ObjectiveTo discuss the strategy of locoregional surgery for breast cancer patients after neoadjuvant chemotherapy. MethodThe pertinent literatures about locoregional surgery concerning breast-conserving therapy, factors of ipsilateral breast tumor recurrence, pathological shrinkage modes of breast primary tumor, and sentinel lymph node biopsy after neoadjuvant chemotherapy were reviewed. Results①The major benefit of neoadjuvant chemotherapy was to increase the proportion of breast-conserving therapy after downstaging the primary breast tumor. However, the use of breast-conserving therapy after neoadjuvant chemotherapy might remain a higher risk of ipsilateral breast tumor recurrence. It was now widely recognized that the risk factors for ipsilateral breast tumor recurrence were multifocal pattern of residual tumor and pathologic residual tumor larger than 2 cm. The shrinkage mode of the primary breast tumor after neoadjuvant chemotherapy and its relative factors were still unclear. 2 Sentinel lymph node biopsy(SLNB) was feasible either before or after neoadjuvant chemotherapy and approval by SLNB guideline and expert consensus. Patients with a cN0 status could get more benefits from SLNB after neoadjuvant chemotherapy. Although there was a bright future for SLNB as an alternative to ALND for patients with primary cN1 and downstaging to cN0 after neoadjuvant chemotherapy, it needed to obtain the accepted clinical identification rate, false negative rate, as well as similar regional recurrence rate and overall survival as compared to ALND. ConclusionsCurrently, surgical management is crucial for reducing the locoregional recurrence risk of breast cancer after neoadjuvant chemotherapy, no matter what the clinical and radiographic efficacy of neoadjuvant chemotherapy is. In the era of genomics and SLNB, individual locoregional surgical management could be arrived according to the primary stage and neoadjuvant chemotherapy response.
ObjectiveTo observe the full-field ERG (ff-ERG) characteristics of patients with acute regional occult outer retinopathy (AZOOR).MethodsA retrospective observational study. From June 2017 to June 2019, 62 eyes of 42 patients (AZOOR group) who were diagnosed with AZOOR in the Department of Ophthalmology of West China Hospital of Sichuan University were included in the study. All patients had no obvious localized disease on the fundus. Among 62 eyes, BCVA of 16 eyes were＜0.1, BCVA of 27 eyes were ≤0.5, and BCVA of 19 eyes were＞0.5. From June 2018 to January 2019, 40 normal volunteers (80 eyes) who attended the outpatient clinic of West China Hospital of Sichuan University and passed detailed ophthalmological examination to exclude all eye diseases including refractive errors were selected as the normal control group. All the examined eyes were tested with ff-ERG using the German Roland visual electrophysiological inspection system. The peak times and amplitudes of the waveforms induced by each response of dark adaptation 0.01 ERG, dark adaptation 3.0 ERG, dark adaptation 3.0 ERG, light adaptation 3.0 ERG, and light adaptation 30 Hz flicker ERG were recorded, respectively. The peak time and amplitude of each ff-ERG response between the two groups were compared by independent sample t test. The peak time and amplitude of each ff-ERG response between different BCVA eyes in the AZOOR group were compared by variance test.ResultsCompared with the normal control group, 0.01 ERG b wave of the dark adaptation of AZOOR group (t=3.601, －6.120), 3.0 ERG a wave and b wave of dark adaptation (t=2.627, －4.263, 3.719, －5.866), 3.0 Oscillation potential P2 wave of dark adaptation (t=－6.625), 3.0 ERG a wave and b wave of bright adaptation (t=3.762, －3.612, 3.648, －3.739) and 30 Hz flicker ERG P wave of bright adaptation (t=－3.832), all peak time of those were significantly delayed, the amplitude decreased, and the difference was statistically significant (P＜0.05). Comparison of different BCVA eyes in the AZOOR group showed that 0.01 ERG b wave amplitude of dark adaptation (F=3.950), 3.0 ERG a peak and b wave amplitude of dark adaptation (F=4.408, 4.876), oscillation potential P2 wave amplitude of dark adaptation (F=4.295), 3.0 ERG b wave amplitude of bright adaptation (F=4.344) and 30 Hz flicker ERG P wave amplitude of bright adaptation (F=4.483) of differences were statistically significant (P＜0.05). There was no statistically significant difference in waveform peak time and amplitude of the other reactions (P＞0.05). Pairwise comparison results showed that, compared with those with 0.1≤BCVA≤0.5 and BCVA＞0.5, those with BCVA＜0.1 dark adaptation to 0.01 ERG b wave, dark adaptation 3.0 ERG b wave, dark adaptation oscillation potential P2 wave, and light adaptation 3.0 ERG b wave and light adaptation 30 Hz scintillation ERG P wave amplitude were significantly reduced, and dark adaptation to 3.0 ERG a peak was significantly delayed, the difference was statistically significant (P＜0.05).ConclusionsThe ff-ERG of patients with AZOOR show delayed peak time and decreased amplitude of each response. The worse BCVA are accompanied by the more obvious decrease of each response amplitude of ff-ERG.
