AIM: To assess the efficacy of ribavirin monotherapy in patients with biochemical relapse after combination therapy.METHODS: Twenty-four weeks of ribavirin monotherapy was given to biochemical relapsers of end treatme...AIM: To assess the efficacy of ribavirin monotherapy in patients with biochemical relapse after combination therapy.METHODS: Twenty-four weeks of ribavirin monotherapy was given to biochemical relapsers of end treatment biochemical responders within 6 mo after combination therapy, including non-responders with HCV-RNA level ≤0.2 Meq/mL and end treatment virologic responders (ETVRs) with or without reappearance of HCV-RNA.RESULTS: Sixty-two chronic HCV-infected patients completed 24 wk of interferon-α plus ribavirin combination therapy. Fifty patients (80%) achieved end treatment biochemical response including 16 non-responders and 34 of 36 ETVRs. Twenty-six patients (41.9%) were nonresponders. Ribavirin monotherapy was given to 20biochemical relapsers including 12 non-responders with HCV-RNA levels ≤0.2 Meq/mL, four of eight HCV-RNA reappearing ETVRs, and four HCV-RNA negative ETVRs.After 24 wk of ribavirin monotherapy, one of 12 nonresponders, two of four HCV-RNA reappearing ETVRs and all four RNA-negative biochemical relapsers of ETVRs showed sustained virologic response. Two of 12monotherapy treated non-responders showed persistent normalization of liver function test. In total, 50% (31/62)of patients achieved sustained virologic response.CONCLUSION: Resumption of ribavirin monotherapy in ETVRs at signs of viral rebound and recurrent biochemical abnormalities rather than continuation of monotherapy appears to be the key to success of ribavirin monotherapy after interferon-related combination therapy.展开更多
AIM:To examined the efficacy and safety of treatment with boceprevir,PEGylated-interferon and ribavirin(PR)in hepatitis C virus genotype 1(HCVGT1) PR treatmentfailures in Asia.METHODS:The Boceprevir Named-Patient Prog...AIM:To examined the efficacy and safety of treatment with boceprevir,PEGylated-interferon and ribavirin(PR)in hepatitis C virus genotype 1(HCVGT1) PR treatmentfailures in Asia.METHODS:The Boceprevir Named-Patient Program provided boceprevir to HCVGT1 PR treatment-failures.Participating physicians were invited to contribute data from their patients:baseline characteristics,ontreatment responses,sustained virological response at week 12(SVR12),and safety were collected and analysed.Multivariate analysis was performed to determine predictors of response.RESULTS:150 patients were enrolled from Australia,Malaysia,Singapore and Thailand(Asians = 86,Caucasians = 63).Overall SVR12 was 61%(Asians= 59.3%,Caucasians = 63.5%).SVR12 was higher in relapsers(78%) compared with non-responders(34%).On-treatment responses predicted SVR,with undetectable HCVRNA at week 4,8 and 12 leading to SVR12 s of 100%,87%,and 82%respectively,and detectable HCVRNA at week 4,8 and 12,leading to SVR12 s of 58%,22%and 6%respectively.Asian patients were similar to Caucasian patients with regards to on-treatment responses.Patients with cirrhosis(n= 69) also behaved in the same manner with regards to on-treatment responses.Those with the IL28 B CC genotype(80%) had higher SVRs than those with the CT/TT(56%) genotype(P = 0.010).Multivariate analysis showed that TW8 and TW12 responses were independent predictors of SVR.Serious adverse events occurred in 18.6%:sepsis(2%),decompensation(2.7%) and blood transfusion(14%).Discontinuations occurred in 30.7%,with 18.6%fulfilling stopping rules.CONCLUSION:Boceprevir can be used successfully in PR treatment failures with a SVR12 > 80%if they have good on-treatment responses;however,discontinuations occurred in 30%because of virological failure or adverse events.展开更多
The Chinese government promotes smoking cessation through smoking cessation clinics(SCCs).This study aimed to identify factors associated with relapse and provide evidence to inform interventions that reduce relapse r...The Chinese government promotes smoking cessation through smoking cessation clinics(SCCs).This study aimed to identify factors associated with relapse and provide evidence to inform interventions that reduce relapse risk.Participants were SCC patients aged≥18 years who enrolled between June 2019 and December 2021,completed follow-up assessments at one and three months,and reported abstinence at one month.Short-term relapse was defined as self-reported smoking at the three-month follow-up.Treatments included counseling,first-line cessation medications,and traditional Chinese medicine(TCM).Logistic regression was used to identify factors associated with short-term relapse.Among 10,724 eligible SCC patients,11.6%experienced short-term relapse.Factors positively associated with relapse included the number of previous quit attempts(1–5 attempts:OR=1.422,95%CI:1.254–1.613,>5 attempts:OR=1.382,95%CI:1.057–1.808),high perceived difficulty in quitting(OR=1.297,95%CI:1.061–1.586),and moderate(OR=1.383,95%CI:1.174–1.629)or weak(OR=1.517,95%CI:1.251–1.841)willingness to quit.Factors negatively associated with relapse included having a college degree or higher(OR=0.796;95%CI:0.650–0.973),high confidence in quitting(OR=0.786;95%CI:0.629–0.983),and use of TCM(OR=0.276;95%CI:0.158–0.482).Enhancing self-efficacy in quitting appears crucial for preventing short-term relapse.The use of TCM may reduce relapse risk and warrants further investigation.展开更多
To the editor:Schizophrenia is a chronic and severe mental disorder characterised by profound disruptions in thinking,affecting language,perception and the sense of self. These disruptions can significantly impair an ...To the editor:Schizophrenia is a chronic and severe mental disorder characterised by profound disruptions in thinking,affecting language,perception and the sense of self. These disruptions can significantly impair an individual’s ability to function socially and occupationally, leading to a high burden on both the individuals affected and society as a whole.展开更多
