BACKGROUND Recent advances in endoscopic technology,especially magnifying endoscopy with narrow band imaging(ME-NBI)enable us to detect superficial esophageal squamous cell carcinoma(ESCC),but determining the appropri...BACKGROUND Recent advances in endoscopic technology,especially magnifying endoscopy with narrow band imaging(ME-NBI)enable us to detect superficial esophageal squamous cell carcinoma(ESCC),but determining the appropriate method of resection,endoscopic resection(ER)vs surgical resection,is often challenging.Recently,several studies have reported that 18F-fluorodeoxyglucose positron emission tomography(FDG-PET)is a useful indicator for decision-making regarding treatment for superficial ESCC.Although,there are not enough reports on association between FDG-PET uptake and clinicopathological characteristics of superficial ESCC.And,there are not enough reports on evaluating the usefulness of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.This study evaluated clinical relevance of FDG-PET and ME-NBI in decision-making regarding the treatment strategy for ESCC.AIM To investigate the association between FDG uptake and the clinicopathological characteristics of superficial ESCC and its usefulness of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.METHODS A database of all patients with superficial ESCC who had undergone both MENBI and FDG-PET for pre-treatment staging at Aichi Cancer Center Hospital between January 2008 and November 2018 was retrospectively analyzed.FDG uptake was defined positive or negative whether the primary lesion was visualized or could be distinguished from the background,or not.The invasion depth of ESCC was classified according to the Japan Esophageal Society.Primary endpoint is to evaluate the association between FDG uptake and clinicopathological characteristics of superficial ESCC.Secondary endpoint is to investigate the efficacy of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.RESULTS A total of 82 lesions in 82 patients were included.FDG-PET showed positive uptake in 29(35.4%)lesions.Univariate analysis showed that uptake of FDG-PET had significant correlations with circumferential extension(P=0.014),pathological depth of tumor invasion(P<0.001),infiltrative growth pattern(P<0.001),histological grade(P=0.002),vascular invasion(P=0.001),and lymphatic invasion(P<0.001).On multivariate analysis,only depth of tumor invasion was independently correlated with FDG-PET/computed tomography visibility(P=0.018).The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of Type B2 in ME-NBI for the invasion depth of T1a muscularis mucosae and T1b upper submucosal layer were 68.4%/79.4%/50.0%/89.3%/76.8%,respectively,and those of Type B3 for the depth of T1b middle and deeper submucosal layers(SM2 and SM3)were 46.7%/100%/100%/89.3%/90.2%,respectively.On the other hand,those of FDGPET for SM2 and SM3 were 93.3%/77.6%/48.2%/98.1%/80.5%,respectively,whereas,if the combination of positive FDG uptake and type B2 and B3 was defined as an indicator for radical esophagectomy or definitive chemoradiotherapy,the sensitivity,specificity,PPV,NPV,and accuracy were 78.3%/91.5%/78.3%/91.5%/87.8%,respectively.CONCLUSION FDG uptake was correlated with the invasion depth of superficial ESCC.Combined use of FDG-PET and ME-NBI,especially with the microvascular findings of Type B2 and B3,is useful to determine whether ER is indicated for the lesion.展开更多
Obstructive jaundice(OJ)is a common problem in daily clinical practice.However,completely understanding the pathophysiological changes in OJ remains a challenge for planning current and future management.The effects o...Obstructive jaundice(OJ)is a common problem in daily clinical practice.However,completely understanding the pathophysiological changes in OJ remains a challenge for planning current and future management.The effects of OJ are widespread,affecting the biliary tree,hepatic cells,liver function,and causing systemic complications.The lack of bile in the intestine,destruction of the intestinal mucosal barrier,and increased absorption of endotoxins can lead to endotoxemia,production of proinflammatory cytokines,and induce systemic inflammatory response syndrome,ultimately leading to multiple organ dysfunction syndrome.Proper management of OJ includes adequate water supply and electrolyte replacement,nutritional support,preventive antibiotics,pain relief,and itching relief.The surgical treatment of OJ depends on the cause,location,and severity of the obstruction.Biliary drainage,surgery,and endoscopic intervention are potential treatment options depending on the patient's condition.In addition to modern medical treatments,Traditional Chinese medicine may offer therapeutic benefits for OJ.A comprehensive search was conducted on PubMed for relevant articles published up to August 1970.This review discusses in detail the pathophysiological changes associated with OJ and presents effective strategies for managing the condition.展开更多
Brain ischemic stroke is the leading cause of long-lasting injury,disability,and death in adults.Although the brain represents only about 2%of the total body mass,it consumes almost 20%of the body＇s oxygen.As a resul...Brain ischemic stroke is the leading cause of long-lasting injury,disability,and death in adults.Although the brain represents only about 2%of the total body mass,it consumes almost 20%of the body＇s oxygen.As a result,brain cells are extremely sensitive to hypoxia.Once cerebral ischemia occurs.展开更多
Objective To investigate the etiology,clinical characteristics,diagnosis,and treatment strategies and efficacy of pulsatile tinnitus(PT)caused by vascular anatomy abnormality.Methods The clinical data of 45 patients w...Objective To investigate the etiology,clinical characteristics,diagnosis,and treatment strategies and efficacy of pulsatile tinnitus(PT)caused by vascular anatomy abnormality.Methods The clinical data of 45 patients with PT in our hospital from 2012 to 2019 were collected and retrospectively analyzed.Results All 45 patients had vascular anatomical abnormalities.The patients were divided into 10 categories according to the different locations of vascular abnormalities:sigmoid sinus diverticulum(SSD),sigmoid sinus wall dehiscence(SSWD),SSWD with high jugular bulb,pure dilated mastoid emissary vein,aberrant internal carotid artery(ICA)in the middle ear,transverse-sigmoid sinus(TSS)transition stenosis,TSS transition stenosis with SSD,persistent occipital sinus stenosis,petrous segment stenosis of ICA,and dural arteriovenous fistula.All patients complained of PT synchronous with heartbeat rhythm.Endovascular interventional therapy and extravascular open surgery were used according to the location of the vascular lesions.Tinnitus disappeared in 41 patients,was significantly relieved in 3 patients,and was unchanged in 1 patient postoperatively.Except for one patient with transient headache postoperatively,no obvious complications occurred.Conclusion PT caused by vascular anatomy abnormalities can be identified by detailed medical history and physical and imaging examination.PT can be relieved or even completely alleviated after appropriate surgical treatments.展开更多
