Over the past two years,6 patients had iliac vein stenosis caused by radiation and pelvic lymphocele secondary to gynecologic malignancy.Patients had symptomatic lymphoceles induced lower limb edema.Poor treatment of ...Over the past two years,6 patients had iliac vein stenosis caused by radiation and pelvic lymphocele secondary to gynecologic malignancy.Patients had symptomatic lymphoceles induced lower limb edema.Poor treatment of symptomatic lymphoceles,compression symptoms persist,all patients were performed endovascular stent therapy,clinical symptoms of lower limb were completely relieved.Iliac vein stenosis caused by radiation and pelvic lymphocele secondary to gynecologic malignancy,endovascular stent placement is a nonsurgical alternative for the reestablishment of venous flow and sustained relief of symptoms.展开更多
Objective To explore the consistency of the Patient-generated Subjective Global Assessment(PG-SGA)and Nutritional Risk Screening-2002(NRS-2002)for nutritional evaluation of patients with gynecologic malignancy and the...Objective To explore the consistency of the Patient-generated Subjective Global Assessment(PG-SGA)and Nutritional Risk Screening-2002(NRS-2002)for nutritional evaluation of patients with gynecologic malignancy and their predictive effect on the length of hospital stay(LOS).Methods We recruited 147 hospitalized patients with gynecologic malignancy from Nanfang Hospital in 2017.Their nutritional status was assessed using the PG-SGA and NRS-2002.The consistency between the two assessments was compared via the Kappa test.The relationship between malnutrition and LOS was analyzed using crosstabs and Spearman’s correlation.Results The PG-SGA demonstrated that 66.7%and 54.4%of patients scoring≥2 and≥4 were malnourished,respectively.Furthermore,the NRS-2002 indicated that 55.8%of patients were at nutritional risk.Patients with ovarian cancer had a relatively high incidence of malnutrition.However,this was only significant for patients who scored≥4 in the PG-SGA(P=0.001 and P=0.019 for endometrial carcinoma and cervical cancer,respectively).The PG-SGA and NRS-2002 showed good consistency in evaluating the nutritional status of patients with gynecologic malignancy(0.689,0.643 for PG-SGA score≥2,score≥4 and NRS-2002,respectively).Both the scores of PG-SGA and NRS-2002 were positively correlated with LOS.Furthermore,prolonged LOS was higher in patients with malnutrition than in those with adequate nutrition.Conclusion The PG-SGA and NRS-2002 shared a good consistency in evaluating the nutritional status of patients with gynecologic malignancy.Both assessments could be used as predictors of LOS.展开更多
Objective:To analyze body composition measurements and explore their correlation with the nutritional risk screening score and neutrophil-to-lymphocyte ratio(NLR;an index of inflammation)to provide a basis for the per...Objective:To analyze body composition measurements and explore their correlation with the nutritional risk screening score and neutrophil-to-lymphocyte ratio(NLR;an index of inflammation)to provide a basis for the perioperative and nutritional management of patients with gynecologic malignancy.Methods:This study included 77 patients with gynecologic malignancies confirmed by surgical pathology between December 2021 and January 2023.Preoperative body composition data were obtained using bioelectrical impedance analysis.Nutritional risk screening and assessment were performed.Differences in body composition by age,nutritional status,International Federation of Gynecology and Obstetrics(FIGO)stage,systemic inflammatory response,and type of gynecologic malignancy were compared.Results:The extracellular water ratio was significantly higher in patients with a high FIGO stage than in those with a low FIGO stage(t=4.047,P<0.001).Other body composition parameters were lower in patients with a high FIGO stage than in those with a low FIGO stage(P<0.05).Regarding the NLR,the extracellular water ratio was significantly higher in patients with a high NLR than in those with a low NLR(t=2.929,P=0.005).As the nutritional condition worsened,the extracellular water ratio increased(H=12.291,P=0.002),with no significant difference in other body composition parameters between patients with different nutritional conditions(H=5.118,P=0.077).Other body composition parameters decreased with the nutritional condition,which was statistically significant(P<0.05).Conclusions:Bioelectrical impedance analysis is an easy-to-perform,noninvasive,and reproducible measurement technique that can assess changes in body composition.Body composition analysis can effectively determine an individual’s nutritional and metabolic status,providing a reference for the management of patients with gynecologic malignancy,and potentially providing predictive biomarkers to stratify these patients.展开更多
BACKGROUND Uterine adenomyosis and pulmonary endometriosis are exceptionally rare in adolescents and can pose significant diagnostic challenges due to their nonspecific clinical presentation and imaging features,which...BACKGROUND Uterine adenomyosis and pulmonary endometriosis are exceptionally rare in adolescents and can pose significant diagnostic challenges due to their nonspecific clinical presentation and imaging features,which may mimic malignancy.Here,we describe a case of adenomyosis-associated uterine rupture(secondary to hemorrhagic necrosis)and concurrent pulmonary endometriosis in a 16-year-old girl initially suspected of having advanced uterine cancer.CASE SUMMARY A 16-year-old girl presented with acute abdominal pain and oliguria.Imaging studies revealed a 15-cm ruptured uterine mass accompanied by hemoperitoneum and multiple pulmonary nodules suggestive of metastatic disease.Laboratory tests demonstrated severe anemia and markedly elevated tumor markers[cancer antigen(CA)-125:1063 U/mL;CA-19-9:1347 U/mL].Emergency laparotomy revealed adenomyosis-associated uterine rupture secondary to hemorrhagic necrosis,with no macroscopic abnormalities in other organs.A total abdominal hysterectomy was performed.Histopathological analysis confirmed uterine adenomyosis with hemorrhagic necrosis.Subsequent thoracoscopic wedge resections of the pulmonary lesions demonstrated histologically confirmed endometriosis.The patient has remained disease-free under treatment with oral dienogest.CONCLUSION This case of an adolescent patient highlights how benign gynecological conditions can mimic malignancy,necessitating broad differential diagnoses despite alarming presentations.展开更多
There is a lack of consensus on the optimal surgical approach for splenic flexure malignancies.Surgeons face the challenge of balancing successful oncological outcomes with the morbidity and functional effects of exte...There is a lack of consensus on the optimal surgical approach for splenic flexure malignancies.Surgeons face the challenge of balancing successful oncological outcomes with the morbidity and functional effects of extended colonic resection,considering the variable‘watershed’vasculature and lymphatic anatomy of the splenic flexure.While there is an increasing body of evidence supporting the oncological safety of a more conservative segmental resection,most of the data stems from retrospective single center studies.This article reviews the management strategies and examines the evidence supporting various surgical approaches to splenic flexure malignancies.展开更多
Objective:Previous studies have demonstrated that the metals cadmium and arsenic exhibit estrogen-like effects and may influence the occurrence and development of gynecological tumors.This study aims to explore the as...Objective:Previous studies have demonstrated that the metals cadmium and arsenic exhibit estrogen-like effects and may influence the occurrence and development of gynecological tumors.This study aims to explore the association between urinary cadmium and arsenic levels and the prevalence of gynecologic cancers using data from the National Health and Nutrition Examination Survey(NHANES).Methods:Data from female participants in NHANES 2003—2018 were analyzed.Using R software,datasets(DEMO,BMX,etc.)were merged,and complete cases were retained by intersecting row names,yielding a total of 2999 participants.After applying strict exclusion criteria,2802 participants were included:83 with gynecologic cancer(cancer group)and 2719 without(control group).Demographic,reproductive health,and urinary cadmium and arsenic data were collected.Binary Logistic regression models were employed to assess associations between urinary cadmium and arsenic levels and gynecologic cancer risk.Results:High urinary cadmium and arsenic levels were risk factors for gynecologic cancers,with odds ratios(ORs)of 1.623(95%CI 1.217 to 2.166)and 1.003(95%CI 1.001 to 1.005),respectively.After propensity score matching(PSM),the trend remained;cadmium was still a statistically significant risk factor with an OR of 2.182(95%CI 1.343 to 3.545),while arsenic’s association,though not statistically significant,still trended toward risk(OR=1.004,95%CI 0.999 to 1.009).Subgroup analyses showed that both cadmium and arsenic were risk factors for ovarian cancer(OR=1.745,95%CI 1.178 to 2.586 and OR=1.005,95%CI 1.002 to 1.008,respectively);these associations persisted after PSM.Additionally,cadmium increased the risk of endometrial cancer(OR=1.617,95%CI 1.109 to 2.356).Conclusion:Exposure to cadmium and arsenic is associated with an increased risk of ovarian and endometrial cancers.These findings suggest that reducing environmental exposure to heavy metals such as cadmium and arsenic may help prevent certain gynecologic cancers.展开更多
