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1.
Dis Esophagus ; 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-32582945

RESUMO

Although robotic techniques have been used for oesophagectomy for many years, whether robot-assisted minimally invasive oesophagectomy (RAMIE) can actually improve outcomes and surpass thoraco-laparoscopic minimally invasive oesophagectomy (MIE) in the success rate of lymph node dissection remains to be empirically demonstrated. Therefore, we performed this systematic review and meta-analysis of case-control studies to systematically compare the effect of lymph node dissection and the incidence of vocal cord palsy between RAMIE and MIE. The PubMed, EMBASE, and Web of Science databases were systematically searched up to December 1, 2019, for case-control studies that compared RAMIE with MIE. Thirteen articles were included, with a total of 1,749 patients with esophageal cancer, including 866 patients in the RAMIE group and 883 patients in the MIE group. RAMIE yielded significantly larger numbers of total dissected lymph nodes (WMD = 1.985; 95% CI, 0.448-3.523; P = 0.011) and abdominal lymph nodes (WMD = 1.686; 95% CI, 0.420-2.951; P = 0.009) as well as lymph nodes along RLN (WMD = 0.729; 95% CI, 0.348-1.109; P < 0.001) than MIE. Additionally, RAMIE could significantly decrease estimated blood loss (WMD = -11.208; 95% CI, -19.358 to -3.058; P = 0.007) and the incidence of vocal cord palsy (OR = 0.624; 95% CI, 0.411-0.947; P = 0.027) compared to MIE. Compared with MIE, RAMIE resulted in a higher total lymph node yield and a higher lymph node yield in the abdomen and along RLN, along with reduced blood loss during surgery and the incidence of vocal cord palsy. Therefore, RAMIE could be considered to be a standard treatment, with less blood loss, lower incidence of vocal cord palsy, and more radical lymph node dissection, exhibiting superiority over MIE.

2.
Pediatr Res ; 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32380506

RESUMO

BACKGROUND: Hirschsprung's disease (HSCR) is the most common congenital cause of intestinal obstruction in children. Sotos syndrome (SoS) is an overgrowth disorder with constipation and sometimes accompanied by HSCR. NSD1 gene mutation is the main cause of SoS. We aimed to investigate association of NSD1 common single nucleotide polymorphisms (SNPs) with HSCR susceptibility in Chinese Han population. METHOD: We genotyped 15 SNPs encompassing NSD1 gene region in 420 HSCR patients and 1665 controls on Fludigm EP1 platform. Association analysis was performed between cases and controls. RESULT: Rs244709 was the most associated SNP with HSCR susceptibility of the sample set (PAllelic = 9.69 × 10-5, OR = 1.37, 95% CI: 1.17-1.61). Gender stratification analysis revealed that NSD1 SNPs were associated with HSCR in males, but not in females. The nonsynonymous coding SNP rs28932178 in NSD1 exon 5 represented the most significant signal in males (PAllelic = 6.43 × 10-5, OR = 1.42, 95% CI: 1.20-1.69). The associated SNPs were expression quantitative trait loci (eQTLs) of nearby genes in multiple tissues. NSD1 expression levels were higher in aganglionic colon tissues than ganglionic tissues (P = 3.00 × 10-6). CONCLUSION: NSD1 variation conferred risk to HSCR in males, indicating SoS and HSCR may share common genetic factors. IMPACT: This is the first study to reveal that NSD1 variation conferred risk to Hirschsprung's disease susceptibility in males of Chinese Han population, indicating Sotos syndrome and Hirschsprung's disease may share some common genetic background.This study indicates more attention should be paid to the symptom of constipation in patients with Sotos syndrome.Our results raise questions about the role of NSD1 in the development of enteric nervous system and the pathogenesis of Hirschsprung's disease.

