116例涂阳肺结核病人不住院全监化疗分析

目的探讨肺结核病人不住院化疗方案的效果。方法分析116例涂阳病人不住院治疗转归的情况分析。结果奎屯市116例涂阳病人不住院治疗,其中109例治愈,治愈率93.96%。结论“项目”推广方案是切实可行的,只要按规范执行即可达较高治愈率。

新辅助化疗配合保肢手术治疗骨肉瘤的临床效果及安全性分析

目的分析新辅助化疗配合保肢手术治疗骨肉瘤的临床效果及安全性。方法选择2020年1月—2023年1月菏泽市牡丹人民医院收治的76例骨肉瘤患者,以随机数表法分为两组,每组38例。观察组予以新辅助化疗配合保肢手术治疗,对照组仅予以保肢手术治疗,比较两组的临床疗效、肿瘤标志物、肢体功能、不良反应。结果观察组临床总有效率较对照组高,差异有统计学意义(P<0.05);两组术后1周的血清淀粉样蛋白A(SAA)、胰岛素样生长因子-1(IGF-1)、骨碱性磷酸酶(BALP)水平均较治疗前降低,且观察组更低,差异有统计学意义(P<0.05);两组术后4周的Enneking量表中疼痛度、肌力、肢体稳定性、生活能力、关节运动、心理承受力各维度评分均较治疗前升高,且观察组更高,差异有统计学意义(P<0.05);两组不良反应比较,差异无统计学意义(P>0.05)。结论新辅助化疗配合保肢手术治疗骨肉瘤的临床效果较高,能提升总有效率,降低肿瘤标志物水平,改善肢体功能,且安全性良好。

晚期胃癌与术后复发转移胃癌擦用卡培他滨化疗的效果分析

目的探讨晚期胃癌与术后复发转移胃癌擦用卡培他滨化疗的效果,为晚期胃癌与术后复发转移胃癌擦用卡培他滨化疗的应用提供理论依据。方法选取2015年11月—2016年11月在医院接受治疗的90例晚期胃癌与术后复发转移胃癌患者作为此次研究对象,给予患者药物治疗,并根据使用药物的不同分为观察组与对照组,每组患者45例,对照组患者采用常规药物奥沙利铂治疗,观察组患者在对照组的基础上采用卡培他滨治疗,对两组患者治疗的情况进行观察和总结,分析比较2组患者治疗效果情况、不良反应发生情况。结果观察组患者总有效率为57.78%,疾病控制率为77.78%相比于对照组的42.22%和68.89%,观察组患者总有效率和控制率明显更高,两组患者的不良反应为白细胞减少、血小板减少、贫血、口腔黏膜、外周神经毒性等,观察组患者发生例数分别为2例、2例、2例、2例、2例,发生率为26.67%,对照组为4例、4例、6例、6例、5例,发生率为55.56%,2组发生率进行比较,观察组明显更低,组间比较,差异有统计学意义(P<0.05)。结论晚期胃癌与术后复发转移胃癌擦用卡培他滨化疗的效果显著,患者的症状和生活质量得到改善,不良反应发生率下降,治愈率和安全性得到提高,值得推广应用。

Liver fibrosis and tissue architectural change measurement using fractal-rectified metrics and Hurst's exponent

AIM： To provide the accurate alternative metrical means of monitoring the effects of new antiviral drugs on the reversal of newly formed collagen. METHODS： Digitized histological biopsy sections taken from 209 patients with chronic C virus hepatitis with different grade of fibrosis or cirrhosis, were measured by means of a new, rapid, user-friendly, fully computeraided method based on the international system meter rectified using fractal principles. RESULTS： The following were described： geometric perimeter, area and wrinkledness of fibrosis; the collation of the Knodell, Sheuer, Ishak and METAVIR scores with fractal-rectified metric measurements; the meaning of the physical composition of fibrosis in relation to the magnitude of collagen islets; the intra- and inter-biopsy sample variability of these parameters; the ＂staging＂ of biopsy sections indicating the pathway covered by fibrosis formation towards its maximum known value; the quantitative liver tissue architectural changes with the Hurst exponent. CONCLUSION： Our model provides the first metrical evaluations of the geometric properties of fibrosis and the quantitative architectural changes of the liver tissue. The representativeness of histological sections of the whole liver is also discussed in the light of the results obtained with the Hurst coefficient.

