Gastrointestinal dysfunction is associated with mortality in severe burn patients:a 10-year retrospective observational study from South China

Background:Data on severe and extensive burns in China are limited,as is data on the prevalence of a range of related gastrointestinal(GI)disorders[such as stress ulcers,delayed defecation,opioid-related bowel immotility,and abdominal compartment syndrome(ACS)].We present a multicentre analysis of coincident GI dysfunction and its effect on burn-related mortality.Methods:This retrospective analysis was conducted on patients with severe[≥20%total burn surface area(TBSA)]and extensive(>50%TBSA or>25%full-thickness TBSA)burns admitted to three university teaching institutions in China between January 1,2011 and December 31,2020.Both 30-and 90-day mortality were assessed by collating demographic data,burn causes,admission TBSA,%full-thickness TBSA,Baux score,Abbreviated Burn Severity Index(ABSI)score,and Sequential Organ Failure Assessment(SOFA)score,shock at admission and the presence of an inhalation injury.GI dysfunction included abdominal distension,nausea/vomiting,diarrhoea/constipation,GI ulcer/haemorrhage,paralytic ileus,feeding intolerance and ACS.Surgeries,length of intensive care unit(ICU)stay,pain control[in morphine milligram equivalents(MME)]and overall length of hospital stay(LOHS)were recorded.Results:We analyzed 328 patients[75.6%male,mean age:(41.6±13.6)years]with a median TBSA of 62.0%(41.0%–80.0%);256(78.0%)patients presented with extensive burns.The 90-day mortality was 23.2%(76/328),with 64(84.2%)of these deaths occurring within 30 d and 25(32.9%)occurring within 7 d.GI dysfunction was experienced by 45.4%of patients and had a significant effect on 90-day mortality[odds ratio(OR)=14.070,95%confidence interval(CI)5.886–38.290,P<0.001].Multivariate analysis showed that GI dysfunction was associated with admission SOFA score and%full-thickness TBSA.Overall,88.2%(67/76)of deceased patients had GI dysfunction[hazard ratio(HR)for death of GI dysfunction=5.951],with a survival advantage for functional disorders(diarrhoea,constipation,or nausea/vomiting)over GI ulcer/haemorrhage(P<0.001).Conclusion:Patients with severe burns have an unfavourable prognosis,as nearly one-fifth died within 90 d.Half of our patients had comorbidities related to GI dysfunction,among which GI ulcers and haemorrhages were independently correlated with 90-day mortality.More attention should be given to severe burn patients with GI dysfunction.

Meta-analysis on inoperable pancreatic cancer: A comparison between gemcitabine-based combination therapy and gemcitabine alone

AIM: To compare gemcitabine-based combination therapy and gemcitabine (GEM) alone in patients with advanced pancreatic cancer (APCa) through meta- analysis. METHODS: MEDLINE and EMBASE searches were supplemented by information from trial registers of randomized controlled trials (RCTs) for GEM-based combination therapy and GEM alone for APCa. A quantitative meta-analysis was carried out by two reviewers based on the inclusion criteria from all available RCTs. The meta-analysis involved overall survival (OS), objective remission rate (ORR), clinical benefit rate (CBR), time to progress/progress free survival (TTP/PFS) and toxicity. RESULTS: The meta-analysis included 22 RCTs. There was significant improvement in the GEM combination group with regard to the 6-mo survival rate (RD = 0.04, 95% CI 0.01-0.06, P = 0.008), 1-year survival rate (RD = 0.03, 95% CI 0.01-0.05, P = 0.01), ORR (RD = 0.04, 95% CI 0.01-0.07, P = 0.02), CBR (RD = 0.10, 95% CI 0.02-0.17, P = 0.01) and 6-mo TTP/PFS (RD = 0.07, 95% CI 0.04-0.10, P < 0.00001). However, the Grade 3-4 toxicity set by WHO was higher for the GEM combination group for neutropenia (RD = 0.05, 95% CI 0.01-0.10, P = 0.02), thrombocytopenia (RD = 0.05, 95% CI 0.02-0.08, P = 0.002) and vomiting/nausea (RD = 0.03, 95% CI 0.00-0.05, P = 0.02). CONCLUSION: GEM-based combination therapy may improve the overall survival and palliation in optimalpatients with APCa as compared with GEM alone.

