Objective To explore the diagnosis and relapse factors of thyroid cancer. Methods Two hundreds fifty-six cases of thyroid cancer approved by surgery and pathology from 1999 to 2006 were analyzed retrospectively. Results Two hundred and thirty-five cases were approved papillary thyroid carcinoma (91.8%)，11 cases were follicular thyroid carcinoma (4.3%)， 7 cases were medullary thyroid carcinoma (2.7%)， 3 cases were anaplastic thyroid cancer (1.2%). All patients underwent surgery. The operation procedures included thyroidectomy and lymph nodes dissection in central zone of affecting side and subtotal thyroidectomy of contralateral side. Total or subtotal thyroidectomy of both sides and the dissection in unilateral or bilateral Ⅵ region lymph nodes or functional cervical lymph nodes dessection plus contralateral side Ⅵ region lymph nodes dissection in multi-focal cancer and double leaf gland cancer. Functional cervical lymph nodes dessection if existing lymph nodes metastasis or thyroid cancer invading anterior cervical muscle. Two hundreds twentyeight cases were followed up with complete clinical information about (6.5±1.3) years (3-9 years). Six cases died during follow-up because of relapse or metastasis.Conclusions Imaging evaluation is the main method for diagnosis of thyroid cancer. Needle biopsy is reliable and accurate for diagnosis of thyroid tumor. Diameter of tumor is related with cervical lymph node metastasis. Patho-type and stage of tumor, local invasion extent, lymph node metastasis and operation procedure are related with the relapse closely.
Objcetive To assess the efficacy and safety of lenalidomide plus dexamethasone (LD) compared with placebo plus dexamethasone (PD) for relapsed or refractory multiple myeloma. Methods Data were searched in The Cochrane Library (Issue 3, 2010), MEDLINE (with PubMed, 1966 to Nov. 2010), EMbase (1984 to Nov. 2010), CBMdisc (1978 to Nov. 2010), and CNKI (1979 to Nov. 2010), and also searched in clinical trials register for ongoing studies and completed studies with unpublished data. The references of the included studies and relevant supplement or conference abstracts were handsearched. Randomized controlled trials were included. The data were extracted, and then the quality of the included studies was assessed by two reviewers independently. RevMan 5.0 software was used for meta-analyses for studies with low heterogeneity. Results Two studies involving 704 participants were included. One was high quality study, while the other was unclear about randomization and allocation concealment. The adverse outcomes of LD, such as mortality (RR=0.78, 95%CI 0.62 to 0.97, P=0.03) and incidence of disease progression (RR=0.16, 95%CI 0.08 to 0.34, Plt;0.000 01), were better than those of PD, which had significant differences. The overall response rate was higher in the LD group than in the PD group (RR=2.75, 95%CI 2.22 to 3.41, Plt;0.000 01). The incidence of thrombotic event (RR=3.20, 95%CI 1.78 to 5.73, Plt;0.000 1), the Grade Three and Grade Four neutropenia (RR=10.20, 95%CI 5.76 to 18.08, Plt;0.000 01), the Grade Three and Grade Four thrombocytopenia (RR=2.08, 95%CI 1.28 to 3.38, P=0.003), and the incidence of drug withdrawal or dosage reduction due to adverse reactions (RR=1.34, 95%CI 1.21 to 1.49, Plt;0.000 01) were all higher in the LD group than in the PD group. Conclusion The efficacy of LD is superior to that of PD for relapsed or refractory multiple myeloma, but the incidence of drug adverse events, such as thrombosis, Grade Three or Grader Four neutropenia or thrombocytopenia, is also higher than that of PD, which has to be prevented positively.
Objective To evaluate the clinical application value of the tauro ursodeoxycholic acid (TUDCA) for preventing the relapse of lithiasis after the gallbladder-protected lithotomy. Methods Totally 80 cholecyslithiasis patients in Chengdu General Military Hospital who met the demand of lithotomy in protecting gallbladder were divided into two groups by random permutations, with 40 patients in each. The calculus was removed by using the percutaneous ultrasonic lithotripsy in order to preserve the well-functioning gallbladder. The patients in the trial group were given TUDCA after surgery for two years, whereas the patients in the control group received the same nursing and diet therapies without medication. The thickness of gallbladder wall and the contraction function of gallbladder were checked two years after surgery, the statistics of the recurrence rate of liary calculus symptoms and cholecyslithiasis were conducted, and the comparison between those two groups was performed. Results All the operations of gallbladder-protected lithotomy were successful. There was significant difference between those two groups two years after surgery in terms of the thickness of gallbladder wall and the contraction function of gallbladder (Plt;0.05). The relapse of lithiasis was remarkably decreased in the trial group (Plt;0.05). Conclusion The application of TUDCA for patients with gallbladder-protected lithotomy can prevent the relapse of cholecyslithiasis.
