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Objectives: To investigate the clinical value of adjuvant chemotherapy(ACT) in patients with intrahepatic cholangiocarcinoma(ICC) who underwent radical resection and to explore the optimal population that can benefit from ACT. Methods: A retrospective cohort study method was adopted. The clinical and pathological data of 685 patients with ICC who underwent curative intent resection in 10 Chinese hepatobiliary surgery centers from January 2010 to December 2018 were collected;There were 355 males and 330 females. The age(M(IQR)) was 58(14) years (range: 22 to 83 years). Propensity score matching(PSM) was applied to balance the differences between the adjuvant and non-adjuvant chemotherapy groups. Log-rank test was used to compare the prognosis of the two groups of patients. A Bayesian network recurrence-free survival(RFS) prediction model was constructed using the median RFS time (14 months) as the target variable, and the importance of the relevant prognostic factors was ranked according to the multistate Birnbaum importance calculation. A survival prognostic prediction table was established to analyze the population benefiting from adjuvant chemotherapy. Results: Among 685 patients,214 received ACT and 471 did not receive ACT. A total of 124 pairs of patients were included after PSM, and patients in the ACT group had better overall survival (OS) and RFS than those in the non-ACT group(OS: 32.2 months vs. 18.0 months,P=0.003;RFS:18.0 months vs. 10.0 months,P=0.001). The area under the curve of the Bayesian network RFS prediction model was 0.7124. The results of the prognostic factors in order of importance were microvascular invasion (0.158 2),perineural invasion (0.158 2),N stage (0.155 8),T stage (0.120 9), hepatic envelope invasion (0.090 3),adjuvant chemotherapy (0.072 1), tumor location (0.057 5), age (0.042 3), pathological differentiation (0.034 0), sex (0.029 3), alpha-fetoprotein (0.028 9) and preoperative jaundice (0.008 5). A survival prediction table based on the variables with importance greater than 0.1 (microvascular invasion,perineural invasion,N stage,T staging) and ACT showed that all patients benefited from ACT (increase in the probability of RFS≥14 months from 2.21% to 7.68%), with a more significant increase in the probability of RFS≥14 months after ACT in early-stage patients. Conclusion: ACT after radical resection in patients with ICC significantly prolongs the OS and RFS of patients, and the benefit of ACT is greater in early patients.
Subject(s)
Female , Humans , Male , Bayes Theorem , Bile Duct Neoplasms/surgery , Bile Ducts, Intrahepatic/pathology , Chemotherapy, Adjuvant , Cholangiocarcinoma/surgery , Prognosis , Retrospective StudiesABSTRACT
By summarizing the existing researches on the prevention and treatment of damp-heat syndrome with traditional Chinese medicine（TCM）， this paper digitized the TCM syndromes of damp-heat syndrome， enriched the TCM theories， and provided reference for the prevention and treatment of damp-heat syndrome and provided innovative ideas for the research of damp-heat syndrome. Damp-heat syndrome can cause pathological changes all over the body. It is easy to induce a variety of acute febrile diseases， including ulcerative colitis， chronic gastritis， chronic hepatitis B， chronic kidney disease， irritable bowel syndrome， pneumonia， cough and asthma， which seriously affects the health of the body. Damp-heat syndrome can be divided into syndrome of damp-heat in upper Jiao， syndrome of damp-heat in middle Jiao and syndrome of damp-heat in lower Jiao .At the same time it can be divided into damp-heat obstructing the lung， large intestine damp-heat， damp-heat containing the spleen， liver-gallbladder damp-heat， and bladder damp-heat syndrome ， nephritic damp-heat syndrome by simulating clinical pathogeny according to basic theories of TCM. Heat-clearing and dampness-expelling is the treatment principle of damp-heat syndrome. TCM achieves the purpose of treating damp-heat syndrome by virtue of its anti-inflammation， anti-oxidation， regulation of intestinal flora， lowering blood glucose， lowering blood lipid and enhancing immunity. Based on the two aspects of TCM and prescription， the application， mainly in the syndrome differentiation of triple energizer differentiation， visceral syndrome differentiation is complementary， pharmacological action and mechanism of TCM in prevention and treatment of damp heat syndrome are reviewed in detail， which is a concrete analysis and discussion， in order to provide relevant experience for data integration and system construction of damp heat syndrome， and provide new ideas and help for follow-up clinical drug research and development and optimization innovation of damp heat syndrome. At present， the material basis and relevant prevention and treatment mechanism of dampness-heat syndrome are still not clear in China， so it is necessary to further study and explore its potential biological diagnostic markers， strengthen the research and development of new Chinese medicine preparation against dampness-heat， and elaborate the mechanism of action of Chinese medicine on damp-heat syndrome in multiple ways and directions.
