The prognostic effects of two comprehensive geriatric assessment methods in elderly patients with acute myeloid leukemia / 中华内科杂志

Objective:To evaluate the prognostic effects of two comprehensive geriatric assessment (CGA) methods in elderly patients with acute myeloid leukemia (AML).Methods:Ninety-seven patients with newly diagnosed AML at Beijing Hospital from August 2008 to December 2019 were included (≥60 years old). All patients were evaluated by two methods of CGA. One was IACA index proposed by Beijing Hospital, including instrumental activities of daily living (IADL), age, Charlson comorbidity index (CCI), albumin; the other was proposed by Italian FIL study group (FIL-CGA), including activities of daily living (ADL), IADL, age, and modified cumulative illness rating score for geriatrics (MCIRS-G).Results:Among 97 patients, 54 patients received standard chemotherapy, 16 with decitabine, 2 with targeted therapy and 25 with the best supportive therapy. The overall response rate (ORR) in 72 treated patients were 67.7%, 33.3% and 0 respectively in fit, unfit and frail groups according to IACA index ( P=0.001). Based on FIL-CGA, the ORRs of fit, unfit and frail groups were 52.5%, 41.7% and 35.0% respectively ( P=0.418). The 1-year OS rates of fit, unfit and frail groups regarding IACA method were 78.7%, 27.7% and 0 respectively ( P<0.01). The 1-year OS rates of fit, unfit and frail groups regarding FIL-CGA method were 67.8%, 28.2% and 13.9% respectively ( P<0.01), while no significant difference was seen between unfit group and frail group ( P=0.111). The early death rates of fit, unfit and frail groups by IACA were 0, 6.0% and 28.6% respectively ( P=0.006), while those by FIL-CGA were 2.3%, 5.9%, 13.9% respectively ( P=0.123). Conclusion:Compared with FIL-CGA method, IACA predicts more effectively the treatment response, survival and early mortality in elderly patients with AML.

Analysis of the prevalence of anemia and its influencing factors in the urban communities-dwelling elderly population in Beijing / 中华老年医学杂志

Objective:To analyze the prevalence of anemia and its influencing factors in the elderly population dwelling in urban communities in Beijing.Methods:A random cluster sampling method was adopted to select the elderly people of communities in Beijing, and cross-sectional research was conducted through questionnaire surveys, field tests and blood sample collection.The criteria for diagnosing anemia were from WHO standards, and the health evaluation indicators in the questionnaire survey included demographic data and eating habits, socio-economic information, information on enjoying health services, health and physical fitness and other information.Blood samples were drawn for routine blood tests and biochemical tests.Results:A total of 1 947 elderly people aged 65 years and above were investigated, including 789 males(40.5%)and 1 158 females(59.5%). Among the 1 947 survey subjects, 288 elderly people had anemia, with the prevalence of anemia of 14.79%(288/1 947). The prevalence of anemia was 16.35%(129/789)in males and 13.73%(159/1 158)in females.There was no statistically significant difference in the prevalence of anemia between male and female( χ2=2.760, P=0.097). Logistic regression analysis was used to analyze the factors affecting anemia.The results showed that the higher age( OR=1.055, P=0.000), the higher frequency of meat-eating( OR=1.353, P=0.046), the lower frequency of fruit-eating( OR=0.759, P=0.048), the worse health status of cohabitants( OR=0.757, P=0.037), the lower BMI( OR=0.905, P=0.001)and the lower exercise frequency( OR=0.769, P=0.012)were correlated to the higher anemia risk in the elderly population dwelling in urban communities in Beijing. Conclusions:The prevalence of anemia is relatively high in the elderly in Beijing communities.According to our findings, older people should reduce the frequency of eating meat, while ensuring nutritional intake, increase the intake of fruits and take appropriate exercises to reduce the prevalence of anemia.

