Research progress of B lymphocytes in non-infectious uveitis / 国际眼科杂志(Guoji Yanke Zazhi)

Non-infectious uveitis, an autoimmune disease that can cause severe visual impairment, can be difficult to treat. According to the prevailing hypothesis, the immune-mediated imbalance that contributes to non-infectious uveitis is primarily driven by CD4+T cells. However, recent research has shown that B cells also play a significant role in this process, participating in various ways such as antibody production, antigen presentation, and cytokine secretion in both human uveitis and experimental autoimmune uveitis models. Therapies targeting B cells have been used extensively in various autoimmune diseases. Rituximab, a B-cell inhibitor, is effective in treating noninfectious uveitis that is unresponsive to conventional corticosteroid and immunosuppressive therapy. This paper provides an overview of the involvement of B cells in non-infectious uveitis and their potential use in cellular therapies, aiming to further investigate the mechanisms and develop more effective strategies for prevention and treatment.

Long-term follow-up outcomes of modified transobturator bulbourethral sling suspension for post-prostatectomy incontinence / 现代泌尿外科杂志

【Objective】 To evaluate the safety and efficacy of transobturator bulbourethral suspension with modified four-armed pelvic sling for post-prostatectomy incontinence (PPI). 【Methods】 The clinical data of 78 male PPI patients treated during Jan.2012 and Dec.2017 in our hospital were collected. The incontinence quality of life (I-QOL) score, daily use of urine pad, 1-hour urine pad test, residual urine volume (RUV), and maximum flow rate (Qmax) were assessed before and after surgery. 【Results】 The total success rate was 79.5%, of which the cure rate was 56.4% and the improvement rate was 23.1%. The preoperative I-QOL score was (54.6±3.9), daily use of urinary pad was (3.6±0.7), and increase in weight of the 1-hour urine pad test was (33.6±5.0) g. Three years after surgery, the I-QOL score was (80.4±5.7), daily use of a urinary pad was (1.9±0.4), and increase in weight of the 1-hour urine pad test was (7.4±1.3) g. Compared to preoperative status, the I-QOL score, daily use of urine pad, and increase in weight of the 1-hour urine pad test 3 years after surgery improved significantly (P<0.05). During the mean follow-up of (61.4±20.5) months, no significant changes in the I-QOL score, daily use of a urinary pad, 1-hour urinary pad test, RUV or Qmax were observed, and no complications occurred. 【Conclusion】 Transobturator bulbourethral suspension with modified four-armed pelvic sling is an effective and safe procedure to treat post-prostatectomy incontinence. The long-term efficacy is satisfactory.

A cohort study of association between sleep duration and cognitive impairment in the elderly aged 65 years and older in China / 中华流行病学杂志

Objective: To explore the effect of sleep duration on the risk of cognitive impairment in the elderly in China. Methods: Baseline data of 9 679 elderly individuals with intact cognition were collected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2005, and followed up was conducted until 2018. Cox proportional hazards model was used to analyze the association between different sleep durations and the risk for cognitive impairment in the elderly. Results: Compared with elderly with sleep duration of 6 hours per day, those with sleep duration less than 5 hours had increased risk for cognitive impairment by 30% (HR=1.30, 95%CI: 1.05-1.62), and those with sleep durations of 7 hours, 8 hours and more than 9 hours had increased risk for cognitive impairment by 34% (HR=1.34,95%CI: 1.09-1.64), 40% (HR=1.40,95%CI: 1.17-1.69) and 43% (HR=1.43,95%CI: 1.19-1.70), respectively. Trend test showed that the risk of cognitive impairment increased with the extension of sleep duration (>6 h), and there was a dose-response relationship (P<0.001). However, self-rated sleep quality was not associated with the risk for cognitive impairment in the elderly. Conclusions: The shorter and longer sleep duration were associated an increased risk of cognitive impairment in the elderly aged ≥65 years in China, suggesting that optimizing sleep duration might delay the occurrence of cognitive impairment.

