Medicine
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The adding-on phenomenon is a common complication in adolescent idiopathic scoliosis (AIS) patients after correction surgery. However, the risk factors of previous studies and the optimal treatment strategies remain controversial. The aim of this study was to identify new risk factors for the adding-on phenomenon after posterior correction surgery in AIS patients and compare different treatment strategies to guide the selection of the lowest instrumented vertebra (LIV). ⋯ Among the 4 methods, only choosing touch type A as LIV shows satisfactory outcome. The Touch classification is an important risk factor that is highly correlated with the incidence of the adding-on phenomenon. The best LIV choice to preserve the lumbar activity segment as much as possible is Touch type C, and no significant difference was observed in the SRS-22 scores between the Touch type C group and the control group in the short-term follow-up.
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Metastases of nonthyroid malignancies to the thyroid gland are rare, and only sporadic cases have been reported in literature. We present our experience in treating patients with metastases to the thyroid gland at Peking Union Medical College Hospital. ⋯ Thyroid metastases are rare, and the lung was the most common primary site of origin. It seems that thyroidectomy has not been considered in cases with a high clinical stage of the neoplastic process such as lung cancer.
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Observational Study
Postmastectomy intensity modulation radiated therapy of chest wall and regional nodes: Retrospective analysis of the performance and complications up for 5 years.
To retrospectively evaluate the performance and complications of postmastectomy intensity modulation radiated therapy (IMRT) technique. From January 2010 to December 2014, IMRT technique was applied to 200 patients after modified radical mastectomy. The acute and late radiation toxicities have been followed up for 5 years. ⋯ The 2-year local-regional recurrence (LRR), distant metastasis (DM), and disease free survival (DFS) were 1.6%, 6.4%, and 92.80%, respectively. Postmastectomy treatment with the IMRT technique can reduce the incidence rate of radiation toxicity by decreasing organs at risk (OARs) irradiation. Patients with risk factors for radiation toxicity should be strictly surveyed throughout radiotherapy.
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Chart reviews have been used to assess the incidence and impact of adverse events, but most of them are not a nationally representative sample. In addition, the definition of adverse events is generally broad and covers unintended events; the relationship to outcome is often unclear, and official estimates have not matched those of medical practitioner's recognition. The number of patient deaths from adverse events remains unknown. ⋯ The mortality rate was high at acute care hospitals with ≥500 beds and at psychiatric hospitals. The nationwide number of patient deaths recognized by medical practitioners as caused by adverse events and its mortality rate were estimated. In comparison with a chart review, a mail survey was a faster and a cheaper way, and was able to cover a wide range of hospitals for estimating mortality rate of adverse events.
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Epithelioid trophoblastic tumor (ETT) is a distinctive but rare gestational trophoblastic neoplasia (GTN) composed of chorionic-type intermediate trophoblast cells. Approximately 50% ETT arose from the uterine cervix or lower uterine segment following a previous pregnancy with vaginal bleeding. With its unusual ability to simulate an invasive epithelioid neoplasm, ETT frequently poses a diagnostic challenge, especially involving the uterine cervix. ⋯ This case report demonstrates that sonographic image of tumor shapes and blood flow could be helpful in differentiating ETT from another GTN and enable more accurate diagnosis before treatment.