COMBINED EFFECTS OF SELECTIVE PHOTOTHERMAL THERAPY AND IMMUNOADJUVANT AGAINST STAGE IV BREAST CANCER

Metastasis to distant sites is a severe treatment challenge and a major cause of death for breast cancer patients.Laser immunotherapy(LIT)is a novel technique,combining a selective photothermal therapy with local application of glycated chitosan,a potent immunoadjuvant.The pre-clinical studies of LIT have shown its unique characteristics in generating specific antitumor immunity.The clinical application of LIT in the treatment of melanoma patients has achieved preliminary success.Recently,LIT has been used to treat late-stage breast cancer patients.Here we report for the first time the clinical results of this combination therapy in breast cancer patients.The LIT treatment procedures are presented and the medical history of two stage Ⅳ breast cancer patients is reviewed.Most of the breast cancer lesions and the metastasis of lung and brain disappeared after repeated treatments of LIT.One patient achieved complete response;the other achieved partial response at the time of this report.Although there is still a long way for LIT to become a standard modality for breast cancer treatment,the results of this study indicated its promising future.

Extra-Oral Digital Panoramic Radiographic Interpretation and Clinical Findings of Stage IV Periodontitis among Some Samples Concerning Saudi/Non-Saudi Nationality

Background: There are associations between the severity of periodontal diseases and some predisposing factors, such as age, race, and income rate. Therefore, the present study was designed to evaluate the extra-oral digital panoramic radiographic interpretation and clinical findings of stage IV periodontitis among some samples concerning Saudi/non-Saudi nationality. Material and Methods: The study comprised a random sample of 298 residents in Saudi Arabia referred to the internship program clinics at the College of Dentistry, King Khalid University. They were according to the age of participants as follows: youth (15 - 24 years), adults (25 - 64 years), and seniors (65 years and over) within two groups according to nationality (Saudi and non-Saudi). Clinical periodontal examination and radiographic extra oral digital panoramic radiographs were done, and then the periodontal parameters, the percentage of bone loss, and the pattern of bone loss were recorded. The data was collected, and the statistical analysis was performed with ANOVA test, Tukey’s test, Chi-square test, and T-test and considered a P-value at (p Results: The samples included 62 (20%) youth participants with mean of age (21.806 ± 3.390), 182 (57%) adults’ participants with mean age (42.802 ± 9.094), and 54 (23%) seniors participants with a mean age (69.074 ± 6.810). There were highly statistically significant differences in the comparison between the participants’ ages (P 0.05). Conclusion: At the end of this study, we concluded that there are alterations in clinical and radiographic and clinical findings of stage IV periodontitis with the alteration of participants’ ages and nationality.

Hip Tuberculosis at Stage IV: Outcomes and Some Conditions for Total Hip Replacement

Background: Treatment of hip disorders during active hip tuberculosis has long been a controversial issue. Some authors have reported performing hip replacement with different strategies with very good outcomes. This study aimed to describe the surgical outcomes and necessary conditions for total hip replacement in active hip tuberculosis. Methods: We conducted a quasi-experimental study. The study enrolled 40 patients with 42 active tuberculosis hips at stage IV treated by total hip replacement from October 2016 to December 2019 at the National Lung Hospital. We followed up with the patients for at least 12 months, evaluated surgical outcomes, and investigated the factors associated with these outcomes by logistic regression analysis. Results: Surgical outcomes showed that 37 patients (88.1%) had excellent hip function, no abscesses, and no sinus tract formation. Four cases (9.5%) had sinus tract formations. One case (2.4%) had good hip function. Binary logistic regression models revealed that sinus tract formation was associated with preoperative tuberculosis infection syndrome. The average time to obtain antituberculosis drug treatment preoperatively was 4.6 weeks. Conclusion: Total hip replacement for active hip tuberculosis is a practical and promising treatment method. Surgeons should consider improving patients’ conditions before performing total hip replacement, administering antitubercular drugs, and arthrotomy to eliminate all abscesses, and decrease the risk of tuberculosis infection syndrome and the inflammatory response.

