OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicent...OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were randomly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis<30% with no 30-day major adverse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area product.RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6%).Both groups achieved 100% clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI group had a technical success rate of 100%.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator radiation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups.CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.展开更多
Retinal ganglion cells are the bridging neurons between the eye and the central nervous system,transmitting visual signals to the brain.The injury and loss of retinal ganglion cells are the primary pathological change...Retinal ganglion cells are the bridging neurons between the eye and the central nervous system,transmitting visual signals to the brain.The injury and loss of retinal ganglion cells are the primary pathological changes in several retinal degenerative diseases,including glaucoma,ischemic optic neuropathy,diabetic neuropathy,and optic neuritis.In mammals,injured retinal ganglion cells lack regenerative capacity and undergo apoptotic cell death within a few days of injury.Additionally,these cells exhibit limited regenerative ability,ultimately contributing to vision impairment and potentially leading to blindness.Currently,the only effective clinical treatment for glaucoma is to prevent vision loss by lowering intraocular pressure through medications or surgery;however,this approach cannot halt the effect of retinal ganglion cell loss on visual function.This review comprehensively investigates the mechanisms underlying retinal ganglion cell degeneration in retinal degenerative diseases and further explores the current status and potential of cell replacement therapy for regenerating retinal ganglion cells.As our understanding of the complex processes involved in retinal ganglion cell degeneration deepens,we can explore new treatment strategies,such as cell transplantation,which may offer more effective ways to mitigate the effect of retinal degenerative diseases on vision.展开更多
OBJECTIVE:To summarize the clinical efficacy characteristics of Suhuang Zhike capsule(苏黄止咳颗粒)and evaluate the incidence of adverse reactions in its broad clinical application.METHODS:This was a multicenter,prosp...OBJECTIVE:To summarize the clinical efficacy characteristics of Suhuang Zhike capsule(苏黄止咳颗粒)and evaluate the incidence of adverse reactions in its broad clinical application.METHODS:This was a multicenter,prospective,singlearm,open-label phase IV clinical trial.A total of 1100 patients diagnosed with cough variant asthma(CVA)and the Traditional Chinese Medicine(TCM)syndrome of wind evil invading the lung and lung Qi failing to propagate were planned for recruitment.Participants received Suhuang Zhike capsule orally,three capsules per dose,taken three times daily,for a treatment duration of 14 d.The primary outcome was the change in cough symptom scores from baseline to week 2.Cough severity was assessed twice daily.Additional evaluations included the rate and time of cough disappearance or basic disappearance rate,as well as the time of cough relief.TCM symptom scores were recorded at baseline and on days 7 and 14 of treatment.Safety assessments included monitoring for adverse events and conducting laboratory tests.RESULTS:A total of 1033 patients with CVA from 40 hospitals across China were enrolled in the study.Of these,1026 patients received the study medication and were included in the safety analysis.Fifty-four patients withdrew from the study,resulting in a drop-out rate of 5.23%.Treatment with Suhuang Zhike capsules significantly reduced cough symptom scores and improved cough-related symptoms in patients with CVA.The overall rate of cough disappearance or basic disappearance increased over the course of treatment,reaching 67.21%after 14 d.The median time of cough relief was 3 d,while the median time to cough disappearance or basic disappearance was 11 d.Additionally,the treatment led to reductions in TCM symptom scores and improvements in accompanying symptoms such as throat itching,expectoration,and shortness of breath.In terms of safety,no serious adverse events were reported.The incidence of related adverse events(AEs)was 2.24%(23 cases,30 events).The incidence of adverse reactions listed in the drug's instructions was 2.14%.Other related AEs not listed in the drug's instructions occurred in 0.39%of patients and included dizziness(0.19%),headache(0.10%),pruritus(0.10%),and palpitation(0.10%).CONCLUSION:Suhuang Zhike capsules demonstrated good efficacy and safety for the treatment of CVA.These findings offer valuable clinical evidence to support their broader application in routine clinical practice.展开更多
