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Elderly patients are often complicated with a variety of underlying diseases.Because aging can impact the pharmacokinetics and pharmacodynamics of drugs,and affect the immune effect,conventional anti-tumor treatment modes such as radiotherapy,chemotherapy,targeted therapy,or immunization,can not achieve optimal efficacy.Comprehensive geriatric assess-ment(CGA)is a multi-dimensional and multidisciplinary diagnostic process,which is currently regarded as the core of the as-sessment of elderly patients with cancer.By utilizing a variety of tools and scales,comprehensive assessment of elderly patients with cancer can facilitate early intervention,guide reasonable treatment,increase the chances of benefit,and improve the quality of life for some elderly patients.Moreover,CGA can help reasonably allocate medical resources and reduce the economic burden on the community.
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Lenvatinib mesylate is an oral receptor tyrosine kinase inhibitor against targets of vascular endothelial growth factor receptors 1-3, fibroblast growth factor receptors 1-4, platelet-derived growth factor receptor α, stem cell growth factor receptor, and rearranged during transfection, et al. Lenvatinib has been approved by the National Medical Products Administration of China on September 4,2018, for the first-line treatment of patients with unresectable hepatocellular carcinoma who have not received systematic treatment before. Up to February 2023, Lenvatinib has been listed in China for more than 4 years, accumulating a series of post-marketing clinical research evidences. Based on the clinical practice before and after the launch of lenvatinib and referring to the clinical experience of other anti-angiogenesis inhibitors, domestic multidisciplinary experts and scholars adopt the Delphi method to formulate the Chinese Expert Guidance on Overall Application of Lenvatinib in Hepatocellular Carcinoma after repeated discussions and revisions, in order to provide reference for reasonable and effective clinical application of lenvatinib for clinicians.
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Objective To observe the clinical efficacy of Jiangshabanxia nano-paste on nausea and vomiting in end-stage patients and its effect on the quality-of-life (QOL) in cancer patients. Methods 120 end-stage patients with nausea and vomiting symptoms above grade III were randomly divided into observation group and control group. They were treated with Jiangshabanxia nano-paste and placebo paste respectively. The paste patch was changed every 24 hours and used continuously for 7 days. The nausea and vomiting symptom score, the quality-of-life measurement score and KPS score of cancer patients in the two groups were observed to evaluate the curative effect. Results After 7 days of treatment, the symptom scores of nausea and vomiting in the observation group decreased significantly, the KPS score of the observation group increased, and the effective rate was higher than that in the control group. The score of QOL measurement showed that after treatment, the score of main symptom areas and other symptom areas (except external dyspnea, diarrhea and economic difficulties) in the observation group decreased, and the score of overall health area increased. After treatment, the score of main symptom areas and other symptom areas (except external dyspnea, diarrhea and economic difficulties) in the observation group was lower than that in the control group, and the scores of overall health area in the observation group were higher than those in the control group. Conclusion Jiangshabanxia nano-paste has a good clinical efficacy nausea and vomiting in end-stage patients, it also can improve the quality of life end-stage cancer patients.
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The IMbrave 150 study opened the door of immunotherapy combined with targeted therapy, and then the data of ORIENTAL-32, a Phase Ⅲ clinical trial for Chinese patients, was released, which confirmed the efficacy of immunotherapy combined with targeted therapy, especially significant survival benefits in Chinese patients. At present, there are many ongoing studies on PD-1/PD-L1 inhibitors combined with small-molecule tyrosine kinase inhibitors, and their corresponding early data provide a considerable objective response rate, which provides an opportunity for conversion therapy/sequential therapy for hepatocellular carcinoma in different stages and courses, as well as a basis for further exploration of neoadjuvant/adjuvant therapy. Combined immunotherapy has entered the era of version 3.0, in which reasonable local therapy can be implemented at different stages in combination with targeted drugs. However, there are still no accurate predictive indicators for efficacy, and it requires comprehensive consideration of the features such as the natural course of the disease, clinicopathological parameters, genomics, and radiomics. Compared with single-drug immunotherapy or single-drug targeted therapy, immunotherapy combined with targeted therapy had a relatively complex spectrum of adverse reactions and difficult identification of correlation, and whole-process management, comprehensive judgment, and timely treatment should be performed within the framework of multidisciplinary team.
