In the absence of large trials, it is important for us to discuss whether a well-conducted meta-analysis of smaller randomized controlled trial (RCT) can replace large trials or not. We have evaluated the quality of original literature and methodological quality. The difference between meta-analysis of smaller RCT and the largest randomized trials have also discussed.
摘要:目的：探讨皮肤平滑肌肉瘤的临床病理特点和诊断要点及预后。方法:对2例皮肤平滑肌肉瘤组织病理学、免疫组化观察,并复习相关文献。结果: 例1为皮下平滑肌肉瘤,具有结节型的生长形态,瘤细胞丰富,异型性较大,核分裂活跃；例2为真皮平滑肌肉瘤,具有弥漫型的生长形态,瘤细胞较少,分化好,核分裂象不明显。免疫组化2例均表达SMA、MSA、Vim,1例灶性表达Desmin。2例随访迄今均无复发及转移。结论:皮肤平滑肌肉瘤少见,可分为真皮和皮下两种类型,两者具有不同的组织起源和预后特点,我们要注意区分,诊断除核分裂象计数外,尚需进行综合评估,对某些病例建议采用恶性潜能未定的平滑肌肉瘤的诊断,治疗首选外科手术切除。Abstract: Objective: To investigate the clinic pathological features diagnosis main point and prognosis of cutaneous leiomyosarcoma（CLMS）.Methods:Histopathology,immunohistochemical stainings observation were analyzed in two cases of CLMS and the related literatures were reviewed. Results:Case 1 was subcutaneous leiomyosarcoma with tubercular growth pattern,rich tumor cell,big heterogeneous type,active mitotic；Case 2 was dermis leiomyosarcoma with diffuse growth pattern,few tumor cell,well differentiated,no more mitotic. Immunohistochemically,the two cases reacted positively with smooth muscle action、MSA and Vim,Case 1 also expressed desman partially. The two cases were revisited to date,no recurrences and metastases.Conclusion:Cutaneous leiomyosar coma is a rare tumor,subdivided into dermis and subcutaneous forms because of their different tissue origins and prognosis features. We must discriminate between them. Diagnosis need synthetic appraisal besides mitotic counts and “smooth muscle tumor of uncertain malignant potential” should be used for diagnosis of certain cases.Primary treatment for cutaneous leiomyosarcoma is surgical excision.
Abstract： Objective To summarize our experience of surgical treatment for anomalous origin of one pulmonary artery in infants and children. Methods From March 2005 to May 2010，11 patients with anomalous origin of one pulmonary artery and other concomitant congenital cardiovascular malformations underwent surgical repair in Xijing Hospital of Fourth Military Medical University．The mean age of the patients was 11.5 months with a range from 2 months to 36 months．Their mean body weight was 7.1 kg with a range from 4 to 13 kg. Seven patients had anomalous origin of the right pulmonary artery from the ascending aorta, and four patients had anomalous origin of the left pulmonary artery from the ascending aorta. All the eleven patients had other concomitant intracardiac anomalies or vascular malformations as well as pulmonary hypertension, and underwent one stage surgical repair via median sternotomy under hypothermia and cardiopulmonary bypass. Results Their operation time was 169 - 293 （231±55） min, cardiopulmonary bypass time was 87-210 （138±47） min, and aortic-clamping time was 45-133 （86±28） min. There was one postoperative death who had low cardiac output syndrome after repair for tetralogy of Fallot and anomalous origin of the right pulmonary artery. The overall postoperative mortality was 9.1％. Postoperative echocardiography of all the surviving patients showed their left and right pulmonary artery origined from the right ventricle and pulmonary artery with satisfactory malformation correction but no residual shunt and pulmonary stenosis . All the surviving ten patients were followed up with a follow-up rate of 100% and mean follow-up time of 13.5 months with a range from 3 to 32 months. Their echocardiography during follow-up showed that there was no pulmonary stenosis in all the patients, and pulmonary blood pressure significantly decreased in 9 patients. Conclusion Patients with anomalous origin of one pulmonary artery should undergo surgical repair as early as possible with satisfactory short-term outcomes in infants and children. For elder patients with irreversible pulmonary hypertension, the choice of surgical treatment should be more cautious. During the surgery, the anomalous pulmonary artery and ascending aorta should be dissociated fully, and transection of the ascending aorta is helpful to get a satisfactory operating field view for the surgeon. Repairing aortic defect with autologous pulmonary arterial patch can effectively avoid the occurrence of postoperative aortic aneurysm.
