Safety and efficacy of trimodality therapy in patients undergoing extrapleural pneumonectomy

Malignant pleural mesothelioma （MPM） is a rare but rapidly deadly disease （1）. Macroscopic complete resection （MCR） is the goal of surgery （2）. MCR seems to have the most significant impact on survival in patients undergoing multimodality treatment for MPM. The role of surgical resection in the management of MPM remains controversial. The selection criterion to perform either extrapleural pneumonectomy （EPP） or extended/radical pleurectomy/ decortication （PD） rely not only on the cardio-pulmonary status of the patient, tumor stage and intraoperative findings but is strongly dependent also on surgeons＇ decision and philosophy. This is reflected by a recent survey of opinions and beliefs among 802 thoracic surgeons, in which EPP was believed to be more effective than PD （3）. Nonetheless, either surgery might achieve MCR.

Sequencing of high-efficacy disease-modifying therapies in multiple sclerosis： perspectives and approaches

Multiple sclerosis（MS） is characterized by chronic inflammation in conjunction with neurodegeneration within the central nervous system. Most individuals with MS begin with a relapsing remitting course that later transitions to secondary progressive MS. Currently available disease-modifying therapies（DMTs） for relapsing MS have been demonstrated to reduce disease activity, however most patients require a change in therapy over the course of their disease. Treatment goals include the prevention of relapses and disability accumulation and to achieve this objective requires careful planning. Sequencing of DMTs for individual patients should be designed in such a way to maximize disease control and minimize risk based on the mechanism of action, pharmacokinetic and pharmacodynamic properties of each therapy. This includes the DMT patients are being switched from to those they are being switched to. The reversibility of immune system effects should be a key consideration for DMT sequence selection. This feature varies across DMTs and should factor more prominently in decision making as newer treatments become available for the prevention of disability accumulation in patients with progressive MS. In this short review, we discuss the landscape of existing therapies with an eye to the future when planning for optimal DMT sequencing. While no cure exists for MS, efforts are being directed toward research in neuroregeneration with the hope for positive outcomes.

Efficacy comparison between conservative therapy and septal ablation in patients with hypertrophic obstructive cardiomyopathy

Objective To compare the effects of septal ablation(SA)versus conservative medication(CM)on the hemodynamic,clinical status and survival in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods This retrospective study included 350 consecutive patients with HOCM(mean age(51.3±13.5)years old)hospitalized in Anzhen Hospital between

Nonstent Combination Interventional Therapy for Treatment of Benign Cicatricial Airway Stenosis

Background：Benign cicatricial airway stenosis （BCAS） is a life-threatening disease.While there are numerous therapies,all have their defects,and stenosis can easily become recurrent.This study aimed to investigate the efficacy and complications of nonstent combination interventional therapy （NSCIT） when used for the treatment of BCAS of different causes and types.Methods：This study enrolled a cohort of patients with BCAS resulting from tuberculosis,intubation,tracheotomy,and other origins.The patients were assigned to three groups determined by their type of stenosis：Web-like stenosis,granulation stenosis,and complex stenosis,and all patients received NSCIT.The efficacy and complications of treatment in each group of patients were observed.The Chi-square test,one-factor analysis of variance （ANOVA）,and the paired t-test were used to analyze different parameters.Results：The 10 patients with web-like stenosis and six patients with granulation stenosis exhibited durable remission rates of 100%.Among 41 patients with complex stenosis,36 cases （88%） experienced remission and 29 cases （71%） experienced durable remission.When five patients with airway collapse were eliminated from the analysis,the overall remission rate was 97%.The average treatment durations for patients with web-like stenosis,granulation stenosis,and complex stenosis were 101,21,and 110 days,respectively,and the average number of treatments was five,two,and five,respectively.Conclusions：NSCIT demonstrated good therapeutic efficacy and was associated with few complications.However,this approach was ineffective for treating patients with airway collapse or malacia.

Clinical Efficacy and Safety of Bathing with Chinese Medicine Taohong Siwu Decoction(桃红四物汤) for Treatment of Diffuse Cutaneous Systemic Sclerosis:A Randomized Placebo-Controlled Trial

Objective：To examine the efficacy and safety of bathing therapy with Taohong Siwu Decoction（桃红四物汤,TSD） in the treatment of early-stage,mild-moderate diffuse cutaneous systemic sclerosis（dc SSc）.Methods：This randomized,placebo-controlled trial enrolled 148 men and women（18–60 years） with dc SSc（disease duration 12 months） and baseline modified Rodnan skin score（MRSS） 10.Patients were randomized into a TSD group（71 cases bathing with TSD plus oral prednisone） or control group（71 cases bathing with placebo plus oral prednisone）.Bathing（40 ℃,30 min） of the upper and lower limbs was carried out once daily for 12 consecutive weeks.The primary outcome measure was MRSS;secondary outcomes were Raynaud＇s phenomenon（RP） score,quality of life（QOL）,physician visual analogue scale（VAS）,patient VAS,percent predicted diffusing capacity for carbon monoxide（DLCO）,percent predicted forced vital capacity（FVC）,erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP） level and overall treatment effect.Results：The final analysis included 135 patients（control group,68 cases;TSD group,67 cases）.Primary and secondary outcome measures after 2 weeks of treatment showed no improvement（versus baseline） in both groups,with no differences between groups.At 12 weeks,QOL,physician VAS,patient VAS,ESR and CRP were improved in both groups,but MRSS and RP score were improved only in the TSD group（all P〈0.05）.MRSS,RP score,QOL,physician VAS,patient VAS,ESR and CRP differed significantly between groups（all P〈0.05）.Meanwhile,the overall treatment effect was significantly higher in the TSD group than in the control group（P〈0.05）.Adverse events in the two groups were similar（P〉0.05）.Conclusions：Bathing with TSD plus oral prednisone achieves better outcomes than oral prednisone alone in patients with dcS Sc and is not associated with serious adverse events.