Cancer incidence and mortality in Guangdong province,2012

Objective： To estimate the cancer incidence and mortality in 2012 in Guangdong province by analyzing the cancer data of selected population-based cancer registries in Guangdong province in 2012. Methods： Eight of nine population-based cancer registries submitted cancer data to the Guangdong Provincial Centre for Disease Control and Prevention （Guangdong CDC）, whose data met the data quality criteria were included for analysis. The statistics of selected registries, stratified by areas, gender, age and cancer types, were used to estimate the cancer incidence and mortality in 2012 in Guangdong province according to the population data in Guangdong province. Segi＇s population and the national census population in 2000 were used for calculating the age-standardized rates （ASR）. Results： A total of 15,084,942 people, accounted for 17.47% of all population in Guangdong province, were covered in 8 selected population-based cancer registries in 2012. The percentage of cases morphologically verified （MV%） and the percentage of death certificate-only cases （DCO%） were 72.84% and 0.87%, respectively, and the mortality/incidence （M/I） ratio was 0.56. It was estimated that there were 211,300 new cancer cases and 117,300 cancer deaths. The incidence crude rate （CR）, the ASR by Chinese standard population （ASRC） and by world standard population （ASRW）, and the accumulated rate （AR） （0-74 years） were 250.20/100,000 （265.39/100,000 in males, 234.29/100,000 in females）, 207.04/100,000, 201.34/100,000 and 22.91%, respectively, in Guangdong province in 2012. The incidence CR and ASRC were 267.25/100,000 and 221.43/100,000 in urban areas, and 215.51/100,000 and 178.77/100,000 in rural areas, respectively. The death CR, ASRC, ASRW and AR （0-74 years） were 148.44/100,000 （190.95/100,000 in males, 105.06/100,000 in females）, 103.73/100,000, 102.44/100,000 and 11.68%, respectively, in Guangdong province in 2012. The death CR and ASRC were 164.57/100,000 and 105.46/100,000 in urban areas, and 124.63/100,000 and 99.97/100,000 in rural areas, respectively. Top 5 cancers were lung cancer, liver cancer, female breast cancer, colon cancer and nasopharyngeal cancers （NPC）, and top 5 death cancers were lung cancer, liver cancer, colon cancer, stomach cancer, and NPC in Guangdong province in 2012. Conclusions： Lung cancer, liver cancer, female breast cancer, colon cancer and NPC were the major economic cancer burdens and health concerns in Guangdong province in 2012. Early prevention, diagnosis and treatment of different cancers, survival quality improvement and cancer burden reduction, are important issues we faced in cancer control and prevention.

Personalized Management of Anastomotic Leak after Surgery for Esophageal Carcinoma

Objective To summarize the management of anastomotic leak following surgery for esophageal car-cinoma. Methods The medical records of the patients developing digestive tract leak after surgery for esophageal carcinoma in our hospital from January 2003 to March 2011 were retrospectively analyzed. Results A total of 36 patients were included, in whom 13 developed cervical anastomotic leak, 18 had intra-thoracic anastomotic leak, and 5 had intra-thoracic gastric necrosis. Of these patients, 7 were treated with resurgery, 6 with esophageal stent implantation, and 23 with conservative treatment. Treatment lasted for 5 to 181 days, averagely 47.0±31.9 days. After management, 9 patients died (25.0%). Among seven patients with resurgery, four had deceased, two were cured, and one developed leak again and was switched to conservative treatment until discharged. All the 6 patients treated with stent implantation were cured. Of the 24 patients receiving conservative treatment (including one switched from resurgery), 18 (75.0%) were cured and 1 was not cured but survived. Conclusions Anastomotic leak following surgery for esophageal carcinoma should be treated individually based on the onset time, location, size, and extent of the leakage. Conservative treatment is still a safe and effective method.The efficacy of stent implantation needs further investigation to confirm.