Receptor activator of nuclear factorκB ligand/osteoprotegerin axis and vascular calcifications in patients with chronic kidney disease

Vascular calcifications are commonly observed in patients with chronic kidney disease （CKD） and contri-bute to the excessive cardiovascular morbidity and mortality rates observed in these patients populations. Although the pathogenetic mechanisms are not yet fully elucidated, recent evidence suggests a link between bone metabolism and the development and progression of vascular calcifications. Moreover, accumulating data indicate that receptor activator of nuclear factor κB ligand/osteoprotegerin axis which plays essential roles in the regulation of bone metabolism is also involved in extra-osseous bone formation. Further studies are required to establish the prognostic significance of the above biomarkers as predictors of the presence and severity of vascular calcifications in CKD patients and of cardiovascular morbidity and mortality. Moreover, randomized clinical trials are needed to clarify whether inhibition of osteoclast activity will protect from vascular calcifcations.

Immunohistochemical expression of intrarenal renin angiotensin system components in response to tempol in rats fed a high salt diet

AIM To determine the effect of tempol in normal rats fed high salt on arterial pressure and the balance between antagonist components of the renal renin-angiotensin system.METHODS Sprague-Dawley rats were fed with 8% NaCl high-salt （HS） or 0.4% NaCl （normal-salt, NS） diet for 3 wk, with or without tempol （T） （1 mmol/L, administered in drinking water）. Mean arterial pressure （MAP）, glomerular fltration rate （GFR）, and urinary sodium excretion （UVNa） were measured. We evaluated angiotensin Ⅱ （Ang Ⅱ）, angiotensin 1-7 （Ang 1-7）, angiotensin converting enzyme 2 （ACE2）, mas receptor （MasR）, angiotensin type 1 receptor （AT1R） and angiotensin type 2 receptor （AT2R） in renal tissues by immunohistochemistry.RESULTSThe intake of high sodium produced a slight but signifcant increase in MAP and differentially regulated components of the renal renin-angiotensin system （RAS）. This included an increase in Ang Ⅱ and AT1R, and decrease in ACE-2 staining intensity using immunohistochemistry. Antioxidant supplementation with tempol increased natriuresis and GFR, prevented changes in blood pressure and reversed the imbalance of renal RAS components. This includes a decrease in Ang Ⅱ and AT1R, as increase in AT2, ACE2, Ang （1-7） and MasR staining intensity using immunohistochemistry. In addition, the natriuretic effects of tempol were observed in NS-T group, which showed an increased staining intensity of AT2, ACE2, Ang （1-7） and MasR.CONCLUSION These findings suggest that a high salt diet leads to changes in the homeostasis and balance between opposing components of the renal RAS in hypertension to favour an increase in Ang Ⅱ. Chronic antioxidant supplementation can modulate the balance between the natriuretic and antinatriuretic components of the renal RAS.

Xiaoaiping injection combined with cisplatin and gemcitabine for non-small cell lung cancer:a meta-analysis

Objective:To evaluate the clinical efficacy of Xiaoaiping injection(XAPI)combined with cisplatin plus gemcitabine(regimen of GP)for patients with non-small cell lung cancer(NSCLC).Methods:A literature search was conducted for collecting the randomized controlled trials(RCTs)on NSCLC treated by Xiaoaiping injection and GP in the Cochrane Library,PubMed,Embase,Chinese National Knowledge Infrastructure(CNKI),China Biology Medicine(CBM),China Science and Technology Journal Database(VIP)and the Wanfang Database from inception to December,2018.The quality of the RCTs was evaluated by the Cochrane risk of bias assessment tool,and data analysis were performed with Review Manager 5.3.Results:A total of 7 randomized controlled trials with 534 patients were incorporated.The results showed that there is no statistical significance in total effective rate[OR=1.39,95%CI(0.97,1.98),P=0.07]and gastrointestinal reactions rate[OR=0.44,95%CI(0.16,1.23),P=0.12]between GP alone and XAPI combined with GP.In comparison with GP alone,the XAPI combined with GP was associated with the lower effects on the decrease rate of hemoglobin[OR=0.49,95%CI(0.26,0.92),P=0.03],leukocyte[OR=0.40,95%CI(0.21,0.74),P=0.004]and platelet[OR=0.43,95%CI(0.22,0.87),P=0.02].However,performance status[OR=3.78,95%CI(2.24,6.38),P<0.0001]of patients in XAPI plus GP group is better than GP alone group.Conclusion:The combination of XAPI and GP has certain curative effect for patients with NSCLC compared with only receiving GP.However,more well-designedand multicenter RCTs should be performed to verify this result because of the quality of enrolled RCTs.

