ObjectiveTo summarize the research progress of neoadjuvant chemotherapy in advanced gastric cancer. MethodThe literatures about the research progress of neoadjuvant chemotherapy in the advanced gastric cancer were reviewed. ResultsThe neoadjuvant chemotherapy in the advanced gastric cancer could significantly improve the R0 resection rate, improve the long-term survival rate, and reduce the risk of death.The course of neoadjuvant chemotherapy for locally advanced gastric cancer without distant metastasis generally was 6-9 weeks, and then according to the results of the curative effect evaluation to decide whether to undergo surgery treatment.Further the clinical research and improvement of chemotherapy sensitivity detection method were helpful to the unity of the standard of neoadjuvant chemotherapy. ConclusionsThe curative effect of neoadjuvant chemotherapy in advanced gastric cancer is clear.But there is no uniform standard on such as indications, chemotherapy regimens, medication time, and curative effect evaluation index, and so on.It is still needed the further research of multicenter and large clinical trials.
Objective To evaluate the efficacy and safety of intraoperative mesenchymal chemotherapy with 5-FU implants in radical gastrectomy of advanced gastric cancer. Methods From January 2008 to September 2009， 102 patients with historically proven advanced gastric cancer were enrolled in our department and were allocated to undergo either radical gastrectomy and intraoperative mesenchymal chemotherapy with 5-FU implants 800 mg（treatment group， n=51）， or radical gastrectomy alone （control group， n=51）. The postoperative complications and recurrence rate between two groups were compared. Results There were no significant differences on the volume of abdominal cavity drainage， count of white blood cells， albumin level， and gastrointestinal adverse events between the two groups （P＞0.05）. After a median follow-up of 28 months， the local recurrence rate was lower among patients in treatment group than that in control group （16.3% vs. 39.1%， P＜0.05）， the survival rate of 3-year was higher in treatment group than that in control group （85.8% vs. 67.3%， P＜0.05）. Conclusions Compared with the control group， there are no significant adverse reactions on patients with advanced gastric cancer who were implanted fluorouraci1 implants during operation， which can reduce local recurrence rates and improve the survival rates.
ObjectiveTo explore the best nursing interventions for advanced-age diabetes with pressure ulcer in Sichuan area. MethodsWe retrospectively analyzed the reasons for pressure ulcer and the nursing process for 37 patients with diabetes treated between March 2012 and March 2013 in our hospital. Then, we analyzed and summarized the susceptibility factors, wound nursing, nutritional support and blood sugar monitoring in all the patients. ResultsThrough intensive nursing, pressure ulcer in 36 patients were cured, and one patient died due to lung infection. ConclusionThe risk of pressure ulcer is high in advanced-age diabetes patients, and they need promising nursing. Individualized plan is necessary for them to improve their life-quality.
Objective To observe the correlation between the level of advanced glycosylation end products (AGE) in skin and diabetic retinopathy (DR), and establish and preliminatively verify the nomogramolumbaric model for predicting the risk of DR. MethodsA clinical case-control study. A total of 346 patients with type 2 diabetes mellitus (T2DM) who were admitted to the Department of Endocrinology and Ophthalmology of the First Affiliated Hospital of Zhengzhou University from January 2023 to June 2024 were included in the study. Among them, 198 were males and 148 were females. The mean age was (54.77±10.92). According to whether the patients were accompanied by DR, the patients were divided into the non-DR group (NDR group) and the DR group (DR group), 174 and 172 cases, respectively. All patients underwent skin AGE detection using a noninvasive diabetes detector. Diabetes duration, hemoglobin A1c (HbA1c), fasting plasma glucose, Urea, creatinine (Crea), uric acid, total cholesterol, triglyceride, estimated glomerular filtration rate (eGFR), urinary albumin concentration (UALB), and body mass index (BMI) were collected in detail. Univariate analysis and multivariate logistic regression analysis were used to determine the independent