A cohort study on the influence of the chronic diseases on falls among middle-aged and older Chinese / 中华流行病学杂志

Objective: To analyze the influence of chronic diseases on falls among middle-aged and older Chinese. Methods: Baseline data of 13 670 middle-aged and older adults recruited from China Health and Retirement Longitudinal Study (CHARLS) in 2011 were used and followed up to 2018, among those were 7 443 (54.45%) middle-aged people aged 45-59 and 6 227 (45.55%) older adults aged 60 and above. The Cox proportional hazards model was used to analyze the effects of different types, the number of chronic diseases and the interaction between chronic illness and other factors on the fall risk of middle-aged and older people. Results: After adjusting for confounding factors, respiratory diseases increased the risk of falls by 21% (HR=1.21, 95%CI:1.02-1.45), and arthritis increased the risk of falls by 27% (HR=1.27,95%CI: 1.12-1.43) in the group aged 45-59, kidney disease increased the risk of falls by 26% (HR=1.26, 95%CI: 1.03-1.53) in the group aged 60 and above. A linear dose-response relationship between the number of chronic diseases and fall risk (χ2=133.61, P<0.001) was found in all the age groups. The interaction between having chronic diseases and the factors of females (HR=1.64, 95%CI: 1.43-1.89), impaired activities of daily living (ADL) (HR=1.66, 95%CI: 1.39-1.99), and having a fall history (HR=2.58, 95%CI: 2.24-2.97) increased the risk of falls. Conclusions: There is a positive linear relationship between the number of chronic diseases and the fall risk among Chinese aged 45 and above. The female middle-aged and elderly patients with chronic diseases and the middle-aged and elderly patients with impaired ADL or a history of falls are the high-risk groups for falls that need to be focused on intervention. The window of fall injury prevention should be moved forward to the middle-aged stage in time.

Influence of metabolic syndrome on activities of daily living in middle-aged and elderly population in China: a prospective cohort study / 中华流行病学杂志

Objective: To examine the associations between metabolic syndrome (MS) and the risks for impaired activities of daily living (ADL) in the middle-aged and elderly population in China and provide basis for improving healthy life expectancy. Methods: Prospective cohort study design was used in this study. Based the data of China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018 and the baseline data in 2011, the follow up for ADL outcomes was conducted in 2013, 2015 and 2018 respectively, and the participants recruited in 2013 and 2015 were new baseline populations. The participants with impaired ADL in three baseline populations were excluded. Cox proportional hazard model was used to estimate the effect of different components and number of MS components on the risk for ADL impairment in the middle-aged and elderly population in China. Results: In 59 795 person-years of follow-up, a total of 1 011 cases of ADL impairments were recorded. The incidence density of ADL impairment was 16.91 per 1 000 person-year; The findings of Cox regression analysis showed that compared with the middle aged and elderly people without MS, the risk for ADL impairments was 1.29 times higher (95%CI: 1.12-1.50) for those with one component of MS, 1.32 times higher (95%CI:1.07-1.64) for those with hyperlipemia complicated with diabetes, 1.78 times higher (95%CI: 1.22-2.59) for those with obesity and one component of MS, 2.48 times higher (95%CI:1.59-3.85) for those with hypertension complicated with hyperlipemia, 3.51 times higher (95%CI:1.66-7.43) for those with hypertension complicated with diabetes, 1.80 times higher (95%CI: 1.40-2.32) for those with ≥3 MS, respectively. Compared with the middle-aged and elderly population without MS, the risk for impaired ADL increased by 30% (HR=1.30, 95%CI: 1.13-1.51), 54% (HR=1.54, 95%CI: 1.28-1.85) and 87% (HR=1.87, 95%CI:1.45-2.41), respectively, in the middle-aged and elderly with one, two, and more than three components of MS, with a significant dose-response relationship that ADL impaired risks increased as the number of MS components increased (P<0.001). Conclusions: Our findings suggested that MS is a risk factor for ADL impairment in middle-aged and elderly population in China. Prevention and early intervention of obesity, hypertension, hyperlipemia, diabetes and metabolic syndrome could help to reduce or delay the incidence of ADL impairment.

