The role and clinical significance of microRNA-29a-3p in the development of hypopharyngeal carcinoma

Abstract Objective MicroRNA-29a-3p has been reported in a variety of cancers, but its role in hypopharyngeal cancer remains unclear. This study was to determine the role of microRNA-29a-3p in the occurrence and development of hypopharyngeal cancer. Methods 40 patients with hypopharyngeal cancer who underwent surgery in the Affiliated Hospital of Jining Medical University from April 2013 to November 2017 were selected for this study. The cancer tissue samples of the patients were collected, and the patients were followed up for three years. The expression of microRNA-29a-3p in tissue samples was detected by in situ hybridization with fluorescent probe, and the relationships among microRNA-29a-3p and clinicopathological factors, postoperative recurrent-metastasis, survival time were studied. Immunohistochemical was used to detect the expression of Ki67 and E-cadherin in tissue samples. Results Combined with HE staining results showed that microRNA-29a-3p expression was relatively high in non-cancer tissue cells (red blood cells and fibroblasts in tumor interstitial vessels), but was relatively low in cancer tissue and cells. According to the follow-up data of 40 patients with hypopharyngeal cancer, tumor size, T-stage, tumor differentiation, postoperative recurrent-metastasis of hypopharyngeal cancer patients were significantly negatively correlated with microRNA-29a-3p (p< 0.05). Immunohistochemica results further confirmed that microRNA-29a-3p was negatively correlated with the expression of Ki67 and E-cadherin. The survival time of patients positively related with microRNA-29a-3p expression (p< 0.05). Moreover, ROC curve analysis showed that the area under the curve of the combined detection of miRNA-29a-3p+Ki67+E-cadherin was larger than that of the single detection of the three indexes. Conclusions The expression of microRNA-29a-3p is closely related to the occurrence, development and prognosis of hypopharyngeal cancer, and it affects the proliferation and invasion. This indicates that microRNA-29a-3p serves as a therapeutic target for the occurrence and development of hypopharyngeal cancer. The evidence of study designs of this study is IV using "Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence".

Analysis of the clinicopathological characteristics of thymoma patients and the influencing factors for prognosis / 中国胸心血管外科临床杂志

@#Objective     To analyze the clinicopathological characteristics of thymoma patients and the influencing factors for prognosis. Methods     Thymoma patients who received treatment in Sichuan Cancer Hospital from March 2015 to March 2021 were collected. Clinical data of the patients were analyzed using Kaplan-Meier and Cox regression analyses. Results     A total of 177 patients were included. There were 89 males and 88 females aged 17-88 (52.3±13.0) years, including 160 surgical patients and 17 non-surgical patients. There were 160 patients survived, 17 died of thymoma, and 5 had recurrence and metastasis. Overall, the 1-year, 3-year and 5-year progression-free survival rates were 94.4%, 88.7%, 88.1%, respectively; the 1-year, 3-year and 5-year overall survival rates were 94.9%, 91.5%, 91.0%, respectively. The Kaplan-Meier analysis showed that World Health Organization classification, clinical symptoms, Masaoka-Koga staging, treatment methods and surgery were statistically associated with progression-free survival; clinical symptoms, age, treatment methods and surgery were statistically associated with overall survival (P<0.05). Patients with younger age (P=0.018), without clinical symptoms (P=0.039), and with surgical treatment (P=0.004) had higher overall survival rates; those patients undergoing surgery had a higher progression-free survival rate (P=0.002). Conclusion     Age, clinical symptoms and surgical treatment are independent factors influencing the prognosis of patients with thymoma.

