Background: The profile of primary brain tumors and treatment modalities employed in Tanzania remains largely unknown. The study aimed to describe the baseline clinical-pathological profile and treatment modalities fo...Background: The profile of primary brain tumors and treatment modalities employed in Tanzania remains largely unknown. The study aimed to describe the baseline clinical-pathological profile and treatment modalities for primary brain tumors in adults treated at the Ocean Road Cancer Institute (ORCI) from 2017 to 2020. Materials and Methods: This was a retrospective study conducted at ORCI by reviewing 61 medical records of patients with primary brain tumors over the age of 15 from January 2017 to December 2020. A structured questionnaire was used to retrieve information on sociodemographic, clinical-pathological characteristics, and treatment modalities. The 2007 WHO classification system and the International Classification of Cancer Diseases (ICD-0-3) were used for classification and diagnosis. The X<sup>2</sup> test and Fisher’s exact test were used to compare the proportions and an independent t-test was used to compare the means. A P-value less than 0.05 was deemed statistically significant. The Results: The mean age of the females was 41.8 years and the mean age of males was 42.9 years. Overall M: F ratio was 1:1.2. Meningioma was the only tumor that was more commonly found in women with M:F of 1:2.1. The most prevalent symptom was headache (57.4%). Glioblastoma (GBM) was the most common tumor among adults (38%), followed by astrocytomas (23%) and meningioma (18%). Approximately 91.8% of all tumors occurred in the supratentorial region. The Frontal lobe was the most common site (29.5%). Approximately 81.9% of patients received surgery. The gross tumor resection (GTR) rate was 26.2%, and the subtotal tumor resection (STR) rate was 55.7%. Roughly 18% of the tumors were inoperable. An estimated 80.3% of respondents received radiation therapy. The radiotherapy technique was 3DCRT in two-thirds of the patients and the rest received conventional 2D radiotherapy. The mean equivalent dose in the 2 Gy fractions (EQD2) was 43.9 Gy. Respondents with low-grade intracranial tumors were treated with a mean EQD2 of 47.3 Gy, while those with high-grade intracranial tumors were treated with a mean EQD2 of 44.3 Gy and the difference was statistically significant. Only half of the patients who received adjuvant radiotherapy received it concurrently with chemotherapy. Temozolomide was the most widely used cytotoxic medication. Conclusion: Mean age of the patients was 41 years old. Most tumors were in the supratentorial area and GBM was the most common tumor. Only meningioma was a bit more common amongst females. Overall, radiotherapy doses and the gross tumor resection rates were low. Concurrent chemotherapy with radiotherapy was given to a few patients.展开更多
Background:Post-liver transplantation(LT)hepatocellular carcinoma(HCC)recurrence still occurs in approximately 20%of patients and drastically affects their survival.This study aimed to evaluate the efficacy of various...Background:Post-liver transplantation(LT)hepatocellular carcinoma(HCC)recurrence still occurs in approximately 20%of patients and drastically affects their survival.This study aimed to evaluate the efficacy of various treatments for recurrent HCC after LT in a Chinese population.Methods:A total of 64 HCC patients with tumor recurrence after LT were enrolled in this study.Univariate and multivariate analyses were performed to identify factors affecting post-recurrence survival.Results:Of the 64 patients with recurrent HCC after LT,those who received radical resection followed by nonsurgical therapy had a median overall survival(OS)of 20.9 months after HCC recurrence,significantly superior to patients who received only nonsurgical therapy(9.4 months)or best supportive care(2.4 months).The one-and two-year OS following recurrence was favorable for patients receiving radical resection followed by nonsurgical therapy(93.8%,52.6%),poor for patients receiving only nonsurgical therapy(30.8%,10.8%),and dismal for patients receiving best supportive care(0%,0%;overall P<0.001).Median OS in sorafenib-tolerant patients treated with lenvatinib was 19.5 months,far surpassing the patients that discontinued sorafenib or were treated with regorafenib after sorafenib failure(12 months,P<0.001).Compared with tacrolimus-based immunosuppressive therapy,OS was significantly increased with sirolimus-based therapy at one and two years after HCC recurrence(P=0.035).Multivariate analysis showed radical resection combined with nonsurgical therapy for recurrent HCC and sorafenib-lenvatinib sequential therapy were independent favorable factors for post-recurrence survival.Conclusions:Aggressive surgical intervention in well-selected patients significantly improves OS after recurrence.A multidisciplinary treatment approach is required to slow down disease progression for patients with unresectable recurrent HCC.展开更多
Bruxism, characterized by involuntary clenching or grinding of teeth, affects approximately 10% - 20% of adults globally and has significant implications for dental and systemic health. Emerging AI-driven diagnostic t...Bruxism, characterized by involuntary clenching or grinding of teeth, affects approximately 10% - 20% of adults globally and has significant implications for dental and systemic health. Emerging AI-driven diagnostic tools have demonstrated a 25% improvement in identifying nocturnal bruxism compared to conventional methods. This study explores the etiology, pathogenesis, and treatment modalities of bruxism, integrating cutting-edge advancements like neuromodulation and personalized medicine. Furthermore, socioeconomic factors and access disparities are analyzed to propose comprehensive strategies for improving patient outcomes. Current management strategies include behavioral therapies, orthodontic appliances, pharmacological interventions, physical therapy, and, in severe cases, surgical options. Emerging technologies, such as artificial intelligence, personalized medicine, and neuromodulation, are highlighted as promising advancements in bruxism diagnosis and treatment. Additionally, the study underscores the socioeconomic and ethical dimensions of bruxism care, advocating for interdisciplinary collaboration, patient education, and equitable access to innovative treatments. This research aims to contribute to improved understanding and management of bruxism, enhancing patient outcomes and quality of life.展开更多
