In colon cancer,classic disease staging remains the key prognosis and treatment determinant.Although adjuvant chemotherapy has an established role in stageⅢcolon cancer patients,in stageⅡit is still a subject of con...In colon cancer,classic disease staging remains the key prognosis and treatment determinant.Although adjuvant chemotherapy has an established role in stageⅢcolon cancer patients,in stageⅡit is still a subject of controversy due to its restriction to a small subgroup of patients with high-risk histopathologic features.Patients with stageⅡtumors form a highly heterogeneous group,with five-year relative overall survival rates ranging from 87.5%(ⅡA)to 58.4%(ⅡC).Identifying those for whom adjuvant chemotherapy would be appropriate and necessary has been challenging,and prognostic markers which could serve in the selection of patients more likely to recur or benefit from adjuvant chemotherapy are eagerly needed.The stronger candidate in this category seems to be microsatellite instability(MSI).The recently reported European Society for Medical Oncology guidelines suggest that MSI should be evaluated in stageⅡcolorectal cancer patients in order to contribute in treatment decisionmaking regarding chemotherapy administration.Thehypothetical predictive role of MSI regarding its response to 5-fluorouracil-based adjuvant chemotherapy has proven a much more difficult issue to address.Almost every possible relation between MSI and chemotherapy outcome has been described in the adjuvant colon cancer setting in the international literature,and the matter is far from being settled.In this current report we critically evaluate the prognostic and predictive impact of MSI status in patients with stageⅡand stageⅢcolon cancer patients.展开更多
AIM: To investigate the prognostic value of chromosome 18q microsatellite alterations (MA) in stage Ⅱ colon cancer. METHODS: One hundred and six patients with sporadic stage Ⅱ colon cancer were enrolled in this stud...AIM: To investigate the prognostic value of chromosome 18q microsatellite alterations (MA) in stage Ⅱ colon cancer. METHODS: One hundred and six patients with sporadic stage Ⅱ colon cancer were enrolled in this study. DNA was extracted from formalin-fixed, paraffin-embedded tumor and adjacent normal mucosal tissue samples. MA, including loss of heterozygosity (LOH) and microsatellite instability (MSI), was analyzed by polymerase chain reaction, polyacrylamide gel-electrophoresis and DNA sequencing at 5 microsatellite loci on chromosome 18q (D18S474, D18S55, D18S58, D18S61 and D18S64).RESULTS: Among the 102 patients eligible for MA information, the overall frequencies of LOH, high and low frequency MSI/microsatellite stable were 49.0%, 17.6% and 82.4%, respectively. The high frequency of 18q-LOH was signif icantly associated with the poor 5-year overall survival (OS) (P=0.008) and disease free survival (P=0.006). High levels of MSI were significantly associated with a longer 5-year OS (P=0.045) while the higher frequency of 18q-LOH at the loci of D18S474 and D18S61 was significantly associated with a poorer 5-year OS (P=0.010 and 0.005, respectively). But multivariate analysis showed that only the frequency of 18q-LOH was significantly associated with the prognosis of the disease. CONCLUSION: High frequency of 18q-LOH is an independent prognostic factor indicating poor prognosis of the patients with stage Ⅱ colon cancer.展开更多
According to Barcelona Clinic Liver Cancer recommendations,intermediate stage hepatocellular carcinomas(stage B)are excluded from liver resection and are referred to palliative treatment.Moreover,Child-Pugh B patients...According to Barcelona Clinic Liver Cancer recommendations,intermediate stage hepatocellular carcinomas(stage B)are excluded from liver resection and are referred to palliative treatment.Moreover,Child-Pugh B patients are not usually candidates for liver resection.However,many hepatobiliary centers in the world manage patients with intermediate stage hepatocellular carcinoma or Child-Pugh B cirrhosis with liver resection,maintaining that hepatic resection is not contraindicated in selected patients with non–early-stage hepatocellular carcinoma and without normal liver function.Several studies demonstrate that resection provides the best survival benefit for selected patients in very early/early and even in intermediate stages of Barcelona Clinic Liver Cancer classification,and this treatment gives good results in the setting of multinodular,large tumors in patients with portal hypertension and/or Child-Pugh B cirrhosis.In this review we explore this controversial topic,and we show through the literature analysis how liver resection may improve the short-and long-term survival rate of carefully selected Barcelona Clinic Liver Cancer B and Child-Pugh B hepatocellular carcinoma patients.However,other large clinical studies are needed to clarify which patients with intermediate stage hepatocellular carcinoma are most likely to benefit from liver resection.展开更多
Uterine cervical cancer is the second most common gynecological malignancy. It is estimated that over 35% of tumors are diagnosed at locally advanced disease, stage ⅠB2-ⅡB with an estimated 5-year overall survival o...Uterine cervical cancer is the second most common gynecological malignancy. It is estimated that over 35% of tumors are diagnosed at locally advanced disease, stage ⅠB2-ⅡB with an estimated 5-year overall survival of 60%. During the last decades, the initial treatment for these women has been debated and largely varies through different countries. Thus, radical concurrent chemoradiation is the standard of care in United Sated and Canada, and neoadjuvant chemotherapy followed by radical surgery is the first line of treatment in some institutions of Europe, Asia and Latin America. Until today, there is no evidence of which strategy is better over the other. This article describe the evidence as well as the advantages and disadvantages of the main strategies of treatment for women affected by uterine cervical cancer stage ⅠB2-ⅡB.展开更多