Combination of docetaxel-carboplatin for adjuvant chemotherapy of epithelial ovarian,primary peritoneal and fallopian tube cancers:a meta-analysis

Objective： The aim of this study was to compare the efficacies and safeties of the combination of docetaxel- carboplatin with the combination of non docetaxel-carboplatin as first-line chemotherapy for advanced epithelial ovarian, pri- mary peritoneal or fallopian tube cancers. Methods： Relevant articles were identified from MEDLINE （1993-2010）, EMBASE （1980-2010）, MEDION, the Cochrane library, Science Citation Index Expanded databases, hand searching of reference lists from primary articles and reviews, conference abstracts and contact with experts in the field. The review included 5 relevant primary studies （1430 women）. Data was extracted for study characteristics and quality. Bivariate random-effect model meta- analysis was used to estimate diagnostic accuracy of the various index tests. A quantitative meta-analysis was carried out by two reviewers based on the inclusion criteria from all available studies. Results： The frequency of the subgroup analysis of toxicity showed that toxicity action of combination of docetaxel-carboplatin was more severe than that of non docetaxel- carboplatin group （OR = 1.33, 95% CI = 1.13-1.56, P = 0.0005）, whereas that of clinical responses was equivalent in com- parison combination of docetaxel-carboplatin with combination of paclitaxel-carboplatin or docetaxel-cisplatin （OR = 1.0, 95% CI = 0.87-1.16, P = 0.95）. There were heterogeneity （X2 = 79.36, P 〈 0.00001） and inconsistency （83.6%） in toxicity analysis among the trials, while neither heterogeneity （x2 = 3.21, P = 0.99） nor inconsistency （F = 0%） in clinical responses among the trials. Conclusion： The safety of combination of docetaxel-carboplatin is less than that of combination of paclitaxel- carboplatin or docetaxel-cisplatin. However, the clinical responses of combination of docetaxel-carboplatin are comparable with combination of paclitaxel-carboplatin or docetaxel-cisplatin.

Clinical analysis of concurrent chemoradiotherapy in 83 patients with locally advanced non-small cell lung cancer

Objective:The purpose of this study was to evaluate the efficacy and safety of concurrent chemoradiotherapy (CCRT) in patients with locally advanced non-small cell lung cancer (LANSCLC). Methods:83 cases of patients who have been diagnosed for locally advanced NSCLC by determined cytology or pathology were divided into two groups randomly, 42 patients in NP group and 41 patients in EP group. All patients accepted thoracic three-dimensional conformal radiotherapy (3D-CRT) and concurrent either NP chemotherapy in NP group or EP chemotherapy in EP group. 3D-CRT were started on day 1 in the first cycle of chemotherapy. Chemotherapy were carried out for 4 cycles, every cycle was 21 days. Thoracic radiotherapy adopted conventional fractionated irradiation with 15 MeV-X ray, a total dose of 60 Gy. Results: In 83 patients were evaluable, there were 5 cases complete regression to be observed, 29 cases had partial regression (PR), 7 cases with stable disease (SD) and 1 case with progression disease (PD) in NP group. CR 3 cases, PR 27 cases, SD 9 cases and PD 2 cases in EP group. The overall response rate (RR) both NP group and EP group were 80.9%, 73.2%, respectively (P = 0.785).1-, 2-, 3-year survival rate were 90.5%, 69.0%, 28.6% and 82.9%, 51.2%, 21.9%, respectively (P = 0.393). The incidence of leukopenia and thrombocytopenia in NP group was higher than that in the EP group (P < 0.05). Conclusion:CCRT in patients with locally advanced non-small cell lung cancer, 3D-CRT with concurrent NP or EP chemotherapy. 1-, 2-, 3-year overall survival (OS) and average survival time (AST) were not statistically differences, a higher incidence of toxicities were observed in NP group but can be tolerable.

