Real-world clinical effectiveness of sorafenib among patients with unresectable hepatocellular carcinoma at two centers in the United States

BACKGROUND In the United States,sorafenib monotherapy was approved in 2007 for first-line(1L)treatment of patients with unresectable hepatocellular carcinoma(uHCC).As other therapies have been approved in recent years for hepatocellular carcinoma treatment in later lines,it is essential to assess clinical effectiveness of older therapies in actual clinical practice to inform healthcare practitioners’decisions for better patient care.AIM To assess patient characteristics/clinical effectiveness of 1L sorafenib in uHCC patients treated in United States academic and community practice settings.METHODS A retrospective observational study was conducted among adult patients(≥18 years)in the United States initiating sorafenib monotherapy as 1L systemic therapy for uHCC with Eastern Cooperative Oncology Group status of 0 or 1 between January 2016 and December 2019 at City of Hope and Advent Health.Data were extracted by trained abstractionists from individual patients’electronic health records and captured in electronic case report forms.Institutional Review Board approvals were obtained prior to study initiation.Data were captured from the time of sorafenib initiation until death or the end of follow-up.All data were de-identified prior to analyses.Clinical outcomes assessed included provider-reported best response,progression-free survival(PFS),and overall survival(OS).PFS and OS were estimated using Kaplan-Meier methods.RESULTS Among 134 uHCC patients treated with 1L sorafenib,majority were male(75%),and most were Caucasian(62%)or Asian(19%).Median patient age was 64 years.The most common etiologies of liver disease were hepatitis C(54%),alcohol-related liver disease(16%),and hepatitis B(11%).Most patients were reported to have Barcelona Clinic Liver Cancer stage B(19%)or stage C(70%)disease.Of 134 patients,110(82%)were reported to have discontinued treatment or died during follow-up.Primary reasons for sorafenib discontinuation were reported as progression(35%)and toxicity(30%).Best overall response was reported for 124 patients,of which 7.3%reported complete or partial response.Median time to treatment discontinuation was 2.3 mo.Overall,103 patients(77%)had disease progression or died during sorafenib therapy.Median PFS was estimated to be 2.9 mo.At the end of follow-up,82 patients(61%)were deceased.Median OS was 8.5 mo.CONCLUSION Newer therapeutic options that have reported higher PFS and OS in real-world clinical practice should be considered to enhance patient outcomes.

Observation on Therapeutic Effects of Electroacupuncture on Polycystic Ovary Syndrome of Kidney Deficiency and Phlegm Dampness Type and Oxidative Stress Level

Objective:To observe the clinical effect of electroacupuncture on improving polycystic ovary syndrome(PCOS)of kidney deficiency and phlegm dampness type and serum oxidative stress level.Methods:There were 68 patients with polycystic ovary syndrome were randomly divided into observation group(34 cases)and the control group(34 cases),The observation group was treated by electroacupuncture,while the control group was treated by placebo electroacupuncture.Combined with the evaluation of menstrual cycle,menstrual color,quality,quantity and TCM symptom integral index,the difference of curative effect between the two groups was observed,and the levels of peripheral blood,sex hormones,insulin resistance and oxidative stress were detected before and after treatment for 3 months.Results:The total effective rate in the observation group was better than that in the control group(P<0.01);After intervention,serum LH,FSH,E_(2) and LH/FSH in the observation group were significantly different from those before intervention.The D values of serum LH,FSH,LH/FSH and E_(2) before and after intervention were significantly different between the two groups(P<0.01);Comparing the level of androgen,the serum A4 and T in the observation group were significantly different from those before intervention(P<0.01);After intervention,there was a significant difference in serum A4 and T between the two groups(P<0.01),and there was a significant difference in D value between the two groups before and after intervention;There was a difference in insulin resistance in the observation group before and after intervention(P<0.05),and there was a significant difference in D value between the two groups before and after intervention(P<0.01);After the intervention,the serum SOD,MDA,ROS in the observation group were significantly different from those before the intervention;After intervention,the results of serum SOD and ROS in the observation group were significantly different from those in the control group;There was no significant difference in serum MDA results.There were significant differences in SOD,MDA,ROS between the two groups before and after intervention.Conclusion:Electroacupuncture can improve oxidative stress injury,insulin resistance and hyperandrogenism in PCOS patients.

