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Adjuvant therapy sparing in rectal cancer achieving complete response after chemoradiation

World Journal of Gastroenterology 2014年第42期20卷 15820-15829页

作者： Xabier García-Albéniz Rosa Gallego Ralf Dieter Hofheinz Gloria Fernández-Esparrach Juan Ramón Ayuso-Colella Josep Antoni Bombí Carles Conill Miriam Cuatrecasas Salvadora Delgado Angels Ginés Rosa Miquel Mario Pagés Estela Pineda Verónica Pereira Aarón Sosa Oscar Reig Iván Victoria Luis Feliz Antonio María de Lacy Antoni Castells Iris Burkholder andreas hochhaus Joan Maurel Department of Epidemiology Harvard School of Public Health Department of Medical Oncology Hospital Clínic ICMHO IDIBAPS CIBEREHD University of Barcelona Interdisciplinary Tumor Center Mannheim and Ⅲ Medical Clinic University Hospital Mannheim University of Heidelberg Department of Gastroenterology Endoscopy Unit Hospital Clínic ICMDiM IDIBAPS CIBEREHD University of Barcelona Department of Radiology Hospital Clínic CDI IDIBAPS University of Barcelona Department of Pathology Hospital Clínic IDIBAPS University of Barcelona Department of Radiation Oncology Hospital Clínic ICMHO University of Barcelona Department of Gastrointestinal Surgery Hospital Clínic ICMDiM IDIBAPS CIBEREHD University of Barcelona Department of Gastroenterology Hospital Clínic ICMDiM IDIBAPS CIBEREHD University of Barcelona Department of Nursing and Health University of Applied Sciences of the Saarland Department for Hematology and Oncology Clinic for Internal Medicine Ⅱ Jena University Hospital

AIM:To evaluate the long-term results of conventional chemoradiotherapy and laparoscopic mesorectal excision in rectal adenocarcinoma patients without adjuvant therapy.METHODS:Patients with biopsy-proven adenocarcinoma of the rectum staged cT3-T4 by endoscopic ultrasound or magnetic resonance imaging received neoadjuvant continuous infusion of 5-fluorouracil for five weeks and concomitant radiotherapy.Laparoscopic surgery was planned after 5-8 wk.Patients diagnosed with ypT0N0 stage cancer were not treated with adjuvant therapy according to the protocol.Patients with ypT1-2N0 or ypT3-4 or N+were offered 5-fluorouracil-based adjuvant treatment on an individual basis.An external cohort was used as a reference for the findings.RESULTS:One hundred and seventy six patients were treated with induction chemoradiotherapy and 170underwent total mesorectal excision.Cancer staging of ypT0N0 was achieved in 26/170(15.3%)patients.After a median follow-up of 58.3 mo,patients withypT0N0 had five-year disease-free and overall survival rates of 96%(95%CI:77-99)and 100%,respectively.We provide evidence about the natural history of patients with localized rectal cancer achieving a complete response after preoperative chemoradiation.The inherent good prognosis of these patients will have implications for clinical trial design and care of patients.CONCLUSION:Withholding adjuvant chemotherapy after complete response following standard neoadjuvant chemoradiotherapy and laparoscopic mesorectal excision might be safe within an experienced multidisciplinary team.

关键词： Exercise Follow-up Gastrointestinal dis-eases Irri

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Tibetan herbal formula Padma Digestin modulates gastrointestinal motility in vitro

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2013年第1期4卷 9-15页

作者： Bruno M Balsiger Magali Krayer andreas Rickenbacher Beatrice Flogerzi Cecile Vennos Juergen M Gschossmann Department of Clinical Research University of Berne 3001 Bern Switzerland Clinic for Gastroenterology Lindenhofspital (Hochhaus) 3001 Bern Switzerland Department of Gastroenterology University of Berne 3001 BernSwitzerland Department of Visceral and Transplant Surgery University of Zürich 8006 Zürich Switzerland Scientific Division Padma Inc. 8340 Hinwil Switzerland Department of Internal Medicine Klinikum Forchheim/Friedrich-Alexander Universit t ErlangenNürnberg 91301 Forchheim Germany

AIM:To examine the effects of Padma Digestin on the smooth muscle motility of different gastrointestinal segments in vitro . METHODS:The effects of the ethanolic extract of Padma Digestin (at 8.16 mg/mL or 81.6mg/mL) on the contractility and susceptibility to acetylcholine (ACh) of muscle strips from the cardia, antrum, pylorus, duodenum, jejunum, ileum and colon of male Wistar rats were analyzed.RESULTS:Compared with the control treatment, the Padma Digestin extract had a procontractile effect on the antral smooth muscle strips. Padma Digestin decreased ACh sensitivity in cardia muscle strips and increased it in those from the antrum and pylorus. In the intestinal segments, spontaneous contractility was inhibited in both the duodenal and jejunal strips, whereas reactivity to ACh was inhibited in the jejunal strips only. In the colonic samples, Padma Digestin inhibited spontaneous and ACh-stimulated contractility at a low dose but seems to have increasing effects at a high dose. CONCLUSION:Padma Digestin extract has regionspecific effects on the contractility and excitability of gastrointestinal smooth muscle. Our results support the traditional use of Padma Digestin for maldigestion and functional gastrointestinal disorders.

关键词： Tibetan Medicine System Herbal Gastrointestinal motility Smooth muscle Padma Digestin

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