Collapsing focal segmental glomerulosclerosis: Current concepts

Collapsing focal segmental glomerulosclerosis （cFSGS）, also known as collapsing glomerulopathy is currently classified under the rubric of FSGS. However, its de-fining morphological features are in stark contrast to those observed in most other variants of FSGS. During the early stage of the disease, the lesion is character-ized pathologically by an implosive segmental and/or global collapse of the glomerular capillary tufts, marked hypertrophy and hyperplasia of podocytes, and severe tubulointerstitial disease. With advancement of the disease, segmental and/or global glomerulosclerosis is also observed in association with the collapsing le-sions. The etiology of this enigmatic disorder is still elusive, but a growing list of diseases/conditions is being reported in association with this morphological pattern of renal parenchymal injury. The pathogenesis of cFSGS involves discreet epithelial cell injury leadingto cell cycle dysregulation and a proliferative cellularphenotype. From the clinical perspective, cFSGS is no-torious for its propensity to affect black people, a highincidence and severity of nephrotic syndrome, markedresistance to empirical therapy, and rapid progressionto end-stage renal disease. The lesion has also beenreported in transplanted kidneys either as recurrent orde novo disease, frequently leading to graft loss. Mostcases have been reported in western countries, but the lesion is also being increasingly recognized in the tropi-cal regions. The recent increase in reporting of cFSGS partly refects a true increase in the incidence and part-ly a detection bias. There is no specifc treatment for the disorder at present. Newer insights into the patho-genesis may lead to the development of targeted and specifc therapy in near future. There is an urgent need to increase awareness of the lesion among pathologists and nephrologists, especially those from developing countries, to ensure accurate diagnosis and appropriate managment. With the accumulation of more and more data, it is hoped that the prevailing confusion about the nosological identity of the lesion will also be resolved in a more logical way.

Is nitric oxide level affected in postmenopausal women with hypothyroidism?

AIMTo analyze serum levels of nitric oxide （NO）, an indicator of cardiovascular health, in post-menopausal females with and without hypothyroidism. METHODSNO was analyzed colorimetrically in 30 newly diag-nosed hypothyroid postmenopausal females and 30 postmenopausal females with normal thyroid profle. Results were compared and subjected to appropriate statistical analysis. RESULTSThe levels of serum NO were found to be significantlydecreased in postmenopausal females with hypothyroidismas compared to the levels in those with normal thyroidprofile （P value 〈 0.05）. A negative correlation of NOwas observed with thyroid stimulating hormone whereasa positive correlation of NO was observed with free T3 （FT3）, free T4 （FT4）, T3 and T4 though it was statistically signifcant only for FT4 among postmenopausal females with hypothyroidism.CONCLUSIONPostmenopausal hypothyroid females may be at a risk of compromised cardiovascular health as indicated by low NO levels. Regular monitoring and risk assessment is essential for timely intervention.

Role of different imaging modalities of vascular calcification in predicting outcomes in chronic kidney disease

Vascular calcification(VC) is common among patientswith chronic kidney disease(CKD).The severity of VC is associated with increased risk of cardiovascular events and mortality.Risk factors for VC include traditional cardiovascular risk factors as well as CKD-related risk factors such as increased calcium and phosphate load.VC is observed in arteries of all sizes from small arterioles to aorta,both in the intima and the media of arterial wall.Several imaging techniques have been utilized in the evaluation of the extent and the severity of VC.Plain radiographs are simple and readily available but with the limitation of decreased sensitivity and subjective and semi-quantitative quantification methods.Mammography,especially useful among women,offers a unique way to study breast arterial calcification,which is largely a medial-type calcification.Ultrasonography is suitable for calcification in superficial arteries.Analyses of wall thickness and lumen size are also possible.Computed tomography(CT) scan,the gold standard,is the most sensitive technique for evaluation of VC.CT scan of coronary artery calcification is not only useful for cardiovascular risk stratification but also offers an accurate and an objective analysis of the severity and progression.

Pancreatic cancer–Adjuvant therapy

Pancreatic cancer ranks tenth in terms of newly diagnosed cases, but just 10%–15% of these patients can undergo resection. Survival after curative surgery is dismal, as recurrences occur either locally or in the liver. Adjuvant treatment with either chemotherapy or chemoradiation (with or without maintenance chemotherapy) has been employed, to improve the poor prognosis. Justification for the use of chemoradiation, with follow on chemotherapy, is based on the results of an underpowered 1987 GITSG study, which closed prematurely and compared intervention to observation. There has been no survival advantage demonstrated in the one randomized controlled trial that examined chemoradiation compared to chemotherapy. There is a clear cut survival advantage however with chemotherapy compared to observation, based on the results from two large randomized controlled trials, and supported by an individual patient data meta-analysis. The standard of care for adjuvant therapy based on level I evidence (from the ESPAC-1 trial) is post operative chemotherapy using 5-Fluorouracil with folinic acid providing a best estimate of 29% five years survival.

