Objective: To discuss the rationality of stage pT3 in the AJCC 8(th) TNM criteria of gallbladder carcinoma. Methods: A retrospective study was performed to analyze the clinical and pathological data of 88 patients with pT3 gallbladder carcinoma admitted to Department of Second Biliary Surgery of Eastern Hepatobiliary Surgery Hospital, affiliated to Naval Medical University from May 2013 to September 2018.pT3 stage tumors were divided into two groups: (1) pT3a stage: tumors had penetrated serosa but not directly invaded liver and/or an adjacent organ or structure; (2) pT3b stage: tumor penetrating serosa and directly invaded liver and/or an adjacent organ or structure. There were 45 patients with pT3a stage, including 15 males and 30 females, aged 36 to 80 years, with a median age of 59 years; 43 patients with pT3b, including 24 males and 19 females, aged 41 to 78 years old, median aged 63 years old.Patients with pT3a and pT3b were further divided into two groups respectively: radical resection group and extended radical resection group according to surgical radicalization. Independent sample t-test was used for comparison between two groups with normal distribution measurement data. Wilcoxon rank sum test was used between groups of non-normally distributed measurement data.The comparison of the count data was performed by χ(2) test or Fisher exact probability method. Survival analysis was performed using Kaplan-Meier method, and survival rate was compared using Log-rank test. Results: (1)Serum total bilirubin(15.6(90.3)mmol/L), albumin(40.2(4.8)mmol/L), and CA19-9(132.90(455.78)U/ml) levels in pT3b patients were higher than that in pT3a patients(10.2(6.8)mmol/L, 41.8(4.9)mmol/L, 14.35(36.27)U/ml), respectively(Z=-3.816, -1.966, -3.739, all P<0.05),postoperative complication rate in pT3b patients(24.4%) was higher than that in pT3a patients(8.9%)(P<0.05),postoperative hospital stay(12(7)days) and overall hospital stay((26±17)days) of pT3b patients were longer than that of pT3a patients((10±5) days and (19±7)days) (P<0.05). (2) The 1-, 3-, 5-year survival rates of pT3b and pT3a patients were 53%,22%,22% and 69%, 46%,38%,and the median survival time was 13 months and 26 months, respectively. The difference in survival rates between the two groups was statistically significant(χ(2)=5.117, P=0.024). (3)The 1-, 3-year survival rates of extended radical resection group(n=19) and radical resection group(n=24) in the pT3b stage were 73%, 36% and 28%, 7%, respectively.The survival time was 20 months and 9 months,respectively,and the difference in survival rates between the two groups was statistically significant(χ(2)=4.976, P=0.026). Conclusions: pT3 gallbladder carcinoma could be further subdivided into pT3a stage and pT3b stage based on the TNM criteria of AJCC 8(th) gallbladder carcinoma. Extended radical resection for pT3b gallbladder carcinoma should be further considered after comprehensive assessment of the patient's basic condition and surgical tolerance.目的： 探讨AJCC第8版胆囊癌TNM分期中pT3期分期的合理性。 方法： 回顾性收集2013年5月至2018年9月海军军医大学东方肝胆外科医院胆道二科收治的88例pT3期胆囊癌患者的临床和病理学资料。将pT3期进一步分为：（1）pT3a期：肿瘤穿透浆膜，但未直接侵入肝脏和（或）一个邻近器官或结构；（2）pT3b期：肿瘤穿透浆膜且直接侵入肝脏和（或）一个邻近器官或结构。pT3a期患者45例，其中男性15例，女性30例，年龄36~80岁，中位年龄59岁；pT3b期患者43例，其中男性24例，女性19例，年龄41~78岁，中位年龄63岁。根据手术根治情况将pT3a期和pT3b期患者进一步分为胆囊癌根治术组和胆囊癌扩大根治术组。符合正态分布计量资料的组间比较采用独立样本t检验；不符合正态分布计量资料的组间比较采用Wilcoxon秩和检验。计数资料的比较采用χ(2)检验或Fisher确切概率法。生存分析采用Kaplan-Meier法，生存率的比较采用Log-rank检验。 结果： （1）pT3b期患者的血清总胆红素[15.6（90.3）mmol/L]、白蛋白[40.2（4.8）mmol/L]、CA19-9[132.90（455.78）U/ml]水平高于pT3a期患者[10.2（6.8）mmol/L、41.8（4.9）mmol/L、14.35（36.27）U/ml]（Z=-3.816、-1.966、-3.739，P值均<0.05），pT3b期患者术后并发症发生率（24.4%）高于pT3a期患者（8.9%）（P<0.05），术后住院时间[12（7）d]和总体住院时间[（26±17）d]长于pT3a期患者[（10±5）d和（19±7）d]（P值均<0.05）。（2）pT3b和pT3a期患者的1、3、5年累积生存率分别为53%、22%、22%和69%、46%、38%，中位生存时间分别为13个月和26个月，两组生存率的差异有统计学意义（χ(2)=5.117，P=0.024）。（3）pT3b期患者中行胆囊癌扩大根治术患者（n=19）和胆囊癌根治术患者（n=24）的1、3年累积生存率分别为73%、28%和36%、7%，中位生存时间分别为20个月和9个月，两组生存率的差异有统计学意义（χ(2)=4.976，P=0.026）。 结论： pT3期胆囊癌在AJCC第8版胆囊癌TNM分期的基础上可进一步细分为pT3a期和pT3b期。将pT3b期胆囊癌患者的基础状况、手术耐受情况等综合评估后可选择合适的患者行胆囊癌扩大根治术。.