This article introduces and compares risk assessment models for venous thromboembolism in gynecological patients at home and abroad.The models assessed included the Caprini risk assessment model,the G-Caprini risk ass...This article introduces and compares risk assessment models for venous thromboembolism in gynecological patients at home and abroad.The models assessed included the Caprini risk assessment model,the G-Caprini risk assessment model,the Rogers risk assessment model,the Autar risk assessment model,the gynecological patient surgical venous thrombosis risk assessment scale,the Wells score,the COMPASS-CAT thrombus risk assessment model,the Khorana risk assessment model,the Padua risk assessment model,and the Chaoyang model.The purpose of this study is to provide a foundation for developing a risk assessment tool for gynecological venous thromboembolism tailored to Chinese patients and to assist clinical health care workers in selecting appropriate risk assessment tools and guiding individualized prevention measures.展开更多
Objective:To analyze common gynecological diseases in women and explore effective preventive health care,treatment,and nursing measures.Methods:A total of 1,025 women who participated in gynecological disease screenin...Objective:To analyze common gynecological diseases in women and explore effective preventive health care,treatment,and nursing measures.Methods:A total of 1,025 women who participated in gynecological disease screening at the gynecological outpatient department of our hospital from January to December 2024 were selected as the research subjects.Among them,252 patients diagnosed with gynecological diseases were included in the observation group,and the remaining 773 healthy women were included in the control group.The detection status of gynecological diseases and related risk factors were analyzed.Results:Through screening,the common gynecological diseases included vaginitis,uterine fibroids,ovarian cysts,and menstrual disorders.Women aged 40–49 years were the high-risk group for gynecological diseases.Conclusion:The risk of gynecological diseases in women is gradually increasing.It is necessary to strengthen the popularization of knowledge about gynecological diseases among women and guide them to take effective preventive health care,treatment,and nursing measures to reduce their risk of developing gynecological diseases.展开更多
Objective:To explore the effect of narrative nursing combined with positive reinforcement nursing intervention on the psychological state of patients with gynecological cancer chemotherapy.Methods:From January 2022 to...Objective:To explore the effect of narrative nursing combined with positive reinforcement nursing intervention on the psychological state of patients with gynecological cancer chemotherapy.Methods:From January 2022 to December 2023,99 cancer patients with postoperative chemotherapy admitted to the Department of Gynecology in the author’s ClassⅲGrade A hospital were selected as the research objects,and they were divided into the control group(49 cases)and the observation group(50 cases)by random number method.The control group was intervened by the nursing model based on positive reinforcement theory,while the observation group received narrative nursing intervention measures on this basis.The self-rating Anxiety scale(SAS),self-rating depression scale(SDS),distress thermometer(DT),Pittsburgh sleep quality index(PSQI),and General Self-Efficacy Scale(GSES)were used to evaluate and compare the changes of various indicators between the two groups after intervention.Results:There were no significant differences in the scores of SAS,SDS,DT,PSQI,and GSES between the two groups at the time of intervention(P>0.05).After chemotherapy,the SAS,SDS,and DT scores of the observation group were significantly lower than those of the control group(P<0.05),and the PSQI and GSES scores were significantly better than those of the control group(P<0.01).Conclusion:Compared with the simple positive reinforcement nursing model,narrative nursing combined with positive reinforcement nursing intervention has more advantages in improving the mental health status of patients with gynecological cancer chemotherapy.It can significantly relieve the negative emotions,such as anxiety and depression of patients,effectively improve their self-efficacy level,optimize their sleep quality,and provide more comprehensive support for the physical and mental rehabilitation of patients.展开更多
Objective:To investigate the application effect of the concept of rapid rehabilitation surgery in patients undergoing gynecological laparoscopic surgery.Method:Seventy laparoscopic surgery patients treated in our gyne...Objective:To investigate the application effect of the concept of rapid rehabilitation surgery in patients undergoing gynecological laparoscopic surgery.Method:Seventy laparoscopic surgery patients treated in our gynecology department from May 2023 to May 2024 were selected and divided into two groups using a random number table method,with 35 patients in each group.The control group received routine nursing care,while the observation group received rapid recovery surgery on the basis of the control group.Record and compare the incidence of incision infection,urinary retention,lung infection and other related complications between the two groups of patients with different nursing modes;Record and compare perioperative indicators such as surgical time,intraoperative blood loss,first exhaust time,first time out of bed,and hospital stay between two groups of patients using different nursing modes.Result:There were significant differences in perioperative indicators such as the incidence of complications,surgical time,intraoperative bleeding volume,first exhaust time,first time out of bed,and hospital stay between the two groups under different nursing modes.The data scores of the observation group were better than those of the control group,and the difference was statistically significant(P<0.05).Conclusion:The application of the concept of rapid recovery surgery in perioperative nursing of gynecological laparoscopic surgery patients has significant effects,which can effectively promote postoperative recovery,reduce the incidence of complications,and improve nursing satisfaction.This model has scientific validity,feasibility,and promotional value,and can provide new ideas and methods for perioperative management of gynecological laparoscopic surgery.展开更多
Objective:To study the application value and application path of pathological examination in gynecological physical examination.Methods:A total of 1200 patients undergoing gynecological physical examination in X Hospi...Objective:To study the application value and application path of pathological examination in gynecological physical examination.Methods:A total of 1200 patients undergoing gynecological physical examination in X Hospital from January 2024 to December 2024 were selected.All patients received cervical Pap smear examination,and patients with abnormal examination results underwent colposcopic biopsy and HPV infection test for cervical cancer screening.Results:The results of cervical Pap smear showed that a total of 780 patients among 1200 patients showed cervical abnormalities.The Pap smear combined with colposcopy was used for pathological examination to detect cervical cancer lesions in time,and biopsy and HPV infection examination were arranged for high-risk patients to provide data reference for clinical treatment.Conclusions:Pathological examination has a good screening effect in gynecological physical examination.It can detect lesions early and take timely intervention measures,which is helpful to reduce the incidence and mortality of the disease.展开更多