Therapeutic effects of four strains of probiotics on experimental colitis in mice

AIM:To investigate the therapeutic effects of four strains of probiotics(E.feacalis,L.acidophilus,C.butyricum and B.adolescentis) on dextran sulphate sodium(DSS)-induced experimental colitis in Balb/c mice.METHODS:Eighty Balb/c mice were randomly divided into 8 groups.Weight-loss,fecal character,fecal occult blood and hematochezia were recorded daily.Disease activity index(DAI) scores were also evaluated everyday.Length of colon was measured and histological scores were evaluated on the 13th day.Myeloperoxidase(MPO) activity was detected.Interleukin-1(IL-1) and IL-4 expression was detected by ELISA and RT-PCR.RESULTS:The four strains of probiotics relieved the inflammatory condition of DSS-induced experimental colitis in mice.Weight loss was slowed down in all probiotics-treated mice.Even weight gain was observed by the end of probiotics treatment.The DAI and histological scores of probiotics-treated mice were lower than those of mice in the control group(1.9 ± 0.2 vs 8.6 ± 0.4,P < 0.05 for E.faecalis).The length of colon of probiotics-treated mice was longer than that of mice in the control group(10.3 ± 0.34 vs 8.65 ± 0.77,P < 0.05 for E.faecalis).The four strains of probiotics decreased the MP activity and the IL-1 expression,but increased the IL-4 expression.E.faecalis had a better effect on DSS-induced experimental colitis in mice than the other three strains.CONCLUSION:The four strains of probiotics have beneficial effects on experimental colitis in mice.E.faecalis has a better effect on DSS-induced experimental colitis in mice than the other three strains.Supplement of probiotics provides a new therapy for UC.

Prognostic significance of the pre-chemotherapy lymphocyte-to-monocyte ratio in patients with previously untreated metastatic colorectal cancer receiving FOLFOX chemotherapy

Background:As a surrogate marker of systemic inflammation,the lymphocyte-to-monocyte ratio(LMR) is an independent prognostic factor for various malignancies.This study investigated the prognostic significance of the pre-chemotherapy LMR in patients with previously untreated metastatic colorectal cancer(mCRC) receiving chemotherapy.Methods:The present study included newly diagnosed mCRC patients treated between January 2005 and December 2013 with FOLFOX chemotherapy,specifically oxaliplatin 180 mg/m^2 on day 1,with leucovorin 400 mg/m^2administered as a 2-hour infusion before the administration of 5-fluorouracil 400 mg/m^2 as an intravenous bolus injection,and 5-fluorouracil 2400 mg/m^2 as a 46-h infusion immediately after 5-fluorouracil bolus injection.The LMR was calculated as the absolute count of lymphocytes divided by the absolute count of monocytes.COX proportional hazards analysis was performed to evaluate the association of LMR with survival outcomes.Results:A total of 488 patients were included.Patients with high pre-chemotherapy LMR experienced significant improvements in progression-free survival(PFS,9.2 vs.7.6 months,P < 0.001) and overall survival(OS,19.4 vs.16.6 months,P < 0.001) compared with patients with low pre-chemotherapy LMR.Subsequent COX multivariate analysis showed that high pre-chemotherapy LMR(>3.11) was an independent favorable prognostic factor for PFS and OS.Additionally,patients whose LMR remained high(high-high subgroup),increased(low-high subgroup),or decreased(high-low subgroup) following chemotherapy showed better results in terms of PFS and OS than patients whose LMR remained low(low-low subgroup) after chemotherapy.Conclusions:For patients with previously untreated mCRC receiving FOLFOX chemotherapy,an elevated pre-chemotherapy LMR is an independent favorable prognostic factor for PFS and OS,and changes in the LMR before and after chemotherapy seem to predict the benefit of chemotherapy.

