Good Short-term Efficacy Research Articles

Short-term Efficacy Study of Lower Tibial Combination Separation in the Treatment of TightRopeight

Objective: To explore the recent efficacy of Lower TibialCombination Separation in the treatment of TightRopeight.Methods: 60 patients were selected as object with lower tibialcombination separation treated in our hospital from May 2013 toMay 2016. All patients were treated with TightRopeight, and theshort-term efficacy has been analyzed. Results: Apart from the 5cases of inflammatory response, other patients were healed wellwith lower intraoperative blood loss and no postoperative re-fracture. The excellent rate of AOFAS score was 96.67%.Conclusion: Applying TightRopeight in the treatment of patientswith lower tibial combination separation can not only achieve goodshort-term efficacy, but also have lower recurrence and highersafety rate a, which is worthy of further promotion and applicationin clinical practice.

Clinical outcome of laparoscopic complete mesocolic excision in the treatment of right colon cancer

BackgroundThis study aimed to investigate the clinical outcome of complete mesocolic excision (CME) with a caudal-to-cranial medial approach in the treatment of right colon cancer.MethodsThe clinical data of 172 patients who underwent laparoscopic CME for right colon cancer and were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2010 to April 2015 were retrospectively analyzed. The 3-year disease-free survival (DFS) and overall survival (OS) in relation to gender, age, history of abdominal surgery, tumor size, complications, and tumor–node–metastasis (TNM) classification were analyzed using the Kaplan–Meier survival curves.ResultsA total of 172 patients with 94 males and 78 females were included. The average surgical time was 113.5 ± 34.4 min, blood loss was 74.2 ± 28.1 mL, and the number of lymph nodes retrieved was 23.3 ± 9.2. No readmission or death occurred within 30 days after surgery. Postoperative complications occurred in 16.3% of the patients, which included wound infection (3 patients), chylous fistula (22 patients), anastomotic leakage (1 patient), anastomotic bleeding (1 patient), and lung infection (1 patient). The 3-year DFS and OS were 81.7 and 89.1%, respectively. The rate of DFS and OS was significantly higher in stages I and II compared with that in stage III (P < 0.05), and in stages IIIA and IIIB compared with that in stage IIIC (P < 0.05).ConclusionsLaparoscopic CME with a caudal-to-cranial medial approach in the treatment of right colon cancer had good short-term efficacy and satisfactory oncological outcome.

Clinical efficacy of superior mesenteric artery-oriented laparoscopic complete mesocolic excision in the treatment of right colonic cancer

To investigate the clinical efficacy of superior mesenteric artery (SMA)-oriented laparoscopic complete mesocolic excision (CME) with a medial-to-lateral approach in the treatment of right colonic cancer. A total of 166 patients with right colonic cancer who were admitted to The First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2016 underwent SMA-oriented laparoscopic CME by the same surgical team. Clinical data of these patients were retrospectively analyzed. All the 166 cases were enrolled in this study, including 96 male and 70 female patients. Right colon adenocarcinoma was diagnosed by preoperative colonoscopy, enhanced computerized tomography(CT) and pathological examination, and the tumor was resectable. There were no emergency surgery patients for bowel obstruction or perforation, no patients with multiple primary cancers, and no stage IIII( patients with liver or lung metastasis. All the patients underwent SMA-oriented laparoscopic CME successfully, without conversion to laparotomy. No ureteral injury, duodenal injury, and superior mesenteric vein injury occurred during the operation. R0 resections were performed in all the cases. The average operation time was (102.4±28.3) min, blood loss was (67.2±26.3) ml, number of lymph nodes retrieved was 20.5±7.6, postoperative anal exhaust time was (2.1±1.1) d, postoperative hospital stay was (7.9±1.4) d. There was no perioperative death or anastomotic leakage. Two patients with small bowel obstruction were readmitted within 30 days after operation. The postoperative complications occurred in 15.1%(25/166) of the patients, including wound infection (2 cases), chylous fistula (20 cases), anastomotic bleeding (1 case), small bowel obstruction (2 cases). A total of 161 patients (97.0%) were followed up for 1 to 24 months, and 10 patients had distant metastasis during the follow-up period. The 2-year overall survival (OS) rate was 96.4%. Superior mesenteric artery-oriented laparoscopic complete mesocolic excision with a medial-to-lateral approach for right colonic cancer has good short-term efficacy.

