Objective:To discuss the effect of prolonged second stage of labor on maternal and neonatal outcomes.Methods:A total of 101 primiparas with the length of second stage of labor longer than 2 h were selected and pregnan...Objective:To discuss the effect of prolonged second stage of labor on maternal and neonatal outcomes.Methods:A total of 101 primiparas with the length of second stage of labor longer than 2 h were selected and pregnant women with the length less than 2 h served as control.The maternal and neonatal outcomes of two groups were observed and compared.Results:A total of 62.1%(18/11) with the length of second stage of labor between 120 min and 180 min,46.7%(28/32) between 181 min and 240 min and 12 longer than 241 min underwent vaginal delivery.The longer the length of second stage of labor,the lower score of Apgar scale for infants in 1 min,and the higher the incidence of asphyxia.But there was no difference in scale in 5 min.As second stage of labor prolonged,the incidences of cesarean section and of postpartum hemorrhage increased. Conclusions:Almost half of puerperas with the length of second stage of labor longer than 2 h underwent vaginal delivery.The prolonged second stage of labor can decrease the score of Apgar scale in 1 min,increase the incidence of asphyxia,but has no effect on scale in 5 min.It still need more evidence from evidence medicine to definition of time and treatment of second stage of labor.展开更多
The second-stage of labor is the most stressful part of childbirth process and the proper maternal position during this period is paramount for women's safe vaginal birth.Midwives play a pivotal role in managing m...The second-stage of labor is the most stressful part of childbirth process and the proper maternal position during this period is paramount for women's safe vaginal birth.Midwives play a pivotal role in managing maternal positions during the second-stage of labor.However,there is limited evidence to support an ideal maternal position during the second-stage of labor.Further,the difference between different maternal positions might not be apparent.This paper aims to review and compare the benefits and risks of common maternal positions during the second-stage of labor,thereby to provide midwives evidence-based practical guidelines.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
Aims: Second hand smoke (SHS) exposure is increasingly recognized as a major public health concern. Assessing adolescents’ motivational level to avoid SHS is vital to promote and reinforce reductions in SHS exposure....Aims: Second hand smoke (SHS) exposure is increasingly recognized as a major public health concern. Assessing adolescents’ motivational level to avoid SHS is vital to promote and reinforce reductions in SHS exposure. Methods: A brief measure based on the Stage of Change model was developed to characterize adolescents’ behavior related to reducing SHS exposure and used to identify potential determinants of SHS stage of change. The sample consisted of 1172 adolescents aged 13 to 15 years who participated in an internet-based cohort study of youth in British Columbia, Canada. Results: Sixty-six percent of the adolescents reported they had consistently made efforts to reduce exposure to SHS for more than 6 months, while 19% did not intend to reduce their exposure to SHS in the next 6 months. Adolescents’ SHS stage of change significantly differed by ethnicity, whether they had tried cigarettes, amount of tobacco smoked in their lifetime, parental and peer smoking statuses, past months’ exposure to SHS, frequent smoking in the home, and home smoking restrictions (all p < 0.05). Active smoking and more frequent exposure to SHS were associated with an increased probability of being in the pre-contemplation stage of change with regard to behavior related to reducing SHS exposure. Conclusion: This brief measure based on the Stage of Change model can be used in future studies to characterize adolescents’ behavior around SHS. Adolescents who smoke or have parents and/or friends who smoke appear to be a population that could benefit from stage-matched interventions designed to raise awareness of the risks associated with SHS for smokers and non-smokers, and ultimately reduce SHS exposure.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
