The fertility-sparing treatment and outcome of epithelioid trophoblastic tumor isolated to lung: a case report and review literature

BackgroundEpithelioid trophoblastic tumor (ETT) is the rarest gestational trophoblastic tumor, with poor response to chemotherapy. Hysterectomy, as the cornerstone therapy for early ETT, is particularly challenging in reproductive-age women who often have a strong desire for fertility preservation. The management of extra-uterine ETT could be even more complicated and inconsistent. Here we reported a case of isolated ETT lesions in lungs managed with thoracic surgery without hysterectomy.Case presentationA 32-year-old woman presented with amenorrhea for 2 months. Her serum β- human chorionic gonadotropin (hCG) levels fluctuated between 52 and 75 mIU/mL. The patient underwent removal of intrauterine device and suction and curettage, but only proliferative endometrium was found. Methotrexate was given for a provisional diagnosis of ectopic pregnancy of unknown location, while β-hCG had no significant decline. She complained of mild chest pain during the past half year, and the chest computed tomography (CT) result showed two mixed ground-glass nodules of 24 mm × 14.2 mm in right upper lobe and 10 mm × 8 mm in the right lower lobe and a thin-walled cavity in the posterior segment of the left lower lobe. Right upper wedge resection and right lower segmentectomy were performed 3 months later. The result of the pathological examination of pulmonary mass indicated an epithelioid trophoblastic tumor. She was diagnosed with ETT at stage III (with right lung metastasis) according to FIGO 2000. Her menstrual cycle recovered within 1 month after the first thoracic surgery. However, β-hCG was elevated again to 9 mIU/mL, and the positron emission tomography/computed tomography (PET/CT) scans revealed the consolidation of the nodule in the left lower lobe which enlarged to about 1.0 cm × 1.7 cm. Her second pulmonary surgery without hysterectomy was conducted. Followed for 12 months for postoperative monitoring, the patient was found to be disease-free with negative results of serial serum β-hCG and chest CT.ConclusionOur case highlights the efficacy of fertility-sparing surgery for isolated ETT in lungs. The surgical management of pulmonary isolated ETT could be individualized under long-term supervision. Sporadic reports on the favorable outcome of extra-uterine ETT with fertility-sparing surgery were described in the last decades. The safety of this surgical strategy might be warranted only if enough reliable data is accumulated

The Impact of Land Transfer on Vulnerability as Expected Poverty in the Perspective of Farm Household Heterogeneity: An Empirical Study Based on 4608 Farm Households in China

Poverty eradication is one of the global challenges, and land transfer provides an effective path to address farmers’ poverty; however, the effect of poverty reduction can show heterogeneity depending on the location, household, and head of household. This study employs the propensity value matching technique to compare the effects of the land transfer on the future alleviation of poverty among farm households, based on the vulnerability as expected poverty, using data from 4608 household tracking surveys. The findings point to the following: In general, rural land transfers can significantly lessen farm households’ VEP. In terms of regional variations, the positive effects of land transfers on farm households’ VEP are mainly in the west. In terms of the differences among households, it was found that land transfers contribute to lower VEP for non-poor, non-financing-constrained, and government-subsidized farm households. With regard to differences in household headship, land transfers have abating effects on the VEP of self-employed heads of farm households. The results of the study can provide a useful reference for policy-making on land management and poverty reduction among farmer

Prevalence of positional obstructive sleep apnoea (OSA) among patients with OSA in a tertiary healthcare institution in Singapore

10.11622/smedj.2020153SINGAPORE MEDICAL JOURNAL6112665-66

Convergence Analysis of the Overall Benefits of Returning Farmland into Forest in the Upper Yangtze River Basin, China

Returning farmland to the forest (RFTF) in the upper Yangtze River basin is a strategic measure to promote the sustainable development of ecological protection. The convergence analysis of the overall benefits of the upper Yangtze River basin provides a basis for a scientific and reasonable understanding of the improvement in the comprehensive benefits of RFTF in the basin. It provides policy suggestions for basin governance and sustainable development. Therefore, the convergence analysis and its spatial effect decomposition are carried out based on the entropy weight method to calculate the overall benefits of RFTF in the upper Yangtze River basin. The results indicate that there is no σ convergence in the overall benefits of RFTF in the upper Yangtze River basin, but there is significant absolute β convergence and significant conditional β convergence, and the overall development trend is stable. After thoroughly considering certain economic and social factors, especially the traffic infrastructure and the intensity of economic activities, the convergence rate of the overall benefits of RFTF in the upper reaches of the Yangtze River is accelerated. From the perspective of the spacing effect, the overall benefits of RFTF in this region and surrounding areas in the previous period significantly affected this region. As a result, sustainable development of the upper Yangtze River basin needs to include coordinated regional action to ensure ecological benefits, to improve transportation infrastructure, to scientifically recognize economic activities, and to guard against food security risks

Clinical evaluation of radiation-induced sinusitis by MRI-based scoring system in nasopharyngeal carcinoma patients

Abstract Objective To explore the application of magnetic resonance imaging (MRI) in the evaluation of radiation-induced sinusitis (RIS), MRI-based scoring system was used to evaluate the development regularity, characteristics and influencing factors of RIS in nasopharyngeal carcinoma (NPC) patients. Patients and methods A retrospective analysis was performed by collecting the clinical and MRI data of 346 NPC patients to analyze the characteristics and prognosis of RIS. The predictive model was constructed according to the influencing factors of RIS. Results (1) In the 2-year follow-up after radiotherapy (RT), there was significant change in L-M score in both groups of NPC patients (sinusitis before RT group: p = 0.000 vs. non-sinusitis before RT group: p = 0.000). After 6 months of RT, the L-M scores of the two groups tended to plateau (sinusitis before RT group: p = 0.311 vs. non-sinusitis before RT group: p = 0.469). (2) The prevalence of sinusitis in two groups of NPC patients (without or with sinusitis before RT) was 83% vs. 93%, 91% vs. 99%, 94% vs. 98% at 1, 6 and 24 months after RT, respectively. (3) In the patients without sinusitis before RT, the incidence of sinusitis in maxillary and anterior/posterior ethmoid, sphenoid and frontal sinuses was 87.1%, 90.0%/87.1%, 49.5%, 11.8% respectively, 1 month after RT. (4) A regression model was established according to the univariate and multivariate analysis of the factors related to RIS (smoking history: p = 0.000, time after RT: p = 0.008 and TNM staging: p = 0.040). Conclusion (1) RIS is a common complication in NPC patients after RT. This disorder progressed within 6 months after RT, stabilized and persisted within 6 months to 2 years. There is a high incidence of maxillary sinus and ethmoid sinus inflammation in NPC patients after RT. (2) Smoking history, time after RT and TNM staging were significant independent risk factors for RIS. (3) The intervention of the risk factors in the model may prevent or reduce the occurrence of RIS in NPC patients