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Objective To compare the efficacy and safety of levofloxacin 750 mg for 5 days versus 500 mg for 7‐14 days intravenous (IV ) infusion in the treatment of community‐acquired pneumonia (CAP ) . Methods This study was a multi‐center , randomized , open‐label , non‐inferiority , controlled clinical trial .The CAP patients were randomized to receive levofloxacin 750 mg IV daily for 5 days or levofloxacin 500 mg IV daily for 7‐14 days .The clinical symptoms , laboratory tests , imaging results and microbiology data were collected and compared between the two treatment groups in terms of efficacy and safety .Results A total of 241 patients were enrolled in this clinical trial from 10 study centers .Among these patients ,223 were eligible for full analysis set (FAS) analysis ,including 111 in 750 mg group and 112 in 500 mg group .Of the 223 patients in FAS ,211 were eligible for per‐protocol set (PPS) analysis ,including 107 in 750 mg group and 104 in 500 mg group .Two hundred and forty‐one patients were included in safety set (SS) ,including 121 patients in 750 mg group and 120 in 500 mg group .The median treatment duration was 5 .0 days in 750 mg and 9 .0 days in 500 mg group .The median total dose was 3 750 mg in 750 mg group and 4 500 mg in 500 mg group .The overall efficacy rate was 86 .2% in 750 mg group and 84 .7% in 500 mg group in terms of FAS at visit 4 ,which suggested that the efficacy of 750 mg group was non‐inferior to 500 mg group .Of the 111 FAS patients in 750 mg group ,40 were bacteriological evaluable ,and 41 strains of pathogens were isolated .Forty‐nine of the 112 FAS patients in 500 mg group were bacteriological evaluable ,and 51 bacterial strains were obtained .The bacterial eradication rate was 100% in both groups .The clinical treatment efficacy rate for atypical pathogens was 100% in both groups .In 750 mg group ,the most common clinical adverse drug reactions (ADRs) were injection site adverse reactions including injection site pruritus ,pain and hyperemia .The other common ADRs were insomnia ,nausea ,skin rash .The most common drug‐related laboratory abnormalities were neutrophil percentage decreased , decreased white blood cell (WBC ) count , alanine aminotransferase (ALT) and aspartate aminotransferase (AST) elevation .Most of the ADRs were mild in severity and well‐tolerated .The safety profile of the two treatments was comparable in terms of the drug‐related treatment discontinuation and the incidence of ADRs .Conclusions The short‐course regimen of levofloxacin 750 mg IV for 5 days is at least as effective and well tolerated as the long‐course regimen of 500 mg IV for 7‐14 days in treatment of CAP .
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<p><b>OBJECTIVE</b>To investigate the feasibility and therapeutic effect of acellular cadaveric dermis (ACD)-assisted immediate breast reconstruction.</p><p><b>METHODS</b>From Sep. 2009 to May 2010, 10 cases received ACD-assisted immediate breast reconstruction. During the operation, the ACD was used to cover inferior and lateral portion of the implants in 2 cases and expanders in 8 cases.</p><p><b>RESULTS</b>The patients were followed up for an average period of 4 months with satisfactory breast appearance. The complications included infection in 2 cases and dehiscence in 2 cases. But no implant or expander was taken out.</p><p><b>CONCLUSIONS</b>The ACD-assisted immediate breast reconstruction is a technically simple procedure with minimal morbidity. Satisfactory clinical outcome can be achieved with appropriate candidates.</p>
Subject(s)
Adult , Female , Humans , Middle Aged , Acellular Dermis , Breast Implants , Dermis , Transplantation , Mammaplasty , Methods , Skin Transplantation , Surgical Flaps , Tissue Expansion Devices , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To investigate the technique of periorbital defects reconstruction with island orbicularis oculi myocutaneous flap in orbital zone.</p><p><b>METHODS</b>The upper or lower eyelid island orbicularis oculi myocutaneous flap,medially based,were used for the defects of the periorbital area, according to the position,shape and size of the defects. The donor site was closed directly.</p><p><b>RESULTS</b>From July 2003 to October 2009, 24 patients were treated in this method, the flaps survived totally. The flap proved to be flexible, safe, relatively simple, and provided good functional and aesthetic results with follow up 6 to 24 months. Complications were minimal.</p><p><b>CONCLUSIONS</b>The upper eyelid or lower eyelid island orbicularis oculi myocutaneous flap, medially based, is a satisfied method in repairing periorbital defects in one stage with good blood supply, excellent color texture matching and inconspicuous donor scar and deformity.</p>