ObjectiveTo explore the value of 3.0 T MRI functional imaging in differential diagnosis of radiation brain injury and recurrence of glioblastoma multiforme.MethodsFrom March 2017 to January 2018, 31 patients diagnosed with brain glioblastoma multiforme in Peking University International Hospital were collected continuously, including 14 cases of tumor recurrence and 17 cases of radiation-induced brain injury. All the patients routinely underwent conventional MRI head scan, three-dimension arterial spin labeling (3D-ASL), dynamic susceptibility contrastperfusion weighted imaging (DSC-PWI), and enhanced MRI scan sequence; related parameters were recorded and compared.ResultsCerebral blood flow (CBF) value of abnormal enhanced area in the recurrence group was significantly higher than that in the brain injury group with 3D-ASL scan (t=3.016, P=0.005), and no difference was found in edema area between the two groups (P>0.05). In the recurrence group, CBF value of abnormal enhanced area was significantly higher than that of the normal area (t=2.628, P=0.014); however, there was no significant difference in the CBF value between the abnormal enhancement foci and the normal areas in the radiation brain injury group (P>0.05). Relative cerebral blood volume (rCBV) ratio (t=2.894, P=0.007) and relative cerebral blood volume (rCBF) ratio (t=2.694, P=0.012) of abnormal enhanced area, as well as rCBV ratio (t=2.622, P=0.013) and rCBF ratio (t=2.775, P=0.010) of edema area in the recurrence group were significantly higher than those in the brain injury group with DSC-PWI scan. No differences were found in relative mean transit time (rMTT) ratio and relative time to peak (rTTP) ratio between the two groups (P>0.05). In the brain injury groupr, CBV ratio (t=2.921, P=0.008) and rCBF ratio (t=3.100, P=0.004) of abnormal enhanced area were significantly higher than those of the edema area, and no difference was found in rMTT ratio or rTTP ratio (P>0.05). In the recurrence group, no difference was found in all focal parameters between abnormal enhanced area and edema area (P>0.05). In diagnosis value analysis, the areas under the curve of CBF in 3D-ASL scan, and rCBF ratio, rCBV ratio in DSC-PWI scan were 0.752, 0.675, and 0.645, respectively; the cut-off values were 34.59, 1.48, and 1.67, respectively; the sensitivities were 79.2%, 61.5%, and 58.3%, respectively; and the specificities were 44.4%, 32.8%, and 22.4%, respectively.ConculsionThe diagnostic value of functional MRI imaging in distinguishing glioblastoma multiforme recurrence and radiation-induced brain injury is high recommendated; further research and clinical application should be needed.
ObjectiveTo compare the efficacy and safety of Huaier and Sorafenib in treatment of small hepatocellular carcinoma(HCC)following radical resection. MethodsEighty-two patients with small HCC accepted radical liver resection and then taken Huaier or Sorafenib were collected retrospectively. These patients were divided into Huaier group(51 cases)and Sorafenib group(31 cases)according to the different administration drugs after operation. The baseline characteristics, tumor characteristics, survival rate, tumor recurrence rate, and side effects were compared between two groups. Results①There were no significant differences on the baseline demographic characteristics, liver function, and tumor characteristics between two groups(P > 0.05).②The overall survival rate and tumor-free survival rate had no significant differences between the Huaier group and the Sorafenib group(P=0.737, P=0.699).③The rate of recurrence or metastasis had no significant difference between the Huaier group and Sorafenib group(37.3% versus 32.3%, P=0.648). The most common site of the recurrence or metastasis was the liver and the lung followed.④There were only 5 cases suffered side effects after taking Huaier and no case needed Huaier discontinuance. However, 11 cases suffered side effects after taking Sorafenib and 3 cases needed Sorafenib discontinuance, and the rate of the side effect in the Sorafenib group was much higher than that in the Huaier group(35.5% versus 9.8%, P=0.026). ConclusionFor the small HCC who accepted radical liver resection, Huaier seems to be an effective and safe drug.
