The efficacy of postoperative radiotherapy in stage Ⅲ(N 2) non-small cell lung cancer: a meta analysis / 中华放射肿瘤学杂志

Objective:To conduct meta analysis to compare the effect of complete resection with or without postoperative radiotherapy (PORT) on survival in stage Ⅲ(N 2) non-small cell lung cancer (NSCLC). Methods:Relevant studies of the efficacy of PORT for stage Ⅲ(N 2) NSCLC were searched from Wanfang Data, PubMed, and Cochrane Library from January 2006 to January 2022. Literature screening, extraction of information and assessment of the risk of bias of the included literature was carried out by two independent researchers. Meta analysis was performed using R4.0.3 software. Results:A total of 12 publications consisting of 2992 patients were included, 1479 cases in the PORT group and 1513 cases in the control group. PORT improved the overall survival (OS) and disease free survival (DFS) compared to the control group. Fixed-effects model meta analysis of 6 randomized controlled trials showed that PORT did not significantly reduce the risk of death ( HR=0.98, 95% CI: 0.80-1.20). Fixed-effects model meta analysis of 6 retrospective studies showed that PORT improved prognosis ( HR=0.68, 95% CI: 0.59-0.79). PORT could improve OS of patients with multiple (station) metastasis of ipsilateral mediastinum and / or submandibular lymph nodes ( HR=0.89, 95% CI: 0.80-0.99). Conclusions:PORT could improve OS and DFS in stage Ⅲ(N 2) NSCLC. A trend towards benefit can be observed in the subgroup with multiple/multi-station N2 metastasis.

Analysis of risk factors for lymph node metastasis in T2 stage non-small cell lung cancer / 中国胸心血管外科临床杂志

@#Objective    To explore the risk factors for lymph node metastasis in patients with T2 stage non-small cell lung cancer. Methods    The clinical data of 271 patients with non-small cell lung cancer who underwent surgical treatment in our hospital from 2014 to 2017 were collected, including 179 males and 92 females, with an average age of 62.73±0.58 years. The patients were divided into N0, N1, and N2 groups according to the lymph node metastasis status. The clinical data of the patients in different groups were compared. Results    The body mass index (BMI, P=0.043), preoperative lymph node enlargement (P<0.001), and tumor diameter (P<0.001) were significantly different among groups. The BMI (OR=1.131, 95%CI 1.001-1.277, P=0.048) and preoperative lymph node enlargement (OR=3.498, 95%CI 1.666-7.342, P=0.001) were independent risk factors for N2 lymph node metastasis, and tumor diameter was an independent risk factor for both N1 (OR=1.538, 95%CI 1.067-2.218, P=0.021) and N2 (OR=1.814, 95%CI 1.196-2.752, P=0.005) lymph node metastasis. Conclusion    Patients with high BMI or enlarged lymph nodes before surgery have a high risk for N2 lymph node metastasis, and those with large tumor diameter have a high risk for both N1 and N2 lymph node metastasis.

OsNAC-like transcription factor involved in regulating seed-storage protein content at different stages of grain filling in rice under aerobic conditions

In this study, we show that NAC-like transcription factor (TF) has 90% sequence similarity with cDNA of the OsNac5 gene present in the NCBI database. Phylogenetic analysis of the NAC gene family was performed with inclusion of the highly diverse C-terminal sequences. We report that this gene is also found to be orthologous to Glycine max NAC8, NAC2, Triticum aestivum NAC6 and paralogous to OsNAC6. mRNA was purified from five recombinant inbred lines (RILs) and parents of rice at three different stages of grain filling under aerobic conditions, with grain protein content (GPC) spanning from 4 to 14%. TheNAC-like TF encoding a protein was found to be upregulated at the S2 stage in the leaf (3.9-fold) and panicle (1.84-fold) of parent HPR14 and in five RILs (1.9 to 4.51-fold in leaves and 0.47 to 3.2-fold in panicles). Expression analysis of the NAC-like TF encoding a protein for the rice gene was found to be upregulated at the S2 stage in the leaf and panicle of parental line HPR14 and RILs with high protein content.

Clinical Result of a Staged Reimplantation of Fungus Related Periprosthetic Joint Infection after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). On the other hand, a standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. The clinical progress of staged reimplantation in patients who had fungus-related PJI after TKA was reviewed retrospectively. MATERIALS AND METHODS: Ten patients who had a fungal related PJI after TKA between 2006 and 2017 using staged reimplantation surgery were reviewed. These patients were compared with 119 patients who had a PJI in the same period. The failure rate of infection control, intravenous antimicrobial using the period, and the clinical results were evaluated by comparing the range of motion and Korean knee score (KKS) between pre-staged reimplantation and the last follow-up. RESULTS: In the fungal infection group, 7 out of 10 cases (70.0%) had failed in infection control using staged reimplantation and in the non-fungal group, 7 out of 119 cases (5.9%) had failed (p=0.04). In the non-fungal group, the mean duration of antibiotics was 6.2 weeks. In the fungus group, the mean duration of antibiotics was 15.3 weeks, which was 9.1 weeks longer (p < 0.001). The range of motion of the knee was increased in the two groups (p=0.265). At the last follow-up, the KKS was 71.01 points in the non-fungal group and 61.3 points in the fungal group (p=0.012). Erythrocyte sedimentation rate and C-reactive protein (CRP) decreased in the two groups, but the CRP was significantly different in the two groups (p=0.007). CONCLUSION: The treatment of fungus-related PJIs using staged reimplantation showed uneven clinical progress and unsatisfactory clinical improvements compared to non-fungal PJI. Therefore, it is necessary to consider the use of an antifungal mixed cement spacer at resection arthroplasty and oral antifungal agent after reimplantation.