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Objective:To evaluate the efficacy and safety of the micro-crosslinked hyaluronic acid injected by Shuiguang Needle Injection in facial rejuvenation.Methods:Thirty-two patients were enrolled. In this split face study, micro-crosslinked hyaluronic acid and non-crosslinked hyaluronic acid were randomly applied in the treated side of the face. Procedure efficacy (judged by VISIA), complication and subjects' satisfaction were assessed before treatment, one month, two months and three months after treatment.Results:According to the VISIA, 32 cases were effective one month after treatment on the treatment side, accounting for 100%; 28 cases were effective three months after the end of treatment, accounting for 87.51%. On the control side, 28 cases were effective one month after treatment, accounting for 87.50%, and 7 cases were effective after three months, accounting for 21.88%. There was no statistically significant difference in complications between the left and right sides; 31 patients were satisfied on the treatment side, accounting for 96.88%, and 28 patients on the control side were satisfied, accounting for 87.50%.Conclusions:The micro-crosslinked hyaluronic acid injected by Shuiguang Needle Injection appears to be effective and durable for facial rejuvenation. And it has a low complication rate and high subject satisfaction.
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Parkinson′s disease (PD) is a common neurodegenerative disease. Its main pathological feature is the progressive loss of substantia nigra and other catecholaminergic neurons containing neuromelanin (NM). Therefore, NM may be closely related to the pathogenesis of PD. The content of NM can be detected by NM magnetic sensitive sequence imaging, and then it can be applied to the study of the neuropathological mechanism of NM and PD. This paper focuses on the physiological significance of NM, its role in the pathogenesis of PD and the prospect of NM as a biomarker to assist diagnosis and disease monitoring of PD.
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The concept of precancerous lesions was first proposed in 1948. With the progress of animal models, genetic analysis, clinical pathology, and imaging studies, precancerous lesions have received much attention, and the reversion of precancerous lesions has also attracted widespread concern. Precancerous lesions are not cancers, nor are they early stages of cancer. They are qualitatively different from cancers; precancerous lesions are only a small part of them which may develop into cancer. It is of great significance to pay attention to the management of diagnosis and treatment of precancerous lesions for the prevention, treatment and maintenance of people's physical and mental health.
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Objective To evaluate the clinical curative effect of multiple interventional techniques with skilled manipulation in treating common bile duct stones. Methods The clinical data of 36 patients with common bile duct stones, who were treated with percutaneous transhepatic puncture of intrahepatic bile duct and multiple interventional techniques, were retrospectively analyzed. Before operation, according to CT or MRI findings the optimal puncture path was selected to perform cholangiography so as to reconfirm the position, number and size of the stones. Depending on the size of the stone, the corresponding sized lithotripsy basket and balloon were selected. The duodenal papilla was dilated by balloon, and the stone was pushed into the duodenum with a balloon. After complete removal of stones, the internal and external biliary drainage tubes were routinely implanted and remained there for two weeks. Results The operation was successfully accomplished in 35 patients, the success rate was 97.2%. Successful removal of stones with single procedure was accomplished in 32 patients, and in 3 patients the complete removal of stones was achieved by secondary procedure. No serious complications were observed during the operation. Early postoperative complications included hyperamylasemia (n=2), bile peritonitis (n=2), small amount of bloody bile (n=3) . No biliary perforation occurred. Conclusion In treating common bile duct stones, the combination use of multiple interventional techniques with skilled manipulation has high success rate, low risk and less complications, therefore, it is an effective therapeutic method
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Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant degenerative disease. The main clinical manifestation of SCA2 is progressive cerebellar syndrome, but a wide range of extracerebellar and non-motor symptoms can be observed clinically. The non-motor symptoms and extra-cerebellar signs in SCA2 patients are reviewed to provide a better understanding in cognition, diagnosis and treatment of the disease.
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Parkinson's disease (PD) is a common disabling and neurodegenerative disease.As the disease progresses,the patient's respiratory system will be affected.PD leads to obstructive and restrictive airway diseases,and PD medications may produce pulmonary side effects,such as pleuropulmonary fibrosis related to dopamine agonists.Finally,motor fluctuations in advanced PD may trigger respiratory symptoms.Abnormal central control of ventilation,obstructive sleep apnea,emotional disorders will influence respiratory system.Recognizing these pulmonary complications will assist the clinician in appropriately managing the disease and potentially reducing the impact of the abnormal respiratory system on overall PD patient health.