Clinical Observation on Effect of Shenqi Fuzheng(参芪扶正)Injection Combined with Chemotherapy in Treating Post-operational Patients with Colorectal Carcinoma

Chemotherapy(CT)is the most impor-tant therapeutic means in treating post-oper-ational patients with colorectal carcinoma(CA),but its efficacy is often affected bythe toxic side-effects of CT agents.TCMcould reinforce body resistance and tonifythe qi,alleviate the toxic side-effects of CT,thus strengthening the efficacy of organismagainst tumor.Shenqi Fuzheng(参芪扶正,

Clinical Observation on the Efficacy Enhancing and Toxicity Attenuating Effect of Nuzhen Yangyin Granule to the Anti-Parkinsonism Therapy Mainly with Medopa

Objective: To observe and assess the efficacy enhancing and toxicity attenuating effect of Nuzhen Yangyin Granule (NYG) to the anti-parkinsonism (paralysis agitans) therapy with medopa and ar-tane. Methods: Adopting the randomized double-blinded method, the effect of adding NYG to 30 patients with Parkinsonism in the treated group,

Clinical efficacy,bone density,and follow-up in implant and orthodontic treatment for inclined adjacent teeth

BACKGROUND Tooth defects can cause elongation of occlusal teeth,leading to insufficient repair space.The combination of dental implant restoration and orthodontic treatment of oblique adjacent teeth has a significant therapeutic effect.AIM To explore clinical efficacy,bone density,and follow-up of implant and orthodontic treatment for patients with inclined adjacent teeth.METHODS In total,98 patients with oblique adjacent teeth were randomly assigned to implant restoration combined with orthodontic treatment(group A,n=49)or to receive implant restoration alone(group B,n=49).Changes in alveolar ridge bone density and apical bone density were observed before and after treatment in the two groups.Changes in chewing function and language function were compared between the two groups of patients.Follow-up lasted for 12 mo after repair to observe any adverse reactions in the oral cavity.RESULTS The clinical effective rates of group A and group B were 97.96%and 85.71%,respectively,with group A having a higher clinical effective rate than group B.After treatment,the bone density of the alveolar ridge and apical bone in both groups decreased compared to before treatment,while the chewing and language functions improved.The changes in various indicators in group A were more significant.After treatment,the satisfaction rate of group A(97.96%)was higher than that of group B(79.59%).The incidence of adverse reactions in group A(2.04%)was lower than that in group B(24.49%).CONCLUSION The amalgamation of implant restoration and orthodontic treatment for adjacent tilted teeth demonstrates notable clinical efficacy,diminishes alveolar bone resorption,and fosters patient functional rehabilitation while exhibiting negligible adverse reactions.

Clinical observation of the effect of crystallitic dermabrasion on skin superficial scars

To oberserve the changes in histopathology and clinical effect after the treatment of superficial scars in human faces and exposed parts of human extremities with crystallitic dermabrasion.Methods The machine made in Italy can produce the high speed crystallite to the surface of the scar,resulting in the alveolate wounds.At the same time the crystolitic drill make the accidented scar smooth.Results Two thousands and five hundreds and thirty eight suffers were treated for 2～10 times.The appearance of the scars was improved.Six patients complicated with milium,Eleven got hypopigmentation,eight got hypomelanotation.Eighty percent patients of this groups got pigmentation after the treatment.This signs disappeared or improved after 2～6 months.Histopathology demonstrated the scar area became small,the fibroblasts increased remarkably and the collagenous fiber arranged regularly.The cells in the stratum spinosum proliferated actively.Conclusion Crystallitic dermabrasion is a simple and safe method for the treatment of skin superficial scars.5 refs,4 figs.