BACKGROUND Gastrointestinal bleeding(GIB)is a major cause of hospitalization worldwide.Patients with hematologic malignancies have a higher risk of GIB as a result of thrombocytopenia and platelet dysfunction.There is...BACKGROUND Gastrointestinal bleeding(GIB)is a major cause of hospitalization worldwide.Patients with hematologic malignancies have a higher risk of GIB as a result of thrombocytopenia and platelet dysfunction.There is no consensus on the optimal platelet level that would be safe for endoscopic intervention,although a platelet level of>50×10^(9)/L was suggested based on expert opinion.There is a paucity of data on whether endoscopic intervention and the timing of endoscopy impacted the outcome of patients with hematologic malignancy and severe thrombocytopenia who experienced acute overt GIB.AIM To assess the safety of endoscopic intervention of inpatients with hematological malignancies and severe thrombocytopenia presenting with acute overt GIB.METHODS This is a single center retrospective study.The data was collected from the electronic health record from 2018 to 2020.Inpatients with hematologic malignancy who presented with acute overt GIB and platelet count≤50×10^(9)/L were included in the study.Outcomes included mortality,transfusion requirements,length of stay,intensive care unit admission and recurrent bleeding.A subgroup analysis was performed to compare the outcomes of urgent endoscopy within 24 hours of GIB vs endoscopy>24 hours.RESULTS A total of 76 patients were identified.The mean platelet count is 24.3 in the endoscopy arm and 14.6 in the conservative management arm.There was no statistically significant difference between patients who had endoscopy vs conservative management in 30-day(P=0.13)or 1 year(P=0.78)mortality,recurrent bleeding(P=0.68),transfusion of red blood cells(P=0.47),platelets(P=0.31),or length of stay(P=0.94).A subgroup analysis comparing urgent endoscopy within 24 hours compared with delayed endoscopy showed urgent endoscopy was not associated with improved 30-day or 1 year mortality(P=0.11 and 0.46,respectively)compared to routine endoscopy,but was associated with decreased recurrent bleeding in 30 days(P=0.01).CONCLUSION Medical supportive treatment without endoscopy could be considered as an alternative to endoscopic therapy for patients with hematologic malignancy complicated by severe thrombocytopenia and acute non-variceal GIB.展开更多
BACKGROUND Gastrointestinal(GI)malignancies,including gastric and colorectal cancers,remain one of the primary contributors to cancer-related illness and death globally.Despite the availability of conventional diagnos...BACKGROUND Gastrointestinal(GI)malignancies,including gastric and colorectal cancers,remain one of the primary contributors to cancer-related illness and death globally.Despite the availability of conventional diagnostic tools,early detection and personalized treatment remain significant clinical challenges.Integrated multi-omics methods encompassing genomic,transcriptomic,proteomic,metabolomic,and microbiome profiles have emerged as powerful tools for advancing precision oncology,improving diagnostic accuracy,and informing therapeutic strategies.AIM To investigate the application of multi-omics approaches in the early detection,risk stratification,treatment optimization,and biomarker discovery of GI malignancies.METHODS The systematic review process was conducted in accordance with the PRISMA 2020 guidelines.Five databases,PubMed,ScienceDirect,Scopus,ProQuest,and Web of Science,were searched for studies published in English from 2015 onwards.Eligible studies involved human subjects and focused on multi-omics integration in GI cancers,including biomarker identification,tumor microenvironment analysis,tumor heterogeneity,organoid modeling,and artificial intelligence(AI)-driven analytics.Data extraction included study characteristics,omics modalities,clinical applications,and evaluation of study quality conducted with the Cochrane risk of bias 2.0 instrument.RESULTS A total of 17196 initially identified articles,20 met the inclusion criteria.The findings highlight the superiority of multi-omics platforms over traditional biomarkers(e.g.,carcinoembryonic antigen and carbohydrate antigen 19-9 in detecting early stage GI cancers.Key applications include the identification of circulating tumor DNA,extracellular vesicles,lipidomic and proteomic signatures,and the adoption of AI algorithms to enhance diagnostic precision.Multi-omics analysis has also revealed the mechanisms of immune modulation,tumor microenvironment regulation,metastatic behavior,and drug resistance.Organoid models and microbiota profiling have contributed to personalized therapeutic strategies and immunotherapy optimization.CONCLUSION Multi-omics approaches offer significant advancements in the early diagnosis,prognostic evaluation,and personalized treatment of GI malignancies.Their integration with AI analytics,organoid biobanking,and microbiota modulation provides a pathway for precision oncology research.展开更多
BACKGROUND Pancreatic cystic neoplasms(PCNs)are increasingly detected due to advancements in radiographic techniques,with a prevalence of approximately 15%in the general population.These lesions range from benign to p...BACKGROUND Pancreatic cystic neoplasms(PCNs)are increasingly detected due to advancements in radiographic techniques,with a prevalence of approximately 15%in the general population.These lesions range from benign to premalignant and malignant,posing a diagnostic challenge.Accurate differentiation is critical,as premalignant and malignant PCNs often require surgical intervention,while benign cysts may only need monitoring unless symptomatic.Current diagnostic methods,including cross-sectional imaging,endoscopic ultrasonography,and endoscopic ultrasonography-guided fine-needle aspiration/biopsy,are specialized,not universally available,and have variable accuracy.Clinical and laboratory parameters such as carbohydrate antigen 19-9(CA 19-9),neutrophillymphocyte ratio,platelet-lymphocyte ratio,and red cell distribution width(RDW)have been associated with malignancy risk,though only CA 19-9 is guideline-supported.AIM To assess the malignancy risk of PCNs using preoperative clinical and routine laboratory parameters.METHODS A retrospective cohort study analyzed 70 patients who underwent surgery for PCNs at Ankara Bilkent City Hospital between February 2019 and March 2023.Patients were categorized into group A(benign or low-grade dysplasia,n=40)and group B(malignancy or high-grade dysplasia,n=30)based on postoperative pathology.Preoperative demographic and laboratory parameters,including age,RDW,albumin,and CA 19-9,were compared.Univariate and multivariate logistic regression analyses identified independent predictors of malignancy.Receiver operating characteristic curve analysis evaluated predictive performance,with internal validation using bootstrapping.RESULTS Group B patients were older(69.86±9.58 years vs 52.74±16.85 years,P<0.001)and had a higher incidence of diabetes mellitus(57.1%vs 21.4%,P=0.002).RDW(16.2%vs 13.7%,P<0.001),platelet-lymphocyte ratio(178 vs 126,P=0.008),and CA 19-9(21.7 U/mL vs 9.3 U/mL,P=0.009)were significantly higher in group B,while albumin was lower(41 g/L vs 45 g/L,P=0.008).Multivariate analysis identified age[odds ratio=1.067,95%confidence interval(CI):1.014-1.122,P=0.012]and RDW(odds ratio=1.784,95%CI:1.172-2.715,P=0.007)as independent predictors.The area under the curve for age,RDW,and their combination was 0.798(95%CI:0.695-0.900),0.801(95%CI:0.692-0.911),and 0.858(95%CI:0.771-0.944),respectively,with bootstrapped validation confirming stability.Cut-off values of age≥60 years and RDW≥15.5%balanced sensitivity and specificity,increasing malignancy risk 15.3-fold and 22.6-fold,respectively.CONCLUSION Age and RDW are independent predictors of malignancy in PCNs,aiding in patient selection for advanced diagnostics and surgery.Larger,multicenter studies are needed to validate these findings.展开更多
BACKGROUND Advancements in immunosuppressive therapies have improved graft survival by enhancing graft tolerance and preventing organ rejection.However,the risk of malignancy associated with prolonged immunosuppressio...BACKGROUND Advancements in immunosuppressive therapies have improved graft survival by enhancing graft tolerance and preventing organ rejection.However,the risk of malignancy associated with prolonged immunosuppression remains a concern,as it can adversely affect recipients’quality of life and survival.While the link be-tween immunosuppression and increased cancer risk is well-documented,the specific interactions between graft rejection and post-transplant malignancy(PTM)remain poorly understood.Addressing this knowledge gap is crucial for devising immunosuppressive strategies that balance rejection prevention with cancer risk reduction.AIM To investigate whether immunosuppression in PTM reduces rejection risk,while immune activation during rejection protects against malignancy.METHODS We analyzed data from the United Network for Organ Sharing’s Organ Procurewith no prior history of malignancy(in donors or recipients).Landmark analyses at 1,2,3,5,10,15,and 20 years post-transplant,Kaplan–Meier analyses,and time-dependent Cox proportional hazards regression models,each incorporating the temporal dimension of outcomes,assessed the association between rejection-induced graft failure(RGF)and PTM.Multivariate models were adjusted for clinical and immunological factors,including immunosuppression regimens.RESULTS The cohort included 579905 recipients(kidney:386878;liver:108390;heart:45046;lung:37643;pancreas:1948)with a mean follow-up of 7.3 years and a median age of 50.6±13.2 years.RGF was associated with a reduction in PTM risk across all time points[hazard ratio(HR)=0.07-0.20,P<0.001],even after excluding mortality cases.Kidney transplant recipients exhibited the most pronounced reduction(HR=0.22,P<0.001).Conversely,among recipients with PTM,RGF risk decreased across all time points up to 15 years after excluding mortality cases(HR=0.49–0.80,P<0.001).This risk reduction was observed in kidney,liver,heart,and lung transplants(HRs=0.90,0.21,0.21,and 0.18,respectively;P<0.001)but not in pancreas transplants.CONCLUSION RGF reduces PTM risk,particularly in kidney transplants,while PTM decreases RGF risk in kidney,liver,heart,and lung transplants.展开更多
