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Objective:To evaluate the efficacy and prognostic factors of 125I seeds implantation for primary hepatocellular carcinoma. Methods:From December 2011 to January 2021, 102 primary hepatocellular carcinoma patients (86 males, 16 females; median age 61 years) who underwent 125I seeds implantation from 5 hospitals in China were enrolled in this retrospective study. Local progression-free survival (LPFS), overall survival (OS) and the prognostic factors were analyzed. Kaplan-Meier method was used to draw the distribution curve of survival time, and LPFS rate and OS rate were calculated. Log-rank test and Cox regression were used to analyze the influencing factors of survival. Results:The median follow-up time was 38 months until April 2021. The local control rate was 96.1%(98/102). The 1-, 3- and 5-year LPFS rate were 61.3%, 25.5% and 12.7%, and the 1-, 3- and 5-year OS rate were 73.9%, 39.1% and 22.6%, respectively. There were 75 patients with progressive disease, including 42 patients with intrahepatic recurrence and metastasis after seed implantation, and 55 patients died. Multivariate analyses showed that short-term efficacy complete response (CR) (hazard ratio ( HR)=0.34, 95% CI: 0.20-0.58) was protective factor related to LPFS; short-term efficacy CR ( HR=0.25, 95% CI: 0.13-0.47) was the protective factors related to OS; Barcelona clinic liver cancer (BCLC) C stage ( HR=2.33, 95% CI: 1.27-4.27), intrahepatic progression and extrahepatic metastasis ( HR=3.18, 95% CI: 1.28-7.86; HR=3.23, 95% CI: 1.27-8.21) were independent risk factors related to OS. No sever adverse effects were observed. Conclusions:125I seeds implantation is safe and effective for the treatment of primary hepatocellular carcinoma. BCLC stage, short-term efficacy and post-implantation progression are independent factors related to survival time.
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Objective:To analyze the risk factors of first-episode hematogenous metastasis in patients with thoracic esophageal squamous cell carcinoma (ESCC) who received non-surgical treatment after radiotherapy and chemotherapy, and its impact on survival and prognosis.Methods:The clinical data of 230 ESCC patients who met the inclusion criteria and received radical radiotherapy in Tengzhou Central People′s Hospital and Affiliated Hospital of Xuzhou Medical University from January 2011 to October 2018 were retrospectively analyzed.Logistic regression analysis and survival were used to analyze the risk factors and prognosis of blood group metastasis after treatment.Results:In 230 patients with thoracic esophageal cancer, 70 cases (30.4%) developed hematogenous metastasis for the first time.Compared with patients without hematogenous metastasis, the median overall survival was 15 months and 20 months (χ 2=7.249, P=0.007), and the median progression free survival was 9 months and 13 months (95% CI was 7.2-10.8 months and 10.8-15.2 months, respectively χ 2=21.664, P<0.001). Logistic multivariate analysis showed that there was significant difference in the occurrence of hematogenous metastasis among different N stages (χ 2=30.764, P<0.001). N stage was an independent factor for judging hematogenous metastasis, and the increased N stage increased the risk of hematogenous metastasis (OR value were 6.000, 12.629 and 48.167, respectively; 95% CI were 1.712-21.025, 3.546-44.976 and 10.848-213.858, respectively; all P<0.05). The overall survival time of patients with concurrent chemoradiotherapy before hematogenous metastasis was longer than that of patients with sequential chemoradiotherapy and radiotherapy alone (χ 2=10.002, P=0.007). Stratified analysis showed that adjuvant chemotherapy after concurrent chemoradiotherapy could prolong the overall survival of patients with N2 and N3 (χ 2=11.025, P=0.001). Conclusion:N staging is an independent factor to judge the hematogenous metastasis.ESCC patients with hematogenous metastasis after chemoradiotherapy have poor prognosis.N2, N3 patients with concurrent chemoradiotherapy after adjuvant chemotherapy have clinical benefits.