Objective To explore the retinal and choroidal thickness of myopic patients with different diopters, and analyze the change rule and its relation with the diopter. Methods From October 2015 to June 2016, a total of 161 patients (322 eyes) with myopia and 53 normal volunteers (106 eyes) were selected from Department of Ophthalmology, West China Hospital of Sichuan University. Optical coherence tomography (OCT) examination was performed in all the subjects with Macular cube 512×128 and EDI HD-OCT model in Cirrus HD-OCT 5000 of Carl Zeiss Company from Germany, measuring the retinal and choroidal thickness in macular central fovea, and 3 and 6 mm above, below, on the nose side, and on the temporal side of macular central fovea; the data were averaged. According to the different diopters, the subjects were divided into four groups, including emmetropia group with 53 patients (106 eyes), low myopia group (equivalent diopter from –0.25 to –3.00) with 64 patients (128 eyes), moderate myopia group (equivalent diopter from –3.25 to –6.00) with 47 patients (94 eyes), and high myopia group (equivalent diopter <–6.00) with 50 patients (100 eyes). All the subjects’ best corrected visual acuities were ≥0.8. The changes of retinal and choroidal thickness in myopia patients with different diopters were compared and analyzed. Results The average retinal thickness of the patients in the emmetropia group, the low myopia group, the moderate myopia group, and the high myopia group was (242.50±29.86), (238.46±23.85), (224.52±26.01), (211.91±23.07) μm, respectively; the average choroidal thickness of the patients in the emmetropia group, the low myopia group, the moderate myopia group, and the high myopia group was (220.16±66.00), (252.39±79.56), (191.09±103.03), (121.83±92.54) μm, respectively. There was no significant difference in retinal thickness between the moderate myopia group and the high myopia group (P>0.05), while the differences in retinal thickness between the remaining groups were statistically significant (P<0.05); there was no statistically significant difference between the emmetropia group and moderate myopia group (P>0.05), while the differences in choroid thickness between the remaining groups were statistically significant (P<0.05). Conclusion In general, there are decreasing trends of the retinal thickness and choroid thickness with the increase of the diopter, which may be associated with the formation process of myopia.
