Efficacy of minimally invasive therapies on unresectable pancreatic cancer

For patients with unresectable pancreatic cancer, current chemotherapies have negligible survival benefits. Thus, developing effective minimally invasive therapies is currently underway. This study was conducted to evaluate the efficacy of transarterial chemoembolization plus radiofrequency ablation and/or 125 I radioactive seed implantation on unresectable pancreatic cancer. We analyzed the outcome of 71 patients with unresectable pancreatic carcinoma who underwent chemoembolization plus radiofrequency ablation and/or radioactive seed implantation. Of the 71 patients, the median survival was 11 months, and the 1-, 2-, and 3-year overall survival rates were 32.4%, 9.9%, and 6.6%, respectively. Patients who had no metastasis, who had oligonodular liver metastases (≤3 lesions), and who had multinodular liver metastases (>3 lesions) had median survival of 12, 18, and 8 months, respectively, and 1-year overall survival rates of 50.0%, 68.8% , and 5.7% , respectively. Although the survival of patients without liver metastases was worse than that of patients with oligonodular liver metastasis, the result was not significant (P = 0.239). In contrast, the metastasis-negative patients had significantly better survival than did patients with multinodular liver metastases (P<0.001). Patients with oligonodular liver lesions had a significanthg longer median survival than did patients with multinodular lesions (P<0.001). In conclusion, combined minimally invasive therapies had good efficacy on unresectable pancreatic cancer and resulted in a good control of liver metastases. In addition, the number of liver metastases was a significant factor in predicting prognosis and response to treatment.

A Minimally Invasive Surgery for Bone Metastases Using the Combination of Photodynamic Therapy and Hyperthermia Treatment

Cancer patients with bone metastases in their extremities may require surgical intervention to prevent deterioration in their quality of life due to a pathological fracture or severe bone pain. However, curative surgical interventions sometimes have severe complications due to the status of the original cancers. To avoid the decreased quality of life caused by bone metastasis, minimally invasive surgery that avoids additional surgical morbidity is required. We have established two therapeutic treatments for bone metastasis, a photodynamic acridine orange treatment (AOT) and an electronic magnetic hyperthermia treatment (EMHT). The present study investigated the clinical outcomes of combination therapy with EMHT and AOT for patients with bone metastases in their extremities. Methods: The study included 6 patients with 7 bone cancer metastasis locations. For bone metastases, all patients received intraregional tumor excision supported by AOT, in which photodynamic and radiodynamic therapy kills tumor cells during surgery with minimal damage to normal tissues. After the curettage, bone reconstruction was performed by using magnetic materials with calcium phosphate cement. EMHT was repeatedly performed after surgery. In EMHT, tumor cells are killed with an electric magnetic field generator, and bony union is promoted by electronic stimulation. Results: The mean duration of follow-up was 14 months. During the follow-up period, only one patient experienced a local recurrence, and this recurrence occurred 14 months after surgery. Bony union occurred in 4 of 5 cases (80%), and the pain score was significantly reduced after surgery. Conclusions: In the present study, AOT reduced the invasiveness of surgery. EMHT reduced the tumor growth without major complications and promoted bone formation after surgery. Our clinical results confirmed that EMHT and AOT combination therapy for bone metastasis can preserve limb function without local recurrence or bone absorption.

Minimally invasive treatment of cholecysto-choledocal lithiasis:The point of view of the surgical endoscopist

The rate of choledocholithiasis in patients with symptomatic cholelithiasis is estimated to be approximately 10%-33%,depending on the patient's age.Development of Endoscopic Retrograde Cholangiopancreatography and Laparoscopic Surgery and improvement of diagnostic procedures have influenced new approaches to the management of common bile duct stones in association with gallstones.At present available minimally-invasive treatments of cholecysto-choledocal lithiasis include:single-stage laparoscopic treatment,perioperative endoscopic treatment and endoscopic treatment alone.Published data evidence that,associated endoscopic-laparoscopic approach necessitates increased number of procedures per patient while single-stage laparoscopic treatment is associated with a shorter hospital stay.However,current data does not suggest clear superiority of any one approach with regard to success,mortality,morbidity and cost-effectiveness.Considering the variety of therapeutic options available for management,a critical appraisal and decision-making is required.endoscopic retrograde cholangiopancreatography/EST should be adopted on a selective basis,i.e.,in patients with acute obstructive suppurative cholangitis,severe biliary pancreatitis,ampullary stone impaction or severe comorbidity.In a setting where all facilities are available,decision in the selection of the therapeutic option depends on the patients,the number and size of choledocholithiasis stones,the anatomy of the cystic duct and common bile duct,the surgical history of patients and local expertise.