The treatment of peritoneal carcinomatosis (PC) of colorectal origin with cytoreductive surgery(CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has a 5-year recurrence-free or cure rate of at least 16%, so...The treatment of peritoneal carcinomatosis (PC) of colorectal origin with cytoreductive surgery(CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has a 5-year recurrence-free or cure rate of at least 16%, so it is no longer labeled as a fatal disease, and offers prolonged survival for patients with a low peritoneal carcinomatosis index. Metachronous PC of colorectal origin is so predictable that there is a model which has been used to successfully determine the individual risk of each patient. Patients at risk are clearly identified; those with the highest risk have small peritoneal nodules present in the first surgery (70% probability of developing PC), ovarian metastases(60%), perforated tumor onset or intraoperative tumor rupture(50%). Current clinical, biological and imaging techniques still lack sufficient sensitivity to diagnose PC in its initial stages, when CRS plus HIPEC has a greater impact and a higher cure rate. Second-look surgery with HIPEC or prophylactic HIPEC at the time of the first intervention have been proposed as means of preventing and/or anticipating clinical or radiological relapse in at-risk patients. Both techniques have shown a significant decrease in peritoneal relapses and should be considered essential weapons in the management of colorectal cancer.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
<strong>Introduction: </strong><span style="font-family:""><span style="font-family:Verdana;">Prolonged Second Stage of Labor (SSL) is known to increase maternal and fo...<strong>Introduction: </strong><span style="font-family:""><span style="font-family:Verdana;">Prolonged Second Stage of Labor (SSL) is known to increase maternal and foetal morbidity. We, therefore, aimed to assess for the occurrence of complications of the SSL in relation to its duration in primiparous women in Yaounde. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> It was a cohort study carried out at the Yaounde Gynaeco-Obstetric and Paediatric Hospital over a period of 6 months, from December 19, 2018 through May 3, 2019. We included for the study nulliparous pregnant women with singleton pregnancies and normal uteri. Data collected were analysed using EPI info 7 and SPSS version 2.0 software.</span><b><span style="font-family:Verdana;"> Results:</span></b><span style="font-family:Verdana;"> Amongst 327 nulliparas, the SSL lasted more than one hour in 120 (36.7%), and more than two hours in 42 (12.8%). The most common maternal complications observed were genital lacerations (23.6%;28/120), instrumental deliveries (20.2%, 24/120), post-partum haemorrhage (8.9%). Foetal complications included caput succedaneum (15.2%;18/120) and perinatal asphyxia (7.5%;9/120). Maternal complications were significantly increased in women with an SSL lasting 1</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">2 hours (44.9% versus 22.7%;p</span><span style="font-family:Verdana;"> < </span><span style="font-family:Verdana;">0.001) and >2 hours (42.9% versus 22.7%;p</span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:Verdana;">0.007). Similarly, for foetal complications 23.1% occurred with SSLs between 1</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">2 hours (versus 6.3%;p</span><span style="font-family:Verdana;"> < </span><span style="font-family:Verdana;">0.001) and 19.0% for SSLs ></span><span style="font-family:""> </span><span style="font-family:Verdana;">2 hours (versus 6.3%;p</span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">0.007).</span><b><span style="font-family:Verdana;"> Conclusion:</span></b><span style="font-family:Verdana;"> Maternal and foetal complications increase when the SSL exceeds 1 hour in primiparas. Identifying factors that predispose to a prolonged SSL and indicating appropriate interventions could help prevent morbidity.</span></span>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