Survival analysis on patients with occupational pneumoconiosis in Guangdong Province from 1980 to 2019 / 中国职业医学

Objective: To study the survival time and its risk factors of patients with occupational pneumoconiosis. Methods: A total of 11 011 newly diagnosed occupational pneumoconiosis patients in Guangdong Province from 1980 to 2019 were selected as study subjects. The life table method was used for survival analysis. The influencing factors of survival time of occupational pneumoconiosis patients were analyzed using the WilCoxon (Gehan) test and Cox proportional hazards regression model. Results: The median survival time of pneumoconiosis patients was 26.0 years. The median survival period of stage Ⅰpatients was 3.5 years longer than that of stage Ⅱ patients and 10.1 years longer than that of stage Ⅲ patients. The median survival time of patients with an initial diagnosis age under 40.0 years old was 34.8 years longer than that of patients with an initial diagnosis age over 60.0 years old. The median survival time of patients with dust exposure duration under 25.0 years old was 13.6 years longer than patients with dust exposure duration age over 45.0 years old. The results of the Cox proportional hazards regression model showed that the initial diagnosis stage, initial diagnosis age, dust exposure duration, and medical insurance were risk factors of the survival time of occupational pneumoconiosis patients (all P<0.01). The risk of reduced survival time for patients with stage Ⅱ and stage Ⅲ as the initial diagnosis stage was 1.15 and 2.04 times higher, respectively, compared with stage Ⅰ patients (both P<0.01). The risk of reduced survival time for patients without medical insurance was 60.22 times higher than those with medical insurance (P<0.01). Conclusion: The risk factors of the survival time of occupational pneumoconiosis patients in Guangdong Province are initial diagnosis stage, initial diagnosis age, the dust exposure age, and medical insurance. Earlier detection, earlier diagnosis, and improvement of medical insurance coverage for patients can effectively improve the survival time of occupational pneumoconiosis patients.

Relationship between the number of peripheral blood endothelial progenitor cells and survival time in individuals aged 75 and older / 中华老年医学杂志

Objective:To investigate the relationship between the number of epithelial progenitor cells(EPCs)in peripheral blood and blood parameter values in order to clarify the relationship between peripheral blood EPCs and the length of survival in elderly individuals aged 75 and beyond.Methods:Analysis was conducted on 114 individuals ≥75 years recruited from the Department of Geriatrics, Tianjin Medical University General Hospital in 2008.Clinical data were collected with December 31, 2020 as the end of the follow-up.Associations between peripheral blood EPC numbers, blood parameter values and all-cause mortality were analyzed.Results:In low and high EPC groups based on orthogonal partial least squares-discriminant analysis(OPLS-DA), D-Dimer was found to be a potential classification marker[the variable importance in projection(VIP)=4.750], out of a panel of blood tests.Blood parameters such as red blood cells(RBC), hemoglobin(HGB), hematocrit(HCT), aspartate aminotransferase(AST), gamma-glutamyl transferase(GGT), lactate dehydrogenase(LDH)and D-Dimer showed statistically significant differences between groups with different levels of EPCs(all P<0.05). Blood EPC numbers were positively correlated with RBC, HGB and HCT and negatively correlated with GGT and D-Dimer in older individuals( r=0.364, 0.343, 0.336, -0.312, -0.312, P<0.05 for all). The number of circulating EPCs had a significant positive correlation with survival time in older individuals( r=0.234, P=0.017). Based on the data of the long-term(12-years)follow-up, Logistic regression analysis suggested that the number of EPCs, age, and HCT were associated with all-cause mortality events in older individuals( OR=0.971, 1.585, 1.231, P=0.013, 0.012, 0.029). Conclusions:EPCs in the peripheral circulation may be involved in the progression of various conditions such as anemia, cardiac, hepatic and renal injury, and coagulation.The number of circulating EPCs may influence the survival of elderly individuals ≥75 years.Age and HCT may be risk factors for all-cause mortality events, whereas the number of EPCs may be a protective factor.

A Real-world Study on the Incidence and Outcome of Immune-related Adverse Events in Lung Cancer Patients / 中国肺癌杂志

