China ; Humans ; Medicine, Chinese Traditional ; Taiwan

Combined Modality Therapy ; Critical Care ; methods ; Humans ; Sepsis ; therapy ; Shock, Septic ; therapy

Critical Care ; trends ; Humans

Critical Care ; General Surgery ; Humans ; Rescue Work

Gastrointestinal Diseases ; Humans ; Infection ; Multiple Organ Failure ; Shock

Objective To explore the clinical features of sentinel polyps (rectal polyps with proximal colon carcinoma) and its correlation with proximal colon carcinoma.Methods From January 2011 to June 2015,the clinical features of 331 hospitalized patients with rectal polyps were retrospectively analyzed.According to whether the patient with colon carcinoma,the clinical data of rectal polyps patients were divided into pure polyps group (n =294) and sentinel polyps group (n =37).The characteristics under endoscopy,clinical pathological features,treatment and prognosis of two groups were observed.Results The positive rate of tumor marker of sentinel polyps group was higher (67.6 ％,25/37) than that of pure polyps group (6.8 ％,20/294;x2 =32.174,P ＜ 0.01).When compared to pure polyps group,most polyps of sentinel polyps group were in maximum diameter over 1 cm [62.2％ (23/37) vs 46.9 ％ (138/294)],multi-polyps [n ＞5,43.2％ (16/37)vs11.6％ (34/294)] and adenomatous polyp [83.8 ％ (31/37) vs 35.7 ％ (105/294)] (x2 =10.863,15.686,and 22.653,P ＜0.01).Majority of the proximal colon carcinoma with rectal polyps was papillary adenoearcinoma and tubular adenocarcinoma which was account for 75.7 ％ (28/37);Duke A,29.7％ (11/37),Duke B,29.7％ (11/37),Duke C,24.3％ (9/37) and Duke D,16.2％ (6/37).96.6 ％ (282/294) of patients with pure polyps underwent endoscopic treatment and all of them were cured and discharged.40.5％ (15/37) of patients of sentinel polyps group accepted the radical operation and 24.3％ (9/37) received endoscopic submucosal dissection.Conclusions If multiple,maximum diameter over 1 cm and adenomatous rectal polyps were detected under colon endoscope,the possibility of carcinogenesis of the polyps or the proximal colon should be aware.The patient should be followed up in short-term and complete the whole colon examination.

Primary CNS lymphoma (PCNSL) is a rare malignancy with peculiar clinical and biologic features,aggressive course,and unsatisfactory outcome.the particular microenvironment of this malignancy,and sanctuary sites where tumor cells grow undisturbed, strongly affects treatment efficacy. The execution of prospective trials is also difficult because of the rarity of the tumor and the impaired general condition and poor performance status of patients. Chemotherapy is indispensable for the treatment of PCNSL. High-dose methotrexate is the most effctive drug.PCNSL is sensitive to irradiation,but responses to radiotherapy alone are short-lived. MTX-based chemotherapy followed by whole-brain radiotherapy prolonged survival but is associated with delayed neurotoxicity especially in patients older than 60 years. A new approach is attempted to treat PCNSL with chemotherapy alone with defered radiotherapy in old patients with similar survival rencenfly. High-dose chemotherapy with autologous stem cell transplantation HDC/ASCT yielded promising results for recurent PCNSL.Clinical investigation with Temozolomide or rituximab have been reported.Further studies with these new drugs are needed.