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Objective@#To evaluate the prognostic factors of T1-2N0M0 esophageal squamous cell carcinoma (ESCC) treated with definitive radiotherapy.@*Methods@#The clinical data of 196 patients with T1-2N0M0 ESCC who were treated with definitive radiotherapy in 10 hospitals were retrospectively analyzed. All sites were members of Jing-Jin-Ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group (3JECROG). Radiochemotherapy were applied to 78 patients, while the other 118 patients received radiotherapy only. 96 patients were treated with three-dimensional conformal radiotherapy (3DCRT) and 100 treated with intensity-modulated radiotherapy (IMRT). The median dose of plan target volume(PTV) and gross target volume(GTV) were both 60 Gy. The median follow-up time was 59.2 months. Log rank test and Cox regression analysis were used for univariat and multivariate analysis, respectively.@*Results@#The percentage of normal lung receiving at least 20 Gy (V20) was (18.65±7.20)%, with average dose of (10.81±42.05) Gy. The percentage of normal heart receiving at least 30 Gy (V30) was (14.21±12.28)%. The maximum dose of exposure in spinal cord was (39.65±8.13) Gy. The incidence of radiation pneumonia and radiation esophagitis were 14.80%(29/196) and 65.82%(129/196), respectively. The adverse events were mostly grade 1-2, without grade 4 toxicity. Median overall survival (OS) and progression-free survival (PFS) were 70.1 months and 62.3 months, respectively. The 1-, 3- and 5-year OS rates of all patients were 75.1%、57.4% and 53.2%, respectively. The 1-, 3- and 5-year PFS rates were 75.1%、57.4% and 53.2%, respectively. Multivariate analysis demonstrated that patients′age (HR=1.023, P=0.038) and tumor diameter (HR=1.243, P=0.028)were the independent prognostic factors for OS, while tumor volume were the independent prognostic factor for PFS.@*Conclusions@#Definitive radiotherapy is a promising therapeutic method in patients with T1-2N0M0 ESCC. Patients′ age, tumor diameter and tumor volume may impact patients′ prognosis.
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Objective:To evaluate the effect of definitive radiotherapy with different doses on overall survival (OS) and identify the prognostic factors of patients with non-metastatic esophageal squamous cell carcinoma (ESCC).Methods:Clinical data of 2 344 ESCC patients treated with definitive radiotherapy (RT) alone or chemoradiotherapy from 2002 to 2016 in 10 hospitals were collected and analyzed retrospectively. After the propensity score matching (PSM)(1 to 2 ratio), all patients were divided into the low-dose group (equivalent dose in 2 Gy fractions, EQD 2Gy<60 Gy; n=303) and high-dose group (EQD 2Gy≥60 Gy; n=606) based on the dose of radiation. Survival analysis was conducted by Kaplan- Meier method. Multivariate prognostic analysis was performed by Cox′s regression model. Results:The median follow-up time was 59.6 months. After the PSM, the 1-, 3- and 5-year overall survival (OS) rate was 66.5%, 34.7%, 27.2% in the low-dose group, 72.9%, 41.7% and 34.7% in the high-dose group, respectively ( P=0.018). The 1-, 3-and 5-year progression-free survival rate was 52.2%, 27.2%, 23.1% in the low-dose group, 58.3%, 38.1% and 33.9% in the high-dose group, respectively ( P=0.001). The outcomes of univariate analysis indicated that cervical/upper esophagus location, early (stage Ⅱ) AJCC clinical stage, node negative status, tumor length ≤5 cm, receiving intensity-modulated radiation therapy (IMRT), receiving concurrent chemotherapy and EQD 2Gy≥60 Gy were closely associated with better OS (all P<0.05). Multivariable analysis demonstrated that tumor location, regional lymph node metastasis, concurrent chemotherapy and EQD 2Gy were the independent prognostic factors for OS (all P<0.05). Conclusion:Three-dimensional conformal or IMRT with EQD 2Gy≥60 Gy yields favorable survival outcomes for patients with locally advanced ESCC.
