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Treatment of invasive fungal disease:A case report 预览
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作者 Xue-Fei Xiao Jiong-Xing Wu Yang-Cheng Xu 《世界临床病例杂志》 2019年第16期2374-2383,共10页
BACKGROUND In recent years,the incidence of fungal infection has been increasing,often invading one or more systems of the body.However,it is rare for lymph nodes to be invaded without the involvement of other organs.... BACKGROUND In recent years,the incidence of fungal infection has been increasing,often invading one or more systems of the body.However,it is rare for lymph nodes to be invaded without the involvement of other organs.CASE SUMMARY A 21-year-old man was admitted to hospital for repeated cough for 2 mo and abdominal pain for 1 mo.Physical examination revealed multiple lymph nodes enlargement,especially those in the left neck and groin.CT scan showed multiple lymph nodes enlargement in the chest,especially left lung,abdominal cavity,and retroperitoneum.The first lymph node biopsy revealed granulomatous lesions of lymph nodes,so intravenous infusion of Cefoperazone tazobactam combined with anti-tuberculosis drugs were given.Because fever and respiratory failure occurred 4 d after admission,mechanical ventilation was given,and Caspofungin and Voriconazole were used successively.However,the disease still could not be controlled.On the 11th day of admission,the body temperature reached 40° C.After mycosis of lymph nodes was confirmed by the second lymph node biopsy,Amphotericin B was given,and the patient recovered and was discharged from the hospital.CONCLUSION No fixed target organ was identified in this case,and only lymph node involvement was found.Caspofungin,a new antifungal drug,and the conventional first choice drug,Voriconazole,were ineffective,while Amphotericin B was effective. 展开更多
关键词 Invasive FUNGAL disease Case report Lymphadenectasis LYMPH node BIOPSY MYCOSIS of LYMPH NODES AMPHOTERICIN B
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Application of indocyanine green-enhanced near-infrared fluorescence-guided imaging in laparoscopic lateral pelvic lymph node dissection for middle-low rectal cancer 预览
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作者 Si-Cheng Zhou Yan-Tao Tian +9 位作者 Xue-Wei Wang Chuan-Duo Zhao Shuai Ma Jun Jiang Er-Ni Li Hai-Tao Zhou Qian Liu Jian-Wei Liang Zhi-Xiang Zhou Xi-Shan Wang 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第31期4502-4511,共10页
BACKGROUND As one effective treatment for lateral pelvic lymph node(LPLN)metastasis(LPNM),laparoscopic LPLN dissection(LPND)is limited due to the complicated anatomy of the pelvic sidewall and various complications af... BACKGROUND As one effective treatment for lateral pelvic lymph node(LPLN)metastasis(LPNM),laparoscopic LPLN dissection(LPND)is limited due to the complicated anatomy of the pelvic sidewall and various complications after surgery.With regard to improving the accuracy and completeness of LPND as well as safety,we tried an innovative method using indocyanine green(ICG)visualized with a near-infrared(NIR)camera system to guide the detection of LPLNs in patients with middle-low rectal cancer.AIM To investigate whether ICG-enhanced NIR fluorescence-guided imaging is a better technique for LPND in patients with rectal cancer.METHODS A total of 42 middle-low rectal cancer patients with clinical LPNM who underwent total mesorectal excision(TME)and LPND between October 2017 and March 2019 at our institution were assessed and divided into an ICG group and a non-ICG group.Clinical characteristics,operative outcomes,pathological outcomes,and postoperative complication information were compared and analysed between the two groups.RESULTS Compared to the non-ICG group,the ICG group had significantly lower intraoperative blood loss(55.8±37.5 mL vs 108.0±52.7 mL,P=0.003)and a significantly larger number of LPLNs harvested(11.5±5.9 vs 7.1±4.8,P=0.017).The LPLNs of two patients in the non-IVG group were residual during LPND.In addition,no significant difference was found in terms of LPND,LPNM,operative time,conversion to laparotomy,preoperative complication,or hospital stay(P>0.05).CONCLUSION ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could bring specific advantages regarding the accuracy and completeness of surgery as well as safety. 展开更多
关键词 RECTAL cancer LATERAL PELVIC LYMPH NODE DISSECTION Indocyanine green LATERAL PELVIC LYMPH NODE
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New metastatic lymph node classification for early gastric cancer should differ from those for advanced gastric adenocarcinoma:Results based on the SEER database 预览
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作者 Jian-Xian Lin Jun-Peng Lin +9 位作者 Ping Li Jian-Wei Xie Jia-Bin Wang Jun Lu Qi-Yue Chen Long-Long Cao Mi Lin Ru-Hong Tu Chao-Hui Zheng Chang-Ming Huang 《世界临床病例杂志》 2019年第2期145-155,共11页
