ABSTRACT
Upper tract urothelial carcinoma (UTUC) patients have high recurrent rate and poor survival. Most of the previous studies of adjuvant chemotherapy in UTUC were retrospective and the results were controversial. Recent clinical trials support that adjuvant chemotherapy can improve disease-free survival of patients with locally advanced UTUC and platinum based regimens are standard adjuvant treatment. Currently the clinical trials results about effect comparison between adjuvant treatment and neoadjuvant treatment are limited. With the development of targeted therapy and immunotherapy, combinations with novel agents in the adjuvant setting might further improve the prognosis for locally advanced UTUC.
ABSTRACT
Objective@#To investigate the incidence and clinical characteristics of urothelial carcinoma (UC) accompanied with multiple primary carcinoma (MPC).@*Methods@#The clinical data of 121 UC patients with MPC in Peking University Third Hospital from January 2010 to May 2018 were retrospectly analyzed.@*Results@#UC patients with MPC accounted for 9.74% (121/1 242) of all the UC patients. The ratio of male to female patients was 2.10∶1 in the total MPC patients, but it was 1∶1 in the upper urinary tract MPC subgroup. The MPC patients were more common in elderly people, whose medium age was 68 (32-93) years old. Of all the location (131 person-time) of other tumors besides UC, the digestive system tumors occurred most frequently, accounting for 41.98% (55/131), followed by the urinary and male reproductive system tumors (20.61%, 27/131) and the female reproductive system (12.21%, 16/131). The proportion of the digestive system tumors (47.37%, 9/19) was the highest in the upper urinary tract MPC, with a total number of the other primary cancer of 19 person-time. However, the proportion of the urinary and male reproductive system tumors (37.14%, 13/35) was higher in the synchronous MPC group, with a total number of the other primary cancer of 35 person-time. Some patients had a history of radiotherapy and/or chemotherapy before UC was diagnosed. We also observed 2 cases of genetically confirmed Lynch syndrome. The median overall survival (mOS) of UC patients with MPC was 132 months, and the mOS of patients with UC as the first malignancy (including synchronous MPC and UC as the first malignancy in metachronous MPC) was 120 months. The mOS of the synchronous MPC group was 84 months, which was significantly shorter than 178 months of metachronous MPC group (χ2 =14.029, P<0.001).@*Conclusions@#The incidence of UC accompanied with MPC is not low, and the most common sites of MPC are the digestive system and reproductive system. Therefore, screening for MPC in UC patients, especially those with personal or family history of tumors, as well as elderly patients, may help early diagnosis and treatment of MPC patients and improve their prognoses.
ABSTRACT
Objective To evaluate the efficacy of systemic glucocorticoids and intravenous immunoglobulin (IVIG)for the treatment of toxic epidermal necrolysis (TEN). Methods Clinical data on TEN inpatients treated with systemic glucocorticoids alone or in combination with IVIG were collected from the Department of Dermatology, First Affiliated Hospital of Nanjing Medical University from January 2006 to December 2012. Therapeutic outcomes were evaluated in these patients. Statistical analysis was carried out by using a multiple linear regression analysis, binary logistic regression analysis and Cox regression analysis with the SPSS 16.0 software. Results A total of 48 inpatients with TEN were included in this study. Multiple linear regression analysis showed that the maximum daily dose of glucocorticoids for disease control was decreased gradually over years (β=-0.461, P=0.004). However, binary logistic regression analysis revealed no obvious changes in the frequency of administration of IVIG over years. Cox regression analysis showed that both hospitalization duration (RR=0.351, 95.0%CI:0.150-0.825)and the time required for the control of skin lesions (RR=0.492, 95.0%CI:0.245-0.986)decreased with the increase in the frequency of IVIG administration. In addition, with the increase in the maximum daily dose of glucocorticoids for disease control, the time required for the control of skin lesions was also shortened (RR=0.997, 95.0%CI:0.994 -1.000), while no obvious changes were observed in hospitalization duration. Conclusions IVIG shows superiority in controlling lesions, reducing complications and improving the prognosis of TEN. Compared with systemic glucocorticoids, IVIG shows better therapeutic efficacy and less adverse effects, and may be preferentially selected.
