OBJECTIVE: To explore the prognostic factors of patients with unresectable liver metastasis colorectal cancer after failed conversion chemotherapy. METHODS: A retrospective, case-controlled study was performed. Study subjects were 105 patients who were diagnosed with synchronous liver metastasis colorectal cancer after failed chemotherapy (metastasis evaluated as unresectable after the conversion chemotherapy) at Xinhua Hospital, Shanghai Jiaotong University from January 2012 to December 2015. Overall survival(OS) was retrospectively analyzed using Kaplan-Meier method. Log-rank test was used to compare survival among groups. Univariate and multivariate analysis was conducted for prognosis using Cox regression model. RESULTS: Of 105 cases,70 were male and 35 were female with median age of 60 years old. Twenty-one patients had right colon cancer, 41 had left colon cancer, 42 had rectal cancer and 1 had synchronous cancers(sigmoid colon and rectum). One hundred and two (97.1%) patients were cT3-4 and 90 patients were cN+ (imaging diagnosis). Eighty-nine (84.8%) patients were loaded with 2 or more liver metastases with the median maximum diameter of 48.3 mm. The patients were followed up for 3 to 43 months from the day of diagnosis. The median OS was 11 months (interquartile range, 8-18). The median OS of patients with cN0, cN1 and cN2 stage was 17, 13 and 10 months, respectively(P=0.026). The median OS of patients with single lesion, 2-3 lesions, 4-10 lesions and more than 10 lesions was 15, 15, 17 and 9 months, respectively (P=0.002). OS of patients with maximum diameter of liver metastatic lesion ≤ 50 mm, 51-100 mm and >100 mm was 15, 10 and 8 months, respectively(P=0.003). The median OS of patients with chemotherapy response of partial response (PR), stable disease (SD) and progressive disease (PD) was 17, 14 and 8 months, respectively(P<0.001). OS was 17 months in patients receiving second line chemotherapy and was 10 months in those without second line chemotherapy (P<0.001). OS in patients undergoing primary tumor resection was 13 month and in those without primary tumor resection was 9 months; the difference was not significant (P=0.060). Multivariate analysis showed that cN2(HR=2.115, 95%CI:1.089-4.109, P=0.027), the maximum diameter of liver metastatic lesion more than 100 mm (HR=3.112, 95%CI:1.455-6.657, P=0.003), chemotherapy response of PD (HR=4.435, 95%CI:2.506-7.533,P<0.001) and without second line chemotherapy(HR=4.432,95%CI:2.186-8.986, P=0.010) were independent prognostic factors. CONCLUSIONS For patients with unresectable liver metastasis from colorectal cancer after failed conversion chemotherapy, prognostic factors include cN2, the maximum diameter of liver metastatic lesion, chemotherapy response and second line chemotherapy. Whether the resection of primary tumor can prolong OS further study.
Antineoplastic Agents ; therapeutic use ; China ; Colorectal Neoplasms ; drug therapy ; pathology ; Female ; Humans ; Liver Neoplasms ; diagnosis ; secondary ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Treatment Failure