BACKGROUND@#Immune-related adverse events (irAEs) are commonly occurred in patients treated with immune checkpoint inhibitors. However, evidence of irAEs derived from the Chinese population is relatively lacking. The aim of this study was to investigate the incidence and outcomes of irAEs in Chinese patients with lung cancer after receiving immune checkpoint inhibitors (ICIs).@*METHODS@#Clinical and follow-up data from lung cancer patients who received at least one time of ICIs from January 2018 to September 2021 at Huadong Hospital, Fudan University were included. Statistical descriptions and Kaplan-Meier method were used to analyze the overall incidence of irAEs, as well as the incidence and outcomes of each type of irAEs.@*RESULTS@#135 patients were included in the study. 106 patients (78.5%) presented at least one type of irAEs, and the median time to first irAEs onset was 28 d. Most irAEs occurred at early time after treatment, and most irAEs were mild-moderate and reversible. 57 patients (42.2%) died at the study cutoff. The mortality rate of severe irAEs was 12.6% (n=17), and among them 7 patients (41.2%) died of pneumonitis. The median progression-free survival (PFS) and overall survival (OS) time of the total population was 505 d (95%CI: 352-658) and 625 d (95%CI: 491-759), respectively. Patients who presented any irAEs achieved a longer PFS than those who did not (median PFS: 533 d vs 179 d, P=0.037, HR=0.57), while patients who presented skin toxicities achieved a longer OS than patients who did not (median OS: 797 d vs 469 d, P=0.006, HR=0.70).@*CONCLUSIONS@#In real-world settings, irAEs in lung cancer patients were commonly observed, with pneumonitis as the most common fatal irAEs. In addition, patients who presented any irAEs may tend to achieve a longer PFS.

Supervivencia en pacientes con fibrosis quística / Survival in Patients with Cystic Fibrosis

Introducción: La fibrosis quística ha dejado de ser una enfermedad pediátrica para ser una enfermedad crónica del adulto. Existen múltiples factores que condicionan la supervivencia de estos enfermos. Objetivo: Determinar la sobrevida de pacientes pediátricos con fibrosis quística hospitalizados en un centro especializado. Métodos: Estudio retrospectivo de cohorte cuyo universo lo conformaron 27 pacientes incluidos en el Registro Provincial de Fibrosis Quística de Granma, 2003-2018. Se analizaron variables: edad actual y sexo, variante genética, presencia de gérmenes, formas clínicas, y supervivencia a partir del diagnóstico y tratamiento. Se utilizó el método de Kaplan-Meier y Log-Rank Test, para un nivel de significación de 95 por ciento. Resultados: El 40,7 por ciento de los pacientes declaró tener actualmente más de 15 años, predominó el sexo masculino (63 por ciento), y la mutación F508 del en su variante genética heterocigótica (44,4 por ciento). El promedio de supervivencia resultó en 21,4 años, no existieron diferencias significativas según sexo, formas clínicas y tipos de gérmenes. Conclusiones: Los pacientes con fibrosis quística en Granma, Cuba mostraron un promedio de supervivencia de 21,4 años, inferior a lo documentado en países desarrollados. El Estado cubano garantiza recursos para la atención de estos pacientes, a pesar de las dificultades económicas del país(AU)

Introduction: Cystic fibrosis is no longer a pediatric disease but a chronic adult disease. There are multiple factors that condition the survival of these patients. Objective: To determine the survival of pediatric patients with cystic fibrosis hospitalized in a specialized center. Methods: Retrospective cohort study whose universe consisted of 27 patients included in the Granma provincial cystic fibrosis registry, 2003-2018. Variables were analyzed: current age and gender, genetic variant, presence of germs, clinical forms and survival after diagnosis and treatment. The Kaplan-Meier method and Log-Rank Test were used, for a significance level of 95 percent. Results: 40.7 percent of patients are currently over 15 years of age, male sex predominates (63 percent) and the F508del mutation in its heterozygous genetic variant (44.4 percent). The average survival is 21.4 years, there were no significant differences according to gender, clinical forms and types of germs. Conclusions: The average survival rate of patients with cystic fibrosis in Granma, Cuba, is 21.4 years, lower than that documented in developed countries. The Cuban State guarantees resources for the care of these patients, despite the country's economic difficulties(AU)

What is the best method for long?term survival analysis?