Objective To study the usefulness of combined detection of 4 tumor markers in patients with recrudescent and metastatic breast cancer. Methods The serum levels of CA153, CEA, TPS and CA125 were determined by chemiluminescence immunoassay. A total of 1245 subjects entered the study. Sensitivities of the tests were evaluated in 1 000 patients with breast cancer (102 preoperative patients and 898 postoperative patients) and 245 with benign breast disease. Results The serum levels of CA153, CEA and TPS were significantly elevated in preoperative patients compared with metastatic patients (Plt;0.001). The serum levels of CA153, CEA, TPS and CA125 were significantly elevated in metastatic patients compared with non-metastatic patients (Plt;0.001). The sensitivity of the 4 tumor markers were significantly elevated in metastatic patients compared with preoperative and postoperative non-metastatic patients (Plt;0.05). The sensitivity of combined detection of the 4 tumor markers were 56.72% and 94.68% in preoperative patients and metastatic patients, respectively. The CEA elevation was bly correlated with CA153 and TPS levels (all P=0.000 1, r=0.410 and 0.396, respectively). Conclusion Combined detection of the 4 tumor markers may play a guiding role in post-therapeutic monitoring of breast cancer in progressive, recrudescent and metastatic patients.
Objective To investigate the clinical features of hypersensitivity pneumonitis and misdiagnosis causes. Methods The morbidity, misdiagnosis, progression, treatment, recovery, relapse and experience of treatment of a case with hypersensitivity pneumonitis was retrospectively analyzed. Results Patients with hypersensitivity pneumonitis usually have a contact history of organic dust, and clinical manifestations are nonspecific. Chest radiography shows wandering pattern of multiple reticular or patchy infiltration shadows. Lung function tests showrestricted ventilation and impaired diffusion. Blood eosinophil is usually normal. Lymphocyte and sedimentation antibody in serum and bronchoalveolar lavage fluid may still be normal. Pathohistology is complicated, with a progression from acute inflammation to chronic fibrosis. Systemic steroid should be prescribed as soon as possible. Antigen avoidance should be emphasized. Conclusions Clinical symptoms of hypersensitivity pneumonitis is atypical, which may be easily misdiagnosed. The contact history, clinical features, chest radiography, laboratory examination and pathological changes should all be considered in such cases.
ObjectiveTo determine the outcome of antiepileptic drugs (AEDs) withdrawal in patients who had been seizure-free for more than two years. MethodsPatients with epilepsy who had been seizure-free for at least two years and decided to stop AEDs therapy gradually were checked on every two months for seizure relapse. The inclusion criteria were:①diagnosis of epilepsy, defined as at least two unprovoked seizures at least 24 hours apart; ②patients remained seizure-free for at least 24 consecutive months during AEDs therapy; ③patients expressed a desire to discontinue AEDs therapy gradually and agreed to return for regular follow-ups; and④electroencephalogram (EEG) showed no epileptic discharge. The time to a seizure relapse and predictive factors were analyzed by survival methods, including sex; age at seizure onset; number of episodes; seizure-free period before AEDs withdrawal; duration of follow-up after AEDs withdrawal; AEDs tapering off period (taper period); results from brain MRI; EEG before seizure-free; EEG before drug withdrawal; seizure type (classified as generalized, partial, or multiple types based on history); the number of AEDs administered for long-term seizure control. A log-rank test was used for univariate analysis, and a Cox proportional hazard model was used for multivariate analysis. ResultsSixty-eight patients (39 male, 29 female) were admithed. The relapsed rate was 23.5%. Univariate analysis and multivariate Cox regression analysis indicated that multiple AEDs, hippocampal sclerosis and withdrawal time were significantly correlated with seizure recurrence and those were significant independent predictive factors, with hazard ratio were 0.861, 2.223 and 2.137 respectively. ConclusionsThe relapsed rate in our study was similar to other studies. Distinguishing variables, such as multiple AEDs, hippocampal sclerosis and withdrawal time, need to be considered when decide to withdraw. Therefore, our recommendation is that after two years of being seizure-free, patients could consider withdrawal unless they are hippocampal sclerosis patients.
ObjectiveTo explore the clinical features and outcomes of relapsed acute lymphoblastic leukemia (ALL) in children. MethodsThirty-two ALL children treated in line with the Chinese Child Leukemia Cooperative Group ALL-2008 protocol with a relapse of the disease during January 2009 to May 2013 were enrolled into this study. Their clinical features and outcomes were retrospectively analyzed and compared with those who achieved continuous complete remission (CCR). ResultsThere were 32 relapsed cases among 319 newly diagnosed ALL cases (excluding infantile ALL) during the study period, with a relapse rate of 10%. In the relapse group, the proportions of patients with peripheral blood white blood cell count ≥50×109/L at diagnosis, positive BCR/ABL fusion gene, poor prednisone response, high risk stratification, and who failed to achieve bone marrow complete remission at d15 and d33 of induction chemotherapy, were significantly higher than those in the CCR group (all P<0.05). Multivariate analysis showed that high risk stratification was an independent risk factor for relapse (OR=3.529, P=0.002). In terms of site of relapse, isolated marrow relapse, isolated central nervous system relapse, isolated testicular relapse and combined relapse accounted for 23 (72%), 6 (19%), 1 (3%) and 2 (6%), respectively. As regard to the time of relapse, 26 cases (81%), 4 cases (13%) and 2 cases (6%) were categorized as very early relapse, early relapse and late relapse respectively. Twenty-four children with relapsed ALL received re-induction chemotherapy. Among them, 16 cases (67%) achieved second complete remission. Nevertheless, 9 cases ultimately suffered second relapse. ConclusionRelapse, which occurs more commonly in high risk ALL group, still remains a great challenge in clinical practice. Relapsed ALL, especially those with very early and early marrow relapse, has poor prognosis.
