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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.
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Advanced gastric cancer (AGC) has a high recurrence rate (especially peritoneal relapse) and a poor prognosis. Systematic chemotherapy or targeted therapy have not been able to significantly reduce the major cause of an unfavorable prognosis, namely the high peritoneal AGC recurrence rate post-surgery. Further studies concerning the application of hyperthermic intraperitoneal chemotherapy (HIPEC) post curative surgery for AGC patients, namely the prophylactic HIPEC (P-HIPEC), have involved a prophylactic approach to prevent peritoneal relapse following curative gastrectomy in high-risk patients. Theoretically, breaking the "plasma-peritoneal barrier" increases cytotoxic chemotherapy activity via a synergistic hyperthermic effect; therefore, HIPEC can eradicate free cancer cells and micro-metastasis within the peritoneal cavity intraoperatively or soon after curative gastrectomy to reduce peritoneal recurrence. Many clinical trials have shown that P-HIPEC can reduce peritoneal recurrence and improve prognosis of AGC patients. However, some studies applying HIPEC at an early stage have revealed a high rate of complications that limited generalizability. This procedure has been increasingly adopted, given the complication rate has now been reduced and safety has been proven. Recently, for assessing the important role of HIPEC, many high-quality prospective randomized controlled clinical trials have been conducted to further investigate the best guidance for P-HIPEC and to demonstrate its effectiveness and safety with a higher grade of evidence. With theory development, the technique, equipment, and management of HIPEC and the role of P-HIPEC for AGC continues to evolve. This study summarizes the progress of P-HIPEC for high-risk AGC patients.
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Humans , Antineoplastic Combined Chemotherapy Protocols , Therapeutic Uses , Chemotherapy, Cancer, Regional Perfusion , Combined Modality Therapy , Hyperthermia, Induced , Neoplasm Recurrence, Local , Peritoneal Neoplasms , Drug Therapy , Randomized Controlled Trials as Topic , Stomach Neoplasms , Drug TherapyABSTRACT
<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of intracorporeal Roux-en-Y esophagojejunostomy via the transoral anvil(OrVil) by mini-laparotomy anastomosis during laparoscopic total gastrectomy (LTG) for gastric cancer.</p><p><b>METHODS</b>From March 2010 to December 2016, 414 consecutive gastric adenocarcinoma patients underwent either intracorporeal Roux-en-Y esophagojejunostomy (n=43) via the OrVil or extracorporeal circular anastomosis (n=371) via auxiliary incision during LTG. After generating propensity scores with six covariates, including gender, age, body mass index (BMI), neoadjuvant chemotherapy, tumor location, and tumor size, 43 patients undergoing OrVil method (OrVil group) were matched with 43 patients undergoing extracorporeal circular anastomosis approach (extracorporeal anastomosis group). Operation-associated parameters and safety were compared between the two groups.</p><p><b>RESULTS</b>Both groups were balanced regarding baseline variables (all P > 0.05). The total operative time [(235.6±49.8) minutes vs. (221.1±46.5) minutes, t=1.397, P=0.166] and anvil insertion time [(10.0±3.2) minutes vs. (10.6±4.5) minutes, t=-0.671, P=0.504] were not significantly different between the two group, whereas the duration of reconstruction and the mean length of minilaparotomy [(48.3±12.0) minutes vs. (55.9±12.3) minutes, t=-2.899, P=0.005; (5.6±0.6) cm vs. (8.1±2.2) cm, t=-7.118, P=0.001] in the OrVil group were significantly shorter. The number of retrieved lymph nodes, mean blood loss and proximal resection margin were not significantly different between two groups (all P > 0.05). As a whole, OrVil group had advantages over extracorporeal anastomosis group during the postoperative recovery course. The time to liquid intake [(3.7±1.8) days vs. (6.2±7.2) days, t=-2.236, P=0.030], time to fluid diet [(4.8±2.3) days vs. (7.2±7.1) days, t=-2.013, P=0.048], and time to semi-fluid diet [(6.7±2.9) days vs. (10.2±9.6) days, t=-2.245, P=0.029] were significantly shorter in the OrVil group. The first ambulatory time, time to first flatus and length of hospital stay were not significantly different between two groups(all P>0.05). The morbidity of intraoperative complication [7.0%(3/43) vs. 4.7%(2/43), χ²=0.000, P=1.000] and postoperative complication [30.2%(13/43) vs. 20.9%(9/43), χ²=1.484, P=0.223], and even the distribution of severity (χ²=0.013, P=0.990) between the two groups were not significantly different. The incidence of anastomotic leakage (AL) was 9.3% (4/43) and 18.6% (8/43) in the OrVil group and extracorporeal anastomosis group respectively without significant difference (χ²=1.550, P=0.213). Multivariate analysis showed that the OrVil anastomosis was not a risk factor of AL(HR=0.663, 95%CI:0.120-3.674, P=0.638).</p><p><b>CONCLUSIONS</b>Intracorporeal esophagojejunostomy using the OrVil system is more minimally invasive and convenient to operate without increasing the risk of operation-related complication. Thus it may be a potential safe approach to optimize the reconstruction for LTG.</p>
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Humans , Anastomosis, Surgical , Gastrectomy , Methods , Laparoscopy , Laparotomy , Postoperative Complications , Propensity Score , Retrospective Studies , Stomach Neoplasms , General Surgery , Treatment OutcomeABSTRACT
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.
