Effects of chemotherapy dose intensity on short-term efficacy in patients with advanced colon cancer: a study based on real-world data / 国际肿瘤学杂志

Objective:To investigate the effects of different chemotherapy dose intensity on the short-term efficacy and adverse reactions of patients with advanced colon cancer.Methods:A real-world database of patients with advanced colon cancer in Wangjing Hospital of China Academy of Chinese Medical Sciences and China-Japan Friendship Hospital from January 2017 to December 2020 was established, including 105 patients treated with the same chemotherapy regimen for two consecutive cycles. The patients were grouped according to the average relative dose intensity (ARDI) of chemotherapy, and the population differences, treatment regimens, short-term efficacy and adverse reactions of different chemotherapy dose intensities were evaluated. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of ARDI for short-term efficacy.Results:There were 31 patients in the high dose intensity group (ARDI≥80%) , 34 patients in the medium dose intensity group (80%<ARDI<60%) , and 40 patients in the low dose intensity group (ARDI≤60%) . There were statistically significant differences in age ( χ2=13.20, P=0.010) and Karnofsky functional status (KPS) score ( χ2=7.99, P=0.008) among the high dose intensity group, medium dose intensity group and low dose intensity group. Compared with the low dose intensity group, the proportion of young and middle-aged patients in the high dose intensity group was higher, and the proportion of elderly patients was lower ( χ2=12.63, P=0.002) . Compared with the medium dose intensity group, the proportion of patients with KPS score ≥60 was lower and the proportion of patients with KPS score <60 was higher in the low dose intensity group ( P=0.013) . There was a statistically significant difference in the application of chemotherapy regimen among the three groups ( χ2=22.88, P=0.027) , and there was a statistically significant difference in the application of chemotherapy regimen between the high dose intensity group and low dose intensity group ( χ2=16.25, P=0.009) . The proportions of the high, medium and low dose intensity groups receiving combined chemotherapy were 96.77% (30/31) , 82.35% (28/34) and 80.00% (32/40) respectively. The incidences of chemotherapy drug reduction in the high, medium and low dose intensity groups were 93.55% (29/31) , 100% (34/34) and 100% (40/40) respectively, and the incidences of chemotherapy delay were 41.94% (13/31) , 79.41% (27/34) and 87.50% (35/40) respectively. The objective response rates of the high, medium and low dose intensity groups were 22.58% (7/31) , 14.71% (5/34) and 2.50% (1/40) respectively, with a statistically significant difference ( χ2=7.11, P=0.027) . The disease control rates of the high, medium and low dose intensity groups were 93.55% (29/31) , 91.18% (31/34) and 87.50% (35/40) respectively, with no statistically significant difference ( χ2=0.75, P=0.714) . The differences of carcinoembryonic antigen before and after treatment in the high, medium and low dose intensity groups were 2.09, 0.47 and -0.72 ng/ml respectively, with a statistically significant difference ( χ2=10.09, P=0.006) . Compared with the low dose intensity group, the difference of carcinoembryonic antigen before and after treatment in the high dose intensity group was greater ( χ2=23.12, P=0.005) . The differences of carbohydrate antigen 199 before and after treatment in the high, medium and low dose intensity groups were 2.30, 0.00 and -0.21 U/ml respectively, with a statistically significant different ( χ2=8.85, P=0.012) . Compared with the low dose intensity group, the difference of carbohydrate antigen 199 before and after treatment in the high dose intensity group was greater ( χ2=21.40, P=0.010) . No adverse reactions above grade 3 occurred in the three groups, and the safety was good. The most common adverse reactions were anemia (61.90%, 65/105) , leucopenia (39.05%, 41/105) , neutropenia (29.52%, 31/105) and nausea (36.19%, 38/105) . There were no statistically significant differences in the incidences of adverse reactions among the high, medium and low dose intensity groups (all P>0.05) . ROC curve analysis found that the area under the curve predicting objective response was 0.70, the sensitivity was 92.30%, and the specificity was 52.10% when the chemotherapy ARDI threshold was 64%. Conclusion:In the real world, colon cancer patients receiving high dose intensive chemotherapy have better objective response rate, and tumor markers decreased significantly. The baseline status of colon cancer patients receiving low dose intensive chemotherapy is poor, but there is no statistically significant difference in disease control rate between patients receiving low dose intensive chemotherapy and patients receiving high dose intensive chemotherapy, and the adverse reactions are controllable.

