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1.
BMC Surg ; 22(1): 338, 2022 Sep 12.
Artículo en Inglés | MEDLINE | ID: mdl-36096791

RESUMEN

OBJECTIVES: We report the 20-year experience of the largest Australian unit performing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer and reflect on learning opportunities. METHODS: A retrospective review of all cases of CRS for ovarian cancer at St George Peritonectomy Unit from Jan 1998 to Jan 2018 was performed. Prospectively collected data include age, stage, histology, disease extent (PCI), completeness of cytoreduction (CC score), HIPEC regime, 30-day surgical morbidity, disease recurrence, and death. Survival was computed using Kaplan-Meier method and analysed using log-rank tests and Cox-proportional hazards models. RESULTS: Forty-one women with advanced ovarian cancer (11 primary stage III/IV, 30 recurrent) underwent CRS, 29 (71%) with HIPEC. Most (68%) had high-volume disease (PCI > 15). In 98%, CC0/CC1 (residual < 2.5 mm) was achieved. Fourteen (34%) had grade 3/4 complications, 1 patient (2%) died within 30 days and 2 patients (5%) died within 90 days. Progression-free and median overall survival was 30.0 and 67.0 months for primary cancer, and 6.7 and 18.1 months for recurrent cancer. Survival was associated with platinum-sensitivity, PCI ≤ 15, and CC score 0, but not HIPEC. CONCLUSION: This study reports outcomes for patients with advanced ovarian cancer patients treated in an Australian centre offering CRS and HIPEC. Whilst survival and morbidity outcomes were good for primary disease, they were poorer than predicted from the literature for cases of recurrent disease. The incorporation of evidence-based predictors of survival and multidisciplinary input are essential to achieve the best survival outcomes.


Asunto(s)
Hipertermia Inducida , Neoplasias Ováricas , Neoplasias Peritoneales , Australia/epidemiología , Procedimientos Quirúrgicos de Citorreducción , Femenino , Humanos , Quimioterapia Intraperitoneal Hipertérmica , Recurrencia Local de Neoplasia/patología , Neoplasias Ováricas/terapia , Neoplasias Peritoneales/tratamiento farmacológico , Tasa de Supervivencia
3.
BMC Surg ; 22(1): 342, 2022 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-36115993

RESUMEN

PURPOSE: About 15%-40% of gastric cancer patients have peritoneal metastasis, which leads to poor prognosis. Hyperthermic intraperitoneal chemotherapy (HIPEC) is considered to be an effective treatment for these patients. This study evaluated the efficacy and safety of HIPEC in patients with gastric cancer diagnosed from laboratory tests. METHODS: The clinical and pathological data of 63 patients with gastric cancer who underwent HIPEC in 2017-2021 were prospectively recorded. Fifty-five patients underwent cytoreductive surgery + HIPEC, and eight patients received HIPEC alone. The factors associated with HIPEC safety and efficacy were analyzed. The primary endpoint was overall survival. RESULTS: The average patient age was 54.84 years and 68.3% of patients were male. Moreover, 79.4% of patients had a peritoneal carcinoma index (PCI) score of ≤ 7 and 61.9% had a completeness of cytoreduction score of 0. Because of peritoneal metastasis, 29 patients (46.03%) were classified as stage IV. Laboratory tests showed no differences in pre-HIPEC blood test results compared to post-HIPEC results after removing the effects of surgery. HIPEC treatment did not cause obvious liver or kidney damage. Serum calcium levels decreased significantly after HIPEC (P = 0.0018). The Karnofsky performance status (KPS) score correlated with the patient's physical function and improved after HIPEC (P = 0.0045). In coagulation tests, FDP (P < 0.0001) and D-dimer (P < 0.0001) levels increased significantly and CA242 (P = 0.0159), CA724 (P < 0.0001), and CEA (P < 0.0014) levels decreased significantly after HIPEC. Completeness of cytoreduction score was an independent prognostic factor. HIPEC did not show a survival benefit in patients with gastric cancer (P = 0.5505). CONCLUSION: HIPEC is a safe treatment for patients with gastric cancer with peritoneal metastasis based on the laboratory tests. However, the efficacy of this treatment on gastric-derived peritoneal metastases requires further confirmation.