Comparing a non-invasive hemodynamic monitor with minimally invasive monitoring during major open abdominal surgery

As part of the enhanced recovery after surgery （ERAS） protocol, the goal-directed fluid management with hemodynamic monitoring can effectively guide perioperative fluid use and significantly improve the outcomes in highrisk patients undergoing major surgeries. Several minimally invasive and non-invasive monitoring devices are commercially available for clinical use. As part of an internal evaluation, we reported the results from three different hemodynamic monitoring devices used in a patient undergoing a major abdominal surgery.

Effect of Oxygen Therapy by Venturi Mask versus Non Invasive Ventillation on the Outcome of Patients Who Devolope Hypoxia after Open Heart Surgery

Background: Cardiothoracic surgery is a common cause of acute respiratory failure and is associated with increased morbidity and mortality. We aimed to compare the outcomes of open heart surgery patients treated using oxygen delivery devices with patients who receive NIV as a first-line therapy for hypoxemic respiratory failure. Materials and Methods: 40 patients who developed acute hypoxemic respiratory failure after open heart surgery and admitted to cardiothoracic ICU 20 patients received NIV and 20 patient received oxygen by venture mask. For all patients the following measurements were performed before and after CPAP AND Venture use: CBC, blood urea, serum creatinine body temperature, chest X-ray, Arterial blood gases (arterial pH, sodium bicarbonate, pcO2, SpO2 and PaO2-to-FiO2 ratio). Results: Mean PO2 and SO2 have increased after using of both venture and Cpap, increase in both PCO2 and HCO3 levels after using Venturi mask, CPAP mask was superior to venturi mask in avoiding the need of intubation, decreasing The ICU stay median length and also median length of hospitalization, all were lower in CPAP group than venture group. Also the mortality rate was lower in CPAP group than the venturi group. Conclusion: Using CPAP mask in severe AHRF following open heart surgery can avoid intubation, decreases the levels of tachypnea and arterial hypoxemia, decreases ICU stay, the length of hospitalization and also decreases the mortality rate compared with patients receiving high-concentration oxygen therapy with venture mask.

Vascular resections in minimally invasive surgery for pancreatic cancer

Pancreatic ductal adenocarcinoma(PDAC)is characterised by poor oncological outcome and is the seventh cause of cancer-related deaths worldwide.With the advances in surgical technology,oncological treatment,and critical care,extended pancreatic resections including vascular resections have become more frequently performed in specialised centres.Furthermore,the boundaries of resectability continue to be pushed in order to achieve a potentially curative approach in selected patients in combination with neoadjuvant and adjuvant treatment strategies.This review gives an overview on the current state of venous and arterial resections in PDAC surgery with particular attention given to the minimally invasive approach.

The Effect of Non-Invasive Goal Directed Fluid Administration on Graft Function in Deceased Donor Renal Transplantation: A Pilot Study

Background: Non-invasive goal directed fluid therapy during deceased donor renal transplant (CRT) may reduce the incidence of delayed graft function. Plethysmograph Variability Index (PVI) has been shown to predict fluid responsiveness during surgery. This pilot study evaluated the feasibility of goal directed fluid administration protocol based upon PVI studying the incidence of delayed graft function (DGF) in renal transplant recipients. Methods: Twenty patients underwent primary CRT. The Control group received intravenous fluid (IVF) at a calculated constant rate. The Treatment group received a baseline IVF infusion throughout the surgery. PVI values greater than 13% were treated with 250 ml boluses of IVF. Primary end point was DGF;total IVF administration and urinary biomarker NGAL levels were secondary endpoints. Results: Treatment group at every time point received significantly less IVF. There was no significant difference in incidence of DGF between the groups. 2 patients in the Control group and 6 in the Treatment group developed DGF. NGAL was not associated with the group assignment or total IVF given (p < 0.2). Conclusions: The effectiveness of goal directed fluid therapy with non-invasive dynamic parameters has not been validated in renal transplant surgery and larger prospective studies are needed to determine its utility in renal transplantation.

