Long-Term Outcomes Comparison of Endoscopic Resection With Gastrectomy for Treatment of Early Gastric Cancer: A Systematic Review and Meta-Analysis.

Background: Endoscopic resection (ER) and gastrectomy have been both accepted as curative treatments for early gastric cancer. We intended to compare ER with gastrectomy treatments on safety of patients, disease-free survival and overall survival for early gastric cancer through this systematic review. Methods: A literature search was performed in Pubmed, Embase, and Cochrane Library databases. Studies that have compared ER with gastrectomy for early gastric cancer were included in this meta-analysis. We searched for clinical studies published before March 2019. Stata 12.0 software was used for systematic analysis. Results: Nine studies were included in this systematic review, ER treatment was associated with a shorter length of stay (WMD = -8.53, 95% CI -11.56 to -5.49), fewer postoperative complications (OR = 0.47, 95% CI 0.34-0.65). ER can be performed safely with shorter hospital stay and fewer postoperative complications than gastrectomy. Recurrence rate was higher for ER than for gastrectomy treatment (HR = 3.56, 95% CI 1.86-6.84), mainly because metachronous gastric cancers developed only in the ER treatment. However, most of the metachronous gastric cancers could be curatively treated with ER again, and it didn't affect overall survival of patients with early gastric cancer. There was no difference in overall survival rate between ER and gastrectomy (HR = 0.84, 95% CI 0.63-1.13). Conclusions: ER and gastrectomy are both acceptable for curative treatment of early gastric cancer. However, due to the comparable overall survival and lower postoperative complications and shorter length of stay, ER is better than gastrectomy for early gastric cancer, who met the indication for ER treatment.

Ultrasonographic observation of the breast in early postmenopausal women during therapy with Cimicifuga foetida extract and sequential therapy with estrogen and progestin.

BACKGROUND: It is now recognized that Cimicifuga foetida (C. foetida) extract is effective in alleviating menopausal symptoms. But the durations reported were usually short. The aim of this study was to investigate the effects of C. foetida extract therapy and different estrogen and progesterone sequential therapies, on the breasts of early postmenopausal women. METHODS: This was a prospective randomized trial. Ninety-six early menopausal women were recruited and randomly assigned into three groups treated with different therapies for 2 years. Patients were given C. foetida extract in Group A, estradiol valerate and medroxyprogesterone acetate in Group B, and estradiol valerate and progesterone in Group C. Ultrasonography was used to monitor changes in breast during treatment. RESULTS: In comparing breast glandular section thickness before and after 1 and 2 years of treatment, no significant difference was observed in Group A (11.97 ± 2.84 mm vs. 12.09 ± 2.58 mm and 12.61 ± 3.73 mm, P > 0.05); in Group B glandular section thickness had increased significantly (10.98 ± 2.34 mm vs. 11.84 ± 2.72 mm and 11.90 ± 3.33 mm, P < 0.05) after treatment, the same as Group C (11.56 ± 3.03 mm vs. 12.5 ± 3.57 mm and 12.22 ± 4.39 mm P < 0.05). In comparing breast duct width before and after 1 and 2 years of treatment, no significant difference was seen in Group A (1.07 ± 0.19 mm vs. 1.02 ± 0.18 mm and 0.98 ± 0.21 mm, P > 0.05); in Group B the duct width had a downward trend after treatment (0.99 ± 0.14 mm vs. 0.96 ± 0.22 mm and 0.90 ± 0.18 mm, P < 0.05), the same as Group C (1.07 ± 0.20 mm vs. 1.02 ± 0.17 mm and 0.91 ± 0.19 mm, P < 0.05). The nodules detected before treatment had disappeared after 1-year of treatment or exhibited no distinct changes in the three groups. However, new breast nodules had appeared after 2 years of treatment: There was one case in Group A, two cases in Group B and four cases in Group C, with breast hyperplasia after the molybdenum target check. CONCLUSIONS: In early postmenopausal patients, C. foetida extract therapy and estrogen and progesterone therapy at low doses did not increase the incidence of malignant breast tumors.