Asunto(s)
Hipertermia Inducida , Neoplasias Peritoneales , Neoplasias Gástricas , Calcio , Antígeno Carcinoembrionario , China/epidemiología , Terapia Combinada , Femenino , Humanos , Hipertermia Inducida/métodos , Quimioterapia Intraperitoneal Hipertérmica , Masculino , Persona de Mediana Edad , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Gástricas/patología , Tasa de Supervivencia
4.
Curr Oncol ; 29(9): 6342-6349, 2022 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-36135068

RESUMEN

Concurrent chemoradiotherapy (CRT) is regarded as the standard treatment for inoperable esophageal cancers (EC). It is still controversial whether consolidation chemotherapy (CCT) or induction chemotherapy (IC) is beneficial for the patients who received CRT. Therefore, we carried out a retrospective analysis at our institution. A total of 186 inoperable EC patients from 20 October 2017 to 7 June 2021 who have previously received CRT were included in our study. The patients were divided into IC + CRT (n = 52), CCRT (n = 64), and CRT + CCT (n = 70) groups according to whether they received induction chemotherapy, consolidation chemotherapy, or not. We used Kaplan-Meier statistics to analyze their 1-, 2-, and 3-year OS. The median follow-up time for the whole group was 14.15 months. The 1-, 2-, 3- year overall survival (OS) for the CCRT group were 72.2%, 52.5%, and 29.5%, and 50.9%, 37.5%, and 25% for the IC + CRT group (p > 0.05). For the CRT + CCT group,1-, 2-, and 3-year OS were 89.8%, 59.0%, and 42.5% (p < 0.05). Adverse reactions in the three groups were mainly graded 0-3. The difference between the three groups was not statistically significant (p > 0.05). For non-surgical EC patients who received CRT, CCT after CRT but not IC before CRT can improve 1-, 2-, and 3-year OS with a low incidence of associated severe adverse effects. As a result, the addition of consolidation chemotherapy to chemoradiotherapy has significant prognostic advantages for inoperable EC patients.


Asunto(s)
Quimioterapia de Consolidación , Neoplasias Esofágicas , Quimioradioterapia , Neoplasias Esofágicas/tratamiento farmacológico , Humanos , Quimioterapia de Inducción , Estudios Retrospectivos , Tasa de Supervivencia
5.
Nan Fang Yi Ke Da Xue Xue Bao ; 42(8): 1230-1236, 2022 Aug 20.
Artículo en Chino | MEDLINE | ID: mdl-36073223

RESUMEN

OBJECTIVE: To analyze the survival rates and quality of life of human papillomaviruse (HPV)-negative patients with advanced oropharyngeal cancer after different combined treatments with chemotherapy, surgery and radiotherapy. METHODS: We retrospectively analyzed the data of patients with oropharyngeal cancer hospitalized in our hospital from January, 2015 to December, 2020, and after case analysis of the clinical, imaging and pathological data, 405 patients were included in this study and grouped according to the treatments they received. Kaplan-Meier and Log-rank analysis were used to calculate the overall survival rate and the survival rate of patients with different treatments. The self-rated quality of life of the tumor-free survivors was assessed using UW-QOL (4) questionnaire and compared among the patients with different treatments. RESULTS: Among the 405 patients included in this study, 146 received treatments with chemotherapy+surgery+radiotherapy (CSRT), 138 received surgery+radiotherapy (SRT) and 121 were treated with radiotherapy+chemotherapy (RCT). The overall survival rates of the 3 groups at 1, 3 and 5 years were 85.1%, 67.1% and 56.9%, respectively, and the survival rates of patients receiving CSRT, SRT and RCT did not differ significantly (P > 0.05). A total of 280 UW-QOL (4) questionnaires were distributed and 202 (72.14%) were retrieved. The average total scores decreased in the order of CSRT > SRT > RCT; the scores were significantly higher in CSRT group than in SRT and RCT (P < 0.05), but did not differ significantly between SRT and RCT groups (P > 0.05). CONCLUSION: CSRT, SRT and RCT are all treatment options for locally advanced oropharyngeal cancer, but CSRT may achieve better quality of life of the patients than SRT and RCT.