Despite intensive research,most neurodegenerative diseases cannot be cured and for some of them no treatment is available to increase survival or quality of life.Among the latter are prion diseases,fatal and transmiss...Despite intensive research,most neurodegenerative diseases cannot be cured and for some of them no treatment is available to increase survival or quality of life.Among the latter are prion diseases,fatal and transmissible neurodegenerative diseases of humans and other animals.展开更多
In this editorial,we highlight the significance of a retrospective study“Analysis of the impact of immunotherapy efficacy and safety in patients with gastric cancer and liver metastasis”performed by Liu et al.The au...In this editorial,we highlight the significance of a retrospective study“Analysis of the impact of immunotherapy efficacy and safety in patients with gastric cancer and liver metastasis”performed by Liu et al.The authors utilized data collected from gastric cancer(GC)patients and assessed immunotherapy effectiveness and survival status.They found significant differences in treatment response.Because immunotherapy seems to be a beneficial strategy for advanced GC patients,strati-fication of the data based on metastasis status may further improve treatment strategies.展开更多
<strong>Objective: </strong>The purpose is to formulate treatment strategies of batches of the wounded and partial first-aid procedures, and further improve the emergency rescue capability of hospitals. &l...<strong>Objective: </strong>The purpose is to formulate treatment strategies of batches of the wounded and partial first-aid procedures, and further improve the emergency rescue capability of hospitals. <strong>Methods: </strong>This study analyzed the emergency treatment case that we participated in. In this case, we used various means to start the emergency plan, run the emergency procedures, optimize diagnosis, treatment, and rescue procedures, mobilize medical rescue resources, provide a reference for emergency command decisions, formulate a set of coping strategies of tertiary general hospitals on public emergencies. <strong>Results:</strong> Through the scientific and effective management of our hospital, 20 wounded have been discharged from the hospital and achieved the ideal effect of zero deaths in the hospital. <strong>Conclusions:</strong> The new mode of first-aid and health emergency management on the scene of modern disaster needs to find ways to minimize the loss of life and property brought by public emergencies, integrate the various sections of modern disaster medicine, integrate a large number of international and domestic basic and clinical research achievements of disaster first-aid, and upgrade to information, digital system.展开更多
<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Treatment strategy for recurrent hepatocellular carc...<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Treatment strategy for recurrent hepatocellular carcinoma (HCC) remains scantily defined. This study was aimed to establish a treatment strategy to manage post-hepatectomy recurrent HCC and report the clinical outcomes. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">From January 2006 to December 2016, 556 consecutive patients who developed post-hepatectomy HCC recurrence were enrolled in the study. The patients were clinically stratified and treated according to a strategy established by a multi-disciplinary team. Clinical data and survival times were collected prospectively and analyzed retrospectively. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">According to the strategy, there were 298 (53.6%), 214 (38.5%), 32 (5.7%) and 12 (2.2%) patients stratified into Early, Intermediate, Advanced and Terminal stages, respectively. In Early stage patients, 164 (55.0%) received curative treatment in the form of repeat resection or local ablation, 134 (45.0%) received transarterial chemoe</span><span style="font-family:Verdana;">mbolization (TACE), and the 1-, 3-, and 5-year overall survival (OS) rates were 82.0%, 46.8% and 37.3%, respectively. In Intermediate stage patients, 207 (96.7%) received TACE, 7 (3.3%) radiotherapy, and the 1-, 3-, and 5-year OS rates were 73.2%, 31.8% and 15.9%, respectively. In Advanced stage patients, 22 patients received sorafenib, 10 radiotherapy, and the mean survival time (MST) was 25.1 ± 3.1 months. All the 12 patients in Terminal stage rece</span><span style="font-family:Verdana;">ived the best supportive treatment, and the MST was 6.5 ± 3.4 months. Clinical stages and duration of disease-free interval were independent factors relating to overall survival. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">A treatment strategy derived from the Barcelona Clinic Liver Cancer staging system, with some modifications, has been successfully established to manage post-hepatectomy recurrent HCC, and the clinical outcomes were commendable.</span></span></span></span>展开更多
In this paper, a disease transmission model with two treatment stages is proposed and analyzed. The results indicate that the basic reproduction number is a critical threshold for the prevalence of the disease. If the...In this paper, a disease transmission model with two treatment stages is proposed and analyzed. The results indicate that the basic reproduction number is a critical threshold for the prevalence of the disease. If the basic reproduction number is less than one, the disease free equilibrium is globally asymptotically stable. Otherwise, the endemic equilibrium is globally asymptotically stable. Therefore, besides the basic reproduction number, a new marker for characterizing the seriousness of the disease, named as dynamical final infective size, is proposed, which differs from traditional final size because the proposed model includes the natural birth and death. Finally, optimization strategies for limited medical resources are obtained from the perspectives of basic reproduction number and dynamical final infective size, and the real-world disease management scenarios are given based on these finding.展开更多
