The NCCN has recently released its 2017 version 1.0 guideline for colorectal cancer. There are several updates from this new version guideline which are believed to change the current clinical practice. Update one, low-dose aspirin is recommended for patients with colorectal cancer after colectomy for secondary chemoprevention. Update two, biological agents are removed from the neoadjuvant treatment regimen for resectable metastatic colorectal cancer (mCRC). This update is based on lack of evidence to support benefits of biological agents including bevacizumab and cetuximab in the neoadjuvant setting. Both technical criteria and prognostic information should be considered for decision-making. Currently biological agents may not be excluded from the neoadjuvant setting for patients with resectable but poor prognostic disease. Update three, panitumumab and cetuximab combination therapy is only recommended for left-sided tumors in the first line therapy. The location of the primary tumor can be both prognostic and predictive in response to EGFR inhibitors in metastatic colorectal cancer. Cetuximab and panitumumab confer little benefit to patients with metastatic colorectal cancer in the primary tumor originated on the right side. On the other hand, EGFR inhibitors provide significant benefit compared with bevacizumab-containing therapy or chemotherapy alone for patients with left primary tumor. Update four, PD-1 immune checkpoint inhibitors including pembrolizumab or nivolumab are recommended as treatment options in patients with metastatic deficient mismatch repair (dMMR) colorectal cancer in second- or third-line therapy. dMMR tumors contain thousands of mutations, which can encode mutant proteins with the potential to be recognized and targeted by the immune system. It has therefore been hypothesized that dMMR tumors may be sensitive to PD-1 inhibitors.
Antibodies, Monoclonal ; pharmacology ; therapeutic use ; Antibodies, Monoclonal, Humanized ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Aspirin ; administration & dosage ; therapeutic use ; Bevacizumab ; therapeutic use ; Biological Products ; therapeutic use ; Brain Neoplasms ; drug therapy ; genetics ; Cetuximab ; therapeutic use ; Clinical Decision-Making ; methods ; Colorectal Neoplasms ; drug therapy ; genetics ; pathology ; prevention & control ; therapy ; Contraindications ; Humans ; Mutation ; physiology ; Neoadjuvant Therapy ; standards ; Neoplasm Metastasis ; drug therapy ; Neoplastic Syndromes, Hereditary ; drug therapy ; genetics ; Practice Guidelines as Topic ; Prognosis ; Secondary Prevention ; methods ; standards

Objective：The aim of this study was to investigate the distribution of carcinoembryonic antigen (CEA) in colorectal cancerous tissue and to evaluate its clinicobiological significance, especially its prognostic value. Methods: Distribution of tissue CEA in 189 patients with colorectal cancer were detected with immunohistochemical method, and its relationship with many clinicopathological parameters was analyzed with SPSS software. Results: CEA distributed in both tumor tissue and normal mucosa but there was a significant difference between them. Staining positive rate of CEA in tumor tissue was 96.3％ , with 52.4％ strong and 36.5％ moderate. While in normal mucosa it was 17.4％ , with 16.2％ weak and 1.2％ moderate. There was a close relationship between tissue CEA and many clinicopathological parameters, such as differentiation, invasion depth, metastasis to regional lymph node, preoperative serum CEA level, postoperative tumor recurrence, metastasis, and postoperative survive. Conclusions: CEA overexpression in colorectal cancer tissue. Tissue CEA is a good prognostic indicator for colorectal cancer reflecting its clinicobiological features. Combining tissue CEA with serum CEA level should be better for predicting prognosis,and patient with both elevated preoperative serum CEA level and strong expression of CEA in tumor tissue indicates the worst prognosis.

Therapeutic goal for locally advance rectal cancer (LARC) patients includes long-term survival and function preservation of pelvic organs. During the recent two decades, treatment strategy for LARC is gradually shifing to minimally invasive surgery, even avoiding a major surgery. "Watch and wait (W&W)" strategy is effective in dramatically decreasing surgical trauma and significantly improving preservation of defecation, urination and sexual function. Total neoadjuvant therapy (TNT) shifts all or part of adjuvant chemotherapy to the neoadjuvant phase and has showed obvious advantage in tumor shrinkage and complete clinical response (cCR) achievement. This article will summarize the transition of treatment strategy of LARC towards W&W from standard treatment. After more than ten years of development, both NCCN and ESMO guidelines recommend stratified neoadjuvant treatment considerations based on distinct risk classifications and especially suggest TNT for LARC patients with advanced diseases, which affirms the value of TNT in tumor shrinkage. Although accumulating data show that pelvic control and organ preservation using W&W strategy after cCR is equal or non-inferior to standard surgery, impact on long-term survival still needs prospective randomized controlled study; no consensus has been achieved for the detail of the W&W strategy. Thus W&W strategy is suggested to applied in hospitals specialized in the treatment of rectal cancer within the framework of multiple disciplinary treatment. In view of special medical conditions of our country, we still need to accumulate more experience and data of W&W strategy for rectal cancer patients with appeals for sphincter preservation and actively participate in international researches.