The purpose of this article is to analyze the efficacy of molecular diagnostic techniques for monitoring tuberculosis relapse.After analyzing the connotation of molecular diagnostic techniques and their specific appli...The purpose of this article is to analyze the efficacy of molecular diagnostic techniques for monitoring tuberculosis relapse.After analyzing the connotation of molecular diagnostic techniques and their specific application process in tuberculosis relapse monitoring,a total of 200 cured tuberculosis patients were selected(100 in the experimental group and 100 in the control group).During the 12-month follow-up period,the experimental group was monitored by molecular diagnostic techniques,while the control group was monitored by traditional techniques.Finally,by comparing the performance indicators of the two monitoring methods,as well as the relapse situations and outcomes of patients,it was demonstrated that molecular diagnostic techniques have higher efficacy in tuberculosis relapse monitoring.展开更多
BACKGROUND Entecavir(ETV)and tenofovir fumarate(TDF)are recommended first-line agents for the treatment of chronic hepatitis B virus(HBV)infection.However,the effect of these 2 antiviral agents on the risk for recurre...BACKGROUND Entecavir(ETV)and tenofovir fumarate(TDF)are recommended first-line agents for the treatment of chronic hepatitis B virus(HBV)infection.However,the effect of these 2 antiviral agents on the risk for recurrence of HBV-associated hepato-cellular carcinoma(HCC)after radical hepatectomy remains controversial.AIM To compare the effect of TDF vs ETV on the risk for HCC recurrence after radical surgery for HBV-related HCC.METHODS Data from consecutive patients,who received TDF or ETV after radical hepatec-tomy for HBV-related HCC and admitted to the Second Hospital of Longyan between December 2018 and December 2023,were retrospectively analyzed.Based on treatment method and propensity score matching(PSM),data from 100 patients were included,with 50 in each of the TDF and ETV groups,respectively.The baseline characteristics of the 2 groups were analyzed,and the risk for HCC recurrence was compared between the groups.RESULTS The median follow-up for 100 patients[median age,61 years;84 male(84%)]who underwent radical resection for HBV-related HCC-Barcelona Clinic Liver Cancer stage 0[n=16(16%)],stage A[n=61(61%)]-was 29 months(range,12-60 months);the median tumor size was 3.0 cm(range,2.1-4.3 cm).Sixty-eight(68%)patients exhibited HBV-DNA levels>1000 IU/mL.Twenty-two(22%)patients tested positive for hepatitis B e antigen,in whom the HCC recurrence rate was 59.1%(13/22).After PSM,HCC recurrence rates in the ETV and TDF groups after hepatectomy were 66%(n=33)and 42%(n=21),respectively(P=0.016),and cumulative recurrence rates at 1,3,and 5 years were 26%,58%,and 66%,and 18%,38%,and 42%,respectively(P=0.045).CONCLUSION TDF treatment is associated with a lower risk for HCC-related outcomes than that for ETV in patients with HBV-associated HCC after curative therapy.展开更多
Objective:This study aimed to explore the effect of aromatherapy combined with emotional release technology on recurrence fear and sleep quality of lung cancer survivors.Methods:114 cases of lung cancer survivors were...Objective:This study aimed to explore the effect of aromatherapy combined with emotional release technology on recurrence fear and sleep quality of lung cancer survivors.Methods:114 cases of lung cancer survivors were divided into routine nursing group,emotional release technology group and aromatherapy combined with emotional release technology group.Routine nursing group received routine nursing;Emotional release technology group implemented emotional release technology for one month on the basis of routine nursing group;Aromatherapy combined with emotional release technology group used lavender aromatherapy on the basis of emotional release technology group.Results:After one month of intervention,there were statistically significant differences in the scores of fear of disease progression and sleep quality among the three groups.Conclusion:Aromatherapy combined with emotional release technology can improve the sleep quality of lung cancer survivors and reduce the economic toxicity of cancer to some extent.展开更多
Multiple myeloma is a complex and challenging blood cancer,particularly in cases where the disease has relapsed or become resistant to treatment.These situations often have a significant impact on both patient surviva...Multiple myeloma is a complex and challenging blood cancer,particularly in cases where the disease has relapsed or become resistant to treatment.These situations often have a significant impact on both patient survival and quality of life.Over recent years,advances in precision medicine and translational medicine have brought about a shift in treatment strategies,moving toward more personalized and targeted approaches.This review highlights the latest developments in the management of refractory and relapsed multiple myeloma,focusing on the current state of precision diagnosis and treatment,the role of translational medicine,and potential future directions in research.By reviewing key studies and clinical trial data,we aim to offer fresh perspectives and strategies that could improve clinical outcomes.展开更多
BACKGROUND 5-aminosalicylates(5-ASA)are the primary treatment for mild to moderate ulcerative colitis(UC).Maintenance therapy with 5-ASA has been shown to reduce both the risk of relapse and colorectal cancer.AIM To e...BACKGROUND 5-aminosalicylates(5-ASA)are the primary treatment for mild to moderate ulcerative colitis(UC).Maintenance therapy with 5-ASA has been shown to reduce both the risk of relapse and colorectal cancer.AIM To evaluate the outcomes of 5-ASA withdrawal due to non-adherence in UC patients while in remission on monotherapy.METHODS Adult patients with UC who were followed up between July 2019 and April 2025 were screened.Patients in remission receiving 5-ASA monotherapy who experienced treatment withdrawal due to non-adherence were included in this study.RESULTS Among 880 patients with UC,30(3.4%)had 5-ASA withdrawal due to nonadherence while in remission on monotherapy.Twelve patients(40%)had disease relapse after a median of 20 months.The rate of patients in remission was 89%in the first year,decreasing to 73%in the second year,and to 64%in the third year.There were no significant differences between patients with and without relapse in terms of demographics,disease extent,remission duration before 5-ASA withdrawal,previous medications,steroid dependence,5-ASA formulation,baseline inflammatory markers,or partial and endoscopic Mayo scores.Most patients(75%)who experienced relapse were successfully treated with 5-ASA monotherapy,while one-fourth of them required corticosteroids.No patients required biologic agents,hospitalization,or surgical intervention.CONCLUSION Intermittent therapy may be safe and feasible for UC patients,especially those in long-term remission,with treatment interruption up to one year considered acceptable.展开更多