Peroral endoscopic myotomy as salvation technique post‐Heller: International experience

Treatment for achalasia has traditionally been Heller myotomy (HM). Despite its excellent efficacy rate, a number of patients remain symptomatic post-procedure. Limited data exist as to the best management for recurrence of symptoms post-HM. We present an international, multicenter experience evaluating the efficacy and safety of post-HM peroral endoscopic myotomy (POEM). Patients who underwent POEM post-HM from 13 centers from January 2012 to January 2017 were included as part of a prospective registry. Technical success was defined as successful completion of the myotomy. Clinical success was defined as an Eckardt score of ≤3 on 12-month follow up. Adverse events (AE) including anesthesia-related, operative, and postoperative complications were recorded. Fifty-one patients were included in the study (mean age 54.2, 47% male). Technical success was achieved in 100% of patients. Clinical success on long-term follow up was achieved in 48 patients (94%), with a mean change in Eckardt score of 6.25. Seven patients (13%) had AE: six experienced periprocedural mucosal defect treated endoscopically and two patients developed mediastinitis treated conservatively. For patients with persistent symptoms after HM, POEM is a safe salvation technique with good short-term efficacy. As a result of the challenge associated with repeat HM, POEM might become the preferred technique in this patient population. Further studies with longer follow up are needed.

Protection of the Proximal Articular Cartilage During Percutaneous Thermal Ablation of Acetabular Metastasis Using Temperature Monitoring.

To review our initial experience in acetabular cartilage protection from thermal injury with temperature monitoring during percutaneous image-guided tumor thermal ablation. Between June 2015 and December 2016, three consecutive oncologic patients (mean age 58years; range 48-67years) with acetabular bone metastasis underwent percutaneous image-guided thermal ablation procedures along with hip joint cartilage thermal monitoring. Due to the close proximity of the metastatic lesion to the acetabular articular cartilage, a thermosensor device was placed under CT and fluoroscopic guidance near the acetabular roof and next to the ablation zone in order to monitor the local temperature around the articular cartilage. Stand-alone thermal ablation (n=1) and combined thermal ablation with cementoplasty (n=2) were performed to optimize local palliation or disease control. Clinical and radiological outcomes at follow-up were assessed. Three acetabular metastatic lesions were treated with thermal ablation, and temperature monitoring of the acetabular articular cartilage was conducted during the ablation procedure. Mean size of lesions was 1.6cm (range 1.5-2cm). Technical success was achieved in all cases (100%) without any immediate complications. No hip cartilage damage occurred clinically and radiologically. Good palliation and local disease control were achieved in two cases, and in the other case, there was local recurrence and distant progression of hip metastatic disease after 7months of follow-up. Temperature monitoring of the articular cartilage during percutaneous image-guided thermal ablation appears technically feasible with good short-term efficacy in a complex patient subset. Further studies are warranted to confirm these promising initial results.

Tibial osteotomy combined with arthroscopic condylar notch plasty to treat flexion deformity of knee varus osteoarthri-tis

Objective To explore the medial open wedge high tibial osteotomy (OWHTO) combined with arthroscopic condyle plasty with clinical flexion deformity in patients with osteoarthritis of knee varus. Methods From January 2014 to July 2015, 11 cases (11 knees) of varus knee joint flexion deformity were applied the procedure of OWHTO combined with arthroscopic condyle plasty, including 4 male and 7 female; the average age was 52.1 years old (ranged from 48 to 58 years). OWHTO could ad-just the line of force of the lower limbs in coronal plane (the connection line between femoral head center point and the center point of ankle joint) through lateral tibial plateau 62.5% position, and implant allogeneic bone to support posterior inclination an-gle, underwent arthroscopic condyle plasty to improve flexion deformity at the same time. Results 11 patients in this group were all followed up, and the follow-up time was 1-2.5 years, average 1.5 years. No case of fracture nonunion or delayed healing was found. Imaging data was measured to evaluate the mechanical axis of lower extremity by the relative position of tibial plateau, femo-ral tibial angle,femoral notch width index, tibial plateau posterior angle before operation and one year after the operation. The rela-tive position of the mechanical axis of the lower limb through the tibial plateau was 17.4% ± 4.9% preoperatively, and 58.9% ± 3.1% after operation, femoral tibial angle changed from 181.6°±1.2° to 170.3°±1.3°, tibial plateau posterior inclination angle: pre-operative 7.7°±2.2°, postoperative 7.9°±1.9°, femoral notch width index was increased from 0.221±0.007 to 0.272±0.009 after op-eration, flexion deformity angle of preoperative was 11.1°±3.1°, and 1.4°±1.5° one years after operation, VAS score was (6.5±1.1) points before surgery, and (2.5±0.8) points of postoperative, Lysholm score was (50.72±6.57) points before operation, and (75.72±7.41) points one year after operation, and the differences were all statistically significant. Conclusion OWHTO combined with arthroscopic condyle plasty can significantly improve the lower limb line and flexion deformity, and also maintain the posterior in-clination angle of tibial plateau,and can get a good short-term efficacy. Key words: Osteoarthritis, knee; Osteotomy; Genu varum; Treatment outcome

