Background: Wrinkles, pigmented spots, and roughness are representative parameters reflecting facial skin aging. Sulci cutis connecting to follicular orifices frequently form perifollicular cracks, which join together...Background: Wrinkles, pigmented spots, and roughness are representative parameters reflecting facial skin aging. Sulci cutis connecting to follicular orifices frequently form perifollicular cracks, which join together adjacent sulci. This follicle-sulcus-crack complex (FSCC) is exacerbated by dehydration. Purpose: Although dehydration is associated with facial skin aging, FSCC’s implications in facial skin aging remain unresolved. Method: We measured facial skin parameters in 1999 and 2010 in 108 Japanese women, and in 2006 and 2016 in 182 Chinese women. We addressed whether expansion of FSCC is associated with other skin aging parameters. We also examined whether skin moisturizer can reverse the expanded FSCC. Results: In both clinical studies, FSCC severity as well as wrinkles, spots, and roughness significantly deteriorated with age. Notably, FSCC significantly increased as early as in subjects in their 20s, whereas wrinkles, spots, and roughness became conspicuous in those in their 40s or older. Moreover, subjects with more severe FSCC in the initial measurement exhibited significantly worse wrinkles, spots, and roughness in the second measurement a decade later. Dehydration was significantly correlated with expanded FSCC. Furthermore, FSCC expansion was reversed after appropriate moisturization by daily application of Galactomyces ferment filtrate (GFF)-containing skincare product (SK-II Skin Power Cream) for 4 weeks in 37 women. Conclusion: The expanded FSCC is likely to be an early indicator of facial skin aging. Appropriate moisturization may reduce FSCC formation and decelerate facial skin aging.展开更多
Background Phakic intraocular lens （pIOL） implantation has been a popular means for the treatment of high ametropia Measurements of ciliary sulcus diameter is important for pIOL size determining. But till now, no pe...Background Phakic intraocular lens （pIOL） implantation has been a popular means for the treatment of high ametropia Measurements of ciliary sulcus diameter is important for pIOL size determining. But till now, no perfect system can directly measure it. The present study was to evaluate the accuracy, repeatability and reproducibility of direct sulcus diameter measurements obtained by a full-scale 50-megahertz （MHz） ultrasound biomicroscopy （UBM）. Methods A fresh cadaver human eye with a scale marker inserted through the posterior chamber plane from 3 o＇clock to 9 o＇clock meridian and 30 randomly selected eyes from 30 normal subjects were scanned by full-scale 50-MHz UBM in horizontal meridional scan plane. The distance between the scales and the whole length of the marker inside the cadaver eye were measured by the same observer using the ＂built-in＂ measurement tools and the indicating error of instrument was calculated. Reproducibility of the measurement was evaluated in 30 eyes by 2 operators using Blander and Altman plot test. Repeatability was evaluated from 10 successive eyes randomly selected from the 30 eyes by one operator. Results On a scale of 1 mm, the greatest indicating error was 40μm; the mean largest indicating error of 1 mm scale from the 10 images was （26_±14） μm; on a scale of 11 mm, the greatest indicating error was 70 μm; the error rate was 0.64%. The mean length of the needle inside the eye of the 10 images was 11.05 mm, with the mean indicating error of 47 μm, the average error rate was 0.43%. For ciliary sulcus diameter measurements in vivo, the coefficient of variation was 0.38%; the coefficients of repeatability for intra-observer and inter-observer measurements were 1.99% and 2.55%, respectively. The limits of agreement for intra-observer and inter-observer measurement were -0.41 mm to 0.48 mm and -0.59 mm to 0.58 mm, respectively. Conclusion The full-scale 50-MHz UBM can be a high accuracy and good repeatability means for direct measuring the ciliary sulcus diameter and useful for size determining of posterior chamber pIOL.展开更多