Asunto(s)
Alphapapillomavirus , Neoplasias Orofaríngeas , Humanos , Neoplasias Orofaríngeas/terapia , Calidad de Vida , Estudios Retrospectivos , Tasa de Supervivencia
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 2258-2261, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-36086591

RESUMEN

Heart transplantation is a difficult procedure compared with other surgical operations, with a greater outcome uncertainty such as late rejection and death. We can model the success of heart transplants from predicting factors such as the age, sex, diagnosis, etc., of the donor and recipient. Although predictions can mitigate the uncertainty on the transplantation outcome, their accuracy is far from perfect. In this paper, we describe a new method to predict the outcome of a transplantation from textual operative reports instead of traditional tabular data. We carried out an experiment on 300 surgical reports to determine the survival rates at one year and five years. Using a truncated TF-IDF vectorization of the texts and logistic regression, we could reach a macro Fl of 59.1 %, respectively, 54.9% with a five-fold cross validation. While the size of the corpus is relatively small, our experiments show that the operative textual sources can discriminate the transplantation outcomes and could be a valuable additional input to existing prediction systems. Clinical Relevance- Heart transplantation involves a significant number of written reports including in the preoperative examinations and operative documentation. In this paper, we show that these written reports can predict the outcome of the transplantation at one and five years with macro 1s of 59.1 % and 54.9 %, respectively and complement existing prediction methods.


Asunto(s)
Trasplante de Corazón , Trasplante de Corazón/métodos , Humanos , Modelos Logísticos , Tasa de Supervivencia , Donantes de Tejidos
7.
Oncol Rep ; 48(4)2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-36082822

RESUMEN

The protein disulfide isomerase (PDI) gene family plays important roles in the maintenance of several cellular functions. Previous studies have showed that protein disulfide isomerase family A member 4 (PDIA4) is aberrantly expressed in several types of cancer, and correlates with prognosis of patients. However, the role of PDIA4 in cervical cancer remains unclear. In the present study, the expression pattern of PDIA4 from both public database and immunohistochemical analysis in cervical samples was analyzed. Cell Counting Kit­8 and Transwell assays were performed to determine the effect of PDIA4 on cervical cancer cell proliferation and migration. Gene set enrichment analysis (GSEA) was used to provide the associated enriched pathways of PDIA4 in regulating cervical tumorigenesis. It was observed that mRNA expression and protein level of PDIA4 were upregulated in cervical cancer tissues. High expression of PDIA4 was significantly associated with poor overall survival (P=0.0095) and relapse­free survival (P=0.0019) in The Cancer Genome Atlas cohort. Knockdown of PDIA4 inhibited cervical cancer cell proliferation and migration. Moreover, PDIA4 affected the expression of proliferation­related molecules (cyclin D1 and PCNA) and migration­related molecules (E­cadherin and Vimentin). Additionally, GSEA revealed that PDIA4 was significantly associated with gene signatures involving glycan biosynthesis, glycosaminoglycan degradation and protein export. In conclusion, the present findings highlighted the importance of PDIA4 in cervical oncogenesis, and suggested that targeting PDIA4 may be a potential therapeutic application for cervical cancer.


Asunto(s)
Proteína Disulfuro Isomerasas , Neoplasias del Cuello Uterino , Movimiento Celular/genética , Proliferación Celular/genética , Femenino , Humanos , Recurrencia Local de Neoplasia , Pronóstico , Proteína Disulfuro Isomerasas/genética , Proteína Disulfuro Isomerasas/metabolismo , Tasa de Supervivencia , Neoplasias del Cuello Uterino/metabolismo
8.
In Vivo ; 36(5): 2514-2520, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36099136

RESUMEN

BACKGROUND/AIM: The present study evaluated the clinical characteristics and prognostic factors of gastric cancer (GC) patients with synchronous and metachronous other primary cancer who received curative treatment for GC. PATIENTS AND METHODS: The study included 244 patients who underwent curative treatment for GC between 2005 and 2018. The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: A total of 244 patients were included in this study. Among them, 58 patients were diagnosed with synchronous and metachronous other primary cancer. When comparing the patient background characteristics and clinical course between GC patients without and with synchronous and metachronous other primary cancer, the background, postoperative surgical complications, and details of adjuvant treatment were similar between the two groups. The 3- and 5-year OS rates in GC patients with synchronous and metachronous other primary cancer were 69.7% and 48.0%, respectively, while those in patients without synchronous and metachronous other primary cancer were 80.6% and 74.3%, respectively, showing a statistically significant difference (p<0.001) The synchronous and metachronous other primary cancer status was included in the final multivariate analysis model (hazard ratio=2.201; 95% confidence interval=1.229-3.942; p=0.008). CONCLUSION: Synchronous and metachronous other primary cancer status is a prognostic factor in GC patients. Therefore, synchronous and metachronous other primary cancer patients need both other primary cancer and GC follow-up to improve their survival.


