Pathologic and Prognostic Outcomes of Very Low- and Low-Risk Prostate Cancer According to the National Comprehensive Cancer Network Guidelines in Japanese Patients with Radical Prostatectomy

Background: The purpose of this study was to validate the treatment strategy for a cohort of Japanese patients with very low-risk (VLR) and low-risk (LR) prostate cancer according to the National Comprehensive Cancer Network (NCCN) guidelines. Methods: We studied 751 patients with T1- 3N0M0 prostate cancer treated with radical prostatectomy at our institution between 2000 and 2012. Patients with neoadjuvant treatments were excluded. We retrospectively reviewed the clinical and pathological outcomes for patients with VLR or LR prostate cancers that were classified by NCCN guidelines. Results: We identified 45 patients with VLR and 137 with LR prostate cancer. Non-biochemical recurrence rate at 5-year for 45 patients with VLR was 86.9% and 81.2% for 137 patients with LR (p = 0.56). However, none of the 19 patients >65 years old with VLR progressed, while 19% of 26 patients ≤65 years old with VLR cancer, 14% of patients >65 years old with LR cancer, and 17% of patients ≤65 years old with LR cancer progressed during the follow-up period (p = 0.04, p = 0.04 and p = 0.05, respectively). In analyses of prostatectomy specimens, both VLR and LR had similarly favorable outcomes, but patients >65 years old with VLR had the smallest tumors, with a mean of 5 mm in diameter. Conclusions: Our results support the treatment strategy of the NCCN that patients with VLR cancer and age >65 years old are good candidates for active surveillance, and that other treatment options—including active surveillance and aggressive treatments—can be applied to the remaining patients with VLR or LR cancers.

Outcomes of combination MRI-targeted and transperineal template biopsy in restaging low-risk prostate cancer for active surveillance

Objective:Active surveillance(AS)offers a strategy to reduce overtreatment and now is a widely accepted treatment option for low-risk prostate cancer.An ideal tool for risk-stratification would detect aggressive cancers and exclude such men from taking up AS in the first place.We evaluate if a combination of transperineal template biopsy with magnetic resonance imaging(MRI)-targeted biopsy identifies significant prostate cancer amongst men initially diagnosed with low-risk prostate cancer.Methods:This prospective,single-blinded study included men with low-risk prostate cancer(D’Amico’s Criteria)diagnosed on conventional transrectal ultrasound-guided biopsy.Patients first underwent multiparametric MRI of the prostate
6 weeks after initial biopsy.Each suspicious lesion is mapped and assigned a Prostate Imaging Reporting and Data System(PIRADS)score.Template biopsy is first performed with the surgeon blinded to MRI findings followed by MRI-targeted biopsy using a robotic transperineal biopsy platform.Results:The age of the 19 men included is 65.4±4.9 years(mean±SD).Prostate specific antigen(PSA)at diagnosis and at the time of transperineal biopsy were comparable(7.3±1.7 ng/mL and 7.0±1.8 ng/mL,p Z 0.67),so were prostate volumes(34.2±8.9 mL and 32.1±13.4 mL,p Z 0.28).MRI-targeted biopsy had a higher percentage of cancer detection per core compared to template biopsy(11.7%vs.6.5%,p Z 0.02),this was more than 3 times superior for Gleason 7 disease(5.9%vs.1.6%,p<0.01).Four of 18(22.2%)patients with MRI lesions had significant disease with MRI-targeted biopsy alone.Three of 19 patients(15.8%)had significant disease with template biopsy alone.In combination,both techniques upclassified five patients(26.3%),all of whom underwent radical prostatectomy.Whole mount histology confirmed tumour location and grade.All six patients with PIRADS 5 lesions had cancer detected(66.6%significant disease).Conclusion:A combination of MRI-targeted and template biopsy may optimally risk-classify“low-risk”patients diagnosed on initial conventional transrectal ultrasonography(TRUS)prostate biopsy.