Objective To analyze the complications of total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA) in treatment of severe or refractory ulcerative colitis (UC).Methods The retrospective cross-sectional study was conducted.The clinical data of 67 patients with severe or refractory UC who underwent TPC-IPAA in the Xinhua Hospital Affiliated to Shanghai Jiaotong University from February 2008 to October 2015 were collected.All the patients received open and laparoscopy-assisted TPC-IPAA,and two-stage or three-stage surgery was performed according to the patients' conditions.Observation indicators:(1) treatment and follow-up situations,(2) short-term complications after TPC-IPAA,(3) long-term complications after TPC-IPAA.The follow-up using telephone interview and outpatient examination was performed to detect the quality of postoperative life in patients and occurrence of complications up to July 2016.Measurement data with skewed distribution were described as M (range).The comparison of quality of pre-and post-operative life in patients was done using the paired t test.Results (1) Treatment and follow-up situations:all the 67 patients received successful surgery,including 45 with two-stage surgery and 22 with three-stage surgery.Thirty-seven patients underwent open surgery and 30 underwent laparoscopic surgery.The average frequency of postoperative daily defecation,average scores of quality of pre-and post-operative lifes were 5.6,0.47 and 0.67,respectively,with a statistically significant difference between preoperative indicators and postoperative indicators (t =-4.80,P ＜ 0.05).All the 67 patients were followed up for a median time of 4.6 years (range,1.0-8.4 years).(2) Short-term complications after TPC-IPAA:Of 67 patients,10 had short-term complications (some patients with multiple complications).One patient was complicated with presacral abscess secondary to sinus formation and then was cured by topical incision of sinus under colonoscopy.Five patients were complicated with anastomotic site-related complications of TPCIPAA,and 1 with pouch-anal anastomotic fistula combined with presacral abscess underwent drainage with ileostomy and didn't undergo stoma reversion of ileum.Two patients with fistula at the top of pouch were improved by surgery and repair.Of 2 patients with pouch-vagina fistula,1 underwent resection of pouch stump-vagina fistula and then were cured,and the space between pouch stump and posterior fornix was filled with a free greater omentum flap and temporary ileal bypass was simultaneously conducted.The other patient received twice transanal vaginal fistula repairs with advancement flap,and unclosed fistula was confirmed by angiography,with a clinical symptomatic relief.Eight patients with wound infection received actively dressing change after discharge,and no wound dehiscence was occurred.(3) Long-term complications after TPC-IPAA:28 of 67 patients had long-term complications.Twelve patients with intestinal obstruction underwent conservative treatments of gastrointestinal decompression,anti-inflammatory with corticosteroid and anti-infection with antibiotic,without the occurrence of severe intestinal perforation and prognosis needing surgical intervention,including 9 undergoing open TPC-IPAA and 3 undergoing laparoscopic TPC-IPAA.Thirteen patients with postoperative pouchitis received the conservative treatment of mesalazine.Three patients with failed pouch underwent small intestine permanent colostomy,including 2 with secondary pouch Crohn's disease and 1 with severe pouchitis.Conclusions TPC-IPAA is safe and effective in treatment of UC,with a lower incidence of complications.Anastomotic site-related complication of TPC-IPAA is the main short-term complication.And in the long-term complications,pouchitis is the most,followed it is intestine obstruction.

ObjectiveTo evaluate the clinical efficacy of Sedum freckle capsule combined with hydroquinone cream phonophoresis in the treatment of chloasma.MethodsA total of 180 patients with chloasma were recruited into two groups according to the random number table, 100 in the treatment group and 80 in the control group. The patients in the control group were treated with 2% hydroquinone cream phonophoresis, and those in the treatment group received 2% hydroquinone cream phonophoresis and Sedum freckle capsules, both for 2 months. The symptom and lesion score were usedto evaluate the clinical efficacy. ResultsThe cure rates were 81.00% in the treatment group and 67.50% (χ2=4.320,P=0.038) in the control group at the end of treatment, 92.0% and 76.3% (χ2=5.538,P=0.019) at 2 months follow-up. The total lesion scores at the end of treatment and at 2 months follow-up were significantly lower than before the treatment in the treatment group (1.61 ± 0.84 and 1.30 ± 0.85vs.3.48 ± 1.02;t=14.152, 16.419, allP<0.01) and also in the control group (2.04 ± 0.61 and 2.03 ± 0.51vs.3.45 ± 1.09;t=10.097, 10.554, allP<0.01). The total lesion score at the end of treatment and at 2 months follow-up were significantly lower than in the treatment group was significantly decreased than the control group (t=3.839, 6.767; allP<0.01).ConclusionSedum freckle capsule combined with hydroquinone cream phonophoresis could effectively treat patients with chloasma.

Objective To explore the influence of salvianolic acid B(SalB) to blood brain‐barrier(BBB) in vitro oxygen/glu‐cose deprivation and reintroduction .Methods We used the human brain microvascular endothelial cells and C6 cells to build BBB model that in vitro ,and the models was divided into normal groups ,experiment groups ,treatment groups .The Earle′s liquid and the condition of 93% N2 ,2% O2 ,5% CO2 replaced the normal culture environment to simulate environment of oxygen /glucose depriva‐tion and reintroduction .The changes of BBB permeability was detected by the horseradish peroxidase permeability test .The tight junctions(TJs) was detected by immunofluorescence and electron microscope .Results The permeability of treatment group was significantly lower than the experiment group (P < 0 .05) ;The TJs of normal group was continuous and density ;the experiment group′s TJs was interruption and osteoporosis ;and the observation of treatment group′s TJs was between of the two group above . Conclusion The SalB can directly protect the BBB during oxygen /glucose deprivation and reintroduction ,and decrease the permea‐bility .The investigation also provided the research foundation for the SalB to protect the BBB .

