Age is the main cause of neurodegenerative changes in the central nervous system (CNS), and the loss of neurons would increase with the migration of the disease. The current treatment is also mainly used to relieve symptoms, while the function of CNS is very difficult to recover. The emergence of endogenous stem cells has brought new hope for the treatment of CNS diseases. However, this nerve regeneration is only in some specific areas, and the recovery of neural function remains unknown. More and more experts in the field of neuroscience have carried out various in vivo or in vitro experiments, in order to increase nerve regeneration and nerve function recovery through mechanism research, in the expectation that the results would be applied to the treatment of CNS diseases. This article reviews the recent progress of endogenous neural stem cells in degenerative diseases of CNS.
【摘要】 目的 探討子宮頸巨大平滑肌瘤在其診斷及治療上的特殊性。 方法 對2007年10月-2010年3月收治的11例子宮頸巨大平滑肌瘤患者的臨床資料進行分析，對其發病率，診斷和手術治療進行評價。 結果 11例子宮頸巨大平滑肌瘤中黏膜下2例，腹膜后9例。術前9例出現誤診，其中誤診為盆腔包塊5例，子宮體肌瘤3例，子宮肉瘤1例。6例行經腹子宮全切加雙附件切除，2例行經腹子宮切除術，1例行經腹肌瘤挖除術，1例行經陰道肌瘤摘除術，1例行經腹肌瘤挖出加宮頸殘端切除術。 結論 子宮頸巨大平滑肌瘤由于其位置的特殊性，尤其是凸向腹膜后的肌瘤，由于盆腔器官被擠壓，使盆腔解剖結構發生改變，術前易被誤診。且手術過程中易出現損傷及出血，因此術前估計充分，術中仔細認清各器官解剖關系，可有效地減少術中損傷和控制出血。【Abstract】 Objective To investigate the particularity of diagnosis and treatment for giant uterine cervical leiomyoma. Methods We analyzed the clinical data of 11 patients with giant uterine cervical leiomyoma who were admitted in our hospital from October 2007 to March 2010. The incidence, diagnosis and surgical treatment of the disease were evaluated. Results Of the 11 cases, nine were retroperitoneal leiomyoma and two were submucous leiomyoma. There were nine misdiagnosed cases before operation, including five diagnosed as pelvic mass, one as uterine sarcoma and three as uterine corpus leiomyoma. Six patients underwent abdominal hysterectomy and bilateral salpingo-oophorectomy; two underwent abdominal hysterectomy; one underwent abdominal myomectomy; one underwent transvaginal myomectomy; and one underwent abdominal myomectomy with excision of cervical stump. Conclusion The giant uterine cervical leiomyoma is easily misdiagnosed preoperatively due to its special anatomic site. A good example is the retroperitoneal leiomyoma in which the pelvic anatomic structure is changed because of the extrusion of the tumor on other pelvic organs. Furthermore, injuries and bleeding often happen during the operation. Consequently, sufficient preoperative assessment and clearly identifying regional anatomical relations can effectively reduce the damage and bleeding during the operation.
Objective To assess the efficacy and toxicity of the maintenance radiotherapy for epithelial ovarian cancer. Methods We searched MEDLINE (1950 to 2009), EMbase (1966 to 2009), The Cochrane Library (Issue 1, 2009), CBMdisc (1978 to 2009), CNKI (1979 to 2009), VIP (1989 to 2009) and relevant internet websites to identify randomized controlled trials (RCTs) of maintenance radiotherapy for epithelial ovarian cancer. The quality of the included trials was assessed by Cochrane Systematic Review Handbook. Meta-analyses were conducted by RevMan 5.0 and SPSS 10.0 software. Results A total of 5 RCTs involving 529 patients were identified. The result of meta-analyses showed that the whole-abdominal radiation increased the 5-year progression-free survival (PFS) at RR1.76 and 95%CI 1.13 to 2.73, while it showed no effect on the 5-year overall survival (OS) at RR1.30 and 95%CI 0.96 to 1.76. The main adverse reactions of maintenance radiotherapy for epithelial ovarian cancer included diarrhea and abdominal pains, whose severity was related to radiation dose. Conclusion The whole-abdominal radiation can increase the 5-year PFS while its effect on the 5-year OS needs to be further studied.
