Objective To summarize the clinical characteristics and surgical treatment experience of 1 106 patients with cardiac myxoma. Methods Clinical data of 1 106 patients with cardiac myxoma who underwent surgical treatment in Beijing Anzhen Hospital from 2002 to 2018 were retrospectively analyzed. There were 749 (67.7%) females and 357 (32.3%) males. Results The highest incidence rate was at the age of 51-70 years. The location of the disease was: left atrium in 987 (89.2%) patients, right atrium in 99 (9.0%) patients, left ventricle in 10 (0.9%) patients, right ventricle in 8 (0.7%) patients. There were 1 013 patients of heart classification (NYHA) Ⅰ-Ⅱ and 93 patients of Ⅲ-Ⅳ. There were 301 patients with cerebral infarction and 57 patients with peripheral arterial embolism. Tumor size was closely related to hemodynamic symptoms (P≤0.05), but not to peripheral vascular embolism (P>0.05). Two (0.2%) patients died in hospital and 306 patients were followed up, with a follow-up rate of 27.7%. The median follow-up time was 7 years (range, 1-18 years). One patient died of all causes, and 23 patients recurred, with a recurrence rate of 2.1%. Among 23 recurrent patients, 15 (65.2%) patients were atypical myxoma and 8 (34.8%) patients were typical myxoma. There was no statistical difference in aortic clamping time, ICU stay time, ventilator-assisted breathing time, postoperative hospital stay time, postoperative mortality, or cardiac ejection fraction at discharge between the reoperation in 23 recurrent patients and the first operation in 1 083 non-recurrentpatients. Conclusion Cardiac myxoma is more common in middle-aged and elderly women, and it often occurs in the left atrium. The size of cardiac myxoma can affect the hemodynamic changes. Surgical treatment is effective. Atypical myxoma is more common in recurrent patients, and the effect is still satisfactory through surgical treatment.
Objective To introduce the surgical technique and results of total mesorectal excision (TME) for rectal cancer. Methods Reviews.Results As a result of TME, local recurrence rates have declined from 20%-30% to 3%-8%, 5-year survival rate have risen to 75%, and the rates of sphincter preservation have risen too.Conclusion Total mesorectal excision reduces the local recurrence rates and raise the survival figures after excision of rectal cancer. Patients have a high quality of life.
Prostate cancer is the most common malignant tumor in male urinary system, and the morbidity and mortality rate are increasing year by year. Traditional imaging examinations have some limitations in the diagnosis of prostate cancer, and the advent of molecular imaging probes and imaging technology have provided new ideas for the integration of diagnosis and treatment of prostate cancer. In recent years, prostate-specific membrane antigen (PSMA) has attracted much attention as a target for imaging and treatment of prostate cancer. PSMA ligand positron emission tomography (PET) has important reference value in the diagnosis, initial staging, detection of biochemical recurrence and metastasis, clinical decision-making guidance and efficacy evaluation of prostate cancer. This article briefly reviews the clinical research and application progress on PSMA ligand PET imaging in prostate cancer in recent years, so as to raise the efficiency of clinical applications.
Objective To observe efficacy of rapamycin combined with sorafenib in hepatocellular carcinoma (HCC) patients with tumor recurrence after liver transplantation beyond Milan criteria. Methods Forty-one beyond Milan criteria HCC patients who underwent the classic orthotopic liver transplantation without bypass and the tumor postoperatively recurred in the Tianjin First Center Hospital from February 1, 2012 to August 31, 2015 were collected retrospectively, then were divided into a local treatment group (n=21) and a comprehensive treatment group (n=20). The local treatment included the surgical resection, radiofrequency ablation, transcatheter arterial chemoembolization, radioactive seed implantation, etc.. The comprehensive treatment was on the basis of the local treatment plus rapamycin in combination with sorafenib. Results There were 12 patients with stable disease and 9 patients with progressive disease in the local treatment group. There were 12 patients with partial response, 10 patients with stable disease and 8 patients with progressive disease in the comprehensive group. In the local treatment group and the comprehensive treatment group, the median survival time were 9 months and 12 months, and the 1-year and 2-year survival rates after the recurrence were 14% versus 55%, 0 versus 15%, respectively. The survival of the comprehensive treatment group was significantly better than that of the local treatment group (P<0.01). Conclusion Combination of rapamycin and sorafenib in HCC patients with tumor recurrence after liver transplantation beyond Milan criteria can significantly improve survival time of patient with recurrence.