Treatment of vesicovaginal fistula after radiotherapy with gracilis flap: one case report / 中华泌尿外科杂志

The treatment of vesicovaginal fistula after radiotherapy is difficult. Surgical repair is challenging and the success rate is low. The gracilis flap is widely used in the repair surgery of the perineal region, while it is rarely reported for the repair of vesicovaginal fistula domestically. This article reports a case of vesicovaginal fistula after radiotherapy treated with gracilis flap tamponade. The patient was admitted to the hospital because of continuous vaginal leakage of urine for more than 3 years. Digital vaginal examination and urethroscopy showed that a fistula with a diameter of about 3 cm located at the bladder triangle leading to the vagina. The patient had history of cervical cancer surgery and 23 times of postoperative adjuvant radiotherapy. She underwent vesicovaginal fistula repair with gracilis muscle flap. The urethral catheter was removed 3 weeks after the operation. The patient could urinate normally without vaginal leakage. After 10 months of follow-up, there was no vaginal leakage of urine and patient remains continent.

Behavior of Seeking Medical Care for People with Disabilities within Context of Health Poverty Alleviation Initiatives / 中国康复理论与实践

Objective:To study the behavior of seeking medical care for people with disabilities under the background of Health Poverty Alleviation. Methods:Descriptive statistics method was used to analyze the behavior of seeking medical care for people with disabilities based on the data of the National Health Poverty Alleviation Dynamic Management System. Results:The Three Batch action plan mainly focuses on contracted services for chronic diseases; the number of visits for people with disabilities gradually increases, the proportion of visits within the county increases, and the proportion of hospitalizations decreases. The hospitals visited are mainly secondary hospitals, township health hospitals and community health service centers, and the medical expenditure is relatively high. These phenomena are different among disability conditions. Conclusion:The behavior of people with disabilities was remarkably improved after Health Poverty Alleviation. In the future, we should consolidate the achievements of Health Poverty Alleviation, increase the prevention of chronic diseases for people with disabilities, and further improve the accessibility of medical services and the level of medical security for people with disabilities.

Analysis of Clinical Efficacy of Recombinant Human Brain Natriuretic Peptide Combined with Levosimendan in the Treatment of Acute Decompensated Heart Failure Complicated with Renal Insufficiency / 中国药房

OBJECTIVE：To observe the clinical effect and safety of recombinant human brain natriuretic peptide （rhBNP） combined with levosimendan in the treatment of acute decompensated heart failure （ADHF）complicated with renal insufficiency. METHODS：A total of 156 patients with ADHF complicated with renal insufficiency admitted to the Dept. of Cardiology in the Affiliated Hospital of Southwest Medical University during Jan.-Dec. 2019 were randomly divided into rhBNP group ，levosimendan group and combination group ，with 52 patients in each group. All patients received rountine treatment. On this basis ，rhBNP group was given rhBNP for injection [after 1.5 μg/kg intravenous pulse injection，intravenous dripping for 24 h with 0.007 5 μg（/ kg· min）]；leosimendan group was given Leosimendan injection 12.5 mg [intravenous dripping for 1 h with 6-12 μg（/ kg·min），then intravenous dripping for 23 h with 0.1 μg（/ kg·min）]. Combination group received drug combination according to the administration method of single drug group. Three groups received treatment for consecutive 7 d. Cardiac function indexes [heart rate （HR），left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVEDD）]，mean arterial pressure （MAP），pulmonary capillary pressure （PCWP），renal function indexes [estimated glomerular filtration rate （eGFR），serum creatinine （Scr）]，serum levels of cystatin C （Cys-c）and amino-terminal brain natriuretic peptide precursor （NT-proBNP）were observed in 3 groups before and after treatment. Clinical efficacy and the occurrence of ADR were recorded. RESULTS ：Three cases withdrew from the study in rhBNP group and 1 case in levosimendan group ；152 cases completed the study. Before treatment ，there was no statistical significance in cardiac function indexes ，MAP，PCMP，renal function indexes or serum levels of Cys-C and NT-proBNP among 3 groups（P＞0.05）. After treatment ，the HP ，MAP，PCWP and serum level of NT-proBNP in 3 group as well as serum level of Cys-C in combination group were decreased significantly （P＜0.05）；the LVEF in 3 group as well as the eGFR and Scr level in levosimendan group and combination group were significantly increased （P＜0.05），compared with before treatment ；above indexes of combination group were significantly better than those of rhBNP group and levosimendan group （P＜0.05）. Total effective rate of combination group was 94.23％ ，which was significantly higher than those of rhBNP group （77.55％）and levosimendan group （76.47％）（P＜0.05）. There was no significant difference in the incidence of ADR among 3 groups（P＞ 0.05）. CONCLUSIONS ：rhBNP combined with levosimendan in the treatment of ADHF complicated with renal insufficiency can significantly increase the clinical efficacy ，and improve cardiac and renal function but don ’t increase the incidence of ADR.