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The paper quantizes symptom data through binary coding,divides 8 syndromes summed up by experts into excess and de-ficiency syndromes,values and quantizes them,and establishes the model for classification of excess and deficiency syndromes of colorec-tal cancer based on BP neural network and decision tree.The result shows that BP neural network classification model is more applicablefor the handling of the nonlinear mapping relation compared with decision tree classification model.
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Objective To evaluate the utilization of human serum albumin (HSA ) in intensive care unit (ICU ) to pro-mote rational use of HSA clinically .Methods Data were collected from the patients received HSA therapy during the period of January 1 ,2015 to December 31 ,2015 .The indications and usage of HSA were analyzed statistically .Results 416 bottles of HSA were administered to 64 patients .The average dose was 62 .5g per patient .The most popular indication was for hypopro-teinemia (39 .1% ) followed by encephaledema ,craniocerebral trauma ,shock and tumors .Before the HSA therapy ,36 patients (56 .3% ) had albumin level of 15-25 g/L and 23 patients (35 .9% ) of 25-35 g/L .Conclusion HSA is widely used in ICU for different indications .Some misuses still exist .Guidelines for proper use of HSA are needed to guarantee its rational use .HSA should be used strictly following these guidelines .
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<p><b>OBJECTIVE</b>To retrospectively analyze the clinicopathology of patients with gastric gastrointestinal stromal tumor(gGIST) who underwent radical excision within 18 years in 10 domestic medical centers in order to understand the status of domestic surgical treatment of gGIST.</p><p><b>METHODS</b>Clinicopathological data of gGIST patients undergoing radical excision in 10 medical centers from January 1998 to January 2016 were collected, and their operational conditions, postoperative adjuvant therapy, gene detection and survival were analyzed retrospectively.</p><p><b>RESULTS</b>A total of 1 846 cases were recruited in this study, including 246 cases from Guangdong General Hospital, 331 cases from Sun Yat-sen University Cancer Center, 374 cases from Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, 342 cases from Nanfang Hospital of Southern Medical University, 265 cases from Fujian Medical University Union Hospital, 148 cases from Fudan University Shanghai Cancer Center, 49 cases from West China Hospital of Sichuan University, 43 cases from Peking University Cancer Hospital and Institute, 28 cases from the 81st Hospital of Pepole's Liberation Army(PLA), 20 cases from Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute. There were 918 male (49.7%) and 928 female patients (50.3%) with median onset age of 59(18 to 95) years old. Fundus(735 cases, 39.8%) and body (781 cases, 42.3%) of stomach were the common sites of lesions. The average size of tumor was (5.3±4.6) cm. There were 1 421 cases with mitotic count ≤5(77.0%). According to the operation procedure, 924 cases (50.1%) underwent laparoscopic surgery, 759 cases (41.1%) laparotomy, 120 cases (6.5%) endoscopic surgery, and 20 cases (1.1%) laparoscopic combined with endoscopic surgery, 6 cases (0.3%) laparoscopic excision surgery through gastric wall and cavity, and 17 cases (0.9%) laparoscopy and then were transferred to laparotomy. Wedge excision were performed in 1 308 cases (70.9%), proximal gastric excision in 226 cases(12.2%), distal gastric excision in 92 cases (5.0%), total gastrectomy in 94 cases (5.1%), and local gastrectomy in 126 cases(6.8%). Multi-visceral excision was performed in 138 cases, and the splenectomy was performed in 83 cases(60.1%)with the highest ratio. According to modified NIH classification, 399 cases(21.6%) were extreme low risk, 580 cases(31.4%) were low risk, 424 cases(23.0%) were moderate risk, 443 cases (24.0%) were high risk. A total of 461 cases received postoperative imatinib adjuvant therapy, accounting for 53.2%(461/867) of patients with moderate and high risk. Among 1 846 cases, 1 402 cases (75.9%) had complete follow-up data and the median follow-up time was 33.6 (0.1 to 158) months. The 5-year survival rates of extreme low risk, low risk, moderate risk and high risk were 100%, 98.5%, 92.5%, and 79.2% with significant difference(P=0.000).</p><p><b>CONCLUSIONS</b>Gastric GIST occurs mostly in fundus and body of stomach in China. Wedge excision is the main operational procedure and laparoscopic operation is over 50%. General prognosis of gastric GIST is quite good.</p>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Antineoplastic Agents , Therapeutic Uses , China , Combined Modality Therapy , Gastrectomy , Gastrointestinal Neoplasms , Gastrointestinal Stromal Tumors , Pathology , General Surgery , Imatinib Mesylate , Therapeutic Uses , Laparoscopy , Laparotomy , Postoperative Period , Prognosis , Retrospective Studies , Splenectomy , Stomach Neoplasms , Pathology , General Surgery , Survival RateABSTRACT
Biliary tract cancer (BTC)is one of the most aggressive malignancies with only 1 0% early-stage diagnosis rate.For advanced BTC,regimen of gemcitabine and cisplatin has been regarded as the first line standard combination,but the curative effect is still unsatisfied.Infiltration of immune cells and immune-related microenvironment can inhibit various types of cancers.In BTC,higher frequencies of tumor-infiltrating CD8 + cytotoxic T cells and CD4 + T cells are closely associated with favorable prognosis.These findings have provided the rationale for further development of immunotherapies as a novel treatment modality against BTC.
