Objective We searched and reviewed medical evidence to find the guide of treatment for local advanced nasopharyngeal carcinoma. Methods Firstly, we put forward clinical questions. Secondly, we searched medical evidence from Medline (1985-2002), Embase (1984-2000), Cochrane library (2002.1) and ACP. And then we reviewed the results. The key words we used were "nasopharyngeal carcinoma, chemotherapy and radiotherapy randomized" and "meta analysis or randomized control trial". Results Through searching, we got 17 papers including 1 systematic review and 16 randomized control trials, in which there were 8 prospective randomized phase Ⅲ trials. Most of these trials concluded that combination chemo-radiotherapy were better than radiotherapy alone. We think these results were suitable for our patient’treatment decision. Conclusion To treat our patients,we choosed the method of the mutimodality of squeitial neoadjuvant chemotherapy, concurrent chemo-radiotherapy and adjuvant chemotherapy with the drug doses down-adjusted.
ObjectiveTo study the advance of malignant anorectal melanoma. MethodsThe literature in recent years about risk factors,clinical characteristic,early diagnosis,treatment and the prognosis of the anorectal melanoma were reviewed.ResultsMalignant anorectal melanoma was very rare.The history of pigment naevus,human immunodeficiency virus infection and sunlight exposure might be the risk factors.Clinic characteristics were rectal bleeding,anorectal mass and changing in bowel habits.Early diagnosis mainly depended on performing routine examination on patients between the ages of 45-80 years.The staining for polycolnal CEA in anorectal melanoma has a role on diagnostic pathology.The treatment is controversial and the combined treatments of chemotherapy with radiation therapy and immunotherapy which were based on surgery (abdominoperineal resection or wide local excision) are introduced.Conclusion Early diagnosis of malignant anorectal melanoma is difficult and the prognosis is poor.It is necessary to pay more attention to this disease and the most successful therapeutic approaches need to be developed.
Tibetan population has been living in Tibet plateau for more than thousands of years ago. Although, the environment is unlikely to be an ideal place for residence. They have evolved genetical and physiological adaptions living in Tibetan highlands. In recent several years, foreign scientists have noticed that lung cancer mortality is reduced at high altitude. Many in vitro and in vivo experiments explored the mechanism of this phenomenon. In this review we discuss the lung cancer incidence and mortally of Tibetan population, as well as the possible underlying mechanism including oxygen level, radiation, inhalable particulate matter, metabolism, hypoxic induced factor pathway and immune system. But, the clinical data as well as basic researches of Tibetan population remain insufficient, which required further investigation.
ObjectiveTo review the nomenclature, functional unit construction, technical essentials, and prevention and treatment of complications of functional perforator flaps, so as to provide references for the structural and functional reconstruction of composite tissue defects. MethodsBy retrieving and analyzing domestic and foreign literature on anatomical research, technical innovation and clinical application of functional design and application of perforator flaps, combined with the clinical practice of our team, the methods for harvesting and integrating functional units of perforator flaps were summarized. ResultsFunctional perforator flap refers to a perforator flap that, on the basis of perforator blood supply, carries one or more tissue functional units (such as muscles, nerves, lymphatic vessels, lymph nodes, bones, mucous membranes, joints or articular cartilages, etc.) with sufficient blood supply located in the supra-fascia and/or sub-fascia, and is used to reconstruct one or more functions of the recipient site. The design and transfer of functional perforator flaps should not only meet the needs of precise coverage of the wound, but also reconstruct the functions of the recipient site such as muscle contraction, flap sensation, lymphatic drainage, blood flow bridging, bone growth, glandular secretion or joint movement, while avoiding iatrogenic dysfunction in the donor site. ConclusionFunctional perforator flaps have broken through the limitation of “wound coverage” and realize the integrated reconstruction of “structure-function-aesthetics”.
Objective To study the distribution of HIV/AIDS high-risk population, HIV infection and the main risk factors for developing HIV/AIDS’ controllable measures and exploring appropriate health education and behavior intervention models. Methods A total of 360 commercial sex workers (CSW) joined together through convenience sampling and 360 drug users (DU) joined together through convenience sampling or snow-balling sampling whose relevant behavior factors were investigated by questionnaires. Results The general rate of knowing knowledge about AIDS was 75.2% among 360 CSW, 67.8% CSW used condom in commercial sex activities; none of 149 CSW blood samples was detected HIV or syphilis antibody positive. The general rate of knowing knowledge about AIDS was 83.7% among 360 DU who injected drugs last month, the rate of sharing needles was 47.6% and the low rate of condom used; 1 HIV antibody and 5 syphilis antibodies positive were found among 198 DU blood samples, so HIV and syphilis infection rate were 0.51%and 2.53%, respectively. Conclusion The rate of HIV infection is a very low level and there are many risk factors among CSW and DU. A good job should be done to integrate AIDS health education with behavioral intervention and the monitoring system for the AIDS/HIV high-risk population should be improved.
