Atrial fibrillation (AF) is one of the most common arrhythmias, which does great harm to patients. Effective methods were urgently required to prevent the recurrence of AF. Four methods were used to analyze RR sequence in this paper, and differences between Pre-AF (preceding an episode of AF) and Normal period (far away from episodes of AF) were analyzed to find discriminative criterion. These methods are: power spectral analysis, approximate entropy (ApEn) and sample entropy (SpEn) analysis, recurrence analysis and time series symbolization. The RR sequence data used in this research were downloaded from the Paroxysmal Atrial Fibrillation Prediction Database. Supporting vector machine (SVM) classification was used to evaluate the methods by calculating sensitivity, specificity and accuracy rate. The results showed that the comprehensive utilization of recurrence analysis parameters reached the highest accuracy rate (95%); power spectrum analysis took second place (90%); while the results of entropy analyses and time sequence symbolization were not satisfactory, whose accuracy were both only 70%. In conclusion, the recurrence analysis and power spectrum could be adopted to evaluate the atrial chaotic state effectively, thus having certain reference value for prediction of AF recurrence.
Objective To investigate the clinical features, treatment methods, and prognostic influence factors of patients with malignant peripheral nerve sheath tumor (MPNST). MethodsA retrospective analysis was conducted on 96 MPNST patients treated between January 1, 2015 and December 31, 2021. There were 46 males and 50 females, aged between 15 and 87 years (mean, 48.2 years). The tumors were located in the trunk in 50 cases, extremities in 39 cases, and head and neck in 7 cases. The maximum tumor diameter was <5 cm in 49 cases, ≥5 cm in 32 cases, with 15 cases missing data. Tumor depth was deep in 77 cases and superficial in 19 cases. The Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) histological grading was G1 in 9 cases, G2 in 12 cases, and G3 in 34 cases, with 41 cases missing data. There were 37 recurrent MPNST cases, 32 cases with neurofibromatosis type 1 (NF1), and 26 cases in stage Ⅳ. Postoperative adjuvant radiotherapy was administered to 25 patients, perioperative chemotherapy to 45 patients, and anlotinib-targeted therapy to 30 patients. R0 resection was achieved in 73 cases. Patients were divided into groups based on the presence or absence of NF1, and baseline data between the two groups were compared. Kaplan-Meier curves were generated to assess disease-free survival (DFS) and overall survival (OS) based on various factors (age, gender, presence of NF1, recurrent MPNST, stage Ⅳ MPNST, FNCLCC grade, R0 resection, tumor location, tumor size, tumor depth, perioperative chemotherapy, postoperative adjuvant radiotherapy, and anlotinib-targeted therapy), and differences between survival curves were analyzed using the Log-Rank test. Multivariate COX proportional hazards regression was used to identify independent prognostic factors for MPNST. Results Patients with NF1 had a significantly higher proportion of superficial tumors and lower FNCLCC grade compared to those without NF1 (P<0.05); no significant difference was found for other variables (P<0.05). Kaplan-Meier analysis showed that recurrent MPNST, stage Ⅳ MPNST, FNCLCC grade, R0 resection, perioperative chemotherapy, and anlotinib-targeted therapy were factors influencing 1-year DFS (P<0.05), while stage Ⅳ MPNST, FNCLCC grade, and perioperative chemotherapy were factors affecting 3-year OS (P<0.05). Multivariate COX proportional hazards regression analysis revealed that recurrent MPNST and high-grade FNCLCC (G3) were independent prognostic factors for 1-year DFS (P<0.05), while stage Ⅳ MPNST, superficial tumor depth, age over 60 years, postoperative adjuvant radiotherapy, and anlotinib-targeted therapy were independent prognostic factors for 3-year OS (P<0.05). Conclusion MPNST patients with NF1 tend to have more superficial tumors and lower FNCLCC grades. FNCLCC grade, R0 resection, and adjuvant therapies, including radiotherapy and anlotinib-targeted therapy, are closely associated with MPNST prognosis. Complete surgical resection should be prioritized in clinical management, along with adjuvant treatments such as radiotherapy and targeted therapy of anlotinib to improve patient outcomes.