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Objective To search MRI features of patients with HIV-negative cryptococcus meningoencephalitis (CM)and evaluate the value in judging the prognosis of CM.Methods The findings of cranial MRI and prognosis were retrospectively analyzed in 19 cases with India-ink capsule staining-proved HIV-negative CM in our department.The prognosis was evaluated by Glasgow Outcome Scale:score 1=death,score 2=persistent vegetative state,score 3=severe disability,score 4=moderate disability,score 5=good recovery. The patients with score 1-3 were classified as the group of poor prognosis,while those with score 4,5 as good prognosis.Results Abnormal manifestations on cranial MRI were observed in 84.2%(1 6/1 9)cases,meninges enhanced in 84.2% (1 6/1 9),brain edema in 31.6%(6/1 9),brain parenchyma lesion in 47.4% (9/1 9 ),vasculitis in 5.2% (1/1 9 ).The mean duration of follow-up was 3.5 years,The prognosis of 5/9(44.4%)cases with brain parenchyma lesion confirmed by cranial MR was poor.Conclusion The MRI manifestation of HIV-negative CM is diverse,and brain parenchyma lesion confirmed by cranial MRI may associated with poor prognosis.
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[Summary] During recent years, increasing evidences have indicated that type 2 diabetes mellitus(T2DM) might increase the risk of certain tumors; the process might be not only related with the chronic pathologic status of T2DM such as hyperglycemia, hyperinsulinemia, insulin resistance, dyslipidemia, status of chronic inflammation but also associated with the long-term use of anti-diabetic drugs (i. e. sulfonylureas, biguanides, glitazones, dipeptidyl peptidase-4 inhibitors, glucagon-like peptitide-1 receptor agonists), as well as the use of insulin and insulin analogues. Herewith a system review was made about the recent progress in studying T2DM and tumor risk.
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OBJECTIVE@#To study the correlation of CD44 with epithelial-mesenchymal transition(EMT) and metastasis in nasopharyngeal cancer cells, and explore the possible mechanism of CD44 regulates EMT and metastasis in nasopharyngeal cancer cells.@*METHOD@#The CD44 and EMT-associated proteins in 5-8F and 6-10B nasopharyngeal cancer cell lines were assayed by Western blotting. The erasion trace test was performed to observe the migratory ability of 5-8F and 6-10B nasopharyngeal cancer cells. Using lipid-mediated DNA transfection technique, the low metastatic nasopharyngeal cancer cells 6-10B were transfected in vitro with plasmid which contained CD44 gene, and then new nasopharyngeal cancer cells were obtained. The CD44 and EMT-associated proteins in 6-10B, empty vector transfected and CD44-transfected cells were assayed by Western blotting. The erasion trace test was performed to observe the alteration of migratory ability of nasopharyngeal cancer cells before and after CD44 transfection.@*RESULT@#The expression of CD44 and EMT-associated protein MMP-9 in 5-8F was higher than that in 6-10B, but EMT-associated protein E-Cadherin in 5-8F was lower than that in 6-10B. The migratory ability of 5-8F was higher than that of 6-10B. The expression of CD44 and MMP-9 were significantly higher in the CD44-transfected nasopharyngeal cancer cells than in the control groups. Compared with control groups, the migratory ability of CD44-transfected nasopharyngeal cancer cells was significantly increased.@*CONCLUSION@#CD44 positively regulates the metastatic ability of nasopharyngeal cancer cells, which is relevant to the process of EMT.
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Humans , Carcinoma , Cell Line, Tumor , Epithelial-Mesenchymal Transition , Hyaluronan Receptors , Genetics , Metabolism , Nasopharyngeal Carcinoma , Nasopharyngeal Neoplasms , Metabolism , Pathology , Neoplasm Metastasis , TransfectionABSTRACT
Objective To observe the relationship between plasma level of homocysteine(HCY) and ischemic stroke in young and middle-aged adults,explore the clinical signficance concerning the occurrence and development of ischemic stroke in young and middle-aged adults.Methods The plasma homocysteine level of 132 young and middle-aged adults patients with ischemic and 86 control peoples were measured by means of enzymatic cycling assay.Results The plasma homocysteine level in ischemic stroke was higher than that in control group( P ＜ 0.01 ).The higher the plasma homocysteine level,the larger infarcted focus in acute ischemic stroke group of young and middleaged adults.The plasma homocysteine level and the infarcted focus was positively linearly correlated.Conclusion Hyperhomocysteinemia is a risk factor of ischemic stroke among young and middle-aged adults.The higher the plasma homocysteine level,the larger infarcted focus in acute ischemic stroke group.The plasma homocysteine level can reflect the size of the infarcted focus and the degree of disease,and the plasma homocysteine level should serve as a kind of regular examination or as an index intervention can be taken,all of which are great importance to prevent ischemic stroke and reduce its morbilily.
