Intensive follow-up vs conventional follow-up for patients with nonmetastatic colorectal cancer treated with curative intent:A metaanalysis

BACKGROUND The frequency and content of follow-up strategies remain controversial for colorectal cancer(CRC),and scheduled follow-ups have limited value.AIM To compare intensive and conventional follow-up strategies for the prognosis of non-metastatic CRC treated with curative intent using a meta-analysis.METHODS PubMed,Embase,and the Cochrane Library databases were systematically searched for potentially eligible randomized controlled trials(RCTs)from inception until April 2023.The Cochrane risk of bias was used to assess the methodological quality of the included studies.The hazard ratio,relative risk,and 95%confidence interval were used to calculate survival and categorical data,and pooled analyses were performed using the random-effects model.Additional exploratory analyses were performed for sensitivity,subgroups,and publication bias.RESULTS Eighteen RCTs involving 8533 patients with CRC were selected for the final analysis.Intensive follow-up may be superior to conventional follow-up in improving overall survival,but this difference was not statistically significant.Moreover,intensive follow-up was associated with an increased incidence of salvage surgery compared to conventional follow-up.In addition,there was no significant difference in the risk of recurrence between intensive and conventional follow-up strategies,whereas intensive follow-up was associated with a reduced risk of interval recurrence compared to conventional follow-up.Finally,the effects of intensive and conventional follow-up strategies differed when stratified by tumor location and follow-up duration.CONCLUSION Intensive follow-up may have a beneficial effect on the overall survival of patients with non-metastatic CRC treated with curative intent.

Network meta-analysis of the prognosis of curative treatment strategies for recurrent hepatocellular carcinoma after hepatectomy

BACKGROUND Recurrent hepatocellular carcinoma(rHCC)is a common outcome after curative treatment.Retreatment for rHCC is recommended,but no guidelines exist.AIM To compare curative treatments such as repeated hepatectomy(RH),radiofrequency ablation(RFA),transarterial chemoembolization(TACE)and liver transplantation(LT)for patients with rHCC after primary hepatectomy by conducting a network meta-analysis(NMA).METHODS From 2011 to 2021,30 articles involving patients with rHCC after primary liver resection were retrieved for this NMA.The Q test was used to assess heterogeneity among studies,and Egger’s test was used to assess publication bias.The efficacy of rHCC treatment was assessed using disease-free survival(DFS)and overall survival(OS).RESULTS From 30 articles,a total of 17,11,8,and 12 arms of RH,RFA,TACE,and LT subgroups were collected for analysis.Forest plot analysis revealed that the LT subgroup had a better cumulative DFS and 1-year OS than the RH subgroup,with an odds ratio(OR)of 0.96(95%CI:0.31-2.96).However,the RH subgroup had a better 3-year and 5-year OS compared to the LT,RFA,and TACE subgroups.Hierarchic step diagram of different subgroups measured by the Wald test yielded the same results as the forest plot analysis.LT had a better 1-year OS(OR:1.04,95%CI:0.34-03.20),and LT was inferior to RH in 3-year OS(OR:10.61,95%CI:0.21-1.73)and 5-year OS(OR:0.95,95%CI:0.39-2.34).According to the predictive P score evaluation,the LT subgroup had a better DFS,and RH had the best OS.However,meta-regression analysis revealed that LT had a better DFS(P<0.001)as well as 3-year OS(P=0.881)and 5-year OS(P=0.188).The differences in superiority between DFS and OS were due to the different testing methods used.CONCLUSION According to this NMA,RH and LT had better DFS and OS for rHCC than RFA and TACE.However,treatment strategies should be determined by the recurrent tumor characteristics,the patient’s general health status,and the care program at each institution.

Risk factors of poor prognosis and portal vein tumor thrombosis after curative resection of solitary hepatocellular carcinoma

