Volume 85  ·   Issue 30  ·  2005

Colorectal cancer is one of the most common malignant tumors, and its incidence is increasing obviously. Although some progress has been made in the diagnosis and treatment in recent years, it is still unsatisfactory. The main reason is that the tumors are mostly in middle and late stage at the time of diagnosis, and some of them have liver metastasis. 20% ~40% of patients cannot achieve radical resection due to wide range of local lesions or distant metastasis. Even if radical surgical resection is achieved, only 70% ~80% of patients have a survival period of 5 years. Liver and lung metastases are still more common after radical resection, especially in patients with Dukes'C stage [1]. Some views on the treatment of liver metastases from colorectal cancer are discussed.

Gastric cancer is a serious harm to the health of our country, and the incidence rate of gastrointestinal cancer is the first. After several generations of medical professionals have made unremitting efforts for decades, the curative effect of gastric cancer has obtained obvious progress, but the overall cure rate is still difficult to satisfy, and the mortality rate is still high. The reasons are, on the one hand, the low detection rate of early gastric cancer caused by the low national economy level and the weak public health care awareness in our country, on the other hand, it also indicates that the existing treatment methods of advanced gastric cancer need to be further improved.

Chemotherapy plays an important role in the treatment of gynecological malignant tumors. For a long time, surgery, radiotherapy and chemotherapy have been regarded as the three main treatment methods for gynecological malignant tumors. With the continuous advent of new effective chemotherapy drugs and the change of medical mode, the value of chemotherapy in the treatment of gynecological malignant tumors has also changed greatly. Chemotherapy, as a systemic treatment measure, can effectively control the growth, spread and metastasis of tumors, and chemotherapy can achieve curative effect for some gynecological malignant tumors that are highly sensitive to chemotherapy. In addition, the irreversible severe toxic side effects caused by chemotherapy are relatively small compared with surgery and radiotherapy, which is of great significance for protecting the organs and functions of patients and improving the quality of life of patients. Chemotherapy has begun to transition from adjuvant treatment to dominant treatment of gynecological tumors, and the combination of chemotherapy with surgery, radiotherapy and immunotherapy is the development trend of gynecological malignant tumor treatment. In the treatment of gynecological malignant tumors, How to use chemotherapy rationally, give full play to its therapeutic effect and reduce its serious toxic and side effects is an issue of great concern in clinic.Three related papers published in this issue of Chinese Medical Journal on chemotherapy of gynecological malignant tumors reflect the role of chemotherapy in the treatment of gynecological malignant tumors from different angles and multiple levels, which are very helpful for clinical treatment.

The combined application of surgery and chemotherapy is the first choice for the treatment of middle and advanced ovarian cancer, especially epithelial ovarian cancer. Chemotherapy requires the correct use of effective regimens and the prevention of drug resistance. The problem of chemotherapy resistance in ovarian cancer is a hot topic.

Objective to investigate the efficacy and influencing factors of primary methotrexate chemotherapy in the treatment of low-risk gestational trophoblastic tumor (GTN) after new clinical staging. Methods 61 patients with GTN who received methotrexate chemotherapy were re-scored according to the clinical staging criteria of the International Federation of Obstetrics and Gynecology (FIGO) in 2000. The clinical data of low-risk patients were collected and analyzed retrospectively. The age of patients, blood human chorionic gonadotropin (hCG) before chemotherapy, the nature of last pregnancy, the interval between the start of treatment and the last pregnancy, clinical stage and prognosis scores, the results of pulmonary X-ray and CT examination, the size of lesions, different dosing regimens and their efficacy were analyzed by univariate and multivariate analysis. Results Among 61 patients with low-risk GTN, 51 patients were treated with methotrexate chemotherapy for 5 days, and 35 cases (68.6%) were in complete remission recently. 10 cases were treated with methotrexate + formyltetrahydrofolate chemotherapy, and 3 cases achieved recent complete remission; The remaining patients reached complete remission after changing chemotherapy regimens.By univariate analysis, hCG before chemotherapy, time to last pregnancy, lesion size, FIGO score and different dosing regimens were significantly correlated with the efficacy of methotrexate monotherapy (all P<0.05). By binomial Logistic regression multivariate analysis with backward deletion method, the results showed that the dosing regimen, FIGO prognostic score and hCG level before chemotherapy were significantly correlated with the efficacy of methotrexate monotherapy (OR values were 2.476, 1.431 and 1.001, respectively). Conclusion After adopting the new FIGO clinical stage, methotrexate monotherapy is still the first choice for low-risk GTN, but its remission rate decreased. Methotrexate regimen, FIGO prognostic score, and blood hCG levels before chemotherapy were independent factors influencing the efficacy of methotrexate monotherapy.

