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In the past decade, rapid breakthroughs have been made in the systemic treat-ment of advanced unresectable hepatocellular carcinoma. Single systemic therapy has little effect on controlling tumor local recurrence and distant metastasis, and the combination modality therapy is the treatment for the majority of patients with advanced hepatocellular carcinoma. The change of tumor microenvironment is the research hotspot of antitumor therapy at present. Targeted therapy, immunotherapy and radiotherapy can lead to a change in the tumor microenvironment of primary hepatic carcinoma. The synergistic effect of combined therapy is particularly important. The authors report the clinical efficacy of programmed death ligand-1 inhibitor plus vascular endothelial growth factor inhibitor in the first-line treatment of a patient with advanced unresectable hepatocellular carci-noma. The results show that partial response being achieved according to the modified response evaluation criteria in solid tumors, and the survival time is more than 20 months with no obvious adverse reactions and high quality of life.
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Objective To explore the effect of apatinib in first-line treatment of advanced liver cancer. Methods Retrospective analysis was performed on 35 patients with advanced liver cancer treated in our department from July 2017 to January 2020. All patients were given apatinib mesylate tablet 250-500 mg orally with QD. The patients with effective disease control (including CR, PR and SD) were given administration until PD or intolerance or death occurred. The primary endpoints were PFS and OS, and the secondary endpoints were DCR and ORR. The side effect was observed. Results There was one case of CR, 17 cases of PR and 11 cases of SD. The ORR and DCR were 51.43% and 82.86%. The median PFS and OS were 9.7 and 11.1 months. The main adverse reactions included hand-foot syndrome, hypertension, proteinuria, etc. Most grade 3-5 adverse reactions were reversible with good safety. Conclusion Apatinib can significantly improve the clinical benefits of liver cancer patients. It is an alternative first-line treatment for advanced liver cancer.
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Objective:To investigate the treatment, safety and prognosis of advanced non-small cell lung cancer patients with leptomeningeal metastasis and performance status score more than 3.Methods:The clinical data of 6 NSCLC patients with leptomeningeal metastasis admitted to the People's Hospital of Wuhan University from November 2016 to September 2018 were analyzed retrospectively. The curative effect and adverse reactions were observed, and the prognosis was analyzed.Results:There were 5 females and 1 male among 6 patients. The median age was 57 years old (46-74 years old). All 6 patients were diagnosed as stage Ⅳ lung adenocarcinoma. There were 3 patients with epidermal growth factor receptor (EGFR) exon 21 mutation, 2 patients with exon 19 mutation and one with anaplastic lymphoma kinase (ALK) fusion mutation. The time window of leptomeningeal metastasis occurred after the progression of adenocarcinoma of lung: 3 cases was more than 12 months, the other 3 cases was less than 12 months, and the average was 20.3 month. Performance status score was more than 3 when leptomeningeal metastasis occurred. The brain magnetic resonance imaging of 6 patients showed linear enhancement of leptomeningeal, cancer cells were found in cerebrospinal fluid in one case, 4 cases were treated with a combination of bevacizumab and EGFR-tyrosine kinase inhibitor (EGFR-TKI), 1 case was treated with oral administration of EGFR-TKI, 1 case was treated with oral administration of EGFR-TKI combined with temozolomide. The median overall survival (mOS) was 9 months (2-13 months), and the median progression free survival was 6 months (2-11 months).Conclusion:Lung adenocarcinoma may be prone to leptomeningeal metastasis; for NSCLC patients with leptomeningeal metastasis and performance status score more than 3, a combination of EGFR-TKI and bevacizumab has good tolerance, high safety and considerable curative effect.