Objective To analysis the original articles published in Chinese Journal of Urology and to evaluate the present situation of the clinical and scientific research in the field of urology, providing clue to raise the clinical and scientific research level. Methods Chinese Journal of Urology and Journal of Urology in American were hand-searched and all original articles were divided into eight types and were identified and analyzed. The classes include descriptive studies, therapeutic studies, studies on diagnosis, etiology, prognosis etc. Results The decreased trend year by year were observed for the descriptive studies (χ2=286.179, Plt;0.005), number of such publications accounting for 71.90% in 1980-1984 down to 26.48% in 1999-2001. Number of randomized controlled trials and clinical controlled trials present distinct increasing trend, especially number of RCT increased from none in 1980-1984 to thirteen articles in 1995-1998. The proportion of laboratory research in all original articles have increased greatly and have exceeded that of Journal of Urology. Conclusions The clinical and scientific research level of urology have been elevating in our country, the constituent ratio of descriptive studies is decreasing and that of RCT and CCT is increasing. The constituent ratio of laboratory research has increased greatly and has exceeded that of similar foreign Journal in some years. Attention needs to be paid to this trend and mechanism of it should be further explored.
Objective To explore the feasibility of identifying clonal origin of hepatocellular carcinoma (HCC) by analyzing the mitochondrial DNA D-Loop region variations. Methods Forty-two patients with a total of 112 HCC nodules consequentially hospitalized for radical resection of HCC in the department of hepatobiliary surgery of the First Affiliated Hospital of Guangxi Medical University from April 2004 to August 2007 were included for study group (multinodular HCCs). Control group included 20 cases of HCC (40 samples) hospitalized in the same period that consisted of two sub-groups: control groupⅠconsisted of 16 cases of single nodular HCC that each had two pieces of inconsecutive tumor tissues and control groupⅡconsisted of 4 cases of HCC with portal vein tumor embolus whose tumor tissues and portal vein tumor embolus were collected simultaneously. Normal control included 5 patients who were donors for liver transplantation or underwent liver trauma without any liver disease. Polymerase chain reaction (PCR) and direct sequencing were applied to study the mtDNA D-Loop region. The sequences of multinodular lesions were compared among different groups. Results For all the 42 cases of the study group, basic group variations appeared in 131 sites (131/1 122, 11.7%, the number 1 122 was the length of mtDNA D-Loop) with point mutation in 15 sites, insert in 9 sites, and deletion in 16 sites. And of all the variations in the study group, 98 were polymorphism. In study group, 20 cases were categorized as multicentric occurrence (MO) based on their variant mtDNA D-Loop sequences in each nodule from the same patient. And 22 cases were characterized as intrahepatic metastasis (IM) based on the identical mtDNA D-Loop sequences found in each nodule from the same patient. In all 20 cases in the control group, the inconsecutive tumor tissues or the portal vein tumor embolus and original tumors shared identical mtDNA D-Loop sequences. For the normal control group, basic group variations appeared in 14 sites, and they were all polymorphism including a new polymorphism (NT 479 Agt;G). Conclusions There is a high rate of changes in mtDNA D-Loop region. And our study speculates a novel discrimination of MO and IM origins among multinodular HCCs using PCR and direct sequencing of the mtDNA D-Loop sequences.
ObjectiveTo investigate the diagnostic value of 18F-FDG PET/CT scan for fever of unknown origin. MethodsThe 18F-FDG PET/CT scan results and clinical data were analyzed retrospectively in 32 patients with fever of unknown origin examined between January 2011 and October 2013. Final diagnoses were determined with recognized diagnostic standard. Results18F-FDG PET/CT scan was able to detect the cause of fever precisely in 53.1% (n=17) of the patients and was helpful in 25 patients (78.1%). The final cause of fever was determined in 20 patients, including infection (40%), malignancy (10%), non-infectious inflammatory disease (40%) and miscellaneous causes (10%). True positive, false positive, true negative and false negative rate of the modality were 17.0%, 4.0%, 8.0% and 3.0%; and the sensitivity and specificity were 85.0% and 66.7%. Conclusion18F-FDG PET/CT scan plays an important role in the diagnosis of fever of unknown origin.
In order to investigate immune protection against swine-origin influenza virus (S-OIV) A H1N1, the helper-dependent adenovirus vector (HDAd) system was exploited to construct recombinant HDAd encoding hemagglutinin (HA). The HA gene was synthesized and cloned to the HDAd backbone. Then, the HDAd/HA DNA molecules were transfected into 293Cre4 cells with calcium phosphate. The cells were infected by helper virus 16 hours after the transfection. The 293Cre4 cells were coinfected with HDAd/HA and the helper virus for large-scale preparation of HDAd/HA. The HDAd/HA was obtained and purified twice with CsCl density ultracentrifugation and observed morphologically under transmission electron microscope, and the expression of HA protein was analyzed with RT-PCR. Recombinant HDAd/HA expressing HA protein was successfully constructed which could pave the way for in vivo investigation on immunogenicity and efficacy against S-OIV A H1N1 infection.