ObjectiveTo analyze the influence of different surgical methods on survival and relapse-free survival in colorectal liver metastases. MethodsClinical data of 71 cases of colorectal liver metastases who treated in PLA General Hospital from January 2002 to may 2013 were collected retrospectively, to analyzed the effect of different surgical methods on survival and relapse-free survival of this kind of cases. ResultsAll of primary lesions underwent radical resection. And for the liver metastases, 20 cases didn't received any intervention (non-intervention group), 20 cases underwent resection of liver metastases, 20 cases underwent radiofrequency ablation, and 11 cases underwent radiofrequency ablation and resection of liver metastases (all 61 cases who received intervention were classified to intervention group). Results of Cox proportional hazards model showed that, in the condition of controlling other confounding factors, intervention can improve the survival (HR=1.724, P=0.043) and relapse-free survival (HR=0.701, P=0.048) of cases of colorectal liver metastases, cases who received intervention had better survival situation and the relapse-free survival situation. ConclusionFor cases of colorectal liver metastases, in condition of radical operation for colorectal cancer, the intervention for liver metastases can prolong the survival time and relapse-free survival time.
Objective To systematically review the pharmacoeconomic evaluation related to relapsed or refractory B-cell acute lymphoblastic leukemia (r/r B-ALL), and to summarize its model structure, parameter inclusion and other methodological parts for future r/r B-ALL-related interventions, and to provide references for conducting pharmacoeconomic evaluations. Methods PubMed, EMbase, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect relevant literature on the pharmacoeconomic evaluation model of r/r B-ALL from inception to August 6th, 2021. Two reviewers independently screened literature, extracted data, and assessed the quality of the included studies. The data on the model structure, methods, and parameter inclusion were then summarized. Results A total of 10 studies using different modeling methods were included. Due to the lack of head-to-head trials, most of the efficacy parameters for the intervention and control groups were derived from different clinical trials and compared indirectly. All studies used quality-adjusted life years (QALYs) as output indicators, and some used life years (LYs) as output indicators and reported the incremental cost effectiveness ratio (ICER). All studies measured the cost of treatment and hematopoietic stem cell transplantation; a few studies also conducted subgroup analysis. Conclusion The number of studies on the economic evaluation of r/r B-ALL is relatively small, and there are large differences in model types, health status, and parameter inclusion. It is suggested that researchers should guarantee the integrity of the report format and normative according to available data choice drug economics evaluation model and establish the reasonable hypothesis under the condition of the patient population heterogeneity uncertainty, perform subgroup analysis especially on the subgroup which did not receive salvage therapy. In the absence of head-to-head clinical trials, appropriate indirect comparison methods are adopted according to the data obtained to reduce methodological differences and improve the quality of relevant pharmacoeconomic research in China.
Objective To investigate the clinical features, diagnosis and treatment of symptomatic epilepsy complicated with central nervous system leukemia (CNSL) recurrence after acute lymphoblastic leukemia (ALL) treatment in children. MethodsThe clinical data of a child with secondary recurrence of CNSL complicated with symptomatic epilepsy after ALL treatment admitted to the Department of Pediatrics of the Second Affiliated Hospital of Auhui Medical University from December 2020 to February 2023 were retrospectively analyzed, and the relevant literature was reviewed and discussed. ResultsPatient was ALL for nealy two years after treatment in the central nervous system leukemia relapse of concurrent symptomatic epilepsy, two of the central nervous system leukemia relapse when starting symptoms are seizure, the first recurrence was status epilepticus, second recurrence of concurrent limb hemiplegia symptoms, cerebrospinal fluid, cranial magnetic resonance (MRI) and abnormal changes of electroencephalogram and clinical features, the abnormal changes of brain MRI lesions and electroencephalogram did not disappear. Chemotherapy, intrathecal injection and radiotherapy were given for the primary treatment, follow up CAR-T immunotherapy, and the treatment was successively combined with nalproate and levetiracetam. Currently, the seizures were controlled. ConclusionFor children with ALL, the recurrence of CNSL should be warned after the end of treatment. Cerebrospinal fluid, cranial imaging and electroencephalogram examination should be completed in time to confirm the diagnosis. If the crania imaging lesions persist after treatment and abnormal electroencephalogram discharge does not disappear, the possibility of CNSL recurrence should be warned when the epileptic seizures are repeated. On the basis of primary disease active treatment, combination of antiseizure medications is preferable.