Objective: To investigate the clinical significance of separate lateral parametrial lymph node dissection(LPLND) in improving parametrial lymph node(PLN) and its metastasis detection rate during radical hysterectomy f...Objective: To investigate the clinical significance of separate lateral parametrial lymph node dissection(LPLND) in improving parametrial lymph node(PLN) and its metastasis detection rate during radical hysterectomy for early-stage cervical cancer.Methods: From July 2007 to August 2017, 2,695 patients with cervical cancer in stage IB1-IIA2 underwent radical hysterectomy were included. Of these patients, 368 underwent separate dissection of PLNs using the LPLND method, and 2,327 patients underwent conventional radical hysterectomy(CRH). We compared the surgical parameters, PLN detection rate and PLN metastasis rate between the two groups.Results: Compared with CRH group, the rate of laparoscopic surgery was higher(60.3% vs. 15.9%, P<0.001),and the blood transfusion rate was lower(19.0% vs. 29.0%, P<0.001) in the LPLND group. PLNs were detected in 356 cases(96.7%) in the LPLND group, and 270 cases(11.6%) in the CRH group(P<0.001), respectively. The number of PLNs detected in the LPLND group was higher than that in the CRH group(median 3 vs. 1, P<0.001).The PLN metastases were detected in 25 cases(6.8%) in the LPLND group, and 18 cases(0.8%) in the CRH group(P<0.001), respectively. In multivariable analysis, LPLND is an independent factor not only for PLN detection [odds ratio(OR)=228.999, 95% confidence interval(95% CI): 124.661-420.664;P<0.001], but also for PLN metastasis identification(OR=10.867, 95% CI: 5.381-21.946;P<0.001).Conclusions: LPLND is feasible and safe. The surgical method significantly improves the detection rate of PLN and avoids omission of PLN metastasis during radical hysterectomy for early-stage cervical cancer.展开更多
We aimed to explore the associations between the age at which children undergo surgery for hypospadias and a range of social and clinical factors in a single center.Our aim was to promote the early surgical treatment ...We aimed to explore the associations between the age at which children undergo surgery for hypospadias and a range of social and clinical factors in a single center.Our aim was to promote the early surgical treatment of children with hypospadias.For a 6-year period,social and clinical data were collected from all children undergoing surgery to repair hypospadias in Children’s Hospital of Chongqing Medical University(Chongqing,China),located in southwest of China.We analyzed the correlations between age at surgery and a range of social and clinical factors.A total of 1611 eligible cases were recruited,with a mean age of 54.3 months and a median age of 42 months:234 cases(14.5%)were classified into a“timely operation”group,419(26.0%)cases into a“subtimely operation”group,and 958(59.5%)cases into a“delayed operation”group.According to multivariate regression analyses,the higher the regional economic level,the closer the urethral opening to the perineum,and the higher the educational level of the guardians was,the younger the children were when they underwent the initial surgery for hypospadias;this was also the case for families without other children.Our subgroup analysis showed that the primary educational level of the guardians was a risk factor for subtimely surgery in their children(odds ratio[OR]=1.52,95%confidence interval[CI]:1.08-2.15,P<0.05).A lower regional economic level(OR=1.87,95%CI:1.26-2.78,P<0.01),a lower educational level of the guardians(OR=3.84,95%CI:2.31-6.41,P<0.01),and an anterior-segment urethral opening(OR_(1)[vs middle hypospadias]=2.07,95%CI:1.42-3.03;0R_(2)[vs posterior hypospadias]=2.63,95%CI:1.75-3.95;P<0.01)were all risk factors for delayed surgery in children.展开更多
BACKGROUND Tenofovir disoproxil fumarate(TDF)is a prodrug of a nucleotide analogue.As an antiviral drug,TDF has been proposed in the first-line treatment of chronic hepatitis B(CHB).Qingzhong,a brand name of TDF,comme...BACKGROUND Tenofovir disoproxil fumarate(TDF)is a prodrug of a nucleotide analogue.As an antiviral drug,TDF has been proposed in the first-line treatment of chronic hepatitis B(CHB).Qingzhong,a brand name of TDF,commercialized by Jiangsu Chia-tai Tianqing Pharmaceutical Co Ltd.,and Viread,another brand name of TDF,commercialized by GlaxoSmithKline,have both been approved by the State Food and Drug Administration,China.AIM To investigate the efficacy and safety of the two TDF agents in the treatment of Chinese CHB patients.METHODS This trial was registered at ClinicalTrials.gov with the identifier number of NCT02287857.A total of 330 Chinese CHB patients,among which 232 were hepatitis B e antigen(HBeAg)-positive,were included in this 5-year-long,multicenter,double-blinded,double-dummy,randomized-controlled,noninferiority phase III trial.The participants were initially randomized into two groups:Group A(n=161),in which the participants received 300 mg Qingzhong once a day for 48 wk;and Group B,in which the participants received 300 mg Viread once a day for 48 wk.Starting from week 49,all the participants in Groups A and B received 300 mg Qingzhong once a day until the 96th week.In this study,the primary endpoint was the decrease in plasma level of hepatitis B virus(HBV)DNA at the 96th week,while the secondary endpoints were suppression of HBV replication,alanine aminotransferase(ALT)normalization,HBeAg loss,and HBeAg seroconversion rates.RESULTS For the participants with HBeAg-positive CHB,the decrease in mean HBV DNA level relative to the baseline value was comparable between Groups A and B(5.77 vs 5.73 log10 IU/mL,P>0.05)at the 96th week.In addition,similar percentages of HBeAg-positive participants in the two groups exhibited undetectable levels of HBV DNA,HBeAg loss,and HBeAg seroconversion(71.05%vs 77.97%,31.00%vs 27.27%,and 20.22%vs 15.79%,respectively,in Group A vs Group B;P>0.05).For the participants with HBeAg-negative CHB,the decrease in mean HBV DNA level relative to the baseline value was also comparable between Groups A and B(4.46 vs 4.70 log10 IU/mL,P>0.05)at the 96th week.In addition,similar percentages of HBeAg-negative participants in the two groups exhibited undetectable levels of HBV DNA(87.23%vs 94.12%in Group A vs Group B,respectively;P>0.05).Finally,similar percentages of CHB patients(HBeAg-positive or HBeAg-negative)in the two groups exhibited normalization of ALT(80.14%vs 84.57%in Group A vs Group B,respectively;P>0.05),and similar incidences of adverse events were observed(106 vs 104 in Group A vs Group B,respectively;P>0.05).CONCLUSION Both Qingzhong and Viread are effective and safe in the treatment of Chinese CHB patients according to the results of our clinical trial.展开更多
