In North Korea, the prevalence of hepatitis B is high due to natural factors, gaps in vaccination, and the lack of antiviral treatment. Aid projects are urgently needed, however impeded by North Korea's political and economical situation and isolation. The feasibility of a joint North Korean and German humanitarian hepatitis B prevention program was assessed. Part 1: Hepatitis B vaccination catch-up campaign. Part 2: Implementation of endoscopic ligation of esophageal varices (EVL) by trainings in Germany and North Korea. By vaccinating 7 million children between 2010 and 2012, the hepatitis B vaccination gap was closed. Coverage of 99.23% was reached. A total of 11 hepatitis B-induced liver cirrhosis patients (mean age 41.1 yr) with severe esophageal varices and previous bleedings were successfully treated by EVL without major complications. A clinical standard operating procedure, a feedback system and a follow-up plan were developed. The bi-modal preventive strategy was implemented successfully. Parts of the project can serve as an example for other low-income countries, however its general transferability is limited due to the special circumstances in North Korea.
Adult ; Combined Modality Therapy/methods/statistics & numerical data ; Democratic People's Republic of Korea/epidemiology ; Esophageal and Gastric Varices/*embryology/*surgery ; Esophagoscopy/statistics & numerical data ; Feasibility Studies ; Female ; Hepatitis B/*epidemiology/*prevention & control ; Hepatitis B Vaccines/*administration & dosage ; Humans ; Male ; Mass Vaccination/*statistics & numerical data ; Middle Aged ; Prevalence ; Retrospective Studies ; Risk Factors ; Secondary Prevention/methods/statistics & numerical data ; Treatment Outcome

The transforming growth factor β1 (TGF-β1) and CD8-positive T cells are two important immune factors that function at opposite directions. The purpose of this study was to verify the relationship between the two factors and their associations with long-term effects of adjuvant chemotherapy or endocrine therapy in breast cancer. Expression of TGF-β1 precursor and CD8 was immunohistochemically detected on surgically-obtained tumor samples of 130 (stage I-III) invasive breast carcinomas from Chinese subjects, who were followed up for a mean time of 112 months. Interstitial CD8-positive cells and TGF-β1 precursor-positive cells adjacent to tumor nests were counted. Infiltration of CD8-positive lymphocytes into tumor nests and TGF-β1 precursor expression in tumor cells were observed and survival analysis was performed. Our results showed that density of interstitial CD8-positive lymphocytes was an independent adverse prognostic factor for distant disease-free survival (DDFS) (HR=8.416, 95% CI=1.636-43.292, P=0.011) in hormone receptor-positive patients who were on adjuvant endocrine therapy. For breast cancer patients who did not receive adjuvant chemotherapy, those without infiltration of CD8-positive cells into tumor nests had a shorter overall survival (OS) than their counterparts with CD8-positive cell infiltration into tumor nests (Log-Rank, P=0.003). But OS of patients without infiltration of CD8-positive cells into tumor nests was significantly prolonged by adjuvant chemotherapy (Log-Rank, P=0.013) and paralleled that of patients with CD8-positive cell infiltration. Although OS was shorter in the tumor cell TGF-β1 precursor (t-TGF-β1-pre)-positive patients than in the negative patients in patients without receiving chemotherapy (P=0.053), OS of t-TGF-β1-pre-positive patients was significantly prolonged by adjuvant chemotherapy (P=0.035) and was longer than that of t-TGF-β1-pre-negative patients. Analysis showed that t-TGF-β1-pre was an independent positive prognostic factor for DDFS (HR=0.392 95% CI=0.157-0.978, P=0.045) in patients who received adjuvant chemotherapy. This study suggested that density of interstitial CD8-positive lymphocytes was of prognostic value in hormone receptor-positive patients who received adjuvant endocrine therapy. Our study verified that adverse immunologic signatures consisting of absence of CD8-positive cells in tumor nests or expression of TGF-β1 precursor in tumor cells in breast cancer were associated with worse prognosis and significantly improved long-term survival with adjuvant chemotherapy, respectively.
Biomarkers, Tumor ; metabolism ; Breast Neoplasms ; drug therapy ; metabolism ; surgery ; CD8-Positive T-Lymphocytes ; metabolism ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Female ; Humans ; Immunohistochemistry ; Kaplan-Meier Estimate ; Middle Aged ; Outcome Assessment (Health Care) ; methods ; statistics & numerical data ; Prognosis ; Proportional Hazards Models ; Protein Precursors ; metabolism ; Retrospective Studies ; Transforming Growth Factor beta1 ; metabolism

OBJECTIVETo summarize the effectiveness of Chinese and Western integrative medicine in treating medium and advanced lung cancer, and to provide guidelines for clinical application.