BACKGROUND:Predictors of poor prognosis of solitary hepatocellular carcinoma(SHCC),a subgroup encompassing most patients with the malignancy,are still controversial.Hence,risk factors for portal vein tumor thrombosis(PVTT) in SHCC are obscure.The present study was designed to address this issue.METHOD:Clinicopathological and follow-up data for 156 consecutive patients with SHCC following curative hepatic resection were analyzed using uni-and multi-variate analyses.RESULTS:Univariate analysis showed that PVTT,tumornode-metastasis(TNM) stage,Edmondson-Steiner grade and preoperative serum alpha-fetoprotein(AFP) level were associated with the overall and disease-free survival,whereas tumor size only influenced the overall survival.In multivariate Cox regression tests,Edmondson-Steiner grade and TNM stage were independent prognostic markers for both overall and diseasefree survival.In addition,the Chi-square test showed that AFP level and Edmondson-Steiner grade were correlated with PVTT.Among them,only Edmondson-Steiner grade was shown to be of independent significance for PVTT in multi-variate logistic regression analysis.Additionally,AFP,the sole preoperative factor for PVTT,was not adequately sensitive and specific.CONCLUSIONS:Factors relating to post-surgical prognosis and PVTT in SHCC are all tumor-related.Of these,EdmondsonSteiner grade and TNM stage might be of particular importance in survival analysis.In addition,accurate prediction of PVTT by clinicopathological parameters before surgery remains difficult.

Characteristics of gastric cancer recurrence five or more years after curative gastrectomy

Objective： To investigate the characteristics of recurrences that occurred 5 or more years after curative resection for gastric cancer.Methods： We analyzed recurrences among 1,299 patients with gastric cancer who underwent curative operations at the Department of Surgery, Inje University Seoul Paik Hospital between September 1998 and December 2002. Recurrences were classified as within 2 years （early）, 2-5 years （intermediate）, and more than 5 years （late） after gastrectomy. The clinicopathologic findings of the patients with late recurrence were compared with those of patients in the other two recurrence groups, with special reference to the patterns of recurrence. Both univariate and multivariate analyses were performed, incorporating factors such as operation type, T-stage, N-stage, stage, lymphatic invasion, neural invasion, histology, tumor size, and recurrence site.Results： At the time of last follow-up, recurrence occurred in 266 （20.5%） patients. Recurrence times were classified as 〈2 years （182 patients）, 2-5 years （61 patients）, or 〉5 years （23 patients）. The late recurrence rate was 8.6%. The occurrence of recurrence 〉5 years after gastrectomy was significantly correlated with age, operation type, T-stage, N-stage, stage, lymphatic invasion, neural invasion, histology, tumor size, location and recurrence site （P〈0.05）. The main recurrence patterns in the 23 patients with late recurrence were locoregional metastasis （10 patients, 43.5%）, peritoneal seeding （8 patients, 34.8%）, hematogenous metastasis （2 patients, 8.7%）, and multiple metastasis （3 patients, 13.0%）. A multivariate analysis showed that larger tumor size and younger age were independent prognostic factors for late recurrence. Additionally, locoregional and peritoneal recurrences were significantly more common than hematogenous recurrences. Conclusions： Although late recurrence was uncommon, younger age and larger tumor size were associated with high risk. Follow-up surveillance is recommended for locoregional and peritoneal metastasis.

Perceptual learning for treating amblyopia in children based on activation of visual signal pathway Relationship of curative effects and time

BACKGROUND： Conventional methods （such as occlusion therapy, fine manipulation, complementary, and alternative medicine） take effects slowly, are time and labor consuming, and have uncertain curative effects in the treatment of amblyopia. Perceptual learning, a new method for treating amblyopia, improves the ability to process signals from the cerebral optic nerve system by specific visual stimulation and visual learning, as well as activation of the visual signal pathway utilizing brain nervous system plasticity. OBJECTIVE： This study investigated and evaluated the curative effects of perceptual learning, which can directionally increase brain plasticity, on the treatment of amblyopia in children. The relationship between curative effect and time was also analyzed. DESIGN： A self-control experiment. SETTING： Visual Science and Optometry Center, People＇s Hospital of Guangxi Zhuang Autonomous Region. PARTICIPANTS： A total of 125 amblyopic children （250 amblyopic eyes）, 73 males, 52 females, averaging （6±2） years of age, received treatment at the Visual Science and Optometry Center, People＇s Hospital of Guangxi Zhuang Autonomous Region between September 2006 and February 2007 and were recruited for this study. All children presented with no structural disease of the eyeballs. Written informed consent for therapeutic regiments was obtained from each child＇s parent. The protocol received approval from the Hospital＇s Ethics Committee. METHODS： Visual function was tested with a perceptual learning system （Research Center for Human Health and Development of Sun Yat-sen University, National Engineering Technique Research Center for Medical Care Implement） for visual noise, position noise, contour discrimination, contrast sensitivity, grating stereogram, and random-dot fusion. These tests helped to evaluate the efficiency of visual information processing of these children, and to determine the degree of defects of the optic nerve cells and the connections of visual cortical neurons. According to results of visual function tests, individualized treatment was adopted for each amblyopia patient using perceptual learning system. One course of treatment lasted one month, and treatment was performed twice every day with two training procedures （each training procedure lasted for ten minutes）. There was a ten-minute time interval between the two training procedures. The training treatment was performed in a quiet and dark environment. Visual acuity and recovery of visual function were tested every month. Original training procedure was continued or adjusted according to the results of visual function. MAIN OUTCOME MEASURES： Visual function change; relationship of curative effects and curative time. RESULTS： A total of 125 amblyopia children were included in the final analysis. The total efficiency of perceptual learning for treating amblyopia in children was 75.2%. Visual acuity began to greatly increase 3 months after treatment （P 〈 0.05）. Visual acuity was best corrected from 0.60 ± 0.23 before treatment to 0.86 ± 0.26 after treatment （P 〈 0.05）. The mean time to reach improved levels with curative effects was （2.82 ± 1.30） months, and to reach a basically cured level was （2.87 ±1.40） months. Percentage of improved visual acuity was the highest [98% （39/40）] in children that received 3 months of treatment and the lowest [55% （31/56）] in children that received 1 month of treatment （P 〈 0.05）. The percentage of basically cured levels with curative effects increased with length of learning time and was the greatest in children that received 4 months of treatment [67% （31/46）, P 〈 0.05]. CONCLUSION： Perceptual learning rapidly and remarkably improves visual function of amblyopia children; however, the curative effects are first apparent two and three months after intervention.