Objective To study direct cortical electrical stimulation technique for the recording of motor evoked potentials under general anesthesia in central sulcus lesions. Methods The largest N20-P25 response was recorded fr...Objective To study direct cortical electrical stimulation technique for the recording of motor evoked potentials under general anesthesia in central sulcus lesions. Methods The largest N20-P25 response was recorded from postcentral gyrus by intraoperative monitoring of cortical motor evoked potentials in 10 patients with intracranial lesions near or in the central area. The muscles of upper extremity in all patients were activated by delivering stimulus to cortical areas continuously. Moving the cortical electrodes forward, the largest P20-N25 response, SEP phase reversal,was obtained as a motor center stimulus. In this site of cortex, a short train stimulation elicited reproducible muscle action potentials that could be observed from the oscilloscope without averaging.Results MEPs can be recorded, pre-and post-operatively, without motor deficits of upper limbs in all patients.Conclusion This technique seems to be preferable for intraoperative localization of motor evoked potentials in central sulcus lesions under total intravenous anesthesia.展开更多
Otolith morphology is widely used for fish stock identification. The sulcus, a structure on the medial side of the otolith, is an important feature in morphological analysis. This study was conducted to evaluate the f...Otolith morphology is widely used for fish stock identification. The sulcus, a structure on the medial side of the otolith, is an important feature in morphological analysis. This study was conducted to evaluate the feasibility of using sulcus morphology for stock identification and to compare its performance with commonly used otolith morphology analysis. Otoliths were collected and analyzed from three geographical groups (the Huanghe (Yellow) River estuary, HHE;the Jiaozhou Bay, JZB;and the Changjiang (Yangtze) River estuary, CJE) of yellow drum Nibea albiflora. The results show that the analysis of sulcus morphology based on shape indices (SIs), elliptic Fourier coefficients (EFc), and a combination of the two parameters identified stocks at overall classification rates of 51.0%, 72.5%, and 73.2%, respectively. These classification rates are similar to those obtained using otolith morphology analysis (57.0%, 73.8%, and 76.5% by SIs, EFc, and their combination, respectively). The findings suggest that sulcus morphology is comparable to the commonly used otolith morphology for identifying stocks of sciaenids, such as the yellow drum. For both otolith and sulcus morphology, EFc could identify the stocks more efficiently than SIs, while the combination of SIs and EFc was even better.展开更多
This study analyzed and compared variations of the sulcus and otolith outlines of three geographic stocks(Huanghe(Yellow)River estuary(HHE),Jiaozhou Bay(JZB),and Changjiang(Yangtze)River estuary(CJE))of white croaker ...This study analyzed and compared variations of the sulcus and otolith outlines of three geographic stocks(Huanghe(Yellow)River estuary(HHE),Jiaozhou Bay(JZB),and Changjiang(Yangtze)River estuary(CJE))of white croaker Pennahia argentata in northern Chinese coastal waters.The sulcus and otolith outline analyses via elliptical Fourier transform(EFT,i.e.,outline analysis)achieved an overall classifi cation rate of 80.4%and 87.2%,respectively.Based on a combination of sulcus and otolith shape indices(SIs)and two derivative ratios,a moderate discriminatory effi ciency of 64.7%was obtained.The results indicate that sulcus outline analysis could be used alone to discriminate white croaker stocks,and that both sulcus and otolith outline analyses discriminated the fi sh stocks at a higher classifi cation rate than the shape indices.The sulcus outline analysis provided complementary information to the whole otolith outline analysis for stock discrimination.Both the sulcus and otolith outline analyses effi ciently discriminated between the most geographically separated CJE and HHE stocks,indicating that they could be considered discrete stocks for fi shery management.展开更多
AIM:To propose a surgical technique that successfully reopened the empty and intact capsular bag after long periods of closure,with repositioning of the intraocular lens(IOL)from the ciliary sulcus into its preferred ...AIM:To propose a surgical technique that successfully reopened the empty and intact capsular bag after long periods of closure,with repositioning of the intraocular lens(IOL)from the ciliary sulcus into its preferred habitat inside the capsular bag.METHODS:This is a case series,prospective,and interventional study.The technique was first performed on an aphakic high myope with a closed posterior capsule for 18 y.Afterwards,five patients with recurrently displaced sulcus IOLs for a range of 1 mo to 7 y were performed for the same technique.During surgery,identifying a"telltale white line"was an important landmark for detecting the site of major adhesions between the edge of the capsulorhexis and the posterior capsule.These adhesions were freed using