Clinical features of severe or critical ill patients with COVID-19 / 南方医科大学学报

OBJECTIVE@#To analyze the clinical features of severe or critical ill adult patients with coronavirus disease (COVID-19).@*METHODS@#The clinical data of 75 patients with severe or critical COVID-19 in Honghu People's Hospital from January to March in 2020 were collected.@*RESULTS@#Of the 75 patients with COVID-19 pneumonia, 41 were male (54.67%) and 34 were female (45.33%) with a mean age of 67.53 ±12.37 years; 43 patients had severe and 32 had critical COVID-19, and 49.3% of the patients had underlying diseases. The main clinical manifestations included fever (78.67%) and coughing (70.67%). Compared with the severe patients, the critically ill patients had higher proportions of patients over 60 years old with elevated white blood cell count, increased prothrombin time, and higher levels of hsCRP, PCT, D-dimer, ALT, LDH, cTnI and NT-proBNP. Univariate logistic regression analysis showed that an age over 60 years, leukocytosis, hs-CRP elevation, prolonged prothrombin time, and increased levels of D-dimer, NT-proBNP and cTnI were associated with severe COVID-19. Multivariate logistic regression showed that an age over 60 years (OR=8.165, 95% : 1.483-45.576, =0.017), prolonged prothrombin time (OR=7.516, 95% : 2.568-21.998, =0.006) and elevated NT-proBNP (OR=6.194, 95% : 1.305-29.404, =0.022) were independent risk factors for critical type of COVID-19.@*CONCLUSIONS@#An age over 60 years, a prolonged prothrombin time and elevated NT-proBNP level are important clinical features of critically ill patients with COVID-19, and can be deemed as early warning signals for critical conditions of the disease.

Success rate of one-stop procedure for atrial fibrillation ablation and its impact on cardiac function: a propensity-matched study / 南方医科大学学报

OBJECTIVE@#To investigate the effect of the combination of atrial fibrillation (AF) ablation and left atrial appendage closure (LAAC) on cardiac function and the success rate of AF ablation.@*METHODS@#We retrospectively analyzed the data of 56 patients with AF undergoing a one-stop procedure for AF ablation and LAAC in our hospital between May, 2015 and May, 2019. Propensity score matching (PSM) at the ratio of 1:1 was used to select 56 control patients undergoing AF ablation at high risk of stroke, for matching with the hybrid procedure group. The perioperative complications, thromboembolic events, recurrence of atrial arrhythmia and cardiac function were compared between the groups.@*RESULTS@#The two groups of patients were comparable for age, gender, BMI, duration and type of AF, concomitant diseases, CHA2DS2-VASc and HAS-BLED scores (@*CONCLUSIONS@#The combination of AF ablation and LAAC is safe but does not improve the success rate of AF ablation. The one-stop procedure can improve cardiac function of the patients, but AF ablation alone can achieve better improvement of cardiac function.