To the Editor:Hepatocellular carcinoma(HCC)represents the fifth most com-mon malignancy and the third cancer-related cause of death worldwide[1].Among several treatment modalities for HCC,liver transplantation(LT)is a...To the Editor:Hepatocellular carcinoma(HCC)represents the fifth most com-mon malignancy and the third cancer-related cause of death worldwide[1].Among several treatment modalities for HCC,liver transplantation(LT)is a preferred option for selected patients[2,3],which removes the tumor and targets the underlying liver disease simultaneously.To minimize the incidence of tumor recurrence,the Milan criteria and subsequently a series of expanded criteria such as UCSF and Hangzhou criteria were introduced[4-6].How-ever,tumor recurrence,which was partially ascribed to the im-paired function of antitumor immune responses following LT,still remains a pivotal obscure that hinders long-term survival[7,8].The human liver is characterized by a dual blood supply,with 80%of blood from the portal vein carrying bacterial endotoxin from the gastrointestinal tract.Liver is thus constantly exposed to a large load of intestinal antigens.展开更多
BACKGROUND Glaucoma is the leading cause of irreversible blindness worldwide,with 60.5 million affected individuals,of whom 11 million are from India.Due to its asymptomatic nature,the disease largely remains underdia...BACKGROUND Glaucoma is the leading cause of irreversible blindness worldwide,with 60.5 million affected individuals,of whom 11 million are from India.Due to its asymptomatic nature,the disease largely remains underdiagnosed or diagnosed in advanced stages,where little can be done to salvage functional vision.The literature suggests that a lack of knowledge is one of the reasons for its grave consequences.Assessment of awareness is the first step in planning management.Several studies have been conducted in the Indian community,but data from healthcare providers,who play a significant role in educating the masses directly or indirectly,are limited.AIM To identify awareness,knowledge,and attitudes about glaucoma among healthcare workers in a tertiary center in India.METHODS This cross-sectional study was conducted at a tertiary care institute in Eastern India.Data were collected from 423 participants by systematic stratified sampling after Institutional Ethics Committee approval via a pretested,self-designed,semistructured,validated questionnaire.Statistical analyses were performed using the Statistical Package for Social Sciences Software v22.0.Continuous variables are expressed as the means±SD for parametric values and medians with interquartile ranges for nonparametric values.The associations between the variables were studied via multivariate linear and logistic regression.P<0.05 was considered statistically significant.RESULTS Most respondents were 20–30 years old(n=345,81.6%).The knowledge regarding glaucoma was good,and almost 56.3%of the participants gained knowledge from their medical training.The majority were aware that it has a familial predisposition and is secondary to high intraocular pressure,leading to irreversible peripheral vision loss.Only 42%knew about the life-long requirements of treatment.The resident group scored highest on knowledgeand attitude-based questions,whereas the faculty group scored highest on practice-based questions.Although 62%of the nursing staff had good attitude scores,their knowledge and practice scores were lower.The occupation group response difference was statistically significant(P<0.05)for all the knowledge-based questions.CONCLUSION Although the majority of healthcare providers are aware of glaucoma,there is a dearth of knowledge about treatment modalities.Education via seminars and media can improve their knowledge,attitudes,and practices.展开更多
Infectious bone defects represent a substantial challenge in clinical practice,necessitating the deployment of advanced therapeutic strategies.This study presents a treatment modality that merges a mild photothermal t...Infectious bone defects represent a substantial challenge in clinical practice,necessitating the deployment of advanced therapeutic strategies.This study presents a treatment modality that merges a mild photothermal therapy hydrogel with a pulsed drug delivery mechanism.The system is predicated on a hydrogel matrix that is thermally responsive,characteristic of bone defect sites,facilitating controlled and site-specific drug release.The cornerstone of this system is the incorporation of mild photothermal nanoparticles,which are activated within the temperature range of 40–43°C,thereby enhancing the precision and efficacy of drug delivery.Our findings demonstrate that the photothermal response significantly augments the localized delivery of therapeutic agents,mitigating systemic side effects and bolstering efficacy at the defect site.The synchronized pulsed release,cooperated with mild photothermal therapy,effectively addresses infection control,and promotes bone regeneration.This approach signifies a considerable advancement in the management of infectious bone defects,offering an effective and patient-centric alternative to traditional methods.Our research endeavors to extend its applicability to a wider spectrum of tissue regeneration scenarios,underscoring its transformative potential in the realm of regenerative medicine.展开更多
Intentional tooth replantation(ITR)is an advanced treatment modality and the procedure of last resort for preserving teeth with inaccessible endodontic or resorptive lesions.ITR is defined as the deliberate extraction...Intentional tooth replantation(ITR)is an advanced treatment modality and the procedure of last resort for preserving teeth with inaccessible endodontic or resorptive lesions.ITR is defined as the deliberate extraction of a tooth;evaluation of the root surface,endodontic manipulation,and repair;and placement of the tooth back into its original socket.Case reports,case series,cohort studies,and randomized controlled trials have demonstrated the efficacy of ITR in the retention of natural teeth that are untreatable or difficult to manage with root canal treatment or endodontic microsurgery.However,variations in clinical protocols for ITR exist due to the empirical nature of the original protocols and rapid advancements in the field of oral biology and dental materials.This heterogeneity in protocols may cause confusion among dental practitioners;therefore,guidelines and considerations for ITR should be explicated.This expert consensus discusses the biological foundation of ITR,the available clinical protocols and current status of ITR in treating teeth with refractory apical periodontitis or anatomical aberration,and the main complications of this treatment,aiming to refine the clinical management of ITR in accordance with the progress of basic research and clinical studies;the findings suggest that ITR may become a more consistent evidence-based option in dental treatment.展开更多