Objective:This study assessed the necessity of surgical re-staging in women with borderline ovarian tumors(BOTs)and evaluated the impact of complete surgical staging,lymphadenectomy,and omentectomy on disease recurren...Objective:This study assessed the necessity of surgical re-staging in women with borderline ovarian tumors(BOTs)and evaluated the impact of complete surgical staging,lymphadenectomy,and omentectomy on disease recurrence and survival.Methods:We retrospectively reviewed the medical records of patients with BOTs.A total of 901 patients were eligible for inclusion in the study,and we evaluated some of the variables and clinical/surgical characteristics of the cases.The effects of the type of surgical procedure,surgical staging,and complete or incomplete staging on recurrence were calculated.The rates of disease-free survival,overall survival,and recurrence were compared according to complete surgical staging.A Cox regression analysis was performed to identify potential prognostic factors,and survival curves were constructed using the Kaplan-Meier method.Results:The overall recurrence rate was 13.9%,and recurrence was comparable between the complete surgical staging group and the incomplete groups(P>0.05).The performance of complete surgical staging did not show an effect on long-term survival,and complete surgical staging,omentectomy,and lymphadenectomy had no effect on recurrence.In multivariate analyses,only radical surgery and adjuvant chemotherapy were risk factors for the recurrence of BOTs.Furthermore,we found that omentectomy led to a relatively low recurrence rate in patients with International Federation of Gynecology and Obstetrics(FIGO)stage>Ⅰ(P=0.022).Conclusion:Our results suggest that complete surgical staging should be considered a standard treatment for patients with advanced stage BOTs but not for those at FIGO stageⅠ.It might be safe to reduce the scope of surgical procedures in patients with early-stage BOTs.However,it is not necessary to perform re-staging operations for BOTs with a macroscopically normal extra-ovarian appearance.展开更多
“Conversion therapy”is a treatment modality that involves the use of radiotherapy,chemotherapy,targeted therapy,immunotherapy,and other therapeutic methods to transform initially late-stage tumors that cannot be cur...“Conversion therapy”is a treatment modality that involves the use of radiotherapy,chemotherapy,targeted therapy,immunotherapy,and other therapeutic methods to transform initially late-stage tumors that cannot be cured into treatments that can achieve an R0 curative effect.However,selecting an appropriate conversion therapy scheme remains a challenge,and there are currently few relevant studies on this topic.This article reviews successful cases of conversion therapy and clinical studies on treatment schemes,at domestic and international levels,over the past few years to offer a broad range of treatment options for patients.展开更多
目的本研究旨在评价Ⅰ期经皮肾镜取石术(PCNL)和Ⅰ期经皮肾穿刺造瘘术(PCN)、Ⅱ期PCNL治疗结石性脓肾患者的临床疗效,以确定此类患者最佳手术方案的选择。方法全面检索PubMed、Cochrane Library、Web of Science和EMBASE数据库以及中国...目的本研究旨在评价Ⅰ期经皮肾镜取石术(PCNL)和Ⅰ期经皮肾穿刺造瘘术(PCN)、Ⅱ期PCNL治疗结石性脓肾患者的临床疗效,以确定此类患者最佳手术方案的选择。方法全面检索PubMed、Cochrane Library、Web of Science和EMBASE数据库以及中国知网、万方、维普数据库,于2012年1月—2022年10月发表的有关于结石性脓肾研究的文章,并根据纳入和排除标准选择文献。在检索数据并评价文献质量后,采用Review Manager software(RevMan 5.4.3,Cochrane协作网,Oxford,UK)进行Meta分析。结果本文从105项研究中选择了11项共688例患者。其中347例接受Ⅰ期PCNL治疗,341例患者接受Ⅰ期PCN及Ⅱ期PCNL治疗(以下简称Ⅱ期PCNL)。Meta分析结果显示:Ⅰ期PCNL和Ⅱ期PCNL在结石清除率(P=0.95)、手术时间(P=0.48)、术后感染性休克(P=0.36)、肾周积液感染(P=0.27)方面差异无统计学意义;Ⅰ期和Ⅱ期PCNL在术后发热(P=0.03)、留置肾造瘘管时间(P<0.01)、住院费用(P<0.01)、住院时间(P<0.01)、术后住院时间(P=0.02)方面差异有统计学意义。对于结石性脓肾患者的治疗,以上2种方案在结石清除率、手术时间、术后发生肾周积液感染及感染性休克的发生方面类似。虽然Ⅰ期PCNL术后发热的患者更多,但是住院费用更低,留置肾造瘘管时间、总住院时间、术后住院时间更短。结论Ⅰ期PCNL治疗肾及输尿管上段结石合并脓肾是经济、安全、有效的,在临床实践中具备一定的推广价值。展开更多
文摘Objective:To discuss the effect of prolonged second stage of labor on maternal and neonatal outcomes.Methods:A total of 101 primiparas with the length of second stage of labor longer than 2 h were selected and pregnant women with the length less than 2 h served as control.The maternal and neonatal outcomes of two groups were observed and compared.Results:A total of 62.1%(18/11) with the length of second stage of labor between 120 min and 180 min,46.7%(28/32) between 181 min and 240 min and 12 longer than 241 min underwent vaginal delivery.The longer the length of second stage of labor,the lower score of Apgar scale for infants in 1 min,and the higher the incidence of asphyxia.But there was no difference in scale in 5 min.As second stage of labor prolonged,the incidences of cesarean section and of postpartum hemorrhage increased. Conclusions:Almost half of puerperas with the length of second stage of labor longer than 2 h underwent vaginal delivery.The prolonged second stage of labor can decrease the score of Apgar scale in 1 min,increase the incidence of asphyxia,but has no effect on scale in 5 min.It still need more evidence from evidence medicine to definition of time and treatment of second stage of labor.
