Objective To systematically evaluate the related factors that lead to the underestimation of puncture pathology of ductal carcinoma in situ (DCIS), and to reduce the underestimation rate of puncture pathology of DCIS by controlling related factors. Methods A computer search of PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, and Wanfang databases were conducted to retrieve clinical studies that led to underestimation of puncture pathology for DCIS between the establishment of the database and April 1, 2021. After two researchers independently screened the literatures, extracted the data, and evaluated the risk of bias in the included studies, RevMan 5.4 software was used for meta analysis. Results A total of 24 studies including 8 810 patients were included. Results of meta analysis showed that puncture pathology underestimation rate in patients ≥50 years old was lower than that <50 years old [OR=0.82, 95%CI (0.70, 0.96), P=0.020]. Breast imaging reporting and data system (BI-RADS) of DCIS ≤4A class patients had a lower puncture pathology underestimation rate [OR=0.38, 95%CI (0.21, 0.68), P=0.001]. Human epidermal growth factorreceptor 2 (HER2) negative [OR=1.69, 95%CI (1.12, 2.55), P=0.010], no calcification in the mass [OR=1.55, 95%CI (1.10, 2.18), P=0.010], estrogen receptor (ER) positive [OR=0.73, 95%CI (0.60, 0.89), P=0.001], progesterone receptor (PR) positive [OR=0.62, 95%CI (0.44, 0.86), P=0.004], tumor diameter ≤2 cm [OR=2.98, 95%CI (2.18, 4.09), P<0.001], DCIS patients with low/intermediate nuclear grading [OR=0.58, 95%CI (0.50, 0.68), P<0.001], and untouchable masses [OR=0.48, 95%CI (0.28, 0.82), P=0.008] had lower puncture pathology underestimation rate. Conclusions In patients with DCIS, age≥50 years, BI-RADS≤4A class, mass diameter ≤2 cm, non-palpable mass, low nuclear grade (low grade/medium grade DCIS), ER positive, PR positive, HER2 negative, and no calcification can reduce the underestimation rate of puncture pathology. Due to the limitation of the number and quality of included studies, the above conclusions need to be confirmed by the results of high quality cohort studies with large samples.
ObjectiveTo investigate the effect and predictive value of systemic inflammatory markers on pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) for locally advanced breast cancer (LABC). MethodsThe clinicopathologic data of female patients with LABC who received NACT and radical surgical resection in the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University from February 2019 to February 2022 were retrospectively analyzed. The factors affecting pCR after NACT were analyzed by the multivariate logistic regression and the prediction model was established. The efficiency of the prediction model was evaluated by receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). ResultsA total of 98 patients were gathered, of which 29 obtained pCR, with a pCR rate of 29.6%. The multivariate analysis of binary logistic regression showed that the patients with non-menopausal status, negative estrogen receptor (ER), chemotherapy+targeted therapy, and systemic immune-inflammation index (SII) <532.70 (optimal critical value) were more likely to obtain pCR after NACT (P<0.05). The prediction model was established according to logistic regression analysis: Logit (P)=0.697–2.974×(menopausal status)–1.932×(ER status)+3.277×(chemotherapy regimen)–2.652×(SII). The AUC (95%CI) of the prediction model was 0.914 (0.840, 0.961), P<0.001. ConclusionsIt is not found that other inflammatory indicators such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio are associated with pCR after NACT. But SII is an important predictor of pCR after NACT for LABC and has a good predictive efficiency.
