Gastroesophageal reflux disease (GERD) is a common, chronic disease of the digestive system. In recent years, endoluminal therapy for GERD has become a research hotspot. The reduced anti-reflux barrier function plays an important role in the occurrence of GERD. Peroral endoscopic therapy can improve the defect of anti-reflux barrier function. According to the involved layers, the endoscopic therapy can be classified as transmural which represented by transoral incisionless and transoral incisionless fundoplication, and non-transmural which represented by peroral endoscopic cardia constriction and radiofrequency ablation. This article reviews the progress of endoscopic non-full-thickness therapy for GERD in recent years, and introduces the action mechanism of peroral endoscopic therapy of GERD, the therapy of the mucosal layer and muscle layer of anti-reflux barrier, and other treatments. The purpose is to provide a reference for further exploring suitable endoscopic treatment of GERD.
ObjectiveTo explore the role of toremifene in postmenopausal operable patients with luminal subtype of breast cancer in China. MethodsA total of 618 eligible patients diagnosed with luminal subtype of breast cancer from January 2000 to December 2009 in the Cancer Center of Sun Yat-sen University were analyzed. One hundred and fifteen patients were treated with toremifene(toremifene group) and 503 patients were treated with tamoxifen(tamoxifen group) as adjuvant endocrine therapy. Survival was compared by Kaplan-Meier with log-rank test in two groups. Cox analysis was used to compare different prognostic factors. ResultsThe general clinical data had no significant differences between the toremifene group and tamoxifen group (P > 0.05). After a median follow-up of 76 months, there was no statistical difference in the 5-year disease free survival rate and 5-year overall survival rate between the toremifene group and the tamoxifen group (5-year disease free survival rate:78.5% versus 85.5%, P=0.083;5-year overall survival rate:86.4% versus 92.0%, P=0.334). Univariated analysis showed that the histological grade, tumor size, lymph node status, TNM stage, HER-2 positive expression were associated with the disease free survival rate and overall survival rate(P < 0.05). Multivariated analysis showed that the tumor size and lymph node status were the independent risk factors of disease free survival rate and overall survival rate for postmenopausal operable patients with luminal subtype of breast cancer(P < 0.05). HER-2 positive expression was the independent risk factor in predicting disease free survival rate for patients with tamoxifen or toremifene. There was no grade 3 or 4 toxicity for all the patients according to CTC AE 4.0 grade. ConclusionsSimilar benefit is found in disease free survival rate and overall survival rate in Chinese postmenopausal patients with operable luminal subtype of breast cancer between patients receiving toremifene and tamoxifen with tolerable adverse effects. HER-2 status is associated with disease free survival rate.