The aim of this study was to evaluate the diagnostic and prognostic role of staging laparoscopy in gallbladder carcinoma (GBC).From January 2007 through December 2010, 79 GBC patients without evidence of metastatic disease on preoperative imaging underwent staging laparoscopy. Peritoneal and liver metastases were assessed by a single surgeon in a systematic manner. Resection rate, safety, and survival analysis were compared between the laparoscopy group and no laparoscopy group.Disseminated disease was detected in 27 patients and no further surgery was performed; the overall accuracy for detecting unresectable disease was 67.5% (27/40), with 39 (75%) and 27 (51.9%) receiving resection and curative resection. In 203 GBC patients undergoing laparotomy, 90 (44.3%) and 53 (26.1%) patients received resection and curative resection; therefore, the resection rate and curative resection rate were significantly much higher in the laparoscopy group (p < 0.000).Staging laparoscopy in GBC is sensitive in detecting disseminated disease and increases the curative resection rate, shortens the recovery time, and has no negative implications on overall survival; therefore, we suggest the routine use of staging laparoscopy in patients with GBC without evidence of disseminated disease on preoperative imaging.
OBJECTIVE Evaluation of imaging navigation system during endoscopic sinus surgury and compared endoscopic sinus surgery with and without image guidance, analyzing a number of parameters that can impact on efficacy. METHODS Retrospective review of 76 imaging-navigated endoscopic sinus surgery with image-guidance systems at our department between Jan 2000 and May 2003, including 20 consecutive pituitary adenoma patients and 10 nasal-sinus ossifying fibroma. The control group consisted of 10 nasal-sinus ossifying fibroma patients between Jan 1997 and May 2003 and 20 consecutive pituitary adenoma patients between Jan 1999 and May 2003 who underwent ESS without image guidance. The main outcomes measured were analysis of the using times of different diseases, the user's satisfication in different diseases, and compared pituitary adenoma/ossifying fibroma ESS with and without image guidance. RESULTS The using times of different diseases are different, the user feel satisfication in all cases but the degree is different with diseases. The patient's characterisitics of the two groups of pituitary adenoma/ossifying fibroma were similar in age and gendle. There are no statistically significant differences in estimated blood loss, operative time, anesthesia time. CONCLUSION Imaging navigation systems in different nasal-sinus diseases are all useful. Our experience illustrates the importance of the learning curve, we believe that the problems we had with those systems were largely operator-dependent and that these can be overcome with proper experience and training. For small group patients, it's no evidence to show in ESS can make more complete resection of nasal-sinus ossifying fibroma, but has evidence to show no more cost.
