Prophylactic lateral pelvic lymph node dissection in stage Ⅳ low rectal cancer

AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal cancer.METHODS We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent primary tumor resection,and enrolled 50 of these 71 patients without clinical LPLN metastasis.The patients had distant metastasis such as liver,lung,peritoneum,and paraaortic LN.Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan.All patients underwent primary tumor resection,27 patients underwent total mesorectal excision(TME) with LPLND(LPLND group),and 23 patients underwent only TME(TME group).Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group.R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients.We evaluated possible prognostic factors for 5-year overall survival (OS),and compared 5-year cumulative local recurrence between the LPLND and TME groups.RESULTS For OS,univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%,P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic factor.Regarding cumulative local recurrence,the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%,P = 0.833).CONCLUSION Prophylactic LPLND shows no oncological benefits in patients with Stage Ⅳ low rectal cancer without clinical LPLN metastasis.

Radical treatment of stage Ⅳ pancreatic cancer by the combination of cryosurgery and iodine-125 seed implantation

AIM:To investigate the therapeutic effect of radical treatment and palliative treatment in stage Ⅳ pancreatic cancer patients.METHODS:81 patients were enrolled in the study.Radical treatment was performed on 51 patients,while 30 patients were put under palliative treatment.The procedural safety and interval survival for stage Ⅳ pancreatic cancer(IS-Ⅳ) was assessed by almost 2.5 years of follow-ups.The IS-Ⅳ of patients under the two kinds of treatment,and the effects of treatment timing and frequency on IS-Ⅳ,were compared.RESULTS:The IS-Ⅳ of patients who received radical treatment was significantly longer than those who received palliative treatment(P < 0.001).The IS-Ⅳ of patients who received delayed radical or palliative treatment was longer than those who received accordingly timely treatment(P = 0.0034 and 0.0415,respectively).Multiple treatments can play an important role in improving the IS-Ⅳ of patients who received radical treatment(P = 0.0389),but not for those who received palliative treatment(P = 0.99).CONCLUSION:The effect of radical treatment was significantly more obvious than that of palliative treatment,and multiple radical treatments may contribute more to patients than a single radical treatment.

Resection of the primary tumor in stage Ⅳ breast cancer

Stage Ⅳ breast cancer refers to breast cancer that has already metastasized to distant regions when initially diagnosed. Treatment for stage Ⅳ is intended to "prolong survival and palliate symptoms". Resection of a primary tumor is considered to be "effective only at alleviating chest symptoms and providing local control" in spite of the advances of imaging examination and medication for breast cancer. Molecular target and endocrine drugs are very effective and useful to tailor-make a treatment strategy according to breast cancer subtypes. Positron emission tomography-computed tomography can detect and diagnose the very small metastases and recurrences which can potentially be cured even if they are distant metastases. Recently, many retrospective studies have reported the survival benefit of surgery for breast cancer patients with metastases and some clinical trials which confirm the surgical prognostic benefit for them have started to enrol patients. The goal of treatment has to be clearly identified:increase the patient's survival time, provide local control or perform histology to determine the cancer's properties. The best evidence is absolutely essential to treat patients who need surgery at the right time. We need to evaluate the treatment strategy, including primary resection for stage Ⅳ breastcancer particularly, and find new evidence by prospective analysis.