Consensus and controversies in primary tumor resection for stage Ⅳ colorectal cancer with unresectable metastases / 中华消化外科杂志

There are controversies and consensus in primary tumor resection (PTR) of colorectal cancer with unresec-table metastasis. PTR is required to palliate presenting symptoms. However, it remains controversial whether up-front PTR is effective for asymptomatic primary tumor. Favorers believe that PTR could prevent tumor-related complications such as bleeding, perforation, and bowel obstruction while create favorable conditions for subsequent chemotherapy. Opponents worry that post-operative recovery and complications would delay the timing of systemic chemotherapy thus increasing risk of disease progression. The authors discuss the correlation between presence of primary tumor and bowel complications and whether PTR brings survival benefits, in order to explore the best treatment strategy for stage Ⅳ colorectal cancer with unresectable metastases.

Quantitative assessment of hemodynamics in patients with moyamoya disease before and after revascularization on phase-contrast magnetic resonance imaging / 国际脑血管病杂志

Objective:To evaluate the hemodynamics of patients with moyamoya disease before and 6 months after cerebral revascularization using phase-contrast magnetic resonance imaging (PC-MRI), and to analyze the risk factors for postoperative cerebral hyperperfusion syndrome (CHS).Methods:Patients with moyamoya disease underwent combined revascularization in Huadong Hospital Affiliated to Fudan University from January 2017 to April 2019 were enrolled retrospectively. PC-MRI was performed before and 6 months after surgery. The blood flow velocity, blood flow and the region of interest (ROI) area of the vascular lumen in internal carotid artery, external carotid artery, superficial temporal artery and vertebral artery were recorded. Multivariate logistic regression analysis was used to determine the independent correlated factors of CHS. Results:A total of 80 patients with moyamoya disease were included, including 35 males (43.75%), aged 42.4±10.1 years (range 19-60 years). The blood flow velocity ( P<0.05), blood flow ( P<0.01) and area of ROI ( P<0.01) of the superficial temporal artery were significantly increased at 6 months after surgery compared with the before surgery, and the blood flow of the vertebral artery was slower compared with the before surgery ( P<0.05). Univariate analysis showed that diabetes, predominant hemispheric operation, preoperative increased superficial temporal artery blood flow rate, reduced internal carotid artery flow, and increased external carotid artery flow were the possible risk factors for occurring CHS in patients with moyamoya disease after surgery. Multivariate logistic regression analysis showed that the predominant hemispheric operation (odds ratio [ OR] 4.627, 95% confidence interval [ CI] 1.019-21.009; P=0.047), preoperative superficial temporal artery blood flow ( OR 1.208, 95% CI 1.053-1.387; P=0.007) and external carotid artery blood flow ( OR 0.139, 95% CI 0.027-0.719; P=0.019) were independently associated with postoperative CHS. Conclusions:PC-MRI can evaluate the hemodynamic parameters of intracranial and extracranial major blood vessels, and it can be used as one of the important basis to evaluate the postoperative risk of moyamoya disease.

Rethinking of neoadjuvant therapy for patients with initially resectable colorectal cancer liver metastases / 中华肝胆外科杂志

Surgical resection is the best method for patients with colorectal cancer liver metastases. However, tumor recurrence rate is still high after surgery. Preoperative chemotherapy can help shrink the tumor, test biological behavior, and reduce recurrence rate; but it may also cause liver injury and delay surgery. There is still controversy whether neoadjuvant chemotherapy should be performed and how to select patients from chemotherapy before surgery. Thus, in this article, combined the research progress and the clinical experience of author's center, we discuss this issue in 4 aspects: the development of neoadjuvant chemotherapy; the indications and guideline recommendation for neoadjuvant chemotherapy; the selection of neoadjuvant chemotherapy regimens; common problems in neoadjuvant chemotherapy.

