Clinical efficacy of combined therapy in children with stage 4 neuroblastoma / 中国当代儿科杂志

OBJECTIVES@#To study the early clinical efficacy of combined therapy of stage 4 neuroblastoma.@*METHODS@#A retrospective analysis was performed on the medical data and follow-up data of 14 children with stage 4 neuroblastoma who were diagnosed in Hong Kong University-Shenzhen Hospital from January 2016 to June 2021.@*RESULTS@#The median age of onset was 3 years and 7.5 months in these 14 children. Among these children, 9 had positive results of bone marrow biopsy, 4 had N-Myc gene amplification, 13 had an increase in neuron-specific enolase, and 7 had an increase in vanilmandelic acid in urine. Based on the results of pathological examination, differentiated type was observed in 6 children, undifferentiated type in one child, mixed type, in one child and poorly differentiated type in 6 children. Of all the children, 10 received chemotherapy with the N7 regimen (including 2 children receiving arsenic trioxide in addition) and 4 received chemotherapy with the Rapid COJEC regimen. Thirteen children underwent surgery, 14 received hematopoietic stem cell transplantation, and 10 received radiotherapy. A total of 8 children received Ch14.18/CHO immunotherapy, among whom 1 child discontinued due to anaphylactic shock during immunotherapy, and the other 7 children completed Ch14.18/CHO treatment without serious adverse events, among whom 1 child was treated with Lu177 Dotatate 3 times after recurrence and is still undergoing chemotherapy at present. The median follow-up time was 45 months for all the 14 children. Four children experienced recurrence within 2 years, and the 2-year overall survival rate was 100%; 4 children experienced recurrence within 3 years, and 7 achieved disease-free survival within 3 years.@*CONCLUSIONS@#Multidisciplinary combined therapy is recommended for children with stage 4 neuroblastoma and can help them achieve better survival and prognosis.

Functional outcomes of 100 patients with adenocarcinoma of the esophagogastric junction undergoing Cheng's GIRAFFE(®) reconstruction after proximal gastrectomy / 中华胃肠外科杂志

Objective: To investigate the functional outcomes and postoperative complications of Cheng's GIRAFFE reconstruction after proximal gastrectomy. Methods: A descriptive case series study was conducted. Clinical data of 100 patients with adenocarcinoma of the esophagogastric junction who underwent Cheng's GIRAFFE reconstruction after proximal gastrectomy in Cancer Hospital of University of Chinese Academy of Sciences (64 cases), Zhejiang Provincial Hospital of Chinese Medicine (24 cases), Lishui Central Hospital (10 cases), Huzhou Central Hospital (1 case) and Ningbo Lihuili Hospital (1 case) from September 2017 to June 2021 were retrospectively analyzed. Of 100 patients, 64 were males and 36 were females; the mean age was (61.3 ± 11.1) years and the BMI was (22.7±11.1) kg/m(2). For TNM stage, 68 patients were stage IA, 24 were stage IIA and 8 were stage IIB. Postoperative functional results and postoperative complications of radical gastrectomy with Giraffe reconstruction were analyzed and summarized. Gastroesophageal reflux disease questionnaire (RDQ) score and postoperative endoscopy were used to evaluate the occurrence of reflux esophagitis and its grade (grade N, grade A, grade B, grade C, and grade D from mild to severe reflux). The continuous data conforming to normal distribution were expressed as (mean ± standard deviation), and those with skewed distribution were presented as median (Q1, Q3). Results: All the 100 patients successfully completed R0 resection, including 77 patients undergoing laparoscopic surgery and 23 patients undergoing laparotomy. The Giraffe anastomosis time was (38.6±14.0) min; the blood loss was (73.0±18.4) ml; the postoperative hospital stay was 9.5 (8.2, 13.0) d; the hospitalization cost was (6.0±0.3) ten thousand yuan. Fourteen cases developed perioperative complications (14.0%), including 7 cases of pleural effusion or pneumonia, 3 cases of anastomotic leakage, 2 cases of gastric emptying disorder, 1 case of gastrointestinal hemorrhage and 1 case of anastomotic stenosis, who were all improved and discharged after symptomatic management. Patients were followed up for (33.3±1.6) months. Eight patients were found to have reflux symptoms by RDQ scale six months after surgery, and 11 patients (11/100,11.0%) were found to have reflux esophagitis by gastroscopy, including 6 in grade A, 3 in grade B, and 2 in grade C. All the patients could control their reflux symptoms with behavioral guidance or oral PPIs. Conclusion: Cheng's GIRAFFE reconstruction has good anti-reflux efficacy and gastric emptying function; it can be one of the choices of reconstruction methods after proximal gastrectomy.

