Comparison of follow-up treatment regimens for colorectal cancer liver metastases without objective response to neoadjuvant chemotherapy: direct surgery or surgery after second-line chemotherapy / 中华外科杂志

Objective: To compare the effect of direct surgery or surgery after second-line chemotherapy for colorectal cancer patients with liver metastases who did not achieve objective remission after neoadjuvant chemotherapy. Methods: A retrospective case cohort study was used. The clinical and pathological data of 107 patients with colorectal cancer liver metastases who did not achieve objective response to neoadjuvant chemotherapy at Department of Hepatobiliary Surgery,Cancer Hospital,Chinese Academy of Medical Sciences from December 2008 to December 2016 were retrospectively collected. There were 71 males and 36 females, median age was 57 years (range: 28 to 79 years). According to the different treatment regimens after neoadjuvant chemotherapy,107 cases were divided into a direct surgery group (direct group,n=65) and an operation after receiving second-line chemotherapy group (second-line group,n=42). The propensity score matching(PSM) of the Logistic regression model was used to match the bilobar distribution of liver metastases and the number of first-line chemotherapy cycles in the two groups of patients. The caliper value was set to 0.10 and the matching ratio was 1∶2. T test, Mann-Whitney U test, χ2 test or Fisher's exat test was used to analyzed the data between the tuo groups, respectively. Survival analysis design was used to investigate the difference in prognosis between the two groups of patients. Results: The follow-up time(M(IQR)) was 56.3(34.3) months (range: 2.1 to 95.0 months),and all patients were followed up. After PSM,there were 28 cases in the direct group and 42 cases in the second-line group, there were no significant differences in whether R0 resection was feasible,blood loss,blood transfusion,postoperative complications and postoperative hospital stay between the two groups (all P>0.05). The 1,3,and 5-year progression-free survival(PFS) rates of the direct group were 40.0%,16.5%,and 11.0%,and the 1,3,and 5-year overall survival(OS) rates were 98.5%,61.2%,and 41.4%,respectively, the second-line group 1,3,5 years PFS rates were 35.7%,14.3%,14.3%,1,3,5-year OS rate were 95.2%,55.1%,44.4%,respectively. The median PFS time of the direct group and the second-line group was 8.5 months and 7.5 months,respectively,and the difference was not statistically significant (P=0.826). The median OS time of the direct group and the second-line group were 33.8 months and 46.9 months,respectively. The difference was not statistically significant(P=0.646).The median PFS time of the direct group and second-line chemotherapy complete remission and partial remission group(CR/PR group) was 10.2 months and 9.1 months,respectively,and the difference was not statistically significant(P=0.669). The median OS time of the direct group and the second-line CR/PR group was 51.0 months and 46.9 months,respectively,and the difference was not statistically significant(P=0.427). The results of survival analysis suggested that major liver resection was an independent prognosis factor for PFS (HR=1.809,95%CI: 1.067 to 3.067,P=0.028) and OS(HR=2.751,95%CI: 1.317 to 5.747,P=0.007). Second-line chemotherapy was not an independent prognostic factor for PFS (HR=0.945, 95%CI:0.570 to 1.567,P=0.828) and OS (HR=0.866,95%CI: 0.468 to 1.602,P=0.646). Conclusions: There is no significant difference in the short-term outcome and long-term prognosis between direct surgery patients and second-line chemotherapy followed by surgery. Second-line chemotherapy is not an independent prognostic factor for colorectal cancer liver metastases patients who fail to achieve objective response after neoadjuvant chemotherapy.

Effects of different phases IOL implantation on the postoperative visual recovery and complications in patients with traumatic cataract / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the visual recovery and complications in patients with traumatic cataract treated by intraocular lens Ⅰ phase implantation and Ⅱ phase implantation.?METHODS: Totally 86 patients with traumatic cataract (86 eyes) treated in our hospital from January 2014 to December 2016 were enrolled in the retrospective study, and they were divided into the control group ( treated by intraocular lens Ⅰ phase implantation, 46 eyes) and the observation group ( treated by intraocular lens Ⅱ phase implantation, 40 eyes). The general situation of surgery, the visual recovery at 6mo after operation and the incidence rate of complications in two groups were observed.?RESULTS: There were no significant differences in surgical time, intraoperative blood loss and hospitalization time between the two groups (P>0. 05). There was no significant difference in the excellent and good rate of visual acuity between the two groups before operation between the twogroups (P>0. 05). At 6mo after operation, the excellent and good rates of visual acuity in two groups obviously increased ( P<0. 05 ), while there was no significant difference in the excellent and good rates of visual acuity at 6mo after operation between the two groups ( P > 0. 05 ). There was no significant difference between the two groups in the incidence rates of posterior capsule rupture and vitreous body prolapse (P>0. 05). The incidence rates of corneal edema, iridocyclitis and posterior capsular opacification in the observation group after operation were significantly lower than those in control group (P<0. 05).?CONCLUSION:The effects of IOLⅠphase implantation and Ⅱ phase implantation are similar in patients with traumatic cataract, in terms of the general situation and improvement of visual recovery. However, the incidence of complications after Ⅱ phase implantation is relatively lower.

Effect of Huazhuo Jiedu formula on HIF-1α, VEGF, and PTEN in chronic erosive gastritis patients with syndrome of accumulation of turbidity and toxicity / 中国中药杂志

To observe the clinical efficacy of Huazhuo Jiedu formula in treating chronic erosive gastritis (CEG) patients with syndrome of accumulation of turbidity and toxicity, explore its mechanism by observing the changes in expression levels of hypoxia inducible factor (HIF-1α), vascular endothelial growth factor (VEGF) in serum and gastric mucosa tissues after treatment, and provide theoretical basis for the clinical application of Huazhuo Jiedu formula in treating chronic erosive gastritis. All 70 patient of CEG were randomly divided into control group and treatment group, 35 cases in each group. The patients in control group received Alatan Wuwei Wan, bid, 1 bag/time; while the patients in treatment group were given with Huazhuo Jiedu formula, 1 dose/day. The course of the treatment was 6 months in both groups. The changes in clinical symptoms, gastroscopic signs, pathology and the expression levels of HIF-1α, VEGF, and phosphatase and tensin homolog deleted on chromosome ten (PTEN) in serum and gastric mucosa tissues were observed in both groups. The results showed that treatment group was better than control group in clinical efficacy, gastroscopic efficacy and pathological effect after treatment (<0.05); the levels of HIF-1α and VEGF in serum of treatment group were lower than those in the control group after treatment (<0.05), while the level of PTEN in serum of treatment group was higher than that in the control group after treatment (<0.05); the levels of HIF-1α and VEGF in gastric mucosa tissues in the treatment group were lower than those in the control group after treatment, while the level of PTEN in gastric mucosa tissues in treatment group was higher than that in the control group after treatment (<0.05), with statistically significant differences between these two groups (<0.05). Huazhuo Jiedu formula can improve the clinical symptoms, gastroscopic signs and pathological conditions in CEG patients with syndrome of accumulation of turbidity and toxicity, and the mechanism may be associated with decreasing the expression level of HIF-1α, VEGF and increasing the expression level of PTEN.