Advances in Neoadjuvant Therapy for Locally Advanced Rectal Cancer / 肿瘤防治研究

The treatment of locally advanced rectal cancer (LARC) is extremely challenging, and it is difficult to achieve satisfactory results with surgical resection alone. In recent years, the diagnosis and treatment of LARC tends to be multi-disciplinary (MDT) mode. The emerging neoadjuvant treatment strategy is a milestone. At present, the preferred treatment for LARC is neoadjuvant chemoradiotherapy combined with total mesorectal excision. This article summarizes the main treatments of LARC neoadjuvant therapy, hoping to provide reference for clinical diagnosis and treatment.

Application and prospect of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal metastasis from colorectal cancer / 中华肿瘤杂志

Colorectal cancer is one of the common malignant tumors in China, and its incidence is increasing with years. As the second most common metastatic site of colorectal cancer, peritoneum is difficult to diagnose early and with a poor prognosis. Systemic intravenous chemotherapy was used as the main treatment strategy for peritoneal metastasis in the past, but its systemic toxic and side effects were obvious, and it could not effectively control tumor progression. In recent years, the continuous development of surgical techniques, concepts, and equipment, as well as the introduction of new chemotherapy drugs and targeted drugs have significantly improved the quality of life and prognosis of patients with peritoneal metastasis of colorectal cancer. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can effectively eradicated the intraperitoneal free cancer cells and subclinical lesions, while reducing systemic side effects of chemotherapy drugs, and achieve the radical cure of the tumor at the macro and micro levels to the greatest extent. It has been used as the first-line treatment program for peritoneal metastasis of colorectal cancer at home and abroad. This article focuses on the analysis and summary of the survival efficacy, prognostic factor analysis, and chemotherapy safety of CRS+ HIPEC in the treatment of colorectal cancer peritoneal metastasis. The existing problems and controversies of HIPEC therapy are discussed simultaneously.

Short-term outcomes of patients treated with enhanced recovery after surgery combined with laparoscopic colorectal cancer surgery / 中华普通外科杂志

Objective To investigate the safety and efficacy of enhanced recovery after surgery (ERAS) used in laparoscopic colorectal cancer surgery.Methods We conducted a retrospective analysis of the medical records of 99 cases treated with ERAS programed laparoscopic colorectal cancer surgery (ERAS group) and 103 cases treated with traditional perioperative care and laparoscopic colorectal cancer surgery (controlled group) from Mar 2017 to Sep 2017 in our center.Results There was no significant difference in age,gender,BMI,ASA classification,tumor location,operation time,pathological stage and the incidence of postoperative complications between ERAS group and controlled group (all P ＞ 0.05).Compared to control group,ERAS had less blood loss,shorter time to pass first flatus,stool and start diet and shorter hospitalization day,with all the difference statistically significant [(60 ± 63)ml vs.(112 ± 245)ml,(3.0±0.8)dvs.(4.3 ±1.2)d,(3.5 ±1.0)dvs.(4.6±1.3)d,(4.1 ±1.2)dvs.(5.4± 2.0)d,(5.8±2.1)dvs.(7.8±2.5)d,t=-2.021、-9.216、-6.887、-5.252、-6.163,allP＜ 0.05].No patients in both groups suffered from readmission or death within 30 days after surgery.Conclusion Patients treated with ERAS programed laparoscopic colorectal cancer surgery is safe and effective,with rapid recovery and reduced hospital stay.

Analysis of 17 cases underwent laparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection / 中华肿瘤杂志

Objective@#To study the feasibility, safety and short-term efficacy of total laparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection.@*Methods@#From May 2014 to March 2016, 17 patients with rectal carcinoma were treated by total laparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection. The clinical data of these patients was collected and retrospectively analyzed to assess the impact of the operation on postoperative recovery time and the incidence of complications.@*Results@#All operations had been successfully accomplished without conversion to open surgery or conversional laparoscopic-assisted surgery . The median operative time was 105 minutes. The median blood loss was 35 ml. The median proximal and distal margin of tumor is 16 cm and 3.5 cm. The median number of lymph nodes harvest is 21, and the median first bowl movement is 43 hours. The hospitalization after operation is 8 days. No patient underwent abdomen hemorrhage or anastomotic leakage.@*Conclusion@#Laparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection appears to be feasible, safe and with promising efficacy for selected patients.

