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Clinical significance of para-aortic lymph node dissection and prognosis in ovarian cancer

null

《医学前沿（英文）》 2014年 第8卷 第1期   页码 96-100 doi: 10.1007/s11684-014-0316-4

摘要：

Lymph node metastasis has an important effect on prognosis of patients with ovarian cancer. Moreover, the impact of para-aortic lymph node (PAN) removal on patient prognosis is still unclear. In this study, 80 patients were divided into groups A and B. Group A consisted of 30 patients who underwent PAN+ pelvic lymph node (PLN) dissection, whereas group B consisted of 50 patients who only underwent PLN dissection. Analysis of the correlation between PAN clearance and prognosis in epithelial ovarian cancer was conducted. Nineteen cases of lymph node metastasis were found in group A, among whom seven cases were positive for PAN, three cases for PLN, and nine cases for both PAN and PLN. In group B, 13 cases were positive for lymph node metastasis. Our study suggested that the metastatic rate of lymph node is 40.0%. Lymph node metastasis was significantly correlated with FIGO stage, tumor differentiation, and histological type both in groups A and B (P<0.05). In groups A and B, the three-year survival rates were 77.9% and 69.0%, and the five-year survival rates were 46.7% and 39.2%, respectively. However, the difference was not statistically significant (P>0.05). The three-year survival rates of PLN metastasis in groups A and B were 68.5% and 41.4%, and the five-year survival rates were 49.7% and 26.4%, respectively. Furthermore, PLN-positive patients who cleared PAN had significantly higher survival rate (P=0.044). In group A, the three-year survival rates of positive and negative lymph nodes were 43.5% and 72.7%, and the five-year survival rates were 27.2% and 58.5%, respectively. The difference was statistically significant (P=0.048). Cox model analysis of single factor suggested that lymph node status affected the survival rate (P<0.01), which was the death risk factor. Consequently, in ovarian carcinoma cytoreductive surgery, resection of the para-aortic lymph node, which has an important function in clinical treatment and prognosis of patients with ovarian cancer, is necessary.

关键词： ovarian cancer     para-aortic lymph node     pelvic lymph node    

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Application progress of lymphography in oncology

Yang YU, Jibin LIU, Lixue YIN

《医学前沿（英文）》 2009年 第3卷 第1期   页码 13-19 doi: 10.1007/s11684-009-0016-7

摘要： Lymphography is often used for the diagnosis of lymphatic metastasis in oncology. Determination of lymphatic metastasis is extremely important for accurate cancer staging, which may directly guide the clinical therapeutic scheme. In recent years, the technology of lymphography has developed rapidly on the basis of traditional lymphography, with the appearance of computed tomography (CT) lymphography, nuclear magnetic resonance (MR) lymphography, contrast-enhanced lymphosonography, and so on; the diagnostic accuracy has also been improved. The imaging principles and methods of these various technologies of lymphography are reviewed in this paper, and their applications and significance in oncology are also discussed in detail.

关键词： lymphography     lymphatic metastasis     sentinel lymph node biopsy    

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The value of ultrasound elastography in differential diagnosis of superficial lymph nodes

Yanrong ZHANG phD , Qing LV MD , Mingxing XIE MD , Feixiang XIANG phD , Chengfa LU BM , Tianwei YAN BM , Wei LI BM , Hui XU BM , Yan HUANG BM , Yehua YIN BM ,

