China is a country with a high incidence of esophageal cancer. Most patients are already in the locally advanced stage when first diagnosed. Preoperative neoadjuvant therapy followed by surgery has become the standard treatment mode for them. Closely related to prognosis, the evaluation of tumor response is essential. Response evaluation criteria in solid tumors is the gold standard to evaluate tumor response, but the lesions must meet the measurement standards. Tumor regression grading (TRG) systems are designed to classify regressive changes after neoadjuvant treatment based on histopathological results to reveal prognostic information. Concentrating on pathologic assessment of esophageal cancer following neoadjuvant therapy, this article reviews histopathological changes, commonly used TRG systems and current debate.
ObjectiveTo summarize controversy and progress of multi-slice spiral CT in efficacy evaluation of transformation therapy for advanced gastric cancer.MethodThe recent studies published at home and abroad on the spiral CT in evaluating the therapeutic effect of transformation therapy for the advanced gastric cancer were reviewed and analyzed.ResultsIn recent years, though the energy spectrum and dual-energy CT examinations had appeared, the most common tool in evaluating of the efficacy of transformation therapy for the advanced gastric cancer was the spiral CT. The most common evaluation standard was still the RECIST standard.ConclusionsSpiral CT has its outstanding diagnostic significance in therapeutic evaluation of transformation therapy for advanced gastric cancer. Although there is some controversy, with advancements of a large number of studies, it will greatly help diagnosis and treatment of advanced gastric cancer.
目的 研究盐酸氨基葡萄糖联合双醋瑞因在伴有骨髓水肿（BME）的膝骨关节炎（KOA）中的疗效评估。 方法 依据MRI检查结果，选取2011年1月－2012年6月入院60例伴BME的KOA患者随机分入A组（口服盐酸氨基葡萄糖）、B组（口服双醋瑞因）、C组（口服盐酸氨基葡萄糖和双醋瑞因），每组各20例；另纳入同期30例不伴BME的KOA患者30例为D组（口服盐酸氨基葡萄糖和双醋瑞因）。完成标准方案后24周，随访临床疗效和影像学评分及炎症因子变化。 结果 治疗24周后4组在20 m 步行后视觉模拟评分（VAS）、关节压痛VAS评分较治疗前有改善（P＜0.05）；在BME改善方面，C组容积积分和程度积分均优于A、B两组（P＜0.05）；在炎症因子方面，治疗24周后4组白细胞介素（IL）-1β、IL-6和肿瘤坏死因子α表达水平明显降低（P＜0.05）。 结论 盐酸氨基葡萄糖联合双醋瑞因能有效改善伴有BME的KOA患者临床症状、降低炎症因子表达水平以及促进BME在影像学方面的改善。
The re-evaluation of the effectiveness of new drugs is of great importance when they are in post-market for there exist some limitations in clinical trials before these drugs are put on the market. The large sample multi-centre randomized controlled trial is the best method of re-evaluation of the effectiveness of new drugs. It could appropriately evaluate not only the large-term efficacy and safety of drugs, but the treatment effect on the survival state and its complications as well. This method will also lead to a great social amp; economic benefit.
ObjectiveTo observe the alteration of serum homocysteine (Hcy) levels of advanced non-small cell lung cancer (NSCLC) patients during gemcitabine with cis-platinum (GP) program of chemotherapy and to explore the clinical value of monitoring Hcy in evaluating chemotherapy curative effect. MethodsA total of 49 advanced NSCLC patients (including 28 squamous carcinoma and 21 adenocarcinoma) first treated between May 2012 and April 2015 were selected. The Hcy, cytokerantin-19-fragment (CYFRA21-1) and carcinoembryonic antigen (CEA) levels of the morning fasting venous blood were measured before the first and after the second cycle of chemotherapy. Combined the pathological types of NSCLC, statistical analysis was carried out on the test results. ResultsAll of the 49 patients completed two cycles of GP chemotherapy, and the chemotherapy was effective on 31 and ineffective in 18. Before the chemotherapy, the differences in the positive rates of Hcy, CYFRA21-1, and CEA were statistically significant respectively between squamous carcinoma and adenocarcinoma patients (P < 0.05). But when combined the two types, the differences of three indicators's positive rates were not significant (P > 0.05). After two cycles of GP chemotherapy, in the patients with effective chemotherapy, the Hcy, CYFRA21-1 and CEA levels were lower in both squamous carcinoma and adenocarcinoma patients compared with that before the chemotherapy; the difference in the decrease of Hcy levels in both of the two pathological types was significant (P < 0.05), while CEA levels was significant only in adenocarcinoma patients (P < 0.05) and CYFRA21-1 levels was significant only in squamous carcinoma patients (P < 0.05). Among the patients with ineffective chemotherapy, the Hcy, CYFRA21-1 and CEA levels increased compared with those before the chemotherapy; the difference in the increase of Hcy levels were significant in both of the two pathological types (P < 0.05), while CYFRA21-1 levels was significant only in squamous carcinoma patients (P < 0.05) and CEA levels was not significant in both of the two pathological types (P > 0.05). ConclusionThe effect of chemotherapy and the pathogenetic condition can be assessed by monitoring serum Hcy levels of NSCLC patients during the chemotherapy.