血清TAP、proGRP、cyfra21-1与Ⅲ~Ⅳ期NSCLC新辅助化疗疗效及预后的关系

目的探讨血清肿瘤异常蛋白(TAP)、胃泌素释放肽前体(proGRP)、细胞角蛋白19片段(cyfra21-1)与Ⅲ~Ⅳ期非小细胞肺癌(NSCLC)新辅助化疗(NCT)疗效及预后的关系。方法选取100例Ⅲ~Ⅳ期NSCLC患者为研究对象,所有患者均采用NCT治疗,根据疗效将患者分为有效组和无效组,比较不同疗效患者化疗前后TAP、proGRP、cyfra21-1水平,分析化疗后TAP、proGRP、cyfra21-1水平对NSCLC患者NCT疗效的评估价值。所有患者均随访1年,分析化疗后TAP、proGRP、cyfra21-1表达水平与预后的关系。结果化疗后,有效组TAP、proGRP、cyfra21-1水平低于无效组(P<0.05)。ROC曲线结果显示,TAP评估NSCLC患者NCT疗效的AUC和截点值分别为0.739、178.18μm 2,proGRP评估NSCLC患者NCT疗效的AUC和截点值分别为0.810、52.21 ng/L,cyfra21-1评估NSCLC患者NCT疗效的AUC和截点值分别为0.775、7.70μmol/L,联合评估NSCLC患者NCT疗效的AUC为0.913,高于单项诊断(P<0.05)。TAP、proGRP、cyfra21-1高表达患者的1年生存率均低于低表达患者(P<0.05)。结论TAP、proGRP、cyfra21-1联合评估Ⅲ~Ⅳ期NSCLC患者NCT疗效具有较高价值,且其均与NSCLC患者预后密切相关。

TRMM/GPM和StageⅣ降水产品在小流域水文模拟效用评估

以地面观测降水作为参照,在美国俄克拉荷马州Little Washita River流域,对比分析了TRMM 3B42 V7,GPM-IMERG卫星降水和StageⅣ雷达降水的精度,并用这3种降水产品驱动CREST分布式水文模型,评估了其水文模拟效用.研究表明:3种降水产品与地面降水的相关系数均大于0.5,通过了0.05置信水平检验;GPM-IMERG和TRMM 3B42 V7卫星降水对无雨和微雨存在低估,对大雨和暴雨存在高估;总体上,StageⅣ降水精度最好,其次GPM降水精度优于TRMM 3B42 V7.在水文模拟效用评估中,设定相同率定期,分别使用3种降水产品率定CREST模型参数,得到率定参数集后,在相同验证期对流域日径流过程进行模拟.对比结果表明:StageⅣ雷达降水在小流域水文模拟中效果最好,GPM-IMERG次之,TRMM 3B42 V7模拟效果不理想.

Ⅳ期C级牙周炎患者预后无望牙疗效的影响因素研究

目的探讨Ⅳ期C级牙周炎患者预后无望患牙经过完善牙周治疗后的效果及其影响因素。方法本回顾性研究纳入63例Ⅳ期C级牙周炎患者,共307颗预后无望患牙,根据2年后患牙存留与否分为存留组和失牙组,存留组中根据临床检查和影像学骨吸收是否恢复至根中1/3分为预后好转组和预后不变组。根据临床资料分析年龄、性别、牙位、基础疾病、吸烟情况、家族遗传、牙列是否完整、牙周炎分型、治疗过程、初诊牙周临床指标对治疗效果的影响。结果307颗患牙两年存留率为83.1%,预后明显好转占比46.2%。存留组和失牙组在家族遗传、初诊时牙列完整性、1个月复查是否按时、维护期治疗规律性、手术情况和患牙初诊临床指标上差异有统计学意义。回归分析显示,未进行翻瓣再生类手术、有家族遗传史、基线深附着丧失值、高松动度为主要风险因素。结论对于Ⅳ期C级牙周炎患者预后无望患牙在短期内大多数可以保留,临床治疗中需要根据风险因素进行个性化的治疗以提高患牙存留率。

Conversion surgery for stage Ⅳ gastric cancer

Gastric cancer with distant metastases,such as para-aortic lymph node metastases,hepatic metastases,and peritoneal dissemination,is classified as stage IV.In this situation,cancer cells have formed micrometastases throughout the body;therefore,according to the algorithm of the Japanese guidelines,stage IV cancer is outside the indication for curative resection.Recent advances in some chemical agents have been remarkable,and some patients have survived for long periods even with stage IV gastric cancer.Thus,even in patients with stage IV gastric cancer,there is a possibility that gastrectomy as conversion surgery could play an important role in the treatment strategy.Gastrectomy as conversion therapy can be safely conducted without perioperative mortality and is considered a sufficiently acceptable treatment strategy.However,the significance of conversion surgery for stage IV gastric cancer remains controversial.In this review,we summarize the treatment strategies and outcomes of conversion surgery for stage IV gastric cancer.