《医学前沿（英文）》 2009年 第3卷 第3期   页码 368-374 doi: 10.1007/s11684-009-0063-0

摘要： The study evaluated the value of ultrasound elastography in differentiating the benign and malignant superficial lymph nodes. A total of 112 subjects, including 82 patients with enlarged lymph nodes and 30 healthy volunteers, were recruited. All the subjects were examined by B-mode ultrasonography, power Doppler ultrasonography and elastography. Most of the patients were histopathologically confirmed by needle aspiration cytology and some patients were diagnosed by clinical data combined with follow-up findings. The sensitivity, specificity and accuracy of B-mode ultrasonography were 59.8%, 76.5% and 67.1%, those of the blood flow classification by power Doppler ultrasonography 77.0%, 82.3% and 79.4% and those of elastographic classification 74.7%, 97.1% and 84.5%, respectively. The elasticity of the lymph nodes was quantitatively measured and defined as stiffness value. When the stiffness value of 2.395 was taken as the cutoff point, the sensitivity and specificity of elastography were 78.41% and 98.51%, and the Youden index reached the highest, with the value being 0.7692. The stiffness values of two indeterminate benign lymph nodes, the elastrographic findings of which were rated as patterns 2 and 3, were below the cutoff point. The elastographic findings of 10 malignant lymph nodes were also classified as pattern 2 or 3. Only one of them had the stiffness values below the cutoff point. It was concluded that ultrasound elastography is a novel, noninvasive and convenient tool for the differentiation of the nature of the superficial lymph nodes in clinical practice.

关键词： ultrasound elastography     lymph node     power Doppler sonography    

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Correlation of Twist upregulation and senescence bypass during the progression and metastasis of cervical cancer

null

《医学前沿（英文）》 2014年 第8卷 第1期   页码 106-112 doi: 10.1007/s11684-014-0307-5

摘要：

Cervical carcinoma is associated with high propensity for local invasion and lymph node metastasis. However, the molecular alterations that drive progression and metastasis of cervical cancer remain unclear. Cellular senescence has been proposed as the mechanism that protects an organism against cancer progression and metastasis. In addition, Twist, a basic helix-loop-helix transcription factor, has been suggested as an oncogene because it is overexpressed in many types of human cancer. This gene also exhibits a positive function in regulating invasion and metastasis. In this study, Twist was strongly and positively expressed in normal tissue, squamous cell carcinoma (SCC) IA--IIA, and SCC IIB--IIIB (4.3%, 44%, and 88.9%, respectively). The strong positive expressions of the senescence marker CBX3 were 39.1%, 32%, and 15.6%, respectively. The strong positive expressions of Twist in the SCC groups with or without lymph node metastasis were 80.8% and 50%. For CBX3, such expressions were 7.7% and 29.5%, respectively. Results also showed that the expression of Twist was inversely correlated with that of CBX3. Moreover, the knockdown of Twist with target siRNA in SiHa triggered the induction of the chromatin marker of the cellular senescence CBX3 and senescence-associated β-galactosidase activity. Our results suggested that the expression of Twist increased during the progression and metastasis of cervical cancer. Furthermore, Twist-induced senescence bypass is important in this process.

关键词： cervical cancer     senescence     Twist     CBX3     lymph node metastasis    

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Adjuvant chemotherapy versus adjuvant concurrent chemoradiotherapy after radical surgery for early-stage cervical cancer: a randomized, non-inferiority, multicenter trial

《医学前沿（英文）》 2023年 第17卷 第1期   页码 93-104 doi: 10.1007/s11684-021-0892-z

摘要： We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB–IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415–1.757; P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.

关键词： chemotherapy     cervical cancer     lymph node metastasis     concurrent chemoradiotherapy     quality of life    

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The evolution of surgical and medical treatment of aortic root aneurysm

null

《医学前沿（英文）》 2014年 第8卷 第4期   页码 427-432 doi: 10.1007/s11684-014-0385-4

摘要：

Since first report of aortic root replacement in 1968, the surgical risk and long term outcome of patients with aortic root aneurysm have been continuously improving. In the last 30 years, the surgical approach is also evolving towards more valve conservation with prophylactical intervention at an earlier clinical stage. Translational research has also led to emerging surgical innovation and new drug therapy. Their efficacies are currently under vigorous clinical trials and evaluations.