文摘The second-stage of labor is the most stressful part of childbirth process and the proper maternal position during this period is paramount for women's safe vaginal birth.Midwives play a pivotal role in managing maternal positions during the second-stage of labor.However,there is limited evidence to support an ideal maternal position during the second-stage of labor.Further,the difference between different maternal positions might not be apparent.This paper aims to review and compare the benefits and risks of common maternal positions during the second-stage of labor,thereby to provide midwives evidence-based practical guidelines.
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Aims: Second hand smoke (SHS) exposure is increasingly recognized as a major public health concern. Assessing adolescents’ motivational level to avoid SHS is vital to promote and reinforce reductions in SHS exposure. Methods: A brief measure based on the Stage of Change model was developed to characterize adolescents’ behavior related to reducing SHS exposure and used to identify potential determinants of SHS stage of change. The sample consisted of 1172 adolescents aged 13 to 15 years who participated in an internet-based cohort study of youth in British Columbia, Canada. Results: Sixty-six percent of the adolescents reported they had consistently made efforts to reduce exposure to SHS for more than 6 months, while 19% did not intend to reduce their exposure to SHS in the next 6 months. Adolescents’ SHS stage of change significantly differed by ethnicity, whether they had tried cigarettes, amount of tobacco smoked in their lifetime, parental and peer smoking statuses, past months’ exposure to SHS, frequent smoking in the home, and home smoking restrictions (all p < 0.05). Active smoking and more frequent exposure to SHS were associated with an increased probability of being in the pre-contemplation stage of change with regard to behavior related to reducing SHS exposure. Conclusion: This brief measure based on the Stage of Change model can be used in future studies to characterize adolescents’ behavior around SHS. Adolescents who smoke or have parents and/or friends who smoke appear to be a population that could benefit from stage-matched interventions designed to raise awareness of the risks associated with SHS for smokers and non-smokers, and ultimately reduce SHS exposure.
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.
文摘The treatment of peritoneal carcinomatosis (PC) of colorectal origin with cytoreductive surgery(CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has a 5-year recurrence-free or cure rate of at least 16%, so it is no longer labeled as a fatal disease, and offers prolonged survival for patients with a low peritoneal carcinomatosis index. Metachronous PC of colorectal origin is so predictable that there is a model which has been used to successfully determine the individual risk of each patient. Patients at risk are clearly identified; those with the highest risk have small peritoneal nodules present in the first surgery (70% probability of developing PC), ovarian metastases(60%), perforated tumor onset or intraoperative tumor rupture(50%). Current clinical, biological and imaging techniques still lack sufficient sensitivity to diagnose PC in its initial stages, when CRS plus HIPEC has a greater impact and a higher cure rate. Second-look surgery with HIPEC or prophylactic HIPEC at the time of the first intervention have been proposed as means of preventing and/or anticipating clinical or radiological relapse in at-risk patients. Both techniques have shown a significant decrease in peritoneal relapses and should be considered essential weapons in the management of colorectal cancer.