AIM To evaluate whether a high risk macroscopic appearance(Type Ⅳ and giant Type Ⅲ) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological sta...AIM To evaluate whether a high risk macroscopic appearance(Type Ⅳ and giant Type Ⅲ) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage Ⅱ/Ⅲ(p Stage Ⅱ/Ⅲ) gastric cancer.METHODS One hundred and seventy-two advanced gastric cancer(defined as pT2 or beyond) patients with p Stage Ⅱ/Ⅲ who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined. RESULTS Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival(RFS)(35.7%) and overall survival(OS)(34%) than an average risk appearance(P = 0.0003 and P < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13^(th) Japanese Gastric Cancer Association(JGCA) pT(P = 0.01), but not with the 13^(th) JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13^(th) JGCA p Stage(P < 0.0001)and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified highrisk macroscopic appearance(P = 0.036, HR = 2.29 for RFS and P = 0.021, HR = 2.74 for OS) as an independent prognostic indicator. CONCLUSION A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13^(th) JGCA stage in p Stage Ⅱ/Ⅲ advanced gastric cancer.展开更多
AIM:To determine the prognostic value of lymphatic and/or blood vessel invasion (LBVI) in patients with stage Ⅱ gastric cancer.METHODS:From January 2001 to December 2006,487 patients with histologically confirmed pri...AIM:To determine the prognostic value of lymphatic and/or blood vessel invasion (LBVI) in patients with stage Ⅱ gastric cancer.METHODS:From January 2001 to December 2006,487 patients with histologically confirmed primary gastric adenocarcinoma were diagnosed with stage Ⅱ gastric cancer according to the new 7th edition American Joint Committee on Cancer stage classification at the Department of Gastric Cancer and Soft Tissue Surgery,Fudan University Shanghai Cancer Center.All patients underwent curative gastrectomy with standard lymph node (LN) dissection.Fifty-one patients who died in the postoperative period,due to various complications or other conditions,were excluded.Clinicopathological findings and clinical outcomes were analyzed.Patients were subdivided into four groups according to the status of LBVI and LN metastases.These four patient groups were characterized with regard to age,sex,tumor site,pT category,tumor grading and surgical procedure (subtotal resection vs total resection),and compared for 5-year overall survival by univariate and multivariate analysis.RESULTS:The study was composed of 320 men and 116 women aged 58.9 ± 11.5 years (range:23-88 years).The 5-year overall survival rates were 50.7% and the median survival time was 62 mo.Stage Ⅱ a cancer was observed in 334 patients,including 268 T3N0,63 T2N1,and three T1N2,and stage Ⅱb was observed in 102 patients,including 49 patients T3N1,51 T2N2,one T1N3,and one T4aN0.The incidence of LBVI was 28.0% in stage Ⅱ gastric cancer with 19.0% (51/269) and 42.5% (71/167) in LN-negative and LNpositive patients,respectively.In 218 patients (50.0%),there was neither a histopathologically detectable LBVI nor LN metastases (LBVI /LN ,group Ⅰ);in 51 patients (11.7%),LBVI with no evidence of LN metastases was detected (LBVI+/LN ,group Ⅱ).In 167 patients (38.3%),LN metastases were found.Among those patients,LBVI was not determined in 96 patients (22.0%) (LBVI /LN+,group Ⅲ),and was determined in 71 patients (16.3%) (LBVI+/LN+,group Ⅳ).Correlation analysis showed that N category and the number of positive LNs were significantly associated with the presence of LBVI (P < 0.001).The overall 5-year survival was significantly longer in LN-negative patients compared with LN-positive patients (56.1% vs 42.3%,P = 0.015).There was a significant difference in the overall 5-year survival between LBVI-positive and LBVInegative tumors (39.6% vs 54.8%,P = 0.006).Overall 5-year survival rates in each group were 58.8% (Ⅰ),45.8% (Ⅱ),45.7% (Ⅲ) and 36.9% (Ⅳ),and there was a significant difference in overall survival between the four groups (P = 0.009).Multivariate analysis in stage Ⅱ gastric cancer patients revealed that LBVI independently affected patient prognosis in LN-negative patients (P = 0.018) but not in LN-positive patients (P = 0.508).CONCLUSION:In LN-negative stage Ⅱ gastric cancer patients,LBVI is an additional independent prognostic marker,and may provide useful information to identify patients with poorer prognosis.展开更多
Aim To determine cephalometrically the mechanism of the treatment effects of non-extraction and multiloop edgewise archwire (MEAW) technique on postpeak Class Ⅱ Division 1 patients. Methodology In this retrospectiv...Aim To determine cephalometrically the mechanism of the treatment effects of non-extraction and multiloop edgewise archwire (MEAW) technique on postpeak Class Ⅱ Division 1 patients. Methodology In this retrospective study, 16 postpeak Class Ⅱ Division 1 patients successfully corrected using a non-extraction and MEAW technique were cephalometrically evaluated and compared with 16 matched control subjects treated using an extraction technique. Using CorelDRAW software, standardized digital cephalograms preand post-active treatments were traced and a reference grid was set up. The superimpositions were based on the cranial base, the mandibular and the maxilla regions,and skeletal and dental changes were measured. Changes following treatment were evaluated using the paired-sample t-test. Student's t-test for unpaired samples was used to assess the differences in changes between the MEAW and the extraction control groups. Results The correction of the molar relationships comprised 54% skeletal change (mainly the advancement of the mandible) and 46% dental change. Correction of the anterior teeth relationships comprised 30% skeletal change and 70% dental change. Conclusion The MEAW technique can produce the desired vertical and sagittal movement of the tooth segment and then effectively stimulate mandibular advancement by utilizing the residual growth potential of the condyle.展开更多