Objective To compare the clinicopathological features of hilar cholangiocarcinoma (HCCA) and hilar benign diseases, and then explore the value of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) in the differential diagnosis between them. Methods Clinical data of 65 patients (54 patients with HCCA and 11 patients with hilar benign diseases) who were diagnosed as HCCA and received treatment from January 2011 to October 2015 in our hospital were retrospectively analyzed. Comparison of clinical data of HCCA patients and patients with hilar benign diseases in age, gender, disease duration, clinical manifestation, laboratory examination, and imaging examination was performed, and the receiver operating characteristic curve (ROC) was used to explore the value of CA19-9 and CEA in differential diagnosis between hilar benign diseases and HCCA. Results The age, levels of serum CA19-9, CEA, alanine aminotransferase (ALT), total bilirubin (BILT), and direct bilirubin (BILD) of HCCA group were significantly higher than that in benign group (P<0.05). However, the gender, disease duration, clinical manifestations (including jaundice, abdominal discomfort, fever, and weight loss), serum aspartate aminotransferase (AST), serum alkaline phosphatase (ALKP), and imaging findings (including hilar mass, intrahepatic bile duct dilatation, thickening of the bile duct wall, lymph node enlargement, vascular invasion, and gallbladder invasion) had no significant difference between the 2 groups (P>0.05). The ROC curve results showed that, when cut-off point for CA19-9 was 233.15 U/mL, the sensitivity was 56% and specificity was 91%; when cut-off point for CEA was 2.98 ng/mL, the sensitivity was 61% and specificity was 90%. Conclusions For the differential diagnosis between HCCA and hilar benign diseases, the elderly patients with high levels of serum transaminase and bilirubin were more likely to be malignant. It is more likely to be malignant when the serum CA19-9>233.15 U/mL or CEA>2.98 ng/mL.
Colorectal cancer (CRC) is a prevalent malignant tumor worldwide. With the development of medical technology, the treatment strategies of CRC are constantly improving and updating. The aim of treating CRC is not only to improve outcomes but also to maintain organ function and enhance quality of life. For patients with locally advanced rectal cancer, a variety of neoadjuvant treatment options are available and it is important to choose an individualized strategy. Immune checkpoint inhibitors have become an important part of the first- and posterior-line treatment for patients with deficient mis-match repair or high microsatellite instability colorectal cancer in metastatic colorectal cancer, and the emergence of new targets and drugs has further improved treatment efficacy and long-term survival. Furthermore, an increasing number of studies have confirmed the potential the value of predicting and guiding treatment for minimal residual disease. This article summarizes the representative research results, guideline updates, and important academic conference reports in the field of colorectal cancer.
The infection of Hepatitis B virus (HBV) can result in severe consequences, including chronic hepatitis, liver fibrosis, cirrhosis, and even liver cancer. Effective antiviral treatment has the potential to slow down the progression of the disease. HBV serum biomarkers play a crucial role in the dynamic management of chronic hepatitis B (CHB) patients. However, the conventional hepatitis B virus markers, such as hepatitis B serologic testing and HBV DNA, are insufficient to meet the clinical requirements. This review provided a comprehensive overview of the current research on the quantification of HBsAg and anti-HBc, HBV RNA and HBV core-associated antigen, which summarized the crucial role these markers play in the administration of antiviral medications, predicting the efficacy of treatment and anticipating the likelihood of virologic rebound following drug cessation, as well as assessing disease progression in CHB patients.
ObjectiveTo evaluate systematically the relationship between obesity and clinical prognosis in acute respiratory distress syndrome (ARDS) patients.MethodsA systematic search was performed in Pubmed, EMBASE, Cochrane databases, Wiley, Ovid, Medline, CNKI, VIP and Wanfang. All studies that reported obesity in the clinical prognosis of ARDS and acute lung injury were included. A meta-analysis was performed using RevMan 5.0 and Stata 10.0.ResultsA total of 28 368 patients from 9 studies were included in this meta-analysis. The combined results showed that obesity was associated with the decreased mortality of ARDS [odds ratio(OR)=0.63, 95% confidence intervals (95%CI) 0.41 to 0.98, P=0.04]. In subgroup analysis, the result showed no obvious relationship between obesity and 28-day mortality in ARDS/ALI (OR=0.92, 95%CI 0.55 to 1.54, P=0.76). However, obesity was associated with lower risk of 60days and 90-day mortality in ARDS/ALI (60-day: OR=0.84, 95%CI 0.75 to 0.94, P=0.002; 90-day: OR=0.38, 95%CI 0.22 to 0.66, P=0.000 5). Compared with normal weight patients with ARDS, hospital length of stay, ICU length of stay, and duration of mechanical ventilation did not differ significantly [hospital length of stay: weighted mean difference (WMD)=3.61, 95%CI –0.36 to 7.57, P=0.07; intensive care unit (ICU) length of stay: WMD=1.52, 95%CI –0.22 to 3.26, P=0.09; duration of mechanical ventilation: WMD=–0.50, 95%CI –2.18 to 1.19, P=0.56], but ventilator-free days was significantly longer in obese patients (WMD=2.68, 95%CI 0.86 to 4.51, P=0.004).ConclusionsObesity is not associated with hospital length of stay, ICU length of stay, and duration of mechanical ventilation in patients with ARDS. However, obesity is associated with a reduction of long-term mortality and increased ventilator-free days in the patients with ARDS. Additional larger randomized controlled studies are needed to confirm the possible role of obesity in the clinical prognosis of ARDS.
Detection of the fraction of exhaled nitric oxide (FeNO) is a safe, simple and easy method to assess airway inflammation noninvasively. Thus, FeNO detection has been paid more attention to diagnosis and guide treatment of pulmonary diseases. The common feature of pneumonia, asthma, chronic obstructive pulmonary disease and chronic cough is the existence of varying degrees of airway inflammation. In this review, FeNO production and its potential pathologic and physiologic role in various pulmonary diseases were discussed.