combined manual and viscoelastic dissection,followed by an easier freeing of adhesions along the whole capsular bag.The IOL was safely implanted,exchanged,or introduced from the sulcus into the fibrotic and closed capsular bag.Patients were followed up for a period ranging from 6 to 17 mo postoperatively.RESULTS:All the patients experienced a remarkable improvement in their subjective refraction.Slit lamp examination showed a postoperative centralized IOL in the bag.The follow up visits confirmed visual and IOL stability.CONCLUSION:This newly-introduced surgical technique facilitates the reopening of the empty yet intact capsular bag that has been closed by fibrotic proliferations,with secured implantation of the IOL inside the capsular bag.Patients with inadvertent implantation of IOLs into the ciliary sulcus,yet having an intact capsular bag,can benefit from this technique.展开更多
AIM: To evaluate the surgical results of sulcus intraocular lens(IOL) implantation in children with unilateral anterior persistent fetal vasculature(PFV) underwent primary vitrectomy combined with lensectomy and prese...AIM: To evaluate the surgical results of sulcus intraocular lens(IOL) implantation in children with unilateral anterior persistent fetal vasculature(PFV) underwent primary vitrectomy combined with lensectomy and preservation of the peripheral anterior capsule.METHODS: Twenty-two eyes of 22 children with unilateral anterior PFV who underwent sulcus secondary IOL implantation were analyzed. Main outcome measures were preoperative and postoperative visual acuity, and complications both intraoperatively and postoperatively. RESULTS: Review of 22 consecutive patients identified best-corrected visual acuity(BCVA) improvement from 1.37±0.84 to 0.73±0.57 logarithm of the minimal angle of resolution(logMAR) after IOL implantation(P<0.001) with a mean follow-up was 16.55±5.86 mo. Average age at secondary IOL implantation was 41.05±15.41 mo. Three eyes(13.64%) achieved BCVA of 0.3 logMAR at the final visit. Transient intraocular pressure rise(4 eyes; 18.18%), postoperative increased inflammation(3 eyes; 13.64%) and postoperative hypotony(2 eyes; 9.09%) were common complications.CONCLUSION: Properly preservation of the anterior lens capsule during the primary surgery facilitated secondary sulcus IOL implantation in pediatric patients with anterior PFV, with favorable postoperative visual outcomes and compatible percentage of complications.展开更多
Despite the aggressive pursuit of diagnostic and treatment modalities for lung cancer, the treatment outcomes are still not satisfactory, and even patients with surgically resectable non-small cell lung cancer (NSCLC)...Despite the aggressive pursuit of diagnostic and treatment modalities for lung cancer, the treatment outcomes are still not satisfactory, and even patients with surgically resectable non-small cell lung cancer (NSCLC) are often at considerable risk of suffering recurrence and/or death from lung cancer. Regarding the treatment of patients with locally advanced, resectable NSCLC, several retrospective and prospective studies have shown the significance of multimodality treatments with preoperative chemoradiotherapy and surgical treatment. However, no definitive treatment strategies for locally advanced NSCLC patients have yet been established. One of the reasons for the lack of established treatment strategies for patients with locally advanced NSCLC is considered to be the heterogeneity of the population, i.e., cT4N0, cT3-4N1 and cT1a-3N2 tumors are included in stage IIIA disease, and superior sulcus tumors (SSTs) are also included in this classification. With regard to SST, two representative prospective phase II trials indicated the efficacy of surgical treatment following concurrent radiation and chemotherapy. In a study conducted by the Southwest Oncology Group, 110 patients with superior sulcus NSCLC were treated with two cycles of cisplatin and etoposide concurrently with 45 gray (Gy) of radiation, followed by surgical treatment and two additional cycles of chemotherapy postoperatively. The response rate (RR) to the preoperative chemoradiotherapy was 86%, and 83 patients (76%) were able to undergo complete resection. A pathological complete response (CR) was observed in 61 patients (56%), and the five-year survival of all patients and those undergoing complete resection was 44% and 54%, respectively. A phase II study conducted by the Japan Clinical Oncology Group examined the safety and efficacy of preoperative concurrent chemoradiotherapy using mitomycin, vinblastin and cisplatin followed by surgical treatment. Seventy-six patients with SST were