N1 characteristics and influencing factors in non-small cell lung cancer of T2 stage / 中国胸心血管外科临床杂志

@#Objective    To investigate the characteristics and influencing factors of N1 in T2 stage of the 8th TNM stage of The International Association for the Study of Lung Cancer (IASLC) (3 cm <tumor size≤5 cm) non-small cell lung cancer (NSCLC), to provide the basis for dissecting intrapulmonary lymph node more accurately during the operation. Methods    We collected the clinical information of patients who underwent the pulmonary malignant tumor surgery in Dalian Central Hospital between October 2011 and November 2016. Through the inclusion and exclusion criteria, a total of 68 patients were obtained, including 48 males and 20 females, aged 48–81 (63.1±7.6) years. According to the pathological results, we invesigated the characteristics and influencing factors of N1 in T2 stage non-small cell lung cancer. Results    The results showed that the highest positive rate of lymph node was 14.8% in the 12th group, 14.3% in the 13th group, and 13.9% in the 6th group, respectively. In the single factor analysis, it showed that male, T2b stage, poorly differentiated degree were the risk factors for intrapulmonary lymph node metastasis in T2 stage (P<0.05). But the intrapulmonary lymph nodes metastasis was no significant correlation with above factors according to the multivariate analysis. Conclusion    It is necessary to extract the intrapulmonary lymph node of T2 stage NSCLC at utmost, especially for the No.12 and No.13 high-risk areas. T2b stage with odd ratio (OR) at 3.038 and poorly differentiated degree (OR=1.945) may be the risk factors for the intrapulmonary lymph nodes metastasis of NSCLC in T2 stage. But they are not determining factors.

Controversies over the treatment for stage Ⅲ A-N2 non-small cell lung cancer and related advances / 中华放射肿瘤学杂志

Stage Ⅲ A non-small cell lung cancer (NSCLC) has high heterogeneity and there are some controversies over the treatment of this disease,especially for patients with stage ⅢA-N2 NSCLC.This article investigates whether preoperative or postoperative radiotherapy can improve the survival of patients with stage ⅢA-N2 NSCLC and evaluates the effect of surgical treatment.

Results of Two Stage Revision of Infected Total Knee Arthroplasty (A Minimum 5-year Follow-up Analysis) / 대한정형외과학회잡지

PURPOSE: We report the results of 26 cases of revised total knee joint arthroplasty (TKA) that were followed up for more than 5 years. MATERIALS AND METHODS: On a retrospective basis, we reviewed 26 cases of infected TKA that underwent 2-stage revision between January 1993 and June 2005. All cases were followed up for more than 5 years. Clinical results were evaluated using Range Of Motion (ROM), Hospital for Special Surgery (HSS) score and radiographic results as part of the Knee Society Roentgenographic evaluation and Scoring system. The mean follow-up period was 70 months (ranging from 60 to 108 months). RESULTS: Infection recurred in 3 out of 26 cases. Patients without recurrence of infection showed improvement in ROM and HSS score, which had decreased with time (p<0.001) (ROM: pre-op. 47.1degrees, 1-year 89.5degrees, 2-year 87.1degrees, last follow-up 79.2degrees and HSS score: pre-op. 54.5, 1-year 85.7, 2-year 84.5, last follow-up 80.7). CONCLUSION: Infection recurred in 11.5% after revision arthroplasty. Outcomes of stage 2 revision arthroplasty were satisfactory at early follow-up, but worsened at the last follow-up.

Selection of range of regional lymphadenectomy for patients with T2 gallbladder cancer / 中华消化外科杂志

Objective To investigate the efficacy of regional lymphadenectomy for patients with T2 gallbladder cancer. Methods From January 1990 to December 2009, 48 patients with T2 gallbladder cancer received regional lymphadenectomy following radical surgery at the Xinhua Hospital of Shanghai Jiaotong University, and their clinical data were retrospectively analyzed. Patients were divided into two groups according to the range of lymphadenectomy. Standard group (23 patients): lymph nodes in the regions of bile duct, common bile duct and hepatoduodenal ligament were dissected; extended group (25 patients): lymph nodes in the regions of hepatoduodenal ligament, head of pancreas, duodenum, portal vein, common hepatic artery and celiac axis were dissected).The condition of patients in the two groups were compared after the treatment. The morbidity and survival rate were analyzed by using Fisher exact test and Kaplan-Meier method, respectively, and the survival rates between the two groups were compared by using Log-rank test. Results No perioperative death was found in the two groups. The morbidities was 17% (4/23) in the standard group and 24% (6/25) in the extended group, with no significant difference between the two groups ( P ＞ 0.05 ). The 5-year cumulative survival rate and median survival time were 40% and 29.8 months in the standard group, and 66% and 53.2 months in the extended group, with significant differences between the two groups ( x2 = 4. 687, P ＜ 0.05 ). Conclusion Extended regional lymphadenectomy should be performed on patients with T2 gallbladder cancer if the primary lesions can be dissected radically.

