Laser-assisted dacryocystorhinostomy in nasolacrimal duct obstruction：5-year follow-up

AIM：To evaluate the long-term sucess rate of laserassisted dacryocystorhinostomy （L-DCR） in patients with nasolacrimal duct obstruction （NDO）.METHODS：Forty-one eyes of forty patients aged between 21-85y （mean 56.7y） who underwent L-DCR for the treatment of NDO were included in this retrospective,non-randomized study. The follow-up time was 72mo.Functional sucess was defined as the disappearance of epiphora under normal conditions and the presence of a patent ostium on lacrimal irrigation. Anatomical success was defined as a patent lacrimal passage on syringing besides continuing epiphora. Surgical failure was defined as persistent epiphora and closed ostium.RESULTS：Twenty-seven of 40 patients （67.5%） were female and 13 of 40 patients （32.5%） were male. The NDO was right-sided in 17 （42.5%） patients and left-sided in 22（55%） patients whereas 1 （2.5%） patient had undergone bilateral surgery. In 11 （27.5%） patients there were additional nasal abnormalities requiring simultaneous surgical approach. The average time for L-DCR was 26.50±4.9min（16-39min） and the average total amount of laser energy used was 287±27.9 J （239-367 J）. At the 5y follow-up, anatomical sucess rate was 75.0%（30 patients） and functional success rate was 65.0%（26 patients）, whereas surgical failure was seen in 25%（10 patients）. Revision of surgery was performed in 10 cases （25.0%）; failure of revision surgery was seen in 2 cases（5.0%）.CONCLUSION： Transcanalicular L-DCR is a reliable and fast procedure in the treatment of NDO. It can be alternative to external DCR which is accepted as the gold standard currently. The functional and anatomical success rate is higher in the first months and years, but still satisfactory at fifth year.

New 5-Year Plan to See Revolutionary Changes

In the next five years,China will place more emphasis on science and technolgy, education,and health care in policy and investment.

Mid-term survival of the Optimys short stem: A prospective case series of 500 patients

BACKGROUND In recent years,there has been an increase in the number of total hip arthroplasty procedures in the younger patient population.This active group has higher expectations of their prosthesis in comparison to the older population,and there is a greater physical demand for the prosthesis.Short femoral stems were in-troduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population.Currently,the long-term survival and functional outcomes of various short stems are still being investigated in different clinics.AIM To determine the 5-year survival of the Optimys hip stem.METHODS This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands.All patients received the Optimys short stem(Mathys Ltd,Bettlach,Switzerland).The primary outcome measure was survival of the hip stem,with revision as the endpoint.The secondary outcome measurements included patient-reported outcome measures(PROMs).Kaplan-Meier analysis was used to calculate the 5-year survival rate.Log-minus-log transformation was performed to calculate the 95%confidence interval(95%CI).Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery.Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs.RESULTS The mean age of the total 500 patients was 62.3 years(standard deviation:10.6)and 202 were male(40%).At a median follow-up of 5.5 years(interquartile range:4.5-6.7),7 patients were deceased and 6 revisions were registered,for infection(n=3),subsidence(n=2)and malposition(n=1).This resulted in an overall 5-year survival of 98.8%(95%CI:97.3-99.5).If infection was left out as reason for revision,a stem survival of 99.4%(95%CI:98.1-99.8)was seen.Baseline questionnaires were completed by 471 patients(94%),317 patients(63%)completed the 1-year follow-up questionnaires and 233 patients(47%)completed the 2-year follow-up.Both outcome measures significantly improved across all domains in the 1st year after the operation(P<0.03 for all domains).In the 2nd year after surgery,no significant changes were observed in any domain in comparison to the 1-year follow-up.CONCLUSION The Optimys stem has a 5-year survival of 98.8%.Patient-reported outcome measures increased significantly in the 1st postoperative year with stabilization at the 2-year follow-up.

