[Immunogenicity, safety and immune persistence of the sequential booster with the recombinant protein-based COVID-19 vaccine (CHO cell) in healthy people aged 18-84 years].

Objective: To evaluate the immunogenicity, safety, and immune persistence of the sequential booster with the recombinant protein-based COVID-19 vaccine (CHO cell) in healthy people aged 18-84 years. Methods: An open-label, multi-center trial was conducted in October 2021. The eligible healthy individuals, aged 18-84 years who had completed primary immunization with the inactivated COVID-19 vaccine 3 to 9 months before, were recruited from Shangyu district of Shaoxing and Kaihua county of Quzhou, Zhejiang province. All participants were divided into three groups based on the differences in prime-boost intervals: Group A (3-4 months), Group B (5-6 months) and Group C (7-9 months), with 320 persons per group. All participants received the recombinant COVID-19 vaccine (CHO cell). Blood samples were collected before the vaccination and after receiving the booster at 14 days, 30 days, and 180 days for analysis of GMTs, antibody positivity rates, and seroconversion rates. All adverse events were collected within one month and serious adverse events were collected within six months. The incidences of adverse reactions were analyzed after the booster. Results: The age of 960 participants was (52.3±11.5) years old, and 47.4% were males (455). The GMTs of Groups B and C were 65.26 (54.51-78.12) and 60.97 (50.61-73.45) at 14 days after the booster, both higher than Group A's 44.79 (36.94-54.30) (P value<0.05). The GMTs of Groups B and C were 23.95 (20.18-28.42) and 27.98 (23.45-33.39) at 30 days after the booster, both higher than Group A's 15.71 (13.24-18.63) (P value <0.05). At 14 days after the booster, the antibody positivity rates in Groups A, B, and C were 91.69% (276/301), 94.38% (302/320), and 93.95% (295/314), respectively. The seroconversion rates in the three groups were 90.37% (272/301), 93.75% (300/320), and 93.31% (293/314), respectively. There was no significant difference among these rates in the three groups (all P values >0.05). At 30 days after the booster, antibody positivity rates in Groups A, B, and C were 79.60% (238/299), 87.74% (279/318), and 90.48% (285/315), respectively. The seroconversion rates in the three groups were 76.92% (230/299), 85.85% (273/318), and 88.25% (278/315), respectively. There was a significant difference among these rates in the three groups (all P values <0.001). During the sequential booster immunization, the incidence of adverse events in 960 participants was 15.31% (147/960), with rates of about 14.38% (46/320), 17.50% (56/320), and 14.06% (45/320) in Groups A, B, and C, respectively. The incidence of adverse reactions was 8.02% (77/960), with rates of about 7.50% (24/320), 6.88% (22/320), and 9.69% (31/320) in Groups A, B, and C, respectively. No serious adverse events related to the booster were reported. Conclusion: Healthy individuals aged 18-84 years, who had completed primary immunization with the inactivated COVID-19 vaccine 3 to 9 months before, have good immunogenicity and safety profiles following the sequential booster with the recombinant COVID-19 vaccine (CHO cell).

[Prevalence and related factors of CD4+T lymphocytes immune recovery among adult HIV/AIDS on antiretroviral therapy in Dehong Dai and Jingpo Autonomous Prefecture].

Objective: To analyze the longitudinal characteristics of CD4+T lymphocytes (CD4) among the adult HIV/AIDS on antiretroviral therapy (ART) and the related factors. Methods: A retrospective cohort of adult HIV/AIDS starting ART in Dehong Dai and Jingpo Autonomous Prefecture (Dehong) in 2007-2016 was followed up to December 31, 2018. Group-based trajectory models were utilized to identify CD4 subgroups based on immune recovery (whether and when CD4 reached the average level of >500 cells/µl). The demographics and information at ART baseline were described, and the related factors were analyzed with polytomous logistic regression. The SAS 9.4 software was used for statistical analysis. Results: A total of 7 605 adults with HIV/AIDS were included, of which the median (P25,P75) age at ART were 36 (30,43) years old, 61.0% were male, 42.5% were Han nationality, and 60.8% with the education of primary school or below. The follow-up duration M (P25, P75) was 6.1 (4.1,8.1) years. HIV/AIDS in Dehong showed four CD4 trajectory subgroups from low to high: below the average level, primary recovery to a normal level, full recovery to a moderate level, and normal steady level, accounting for 34.4%, 39.8%, 20.6%, and 5.2%, respectively. When compared with corresponding control groups, age <35 years at ART, female, education of middle school or above, sexual transmission, no opportunistic infection, CD4 ≥200 cells/µl, baseline regimen with tenofovir (TDF) and time from HIV diagnosis to ART <1 year were the related factors facilitating the higher CD4 subgroups. Conclusions: The various CD4 immune recoveries of HIV/AIDS were changing patterns after ART. Starting ART with a high CD4 level was beneficial to CD4 recovery to normal level during the follow-up period. Early initiation of ART and exceptional attention to CD4 immune recovery should be encouraged after the ART.

