Research Progress on Postoperative Minimal/Molecular Residual Disease Detection in Lung Cancer

Lung cancer is the leading cause of cancer‐related deaths worldwide. Approximately 10%–50% of patients experience relapse after radical surgery, which may be attributed to the persistence of minimal/molecular residual disease (MRD). Circulating tumor DNA (ctDNA), a common liquid biopsy approach, has been demonstrated to have significant clinical merit. In this study, we review the evidence supporting the use of ctDNA for MRD detection and discuss the potential clinical applications of postoperative MRD detection, including monitoring recurrence, guiding adjuvant treatment, and driving clinical trials in lung cancer. We will also discuss the problems that prevent the routine application of ctDNA MRD detection. Multi‐analyte methods and identification of specific genetic and molecular alterations, especially methylation, are effective detection strategies and show considerable prospects for future development. Interventional prospective studies based on ctDNA detection are needed to determine whether the application of postoperative MRD detection can improve the clinical outcomes of lung cancer patients, and the accuracy, sensitivity, specificity, and robustness of different detection methods still require optimization and refinement.     

Anatomy of coarctation,hypoplastic and interrupted aortic arch: relevance to interventional/surgical treatment

Obstructive lesions in the aortic arch are comprised of discrete coarctation, tubular hypoplasia and interruption. This review discusses the anatomy of the lesions relevant to interventional treatment. Catheter intervention, using not only balloon angioplasty but also stent implantation for coarctation, has been developed over the past couple of decades as an alternative treatment to surgery. Several studies have reported long-term outcome and the benefits of surgery and catheter intervention for treating obstructive lesions in the aortic arch but more studies are needed for comparable evaluations. The development of imaging and further improvement of surgical and catheter intervention, such as hybrid intervention or new devices, will help in removing the obstruction safely.     

B超在产后宫内胎盘残留清宫术中的临床应用研究

目的：研究B超在产后宫内胎盘残留清宫术中的应用。方法将120例产后宫内胎盘残留需行清宫术的患者分为观察组和对照组,观察组给予B超清宫术,对照组直接行清宫术。结果观察组平均手术时间、平均术中出血量均明显优于对照组,手术一次成功率为100%,高于对照组的65%,两组差异具有统计学意义。结论在B超监护下行清宫术能缩短手术时间,有效减轻了患者的痛苦,一次成功率高,临床应用价值较高。     

Protaper器械治疗不可复性牙髓炎中残髓与IAE关系的临床研究

目的：探讨Protaper镍钛器械根管预备不可复性牙髓炎后残髓与IAE的关系。方法：按Crown-down预备技术进行根管预备,约诊时记录初次预备后是否疼痛和发生时间、程度并做再次清理预备,仔细观察是否存在残髓和预备过程疼痛与否,必要时行多次清理和预备。结果：第1次预备后疼痛者往往在第2次预备时发现残髓。结论：残髓的存在是导致根管治疗期间疼痛应足够重视的原因之一,约诊期间最好行二次或以上次数的根管清理和预备。     

Outcome analysis of pelvic ring fractures

Background:

The behavior of pelvic ring fractures in the long run has been very sparsely studied. The purpose of this study is to assess the long-term outcome of pelvic ring fractures.

Materials and Methods:

A total of 24 patients with pelvic ring fractures, not involving the acetabulum, were followed up for an average duration of 33 months (range 24–49 months). The clinicoradiological assessment was done using the pelvic scoring system adapted from Cole et al. Parameters assessed included sacroiliac (SI) joint involvement and, among SI joint injuries, the presence of a fracture disruption and the degree of displacement.

Results:

Pain and limp were present in 13 patients (54.2%) each and residual working disability in 9 patients (37.5%). The overall Cole''s pelvic score was 31.3 ± 7.02 of a total score of 40. The average pelvic score in patients with SI disruption was 29.2 ± 6.75; much lower than patients without SI disruption with an average score of 34.9 ± 6.25 reaching statistical significance. The pelvic score among patients with a displacement ≤10 mm was 33.0 ± 3.92 and with a displacement >10 mm 25.88 ± 7.14. The difference was statistically significant.

Conclusions:

Pelvic ring injuries can lead to long term problems significantly. The involvement of the SI joint affects the long-term outcome adversely, more so if the residual displacement is >10 mm. The pelvic scoring system is comprehensive and depicts subtle differences in the outcome, which the individual parameters of the assessment fail to show.     