On the Association between Travel Distance and Treatment Choice for Low-Risk Prostate Cancer: Results from a Rural State

Background: Evidence suggests that cancer patients with increased travel burden to treatment centers may have limited treatment options. Purpose: To investigate the association between travel distance to a treatment facility and initial treatment choice among young men with low-risk prostate cancer in a rural state. Methods: A retrospective medical charts review was conducted of young men (65 years or younger) newly diagnosed with low-risk prostate cancer from January 1, 2005 through December 31, 2014 who were treated with either active surveillance, radical prostatectomy, or brachytherapy at either of the two major hospital systems in Bismarck, ND, USA. Results: Information on a random sample of 242 patients was studied. The majority of patients (66%) received radical prostatectomy. Patients who received radical prostatectomy were significantly younger (p-value 0.001). PSA at diagnosis, clinical stage, and Gleason score were not associated with treatment choice (p-value = 0.06;p-value = 0.1794;and p-value = 1.00;respectively). Adjusting for age at diagnosis, PSA at diagnosis, and treatment facility, treatment choice was not associated with travel distance (p-value = 0.309). Patients treated at St. Alexius facility were more likely to undergo radical prostatectomy than Sanford health patients (p-value Conclusions: We found no association between travel distance and treatment choice for low-risk prostate cancer. Treatment choice was associated with institution which may suggest institutional bias in patterns of care.

A meta-analysis of 1-year outcomes of transcatheter versus surgical aortic valve replacement in low-risk patients with severe aortic stenosis

Background Transcatheter aortic valve replacement(TAVR)for the treatment symptomatic severe aortic stenosis(AS)is indicated in patients with intermediate or higher surgical risk.Latest trials showed TAVR,and surgical aortic valve replacement(SAVR)perform similarly at 1-year for the composite outcomes of mortality,stroke and rehospitalization.We performed a comprehensive meta-analysis to compare individual outcomes at 1-year for TAVR compared to SAVR in low-risk patients.Methods Pub Med,Embase,and Cochrane central were searched for all the randomized controlled trials(RCTs)that reported 1-year comparative outcomes of TAVR and surgical aortic valve replacement(SAVR).Our conclusions are based upon the random-effects model using Der Simonian-Laird estimator.Results Data from 4 trials and 2887 randomized patients showed that TAVR had lower rates of all-cause mortality,cardiovascular mortality,and atrial fibrillation compared to SAVR at 1-year follow-up(P<0.05 for all).Also,TAVR was also associated with a significantly higher risk of permanent pacemaker implantation and moderate-severe paravalvular leak(P<0.05).Conclusions The latest randomised trial data demonstrates that in short-term,TAVR is safe and effective in reducing all-cause mortality or stroke.Longer follow-up of RCTs is needed to determine the durability of clinical benefits in TAVR over SAVR in low-risk patients.

Positron emission tomography-adapted therapy in low-risk diffuse large B-cell lymphoma:results of a randomized,phase Ⅲ,non-inferiority trial

Background:The current standard of care for non-bulky diffuse large B-cell lymphoma(DLBCL)patients with an International Prognostic Index(IPI)of 0 is four cycles of rituximab plus cyclophosphamide,doxorubicin,vincristine and prednisone(R-CHOP)but whether the same efficacy can be achieved with reduced chemotherapy regimen of four cycles for non-bulky DLBCL patients with an IPI of 1 remains unclear.This study compared four cycles versus six cycles of chemotherapy in non-bulky low-risk DLBCL patients with negative interim positron emission tomography with computed tomography(PET-CT,Deauville 1-3),irrespective of age and other IPI risk factors(IPI 0-1).Methods:This was an open-label,randomized,phaseⅢ,non-inferiority trial.Patients aged 14-75 years with newly diagnosed low-risk DLBCL,according to IPI,achieving PET-CT confirmed complete response(CR)after four cycles of R-CHOPwere randomized(1:1)between four cycles of rituximab(4R-CHOP+4R arm)or two cycles of R-CHOP plus two cycles of rituximab(6R-CHOP+2R arm).The primary endpoint was 2-year progression-free survival(PFS),conducted in the intention-to-treat population.Safety was assessed in patients with at least one cycle of assigned treatment.The non-inferiority margin was-8%.Results:A total of 287 patients were included in the intention-to-treat analysis,the median follow-up was 47.3 months,and the 2-year PFS rate was 95%(95%confidence interval[CI],92%to 99%)and 94%(95%CI,91%to 98%)for the 4R-CHOP+4R and 6R-CHOP+2R arm.The absolute difference in 2-year PFS between the two arms was 1%(95%CI,-5%to 7%),supporting the non-inferiority of 4R-CHOP+4R.Grade 3-4 neutropenia was lower in the last four cycles of rituximab alone in the 4R-CHOP+4R arm(16.7%versus 76.9%),with decreased risk of febrile neutropenia(0.0%versus 8.4%)and infection(2.1%versus 14.0%).Conclusions:For newly diagnosed low-risk DLBCL patients,interim PET-CT after four cycles of R-CHOP was effective in identifying patients with Deauville 1-3 who would have a good response and Deauville 4-5 patients who might have high-risk biological features or develop resistance.Reducing the standard six cycles to four cycles of chemotherapy had comparable clinical efficacy and fewer adverse events in low-risk,non-bulky DLBCL with interim PET-CT confirmed CR.