Objective to evaluate the efficacy of irinotecan hydrochloride combined with cisplatin regimen in the treatment of cervical cancer, observe the toxic and side effects of this regimen in the treatment of cervical cancer, and explore the position of chemotherapy in the treatment of cervical carcinoma. Methods 46 patients with cervical cancer were treated with irinotecan hydrochloride combined with cisplatin regimen. The medication regimen was irinotecan hydrochloride 60 mg/m2 dissolved in 250 ml of normal saline for 1 h on the 1st, 8th and 15th days, cisplatin 60 mg/m2 dissolved in 500 ml of 5% glucose for 4 h, and the course of treatment was repeated every 28 d on the 1st day. The pathological types of 46 patients were: 43 cases of squamous cell carcinoma, 2 cases of adenocarcinoma and 1 case of small cell carcinoma. Results 41 patients with Ⅰb ~ Ⅲb were treated with this regimen of neoadjuvant chemotherapy. After 1~2 courses of chemotherapy, 4 cases (9.8%) were in complete remission; Partial remission occurred in 30 cases (73.2%); Stable disease in 7 cases (17.1%); The disease progressed in 0 cases; The total effective rate was 82.9%. 29 patients in stage Ⅱb and Ⅲb were inoperable before chemotherapy. After chemotherapy, 20 patients underwent radical hysterectomy with tumor-free space ≥3 cm from the parauterine to the pelvic wall, and the operable rate was 69%. After 4~6 courses of chemotherapy, 1 case was in complete remission, 2 cases were in partial remission, 2 cases were stable, 0 cases were progressive, and 3 cases were effective. The main toxic side effects were bone marrow suppression and diarrhea.

Objective to compare the effects of Taxol weekly therapy and platine combined chemotherapy with Taxol 3 weeks therapy and platine combined chemotherapy as first-line chemotherapy for ovarian cancer, and to observe the toxic effects of the two combined regimens and the effects of the two combined regimens on the two-year survival of ovarian cancer patients.Methods A multicenter controlled study was performed to divide 125 patients with advanced ovarian epithelial carcinoma diagnosed by pathology after surgery into two groups. (1) Weekly treatment group: 51 patients were given Taxol 60~80 mg/m2 once a week, a total of 6 times. Platine (drug release curve =5.0) was administered only in the first week and after Taxol was used in the fourth week. 8 weeks as a course of treatment, 6 weeks of chemotherapy and 2 weeks of rest. The efficacy was evaluated after 2 courses (16 weeks). (2) 3-week treatment group: 74 patients were given Taxol 175 mg/m2, 3 h intravenous drip. Platine: (drug release curve area 5.0). The combination of Taxol + platine was administered on the first day of each course of treatment, 3 weeks as a course of treatment, and the efficacy was evaluated after 6 courses of treatment (18 weeks). Results (1) Decrease of CA125: After surgery There were 58 cases (78.4%) in the 3-week therapy group and 44 cases (86.3%) in the weekly therapy group, and there was no significant difference between the two groups (P>0.05). (2) Relapse and uncontrolled cases: ① There were 32 cases of relapse and/or uncontrolled cases, accounting for 26.4%. There were 22 cases (29.7%) of relapse and/or uncontrolled cases in the 3-week therapy group, among which 8 cases had relapse after stopping chemotherapy for more than 6 months, and 8 cases had stopping chemotherapy<There were 9 cases of recurrence in 6 months, 5 cases of tumor continuous progression, 10 cases (19.6%) of recurrence and/or uncontrolled cases in the weekly treatment group, 2 cases of recurrence after stopping chemotherapy for more than 6 months, stopping chemotherapy<There were 6 cases of 6-month recurrence and 2 cases of continuous tumor progression. There was no significant difference in the incidence of recurrence and uncontrolled incidence between the two groups (P>0.05). ② The mean time of tumor recurrence was 15.7 months in the 3-week treatment group and 13.6 months in the weekly treatment group (P>0.05). ③ The mean time of progress-free survival (PFS) was 16.5 months in the 3-week treatment group and 15.6 months in the weekly treatment group (P>0.05). ④ survival: The 1-year survival rate of the 3-week treatment group was 95.2% and the 2-year survival rate was 78.7%; The 1-year survival rate was 93.9% and the 2-year survival rate was 85.3% in the weekly treatment group. There was no statistically significant difference between the 1-year and 2-year survival rates between the two groups (P>0.05). (3) Toxicity and side effects: In the hematotoxicity: In the 3-week treatment group, 34 cases had 3-4 degree myelosuppression, the incidence rate was 45.9%, and in the weekly treatment group, 14 cases had 3-4 degree myelosuppression, the incidence rate was 27.5%, the difference between the two groups was statistically significant (P<In terms of neurotoxicity, the incidence of 3-week therapy was slightly lower than that of 3-week therapy, but the difference was not statistically significant (P>0.05). Other toxic effects, there was no statistically significant difference between the two groups (P>0.05). Conclusion (1) The clinical efficacy of Taxol weekly therapy is the same as that of 3-week therapy. (2) The incidence of myelosuppression of Taxol weekly therapy is significantly lower than that of 3-week therapy, and the difference between other toxic effects and 3-week therapy is not statistically significant. (3) The toxic side effects of Taxol weekly therapy are milder, and it is more suitable for elderly and frail patients and outpatient chemotherapy.