Background: Acute Leukemia is the most common childhood cancer, with two main types: ALL and AML. In Tanzania, recent improvements in treatment and survival have been noted, but the latest data is from 2013. This stud...Background: Acute Leukemia is the most common childhood cancer, with two main types: ALL and AML. In Tanzania, recent improvements in treatment and survival have been noted, but the latest data is from 2013. This study will update survival and relapse information from 2013 to 2020 to help enhance future treatment strategies. Methodology: This study was conducted at two tertiary hospitals in Tanzania. The study analyzed data from children diagnosed with Acute Leukemia between January 2015 to December 2020. Patient data were collected via questionnaires and analyzed using STATA software. Results: This study included a total of 95 participants 64 had age less than 10 years and majority were males 56.8%, 55 had duration of symptoms for more than 1 month 66 had ALL, 49 had attained remission, the overall three years survival was 44.2% with those children with no health insurance having high risk of dying, rate of relapse was 18.4%, with those diagnosed with B-ALL having low risk of relapse. Conclusion: This study provides insights into survival and relapse predictors for childhood leukemia in northern Tanzania. It found an overall survival rate of 44.2%, with health insurance and minimal residual disease after induction being key predictors of survival. The relapse rate was 18.4%, with health insurance linked to a lower relapse risk. Health insurance emerged as a strong predictor of better survival, leading to the recommendation that all children should have health insurance. Additionally, the study suggests that policymakers should support the expansion of global health coverage in Tanzania.展开更多
Depression is a prevalent mental health disorder characterized by high relapse rates,highlighting the need for effective preventive interventions.This paper reviews the potential of reinforcement learning(RL)in preven...Depression is a prevalent mental health disorder characterized by high relapse rates,highlighting the need for effective preventive interventions.This paper reviews the potential of reinforcement learning(RL)in preventing depression relapse.RL,a subset of artificial intelligence,utilizes machine learning algorithms to analyze behavioral data,enabling early detection of relapse risk and optimization of personalized interventions.RL's ability to tailor treatment in real-time by adapting to individual needs and responses offers a dynamic alternative to traditional therapeutic approaches.Studies have demonstrated the efficacy of RL in customizing e-Health interventions and integrating mobile sensing with machine learning for adaptive mental health systems.Despite these advantages,challenges remain in algorithmic complexity,ethical considerations,and clinical implementation.Addressing these issues is crucial for the successful integration of RL into mental health care.This paper concludes with recommendations for future research directions,emphasizing the need for larger-scale studies and interdisciplinary collaboration to fully realize RL’s potential in improving mental health outcomes and preventing depression relapse.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is a minimally invasive,safe,and efficient treatment technique for patients diagnosed with early esophageal cancer.However,postoperative disease recurrence remains an im...BACKGROUND Endoscopic submucosal dissection(ESD)is a minimally invasive,safe,and efficient treatment technique for patients diagnosed with early esophageal cancer.However,postoperative disease recurrence remains an important clinical challenge because it negatively alters patient prognosis and quality of life.As such,identification of relevant risk factors for recurrence can help optimize postoperative management strategies.AIM To assess factors that contribute to the risk for disease recurrence after ESD for early esophageal cancer.METHODS Clinical data from 210 patients diagnosed with early stage esophageal cancer,who underwent ESD at the authors’center between March 2012 and March 2025,were retrospectively collected and analyzed.Patients were categorized into 2 groups according to postoperative disease recurrence:Recurrence(n=30),and without recurrence(n=180).Disease recurrence was defined as the appearance of new tumor lesions or pathologically confirmed tumor recurrence during the postoperative follow-up period.Risk factors associated with postoperative recurrence were identified using univariate and multivariate logistic regression analyses.RESULTS During the follow-up period,30 patients experienced tumor recurrence,corresponding to a recurrence rate of 14.19%.Multivariate analysis revealed that poor differentiation was a significant potential cause of esophageal cancer recurrence[odds ratio(OR)=1.782,95%confidence interval(CI):1.154-2.196;P<0.001].Tumors infiltrating the submucosa were more likely to recur than those penetrating the lamina propria or muscularis mucosa(OR=1.573,95%CI:1.073-2.481;P<0.001).Furthermore,inability to completely resect the tumor greatly increased the likelihood of recurrence(OR=2.189,95%CI:1.193-3.125;P=0.001).Tumor diameter≥2 cm was an independent risk factor for postoperative recurrence(OR=1.981,95%CI:1.482-2.862;P=0.005).CONCLUSION Recurrence of early esophageal cancer after ESD is largely influenced by the degree of differentiation,depth of lesion invasion,complete resection status of the tumor,and tumor diameter.展开更多