ObjectiveTo explore surgical methods and risk factors of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). MethodsClinical data of 28 ALCAPA patients who underwent surgical repair from October 1993 to September 2013 in Beijing Anzhen Hospital were retrospectively reviewed. There were 8 male and 20 female patients with their age of 0.6-l6.8 (4.3±0.7)years including 10 patients less than 1 years old. Surgical procedures included simple ligation of left coronary artery, intrapulmonary tunnel procedure (Takeuchi)and direct coronary reimplantation of the anomalous artery. Postoperative death, complication and cardiac function were observed. ResultsAmong the 28 patients, 1 patient received simple ligation of left coronary artery, and 7 patients received intrapulmonary tunnel procedure (Takeuchi), among whom 2 patients died postoperatively. Twenty patients received direct implantation of the anomalous artery into the ascending aorta, and 3 patients died postoperatively. Five patients who died postoperatively were 10.20±3.27 months old, including 3 patients with moderate mitral regurgitation (MR)and 2 patients with mild MR preoperatively. Preoperative heart function of the patients who died postoperatively was significantly reduced. Preoperative left ventricular ejection fraction of the patients who died postoperatively was significantly lower than that of the patients who survived (36.6%±8.5% vs. 60.9%±10.7%, P=0.000). Low cardiac output syndrome was the reason for all postoperative death. All survival patients were followed up from 1 month to 18 years. One patient who underwent intra-pulmonary tunnel procedure (Takeuchi)received pulmonary artery balloon dilatation for pulmonary supravalvular stenosis 15 years after discharge. None of the other patients received a secondary operation. During follow-up, left ventricular function was improved. Growth and development of all the patients was normal. MR did not significantly aggravate in all the patients. ConclusionPatients with younger age and worse left ventricular function have greater surgical risks of ALCAPA.
Objective To summarize the method and outcomes of surgical treatment for 21 patients with congenital anomalous left coronary artery from the pulmonary artery (ALCAPA). Methods We retrospectively analyzed the clinical data of 21 patients with ALCAPA underwent surgical treatment in our center from January 2010 to January 2015. There were 11 males and 10 females with a mean age of 4.3 years (ranging from 0.5 to 16.0 years) and a mean weight of 19.3 kg (ranging from 5.0 to 97.0 kg). All of 21 patients underwent surgery under cardiopulmonary bypass and corrected malformations. Results There were 2 perioperative deaths and the mortality rate was 9.5%. The mean cardiopulmonary bypass time was 116.6 minutes ranging from 109.0 to 388.0 minutes and the mean aortic cross clamping time was 82.9 minutes ranging from 62.0 to 129.0 minutes. The mean time of hospital stay was 11.1 days ranging from 1.0 to 25.0 days. After surgery, cardiac function improved significantly in all patients. The mean left ventricular ejection fraction (EF), left ventricular fractional shortening (FS), and left ventricular end-diastolic diameter (LVEDD) have significantly improved after surgery (P < 0.05). Conclusions Once patients with ALPACA are diagnosed, they should be treated with surgery and most of them will achieve a satisfactory long term clinical result.
Objective To analyze the clinical efficacy and mid-term outcomes of reimplantation of anomalous origin of left coronary artery from the pulmonary artery (ALCAPA), and to evaluate whether concomitant management of mitral regurgitation (MR) during ALCAPA repair is needed. Methods Between March 2005 and March 2015, 52 consecutive patients (20 males and 32 females with a median age of 10 months ranging 2-193 months) underwent reimplantation of ALCAPA at Department of Cardiac Surgery, Guangdong Cardiovascular Institute. There were 14 males and 21 females with a mean age of 35.4±42.8 months not receiving mitral valvuloplasty (a Non-MVP group), and 6 males and 11 females with a mean age of 13.5±11.0 months receiving mitral valvuloplasty (a MVP group). In order to facilitate the analysis, degree of MR was graded by number: 0.0=none, 1.0=trivial, 2.0=mild, 2.5=mild-moderate, 3.0=moderate, 3.5=moderate-severe and 4.0=severe. Results The left ventricular fractional shortening (LVFS) and left ventricular end diastolic diameter (LVEDD) demonstrated significant improvement between preoperation and discharge (28.6%±9.6% vs. 32.1%±10.1%, P=0.023; 38.4±5.6 mm vs. 30.5±5.7 mm, P<0.001), and there was also significant improvement in the mean MR grade between preoperation and discharge (2.9±1.2,vs. 2.4±1.2, P=0.001). There were 4 in-hospital deaths (7.7%). The median follow-up was 21.0 months (ranging 1.5-111.0 months). Three patients (5.8%) were lost to follow-up, 1 patient required reoperation for mitral valve replacement and there was no death during follow-up. Significant improvement was seen in LVFS between discharge and final follow-up (32.1%±10.1% vs. 38.0%±6.0%, P=0.001); however, there was no significant difference in the degree of MR between discharge and final follow-up (2.4±1.2 vs. 2.3±1.2, P=0.541). There was no significant difference in cardiopulmonary bypass time, aortic cross-clamping time, mechanical ventilation time or hospital stay between the two groups. Conclusion Creation of a dual coronary system with reimplantation of the left coronary artery results in complete recovery of left ventricular function. However, concomitant management of MR during ALCAPA repair remains controversial. Concomitant mitral valve repair for ALCAPA patients with moderate-severe and severe MR is helpful to early function recovery of mitral valve.