Patients with locally advanced thyroid cancer often face challenges in achieving radical surgery during initial diagnosis. This has become a significant hurdle in the treatment of thyroid cancer. With the continuous development of systemic therapy for thyroid cancer, several studies have demonstrated that neoadjuvant therapy can shrink tumors in some patients, thereby increasing the chances of complete resection and improving prognosis. Targeted therapy plays a crucial role as a core component of neoadjuvant treatment. Simultaneously, the potential efficacy of immunotherapy has gained attention, showing promising prospects. We aim to summarize the research progress and existing issues regarding neoadjuvant therapy for locally advanced thyroid cancer. We look forward to more high-quality clinical studies providing robust evidence for neoadjuvant therapy in locally advanced thyroid cancer, expanding the breadth of treatment options.
The rotary left ventricular assist device (LVAD) has been an effective option for end-stage heart failure. However, while clinically using the LVAD, patients are often at significant risk for ventricular collapse, called suction, mainly due to higher LVAD speeds required for adequate cardiac output. Some proposed suction detection algorithms required the external implantation of sensors, which were not reliable in long-term use due to baseline drift and short lifespan. Therefore, this study presents a new suction detection system only using the LVAD intrinsic blood pump parameter (pump speed) without using any external sensor. Three feature indices are derived from the pump speed and considered as the inputs to four different classifiers to classify the pumping states as no suction or suction. The in-silico results using a combined human circulatory system and LVAD model show that the proposed method can detect ventricular suction effectively, demonstrating that it has high classification accuracy, stability, and robustness. The proposed suction detection system could be an important part in the LVAD for detecting and avoiding suction, while at the same time making the LVAD meet the cardiac output demand for the patients. It could also provide theoretical basis and technology support for designing and optimizing the control system of the LVAD.
Objective To determine the effects of controlled hypotension (CH) on cerebra1 blood flow, cerebra1metabolism, and cognitive functions. Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1966 to 2008), EMbase (1974 to 2008), The Cochrane Library (Issue 2, 2008), CBM (1978 to 2008), and CNKI (1994 to 2008). The quality of included trials was assessed by two reviewers independently. RevMan 4.2.7 software provided by The Cochrane Collaboration was used for statistical analysis. Results Nine RCTs involving a total of 295 patients were included. Most of the studies were of poor methodological quality. Meta-analysis was performed because the outcomes were the comparisons of the means of several repeated measures, and so a descriptive analysis was conducted. There were no significant differences in cerebral blood flow velocity, hypoxia-induced metabolites, and cognitive function between the CH group and the control group (Plt;0.05). But the S100B protein level in cerebrospinal fluid or blood was significantly higher in the CH group than that in the control group (Plt;0.02). Conclusion CH has no adverse effects on cerebra1 blood flow, cerebra1 metabolism, or cognitive functions. But isoflurane-induced hypotension may increase the release of S100B, indicating worse brain injury. The above conclusions were made from the limited evidence, and more rigorous RCTs are needed.
目的 總結胰腺瘺管空腸Roux-en-Y吻合術治療胰管離斷綜合征的治療效果。方法 回顧性分析2002年3月至2010年7月期間我院行胰腺瘺管空腸Roux-en-Y吻合術治療的5例胰管離斷綜合征患者的臨床資料，分析其治療效果及手術并發癥。結果 5例患者均為急性出血壞死性胰腺炎手術治療后，經MRCP確診為胰管離斷綜合征，手術方式為瘺管空腸Roux-en-Y吻合術，中位手術時間為178min（120～360min），中位術中失血量為300ml（150～600ml），術后中位進食時間為5d（3～8d）。隨訪中位時間為390d（120～712d），5例患者恢復順利。2例患者切口感染，經切口換藥治愈；1例患者出現短暫的胰腸吻合口漏，經保守治療治愈。結論 從本組有限的病例資料看，胰腺瘺管空腸Roux-en-Y吻合術是胰管離斷綜合征較安全的治療方式。
Objective To summarize the current research progress about influence of patellofemoral osteoarthritis on clinical outcome of unicompartmental knee arthroplasty (UKA). Methods The recent related literature was extensively reviewed and summarized, including pros and cons to regard the patellofemoral osteoarthritis as the contraindication. Results Previous studies regarded patellofemoral osteoarthritis as the contraindication of UKA. Most of current researches show that the damage to the articular cartilage of the patellofemoral joint to the extent of full-thickness cartilage loss has no influence on outcome of UKA. There is no correlation between preoperative anterior knee pain or medial patellofemoral joint degeneration and the clinical outcome. However, lateral subluxation of the patella has an adverse impact on postoperative curative effect. Degeneration of the lateral patellofemoral joint may be a risk factor of the outcome. Conclusion Patellofemoral osteoarthritis should not be the absolute contraindication of UKA. The effect of degeneration of the lateral patellofemoral joint is not clear at present, and still needs further studies in the future.