Accurate prediction of lymph node(LN) status is crucially important for appropriate treatment planning in patients with early gastric cancer(EGC). However,consensus on patient and tumor characteristics associated with...Accurate prediction of lymph node(LN) status is crucially important for appropriate treatment planning in patients with early gastric cancer(EGC). However,consensus on patient and tumor characteristics associated with LN metastasis are yet to be reached. Through systematic search,we identified several independent variables associated with LN metastasis in EGC,which should be included in future research to assess which of these variables remain as significant predictors of LN metastasis. On the other hand,even if we use these promising parameters,we should realize the limitation and the difficulty of predicting LN metastasis accurately. The sentinel LN(SLN) is defined as first possible site to receive cancer cells along the route of lymphatic drainage from the primary tumor. The absence of metastasis in SLN is believed to correlate with the absence of metastasis in downstream LNs. In this review,we have attempted to focus on several independent parameters which have close relationship between tumor and LN metastasis in EGC. In addition,we evaluated the history of sentinel node navigation surgery and the usefulness for EGC.展开更多
Congenital cataract occurs during infancy when the axial length and corneal and visual function are in the sensitive stages of rapid development..Inappropriate surgical intervention not only fails to restore visual fu...Congenital cataract occurs during infancy when the axial length and corneal and visual function are in the sensitive stages of rapid development..Inappropriate surgical intervention not only fails to restore visual function,.but also causes irreversible serious influences upon eyeball development in children diagnosed with congenital cataract. At present, the uncertainty of selection of intraocular lens(IOL) degrees during the eyeball development period is averted by using a main treatment of congenital cataract that includes two-stage surgery:.stage I cataract extraction and stage II IOL implantation. However, the accurate selection of a refractive correction method and the timing of IOL implantation during stage II surgery for aphakic eyes remains controversial following stage I cataract extraction..This review retrospectively summarizes the current progress and existing problems indicated by related recent studies focusing on refractive correction pattern and IOL implantation timing.展开更多
In the construction of Three Gorges Project, the total amount of concrete is about 28 Mm\+3 , and the total amount of metal works and reinforcement is approximately 0.72 Mt . The TGP is constructed in 3 stages . The p...In the construction of Three Gorges Project, the total amount of concrete is about 28 Mm\+3 , and the total amount of metal works and reinforcement is approximately 0.72 Mt . The TGP is constructed in 3 stages . The preparation period together with the first stage is 5 years , the second stage and third stage are both 6 years .In the second stage construction of 6 years (1998~2003) , there are 18.46 Mm\+3 of concrete to be placed and 0.192 Mt of metal works and embedded parts for mechanical and electric equipment to be installed . In 1999, a world record of annual concrete placement of 4.585 Mm\+3 was set . In 2000, it is planned to place 5.4 Mm\+3 of concrete and to install 38 000 t of metal works . Construction equipments and layout of construction site , concrete production and its temperature control, metal works, mechanical and electric equipments in the second stage construction are presented.展开更多
BACKGROUND Patient satisfaction with facial appearance at the end of orthodontic camouflage treatment is very important, especially for skeletal malocclusion. This case report highlights the importance of the treatmen...BACKGROUND Patient satisfaction with facial appearance at the end of orthodontic camouflage treatment is very important, especially for skeletal malocclusion. This case report highlights the importance of the treatment plan for a patient initially treated with four-premolar-extraction camouflage, despite indications for orthognathic surgery.CASE SUMMARY A 23-year-old male sought treatment complaining about his unsatisfactory facial appearance. His maxillary first premolars and mandibular second premolars had been extracted, and a fixed appliance had been used to retract his anterior teeth for two years without improvement. He had a convex profile, a gummy smile, lip incompetence, inadequate maxillary incisor inclination, and almost a class I molar relationship. Cephalometric analysis showed severe skeletal class Ⅱ malocclusion(A point-nasion-B point = 11.5°) with a retrognathic mandible(sella-nasion-B point = 75.9°), a protruded maxilla(sella-nasion-A point = 87.4°), and vertical maxillary excess(upper incisor to palatal plane = 33.2 mm). The excessive lingual inclination of the maxillary incisors(upper incisor to nasion-A point line =-5.5°)was due to previous treatment attempts to compensate for the skeletal class Ⅱ malocclusion. The patient was successfully retreated with decompensating orthodontic treatment