Influence of Photodynamic Therapy on Apoptosis and Invasion of Human Cholangiocarcinoma QBC939 Cell Line

Objective To investigate the effect of photodynamic therapy(PDT) mediated by hematoporphyrin derivative(HPD) on apoptosis and invasion of cholangiocarcinoma QBC939 cell lines. Methods In vitro cultured cholangiocarcinoma QBC939 cell line was exposed to 2, 4, 6, 8, 10, 12, and 14 μg/ml HPD with 5, 10, and 15 J/cm2 light intensity, respectively. The optical density at 450 nm of the QBC939 cells was measured by CCK8 assay and its growth inhibition ratio was calculated. Flow cytometry and transwell migration assay were applied to detect cell apoptosis and invasion respectively. RT-PCR and immunocytochemistry analyses were used to detect expressions of vascular endothelial growth factor-C(VEGF-C), cyclooxygenase-2(COX-2), and proliferating cell nuclear antigen(PCNA). Enzyme-linked immunosorbent assay(ELISA) was carried out to examine the secretion of VEGF-C and COX-2 in QBC939 cells. Results Exposure to HPD-PDT can significantly suppress the growth of QBC939 cells(all P<0.05). HPD-PDT can promote apoptosis of QBC939 cells at the early stage. When the concentration of HPD was 2 μg/ml and light irradiation was 5 J/cm2, HPD-PDT had no obvious inhibitory effect on QBC939 cell growth, but can obviously inhibit cell invasion, and significant difference was observed between the HPD-PDT and control groups(P<0.01). The HPD-PDT can reduce the m RNA and protein expressions of VEGF-C, COX-2, and PCNA, and decrease the secretion of VEGF-C and COX-2 in QBC939 cells. Conclusion PDT could promote apoptosis and inhibit growth and invasion of cholangiocarcinoma cells QBC939 in vitro.

Radiation therapy for portal venous invasion by hepatocellular carcinoma

AIM： To darify bhe efficacy and safety of bhree-dimensional conformal radiotherapy （3-D CRT） for bhis disease and to specify patient subgroups suitable for this treatment. METHODS： Fifty-two patients with HCC received PVItargeted radiation therapy from .January 1995 through December 2003. Portal venous invasion （PVI） was found in the second or lower order branches of the portal vein in 6 patients, in the first branch in 24 patients and in the main trunk in 22 patients. Child classifications of liver function before radiation therapy were A, B, and C for 19, 24 and 2 patients, respectively. All patients received three-dimensional conformal radiotherapy with a total dose ranging from 39 to 60 Gy （57.0 Gy in average）. RESULTS： Overall survival rates at 1, 2, 3, 4, and 5 years were 45.1%, 25.3%, 15.2%, 10.1%, and 5.1%, respectively. Univariate analysis revealed that Child status, the number of tumor foci, tumor type, transcatheter arterial embolization （TAE） after radiation therapy were statistically significant prognostic factors. Multivariate analysis showed that the number of tumor foci and TAE after radiation therapy were statistically significant. CONCLUSION： The results of this study strongly suggest the efficacy of 3-D CRT as treatment for PVI in HCC. 3-D CRT is recommended in combination with postradiation TAE for PVI of HCC with 5 tumor foci or less in the liver and with Child A liver function.