This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma （PTL） patients. We retrospectively reviewed the clinical recor...This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma （PTL） patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan-Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival （PFS）, overall survival （OS）, and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage （Ill/IV） （P 〈 0.001）, B symptoms （P 〈 0.001）, and extranodal involvement other than testis （P = 0.001） were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS （OR = 11.58, P = 0.049）, whereas B symptom was significantly associated with PFS （OR = 11.79, P = 0.049）. In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months （P = 0.032）. The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.展开更多
Malignant tumor has become a major threat affecting human health,and is one of the main causes of human death.Recent studies have shown that many traditional Chinese medicines(TCM)have good anti-tumor activity,which m...Malignant tumor has become a major threat affecting human health,and is one of the main causes of human death.Recent studies have shown that many traditional Chinese medicines(TCM)have good anti-tumor activity,which may improve the therapeutic effect of routine treatment and quality of life with lower toxicity.However,the efficacy of TCM alone for the treatment of tumors is limited.Metal ions are essential substances for maintaining normal physiological activities.This article summarized the multiple mechanisms in which metal ions are involved in the prevention and treatment of tumors in TCM.展开更多
Objective:The extremely low incidence of male breast cancer (MBC) leads to lack of prospective randomized phase III studies worldwide. Especially in China,all studies on Chinese patients with MBC were based on small s...Objective:The extremely low incidence of male breast cancer (MBC) leads to lack of prospective randomized phase III studies worldwide. Especially in China,all studies on Chinese patients with MBC were based on small sample size and single institute experience. The aim of this study was to provide overall view of characteristics of Chinese patients with MBC by means of summarizing all related papers published in Chinese journals. Methods: An online search was made in CBM,VIP,CNKI,and CBA databases to find all published articles of interest on Chinese patients with MBC. And eight subjects including the proportion of MBC in all breast cancer,age,tumor location,clinical stages,pathological subtypes,treatment modalities,ER/PR expression,and 5-year survival rate were selected to calculate the proportion and their 95% interval confidence. Results: There were 122 papers with 2584 patients enrolled. The basic features of Chinese patients with MBC included:(1) MBC only with a proportion of 1.06% of all the breast cancer; (2) The mean age at diagnosis was 57.6 years old; (3) Tumor mainly located in the areolar region (74.83%) with obvious nipple and/or skin involvement; (4) Nearly 62.62% patients were in early stage before accepting treatment; (5) Infiltrating ductal carcinoma accounted for 79.05% of all pathological subtypes; (6) ER/PR expression rate was 65.86%; (7) Radical resection was up to 86.06% in all surgical modalities; (8) The 5-year survival rate was 57.33%. Conclusion: The results showed in this study were an overall view of Chinese patients with MBC whose characteristics were similar to that reported in the West. Though this study provided a little bit stronger confidence than a single study collected in this paper,studies with more powerful evidence are urgently demanding in China.展开更多
objective:Two cycles of induction chemotherapy(IC)followed by 2 cycles of platinum-based concurrent chemoradiotherapy(CCRT)(2IC+2CCRT)for locoregionally advanced nasopharyngeal carcinoma(LA-NPC)is widely adopted but n...objective:Two cycles of induction chemotherapy(IC)followed by 2 cycles of platinum-based concurrent chemoradiotherapy(CCRT)(2IC+2CCRT)for locoregionally advanced nasopharyngeal carcinoma(LA-NPC)is widely adopted but not evidence-confirmed.This study aimed to determine the clinical value of 2IC+2CCRT regarding efficacy,toxicity and cost-effectiveness.Methods:This real-world study from two epidemic centers used propensity score matching(PSM)and inverse probability of treatment weighting(IPTW)analyses.The enrolled patients were divided into three groups based on treatment modality:Group A(2IC+2CCRT),Group B(3IC+2CCRT or 2IC+3CCRT)and Group C(3IC+3CCRT).Long-term survival,acute toxicities and cost-effectiveness were compared among the groups.We developed a prognostic model dividing the population into high-and low-risk cohorts,and survivals including overall survival(OS),progression-free survival(PFS),distant metastasis-free survival(DMFS)and locoregional relapse-free survival(LRRFS)were compared among the three groups according to certain risk stratifications.Results:Of 4,042 patients,1,175 were enrolled,with 660,419,and 96 included in Groups A,B and C,respectively.Five-year survivals were similar among the three groups after PSM and confirmed by IPTW.Grade 3-4 neutropenia and leukocytopenia were significantly higher in Groups C and B than in Group A(52.1%vs.41.5%vs.25.2%;41.7%vs.32.7%vs.25.0%)as were grade 3-4 nausea/vomiting and oral mucositis(29.2%vs.15.0%vs.6.1%;32.3%vs.25.3%vs.18.0%).Cost-effective analysis suggested that 2IC+2CCRT was the least expensive,while the health benefits were similar to those of the other groups.Further exploration showed that 2IC+2CCRT tended to be associated with a shorter PFS in high-risk patients,while 3IC+3CCRT potentially contributed to poor PFS in low-risk individuals,mainly reflected by LRRFS.Conclusions:In LA-NPC patients,2IC+2CCRT was the optimal choice regarding efficacy,toxicity and costeffectiveness;however,2IC+2CCRT and 3IC+3CCRT probably shortened LRRFS in high-and low-risk populations,respectively.展开更多