Background:Previous single-center studies have demonstrated that drug-coated balloons(DCBs)may reduce restenosis rates,which is an important factor affecting the prognosis for intracranial interventional therapy.Howev...Background:Previous single-center studies have demonstrated that drug-coated balloons(DCBs)may reduce restenosis rates,which is an important factor affecting the prognosis for intracranial interventional therapy.However,currently available cardiac DCBs are not always suitable for the treatment of intracranial atherosclerotic stenosis(ICAS).This study aimed to evaluate the safety and efficacy of a novel DCB catheter designed for patients with severely symptomatic ICAS.Methods:This prospective,multicenter,single-arm,target-value clinical trial was conducted in 9 Chinese stroke centers to evaluate the safety and efficacy of a novel DCB catheter for treating symptomatic severe ICAS.Primary metrics and other indicators were collected and analyzed using SAS version 9.4(SAS Institute,Cary,NC,USA).Results:A total of 155 patients were enrolled in this study.The preliminary collection of follow-up data has been completed,while data quality control is ongoing.Conclusion:Results of this study demonstrated the patency rate,safety,and effectiveness of a novel on-label paclitaxel DCB designed for the treatment of ICAS.Ethics and dissemination:This study,involving human participants,was reviewed and approved by the Ethics Committee of Drugs(Devices)Clinical Experiment at Henan Provincial People’s Hospital(reference number:2020-145-03)and other research centers participating in the clinical trial.The results of this study will be presented at international conferences and sent to peer-reviewed journals for publication.Standard protocol items:The Recommendations for Interventional Trials checklist was used when drafting the study protocol.Trial registration number:Registered with the Chinese Clinical Trial Registry on June 11,2021(Chi CTR2100047223).展开更多
Dear editor,The black widow spider species, also known as the Latrodectus species by its biological nomenclature, is one of more than 40,000 different spider species and one of the most common poisonous species to hum...Dear editor,The black widow spider species, also known as the Latrodectus species by its biological nomenclature, is one of more than 40,000 different spider species and one of the most common poisonous species to humans.[1] It is reported to be responsible for most of the clinically significant envenomation among all species of spiders in the USA.展开更多
Introduction: Globally, tuberculosis is the leading cause of death from a single infectious agent ahead of HIV/AIDS. Approximately 10 million people contracted TB in 2017, 10% of whom were children aged 0 - 15 years, ...Introduction: Globally, tuberculosis is the leading cause of death from a single infectious agent ahead of HIV/AIDS. Approximately 10 million people contracted TB in 2017, 10% of whom were children aged 0 - 15 years, or about 1 million with 250,000 deaths in 2016 (including children with HIV-associated TB). The signs of TB in children are not always specific and diagnosis remains difficult unlike in adults. According to a study conducted in 2011 in the paediatric department of the CHU-Gabriel Touré, only seventeen cases of all forms of tuberculosis were found, or approximately 0.2% of hospitalised children. The objective of our study was to investigate the epidemiological and clinical aspects of tuberculosis in children. Materials and Method: This was a prospective, cross-sectional and descriptive study that took place from 24 October 2017 to 23 October 2018, or 12 months in children aged 0-15 years. Data were collected from an individual medical record opened for each patient and an individual survey form established for each child. Results: During the study period, 40,434 children were consulted. Tuberculosis was suspected in 91 children, with a frequency of 0.22%. The age range of 1 to 4 years was 36.3% with a median age of 72 months. The sex ratio was 1.8. Chronic cough with 84.6% and malnutrition with 24.17% were the most frequent symptoms. Chest X-ray revealed bilateral pulmonary lesions in 52.7% and mediastinal adenopathy in 12.1%. TST was positive in 10.9% of patients, microscopy in 26.4%, Gene Xpert in 18.7%, and culture in 16.5%. The biological diagnosis of tuberculosis was retained in 48.4% of the patients, the pulmonary form represented 93.2%. The therapeutic regime (2RHZE/4RH) was used in 81.6% of cases and the evolution was favourable in 65.9% of patients. Conclusion: The diagnosis of tuberculosis in children remains difficult in our context. The clinical signs are not always specific, and further studies are needed to further elucidate this disease.展开更多