AIM To establish an appropriate N classification system for early gastric cancer(EGC).METHODS Data from 10714 patients who underwent radical gastrectomy between 1988 and 2011 were retrieved from the National Cancer In... AIM To establish an appropriate N classification system for early gastric cancer(EGC).METHODS Data from 10714 patients who underwent radical gastrectomy between 1988 and 2011 were retrieved from the National Cancer Institute’s Surveillance,Epidemiology,and End Result database.The overall survival(OS)based on the eighth edition and new tumor lymph node metastasis(TNM)staging systems were compared,and the analysis was repeated in an external validation set from the Fujian Medical University Union Hospital database.RESULTS There were no significant differences in OS between N1 and N2 cancers or between N3a and N3b cancers in cases of EGC.The X-tile program identified that the new staging system for EGC consisted of T1N0,T1N1’[1-6 metastatic lymph nodes(LNs)],and T1N2’(≥7 metastatic LNs).Compared with the eighth edition of the TNM staging system,the OS of patients in T1N1’stage was similar to that of patients with stage IIA disease,whereas the OS of patients in T1N2’stage was similar to that of patients with stage IIB disease.The new TNM staging system exhibited a slightly lower Akaike Information Criterion value and higher χ^2 and c-statistic compared with the eighth edition of the TNM classification system.Similar results were found in the external validation dataset from the external validation set.CONCLUSION We have developed an optional new TNM staging system with a better predictive ability that can be used to accurately predict the 5-year OS of patients with EGC. 展开更多
关键词 Early gastric cancer GASTRECTOMY Tumor LYMPH NODE METASTASIS CLASSIFICATION N CLASSIFICATION LYMPH NODE Prognosis
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Feasibility of endoscopic treatment and predictors of lymph node metastasis in early gastric cancer 预览
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作者 Yu-Ning Chu Ya-Nan Yu +6 位作者 Xue Jing Tao Mao Yun-Qing Chen Xiao-Bin Zhou Wen Song Xian-Zhi Zhao Zi-Bin Tian 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第35期5344-5355,共12页
BACKGROUND Endoscopic submucosal dissection (ESD) has been routinely performed in applicable early gastric cancer (EGC) patients as an alternative to conventional surgical operations that involve lymph node dissection... BACKGROUND Endoscopic submucosal dissection (ESD) has been routinely performed in applicable early gastric cancer (EGC) patients as an alternative to conventional surgical operations that involve lymph node dissection. The indications for ESD have been recently expanded to include larger, ulcerated, and undifferentiated mucosal lesions, and differentiated lesions with slight submucosal invasion. The risk of lymph node metastasis (LNM) is the most important consideration when deciding on a treatment strategy for EGC. Despite the advantages over surgical procedures, lymph nodes cannot be removed by ESD. In addition, whether patients who meet the expanded indications for ESD can be managed safely remains controversial. AIM To determine whether the ESD indications are applicable to Chinese patients and to investigate the predictors of LNM in EGC. METHODS We retrospectively analyzed 12552 patients who underwent surgery for gastric cancer between June 2007 and December 2018 at the Affiliated Hospital of Qingdao University. A total of 1262 (10.1%) EGC patients were eligible for inclusion in this study. Data on the patients’ clinical, endoscopic, and histopathological characteristics were collected. The absolute and expanded indications for ESD were validated by regrouping the enrolled patients and determining the positive LNM results in each subgroup. Predictors of LNM in patients were evaluated by univariate and multivariate analyses. RESULTS LNM was observed in 182 (14.4%) patients. No LNM was detected in the patients who met the absolute indications (0/90). LNM occurred in 4/311 (1.3%) patients who met the expanded indications. According to univariate analysis, LNM was significantly associated with positive tumor marker status, medium (20-30 mm) and large (>30 mm) lesion sizes, excavated macroscopic-type tumors, ulcer presence, submucosal invasion (SM1 and SM2), poor differentiation, lymphovascular invasion (LVI), perineural invasion, and diffuse and mixed Lauren’s types. Multivariate analysis demonstrated SM1 in 展开更多
关键词 Early gastric cancer LYMPH node metastasis PREDICTORS Endoscopic SUBMUCOSAL DISSECTION Expanded INDICATIONS
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Gastric neuroendocrine neoplasms type 1: A systematic review and meta-analysis 预览
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作者 Apostolos V Tsolakis Athanasia Ragkousi +2 位作者 Miroslav Vujasinovic Gregory Kaltsas Kosmas Daskalakis 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第35期5376-5387,共12页
BACKGROUND To date, the histopathological parameters predicting the risk of lymph node (LN) metastases and local recurrence, associated mortality and appropriateness of endoscopic or surgical resection in patients wit... BACKGROUND To date, the histopathological parameters predicting the risk of lymph node (LN) metastases and local recurrence, associated mortality and appropriateness of endoscopic or surgical resection in patients with gastric neuroendocrine neoplasms type 1 (GNENs1) have not been fully elucidated. AIM To determine the rate of LN metastases and its impact in survival in patients with GNEN1 in relation to certain clinico-pathological parameters. METHODS The PubMed, EMBASE, Cochrane Library, Web of Science and Scopus databases were searched through January 2019. The quality of the included studies and risk of bias were assessed using the Newcastle-Ottawa Scale (NOS) in accordance with the Cochrane guidelines. A random effects model and pooled odds ratios (OR) with 95%CI were applied for the quantitative meta-analysis. RESULTS We screened 2933 articles. Thirteen studies with 769 unique patients with GNEN1 were included. Overall, the rate of metastasis to locoregional LNs