18F-FDG-PET/CT to Select Patients with Peritoneal Carcinomatosis for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Background

Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with significantly longer survival in patients with peritoneal carcinomatosis (PC). So far, no morphological imaging method has proven to accurately assess the intra-abdominal tumor spread. This study was designed to predict tumor load in patients with PC using dual-modality ¹⁸FDG-PET/CT and to compare the results with those of PET and CT alone by correlating imaging findings with intraoperative staging.

Methods

Twenty-two patients with PC from gastrointestinal (n = 13), ovarian cancer (n = 8), and mesothelioma (n = 1) underwent contrast-enhanced ¹⁸FDG-PET/CT before surgery and HIPEC. In a retrospective analysis PET, CT, and fused PET/CT were separately and blindly reviewed for the extent of peritoneal involvement using the Peritoneal Cancer Index (PCI). Imaging results were correlated with the intraoperative PCI using Pearson’s correlation coefficient and linear regression analysis.

Results

There was a strong correlation between the PCI obtained with PET/CT and the surgical PCI with respect to the total score (r = 0.951) as well as in the regional analysis (small bowel, r = 0.838; other, r = 0.703). The correlation was slightly lower for CT alone (total score, r = 0.919; small bowel, r = 0.754; other, r = 0.666) and significantly lower (p = 0.002) for PET alone (total score, r = 0.793; small bowel, r = 0.553, other, 0.507).

Conclusions

Contrast-enhanced CT is superior compared with PET alone to predict the extent of PC. In our patient group, the combination of both modalities (contrast enhanced PET/CT) yielded the best results and proved to be a useful tool for selecting candidates for peritonectomy and HIPEC.     

Demography of paediatric renal care in Europe: organization and delivery.

BACKGROUND: Members of the European Society of Paediatric Nephrology (ESPN) initiated a study of the demography and policy of paediatric renal care among European countries at the end of the 20th century. METHODS: A questionnaire was mailed to the presidents of each of 43 national renal paediatric societies or working groups in Europe. Data on each country's population, income as reflected by its gross national product and infant mortality rate, were obtained from the United Nations. The paediatric health care systems were previously divided into three types: general practitioner care system, paediatric care system and combined care system (CCS). RESULTS: In 1998, 842 specialized paediatric nephrologists worked in hospitals in 42 European countries. The median number of paediatric nephrologists per million child population (pmcp) was 4.9 (range 0-15). The median number of children served per paediatric nephrologist was significantly higher in countries with the general practitioner care system than in those with the paediatric or combined care system (CCS), namely 370 747 vs 169 456 and 191 788, respectively. In addition to specially trained paediatric nephrologists, there were 1087 paediatricians with a part-time interest/activity in paediatric nephrology in hospitals in 34 European countries. Eastern European countries had significantly more general paediatricians with part-time nephrological activities than countries belonging to the European Union (EU), 16.7 vs 6.6 pmcp. In 1998, 92% of 42 European countries offered paediatric dialysis facilities for acute renal failure and 90% for chronic renal failure and 55% offered paediatric renal transplantation (RTx). Only 30% of Eastern European countries (central omitted) offered paediatric RTx vs 87% of EU countries. The availability of paediatric RTx was associated significantly with the countries' gross national product (r = 0.53, P<0.001). The median number of paediatric hospitals offering dialysis for childhood chronic renal failure was 1.5 pmcp (range 0-5.0) and the median number of paediatric hospitals offering paediatric RTx was 0.4 pmcp (range 0-3.5). Fewer children were on dialysis or were transplanted in Eastern European countries than in the EU. CONCLUSIONS: At the end of the 20th century, there was a marked variation in delivery of paediatric renal care within Europe. This was related to factors such as size of the population, geographical and political situation, the type of primary paediatric care system and economic situation. European countries were far from equal with regard to access of renal replacement therapy for children. Improvement of the economic situation is beyond the capabilities of paediatric nephrologists. However, in these days of world-wide globalization paediatricians in greater Europe should be able to achieve better cooperation and exchange of ideas and information which would be the first step towards equality of renal care for children.     

