ObjectiveTo evaluate the therapeutic effect of liver transplantation (LT) combined with adenovirus-mediated delivery of herpes simplex virus thymidine kinase / ganciclovir (ADV-TK/GCV) in treatment of patients with hepatocellular carcinoma (HCC), so as to benefit more patients with HCC beyond the Milan criteria. MethodsThe clinicopathologic data of patients with HCC underwent LT by the author team since 2007 were collected and analyzed. The patients were assigned into simple LT group and LT+ADV-TK/GCV group. The 5-year cumulative overall survival rate and relapse free survival rate of all LT patients and the patients with LT beyond the Milan criteria by simple LT and LT+ADV-TK/GCV therapy were compared. Meanwhile, Cox regression was used to analyze the risk factors affecting long-term overall survival rate and relapse free survival rate of all patients with HCC after LT. ResultsA total of 216 patients eligible for inclusion were collected in this study, including 134 patients in the simple LT group and 82 patients in the LT+ADV-TK/GCV group, 162 of whom beyond the Milan criteria, including 101 patients underwent the simple LT and 61 patients underwent the LT+ADV-TK/GCV. There were no statistical differences in the baseline data between the simple LT and LT+ADV-TK/GCV in all patients and patients beyond the Milan criteria (P>0.05). There were no statistical differences in 5-year overall survival rate and relapse free survival rate of all patients with HCC (P>0.05). The 5-year cumulative overall survival rate of the LT+ADV-TK/GCV group was better than that of the simple LT group in the patients beyond the Milan criteria (χ2=4.11, P=0.047), but it was not found that the 5-year cumulative relapse free survival rate had statistical difference (27-month survival time as the critical value, P=0.46, P=0.06). Cox regression multivariate analysis results showed that the larger cumulative tumor diameter, the preoperative elevated serum alpha fetoprotein (>400 μg/L), later TNM stage, and without combination of ADV-TK/GCV therapy increased the probability of shorter overall survival of patients after LT; and the patient’s older age, the larger cumulative tumor diameter, and later TNM stage increased the probability of shorter relapse free survival after LT, and it was not found that the combination of ADV-TK/GCV therapy had an impact on the relapse free survival. ConclusionLT combined with ADV-TK/GCV therapy can obviously improve overall survival among patients beyond the Milan criteria, more patients with advanced HCC will be candidates for LT combined with ADV-TK/GCV therapy.
Objective To investigate the general state, psychologic status and health related quality of life (HRQOL) in patients with post-herpetic neuralgia (PHN), and explore the influencing factors on HRQOL and their major and minor relationship. Methods From August 2014 to August 2015, a questionnaire survey was conducted to patients with PHN. The data of the patients’ general situation was colleted, the psychologic status was assessed by Self-rating Depression Scale (SDS), and the HRQOL of the patients was assessed by 36-item Short Form Survey. One-way ANOVA and stepwise regression analysis were used to analyze the influencing factors of HRQOL. Results A total of 177 questionnaires were issued, and 158 were recovered with a response rate of 89.3%. The average score of HRQOL of the 158 patients was 513.67±119.79, and the average score of SDS was 43.65±11.34. SDS scores showed no depression in 41 patients (25.9%), mild depression in 47 (29.7%), moderate depression in 39 (24.8%), and severe depression in 31 (19.6%). Whether receiving regular treatment, course of PHN, SDS score, physical exercise, sleep time and age were the main influencing factors of HRQOL. Conclusions Most patients with PHN suffer from depressive symptoms with poor HRQOL scores. Receiving early treatment with integrated traditional Chinese and western medicine, strengthening exercise, ensuring adequate sleep and receiving psychological counseling can significantly improve the HRQOL of PHN patients.
Objective To assess the quality reports on acupuncture in the treatment of postherpetic neuralgia. Methods MEDLINE, CBM, CMCC and CNKI from 1994 to 2006 were searched electronically. Handsearching was also done. The retrieved articles were assessed in terms of several factors, including the type of clinical research, methodology, diagnostic criteria, inclusion/exclusion criteria, effectiveness measurements, calculation of sample size, follow-up, etc. Results Among the 109 included articles, only 6 were true randomized controlled trials. There were 17 quasi-randomized controlled trials, 13 non-randomized concurrent controlled trials, 1 case-control study and 63 narrative studies. 29 of the reports clearly described the diagnostic criteria, 14 mentioned the inclusion/exclusion criteria, 79 reported the effectiveness measurements, none mentioned the calculation of sample size, 24 reported the follow-up outcomes, and only 1 mentioned adverse reactions. Conclusion More prospective, multicenter, large-scale, high-quality randomised trials are needed, and recommendations should also be made for future evaluations of methodological quality.
ObjectiveTo systematically review the efficacy and safety of fire needle in the treatment of post-herpetic neuralgia. MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of fire needle for post-herpetic neuralgia from inception to June 5th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies; then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 31 RCTs involving 2 755 patients were included. The results of meta-analysis showed that compared with western medicine, fire needle could reduce VAS score (SMD=−1.00, 95%CI −1.36 to −0.63, P<0.000 01). Fire needle combined with western medicine could improve the total efficiency (RR=1.15, 95%CI 1.06 to 1.23, P=0.000 3), reduce VAS score (SMD=−1.92, 95%CI −2.87 to −0.97, P<0.000 1), and SAS rating (SMD=−0.89, 95%CI −1.20 to −0.59, P<0.000 01). Compared with conventional acupuncture, fire needle could reduce VAS score (SMD=−1.37, 95%CI −2.35 to −0.39, P=0.006), and immediate analgesic time (SMD=−0.64, 95%CI −0.88 to −0.39, P<0.000 01). Compared with the traditional Chinese medicine, fire needle could reduce VAS score (SMD=−1.00, 95%CI −1.53 to −0.47, P=0.000 2), SDS rating (SMD=−1.59, 95%CI −1.18 to −1.31, P<0.000 01), SAS rating (SMD=−1.79, 95%CI −2.08 to −1.49, P<0.000 01). In addition, the incidence of adverse reactions in experimental group was significantly lower than that in the control group. ConclusionCurrent evidence shows that fire needle can significantly reduce pain intensity, relieve anxiety, and improve the quality of life of post-herpetic neuralgia patients. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.