The proportions of patients with hepatocellular carcinoma(HCC)involving portal vein tumor thrombus(PVTT)varies greatly in different countries or regions,ranging from 13%to 45%.The treatment regimens for PVTT recommend...The proportions of patients with hepatocellular carcinoma(HCC)involving portal vein tumor thrombus(PVTT)varies greatly in different countries or regions,ranging from 13%to 45%.The treatment regimens for PVTT recommended by HCC guidelines in different countries or regions also vary greatly.In recent years,with the progress and development of surgical concepts,radiotherapy techniques,systematic therapies(for example,VEGF inhibitors,tyrosine kinase inhibitors and immune checkpoint inhibitors),patients with HCC involving PVTT have more treatment options and their prognoses have been significantly improved.To achieve the maximum benefit,both clinicians and patients need to think rationally about the indications of treatment modalities,the occurrence of severe adverse events,and the optimal fit for the population.In this review,we provide an update on the treatment modalities available for patients with HCC involving PVTT.Trials with large sample size for patients with advanced or unresectable HCC are also reviewed.展开更多
Background:The aim of this study was to comprehensively evaluate the risk factors of periprocedural ischemic stroke associated with endovascular treatment of intracranial aneurysms using a real-world database.Methods:...Background:The aim of this study was to comprehensively evaluate the risk factors of periprocedural ischemic stroke associated with endovascular treatment of intracranial aneurysms using a real-world database.Methods:From August 2016 to March 2017,167 patients were enrolled.Univariate analysis and multivariate logistic regression analysis were used to examine the risk factors for periprocedural ischemic stroke.Results:Among the 167 cases,periprocedural ischemic stroke occurred in 20 cases(11.98%).After univariate analysis,the ischemic group had a higher proportion of large(≥10 mm)aneurysms than the control group(45.0%vs.23.1%,p=0.036).The incidence of periprocedural ischemic stroke was higher in cases treated by flow diverter(21.6%)or stent-assisted coiling(11.8%)than in cases treated by coiling only(2.7%),and the differences were statistically significant(p=0.043).After multivariate logistic regression analysis,treatment modality was the independent risk factor for periprocedural ischemic stroke.Compared with the coiling-only procedure,flow diverter therapy was associated with a significantly higher rate of periprocedural ischemic stroke(OR 9.931;95%CI 1.174-84.038;p=0.035).Conclusions:Aneurysm size and treatment modality were associated with periprocedural ischemic stroke.Larger aneurysms were associated with increased risk of periprocedural ischemic stroke.Flow diverter therapy was associated with significantly more periprocedural ischemic stroke than the coiling procedure alone.展开更多
Precision medicine aims to empower clinicians to predict the most appropriate course of action for patients with complex diseases like cancer and others.1 With an efficient interrogation of the omics,molecular,and cli...Precision medicine aims to empower clinicians to predict the most appropriate course of action for patients with complex diseases like cancer and others.1 With an efficient interrogation of the omics,molecular,and clinical data at play in diseases,effective,personalized,and precise medical treatment strategies are expected for many disorders.In addition,the treatment modality of precision medicine is increasingly diversified,spanning from mainstream drug and antibody treatment to newly developed gene and cell therapy,etc.In various treatment modalities,including the treatment by Chinese medicine,precision is the highest demand,and the underlying patterns and rationales across various factors to uncover the biological mechanism and actionable information that support early detection,prevention,and therapy of complex disorders can be identified by the omics data.1,2 Therefore,the omics sequencing technology and accumulated omics data serve as the core technology and resources that can have a huge impact on such a course of action.Accordingly,the integrative analysis of such omics data provides a great opportunity to support precision medicine studies.However,facing the unique features of the omics data,like the dominant characteristics of“high dimension and small sample,”traditional data analysis strategies are likely unsuitable,and data-driven artificial intelligence(AI)technology is emerging as an effective paradigm for precision medicine study.To this end,this study aims to present a concise and overview perspective of the characteristics and the emerging directions of omics sequencing data,as well as the related AI analysis schema in handling such data,together with the summarized precision therapy cases based on the integration of AI and omics.展开更多
“What's in a name?That which we call a rose by any other name would smell as sweet”-William Shakespeare Polycystic ovary syndrome(PCOS)is one of the commonest endocrinopathy in the reproductive age group,as depi...“What's in a name?That which we call a rose by any other name would smell as sweet”-William Shakespeare Polycystic ovary syndrome(PCOS)is one of the commonest endocrinopathy in the reproductive age group,as depicted in a study among the North Indian population[1].The nomenclatures,the diagnostic criteria,the pathophysiology,and the modalities of treatment are full of controversies.Other names for this syndrome include Stein-Leventhal syndrome,polycystic ovary disease(PCOD),polycystic ovarian disease,functional ovarian hyperandrogenism,ovarian hyperthecosis and sclerocystic ovary syndrome,etc.展开更多
The current mainstay treatment modalities for inflammatory bowel disease(IBD)include immunomodulators(methotrexate and thiopurines),biologics(antitumour necrosis factor alpha(TNF-α)being the most commonly used)and ot...The current mainstay treatment modalities for inflammatory bowel disease(IBD)include immunomodulators(methotrexate and thiopurines),biologics(antitumour necrosis factor alpha(TNF-α)being the most commonly used)and other monoclonal antibodies such as the anti-integrins and anti-interleukins(IL-12/23).While ideally treatment should be initiated early in the disease process to avoid relapses and complications,the major recurring issue continues to be primary and secondary loss of response,with often‘diminishing returns’in terms of efficacy for the next line of therapies prescribed for patients with IBD.Additional concerns include the long-term risk factors such as malignancy and susceptibility to infections.Recently,there has been an influx of new and emerging medications entering the market that are showing promising efficacy results in patients with moderate-to-severe disease who have previously failed to respond to multiple drugs.This review will focus on these novel and emerging therapies—in essence,‘horizon scanning’—which includes the antiadhesion agents,cytokine inhibitors,Janus kinase inhibitors,phosphodiesterase inhibitors,sphingosine-1 phosphate receptor modulators and MicroRNA-124(miR-124)upregulators.展开更多
