Predictive value of admission CO2 combining power combined with serum sodium for the prognosis in acute Stanford type A aortic dissection patients.

Acute Stanford type A aortic dissection (ATAAD) with sudden onset and high mortality requiries a standard Bentall operation and a accurate prognosis in common, together with alteration of CO2 combining power (CO2CP) and serum sodium rase concern, hence, we evaluated the prognostic value of CO2CP combined with serum sodium in ATAAD patients. This retrospective study included 183 patients who underwent Bentall operation for ATAAD from 2015 to 2021 in the Fourth Hospital of Hebei Medical University, subsequently followed grouping by the levels of CO2CP and serum sodium. The study endpoint was 30-day all-cause mortality, and the prognostic value of CO2CP combined with serum sodium levels in ATAAD patients were evaluated with multivariate logistic regression method. The postoperative incidence of in-hospital death and adverse events in patients with ATAAD were 18% and 25.7%, respectively. Combination of CO2CP and serum sodium for predicting ATAAD death and adverse events presented a higher predictive value than each single indicator with ROC curve analysis (the AUC of CO2CP combined with serum sodium was 0.786, 95% CI 0.706-0.869, P < 0.001), along with CO2CP < 22.5 mmol/L + serum sodium > 138.5 mmol/L group had the worst prognostic. Multivariate regression analyse showed that CO2CP < 22.5 mmol/L combined with serum sodium > 138.5 mmol/L preferably predicted the prognosis of ATAAD (OR =6.073, 95% CI 2.557-14.425, P < 0.001). Consistently, the cumulative 30-day survival after surgery in ATAAD patients with the low CO2CP and high serum sodium simultaneously was the worst (log-rank P < 0.05). The combination of CO2CP and serum sodium increases the predictive value of prognosis, which is conducive to risk stratification of patients with ATAAD.

[A randomized controlled trial of two chemotherapy regimens (paclitaxel liposome combined with platinum and paclitaxel combined with platinum) in concurrent chemoradiotherapy for cervical carcinoma].

OBJECTIVE: To compare the efficacy, side effects and influence of two chemotherapy regimens, paclitaxel liposome combined with platinum and paclitaxel combined with platinum, on the survival rate in patients with cervical carcinoma receiving concurrent chemoradiotherapy. METHODS: One hundred and sixty two cases with primary cervical carcinoma diagnosed and treated in the Jiangxi Maternal and Children Hospital between January 2008 and November 2009 were enrolled in this randomized controlled trial. Seventy one cases were included in the paclitaxel group and 91 in the paclitaxel liposome group. The chemotherapy doses were as followings: paclitaxel liposome and paclitaxel 135 mg/m(2); cisplatin 80 mg/m(2) or carboplatin AUC 4 - 6, repeated every 21 days for two or three times. Radical radiotherapy was given to both groups at the same time. The efficacy was evaluated by the tumor regression and the patients were followed-up for six months. RESULTS: The overall response rates of paclitaxel group and paclitaxel liposome group were 90.1% and 89.0%, respectively (P > 0.05). The 1-year cumulative survival rate was 91.4% for the paclitaxel group and 89.2% for the paclitaxel liposom group (P > 0.05). The incidence rate of adverse effects such as rash, gastrointestinal toxicity, bone marrow suppression and muscle/joint pain in the paclitaxel liposome group was significantly lower than that in the paclitaxel group (P < 0.05), while there was no significant difference regarding the hair loss, liver damage, and peripheral neuritis (P > 0.05). CONCLUSIONS: Paclitaxel liposome plus platinum is a safe and effective therapeutic regimen for stage IIa-IV cervical carcinoma. However, the long-term efficacy of this regimen should be further observed.

[Efficacy of complications of different surgical treatments in cervical intraepithelial neoplasia III].