risk factors for T2DM concurrent DR, and to construct a nomogram prediction model for DR risk. Receiver operating characteristic curve (ROC curve), calibration curve and decision curve (DCA) were used to evaluate the model. ResultsHypertension prevalence rate (χ2=3.892), Diabetes duration (Z=?7.708), BMI (Z=?2.627), HbA1c (Z=?4.484), Urea (Z=?4.620), Crea (Z=?3.526), UALB (Z=?6.999), AGE (Z=?8.097) in DR group were significantly higher than those in NDR group, with statistical significance (P＜0.05); eGFR was lower than that in NDR group, the difference was statistically significant (Z=?6.061, P＜0.05). Logistic regression analysis showed that AGE, diabetes duration, HbA1c, UALB and eGFR were independent risk factors for DR (P＜0.05). Based on the results of multi-factor regression analysis, a nomogram prediction model was constructed. The area under ROC curve of the model was 0.843, 95% confidence interval was 0.802-0.884, sensitivity and specificity were 79.1% and 75.9%, respectively. The calibration curve was basically consistent with the ideal curve. The results of DCA analysis showed that when the model predicted the risk threshold of patients with DR between 0.17 and 0.99, the clinical net benefit provided by the nomogram model was＞0. ConclusionsSkin AGE level is an independent risk factor for DR. The nomogram prediction model based on AGE, diabetes duration, HbA1c, eGFR and UALB can accurately predict the risk of DR, and has good clinical practicability.
Objectives To systematically review the efficacy and safety of docetaxel or epirubicin based regimens in the treatment of advanced gastric cancer. Methods We searched EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI and WanFang Data from inception to March 2017, to collect randomized controlled trials (RCTs) on docetaxel or epirubicin based regimens in the treatment of advanced gastric cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 12 RCTs involving 984 advanced gastric cancer patients were included. The results of meta-analysis showed that docetaxel based regimens were superior to epirubicin based regimens in ORR (RR=1.21, 95%CI 1.02 to 1.43, P=0.03), DCR (RR=1.13, 95%CI 1.01 to 1.26, P=0.03), 1-year survival rate (RR=1.26, 95%CI 1.01 to 1.56, P=0.04) and 2-year survival rate (RR=3.03, 95%CI 1.59 to 5.75, P=0.000 7), while there was no statistical difference between two groups in the incidence of grade Ⅲ to Ⅳ adverse events. The results of sensitivity analysis showed that docetaxel based regimens were superior to epirubicin based regimens in 2-year survival rate (RR=2.56, 95%CI 1.06 to 6.19, P=0.04), but there were no statistical differences in ORR (RR=1.13, 95%CI 0.88 to 1.45, P=0.34), DCR (RR=1.02, 95%CI 0.85 to 1.21, P=0.84) and 1-year survival rate (RR=1.29, 95%CI 0.92 to 1.80, P=0.14). The results of sensitivity analysis indicated that the overall outcomes might be affected by the risk bias of included studies. The comparision between docetaxel based regimens and epirubicin based regimens was consistent with the overall outcomes in the incidence of grade Ⅲ to Ⅳ adverse events. Conclusions Compared with epirubicin based regimens, docetaxel based regimens may have more clinical benefits for advanced gastric cancer patients. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To formulate an evidence-based treatment plan for a patient with advanced hepatocellular carcinoma. Methods The clinical problems were put forward after full evaluation of patient’s conditions, and then the evidence related to the diagnosis and treatment of primary hepatocellular carcinoma was collected from The Cochrane Library (Issue 4, 2010), PubMed (1980 to 2010), Embase (1990 to 2010) and Wanfang Data (1990 to 2010). All the collected evidence was critically assessed. Both patient preferences and physician clinical experience were also taken into consideration in the decision-making treatment. Results A total of 153 relevant literatures were detected, and 13 meta-analyses or systematic reviews, 23 RCTs and 4 practice guidelines were identified. A rational treatment plan was made upon a serious evaluation of the data and the opinion of the patient. After a 6-month follow-up, the plan proved to be optimal. Conclusion The individualized treatment plan according to evidence-based methods for patients with advanced hepatocellular carcinoma can effectively improve the therapeutic efficacy and the life quality.