Objective To investigate treatment strategy of intracranial arachnoid cysts. Methods 47 cases of Intracranial arachnoid cysts from Sep 1,2010 to Des 1,2010 were analyzed. 25 cases received no intervention but follow ....Objective To investigate treatment strategy of intracranial arachnoid cysts. Methods 47 cases of Intracranial arachnoid cysts from Sep 1,2010 to Des 1,2010 were analyzed. 25 cases received no intervention but follow . 22 cases received operation,13 of 22 cases neuroendoscopic partial cystectomy and communication between cystic cavity and brain cistern; 7 of 22 cases cysts peritoneal shunt, 2 of 22展开更多
1 Identify underlying diseases (Table 1),active treatment and seeks to eradicate.Even if the cause of the same,each trying to individualized treatment of patients.Such as pneumococcal sepsis and DIC,the prognosis of y...1 Identify underlying diseases (Table 1),active treatment and seeks to eradicate.Even if the cause of the same,each trying to individualized treatment of patients.Such as pneumococcal sepsis and DIC,the prognosis of young people and the elderly is different from primary and secondary immune deficiencies are different treatment options.展开更多
Objective:To establish the dynamic treatment strategy of Chinese medicine(CM)for metastatic colorectal cancer(mCRC)by machine learning algorithm,in order to provide a reference for the selection of CM treatment strate...Objective:To establish the dynamic treatment strategy of Chinese medicine(CM)for metastatic colorectal cancer(mCRC)by machine learning algorithm,in order to provide a reference for the selection of CM treatment strategies for mCRC.Methods:From the outpatient cases of mCRC in the Department of Oncology at Xiyuan Hospital,China Academy of Chinese Medical Sciences,197 cases that met the inclusion criteria were screened.According to different CM intervention strategies,the patients were divided into 3 groups:CM treatment alone,equal emphasis on Chinese and Western medicine treatment(CM combined with local treatment of tumors,oral chemotherapy,or targeted drugs),and CM assisted Western medicine treatment(CM combined with intravenous regimen of Western medicine).The survival time of patients undergoing CM intervention was taken as the final evaluation index.Factors affecting the choice of CM intervention scheme were screened as decision variables.The dynamic CM intervention and treatment strategy for mCRC was explored based on the cost-sensitive classification learning algorithm for survival(CSCLSurv).Patients'survival was estimated using the Kaplan-Meier method,and the survival time of patients who received the model-recommended treatment plan were compared with those who received actual treatment plan.Results:Using the survival time of patients undergoing CM intervention as the evaluation index,a dynamic CM intervention therapy strategy for mCRC was established based on CSCLSurv.Different CM intervention strategies for mCRC can be selected according to dynamic decision variables,such as gender,age,Eastern Cooperative Oncology Group score,tumor site,metastatic site,genotyping,and the stage of Western medicine treatment at the patient's first visit.The median survival time of patients who received the model-recommended treatment plan was 35 months,while those who receive the actual treatment plan was 26.0 months(P=0.06).Conclusions:The dynamic treatment strategy of CM,based on CSCLSurv for mCRC,plays a certain role in providing clinical hints in CM.It can be further improved in future prospective studies with larger sample sizes.展开更多
Background A hepatic adverse event(HAE)is defined as a liver injury that occurs following immune checkpoint inhibitor(ICI)administration in oncology Patients.Immune-mediated hepatotoxicity(IMH)is a type of HAE directl...Background A hepatic adverse event(HAE)is defined as a liver injury that occurs following immune checkpoint inhibitor(ICI)administration in oncology Patients.Immune-mediated hepatotoxicity(IMH)is a type of HAE directly caused by ICI and is associated with immune system hyperactivation.HAE incidence varies across different clinical studies.This study aimed to explore the risk factors of HAE and establish a personalized IMH treatment strategy.Methods Randomized controlled trials(RCTs)on ICIs and case reports related to IMH were collected and summarized separately.Meta-analysis was performed using Review Manager(version 5.0),whereas correlation analysis and linear regression were performed using SPSS(version 24.0)to evaluate any correlations between the two variables.Results Overall,36 RCTs containing 18,515 patients and 39 case reports met our inclusion criteria.The ICI administration increased the HAE risk(risk ratio[RR]=1.40)as well as severe HAE(RR=2.55).The overall HAE incidence and severe incidence were about 15.3%and 4.3%,respectively.Cytotoxic T-lymphocyte-associated protein 4(CTLA-4)inhibitors have a higher incidence of HAE than programmed cell death protein 1(PD-1)and programmed death-ligand 1(PD-L1)inhibitors.Finally,we found a positive correlation between the onset time of IMH and the recovery time of liver injury.Conclusions ICI administration increased the incidence risk of HAE,especially in patients treated with CTLA-4 inhibitors.Regarding IMH treatment,the glucocorticoid dosage must be individually reduced according to the severity and onset time of HAE.展开更多
This case reports a 63-year-old male patient who was admitted to the hospital due to the discovery of sigmoid colon protrusion during physical examination.EUS indicated submucosal lesions,and lymphangioma was initiall...This case reports a 63-year-old male patient who was admitted to the hospital due to the discovery of sigmoid colon protrusion during physical examination.EUS indicated submucosal lesions,and lymphangioma was initially considered.Colonoscopy revealed a 0-Is+Ⅱc type protrusion,with a smooth surface and visible dendritic vessels.The biopsy was tough.Auxiliary imaging showed no distant metastasis or obvious organ damage,and the laboratory test results were normal.The pathological confirmation after submucosal dissection was non-Hodgkin's small B-cell lymphoma(MALT lymphoma).Combining imaging,pathological and immunohistochemical analyses,this case emphasizes the precise sampling and classification strategy for submucosal masses in the digestive tract,suggesting that endoscopic biopsy is difficult to fully reflect submucosal infiltration and should be supplemented by EUS and large tissue sampling.In terms of treatment,based on the local lesion,pathological classification and the patient's overall condition,a strategy combining endoscopic dissection and subsequent chemotherapy is selected to achieve a balance between local control and systemic intervention.展开更多