Non-selective beta-blockers in cirrhosis:Current concepts and controversies

Non-selective beta-blockers(NSBBs) have been at the forefront in the management of portal hypertension in liver cirrhosis for the last three decades, a trusty component in the armamentarium of the Hepatologist. The role of beta-blockers has been cemented for years in cardiac disease including angina, hypertension and in heart failure, however NSBBs with their non-selective effects on β1 and β2 receptors have led to them fondly being termed "the hepatologist's aspirin". NSBBs' role in reduction of portal pressure in the setting of primary and secondary prophylaxis for variceal haemorrhage has been well established. NSBBs include propranolol, nadolol and carvedilol- with the latter having been shown to be effective in patients who often fail to demonstrate a haemodynamic response to propranolol. Recent observational studies however have served for the Hepatology community to question the beneficial role of NSBBs in portal hypertension, especially in advanced cases with refractory ascites. The deleterious effect in patients with refractory ascites in a few studies led to a U-turn in clinical practice, with some in the Hepatology community withdrawing their usage in patients with advanced cirrhosis. This also led to the "window hypothesis" suggesting there may be only be a finite time frame when NSBBs have a beneficial effect in portal hypertension. The window hypothesis proposed the window for the benefits of NSBBs is closed in early portal hypertension, opening as portal hypertension progresses with it closing in advanced liver disease. The window was proposed to close in conditions such as refractory ascites or spontaneous bacterial peritonitis when patients may not necessarily mount a compensatory haemodynamic response when on NSBBs. Some centres however have continued the practice of NSBBs in advanced cirrhosis with published data challenging the scepticisms of other groups who stop NSBBs. Thus the debate, like the window hypothesis has opened, with more questions to be answered about NSBB's mechanism of action not only in reducing portal hypertension but also their effects on systemic haemodynamics and on the pro-inflammatory pathways often activated in cirrhosis especially in advanced disease. This article serves to review the role of NSBBs in the management of portal hypertension/cirrhosis and concentrate on current concepts and controversies in this field.

Matrix metalloproteinase-2 as a superior biomarker for peritoneal deterioration in peritoneal dialysis

AIM： To investigate the effcacy of effuent biomarkers for peritoneal deterioration with functional decline in peritoneal dialysis （PD）.METHODS： From January 2005 to March 2013, the subjects included 218 PD patients with end-stage renal disease at 18 centers. Matrix metalloproteinase-2 （MMP-2）, interleukin-6 （IL-6）, hyaluronan, and cancer antigen 125 （CA125） in peritoneal effluent were quantified with enzyme-linked immunosorbent assay. Peritoneal solute transport rate was assessed by peritoneal equilibration test （PET） to estimate peritoneal deterioration.RESULTS： The ratio of the effuent level of creatinine （Cr） obtained 4 h after injection （D） to that of plasma was correlated with the effluent levels of MMP-2 （ρ = 0.74, P 〈 0.001）, IL-6 （ρ = 0.46, P 〈 0.001）, and hyaluronan （ρ = 0.27, P 〈 0.001）, but not CA125 （ρ = 0.13, P = 0.051）. The area under receiver operating characteristic curve for the effluent levels of MMP-2, IL-6, and hyaluronan against high PET category were 0.90, 0.78, 0.62, and 0.51, respectively. No patient developed new-onset encapsulating peritoneal sclerosis for at least 1.5 years after peritoneal effuent sampling.CONCLUSION： The effuent MMP-2 level most closely reflected peritoneal solute transport rate. MMP-2 can be a reliable indicator of peritoneal deterioration with functional decline.