Objective to observe the effect of MAGE-3 antigen peptide pulsed dendritic cells (DC/MAGE-3) as tumor vaccine on the growth of gastric cancer transplantation in mice. Methods The killing activity of cytotoxic T lymphocytes (CTL) induced by MAGE-3 antigen peptide on mice pre-gastric cancer cell line MFC cells was detected. In the immunoprotection experiment, mice were immunized with DC/MAGE-3 (1×106 cells/rat) twice subcutaneously, and then inoculated with MFC cells (5×105 cells/rat); In the immunotherapy experiment, MFC cells (5×105 cells/rat) were inoculated first, then DC/MAGE-3 (1×106 cells/rat) were injected subcutaneously twice, and the pulsed DC/Nup and blank DC were used as controls to observe the growth and survival of mice tumors and statistical processing were performed. Results (1) CTL cells induced by MAGE-3 antigen peptide had high killing activity on MFC cells; (2) DC/MAGE-3 can significantly delay the tumor growth and prolong the survival time of mice in immunoprotection experiment and immunotherapy experiment (P<Conclusion DC pulsed with MAGE-3 antigen peptide can activate tumor-specific CTL by enhancing antigen presentation and have obvious anti-tumor activity.

Methods Fifty-four patients with distal gastric cancer were divided into two groups: Group A (26 cases) underwent end-to-side anastomosis of residual stomach and jejunum, duodenum and jejunum with manual suture or tubular gastrointestinal stapler after subtotal gastrectomy, and then underwent lateral jejunal anastomosis. The proximal jejunum of gastrojejunostomy and the distal jejunum of duodenojejunostomy were ligated and blocked respectively to form a continuous interposed jejunum; Group B (28 cases) underwent Billroth Ⅱ digestive tract reconstruction after subtotal gastrectomy; The time of digestive tract reconstruction, body weight, prognostic nutritional index (PNI) and Visick grading index at 3 and 6 months after operation were counted in the two groups. Results the patients in both groups recovered smoothly after operation, and there were no postoperative complications such as anastomotic leakage or obstruction. The mean digestive tract reconstruction time in groups A and B was 53 min±9 min and 57 min±6 min, respectively (t = -2.145, P =0.037); Both body weight and PNI recovered to pre-operative level in group A at 6 months postoperatively, while in group B, although there was some recovery, the difference was statistically significant compared with pre-operative level. Visick grading index in group A was significantly better than that in group B at 6 months postoperatively (u =2.1, P<Conclusion the remaining stomach, duodenum and continuous jejunal interposition can make food pass through the duodenum, restore physiological channels, reduce the difficulty of digestive tract reconstruction during subtotal gastrectomy, avoid bile reflux and improve the quality of life.

