BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD....BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD.However,their effects on the small bowel(SB)mucosa remain underexplored.AIM To prospectively assess clinical and mucosal responses to Modulen vs budesonide in adults with CD,using SB capsule endoscopy.METHODS Thirty patients were divided into two groups:Modulen+home-based diet(21 patients)and budesonide(9 patients)for an eight-week intervention followed by four weeks of follow-up.Clinical,laboratory,and endoscopic responses were evaluated.The mucosal changes were assessed through SB capsule endoscopy.RESULTS Results indicated significant clinical improvement in the Modulen group with reduced CD activity index(P=0.041)and improved inflammatory bowel disease questionnaire score(P=0.016).Moreover,Modulen was associated with a signifi-cant SB mucosal improvement,evidenced by a decrease in Lewis score(P=0.027).No significant changes were observed in calprotectin or other laboratory parame-ters.Conversely,budesonide exhibited more modest clinical effects,but it improved calprotectin,hemoglobin,and C-reactive protein levels(P=0.051,P=0.014,and P=0.038,respectively).The capsule endoscopy did not reveal a significant mucosal response in the budesonide group.CONCLUSION Both interventions have a role in CD treatment.Yet,their effects differ and may complement each other:Modulen yields clinical and mucosal improvements,while budesonide primarily leads mainly to laboratory improvements.展开更多
BACKGROUND Descending duodenal adenocarcinoma(DDA)is a rare malignancy of the digestive system,typically characterized by microsatellite instability-high(MSIH).Pembrolizumab is a monoclonal antibody that has been appr...BACKGROUND Descending duodenal adenocarcinoma(DDA)is a rare malignancy of the digestive system,typically characterized by microsatellite instability-high(MSIH).Pembrolizumab is a monoclonal antibody that has been approved for the treatment of MSI-H solid tumors in China.CASE SUMMARY We present the case of a 55-year-old female patient diagnosed with DDA.Biopsy findings indicated MSI-H status with high expression of programmed cell deathligand 1(PD-L1).The patient was unable to undergo immediate surgery due to multiple metastatic lymph nodes in the retroperitoneum.After one cycle of the SOX(S-1+oxaliplatin)chemotherapy regimen,the patient’s performance status significantly declined,and she experienced active gastrointestinal bleeding.Following active communication with the patient's family,pembrolizumab treatment was initiated.After two cycles of treatment,the disease was assessed as a partial response.A positron emission tomography/computed tomography scan performed after two years of treatment indicated a clinical complete response(CCR).The patient maintained this CCR for four years.She has now discontinued pembrolizumab for over one year,and no disease recurrence has been observed during re-examination.CONCLUSION Patients with MSI-H DDA exhibiting high PD-L1 expression who are treated with pembrolizumab can achieve sustained CCR.展开更多
Objective: To compare the curative effectiveness of continuous transarterial infusion chemotherapy and systemic venous chemotherapy in treating patients with advanced pancreatic cancer, and to evaluate the value of se...Objective: To compare the curative effectiveness of continuous transarterial infusion chemotherapy and systemic venous chemotherapy in treating patients with advanced pancreatic cancer, and to evaluate the value of selective continu-ous transarterial infusion chemotherapy in treating advanced pancreatic cancer. Methods: Of the 51 patients with advanced pancreatic cancer receiving chemotherapy with gemcitabine and 5-fluorouracil, 25 patients were treated with selective con-tinuous transarterial infusion chemotherapy, 26 were treated with systemic venous chemotherapy, and curative effective-ness was analyzed retrospectively. Curative effectiveness included tumor volume, clinical benefit response (CBR), acute and subacute toxic reactions of antitumor drugs, survival rate and median survival time. Results: The objective effective rate in transarterial group was 32.0% versus 23.1% in systemic group without any significant difference (P = 0.475). Clinical benefit rates in transarterial group and systemic group were 80.0% and 50.0% respectively (P = 0.025). The 6-, 9-and 12-month accumulated survival rates and median survival time in transarterial group were higher than those of the systemic group (P = 0.002), the differences were statistically significant. However, the adverse reactions between the two groups were not statistically significant. Conclusion: Compared with systemic chemotherapy, continuous transarterial infusion chemotherapy with gemcitabine and 5-fluorouracil could improve clinical benefit rate and survival time of patients with advanced pancreatic cancer, it is safe and reliable, and the adverse reactions is less.展开更多
