Objective To systematically analyze and compare the casualties’ medical evacuation (ME) in Wenchuan and Yushu earthquakes, so as to provide useful references for earthquake casualties’ ME in the future. Methods The data about casualties’ ME in Wenchuan and Yushu earthquakes were collected from the field research, work statement of the Ministry of Health, official websites, and literatures. And the descriptive analysis was then performed. Results From Wenchuan to Yushu, the principle of ME tended to be “early evacuation, all evacuation”; the evacuation level was gradually simplified, the casualties were evacuated directly from the disaster area to the rear hospital through highway and railway, or air evacuation became the major method of ME; triage became less prominent, while specialist treatment was strived as early as possible. Conclusion The early establishment of appropriate evacuation principles, building of a simplified evacuation system, ensuring adequate medical transport capacity, and scientific assessment of treatment capacity at all levels are the main issues of effective and safe ME after earthquakes that require to be solved urgently.
ObjectiveTo investigate the value of integrin αvβ3 targeted microPET/CT imaging with 68Ga-NODAGA-RGD2 as radiotracer for the detection of osteosarcoma and theranostics of osteosarcoma lung metastasis.MethodsThe 68Ga-NODAGA-RGD2 and 177Lu-NODAGA-RGD2 were prepared via one-step method and their stability and integrin αvβ3 binding specificity were investigated in vitro. Forty-one nude mice were injected with human MG63 osteosarcoma to established the animal model bearing subcutaneous osteosarcoma (n=21), osteosarcoma in tibia (n=5), and osteosarcoma pulmonary metastatic (n=15). The microPET-CT imaging was carried out in 3 animal models at 1 hour after tail vein injection of 68Ga-NODAGA-RGD2. Biodistribution study of 68Ga-NODAGA-RGD2 was performed in animal model bearing subcutaneous osteosarcoma at 10, 60, and 120 minutes. The animal model bearing pulmonary metastatic osteosarcoma was injected with 177Lu-NODAGA-RGD2 at 7 weeks after model establishment to observe the therapeutic effect of pulmonary metastatic osteosarcoma. Histological and immunohistochemistry examinations were also done to confirm the establishment of animal model and integrin β3 expression in animal models bearing subcutaneous osteosarcoma and bearing pulmonary metastatic osteosarcoma.Results68Ga-NODAGA-RGD2 and 177Lu-NODAGA-RGD2 had good stability in vitro with the 50% inhibitory concentration value of (5.0±1.1) and (6.5±0.8) nmol/L, respectively. The radiochemical purity of 68Ga-NODAGA-RGD2 at 1, 4, and 8 hours was 98.5%±0.3%, 98.3%±0.5%, and 97.9%±0.4%; while the radiochemical purity of 177Lu-NODAGA-RGD2 at 1, 7, and 14 days was 99.3%±0.7%, 98.7%±1.2%, and 96.0%±2.8%. 68Ga-NODAGA-RGD2 microPET-CT showed that the accumulation of 68Ga-NODAGA-RGD2 in animal models bearing subcutaneous osteosarcoma and osteosarcoma in tibia and in lung metastasis as small as 1-2 mm in diameter of animal model bearing pulmonary metastatic osteosarcoma. Biodistribution study of 68Ga-NODAGA-RGD2 in animal model bearing subcutaneous osteosarcoma revealed rapid clearance from blood with tumor peak uptake of (3.85±0.84) %ID/g at 120 minutes. The distribution of 177Lu-NODAGA-RGD2 in lung metastasis was similar with 68Ga-NODAGA-RGD2. The number and size of osteosarcoma metastasis decreased at 2 weeks after 177Lu-NODAGA-RGD2 administration and integrin targeting specificity was confirmed by pathology examination.Conclusion68Ga-NODAGA-RGD2 was potential for positive imaging and early detection of osteosarcoma and metastasis. Targeted radiotherapy with 177Lu-NODAGA-RGD2 was one potential alternative for osteosarcoma lung metastasis.