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Objective:To investigate the clinical characteristics and prognosis of patients with cutaneous intravascular large B-cell lymphoma (IVLBCL).Methods:The data of 30 cutaneous IVLBCL published between January 1989 and May 2019 in China were systematically reviewed. The clinical manifestation, biochemical and imaging characteristics and diagnostic features of patients were summarized, and then the survival of different groups was also analyzed.Results:The median onset age was 61.5 years old (25.0-83.0 years old), and there were 22 (73.3%) females. All 30 patients presented with cutaneous lesions. Initial symptoms showed cutaneous lesions in 16 (53.3%) patients; and B symptom, respiratory symptoms or central nervous system (CNS) occurred in 14 (46.7%) patients with late cutaneous lesions. Cutaneous lesions were heterogeneous, and 76.7% (23/30) lesions located in lower abdomen and proximal limbs. And 76.2% (16/21) were positive in image examination, and 78.3% (18/23) had two or more extranodal organs invasion. The median time from onset to visit was 2.5 months (0.4-24.0 months), and clinical misdiagnosis rate was 56.7%(17/30). All IVLBCL patients were confirmed by biopsy, including 6 cases (27.3%, 6/22) of bone marrow involvement, 1 case (3.3%) of hemophagocytic syndrome-associated variant, and 29 cases (96.7%) of classical variant. Finally, 81.8% (18/22) patients received anthracycline-based combined chemotherapy. Compared with non-chemotherapy group, the median OS time of chemotherapy group was prolonged [11.0 months (2.0-60.0 months) vs. 2.0 months (0.7-24.0 months), P = 0.002]. Patients with CNS symptoms had shorter median OS time compared with patients without CNS symptoms [2.0 months (0.7-6.0 months) vs. 11.0 months (1.0-60.0 months), P < 0.01]. The median OS time in the group of cutaneous lesions as initial symptom combined with other symptoms was longer than that in group of late cutaneous lesions and other symptoms as initial symptom [unreached (2.0-60.0 months) vs. 3.0 months (1.5-24.0 months), P = 0.032]. Conclusions:Cutaneous IVLBCL is a rare disease with atypical clinical characteristics in China. Prompt attention and biopsy in time will be helpful for early diagnosis. Accompanied with CNS symptoms suggests poor prognosis; and timely chemotherapy can improve the prognosis of the patients.
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Objective@#To investigate the salvage strategy and efficacy for patients with locally recurrent esophageal squamous cell carcinoma after definitive radiochemotherapy.@*Methods@#A total of 126 patients who met the inclusion criteria were enrolled in this study and divided into the salvage surgery, salvage radiochemotherapy and best supportive care.@*Results@#Fifty-eight of 126 patients received salvage esophagectomy, 52 underwent salvage radiochemotherapy and the remaining 16 patients received best supportive care. The 1-, 3-, 5-year overall survival rates of patients receiving salvage therapy were 51%, 16% and 4% for the three groups, whereas all patients in the best supportive care group died within 12.0 months (P<0.001). The 1-, 3-, 5-year survival rates in the salvage surgery and salvage radiochemotherapy groups were 48%, 20% and 7%, and 51%, 11% and 3%, respectively (P=0.473). Multivariate analysis by Cox proportional hazard model showed that T staging of recurrent tumors and salvage regimen were the independent prognostic factors in patients with locally recurrent esophageal cancer (both P<0.001). Postoperative infection occurred in 16% of the patients in the salvage surgery group, and the incidence of esophagotracheal fistula and mediastinoesophageal fistula was 10% and 6% in the salvage radiochemotherapy group.@*Conclusions@#A survival benefit can be elicited by salvage surgery or salvage radiochemotherapy in patients with locally recurrent esophageal cancer after definitive radiochemotherapy. Nevertheless, extensive attention should be paid to the management of postoperative complications in clinical practice.
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Objective:To investigate the clinical effect of arthroscope treating traumatic omarthralgia with Bankart injury.Methods: 69 patients with traumatic omarthralgia with Bankart injury were divided into observation group (38 cases) and control group (31cases). And patients of observation group received the treatment of arthroscopic while those of control group received routine treatment. And then the shoulder joint score and visual analogue scale (VAS) of the two groups at post-treatment 1 week and post-treatment 1 month were compared, respectively.Results: At post-treatment 1 week, series of shoulder joint scores, included of pain, functional activity, activity degree of shoulder joint, muscle force and total score, of observation group were significantly higher than those of control group, respectively (t=5.27,t=6.02,t=6.81,t=3.37,t=8.22,P<0.05). While at post-treatment 1 month, all of above shoulder joint scores between the two groups were no significantly (t=1.02,t=1.73,t=2.85,t=2.46,t=4.01,P>0.05), respectively. And for all of these scores, post-treatment 1 month were higher than that of post-treatment 1 week. Besides, for both of the two groups, the VASs of post-treatment were lower than that of pre-treatment, and the VAS of observation group was significantly lower than that of control group(t=6.88,P<0.05).Conclusions: In the process of arthroscopic treating traumatic omarthralgia with Bankart injury, the recovery of shoulder joint function and the alleviating of painful of patients achieve better effect, and post-operative recovery is faster. Therefore, the therapy method is worthy in the popularization and application of clinical practice.
