Role of surgery in the treatment of patients with high-risk neuroblastoma who have a poor response to induction chemotherapy

Background

In instances of high-risk neuroblastoma that do not show a clinical response to induction therapy, whether it is worth performing surgical resection or not and whether gross total resection (GTR) is more important than subtotal resection (STR) remain controversial.

Methods

We retrospectively analyzed the data of patients with stage 4 neuroblastoma aged 18 months or older at diagnosis. Primary tumor volumes were measured both at diagnosis and at the first tumor response evaluation (after 6 cycles of induction chemotherapy). If the tumor volume at the first response evaluation was > 50% of the initial tumor volume, the patient was categorized as a poor responder. Otherwise, the patient was categorized as a good responder. Only poor responders were included. Patients were evaluated for event-free survival (EFS), overall survival (OS), and complications of surgery based on extent of surgical intervention.

Results

Sixty-five patients were included in this study. The 41 patients who underwent surgical intervention had a higher 3-year OS than the 24 patients who had a biopsy only (55.4% ± 8.1% vs. 31.3% ± 10.2%, P = 0.02). However, there was limited improvement in 3-year EFS following surgical intervention. Three-year EFS rates of BX group (biopsy only) and OP group (surgical resection) were 24.2% ± 9.3% and 37.7% ± 7.9%, respectively (P = 0.063). The extent of resection had no impact on 3-year OS (P = 0.631) and 3-year EFS (P = 0.796). Patients in the GTR group trended to have more severe surgical complications than patients in the STR group (P = 0.105).

Conclusions

For high-risk neuroblastomas that do not show a clinical response to induction therapy, surgical resection is important in predicting outcome, but the extent of resection is not.     

肺淋巴管肌瘤病的高分辨率CT表现

目的 探讨肺淋巴管肌瘤病的高分辨率CT（HRCT）特点,以提高对本病的诊断水平.方法 回顾性分析13例经病理证实的肺淋巴管肌瘤病患者胸部HRCT改变.结果 13例均为女性,年龄28 ～ 57岁,平均40岁.11例患者胸部HRCT表现为两肺均匀分布、多发的薄壁气囊影,直径数毫米至2 cm,囊壁厚1～2mm,气囊影无分布差异;囊腔周围为正常肺组织;2例患者弥漫分布大小不一囊腔、周围未见明显正常肺组织.1例患者左侧胸腔积液、腹膜后多发淋巴结肿大.结论 肺淋巴管肌瘤病的HRCT表现具有特征性,是诊断本病首选的影像学检查方法.     

洗涤式自体血液回输在异位妊娠术中的临床应用

目的：探讨洗涤式自体血液回输在异位妊娠致腹腔内出血手术治疗中的安全性与有效性。方法选择2009年1月至2012年12月在湖北省孝感市中心医院妇产科就诊并确诊为异位妊娠的45例患者为研究对象,其年龄为17-42岁。分别接受急诊全身麻醉腹腔镜下患侧输卵管切除术,腹腔镜下患侧卵巢异位妊娠病灶切除＋卵巢修补术或经腹患侧子宫角部楔形切除术。45例异位妊娠患者于术中采用洗涤式自体血液回输,观察其输血时有无不良反应,并动态监测患者术前和术后第2天血常规[红细胞（RBC）、白细胞（WBC）、血红蛋白（Hb）、红细胞压积（HCT）和血小板（PLT）]及凝血功能[凝血酶原时间（PT）及由其衍化出的国际标准化比值（INR）、部分凝血活酶时间（APTT）和纤维蛋白原（FIB）]水平变化,并进行统计学分析（本研究遵循的程序符合湖北省孝感市中心医院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试对象的知情同意）。结果本组45例患者中,术中腹腔内出血量为500-3000 mL,经血液回收机回收洗涤后回输自体血最多为1900 mL,最少为300 mL。术前和术后第2天RBC、WBC、Hb、HCT和PLT比较[（2.48＆#177;0.49）＆#215;1012/L vs.（3.81＆#177;0.35）＆#215;1012/L,（12.01＆#177;3.71）＆#215;109/L vs.（7.88＆#177;3.93）＆#215;109/L,（69.41＆#177;9.49）g/L vs.（79.01＆#177;8.83）g/L,0.26＆#177;0.04 vs.0.34＆#177;0.08,（125.98＆#177;54.31）＆#215;109/L vs.（171.34＆#177;59.69）＆#215;109/L],差异均有统计学意义（t=2.346,2.683,3.104,2.712,2.695;P〈0.05）;术前和术后第2天凝血功能（PT、INR、APTT、FIB）比较[（11.98＆#177;0.99）s vs.（12.08＆#177;1.01）s,1.27＆#177;0.05 vs.1.26＆#177;0.06,（34.98＆#177;5.96）s vs.（35.13＆#177;4.37）s,（2.49＆#177;0.41）g/L vs.（2.51＆#177;0.39）g/L],均差异无统计学意义（t=1.963,1.622,1.653,1.882;P〉0.05）。无一例患者输自体血时发生输血反应。结论异位妊娠术中采用洗涤式自体血液回输安全、有效,既可节约血源,又可降低输注异体血的风险。     