Breast cancer is the first cancer of women in the world and in France.In very elderly patients,the treatment options are often very limited.Neoadjuvant hormone therapy has shown similar or even better results than che...Breast cancer is the first cancer of women in the world and in France.In very elderly patients,the treatment options are often very limited.Neoadjuvant hormone therapy has shown similar or even better results than chemotherapy.This is why we decided to evaluate the clinical response following exclusive hormonal therapy and the 5,then 10 years survival in these very elderly women.This was a retrospective,longitudinal cohort-type study with descriptive and analytical purposes.The study population consisted of 59 patients,with an average age of 85 years.Fifteen(15,25%)of our patients had a complete clinical response after two years of treatment,16(27%)a partial clinical response,23(39%)lesion stabilization and 5(9%)cancer progression.The presence of metastasis at diagnosis increased the risk of cancer progression by 2.84.Overall 5-year survival was 72.5%,and breast cancer mortality 5.88%.The 10-year survival was 27.5%and breast cancer mortality 15%.In the age group 85 and over increased the risk of death by 3.25 in the first 10 years of treatment.The clinical response after 2 years was marked by a low rate of cancer progression.Mortality over 5 and 10 years was mostly related to patient comorbidities.展开更多
BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete cli...BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete clinical response after neoadjuvant treatment,which often translates to pathologic complete response(pCR)as assessed on surgical specimens after curative intent surgery.Endoscopy plays a significant role in assessing treatment response to neoadjuvant therapies.AIM To explore the role of endoscopy in predicting subsequent pCR after neoadjuvant treatment in rectal cancer patients.METHODS An extensive literature review was undertaken to identify the criteria used for assessment of endoscopic response and their ability to predict pCR.RESULTS Fifteen studies were identified through literature review.The most commonly used endoscopic criteria for evaluation included the presence of a flat white scar and the absence of nodularity or telangiectasia.Information on the timing of endoscopic assessment in relation to neoadjuvant treatment protocols were also extracted from the studies.In most studies,the diagnostic accuracy for predicting pCR exceeded 0.8.The main limitations identified were the retrospective design of included studies included and a moderate risk of bias.CONCLUSION Endoscopy can be a key prognostic factor in predicting pCR to neoadjuvant treatment in rectal cancer despite significant limitations in currently available data.展开更多
We aimed to evaluate the efficacy of tricyclic antidepressants(TCAs) as a therapeutic option for irritable bowel syndrome(IBS) through meta-analysis of randomized controlled trials.For the years 1966 until September 2...We aimed to evaluate the efficacy of tricyclic antidepressants(TCAs) as a therapeutic option for irritable bowel syndrome(IBS) through meta-analysis of randomized controlled trials.For the years 1966 until September 2008,PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were searched for double-blind,placebo-controlled trials investigating the effi cacy of TCAs in the management of IBS.Seven randomized,placebo-controlled clinical trials met our criteria and were included in the metaanalysis.TCAs used in the treatment arm of these trials included amitriptyline,imipramine,desipramine,doxepin and trimipramine.The pooled relative risk for clinical improvement with TCA therapy was 1.93(95% CI:1.44 to 2.6,P<0.0001).Effect size of TCAs versus placebo for mean change in abdominal pain score among the two studies was -44.15(95% CI:-53.27 to -35.04,P<0.0001).It is concluded that low dose TCAs exhibit clinically and statistically signifi cant control of IBS symptoms.展开更多
According to the main international clinical guidelines,the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery.However,doubts have been raised about the appro...According to the main international clinical guidelines,the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery.However,doubts have been raised about the appropriate definition of clinical complete response(cCR)after neoadjuvant therapy and the role of surgery in patients who achieve a cCR.Surgical resection is associated with significant morbidity and decreased quality of life(QoL),which is especially relevant given the favourable prognosis in this patient subset. Accordingly, therehas been a growing interest in alternative approaches with less morbidity,including the organ-preserving watch and wait strategy, in which surgery isomitted in patients who have achieved a cCR. These patients are managed with aspecific follow-up protocol to ensure adequate cancer control, including the earlyidentification of recurrent disease. However, there are several open questionsabout this strategy, including patient selection, the clinical and radiologicalcriteria to accurately determine cCR, the duration of neoadjuvant treatment, therole of dose intensification (chemotherapy and/or radiotherapy), optimal followupprotocols, and the future perspectives of this approach. In the present review,we summarize the available evidence on the watch and wait strategy in thisclinical scenario, including ongoing clinical trials, QoL in these patients, and thecontroversies surrounding this treatment approach.展开更多