文摘Background: The profile of primary brain tumors and treatment modalities employed in Tanzania remains largely unknown. The study aimed to describe the baseline clinical-pathological profile and treatment modalities for primary brain tumors in adults treated at the Ocean Road Cancer Institute (ORCI) from 2017 to 2020. Materials and Methods: This was a retrospective study conducted at ORCI by reviewing 61 medical records of patients with primary brain tumors over the age of 15 from January 2017 to December 2020. A structured questionnaire was used to retrieve information on sociodemographic, clinical-pathological characteristics, and treatment modalities. The 2007 WHO classification system and the International Classification of Cancer Diseases (ICD-0-3) were used for classification and diagnosis. The X<sup>2</sup> test and Fisher’s exact test were used to compare the proportions and an independent t-test was used to compare the means. A P-value less than 0.05 was deemed statistically significant. The Results: The mean age of the females was 41.8 years and the mean age of males was 42.9 years. Overall M: F ratio was 1:1.2. Meningioma was the only tumor that was more commonly found in women with M:F of 1:2.1. The most prevalent symptom was headache (57.4%). Glioblastoma (GBM) was the most common tumor among adults (38%), followed by astrocytomas (23%) and meningioma (18%). Approximately 91.8% of all tumors occurred in the supratentorial region. The Frontal lobe was the most common site (29.5%). Approximately 81.9% of patients received surgery. The gross tumor resection (GTR) rate was 26.2%, and the subtotal tumor resection (STR) rate was 55.7%. Roughly 18% of the tumors were inoperable. An estimated 80.3% of respondents received radiation therapy. The radiotherapy technique was 3DCRT in two-thirds of the patients and the rest received conventional 2D radiotherapy. The mean equivalent dose in the 2 Gy fractions (EQD2) was 43.9 Gy. Respondents with low-grade intracranial tumors were treated with a mean EQD2 of 47.3 Gy, while those with high-grade intracranial tumors were treated with a mean EQD2 of 44.3 Gy and the difference was statistically significant. Only half of the patients who received adjuvant radiotherapy received it concurrently with chemotherapy. Temozolomide was the most widely used cytotoxic medication. Conclusion: Mean age of the patients was 41 years old. Most tumors were in the supratentorial area and GBM was the most common tumor. Only meningioma was a bit more common amongst females. Overall, radiotherapy doses and the gross tumor resection rates were low. Concurrent chemotherapy with radiotherapy was given to a few patients.
基金the grants from National S&T Major Project(2017ZX10203205)the Medical Science and Technology Project of Zhejiang Province(2014KYA082)+1 种基金the Fundamental Research Funds for the Central Universities(2018FZA7002)the Shulan Talent Foundation.
文摘Background:Post-liver transplantation(LT)hepatocellular carcinoma(HCC)recurrence still occurs in approximately 20%of patients and drastically affects their survival.This study aimed to evaluate the efficacy of various treatments for recurrent HCC after LT in a Chinese population.Methods:A total of 64 HCC patients with tumor recurrence after LT were enrolled in this study.Univariate and multivariate analyses were performed to identify factors affecting post-recurrence survival.Results:Of the 64 patients with recurrent HCC after LT,those who received radical resection followed by nonsurgical therapy had a median overall survival(OS)of 20.9 months after HCC recurrence,significantly superior to patients who received only nonsurgical therapy(9.4 months)or best supportive care(2.4 months).The one-and two-year OS following recurrence was favorable for patients receiving radical resection followed by nonsurgical therapy(93.8%,52.6%),poor for patients receiving only nonsurgical therapy(30.8%,10.8%),and dismal for patients receiving best supportive care(0%,0%;overall P<0.001).Median OS in sorafenib-tolerant patients treated with lenvatinib was 19.5 months,far surpassing the patients that discontinued sorafenib or were treated with regorafenib after sorafenib failure(12 months,P<0.001).Compared with tacrolimus-based immunosuppressive therapy,OS was significantly increased with sirolimus-based therapy at one and two years after HCC recurrence(P=0.035).Multivariate analysis showed radical resection combined with nonsurgical therapy for recurrent HCC and sorafenib-lenvatinib sequential therapy were independent favorable factors for post-recurrence survival.Conclusions:Aggressive surgical intervention in well-selected patients significantly improves OS after recurrence.A multidisciplinary treatment approach is required to slow down disease progression for patients with unresectable recurrent HCC.
文摘Bruxism, characterized by involuntary clenching or grinding of teeth, affects approximately 10% - 20% of adults globally and has significant implications for dental and systemic health. Emerging AI-driven diagnostic tools have demonstrated a 25% improvement in identifying nocturnal bruxism compared to conventional methods. This study explores the etiology, pathogenesis, and treatment modalities of bruxism, integrating cutting-edge advancements like neuromodulation and personalized medicine. Furthermore, socioeconomic factors and access disparities are analyzed to propose comprehensive strategies for improving patient outcomes. Current management strategies include behavioral therapies, orthodontic appliances, pharmacological interventions, physical therapy, and, in severe cases, surgical options. Emerging technologies, such as artificial intelligence, personalized medicine, and neuromodulation, are highlighted as promising advancements in bruxism diagnosis and treatment. Additionally, the study underscores the socioeconomic and ethical dimensions of bruxism care, advocating for interdisciplinary collaboration, patient education, and equitable access to innovative treatments. This research aims to contribute to improved understanding and management of bruxism, enhancing patient outcomes and quality of life.
