Prostate cancer is the most common non-cutaneous cancers occurring in American men,and whilemost men with early-stage prostate cancers are cured,up to a third might manifest with biochemical recurrence(BCR)of prostate...Prostate cancer is the most common non-cutaneous cancers occurring in American men,and whilemost men with early-stage prostate cancers are cured,up to a third might manifest with biochemical recurrence(BCR)of prostate cancer.BCR is a disease entitywhich is characterized by a rising prostate-specific antigen(PSA)in the setting of a previously treated localized prostate cancerwith either surgery or radiation therapywith curativeintent.展开更多
BACKGROUND Salvage surgery following conversion therapy[transcatheter arterial chemoembolization(TACE)combined with tyrosine kinase inhibitors(TKIs)and anti-programmed cell death protein 1(PD-1)antibodies]provides a c...BACKGROUND Salvage surgery following conversion therapy[transcatheter arterial chemoembolization(TACE)combined with tyrosine kinase inhibitors(TKIs)and anti-programmed cell death protein 1(PD-1)antibodies]provides a chance for a cure in patients with unresectable hepatocellular carcinoma(uHCC).AIM To primarily analyze the efficacy and safety of salvage surgery in patients initially diagnosed with uHCC who underwent conversion therapy.METHODS We retrospectively collected data from patients at the First Affiliated Hospital of the University of Science and Technology of China(Anhui Provincial Hospital)who met the study criteria.These patients were initially diagnosed with uHCC and received TACE combined with TKIs and anti-PD-1 antibodies as conversion therapy.The main endpoints studied were the safety of salvage surgery,overall survival(OS),and recurrence-free survival(RFS)after surgery.Secondary endpoints included postoperative complications.We performed univariate and multivariate Cox regression analyses to identify independent risk factors for postoperative RFS.RESULTS A total of 117 patients were enrolled in this study,including 28 patients(23.9%)who underwent curative surgery after triplet therapy conversion treatment.Among the 28 patients who underwent salvage surgery,the 1-year and 2-year RFS rates were 75.0%and 59.4%,respectively,and the 1-year and 2-year OS rates were 92.7%and 87.6%,respectively.The median follow-up time after surgery was 15.0 months(range:1.6-37.2 months),with median OS and RFS not yet reached.Pathological complete response was achieved in 14 cases(50.0%),and postoperative complications occurred in 20 patients(71.4%).Univariate and multivariate Cox regression analyses indicated that pathological complete response and preoperative albumin levels were risk factors for postoperative RFS.CONCLUSION Salvage surgery following conversion therapy with TACE combined with TKIs and anti-PD-1 antibodies appears to be an effective and safe treatment option for patients with uHCC.It extends OS and may offer additional potential benefits to uHCC patients.展开更多
BACKGROUND Testicular torsion is the most common acute scrotum worldwide and mainly occurs in children and adolescents.Studies have demonstrated that the duration of symptoms and torsion grade lead to different outcom...BACKGROUND Testicular torsion is the most common acute scrotum worldwide and mainly occurs in children and adolescents.Studies have demonstrated that the duration of symptoms and torsion grade lead to different outcomes in children diagnosed with testicular torsion.AIM To predict the possibility of testicular salvage(TS)in patients with testicular torsion in a tertiary center.METHODS We reviewed the charts of 75 pediatric patients with acute testicular torsion during a 12-year period from November 2011 to July 2023 at the Suzhou Hospital of Anhui Medical University.Univariate and multivariate logistic regression analyses were used to determine independent predictors of testicular torsion.The data included clinical findings,physical examinations,laboratory data,color Doppler ultrasound findings,operating results,age,presenting institution status,and follow-up results.RESULTS Our study included 75 patients.TS was possible in 57.3%of all patients;testicular torsion occurred mostly in winter,and teenagers aged 11-15 years old accounted for 60%.Univariate logistic regression analyses revealed that younger age(P=0.09),body mass index(P=0.004),torsion angle(P=0.013),red blood cell count(P=0.03),neutrophil-to-lymphocyte ratio(P=0.009),and initial presenting institution(P<0.001)were associated with orchiectomy.In multivariate analysis,only the initial presenting institution predicted TS(P<0.05).CONCLUSION The initial presenting institution has a predictive value for predicting TS in patients with testicular torsion.Children with scrotal pain should be admitted to a tertiary hospital as soon as possible.展开更多
After Hurricane Katrina in 2005,literary works related to such a crisis sprouted the southern America,which are known as Post-Katrina Literature.This thesis,taking Salvage the Bones and The Not Yet as examples,scrutin...After Hurricane Katrina in 2005,literary works related to such a crisis sprouted the southern America,which are known as Post-Katrina Literature.This thesis,taking Salvage the Bones and The Not Yet as examples,scrutinizes how writers respond to the Post-Katrina environmental crisis in different ways.In Salvage the Bones,Jesmyn Ward employs a biographical genre to record the Katrina disaster,thereby,writings serving as a way of healing the psychic trauma of the writer herself;and in The Not Yet,Moira Crone presents a post-natural world by the employment of the Cli-Fi genre.Both writers enrich the tradition of Southern literature as well as American eco-literature.展开更多
Even experienced endoscopists have 90% success in achieving deep biliary cannulation with standard methods. Biliary cannulation may become difficult in 10%-15% of patients with biliary obstruction and pre- cut (access...Even experienced endoscopists have 90% success in achieving deep biliary cannulation with standard methods. Biliary cannulation may become difficult in 10%-15% of patients with biliary obstruction and pre- cut (access) sphincterotomy is frequently chosen as a rescue treatment in these cases. Generally, precut sphincterotomy ensures a rate of 90%-100% success- ful deep biliary cannulation. The precut technique has been performed as either a fistulotomy with a needle knife sphincterotome or as a transpapillary septotomy with a standard sphincterotome. Both methods have similar efficacy and complication rates when adminis- tered to the proper patient. Although precut sphincter- otomy ensures over 90% success of biliary cannula- tion, it has been characterized as an independent risk factor for pancreatitis. The complications of the precut technique are not limited to pancreatitis. Two more important ones, bleeding and perforation, are also re- ported in some publications as being observed more commonly than during standard sphincterotomy. It is also reported that precut sphincterotomy increases morbidity when performed in patients without dilata- tion of their biliary tract. Nevertheless, precut sphinc- terotomy is a good alternative as a rescue method in the setting of a failed standard cannulation method. This paper discusses the technical details, timing, ef- ficacy and potential complications of precut sphincter- otomy.展开更多
AIM: To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy and azygoportal disconnection (MLSD) with intraoperative autologous cell salvage.