Analysis of short-term efficacy and pathological outcome of paclitaxel plus platinum as neoadjuvant chemotherapy in the treatment of locally advanced cervical cancer.

e17002 Background:The purpose of this study is to observe the short-term efficacy and pathological outcomes of paclitaxel combined with platinum (TP) as neoadjuvant chemotherapy (NACT) regimen in patients with locally advanced cervical cancer (LACC). Methods: This is a prospective study involving 61 women with histologically confirmed LACC referred for NACT at Beijing Obstetrics and Gynecology Hospital between April 2013 and January 2015. Results: The short-term efficacy of NACT was evaluated by the Response Evaluation Criteria in Solid Tumors (RECIST). The short-term efficacy of NACT was 91.8% (complete remission and partial remission). The cervical invasion ≤1/2 was 82.4% in the complete remission (CR) group, 46.2% in the partial remission(PR) group and 20% in the stable disease (SD) group. The difference between groups was statistically significant (p=0.012). The slides of all surgical specimens were reviewed and classified according to Tumor Regression Grade (TRG). The good response was defined by good short-term efficacy (RECIST) and the difference between the groups was statistically significant (p=0.042). The short-term efficacy of NACT in artery intervention (AI) group (70-80%) was better than that in intravenous (IV) group (20%-30%) and the difference was statistically significant (p=0.011). The patients with tumor diameter ≤5cm and multiple cycles of chemotherapy have good short-term efficacy of NACT in LACC. All patients were followed up to the last day of 2015 with the median follow-up time of 21.5 months for NACT. For the 61 patients referred for NACT in LACC, two patients had relapsed and 1 patient died from the disease. Conclusions: The study showed that the Paclitaxel plus platinum as NACT for LACC treatment had a significant local effects. It could reduce tumor myometrial invasion and regress tumor. The short-term efficacy of the treatment in the AI group was more effective than in the IV group, two cycles of NACT of AI treatment to LACC patients would obtain an optimal short-term efficacy. Clinical trial information: NCT02471027.

Efficacy of preoperative neoadjuvant simultaneous integrated boost intensity-modulated radiotherapy combined with preoperative chemotherapy for locally advanced rectal cancer: a phase II clinical study

Objective To investigate the feasibility, safety, and short-term efficacy of preoperative capecitabine and simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) followed by one cycle of neoadjuvant capecitabine in patients with locally advanced rectal cancer (LARC). Methods From March 2015 to April 2016, a total of 37 patients with LARC were enrolled in this study. They received capecitabine (825 mg/m2 orally twice daily for 5 weeks, days 1-5 weekly) and SIB-IMRT (58.75 Gy in 25 fractions for rectal lesion and positive lymph nodes and 50.00 Gy in 25 fractions for pelvic lymphatic drainage area). After the concurrent chemoradiotherapy, they were allowed to rest for one week. And then they received one cycle of induction chemotherapy with capecitabine (1250 mg/m2 orally twice daily for 14 days). And total mesorectal excision (TME) was scheduled at 6-8 weeks after the concurrent chemoradiotherapy. The primary endpoint was pathologic complete response (pCR) rate, and the secondary endpoints included tumor and nodal (TN) downstaging rate, the rate of sphincter-preserving surgery, and adverse events. Results All the 37 patients successfully received the preoperative concurrent chemoradiotherapy. Only 32 patients underwent the surgical resection, 4 patients refused surgery due to symptom relief, and 1 patient delayed surgery due to perianal edema after radiotherapy. The pCR rate was 34%(11/32); the TN downstaging rate was 91%(29/32); the R0 resection rate was 100%; 24 patients (75%) underwent the sphincter-preserving surgery. During the period of chemoradiotherapy, most of the patients experienced grade 1/2 acute adverse events and grade 3/4 adverse events occurred in 3 patients. The postoperative complications included ureteral injury (1 patient) and intestinal obstruction (1 patient), and no death occurred in the perioperative period. Conclusions For patients with LARC, preoperative SIB-IMRT combined with one cycle of capecitabine followed by TME is safe and feasible, and has good short-term efficacy and mild acute adverse events. Key words: Rectal neoplasms/intensity modulated radiotherapy; Intensity modulated radiotherapy, boost; Rectal neoplasms/chemotherapy; Capecitabine

Three-year Randomized Clinical Study of a One-step Universal Adhesive and a Two-step Self-etch Adhesive in Class II Composite Restorations.