Spinal cord injury （SCI） continues to be a pressing health and social problem. The injury leads to neuronal and glial cell death accompanied by degeneration of nerve fibers. There are currently no particularly effec...Spinal cord injury （SCI） continues to be a pressing health and social problem. The injury leads to neuronal and glial cell death accompanied by degeneration of nerve fibers. There are currently no particularly effective treatments. SCI causes profound disabil- ity of people affected and has attracted increased attention in the international field of neuroregeneration. For the past two decades, much hope has been placed in cell therapies for the restoration of both structure and function of the injured spinal cord. Embryonic and neural stem cells, olfactory ensheathing cells, microglia-like cells, Schwann cells, mesenchymal stem cells.展开更多
Traumatic injuries to the central nervous system （CNS）, in- cluding traumatic brain injury （TBI） and spinal cord injury （SCI）, often involve an immediate mechanical damage to plas- ma membrane that surrounds neu...Traumatic injuries to the central nervous system （CNS）, in- cluding traumatic brain injury （TBI） and spinal cord injury （SCI）, often involve an immediate mechanical damage to plas- ma membrane that surrounds neuronal sornata and axons. This initial disruption of plasma membrane following injuries has been convincingly demonstrated by increased membrane permeability to large molecules and dyes that are normally inaccessible to cellular plasma （Farkas et al., 2006; Cho and Borgens, 2012）. Further evidence comes from experiments that showed ultra-structural changes of plasma membranes, axons, and organelles, and subsequent neuronal death and axotomy （Povlishock and Pettus, 1996; Whalen et al., 2008）.展开更多
Cranial hemophilic pseudotumor(cHPT)is a very rare disease,which is easy to misdiagnose.It is also difficult to manage such patients.We reported the first case of occipital cHPT.Case presentation:Here,we presented a r...Cranial hemophilic pseudotumor(cHPT)is a very rare disease,which is easy to misdiagnose.It is also difficult to manage such patients.We reported the first case of occipital cHPT.Case presentation:Here,we presented a rare case of an occipital bone mass in a 3-year-old boy who was diagnosed with hemophilia A.The mass was misdiagnosed as an aneurysmal bone cyst by pathological examination.After resection,the patient underwent one-stage cranioplasty.However,the patient was admitted again for hematoma caused by an invasive procedure.A second surgery and one-stage cranioplasty were performed at the same time.A follow-up 3 months after discharging showed the patient was uneventful,and the titanium mesh was well fixed.Conclusion:The diagnosis of cHPT requires the combining of history,radiological examination,and pathological examination.Resection is the best choice for symptomatic cHPT.Replacement treatment and less invasive treatment can make perioperative management safer.One-stage cranioplasty for resection of an occipital cHPT can improve the quality of life.展开更多
In this editorial we examine the article by Wu et al published in the World Journal of Gastrointestinal Oncology.Surgical resection for peritoneal metastases from colorectal cancer(CRC)has been gradually accepted in t...In this editorial we examine the article by Wu et al published in the World Journal of Gastrointestinal Oncology.Surgical resection for peritoneal metastases from colorectal cancer(CRC)has been gradually accepted in the medical oncology community.A randomized trial(PRODIGE 7)on cytoreductive surgery(CRS)with hyperthermic intraperitoneal chemotherapy(HIPEC)failed to prove any benefit of oxaliplatin in the overall survival of patients with peritoneal metastases from colorectal origin.Nevertheless,isolated systemic chemotherapy for CRC stage IV has demonstrated a reduced response in peritoneal metastases than that obtained in other metastatic sites such as the liver.Another tool is required in those patients to achieve more local control of the disease.Surgical groups in peritoneal surgery continue to use HIPEC in their procedures,using other agents than oxaliplatin for peritoneal cavity infusion,such as mitomycin C.These patients present with complex surgical issues to manage,and consequently a large burden of complications has to be anticipated.Therefore,identifying patients who will benefit from CRS with or without HIPEC would be of great interest.展开更多
Parkinson’s disease （PD） is caused by progressive degeneration of dopamine （DA） neurons in the substantia nigra pars compacta （SNpc）, resulting in the deficiency of DA in the striatum. Thus, symptoms are develo...Parkinson’s disease （PD） is caused by progressive degeneration of dopamine （DA） neurons in the substantia nigra pars compacta （SNpc）, resulting in the deficiency of DA in the striatum. Thus, symptoms are developed, such as akinesia, rigidity and tremor. The aetiology of neuronal death in PD still remains unclear. Several possible mechanisms of the degeneration of dopaminergic neurons are still elusive. Various mechanisms of neuronal degeneration in PD have been proposed, including formation of free radicals, oxidative stress, mitochondrial dysfunction, excitotoxicity, calcium cytotoxicity, trophic factor deficiency, inflammatory processes, genetic factors, environmental factors, toxic action of nitric oxide, and apoptosis. All these factors interact with each other, inducing a vicious cycle of toxicity causing neuronal dysfunction, atrophy and finally cell death. Considerable evidence suggests that free radicals and oxidative stress may play key roles in the pathogenesis of PD. However, currently, drug therapy cannot completely cure the disease. DA replacement therapy with levodopa （L-Dopa）, although still being a gold standard for symptomatic treatment of PD, only alleviates the clinical symptoms. Furthermore, patients usually experience severe side effects several years after the L-Dopa treatment. Until now, no therapy is available to stop or at least slow down the neurodegeneration in patients. Therefore, efforts are made not only to improve the effect of L-Dopa treatment for PD, but also to investigate new drugs with both antiparkinsonian and neuroprotective effects. Here, the advantages and limitations of current and future therapies for PD were dicussed. Current therapies include dopaminergic therapy, DA agonists, MAO-B inhibitor, COMT inhibitors, anticholinergic drugs, surgical procedures such as pallidotomy and more specifically deep brain stimulation of the globus pallidus pars interna （GPi） or subthalamic nucleus （STN）, and stem cell transplantation.展开更多