AIM To review the conversion therapy for initially unre-sectable hepatocellular carcinoma(HCC) patients and the suitable timing for subsequent salvage surgery. METHODS A Pub Med search was undertaken from 1987 to 2017...AIM To review the conversion therapy for initially unre-sectable hepatocellular carcinoma(HCC) patients and the suitable timing for subsequent salvage surgery. METHODS A Pub Med search was undertaken from 1987 to 2017 to identify articles using the keywords including "unresectable" "hepatocellular carcinoma", "hepate-ctomy", "conversion therapy", "resection", "salvage surgery" and "downstaging". Additional studies were investigated through a manual search of the references from the articles. The exclusion criteria were duplicates, case reports, case series, videos, contents unrelated to the topic, comments, and editorial essays. The main and widely used conversion therapies and the suitable timing for subsequent salvage surgery were discussed in detail. Two members of our group independently performed the literature search and data extraction. RESULTS Liver volume measurements [future liver remnant(FLR)/total liver volume or residual liver volume/bodyweight ratio] and function tests(scoring systems and liver stiffness) were often performed in order to justify whether patients were suitable candidates for surgery. Successful conversion therapy was usually defined as downstaging the tumor, increasing FLR and providing subsequent salvage surgery, without increasing com-plications, morbidity or mortality. The requirementsfor performing salvage surgery after transcatheter arterial chemoembolization were the achievement of a partial remission in radiology, the disappearance of the portal vein thrombosis, and the lack of extrahepatic metastasis. Patients with a standardized FLR(sF LR) > 20% were good candidates for surgery after portal vein embolization, while other predictive parameters like growth rate, kinetic growth rate were treated as an effective supplementary. There was probably not enough evidence to provide a standard operation time after associating liver partition and portal vein ligation for staged hepatectomy or yttrium-90 microsphere radioembolization. The indications of any combinations of conversion therapies and the subsequent salvage surgery time still need to be carefully and comprehen-sively evaluated. CONCLUSION Conversion therapy is recommended for the treatment of initially unresectable HCC, and the suitable subse-quent salvage surgery time should be reappraised and is closely related to its previous therapeutic effect.展开更多
Liver transplant(LT) is the primary treatment for patients with end-stage liver disease. About 25000 LTs are performed annually in the world. The potential for intraoperative bleeding is quite variable. However, massi...Liver transplant(LT) is the primary treatment for patients with end-stage liver disease. About 25000 LTs are performed annually in the world. The potential for intraoperative bleeding is quite variable. However, massive bleeding is common and requires blood transfusion. Allogeneic blood transfusion has an immunosuppressive effect and an impact on recipient survival, in addition to the risk of transmission of viral infections and transfusion errors, among others.Techniques to prevent excessive bleeding or to use autologous blood have been proposed to minimize the negative effects of allogeneic blood transfusion.Intraoperative reinfusion of autologous blood is possible through previous selfdonation or blood collected during the operation. However, LT does not normally allow autologous transfusion by prior self-donation. Hence, using autologous blood collected intraoperatively is the most feasible option. The use of intraoperative blood salvage autotransfusion(IBSA) minimizes the perioperative use of allogeneic blood, preventing negative transfusion effects without negatively impacting other clinical outcomes. The use of IBSA in patients with cancer is still a matter of debate due to the theoretical risk of reinfusion of tumor cells. However, studies have demonstrated the safety of IBSA in several surgical procedures, including LT for hepatocellular carcinoma. Considering the literature available to date, we can state that IBSA should be routinely used in LT, both in patients with cancer and in patients with benign diseases.展开更多
AIM:To evaluate survival and recurrence after salvage liver transplantation(SLT) for the treatment of hepatocellular carcinoma(HCC) compared with primary liver transplantation(PLT) using a meta-analysis.METHODS:Litera...AIM:To evaluate survival and recurrence after salvage liver transplantation(SLT) for the treatment of hepatocellular carcinoma(HCC) compared with primary liver transplantation(PLT) using a meta-analysis.METHODS:Literature on SLT versus PLT for the treatment of HCC published between 1966 and July 2011 was retrieved.A meta-analysis was conducted to estimate pooled survival and disease-free rates.A fixed or random-effect model was established to collect the data.RESULTS:The differences in overall survival and disease-free survival rates at 1-year,3-year and 5-year survival rates were not statistically significant between SLT group and PLT group(P > 0.05).After stratifying the various studies by donor source and Milan criteria,we found that:(1) Living donor liver transplantation recipients had significantly higher 1-year survival rate,lower 3-year and 5-year survival rates compared with deceased-donor liver transplantation(DDLT) recipients.And in DDLT recipients they had better 1-year and 5-year disease-free survival rate in SLT group;and(2) No difference was seen in 1-year,3-year and 5-year survival rates between two groups who beyond Milan criteria at the time of liver transplantation.CONCLUSION:SLT can be effectively performed for patients with recurrence or deterioration of liver function after hepatectomy for HCC.It does not increase the perioperative mortality and has a similar long-term survival rates compared to PLT.展开更多
Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular c...Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. The critical points include whether tumor cells can be cleared by IBSA, whether IBSA increases the risk of recurrence or metastasis, and what are the indications for IBSA. Moreover, is it warranted to take the risk of tumor dissemination by using IBSA to avoid allogeneic blood transfusion? Do the remaining tumor cells after additional filtration by leukocyte depletion filters still possess potential tumorigenicity? Does IBSA always work well? We have reviewed the literature and tried to address these questions. The available data indicate that IBSA is safe in LT for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.展开更多
Background: After deinitive chemoradiotherapy for non-metastatic nasopharyngeal carcinoma(NPC), more than 10% of patients will experience a local recurrence. Salvage treatments present signiicant challenges for locall...Background: After deinitive chemoradiotherapy for non-metastatic nasopharyngeal carcinoma(NPC), more than 10% of patients will experience a local recurrence. Salvage treatments present signiicant challenges for locally recurrent NPC. Surgery, stereotactic ablative body radiotherapy, and brachytherapy have been used to treat locally recurrent NPC. However, only patients with small-volume tumors can beneit from these treatments. Re-irradiation with X-ray—based intensity-modulated radiotherapy(IMXT) has been more widely used for salvage treatment of locally recurrent NPC with a large tumor burden, but over-irradiation to the surrounding normal tissues has been shown to cause frequent and severe toxicities. Furthermore, locally recurrent NPC represents a clinical entity that is more radioresistant than its primary counterpart. Due to the inherent physical advantages of heavy-particle therapy, precise dose delivery to the target volume(s), without exposing the surrounding organs at risk to extra doses, is highly feasible with carbon-ion radiotherapy(CIRT). In addition, CIRT is a high linear energy transfer(LET) radiation and provides an increased relative biological efectiveness compared with photon and proton radiotherapy. Our prior work showed that CIRT alone to 57.5 Gy E(gray equivalent), at 2.5 Gy E per daily fraction, was well tolerated in patients who were previously treated for NPC with a deinitive dose of IMXT. The short-term response rates at 3–6 months were also acceptable. However, no patients were treated with concurrent chemotherapy. Whether the addition of