Analysis of "Gansu Prescriptions" in Prevention and Treatment of Coronavirus Disease-2019 / 中国实验方剂学杂志

Coronavirus disease-2019 (COVID-19) is an acute infectious disease caused by a 2019 novel coronavirus (2019-nCoV) infection. It is highly contagious, and can spread quickly home and abroad. It has caused a global pandemic. After the outbreak, Gansu province actively responded to the national "integrated Chinese and western medicine(ICWM)" epidemic prevention policy by organizing an expert group on the prevention and treatment of traditional Chinese medicine(TCM) and establishing a joint working mechanism of ICWM. In adherence to the principle of ICWM, it highlighted the advantages of TCM in epidemic prevention, and emphasized early, timely and whole course use of TCM. The expert group continued to summarize in practice and form a series of "Gansu prescriptions", so as to explore the prevention and control strategy of "prevention in advance, timely interruption and reversal, early prevention and cure, and cure in early stage". Before illness, the prevention shall be made in advance by taking Fuzheng Biwen prescription based on constitution differentiation, in order to strengthen the body resistance and removing pathogenic Qi, after the onset, the syndromes were first treated, interrupted and reversed, and Xuanfei Huazhuo prescription and Qingfei Tongluo prescription were administered based on syndrome differentiation, so as to exorcise pathogenic Qi and cure COVID-19 at the early stage, at the beginning stage of recovery, Jianpi Yifei prescription was used to strengthen the spleen and lungs, and harmonize the stomach and resolve dampness, so as to prevent recurrence. In the principle of ICWM, "Gansu prescriptions" were selected based on the constitution differentiation and syndrome differentiation, so as to prevent the occurrence of epidemics, block light and common symptoms from developing to heavy and critical symptoms, improve the clinical efficacy, shorten the course of disease, and reduce the incidence of critical illness, thereby reducing mortality.

The application of hybrid operation suite in the management of cerebral and spinal vascular diseases and intracranial hypervascular tumors / 中华外科杂志

Objective@#To evaluate the effect of hybrid operation suite in the treatment of cerebral and spinal vascular diseases and intracranial hypervascular tumors.@*Methods@#A retrospective study was conducted on 132 patients with various cerebral and spinal vascular diseases and intracranial hypervascular tumors who were treated by hybrid surgery at Department of Neurosurgery, Huashan Hospital from October 2016 to December 2017.There were 70 male and 62 female patients with a mean age of 48.33 years (range: 14-78 years), including 64 cases of intracranial aneurysm (41 complicated aneurysm cases), 28 cases of brain arteriovenous malformation (BAVM), 12 cases of hypervascular tumor, 12 cases of dural arteriovenous fistula (DAVF), 6 cases of carotid artery stenosis, 5 cases of Moyamoya disease, 3 cases of intracranial aneurysm or BAVM combined with tumor, 1 case of scalp arteriovenous fistula and 1 case of critical brain trauma in which a foreign metal stick approached the basal vascular circuit.Abnormalities were found in 16 cases in intraoperative angiography. The clinical data of all patients was collected as a perspective cohort. The success rate of hybrid surgery, intra-operative and post-operative complications, morbidity, mortality, rate of infection, the length of hospital stay were all analyzed to illustrate the effect of hybrid operation mode to traditional surgical pattern.@*Results@#For 64 cases with intracranial aneurysms, the immediate complete occlusion rate was 90.5%, with a mortality of 4.7% and a morbidity of 14.0%. For 28 cases of BAVM and 12 cases of DAVF, all patients achieved total obliteration and favorable social independent outcomes after hybrid surgery, with no complication.For 6 cases of carotid artery stenosis and 5 cases of Moyamoya, intra-operative confirmed good cerebral reperfusion without any new post-operative neurologic deficits. After tumor vessels embolization, 4 out of 12 cases of hypervascular tumor needed intra-operative blood transfusion, and all patients achieved total tumor resection in a single stage. Only one patient with medulla oblongata hemangioblastoma died 6 months after operation due to respiratory deficit related pneumonia. Compared to traditional surgeries, the hybrid operation pattern did not significantly increase the total infection rate, central nervous system infection rate, hospital stay days and post-operative hospital stay days (all P>0.05) while the in-patient cost increased mildly (119 332 yuan vs.98 215 yuan, t=2.38, P=0.02).@*Conclusions@#The operations of complex cerebral and spinal vascular diseases and intracranial hypervascular tumors can be performed in hybrid operation suite safely.This surgical mode can ensure the quality of operation and promote the development of innovative and complicated surgical procedures.