OBJECTIVE: To compare the rate of surgical complications and surgical failure of different surgical treatments in cervical intraepithelial neoplasia (CIN) III. METHODS: From Jan 2002 to Jun 2007, 1256 patients with CIN III confirmed by histopathologic punch biopsy and excision biopsy of cervical specimens were analyzed retrospectively. Among them, 74 patients accepted loop electrosurgical excision procedure (LEEP), 869 patients adopted cold knife conization (CKC), 49 patients received vaginal enlarged amputation of cervix, as well as 264 patients accepted external fascia hysterectomy, Chi-square test was used to compare the rate of surgical efficacy and complications of different surgical treatments. RESULTS: The surgical failure incidence of LEEP, CKC, vaginal enlarged amputation of cervix and external fascia hysterectomy were 4.1% (3/74), 0.2% (2/869), 0 and 0.4% (1/264) respectively, which was significantly higher in LEEP than that in CKC (P = 0.004) and external fascia hysterectomy (P = 0.034), while there was no statistical difference between CKC and external fascia hysterectomy (P = 0.549). The rate of surgical complications of LEEP, CKC, vaginal enlarged amputation of cervix and external fascia hysterectomy were 8.1% (6/74), 6.2% (54/869), 6.1% (3/49) and 2.3% (6/264) respectively, which were not statistically significant (P = 0.067) among them. CONCLUSION: LEEP, CKC, vaginal enlarged amputation of cervix and external fascia hysterectomy are all secure and effective procedures for patients with CIN III, who can take the individual choice depending on their different conditions.

[Analysis of 4223 hospitalized patients with cervical cancer during 1990-2007].

OBJECTIVE: To analyze the changes in epidemiology and treatment of hospitalized patients with cervical cancer during 1990-2007. METHODS: Overall, 4648 patients with cervical cancer were diagnosed in our hospital from Jan 1990 to Nov 2007, but only 4223 patients with initial treatment in our hospital were studied retrospectively. Pearson Chi-square test was used to compare the age, stage, histopathologic type and treatment methods between different times. RESULTS: (1) The mean age of cervical cancer patients gradually decreased over the past 18 years, from 54.4 years during 1990-1999 to 47.2 years during 2000-2007; the proportion of young patients aged < or = 35 years increased from 4.77% (89/1865) during 1990-1999 to 11.75% (277/2358) during 2000-2007. (2) The proportion of patients with cervical cancer (stage I a-II a) increased from 14. 32% (267/1865) during 1990-1999 to 40.75% (961/2358) during 2000-2007, whereas the proportion of patients with cervical cancer (stage II b-IV) decreased from 85.68% (1598/1865) during 1990-1999 to 59.25% (1397/2358) during 2000-2007. (3) There was no significant change in histopathologic type of cervical cancer, and squamous cell carcinoma of cervix remained the main type of cervical cancer. (4) The treatment pattern of cervical cancer changed significantly: radiotherapy was the main method (75.28%) for cervical cancer during 1990-1999, but during 2000-2007, it was replaced by concurrent chemoradiotherapy (35.79%). CONCLUSIONS: The proportion of young women with cervical cancer was increased during 1990-2007, and at the same period early stage cervical cancer increased, but late stage cervical cancer decreased. It is obvious that chemotherapy has become the important therapy in cervical cancer.

[Clinical analysis of 48 patients with vaginal enlarged amputation of cervix].

OBJECTIVE: To evaluate the feasibility and safety of vaginal enlarged amputation of cervix to treat patients with cervical cancer of stage Ia1 and cervical intraepithelial neoplasia grade III (CIN III) who were unfit for conization surgery. METHODS: From July 2002 to May 2007, patients with cervical cancer at stage Ia1, diagnosed by pathology after loop electrosurgical excision procedure (LEEP), large area CIN III (the area of lesion>or=3/4 on colposcopy), CIN III coexisted with vaginal intraepithelial neoplasia (VAIN) in the superior segment of vagina, CIN II-III recurrence or with residual lesion, positive margin after conization of cervix, who wanted to preserve fertility and (or) corpus uteri were selected to receive vaginal enlarged amputation of cervix. RESULTS: Forty-eight cases including 5 with cervical cancer in stage Ia1, 38 with large area CIN III (9 with gland involvement), 2 with residual lesion and 2 with positive margin after LEEP, 1 recurrence after cold knife conization, received the procedure successfully. The median age was 34 years (range 27-40), median operation time was 60 minutes (range 30-100), median blood loss was 40 ml (range 5-300), and median hospital stay was 10 days (range 7-17). After follow-up 1-39 months, no patient had postoperative complications and recurrence, and all patients resumed normal menstrual cycle and sexual life. CONCLUSION: Vaginal enlarged amputation of cervix appears to be a safe and feasible procedure for patients with cervical cancer at stage Ia1 and CIN III who are unfit for conization surgery.