Intravesical bacillus Calmette-Guerin(BCG)in treating non-muscle invasive bladder cancer—analysis of adverse effects and effectiveness of two strains of BCG(Danish 1331 and Moscow-I)

Objective:To compare the differences in adverse effects and efficacy profile between bacillus Calmette-Guerin(BCG)Danish 1331 and BCG Moscow-I strain in management of non-muscle invasive bladder cancer.Methods:Clinical data of 188 cases of non-muscle invasive bladder cancer treated with BCG between January 2008 and December 2018 in our institute were collected prospectively and analysed retrospectively,and 114 patients who completed a minimum of 12 months of follow-up were analysed.Patient and tumor characteristics,strain of BCG,adverse effects,and tumor progression were included for analysis.Intravesical BCG was instilled in intermediate-and high-risk patients.Six weeks of induction BCG,followed by three weekly maintenance BCG at 3,6,12,18,and 24 months was advised in high-risk patients.Results:Overall 68 patients received BCG Danish 1331 strain and 46 patients received Moscow-I strain.Patient and tumor characteristics were well balanced between the two groups.The median follow-up period was 42.5 months and 34.5 months in Danish 1331 and Moscow-I groups,respectively.Adverse events like dropout rate,antitubercular treatment requirement,and need of cystectomy were higher in Moscow-I group(n=31,67.4%)when compared to Danish 1331 strain(n=33,48.5%)(p=0.046).On direct comparison between Danish 1331 and Moscow-I strain,there was similar 3-year recurrence-free survival(80.0%vs.72.9%)and 3-year progression-free survival(96.5%vs.97.8%).Conclusion:Study results suggest no significant differences between Danish 1331 and Moscow-I strain in recurrence-free survival and progression-free survival,but a significantly higher incidence of moderate to severe adverse events in BCG Moscow-I strain.

Gene-modified leucoconcentrate for personalized ex vivo gene therapy in a mini pig model of moderate spinal cord injury

We previously demonstrated that gene-modified umbilical cord blood mononuclear cells overexpressing a combination of recombinant neurotrophic factors are a promising therapeutic approach for cell-mediated gene therapy for neurodegenerative diseases,neurotrauma,and stroke.In this study,using a mini pig model of spinal cord injury,we proposed for the first time the use of gene-modified leucoconcentrate prepared from peripheral blood in the plastic blood bag for personalized ex vivo gene therapy.Leucoconcentrate obtained from mini pig peripheral blood was transduced with a chimeric adenoviral vector(Ad5/35 F)that carried an enhanced green fluorescent protein(EGFP)reporter gene in the plastic blood bag.The day after blood donation,the mini pigs were subjected to moderate SCI and four hours post-surgery they were intravenously autoinfused with gene-modified leucoconcentrate.A week after gene-modified leucoconcentrate therapy,fluorescent microscopy revealed EGFP-expressing leucocytes in spinal cord at the site of contusion injury.In the spleen the groups of EGFP-positive cells located in the lymphoid follicles were observed.In vitro flow cytometry and fluorescent microscopy studies of the gene-modified leucoconcentrate samples also confirmed the production of EGFP by leucocytes.Thus,the efficacy of leucocytes transduction in the plastic blood bag and their migratory potential suggest their use for temporary production of recombinant biologically active molecules to correct certain pathological conditions.This paper presents a proof-of-concept of simple,safe and effective approach for personalized ex vivo gene therapy based on gene-modified leucoconcentrate autoinfusion.The animal protocols were approved by the Kazan State Medical University Animal Care and Use Committee(approval No.5)on May 27,2014.

Effects of Taxotere on invasive potential and multidrug resistance phenotype in pancreatic carcinoma cell line SUIT-2

INTRODUCTIONDevelopment of drug-resistance to chemotherapyand subsequent metastasis of tumor are primarilyresponsible for treatment failure and the death fromcancer. There have been many previous studies onthe relationship between expression of multidrugresistance (MDR) phenotype P-glycoprotein (P-gp)and the malignant properties of tumors, but theresults are often conflicting[1-8]. The difference intumor types or MDR phenotype induced by specificagents might account for this discrepancy. Taxotere(TXT), a member of the family of taxanes, hasantitumor activity through its effect of promotingthe polymerization of tubulin[9,10].