METHODSFor this metaanalysis, a comparative search of Chinese medicine data in Chinese National Knowledge Infrastructure (CNKI) and Chinese BioMedical Literature Database (CBM) was undertaken to identify articles related to randomized comparative research of Chinese and Western integrative medicine in treating medium and advanced lung cancer between 1996 to 2006. Quality of life (QOL) was estimated using RevMan 4.2 software for data processing, adopting the odd ratio (OR) and the 95% confidence interval (CI).

RESULTSThrough meta-analysis of 10 qualified articles, the results were as follows: the merging effectiveness of QOL [OR=3.80, 95% CI (2.65, 5.47)]; the rate of survival [OR=3.44, 95% CI (2.04, 5.80)]; the tumor response rate [OR=1.88, 95% CI (1.37, 2.58)]; the tumor developing rate [OR=0.33, 95% CI (0.23, 0.48)]. Significant differences existed between the Chinese and Western integrative medicine treatment group and the Western treatment group (P<0.01).

CONCLUSIONSChinese and Western integrative medicine treatment of medium and advanced lung cancer has shown to improve patients' QOL and survival rate; it also can control tumor development in the short term.

Carcinoma ; epidemiology ; pathology ; therapy ; Combined Modality Therapy ; Disease Progression ; Humans ; Integrative Medicine ; methods ; Lung Neoplasms ; epidemiology ; pathology ; therapy ; Medicine, Chinese Traditional ; methods ; Neoplasm Staging ; Publication Bias ; statistics & numerical data ; Randomized Controlled Trials as Topic ; statistics & numerical data ; Treatment Outcome ; Western World

OBJECTIVE: Arsenic trioxide (As2O3) can be used as a possible pharmaceutical alternative that augments radiofrequency (RF) ablation by reducing tumor blood flow. The aim of this study was to assess the effect of intraarterial and intravenous administration of As2O3 on RF-induced ablation in an experimentally induced liver tumor. MATERIALS AND METHODS: VX2 carcinoma was grown in the livers of 30 rabbits. As2O3 (1 mg/kg) was administered through the hepatic artery (n = 10, group A) or ear vein (n = 10, group B), 30 minutes before RF ablation (125 mA +/- 35; 90 +/- 5degrees C). As a control group, 10 rabbits were treated with RF ablation alone (group C). RF was intentionally applied to the peripheral margin of the tumor so that ablation can cover the tumor and adjacent hepatic parenchyma. Ablation areas of the tumor and adjacent parenchymal changes among three groups were compared by the Kruskal-Wallis and Mann-Whitney U test. RESULTS: The overall ablation areas were 156 +/- 28.9 mm2 (group A), 119 +/- 31.7 (group B), and 92 +/- 17.4 (group C, p < 0.04). The ablation area of the tumor was significantly larger in group A (73 +/- 19.7 mm2) than both group B (50 +/- 19.4, p = 0.02) and group C (28 +/- 2.2, p < 0.01). The ratios of the tumoral ablation area to the overall ablation area were larger in group A (47 +/- 10.5%) than that of the other groups (42 +/- 7.3% in group B and 32 +/- 5.6% in group C) (p < 0.03). CONCLUSION: Radiofrequency-induced ablation area can be increased with intraarterial or intravenous administration of As2O3. The intraarterial administration of As2O3 seems to be helpful for the selective ablation of the tumor.
Animals ; Arsenicals/*pharmacology ; Catheter Ablation/*methods ; Combined Modality Therapy ; Contrast Media/diagnostic use ; Disease Models, Animal ; Liver/radiography ; Liver Neoplasms, Experimental/*drug therapy/radiography/*surgery ; Oxides/*pharmacology ; Rabbits ; Statistics, Nonparametric ; Tomography, X-Ray Computed

OBJECTIVETo analyze the clinical and pathological features in order to investigate appropriate way of diagnosis and treatment for non-functional islet cell tumors of the pancreas (NFICT).