BACKGROUND Complete response after neoadjuvant chemotherapy(r NACT) elevates the surgical outcomes of patients with breast cancer, however, non-r NACT have a higher risk of death and recurrence.AIM To establish novel ...BACKGROUND Complete response after neoadjuvant chemotherapy(r NACT) elevates the surgical outcomes of patients with breast cancer, however, non-r NACT have a higher risk of death and recurrence.AIM To establish novel machine learning(ML)-based predictive models for predicting probability of r NACT in breast cancer patients who intends to receive NACT.METHODS A retrospective analysis of 487 breast cancer patients who underwent mastectomy or breast-conserving surgery and axillary lymph node dissection following neoadjuvant chemotherapy at the Hubei Cancer Hospital between January 1, 2013, and October 1, 2021. The study cohort was divided into internal training and testing datasets in a 70:30 ratio for further analysis. A total of twenty-four variables were included to develop predictive models for r NACT by multiple MLbased algorithms. A feature selection approach was used to identify optimal predictive factors. These models were evaluated by the receiver operating characteristic(ROC) curve for predictive performance.RESULTS Analysis identified several significant differences between the r NACT and nonr NACT groups, including total cholesterol, low-density lipoprotein, neutrophilto-lymphocyte ratio, body mass index, platelet count, albumin-to-globulin ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. The areas under the curve of the six models ranged from 0.81 to 0.96. Some ML-based models performed better than models using conventional statistical methods in both ROC curves. The support vector machine(SVM) model with twelve variables introduced was identified as the best predictive model.CONCLUSION By incorporating retreatment serum lipids and serum inflammation markers, it is feasible to develop ML-based models for the preoperative prediction of r NACT and therefore facilitate the choice of treatment, particularly the SVM, which can improve the prediction of r NACT in patients with breast cancer.展开更多
The escalating prevalence of gastrointestinal cancers underscores the urgency for transformative approaches.Current treatment costs amount to billions of dollars annually,combined with the risks and comorbidities asso...The escalating prevalence of gastrointestinal cancers underscores the urgency for transformative approaches.Current treatment costs amount to billions of dollars annually,combined with the risks and comorbidities associated with invasive surgery.This highlights the importance of less invasive alternatives with organ preservation being a central aspect of the treatment paradigm.The current standard of care typically involves neoadjuvant systemic therapy followed by surgical resection.There is a growing interest in organ preservation approaches by way of minimizing extensive surgical resections.Endoscopic ablation has proven to be useful in precursor lesions,as well as in palliative cases of unrese-ctable disease.More recently,there has been an increase in reports on the utility of adjunct endoscopic ablative techniques for downstaging disease as well as contributing to non-surgical complete clinical response.This expansive field within endoscopic oncology holds great potential for advancing patient care.By addressing challenges,fostering collaboration,and embracing technological advancements,the gastrointestinal cancer treatment paradigm can shift towards a more sustainable and patient-centric future emphasizing organ and function preservation.This editorial examines the evolving landscape of endoscopic ablation strategies,emphasizing their potential to improve patient outcomes.We briefly review current applications of endoscopic ablation in the esophagus,stomach,duodenum,pancreas,bile ducts,and colon.展开更多
Objective To observe the therapeutic effect of non-surgical treatment on diabetic Chinese withchronic periodontitis. Methods Moderate to advanced chronic periodontitis ( CP) was studied in 36 diabetes mellitus (DM) pa...Objective To observe the therapeutic effect of non-surgical treatment on diabetic Chinese withchronic periodontitis. Methods Moderate to advanced chronic periodontitis ( CP) was studied in 36 diabetes mellitus (DM) patients classified as 20 with high and fluctuating blood glucose level (DM-H) and 16 with relatively low and stable blood glucose level (DM-L). 28 non-DM CP patients acted as controls (Non-DM). Plaque index (PlI) , gingival index (GI) , bleeding on probing (BOP) , probing depth (PD) and clinical attachment loss (AL) of all patients were recorded at 6 sites on each tooth at the baseline and 1, 3 and 6 months after oral hygiene instruction (OHI), scaling and root planing. Results It was found that the short-term effect of non-surgical periodon-tal procedure had resulted in significant resolution of gingival inflammation and pronounced reduction in pocket depth and gain of attachment loss in both DM and Non-DM CP patients. Conclusion The pilot study suggested that non-surgical periodontal treatment allowed for favorable treatment responses in a group of Chinese diabetic subjects with chronic periodontitis and that their various profiles of blood glucose did not influence the short-term healing response to OHI, scaling and root planning.展开更多