Objective To evaluate the value of 18 F-fluorodeoxyglucose ( 18 F-FDG) metabolism imaging in evaluating the response of patients with non-small cell lung cancer ( NSCLC) in stable diseaseafter chemotherapy. Methods 28 patients with NSCLC in stable disease after chemotherapy admitted between September 2010 to September 2012 were retrospectively investigated. The reduction ratio of targetto-nontarget ratio ( T/N) before and after chemotherapy was calculated. The patients were followed up 3 to 12 months to measure progression-free survival ( PFS) . The correlation between the reduction ratio of T/N and PFS was analyzed. The patients were divided into a reduction group and a non-reduction group according to the difference of the reduction ratio of T/N and was compared the difference of the PFS.Results The reduction ratio of T/N had positive correlation with PFS( Pearson r = 0. 668, P lt; 0. 01) . The PFS of the reduction group was longer than that in the non-reduction group ( 8. 0 ±2. 5 months vs. 5. 3 ±1. 2 months,P lt;0. 05) . Conclusions The reduction ratio of T/N is positively correlated with PFS in NSCLC patients in stable disease after chemotherapy. It is possible to evaluate the efficacy of the treatment according to the reduction ratio of T/N.
Electroencephalogram (EEG) has been an important tool for scientists to study epilepsy and evaluate the treatment of epilepsy for half a century, since epilepsy seizures are caused by the diffusion of excessive discharge of brain neurons. This paper reviews the clinical application of scalp EEG in the treatment of intractable epilepsy with vagus nerve stimulation (VNS) in the past 30 years. It mainly introduces the prediction of the therapeutic effect of VNS on intractable epilepsy based on EEG characteristics and the effect of VNS on EEG of patients with intractable epilepsy, and expounds some therapeutic mechanisms of VNS. For predicting the efficacy of VNS based on EEG characteristics, EEG characteristics such as epileptiform discharge, polarity of slow cortical potential changes, changes of EEG symmetry level and changes of EEG power spectrum are described. In view of the influence of VNS treatment on patients’ EEG characteristics, the change of epileptiform discharge, power spectrum, synchrony, brain network and amplitude of event-related potential P300 are described. Although no representative EEG markers have been identified for clinical promotion, this review paves the way for prospective studies of larger patient populations in the future to better apply EEG to the clinical treatment of VNS, and provides ideas for predicting VNS efficacy, assessing VNS efficacy, and understanding VNS treatment mechanisms, with broad medical and scientific implications.
Stem cell transplantation is one of the main methods to treat thromboangiitis obliterans (TAO). In recent years, research on the treatment mechanism of stem cell transplantation has made some progress. The results of a number of stem cell clinical trials specifically for TAO have been published. Some new stem cell types have gradually been used in the clinic. There is no major dispute over security. In addition, research shows that the efficacy of stem cell transplantation is affected in many ways, and some factors have a certain predictive effect on the possibility of amputation after transplantation. This paper reviews the clinical research progress of stem cell transplantation for TAO, and aims to provide some basis for the better use of stem cell transplantation in the treatment of TAO.
The administration of radioactive iodine-131 (131I) is one of the representative traditional targeted therapy for post-surgical differentiated thyroid carcinoma (DTC). As DTC tumor cells largely preserve the capability of thyroid follicular epithelial cells, including the expression of the sodium iodide symporter (NIS), 131I can be selectively internalized by these cells once introduced into the body. The simultaneous emitting of both γ-ray and β-ray from 131I featured its unique theranostic value in managing DTC, through γ-ray to detect the residual thyroid tissue and DTC lesions via nuclear medical imaging, while through β-ray to yield the precise tumoricidal effect as well as remnant thyroid ablation. This theranostic potential of 131I significantly enhances progression-free survival, disease-specific survival, and overall survival in DTC patients with residual/recurrent/metastatic lesions as long as they are capable of iodine uptake. Nevertheless, the clinical application of 131I, despite its “precise” treatment philosophy, remains far from precision medicine while clinical practice, which urges further refinement in pre-treatment assessment, dosage tailoring, and post-treatment efficacy evaluation to fully capitalize on its theranostic benefits. Recently, with the accumulation of evidence-based medical data, 131I treatment has evolved with respect to treatment principles, pre-treatment risk stratification, post-treatment dynamic assessment, and comprehensive patient management, with an aim to optimize the diagnostic and therapeutic precision of 131I. Here we briefly review and update the recent advance on 131I management on DTC.