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Treatment and Diagnosis of Recurrence Following Resection for Gastric Cancer

复发性心瓣膜病患者再次心瓣膜置换术的临床分析

摘要： 目的 总结复发性心瓣膜病患者再次行心瓣膜置换术的临床经验。 方法 回顾性分析1998年1月至2008年12月第四军医大学西京医院收治的319例复发性心瓣膜病再次行心瓣膜置换术患者的临床资料，男138例，女181例；年龄12～73岁(43.2±13.5岁)。需再次手术的原因为：心瓣膜成形术后、生物瓣衰坏、瓣周漏等。两次手术间隔时间3个月～25年(18.7±8.3年)。 结果 全组共死亡25例，其中手术死亡4例，早期死亡21例。主要死亡原因为：低心排血量综合征、室性心律失常、多器官功能衰竭等。其余294例患者治愈出院。随访252例，随访率85.7％，随访时间6个月～11年(9.6±7.1年)；失访42例。随访期间死亡17例，死于心力衰竭9例，人工瓣膜感染性心内膜炎2例，颅内出血、脑栓塞3例，消化道出血1例，原因不明2例。长期生存的235例患者中心功能恢复至Ⅰ～Ⅱ级183例，Ⅲ级29例。 结论 尽管复发性心瓣膜病患者心功能和全身状况均较差，手术操作较困难，但适时而妥善的外科手术仍可获得良好的效果。

A case-control study of idiopathic hypereosinophilia combined with thrombosis and recurrence

Objective To investigate the risk factors, clinical characteristics and prognostic factors of venous thrombosis (and pulmonary embolism) in patients with idiopathic hypereosinophilia (IHE) so as to provide a theoretical basis for clinical prevention of venous thrombosis and improve prognosis.Methods Thirty-nine patients with IHE admitted to West China Hospital of Sichuan University from January 2010 to January 2022 were collected in this retrospective case-control study to explore the risk factors of venous thrombosis (including pulmonary embolism) and thrombosis recurrence after treatment. Results There were 17 (43.5%) patients combined with venous thrombosis of 39 patients with IHE. In the patients with vascular involvement, pulmonary embolism was the initial expression of IHE accounted for 29% (5/17). patients of IHE with pulmonary embolism were younger [44 (24.5 - 51.0) vs. 56 (46.3 - 67.8) year, P=0.035] and had higher peak absolute eosinophil counts [11.7 (7.2 - 26.5)×109/L vs. 3.8 (2.9 - 6.7)×109/L, P=0.020] than those without pulmonary embolism. After a mean follow-up of 13 months (2 - 21 months), thrombosis recurred in 35.3% (6/17) of patients. Persistent increasing in eosinophils (>0.5×109/L) was an independent risk factor for thrombus recurrence (odds ratio 13.33, 95% confidential interval 1.069 - 166.374). Conclusions Thrombosis is a common vascular impaired complication in IHE , and increased eosinophilia is a risk factor for thrombosis and thrombus recurrence after therapy. Controlling and monitoring the eosinophilic cell levels in patients with IHE may avoid severe comorbidities.

Study on The Progress of Relationship Between Cellular Immunological Function and Primary Liver Cancer

Objective　To summarize the role of the relationship between liver cancer and cellular immunological function, and the role of immune therapy in clinical application. Methods　To analyze the relationship between liver cancer and cellular immunological function, and the present research situation of immune therapy for liver cancer in clinical application retrospectively via review the related domestic and foreign literatures. Results　The cellular immune dysfunction existed in all liver cancer patients. The state of body’s cellular immunological function is closely related with the arising and development of liver cancer, and the lowness of cellular immunological function is an important factor of hepatocellular carcinoma hard to cure or recurrence and metastasis. Immune therapy plays an important role in the treatment of liver cancer by adjusting the body’s cellular immunological function. Conclusions　Liver cancer is closely related with the body’s cellular immunological function. Immune therapy is expected to offer a new way for the treatment of liver cancer, which can also be used as an important auxiliary treatment way.

Progress of Multidisciplinary Modality in Diagnosis and Treatment for Local Recurrence of Rectal Cancer

Exploration of safety and efficacy of lenvatinib in combination with TACE and PD-1 antibody in treatment of recurrent liver cancer

