Primary Surgery Followed by Selective Chemoradiotherapy Versus Preoperative Chemoradiotherapy Followed by Surgery for Locally Advanced Rectal Cancer: A Randomized Clinical Trial.

PURPOSE: The aim of this work was to determine whether locally advanced rectal cancer (LARC) with negative mesorectal fascia (MRF) predicted by magnetic resonance imaging (MRI) can be excluded from preoperative radiation therapy treatment. METHODS AND MATERIALS: This multicenter, open-label, non-inferiority, randomized clinical trial enrolled patients with LARC within 6 to 12 cm from the anal verge and with negative MRI-predicted MRF. Participants were randomized to the intervention group (primary surgery, in which the patients with positive pathologic [CRM] circumferential margins were subjected to chemoradiotherapy [CRT] and those with negative CRM underwent adjuvant chemotherapy according to pathologic staging) or the control group (preoperative CRT, in which all patients underwent subsequent surgery and adjuvant chemotherapy). The primary endpoint was 3-year disease-free survival (DFS). RESULTS: A total of 275 patients were randomly assigned to the intervention (n = 140) and control (n = 135) groups, in which 33.57% and 28.15% patients were at clinical T4 stage and 85.92% and 80.45% patients were at "bad" or "ugly" risk in the intervention and control groups, respectively. There were 2 patients (1.52%) and 1 patient (0.77%) with positive CRM in the intervention and control groups, respectively (P > .05). The non-adherence rates for the intervention and control groups were 3.6% and 23.7%, respectively. After a median follow-up of 34.6 months (IQR, 18.2-45.7), 43 patients had positive events (28 patients and 15 patients in the intervention and control groups, respectively). There were 6 patients (4.4%) with local recurrence in the intervention group and none in the control group, which led to the termination of the trial. The 3-year DFS rate was 81.82% in the intervention group (95% CI, 78.18%-85.46%) and 85.37% in the control group (95% CI, 81.75%-88.99%), with a difference of -3.55% (95% CI, -3.71% to -3.39%; hazard ratio, 1.76; 95% CI, 0.94-3.30). In the per-protocol data set, the difference between 3-year DFS rates was -5.44% (95% CI, -5.63% to -5.25%; hazard ratio, 2.02; 95% CI, 1.01-4.06). CONCLUSIONS: Based on the outcomes of this trial, in patients with LARC and MRI-negative MRF, primary surgery could negatively influence their DFS rates. Therefore, primary surgery was an inferior strategy compared with preoperative CRT followed by surgery and cannot be recommended for patients with LARC.

[Therapeutic effect of chlorhexidine combined with mechanical debridement on peri-implantitis and its influence on patients' SF-36 score].

PURPOSE: To study the effect of chlorhexidine combined with mechanical debridement on peri-implant inflammation and the influence on SF-36 score of patients. METHODS: One hundred patients with peri-implantitis admitted to Zhejiang Provincial People's Hospital from January 2015 to January 2019 were selected and randomly divided into control group and combined group with 50 cases in each group according to random number table method.Patients in both groups were treated with mechanical debridement, and patients in the combined group were gargled with chlorhexidine gargle apart from mechanical debridement. Plaque biofilm average activity and modified plaque index (mPLI), bleeding on probing (BOP), modified sulcus bleeding index (mSBI), probing the depth (PPD), clinical attachment level(AL) were measured before and after treatment. Sf-36 scale and VAS visual pain score were used to evaluate the quality of life and pain degree of patients, and the therapeutic effect and incidence of complications were assessed. The data were analyzed with SPSS 20.0 software package. RESULTS: There was no significant difference in average activity, mPLI, mSBI, AL, PPD, BOP, VAS and SF-36 scores between the two groups before treatment(P>0.05); after treatment, the average activity, mPLI, mSBI, AL, PPD, BOP and VAS scores of plaque biofilm in the combined group were significantly lower than those of the control group, and the total effective rate of SF-36 score was significantly higher than that of the control group. The total effective rate of the combined group was significantly higher than that of the control group(P<0.05). The incidence of complications in the combined group was significantly lower than that in the control group(P<0.05). CONCLUSIONS: Chlorhexidine combined with mechanical debridement is an effective treatment of peri-implantitis, which can effectively inhibit plaque biofilm activity and plaque formation, alleviate pain and improve the quality of life of patients.

[Analysis of factors affecting soft tissue infection after oral and maxillofacial debridement].

PURPOSE: To explore the factors affecting soft tissue infection after oral and maxillofacial debridement. METHODS: Fifty hundred patients with debridement were enrolled in this study from January 2013 to June 2016. The patients were divided into 2 groups according to soft tissue infection, 18 cases in infection group and 482 cases in non-infection group. Age, mean time to surgery, average length of stay, duration of antibiotics use, abbreviated injury scale (AIS), combined injuries, maxillofacial fractures, soft tissue injury, type of fracture, and history of diabetes were recorded and analyzed using SPSS 19.0 software package. RESULTS: The factors influencing soft tissue infection after oral and maxillofacial surgery were the aged, longer hospital stay, longer operation time, longer antibiotics use time, higher AIS score, Jaw bone injury and diabetes. CONCLUSIONS: The factors influencing soft tissue infection after oral and maxillofacial debridement are various. The aged, longer operation time, higher AIS score, jaw bone involvement lip and chin injury as well as diabetes might be the independent factors. Health care providers should give preventive measures to reduce the incidence of infection, according to specific factors.

Giant cell tumor of the tendon sheath: Magnetic resonance imaging findings in 38 patients.

