ObjectiveTo evaluate the effectiveness of preoperative immunosuppressive therapy combined with surgical intervention. MethodsA retrospective study was conducted on Behçet's disease patients who underwent cardiac surgery at Guangdong Provincial People's Hospital from 2012 to 2021. Patients were divided into immunosuppressive group and non-immunosuppressive group based on whether they received immunosuppressive therapy before surgery. The complications and long-term survival rates of the two groups were analyzed. ResultsA total of 28 patients were included, among which 2 patients underwent reoperation, a total of 30 surgeries were performed, including 16 males (53.3%), and the confirmed age was 37 (31, 45) years old. There were 15 surgeries in the immunosuppressive group and 15 surgeries in the non-immunosuppressive group. Compared with the non-immunosuppressive group, the incidence of complications during hospitalization in the immunosuppressive group was lower (13.3% vs. 53.3%, P=0.008). One patient died in hospital, and the rest were discharged and followed up, with a median follow-up time of 38.7 (15.1, 57.3) months, and there was no statistically significant difference in long-term survival rate between the two groups (26.7% vs. 6.7%, P=0.158). There was no statistically significant difference in the cumulative incidence of complications one month (20% vs. 53%, P=0.058) and one year (27% vs. 60%, P=0.065) after surgery between the immunosuppressive group and the non-immunosuppressive group, but there was a statistically significant difference in the cumulative incidence of complications three years after surgery (47% vs. 92%, P=0.002). ConclusionSurgical treatment can save lives in Behçet's disease patients with cardiovascular diseases, but the incidence of postoperative complications is high. Timely use of immunosuppressants before cardiovascular surgery can reduce the incidence of postoperative complications.
Objective To evaluate early to medium-term effectiveness of total hip arthroplasty (THA) in patients with a history of hip preservation surgery with secondary severe osteoarthritis for developmental dysplasia of the hip (DDH). Methods The clinical data of 25 DDH patients (31 hips) who had severe osteoarthritis after hip preservation surgery and received THA between September 2009 and March 2021 were retrospectively analyzed. There were 1 male and 24 females; the age ranged from 18 to 65 years, with an average age of 43 years; 8 hips were classified into Crowe type Ⅰ, 9 hips were type Ⅱ, 3 hips were type Ⅲ, and 11 hips were type Ⅳ. The time between osteotomy and THA ranged from 31 to 51 years, with an average of 31.96 years. Preoperative hip flexion range of motion was (69.31±29.72)°, abduction range of motion was (24.00±14.79)°; and Harris hip score was 45.3±15.5. Postoperative Harris hip score, hip range of motion, complications, radiographic findings, and implant survival rate were analyzed. Results Patients in both groups were followed up 2-132 months, with an average of 51 months. During the follow-up, periprosthetic fracture occurred in 1 case; there was no complication such as dislocation, periprosthetic infection, nerve palsy, or deep vein thrombosis. At last follow-up, the hip flexion range of motion was (109.52±11.17)°, abduction range of motion was (41.25±5.59)°, showing significant differences when compared with preoperative values (t=8.260, P=0.000; t=6.524, P=0.000). The Harris hip score was 91.5±4.1, and the difference was significant when compared with preoperative score (t=11.696, P=0.000); among them, 13 cases were excellent and 12 cases were good. Radiographic evaluation showed that the center of acetabular rotation moved up 0-18 mm (mean, 6.35 mm). The cup abductor angle was 28°-49° (mean, 37.74°) and the coverage rate was 69.44%-98.33% (mean, 81.04%). All femoral stems were fixed in neutral position without varus or valgus. No osteolysis, radiolucent line, or implant migration was observed. By the end of follow-up, none of the patients underwent revision and the survival rate of prothesis was 100%. ConclusionTHA is still the gold standard for the treatment of DDH patients with secondary osteoarthritis after hip preservation surgery. The postoperative joint function can be rapidly restored, the patients’ quality of life can significantly improve, and the early to medium-term survival rate of the prosthesis is satisfactory.
Objective To use a meta-analysis method to establish quantitatively the association between the HER-2/neu gene amplification/enhanced protein expression status and the 5-year post-operative survival rate or median survival time in women with epithelial ovarian carcinoma. Methods We searched and screened Chinese and English literature published since 1989 to collect all retrospective cohort studies on the prognostic significance of HER-2/neu status in this population. The survival data were analyzed using Ludwig’s centered signed rank and the DerSimonian-Laird method. Results In total, 25 studies involving 3 251 patients were included. HER-2/neu was positive in 27.1% (95%CI 0 to 54.8%) of patients, which was not related to the pathological stage, type or grade of epithelial ovarian carcinoma. In HER-2/neu positive cases, the median survival time was shortened by 0.65 years, and the 5-year survival rate was lowered. The hazard ratio (HR) for mortality was 1.22 (95%C 1.09 to 1.36). By subgroup analysis, HER-2/neu protein expression was found to be most significant in prognostic assessment. Patients with a b positive value of HER-2/neu had an increased HR for the 5-year survival; and platinum-based chemotherapy was demonstrated to be less effective in HER-2/neu positive ovarian carcinoma. Conclusion In gynecological oncology, it is reasonable to measure HER-2/neu as a routine pathological marker to predict a patient’s prognosis and to determine the most appropriate adjuvant chemotherapy regimen.