In the Cox proportional hazards regression model, which is the most commonly used model in survival analysis, the effects of independent variables on survival may not be constant over time and proportionality cannot be achieved, especially when long-term follow-up is required. When this occurs, it would be better to use alternative methods that are more powerful for the evaluation of various effective independent variables, such as milestone survival analysis, restricted mean survival time analysis (RMST), area under the survival curve (AUSC) method, parametric accelerated failure time (AFT), machine learning, nomograms, and offset variable in logistic regression. The aim

A Propensity Score Matching Study of Autologous Hematopoietic Stem Cell Transplantation and New Drug Chemotherapy for Newly Diagnosed Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To compare the clinical efficacy, survival, and prognosis of autologous hematopoietic stem cell transplantation (ASCT) with new drug chemotherapy in the treatment of newly diagnosed multiple myeloma (NDMM) in the new drug era.@*METHODS@#The clinical data of 149 patients with NDMM treated with new drug induction regimen in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2012 to December 2019 were retrospectively analyzed. Twenty-four patients who received ASCT were in ASCT group, and 125 patients who did not receive ASCT were in non-ASCT group. The median follow-up time was 43 (1-90) months. The propensity score matching (PSM) method was used to balance confounding factors, then depth of response, overall survival (OS), and progression-free survival (PFS) between the two groups were compared and subgroup analysis was performed.@*RESULTS@#After matching, the covariates were balanced between the two groups. Fifty-one patients (15 cases in ASCT group and 36 cases in non-ASCT group) were included. ASCT patients had a better complete response (CR) rate than non-ASCT patients receiving maintenance therapy (93.3% vs 42.3%, P=0.004), while there were no statistical differences in deep response rate and overall response rate (ORR) between the two groups (93.3% vs 65.4%, P=0.103; 93.3% vs 96.2%, P=1.000). Before matching, the 3 and 5-year PFS rate and median PFS (mPFS) in ASCT group and non-ASCT group were [89.6% vs 66.5%, P=0.024; 69.8% vs 42.7%; non-response (NR) vs 51.0 months], and the 3 and 5-year OS rate and median OS (mOS) were (100% vs 70.6%, P=0.002; 92.3% vs 49.6%; NR vs 54.0 months). After matching, the 3 and 5-year PFS rate and mPFS in ASCT group and non-ASCT group were (83.6% vs 61.7%, P=0.182; 62.7% vs 45.7%; NR vs 51.0 months), the 3 and 5-year OS rate and mOS were (100% vs 65.6%, P=0.018; 88.9% vs 46.9%; NR vs 51.0 months). Subgroup analysis showed that patients with mSMART 3.0 high risk stratification, the 3-year PFS rate and mPFS in ASCT group and non-ASCT group were (83.3% vs 41.5%, P=0.091; NR vs 34.0 months), and the 3-year OS rate and mOS were (100% vs 41.5%, P=0.034; NR vs 34.0 months). Patients with mSMART 3.0 standard risk stratification, the 3-year PFS rate and OS rate in ASCT group and non-ASCT group were (83.3% vs 76.8%, P=0.672; 100% vs 87.2%, P=0.155). The 3-year PFS and OS rate in MM patients who achieved deep response within 3 months after transplantation compared with non-ASCT patients who achieved deep response after receiving maintenance therapy were (83.1% vs 56.7%, P=0.323; 100% vs 60.5%, P=0.042), and the 3-year PFS and OS rate in patients who achieved overall response in both groups were (83.1% vs 62.5%, P=0.433; 100% vs 68.1%, P=0.082). After matching, Cox multivariate regression analysis showed that mSMART 3.0 risk stratification and ASCT were independent prognostic factors for OS.@*CONCLUSION@#In the new drug era, ASCT can increase CR rate and prolong OS of NDMM patients. ASCT patients who are mSMART 3.0 high risk stratification or achieved deep response within 3 months after transplantation have better OS than non-ASCT patients receiving new drug chemotherapy. ASCT and mSMART 3.0 risk stratification are independent prognostic factors for OS in NDMM patients.