To evaluate in a randomized clinical evaluation the 3-year clinical durability of a one-step universal adhesive and compare it intraindividually with a 2-step self-etch adhesive in Class II restorations. Each of 57 participants (mean age 58.3 years) received at least two extended Class II restorations that were as similar as possible. The cavities in each of the 60 individual pairs of cavities were randomly distributed to the 1-step universal adhesive (All-Bond Universal: AU) and the control 2-step self-etch adhesive (Optibond XTR: OX). A low shrinkage composite (Aelite LS) was used for all restorations, which were evaluated using slightly modified USPHS criteria at baseline and 1, 2, and 3 years. 114 Class II restorations were evaluated at three years. Eight restorations, 3 AU and 5 OX, failed during the follow-up, resulting in 94.7% (AU) and 91.2% (OX) success rates (p > 0.05). Annual failure rates were 1.8% and 2.9%, respectively.The main reason for failure was composite fracture. Class II composite restorations placed with a 1-step universal adhesive showed good short-term efficacy.

Efficacy analysis of laparoscopic curve resection for gastric gastrointestinal stromal tumor

To evaluate the feasibility and safety of curved cutter stapler in laparoscopic curve resection for gastric gastrointestinal stromal tumor(GIST). A retrospective clinical study was carried out with the clinical data of 19 cases of gastric GIST, who received laparoscopic curve resection with the curved cutter stapler during the period between January 2015 and December 2015 in Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University. Curved cutter stapler was used intraoperatively to run curve resection for stomach, at least 0.5 cm away from the tumor outer margin. If the curved cutter stapler could not completely cut off the gastric wall at first time, the linear cutter stapler would be used secondly to cut off the remaining gastric wall. All the cases were successfully performed under laparoscopy, without conversion to open surgery and the occurrence of severe complications. Fourteen(73.7%) patients received complete transection by the first curved cutter stapler, the other 5(26.3%) cases accepted complete transection by the second linear cutter stapler. The operative time ranged from 50 to 100(71.8±12.7) minutes, the blood loss ranged from 20 to 50 (33.6±7.4) ml, the postoperative exhaust time ranged from 1 to 4 (2.4±0.9) days, the postoperative hospital stay ranged from 5 to 9(6.8±1.1) days. There was no patient suffered from incision infection, delayed gastric emptying, anastomotic leakage and anastomotic bleeding. The postoperative pathological examination confirmed that all the cases were GIST. The tumor length ranged from 1.5 to 5.5(2.9±1.1) cm, the resection margin ranged from 0.5 to 2.0(1.2±0.4) cm and all the patients had negative resection margins. Of the 19 cases, 8(42.1%) were classified as very low risk, 5(26.3%) as low risk, 5(26.3%) as moderate risk and 1(5.3%) as high risk according to the National Institute of Health classification. Six patients with moderate and high risk were treated with imatinib. In the follow-up time of 5 to 16 months(mean 10 months) after operation, no distant metastasis and local recurrence occurred in all the cases. The application of curved cutter stapler in laparoscopic curve resection for GIST is safe and feasible with good short-term efficacy.

Long-term outcomes of hallux valgus treated by the suturing of fascial flap of bursa of hallux with the tendon of adductor hallucis

Objective To evaluate the long-term clinical effect of adductor pollicis and pollicis sac fascial flap anastomosis for hallux valgus. Methods Data 12 cases with hallux valgus who who were treated by adductor pollicis and pollicis sac fascial flap anastomosis from April 1993 to November 1996 and were followed up for more than 19 years were retrospectively analyzed. All the patients were female with an average age of 43.6±7.6 years old (range, 24-56 years). HVA, IMA, and tibial sesamoid position (TSP) were measured by foot X-ray and compared between presurgery, 4 years postsurgery and 19 years postsurgery. The American Orthopaedic Foot and Ankle Society (AOFAS), hallux metatarsophalangeal joints, interphalangeal joint function scores were used to evaluatethe foot function. Patient satisfactions were investigated by Glynn's comprehensive clinical evaluation and hallux score. Results Average preoperative HVA was 30.68°±9.71°, and average 1st and 2nd IMA was 12.92°±4.02°. Average HVA 4 years and 19 years post-op were 24.62°±7.61° and 21.47°±6.52°, and average 1st and 2nd IMA were 7.32°±3.21° and 6.15°±2.92°, which were significantly less than those of pre-surgery. Average TSP was 4.46±1.03, average TSP 4 years and 19 years post-op were 2.01±0.75 and 1.79±0.62, which were significantly less than those of pre-surgery. There was no significant difference between 4 years and 19 years post-op. The incidence of plantar anterior callus was 95.2% (20/21); the incidence of pain was 85.7% (18/21), and the number of the corpus callosum was significantly reduced 19 year post-op. Only 1 foot had painful callus under the head of third metatarsal, and the rest of the corpus callosum were painless; the incidence of the corpus callosum was 33.3% (7/21); the incidence of pain of the corpus callosum was 4.7% (1/21); the incidence of pain of the corpus callosum was 4.7%, and patients with long-term improvement of the effect of the corpus callosum was significantly better than preoperative. The results of postoperative follow-up Glynn comprehensive clinical evaluation were 16 excellent feet, 2 good feet, 3 poor feet, and the excellent rate was 88.5% (18/21); the results of Glynn toe evaluation were 18 excellent feet, 3 good feet, and the excellent rate was 100%. Conclusion The adductor pollicis and pollicis sac fascial flap anastomosis in the treatment of hallux valgus can obtain good short-term and long-term clinical efficacy, by which postoperative hallux valgus deformity is excellently corrected, and the rate of patient satisfaction is high. Key words: Foot; Hallux valgus; Follow-up studies