社区老人轻度认知功能损害和早期老年痴呆发生率调查及5年随访分析

目的筛查老人认知功能损害和早期阿尔采莫氏病(AD)人群,并分析危险因素,了解同一人群MCI和早期AD人群时点发生率和危险因素变化情况。方法在社区随机抽取400例老人,使用自编的老年一般情况调查表、蒙特利尔认知评估量表(CMOCA)、简易精神状态检查表(MMSE)、体检和必要的辅助检查,筛查出MCI和早期AD人群,并对筛查出的MCI和早期AD人群的一般资料进行分析,了解MCI和早期AD人群的易发因素,随后在每年同一时间对同一人群重测CMOCA、MMSE等,并连续观察5年,最后对完成5年随访的MCI和AD患者进行追踪分析,以了解在无干预状况下MCI和早期AD患者的转归情况。结果入组的400例老人中,共筛查出CMOCA异常并符合MCI诊断患者151例(MCI组),符合轻度AD者78例(早期AD组),5年后仅190例完成随访,其中MCI组有79例,早期AD组有52例;MCI组5年来MCI异常率从43.77%上升到53.16%,CMOCA平均分从(24.95±2.88)下降到(21.35±2.26),早期AD组5年来异常率从22.63%上升到27.37%,平均分值从(21.64±1.87)下降到(19.64±2.13);显示5年中MCI异常率上升了10个百分点,早期AD异常率5年上升了5个百分点,两组不同年龄比较,80岁以上组异常率增加和均分值下降要大于70岁和60岁组。结论无论是MCI还是早期AD人群,当没有任何认知功能干预时,MCI和早期AD在老年人群中发病率均会逐年上升,而且年龄越大,患MCI和早期AD的风险就越高。

玻璃体腔注射抗VEGF药物治疗湿性年龄相关性黄斑变性的5年回顾性研究

目的:调查抗VEGF药物治疗湿性年龄相关性黄斑变性(wet age-related macular degeneration,wAMD)5年的疗效。方法:2011年至2021年于北京医院眼科诊断为wAMD的患者共84人103只眼进行回顾性分析。抗VEGF治疗采用3+PRN方案。观察5年来的最佳矫正视力(best-corrected visual acuity,BCVA)、玻璃体腔注射次数、随访次数和病灶的解剖学变化。结果:治疗5年后平均BCVA为38.1个字母,与基线相比下降9.4个字母,差异有统计学意义(P<0.001)。23.3%的患眼5年后可维持初始视力。5年内平均注射次数为13.8次,第1年注射次数最多,平均为4.3次。5年内平均随访次数为24.3次,仅有34.0%的患眼可遵循每次随访间隔≤3个月。5年后有68.0%的患眼出现纤维瘢痕,27.2%的患眼出现地图样萎缩,69.0%(71/103)的患眼存在持续的色素上皮脱离(pigment epithelial detachment,PED)。年龄、基线BCVA、是否初始治疗、随访年限、注射次数、中心视网膜厚度(central retina thickness,CRT)、地图样萎缩等对BCVA有显著影响。结论:多数患者在抗VEGF治疗1年内可维持视力,但5年以上维持效果不佳。早期诊治、提高注射频率,可能是未来改善预后的研究方向。

Predictive model for 5.year mortality after breast cancer surgery in Taiwan residents

Background:Few studies of breast cancer surgery outcomes have used longitudinal data for more than 2 years.This study aimed to validate the use of the artificial neural network(ANN)model to predict the 5?year mortality of breast cancer patients after surgery and compare predictive accuracy between the ANN model,multiple logistic regression(MLR)model,and Cox regression model.Methods:This study compared the MLR,Cox,and ANN models based on clinical data of 3632 breast cancer patients who underwent surgery between 1996 and 2010.An estimation dataset was used to train the model,and a validation dataset was used to evaluate model performance.The sensitivity analysis was also used to assess the relative signifi?cance of input variables in the prediction model.Results:The ANN model significantly outperformed the MLR and Cox models in predicting 5?year mortality,with higher overall performance indices.The results indicated that the 5?year postoperative mortality of breast cancer patients was significantly associated with age,Charlson comorbidity index(CCI),chemotherapy,radiotherapy,hormone therapy,and breast cancer surgery volumes of hospital and surgeon(all P<0.05).Breast cancer surgery volume of surgeon was the most influential(sensitive)variable affecting 5?year mortality,followed by breast cancer surgery volume of hospital,age,and CCI.Conclusions:Compared with the conventional MLR and Cox models,the ANN model was more accurate in predict?ing 5?year mortality of breast cancer patients who underwent surgery.The mortality predictors identified in this study can also be used to educate candidates for breast cancer surgery with respect to the course of recovery and health outcomes.

Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity:A prospective study

AIM To prospectively evaluate the postoperative morbimortality and weight loss evolution of patients who underwent a laparoscopic sleeve gastrectomy(LSG) as a primary bariatric procedure during 5 years of follow-up. METHODS Since 2006,data from patients undergoing a highly restrictive primary LSG have been prospectively registered in a database and analysed. Preoperative co-morbid conditions,operating time,hospital stay,early and late complications rate and evolution of weight loss after 5 years of follow-up were analysed.RESULTS A total of 156 patients were included,74.3% of whom were women. The mean age was 43.2 ± 13.1 years and the mean body mass index(BMI) was 41.5 ± 7.9 kg/m^2. Seventy patients(44.8%) presented a BMI under 40 kg/m^2. The mortality rate was 0%. The leakage rate was 1.2%,and the total 30-d morbidity rate was 5.1%(8/156). With a mean follow-up of 32.7 ± 28.5(range 6-112) mo,the mean percent of excess of weight loss(%EWL) was 82.0 ± 18.8 at 1 year,76.7 ± 21.3 at 3 years and 60.3 ± 28.9 at 5 years. The mean percent of excess of BMI loss(%EBMIL) was 94.9 ± 22.4 at 1 year,89.4 ± 27.4 at 3 years and 74.8 ± 29.4 at 5 years. Patients with preoperative BMI less than 40 kg/m^2 achieved greaterweight loss than did the overall study population. Diabetes remitted in 75% of the patients and HTA improved in 71.7%. CPAP masks were withdrawn in all patients with obstructive sleep apnoea.CONCLUSION LSG built with a narrow 34 F bougie and starting 3 cm from the pylorus proved to be safe and highly effective in terms of weight loss as a stand-alone procedure,particularly in patients with a preoperative BMI lower than 40 kg/m^2.

Thirty-one patients with primary hepatocellular carcinoma survived for more than 5 years after hepatectomy

Objective: To investigate the factors affecting progno- sis of patients with primary hepatocellular carcinoma (PHC) after resection. Methods: From 1976 to 1992, 213 patients with PHC treated with hepatectomy were followed up for more than 5 years. Thirty-one of the patients who had sur- vived for more than 5 years were compared with 56 patients who had survived for less than 5 years. Results: Early detection of tumor, radical resection, number of tumors, capsule formation, operation safe distance, presence of portal tumor embolus, pre- sence of cirrhosis and tumor size were important fac- tors affecting the prognosis of patients with PHC. The proportion of small liver cancer in the patients who had survived for more than 5 years was greatly larger than that in the control group. Conclusions: Early detection of tumor and radical re- section are of value in raising the 5-year survival rate. Much remains to be investigated about the rela- tionship between safe margin distance and prognosis of patients with PHC.

No long-term survival benefit with sustained-release 5-fluorouracil implants in patients with stages Ⅱ and Ⅲ gastric cancer

BACKGROUND The prognosis of gastric cancer in an advanced stage remains poor. The exact efficacy of the use of intraoperative sustained-release chemotherapy with 5-fluorouracil(5-FU) in advanced-stage gastric cancer is still unelucidated.AIM To explore the long-term survival benefit of using sustained-release 5-FU implants in stage Ⅱ and stage Ⅲ gastric cancer patients.METHODS Patients with gastric cancer in a locally advanced stage and who underwent an R0 radical resection between Jan 2014, to Dec 2016, in this single institution were included. Patients with pathological diagnoses other than adenocarcinoma were excluded. All included patients were grouped according to whether intraoperative sustained-release(SR) chemotherapy with 5-FU was used or not(NSR). The primary end-point was 5-year overall survival. Kaplan–Meier method with logrank test was used to analyze the overall survival of patients and Cox analysis was used to analyze prognosis factors of these patients.RESULTS In total, there were 563 patients with gastric cancer with locally advanced stage, who underwent an R0 radical resection. 309 patients were included in the final analysis. 219(70.9%) were men, with an average age of 58.25 years. Furthermore, 56(18.1%) received neoadjuvant chemotherapy, and 191(61.8%) were in TNM stage Ⅲ. In addition, 158 patients received intraoperative sustainedrelease chemotherapy with 5-FU and were included in the SR group, while the other 161 patients were included in the NSR group. The overall complication rate was 12.94% in the whole group and 10.81%, 16.46% in SR and NSR groups, respectively. There were no significant differences between the two groups in overall survival and complication rate(P > 0.05). The multivariate cox analysis indicated that only N Stage and neoadjuvant therapy were independent influencing factors of survival.CONCLUSION Intraoperative sustained-release chemotherapy usage with 5-FU, did not improve the survival of patients who underwent an R0 radical resection in locally advanced stage of gastric cancer.