ABSTRACT
Objective To study the role of the transforming growth factor-β-activating kinase 1 (TAK1) poly-ubiquitination in radiation-induced NF-κB activation.Methods FLAG-TAK1 and HA-UbK63 plasmids were transiently transfected into HEK-293T cells.The radiation effect on TAK1 ubiquitination was detected by immunoprecipitation and Western blot,which was further confirmed in FLAG-TAK1 HeLa stable cell line.Results At 1 h after irradiation,Lys 63-1ink TAK1 ubiquitination was induced in the HEK-293T cells with plasmids transfection.This result was further confirmed by using a FLAG-TAK1 stably expressed HeLa cell line.Radiation-induced IKKs and p38 phosphorylation were greatly impaired in MEFs reconstituted with TAK1 K158R mutant compared to ones with wild-type TAK1.Conclusions Lys63-1inked TAK1 poly-ubiquitination at Lys-58 plays a key role in the process of radiation-induced NF-κB activation.
ABSTRACT
Objective To prospective study the use of minimally invasive surgery (MIS) for colorectal cancer with liver metastases (CRCLM) and to analyze the safety and survival outcomes.Methods 31 patients with resectable CRCLM were enrolled into this study from January 2009 to August 2011.Synchronous or metachronous liver metastases were diagnosed in 26 and 5 patients,respectively.The treatment strategy was discussed and decided by a multi disciplinary team which consisted of experienced colorectal surgeons,hepatic surgeons,medical oncologists,radiologists,and pathologists.Treatment included the use of neoadjuvant chemotherapy,one or two-staged surgery,and suitability to use laparoscopic surg(e)ry.Results Coloproctectomy and partial hepatectomy were carried out in all these patients,and every patient received at least one laparoscopic procedure.The operations in cluded: laparoscopic coloproctectomy plus hepatectomy (n=10),laparoscopic coloproctectomy only (n 18) and laparoscopic partial hepatcctomy only (n=3).One-staged coloproctectomy and hepatectomy were performed in 19 patients who presented with synchronous CRCLM.Colorectal and hepatic specific complications,such as anastomotic leak,liver failure,biliary leak,abdominal infection and abdominal bleeding,were not detected in these pati(e)nts.Neoadjuvant chemotherapy was used in 12 patients.Adjuvant chemotherapy was given to every patient.At a mean follow-up of 23.3 months from the diagnosis of liver metastases,the overall survival and disease-free survival were 87.1％ and 71.0％,respectively.Conclusions MIS for resectable CRCLM in carefully selected patients was safe and feasible.A one staged laparoscopic coloproctectomy and partial hepatectomy was possible.The short-middle oncologic outcomes were acceptable,but the long-term survival was still not clear.
ABSTRACT
Objective To reconstruct the absorbed dose for the individual who was accidentally exposed in uterus 16 years ago.Methods Peripheral blood samples were taken from the victim and her mother.The dicentric and centric ring chromosome aberrations were analyzed with conventional method,the micronucleus was observed with cytokinesis-block micronucleus method,and fluorescence in situ hybridization (FISH) with chromosomes 1,2 and 4 painting probes were used for translocation detection.Dose was estimated according to the standard dose-response curves previously established.Results No unstable chromosome aberrations and normal micronucleus frequencies were observed in two persons 16years after the accident.Against the established dose-response curves with FISH,the doses to the mother and her daughter were 0.76 Gy (95% GI 0.41-1.00 Gy) and 0.61 Gy (95% CI 0.44-0.86 Gy),respectively.Because the biological dose estimated for the mother 1 month after the accident was 2.30 Gy (95% CI 2.07-2.50 Gy),the dose correction factor was 3.03 for dose estimation 16 years later.The estimated dose in uterus to the victim was 1.85 Gy (95% CI 1.33-2.61 Gy).Conclusions The estimated dose to the individual accidentally exposed in uterus 16 years ago can be obtained according to the dose correction factor of the mother with FISH method.