combined with orthognathic surgery. The maxillary incisors were repositioned and proclined in the alveolar bone, the overjet was increased, and a space was created for orthognathic surgery, including maxillary impaction, anterior maxillary back-setting, and bilateral sagittal split ramus osteotomy to correct his skeletal anteroposterior discrepancy. Gingival display was reduced, and lip competence was restored. In addition, the results remained stable after 2 years. The patient was satisfied with his new profile as well as with the functional malocclusion at the end of treatment.CONCLUSION This case report provides orthodontists a good example of how to treat an adult with severe skeletal class Ⅱ malocclusion with vertical maxillary excess after an unsatisfactory orthodontic camouflage treatment. Orthodontic and orthognathic treatment can significantly correct a patient’s facial appearance.展开更多
Background:?Ovarian cancer (OC) is the most lethal gynecologic malignancy. About 70% of ovarian cancer patients have advanced disease and often not totally resectable. Previous studies of neoadjuvant chemotherapy (NAC...Background:?Ovarian cancer (OC) is the most lethal gynecologic malignancy. About 70% of ovarian cancer patients have advanced disease and often not totally resectable. Previous studies of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) versus primary debulking surgery (PDS) give inconsistent results. The aim of this retrospective study is to evaluate the outcome of the neoadjuvant chemotherapy followed by IDS versus PDS followed by adjuvant chemotherapy for the International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer.?Methods:?This study was performed on eligible patients with ovarian cancer admitted in Surgical Oncology and Medical Oncology departments at South Egypt Cancer Institute-Assiut University in the period from January 2010 to December 2015. Patients were divided into two groups, the first group included those who have NACT and underwent IDS plus adjuvant chemotherapy, and the second group included those who underwent PDS followed by adjuvant chemotherapy.?Results:?This study included 380 cases. One hundred and fifty-four patients (40.53%) had IDS. The remaining two hundred and twenty-six patients (59.47%) underwent PDS. In this study, treatment modality was significant for both disease-free survival (DFS) and overall survival (OS). DFS was significantly reduced after IDS when compared to PDS (median DFS: 33.00 months vs. 45.00 months, respectively;p??0.001). Also, OS was significantly reduced after IDS when compared to PDS. (Median OS: 43 months vs. 46 months, respectively;p = 0.047). Moreover, this drop of the survivals mainly occurred in specific subgroups such as the elderly patients, patients with bad performance status, suboptimal cytoreduction, as well as high-grade tumors. Conclusion:?This study showed that PDS resulted in a better disease-free survival and overall survival than IDS. Moreover, OS and DFS have significantly dropped in specific patients’ subgroups. Therefore, patients selection should be considered.展开更多
New anticancer drugs are being increasingly used for advanced and recurrent gastric cancer in many institutions. Therefore, the relative importance of surgery may have changed, and there may also be controversy as to ...New anticancer drugs are being increasingly used for advanced and recurrent gastric cancer in many institutions. Therefore, the relative importance of surgery may have changed, and there may also be controversy as to whether patients with stage IV gastric cancer should or not undergo surgical resection. The relevance of surgery in this population was studied. The relevance of surgery was studied in 304 cases of stage IV gastric cancer who were treated at KurumeUniversityHospitalfrom 1995 to 2009. Multivariate analysis showed that distant organ metastasis was significantly correlated with surgery. In stage IV cases, chemotherapy and the number of stage IV factors were independent prognostic factors. In surgery cases, venous invasion, chemotherapy, and residual tumor were independent prognostic factors. R0 was significantly higher in the surgery with chemotherapy group than in the chemotherapy alone group, but there was no significant difference in R1 or R2 cases between the surgery with chemotherapy group and the chemotherapy alone group. In R2 cases, use of a new drug was an independent prognostic factor. The rate of R0 was significantly higher in the preoperative chemotherapy group than in the surgery alone group. In preoperative chemotherapy cases, the S-1/cisplatin (CDDP) group had a 50% 2-year survival rate, and these cases underwent postoperative chemotherapy using the S-1 regimen. A multimodal treatment is considered most effective for stage IV gastric cancer, where this includes preoperative chemotherapy, surgery, and postoperative chemotherapy using the new anti-cancer drugs.展开更多
This is a report of a nonrandomized comparison of treatment results of 139 patients with stage IB, HA and proximal IIB carcinoma of the uterine cervix treated by radiation alone and 113 treated with a combination of r...This is a report of a nonrandomized comparison of treatment results of 139 patients with stage IB, HA and proximal IIB carcinoma of the uterine cervix treated by radiation alone and 113 treated with a combination of radiation and surgery. The five-year tumor free acturial survival for the patients with stage IB either with irradiation alone (RT) or combined with surgery (RS) was approximately 87%. For stage Ⅱ the tumor free actuarial five-year survival 79% with patients of RS, and 76% with RT. In the 113 patients treated with RS there were 18 (16%). In the 139 patients treated by RT there were 18 (13%) recurrences of pelvic, 4 local recurrences, 11 combined with parametrial, and free parametrial recurrences. There was no significant difference in the survival and recurrence rate of the patients treated with either method. Major complications were comparable in both groups (RT approximately 25% and RS approximately 10%), but 2/3 of those complications recovered without sequelae. The most frequent minor complication in the patients treated with RT was rectosigmoiditis.展开更多