Objective:To investigate the optimal management of patients with epidermal growth factor receptor gene(EGFR)mutant locally advanced non-small cell lung cancer(LA-NSCLC).Methods:Patients with unresectable stage III lun...Objective:To investigate the optimal management of patients with epidermal growth factor receptor gene(EGFR)mutant locally advanced non-small cell lung cancer(LA-NSCLC).Methods:Patients with unresectable stage III lung adenocarcinoma(LAC)harboring EGFR mutations from 2012 to 2018 were analyzed retrospectively,and were categorized into three groups according to the primary treat-ment:chemoradiotherpy(CRT)(group 1),combined radiation therapy(RT)and EGFR-tyrosine kinase inhibitors(TKI)with/without chemotherapy(group 2),and EGFR-TKI alone until tumor progression(group 3).Inverse probability of multiple treatment weighting(IPTW)of propensity score was used to compare overall survival(OS)and progression free survival(PFS)between treatments and account for confounding.Results:A total of 104,105,and 231 patients were categorized into groups 1,2,and 3,respectively.After IPTW adjustment,the median PFS for each group was 12.4,26.2,and 16.2 months(log-rank P<0.001),and the median OS was 51.0,67.4 and 49.3 months(log-rank P=0.084),respectively.Compared with those in group 1,patients in group 2 had significantly improved PFS[adjusted hazard ratio HR(aHR),0.40;95% confidence interval(CI):0.29,0.54;P<0.001]and OS(aHR,0.61;95%CI:0.38,0.98;P=0.039).Patients in group 3 had prolonged PFS(aHR,0.66;95%CI:0.50,0.87;P=0.003),but not OS(aHR,0.90;95%CI:0.62,1.32;P=0.595).Doubly robust IPTW analysis and multivariable Cox regression analysis yielded similar findings.Conclusions:EGFR-TKIs after chemoradiation or combined with radiation alone correlated with the longest PFS and OS(versus CRT or TKIs alone)in patients with EGFR-mutant unresectable LA-NSCLC.Well-designed prospec-tive trials were warranted.展开更多
Clear aligner treatment is a novel technique in current orthodontic practice.Distinct from traditional fixed orthodontic appliances,clear aligners have different material features and biomechanical characteristics and...Clear aligner treatment is a novel technique in current orthodontic practice.Distinct from traditional fixed orthodontic appliances,clear aligners have different material features and biomechanical characteristics and treatment efficiencies,presenting new clinical challenges.Therefore,a comprehensive and systematic description of the key clinical aspects of clear aligner treatment is essential to enhance treatment efficacy and facilitate the advancement and wide adoption of this new technique.This expert consensus discusses case selection and grading of treatment difficulty,principle of clear aligner therapy,clinical procedures and potential complications,which are crucial to the clinical success of clear aligner treatment.展开更多
Background:Following the short-term outbreak of coronavirus disease 2019(COVID-19)in December 2022 in China,clinical data on kidney transplant recipients(KTRs)with COVID-19 are lacking.Methods:We conducted a single-ce...Background:Following the short-term outbreak of coronavirus disease 2019(COVID-19)in December 2022 in China,clinical data on kidney transplant recipients(KTRs)with COVID-19 are lacking.Methods:We conducted a single-center retrospective study to describe the clinical features,complications,and mortality rates of hospitalized KTRs infected with COVID-19 between Dec.16,2022 and Jan.31,2023.The patients were followed up until Mar.31,2023.Results:A total of 324 KTRs with COVID-19 were included.The median age was 49 years.The median time between the onset of symptoms and admission was 13 d.Molnupiravir,azvudine,and nirmatrelvir/ritonavir were administered to 67(20.7%),11(3.4%),and 148(45.7%)patients,respectively.Twenty-nine(9.0%)patients were treated with more than one antiviral agent.Forty-eight(14.8%)patients were treated with tocilizumab and 53(16.4%)patients received baricitinib therapy.The acute kidney injury(AKI)occurred in 81(25.0%)patients and 39(12.0%)patients were admitted to intensive care units.Fungal infections were observed in 55(17.0%)patients.Fifty(15.4%)patients lost their graft.The 28-d mortality rate of patients was 9.0%and 42(13.0%)patients died by the end of follow-up.Multivariate Cox regression analysis identified that cerebrovascular disease,AKI incidence,interleukin(IL)-6 level of>6.8 pg/mL,daily dose of corticosteroids of>50 mg,and fungal infection were all associated with an increased risk of death for hospitalized patients.Conclusions:Our findings demonstrate that hospitalized KTRs with COVID-19 are at high risk of mortality.The administration of immunomodulators or the late application of antiviral drugs does not improve patient survival,while higher doses of corticosteroids may increase the death risk.展开更多
During cardiac arrest (CA),severe ischemia and hypoxia occur in tissues and organs of the entire body,inflammatory cytokines are released,and ischemiareperfusion injury occurs after the return of spontaneous circulati...During cardiac arrest (CA),severe ischemia and hypoxia occur in tissues and organs of the entire body,inflammatory cytokines are released,and ischemiareperfusion injury occurs after the return of spontaneous circulation (ROSC),leading to multiple organ dysfunction in the body;this condition is called post-CA syndrome(PCAS).^([1])According to the BASeline Investigation of Out-of-Hospital Cardiac Arrest (BASIC-OHCA) study,the crude incidence of emergency medical service (EMS)-assessed OHCA was 95.7 per 100,000 individuals,and only1.2%of those individuals survived to hospital discharge or30 d after being resuscitated by the EMS in China.展开更多
BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in ...BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in military personnel.Current guidelines in China state all patients with evidence of active infection with H.pylori are offered treatment.However,the prevalence of H.pylori infection and its regional distribution in the military population remain unclear,which hinders effective prevention and treatment strategies.Understanding the prevalence of H.pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.AIM To investigate the prevalence of H.pylori infection in the Chinese military population in different geographic areas.METHODS This multicenter,retrospective study included 22421 individuals from five tertiary hospitals located in north,east,southwest,and northwest cities of China.H.pylori infection was identified using the urea breath test,which had been performed between January 2020 and December 2021.RESULTS Of the 22421 military service members,7416(33.1%)were urea breath test-positive.The highest prevalence of H.pylori was in the 30-39 years age group for military personnel,with an infection rate of 34.9%.The majority of infected subjects were younger than 40-years-old,accounting for 70.4%of the infected population.The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing,Nanjing,and Guangzhou,with prevalence rates of 44.3%,37.9%,29.0%,31.1%,and 32.3%,respectively.CONCLUSION H.pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.展开更多
BACKGROUND Hepatitis B-associated cirrhosis is an important disease burden in China.However,there is a lack of effective predictors in clinical practice to drive delivery and enable early treatment to delay disease pr...BACKGROUND Hepatitis B-associated cirrhosis is an important disease burden in China.However,there is a lack of effective predictors in clinical practice to drive delivery and enable early treatment to delay disease progression.AIM To analyzing the clinical characteristics of patients with hepatitis and cirrhosis,the nomogram model was established and validated.METHODS The clinical data of 1070 patients with hepatitis B who were treated in our hospital from October 2015 to July 2022 were collected.In a 7:3 ratio,749 cases were divided into training cohorts and 321 cases were divided into validation cohorts.In addition,the training cohort and validation cohort were further divided into hepatitis group and hepatitis B-related cirrhosis group based on whether the patient progressed to cirrhosis.Binary logistic regression was used to analyze the influencing factors of hepatitis progression to cirrhosis.A roadmap prediction model was established,and the predictive effect of the model was evaluated by patientsubject receiver operating characteristic curve(ROC),and the effectiveness of the model was evaluated by decision curve analysis.RESULTS Binary logistic regression analysis was performed using hepatitis B-related cirrhosis=1 and hepatitis=0 as dependent variables,and univariate analysis of serological indicators was used as covariates.The results showed that glutamic oxaloacetate aminotransferase/glutamate acetone aminotransferase levels,prothrombin time activity,and hepatitis B e antigen levels were all contributing factors to the progression of hepatitis to cirrhosis.The area under the ROC curve was 0.693[95%confidence interval(CI):0.631 to 0.756]for the training cohort and 0.675(95%CI:0.561 to 0.790)for the validation cohort.In addition,the decision analysis curves of the prediction models of both the training cohort and the validation cohort confirmed the effectiveness of the nomogram prediction model.CONCLUSION Three independent factors influencing the progression to cirrhosis in patients with hepatitis B were identified.The construction of a nomogram prediction model from hepatitis to cirrhosis has high application value as a tool for predicting the occurrence of liver cirrhosis in hepatitis B patients.展开更多
BACKGROUND The prevalence and clinical characteristics of chronic kidney disease(CKD)among patients with ketosis-onset diabetes(also known as ketosis-prone diabetes)remain unclear.Furthermore,the classification of ket...BACKGROUND The prevalence and clinical characteristics of chronic kidney disease(CKD)among patients with ketosis-onset diabetes(also known as ketosis-prone diabetes)remain unclear.Furthermore,the classification of ketosis-onset diabetes remains controversial and requires further investigation.AIM To investigate the prevalence and clinical features of CKD in patients with newly diagnosed ketosis-onset diabetes.METHODS This real-world study included 217 patients with type 1 diabetes mellitus(T1DM),698 with ketosis-onset diabetes,and 993 with non-ketotic T2DM.The prevalence and clinical characteristics of CKD were compared among the three groups.Risk factors associated with CKD were evaluated using binary logistic regression for each group.RESULTS After adjusting for age and sex,the prevalence of CKD among patients with ketosis-onset diabetes(17.8%)was significantly higher than that in those with T1DM(8.3%,P=0.007),but was not statistically different compared to those with non-ketotic T2DM(21.7%,P=0.214).Furthermore,some risk factors for CKD,including age,and serum uric acid and C-reactive protein levels,in patients with ketosis-onset diabetes were similar to those with T2DM,but significantly different from those with T1DM.CONCLUSION The prevalence,clinical characteristics,and risk factors for CKD among patients with ketosis-onset diabetes were more similar to those with non-ketotic T2DM but considerably different from those with T1DM.These findings further support the classification of ketosis-onset diabetes as a subtype of T2DM rather than idiopathic T1DM.展开更多