ObjectiveTo investigate the cause of stoma recurrence after anterior resection of rectal cancer and discover the methods of prevention and treatment.MethodsA total 91 patients with stoma recurrence after anterior resection of rectal cancer (or Dixon) were analysed retrospectively between 1985 and 1996. Fourtyseven patients experienced reradical resection (Miles), 27 cases palliative resection, and 11 cases only exploration. Thirtytwo cases had been followed up for 5 years and obtained 1，3，5year survival rate for reradical radical resection (Miles). Diagnosis and treatment of stomal recurrence after Dixon were evaluated. ResultsOne, three and fiveyear survival rate of reradical resection (Miles) was 93%，77%，45% respectively.ConclusionTo amplify blindly the adaptation of Dixon is to raise the rate of stoma recurrence. Digital rectal examination and fiberopic colonoscopy (and biopsy) are very essential methods for the diagnosis of stoma recurrence, and we strive to do reradical resection (Miles) for the patients with stoma recurrence after Dixon’s operation.
Objective To investigate the situation and prospect of local recurrence of rectal cancer by using CT and MRI. Method Relevant references about the imaging diagnosis of local recurrence of rectal cancer， which were published domestic and abroad in recent years， were collected and reviewed. Results In the diagnosis of local recurrence of rectal cancer， the sensitivity of CT was higher than that of MRI， while the specificity and accuracy were not. Perfusion CT， dynamic contrast-enhanced MRI， and diffusion weighted imaging were valuable in diagnosing local recurrence of rectal cancer， as new diagnostic techniques. Conclusion Both CT and MRI are important and valuable methods in diagnosing for local recurrence of rectal cancer.
Objective To explore the clinical and imaging features of patients with acute dizziness and assess their associations with 3-month prognosis. Methods We enrolled adult patients with a chief complaint of acute dizziness, who were admitted to the Neurological Clinic at the Emergency Department of West China Hospital, Sichuan University between January 1st and May 31st 2022. We collected clinical and imaging features at baseline for each patient. The primary outcome was recurrent dizziness within 3 months after index dizziness. Secondary outcome was stroke within 3 months after index dizziness. Results A total of 1 322 patients who visited the Neurological Clinic were included, of which 617 (46.7%) had a chief complaint of acute dizziness. Among 222 patients who performed emergent brain and neck CT angiography, 1 patient presented with intracerebral haemorrhage. Among the remaining 221 patients, 206 patients completed 3-month follow-up, with 76 patients reported recurrent dizziness and 7 patients had stroke (6 ischaemic, 1 hemorrhagic). The multivariate logistic regression showed that chronic dizziness duration and parenchymal hypodensity on brain CT were each associated with a higher risk of recurrent dizziness. Compared with those who did not report stroke, the stroke patients were more likely to present with hypertension, headache symptoms, and exhibit parenchymal hypodensity on baseline CT (P<0.05). Conclusions In patients with acute dizziness, those with chronic dizziness duration and parenchymal hypodensity on baseline CT were associated with a higher risk of 3-month recurrent dizziness. Acute dizziness patients experiencing 3-month stroke often have hypertension, headache symptoms, and parenchymal hypodensity on baseline CT.