Comparative study of the clinical efficacy of all-inside and traditional techniques in anterior cruciate ligament reconstruction

BACKGROUND Many studies have focused on the femoral tunnel technique and fixation method,but few studies have involved the tibial tunnel technique and fixation method.The all-inside technique is one of the new techniques that has been described in recent years.All-inside anterior cruciate ligament(ACL)reconstruction is based on a tibial socket instead of a full tunnel.This method has many potential advantages.AIM To compare clinical outcomes of knee ACL autograft reconstruction using allinside quadrupled semitendinosus(AIST)and traditional hamstring tendon(TBT)techniques.METHODS From January 2017 to October 2019,the clinical data of 80 patients with ACL reconstruction were retrospectively analyzed,including 67 males and 13 females.The patients had an average age of 24.3±3.1 years(age range:18-33 years).The AIST technique was used in 42 patients and the TBT technique was used in 38 patients.The time between operation and injury,operative duration,postoperative visual analogue scale(VAS)score and knee functional recovery were recorded and compared between the two groups.The International Knee Documentation Committee(IKDC)and Lysholm scoring system were used to comprehensively evaluate clinical efficacy.RESULTS Eighty patients were followed for 24-36 mo,with an average follow-up duration of 27.5±1.8 mo.There were no significant differences in the time between surgery and injury,operative duration,IKDC and Lysholm scores of the affected knee at the last follow-up evaluation between the two groups.There were significant differences in VAS scores 1 d,3 d,7 d,2 wk and 1 mo after surgery(P<0.05).There was no significant difference in VAS score at 3 mo,6 mo and 1 year after operation.CONCLUSION The efficacy of the AIST ACL reconstruction technique was comparable to the TBT technique,but the postoperative pain was less with the AIST technique.Thus,the AIST technique is an ideal treatment choice for ACL reconstruction.

Observation of Curative Effect of Massage and Acupoint Block on 250 Patients with Scapulohumeral periarthritis

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THE RELATIONSHIP BETWEEN THE CONCENTRATION OF METHIMAZOLE IN PLASMA AND INTRATHYROID AND ITS CURATIVE EFFECT

In order to investigate the relationship between concentration of methimazole(MMTand clinical curative efficacy,the concentration of MMI in Plasma and thyroid tissue was measuredin 26 patients with Graves' disease by HPLC,meanwhile their T-lymphocyte subsets,thyroid autoimmune antibodies and serum immunoglobulin were also measured.The results showed: ① The plasmaand intrathyroid concentrations of MMI of recovery group were much higher than those of unrecovery group(P<0.001).② The hardness of thyroid had a significant effect on the concentration ofMMI in thyroid.③Plasma concentration of MMI in the patients with no or 1￣2-degree enlargement of thyroid was much higher than that in the patients with 3-degree enlargement of thyroid(P<0.001). In addition, the plasma concentration of MMI in the subjects with soft thyroid was mudhigher than that in those with hard thyroid(P<0.001).Our study demonstrated that MMI playeda role in the immune supression of thyroid autoimmune antibodies and the immune regulation of Tand B-lymphocytes.Effective MMI concentration in the plasma and intrathyroid is the key of thesuccessful clinical treatment and correlates with the size and hardness of thyroid.

