The purpose of this study is to investigate the clinical and histological features that may affect the survival of the patients and to evaluate the impact of post-operative adjuvant therapy on the outcomes of patients with stage IB and IIA carcinoma of the cervix. From August 1998 to January 2005, 140 patients with International Federation of Gynecology and Obstetrics stage IB and IIA cervical cancer were treated with radical hysterectomy and post-operative pelvic radiation therapy with or without chemotherapy. The median age was 55 years (range, 29-86 years). Seventy-six patients had stage IB and 64 patients had stage IIA disease. Tumour size was <4 cm in 96 patients and > or = 4 cm in 44 patients. One hundred and eleven patients had histology of squamous cell carcinoma, 12 patients has adenocarcinoma and 17 patients had other histologic types. Depth of stromal invasion was <2/3 in 20 patients and > or = 2/3 in 120 patients. Twenty-three patients had parametrial invasion and 117 patients had no parametrial invasion. Thirteen patients had lymphovascular space invasion and 127 had no lymphovascular space invasion. Nine patients had positive surgical margin and 131 patients had negative margin. Twenty-seven patients had pelvic lymph node metastasis and 113 patients had no pelvic lymph node metastasis. Seventy-five patients received concurrent chemoradiotherapy and 65 patients received radiotherapy alone. The 5-year overall survival (OAS) and disease-free survival were 83% and 72% respectively. In the log rank test, tumour size (P = 0.0235), pararmetrial invasion (P = 0.0121), pelvic lymph node metastasis (P < 0.0001) and adjuvant chemotherapy + radiotherapy (P = 0.0119) were significant prognostic factors for OAS, favouring tumour size <4 cm, absence of parametrial invasion and pelvic lymph node metastasis, and those who received adjuvant chemoradiotherapy. The patients who received radiation with concomitant chemotherapy had a 5-year OAS rate of 90% versus those who received radiotherapy alone, with a rate of 76%. For patients with high-risk early stage cervical cancer who underwent a radical hysterectomy and pelvic lymphadenectomy, adjuvant chemoradiotherapy resulted in better survival than radiotherapy alone. The addition of weekly cisplatin to radiotherapy is recommended. The treatment-related morbidity is tolerable.

BackgroundLung immune prognostic index (LIPI) refers to a biomarker combining derived neutrophil-to-lymphocyte ratio (dNLR) and lactate dehydrogenase (LDH). Its prognostic effect on advanced small cell lung cancer (SCLC) patients receiving programmed cell death 1/programmed cell death ligand-1 (PD-1/PD-L1) inhibitors plus chemotherapy as first-line treatment remains unclear. Our research investigated the relationship between pretreatment LIPI and the prognosis of patients receiving first-line PD-1/PD-L1 inhibitors plus chemotherapy.MethodsAdvanced SCLC patients receiving PD-1/PD-L1 inhibitors plus chemotherapy as first-line treatment from Jan 2015 to Oct 2020 were included. Based on the values of dNLR and LDH, the study population was divided into two groups: LIPI good and LIPI intermediate/poor. The Kaplan-Meier method was used to compute the median survival time and the log-rank test was used to compare the two groups. Univariate and multivariate analyses were used to examine the correlation between the pretreatment LIPI and clinical outcomes.ResultsOne hundred patients were included in this study, of which, 64% were LIPI good (dNLR &lt; 4.0 and LDH &lt; 283 U/L), 11% were LIPI poor (dNLR ≥ 4.0 and LDH ≥ 283 U/L), and the remaining 25% were LIPI intermediate. The LIPI good group had better progression-free survival (PFS) (median: 8.4 vs 4.7 months, p = 0.02) and overall survival (OS) (median: 23.8 vs 13.3 months, p = 0.0006) than the LIPI intermediate/poor group. Multivariate analysis showed that pretreatment LIPI intermediate/poor was an independent risk factor for OS (HR: 2.34; 95%CI, 1.13, 4.86; p = 0.02). Subgroup analysis showed that pretreatment LIPI good was associated with better PFS and OS in males, extensive disease (ED), PD-1 inhibitor treatment, smokers, and liver metastasis (p &lt; 0.05).ConclusionsPretreatment LIPI could serve as a prognostic biomarker for advanced SCLC patients receiving first-line PD-1/PD-L1 inhibitors plus chemotherapy.

Background Cortical spreading depression (CSD) is an electrophysiological event underlying migraine aura. Traditional CSD models are invasive and often cause injuries. The aim of the study was to establish a minimally invasive optogenetic CSD model and identify the active networks after CSD using whole-brain activity mapping. Methods CSD was induced in mice by light illumination, and their periorbital thresholds and behaviours in the open field, elevated plus-maze and light-aversion were recorded. Using c-fos, we mapped the brain activity after CSD. The whole brain was imaged, reconstructed and analyzed using the Volumetric Imaging with Synchronized on-the-fly-scan and Readout technique. To ensure the accuracy of the results, the immunofluorescence staining method was used to verify the imaging results. Results The optogenetic CSD model showed significantly decreased periorbital thresholds, increased facial grooming and freezing behaviours and prominent light-aversion behaviours. Brain activity mapping revealed that the somatosensory, primary sensory, olfactory, basal ganglia and default mode networks were activated. However, the thalamus and trigeminal nucleus caudalis were not activated. Conclusions Optogenetic CSD model could mimic the behaviours of headache and photophobia. Moreover, the optogenetic CSD could activate multiple sensory cortical regions without the thalamus or trigeminal nucleus caudalis to induce cortical pain.