Objective To investigate the clinical features of autoimmune hepatitis(AIH)patients with poor response to treatment.Methods A total of 61 AIH patients were enrolled,among whom 49(80.33%)achieved complete response(good...Objective To investigate the clinical features of autoimmune hepatitis(AIH)patients with poor response to treatment.Methods A total of 61 AIH patients were enrolled,among whom 49(80.33%)achieved complete response(good response group)and 12(19.67%)had incomplete response(poor response group).The展开更多
Introduction:Malaria remains the leading cause of infectious disease-related morbidity and mortality worldwide.ACTs continue to be the first-line treatment for uncomplicated malaria caused by P.falciparum.However,the ...Introduction:Malaria remains the leading cause of infectious disease-related morbidity and mortality worldwide.ACTs continue to be the first-line treatment for uncomplicated malaria caused by P.falciparum.However,the global spread of antimalarial drug resistance,particularly artemisinin resistance,has become an increasing concern over time.Methods:Therapeutic efficacy was evaluated following the World Health Organization’s guidelines for iDES.This study assessed adequate clinical and parasitological response(ACPR)and parasitemia on day 3 of treatment.Molecular surveillance of resistance-associated genes,including pfk13,pfcrt,and pfmdr1,was conducted on collected P.falciparum isolates.Results:The iDES of AS plus DHA-PPQ was implemented in 2023,while CQ efficacy was monitored from 2021 to 2023.Late parasitological failure(LCF)for DHA-PPQ was detected in 1 of 26 P.falciparum cases in 2023,and in 1 of 26 and 1 of 90 P.vivax cases for CQ in 2022 and 2023,respectively.The corresponding ACPR rates were 96.2%,100%,96.2%,and 98.8%.The average positive parasitemia rate on day 3 post-treatment was 21.8%.Molecular polymorphism analysis revealed 9 nonsynonymous mutation haplotypes in the pfk13 gene,while 97.7%of samples presented the wild-type genotype.For the chloroquine resistance-associated pfcrt gene,2 mutant haplotypes,‘CVIET’and‘SVMNT’,were detected with frequencies of 16.7%(70/418)and 0.5%(2/418),respectively,while the wild-type haplotype‘CVMNK’predominated at 82.8%(346/418).In the pfmdr1 gene,5 nonsynonymous point mutations and 8 haplotypes were identified.The Y184F mutation showed the highest prevalence at 40.5%(170/420).The 7 mutant haplotypes detected were V65L(0.2%,1/420),N86Y(1.9%,8/420),F408V(0.9%,4/420),D1246Y(0.5%,2/420),V65L/Y184F(0.2%,1/420),N86Y/Y184F(0.7%,3/420),and Y184F(39.8%,167/420).Conclusion:The antimalarial drug efficacy studies conducted for AS plus DHA-PPQ and CQ demonstrated that these treatments remain effective.However,the occurrence of LCF cases and persistent parasitemia on day 3 indicate decreasing sensitivity of these first-line drugs for treating P.falciparum and P.vivax,respectively.Therefore,continuous iDES and molecular surveillance of antimalarial drugs must be enhanced to provide early warning and guide appropriate responses to the spread of antimalarial drug resistance.展开更多
The"watch and wait"(W&W)strategy has been widely used in rectal cancer patients who have achieved clinical complete response(cCR)after neoadjuvant chemoradiotherapy(nCRT),which can save them from surgery...The"watch and wait"(W&W)strategy has been widely used in rectal cancer patients who have achieved clinical complete response(cCR)after neoadjuvant chemoradiotherapy(nCRT),which can save them from surgery and improve their quality of life.However,this strategy also has many unsolved practical problems,including the improvement of cCR/pCR rate,the search for efficient predictors,the standard follow-up and the methods of rescue surgery,etc.Larger sample size and more standardized clinical trials are still needed to obtain credible evidence.Therefore,we must rationally view the cCR after nCRT for middle and low rectal cancer,understand the risk of W&W strategy,and make a reasonable choice.It is particularly important to emphasize that we should actively carry out prospective multi-center clinical trials to produce high-level evidence suitable for Chinese characteristics,so that more rectal cancer patients can benefit from nCRT.展开更多
Background:Standardized assessments of clinical complete response(cCR)to neoadjuvant chemoradiotherapy(nCRT)for rectal cancer have been established,but their utility and accuracy remain unclear.This study aimed to eva...Background:Standardized assessments of clinical complete response(cCR)to neoadjuvant chemoradiotherapy(nCRT)for rectal cancer have been established,but their utility and accuracy remain unclear.This study aimed to evaluate the clinical diagnostic value of rectal magnetic resonance imaging(MRI)and endorectal ultrasonography(ERUS)for the determination of cCRs after neoadjuvant immunotherapy and to investigate the concordance between cCR and pathological complete response(pCR).Methods:Ninety-four patients with rectal cancer treated with neoadjuvant radiotherapy with or without immunotherapy were included.The sensitivity,specificity,and accuracy of each evaluation method were calculated.Results:Combined MRI and ERUS assessments found cCR in seven of the 94 patients in our cohort.In the non-immunotherapy group,the sensitivity,specificity,and accuracy of MRI for diagnosing cCR were 50.0%,85.2%,and 77.1%,respectively,whereas those of ERUS were 50.0%,92.6%,and 82.9%,respectively;those of combined MRI and ERUS were 25.0%,96.3%,and 87.5%,respectively.In the immunotherapy group,the sensitivity,specificity,and accuracy with which MRI identified CR were 51.7%,76.7%,and 64.4%,respectively;those of ERUS were 13.8%,90.0%,and 52.5%,respectively,and those of combined MRI and ERUS were 10.3%,96.7%,and 54.2%,respectively.We also found that 32 of 37 patients with pCR did not meet the cCR evaluation criteria.Of these pCR patients,78.4%(29/37)received immunotherapy.In the entire cohort,there were five pCRs among the seven cCRs.Of the four cCRs that occurred in the immunotherapy group,three were pCRs.Conclusions:Rectal MRI and/or ERUS did not provide sufficiently accurate assessments of cCR in patients with rectal cancer receiving neoadjuvant therapy,especially immunotherapy,and cCR did not predict pCR.展开更多