Two-Stage Reimplantation in Infected Total Knee Arthroplasty (A Method of Reinsertion of the Autoclaved Femoral Component and a Polyethylene Liner)

PURPOSE: We wanted to evaluate the results of treating infected total knee arthroplasty with an autoclaved femoral component and polyethylene liner. MATERIALS AND METHODS: From March 2003 to March 2008, 25 knees were diagnosed as infected total knee arthroplasty (TKA) and they underwent two-stage re-implantation. These knees were treated with debridement, reinsertion of the removed femoral component and a polyethylene liner, which were autoclaved, and antibiotic cement was used as an articulating spacer during the interim period to allow maintenance of motion and function. The range of motion and the Hospital for Special Surgery (HSS) score, the Knee Society Knee Score and the Function Score were evaluated. RESULTS: The mean follow up period was 52 months. There was one recurrence of infection. Prior to revision, the average range of motion was 83degrees and the average HSS score was 60 points. At final follow-up, the average range of motion was 110degrees and the average HSS score was 86 points. The knee score and function score showed an increase from a mean of 46 and 31 points preoperatively to a mean of 82 and 50 points postoperatively. The complications during reimplantation were one medial collateral ligament rupture, one lateral condyle fracture and one femoral distal metaphyseal fracture. CONCLUSION: The articulating spacer using an autoclaved femoral component and polyethylene can improve knee function and motion in two stage revision TKA.

An Articulating Versus Non-articulating Spacer for 2-Stage Reimplantation Patients Who Undergo in Infected Total Knee Arthroplasty

PURPOSE: We compared the results between an articulating spacer and a non-articulating spacer for 2-stage reimplantation when performing infected total knee arthroplasty (TKA). MATERIALS AND METHODS: From 1998 to 2007, for 22 patients with infected TKA, we retrospectively evaluated 23 knees that were treated with debridement, component removal and insertion of a non-articulating or articulating spacer, followed by second-stage TKA revision. Non-articulating spacers were used in 13 knees and articulating spacers were used in 10 knees. The most common infecting organism was Staphylococcus aureus in 9 cases, but the infecting organism could not be found in 10 cases. The average length of follow-up was 24 months. RESULTS: The eradication rate was 100% (0 infections in 10 knee) in the articulating group compared with 92.3% (1 infection in 13 knee) in the non-articulating group. The average range of motion before removal of the implant was 60.3degrees for the articulating group and 61degrees for the non-articulating group. After revision arthroplasty, the average range of motion was 104.3degrees for the articulating group and 92.3degrees for the non-articulating group. The rectus snip was done for 3 cases in the articulating group and in 13 cases for the non-articulating group. Yet there were no functional differences between the two groups during the final follow-up period. CONCLUSION: We conclude that the articulating spacer can maintain knee mobility during between the interval stages and improve knee flexion without an increased risk of infection at the final follow-up period.

Two-Stage Hepatectomy for Bilateral Hepatocellular Carcinoma with Bile Duct Tumor Thrombi

Curative hepatectomy is the most important prognostic factor for hepatic cancer, but also has a high rate of morbidity and mortality. Liver failure due to insufficient liver volume is the main cause of postoperative mortality. Preoperative portal vein embolization can induce hypertrophy of the remnant liver, and a two-stage hepatectomy, with or without portal vein embolization, could be used to treat patients with unresectable liver tumors. We report the case of a successful two-staged hepatectomy for bilateral hepatocellular carcinoma with tumor thrombi.

Effect of the early exposure of cover screws on the survival rate of implants / 대한치주과학회지

The early exposure of cover screws is a common complication of 2-stage implant technique. The exposure of cover screws between stage I and II surgery may cause inflammation in the soft tissues surrounding the implants, and lead to peri-implantitis or marginal bone loss. The purpose of this study was to evaluate the effect of the early exposure of cover screws on implants placed using 2-stage technique. Two hundred and nineteen implants in 77 patients were examined for cumulative survival rate, radiographic marginal bone level change, cause and frequency of the early exposure. The results were as follows: 1. Twenty-five implants showed early exposure of cover screws with a frequency of 11.4%. 2. Cumulative survival rate of the implants with early cover screw exposure was 88.0%, and that of the implants without cover screw exposure was 96.9%. 3. At the time of stage II surgery and 1 year after loading, the marginal bone loss was greater around the implants with early exposure of cover screws than around the implants without cover screw exposure(p 0.05).