enrolled in this study, and all received chemotherapy using two cycles of MVP concurrently with 45 Gy of radiation, followed by surgery. Neoadjuvant chemoradiotherapy resulted in a 61% RR, and pathological complete resection was successfully achieved in 51 patients (68%). A pathological CR was observed in 12 patients (16%), and the disease-free and overall survival rates at five years were 45% and 56%, respectively. Both studies showed the efficacy and tolerability of the multimodality treatment for SST, thus suggesting that multimodality treatment with preoperative chemoradiotherapy followed by surgery may therefore be an effective treatment for resectable SST. We herein review the results of retrospective and prospective studies while assessing the treatment outcomes of NSCLC patients with SST.展开更多
Objective： To compare the clinical effect and toxicities of preoperative concurrent chemoradiotherapy （CT/RT） with radiotherapy （RT） alone in patients with superior sulcus lung tumor. Methods： Fifty-six patients...Objective： To compare the clinical effect and toxicities of preoperative concurrent chemoradiotherapy （CT/RT） with radiotherapy （RT） alone in patients with superior sulcus lung tumor. Methods： Fifty-six patients with superior sulcus lung tumor were divided randomly into two groups： twenty-six patients received concurrent chemoradiotherapy, the other thirty patients received only radiotherapy. For both groups, the same radiation technic was given with the convention fraction. The total dose was 45 Gy/25 Fr/5 Wk. For the CT/RT group, the patients were also given with concurrent chemotherapy （navelbine 15-18 mg/m^2 on the 1st and 8th day, cisplatin 60 mg/m^2 on the 1st day）. Results： The rate of complete resection in the CT/RT group was significantly higher than that in the RT group （92.3% vs 80%, P 〈 0.05）. The complete pathological response rate and 2-year survival rate in the CT/RT group were significantly higher than those in the RT group （P 〈 0.01, P 〈 0.01）. The incidences of grades Ill-IV radiation esophagitis and leukopenia in the CT/RT group were significantly higher than those in the RT group （23.1% and 23.1% vs 6.7% and 0, P 〈 0.01, P 〈 0.01）. Conclusion： Preoperative concurrent chemoradiotherapy has the potential of improving the survival rate of superior sulcus lung tumors. Though this treatment regimen also increases the acute toxic effect, all patients can tolerate it. It is expected to be a new ＂standard treatment＂ for this malignant tumor.展开更多
Traditional descriptions of liver anatomy refer to a smooth,convex surface contacting the diaphragm.Surface depressions are recognized anatomic variants.There are many theories to explain the cause of the depressions....Traditional descriptions of liver anatomy refer to a smooth,convex surface contacting the diaphragm.Surface depressions are recognized anatomic variants.There are many theories to explain the cause of the depressions.We discuss the theory that these are caused by hypertrophic muscular bands in the diaphragm.展开更多
文摘Background: Wrinkles, pigmented spots, and roughness are representative parameters reflecting facial skin aging. Sulci cutis connecting to follicular orifices frequently form perifollicular cracks, which join together adjacent sulci. This follicle-sulcus-crack complex (FSCC) is exacerbated by dehydration. Purpose: Although dehydration is associated with facial skin aging, FSCC’s implications in facial skin aging remain unresolved. Method: We measured facial skin parameters in 1999 and 2010 in 108 Japanese women, and in 2006 and 2016 in 182 Chinese women. We addressed whether expansion of FSCC is associated with other skin aging parameters. We also examined whether skin moisturizer can reverse the expanded FSCC. Results: In both clinical studies, FSCC severity as well as wrinkles, spots, and roughness significantly deteriorated with age. Notably, FSCC significantly increased as early as in subjects in their 20s, whereas wrinkles, spots, and roughness became conspicuous in those in their 40s or older. Moreover, subjects with more severe FSCC in the initial measurement exhibited significantly worse wrinkles, spots, and roughness in the second measurement a decade later. Dehydration was significantly correlated with expanded FSCC. Furthermore, FSCC expansion was reversed after appropriate moisturization by daily application of Galactomyces ferment filtrate (GFF)-containing skincare product (SK-II Skin Power Cream) for 4 weeks in 37 women. Conclusion: The expanded FSCC is likely to be an early indicator of facial skin aging. Appropriate moisturization may reduce FSCC formation and decelerate facial skin aging.