Recent Advances in the Management of Stage IV Colon Cancer

Colon cancer is the second commonest cause of cancer-related death in Canadian men and women, with approximately one-third of patients dying from this disease. One quarter of patients present with metastases initially, and up to half of all colon cancer patients will develop stage IV disease over the course of their life. Despite ongoing advances in the evolution of newer cytotoxic drugs, targeted biological agents and improved metastasectomy techniques, the gain in overall survival in these patients is of low magnitude. This manuscript is a targeted review of the recent advances over the last decade in the management of advanced stage IV colon cancer as available in the published English literature. The two major arms of metastatic colon cancer management that include surgery and systemic chemotherapy and palliative measures as available are discussed. A multi-modality team-based approach involving medical oncologists, surgical oncologists, radiologists, and other health-care providers continues to be critical for ongoing success in the therapeutic management of these patients. Future studies of well-designed prospective, randomized-controlled clinical trials to develop and evaluate newer therapeutic strategies are recommended for continued and improved understanding for optimization of clinical management in advanced colon cancer.

Relevance of Surgery in Stage IV Gastric Carcinoma

New anticancer drugs are being increasingly used for advanced and recurrent gastric cancer in many institutions. Therefore, the relative importance of surgery may have changed, and there may also be controversy as to whether patients with stage IV gastric cancer should or not undergo surgical resection. The relevance of surgery in this population was studied. The relevance of surgery was studied in 304 cases of stage IV gastric cancer who were treated at KurumeUniversityHospitalfrom 1995 to 2009. Multivariate analysis showed that distant organ metastasis was significantly correlated with surgery. In stage IV cases, chemotherapy and the number of stage IV factors were independent prognostic factors. In surgery cases, venous invasion, chemotherapy, and residual tumor were independent prognostic factors. R0 was significantly higher in the surgery with chemotherapy group than in the chemotherapy alone group, but there was no significant difference in R1 or R2 cases between the surgery with chemotherapy group and the chemotherapy alone group. In R2 cases, use of a new drug was an independent prognostic factor. The rate of R0 was significantly higher in the preoperative chemotherapy group than in the surgery alone group. In preoperative chemotherapy cases, the S-1/cisplatin (CDDP) group had a 50% 2-year survival rate, and these cases underwent postoperative chemotherapy using the S-1 regimen. A multimodal treatment is considered most effective for stage IV gastric cancer, where this includes preoperative chemotherapy, surgery, and postoperative chemotherapy using the new anti-cancer drugs.

Clinical information and management status of de novo stage IV breast cancer patients: a Chinese multicenter investigation (CSBrS-002)

Background:Although de novo stage IV breast cancer is so far incurable,it has entered an era of individualized treatment and chronic disease management.Based on systemic treatment,whether the surgical resection of primary or metastatic foci of de novo stage IV breast cancer can bring survival benefits is currently controversial.We aimed to explore the clinicopathological factors and current status of the management of de novo stage IV breast cancer in China to provide a reference for clinical decisions.Methods:Based on the assistance of Chinese Society of Breast Surgery,a retrospective study was conducted to analyze the clinical data of patients with de novo stage IV breast cancer in 33 centers from January 2017 to December 2018.The relationship between basic characteristic(age,menstrual status,family history,reproductive history,pathological type,estrogen receptor[ER]status,progesterone receptor[PR]status,human epidermal growth factor receptor 2[HER2]status,Ki-67 percentage,and molecular subtype),and metastasis sites(lung metastasis,liver metastasis,and bone metastasis)was examined by Pearson Chi-square tests.Results:A total of 468 patients with de novo stage IV breast cancer were enrolled.The median age of the enrolled patients was 51.5 years.The most common pathological type of primary lesion was invasive carcinoma(97.1%).Luminal A,luminal B,HER2 overexpressing,and triple-negative subtypes accounted for 14.3%,51.8%,22.1%,and 11.8% of all cases,respectively.Age,PR status,and HER2 status were correlated with lung metastasis(χ^(2)=6.576,4.117,and 8.643 and P=0.037,0.043,and 0.003,respectively).Pathological type,ER status,PR status,and molecular subtype were correlated with bone metastasis(χ^(2)=5.117,37.511,5.224,and 11.603 and P=0.024,<0.001,0.022,and 0.009,respectively).Age,PR status,HER2 status,Ki-67 percentage,and molecular subtype were correlated with liver metastasis(χ^(2)=11.153,13.378,10.692,21.206,and 17.684 and P=0.004,<0.001,0.001,<0.001,and 0.001,respectively).Combined treatment with paclitaxel and anthracycline was the most common first-line chemotherapy regimen for patients with de novo stage IV breast cancer(51.7%).Overall,91.5% of patients used paclitaxel-containing regimens.Moreover,59.3% of hormone receptor-positive patients underwent endocrine therapy.Conclusions:In 2018,1.07% of patients from all studied centers were diagnosed with de novo stage IV breast cancer.This study indicated that 95.1% of patients received systemic therapy and 54.2% of patients underwent surgical removal of the primary lesion in China.