3.
Nutrition ; 77: 110787, 2020 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-32438300

RESUMO

OBJECTIVES: In recent years, home enteral nutrition (HEN) has been adopted as a feasible and safe form of nutrition for patients undergoing esophagectomy. The aim of this study was to compare the effects of 4 wk of HEN with standard enteral nutrition (SEN) on immune function, nutritional status, and survival in patients undergoing esophagectomy. METHODS: A parallel-group, randomized, single-blind, clinical trial was conducted between April 1 and August 1, 2017. Eighty patients were enrolled in the study and 62 were eligible for analysis. An enteral feeding pump was used to infuse enteral nutrition via jejunostomy tube postoperatively. Patients in HEN group were instructed to independently administer jejunostomy feeds at home. Immune parameters and nutritional indicators were measured at preoperative day 7 and at postoperative day 30. RESULTS: There were no significant differences in baseline characteristics between the two groups. The levels of immunoglobulin (Ig)A and IgG, which can reflect a patient's immune function, significantly increased in the HEN group compared with those in the SEN group (P = 0.042 and P = 0.003, respectively). Comparing the two groups, 2-y progression-free survival and overall survival had no significant differences in survival curves (P = 0.36 and P = 0.29, respectively). CONCLUSION: Four weeks of HEN is a safe and feasible nutritional strategy to improve immune function and nutritional status after esophagectomy. Although there was no significant difference in survival between the two groups, HEN could still be more effective and beneficial than SEN to patients with defective nutritional and immune status.

4.
Emerg Infect Dis ; 26(6): 1337-1339, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32150527

RESUMO

We report an asymptomatic child who was positive for a coronavirus by reverse transcription PCR in a stool specimen 17 days after the last virus exposure. The child was virus positive in stool specimens for at least an additional 9 days. Respiratory tract specimens were negative by reverse transcription PCR.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Fezes/virologia , Pneumonia Viral/diagnóstico , RNA Viral/isolamento & purificação , Criança , Humanos , Masculino , Pandemias , Reação em Cadeia da Polimerase Via Transcriptase Reversa
5.
J Craniomaxillofac Surg ; 48(5): 508-513, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32143863

RESUMO

PURPOSE: The aim of this study was to evaluate the feasibility and diagnostic accuracy of core needle biopsy (CNB) in patients with focal fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) in deep regions of the head and neck, with the guidance of infrared navigation integrated with PET. MATERIALS AND METHODS: Patients with suspected primary or recurrent malignancies of the head and neck on PET/CT, from June 2016 to December 2018, were included. Before CNB, the region of interest was delineated and the ideal needle entry points, target sites, and a number of trajectories were designed on iPlan CMF 3.0. CNB was performed with the guidance of infrared navigation integrated with PET, according to the pre-plan. Sensitivity and diagnostic accuracy were analyzed by comparing the biopsy results with the final diagnosis. RESULTS: Thirty-one consecutive patients were included. Among the 31 lesions, 18 were skull base, six were infratemporal fossa, and seven were maxillary region. The median values for SUVmax, SUVmean, and MTV were 6.09 (range: 1.43-24.67), 3.41 (range: 0.38-20.96), and 25.83 (range: 3.54-361.94) for the 31 lesions, respectively. Combined needle approaches were employed, including temporal (nine), subzygomatic (19), paramaxillary (11), and retromandibular (16) approaches. The depths of the 31 deep-region lesions, measured from the needle entry site on the skin to the target point, ranged from 1.33 cm to 7.82 cm (median 4.25 cm). There were three non-diagnostic lesions resulting from CNB, and these were all skull base. The diagnostic accuracy was 90.3%, while the sensitivity was 88%. According to the binary logistic regression for the final diagnosis, the only significant parameter was SUVmax. CONCLUSION: With the guidance of navigation integrated with PET, CNB is a feasible and accurate diagnostic modality, which is also an alternative to open biopsy in patients with suspected primary or recurrent malignancies in deep regions of the head and neck on PET/CT.

6.
Interact Cardiovasc Thorac Surg ; 30(6): 854-862, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32206808

RESUMO

OBJECTIVES: According to retrospective studies, oesophageal carcinoma is the second deadliest gastrointestinal cancer after gastric cancer. Enteral immunonutrition (EIN) has been increasingly used to enhance host immunity and relieve the inflammatory response of patients undergoing oesophagectomy; however, conclusions across studies remain unclear. We aimed to evaluate the effect of EIN on the clinical and immunological outcomes of patients undergoing oesophagectomy. METHODS: Four electronic databases (MEDLINE, Embase, Web of Science and Cochrane Library) were used to search articles in peer-reviewed, English-language journals. The mean difference, relative risk or standard mean difference with 95% confidence interval were calculated. Heterogeneity was assessed by the Cochran's Q test and I2 statistic combined with the corresponding P-value. The analysis was carried out with RevMan 5.3. RESULTS: Six articles were finally included, with a total of 320 patients with oesophageal cancer. The meta-analysis results showed that EIN did not improve clinical outcomes (such as infectious complications, pneumonia, surgical site infection, anastomotic leak and postoperative hospital stay) or immune indices [referring to C-reactive protein, interleukin (IL)-6, IL-8, tumour necrosis factor-α]. Descriptive analysis suggested that EIN also increased the serum concentrations of IgG and the percentage of the B-cell fraction. Thus, its impact on IL-8 and IL-6 remains inconsistent. CONCLUSIONS: The early-stage impact of EIN on immunological status in patients undergoing oesophagectomy is still unclear. According to the results of this meta-analysis, whether EIN could improve the clinical outcomes or biological status after oesophagectomy compared to standard enteral nutrition is uncertain. Since the impact of EIN is unclear, current guidelines that strongly advise the use of EIN should be changed, as the utility of EIN is very uncertain. More appropriately powered clinical studies are warranted to confirm its effectiveness.