Objective To explore the safety and efficacy of lenvatinib in combination with transarterial chemoembolization (TACE) and programmed death receptor 1 (PD-1) antibody in the treatment of recurrent liver cancer. Method The clinical data of 22 patients with unresectable recurrent liver cancer admitted to Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University and received the conversion therapy of lenvatinib+TACE+PD-1 antibody between January 2019 and January 2022 were retrospectively analyzed. Results All 22 patients experienced some degree of adverse events, with a grade 3 adverse event rate of 18.2% (4/22) and no grade 4 or higher adverse events. At 4 months of treatment, according to the modified response evaluation criteria solid tumors (mRECIST), 2 cases were in complete response (CR), 5 cases were in partial response (PR), and 6 cases were in stable disease (SD), 9 cases were in progressive disease (PD), and the objective response (CR+PR) rate (ORR) was 31.8% (7/22). At the last follow-up, there was 1 case in CR, 5 cases in PR, 1 case in SD, and 15 cases in PD, with an ORR of 27.3% (6/22). The 1-year overall survival (OS) rate was 83.8% and the 1-year progression-free survival (PFS) rate was 38.2%. In the subgroup analysis, the 1-year OS rate for patients with recurrent liver cancer with intrahepatic lesions (n=16) only was 86.2% [95%CI (77.1%, 95.3%)], the 1-year PFS rate was 46.9% [95%CI (34.0%, 59.8%)], and the ORR based on mRECIST criteria was 43.8% (7/16). Patients with intrahepatic combined with extrahepatic lesions (n=6) had a 1-year OS rate of 75.0% [95%CI (53.3%, 96.7%)] and a 1-year PFS rate of 16.7% [95%CI (15.0%, 31.9%)], and the ORR based on mRECIST criteria was 0% (0/6). There were no significant differences in OS (P=0.864) and PFS (P=0.125) between the two subgroups. The ORR of intrahepatic combined with extrahepatic lesions group was worse compared to the intrahepatic lesion group (P=0.049). Conclusion Lenvatinib in combination with TACE and PD-1 antibody is safe and effective in the treatment of unresectable recurrent liver cancer, but there are still many issues that deserve further exploration.

The research progress of microRNA in the recurrence and metastasis of hepatocellular carcinoma

Objective To summarize the mechanism of microRNA in the recurrence and metastasis of hepatocellular carcinoma (HCC) and its possible clinical application. Methods The relevant literatures at home and abroad were reviewed to summarize the results of various scholars. Results microRNA played an important role in cell proliferation and apoptosis of HCC. microRNA of different types promoted or inhibited the recurrence and metastasis of HCC through different action targets and molecular pathways. Conclusions microRNA has a regulation role in the recurrence and metastasis of HCC, and the depth mechanisms study of microRNA in the recurrence and metastasis of HCC provides great significance to clinical therapy. The miRNA is expected to be one of the new target on the prediction and treatment of recurrence and metastasis in HCC.

Comprehensive Treatment for Recurrent Hepatocelluler Carcinoma

MICROTRAUMATIC TECHNIQUE TREATMENT OF POSTOPERATIVE RECURRENT BONE CYSTS IN JUVENILE PATIENTS

Objective To study the effect of microtraumatic treatment of postoperative recurrent bone cysts in juvenile patients. Methods FromDecember 1984 to December 2003, 36 cases of postoperative recurrent bone cysts after focal curettage and bone graft included 19 males and 17 females, aging 9-21 years-with an average of 15 years. The size of bone cyst ranged from 2.5 cm×6.0 cm to 3.5 cm×13.0 cm with an average of 3.0 cm×8.0 cm. The locations were proximal humerus in 18 cases, humeral shaft in 10 and femoral trochanteric region in 8. The focal curette and bonegraft were given once in 23 cases, twice in 10 cases and 3 times in 3 cases. The interval between recurrence and microtraumatic treatment was 5-13 months (6.5 months on average). The posteroanterior and lateral X-ray films were takento determine the location, range and feature of the focus. Under local anesthesia, 2 canulated needles were used; one was used to aspirate the contents of the cyst, the other was used to inject hydrocortisone acetate. The dose was determined according to the range of the focus. The treatment was repeated every 3.54 months until the focus healed. Results All patients were followed up from 3 to 18 years with an average of 5 years. The microtraumatic treatment was repeated 3-11 times with an average of 6 times. Twenty-six cases healed completely, 6 cases healed significantly, and 4 cases healed partially. No local or general complications occurred during the treatment. Conclusion This microtraumatic method for the treatment of postoperative recurrent bone cyst in juvenile patients has following advantages : less pain, easy manipulation, no hospitalization, low cost and definite effect.

螺钉固定并植骨融合治疗复发性下胫腓关节分离

目的 总结采用螺钉固定并植骨融合治疗复发性下胫腓关节分离的疗效。 方法 2004 年7 月－2008 年12 月，采用螺钉固定并植骨融合治疗复发性下胫腓关节分离29 例29 踝。男19 例，女10 例；年龄16 ～ 68 岁，平均34 岁。受伤至初次治疗时间1 ～ 7 d，平均3 d。手法复位石膏固定后复发20 例；经螺钉固定后去除内固定复发4 例，螺钉断裂复发5 例。复发时间2 ～ 6 个月，平均3.5 个月。 结果 术后切口均Ⅰ期愈合。29 例均获随访，随访时间6 ～ 24个月，平均13 个月。移植髂骨块均愈合良好，未出现断钉现象，无复发。术后6 个月下胫腓间距、踝距关节间隙、踝关节背伸（中立位0° 法）、跖屈与术前比较，差异均有统计学意义（P lt; 0.01）。按Sarkision 疗效评定标准：优12 例，良15 例，可2 例，优良率93.1%。 结论 螺钉固定并植骨融合是治疗复发性下胫腓关节分离简便、有效的方法之一。