Objective:In recent decades,studies have underscored nuclear proteins and signaling pathways in prostate cancer(PCa)development.Key biomarkers like Enhancer of zeste homolog 2(EZH2)and Forkhead box M1(FOXM1)are expres...Objective:In recent decades,studies have underscored nuclear proteins and signaling pathways in prostate cancer(PCa)development.Key biomarkers like Enhancer of zeste homolog 2(EZH2)and Forkhead box M1(FOXM1)are expressed in both healthy and malignant prostate cells.This study aimed to demonstrate the relationship between pathological characteristics,survival,recurrence,and tissue expression of EZH2 and FOXM1 in high-risk PCa patients.Methods:PCa tissues were used in a retrospective analysis that spanned from September 2009 to August 2019.Inclusion criteria comprised pathological tumor stage(pT)3 patients with positive surgical margins or tumor proximity to inked margins within 5 mm.After case selection,tissue slides were stained for EZH2 and FOXM1 antibodies,and Allred scores were calculated.Patients or relatives of deceased patients were contacted for signed agreements and disease follow-ups.Results:The pT3b,ductal carcinoma component,and moderate EZH2 expression were associated with relapse(odds ratio[OR]6.21,95%confidence interval[CI]1.41-27.27,p=0.016;OR 7.29,95%CI 1.03-51.43,p=0.046;OR 5.96,95%CI 1.09-32.48,p=0.039;respectively).The unilateral and bilateral seminal vesicle invasion increased the likelihood of recurrence by 9.98 times and 5.36 times,and the risk of death by around 9.78 times and 10.79 times,respectively.The pT3b was linked to higher death likelihood(OR 7.16,95%CI 1.38-37.23,p=0.019),while moderate EZH2 expression did not show statistical significance(OR 4.54,95%CI 0.87-23.60,p=0.072,marginally).Pathological regional lymph node stage(pN)1 had significantly higher probability of mortality than pN unknown(3.9%vs.27%,p<0.001).PCa in the neck and apex of the prostate gland increased death risk tenfold.Conclusion:Sufficient immunoexpression of EZH2,ductal carcinoma component,and neoplastic proliferation in the seminal vesicles,apex and neck of the prostate gland correlates with elevated risks of recurrence and mortality.Clinicians should use these criteria for appropriate patient referrals,and a multicenter trial could provide accurate classifications.展开更多
Alcohol-associated liver disease(ALD)is a rapidly increasing indication for liver transplantation(LT)globally with a significant rise in transplants for ALD with limited sobriety including patients with alcohol-associ...Alcohol-associated liver disease(ALD)is a rapidly increasing indication for liver transplantation(LT)globally with a significant rise in transplants for ALD with limited sobriety including patients with alcohol-associated hepatitis(AH).This evolution challenges the older paradigm that mandates prolonged periods of alcohol abstinence prior to LT.Due to the limited armamentarium of effective pharmacotherapy to treat severe AH,the mortality rates are significantly higher when LT is not available.In the patients who are transplanted for ALD with limited sobriety including AH,patient and graft survival are equivalent,if not better,compared to patients transplanted for other etiologies.However,due to the risk of alcohol relapse and other psychosocial factors,public opinion regarding early LT may continue to impact how the field moves forward particularly regarding organ stewardship and the need for equitable allocation of organs.Numerous tools for psychosocial evaluations have been developed to assist liver transplant teams to identify appropriate patients in a more uniform manner.In this review,we aim to assess the available evidence to support early LT for alcohol AH and propose directions for the future as the field continues to evolve.展开更多
Cancer relapse often originates from dormant tumor cells lurking in distant organs-untouched by chemotherapy.Despite predictions that dormant disseminated tumor cells(DTCs)might awaken to cause relapse after a clinica...Cancer relapse often originates from dormant tumor cells lurking in distant organs-untouched by chemotherapy.Despite predictions that dormant disseminated tumor cells(DTCs)might awaken to cause relapse after a clinically silent period,direct evidence and chemotherapy’s precise role remained unknown.展开更多
CD5-positive(CD5+)diffuse large B-cell lymphoma(DLBCL)represents a special subgroup of DLBCL with a more aggressive disease course and is more likely to develop into relapsed/refractory(r/r)DLBCL in response to immuno...CD5-positive(CD5+)diffuse large B-cell lymphoma(DLBCL)represents a special subgroup of DLBCL with a more aggressive disease course and is more likely to develop into relapsed/refractory(r/r)DLBCL in response to immunochemotherapy.The incidence of CD5+DLBCL is 5%–10%among DLBCL patients1.展开更多
Cortical malformations,including focal cortical dysplasia type II(FCDII),are a common cause of drug-resistant epilepsy and developmental delay.Consideration of surgery has become the standard of care for those patient...Cortical malformations,including focal cortical dysplasia type II(FCDII),are a common cause of drug-resistant epilepsy and developmental delay.Consideration of surgery has become the standard of care for those patients.However,10%-50% of patients with FCD experience post-surgical relapses[1],and many do not even qualify as surgical candidates.Effective treatments for FCD-associated epilepsy are lacking.展开更多
Autologous stem cell transplantation(ASCT)and chimeric antigen receptor T-cell(CAR-T)therapy represent pivotal treatments for hematologic malignancies,each with distinct strengths and limitations.ASCT reduces tumor bu...Autologous stem cell transplantation(ASCT)and chimeric antigen receptor T-cell(CAR-T)therapy represent pivotal treatments for hematologic malignancies,each with distinct strengths and limitations.ASCT reduces tumor burden through myeloablative conditioning but remains susceptible to relapse,while CAR-T therapy precisely targets malignant cells but encounters challenges,including cytokine release syndrome(CRS),immune effector cell-associated neurotoxicity syndrome(ICANS),and limited persistence.Emerging evidence suggests that combining ASCT with CAR-T therapy yields synergistic effects.ASCT reshapes the immune microenvironment,lowers immunosuppressive cells and CRS risk,while CAR-T eliminates residual disease and promotes immune recovery.Clinical trials in relapsed/refractory B-cell lymphomas and multiple myeloma demonstrate complete remission rates(CRR)of 72%-100%and two-year progression-free survival(PFS)rates of 59%-83%,with severe CRS/ICANS incidences below 10%.However,the precise mechanisms underlying this synergy,optimal timing of CAR-T infusion after ASCT,and ideal dosing regimens require further definition.Future research should prioritize large-scale,randomized controlled trials and establish standardized protocols for toxicity management to maximize therapeutic benefits.By integrating the complementary strengths of ASCT and CAR-T,this combination strategy represents a promising approach for improving outcomes in high-risk hematologic malignancies;however,additional studies are necessary to validate its efficacy and expand its clinical applicability.展开更多