The incidence of colorectal cancer is gradually increasing,and a majority of patients are diagnosed with distant metastases at the time of initial diagnosis,with the liver being the most common site of metastasis.Unli...The incidence of colorectal cancer is gradually increasing,and a majority of patients are diagnosed with distant metastases at the time of initial diagnosis,with the liver being the most common site of metastasis.Unlike most malignant tumors,patients with distant metastases can still achieve favorable prognoses if both the primary tumor and liver metastases are surgically resected.With ad-vances in systemic therapies,many patients with initially unresectable liver me-tastases from colorectal cancer can undergo systemic treatment to achieve con-version therapy,thereby gaining the opportunity for surgery.However,there is still no consensus on several issues,including the timing of systemic therapy before and after surgery,whether neoadjuvant therapy should be employed,and the choice between simultaneous or staged surgeries.This review aims to system-atically describe the current treatment landscape for colorectal cancer with liver metastases and highlight several unresolved controversial issues,providing valuable insights for the diagnosis and treatment of colorectal liver metastases.展开更多
文摘BACKGROUND Recent advances in endoscopic technology,especially magnifying endoscopy with narrow band imaging(ME-NBI)enable us to detect superficial esophageal squamous cell carcinoma(ESCC),but determining the appropriate method of resection,endoscopic resection(ER)vs surgical resection,is often challenging.Recently,several studies have reported that 18F-fluorodeoxyglucose positron emission tomography(FDG-PET)is a useful indicator for decision-making regarding treatment for superficial ESCC.Although,there are not enough reports on association between FDG-PET uptake and clinicopathological characteristics of superficial ESCC.And,there are not enough reports on evaluating the usefulness of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.This study evaluated clinical relevance of FDG-PET and ME-NBI in decision-making regarding the treatment strategy for ESCC.AIM To investigate the association between FDG uptake and the clinicopathological characteristics of superficial ESCC and its usefulness of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.METHODS A database of all patients with superficial ESCC who had undergone both MENBI and FDG-PET for pre-treatment staging at Aichi Cancer Center Hospital between January 2008 and November 2018 was retrospectively analyzed.FDG uptake was defined positive or negative whether the primary lesion was visualized or could be distinguished from the background,or not.The invasion depth of ESCC was classified according to the Japan Esophageal Society.Primary endpoint is to evaluate the association between FDG uptake and clinicopathological characteristics of superficial ESCC.Secondary endpoint is to investigate the efficacy of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.RESULTS A total of 82 lesions in 82 patients were included.FDG-PET showed positive uptake in 29(35.4%)lesions.Univariate analysis showed that uptake of FDG-PET had significant correlations with circumferential extension(P=0.014),pathological depth of tumor invasion(P<0.001),infiltrative growth pattern(P<0.001),histological grade(P=0.002),vascular invasion(P=0.001),and lymphatic invasion(P<0.001).On multivariate analysis,only depth of tumor invasion was independently correlated with FDG-PET/computed tomography visibility(P=0.018).The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of Type B2 in ME-NBI for the invasion depth of T1a muscularis mucosae and T1b upper submucosal layer were 68.4%/79.4%/50.0%/89.3%/76.8%,respectively,and those of Type B3 for the depth of T1b middle and deeper submucosal layers(SM2 and SM3)were 46.7%/100%/100%/89.3%/90.2%,respectively.On the other hand,those of FDGPET for SM2 and SM3 were 93.3%/77.6%/48.2%/98.1%/80.5%,respectively,whereas,if the combination of positive FDG uptake and type B2 and B3 was defined as an indicator for radical esophagectomy or definitive chemoradiotherapy,the sensitivity,specificity,PPV,NPV,and accuracy were 78.3%/91.5%/78.3%/91.5%/87.8%,respectively.CONCLUSION FDG uptake was correlated with the invasion depth of superficial ESCC.Combined use of FDG-PET and ME-NBI,especially with the microvascular findings of Type B2 and B3,is useful to determine whether ER is indicated for the lesion.
基金Tianjin Municipal Education Commission Scientific Research Program,China,No.2022KJ271。
文摘Obstructive jaundice(OJ)is a common problem in daily clinical practice.However,completely understanding the pathophysiological changes in OJ remains a challenge for planning current and future management.The effects of OJ are widespread,affecting the biliary tree,hepatic cells,liver function,and causing systemic complications.The lack of bile in the intestine,destruction of the intestinal mucosal barrier,and increased absorption of endotoxins can lead to endotoxemia,production of proinflammatory cytokines,and induce systemic inflammatory response syndrome,ultimately leading to multiple organ dysfunction syndrome.Proper management of OJ includes adequate water supply and electrolyte replacement,nutritional support,preventive antibiotics,pain relief,and itching relief.The surgical treatment of OJ depends on the cause,location,and severity of the obstruction.Biliary drainage,surgery,and endoscopic intervention are potential treatment options depending on the patient's condition.In addition to modern medical treatments,Traditional Chinese medicine may offer therapeutic benefits for OJ.A comprehensive search was conducted on PubMed for relevant articles published up to August 1970.This review discusses in detail the pathophysiological changes associated with OJ and presents effective strategies for managing the condition.
文摘Brain ischemic stroke is the leading cause of long-lasting injury,disability,and death in adults.Although the brain represents only about 2%of the total body mass,it consumes almost 20%of the body＇s oxygen.As a result,brain cells are extremely sensitive to hypoxia.Once cerebral ischemia occurs.
基金supported by the Medical Science and Technology Project of Zhejiang Province(No.2019KY584)Traditional Chinese Medicine Science and Technology Project of Zhejiang Province(No.2023ZL648).