Objective To determine whether preimplantation genetic testing for aneuploidy (PGT-A) can improve the pregnancy outcomes of patients aged under 38 years who have a history of recurrent implantation failure(RIF). Design Retrospective cohort study. Methods We retrospectively studied the pregnancy outcomes of RIF patients aged under 38 years from January 2017 to December 2021.178 patients were divided into two groups according to whether they underwent PGT-A: the PGT-A group(n=59)and the control group(n=119).In the PGT-A group, we compared the euploidy rate of the different quality and developmental rate blastocysts. In both groups,the patients were the first frozen-thaw single blastocysts transfer after the diagnosis of RIF. Among the pregnancy outcomes, the clinical pregnancy rate was assessed as the primary outcome. The spontaneous abortion rate and ongoing pregnancy rate were the secondry outcomes. The generalized estimation equation was used to adjust for the blastocysts derived from the same patients. Multivariate logistic analysis models were used to compare the pregnancy outcomes between the two groups. Results In the PGT-A group, 293 blastocysts obtained from59 patients underwent PGT-A. The proportions of euploidy, aneuploidy and mosaic blastocysts were 56.31%, 25.60% and 18.09%, respectively. A comparison of the euploidy rates of different quality blastocysts showed that the rate of good-quality blastocysts was significantly higher than that of poor-quality blastocysts (67.66% vs 46.88%; odds ratio [OR], 2.203; 95%confidence interval[CI], 0.943–3.612; P=0.002). However, no significant difference was observed in the different developmental rates blastocysts. Compared with Day 5 blastocysts, the euploidy rates of Day 6 and Day 7 blastocysts were not significantly different(61.54%vs51.91%; OR,0.945; 95%CI, 0.445–2.010; P=0.884; and 61.54%vs47.37%; OR, 1.106; 95%CI, 0.774–1.578; P=0.581, respectively).As for the pregnancy outcomes, the clinical pregnancy rate was significantly increase after the use of PGT-A compared with the control group(71.19%vs56.30%; OR, 0.538; 95%CI, 0.262–1.104; P=0.039). However, the spontaneous abortion rates and ongoing pregnancy rates were not significantly different between the control and PGT-A groups (21.43% vs 19.40%; aOR,0.727; 95%CI,0.271–1.945; P=0.525; and55.93% vs 45.38%; aOR, 0.649; 95%CI, 0.329–1.283; P = 0.214,respectively). Conclusion PGT-A improved the clinical pregnancy rate after blastocyst transfer in RIF patients aged under 38 years.
Objective To investigate whether patients with a history of recurrent implantation failure (RIF) are associated with adverse perinatal outcomes in singleton live births following frozen-thawed embryo transfer (FET) cycles. Design Retrospective cohort study. Methods This study analyzed the obstetric and neonatal outcomes of patients with and without a history of RIF who underwent FET cycles in a single reproductive center between January 2017 and October 2020. A total of 1,100 women with singleton live births beyond 28 weeks of gestation were included. The primary outcome measures were perinatal outcomes, especially gestational age, birthweight, preterm birth (PTB), large for gestational age (LGA), small for gestational age (SGA), congenital malformation rates, and premature rupture of the membranes (PROM). Multiple logistic regression was used to establish relationships between RIF and adverse perinatal outcomes after adjusting for relevant baseline demographics and cycle characteristics. Result(s) The RIF group showed a preferred transfer of two embryos and cleavage embryos compared with the control group ( P < 0.05). Regarding perinatal outcomes in singleton deliveries, women with RIF had increased rates of LBW (adjusted odds ratio [aOR] 2.027; 95% confidence interval [CI], 1.025–4.009), PTB (aOR 1.785; 95% CI, 1.050–3.036), and PROM (aOR 2.259; 95% CI, 1.142–4.467). The incidence of congenital malformations was similar between the two groups (4.1% vs. 2.4%; P = 0.759). Furthermore, multiple intrauterine procedures were associated with a statistically significant increased risk of PROM in RIF patients (aOR 1.537; 95% CI, 1.105–2.137). Conclusions Women with a history of RIF were associated with an increased risk of LBW, PTB, and PROM in singleton live births after FET cycles. In addition, multiple intrauterine procedures were independent risk factors for PROM.
Load and resistance factor design (LRFD), also known as partial factor design, is becoming a design method of choice in geotechnical practice. The partial factors (i.e., resistance factor and load factor) to ensure safety are specified in the adopted code; however, engineers still need to select values for the uncertain soil parameters in a design. The selection of these parameter values, often called characteristic values, is quite challenging given soil variability and limited test data. This paper presents a fractile-based method for the selection of the characteristic values for the uncertain soil parameters in a design with LRFD. A framework that considers safety, cost, and robustness is established to determine an appropriate fractile for selecting the characteristic values. This framework is demonstrated with two examples, a drilled shaft in sand and a shallow spread foundation. The results show that robust designs can be achieved using LRFD with the characteristic values obtained through the proposed fractile-based method.
Objective To summarize experience of diagnosis and treatment of the mucin-producing bile duct tumors(MPBTs). Methods Clinicopathological features of 7 patients with MPBT undergoing surgery from Nov 2002 to May 2005,were retrospectively reviewed.The clinical radiography characteristics and the resection type were summarized respectively. Results Fluctuant iaundice was the most common manifestation of MPBTs,with different characteristics of magnetic resonance cholangiopancreatography when compared with gallbladder carcinoma,hilar cholangiocarcinoma and distal bile duct cancer.All the 7 patients with MPBT underwent successful surgical resection and were cured. Conclusion Appropriate diagnosis and treatment of MPBTs made it possible to achieve long-term survival of these patients.
Key words:
Biliary tract neoplasms; Pathology,clinical; Diagnosis; Therapy; Mucin-producing
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