METHODSThe data and experience of surgically treated 43 patients with pathologically confirmed NFICT over the last 30 years were retrospectively reviewed. The survival rate was estimated using Kaplan-Meier method and the potential risk factors affecting survival were compared with Log rank test.

RESULTSThere were 7 males and 36 females in this series with a mean age of 31.6 years ranged from 8 to 67 years. Twenty-eight patients were diagnosed as having non-functional islet cell carcinomas of the pancreas (NFICC) and 15 patients benign islet cell tumors. The most common symptoms in NFICT were abdominal pain 55.8%, nausea and/or vomiting (32.6%), fatigue (25.6%) and abdominal mass (23.3%). Preoperatively, all of those were found to have a mass in their pancrease by ultrasonic and computed tomography examination, with 21 in the head, 10 in the body and 6 in the tail of the pancreas. Multicemtric tumor were found in one patient. Thirty-nine of these 43 patients (90.7%) underwent surgical resection, with a curative resection in 30 (69.8%) and palliative in 9 (20.9%). The resectability and curative resection rate in 28 patients with nonfunctioning islet cell carcinomas of the pancreas was 78.6% and 60.7%, respectively. None of the 15 patients with benign nonfunctioning islet cell tumor of the pancreas died of this disease. While the overall cumulative 5- and 10-year survival rate in 28 patients with non-functional islet cell carcinomas of the pancreas was only 58.1% and 29.0%, respectively. Curative resection, female, younger than 30 years old and mass diameter < 10 cm were found to be positive prognostic factors. But multivariate Cox regression analysis indicated that radical resection was the only independent prognostic factor (P = 0.007).

CONCLUSIONNonfunctioning islet cell tumor of the pancreas is frequently found in young female. Surgical resection, especially curative resection can achieve satisfactory long-term survival.

Adenoma, Islet Cell ; diagnosis ; therapy ; Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Islet Cell ; diagnosis ; therapy ; Chemotherapy, Adjuvant ; methods ; statistics & numerical data ; Child ; Combined Modality Therapy ; Doxorubicin ; therapeutic use ; Female ; Fluorouracil ; therapeutic use ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Mitomycin ; therapeutic use ; Multivariate Analysis ; Pancreatic Neoplasms ; diagnosis ; therapy ; Pancreaticoduodenectomy ; methods ; statistics & numerical data ; Proportional Hazards Models ; Regression Analysis ; Retrospective Studies

OBJECTIVETo evaluate the combinated transcatheter hepatic artery chemoembolization (TACE) and analyse the factors affecting prognosis in patients with primary hepatic carcinoma.

METHODS141 consecutive patients with primary hepatic carcinoma were treated, including 125 men and 16 women (mean age, 52 years; age range, 21 - 76 years). Combinated TACE procedures included TACE, TACE followed by surgical resection, TACE and percutaneous ethanol injection (PEI) and transcatheter hepatic artery infusion (TAI). The factors included sex, age, ALT, AFP, HBsAg, liver function (Child's system), the way of treatment, tumor size and number, serum albumin, portal cancerous thrombus, pathological type of tumors, and HBeAg. The Cox's regression analysis model was used to analyse the factors affecting the prognosis. P < 0.05 means statistically significant difference.

RESULTSThe total median survival time was 19 months and mean survival time 23.59 months. The total survival rates of 1, 2, 3, 5 years were 63.9%, 44.5%, 25.8% and 7.4%, respectively. Multivariable analysis revealed significant prognostic factors as follows: age, liver function, the way of treatment, portal cancerous thrombus and pathological types of tumors (chi2 = 45.993, P = 0.0001).