Therapeutic effect of Panax notoginseng saponins combined with cyclophosphamide in mice bearing hepatocellular carcinoma H22 cell xenograft / 南方医科大学学报

OBJECTIVE@#To investigate the therapeutic effects of total saponins from Panax notognseng (PNS) combined with cyclophosphamide (CTX) in mice bearing hepatocellular carcinoma H22 cell xenograft.@*METHODS@#We examined the effects of treatment with different concentrations of PNS on H22 cell proliferation for 24 to 72 h in vitro using CCK8 colorimetric assay. Annexin V/PI double fluorescence staining was used to detect the effect of PNS on apoptosis of H22 cells. Mouse models bearing H22 cell xenograft were established and treated with CTX (25 mg/kg), PNS (120, 240 or 480 mg/kg), alone or in combinations. After treatments for consecutive 10 days, the mice were euthanized for examinations of carbon clearance ability of the monocytes and macrophages, splenic lymphocyte proliferation, tumor necrosis factor (TNF-α), interleukin-2 (IL-2), serum hemolysin antibody level, blood indicators, and the tumor inhibition rate.@*RESULTS@#Treatment with PNS concentration-dependently inhibited the proliferation and significantly promoted apoptosis of cultured H22 cells (P < 0.01). In the tumor-bearing mouse models, PNS alone and its combination with CTX both resulted in obvious enhancement of phagocytosis of the monocyte-macrophages, stimulated the proliferation of splenic lymphocytes, promoted the release of TNF-α and IL-2 and the production of serum hemolysin antibody, and increased the number of white blood cells, red blood cells and lymphocytes in the peripheral blood. Treatment with 480 mg/kg PNS combined with CTX resulted in a tumor inhibition rate of 83.28% (P < 0.01) and a life prolonging rate of 131.25% in the mouse models (P < 0.05).@*CONCLUSION@#PNS alone or in combination with CTX can improve the immunity and tumor inhibition rate and prolong the survival time of H22 tumor-bearing mice.

Preliminary survival analysis of postoperative simultaneous radiochemotherapy with hyperthermia in glioblastoma patients / 中华放射肿瘤学杂志

Objective:To initially investigate whether simultaneous radiochemotherapy with hyperthermia can prolong the survival of glioblastoma (GBM) patients.Methods:Clinical data of 61 GBM patients undergoing surgery in our hospital from September 2016 to June 2019 were retrospectively analyzed. According to different treatment methods, all patients were divided into the control group ( n=34) and observation group ( n=27). In the control group, three-dimensional radiotherapy with a dose of 60 Gy combined with temoazolamine chemotherapy was delivered. In the observation group, simultaneous radiochemotherapy with 15-20 cycles of hyperthermia at 40-41℃ was supplemented. The survival time was calculated by Kaplan-Meier method, and the survival time was compared with log-rank test between two groups. Results:The median progression-free survival in the observation group was significantly longer than that in the control group (14.33 months vs.9.94 months, P<0.05). The median overall survival in the observation group was also remarkably higher than that in the control group (18 months vs. 14 months, P<0.05). Conclusions:Simultaneous radiochemotherapy with hyperthermia is innovatively applied to treat GBM after surgical resection. Preliminary findings demonstrate that compared with chemoradiotherapy, simultaneous radiochemotherapy with hyperthermia can prolong the survival time of GBM patients.

Chinese Medicine Treatment Prolonged Survival in Small Cell Lung Cancer Patients: A Clinical Observation / 中国结合医学杂志

OBJECTIVE@#To evaluate the effect of Chinese medicine (CM) treatment on survival time and quality of life (QOL) in patients with small cell lung cancer (SCLC).@*METHODS@#This was an exploratory and prospective clinical observation. Patients diagnosed with SCLC receiving CM treatment were included and followed up every 3 months. The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS) and QOL.@*RESULTS@#A total of 136 patients including 65 limited-stage SCLC (LS-SCLC) patients and 71 extensive-stage SCLC (ES-SCLC) patients were analyzed. The median OS of ES-SCLC patients was 17.27 months, and the median OS of LS-SCLC was 40.07 months. The survival time was 16.27 months for SCLC patients with brain metastasis, 9.83 months for liver metastasis, 13.43 months for bone metastasis, and 18.13 months for lung metastasis. Advanced age, pleural fluid, liver and brain metastasis were risk factors, while longer CM treatment duration was a protective factor. QOL assessment indicated that after 6 months of CM treatment, scores increased in function domains and decreased in symptom domains.@*CONCLUSION@#CM treatment might help prolong OS of SCLC patients. Moreover, CM treatment brought the trend of symptom amelioration and QOL improvement. These results provide preliminary evidence for applying CM in SCLC multi-disciplinary treatment.