Expressions and clinical significance of miR-124 and miR-494 in elderly patients with Parkinson disease / 中华行为医学与脑科学杂志

Objective:To investigate the expression levels of microRNA-124 (miR-124) and microRNA-494(miR-494) in the serum of elderly patients with Parkinson disease (PD) and its clinical significance.Methods:Ninety PD patients (PD group) who were hospitalized in Zhengzhou Central Hospital Affiliated to Zhengzhou University from March 2018 to April 2020 were selected.At the same time, 100 non-PD elderly people examined in the physical examination center of the same hospital who matched with age and gender of PD patients were selected as the control group.After 12 hours of fasting, 4 ml of venous blood was taken from all subjects.All PD patients were graded by unified Parkinson disease rating scale(UPDRS) from the aspects of mental state, behavior and emotion, quality of life and motor examination, and graded by the Hoehn-Yahr rating scale for Parkinson disease.The expression levels of miR-124 and miR-494 in serum were detected by real-time fluorescent quantitative PCR (qRT-PCR), and the diagnostic values of miR-124 and miR-494 in PD patients were evaluated by ROC curve.Results:Hoehn-Yahr grade of PD patients with UPDRS≤60 points was significantly lower than that of patients with UPDRS >60 points((2.47±0.43) vs (3.42±0.47))( t=9.055, P<0.001), and there was no significant difference in serum miR-124 and miR-494 expression levels((0.72±0.14) vs (0.70±0.12), (1.17±0.19) vs (1.18±0.22)) ( t=0.633, 0.230, P=0.529, 0.819). Compared with that in control group, the expression of miR-124 in PD group was down-regulated ((0.71±0.20) vs (1.05±0.24)), and the expression of miR-494 was up-regulated((1.18±0.26) vs (0.96±0.22)) ( t=10.542, 6.315, P<0.001). The results of ROC showed that the area under curve (AUC) of serum miR-124 and miR-494 in the diagnosis of PD were 0.847 and 0.760 respectively, the cutoff values were 0.901 and 1.126, respectively, the sensitivities were 86.67% and 61.11% respectively, and the specificities were 75.03% and 79.00% respectively. The AUC of the combined diagnosis of PD was 0.898, and the sensitivity and specificity were 85.56% and 85.00% respectively. Conclusions:The expression of miR-124 is low in PD patients, while the expression of miR-494 is high, which suggests that the changes of the two miRNA levels may be related with the occurrence and development of PD.Both of them have a certain diagnostic value for PD, and the value of combined diagnosis is higher.

Application of immunosuppressants in patients with autosomal dominant polycystic kidney disease after kidney transplantation / 南方医科大学学报

OBJECTIVE@#To investigate the optimal dose range of immunosuppressants in patients with autosomal dominant polycystic kidney disease (ADPKD) after renal transplantation.@*METHODS@#A cohort of 68 patients with ADPKD who received their first renal transplantation between March, 2000 and January, 2018 in our institute were retrospectively analyzed, with 68 non-ADPKD renal transplant recipients matched for gender, age and date of transplant as the control group. We analyzed the differences in patient and renal survival rates, postoperative complications and concentrations of immunosuppressive agents between the two groups at different time points within 1 year after kidney transplantation. The concentrations of the immunosuppressants were also compared between the ADPKD patients with urinary tract infections (UTI) and those without UTI after the transplantation.@*RESULTS@#The recipients with ADPKD and the control recipients showed no significantly difference in the overall 1-, 5-, and 10- year patient survival rates (96.6% 96.0%, 94.1% 93.9%, and 90.6% 93.9%, respectively; > 0.05), 1-, 5-, and 10-year graft survival rates (95.2% 96.0%, 90.8% 87.2%, and 79.0% 82.3%, respectively; > 0.05), or the incidences of other post- transplant complications including acute rejection, gastrointestinal symptoms, cardiovascular events, pneumonia, and neoplasms ( > 0.05). The plasma concentrations of both tacrolimus and mycophenolate mofetil (MPA) in ADPKD group were significantly lower than those in the control group at 9 months after operation ( < 0.05). The incidence of UTI was significantly higher in ADPKD patients than in the control group ( < 0.05). In patients with ADPKD, those with UTI after transplantation had a significantly higher MPA plasma concentration ( < 0.05).@*CONCLUSIONS@#In patients with ADPKD after renal transplant, a higher dose of MPA is associated with a increased risk of UTI, and their plasma concentrations of immunosuppressants for long-term maintenance of immunosuppression regimen can be lower than those in other kidney transplantation recipients.

