Background
The management for patients with vulvar cancer after sentinel lymph-node biopsy (SLNB) remains controversial. The aim of this study was to investigate the long-term outcomes of ...individualized management after SLNB for early stage vulvar cancer.
Methods
The medical records of patients with vulvar cancer treated by surgery involving SLNB between 2004 and 2019 were retrospectively reviewed. During this period, the inguinofemoral lymphadenectomy (IL) were performed with individualized strategy, while the postoperative intensity-modulated radiotherapy was planned with a consistent policy.
Results
We identified 138 patients with at least one sentinel node detected, of whom 64 underwent further IL while 74 had SLNB only. Nodal metastases (pN+) were confirmed in 22 patients with IL and 16 without. Radiotherapy was scheduled with the dose of 60–70 Gy for all pN+ patients and finally completed in 15 with IL and 15 without. The median follow-up time was 56 months (6–156 months). Recurrence was observed in 24 patients, of whom 10 were pN- at primary treatment. The 3-year overall survival (OS) was 97.2, 95.2, 68.3, and 71.8%; 3-year disease-free survival (DFS) was 94.5, 91.4, 60.2, and 59.2%, respectively, for patients with pN− and IL, pN− and SLNB, pN+ and IL, and pN+ and SLNB. Neither OS nor DFS showed significant difference between SLNB and IL in pN− (
P
= 0.564 for OS,
P
= 0.423 for DFS), or pN + patients (
P
= 0.920 for OS,
P
= 0.862 for DFS).
Conclusions
With appropriate adjuvant radiotherapy, SLNB alone provided similar long-term survival compared with IL for both patients with and without sentinel node metastasis.
It is conducive to the sustainable development of human beings in karst regions to research the mechanism of karst rocky desertification (KRD) expansion. Whether the large-scale KRD in southwestern ...China is caused by climate change or human activities is still controversial. In this study, the evolution of the KRD in southwestern China over the past 2000 years was reconstructed through the high-precision
δ
13
C record of stalagmites from Shijiangjun (SJJ) Cave, Guizhou Province, China. The
δ
13
C of the stalagmites from SJJ Cave exhibited heavy values from the Medieval Warm Period (MWP) to the Little Ice Age (LIA). Furthermore, the
δ
13
C records of other stalagmites and tufa from southwestern China also showed the same significant heavy trend. Because the stalagmite
δ
13
C could record the change of ecological environment, it indicated that the consistent change of the stalagmites
δ
13
C may record the process of KRD expansion in the karst regions of southwestern China. During the MWP, the stronger Asian summer monsoon and the northward movement of the rain belt led to a dry period in southwestern China and a wet period in northern China. In contrast, it was wet in southwestern China and dry in northern China during the LIA. In addition, after the Jing-Kang event (JK event, AD1127) occurred at the end of the Northern Song dynasty, the political and economic center of China migrated to southern China for the first time, which changed the population distribution pattern of larger population in the north and smaller population in the south. Therefore, the expansion of KRD in southwestern China was exacerbated in the MWP due to the change of climate in southwestern China, the migration of a large number of people, wars, the large-scale reclamation of arable land, and the cultivation of large areas of crops.
Small cell carcinoma of the uterine cervix is associated with a poor prognosis with a median overall survival that is quite low. The aim of this study was to determine the clinico-pathologic ...characteristics that have an impact on survival in patients with small cell carcinoma of the uterine cervix.
A total of 93 patients were involved in this retrospective study. Inclusion criteria were patients diagnosed with histopathologically confirmed small cell carcinoma of the uterine cervix and then later treated at three participating centers, between June 2001 and March 2015. Those without complete available follow-up records were excluded. The endpoints of this study were disease-free survival and overall survival. Kaplan-Meier and Cox regression methods were used for analyses.