Clinical symptoms of cervical and shoulder MTrPs combined with the "third stage" dialectical traction in the treatment of cervical radiculopathy and its effect on the serum inflammatory factors of patients

Objective:To observe the clinical efficacy of acupotomology in the treatment of cervical and shoulder myofascial pain trigger point for cervical radiculopathy,and to detect its effect on COX-2,PGE2,5-HT,TNF-α and other inflammatory factors.Methods:A total of 110 CSR patients were selected as the research objects and divided into observation group(Acupotomology to release the trigger points of myofascial pain in neck and shoulder combined with"three-stage"dialectical traction method)and control group(conventional acupuncture combined with"Stage 3"dialectical traction)with 55 cases.Before and after treatment,the two groups were compared by improving the efficacy of MacNab,simplifying the SCORE of Mc Gill Pain Scale,measuring cervical curvature and serum levels of inflammatory factors such as COX-2,PGE2,5-HT and TNF-α.Results:After two weeks of treatment,the total effective rate of the observation group was 96.36%,higher than that of the control group(83.63%),and the difference was statistically significant(P<0.05).After the treatment,PRI,VAS,PPI and other scores of the two groups were all lower than those before the treatment,with statistical significance(P<0.05).However,there was no statistically significant difference in PRI,VAS and PPI scores between the two groups after treatment(P>0.05).The serum inflammatory factors of coX-2,PGE2,5-HT and TNF-αin the two groups were significantly lower after treatment than before treatment(P<0.05).However,the comparison of cox-2,PGE2,5-ht and TNF-αbetween the two groups showed no statistical significance(P>0.05).The cervical curvature values measured after treatment were significantly increased compared with those before treatment,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups(P>0.05).Conclusion:The combination of acumotomology and"three-stage"dialectical traction method can significantly improve the pain and discomfort of patients with cervical radiculopathy,significantly reduce the symptoms,restore the physiological curvature of cervical vertebra,and reduce the inflammatory factors in serum.

Clinical Observation and Network Pharmacology Study on Analgesic Effect of Qianghuo Chushi Decoction on Fasciitis

[Objectives]To observe the clinical analgesic effect of Qianghuo Chushi Decoction(QHCSD)on patients with fasciitis,and explore its possible molecular mechanism based on network pharmacology.[Methods]120 enrolled patients were randomly divided into experimental group and control group,and were separately treated with QHCSD formula granules and Diclofenac Sodium Enteric-coated Tablets for 4 weeks.The patient’s pain visual analogue scale(VAS)was used as the curative effect indicator.The molecular action mechanism of QHCSD was predicted based on network pharmacology,the active components of QHCSD were screened using TCMSP database,potential targets were predicted by PharmMapper server,compound-target network and protein interaction network were constructed,and GO-based enrichment analysis and KEGG-based biological pathway enrichment analysis were performed.[Results]After treatment,the pain scores in each group were significantly lower than those before treatment(P<0.01),the score of the experimental group was significantly lower than that of the control group(P<0.01),and the total effective rate of the experimental group was 83.33%,which was significantly higher than that of the control group(78.33%,P<0.05).Based on 108 active components in QHCSD,a compound-target network was constructed.The PPI network contained 155 nodes and 527 interaction relationships,and key nodes included FOS,ESR1,NCOA1,RELA,EGFR,MAPK8,IL-6,etc.The GO pathway mainly involved steroid hormone and its receptor activity,RNA polymerase II transcriptional regulator binding,nuclear receptor activity,protein heterodimerization activity and other pathways.KEGG metabolic pathways included PI3 K-Akt signaling pathway,Kaposi’s sarcoma-associated herpesvirus(KSHV)infection and other pathways.[Conclusions]QHCSD has a significant analgesic effect on fasciitis,and the PI3 K-Akt signaling pathway may be the key pathway for its analgesic effect.