Objective To study the expression of receptor of advanced glycation end products (RAGE) in autogenous vein graft of streptozotocin induced diabetic rats and the inhibitory effects of aminoguanidine on intimal hyperplasia. Methods Sixty male Sprague-Dawley rats were randomly divided into three groups: aminoguanidine group, distilled water group and control group. Autogenous vein graft models were established in all groups. Streptozotocin was injected into abdominal cavity to induce diabetes in both aminoguanidine group and distilled water group, and they were intragastric administrated with aminoguanidine or distilled water, respectively before and after transplantation. Specimens were collected from autogenous vein graft 7 days and 14 days after surgery to undergo histological examination. At the same time, the level of serum advanced glycation end products (AGE) was tested. Western blotting and immunohistochemistry were used to detect the protein expression of RAGE and NF-κB p65. RAGE and NF-κB p65 mRNA were measured by reverse transcription-PCR. Results The mRNA and protein expressions of RAGE, NF-κB p65, the level of serum AGE and the intimal thickness of vein graft in distilled water group increased in comparison with those in control group 7 days and 14 days after surgery （P＜0.05). The level of serum AGE, mRNA and protein expressions of NF-κB p65 and the intimal thickness of vein graft in aminoguanidine group were lower than those in distilled water group （P＜0.05), and showed no significant difference compared with control group （P＞0.05). Conclusion The over-expression of RAGE in vein graft activats NF-κB in streptozotocin-induced diabetic rat, which has a close relation with intimal hyperplasia. Aminoguanidine can block the binding of AGE and RAGE by inhibiting the production of AGE, which will prevent intimal hyperplasia of vein graft.
Large sample-size registries have become a necessary complement to randomized controlled trials. This study introduced the registries in the field of clinical application of implantable cardioverter defibrillator, especially the two large registries of the US NCDR ICD and Boston Scientifi?s ALTITUDE, described the current status and future direction, thus to guide such registry researches in China.
Objective To discuss the recent advancement of total knee arthroplasty (TKA) in the aspects of prosthesis selection, and compare the cl inical effect of every kind of knee prostheses so as to provide more information for cl inical appl ication. Methods The l iterature concerning prosthesis selection was extensively reviewed, and the methods and data were analyzed and summarized. Results The major disputes consisted of posterior cruciate retained versus excised,fixed-bearing versus mobile-bearing, high-flex versus standard implants and patella resurfacing versus nonresurfacing for TKA. Every kind of knee prostheses displayed safety and effectiveness in early and medium term follow-up, no significant differences were found in cl inical results. Conclusion Prosthesis selection in TKA should be overall considerated, and the merits of every kind of prostheses should be judged with long-term follow-up results.
Objective To evaluate the efficacy and toxicity of the combination of S-1 and oxaliplatin in the first-line chemotherapy of patients with advanced gastric cancer. Methods From March 2012 to April 2013, 57 patients in the First Affiliated Hospital of Guangxi Medical University were enrolled in this study. Oxaliplatin was administered at 130 mg/m2 on day 1, while S-1 was administered orally (< 1.25 m2: 40 mg twice per day; 1.25-1.50 m2: 50 mg twice per day; > 1.50 m2: 60 mg twice per day) for 14 days. The response was evaluated every two chemotherapy cycles. Results The objective response rate was 52.6%, and the disease control rate was 84.2%. The median time to progression was 5.8 months, and the median survival time was 13.5 months. The major grade 3/4 hematological toxic effects were neutropenia (12.3%) and thrombocytope nia (12.3%), and the grade 3/4 non-hematological toxic effects were vomiting, fatigue and sensory neuropathy. The rate of clinical benefit response was 71.9% (41/57). Conclusion The regimen of oxaliplatin and S-1 shows precise efficacy and good tolerance against advanced gastric cancer, and it is worthy of promotion and application in the future.