目的:对比剑突下入路、经肋间入路单孔3D胸腔镜在Ⅰ-Ⅱ期非小细胞肺癌(NSCLC)切除术中的应用效果。方法:回顾性分析2018年07月至2020年02月于我院胸外科行单孔3D胸腔镜NSCLC切除术的83例Ⅰ-Ⅱ期患者的临床资料,其中剑突下入路单孔3D胸腔...目的:对比剑突下入路、经肋间入路单孔3D胸腔镜在Ⅰ-Ⅱ期非小细胞肺癌(NSCLC)切除术中的应用效果。方法:回顾性分析2018年07月至2020年02月于我院胸外科行单孔3D胸腔镜NSCLC切除术的83例Ⅰ-Ⅱ期患者的临床资料,其中剑突下入路单孔3D胸腔镜NSCLC切除43例(研究组),经肋间入路单孔3D胸腔镜NSCLC切除40例(对照组),术后随访12个月,比较两组相关临床指标。结果:研究组术中出血量、术后胸管留置时间均低于对照组(169.83 mL vs 210.47 mL,4.24 d vs 4.89 d,P<0.05);研究组手术时间高于对照组(154.16 min vs 142.38 min,P<0.05)。研究组术后12 h、术后24 h、术后48 h的疼痛视觉模拟评分(VAS)均低于对照组(4.01分vs 4.39分,4.43分vs 4.97分,2.84分vs 3.21分,P<0.05)。研究组术后24 h、术后48 h的前列腺素E2(PEG2)、P物质(SP)水平均低于对照组(264.02 pg/mL vs 316.28 pg/mL,221.13 pg/mL vs 272.28 pg/mL;2.02μg/mL vs 2.39μg/mL,1.62μg/mL vs 2.07μg/mL;P<0.05)。两组术前、术后1个月、术后12个月的第一秒用力呼气容积(FEV1)对比差异均无统计学意义(2.49 L vs 2.43 L,1.61 L vs1.57 L,2.33 L vs 2.29 L,P>0.05)。两组术后总并发症发生率对比差异无统计学意义(15.00%vs 11.63%,P>0.05)。术后12个月两组均无死亡情况出现,两组复发率、远处转移率对比差异均无统计学意义(4.65%vs 7.50%,2.33%vs 5.00%,P>0.05)。结论:剑突下入路单孔3D胸腔镜NSCLC切除术与经肋间入路相比,具有术中出血量少、术后胸管留置时间短、术后疼痛轻的优势,但两种入路手术近期预后相似。展开更多
文摘In colon cancer,classic disease staging remains the key prognosis and treatment determinant.Although adjuvant chemotherapy has an established role in stageⅢcolon cancer patients,in stageⅡit is still a subject of controversy due to its restriction to a small subgroup of patients with high-risk histopathologic features.Patients with stageⅡtumors form a highly heterogeneous group,with five-year relative overall survival rates ranging from 87.5%(ⅡA)to 58.4%(ⅡC).Identifying those for whom adjuvant chemotherapy would be appropriate and necessary has been challenging,and prognostic markers which could serve in the selection of patients more likely to recur or benefit from adjuvant chemotherapy are eagerly needed.The stronger candidate in this category seems to be microsatellite instability(MSI).The recently reported European Society for Medical Oncology guidelines suggest that MSI should be evaluated in stageⅡcolorectal cancer patients in order to contribute in treatment decisionmaking regarding chemotherapy administration.Thehypothetical predictive role of MSI regarding its response to 5-fluorouracil-based adjuvant chemotherapy has proven a much more difficult issue to address.Almost every possible relation between MSI and chemotherapy outcome has been described in the adjuvant colon cancer setting in the international literature,and the matter is far from being settled.In this current report we critically evaluate the prognostic and predictive impact of MSI status in patients with stageⅡand stageⅢcolon cancer patients.
文摘AIM: To investigate the prognostic value of chromosome 18q microsatellite alterations (MA) in stage Ⅱ colon cancer. METHODS: One hundred and six patients with sporadic stage Ⅱ colon cancer were enrolled in this study. DNA was extracted from formalin-fixed, paraffin-embedded tumor and adjacent normal mucosal tissue samples. MA, including loss of heterozygosity (LOH) and microsatellite instability (MSI), was analyzed by polymerase chain reaction, polyacrylamide gel-electrophoresis and DNA sequencing at 5 microsatellite loci on chromosome 18q (D18S474, D18S55, D18S58, D18S61 and D18S64).RESULTS: Among the 102 patients eligible for MA information, the overall frequencies of LOH, high and low frequency MSI/microsatellite stable were 49.0%, 17.6% and 82.4%, respectively. The high frequency of 18q-LOH was signif icantly associated with the poor 5-year overall survival (OS) (P=0.008) and disease free survival (P=0.006). High levels of MSI were significantly associated with a longer 5-year OS (P=0.045) while the higher frequency of 18q-LOH at the loci of D18S474 and D18S61 was significantly associated with a poorer 5-year OS (P=0.010 and 0.005, respectively). But multivariate analysis showed that only the frequency of 18q-LOH was significantly associated with the prognosis of the disease. CONCLUSION: High frequency of 18q-LOH is an independent prognostic factor indicating poor prognosis of the patients with stage Ⅱ colon cancer.
文摘According to Barcelona Clinic Liver Cancer recommendations,intermediate stage hepatocellular carcinomas(stage B)are excluded from liver resection and are referred to palliative treatment.Moreover,Child-Pugh B patients are not usually candidates for liver resection.However,many hepatobiliary centers in the world manage patients with intermediate stage hepatocellular carcinoma or Child-Pugh B cirrhosis with liver resection,maintaining that hepatic resection is not contraindicated in selected patients with non–early-stage hepatocellular carcinoma and without normal liver function.Several studies demonstrate that resection provides the best survival benefit for selected patients in very early/early and even in intermediate stages of Barcelona Clinic Liver Cancer classification,and this treatment gives good results in the setting of multinodular,large tumors in patients with portal hypertension and/or Child-Pugh B cirrhosis.In this review we explore this controversial topic,and we show through the literature analysis how liver resection may improve the short-and long-term survival rate of carefully selected Barcelona Clinic Liver Cancer B and Child-Pugh B hepatocellular carcinoma patients.However,other large clinical studies are needed to clarify which patients with intermediate stage hepatocellular carcinoma are most likely to benefit from liver resection.