Prognosis factors for the perineal incision complications after abdominoperineal resection for low rectal cancer / 中华外科杂志

Objective@#To evaluate the prognosis factors affecting perineal incision complications after abdominoperineal resection (APR) for the low rectal cancer.@*Methods@#This was a retrospective analysis of 151 consecutive patients with low rectal cancer undergoing APR between January and December 2013 at Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The patients were comprised of 95 males and 56 females. The mean age of the patients was (57.3±10.9) years (ranging from 31 to 79 years). χ2 test and Logistic regression analysis were used to identify the prognosis factors of perineum incision complications.@*Results@#In all 151 patients, perineal incision complications were confirmed in 31 patients (20.5%), including 8 cases of incision infection, 22 cases of poor healing of perineal wound, and 1 case of incision fistula formation. In univariate analysis, the factors associated with perineal incision complications were American Society of Anesthesiologists grade (χ2=7.116, P=0.008), intraoperative blood loss (χ2=9.157, P=0.002), while the protective factors associate with perineal incision complications were the intraperitoneal chemotherapy with fluorouracil sustained release (χ2=5.020, P=0.025), pelvic restoration (χ2=10.158, P=0.001), operation experience (χ2=7.334, P=0.007). The gender, age, body mass index, diabetes, preoperative radiochemtherapy, hemoglobin level, albumin level, distance from distal tumor to anal verge, the procedure of APR, operating time, intraoperative blood transfusion, total drainage volume 3 days after operation, tumor differentiation and the postoperative TNM staging were not associated with perineal incision complications (P>0.05). Multivariable logistic regression analysis showed that the intraoperative pelvic restoration (OR=0.200, 95% CI: 0.045 to 0.894, P=0.035) and intraoperative blood loss (OR=2.953, 95% CI: 1.155 to 7.551, P=0.024) were independent prognosis factors of perineum incision complications.@*Conclusions@#For patients with low rectal cancer undergoing APR procedure, pelvic restoration wound be needed. The operation should be performed by experienced doctors, intraoperative blood loss should be reduced when possible.

Study on Prescription Regularity of Traditional Chinese Medicine in Treating Cirrhosis Based on Machine Learning / 世界科学技术-中医药现代化

This study was aimed to use machine learning techniques for the prescription regularity of traditional Chinese medicine (TCM) in the treatment of liver diseases in order to provide a reference basis for clinical treatment as well as research and development of new drugs.According to the prescription data of liver disease treatment of the last two years in the hepatology department of a triple-A TCM hospital,the related structure between drugs was firstly found by the complex structure of drugs.And then,association rule,cluster analysis and other unsupervised machine learning methods were used.The prescription regularity of TCM in the treatment of cirrhosis was received through the comparison and analysis.The results showed that there were 589 prescriptions with 257 types of Chinese medicine herbs.The high frequency drug combination included 2 items of 12,3 items of 15,4 items of 14;support ＞ 10％,confidence ＞ 90％ of the association rule include "dried tangerine peel,medicated leaven → largehead atractylodes rhizome," "polyporus umbellatus,dried tangerine peel → largehead atractylodes rhizome" and other 34;through cluster analysis,it showed that Chinese medicine was mainly classified by 5 characteristics.The machine learning result was the same as the constructed complex network.It was concluded that the combination of complex network and machine learning methods in the exploration of prescription regularity of TCM in the treatment of cirrhosis were feasible.It provided clinical treatment of cirrhosis and clues for finding new prescription in the treatment of cirrhosis.