The condition of collateral pathways is an important predictor of stroke prognoses; however the major determinants of collaterals are still unknown. The purpose of this study is to identify potentially determinants for collateral circulation status in patients with chronic occlusion of cerebral arterial circle. All patients with chronic occlusion of either unilateral internal carotid artery or middle cerebral artery M1 or M2 segment, diagnosed by digital subtraction angiography at the neurology department of the First Medical Centre of Chinese PLA General Hospital from January 2015 to December 2017, were retrospectively collected in our sample. After screening according to inclusion and exclusion criteria, the patients’ relevant clinical data were collected and analyzed. Collateral circulations were assessed by 2 independent raters using the American society of interventional and therapeutic neuroradiology/society of interventional radiology flow-grading system. Baseline characteristics (n = 163): our sample consists of 116 (71.2%) male and 47 (28.8%) female patients with an average age of 57.5 ± 11.9 years. Cerebral collateral flow was poor in 59 (36.2%) patients. Our univariate analyses showed that poor collateral circulation was associated with lower high-density lipoproteins cholesterol (HDL), elevated homocysteine levels, aging and hyperlipidemia. A multivariate analysis identified HDL, homocysteine levels and ageing as major predictors for collateral circulation status. In the subgroup analysis, the HDL contributed to collateral angiogenesis internal carotid artery occlusion group. In the middle cerebral artery occlusion group, the homocysteine and ageing were related to the poor collateral status. Low HDL, high levels of homocysteine and ageing are identified as possible risk factors for a poor collateral vessel blood flow in patients with chronic anterior circulation occlusion.

Background: Headache disorders are common diseases that cause a social burden. This systematic review and meta-analysis aimed to evaluate the effects of various non-pharmacological treatments to address or prevent acute headaches, including neuromodulation, acupuncture, and aerobic exercises in patients with episodic migraine and tension-type headache (TTH).Methods: We performed a systematic search of the electronic databases PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, WANFANG MEDICINE ONLINE, and Chinese Medical Journal database using Stata/SE 14.0 to obtain weighted mean differences (WMDs). The outcomes included monthly headache days, headache intensity, headache duration, days per month of acute medication use, and the Medical Outcomes Study 36-Item Short-Form Health Survey. Results: Of 872 identified articles, 27 were included in the meta-analysis. Neuromodulation was associated with reduced headache days (WMD: −1.274, 95% CI [−1.914, −0.634], P < .001), duration (WMD: −2.2, 95% CI [−3.32, −0.107], P < .001) and medication consumption (WMD: −1.808, 95% CI [−2.546, −1.071], P < .001) in cases of migraine. Acupuncture was associated with the alleviation of headache days (WMD: −0.677, 95% CI [−0.932, −0.422], P < .001) and intensity (WMD: −0.893, 95% CI [−1.573, −0.212], P = .01) in cases of migraine and acute medication use (WMD: −3.29, 95% CI [−4.86, −1.72], P < .001) in cases of TTH. Aerobic exercise was associated with reduced headache duration (WMD: −5.1, 95% CI [−8.97, −1.22], P = .01) in cases of TTH. The risk of bias for included articles was moderate.Conclusions: There is low-and moderate-quality evidence that neuromodulation, acupuncture, and aerobic exercises are associated with attenuated headache symptoms in patients with episodic migraine or TTH. However, high-quality studies are needed to draw more detailed conclusions.

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Purpose/Objective(s): Lung and cardiac toxicity were found to be negative prognostic factors of survival in patients with lung or breast cancer who received radiotherapy as part of their treatment. Their roles in patients with operable esophageal carcinoma (EC) who received neoadjuvant chemoradiotherapy are not well established. The purpose of this study was to determine the impacts of lung and / or heart dose on survival outcome in patients with EC receiving trimodality therapy. Materials/Methods: The medical charts and treatment plans of 127 patients with EC treated with trimodality therapy in two institutions between January 2010 and December 2015 were reviewed. Clinical factors and dosimetry parameters were collected to analyze their impacts on survival outcome by using the Kaplan-Meier method and Cox proportional hazards model. Results: Of all the patients, with a majority of clinical stage III disease (n Z 96, 75.6%), squamous cell histology (n Z 121, 95.3%), and smoking history (n Z 120/127, 94.5%), 91 patients (71.7%) underwent pre-treatment feeding jejunostomy. The median dose of radiotherapy was 5,000 cGy (range: 4,000-6,600 cGy). At a median follow-up of 27.7 months (range: 4.7-92.8 months), the median survival of all the patients was 32.7 months (95% confidence interval [CI], 24.9-40.5 months). In the Cox proportional hazards model, pathological complete response (PCR); (hazard ratio [HR], 0.232; 95% CI, 0.127-0.422; p < 0.001), the Eastern Cooperative Oncology Group (ECOG) performance status (HR, 2.111; 95% CI, 1.297-3.437; p Z 0.003), and volume of lung receiving at least 20 Gy (V20); (HR, 1.089; 95% CI, 1.045-1.134; p < 0.001) significantly predicted mortality risk, but not heart mean dose (HR, 1.000; p Z 0.844]. Patients with PCR and lung V20 & 20% had a longer median survival time than those without PCR and with lung V20 >20% (67.5 and 65.7 months vs 24.6 and 27.7 months, respectively; p < 0.001 and < 0.001, respectively). Conclusion: Lung V20 >20% was associated with poor outcomes in patients with EC receiving trimodality therapy. The heart mean dose was not a negative prognostic factor of survival. Limiting the lung radiation dose during radiotherapy in EC patients could potentially improve the outcomes. Future study should aim to reduce the lung dose using novel radiotherapy technique or modalities with a goal of optimizing the outcomes in patients with operable EC.

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