基金supported by grants from the National Natural Science Foundation of China(82300742)Zhejiang Provincial Natural Science Foundation of China(LQ22H160052).
文摘To the Editor:Hepatocellular carcinoma(HCC)represents the fifth most com-mon malignancy and the third cancer-related cause of death worldwide[1].Among several treatment modalities for HCC,liver transplantation(LT)is a preferred option for selected patients[2,3],which removes the tumor and targets the underlying liver disease simultaneously.To minimize the incidence of tumor recurrence,the Milan criteria and subsequently a series of expanded criteria such as UCSF and Hangzhou criteria were introduced[4-6].How-ever,tumor recurrence,which was partially ascribed to the im-paired function of antitumor immune responses following LT,still remains a pivotal obscure that hinders long-term survival[7,8].The human liver is characterized by a dual blood supply,with 80%of blood from the portal vein carrying bacterial endotoxin from the gastrointestinal tract.Liver is thus constantly exposed to a large load of intestinal antigens.
文摘BACKGROUND Glaucoma is the leading cause of irreversible blindness worldwide,with 60.5 million affected individuals,of whom 11 million are from India.Due to its asymptomatic nature,the disease largely remains underdiagnosed or diagnosed in advanced stages,where little can be done to salvage functional vision.The literature suggests that a lack of knowledge is one of the reasons for its grave consequences.Assessment of awareness is the first step in planning management.Several studies have been conducted in the Indian community,but data from healthcare providers,who play a significant role in educating the masses directly or indirectly,are limited.AIM To identify awareness,knowledge,and attitudes about glaucoma among healthcare workers in a tertiary center in India.METHODS This cross-sectional study was conducted at a tertiary care institute in Eastern India.Data were collected from 423 participants by systematic stratified sampling after Institutional Ethics Committee approval via a pretested,self-designed,semistructured,validated questionnaire.Statistical analyses were performed using the Statistical Package for Social Sciences Software v22.0.Continuous variables are expressed as the means±SD for parametric values and medians with interquartile ranges for nonparametric values.The associations between the variables were studied via multivariate linear and logistic regression.P<0.05 was considered statistically significant.RESULTS Most respondents were 20–30 years old(n=345,81.6%).The knowledge regarding glaucoma was good,and almost 56.3%of the participants gained knowledge from their medical training.The majority were aware that it has a familial predisposition and is secondary to high intraocular pressure,leading to irreversible peripheral vision loss.Only 42%knew about the life-long requirements of treatment.The resident group scored highest on knowledgeand attitude-based questions,whereas the faculty group scored highest on practice-based questions.Although 62%of the nursing staff had good attitude scores,their knowledge and practice scores were lower.The occupation group response difference was statistically significant(P<0.05)for all the knowledge-based questions.CONCLUSION Although the majority of healthcare providers are aware of glaucoma,there is a dearth of knowledge about treatment modalities.Education via seminars and media can improve their knowledge,attitudes,and practices.
基金supported by the National Natural Science Foundation of China(32171354,82222015,82171001)The National Key Research and Development Program of China2023YFC2413600Research Funding from West China School/Hospital of Stomatology,Sichuan University(No.RCDWIS2023-1).
文摘Infectious bone defects represent a substantial challenge in clinical practice,necessitating the deployment of advanced therapeutic strategies.This study presents a treatment modality that merges a mild photothermal therapy hydrogel with a pulsed drug delivery mechanism.The system is predicated on a hydrogel matrix that is thermally responsive,characteristic of bone defect sites,facilitating controlled and site-specific drug release.The cornerstone of this system is the incorporation of mild photothermal nanoparticles,which are activated within the temperature range of 40–43°C,thereby enhancing the precision and efficacy of drug delivery.Our findings demonstrate that the photothermal response significantly augments the localized delivery of therapeutic agents,mitigating systemic side effects and bolstering efficacy at the defect site.The synchronized pulsed release,cooperated with mild photothermal therapy,effectively addresses infection control,and promotes bone regeneration.This approach signifies a considerable advancement in the management of infectious bone defects,offering an effective and patient-centric alternative to traditional methods.Our research endeavors to extend its applicability to a wider spectrum of tissue regeneration scenarios,underscoring its transformative potential in the realm of regenerative medicine.
文摘Intentional tooth replantation(ITR)is an advanced treatment modality and the procedure of last resort for preserving teeth with inaccessible endodontic or resorptive lesions.ITR is defined as the deliberate extraction of a tooth;evaluation of the root surface,endodontic manipulation,and repair;and placement of the tooth back into its original socket.Case reports,case series,cohort studies,and randomized controlled trials have demonstrated the efficacy of ITR in the retention of natural teeth that are untreatable or difficult to manage with root canal treatment or endodontic microsurgery.However,variations in clinical protocols for ITR exist due to the empirical nature of the original protocols and rapid advancements in the field of oral biology and dental materials.This heterogeneity in protocols may cause confusion among dental practitioners;therefore,guidelines and considerations for ITR should be explicated.This expert consensus discusses the biological foundation of ITR,the available clinical protocols and current status of ITR in treating teeth with refractory apical periodontitis or anatomical aberration,and the main complications of this treatment,aiming to refine the clinical management of ITR in accordance with the progress of basic research and clinical studies;the findings suggest that ITR may become a more consistent evidence-based option in dental treatment.