7.
J Sep Sci ; 43(7): 1372-1381, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31944578

RESUMO

A novel, simple, and sensitive method has been developed for simultaneous determination of 14 heterocyclic aromatic amines in meat product using solid-phase extraction combined with ultrahigh-performance supercritical fluid chromatography coupled to tandem quadrupole mass spectrometry. The analytes could be separated within 7 min and identified using their retention times and mass. The developed method was validated based on the linearity, limits of quantification, precision, and accuracy. The recovery ranged from 52.3 to 97.5% with an acceptable standard deviation, which is not higher than 6%. The limits of quantitation ranged from 0.03 to 0.17 µg/kg. The selectivity and sensitivity were satisfactory in multiple reaction monitoring mode. The method was applied to commercial meat products, and the results demonstrated that the novel method has potential for the analysis of the targets in food matrices. This is the first work reporting the simultaneous quantification of 14 heterocyclic aromatic amines by means of ultrahigh-performance supercritical fluid chromatography coupled to tandem quadrupole mass spectrometry.

8.
J Oral Maxillofac Surg ; 78(1): 167-172, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31604061

RESUMO

PURPOSE: The aim was to evaluate the safety and efficacy of subcutaneous injection of hyaluronic acid in decreasing acute skin toxicity after adjuvant interstitial brachytherapy in parotid gland cancer patients. MATERIALS AND METHODS: Patients with histologically proven parotid gland cancer who would be treated with adjuvant interstitial brachytherapy were included in this nonrandomized controlled trial. Participants were nonrandomly divided into the experimental group and control group. Participants in the experimental group received an injection of hyaluronic acid subcutaneously immediately after interstitial brachytherapy during the operation. Acute toxicity was evaluated in the first 2 months. RESULTS: Thirty consecutive participants were included from April to September 2018. Twenty participants were in the experimental group, and 10 were in the control group. The median volume of hyaluronic acid was 8 mL (range, 4 to 11 mL). In total, the incidence of acute skin toxicity was 40% (8 of 20 patients) and 100% (10 of 10 patients) in the experimental group and control group, respectively. The difference in the dose delivered to 90% of the target volume of the affected skin was significant between the pre-plan (mean, 36.93 Gy) and the actuarial quality verification (mean, 27.70 Gy) in the experimental group (P = .004). The difference in scoring of acute skin toxicity was significant between the experimental and control groups (P = .001). No clear correlation was found between the dose delivered to 90% of the target volume of the affected skin and the scoring of acute skin toxicity (P = .266). CONCLUSIONS: Subcutaneous injection of hyaluronic acid was safe and efficient in decreasing acute skin toxicity after adjuvant interstitial brachytherapy in parotid gland cancer patients according to the preliminary results.

9.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 37(6): 681-683, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31875451

RESUMO

Maxillary defects result in esthetic and functional defects in patients. Several techniques are available for ma-xillary reconstruction. Herein, we present a case of maxillary reconstruction with medial femoral condyle periosteal flap by intraoral anastomosis. The characteristics of medial femoral condyle periosteal flap and the advantages of intraoral anasto-mosis are introduced.


Assuntos
Estética Dentária , Procedimentos Cirúrgicos Reconstrutivos , Anastomose Cirúrgica , Fêmur , Humanos , Maxila , Retalhos Cirúrgicos
10.
Inorg Chem ; 58(23): 15705-15709, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31710218

RESUMO

The reaction of 1,1,2,2-tetrakis(4-(pyridin-4-yl)phenyl)ethene (tppe) with [Fe(NCBH3)2] produced a two-dimensional coordination polymer [Fe(NCBH3)2(tppe)]n (1), which was pillared in an ABAB manner through interlayer multiple [C-Hδ+···Hδ--B] dihydrogen bonds (DHBs) to form a stable porous three-dimensional (3D) supramolecular structure that showed guest-molecule-dependent spin-crossover behaviors.