Degrader–antibody conjugates(DACs)represent a promising drug modality for targeting hematological malignancy,but still lack rational design frameworks.Here,we show the strategies of reasonable antibody-degrader compa...Degrader–antibody conjugates(DACs)represent a promising drug modality for targeting hematological malignancy,but still lack rational design frameworks.Here,we show the strategies of reasonable antibody-degrader compatibility and degradation tail-derived conjugatability through a systematic exploration.Inspired by the success of IKZF1/3 degraders,we sought to explore the potential of cereblon E3 ligase modulators(CELMoDs)in constructing novel conjugates.By combining a modular library with neo-substrate screening and further conjugatable derivation,I034 was identified,a potent CELMoD payload with picomolar degradation activity and antiproliferative effects.Through linker chemistry,I034-based DACs were constructed and demonstrated superior efficacy and safety compared to auristatin-based conjugates both in vitro and in vivo,with the CD38-targeting Dara-VA-I034 achieving complete tumor eradication at low doses.Mechanistic insights revealed distinct positive feedback regulation of CD38 conjugates,highlighting the need for compatibility between payloads and antigens.These results demonstrate that the approach could provide a framework for discovering CELMoD payloads and advancing DACs for treating multiple myeloma and other malignancies.展开更多
Gastrointestinal bleeding(GIB)presents a significant challenge for patients with hematologic malignancies,especially those with severe thrombocytopenia.Although endoscopic intervention is frequently used in managing G...Gastrointestinal bleeding(GIB)presents a significant challenge for patients with hematologic malignancies,especially those with severe thrombocytopenia.Although endoscopic intervention is frequently used in managing GIB,its safety and effectiveness in this high-risk group remain unclear.A recent study by Alhumayyd et al provided insight into this issue.However,it has notable limitations,including its retrospective nature,small sample size,and failure to adjust for important confounding factors such as disease severity,hemodynamic status,and platelet function.The study’s findings indicated that urgent endoscopy may help decrease the incidence of recurrent bleeding;however,it did not show a clear benefit in terms of mortality.Future research ought to prioritize prospective,multicenter studies that employ standardized protocols and incorporate risk stratification models to better understand the impact of endoscopic treatment for GIB in these patients.Additionally,integrating platelet function assays could improve clinical decision-making.Addressing these research gaps is essential for improving patient outcomes and developing effective guidelines for managing GIB in individuals with thrombocytopenia.展开更多
Objective： To evaluate the clinical course of patients with small cell lung cancer （SCLC） as second primary malignancy. Methods： Among the 355 patients diagnosed with SCLC at Helen and Harry Gray Cancer Center of ...Objective： To evaluate the clinical course of patients with small cell lung cancer （SCLC） as second primary malignancy. Methods： Among the 355 patients diagnosed with SCLC at Helen and Harry Gray Cancer Center of Hartford Hospital Connecticut USA between 1988 and 1998, the records of 48 patients, which had been diagnosed with other malignancies before their diagnosis of SCLC, were retro- spectively reviewed. Results： Forty-eight patients （13.5%） were diagnosed with other malignancies prior to their SCLC among which 43 had documented smoking history and 93% of them （40/43） were current/former smokers. Of the 28-second primary SCLC patients who were treated with standard method, 11 （39.3%） achieved CR. 12 （42.8%） achieved PR, and the RR was 82.1%. The median survival of the 28 treated with standard method was 11.3 months （5.1-77.7 months）, while that of the rest 19 untreated patients （1 of 20 was lost to follow-up） was only 2.0 months （0.5 34.0 months）. There was no significant difference in the median survival and RR between 165 treated first primary SCLC （13.5 months and 77.6% respectively） and 28 treated secondary primary SCLC （11.3 months and 82.1% respectively） （P〉0.05）. The patients who had prostate cancer were older and subjected to less treatments than those with skin cancer, so their survival was shorter than the latter （3.5 months vs. 15 months, P〈0.05）. Conclusion： The response and survival of the treated patients with SCLC as a second malignancy showed no difference as compared to the treated ones with SCLC only. Therefore, an active medical treatment is important to relieve symptom and prolong survival of the second primary SCLC patients.展开更多
The number of cancer survivors is increasing and most healthcare providers will manage patients who have completed therapy for malignancy at some point. The care of survivors of gynecologic malignancies may seem daunt...The number of cancer survivors is increasing and most healthcare providers will manage patients who have completed therapy for malignancy at some point. The care of survivors of gynecologic malignancies may seem daunting in a busy general gynecology practice. This paper intends to review the literature and suggest management of these women for the general gynecologist.展开更多
Background: Early cholecystectomy has been recommended for patients with acute cholecystitis and gallstone pancreatitis. However, patients with pancreaticobiliary malignancy may present acutely with similar symptoms. ...Background: Early cholecystectomy has been recommended for patients with acute cholecystitis and gallstone pancreatitis. However, patients with pancreaticobiliary malignancy may present acutely with similar symptoms. We hypothesize that the diagnoses of these malignancies may potentially be delayed as an unintended consequence of expedited cholecystectomies. This study reviews a cohort of patients who underwent pancreaticoduodenectomy (PD) to identify those who underwent a separate cholecystectomy before their PD. Methods: We retrospectively reviewed 162 PDs performed between 2012 and 2022. Data collected included: demographics, disease etiology and the presence of cholelithiasis. We identified patients who had a previous cholecystectomy and the time elapsed before PD as well as procedures done during the interval. We reported detailed case summaries on those patients who had a cholecystectomy within 1 year of PD. Results: In the entire cohort, mean age was 65 years, 54% were males, and 83% had a malignant reason for PD. Thirty-one patients had cholelithiasis with 23 (14%) patients having had previous cholecystectomy. Six patients had cholecystectomy within 1 year of PD. They had the following malignancies: ampullary—3, pancreas—1, cholangiocarcinoma—1 and neuroendocrine—1. Four of these patients had expedited cholecystectomy on their index hospital admission and were later found to have a periampullary malignancy with further work up. Conclusions: Pancreaticobiliary malignancies can be difficult to diagnose, and surgeons should not overlook these potential diagnoses when considering expedited cholecystectomy. Future studies in large cohorts are needed to identify high risk candidates who should undergo more detailed testing to exclude malignancy before proceeding with cholecystectomy.展开更多
文摘Over the past two years,6 patients had iliac vein stenosis caused by radiation and pelvic lymphocele secondary to gynecologic malignancy.Patients had symptomatic lymphoceles induced lower limb edema.Poor treatment of symptomatic lymphoceles,compression symptoms persist,all patients were performed endovascular stent therapy,clinical symptoms of lower limb were completely relieved.Iliac vein stenosis caused by radiation and pelvic lymphocele secondary to gynecologic malignancy,endovascular stent placement is a nonsurgical alternative for the reestablishment of venous flow and sustained relief of symptoms.
