Primary Treatment for Clinically Early Cervical Cancer with Lymph Node Metastasis:Radical Surgery or Radiation?

Objective To compare survival outcomes between primary radical surgery and primary radiation in early cervical cancer.Methods Patient information was extracted from the Surveillance,Epidemiology,and Results database.Patients diagnosed with early cervical cancer of stage T1a,T1b,and T2a(American Joint Committee on Cancer,7th edition)from 1998 to 2015 were included in this study after propensity score matching.Overall survival(OS)was analyzed using the Kaplan-Meier method.Results Among the 4964 patients included in the study,1080 patients were identified as having positive lymph nodes(N1),and 3884 patients were identified as having negative lymph nodes(N0).Patients with primary surgery had significantly longer 5-year OS than those with primary radiotherapy in both the N1 group(P<0.001)and N0 group(P<0.001).In the subgroup analysis,similar results were found in patients with positive lymph nodes of stage T1a(100.0%vs.61.1%),T1b(84.1%vs.64.3%),and T2a(74.4%vs.63.8%).In patients with T1b1 and T2a1,primary surgery resulted in longer OS than primary radiation,but not in patients with T1b2 and T2a2.In multivariate analysis,the primary treatment was identified as an independent prognostic factor in both N1 and N0 patients(HR_(N1)=2.522,95%CI=1.919–3.054,PN1<0.001;HR_(N0)=1.895,95%CI=1.689–2.126,PN0<0.001).Conclusion In early cervical cancer stage T1a,T1b1,and T2a1,primary surgery may result in longer OS than primary radiation for patients with and without lymph node metastasis.

Surface electromyography for diagnosing dysphagia in patients with cerebral palsy

AIM: To determine the accuracy of 2-channel surface electromyography(sE MG) for diagnosing oropharyngeal dysphagia(OPD) in patients with cerebral palsy.METHODS: Participants with cerebral palsy and OPD between 5 and 30 years of age and age- and sexmatched healthy individuals received s EMG testing during swallowing. Electrodes were placed over the submental and infrahyoid muscles, and s EMG recordings were made during stepwise(starting at 3 mL) determination of maximum swallowing volume. Outcome measures included submental muscle group maximum amplitude, infrahyoid muscle group maximum amplitude(IMGMA), time lag between the peak amplitudes of 2 muscle groups, and amplitude difference between the 2 muscle groups.RESULTS: A total of 20 participants with cerebral palsy and OPD(OPD group) and 60 age- and sex-matched healthy volunteers(control group) were recruited. Among 20 patients with OPD, 19 had Dysphagia Outcome and Severity Scale records. Of them, 8 were classified as severe dysphagia(level 1), 1 was moderate dysphagia(level 3), 4 were mild to moderate dysphagia(level 4), 3 were mild dysphagia(level 5), and 3 were within functional limits(level 6). Although the groups were matched for age and sex, participants in the OPD group were significantly shorter, weighed less and had lower body mass index than their counterparts in the control group(both, P < 0.001). All s EMG parameter values were significantly higher in the OPD group compared with the control group(P < 0.05). Differences were most pronounced at the 3 mL swallowing volume. IMGMA at the 3 mL volume was the best predictor of OPD with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 85.0%, 90.0%, 73.9%, 94.7% and 88.8%, respectively.

Adjuvant Chemotherapy versus Radiotherapy in High-risk,Early-stage Endometrioid Endometrial Carcinoma

Objective:The present study was designed to evaluate the effects of adjuvant chemotherapy(CT)vs.radiotherapy(RT,alone or combined with CT)on the prognosis of patients with high-risk,early-stage(stage I and stage II)endometrioid endometrial carcinoma.Methods:This single-center retrospective clinical study was conducted in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology between 2010 and 2019.

Combined effect of cortical superficial siderosis and cerebral microbleed on short-term and long-term outcomes after intracerebral haemorrhage

Background and purpose Cortical superficial siderosis(cSS)and cerebral microbleed(CMB)have distinct effects on intracerebral haemorrhage(ICH).We aim to investigate the combined effect of cSS and CMB on outcomes after ICH.Methods Based on a single-centre stroke registry database,patients with spontaneous ICH who had CT scan within 48 hours after ictus and MRI subsequently were identified.Eligible patients were divided into four groups(cSS-CMB−,cSS-CMB+,cSS+CMB−,cSS+CMB+)according to cSS and CMB on susceptibility-weighted image of MRI.Primary outcomes were haematoma volume on admission and unfavourable outcome defined as modified Rankin Scale scores≥3 at 3 months.Secondary outcomes were all-cause death,recurrence of stroke and ICH during follow-up(median follow-up 2.0 years,IQR 1.0-3.0 years).Results A total of 673 patients were identified from 1044 patients with spontaneous ICH.131(19.5%)had cSS and 468(69.5%)had CMB.Patients with cSS+CMB+had the highest rate of poor outcome at 3 months,as well as all-cause death,recurrent stroke and ICH during follow-up.In cSS−patients,CMB was associated with smaller haematoma(β−0.13;95%CI−0.22 to−0.03;p=0.009),but it still increased risks of recurrent ICH(OR 4.6;95%CI 1.3 to 15.6;p=0.015)and stroke(OR 2.0;95%CI 1.0 to 4.0;p=0.049).These effects of CMB became unremarkable in the context of cSS+.Conclusions Patients with different combinations of cSS and CMB have distinct patterns of short-term and long-term outcomes.Although CMB is related to restrained haematoma,it does not improve long-term outcomes.

Numerical study on cavity ignition process in a supersonic combustor

Large eddy simulations(LESs)of cavity ignition processes were performed in a 2 D ethylene-fueled supersonic combustor with a single rear-wall-expansion cavity based on OpenFOAM.The ethylene combustion was modelled using a 35-step with 20-specie ethylene chemical mechanism,which had been validated by CHEMKIN calculations.The effect on the ignition process of different ignition sites inside the cavity was then studied.It was found that the rear region of the cavity floor is an optimized ignition site where successful ignitions will be achieved.According to different ignition behaviors,two flame extinguishing modes could be identified:blown-off extinguishing mode and flow dissipation extinguishing mode.Blown-off extinguishing mode mainly occurred after ignition near the cavity shear layer,in which the initial flame was blown off directly due to the high speed of the supersonic core flow.Flow dissipation extinguishing mode is likely to occur after ignition near the front and middle cavity floor as a result of severe turbulent dissipations and limited chemical reactions.The study indicates that the movement routine of the initial flame is important for the ignition process,including both moving towards a favorable flow field and forming a large heat release region along the movement.