Experience and thoughts on digestive tract reconstruction after radical resection of adenocarcinoma of the esophagogastric junction / 中华胃肠外科杂志

In the surgical treatment of adenocarcinoma of the esophagogastric junction (AEG), the scope of lymph node dissection, surgical approach selection, extent of tumor resection and digestive tract reconstruction have always been controversial, with the digestive tract reconstruction in AEG facing many challenges especially. The digestive tract reconstruction is related to the extent of resection. At present, the digestive tract reconstruction after total gastrectomy includes Roux-en-Y anastomosis, jejunum interposition and its derivatives. According to different reconstruction methods, they can be divided into tube anastomosis, linear anastomosis and manual anastomosis. Anti-reflux digestive tract reconstruction after proximal gastrectomy mainly includes esophagogastric anastomosis, interposition jejunum and double channel anastomosis. At present, double channel anastomosis is the most common reconstruction method in China. Based on the concept of interposition tubular stomach and reconstruction of gastric angle for anti-reflux, we propose "Giraffe" anastomosis, which moves artificial fundus and His angle downward to retain more residual stomach, showing good gastric emptying and anti-reflux effect. In this paper, combined with our clinical experience and understanding, we discuss the selection and technical key points of digestive tract reconstruction methods in AEG, and suggest that composite anti-reflux mechanism design may be the development trend of anti-reflux reconstruction in the future. The composite mechanism includes the retention of gastric electrical pacemaker in greater curvature of the middle part of gastric body to increase the emptying capacity of residual stomach, the reconstruction of gastric fundus and His angle anti-reflux barrier, and the establishment of an interposition tubular stomach acting as a buffer zone in Giraffe construction, and so on.

Physical activities and dietary intervention on metabolic syndrome in children / 中华流行病学杂志

Objective To study the effect of physical activities and dietary intervention on metabolic syndrome (MS) in primary school students.Methods Either one-year physical activities (PA) or dietary intervention was conducted in Grade 1-5 children from eight primary schools in Haidian district,Beijing.A ‘happy 10 minutes' program was held in the PA group,while the dietary group receiving nutrition lectures.Baseline and post-intervention data on height,weight,waist circumference,serum lipids,glucose,and blood pressure were collected.Results The prevalence of MS at baseline was 9.0％.After intervention programs were carried out,improvements on triglyceride,high density lipoprotein,fasting blood glucose,diastolic blood pressure and waist circumference in the dietary group or PA group were seen,with the dietary group showed better effects than the PA group.The prevalence of MS decreased from 10.4％ to 4.6％ in the dietary group with statistically significant difference,while it increased in both the PA group and the control group.Girls showed better effects in the dietary group.Older students showed better effects than the younger students in the PA group.In non-overweight and overweight students of the dietary intervention group,the MS related components were significantly improved.Conclusion The prevalence of metabolic syndrome was relatively high in the primary school students in Beijing.Education on nutrition could reduce the prevalence and improve the related components,which seemed to be more effective than in the PA intervention.Sex,age and nutritional status were the confounding factors for intervention programs.

Risk factors and prognosis for patients with residual tumor after radiofrequency ablation of hepatocellular carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the risk factors and prognosis of patients with residual tumor after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>The clinicopathological data of 114 patients with HCC undergoing RFA in our hospital from May 2000 to March 2007 were retrospectively studied, and the prognostic factors of residual tumor were analyzed.</p><p><b>RESULTS</b>After one session of RFA, 90 patients had complete ablation and 24 had residual tumor. The median overall survivals in the complete ablation group and residual tumor group were 40 and 29 months, respectively. There was no statistically significant difference between those two groups (P = 0.242). 24 patients with residual tumor were re-treated by RFA or hepatectomy or TACE. Among them 11 patients achieved complete response and 13 incomplete response, their median overall survival were 53 and 28 months, respectively. There was no significant difference between first complete ablation group and second complete response group (P = 0.658). However, compared with the first complete ablation group, the incomplete response group had poor prognosis (P = 0.012). Multivariate analysis showed that tumor size > 3 cm (P = 0.007) and proximity to a large vessel (P = 0.042) were independent risk factors for residual tumor after RFA.</p><p><b>CONCLUSION</b>Tumor size > 3 cm and proximity to a large vessel are independent risk factors for residual tumor after RFA. Further treatment of residual tumor is necessary to eliminate the tumor and improve prognosis.</p>

Effects of experimental liver injury on the intestinal barrier in rats / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the effects of experimental liver injury on the intestinal barrier, and to evaluate the significance of plasma D(-)-lactate, diamine oxidase (DAO) and endotoxin in live injury.</p><p><b>METHODS</b>Fifty-five rats were randomized into the acute liver failure group (group C, n = 25), acute liver injury group (group B, n = 15), and control group (group A, n = 15). The concentrations of D(-)-lactate, DAO and endotoxin in plasma were detected by spectrophotograph. The morphology and subcellular structure were observed under optical microscope and transmission electron microscope.</p><p><b>RESULTS</b>Acute liver failure and acute liver injury models were established successfully. The concentrations of D(-)-lactate and DAO in the plasma of experimental groups (group B and C) were significantly higher than those in the control group (P less than 0.05); the concentration of intestinal DAO in experimental groups were significantly lower than that in the control group (P less than 0.05); the level of endotoxin in C group was significantly higher than that in group A and group B (P less than 0.05).</p><p><b>CONCLUSION</b>Liver injury induces hyperpermeability of the rat intestinal mucosal barrier, plasma D(-)-lactate and DAO are sensitive markers for early diagnosis of liver injury, plasma endotoxin may accelerate deterioration of liver function.</p>