Transition of treatment strategy for locally advanced rectal cancer towards "watch and wait" / 中华胃肠外科杂志

Therapeutic goal for locally advance rectal cancer (LARC) patients includes long-term survival and function preservation of pelvic organs. During the recent two decades, treatment strategy for LARC is gradually shifing to minimally invasive surgery, even avoiding a major surgery. "Watch and wait (W&W)" strategy is effective in dramatically decreasing surgical trauma and significantly improving preservation of defecation, urination and sexual function. Total neoadjuvant therapy (TNT) shifts all or part of adjuvant chemotherapy to the neoadjuvant phase and has showed obvious advantage in tumor shrinkage and complete clinical response (cCR) achievement. This article will summarize the transition of treatment strategy of LARC towards W&W from standard treatment. After more than ten years of development, both NCCN and ESMO guidelines recommend stratified neoadjuvant treatment considerations based on distinct risk classifications and especially suggest TNT for LARC patients with advanced diseases, which affirms the value of TNT in tumor shrinkage. Although accumulating data show that pelvic control and organ preservation using W&W strategy after cCR is equal or non-inferior to standard surgery, impact on long-term survival still needs prospective randomized controlled study; no consensus has been achieved for the detail of the W&W strategy. Thus W&W strategy is suggested to applied in hospitals specialized in the treatment of rectal cancer within the framework of multiple disciplinary treatment. In view of special medical conditions of our country, we still need to accumulate more experience and data of W&W strategy for rectal cancer patients with appeals for sphincter preservation and actively participate in international researches.

A New Micro-traumatic Laparoscopic Surgery Robot System / 中国医疗器械杂志

At present, there still exist some limitations in the laparoscopic surgery robot represented by da Vinci surgical robot, such as the lack of force feedback function. Doctor can not feel the force feedback while operating. In this paper, a new minimally invasive laparoscopic surgery robot system is designed. Based on the master side surgeon's console, stereo vision subsystem and the slave side surgical cart, the multi-dimensional instrument force feedback technology and force feedback based safety protection strategy are introduced. The design realizes the force sensing function of full state operation. Besides, a number of different live pig experiments are carried out. The amount of bleeding in these experiments is relatively small compared with the data of the same kind of surgical robots, which effectively validates the force feedback and surgical safety protection strategies of the new robot system.

Ethical Boundary for the Application of the Next-generation Sequencing in Genetic Counseling / 中国医学伦理学

The next-generation sequencing technology has been widely used in genetic counseling, but there are two major problems in the application of new technology, namely, the lack of unified technical specifications and clear ethical boundary, which would limit industry development and impaired public rights and interests. The solution of the former problem depends on technological progress, while the latter requires the delineation of ethical boundary.Genetic counseling should follow WHO's recommendations and guidelines. Four basic principles of medical ethics, namely, no harm, good deeds, autonomy and impartiality, constitute the principle boundary of genetic counseling ethics. Informed consent in practice is the rigid red line of the ethical principle boundary of next-generation sequencing.There are many problems in the implementation of informed consent in China. Five types and 15 notification points of informed consent in the application of next-generation sequencing were proposed from the technical point of view in this article.