Effect of TCM Combined with Chemotherapy on Immune Function and Quality of Life of Patients with Non-small Cell Lung Cancer inStage Ⅲ-Ⅳ

Objective: To observe and compare the effect of traditional Chinese medicine (TCM) combined with chemotherapy (CT) on immune function and quality of life (QOL)of patients with non-small cell lung cancer (NSCLC) in stage Ⅲ-Ⅳ. Methods: One hundred cases with stage Ⅲ-Ⅳ NSCLC were randomly divided into two groups. The treated group (n=50) received CT combined with TCM, and the control group received CT alone. The percentage of T lymphocyte subset in peripheral blood and the change of natural killer (NK) cell count were observed after treatment. The QOL and tolerance of CT were also compared between the two groups after treatment. Results: In the treated group, CD3 cell count, CD4 cell count, CD4/ CDg ratio and NK cell activity were higher than those in control group, while CD8 cell count in the treated group was lower than that in the control group (P<0.05), and QOL and tolerance of CT in the treated group were also better (P<0.05). Conclusion: TCM combined with CT could raise the patients' ability in tolerating CT in stage Ⅲ-ⅣNSCLC.

Macroscopic appearance of TypeⅣand giant Type Ⅲ is a high risk for a poor prognosis in pathological stage Ⅱ/Ⅲ advanced gastric cancer with postoperative adjuvant chemotherapy

AIM To evaluate whether a high risk macroscopic appearance(Type Ⅳ and giant Type Ⅲ) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage Ⅱ/Ⅲ(p Stage Ⅱ/Ⅲ) gastric cancer.METHODS One hundred and seventy-two advanced gastric cancer(defined as pT2 or beyond) patients with p Stage Ⅱ/Ⅲ who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined. RESULTS Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival(RFS)(35.7%) and overall survival(OS)(34%) than an average risk appearance(P = 0.0003 and P < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13^(th) Japanese Gastric Cancer Association(JGCA) pT(P = 0.01), but not with the 13^(th) JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13^(th) JGCA p Stage(P < 0.0001)and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified highrisk macroscopic appearance(P = 0.036, HR = 2.29 for RFS and P = 0.021, HR = 2.74 for OS) as an independent prognostic indicator. CONCLUSION A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13^(th) JGCA stage in p Stage Ⅱ/Ⅲ advanced gastric cancer.

舒肝宁注射液对晚期血吸虫病肝纤维化患者HA,Ⅳ-C,LN,PC-Ⅲ水平的影响

目的分析舒肝宁注射液对晚期血吸虫病肝纤维化患者HA、Ⅳ-C、LN、PC-Ⅲ水平的影响。方法以住院部2020年8月-2022年6月收治的晚期血吸虫病肝纤维化患者50例为研究对象,采用抛硬币的方式将患者分为对照组(25例患者,行常规治疗)和观察组(25例患者,行常规治疗+舒肝宁注射液治疗),对比两组患者的治疗结果(肝纤维化水平、肝功能指标以及炎性因子水平)。结果观察组患者治疗后HA、Ⅳ-C、LN、PC-Ⅲ水平均低于对照组患者,观察组患者治疗后ALT、AST、TBIL均低于对照组,ALB高于对照组,护理前组间(P>0.05),护理前后组内(P<0.05)。观察组患者治疗后炎性因子(CRP、PCT、IL-6)水平明显更低,差异存在统计学意义(P<0.05),观察组患者的不良反应发生率(12.00%)与对照组(8.00%)之间差异不显著(P>0.05)。结论舒肝宁注射液对晚期血吸虫病肝纤维化患者的治疗效果较好,患者治疗后HA、Ⅳ-C、LN、PC-Ⅲ水平更低,炎性因子水平更低。该治疗方式的综合应用价值高,值得推广使用。