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Objective:To explore the effect of magnetic resonance imaging (MRI) examination in evaluating the severity of liver fibrosis in schistosomiasis.Methods:A prospective study was carried out to select 50 patients with chronic schistosomiasis admitted to the First People's Hospital of Huzhou City from December 2016 to December 2019 as the observation group, and 35 healthy physical examination subjects during the same period as the control group. All subjects underwent 1.5T MRI scan and diffusion-weighted imaging, and the diffusion sensitivity coefficient (b value) was set to 600 s/mm 2. Using liver biopsy as the gold standard, the degree of liver fibrosis stage was determined. The correlation between apparent diffusion coefficient (ADC), exponential apparent diffusion coefficient (eADC) of diffusion-weighted imaging and liver fibrosis stage was analyzed. And receiver operating characteristic curve (ROC curve) was drawn to evaluate the diagnostic value of ADC and eADC in liver fibrosis of schistosomiasis. Results:Among the 50 patients with chronic schistosomiasis, the MRI scan showed that 39 patients presented with liver lobe proportion imbalance, widened liver fissure, atrophy of right lobe of liver, obvious enlargement of the left outer lobe and caudate lobe of liver; hyperfibrosis and hyperplasia around portal vein leaded to thickening of portal vein wall and appearance of fiber cuff sign; both T1WI and T2WI showed low signals but were not sensitive to late calcification; and there was no obvious change of liver lobe contour and proportion imbalance in other 11 patients. Among them, 7 cases were complicated with liver cancer, and 44 cases were complicated with cholecystolithiasis and cholecystitis. The MRI diffusion-weighted imaging showed that there were statistically significant differences in ADC [(1.17 ± 0.08) × 10 -3, (1.38 ± 0.13) × 10 -3 mm 2/s] and eADC value [(0.51 ± 0.07) × 10 -3, (0.40 ± 0.06) × 10 -3 mm 2/s] between the observation group and the control group ( t = 8.497, 7.762, P < 0.05); and the differences in ADC and eADC values of patients in different liver fibrosis stages in the observation group were statistically significant ( F = 21.526, 23.814, P < 0.05). Correlation analysis results showed that chronic schistosomiasis liver fibrosis was negatively correlated with ADC value ( r = - 0.236, P < 0.05), and positively correlated with eADC value ( r = 0.484, P < 0.05). The ADC value for diagnosing of schistosomiasis liver fibrosis with area under ROC curve (AUC) was 0.826, the 95% confidence interval ( CI) was 0.785 - 0.953, the diagnostic specificity was 89.25%, and the sensitivity was 79.58%; eADC value for diagnosing schistosomiasis liver fibrosis with AUC was 0.681, the 95% CI was 0.582 - 0.879, the diagnostic specificity was 81.14%, and the sensitivity was 73.81%. The ADC and eADC values diagnosed liver fibrosis in S2 - S4 stages were significantly higher in AUC than those in S0 and S1 stages ( P < 0.05), but there was no significant difference between S1 and S0 stages ( P > 0.05). Conclusions:In MRI examination of patients with chronic schistosomiasis liver fibrosis, ADC values decreases significantly, and eADC values increases significantly; and there is a correlation between chronic schistosomiasis liver fibrosis and ADC and eADC values. The ADC and eADC values have certain diagnostic value for schistosomiasis liver fibrosis.