Effectiveness of 5-flurouracil-based neoadjuvant chemotherapy in locally-advanced gastric/gastroesophageal cancer:A meta-analysis

AIM:To investigate the effectiveness of 5-flurouracilbased neoadjuvant chemotherapy(NAC) for gastroesophageal and gastric cancer by meta-analysis.METHODS:MEDLINE and manual searches were performed to identify all published randomized controlled trials(RCTs) investigating the efficacy of the flurouracilbased NAC for gastroesophageal and gastric cancer,and RCTs of NAC for advanced gastroesophageal and gastric cancer vs no therapy before surgery.Studies that included patients with metastases at enrollment were excluded.Primary endpoint was the odds ratio(OR) for improving overall survival rate of patients with gastroesophageal and gastric cancer.Secondary endpoints were the OR of efficiency for down-staging tumor and increasing R0 resection in patients with gas-troesophageal and gastric cancer.Safety analyses were also performed.The OR was the principal measurement of effect,which was calculated as the treatment group(NAC plus surgery) vs control group(surgery alone) and was presented as a point estimate with 95% confidence intervals(CI).All calculations and statistical tests were performed using RevMan 5.1 software.RESULTS:Seven RCTs were included for the analysis.A total of 1249 patients with advanced gastroesophageal and gastric cancer enrolled in the seven trials were divided into treatment group(n = 620) and control group(n = 629).The quality scores of the RCTs were assessed according to the method of Jadad.The RCT quality scores ranged from 2 to 7(5-point scale),with a mean of 3.75.The median follow-up time in these studies was over 3 years.The meta-analysis showed that NAC improved the overall survival rate(OR 1.40,95%CI 1.11-1.76;P = 0.005),which was statistically significant.The 3-year progression-free survival rate was significantly higher in treatment group than in control group(37.7% vs 27.3%)(OR 1.62,95%CI 1.21-2.15;P = 0.001).The tumor down-stage rate was higher in treatment group than in control group(55.76% vs 41.38%)(OR 1.77,95%CI 1.27-2.49;P = 0.0009) and the R0 resection rate of the gastroesophageal and gastric cancer was higher in treatment group than in control group(75.11% vs 68.56%)(OR 1.38,95%CI 1.03-1.85;P = 0.03),with significant differences.No obvious safety concerns about mortality and complications were raised in these trials.There were no statistically significant differences in perioperative mortality(5.08% vs 4.86%)(OR 1.05,95%CI 0.57-1.94;P = 0.87 fixed-effect model) and in the complication rate between the two groups(13.25% vs 9.66%)(OR 1.40,95%CI 0.91-2.14;P = 0.12 fixed-effect model).Trials showed that patients from Western countries favored NAC compared with those from Asian countries(OR 1.40,95%CI 1.07-1.83).Monotherapy was inferior tomultiple chemotherapy(OR 1.40,95%CI 1.07-1.83).Intravenous administration of NAC was more advantageous than oral route(OR 1.41,95%CI 1.09-1.81).CONCLUSION:Flurouracil-based NAC can safely improve overall survival rate of patients with gastroesophageal/gastric cancer.Additionally,NAC can down the tumor stage and improve R0 resection.

Traditional Chinese medicine combined with chemotherapy in the treatment ofliver cancer： a meta-analysis

Objective： To analyze the clinical efficacy of traditional Chinese medicine （TCM） combined with chemotherapy inthe treatment of primary liver cancer on the basis of meta-analysis software. Method： Retrieval randomizedcontrolled trials （RCT） of TCM combined with chemotherapy in the treatment of the liver cancer from the networkdatabase （such as MEDLINE, EMBASE, PUBMED, Chinese CNKI database, Wanfang database, VIP databaseetc.）. The retrieval period was from January 2011 to July 2017. Results： A total of 16 RCT studies were includedand involving 1873 patients, with 949 patients in the treatment （TCM with chemotherapy） group and 924 patientsin the control group （chemotherapy alone）. Meta-analysis results suggest that TCM combined with chemotherapyin the treatment of primary hepatocellular carcinoma can improve curative effect, improve the degree of ascites ofpatients, improve the quality of life of patients and alleviate chemotherapy side effects. Conclusion： TCMcombined with chemotherapy in the treatment of primary liver cancer is helpful to improve the short term curativeeffect, improve the quality of life of patients, and alleviate the toxic and side effects.