[The effect of diallyl sulfide on the lung tissue of rats poisoned by paraquat].

Objective: To investigate the mechanism of diallyl sulfide (DAS) on paraquat (PQ) - induced acute lung injury in rats. Methods: In May 2016, 32 adult male Wistar rats were randomly divided into control group, model (PQ) group, DAS treatment group and dexamethasone (DXM) treatment group, with 8 rats in each group. PQ poisoning model was established by intragastric administration of PQ solution (70 mg/kg) . 100 mg/kg DAS (DAS treatment group) , normal saline (control group and PQ group) and 1 mg/kg DXM (DXM treatment group) were injected intraperitoneally before and after modeling. After 24 hours, the rats were killed and the degree of lung injury was observed. The expression of inducible nitric oxide synthase (iNOS) in lung tissue was measured. Alveolar macrophages were isolated and cultured. The supernatant was taken to determine the content of NO, and the expressions of iNOS mRNA in alveolar macrophages were detected. Results: Compared with the control group, the pathological injury score and the expression of iNOS in the lung tissue of PQ group were significantly increased, and the content of NO secreted by alveolar macrophages and the expression of iNOS mRNA were significantly increased (P<0.05) . Compared with PQ group, the pathological injury scores and the expressions of iNOS in lung tissue of rats in DAS treatment group and DXM treatment group were significantly decreased, and the contents of NO secreted by alveolar macrophages and the expressions of iNOS mRNA were significantly decreased (P<0.05) . There was no significant difference between DXM group and DAS group (P>0.05) . Conclusion: DAS may have protective effect on acute lung injury induced by PQ in rats.

[The effect of a breathing trainer on relieving airway pressure caused by active cough in patients with mechanical ventilation].

Objective: To explore the effect of a breathing trainer on relieving the peak airway pressure caused by forced exhalation at the end of deep inspiration, gentle coughing at the end of calm inspiration and forced coughing at the end of deep inspiration in patients undergoing mechanical ventilation. Methods: From July to September 2018, 15 patients undergoing mechanical ventilation were selected from the First Affiliated Hospital of Guangzhou Medical University, including 5 patients with invasive ventilation (3 with tracheotomy and 2 with endotracheal intubation), and 10 patients with non-invasive ventilation through mask. The patients included 14 males and 1 female, aging 48-79 years, with an average age of (68±10) years. A Breathing Trainer developed by both Dongguan Yongsheng Medical Products Co., Ltd. and Guangzhou Institute of Respiratory Health was used to relieve the peak airway pressure. A one-way expiratory valve connected with a spring at the expiratory end of the Breathing Trainer was not opened until the pressure inside the airway was higher than 20 cmH(2)O (1 cmH(2)O=0.098 kPa), and opened completely when the pressure was higher than 35 cmH(2)O. Both before and after the Breathing Trainer was connected to the respiratory circuit, the patients were asked to exhale hard at the end of deep inspiration, to cough gently at the end of calm inspiration and to cough forcefully at the end of deep inspiration and the airway pressure were measured respectively. Each action was tested 3 times, and the interval time of each test was 1 min, and the interval of each action was 10 min. Results: Among the patients with tracheotomy or endotracheal intubation for invasive mechanical ventilation, when the patients exhaled hard at the end of deep inspiration,coughed gently at the end of gentle inspiration and coughed forcefully at the end of deep inspiration, the peak airway pressure measured before the ventilation circuit was connected to the Breathing Trainer was (30.0±4.5), (31.4±5.0) and (34.9±5.0)cmH(2)O, respectively, which was significantly higher than that after the ventilation circuit was connected to the Breathing Trainer(26.3±2.9), (26.7±3.5) and (29.0±4.1) cmH(2)O (all P<0.01). Among the patients with non-invasive mechanical ventilation wearing face masks, when the patients exhaled hard at the end of deep inspiration, coughed gently at the end of gentle inspiration and coughed forcefully at the end of deep inspiration, the peak airway pressure was (17.7±1.9), (16.6±2.5) and (18.9±2.5) respectively, before the ventilation circuit was connected to the Breathing Trainer, and was (18.9±2.5), (16.3±1.9) and (18.8±2.0) cmH(2)O respectively, after the ventilation circuit was connected to the Breathing Trainer. There was no significant difference between them (P>0.05). Conclusion: The application of Breathing Trainer in the mechanical ventilation circuit of tracheotomy or endotracheal intubation could significantly reduce the peak airway pressure caused by hard exhalation and cough. It could be used as an active cough assist device for mechanical ventilation patients to prevent high airway pressure.