文摘Uterine cervical cancer is the second most common gynecological malignancy. It is estimated that over 35% of tumors are diagnosed at locally advanced disease, stage ⅠB2-ⅡB with an estimated 5-year overall survival of 60%. During the last decades, the initial treatment for these women has been debated and largely varies through different countries. Thus, radical concurrent chemoradiation is the standard of care in United Sated and Canada, and neoadjuvant chemotherapy followed by radical surgery is the first line of treatment in some institutions of Europe, Asia and Latin America. Until today, there is no evidence of which strategy is better over the other. This article describe the evidence as well as the advantages and disadvantages of the main strategies of treatment for women affected by uterine cervical cancer stage ⅠB2-ⅡB.
文摘AIM To evaluate whether a high risk macroscopic appearance(Type Ⅳ and giant Type Ⅲ) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage Ⅱ/Ⅲ(p Stage Ⅱ/Ⅲ) gastric cancer.METHODS One hundred and seventy-two advanced gastric cancer(defined as pT2 or beyond) patients with p Stage Ⅱ/Ⅲ who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined. RESULTS Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival(RFS)(35.7%) and overall survival(OS)(34%) than an average risk appearance(P = 0.0003 and P < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13^(th) Japanese Gastric Cancer Association(JGCA) pT(P = 0.01), but not with the 13^(th) JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13^(th) JGCA p Stage(P < 0.0001)and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified highrisk macroscopic appearance(P = 0.036, HR = 2.29 for RFS and P = 0.021, HR = 2.74 for OS) as an independent prognostic indicator. CONCLUSION A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13^(th) JGCA stage in p Stage Ⅱ/Ⅲ advanced gastric cancer.
文摘AIM:To determine the prognostic value of lymphatic and/or blood vessel invasion (LBVI) in patients with stage Ⅱ gastric cancer.METHODS:From January 2001 to December 2006,487 patients with histologically confirmed primary gastric adenocarcinoma were diagnosed with stage Ⅱ gastric cancer according to the new 7th edition American Joint Committee on Cancer stage classification at the Department of Gastric Cancer and Soft Tissue Surgery,Fudan University Shanghai Cancer Center.All patients underwent curative gastrectomy with standard lymph node (LN) dissection.Fifty-one patients who died in the postoperative period,due to various complications or other conditions,were excluded.Clinicopathological findings and clinical outcomes were analyzed.Patients were subdivided into four groups according to the status of LBVI and LN metastases.These four patient groups were characterized with regard to age,sex,tumor site,pT category,tumor grading and surgical procedure (subtotal resection vs total resection),and compared for 5-year overall survival by univariate and multivariate analysis.RESULTS:The study was composed of 320 men and 116 women aged 58.9 ± 11.5 years (range:23-88 years).The 5-year overall survival rates were 50.7% and the median survival time was 62 mo.Stage Ⅱ a cancer was observed in 334 patients,including 268 T3N0,63 T2N1,and three T1N2,and stage Ⅱb was observed in 102 patients,including 49 patients T3N1,51 T2N2,one T1N3,and one T4aN0.The incidence of LBVI was 28.0% in stage Ⅱ gastric cancer with 19.0% (51/269) and 42.5% (71/167) in LN-negative and LNpositive patients,respectively.In 218 patients (50.0%),there was neither a histopathologically detectable LBVI nor LN metastases (LBVI /LN ,group Ⅰ);in 51 patients (11.7%),LBVI with no evidence of LN metastases was detected (LBVI+/LN ,group Ⅱ).In 167 patients (38.3%),LN metastases were found.Among those patients,LBVI was not determined in 96 patients (22.0%) (LBVI /LN+,group Ⅲ),and was determined in 71 patients (16.3%) (LBVI+/LN+,group Ⅳ).Correlation analysis showed that N category and the number of positive LNs were significantly associated with the presence of LBVI (P < 0.001).The overall 5-year survival was significantly longer in LN-negative patients compared with LN-positive patients (56.1% vs 42.3%,P = 0.015).There was a significant difference in the overall 5-year survival between LBVI-positive and LBVInegative tumors (39.6% vs 54.8%,P = 0.006).Overall 5-year survival rates in each group were 58.8% (Ⅰ),45.8% (Ⅱ),45.7% (Ⅲ) and 36.9% (Ⅳ),and there was a significant difference in overall survival between the four groups (P = 0.009).Multivariate analysis in stage Ⅱ gastric cancer patients revealed that LBVI independently affected patient prognosis in LN-negative patients (P = 0.018) but not in LN-positive patients (P = 0.508).CONCLUSION:In LN-negative stage Ⅱ gastric cancer patients,LBVI is an additional independent prognostic marker,and may provide useful information to identify patients with poorer prognosis.
文摘Aim To determine cephalometrically the mechanism of the treatment effects of non-extraction and multiloop edgewise archwire (MEAW) technique on postpeak Class Ⅱ Division 1 patients. Methodology In this retrospective study, 16 postpeak Class Ⅱ Division 1 patients successfully corrected using a non-extraction and MEAW technique were cephalometrically evaluated and compared with 16 matched control subjects treated using an extraction technique. Using CorelDRAW software, standardized digital cephalograms preand post-active treatments were traced and a reference grid was set up. The superimpositions were based on the cranial base, the mandibular and the maxilla regions,and skeletal and dental changes were measured. Changes following treatment were evaluated using the paired-sample t-test. Student's t-test for unpaired samples was used to assess the differences in changes between the MEAW and the extraction control groups. Results The correction of the molar relationships comprised 54% skeletal change (mainly the advancement of the mandible) and 46% dental change. Correction of the anterior teeth relationships comprised 30% skeletal change and 70% dental change. Conclusion The MEAW technique can produce the desired vertical and sagittal movement of the tooth segment and then effectively stimulate mandibular advancement by utilizing the residual growth potential of the condyle.
