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991.
《Urologic oncology》2015,33(5):197-200
Due to the increased utilization of cross-sectional imaging and prolonged life expectancy, the incidence of incidentally diagnosed renal tumors continues to rise. While partial nephrectomy is currently recommended as the gold standard treatment of cT1a small renal mass whenever technically feasible, the perceived benefits of partial nephrectomy may not be applicable to all patient groups. Selecting between treatment options in elderly and the infirm can present a significant challenge. Informed and thoughtful small renal mass management decisions require consideration and balance of patient, tumor, and procedural risks to maintain oncological efficacy while minimizing treatment associated morbidity. Herein we review the comparative effectiveness of partial versus radical nephrectomy in the elderly and the role of standardized tools to quantify risk. 相似文献
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目的 本研究采用二维斑点追踪显像技术(2D-STI)评价使用蒽环类化疗药物患者左室收缩功能及左室收缩同步性,探讨2D-STI在评价蒽环类药物化疗早期心肌毒性中的应用价值。方法 选取我院诊断为乳腺癌的女性患者40例,所有患者均接受表柔比星化疗。分别在化疗前(T0)、第一周期及第二周期化疗后(T1、T2)进行二维超声心动图检查,用EchoPAC软件分析蒽环类药物化疗患者左室心肌内膜、心肌外膜、整体纵向应变(EndoGLS、EpiGLS、GLS)、环向应变(EndoGCS、EpiGCS、GCS)及左室整体径向应变(GRS);获取纵向、环向及径向整体达峰时间标准差(Tssl-SD、Tssc-SD,Tssr-SD)及纵向、环向及径向达峰时间最大差值(Tssl-Dif、Tssc-Dif、Tssr-Dif),获取纵向、环向及径向延迟指数(LSDI、CSDI、RSDI)。结果 与T0周期相比,GLS、endoGLS及endoGCS在T2周期化疗后的变化有统计学意义(p2均<0.05);与T0周期相比,患者Tssl-SD及LSDI 在T2周期化疗后的变化有统计学意义(p2均<0.05)。结论 2D-STI技术获取的分层应变参数及同步性参数可以准确分析蒽环类药物化疗患者早期心肌收缩功能的损伤及室壁运动协调性的损伤,能够敏感发现蒽环类药物化疗后的早期心肌毒性表现。 相似文献
994.
Morihito Okada Yoshihiro Miyata Kazuya Takamochi Yasuhiro Tsutani Shiaki Oh Kenji Suzuki 《The Journal of thoracic and cardiovascular surgery》2019,157(1):388-395
Objective
Vascular sealing with an energy vessel sealing system during lung resection may allow surgeons to treat small vessels with minimal dissection, possibly decreasing likelihood of injury. Few large prospective trials have examined the proximal sides of vessels not ligated in addition to sealing during surgery. We therefore assessed feasibility of an energy device to seal pulmonary artery and vein branches without further ligation.Methods
This prospective, preoperative registration study at 2 institutions evaluated safety of energy sealing with the LigaSure (Medtronic, Minneapolis, Minn), with no additional reinforcing material such as suture ligation, for pulmonary vessels as large as 7 mm during anatomic lung resection (cohort 1 study). A postoperative hemorrhage occurred in the 128th case, so a cohort 2 study proceeded after we changed inclusion criterion for pulmonary arteries from a maximum of 7 mm to a maximum of 5 mm.Results
In cohort 1 (n = 128) and cohort 2 (n = 200), 216 and 250 pulmonary arteries and 189 and 213 pulmonary veins, respectively, were treated with energy sealing. Overall postoperative hemorrhage rate was 0.3% (1/328 patients); however, no serious postoperative complications were associated with energy sealing among the 200 patients in cohort 2. Subsequent inspection of the torn artery stump confirmed that the bleeding in the 128th case was in an area adjacent to the sealing zone.Conclusions
Energy sealing without reinforcement allows secure treatment during lung resection of pulmonary arteries as large as 5 mm in diameter and pulmonary veins as large as 7 mm. 相似文献995.
Nancy M. Cappello Dorinda Richetelli Christoph I. Lee 《Journal of the American College of Radiology》2019,16(2):139-146
Objective
We conducted a national survey to understand the impact of state-level density reporting laws on women’s level of density risk awareness and their engagement in conversations with providers regarding supplemental screening.Methods
In all, 1,500 US women aged 40 to 74 years who obtained a mammogram within 2 years were surveyed in February 2018. The sampling design yielded 300 respondents in each of five groups categorized based on density reporting law features. Women were asked about their breast density-related knowledge, importance of being notified, and sources of information and if conversations with providers regarding density and supplemental screening occurred. Survey results were compared across groups and between women residing in states with versus without density laws.Results
The majority of respondents in all groups felt that it is important for women to know their breast density type (range, 85%-90%). Women were most likely informed of breast density type by a health care provider (range, 68%-72%), followed by the mammography result letter (range, 48%-68%), and then a radiologist (range, 46%-61%). Women from states with a density law were significantly more likely to have learned of their breast tissue type from a mammogram results letter (60% versus 48%, P = .011) and discuss supplemental screening (67% versus 53%, respectively; P = .008) than women from states without a law.Conclusion
State-level density reporting laws are associated with increased breast density awareness and increased likelihood of conversations between women and their providers regarding supplemental screening. 相似文献996.
Nayoung Kim 《Journal of gastroenterology and hepatology》2019,34(8):1287-1295
The cascade of gastric cancer, a leading cause of cancer incidence and mortality, is multifactorial. Helicobacter pylori (HP) infection plays a major role in gastric cancer (GC), and there has been an accumulation of data regarding the chemopreventive effect of HP eradication. However, it remains unclear how HP infection causes GC and how HP eradication prevents GC. To clarify this issue, the following approaches were performed in this review article. First, how HP‐induced atrophic gastritis (AG) and intestinal metaplasia (IM) provoke the development of GC is shown, followed by how long HP eradication takes to induce a reversible change in AG and IM. Second, epigenetic studies of PTPN6, MOS, DCC, CRK, and VAV1 were performed in noncancerous gastric specimens in terms of HP status. Among these genes, MOS was found to be a possible surrogate marker for GC development. HP eradication decreased aberrant DNA methylation in a gene‐specific manner, and MOS played a role in metachronous gastric neoplasms. Third, transforming growth factor‐β1 (TGF‐β1) and TGF‐β1‐induced epithelial‐mesenchymal transition (EMT) markers were investigated in gastric mucosa. HP infection triggered the TGF‐β1‐induced EMT pathway and caused the emergence of GC stem cells, such as CD44v8‐10. When HP was eradicated, these two pathways were inhibited. Finally, a 2222 cohort study showed that HP eradication significantly decreased the risk of noncardiac GC. Taken together, HP eradication is effective as a primary GC prevention method, and its underlying mechanism includes reversibility of AG and IM, methylation, EMT, and stem cells. 相似文献
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