文摘BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD.However,their effects on the small bowel(SB)mucosa remain underexplored.AIM To prospectively assess clinical and mucosal responses to Modulen vs budesonide in adults with CD,using SB capsule endoscopy.METHODS Thirty patients were divided into two groups:Modulen+home-based diet(21 patients)and budesonide(9 patients)for an eight-week intervention followed by four weeks of follow-up.Clinical,laboratory,and endoscopic responses were evaluated.The mucosal changes were assessed through SB capsule endoscopy.RESULTS Results indicated significant clinical improvement in the Modulen group with reduced CD activity index(P=0.041)and improved inflammatory bowel disease questionnaire score(P=0.016).Moreover,Modulen was associated with a signifi-cant SB mucosal improvement,evidenced by a decrease in Lewis score(P=0.027).No significant changes were observed in calprotectin or other laboratory parame-ters.Conversely,budesonide exhibited more modest clinical effects,but it improved calprotectin,hemoglobin,and C-reactive protein levels(P=0.051,P=0.014,and P=0.038,respectively).The capsule endoscopy did not reveal a significant mucosal response in the budesonide group.CONCLUSION Both interventions have a role in CD treatment.Yet,their effects differ and may complement each other:Modulen yields clinical and mucosal improvements,while budesonide primarily leads mainly to laboratory improvements.
基金Supported by Medical Science Research Project of Hebei Province in 2023,Key Laboratory of Research on Molecular Mechanism of Gastrointestinal Tumors in Qinhuangdao,No.20231891.
文摘BACKGROUND Descending duodenal adenocarcinoma(DDA)is a rare malignancy of the digestive system,typically characterized by microsatellite instability-high(MSIH).Pembrolizumab is a monoclonal antibody that has been approved for the treatment of MSI-H solid tumors in China.CASE SUMMARY We present the case of a 55-year-old female patient diagnosed with DDA.Biopsy findings indicated MSI-H status with high expression of programmed cell deathligand 1(PD-L1).The patient was unable to undergo immediate surgery due to multiple metastatic lymph nodes in the retroperitoneum.After one cycle of the SOX(S-1+oxaliplatin)chemotherapy regimen,the patient’s performance status significantly declined,and she experienced active gastrointestinal bleeding.Following active communication with the patient's family,pembrolizumab treatment was initiated.After two cycles of treatment,the disease was assessed as a partial response.A positron emission tomography/computed tomography scan performed after two years of treatment indicated a clinical complete response(CCR).The patient maintained this CCR for four years.She has now discontinued pembrolizumab for over one year,and no disease recurrence has been observed during re-examination.CONCLUSION Patients with MSI-H DDA exhibiting high PD-L1 expression who are treated with pembrolizumab can achieve sustained CCR.
文摘Objective: To compare the curative effectiveness of continuous transarterial infusion chemotherapy and systemic venous chemotherapy in treating patients with advanced pancreatic cancer, and to evaluate the value of selective continu-ous transarterial infusion chemotherapy in treating advanced pancreatic cancer. Methods: Of the 51 patients with advanced pancreatic cancer receiving chemotherapy with gemcitabine and 5-fluorouracil, 25 patients were treated with selective con-tinuous transarterial infusion chemotherapy, 26 were treated with systemic venous chemotherapy, and curative effective-ness was analyzed retrospectively. Curative effectiveness included tumor volume, clinical benefit response (CBR), acute and subacute toxic reactions of antitumor drugs, survival rate and median survival time. Results: The objective effective rate in transarterial group was 32.0% versus 23.1% in systemic group without any significant difference (P = 0.475). Clinical benefit rates in transarterial group and systemic group were 80.0% and 50.0% respectively (P = 0.025). The 6-, 9-and 12-month accumulated survival rates and median survival time in transarterial group were higher than those of the systemic group (P = 0.002), the differences were statistically significant. However, the adverse reactions between the two groups were not statistically significant. Conclusion: Compared with systemic chemotherapy, continuous transarterial infusion chemotherapy with gemcitabine and 5-fluorouracil could improve clinical benefit rate and survival time of patients with advanced pancreatic cancer, it is safe and reliable, and the adverse reactions is less.