Treatment and prognosis analysis of 64 cases with anorectal malignant melanoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the surgical treatment patterns and clinicopathological prognostic factors of anorectal malignant melanoma (ARMM).</p><p><b>METHODS</b>The medical records and follow-up data of 64 patients with anorectal malignant melanoma undergoing surgical treatment from August 1972 to December 2015 were collected and analyzed retrospectively. Distant metastasis was discovered in 4 patients when diagnosis, of whom 3 underwent abdominoperineal resection(APR), the other underwent wide local excision (WLE). In the other 60 cases, 46 underwent ARP(1 case received additional right inguinal lymph node dissection), the other 14 underwent WLE(1 case received additional right inguinal lymph node dissection).</p><p><b>RESULTS</b>The median follow-up time of 64 cases was 24(4 to 139) months. The 1-year, 3-year and 5-year overall survival rate was 70.3%, 35.3% and 18.4%, respectively. The 5-year survival rate of 60 patients without distant metastasis undergoing APR and WLE was 19.7% and 23.1%, and the median survival was 19.6 and 24.3 months, respectively(P =0.634), which was not significantly different. According to the Kaplan-Meier method for univariate analysis, involved margins (P=0.024), lymph metastasis (P=0.018) and clinical staging(P=0.003) had significant effects on overall survival. Multivariate analysis indicated that only the lymph node metastasis was significant predictive factor (RR=16.614, 95%CI:1.165 to 236.847, P=0.038).</p><p><b>CONCLUSIONS</b>The prognosis of ARMM is poor. The lymph node metastasis is the main predictive factors. Operation procedure (APR or WLE) has no obvious effect on prognosis.</p>

Cationic liposomes for the co-delivery of siRNA and honokiol / 中国药学杂志

OBJECTIVE: To develop a polyethylene glycol (PEG) modified cationic liposomes for the co-delivery of siRNA and honokiol to improve tumor therapy. METHODS: The PEG-modified cationic liposomes were prepared by thin film hydration method. Honokiol was loaded in the liposomes with hydrophobic interaction and siRNA was loaded with electrostatic interaction. The optimal formulation was screened according to size, Zeta potential, entrapment efficiency and serum stability. The liposomes were characterized with cellular uptake and intracellular localization of siRNA. The pharmacodynamic effect of honokiol-loaded liposomes (LH) and hono-kiol-siRNA-loaded liposomes (LH-siRNA) were verified by inhibition of cancer cell growth. RESULTS: All the honokiol-loaded liposomes had an average particel size of about 100 nm with high drug entrapment efficiency. The optimal liposome formulation (N/P ratio of 5) exhibited the best cellular uptake. The results of pH-dependent hemolysis and intracellular localization suggested that the LH-siRNA had good ability of endosomal escape. In vitro cell growth experiments showed that both LH and LH-siRNA had good inhibition action on tumor cell growth based on the effects of honokiol and siRNA. CONCLUSION: The PEG-modified cationic liposomes can be a potential carrier for co-delivery of siRNA and honokiol to tumors.

Efficacy observation on rear thigh muscles strain of athletes treated with surrounding needling of electroacupuncture and hot compress of Chinese medicine / 中国针灸

<p><b>OBJECTIVE</b>To verify the clinical efficacy on rear thigh muscles strain of athletes treated with surrounding needling of electroacupuncture and hot compress of Chinese medicine.</p><p><b>METHODS</b>Eighty-six cases were randomly divided into an observation group and a control group, 43 cases in each one. In the observation group, surrounding needling of electroacupuncture and hot compress of Chinese medicine were used at Ashi points around the local affected area of rear thigh muscles. In the control group, conventional needling method and local cupping were applied at Chengfu (BL 36), Yinmen (BL 37), Weizhong (BL 40), etc. The treatment was given once a day. Ten treatments made one session. Two sessions were required. The score of rear thigh muscles pain, swelling and tenderness, walking function recovery and the total score were compared before and after treatment between two groups. The efficacy was compared between two groups.</p><p><b>RESULTS</b>The score of pain, swelling and tenderness, walking function recovery and the total score were reduced obviously after treatmeat in two groups (all P < 0.01), and the improvements in the observation group were superior to those in the control group (P < 0.01, P < 0.05). The cured and remarkably effective rate was 83.7% (36/43) in the observation group, which was better than 60.5% (26/43) in the control group (P < 0.05).</p><p><b>CONCLUSION</b>The efficacy of the surrounding needling of electroacupuncture and the hot compress of Chinese medicine is significant on rear thigh muscles strain for the athletes, which is superior to that of the conventional needling method and cupping in terms of the improvements in the symptoms and physical signs as well as the recovery of the walking function.</p>

Comparisons of endocrine hormones levels between Tibetan antelope and Tibetan sheep / 生理学报