Electrothermal acupuncture in the prevention and treatment of chemotherapy-induced nausea and vomiting:a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To observe the effectiveness and safety of electrothermal acupuncture in the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV) in the cancerous patients of phlegm-stasis interaction in cisplatin-containing chemotherapy.</p><p><b>METHODS</b>Sixty cases of phlegm-stasis interaction in cisplatin-containing chemotherapy were randomized into a trial group and a control group, 30 cases in each one. In the control group, the intravenous drip of granisetron hydrochloride injection was adopted, 3 mg before and after cisplatin-containing chemotherapy 30 min, continuously for 3 days. 43 to 45℃ electrothermal acupuncture at zusanli(ST 36) for 30 min was used on the basis of the treatment as the control group in the trial group,once a day for 3 days. CINV, anti-nausea effects, Karnofsky score, the syndrome score of phlegm-stasis interaction, and relevant indices of safety were observed on the 1st and 7th days of cisplatin-containing chemotherapy separately.</p><p><b>RESULTS</b>1.Regarding CINV and anti-nausea effect, CINV did not occur before chemotherapy in the patients of the two groups. On the 1st and 7th days of chemotherapy, CINV in the trial group were milder than those in the control group (both<0.05).The anti-nausea effects in the trail group were better than those of the control group.2.Regarding Karnofsky score and the syndrome score of phlegm-stasis interaction, the improvements on the 7th days of chemotherapy in the trial group were better than those in the control group, indicating the significant differences (both<0.05). 3.Regarding the safety indies, there was no adverse reaction during the treatment in the two groups.</p><p><b>CONCLUSIONS</b>The electrothermal acupuncture effectively relieves CINV, and improves self-care dbility and the symptoms of phlegm-stasis interaction.</p>

Preliminary study of correlation between elasticity and blood perfusion in renal carcinoma / 中华超声影像学杂志

Objective To investigate the correlation between elasticity obtained with acoustic radiation force impulse(ARFI) and blood perfusion obtained with contrast enhanced ultrasound(CEUS) in renal carcinoma.Methods Tweenty-four patients with renal carcinoma confirmed by operation and pathology underwent ARFI and CEUS sequentially,got preliminary information of elasticity,size and border with virtual touch tissue imaging (VTI),shear wave velocity (SWV) of tumor and renal cortex at least 2centimeters from the tumor margin were measured with virtual touch tissue quantification (VTQ),and then the imaging characteristics were analyzed with time intensity curve (TIC).The elasticity obtained with ARFI were compared with the blood perfusion obtained with CEUS.ResultsTotally 24 cases included 18 renal cell carcinomas,3 papillary renal cell carcinomas,2 chromophobe cell renal carcinomas and 1 rena1collecting duct carcinoma.In VTI,18 appeared darker,4 appeared brighter,and 2 had the same brightness as renal cortex.The SWV of tumor and renal cortex were (2.47±0.61)m/s,(2.10±0.94) m/s,respectively,19 were stiffer than renal cortex (79.2％),among which 18 appeared hyper-enhancement and 1 appeared hypo-enhancement;5 were softer than renal cortex (20.8％),among which 2 appeared hyper-enhancement and 3 appeared hypo-enhancement in CEUS.Tumors with different elasticity had different enhancement,stiff cases appeared hyper-enhancement,soft cases appeared hypo-enhancement (P ＜ 0.05).Conclusions There is correlation between elasticity obtained with ARFI and blood perfusion obtained with CEUS in renal carcinoma

Clinical evaluation of the efficacy of external therapies of traditional Chinese medicine in treatment of cancer pain / 中西医结合学报

There lack scientific methods for evaluating the treatment of cancer pain with external therapies of traditional Chinese medicine (TCM). The level of clinical study in this field needs to be improved. The authors assert that when external therapies of TCM are applied to treat cancer pain, different types of cancer pain should be distinguished and treatment should be applied according to such a differentiation. Under this framework scientific evaluation can be conducted. The authors also assert that the findings of randomized, blinded and controlled trials should be given particular attention, and it is necessary to include titration of morphine into clinical trails of external therapies for the treatment of cancer pain, not only complying with the three-ladder principle for treating cancer pain suggested by the World Health Organization, but also not influencing the effect evaluation of external therapies of TCM on cancer pain. Patient diaries recording pain were revised as observation indexes. The primary indicator of efficacy was the pain intensity score and the secondary indicators were the equivalent of morphine and the remission rate of pain. The time to onset, remission duration and comparison of assessment of pain influence can mirror the characteristics of external therapies of TCM on cancer pain.