ObjectiveTo analyze rate of intraperitoneal lymph node metastasis (LNM) in Siewert type Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction (AEG) so as to determine optimal extent of lymph node dissection. MethodsA systematic and comprehensive search of PubMed, Medline, and Cochrane Library databases for study reports on LNM in patients with Siewert type Ⅱ/Ⅲ AEG was performed. The retrieval time ranged from database establishment to October 1, 2021. The pooled LNM rate was analyzed for each lymph node group. In addition, the influencing factors of LNM in AEG were analyzed. ResultsAfter screening, a total of 22 relevant studies were included, with a total of 3 934 cases. For the patients with Siewert type Ⅱ/Ⅲ AEG, the LNM rates of No.1, 2, 1&2, 3, 7 lymph nodes were ≥20%, LNM rates of No.4, 9, 11 (11p+11d), 11p, 16 lymph nodes were 10%–20%, LNM rates of No.4sa, 8a, 10, 11d lymph nodes were 5%–10%, the rest were <5%. For the patients with Siewert type Ⅱ AEG, the LNM rates of No.1, 2, 1&2, 3, 7 lymph nodes were ≥20%, LNM rates of No.4, 9, 11 (11p+11d), 11p lymph nodes were 10%–20%, LNM rates of No.8a, 10 lymph nodes were 5%–10%, and the rest were <5%. For the patients with Siewert type Ⅲ AEG, the LNM rates of No.1, 2, 1&2, 3, 4, 7 lymph nodes were ≥20%, LNM rate of No.11p lymph nodes was 10%–20%, LNM rates of No.4sa, 4sb, 4d, 8a, 9, 10, 11(11p+11d), 11d lymph nodes were 5%–10%, and the rest were <5%. No matter Siewert Ⅱ and (or) Ⅲ AEG patients, the rates of LNM in No.5, 6, and 12a lymph nodes were <5%. The tumor diameter ≥2 cm and higher T stage (T2–T4) increased the probability of LNM in AEG (P<0.05). ConclusionsThe results of this meta-analysis combined with the literature suggest that in clinical practice, No.10 lymph node dissection is not necessary for Siewert Ⅱ and Siewert Ⅲ AEG patients with tumor length diameter <2 cm and T1 of tumor invasion. No matter Siewert Ⅱ or Ⅲ AEG, as long as the tumor length diameter <2 cm and T1 of tumor invasion, the distal perigastric lymph nodes (No.4d, 5, 6) may not be dissected; Siewert type Ⅱ or Ⅲ AEG patients don’t need to clean No.12a lymph nodes.
Objective To evaluate the clinical short-term efficacy and safety of application of glucocorticoids (GCs) before major abdominal surgery. Methods The randomized controlled trials (RCTs) on application of GCs before major elective abdominal surgery were systematically and comprehensively searched in Medline (1966–2022), Embase (1947–2022), Web of Science, and PubMed databases, and systematic review and meta-analysis of the included studies were performed to explore the effects of application of GCs before major abdominal surgery on postoperative complication, hospital stay, and serum interleukin-6 level. Results Nineteen moderate quality RCTs with 1 535 patients were finally included in the analysis. Preoperative application of GCs reduced postoperative IL-6 level [MD=–51.00, 95%CI (–62.36, –39.63), P<0.001], reduced postoperative complications [OR=0.53, 95%CI (0.35, 0.81), P=0.003], shorten hospital stay [MD=–0.64, 95%CI (–1.04, –0.24), P=0.002], and reduced the occurrence of infectious complications [OR=0.50, 95%CI (0.36, 0.70), P<0.01]. However, there were no statistically significant difference in incidence of anastomotic leakage [OR=1.15, 95%CI (0.43, 3.04), P=0.780] and bile leakage [OR=1.95, 95%CI (0.76, 5.00), P=0.170]. Conclusion Preoperative application of GCs can reduce the level of IL-6, reduce complications after major abdominal surgery and shorten postoperative hospital stay.