头孢哌酮/舒巴坦联合胸腺肽α1治疗鲍曼不动杆菌重症肺炎的临床应用研究

目的观察头孢哌酮/舒巴坦联合胸腺肽α1治疗鲍曼不动杆菌重症肺炎的临床疗效及预后评估。方法随机选取84例临床诊断为鲍曼不动杆菌感染致重症肺炎的患者,分为治疗组(应用头孢哌酮/舒巴坦联合胸腺肽α1进行治疗)和对照组(单用头孢哌酮/舒巴坦进行治疗),各42例,比较两组患者治疗前和治疗7 d后降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)、外周血T细胞亚群、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、免疫球蛋IgG和APACHEⅡ评分,同时观察脱机成功率、住ICU时间和28 d病死率。结果治疗7 d后治疗组与对照组相比,CD4^+T细胞、CD4^+/CD8^+、IL-10和IgG均明显升高,差异有统计学意义(均P<0.05);同时PCT、CRP、WBC、IL-6和APACHEⅡ评分均明显下降,差异均有统计学意义(均P<0.05)。治疗组脱机成功率高于对照组(64.29%vs 38.10%),平均住ICU时间短于对照组[(12.41±2.25)d vs(18.23±2.50)d],28 d病死率低于对照组(19.05%vs 45.24%),差异均有统计学意义(均P<0.05)。结论头孢哌酮/舒巴坦联合胸腺肽α1治疗鲍曼不动杆菌重症肺炎可以改善患者机体的免疫功能,减轻炎症反应,提高呼吸机脱机成功率,缩短ICU住院时间,降低28 d病死率。

Clinical features and prognosis of patients with extrahepatic metastases from hepatocellular carcinoma

AIM: To assess the clinical features and prognosis of 151 patients with extrahepatic metastases from primary hepatocellular carcinoma (HCC), and describe the treatment strategy for such patients. METHODS: After the diagnosis of HCC, all 995 consecutive HCC patients were followed up at regular intervals and 151 (15.2%) patients were found to have extrahepatic metastases at the initial diagnosis of primary HCC or developed such tumors during the follow-up period. We assessed their clinical features, prognosis, and treatment strategies. RESULTS: The most frequent site of extrahepatic metastases was the lungs (47%), followed by lymph nodes (45%), bones (37%), and adrenal glands (12%). The cumulative survival rates after the initial diagnosis of extrahepatic metastases at 6, 12, 24, and 36 mo were 44.1%, 21.7%, 14.2%, 7.1%, respectively. The median survival time was 4.9 mo (range, 0-37 mo). Fourteen patients (11%) died of extrahepatic HCC, others died of primary HCC or liver failure. CONCLUSION: The prognosis of HCC patients with extrahepatic metastases is poor. With regard to the cause of death, many patients would die of intrahepatic HCC and few of extrahepatic metastases. Although most of HCC patients with extrahepatic metastases should undergo treatment for the primary HCC mainly, treatment of extrahepatic metastases in selected HCC patients who have good hepatic reserve, intrahepatictumor stage (T0-T2), and are free of portal venous invasion may improve survival.

Advanced duodenal carcinoma:Chemotherapy efficacy and analysis of prognostic factors

Objective This study aimed to determine the ef icacy of chemotherapy and to identify potential chemo-therapy agents to treat advanced primary duodenal carcinoma （PDC）. Methods Seventy-three patients with advanced PDC were included in the study. Response rate （RR）, disease control rate （DCR）, progression-free survival （PFS）, overal survival （OS） and prognosis were com-pared among patients using the Cox proportional hazards model. Results The overal RR and DCR of 52 patients were 21.15% and 69.23%, respectively. The median PFS and OS times were 4.51 and 11.47 months, respectively. Pal iative chemotherapy improved the OS of patients with advanced PDC compared with patients who did not receive chemotherapy （14.28 months vs. 5.20 months, HR = 0.205, 95% CI： 0.077 to 0.547, P = 0.0016）. Multivariate analysis indicated mucinous histology and liver metastasis as factors predictive of poor prognosis in patients with advanced PDC. Conclusion Pal iative chemotherapy may improve the OS of patients with advanced PDC. Mucinous histology and liver metastasis were the main prognostic factors in patients with advanced PDC.