Asunto(s)
Neoplasias Primarias Múltiples , Neoplasias Gástricas , Humanos , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Gástricas/cirugía , Tasa de Supervivencia
9.
In Vivo ; 36(5): 2350-2356, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36099142

RESUMEN

BACKGROUND/AIM: Up to a third of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC) of appendiceal or colorectal origin receive a stoma during primary surgery. Stoma reversal provides an opportunity for second-look surgery. PATIENTS AND METHODS: We performed a retrospective analysis of prospectively collected data of patients with colorectal cancer (CRC) or high-grade appendiceal cancer (AC) from 2006 to 2021 from our database. A total of 34 consecutive stoma closure patients with no evidence of preoperative disease recurrence (tumor markers and CT scans) were compared with 141 consecutive re-do CRS/HIPEC patients with known recurrence. RESULTS: Eleven patients (32.4%) were identified to have peritoneal recurrence at stoma closure. Time between first and second CRS was 12 months (4 to 64.2) in the stoma closure group vs. 24.6 months (5.8 to 119.8) in the re-do group, while median peritoneal cancer index (PCI) was 4 (3 to 6) vs. 8 (1 to 39), respectively (p=0.0143). CONCLUSION: Second-look laparotomy during stoma closure identified unexpected PC in 32.4% of our patients with significantly lower PCI than planned re-do operations.


Asunto(s)
Neoplasias del Apéndice , Neoplasias Colorrectales , Hipertermia Inducida , Neoplasias Peritoneales , Neoplasias del Apéndice/tratamiento farmacológico , Neoplasias del Apéndice/patología , Neoplasias Colorrectales/patología , Terapia Combinada , Procedimientos Quirúrgicos de Citorreducción/efectos adversos , Humanos , Quimioterapia Intraperitoneal Hipertérmica , Recurrencia Local de Neoplasia/patología , Neoplasias Peritoneales/patología , Estudios Retrospectivos , Segunda Cirugía , Tasa de Supervivencia
10.
Zhongguo Dang Dai Er Ke Za Zhi ; 24(9): 1036-1041, 2022.
Artículo en Chino | MEDLINE | ID: mdl-36111723

RESUMEN

OBJECTIVES: To study the clinical features of children with rhabdomyosarcoma (RMS) and the influencing factors for prognosis. METHODS: A retrospective analysis was performed on the clinical and follow-up data of 20 children with RMS who were admitted to the Department of Pediatric Hematology, Xiangya Hospital of Central South University, from June 2014 to September 2020. RESULTS: The most common clinical symptoms of the 20 children with RMS at the first visit were painless mass (13/20, 65%), exophthalmos (4/20, 20%), and abdominal pain (3/20, 15%). According to the staging criteria of Intergroup Rhabdomyosarcoma Study Group (IRSG), there was 1 child (5%) with stage I RMS, 4 (20%) with stage II RMS, 9 (45%) with stage III RMS, and 6 (30%) with stage IV RMS. The median follow-up time was 19 months for the 20 children (range: 3-93 months), with a 2-year overall survival (OS) rate of 79.5% (95%CI: 20.1-24.3) and a 2-year event-free survival (EFS) rate of 72.0% (95%CI: 19.5-23.9). Pleomorphic RMS was associated with the reduced 2-year OS rate (P<0.05), and distant metastasis, IRSG stage IV RMS, and high-risk RMS were associated with the reduced 2-year EFS rate (P<0.05). CONCLUSIONS: RMS has no specific clinical symptoms at the first visit, with painless mass as the most common symptom. Distant metastasis, IRSG stage, and risk degree may be associated with the prognosis of children with RMS.