胆囊切除术后肝外胆管残余结石的预防

目的 探讨胆囊切除术后肝外胆管残余结石的预防.方法 回顾分析7 921例胆石症患者的临床资料.将磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)作为胆石症术前常规检查,术中疑有胆管结石者及时行经胆囊管造影或经胆囊管胆道镜探查,术中尽量避免医源性胆管结石残留.结果 本组7921例胆石症患者,经MRCP检查及术中造影、胆道镜探查发现B超漏诊胆管结石152例,仅发生3例胆管结石残余,明显低于国外同类报道.结论 MRCP可作为胆囊切除术前常规辅助检查,能有效提高胆总管下端结石的确诊率.术中采取经胆囊管造影、经胆囊管胆道镜探查以及提高术者操作技巧等措施,可明显地减少胆囊切除术后肝外胆管残余结石的发生率.     

Occult tumor cells in lymph nodes as a predictor for tumor relapse in pancreatic adenocarcinoma

Background and aims Occurrence of tumor relapse is frequent in patients with pancreatic cancer despite the absence of residual tumor detectable at primary surgery and in histopathological examination. Therefore, it has to be assumed that current tumor staging procedures fail to identify minimal amounts of disseminated tumor cells, which might be precursors of subsequent metastatic relapse. The aim of this study was to assess the prognostic impact of minimal tumor cell spread detected in lymph nodes classified as “tumor-free” in routine histopathologic evaluation. Materials and methods A total of 154 “tumor-free” lymph nodes from 59 patients with pancreatic cancer who underwent intentionally curative tumor resection were examined by immunohistochemistry for disseminated tumor cells. Results Fifty (32.5%) of the “tumor-free” lymph nodes obtained from 36 (61%) patients displayed disseminated tumor cells. Multivariate survival analysis revealed that the presence of disseminated tumor cells in “tumor-free” lymph nodes is an independent prognostic factor for both a significantly reduced relapse-free survival (p = 0.03) and overall survival (p = 0.02). Conclusions The frequent occurrence and prognostic impact of immunohistochemically identifiable disseminated tumor cells in lymph nodes of patients with operable pancreatic cancer supports the need for a refined staging system of excised lymph nodes, which should include immunohistochemical examination.     

胆道镜下胆管脓絮形态的分类及临床意义

目的：阐述胆道镜下胆管脓絮的形态及其形成病理基础;阐述胆管脓絮形态及分类对纤维胆道镜（CHF）治疗的指导意义。方法：通过对CHF治疗169例病例胆管脓絮形态的观察,发现各种形态的胆管脓絮共491例次,并对之进行分类研究,描述不同类型的胆管脓絮形成的病理基础,同时以之指导CHF的治疗。结果：胆管脓絮胺其不同的形态被分为五类：慧星征,海葵絮,纱贴絮和附壁脓苔,以之指导CHF治疗胆管残留结石,残瘤线结,胆管炎等取得了较好的效果,结石取尽率为92％（未取尽的13例中3例为自动放弃治疗者）,平均取石次数为3．97次。结论：胆管脓絮是胆道镜下的常见征象,不同形态脓絮的形成有不同的病理基础,了解胆管脓絮形态及分类对纤维胆道镜的探查和治疗有一定的指导作用。     

Strict Closed-System Drainage for Treating Chronic Subdural Haematoma

Summary. A comparative study chiefly of the recurrence rate of chronic subdural haematoma after two treatment modalities was conducted. Patients were divided into a burr hole strict closed-system drainage group (SCD group; n=56) and a burr hole closed-system drainage with irrigation group (CDI group; n=45). The burr hole strict closed-system drainage involved simply inserting a drainage tube into the haematoma cavity as quickly as possible after minimally incising the haematoma capsule. The introduction of air into the haematoma cavity was prevented, and irrigation was not performed. Symptoms in both groups disappeared soon after surgery, with no postoperative complications. Haematoma recurred in one patient (1.8%) of the SCD group compared with 5 (11.1%) of the CDI group. The rate of recurrence was significantly lower for the SCD than for the CDI group (p<0.05). In 4 of 5 recurrences in the CDI group, the volume of residual intracapsular air was sufficient after initial surgery. These results suggested that postoperative residual intracapsular air is a factor contributing to recurrence. Burr hole strict closed-system drainage is a simple, less invasive procedure with which to treat chronic subdural haematoma and the outcome is excellent. Furthermore, prevention of intracapsular air intrusion during surgery might help prevent recurrence.     

两种前牙残根桩核冠修复技术的疗效比较

目的:对两种桩核冠技术用于残根残冠修复的临床疗效进行对比。方法:将256例残根残冠患者(432颗前牙)随机分为对照组(n=216)与实验组(n=216,对照组患者采用金属铸造核桩技术进行治疗,实验组患者采用玻璃纤维桩树脂核技术进行治疗,每隔6个月对患者进行再次检测。结果:1年期成功率无显著性差异(P0.05),2年后成功率:对照组成功率86.1%,实验组成功率97.2%,有显著性差异(P0.05),实验组治疗效果要优于对照组。结论:对于前牙残根残冠的修复,玻璃纤维桩核冠技术的临床疗效要比金属铸造桩核冠技术更加安全、高效,值得临床推广应用。