关键词： aortic root aneurysm     aortic root replacement     valve sparing root replacement     personalised external aortic root support    

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Evaluation of the harmonic scalpel in open surgery for abdominal aortic aneurysm

null

《医学前沿（英文）》 2012年 第6卷 第1期   页码 85-88 doi: 10.1007/s11684-012-0174-x

摘要：

The harmonic scalpel is a hemostatic device primarily designed for use in laparoscopic surgery. During the last few years, many surgeons have begun to use the harmonic scalpel in open surgery. Several papers have cited the benefits of the device compared with conventional knot-tying techniques; however, no evidence showing the advantages of using the harmonic scalpel in complicated abdominal aortic aneurysm (AAA) surgery has been presented. The aim of the present study is to determine the value of the harmonic scalpel in open operation for AAA. A total of 153 patients who underwent open surgery for AAA at the Department of Vascular Surgery of Guangdong General Hospital, China between January 2001 and December 2010, were retrospectively analyzed. Open surgery performed with the harmonic scalpel on 105 patients was compared with open operation using conventional knot-tying techniques on 48 patients. The operative time, intraoperative blood loss, total postoperative drainage fluid volumes, hospital stay, and postoperative complications between the two groups were compared. The harmonic scalpel group was associated with a shorter operation time (113.2±23.6 min vs. 232.1±39.2 min, P<0.01) and lower intraoperative blood loss (126.1±96.6 ml vs. 592.1±207.2 ml, P<0.01). Postoperative drainage fluid volumes were greater in the conventional surgery group than in the harmonic scalpel group (702.1±192.8 ml vs. 198.5±97.4 ml, P<0.01). The hospital stay was shorter for the harmonic scalpel group than for the conventional surgery group (10.7±3.3 d vs. 16.5±4.7 d, P<0.05). No differences between the postoperative complications or hospital mortality of the two groups were found. The harmonic scalpel is a safe and minimally invasive tool in open surgery for AAA and is associated with shorter operative time, shorter hospital stay, and lower intraoperative blood loss and postoperative drainage fluid volumes compared with conventional knot-tying techniques.

关键词： abdominal aortic aneurysm     harmonic scalpel     minimally invasive    

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engineering in the construction of numerical simulation oriented patient-specific model of stented aortic

Xianlong MENG, Wenyu FU, Yun ZHANG, Aike QIAO,

《机械工程前沿（英文）》 2010年 第5卷 第3期   页码 328-335 doi: 10.1007/s11465-010-0026-9

摘要： Patient-specific models are widely used in hemodynamic simulations. The flow in the boundary layer changes so strongly that fine meshes in the boundary layer are required in numerical simulations, especially for the calculation of wall shear stress and its gradient. To precisely analyze hemodynamics, it is necessary to investigate the approaches to the reconstruction of a numerical simulation-oriented patient-specific model for aortic arch aneurysm that can perform particular meshing in the boundary layer. Based on a surface model of aortic arch aneurysm in STL format, reverse engineering concept was applied to reconstruct a solid model using CAD software Geomagic and Pro/E, and a simplified model of stent for the intervention of aortic arch aneurysm was also created. After these models were imported to ANSYS, a block modeling approach was employed to divide the whole model into several domain blocks to adopt different meshing strategies. Particular meshing was performed especially in the boundary layer and around the stents. The finite element model particularly suitable for numerical simulation of hemodynamics was obtained. Hemodynamic simulation was performed, using the constructed finite element model to verify its applicability. The results indicate that reverse engineering concept and the proposed block modeling approach can be used to divide the solid model of aortic arch aneurysm into multiple volumes, which can be meshed according to particular requirements in each volume; the finite element model of stented aortic arch aneurysm can be employed to simulate hemodynamics. The approaches of modeling were applicable not only for aortic arch aneurysm, but also for similar model reconstruction as a reference in hemodynamic simulation investigations.