De novo malignant tumor after renal transplantation: single-center trial / 器官移植

Objective To analyze the incidence and risk factors of de novo malignant tumors in renal transplant recipients. Methods Clinical data of 1 549 renal transplant recipients were retrospectively analyzed, including the basic status, pathological type and incidence rate of patients with de novo malignant tumors after renal transplantation. The survival situation of these patiensts was assessed. And the risk factors of de novo malignant tumors after renal transplantation were identified. Results The incidence rate of de novo malignant tumors in renal transplant recipients was 3.03%(47/1 549). The 47 recipients were (48±12) years old when undergoing renal transplantation, and they were (55±12) years old when diagnosed malignant tumors. The time interval between transplantation and diagnosis was 66 (36, 100) months. Among the de novo malignant tumors, colorectal cancer was the most common, with a cumulative incidence rate (CIR) of 0.58%. The survival time of 47 recipients with de novo malignant tumors after renal transplantation was 59 (2, 135) months, and the 5-year survival rate was 50%. The recipients with the age > 45 years old when undergoing renal transplantation was a risk factor for de novo malignant tumors after renal transplantation (P < 0.05). Conclusions The incidence rate of de novo malignant tumors is relatively high in renal transplant recipients. The recipients with the age > 45 years old when undergoing renal transplantation is a risk factor for de novo malignant tumors.

Pilot study of the relationship between clinical classification of gallbladder cancer and prognosis: a retrospective multicenter clinical study / 中华外科杂志

Objectives@#To propose a novel clinical classification system of gallbladder cancer, and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer.@*Methods@#The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females, aged (62.0±10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type, hepatic type, hepatic hilum type and mixed type, the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage, N stage, vascular invasion, neural invasion, median survival time and surgical procedures were analyzed.Rates were compared by χ2 test, survival analysis was carried by Kaplan-Meier and Log-rank test.@*Results@#Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5%).The overall median survival time was 28 months.There were 81 patients in Tis-T1 stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage: 345 cases(35.3%)of peritoneal type, 331 cases(33.8%) of hepatic type, 122 cases(12.5%) of hepatic hilum type and 180 cases(18.4%) of mixed type.T stage(χ2=288.60,P<0.01),N stage(χ2=68.10, P<0.01), vascular invasion(χ2=128.70, P<0.01)and neural invasion(χ2=54.30, P<0.01)were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(χ2=80.60,P<0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P>0.05).@*Conclusion@#With application of new clinical classification, different types of gallbladder cancer are proved to be correlated with TNM stage, malignant biological behavior and prognosis, which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.

The prognosis value of comprehensive geriatric assessment in elder patients with acute myeloid leukemia in a single center / 中华血液学杂志

Objective@#To evaluate the prognostic significance of comprehensive geriatric assessment (CGA) in Chinese elderly acute myeloid leukemia (AML) patients.@*Methods@#73 AML patients over the age of 60 were enrolled. CGA stratification included the following 3 instrument assessment: activity of daily living (ADL) ; instrumental activity of daily living (IADL) ; comorbidity score according to the Modified cumulative illness rating score for geriatrics (MCIRS-G) . According to CGA and age, the enrolled patients were grouped into 'fit’, 'unfit’ and 'frail’ categories.@*Results@#The median age of 73 elderly AML patients were 75 years old. According to CGA, 37 (50.1%) patients were classified as 'fit’, 14 (19.2%) as 'unfit’, and 22 (30.7%) as 'frail’. 33 (89.2%) patients in fit group received induction chemotherapy, or demethylation treatment, as 8 (57.9%) in unfit, 10 (45.5%) in frail. The overall response rate was 68.7%、62.5%, 75.0% in fit, unfit, and frail group, respectively (χ2=0.615, P=0.769) .The early mortality (8 weeks) in three groups were different: 5.4%, 7.1%, 27.3%, respectively (P<0.05) . The 1-year overall survival in the 'fit’, 'unfit’ and 'frail’ groups was 64.9%, 28.6% and 22.7%, respectively (P<0.05) . The CGA score, age, ECOG score, WHO classification (2016) were the prognostic factors of AML patients.@*Conclusion@#CGA can be used to determine the prognosis of elderly AML patients.

The new classifications of biliary tract diseases based on actual anatomy / 中华外科杂志

In order to facilitate the treatment strategies for biliary tract injury, hilar cholangiocarcinoma, bile duct tumor thrombus, cholangiocellular carcinoma and bile duct cystic dilatation, many classifications have been made, even more than 10 types for one disease. Each type is represented by numbers or English alphabet, which are not only confusing but also difficult to remember. The Academician Mengchao Wu divided the liver into five sections and four segments base on its anatomy, this classification is very direct and visual, thus had been using till now. In order to overcome those complicated problems, it is considered to develop a new classification based on actual anatomic location similar to that for liver cancer, which is easy to remember and to directly determine the treatment strategy. All kinds of classifications have their own characteristics and advantages and disadvantages. This practical classifications avoid the complexity and may be useful for clinicians.