文摘Background Phakic intraocular lens （pIOL） implantation has been a popular means for the treatment of high ametropia Measurements of ciliary sulcus diameter is important for pIOL size determining. But till now, no perfect system can directly measure it. The present study was to evaluate the accuracy, repeatability and reproducibility of direct sulcus diameter measurements obtained by a full-scale 50-megahertz （MHz） ultrasound biomicroscopy （UBM）. Methods A fresh cadaver human eye with a scale marker inserted through the posterior chamber plane from 3 o＇clock to 9 o＇clock meridian and 30 randomly selected eyes from 30 normal subjects were scanned by full-scale 50-MHz UBM in horizontal meridional scan plane. The distance between the scales and the whole length of the marker inside the cadaver eye were measured by the same observer using the ＂built-in＂ measurement tools and the indicating error of instrument was calculated. Reproducibility of the measurement was evaluated in 30 eyes by 2 operators using Blander and Altman plot test. Repeatability was evaluated from 10 successive eyes randomly selected from the 30 eyes by one operator. Results On a scale of 1 mm, the greatest indicating error was 40μm; the mean largest indicating error of 1 mm scale from the 10 images was （26_±14） μm; on a scale of 11 mm, the greatest indicating error was 70 μm; the error rate was 0.64%. The mean length of the needle inside the eye of the 10 images was 11.05 mm, with the mean indicating error of 47 μm, the average error rate was 0.43%. For ciliary sulcus diameter measurements in vivo, the coefficient of variation was 0.38%; the coefficients of repeatability for intra-observer and inter-observer measurements were 1.99% and 2.55%, respectively. The limits of agreement for intra-observer and inter-observer measurement were -0.41 mm to 0.48 mm and -0.59 mm to 0.58 mm, respectively. Conclusion The full-scale 50-MHz UBM can be a high accuracy and good repeatability means for direct measuring the ciliary sulcus diameter and useful for size determining of posterior chamber pIOL.
基金Science and Technology Committee of Shanghai, China (024119019).
文摘Objective To study direct cortical electrical stimulation technique for the recording of motor evoked potentials under general anesthesia in central sulcus lesions. Methods The largest N20-P25 response was recorded from postcentral gyrus by intraoperative monitoring of cortical motor evoked potentials in 10 patients with intracranial lesions near or in the central area. The muscles of upper extremity in all patients were activated by delivering stimulus to cortical areas continuously. Moving the cortical electrodes forward, the largest P20-N25 response, SEP phase reversal,was obtained as a motor center stimulus. In this site of cortex, a short train stimulation elicited reproducible muscle action potentials that could be observed from the oscilloscope without averaging.Results MEPs can be recorded, pre-and post-operatively, without motor deficits of upper limbs in all patients.Conclusion This technique seems to be preferable for intraoperative localization of motor evoked potentials in central sulcus lesions under total intravenous anesthesia.
基金Supported by the National Key Basic Research Program of China(973Program)(No.2015CB453302)the NSFC-Shandong Joint Fund for Marine Science Research Centre(No.U1606404)
文摘Otolith morphology is widely used for fish stock identification. The sulcus, a structure on the medial side of the otolith, is an important feature in morphological analysis. This study was conducted to evaluate the feasibility of using sulcus morphology for stock identification and to compare its performance with commonly used otolith morphology analysis. Otoliths were collected and analyzed from three geographical groups (the Huanghe (Yellow) River estuary, HHE;the Jiaozhou Bay, JZB;and the Changjiang (Yangtze) River estuary, CJE) of yellow drum Nibea albiflora. The results show that the analysis of sulcus morphology based on shape indices (SIs), elliptic Fourier coefficients (EFc), and a combination of the two parameters identified stocks at overall classification rates of 51.0%, 72.5%, and 73.2%, respectively. These classification rates are similar to those obtained using otolith morphology analysis (57.0%, 73.8%, and 76.5% by SIs, EFc, and their combination, respectively). The findings suggest that sulcus morphology is comparable to the commonly used otolith morphology for identifying stocks of sciaenids, such as the yellow drum. For both otolith and sulcus morphology, EFc could identify the stocks more efficiently than SIs, while the combination of SIs and EFc was even better.
