Clinical role of additional adjuvant chemotherapy in patients with locally advanced urothelial carcinoma following neoadjuvant chemotherapy and cystectomy

Purpose

Neoadjuvant chemotherapy (NAC) can downstage invasive bladder cancers prior to radical cystectomy (RC) and improve overall survival. However, the optimal management in patients with persistent non-organ confined disease (pT3–T4 and/or pN+) following RC has not been completely defined. The aim of this study was to describe outcomes associated with the use of adjuvant chemotherapy (AC) in patients with residual non-organ confined cancer at RC following NAC.

Materials and methods

Using data from a high-volume referral institution, pT3–T4 and/or pN+ patients who received NAC and then also RC were identified. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were assessed with Kaplan–Meier analysis.

Results

From 2001 to 2013, 161 patients received NAC and then RC. Eighty-eight pT3–T4 and/or pN+ patients were identified. Twenty-nine (33 %) received AC. Adjuvant chemotherapy in the majority of patients was carboplatin-based (16), followed by cisplatin (8) and other, mainly taxane-containing regimens (5). The median RFS was 17.5 months in the AC and 13.7 months in the non-AC group (p = 0.78). AC remained an insignificant predictor for RFS after adjusting for pT, pN and margin status (HR 0.89, 95 % CI 0.48–1.68]). CSS was 23 and 22 months (p = 0.65) and remained insignificant after adjusting for pathologic confounders.

Conclusions

In our current study population, adjuvant conventional cytotoxic chemotherapy was not associated with significant improvements in RFS or CSS. The choice of AC regimens, and incorporation of newer treatments, may be the key for improving outcomes in this high-risk patient group.

     

多次精液优化对IUI成功率的影响

目的探讨多次精液优化对宫腔内人工授精(IUI)成功率的影响。方法回顾分析我院生殖医学中心41例多次精液优化人工授精周期,分析多次精液优化对妊娠率的影响。结果 41例多次精液优化人工授精周期妊娠率为29.27%,对照组为11.62%,两组临床妊娠率比较,差异有统计学意义(P<0.05)。结论多次精液优化人工授精是一种可以提高人工授精周期妊娠率的方法,具有积极的临床意义。     

纳晶微针的促渗透作用及安全性实验研究

目的探讨纳晶针作用于皮肤后,可在皮肤表面形成开放给药通道,从而促进外用药物经皮渗透和吸收的价值及安全性。方法 (1)扫描电镜观察纳晶针作用后在皮肤表面形成针孔的存在和闭合;(2)以0.125%荧光素钠为模型药物,在荧光显微镜下对比观察纳晶针+荧光素钠和单纯外用荧光素钠后,荧光在大鼠皮肤的分布情况。结果 (1)纳晶针可在皮肤表层形成给药通道,该通道在20 min左右即可闭合;(2)经过纳晶针处理过的大鼠皮肤可见耀眼的荧光(+++);而未经纳晶针处理的大鼠皮肤仅在角质层可见明确的线状荧光(+),其他部位可见微弱荧光(-)。结论纳晶针对外用药物有明显的促进渗透作用,且安全简便。     

老年糖尿病并消化性溃疡的临床特点

目的探讨老年糖尿病患者并消化性溃疡的临床特点。方法将237例老年消化性溃疡患者按是否患糖尿病分为观察组和对照组,比较两组的临床表现、溃疡部位、溃疡直径及HP感染情况。结果两组患者在临床症状、溃疡部位、溃疡直径及HP感染率等方面比较差异均有统计学意义(P<0.05)。结论与老年单纯性溃疡患者比较,老年糖尿病并消化性溃疡患者其腹痛和反酸、暖气等症状不明显,胃溃疡和复合溃疡发生率较高,溃疡直径较大,HP感染率较高。     

枳术汤加味对外科手术患者肠黏膜屏障功能影响

目的:探讨中药枳术汤加味对外科手术患者肠黏膜屏障功能保护作用及临床意义。方法:将外科手术患者98例随机分为对照组(n=46)、中药组(n=52),分别检测两组病人术前1d、术后1、3、7d血浆二胺氧化酶(DAO)、D-乳酸、C反应蛋白(CRP)浓度,进行统计学分析。结果:对照组血浆DAO、D-乳酸、CRP浓度术后1、3、7d明显升高,与术前1d比较P<0.01;中药组各项指标术后1、3d升高,术后7d恢复正常水平,DAO、D-乳酸均低于对照组P<0.01;CRP术后3、7d低于对照组P<0.01。结论:外科手术后机体处于应激状态,肠黏膜屏障受损,通透性增加,中药枳术汤加味对患者肠黏膜屏障有一定的保护作用。     

A new experimental inbred Wistar rat varicocele model: anatomy of the left spermatic vein and the effect on histology

Because of venous anatomical differences between rats and humans and the personal interpretation of these differences, there is neither consistent animal prototype nor consistent results in the study of varicocele. We established a new substrain of Wistar inbred rats, of which the left testis vein has no significant branches to the common iliac vein up pampiniform plexus, but instead enters the left renal vein directly (similar to humans) and used them to create experimental varicocele model by partial ligation of the left renal vein. One month later, the predominant lesion of the left testis in induced group was spermatogenic arrest at the spermatid and preliminary spermatocyte phases, and considerable interstitial and Sertoli cell vacuolation. The right testis also showed spermatogenic arrest. Most important, the characteristics of the lesions differed in both testes, with the left testis having more severe lesions. Allowing for the unique anatomy of the left spermatic vein, the standard of the surgical procedure, the high rate of varicocele induction, and identical histological alteration as occurs in humans, we believe that this inbred Wistar rat substrain is suitable for the creation of an experimental varicocele model, which has promise for practical application in humans.     

Blunt injury to the inferior gluteal artery: case report of a rare "near miss" event

Traumatic injuries of the inferior gluteal artery are rare, the majority of which are aneurysms due to sharp or blunt trauma. We report the rare case of a "near miss" event of a patient with an acute hemorrhagic mass in the right buttock caused by blunt trauma to the inferior gluteal artery without "hard" clinical signs of vascular injury. Despite the unusual presentation, diffuse injury of the inferior gluteal artery branches was diagnosed by ultrasonography and angiography. This article highlights the importance of considering an arterial injury following blunt trauma to the buttock with subsequent pain and swelling. Appreciation of this rare injury pattern is necessary in order to facilitate rapid diagnosis and appropriate treatment.     

全麻术后双侧气胸并皮下气肿一例

一、临床资料 患者系女性，22岁。主因“左侧头痛十余天”入院。既往体健；无烟酒等嗜好：无家族遗传病史。入院查体体重60kg，身高1．63m，T35．7℃，P72次／分，R18次／分，BP103／68mmhg，气管居中，胸廓对称无畸形，双肺呼吸音清，未闻及下湿罗音。