Efficacy of Long-term Selenium Supplementation in the Treatment of Chronic Keshan Disease with Congestive Heart Failure

Few effective treatments for chronic Keshan disease have been available till now.The efficacy of long-term selenium supplementation in the treatment of chronic Keshan disease with congestive heart failure is inconclusive.This study aimed to determine whether selenium supplementation is associated with a decreased risk of cardiac death in chronic Keshan disease with congestive heart failure by ten years of follow-up.A retrospective long-term follow-up analysis was performed on a monitored cohort consisting of 302 chronic Keshan disease patients with a mean age of 40.8±11.4 years.Of the 302 chronic Keshan disease patients,170(56.3%)were given selenium supplementation until the end point of follow-up.Cox proportional hazards regression models were used to identify the independent predictors of cardiac events.Our results showed that during the follow-up,there were 101 deaths of patients with chronic Keshan disease in the selenium supplementation group(101/170,59.4%)and 98 in non-selenium supplementation group(98/132,74.2%).Multivariate analyses suggested that selenium supplementation was associated with a decreased risk of cardiac death(HR 0.39,95%CI 0.28-0.53)after adjustment for baseline age,sex,cigarette smoking,family history of Keshan disease,body mass index(BMI),heart rate,electrocardiogram(ECG)abnonnalities,blood pressure,initial cardiothoracic ratio,left ventricular可ection fractions(LVEF)and whole-blood selenium concentration.Our ten-year follow-up analysis indicated that selenium supplementation,specifically combined with the use of angiotensinconverting cnzyme inhibitor and beta blocker therapy,improved the survival of patients with chronic Keshan disease with congestive heart failure.BMI,selenium deficiency,male,combined ECG abnonnalities,LVEF,and fast heart rate increased the risk of cardiac events.

Hypertrophic adenoids in patients with nasopharyngeal carcinoma:appearance at magnetic resonance imaging before and after treatment

Introduction:Patients with nasopharyngeal carcinoma(NPC) sporadically develop abnormal adenoids.Nasopharyngeal adenoids are usually included in the gross tumor volume(GTV) but may have different therapeutic responses than tumor tissue.Therefore,distinguishing adenoids from tumor tissue may be required for precise and efficient chemoradiotherapy and radiotherapy.We characterized nasopharyngeal adenoids and investigated the therapeutic responses of NPC and nasopharyngeal adenoids using magnetic resonance imaging(MRI).Methods:MRI data from 40 NPC patients with a coexisting adenoid mass before and after treatment were analyzed.The features of the adenoid masses,including location,striped appearance,size,interface,symmetry/asymmetry,and cysts,were evaluated.Treatment response were scored according to the World Health Organization guidelines.Results:A striped appearance was observed in 36 cases before treatment and in all cases after treatment.In these 36 cases,the average GTVs including and excluding the uninvolved adenoids were 19.8 cm^3 and 14.8 cm^3,respectively.The average percentage change after excluding the uninvolved adenoids from the GTV was 31.0%.Stable disease in the adenoids was identified in 27(96.4%) of 28 patients after neoadjuvant chemotherapy,while NPC clearly regressed.Partial adenoid responses were identified in 33(82.5%) of 40 patients at 3 months after chemoradiotherapy or radiotherapy,whereas complete tumor responses were achieved in all patients.Six months after treatment,the adenoids continued to atrophy but did not disappear,and tumor recurrence was not found.Conclusions:Nasopharyngeal adenoids and carcinoma tissue in NPC patients can be distinguished by using MRI and have different responses to chemoradiotherapy and radiotherapy.These findings contribute to better delineating the GTV of NPC,based on which spatially optimized strategies can be developed to render precise and efficient chemoradiotherapy and radiotherapy.Additionally,we observed a clear difference in the responses of these two tissue types to current therapies.This finding may reduce or avoid unnecessary biopsies or overtreatment.