ABSTRACT
Objective To investigate the late effect of radiation on child-bearing women,through observing "Fang",a 19-week-pregnant woman at age of 23,who was exposed to 60Co radiation in Shanxi Xinzhou radiation accident in November,1992 and diagnosed as moderate bone marrow type acute radiation sickness and recovered after 16 year of follow-up treatment.Methods Clinical data including medical history,physical examination,laboratory data,imaging findings and consulting relevant departments were reviewed.Results The followed-up woman "Fang" often felt weak and caught cold after recovery.When she was 32 years old (9 years after radiation),her hair turned grey,but without hair loss.Her menstrual quantity was lessened since 31 years old (8 years after radiation).She was remarried and pregnant twice in the same year.At the first time she underwent artificial abortion and the second child suffered from intrauterine death after 6 months of pregnancy.The physical examination found bilateral degree Ⅰ thyroid enlargement and sparse armpit hair.The laboratory test showed the increased levels of triiodothyronine,thyroxine and anti-thyroid peroxidase antibody (TMAb) and the decreased thyroid stimulating hormone (TSH).Unstable chromosome aberrations were totally lost and stable aberrations in chromosomes were detected by fluorescence in situ hybridization (FISH).The dose estimated with the residue chromosome aberration was 0.76 Gy.Other laboratory results were normal.Ultrasonic test showed diffuse lesion in bilateral thyroid and multiple cystic nodules in right lobe of thyroid,which was considered to be nodular goiter.The examination of bone mineral density (BMD) showed osteoporosis from the second to the fourth lumber vertebra.There were no diseases associated with radiation based on the consultation from related departments.Conclusions Intrauterine death after 6 months of pregnancy might be associated with the previous exposure.There is no evidence of malignant tumor,but non-cancerous diseases are obvious.
ABSTRACT
Objective To observe and study the late effects of intrauterine exposure to irradiation.Methods A 16-year-old girl,borne by a woman exposed to 60Co irradiation during the Xinzhou radiation accident 16 years ago underwent inquiry,general medical examination.Conventional chromosome aberration analysis and fluorescence in situ hybridization (FISH) were used to examine non-stability and stability chromosome aberrations,and China revised Wechsler Intelligence Scale for Children (C_WISC)was used to detect IQ level.Results Inquiry revealed no history of carcinoma and no family history of hereditary diseases.The girl often caught cold when she was a child,but she hadn' t any other diseases.Menarche occurred when she was 12 years old,and she had not suffered from dysmenorrhea.Her development of body frame constitution was normal.She could not carry out addition and subtraction,but she could make simple verbal communication,writing and even reciting text.The results of the routine lab examination were within the normal range.Unstable chromosome aberrations were not shown,and the chromosome translocation rate was 2.3%.The dose that induced the chromosome injury was deduced as 0.81 Gy.The biological dose of the radiation that she was exposed to was inferred to be 1.85 Gy when she was in ther mother's uterus.Ultrasonic sound showed nodular goiter and no malignant change.China's revised Wechsler Intelligence Scale for Children (C_WISC) test results showed that speech,operation and full-scale IQ was 51,50,and 46 respectively.The total intelligence was better than 0.01% ,and worse than 99.90% of the population.Conclusions Exposure in utero does not affect the body frame constitution development after birth of the fetus,but mental retardation is clear.No evidence of any tumor can be found for the children exposed to radiation before their birth.
ABSTRACT
Objective To evaluate the effect of sequential intrahepatic arterial FAM for the treatment of metastatic gastric cancer to the liver. Methods 14 patients with multiple hepatic metastases from gastric cancer were treated with sequential intrahepatic arterial FAM using the hepatic artery infusion port. Results Of 14 patients, CR, PR, NC and PD were observed in 1, 7, 4 and 2 cases respectively. The overall median survival was 15 months. The survival rate at 1, 2 and 3 years was 80.0%; 57.1% and 14.3% respectively. No severe complication was observed. Conclusions Sequential intrahepatic artery FAM is effective to increase the survival rate in patients with hepatic metastases from gastric cancer.