【Abstract】ObjectiveTo evaluate the therapeutic benefits of three styles of hernioplasties such as the traditional hernioplasty, the mesh only hernioplasty and the plug amp; mesh hernioplasty. MethodsThe traditional hernioplasty in 534 cases(583 sides), the mesh only hernioplasty in 57 cases(60 sides) and the plug amp; mesh hernioplasty in 51 cases(54 sides) were performed. The comparing studies on the operative time, the postoperative complications, the recurrent rate and so on were analyzed. ResultsThe average operative time of the traditional styles group was (34.26±4.56) min, which was significantly shorter than the mesh only group 〔(40.35±6.24) min, P＜0.05〕 and the plug amp; mesh group 〔(49.12±8.69) min, P＜0.01〕 respectively. This significant difference between the mesh only group and the plug amp; mesh group was also identified (P＜0.05). Postoperative complications in the traditional styles group, the mesh only group and the plug amp; mesh group were 1.12%, 1.75% and zero,respectively (Pgt;0.05). Recurrent rate in the traditional styles group was 5.99%(32/534), which was significantly higher than that of the mesh only and the plug amp; mesh group (no recurrence). The average hospitalizing time in the traditional styles group, the mesh only group and the plug amp; mesh group was (7.11±3.06) days，（5.38±2.53） days and （6.19±3.61） days, respectively, in which there was no significant difference among groups. The activityrecovering time in the traditional styles group was (16.98±4.35) days, which was significantly longer than （7.26±2.46） days in the mesh only group and （8.02±3.35） days in the plug amp; mesh group. Conclusion The mesh only hernioplasty or the plug amp; mesh hernioplasty have a lower recurrent rate comparing with that in the traditional hernioplasty, which should be much more popularly applied in the treatment of inguinal hernia.
ObjectiveTo systematically review the effect of laparoscopy versus laparotomy for borderline ovarian tumors (BOTs) on postoperative recurrence. MethodsWe searched PubMed, The Cochrane Library (Issue 11, 2015), EMbase, Web of Science, CNKI, WanFang Data and CBM databases from inception to Nov. 2015, to collect relevant clinical studies comparing laparoscopy and laparotomy for BOTs. Two reviewer independently screened literature, extracted data and assessed the risk of bias of include studies by using NOS scale. Then, meta-analysis was performed by using RevMan 5.3 software. ResultsNineteen cohort studies were included. The scores of NOS scale showed that 10 studies were < 7 points, while the other 9 studies were≥7 points. The results of meta-analysis showed that: the recurrence rate of tumor (OR=1.75, 95%CI 1.05 to 2.91, P=0.03) in the laparoscopy group was higher than that in the laparotomy group, but no significant differences were found in further subgroup analysis according to type of operations (conservative surgery: OR=1.22, 95%CI 0.71 to 2.08, P=0.47; non-conservative surgery: OR=4.38, 95% CI 0.85 to 22.68, P=0.08). The diameter of tumor in the laparoscopy group was significant smaller than that in the laparotomy group (MD=-6.88, 95% CI-8.15 to-5.61, P < 0.000 01), and the rate of rupture of tumor in the laparoscopy group was significant higher than that in the laparotomy group (OR=3.99, 95% CI 2.54 to 6.26, P < 0.000 01). ConclusionCurrent evidence shows, compared with laparotomy, laparoscopy has similar effect on postoperative recurrence and smaller diameter of tumor, but laparoscopy could increase the rate of rupture of tumor. Due to the limited quality and sample size of included studies, more high quality and large sample size studies are need to prove the above conclusion.