The present study aimed to investigate the value of magnetic resonance imaging (MRI) in the diagnosis of giant cell tumor of the tendon sheath (GCTTS), including localized (L-) and diffuse (D-) types. A total of 38 patients with GCTTS, including 31 with L-GCTTS and 7 with D-GCTTS, diagnosed by surgery and pathology, were retrospectively analyzed. All patients underwent MRI examination. Of the 31 patients with L-GCTTS, the tumors were located in the hand and wrist (18 patients), the ankle and foot (10 cases), the knee joint (2 cases) and the temporomandibular joint (1 case). All 31 lesions were either located in relation to a tendon or were partially/completely enveloping it and all were well marginated. With respect to the 7 D-GCTTS patients, the tumors were located in the ankle and foot (6 cases) or the hand and wrist (1 cases). All 7 lesions presented as an aggressive soft tissue mass infiltrating the tendon sheath and adipose tissue around the joint. The characteristic internal signal of GCTTS, including L-GCTTS and D-GCTTS, was demonstrated by MRI examination. MRI is currently the optimal modality for preoperative assessment of tumor size, extent and invasion of adjacent joint and tenosynovial space.

Metachronous Primary Adenocarcinoma of Lung During Adjuvant Imatinib Mesylate Therapy for Gastrointestinal Stromal Tumor of Stomach: A Case Report.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in gastrointestinal tracts; however, the synchronous or metachronous coexistence of GIST with additional primary malignancy is not common.Here, we present an unusual case of gastric GIST with metachronous primary lung adenocarcinoma diagnosed during his adjuvant treatment with oral receptor tyrosine kinase inhibitor imatinib mesylate (400 mg daily). After 6-month use of imatinib, the patient suffered from dry cough and dyspnea. Subsequent lung biopsy demonstrated adenocarcinoma with diffuse interstitial changes.Our research emphasizes the possibility of an additional primary tumor with GIST, and reminds the clinicians to strengthen the surveillance of the additional cancer during the follow-up of GIST patients.

Use of digital subtraction angiography for assessment of digital replantation.

OBJECTIVE: To assess the blood flow of the proper digital artery using digital subtraction angiography (DSA) in the early stage after replantation. METHODS: From January 2006 to October 2010, 27 anastomosed arteries in 27 replanted digits were included in the study. The patients included nine males and four females. The patients received DSA at 48 to 96 h after digital replantation. Based on DSA image, the blood flow was classified into normal, slow-running, and flow-stopping types. The patients with normal digital blood flow were given continuous routine treatments; the patients with slow-running flow were given the conservative treatments, such as release of the tight dressings, removal of stitches, keeping warm, the use of massage, and the use of anticoagulants and anti-inflammatory drugs; the patients with flow-stopping received immediate surgical re-exploration. RESULTS: In this series, 23 digits in 11 patients showed a normal blood flow, and these digits all survived. In one of 13 patients, two digits which displayed slow-running flow also survived after conservative treatments. In two of 13 patients, two digits showed flow stopping, with one surviving and one failing after re-exploration and arterial revision. CONCLUSIONS: The DSA can be used to assess the blood flow of the proper digital artery in the early stage after replantation. It provides essential information for salvaging the replanted finger.

[Functional MR study of hepatic fibrosis].

The accurate diagnosis and staging of hepatic fibrosis is crucial for treatment and prognosis of liver disease. The current gold standard is liver biopsy, but it cannot be used in population-based screening, and has well known drawbacks if used for monitoring of disease progression or treatment results. Functional MR, as a non-invasive method, is increasingly used in hepatic fibrosis and became the current hot spot. Most recently available functional MR imaging techniques including diffusion weighted imaging, perfusion weighted imaging and MR spectroscopy can detect cirrhosis or fibrosis reasonably accurately. However, to date only MR elastography has been able to stage fibrosis or diagnose mild disease. MR diffusion weighted appears next most promising.

A large functional somatostatinoma in the pancreatic tail: atypical CT appearances.

Somatostatinomas are extremely rare endocrine tumors, and those with diameters above 2 cm are reported to increase the risk of metastasis significantly. We report a case of a large functional somatostatinoma in the pancreatic tail without metastases. A 46-year-old woman with a history of recurrent mild upper abdominal pain and diarrhea for 10 months was admitted to our hospital. Multiple-phase spiral computed tomography revealed a 10 cm x 8 cm, ill-defined, elliptic mass in the body and tail of the pancreas. There was a slightly heterogeneous enhancement on hepatic arterial phase and isodensity to the pancreatic parenchyma with small dotted necrosis within the middle region of the mass on hepatic portal venous and parenchymal phase, with patent splenic vein, dilated collaterals at the splenic hilum and no dilated pancreatic duct, resembling a diffuse infiltration tumor. To the best of our knowledge, this is the first description of multiple-phase spiral computed tomography findings of a functional somatostatinoma in the pancreatic tail and the largest thus far on reported computed tomography, with some differences compared with the previous reports.

Primary hepatic sarcomas: CT findings.

Primary hepatic sarcomas are rare tumors that are difficult to diagnose clinically. Different primary hepatic sarcomas may have different clinical, morphologic, and radiological features. In this pictorial review, we summarized computed tomography (CT) findings of some relatively common types of hepatic sarcomas, including angiosarcoma, epithelioid hemangioendothelioma (EHE), liposarcoma, undifferentiated embryonal sarcoma (UES), leiomyosarcoma, malignant fibrous histiocytoma (MFH), and carcinosarcoma (including cystadenocarcinosarcoma). To our knowledge, hepatic cystadenocarcinosarcoma has not been described in the English literature. The CT findings in our case are similar to that of cystadenocarcinoma, a huge, multilocular cystic mass with a large mural nodule and solid portion. The advent of CT has allowed earlier detection of primary hepatic sarcomas as well as more accurate diagnosis and characterization. In addition, we briefly discuss the MRI findings and diagnostic value of primary hepatic sarcomas.