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Objective To retrospectively analyze the effect of tumor length on the prognosis in stage Ⅱ/Ⅲ esophageal squamous cell carcinoma (ESCC) patients treated with definitive radiotherapy and to evaluate the role of tumor length in clinical stage for non-operative ESCC patients.Methods The data of 2 086 ESCC patients who were treated with definitive radiotherapy from 2002 to 2016 in 10 hospitals (3JECROG) were analyzed.The effect of tumor length on overall survival (OS) was analyzed and stratified analysis of tumor length was done in different stages of ESCC.Results The median OS and median progression-free survival (PFS) time of the whole group were 25.6 months and 18.2 months respectively.The Cox multivariate analysis showed that treatment moda,aga,alinical stage and tumor length were independent prognostic factors.The median,1-,3-,and 5-year OS were 28.9 months,77.3％,45.0％,and 36.3％ versus 21.9 months,69.9％,37.9％,and 28.1％ for patients with ≤ 5 cm and patients ＞ 5 cm respectively (P＜0.05).For stage Ⅱ patienta,abe median OS were 42.1 and 38.9 months respectively in ≤ 5 cm group and＞5 cm group (P=0.303).And for stage Ⅲ patienta,abe median OS were 23.9 and 19.3 months respectively in ≤5 cm group and＞5 cm group (P＜0.001).The median OS with N1was 24.1 and 18.4 montha,aespectively in ≤5 cm group and＞5 cm group (P＜0.001).Conclusions The tumor length was an independent prognostic factor for stage Ⅱ/Ⅲ patients treated definitive radiotherapy.The tumor length may be helpful in clinical staging of ESCa,aspecially for stage Ⅲ and N1.
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Objective To compare the therapeutic effects between three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in patients with stage Ⅱ/Ⅲ esophageal cancer and investigate the prognostic factors.Methods Medical record of 2 132 patients with stage Ⅱ/Ⅲ esophageal cancer who underwent definitive radiotherapy with/without chemotherapy in 10 hospitals from January 2002 to December 2016 from were retrospectively analyzed.Among these patients,37.9％ of them were aged ≥ 70 years,33.9％ with neck and upper esophageal tumors and 66.1％ with middle and lower esophageal and borderline tumors.The median gross tumor volume (GTV) and lymph node gross tumor volume (GTVnd) was 41.6 cm3.Among them,32％ were stage Ⅱ] and 68％ were stage Ⅲ.A total of 723 patients received 3DCRT and 1 409 cases received IMRT.Patients received an equivalent dose in 2 Gy (EQD2) ≥ 60 Gy accounted for 86.1％,and 41.1％ of them received concurrent chemoradiotherapy.Results The median follow-up time was 60.8 months.The 1-,3-and 5-year overall survival (OS) of all patients was 73.9％,41.7％ and 32.6％,and the 1-,3-and 5-year progression-free survival (PFS) was 62.2％,37.3％ and 32％,respectively.Multivariate analysis demonstrated that age,primary tumor location,clinical stage,tumor target volume,EQD2 and concurrent chemoradiotherapy were the independent prognostic factors for OS.Age,primary tumor location,clinical stage,tumor target volume and EQD2 were the independent prognostic factors for PFS.The OS and PFS did not significantly differ among the low-risk,low-/moderate-risk,moderate-/high-risk and high-risk groups according to age≥70 years,tumor diameter＞5 cm,tumor volume ≥41.6 cm3 and stage Ⅲ (P＜0.001).After the propensity score matching (PSM) method,neither 3DCRT nor IMRT yielded significant advantages in OS or PFS (P=0.971;P=0.658).However,IMRT tended to yield survival benefits in low-risk patients (P=0.125).Conclusions Both 3DCRT and IMRT yield relatively high OS rate in patients with stage Ⅱ/Ⅲ esophageal cancer.The prognosis model established in this investigation can properly predict the survival of patients.Low-risk patients tend to obtain survival benefits from IMRT.