Stereotactic body radiation therapy in patients with hepatocellular carcinoma: A mini-review

Stereotactic body radiation therapy(SBRT) is an emerging treatment for hepatocellular carcinoma. This technique results in excellent local control rates with favorable toxicity profile despite being predominantly used in heavily pretreated patients or those unsuitable for other local therapies. SBRT may be used as a sole treatment or in combination with other local therapies as well as a bridging strategy for patient awaiting liver transplants. This brief review describes current practice of SBRT with respect to radiation technique, patient selection and treatment concepts. It summarizes available evidence from retroand prospective studies evaluating SBRT alone, SBRT in combination with other treatments and SBRT compared to other local treatment approaches.

Effects of intensity modulated radiation therapy + local hyperthermia on the cancer cell apoptosis and invasion in liver cancer lesion

Objective: To investigate the effects of intensity modulated radiation therapy + local hyperthermia on the cancer cell apoptosis and invasion in liver cancer lesion. Methods:A total of 94 patients with middle-advanced primary liver cancer who were diagnosed and treated in this hospital between November 2015 and February 2017 were divided into control group (n=47) and experimental group (n=47) by random number table method. Control group received intensity modulated radiation therapy and experimental group received intensity modulated radiation therapy + local hyperthermia. Both groups accepted peritoneal lesion biopsy before and after treatment, and the expression of apoptosis and invasion genes in specimen tissue were detected by fluorescence quantitative PCR. Results: There was no statistically significant difference in apoptosis and invasion gene expression between the two groups of patients before treatment. After treatment, apoptosis genes Fas, caspase-3, Bax and p53 mRNA expression in lesion tissue of experimental group were higher than those of control group whereas FasL and Bcl-2 mRNA expression were lower than those of control group;invasion genes Cofilin-1, Bmi-1, STAT3 and SOX18 mRNA expression in lesion tissue of experimental group were lower than those of control group whereas Tip30 and TP53IP1 mRNA expression were higher than those of control group. Conclusion: intensity modulated radiation therapy + local hyperthermia can effectively promote cancer cell apoptosis and inhibit its invasion activity in patients with middle and advanced primary liver cancer.

A Case of Invasive Pulmonary Aspergillosis Resulted from the Treatment of Chronic Eczema

This was an advanced male(87-year-old)with refractory chronic eczema for over 40 years,based on his allergic constitution,accompanied with chronic kidney disease due to primary hypertension(CKD,phase 3).It was so difficult to tolerate the severe itching that the glucocorticoids(GC)had to be applied to it,but some new-onset respiratory symptoms,such as cough,dyspnea after exertion etc.,occurred to this patient.Some classical IPA images were found on his pulmonary CT scanning,which were further comfirmed by the positive findings of GM-test,and then a final diagno­sis of IPA was accordingly established.Unfortunately,a persistent fever emerged after starting an antifungal therapy to the patient,and his IL-2 level was detected to be superhigh.As a response to allergic fever,GC was carefully given intravenously again to treat it,and it turned out to be totally improved since then;suggesting that systemic thinking(integrated with the other clinical evidences)is essential to diagnose IPA,and GC can also be used to improve its symptoms with the existence of antifungal therapy.

2023年度非小细胞肺癌外科治疗进展

肺癌是当前世界各地最普遍和最致命的癌症,严重威胁人们的生命健康。外科手术切除是最早治疗肺癌的手段,也是目前肺癌最主要的治疗手段。随着医学技术的进步,外科手术方法和辅助治疗策略不断革新,这为肺癌患者带来了新的希望。因此总结肺癌外科治疗领域的最新研究进展具有重要意义。本文旨在综述2023年度非小细胞肺癌(non-small cell lung cancer,NSCLC)外科治疗的主要进展,包括手术技术的创新、微创手术、辅助分子靶向治疗及免疫治疗在NSCLC围手术期的应用等。