concurrent chemotherapy to CIRT can beneit locally recurrent NPC patients over CIRT alone has never been addressed. It is possible that the beneits of high-LET CIRT may make radiosensitizing chemotherapy unnecessary. We therefore implemented a phase I/II clinical trial to address these questions and present our methodology and results.Methods and design: The maximal tolerated dose(MTD) of re-treatment using raster-scanning CIRT plus concurrent cisplatin will be determined in the phase I, dose-escalating stage of this study. CIRT dose escalation from 52.5 to 65 Gy E(2.5 Gy E × 21–26 fractions) will be delivered, with the primary endpoints being acute and subacute toxicities. Eicacy in terms of overall survival(OS) and local progression-free survival of patients after concurrent chemotherapy plus CIRT at the determined MTD will then be studied in the phase II stage of the trial. We hypothesize that CIRT plus chemotherapy can improve the 2-year OS rate from the historical 50% to at least 70%.Conclusions: Re-treatment of locally recurrent NPC using photon radiation techniques, including IMXT, provides moderate eicacy but causes potentially severe toxicities. Improved outcomes in terms of eicacy and toxicity proile are expected with CIRT plus chemotherapy. However, the MTD of CIRT used concurrently with cisplatin-based chemotherapy for locally recurrent NPC remains to be determined. In addition, whether the addition of chemotherapy to CIRT is needed remains unknown. These questions will be evaluated in the dose-escalating phase I and randomized phase II trials.展开更多
The application of the vertical hoisting jack and wave motion compensation techniques to the salvage of an ancient sunken boat is introduced. The boat is wooden, loaded with cultural relics. It has been immersed at th...The application of the vertical hoisting jack and wave motion compensation techniques to the salvage of an ancient sunken boat is introduced. The boat is wooden, loaded with cultural relics. It has been immersed at the bottom of the South China Sea for more than 800 years. In order to protect the structure of the boat and the cultural relics inside to the largest extent, an open caisson is used to hold the sunken beat and the silts around before they are raised from the seabed all together as a whole. In the paper, first, the seakeeping model test of the system of the salvage barge and the open caisson is done to determine some important wave response parameters. And then a further experimental study of the ap- plication of the vertical hoisting jack and wave motion compensation scheme to the salvage of the sunken boat is carried out. In the model tests, the techniques of the integrative mechanic-electronic-hydraulic control, wave motion forecast and wave motion compensation are used to minimize the heave motion of the open caisson. The results of the model tests show that the heave motion of the open caisson can be reduced effectively by the use of the present method.展开更多
Objectives:To evaluate hearing outcome of salvage treatment with intratympanic steroids(ITS)in idiopathic sudden sensorineural hearing loss(ISSNHL)refractory to initial systemic steroid(SS)therapy.Material and methods...Objectives:To evaluate hearing outcome of salvage treatment with intratympanic steroids(ITS)in idiopathic sudden sensorineural hearing loss(ISSNHL)refractory to initial systemic steroid(SS)therapy.Material and methods:A retrospective medical chart review was conducted on 54 consecutive patients with ISSNHL refractory to SS.Salvage treatment with a low dose intratympanic dexamethasone(4 mg/ml)was offered after one week of primary treatment.Patients were divided into two groups:25 patients accepted ITS(treatment group)and 29 patients did not undergo additional treatment(control group).A pure tone average(PTA)gain of at least 10 dB was considered hearing improvement.Results:Hearing improvement rate was higher in ITS group compared to control group(40%vs.13.8%,p=0.035).A mean PTA improvement of 8.6±9.8 dB was observed in the ITS group and,whereas the control group had an average hearing gain of 0.7±2 dB(p<0.001).Audiometric analysis revealed a significant hearing gain in ITS group at all tested frequencies compared to control group(p<0.05).Analysis of the selected variables,identified intratympanic steroid treatment as the only independent prognostic factor for hearing improvement(OR=4.2,95%CI:1.1e15.7;p=0.04).Conclusion:Intratympanic low dose dexamethasone is effective in patients with incomplete hearing recovery after primary systemic steroid treatment.展开更多
Glioblastoma multiforme(GBM) is the most common malignant primary brain tumor with a survival prognosis of 14-16 mo for the highest functioning patients. Despite aggressive, multimodal upfront therapies, the majority ...Glioblastoma multiforme(GBM) is the most common malignant primary brain tumor with a survival prognosis of 14-16 mo for the highest functioning patients. Despite aggressive, multimodal upfront therapies, the majority of GBMs will recur in approximately six months. Salvage therapy options for recurrent GBM(r GBM) are an area of intense research. This study compares recent survival and quality of life outcomes following Gamma Knife radiosurgery(GKRS) salvage therapy. Following a Pub Med search for studies usingGKRS as salvage therapy for malignant gliomas, nine articles from 2005 to July 2013 were identified which evaluated rG BM treatment. In this review, we compare overall survival following diagnosis, overall survival following salvage treatment, progression-free survival, time to recurrence, local tumor control, and adverse radiation effects. This report discusses results for rG BM patient populations alone, not for mixed populations with other tumor histology grades. All nine studies reported median overall survival rates(from diagnosis, range:16.7-33.2 mo; from salvage, range:9-17.9 mo). Three studies identified median progression-free survival(range:4.6-14.9 mo). Two showed median time to recurrence of GBM. Two discussed local tumor control. Six studies reported adverse radiation effects(range:0%-46% of patients). The greatest survival advantages were seen in patients who received GKRS salvage along with other treatments, like resection or bevacizumab, suggesting that appropriately tailored multimodal therapy should be considered with each rG BM patient. However, there needs to be a randomized clinical trial to test GKRS for rG BM before the possibility of selection bias can be dismissed.展开更多
The overall incidence of osteochondral defect in the general population is estimated to be 15 to 30 per100000 people.These lesions can become symptomatic causing pain,swelling and decreased function of the knee,and ma...The overall incidence of osteochondral defect in the general population is estimated to be 15 to 30 per100000 people.These lesions can become symptomatic causing pain,swelling and decreased function of the knee,and may eventually progress to osteoarthritis.In the young and active population,partial or total knee arthroplasty(TKA)is rarely the treatment of choice due to risk of early failure.Osteochondral allograft transplantation has been demonstrated to be a safe and effective treatment of large osteochondral and chondral defects of the knee in appropriately selected patients.The treatment reduces pain,improves function and is a viable limb salvage procedure for patients,especially young and active patients for whom TKA is not recommended.Either large dowels generated with commercially available equipment or free hand shell allografts can be implanted in more posterior lesions.Current recommendations for fresh allografts stored at4C advise implantation within 21-28 d of procurement for optimum chondrocyte viability,following screening and testing protocols.Higher rates of successful allograft transplantation are observed in younger patients,unipolar lesions,normal or corrected malalignment,and defects that are treated within 12 mo of symptom onset.Patients with bipolar lesions,uncorrectable malalignment,advanced osteoarthritis,and those over40 tend to have less favourable outcomes.展开更多