11.
Orthop Surg ; 11(5): 906-913, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31663291

RESUMO

This article describes the trepan technique for treating single segment ossification of the ligamentum flavum (OLF) using an endoscope. OLF is the most common cause of thoracic spinal stenosis. The most common surgical procedures involve semi-lamina or full-lamina resection and decompression. However, considering the anatomical structure of the thoracic spinal canal and the combination of OLF, traditional surgery has higher risks, more complications, and greater technical requirements. In the past ten years, with the development of endoscopic technology, spinal endoscopy has been increasingly applied for the treatment of intervertebral disc herniation and spinal canal stenosis. The present study demonstrated the effectiveness of visual trepan decompression under spinal endoscopy used for patients with single segment OLF. This surgical procedure had many advantages, including a shorter operation time, minimal trauma, less expenditure, and better functional recovery over the conventional open surgery.


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Ligamento Amarelo/cirurgia , Ossificação Heterotópica/cirurgia , Estenose Espinal/cirurgia , Vértebras Torácicas/cirurgia , Humanos , Ligamento Amarelo/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Ossificação Heterotópica/complicações , Medição da Dor , Estenose Espinal/etiologia
12.
Orthop Surg ; 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31568641

RESUMO

OBJECTIVE: To evaluate the efficacy of three surgical approaches for the treatment of cervicothoracic tuberculosis. METHODS: This is a multicenter retrospective study. We analyzed 74 patients with cervicothoracic tuberculosis who were treated in six institutions between January 2000 and January 2015. There were 37 male and 37 female patients, with an average age of 24 years (range, 5-62 years). The operative method was selected according to the indications. A total of 33 patients underwent one-stage anterior surgery (group A); 16 underwent a combined anterior and posterior surgery (group B) and 25 underwent one-stage posterior surgery (group C). Clinical outcomes, laboratory indexes, and radiological results were analyzed. RESULTS: All cases were followed up for approximately 36-96 months post-surgery (average, 39 months). At the last follow-up, patients in all three groups had achieved bone fusion, with pain relief and neurological recovery. No major vessel and nerve injuries were found during the operation. There were significant differences before and after treatment for visual analogue scale (VAS), neck disability index (NDI), and Japanese Orthopedic Association (JOA) score (P < 0.001). Three surgical strategies significantly improved kyphosis (P < 0.001). CONCLUSION: The choice of operation for cervicothoracic tuberculosis should be selected based on the pathological changes, scope, and general physical condition of the patient. The indication for a posterior approach is narrow and it should be used selectively. The combined anterior and posterior approach involved a longer operating time, larger blood loss, and greater trauma, and also required a higher level of surgical skill. Therefore, the indications for this approach should be strictly controlled. Anterior approach surgery for the treatment of cervicothoracic tuberculosis showed excellent efficacy and fewer complications.

13.
EJNMMI Res ; 9(1): 89, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511990

RESUMO

BACKGROUND: The aim of this study was to evaluate the prognostic value of positron emission tomography (PET) parameters and the PET texture features of fluorine 18-fluorodeoxyglucose ([18F]FDG) uptake on pretreatment PET/computed tomography (CT) in patients with locally advanced salivary gland carcinoma treated with interstitial brachytherapy. METHODS: Forty-three patients with locally advanced salivary gland carcinoma of the head and neck were treated with 125I interstitial brachytherapy as the sole modality and underwent [18F]FDG PET/CT scanning before treatment. Tumor segmentation and texture analysis were performed using the 3D slicer software. In total, 54 features were extracted and categorized as first-order statistics, morphology and shape, gray-level co-occurrence matrix, and gray-level run length matrix. Up to November 2018, the follow-up time ranged from 6 to 120 months (median 18 months). Cumulative survival was calculated by the Kaplan-Meier method. Factors between groups were compared by the log-rank test. Multivariate Cox regression analysis with a backward conditional method was used to predict progression-free survival (PFS). RESULTS: The 3- and 5-year locoregional control (LC) rates were 55.4% and 37.0%, respectively. The 3- and 5-year PFS rates were 51.2% and 34.1%, respectively. The 3- and 5-year overall survival (OS) rates were 77.0% and 77.0%, respectively. Univariate analysis revealed that minimum intensity, mean intensity, median intensity, root mean square, and long run emphasis (LRE) were significant predictors of PFS, whereas clinicopathological factors, conventional PET parameters, and PET texture features failed to show significance. Multivariate Cox regression analysis showed that minimum intensity and LRE were significant predictors of PFS. CONCLUSIONS: The texture analysis of pretreatment [18F]FDG PET/CT provided more information than conventional PET parameters for predicting patient prognosis of locally advanced salivary gland carcinoma treated with interstitial brachytherapy. The minimum intensity was a risk factor for PFS, and LRE was a favorable factor in prognostic prediction according to the primary results.