Intratumoral IL17-producing cells infiltration correlate with antitumor immune contexture and improved response to adjuvant chemotherapy in gastric cancer.

BACKGROUND: Tumor IL17-producing (IL17A+) cells infiltration has different prognostic values among various cancers. The objective of this study was to assess the effect of IL17A+ cells in gastric cancer. PATIENTS AND METHODS: The study included two patient cohorts, the Cancer Genome Atlas cohort (TCGA, n = 351) and the Zhongshan Hospital cohort (ZSHC, n = 458). The TCGA and ZSHC were used for mRNA-related and cells infiltration-related analyses, respectively. The roles of IL17A mRNA and IL17A+ cells in overall survival (OS), response to adjuvant chemotherapy (ACT), and immune contexture were evaluated. Another independent cohort was included to identify the correlation between mRNA of IL17A and IL17A+ cells infiltration (the preliminary Zhongshan Hospital cohort, PZSHC, n = 21). RESULTS: The infiltration of IL17A+ cells was positively correlated with the expression of IL17A mRNA (Spearman's ρ = 0.811; P < 0.001). High IL17A mRNA expression and intratumoral IL17A+ cells were correlated with improved OS and remained to be significant after adjusted for confounders. Patients with TNM II/III disease whose tumor present higher intratumoral IL17A+ cells or lower peritumoral IL17A+ cells can benefit more from ACT. Elevated IL17A mRNA expression and increased intratumoral IL17A+ cells infiltration was associated with more antitumor mast cells and nature killer cells infiltration and less pro-tumor M2 macrophages infiltration. High IL17A mRNA expression represented a Th17 cells signature and immune response process and was correlated with increased cytotoxic GZMA, GZMB, IFNG, PRF1, and TNFSF11 expression. CONCLUSIONS: IL17A mRNA expression and intratumoral IL17A+ cells infiltration were correlated with antitumor immune contexture. IL17A+ cells infiltration could be used as an independent prognostic biomarker for OS and predictive biomarker for superior response to ACT, and further prospective validation needs to be conducted.

Long non-coding RNA CCAT1 promotes the migration and invasion of prostate cancer PC-3 cells.

OBJECTIVE: To investigate the effect of long non-coding RNA CCAT1 on the proliferation, migration, and invasion of prostate cancer PC-3 cells. PATIENTS AND METHODS: The expression of CCAT1 was detected by Real-time PCR. The effect of CCAT1 down-regulation on the proliferation of PC-3 cells was observed by MTT assay. The regulatory of CCAT1 low-expression on the migration ability of PC-3 cells was investigated by transwell assay. The influence of decreased CCAT1 on the invasion ability of PC-3 cells was detected by  Matrigel invasion assay. RESULTS: Increased CCAT1 was significantly related to lymph node metastasis in prostate cancer. Low-expression of CCAT1 could suppress cell proliferation. Knockdown of CCAT1 inhibited the migration of PC-3 cells. Down-regulation of CCAT1 attenuated the invasion of PC-3 cells. CONCLUSIONS: CCAT1 promoted the growth and the metastasis of prostate cancer. Our findings might provide a potential target for the diagnosis and treatment of prostate cancer.

[Unprotected sexual intercourse and its correlates within HIV serodiscordant couples in Dehong prefecture of Yunnan Province, China, in 2014].