was 3.3%(25/769). The rate of LN metastases with a cut-off size of 10 mm was 15.3% for lesions > 10 mm (vs 0.8% for lesions < 10 mm) with a random-effects OR of 10.5 (95%CI: 1.4 -80.8;heterogeneity: P = 0.126;I2 = 47.5%). Invasion of the muscularis propria was identified as a predictor for LN metastases (OR: 17.2;95%CI: 1.8-161.1;heterogeneity: P = 0.165;I2 = 44.5%), whereas grade was not clearly associated with LN metastases (OR: 2;95%CI: 0.3-11.6;heterogeneity: P = 0.304;I2 = 17.4%). With regard to GNEN1 local recurrence, scarce data were available. The 5-year disease-specific survival for patients with and without LN metastases was 100% in most available studies irrespective of the type of intervention. Surgical resection was linked to a lower risk of recurrence (OR: 0.3;95%CI: 0.1-1.1;heterogeneity: P = 0.173;I2 = 31.9%). The reported complication rates of endoscopic and surgical intervention were 0.6 and 3.8%, respectively. CONCLUSION This meta-analysis confirms that tumor size ≥ 10 mm and invasion of the muscularis propria are linked to a hi 展开更多
关键词 GASTRIC NEUROENDOCRINE neoplasms TYPE 1 META-ANALYSIS LYMPH node metastasis Tumor size Invasion ENDOSCOPY Surgery
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Artificial intelligence system of faster region-based convolutional neural network surpassing senior radiologists in evaluation of metastatic lymph nodes of rectal cancer
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作者 Lei Ding Guang-Wei Liu +11 位作者 Bao-Chun Zhao Yun-Peng Zhou Shuai Li Zheng-Dong Zhang Yu-Ting Guo Ai-Qin Li Yun Lu Hong-Wei Yao Wei-Tang Yuan Gui-Ying Wang Dian-Liang Zhang Lei Wang 《中华医学杂志:英文版》 SCIE CAS CSCD 2019年第4期379-387,共9页
Background: An artificial intelligence system of Faster Region-based Convolutional Neural Network (Faster R-CNN) is newly developed for the diagnosis of metastatic lymph node (LN) in rectal cancer patients. The primar... Background: An artificial intelligence system of Faster Region-based Convolutional Neural Network (Faster R-CNN) is newly developed for the diagnosis of metastatic lymph node (LN) in rectal cancer patients. The primary objective of this study was to comprehensively verify its accuracy in clinical use. Methods: Four hundred fourteen patients with rectal cancer discharged between January 2013 and March 2015 were collected from 6 clinical centers, and the magnetic resonance imaging data for pelvic metastatic LNs of each patient was identified by Faster R-CNN. Faster R-CNN based diagnoses were compared with radiologist based diagnoses and pathologist based diagnoses for methodological verification, using correlation analyses and consistency check. For clinical verification, the patients were retrospectively followed up by telephone for 36 months, with post-operative recurrence of rectal cancer as a clinical outcome;recurrence-free survivals of the patients were compared among different diagnostic groups, by methods of Kaplan-Meier and Cox hazards regression model. Results: Significant correlations were observed between any 2 factors among the numbers of metastatic LNs separately diagnosed by radiologists, Faster R-CNN and pathologists, as evidenced by rradiologist-Faster R-CNN of 0.912, rPathologist-radiologist of 0.134, and rPathologist-Faster R-CNN of 0.448 respectively. The value of kappa coefficient in N staging between Faster R-CNN and pathologists was 0.573, and this value between radiologists and pathologists was 0.473. The 3 groups of Faster R-CNN, radiologists and pathologists showed no significant differences in the recurrence-free survival time for stage N0 and N1 patients, but significant differences were found for stage N2 patients. Conclusion: Faster R-CNN surpasses radiologists in the evaluation of pelvic metastatic LNs of rectal cancer, but is not on par with pathologists. 展开更多
关键词 AI (Artificial Intelligence) Magnetic resonance imaging PATHOLOGY LYMPH NODES RECTAL cancer
Current surgical treatment of esophagogastric junction adenocarcinoma 预览
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作者 Shun Zhang Hajime Orita Tetsu Fukunaga 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2019年第8期567-578,共12页
The incidence of esophagogastric junction(EGJ)adenocarcinoma has shown an upward trend over the past several decades worldwide.In this article,we review previous studies and aimed to provide an update on the factors r... The incidence of esophagogastric junction(EGJ)adenocarcinoma has shown an upward trend over the past several decades worldwide.In this article,we review previous studies and aimed to provide an update on the factors related to the surgical treatment of EGJ adenocarcinoma.The Siewert classification has implications for lymph node spread and is the most commonly used classification.Different types of EGJ cancer have different incidences of mediastinal and abdominal lymph node metastases,and different surgical approaches have unique advantages and disadvantages.Minimally invasive surgeries have been increasingly applied in clinical practice and show comparable oncologic outcomes.Endoscopic resection may be a good therapy for early EGJ cancer.Additionally,there is still a great need for well-designed,large RCTs to forward our knowledge on the surgical treatment of EGJ cancer. 展开更多
关键词 Esophagogastric JUNCTION cancer SURGERY LYMPH NODES Siewert classification
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Comparison of efficacy and safety between late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy for cervical cancer complicated with pelvic lymph node metastasis 预览
