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1.
IntroductionIntensive local treatment comprising total mesorectal excision (TME) with selective lateral pelvic lymph node dissection (LPND) after neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC) has received attention among clinicians treating rectal cancer. It remains unclear whether adjuvant chemotherapy (ACT) after intensive local treatment is beneficial for these patients. We evaluated the oncologic benefit of ACT for patients with LARC who received intensive local treatment.Materials and methodsThis international multicentre retrospective cohort study included 737 patients treated in Japan and Korea between 2010 and 2017. The effectiveness of ACT on recurrence-free survival (RFS) was evaluated using univariable and multivariable Cox proportional hazards models, with subgroup analyses to identify subpopulations potentially benefiting from ACT.ResultsThe median follow-up was 49 months; the 5-year RFS and local recurrence rates for the entire cohort were 72.1% and 4.9%, respectively; 514 patients (69.7%) received adjuvant chemotherapy, without an oncologic benefit (hazard ratio, 1.14; 95% confidence interval [CI]: 0.79–1.68) demonstrated in the multivariable Cox regression analysis. In subgroup analyses, the distributions of the 95% CI in patients aged ≥70 years and those with ypStage 0 tended to place a disproportionate emphasis that favoured the non-ACT treatment strategy.ConclusionDespite achieving good local control with intensive local treatment strategy, the effectiveness of ACT for the LARC patients with CRT followed by TME with selective LPND was not proved. Elderly patients and those with ypStage0 may not receive benefit from ACT after CRT and TME ± LPND.  相似文献   
2.
AimsDue to the lack of high-quality evidence and consensus on adjuvant treatment for locoregionally advanced penile cancer, we reviewed the outcomes of pN3 patients to determine the suitable adjuvant treatment options.Patients and methodsAll consecutive pN3 penile cancer patients treated at our institution between January 2010 and December 2018 were reviewed to assess the impact of demographical, pathological and treatment factors on disease-free survival (DFS) and overall survival. The DFS and overall survival were estimated using the Kaplan–Meier method and association was tested using the Cox regression model (two-sided test with P < 0.05 considered significant).ResultsOf 128 patients, 31 (24%) had pelvic nodal involvement. Twenty-six patients (20.3%) received no adjuvant treatment, 40 (31.3%) received single modality adjuvant treatment and 62 (48.4%) received multimodality adjuvant treatment (a combination of chemotherapy and radiotherapy). At a median follow-up of 22 months, the DFS and overall survival were 55.4 and 62%, respectively. The best DFS and overall survival was noted with chemotherapy followed by concurrent chemoradiation (C-CTRT; 93% each). On multivariate analysis, both DFS and overall survival were worse with pelvic node involvement (2.2 [1.3–4], P = 0.027 and 2.2 [1.3–4], P = 0.027, respectively) and better with any adjuvant treatment (single modality: 3 [1.5–5.5], P < 0.001; multimodality: 3.1 [1.6–6], P < 0.001). C-CTRT was associated with improved DFS over chemotherapy alone (0.17 [0.4–0.78], P = 0.02) but not over radiotherapy alone (0.35 [0.07–1.6], P = 0.19). In patients with no pelvic nodes involved, chemotherapy and radiotherapy as single modalities were associated with similar DFS and overall survival. In patients with pelvic nodes, multimodality treatment was associated with better DFS than single modality treatment (0.3 [0.1–1], P = 0.05).Conclusion: pN3 penile cancer is a diverse prognostic group with poorer outcomes associated with pelvic nodes. Single modality adjuvant treatment may be adequate in inguinal nodes with extranodal extension, but multimodality treatment should be given in patients with pelvic nodal involvement.  相似文献   