基金Supported by the National Natural Science Foundation of China(NSFC)under the Programs Science Fund for Creative Research Groups(Nos.40821004,41121064)。
文摘This study analyzed and compared variations of the sulcus and otolith outlines of three geographic stocks(Huanghe(Yellow)River estuary(HHE),Jiaozhou Bay(JZB),and Changjiang(Yangtze)River estuary(CJE))of white croaker Pennahia argentata in northern Chinese coastal waters.The sulcus and otolith outline analyses via elliptical Fourier transform(EFT,i.e.,outline analysis)achieved an overall classifi cation rate of 80.4%and 87.2%,respectively.Based on a combination of sulcus and otolith shape indices(SIs)and two derivative ratios,a moderate discriminatory effi ciency of 64.7%was obtained.The results indicate that sulcus outline analysis could be used alone to discriminate white croaker stocks,and that both sulcus and otolith outline analyses discriminated the fi sh stocks at a higher classifi cation rate than the shape indices.The sulcus outline analysis provided complementary information to the whole otolith outline analysis for stock discrimination.Both the sulcus and otolith outline analyses effi ciently discriminated between the most geographically separated CJE and HHE stocks,indicating that they could be considered discrete stocks for fi shery management.
文摘AIM:To propose a surgical technique that successfully reopened the empty and intact capsular bag after long periods of closure,with repositioning of the intraocular lens(IOL)from the ciliary sulcus into its preferred habitat inside the capsular bag.METHODS:This is a case series,prospective,and interventional study.The technique was first performed on an aphakic high myope with a closed posterior capsule for 18 y.Afterwards,five patients with recurrently displaced sulcus IOLs for a range of 1 mo to 7 y were performed for the same technique.During surgery,identifying a"telltale white line"was an important landmark for detecting the site of major adhesions between the edge of the capsulorhexis and the posterior capsule.These adhesions were freed using combined manual and viscoelastic dissection,followed by an easier freeing of adhesions along the whole capsular bag.The IOL was safely implanted,exchanged,or introduced from the sulcus into the fibrotic and closed capsular bag.Patients were followed up for a period ranging from 6 to 17 mo postoperatively.RESULTS:All the patients experienced a remarkable improvement in their subjective refraction.Slit lamp examination showed a postoperative centralized IOL in the bag.The follow up visits confirmed visual and IOL stability.CONCLUSION:This newly-introduced surgical technique facilitates the reopening of the empty yet intact capsular bag that has been closed by fibrotic proliferations,with secured implantation of the IOL inside the capsular bag.Patients with inadvertent implantation of IOLs into the ciliary sulcus,yet having an intact capsular bag,can benefit from this technique.
基金Supported by Beijing Tongren Hospital,Capital Medical University(No.TRZDYXZY201703)
文摘AIM: To evaluate the surgical results of sulcus intraocular lens(IOL) implantation in children with unilateral anterior persistent fetal vasculature(PFV) underwent primary vitrectomy combined with lensectomy and preservation of the peripheral anterior capsule.METHODS: Twenty-two eyes of 22 children with unilateral anterior PFV who underwent sulcus secondary IOL implantation were analyzed. Main outcome measures were preoperative and postoperative visual acuity, and complications both intraoperatively and postoperatively. RESULTS: Review of 22 consecutive patients identified best-corrected visual acuity(BCVA) improvement from 1.37±0.84 to 0.73±0.57 logarithm of the minimal angle of resolution(logMAR) after IOL implantation(P<0.001) with a mean follow-up was 16.55±5.86 mo. Average age at secondary IOL implantation was 41.05±15.41 mo. Three eyes(13.64%) achieved BCVA of 0.3 logMAR at the final visit. Transient intraocular pressure rise(4 eyes; 18.18%), postoperative increased inflammation(3 eyes; 13.64%) and postoperative hypotony(2 eyes; 9.09%) were common complications.CONCLUSION: Properly preservation of the anterior lens capsule during the primary surgery facilitated secondary sulcus IOL implantation in pediatric patients with anterior PFV, with favorable postoperative visual outcomes and compatible percentage of complications.