Five-Year Survivors of Non-Small Cell Lung Cancer Patients with Positive Pleural Lavage Cytology

Background: The pleural lavage cytology (PLC) for non-small cell lung cancer (NSCLC) patients has been reported as a significant prognostic factor. The aim of this study is to clarify the clinicopathological characteristics of 5-year survivors of patients with positive PLC. Methods: Among 401 resected NSCLC patients, 30 (7.48%) patients with positive PLC were reviewed retrospectively. Results: Only 7 of 30 patients (23.3%) survived more than 5-year. There were no differences in age, gender, histology, pT status and pN status between 5-year survivors and non-survivors. On the other hand, the serum carcinoembryonic antigen (CEA) level was significantly higher in non-survivors. Among these 5-year survivors, 4 of 7 patients died of NSCLC recurrences more than 5 years after surgery. Remaining 3 patients survived without cancer recurrences. Interestingly these 3 survivors had not received any adjuvant therapies after surgery. Conclusion: None of the 5-year survivor with positive PLC had high serum CEA level. Furthermore 5-year survival did not equal to cure in NSCLC patients with positive PLC.

Chronic disease and its therapeutic drugs may effect on the postoperative 5-year survival rate of lung cancer patients

In this study, we aimed to investigate the influencing factors of postoperative 5-year survival rate in non small-cell lung cancer（NSCLC） patients with stage I–III. We enrolled 220 patients who underwent surgical operation and survived longer than 3 months, with histologically confirmed adenocarcinoma or squamous cell carcinoma from Jan. 2009 to Dec. 2009. Multiple variables, like age, gender, smoking, alcohol, obesity, family history of cancer, diabetes, hypertension, antidiabetic drugs, tumor staging, pathology, treatments, surgical side as well as lipid levels, were selected. We found that tumor staging was associated with 5-year survival rate of stage I–III NSCLC patients by univariate analysis. Furthermore, diabetes mellitus, hypertension and surgical side were associated with the overall survival of NSCLC patients with stage I, stageⅡand stage III, respectively. In conclusion, the status of chronic disease had potential effect on the postoperative 5-year survival rate of lung cancer patients.

108例天疱疮患者的生存分析

目的调查新疆地区天疱疮患者的5年生存情况,以及影响天疱疮预后的多种综合因素。为天疱疮的临床诊疗和预后评估提供参考。方法收集108例天疱疮患者的临床资料,并通过电话咨询进行5年的随访。生存单因素分析采用Kaplan-Meier法,并进行Log-rank时序检验;多因素分析采用Cox逐步回归模型。结果天疱疮患者的5年生存率为9.26%,在死亡的患者中,患者分别在8、11、12、12、15、24、27、34、34、35月死亡。Kaplan-Meier生存分析提示年龄、疾病分型、疾病严重程度、皮质类固醇初始剂量以及CRP值与预后相关。多因素分析显示,其中年龄≥50岁、皮质类固醇初始剂量≥1mg/kg以及CRP≥8 mg/L是天疱疮生存的独立危险因素。结论年龄≥50岁、皮质类固醇初始剂量≥1 mg/kg/天以及CRP≥8 mg/L是天疱疮生存的独立危险因素,对该类天疱疮患者要做到尽早干预治疗,密切随访,以降低死亡率。

prognostic significance of pretreatment serum carcinoembryonic antigen levels in gastric cancer with pathological lymph node-negative: A large sample singlecenter retrospective study