Objective To explore the impact of microvascular invasion (MVI) on the survival prognosis of patients after radical hepatectomy for hepatocellular carcinoma, to analyze its related risk factors and preoperative prediction methods, and to provide reference and support for the treatment of early postoperative recurrence. MethodsBy searching domestic and international medical literature databases, we screened studies related to MVI in hepatocellular carcinoma, focusing on the definition, grading, risk factors, preoperative prediction methods, and postoperative treatment strategies of MVI, and summarized the results of the existing studies. ResultsMVI was a well-established risk factor for the intrahepatic metastasis and early postoperative recurrence of hepatocellular carcinoma. Currently, various methods were employed to predict MVI, including laboratory indicators, imaging genomics, and genomics. The laboratory indicators used for prediction included alpha-fetoprotein, protein induced by vitamin K absence or antagonist-Ⅱ, hepatitis B virus, tumor diameter, vascular endothelial growth factor A, and circulating tumor cells. Imaging genomics involved preoperative MRI with irregular tumor shape and intra-voxel incoherent motion diffusion-weighted imaging D value < 1.16 × 10-3 mm2/S, CT enhancement imaging features with irregular tumor margins, multiple foci, and contrast-enhanced ultrasound portal venous and delayed phase scores. Genomics included the maximum variant allele frequency of circulating tumor DNA. In cases where MVI was detected after surgery, adjuvant therapy options had gained attention, such as transcatheter arterial chemoembolization, hepatic arterial infusion chemotherapy, targeted therapy, immunotherapy, radiation therapy, antiviral therapy, and local treatment combined with systemic treatment. ConclusionsThe study of MVI and its targeted treatment strategies are important for reducing the postoperative recurrence rate of hepatocellular carcinoma and improving patient survival. The preoperative prediction model and postoperative treatment plan should be optimized in the future to provide more effective treatment reference for patients.
Objective To summarize the current advancement of preoperative radiotherapy for rectal cancer. Methods Relevant literatures about current advancement of preoperative radiotherapy for rectal cancer published domesticly and abroad recently were collected and reviewed. Results The lower local recurrence rate and longer disease-free survival time were observed in preoperative radiotherapy， compared with postoperative radiotherapy for rectal cancer. The recurrence rate was higher in short-course radiotherapy， compared with conventionally radiotherapy for stageⅢrectal cancer， but there was no significant difference for stageⅡrectal cancer. The biology molecular such as p53， CEA， Cox-2， EGFR， and VEGF had shown to be radiosensitive. Conclusions The proposal of preoperative radiotherapy for rectal cancer， could be prone to conventionally radiotherapy. There are more screening targets for preoperative radiotherapy in extensive exploration of diverse radiosensitivity. Biology molecular， developed gene expression profiling， and gene chips for rectal cancer may contribute to the individualization treatment.
ObjectiveTo compare the clinicopathological features of Luminal A breast cancer patients in early and middle stage, and locally advanced Luminal A breast cancer, then the influencing factors of disease-free survival (DFS) in locally advanced Luminal A breast cancer patients were further discussed.MethodsFrom January 2010 to December 2012, 295 Luminal A breast cancer patients who completed diagnosis, treatment, and follow-up in our hospital were retrospectively collected. According to TNM stage, 227 cases of early and middle breast cancer and 68 cases of locally advanced breast cancer were divided into two groups. Chi-square test or rank sum test was used to compare the clinicopathological characteristics of patients between the two groups, and log-rank test and Cox proportional risk regression model were used to explore the influencing factors of 5-year DFS situation in patients with locally advanced Luminal A breast cancer.ResultsT stage and N stage were later in locally advanced Luminal A breast cancer patients than that of the early and middle breast cancer patients (P<0.05), and the tumor grade was higher in locally advanced Luminal A breast cancer patients (P<0.05). The 5-year DFS rate was 87.8% (259/295). In this study, there were5 comprehensive treatment schemes as follows: neoadjuvant chemotherapy + surgery + radiotherapy + endocrine therapy, neoadjuvant chemotherapy + surgery + endocrine therapy, surgery + chemotherapy + radiotherapy + endocrine therapy, surgery + chemotherapy + endocrine therapy, and surgery + radiotherapy + endocrine therapy. The 5-year DFS rate of locally advanced Luminal A breast cancer patients was lower than that of the early and middle Luminal A breast cancer patients (76.5% vs. 91.2%, P=0.001). Univariate analysis showed that T stage (χ2=8.248, P=0.040), N stage (χ2=9.470, P=0.024), vascular invasion (χ2=4.211, P=0.031), and tumor grade (χ2=6.985, P=0.030) were the factors influencing the5-year DFS situation of locally advanced Luminal A breast cancer patients. Multivariate analysis showed that T staging (HR=5.062, P<0.001) and N staging (HR=7.075, P<0.001) were the influencing factors for 5-year DFS situation in locally advanced Luminal A breast cancer patients. The later the T stage and N stage, the worse the 5-year DFS situation.ConclusionsT stage and N stage are independent risk factors for prognosis of patients with locally advanced Luminal A breast cancer. Individualized comprehensive treatment program is an important guarantee for improving the 5-year DFS rate of this kind of patients.