文摘Objective To investigate the etiology,clinical characteristics,diagnosis,and treatment strategies and efficacy of pulsatile tinnitus(PT)caused by vascular anatomy abnormality.Methods The clinical data of 45 patients with PT in our hospital from 2012 to 2019 were collected and retrospectively analyzed.Results All 45 patients had vascular anatomical abnormalities.The patients were divided into 10 categories according to the different locations of vascular abnormalities:sigmoid sinus diverticulum(SSD),sigmoid sinus wall dehiscence(SSWD),SSWD with high jugular bulb,pure dilated mastoid emissary vein,aberrant internal carotid artery(ICA)in the middle ear,transverse-sigmoid sinus(TSS)transition stenosis,TSS transition stenosis with SSD,persistent occipital sinus stenosis,petrous segment stenosis of ICA,and dural arteriovenous fistula.All patients complained of PT synchronous with heartbeat rhythm.Endovascular interventional therapy and extravascular open surgery were used according to the location of the vascular lesions.Tinnitus disappeared in 41 patients,was significantly relieved in 3 patients,and was unchanged in 1 patient postoperatively.Except for one patient with transient headache postoperatively,no obvious complications occurred.Conclusion PT caused by vascular anatomy abnormalities can be identified by detailed medical history and physical and imaging examination.PT can be relieved or even completely alleviated after appropriate surgical treatments.
基金funded by grants from the Alberta Prion Research Institutethe Alzheimer Society of Alberta and Northwest Territories+2 种基金the Natural Sciences and Engineering Research Council(NSERC)of Canadasupported by the Canada Research Chair programa postdoctoral fellowship from the German Research Foundation(DFG)
文摘Despite intensive research,most neurodegenerative diseases cannot be cured and for some of them no treatment is available to increase survival or quality of life.Among the latter are prion diseases,fatal and transmissible neurodegenerative diseases of humans and other animals.
文摘In this editorial,we highlight the significance of a retrospective study“Analysis of the impact of immunotherapy efficacy and safety in patients with gastric cancer and liver metastasis”performed by Liu et al.The authors utilized data collected from gastric cancer(GC)patients and assessed immunotherapy effectiveness and survival status.They found significant differences in treatment response.Because immunotherapy seems to be a beneficial strategy for advanced GC patients,strati-fication of the data based on metastasis status may further improve treatment strategies.
文摘<strong>Objective: </strong>The purpose is to formulate treatment strategies of batches of the wounded and partial first-aid procedures, and further improve the emergency rescue capability of hospitals. <strong>Methods: </strong>This study analyzed the emergency treatment case that we participated in. In this case, we used various means to start the emergency plan, run the emergency procedures, optimize diagnosis, treatment, and rescue procedures, mobilize medical rescue resources, provide a reference for emergency command decisions, formulate a set of coping strategies of tertiary general hospitals on public emergencies. <strong>Results:</strong> Through the scientific and effective management of our hospital, 20 wounded have been discharged from the hospital and achieved the ideal effect of zero deaths in the hospital. <strong>Conclusions:</strong> The new mode of first-aid and health emergency management on the scene of modern disaster needs to find ways to minimize the loss of life and property brought by public emergencies, integrate the various sections of modern disaster medicine, integrate a large number of international and domestic basic and clinical research achievements of disaster first-aid, and upgrade to information, digital system.
文摘<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Treatment strategy for recurrent hepatocellular carcinoma (HCC) remains scantily defined. This study was aimed to establish a treatment strategy to manage post-hepatectomy recurrent HCC and report the clinical outcomes. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">From January 2006 to December 2016, 556 consecutive patients who developed post-hepatectomy HCC recurrence were enrolled in the study. The patients were clinically stratified and treated according to a strategy established by a multi-disciplinary team. Clinical data and survival times were collected prospectively and analyzed retrospectively. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">According to the strategy, there were 298 (53.6%), 214 (38.5%), 32 (5.7%) and 12 (2.2%) patients stratified into Early, Intermediate, Advanced and Terminal stages, respectively. In Early stage patients, 164 (55.0%) received curative treatment in the form of repeat resection or local ablation, 134 (45.0%) received transarterial chemoe</span><span style="font-family:Verdana;">mbolization (TACE), and the 1-, 3-, and 5-year overall survival (OS) rates were 82.0%, 46.8% and 37.3%, respectively. In Intermediate stage patients, 207 (96.7%) received TACE, 7 (3.3%) radiotherapy, and the 1-, 3-, and 5-year OS rates were 73.2%, 31.8% and 15.9%, respectively. In Advanced stage patients, 22 patients received sorafenib, 10 radiotherapy, and the mean survival time (MST) was 25.1 ± 3.1 months. All the 12 patients in Terminal stage rece</span><span style="font-family:Verdana;">ived the best supportive treatment, and the MST was 6.5 ± 3.4 months. Clinical stages and duration of disease-free interval were independent factors relating to overall survival. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">A treatment strategy derived from the Barcelona Clinic Liver Cancer staging system, with some modifications, has been successfully established to manage post-hepatectomy recurrent HCC, and the clinical outcomes were commendable.</span></span></span></span>
文摘In this paper, a disease transmission model with two treatment stages is proposed and analyzed. The results indicate that the basic reproduction number is a critical threshold for the prevalence of the disease. If the basic reproduction number is less than one, the disease free equilibrium is globally asymptotically stable. Otherwise, the endemic equilibrium is globally asymptotically stable. Therefore, besides the basic reproduction number, a new marker for characterizing the seriousness of the disease, named as dynamical final infective size, is proposed, which differs from traditional final size because the proposed model includes the natural birth and death. Finally, optimization strategies for limited medical resources are obtained from the perspectives of basic reproduction number and dynamical final infective size, and the real-world disease management scenarios are given based on these finding.