Clinical value of comprehensive geriatric assessment scoring in predicting the outcome of diffuse large B-cell lymphoma in patients aged 80 years and over / 中华老年医学杂志

Objective To investigate the clinical characteristics of diffuse large B-cell lymphoma (DLBCL) and to evaluated the predictive value of comprehensive geriatric assessment (CGA)in advanced-aged DLBCL patients.Methods A total of 24 patients aged 80 years and over diagnosed with DLBCL in our hospital from March 2010 to July 2017 were enrolled in this study.CGA included three parts:age,activities of daily living(ADL)/instrumental activities of daily living(IADL)and comorbidity evaluated by the cumulative illness rating score for geriatrics(CIRS-G).According to CGA scores,all patients were classified into either the not-applicable group or the frail group.Results There were 10 and 14 patients in the not-applicable group and the frail group,respectively.Twenty-two patients received chemotherapy,and the incidences of toxicity after chemotherapy were comparable between the two groups.Nine patients achieved complete remission (CR),five patients partial remission(PR),and the overall response rate(ORR) was 63.6 ％.The not-applicable group seemed to have a higher complete remission rate than the frail group(60.0 ％ vs.25.0 ％,x2=2.764,P =0.192).However,the overall response rates were comparable between the two groups.Treatment-related deaths occurred in 2 and 3 patients(20.0 ％ vs.25.0 ％,x2 =0.078,P =1.000)in the not-applicable and frail groups,respectively.Relapse/progression-related deaths occurred in 3 and 5 patients in the not-applicable and frail groups(30.0％ vs.41.7％,x2 =0.321,P =0.675),respectively.The 2-year overall survival rates and progression-free survival rates were 56.3 ％ versus 35.2 ％ (x2 =0.635,P =0.426)and 42.2 ％ versus 16.7 ％ (x2 =2.156,P =0.142) in the not-applicable and frail groups,respectively.Conclusions Advanced-aged patients with DLBCL have a poor prognosis,which can be predicted by CGA to a certain extent.Further improvement in the current CGA scoring system is still needed to accurately predict the prognosis of DLBCL in advanced-aged patients and to guide treatment.

A prospective study of comprehensive geriatric assessment in elderly patients with acute myeloid leukemia / 中华老年医学杂志

Objective To evaluate the performance on comprehensive geriatric assessment (CGA) in elderly patients with acute myeloid leukemia (AML)and to investigate the differences between Eastern Cooperative Oncology Group (ECOG) performance status (PS) and CGA scoring.Methods Patients aged 60 years or over diagnosed with AML at Beijing Hospital from September 2008 to April 2018 were enrolled in this study.CGA was performed during staging procedures through application of age,activities of daily living(ADL)/instrumental activities of daily living(IADL)and the comorbidity score based on the cumulative illness rating scale for geriatrics(CIRS-G).According to CGA scores,patients were classified into a not-applicable group,an applicable group and a frail group.The difference between ECOG-PS and CGA scoring was compared.Results A total of 73 patients were enrolled in this study.There were 37 (50.7 ％),14 (19.2 ％) and 22 (30.1％) patients in the applicable,not-applicable and frail groups,respectively.Comorbidities were observed in the majority of patients,with cardiovascular disease,diabetes mellitus and hypertension among the most common disorders.In patients aged 60 to 64 years,16.7％ (1/6) were considered as frail,and the percentage of frail patients increased to 36.4％ (8/22)in patients aged 80 years and over.Moreover,functional impairment evaluated by CGA was observed in 36.5 ％ (19/52)of patients with ECOG-PS ≤ 1.Conclusions According to CGA scoring,approximately half of AML patients aged 60 years or over have functional impairment.Functional impairment is observed in some patients with ECOG-PS ≤1,indicating that ECOG-PS may underestimate functional impairment in elderly AML patients.