Objective: To study the prevalence and correlates of unprotected sexual intercourse within HIV serodiscordant couples in Dehong prefecture, Yunnan Province, China, in 2014. Methods: This study was based on the follow-up investigation of "the AIDS cohort of seronegative spouses of HIV-infected individuals in Dehong prefecture" in 2014. The 1 520 participants were HIV seronegative spouses from all five counties/cities of Dehong prefecture who voluntarily participated in the cohort. Inclusion criteria included: having a HIV-positive spouse; ≥16 years of age; having had sexual intercourse with spouse in the past year; and being a resident of Dehong prefecture. Information on HIV-positive spouses were also collected through the local AIDS epidemic database. Chi square analysis was performed to compare differences in the rates of unprotected sexual intercourse between participants with different characteristics and lifestyle choices. Multivariable logistic regression model analysis was performed to determine correlates with unprotected sexual intercourse. Results: The 1 520 participants had a mean age of 38.7±9.4, compared with 39.7±8.9 for their HIV-positive spouses. Among the HIV-positive spouses, 77.8% (1 183/1 520) had been infected for more than 3 years, and 87.6% (1 332/1 520) had received antiretroviral therapy. The prevalence of unprotected sexual intercourse within serodiscordant couples over the past 12 months was 16.1% (244/1 520). The prevalence of unprotected sexual intercourse correlated with the level of education of HIV-negative spouses (illiterate vs. middle school and above, OR=1.58, P=0.044), the number of years since diagnosis of HIV-positive spouses (short vs. long, OR=1.6, P=0.006), antiretroviral therapy of HIV-positive spouses (no vs. yes, OR=2.78, P<0.001), the frequency of sexual intercourse per month (high vs. low, OR=1.66, P=0.019), and whether the couple had children (no vs. yes, OR=1.72, P=0.007). Conclusion: The prevalence of unprotected sexual intercourse within serodiscordant couples in Dehong prefecture was relatively high in 2014. Factors found to correlate with the occurrence of unprotected sexual intercourse within these couples included illiteracy of HIV-negative spouses, short time since diagnosis of HIV-positive spouses and lack of antiretroviral therapy, high frequency of sexual intercourse and no children.

[Risk behaviors among newly reported Burmese HIV infection in Dehong, Dai and Jingpo Autonomous Prefectures of Yunnan province, 2015].

Objective: To study the AIDS-related socio-demographic characteristics and high risk behaviors of Burmese HIV-infected individuals, in Dehong prefecture, Yunnan province. Methods: A cross-sectional study with questionnaire interview, was conducted. Results: Features of the 489 HIV-infected individuals appearfed as: 367(75.1%) males, 407(83.2%) illiterate or with primary education, 371(75.9%) from Kachin State or Shan State, 306(62.6%) visited Dehong twice or more per year, 238(48.7%) entered Dehong illegally, 339(69.3%) came to the city looking for jobs or working on cargo transportation, 309(63.2%) of them living in working place/rented house/own house, and 313(64.0%) with the length of stay shorter than six months. Only 36(7.4%) of the interviewees were aware of their HIV sero-positive status, with 23.3% of them (113/485) reported having had unprotected sex experiences in Dehong. Results from the multivariate logistic regression model analysis showed that HIV-infected individuals with the following characteristics: having spouses/regular sexual partners (OR=12.98, 95%CI: 6.53-25.83, P<0.001), living in working place (OR=2.88, 95% CI: 1.09-7.61, P=0.033), living in rented houses (OR=5.36, 95% CI: 1.94-14.84, P=0.001). Those living in their own houses (OR=5.14, 95% CI: 1.36-19.35, P=0.016) were more likely to engage in unprotected sex. 32.0% (156/487) of the interviewees clained that they ever used drugs in Dehong, with 9.7% (47/487) of them sharing syringe. Data also showed that HIV-infected individuals who had the following feartures as: being male (OR=15.61, 95% CI: 6.47-37.69, P<0.001), illiterate (OR=2.89, 95% CI: 1.44-5.84, P=0.003), coming from Kachin State (OR=3.01, 95% CI: 1.50-6.04, P=0.002) or Shan State (OR=5.30, 95% CI: 2.66-10.58, P<0.001), illegal visiters (OR=1.93, 95% CI: 1.18-3.14, P=0.009), living with friends/relatives (OR=5.78, 95% CI: 2.01-16.61, P=0.001), living in working place (OR=6.67, 95% CI: 3.06-14.53, P<0.001), or in rented houses (OR=11.84, 95% CI: 4.76-29.47, P<0.001). The ones who were living in their own houses (OR=6.77, 95%CI: 1.84-24.85, P=0.004) were more likely to engage in drug use in Dehong. Conclusion: Results from our study showed that the Burmese HIV-infected citizens in Dehong prefecture had the following characteristics: high mobility, low awareness of HIV positive status and high prevalence of AIDS-related risky behaviors. These findings called for greater efforts on HIV/AIDS prevention and management in Dehong city.

[A cohort study of HIV incidence among injecting drug users in Dehong Prefecture, Yunnan Province].