Objective To evaluate the impact of transcatheter arterial chemoembolization（TACE） on survival and tumor recurrence in patients with primary liver cancer， provide reference of clinical diagnosis and treatment for the primary liver cancer patients. Methods Two hundred and twenty-two cases of primary liver cancer were divided into TACE group （n=110） and control group （n=110）， TACE was performed after operation in the TACE group， convention treatment was performed after operation in the control group. The survival and tumor recurrence rates were compared between the TACE group and control group. Results The 1-， 2-， and 3-year survival rates were 83.64%， 56.36%，and 42.73% in the TACE group， respectively， which were 65.45%， 40.91%， and 21.82% in the control group，respectively. The differences were statistically significant （P＜0.05）. The 1-， 2-， and 3-year tumor recurrence rates were 20.91%， 54.55%， and 67.27% in the TACE group， respectively， which were 38.18%， 57.27%， and 70.91% in the control group， respectively. The 1-year tumor recurrence rate in the TACE group was significantly lower than that in the control group （P＜0.05）， but the differences of the 2- and 3-year recurrence rates were not statistically significant（P＞0.05）. Conclusions TACE treatment for primary liver cancer patients can increase long-term survival， but can’tdecrease long-term recurrence.
Abstract: Objective [WTBZ]To evaluate the longterm effects of preoperative glucocorticoid treatment on postoperative complications and survival rates for patients receiving cardiac surgery. Methods [WTBZ] We selected 57 patients including 22 males and 35 females at an average age of 52.3±11.2 years in the First Hospital of China Medical University who took steroids for a long time because of various combined diseases from September 2002 to August 2009 in the trial group, and we chose another 171 patients including 62 males and 109 females at an average age of 53.6±9.2 years who were hospitalized at the same time and had comparative basic features in the control group. There was no statistical difference between the two groups in age, gender, and organ function. Different kinds of surgeries including coronary artery bypass grafting, heart valvuloplasty or valve replacement, coronary artery bypass grafting combined with heart valve replacement, and congenital heart disease surgery were performed on the patients. The proportion of surgeries carried out was similar in the two groups. Postoperative complications were compared between the two groups, and survival rates at the end of 6 months and one year followup were observed. Results [WTBZ]There was no statistical difference between the two groups in complications with respect to cardiopulmonary bypass (CPB) time (t=1.27, Pgt;0.05), reoperation for excessive postoperative bleeding (χ2=0.03, P=0.87), sternal and mediastinal infection (χ2=0.04, P=0.84), stroke (χ2=0.07, P=0.79), and gastrointestinal tract complications (χ2=2.89, P=0.09). The incidence of ventricular arrhythmia and requirement for intraaortic balloon pump in the trial group was higher, but no statistical difference was detected (χ2=2.24, P=0.13; χ2=2.20, P=0.14, respectively). Patients in the trial group were more likely to require prolonged ventilation (t=2.32, Plt;0.05), had higher rate of atrial fibrillation (χ2=4.09, P=0.04), and higher inhospital mortality (χ2=5.35, P=0.02). The sixmonth and oneyear survival rates were 0.79±0.10 and 0.73±0.12, respectively for the trial group, 0.94±0.09 and 0.86±0.10, respectively for the control group. Conclusion Longterm steroid treatment leads to higher atrial fibrillation incidence, longer ventilation time and increases the mortality rate following cardiac surgery.
ObjectiveTo analyze impact of body mass index (BMI) on postoperative complications and disease-free survival (DFS) after hepatectomy for patients with hepatocellular carcinoma (HCC). MethodsIn total, 858 patients with HCC underwent hepatectomy were analyzed by retrospective cohort study. Patients were divided into two groups according to BMI:normal group (18.5 kg/m2 < BMI < 25.0 kg/m2) and obesity group (BMI≥25.0 kg/m2). The clinical and postoperative follow-up data were collected and statistically analyzed. Results① Compared with the normal group, the preoperative HBV-DNA loading was significantly lower (P<0.05), albumin was significantly higher (P<0.05), intraopera-tive blood loss was significantly increased (P<0.05), operation time, and the first portal hepatis occlusion time were signifi-cantly prolonged (P<0.05) in the obesity group. The postoperative complications and hospital stay had no significant differences between these two groups (P>0.05). ② The results of univariate analysis showed that the preoperative HBV-DNA≥ 104 U/mL, total bilirubin >21 μmol/L, albumin <35 g/L, grade B of Child-Pugh, intraoperative blood loss >500 mL, and operation time >240 min were associated with the postoperative complications after hepatectomy for patients with HCC (P<0.05). The results of multivariate analysis showed that preoperative total bilirubin >21 μmol/L, albumin <35 g/L, and operation time >240 min were the independent risk factors for postoperative complications (P<0.05). ③ Kaplan-Meier analysis showed that the 3-year DFS in the obesity group was significantly better than that in the normal group (P<0.05). The results of multivariate analysis showed that the major blood vessel tumor thrombi, multicenter tumor, tumor diameter ≥5 cm, and operation time >240 min were the independent risk factors for DFS (P<0.05), while the obesity was the protective factor for DFS (P<0.05). ConclusionFor HCC patients who receiving hepatectomy, obesity does not increase risk of postoperative complications, and could increase 3-year DFS. Thus preoperative improvement of nutritional status of patient with HCC has a great significance.