Retrospective epidemiological study of thyroid nodules by ultrasound in asymptomatic subjects / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The purpose of this study was to conduct thyroid ultrasound examinations on a large sample of subjects and explore the occurrence, distribution, and characteristics of thyroid nodules and thyroid cancer to provide some information on the epidemic trend of thyroid nodules and cancer.</p><p><b>METHODS</b>The thyroid ultrasonic examination results of 19 895 healthy physical examinees who visited the Department of Health Management, Peking Union Medical College Hospital from January 2009 to December 2011 were analyzed retrospectively to determine the detection rate and characteristics of thyroid nodules. Fine needle aspiration or surgical resection was suggested to subjects suspected of having thyroid cancer.</p><p><b>RESULTS</b>The detection rate of thyroid nodules was 42.6% (8 480/19 895), 40.0% (4 661/11 678) in men and 46.5% (3 819/8 217) in women. The detection rate noticeably increased with increasing age. The detection rate of thyroid nodules by palpation was obviously lower than by ultrasonic examination in various age groups. Among those with thyroid nodules, 61.3% were multiple and 38.7% were solitary; multiple nodule was the major type both in men and women. Twenty-nine cases of malignant nodules were solitary, and 30 cases of malignant nodules were multiple. There was no significant difference. The detection rate of thyroid cancer was 0.30% for the entire group of examinees, and 0.15% in men and 0.50% in women. Among all sex and age groups, 30- to 40-year-old women had the highest detection rate (0.76%). The detection rate of thyroid nodules correlated with age, systolic blood pressure, height, and weight. Increasing age and/or higher systolic blood pressure correlated with a higher detection rate, while smaller height and weight also correlated with a higher detection rate with significant differences. However, there were no significant correlations between the detection rate and diastolic blood pressure or body mass index.</p><p><b>CONCLUSIONS</b>The detection of thyroid cancer increased significantly, especially in women. Thus, precautions needed to be taken. Regular physical examination and timely intervention after detection of malignant nodules are critical to improve the prognosis in thyroid cancer patients.</p>

Thyroidnodule scanning by using ultrasonography during health check-up / 中华健康管理学杂志

Objective To study the effectiveness of ultrasonography in thyroidnodule disease detection and malignant/benign lesion differentiation during health check-up.Method Thyroid examination data of Peking Union Medical College Hospital(PUMCH)staff over the last 6 years were retrospectively reviewed.The results of thyroidnodule scanning by using ultrasonography were compared with the findings of physical examinations.Results Among 6348 health check-up receivers from 2006 to 2010,450 were found to have thyroidnodule(detection rate 7.09％).Twenty malignant lesions were confirmed in histological examinations(mean detection rate per year 0.38％).In 2011,1706 thyroid glands were scanned by both physical examination and ultrasonography,and 525 thyroidnodules were identified(detection rate 30.77％).Surgical operations were performed for 22 suspected malignant tumors,and 18 malignant lesions were finally confirmed(detection rate 1.06％).Conclusion Ultrasonography can improve the detection of thyroidnodule.Irregular shape,microcalcification,and rich blood-flow may indicate malignant nodules.

The role of experience in physical examination for early detection of breast cancer / 中华健康管理学杂志

Objective To highlight the role of physician's experience in physical examination for the early diagnosis of breast cancer.Methods Data of physical examination of mammary glands in 1785 female were analyzed and compare with the uhrasonography and mammngraphy results.Results Of the 31 breast cancers confirmed by pathologic examination after operation,2 cases were bilateral breast cancers and 1 was nonpalpable.9 of 41 cases which suspected by inspection were confirmed as breast cancers.The significant difference was found comparing with control group by X2 test (X2=100.5,P＜0.05).The 34 breast cancers were found in 2089 focus in palpation and there were 6 minimal cancers (diameter≤1.0 cm) among them.Some cancers were found in special location with no malignant clinical manifestation.The rate of missed diagnosis of ultrasonography and rnammography is 16.1% and 19.4%,respectively.Conclusions Physical examination plays an important role in the early detection of breast cancer and physician's experience is a major determinant for avoiding misdiagnosis.