Clinical observation on therapeutic effect of acupuncture for chronic functional constipation

Methods Two Qihai （气海 CV Objective To discuss the efficacy of acupuncture for groups of points were applied alternatively to 90 cases by chronic functional constipation acupuncture： （1） Tianshhu （CFC）. ST 25）, 6）, Shemgjfuxu （上巨虚 ST 37）, etc. （2）Zhongliao （中髎 BL 33）, Xiadiao （下髎 BL 34）, Dachangshu （大肠俞 BL 25）, etc. Electroacupuncture was applied in combination at Zhongliao （中髎 BL 33）, Xialiao （下髎 BL 34）, Tianshu（天枢 ST 25） and Shamgjuxu （上巨虚 ST 37）, once a day, 10 treatments made one session. By constipation diary of patients, frequency of going to stool, straining severity, time of once bowl evacuation, a sense of incomplete bowel emptying, stool quality, a sense of defecation and the Patient Assessment of Constipation Quality of Life questionnaire （PAC-QOL）, as well as the changes before and after treatment were observed. Results After treatment, the apparent improvements were achieved in frequency of going to stool, straining severity, time of once bowl evacuation, a sense of incomplete bowel emptying, a sense of defecation and score of PAC-QOL as compared with those before treatment （all P〈0.01）. The total effective rate was 67.7% （61/70）. The acupuncture effieacies were various on CFC of different dynamic mechanisms. The efficacy on slow transit constipation （STC） was superior to that caused by spastic pelvic floor syndrome （SPFS-C） （P〈0.05）, the efficacy on constipation caused by irritable bowel syndrome （IBS-C） was superior to that on either SPFS-C or constipation caused by relaxant pelvic floor syndrome （RPFS-C） （both P〈0.05）. Of 52 eases in effective follow-up, 1 month after treatment, 3 eases were cured, 6 eases markedly effective, 23 eases effective, and 20 cases failed; 3 months after treatment, 3 eases were cured, 5 eases markedly effective, 16 cases effective and 28 cases failed. Conclusion Acupuncture has definite efficacy on CFC with definite etiology, loci and diagnostic classification. But, the efficacies are different due to various dynamic mechanisms. A further optimized treatment program is required to improve the efficacy on SPFS-C and RPFS-C.

Persistent EGFR/K-RAS/SIAH pathway activation drives chemo-resistance and early tumor relapse in triple-negative breast cancer

Triple-negative breast cancer(TNBC)is the most aggressive breast cancer subtype.It disproportionately affects BRCA mutation carriers and young women,especially African American(AA)women.Chemoresistant TNBC is a heterogeneous and molecularly unstable disease that challenges our ability to apply personalized therapies.With the approval of immune checkpoint blockade(ICB)for TNBC,the addition of pembrolizumab to systemic chemotherapy has become standard of care(SOC)in neoadjuvant systemic therapy(NST)for high-risk early-stage TNBC.Pembrolizumab plus chemotherapy significantly increased the pathologic complete response(pCR)and improved event-free survival in TNBC.However,clinical uncertainties remain because similarly treated TNBC partial responders with comparable tumor responses to neoadjuvant therapy often experience disparate clinical outcomes.Current methods fall short in accurately predicting which high-risk patients will develop chemo-resistance and tumor relapse.Therefore,novel treatment strategies and innovative new research initiatives are needed.We propose that the EGFR-K-RAS-SIAH pathway activation is a major tumor driver in chemoresistant TNBC.Persistent high expression of SIAH in residual tumors following NACT/NST reflects that the EGFR/K-RAS pathway remains activated(ON),indicating an ineffective response to treatment.These chemoresistant tumor clones persist in expressing SIAH(SIAH^(High/ON))and are linked to early tumor relapse and poorer prognosis.Conversely,the loss of SIAH expression(SIAH^(Low/OFF))in residual tumors post-NACT/NST reflects EGFR/K-RAS pathway inactivation(OFF),indicating effective therapy and chemo-sensitive tumor cells.SIAH^(Low/OFF) signal is linked to tumor remission and better prognosis post-NACT/NST.Therefore,SIAH is well-positioned to become a novel tumor-specific,therapy-responsive,and prognostic biomarker.Potentially,this new biomarker(SIAH^(High/ON))could be used to quantify therapy response,predict chemo-resistance,and identify those patients at the highest risk for tumor relapse and poor survival in TNBC.