不同慢性病中老年女性骨折风险及低骨量切点预测分析

背景:中老年女性是骨质疏松的高发人群,慢性病增加骨质疏松罹患风险。低骨量是骨质疏松发病前的危险阶段,目前缺少常见慢性病人群的骨折风险差异及诊断指标切点值的相关报道。目的:通过对不同慢性病中老年女性骨折风险的分析,探讨肥胖、高血压、高血脂、糖尿病、动脉硬化与骨密度的相关性,找到可预测低骨量指标的切点值,为防治骨质疏松提供参考。方法:将45-70岁203名女性受试者分为正常组和慢性病组,采用超声骨密度测量仪进行跟骨骨密度测试,采用动脉硬化仪测试肱-踝脉搏波传导速度,采用全自动生化分析仪测试血糖、血脂,采用身体成分分析仪测试体质量指数、脂肪质量及肌肉质量。结果与结论:①61-70岁女性骨密度和骨折风险系数及51-60岁、61-70岁骨强度与<50岁比较,差异有显著性意义(P<0.05);②糖尿病组骨折风险明显高于其余各组,动脉硬化组则高于正常组和肥胖组(P<0.05);③骨密度与年龄、左侧血管弹性程度、右侧血管弹性程度、三酰甘油呈负相关,与体质量指数呈正相关(P<0.05);上述指标与骨密度受试者工作特征(ROC)曲线下面积介于0.5-0.7之间,低骨量对应切点分别为55.5岁(年龄)、756.0 cm/s(左侧血管弹性)、789.0 cm/s(右侧血管弹性)、1.115 mmol/L(三酰甘油)、22.35 kg/m^(2)(体质量指数);④结论:糖尿病和动脉硬化增加中老年女性骨折风险,测定体质量指数、血管弹性和三酰甘油对女性低骨量预测具有一定早期诊断价值。

ICG示踪前哨淋巴结在早期低危和中高危子宫内膜癌治疗中的应用研究

目的探讨吲哚菁绿(ICG)示踪前哨淋巴结(SLN)在早期低危和中高危子宫内膜癌(EC)中的应用价值。方法选取2020年7月1日至2022年6月30日于新疆医科大学附属肿瘤医院经宫腔镜或诊断性刮宫病理证实为早期EC的62例患者作为研究对象。先行腹腔镜下SLN活检(SLNB),然后行全子宫、双侧附件切除术+腹主动脉旁、盆腔淋巴结切除术。将患者分为低危组(n=42)、中高危组(n=20),比较两组检出率、灵敏度、阴性预测值(NPV)及SLN分布特征;采用Logistic回归分析影响SLN显影的因素。结果低危组和中高危组EC患者的总检出率分别为90.3%和90.0%,灵敏度均为100%,NPV均为100%,两组间差异无统计学意义(P>0.05)。低危组EC患者SLN显影分布:髂外淋巴结和闭孔淋巴结62.0%,髂内淋巴结和骶前淋巴结34.0%,髂总淋巴结2.7%,腹主动脉旁淋巴结1.3%;中高危组EC患者SLN显影分布:髂外淋巴结和闭孔淋巴结63.3%,髂内淋巴结和骶前淋巴结33.3%,髂总淋巴结0%,腹主动脉旁3.3%;低危组与中高危组SLN显影分布比较,差异无统计学意义(P>0.05)。结论ICG示踪SLN在早期低危和中高危EC中均是有效和可行的。

华北平原深层地下水可更新性与水位管控探讨

结合已有研究,讨论大规模开发利用作用下,华北平原深层地下水循环及补排路径的变化,并从山前侧向量现场试验、浅层和深层地下水水位变化同步性、咸淡水界面下移、地下水年龄和水化学分析等方面,论证了深层地下水在开采条件下具有一定可更新性。辨析了可更新性与可开采性的关系,认为尽管具有一定可更新性,但华北平原深层地下水开采仍应严格管控以避免地质环境风险。研究提出现阶段必要开采时深层地下水水位控制阈值,以期为现阶段深层地下水开发利用和保护提供参考借鉴。