Objective To comprehensively analyze the clinical outcomes of total cavopulmonary connection (TCPC) in the treatment of functional single ventricle combined with heterotaxy syndrome (HS). MethodsA retrospective analysis was conducted on the patients with functional single ventricle and HS who underwent TCPC (a HS group) in Guangdong Provincial People's Hospital between 2004 and 2021. The analysis focused on postoperative complications, long-term survival rates, and identifying factors associated with patient survival. Early and late postoperative outcomes were compared with matched non-HS patients (a non-HS group). Results Before propensity score matching, 55 patients were collected in the HS group, including 42 males and 13 females, with a median age of 6.0 (4.2, 11.8) years and a median weight of 17.0 (14.2, 28.8) kg. Among the patients, there were 53 patients of right atrial isomerism and 2 patients of left atrial isomerism. Eight patients underwent TCPC in one stage. TCPC procedures included extracardiac conduit (n=39), intracardiac-extracardiac conduit (n=14), and direct cavopulmonary connection (n=2). Postoperative complications included infections in 27 patients, liver function damage in 19 patients, and acute kidney injury in 11 patients. There were 5 early deaths. The median follow-up time was 94.7 (64.3, 129.8) months. The 1-year, 5-year, and 10-year survival rates were 87.2%, 85.3%, and 74.3%, respectively. After propensity score matching, there were 45 patients in the HS group and 81 patients in the non-HS group. Compared to the non-HS group, those with HS had longer surgical and mechanical ventilation time, higher infection rates (P<0.05), and a 12.9% lower 10-year survival rate. Multivariate Cox regression analysis identified asplenia was a risk factor for mortality (HR=8.98, 95%CI 1.86-43.34, P=0.006). ConclusionCompared to non-HS patients, patients with HS have lower survival rates after TCPC, and asplenia is an independent risk factor for the survival of these patients.
ObjectiveTo summarize the procedures of the shoulder arthroplasty and the evolution of the shoulder prosthesis, and to discuss the indications and contraindications of the several common shoulder arthroplastis. MethodsThe related literature on shoulder arthroplasty was extensively reviewed, summarized, and analyzed. ResultsAt present, shoulder arthroplasties can be classified into shoulder hemiarthroplasty, total shoulder arthroplasty, resurfacing shoulder arthroplasty, stemless shoulder arthroplasty, and reserve shoulder arthroplasty, etc. Each type of the prosthesis has several special indications and contraindications. Mostly, the shoulder arthroplasties achieved the satisfied results, such as pain-relief and restoration of the elevation and adduction of shoulder. The survival rate of the most shoulder prostheses may reach 10 years or more. ConclusionMost shoulder arthroplasties are effective and satisfied to treat the shoulder traumas and diseases in pain-free and functional restoration of shoulders.
Patients with brain metastases are more prone to developing life-threatening neurological symptoms. Initial therapies include surgery, whole brain radiotherapy (WBRT), and stereotactic radiotherapy. With the progress of stereotactic radiotherapy, the indication of stereotactic radiosurgery (SRS) is gradually expanding, and the indications for surgery and WBRT gradually narrowed. The existing studies have shown that SRS can significantly benefit patients who are <50 years old with single brain metastasis, but the specific scope of the application with SRS is still controversial, and a large number of the phase Ⅲ randomized multicenter trials designed around the controversies are also developing. This review summarizes the results of clinical research and came to the conclusion. Firstly, postoperative adjuvant SRS in the treatment of brain metastases is superior to postoperative adjuvant WBRT. Secondly, using SRS in the elderly patients with multiple brain metastases are safe and effective. Thirdly, the use of targeted therapy in patients with brain metastases thereby delaying SRS may lead to poor prognosis. The focus of future research include selection of optimal timing for adjuvant targeted therapy after SRS and the appropriate patient population, as well as prevention of recurrence and metastasis after lacal treatment.