文摘Breast cancer is the first cancer of women in the world and in France.In very elderly patients,the treatment options are often very limited.Neoadjuvant hormone therapy has shown similar or even better results than chemotherapy.This is why we decided to evaluate the clinical response following exclusive hormonal therapy and the 5,then 10 years survival in these very elderly women.This was a retrospective,longitudinal cohort-type study with descriptive and analytical purposes.The study population consisted of 59 patients,with an average age of 85 years.Fifteen(15,25%)of our patients had a complete clinical response after two years of treatment,16(27%)a partial clinical response,23(39%)lesion stabilization and 5(9%)cancer progression.The presence of metastasis at diagnosis increased the risk of cancer progression by 2.84.Overall 5-year survival was 72.5%,and breast cancer mortality 5.88%.The 10-year survival was 27.5%and breast cancer mortality 15%.In the age group 85 and over increased the risk of death by 3.25 in the first 10 years of treatment.The clinical response after 2 years was marked by a low rate of cancer progression.Mortality over 5 and 10 years was mostly related to patient comorbidities.
文摘BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete clinical response after neoadjuvant treatment,which often translates to pathologic complete response(pCR)as assessed on surgical specimens after curative intent surgery.Endoscopy plays a significant role in assessing treatment response to neoadjuvant therapies.AIM To explore the role of endoscopy in predicting subsequent pCR after neoadjuvant treatment in rectal cancer patients.METHODS An extensive literature review was undertaken to identify the criteria used for assessment of endoscopic response and their ability to predict pCR.RESULTS Fifteen studies were identified through literature review.The most commonly used endoscopic criteria for evaluation included the presence of a flat white scar and the absence of nodularity or telangiectasia.Information on the timing of endoscopic assessment in relation to neoadjuvant treatment protocols were also extracted from the studies.In most studies,the diagnostic accuracy for predicting pCR exceeded 0.8.The main limitations identified were the retrospective design of included studies included and a moderate risk of bias.CONCLUSION Endoscopy can be a key prognostic factor in predicting pCR to neoadjuvant treatment in rectal cancer despite significant limitations in currently available data.
基金Supported by National Science Foundation, Tehran
文摘We aimed to evaluate the efficacy of tricyclic antidepressants(TCAs) as a therapeutic option for irritable bowel syndrome(IBS) through meta-analysis of randomized controlled trials.For the years 1966 until September 2008,PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were searched for double-blind,placebo-controlled trials investigating the effi cacy of TCAs in the management of IBS.Seven randomized,placebo-controlled clinical trials met our criteria and were included in the metaanalysis.TCAs used in the treatment arm of these trials included amitriptyline,imipramine,desipramine,doxepin and trimipramine.The pooled relative risk for clinical improvement with TCA therapy was 1.93(95% CI:1.44 to 2.6,P<0.0001).Effect size of TCAs versus placebo for mean change in abdominal pain score among the two studies was -44.15(95% CI:-53.27 to -35.04,P<0.0001).It is concluded that low dose TCAs exhibit clinically and statistically signifi cant control of IBS symptoms.
文摘According to the main international clinical guidelines,the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery.However,doubts have been raised about the appropriate definition of clinical complete response(cCR)after neoadjuvant therapy and the role of surgery in patients who achieve a cCR.Surgical resection is associated with significant morbidity and decreased quality of life(QoL),which is especially relevant given the favourable prognosis in this patient subset. Accordingly, therehas been a growing interest in alternative approaches with less morbidity,including the organ-preserving watch and wait strategy, in which surgery isomitted in patients who have achieved a cCR. These patients are managed with aspecific follow-up protocol to ensure adequate cancer control, including the earlyidentification of recurrent disease. However, there are several open questionsabout this strategy, including patient selection, the clinical and radiologicalcriteria to accurately determine cCR, the duration of neoadjuvant treatment, therole of dose intensification (chemotherapy and/or radiotherapy), optimal followupprotocols, and the future perspectives of this approach. In the present review,we summarize the available evidence on the watch and wait strategy in thisclinical scenario, including ongoing clinical trials, QoL in these patients, and thecontroversies surrounding this treatment approach.
