【摘要】 目的 评价早期巨块型宫颈癌患者术前行新辅助化学疗法的近期疗效。 方法 回顾分析2005年10月-2010年6月收治的Ⅰb~Ⅱa期巨块型宫颈癌患者90例患者的临床资料。根据术前是否行化学疗法将患者分为两组；新辅助化学疗法（neoadjuvant chemotherapy，NACT）组50例，术前予静脉化学疗法或子宫动脉灌注化学疗法治疗1～3个疗程;直接手术组40例，直接行根治性手术。比较新辅助化学疗法前后病灶大小变化，化学疗法不良反应，手术情况及术后病理情况。 结果 NACT组总有效率86%（43/50），鳞癌疗效优于腺癌，动脉与静脉化学疗法近期有效率比较，两组差异无统计学意义（Pgt;0.05）。NACT不良反应小。NACT组术中出血少于直接手术组，两者差异有统计学意义（Plt;0.05）。两组深肌层浸润、淋巴结转移、脉管浸润差异均无统计学意义（Pgt;0.05），NACT组宫旁浸润率低于直接手术组。 结论 术前NACT对早期巨块型宫颈癌患者近期疗效显著。【Abstract】 Objective To evaluate the short-term curative effect of preoperative neoadjuvant chemotherapy on the early-stage bulky cervical carcinoma. Methods We retrospectively analyzed the clinical data of 70 patients with bulky ⅠB-ⅡA cervical carcinoma treated in our hospital between October 2005 and June 2010. Based on whether the patients received chemotherapy, they were divided into two groups: neoadjuvant chemotherapy group (NACT group) and direct surgery group. In the former group, there were 50 patients who underwent surgery after 1 to 3 cycles of preoperative chemotherapy by uterus artery infusion or intravenous chemoembolization. For the 40 patients in the latter group, direct radical surgery was performed. The size of the tumor before and after chemotherapy, the operation conditions and the postoperative pathological conditions of patients between the two groups were compared and the adverse reactions of neoadjuvant chemotherapy were analyzed as well. Results The total effective rate of NACT group was 86% (43/50). The response to chemotherapy in squamous cell caner was significantly higher than adenocarcinoma. There was no statistical difference between arterial and venous chemotherapy in terms of immediate effect (Pgt;0.05). The incidence of adverse reactions of neoadjuvant chemotherapy was low. There was significant difference between the NACT group and the direct surgery group in intraoperative bleeding (Plt;0.05). There were no significant differences between the above two groups in deep muscularis infiltration rate, lymph node metastasis rate and vascular invasion rate. However, the parametrial infiltration rate for the NACT group was lower than that for the direct surgery group. Conclusion Preoperative neoadjuvant chemotherapy on patients with early-stage bulky cervical carcinoma has a remarkable immediate curative effect.
【摘要】 目的 探讨甲氨蝶呤(MTX)联合米非司酮治疗早期异位妊娠(EP)的临床效果。 方法 收集2006年2月-2010年2月收治的早期未破裂型EP患者126例，随机分为MTX联合米非司酮组62例，单独应用MTX组64例， MTX治疗采用小剂量分次肌肉注射给药进行。 结果 126例患者中，MTX联合米非司酮组和单独应用MTX治疗组的成功率为分别为88%和65%，两组差异有统计学意义(Plt;0.05)。 结论 MTX小剂量分次给药联合米非司酮治疗早期未破裂型EP效果优于MTX的单独使用。【Abstract】 Objective To observe the therapeutic effect of methotrexate (MTX) combined with mifepristone on early ectopic pregnancy. Methods A total of 126 patients with early ectopic pregnancy diagnosed from February 2006 to Febrary 2010 were randomly divided into two groups. In 126 patients, 62 treated with MTX combined with mifepristone were in the treatment group,and 64 treated independently with MTX were in the control group. MTX was administrated at a low dose in several times. Results In 126 patients,the success ratio of the treatment was 88% in treatment group groups and 65% in the control group; the difference between the two groups was significant (Plt;0.05). Conclusion Low-dose MTX in separate times combined with mifepriston is effective on the early ectopic pregnancy, and the therapeutic effect of the combined administration of MTX and mifepriston is better than that of the single administration with MTX.
