Renal tubular acidosis and associated factors in patients with primary Sjögren’s syndrome: a registry-based study

Clinical Rheumatology - To investigate the clinical features and factors associated with primary Sjögren’s syndrome (pSS)–associated renal tubular acidosis (RTA). This...     

Primary site disease and recurrence location in ovarian cancer patients undergoing primary debulking surgery vs. interval debulking surgery

IntroductionThe natural history and patterns of ovarian cancer (OC) relapse are still unclear. Recurrent disease can be peritoneal, parenchymal, or nodal. This study aims to analyze the location and pattern of OC recurrence according to the primary site of disease and to the type of surgical approach used.Material and methodsAll OC patients underwent primary debulking surgery (PDS) or interval debulking surgery (IDS), with 2014 FIGO stage III-IV, and with platinum-sensitive recurrence were included in the study. Primary disease location and site of recurrences were divided into peritoneal, parenchymal, and nodal, according to the presence of peritoneal carcinomatosis, parenchymal metastasis, and nodal involvement, respectively.ResultsA total of 355 patients were initially considered; of them, 295 met the inclusion criteria. Two hundred thirty-three patients obtained no macroscopic residual tumor at the end of primary surgical treatment. Primary parenchymal disease relapsed in 84.6% cases at a parenchymal site (p < 0.001), 97.2% of peritoneal diseases relapsed on the peritoneum (p < 0.001), and 100% of nodal diseases had a nodal recurrence (p < 0.001). Stratifying by the surgical approach all these correlations have been confirmed both in the PDS (p < 0.001) and IDS (p < 0.001) groups.ConclusionOur study shows that the site of relapse in cases of platinum-sensitive OC recurrence is closely related to the primary location of the disease, regardless of the type of initial treatment. Therefore, more attention during followup should be paid to areas where the initial tumor was present.     

Transvaginal ultrasound assessment of urinary tract in gynecological oncology patients: A multicenter prospective study

IntroductionThe aim of this study was to assess the prevalence of urinary tract involvement diagnosed on transvaginal ultrasound examination in women gynecological cancers. The diagnostic performance of transvaginal ultrasound in detecting ureteral and bladder involvement was also evaluated.MethodsThis is a multicenter prospective study. Women with gynecological cancers or recurrence undergoing ultrasound examination were included. Transvaginal ultrasound is simple and non-invasive method. Ureters, vesico-uterine septum, bladder involvement were evaluated. Sensitivity, specificity, positive predictive values (PPV), negative predictive value (NPV) of ultrasound were calculated. Surgery or imaging methods (MRI or CT scan) were considered as reference standard.ResultsA total of 569 patients were enrolled and 547 of them had diagnosis of malignancy. 56/547 (10.2%) had a diagnosis of urinary tract infiltration at ultrasound examination. On ultrasound examination, both ureters were clearly visualized in the vast majority of cases (507/547, 92.7%), whereas only one ureter was identified in 21/547 (3.8%) patients and both ureters were not visualized in 19/547 (3.5%). Ultrasound examination demonstrated high specificity (>99.0%) and high NPV (>97.0%) for all ultrasound parameters; sensitivity was good for bladder wall infiltration (83.3%) and for vesico-uterine septum infiltration (80.8%), and low for right (69.23%) and left (65.4%) ureter infiltration.ConclusionsThe prevalence of pelvic urinary tract infiltration on transvaginal ultrasound examination in women with gynecologic malignancy was 10%. We believe that pelvic urinary tract assessment plays a key role during transvaginal ultrasound examination, in order to plan the management of patients with gynecologic cancers.     

Impact of neoadjuvant chemotherapy on the postoperative pathology of locally advanced cervical squamous cell carcinomas: 1:1 propensity score matching analysis

ObjectiveTo assess the impact of neoadjuvant chemotherapy on postoperative pathology for stage IB2 and IIA2 cervical squamous cell carcinoma.MethodsPostoperative pathology was compared between patients who received neoadjuvant chemotherapy followed by radical hysterectomy (NACT group) and patients who received upfront radical hysterectomy (URH group). Then, patients in the NACT group were divided into a chemotherapy-sensitive group and a chemotherapy-insensitive group according to their response to chemotherapy.ResultsAfter 1:1 propensity score matching (PSM), the positive rates of lymphovascular space invasion (LVSI) (7.9% vs 17.7%, P = 0.001) and cervical deep stromal invasion (60.4% vs 76.2%, P < 0.001) in the NACT group were significantly lower than those in the URH group, while the positive rates of parametrial invasion, lymph node metastasis, and vaginal margin invasion were not significantly different between the two groups. The rate of positive lymph node metastasis in the chemotherapy-sensitive group was significantly lower than that in the URH group (18.1% vs 26.5%, P = 0.037).ConclusionAmong patients with stage IB2 and IIA2 cervical squamous cell carcinomas, NACT can reduce the positive rate of intermediate-risk factors, such as deep cervical stromal invasion and LVSI, but cannot reduce the positive rate of high-risk factors. For patients who are chemotherapy sensitive, NACT can reduce the positive rate of lymph node metastasis.     