Several studies have evaluated the risk factors influencing biochemical recurrence （BCR） of prostate cancer in patients receiving salvage radiotherapy （SRT） for BCR after radical prostatectomy （RP）, but the resu...Several studies have evaluated the risk factors influencing biochemical recurrence （BCR） of prostate cancer in patients receiving salvage radiotherapy （SRT） for BCR after radical prostatectomy （RP）, but the results remain conflicting. In this study, we performed a meta-analysis to resolve this conflict. We searched the following databases： PubMed, Embase, and Web of Science using the following terms in ＂All fields＂： ＂salvage radiation therapy,＂ ＂salvage IMRT, S-IMRT, salvage radiotherapy, SRT, radical prostatectomy,＂ ＂RP, biochemical recurrence,＂ ＂BCR,＂ ＂biochemical relapse.＂ Eleven studies, with a total of 1383 patients, were included in our meta-analysis. Of all the variables, only Gleason score （GS） 〉7 （odds ratio [OR]： 3.82; 95% confidence interval [CI]： 2.60-5.64） and pathological tumor （pT） stage 〉3a （OR： 1.82; 95% Ch 1.36-2.42） were positively correlated with BCR. However, SRT combined with androgen deprivation therapy （ADT） （OR： 0.63; 95% CI： 0.44-0.90） and radiation therapy （RT） dose 〉64 Gy （OR： 0.35; 95% CI： 0.19-0.64） were negatively correlated with BCR. Perineural invasion （OR： 2.64; 95% CI： 1.11-6.26）, preoperative prostate-specific antigen （PSA） 〉10 ng m1-1 （OR： 1.36; 95% CI： 0.94-1.96）, positive surgical margin （OR： 0.92; 95% Ch 0.7-1.19）, and seminal vesicle involvement （SVI） （OR： 1.09; 95% Ch. 0.83-1.43） had no effect on BCR. Our meta-analysis indicated that pT stage, GS, RT dose, and SRT combined with ADT may influence BCR, while preoperative PSA, surgical margin, perineural invasion, and SVI have only a weak effect on BCR.展开更多
External beam radiotherapy(EBRT) is one of the principal curative treatments for patients with prostate cancer(PCa). Risk group classification is based on prostate-specific antigen(PSA) level, Gleason score, and T-sta...External beam radiotherapy(EBRT) is one of the principal curative treatments for patients with prostate cancer(PCa). Risk group classification is based on prostate-specific antigen(PSA) level, Gleason score, and T-stage. After risk group determination, the treatment volume and dose are defined and androgen deprivation therapy is prescribed, if appropriate. Traditionally, imaging has played only a minor role in T-staging due to the low diagnostic accuracy of conventional imaging strategies such as transrectal ultrasound, computed tomography, and morphologic magnetic resonance imaging(MRI). As a result, a notable percentage of tumours are understaged, leading to inappropriate and imprecise EBRT. The development of multiparametric MRI(mp MRI), an imaging technique that combines morphologic studies with functional diffusion-weighted sequences and dynamic contrastenhanced imaging, has revolutionized the diagnosis and management of PCa. As a result, mpM RI is now used in staging PCa prior to EBRT, with possible implications for both risk group classification and treatment decisionmaking for EBRT. mpM RI is also being used in salvageradiotherapy(SRT), the treatment of choice for patients who develop biochemical recurrence after radical prostatectomy. In the clinical context of biochemical relapse, it is essential to accurately determine the site of recurrence-pelvic(local, nodal, or bone) or distant-in order to select the optimal therapeutic management approach. Studies have demonstrated the value of mpM RI in detecting local recurrences-even in patients with low PSA levels(0.3-0.5 ng/m L)-and in diagnosing bone and nodal metastasis. The main objective of this review is to update the role of mpM RI prior to radical EBRT or SRT. We also consider future directions for the use and development of MRI in the field of radiation oncology.展开更多
Hepatocellular carcinoma(HCC)is the second most common cause of cancerrelated death worldwide.Despite the advent of screening efforts and algorithms to stratify patients into appropriate treatment strategies,recurrenc...Hepatocellular carcinoma(HCC)is the second most common cause of cancerrelated death worldwide.Despite the advent of screening efforts and algorithms to stratify patients into appropriate treatment strategies,recurrence rates remain high.In contrast to first-line treatment for HCC,which relies on several factors,including clinical staging,tumor burden,and liver function,there is no consensus or general treatment recommendations for recurrent HCC(R-HCC).Locoregional therapies include a spectrum of minimally invasive liver-directed treatments which can be used as either curative or neoadjuvant therapy for HCC.Herein,we provide a comprehensive review of recent evidence using salvage loco-regional therapies for R-HCC after failed curative-intent.展开更多
To efficiently remove all recurrent lymph nodes(rLNs)and minimize complications,we developed a combination approach that consisted of ^(68)Gallium prostate-specific membrane antigen(PSMA)ligand positron emission tomog...To efficiently remove all recurrent lymph nodes(rLNs)and minimize complications,we developed a combination approach that consisted of ^(68)Gallium prostate-specific membrane antigen(PSMA)ligand positron emission tomography(PET)/computed tomography(CT)and integrated indocyanine green(ICG)-guided salvage lymph node dissection(sLND)for rLNs after radical prostatectomy(RP).Nineteen patients were enrolled to receive such treatment.^(68)Ga-PSMA ligand PET/CT was used to identify rLNs,and 5 mg of ICG was injected into the space between the rectum and bladder before surgery.Fluorescent laparoscopy was used to perform sLND.While extensive LN dissection was performed at level I,another 5 mg of ICG was injected via the intravenous route to intensify the fluorescent signal,and laparoscopy was introduced to intensively target stained LNs along levels I and II,specifically around suspicious LNs,with ^(68)Ga-PSMA ligand PET/CT.Next,both lateral peritonea were exposed longitudinally to facilitate the removal of fluorescently stained LNs at levels III and IV.In total,pathological analysis confirmed that 42 nodes were rLNs.Among 145 positive LNs stained with ICG,24 suspicious LNs identified with ^(68)Ga-PSMA ligand PET/CT were included.The sensitivity and specificity of ^(68)Ga-PSMA ligand PET/CT for detecting rLNs were 42.9%and 96.6%,respectively.For ICG,the sensitivity was 92.8%and the specificity was 39.1%.At a median follow-up of 15(interquartile range[IQR]:6–31)months,15 patients experienced complete biochemical remission(BR,prostate-specific antigen[PSA]<0.2 ng ml−1),and 4 patients had a decline in the PSA level,but it remained>0.2 ng ml−1.Therefore,^(68)Ga-PSMA ligand PET/CT integrating ICG-guided sLND provides efficient sLND with few complications for patients with rLNs after RP.展开更多
Korean Sewol is successfully lifted up with the strand jack system based on twin barges. During the salvage operation, two barges and Sewol encounter offshore environmental conditions of wave, current and wind. It is ...Korean Sewol is successfully lifted up with the strand jack system based on twin barges. During the salvage operation, two barges and Sewol encounter offshore environmental conditions of wave, current and wind. It is inevitable that the relative motions among the three bodies are coupled with the sling tensions, which may cause big dynamic loads for the lifting system. During the project engineering phase and the site operation, it is necessary to build up a simulation model that can precisely generate the coupled responses in order to define a suitable weather window and monitor risks for the salvage operation. A special method for calculating multibody coupled responses is introduced into Sewol salvage project. Each body’s hydrodynamic force and moment in multibody configuration is calculated in the way that one body is treated as freely moving in space, while other bodies are set as fixed globally.The hydrodynamic force and moment are then applied into a numerical simulation model with some calibration coefficients being inserted. These coefficients are calibrated with the model test results. The simulation model built up this way can predict coupled responses with the similar accuracy as the model test and full scale measurement,and particularly generate multibody shielding effects. Site measured responses and the responses only resulted from from the simulation keep project management simultaneously to judge risks of each salvage stage, which are important for success of Sewol salvage.展开更多
文摘Prostate cancer is the most common non-cutaneous cancers occurring in American men,and whilemost men with early-stage prostate cancers are cured,up to a third might manifest with biochemical recurrence(BCR)of prostate cancer.BCR is a disease entitywhich is characterized by a rising prostate-specific antigen(PSA)in the setting of a previously treated localized prostate cancerwith either surgery or radiation therapywith curativeintent.