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<p><b>Background</b>Although fasting plasma glucose (FPG) has been highly recommended as the sole test for diabetes screening, the efficacy of FPG alone for diabetes screening is potentially limited due to its low sensitivity. The aim of this study was to improve the efficacy of FPG for diabetes screening using urinary glucose (UG).</p><p><b>Methods</b>This study was initiated on November 12, 2015, and ended on June 28, 2016. A representative sample of individuals aged between 18 and 65 years, with no history of diabetes, from 6 cities in Jiangsu Province participated in this study. A 75-g oral glucose tolerance test was used to diagnose diabetes. All urine samples were collected within 2 h of oral glucose loading to measure UG. Partial correlation analyses were used to evaluate the associations between UG and other glycemic variables, including FPG, 2-h plasma glucose (2h-PG), and glycated hemoglobin A1c, after adjustment for age. The performance of UG was evaluated using a receiver operating characteristic (ROC) curve analysis.</p><p><b>Results</b>Of the 7485 individuals included, 8% were newly diagnosed with diabetes and 48.7% had prediabetes. The areas under the ROC curves for UG were 0.75 for estimation of 2h-PG ≥7.8 mmol/L and 0.90 for 2h-PG ≥11.1 mmol/L, respectively. The sensitivity and specificity of UG were 52.3% and 87.8%, respectively, for 2h-PG ≥7.8 mmol/L (cutoff point ≥130 mg), and 83.5% and 87.5%, respectively, for 2h-PG ≥11.1 mmol/L (cutoff point ≥178.5 mg). The combination of FPG and UG demonstrated a significantly higher sensitivity than that of FPG alone for the identification of diabetes ([483/597] 80.9% vs. [335/597] 56.1%, χ = 85.0, P < 0.001) and glucose abnormalities ([2643/4242] 62.3% vs. [2365/4242] 55.8%, χ = 37.7, P < 0.001).</p><p><b>Conclusions</b>The combination of UG and FPG substantially improves the efficacy of using FPG alone for diabetes screening; this combination might be a practical screening tool and is worth being recommended in the future.</p>
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Regular physical activity (PA) is a key element in the prevention and management of type 2 diabetes mellitus (T2DM). Participation in regular PA improves blood glucose control and can prevent or delay T2DM and its complications, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. However, most people with T2DM are not active and show poor adherence. This paper reviews the possible barriers to PA and strategies to improve the adherence to PA. Based on the currently available literature, it is concluded that self-efficacy and social support from family, friends, and health care providers play the important role in adoption and maintenance of regular PA. Here we also highlight some new modern and innovative interventions that facilitate exercise participation and improve the adherence.