关键词： reverse engineering     aortic arch aneurysm     surface model     meshing     finite element model    

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Identification of variants associated with sporadic thoracic aortic dissection: a case--control study

《医学前沿（英文）》 2021年 第15卷 第3期   页码 438-447 doi: 10.1007/s11684-020-0826-1

摘要： Thoracic aortic dissection (TAD) without familial clustering or syndromic features is known as sporadic TAD (STAD). So far, the genetic basis of STAD remains unknown. Whole exome sequencing was performed in 223 STAD patients and 414 healthy controls from the Chinese Han population (N = 637). After population structure and genetic relationship and ancestry analyses, we used the optimal sequence kernel association test to identify the candidate genes or variants of STAD. We found that COL3A1 was significantly relevant to STAD (P = 7.35 × 10−6) after 10 000 times permutation test (P = 2.49 × 10−3). Moreover, another independent cohort, including 423 cases and 734 non-STAD subjects (N = 1157), replicated our results (P = 0.021). Further bioinformatics analysis showed that COL3A1 was highly expressed in dissected aortic tissues, and its expression was related to the extracellular matrix (ECM) pathway. Our study identified a profile of known heritable TAD genes in the Chinese STAD population and found that COL3A1 could increase the risk of STAD through the ECM pathway. We wanted to expand the knowledge of the genetic basis and pathology of STAD, which may further help in providing better genetic counseling to the patients.

关键词： sporadic thoracic aortic dissection     exome sequencing     gene COL3A1     case–control study     extracellular matrix    

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Aneurysmal dilatation of the aortic sinuses of Valsalva — beyond Marfan syndrome: a single centre experience

null

《医学前沿（英文）》 2014年 第8卷 第4期   页码 419-426 doi: 10.1007/s11684-014-0383-6

摘要：

Aneurysmal dilatation of the aortic sinuses of Valsalva has been most extensively documented in the setting of aortopathies, particularly Marfan syndrome. On the other hand, there is limited data in the literature about congenital sinus of Valsalva aneurysms outside this context. For the purpose of this review, we carried out a literature search on aneurysmal dilatation of the sinuses of Valsalva in Marfan syndrome, and compared this with congenital sinus of Valsalva aneurysms, also including data from a case series from our institution. In conclusion, there are differences in management of aortic dilatation in Marfan syndrome and congenital sinus of Valsalva aneurysms. Though less well-recognised, congenital aneurysms are often associated with significant morbidity and mortality and timely intervention is necessary.

关键词： sinus of Valsalva aneurysms     Marfan syndrome     aortic dissection    

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Right coronary occlusion following transcatheter aortic valve implantation: two case reports

null

《医学前沿（英文）》 2016年 第10卷 第3期   页码 351-355 doi: 10.1007/s11684-016-0465-8

摘要：

This paper discusses two male patients with severe aortic stenosis, whose right coronary arteries (RCA) were completely occluded during transcatheter aortic valve implantation (TAVI), leading to fatal hemodynamic disorder. Occlusions of RCA complicated by TAVI are rare. In addition, emergency cardiopulmonary bypass (CPB) played a critical role in rescuing our second patient. Both patients were admitted for “severe aortic stenosis,” and TAVIs were performed. The first patient’s blood pressure immediately dropped to 70/40 mmHg after the balloon expansion and did not increase much after the administration of aramine or fluid therapy. He did not receive emergency surgery and died after 1.5 h of resuscitation. The second patient’s blood pressure fluctuated greatly for several minutes after the valve implantation, ranging from 170/100 mmHg to 60/40 mmHg. Angiography revealed a total occlusion of RCA. Thoracic surgery with CPB was performed, and the patient survived.

关键词： aortic stenosis     transcatheter aortic valve implantation     right coronary occlusion     cardiac group    

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in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic

《医学前沿（英文）》 2021年 第15卷 第3期   页码 416-437 doi: 10.1007/s11684-021-0852-7

摘要： Over the last half century, surgical aortic valve replacement (SAVR) has evolved to offer a durable and efficient valve haemodynamically, with low procedural complications that allows favourable remodelling of left ventricular (LV) structure and function. The latter has become more challenging among elderly patients, particularly following trans-catheter aortic valve implantation (TAVI). Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss, valvular-vascular impedance to myocardial activation, force-velocity relationship, and myocardial strain. LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour. Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome. Physiological pacing via the His-Purkinje system for conduction abnormalities, further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression, LV coordinate contraction, and global vascular function. TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions. Until comparable long-term durability and the resolution of TAVI related complications become available, SAVR remains the first choice for lower risk younger patients.