Recent advances in conversion therapy schemes for stage Ⅳ gastric cancer

“Conversion therapy”is a treatment modality that involves the use of radiotherapy,chemotherapy,targeted therapy,immunotherapy,and other therapeutic methods to transform initially late-stage tumors that cannot be cured into treatments that can achieve an R0 curative effect.However,selecting an appropriate conversion therapy scheme remains a challenge,and there are currently few relevant studies on this topic.This article reviews successful cases of conversion therapy and clinical studies on treatment schemes,at domestic and international levels,over the past few years to offer a broad range of treatment options for patients.

参苓白术散对胃癌IV期患者外周血CD4+CD25+Tregs的影响

目的探讨参苓白术散对胃癌IV期患者外周血CD4+CD25+Tregs、Foxp3 m RNA及血清细胞因子IL-10、TGF-β1的影响。方法将40例胃癌IV期患者随机分为观察组、对照组各20例。对照组予对症支持治疗,观察组对症支持治疗同时予参苓白术散治疗,治疗4 w后观察两组患者外周血CD4+CD25+Tregs、单核细胞Foxp3 m RNA及血清IL-10、TGF-β1浓度的变化。结果治疗后观察组患者外周血CD4+CD25+Tregs、单核细胞Foxp3 m RNA及血清IL-10、TGF-β1浓度均显著降低(P<0.05),对照组治疗后各项指标无明显变化(P>0.05),两组治疗后比较差异有统计学意义(P<0.05)。结论参苓白术散能降低胃癌IV期患者外周血CD4+CD25+Tregs和单核细胞Foxp3 m RNA的表达,降低抑制性细胞因子IL-10、TGF-β1浓度,具有免疫调节作用。

解毒化瘀退黄方对乙肝相关CNLCⅣ期湿热瘀阻证患者炎症介质的影响及临床疗效

目的观察解毒化瘀退黄方对乙肝相关中国肝癌分期(CNLC)Ⅳ期湿热瘀阻证患者的临床疗效及安全性。方法选取2021年1月至2022年6月于我院肝病科确诊为乙肝相关CNLCⅣ期湿热瘀阻证患者72例,随机分为对照组、观察组,每组36例;对照组采用西医治疗,观察组给予西医治疗+解毒化瘀退黄方口服,疗程均为12周,随访24周。比较两组治疗前及治疗4、12周后肿瘤大小、肿瘤个数、中医证候积分、细胞因子、肿瘤标志物、生化指标、Child-Pugh分级评分、体力及功能状态评分、患者生存率。结果治疗4周后,观察组瘤体大小较对照组增长缓慢,观察组的临床证候积分、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、甲胎蛋白(AFP)、甲胎蛋白异质体-L3(AFP-L3)、总胆红素(TBIL)、凝血酶原时间(PT)、Child-Pugh分级较对照组降低且ALB较对照组升高,观察组KPS较对照组降低延缓;治疗12周后,观察组瘤体大小及个数较对照组增长缓慢,观察组的临床证候积分、肿瘤坏死因子α(TNF-α)、IL-1β、IL-6、AFP、AFP-L3、异常凝血酶原(DCP)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、TBIL、PT、Child-Pugh分级均较对照组降低且白蛋白(ALB)较对照组升高,观察组KPS较对照组降低延缓,ZPS较对照组升高较慢;观察组较之对照组的临床疗效及生存率较高。结论解毒化瘀退黄方能抑制乙肝相关CNLCⅣ期湿热瘀阻证患者的肿瘤增长,降低中医证候积分、TNF-α、IL-1β、IL-6、AFP、AFP-L3、DCP、ALT、AST、TBIL、PT、Child-Pugh分级评分水平,改善肝功能,延缓体力及功能状态的恶化,明显提高乙肝相关CNLCⅣ期湿热瘀阻证患者的临床疗效及带瘤生存质量。