There were statistical differences in overall survival between patients in early and in advanced stages by using the 2009 International Federation of Gynecology and Obstetrics (FIGO) clinical stage. There were 75 patients with FIGO stage I to IIA (56 patients stage I, 17 patients stage IIA, and two patients stage IB or IIA because of uncertainty as to whether the fornix was involved); and 18 patients with FIGO stage IIB and above (10 patients IIB stage, five patients stage III, and three patients stage IV). Among the 76 patients who had surgery, 73 (96%) had a radical hysterectomy with pelvic lymph node dissection and three (4%) patients had a simple hysterectomy without lymph node dissection. For early-stage patients, the 5 year disease-free survival rate was 52.7% compared with 32.4% in the advanced stage group (p=0.022). The disease-free survival for the early-stage group was 64.4% compared with 36.7% in the advanced-stage group (p=0.047). For factors affecting overall survival, age at diagnosis, tumor homology, tumor size, depth of stromal invasion, lymph node involvement, and treatment modality failed to reach significance in both univariate and multivariate analysis.
FIGO stage was a prognostic factor impacting survival-both overall survival and disease-free survival. Age at diagnosis, tumor histology (pure or mixed), tumor size, depth of stromal invasion, lymph node involvement, and treatment modality did not have an impact on overall survival.
Abstract
Background
The present study identified survival and progression-free rates and evaluated prognostic factors for IVB stage cervical cancer in patients that presented with synchronous ...oligometastases (sync-oligometastases) who received definitive irradiation for primary and metastatic sites.
Methods
The study retrospectively included 60 patients with newly diagnosed stage IVB cervical cancer. Patients received definitive radiation for both primary and metastatic sites through Volumetric Modulated Arc Therapy (VMAT) or intensity modulated radiation therapy (IMRT) followed by three dimensional-intracavitary/interstitial brachytherapy at our institution between July 2014 to December 2020. All patients were staged based on the International Federation of Gynecology and Obstetrics (FIGO) 2018 guidelines. Overall survival (OS), progression-free survival (PFS), and patient prognostic factors were analyzed.
Results
The 60 patients who received curative-intent irradiation for primary and metastatic sites showed a 5-year OS rate of 51.4% and a 5-year PFS rate of 25.9%. The median PFS was 52.3 months, and the median OS had not been reached. Lymphatic metastases had a better OS compared with hematogenous metastases (3-year OS rates: 57.2% vs. 20%, p = 0.017). Patients with one metastasis site showed a more favorable prognosis than patients with ≥ 2 metastases sites (3-year OS rates: 60.4% vs. 20.6%, p = 0.003). Patients that presented with tumors larger than 4 cm in diameter before treatment demonstrated a poorer prognosis (5-year OS rates: 41.2% vs. 65.2%, p = 0.029; 5-year PFS rates: 10.4% vs. 53.7%, p = 0.021).
Conclusion
Definitive irradiation for both primary and oligo-metastatic sites for selected IVB patients is a feasible treatment strategy. Metastatic type, number of metastatic sites, and pre-treatment tumor diameter were significant prognostic factors. Neoadjuvant chemotherapy, the lymph nodal metastatic type (supraclavicular or inguinal), and number of lymphatic metastatic sites failed to reach statistical significance as prognostic factors.
•Re-irradiation with VMAT is an effective and safe salvage treatment option for selected recurrent cervical cancer.•Recurrent patients with interval between the two radiotherapy courses beyond ...12 months and the serum SCC-Ag level less than 1.5 ng/ml tend to have improved outcomes.•Re-irradiation was still worthy considering to be performed for the in-field recurrent patients with distant oligometastases.
Salvage treatment of recurrent cervical cancer of patients with a history of radiotherapy is currently a major clinical challenge. The purpose of our study was to retrospectively analyze clinical outcomes of radiation in patients with recurrent cancer who have previously received radiotherapy at our hospital and further explore the efficacy and safety of this treatment modality.
All consecutive patients who underwent re-irradiation were included in our department between January 2015 and December 2017. All the patients received Volumetric Modulated Arc Therapy (VMAT) alone or VMAT followed by three dimensional–image-guided brachytherapy (3D-IGBT). The volume and dose for re-irradiation depended on previous radiation fields, dosimetry and recurrence sites. All patients received systemic chemotherapy before or after re-irradiation.