Follow-up observation of rectal cancer patients with clinical complete response receiving non-operative and standard operative management after neo-adjuvant chemoradiotherapy / 中华放射肿瘤学杂志

Objective To investigate the feasibility of non-operative management (NOM) by comparing the therapeutic effects between NOM and total mesorectal excision (TME) for rectal cancer patients with clinical complete response (cCR) after neo-adjuvant chemoradiotherapy.Methods A total of 135 patients with stage Ⅱ/Ⅲ rectal cancer who obtained cCR after neo-adjuvant chemoradiotherapy in Sun Yat-sen University Cancer Center from 2006 to 2016 were recruited and assigned into the NOM (n =43) and standard operative management (SOM) groups (n=92).The local recurrence rate,accumulative local control (LC) rate after salvage therapy,disease-free survival (DFS),overall survival (OS) and sphincter preservation rate were statistically compared between two groups.Kaplan-Meier analysis and log-rank test were utilized to calculate the LC,OS and DFS.Chi-square test was performed to calculate the sphincter preservation rate.Results The mean follow-up duration was 39 months (range:10-127 months).Of 135 patients,the local recurrence rate and distant metastasis rate were 3.7％ and 11.1％,and the 3-year DFS and OS were 90.5％ and 97.0％.In the NOM and SOM groups,the 3-year DFS were 87％ and 93％,and the 5-year DFS were 73％ and 87％(P=0.089).The 3-year OS were 98％ and 99％,and the 5-year OS were 98％ and 97％ (P=0.578).In the NOM group,the local recurrence rate was 12％ (n =5),80％ of patients received salvage treatment and the accumulative LC rate was calculated as 98％.In the SOM group,the local recurrence rate was 0,which was significantly lower than that in the NOM group (P=0.O10).In the NOM group,the sphincter preservation rate was 93％,significantly higher compared with 70％ in the SOM group (P=0.030).Conclusions It is feasible for rectal cancer patients with cCR to receive NOM following neo-adjuvant chemoradiotherapy.Partial locally recurrent patients can be healed by timely salvage therapy,thereby averting TME and relevant complications and enhancing the quality of life of rectal cancer patients.

Application of magnetic resonance in "non-operative treatment" strategy for rectal cancer / 中华胃肠外科杂志

The primary curative modality for localized rectal cancer is total mesorectal excision (TME). Local control rate of rectal cancer has been improved after neoadjuvant chemoradiotherapy and even pathological complete response (pCR) has been demonstrated in a significant minority. Patients who achieve pCR to neoadjuvant chemoradiotherapy have an excellent prognosis compared with those without pCR. If the patients with complete response to neoadjuvant chemoradiation can be demonstrated by clinical findings and medical imaging (cCR), a non-operative management (NOM) strategy may be pursued to preserve sphincter function and avoid complications induced by TME, which is a new tendency in the treatment of rectal cancer in recent years. Assisting diagnosis of cCR by iconography is the important element of NOM practice. Selected patients should be followed up with intensive surveillance. The curative strategy must be carried out once the recurrence is detected. Imaging modalities, including magnetic resonance imaging (MRI), diffusion-weighted MRI, or proton emission tomography (PET), are limited in their ability to distinguish patients who have achieved cCR. Up to now, MRI, DW-MRI and 18F-FDG PET/CT before neoadjuvant chemoradiotherapy are not accurate enough to predict cCR and safely select patients for organ-sparing strategies. However, depth of tumor infiltration, extramural vascular invasion, circumferential resection margin, and location of rectal cancer can be demonstrated by high resolution MRI as independent risk factors in prediction of long-term survival of patients, which is a necessary manner of stratification treatment for rectal cancer. Therefore, patients who are defined as early rectal cancer with low risk factors are selected as candidates for NOM in recent studies in order to pursue low rate of local recurrence and distant metastasis. High resolution MRI assessment of tumor regression grade (mrTRG) can be used to assess response of rectal cancer to neoadjuvant chemoradiotherapy, which is associated with tumor burden. mrTRG is an imaging marker that indicates the difference in survival between good and poor responders and provides an opportunity for the multidisciplinary team to offer additional treatment options before planning definitive surgery. Functional imaging and even molecular imaging are needed in the future to screen suitable rectal cancer patients who are easier to achieve cCR from neoadjuvant chemoradiotherapy and to evaluate the efficacy of neoadjuvant chemoradiotherapy.