【摘要】目的探讨实时超声弹性成像在淋巴结疾病诊断中的应用价值。 方法分析2008年2月4月27例淋巴结疾病患者的65个淋巴结病灶超声弹性图表现,弹性图分级为0~Ⅳ级,弹性图分型为Ⅰ~Ⅲ型。所有淋巴结均经术后病理学或细针抽吸细胞学检查证实,或经随访证实。结果转移性淋巴结弹性分级较高,≥Ⅲ级11/13,占84.62％;淋巴瘤性淋巴结弹性分级较低,≤Ⅱ级16/21,占76.19％。转移性淋巴结中Ⅱ型7/13,占53.85％,转移性淋巴结占全部Ⅱb型的54.55%(6/11);淋巴瘤性淋巴结中Ⅱ型13/21,占61.90％,淋巴瘤性淋巴结占全部Ⅱa型的73.33％(11/15);反应性淋巴结占全部Ⅰa型的68.18％(15/22)。结论实时超声弹性成像能为淋巴结疾病的诊断提供一定信息,弹性图分级对鉴别良恶性淋巴结有统计学意义,分型对于鉴别特定类型淋巴结疾病有一定提示作用。
ObjectiveTo explore the possibility that GREM1, a bone morphogenetic protein (BMP) antagonist, is a mechanical explanation for BMP signal suppression in congenital heart disease associated pulmonary arterial hypertension (CHD/PAH) patients.MethodsSystemic-to-pulmonary shunt induced PAH was surgically established in rats. At the postoperative 12th week, right heart catheterization and echocardiography evaluation were performed to evaluate hemodynamic indexes and morphology of right heart system. Right heart hypotrophy index and pulmonary vascular remodeling were evaluated. Changes of BMP signal pathway related proteins and GREM1 in lungs and plasma GREM1 concentration were detected. The effect of GREM1 on the proliferation and apoptosis of pulmonary arterial endothelial cells (PAECs) was also explored.ResultsThe hypertensive status was successfully reproduced in rats with systemic-to-pulmonary shunt model. BMP signal pathway was suppressed but GREM1 was up-regulated with no change in hypoxia inducible factor-1 in lungs exposed to systemic-to-pulmonary shunt, while this trend was reversed by systemic-to-pulmonary shunt correction (P<0.05). Immunohistochemical staining demonstrated enhanced staining of GREM1 in remodeled pulmonary arteries. In vitro experiments found that BMP signal was down-regulated but GREM1 expression and secretion were up-regulated in proliferative PAECs (P<0.05). Furthermore, BMP2 significantly inhibited PAECs proliferation and promoted PAECs apoptosis (P<0.05), which could be antagonized by GREM1. In addition, plasma level of GREM1 in rats with systemic-to-pulmonary shunt was also increased and positively correlated with pulmonary hemodynamic indexes.ConclusionSystemic-to-pulmonary shunt induces the up-regulation of GREM1 in lungs, which promotes pulmonary vascular remodeling via antagonizing BMP cascade. These results present a new mechanical explanation for BMP pathway suppression in lungs of CHD/PAH patients.
Objective The aim of this study is to review the molecular landscape of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Method The relevant literatures about molecular profiling of NIFTP were retrospectively analyzed and summarized. Results The most common mutation in NIFTP was rat sarcoma viral oncogene homolog (RAS) mutation. B-type RAF (BRAFK601E) mutation, PPARG fusion, and THADA fusion also could be seen. There was usually no BRAFV600E mutation. miRNAs also were found to be differentially expressed in NIFTP. Conclusion The molecular profiling of NIFTP may become a new molecular marker for the diagnosis of NIFTP.