Fifty patients were included in our study. The median time from primary radiotherapy to re-irradiation was 12 months. Local recurrence, which was the most common failure following primary treatment, was present in 25 patients (50.0 %) while regional recurrence, loco-regional recurrence and distant recurrence combined in-filed recurrence was present in 8 (16.0 %), 9 (18.0 %) and 8 patients (16.0 %). Re-irradiation dose to lymph nodes was 45 Gy with or without a boost up to 55–60 Gy, and to the gross mass was 36–45 Gy with or without a boost up to 45–61 Gy. The median follow-up period was 22 (range,4–59) months. The 3-year local control (LC), progression-free survival (PFS), and overall survival (OS) rates were 58.0, 38.7, and 44.4 %, respectively. The median time of PFS and OS was 14 and 26 months, respectively. The interval between two successive radiotherapies beyond 12 months was significantly associated with better LC and PFS (p ≤ 0.05), but without the benefit of OS (p > 0.05). Serum SCC antigen level less than 1.5 ng/ml had a significantly better impact on PFS (p ≤ 0.05). Overall, 14 patients (28 %) experienced ≥ grade 3 acute toxicities, while 9 (18 %) experienced ≥ grade 3 late toxicities.
Re-irradiation with VMAT is an effective and safe salvage treatment option with a reasonably good clinical outcome and toxicity profile in selected patients. In our experience, recurrent cancer patients with an interval between two successive radiotherapy courses beyond 12 months and with a serum SCC-Ag level less than 1.5 ng/ml, had improved outcomes.
The purpose of the study is to summarize the clinical characteristics and identify the prognosis of clear cell adenocarcinoma of the uterine cervix (CCAUC) in patients without a history of ...diethylstilbestrol (DES) exposure.
Forty-two patients with CCAUC, treated initially at Sun Yat-sen University Cancer Center between 1985 and 2017, were studied.
Of all the CCAUC patients, the median age was 47 years old, and the median tumor size was 3 cm. Thirty-four early stage patients (IB = 28, IIA = 6) underwent radical surgery. Eight advanced stage patients (IIB = 8) received concurrent chemoradiotherapy (n = 4) or radical surgery (n = 4). Survival analysis showed that patients with early stage (IB-IIA) had a significantly better 5-year progression-free survival (PFS) and overall survival (OS) than those with advanced stage (IIB) (
< 0.05). The patients with negative pelvic lymph node (PLN) had a significantly better 5-year PFS and OS than those with positive PLN (
< 0.05). Radiotherapy (RT) did not affect PFS or OS in early stage patients with intermediate risk factors (
> 0.05). Adjuvant chemotherapy (CT) did not affect PFS or OS in early stage patients without risk factors (
> 0.05).
The FIGO stage and pelvic node status were important prognostic factors for both PFS and OS. For treatment modality, we recommended that radical surgery alone was used in early stage patients without high risk factors. Ovarian preservation in early stage patients involved some risk.
•This is the first reported atomic resolution scanning tunneling microscope (STM) that is designed to work in a harsh vibrational cryogen-free superconducting magnet.•Large range of sample ...temperature, covering from 1.6 to 300 K.•Ultra-low noise down to 1.5 pA.Hz−1/2 when we set the current to 0.5nA and opened the feedback loop and drifting of 1.15 and 1.71 pm/min in X–Y plane and Z direction for the STM are achieved.•High quality STM images of graphite are obtained in sweeping the magnetic fields from 0–8 T.•Atomically resolved STM images of NbSe2 at 1.6 K are obtained, as well as scanning tunnelling spectrum (STS, i.e. dI/dV spectrum) data near its critical temperature, showing the formation process of the superconducting gap as a function of temperature.
We present a probe-type scanning tunnelling microscope (STM) with atomic resolution that is designed to be directly inserted and work in a harsh vibrational cryogen-free superconducting magnet system. When a commercial variable temperature insert (VTI) is installed in the magnet and the STM is housed in the VTI, a lowest temperature of 1.6 K can be achieved, at which the STM still operates well. We tested the STM in an 8 T superconducting magnet cooled with a pulse-tube cryocooler and obtained atomically resolved graphite and NbSe2 images as well as the scanning tunnelling spectrum (i.e., dI/dV spectrum) data of the latter near its critical temperature, which show the formation process of the superconducting gap as a function of temperature. The drifting rates of the STM at 1.6 K in the X–Y plane and Z direction are 1.15 and 1.71 pm/min, respectively. Noise analysis for the tunnelling current shows that the amplitudes of the dominant peaks (6.84 and 10.25 Hz) are as low as 1.5 pA.Hz−1/2 when we set the current to 0.5 nA and open the feedback loop. This is important as a cryogen-free magnet system has long been considered too harsh for any atomic resolution measurement.