Outcome of curative resection for perihilar cholangiocarcinoma in Northeast Thailand

AIM: To examine survival outcomes of perihilar cholangiocarcinoma(PCCA) resection including mortality, morbidity and prognostic factors. METHODS: Multivariate analyses were carried out based on the survival data of all patients with histologically confirmed PCCA who underwent curative resection at Srinagarind Hospital from January 2006 to December 2011. RESULTS: There were 29(19%) cases of intrahepatic CCA that involved hilar and 124(81%) with hilar bileduct cancer. R0 resection was carried out on 66(43.1%) patients of whom 50(32.7%) also had lymph node metastasis. The other patients underwent R1 resection. The overall 5-year survival rate was 20.6%(95%CI: 13.8-28.4) and median survival time was 19.9 mo. Postoperative mortality was 2%, and 30% of patients had complications. Patients without lymph node metastasis were 60% less likely to die than those with metastasis. Achieving R0 led to a 58% reduction in the chance of mortality as compared to R1. CONCLUSION: To achieve a better survival outcome, focus should center on performing radical surgery and detection of patients with early stage cancer.

Oligometastatic disease, the curative challenge in radiation oncology

The concept of oligometastatic disease was first described by Hellman and Weichselbaum in 1995. The mere insight of this concept led to the hypothesis that this disease may be cured using local ablative weapons. Surgery has already demonstrated this hypothesis. Surgery limitations, either technical or due to refusalor associated comorbidity, have led to implement alternative ablative options such as stereotactic body radiation therapy(SBRT). SBRT evolved from(stereotactic radiosurgery) because of the need to irradiate extracranial lesions and has been shown to be safe and effective. SBRT achieves local control rates ranging from 70%-90%, but highly variable survival rates depending on the group analyzed. Series with heterogeneous metastatic sites and tumor origin have reported 20% survival rates at 2-3 years, similar to those achieved with surgery. Despite its excellent results, SBRT still faces significant clinical challenges. Its optimal integration with systemic treatment is unknown, and response assessment is very difficult. However, the greatest challenge lies in selection of patients most likely to remain oligometastatic, those who will most benefit from the technique. Biomarkers, molecular signatures, that accurately predict the biological behavior of malignancy are needed. The expression profile of specific mi RNAs has been shown to have a potential in this regard.