AIM To assess whether elevated serum carcinoembryonic antigen(CEA) is in the inferior prognosis for pathological lymph node-negative(p N_0) gastric cancer(GC) patients who underwent D_2 gastrectomy.METHODS About 469 p N0 GC patients,who received D^2 radical gastrectomy were retrospectively analyzed. The X-tile plots cut-off point for CEA were 30.02 ng/m L using minimum P-value from log-rank χ~2 statistics,and p N_0 GC patients were assigned to two groups: those more than 30.02 ng/m L(n = 48;CEA-high group) and those less than 30.02 ng/m L(n = 421;CEA-low group). Clinicopathologic characteristics were compared usingPearson's χ2 or Fisher's exact tests,and survival curves were so manufactured using the Kaplan-Meier method. Univariate and multivariate analysis were carried out using the logistic regression method.RESULTS The percentage of vessel carcinoma embolus(31.35% vs 17.1%) and advanced GC(T_(2-4b))(81.25% vs 65.32%) were higher in CEA-high group than CEA-low group. The CEA-positive patients had a significantly poorer prognosis than the CEA-nagetive patients in terms of overall survival(57.74% vs 90.69%,P < 0.05),and no different was found between subgroup of T category,differentiation,nerve invasion,and vessel carcinoma embolus(all P > 0.05). Multivariate survival analysis showed that CEA(OR = 4.924),and T category(OR = 2.214) were significant prognostic factors for stage p N0 GC(all P < 0.05). Besides,only T category(OR = 1.962) was an independent hazard factor in the CEA-high group(P < 0.05).CONCLUSION Those pretreatment serum CEA levels over 30.02 ng/m L on behalf of worse characteristics and unfavourable tumor behavior,and a poor prognosis for a nearly doubled risk of mortality in GC patients.

Rare long-term survivors of pancreatic adenocarcinoma without curative resection

Long-term outcome data in pancreatic adenocarcinoma are predominantly based on surgical series, as resection is currently considered essential for longterm survival. In contrast, five-year survival in nonresected patients has rarely been reported. In this report, we examined the incidence and natural history of ≥ 5-year survivors with non-resected pancreatic adenocarcinoma. All patients with pancreatic adenocarcinoma who received oncologic therapy alone without surgery at our institution between 1995 and 2009 were identified. Non-resected ≥ 5-year survivors represented 2%(11/544) of all non-resected patients undergoing treatment for pancreatic adenocarcinoma, and 11%(11/98) of ≥ 5-year survivors. Nine patients had localized tumor and 2 metastatic disease at initial diagnosis. Disease progression occurred in 6 patients, and the local tumor bed was the most common site of progression. Six patients suffered from significant morbidities including recurrent cholangitis, second malignancy, malnutrition and bowel perforation. A rare subset of patients with pancreatic cancer achieve longterm survival without resection. Despite prolonged survival, morbidities unrelated to the primary cancer were frequently encountered and a close follow-up is warranted in these patients. Factors such as tumor biology and host immunity may play a key role in disease progression and survival.

子宫内膜异位症生育指数对异位症患者术后自然妊娠的预测价值

目的:探讨子宫内膜异位症生育指数(EFI)对子宫内膜异位症(EMT)患者术后自然妊娠的预测价值。方法:分析2010年5月-2013年10月本院行腹腔镜联合宫腔镜检查并治疗的EMT合并不孕患者200例,术后EFI评分并利用患者可接受方式随访,记录术后妊娠情况,不同EFI分值患者不同时间段内累积妊娠率,利用受试工作者曲线(ROC)评价EFI对患者术后妊娠预测价值。结果:共纳入分析108例,5年自然妊娠率82例(75.9%),自然累计妊娠率EFI 0~3分为25.0%、4分为46.2%、5分为62.5%、6分为77.8%、7~8分为86.7%、9~10分为92.6%。ROC曲线分析EFI预测术后12个月内自然妊娠的临界值为7.37分,ROC曲线下面积为0.769(95%的可信区间0.565~0.972,P<0.05),预测敏感度为54.5%,特异度为90.9%。结论:EFI可对EMT术后患者自然妊娠进行预测,为临床选择治疗方案提供参考。

Meta-analysis of immunohistochemical expression of hypoxia inducible factor-1α as a prognostic role in gastric cancer

AIM: To conduct a meta-analysis to evaluate the prognostic role of hypoxia inducible factor-1&#x003b1; (HIF-1&#x003b1;) expression in gastric cancer.