Drug resistance continues to be the principal limiting factor in achieving a cure for patients with cancer,significantly hindering the long-term efficacy of novel cancer drugs.Accumulating evidence has shown that meta...Drug resistance continues to be the principal limiting factor in achieving a cure for patients with cancer,significantly hindering the long-term efficacy of novel cancer drugs.Accumulating evidence has shown that metabolites derived from tumor cells regulate immune cell metabolism via tumor microenvironment crosstalk.However,as immunometabolic research has deepened,the leading role played by the intrinsic metabolic regulation of immune cells in the drug resistance of tumor cells has been discovered.Immune metabolites have been shown to cause immune resistance,target therapy resistance,and chemotherapy resistance,and drugs that target immune metabolism have great potential.To date,researchers have not fully explored the impact of immune-derived metabolites on tumor cells and their influence on the responsiveness to cancer drugs.In this review,we focus on the lactate,fatty acid,glucose,and nucleotide metabolic alterations that take place in T cells and macrophages and how these changes can impair anti-tumor immunity,ultimately promoting tumor cell survival and decreasing responsiveness to the corresponding therapeutic approaches.We present the current developments in drugs targeting immunometabolic pathways and propose constructive suggestions,such as precise delivery to immune cell targets to enhance efficacy and safety,offering novel perspectives for cancer drug development.展开更多
BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gas...BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gastrectomy(PG)or total gastrectomy(TG)should be used for advanced proximal GC,and the choice of postoperative gastrointestinal reconstruction method remains controversial.AIM To compare the short-term efficacy,long-term survival,and postoperative reflux outcomes of PG with tubular stomach reconstruction vs TG with Roux-en-Y re-construction in patients with proximal GC following neoadjuvant chemotherapy(NACT)in an effort to provide valuable insights for clinical decision-making regarding the optimal surgical approach.METHODS A multicenter retrospective cohort study was conducted at two Chinese medical centers between December,2012 and December,2022.Patients with histologically confirmed proximal GC who received NACT followed by either PG with tubular stomach reconstruction or TG with Roux-en-Y reconstruction were included.Propensity score matching(PSM)was performed to balance baseline characteristics,and the primary endpoint was 5-year overall survival(OS).Se-condary endpoints included recurrence-free survival(RFS),postoperative complications,and reflux severity.RESULTS After PSM,244 patients(122 PG,122 TG)were finally included and all baseline characteristics were comparable between groups.The PG group had a significantly shorter operation time compared to the TG group(189.50 vs 215.00 minutes,P<0.001),with no differences in intraoperative blood loss or postoperative complications(19.68%vs 14.75%,P=0.792).The 5-year OS rates were 52.7%vs 45.5%(P=0.330),and 5-year RFS rates were 54.3%vs 47.6%(P=0.356)for the PG and TG groups,respectively.Reflux symptoms(18.0%vs 31.1%,P=0.017)and clinically significant reflux based on gastroesophageal reflux disease questionnaire scores≥8(7.4%vs 21.3%,P<0.001)were significantly less frequent in the PG group.Multivariate analysis identified histological differentiation(HR=2.98,95%CI:2.03-4.36,P<0.001)and tumor size(HR=0.26,95%CI:0.17-0.41 for tumors≤4 cm,P<0.001)as independent prognostic factors.CONCLUSION PG with tubular stomach reconstruction is comparable to TG in terms of surgical safety and long-term oncological outcomes for proximal GC patients following NACT.Additionally,PG has the advantages of shorter operation time and lower rates of postoperative reflux,suggesting potential benefits for patient quality of life.Notably,the analysis of postoperative prognostic factors,including histological differentiation and tumor size,further informs clinical decision-making and highlights the importance of individualized treatment strategies.展开更多
In China,approximately 13% of people living with human immunodeficiency virus(HIV)(PLWH)are receiving lopinavir/ritonavir(LPV/r)-based regimens.These PLWH typically have a history of either treatment failure or intole...In China,approximately 13% of people living with human immunodeficiency virus(HIV)(PLWH)are receiving lopinavir/ritonavir(LPV/r)-based regimens.These PLWH typically have a history of either treatment failure or intolerance to first-line efavirenz-based regimens.Given the considerable pill burden and adverse effects associated with LPV/r,treatment optimization is important for this population.This multicenter retrospective study aimed to evaluate the efficacy and safety of switching from LPV/r-based regimens to the single-tablet regimen of bictegravir/emtricitabine/tenofovir alafenamide(BIC/FTC/TAF).Virological suppression rates(HIV-RNA<40 copies/mL)were primarily compared between the 48-week periods before and after switching to BIC/FTC/TAF.CD4 counts and metabolic data were also assessed.A total of 461 PLWH were recruited between January 2021 and December 2023,with 92.2% being