Multivisceral transplantation for diffuse portomesenteric thrombosis in a patient with life-threatening esophagogastroduodenal bleeding

Portal vein thrombosis is the most common cause of portal hypertension in noncirrhotic patients. Variceal bleeding is difficult to treat in these patients, especially those with prehepatic diffuse portal mesenteric thrombosis. In a patient with refractory esophagogastroduodenal variceal bleeding as a result of diffuse portomesenteric thrombosis and portal hypertension, life-threatening bleeding was unresponsive to endoscopic therapy and other surgical procedures. A multivisceral transplant was performed. It was curative and also lifesaving. There is only one report in the literature mentioning multivisceral transplantation for a patient with life-threatening esophagogastroduodenal bleeding; however that patient had protein C deficiency. Our patient had normal liver and intestinal function tests and no signs of hypercoagulable disease. We believe that multivisceral transplantation should be considered as a treatment option for patients with diffuse mesenteric thrombosis, even in the absence of liver and intestinal failure, when other treatment options for variceal bleeding have failed, particularly in a younger patient with a relatively good nutritional status before transplantation.     

围绝经期及绝经后女性性功能障碍状况及与更年期症状的关系分析

目的 调查围绝经期及绝经后女性性功能障碍状况,分析更年期症状对女性性功能障碍（female sexual dysfunction,FSD）的影响。方法 选取2019年6月至2019年10月在首都医科大学附属北京妇产医院内分泌科就诊的40岁以上女性180例进行问卷调查,根据生殖衰老分期研讨会（Stages of Reproductive Aging Workshop,STRAW+10）标准将研究对象分为4组：绝经过渡早期（A组）、绝经过渡晚期（B组）、绝经后期早期（C组）、绝经后期晚期（D组）。应用改良Kupperman评分表（Modified Kupperman Index,KMI）评价女性更年期症状;女性性功能指数（Female Sexual Function Index,FSFI）量表评价女性性功能障碍。结果 随着生殖衰老分期的提高,4组患者的年龄中位数逐渐增大,从45.5岁提高到57.0岁;与伴侣共同生活时间的年限中位数从20年增加到23.5年,性生活的间隔时间中位数从7 d增加到15 d;KMI中位数从9.5分提高到15分（P<0.05）。随着生殖衰老分期的升高,FSD和性欲障碍、性唤起障碍、阴道湿润障碍、性高潮障碍、性满意度障碍和性交痛的患病率均明显升高（P<0.05）。FSD和性欲障碍、性唤起障碍、阴道湿润障碍、性高潮障碍、性满意度障碍和性交痛的患病率随更年期症状的严重程度提高而升高（P<0.05）。结论 随着女性生殖衰老分期的提高,FSD的患病率明显升高。出现更年期症状以及其严重程度是40岁以上女性发生FSD的重要影响因素,应积极治疗更年期症状以提高女性的生活质量。     