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作者 Yi Cheng Nan Huang +3 位作者 Jing Zhao Jianhua Wang Chen Gong Kai Qin 《肿瘤学与转化医学:英文版》 2019年第1期25-29,共5页
Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated... Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated with pelvic lymph node metastasis. Methods Sixty patients with cervical cancer complicated with pelvic lymph node metastasis who were admitted to our hospital from January 2013 to January 2015 were enrolled. The patients were randomly divided into the late-course dose-increasing IMRT group and the simultaneous integrated dose-increasing IMRT group, with 30 cases included in each group, respectively. All patients were concurrently treated with cisplatin. After treatment, the clinical outcomes of the two groups were compared. Results The remission rate of symptoms in the simultaneous integrated dose-increasing IMRT group was significantly higher than that in the late-course dose-increasing IMRT group(P < 0.05). The follow-up results showed that the overall survival time, progression-free survival time, and distant metastasis time of patients in the simultaneous integrated dose-increasing IMRT group were significantly longer than those in the late-course dose-increasing IMRT group(P < 0.05). The recurrent rate of lymph nodes in the radiation field in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in the incidence of cervical and vaginal recurrence and distant metastasis between the two groups(P > 0.05). The radiation doses of Dmax in the small intestine, D1 cc(the minimum dose to the 1 cc receiving the highest dose) in the bladder, and Dmax in the rectum in the simultaneous integrated dose-increasing IMRT group were significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in intestinal D2 cc(the minimum dose to the 2 cc receiving the highest dose) between the two groups(P > 0.05). The incidence of bone marrow suppr 展开更多
关键词 simultaneous integrated dose-increasing INTENSITY-MODULATED radiation therapy late-course dose-increasing INTENSITY-MODULATED radiation therapy cervical cancer COMPLICATED with pelvic lymph node metastasis clinical efficacy safety
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Fat clearance and conventional fixation identified ypN0 rectal cancers following intermediate neoadjuvant radiotherapy have similar long-term outcomes 预览
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作者 Nan Chen Ting-Ting Sun +3 位作者 Zhong-Wu Li Yun-Feng Yao Lin Wang Ai-Wen Wu 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2019年第10期877-886,共10页
BACKGROUND As a prognostic factor for colorectal cancer,lymph node(LN)status,particularly the number of LN harvested,has been demonstrated to be essential in the evaluation of quality control in terms of surgical spec... BACKGROUND As a prognostic factor for colorectal cancer,lymph node(LN)status,particularly the number of LN harvested,has been demonstrated to be essential in the evaluation of quality control in terms of surgical specimen.Neoadjuvant chemoradiation,however,decreases the LN harvest.Therefore,certain approaches(such as fat clearance or methylene blue)has drawn significant attention in order to raise LN yield.AIM To compare the long-term oncologic outcome of ypN0 rectal cancer identified using fat clearance(FC)or conventional fixation(CF)following 30 Gy in 10 fractions(30 Gy/10f)of neoadjuvant radiotherapy(nRT).METHODS Three hundred and eighty-two patients with resectable and locally advanced rectal cancer were treated by 30 Gy/10f intermediate nRT(biologically equivalent dose of 36 Gy)plus total mesorectal excision.Two specimen fixation methods(FC or CF)were non-randomly used.The ypN0 status was identified in 124 and 101 patients in the FL and CF groups,respectively.Primary endpoints were local recurrence-free survival(LRFS)and cancer-specific survival(CSS).RESULTS The median follow-up of patients was 5.1 years.The median numbers of retrieved LNs in the FC and CF groups were 19.5(range,4-47)and 12(range,0-44),respectively,with a significant difference(P=0.000).The percentages of patients with 12 or more retrieved nodes were 82.3%and 50.5%(101/159)in the FC and CF groups,respectively,with a significant difference(P=0.000).The LRFS at 5 years were 95.7%and 94.6%in the FC and CF groups,respectively,without statistical difference(P=0.819).The CSS at 5 years were 92.0%and 87.2%in the FC and CF groups,respectively,without statistical difference(P=0.482).CONCLUSION For patients with ypN0 rectal cancer who underwent 30 Gy/10f preoperative radiotherapy,the increased retrieval of LNs using fat clearance is not associated with survival benefit.This time-consuming fixation method has a low efficacy as a routine practice. 展开更多
关键词 NEOADJUVANT radiotherapy RECTAL cancer Fat clearance Survival LYMPH node CONVENTIONAL FIXATION
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Role of D2 gastrectomy in gastric cancer with clinical para-aortic lymph node metastasis 预览
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作者 Xiao-Hao Zheng Wen Zhang +5 位作者 Lin Yang Chun-Xia Du Ning Li Gu-Sheng Xing Yan-Tao Tian Yi-Bin Xie 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第19期2338-2353,共16页