文摘BACKGROUND Complete response after neoadjuvant chemotherapy(r NACT) elevates the surgical outcomes of patients with breast cancer, however, non-r NACT have a higher risk of death and recurrence.AIM To establish novel machine learning(ML)-based predictive models for predicting probability of r NACT in breast cancer patients who intends to receive NACT.METHODS A retrospective analysis of 487 breast cancer patients who underwent mastectomy or breast-conserving surgery and axillary lymph node dissection following neoadjuvant chemotherapy at the Hubei Cancer Hospital between January 1, 2013, and October 1, 2021. The study cohort was divided into internal training and testing datasets in a 70:30 ratio for further analysis. A total of twenty-four variables were included to develop predictive models for r NACT by multiple MLbased algorithms. A feature selection approach was used to identify optimal predictive factors. These models were evaluated by the receiver operating characteristic(ROC) curve for predictive performance.RESULTS Analysis identified several significant differences between the r NACT and nonr NACT groups, including total cholesterol, low-density lipoprotein, neutrophilto-lymphocyte ratio, body mass index, platelet count, albumin-to-globulin ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. The areas under the curve of the six models ranged from 0.81 to 0.96. Some ML-based models performed better than models using conventional statistical methods in both ROC curves. The support vector machine(SVM) model with twelve variables introduced was identified as the best predictive model.CONCLUSION By incorporating retreatment serum lipids and serum inflammation markers, it is feasible to develop ML-based models for the preoperative prediction of r NACT and therefore facilitate the choice of treatment, particularly the SVM, which can improve the prediction of r NACT in patients with breast cancer.
文摘The escalating prevalence of gastrointestinal cancers underscores the urgency for transformative approaches.Current treatment costs amount to billions of dollars annually,combined with the risks and comorbidities associated with invasive surgery.This highlights the importance of less invasive alternatives with organ preservation being a central aspect of the treatment paradigm.The current standard of care typically involves neoadjuvant systemic therapy followed by surgical resection.There is a growing interest in organ preservation approaches by way of minimizing extensive surgical resections.Endoscopic ablation has proven to be useful in precursor lesions,as well as in palliative cases of unrese-ctable disease.More recently,there has been an increase in reports on the utility of adjunct endoscopic ablative techniques for downstaging disease as well as contributing to non-surgical complete clinical response.This expansive field within endoscopic oncology holds great potential for advancing patient care.By addressing challenges,fostering collaboration,and embracing technological advancements,the gastrointestinal cancer treatment paradigm can shift towards a more sustainable and patient-centric future emphasizing organ and function preservation.This editorial examines the evolving landscape of endoscopic ablation strategies,emphasizing their potential to improve patient outcomes.We briefly review current applications of endoscopic ablation in the esophagus,stomach,duodenum,pancreas,bile ducts,and colon.
基金Supported by Foundation of Major Subjects of Advanced Medical Specialities in Shanghai, China (983010)
文摘Objective To observe the therapeutic effect of non-surgical treatment on diabetic Chinese withchronic periodontitis. Methods Moderate to advanced chronic periodontitis ( CP) was studied in 36 diabetes mellitus (DM) patients classified as 20 with high and fluctuating blood glucose level (DM-H) and 16 with relatively low and stable blood glucose level (DM-L). 28 non-DM CP patients acted as controls (Non-DM). Plaque index (PlI) , gingival index (GI) , bleeding on probing (BOP) , probing depth (PD) and clinical attachment loss (AL) of all patients were recorded at 6 sites on each tooth at the baseline and 1, 3 and 6 months after oral hygiene instruction (OHI), scaling and root planing. Results It was found that the short-term effect of non-surgical periodon-tal procedure had resulted in significant resolution of gingival inflammation and pronounced reduction in pocket depth and gain of attachment loss in both DM and Non-DM CP patients. Conclusion The pilot study suggested that non-surgical periodontal treatment allowed for favorable treatment responses in a group of Chinese diabetic subjects with chronic periodontitis and that their various profiles of blood glucose did not influence the short-term healing response to OHI, scaling and root planning.
文摘Objective To investigate the clinical features of autoimmune hepatitis(AIH)patients with poor response to treatment.Methods A total of 61 AIH patients were enrolled,among whom 49(80.33%)achieved complete response(good response group)and 12(19.67%)had incomplete response(poor response group).The
基金Supported by Young Scholar Science Foundation of China CDC(grant number 2024A105)Three-Year Initiative Plan for Strengthening Public Health System Construction in Shanghai(2023-2025)Key Discipline Project[grant number GWVI-11.1-12 to JC].