The Tibetan antelope, a prototype mammal, has developed a unique adaptation to extreme high altitude-associated hypoxia. To investigate the role of the endocrine system in adaptation to high altitude in the Tibetan antelope, comparisons of endocrine hormones levels between Tibetan antelope (n = 9) and Tibetan sheep (n = 10) were performed. Both two kinds of animals were captured at an altitude of 4 300 m and then transported to experimental base at 2 800 m altitude. The blood samples were drawn from right external jugular vein in the next morning, and the 20 hormones in hypothalamus-adenohypophysis-peripheral hormonal axis were measured with radioimmunoassay or enzyme-linked immunosorbent assay. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean pulmonary arterial pressure (mPAP) were recorded using catheterization. Moreover, hemoglobin (Hb) content was measured by blood analyser. The results showed that, the levels of FT(3), FT(4) and Ang II in Tibetan antelope were significantly lower than those in Tibetan sheep, whereas TRH, CRH, GHRH, F, E(2), Ald, ACTH and CGRP levels were significantly greater in Tibetan antelope than those in the Tibetan sheep. Compared with Tibetan sheep, Tibetan antelope showed lower HR, mPAP, SBP, DBP and Hb content. In Tibetan antelope and Tibetan sheep, both Hb and Ang II were correlated positively with respective mPAP. In Tibetan antelope, FT(3) level was correlated positively with GH and negatively with ACTH. These results suggest that the endocrine system of Tibetan antelope is characterized by low energy expenditure and high stress, which may be one of the mechanisms underlying the Tibetan antelope adaptation to chronic hypoxia.

Surgical Treatment for Colorectal Cancer with Obstruction in Elderly Patients / 中国肿瘤临床

Objective: To evaluate the surgical procedures and prognostic factors for colorectal carcinoma in patients aged over 70. Methods: We retrospectively reviewed 31 colorectal cancer patients aged over 70 seen in our hospital between January 1992 and December 2001.Treatment procedures and outcome of these patients were analyzed.Kaplan-Meier method was used for survival analysis and Cox regression analysis was conducted to analyze prognostic factors. Results: The median age of these patients was 74 years.The median follow-up period was 12 months.The postoperative complication rate was 22.6%.The thirty-days mortality was 6.5%.There were 28 cases of tubular adenocarcinoma (well differentiated in 5 cases,moderately differentiated in 16 cases,and poorkly differentiated in 7 cases)and 3 cases of mucinous adenocarcinoma.As to Dukes stage,there were 8 cases of B stage,9 cases of C stge,and 14 cases of D stage.The overall 5-year survival rate was 22.7%.The 5-year survival rate was 44.4%in the radical surgery group and 7.7%in the palliative surgery group.The median survival period of all patients was 12 months.The median survival period was 38 months in the radical surgery group and 9 months in the palliative surgery group.Univariate analysis showed that the predictors for survival were age,co-morbidity,preoperative serum CEA level,preoperative serum albumin concentration,duration of surgery,radical surgery,and cancer stage. Conclusion: Radical resection is a prerequisite for cure of colorectal cancer with obstruction in elderly patients.Age and preoperative serum albumin concentration are independent prognostic indicators.

Clinical characteristics and prognosis of combined hepatocellular-cholangiocarcinoma / 中华普通外科杂志

Objective To investigate the clinical characteristics and analyze prognostic risk factors of combined hepatocellular-cholangiocarcinoma. Methods The clinical data of 19 cases of combined hepatocellular-cholangiocarcinoma admitted in our hospital from January 1999 to December 2009 were analyzed retrospectively. The survival function was analyzed by Kaplan-Meier. The possible prognostic risk factors were tested by χ2-test. Results Hepatocellular-cholangiocarcinoma was diagnosed by pathology in the 19 patients, among which hepatic tunic was infiltrated in 13 cases, peritoneum involved in 1 case, intravascular cancer embolus in 1 case. At that time lymphocyte nodes metastasis in 2 cases were found by regional lymphadenectomy in 7cases. The 1-year and 3-year survival rates were 61% and 42%,respectively. Prognosis of patients with tumor size ＞ 5 cm ( χ2 = 4. 392, P = 0. 036 ), history of heavy drinking ( χ2 = 11.010, P = 0.001 ) or intraoperative blood transfusion ( χ2 = 4. 645,P = 0. 031 ) were worse than others. Conclusion It was difficult to get correct preoperative diagnosis of combined hepatocellularcholangiocarcinoma. Tumor size, history of heavy drinking and blood transfusion were all prognostic related risk factors.