The role of vascular resection and reconstruction in the treatment of hilar cholangiocarcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the role of vascular resection and reconstruction in the treatment of hilar cholangiocarcinoma.</p><p><b>METHODS</b>117 patients with potentially resectable hilar cholangiocarcinoma underwent exploration. Twenty-one patients had exploration or drainage only due to distant metastases, and the other 96 patients received surgical resection. Thirty-one of those had vascular resection and reconstruction, including portal vein resection alone in 21 patients, combined hepatic artery and portal vein resection in 2 and hepatic artery resection alone in 8. Therefore, the patients were divided into four groups: non-surgical resection (21), portal vain resection (21), hepatic artery resection (10) and non-vascular resection (65) and their clinical data were reviewed retrospectively.</p><p><b>RESULTS</b>The hepatic artery resection group had significantly higher perioperative morbidity and mortality rate (80.0% and 20.0%) than non-vascular resection group (16.9% and 1.5%), respectively, (P < 0.05), while no significant difference was found between the portal vein resection alone group and the non-vascular resection group (P > 0.05). Of all resected vessel specimens, vascular wall invasion beyond the adventitia was pathologically confirmed in 82.6% of the portal veins and 50.0% of the hepatic arteries. The 1-, 3- and 5-year survival rates were 59.0%, 34.0%, and 16.0% in the non-vascular resection group, versus 44.0%, 23.0% and 11.0% in the portal vein resection alone group (P < 0.05) and 18.0%, 0 and 0 in the hepatic artery resection group (P < 0.01), respectively, with a significant difference among the three groups. The 1-, 3- and 5-year survival rates in the non-surgical resection group were 13.0%, 0 and 0, respectively, which were similar to those in the hepatic artery resection group. Though a significant difference in survival rates existed between the portal vein resection alone group and non-resected group (P < 0.001), no significant difference was found between the hepatic artery resection group and non-resected group (P > 0.05).</p><p><b>CONCLUSION</b>Both portal vein and hepatic artery resection can improve resection rate for hilar cholangiocarcinoma, and portal vein resection may improve the prognosis in selected patients. However, hepatic artery resection can not improve survival and may even lead to an increase of perioperative morbidity and mortality.</p>

Liver histopathology, clinical features and prognostic factors of primary biliary cirrhosis: an analysis of 60 cases / 中华肝脏病杂志

<p><b>OBJECTIVE</b>Clinical and liver pathological features of 60 primary biliary cirrhosis (PBC) patients were reviewed to identify prognostic factors in order to improve the diagnosis and treatment of the disease.</p><p><b>METHODS</b>The general conditions, clinical manifestations, serum biochemical and immunological changes, and liver pathological findings were assessed in 60 PBC patients. All cases were followed up and 5 variables were studied by univariate analysis; the variables linked with survival were included in a Cox model.</p><p><b>RESULTS</b>Forty-eight patients were females (80%), 12 were males (20%), and the mean age at their diagnoses was (52.5+/-9.4). The symptoms most frequently complained about were jaundice (61.6%), fatigue (51.6%), anorexia (43.3%) and pruritus (25%). Serum alkaline phosphatase (ALP) and glutamyl transpeptidase (GGT) levels were markedly elevated in the majority of the patients [(242.3+/-137.1) U/L and (250.6+/-216.1) U/L, respectively], whereas ALT and AST levels were mildly to moderately elevated [(185.8+/-269.1) U/L and (172.5+/-163.6) U/L, respectively]. Thirty-two patients (53.3%) had a total bilirubin level of > or = 34.2 micromol/L. Twenty-eight patients (59.5%) had elevated serum IgM and 41 patients (68.3%) were anti-mitochondrial antibody AMA/AMA-M2 positive. Forty-two of the 60 patients had liver biopsies. The liver pathological changes: 33.3% of the cases were in I or II stage and 66.6% in III or IV stage. The follow up results: Five patients died of liver failure or massive upper gastrointestinal bleeding; 45 were still alive; the average survival period was 3.92 years; 10 patients were lost in the follow-up. With multivariate analysis (Cox model), age, level of total bilirubin and the stage of the liver pathological changes were found to be independent factors linked to the survival of the patients.</p><p><b>CONCLUSION</b>PBC may not be a rare liver disease in China. The awareness to recognize PBC is important in making an early diagnosis and treatment.</p>

The value of MRCP combined with MRI in the preoperative assessment of hilar cholangiocarcinoma / 肿瘤研究与临床

0.5 cm or beneficial anatomical vari- ations displayed on MRCP,were obviously improved and there were no significantly different among the 4 types hilar eholangiocarcinoma.Conclusion MRCP could accurately make the preoperative diagnosis and type of hilar cholangiocarcinoma; the image of second branch of bile duct and the variation of the confluence of hepatic hilar displayed on MRCP has great clinical significance for operative regimes of hilar cholangiocar- cinoma,especially for typeⅣ.It does benefit not only to improve the resection and radical rate of some hilar cholangiocarcinomas, but also to select suitable method of biliary enteric anastomosis and avoid injuring the bile duct in operation.