ObjectiveTo indirectly compare the efficacy and safety of bipolar radiofrequency ablation versus hysterectomy in abnormal uterine bleeding by using network meta-analysis. MethodsThe PubMed, EMbase, Web of Science, Cochrane Library, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of different surgical methods in abnormal uterine bleeding from inception to May 20, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Network meta-analysis was then performed by using Stata 16.0 software. ResultsA total of 39 RCTs involving 3 307 patients were included. The results of network meta-analysis showed that hysterectomy was superior to bipolar radiofrequency ablation in terms of amenorrhea rate and reintervention rate, while the hospital stay and patient satisfaction rate were opposite. ConclusionCurrent evidence shows that bipolar radiofrequency ablation has more advantages in terms of hospital stay and satisfaction rate, while hysterectomy has more advantages in terms of amenorrhea rate and reintervention rate. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To compare therapeutic effects of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and transcatheter arterial chemoembolization (TACE) on patients with advanced hepatocellular carcinoma. Methods Thirty-five patients with advanced hepatocellular carcinoma admitted in the Department of Hepatobiliary and Pancreatic Surgery of Shiyan Taihe Hospital Affiliated to Hubei University of Medicine from August 1, 2014 to August 1, 2015 were randomly divided into ALPPS group and TACE group, in which 17 cases treated by the ALPPS and 18 cases treated by the TACE. The survival, changes of liver function and life quality, postoperative complications and mortality were compared in these two groups. The follow-up was performed by the telephone and the outpatient. Results ① The baselines such as the age, gender, diameter of tumor, complications had no significant differences in these two groups (P>0.05). ② The changes of liver function and life quality after operation in the ALPPS group were significantly better than those in the TACE group (P<0.05). ③ The complications after operation were observed in 5 cases (there were 2 cases of bile leakage, 1 case of intraabdominal bleeding, 1 case of peritoneal effusion, and 1 case of pulmonary infection) in the ALPPS group, which in 13 cases (there were 6 cases of nausea and vomiting, 4 cases of liver function damage, 2 cases of granulocytopenia, 1 case of fever) in the TACE group. The rate of the overall complications in the ALPPS group was significantly lower than that in the TACE group (5/17versus 13/18, P=0.018). ④ The overall survival in the the ALPPS group was significantly better than that in the TACE group (P=0.024). During follow-up period, the deaths happened in 3 cases duo to hepatocellular carcinoma and 1 case duo to traffic accident, 1 case was lost on month 8, 12 cases were still alive in the ALPPS group; the deaths happened in 10 cases duo to hepatocellular carcinoma, 1 case duo to coronary disease, and 1 case duo to cerebral infarction, 6 cases were still alive in the TACE group. Conclusion Preliminary results of limited cases in this study show that ALPPS has a better effect than TACE on patients with advanced hepatocellular carcinoma.
Objective To analyze the clinical features and survival of lung cancer with pleural effusions. Methods A total of 982 consecutive patients with a newly diagnosed lung cancer from January 2008 to December 2014 were retrospectively reviewed. To analyze the clinical features and survival differences, the total patients were divided into the following two groups: with (n=204) or without (n=778) pleural effusions. Results Lung cancer comprised 682 (69.5%) males and 300 (30.5%) females, with an average age of 59.74 years (19–93 years). There were 487(49.6%) squamous carcinoma, 254 (25.9%) adenocarcinoma and 166 (16.9%) small cell lung cancer; 113 (11.5%) lung cancer at early stage (Ⅰ–Ⅱ), 247 (25.2%) cases at stage Ⅲ and 567 (57.7%) at stage Ⅳ. The median survival time of all patients was 12 months. Patients with pleural effusions had a worse prognosis compared to patients without (median survival time: 11 vs.12 months, P=0.003), the median survival time could be reduced by 1 month in males (P=0.004), 3 months in elder patients over 60 years (P<0.001), 4 to 8 months in carcinoma and small cell lung cancer (P≤0.001), and 2 to 3 months in advanced lung cancer (stage Ⅲ and Ⅳ) (P<0.05). Any or combined treatment of surgery, radiotherapy, chemotherapy and targeted therapy was associated with an improved overall survival of about 2 months (P=0.009), and targeted therapy could even improve the median survival time by 1 to 8 months (P=0.002). Conclusions About 20.8% of the patients developed pleural effusion at the same time during the course of lung cancer. Pleural effusion is a poor prognostic factor of lung cancer.