Objective: To investigate the incidence rates of HIV among injection drug users (IDU) in Dehong Prefecture, Yunnan Province. Methods: We recruited 1 413 HIV-negative IDU attending drug rehabilitation centers and identified a further 1 830 potential participants from a historical database from 2004-2009 using the same criteria. Fingerprint recognition technology was used to confirm the identity of all participants. A total of 3 243 HIV-negative IDU were recruited by the end of 2015, of which 2 546 (78.5%) had been followed up at least once since the initial data collection and 697 (21.5%) were lost to follow-up. Epidemiological data were collected through structured face-to-face interviews which included items on knowledge of AIDS, drug use, sexual activity and history of HIV testing. We collected 3-5 ml of venous blood from each subject for HIV testing. The Chi-squared test was used to compare the characteristics of those IDUs successfully followed up and those lost to follow-up. Results: We identified 226 new HIV cases among the 2 546 respondents-representing 13 907.1 person-years of follow-up and implying an average HIV incidence rate of 1.6 per 100 person-years over the entire study period (95%CI: 1.4-1.9). The incidence rate (per 100 person-years) was 2.6 (95%CI: 2.2-3.1) for the period 2004-2009 and 1.6 (95%CI: 1.0-2.3), 1.7 (95%CI: 1.1-2.4), 1.2 (95%CI: 0.8-1.9), 0.6 (95%CI: 0.3-1.1), 0.2 (95%CI:0.0-0.7), 0.5 (95%CI: 0.1-1.4) for each year from 2010 to 2015 respectively. Conclusion: Although the incidence rate of HIV remains high among IDUs in Dehong, there was a declining trend over the period studied.

[Phenotypic characteristics of LAP(+) CD4(+) T lymphocytes in colorectal cancer tissues].

OBJECTIVE: To analyze the phenotypic characteristics of LAP(+) CD4(+) T lymphocytes and investigate their molecular mechanisms in colorectal cancer (CRC) microenvironment. METHODS: Fifty colorectal cancer patients treated in our two hospitals from January 2014 to May 2014 were included in this study. Their tumor tissues and adjacent normal tissues, peripheral blood samples, and peripheral blood samples of 25 healthy donors (HD) were collected to isolate the lymphocytes. The different expressions of CCR7, CD45RA, Foxp3, CTLA-4, CCR4 and CCR5 in LAP(+) CD4(+) T and LAP(-)CD4(+) T lymphocytes were analyzed by flow cytometry (FCM). RESULTS: The FCM assay detected that the percentage of LAP(+) CD4(+) T cells in peripheral blood of the CRC patients were significantly higher than that of HD [(9.44±3.18)% versus (1.49±1.00)%, P<0.001]. In addition, significantly more LAP(+) CD4(+) T cells were also recruited into tumor tissue than those in the tumor-adjacent normal tissue [(11.76±3.74)% versus (3.87±1.64)%, P<0.001]. LAP(+) CD4(+) T cells in the tumor-adjacent normal tissue and peripheral blood of both HDs and CRC patients mainly displayed a central memory phenotype. However, effector memory lymphocytes were predominant in the tumor tissue.In the tumor tissue, the expression of Foxp3 in the LAP(+) CD4(+) T cells was (3.87±1.12)%, significantly lower than that in the LAP(-)CD4(+) T cells (16.70±2.61)%, (P<0.001); the expression of CTLA-4 in the LAP(+) CD4(+) T cells was (36.36±19.14)%, significantly higher than the (19.60±8.91)% in the LAP(-)CD4(+) T cells (P<0.001); the expression of CCR4 in the LAP(+) CD4(+) T cells was (37.72±11.14)%, significantly higher than the (30.06±9.14)% in the LAP(-)CD4(+) T cells (P<0.001); and the expression of CCR5 in the LAP(+) CD4(+) T cells was (18.86±7.10)%, significantly higher than the (13.92±3.31)% in the LAP(-)CD4(+) T cells (P<0.001). CONCLUSIONS: LAP(+) CD4(+) T cells with low expression of Foxp3 and high expressions of CTLA-4, CCR4 and CCR5 are tend to be enriched and accumulated in the tumor tissue. The unique phenotypic characteristics make these cells a distinct subset of lymphocytes, apparently different from the traditional CD4(+) CD25(+) Treg cells.

CYP3A catalyses schizandrin biotransformation in human, minipig and rat liver microsomes.