Comparison of three data mining methods in predicting 5-year survival of colorectal cancer patients

The prediction of colorectal cancer(CRC) survivability has always been a challenging research issue. Considering the importance of predicting CRC patients’ survival rates, we compared the performance of three data mining methods: decision trees(DTs), artificial neural networks(ANNs) and support vector machines(SVMs), for predicting 5-year survival of CRC patients to assist clinicians in making treatment decisions. The CRC dataset used to build the prediction model comes from the surveillance, epidemiology, and end results(SEER) program. The 5-fold cross-validation and random forest algorithm were respectively utilized for measuring the model predictive accuracy and the importance of features. Experimental results show that the predictive accuracy of ANNs(0.73) and SVMs(0.75) were higher than that of DTs, and they also have the best result in the area under the receiver operating characteristic(ROC) curve(area under curve(AUC)=0.82). This result may indicate high predictive power of ANNs and SVMs for predicting 5-year survival of CRC patients.

Survival of patients with gastric cancer surgically treated at the National Cancer Center of China from 2011 to 2018 according to stage at diagnosis

Objective:The postoperative survival rates of patients with gastric cancer at different stages treated at the National Cancer Center(NCC)of China have not been reported.Therefore,we evaluated the survival of patients with gastric cancer who underwent surgery at the NCC from 2011 to 2018 to provide baseline information for further studies.Methods:We identified 7,301 patients with primary gastric carcinoma who underwent surgery at the NCC be-tween January 2011 and May 2018;among these,5,008 patients were enrolled in this study.Follow up was completed on April 30,2020.We analyzed the 5-year survival according to the stage,sex,age,and other clini-copathological features.Results:Five-year survival rates of patients with pTNM stages ⅠA,ⅠB,ⅡA,ⅡB,ⅢA,ⅢB,ⅢC,and Ⅳ treated at the NCC were 94.9%,91.8%,86.5%,76.1%,61.1%,44.2%,29.7%,and 8.1%,respectively,which were similar to those reported in Japan during the same period.Five-year survival rates of patients with ypTNM stages I,II,III,and IV were 93.1%,63.2%,27.2%,and 0.0%,respectively.In multivariable analysis,age,signet ring cell carcinoma,adjuvant chemotherapy,and degree of differentiation were revealed as important prognostic factors.Conclusion:The survival rates of patients with gastric cancer treated at the NCC have been significantly improved,reaching the levels of Japan in the same period.

Magnetic Resonance Spectroscopy and Prognostic Analysis of Molecular Subtypes of Medulloblastoma

Aim: The aim of this study was to investigate whether magnetic resonance spectrum (MRS) and MR imaging features can be used for non-invasive medulloblastoma subgrouping, and analyse patient characteristics and prognosis of molecular subtypes of medulloblastoma. Material and Methods: 32 patients with medulloblastoma underwent MRI prior to surgical resection, 16 of them underwent MRS. MR imaging features and metabolites measured by MRS were analysed to distinguish molecular subtypes of medulloblastoma. Patient demographics, histopathological types, and prognosis of different molecular subtypes were analysed and compared respectively. Results: MRS and MR imaging features differed from different individuals, but without statistical significance that involves acquiring non-quantitative MR imaging features and NAA/Cr, Cho/Cr, Lip/Cr, Glu and Gln/Cr ratio, to be used to determine molecular subtypes. There was no significant difference of the three molecular subtypes in age, gender and pathological type. The 5-year event-free survival (EFS) of SHH, WNT and non SHH/WNT subtype respectively were 75%, 57.1%, 38.1%, with no significant difference (p = 0.382). 5-year EFS of non SHH/WNT subtype was significantly higher in ≤3 years old group than >3 years old group (p = 0.047). Conclusion: MRS and MR imaging features can’t be used to determine molecular subtypes based on our small sample study. There was no significant difference of the prognosis in the three molecular subtypes. The prognosis of ≤3 years old group of non SHH/WNT subtype is better than >3 years old group.