The 2-year efficacy study of femtosecond laser corneal small incision lenticule extraction for correction of myopia and myopic astigmatism

Background Researches showed that femtosecond laser corneal small incision lenticule extraction (SMILE) was used in the correction of myopia and myopic astigmatism due to its fast recovery, good short-term efficacy and few complications.However, few research focused on its long-term efficacy. Objective This study was to evaluate the effectiveness, safety, predictability, stability and complications of SMILE. Methods A serial cases-observational study was carried out under the approval of Ethic Committee of Henan Eye Institute and informed consent of patients.Sixty-seven eyes of 34 patients with myopia and myopic astigmatism were included in Henan Eye Institute from January to June 2013.All the patients received SMILE and followed-up for 2-year duration.The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), automatic optometry, intraocular pressure and corneal topography were examined before surgery and 1 day, 1 week, 1 month, 3 months, 1 year and 2 years after surgery and calculated the spherical equivalent (SE). The long-term efficacy of SMILE included effective index (preoperative BCVA/postoperative UCVA), safety index (postoperative BCVA/ preoperative BCVA), predictability (linear regression analysis between actual SE and attempted SE) and refractive stability (SE changes at postoperative time points). Results The preoperative BCVA was ≥20/20 in 60 eyes with the percentage of 89.55%.UCVA≥20/20 were found in 61 eyes and 60 eyes in postoperative 3 months and 2 years respectively (91.04% and 89.55%). The effective index was 1.038±0.182 and 1.029±0.231 in postoperative 3 months and 2 years respectively, showing an insignificant difference between them (t=0.400, P>0.05). Compared with the preoperative BCVA, 8.96% (6/67) and 10.45% (7/67) eyes lost 1 line at 3 months and 2 years after surgery, respectively.The safety indexes were 1.141±0.193 and 1.312±0.242 at 3 months and 2 years after surgery, with no significant difference between them (t=0.414, P>0.05). A linear correlation was found between actual SE and attempted SE both at postoperative 3 months and 2 years, with the linear regression equations of Y=0.897 1X-0.440 8 (R2=0.914 2, P<0.05) and Y=0.893 7X-0.382 3 (R2=0.915 7, P<0.05), respectively.The SE was (0.013±0.578), (-0.033±0.489), (-0.106±0.508), (-0.103±0.375), (-0.154±0.518) and (-0.147±0.366)D 1 day, 1 week, 1 month, 3 months, 1 year and 2 years after surgery, respectively, and there were no significant difference among different time points (F=0.185, P=0.176). Eighteen in the 67 eyes occurred opaque bubble layer after surgery.Diffuse lamellar keratitis appeared in 6 eyes and punctate keratitis was in 2 eyes.These complications were cured 1 month after administration of drugs. Conclusions SMILE is good in effectiveness, safety, predictability and refreactive stability and has fewer complications during 2-year following-up. Key words: Corneal stroma/surgery; Laser therapy; Treatment outcome; Myopia/surgery; Astigmatism/surgery; Femtosecond laser; Corneal lenticule extraction; Small incision; Human

Hypofractionated radiotherapy for organ-confined prostate cancer: is less more?