3.
目的探究宫腔粘连分离术(TCRA)后患者接受IVF治疗的活产率及其影响因素。方法选择2014年1月至2019年12月于山东大学附属生殖医院行TCRA手术治疗后接受IVF助孕的635例宫腔粘连(IUA)患者。随访其妊娠结局,并分析可能影响活产率的因素。结果TCRA术后患者行鲜胚移植的活产率为36.7%。年龄(OR=0.930,P<0.001)、AFS评分(OR=0.898,P=0.035)、移植胚胎数(OR=1.875,P=0.001)、促性腺激素(Gn)启动量(OR=0.994,P=0.001)是活产率的独立影响因素。结论年龄、AFS评分、移植胚胎数、Gn启动量可能是活产率的独立影响因素。对于TCRA术后准备接受IVF鲜胚移植的患者,医生应根据以上因素制定个体化治疗方案。  相似文献   
4.
目的:探讨实时呼吸监测(RPM)技术在盆腔肿瘤放射治疗CT模拟定位中的应用价值。方法:选取我院2019年5月-2019年12月盆腔肿瘤放疗患者70例,其中实验组和对照组各35例。实验组患者CT模拟定位时采用RPM监测患者呼吸状态稳定后定位扫描,对照组常规方法定位扫描,利用锥形束CT采集患者放疗时的摆位误差信息同时记录当次放疗是否重复摆位,应用统计学方法对两组患者放疗时的摆位误差及重复摆位率数据进行分析。结果:两组在Y、Z 轴线性方向、X轴旋转方向误差及重复摆位率比较有统计学差异(P<0.05),X轴线性方向及Y、Z轴旋转方向误差比较无统计学意义(P>0.05)。结论:盆腔肿瘤放疗患者在行CT模拟定位时应实时关注其身体状态变化,采用实时呼吸监测可有效的观测患者是否有紧张情绪或其他身体不适,避免了CT模拟定位时患者异常身体状态引起的放疗误差,可显著提高放射治疗精度及效率。  相似文献   
5.
石雯  周抒 《新医学》2022,53(9):649-654
目的 建立稳定的宫腔粘连(IUA)病理性再生动物实验模型。方法 将30只雌性SD大鼠随机分为实验组和对照组, 每组各15只。实验组通过自制2 mm直径刮匙分别对动情期大鼠的左、右侧子宫内膜进行轻度、重度机械损伤并设为轻度机械损伤组、重度机械损伤组;对照组大鼠开腹后不做子宫内膜损伤处理, 进行假手术对照。分别于术后0 h、24 h、72 h、5 d、7 d从每组随机选取3只大鼠取出双侧子宫行快速冰冻切片, 分别进行子宫内膜细胞中主要组织相容性复合体Ⅱ类分子(MHCⅡ)、5-溴脱氧尿苷(BrdU)免疫组织化学染色, 观察术后7 d不同大鼠内膜腺体情况以及术后不同时期不同机械损伤程度的大鼠子宫内膜组织炎性反应及子宫内膜组织增生修复变化。结果 轻度机械损伤组术后7 d可见少量红染含BrdU的细胞及蓝染的MHCⅡ细胞, 子宫内膜基本修复, 轻度炎症反应存在;重度机械损伤组术后7 d未见腺体或腺体数目极少, 未见明显红染含BrdU的细胞, 可见少许蓝染的MHCⅡ细胞、轻度炎症反应、内膜组织纤维化, 局部管腔闭合, 出现粘连。与对照组相比, 术后7 d大鼠子宫内膜腺体数目随着子宫内膜机械性受损伤程度增加而相应减少(P < 0.001)。结论 采用切开缝合子宫内膜机械损伤法可以成功建立大鼠IUA模型。大鼠子宫内膜轻度机械损伤后可以再生达到基本修复水平, 而重度机械损伤后子宫内膜组织无法达到基本修复, 且出现组织纤维化导致IUA。  相似文献   
6.
《Saudi Dental Journal》2022,34(7):565-571
PurposeThis study aimed to evaluate the neuroprotective ability of the conditioned medium of stem cells from human exfoliated deciduous teeth (CM-SHED) to prevent glutamate-induced apoptosis of neural progenitors.Materials and methodsNeural progenitors were isolated from two-day-old rat brains, and the conditioned medium was obtained from a mesenchymal stem cell SHED. Four groups were examined: neural progenitor cells cultured in neurobasal medium with (N + ) and without (N-) glutamate and glycine, and neural progenitor cells cultured in CM-SHED with (K + ) and without (K-) glutamate and glycine.ResultsThe expression of GABA A1 receptor (GABAAR1) messenger RNA (mRNA) in neural progenitor measured by real-time quantitative PCR. GABA contents were measured by enzyme-linked immunosorbent assay, whereas the apoptosis markers caspase-3 and 7-aminoactinomycin D were analysed with a Muse® cell analyzer. The viability of neural progenitor cells in the K + group (78.05 %) was higher than the control group N- (73.22 %) and lower in the N + group (68.90 %) than in the control group. The K + group showed the highest GABA content, which significantly differed from that in the other groups, whereas the lowest content was observed in the N + group. The expression level of GABAAR1 mRNA in the K + group was the highest compared to that in the other groups. CM-SHED potently protected the neural progenitors from apoptosis.ConclusionsCM-SHED may effectively prevent glutamate-induced apoptosis of neural progenitors.  相似文献   
7.