文摘Accurate prediction of lymph node(LN) status is crucially important for appropriate treatment planning in patients with early gastric cancer(EGC). However,consensus on patient and tumor characteristics associated with LN metastasis are yet to be reached. Through systematic search,we identified several independent variables associated with LN metastasis in EGC,which should be included in future research to assess which of these variables remain as significant predictors of LN metastasis. On the other hand,even if we use these promising parameters,we should realize the limitation and the difficulty of predicting LN metastasis accurately. The sentinel LN(SLN) is defined as first possible site to receive cancer cells along the route of lymphatic drainage from the primary tumor. The absence of metastasis in SLN is believed to correlate with the absence of metastasis in downstream LNs. In this review,we have attempted to focus on several independent parameters which have close relationship between tumor and LN metastasis in EGC. In addition,we evaluated the history of sentinel node navigation surgery and the usefulness for EGC.
基金The Pearl River Science and Technology New Star(Grant No.2014J2200060)Project of Guangzhou City,the Guangdong Provincial Natural Science Foundation for Distinguished Young Scholars(Grant No.14050000151)the Cultivation Projects for Young Teaching Staff of Sun Yat-sen University(12ykpy61) from the Fundamental Research Fundsfor the Central Universities
文摘Congenital cataract occurs during infancy when the axial length and corneal and visual function are in the sensitive stages of rapid development..Inappropriate surgical intervention not only fails to restore visual function,.but also causes irreversible serious influences upon eyeball development in children diagnosed with congenital cataract. At present, the uncertainty of selection of intraocular lens(IOL) degrees during the eyeball development period is averted by using a main treatment of congenital cataract that includes two-stage surgery:.stage I cataract extraction and stage II IOL implantation. However, the accurate selection of a refractive correction method and the timing of IOL implantation during stage II surgery for aphakic eyes remains controversial following stage I cataract extraction..This review retrospectively summarizes the current progress and existing problems indicated by related recent studies focusing on refractive correction pattern and IOL implantation timing.
文摘In the construction of Three Gorges Project, the total amount of concrete is about 28 Mm\+3 , and the total amount of metal works and reinforcement is approximately 0.72 Mt . The TGP is constructed in 3 stages . The preparation period together with the first stage is 5 years , the second stage and third stage are both 6 years .In the second stage construction of 6 years (1998~2003) , there are 18.46 Mm\+3 of concrete to be placed and 0.192 Mt of metal works and embedded parts for mechanical and electric equipment to be installed . In 1999, a world record of annual concrete placement of 4.585 Mm\+3 was set . In 2000, it is planned to place 5.4 Mm\+3 of concrete and to install 38 000 t of metal works . Construction equipments and layout of construction site , concrete production and its temperature control, metal works, mechanical and electric equipments in the second stage construction are presented.
文摘BACKGROUND Patient satisfaction with facial appearance at the end of orthodontic camouflage treatment is very important, especially for skeletal malocclusion. This case report highlights the importance of the treatment plan for a patient initially treated with four-premolar-extraction camouflage, despite indications for orthognathic surgery.CASE SUMMARY A 23-year-old male sought treatment complaining about his unsatisfactory facial appearance. His maxillary first premolars and mandibular second premolars had been extracted, and a fixed appliance had been used to retract his anterior teeth for two years without improvement. He had a convex profile, a gummy smile, lip incompetence, inadequate maxillary incisor inclination, and almost a class I molar relationship. Cephalometric analysis showed severe skeletal class Ⅱ malocclusion(A point-nasion-B point = 11.5°) with a retrognathic mandible(sella-nasion-B point = 75.9°), a protruded maxilla(sella-nasion-A point = 87.4°), and vertical maxillary excess(upper incisor to palatal plane = 33.2 mm). The excessive lingual inclination of the maxillary incisors(upper incisor to nasion-A point line =-5.5°)was due to previous treatment attempts to compensate for the skeletal class Ⅱ malocclusion. The patient was successfully retreated with decompensating orthodontic treatment combined with orthognathic surgery. The maxillary incisors were repositioned and proclined in the alveolar bone, the overjet was increased, and a space was created for orthognathic surgery, including maxillary impaction, anterior maxillary back-setting, and bilateral sagittal split ramus osteotomy to correct his skeletal anteroposterior discrepancy. Gingival display was reduced, and lip competence was restored. In addition, the results remained stable after 2 years. The patient was satisfied with his new profile as well as with the functional malocclusion at the end of treatment.CONCLUSION This case report provides orthodontists a good example of how to treat an adult with severe skeletal class Ⅱ malocclusion with vertical maxillary excess after an unsatisfactory orthodontic camouflage treatment. Orthodontic and orthognathic treatment can significantly correct a patient’s facial appearance.