Moderate hypofractionation of radiotherapy is widely considered a viable alternative to conventional fractionation for the treatment of patients with organ-confined prostate cancer, but stereotactic body radiotherapy (SBRT) is rapidly emerging as a novel treatment modality for this disease. Advances in treatment planning, image guidance, target position reproducibility and on-line tracking, coupled with a compelling radiobiological rationale, have promoted SBRT as a safe and effective treatment. Dose escalation to the tumour tissue through a decreased number of radiation fractions improves patient comfort and convenience, as well as treatment cost-effectiveness, compared with conventional radiotherapy regimens. Several clinical trials have investigated moderate and extreme hypofractionation of radiotherapy in patients with prostate cancer. Evidence is accumulating which suggests that the use of moderately hypofractionated radiotherapy can be recommended regardless of cancer risk group. Regimens of extremely hypofractionated radiotherapy have shown very good short-term efficacy and safety outcomes, but appropriately designed trials with extended follow-up monitoring are required to confirm long-term outcomes.

Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus.

To review outcomes and local evolution of treated lesions following percutaneous image-guided screw fixation (PIGSF) of pathological/insufficiency fractures (PF/InF) and impeding fractures (ImF) in cancer patients at two tertiary centres. Thirty-two consecutive patients (mean age 67.5years; range 33-86years) with a range of tumours and prognoses underwent PIGSF for non/minimally displaced PF/InF and ImF. Screws were placed under CT/fluoroscopy or cone-beam CT guidance, with or without cementoplasty. Clinical outcomes were assessed using a simple 4-point scale (1=worse; 2=stable; 3=improved; 4=significantly improved). Local evolution was reviewed on most recent follow-up imaging. Technical success, complications, and overall survival were evaluated. Thirty-six lesions were treated with 74 screws mainly in the pelvis and femoral neck (58.2%); including 47.2% PF, 13.9% InF, and 38.9% ImF. Cementoplasty was performed in 63.9% of the cases. Technical success was 91.6%. Hospital stay was ≤3days; 87.1% of lesions were improved at 1-month follow-up; three major complications (early screw-impingement radiculopathy; accelerated coxarthrosis; late coxofemoral septic arthritis) and one minor complication were observed. Unfavourable local evolution at imaging occurred in 3/24 lesions (12.5%) at mean 8.7-month follow-up, including poor consolidation (one case) and screw loosening (two cases, at least 1 symptomatic). There were no cases of secondary fractures. PIGSF is feasible for a wide range of oncologic patients, offering good short-term efficacy, acceptable complication rates, and rapid recovery. Unfavourable local evolution at imaging may be relatively frequent, and requires close clinico-radiological surveillance.

Efficacy of Brachytherapy Synchronized Chemotherapy with Docetaxel, Cisplatin, 5-Fluorouracil for Unresectable Head and Neck Squamous Cell Carcinoma

Background: Brachytherapy is a form of targeted therapy and has shown good short-term efficacy in clinical practice. Objective: A clinical trial was conducted to determine the feasibility and safety of radioactive iodine 125 seeds implantation synchronized chemotherapy with docetaxel, cisplatin, 5-fluorouracil (TPF). Materials and methods: A total of 23 previously untreated patients with histologically documented advanced unresectable head and neck squamous cell carcinoma (HNSCC) underwent percutaneous radioactive iodine 125 seeds interstitial implantation, and simultaneously received three cycles of chemotherapy every 21 days at a dose of 75 mg/m2 docetaxel D1, 75 mg/m2 cisplatin D1, 750 mg/m2 5-fluorouracil D ~5. The effectiveness of treatment was evaluated based on tumor size and clinical symptoms in patients. Results: The overall responding rate was 78.3%. No acute complications and treatment related radiation damages occurred in the trail. A progression-free survival of 60.9% and overall survival of 52.2% was achieved at 2 years. Four patients died of cardiovascular and local recurrence. Conclusion: The scheme of brachytherapy based on iodine 125 seeds implantation synchronized chemotherapy is a mildly invasive, effective and safety regimen for advanced head and neck squamous cell carcinoma.

Comparative investigation of efficacy of epirubicin joint docetaxel for triple-negative and non-triple-negative breast cancer

Objective To investigate clinical efficacy of epirubicin joint docetaxel for triple-negative and non-triple-negative breast cancer, to provide reference for clinical treatment. Methods A retrospective analysis of 80 cases with breast cancer was conducted, 26 patients with triple-negative breast cancer were set as study group, and 54 patients with non-triple negative breast cancer were set as control group.All patients used epirubicin docetaxel chemotherapy, the curative effect, survival rate, toxicity were compared between the two groups. Results The chemotherapy response rate of triple-negative breast cancer group was 84.62%, which was significantly higher than 53.70% in non-triple-negative breast cancer group (χ2=6.45, P<0.01). The 5-year disease-free survival rate, overall survival rate of triple-negative breast cancer group were 50.00%, 73.08%, which were significantly lower than those of non-triple-negative breast cancer group (χ2=5.89, P<0.01; χ2=4.19, P<0.01). The incidence rates of constipation, nausea, vomiting, leukopenia, neutropenia Ⅲ-Ⅳ degrees reaction were 13.75%, 10.00%, 15.00%, 13.75%, and the overall incidence rates were 41.25%, 42.50%, 41.25%, 43.75% respectively. Conclusion Epirubicin joint docetaxel adjuvant chemotherapy has good short term efficacy for triple negative breast cancer, but its long-term efficacy is poor to non-triple-negative breast cancer. Key words: Breast neoplasms; Epirubicin; Docetaxel