In order to explore new ways in restraining the ascending blood pressure, this paper reports a research on the effects of multi-mode audio frequency pulse modulating laser irradiation with electrical stimulation on the hemorrheology and blood pressure of the spontaneously hypertensive rats (SHR). Forty male SHR were randomly divided into four groups: Group A (control), Group B (treated with electrical stimulation on stomach 36 point (ST-36)), Group C (treated with low level pulse laser irradiation on Erjian acupuncture point), Group D (low level laser irradiation together with electrical stimulation on Erjian acupuncture point and ST-36). Laser irradiation lasted for 45 min/ day, while electrical stimulation lasted for 30 min/day. After 10 days' treatment, we compared the hemorrheology and blood pressure of the rats in the four groups. The results were that values of hemorrheology in group A and group C were obviously improved compared with those in the other two groups. Meanwhile, the blood pressures in the three treated groups (B, C, and D) were lower than in the control group after the treatment, and the value of the rats in group A was the lowest. In conclusion, the treatment the laser irradiation combined with electrodes stimulation on spontaneously hypertensive rats brought better results of hemorrheology and blood pressure in the tested rats.
Acupuncture Points ; Animals ; Blood Pressure ; physiology ; Blood Viscosity ; Electric Stimulation ; Electroacupuncture ; Hemorheology ; physiology ; Hypertension ; blood ; physiopathology ; therapy ; Laser Therapy ; Male ; Rats ; Rats, Inbred SHR

OBJECTIVETo screen human stem cell factor (hSCF) mimetic peptides in vitro with a phage-display random peptide library.

METHODSPhage clones with high hSCF receptor (rc-kit/Ig 1-3)-binding activity was screened from phage-displayed random hepta/dodecapeptide library by phage enzyme-linked immunosorbent assay (ELISA). Phage single DNA was extracted and sequenced. Four kinds of peptide with higher c-Kit/Ig 1-3 binding activity were chosen for synthesis and characterized by using cell proliferation assay with 3-(4,5-dimethylthiazol-2-yl)2,5-diphenyltetrazolium bromide (MTT) method in UT-7 cells.

RESULTSEleven Ph.D.-C7C clones and eight Ph.D-12 phage clones with high hSCF receptor-binding activity were selected from phage-displayed random hepta/dodecapeptide library, respectively. Sequence analysis showed there were no homologous sequence between hSCF and these screened mimetic peptides except one homologous sequence DPSPHTH found in heptapeptide library. All these four synthesized peptides (CE3, CE16, LE4, and LE20), particularly CE16 and LE20, stimulated UT-7 cell proliferation.

CONCLUSIONFour hSCF mimetic peptides were successfully isolated from phage-displayed random peptide library..

Objective:To investigate the effects and potential mechanisms of resveratrol on obesity in elderly mice.Methods:In this study, 3 groups were randomly formed for 32-week-old mice and for 48-week-old mice.The normal diet group received regular chow and 0.3 ml saline by gavage once a day, the high-fat diet group received a high-fat diet(containing 21% fat and 1.25% cholesterol)and 0.3 ml saline once a day, and the high-fat diet plus resveratrol group received a high-fat diet and resveratrol(22.4 mg/kg, dispersed in 0.3 ml saline)by gavage once a day.After 12 weeks, body weight and adipose tissues were measured.Plasma leptin concentrations were determined by an enzyme-linked immunosorbent assay(ELISA), and values for hypertrophic obesity-related indexes of mice were obtained by quantitative real-time PCR.Results:The body weight and the proportion of subcutaneous fat tissues were lower in the high-fat diet plus resveratrol group than in the high-fat diet group[(34.43±3.23)g vs.(53.16±2.16)g, (3.21±1.58)% vs.(4.86±0.64)%, P<0.01], and were similar to those in the normal diet group.Resveratrol had a more obvious inhibitory effect on leptin in elderly mice than in middle-aged mice.In elderly mice, the plasma leptin concentration was lower in the high-fat diet plus resveratrol group than in the high-fat diet group[(0.015±0.009)g/L vs.(0.100±0.027)g/L]and the normal diet group( F=19.85, P=0.001), and it was similar to that in the middle-aged mice on a normal diet.Resveratrol significantly increased the expression of peroxisome proliferator-activated receptor gamma(PPARγ)and glucose transporter 4(GLUT4)and reduced the expression of tumor necrosis factor-α(TNF-α)( F=10.79, 9.31 and 7.02, P=0.003, 0.006 and 0.010). Conclusions:Resveratrol can significantly improve hypertrophic obesity in elderly mice, and the inhibition of leptin secretion and up-regulation of PPARγ may be the key mechanisms.