Changes in the number of endothelial progenitor cells from peripheral blood and significance in mouse abdominal aortic allografts / 中华器官移植杂志

Objective To investigate changes in the number of endothelial progenitor cells (EPC) from peripheral blood and pathological feature in the development of transplant arteriosclerosis in mouse abdominal aortic allografts, and discuss their correlations. Methods A segment of abdominal aorta was transplanted orthotopically from C57BL/6 to Balb/c mice. The grafts were harvested at 3rd day, 2nd week, 4th week and 6th week after the operation and studied by light and electronic microscopy. Regional changes in the lumen and intima were measured with computer imaging analysis system. EPC from peripheral blood were quantified by flow cytometry. Results Endothelium injury and inflammatory cells infiltration were seen in the aortic allografts at 3rd day after transplantation.Neointimal lesions and acute rejection were observed as early as 2nd week after surgery. The lumen of allografts was significantly narrowed due to neointima hyperplasia and had progressed at 4th and 6th week postoperatively. The number of circulation EPC was increased from 1 st day after operation and reached the peak at 3rd day. Thereafter the number of EPC was decreased rapidly and significantly less at 14th and 28th day postoperation than that pre-operation. Conclusion Abdominal aortic transplantation from C57BL/6 to Balb/c mice presents typical pathological feature of transplant arteriosclerosis. The number of EPC from peripheral blood is related to the process of injured endothelial repair and neointima formation of aortic grafts. EPC count may be considered a novel biological marker and therapeutic intervention for transplant arteriosclerosis.

Evaluating acute rejection after heterotopic cardiac transplantation in rats by speckle tracking imaging / 中华超声影像学杂志

Objective To examine whether speckle tracking imaging(STI) could provide for the assessment of acute cardiac rejection. Methods Hearts from Brown Norway rats or Lewis rats were transplanted into other Brown Norway rats. Isografts and groups of allografts either untreated or treated with cyclosporin A (CsA) at a low dose (3 mg ·kg-1 ·d-1) or high dose (10mg · kg-1 ·d-1) from 1　day before transplantation were compared at posttransplantation day 7. Results Echocardiography-derived left ventricular post wall thickness was increased only in untreated allografts. The left ventricular eject fraction was significant lower in the allografts compared with isograft, but allografts treated without or with low-dose CsA showed similar results. The radial systolic radial strain rate showed a lower value in untreated allografts than other grafts,but there was no significant differences between allograft treated with high- or low-dose CsA and isografts. The circumferential strain and circumferential strain rate was comparable among the 4 groups. However the radial strain exhibited a clear gradient in these groups [(2. 8 ± 1.3)％ in untreated allografts, (5.2 ± 0.9)％ in allografts treated with low-dose CsA, (6.3 ± 1.8 )％ in allografts treated with high-dose CsA,and (12.7 ± 7.9) in isografts, P＜0.001]. The radial strain exhibited a clear correlation with the severity of rejection ( r =-0.812, P＜ 0.0000). Conclusions The radial strain decreased as the severity of rejection worsen. STI offers promise as a noninvasive method for detecting transplant allograft rejection.

The characters of infections after heart transplantation: prevention and management / 中华器官移植杂志

Objective To explore the incidence and etiology of infection after heart transplantation and discuss the prophylaxis and management. Methods Retrospective study was conducted on the 140 survival heart transplant recipients (HTs) with detail follow-up information. All patients received preventive therapy against bacterial infections postoperatively, of which 87. 8% patients used antiviral drugs to prevent cytomegalovirus (CMV) infection. The immuosuppressive regiment was as follows: tacrolimus (Tac) or cyclosporine A (CsA), mycophenolate mofetil (MMF),glucocorticoid. Postoperatively all patients had throat swabs, sputum smear Gram stain, sputum culture, blood culture, urine culture and fecal culture for microbiological monitoring. Schedule tables were made to record and analyze the demography of the patients and the timetable of infections. Results The incidence of infections was 42.9 episodes per 100 HTs. Sixty-four cases (76. 2% ) of the infections occurred in the first month after transplantation and all recovered, 20 cases (23.8%) took place after 1 months, and 4 patients died. Conclusion Perioperative infections are mostly caused by bacteria and the prognosis is good. Infections 2 months after operation are commonly caused by virus or fungi with poor prognosis.