With the advances in allogeneic hematopoietic cell transplantation(allo-HCT)and supportive care,the number of allo-HCT for elderly patients has been increasing in recent years.However,the advanced donor age limits the...With the advances in allogeneic hematopoietic cell transplantation(allo-HCT)and supportive care,the number of allo-HCT for elderly patients has been increasing in recent years.However,the advanced donor age limits the availability of human leukocyte antigen(HLA)-matched sibling donors(MSD)for elderly individuals.展开更多
Diffuse large B-cell lymphoma(DLBCL),the most common subtype of non-Hodgkin’s lymphoma(NHL)worldwide,accounts for 39% and 44% of nodal and extranodal NHL cases in China,respectively1.Standard first-line treatment for...Diffuse large B-cell lymphoma(DLBCL),the most common subtype of non-Hodgkin’s lymphoma(NHL)worldwide,accounts for 39% and 44% of nodal and extranodal NHL cases in China,respectively1.Standard first-line treatment for DLBCL is chemo-immunotherapy with rituximab,cyclophos-phamide,doxorubicin,vincristine,and prednisone,which cures 50%-60% of patients2.展开更多
基金Supported by the Chang Gung Memorial Hospital Medical Research Program CMRPG-2044 and CMRP-800-VI
文摘AIM: To assess the efficacy of ribavirin monotherapy in patients with biochemical relapse after combination therapy.METHODS: Twenty-four weeks of ribavirin monotherapy was given to biochemical relapsers of end treatment biochemical responders within 6 mo after combination therapy, including non-responders with HCV-RNA level ≤0.2 Meq/mL and end treatment virologic responders (ETVRs) with or without reappearance of HCV-RNA.RESULTS: Sixty-two chronic HCV-infected patients completed 24 wk of interferon-α plus ribavirin combination therapy. Fifty patients (80%) achieved end treatment biochemical response including 16 non-responders and 34 of 36 ETVRs. Twenty-six patients (41.9%) were nonresponders. Ribavirin monotherapy was given to 20biochemical relapsers including 12 non-responders with HCV-RNA levels ≤0.2 Meq/mL, four of eight HCV-RNA reappearing ETVRs, and four HCV-RNA negative ETVRs.After 24 wk of ribavirin monotherapy, one of 12 nonresponders, two of four HCV-RNA reappearing ETVRs and all four RNA-negative biochemical relapsers of ETVRs showed sustained virologic response. Two of 12monotherapy treated non-responders showed persistent normalization of liver function test. In total, 50% (31/62)of patients achieved sustained virologic response.CONCLUSION: Resumption of ribavirin monotherapy in ETVRs at signs of viral rebound and recurrent biochemical abnormalities rather than continuation of monotherapy appears to be the key to success of ribavirin monotherapy after interferon-related combination therapy.
文摘AIM:To examined the efficacy and safety of treatment with boceprevir,PEGylated-interferon and ribavirin(PR)in hepatitis C virus genotype 1(HCVGT1) PR treatmentfailures in Asia.METHODS:The Boceprevir Named-Patient Program provided boceprevir to HCVGT1 PR treatment-failures.Participating physicians were invited to contribute data from their patients:baseline characteristics,ontreatment responses,sustained virological response at week 12(SVR12),and safety were collected and analysed.Multivariate analysis was performed to determine predictors of response.RESULTS:150 patients were enrolled from Australia,Malaysia,Singapore and Thailand(Asians = 86,Caucasians = 63).Overall SVR12 was 61%(Asians= 59.3%,Caucasians = 63.5%).SVR12 was higher in relapsers(78%) compared with non-responders(34%).On-treatment responses predicted SVR,with undetectable HCVRNA at week 4,8 and 12 leading to SVR12 s of 100%,87%,and 82%respectively,and detectable HCVRNA at week 4,8 and 12,leading to SVR12 s of 58%,22%and 6%respectively.Asian patients were similar to Caucasian patients with regards to on-treatment responses.Patients with cirrhosis(n= 69) also behaved in the same manner with regards to on-treatment responses.Those with the IL28 B CC genotype(80%) had higher SVRs than those with the CT/TT(56%) genotype(P = 0.010).Multivariate analysis showed that TW8 and TW12 responses were independent predictors of SVR.Serious adverse events occurred in 18.6%:sepsis(2%),decompensation(2.7%) and blood transfusion(14%).Discontinuations occurred in 30.7%,with 18.6%fulfilling stopping rules.CONCLUSION:Boceprevir can be used successfully in PR treatment failures with a SVR12 > 80%if they have good on-treatment responses;however,discontinuations occurred in 30%because of virological failure or adverse events.
文摘The Chinese government promotes smoking cessation through smoking cessation clinics(SCCs).This study aimed to identify factors associated with relapse and provide evidence to inform interventions that reduce relapse risk.Participants were SCC patients aged≥18 years who enrolled between June 2019 and December 2021,completed follow-up assessments at one and three months,and reported abstinence at one month.Short-term relapse was defined as self-reported smoking at the three-month follow-up.Treatments included counseling,first-line cessation medications,and traditional Chinese medicine(TCM).Logistic regression was used to identify factors associated with short-term relapse.Among 10,724 eligible SCC patients,11.6%experienced short-term relapse.Factors positively associated with relapse included the number of previous quit attempts(1–5 attempts:OR=1.422,95%CI:1.254–1.613,>5 attempts:OR=1.382,95%CI:1.057–1.808),high perceived difficulty in quitting(OR=1.297,95%CI:1.061–1.586),and moderate(OR=1.383,95%CI:1.174–1.629)or weak(OR=1.517,95%CI:1.251–1.841)willingness to quit.Factors negatively associated with relapse included having a college degree or higher(OR=0.796;95%CI:0.650–0.973),high confidence in quitting(OR=0.786;95%CI:0.629–0.983),and use of TCM(OR=0.276;95%CI:0.158–0.482).Enhancing self-efficacy in quitting appears crucial for preventing short-term relapse.The use of TCM may reduce relapse risk and warrants further investigation.