Analysis of the Long-term Effect of Intraoperative Radiotherapy (IORT) for Non-Small Cell Lung Carcinoma (NSCLC)

OBJECTIVE To analyze the long-term effects of treatment with an op-eration + postoperative irradiation (A group) and an operation+intraoperative radiotherapy+postoperative irradiation (B group) in non-small cell lung cancer patients. METHODS Through a prospective randomized clinical trial, a total of 154 patients with non-small cell lung carcinoma were divided into two groups of 77 cases. Among the 154 cases, there were 134 squamous carcinomas, 17 adenocarcinomas and 3 adeno-squamous carcinomas. TNM staging: there were 17 in StageⅠ, 76 in Stage Ⅱ and 61 in Stage Ⅲ. A dosage of 15～25 Gy IORT, energy 9～16 MeV electrons, was delivered to the tumors. The doses given were 40～60 Gy postoperation. RESULTS The local control rates in A and B groups were 49.4% and 62.3% respectively (P<0.05). The survivals at 3, 5 and 7 years for group A were 40.3%, 27.3%, and 5.2% and for group B 44.2%, 28.6% and 6.5% (P>0.05). There were 16 deaths from radiotherapy complications, with 2 cases in group A and 14 in group B. CONCLUSION IORT+postoperative irradiation can enhance the local control rate of non-small cell lung cancer patients and reduce the recurrent rates, but it can not improve long-term survival.

EGFR / HER2 / HER3 expression in tumour and gefitinib treatment in Chinese patients with advanced non-small cell lung cancer

Objective： Biological markers performable in routine practice and able to predict the clinical outcome of advanced non-small cell lung cancer （NSCLC） treated with gefitinib are urgently needed. Methods： We analyzed EGFR / HER2 / HER3 primary tumour immunohistochemical expression in a prospective and consecutive series of 90 Chinese patients. Platinumpretreated patients received a 250 mg oral dose of gefitinib once daily until disease progression; EGFR / HER2 / HER3 tumour status was related with the clinical outcome in terms of response rate （RR）, time to disease progression （TTP）, and overall survival （OS）. Results： A high expression （scores 2-3） of EGFR, HER2 and HER3 was venfied in 16.7%, 43.3% and 21.1% of tumors, respectively. EGFR and HER3 status were not significantly related with response, while the HER2 overexpression result was significantly associated with a higher RR （35.9% vs. 15.7%, P = 0.027）. The RR in the 13 patients with both HER2 and HER3 expression was also significantly higher than in the other 77 patients （53.8% vs. 22.1%, P = 0.036）. EGFR / HER2 / HER3 status was not significantly correlated with TTP or OS. Conclusion： The HER2 immunohistochemical expression can play a role in the clinical management of Chinese patients with advanced NSCLC who are candidates for gefitinib therapy.

Highlights for α-fetoprotein in determining prognosis and treatment monitoring for hepatocellular carcinoma

AIM:To explore the prognostic value in the monitoring of treatment efficacy of serial α-fetoprotein(AFP) in hepatocellular carcinoma(HCC) patients.METHODS:We searched MEDLINE,EMBASE and COCHRANE LIBRARY through April 21,2012,to find qualifying articles.Our overall search strategy included terms for HCC,AFP,treatment response,and prognosis.Literature was limited to English-language,human studies.Studies reporting cumulative survival rates were summa-rized qualitatively.For the prognostic meta-analysis,we undertook a series of meta-analyses that summarised the Cox proportional hazard ratios(HRs) by assuming a random effects model.With regards to the correlation of AFP change with radiologic response,the categorical dichotomous variables were assessed using Poisson relative risks(RRs),which were incorporated into the random effects model meta-analysis of accuracy prediction.Between-study heterogeneity was estimated by use of the I2 statistic.Publication bias was evaluated using the Begg funnel plot and Egger plot.Sensitivity analyses were conducted first by separating systemic treatment estimates from locoregional therapy estimates,evaluating different AFP response cut-off point effects,and exploring the impact of different study sizes.RESULTS:Of 142 titles identified in our original search,11 articles(12 clinical studies) met our criteria.Six studies investigated outcome in a total of 464 cases who underwent systemic treatment,and six studies investigated outcome in a total of 510 patients who received locoregional therapy.A random-effects model metaanalysis showed that AFP response was associated with an mortality HR of 0.55(95%CI,0.47-0.65) across HCC in overall survival(OS) and 0.50(95%CI,0.38-0.65) in progression-free survival.Restricting analysis to the six eligible analyses of systemic treatment,the pooled HRs were 0.64(95%CI,0.53-0.77) for OS.Limiting analysis to the six analyses of locoregional therapy,the pooled HRs for OS was 0.39(95%CI,0.29-0.53).We showed a larger pooled HR in the 50% definition studies(HR,0.67,95%CI,0.55-0.83) compared with that from the 20% definition studies(HR,0.41,95%CI,0.32-0.53).Restricting analysis to the four studies including over 100 patients individually,the pooled HR was 0.65(95%CI,0.54-0.79),with a pooled HR for OS of 0.35(95%CI,0.23-0.46) in the studies of less than 100 patients.As to radiological imaging,43.1%(155/360) of the patients in the AFP response group presented with a radiological overall response,while the response rate decreased to 11.5%(36/313) in the patients from theAFP nonresponse group.The RR of having no overall response was significantly lower in the AFP response group than the AFP nonresponse group(RR,0.67;95%CI,0.61-0.75).In terms of disease control rate,86.9%(287/330) in the AFP response group and 51.0%(153/300) in the AFP nonresponse group showed successful disease control,respectively.The RR of disease control failure,similarly,was significantly lower in the AFP response group(RR,0.37;95%CI,0.23-0.58).But these findings could be overestimates because of publication and reporting bias.CONCLUSION:HCC patients presenting with an AFP response are at decreased risk of mortality.In addition,patients with an AFP response also present with a higher overall response rate and disease control rate.