Objective to analyze the relationship between lymph node metastasis rate (rN) and quantitative grading and prognosis and pathological factors of gastric carcinoma. Methods the relationship between rN grading and lymph node grading standard (pN) in the 5th edition of TNM in 1997 and prognosis and pathological factors reflecting biological behavior of gastric carcinoma in 341 patients with gastric carcinoma was compared and analyzed. Results the 5-year survival rate was 69.9% in rN 1 group, 45.7% in rN 2 group and 10.6% in rN 3 group. The difference in survival rate was statistically significant (χ 2=14.38, P mean<0.05); The difference in 5-year survival rate was also statistically significant when compared by rN in the same pN classification group, but there was no statistically significant difference in 5-year survival rate when compared by pN classification in the same rN classification group; COX model analysis showed that rN grade was the most important independent index to reflect the prognosis of gastric cancer; The difference of lymph node metastasis rate and tumor size, invasion depth and gross type were statistically significant (P all<0.05); rN classification is correlated with the lymph node metastasis substation in the Japanese Gastric Cancer Protocol. Conclusion rN classification can better guide the treatment and prognosis of gastric cancer, and is helpful to perfect the TNM staging system of gastric cancer.

Objective to detect the expression level of dihydropyrimidine dehydrogenase (DPD) in human colorectal cancer tissues and to explore its clinical significance. Methods The expression level of DPD was detected by immunohistochemistry in 53 patients undergoing radical colorectal cancer resection in the First Hospital of Xi'an Jiaotong University. Results the expression of DPD was mainly found in the cytoplasm and nucleus of tumor cells. The expression level of DPD was statistically significant in 39 patients, accounting for 73.58%. The difference of expression level of DPD in different histopathological grades was statistically significant, and the expression level of DPD was not related to the efficacy of chemotherapy (P>0.05). Kaplan-Meier survival analysis showed that the survival time of DPD positive expression was statistically significant difference with that of DPD negative expression. The 5-year survival rate of DPD positive expression was 12.97%, while that of DPD negative expression was 42.86% (P<The results indicated that the prognosis of patients with positive DPD expression was worse than that of patients with negative DPD expression. Conclusion DPD expression can be used as a reference index to judge the prognosis of patients with colorectal cancer.

Objective The relationship between FAS-1377G/A and FASL-844T/C polymorphisms and the risk of colorectal carcinoma was investigated by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). The genotypes of FAS-1377G/A and FASL-844T/C polymorphisms in 382 patients with colorectal carcinoma and 648 paired controls were detected. Results Compared with those with FAS-1377GG genotype and FASL-844TT genotype, the risk of colorectal carcinoma was increased by 64.0% (95% CI, 1.11-2.44) and 69.0% (95% CI, 1.03-2.78), respectively

Objective to investigate the proteins associated with colorectal carcinogenesis and liver metastasis and their relationship with liver metastasis.Methods Isoelectric focusing/SDS polyacrylamide bidimensional gel electrophoresis was used to compare and analyze the difference of proteome expression in primary colorectal carcinoma, paracancerous intestinal mucosa and liver metastasis, and identify the difference protein spots by mass spectrometry. The differential protein genes were introduced into colorectal cancer cells by cell transfection, and the biological behavior changes of the cells were observed. Results There were obvious differences in the protein components between the primary tumor of colorectal cancer, liver metastasis and normal intestinal mucosa in the PH range of 7.0~9.5. The expression of 13 differential protein spots was analyzed. Among them, the expression of 2 protein spots was down-regulated in the primary tumor tissues, 5 protein spots were up-regulated in the primary tumor tissues, and 6 protein spots were up-regulated in the liver metastasis tissues. By mass spectrometry, the expression of carbonic anhydrase Ⅱ (CAⅡ) was down-regulated in the cancer tissues, the expression of phosphoglycerate kinase Ⅰ, fumarate hydratase and aldolase A was up-regulated in the primary tumor, and the expression of arginase and glutathione S-transferase A3 was up-regulated in the liver metastasis tissues. The down-regulation of carbonic anhydrase Ⅱ expression and the enhanced expression of arginase and glutathione S-transferase A3 can change the biological behavior of colorectal cancer cells and promote liver metastasis.