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<strong>Introduction: </strong><span style="font-family:""><span style="font-family:Verdana;">Prolonged Second Stage of Labor (SSL) is known to increase maternal and foetal morbidity. We, therefore, aimed to assess for the occurrence of complications of the SSL in relation to its duration in primiparous women in Yaounde. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> It was a cohort study carried out at the Yaounde Gynaeco-Obstetric and Paediatric Hospital over a period of 6 months, from December 19, 2018 through May 3, 2019. We included for the study nulliparous pregnant women with singleton pregnancies and normal uteri. Data collected were analysed using EPI info 7 and SPSS version 2.0 software.</span><b><span style="font-family:Verdana;"> Results:</span></b><span style="font-family:Verdana;"> Amongst 327 nulliparas, the SSL lasted more than one hour in 120 (36.7%), and more than two hours in 42 (12.8%). The most common maternal complications observed were genital lacerations (23.6%;28/120), instrumental deliveries (20.2%, 24/120), post-partum haemorrhage (8.9%). Foetal complications included caput succedaneum (15.2%;18/120) and perinatal asphyxia (7.5%;9/120). Maternal complications were significantly increased in women with an SSL lasting 1</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">2 hours (44.9% versus 22.7%;p</span><span style="font-family:Verdana;"> < </span><span style="font-family:Verdana;">0.001) and >2 hours (42.9% versus 22.7%;p</span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:Verdana;">0.007). Similarly, for foetal complications 23.1% occurred with SSLs between 1</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">2 hours (versus 6.3%;p</span><span style="font-family:Verdana;"> < </span><span style="font-family:Verdana;">0.001) and 19.0% for SSLs ></span><span style="font-family:""> </span><span style="font-family:Verdana;">2 hours (versus 6.3%;p</span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">0.007).</span><b><span style="font-family:Verdana;"> Conclusion:</span></b><span style="font-family:Verdana;"> Maternal and foetal complications increase when the SSL exceeds 1 hour in primiparas. Identifying factors that predispose to a prolonged SSL and indicating appropriate interventions could help prevent morbidity.</span></span>
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.
基金funded by the National Natural Science Foundation of China(No.81802612).
文摘Objective:This study assessed the necessity of surgical re-staging in women with borderline ovarian tumors(BOTs)and evaluated the impact of complete surgical staging,lymphadenectomy,and omentectomy on disease recurrence and survival.Methods:We retrospectively reviewed the medical records of patients with BOTs.A total of 901 patients were eligible for inclusion in the study,and we evaluated some of the variables and clinical/surgical characteristics of the cases.The effects of the type of surgical procedure,surgical staging,and complete or incomplete staging on recurrence were calculated.The rates of disease-free survival,overall survival,and recurrence were compared according to complete surgical staging.A Cox regression analysis was performed to identify potential prognostic factors,and survival curves were constructed using the Kaplan-Meier method.Results:The overall recurrence rate was 13.9%,and recurrence was comparable between the complete surgical staging group and the incomplete groups(P>0.05).The performance of complete surgical staging did not show an effect on long-term survival,and complete surgical staging,omentectomy,and lymphadenectomy had no effect on recurrence.In multivariate analyses,only radical surgery and adjuvant chemotherapy were risk factors for the recurrence of BOTs.Furthermore,we found that omentectomy led to a relatively low recurrence rate in patients with International Federation of Gynecology and Obstetrics(FIGO)stage>Ⅰ(P=0.022).Conclusion:Our results suggest that complete surgical staging should be considered a standard treatment for patients with advanced stage BOTs but not for those at FIGO stageⅠ.It might be safe to reduce the scope of surgical procedures in patients with early-stage BOTs.However,it is not necessary to perform re-staging operations for BOTs with a macroscopically normal extra-ovarian appearance.
基金Funded by the Science and Technology Plan of Inner Mongolia Autonomous Region(No.2022YFSH0097).
文摘“Conversion therapy”is a treatment modality that involves the use of radiotherapy,chemotherapy,targeted therapy,immunotherapy,and other therapeutic methods to transform initially late-stage tumors that cannot be cured into treatments that can achieve an R0 curative effect.However,selecting an appropriate conversion therapy scheme remains a challenge,and there are currently few relevant studies on this topic.This article reviews successful cases of conversion therapy and clinical studies on treatment schemes,at domestic and international levels,over the past few years to offer a broad range of treatment options for patients.