乳腺癌患者血液中PGRMC1浓度与临床相关性

目的 本研究通过检测乳腺癌患者血液中孕激素受体膜组分1（progesterone receptor membrane component 1,PGRMC1）表达浓度来评价其在乳腺癌诊断中的临床价值。方法 选取2016年9月至2018年1月期间因乳腺疾病就诊于首都医科大学附属北京妇产医院乳腺外科、中国医学科学院肿瘤医院乳腺外科以及解放军263医院乳腺外科的患者140例,检测其血清及全血标本,其中乳腺癌组90例。根据临床分期早期50例：Ⅰ期（n=24）、Ⅱ期（n=26）,晚期40例：Ⅲ期（n=20）、Ⅳ期（n=20）。乳腺良性肿瘤组50例。采用数字表法随机抽取同期门诊健康体检者30例作为对照组。全血样本处理后采用酶联免疫吸附剂测定法（enzyme linked immunosorbent assay,ELISA）测定各组PGRMC1浓度,化学发光免疫分析法（chemiluminescent immunoassay,CLIA）测定各组血清CA125、CA153和CEA表达浓度。ROC曲线评价PGRMC1在乳腺癌诊断中的应用价值。结果 PGRMC1浓度在乳腺癌、乳腺良性疾病患者及正常对照人群中差异有统计学意义（P=0.000）。乳腺癌患者中PGRMC1浓度随临床分期增加而逐渐升高,明显高于乳腺良性疾病组及对照组浓度[Ⅱ期（60.89 ±16.86）ng/L,Ⅲ期（95.54 ±16.79）ng/L,Ⅳ期（113.78 ±41.20）ng/L vs良性肿瘤组（42.77 ±29.81）ng/L,对照组（39.36 ±25.10）ng/L],组间比较差异有统计学意义（P<0.05）。与乳腺良性疾病组与正常对照组相比,乳腺癌晚期组3种肿瘤标志物明显升高（Ⅲ期：CA125：χ²=12.26,P=0.000;CA153：χ²=28.19,P=0.000;CEA：χ²=6.52,P=0.011;Ⅳ期：CA125：χ²=16.46,P=0.000;χ²=42.19,P=0.000;CEA：χ²=14.29,P=0.000）。与乳腺癌早期组比较,差异无统计学意义（P>0.05）;乳腺良性疾病组与正常组比较,差异无统计学意义（P>0.05）。受试者工作特征（receiver operating characteristic,ROC）曲线分析显示晚期组PGRMC1的曲线下面积（area under the ROC,AUC）为82.7%（P<0.05）,CA125、CA153、CEA的AUC分别为78.3%（P<0.05）、86.8%（P<0.05）、77.3%（P<0.05）。早期组中,CA125、CA153和CEA的AUC均小于60%（P>0.05）。而PGRMC1的AUC为86.6%（P<0.05）,敏感度为94.0%,特异度为50.0%。结论 乳腺癌患者全血中PGRMC1表达含量高,且表达程度随乳腺癌期别的增加而增高;PGRMC1对早晚期乳腺癌诊断均有一定的临床参考价值,有望成为激素治疗前乳腺癌风险常规筛查的血液学标志物。     

丙二醛、视黄醇与多囊卵巢综合征发病机制关系的探索

目的 研究氧化应激指标丙二醛（malondialdehyde,MDA）、视黄醇（retinol,RET）与多囊卵巢综合征（polycystic ovary syndrome,PCOS）发病机制的关系。方法 选取2017年7月至10月就诊于首都医科大学附属北京妇产医院内分泌科的PCOS患者65例作为研究组,同时选取因女方输卵管因素或男方因素而不孕或正常体检的健康育龄女性24例作为对照组。测量所有参与者的人体测量学指标、内分泌代谢指标及各氧化应激指标,比较PCOS患者与对照组各氧化应激指标特点。结果 PCOS组MDA、超氧化物歧化酶（superoxide dismutase,SOD）均显著高于对照组（P<0.05）,血清RET浓度低于对照组（P<0.05）。PCOS组氧化型谷胱甘肽（oxidized glutathione,Glut oxyd,）、总抗氧化活性（total antioxidant activity,TAA）、维生素C（vitamin C,VC）、维生素E（vitamin E,VE）与对照组相比差异无统计学意义（P>0.05）。MDA与抗苗勒管激素（anti-Müllerian hormone,AMH）呈明显正相关（r=0.208,P=0.05）,与睾酮（testosterone,TT）、空腹胰岛素（fasting insulin,FINS）、稳态胰岛素指数（homeostasis model assessment insulin resistance,HOMA-IR）无明显相关性（P>0.05）;RET与AMH呈明显负相关（r=-0.232,P<0.05）,与TT、FINS、HOMA-IR无明显相关性（P>0.05）。结论 多个氧化应激指标显示PCOS患者体内MDA代表的氧化应激水平增高,RET代表的抗氧化水平降低,深入研究氧化应激与PCOS的关系可能有助于阐明PCOS的发病机制。     

