Insight into the oxidative stress induced by lead and/or cadmium in blood,liver and kidneys

Besides being important occupational hazards, lead and cadmium are nowadays metals of great environmental concern. Both metals, without any physiological functions, can induce serious adverse health effects in various organs and tissues.Although Pb and Cd are non-redox metals, one of the important mechanisms underlying their toxicity is oxidative stress induction as a result of the generation of reactive species and/or depletion of the antioxidant defense system. Considering that the co-exposure to both metals is a much more realistic scenario, the effects of these metals on oxidative status when simultaneously present in the organism have become one of the contemporary issues in toxicology.This paper reviews short and long term studies conducted on Pb or Cd-induced oxidative stress in blood, liver and kidneys as the most prominent target organs of the toxicity of these metals and proposes the possible molecular mechanisms of the observed effects. The review is also focused on the results obtained for the effects of the combined treatment with Pb and Cd on oxidative status in target organs and on the mechanisms of their possible interactions.     

The prevalence of undiagnosed postoperative lower limb lymphedema among gynecological oncology patients

ObjectiveLower limb lymphedema (LLL) is a common postoperative complication among gynecological oncology patients following lymph node resection. In the absence of a screening strategy, LLL is frequently diagnosed only through patient's self-reported symptoms. This study investigated the prevalence of undiagnosed postoperative LLL among gynecological oncology patients and identified the associated risk factors.Materials and methodsThis was a cross-sectional postal questionnaire survey at a tertiary gynecological oncology center. Women with gynecological malignancies who underwent lymph node (inguinal/pelvic/para-aortic) resection between 2010 and 2017 were eligible. The Gynecological Cancer Lymphedema Questionnaire (GCLQ) was used and those with a score of ≥4 were referred to a lymphedema specialist for clinical confirmation.ResultsAmong 376 eligible women, postoperative LLL was already diagnosed in 45/376 (12%) women. In the remaining women, 117/331 (35.3%) completed the GCLQ, of which 67/117 (57.3%) scored ≥4. Fifty-five women (55/67, 82.1%) were assessed by a lymphedema specialist and eight cases of postoperative LLL were confirmed. In the 12/67 who declined a clinical assessment, they reported no evidence of LLL. The prevalence of undiagnosed postoperative LLL in our study was 8/117 (6.8%, 95% C.I. 2.3–11.4). On univariate analysis, older women were more likely to have undiagnosed postoperative LLL.ConclusionsUndiagnosed postoperative LLL is not uncommon among gynecological oncology patients, especially in older patients. No vulvar cancer patient had undiagnosed LLL. Increased awareness and improved strategies for lymphedema screening are required after lymph node surgery in gynecological oncology.     

Ultrasound characteristics of a symptomatic and asymptomatic lymphocele after pelvic and/or paraaortic lymphadenectomy

ObjectiveTo describe the sonographic characteristics of a lymphocele after pelvic and/or paraaortic lymphadenectomy for gynecological malignancy, analyze and identify ultrasound characteristics related to the symptomatic and asymptomatic lymphoceles.Materials and methodsThis is a retrospective analysis of ultrasound examination data collected consecutively in patients after pelvic and/or paraaortic lymphadenectomy in one institution. We recorded the number of lymphoceles, localization, size; ultrasound morphology following International Ovarian Tumor Analysis group classification and symptoms.ResultsWe described and analyzed 227 lymphoceles (150 asymptomatic and 77 symptomatic) in 161 patients. The asymptomatic lymphocele is typically a thick-walled cystic lesion without vascularization, round and unilocular with anechoic or ground-glass content. The symptomatic lymphocele is typically an oval, or ovoid, unilocular lesion with low-level or anechoic content (ground glass content is unlikely to be present, p < 0.001) and the presence of debris and septations. The lymphocele size (p = 0.001), number of lymphoceles (>1) (p = 0.005), septa (p = 0.002), and debris (p < 0.001) were independent ultrasound features correlating to symptoms development. More than one lymphocele (p = 0.047), septations (p = 0.007) and presence of debris (p < 0.001) were independent ultrasound features correlated to infection.ConclusionUltrasound features of symptomatic and asymptomatic lymphocele differ. The clues for lymphocele differential diagnosis are the history of lymphadenectomy and the finding cystic lesion with typically ultrasound features of lymphocele, adjacent to great pelvic vessels. Unique ultrasound features of lymphocele may help to distinguish from tumor relapse, hematoma, abscess, seroma or urinoma.     

3D打印个体化模具在宫颈癌近距离治疗中的应用

  目的  通过3D打印个体化模具辅助插植，降低宫颈癌近距离治疗难度。  方法  前瞻性研究2019年6月至2020年7月30例于重庆大学附属肿瘤医院行根治性放化疗宫颈鳞状细胞癌患者，随机分为15例3D打印组（试验组）和15例通用施源器组（对照组）。评估两组治疗情况、靶区适形指数（coformity index，CI）、高危临床靶区（high-risk clinical target area，HR-CTV）90%体积的最低吸收剂量（D₉₀）、危及器官（organs-at-risk，OARs）受量及临床治疗结果。  结果  试验组无子宫穿孔，对照组子宫穿孔率为8.97%（7/78）。试验组的CI为0.81±0.01，与对照组的0.61±0.01相比，差异具有统计学意义（P < 0.05）；试验组HR-CTV D₉₀及膀胱的分次/总外照射等效剂量（equivalent dose in 2 Gy per fraction，EQD₂）分别为6.65±0.06/91.84±1.35及3.75±0.07/71.02±1.39，与对照组的6.17±0.06/88.59±0.11及4.09±0.07/74.81±1.50相比，差异均具有统计学意义（均P < 0.05）。试验组直肠及乙状结肠的受量降低，差异无统计学意义（P > 0.05），试验组治疗结束后3个月完全缓解（complete response，CR）率为93.33%（14/15），与对照组的86.67%（13/15）相比，差异具有统计学意义（P < 0.05）。  结论  3D打印个体化模具在辅助宫颈癌近距离插植治疗中有明显的优势，操作简单、安全性高、有利于组织间插植技术推广。      