基金Supported by grants from the Guangdong Medical Research Fund(No.A2021054)and Nanfang Hospital President’s Fund(No.2019B019).
文摘Objective To explore the consistency of the Patient-generated Subjective Global Assessment(PG-SGA)and Nutritional Risk Screening-2002(NRS-2002)for nutritional evaluation of patients with gynecologic malignancy and their predictive effect on the length of hospital stay(LOS).Methods We recruited 147 hospitalized patients with gynecologic malignancy from Nanfang Hospital in 2017.Their nutritional status was assessed using the PG-SGA and NRS-2002.The consistency between the two assessments was compared via the Kappa test.The relationship between malnutrition and LOS was analyzed using crosstabs and Spearman’s correlation.Results The PG-SGA demonstrated that 66.7%and 54.4%of patients scoring≥2 and≥4 were malnourished,respectively.Furthermore,the NRS-2002 indicated that 55.8%of patients were at nutritional risk.Patients with ovarian cancer had a relatively high incidence of malnutrition.However,this was only significant for patients who scored≥4 in the PG-SGA(P=0.001 and P=0.019 for endometrial carcinoma and cervical cancer,respectively).The PG-SGA and NRS-2002 showed good consistency in evaluating the nutritional status of patients with gynecologic malignancy(0.689,0.643 for PG-SGA score≥2,score≥4 and NRS-2002,respectively).Both the scores of PG-SGA and NRS-2002 were positively correlated with LOS.Furthermore,prolonged LOS was higher in patients with malnutrition than in those with adequate nutrition.Conclusion The PG-SGA and NRS-2002 shared a good consistency in evaluating the nutritional status of patients with gynecologic malignancy.Both assessments could be used as predictors of LOS.
基金funded by the Jiangsu Graduate Student Practice and Innovation Program(No.SJCX23_0665).
文摘Objective:To analyze body composition measurements and explore their correlation with the nutritional risk screening score and neutrophil-to-lymphocyte ratio(NLR;an index of inflammation)to provide a basis for the perioperative and nutritional management of patients with gynecologic malignancy.Methods:This study included 77 patients with gynecologic malignancies confirmed by surgical pathology between December 2021 and January 2023.Preoperative body composition data were obtained using bioelectrical impedance analysis.Nutritional risk screening and assessment were performed.Differences in body composition by age,nutritional status,International Federation of Gynecology and Obstetrics(FIGO)stage,systemic inflammatory response,and type of gynecologic malignancy were compared.Results:The extracellular water ratio was significantly higher in patients with a high FIGO stage than in those with a low FIGO stage(t=4.047,P<0.001).Other body composition parameters were lower in patients with a high FIGO stage than in those with a low FIGO stage(P<0.05).Regarding the NLR,the extracellular water ratio was significantly higher in patients with a high NLR than in those with a low NLR(t=2.929,P=0.005).As the nutritional condition worsened,the extracellular water ratio increased(H=12.291,P=0.002),with no significant difference in other body composition parameters between patients with different nutritional conditions(H=5.118,P=0.077).Other body composition parameters decreased with the nutritional condition,which was statistically significant(P<0.05).Conclusions:Bioelectrical impedance analysis is an easy-to-perform,noninvasive,and reproducible measurement technique that can assess changes in body composition.Body composition analysis can effectively determine an individual’s nutritional and metabolic status,providing a reference for the management of patients with gynecologic malignancy,and potentially providing predictive biomarkers to stratify these patients.
文摘BACKGROUND Uterine adenomyosis and pulmonary endometriosis are exceptionally rare in adolescents and can pose significant diagnostic challenges due to their nonspecific clinical presentation and imaging features,which may mimic malignancy.Here,we describe a case of adenomyosis-associated uterine rupture(secondary to hemorrhagic necrosis)and concurrent pulmonary endometriosis in a 16-year-old girl initially suspected of having advanced uterine cancer.CASE SUMMARY A 16-year-old girl presented with acute abdominal pain and oliguria.Imaging studies revealed a 15-cm ruptured uterine mass accompanied by hemoperitoneum and multiple pulmonary nodules suggestive of metastatic disease.Laboratory tests demonstrated severe anemia and markedly elevated tumor markers[cancer antigen(CA)-125:1063 U/mL;CA-19-9:1347 U/mL].Emergency laparotomy revealed adenomyosis-associated uterine rupture secondary to hemorrhagic necrosis,with no macroscopic abnormalities in other organs.A total abdominal hysterectomy was performed.Histopathological analysis confirmed uterine adenomyosis with hemorrhagic necrosis.Subsequent thoracoscopic wedge resections of the pulmonary lesions demonstrated histologically confirmed endometriosis.The patient has remained disease-free under treatment with oral dienogest.CONCLUSION This case of an adolescent patient highlights how benign gynecological conditions can mimic malignancy,necessitating broad differential diagnoses despite alarming presentations.
文摘There is a lack of consensus on the optimal surgical approach for splenic flexure malignancies.Surgeons face the challenge of balancing successful oncological outcomes with the morbidity and functional effects of extended colonic resection,considering the variable‘watershed’vasculature and lymphatic anatomy of the splenic flexure.While there is an increasing body of evidence supporting the oncological safety of a more conservative segmental resection,most of the data stems from retrospective single center studies.This article reviews the management strategies and examines the evidence supporting various surgical approaches to splenic flexure malignancies.