ObjectiveTo investigate the impact of elevated fasting blood glucose (FBG) level after open radical hepatectomy on the early recurrence of hepatocellular carcinoma (HCC).MethodsThe clinical data of 112 patients with HCC who underwent the open radical hepatecomy from January 2013 to December 2014 in the Affiliated Hospital of Qingdao University were retrospectively analyzed. After the radical resection of HCC, 86 patients with level of FBG 3.9–6.1 mmol/L and 26 patients with level of FBG≥6.1 mmol/L were design into a normal FBG group and an elevated FBG group, respectively. The recurrence rates of HCC were compared between the two groups at 1- and 2-year after the opreation.ResultsThere were no significant differences between the 2 groups in the gender, age, history of alcohol drinking, hepatitis B history, preoperative ALT, AST, AFP and Child-Pugh classification, scope of hepatectomy, intraoperative hemorrhage, hepatic blood flow occlusion, diameter of maximal tumor, histopathological differentiation, tumor number, cirrhosis, satellite lesion, postoperative adjuvant TACE treatment or not (P>0.05). The postoperative 1- and 2-year recurrence rates of HCC were 19.8% (17/86) and 33.7% (29/86) in the normal FBG group and 42.3% (11/26) and 61.5% (16/26) in the elevated FBG group, respectively, showing significant differences between the 2 groups (P<0.05). The results of multivariate analysis showed that the level of FBG≥6.1 mmol/L, low histopathological differentiation, and no postoperative TACE treatment were the independent risk factors affecting tumor-free survival rate after the open radical resection of HCC (P<0.05). ConclusionsElevated FBG level after open radical resection has a stimulative effect on early recurrence of HCC. As a result, monitoring and controlling of FBG level after operation is helpful in decreasing early recurrence rate of patients with HCC.
Objective To investigate the clinical features, treatment methods, and prognostic influence factors of patients with malignant peripheral nerve sheath tumor (MPNST). MethodsA retrospective analysis was conducted on 96 MPNST patients treated between January 1, 2015 and December 31, 2021. There were 46 males and 50 females, aged between 15 and 87 years (mean, 48.2 years). The tumors were located in the trunk in 50 cases, extremities in 39 cases, and head and neck in 7 cases. The maximum tumor diameter was <5 cm in 49 cases, ≥5 cm in 32 cases, with 15 cases missing data. Tumor depth was deep in 77 cases and superficial in 19 cases. The Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) histological grading was G1 in 9 cases, G2 in 12 cases, and G3 in 34 cases, with 41 cases missing data. There were 37 recurrent MPNST cases, 32 cases with neurofibromatosis type 1 (NF1), and 26 cases in stage Ⅳ. Postoperative adjuvant radiotherapy was administered to 25 patients, perioperative chemotherapy to 45 patients, and anlotinib-targeted therapy to 30 patients. R0 resection was achieved in 73 cases. Patients were divided into groups based on the presence or absence of NF1, and baseline data between the two groups were compared. Kaplan-Meier curves were generated to assess disease-free survival (DFS) and overall survival (OS) based on various factors (age, gender, presence of NF1, recurrent MPNST, stage Ⅳ MPNST, FNCLCC grade, R0 resection, tumor location, tumor size, tumor depth, perioperative chemotherapy, postoperative adjuvant radiotherapy, and anlotinib-targeted therapy), and differences between survival curves were analyzed using the Log-Rank test. Multivariate COX proportional hazards regression was used to identify independent prognostic factors for MPNST. Results Patients with NF1 had a significantly higher proportion of superficial tumors and lower FNCLCC grade compared to those without NF1 (P<0.05); no significant difference was found for other variables (P<0.05). Kaplan-Meier analysis showed that recurrent MPNST, stage Ⅳ MPNST, FNCLCC grade, R0 resection, perioperative chemotherapy, and anlotinib-targeted therapy were factors influencing 1-year DFS (P<0.05), while stage Ⅳ MPNST, FNCLCC grade, and perioperative chemotherapy were factors affecting 3-year OS (P<0.05). Multivariate COX proportional hazards regression analysis revealed that recurrent MPNST and high-grade FNCLCC (G3) were independent prognostic factors for 1-year DFS (P<0.05), while stage Ⅳ MPNST, superficial tumor depth, age over 60 years, postoperative adjuvant radiotherapy, and anlotinib-targeted therapy were independent prognostic factors for 3-year OS (P<0.05). Conclusion MPNST patients with NF1 tend to have more superficial tumors and lower FNCLCC grades. FNCLCC grade, R0 resection, and adjuvant therapies, including radiotherapy and anlotinib-targeted therapy, are closely associated with MPNST prognosis. Complete surgical resection should be prioritized in clinical management, along with adjuvant treatments such as radiotherapy and targeted therapy of anlotinib to improve patient outcomes.