Asunto(s)
Rabdomiosarcoma Embrionario , Rabdomiosarcoma , Niño , Humanos , Pronóstico , Estudios Retrospectivos , Rabdomiosarcoma/diagnóstico , Rabdomiosarcoma/terapia , Tasa de Supervivencia
11.
Breast J ; 2022: 5763810, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36051468

RESUMEN

The prognosis of breast cancer patients with brain metastasis is poor. It was aimed to define the clinicopathological features of breast cancer patients with brain metastases and to determine the risk factors and survival outcomes associated with brain metastasis. This is a single-center, retrospective, cross-sectional study. A total number of 127 patients diagnosed with breast cancer and who developed brain metastasis between January 2011 and March 2021 were retrospectively analyzed. The survival and clinicopathological data of these patients according to 4 biological subtypes were evaluated (luminal A, luminal B, HER-2 overexpressing, and triple-negative). The median overall survival for all patients was 45.6 months. The median time from the diagnosis of breast cancer to the occurrence of brain metastasis was 29.7 months, and the median survival time after brain metastasis was 7.2 months. The time from the diagnosis of breast cancer to brain metastasis development was significantly shorter in HER-2 overexpressing and triple-negative subtypes than in luminal A and B subtypes. The median time from breast cancer diagnosis to brain metastasis was 33.5 months in luminal A, 40.6 months in luminal B, 16.8 months in HER-2 overexpressing, and 22.8 months in the triple-negative groups (p=0.003). We found the worst median survival after brain metastasis in the triple-negative group with 3.5 months. Early and close surveillance of high-risk patients may help early diagnosis of brain metastasis and may provide to perform effective treatments leading to longer overall survival times for this patient population.


Asunto(s)
Neoplasias Encefálicas , Neoplasias de la Mama , Neoplasias Encefálicas/secundario , Neoplasias de la Mama/patología , Estudios Transversales , Femenino , Humanos , Recurrencia Local de Neoplasia/patología , Pronóstico , Receptor ErbB-2 , Receptores de Progesterona , Estudios Retrospectivos , Tasa de Supervivencia
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 65-68, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-36083923

RESUMEN

Metabolism plays an important role in the pathogenesis of prostate cancer (PCa). Hence, we explored candidate metabolic-related genes attributed to biochemical relapse (BCR) of PCa. Gene expression profile and clinical parameters were downloaded from GSE70769 as a "training set". Using univariate Cox and LASSO-COX regression models, risk scores (RSs) were constructed. Kaplan-Meier (K-M) survival and time-dependent receiver operating characteristic (t-ROC) curves were employed. Univariate and multivariate Cox models were utilized to validate prognostic factors for biochemical relapse-free survival (BCRFS). Nomogram was plotted to facilitate clinical application. The dataset obtained from GSE70768 served as "validation set". RSs were constructed by using 7 metabolic-related genes. RSs could significantly predict 1, 3, 5-year BCRFS (AUCs for training set: 0.810-0.836; AUC for validation set: 0.673-0.827). Nomograms could effectively predicted BCRFS (training set: C-index=0.831; validation set: C-index=0.737). RSs model is an independent prognostic factor for BCR, holding greater predictive value than traditional clinicopathological parameters. Clinical Relevance- We built the prognostic nomogram based on metabolic-related gene signatures and clinicopathological features. The nomogram might further optimize biochemical relapse risk stratification for prostate cancer patients with crucial accuracy.


Asunto(s)
Nomogramas , Neoplasias de la Próstata , Área Bajo la Curva , Humanos , Masculino , Modelos de Riesgos Proporcionales , Neoplasias de la Próstata/genética , Tasa de Supervivencia
13.
Int J Mol Sci ; 23(17)2022 Aug 31.
Artículo en Inglés | MEDLINE | ID: mdl-36077320

RESUMEN

Paediatric brain cancer is the second most common childhood cancer and is the leading cause of cancer-related deaths in children. Despite significant advancements in the treatment modalities and improvements in the 5-year survival rate, it leaves long-term therapy-associated side effects in paediatric patients. Addressing these impairments demands further understanding of the molecularity and heterogeneity of these brain tumours, which can be demonstrated using different animal models of paediatric brain cancer. Here we review the use of zebrafish as potential in vivo models for paediatric brain tumour modelling, as well as catalogue the currently available zebrafish models used to study paediatric brain cancer pathophysiology, and discuss key findings, the unique attributes that these models add, current challenges and therapeutic significance.