Efficacy comparison between pylorus-preserving pancreaticoduodenectomy and standard pancreaticoduodenectomy for periampullary carcinoma

Objective To compare the short-term efficacy of pylorus-preserving pancreaticoduodenectomy (PPPD) and standard pancreaticoduodenectomy (SPD) for the treatment of periampullary carcinoma. Methods The clinical data of 85 patients with periampullary carcinoma who were admitted to the Zhongshan Hospital of Fudan University from October 2010 to October 2012 were retrospectively analyzed. Forty-four patients who underwent PPPD were divided into the PPPD group and 41 patients who underwent SPD were divided into the SPD group. The pancreatic fistula(Grade B and above), biliary fistula, blood loss, intra-abdominal infection, delayed gastric emptying (DGE) and prognosis were analyzed. Patients were followed up by telephone interview and outpatient examination once every 3 months within postoperative 1 year and once every 6 months within postoperative 2-3 years till October 2014. Count data were analyzed using the chi-square test, measurement data with normal distribution were presented as M(Qn) and comparison was analyzed using the Mann-Whitney U test. The survival curve was drawn by the Kaplan-Meier method, and survival rate was analyzed using the Log rank test. Results The operation time was 195 minutes (180 minutes, 240 minutes) in the PPPD group and 210 minutes (180 minutes, 300 minutes) in the SPD group, with a significant difference (Z=-2.090, P 0.05). There was no perioperative death and incidence of overall complication was 42.4%(36/85) with pancreatic fistula, intra-abdominal infection and DGE as the top 3 common postoperative complications. The incidence of DGE was 20.5%(9/44) in the PPPD group, which was significantly different from 4.9%(2/41) in the SPD group (χ2=4.571, P 0.05). Eighty-five patients were followed up for 6-47 months with a median time of 31 months, and postoperative overall 1- and 3-year survival rates were 95.3% and 75.5%, respectively. The 1- and 3-year survival rates were 97.7% and 78.9% in the PPPD group, and 92.7% and 71.7% in the SPD group, respectively, with no significant difference in 3-year survival rate (χ2=0.690, P>0.05). The 3-year overall survival rate was 80.5% in patients without lymph node involvement (LNI) compared with 54.9% in patients with LNI, showing a significant difference (χ2=4.290, P<0.05). Conclusions Both PPPD and SPD have good short-term efficacy for periampullary carcinoma. There is no significant difference between PPPD and SPD concerning short-term survival rate of periampullary carcinoma. PPPD has shorter operation time, but has a higher postoperative DGE incidence. LNI is a significant prognostic factor for short-term survival of periampullary carcinoma. PPPD is not recommended while the lymph nodes are involved. Key words: Periampullary neoplasms; Pancreaticoduodenectomy; Delayed gastric emptying; Pancreatic fistula

The safety of telbivudine in preventing mother-to-infant transmission of hepatitis B virus in pregnant women after discontinuation

To determine the efficacy and safety of telbivudine for blocking intrauterine transmission of hepatitis B virus (HBV) in pregnant women with high-load HBV DNA. Women in general good health and pragnant were enrolled for study between the ages of 20 to 40 year-old, with a diagnosis of HBV infection with high-load HBV DNA level (≥1*10(6) IU/ml). According to each participant's willingness, the women were divided into a telbivudine treatment group (82 women) and an untreated control group (75 women). The telbivudine treatment was initiated at gestation week 26 as oral dosing of 600 mg/d and continued until 1 month after the birth.Women in the control group had not gotten any antiviral drug treatment. All of the women delivered by cesarean section, and all of the neonates were administered the standard passive immunization therapy, which consisted of a hepatitis B immunoglobulin (200 IU) injection given within 12 hours of birth and an injection of hepatitis B vaccine (20 µg) at birth and at postnatal month 1 and 6. None of the mother's performed breastfeeding. The telbivudine-treated women showed a significant decrease in HBV DNA levels prior to delivery, as well as significantly decreased prenatal HBV DNA levels (>2 logl0). Efficiency of the telbivudine treatment was 100%. Immediately prior to delivery, 16 (19.5%) of the women in the telbivudine treatment group showed negative HBV DNA status, as opposed to the untreated control group in which no women showed negative status. The telbivudine treatment group had no case of maternal or fetal adverse reaction or of congenital malformation. Use of telbivudine antiviral therapy during late pregnancy in women with high-load HBV DNA can significantly reduce level of HBV DNA in maternal peripheral blood, block HBV intrauterine transmission, and provide good short-term efficacy, with good tolerability and safety.

