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OBJECTIVE@#Neoadjuvant chemotherapy (NACT) for the treatment of epithelial ovarian cancer (EOC) has remained controversial. This meta-analysis was performed to systematically assess the efficacy and safety of NACT versus primary debulking surgery (PDS) in patients with EOC.@*METHODS@#PubMed, Embase, ClinicalTrials.gov, and Cochrane Library were queried to assess the therapeutic value of NACT versus PDS in EOC. Electronic databases were queried by using the keywords “ovarian cancereoplasmsâ€, “primary debulking surgeryâ€, and “neoadjuvant chemotherapyâ€.@*RESULTS@#The available trials were pooled, and hazard ratios (HRs), relative risk ratios (RRs) and associated 95% confidence intervals (95% CIs) were determined. Sixteen trials involving 57,450 participants with EOC (NACT, 9,475; PDS, 47,975) were evaluated. We found that NACT resulted in markedly decreased overall survival than PDS in patients with EOC (HR=1.30; 95% CI=1.13–1.49; heterogeneity: p<0.001, ²=82.7%). Furthermore, our results demonstrated that the NACT group displayed increased completeness of debulking removal (RR=1.69, 95% CI=1.32–2.17; heterogeneity: p<0.001, ²=81.9%), and reduced risk of postsurgical death (RR=0.18, 95% CI=0.06–0.51; heterogeneity: p=0.698, ²=0%) and major infection (RR=0.29, 95% CI=0.17–0.51; heterogeneity: p=0.777, ²=0%) compared with patients administered PDS.@*CONCLUSIONS@#This meta-analysis indicated that NACT results in increased completeness of debulking removal, and reduced risk of postsurgical death and major infection compared with PDS, while PDS is associated with improved survival in comparison with NACT in EOC patients.TRIAL REGISTRATION: PROSPERO Identifier: CRD42019120625
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OBJECTIVE: Neoadjuvant chemotherapy (NACT) for the treatment of epithelial ovarian cancer (EOC) has remained controversial. This meta-analysis was performed to systematically assess the efficacy and safety of NACT versus primary debulking surgery (PDS) in patients with EOC.METHODS: PubMed, Embase, ClinicalTrials.gov, and Cochrane Library were queried to assess the therapeutic value of NACT versus PDS in EOC. Electronic databases were queried by using the keywords “ovarian cancer/neoplasms”, “primary debulking surgery”, and “neoadjuvant chemotherapy”.RESULTS: The available trials were pooled, and hazard ratios (HRs), relative risk ratios (RRs) and associated 95% confidence intervals (95% CIs) were determined. Sixteen trials involving 57,450 participants with EOC (NACT, 9,475; PDS, 47,975) were evaluated. We found that NACT resulted in markedly decreased overall survival than PDS in patients with EOC (HR=1.30; 95% CI=1.13–1.49; heterogeneity: p<0.001, ²=82.7%). Furthermore, our results demonstrated that the NACT group displayed increased completeness of debulking removal (RR=1.69, 95% CI=1.32–2.17; heterogeneity: p<0.001, ²=81.9%), and reduced risk of postsurgical death (RR=0.18, 95% CI=0.06–0.51; heterogeneity: p=0.698, ²=0%) and major infection (RR=0.29, 95% CI=0.17–0.51; heterogeneity: p=0.777, ²=0%) compared with patients administered PDS.CONCLUSIONS: This meta-analysis indicated that NACT results in increased completeness of debulking removal, and reduced risk of postsurgical death and major infection compared with PDS, while PDS is associated with improved survival in comparison with NACT in EOC patients.TRIAL REGISTRATION: PROSPERO Identifier: CRD42019120625
Subject(s)
Humans , Cytoreduction Surgical Procedures , Drug Therapy , Neoadjuvant Therapy , Odds Ratio , Ovarian Neoplasms , Population CharacteristicsABSTRACT
Objective To observe HRCT features of cochlear aqueduct (CA) in normal infants,and to explore the differences of CA diameters between sensorineural hearing loss (SNHL) infants and normal infants.Methods Totally temporal bone HRCT data of 129 infants without abnormal hearing (258 ears) were taken as control group,while temporal bone CT data of 58 infants (116 ears) diagnosed as sensorineural hearing loss (SNHL) with normal inner ear structure were collected as SNHL group.Infants in both 2 groups were divided into 1-year,2-year and 3-year subgroups.The width of external aperture and length of CA were measured,and the results were statistically analyzed.Results In normal group,CA diameters and the width of external aperture had no statistical differences between sides and genders (both P＞0.05).There was no statistical difference of CA diameters between the same subgroup in 2 groups (t=0.160,0.979,0.432,all P＞0.05),but the width of CA external aperture in subgroups of SNHL group was smaller than those of normal group (t=3.722,3.101,3.336,all P＜0.01).Conclusion The length of CA and width of external aperture increase with age,and there may be relationship between smaller width of CA external aperture and SNHL.