Clinical analysis of posttransplant lymphoproliferative disorder in kidney transplant recipients and hematopoietic stem cell transplant recipients summary / 中华器官移植杂志

Objective To provide theoretic rationales and clinical experience for post-transplant lymphoproliferative disorder (PTLD ) by comparing the characteristics of PTLD in kidney and hematopoietic stem cell transplant recipients and reviewing the relevant literature reports .Methods Twenty-seven adult PTLD patients from 2000 to 2017 were retrospectively reviewed .There were 11 kidney transplant recipients (KT group) and 16 hematopoietic stem cell transplant recipients (HSCT group) .Clinical characteristics and outcomes were analyzed between two groups .Cox's proportional hazard model was utilized for evaluating the prognostic factors .Results The incidence of PTLD for KT and HSCT groups were 0 .5 ％ and 1 .1 ％ respectively .PTLD patients of KT group had a later onset than that of HSCT group (105 .1 vs 3 .1 months , P<0 .01) .Also Epstein-Barr virus was less frequently detected in KT group (36 .4 ％ vs 81 .3 ％ , P< 0 .05) .The 5-year overall survival was (46 .8％ ± 10 .5％ ) .According to Cox analysis ,application of antithymocyte globulin (ATG) and high ECOG scores were risk factors for a poor prognosis of PTLD .Conclusions Most cases of KT-PTLD have a late onset . In contrast , HSCT-PTLD has an earlier onset and a higher incidence of EBV infectious .And application of ATG and high ECOG scores are poor prognosis factors of PTLD .

Comprehensive geriatric assessment can predict the clinical outcomes of elderly patients with diffuse large B cell lymphoma in China / 中华血液学杂志

Objective@#To validate comprehensive geriatric assessment (CGA) system in Chinese elderly diffuse large B cell lymphoma (DLBCL) patients.@*Methods@#Patients ≥ 65 years of age who had been diagnosed with de novo DLBCL were screened for eligibility (n=99). CGA was performed during staging procedures through application of the following instruments: age, comorbidity score according to the Cumulative Illness Rating Score for Geriatrics(CIRS-G), activities of daily living (ADL), and instrumental activities of daily living (IADL).@*Results@#All patients were classified as "ft" , "unfit" , and "frail" . Forty-nine (49.5%), 14 (14.1%), and 34 (36.4%) patients were categorized into the fit, unfit, and frail groups, respectively. The overall response rate was 91.8%, 64.3%, and 69.5% in fit, unfit, and frail group, respectively (χ2=9.311, P=0.007). Eleven (22.4%), 7 (50.0%), and 16(44.4%) patients showed disease relapse/progression in fit, unfit, and frail group, respectively (χ2=6.309, P=0.040). The 2-year probability of overall survival was 90.6%, 43.0%, and 58.5% in fit, unfit, and frail group, respectively (χ2=14.774, P=0.001). The 2-year probability of progression-free survival was 72.9%, 32.5%, and 37.3% in fit, unfit, and frail group, respectively (χ2=11.038, P=0.004).@*Conclusion@#The CGA index can predict the clinical outcomes of elderly DLBCL patients in China.

A comparative study of comprehensive geriatric assessment in elder patients with non-Hodgkin's lymphoma / 中华内科杂志

Objective To measure the comprehensive geriatric assessment (CGA) in elder non-Hodgkin's Lymphoma (NHL) patients in a cross-sectional study;to compare the differences between Eastern Cooperative Oncology Group (ECOG)-performance status (PS) and CGA.Methods CGA stratification included the following 3 instrument assessments:activity of daily living (ADL);instrumental activity of daily living (IADL);comorbidity score according to the modified cumulative illness rating score for geriatrics (MCIRS-G).According to CGA and age,NHL patients,aged ≥60 years,were classified as "fit","unfit" and "frail" groups.ECOG-PS was evaluated and compared with CGA.Results According to CGA,51.6％ senior NHL patients (33 cases) were classified as "fit",12.5％(8 cases) as " unfit" and 35.9％ (23 cases) as "frail".Several comorbidities were observed in majority patients,such as cardiovascular disease,diabetes nellitus and hypertension.In the "younger aged" patients between 60 to 64ys,25％(3/12) was considered as "frail".However,this proportion increased to 42.9％ (6/14) in patients older than 80ys.Moreover,impaired CGA was observed in 38.9％(21/54) of ECOG-PS ≤1 patient.Conclusions Impaired CGA is as common as approximately half in elderly NHL patients and more than one third even in ECOG-PS ≤ 1 patients.ECOG-PS may underestimate the impaired fitness function in elder NHL patients.