Understanding the hydrological processes of dissolved organic matter (DOM) in the surface karst zone is crucial for the utilization and safety of groundwater resources. However, research on DOM in ...drip water from karst caves is limited. In this study, continuous monitoring was conducted for four years at four drip water monitoring sites (MP1, MP2, MP3, and MP9) in Furong Cave, Southwest China. The three-dimensional fluorescence excitation–emission spectroscopy (3D-EEM) and fluorescence region integration (FRI) methods were employed, along with correlation analysis, to investigate the spectral characteristics, composition, sources, and influencing factors of the DOM in the drip water of Furong Cave. The results indicated that (1) the three-dimensional fluorescence peaks in the drip water were classified into six categories: A, B, C, T, Ti, and M. (2) The dominant source of the drip water DOM is endogenous organic matter. (3) The FRI analysis indicates a relatively high proportion of Type II substances in the drip water, predominantly composed of tryptophan-like substances. (4) The DOM in the drip water of Furong Cave was influenced by various factors, including the mixing effect of “new” and “old” water, water residence time in karst systems, and water–rock interactions (WRI), resulting in the complex responses of drip rates and DOM to surface precipitation and temperature at different drip water sites. This study provides a reference for comparative research on DOM in cave drip water in karst regions, which contributes to a better understanding of the migration mechanism of DOM in karst aquifers under different climate and karst ecological conditions.
This paper explores the influence of the local meteoric conditions, the overlying soil on the concentrations of Ca, Mg, and St, and the ratios of Mg/Ca, Sr/Ca, and Mg/Sr in soil infiltrating water ...（SIW）. An in situ monitoring program was carried out above the Furong Cave throughout 2010 to collect data on SIW, monthly temperature and rainfall, and the geochemical com- position and granularity of soils. The discharge of SIW responded quickly to the local rainfall, and its residence time was the primary factor affecting the Ca, Mg, and Sr content of the SIW. The high concentrations of Ca, Mg, and Sr in the SIW during April should be attributed primarily to the prolonged residence of SIW in the soil during the local dry seasons of winter and early spring. The maximum Mg/Sr ratio also occurred in April. The ratio of Mg/Ca in SIW is positively correlated with pro- longed residence time and with high temperatures, which do not strongly affect the ratio of Sr/Ca. The Mg/Ca ratio was lowest when the Sr/Ca ratio was highest because plant metabolism increased the absorption of Ca and Mg, but not St, and also be- cause higher temperatures enhanced the dissolution of Mg more than that of Sr. These different responses of Mg and Sr to temperature increases resulted in high Mg/Sr ratios during July and August.
To investigate the effects of centipede acidic protein (CAP) on atherosclerotic rats and the mechanisms involved.
Male Sprague–Dawley rats were randomly divided into five groups: control, ...atherosclerotic, low-dose CAP (L-CAP), high-dose CAP (H-CAP) and simvastatin group (
n
=
12 in each group). Atherosclerotic model was established by a single dose of vitamin D
3 and an atherogenic diet. Rats of H-CAP and simvastatin groups simultaneously received CAP or simvastatin daily for 6 weeks. At the completion of the experiment, the changes in lipid profile, hemorrheology, nitric oxide (NO), endothelin-1 (ET-1), malondialdehyde (MDA) and superoxide desmutase (SOD) were measured, and the histological changes in aorta and liver were observed.
Treatment of atherosclerotic rats with either low or high doses of CAP led not only to significant decreases in plasma total cholesterol, triglyceride, low density lipoprotein and increase in plasma high density lipoprotein, but also to improvement of the hemorrheologic abnormalities. On the other hand, CAP suppressed the lipid peroxidation, regulated the levels of ET-1 and NO. From the histopathological examination, treatment with CAP ameliorated the pathological changes in thoracic aorta and liver in atherosclerotic rats.
These results suggest that CAP significantly suppress the development of atherosclerosis, improves the hemorrheological disturbances and histopathological changes in the atherogenic diet fed rat model. These effects may partly attribute to reverse of dyslipidemia, inhibition of lipid peroxidation, regulation of NO and ET-1 system.
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