文摘Introduction:Malaria remains the leading cause of infectious disease-related morbidity and mortality worldwide.ACTs continue to be the first-line treatment for uncomplicated malaria caused by P.falciparum.However,the global spread of antimalarial drug resistance,particularly artemisinin resistance,has become an increasing concern over time.Methods:Therapeutic efficacy was evaluated following the World Health Organization’s guidelines for iDES.This study assessed adequate clinical and parasitological response(ACPR)and parasitemia on day 3 of treatment.Molecular surveillance of resistance-associated genes,including pfk13,pfcrt,and pfmdr1,was conducted on collected P.falciparum isolates.Results:The iDES of AS plus DHA-PPQ was implemented in 2023,while CQ efficacy was monitored from 2021 to 2023.Late parasitological failure(LCF)for DHA-PPQ was detected in 1 of 26 P.falciparum cases in 2023,and in 1 of 26 and 1 of 90 P.vivax cases for CQ in 2022 and 2023,respectively.The corresponding ACPR rates were 96.2%,100%,96.2%,and 98.8%.The average positive parasitemia rate on day 3 post-treatment was 21.8%.Molecular polymorphism analysis revealed 9 nonsynonymous mutation haplotypes in the pfk13 gene,while 97.7%of samples presented the wild-type genotype.For the chloroquine resistance-associated pfcrt gene,2 mutant haplotypes,‘CVIET’and‘SVMNT’,were detected with frequencies of 16.7%(70/418)and 0.5%(2/418),respectively,while the wild-type haplotype‘CVMNK’predominated at 82.8%(346/418).In the pfmdr1 gene,5 nonsynonymous point mutations and 8 haplotypes were identified.The Y184F mutation showed the highest prevalence at 40.5%(170/420).The 7 mutant haplotypes detected were V65L(0.2%,1/420),N86Y(1.9%,8/420),F408V(0.9%,4/420),D1246Y(0.5%,2/420),V65L/Y184F(0.2%,1/420),N86Y/Y184F(0.7%,3/420),and Y184F(39.8%,167/420).Conclusion:The antimalarial drug efficacy studies conducted for AS plus DHA-PPQ and CQ demonstrated that these treatments remain effective.However,the occurrence of LCF cases and persistent parasitemia on day 3 indicate decreasing sensitivity of these first-line drugs for treating P.falciparum and P.vivax,respectively.Therefore,continuous iDES and molecular surveillance of antimalarial drugs must be enhanced to provide early warning and guide appropriate responses to the spread of antimalarial drug resistance.
基金supported by Capital’s Funds for Health Improvement and Research(CFH 2020–1-6041)the National Natural Science Foundation of China(82073223).
文摘The"watch and wait"(W&W)strategy has been widely used in rectal cancer patients who have achieved clinical complete response(cCR)after neoadjuvant chemoradiotherapy(nCRT),which can save them from surgery and improve their quality of life.However,this strategy also has many unsolved practical problems,including the improvement of cCR/pCR rate,the search for efficient predictors,the standard follow-up and the methods of rescue surgery,etc.Larger sample size and more standardized clinical trials are still needed to obtain credible evidence.Therefore,we must rationally view the cCR after nCRT for middle and low rectal cancer,understand the risk of W&W strategy,and make a reasonable choice.It is particularly important to emphasize that we should actively carry out prospective multi-center clinical trials to produce high-level evidence suitable for Chinese characteristics,so that more rectal cancer patients can benefit from nCRT.
基金supported by the National Natural Science Foundation of China(No.82373050)Chinese Society of Clinical Oncology(CSCO)-Tongshu Oncology Research Fund(Y-tongshu2021/qn-0205)+1 种基金Chinese Society of Clinical Oncology(CSCO)-Xinda Oncology Immunotherapy Research Fund(Y-XD202002-0168)Scientific Research Fund of Wuhan Union Hospital-Joint Research Fund(2023XHYN003).
文摘Background:Standardized assessments of clinical complete response(cCR)to neoadjuvant chemoradiotherapy(nCRT)for rectal cancer have been established,but their utility and accuracy remain unclear.This study aimed to evaluate the clinical diagnostic value of rectal magnetic resonance imaging(MRI)and endorectal ultrasonography(ERUS)for the determination of cCRs after neoadjuvant immunotherapy and to investigate the concordance between cCR and pathological complete response(pCR).Methods:Ninety-four patients with rectal cancer treated with neoadjuvant radiotherapy with or without immunotherapy were included.The sensitivity,specificity,and accuracy of each evaluation method were calculated.Results:Combined MRI and ERUS assessments found cCR in seven of the 94 patients in our cohort.In the non-immunotherapy group,the sensitivity,specificity,and accuracy of MRI for diagnosing cCR were 50.0%,85.2%,and 77.1%,respectively,whereas those of ERUS were 50.0%,92.6%,and 82.9%,respectively;those of combined MRI and ERUS were 25.0%,96.3%,and 87.5%,respectively.In the immunotherapy group,the sensitivity,specificity,and accuracy with which MRI identified CR were 51.7%,76.7%,and 64.4%,respectively;those of ERUS were 13.8%,90.0%,and 52.5%,respectively,and those of combined MRI and ERUS were 10.3%,96.7%,and 54.2%,respectively.We also found that 32 of 37 patients with pCR did not meet the cCR evaluation criteria.Of these pCR patients,78.4%(29/37)received immunotherapy.In the entire cohort,there were five pCRs among the seven cCRs.Of the four cCRs that occurred in the immunotherapy group,three were pCRs.Conclusions:Rectal MRI and/or ERUS did not provide sufficiently accurate assessments of cCR in patients with rectal cancer receiving neoadjuvant therapy,especially immunotherapy,and cCR did not predict pCR.