中医药序贯治疗模式和巩固治疗模式对III/IV期胃癌患者总生存和中位生存期的影响

目的:探讨中医药序贯治疗模式和巩固治疗模式对III/IV期胃癌患者总生存期和中位生存期的临床影响。方法:选择于2009年3月至2010年9月在我院治疗的72例经临床诊断为III/IV期胃癌的患者,采用随机数字表法将其分为治疗组和对照组各36例,其中给予治疗组患者中医药序贯治疗模式,对照组给予中医药巩固治疗模式,对比患者在接受治疗后总生存和中位生存期情况。结果:治疗组中位OS为32个月,明显优于对照组的19个月,2组比较有统计学意义(P<0.05),早期服用中药汤剂的患者中位OS为24.1个月,明显优于服用较晚患者的14.3个月,比较亦有统计学意义(P<0.05);治疗组的MST为17.2个月,明显优于对照组的6.9个月,2组比较亦有统计学意义(P<0.05)。结论:虽中西医结合治疗胃癌可有效延长患者生存期,但中医药序贯治疗模式较巩固治疗模式而言,能更加有较的延长患者生存期,值得进一步推广应用。

Jejunostomy in the palliative treatment of gastric cancer:A clinical prognostic score

BACKGROUND Clinical stage IV gastric cancer(GC)may need palliative procedures in the presence of symptoms such as obstruction.When palliative resection is not possible,jejunostomy is one of the options.However,the limited survival of these patients raises doubts about who benefits from this procedure.AIM To create a prognostic score based on clinical variables for 90-d mortality for GC patients after palliative jejunostomy.METHODS We performed a retrospective analysis of Stage IV GC who underwent jejunostomy.Eleven preoperative clinical variables were selected to define the score categories,with 90-d mortality as the main outcome.After randomization,patients were divided equally into two groups:Development(J1)and validation(J2).The following variables were used:Age,sex,body mass index(BMI),American Society of Anesthesiologists classification(ASA),Charlson Comorbidity index(CCI),hemoglobin levels,albumin levels,neutrophil-lymphocyte ratio(NLR),tumor size,presence of ascites by computed tomography(CT),and the number of disease sites.The score performance metric was determined by the area under the receiver operating characteristic(ROC)curve(AUC)to define low and high-risk groups.RESULTS Of the 363 patients with clinical stage IVCG,80(22%)patients underwent jejunostomy.Patients were predominantly male(62.5%)with a mean age of 62.4 years old.After randomization,the binary logistic regression analysis was performed and points were assigned to the clinical variables to build the score.The high NLR had the highest value.The ROC curve derived from these pooled parameters had an AUC of 0.712(95%CI:0.537–0.887,P=0.022)to define risk groups.In the validation cohort,the diagnostic accuracy for 90-d mortality based on the score had an AUC of 0.756,(95%CI:0.598–0.915,P=0.006).According to the cutoff,in the validation cohort BMI less than 18.5 kg/m2(P<0.001),CCI≥1(P=0.001),ASA III/IV(P=0.002),high NLR(P=0.012),and the presence of ascites on CT exam(P=0.004)were significantly associated with the high-risk group.The risk groups showed a significant association with first-line(P=0.012),second-line chemotherapy(P=0.009),30-d(P=0.013),and 90-d mortality(P<0.001).CONCLUSION The scoring system developed with 11 variables related to patient’s performance status and medical condition was able to distinguish patients undergoing jejunostomy with high risk of 90 d mortality.