BACKGROUND Owing to the technical difficulty of pathological diagnosis, imaging is still the most commonly used method for clinical diagnosis of para-aortic lymph node metastasis (PALM) and evaluation of therapeutic e... BACKGROUND Owing to the technical difficulty of pathological diagnosis, imaging is still the most commonly used method for clinical diagnosis of para-aortic lymph node metastasis (PALM) and evaluation of therapeutic effects in gastric cancer, which leads to inevitable false-positive findings in imaging. Patients with clinical PALM may have entirely different pathological stages (stage IV or not), which require completely different treatment strategies. There is no consensus on whether surgical intervention should be implemented for this group of patients. In particular, the value of D2 gastrectomy in a multidisciplinary treatment (MDT) approach for advanced gastric cancer with clinical PALM remains unknown. AIM To investigate the value of D2 gastrectomy in a MDT approach for gastric cancer patients with clinical PALM. METHODS In this real-world study, clinico-pathological data of all gastric cancer patients treated at the Cancer Hospital, Chinese Academy of Medical Sciences between 2011 and 2016 were reviewed to identify those with clinically enlarged PALM. All the clinico-pathological data were prospectively documented in the patient medical record. For all the gastric cancer patients with advanced stage disease, especially those with suspicious distant metastasis, the treatment methods were determined by a multidisciplinary team. RESULTS In total, 48 of 7077 primary gastric cancer patients were diagnosed as having clinical PALM without other distant metastases. All 48 patients received chemotherapy as the initial treatment. Complete or partial response was observed in 39.6%(19/48) of patients in overall and 52.1%(25/48) of patients in the primary tumor. Complete response of PALM was observed in 50.0%(24/48) of patients. After chemotherapy, 45.8%(22/48) of patients received D2 gastrectomy, and 12.5%(6/48) of patients received additional radiotherapy. The postoperative major complication rate and mortality were 27.3%(6/22) and 4.5%(1/22), respectively. The median overall survival and progression-free survival of 展开更多
关键词 Gastric cancer Para-aortic LYMPH NODE MULTIDISCIPLINARY GASTRECTOMY Conversion NEOADJUVANT
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Endoscopic ultrasound-guided fine-needle aspiration biopsy - Recent topics and technical tips 预览
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作者 Kazuya Matsumoto Yohei Takeda +5 位作者 Takumi Onoyama Soichiro Kawata Hiroki Kurumi Hiroki Koda Taro Yamashita Hajime Isomoto 《世界临床病例杂志》 2019年第14期1775-1783,共9页
Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is a useful procedure that enables reliable pathological diagnoses of pancreatobiliary diseases, subepithelial lesions, and swollen lymph nodes. In ... Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is a useful procedure that enables reliable pathological diagnoses of pancreatobiliary diseases, subepithelial lesions, and swollen lymph nodes. In recent years, a pathological diagnosis based on EUS-FNA has made it possible to provide accurate treatment methods not only in these fields, but also in respiratory organs and otorhinolaryngology. This review discusses the latest topics pertaining to EUS-FNA as well as procedural tips. 展开更多
关键词 Endoscopic ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION BIOPSY CYTOLOGY Pathology Pancreatobiliary diseases Subepithelial lesions Lymph nodes
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Short-term efficacy of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy via Huang's three-step maneuver for advanced upper gastric cancer:Results from a propensity scorematched study 预览
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作者 Jia-Bin Wang Zhi-Yu Liu +14 位作者 Qi-Yue Chen Qing Zhong Jian-Wei Xie Jian-Xian Lin Jun Lu Long-Long Cao Mi Lin Ru-Hong Tu Ze-Ning Huang Ju-Li Lin Hua-Long Zheng Si-Jin Que Chao-Hui Zheng Chang-Ming Huang Ping Li 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第37期5641-5654,共14页
BACKGROUND Robotic surgery has been considered to be significantly better than laparoscopic surgery for complicated procedures.AIM To explore the short-term effect of robotic and laparoscopic spleen-preserving splenic... BACKGROUND Robotic surgery has been considered to be significantly better than laparoscopic surgery for complicated procedures.AIM To explore the short-term effect of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy(SPSHL)for advanced gastric cancer(GC)by Huang’s three-step maneuver.METHODS A total of 643 patients who underwent SPSHL were recruited from April 2012 to July 2017,including 35 patients who underwent robotic SPSHL(RSPSHL)and 608 who underwent laparoscopic SPSHL(LSPSHL).One-to-four propensity score matching was used to analyze the differences in clinical data between patients who underwent robotic SPSHL and those who underwent laparoscopic SPSHL.RESULTS In all,175 patients were matched,including 35 patients who underwent RSPSHL and 140 who underwent LSPSHL.After matching,there were no significant differences detected in the baseline characteristics between the two groups.Significant differences in total operative time,estimated blood loss(EBL),splenic hilar blood loss(SHBL),splenic hilar dissection time(SHDT),and splenic trunk dissection time were evident between these groups(P<0.05).Furthermore,no significant differences were observed between the two groups in the overall noncompliance rate of lymph node(LN)dissection(62.9%vs 60%,P=0.757),number of retrieved No.10 LNs(3.1±1.4 vs 3.3±2.5,P=0.650),total number of examined LNs(37.8±13.1 vs 40.6±13.6,P=0.274),and postoperative complications(14.3%vs 17.9%,P=0.616).A stratified analysis that divided the patients receiving RSPSHL into an early group(EG)and a late group(LG)revealed that the LG experienced obvious improvements in SHDT and length of stay compared with the EG(P<0.05).Logistic regression showed that robotic surgery was a significantly protective factor against both SHBL and SHDT(P<0.05).CONCLUSION RSPSHL is safe and feasible,especially after overcoming the early learning curve,as this procedure results in a radical curative effect equivalent to that of LSPSHL. 展开更多