Asunto(s)
Neoplasias Encefálicas , Pez Cebra , Animales , Neoplasias Encefálicas/patología , Humanos , Tasa de Supervivencia
14.
Biomed Res Int ; 2022: 9559496, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36051481

RESUMEN

To build a nomogram model for predicting the survival risk of teens and adults with osteosarcoma based on the TARGET database, patients with osteosarcoma were collected via the TARGET database, and the survival curves of the patients were plotted using the Kaplan-Meier method in SPSS 24.0. Least absolute shrinkage and selection operator (LASSO) univariate regression analysis was performed to identify risk factors that influence osteosarcoma survival. A model (nomogram) for predicting the survival risk of adolescent and adult patients with osteosarcoma was built or plotted using the rms26 package as implemented in R (ver. 3.5.3). The predictive accuracy and discriminating power of the nomogram were determined by the C-index and calibration curves. A total of 94 patients with osteosarcoma were included. Classification of cases based on the tumor site revealed 59 cases involving the femur (62.8%), 5 involving the fibula (5.3%), 6 humerus (6.4%), 2 radius (2.1%), 19 tibia (20.2%), and 3 ulna (3.2%). Classification of cases based on surgical method showed 81 cases involving limb sparing (86.2%), 9 cases of amputation (9.6%), and 4 without surgery (4.2%). Among the 94 cases, bone metastasis occurred in 3 cases (3.2%) and lung metastasis in 14 cases (14.9%). Among all survivors, the median rate of survival is 8.6 years (95% CI: 8.0210.92); the three-year and five-year survival rates are 64.6% and 52.6%, respectively. The LASSO regression analysis showed that metastasis site, definitive surgery, and histologic response were potential risk predictors. The C-index of the nomogram plotted was 0.729, and the C-index of the validated sample was 0.742. The nomogram used in this study allows physicians to objectively and accurately predict the prognosis and survival of osteosarcoma patients. In order to determine whether the method is applicable to other groups of patients, additional studies need to be conducted.


Asunto(s)
Neoplasias Óseas , Osteosarcoma , Adolescente , Adulto , Neoplasias Óseas/patología , Humanos , Nomogramas , Osteosarcoma/patología , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia
15.
Neurosurg Focus ; 53(3): E15, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36052631

RESUMEN

Significant advancements in the treatment of spinal cord injury (SCI) were developed in the setting of military conflicts, partly due to the large numbers of injuries sustained by service members. No effective SCI treatment options existed into the early 20th century, and soldiers who sustained these injuries were usually considered untreatable. Extensive progress was made in SCI treatment during and after World War II, as physical therapy was increasingly encouraged for patients with SCI, multidisciplinary teams oversaw care, pathophysiology was better understood, and strategies were devised to prevent wound infection and pressure sores. Recent conflicts in Iraq and Afghanistan have caused a substantial rise in the proportion of SCIs among causes of casualties and wounds, largely due to new forms of war and weapons, such as improvised explosive devices. Modern military SCIs resulting from blast mechanisms are substantively different from traumatic SCIs sustained by civilians. The treatment paradigms developed over the past 100 years have increased survival rates and outcomes of soldiers with SCI. In this paper, the authors review the role of military conflicts in the development of therapeutic interventions for SCI and discuss how these interventions have improved outcomes for soldiers and civilians alike.