14.
J Orthop Surg Res ; 14(1): 233, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337417

RESUMO

BACKGROUND: The purpose of this multicentre, retrospective study was to evaluate the safety and efficacy of different surgical approaches for treating thoracolumbar tuberculosis. METHODS: This study reviewed 132 patients with thoracolumbar tuberculosis in six institutions between January 1999 and January 2015 surgically treated by an anterior-only approach (n = 22, group A), an anterior combined with posterior approach (n = 79, group B), and a posterior-only approach (n = 31, group C). All patients were treated with standard antituberculosis drugs pre- and postoperatively and were followed regularly after surgery. Clinical symptoms, nerve function, and the erythrocyte sedimentation rate were observed, and kyphosis correction and bone fusion were evaluated by X-ray or computed tomography. RESULTS: At the last follow-up, all patients had achieved bone fusion, relief from pain, and neurological recovery. The Cobb angle was improved; however, the Cobb angle showed a degree of loss at the final follow-up after all three surgical approaches. Further comparisons revealed a difference in angle loss at the final follow-up among the three groups; groups B and C were superior to group A in maintenance of the correction. The posterior-only approach was characterized by a shorter operative time and reduced blood loss. CONCLUSIONS: Surgery by a posterior-only approach is superior to that by an anterior-only approach and anterior combined with posterior approach in terms of permanent kyphosis correction and spinal stability maintenance. Therefore, we recommend surgery by a posterior-only approach as the optimized treatment for thoracolumbar tuberculosis if the indications for this treatment are met.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
Interact Cardiovasc Thorac Surg ; 29(5): 706-713, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31237938

RESUMO

OBJECTIVES: Pulmonary sequestration is a rare congenital pulmonary malformation. The aim of this study was to explore the effect of different therapeutic strategies on the clinical outcome of asymptomatic intralobar pulmonary sequestration. METHODS: We retrospectively reviewed the clinical data of 37 patients diagnosed with intralobar sequestration. All the patients were asymptomatic. Seventeen patients underwent video-assisted thoracoscopic surgery (VATS) once diagnosed and 20 patients chose to undergo observation. Of these 20 patients, 16 patients developed symptoms during the observation period and also underwent VATS; 4 patients never showed symptoms and did not have surgery. The 33 patients who had VATS were divided into 2 groups: group 1, patients who underwent VATS once diagnosed; group 2, patients who underwent VATS once symptoms appeared. Postoperative data and respiratory function data were compared between the 2 groups. RESULTS: Twenty of the patients were men and 17 were women (mean age 37.05 ± 7.89 years). Results of a comparative analysis of the 2 groups indicated that patients in group 1 had better values for median estimated blood loss, median duration of chest tube insertion, postoperative hospital stay and postoperative hospital stay than those in group 2. Postoperative complications were reported in 1 patient in group 1 and in 3 patients in group 2. Meanwhile, the loss of lung function between group 1 and group 2 was statistically significant, which also suggested that patients benefited from surgery once diagnosed. CONCLUSIONS: For asymptomatic intralobar sequestration, VATS could be effective and safe. The surgical intervention should be performed once the condition is diagnosed to avoid manifestations occurring and to preserve patients' quality of life.