Objective To explore the causal relationship between heart failure and memory impairment using a two-sample two-way Mendelian randomization (MR) approach. Methods The data for this study was sourced from the genome-wide association studies database and analyzed using a two-sample two-way MR method. In the forward study, the exposure factor was heart failure, and the outcome was memory loss. In the reverse study, the exposure factor was memory loss, and the outcome was heart failure. The instrumental variables were selected, and the causal relationship between heart failure and memory impairment was mainly analyzed using the inverse variance weighted method (IVW). At the same time, MR Egger regression, weighted mode, weighted median estimator, and simple mode were used to supplement the IVW analysis results. Cochran’s Q test was used to assess statistical heterogeneity among single nucleotide polymorphisms (SNPs), the intercept term of MR Egger regression was used to evaluate the presence of horizontal pleiotropy among SNPs, and the leave one method was used to evaluate the impact of individual SNPs on IVW analysis results. To avoid reverse causality, memory loss was identified as the exposure factor and heart failure as the outcome event, and reverse MR analysis was conducted. Results A total of 9 SNPs strongly associated with heart failure. The IVW analysis results [β=−0.81, odds ratio (OR)=0.45, 95% confidence interval (CI) (0.27, 0.73), P=0.0015] showed a negative causal relationship between heart failure and memory impairment. The results of weighted median estimator [β=−0.92, OR=0.40, 95%CI (0.21, 0.77), P=0.0059] and weighted mode [β=−1.16, OR=0.31, 95%CI (0.12, 0.83), P=0.047] showed a negative causal relationship between heart failure and memory impairment. Although MR Egger regression [β=−1.19, OR=0.30, 95%CI (0.08, 1.21), P=0.14] and simple mode [β=−0.32, OR=0.72, 95%CI (0.26, 2.01), P=0.55] analysis showed that heart failure did not increase the risk of memory loss. Cochran’s Q test and prompt yielded robust and non-heterogeneous results (P=0.890), while the intercept assessment of MR Egger regression indicated stable results without horizontal pleiotropy (P=0.578). Reverse MR analysis revealed that there was no causal relationship between exposure factor memory impairment and outcome heart failure [β=3.71×10−3, OR=1.00, 95%CI (0.96, 1.03), P=0.85]. Conclusions There is a negative correlation between genetic prediction of heart failure and the risk of memory loss, which is inconsistent with clinical observations and previous research conclusions. Observational associations may be overestimated or misled, which is also one of the core values of MR research.
Objective To explore the value of iodine overlay image technique based on dual-source CT dual-energy for the diagnosis in the primary hepatocellular carcinoma patients undergoing transcatheter arterial chemoembolization (TACE). Methods The imaging data of patients with primary hepatocellular carcinoma after TACE treatment from September 2015 to November 2018 were retrospectively analyzed. All patients completed dual-source CT dual-energy examination and digital subtraction angiography (DSA). The imaging data of the patients were analyzed by conventional linear blending images and iodine overlay image. The results of DSA were taken as the gold standard. The data indexes measured by the two imaging methods were compared. The consistency between the two imaging methods and DSA was determined by Kappa statistics. Results A total of 31 patients were included, and 57 nodes were found under DSA examination. The image quality evaluation (P<0.05), sensitivity (95.35% vs. 69.77%), specificity (92.86% vs. 64.29%), accuracy (94.74% vs. 68.42%), positive predictive value (97.62% vs. 85.71%) and negative predictive value (86.67% vs. 40.91%) of iodine overlay images were higher than those of conventional linear blending images. The consistency between conventional linear blending images and DSA was low (Kappa=0.286, P=0.023), and the consistency between iodine overlay images and DSA was excellent (Kappa=0.861, P<0.001). Conclusions Iodine overlay image could avoid the iodide artifact effectively and evaluate the abnormal enhancement quantitatively and qualitatively in patients undegoing TACE. This method could obtain more information to help diagnose in clinical and evaluate the postoperative efficacy of TACE accurately and objectively.
目的 探讨音乐疗法在儿童青少年情绪障碍患者中的应用效果。 方法 2011年1月－7月，将70例儿童青少年情绪障碍患者随机分为试验组和对照组，每组各35例，对照组给予常规药物治疗和护理，试验组除给予常规治疗和护理外，结合音乐治疗。用汉密尔顿抑郁量表、汉密尔顿焦虑量表对其情绪进行评价。 结果 两组在疗程结束后，汉密尔顿焦虑量表和抑郁量表评分差异具有统计学意义（P＜0.01）。 结论 音乐治疗在改善儿童青少年情绪障碍方面具有显著作用。