TGF-β1 expression and distribution in the extracellular matrix of the dissected wall of thoracic aorta / 中华胸心血管外科杂志

Objective Mechanisms for the dissection of aorta, a devastating disease, remain unknown. Studies showed that cytokine transforming growth factor (TGF)-131, a multifunctional regulator, was highly expressed in the aneurysms or dis-section of aorta and was responsible for the onset of the diseases. We try to explore the mechanisms of thoracic aortic dissection (TAD) by comparing the expression and distribution of TGF-β1 in the aortic wall and analyzing the association of TGF-β1 with extracellular matrix (ECM) in patients with TAD and control subjects. Methods Aortic specimens taken from surgical pa-tients with TAD( n = 20 ) at Zhongshao Hospital and organ donors ( n = 20, controls) were prepared with paraffin embedded tis-sue slide. ECM was investigated with hematoxylin-eosin, Verhoeff van-Giesen (EVG) and Maason's triehrome (MT) staining.Distribution and expression of TGF-β1 within aortic wall was examined with double immunofluoreseent staining and semi-quan-tiffed by fluoreseent intensity analysis. The expression of TGF-β1 in the two groups and among various layers of the arterial wall was compared. Results TAD was morphologically characterized by decreased and disrupted elastic fibers in the tunica media of the aorta wall with hyperplasia of the collagen fibers. TGF-β1 was expressed unevenly within aortic wall, with highest in the media, followed by intima and adventitia, in both TAD patients and eantrols. Specimen from TAD patients exhibited overall in-creased TGF-β1 expression by 9.56% as compared with that from the controls ( P <0.05 ). TGF-131 expression was increased by 16.09% (P<0.05) in the media and 16.75% (P<0.05) in the adventitia in TAD group as compared with those in the control group, but no difference was detected in intima between the two groups. TGF-β1 distribution histogram analysis dis-closed that TGF-β1 expression in the tunica media was evident in the elastic fibers, and was increased by 34.83% in TAD pa-tients as compared with that in the controls (P <0. 01 ). No significant associations between TGF-β1 expression and age, gen-der, maximal aortic diameter and type of dissection in TAD patients were detected. Conclusion TGF-β1 expression is up-reg-ulated and unevenly distributed in the dissected aortic wall of TAD patients. The finding that TGF-β1 was significantly up-regulated and condensed in the elastic fibers of the tuniea media suggested the crucial role of TGF-β1 in the development of TAD.

Evaluation of cardiopulmonary allograft function for a combined heart-lung transplantation patient survived 5 years / 复旦学报（医学版）

