ABSTRACT
The prognosis of advanced gastric cancer (AGC) is extremely poor. There is no standard and satisfactory treatment strategy for AGC. In clinical practice, some AGC patients can achieve long-term survival. However, it is not clear which type of AGC can benefit the best in specific treatment mode. Because of the high heterogeneity of AGC, it is particularly important to further dig out more significant beneficiary groups. Therefore, experts put forward the classification based on the biological characteristics and the surgery-oriented classification to predict and select patients who benefit from conversion therapy. While for immunotherapy, the biomarkers, molecular subtyping and potential combination strategies are explored to break through its bottleneck in the treatment in AGC that only certain individuals benefit from it. The authors review the research progress in treatment for advanced gastric cancer.
ABSTRACT
Conversion therapy is adopted to achieve radical cure for patients with originally unresectable but potentially resectable late stage gastric cancer, who obtain partial or complete remission after systemic chemotherapy, to acquire relatively longer postoperative survival and recurrence-free survival. Some of the previous researches on conversion therapy for originally unresectable gastric cancer suggest that high chemotherapy response rate, high pathological response rate and R0 resection rate are associated with favorable prognosis. And the efficacy of patients with lymphatic metastasis is better than that of those with peritoneal metastasis. The protocol of conversional chemotherapy varies and so does its efficacy according to different reports. Latest clinical researches indicate that initially unresectable gastric cancer gained higher remission rate and better chance of R0 operation and consequently prolonged survival from paclitaxel based triplet chemotherapy. However, not all originally unresectable gastric cancer can benefit from conversion therapy due to the high heterogeneity of its biological behavior. Regarding the enormous number of originally unresectable gastric cancer patients, it will be a research hot spot in the field of surgical oncology, on screening criteria to select cases suitable for conversion. Exploration on conversion therapy for gastric cancer is still at initial stage, and reports that have been published are mostly single-centered with limited sample, lacking of sufficient evidence on its feasibility, safety and efficacy. Expert consensus on conversion indication, case selection, chemotherapy regimen, efficacy assessment and resection range is absent. So it is in urgent need for higher level clinical evidence to support and guide this practice. Such goal can never be achieved without joint efforts of all parties to carry out clinical trial to modify the practice of conversion therapy for late stage gastric cancer, and determine the proper selection of suitable candidates for conversion therapy, eventually to offer optimal strategy for originally unresectable gastric cancer patients. Thus, this article focuses on reviewing research progress of conversion therapy for originally unresectable late stage gastric cancer.
ABSTRACT
Objective To study the clinical efficacy and safety of Bryan-Morrey approach combined with anatomic locking plate fixation for the treatment of type C fractures of distal humerus.Methods Performed a prospective study from from Mar.2011 to Aug.2014.Thirty-three cases of distal humerus fracture were included in our study,and the mean age was (37.3 ±4.1) years old.The fracture type of distal humerus was 13-C according to Mayo classification.All the fractures treated with a Bryan-Morrey approach and anatomic locking plates.In the follow-up,Mayo scores of elbow,measurement of range of motion,elbow flexion and extension muscle strength were recorded and analysed.Results In this study,there were no serious complications,such as nonunion,rupture of triceps tendon and the infection,except partial sensory function injury of ulnar nerve in 5 cases.At the last time of the follow-up,elbow flexion muscle strength and extension muscle strength did not significantly decreased significantly compared with strength of the normal side.The mean flexion of the injured side was (134.5 ± 10.1) degrees,and the mean extension was (-1 1.5 ± 8.1) degrees.According to Mayo elbow performance score,the average scores of elbow was (86.2 ± 7.8),84％ of the patients got excellent or very excellent function results.Conclusion The Bryan-Morrey approach combined with anatomic locking plate fixation is a good choice for the treatment of distal humerus fractures of AO C type.
ABSTRACT
BACKGROUND:In dynamic hip screw fixation for treating aged osteoporotic intertrochanteric fracture, avoiding the loss of bone mass, or by other means that can increase the fixed screw pulout strength, wil improve the therapeutic effect of dynamic hip screw fixation. OBJECTIVE: To compare the effects of three kinds of repair methods on aged osteoporotic intertrochanteric fracture. METHODS:Data of aged osteoporosis intertrochanteric fracture patients, who received conventional dynamic hip screw fixation, bone cement augmentation with dynamic hip screw fixation and bone grafting with dynamic hip screw fixation, were retrospectively analyzed. They were divided into control group, bone cement group and bone grafting group. RESULTS AND CONCLUSION:After two years of folow-up, the excelent and good rates of Harris hip function were 95%, 80% and 70% in the bone grafting, bone cement and control groups, respectively. The healing time of fractures was significantly shortened in the bone grafting group (P < 0.05). The failure of screw fixation was similar between the bone grafting and bone cement groups. Screw withdrawing appeared in the control group. Results suggest that compared with conventional dynamic hip screw fixation and bone cement augmentation with dynamic hip screw fixation, the therapeutic effect and safety of bone grafting in nail path with dynamic hip screw fixation were better.
ABSTRACT
Objective To explore the clinical efficacy and application value of hemivertebra resection for treating congenital ky‐phoscoliosis .Methods 30 cases of congenital kyphoscoliosis and hemivertebral deformity in our hospital from January 2011 to Jan‐uary 2013 were selected as the research subjects .Among them ,12 cases of simple vertebral and non‐structural bending were per‐formed the posterior hemivertebral resection and short segment pedicle screw fixation ;3 cases of complicating lordosis and hemiver‐tebral protruding to the ventral side were performed the anterior hemivertebral resection and bone graft fusion fixation ;15 cases of complicating structural compensatory curve were performed the posterior transpedicle hemivertebral resection and compensatory bend long segment fixation and fusion .The clinical effects of surgical treatment for all patients were performed the comparative a‐nalysis .Results The mean postoperative kyphosis Cobb angle and the average final follow‐up Cobb angle were (8 .6 ± 3 .14) °and (11 .2 ± 7 .23) °respectively .The ultimate orthopedic rate of kyphosis was 58 .6% ;the average postoperative Cobb angle and and the average final follow‐up Cobb angle of scoliosis were (12 .8 ± 5 .47)°and (16 .2 ± 6 .24)°respectively ,the final orthopedic rate of scoliosis was 66 .5% .The mean Cobb angle of kyphosis and scoliosis after operation was significantly less than that before opera‐tion ,the difference was statistically significant(P< 0 .05) .Kyphosis and scoliosis were significantly improved .No significant post‐operative complications occurred .The effects were satisfied by the patients .Conclusion The hemivertebral resection has significant effect for treating congenital kyphoscoliosis with high kyphoscoliosis orthopedic rate and is worthy of further clinical study .