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21.
Wang-Shu Zhu Si-Ya Shi Ze-Hong Yang Chao Song Jun Shen 《World journal of gastroenterology : WJG》2020,26(11):1208-1220
BACKGROUND Postoperative liver failure is the most severe complication in cirrhotic patients with hepatocellular carcinoma(HCC) after major hepatectomy. Current available clinical indexes predicting postoperative residual liver function are not sufficiently accurate.AIM To determine a radiomics model based on preoperative gadoxetic acid-enhanced magnetic resonance imaging for predicting liver failure in cirrhotic patients with HCC after major hepatectomy.METHODS For this retrospective study, a radiomics-based model was developed based on preoperative hepatobiliary phase gadoxetic acid-enhanced magnetic resonance images in 101 patients with HCC between June 2012 and June 2018. Sixty-one radiomic features were extracted from hepatobiliary phase images and selected by the least absolute shrinkage and selection operator method to construct a radiomics signature. A clinical prediction model, and radiomics-based model incorporating significant clinical indexes and radiomics signature were built using multivariable logistic regression analysis. The integrated radiomics-based model was presented as a radiomics nomogram. The performances of clinical prediction model, radiomics signature, and radiomics-based model for predicting post-operative liver failure were determined using receiver operating characteristics curve, calibration curve, and decision curve analyses.RESULTS Five radiomics features from hepatobiliary phase images were selected to construct the radiomics signature. The clinical prediction model, radiomics signature, and radiomics-based model incorporating indocyanine green clearance rate at 15 min and radiomics signature showed favorable performance for predicting postoperative liver failure(area under the curve: 0.809-0.894). The radiomics-based model achieved the highest performance for predicting liver failure(area under the curve: 0.894; 95%CI: 0.823-0.964). The integrated discrimination improvement analysis showed a significant improvement in the accuracy of liver failure prediction when radiomics signature was added to the clinical prediction model(integrated discrimination improvement = 0.117, P =0.002). The calibration curve and an insignificant Hosmer-Lemeshow test statistic(P = 0.841) demonstrated good calibration of the radiomics-based model. The decision curve analysis showed that patients would benefit more from a radiomics-based prediction model than from a clinical prediction model and radiomics signature alone.CONCLUSION A radiomics-based model of preoperative gadoxetic acid–enhanced MRI can be used to predict liver failure in cirrhotic patients with HCC after major hepatectomy. 相似文献
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23.
M.F. Werner A. López-Rueda F.X. Zarco J. Blasco L. San Román S. Amaro E. Carrero R. Valero L. Oleaga J.M. Macho N. Bargalló 《Radiologia》2019,61(2):143-152
Purpose
Endovascular treatment with mechanical thrombectomy devices demonstrated high recanalization rates but functional outcome did not correlate with high rates of recanalization obtained. Patient selection prior to the endovascular treatment is very important in the final outcome of the patient. The primary aim of our study was to evaluate the prognostic value of posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and Pons-Midbrain Index (PMI) scores in patients with Basilar Artery Occlusion (BAO) treated with successful angiographic recanalization after mechanical thrombectomy.Methods
Retrospective single-center study including 18 patients between 2008 and 2013 who had acute basilar artery occlusion managed with endovascular treatment within 24 hours from symptoms onset and with successful angiographic recanalization. The patients were initially classified into two groups according to clinical outcome and mortality at 90 days. For analysis we also divided patients into groups based on pc-ASPECTS (≥8vs.< 8) and PMI (≥3vs.< 3) on non-contrast CT (NCCT) and CT Angiography Source Images (CTASI). Imaging data were correlated to clinical outcome and mortality rate.Results
CTASI pc-ASPECTS, dichotomized at < 8 versus≥8, was associated with a favorable outcome (RR: 2.6; 95% CI: 1.3-5.2) and a reduced risk of death (RR: 6.5: 95% CI: 7.8-23.3). All patients that survived and were functionally independent had pc-ASPECTS score≥8. None of the 5 patients with CTASI pc-ASPECTS score less than 8 survived.Conclusion
PC-ASPECTS on CTASI is helpful for predicting functional outcome after BAO recanalization with endovascular treatment. These results should be validated in a randomized controlled trial in order to decide whether or not to treat a patient with BAO. 相似文献24.