Schizandrin is recognized as the major absorbed effective constituent of Fructus schisandrae, which is extensively applied in Chinese medicinal formula. The present study aimed to profile the phase I metabolites of schizandrin and identify the cytochrome P450 (CYP) isoforms involved. After schizandrin was incubated with human liver microsomes, three metabolites were isolated by high-performance liquid chromatography (HPLC) and their structures were identified to be 8(R)-hydroxyl-schizandrin, 2-demethyl-8(R)-hydroxyl-schizandrin, 3-demethyl-8(R)-hydroxyl-schizandrin, by liquid chromatography-mass spectrometry (LC-MS), (1)H-nuclear magnetic resonance (NMR), and (13)C-NMR, respectively. A combination of correlation analysis, chemical inhibition studies, assays with recombinant CYPs, and enzyme kinetics indicated that CYP3A4 was the main hepatic isoform that cleared schizandrin. Rat and minipig liver microsomes were included when evaluating species differences, and the results showed little difference among the species. In conclusion, CYP3A4 plays a major role in the biotransformation of schizandrin in human liver microsomes. Minipig and rat could be surrogate models for man in schizandrin pharmacokinetic studies. Better knowledge of schizandrin's metabolic pathway could provide the vital information for understanding the pharmacokinetic behaviours of schizandrin contained in Chinese medicinal formula.

[Multiple primary lung cancer].

From November 1957 to June 1984, 30 patients with multiple primary lung cancer were diagnosed, basing on clinical features, diagnostic means, histologic type, treatment and prognosis. Out of 3,815 cases of resected primary lung cancer, the incidence of multiple primary cancer was 0.8%. There were 10 synchronous and 20 metachronous cases. There were 17 unilateral, only 1 simultaneous bilateral and 12 contralateral after resection of cancer in the opposite lung. Four of the 10 synchronous cases were definitely diagnosed preoperatively. Among the 20 metachronous cases, 9 were definitely diagnosed as a second primary lesion and the other 11 were proved by thoracotomy. Pathologically, 19 had identical types (15 squamous cell and 4 adenocarcinoma) but 11 had double types (9 squamous cell + adenocarcinoma, 2 squamous cell + anaplastic). The average survival of these 30 patients was 27.1 months, that in the synchronous group was 29 months and that in the metachronous group was 26.2 months. The 5 year survival rate of the synchronous cases was 35%, that of the metachronous cases was 42%. The clinicopathological criteria of multiple primary lung cancer, early diagnostic and operative procedure are also discussed.

[CMC chemotherapy regimen combined with surgery of small cell lung cancer (SCLC)].

From Dec. 1982 to Oct. 1984, 35 patients with SCLC proved by pathology or cytology, were treated by cyclophosphamide + methotrexate + CCNU (CMC) regimen combined with surgery in our hospital. All the patients received chemotherapy for more than 2 courses and the overall response rate was 85.7%, complete remission (CR) rate was 14.3%. Toxic reactions were tolerable to the patients. Treatment result was better in SCLC with localized than extensive disease. Operation was done for 9 out of 21 patients with localized lesions which had responded to chemotherapy. Of them, 1 died of postoperative complication, 2 were lost in follow-up and the rest 6 were disease-free for 8-32 months with a median survival time of 19 months. The 1 year survival rate was 75%. The results indicate that in limited disease of SCLC, successful chemotherapy combined with surgery can prolong the survival time. For patients with an limited disease which has given a CR, surgical resection should be strived for.

[Chemotherapy combined with selective resection in small cell lung cancer--analysis of 239 patients].

From 1957 to 1976, 143 patients with small cell lung cancer (SCLC) were treated with surgical resection followed by chemotherapy. The 5 year survival rates were 38.7%, 8.7% and 3.5% in stages I, II and III. The prognostic factors were clinical stage and chemotherapy. 4 stage I and 1 stage II patients without chemotherapy have survived for more than 5 years. It seems to suggest that SCLC in stage I be indicated for surgery. 4 stage III have survived for more than 5 years, all of whom had received postoperative chemotherapy for more than 4 courses. From 1980 to 1982, 96 patients with SCLC were treated, 37 of whom by chemotherapy combined with surgery. 11/37 patients were alive for more than 2 years, 7 for more than 3 years and 4 for more than 4 years. In the preoperative chemotherapy followed by selective resection plus postoperative chemotherapy group (13 patients), the mean survival time was 22.7 months, but in the postoperative chemotherapy group (24 patients), it was 11.0 months. It indicates that full-dose chemotherapy before and after operation may be superior to the postoperative chemotherapy alone.