分段进水多级AO应用于高出水标准市政污水处理厂工程及运行分析

山东省某市政污水处理厂迁建项目迁建后污水厂总处理规模为25×10^(4)m^(3)/d,设计二级处理采用分段进水多级AO,深度处理采用“高效澄清池+Ⅴ型滤池+臭氧催化氧化”的组合。设计出水标准为地表水准Ⅳ类,其中TN<15 mg/L。2022年山东省发布《山东省城市排水“两个清零、一个提标”工作方案》,要求城市污水处理厂出水标准达到地表水准Ⅳ类,其中TN控制在10 mg/L。工程未实施工程性改造,即实现了新的排放标准。

1例全身多发性IV期压疮的治疗与护理

为探讨1例全身多发性IV期压疮的治疗与护理方法,对收治的1例胸12椎体暴裂性骨折、椎管狭窄不全截瘫因护理不当而致全身多发性IV期压疮（pressure sores）患者,采用清创、胰岛素＋维生素C湿敷换药、全身抗感染的治疗方法和基础护理、压疮护理方法。结果为患者骶尾部和双侧股骨粗隆部IV期压疮在治疗和护理75d左右愈合,双下肢内、外踝,足跟部Ⅱ~Ⅲ期压疮在治疗和护理45d左右即已愈合。压疮患者以胰岛素＋维生素C湿敷换药法为主的治疗和护理方法是可行的,值得推广。

对车用柴油机国IV以上技术路线的思考

为降低柴油机的排放污染,使柴油机达到国IV以上排放要求,参考国际柴油机的排放技术,目前,主要有2条技术路线可供选择,即SCR技术路线和EGR技术路线。文章对这2种技术路线从结构特点、工作原理、优缺点进行比较分析,结果表明,柴油机在我国近期和远期,不同的车型应采取不同的技术方案,为我国柴油机达到国IV以上排放标准提供了参考。

温阳通络汤辅治糖尿病肾病Ⅳ期瘀浊内阻型临床研究

目的:观察温阳通络汤辅治糖尿病肾病Ⅳ期瘀浊内阻型的临床疗效。方法:60例随机分为两组各30例。两组均给予西药降糖、调脂,研究组加用温阳通络汤治疗。结果:研究组总有效率高于对照组(P<0.05)。研究组GFR、Scr、24h尿蛋定量均高于对照组(P<0.05),2h PG、FBG、Hb A1c水平以及白细胞介素-6和α肿瘤坏死因子低于对照组(P<0.05)。研究组中医症状积分改善优于对照组(P<0.05)。结论:温阳通络汤辅治糖尿病肾病Ⅳ期瘀浊内阻型可提高疗效,且安全。

满足非道路印度四阶段法规的排放控制技术研究

本文基于一台电控共轨柴油机研究了柴油机采用DOC+POC+SCR技术路线满足非道路印度四阶段排放法规要求的可行性。通过台架试验研究发动机本体氮氧化物和颗粒物排放关系,并使用近后喷喷油策略来降低发动机本体颗粒物排放。然后对比不同结构的POC方案对颗粒物捕集效率以确定POC方案。最终采用DOC+POC+SCR技术路线满足非道路印度四阶段污染物排放限值要求。

参芪扶正汤治疗Ⅲ~Ⅳ胃癌的疗效

目的 分析Ⅲ~Ⅳ期胃癌患者采取参芪扶正汤治疗的效果。方法 本次研究所抽取的78例Ⅲ~Ⅳ期胃癌患者为广州中医药大学金沙洲医院2021年1月—2022年1月收治。采取随机数字表法分为两组。施行卡培他滨联合奥沙利铂化疗39例患者设为对照组;在上述基础上采取施行参芪扶正汤治疗的39例患者设为试验组。以T淋巴细胞亚群指标、血清细胞因子指标、生活质量及化疗不良反应评价两组治疗效果。结果 治疗后试验组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)较高(P<0.05)。血清细胞因子指标试验组较低(P<0.05)。生活质量试验组较高(P<0.05)。化疗不良反应中试验组明显较轻(P<0.05)。结论 Ⅲ~Ⅳ期胃癌患者采取参芪扶正汤治疗可获得凸显的效果,能够有效改善患者的免疫力及血清细胞因子,同时能够促进患者的生活质量得到改善,且可减少化疗不良反应。