基金Supported by the Anhui Provincial Department of Education,No.2022AH020077.
文摘BACKGROUND Salvage surgery following conversion therapy[transcatheter arterial chemoembolization(TACE)combined with tyrosine kinase inhibitors(TKIs)and anti-programmed cell death protein 1(PD-1)antibodies]provides a chance for a cure in patients with unresectable hepatocellular carcinoma(uHCC).AIM To primarily analyze the efficacy and safety of salvage surgery in patients initially diagnosed with uHCC who underwent conversion therapy.METHODS We retrospectively collected data from patients at the First Affiliated Hospital of the University of Science and Technology of China(Anhui Provincial Hospital)who met the study criteria.These patients were initially diagnosed with uHCC and received TACE combined with TKIs and anti-PD-1 antibodies as conversion therapy.The main endpoints studied were the safety of salvage surgery,overall survival(OS),and recurrence-free survival(RFS)after surgery.Secondary endpoints included postoperative complications.We performed univariate and multivariate Cox regression analyses to identify independent risk factors for postoperative RFS.RESULTS A total of 117 patients were enrolled in this study,including 28 patients(23.9%)who underwent curative surgery after triplet therapy conversion treatment.Among the 28 patients who underwent salvage surgery,the 1-year and 2-year RFS rates were 75.0%and 59.4%,respectively,and the 1-year and 2-year OS rates were 92.7%and 87.6%,respectively.The median follow-up time after surgery was 15.0 months(range:1.6-37.2 months),with median OS and RFS not yet reached.Pathological complete response was achieved in 14 cases(50.0%),and postoperative complications occurred in 20 patients(71.4%).Univariate and multivariate Cox regression analyses indicated that pathological complete response and preoperative albumin levels were risk factors for postoperative RFS.CONCLUSION Salvage surgery following conversion therapy with TACE combined with TKIs and anti-PD-1 antibodies appears to be an effective and safe treatment option for patients with uHCC.It extends OS and may offer additional potential benefits to uHCC patients.
基金Supported by Anhui Province Translational Medicine Research Fund Project,No.2021zhyx-C59 and No.2021zhyx-C75.
文摘BACKGROUND Testicular torsion is the most common acute scrotum worldwide and mainly occurs in children and adolescents.Studies have demonstrated that the duration of symptoms and torsion grade lead to different outcomes in children diagnosed with testicular torsion.AIM To predict the possibility of testicular salvage(TS)in patients with testicular torsion in a tertiary center.METHODS We reviewed the charts of 75 pediatric patients with acute testicular torsion during a 12-year period from November 2011 to July 2023 at the Suzhou Hospital of Anhui Medical University.Univariate and multivariate logistic regression analyses were used to determine independent predictors of testicular torsion.The data included clinical findings,physical examinations,laboratory data,color Doppler ultrasound findings,operating results,age,presenting institution status,and follow-up results.RESULTS Our study included 75 patients.TS was possible in 57.3%of all patients;testicular torsion occurred mostly in winter,and teenagers aged 11-15 years old accounted for 60%.Univariate logistic regression analyses revealed that younger age(P=0.09),body mass index(P=0.004),torsion angle(P=0.013),red blood cell count(P=0.03),neutrophil-to-lymphocyte ratio(P=0.009),and initial presenting institution(P<0.001)were associated with orchiectomy.In multivariate analysis,only the initial presenting institution predicted TS(P<0.05).CONCLUSION The initial presenting institution has a predictive value for predicting TS in patients with testicular torsion.Children with scrotal pain should be admitted to a tertiary hospital as soon as possible.
文摘After Hurricane Katrina in 2005,literary works related to such a crisis sprouted the southern America,which are known as Post-Katrina Literature.This thesis,taking Salvage the Bones and The Not Yet as examples,scrutinizes how writers respond to the Post-Katrina environmental crisis in different ways.In Salvage the Bones,Jesmyn Ward employs a biographical genre to record the Katrina disaster,thereby,writings serving as a way of healing the psychic trauma of the writer herself;and in The Not Yet,Moira Crone presents a post-natural world by the employment of the Cli-Fi genre.Both writers enrich the tradition of Southern literature as well as American eco-literature.
文摘Even experienced endoscopists have 90% success in achieving deep biliary cannulation with standard methods. Biliary cannulation may become difficult in 10%-15% of patients with biliary obstruction and pre- cut (access) sphincterotomy is frequently chosen as a rescue treatment in these cases. Generally, precut sphincterotomy ensures a rate of 90%-100% success- ful deep biliary cannulation. The precut technique has been performed as either a fistulotomy with a needle knife sphincterotome or as a transpapillary septotomy with a standard sphincterotome. Both methods have similar efficacy and complication rates when adminis- tered to the proper patient. Although precut sphincter- otomy ensures over 90% success of biliary cannula- tion, it has been characterized as an independent risk factor for pancreatitis. The complications of the precut technique are not limited to pancreatitis. Two more important ones, bleeding and perforation, are also re- ported in some publications as being observed more commonly than during standard sphincterotomy. It is also reported that precut sphincterotomy increases morbidity when performed in patients without dilata- tion of their biliary tract. Nevertheless, precut sphinc- terotomy is a good alternative as a rescue method in the setting of a failed standard cannulation method. This paper discusses the technical details, timing, ef- ficacy and potential complications of precut sphincter- otomy.