Comparison of the Outcomes of Monopolar and Bipolar Radiofrequency Ablation in Surgical Treatment of Atrial Fibrillation

Objective To compare the therapeutic effects and safety of monopolar and bipolar radiofrequency(RF) ablation used during cardiac surgery to treat atrial fibrillation.Methods We retrospectively studied a total of 81 patients with chronic atrial fibrillation who underwent open cardiac surgery with concomitant RF ablation between January 2007 and March 2011.Fifty-eight patients received bipolar RF ablation and 23 received monopolar RF ablation,respectively.The sinus rhythm restoration rate,the procedural duration,the frequency of severe perioperative complications,and mortality were compared between the two groups.Results The sinus rhythm restoration rate did not differ significantly between the two groups after follow-up of 15.1 ± 12.6 months(P=0.199).The frequencies of severe perioperative complications and mortality were also similar in the two groups.The total procedural time using bipolar RF ablation was significantly shorter than that using monopolar ablation(19.7±4.6 minutes vs.28.1±8.5 minutes,P< 0.001).Conclusions Both monopolar and bipolar RF ablation are safe and effective in treating chronic atrial fibrillation patients during open cardiac surgery,but bipolar RF ablation is more convenient in practice.

阿瑞匹坦用于预防女性胃肠道肿瘤患者化疗所致恶心呕吐的疗效研究

背景与目的 预防化疗所致恶心呕吐在肿瘤治疗的全程管理中是十分重要的一环。本研究评价了在高危女性胃肠道肿瘤患者中,在帕洛诺司琼、地塞米松基础上联用阿瑞匹坦能否进一步预防或减轻FOLFIRI方案(氟尿嘧啶、亚叶酸和伊立替康)或FOLFOX方案(氟尿嘧啶、亚叶酸和奥沙利铂)化疗所致恶心呕吐的发生率和严重程度。方法 本研究为随机、双盲、安慰剂对照、Ⅲ期临床研究。纳入患者为年龄≤50岁的年轻女性,既往饮酒较少或无饮酒史,确诊为胃肠道肿瘤且正在接受FOLFOX或FOLFIRI方案化疗。2015年8月4日至2020年3月31日期间共有248例女性患者入组,按1∶1比率随机分配至干预组和对照组。采用意向性分析评价患者的基线特征和疗效。分析日期为2020年10月30日。患者随机分配至阿瑞匹坦组(阿瑞匹坦:化疗第1天125 mg,化疗开始前60 min口服;第2、3天80 mg,每天早上口服;帕洛诺司琼0.25 mg静脉注射;地塞米松:化疗第1天6 mg,化疗开始前30 min口服)或安慰剂组(安慰剂:化疗第1天125 mg,化疗开始前60 min口服;第2、3天80 mg,每天早上口服;帕洛诺司琼0.25 mg静脉注射;地塞米松:化疗第1天12 mg,化疗开始前30 min口服)。主要研究终点为完全缓解(complete response,CR)率,定义为第1周期化疗后全程(overall phase)无呕吐发作或未使用解救性治疗药物的患者的比例。其他疗效指标,如无恶心、无呕吐的患者比例等,作为次要研究终点和探索性研究终点。结果 共有来自中国4个临床研究中心的248例患者入组,其中243例[阿瑞匹坦组125(51.4%)例、对照组118(48.5%)例]患者可进行疗效和安全性分析。所有患者的平均[mean(SD)]年龄为40.1(7.3)岁。阿瑞匹坦组的CR率显著高于对照组,包括全程[107(87.0%)vs. 80(66.7%),P<0.001]、急性期[114(92.7%)vs. 91(75.8%),P=0.001]和延迟期[109(88.6%)vs. 84 (70.0%),P=0.001]。两组不良事件的发生率[100(80.0%)vs. 96(81.3%),P=0.79]相似,未观察到与阿瑞匹坦治疗相关的3或4级不良事件。多因素分析显示阿瑞匹坦的应用是唯一与全程CR相关的独立因素。结论 在较年轻的、少量饮酒或无饮酒史的胃肠道肿瘤的女性患者中,帕洛诺司琼和地塞米松基础上联用阿瑞匹坦可增强FOLFOX或FOLFIRI方案化疗时的止吐疗效,耐受性良好。