ABSTRACT
Objective To explore the effects of interstitial brachytherapy with permanent seed implants on peripheral blood cells, liver functions, renal functions, T cells subgroups and the activity of natural killer cells (NK). Methods Ultrsound-guided or intraoperative implants of radioactive seed 125I were used in 25 patients with pathologically diagnosed and ineradicable malignant tumors. Clinical data of peripheral blood cells, liver functions, renal functions, T cells subgroups and the activity of NK cells prior and after the treatment were compared. Results The white blood cells, hemoglobin and platelet prior the treatment were (6 3?2 2)?10 9/L, (122 7?17 3) g/L and (219 9?117 5)?10 9/L, respectively, while at the 1st and 3rd months after the treatment, these were (6 4?1 8)?10 9/L, (114 5?30 9)g/L, (191 5?59 6)?10 9/L, respectively and (6 1?1 2)?10 9/L, (116 3?16 0) g/L, (191 7?108 2)?10 9/L, respectively, without statistically significant differences ( F =1 893, 0 616, 0 596; P =0 072, 0 779, 0 762). In addition, no significant differences were found in values of ALT, AST, BUN, Cr, CK and CK-MB at different times ( F =1 861, 0 551, 1 740, 1 934, 0 412, 0 052; P =0 118, 0 737, 0 142, 0 105, 0 837, 0 998). The values of TB and DB in patients with pancreatic carcinoma obviously decreased within 1 month after the treatment. Interstitial brachytherapy had little effects on T-cell immunity (CD3, CD4 and CD8) and the activity of NK cells ( F =0 287, 0 520, 0 497, 1 101; P =0 752, 0 598, 0 612, 0 342). Conclusions Interstitial brachytherapy with permanent seed implants has no effects on vital organs and immunologic functions, being a safe and minimally invasive technique for cancer.
ABSTRACT
Objective To explore the value of center vein catheter thoracostomy in the chemotherapy of malignant pleural effusion. Methods Carboplatin and ?-2b Interferon were infused into pleural cavity by implanted center vein catheter in the group observation (n=17). After repeated thoracocentesis, the same drugs were introduced into pleural cavity in the group control (n=29). At the end of the 1st, 3rd and 6th month after drug administration, follow-up was carried out to assess the response rates. Results At the end of the 1st, 3rd and 6th month after intrapleural therapies, the number of intrapleural therapies in the group observation was (2.2?1.9) times and in the group control (5.3?1.3)times, with statistically significant difference between the two groups (t=5.924, P=0.00). Numbers of complete remission (CR) in the group observation was 10 of 16, 11 of 16 and 10 of 15, respectively and in the group control 9 of 29, 11 of 29 and 5 of 19, respectively, producing significant difference (P=0.043, 0.050, 0.020, respectively). Overall response rates in the group observation were 87.5%, 87.5% and 80.0%, respectively, while in control were 62.5%, 68.7% and 66.7%, respectively, without significant difference (P=0.356, 0.114, 0.178, respectively). Compared with the control, long-term follow-up (six months) showed higher response rates in the group observation: 10 of 15 patients remained CR at 6th month after therapies. No significant difference was seen in respect to adverse effects(?2=2.491,P=0.114). Conclusions Intrapleural chemotherapy by center vein catheter may increase CR and decrease application times of Carboplatin and ?-2b Interferon in the treatment of malignant pleural effusion, with fewer side effects.
ABSTRACT
Objective To evaluate the efficacy of FAP combined intrahepatic artery with intravenous infusion chemotherapy in the treatment hepatic metastatic carcinoma. Methods 23 patients with metastatic hepatic carcinoma were diagnosed with CT or MRI. EPI 40mg/m 2, CDDP 60mg/m 2 were given intrahepcic arterial by means of one shot infusion and 5-FU 500mg/m2 (d1, d8) intravenously respectively. All patients were reexamined by with CT or MRI after 2～4 weeks. Results The total response rates was 74%. The survival rates at 1 year, 2 year and 3 year were 88 8%?7 9%;66 9%?12 3% and 24 6%?23 4% respectively. The median survival time was 25 months. Conclusions FAP was a traditional regimen,combined intrahepatic arterial and intravenous chemotherapy can improve response rate and prolong median survival to metastatic liver cancer .
ABSTRACT
Purpose:To find out the clinical biology value of p53 overexpression on Chinese breast cancer by Meta analysis. Methods:Reviewed all the published studies during the recent 10 years regarding p53 and breast cancer, and used standard techniques of Meta-analysis to combine the results of these studies to produce a more precise estimate of the prognostic significance of p53 mutations.Results:the mean of p53 positive express was 45%,95% confidence interval (43-47)%:, p53 positive was related with node metastasis, recurrence after surgery, over survival, tumor size and nuclear grade, but not related with age and pathology type, p53 was a special and sensitive prognostic factor for breast cancer.Conclusions:p53 can be an independent molecular marker to definitive prognostic of breast cancer, and possibly can be a reliable marker for choice of standard and individulized therapy.