CONCLUSIONThe combinated TACE procedure is safe and effective. In this study, 5 factors directly influencing the prognosis are age, liver function, portal cancerous thrombus and pathological types of tumors are risk prognostic factors, and the way of treatment is a protective factor (chi2 = 45.993, chi2 = 0.0001).

Acetaldehyde ; administration & dosage ; Adult ; Age Factors ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Hepatocellular ; pathology ; surgery ; therapy ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; statistics & numerical data ; Female ; Follow-Up Studies ; Hepatectomy ; methods ; Humans ; Infusions, Intra-Arterial ; Injections, Intradermal ; Liver Neoplasms ; pathology ; surgery ; therapy ; Male ; Middle Aged ; Neoplastic Cells, Circulating ; pathology ; Portal Vein ; Prognosis ; Proportional Hazards Models ; Survival Analysis

OBJECTIVETo investigate the clinical characteristics and prognosis of second primary tumor of tongue (SPTr) after nasopharyngeal carcinoma (NPCR) treated with radiotherapy.

METHODSClinical data of 53 patients with SP7T after NPCR (group A) and 252 patients with primary tongue carcinoma (group B) were analyzed retrospectively with regard to clinical characteristics and survival rate (Kaplan-Meier); and multivariate analysis was performed using Cox proportional hazards model.

RESULTSThere was no significant difference between group A and group B ( P > 0. 05) in the presenting age, sex, tumor size, cTNM stage, tumor differentiation and the rate of distant metastasis. The overall 5-year survival rates were 41.6% in group A and 56.3% in group B (chi2 = 4.40, P = 0.0359) with a statistically significant difference between two groups. The differences of tumor location (chi2 = 61.18, P = 0.000) and rate of clinical (cN+, chi2 = 6.846, P = 0.009) or pathological lymph node metastasis (pN+, X2 = 3.993, P = 0.046) were also statistically significant between group A and group B, respectively. Multivariate analysis showed that age at presence, cTNM stage and with or without neck lymph node dissection were independent risk factors affecting survival.

CONCLUSIONSecond primary tongue carcinoma after radiotherapy for nasopharyngeal carcinoma is likely to occur on the dorsal aspect of the tongue with worse prognosis but with a lower rate of lymph node metastasis than that of primary tongue carcinoma. However, radiotherapy history is not an independent influencing factor on prognosis. Surgical resection or combined modality therapy may give a better prognosis.

Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents ; therapeutic use ; Combined Modality Therapy ; statistics & numerical data ; Female ; Follow-Up Studies ; Glossectomy ; methods ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Nasopharyngeal Neoplasms ; radiotherapy ; Neck Dissection ; Neoplasms, Radiation-Induced ; etiology ; pathology ; therapy ; Neoplasms, Second Primary ; etiology ; pathology ; therapy ; Prognosis ; Proportional Hazards Models ; Radiotherapy ; adverse effects ; Retrospective Studies ; Tongue Neoplasms ; etiology ; pathology ; therapy

OBJECTIVETo investigate the clinical characterstics, effective treatment and prognosis in patients with primary germ cell tumors in the mediastinum.

METHODSThe data of 47 such patients treated from 1967 to 2005 were retrospectively reviewed.

RESULTSOf these 47 patients, 41 were male and 6 female with a median age of 26 years; 8 (17.0%) had seminoma, and 39 (83.0%) non-seminoma. The overall 1-, 3-, 5-year survival rate was 63.4%, 37.5% and 34.8% with a median survival time of 16 months; which was 100%, 83.3% and 83.3% for seminoma and 56.4%, 30% and 27.3% for nonseminoma, respectively. The pathologic type was found to be the only independent prognostic factor (P = 0.045).

CONCLUSIONPrimary mediastinal serminoma is sensitive to radiotherapy or chemotherapy with a good prognosis, but the prognosis of primary mediastinal non-seminoma is poor. Cisplatin-based chemotherapy still plays a key role in the treatment of primary mediastinal non-seminoma as the survival of those has been improved.

Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Child ; Cisplatin ; administration & dosage ; Combined Modality Therapy ; Cyclophosphamide ; administration & dosage ; Drug Therapy ; methods ; statistics & numerical data ; Female ; Fluorouracil ; administration & dosage ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Mediastinal Neoplasms ; surgery ; therapy ; Middle Aged ; Neoplasms, Germ Cell and Embryonal ; surgery ; therapy ; Prognosis ; Proportional Hazards Models ; Radiotherapy ; methods ; statistics & numerical data ; Retrospective Studies ; Seminoma ; surgery ; therapy ; Vincristine ; administration & dosage

OBJECTIVETo analyze the clinical characteristics, efficiency of treatment and potential prognostic factors of breast cancer patients with liver metastases (BCLM).

METHODSThe data of clinical characteristics, response to treatment and survival were retrospectively analyzed in 152 breast cancer patients with liver metastasis using SPSS 11.5.

RESULTSThe median disease free survival (DFS), the median survival of recurrence (MSR) and median time to progress (TTP) of this series was 21 months, 16 months and 7.4 months, respectively. The response rate in chemotherapy group was higher than that in the transcatheter arterial chemoembolization (TACE) group (37.7% vs. 53%, P = 0. 039). The TTP was longer (7 m vs. 10 m, P = 0.048) and the response rate (63.3% vs. 40.0%, P = 0.04) in taxanes-based chemotherapy group was significantly higher than that in non-taxanes-containing regimen. The MSR in patients with single liver metastases treated by TACE was longer than that by chemotherapy (16 m vs. 30 m, P = 0.0052), but it was not observed in the patients with multiple metastases. Pathological tumor size (PT) and axillary lymph node status at diagnosis, negative estrogen receptor (ER) status, abnormal ALT level induced by liver metastases, metastastic tumor size were significantly correlated with shorter survival.

CONCLUSIONThe effective chemotherapy especially the taxane-containing regimen and TACE may improve outcome for breast cancer patient with liver metastasis.

Alanine Transaminase ; blood ; Antineoplastic Agents ; administration & dosage ; therapeutic use ; Breast ; drug effects ; pathology ; surgery ; Breast Neoplasms ; metabolism ; pathology ; therapy ; Bridged-Ring Compounds ; administration & dosage ; therapeutic use ; Chemoembolization, Therapeutic ; methods ; statistics & numerical data ; Combined Modality Therapy ; Disease Progression ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; metabolism ; secondary ; therapy ; Lymphatic Metastasis ; Mastectomy ; methods ; statistics & numerical data ; Middle Aged ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Receptors, Estrogen ; metabolism ; Retrospective Studies ; Taxoids ; administration & dosage ; therapeutic use

OBJECTIVETo evaluate the effects of acute normovolemic hemodilution (ANH) combined with controlled hypotension on reducing heterogeneous transfusion and safety during liver tumorectomy.

METHODSThirty patients undergoing elective liver tumorectomy were randomly divided into 3 groups (10 each), namely ANH group (group A), ANH combined with controlled hypotension group (group B) and control group (group C). All the patients were anesthetized via endotracheal intubation. Before the operation, ANH was performed in groups A and B after anesthesia induction, and controlled hypotension was initiated in group B during tumorectomy. Blood transfusion and fluid infusion were carried out routinely in group C. Hb and Hct were measured before operation, after ANH, and immediately, 1 day and 7 days after the operation. The difference in intraoperative blood loss and heterogeneous blood transfusion volume in the 3 groups was observed.

RESULTSIn group A, heterogeneous blood transfusion was avoided in 6 cases and but given in the other cases for an average of 400 ml. In group C, every patient received heterogeneous blood transfusion (664.8-/+248.1 ml), but none of the patients received heterogeneous blood in group B. The difference in transfusion volume between the 3 groups was significant (P<0.01). Hemodynamics was basically stable during operation in the 3 groups.

CONCLUSIONANH combined with controlled hypotension is safe and effective for decreasing and even avoiding homologous blood transfusion in liver tumorectomy.

Adult ; Aged ; Blood Loss, Surgical ; prevention & control ; Blood Transfusion ; statistics & numerical data ; Combined Modality Therapy ; Female ; Hemodilution ; methods ; Hepatectomy ; methods ; Humans ; Hypotension, Controlled ; methods ; Isotonic Solutions ; Liver Neoplasms ; surgery ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Treatment Outcome