关键词 Advanced gastric cancer ROBOTIC surgery LAPAROSCOPIC surgery Dissection of SPLENIC HILAR lymph node Propensity score matching Huang’s three-step MANEUVER
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Dual energy computed tomography for detection of metastatic lymph nodes in patients with hepatocellular carcinoma 预览
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作者 Yu-Rong Zeng Qi-Hua Yang +4 位作者 Qing-Yu Liu Jun Min Hai-Gang Li Zhi-Feng Liu Ji-Xin Li 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第16期1986-1996,共11页
BACKGROUND Regional lymph node metastasis in patients with hepatocellular carcinoma (HCC) is not uncommon, and is often under- or misdiagnosed. Regional lymph node metastasis is associated with a negative prognosis in... BACKGROUND Regional lymph node metastasis in patients with hepatocellular carcinoma (HCC) is not uncommon, and is often under- or misdiagnosed. Regional lymph node metastasis is associated with a negative prognosis in patients with HCC, and surgical resection of lymph node metastasis is considered feasible and efficacious in improving the survival and prognosis. It is critical to characterize lymph node preoperatively. There is currently no consensus regarding the optimal method for the assessment of regional lymph nodes in patients with HCC. AIM To evaluate the diagnostic value of single source dual energy computed tomography (CT) in regional lymph node assessment for HCC patients. METHODS Forty-three patients with pathologically confirmed HCC who underwent partial hepatectomy with lymphadenectomy were retrospectively enrolled. All patients underwent dual-energy CT preoperatively. Regional lymph nodes (n = 156) were divided into either a metastatic (group P, n = 52) or a non-metastasis group (group N, n = 104), and further, according to pathology, divided into an active hepatitis (group P1, n = 34;group N1, n = 73) and a non-active hepatitis group (group P2, n = 18;group N2, n = 31). The maximal short axis diameter (MSAD), iodine concentration (IC), normalized IC (NIC), and the slope of the spectral curve (λHU) of each group in the arterial phase (AP), portal phase (PP), and delayed phase (DP) were analyzed. RESULTS Analysis of the MSAD, IC, NIC, and λHU showed statistical differences between groups P and N (P < 0.05) during all three phases. To distinguish benign from metastatic lymph nodes, the diagnostic efficacy of IC, NIC, and λHU in the PP was the best among the three phases (AP, PP, and DP), with a sensitivity up to 81.9%, 83.9%, and 81.8%, and a specificity up to 82.4%, 84.1% and 84.1%, respectively. The diagnostic value of combined analyses of MSAD with IC, NIC, or λHU in the PP was superior to the dual energy CT parameters alone, with a sensitivity up to 84.5%, 86.9%, and 86.2%, and a specificity u 展开更多
关键词 COMPUTED TOMOGRAPHY Hepatocellular carcinoma LYMPH NODE METASTASIS Hepatitis Dual energy
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Precision surgical approach with lymph-node dissection in early gastric cancer 预览
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作者 Shinichi Kinami Naohiko Nakamura +4 位作者 Yasuto Tomita Takashi Miyata Hideto Fujita Nobuhiko Ueda Takeo Kosaka 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第14期1640-1652,共13页
The gravest prognostic factor in early gastric cancer is lymph-node metastasis, with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to trea... The gravest prognostic factor in early gastric cancer is lymph-node metastasis, with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinicpathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy, functional symptoms may still result. Physicians must strive to minimize postgastrectomy symptoms and optimize long-term quality of life after this operation. Depending on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative patients. Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition. 展开更多
关键词 Stomach neoplasms SURGERY GASTRECTOMY methods Recovery of function SENTINEL LYMPH NODE SURGERY Gastric cancer
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纳米炭示踪剂在全腹腔镜远端进展期胃癌根治术中的应用
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作者 刘向东 徐有超 +2 位作者 杨帅帅 张文星 孙作成 《潍坊医学院学报》 2019年第4期288-291,共4页
目的探讨纳米炭示踪剂(CNSI)在全腹腔镜远端进展期胃癌根治术中的临床应用价值。方法选取在潍坊市人民医院术前接受内镜下注射纳米炭后行全腹腔镜远端进展期胃癌根治术治疗的患者45例(纳米炭组),未注射的患者42例(对照组)。比较两组手... 目的探讨纳米炭示踪剂(CNSI)在全腹腔镜远端进展期胃癌根治术中的临床应用价值。方法选取在潍坊市人民医院术前接受内镜下注射纳米炭后行全腹腔镜远端进展期胃癌根治术治疗的患者45例(纳米炭组),未注射的患者42例(对照组)。比较两组手术耗时、术中出血量、术后并发症等手术指标;分析两组的淋巴结清扫、转移以及纳米炭的肿瘤定位效果。结果两组患者的术后排气时间、住院时间、并发症等无统计学差异(P>0.05)。纳米炭组的手术耗时及术中失血量明显低于对照组(P<0.05),纳米炭组检测到的淋巴结平均数、小淋巴结数与对照组有统计学差异(P<0.05),纳米炭组总淋巴结及黑染淋巴结转移率较高(P<0.05)。结论纳米炭示踪剂在全腹腔镜远端进展期胃癌根治术的淋巴结示踪及肿瘤定位作用效果显著,可提高淋巴结清扫率,缩短手术时间,具有微创效果佳及清扫更彻底的优势。 展开更多
关键词 全腹腔镜 淋巴结 纳米炭示踪剂 肿瘤定位 胃肿瘤 胃癌根治术
Prediction of cervical lymph node metastases in papillary thyroid microcarcinoma by sonographic features of the primary site 预览
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作者 Xi Wei Meng Wang +9 位作者 Xiaoqing Wang Xiangqian Zheng Ying Li Yi Pan Yueguo Li Jiali Mu Yang Yu Dapeng Li Ming Gao Sheng Zhang 《癌症生物学与医学:英文版》 CAS CSCD 2019年第3期587-594,共8页