Objective To assess the clinical effectiveness, safety and cost-effectiveness of adjuvant radiotherapy(RT) for endometrial cancer compared to other treatmen. Method The following electronic databases were searched: MEDLINE, EMBAS, CancerLit, CBMdisc, CNKI. The Cochrane Library (Issue 3, 2007). Correlative websites, such as ‘google’, were searched by hand. The studies included in the references of eligible studies were additionally searched RCTs of adjuvant radiotherapy before March, 2007 comparing adjuvant radiotherapy with other treatment for endometrial cancer were included. Eligible RCTs were assessed for quality by two reviewers independently: criteria of concealment of treatment, blinding, standard validity and reliability of outcome measures, withdraw rate, intention-to-treat analysis and homogeneity between centers were analyzed for each study. All data were performed by a meta-analysis. Result Seven RCTs met the inclusion criteria/ Methodological quality was level B. Five RCTs were compared adjuvant radiotherapy (external beam radiotherapy (EBRT) and /or intracavitary radiotherapy (ICRT) with other treatment, Two RCTs including one RCT was compared two different fractionation schedules for postoperative vagina high-dose-rate(HDR) irradiation in endometrial carcinoma the other RCT was compared two different radiotherapy method (pelvic radiotherapy and vagina radiotherapy vs vagina radiotherapy) for endometrial carcinoma. No survival different were identified; none of the studies was powered enough to show a survival benefit. But who received RT had fewer local (pelvic and/or vagina) recurrences compared to women not receiving RT. Adverse effects is found more often in RT than in not RT, there is less localrecurrences in combined radiotherapy (pelvic radiotherapy and vagina radiotherapy) than in vagina radiotherapy. lowdose vagina radiotherapy had few vagina shortening than high-dose radiotherapy, there are the same 5-overall surviva, local recurrences and distant recurrences. Conclusions Adjuvant radiotherapy for endometrial can cer can better control local recurrences than observation for postoperative endometrial cancer. Effects about overall survival, distant recurrences and disease-free survival are similar; low-dose vagina radiotherapy has few vagina shortening than high-dose radiotherapy, there are the same 5-years overall survival, local recurrences and distant recurrences for endometrial cancer, there is less local recurrences in combined radiotherapy (pelvic radiotherapy plus vagina radiotherapy) than in vagina radiotherapy for endometrial cancer; postoperative high-dose brachytherapy can get good cost-effectiveness; Effect of adjuvant radiotherapy for overall survival and disease-free survival of endometrial carcinoma are needed to further assessed by rigorously designs, randomized, double-blind, placebo-controlled trials adjuvant radiotherapy for endometrial carcinoma.
Transcatheter intervention for congenital heart disease has been developed for 40 years in China, it has experienced the transition of learning to self-dependent innovation, and witnessed the intervention therapy system starting from scratch and gradually reaching the top level and gaining high achievements in the world scale. With the continuous development of interventional technology and devices, cutting-edge ideas and viewpoints are constantly discussed. This review summarized the development of intervention techniques and devices, hoping to provide some experience for the further development of transcatheter interventions for congenial heart disease.
Objective To evaluate the clinical effectiveness, safety and cost-effectiveness of postoperative radiotherapy on endometrial carcinoma. Methods We searched The Cochrane Library, The Cochrane Central Register of Controlled Trials (CENTRAL), The National Research Register, Health Technology Assessment Database (HTA), MEDLINE, EMbase, CancerLit, CBMdisc, VIP, WANFANG DATABASE and CNKI to March 2007. Relevant journals were also hand searched. Study selection and assessment, data collection and analyses were undertaken by two reviewers independently according to the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analyses were performed. Results Three RCTs involving 1126 patients were included. Each of the 3 RCTs compared adjuvant radiotherapy (external beam radiotherapy, EBRT) versus chemotherapy. Two trials (730 patients) compared adjuvant radiotherapy versus CAP chemotherapy (carboplatin + adriamycin + cisplatin). The other trial (396 patients) compared adjuvant radiotherapy versus AP chemotherapy (adriamycin + cisplatin). The meta-analyses showed that for patients with endometrial cancer at stage Ic, II or III, there were no significant differences between adjuvant radiotherapy and CAP in 5-year overall survival (OS), 5-year progress-free survival (PFS) and 5-year recurrence (local, distant, total). For patients with endometrial cancer at stage III or IV, adjuvant radiotherapy was superior to AP regimen on 5-year OS and 5-year PFS. The incidence of grade 3/4 toxicities of digestive system and urogenital system was similar between the two groups of patients. The chemotherapy group showed a higher incidence of grade 3/4 toxicities of hematology than the radiotherapy group. Conclusion The effect of adjuvant pelvic radiotherapy for endometrial carcinoma at stage Ic, II or III is similar to that of adjuvant chemotherapy. However, for endometrial carcinoma at stage III or IV, the effect of radiotherapy is superior to that of chemotherapy. Radiotherapy has a lower role of myelosuppression than chemotherapy. No significant difference was observed between the radiotherapy and chemotherapy in grade 3/4 toxicities of the digestive system and the urogenital system.