基金funded by Peking University Sixth Hospital(BDLYYLZL2024-01)the Capital Health Development Research Project Program of China(2014-4-4112).
文摘To the editor:Schizophrenia is a chronic and severe mental disorder characterised by profound disruptions in thinking,affecting language,perception and the sense of self. These disruptions can significantly impair an individual’s ability to function socially and occupationally, leading to a high burden on both the individuals affected and society as a whole.
文摘The purpose of this article is to analyze the efficacy of molecular diagnostic techniques for monitoring tuberculosis relapse.After analyzing the connotation of molecular diagnostic techniques and their specific application process in tuberculosis relapse monitoring,a total of 200 cured tuberculosis patients were selected(100 in the experimental group and 100 in the control group).During the 12-month follow-up period,the experimental group was monitored by molecular diagnostic techniques,while the control group was monitored by traditional techniques.Finally,by comparing the performance indicators of the two monitoring methods,as well as the relapse situations and outcomes of patients,it was demonstrated that molecular diagnostic techniques have higher efficacy in tuberculosis relapse monitoring.
文摘BACKGROUND Entecavir(ETV)and tenofovir fumarate(TDF)are recommended first-line agents for the treatment of chronic hepatitis B virus(HBV)infection.However,the effect of these 2 antiviral agents on the risk for recurrence of HBV-associated hepato-cellular carcinoma(HCC)after radical hepatectomy remains controversial.AIM To compare the effect of TDF vs ETV on the risk for HCC recurrence after radical surgery for HBV-related HCC.METHODS Data from consecutive patients,who received TDF or ETV after radical hepatec-tomy for HBV-related HCC and admitted to the Second Hospital of Longyan between December 2018 and December 2023,were retrospectively analyzed.Based on treatment method and propensity score matching(PSM),data from 100 patients were included,with 50 in each of the TDF and ETV groups,respectively.The baseline characteristics of the 2 groups were analyzed,and the risk for HCC recurrence was compared between the groups.RESULTS The median follow-up for 100 patients[median age,61 years;84 male(84%)]who underwent radical resection for HBV-related HCC-Barcelona Clinic Liver Cancer stage 0[n=16(16%)],stage A[n=61(61%)]-was 29 months(range,12-60 months);the median tumor size was 3.0 cm(range,2.1-4.3 cm).Sixty-eight(68%)patients exhibited HBV-DNA levels>1000 IU/mL.Twenty-two(22%)patients tested positive for hepatitis B e antigen,in whom the HCC recurrence rate was 59.1%(13/22).After PSM,HCC recurrence rates in the ETV and TDF groups after hepatectomy were 66%(n=33)and 42%(n=21),respectively(P=0.016),and cumulative recurrence rates at 1,3,and 5 years were 26%,58%,and 66%,and 18%,38%,and 42%,respectively(P=0.045).CONCLUSION TDF treatment is associated with a lower risk for HCC-related outcomes than that for ETV in patients with HBV-associated HCC after curative therapy.
基金Guiding Science and Technology Program Project of Yichang City in 2024(Project No.:B24-2-002)。
文摘Objective:This study aimed to explore the effect of aromatherapy combined with emotional release technology on recurrence fear and sleep quality of lung cancer survivors.Methods:114 cases of lung cancer survivors were divided into routine nursing group,emotional release technology group and aromatherapy combined with emotional release technology group.Routine nursing group received routine nursing;Emotional release technology group implemented emotional release technology for one month on the basis of routine nursing group;Aromatherapy combined with emotional release technology group used lavender aromatherapy on the basis of emotional release technology group.Results:After one month of intervention,there were statistically significant differences in the scores of fear of disease progression and sleep quality among the three groups.Conclusion:Aromatherapy combined with emotional release technology can improve the sleep quality of lung cancer survivors and reduce the economic toxicity of cancer to some extent.
基金supported by grants from the 925th Science Foundation(Grant Nos.2023-3 and 2024-2/3).
文摘Multiple myeloma is a complex and challenging blood cancer,particularly in cases where the disease has relapsed or become resistant to treatment.These situations often have a significant impact on both patient survival and quality of life.Over recent years,advances in precision medicine and translational medicine have brought about a shift in treatment strategies,moving toward more personalized and targeted approaches.This review highlights the latest developments in the management of refractory and relapsed multiple myeloma,focusing on the current state of precision diagnosis and treatment,the role of translational medicine,and potential future directions in research.By reviewing key studies and clinical trial data,we aim to offer fresh perspectives and strategies that could improve clinical outcomes.
文摘BACKGROUND 5-aminosalicylates(5-ASA)are the primary treatment for mild to moderate ulcerative colitis(UC).Maintenance therapy with 5-ASA has been shown to reduce both the risk of relapse and colorectal cancer.AIM To evaluate the outcomes of 5-ASA withdrawal due to non-adherence in UC patients while in remission on monotherapy.METHODS Adult patients with UC who were followed up between July 2019 and April 2025 were screened.Patients in remission receiving 5-ASA monotherapy who experienced treatment withdrawal due to non-adherence were included in this study.RESULTS Among 880 patients with UC,30(3.4%)had 5-ASA withdrawal due to nonadherence while in remission on monotherapy.Twelve patients(40%)had disease relapse after a median of 20 months.The rate of patients in remission was 89%in the first year,decreasing to 73%in the second year,and to 64%in the third year.There were no significant differences between patients with and without relapse in terms of demographics,disease extent,remission duration before 5-ASA withdrawal,previous medications,steroid dependence,5-ASA formulation,baseline inflammatory markers,or partial and endoscopic Mayo scores.Most patients(75%)who experienced relapse were successfully treated with 5-ASA monotherapy,while one-fourth of them required corticosteroids.No patients required biologic agents,hospitalization,or surgical intervention.CONCLUSION Intermittent therapy may be safe and feasible for UC patients,especially those in long-term remission,with treatment interruption up to one year considered acceptable.