Objective To investigate the diagnosis and treatment strategy of urosepsis caused by ureteral calculi in solitary kidney. Methods The clinical data of patients with urosepsis caused by ureteral calculi in solitary kidney in the Department of Urology of Chengdu 363 Hospital Affiliated to Southwest Medical University from March 2015 to March 2020 were analyzed retrospectively. Results A total of 23 patients were included. One patient received ureteroscopic holmium laser lithotripsy, after which urosepsis and renal function deteriorated, then got better after anti-infection and hemodialysis treatment in intensive care unit; 17 patients received implantation of ureteral stent by cystoscopy, and 5 patients received percutaneous nephrostomy by ultrasound guiding, the 22 patients received ureteroscopic lithotripsy or flexible ureteroscopic lithotripsy electively. One patients had subcapsular renal hematoma postoperatively and worse renal insufficiency, the rest 22 patients had improved renal function. All patients were cured clinically. Conclusions For solitary kidney patients who have urosepsis caused by ureteral calculi, emergency treatment is necessary. The relief of urinary obstruction must be based on effective anti-infection. Choosing cystoscopic ureteral stent implantation or percutaneous nephrostomy depends on patients’ individualization. Ureterscopic lithotripsy simultaneously is not recommended. Ureteral intubation before cystoscopic ureteral stent implantation is important, which can increase the success rate of ureteral stent implantation.
【Abstract】ObjectiveTo investigate the effect of genetic modulation of the hepatic graft with IL-10 during liver preservation in rat liver transplantation. MethodsEleven cases of orthotopic liver transplantation were performed in Lewis to BN rats according to the cuff’s technique. All rats were divided into 3 groups,which were control group(n=3), Lipo group(n=4) and Lipo-rIL-10 group(n=4). Lipofectamine 2000-pCR3.1 complex and Lipofectamine 2000-pCR3.1 rIL10 complex were respectively injected into portal vein and kept for 45 minutes to transfect grafts during cold preservation in vitro. All rats were killed on postoperative day 6. Serum samples were collected for decting IL-10 by means ELISA. Transgene expression of rIL-10 was assessed by means of RT-PCR and immunohistochemistry. ResultsIn Lipo-rIL-10 group, levels of IL-10 from suprahepatic vena cava were significant higher than those from infrahepatic vena cava (P=0.024), transgene expression of rIL-10 in Lipo-rIL-10 were higher than those of control group and Lipo group assessed by means of RT-PCR and immunohistochemistry. ConclusionDuring cold preservation in vitro through portal vein injection to donor liver, liposome mediated gene transfection can successfully achieve local gene expression.
【摘要】 目的 探討高頻彩色多普勒超聲對淺表軟組織腫物的診斷價值。 方法 回顧性分析2008年1-11月70例經手術、活檢病理證實的淺表軟組織腫物的聲像圖特征，包括腫物的部位、形態大小、內部回聲、邊界及其與周邊組織的關系、長徑與厚度比值（L/T）及病變周邊與內部血流分布情況。 結果 超聲對淺表腫塊病灶的顯示率為100%，良性腫瘤有脂肪瘤、表皮囊腫、滑膜囊腫、神經鞘瘤，血管瘤、異物肉芽腫等，惡性腫物包括皮膚纖維肉瘤，轉移性腺癌。 結論 彩色多普勒超聲對淺表腫塊的檢出、定位及物理性質可做出準確的診斷，綜合分析腫物的邊界、形態、內部回聲及血流分布等特點對腫物的良惡性診斷具有重要價值。【Abstract】 Objective To evaluate the value of high-frequency color Doppler ultrasonography in diagnosing the superficial soft tissue masses. Methods The clinical data of 70 patients with superficial soft tissue masses from January to November 2008 were retrospectively analyzed. Superficial soft tissue masses was diagnosed by the surgery and biopsy. The sonographic features, including the location, morphology, size, internal echo, boundary, relationship with peripheral tissues, longitude to transverse ratio (L/T), and the vascularity, were observed. Results The results of sonographic examination showed that 100% superficial masses could be found. Benign masses included lipoma, sebaceous cysts, synovial cysts, nerve sheath tumors, haemangioma, foreign body granulomas, etc. Malignant soft tissue tumors included fibrous sarcoma and metastatic neoplasms. Conclusion Color Doppler ultrasonography can precisely diagnose the presence, localization and the physical characters of superficial soft tissue masses. It is an excellent modality to diagnose the benign or malignant masses by analyzing the boundary, configuration, internal echo and vascularity of the masses.