ObjectiveTo analyze the factors influencing the occurrence of subclinical leaflet thrombosis (SLT) after percutaneous aortic valve replacement using balloon-expandable valve (Sapien3, S3). Methods Retrospective analysis was made on 62 patients with severe aortic stenosis undergoing percutaneous aortic valve replacement using S3 in our center from September 2020 to June 2022. Patients with a history of vascular atherosclerosis or with significant increase or insignificant decrease of aortic valve flow or gradient pressure during follow-up were selected for CT examination. Results A total of 26 patients were finally included, with an average age of 70.31±8.90 years, and the male proportion was higher (n=15, 57.69%). Among them, 5 patients had SLT. Compared with the non-SLT group, patients in the SLT group were older (68.52±8.80 years vs. 77.80±4.66 years, P=0.007). The age factor (≥75 years) and the diameter of the ascending aorta were associated with SLT (both P<0.05). Conclusion The incidence of SLT is higher in the elderly patients. It is speculated that SLT is related to the characteristics of short balloon dilation valves and low blood flow dynamics of valve racks.
Objective To summarize our clinical experience of pulmonary artery banding （PAB） for the treatment of complex congenital heart diseases as a palliative procedure.?Methods?From January 1997 to November 2010, 138 patients with complex congenital heart diseases underwent PAB in Fu Wai Hospital. There were 87 male patients and 51 female patients with their age of 22.2±26.5 months and average body weight of 7.5±4.6 kg. All the 138 patients were divided into 3 groups according to the purpose of PAB：left ventricular retraining （group 1, n=55）, initial procedure for functional single ventricle with unobstructed pulmonary blood flow （group 2, n=32） and initial palliative procedure followed by later biventricular repair （group 3, n=51）. The intraoperative and postoperative clinical parameters of all participants were observed, and follow-up was made for these 3 groups of patients.?Results?The in-hospital mortality of PAB was 5.1% （7/138）. Three patients underwent re-banding procedure to adjust the size of banding. In group 1, there was 1 postoperative death. Among the 55 patients, 36 patients with dextro-transposition of great arteries received PAB at an average age of 19.6±29.5 months, 29 patients of whom underwent concomitant modified Blalock-Taussig shunt. After an average training interval for 42 days, 83.3% of them（30/36）successfully received arterial switch operation. The other 19 patients in group 1 with isolated corrected transposition of great arteries received PAB at an average age of 45.3±27.2 months. Afteran average training interval for 9 months, 42.1% of them （8/19） successfully received double-switch operation. In group 2, there was 2 postoperative death. Thirty-two patients with functional single ventricle and unobstructed pulmonary blood flow received PAB at an average age of 14.1±14.9 months. Their postoperative mean pulmonary artery pressure decreased significantly from 34.00±10.00 mm Hg to 23.00±7.40 mm Hg, and their oxygen saturation of blood （SpO2） significantly decreased from 92.60%±5.90% to 83.30%±6.30%. After a median interval of 2 years, 18.8% of them （6/32） underwent right heart bypass operation. In group 3, there was 4 postoperative death. Fifty-one patients received PAB at an average age of 20.60±25.60 months. After PAB procedure, the ratio of systolic pulmonary artery pressure and systolic blood pressure significantly decreased from 0.81±0.14 to 0.46±0.15, and their SpO2 significantly decreased from 93.10%±7.60% to 85.00%±10.00%. After a median interval of 6 months, 23.5% of them （12/51） received biventricular repair.?ConclusionAlthough PAB is a palliative procedure with comparatively high risks, it still plays an indispensable role in terms of protecting pulmonary vascular beds, retraining ventricular function and two-stage surgical correction for the treatment of complex congenital heart diseases.
ObjectiveTo identify characteristic high-resolution computed tomography (HRCT) findings for connective tissue disease (CTD) associated interstitial pneumonia (IP).MethodsThe HRCT findings of 76 patients with CTD-IP were evaluated, the abnormalities were compared among CTD-IP patients using χ2 test, nonparametric test, and binary logistic regression analysis.ResultsIn rheumatoid arthritis associated IP (RA-IP), traction bronchiectasis was identified as the significant indicator based on binary logistic regression analyses. Traction bronchiectasis and honeycombing was identified as the most frequent finding based on χ2 test. In polymyositis/dermatomyositis associated IP (PM/DM-IP), consolidation was identified as the most frequent findings based on χ2 test, which reflected the higher frequency of the pathological organising pneumonia patterns. In systemic lupus erythematosus associated IP, traction bronchiectasis was identified as the least frequent findings based on χ2 test. In systemic sclerosis associated IP, esophageal dilatation was the most extensive based on Kruskale-Wallis test. In primary Sjogren’s syndrome associated IP, honeycombing was identified as the least frequent findings based on χ2 test. RA-IP was identified as the most frequent among CTD-IP which characterized as the predominance of honeycombing; PM/DM-IP was identified as the most frequent among CTD which characterized as the predominance of consolidation.ConclusionSeveral characteristic HRCT findings are identified in CTD-IP patients which are helpful for estimating underlying CTD.