Assuntos
Sequestro Broncopulmonar/cirurgia , Pneumonectomia/métodos , Qualidade de Vida , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Doenças Assintomáticas , Sequestro Broncopulmonar/diagnóstico , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Head Neck ; 41(9): 3219-3225, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31116488

RESUMO

BACKGROUND: This study aimed to determine the effectiveness and safety of surgery combined with postoperative 125 I seed brachytherapy for treatment of primary mucoepidermoid carcinoma (MEC) of the parotid gland. METHODS: Retrospective analysis of data of patients with MEC (n = 108) treated with surgery plus postoperative 125 I seed brachytherapy between 2004 and 2016. Overall survival (OS), disease-free survival (DFS), local control rate (LCR), distant metastasis, and radiation-associated toxicities were analyzed, and factors affecting outcomes were evaluated. RESULTS: The 5- and 10-year OS were 98.8% and 95.8%, respectively. The DFS and LCR at 5 and 10 years were all 91.4%. Age ≥ 60 years (hazard ratio [HR] = 6.86, 95% confidence interval [CI]: 1.54-30.55) and T4 disease (HR = 7.15, 95% CI: 1.40-36.52) were poor prognostic factors. Acute radiation-associated toxicities were minor. CONCLUSION: Surgery plus 125 I seed brachytherapy appears to be an effective treatment for parotid gland MEC, capable of providing satisfactory outcomes with few complications.

17.
J Oral Maxillofac Surg ; 77(10): 2143-2153, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31028735

RESUMO

PURPOSE: Adenoid cystic carcinoma (ACC) involving the skull base is difficult to treat and sometimes unresectable. The purpose of this study was to evaluate the efficacy and safety of 125I radioactive seed interstitial brachytherapy for treatment of these patients. MATERIALS AND METHODS: Patients with ACC involving the skull base treated by definitive 125I brachytherapy from March 2008 through December 2018 at the Peking University Hospital of Stomatology (Beijing, China) were retrospectively identified. Overall survival (OS), as the primary efficacy indicator, and progression-free survival (PFS) and distant metastasis-free survival (DFS), as the secondary efficacy indicators, were analyzed by Kaplan-Meier survival analysis and Cox regression analysis. Adverse radiotherapy (RT) reactions, as safety indicators, were recorded. RESULTS: Thirty-two patients with (r)T4b locally advanced disease were enrolled. The prescription dose (PD) was 60 to 120 Gy. The dose delivered to 90% of the target volume was 99.1 to 145.2 Gy, the percentage of the target volume receiving at least 100% of the PD was at least 88.2%, and the percentage of the target volume receiving at least 150% of the PD was smaller than 74.0%. Mean follow-up was 32 months (median, 21 months; range, 3 to 95 months). The 1- and 3-year OS rates were 93.3 and 62.6%, the 1- and 3-year PFS rates were 90.0 and 46.4%, and the 1- and 3-year DFS rates were 91.7 and 61.1%, respectively. Survival was significantly associated with local recurrence (P = .04) and distant metastasis except in the lung (P = .05). The rate of severe chronic adverse RT reactions was 3.1%; no severe acute adverse RT reactions were observed. CONCLUSION: 125I brachytherapy appears to be an effective and safe treatment in the short-term for ACC involving the skull base and could be the preferred treatment for patients with prior RT. Local control with brachytherapy could provide survival benefit even in patients with lung metastasis.

18.
Int J Biol Macromol ; 133: 564-574, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31004640

RESUMO

Dendrobium devonianum has been used as herbal medicines and nutraceutical products since ancient time in China. However, its chemical composition and pharmacological mechanisms are not fully known. In present studies, by chemical purification and characteristic identification, we discovered a novel polysaccharide from D. devonianum, which was designated as DvP-1 with molecular weights of 9.52 × 104 Da. DvP-1 is a homogeneous heteropolysaccharide consisting of D-mannose and d-glucose in the molar ration of 10.11: 1. The main glycosidic linkages were ß-1, 4-Manp, which were substituted with acetyl groups at the O-2, O-3 and/or O-6 positions. DvP-1 was found to directly stimulate the activation of macrophages in vitro, as evidenced by inducing morphologic change, thereby promoting the production of cytokines TNF-α, IL-6 and NO, and enhancing the pinocytic activity of macrophages. By establishing a zebrafish model, we also found that DvP-1 could alleviate vinorelbine-induced decrease of macrophages in vivo. Further findings indicated that DvP-1 activated macrophages through several toll-like receptors (TLRs), but mainly through TLR4. DvP-1 served as a TLR4 agonist and induced ERK, JNK, p38, and IκB-α phosphorylation, suggesting the activation of MAPK and NFκB signaling pathways downstream of TLR4. These findings could help us further understand the immunomodulating effects of D. devonianum in Chinese medicines or health foods for immunocompromised persons. They also show the medicinal value of DvP-1 for the treatment of cancer and infectious diseases caused by TLR4 dysfunction.