Clinical Observation of Breast Conserving Surgery and Modified Radical Mastectomy in the Treatment of Early Breast Cancer

The purpose of the study was to compare the clinical efficacy of breast conserving surgery and modified radical mastectomy in the treatment of early breast cancer.Firstly,the clinical data of 74 patients with early breast cancer treated in our hospital from June 2015 to June 2016 were retrospectively analyzed.Among them,37 patients treated with breast-conserving surgery were set as the study group,and 37 patients treated with modified radical surgery were set as the control group,and the therapeutic effects of the two groups were compared.The results showed that compared with the control group,the incision length,intraoperative blood loss,operation time and hospital stay time were better in the study group,and the excellent and good rate of postoperative breast beauty was higher,with statistically significant differences(P<0.05).There were no statistically significant differences in distant metastasis rate,local recurrence rate,axillary lymph node recurrence rate and fatality rate between the two groups(P>0.05).Therefore,breast-conserving surgery and modified radical surgery have better efficacy in the treatment of early breast cancer,but breast-conserving surgery has more advantages,such as smaller incision,less intraoperative blood loss,shorter operative time and hospital stay,and better postoperative aesthetic effect,which can be used as the first choice for early breast cancer.

Clinical Observation on Effect of Xuesaitong Injection (血塞通注射液) as Auxiliary Treatment of Severe Craniocerebral Injury

Objective To evaluate the effect of Xuesai-tong injection (XSTI, 血塞通注射液 , a preparation of Panax Notoginseng) as auxilliary treatment of severe craniocerebral injury. Methods Eighty-seven patients with severe craniocerebral injury were selected and randomly divided into the treated group (n=44) and the control group (n = 43), they were treated with conventional treatment, and XSTI was given additionally to the treated group. Intracranial pressure (ICP) and Glasgow coma score (GCS) of all patients were measuredafter 1 or 2-week treatment, and Glasgow outcome scale (GOS) of them was determined 3 months later. Then the therapeutic effect in the two groups were compared. Results After treatment, the ICP was lower, GCS higher and GOS better in the treated group than those in the control group significantly, all showing statistical significance (P<0.05). Conclusion XSTI has marked clinical therapeutic effect in treating patients with severe craniocerebral injury.Original article on CJITWM (Chin) 2004 ;23 (3): 213

Clinical Observation on Effect of Combination of Zhuanyindan (转阴丹) and Hormone in Treating MaleInfertility with Positive Antisperm Antibody

Objective:To explore the therapeutic effect of combination of Zhuanyindan (ZYD, 转阴丹, a self-made Chinese herbal preparation) and hormone in treating male infertility with positive antisperm antibody and its influence on nitric oxide (NO) level. Methods:Eighty-two patients were randomly divided (according to the digital list) into the WM group (n = 20, treated with prednisone), the TCM group (n=28, treated with ZYD) and the ICWM group (n=34, treated with prednisone plus ZYD). The clinical effect, negative converting rate of antisperm antibody, changes of NO level in semen and various parameters of sperm motion before and after treatment were observed. Results: The total effective rate in the ICWM group was 88.2%, that in theTCM group 75. 0% and in the WM group 65. 0%. Significant difference was seen in the ICWM and TCM group before and after treatment in NO level, sperm motion parameters, including linear motion speed, linearity, propulsion, whip frequency, sperm vitality and mean moving angle, and quality of semen ( P < 0. 05 or P < 0. 01). In the WM group, significant difference in comparison before and after treatment was seen in NO level, propulsion, whip frequency, mean moving angle and quality of semen, including vitality and survival rate (P<0. 01). Conclusion: Combination of Chinese herbs and hormone could lower the NO level in semen and improve the quality of sperm.Original article on CJITWM (Chin) 2004 ;23 (3): 223

Clinical effects of acupoints moxibustion therapy on postsurgical gastroparesis syndrome after resection of esophageal cardia cancer