OBJECTIVE: To investigate the difference of phonation patterns by dividing patients with vocal fold polyps and vocal nodules into two groups according to muscle tension patterns (MTP). METHOD: Fifty-six patients with vocal fold polyps and vocal nodules were divided into two groups according to phonation with MTP or not by video strobolaryngoscopy. RESULT: MTP could be found in 85% patients with vocal nodules and in 55.56% patients with vocal fold polyps. Significant difference was found in patients with/without MTP, and difference was also found in every type of MTP. CONCLUSION MTP lies in most patients with vocal nodules while only part of patients with vocal fold polyps, which indicated that vocal fold polyps and vocal nodules may demonstrate different phona
Adolescent ; Adult ; Aged ; Female ; Humans ; Laryngeal Diseases ; physiopathology ; Male ; Middle Aged ; Phonation ; Polyps ; physiopathology ; Vocal Cords ; pathology ; Voice Disorders ; physiopathology ; Young Adult

Compared with the 2013 version, the basic strategies of diagnosis and treatment for rectal cancer in the 2017 version guideline remain the same. These strategies include accurate local staging approaches which combines digital rectal examination, endorectal ultrasound (ERUS), and high resolution pelvic MRI, and local recurrence risk grading system which combines tumor location/distance, T staging, N staging, EMVI (extramural vascular invasion) and MRF(mesorectal fascia). And personalized therapeutic principle based on the above local risk grading. Main updates for the 2017 version are as following: (1) x-ray chest film is placed by CT scan for baseline staging, and PET-CT is recommended for patients with extensive EMVI on MRI imaging to exclude further distant metastasis. (2) For local recurrence risk grading, there is one new grade clarified as "intermediate group" added to the 2017 version, which includes patients with very low cT3a/b, levators clear, MRF clear or cT3a/b in mid or high rectum, cN1-2, no EMVI. These patients were classified as "bad group" in the old 2013 version. Accordingly, treatment recommendations for this group changed from preoperative CRT or SCPRT followed by TME surgery to TME surgery alone if good quality of TME assured. Another important notice made in the new guideline is to emphasize the critical role of surgical quality of TME, which should be assessed by a pathologist with help of photography of fresh specimen. In summary, 2017 version of ESMO guideline for rectal cancer is a more personalized and clinically relevant guideline.

The primary curative modality for localized rectal cancer is total mesorectal excision (TME). Local control rate of rectal cancer has been improved after neoadjuvant chemoradiotherapy and even pathological complete response (pCR) has been demonstrated in a significant minority. Patients who achieve pCR to neoadjuvant chemoradiotherapy have an excellent prognosis compared with those without pCR. If the patients with complete response to neoadjuvant chemoradiation can be demonstrated by clinical findings and medical imaging (cCR), a non-operative management (NOM) strategy may be pursued to preserve sphincter function and avoid complications induced by TME, which is a new tendency in the treatment of rectal cancer in recent years. Assisting diagnosis of cCR by iconography is the important element of NOM practice. Selected patients should be followed up with intensive surveillance. The curative strategy must be carried out once the recurrence is detected. Imaging modalities, including magnetic resonance imaging (MRI), diffusion-weighted MRI, or proton emission tomography (PET), are limited in their ability to distinguish patients who have achieved cCR. Up to now, MRI, DW-MRI and 18F-FDG PET/CT before neoadjuvant chemoradiotherapy are not accurate enough to predict cCR and safely select patients for organ-sparing strategies. However, depth of tumor infiltration, extramural vascular invasion, circumferential resection margin, and location of rectal cancer can be demonstrated by high resolution MRI as independent risk factors in prediction of long-term survival of patients, which is a necessary manner of stratification treatment for rectal cancer. Therefore, patients who are defined as early rectal cancer with low risk factors are selected as candidates for NOM in recent studies in order to pursue low rate of local recurrence and distant metastasis. High resolution MRI assessment of tumor regression grade (mrTRG) can be used to assess response of rectal cancer to neoadjuvant chemoradiotherapy, which is associated with tumor burden. mrTRG is an imaging marker that indicates the difference in survival between good and poor responders and provides an opportunity for the multidisciplinary team to offer additional treatment options before planning definitive surgery. Functional imaging and even molecular imaging are needed in the future to screen suitable rectal cancer patients who are easier to achieve cCR from neoadjuvant chemoradiotherapy and to evaluate the efficacy of neoadjuvant chemoradiotherapy.

OBJECTIVE: To investigate the clinical presentation, diagnosis and therapy of syphilis with sensorineural deafness. METHOD: Three patients of syphilis with sensorineural deafness were analyzed including the clinical manifestation, serum and therapy response. RESULT: Three patients of syphilis with sensorineural deafness: 2 cases with rapid plasma reagin (RPR) and treponema pallidum particle agglutination (TPPA) positive, 1 case with RPR negative and TPPA positive; 2 cases had been diagnosed with syphilis and treated once; 2 cases with sudden sensorineural deafness and tinnitus, 1 case with tinnitus and high-frequency hearing loss. All cases hadn't another identified cause of the hearing loss or tinnitus. Their hearing loss level weren't improved after therapy. CONCLUSION Sudden hearing loss or nervous tinnitus may be the clinical manifestations of syphilis with sensorineural deafness. It is easy to miss diagnosis in clinical work. Some lab examinations were necessary to diagnose the cases with the etiology unknown of hearing loss, tinnitus or nystagmic.
Adult ; Female ; Hearing Loss, Sensorineural ; etiology ; microbiology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Syphilis ; complications