Application of enhanced recovery after surgery in abdominal tumor surgery / 中国肿瘤临床

Enhanced recovery after surgery (ERAS) represents a transformation to the evidence-based medicine paradigm in perioperative treatment. ERAS aims to reduce recovery time, postoperative complications, and healthcare costs. Here, we review the development and principal components of ERAS along with its application in abdominal tumor surgery. The benefits and feasibility of the ERAS protocol have been demonstrated in clinical practice, particularly in relation to colorectal surgery.

Clinical relationships between the rs2212020 and rs189897 polymorphisms of the ITGA9 gene and epithelial ovarian cancer

To better understand the role of integrin subunit alpha 9 (ITGA9) gene polymorphism in epithelial ovarian cancer (EOC), we investigated the distribution of ITGA9 gene polymorphisms (rs2212020 and rs189897) and revealed whether these polymorphisms were associated with a curative effect in EOC. It was found that rs2212020 and rs189897 were correlated significantly with EOC incidence. The frequency of the C allele of rs2212020 was significantly higher in EOC patients than in the control group (P = 0.009, χ2 = 6.857). The population with the C allele of rs2212020 had a higher EOC risk than the population with the T allele (hazard ratio = 1.97, 95.0% CI = 1.178−3.299). Further, our results showed that the CC genotype was a risk factor for EOC. Regarding the association between ITGA9 and the sensitivity to platinum-based chemotherapy in EOC, there were no statistically significant differences in the frequencies of the rs189897 and rs2212020 polymorphisms between the chemosensitivegroup and the control group. In multivariate analysis, the patients with the TT genotype of rs189897 had longer progression free survival (PFS) than the patients without this genotype (P = 0.010, OR = 2.491). The AT genotype of rs189897 was a risk factor for PFS in EOC. These findings suggested that rs189897 and rs2212020 could play important roles in EOC diagnosis and prognosis.

Research progress on traditional Chinese medicine in treatment of castration-resistant prostate cancer / 中草药

The incidence of prostate cancer is increasing, and inevitably progresses to castration-resistant prostate cancer. Although the treatment is constantly updated, the prognosis is still not optimistic. Because of its unique advantages of effect-enhancing and toxicity-reducing, improving quality of life, and prolonging survival time, Chinese medicine has occupied a very important position in the treatment of castration resistant prostate cancer. This article summarizes the clinical and basic research of traditional Chinese medicine in the treatment of castration-resistant prostate cancer, and provides reference for clinical treatment and basic research.

Survival rate and the determinants of progression from HIV to AIDS and from AIDS to the death in Iran: 1987 to 2016

Objective: To examine the prognostic factors of progression from HIV to AIDS and AIDS to the death in people living with HIV/AIDS in Iran. Methods: In this registry-based retrospective cohort study, we recruited 28 873 HIV-infected people from 158 Behavioral Diseases Counseling Centers of Iran. Two outcomes of interest included survival rates from HIV diagnosis to AIDS and from AIDS to the death. We used Kaplan-Meier and Cox regression model to investigate survival rate and factors affecting on survival controlling effect of confounding factors. Results: The one, three, five, and ten-year survival rate from HIV to AIDS were 85%, 73%, 61% and 32%, and for AIDS to death were 90%, 81%, 74% and 55%, respectively. Multivariate Cox regression analysis indicated that the risk of progression from AIDS phase toward death in individuals with CD4 less than 200/mm3, infected with tuberculosis (TB) and not treated by antiretroviral therapy (ART) was 2.17 (95% CI: 1.62-2.90), 1.49 (95% CI: 1.01-2.20) and 4.88 (95% CI: 3.42-6.96) times higher respectively. The risk of progression to AIDS in patients with baseline CD4 less than 200/mm3 was 2.32 (95% CI: 2.14, 2.51) times higher than patients with CD4 > 200/mm3 (P=0.001). On the other hand, tuberculosis increases the risk of death by 49.0% (P=0.04). The hazard ratio of death in patients who did not receive ART was 4.88 (95% CI: 3.42, 6.96) times higher than patients who received ART (P<0.001). Conclusion: The early detection of HIV, the screening and treatment of TB and receiving the ART improve the survival of HIV/AIDS patients significantly, and prevent the transmission of HIV to other people.