Prognostic Factors for Patients after Curative Resection for Proximal Gastric Cancer

The factors influencing the long-term survival of patients with proximal gastric cancer (PGC) after curative resection were investigated. Data from 171 patients who underwent curative resection for PGC were retrospectively analyzed. The patients were grouped according to the clinicopathological factors and operative procedures. The tumor depth (T stage) and lymph node metastasis (pN stage) were graded according to the fifth edition of TNM Staging System published by UICC in 1997. The metastatic lymph node ratio (MLR) was divided into four levels: 0%, 30%. The data of survival rate were analyzed by Kaplan-Meier method (log-rank test) and Cox regression model. The 5-year overall survival rate of 171 patients was 37.32%. The univariate analysis demonstrated that the survival time of the postoperative patients with PGC was related to tumor size (χ2=4.57, P=0.0325), gross type (χ2=21.38, P30% (χ2=13.34, P=0.0003), TNM Ⅲ (χ2=14.05, P=0.0002) or TNM Ⅳ stage (χ2=4.37, P=0.0366); and combining splenectomy was beneficial to the cases of T3 (χ2=5.68, P=0.0171) or MLR >30% (χ2=6.11, P=0.0134). It was concluded that MLR, pN stage, TNM stage, T stage, and gross type had advantages in providing a precise prognostic evaluation for patients undergoing curative resection for PGC, in which MLR was the most valuable index. TG and combining splenectomy were useful to improve the prognosis to patients with PGC of TNM Ⅲ/Ⅲ stage, serosa invasion, or extensive regional lymph node metastasis.

Towards curative therapy in gastric cancer:Faraway, so close!

Although recent diagnostic and therapeutic advances have substantially improved the survival of patients with gastric cancer(GC), the overall prognosis is still poor. Surgery is the only curative treatment and should be performed in experienced centers. Due to high relapse following surgery, complementary and systemic treatment aimed at eradicating micrometastasis should be performed in most cases. Cytotoxic treatments are effective in downstaging locally advanced cancer, but different sensitivities and toxicities probably exist in different GC subtypes. Current treatment protocols are based primarily on clinical data and histological features, but molecular biomarkers that would allow for the prediction of treatment responses are urgently needed. Understanding how host factors are responsible for inter-individual variability of drug response or toxicity will also contribute to the development of more effective and less toxic treatments.

System security of hybrid AC-HVDC-systems challenges and new approaches for combined security assessment,preventive optimization and curative actions

The intense application of Voltage Source Converter based HVDC interconnections and grids will result in a hybrid AC-HVDC-system. The operation of such a system becomes complex regarding system security and system operation. This paper describes major challenges and proposes potential solutions, including a combined security assessment, preventive optimization and curative actions. A coordination of both systems enables an efficient application of existing transport capacity.

Evaluation of diagnosis and curative criterion for concussion patients by color three-dimensional trascrani doppler

Objective In order to offer a noninvasive and objective examination method for assessing the clinical diagnosis and eurative criterion of concussion patients,the patients color three－dimensional transcranial doppler(3D－TCD)characteristic at deferent phases,parameter and clincal manifestation were studied.Method Parameter of Median Cerebral Artery(MCA),Base Artery(BA),the average peak forwand velocity of cerebral blood flow,train figure were tested by 3D－TCD within 24 hours,3－6 days and at the end of treatment,respectively.The results were compared with clinical diagnoses and curative criterion.Result Among 135 patients who had clinically diagnosed concussion,agreeable diagnoses 101 cases,basically agreeable diagnoses 12 cases,disagreeable diagnosis 22 cases(16.2％).At the end of treatment, according to clinical determination 96 cases(71.1％)were cured,39 cases(28.9％)were improved.Wave train character,figure and diagnoses parameter of cerebral spasm caused by concussion were suggested.Conclusion To be one of the diagnostic bases and curative criterion,3D－TCD technology is performable.Meanwhile,it is a new testing objective technique for assessing curative and determining prognosis.

OBSERVATION ON THE CURATIVE EFFECT OF ACUPUNCTURE ON TYPE I ALLERGIC DISEASES

In a comparative study on treatment of type Ⅰ allergic diseases,acupuncture and desensitizationtherapies were performed in 143 cases.The results showed that acupuncture therapy had an ex-tensive and remarkable action against type Ⅰ allergic reaction.The curative effect was higher inthe acupuncture group than in the desensitization group in allergic asthma,allergic rhinitis andchronic urticaria.

OBSERVATION OF CURATIVE EFFECT ON EOSINOPHILIC GASTROENTERITIS BY TREATMENT WITH METHOD OF REINFORCEMENT OF ESSENCE OF THE KIDNEY

12 patients with eosinophilic gastroenteritis were treated with prescriptions and drugs based mainly on the method of reinforcement of essence of the kidney. Remarkable curative effect was achieved in 9 cases and eutherapeutk effect in 3, Le, the cure rate was 100%. The efficacy began to appear hi a minimum of 7 days and a maximum of 12 days. There was no recurrence over 1 to 3 years’ follow-up observation.

