Clinical features and therapeutic strategies of cervicocranial arterial dissection (CCAD) are still unclear. A retrospective review was conducted on 71 CCAD patients. Diagnosed by DSA and outcome evaluation was through mRS scores follow-up 12 months. All patients were allocated into three groups according to clinical situation: 1) subarachnoid hemorrhage (SAH), 2) ischemic symptoms and 3) mass effect. CCAD with anterior circulation arterial dissection (ACAD) had higher ischemia than that with posterior circulation arterial dissection (PCAD) (p=0.023). The non-aneurysmal dissection (NAD) patients were susceptible to ischemia (p=0.00) and patients with aneurismal dissection (AD) were more susceptible to SAH (p=0.001); The outcome of patients with SAH was significantly worse than patients with other manifestations (p=0.012). Following up one year, the outcome of CCAD involving posterior inferior cerebellar artery (PICA) was significantly worse than the other area (p=0.035). There was no statistically significant difference in mRS scores between endovascular treatment and conservative treatment (p=0.052) at one year follow-up. Patients suffering from SAH that received endovascular treatment experienced improved outcomes than patients with conservative treatment (p=0.033). The patients in the ACAD, NAD and extracranial CCAD groups were more likely to suffer from ischemia, while patients in the AD group were susceptible to SAH. CCAD with SAH or involving PICA had poor prognoses. The therapeutic efficacy of conservative treatment is nearly equal to endovascular treatment in CCAD patients follow up 12 months; however, endovascular treatment may decrease the risk of mortality for the patient with SAH. Keywords: cervicocranial arterial dissection, clinical features, conservative treatment, dissecting aneurysm, endovascular treatment, prognosis, vertebrobasilar artery
Peritoneal metastasis in gastric cancer is associated with rapid disease progression. Hyperthermic intraoperative peritoneal chemotherapy (HIPEC) done immediately after cytoreductive surgery (CRS) has become an important treatment for peritoneal metastasis in gastric cancer patients. However, different treatment options for HIPEC exist with potential influence on survival rates and prognosis in patients, exist. These treatment options include open or closed abdomen technique, perfusion solution, number of catheters, temperature, duration, and drug regimens. This paper aims to provide more evidence on standardization of HIPEC treatment options and technologies by systematically reviewing different drug regimens and technical approaches. The study included 2 randomized controlled trials, 3 phase I/II clinical trials, 2 prospective cohort studies, and 34 retrospective cohort studies, involving 1511 patients. The most common HIPEC option is to dissolve 50-75 mg/m
The incidence of synchronous and metachronous multiple primary lung cancers (MPLCs) has been increasing recently. The new multidisciplinary classification of lung adenocarcinoma and TNM Classification of Lung Cancer (7(th) edition, 2009), have improved the understanding of MPLC. Most researchers recommend that surgical therapy should be actively pursued if the patient's physical condition and lung function permit it and if a complete cure can be achieved. However, few studies have reported the long-term efficacy of surgical treatment for MPLC, which we explored in this study.A total of 1,290 Lung cancer patients from a prospectively maintained database, treated by a single surgeon group between January 2000 and July 2013, at Beijing Cancer Hospital, Peking University, were reviewed. We retrospectively analyzed the clinical data of 31 patients diagnosed with MPLC out of 1290 lung cancer patients, focusing on long-term survival.MPLC patients accounted for 2.4% (31/1,290) of the patient cohort: 27 had synchronous MPLC (87.1%) and 4 had metachronous MPLC (12.9%). The 1-, 3- and 5-year postoperative survival rates were 100%, 75.8% and 75.8%. On stratification according to TNM stage, the 1-, 3- and 5-year of patients with stage I cancer (20 patients) were 100%, 77.2% and 77.2%, not statistically significant with those for the entire cohort (1,290 patients; 95.4%, 80.5% and 66.2%, P=0.455).When the patient's physical condition and tumor-related factors permit it, surgery should be the first choice of treatment for MPLC; it is associated with an equivalent efficacy to that of surgery for single primary lung cancer.
The first choice of treatment for neck cancer is often radiotherapy. Therefore, we aimed to investigate the microinflammation after radiotherapy of the neck and the incidence of carotid stenosis. This study reports on patients treated with radiotherapy as part of the treatment for laryngeal cancer in the Department of Radiation Oncology, The Second Hospital of Jilin University, Changchun, P.R. China. Sixty-two males and nine females were treated with radiotherapy between 2006 and 3012. The carotid diameter was determined by measuring carotid intima-media thickness (IMT) in the common, external and internal carotid artery. Microinflammatory conditions were assessed by high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factoralpha (TNF-α). Other studied risk factors included age, treatment modalities, radiation dose and energy, the height of the radiation field, and follow-up time. Carotid stenosis was detected in all of the 71 patients. It was mainly clinically unsuspected; 19 patients had sustained a vascular event (14 TIA, 5 CVI) at a median of 3.11 years (range 2.35.6 years) following RT. In four of five CVI patients, CVI occurred on the side of the irradiation. Eleven patients who suffered vascular incident had severe stenosis of the carotid artery and 6 had moderate (31-49% of the lumen). Only two patients with mild stenosis on the irradiated side suffered TIAs. Serum hs-CRP levels in carotid stenosis were 9.4 (±SD=5.97) mg/ml, IL-6 = 12.8 (±SD=2.62) pg/ml and TNF-α = 15.4 (±SD=4.49) ng/ml. The clinical detection of asymptomatic carotid stenosis is challenging, and current recommendations regarding the follow-up period should be scrutinized.