文摘Background: Acute Leukemia is the most common childhood cancer, with two main types: ALL and AML. In Tanzania, recent improvements in treatment and survival have been noted, but the latest data is from 2013. This study will update survival and relapse information from 2013 to 2020 to help enhance future treatment strategies. Methodology: This study was conducted at two tertiary hospitals in Tanzania. The study analyzed data from children diagnosed with Acute Leukemia between January 2015 to December 2020. Patient data were collected via questionnaires and analyzed using STATA software. Results: This study included a total of 95 participants 64 had age less than 10 years and majority were males 56.8%, 55 had duration of symptoms for more than 1 month 66 had ALL, 49 had attained remission, the overall three years survival was 44.2% with those children with no health insurance having high risk of dying, rate of relapse was 18.4%, with those diagnosed with B-ALL having low risk of relapse. Conclusion: This study provides insights into survival and relapse predictors for childhood leukemia in northern Tanzania. It found an overall survival rate of 44.2%, with health insurance and minimal residual disease after induction being key predictors of survival. The relapse rate was 18.4%, with health insurance linked to a lower relapse risk. Health insurance emerged as a strong predictor of better survival, leading to the recommendation that all children should have health insurance. Additionally, the study suggests that policymakers should support the expansion of global health coverage in Tanzania.
文摘Depression is a prevalent mental health disorder characterized by high relapse rates,highlighting the need for effective preventive interventions.This paper reviews the potential of reinforcement learning(RL)in preventing depression relapse.RL,a subset of artificial intelligence,utilizes machine learning algorithms to analyze behavioral data,enabling early detection of relapse risk and optimization of personalized interventions.RL's ability to tailor treatment in real-time by adapting to individual needs and responses offers a dynamic alternative to traditional therapeutic approaches.Studies have demonstrated the efficacy of RL in customizing e-Health interventions and integrating mobile sensing with machine learning for adaptive mental health systems.Despite these advantages,challenges remain in algorithmic complexity,ethical considerations,and clinical implementation.Addressing these issues is crucial for the successful integration of RL into mental health care.This paper concludes with recommendations for future research directions,emphasizing the need for larger-scale studies and interdisciplinary collaboration to fully realize RL’s potential in improving mental health outcomes and preventing depression relapse.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is a minimally invasive,safe,and efficient treatment technique for patients diagnosed with early esophageal cancer.However,postoperative disease recurrence remains an important clinical challenge because it negatively alters patient prognosis and quality of life.As such,identification of relevant risk factors for recurrence can help optimize postoperative management strategies.AIM To assess factors that contribute to the risk for disease recurrence after ESD for early esophageal cancer.METHODS Clinical data from 210 patients diagnosed with early stage esophageal cancer,who underwent ESD at the authors’center between March 2012 and March 2025,were retrospectively collected and analyzed.Patients were categorized into 2 groups according to postoperative disease recurrence:Recurrence(n=30),and without recurrence(n=180).Disease recurrence was defined as the appearance of new tumor lesions or pathologically confirmed tumor recurrence during the postoperative follow-up period.Risk factors associated with postoperative recurrence were identified using univariate and multivariate logistic regression analyses.RESULTS During the follow-up period,30 patients experienced tumor recurrence,corresponding to a recurrence rate of 14.19%.Multivariate analysis revealed that poor differentiation was a significant potential cause of esophageal cancer recurrence[odds ratio(OR)=1.782,95%confidence interval(CI):1.154-2.196;P<0.001].Tumors infiltrating the submucosa were more likely to recur than those penetrating the lamina propria or muscularis mucosa(OR=1.573,95%CI:1.073-2.481;P<0.001).Furthermore,inability to completely resect the tumor greatly increased the likelihood of recurrence(OR=2.189,95%CI:1.193-3.125;P=0.001).Tumor diameter≥2 cm was an independent risk factor for postoperative recurrence(OR=1.981,95%CI:1.482-2.862;P=0.005).CONCLUSION Recurrence of early esophageal cancer after ESD is largely influenced by the degree of differentiation,depth of lesion invasion,complete resection status of the tumor,and tumor diameter.
文摘Objective:In recent decades,studies have underscored nuclear proteins and signaling pathways in prostate cancer(PCa)development.Key biomarkers like Enhancer of zeste homolog 2(EZH2)and Forkhead box M1(FOXM1)are expressed in both healthy and malignant prostate cells.This study aimed to demonstrate the relationship between pathological characteristics,survival,recurrence,and tissue expression of EZH2 and FOXM1 in high-risk PCa patients.Methods:PCa tissues were used in a retrospective analysis that spanned from September 2009 to August 2019.Inclusion criteria comprised pathological tumor stage(pT)3 patients with positive surgical margins or tumor proximity to inked margins within 5 mm.After case selection,tissue slides were stained for EZH2 and FOXM1 antibodies,and Allred scores were calculated.Patients or relatives of deceased patients were contacted for signed agreements and disease follow-ups.Results:The pT3b,ductal carcinoma component,and moderate EZH2 expression were associated with relapse(odds ratio[OR]6.21,95%confidence interval[CI]1.41-27.27,p=0.016;OR 7.29,95%CI 1.03-51.43,p=0.046;OR 5.96,95%CI 1.09-32.48,p=0.039;respectively).The unilateral and bilateral seminal vesicle invasion increased the likelihood of recurrence by 9.98 times and 5.36 times,and the risk of death by around 9.78 times and 10.79 times,respectively.The pT3b was linked to higher death likelihood(OR 7.16,95%CI 1.38-37.23,p=0.019),while moderate EZH2 expression did not show statistical significance(OR 4.54,95%CI 0.87-23.60,p=0.072,marginally).Pathological regional lymph node stage(pN)1 had significantly higher probability of mortality than pN unknown(3.9%vs.27%,p<0.001).PCa in the neck and apex of the prostate gland increased death risk tenfold.Conclusion:Sufficient immunoexpression of EZH2,ductal carcinoma component,and neoplastic proliferation in the seminal vesicles,apex and neck of the prostate gland correlates with elevated risks of recurrence and mortality.Clinicians should use these criteria for appropriate patient referrals,and a multicenter trial could provide accurate classifications.