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Objective To systematically review the clinical efficacy and safety of early use of recombinant human erythropoietin (rHu-EPO) for neuroprotection in premature infants.Method From establishment of the databases to November 2017,clinical randomized controlled trials (RCTs) of early use of rHu-EPO in premature infants were searched on English databases (PubMed,Embase,Cochrane Collaboration) and Chinese databases (CNKI,SinoMed,Wanfang,and VIP Database).Patients receiving conventional therapy were assigned into control group,and patients receiving both conventional therapy and rHu-EPO were assigned into rHu-EPO group.rHu-EPO group was subdivided into high-dose continuous group and low-dose intermittent group.We retrieved the related literatures,evaluated the quality,and then performed Meta-analysis using RevMan 5.3 software.Result A total of 2 588 patients in 17 studies were included and analyzed.Compared with the control group,Meta-analysis showed that early use of rHu-EPO was more effective in improving NBNA scores at 40 weeks of corrected gestational age (cGA) (MD=2.46,95％CI 1.58～3.33,P＜0.001),and high-dose continuous group was better than low-dose intermittent group (MD=3.19,95％CI 0.45～5.93,P=0.002;MD=2.22,95％CI 1.29～3.16,P＜0.001).Low-dose intermittent use of rHu-EPO significantly increased mental development index (MDI) (MD=6.66,95％CI 0.80～12.51,P=0.010) and psychomotor development index (PDI) (MD=5.77,95％CI 4.00～7.55,P＜0.001),and reduced the incidence of MDI＜70 at cGA 18～22 months (OR=0.42,95％CI 0.27～0.67,P＜0.001).As to the safety and side effects,treatment with rHu-EPO reduced the risk of necrotizing enterocolitis (OR=0.48,95％CI 0.31 ～0.72,P＜0.001) and periventricular leukomalacia (OR=0.52,95％CI 0.35～0.75,P＜0.001)without increasing the risk of bronchial dysplasia,patent ductus arteriosus,retinopathy in prematurity and intraventricular hemorrhage.Conclusion Current evidence shows that the early use of rHu-EPO in premature infants is relatively effective and safe,but multi-center RCTs are still needed.
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Objective To evaluate the survival and prognostic factors of esophageal cancer treated with definitive ( chemo ) radiotherapy by applying novel radiation techniques including three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT). Methods Clinical data of 2762 patients with non-operated esophageal squamous cell carcinoma who underwent definitive ( chemo ) radiotherapy from 2002 to 2016 in 10 hospitals were retrospectively analyzed.The prognostic factors were also identified and analyzed. Results The median follow-up time was 60. 8 months. The 1-, 2-, 3-and 5-year overall survival (OS) of all patients was 71. 4％,48. 9％,39. 3％,and 30. 9％,respectively.The 1-,2-,3-and 5-year progression-free survival (PFS) was 59.5％,41.5％,35.2％,and 30％,respectively.The median survival was 23 months.The median time to progression was 17. 2 months.Multivariate analysis demonstrated that age, primary tumor location, clinical stage, tumor target volume, EQD2 and treatment mode were the independent prognostic factors for OS.Primary tumor location,clinical stage,tumor target volume and EQD2 were the independent prognostic factors for PFS. Conclusions In this first large-scale multi-center retrospective analysis of definitive ( chemo) radiotherapy for esophageal squamous cell carcinoma in China, the 5-year OS of patients with esophageal squamous cell carcinoma is significantly improved by 3DCRT, IMRT combined with chemotherapy drugs. However, the findings remain to be validated by prospective clinical trials with high-level medical evidence.
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Objective To compare the dose distribution of postoperative plans with preoperative plans for 3D printing coplanar template assisted radioactive seed implantation,and to explore the accuracy of the technique in seed implantation.Methods From November 2015 to December 2016 a total of 32 patients were selected and underwent 3D printing coplanar template assisted radioactive seed implantation in Tengzhou Central People's Hospital of Shandong province.There were 36 implanted lesions,including l0 in the lungs,5 in neck lymphs,3 in pelvic cavities,3 in vertebral body,2 in pancreas,2 in abdominal lymph nodes,2 in portal veins,and 9 in the other parts.All patients were given preoperative planning and guided by the coplanar templates.Compared with the preoperative plan,all levels needles inserted at the same time.According to preoperative planning the implantation surgery was completed accurately.The postoperative dosimetry was evaluated.The preoperative and postoperative dosimetry parameters were compared,including Dg0,D100,V90,V100.V150,V200 and conformal index (CI),external index (EI),and homogeneity index(HI).The paired t test was used to perform the statistical analysis.Result There was no significant differences in Dg0,D100,V90,V100,V150,V200,CI,EI and HI between before and after operation(P ＞ 0.05).Conclusions The dose parameters in postplan showed no difference compared with preplan in this study.For fixed and moving organ tumors,3D printing coplanar template assisted radioactive seed implantation has good therapeutic accuracy,and may be a standardized surgicalmethod for seed implantation in the future.