Treatment of gallbladder carcinoma invading porta hepatis with the conventional surgery approach and the transhepatic hilar approach: A retrospective comparative study / 中国实用外科杂志

OBJECTIVE: To evaluate the clinical efficacy of transhepatic hilar approach exposing porta hepatis for the treatment of gallbladder carcinoma invading porta hepatis. METHODS: The clinicopathological data of patients with gallbladder carcinoma invading porta hepatis who underwent surgical treatment at Department of General Surgery and Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University from January 2007 to December 2017 was collected. There were 39 patients enrolled in the study, including 19 patients in the conventional surgical approach group and 20 patients in the transhepatic hilar approach group. The R0 resection, intraoperative bleeding, postoperative complications and overall survival time were compared between the conventional approach group and the transhepatic hilar approach group. RESULTS: CT and/or MRI were used for preoperative evaluation in the conventional approach group, and CT + MRI + 3 D reconstruction were used in the transhepatic hilar approach group.The accuracy rate of preoperative resectable evaluation was 57.9%(11/19) in the conventional approach group, and 90.0%(18/20) in the transhepatic hilar approach group(P=0.031). The R0 resection rate of the conventional approach group was 26.3%(5/19), while the R0 resection rate of transhepatic hilar approach group was 85.0%(17/20)(P=0.000). The operations of the conventional approach group and the transhepatic hilar approach group were shown as follow: S4 b,5 + extrahepatic bile duct (7/8), S4 b,5,6,7,8 + extrahepatic bile duct (3/6), S4 a,4 b,5,6,7,8 +extrahepatic bile duct (0/1), extended resection(1/3) and others (8/2)(P= 0.156). The number of death within 30 days after surgery in the conventional approach group and the transhepatic hilar approach group was 4 and 0 respectively (P=0.047). Among the hepatectomy patients, the blood loss in the conventional approach group was significantly higher than that in the transhepatic hilar approach group [(660 ± 219.1)mL vs.(358.8 ± 184.8)m L,P=0.006]. The postoperative complication rate of Clavien Ⅲ to Clavien Ⅴwas significantly higher in the conventional approach group [Clavien Ⅲ was72.7% vs. 27.8% (P=0.027), Clavien Ⅳ was 45.5% vs. 0 (P=0.004), and Clavien Ⅴ was 27.3% vs. 0(P=0.045)]. The 1-year survival rate of the conventional approach group and the transhepatic hilar approach group was 21.1%(4/19) and61.1%(11/18)(P=0.020), respectively. The overall survival time of the transhepatic hilar approach group was significantly better than that of the conventional approach group(16.0 months vs. 8.4 months, P=0.0005). CONCLUSION: The transhepatic hilar approach can improve the R0 resection rate, reduce intraoperative blood loss, perioperative mortality and serious complication rate, and improve the overall survival time. CT+MRI+3 D reconstruction can improve the accuracy of preoperative resectable evaluation and reduce unnecessary surgical exploration.

Intraperitoneal chemotherapy combined with intravenous chemotherapy for neoadjuvant chemotherapy in advanced ovarian cancer:a phaseⅠclinical trial / 中国实用妇科与产科杂志