基金supported by the Science and Technology Innovation Program of Hunan Province,China(2020SK2073).
文摘Objective:Previous studies have demonstrated that the metals cadmium and arsenic exhibit estrogen-like effects and may influence the occurrence and development of gynecological tumors.This study aims to explore the association between urinary cadmium and arsenic levels and the prevalence of gynecologic cancers using data from the National Health and Nutrition Examination Survey(NHANES).Methods:Data from female participants in NHANES 2003—2018 were analyzed.Using R software,datasets(DEMO,BMX,etc.)were merged,and complete cases were retained by intersecting row names,yielding a total of 2999 participants.After applying strict exclusion criteria,2802 participants were included:83 with gynecologic cancer(cancer group)and 2719 without(control group).Demographic,reproductive health,and urinary cadmium and arsenic data were collected.Binary Logistic regression models were employed to assess associations between urinary cadmium and arsenic levels and gynecologic cancer risk.Results:High urinary cadmium and arsenic levels were risk factors for gynecologic cancers,with odds ratios(ORs)of 1.623(95%CI 1.217 to 2.166)and 1.003(95%CI 1.001 to 1.005),respectively.After propensity score matching(PSM),the trend remained;cadmium was still a statistically significant risk factor with an OR of 2.182(95%CI 1.343 to 3.545),while arsenic’s association,though not statistically significant,still trended toward risk(OR=1.004,95%CI 0.999 to 1.009).Subgroup analyses showed that both cadmium and arsenic were risk factors for ovarian cancer(OR=1.745,95%CI 1.178 to 2.586 and OR=1.005,95%CI 1.002 to 1.008,respectively);these associations persisted after PSM.Additionally,cadmium increased the risk of endometrial cancer(OR=1.617,95%CI 1.109 to 2.356).Conclusion:Exposure to cadmium and arsenic is associated with an increased risk of ovarian and endometrial cancers.These findings suggest that reducing environmental exposure to heavy metals such as cadmium and arsenic may help prevent certain gynecologic cancers.
基金funded by the National College Students Innovation and Entrepreneurship Training Program(S202310760049).
文摘This article introduces and compares risk assessment models for venous thromboembolism in gynecological patients at home and abroad.The models assessed included the Caprini risk assessment model,the G-Caprini risk assessment model,the Rogers risk assessment model,the Autar risk assessment model,the gynecological patient surgical venous thrombosis risk assessment scale,the Wells score,the COMPASS-CAT thrombus risk assessment model,the Khorana risk assessment model,the Padua risk assessment model,and the Chaoyang model.The purpose of this study is to provide a foundation for developing a risk assessment tool for gynecological venous thromboembolism tailored to Chinese patients and to assist clinical health care workers in selecting appropriate risk assessment tools and guiding individualized prevention measures.
文摘Objective:To analyze common gynecological diseases in women and explore effective preventive health care,treatment,and nursing measures.Methods:A total of 1,025 women who participated in gynecological disease screening at the gynecological outpatient department of our hospital from January to December 2024 were selected as the research subjects.Among them,252 patients diagnosed with gynecological diseases were included in the observation group,and the remaining 773 healthy women were included in the control group.The detection status of gynecological diseases and related risk factors were analyzed.Results:Through screening,the common gynecological diseases included vaginitis,uterine fibroids,ovarian cysts,and menstrual disorders.Women aged 40–49 years were the high-risk group for gynecological diseases.Conclusion:The risk of gynecological diseases in women is gradually increasing.It is necessary to strengthen the popularization of knowledge about gynecological diseases among women and guide them to take effective preventive health care,treatment,and nursing measures to reduce their risk of developing gynecological diseases.
基金the First Affiliated Hospital of Shihezi University(Project No.:HL202110)。
文摘Objective:To explore the effect of narrative nursing combined with positive reinforcement nursing intervention on the psychological state of patients with gynecological cancer chemotherapy.Methods:From January 2022 to December 2023,99 cancer patients with postoperative chemotherapy admitted to the Department of Gynecology in the author’s ClassⅲGrade A hospital were selected as the research objects,and they were divided into the control group(49 cases)and the observation group(50 cases)by random number method.The control group was intervened by the nursing model based on positive reinforcement theory,while the observation group received narrative nursing intervention measures on this basis.The self-rating Anxiety scale(SAS),self-rating depression scale(SDS),distress thermometer(DT),Pittsburgh sleep quality index(PSQI),and General Self-Efficacy Scale(GSES)were used to evaluate and compare the changes of various indicators between the two groups after intervention.Results:There were no significant differences in the scores of SAS,SDS,DT,PSQI,and GSES between the two groups at the time of intervention(P>0.05).After chemotherapy,the SAS,SDS,and DT scores of the observation group were significantly lower than those of the control group(P<0.05),and the PSQI and GSES scores were significantly better than those of the control group(P<0.01).Conclusion:Compared with the simple positive reinforcement nursing model,narrative nursing combined with positive reinforcement nursing intervention has more advantages in improving the mental health status of patients with gynecological cancer chemotherapy.It can significantly relieve the negative emotions,such as anxiety and depression of patients,effectively improve their self-efficacy level,optimize their sleep quality,and provide more comprehensive support for the physical and mental rehabilitation of patients.
文摘Objective:To investigate the application effect of the concept of rapid rehabilitation surgery in patients undergoing gynecological laparoscopic surgery.Method:Seventy laparoscopic surgery patients treated in our gynecology department from May 2023 to May 2024 were selected and divided into two groups using a random number table method,with 35 patients in each group.The control group received routine nursing care,while the observation group received rapid recovery surgery on the basis of the control group.Record and compare the incidence of incision infection,urinary retention,lung infection and other related complications between the two groups of patients with different nursing modes;Record and compare perioperative indicators such as surgical time,intraoperative blood loss,first exhaust time,first time out of bed,and hospital stay between two groups of patients using different nursing modes.Result:There were significant differences in perioperative indicators such as the incidence of complications,surgical time,intraoperative bleeding volume,first exhaust time,first time out of bed,and hospital stay between the two groups under different nursing modes.The data scores of the observation group were better than those of the control group,and the difference was statistically significant(P<0.05).Conclusion:The application of the concept of rapid recovery surgery in perioperative nursing of gynecological laparoscopic surgery patients has significant effects,which can effectively promote postoperative recovery,reduce the incidence of complications,and improve nursing satisfaction.This model has scientific validity,feasibility,and promotional value,and can provide new ideas and methods for perioperative management of gynecological laparoscopic surgery.
文摘Objective:To study the application value and application path of pathological examination in gynecological physical examination.Methods:A total of 1200 patients undergoing gynecological physical examination in X Hospital from January 2024 to December 2024 were selected.All patients received cervical Pap smear examination,and patients with abnormal examination results underwent colposcopic biopsy and HPV infection test for cervical cancer screening.Results:The results of cervical Pap smear showed that a total of 780 patients among 1200 patients showed cervical abnormalities.The Pap smear combined with colposcopy was used for pathological examination to detect cervical cancer lesions in time,and biopsy and HPV infection examination were arranged for high-risk patients to provide data reference for clinical treatment.Conclusions:Pathological examination has a good screening effect in gynecological physical examination.It can detect lesions early and take timely intervention measures,which is helpful to reduce the incidence and mortality of the disease.