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Humans , Adoption , Blood Glucose , Blood Pressure , Diabetes Mellitus , Diabetes Mellitus, Type 2 , Friends , Health Personnel , Motor Activity , Quality of Life , Self EfficacyABSTRACT
<p><b>OBJECTIVE</b>To observe the therapeutic effects on pricking blood along meridians combined with electroacupuncture for treatment of prolapse of lumbar intervertebral disc.</p><p><b>METHODS</b>One hundred cases were randomly divided into an observation group (50 cases) and a control group (50 cases). The observation group was treated with pricking blood along meridians combined with electroacupuncture. The main points for pricking blood were collaterals with blood stasis around Weizhong (BL 40) on the affected side, and collaterals with blood stasis on corresponding meridians such as Foot Shaoyang Meridian, Foot Taiyang Meridian and Foot Yangming Meridian according to body parts syndrome differentiation could also be used. The points for electroacupuncture included Ashi point (1 cun away from the spinal space of segmental lesions), Dachangshu (BL 25), Guanyuanshu (BL 26), Zhibian (BL 54), Huantiao (GB 30) and so on. The control group was only treated with electroacupuncture and treatment was same as the observation group. The therapeutic effects and scores of Visual Analogue Scale (VAS) of two groups were compared.</p><p><b>RESULTS</b>The cured rate of observation group (68.0%, 34/50) was higher than that of control group (46.0%, 23/50, P < 0.05). The cured and markedly effective rate of observation group (92.0%, 46/50) was also higher than that of control group (74.0%, 37/50, P < 0.05). The scores of VAS after treatment in both groups decreased obviously (both P < 0.01), and the decreasing degree of VAS in observation group was more obvious than that in control group (P < 0.01).</p><p><b>CONCLUSION</b>Pricking blood along meridians combined with electroacupuncture has outstanding effect for treatment of prolapse of lumbar intervertebral disc.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Acupuncture Points , Bloodletting , Combined Modality Therapy , Electroacupuncture , Intervertebral Disc Displacement , Therapeutics , Medicine, Chinese Traditional , Meridians , Pain MeasurementABSTRACT
<p><b>OBJECTIVE</b>To find a better method for treatment of acute lumbar disc herniation.</p><p><b>METHODS</b>One hundred cases were randomly divided into 2 groups. The observation group of 52 cases was treated with electroacupuncture at Yaoyangguan (GV 3), Dachangshu (BL 25), Guanyuanshu (BL 26), Xiaochangshu (BI. 27) as main points, and blood-letting puncture at stagnant collaterals nearby Weizhong (BL 40); the control group of 48 cases was treated with traction combined with electroacupuncture at main points Jiaji (EX-B 2), Shenshu (BL 23), Dachangshu (BL 25). Their therapeutic effects were observed and compared.</p><p><b>RESULTS</b>The cured rate and the cured markedly effective rate were 55.8% and 82.7% in the observation group and 33.3% and 54.2% in the control group, respectively, with significant differences between the two groups (P < 0.05, P < 0.01).</p><p><b>CONCLUSION</b>Electroacupuncture combined with blood letting puncture at stagnant collaterals nearby Weizhong (BL 40) has a signifi cant therapeutic effect on acute lumbar disc herniation.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Acupuncture Points , Bloodletting , Combined Modality Therapy , Electroacupuncture , Intervertebral Disc Displacement , Therapeutics , Lumbar Vertebrae , Wounds and InjuriesABSTRACT
<p><b>OBJECTIVE</b>To search for a more effective penetration needling method for peripheral facial paralysis.</p><p><b>METHODS</b>The patients were divided into a treatment group and a control group according to visiting sequence. The treatment group of 50 cases were treated with Yangbai (GB 14)-through-Touwei (ST 8), Yangbai (a little above the original point)-through-Shangxing (GV 23), Sizhukong (TE 23)-through-Yuyao (EX-HN 4), Qianzheng-through-Yingxiang (LI 20), Dicang (ST 4)-through-Jiache (ST 6) and Jiache-through-Yingxiang, at an angle about 45 degrees between the penetration needling direction and local paralysis muscle bundle, and the control group (n=45) with Yangbai-through-Yuyao, Zanzhu (BL 2)-through-Yuyao, Dicang-through-Jiache, Jiache-through-Dicang, Qianzheng-through-Dicang, Sibai (ST 2)-through-Yingxiang.</p><p><b>RESULTS</b>The cured rate and the cured and markedly effective rate were 76.0% and 92.0% in the treatment group, and 55.6% and 75.6% in the control group respectively, with significant differences between the two groups in the cured rate, the cured and markedly effective rate and the therapeutic times for cure.</p><p><b>CONCLUSION</b>The penetration needling method at an angle about 45 degrees between the penetration needling and paralysis muscle bundle is more beneficial to recovery of facial paralysis.</p>