OBJECTIVE:To evaluate effects of acupoints moxibustion therapy on postsurgical gastroparesis syndrome(PGS) after resection of esophageal cardia cancer.METHODS:60 patients with PGS after resection of esophageal cardia cancer,admitted to the second affiliated hospital to Nanyang medical college from August 2012 to August 2015,were selected and studied randomly.They were divided into the treatment group and the control group by single blind controlled method,30 cases in each group.The gastric paralysis main symptom index(GCSI,by symptom ratings quantitative score table) score,drainage volume of gastric juice and value of motilin were recorded respectively at 1,7,14 and 21 days after treatment in two groups.Apart from conventional therapies,acupoints moxibustion was given on Shenque,Guanyuan,Qihai,Zhongwan acupoints,twice a day,30 minutes once,7 days as a course of treatment and for 3 courses in the treatment group.In the control group,the conventional therapies were given,7 days as a course of treatment and for 3 courses.RESULTS:The GCSI score,drainage volume of gastric juice,value of motilin in the treatment group were better than that of the control group at 7,14,21 days respectively,and there were significant differences between two groups(P<0.05).The treatment group had a more sigi curative effect than that in the control group at 7,14 days respectively(P<0.05),but there was no significant difference at 21 day between the two groups(x^2=5.68,P<0.13);nevertheless,there were more recovery cases in the treatment group than those in the control group at 21 day(x^2=4.59,P<0.032).The total effective rate was 100.00% in treatment group,and 83.00% in the control group(P<0.05).CONCLUSIONS:Acupoints moxibustion has the advantageof addressing both the symptoms and root causes of PGS after resection of esophageal cardia cancer.

Clinical observation of traditional Chinese medicine nursing on recovery of gastrointestinal function in patients after abdominal operation

Objective: To observe the clinical effect of traditional Chinese medicine nursing on the recovery of gastrointestinal function after abdominal operation. Methods: A total of 148 patients undergoing abdominal surgery from June 2013 to June 2014 in our hospital were randomly divided into observation group and control group, 74 cases in each group. The control group received routine nursing and the observation group was treated with the pointer, acupuncture and external application of abdominal treatment on the basis of routine nursing, which is 2 times a day,7 days for a course of treatment. Results: The recovery time of bowel sound, the first anal exhaust defecation time the in the observation group and the hospital day was less than the control group. With the comparison of two groups, the difference between the two groups was statistically significant (P < 0.05). The incidence of abdominal pain, abdominal distension, nausea, vomiting and constipation in the observation group was significantly lower than that in the control group (P < 0.05). Conclusion: On the basis of routine nursing, the implementation of traditional Chinese medicine characteristic nursing can effectively promote the recovery of gastrointestinal function, reduce the occurrence of complications, shorten the length of stay and improve the clinical effect.

Clinical Observation of 48 Cases of Black Eye Circle Treated with Modified Yu Rong San Gel Eye Mask

Objective:To observe the clinical effect of modified Yu Rong San gel eye mask in the treatment of dark circles.Methods:96 cases of patients with dark circles were randomly divided into treatment group and control group.In the control group and the treatment group,the common eye mask and the modified Yu Rong San gel eye mask were applied to the black circle area respectively.After 15min,water was used to wash the face,the application of the mask for one time a day,four weeks,one course,and three courses were observed.Results:After three courses of treatment,the total effective rate of the treatment group was higher than that of the control group(P<0.05);the area of black eye circles in the treatment group was smaller than that before treatment(P<0.05);compared with the control group,the score of black eye circles was lower than that before treatment,the difference was statistically significant(P<0.05).Conclusions Addition and reduction of Yu Rong San gel eye mask is effective in the treatment of dark circles.

Clinical Effect of Integrated Traditional Chinese and Western Medicine on Diabetic Peripheral Neuropathy

Objective:Patients with diabetic peripheral neuropathy were treated with integrated traditional Chinese and western medicine,and the final results were observed.Methods:70 patients with such symptoms were randomly divided into two groups.The number of people is the same,and the treatment methods are different.The control group uses western medicine,while the observation group uses traditional Chinese medicine to evaluate the treatment effect.Results:After treatment,the effective rate of the observation group was(P<0.05),indicating that the treatment effect was significantly better.Conclusion:Patients with clinical diabetic peripheral neuropathy treated with routine nutrition and nerve repair,and with Chinese medicine,the effect is more satisfactory,and the effect is positive,so as to promote the optimization of their health.