Objective To assess the effect of astragaulus membranaceus in the treatment of pulmonary tuberculosis. Methods Through applying the methods provided by the Cochrane Collaboration, the randomized controlled trials (RCTs) or quasi-RCTs of astragaulus membranaceus in the treatment of pulmonary tuberculosis were searched in The Cochrane Library (Issue 3, 2010), CNKI (1991 to May 2010), VIP (1989 to May 2010), EMbase (1981 to May 2010), and PubMed (1981 to May 2010). Two reviewers independently screened the included studies, extracted the data, assessed the quality, and cross checked then. The RevMan 5.0 software was used to conduct meta-analyses. Results Twelve RCTs involving 1 054 patients were included. All trials were tested in the mainland China. The results of meta-analyses showed that: a) The astragaulus membranaceus could assist the conventional drug to cure pulmonary tuberculosis, promote sputum negative conversion, focal absorption and cavity reduction in lung; b) The astragaulus membranaceus could reduce the adverse reactions of the conventional drug; c) The astragaulus membranaceus combined with the conventional drug could improve the patients’ symptoms and signs; and d) The astragaulus membranaceus combined with the conventional drug could reduce the bacterial relapse rates in follow-up after treatment. Conclusion The current evidence shows that the astragaulus membranaceus has some effects and is relatively safe to treat pulmonary tuberculosis. However, it is far from enough to recommend astragaulus membranaceus as a conventional adjuvant therapy for pulmonary tuberculosis because of no sufficient evidence obtained from this study for its small sample and low methodology quality. Therefore, more double-blind multi-center RCTs with high quality, large sample, and adequate follow up are required for further verification.
Objective To evaluate and select essential medicine for the treatment of coronary heart disease by means of evidence-based approaches based on the burden of disease for township health centers located in eastern, central and western regions of China. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) 11 clinical guidelines on coronary heart disease were included, three of which are evidence-based guidelines. (2) Totally, those guidelines contained 61 medicines (of 13 classes). (3) According to WHOEML (2011), NEML (2009), CNF (2010), other guidelines and the quantity and quality of evidence, we made a b recommendation for nitroglycerin, isosorbide dinitrate, metoprolol, nifedipine, verapamil, enalapril and aspirin as essential medicine for coronary heart disease. We made a weak recommendation for amlodipine, clopidogrel, heparin, propranolol, simvastatin and streptokinase. (4) 13 recommended medicines have been marketed in China and their prices were affordable. (5) Results of domestic low-quality studies indicated that nitroglycerin, isosorbide dinitrate, metoprolol, aspirin and heparin were effective for coronary heart disease. We didn’t find systematic reviews or pharmacoeconomic studies on the recommended medicines in Chinese literature databases. Conclusion For coronary heart disease: (1) We offer a b recommendation for nitroglycerin, isosorbide dinitrate, metoprolol, nifedipine, verapamil, enalapril and aspirin and a weak recommendation for propranolol, amlodipine, clopidogrel, heparin, simvastatin and streptokinase. (2) There is lack of high-quality evidence from relevant domestic studies, especially on pharmacoeconomic evaluation. (3) We propose that more studies should be carried out on clinical guideline of coronary heart disease and pharmacoeconomic comparison should be also made between recommended medicine and medicine of the same class.