Extracorporeal membrane oxygenation for coronavirus disease 2019-associated acute respiratory distress syndrome:Report of two cases and review of the literature

BACKGROUND Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus-2,is a worldwide pandemic.Some COVID-19 patients develop severe acute respiratory distress syndrome and progress to respiratory failure.In such cases,extracorporeal membrane oxygenation(ECMO)treatment is a necessary life-saving procedure.CASE SUMMARY Two special COVID-19 cases—one full-term pregnant woman and one elderly(72-year-old)man—were treated by veno-venous(VV)-ECMO in the Second People’s Hospital of Zhongshan,Zhongshan City,Guangdong Province,China.Both patients had developed refractory hypoxemia shortly after hospital admission,despite conventional support,and were therefore managed by VV-ECMO.Although both experienced multiple ECMO-related complications on top of the COVID-19 disease,their conditions improved gradually.Both patients were weaned successfully from the ECMO therapy.At the time of writing of this report,the woman has recovered completely and been discharged from hospital to home;the man remains on mechanical ventilation,due to respiratory muscle weakness and suspected lung fibrosis.As ECMO itself is associated with various complications,it is very important to understand and treat these complications to achieve optimal outcome.CONCLUSION VV-ECMO can provide sufficient gas exchange for COVID-19 patients with acute respiratory distress syndrome.However,it is crucial to understand and treat ECMO-related complications.

Levels of Soluble P-Selectin in Patients With Unstable Angina

Background Unstable angina occurs when atherosclerotic plaquerupture.Recent evidence suggests a role for inflammation in this process.Leukocyte-endothelial cell interactions are important in inflammationand are regulated by cell adhesion melecules.As a kind of cell adhesionmelecules,P-selectin in platelets and endothelial cells mediates adhesiveinteraction with leukocytes to form thrombi.The purpuru of this studywar to invvstigate plasma levels of soluble P-selectin in patients withunstable angina and in health volunteers.Methods and Results Plasma P-selectin levels were determinedby a monoclonal antibody-bared enzyme immunoassay on plasma samplestaken from 27 patients with unstable angina,46 healthy volunteers.Patientswith unstable angina had angina at rest associated with ECG changes.Blood sample(2ml)was collected within 3 hours after the attack .Inpatiants with unstable angina,plasma P-seleatin levels(23.2±7.5ng/ml)were significently(P【0.005)higher than those in volunteers(10.12±7.61ng/ml)Conclusions our data indicate that soluble P-selectin released intothe blood after the attack of unstable angina and the levels of P-selectin inpatients with unstable angina were increased significantly.Our data indicatethat measur-ements of plasma P-selectin may help us to understandthe pathophysiology of unstable angina and may be clinically usefulas a new molecular marker of platelet aggregation and thrombus fomationin acute coronary syndrom.