Interpretation of the updates of NCCN 2017 version 1.0 guideline for colorectal cancer / 中华胃肠外科杂志

The NCCN has recently released its 2017 version 1.0 guideline for colorectal cancer. There are several updates from this new version guideline which are believed to change the current clinical practice. Update one, low-dose aspirin is recommended for patients with colorectal cancer after colectomy for secondary chemoprevention. Update two, biological agents are removed from the neoadjuvant treatment regimen for resectable metastatic colorectal cancer (mCRC). This update is based on lack of evidence to support benefits of biological agents including bevacizumab and cetuximab in the neoadjuvant setting. Both technical criteria and prognostic information should be considered for decision-making. Currently biological agents may not be excluded from the neoadjuvant setting for patients with resectable but poor prognostic disease. Update three, panitumumab and cetuximab combination therapy is only recommended for left-sided tumors in the first line therapy. The location of the primary tumor can be both prognostic and predictive in response to EGFR inhibitors in metastatic colorectal cancer. Cetuximab and panitumumab confer little benefit to patients with metastatic colorectal cancer in the primary tumor originated on the right side. On the other hand, EGFR inhibitors provide significant benefit compared with bevacizumab-containing therapy or chemotherapy alone for patients with left primary tumor. Update four, PD-1 immune checkpoint inhibitors including pembrolizumab or nivolumab are recommended as treatment options in patients with metastatic deficient mismatch repair (dMMR) colorectal cancer in second- or third-line therapy. dMMR tumors contain thousands of mutations, which can encode mutant proteins with the potential to be recognized and targeted by the immune system. It has therefore been hypothesized that dMMR tumors may be sensitive to PD-1 inhibitors.

Surgical treatment and prognostic analysis for 57 patients with gastrointestinal lymphoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore clinicopathologic characteristics, surgical features and prognostic factors in patients with primary gastrointestinal lymphoma(PGIL) in order to provide evidence for optimizing surgical treatment.</p><p><b>METHODS</b>Clinicopathological data of 57 PGIL patients undergoing abdominal surgery in Sun Yat-sen University Cancer Center between October 1990 and January 2015 were retrospectively collected. The survival rates were compared among patients with different clinicopathologic characteristics by Kaplan-Meier method, while Cox regression model was employed to analyze the prognostic factors.</p><p><b>RESULTS</b>Among 57 patients, 43 were male and 14 were female, with a median age of 48 (range 16 to 80) years. Seventeen (29.8%) cases were classified as Musshoff I( stage, 19 (33.3%) cases as II( stage, 9 (15.8%) cases as III( stage, and 12(21.1%) cases as IIII( stage. Forty-four (77.2%) cases underwent selective operation, 13(22.8%) cases underwent emergent operation due to acute abdomen. Thirty-two(56.1%) cases had radical resection, 18 (31.6%) cases had partial resection and the rest 7(12.3%) cases failed to perform resection. Four (7.0%) cases received simple surgical operation, and 53 (93.0%) cases received comprehensive treatment, including 5(8.8%) cases with preoperative chemotherapy and surgery, 40 (70.2%) cases with surgery and postoperative chemotherapy, and 8 (14.0%) cases with surgery and perioperative chemotherapy. Stage III( and IIII( accounted for 76.9%(10/13) in patients undergoing emergent operation and accounted for 25.0%(11/44) in patients undergoing selective operation, whose difference was statistically significant (χ=9.503, P=0.002). Univariate prognostic analysis showed that T lymphocyte source pathological cell phenotype (P=0.000), clinical Musshoff stage III( and IIII((P=0.001), emergent operation (P=0.000) and incomplete tumor resection(P=0.007) had worse 5-year overall survival. Multivariate Cox regression analysis indicated that tumor pathological cell phenotype (HR=13.75, 95%CI:3.546-53.308, P=0.000) and surgical timing (HR=7.497, 95%CI:1.163-48.313, P=0.034) were independent prognostic risk factors of patients with stage I( and II(.</p><p><b>CONCLUSIONS</b>Surgical operation is an important part of comprehensive treatment for PGIL. T lymphocyte source and ulcerative lymphoma indicates poorer prognosis.</p>