male,a median age of 38 years,and a median antiretroviral therapy duration of 8 years.Prior to initiating LPV/r,23.0%(106/461)had documented virological failure.During LPV/r treatment,18.9%(20/106)of these individuals experienced viral rebound.Among all participants,the overall virological suppression rates significantly increased from 94.6%(pre-switch)to 98.6%(post-switch)(P<0.001).Notably,among participants with prior virological failure,suppression rates improved significantly from 81.1%to 97.2%(P<0.001),whereas no significant difference was observed in those without such history(from 98.6% to 99.2%,P=0.764).The median triglyceride level decreased from 2.4 mmol/L to 1.8 mmol/L(P<0.001),while no difference in CD4 counts was observed.These findings demonstrate that BIC/FTC/TAF is an effective and metabolically favorable treatment option for PLWH switching from LPV/r based regimens,regardless of whether they have a prior history of virological failure.展开更多
Objective This is a self-controlled multicenter retrospective study based on the clinical efficacy and complications of physiological reconstruction in the treatment of moderate and severe pelvic organ prolapse.Method...Objective This is a self-controlled multicenter retrospective study based on the clinical efficacy and complications of physiological reconstruction in the treatment of moderate and severe pelvic organ prolapse.Methods From December 2014 to August 2021,517 women were included and registered for physiological reconstruction at four Chinese urogynecology institutions.We enrolled 364 women with POP-Q stage≥3.The degree of POP was quantified via a POP-Q system.The surgical purpose of physiological reconstruction is to repair the vagina,levator ani muscle,perineum,and urogenital hiatus and adopt a repair method in accordance with the axial direction of physiology.All 330 evaluable participants were followed for 2 years.The evaluation indices included the PFDI-20,PGI-I,PFIQ-7,PISQ-12,PGI-I,and PGI-S.All complications were coded according to the category-time-site system proposed by the International Urogynecological Association(IUGA)and International Continence Society(ICS).Results Compared with the preoperative POP-Q scores,statistically significant improvements were observed at the 6-month,1-year and 2-year time points(P<0.001).Statistically significant improvements in quality of life were observed across all time points.Conclusions Physiologic reconstructive surgical techniques combined with modified anterior pelvic floor mesh implantation could help restore the physiologic axis and vaginal shape,which may be the most important factors in maintaining the functional position of pelvic floor organs and is the most effective method for repairing the pelvic fascia tendon arch.This surgical method is safe,feasible,and effective in patients with severe prolapse.展开更多
基金supported by the National Key Research and Development Program of China(No.2022YFC3602500)Beijing High-level Public Health Technical Talents Construction Project(Discipline Leader-03-24)Beijing Hospitals Authority’s Ascent Plan(DFL20240601).
文摘OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were randomly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis<30% with no 30-day major adverse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area product.RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6%).Both groups achieved 100% clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI group had a technical success rate of 100%.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator radiation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups.CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.
基金supported by the National Key Research and Development Program of China,No.2019YFA0111200the National Natural Science Foundation of China,Nos.U23A20436,82371047+3 种基金Key Research Project in Shanxi Province,No.202302130501008Shanxi Provincial Science Fund for Distinguished Young Scholars,No.202103021221008Key Research and Development Program in Shanxi Province,No.202204051001023Shanxi Medical University Doctor’s Startup Fund Project,No.SD22028(all to YG)。
文摘Retinal ganglion cells are the bridging neurons between the eye and the central nervous system,transmitting visual signals to the brain.The injury and loss of retinal ganglion cells are the primary pathological changes in several retinal degenerative diseases,including glaucoma,ischemic optic neuropathy,diabetic neuropathy,and optic neuritis.In mammals,injured retinal ganglion cells lack regenerative capacity and undergo apoptotic cell death within a few days of injury.Additionally,these cells exhibit limited regenerative ability,ultimately contributing to vision impairment and potentially leading to blindness.Currently,the only effective clinical treatment for glaucoma is to prevent vision loss by lowering intraocular pressure through medications or surgery;however,this approach cannot halt the effect of retinal ganglion cell loss on visual function.This review comprehensively investigates the mechanisms underlying retinal ganglion cell degeneration in retinal degenerative diseases and further explores the current status and potential of cell replacement therapy for regenerating retinal ganglion cells.As our understanding of the complex processes involved in retinal ganglion cell degeneration deepens,we can explore new treatment strategies,such as cell transplantation,which may offer more effective ways to mitigate the effect of retinal degenerative diseases on vision.