Objective To summarize the current advancement of preoperative radiotherapy for rectal cancer. Methods Relevant literatures about current advancement of preoperative radiotherapy for rectal cancer published domesticly and abroad recently were collected and reviewed. Results The lower local recurrence rate and longer disease-free survival time were observed in preoperative radiotherapy， compared with postoperative radiotherapy for rectal cancer. The recurrence rate was higher in short-course radiotherapy， compared with conventionally radiotherapy for stageⅢrectal cancer， but there was no significant difference for stageⅡrectal cancer. The biology molecular such as p53， CEA， Cox-2， EGFR， and VEGF had shown to be radiosensitive. Conclusions The proposal of preoperative radiotherapy for rectal cancer， could be prone to conventionally radiotherapy. There are more screening targets for preoperative radiotherapy in extensive exploration of diverse radiosensitivity. Biology molecular， developed gene expression profiling， and gene chips for rectal cancer may contribute to the individualization treatment.
Objective To provide a clinical basis for the prevention of diabetic foot ulcers by analyzing the clinical data and prognosis of high-risk diabetic foot patients. Methods A retrospective analysis was performed on high-risk diabetic foot patients who were hospitalized in West China Hospital of Sichuan University between January 1, 2012 and December 31, 2018. Patients were divided into high-risk group and low-risk group according to whether they hada history of foot ulcer or amputation. The clinical characteristics of the two groups of patients were compared. The patients were followed up from hospital discharge to January 31, 2021, and their survival and ulcer recurrence or new-onset status were evaluated. Results Finally, 123 patients were included, including 29 patients in the high-risk group and 94 patients in the low-risk group. There was no statistical difference in the duration of diabetes, smoking history, drinking history, education level, proportion of receiving regular treatment, proportion of regular blood glucose monitoring, body mass index, proportion of diabetic peripheral neuropathy, callus, foot deformity, diabetic nephropathy, diabetic retinopathy, diabetic cardiac autonomic neuropathy, diabetic gastrointestinal autonomic neuropathy, hypertension, coronary heart disease and laboratory test results between the two groups (P>0.05). The proportion of women (51.7% vs. 29.8%), age [(69.8±10.3) vs. (64.4±11.3) years], proportion of lower extremity arterial disease (62.1% vs. 34.4%), proportion of hyperuricemia (27.6% vs. 10.6%) in the high-risk group were higher than the low-risk group (P<0.05). After follow-up (67±20) months, 25.8% of the patients had ulcer recurrence or new onset, and 24.2% of the patients died. The most common cause of death was diabetes complications (43.8%). The overall 1-, 3-, and 5-year cumulative mortality rates of the patients were 4.5%, 12.7%, and 20.6%, respectively. The 3- and 5-year recurrence or new ulcer rates were 8.3% and 18.2%, respectively. The 5-year recurrence or new ulcer rates in the low-risk group and high-risk group were 10.3% and 40.3%, respectively, and there was a difference in ulcer recurrence between the two groups (P=0.004). Conclusions Compared with high-risk diabetic foot patients without ulcer or amputation, patients with a history of ulcer or amputation have higher rates of lower extremity arterial disease and hyperuricemia. Patients with a history of ulceration or amputation have a higher risk of recurrent or new ulceration than patients without a history of ulceration or amputation.