国Ⅳ城市公交车NO_x排放特性的试验研究

利用车载排放测试系统对两辆国Ⅳ城市公交车在实际运行时的排放特性进行了试验研究。结果表明,车辆的NOx排放受车辆行驶状况影响较大,当行驶道路畅通,车速较高且输出功率较大时,车辆的NOx排放率较低,反之,NOx排放率较高;当车速由15km/h提高到55km/h以上时,NOx的平均排放率可以降低70%,而尿素喷射时间占比可提高25个百分点。因此,提高车速是充分发挥国Ⅳ车辆排放优势,改善交通的有效手段之一。

儿童Ⅳ期神经母细胞瘤远期随访报告

目的总结分析儿童Ⅳ期神经母细胞瘤(NB)诊断治疗方案的远期疗效及影响预后的因素,为方案的改进提供依据。方法研究对象为1996年4月1日至2005年12月31日新诊断的Ⅳ期NB患儿,年龄1个月至15岁,共69例。其中Ⅳ期67例,Ⅳs期2例。根据年龄将患儿分为中危组和高危组,综合治疗方案包括根据分组采用不同强度化疗、完成化疗后全顺式维甲酸诱导分化治疗及适时肿瘤根治性切除术,起病年龄>1岁的患儿在停药前造血干细胞支持下超剂量化疗(ASCT),部分术后有残留者接受局部放疗。结果16/69例在接受44疗程后好转中放弃治疗。53例按计划治疗>4个疗程,22例接受了ASCT(中危组3例,高危组19例)。获得非常好的部分缓解(very good partial remission,VGPR)49例(92.45%),获得部分缓解(PR)4例(7.55%)。中位随访期28个月(7个月至79个月)。末次随访时在VGPR中13例(24.53%),中位VGPR时间为38个月。带病生存病情稳定5例。疾病进展、复发或已死亡35例(66.04%)。2年总体生存率(OS)和VGPR生存率(VGPRS)分别为64.4%和60.4%,3年OS和VGPRS分别为43.9%和41.2%,4年OS和VGPRS分别为19.8%和14.4%。肿瘤原发于后腹膜、骨髓转移对预后的影响达统计学有效水平,P值均<0.05。结论Ⅳ期NB在强烈化疗等综合治疗下远期预后仍然极差,原发于后腹膜并有骨髓转移者预后更差,需进一步探索研究新的治疗手段,以改善其预后。

17例Ⅳ期高危神经母细胞瘤肿瘤包绕大血管放疗介入诊治分析

目的:探讨对Ⅳ期高危神经母细胞瘤肿瘤包绕大血管放疗介入时机。方法:2010年1月至2011年12月上海交通大学医学院附属新华医院肿瘤放化疗科收治17例Ⅳ期高危神经母细胞瘤肿瘤包绕大血管患儿,其中男性11例,女性6例,对12例行术前化疗、手术、术后化疗、造血干细胞移植后大剂量化疗,然后接受局部放疗;5例因术前化疗效果不明显而行术前放疗。结果:12例中有7例复发:2例脑转移及骨转移、2例局部复发、3例骨转移中2例为腹腔广泛转移,平均复发时间在放疗结束后2个月。5例行术前放疗的患儿中4例放疗后3～4周完成手术,1例出现全身广泛转移死亡。结论:Ⅳ期高危神经母细胞瘤肿瘤包绕大血管者预后较差,复发率高,治疗包括术前化疗、手术、术后化疗、造血干细胞移植的大剂量化疗治疗,对原发肿瘤部位的进一步放疗通常认为是必需的,在造血干细胞移植的巩固化疗前用放疗来提高局控率可减少转移。当术前化疗不敏感时可采用术前放疗,从而获得手术治疗机会。

64排螺旋CT对Ⅳ期胃癌术前分期的价值

目的评价64排螺旋CT对Ⅳ期胃癌术前分期的准确性。方法收集2007年7月至2008年4月期间我院胃肠外科收治的49例Ⅳ期胃癌患者的临床资料,对其中术前行64排螺旋CT(64MDCT)检查的29例患者进行回顾性分析并按日本胃癌规约对肿瘤进行分期。将CT术前分期结果与临床-手术-病理分期结果进行对照分析。结果本组病例经64MDCT术前分期,其中65.2%(15/23)T分期准确,47.8%(11/23)N分期准确,70.8%(17/24)M分期准确,58.6%TNM分期准确(17/29)。而腹膜转移患者中6/9未能经术前64MDCT检出。结论64MDCT可以对Ⅳ期胃癌进行较准确的分期,其分期准确率降低的主要原因为腹膜转移的漏诊,但64MDCT分期降低并不增加剖腹探查率。