二甲双胍对前列腺癌合并糖尿病患者疗效影响的Meta分析

目的:通过Meta分析观察二甲双胍对前列腺癌合并糖尿病患者疗效的影响。方法:检索万方、中国知网、Pubmed、Embase、Cochrane Library等数据库,采用Review Manager 5.3软件进行数据分析。结果:有13篇文献被纳入,共37 972名患者。Meta分析结果显示:二甲双胍组可提高患者10年生存率（OR=1.95,95％CI:1.13~3.37,P=0.02）、5年无生化复发生存率（OR=1.93,95％CI:1.07~3.47,P=0.03）,并降低5年前列腺癌特异性死亡率（OR=0.86,95％CI:0.81~0.91,P＜0.000 01）。结论:二甲双胍在一定程度上可以改善前列腺癌合并糖尿病患者的预后,但上述结论仍需更多的更大样本的研究进一步加以证明。     

小细胞肺癌c-kit蛋白表达及小细胞肺癌化疗后维持治疗探讨

c-kit蛋白受体是跨膜酪氨酸激酶受体(RTK)家族中的一员,与其配体干细胞因子结合后受体酪氨酸激酶功能区被激活,产生自身磷酸化,完成细胞内外的信号传导,对这些细胞的分化发育以及功能维持起重要作用。近年来研究发现小细胞肺癌(SCLC)存在c-kit蛋白受体的异常高表达,推测其突变与SCLC发生存在着一定的联系,本文综述了c-kit蛋白受体在SCLC研究中的进展。小细胞肺癌是高侵袭性疾病,其在所有肺癌的诊断中约占15%²0%,其特点是肿瘤倍增时间快、生长分数高、播散转移早,对一线化学治疗(化疗)和放射治疗(放疗)高度敏感,但是无论疾病程度如何,绝大多数患者最终化疗后会发生疾病复发或化疗耐受,使SCLC化疗后维持治疗成为研究重点。目前,新的靶向药物在临床中的研究让我们看到了方向,分子靶向治疗可能成为化疗后维持治疗的最有效疗法。本文提供了一例舒尼替尼在小细胞肺癌患者化疗后维持治疗的病例,旨在为SCLC化疗后维持治疗提供新的思路。     

缓激肽在大鼠血栓闭塞性脉管炎模型中的表达

目的：观察大鼠血栓闭塞性脉管炎（TAO）模型中缓激肽的表达水平,探讨其在TAO发病过程中的意义。方法：Wister雄性大鼠股动脉注射月桂酸法制作TAO模型,随机分为对照组及1,3,7,14,21,28 d 7个组别,每组均设术前对照,采用酶联免疫吸附法（ELISA）分别测定各组大鼠血清中缓激肽水平。结果：注射月桂酸钠后大鼠肢体出现不同程度的缺血坏死。病理切片示大量新生血管与炎性细胞浸润,与对照组相比,随着缺血时间的延长,模型鼠血清缓激肽水平呈升高趋势,至第14天达到最高峰,之后开始下降,但仍高于术前水平（P〈0.05）。结论：缓激肽水平在TAO模型的血清中呈先高后低趋势,其可能在TAO侧支循环建立代偿中起到了一定作用。     

Longitudinal assessment of mortality risk among candidates for liver transplantation

Liver allocation policy recently was modified to use the Model for End-Stage Liver Disease (MELD) for patients with chronic liver disease to stratify potential recipients according to risk for waitlist death. In this study, a retrospective cohort of 760 adult patients with chronic liver disease placed on the liver transplant waitlist between January 1995 and March 2001 and followed up for up to 74 months was studied to assess the ability of the MELD to predict mortality among waitlisted candidates and evaluate the prognostic importance of changes in MELD score over time. Serial MELD scores predicted waitlist mortality significantly better than baseline MELD scores or medical urgency status. Each unit of the 40-point MELD score was associated with a 22% increased risk for waitlist death (P < .001), whereas medical urgency status was not a significant independent predictor. For any given MELD score, the magnitude and direction of change in MELD score during the previous 30 days (ΔMELD) was a significant independent mortality predictor. Patients with MELD score increases greater than 5 points over 30 days had a threefold greater waitlist mortality risk than those for whom MELD scores increased more gradually (P < .0001). We conclude that mortality risk on the liver transplant waitlist is predicted more accurately by serial MELD score determinations than by medical urgency status or single MELD measurements. ΔMELD score over time reflects progression of liver disease and conveys important additional prognostic information that should be considered in the further evolution of national liver allocation policy. (Liver Transpl 2003;9:12-18.)     

Diagnostic blood loss from phlebotomy and hospital acquired anemia in patients with severe burns

PurposeThe study was performed to estimate the diagnostic blood loss (DBL) volume during hospitalization and investigate its relationship with the development of moderate to severe hospital acquired anemia (HAA) and increased number of red blood cell (RBC) transfusion following extensive burns.Materials and methodsThis was a retrospective study of adult burned patients with total body surface area (TBSA) burn larger than 40%, who were admitted to burn center of Changhai hospital between January 2005 and December 2017.ResultsWe included a final number of 157 patients in the present study. Moderate to severe HAA within the fourth week postburn was developed in 46 of 121 patients who stayed over 28-day hospitalization. Patients with moderate to severe HAA had both significantly higher total DBL volume [245 (IQR: 183.75, 325.25) mL vs 168 (119, 163) mL ; P = 0.001] and DBL volume per day [10.22 (IQR: 8.57, 12.38) mL vs 6.63 (5.22, 10.42) mL/day; P = 0.005]. Logistic regression analysis revealed that both DBL volume per day and TBSA burn were independent risk factors for the development of moderate to severe HAA.ConclusionsSeverely burned patients appear to be prone to develop HAA during hospitalization. The DBL volume contribute to the occurrence of moderate to severe HAA, which might be a modifiable target for preventing HAA.     

rhBMP in lumber fusion for lumbar spondylolisthesis: A systematic review and meta-analysis

Purpose

To compare the efficacy and safety of recombinant human bone morphogenetic protein (rhBMP) and iliac crest autograft in the fusion treatment of lumbar spondylolisthesis.