文摘Objective To investigate treatment strategy of intracranial arachnoid cysts. Methods 47 cases of Intracranial arachnoid cysts from Sep 1,2010 to Des 1,2010 were analyzed. 25 cases received no intervention but follow . 22 cases received operation,13 of 22 cases neuroendoscopic partial cystectomy and communication between cystic cavity and brain cistern; 7 of 22 cases cysts peritoneal shunt, 2 of 22
文摘1 Identify underlying diseases (Table 1),active treatment and seeks to eradicate.Even if the cause of the same,each trying to individualized treatment of patients.Such as pneumococcal sepsis and DIC,the prognosis of young people and the elderly is different from primary and secondary immune deficiencies are different treatment options.
基金Supported by Special Project of Scientific Research of Capital Health Development(No.2022-1-4171)。
文摘Objective:To establish the dynamic treatment strategy of Chinese medicine(CM)for metastatic colorectal cancer(mCRC)by machine learning algorithm,in order to provide a reference for the selection of CM treatment strategies for mCRC.Methods:From the outpatient cases of mCRC in the Department of Oncology at Xiyuan Hospital,China Academy of Chinese Medical Sciences,197 cases that met the inclusion criteria were screened.According to different CM intervention strategies,the patients were divided into 3 groups:CM treatment alone,equal emphasis on Chinese and Western medicine treatment(CM combined with local treatment of tumors,oral chemotherapy,or targeted drugs),and CM assisted Western medicine treatment(CM combined with intravenous regimen of Western medicine).The survival time of patients undergoing CM intervention was taken as the final evaluation index.Factors affecting the choice of CM intervention scheme were screened as decision variables.The dynamic CM intervention and treatment strategy for mCRC was explored based on the cost-sensitive classification learning algorithm for survival(CSCLSurv).Patients'survival was estimated using the Kaplan-Meier method,and the survival time of patients who received the model-recommended treatment plan were compared with those who received actual treatment plan.Results:Using the survival time of patients undergoing CM intervention as the evaluation index,a dynamic CM intervention therapy strategy for mCRC was established based on CSCLSurv.Different CM intervention strategies for mCRC can be selected according to dynamic decision variables,such as gender,age,Eastern Cooperative Oncology Group score,tumor site,metastatic site,genotyping,and the stage of Western medicine treatment at the patient's first visit.The median survival time of patients who received the model-recommended treatment plan was 35 months,while those who receive the actual treatment plan was 26.0 months(P=0.06).Conclusions:The dynamic treatment strategy of CM,based on CSCLSurv for mCRC,plays a certain role in providing clinical hints in CM.It can be further improved in future prospective studies with larger sample sizes.
文摘Background A hepatic adverse event(HAE)is defined as a liver injury that occurs following immune checkpoint inhibitor(ICI)administration in oncology Patients.Immune-mediated hepatotoxicity(IMH)is a type of HAE directly caused by ICI and is associated with immune system hyperactivation.HAE incidence varies across different clinical studies.This study aimed to explore the risk factors of HAE and establish a personalized IMH treatment strategy.Methods Randomized controlled trials(RCTs)on ICIs and case reports related to IMH were collected and summarized separately.Meta-analysis was performed using Review Manager(version 5.0),whereas correlation analysis and linear regression were performed using SPSS(version 24.0)to evaluate any correlations between the two variables.Results Overall,36 RCTs containing 18,515 patients and 39 case reports met our inclusion criteria.The ICI administration increased the HAE risk(risk ratio[RR]=1.40)as well as severe HAE(RR=2.55).The overall HAE incidence and severe incidence were about 15.3%and 4.3%,respectively.Cytotoxic T-lymphocyte-associated protein 4(CTLA-4)inhibitors have a higher incidence of HAE than programmed cell death protein 1(PD-1)and programmed death-ligand 1(PD-L1)inhibitors.Finally,we found a positive correlation between the onset time of IMH and the recovery time of liver injury.Conclusions ICI administration increased the incidence risk of HAE,especially in patients treated with CTLA-4 inhibitors.Regarding IMH treatment,the glucocorticoid dosage must be individually reduced according to the severity and onset time of HAE.
文摘This case reports a 63-year-old male patient who was admitted to the hospital due to the discovery of sigmoid colon protrusion during physical examination.EUS indicated submucosal lesions,and lymphangioma was initially considered.Colonoscopy revealed a 0-Is+Ⅱc type protrusion,with a smooth surface and visible dendritic vessels.The biopsy was tough.Auxiliary imaging showed no distant metastasis or obvious organ damage,and the laboratory test results were normal.The pathological confirmation after submucosal dissection was non-Hodgkin's small B-cell lymphoma(MALT lymphoma).Combining imaging,pathological and immunohistochemical analyses,this case emphasizes the precise sampling and classification strategy for submucosal masses in the digestive tract,suggesting that endoscopic biopsy is difficult to fully reflect submucosal infiltration and should be supplemented by EUS and large tissue sampling.In terms of treatment,based on the local lesion,pathological classification and the patient's overall condition,a strategy combining endoscopic dissection and subsequent chemotherapy is selected to achieve a balance between local control and systemic intervention.
基金supported by grants 15-04-07527(AAR) and 16-34-60101(YOM) from Russian Foundation for Basic Researchsupported by a Presidential Grant for government support of young scientists(PhD) from the Russian Federation(MK-4020.2015.7)+1 种基金performed in accordance with Program of Competitive Growth of Kazan Federal Universitya subsidy allocated to Kazan Federal University for the state assignment in the sphere of scientific activities
文摘Spinal cord injury （SCI） continues to be a pressing health and social problem. The injury leads to neuronal and glial cell death accompanied by degeneration of nerve fibers. There are currently no particularly effective treatments. SCI causes profound disabil- ity of people affected and has attracted increased attention in the international field of neuroregeneration. For the past two decades, much hope has been placed in cell therapies for the restoration of both structure and function of the injured spinal cord. Embryonic and neural stem cells, olfactory ensheathing cells, microglia-like cells, Schwann cells, mesenchymal stem cells.