文摘BACKGROUND Gastrointestinal bleeding(GIB)is a major cause of hospitalization worldwide.Patients with hematologic malignancies have a higher risk of GIB as a result of thrombocytopenia and platelet dysfunction.There is no consensus on the optimal platelet level that would be safe for endoscopic intervention,although a platelet level of>50×10^(9)/L was suggested based on expert opinion.There is a paucity of data on whether endoscopic intervention and the timing of endoscopy impacted the outcome of patients with hematologic malignancy and severe thrombocytopenia who experienced acute overt GIB.AIM To assess the safety of endoscopic intervention of inpatients with hematological malignancies and severe thrombocytopenia presenting with acute overt GIB.METHODS This is a single center retrospective study.The data was collected from the electronic health record from 2018 to 2020.Inpatients with hematologic malignancy who presented with acute overt GIB and platelet count≤50×10^(9)/L were included in the study.Outcomes included mortality,transfusion requirements,length of stay,intensive care unit admission and recurrent bleeding.A subgroup analysis was performed to compare the outcomes of urgent endoscopy within 24 hours of GIB vs endoscopy>24 hours.RESULTS A total of 76 patients were identified.The mean platelet count is 24.3 in the endoscopy arm and 14.6 in the conservative management arm.There was no statistically significant difference between patients who had endoscopy vs conservative management in 30-day(P=0.13)or 1 year(P=0.78)mortality,recurrent bleeding(P=0.68),transfusion of red blood cells(P=0.47),platelets(P=0.31),or length of stay(P=0.94).A subgroup analysis comparing urgent endoscopy within 24 hours compared with delayed endoscopy showed urgent endoscopy was not associated with improved 30-day or 1 year mortality(P=0.11 and 0.46,respectively)compared to routine endoscopy,but was associated with decreased recurrent bleeding in 30 days(P=0.01).CONCLUSION Medical supportive treatment without endoscopy could be considered as an alternative to endoscopic therapy for patients with hematologic malignancy complicated by severe thrombocytopenia and acute non-variceal GIB.
文摘BACKGROUND Gastrointestinal(GI)malignancies,including gastric and colorectal cancers,remain one of the primary contributors to cancer-related illness and death globally.Despite the availability of conventional diagnostic tools,early detection and personalized treatment remain significant clinical challenges.Integrated multi-omics methods encompassing genomic,transcriptomic,proteomic,metabolomic,and microbiome profiles have emerged as powerful tools for advancing precision oncology,improving diagnostic accuracy,and informing therapeutic strategies.AIM To investigate the application of multi-omics approaches in the early detection,risk stratification,treatment optimization,and biomarker discovery of GI malignancies.METHODS The systematic review process was conducted in accordance with the PRISMA 2020 guidelines.Five databases,PubMed,ScienceDirect,Scopus,ProQuest,and Web of Science,were searched for studies published in English from 2015 onwards.Eligible studies involved human subjects and focused on multi-omics integration in GI cancers,including biomarker identification,tumor microenvironment analysis,tumor heterogeneity,organoid modeling,and artificial intelligence(AI)-driven analytics.Data extraction included study characteristics,omics modalities,clinical applications,and evaluation of study quality conducted with the Cochrane risk of bias 2.0 instrument.RESULTS A total of 17196 initially identified articles,20 met the inclusion criteria.The findings highlight the superiority of multi-omics platforms over traditional biomarkers(e.g.,carcinoembryonic antigen and carbohydrate antigen 19-9 in detecting early stage GI cancers.Key applications include the identification of circulating tumor DNA,extracellular vesicles,lipidomic and proteomic signatures,and the adoption of AI algorithms to enhance diagnostic precision.Multi-omics analysis has also revealed the mechanisms of immune modulation,tumor microenvironment regulation,metastatic behavior,and drug resistance.Organoid models and microbiota profiling have contributed to personalized therapeutic strategies and immunotherapy optimization.CONCLUSION Multi-omics approaches offer significant advancements in the early diagnosis,prognostic evaluation,and personalized treatment of GI malignancies.Their integration with AI analytics,organoid biobanking,and microbiota modulation provides a pathway for precision oncology research.
文摘BACKGROUND Pancreatic cystic neoplasms(PCNs)are increasingly detected due to advancements in radiographic techniques,with a prevalence of approximately 15%in the general population.These lesions range from benign to premalignant and malignant,posing a diagnostic challenge.Accurate differentiation is critical,as premalignant and malignant PCNs often require surgical intervention,while benign cysts may only need monitoring unless symptomatic.Current diagnostic methods,including cross-sectional imaging,endoscopic ultrasonography,and endoscopic ultrasonography-guided fine-needle aspiration/biopsy,are specialized,not universally available,and have variable accuracy.Clinical and laboratory parameters such as carbohydrate antigen 19-9(CA 19-9),neutrophillymphocyte ratio,platelet-lymphocyte ratio,and red cell distribution width(RDW)have been associated with malignancy risk,though only CA 19-9 is guideline-supported.AIM To assess the malignancy risk of PCNs using preoperative clinical and routine laboratory parameters.METHODS A retrospective cohort study analyzed 70 patients who underwent surgery for PCNs at Ankara Bilkent City Hospital between February 2019 and March 2023.Patients were categorized into group A(benign or low-grade dysplasia,n=40)and group B(malignancy or high-grade dysplasia,n=30)based on postoperative pathology.Preoperative demographic and laboratory parameters,including age,RDW,albumin,and CA 19-9,were compared.Univariate and multivariate logistic regression analyses identified independent predictors of malignancy.Receiver operating characteristic curve analysis evaluated predictive performance,with internal validation using bootstrapping.RESULTS Group B patients were older(69.86±9.58 years vs 52.74±16.85 years,P<0.001)and had a higher incidence of diabetes mellitus(57.1%vs 21.4%,P=0.002).RDW(16.2%vs 13.7%,P<0.001),platelet-lymphocyte ratio(178 vs 126,P=0.008),and CA 19-9(21.7 U/mL vs 9.3 U/mL,P=0.009)were significantly higher in group B,while albumin was lower(41 g/L vs 45 g/L,P=0.008).Multivariate analysis identified age[odds ratio=1.067,95%confidence interval(CI):1.014-1.122,P=0.012]and RDW(odds ratio=1.784,95%CI:1.172-2.715,P=0.007)as independent predictors.The area under the curve for age,RDW,and their combination was 0.798(95%CI:0.695-0.900),0.801(95%CI:0.692-0.911),and 0.858(95%CI:0.771-0.944),respectively,with bootstrapped validation confirming stability.Cut-off values of age≥60 years and RDW≥15.5%balanced sensitivity and specificity,increasing malignancy risk 15.3-fold and 22.6-fold,respectively.CONCLUSION Age and RDW are independent predictors of malignancy in PCNs,aiding in patient selection for advanced diagnostics and surgery.Larger,multicenter studies are needed to validate these findings.