基金Supported by Science and Education Foundation of Yangzhou,China
文摘AIM: To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy and azygoportal disconnection (MLSD) with intraoperative autologous cell salvage.
文摘AIM To review the conversion therapy for initially unre-sectable hepatocellular carcinoma(HCC) patients and the suitable timing for subsequent salvage surgery. METHODS A Pub Med search was undertaken from 1987 to 2017 to identify articles using the keywords including "unresectable" "hepatocellular carcinoma", "hepate-ctomy", "conversion therapy", "resection", "salvage surgery" and "downstaging". Additional studies were investigated through a manual search of the references from the articles. The exclusion criteria were duplicates, case reports, case series, videos, contents unrelated to the topic, comments, and editorial essays. The main and widely used conversion therapies and the suitable timing for subsequent salvage surgery were discussed in detail. Two members of our group independently performed the literature search and data extraction. RESULTS Liver volume measurements [future liver remnant(FLR)/total liver volume or residual liver volume/bodyweight ratio] and function tests(scoring systems and liver stiffness) were often performed in order to justify whether patients were suitable candidates for surgery. Successful conversion therapy was usually defined as downstaging the tumor, increasing FLR and providing subsequent salvage surgery, without increasing com-plications, morbidity or mortality. The requirementsfor performing salvage surgery after transcatheter arterial chemoembolization were the achievement of a partial remission in radiology, the disappearance of the portal vein thrombosis, and the lack of extrahepatic metastasis. Patients with a standardized FLR(sF LR) > 20% were good candidates for surgery after portal vein embolization, while other predictive parameters like growth rate, kinetic growth rate were treated as an effective supplementary. There was probably not enough evidence to provide a standard operation time after associating liver partition and portal vein ligation for staged hepatectomy or yttrium-90 microsphere radioembolization. The indications of any combinations of conversion therapies and the subsequent salvage surgery time still need to be carefully and comprehen-sively evaluated. CONCLUSION Conversion therapy is recommended for the treatment of initially unresectable HCC, and the suitable subse-quent salvage surgery time should be reappraised and is closely related to its previous therapeutic effect.
文摘Liver transplant(LT) is the primary treatment for patients with end-stage liver disease. About 25000 LTs are performed annually in the world. The potential for intraoperative bleeding is quite variable. However, massive bleeding is common and requires blood transfusion. Allogeneic blood transfusion has an immunosuppressive effect and an impact on recipient survival, in addition to the risk of transmission of viral infections and transfusion errors, among others.Techniques to prevent excessive bleeding or to use autologous blood have been proposed to minimize the negative effects of allogeneic blood transfusion.Intraoperative reinfusion of autologous blood is possible through previous selfdonation or blood collected during the operation. However, LT does not normally allow autologous transfusion by prior self-donation. Hence, using autologous blood collected intraoperatively is the most feasible option. The use of intraoperative blood salvage autotransfusion(IBSA) minimizes the perioperative use of allogeneic blood, preventing negative transfusion effects without negatively impacting other clinical outcomes. The use of IBSA in patients with cancer is still a matter of debate due to the theoretical risk of reinfusion of tumor cells. However, studies have demonstrated the safety of IBSA in several surgical procedures, including LT for hepatocellular carcinoma. Considering the literature available to date, we can state that IBSA should be routinely used in LT, both in patients with cancer and in patients with benign diseases.
文摘AIM:To evaluate survival and recurrence after salvage liver transplantation(SLT) for the treatment of hepatocellular carcinoma(HCC) compared with primary liver transplantation(PLT) using a meta-analysis.METHODS:Literature on SLT versus PLT for the treatment of HCC published between 1966 and July 2011 was retrieved.A meta-analysis was conducted to estimate pooled survival and disease-free rates.A fixed or random-effect model was established to collect the data.RESULTS:The differences in overall survival and disease-free survival rates at 1-year,3-year and 5-year survival rates were not statistically significant between SLT group and PLT group(P > 0.05).After stratifying the various studies by donor source and Milan criteria,we found that:(1) Living donor liver transplantation recipients had significantly higher 1-year survival rate,lower 3-year and 5-year survival rates compared with deceased-donor liver transplantation(DDLT) recipients.And in DDLT recipients they had better 1-year and 5-year disease-free survival rate in SLT group;and(2) No difference was seen in 1-year,3-year and 5-year survival rates between two groups who beyond Milan criteria at the time of liver transplantation.CONCLUSION:SLT can be effectively performed for patients with recurrence or deterioration of liver function after hepatectomy for HCC.It does not increase the perioperative mortality and has a similar long-term survival rates compared to PLT.
文摘Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. The critical points include whether tumor cells can be cleared by IBSA, whether IBSA increases the risk of recurrence or metastasis, and what are the indications for IBSA. Moreover, is it warranted to take the risk of tumor dissemination by using IBSA to avoid allogeneic blood transfusion? Do the remaining tumor cells after additional filtration by leukocyte depletion filters still possess potential tumorigenicity? Does IBSA always work well? We have reviewed the literature and tried to address these questions. The available data indicate that IBSA is safe in LT for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.