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Objective To analyze the diagnostic value of parameters derived from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and dynamic contrast-enhanced MRI (DCE-MRI) in cervical cancer and to explore the correlation of parameters between DCE-MRI and IVIM-DWI.Methods MRI data of 30 patients with cervical cancer confirmed by surgical pathology and 26 patients with normal cervix confirmed by clinical or MRI examination were analyzed retrospectively.All patients underwent IVIM-DWI and DCE-MRI.The IVIM-DWI was performed to calculate the values of ADC,D,D* and f.The values of Ktrans,Kep and Ve were measured on DCE-MRI.All parameters between cervical cancer and normal cervix were compared by two independent sample t-test.Diagnostic efficacy of these parameters in cervical cancer group was evaluated by using area under curve(AUC).The correlation of these parameters between IVIM-DWI and DCE-MRI was analyzed by Pearson correlation.Results The D*,f,Ktrans,Kep and Ve in cervical cancer were significantly higher than those in normal cervix.The ADC and D in cervical cancer were significantly lower than those in normal cervix.The differences of these parameters between the two groups were statistically significant (P ＜0.05).The AUC of Ktrans was the maximum (0.958),with diagnostic sensitivity of 86.7％ and specificity of 100％.F and K were positively correlated (r=0.446,P＜0.05).F and Kep were positively correlated (r=0.400,P＜0.05).Conclusion IVIM-DWI and DCE-MRI can improve the diagnostic value of cervical cancer.DCE-MRI has better diagnostic performance than IVIM-DWI.Significantly positive correlations were found between perfusion paramenters from IVIM-DWI and quantitative perfusion paramenters from DCE-MRI.
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Objective To explore the application of diffusion tensor imaging(DTI) in neonates with hypoxic ischemic encephalopathy(HIE).Methods 37 cases of full-term neonates diagnosed as HIE by pediatricians and 12 normal neonates were selected.All subjects underwent MRI and DTI at 3.0 Tesla.The correlation of FA value in posterior limb of internal capsule and neonatal NBNA score was examined.Results The FA values in posterior limb of internal capsule, splenium had significant difference between the HIE group (mild group, moderate group, severe group) and control group (P0.05).The FA in posterior limb of internal capsule and NBNA score(12-14 d;26-28 d)showed significant correlation (r=0.96,P<0.05),as well as the sequelae shape (r=0.87,P<0.05).Conclusion DTI is promising for early diagnosis of anisotropic index changes to evaluate HIE brain damage and prognosis.
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Objective To discuss the role of MRI in diagnosis and for the placenta previa and implantation presented negative in ultrasound.Methods Patients of placenta previa without placenta implantation confirmed by ultrasound were analyzed retrospectively.The patients were divided into A and B groups according to different treatment stages.A group underwent uterine segment cesarean section directly without MRI.B group underwent MRI scan first.And the MRI positive patients (B1 group) got abdominal aortic balloon temporarily block technique combined with the lower uterine segment cesarean section,if necessary,uterine artery embolization.The negative ones (B2 group) got uterine segment cesarean section directly.The placenta implantation was diagnosed by operation and (or) pathology.The maternal blood loss and hysterectomy rate between A and B group were compared.Results The sensitivity and specificity of MRI scan in placenta implantation was 0.75 and 0.916.The blood loss showed significant difference (P＜0.001).Hysterectomy rates presented no significant difference (P＞0.05).Conclusion When the ultrasound only showed placenta previa without implantation,the further test of MRI scan could detect the placenta implantation patients.After diagnosed by MRI,obstetrics and gynecology jointly intervene could effectively reduce the blood loss,or reduce the rate of hysterectomy.