BACKGROUNDCardiac resynchronization therapy (CRT) on patients with advanced and refractory heart failure has made remarkable progress. Clinically, notched QRS (nQRS) is commonly seen on electrocardiographs (ECGs) with bundle branch block morphology and on paced ECGs after implantation of a CRT device, which may reflect the heterogeneity of ventricular myocardial depolarization and electrical activity. The aim of this study was to determine whether patients with more nQRS myocardial segments on paced ECGs had a worse response to CRT than patients with fewer nQRS myocardial segments.

METHODSWe prospectively enrolled 56 patients of CRT with chronic heart failure from People's Hospital affiliated to Peking University from January 2007 to October 2013. Based on nQRS segments on ECGs before CRT, we allocated them to two groups: fewer nQRS (<2) myocardial segments (lateral, inferior, anterior segments) group (F-nQRS, G1, n = 23) and more nQRS (≥2) myocardial segments group (M-nQRS, G2, n = 33). Then according to nQRS segments on ECGs after CRT, we divided them into two groups similarly: fewer nQRS (<2) myocardial segments group (G3, n = 24) and more nQRS (≥2) myocardial segments group (G4, n = 32). This study was approved by the ethics committee of People's Hospital.

RESULTSAt 6 months in the baseline-ECG group, there was a greater absolute increase in left ventricular ejection fraction (LVEF) in G2 than in G1 ((11.5±8.9)% vs. (5.5±10.4)%, P = 0.023), with the incidence of nonresponse lower in G2 than in G1 (9.1% vs. 39.1%, P = 0.018). In the paced-ECG group, the absolute increase in LVEF was less in G4 than in G3 ((6.4±8.8)% vs. (12.5±10.4)%, P = 0.024) and the incidence of nonresponse was higher in G4 than in G3 (31.3% vs. 8.3%, P = 0.039). Multivariate analysis showed that fewer nQRS (<2) myocardial segments on paced ECGs (odds ratio 13.920) was a predictor of positive response to CRT.

CONCLUSIONnQRS ≥2 myocardial segments (lateral, inferior, anterior) on paced ECGs may predict a poor response to CRT.

Aged ; Cardiac Resynchronization Therapy ; Electrocardiography ; Female ; Heart Failure ; therapy ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies

Objective To establish a stable in vitro model of blood-brain/tumor barrier (BBB/BTB) simulating in vivo state u-sing the human brain endothelial cells(hBMEC) ,brain pericytes (PC) and U251 glioma cells(U251) .Methods An in vitro model of BBB/BTB was constructed using Transwell inserts(pore size 1 .0 μm)coculture while three cell subculture reaches a certain num-ber .Its barrier function was evaluated by the 4-hour leakage test ,inverted microscope to observe morphological changes ,horseradish peroxidase permeability test and tight junction protein Claudin-5 and Occludin identification expression observed by immunofluores-cence technology .Results hBM EC monolayers demonstrated a typical cobblestone-like appearance ,Non-contact spindle cocultured monolayer growth appeared its uniqueswirl poolshape ,fusiform morphology ;the pericytes displayed irregular shape and overlap-ping grow ;U251 showed typical tumor cell growth .Fluid leakage test were interviewing a certain level difference in three different ways to build models ;immnocytochemical staining showed a continuous and dense tight junction formed between the endothelial cells but intensity ranging ;horseradish peroxidase permeability of three different models showed that pure hBMEC (43 .490 ± 3 .572)% ,hBMEC+U251(36 .540 ± 1 .475)% ,hBMEC+ PC+U251(26 .460 ± 2 .372)% was significantly lower ,the difference was statistically significant(t=19 .330 ,P<0 .01) .Conclusion hBMEC+ PC+ U251 cocultured the morphology ,tructure and barrier function have more advantages than pure hBMEC and hBMEC+U251 ,have the basic characteristics and function of BTB/BBB ,and they have provided a new tool reseach function ,regulation mechanisms and drug screening the BTB/BBB in future .