非四自吸柴油机高海拔碳烟排放特性研究

基于高原进排气海拔模拟系统,针对非四自吸柴油机开展变海拔的碳烟排放差异性研究,并分析高海拔碳烟排放差异的影响因素。研究表明,随着海拔的增加,柴油机碳烟排放降低,主要与高原进气量不足而降低供油量以实现低排放的标定策略相关;随着海拔的增加,柴油机的进气量、供油量与喷油提前角均降低,降幅速率约为10%/1000m, 4000m海拔的供油参数较平原的降幅超过35%;非道路移动机械因其作业的特殊性,其实际运行工况多集中于中间转速与额定转速下,该发动机相同负荷的碳烟排放相近,但额定转速下的碳烟排放较中间转速高。

Ⅲ~Ⅳ期压疮合并血流感染患者30 d死亡的危险因素分析

目的 对Ⅲ~Ⅳ期压疮合并血流感染患者进行病原菌检测,分析其30 d死亡的危险因素。方法 回顾性研究2019年9月至2022年6月医院重症监护病房收治的Ⅲ~Ⅳ期压疮合并血流感染患者,收集临床资料和实验室指标,检测病原菌,记录30 d的死亡情况,分析其死亡相关危险因素。结果 共纳入Ⅲ~Ⅳ期压疮合并血流感染患者69例,总计分离出病原菌97株,其中革兰阳性菌55株(56.70%)、革兰阴性菌39株(40.21%)、真菌3株(3.09%)。30 d死亡率达24.64%(17/69),死亡组患者平均存活时间(10.65±5.10)d。单因素分析结果显示,死亡组患者年龄、肾功能不全比例、白细胞计数、Pitt菌血症评分≥6分及血白蛋白浓度≤30 g/L比例均高于生存组患者,差异均有统计学意义(χ~2分别=-3.29、32.98、-2.29、35.96、8.99,P均<0.05),多因素logistic回归分析结果显示,年龄、肾功能不全及血白蛋白浓度≤30 g/L是Ⅲ~Ⅳ期压疮合并血流感染患者30 d死亡的危险因素(OR分别=1.28、37.32、41.52,P均<0.05)。结论 Ⅲ~Ⅳ期压疮合并血流感染患者30 d死亡率较高,年龄、肾功能不全及血白蛋白浓度≤30 g/L是Ⅲ~Ⅳ期压疮合并血流感染患者30 d死亡的危险因素,临床应重点关注和预防。

慢性肾脏病Ⅲ~Ⅳ期维持性血液透析患者发生动静脉内瘘失功的影响因素

目的:分析慢性肾脏病(CKD)Ⅲ~Ⅳ期维持性血液透析患者发生动静脉内瘘(AVF)失功的影响因素。方法:选取2018年3月至2021年11月346例CKDⅢ~Ⅳ期维持性血液透析患者进行横断面研究,比较AVF失功与AVF畅通患者的临床资料,采用多因素Logistic回归分析CKDⅢ~Ⅳ期维持性血液透析患者发生AVF失功的影响因素。结果:AVF失功患者的透析中低血压占比、纽扣式穿刺法占比、止血压迫时间≥30 min占比、血清脂蛋白相关磷脂酶A2(Lp-PLA_(2))水平、血清超敏C反应蛋白(hs-CRP)水平高于AVF畅通患者,差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,透析中低血压、纽扣式穿刺法、止血压迫时间≥30 min、血清Lp-PLA_(2)水平>1177.55 ng/mL、血清hs-CRP水平>5.65 mg/L均为CKDⅢ~Ⅳ期维持性血液透析患者发生AVF失功的危险因素(OR>1,P<0.05)。结论:透析中低血压、纽扣式穿刺法、止血压迫时间≥30 min、血清Lp-PLA_(2)水平>1177.55 ng/mL、血清hs-CRP水平>5.65 mg/L均为CKDⅢ~Ⅳ期维持性血液透析患者发生AVF失功的危险因素。