188例Ⅳ期非小细胞肺癌化疗过程中原发灶区放疗与否的预后分析

目的:回顾性分析Ⅳ期非小细胞肺癌(NSCLC)全身化疗过程中,原发灶放疗与否与生存期的关系。方法:188例Ⅳ期NSCLC患者(1999年12月至2004年1月)接受含铂方案为主的一线方案化疗,疗效达PR或SD者。其中63例择期予以原发灶区放疗,简称放疗组;125例未行原发灶放疗,简称非放疗组。比较两组生存期、安全性。结果:全组188例患者1年生存率(SR)48.9%,中数生存期(MS)12个月。放疗组1年SR77.8%,MS15个月;未放疗组1年SR41.6%,MS10个月。两组SR差别明显(P=0.025)。全组疗效达PR者(74例),放疗组(37例)与未放疗组(37例)MS分别为17和13个月,1年SR分别为84.2%和66.7%,但生存趋势无差别(P=0.454)。疗效SD者,两组MS分别为12和8个月,1年SR分别为45.0%和24.6%,生存率差别明显(P=0.0027)。放疗组中无WHOⅢ～Ⅳ度血液学毒性,WHOⅢ度的放射性肺炎7例(11.1%),需静脉营养支持的WHOⅢ度食管炎1例(1.5%)。结论:Ⅳ期NSCLC在全身化疗基础上择期行原发灶放疗,有延长生存期作用,对化疗达SD者似更有意义。

糖尿病肾病患者Ⅲ、Ⅳ、Ⅴ期中医证候及分布规律

目的探讨280例糖尿病肾病(DN)患者Ⅲ、Ⅳ、Ⅴ期中医证候规律及证候分布规律,以期为DN的规范化诊治提供新的思路及理论支持。方法采用回顾性方法研究分析280例符合中西医诊断标准的Ⅲ、Ⅳ、Ⅴ期DN患者,针对各期患者主要及次要临床表现及问卷调查结果,采用德尔菲法总结DNⅢ、Ⅳ、Ⅴ期中医证候规律,采用聚类分析法探讨DNⅢ、Ⅳ、Ⅴ期中医证候分布规律,并进行描述性统计分析中医证候规律及其证候分布规律的特点。结果Ⅲ期和大量蛋白尿期DN患者中医症候特点为本虚标实,气阴两虚夹瘀型,Ⅴ期逐渐发展至气血阴阳俱虚,兼见湿浊、瘀血夹杂重症。结论随着DN的不断进展,中医症状出现相应频次的变化,其中医证候规律及其分布规律各有特点,对本病的临床诊治研究意义重大。

化疗放射综合治疗Ⅳ期肺癌对生存期的影响

本文对44例接受化疗和60Co放疗综合治疗的Ⅳ期肺癌患者和25例单纯接受化疗的Ⅳ期肺癌这两组病人的疗效进行观察，放化组有效率34．1％，中位生存期11月，单化组有效率12％，中位生存期4.5月。本文显示应用适当有效的化疗和放疗综合治疗Ⅳ期肺癌能够缓解病情，延长生存期。