基金Shanghai Hospital Development Center(Joint Breakthrough Project for New Frontier Technologies.Project No.SHDC 12015118)Science and Technology Commission of Shanghai Municipality(Project No.15411950102&15411950106)Natural Science Foundation of Shanghai(Project No.14ZR1407100)
文摘Background: After deinitive chemoradiotherapy for non-metastatic nasopharyngeal carcinoma(NPC), more than 10% of patients will experience a local recurrence. Salvage treatments present signiicant challenges for locally recurrent NPC. Surgery, stereotactic ablative body radiotherapy, and brachytherapy have been used to treat locally recurrent NPC. However, only patients with small-volume tumors can beneit from these treatments. Re-irradiation with X-ray—based intensity-modulated radiotherapy(IMXT) has been more widely used for salvage treatment of locally recurrent NPC with a large tumor burden, but over-irradiation to the surrounding normal tissues has been shown to cause frequent and severe toxicities. Furthermore, locally recurrent NPC represents a clinical entity that is more radioresistant than its primary counterpart. Due to the inherent physical advantages of heavy-particle therapy, precise dose delivery to the target volume(s), without exposing the surrounding organs at risk to extra doses, is highly feasible with carbon-ion radiotherapy(CIRT). In addition, CIRT is a high linear energy transfer(LET) radiation and provides an increased relative biological efectiveness compared with photon and proton radiotherapy. Our prior work showed that CIRT alone to 57.5 Gy E(gray equivalent), at 2.5 Gy E per daily fraction, was well tolerated in patients who were previously treated for NPC with a deinitive dose of IMXT. The short-term response rates at 3–6 months were also acceptable. However, no patients were treated with concurrent chemotherapy. Whether the addition of concurrent chemotherapy to CIRT can beneit locally recurrent NPC patients over CIRT alone has never been addressed. It is possible that the beneits of high-LET CIRT may make radiosensitizing chemotherapy unnecessary. We therefore implemented a phase I/II clinical trial to address these questions and present our methodology and results.Methods and design: The maximal tolerated dose(MTD) of re-treatment using raster-scanning CIRT plus concurrent cisplatin will be determined in the phase I, dose-escalating stage of this study. CIRT dose escalation from 52.5 to 65 Gy E(2.5 Gy E × 21–26 fractions) will be delivered, with the primary endpoints being acute and subacute toxicities. Eicacy in terms of overall survival(OS) and local progression-free survival of patients after concurrent chemotherapy plus CIRT at the determined MTD will then be studied in the phase II stage of the trial. We hypothesize that CIRT plus chemotherapy can improve the 2-year OS rate from the historical 50% to at least 70%.Conclusions: Re-treatment of locally recurrent NPC using photon radiation techniques, including IMXT, provides moderate eicacy but causes potentially severe toxicities. Improved outcomes in terms of eicacy and toxicity proile are expected with CIRT plus chemotherapy. However, the MTD of CIRT used concurrently with cisplatin-based chemotherapy for locally recurrent NPC remains to be determined. In addition, whether the addition of chemotherapy to CIRT is needed remains unknown. These questions will be evaluated in the dose-escalating phase I and randomized phase II trials.
文摘The application of the vertical hoisting jack and wave motion compensation techniques to the salvage of an ancient sunken boat is introduced. The boat is wooden, loaded with cultural relics. It has been immersed at the bottom of the South China Sea for more than 800 years. In order to protect the structure of the boat and the cultural relics inside to the largest extent, an open caisson is used to hold the sunken beat and the silts around before they are raised from the seabed all together as a whole. In the paper, first, the seakeeping model test of the system of the salvage barge and the open caisson is done to determine some important wave response parameters. And then a further experimental study of the ap- plication of the vertical hoisting jack and wave motion compensation scheme to the salvage of the sunken boat is carried out. In the model tests, the techniques of the integrative mechanic-electronic-hydraulic control, wave motion forecast and wave motion compensation are used to minimize the heave motion of the open caisson. The results of the model tests show that the heave motion of the open caisson can be reduced effectively by the use of the present method.
文摘Objectives:To evaluate hearing outcome of salvage treatment with intratympanic steroids(ITS)in idiopathic sudden sensorineural hearing loss(ISSNHL)refractory to initial systemic steroid(SS)therapy.Material and methods:A retrospective medical chart review was conducted on 54 consecutive patients with ISSNHL refractory to SS.Salvage treatment with a low dose intratympanic dexamethasone(4 mg/ml)was offered after one week of primary treatment.Patients were divided into two groups:25 patients accepted ITS(treatment group)and 29 patients did not undergo additional treatment(control group).A pure tone average(PTA)gain of at least 10 dB was considered hearing improvement.Results:Hearing improvement rate was higher in ITS group compared to control group(40%vs.13.8%,p=0.035).A mean PTA improvement of 8.6±9.8 dB was observed in the ITS group and,whereas the control group had an average hearing gain of 0.7±2 dB(p<0.001).Audiometric analysis revealed a significant hearing gain in ITS group at all tested frequencies compared to control group(p<0.05).Analysis of the selected variables,identified intratympanic steroid treatment as the only independent prognostic factor for hearing improvement(OR=4.2,95%CI:1.1e15.7;p=0.04).Conclusion:Intratympanic low dose dexamethasone is effective in patients with incomplete hearing recovery after primary systemic steroid treatment.
文摘Glioblastoma multiforme(GBM) is the most common malignant primary brain tumor with a survival prognosis of 14-16 mo for the highest functioning patients. Despite aggressive, multimodal upfront therapies, the majority of GBMs will recur in approximately six months. Salvage therapy options for recurrent GBM(r GBM) are an area of intense research. This study compares recent survival and quality of life outcomes following Gamma Knife radiosurgery(GKRS) salvage therapy. Following a Pub Med search for studies usingGKRS as salvage therapy for malignant gliomas, nine articles from 2005 to July 2013 were identified which evaluated rG BM treatment. In this review, we compare overall survival following diagnosis, overall survival following salvage treatment, progression-free survival, time to recurrence, local tumor control, and adverse radiation effects. This report discusses results for rG BM patient populations alone, not for mixed populations with other tumor histology grades. All nine studies reported median overall survival rates(from diagnosis, range:16.7-33.2 mo; from salvage, range:9-17.9 mo). Three studies identified median progression-free survival(range:4.6-14.9 mo). Two showed median time to recurrence of GBM. Two discussed local tumor control. Six studies reported adverse radiation effects(range:0%-46% of patients). The greatest survival advantages were seen in patients who received GKRS salvage along with other treatments, like resection or bevacizumab, suggesting that appropriately tailored multimodal therapy should be considered with each rG BM patient. However, there needs to be a randomized clinical trial to test GKRS for rG BM before the possibility of selection bias can be dismissed.
文摘The overall incidence of osteochondral defect in the general population is estimated to be 15 to 30 per100000 people.These lesions can become symptomatic causing pain,swelling and decreased function of the knee,and may eventually progress to osteoarthritis.In the young and active population,partial or total knee arthroplasty(TKA)is rarely the treatment of choice due to risk of early failure.Osteochondral allograft transplantation has been demonstrated to be a safe and effective treatment of large osteochondral and chondral defects of the knee in appropriately selected patients.The treatment reduces pain,improves function and is a viable limb salvage procedure for patients,especially young and active patients for whom TKA is not recommended.Either large dowels generated with commercially available equipment or free hand shell allografts can be implanted in more posterior lesions.Current recommendations for fresh allografts stored at4C advise implantation within 21-28 d of procurement for optimum chondrocyte viability,following screening and testing protocols.Higher rates of successful allograft transplantation are observed in younger patients,unipolar lesions,normal or corrected malalignment,and defects that are treated within 12 mo of symptom onset.Patients with bipolar lesions,uncorrectable malalignment,advanced osteoarthritis,and those over40 tend to have less favourable outcomes.