Investigation on medical students' integrity in examinations and influencing factors / 中华医学教育探索杂志

Objective To understand the status quo of medical students' integrity in examinations and to explore the influencing factors. Methods 2013-2015 undergraduate students from Clinical Medi-cine, Preventive Medicine and other professional subjects were included in Shanxi Medical University. A total of 221 questionnaires were issued for each grade by stratified random sampling. The database was built with EpiData 3.1. All statical analyses were performed with SPSS software (version 22.0) by means of chi-square test and binary logistic regression. Results Among the 600 medical students, 16.5% of the students had cheating. A statistically significant difference was observed in the cheating rate among the medical stu-dents in terms of gender, grade, academic performance, medical knowledge, memory, family factors, and invigilators' attitude (P<0.05). Litter pressure from the family, the teacher's proctoring is rigorous invigilation, and top scores were the protective factors for medical students' cheating in exams. Conclusion Through the analysis of the influencing factors for the medical students' integrity in examinations, corresponding measures are formulated to provide reference for relevant medical personnel in various medical colleges and universities.

A study on detection of α-helix protein in posttraumatic epileptogenic focus by FTIR-mapping / 中国法医学杂志

Objective The article is to study on the detection of α-helix proteins in post-traumatic epileptogenic focus by FTIR-mapping. Methods Fourier transform infrared spectroscopy-mapping were applied to identifying α-helix by point-by-point scanning in post-traumatic epileptogenic focus sections and to develop FTIR-mapping profiles. Result The high absorbance of α-helix is accord with post-traumatic epilepsy, there are some significant differences between high absorbance and low absorbance. Conclusion α-helix proteins are distributed in post-traumatic epileptogenic focus widely, thus α-helix protein are involved in post-traumatic epilepsy.

Current status of laparoscopic central pancreatectomy / 临床肝胆病杂志

Central pancreatectomy is an ideal surgical procedure for the treatment of benign or low-grade malignant tumors in the pancreatic neck or the proximal body of the pancreas,and it can preserve more normal pancreatic tissue in order to reduce the incidence of endocrine and exocrine insufficiency after surgery.Although some clinical studies have demonstrated the feasibility and safety of this procedure,laparoscopic central pancreatectomy was technically challenging with a few number of cases.This article reviews the current status of laparoscopic central pancreatectomy and introduces our clinical experience of laparoscopic central pancreatectomy and pancreaticojejunostomy.

Extended lymph node dissection for pancreatic head carcinoma: controversy and update / 中华肝胆外科杂志

Lymph node dissection was the key procedure of pancreatic surgery.The majority of guidelines indicated that extended lymph node dissection was helpless for improving survival rate.However,there were still quite a few researches which demonstrated that the extended dissection was a valuable procedure.It was still a controversial topic considering lymph node dissection.To review the shortcomings of previous randomized controlled trials (RCT),this article combined the experience of new techniques in pancreatic surgery,which are developing rapidly in recent years,and our theory and practice of radical resection of retroperitoneal lipo-lymphatic layer (RRRLLL).Therefore,the controversy and update of extended lymph node dissection for pancreatic head carcinoma were discussed,which could provide references for standardizing the treatment of extended lymph node dissection in clinical practice.

Clinical effect of terminal branches portal vein embolization combined with transcatheter arterial chemoembolization on liver neoplasms / 中华外科杂志

Objective@#To analyze the efficacy of branches portal vein embolization (TBPVE) combined with transcatheter arterial chemoembolization (TACE) on liver neoplasms.@*Methods@#From August 2016 to May 2017, there were 13 patients including 11 males and 2 females with primary hepatocellular carcinoma who underwent TBPVE+ TACE , among whom there were 11 cases with a history of HBV infection.Average age of the 13 patients was (60.8±6.2)years. The live function of all patients were Child-Pugh A classification.The CT or MRI images of each patient was reconstructed and the standard liver volume(SLV) before TBPVE+ TACE was (1 181.2±49.3)ml, estimated future liver remnant(FLR) was (326.1±72.1)ml and FLR/SLV was (27.6±6.0)%.The puncture site for TBPVE was determined by the three-dimensional reconstruction of portal vein.CT scan or MRI, AFP and liver function test were repeated after one and two weeks after TBPVE+ TACE.FLR and FLR/SLV were calculated respectively.Hepatectomy would be performed if the patients agreed.The postoperative complications were analyzed.@*Results@#On the 7thday after TBPVE+ TACE, the FLR/SLV was(42.6±8.0)% and the FLR increasement was(56.0±24.6)%.The level of AFP decreased from(87.9±81.8)μg/L to (29.7±20.9)μg/L.On the 14thday after TBPVE+ TACE, the FLR/SLV was(45.8±6.2)% and the FLR increasement was(71.8±29.0)%.Four patients underwent surgery which including 2 right hepatectomies and 2 right trisegmentectomies in 2 weeks after TBPVE+ TACE.Nine patients were performed with targeting intratumoral lactic acidosis TACE (TILA-TACE). No severe complication occurred in all patients.@*Conclusions@#TBPVE could induce a rapid growth of the liver remnant but still with the concern of inducing the growth of neoplasms at the same time.To combine TACE in TBPVE therapy not also can the growth of neoplasms be prevented but also inducing its shrinking.This method might be a new mode for the treatment of hepatocellular carcinoma.