关键词： surgical aortic valve replacement     trans-catheter aortic valve implantation     left ventricular hypertrophy and fibrosis     myocardial force-velocity relationship     His-Purkinje pacing     renin-angiotensin system inhibitors     coronary access impairment    

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Aortic aneurysm and chronic disseminated intravascular coagulation: a retrospective study of 235 patients

null

《医学前沿（英文）》 2017年 第11卷 第1期   页码 62-67 doi: 10.1007/s11684-017-0498-7

摘要：

Chronic disseminated intravascular coagulation (DIC) is a rare but devastating complication of aortic aneurysm (AA). This study investigated the clinical manifestations, laboratory findings, and treatment of patients with AA-associated chronic DIC (AA-DIC) and explored the mechanisms, duration, and therapeutic response of AA-DIC. We retrospectively reviewed the medical records of 235 AA patients admitted at the Peking Union Medical College Hospital between September 2009 and January 2015. The patients were classified as those with DIC (AA-DIC) and those without DIC (non-DIC). The AA-DIC group showed a significantly higher proportion of female patients and a significantly longer AA disease course than the non-DIC group did. The AA-DIC patients presented mural thrombi, dissecting aneurysms, a family history of AA, and diabetes significantly more frequently than the non-DIC patients did. Furthermore, multiple regression analyses revealed that sex, mural thrombus, aneurysm type, diabetes, and stent surgery are possible independent risk factors for AA-DIC patients. Fifty-two (22.1%) patients presented AA-DIC. Among these patients, 43 had non-typical DIC and 9 had typical DIC; the mortality rate of the latter was 22.2%. The mean age of the patients with typical DIC was significantly higher than of that of patients with non-typical DIC. The non-typical DIC patients also presented abnormal coagulation disorders of varying degrees. Furthermore, heparin or low-molecular-weight heparin improved the clinical symptoms and laboratory parameters in patients with AA and typical DIC. Thus, chronic DIC should be considered in patients with AA.

关键词： aortic aneurysm     disseminated intravascular coagulation     anticoagulation therapy    

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Histopathological study of congenital aortic valve malformations in 32 children

HUANG Ping, WANG Hongwei, LI Yanping, CHENG Peixuan, LIU Qingjun, ZHANG Zhenlu, LIU Jianying

《医学前沿（英文）》 2007年 第1卷 第1期   页码 74-78 doi: 10.1007/s11684-007-0015-5

摘要： The histopathological characteristics of congenital aortic valve malformations in children were investigated. All the native surgically excised aortic valves from 32 pediatric patients suffering from symptomatic aortic valve dysfunction due to congenital aortic valve malformations between January 2003 and December 2005 were studied macroscopically and microscopically. The patients medical records were reviewed and the clinical information was extracted. The diagnosis was made by the clinical presentation, preoperative echocardiography, intraoperative examination, and postoperative histopathological study, excluding rheumatic or degenerative aortic valve diseases, infective endocarditis and primary connective tissue disorders, e.g. Marfan syndrome. Among 32 children with congenital aortic valve malformations, the age was ranged from six to 18 years, with a mean of 14.9 years, and there were 27 boys and five girls (male: female = 5.4:1). There were five cases of aortic stenosis (AS, 15.62%), 25 cases of aortic insufficiency (AI, 78.13%) and two cases of AS-AI (6.25%), without other valve diseases. Twenty cases still had other congenital heart diseases: ventricular septal defect (19 cases), patent ductus arteriosus (two cases), double-chambered right ventricle (one case), aneurysm of the right anterior aortic sinus of valsalva (three cases). Histopathological examination indicated that the cusps became thickening with unequal size, irregular shape (coiling and prolapse edge), enhanced hardness, and partly calcification. Microscopic investigation revealed the unsharp structure of valve tissue, fibrosis, myxomatous, reduced collagen fiber, rupture of elastic fibers, different degrees of infiltration of inflammatory cells, secondary calcareous and lipid deposit, and secondary fibrosis. Congenital aortic valve malformations in children involve males more than females, mostly associated with other congenital heart diseases. Aortic insufficiency is more common in children with congenital aortic valve malformations. Histopathologically, the leaflets of aortic valve are mainly myxomatous, thickening with unequal size, irregular shape (coiling and prolapse edge), reduced collagen fiber, rupture of elastic fibers, without small vessel proliferation and inflammatory cell infiltration, fibrosis and calcification rarely seen.
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Spatial embedded reinforcement of 20-node block element for analysis PC bridges