2型糖尿病患者药学监护路径的建立及应用

摘 要 目的：建立2型糖尿病患者药学监护路径（PCP）,为开展规范化糖尿病药学服务提供思路。 方法: 100例2型糖尿病患者随机分为对照组（n=50）和监护组（n=50）。应用临床路径的方法和原理,按糖尿病治疗特点,建立2型糖尿病患者PCP并用于监护组患者,对照组患者则给予常规管理。随访6个月后比较两组患者不合理用药发生率、糖尿病主要控制指标情况、自我管理水平、疾病认知情况和相关药物知识了解情况。 结果: 与对照组比较,监护组患者的不合理用药发生率,糖尿病主要监测指标空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbAlc）、收缩压（SBP）和舒张压（DBP）情况,自我管理水平（用药依从性、每天监测血糖、饮食、睡眠）、对疾病的认知情况（相关指标控制水平、并发症、饮食、运动、吸烟、饮酒）和对糖尿病药物相关知识的了解情况（降糖药的种类、降糖药的作用机制、降糖药的使用时间、降糖药的不良反应、胰岛素名称）等各项指标均优于对照组（P<0.05）。 结论: 采用本研究制定的2型糖尿病PCP对患者进行药学监护,有利于保障患者的合理用药,改善患者的糖尿病相关控制指标,提高患者的自我管理水平、对疾病的认知及相关药物知识的了解水平。     

Nano‐selenium attenuates nickel‐induced testosterone synthesis disturbance through inhibition of MAPK pathways in Sprague‐Dawley rats

The aim of this study was to investigate the protective effects of Nano‐Se against Ni‐induced testosterone synthesis disorder in rats and determine the underlying protective mechanism. Sprague‐Dawley rats were co‐treated with Ni (5.0 mg/kg, i.p.) and Nano‐Se (0.5, 1.0, and 2.0 mg/kg, oral gavage) for 14 days after which various endpoints were evaluated. The Ni‐induced abnormal pathological changes and elevated 8‐OHdG levels in the testes were attenuated by Nano‐Se administration. Importantly, decreased serum testosterone levels in the Ni‐treated rats were significantly restored by Nano‐Se treatment, particularly at 1.0 and 2.0 mg/kg. Furthermore, the mRNA and protein levels of testosterone synthetase were increased by Nano‐Se compared to the Ni group, whereas phosphorylated protein expression levels of mitogen‐activated protein kinase (MAPK) pathways were suppressed by Nano‐Se administration in the Ni‐treated rats. Overall, the results suggest that Nano‐Se may ameliorate the Ni‐induced testosterone synthesis disturbance via the inhibition of ERK1/2, p38, and JNK MAPK pathways.     

Relationship between long non-coding RNA and prognosis of patients with coronary heart disease after percutaneous coronary intervention: A protocol for systematic review and meta-analysis

Background:Long non-coding RNA (lncRNA) can predict the prognosis of patients with coronary heart disease (CHD) after obtaining percutaneous coronary intervention (PCI), while this conclusion still needs to be further confirmed. Therefore, this study attempted to explore the relationship between lncRNA and prognosis in CHD patients after PCI.Methods:The database was retrieved from China National Knowledge Infrastructure (CNKI), Chinese Biomedical literature Database (CBM), Chinese Scientific and Journal Database (VIP), Wan Fang database, PubMed, and EMBASE. Hazard ratios (HRs) and its 95% confidence interval (CIs) were applied to assess the prognostic effects of lncRNA on overall survival (OS). RevMan 5.3 and STATA 16.0 software were used to perform meta-analysis.Results:The results of this meta-analysis would be submitted to peer-reviewed journals for publication.Conclusion:This review provided a comprehensive overview of the relationship between lncRNA and prognosis in CHD patients after PCI, and offered recommendations for clinical practices or guidelines.