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OBJECTIVE: To present the surgical outcomes of advanced epithelial ovarian cancer (AEOC) since the implementation of a personalized approach and to validate multiple predictive models for R0 resection. METHODS: Personalized strategies included: 1) Non-invasive model: preoperative clinico-radiological assessment according to Suidan criteria with a predictive score for all individuals. Patients with a score 0–2 were recommended for primary debulking surgery (PDS, group A), or otherwise were counseled on the choices of PDS, neoadjuvant chemotherapy (NAC, group B) or staging laparoscopy (S-LPS). 2) Minimally invasive model: S-LPS with a predictive index value (PIV) according to Fagotti. Individuals with a PIV < 8 underwent PDS (group C) or otherwise received NAC (group D). Intraoperative assessment (with Eisenkop, peritoneal cancer index [PCI], and Aletti scores) and surgical results were prospectively collected. RESULTS: Between September 2015 and August 2017, 161 pathologically confirmed epithelial ovarian cancer patients were included. A total of 52 (32.3%) patients had a predictive score of 0–2, and 109 (67.7%) patients had a score ≥ 3. Among these individuals, 41 (25.5%) patients received S-LPS. Finally, 110 (68.3%) patients underwent PDS (A+C), and 51 (31.7%) patients received NAC (B+D). The R0 resection rates in PDS and NAC patients were 56.4% and 60.8%, respectively. The area under the curve (AUC) of Suidan criteria was 0.548 for group (A+C). The AUC of Fagotti score was 0.702 for group C. The AUC of Eisenkop, PCI, and Aletti scores were 0.808, 0.797, and 0.524, respectively. CONCLUSION: The Suidan criteria were not effective in these AEOC patients. S-LPS was helpful in decision-making for PDS and should be endorsed in the future.
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Humans , Area Under Curve , Cohort Studies , Drug Therapy , Laparoscopy , Ovarian Neoplasms , Prospective Studies , Research Design , TriageABSTRACT
Objective To explore the application effect of clinical nursing pathway on maintenance hemodialysis patients.Methods Totally 120 patients with maintenance hemodialysis between January 1 and December 31 2009 were randomly assigned to the control group and the observation group with 60 patients in each group.The clinical pathway was established and applied to the observation group.The treatment effect was compared between two groups.Results The incidence of complications and nursing errors declined with the application of clinical nursing pathway,and the doctor's orders compliance and the satisfaction and quality of care were improved significantly.Conelusions The application of clinical nursing pathway in maintenance hemodialysis patients is an effective method for improving overall care quality and the satisfaction degree of the patients with nursing,so as to improve their survival rate.
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Objective To discuss the values of three screening methods for the detection of early breast cancer,and to analyze the features of the screening cancer.Methods The first screening of breast cancer were performed in 5307 women who aged from 20 to 76 years with median age of 49 years.The three screening methods included physical examination with ultrasound and mammography,physical examination with mammography and mammography only.The rate of recall,biopsy,cancer detection of three methods were analyzed and the mammographic findings were reviewed Chi-square test or Fisher's exact test were used for the statistics.Results The recall rates were 4.90% (49/1001),6.90%(166/2407)and 4.48% (85/1899) in three methods respectively,the biopsy rates were 1.60% (16/1001),1.04% (25/2407) and 0.63%(12/1899),the cancer detection rates were 0.50% (5/1001),0.17% (4/2407) and 0 (0/1899).There were statistical differences among the three groups (X2=12.99,6.264,8.764,P < 0.05).Physical examination with ultrasound and mammnography had the highest cancer detection rate,ten breast cancers were detected and 8 were early stage breast cancer.Of seven cancers detected by mammography,only two were found by ultrasound.A cluster of calcifications were found in 2 cases,linear calcifications in 2 cases.One case presented as a asymmetric density,one as a asymmetric density with calcifications,one as multiple nodules with a duster of calcifications.Two breast cancers presented as asymmetric density were missed on mammography and diagnosed correctly after retrospective review.Conclusion Physical examination with ultrasound and mammography is the best method for breast cancer screening.The breast cancer can be detected by mammography earlier than other methods.
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OBJECTIVE To analyze the causes of unqualified medical appliance packs before sterilization and to find countermeasures in order to assure their quality,and to avoid emergence of hospital infection and medical tangles. METHODS Totally 320 packs were checked before sterilization from supply room and clinical departments from Jun 1,2004 to Mar 30,2005. RESULTS The rate of unqualified packs checked before sterilization was 14.12% including 460 medical apparatuses unqualified(21.70%). CONCLUSIONS To avoid the emergence of hospital infection and medical tangles,we should strengthen the work of supply room to realize the centralization of sterilization and supply,and make much of personnel′s professional training,normalize job′s process and quality criterion,and intensify professional and systematizing management of medical appliance purged and packed.
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Objective To evaluate the value of computed tomography(CT)in diagnosing abdominal tuberculosis.Methods CT features of abdominal tuberculosis proven histopathologically or by antituberculous therapy in 16 cases were retrospectively analysed.There were 8 men and 8 women,the age ranged from 20 to 66 years,mean age was 36.4 years.Results The most common CT features of abdominal tuberculosis were:lymphadenectasis(n=11),mesenteric masses(n=6),ascites(n=6,all were loculated),omental thickening(n=7),bowel wall thickening(n=6),pleural fluid(n=2),and pancreatic involvement(n=1).Tuberculous lymphadenosis(mainly the mesentery and peripancreatic lymph nodes involved)had typical CT findings including circular or multilocular enhancement,calcification of lymph nodes,abdominal lymph nodes involved more than that of retroperitoneum and peritonitis(high dense ascites,patchy or nodular lesions in the mesentery and omentum,and intestinal adhesion).Conclusion CT findings in combination with clinical symptoms and laboratory test can improve the diagnosis of abdominal tuberculosis.