INTRODUCTION: Surgical resection of the primary and metastatic tumour is increasingly recommended in suitable patients with metastatic colorectal cancer (CRC). While the role of metastasectomy is well studied and established in colorectal liver metastasis, evidence remains limited in pulmonary metastases. This systematic review was conducted to examine the current evidence on the role of lung metastasectomy (LUM) in CRC. METHODS: Three databases were systematically searched, to identify studies that compared survival outcomes of LUM, and factors that affected decision for LUM. RESULTS: From a total of 5,477 records, 6 studies were eventually identified. Two papers reported findings from one randomised controlled trial and 4 were retrospective reviews. There was no clear survival benefit in patients who underwent LUM compared to those who did not. When compared against patients who underwent liver metastasectomy, there was also no clear survival benefit. Patients who underwent LUM were also more likely to have a single pulmonary tumour, and metachronous disease. CONCLUSION The evidence suggests a role for LUM, but is limited by inherent selection bias in retrospective reviews, and the single randomised clinical trial performed was not completed. More prospective studies are required to understand the true effect of LUM on outcomes in metastatic CRC.
Colorectal Neoplasms/surgery* ; Humans ; Liver Neoplasms/surgery* ; Lung Neoplasms/surgery* ; Metastasectomy ; Pneumonectomy ; Prognosis ; Randomized Controlled Trials as Topic ; Retrospective Studies ; Survival Rate

In recent years the role of sphingosine kinase 2 (SphK2), a key enzyme in the sphingolipid pathway, in the process of tumorigenesis has gradually been elucidated. Recent research has shown that SphK2 inhibitors can be used as anticancer drugs alone or in combination with existing drugs to increase the therapeutic sensitivity of drug-resistant tumors. Among them, one selective SphK2 inhibitor, ABC294640, shows excellent oral bioavailability and biodistribution in vivo and has now entered Phase II clinical research. Therefore, developing innovative drugs based on SphK2 is of great interest. Herein, we discuss progress in understanding the role of SphK2 in tumorigenesis and review the recent development of inhibitors of SphK2.

Objective To investigate the prevalence and molecular features of Cryptosporidium in sheep and goats from Anhui Province and neighboring provinces. Methods A total 832 and 781 fresh fecal samples were collected from seven large-scale sheep farms and ten large-scale goat farms in Anhui Province and neighboring provinces of Henan, Jiangsu and Shandong. The prevalence and species of Cryptosporidium were investigated in the fecal samples from the sheep and goats in the study areas using nested PCR assay based on the Cryptosporidium-specific SSU rDNA gene, and the subgenotypes of C. parvum and C. ubiquitum were characterized by amplification and sequencing of the 60 kDa glycoprotein (gp60) gene. Results The overall prevalence of Cryptosporidium was 5.8% (48/832) in sheep and 8.7% (68/781) in goats in Anhui Province and neighboring provinces, respectively. The SSU rDNA gene-based PCR assay identified C. xiaoi and C. ubiquitum in sheep and C. parvum in goats, and subtyping revealed that all C. ubiquitum subgenotypes belonged to XIIa subtype 2 and C. parvum subgenotypes belonged to IIdA19G1. Conclusion The identification of zoonotic C. ubiquitum XIIa subtype 2 and C. parvum subtype IIdA19G1 suggests that sheep and goats may serve as a potential source for human Cryptosporidium infections.

Objective To evaluate the risk factors for intraoperative hemodynamic instability (HI) in patients with adrenal incident pheochromocytoma.Methods Perioperative clinical parameters of patients undergoing surgery for adrenal incident pheochromocytoma at the First Hospital of Peking University from January 2001 to July 2018 were analyzed.There were 39 males and 41 females,with mean age of 45.1 years (13-76 years old).The median tumor length was 5.1 cm (1.5-14.0 cm),with 25 cases (31.3％) on the left side,55 cases (68.8％) on the right side.There were 37 cases combined with coronary heart disease or diabetes or BMI≥24 kg/m2.Patients were divided into hemodynamic instability (HI group) and hemodynamic stability group (HS group) by whether intraoperative hemodynamic instability occurred.The differences of demographic characteristics and clinical parameters between the two groups were compared.Logistic regression analysis was done for seeking the risk factors for hemodynamic instability during surgery.Results There were 54 cases (67.5％) in the HS group and 26 cases (32.5％) in the HI group.Univariate analysis showed that there was no significant difference in age [(44.06 ± 13.58) years old vs.(47.35 ± 16.11) years old],combined with coronary heart disease or diabetes or BMI≥24 kg/m2 [50.0％(27/54) vs.38.5％ (10/26)],tumor long diameter [median 5.0 cm(1.5-14.0 cm) vs.6.0cm(1.5-13.5 cm)],tumor location [left:29.6％ (16/54) vs.34.6％ (9/26)],preoperative catecholamine test positive [44.4％ (20/45) vs.50.0％ (10/20)],open surgery [27.8％ (15/54) vs.34.6％ (9/26)]and preoperative non-alpha blockers[13.0％ (7/54) vs.30.8％ (8/26)] between HS group and HI group (P ＞ 0.05).Further logistic regression analysis was used to analyze the risk factors of intraoperative hemodynamic instability.Multivariate analysis found that patients who preoperative non-alpha blockers before surgery were independent risk factor for HI (OR =4.574,95 ％ CI 1.273-16.432,P =0.020).Conclusions Preoperative non-alpha blocker in patients with adrenal incidental pheochromocytoma could be independent risk factor for intraoperative hemodynamic instability.Therefore,it is recommended that patients with adrenal incidental tumors,especially those who fail to rule out pheochromocytoma,take preoperative alpha blockers.

[Objective]To ascertain the status and related factors of antiretroviral therapy adherence and analyze the influence of management mode on adherence in HIV infected patients in Jing' an District, Shanghai. [Methods]We recruited 150 HIV infected patients who participated in the "peer group care"activities (target group) and those from another 150 patients who did not (control group) but received antiviral treatment during the period from 2015 to 2016 (221 cases in total) into the study. We collected data on general conditions, behavioral way, antiretroviral therapy adherence, life quality, social support, mental status and medical coping modes, and analyzed the related factors of antiretroviral therapy adherence by linear regression model. [Results]The 221 HIV infected patients were included, with 124 in target group and 97 in control group. The proportion of good antiretroviral therapy adherence was 86.0％, with 91.9％ in target group and 78.4％ in control group. Multiple analysis showed that the related factors of antiretroviral therapy adherence were management mode (β = 1.871, P < 0.001) , disposable income per month (β = 0.600, P = 0.001) , social support utilization (β = 0.174, P = 0.044) and yield attitude of medical coping modes (β =-0.153, P = 0.003). [Conclusion]Antiretroviral therapy adherence of HIV infected patients in Jing'an District should be further improved. "Peer group level care and management mode"could effectively promote the increase of antiretroviral therapy adherence; however, it should be improved and perfected in the aspects of its coverage and content.

A comprehensive physician authorization management system has been established at Renmin Hospital of Wuhan University in its effort of promoting the clinical standardization.This system covers authorization of prescription,disposition,surgery,and medical report among others,adhering to the principle of clear,complete quantitative competence-based,authorization.The training and assessment of physicians in parallel canimprove physicians' competence and quality of care.