Angioplasty versus stenting for iliac artery lesions.

Atherosclerosis of the iliac artery may result in a stenosis or occlusion, which is defined as iliac artery occlusive disease. A range of surgical and endovascular treatment options are available. Open surgical procedures have excellent patency rates but at the cost of substantial morbidity and mortality. Endovascular treatment has good safety and short-term efficacy with decreased morbidity, complications and costs compared with open surgical procedures. Both percutaneous transluminal angioplasty (PTA) and stenting are commonly used endovascular treatment options for iliac artery occlusive disease. A stenotic or occlusive lesion of the iliac artery can be treated successfully by PTA alone. If PTA alone is technically unsuccessful, additional stent placement is indicated. Alternatively, a stent could be placed primarily to treat an iliac artery stenosis or occlusion (primary stenting, PS). However, there is limited evidence to prove which endovascular treatment strategy is superior for stenotic and occlusive lesions of the iliac arteries. To assess the effects of percutaneous transluminal angioplasty versus primary stenting for stenotic and occlusive lesions of the iliac artery. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched April 2015) and Cochrane Register of Studies (CRS) (2015, Issue 3). The TSC searched trial databases for details of ongoing and unpublished studies. We included all randomised controlled trials (RCTs) comparing percutaneous transluminal angioplasty and primary stenting for iliac artery occlusive disease. We excluded quasi-randomised trials, case reports, case-control or cohort studies. We excluded no studies based on the language of publication. Two authors (JB, NA) independently selected suitable trials. JB and HJ independently performed data extraction and trial quality assessment. When there was disagreement, consensus would be reached first by discussion among both authors and, if still no consensus could be reached, through consultation with BF. We identified two RCTs with a combined total of 397 participants as meeting the selection criteria. One study included mostly stenotic lesions (95%), whereas the second study included only iliac artery occlusions. Both studies were of moderate methodological quality with some risk of bias relating to selective reporting and non-blinding of participants and personnel. The overall quality of evidence was low due to the small number of included studies, the differences in study populations and definitions of the outcome variables. Due to the heterogeneity among these two studies it was not possible to pool the data. Percutaneous transluminal angioplasty (PTA) with selective stenting and primary stenting (PS) resulted in similar improvement in the stage of peripheral arterial occlusive disease according to Rutherford's criteria, resolution of symptoms and signs, improvement of quality of life, technical success of the procedure and patency of the treated vessel. Improvement in walking distance as reported by the patient, measured claudication distance, ulcer healing, major amputation-free survival and delayed complications (> 72 hours) were not reported in either of the studies. In one trial, PTA of iliac artery occlusions resulted in a significantly higher rate of major complications, especially distal embolisation. The other trial showed a significantly higher mean ankle brachial index (ABI) at two years in the PTA group (1.0) compared to the mean ABI in the PS group (0.91); mean difference (MD) 0.09 (95% confidence interval (CI) 0.04 to 0.14; P value = 0.001, analysis performed by review authors). However, at other time points there was no difference. We consider it unlikely that this difference is attributable to the study procedure, and also believe this difference may not be clinically relevant. There is insufficient evidence to assess the effects of PTA versus PS for stenotic and occlusive lesions of the iliac artery. From one study it appears that PS in iliac artery occlusions may result in lower distal embolisation rates. More studies are required to come to a firm conclusion.

Efficacy analysis of laparoscopic adjustable gastric placation for obesity

To analyze the efficacy and safety of laparoscopic adjustable gastric placation (LAGBP), a new procedure for surgical treatment of obesity. Clinical and 1-year follow-up data of 10 patients who underwent LAGBP in our department between September and November 2011 were analyzed retrospectively. The mean operative time was (93.0±13.4) min, while the mean intraoperative blood loss was (15.5±4.7) ml. The mean excessive body weight loss rate(%EWL) at 3, 6, 9 and 12 months after the operation was 25.1%, 40.6%, 45.3% and 50.8% respectively. There were no severe post operative complications. LAGBP is associated with high safety and good short-term efficacy.