文摘This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma （PTL） patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan-Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival （PFS）, overall survival （OS）, and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage （Ill/IV） （P 〈 0.001）, B symptoms （P 〈 0.001）, and extranodal involvement other than testis （P = 0.001） were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS （OR = 11.58, P = 0.049）, whereas B symptom was significantly associated with PFS （OR = 11.79, P = 0.049）. In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months （P = 0.032）. The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.
文摘Malignant tumor has become a major threat affecting human health,and is one of the main causes of human death.Recent studies have shown that many traditional Chinese medicines(TCM)have good anti-tumor activity,which may improve the therapeutic effect of routine treatment and quality of life with lower toxicity.However,the efficacy of TCM alone for the treatment of tumors is limited.Metal ions are essential substances for maintaining normal physiological activities.This article summarized the multiple mechanisms in which metal ions are involved in the prevention and treatment of tumors in TCM.
文摘Objective:The extremely low incidence of male breast cancer (MBC) leads to lack of prospective randomized phase III studies worldwide. Especially in China,all studies on Chinese patients with MBC were based on small sample size and single institute experience. The aim of this study was to provide overall view of characteristics of Chinese patients with MBC by means of summarizing all related papers published in Chinese journals. Methods: An online search was made in CBM,VIP,CNKI,and CBA databases to find all published articles of interest on Chinese patients with MBC. And eight subjects including the proportion of MBC in all breast cancer,age,tumor location,clinical stages,pathological subtypes,treatment modalities,ER/PR expression,and 5-year survival rate were selected to calculate the proportion and their 95% interval confidence. Results: There were 122 papers with 2584 patients enrolled. The basic features of Chinese patients with MBC included:(1) MBC only with a proportion of 1.06% of all the breast cancer; (2) The mean age at diagnosis was 57.6 years old; (3) Tumor mainly located in the areolar region (74.83%) with obvious nipple and/or skin involvement; (4) Nearly 62.62% patients were in early stage before accepting treatment; (5) Infiltrating ductal carcinoma accounted for 79.05% of all pathological subtypes; (6) ER/PR expression rate was 65.86%; (7) Radical resection was up to 86.06% in all surgical modalities; (8) The 5-year survival rate was 57.33%. Conclusion: The results showed in this study were an overall view of Chinese patients with MBC whose characteristics were similar to that reported in the West. Though this study provided a little bit stronger confidence than a single study collected in this paper,studies with more powerful evidence are urgently demanding in China.
基金supported by grants from the National Natural Science Foundation of China(No.81872375 and 82172863)the Natural Science Foundation of Guangdong Province(No.2021A1515010118).
文摘objective:Two cycles of induction chemotherapy(IC)followed by 2 cycles of platinum-based concurrent chemoradiotherapy(CCRT)(2IC+2CCRT)for locoregionally advanced nasopharyngeal carcinoma(LA-NPC)is widely adopted but not evidence-confirmed.This study aimed to determine the clinical value of 2IC+2CCRT regarding efficacy,toxicity and cost-effectiveness.Methods:This real-world study from two epidemic centers used propensity score matching(PSM)and inverse probability of treatment weighting(IPTW)analyses.The enrolled patients were divided into three groups based on treatment modality:Group A(2IC+2CCRT),Group B(3IC+2CCRT or 2IC+3CCRT)and Group C(3IC+3CCRT).Long-term survival,acute toxicities and cost-effectiveness were compared among the groups.We developed a prognostic model dividing the population into high-and low-risk cohorts,and survivals including overall survival(OS),progression-free survival(PFS),distant metastasis-free survival(DMFS)and locoregional relapse-free survival(LRRFS)were compared among the three groups according to certain risk stratifications.Results:Of 4,042 patients,1,175 were enrolled,with 660,419,and 96 included in Groups A,B and C,respectively.Five-year survivals were similar among the three groups after PSM and confirmed by IPTW.Grade 3-4 neutropenia and leukocytopenia were significantly higher in Groups C and B than in Group A(52.1%vs.41.5%vs.25.2%;41.7%vs.32.7%vs.25.0%)as were grade 3-4 nausea/vomiting and oral mucositis(29.2%vs.15.0%vs.6.1%;32.3%vs.25.3%vs.18.0%).Cost-effective analysis suggested that 2IC+2CCRT was the least expensive,while the health benefits were similar to those of the other groups.Further exploration showed that 2IC+2CCRT tended to be associated with a shorter PFS in high-risk patients,while 3IC+3CCRT potentially contributed to poor PFS in low-risk individuals,mainly reflected by LRRFS.Conclusions:In LA-NPC patients,2IC+2CCRT was the optimal choice regarding efficacy,toxicity and costeffectiveness;however,2IC+2CCRT and 3IC+3CCRT probably shortened LRRFS in high-and low-risk populations,respectively.
基金This review was in part supported by the National Natural Science Foundation of China(No.82060510)the‘Guangxi BaGui Scholars’Special Fund(No.2019AQ20)+1 种基金the Guangxi Natural Science Foundation(Nos.2018GXNSFBA138018,2020GXNSFAA159022,and 2018GXNSFAA050124)the Guangxi Undergraduate Training Program for Innovation and Entrepreneurship(Nos.202110598178 and 202110598073).