LONG Peiheng, DU Xianting, CHEN Weizhen

《结构与土木工程前沿（英文）》 2008年 第2卷 第3期   页码 274-280 doi: 10.1007/s11709-008-0039-1

摘要： The formula for the contribution of prestressed reinforcement on embedded reinforcement element is derived according to the mechanical behavior of PC bridges and the foundational principle of finite element method. Mechanical concept is definite and examples validate the calculation results. Reinforcement element model allows generating a finite element mesh without taking into consideration the layout of reinforcements. Furthermore, the prestressing tendon may pass through the concrete elements in an arbitrary manner. It is an effective approach that the no-node loads are diverted from the tendons to the adjacent concrete elements. A useful arithmetic analysis of the spatial curved tendon PC Bridges is provided.

关键词： arithmetic analysis     calculation     prestressed reinforcement     mechanical     arbitrary    

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标题 作者 时间 类型 操作

Clinical significance of para-aortic lymph node dissection and prognosis in ovarian cancer

null

期刊论文

Application progress of lymphography in oncology

Yang YU, Jibin LIU, Lixue YIN

期刊论文

The value of ultrasound elastography in differential diagnosis of superficial lymph nodes

Yanrong ZHANG phD , Qing LV MD , Mingxing XIE MD , Feixiang XIANG phD , Chengfa LU BM , Tianwei YAN BM , Wei LI BM , Hui XU BM , Yan HUANG BM , Yehua YIN BM ,

期刊论文

Correlation of Twist upregulation and senescence bypass during the progression and metastasis of cervical cancer

null

期刊论文

Adjuvant chemotherapy versus adjuvant concurrent chemoradiotherapy after radical surgery for early-stage cervical cancer: a randomized, non-inferiority, multicenter trial

期刊论文

The evolution of surgical and medical treatment of aortic root aneurysm

null

期刊论文

Evaluation of the harmonic scalpel in open surgery for abdominal aortic aneurysm

null

期刊论文

engineering in the construction of numerical simulation oriented patient-specific model of stented aortic

Xianlong MENG, Wenyu FU, Yun ZHANG, Aike QIAO,

期刊论文

Identification of variants associated with sporadic thoracic aortic dissection: a case--control study

期刊论文

Aneurysmal dilatation of the aortic sinuses of Valsalva — beyond Marfan syndrome: a single centre experience

null

期刊论文

Right coronary occlusion following transcatheter aortic valve implantation: two case reports

null

期刊论文

in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic

期刊论文

Aortic aneurysm and chronic disseminated intravascular coagulation: a retrospective study of 235 patients

null

期刊论文

Histopathological study of congenital aortic valve malformations in 32 children

HUANG Ping, WANG Hongwei, LI Yanping, CHENG Peixuan, LIU Qingjun, ZHANG Zhenlu, LIU Jianying

期刊论文

Spatial embedded reinforcement of 20-node block element for analysis PC bridges

LONG Peiheng, DU Xianting, CHEN Weizhen

期刊论文