24158例人乳头瘤病毒基因检测结果分析

目的:回顾性分析广西壮族自治区南宁市女性人乳头瘤病毒(humanpapillomavirus,HPV)的感染情况、基因分型及年龄的分布特征,为宫颈癌的早期筛查、诊断和治疗提供参考依据。方法:收集2020年4月-2022年12月在广西南宁市第二人民医院妇科门诊、妇科住院部及体检中心就诊的女性宫颈脱落细胞标本24158例,应用聚合酶链式反应和导流杂交法检测样本中人乳头瘤病毒的21种基因分型,分析不同年龄段HPV的感染状况、高危型和低危型分布情况、感染型别的情况。结果:在24158例标本中,4745例检查出感染HPV,感染率为19.64%;检测出HPV基因型别6546例,其中高危型别5231例,在总阳性例数中的比例为79.91%,低危型别1315例,所占的比例为20.09%,单一型别感染3527例,双重型别感染865例,三重及以上型别感染353例。其中居前五位的高危型基因型别依次为HPV53型、HPV59型、HPV18型、HPV52型、HPV56型,居前三位的低危型基因型别依次为HPV11、HPV42型、CP8304型。其中≤20岁患者占38.43%(362/942),41~50岁患者占14.44%(735/5091)。结论:24158例样本中,HPV感染率达19.64%,高危型感染以HPV53型、HPV59型、HPV18型、HPV52型、HPV56型为主,低危型感染以HPV11、HPV42、CP8304型为主,高危型别的检出率均高于低危型别。因此定期对青年和中老年女性群体HPV筛查,科普HPV知识,提高多价HPV疫苗的人群接种率,对于预防HPV感染及早期诊断、临床治疗具有重大意义。

胸腰椎骨质疏松性压缩骨折患者经皮椎体后凸成形术后残留腰背部疼痛的影响因素分析

目的分析胸腰椎骨质疏松性压缩骨折(OVCF)患者经皮椎体后凸成形术(PKP)后残留腰背部疼痛的影响因素。方法选取2019年1月至2022年12月在我院择期行PKP的胸腰椎OVCF患者97例,术后随访1个月,根据是否存在残留腰背部疼痛[视觉模拟评分(VAS)>4分]分为疼痛组(n=15)和无痛组(n=82)。比较两组手术前后VAS评分,收集患者临床资料,分析胸腰椎OVCF患者行PKP后残留腰背部疼痛的影响因素。结果末次随访时97例患者VAS>4分有15例(15.46%),VAS≤4分有82例(84.54%)。术后12 h、1周和1个月两组VAS评分较术前均降低(P<0.05),且术后1周、1个月疼痛组VAS评分显著高于无痛组(P<0.05)。单因素Logistic回归分析显示,体质量指数、筋膜损伤、手术入路方式、单个椎体骨水泥注入量、骨水泥渗漏情况、术后椎体高度恢复率和术前骨密度等均为影响胸腰椎OVCF患者行PKP后残留腰背部疼痛的影响因素(P<0.05);多因素Logistic回归分析显示,有筋膜损伤、有骨水泥渗漏和术前骨密度<-3.10均为影响胸腰椎OVCF患者行PKP后残留腰背部疼痛的独立危险因素(P<0.05)。结论PKP治疗胸腰椎OVCF仍有部分患者存在残留腰背部疼痛,与筋膜损伤、骨水泥渗漏和术前骨密度<-3.10有关,临床应采取积极有效的针对性措施来降低残留腰背部疼痛发生率,改善预后。

“z值评价-风险评估-技术核验”统计评价模型用于低样本量能力验证——以水质监测为例

为解决低样本量下的能力验证z比分数评价结果可能偏离参加者真实能力水平的问题,建立了“z值评价-风险评估-技术核验”统计评价模型,以“一带一路”共建国家“水中铁和氟化物的检测”国际能力验证项目为例进行了验证。结果显示:样本量为14家(低样本量)、指定值与样本真值相对误差的绝对值大于4%时,铁检测项目获得“满意”评价结果的14家参加者中,5家存在数据“不准确”中/高风险;氟化物检测项目获得“满意”评价结果的11家参加者中,7家存在数据“不准确”中/高风险。技术核验反映出的突出问题是参加者未按照检测方法的要求实施质量控制措施,标准曲线绘制、试剂配制、关键仪器参数设置记录缺失,原始记录可追溯性较差。由此证实了数据风险点的存在,同时也印证了该统计评价模型的可靠性和必要性。