Predictors of neoadjuvant chemotherapy for triple-negative breast cancer:a meta-analysis with 723 cases

Objective: Neoadjuvant chemotherapy (NAC) was increasingly used as a systemic therapy for triple-negative breast cancer (TNBC). The pathological complete response (PCR) rates of neoadjuvant chemotherapy in TNBC were higher than other types of breast cancer with fluctuate data. Predictors to identify which subgroup TNBC was more likely to achieve PCR in neoadjuvant chemotherapy would give us some hints on how to improve outcomes of TNBC patients. The meta-analysis was conducted to contrast the prognostic function of some clinicopathological parameters in the PCR rates of neoadjuvant chemotherapy for TNBC. Methods: Studies were selected from the PubMed database. The relevant parameters to PCR rates in TNBC group were recorded. Review Manager and MIX were used to estimate prognostic function of some biological markers and clinicopathological parameters in PCR rates of TNBC. Results: The analysis included 6 studies with 723 patients, the aggregate PCR rate was 27.9% in TNBC group. The association of lymph nodes metastasis, Ki-67 expression, p53 expression and CK5/6 expression with PCR rate of TNBC was investigated in the analysis, and the odds ratios were 0.50, 9.87, 1.17 and 0.53 respectively. Conclusion: This meta-analysis demonstrated that Ki-67 expression and lymph nodes metastasis were predictors of PCR rate for TNBC in neoadjuvant chemotherapy, while p53 and CK5/6 expression could not be confirmed for the prognostic function.

Neoadjuvant chemotherapy for osteosarcoma of the extremity: Outcome of the Chinese 1st protocol in a single institute

Objective： The aim of this study was to determine stand protocol for patients with extremity osteosarcoma by case following up after neoadjuvant chemotherapy and limb salvage operation. Methods： Between January 2000 and January 2007, 121 patients with extremity osteosarcoma were eligible for this analysis. After being graded according to Enneking classification, all patients were preoperative chemotherapy （methotrexate, cisplatin, doxorubicin, and ifosfamide. Some patients with liB tumors received extra interventional embolism）. And postoperatively, the same protocols were employed, but poor responders （tumor necrosis 〈 95%） received more treatment cycles than good responders and took some new medicine in place of the former one. Most of patients underwent limb salvage operation （99/121）, and the Musculoskeletal Tumor Society Score （MSTS） was used to evaluate the recovery of their limb functions. Results： The followed up last for average 37.3 months （range： 16-101 months）. Most patients （76/121） survived, and the overall survival （OS） was 62.8%. Forty-seven of the 121 patients underwent osteoarticular allografts, among which 12 cases of disunion between the host bone and graft bone, 4 cases of allograft absorption and 3 local recurrences appeared. The mean MSTS score was 22.6 ± 4.13, with an excellent limb function in 17 patients, good in 19 patients, fair in 6 patients and poor in 7 patients. The overall excellent and good function outcome was obtained in 76.6% of the patients. Fifty-two of 121 patients underwent custom-made or modular tumor endoprosthesis replacememt, among which 1 case of aseptic loosening, 1 case of peri-prosthesis infection and 4 local recurrences appeared. The mean MSTS was 24.32 ＋ 3.85, with an excellent limb function in 28 patients, good in 16 patients, fair in 5 patients and poor in 3 patients. The overall excellent and good function outcome was obtained in 84.6% of the patients. Conclusion： Neoadjuvant chemotherapy and limb salvage surgery are effective methods to treat osteosarcoma at present, although some patients still dying from postoperative metastases. Therefore, early diagnosis individualized treatment and exploring for new and effective therapeutic strategy should be the key to an ideal treatment for osteosarcoma.

Surgery with and without chemotherapy for localized carcinoma of esophagus:a meta-analysis

Objective: To evaluate the efficacy of adjuvant chemotherapy in patients with esophageal carcinoma undergoing radical surgery by meta-analysis. Methods: CBMDisc, CNKI, Pubmed databases were searched from January 1995 to June 2005. Randomized trials on comparison surgery plus adjuvant chemotherapy (S + C) and surgery alone for patients with local- ized carcinoma of esophagus were selected. RevMan 4.2 software was used for meta-analysis. Results: 7 studies were in- cluded in the meta-analysis. A total of 401 patients underwent radical surgery plus chemotherapy and 463 underwent surgery alone. Compared with surgery alone, the patients underwent S + C were significantly superior in the 3-year survival rate: the combined relative risk (RRs) of death was 0.83, 95% confidence interval (CI) was 0.71 to 0.95, P = 0.009. Conclusion: Based on the review, adjuvant chemotherapy has a benefit on the 3-year survival rate in the patients with esophageal carcinoma.