文摘Several studies have evaluated the risk factors influencing biochemical recurrence （BCR） of prostate cancer in patients receiving salvage radiotherapy （SRT） for BCR after radical prostatectomy （RP）, but the results remain conflicting. In this study, we performed a meta-analysis to resolve this conflict. We searched the following databases： PubMed, Embase, and Web of Science using the following terms in ＂All fields＂： ＂salvage radiation therapy,＂ ＂salvage IMRT, S-IMRT, salvage radiotherapy, SRT, radical prostatectomy,＂ ＂RP, biochemical recurrence,＂ ＂BCR,＂ ＂biochemical relapse.＂ Eleven studies, with a total of 1383 patients, were included in our meta-analysis. Of all the variables, only Gleason score （GS） 〉7 （odds ratio [OR]： 3.82; 95% confidence interval [CI]： 2.60-5.64） and pathological tumor （pT） stage 〉3a （OR： 1.82; 95% Ch 1.36-2.42） were positively correlated with BCR. However, SRT combined with androgen deprivation therapy （ADT） （OR： 0.63; 95% CI： 0.44-0.90） and radiation therapy （RT） dose 〉64 Gy （OR： 0.35; 95% CI： 0.19-0.64） were negatively correlated with BCR. Perineural invasion （OR： 2.64; 95% CI： 1.11-6.26）, preoperative prostate-specific antigen （PSA） 〉10 ng m1-1 （OR： 1.36; 95% CI： 0.94-1.96）, positive surgical margin （OR： 0.92; 95% Ch 0.7-1.19）, and seminal vesicle involvement （SVI） （OR： 1.09; 95% Ch. 0.83-1.43） had no effect on BCR. Our meta-analysis indicated that pT stage, GS, RT dose, and SRT combined with ADT may influence BCR, while preoperative PSA, surgical margin, perineural invasion, and SVI have only a weak effect on BCR.
文摘External beam radiotherapy(EBRT) is one of the principal curative treatments for patients with prostate cancer(PCa). Risk group classification is based on prostate-specific antigen(PSA) level, Gleason score, and T-stage. After risk group determination, the treatment volume and dose are defined and androgen deprivation therapy is prescribed, if appropriate. Traditionally, imaging has played only a minor role in T-staging due to the low diagnostic accuracy of conventional imaging strategies such as transrectal ultrasound, computed tomography, and morphologic magnetic resonance imaging(MRI). As a result, a notable percentage of tumours are understaged, leading to inappropriate and imprecise EBRT. The development of multiparametric MRI(mp MRI), an imaging technique that combines morphologic studies with functional diffusion-weighted sequences and dynamic contrastenhanced imaging, has revolutionized the diagnosis and management of PCa. As a result, mpM RI is now used in staging PCa prior to EBRT, with possible implications for both risk group classification and treatment decisionmaking for EBRT. mpM RI is also being used in salvageradiotherapy(SRT), the treatment of choice for patients who develop biochemical recurrence after radical prostatectomy. In the clinical context of biochemical relapse, it is essential to accurately determine the site of recurrence-pelvic(local, nodal, or bone) or distant-in order to select the optimal therapeutic management approach. Studies have demonstrated the value of mpM RI in detecting local recurrences-even in patients with low PSA levels(0.3-0.5 ng/m L)-and in diagnosing bone and nodal metastasis. The main objective of this review is to update the role of mpM RI prior to radical EBRT or SRT. We also consider future directions for the use and development of MRI in the field of radiation oncology.
文摘Hepatocellular carcinoma(HCC)is the second most common cause of cancerrelated death worldwide.Despite the advent of screening efforts and algorithms to stratify patients into appropriate treatment strategies,recurrence rates remain high.In contrast to first-line treatment for HCC,which relies on several factors,including clinical staging,tumor burden,and liver function,there is no consensus or general treatment recommendations for recurrent HCC(R-HCC).Locoregional therapies include a spectrum of minimally invasive liver-directed treatments which can be used as either curative or neoadjuvant therapy for HCC.Herein,we provide a comprehensive review of recent evidence using salvage loco-regional therapies for R-HCC after failed curative-intent.
基金This work was supported by the National Natural Science Foundation of China(General Program,No.81772722)Guangdong Province Science and Technology Planning Project(No.2017B020227008).
文摘To efficiently remove all recurrent lymph nodes(rLNs)and minimize complications,we developed a combination approach that consisted of ^(68)Gallium prostate-specific membrane antigen(PSMA)ligand positron emission tomography(PET)/computed tomography(CT)and integrated indocyanine green(ICG)-guided salvage lymph node dissection(sLND)for rLNs after radical prostatectomy(RP).Nineteen patients were enrolled to receive such treatment.^(68)Ga-PSMA ligand PET/CT was used to identify rLNs,and 5 mg of ICG was injected into the space between the rectum and bladder before surgery.Fluorescent laparoscopy was used to perform sLND.While extensive LN dissection was performed at level I,another 5 mg of ICG was injected via the intravenous route to intensify the fluorescent signal,and laparoscopy was introduced to intensively target stained LNs along levels I and II,specifically around suspicious LNs,with ^(68)Ga-PSMA ligand PET/CT.Next,both lateral peritonea were exposed longitudinally to facilitate the removal of fluorescently stained LNs at levels III and IV.In total,pathological analysis confirmed that 42 nodes were rLNs.Among 145 positive LNs stained with ICG,24 suspicious LNs identified with ^(68)Ga-PSMA ligand PET/CT were included.The sensitivity and specificity of ^(68)Ga-PSMA ligand PET/CT for detecting rLNs were 42.9%and 96.6%,respectively.For ICG,the sensitivity was 92.8%and the specificity was 39.1%.At a median follow-up of 15(interquartile range[IQR]:6–31)months,15 patients experienced complete biochemical remission(BR,prostate-specific antigen[PSA]<0.2 ng ml−1),and 4 patients had a decline in the PSA level,but it remained>0.2 ng ml−1.Therefore,^(68)Ga-PSMA ligand PET/CT integrating ICG-guided sLND provides efficient sLND with few complications for patients with rLNs after RP.
基金financially supported by the Korean‘Sewol’Salvage Project
文摘Korean Sewol is successfully lifted up with the strand jack system based on twin barges. During the salvage operation, two barges and Sewol encounter offshore environmental conditions of wave, current and wind. It is inevitable that the relative motions among the three bodies are coupled with the sling tensions, which may cause big dynamic loads for the lifting system. During the project engineering phase and the site operation, it is necessary to build up a simulation model that can precisely generate the coupled responses in order to define a suitable weather window and monitor risks for the salvage operation. A special method for calculating multibody coupled responses is introduced into Sewol salvage project. Each body’s hydrodynamic force and moment in multibody configuration is calculated in the way that one body is treated as freely moving in space, while other bodies are set as fixed globally.The hydrodynamic force and moment are then applied into a numerical simulation model with some calibration coefficients being inserted. These coefficients are calibrated with the model test results. The simulation model built up this way can predict coupled responses with the similar accuracy as the model test and full scale measurement,and particularly generate multibody shielding effects. Site measured responses and the responses only resulted from from the simulation keep project management simultaneously to judge risks of each salvage stage, which are important for success of Sewol salvage.