Asunto(s)
Medicina Militar , Personal Militar , Traumatismos de la Médula Espinal , Traumatismos Vertebrales , Afganistán , Humanos , Traumatismos de la Médula Espinal/etiología , Traumatismos de la Médula Espinal/terapia , Tasa de Supervivencia
16.
Chirurgia (Bucur) ; 117(4): 486-492, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-36049107

RESUMEN

Pancreatic cancer remains one of the biggest challenges in oncology, as most patients are diagnosed in a stage of regional lymphatic or systemic spread of the disease. 10% of the patients present with peritoneal carcinomatosis upon diagnosis. In the past decades, cytoreductive surgery (CRS) combined with hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) has been developed and presents a new, individualized treatment option for patients with peritoneal disseminated cancer. This case report presents the case of a 39-year-old male with the initial diagnosis of a carcinoma of the pancreatic tail with localized peritoneal carcinomatosis. As an individualized approach, neoadjuvant chemotherapy was recommended with an option for a second exploration. Re-Staging revealed a reduction in tumor size. Cytoreductive surgery (CRS) including a distal splenopancreatectomy was performed and followed by HIPEC. Postoperatively, the patient developed a clinically relevant pancreatic fistula, however recovered and was able to receive adjuvant chemotherapy. Taken together, in pancreatic cancer with localized peritoneal carcinomatosis CRS and HIPEC are a valid option in highly selective cases with potential extended overall survival and an acceptable quality of life.


Asunto(s)
Adenocarcinoma , Hipertermia Inducida , Neoplasias Pancreáticas , Neoplasias Peritoneales , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia del Cáncer por Perfusión Regional , Terapia Combinada , Humanos , Quimioterapia Intraperitoneal Hipertérmica , Masculino , Páncreas , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Peritoneales/tratamiento farmacológico , Calidad de Vida , Tasa de Supervivencia , Resultado del Tratamiento
18.
Front Endocrinol (Lausanne) ; 13: 984137, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36017319

RESUMEN

Optimal control of diabetes and relevant risk factors substantially reduce the risks of chronic complications and mortality. We investigated all-cause mortality rate and major causes of death between 2007 and 2018 in patients with diabetes in Taiwan. This study was conducted using data from Taiwan National Health Insurance Research Database. We selected patients with diabetes diagnosed between 2007 and 2017 (grouped according to the year of diabetes diagnosis 2007-2010 vs. 2011-2017). Information on mortality and causes of death by the end of 2018 was confirmed through linking to the National Death Registry. Standardized mortality rate (SMR) were calculated by weighting the World Health Organization (WHO) standard population (WHO 2000-2025). More than 2.7 million of patients with diabetes were analyzed and a total of 566121 deaths were identified. Overall, the SMR was 11.72 per 1000 person-years. Patients with diabetes diagnosed in 2011-2017 had a lower SMR (8.42 vs. 12.92 per 1000 person-years) than those diagnosed in 2007-2010. Similar finding were noted regarding the major causes of death (cancer, diabetes, heart disease, hypertensive disease, and cerebrovascular disease). Compared with patients who were diagnosed in 2008-2010, those who were diagnosed in 2011-2014 and 2015-2018 had a higher 3-year survival rate (0.9356 vs. 0.9438 vs. 0.946, log-rank test p<0.001) after the diagnosis of diabetes. Patients who were diagnosed with diabetes after 2011 had a lower rate of all-cause mortality and major causes of death, compared with those who were diagnosed before 2010 in Taiwan.


Asunto(s)
Diabetes Mellitus , Causas de Muerte , Diabetes Mellitus/epidemiología , Humanos , Factores de Riesgo , Tasa de Supervivencia , Taiwán/epidemiología
19.
Zhonghua Er Ke Za Zhi ; 60(9): 908-914, 2022 Sep 02.
Artículo en Chino | MEDLINE | ID: mdl-36038300