OBSERVATION OF CURATIVE EFFECT OF ACUPUNCTURE THERAPY PLUS SCALP ACUPUNCTURE FOR RESTORING CONSCIOUSNESS AND INDUCING RESUSCITATION IN 80 CASES OF ACUTE APOPLEXY

During our 4-year work in The Republic of Yemen, the authors used acupuncture therapy to restore consciousness and induce resuscitation plus scalp acupuncture in 80 cases of acute apoplexy, with 63 cases cured, accounting for 78.75%. This therapy is obviously superior to the traditional principle of point selection in acupuncture used in 25 cases as to curative effect, treatment course and other aspects. There is an obvious statistical difference (P【 0.005).

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

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OBSERVATION OF CURATIVE EFFECTS OF HUATUOJIAJI IN THE TREATMENT OF 300 CASES OF APOPLEXY

Huatuojiaji are extra-channel acupoints which are first described in A Handbook of Prescriptions for Emergencies, and the clinical application of which has been expanded a great deal in modern times. In the end of 1970s, the successful application of Huatuojiaji points in acupuncture anaesthesia brought the research on Huatuojiaji points to its climax; and in recent years, great progress has been made in the study of clinical application, improvement of curative effects and functional mechanism of Huatuojiaji points. According to the theories of acupuncture and moxibustion that puncturing Huatuojiaji can dredge channels, promote flow of qi, regulate yin and yang, and activate the Du Channel and the Urinary Bladder Channel, 300 cases of apoplexy were thus treated with good curative effects. There are altogther 56 points, 28 on each side of the spine, 0.5 cun lateral to the spinous process. The prescription for apoplexy includes C1-7, T1-9 and L2-4. Of the 300 cases of apoplexy, 100 were cured, 107 markedly effective, 87 improved, and 6 ineffective, the total effective rate being 98%.

100 Cases of Obstinate Insominia of Curative Effect by Acupuncture Da Ling Point

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OBSERVATION ON CURATIVE EFFECTS OF BEATING-ACUPUNCTURE ON 100 CASES OF CERVICAL SPONDYLOPATHY

Beating-acupuncture therapy is developed by Li Xutang, Director of the Section of TCM in the Jingdezhen Municipal First Hospital. Amng the 100 cases in the beating-acupuncture group, 85 cases were cured and 11 cases improved, the cure rate was 85 %; Of the 50 cases in the filiform needle acupuncture group, 25 cases were cured and 23 improved, the cure rate was 50 %. There was a statis-tically significant difference(P<0.01 ) between the two grdrips. It is indicated that the curative effect of beating-acupuncture on cervical spondylopathy is obviously superior to that of fili form-needle acupuncture, which provides a new therapy without traumatic pain for clinical treatment of cervical spondylopathy,

Analysis of the Curative Effect of Cold-Dampness Epidemic Prescription(寒湿疫方)on the Main Symptoms of Quarantined People in Community

Objective:To evaluate the curative effect of"Cold-Dampness Epidemic Prescription(寒湿疫方)"on the main symptoms of quarantined people in community based on real-world research data,and to provide scientific basis for Chinese medicine to fight Coronavirus disease 2019 under the"Wuchang Model".Methods:From February 4,2020 to March 5,2020,the data of community quarantined people who only took"Cold-Dampness Epidemic Prescription(寒湿疫方)"under the management of"Wuchang Model"were collected,and the demographic characteristics,basic diseases,distribution of sick people,treatment process,disappearance time of eight clinical symptoms,adverse reactions and clinical outcomes of patients were statistically analyzed.Results:A total of 951 quarantined people in COVID-19 community were included,including 440 males(46.27%)and 511 females(53.73%),the oldest was 89 years old,the youngest was 2 years old,and the average age was 43.34 years old;Among the quarantined population in the community,there were 141 cases diagnosed by CDC(14.83%),CDC excluded 810 cases(85.17%);106 cases of CDC were diagnosed as COVID-19,accounting for 47.96%of the self-reported cases,and 311 cases(32.70%)had previous medical history;696(73.19%)had no obvious symptoms,and 255(26.81%)developed fever,fatigue,cough,sputum,shortness of breath,loss of appetite,diarrhea and mood,of which 187(19.66%)had cough symptoms,followed by sputum coughing(14.30%)and fever(13.56%).Conclusion:"Cold-Dampness Epidemic Prescription(寒湿疫方)"is effective in treating the clinical symptoms of COVID-19 without obvious adverse reactions.