文摘Traumatic injuries to the central nervous system （CNS）, in- cluding traumatic brain injury （TBI） and spinal cord injury （SCI）, often involve an immediate mechanical damage to plas- ma membrane that surrounds neuronal sornata and axons. This initial disruption of plasma membrane following injuries has been convincingly demonstrated by increased membrane permeability to large molecules and dyes that are normally inaccessible to cellular plasma （Farkas et al., 2006; Cho and Borgens, 2012）. Further evidence comes from experiments that showed ultra-structural changes of plasma membranes, axons, and organelles, and subsequent neuronal death and axotomy （Povlishock and Pettus, 1996; Whalen et al., 2008）.
基金supported by“Major special projects in the 13th five-year plan”(Grant No.2016YFC1301800)
文摘Cranial hemophilic pseudotumor(cHPT)is a very rare disease,which is easy to misdiagnose.It is also difficult to manage such patients.We reported the first case of occipital cHPT.Case presentation:Here,we presented a rare case of an occipital bone mass in a 3-year-old boy who was diagnosed with hemophilia A.The mass was misdiagnosed as an aneurysmal bone cyst by pathological examination.After resection,the patient underwent one-stage cranioplasty.However,the patient was admitted again for hematoma caused by an invasive procedure.A second surgery and one-stage cranioplasty were performed at the same time.A follow-up 3 months after discharging showed the patient was uneventful,and the titanium mesh was well fixed.Conclusion:The diagnosis of cHPT requires the combining of history,radiological examination,and pathological examination.Resection is the best choice for symptomatic cHPT.Replacement treatment and less invasive treatment can make perioperative management safer.One-stage cranioplasty for resection of an occipital cHPT can improve the quality of life.
文摘In this editorial we examine the article by Wu et al published in the World Journal of Gastrointestinal Oncology.Surgical resection for peritoneal metastases from colorectal cancer(CRC)has been gradually accepted in the medical oncology community.A randomized trial(PRODIGE 7)on cytoreductive surgery(CRS)with hyperthermic intraperitoneal chemotherapy(HIPEC)failed to prove any benefit of oxaliplatin in the overall survival of patients with peritoneal metastases from colorectal origin.Nevertheless,isolated systemic chemotherapy for CRC stage IV has demonstrated a reduced response in peritoneal metastases than that obtained in other metastatic sites such as the liver.Another tool is required in those patients to achieve more local control of the disease.Surgical groups in peritoneal surgery continue to use HIPEC in their procedures,using other agents than oxaliplatin for peritoneal cavity infusion,such as mitomycin C.These patients present with complex surgical issues to manage,and consequently a large burden of complications has to be anticipated.Therefore,identifying patients who will benefit from CRS with or without HIPEC would be of great interest.
文摘Parkinson’s disease （PD） is caused by progressive degeneration of dopamine （DA） neurons in the substantia nigra pars compacta （SNpc）, resulting in the deficiency of DA in the striatum. Thus, symptoms are developed, such as akinesia, rigidity and tremor. The aetiology of neuronal death in PD still remains unclear. Several possible mechanisms of the degeneration of dopaminergic neurons are still elusive. Various mechanisms of neuronal degeneration in PD have been proposed, including formation of free radicals, oxidative stress, mitochondrial dysfunction, excitotoxicity, calcium cytotoxicity, trophic factor deficiency, inflammatory processes, genetic factors, environmental factors, toxic action of nitric oxide, and apoptosis. All these factors interact with each other, inducing a vicious cycle of toxicity causing neuronal dysfunction, atrophy and finally cell death. Considerable evidence suggests that free radicals and oxidative stress may play key roles in the pathogenesis of PD. However, currently, drug therapy cannot completely cure the disease. DA replacement therapy with levodopa （L-Dopa）, although still being a gold standard for symptomatic treatment of PD, only alleviates the clinical symptoms. Furthermore, patients usually experience severe side effects several years after the L-Dopa treatment. Until now, no therapy is available to stop or at least slow down the neurodegeneration in patients. Therefore, efforts are made not only to improve the effect of L-Dopa treatment for PD, but also to investigate new drugs with both antiparkinsonian and neuroprotective effects. Here, the advantages and limitations of current and future therapies for PD were dicussed. Current therapies include dopaminergic therapy, DA agonists, MAO-B inhibitor, COMT inhibitors, anticholinergic drugs, surgical procedures such as pallidotomy and more specifically deep brain stimulation of the globus pallidus pars interna （GPi） or subthalamic nucleus （STN）, and stem cell transplantation.
基金Supported by the Project of Guizhou Provincial Department of Science and Technology,No.Qian Ke He Cheng Guo-LC[2024]109.
文摘The incidence of colorectal cancer is gradually increasing,and a majority of patients are diagnosed with distant metastases at the time of initial diagnosis,with the liver being the most common site of metastasis.Unlike most malignant tumors,patients with distant metastases can still achieve favorable prognoses if both the primary tumor and liver metastases are surgically resected.With ad-vances in systemic therapies,many patients with initially unresectable liver me-tastases from colorectal cancer can undergo systemic treatment to achieve con-version therapy,thereby gaining the opportunity for surgery.However,there is still no consensus on several issues,including the timing of systemic therapy before and after surgery,whether neoadjuvant therapy should be employed,and the choice between simultaneous or staged surgeries.This review aims to system-atically describe the current treatment landscape for colorectal cancer with liver metastases and highlight several unresolved controversial issues,providing valuable insights for the diagnosis and treatment of colorectal liver metastases.