低碳技术发展产业链风险评估

“双碳”目标下,低碳技术将迎来大规模发展,传统技术被加速替代,会对产业链相关行业原材料、资金、劳动力需求以及污染物排放等产生直接影响。因此,亟须提前评估低碳技术发展可能引发的关键要素失衡以及部分行业环境影响攀升风险,以避免威胁产业链安全,制约“双碳”目标实现。为此,选取未来有望大规模普及的电解水制氢、电化学储能、低碳发电技术、电弧炉炼钢技术及多通道燃煤等10类低碳技术作为研究对象,评估2024—2030年各项技术大规模普及对产业链相关行业原材料、资金、劳动力需求和污染物排放的综合影响,识别潜在风险。结果表明:钴、铜、镍、锂、锰等关键矿产资源对外依存度高且未来需求增长快,面临短缺风险相对更大;发展光伏发电技术对资金的需求最大;电化学储能技术普及引致的劳动力需求增长最快;关键低碳技术产业链上游的电气机械和器材制造业将面临严峻的资金和劳动力供给不足风险;煤炭采选业将面临一定的劳动力过剩风险;金属矿采选业将面临较大的环境污染上升风险。并进一步针对技术、组件、上中下游行业可能面临的风险提出了应对策略。

老年不稳定心绞痛及伴有衰弱患者皮下注射低分子肝素后出血的危险因素分析

目的 分析老年不稳定心绞痛伴有衰弱患者皮下注射低分子肝素后出血的危险因素。方法 选取2020年6月—2023年6月在南京医科大学附属南京医院(南京市第一医院)老年医学科与心内科住院治疗的老年不稳定心绞痛伴衰弱患者,按照是否发生皮下出血将其分为皮下出血组(90例)和对照组(90例),对比两组年龄、性别、体质量指数(BMI)等一般资料,以及合并疾病及注射方法等变量。多因素logistic回归分析皮下注射低分子肝素后发生皮下出血的危险因素。结果 皮下出血组患者BMI、注射低分子肝素后进行注射点按压的患者比例及皮下脂肪厚度均显著低于对照组,差异具有统计学意义(P<0.05);多因素logistic回归分析显示,皮下脂肪厚度低、BMI较低及拔针后未进行注射点按压均是患者使用低分子肝素皮下注射后发生皮下出血风险的独立危险因素(P<0.05)。结论 皮下脂肪厚度低、BMI较低及拔针后未进行注射点按压是老年不稳定心绞痛及伴有衰弱患者使用低分子肝素皮下注射后发生皮下出血风险的独立危险因素,在临床应用低分子肝素时应注意控制血压或增加按压时间,进而降低患者皮下出血的发生风险。

高通量测序技术在低频突变检测中的应用

体细胞突变的累积与衰老、肿瘤及多种疾病的发生密切相关。在正常组织细胞中,基因组中自发突变和诱发突变的变异等位基因频率极低,对这类低频突变的检测一直面临挑战。第二代和第三代高通量测序(next-generation sequencing,NGS)技术的出现,可以实现任意物种全基因组上变异的直接检测,克服传统突变检测技术的诸多局限性。但是常规NGS由于测序错误率较高从而限制了其在低频突变检测上的应用,基于分子一致性测序策略进行错误矫正的高准确性NGS测序技术作为有效的低频突变检测工具,有望在环境诱变剂的评价与研究、细胞与基因治疗药物风险评估、人群健康风险监测和生命科学基础研究领域发挥重要作用。本文对比经典突变检测方法,对基于NGS的低频突变检测技术研究进展进行综述,并对应用前景进行展望,以期为该技术的进一步开发、研究和在相关领域的应用提供参考。