Effects of flexible ureteroscopy combined with percutaneous nephrolithotomy on inflammatory immune indexes and related factors in patients with renal calculi

Objective:To explore the effects of flexible ureteroscopy combined with percutaneous nephrolithotomy on inflammatory immune indexes and related factors in patients with renal calculi.Methods: From December 2016 to November 2017, 97 patients with renal calculi were selected and divided into control group (48 cases) and observation group (49 cases), the control group was treated with percutaneous nephrolithotomy. On the basis of the treatment of the control group, the observation group was treated with ureteroscopic lithotripsy. The changes of inflammatory mediators, immune index, thyroxine (TH), urokinase (UK) and renal function were compared between the two groups before and after treatment.Results: After treatment, the levels of prostaglandin E2 (PGE2), substance P (SP), nitric oxide (NO) and lipid peroxide (LPO) in the two groups were significantly higher than those before treatment, and the levels of PGE2, SP, NO and LPO in the control group were significantly higher than those in the observation group;the levels of CD4+, CD4+/CD8+ in the two groups were significantly lower than those before treatment, but the levels of CD8+ were significantly higher than those before treatment, and the levels of CD4+, CD4+/CD8+in the control group were significantly lower than those in the observation group, and the levels of CD8+ were significantly higher than those in the observation group;the levels of TH in the two groups were significantly lower than those before treatment, but the levels of UK were significantly higher than those before treatment, and the levels of TH in the observation group were significantly lower than those in the control group, and the levels of UK were significantly higher than those in the control group;the levels of urea nitrogen (BUN), serum creatinine (Scr), cystatin C (CysC) in the two groups were significantly higher than those before treatment, and the levels of BUN, Scr, CysC in the control group were significantly higher than those in the observation group. Conclusions:The combination of ureteroscope and percutaneous nephroscope can relieve inflammation stress, alleviate immunosuppression, enhance stone clearance and reduce the damage to renal function. It is of clinical significance.

An alternative approach in the treatment of thumb web contracture skin defects： lateral tarsal artery flap

Background Thumb web contracture is a common complication after hand injury, and can markedly affect whole hand function. Therefore, surgery involving thumb web reconstruction is often necessary to restore normal function of the involved hand. In this study, we present the application of the lateral tarsal artery （LTA） flap in first web reconstruction. Methods From November 1, 2005 to October 31, 2007, seven patients with severe post trauma or burn contractures around the first web space were treated with a LTA flap. All the patients were followed up. Results All flaps survived, with an average size of 6.7 cm×4.8 cm. There were no complications or recurrent contractures during follow-up. All patients were satisfied with the esthetic appearance and functional outcome of the reconstruction. Conclusion The L＇I-A flap could be an excellent option for covering various defects in the thumb web space, serving as an excellent alternative for the thumb web space reconstruction.

A randomized controlled trial of postoperative tumor lysate-pulsed dendritic cells and cytokine-induced killer cells immunotherapy in patients with localized and locally advanced renal cell carcinoma

Background It remains a challenge to inhibit the local recurrence or distant metastasis of localized or locally advanced renal cell carcinoma （RCC） after surgical resection. We investigated the feasibility, safety and efficacy of immunotherapy using autologous tumor lysate （TL）-pulsed dendritic cells （DCs） and cytokine-induced killer （CIK） cells in patients with localized or locally advanced RCC.

Traditional Chinese medicines and their active ingredients sensitize cancer cells to TRAIL-induced apoptosis