Objective The aim of this article is to analyze the clinical characteristics of intra-abdominal aggressive fibromatosis and discuss its treatment methods. Methods Retrospective analysis of the clinical data in 8 cases of intra-abdominal aggressive fibromatosis who were confirmed by surgery and pathological diagnosis between Feb. 2011 and Mar. 2017 in Shengjing hospital was performed. Results Of the 8 cases (3 males and 5 females), there were 4 cases of simple abdominal pain (2 cases of repeated intermittent abdominal pain and 2 cases of acute abdominal pain), 3 cases of abdominal mass, and 1 case of relapses after surgery in outside hospital (others 7 cases were the first visit). The course of disease was 4 to 720 d, with median of 130 d. All cases underwent radical surgery, and the operative time was 92 to 493 min, with an average of 246 min. Intraoperative blood loss was 20 to 1 000 mL, with an average of 321 mL. The drainage tube placement time in all patients was 5 to 9 d, with an average of 6 d. The hospital stay was 11 to 75 d, with an average of 25 d. Two cases suffered from postoperatively appeared abdominal pain symptoms. All cases were followed-up for 6 to 40 months, with median of 23 months. During the follow-up period, 1 case relapsed on 212 dafter surgery, and the remaining 7 cases had no recurrence. Conclusion For intra-abdominal aggressive fibromatosis, it is difficult to make clear diagnosis before operation and surgery is the primary choice of treatment when symptom appeared.
ObjectiveTo predict the risk factors affecting postoperative recurrence of granulomatous lobular mastitis (GLM) in the mass stage by machine learning algorithm, and to provide a reference for the early identification and prevention of postoperative recurrence of GLM in the mass stage. MethodsThe electronic medical records and follow-up data of patients with GLM in the Department of Breast Disease Unit, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from October 2020 to January 2023 were selected. A total of 340 patients with GLM in the mass stage who met the inclusion and exclusion criteria were selected as the research subjects. According to whether the patients relapsed after surgery, they were divided into recurrence group and non-recurrence group. The collected cases were randomly divided into training set and test set according to the ratio of 7:3. In the training set, the recurrence prediction model was constructed by using traditional logistic regression and three machine learning algorithms: artificial neural network, random forest and XGBoost (extrem gradient boosting). In the test set, the performance of the model was evaluated by sensitivity, specificity, accuracy,positive predictive value, negative predictive value, F1 value and area under the curve (AUC) value. The Shapley Additive exPlanation (SHAP) method was used to explore the important variables that affect the optimal model in identifying postoperative recurrence in the GLM mass phase. The optimal risk cutoff value of the prediction model was determined by the Youden index. Based on this, the postoperative patients in the GLM mass phase of the external test set were divided into high-risk and low-risk groups. ResultsA total of 392 patients who met the GLM mass stage were included, and 52 cases were excluded according to the exclusion criteria, and 340 cases were finally included, including 60 cases in the recurrence group and 280 cases in the non-recurrence group. Based on the results of univariate analysis, correlation analysis and clinically meaningful influencing factors, 12 non-zero coefficient characteristic variables were screened for the construction of the prediction model, and these 12 characteristic variables included other disease history, number of miscarriages, breastfeeding duration of the affected breast, history of milk stasis, lesion location, nipple indentation, fluctuation sensation, low-density lipoprotein, testosterone, previous antibiotic therapy, previous oral hormone medication, and perioperative traditional Chinese medicine treatment duration. The logistic regression prediction model, artificial neural network, random forest and XGBoost prediction models were constructed, and the results showed that the accuracy, positive predictive value and negative predictive value of the four prediction models were all >75%, among which the XGBoost model had the best performance, with accuracy, specificity, sensitivity, AUC, positive predictive value, negative predictive value and F1 values of 0.93, 0.99, 0.65, 0.87, 0.92, 0.93 and 0.76, respectively. SHAP method found that the duration of traditional Chinese medicine treatment during perioperative period, the duration of breast-feeding on the affected side, low density lipoprotein, testosterone and previous hormone drugs were the top five factors affecting XGBoost model to identify postoperative recurrence of GLM in mass stage. ConclusionsCompared with the traditional Logistic regression prediction model, the models based on machine learning for identifying postoperative recurrence in the GLM mass phase showed better performance, among which the XGBoost model performed best. Targeted preventive measures can be given based on the above risk factors to improve the postoperative prognosis of the GLM mass phase.