加减猪苓汤治疗糖尿病肾病Ⅳ期的临床观察及对尿AQP2的影响

目的探讨加减猪苓汤治疗糖尿病肾病(diabetic kidney disease,DKD)Ⅳ期的临床疗效及对尿水通道蛋白2(Aquaporin2,AQP2)的影响。方法临床采用辨证属阴虚水肿型DKDⅣ期样本50例,随机分为治疗组25例和对照组25例,所有病例均进行常规降糖药控制血糖、低盐、优质低蛋白、低脂饮食、控制血压和运动指导等一般治疗。对照组口服厄贝沙坦片150 mg/d,治疗组在上述治疗基础上,加用加减猪苓汤,6周后比较治疗前后两组24尿蛋白定量、肝肾功能、糖化血红蛋白、血糖、中医症候积分情况等,同时分别在第1、3、6周末检测两组尿AQP2表达。结果治疗6周后,两组中医症候积分、24 h尿蛋白定量、血浆白蛋白、血肌酐及均较治疗前有所改善,差异有统计学意义(P<0.05),且治疗组优于对照组(P<0.05),治疗组尿AQP2在第3周及第6周均表达高于第1周(P<0.05),且高于对照组(P<0.05)。结论猪苓汤猪苓汤治疗DKDⅣ期的患者可减少尿蛋白、改善肾功能及减少中医症候积分,同时提高尿中AQP2表达,延缓DKD的进展。

吉西他滨联合长春瑞滨与联合紫杉醇姑息治疗铂类耐药的Ⅳ期鼻咽癌患者的随机对照试验

目的:观察吉西他滨联合长春瑞滨与联合紫杉醇方案作为姑息治疗方案治疗铂类耐药的Ⅳ期鼻咽癌患者的有效性及安全性。方法:收集2012年7月至2014年7月含铂一线治疗失败的晚期鼻咽癌患者共105例的临床资料,随机分为吉西他滨联合长春瑞滨组(GV组)与吉西他滨联合紫杉醇组(GT组),比较两方案在总有效率(ORR)、疾病控制率(DCR)、无进展生存期(PFS)、总生存期(OS)及不良反应发生率等方面的差异。采用Log-rank检验比较PFS及OS。结果:两组间的ORR无统计学差异(P=0.491),DCR存在统计学差异(GT组较优,P=0.034)。两组间的PFS、OS的差别均无统计学意义(P=0.387,P=0.673)。不良反应方面,GV组Ⅰ度感觉异常较多,而GT组Ⅲ度白细胞降低、Ⅰ度疲乏无力、过敏反应、肌肉关节疼痛、脱发及Ⅱ度脱发较多,差别均有统计学意义。结论:GV、GT两种方案治疗铂类耐药的晚期鼻咽癌患者在总有效率、无进展生存期及总生存期上近似,GT方案可提高患者疾病控制率(DCR),不良反应较GV方案多,多为轻中度,患者可耐受。

AHSG和IL-6基因多态性与Ⅳ期卵巢子宫内膜异位囊肿的相关性研究

目的：探讨α2-HS-糖蛋白（AHSG）基因和白细胞介素-6（IL-6）基因调控区-174位点多态性与中国河北省育龄妇女Ⅳ期卵巢子宫内膜异位囊肿遗传易感性的关系。方法：采用病例对照研究的方法，以50例Ⅳ期卵巢子宫内膜异位囊肿患者（评分〉40）及62例非子宫内膜异位症对照者的外周血白细胞为样本，利用聚合酶链反应（PCR）技术分析AHSG基因和IL-6基因调控区-174位点基因的多态性。结果：Ⅳ期卵巢子宫内膜异位囊肿组中AHSG基因的3种基因型AHSG1＊1、AHSG1＊2、AHSG2＊2各占44％、46％、10％，对照组则分别为71％、25．8％、3．2％。将突变型与杂合型合并与野生型比较，两组间差异有统计学意义（χ=8．317，P=0．004），其OR为3．111（95％CI为1．422～6．805），携带变异基因的患病风险率高。AHSG1、AHSG2等位基因频率总体分布差异有统计学意义（χ^2=8．723，P=0．003），携带AHSG2等位基因的患病危险度高，OR为2．561，（95％CI为1．358-4．831）。在50例试验组与62例对照组中均未发现IL-6突变基因。结论：AHSG2基因可使患Ⅳ期卵巢子宫内膜异位囊肿的遗传易感性升高，未发现Ⅳ期卵巢子宫内膜异位囊肿与IL-6基因调控区-174位点突变有相关性。