Objective To evaluate the cardiopulmonary allograft function and to analyze key factors for long-term survival of heart-lung transplantation in a patient survived more than 5 years. Methods On December 17th, 2003 at Zhongshan Hospital of Fudan University, a homologous heart-lung transplantation was performed on a female who diagnosed with cardiopulmonary failure secondary to congenital atrial septal defect with severe pulmonary hypertension. Heart-lung allograft was preserved with 1 000 mL UW solution and 4 000 mL HTK solution.Postoperative immunosuppressive therapies were managed with Zenapax, cyclosporine A (or tacrolimus), mycophenolate mofetil and corticosteroids. Cyclosporine A maintained with serum trough levels of 100-200 μg/L and tacrolimus with serum trough levels of 8-20 μg/L. Cardiopulmonary allograft functions were evaluated by echocardiogram, pulmonary function test and thoracic CT periodically. Results The patient survived operation and experienced normal daily life with NYHA cardiac function of class Ⅰ-Ⅱ during the follow-up of 5 years and 6 months. Echocardiogram showed left ventricular ejection fraction of 65% to 86%. Pulmonary function test exhibited with nearly normal oxygen exchange, meanwhile, small airway obstruction was detected from one year after operation and keeping stable from then on. Two episodes of severe pneumonia were complicated and treated with antibiotics and fhconazob, no severe acute allograft rejection episode was experienced. Conclusions Heart-lung transplantation proves to be a reliable therapy modality for terminal cardiopulmonary failure. Excellent donor organ preservation, accurate balance of the risk between acute allograft rejection and infection, and strict preventive measures against infection are key factors for long-term survival of heart-lung transplantation.

A review of the therapy of aged lung cancer / 肿瘤研究与临床

The article briefly reviews the aged lung cancer in epidemiology, physical and pathologic traits, and treatments. It includes the matters needing attention of operation with elder lung cancer patients; matters about the radiotherapy; choice of chemotherapeutics or dosage; situation of targeted drug and treatment of Chinese Medicine. Goals of treatment with elder lung cancer patients are prolonging lifetime, improving quality of life. Patients should be treated individually according to their state of illness and constitutions.

Evaluation of left ventricular systolic and twist function in patients with heart transplantation using ultrasound speckle tracking imaging / 中华超声影像学杂志

Objective To investigate the feasibility of ultrasound speckle tracking imaging(STI)in assessing left ventricular(LV)systolic and twist function in patients with heart transplantation.Methods Nine patients with heart transplantation and 10 subjects with normal LV function were examined by GE Vivid 7 with a M3S probe.Eighteen regional peak systolic strain and displacement in longitudinal,radial,circumferential,and 18 regional degree of rotation were measured respectively.Results The segmental regional peak systolic strain and displacement were less than those in subjects with normal LV function(P ＜0.05),but segmental regional degree of rotation was more than that in subjeets with normal LV function (P＜0.05).Conclusions STI may provide a noninvasive,simple and quick tool for evaluation of left ventricular systolic and twist function in patients with heart transplantation.

Development of multimedia network testing system on "three-primary" training / 医疗卫生装备

Objective To develop multimedia network testing system on"three-primary" Training.Methods Java was used to develop the application program,MySQL was used to establish database of test questions.The stable communication protocol(SOAP,Web service,etc.) and link were applied.Results With this system,random test questions and choices are provided;questions are answered by human-computer interaction;answer time is restricted;the paper is automatically scored;database of test questions is managed openly;test paper is automatically set.Conclusion This testing system is highly automatic,secure,impersonal,extensible,stable,open and efficient.

Pingfei Mixture's two-way adjustment to cell proliferation in mice with tumor / 中西医结合学报

OBJECTIVE: To study the antineoplastic mechanism of Pingfei Mixture. METHODS: Thirty C57BL mice bearing Lewis pulmonary carcinoma were randomly divided into 3 groups: saline control group, Pingfei Mixture group and cisplatin group. Fifteen days later, tumor tissues and spleens were taken out and made into unicellular suspension. Argyrophil staining was taken to carcinoma cells and cultured T cells. KL-2 style cell image analysis system was used to analyze the rate between AgNORs and nuclear region (I.S). RESULTS: There were dense brownish-black granules in tumor cell nuclear of saline control group. The brownish-black granules of Pingfei Mixture group and cisplatin group were less than those of saline control group. The differences of T cell I.S in these three groups were significant. The I.S of Pingfei Mixture was higher than that of the other groups, and the I.S of the cisplatin group was the lowest. CONCLUSION: Pingfei Mixture can inhibit tumor cell proliferation, although the effect is inferior to cisplatin. Pingfei Mixture can also promote T cell proliferation and its effect was superior to cisplatin.