Objective: To study the sonographic features of the primary site of papillary thyroid microcarcinoma(PTMC) for the prediction of cervical lymph node metastasis during preoperative diagnosis.Methods: A total of 710 PTM... Objective: To study the sonographic features of the primary site of papillary thyroid microcarcinoma(PTMC) for the prediction of cervical lymph node metastasis during preoperative diagnosis.Methods: A total of 710 PTMC patients between 2013 and 2016 with a diagnosis of cervical lymph node metastases were reviewed.We analyzed the sonographic features of the PTMC primary site to predict ipsilateral or central lymph node metastases in univariate and multivariate models.The ratio of abutment/perimeter of the PTMC primary site was utilized to evaluate cervical lymph node status.Results: Regarding clinical characteristics, multifocality and extrathyroidal extension were associated with cervical lymph node involvement.In the multivariate regression model, calcification and the abutment/perimeter ratio of lesions were evaluated as independent factors in level Ⅵ, ipsilateral or skip cervical lymph node metastases.The cut-off value of the ratio of abutment/perimeter of the PTMC primary site(25%) was significantly correlated with cervical lymph node metastases(P = 0.000).Conclusions: Independent sonographic features, including lesion size, lesion location, calcification, and the ratio of abutment/perimeter of the primary site, were associated with cervical lymph node metastases in PTMC patients. 展开更多
关键词 ULTRASONOGRAPHY THYROID LYMPH NODES METASTASIS evaluation
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Prognostic significance of 14v-lymph node dissection to D2 dissection for lower-third gastric cancer 预览
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作者 Chen Zheng Zi-Ming Gao +4 位作者 An-Qi Sun Hai-Bo Huang Zhen-Ning Wang Kai Li Shan Gao 《世界临床病例杂志》 2019年第18期2712-2721,共10页
BACKGROUND Radical gastrectomy with D2 lymph node (LN) dissection is the standard surgical procedure for patients with resectable gastric cancer (GC). In the fifteenth edition of the Japanese Classification of Gastric... BACKGROUND Radical gastrectomy with D2 lymph node (LN) dissection is the standard surgical procedure for patients with resectable gastric cancer (GC). In the fifteenth edition of the Japanese Classification of Gastric Carcinoma, the 14v LN (LNs along the root of the superior mesenteric vein) was defined as the regional gastric LN. The efficacy of 14v LN dissection during radical distal gastrectomy for lower-third GC remains controversial. AIM To analyze whether the addition of 14v LN dissection improved the survival of patients with lower-third GC. METHODS The data from 65 patients who underwent 14v LN dissection and 65 patients treated without 14v LN dissection were selected using the propensity scorematched method from our institute database constructed between 2000 and 2012. Overall survival was compared between the groups. RESULTS Overall survival was similar between patients with 14v LN metastasis and those with distant metastasis (P = 0.521). Among patients with pathological stage IIIA disease, those who were treated with 14v LN dissection had a significantly higher overall survival than those treated without it (P = 0.020). Multivariate analysis showed that age < 65 years and pT2-3 stage were independent favorable prognostic factors for prolonged overall survival in patients with pathological stage IIIA disease. Patients with No. 1, No. 6, No. 8a, or No. 11p LN metastasis were at higher risk of having 14v LN metastasis.CONCLUSION Adding 14v LN dissection to D2 dissection during radical distal gastrectomy may improve the overall survival of patients with pathological stage IIIA lower-third GC. 展开更多
关键词 Gastric cancer No. 14v LYMPH NODE LYMPHADENECTOMY Prognosis PROPENSITY SCORE matching
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Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma 预览
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作者 Wei Jiang, Hong-Yan Wei +1 位作者 Hai-Yan Zhang Qiu-Luan Zhuo 《世界临床病例杂志》 2019年第1期49-57,共9页
BACKGROUND Cervical lymph node metastasis in papillary thyroid carcinoma(PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients;h... BACKGROUND Cervical lymph node metastasis in papillary thyroid carcinoma(PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients;however, it is not accurate in determining lymph node metastasis.AIM To evaluate the value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in PTC.METHODS A total of 94 patients with PTC were recruited. According to pathological results,lymph nodes were divided into two groups: metastatic group(n = 50) and reactive group(n = 63). The routine ultrasound findings, contrast-enhanced ultrasound and elastography data were recorded and compared. Logistic regression was used to generate predictive probability distributions for the diagnosis of lymph node metastasis with different indicators. Receiver operating characteristic curve analysis was used to test the efficacy of contrast-enhanced ultrasound combined with elastography based on routine ultrasound in evaluating PTC cervical lymph node metastasis.RESULTS The ratio of long diameter/short diameter(L/S) ≤ 2, irregular marginal morphology, missing lymphatic portal, peripheral or mixed blood flow distribution, peak intensity(PI), non-uniform contrast distribution and elasticity score in the metastatic group were significantly higher than those in the reactive group(P < 0.05). L/S ratio, missing lymphatic portal, PI and elasticity score had a significant influence on the occurrence of PTC cervical lymph node metastasis(P< 0.05). Furthermore, the area under the curve(AUC) for lymph node metastasis diagnosed using the combination of PI ratio, elasticity score, missing lymphatic portal and LS was 0.936, which was significantly higher than the AUC for PI ratio alone. The difference was statistically significant(P < 0.05). The fitting equation for the combined diagnosis was logit(P) =-12.341 + 1.482 × L/S ratio + 3.529 ×missing lymphatic portal + 0.392 × PI + 3.288 × elasticity score.CONCLUSION Based on 展开更多