The rapidly developing resistance of cancers to chemotherapy agents and the severe cytotoxicity of such agents to normal cells are major stumbling blocks in current cancer treatments.Most current chemotherapy agents have significant cytotoxicity,which leads to devastating adverse effects and results in a substandard quality of life,including increased daily morbidity and premature mortality.The death receptor of tumor necrosis factor-related apoptosis-inducing ligand(TRAIL)can sidestep p53-dependent pathways to induce tumor cell apoptosis without damaging most normal cells.However,various cancer cells can develop resistance to TRAIL-induced apoptosis via different pathways.Therefore,it is critical to find an efficient TRAIL sensitizer to reverse the resistance of tumor cells to TRAIL,and to reinforce TRAIL’s ability to induce tumor cell apoptosis.In recent years,traditional Chinese medicines and their active ingredients have shown great potential to trigger apoptotic cell death in TRAIL-resistant cancer cell lines.This review aims to collate information about Chinese medicines that can effectively reverse the resistance of tumor cells to TRAIL and enhance TRAIL’s ability to induce apoptosis.We explore the therapeutic potential of TRAIL and provide new ideas for the development of TRAIL therapy and the generation of new anticancer drugs for human cancer treatment.This study involved an extensive review of studies obtained from literature searches of electronic databases such as Google Scholar and PubMed."TRAIL sensitize"and"Chinese medicine"were the search keywords.We then isolated newly published studies on the mechanisms of TRAIL-induced apoptosis.The name of each plant was validated using certified databases such as The Plant List.This study indicates that TRAIL can be combined with different Chinese medicine components through intrinsic or extrinsic pathways to promote cancer cell apoptosis.It also demonstrates that the active ingredients of traditional Chinese medicines enhance the sensitivity of cancer cells to TRAIL-mediated apoptosis.This provides useful information regarding traditional Chinese medicine treatment,the development of TRAIL-based therapies,and the treatment of cancer.

颊针对原发性中晚期肝癌患者镇痛效应、免疫指标及Survivin、Livin蛋白表达的影响

目的探讨颊针对原发性中晚期肝癌患者镇痛效应、免疫指标及Survivin、Livin蛋白表达的影响.方法选取80例原发性中晚期肝癌患者,根据治疗方式的差异,将其分为对照组与治疗组,每组40例.对照组接受经导管肝动脉栓塞化疗(TACE),治疗组在此基础上加用颊针疗法.对两组患者近期疗效、镇痛效应、肝功能、血清肿瘤标志物、肝癌组织Survivin、Livin蛋白表达水平及免疫指标进行分析比较.结果治疗组客观缓解率(ORR)、疾病控制率(DCR)分别为37.5%和77.5%,明显高于对照组的22.5%和52.5%,治疗组近期疗效明显优于对照组(P<0.05).治疗组镇痛起效时间明显短于对照组(P<0.05),镇痛持续时间明显长于对照组(P<0.05),治疗后疼痛数字评分法(NRS)评分明显低于对照组(P<0.05).治疗后,治疗组谷草转氨酶(AST)、谷丙转氨酶(ALT)、白蛋白与球蛋白比值(A/G)均明显低于对照组(P<0.05),血清肿瘤标志物甲胎蛋白(AFP)、α-L-岩藻糖苷酶(AFU)、癌胚抗原(CEA)水平均明显低于对照组(P<0.05),肝癌组织Survivin、Livin蛋白表达水平均明显低于对照组(P<0.05);治疗后,治疗组CD4^(+)、CD4^(+)/CD8^(+)比值均明显高于对照组,CD8^(+)明显低于对照组(P<0.05).结论颊针可以减轻原发性中晚期肝癌患者疼痛程度及肝功能损伤,降低血清肿瘤标志物水平,其作用机制可能与下调肝癌组织Survivin、Livin蛋白表达水平,调节机体免疫功能有关.

Reconstruction of soft tissue defect of the extremity with the perforator flap from inguinal region

Background The perforator flap has become a very useful reconstructive means of soft tissue defect of extremities. The perforator flap from the inguinal region has advantages that include the ability to cover a large area with little donor site morbidity and provision of suitable thickness for reconstruction. Methods From July 1, 2005 to June 30, 2007, 10 patients with various types of soft tissue defect underwent reconstruction with 10 perforator flaps from the inguinal region. Six flaps were applied to the upper extremities and four flaps to the lower extremities. The dimensions of the transferred flaps ranged from 7-30 cm in length and 4-10 cm in width. Results The postoperative course of all 10 flaps was uneventful and all flaps survived. Distal small partial necrosis was observed in one case due to arterial insufficiency of the distal part of the flap. All patients were satisfied with the functional and esthetic resurfacing outcome. Conclusion Use of perforator flap from the inguinal region could overcome the disadvantages of the traditional free groin flap, and represents a safe and useful tool for coverage of soft tissue defects.