文摘The proportions of patients with hepatocellular carcinoma(HCC)involving portal vein tumor thrombus(PVTT)varies greatly in different countries or regions,ranging from 13%to 45%.The treatment regimens for PVTT recommended by HCC guidelines in different countries or regions also vary greatly.In recent years,with the progress and development of surgical concepts,radiotherapy techniques,systematic therapies(for example,VEGF inhibitors,tyrosine kinase inhibitors and immune checkpoint inhibitors),patients with HCC involving PVTT have more treatment options and their prognoses have been significantly improved.To achieve the maximum benefit,both clinicians and patients need to think rationally about the indications of treatment modalities,the occurrence of severe adverse events,and the optimal fit for the population.In this review,we provide an update on the treatment modalities available for patients with HCC involving PVTT.Trials with large sample size for patients with advanced or unresectable HCC are also reviewed.
基金National Key Research and Development Plan of China(grant number:2016YFC1300800)National Natural Science Foundation of China(grant numbers:8207071595,81801156,81801158 and 81671139)+1 种基金Special Research Project for Capital Health Development(grant number:2018-4-1077)Beijing Hospitals Authority Youth Programme(code:QML20190503)。
文摘Background:The aim of this study was to comprehensively evaluate the risk factors of periprocedural ischemic stroke associated with endovascular treatment of intracranial aneurysms using a real-world database.Methods:From August 2016 to March 2017,167 patients were enrolled.Univariate analysis and multivariate logistic regression analysis were used to examine the risk factors for periprocedural ischemic stroke.Results:Among the 167 cases,periprocedural ischemic stroke occurred in 20 cases(11.98%).After univariate analysis,the ischemic group had a higher proportion of large(≥10 mm)aneurysms than the control group(45.0%vs.23.1%,p=0.036).The incidence of periprocedural ischemic stroke was higher in cases treated by flow diverter(21.6%)or stent-assisted coiling(11.8%)than in cases treated by coiling only(2.7%),and the differences were statistically significant(p=0.043).After multivariate logistic regression analysis,treatment modality was the independent risk factor for periprocedural ischemic stroke.Compared with the coiling-only procedure,flow diverter therapy was associated with a significantly higher rate of periprocedural ischemic stroke(OR 9.931;95%CI 1.174-84.038;p=0.035).Conclusions:Aneurysm size and treatment modality were associated with periprocedural ischemic stroke.Larger aneurysms were associated with increased risk of periprocedural ischemic stroke.Flow diverter therapy was associated with significantly more periprocedural ischemic stroke than the coiling procedure alone.
基金supported by the National Key Research and Development Program of China(2021YFF1201200 and 2021YFF1200900)National Natural Science Foundation of China(32341008 and 62088101)+1 种基金Shanghai Pilot Program for Basic Research,Shanghai Science and Technology Innovation Action Plan-Key Specialization in Computational Biology,Shanghai Shuguang Scholars Project,Shanghai Excellent Academic Leader Project,Shanghai Municipal Science and Technology Major Project(2021SHZDZX0100)Fundamental Research Funds for the Central Universities.
文摘Precision medicine aims to empower clinicians to predict the most appropriate course of action for patients with complex diseases like cancer and others.1 With an efficient interrogation of the omics,molecular,and clinical data at play in diseases,effective,personalized,and precise medical treatment strategies are expected for many disorders.In addition,the treatment modality of precision medicine is increasingly diversified,spanning from mainstream drug and antibody treatment to newly developed gene and cell therapy,etc.In various treatment modalities,including the treatment by Chinese medicine,precision is the highest demand,and the underlying patterns and rationales across various factors to uncover the biological mechanism and actionable information that support early detection,prevention,and therapy of complex disorders can be identified by the omics data.1,2 Therefore,the omics sequencing technology and accumulated omics data serve as the core technology and resources that can have a huge impact on such a course of action.Accordingly,the integrative analysis of such omics data provides a great opportunity to support precision medicine studies.However,facing the unique features of the omics data,like the dominant characteristics of“high dimension and small sample,”traditional data analysis strategies are likely unsuitable,and data-driven artificial intelligence(AI)technology is emerging as an effective paradigm for precision medicine study.To this end,this study aims to present a concise and overview perspective of the characteristics and the emerging directions of omics sequencing data,as well as the related AI analysis schema in handling such data,together with the summarized precision therapy cases based on the integration of AI and omics.
文摘“What's in a name?That which we call a rose by any other name would smell as sweet”-William Shakespeare Polycystic ovary syndrome(PCOS)is one of the commonest endocrinopathy in the reproductive age group,as depicted in a study among the North Indian population[1].The nomenclatures,the diagnostic criteria,the pathophysiology,and the modalities of treatment are full of controversies.Other names for this syndrome include Stein-Leventhal syndrome,polycystic ovary disease(PCOD),polycystic ovarian disease,functional ovarian hyperandrogenism,ovarian hyperthecosis and sclerocystic ovary syndrome,etc.
文摘The current mainstay treatment modalities for inflammatory bowel disease(IBD)include immunomodulators(methotrexate and thiopurines),biologics(antitumour necrosis factor alpha(TNF-α)being the most commonly used)and other monoclonal antibodies such as the anti-integrins and anti-interleukins(IL-12/23).While ideally treatment should be initiated early in the disease process to avoid relapses and complications,the major recurring issue continues to be primary and secondary loss of response,with often‘diminishing returns’in terms of efficacy for the next line of therapies prescribed for patients with IBD.Additional concerns include the long-term risk factors such as malignancy and susceptibility to infections.Recently,there has been an influx of new and emerging medications entering the market that are showing promising efficacy results in patients with moderate-to-severe disease who have previously failed to respond to multiple drugs.This review will focus on these novel and emerging therapies—in essence,‘horizon scanning’—which includes the antiadhesion agents,cytokine inhibitors,Janus kinase inhibitors,phosphodiesterase inhibitors,sphingosine-1 phosphate receptor modulators and MicroRNA-124(miR-124)upregulators.