文摘Despite the aggressive pursuit of diagnostic and treatment modalities for lung cancer, the treatment outcomes are still not satisfactory, and even patients with surgically resectable non-small cell lung cancer (NSCLC) are often at considerable risk of suffering recurrence and/or death from lung cancer. Regarding the treatment of patients with locally advanced, resectable NSCLC, several retrospective and prospective studies have shown the significance of multimodality treatments with preoperative chemoradiotherapy and surgical treatment. However, no definitive treatment strategies for locally advanced NSCLC patients have yet been established. One of the reasons for the lack of established treatment strategies for patients with locally advanced NSCLC is considered to be the heterogeneity of the population, i.e., cT4N0, cT3-4N1 and cT1a-3N2 tumors are included in stage IIIA disease, and superior sulcus tumors (SSTs) are also included in this classification. With regard to SST, two representative prospective phase II trials indicated the efficacy of surgical treatment following concurrent radiation and chemotherapy. In a study conducted by the Southwest Oncology Group, 110 patients with superior sulcus NSCLC were treated with two cycles of cisplatin and etoposide concurrently with 45 gray (Gy) of radiation, followed by surgical treatment and two additional cycles of chemotherapy postoperatively. The response rate (RR) to the preoperative chemoradiotherapy was 86%, and 83 patients (76%) were able to undergo complete resection. A pathological complete response (CR) was observed in 61 patients (56%), and the five-year survival of all patients and those undergoing complete resection was 44% and 54%, respectively. A phase II study conducted by the Japan Clinical Oncology Group examined the safety and efficacy of preoperative concurrent chemoradiotherapy using mitomycin, vinblastin and cisplatin followed by surgical treatment. Seventy-six patients with SST were enrolled in this study, and all received chemotherapy using two cycles of MVP concurrently with 45 Gy of radiation, followed by surgery. Neoadjuvant chemoradiotherapy resulted in a 61% RR, and pathological complete resection was successfully achieved in 51 patients (68%). A pathological CR was observed in 12 patients (16%), and the disease-free and overall survival rates at five years were 45% and 56%, respectively. Both studies showed the efficacy and tolerability of the multimodality treatment for SST, thus suggesting that multimodality treatment with preoperative chemoradiotherapy followed by surgery may therefore be an effective treatment for resectable SST. We herein review the results of retrospective and prospective studies while assessing the treatment outcomes of NSCLC patients with SST.
文摘Objective： To compare the clinical effect and toxicities of preoperative concurrent chemoradiotherapy （CT/RT） with radiotherapy （RT） alone in patients with superior sulcus lung tumor. Methods： Fifty-six patients with superior sulcus lung tumor were divided randomly into two groups： twenty-six patients received concurrent chemoradiotherapy, the other thirty patients received only radiotherapy. For both groups, the same radiation technic was given with the convention fraction. The total dose was 45 Gy/25 Fr/5 Wk. For the CT/RT group, the patients were also given with concurrent chemotherapy （navelbine 15-18 mg/m^2 on the 1st and 8th day, cisplatin 60 mg/m^2 on the 1st day）. Results： The rate of complete resection in the CT/RT group was significantly higher than that in the RT group （92.3% vs 80%, P 〈 0.05）. The complete pathological response rate and 2-year survival rate in the CT/RT group were significantly higher than those in the RT group （P 〈 0.01, P 〈 0.01）. The incidences of grades Ill-IV radiation esophagitis and leukopenia in the CT/RT group were significantly higher than those in the RT group （23.1% and 23.1% vs 6.7% and 0, P 〈 0.01, P 〈 0.01）. Conclusion： Preoperative concurrent chemoradiotherapy has the potential of improving the survival rate of superior sulcus lung tumors. Though this treatment regimen also increases the acute toxic effect, all patients can tolerate it. It is expected to be a new ＂standard treatment＂ for this malignant tumor.
文摘Traditional descriptions of liver anatomy refer to a smooth,convex surface contacting the diaphragm.Surface depressions are recognized anatomic variants.There are many theories to explain the cause of the depressions.We discuss the theory that these are caused by hypertrophic muscular bands in the diaphragm.