观察并评估角膜电刺激对糖尿病大鼠前部缺血性视神经病变(AION)模型的影响。方法:实验 研究。健康雄性Sparague-Dawley大鼠40只,随机分组后抽出8只作为正常大鼠组。余下32只先予 以链脲佐菌素腹腔注射建立糖尿病大鼠模型,将造模成功的大鼠随机抽出8只作为糖尿病组,余下 24只糖尿病大鼠采用孟加拉玫瑰红联合532 nm激光方法建立AION大鼠模型。将24只造模成功的 AION大鼠随机分成3组,每组8只,分别为AION模型组,不予任何处理;电刺激组,予以角膜电刺 激(刺激参数为:电流1 mA,频率20 Hz,波宽1 ms/phase,刺激时间1 h,隔日1次,刺激2周);假电 刺激组,电极安放位置与电刺激组相同,仅不接通电源。2周后5组大鼠进行眼底照相、光学相干断 层扫描和视觉诱发电位,然后处死,行视网膜及视神经冰冻切片,苏木精伊红染色观察。数据采用 单因素方差分析和LSD-t检验进行分析。结果:正常大鼠组视盘上半部视网膜厚度为(211±13)μm, 糖尿病大鼠组为(206±16)μm,AION模型组为(240±54)μm,假电刺激组为(216±11)μm,电刺 激组为(198±4)μm,5组视盘上半部视网膜厚度差异有统计学意义(F=2.854,P=0.038)。其中AION 模型组视盘上半部视网膜厚度高于正常组、糖尿病组、电刺激组,差异均有统计学意义(P<0.05); 正常组与糖尿病组差异无统计学意义,AION模型组与假电刺激组未见明显差异。视觉诱发电位示 AION模型组N1潜伏期较电刺激组延长,差异有统计学意义(t=4.1,P<0.001);AION模型组P1潜伏 期较正常组、糖尿病组、假电刺激组、电刺激组延长,差异均有统计学意义(t=4.1、2.5、2.6、3.2, P<0.05);电刺激组N1-P1波幅大于假电刺激组,差异有统计学意义(t=4.0,P<0.001)。结论:角膜电 刺激能促进糖尿病大鼠前部缺血性视神经病变模型肿胀的视盘变薄,加速视盘水肿的消退,同时在 一定程度上改善视功能。 相似文献
25.
BackgroundLymph node recurrences (LNR) from colorectal cancer (CRC) still represent a therapeutic challenge, as standardized recommendations have yet to be established. The aim of this study was to analyze short- and long-term oncological outcomes following resection of LNR from CRC.MethodsAll patients with previously resected CRC who underwent histopathologically confirmed LNR resection in 3 tertiary referral centers between 2010 and 2017 were reviewed. Short- and long-term outcomes were analyzed, mainly recurrence-free and overall survival. Further recurrences following LNR resection were also analyzed.ResultsOverall, 18 patients were included. Primary CRC was left-sided in 16 (89%) patients, staged T3-4 in 15 (83%), N+ in 14 (78%) and presented with synchronous metastases in 8 (43%). Median time interval between primary CRC and LNR resections was 31 months. Performed lymphadenectomies were aortocaval (n = 10), pelvic (n = 7), in hepatic pedicle (n = 3) and mesenteric (n = 1). Four patients had associated liver metastases resection. Three (17%) presented with postoperative complications, of which one Clavien-Dindo 3. Fourteen (78%) patients presented with further recurrences after a mean delay of 9 months, with 36% of patients presenting with early (<6 months) recurrence. Five (36%) patients could undergo secondary recurrence resection and 3 (21%) patients radiotherapy. Median overall survival following LNR resection reached 44 months.ConclusionsCurrent results suggest that LNR resection is feasible and associated with improved survival, in selected patients. Longer time interval between primary CRC resection and LNR occurrence appeared to be a favorable prognostic factor whereas multisite recurrence appeared to be associated with impaired long-term survival. 相似文献
26.