房角切开术围手术期前房出血及术后一过性眼压升高管理方案专家推荐意见

房角切开术(GT)是一种安全、有效的微创青光眼手术(MIGS),在我国已得到广泛应用,适用于治疗原发性开角型青光眼和中晚期原发性闭角型青光眼。尽管GT手术的安全性较高,但前房出血和一过性眼压升高仍然是GT术后常见的并发症。然而,在处理这类问题时,临床医生缺乏统一的标准化规范。这种情况不仅可能影响临床医生对手术效果的判断,还可能对手术预后产生不利影响。因此,有必要制定详细、完整的围手术期前房出血及术后一过性眼压升高管理方案,指导临床医生合理、规范地处理并发症,推动MIGS的进一步发展和完善。为此国内部分青光眼治疗专家及广东省医学会眼科学分会青光眼学组相关专家共同回顾既往文献,通过反复讨论,对GT围手术期前房出血和术后一过性眼压升高的管理方案达成一致性推荐意见,包括围手术期前房出血的定义、高危因素、转归,术前预防出血的方法、术中减少出血的方法、术后前房出血的管理,及一过性眼压升高的定义、发生原因、影响因素、处理及转归等方面,以供临床医生参考使用。

关于儿童微创外科的几点反思

微创手术已经在小儿外科大量应用并取得了良好的治疗效果,但在目前临床实践中,儿童微创手术普遍存在"重外观、轻功能"等问题,尚缺乏针对小儿微创外科的科学的内涵定义与评价标准,术前准确决策、术中完整清除目标病灶、损伤控制以及合理的手术方式等一系列体现手术精准化的策略需要进一步加强,围手术期实施加速康复外科方案以及有效的营养管理、心理干预等一系列旨在达到功能性微创理念的具体措施还有待进一步优化。进一步提高儿童微创手术治疗效果,必须将功能性微创理念贯穿到术前诊断评估和营养管理、手术规划、手术操作、加速康复外科等整个外科诊断与治疗过程,制订个体化诊断与治疗方案,以患者器官及整体功能恢复作为评价标准。

经鼻高流量氧疗对稳定期慢性阻塞性肺疾病合并高碳酸血症的疗效分析

目的分析经鼻高流量氧疗(HFNC)对稳定期慢性阻塞性肺疾病(COPD)合并高碳酸血症患者的干预效果。方法选取45例需长期氧疗的稳定期COPD合并高碳酸血症患者作为研究对象,根据不同呼吸支持模式分为长期家庭氧疗(LTOT)组、无创通气(NIV)组、HFNC组,每组15例。比较3组患者出院后一般情况、血气指标、肺功能指标、呼吸状况、生活质量及步行试验结果。结果随访期内,HFNC组、NIV组住院次数、急性加重次数均少于LTOT组,差异有统计学意义(P<0.05);出院后6、12个月,3组动脉血二氧化碳分压[p_(a)(CO_(2))]低于出院前,动脉血氧分压[p_(a)(O_(2))]、脉搏血氧饱和度(SpO_(2))、用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))高于出院前,且HFNC组上述指标变化程度大于NIV组、LTOT组,差异有统计学意义(P<0.05);出院后1、3、6、12个月,3组英国医学研究委员会呼吸困难量表(mMRC)评分、圣乔治呼吸问卷(SGRQ)评分均逐渐降低,6 min步行距离(6MWD)均逐渐增加,且HFNC组上述指标变化程度大于NIV组、LTOT组,差异有统计学意义(P<0.05)。结论HFNC可有效减轻稳定期COPD合并高碳酸血症患者呼吸困难症状,改善肺功能,促进血气指标恢复正常,还可提升生活质量和运动耐力,降低再入院率。

儿童功能性微创理念与应用

近几十年来,微创内镜手术已经广泛应用于小儿外科各个领域,微创内镜手术具有创伤小、恢复快、痛苦少等优势,但手术切口的微创并不等于功能上的微创。本文旨在评述功能性微创的理念及其在儿童外科领域的临床应用,通过与精准医疗、新技术应用以及加速康复外科理念的结合,实现以最小创伤获得最佳治疗效果,提高患儿生活质量。