文摘Alcohol-associated liver disease(ALD)is a rapidly increasing indication for liver transplantation(LT)globally with a significant rise in transplants for ALD with limited sobriety including patients with alcohol-associated hepatitis(AH).This evolution challenges the older paradigm that mandates prolonged periods of alcohol abstinence prior to LT.Due to the limited armamentarium of effective pharmacotherapy to treat severe AH,the mortality rates are significantly higher when LT is not available.In the patients who are transplanted for ALD with limited sobriety including AH,patient and graft survival are equivalent,if not better,compared to patients transplanted for other etiologies.However,due to the risk of alcohol relapse and other psychosocial factors,public opinion regarding early LT may continue to impact how the field moves forward particularly regarding organ stewardship and the need for equitable allocation of organs.Numerous tools for psychosocial evaluations have been developed to assist liver transplant teams to identify appropriate patients in a more uniform manner.In this review,we aim to assess the available evidence to support early LT for alcohol AH and propose directions for the future as the field continues to evolve.
文摘Cancer relapse often originates from dormant tumor cells lurking in distant organs-untouched by chemotherapy.Despite predictions that dormant disseminated tumor cells(DTCs)might awaken to cause relapse after a clinically silent period,direct evidence and chemotherapy’s precise role remained unknown.
基金supported by funding from the National Natural Science Foundation of China(Grant No.82170167 to Xiaoxi Zhou and Grant No.82300226 to Hui Luo)。
文摘CD5-positive(CD5+)diffuse large B-cell lymphoma(DLBCL)represents a special subgroup of DLBCL with a more aggressive disease course and is more likely to develop into relapsed/refractory(r/r)DLBCL in response to immunochemotherapy.The incidence of CD5+DLBCL is 5%–10%among DLBCL patients1.
基金supported by the Natural Science Foundation of Zhejiang Province(LQ23H090002)the National Natural Science Foundation of China(82201607).
文摘Cortical malformations,including focal cortical dysplasia type II(FCDII),are a common cause of drug-resistant epilepsy and developmental delay.Consideration of surgery has become the standard of care for those patients.However,10%-50% of patients with FCD experience post-surgical relapses[1],and many do not even qualify as surgical candidates.Effective treatments for FCD-associated epilepsy are lacking.
基金supported by funding from the National KeyR&D Program of China(No.2022YFC2502604)the National Natural Science Foundation of China(No.82470194)+1 种基金the CAMS Innovation Fund for Medical Sciences(CIFMS)(No.2024-I2M-3-021)the ChenXiaoping Foundation for the development of Science and Technology of Hubei Province(No.CXPJJH122001-2221)。
文摘Autologous stem cell transplantation(ASCT)and chimeric antigen receptor T-cell(CAR-T)therapy represent pivotal treatments for hematologic malignancies,each with distinct strengths and limitations.ASCT reduces tumor burden through myeloablative conditioning but remains susceptible to relapse,while CAR-T therapy precisely targets malignant cells but encounters challenges,including cytokine release syndrome(CRS),immune effector cell-associated neurotoxicity syndrome(ICANS),and limited persistence.Emerging evidence suggests that combining ASCT with CAR-T therapy yields synergistic effects.ASCT reshapes the immune microenvironment,lowers immunosuppressive cells and CRS risk,while CAR-T eliminates residual disease and promotes immune recovery.Clinical trials in relapsed/refractory B-cell lymphomas and multiple myeloma demonstrate complete remission rates(CRR)of 72%-100%and two-year progression-free survival(PFS)rates of 59%-83%,with severe CRS/ICANS incidences below 10%.However,the precise mechanisms underlying this synergy,optimal timing of CAR-T infusion after ASCT,and ideal dosing regimens require further definition.Future research should prioritize large-scale,randomized controlled trials and establish standardized protocols for toxicity management to maximize therapeutic benefits.By integrating the complementary strengths of ASCT and CAR-T,this combination strategy represents a promising approach for improving outcomes in high-risk hematologic malignancies;however,additional studies are necessary to validate its efficacy and expand its clinical applicability.
基金supported by National Natural Science Foundation of China(No.82370215,82020108003,and 82330008)Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD),Jiangsu Provincial Medical Innovation Center(No.CXZX202201)Science and Technology Program of Suzhou(No.SKY2023047)。
文摘With the advances in allogeneic hematopoietic cell transplantation(allo-HCT)and supportive care,the number of allo-HCT for elderly patients has been increasing in recent years.However,the advanced donor age limits the availability of human leukocyte antigen(HLA)-matched sibling donors(MSD)for elderly individuals.
基金sponsored by Shanghai Roche Pharmaceuticals Ltd.
文摘Diffuse large B-cell lymphoma(DLBCL),the most common subtype of non-Hodgkin’s lymphoma(NHL)worldwide,accounts for 39% and 44% of nodal and extranodal NHL cases in China,respectively1.Standard first-line treatment for DLBCL is chemo-immunotherapy with rituximab,cyclophos-phamide,doxorubicin,vincristine,and prednisone,which cures 50%-60% of patients2.