Abstract The purpose of this study is to investigate the characteristics of intracranial vessel wall enhancement and its relationship with ischemic infarction in patients with Moyamoya vasculopathy (MMV). Forty-seven patients with MMV confirmed by angiography were enrolled in this study. The vessel wall enhancement of the distal internal carotid artery, anterior cerebral artery and middle cerebral artery was classified into eccentric and concentric patterns, as well as divided into three grades: grade 0, grade 1 and grade 2. The relationship between ischemic infarction and vessel wall enhancement was also determined. Fifty-six enhanced lesions were found in patients with (n = 25) and without acute infarction (n = 22). The incidence of lesions with grade 2 enhancement in patients with acute infarction was greater than that in those without acute infarction ( p = 0.011). In addition, grade 2 enhancement of the intracranial vessel wall was significantly associated with acute ischemic infarction (Odds ratio, 26.7; 95% confidence interval: 2.8–258.2; p = 0.005). Higher-grade enhancement of the intracranial vessel wall is independently associated with acute ischemic infarction in patients with MMV. The characteristics of intracranial vessel wall enhancement may serve as a marker of its stability and provide important insight into ischemic stroke risk factors.
Background The current study aimed to determine the oncological efficacy and surgical safety of multiple pulmonary resections (MPRs) after prior curative surgery for local regional recurrent or second primary lung cancers. Methods All cases of lung cancer included in our prospective database between January 2000 and July 2015 were retrospectively reviewed. The oncological efficacy endpoints for synchronous and metachronous MPR were five‐year overall survival (OS), disease‐free survival (DFS), and progression‐free survival (PFS) rates after the second surgery. The surgical safety endpoints were postoperative mortality and complications (Clavien‐Dindo classification) within 30 days. Results In total, 67 MPR cases were identified. There were no significant differences in the five‐year OS and DFS between the synchronous MPR group ( n = 50) and the propensity score‐matched solitary major pulmonary resection group ( n = 250) (5‐year OS 84.5% vs. 69.0%, log rank P = 0.112; DFS 64.4% vs. 58.0%, log rank P = 0.278). The five‐year OS and PFS of the metachronous MPR group ( n = 17) were significantly better than those in the non‐surgical control group ( n = 19) (5‐year OS 94.1% vs. 50.7%, log rank P = 0.005; 5‐year PFS 53.9% vs. 10.5%, log rank P = 0.020). No postoperative mortality or severe complications occurred in the MPR group. Conclusion The oncological efficacy of MPR is superior to the non‐surgical approach for the management of local regional recurrent or second primary lung cancer, with comparable postoperative mortality and complications.
Abstract Background Duodenal papilla carcinoma (DPC) is a rare malignancy of the gastrointestinal tract with high recurrence rate, and the pathogenesis of this highly malignant neoplasm is yet to be fully elucidated. This study aims to identify key genes to further understand the biology and pathogenesis underlying the molecular alterations driving DPC, which could be potential diagnostic or therapeutic targets. Methods Tumor samples of three DPC patients were collected and integrating RNA-seq analysis of tumor tissues and matched normal tissues were performed to discover differentially expressed genes (DEGs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were carried out to understand the potential bio-functions of the DPC differentially expressed genes (DEGs). Protein–protein interaction (PPI) network was constructed for functional modules analysis and identification of hub genes. qRT-PCR of clinical samples was conducted to validate the expression level of the hub genes. Results A total of 110 DEGs were identified from our RNA-seq data, GO and KEGG analyses showed that the DEGs were mainly enriched in multiple cancer-related functions and pathways, such as cell proliferation, IL-17signaling pathway, Jak-STAT signaling pathway, PPAR signaling pathway. The PPI network screened out five hub genes including IL-6, LCN2, FABP4, LEP and MMP1, which were identified as core genes in the network and the expression value were validated by qRT-PCR. The hub genes identified in this work were suggested to be potential therapeutic targets of DPC. Discussion The current study may provide new insight into the exploration of DPC pathogenesis and the screened hub genes may serve as potential diagnostic indicator and novel therapeutic target.
Porcine reproductive and respiratory syndrome (PRRS), which causes reproductive failure in sows and respiratory symptoms in piglets, poses a significant threat to the global pig industry. PRRS virus (PRRSV) variants continue to emerge and spread among pigs. NADC34-like PRRSV has been imported into China in recent years and has shown potential as an endemic strain, which is of great concern. In this study, a NADC34-like PRRSV, named HLJ13 strain, was isolated from a farm where pigs experienced respiratory symptoms and abortions. Genomic analysis revealed that the HLJ13 strain was a potential recombinant of NADC34-like and NADC30-like strains, and the restriction fragment length polymorphism of HLJ13 was a novel pattern that was not yet listed. In the PRRSV HLJ13-inoculated group, the piglets showed mild clinical symptoms, such as persistent fever, and showed histopathological lesions in the lungs, and the virus was detectable at 3 and 7 days postinoculation in anal and nasal swabs, respectively. Recombination analysis revealed that interlineage recombinant events were detected in 8 out of 27 Chinese NADC34-like PRRSVs. Phylogenetic analysis showed that Chinese NADC34-like PRRSVs were distributed in two clades of lineage 1, and Chinese NADC34-like PRRSVs showed different N-glycosylation modifications in glycoproteins, especially in GP3 and GP5. These findings shed light on the genomic characteristics and pathogenicity of the NADC34-like PRRSV in China.
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