Prevention of No-flow With Distal Protection Device in Patients Underwent Percutaneous Coronary Intervention

Objectives To evaluate the feasibility and safety of distal protection device (PercuSurge) during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome. Methods From October 2004 to August 2007, 40 patients with high risk acute coronary syndrome who received primary coronary intervention were included in this study. Patients were divided into two groups according to whether PercuSurge was attempted during PCI. The basic clinical characteristics, angiographic results, and follow-up data before discharge were compared. Coronary arteries blood flow thrombolysis in myocardial infarction (TIMI) grade, TIMI myocardial perfusion (TMP) grade and the rate of no-reflow were performed in all cases after PCI. Results There was no significant difference between the two groups in basic clinical characteristics and angiography before PCI (P>0.05). All patients underwent PCI successfully in both groups. In the PercuSurge group, PCI with PercuSurge guardwire protection was performed successfully in 18 patients. There was significant difference between the two groups in TIMI 3 flows gained in target vessels after PCI. Better percentage of TMP grade 3 of target vessels was achieved in PercuSurge group. Less no-reflow were found in PercuSurge group. There were lower peak troponin I and serum MB isoenzyme of creatine kinase levels, higher left ventricular ejection fraction and smaller left ventricular end-diastolic dimension in the PercuSurge group after PCI at the date before discharge (P<0.05). There was no major adverse cardiac events in PercuSurge group, only one patient died in the control group. Conclusions This study demonstrates that using the PercuSurge Guardwire system during PCI in high risk acute coronary syndrome patients to prevent no-reflow is feasibility and safety.

Three-year Follow-up on the Safety and Effectiveness of Rituximab Plus Chemotherapy as First-Line Treatment of Diffuse Large B-Cell Lymphoma and Follicular Lymphoma in Real-World Clinical Settings in China： A Prospective, Multicenter, Noninterventional Study

Background： Prospective real-life data on the safety and effectiveness of rituximab in Chinese patients with diffuse large B-cell lymphoma （DLBCL） or follicular lymphoma （FL） are limited. This real-world study aimed to evaluate long-term safety and effectiveness outcomes ofrituximab plus chemotherapy （R-chemo） as first-line treatment in Chinese patients with DLBCL or FL. Hepatitis B virus （HBV） reactivation management was also investigated. Methods： A prospective, multicenter, single-arm, noninterventional study of previously untreated CD20-positive DLBCL or FL patients receiving first-line R-chemo treatment at 24 centers in China was conducted between January 17, 2011 and October 31, 2016. Enrolled patients underwent safety and effectiveness assessments after the last rituximab dose and were followed up for 3 years. Effectiveness endpoints included progression-free survival （PFS） and overall survival （OS）. Safety endpoints were adverse events （AEs）, serious AEs, drug-related AEs, and AEs of special interest. We also reported data on the incidence of HBV reactivation. Results： In total, 283 previously untreated CD20-positive DLBCL and 31 FL patients from 24 centers were enrolled. Three-year PFS was 59% （95% confidence interval [CI]： 50-67%） for DLBCL patients and 46% （95% CI： 20-69%） for FL patients. For DLBCL patients, multivariate analyses showed that PFS was not associated with international prognostic index, tumor maximum diameter, HBV infection status, or number ofrituximab treatment cycles, and OS was only associated with age 〉60 years （P 〈 0.05）. R-chemo was well tolerated. The incidence of HBV reactivation in hepatitis B surface antigen （HBsAg）-positive and HBsAg-negative/hepatitis B core antibody-positive patients was 13% （3/24） and 4% （3/69）, respectively. Conclusions： R-chemo is effective and safe in real-world clinical practice as first-line treatment for DLBCL and FL in China, and that HBV reactivation during R-chemo is manageable with preventive measures and treatment.