Objective To evaluate the clinical efficacy and safety of application of anterograde flexible ureteroscope in the treatment of ureterointestinal anastomotic strictures in patients after Bricker urinary diversion. Methods From March 2009 to July 2012, 6 patients with ureterointestinal anastomotic strictures after Bricker procedure were enrolled in this study. The average age of the patients was (61 ±7) years old. The first clinical presentation was averagely (6.3 ±2.5) months after the Bricker procedure. There were 4 cases with left side strictures and 2 cases with right side ones. The urinary tract ultrasound, CT, KUB+IVP and antegrade urography were carried out to identify the obstructive portion. The mean length of stricture was 0.9cm (0.4~2.5) . First, all patients underwent percutaneous nephrostomy (PCN), then inside incision by Holmium:YAG laser under anterograde flexible ureteroscopy and lithotripsy (with calculi) . The F6 double J ureteral stent was indwelled for 12 weeks. KUB+IVP was performed after removal of double J ureteral stents. Results The mean operative time was (53±8) min. The mean hospital stay was (5.5±2) days. The blood loss was 3~6 mL. The average follow-up was 18 months (6~30) . No recurrence was found in 5 patients. One case had recurrent stricture after the first procedure, which was successfully managed by the flexible ureteroscopy again and replacing double J ureteral stent every 12 months. Conclusion The inside incision by anterograde flexible ureteroscopic Holmium:YAG laser is safe and effective for ureterointestinal anastomotic strictures in patients after Bricker urinary diversion, with less complications.

Objective To investigate the clinical characteristics,pathogenic causes and treatment outcomes of acute kidney injury (AKI) in very old patients in order to improving the diagnosis and treatment.Methods 39 AKI patients aged ≥80 years in the department of geriatric medicine of our hospital were enrolled and followed up for 3 months.Clinical and laboratory data were analyzed and the pathogenic causes as well as the treatment outcomes were summarized.Results Among the 39 very old patients,31(79.5％) were male,8(20.5％) were female,and the mean age was (93.5±4.6) years.33 (84.6％)patients had chronic kidney diseases.The pathogenic causes of AKI were mainly as follows:urological infections (71.8％),blood volume deficiency (48.7％),cardiac dysfunction (23.1％) and hypotension (15.4％).2 to 4 pathogenic causes were co present in 64.1％ patients.Renal function was improved and recovered in 69.2 ％ patients and the death rate was 25.6％ after treatment.The main causes of death were septic shock (30.0％),multiple organ failure (20.0％),massive gastrointestinal hemorrhage (20.0％) et al.Conclusions Most of the very old patients may suffer from AKI on the basis of chronic kidney disease.AKI is often induced by multiple pathogenic causes.The main factors leading to AKI are urological infections,followed by blood volume deficiency and cardiac dysfunction.Most patients with AKI can recover after the precipitating factors are removed and supportive treatments are administered in time.Septic shock is the main cause of death.

0.05).[Conclusion]The osteochondral scaffold of the collagenⅠ-sodium hyaluronate-fbrin glue tri-copolymer scaffold bonding with antigen-extracted bovine cancellous bone has an appropriate structure and a good biocompatibility,which makes it a useful scaffold in the osteochondral tissue engineering.

Objective To explore the efficacy of closed reduction with cannlated compression screws for the treatment of elderly paitents with intertrochanteric fracture.Methods From April 2002 to July 2006,guided by a C-arm X-ray system,58 elderly patients with intertrochanteric fracture were treated by closed reduction with cannlated compression screws.Results The mean operation time was 55 minutes(40 to 70 minutes),and the mean blood loss was 35 ml(30 to 40).The patients were discharged from hospital in 3 to 10 days after the operation(mean,6.5 days).All of the 58 patients were cured.According to criteria for evaluating the outcomes of intertrochantenic fracture,28 cases were excellent,25 were good,3 were fair,and 2 were poor.The Rate of excellent and good outcomes was 91.4%(53/58).Conclusion Closed reduction with cannlated compression screws is effective for elderly paitents with intertrochanteric fracture.