No detrimental effect of perioperative blood transfusion on recurrence in 2905 stage II/III gastric cancer patients: A propensity-score matching analysis

BackgroundThe effects of perioperative blood transfusion on the prognosis of gastric cancer patients remain controversial. This study aimed to assess the association between perioperative blood transfusion and survival outcomes.MethodsThe study included 2905 patients who underwent curative gastrectomy for stage II/III gastric cancer between 2006 and 2015 and were followed until 2018. Propensity-score matching was used to adjust for differences in baseline clinicopathologic characteristics between patients with or without blood transfusion.ResultsOf 2905 patients, 543 (18.7%) received a perioperative blood transfusion. Patients with blood transfusion had significantly worse overall survival and recurrence-free survival than those without blood transfusion (p < 0.001 for both). Survival outcomes did not differ according to timing of transfusion (preoperative, intraoperative, or postoperative), transfused volume (1–2 units of packed red cells vs ≥ 3 units of packed red blood cells), and volume of intraoperative blood loss (≤300 mL vs > 300 mL). After propensity-score matching adjusting for risk factors associated with blood transfusion, 498 patients were included in each group. Long-term recurrence-free survival was not significantly different between patients with or without blood transfusion in the matched analysis (p = 0.808).ConclusionsIn propensity-score matched analysis, blood transfusion was not associated with recurrence-free survival. Clinical circumstances, including demographic, pathologic, and surgical characteristics, rather than blood transfusions, appear to be the main prognostic factors for recurrence.     

Retiform hemangioendothelioma: a rare lesion of the vulva

Retiform hemangioendothelioma (RH) is a rare borderline-malignant vascular tumor with specific histological characteristics, usually occurring in the limbs and trunk. We report the case of a 63-year-old woman who presented with a painless, oval nodule that had been growing slowly on her left vulva for 3 years. Magnetic resonance imaging of the pelvic cavity revealed a 4.4- × 2.7- × 1.8-cm cystic lesion in the subcutaneous fat of the left vulva. Resection beyond the macroscopic border was performed. Pathology revealed vascular structures with elongated and narrow arborizing vascular channels that were arranged in a retiform pattern resembling rete testis tissue. Immunohistochemical endothelial staining was positive for CD31, CD34, and Friend leukemia integration-1 (FLI-1). The above features confirmed a diagnosis of RH. There was no local recurrence or metastasis during the 26-month follow-up. RH of the vulva is rare, and its diagnosis is supported by specific histological characteristics and immunohistochemical staining for CD31, CD34, and FLI-1. Wide surgical resection with tumor-free margins is important for a favorable prognosis.     

化疗在子宫内膜癌治疗中的地位与应用

子宫内膜癌的发病率近年来呈明显上升趋势,具有高危因素的早期及晚期患者复发转移率高,预后相对较差。化疗对早期高危子宫内膜样腺癌及特殊病理类型子宫内膜癌的作用越来越突出,是晚期及复发子宫内膜癌的主要辅助治疗方式。现就化疗对具有高危因素早期子宫内膜癌的作用及晚期患者最佳化疗方案的研究简要综述。     

A phase II study of docetaxel weekly in combination with carboplatin every three weeks as first line chemotherapy in stage IIB-IV epithelial ovarian cancer: neurological toxicity and quality-of-life evaluation

The purpose of this study was to assess the response rate, toxicity, progression-free survival (PFS) and overall survival (OS) in a series of advanced stage ovarian carcinoma patients treated with a first-line weekly docetaxel and three weekly carboplatin regimens. All eligible patients were treated with intravenous docetaxel (30?mg/m2) on Days 1, 8 and 15, and carboplatin (area under the curve, 5) on Day 1; Q21 days for at least 6 cycles. Neurological tests, questionnaires, and the EORTC QLQ-C30 and OV28 were used for quality-of-life assessments. One hundred and six patients received at least one cycle of primary chemotherapy (median 6.0; range, 1-9) and they were evaluable for toxicity assessment. Eighty-five patients had evaluable disease and received at least 3 courses of chemotherapy and were evaluable for clinical response rate. The overall response rate was 78.8% (95% CI 70.1-87.5%) and the biochemical response was 92.8% (95% CI 87.2-98.4%). The median PFS was 12.0 months and the median OS was 35.3 months. Thirty-six patients (34.0%) experienced grades 3 and 4 neutropenia, which resulted in the removal of 3 patients. Six patients (5.7%) experienced grades 3 or 4 thrombocytopenia. No patients experienced grade 3-4 sensory neuropathy. Epiphora, nail changes and fatigue were frequently recorded non-hematological side effects. The tolerable hematological toxicity (no need for colony-stimulating factors) and the low rate of severe neurotoxicity (only grade 1-2) and response rates in line with the standard 3-week paclitaxel-carboplatin regimen for advanced primary ovarian carcinoma after suboptimal cytoreductive surgery make this regimen an interesting alternative in selected patients.