RESUMO
BackgroundAs the novel coronavirus triggering COVID-19 has broken out in Wuhan, China and spread rapidly worldwide, it threatens the lives of thousands of people and poses a global threat on the economies of the entire world. However, infection with COVID-19 is currently rare in children. ObjectiveTo discuss the latest findings and research focus on the basis of characteristics of children confirmed with COVID-19, and provide an insight into the future treatment and research direction. MethodsWe searched the terms "COVID-19 OR coronavirus OR SARS-CoV-2" AND "Pediatric OR children" on PubMed, Embase, Cochrane library, NIH, CDC, and CNKI. The authors also reviewed the guidelines published on Chinese CDC and Chinese NHC. ResultsWe included 25 published literature references related to the epidemiology, clinical manifestation, accessary examination, treatment, and prognosis of pediatric patients with COVID-19. ConclusionThe numbers of children with COVID-19 pneumonia infection are small, and most of them come from family aggregation. Symptoms are mainly mild or even asymptomatic, which allow children to be a risk factor for transmission. Thus, strict epidemiological history screening is needed for early diagnosis and segregation. This holds especially for infants, who are more susceptible to infection than other age groups in pediatric age, but have most likely subtle and unspecific symptoms. They need to be paid more attention to. CT examination is a necessity for screening the suspected cases, because most of the pediatric patients are mild cases, and plain chest X-ray do not usually show the lesions or the detailed features. Therefore, early chest CT examination combined with pathogenic detection is a recommended clinical diagnosis scheme in children. The risk factors which may suggest severe or critical progress for children are: Fast respiratory rate and/or; lethargy and drowsiness mental state and/or; lactate progressively increasing and/or; imaging showed bilateral or multi lobed infiltration, pleural effusion or rapidly expending of lesions in a short period of time and/or; less than 3 months old or those who underly diseases. For those critical pediatric patients with positive SARS-CoV-2 diagnosis, polypnea may be the most common symptom. For treatment, the elevated PCT seen in children in contrast to adults suggests that the underlying coinfection/secondary infection may be more common in pediatric patients and appropriate antibacterial treatment should be considered. Once cytokine storm is found in these patients, anti-autoimmune or blood-purifying therapy should be given in time. Furthermore, effective isolation measures and appropriate psychological comfort need to be provided timely.
RESUMO
OBJECTIVE: To evaluate the efficacy,safety,and potential benefits of neoadjuvant intraperitoneal chemotherapy(NIPC)in patients with newly diagnosed advanced ovarian cancer.METHODS: From December 2011 to December 2015,in Sun Yat-sen Memorial Hospital of Sun Yat-sen University,27 patients with stage ⅢC-Ⅳ ovarian cancer were enrolled in the study.NIPC was used as the initial treatment.The regimen was paclitaxel(T)intravenous chemotherapy combined with cisplatin/carboplatin(P/C)intraperitoneal chemotherapy.The primary endpoint were complication and toxicity.Secondary endpoints were progression-free survival(PFS)and overall survival(OS).RESULTS: Nine patients completed 3 times of NIPC,7 had once and 7 had twice.Nine patients completed NIPC,18 patients discontinued,includeding disease progression(n=3),patient refusal(n=3),unknown reason(n=3),myelosuppression(n=2),nephrotoxicity(n=2),arrhythmia(n=2),abdominal pain(n=1),diarrhea(n=1),and headache(n=1);there was no treatment-related death.Fourteen accepted intermittent cytoreduction surgery,and 13 were R0.There were 13 patients without surgery,of whom 4 progressed,3 gave up,and 6 had negative CA125.The median follow-up time was 36 months(10-82 months),the median follow-up time was 53.8±5.59 months,the 3-year OS rate was 57.2%,and the median PFS was 20 months(0-82 months);the 3-year PFS rate was 24.7%.CONCLUSION: It is safe and feasible to use NIPC for neoadjuvant chemotherapy in patients with advanced ovarian cancer.It may improve the satisfactory operation rate and prolong survival.
RESUMO
<p><b>BACKGROUND</b>Occult invasive cervical cancer discovered after simple hysterectomy is not common, radical parametrectomy (RP) is a preferred option for young women. However, the morbidity of RP was high. The aim of our study is to assess the incidence of parametrial involvement in patients who underwent radical parametrectomy for occult cervical cancer or radical hysterectomy for early-stage cervical cancer and to suggest an algorithm for the triage of patients with occult cervical cancer to avoid RP.</p><p><b>METHODS</b>A total of 13 patients with occult cervical cancer who had undergone RP with an upper vaginectomy and pelvic lymphadenectomy were included in this retrospective study. Data on the clinicopathologic characteristics of the cases were collected. The published literature was also reviewed, and low risk factors for parametrial involvement in early-stage cervical cancer were analyzed.</p><p><b>RESULTS</b>Of the 13 patients, 9 had a stage IB1 lesion, and 4 had a stage IA2 lesion. There were four patients with grade 1 disease, seven with grade 2 disease, and two with grade 3 disease. The median age of the entire patients was 41 years. The most common indication for extrafascial hysterectomy was cervical intraepithelial neoplasia 3. Three patients had visible lesions measuring 10-30 mm, in diameter and ten patients had cervical stromal invasions with depths ranging from 4 to 9 mm; only one patient had more than 50% stromal invasion, and four patients had lymph-vascular space invasion (LVSI). Perioperative complications included intraoperative bowel injury, blood transfusion, vesico-vaginal fistula, and ileus (1 case for each). Postoperative pathologic examination results did not show residual disease or parametrial involvement. One patient with positive lymph nodes received concurrent radiation therapy. Only one patient experienced recurrence.</p><p><b>CONCLUSIONS</b>Perioperative complications following RP were common, whereas the incidence of parametrial involvement was very low among selected early-stage cervical cancer patients. Based on these results, we thought that patients with very low-risk parametrial involvement(tumor size ≤ 2 cm, no LVSI, less than 50% stromal invasion, negative lymph nodes) may benefit from omitting RP. Further prospective data are warranted.</p>