ObjectiveTo evaluate the efficacy and cost-effectiveness of thymalfasin (Tα1) as an adjuvant therapy for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after surgery.MethodsPatients with HBV-related HCC who underwent hepatectomy from February 2007 to December 2015 in West China Hospital of Sichuan University, Chengdu Military General Hospital, or the Third Affiliated Hospital of Sun Yat-sen University were retrospectively collected and divided into the Tα1 group and the observation group. Log-rank test and Kaplan-Meier curve were used to assess the overall survival, recurrence-free survival, and safety of patients. A Markov model was used to calculate the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) of the Tα1 group compared with the observation group. Cost data was from the hospital information system of the three hospitals. Utility scores mainly came from published data. Sensitivity analyses were applied to explore the impact of essential variables.ResultsA total of 208 patients with HCC after liver resection were enrolled, among them 48 received Tα1 treatment (the Tα1 group) and 160 were only followed up (the observation group). There was no significant difference between the two groups in the baseline characteristics. The median overall survival of the Tα1 group and the observation group was 102.0 months [95% confidence interval (CI) (74.8, 129.2) months] and 81.6 months [95%CI (65.7, 97.6) months], respectively, and the difference was statisitically significant (P=0.047); the median recurrence-free survival was 66.7 months [95%CI (17.3, 116.1) months] and 37.4 months [95%CI (28.7, 46.2) months], respectively, and the difference was statistically significant (P=0.044). There were no grade Ⅲ-Ⅳ adverse events and no treatment-related death occurred. The ICER of Tα1 group was ￥108 050.02/QALY, which was less than the willingness to pay (￥177 785.25/QALY).ConclusionsTα1, as an adjuvant therapy for HBV-related HCC patients, can improve the prognosis of the patients, and the cost is within the acceptable level in our country, so this strategy is likely to be a cost-effective option compared with the observation group.
Objective To study the effects of partial axillary lymph node dissection (PALD) on prognosis and upper limb function in patients with breast cancer. Methods Ninety-eight breast cancer patients with stage Ⅰ and Ⅱ were randomly divided into two groups and different surgical procedures following modified mastectomy were performed: partial axillary lymph node (level Ⅰ and Ⅱ) dissection (PALD) group (n=48) and total axillary lymph node (levelⅠ, Ⅱ and Ⅲ) dissection (TALD) group (n=50). The longterm positive relapse rate and upper limb function between 2 groups were compared. Results During the follow-up of 5 to 10 years (average 4.5 years), there were 2 cases (4.2%) of local recurrence on chest wall and one case (2.1%) of recurrence in axillary lymph node and one case (2.1%) of recurrence in supraclavicular lymph node in PALD group, and 2 cases (4.0%) of local recurrence on chest wall and no axillary lymph node recurrence and one case (2.0%) of recurrence in supraclavicular lymph node happened in TALD group. There was no statistical difference between PALD group and TALD group (Pgt;0.05). The incidence of upper limb edema and dysfunction was 4.2% (2/48) in PALD group and 16.0%(8/50) in TALD group (P＜0.01). There was no significant statistical difference of 5year and 10year survival rate between PALD group and TALD group (89.6% vs. 88.0%， 79.2% vs. 78.0%，Pgt;0.05). Conclusion PALD may reduce upper limb dysfunction after operation in patients with stage Ⅰ and Ⅱ breast cancer, and does not increase prognostic risk.
Intravitreal injection of anti-VEGF drugs for the treatment of retinopathy of prematurity (ROP) is a hot topic of research, and it can be used to treat the ROP (Ⅰzone). The current anti-VEGF drugs include bevacizumab, ranibizumab, aflibercept and conbercept, etc. However, in recent years, several studies have confirmed that anti-VEGF drugs have an increased recurrence rate and a longer recurrence time than conventional laser photocoagulation therapy. The follow-up period should be extended and repeated injections may be required. Due to the lack of large-scale prospective clinical studies, the recurrence rate, time window of recurrence, risk factors and treatment methods of various anti-VEGF drugs for ROP are still unclear. Anti-VEGF drugs in the treatment of ROP needs to accumulate more evidence-based medical evidence.
Objective To discussion the diagnostic significance of CT three dimension reconstruction in local recurrence after surgery for gastric cancer. Methods Thirty-nine patients with gastric cancer recurrence after radical surgery were performed multislice CT scan between December 2004 and December 2008 in The Third Affiliated Hospital of Harbin Medical University, and the images were reconstructed by three dimension reconstruction in workstation. The axial CT images and three dimension images of gastric cancer recurrence patients were diagnosed and compared. Results The detection rates of axial images and three dimensional CT images were 82.1% (23/28) and 100% (28/28) for pathological morphology, 62.5% (10/16) and 93.8%(15/16) for extension of tumors, 66.7% (10/15) and 93.3% (14/15) for lymph node metastasis, 87.5% (7/8) and 87.5% (7/8) for distant metastasis, respectively. Conclusions CT three dimension reconstruction can carry out more direct and solid results, such as measuring the vertical thickness of the thickened gastric wall, observing the infiltration situation with proximal organ, and metastasis of the lymph node. The method of three dimension reconstruction used for the diagnosis of local recurrence after surgery for gastric cancer is better than the axial image, and it can supply data which would be useful for the tumor advancing treatment.