罗沙司他治疗难治性NSAA和低风险MDS相关贫血的疗效和安全性

目的探讨罗沙司他治疗难治性非重型再生障碍性贫血(NSAA)和低风险MDS(LR-MDS)的整组及亚组疗效、亚组疗效差异、疗效预测因素及安全性。方法收集2020年8月至2022年12月在北京协和医院血液内科就诊的难治性NSAA和LR-MDS患者,所有患者在罗沙司他治疗前,都接受过一线的标准治疗,并包括至少3个月以上的重组人促红细胞生成素(rhEPO)。患者均使用过罗沙司他2.5 mg/kg隔天1次,至少3个月,并随访至少8个月。分析患者临床特征、罗沙司他的疗效、疗效预测因素、不良反应、复发及疾病克隆演变情况。结果共纳入40例患者,包括24例难治性NSAA和16例LR-MDS。年龄18~81岁,中位年龄56岁,男性占40%。65%的患者有输血依赖。随访9~34个月,中位随访21个月,在第1、2、3、4、5、6个月及随访期末,分别有22.5%、25.0%、47.5%、55.0%、57.5%、60.0%和50.0%的患者达到血液学改善-红系反应(HI-E),未发现影响HI-E的因素。两组患者组间血红蛋白较基线变化在随访期末差异有统计学意义(P<0.05)。50%患者脱离输血依赖。22.5%患者报告了不良反应。28.5%患者在达到HI-E后复发,复发时间4~12个月,复发中位时间为7个月。在随访期末未观察到克隆演变。结论罗沙司他对传统疗法和rhEPO难治的NSAA或LR-MDS患者可能有效,不良反应轻微,复发率较低。难治性NSAA患者血红蛋白改善的程度可能更好。

低空空域无人机运行安全保障技术研究综述

低空空域飞行活动日趋频繁,无人机类型多样且性能差异较大,飞行过程中易与建筑物或其他航空器发生飞行冲突。为实现低空空域的规范化、安全化、精细化和智慧化管控,需不断提升保障无人机运行安全的技术手段,例如冲突风险探测、安全风险评估等。文章从无人机的轨迹预测与意图识别、低空空域飞行冲突探测、低空空域风险评估及预警告警等3方面进行了研究。首先,总结了在无人机轨迹预测和意图识别方面的研究成果和面临的问题挑战;其次,基于低空空域冲突探测形式,分析不同探测方法的优缺点;随后,围绕低空空域风险评估及预警告警技术,分析当前研究需要解决的核心问题;最后,对无人机冲突探测和风险评估技术等方面进行了展望。

四川盆区油菜花期低温阴雨灾损评估及风险区划

花期低温阴雨是四川盆区油菜生产的主要气象灾害之一。本研究利用四川盆区1961-2020年101个气象站的逐日气象资料,1983-2000年油菜产量资料和干旱、低温冷害、连阴雨、大风、冰雹灾情资料,筛选花期低温阴雨灾害年份,采用数理统计方法获取花期低温阴雨产量灾损率和致灾因子,通过相关性分析确定油菜花期低温阴雨致灾指标,并利用2001-2020年灾情资料进行检验;基于筛选出的低温、连阴雨关键致灾因子,采用回归分析法建立油菜花期低温阴雨灾害损失评估模型,并进行回代和预测检验,分析灾害风险区划和变化趋势。结果表明:(1)日平均气温≤7℃、过程持续天数≥1d是四川盆区油菜花期低温致灾指标,日平均气温≤7℃的负积温和≥3d过程持续降水量共同组成低温阴雨灾害的关键致灾因子;选用2001-2020年油菜花期低温冷害发生情况对指标进行检验,与实际情况相符。(2)选用1983-2000年的气象、产量、灾情数据建立四川盆区油菜花期低温阴雨灾损评估模型,模型对轻度、中度灾害损失评估等级与实际等级相同或相差1级的评估准确率在96%以上;重度、特重评估等级与实际等级相同的准确率为0,与实际等级相差1级的准确率为75%和0。选用2001-2020年油菜花期低温阴雨灾害发生情况对模型检验,与实际情况基本相符。(3)1961-2020年四川盆区油菜花期低温阴雨灾害风险偏高区域主要分布于盆区西南部、南部及东北部,以中-高风险为主;灾害风险偏低的区域集中于盆区西北部及中部,以低-次低风险为主。(4)气候变暖背景下,四川盆区油菜花期低温阴雨灾害高风险区域呈减少趋势,低风险区域呈增加趋势。综上分析,四川盆区油菜花期低温冷害指标结果可靠,低温阴雨灾损评估模型能够较好地评估灾害损失,可应用于农业气象业务服务;灾害风险区划结果可为四川油菜生产布局提供参考依据。

