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Zhu H.-D.,Nanjing Southeast University | Guo J.-H.,Nanjing Southeast University | Mao A.-W.,Shanghai St. Lukes Hospital | Lv W.-F.,Interventional Imaging | And 19 more authors.
The Lancet Oncology | Year: 2014

Background: The combination of stent insertion and single high-dose brachytherapy is a feasible and safe palliative treatment regimen in patients with unresectable oesophageal cancer. We aimed to further assess the efficacy of this treatment strategy compared to a conventional covered stent in patients with dysphagia caused by unresectable oesophageal cancer. Methods: In this multicentre, single-blind, randomised, phase 3 trial, we enrolled patients with unresectable oesophageal cancer from 16 hospitals in China. We included adult patients (aged ≥20 years) with progressive dysphagia, unresectable tumours due to extensive lesions, metastases, or poor medical condition, and with clear consciousness, cooperation, and an Eastern Cooperative Oncology Group (ECOG) performance status score of 0-3. Eligible patients were randomly assigned (in 1:1 ratio, no stratification) to receive either a stent loaded with 125iodine radioactive seeds (irradiation group) or a conventional oesophageal stent (control group). The primary endpoint was overall survival. Survival analyses were done in a modified intention-to-treat group. This study is registered with ClinicalTrials.gov, number NCT01054274. Findings: Between Nov 1, 2009, and Oct 31, 2012, 160 patients were randomly assigned to receive treatment with either an irradiation stent (n=80) or a conventional stent (n=80). During a median follow-up of 138 days (IQR 72-207), 148 stents (73 in the irradiation group and 75 in the control group) were successfully placed into the diseased oesophagus in 148 participants. Median overall survival was 177 days (95% CI 153-201) in the irradiation group versus 147 days (124-170) in the control group (p=0·0046). Major complications and side-effects of the treatment were severe chest pain (17 [23%] of 73 patients in the irradiation group vs 15 [20%] of 75 patents in the control group), fistula formation (six [8%] vs five [7%]), aspiration pneumonia (11 [15%] vs 14 [19%]), haemorrhage (five [7%] vs five [7%]), and recurrent dysphagia (21 [28%] vs 20 [27%]). Interpretation: In patients with unresectable oesophageal cancer, the insertion of an oesophageal stent loaded with 125iodine seeds prolonged survival when compared with the insertion of a conventional covered self-expandable metallic stent. Funding: National High-tech Research Foundation of China, National Basic Research Program of China, Jiangsu Provincial Special Program of Medical Science, National Scientific and Technical Achievement Translation Foundation, and National Natural Science Foundation of China. © 2014 Elsevier Ltd.


He W.,The Affiliated Jiangyin Peoples Hospital Of Southeast University Medical College | Liu D.,The Affiliated Jiangyin Peoples Hospital Of Southeast University Medical College | Radua J.,Institute of Psychiatry | Li G.Q.,The Affiliated Jiangyin Peoples Hospital Of Southeast University Medical College | And 2 more authors.
Cell Biochemistry and Biophysics | Year: 2014

We conducted a meta-analysis of positron emission tomography (PET) findings in Alzheimer’s disease (AD) and mild cognitive impairment (MCI) to clarify the changes underpinning these conditions. All studies that utilised the PET tracers Pittsburgh Compound-B (PIB) or 2-[18F]fluoro-2-deoxy-d-glucose (FDG) to investigate patients with MCI or AD, were considered for the meta-analysis. Meta-analyses of PIB-PET and FDG-PET changes between patients and controls were undertaken with the effect-size signed differential mapping (ES-SDM) voxel-based meta-analytic method. A total of 24 studies were included involving 728 AD patients, 211 MCI patients and 658 healthy controls. Individuals with AD showed a significant PIB retention in bilateral precuneus and temporal, supramarginal, cingulate and fusiform gyri, as well as right insula and putamen. In addition, AD patients showed significant glucose hypometabolism in bilateral precuneus and temporal, supramarginal, cingulate, fusiform, angular, inferior parietal and middle frontal gyri, as well as left precentral and parahippocampal gyri and right superior frontal gyrus and thalamus. An exploratory meta-analysis of the few studies on MCI showed mildly decreased glucose metabolism with a similar regional distribution than in patients with AD. We suggest that our results can be used for further region-of-interest studies of AD and MCI patients. © 2014, Springer Science+Business Media New York.

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