ObjectiveTo discuss the strategy of locoregional surgery for breast cancer patients after neoadjuvant chemotherapy. MethodThe pertinent literatures about locoregional surgery concerning breast-conserving therapy, factors of ipsilateral breast tumor recurrence, pathological shrinkage modes of breast primary tumor, and sentinel lymph node biopsy after neoadjuvant chemotherapy were reviewed. Results①The major benefit of neoadjuvant chemotherapy was to increase the proportion of breast-conserving therapy after downstaging the primary breast tumor. However, the use of breast-conserving therapy after neoadjuvant chemotherapy might remain a higher risk of ipsilateral breast tumor recurrence. It was now widely recognized that the risk factors for ipsilateral breast tumor recurrence were multifocal pattern of residual tumor and pathologic residual tumor larger than 2 cm. The shrinkage mode of the primary breast tumor after neoadjuvant chemotherapy and its relative factors were still unclear. 2 Sentinel lymph node biopsy(SLNB) was feasible either before or after neoadjuvant chemotherapy and approval by SLNB guideline and expert consensus. Patients with a cN0 status could get more benefits from SLNB after neoadjuvant chemotherapy. Although there was a bright future for SLNB as an alternative to ALND for patients with primary cN1 and downstaging to cN0 after neoadjuvant chemotherapy, it needed to obtain the accepted clinical identification rate, false negative rate, as well as similar regional recurrence rate and overall survival as compared to ALND. ConclusionsCurrently, surgical management is crucial for reducing the locoregional recurrence risk of breast cancer after neoadjuvant chemotherapy, no matter what the clinical and radiographic efficacy of neoadjuvant chemotherapy is. In the era of genomics and SLNB, individual locoregional surgical management could be arrived according to the primary stage and neoadjuvant chemotherapy response.
ObjectiveTo observe the children with idiopathic epilepsy who received AED therapy and seizure-free, withdrawal at least 1 year, and analyze the risk factors of seizure recurrence. In order to give better instructions for AED withdrawal of children with idiopathic epilepsy in pediatric department. MethodsChildren with idiopathic epilepsy who were seizure-free and had stopped AED treatment at least 1 year before the deadline of observation were collected from pediatric outpatient and inpatient department of the First Affiliated Hospital of Guangxi Medical University from January 2011 to January 2014. The following variables, derived from the case records were analyzed: sex, age at seizure onset, type of seizure, time period between the onset of the first seizure and start of treatment, number of seizures in the time period between the start of AED therapy and the last seizure, number of AEDs before remission, time period between the start of AED therapy and the last seizure, time period between the last seizure and withdrawal of AED treatment (seizure-free period, timing of AED withdrawal), time period between the start of AED withdrawal and total discontinuation(speed of withdrawal), EEG registered at the time of diagnosis, before AED withdrawal, during and after AED withdrawal, and the condition of recurrence, data analysed by multi-variate step-wise Cox regression model analysis. ResultsA total of 16(12.8%) children relapsed in a total number of 125 children with idiopathic epilepsy we collected; date evaluated by multi-variable analysis showed that the children suffering from seizure type of focal seizure, starting withdrawal after a seizure-free period of less than 3 years and with abnormal post-withdrawal EEG recording was associated with a higher risk of seizure recurrence. ConclusionsChildren with idiopathic epilepsy have a low risk of recurrence after AED withdrawal. Those who suffer from seizure type of focal seizure, start withdrawal after a seizure-free period of less than 3 years and with abnormal post-withdrawal EEG recording are associated with a higher risk of seizure recurrence.