ObjectiveTo analyze the factors influencing axillary pathological complete response (pCR) after neoadjuvant therapy (NAT) and to provide the possibility of exempting axillary surgery for patients with better pathological efficacy of primary breast lesions after NAT. MethodsAccording to the inclusion and exclusion criteria, the patients with breast cancer admitted to the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University from January 1, 2020 to June 30, 2022 were retrospectively analyzed. All patients were diagnosed with ipsilateral axillary lymph node metastasis of breast cancer and the NAT cycle was completed according to standards. All patients underwent axillary lymph node dissection (ALND) after NAT. The therapeutic effect of primary breast lesions was evaluated by Miller-Payne (MP) grading system. The axillary pCR was judged according to whether there was residual positive axillary lymph nodes after ALND. The unvariate and multivariate logistic regressions were used to analyze the risk factors affecting the axillary pCR. At the same time, the possibility of exempting axillary surgery after NAT in the MP grade 5 or in whom without ductal carcinoma in situ (DCIS) was evaluated. The ALND was considered to exempt when the negative predictive value was 90% or more and false negative <10% or almost same. ResultsA total of 111 eligible patients with breast cancer were gathered in the study, 64 of whom with axillary pCR. There were 43 patients of MP grade 5 without DCIS after NAT, 41 of whom were axillary pCR. The univariate analysis results showed that the estrogen receptor and progesterone receptor statuses, molecular type, NAT regimen, and MP grade were associated with the axillary pCR after NAT, then the logistic regression multivariate analysis results showed that the MP grade ≤3 and MP grade 4 decreased the probability of axillary pCR as compared with the MP grade 5 [OR=0.105, 95%CI (0.028, 0.391), P=0.001; OR=0.045, 95%CI (0.012, 0.172), P<0.001]. There were 51 patients of MP grade 5 after NAT, 46 of whom were axillary pCR. The negative predictive value and the false negative rate of MP grade 5 on predicting the postoperative residual axillary lymph nodes were 90.2% [95%CI (81.7%, 98.6%)] and 10.6% [95%CI (1.5%, 19.8%)], respectively, which of MP grade 5 without DCIS were 95.3% [95%CI (88.8%, 101.9%)] and 4.3% [95%CI (–1.7%, 10.2%)] , respectively. ConclusionsThe probability of axillary pCR for the patient with higher MP grade of breast primary after NAT is higher. It is probable of exempting axillary surgery when MP grade is 5 after NAT.
【摘要】 目的 评价舒林酸治疗结直肠息肉的有效性和安全性。 方法 计算机检索PubMed、Cochrane Iibrary、Embase、SCI、CNKI、万方、维普、CBM数据库。按Cochrane系统评价的方法评价纳入研究质量，并进行Meta分析。 结果 共纳入7个随机对照试验（RCT），共235例患者。Meta分析结果显示舒林酸治疗腺瘤性息肉病（FAP）在有效率、息肉消失率方面与安慰剂比较，差异无统计学意义（Pgt;0.05）；治疗散发性结肠腺瘤性息肉病（SCAP）在有效率、息肉消失率、腺瘤直径变化方面与安慰剂比较，差异有统计学意义（Plt;0.05）；舒林酸的不良反应多为消化道症状，与安慰剂比较差异有统计学意义（Plt;0.05）。 结论 系统评价结果显示舒林酸对于家族性FAP的疗效尚不确切，而对SCAP有一定的疗效。【关键词】结直肠息肉；舒林酸；有效性；不良反应；系统评价【Abstract】 Objective To assess the efficacy and safety of sulindac on colorectal polyps. Methods The literatures were searched from several databases including PubMed,Cochrane Iibrary,SCI,CNKI,Wanfang,VIP,and CBM. The quality of the researches was evaluated according to Cochrane systematic reviews, and the Meta analysis was performed. Results Seven RCT were enrolled with a total of 235 patients. Meta analysis showed that there was no significant difference in the effective rate and polyps disappearance rate of FAP between the two groups (Pgt;0.05). There were significant differences in the effective rate, polyps disappearance rate and size of adenomas between the two groups (Plt;0.05); the most common adverse event was the symptoms of digestive tract which differed much from that in the placebo group (Plt;0.05). Conclusion The therapeutic effect of sulindac on FAP is not sure, but it is effective on SCAP.