中国女性轻度认知障碍的影响因素及其与绝经症状的关系

目的 调查中国女性轻度认知障碍(mild cognitive impairment, MCI)的影响因素及其与各种典型绝经症状之间的关系。方法 采用蒙特利尔认知评估量表(Montreal Cognitive Assessment , MoCA)评估150名志愿者的认知功能,将其中患有轻度认知障碍的61例患者作为病例组(MCI组),认知功能正常的89例患者作为对照组(Non-MCI组)。收集临床、社会人口学和人体测量学数据,用改良Kupperman评分表(Modified Kupperman Index, KMI)评估绝经症状。两组间比较应用t检验和χ²检验。采用二元Logistic回归模型筛选轻度认知功能障碍的危险因素。结果 单因素分析显示,两组患者间年龄(P=0.001)、教育水平(P=0.001)、KMI评分(P <0.001)、失眠(P=0.033)与轻度认知功能障碍有关。多因素分析显示,对于年龄不超过55岁的患者,失眠(P=0.032)、头痛(P=0.021)是MCI的独立危险因素,高教育水平(P=0.004)是MCI的独立保护性因素。结论 各种更年期症状与MCI之间明确关联,这可能为预防痴呆症提供了新的方向。     

Aesthetic aspects in reconstructive microsurgery

The reconstruction of a part of the body that has lost or inhibited function has been the most important aspect of reconstructive surgery in the past. Because of the existence of better techniques and the patient's wish for social reintegration, the plastic surgeon today is forced to consider the aesthetic results of his work more than in the past. Sometimes microsurgical procedures in reconstructive surgery are the only chance for the patient to be healed or palliated. Experience with more than 350 free tissue transfers gave us the opportunity to estimate the value of a donor flap with respect to the requirements of the receiving site. To satisfy the high aesthetic demands in these cases, it was necessary for the right place and shape the flap to fit as closely as possible, even if further corrections were necessary to achieve a satisfactory result. The transfer of latissimus dorsi and radial forearm flaps to the face and lower leg is discussed in cases of tumorus diseases and severe injuries of young and old patients.Presented to the IXth Congress of the International Society of Aesthetic Plastic Surgery, New York, October 13, 1987     

The immune status of uraemic children/adolescents with chronic renal failure and renal replacement therapy

In adults with chronic renal failure (CRF) and/or renal replacement therapy (RRT) various immunological abnormalities have been described, but few data are available for the paediatric age group. We performed basic in vitro immunological studies in 26 patients 10 months–19 years of age with advanced renal failure, 11 with CRF (creatinine clearance 16.8±5.2 ml/min per 1.73 m²), 15 on RRT with haemodialysis (HD;n=9) and continuous ambulatory peritoneal dialysis (CAPD;n=6) as well as in 16 healthy controls. None had clinical evidence of deranged immune function. No significant differences were found in the percentages of B- and T-cells, T-cell subsets CD3, CD4, CD8 and mitogenic responses to phytohaemagglutinin and concanavalin A (Con A) between RRT patients (HD=CAPD) and control children. Most parameters in CRF patients were also normal, although they had a low percentage of B-cells (12.1±4.1; RRT: 19.7±6.5; controls: 18.5±7.1;P<0.01), relatively low levels of serum immunoglobulin G (948.4±209.4 mg/dl; HD: 1374.7±235.2 mg/dl;P<0.01; CAPD: 966.3±430.2 mg/dl, NS) and a high normal response to Con A (34.3±13.6 cpm ×10^–3; RRT: 34.5±11.3 cpm ×10^–3; controls: 23.4±9.9 cpm ×10^–3,P<0.01). All these values were, however, well within the normal accepted range. These data indicate that children/adolescents with CRF and/or RRT have no significant basic in vitro immunological defects. This study did not test the functional immune status of the young uraemic patients.     

Guidelines for a short-term therapy of a torture depression

Psychotherapeutic work with torture traumas and their aftereffects are made difficult through a number of factors. Six guiding principles are presented in this publication through which make it possible to influence the actual symptomatology within the limits of the short therapy, even under difficult conditions. Creative images, described in detail as process fantasies, are the focus of this short therapy. Situative experiences in the treatment process are not interpreted with reference to the subject or the concrete trauma. This leads to the intra-psychic patterns being unlinked from traumatic torture experience patterns. With the aid of a model which discusses the torture as a superinfection with psychogenic violence-viruses, the penetration and resistance to therapy towards the torture trauma can be illuminated so that a differentiation of social and psychological factors of the torture experience is made possible.