ObjectiveTo analyze the influencing factors of fear of cancer recurrence (FCR) and its correlation with social support and quality of life in patients with differentiated thyroid cancer (DTC) at 5 years after surgery. MethodsA total of 116 patients with DTC from West China Hospital, Sichuan University at 5 years after surgery were selected as the research objects. The patients were investigated using the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Social Support Rating Scale (SSRS) and the European Organization for Reasearch and Treatment of Cancer Quality of Life Questionnare-Core 30 (EORTC QLQ-C30, hereinafter referred to as QLQ-C30). The χ2 test or Fisher exact probability method were used for univariate analysis, and multivariate logistic regression analysis was used for influencing factor analysis. The diagnostic value of variables with significant influence on FCR in multivariate logistic regression was further studied by receiver operating characteristic (ROC) curve, and Pearson correlation analysis was finally adopted to analyze the relationship between FCR and social support and quality of life in patients with DTC at 5 years after operation. ResultsThe questionnaire survey showed that the FoP-Q-SF score of 116 patients with DTC at 5 years after surgery was (35.92±2.52) scores, of which 75 patients had FoP-Q-SF score ≥34 scores, 41 patients had FoP-Q-SF score <34 scores, and the FCR rate was 64.66% (75/116). Multivariate logistic regression showed that gender, family annual income, SSRS score and total QLQ-C30 score were the main factors of FCR in patients with DTC at 5 years after surgery (P<0.05). Further ROC curve diagnosis showed that the accuracy rate of diagnosis of FCR with SSRS score ≤47.5 scores was 70.70%, the total score of QLQ-C30 ≤617.225 scores was 69.02%. The accuracy rate of diagnosis of FCR was 66.03% when the annual income of family was less than 150 000 yuan. The accuracy of women’s diagnosis of FCR was 62.28%. Pearson correlation analysis showed that FoP-Q-SF score was negatively correlated with SSRS score and total score of QLQ-C30 in DTC patients at 5 years after operation (r=–0.629 6, P=0.000 1; r=–0.568 5, P=0.000 1). ConclusionsThe proportion of patients who have FCR at 5 years after DTC operation is high, and gender, family annual income, SSRS score and total score of QLQ-C30 are the influencing factors. Therefore, we can develop targeted management strategies to reduce patients’ FCR and improve their quality of life.
ObjectiveTo investigate the optimal treatment scheme for the first primary spontaneous pneumothorax (PSP) in young patients.MethodsThe clinical data of 171 patients with the first PSP were retrospectively analyzed who were treated in Huaihe Hospital of Henan University between November 2011 and October 2017. There were 157 males and 14 females with a median age of 18 years at onset and a median body mass index of 18.51 kg/m2. According to the treatment methods, they were classified into two groups, a conservative treatment group (a non-surgical group, n=86) and a surgical group (n=85). The characteristics including clinical data, efficacy evaluation criteria, complications and recurrence of the two groups were analyzed.ResultsAs a result, 73.68% of the patients suffered PSP in their daily routine. The drainage duration in the non-surgical group was longer than that in the surgical group (4 d vs. 3 d, P=0.008). There was no statistical difference in the success rate of lung re-expansion between the two groups (98.85% vs. 100.00%, P=1.000). The proportion of the surgical group using postoperative analgesic drugs was higher than that in the non-surgical group (48.23% vs. 10.46%, P=0.000). The recurrence rate of the surgical group was lower than that of the non-surgical group (3.53% vs. 46.51%, P=0.000). No relationship between smoking and recurrence of pneumothorax was found in both groups (P=0.301, P=1.000). The success rate of lung re-expansion in the non-surgical group was not statistically different between the 24F subgroup and the 12F subgroup (39/39 vs. 33/34, P=0.458). No advantage of intraoperative pleural fixation was found in the surgical group (P=0.693).ConclusionThoracoscopic surgery is the first choice for the treatment of the first PSP in young patients.