Background

Volatile propofol can be measured in exhaled air and correlates to plasma concentrations with a time delay. However, the effect of single-lung ventilation on exhaled propofol is unclear. Therefore, our goal was to evaluate exhaled propofol concentrations during single-lung compared to double-lung ventilation using double-lumen tubes.

Methods

In a first step, we quantified adhesion of volatile propofol to the inner surface of double-lumen tubes during double- and single-lumen ventilation in vitro. In a second step, we enrolled 30 patients scheduled for lung surgery in two study centers. Anesthesia was provided with propofol and remifentanil. We utilized left-sided double-lumen tubes to separately ventilate each lung. Exhaled propofol concentrations were measured at 1-min intervals and plasma for propofol analyses was sampled every 20 min. To eliminate the influence of dosing on volatile propofol concentration, exhalation rate was normalized to plasma concentration.

Results

In-vitro ventilation of double-lumen tubes resulted in increasing propofol concentrations at the distal end of the tube over time. In vitro clamping the bronchial lumen led to an even more pronounced increase (Δ AUC +62%) in propofol gas concentration over time. Normalized propofol exhalation during lung surgery was 31% higher during single-lung compared to double-lung ventilation.

Conclusion

During single-lung ventilation, propofol concentration in exhaled air, in contrast to our expectations, increased by approximately one third. However, this observation might not be affected by change in perfusion-ventilation during single-lung ventilation but rather arises from reduced propofol absorption on the inner surface area of the double-lumen tube. Thus, it is only possible to utilize exhaled propofol concentration to a limited extent during single-lung ventilation.

Registration of Clinical Trial

DRKS-ID DRKS00014788 ( www.drks.de ).  相似文献   
8.
ObjectiveTo determine the UPOINT-positive domain numbers and evaluate the significance of the sexual dysfunction domain in patients with chronic prostatitis or chronic pelvic pain (CP/CPPS) in Japan.MethodsA total of 58 patients with CP/CPPS with moderate or greater symptoms were included. Symptom severity was determined by > 14 on the chronic prostatitis symptom index (CPSI). The main outcome was to confirm the number and distribution of the positive UPOINT domains in this group. As secondary outcomes, the correlation between positive domain numbers and CPSI scores was evaluated. We also examined whether the sexual dysfunction subdomain, as determined by the five-item international index of erectile function, could improve the correlation with symptom severity.ResultsThe mean age was 48.6 ± 15.4 years, CPSI score 24.3 ± 6.1, and positive UPOINT domain number 2.4 ± 0.9. The distribution of each positive domain was 67.2% for urinary, 15.5% for psychosocial, 75.8% for organ-specific, 3.4% for infection, 5.1% for neurological/systemic conditions, and 75.8% for tenderness. Although the mean CPSI total scores tended to increase with an increasing number of positive UPOINT domains, a significant correlation was not observed (r = 0.134, p = 0.312). The sexual dysfunction domain was positive in 62.0% of the cases, but the correlation could not be improved.ConclusionsUrinary, organ specific, and tenderness domains were mainly observed in patients with CP/CPPS. When patients with moderate or grater CPSI scores are clinically evaluated, clinicians should recognize that the UPOINT-positive domain and CPSI score are clinically and pathologically different concepts. (250 words).  相似文献   
9.
该研究基于下肢康复机器人对人体静态平衡能力进行评估。对下肢功能正常者和下肢功能障碍者进行平衡对照实验,根据人体骨盆中心运动轨迹得到的平衡参数,用SPSS统计软件验证两组间具有显著性差异(P<0.01)。运用主成分分析法对各参数权重分配,建立综合评价值。对照组综合评价值为0.383±0.038,实验组综合评价值为0.875±0.136。当受试者综合评价值在0.739~1.011范围内时,说明存在平衡功能障碍,在0.345~0.421范围内时,则说明受试者下肢平衡正常。实验证明,该评价方法能够客观定量地反映人体静态平衡状态。  相似文献   
10.
任超  易发现  张莉 《现代肿瘤医学》2022,(15):2775-2778
目的:探讨腹腔镜根治性膀胱切除术后淋巴漏原因及相关危险因素、预防措施。方法:收集2015年01月至2020年12月在我院泌尿外科行腹腔镜根治性膀胱切除及盆腔淋巴结清扫术患者的年龄、BMI、术前术后血红蛋白、术前术后白蛋白、清扫淋巴结数、阳性淋巴结数、术中是否Hem-o-lock夹闭淋巴管资料,采用t检验和Logistic回归分析淋巴漏发生因素。结果:45例患者中,淋巴漏组18例,非淋巴漏组27例,t检验显示阳性淋巴结数与术后淋巴漏发生密切相关,Logistic回归分析显示是否使用Hem-o-lock夹闭淋巴管及阳性淋巴结数与术后淋巴漏发生密切相关。经营养支持、补充白蛋白、抗感染、保持引流管通畅,术后10~20天淋巴漏均治愈。结论:阳性淋巴结数及清扫术后是否夹闭淋巴管是淋巴漏发生的高危因素,术后贫血严重患者更易发生淋巴漏。加强营养,纠正贫血,补充白蛋白,术中精准操作,使用Hem-o-lock确切结扎可减少淋巴漏的发生。  相似文献   
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