文摘BACKGROUND Advancements in immunosuppressive therapies have improved graft survival by enhancing graft tolerance and preventing organ rejection.However,the risk of malignancy associated with prolonged immunosuppression remains a concern,as it can adversely affect recipients’quality of life and survival.While the link be-tween immunosuppression and increased cancer risk is well-documented,the specific interactions between graft rejection and post-transplant malignancy(PTM)remain poorly understood.Addressing this knowledge gap is crucial for devising immunosuppressive strategies that balance rejection prevention with cancer risk reduction.AIM To investigate whether immunosuppression in PTM reduces rejection risk,while immune activation during rejection protects against malignancy.METHODS We analyzed data from the United Network for Organ Sharing’s Organ Procurewith no prior history of malignancy(in donors or recipients).Landmark analyses at 1,2,3,5,10,15,and 20 years post-transplant,Kaplan–Meier analyses,and time-dependent Cox proportional hazards regression models,each incorporating the temporal dimension of outcomes,assessed the association between rejection-induced graft failure(RGF)and PTM.Multivariate models were adjusted for clinical and immunological factors,including immunosuppression regimens.RESULTS The cohort included 579905 recipients(kidney:386878;liver:108390;heart:45046;lung:37643;pancreas:1948)with a mean follow-up of 7.3 years and a median age of 50.6±13.2 years.RGF was associated with a reduction in PTM risk across all time points[hazard ratio(HR)=0.07-0.20,P<0.001],even after excluding mortality cases.Kidney transplant recipients exhibited the most pronounced reduction(HR=0.22,P<0.001).Conversely,among recipients with PTM,RGF risk decreased across all time points up to 15 years after excluding mortality cases(HR=0.49–0.80,P<0.001).This risk reduction was observed in kidney,liver,heart,and lung transplants(HRs=0.90,0.21,0.21,and 0.18,respectively;P<0.001)but not in pancreas transplants.CONCLUSION RGF reduces PTM risk,particularly in kidney transplants,while PTM decreases RGF risk in kidney,liver,heart,and lung transplants.
基金supported by the National Natural Science Foundation of China[82173660(Xiaowu Dong),82273951(Yubo Zhou),82404655(Hanlin Wang),92253306(Jia Li)]China Postdoctoral Science Foundation 2024M750708(Jingyu Zhang)Shanghai Science and Technology Development Foundation 24YF275530(Hanlin Wang).
文摘Degrader–antibody conjugates(DACs)represent a promising drug modality for targeting hematological malignancy,but still lack rational design frameworks.Here,we show the strategies of reasonable antibody-degrader compatibility and degradation tail-derived conjugatability through a systematic exploration.Inspired by the success of IKZF1/3 degraders,we sought to explore the potential of cereblon E3 ligase modulators(CELMoDs)in constructing novel conjugates.By combining a modular library with neo-substrate screening and further conjugatable derivation,I034 was identified,a potent CELMoD payload with picomolar degradation activity and antiproliferative effects.Through linker chemistry,I034-based DACs were constructed and demonstrated superior efficacy and safety compared to auristatin-based conjugates both in vitro and in vivo,with the CD38-targeting Dara-VA-I034 achieving complete tumor eradication at low doses.Mechanistic insights revealed distinct positive feedback regulation of CD38 conjugates,highlighting the need for compatibility between payloads and antigens.These results demonstrate that the approach could provide a framework for discovering CELMoD payloads and advancing DACs for treating multiple myeloma and other malignancies.
文摘Gastrointestinal bleeding(GIB)presents a significant challenge for patients with hematologic malignancies,especially those with severe thrombocytopenia.Although endoscopic intervention is frequently used in managing GIB,its safety and effectiveness in this high-risk group remain unclear.A recent study by Alhumayyd et al provided insight into this issue.However,it has notable limitations,including its retrospective nature,small sample size,and failure to adjust for important confounding factors such as disease severity,hemodynamic status,and platelet function.The study’s findings indicated that urgent endoscopy may help decrease the incidence of recurrent bleeding;however,it did not show a clear benefit in terms of mortality.Future research ought to prioritize prospective,multicenter studies that employ standardized protocols and incorporate risk stratification models to better understand the impact of endoscopic treatment for GIB in these patients.Additionally,integrating platelet function assays could improve clinical decision-making.Addressing these research gaps is essential for improving patient outcomes and developing effective guidelines for managing GIB in individuals with thrombocytopenia.
文摘Objective： To evaluate the clinical course of patients with small cell lung cancer （SCLC） as second primary malignancy. Methods： Among the 355 patients diagnosed with SCLC at Helen and Harry Gray Cancer Center of Hartford Hospital Connecticut USA between 1988 and 1998, the records of 48 patients, which had been diagnosed with other malignancies before their diagnosis of SCLC, were retro- spectively reviewed. Results： Forty-eight patients （13.5%） were diagnosed with other malignancies prior to their SCLC among which 43 had documented smoking history and 93% of them （40/43） were current/former smokers. Of the 28-second primary SCLC patients who were treated with standard method, 11 （39.3%） achieved CR. 12 （42.8%） achieved PR, and the RR was 82.1%. The median survival of the 28 treated with standard method was 11.3 months （5.1-77.7 months）, while that of the rest 19 untreated patients （1 of 20 was lost to follow-up） was only 2.0 months （0.5 34.0 months）. There was no significant difference in the median survival and RR between 165 treated first primary SCLC （13.5 months and 77.6% respectively） and 28 treated secondary primary SCLC （11.3 months and 82.1% respectively） （P〉0.05）. The patients who had prostate cancer were older and subjected to less treatments than those with skin cancer, so their survival was shorter than the latter （3.5 months vs. 15 months, P〈0.05）. Conclusion： The response and survival of the treated patients with SCLC as a second malignancy showed no difference as compared to the treated ones with SCLC only. Therefore, an active medical treatment is important to relieve symptom and prolong survival of the second primary SCLC patients.
文摘The number of cancer survivors is increasing and most healthcare providers will manage patients who have completed therapy for malignancy at some point. The care of survivors of gynecologic malignancies may seem daunting in a busy general gynecology practice. This paper intends to review the literature and suggest management of these women for the general gynecologist.
文摘Background: Early cholecystectomy has been recommended for patients with acute cholecystitis and gallstone pancreatitis. However, patients with pancreaticobiliary malignancy may present acutely with similar symptoms. We hypothesize that the diagnoses of these malignancies may potentially be delayed as an unintended consequence of expedited cholecystectomies. This study reviews a cohort of patients who underwent pancreaticoduodenectomy (PD) to identify those who underwent a separate cholecystectomy before their PD. Methods: We retrospectively reviewed 162 PDs performed between 2012 and 2022. Data collected included: demographics, disease etiology and the presence of cholelithiasis. We identified patients who had a previous cholecystectomy and the time elapsed before PD as well as procedures done during the interval. We reported detailed case summaries on those patients who had a cholecystectomy within 1 year of PD. Results: In the entire cohort, mean age was 65 years, 54% were males, and 83% had a malignant reason for PD. Thirty-one patients had cholelithiasis with 23 (14%) patients having had previous cholecystectomy. Six patients had cholecystectomy within 1 year of PD. They had the following malignancies: ampullary—3, pancreas—1, cholangiocarcinoma—1 and neuroendocrine—1. Four of these patients had expedited cholecystectomy on their index hospital admission and were later found to have a periampullary malignancy with further work up. Conclusions: Pancreaticobiliary malignancies can be difficult to diagnose, and surgeons should not overlook these potential diagnoses when considering expedited cholecystectomy. Future studies in large cohorts are needed to identify high risk candidates who should undergo more detailed testing to exclude malignancy before proceeding with cholecystectomy.