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Objective To analyze the mechanical stimulation to the endometrium on the clinical pregnancy rate and embryo implantation rate in the frozen thawed embryo transfer of hormone replacement therapy.Methods There were 193 patients undergoing the frozen thawed embryo transfer of hormone replacement therapy.According to the endometrial condition on the second or third day of the menstrual cycle,they were divided into three groups.Group A,54 patients whose endometrial thickness was no less than 0.6 cm or abnormal endometrium were operated the mechanical stimulation.Group B,55 patients whose endometrial thickness was no less than 0.6 cm or abnormal endometrial were not operated the mechanical stimulation.Group C,84 patients whose endometrial thickness was less than 0.6 cm and normal endometrium.Each group was divided into blastomere transplantation and blastula transplantation.Group A was 23,31 patients,group B was 24,31 patients,group C was 39,45 patients.The age,number of embryo,level of estradiol when injecting chorionic gonadotrophin,clinical pregnancy rate and embryo implantation rate were compared.Results (1) The clinical feature of blastula transplantation.The age,number of embryo,embryo implantation rate among three groups had no significant difference (P > 0.05).The clinical pregnancy rate in group A and group C was significantly higher than that in group B [73.91% (17/23),69.23% (27/39)vs.37.50%(9/24)] (P < 0.05),and there was no significant difference between group A and group C (P > 0.05).The level of estradiol when injecting chorionic gonadotrophin in group C was significantly higher than that in group B [(841.56 ± 802.73) μ g/L vs.(293.34 ± 69.14) μ g/L] (P < 0.05).There was no significant difference between group A and group B,group A and group C (P >0.05).(2)The clinical feature of blastomere transplantation.The age,number of embryo,level of estradiol when injecting chorionic gonadotrophin,embryo implantation rate and clinical pregnancy rate among three groups had no significant difference (P > 0.05).Conclusions Mechanical stimulation to the endometrium can significantly improve the clinical pregnancy rate of blastula transplantation.It has no improvement for embryo implantation rate and clinical pregnancy rate of blastomere transplantation.
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Objective To compare the serum cytokines and high-sensitive C-reactive protein (hs-CRP) in the post-stroke depression(PSD) and depression patients,and further study of the pathogenesis PSD and depression.Methods The levels of serum IL-1β,IL-6 and TNF-α in the PSD group(n=30),the depression group(n=30),the post-stroke non-depression group(n=30)and normal control group(n=30)were measured with enzymatic-linked immunosorbent assay(ELISA),and the levels of serum hs-CRP were measured by scatter rate nephelometryat for these four groups.Results The levels of serum IL-1β,IL-6,TNF-α and hs-CRP in the PSD group,the depression group,the the post-stroke non-depression group and the normal control group were respectively((137.23 ±8.12) pg/ml,(34.12±3.12) pg/ml,(64.62±6.11) pg/ml,(15.36±6.25) mg/L) ; ((133.21 ±7.56) pg/ml,(33.56±2.65) pg/ml,(62.95±5.66) pg/ml,(4.02± 1.21) mg/L) ; ((43.25 ±6.23) pg/ml,(16.12±2.60) pg/ml,(32.23±7.12) pg/ml,(14.88±7.23) mg/L) ; ((42.12±5.78) pg/ml,(15.32±3.23) pg/ml,(31.55±6.70) pg/ml,(3.68± 1.11)mg/L).The levels of serum IL-1β,IL-6 and TNF-αt in the PSD group and the depression group increased significantly than those in the the post-stroke non-depression group and the normal control group(P<0.01).The levels of serum hs-CRP:PSD group > post-stroke non-depression group > depression group > normal control group(P<0.05).Conclusion The PSD and depression may have the same immune mechanism.