ObjectiveTo investigate the clinicopathological significance of integrin α5β1 expression and microvessel density(MVD) in gastric cancer(GC) and the correlation of MVD with integrin α5β1. MethodsThe expression of integrin α5β1 was detected by means of immunohistochemical staining (SP method) on paraffinembeded tissue specimens from 35 primary gastric carcinoma(PGC), 10 metastasic lymph node of gastric cancer and 8 chronic superficial gastritis (CSG). Vascular endothelial cells were stained immunohistochemically using antiCD34 monoclonal antibody to recognize microvessel(MV) in 35 cases of PGC and 8 CSG, MV was counted in 4 hot spot per slide under lightmicroscope (×400) and the average was defined as MVD. The results combined with clinicopathological parameters were analyzed statistically to characterize the role of integrin α5β1 and MVD in the progression of gastric cancer. ResultsIntegrin α5β1 expression and MVD in PGC were significantly higher than those in CSG respectively （t=3.32, P lt;0.01; t=2.30, Plt;0.05）; the expression of integrin α5β1 in PGC showed only a correlation with the invasion depth of tumor (t=2.29, Plt;0.05） while MVD showed all correlations with invasion depth,lymph node status and TNM stage （t=3.07, Plt;0.01; t=2.48, Plt;0.05; t=2.94,Plt;0.01）. Neither integrin α5β1expression nor MVD showed a relation with differential of PGC （t=0.15, Pgt;0.05; t=0.41, Pgt;0.05）. Integrin α5β1 was significantly overexpressed in lymph node metastatic cancer compared with that in corresponding PGC （t=2.45, Plt;0.05）; the difference of MVD showed no statistical significance among levels of integrin α5β1 expression in PGC （F =1.43,P＞0.05） and it showed no correlation with integrin α5β1 expression（r= 0.156, P=0.37）.Conclusion Overexpression of integrin α5β1 is present in GC and associates with the progression of tumor, implying that it may be viewed as the indicator of invasion and metastasis and the candidate target of gene therapy of gastric cancer. However, integrin α5β1 may not play an important role in the vascularization of GC.
ObjectiveTo investigate the expression of vascular endothelial growth factor （VEGF） and proliferating cell nuclear antigen (PCNA) in colorectal cancer and its relationship with metastasis and recurrence. MethodsParaffinembedded specimens from 59 patients with colorectal cancer, 16 patients with adenomas and 12 normal colonic tissues were examined and compared by SP immunohistochemical method. ResultsThe positive rate of VEGF in colorectal cancer were significantly higher than that in adenomas (P＜0.05). The positive rate of VEGF in Dukes A and B stage of colorectal cancer were significantly higher than those in Dukes C and D (P＜0.05). Expression of VEGF in postoperative recurrence group was markedly higher than that in the group with no recurrence (P＜0.05). Proliferative activity expression suggested that the poorer the differentiation, the more PCNA increased in case of lymphnode or hepatic metastasis. The PCNA showed marked difference between postoperative and nonpostoperative recurrences (P＜0.05). Conclusion The expression of VEGF and PCNA is closely related to the invasion and metastasis of tumor during the operation. The increased VEGF and high PCNA implies that there may be some potential metastasis present.
Objective To observe the biocompatibil ity of self-assembled FGL peptide nano-fibers scaffold with neural stem cells (NSCs). Methods FGL peptide-amphiphile (FGL-PA) was synthesized by sol id-phase peptide synthesistechnique and thereafter It was analyzed and determined by high-performance l iquid chromatography (HPLC) and massspectrometry (MS). The diluted hydrochloric acid was added into FGL-PA solution to reduce the pH value and accordinglyinduce self-assembly. The morphological features of the assembled material were studied by transmission electron microscope (TEM). NSCs were cultured and different concentrations of FGL-PA assembled material were added with the terminal concentrations of 0, 50, 100, 200, 400 mg/L, respectively. CCK-8 kit was used to test the effect of FGL assembled material on prol iferation of NSCs. NSCs were added into differentiation mediums (control group: DMEM/F12 medium containing 2% B27 supplement and 10% FBS; experimental group: DMEM/F12 medium containing 2% B27 supplement, 10% FBS and 100 mg/L FGL-PA, respectively). Immunofluorescence was appl ied to test the effect of FGL-PA assembled material on differentiation of NSCs. Results FGL-PA could be self-assembled to form a gel. TEM showed the self-assembled gel was nano-fibers with diameter of 10-20 nm and length of hundreds nanometers. After NSCs were incubated for 48 hours with different concentrations of FGL-PA assembled material, the result of CCK-8 assay showed that FGL-PA with concentrations of 50, 100 or 200 mg/L could promote the prol iferation of NSCs and absorbance of them was increased (P lt; 0.05). Immunofluorescence analysis notified that the differentiation ratio of neurons from NSCs in control group and experimental group were 46.35% ± 1.27% and 72.85% ± 1.35%, respectively, when NSCs were induced to differentiation for 14 days, showing significant difference between 2 groups (P lt; 0.05). Conclusion FGL-PA can self-assemble to nano-fiber gel, which has good biocompatibil ity and neural bioactivity.