Assuntos
Dendrobium/química , Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , Polissacarídeos/farmacologia , Receptor 4 Toll-Like/agonistas , Animais , Proliferação de Células/efeitos dos fármacos , Citocinas/biossíntese , Macrófagos/citologia , Camundongos , Monossacarídeos/análise , Polissacarídeos/química , Células RAW 264.7 , Baço/imunologia , Vinorelbina/farmacologia , Peixe-Zebra
19.
World Neurosurg ; 126: e1309-e1314, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30898751

RESUMO

OBJECTIVE: We evaluated the clinical efficacy of the Biocage in lumbar fusion surgery and its safety and effectiveness. METHODS: A total of 431 patients with single-segment lumbar degenerative disease diagnosed from January 2013 to December 2016 were considered for the present prospective, nonrandomized, and controlled study; 52 patient met the exclusion criteria and were excluded. The patients were divided into 2 groups according to their cage choice: Biocage (n = 206) and polyether ether ketone (PEEK) cage (n = 173). The patients were followed up for 24-48 months (average, 32). The operative time, blood loss, hospitalization duration, mean intervertebral fusion segment height, height of intervertebral foramen, fusion time, fusion rate, internal fixation failure rate, visual analog scale score, and Oswestry disability index were compared between the 2 groups. RESULTS: All the patients underwent surgery successfully. No significant differences were found in gender, age, clinical diagnosis, lesion segment, operative time, blood loss, visual analog scale score, or Oswestry disability index between the 2 groups. No significant differences were found in the fusion rate; however, the Biocage group had a greater fusion rate and shorter fusion time than the PEEK group. During follow-up, the mean intervertebral height recovered significantly in the Biocage group compared with the PPEK group (P < 0.05). The height of the intervertebral foramen was significantly different between the 2 groups, and recovery was better in the Biocage group (P < 0.05). The Cobb angle of fusion segment in both groups improved significantly postoperatively compared with preoperatively (P < 0.05). The improvement in Cobb angle was significantly different between the 2 groups (P < 0.05). CONCLUSIONS: The Biocage has excellent clinical efficacy in the treatment of lumbar degenerative disease. Although the Biocage achieved good therapeutic effects, it did not show obvious advantages compared with the PEEK cage. Therefore, the Biocage can only be used as a choice of bone graft materials for lumbar fusion surgery and should not completely replace the PEEK cage.


Assuntos
Bioprótese , Substitutos Ósseos , Degeneração do Disco Intervertebral/cirurgia , Fusão Vertebral/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Próteses e Implantes
20.
Brachytherapy ; 18(2): 217-223, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30638911

RESUMO

PURPOSE: We sought to investigate the feasibility and accuracy of computer-assisted techniques in the interstitial brachytherapy of the deep regions of the head and neck. MATERIALS AND METHODS: A computer-assisted brachytherapy workflow was applied to 10 patients with tumors in the deep regions of the head and neck. Based on the brachytherapy treatment preplan, we constructed a digital stereotactic model to accurately transfer the virtual plan into the navigation system, and subsequently printed the individual templates. The navigation system and the individual template were combined together to visualize and guide brachytherapy needle implantation. Preoperative and intraoperative image data were reconstructed and registered to measure and analyze the needle deviation. RESULTS: A total of 58 needles were successfully inserted in 10 patients with the guidance of computer-assisted techniques and a mean deviation of 5.2 mm. The inserting trajectories and depths of the needles were as follows: from the parotid and masseter regions to the infratemporal fossa or skull base, the range was 15.7-74.6 mm; from the submandibular and retromandibular regions to the infratemporal fossa or skull base, the range was 15.6-70.6 mm; from the infraorbital region to the pterygomandibular region, the range was 63.7-69.7 mm; and from the periorbital region to the intraorbital region, the range was 47.6-61.8 mm. The dose distribution met the treatment requirement well. CONCLUSIONS: The computer-assisted interstitial brachytherapy workflow was proven to be feasible and accurate for the deep regions of the head and neck.


Assuntos
Braquiterapia/métodos , Neoplasias de Cabeça e Pescoço/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Estudos de Viabilidade , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Agulhas , Tomografia Computadorizada por Raios X
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