Analysis of long-term outcomes and application of the tumor regression grading system in the therapeutic assessment of resectable limited-disease small cell lung cancer

Objective The present study attempted to evaluate the value of neoadjuvant chemotherapy in limiteddisease small cell lung cancer(LD-SCLC),and to identify the predictive value of the tumor regression grading(TRG) system in LD-SCLC treatment-response and prognosis.Methods The records of patients with LD-SCLC(p-Stage I–IIIa) who underwent definitive radical resection at Shaanxi Provincial People's Hospital between March 1,2000 and March 31,2014 were retrospectively analyzed.We compared the disease-free survival(DFS) and overall survival(OS) rates between Group A patients(patients who underwent surgery combined with pre-and post-operative chemotherapy) and Group B patients(patients who underwent surgery combined with adjuvant chemotherapy only) using the Kaplan-Meier method and the Mantel-Cox test.The specimens of patients who received neoadjuvant chemotherapy were reassessed according to the TRG system.Results The median DFS for 27 patients was 16.267 months and the median OS was 81.167 months(1-year OS,74.07%;3-year OS,22.22%;5-year OS,14.81%).Thirteen patients received neoadjuvant chemotherapy,and their specimens were reassessed by TRG(pathological complete remission,3/13,23.08%).Patients in group A had a longer OS than those in group B(mean,93.782 months versus 42.322 months,P = 0.025),although there was no significant difference in DFS between the two groups(median 20.100 months versus 14.667 months,P = 0.551).Statistical analysis revealed that TRG Grade(G) 0(mean,61.222 months) was associated with better OS than G1-2(mean,31.213 months)(P = 0.311).Conclusion Our study indicated that neoadjuvant chemotherapy combined with surgical resection may represent a feasible treatment method for patients with LD-SCLC.The TRG system may be a valuable prediction tool to assess neoadjuvant chemotherapeutic efficacy,especially in patients with G0 disease as determined by TRG;these patients may attain an improved survival benefit with neoadjuvant chemotherapy.

局部进展期直肠癌术前放化疗研究进展

直肠癌（rectalcancer）是常见消化道肿瘤之一，发病率仅次于胃癌，确诊时多数患者为局部进展期，单纯手术治疗预后较差，提高和改善局部进展期直肠癌的疗效和登学，是粤肠癌治疗关键，术前放化疗有利于降低局部进展期直肠癌的分期，有利于手术治疗，有利于提高局部进展期直肠癌的疗效，改善预后。

Outcome of 2 284 cases with acute traumatic brain injury

Objective: To analyze the prognosis of 2 284 cases with acute traumatic brain injury and discuss possible methods to improve the outcome of head injuries. Methods: The relationship between trauma cause, trauma severity and management and patients outcome was retrospectively analyzed. Results: Good recovery was achieved in 60.20% , moderate disability was 13.22 %, severe disability 15.24 %, vegetative status 0.31 % and mortality 11.03 %. The mortality was 1.07 % in cases with GCS 15 13, 2.47 % in cases with GCS 12 9, 13.29 % in cases with GCS 8 6, and 57.4 % in cases with GCS 5 3. Conclusions: To prevent hypoxia, remove intracranial hematoma as soon as possible, use standard large traumatic craniotomy and apply mild hypothermia may be useful means for improving the outcome of severely head injured patients.