关键词 CONTRAST-ENHANCED ultrasound ELASTOGRAPHY PAPILLARY THYROID cancer CERVICAL LYMPH node metastasis
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Metastatic patterns and surgical methods for lymph nodes No.5 and No.6 in proximal gastric cancer 预览
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作者 Jinou Wang Pei Wu +5 位作者 Zhenning Wang Kai Li Baojun Huang Pengliang Wang Huimian Xu Zhi Zhu 《中国癌症研究:英文版》 SCIE CAS CSCD 2019年第1期171-177,共7页
Objective: The current surgical treatment guidelines for early proximal gastric cancer(PGC) still lack agreement. Lymphadenectomy of lymph nodes No. 5 and No. 6 is the major difference between total and proximal gastr... Objective: The current surgical treatment guidelines for early proximal gastric cancer(PGC) still lack agreement. Lymphadenectomy of lymph nodes No. 5 and No. 6 is the major difference between total and proximal gastrectomy. We elucidated the appropriate surgical procedure for PGC by investigating the pathological characteristics and prognostic significance of lymph nodes No. 5 and No. 6.Methods: In total, 333 PGC patients who underwent total gastrectomy were enrolled in this study. We investigated their clinicopathological characteristics and the metastatic patterns of the lymph nodes. Patients with metastasis in lymph nodes No. 5 and No. 6 were combined into one group and we compared the difference in survival between those with and without metastasis in lymph nodes No. 5, 6(lymph nodes No. 5 and No. 6 in any group of metastasis) for different subgroups.Results: The metastatic rates for lymph nodes No. 5 and No. 6 in PGC were 9.91% and 16.11%, respectively.The metastatic rate for both lymph nodes No. 5, 6 was 20.42%. Multivariate analysis showed that positive metastasis in lymph node No. 4, depth of invasion, and tumor size were independently correlated with the presence of metastasis in lymph nodes No. 5, 6.Conclusions: When lymph node No. 4 is positive(intraoperative pathology) or tumor size ≥5 cm or T4 stage,lymphadenectomy should be performed for lymph nodes No. 5 and No. 6, and total gastrectomy is recommended. 展开更多
关键词 GASTRECTOMY LYMPH NODES No.5 and No.6 METASTASIS prognosis PROXIMAL gastric cancer
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Radiomics-based predictive risk score: A scoring system for preoperatively predicting risk of lymph node metastasis in patients with resectable non-small cell lung cancer 预览
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作者 Lan He Yanqi Huang +3 位作者 Lixu Yan Junhui Zheng Changhong Liang Zaiyi Liu 《中国癌症研究:英文版》 SCIE CAS CSCD 2019年第4期641-652,共12页
Objective: To develop and validate a radiomics-based predictive risk score(RPRS) for preoperative prediction of lymph node(LN) metastasis in patients with resectable non-small cell lung cancer(NSCLC).Methods: We retro... Objective: To develop and validate a radiomics-based predictive risk score(RPRS) for preoperative prediction of lymph node(LN) metastasis in patients with resectable non-small cell lung cancer(NSCLC).Methods: We retrospectively analyzed 717 who underwent surgical resection for primary NSCLC with systematic mediastinal lymphadenectomy from October 2007 to July 2016. By using the method of radiomics analysis, 591 computed tomography(CT)-based radiomics features were extracted, and the radiomics-based classifier was constructed. Then, using multivariable logistic regression analysis, a weighted score RPRS was derived to identify LN metastasis. Apparent prediction performance of RPRS was assessed with its calibration,discrimination, and clinical usefulness.Results: The radiomics-based classifier was constructed, which consisted of 13 selected radiomics features.Multivariate models demonstrated that radiomics-based classifier, age group, tumor diameter, tumor location, and CT-based LN status were independent predictors. When we assigned the corresponding score to each variable,patients with RPRSs of 0-3, 4-5, 6, 7-8, and 9 had distinctly very low(0%-20%), low(21%-40%), intermediate(41%-60%), high(61%-80%), and very high(81%-100%) risks of LN involvement, respectively. The developed RPRS showed good discrimination and satisfactory calibration (C-index: 0.785, 95% confidence interval(95% CI):0.780-0.790)Additionally, RPRS outperformed the clinicopathologic-based characteristics model with net reclassification index(NRI) of 0.711(95% CI: 0.555-0.867).Conclusions: The novel clinical scoring system developed as RPRS can serve as an easy-to-use tool to facilitate the preoperatively individualized prediction of LN metastasis in patients with resectable NSCLC. This stratification of patients according to their LN status may provide a basis for individualized treatment. 展开更多
关键词 LYMPH NODE radiomics RISK SCORE CT NON-SMALL cell lung cancer
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