单胎低危初产孕妇终止妊娠的时机

目的探讨单胎低危初产孕妇不同分娩孕周的妊娠结局,为孕晚期适时终止妊娠提供科学依据。方法回顾性分析2021年4~7月于石家庄市第四医院阴道试产的单胎低危妊娠孕妇993例,根据分娩孕周分为3组:(1)孕39~39^(+6)周组,共358例,其中自然临产316例,引产42例;(2)孕40~40^(+6)周组,共376例,其中自然临产320例,引产56例;(3)孕41~41^(+6)周组,共259例,其中自然临产103例,引产156例。收集临床资料,分析3组间孕妇基本情况,比较组间中转剖宫产率、阴道助产率、产后出血率、巨大儿发生率、羊水污染率、新生儿窒息率以及新生儿转儿科率。结果3组间孕妇基本情况比较差异无统计学意义(P>0.05)。自然临产孕妇中,孕39~39^(+6)周组、孕40~40^(+6)周组阴道助产率、中转剖宫产率、羊水污染率及巨大儿发生率均明显低于孕41~41^(+6)周组。孕39~39^(+6)周、孕40~40^(+6)周引产孕妇中转剖宫产率、产后出血率、羊水污染率明显低于孕41~41^(+6)周引产孕妇。结论单胎低危初产孕妇最佳分娩孕周为孕39~39^(+6)周,最晚不应超过41周分娩,可有效改善分娩结局,降低产科并发症发生,提高产科质量。因此,临床可考虑孕39周以后对单胎低危妊娠孕妇,采用合理临床干预,适时终止妊娠,提高自然分娩率。

超声引导下射频消融与外科手术治疗低风险甲状腺微小乳头状癌患者的疗效比较

目的比较低风险甲状腺微小乳头状癌患者应用超声引导下射频消融与外科手术治疗的疗效。方法回顾分析205例甲状腺微小乳头状癌患者的临床资料。按手术方式将其分为外科组(n=91,采用外科手术治疗)和射频消融组(n=114,采用超声引导下射频消融治疗),对比两组围术期指标,术后随访24个月,比较两组手术前及术后1个月的甲状腺功能,对比两组预后,比较两组并发症发生率。结果射频消融组与外科组相比较,围术期各指标均更低,差异有统计学意义(P<0.05),术后1个月相较于术前,射频消融组TG、TGAb差异无统计学意义(P>0.05),外科组TG、TGAb高于术前,差异有统计学意义(P<0.05)。射频消融组TG、TGAb低于外科组,差异有统计学意义(P<0.05)。射频消融组与外科组相互比较,术后24个月内肿瘤复发率、淋巴结转移率差异无统计学意义(P>0.05),并发症总发生率更低,差异有统计学意义(P<0.05)。结论应用超声引导下射频消融治疗低风险甲状腺微小乳头状癌患者疗效尚可,可加速患者康复进程,减少术中对甲状腺功能的损伤,降低并发症发生风险。

Long-term prognosis of low-risk neuroblastoma treated by surgery alone: an experience from a single institution of China

Background Low-risk neuroblastomas have favorable biologic characteristics.Children Oncology Group (COG) proposed that surgical resection of the primary tumor was sufficient.We evaluated the long-term prognosis of surgery alone for patients with low-risk neuroblastoma in China.Methods A total of 34 patients with low-risk neuroblastoma were treated in our center between Jan 2009 and Dec 2013.The medical records of these patients were reviewed.Results The primary lesion was located in the adrenal gland in 19 patients,the retroperitoneum in 5,the posterior mediastinum in 9 and the neck in 1.The tumor diameters and volumes were 1.80-10.0 cm (average 5.5 ±2.3 cm) and 1.28-424.10 cm3 (average 58.81 ± 92.00 cm3),respectively.The stages of the patients were as follows:stage Ⅰ in 25,stage Ⅱ in 7,and stage Ⅳs in 2.All patients were in the low-risk group according to COG risk stratification criteria.No patients showed MYCN amplification.The primary tumors of all patients were completely resected.Nine adrenal tumors were completely resected by laparoscopy.All patients were successfully followed for 66-115 (average 89.71 ± 16.17) months.Recurrence was observed in 4 patients.In addition to one local recurrence,another three recurrences were metastases.The lesions were effectively controlled in all patients with recurrences.All patients survived,including 28 cases of tumor-free survival;the 4-year overall and event-free survival rates were both 100%.Conclusions Surgery alone is a safe and effective treatment strategy for low-risk neuroblastoma.Recurrent lesions may be controlled and treated by rescue chemotherapy and surgery.