Objective To assess the efficacy and safety of mesalazine versus sulfasalazine in the treatment of ulcerative colitis.Methods The literatures were searched from PubMed (1966 to January 2010), the Cochrane Library (1966 to January 2010), EMbase (1974 to January 2010), CNKI (1994 to January 2010), VIP (1989 to January 2010), and CBM (1978 to January 2010). The data were extracted, the quality of studies was evaluated according to The Cochrane Handbook, and meta-analyses were performed using RevMan 5.0 software. Results Sixteen RCTs involving 1 333 patients were included in this study. The results of meta-analyses showed that the total effective rate of the mesalazine group was significantly higher than that of the sulfasalazine group (RR=1.10, 95%CI 1.04 to 1.17, Plt;0.05), and significant differences were noted in the total remission rate (RR=1.82, 95%CI 1.14 to 2.91, Plt;0.05), while there was no significant difference in the relapse rate between the two groups (RR=0.86, 95%CI 0.57 to 1.29, Pgt;0.05). Twelve RCTs reported adverse effects and meta-analyses showed that the incidence of adverse effects was significantly lower in the mesalazine group than in the sulfasalazine group (RR=0.56, 95%CI 0.42 to 0.73, Plt;0.05). Conclusion Analyses show that mesalazine is much more effective and safe in the management of ulcerative colitis than sulfasalazine. However, there is a moderate risk of bias due to methodological quality problems in all 16 included RCTs, so more strictly-designed multi-centered randomized controlled trials with high quality in large-scale are needed to confirm this result.
Objective To review the efficacy and safety of Kushenin combined with Adefovir Dipivoxil for Chronic Hepatitis B (CHB). Method Randomized controlled trails of Kushenin combined with Adefovir Dipivoxil for CHB were gathered from PubMed, CBMdisc (1978 to 2009), and CSJD (1989 to 2009), while other relative researches were searched manually; every research was evaluated, and then analyzed with RevMan 5.0.0 software. Result Ten randomized controlled trials were included; among total 855 patients, 436 were in trial group and the other 419 were in control group. As the Meta-analysis showed, the therapeutic effect of kushenin combined with Adefovir Dipivoxil was better than that of Adefovir Dipivoxil in aspects of improving the negative rate of serum ALT (RR=1.28, 95%CI 1.17 to 1.40), the negative rate of serum HBV-DNA (RR=1.27, 95%CI 1.13 to 1.42), the negative rate of serum HBeAg (RR=1.80, 95%CI 1.32 to 2.44), and the conversion rate of HBeAg and anti-HBe (RR2.06, 95%CI 1.43 to 2.95). Conclusion Kushenin combined with Adefovir Dipivoxil in treating CHB can improve the conversion rate of HBeAg and anti-HBe and further take better therapeutic effect.
Objective To evaluate the efficacy and safety of low-dose versus standard-dose cyclosporine immunosuppressive therapy in kidney transplant recipients. Methods We searched MEDLINE, EMbase, SCI, CBM and The Cochrane Library from the establishment to December 2009 to screen randomized controlled trials (RCTs) of low-dose versus standard-dose cyclosporine immunosuppressive therapy in kidney transplant recipients. Quality assessment and meta-analyses were performed for the included studies. Results A total of 6 RCTs involving 1551 patients were identified, among which 4 RCTs were graded A and two were graded B. The meta-analyses indicated that there were no significant differences between the two groups at the end of 6-month and 12-month follow-up in the acute rejection rate at a RR 1.07, 95%CI 0.69 to 1.65 and a RR 1.06, 95%CI 0.71 to 1.57, respectively. There were no significant differences between the two groups at the end of 6-month and 12-month follow-up in the patients’ death rate at a RR 0.64, 95%CI 0.20 to 2.03 and a RR 0.61, 95%CI 0.30 to 1.24, respectively. There were no significant differences between the two groups in renal function and safety. Conclusion Based on the current evidence, compared with standard-dose CsA, low-dose CsA has the same effect and safety for the short-term results, but the long-term results need to be further studied.