Objective Heterozygous deletion (LOH) of tumor suppressor genes is considered to be one of the pathways of colorectal carcinoma. This experiment aims to identify high-frequency heterozygous deletion regions and screen tumor suppressor genes related to colorectal carcinoma by analyzing LOH in chromosome 10q23~24. Methods Seven fluorescence-labeled microsatellite primers (around D10S185) were reacted with 83 tumors and normal tissues of colorectal carcinoma by polymerase chain reaction (PCR). The products were electrophoretized in ABI Prism 377 automatic fluorescence sequencer, scanned by GeneScan3.1 and Genotyper 2.1 software, and the relationship between LOH and clinical pathological factors was compared by χ 2 test. Results The average heterozygous deletion rate of 7 sites was 36.11%, and the highest was 54.84% at D10S583 site; The lowest was D10S205,21.3%.Two high frequency heterozygous deletion regions were found: one between D10S583 and D10S185 at a distance of about 0.9 cM (10q23.33); The other is about 1.5 cM (10q24.2~24.31) between D10S1709 and D10S1265. The heterozygous deletion at D10S1265 is significantly correlated with Dukes staging, while the other loci are not significantly correlated with clinicopathological factors. Conclusion Two high frequency LOH regions were found in 10q23-24 of sporadic colorectal cancer: 10q23.33 and 10q24.2~24.31. Besides the para-phospholipase homogeneous protein (PTEN) gene, there may be other tumor suppressor genes associated with sporadic colorectal cancer.

Evidence-based medicine is a medical practice based on evidence [1]. No matter what the mode of medical practice is, it must bring health benefits to patients in the end. Only effective intervention measures can produce real benefits, and misuse of ineffective measures means waste of resources and unnecessary harm to patients. Scientific research is the most reliable method to prove the effect of medical measures, and evidence-based medicine is an action that transforms scientific research results into health benefits.

The understanding and expectation of evidence-based medicine influence the allocation of social resources, the development and the function of evidence-based medicine.<In 2004, two reviews were published in Chinese Medical Journal, which discussed the main misunderstandings and the orientation of evidence-based medicine in China [1, 2]. The editor's note issued before the second review introduced the purpose of organizing the discussion or debate about evidence-based medicine.<When discussing the definition, concept, connotation, essence and status of evidence-based medicine, we should explain the basic point, direction and criterion of the discussion, and then incorporate several representative main viewpoints into the criterion for analysis, so as to select or "synthesize" a relatively reasonable viewpoint. The viewpoints used to position evidence-based medicine all reflect some characteristics of evidence-based medicine, but it is more appropriate to interpret evidence-based medicine by methodology.

In recent years, with the maturity of the theory of nervous system plasticity, the relationship between early fine motor skills development and cognitive development has aroused great interest among brain scientists. Studies in psychology, behavior, neuroanatomy, function, neuroelectrophysiology, molecular biology and other fields suggest that there may be a temporal and spatial overlap between early fine motor skills development and brain cognitive development. The smooth and effective development of early fine motor skills may be beneficial to the maturation of early brain structure and function, and then promote the development of cognitive system.

locally advanced cervical cancer refers to high-risk cervical cancer with poor prognostic factors. Its broad range includes cervical cancer stage IB 2~ IVa, and in narrow sense it refers to early cervical cancer with local tumor ≥4 cm [1]. Radiotherapy is a traditional treatment method, but the 5-year survival rate is only about 40% [2, 3]. Therefore, many scholars at home and abroad have tried to change this situation through continuous improvement of surgical skills, radiation equipment and technology, but it has not worked, so people have turned their attention to chemotherapy. Since 1980s, neoadjuvant chemotherapy (NACT) has been gradually applied to locally advanced cervical cancer. Although some literatures believe that it has positive significance for the treatment of locally advanced cervical cancer, there are still controversies. Therefore, we summarize the progress of this aspect at home and abroad in recent years as follows.