The effect of comprehensive geriatric assessment on the therapeutic decision-makingin elderly patients with diffuse large B-cell lymphoma / 中华老年医学杂志

Objective To evaluate the feasibility of using comprehensive geriatric assessment (CGA) in estimating if standard dose treatment is fit for the elderly patients with diffuse large B cell lymphoma.Methods.Comprehensive geriatric assessments including three assessments of activity of daily living,instrumental activity of daily living and comorbidity scoring according to Cumulative Illness Rating Score for Geriatrics were adopted to assess if standard dose treatment is fit for the elderly patients in our prospective study.Thirty seven patients with diffuse large B cell lymphoma,aged ＞70 years were enrolled in the study,and grouped into fit,unfit and frail groups according to comprehensive geriatric assessment scoring and their age.The treatment protocolswere not determined by comprehensive geriatric assessment scores,but by clinical judgments made by clinicians based on their clinical experience and disease features.The clinically effective response and overall survival (OS) were analyzed in the three groups.Results According to CGA scores,patients were grouped into fit [21 cases (56.8％)],unfit [7 (18.9％)] and frail [9 (24.3％)].37 cases received 213 courses of treatment at average 5.76 courses per case.The overall response (complete / partial remission) rates were [85.7％(18/21) vs.28.6％ (2/7) vs.44.4％ (4/9),x2=9.69,P=0.008] and median survival times were (44 months vs.10 months vs.9 months;x2 =7.03,P=0.03) among fit,unfit and frail groups with statistically significant differences.Total effective rate (achieving all clinical targets) in fit group of 21 cases were 100 ％ (12/12)with receiving standard dose therapy,and 66.7％ of(6/9)with low dose therapy(P=0.06).Overall response rate(total/partial remission) [85.7％(18/21) vs.28.6％(2/7) vs.44.4％(4/9),x2=9.69,P=0.008] and median survival (44 months vs.10 months vs.9 months;x2 =7.03,P=0.03) amongfit,unfit and frail groups.In fit group,the two-year overall survival was higher in patients receiving standard dose treatment than receivingpalliativetreatment,with statistical significance [83.3 ％ (10/12) vs.33.3 ％ (3/9),P =0.032],without significant hematologic toxicity observed between the subgroups.Conclusions Comprehensive geriatric assessment can identify if elderly patients diffuse large B cell lymphoma can acquire a satisfactory curative effect from a standard dose treatment ofimmunochemotherapy.

Fequency of CD19+CD24hiCD38hi Breg cells and its association with Treg in pancreatic cancer patients / 实用医学杂志

Objectives The aim of the study was to detect the frequency of B regulatory cells (Breg)and the correlation between Breg and T regulatory cells (Treg) in pancreatic cancer patients,and to investigate its role in pathogenesis of pancreatic cancer.Methods 50 pancreatic cancer patients and 21 healthy controls were enrolled.CD19+CD24hiCD38hi Breg and CD4+CD25high Treg was also determined via flow cytometry.The correlation between Breg and Treg was analyzed by Spearman correlation test.Results Upregulation of CD19+CD24hiCD381hi Breg was associated with pancreatic cancer progression.Furthermore,this B cell subset was positively correlated with the frequency of CD4 + CD25high Treg cells.Conclusions Together,CD19 + CD24hiCD38hi Breg cells are significantly elevated in pancreatic cancer patients,indicating this B cell subset might play an vital role in clinical progression of pancreatic cancer.The significant positive correlation between Breg and Treg may suggest CD 1TCD24hiCD38hi Breg are affecting tumor progression through Treg cells.