Objective: To investigate the expression of Notch1 and NF-κB in gastric cancer and discuss the association between the expressions of both and their relationship with the clinicopathological features. Methods: The expression of Notch1 and NF-κB in 168 specimens of gastric cancer and 27 specimens of normal gastric tissues were detected by SP immunohistochemistry. Results: The expression of Notch1 was significantly upregulated in gastric cancer as compared with normal gastric tissues (P < 0.0 1). It was closely related with tumor size, differentiation grade, depth of invasion, and vessel invasion. The expression of NF-κB in gastric cancer was remarkably higher than that in control group (P < 0.01) and was significantly associated with tumor size, differentiation degree, depth of invasion, distant metastasis, and vessel invasion. Kaplan-Meier analysis showed that Notch1- and NF-KB positive patients had poor prognosis than Notch1- and NF-κB-negative patients. Cox regression multivariate analysis showed that Notch1 was one of the independent prognostic factors for gastric cancer (P <0.05). Conclusion: The over-expression of NF-κB may be involved in the carcinogenesis and progression of gastric cancer mediated by Notch1 signaling pathway. Notch1 may become a potentially useful marker for evaluating the prognosis and survival of gastric cancer and a new therapeutic target.

Objective To investigate the pregnancy outcome of patients with preeclampsia (PE). Methods The data of 26 206 pregnant and lying-in women were retrospective analyzed who gave birth in Daping Hospital of the Army Medical University from Jan. 1, 2013 to Apr. 30, 2019, diagnosed with the 8th and 9th version of gynecology and obstetrics textbook. Excluding 62 cases of diabetes combined pregnancy, 445 cases of hypothyroidism combined pregnancy, 180 cases of polyhydramnios, 1592 cases of macrosomia (≥4 kg), 89 cases of chronic hypertension with PE, and 629 cases of multifetation. The remaining 23 209 cases, according to the final diagnosis, were divided into PE group (532 cases) which was divided again into mild-PE group (134 cases) and severe-PE groups (398 cases), and the 22 677 remainders acted as the control group. The age, gestational weeks, number of births, mode of delivery, pregnancy complications and neonatal status in the three groups were compared, and the thyroid function among the groups was analyzed in detail. Results The proportion of elderly parturients was higher in both mild-PE group (29.2%) and severe-PE groups (20.6%) than that in control group (12.4%). The rates of premature delivery and cesarean section were higher in both mild-PE group (19.7% and 55.0%) and severe-PE groups (70.1% and 94.2%) than those in control group (10.0% and 48.2%). The incidences of hypothyroidism during pregnancy, intrahepatic cholestasis of pregnancy (ICP) and infants younger than gestational age were higher in both mild-PE group (26.9%, 10.5% and 7.5%) and severe-PE groups (23.9%, 9.3% and 22.1%) than those in control group (17.5%, 3.5% and 2.9%); The incidences of placental abruption and stillborn foetus were obviously higher in severe-PE group (3.8% and 7.3%) than those in control group (0.6% and 0.7%). The incidence of gestational diabetes was significantly higher in mild-PE group (41.8%) than that in control group (30.0%), and of umbilical cord around neck was significantly lower in severe-PE group (17.6%) than that in control group (25.1%). Conclusions The incidences of complications and therapeutic premature delivery in PE patients is increased. Hypothyroidism during pregnancy is a potential risk factor and should be strenuously supervised.

Objective Cavernous hemangioma of infant was reported as an obscure diagnosis with the different sensitivity to corticosteroid therapy and various natural courses. Therefore, a clinical studies for the biological classification of deep subcutanious vascular lesions might be needed, which was alluded by Mulliken two decades ago. Methods Infants with cavernous hemangiomas accepted normal system corticosteroid therapy during the first 6 months of life before eight-year-follow-up, which continued until the children were 9 to 10 years old. The expression of PCNA and bFGF, and cellular histological characteristics were observed in 12 cases by biopsy. Results There were two major categories of subcutaneous vascular lesions groups: deep capillary hemangiomas, a lesion regressing slowly, and venous malformation, a lesion growing commensurated with the child. They will be also distinguished on the basis of diverse final treatment results, expression of cellular markers, microscopical characteristics, and physical signs. Conclusion The new classification appears to be helpful to make the choice of therapy for infants with "cavernous hemangiomas" , which is proven to be a terminologic confusion.