Suitable treatment of post operative anastomotic recurrence after anterior resection of rectal cancer and relationship between different kinds of therapy with prognosis / 肿瘤研究与临床

Objective To investigate the suitable treatment of post operative anastomotic recurrence after anterior resection of rectal cancer and analyze the relationship between different kinds of therapy with prognosis. Methods The clinical data of 41 cases of local recurrent rectal cancer after anterior resection admitted in our hospital from 1999 to 2009 were analyzed retrospectively. The median survival time and survival rate were calculated by Life Tables method. The influence of different kinds of treatment to prognosis was evaluated by Kaplan-Meier method and the variability was analyzed by Log-rank method. P <0.01 means statistical significance. Results Thirty-three (80.5 %) of 41 patients were recurrent in the first 3 years and the median survival time was 23 months. Seventeen (41.5 %) of 41 patients underwent radical R0 resection. The median survival time of radical resection patients and non-radical resection ones were 49 months and 18 months, respectively, and the difference was significant (χ2=12.245, P=0.000). Thirty-one patients with radiotherapy and/or chemotherapy showed a statistically longer median survival time than the other 10 patients without these adjuvant treatment (39 months and 9 months, respectively) (χ2=17.533, P =0.000). Conclusion Most post operative anastomotic recurrent of rectal cancer cases occurs in the first 3 years after primary surgery. Radical resection, radiotherapy and chemotherapy can improve the prognosis.

Diagnosis and management of hepatic angiomyolipoma / 中华普通外科杂志

Objective To investigate the clinical characteristics, diagnosis, treatment and prognosis of hepatic angiomyolipoma (HAML). Methods The clinical data of 14 patients with hepatic angiomyolipoma admitted in our hospital from 1989 to 2007 were analyzed retrospectively. Result There were 4 male patients and 10 female patients. Median age was 41 years old. The lesions located in right lobe in 8 patients, and in left lobe in 6 patients. B-US was taken in 12 patients before operation, and other examinations included CT in 8 patients, MRI in 7 patients and angiography in 2 patients. Five patients were diagnosed with HAML by imagine features. Fine needle biopsy was taken in 1 patient with no definite diagnosis. All patients underwent resection and got the histopathologic diagnosis with HAML. All specimens were HMB-45 positive. S-100 and SMA were tested in 7 and 6 patients respectively, and were positive in all those patients. All cases were followed up for 6 months to 18 years (median time was 3 years). 13 patients were still alive without recurrence and 1 patient died of postoperative DIC and heart failure. Conclusion There was marked female predominance in HAML. Imaging features are helpful for preoperative diagnosis of HAML, but correct diagnosis was achieved in only a fraction of patients. HMB-45 positive was definitive proof for histopathologic diagnosis of HAML. Hepatectomy was an effective treatment for HAML.

Risk factors and surgical treatment of recurrent gastrointestinal stromal tumor in the rectum / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors and surgical treatment of recurrent gastrointestinal stromal tumors in the rectum.</p><p><b>METHODS</b>The clinical data of 24 cases,admitted to our hospital, were analyzed retrospectively. The possible risk factors were tested by chi(2)-test. The resectable rate and recurrent rate of recurrent cases were compared with the first-treated cases.</p><p><b>RESULTS</b>The tumors with biggest diameter >or=3 cm and high invasive risk had higher recurrent rates (chi(2)=4.874, P=0.027, chi(2)=6.659, P=0.010). The resectable rate of recurrent gastrointestinal stromal tumors in rectum was 64.3% (9/14), which was significantly lower than that of first-treated ones (23/24) (chi(2)=6.618, P=0.010). There was no significant difference of recurrent rate between the recurrent group and the first-treated group (chi(2)=1.459, P>0.05).</p><p><b>CONCLUSIONS</b>The size and invasive risk of tumor are associated with the recurrent rate of gastrointestinal stromal tumors in rectum. The resectable rate of recurrent gastrointestinal stromal tumors in rectum is significantly lower than that of first-treated ones, but recurrent rates are similar in the 2 groups.</p>