Abnormal pancreaticobiliary junction (APBDJ) can cause a variety of biliary pancreatic diseases, especially its malignant tendency is more remarkable. APBDJ complicated with pancreaticobiliary duodenal junction (PDDU) carcinoma is rare and difficult to find in clinic. We recently found 2 cases of APBDJ complicated with PDDU carcinoma, and the experience of diagnosis and treatment is summarized as follows.

A 5-month-old female was admitted to the hospital due to fever for 2 days. From 3 months after birth to before admission, the child had 3 repeated fever, and the body temperature was between 38.5℃ and 40.2℃. The first 2 times were simple fever without other accompanying symptoms, and all were diagnosed and treated as upper respiratory tract infection in the outpatient clinic of the local hospital. The third time was admitted to the hospital due to high fever (body temperature was 40.2℃) with convulsions once, and was diagnosed as meningitis in the local hospital. Cerebrospinal fluid, brain CT, chest X-ray and other examinations showed no abnormal findings except white blood cell increase.

Extended thymectomy is the first choice for the treatment of myasthenia gravis at present, and its efficacy is better than that of medication alone. In this study, the quantitative MG score (QMG) published by the American Association for Myasthenia Gravis in 2000 [1] was used to study the postoperative efficacy and the influencing factors of 121 patients with myasthenia gravis.

The intervertebral foramen of lower lumbar vertebra is a part where nerve roots are easily compressed, and its incidence rate accounts for 8% ~11% of all nerve root compressions [1]. However, some biomechanical experiments have shown that when intervertebral foramen stenosis occurs, nerve roots are not directly compressed by the intervertebral foramen itself [2]. Morphological studies on the ligaments in the intervertebral foramen of lower lumbar vertebra have confirmed that the transverse ligaments in the intervertebral foramen exit area are closely related to nerve roots, which may play a certain role in the occurrence of nerve root compression [3].

IL-5 antisense oligonucleotide can inhibit the expression of IL-5 mRNA and protein in CD4+ T lymphocytes of asthmatic rats with an inhibitory efficiency of nearly 60% [1]. Among the vectors of gene therapy, adeno-associated virus (AAV) has many advantages, it hardly causes the host immune response, and can integrate the target gene into the chromosome, so that the foreign gene can be expressed for a long time, so it has been widely used in scientific research [2, 3]. We constructed the recombinant adeno-associated virus eukaryotic expression vector plasmid pasIL-5/rAAV inserted with antisense IL-5 sequence, and observed the effect of transfection of this plasmid on the expression of IL-5 mRNA and protein in CD4+ T lymphocytes of asthmatic rats.

Animal experiments have shown that transesophageal arterial oxygen saturation (SteO2) is more sensitive than surface pulse oxygen saturation (SpO2) [1]. The purpose of this experiment is to explore the rapid response performance of SteO2 to the sudden change of hypoxia in clinical application, so as to guide clinical monitoring.

stapled hemorrhoidopexy (stapled hemorrhoidopexy) has been standardized since it was invented by Dr. Longo, and has been applied in many countries. Many controlled studies have shown that the patients' postoperative pain is significantly reduced and their recovery is quicker after using this procedure. However, most of the research reports are from highly specialized anorectal centers, and there are no reports on the long-term effects after surgery. Therefore, Gravie et al. conducted a prospective, randomized controlled clinical study for 2 years in 7 medical centers in France to compare the long-term efficacy of stapled hemorrhoidopexy with traditional Milligan-Morgan hemorrhoidopexy. The results were published in July 2005<Ann Surg, 2005, 242:29-35.

X-linked adrenoleukodystrophy (X-ALD) is an X-linked recessive hereditary disease. Two children with X-ALD were treated by hematopoietic stem cell transplantation (HCT) in August 2004 and May 2005. Two children were diagnosed with early X-ALD by clinical and laboratory family genetic disease screening, and both were treated with HCT by father. One of them was followed up for nearly 1 year. Through clinical observation such as regular neurological and growth and development assessment, it was confirmed that the condition was stable after transplantation. Another case was still under follow-up observation.