Whitney S. Brandt Wanpu Yan Jian Zhou Kay See Tan Joseph Montecalvo Bernard J. Park Prasad S. Adusumilli James Huang Matthew J. Bott Valerie W. Rusch Daniela Molena William D. Travis Mark G. Kris Jamie E. Chaft David R. Jones 《The Journal of thoracic and cardiovascular surgery》2019,157(2):743-753.e3
Objective
Comparative survival between neoadjuvant chemotherapy and adjuvant chemotherapy for patients with cT2-4N0-1M0 non–small cell lung cancer has not been extensively studied.Methods
Patients with cT2-4N0-1M0 non–small cell lung cancer who received platinum-based chemotherapy were retrospectively identified. Exclusion criteria included stage IV disease, induction radiotherapy, and targeted therapy. The primary end point was disease-free survival. Secondary end points were overall survival, chemotherapy tolerance, and ability of Response Evaluation Criteria In Solid Tumors response to predict survival. Survival was estimated using the Kaplan–Meier method, compared using the log-rank test and Cox proportional hazards models, and stratified using matched pairs after propensity score matching.Results
In total, 330 patients met the inclusion criteria (n = 92/group after propensity-score matching; median follow-up, 42 months). Five-year disease-free survival was 49% (95% confidence interval, 39-61) for neoadjuvant chemotherapy versus 48% (95% confidence interval, 38-61) for adjuvant chemotherapy (P = .70). On multivariable analysis, disease-free survival was not associated with neoadjuvant chemotherapy or adjuvant chemotherapy (hazard ratio, 1.1; 95% confidence interval, 0.64-1.90; P = .737), nor was overall survival (hazard ratio, 1.21; 95% confidence interval, 0.63-2.30; P = .572). The neoadjuvant chemotherapy group was more likely to receive full doses and cycles of chemotherapy (P = .014/0.005) and had fewer grade 3 or greater toxicities (P = .001). Response Evaluation Criteria In Solid Tumors response to neoadjuvant chemotherapy was associated with disease-free survival (P = .035); 15% of patients receiving neoadjuvant chemotherapy (14/92) had a major pathologic response.Conclusions
Timing of chemotherapy, before or after surgery, is not associated with an improvement in overall or disease-free survival among patients with cT2-4N0-1M0 non–small cell lung cancer who undergo complete surgical resection. 相似文献27.
Wojciech Szychta M.D. Ph.D. Gheorghe Cerin M.D. Ph.D. F.E.S.C. Bogdan Adrian Popa M.D. Armienti Felice M.D. Guido Lanzillo M.D. Ph.D. Marco Diena M.D. Grzegorz Opolski M.D. Ph.D. F.E.S.C. 《Echocardiography (Mount Kisco, N.Y.)》2015,32(6):1040-1043
Sinus venosus atrial septal defect (SV‐ASD) usually coexists with partial anomalous pulmonary vein connection (PAPVC). It is a difficult diagnosis in transthoracic echocardiography (TTE) due to eccentric position of defects. We present a rare case of atypical anatomical variation in PAPVC, which was never described before. Two right pulmonary veins drained into superior vena cava, which overrode SV‐ASD and interatrial septum, a third pulmonary vein into the right atrium. Complete diagnosis could not be set after TTE, nor transesophageal echocardiography, whereas angio‐CT was finally conclusive. This diagnostic approach allowed the surgical planning. 相似文献
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29.
《Neuro-Chirurgie》2022,68(4):414-425
Intraoperative monitoring of cerebral blood flow (CBF) has become an invaluable adjunct to vascular and oncological neurosurgery, reducing the risk of postoperative morbidity and mortality. Several technologies have been developed during the last two decades, including laser-based techniques, videomicroscopy, intraoperative MRI, indocyanine green angiography, and thermography. Although these technologies have been thoroughly studied and clinically applied outside the operative room, current practice lacks an optimal technology that perfectly fits the workflow within the neurosurgical operative room. The different available technologies have specific strengths but suffer several drawbacks, mainly including limited spatial and/or temporal resolution. An optimal CBF monitoring technology should meet particular criteria for intraoperative use: excellent spatial and temporal resolution, integration in the operative workflow, real-time quantitative monitoring, ease of use, and non-contact technique. We here review the main contemporary technologies for intraoperative CBF monitoring and their current and potential future applications in neurosurgery. 相似文献
30.