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Objective To determine the prevalence of organ failure and its risk factors in patients with severe acute pancreatitis(SAP). Method A retrospective analysis was conducted in 186 patients, who were hospitalized in the intensive care unit of Jinzhong First People's Hospital with SAP between March 2000and October 2009. SAP patients met the diagnostic criteria of SAP set by Surgery Society of Chinese Medical Association in 2006. The variables included age, gender, etiology of SAP, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis, CT Severity Index ( CTSI ), abdomen compartment syndrome (ACS) ,the number of organ failure and the number of death. The prevalence and mortality of organ failure were calculated. The above-mentioned variables were analyzed by unconditional multivariate logistic regression analysis to determine the independent risk factors for organ failure in SAP. Results Of 186 patients, 96had organ failure. In 96 patients with organ failure, 47 died. There was a significant association between the prevalence of organ failure and age, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis, CTSI, ACS. An increase in age, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis correlated with an increase in the number of organ failure. Age, the number of comorbidit, APACHE Ⅱ score,CECT pancreatic necrosis, CTSI and ACS went into the unconditional multivariate logistic regression equation. Conclusions Organ failure occurred in 51.6% of 186 patients with SAP. The mortality of SAP with organ failure is 49.0%. Age, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis,CTSI and ACS are independent risk factors of organ failure.
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Objective To explore the effects of L-Arginine on diabetic vascular endothelial function. Methods 60 patients with Diabetes were randomly divided into two group:placebo control group(30 patients)and L-Arginine group(30 patients). Patients in L-Arginine group were taken L-Arginine 7g a day. All patients were treated for 28days and other 7days for elution. The plasma concentration of nitric oxide(NO) and endothelin (ET), vWF were measured in each group before and after the experiment. Flow Mediated Dilation(FMD) function of brachial artery of all patients were measured by high resolution vascular ultrasound. Results After the experiment, the plasma concentration of NO in L-Arginine group was higher than that of placebo group, meanwhile the plasma concentration of ET and vWF were lower than placebo group (P < 0. 05). Moreover, FDM in L-Arginine group were significant higher than placebo group(P < 0. 05). Conclusion L-Arginine could protect the vascular function in the diabetic patients.
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Objective To observe the k-ras mutation rate of colorectal cancer in China, and assess the effect and toxicity in advanced colorectal cancer (CRC) patients (pts) receiving chemotherapy combined with monoclonal antibody against Epidermal Growth Factor Receptor (EGFR). Methods The k-ras mutation of 139 samples collected from our hospital were tested by pyrophosphoric acid sequencing. Twenty-three advanced colorectal cancer patients were treated with chemotherapy combined with anti-EGFR monoclonal antibody, including 3 initial treated and 20 retreated. In the total 23 patients, 18 were treated with cetuximab and chemotherapy, and S were treated with nimotuzumab and chemotherapy. Cetuximab was taken with 400 mg/m2 first time, and then 250 mg/m2 every week. Nimotuzumab was taken with 400 mg first time, and then 200 mg every week. Eight patients of the total 23 received anti-EGFR monoclonal antibody combined with irinotecan, 12 with FOLFIRI, 3 with FOLFOX4. Results k-ras mutation type (mt) was detected in 39.6 % (55/139) of pts, k-ras wild type (wt) was 60.4 % (94/139). In 22 effect evaluable patients, 5 received PR and 9 SD, and RR and DCR were 22.7 % and 63.6 %, respectively. TTP was 124 days. Thirteen of the 22 patients tested k-ras mutation, of the 11 k-ras mt pts, 4 received PR, 4 SD and 3 PD. Two patients of k-ras mt received PD after 2 cycles treatment. Acneform eruptions were observed in 15 patients of 18 pts who received cetuximab and paronychia in 3 pts. Eruption or paronychia was not observed in all patients who received nimotuzumab. Grade 3 hypersensitivity were occured in 2 patients with cetuximab, and one of them alternated nimotuzumab in next cycle didn't get hypersensitivity any more. Conclusion The mutation rate of k-ras in Chinese colorectal cancer patients was similar with westerners. The effect of cetuximab combined with chemotherapy on advanced colorectal cancer was reliable. Nimotuzumab combined with chemotherapy worth to be studied further because of the promising effect and mild toxicity.
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This paper discussed the development history,study fields and course construction of medical informatics(MI) and compared the similarities and differences of MI between China and the other countries.