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ObjectiveTo observe the therapeutic effect of nicorandil in treatment of angina pectoris. Methods155 cases of angina pectoris patients were randomly divided into the therapeutic group(85 cases)and control group(70 cases),both of which took normal doses of aspirin vitamin C effervescent tablets 0.1g/day,clopidogrel 50mg/day,elantan 50mg/day and simvastatin 40mg/day,where hypertensions or diabetics were given blood pressure and sugar control and heart failure patients were given proper diuretic therapy and other methods to release heart Ioad.Patients in the therapeutic group were additionally given 5 mg nicorandil,3 times/day.The two groups were both given one period of treatment about one month. ResultsIn therapeutic group,32 cases had significant therapeutic effectiveness,34 cases had effectiveness and 14 cases had no effectiveness with a total effective rate of 82.5%.In the control group,23 cases had significant therapeutic effectiveness,28 cases had effectiveness and 24 cases had no effectiveness with a total effective rate of 67.0%.The comparative difference of the total effectiveness of the twogroups had statistical significance(x2 =4.40,P＜0.05).No other significant adverse reaction was found except several cases of light dizzy in the two groups. ConclusionNicorandil has good therapeutic effective in treatment of angina pectoris and no significant adverse reaction.
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OBJECTIVE@#To investigate the epidemiological characteristics of allergic rhinitis (AR) in urban and rural areas of Ningbo and Yongzhou.@*METHOD@#Fifteen fields in the two cities from October 2006 to June 2007 were randomly selected. Cases suspected with symptoms of AR by a self-administered and interview questionnaire were recommended to special examinations for confirmed diagnosis.@*RESULT@#1. A total of 9969 individuals from 3803 families were surveyed, of whom 303 suffered with AR. 2. The prevalence rate was 4.10% in Ningbo and 1.65% in Yongzhou (the sex-adjusted rate was 4.10% and 1.64% respectively, and the age-adjusted rate was 4.33% and 1.58%); the population of island inhabitants had the lowest prevalence rate of 0.73%. 3. The prevalence rate in patients with asthma and that with family genetic history was 8% and 12% respectively.@*CONCLUSION@#It demonstrates that the prevalence rate is higher in Ningbo than in Yongzhou, in urban than in rural and in adolescent than in other ages. Allergic rhinitis may be associated with asthma and related to genetic factors. Allergic rhinitis may be curable.
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Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , Asthma , Epidemiology , China , Epidemiology , Prevalence , Rhinitis, Allergic, Perennial , Epidemiology , Rhinitis, Allergic, Seasonal , Epidemiology , Rural Population , Surveys and Questionnaires , Urban PopulationABSTRACT
OBJECTIVE To enhance the standardized management for cleaning and disinfection of endoscope,and prevent hospital infection due to endoscope examination and treatment.METHODS The main measured were established and consummated the system,increased the investment of facilities,strengthened personal training and standardized the cleaning and disinfection work procedures.RESULTS The endoscopes after disinfection were all reached the standards.CONCLUSIONS The standardized management for cleaning and disinfection of endoscope is the assurance for the endoscope sterilization reaching the standards.
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OBJECTIVE To analyze the cleaning and disinfecting effect of digestive endoscope by the Mall disinfection center for endoscopes.METHODS Fifty-six pieces of endoscopes were cleaned and disinfected by the Mall disinfection center,and checked randomly. An other 50 endoscopes were treated as control group.All pieces were taken the biological inspection.RESULTS The qualification rate of lumen disinfection was 100% in test group,and 92% in control group(P
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Objective To study the clinical and neuroimaging features of top of the basilar artery syndrome(TOBS).Methods The clinical and neuroimaging features of 63 cases with TOBS were analyzed retrospectively.Results Main causes of TOBS were atherosclerosis and embolisms.Vertigo and disturbance of consciousness and movement of the eye-ball,abnormality of pupils,partial blindness were the main clinical features.The most important imageologic feature of TOBS was infarction of thalami or midbrain,which was frequently complicating with infarction in other locations.Conclusion TOBS has simultaneously more than two infarction lesions,either superior or inferior tentorium of cerebellum with many complications and poor prognosis.MRI is more sensitive than CT.Early MRI examination,systemic and comprehansive treatment may improve the prognosis of the TOBS patients.