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Objective To evaluate the efficacy and safety of early use of high-dose rHu-EPO in the prevention of anemia in premature infants .Method Available data from clinical randomized controlled trials of early application of high-dose rHu-EPO to prevent premature infant anemia since database building till February 2017 were retrieved, which includes Pubmed, Embase, Cochrane Collaboration and CNKI , SinoMed, Wanfang, VIP.Premature infants less than gestational age of 37 weeks, with routine prevention of anemia as the control group and early combined use of high-dose rHu-EPO≥750 IU/( kg· w) as the treatment group.The relevant data from the literatures obtained were then screened and analyzed by the RevMan 5.3 software.Result A total of 1779 preterm infants from 21 articles including 898 cases of rHu-EPO treatment group and 881 cases in control group.Meta-analysis showed that rHu-EPO treatment group apparently increased the hemoglobin ( MD=27.42, 95%CI 20.01~34.84, P<0.001), hematocrit and reticulocyte count , reduced the blood transfusion. As to the risk of retinopathy of prematurity in rHu-EPO treatment group was significantly higher than that in the control group (RR=1.21, 95%CI 1.01~1.46, P=0.04), and reduced risks of bronchopulmonary dysplasia (RR=0.79, 95%CI 0.46 ~1.35, P =0.39) and patent ductus arteriosus ( RR =0.83, 95% CI 0.68 ~1.01, P=0.07) the difference, however, was not statistically significant, and there was no increasing risks of necrotizing enterocolitis , periventricular leukomalacia , intraventricular hemorrhage .Conclusion Early administration of high-dose of rHu-EPO can effectively prevent anemia in premature infants , but there is an increased risk of retinopathy of prematurity .
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Objective To analyze retrospectively the MR manifestations and differential diagnosis of extraventricular neurocytoma (EVN).Methods 7 patients with EVN confirmed by pathologic examination were performed non-enhanced and contrast-enhanced MR scan,and one of them was also performed DWI.Results 4 tumors were located in cerebra,2 tumors located in cerebellum,involving both cortex and white matter,and 1 tumor was located in the seller region.5 tumors were solid-cystic lesions and 2 tumors were solid lesions.5 lesions were well demarcated and 2 lesions were ill defined.Edema around the lesion was found in 2 cases.The solid part of tumors showed iso-or hyper intensity on T1WI,hypo-or hyper intensity on T2WI.Necrosis and hemorrhage occurred in some cases.The degree of enhancement in solid part ranged from mild enhancement to intense enhancement heterogeneously.The cystic part showed ring like enhancement with a thin wall.Conclusion The manifestations of EVN on MRI have some characteristics.If a solid-cystic lesion was well defined,involving both cortex and white matter,EVN should be considered.
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As the effects of the nitric oxide and nitric oxide synthase have been investigated a lot,the nitric oxide synthase inhibitors were widely explored and become one of the highlights in the cerebral ischemia research.This paper reviewed the effects of nitric oxide synthase inhibitors especially the nNOS inhibitors and iNOS inhibitors on the cerebral ischemia damage.
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The neuropeptide orexins, including orexin A and orexin B, are located exclusively in hypothalamus OX1R and OX2R are receptors of orexin. OX1R is selective to orexin A while OX2R is not. The distributions of orexin neurons in human brain are the same as those of rats. Orexin was closely related with sleep and awakening behavior besides regulating the feeding behavior. Orexin-containing terminals are also found in areas modulating sleep and awakening such as the locus ceruleus, tuberomammillary nucleus, dorsal raphe, and the basal forebrain. In those areas, there are also lots of OX1R and OX2R and their precursors. Orexin neurons are extremely active during rapid wave sleep and awakening. If hypothalamus in some areas is destroyed and orexin neurons are reduced, sleep-awakening dysfunction will appear (for instance: narcolepsy).