no cases of esophageal cancer or cell dysplasia in normal an d deep stained groups, 3 cases of severe dysplasia and 1 case of canceration in light stained group, 17 cases of esophageal squamous cell carcinoma and 5 cases of severe dysplasia in un-stained group.Conclusion The cancerous and precancerous lesions are liable to occur in cases with non- and light Lugol’s staining groups. The rate of detec ting early esophageal cancer increased when Lugol’s staining and biopsy are use d in combination.