RESUMEN

Objective: To investigate the clinical characteristics, treatment and prognosis of malignant rhabdoid tumor (MRT) in children. Methods: Clinical data total of 18 children with MRT treated in the Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University between June 2015 to June 2021 were analyzed retrospectively. The patients were grouped according to age, gender, tumor type, clinical stage and other factors.Progression free survival (PFS) and overall survival (OS) were calculated by Kaplan-Meier method, survival differences among different groups were compared by Log-rank test, and prognostic factors were analyzed by Cox regression model. Results: Among the 18 patients, there were 5 males and 13 females. The age of disease onset was 30.5 (12.0, 75.0) months, the tumor diameter was (80±29) mm, and no integrase interactor 1 (INI-1) expression was detected by immunohistochemistry. There were 7 cases of malignant rhabdoid tumor of the kidney (MRTK), 6 cases of atypical teratoid rhabdoid tumor (ATRT) and 5 cases of extrarenal extracranial rhabdoid tumor (EERT). At the time of early diagnosis, 12 patients were clinically stage Ⅲ-Ⅳ, 11 patients had local or distant metastasis, and 4 patients had metastasis during treatment. Surgical excision is the preferred treatment. There were 3 cases with preoperative puncture biopsy, 13 cases with complete resection, 4 cases with partial resection, and 1 case without operation. Thirteen patients were treated with the domestic conventional chemotherapy regimen for Wilms' tumor, medulloblastoma and rhabdomyosarcoma, and 5 patients were treated with the international conventional chemotherapy regimen. Nine patients received radiotherapy, including 1 case of MRTK, 4 cases of ATRT and 4 cases of EERT. By the end of follow-up in January 2022, 7 patients survived and 11 patients died. The 3-year PFS and OS rates were (8±8) % and (14±12) %. Log-rank test showed that the 5-year OS of EERT group was higher than ATRT and MRTK groups (χ²=16.31, P<0.001), the tumor diameter <80 mm group was higher than that of the ≥80 mm group (χ²=4.49, P=0.034), and the radiotherapy group was higher than no radiotherapy group (χ²=3.97, P=0.046). The differences were statistically significant. There was no significant difference in the influence of tumor type, age, tumor diameter, radiotherapy and chemotherapy on OS by Cox regression model (all P>0.05). Log-rank test showed that the 3-year PFS of EERT group was higher than ATRT and MRTK groups (χ²=11.14, P=0.004),>3 years group was higher than ≤3 years group (χ²=10.10, P=0.001), the differences were statistically significant. Tumor type, clinical stage, tumor diameter, age, tumor rupture and radiotherapy were included in the Cox regression model, and the results showed that clinical stage (HR=0.49, 95%CI 0.26-0.94, P=0.031), tumor diameter (HR=8.67, 95%CI 1.84-40.89, P=0.006), age (HR=0.01, 95%CI 0.00-0.15, P=0.001) had statistical significance on PFS. Conclusions: MRT is one of the most aggressive and fatal cancers in early childhood and infancy. There is no standard treatment and the prognosis is extremely poor. Clinical stage, tumor size and age are risk factors for disease progression.


Asunto(s)
Neoplasias Renales , Tumor Rabdoide , Rabdomiosarcoma Embrionario , Niño , Preescolar , Femenino , Humanos , Masculino , Pronóstico , Estudios Retrospectivos , Tumor Rabdoide/diagnóstico , Tumor Rabdoide/patología , Tumor Rabdoide/terapia , Tasa de Supervivencia
20.
Anticancer Res ; 42(9): 4553-4561, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36039454

RESUMEN

BACKGROUND/AIM: The potential for repeat hepatectomy has been increasing in hepatocellular carcinoma (HCC) patients. PATIENTS AND METHODS: To assess its significance, we examined the clinical features, surgical records, and survival of 279 HCC patients who underwent hepatectomy as primary treatment. Patients were divided into three groups: single hepatectomy without HCC relapse in 97 patients (Group 1), single hepatectomy with HCC relapse in 133 patients (Group 2) and repeat hepatectomy for HCC relapse in 49 patients (Group 3). Group 3 was divided into three subgroups. Multiple, larger size (>5 cm), and confluent nodular HCC. RESULTS: Child-Pugh B patients were significantly higher in Group 2 (p<0.01). The prevalence of histological vascular involvement was significantly higher in Group 2 than in the other groups (p<0.01). Although Group 2 showed significantly poorer survival (p<0.01), the 10-year overall survival in Groups 1 and 3 was over 70% but not different between groups. The relapse-free survival period was significantly correlated with overall survival, and patients with a cancer-free period of over 36 months showed significantly better 10-year survival rates than those with a period of less than 36 months (p<0.01). Patients undergoing 3 or more repeat hepatectomies also showed good survival periods. CONCLUSION: Careful follow-up and proper decision-making in terms of repeat hepatectomy with multimodal treatments including novel chemotherapies upon assessment of postoperative tumor relapse are important in HCC patients to prolong survival.


Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/patología , Supervivencia sin Enfermedad , Hepatectomía , Humanos , Neoplasias Hepáticas/patología , Recurrencia Local de Neoplasia/patología , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia
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