OBJECTIVE: To evaluate the efficacy,safety,and potential benefits of neoadjuvant intraperitoneal chemotherapy(NIPC)in patients with newly diagnosed advanced ovarian cancer.METHODS: From December 2011 to December 2015,in Sun Yat-sen Memorial Hospital of Sun Yat-sen University,27 patients with stage ⅢC-Ⅳ ovarian cancer were enrolled in the study.NIPC was used as the initial treatment.The regimen was paclitaxel(T)intravenous chemotherapy combined with cisplatin/carboplatin(P/C)intraperitoneal chemotherapy.The primary endpoint were complication and toxicity.Secondary endpoints were progression-free survival(PFS)and overall survival(OS).RESULTS: Nine patients completed 3 times of NIPC,7 had once and 7 had twice.Nine patients completed NIPC,18 patients discontinued,includeding disease progression(n=3),patient refusal(n=3),unknown reason(n=3),myelosuppression(n=2),nephrotoxicity(n=2),arrhythmia(n=2),abdominal pain(n=1),diarrhea(n=1),and headache(n=1);there was no treatment-related death.Fourteen accepted intermittent cytoreduction surgery,and 13 were R0.There were 13 patients without surgery,of whom 4 progressed,3 gave up,and 6 had negative CA125.The median follow-up time was 36 months(10-82 months),the median follow-up time was 53.8±5.59 months,the 3-year OS rate was 57.2%,and the median PFS was 20 months(0-82 months);the 3-year PFS rate was 24.7%.CONCLUSION: It is safe and feasible to use NIPC for neoadjuvant chemotherapy in patients with advanced ovarian cancer.It may improve the satisfactory operation rate and prolong survival.

Value of lymph node ratio in prognosis of patients with intrahepatic cholangiocarcinoma / 中华肝胆外科杂志

Objective To determine the value of lymph node ratio (LNR) in prognosis of patients with intrahepatic cholangiocarcinoma (ICC).Methods The pathological and survival data of ICC patients were extracted from the Surveillance Epidemiology and End Result Database (SEER).The value of LNR in prognosis of patients with intrahepatic cholangiocarcinoma was evaluated by the Kaplan-Meier and Cox proportional hazard models.Results A total of 357 pathologically confirmed ICC patients were included in this study (158 males,199 females).The results showed that patients with lymph node metastasis had significantly shorter survival time than patients without metastasis [(41.6 ± 1.8) vs.(23.2 ± 2.2) months,P＜ 0.05].Multivariate analysis on survival showed that the status of lymph node metastasis was independent prognostic factor of survival,after adjusting for age,gender and tumor stage.Only a LNR ≥ 20％ was an independent risk factor of prognosis (HR=2.3,95％CI:1.4～3.8,P＜0.05).Conclusion A positive lymph node ratio was superior to lymph node metastasis in predicting survival in patients with intrahepatic cholangiocarcinoma.

Survival Time and Prognostic Factors of Mortality among Patients with Acquired Immunodeficiency Syndrome in North-East Peninsular Malaysia

@#Background: Death resulting from the acquired immunodeficiency syndrome (AIDS) is a worldwide concern. This study is aimed at determining the overall median survival time, and the prognostic factors of mortality among AIDS-infected patients in North-East Peninsular Malaysia. Methods: In 2018, a retrospective cohort study stretching from January to April was conducted. This study involved a review of data obtained from the National AIDS Registry. A total of 1,073 AIDS cases diagnosed from 1 January 2010 to 31 December 2014 were selected, and followup procedures were conducted until 31 March 2015 (a 3-month follow-up). The Kaplan-Meier plot and Cox’s proportional hazard regression were used for data analyses. Results: 564 (52.5%) patients died due to AIDS, while the remaining 509 (47.4%) were censored. The overall median survival time was 11 months. The probability of survival in 1-year, 2-year, 3-year, 4-year and 5-year periods were 49.1%, 47.8%, 47.3%, 47.0% and 46.7%, respectively. Multiple Cox regression revealed that the significant prognostic factors were age 30– 49 years [adjusted hazard ratio (Adj. HR) 1.57; 95% CI: 1.14, 2.16; P = 0.006], male (Adj. HR 1.39; 95% CI: 1.07, 1.79; P = 0.012), unemployed (Adj. HR 1.40; 95% CI: 1.12, 1.75; P = 0.003) and HIV-TB co-infection (Adj. HR 1.78; 95% CI: 1.37, 2.31; P < 0.001). Conclusion: The overall median survival time among AIDS patients in North-East Peninsular Malaysia was revealed to be short, in comparison to the other studies. The chances for survival can be improved with more emphasis on early detection (to ensure early treatment) and social support, particularly for HIV-TB co-infected patients, as well as for younger and unemployed patients.