文摘Background:?Ovarian cancer (OC) is the most lethal gynecologic malignancy. About 70% of ovarian cancer patients have advanced disease and often not totally resectable. Previous studies of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) versus primary debulking surgery (PDS) give inconsistent results. The aim of this retrospective study is to evaluate the outcome of the neoadjuvant chemotherapy followed by IDS versus PDS followed by adjuvant chemotherapy for the International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer.?Methods:?This study was performed on eligible patients with ovarian cancer admitted in Surgical Oncology and Medical Oncology departments at South Egypt Cancer Institute-Assiut University in the period from January 2010 to December 2015. Patients were divided into two groups, the first group included those who have NACT and underwent IDS plus adjuvant chemotherapy, and the second group included those who underwent PDS followed by adjuvant chemotherapy.?Results:?This study included 380 cases. One hundred and fifty-four patients (40.53%) had IDS. The remaining two hundred and twenty-six patients (59.47%) underwent PDS. In this study, treatment modality was significant for both disease-free survival (DFS) and overall survival (OS). DFS was significantly reduced after IDS when compared to PDS (median DFS: 33.00 months vs. 45.00 months, respectively;p??0.001). Also, OS was significantly reduced after IDS when compared to PDS. (Median OS: 43 months vs. 46 months, respectively;p = 0.047). Moreover, this drop of the survivals mainly occurred in specific subgroups such as the elderly patients, patients with bad performance status, suboptimal cytoreduction, as well as high-grade tumors. Conclusion:?This study showed that PDS resulted in a better disease-free survival and overall survival than IDS. Moreover, OS and DFS have significantly dropped in specific patients’ subgroups. Therefore, patients selection should be considered.
文摘New anticancer drugs are being increasingly used for advanced and recurrent gastric cancer in many institutions. Therefore, the relative importance of surgery may have changed, and there may also be controversy as to whether patients with stage IV gastric cancer should or not undergo surgical resection. The relevance of surgery in this population was studied. The relevance of surgery was studied in 304 cases of stage IV gastric cancer who were treated at KurumeUniversityHospitalfrom 1995 to 2009. Multivariate analysis showed that distant organ metastasis was significantly correlated with surgery. In stage IV cases, chemotherapy and the number of stage IV factors were independent prognostic factors. In surgery cases, venous invasion, chemotherapy, and residual tumor were independent prognostic factors. R0 was significantly higher in the surgery with chemotherapy group than in the chemotherapy alone group, but there was no significant difference in R1 or R2 cases between the surgery with chemotherapy group and the chemotherapy alone group. In R2 cases, use of a new drug was an independent prognostic factor. The rate of R0 was significantly higher in the preoperative chemotherapy group than in the surgery alone group. In preoperative chemotherapy cases, the S-1/cisplatin (CDDP) group had a 50% 2-year survival rate, and these cases underwent postoperative chemotherapy using the S-1 regimen. A multimodal treatment is considered most effective for stage IV gastric cancer, where this includes preoperative chemotherapy, surgery, and postoperative chemotherapy using the new anti-cancer drugs.
文摘This is a report of a nonrandomized comparison of treatment results of 139 patients with stage IB, HA and proximal IIB carcinoma of the uterine cervix treated by radiation alone and 113 treated with a combination of radiation and surgery. The five-year tumor free acturial survival for the patients with stage IB either with irradiation alone (RT) or combined with surgery (RS) was approximately 87%. For stage Ⅱ the tumor free actuarial five-year survival 79% with patients of RS, and 76% with RT. In the 113 patients treated with RS there were 18 (16%). In the 139 patients treated by RT there were 18 (13%) recurrences of pelvic, 4 local recurrences, 11 combined with parametrial, and free parametrial recurrences. There was no significant difference in the survival and recurrence rate of the patients treated with either method. Major complications were comparable in both groups (RT approximately 25% and RS approximately 10%), but 2/3 of those complications recovered without sequelae. The most frequent minor complication in the patients treated with RT was rectosigmoiditis.
文摘目的:对比剑突下入路、经肋间入路单孔3D胸腔镜在Ⅰ-Ⅱ期非小细胞肺癌(NSCLC)切除术中的应用效果。方法:回顾性分析2018年07月至2020年02月于我院胸外科行单孔3D胸腔镜NSCLC切除术的83例Ⅰ-Ⅱ期患者的临床资料,其中剑突下入路单孔3D胸腔镜NSCLC切除43例(研究组),经肋间入路单孔3D胸腔镜NSCLC切除40例(对照组),术后随访12个月,比较两组相关临床指标。结果:研究组术中出血量、术后胸管留置时间均低于对照组(169.83 mL vs 210.47 mL,4.24 d vs 4.89 d,P<0.05);研究组手术时间高于对照组(154.16 min vs 142.38 min,P<0.05)。研究组术后12 h、术后24 h、术后48 h的疼痛视觉模拟评分(VAS)均低于对照组(4.01分vs 4.39分,4.43分vs 4.97分,2.84分vs 3.21分,P<0.05)。研究组术后24 h、术后48 h的前列腺素E2(PEG2)、P物质(SP)水平均低于对照组(264.02 pg/mL vs 316.28 pg/mL,221.13 pg/mL vs 272.28 pg/mL;2.02μg/mL vs 2.39μg/mL,1.62μg/mL vs 2.07μg/mL;P<0.05)。两组术前、术后1个月、术后12个月的第一秒用力呼气容积(FEV1)对比差异均无统计学意义(2.49 L vs 2.43 L,1.61 L vs1.57 L,2.33 L vs 2.29 L,P>0.05)。两组术后总并发症发生率对比差异无统计学意义(15.00%vs 11.63%,P>0.05)。术后12个月两组均无死亡情况出现,两组复发率、远处转移率对比差异均无统计学意义(4.65%vs 7.50%,2.33%vs 5.00%,P>0.05)。结论:剑突下入路单孔3D胸腔镜NSCLC切除术与经肋间入路相比,具有术中出血量少、术后胸管留置时间短、术后疼痛轻的优势,但两种入路手术近期预后相似。