Disparities in Survival Outcomes Between Locally Advanced Cervical Squamous Cell Carcinoma and Adenocarcinoma Treated with Chemoradiotherapy.

Purpose: To determine the disparities in survival outcomes between stage IIB-IVA cervical squamous cell carcinoma (SCC) and adenocarcinoma (AC) treated with chemoradiotherapy. Methods: Patients diagnosed between 2004 and 2015 were retrospectively included from the Surveillance, Epidemiology, and End Results databases. Propensity score matching (PSM) was used in this study. The primary endpoints were cervical cancer-specific survival (CCSS) and overall survival (OS). Results: A total of 2752 patients were identified, including 87.5% (n=2408) were SCC and 12.5% (n=344) were AC. Patients with AC had inferior 5-year CCSS (67.5% vs 54.8%, P<0.001) and OS (58.4% vs 47.2%, P<0.001) compared to those with the SCC subtype. The hazard curve of cervical cancer-related death in AC peaked at 2 years (19%) and still small peaks in the 7 and 11 years of follow-up. Regarding SCC, cervical cancer-related deaths peaked at 2 years (15%) and the hazard rate was 2.0% during the six years of follow-up. The multivariate Cox regression analyses indicated that histology was an independent prognostic factor associated with survival outcomes. Patients with AC had significantly poor CCSS (P<0.001) and OS (P<0.001). Similar results were found after PSM. Conclusion: Our study demonstrates a significantly better prognosis for cervical SCC patients compared to those with cervical AC undergoing chemoradiotherapy. These results highlight the importance of histological subtyping in predicting treatment outcomes and tailoring therapeutic strategies.

[Early assessment of severe hypoxic-ischemic encephalopathy in neonates by diffusion-weighted magnetic resonance imaging techniques and its significance].

OBJECTIVE: Hypoxic-ischemic encephalopathy (HIE) is an important cause of morbidity and mortality in the neonates. Early and accurate diagnosis is helpful not only for assessing prognosis but also for making treatment decisions. The aim of this study was to explore the value of early assessment of HIE by applying the diffusion-weighted imaging (DWI) in acute (within 72 hours), subacute or chronic stages of HIE in comparison to conventional magnetic resonance imaging (MRI) in clinical practice. METHODS: Images and clinical charts of fourteen term neonates with clinically diagnosed severe hypoxic-ischemic encephalopathy treated in the NICU from January 2006 to February 2007 were retrospectively reviewed. Inclusion criteria were: term infant (37 approximately 42 weeks) and high clinical suspicion of severe HIE (low Apgar scores, need for resuscitation, metabolic acidosis, acute encephalopathy (eg, hypotonia, coma, seizures). All examinations were performed on a 3.0-T MRI system (Philips Intera Acheva Magnetom Vision) with echo-planar imaging capability with the use of a standard protocol. The imaging protocol for all the patients contained diffuse weighted images (EPI-SE, TR = 2144 ms, TE = 56 ms), T1-weighted images (TR = 389 ms; TE = 15 ms; slice thickness = 4 mm) as well as T2-weighted images (TR = 3035 ms; TE = 100 ms; slice thickness = 4 mm). The studies were first performed within 72 hours of life in these 14 consecutive patients, including both standard T1, T2-weighted image and DWI; follow-up MR studies were performed for 4 patients at the ages of 7 days, for 4 at 14 days, for another 3 at ages of both 21 days and 8 months. RESULTS: First inspection (on an average of 48 hours after birth): routine T1, T2-weighted images showed normal images in all patients, while diffusion images showed symmetric high intensity signal in the lateral thalami and posterior limbs of internal capsules (PLIC). Following up: on day 7, routine MRI showed both symmetric T1 prolongation and T2 slightly shortening in lateral thalami, DWI showed abnormal high signal intensity in bilateral basal ganglion (mainly in the back site of lentiform nuclei, putamen) and the cortex around central sulcus, but the previous hyperintensity in lateral thalami and PLIC disappeared. On day 14, routine MRI showed symmetric T1 prolongation, T2 shortening in bilateral thalami, lentiform nuclei and cortex around central sulus. On day 21, routine MRI showed T1 prolongation, T2 shortening in bilateral thalami and basal ganglion while previously obvious PLIC disappeared, whereas DWI showed normal images. Eight months later, deeper cerebral sulus, dilation of ventricles and widening of extracerebral space were shown. CONCLUSION: Diffusion-weighted imaging has proved more sensitive than conventional MR imaging sequences in detecting acute cerebral infarction in adult subjects. DWI is proposed as a method for early detection of hypoxic-ischemic brain injury. In this study, DWI showed the same focus (lateral thalami and PLIC) and similar extent of the injury in these severe HIE patients in the early stage after birth (in 72 hours). The sites which showed hyperintensive signals in DWI were consistent with the foci in subsequent follow-up by routine MRI. Thus, DWI is supposed to be a technique for early assessment of the extent of hypoxic-ischemic brain injury and the prognosis in clinic. Though DWI is superior to the other imaging modalities in detecting ischemia, diffusion restriction is not necessarily indicative of permanent damage. The abnormal image on DWI may not last long. However, in chronic stage, the follow-up conventional MRI may compensate the inadequacy of DWI.

Comparison of low-molecular-weight-heparin and unfractionated heparin for acute PTE.

OBJECTIVE: Acute pulmonary thromboembolism (PTE) is a serious high mortality pulmonary vascular disease whose effective treatment decreases morbidity and mortality. To determine if low-molecular-weight-heparin (LMWH) is clinically as efficient and safe as unfractionated heparin (UH) in patients with diagnosis of acute non-massive PTE, our study compares the efficacy, adverse effects and costs of LMWH and UH. METHODS: One hundred and fourteen patients with non-massive acute PTE were randomly divided into LMWH (nadroparin calcium) and UH groups. Oxygenation index, D-dimer, fibrinogen (FG), lung ventilation/perfusion (V/Q) scan and computed tomography pulmonary angiography (CTPA) were observed before anticoagulation and on day 14 after anticoagulation. RESULTS: In both groups, the ABG (arterial blood gas) analysis showed PaO(2) and PaCO(2) were elevated, P(A-a)O(2) was decreased and oxygenation index (PaO(2)/FIO(2)) was elevated, D-dimer and fibrinogen were decreased, lung V/Q and CTPA showed embolized segments reduced (P<0.05). Hemorrhage and thrombocytopenia occurred in 3.5% of the LMWH group. Hemorrhage occurred in 5.3% and thrombocytopenia occurred in 7.0% of the UH group. The average cost in the LMWH group was RMB 1218.60 Yuan and RMB 1541.40 Yuan in the UH group. CONCLUSION: LMWH and UH are equally effective for treatment of non-massive acute PTE, but LMWH may have a lower prevalence of complications and is less expensive.