基金Supported by the Inheritance and Innovation of Traditional Chinese Medicine"Hundred Million"Talent Project(Qihuang Project)(2019-QTL-003)。
文摘OBJECTIVE:To summarize the clinical efficacy characteristics of Suhuang Zhike capsule(苏黄止咳颗粒)and evaluate the incidence of adverse reactions in its broad clinical application.METHODS:This was a multicenter,prospective,singlearm,open-label phase IV clinical trial.A total of 1100 patients diagnosed with cough variant asthma(CVA)and the Traditional Chinese Medicine(TCM)syndrome of wind evil invading the lung and lung Qi failing to propagate were planned for recruitment.Participants received Suhuang Zhike capsule orally,three capsules per dose,taken three times daily,for a treatment duration of 14 d.The primary outcome was the change in cough symptom scores from baseline to week 2.Cough severity was assessed twice daily.Additional evaluations included the rate and time of cough disappearance or basic disappearance rate,as well as the time of cough relief.TCM symptom scores were recorded at baseline and on days 7 and 14 of treatment.Safety assessments included monitoring for adverse events and conducting laboratory tests.RESULTS:A total of 1033 patients with CVA from 40 hospitals across China were enrolled in the study.Of these,1026 patients received the study medication and were included in the safety analysis.Fifty-four patients withdrew from the study,resulting in a drop-out rate of 5.23%.Treatment with Suhuang Zhike capsules significantly reduced cough symptom scores and improved cough-related symptoms in patients with CVA.The overall rate of cough disappearance or basic disappearance increased over the course of treatment,reaching 67.21%after 14 d.The median time of cough relief was 3 d,while the median time to cough disappearance or basic disappearance was 11 d.Additionally,the treatment led to reductions in TCM symptom scores and improvements in accompanying symptoms such as throat itching,expectoration,and shortness of breath.In terms of safety,no serious adverse events were reported.The incidence of related adverse events(AEs)was 2.24%(23 cases,30 events).The incidence of adverse reactions listed in the drug's instructions was 2.14%.Other related AEs not listed in the drug's instructions occurred in 0.39%of patients and included dizziness(0.19%),headache(0.10%),pruritus(0.10%),and palpitation(0.10%).CONCLUSION:Suhuang Zhike capsules demonstrated good efficacy and safety for the treatment of CVA.These findings offer valuable clinical evidence to support their broader application in routine clinical practice.
基金special fund for “Capital City Clinical Specific Application Study”(No.Z171100001017115)。
文摘Objective: To investigate the clinical significance of separate lateral parametrial lymph node dissection(LPLND) in improving parametrial lymph node(PLN) and its metastasis detection rate during radical hysterectomy for early-stage cervical cancer.Methods: From July 2007 to August 2017, 2,695 patients with cervical cancer in stage IB1-IIA2 underwent radical hysterectomy were included. Of these patients, 368 underwent separate dissection of PLNs using the LPLND method, and 2,327 patients underwent conventional radical hysterectomy(CRH). We compared the surgical parameters, PLN detection rate and PLN metastasis rate between the two groups.Results: Compared with CRH group, the rate of laparoscopic surgery was higher(60.3% vs. 15.9%, P<0.001),and the blood transfusion rate was lower(19.0% vs. 29.0%, P<0.001) in the LPLND group. PLNs were detected in 356 cases(96.7%) in the LPLND group, and 270 cases(11.6%) in the CRH group(P<0.001), respectively. The number of PLNs detected in the LPLND group was higher than that in the CRH group(median 3 vs. 1, P<0.001).The PLN metastases were detected in 25 cases(6.8%) in the LPLND group, and 18 cases(0.8%) in the CRH group(P<0.001), respectively. In multivariable analysis, LPLND is an independent factor not only for PLN detection [odds ratio(OR)=228.999, 95% confidence interval(95% CI): 124.661-420.664;P<0.001], but also for PLN metastasis identification(OR=10.867, 95% CI: 5.381-21.946;P<0.001).Conclusions: LPLND is feasible and safe. The surgical method significantly improves the detection rate of PLN and avoids omission of PLN metastasis during radical hysterectomy for early-stage cervical cancer.
基金the National Natural Science Foundation of China(No.81970571)。
文摘We aimed to explore the associations between the age at which children undergo surgery for hypospadias and a range of social and clinical factors in a single center.Our aim was to promote the early surgical treatment of children with hypospadias.For a 6-year period,social and clinical data were collected from all children undergoing surgery to repair hypospadias in Children’s Hospital of Chongqing Medical University(Chongqing,China),located in southwest of China.We analyzed the correlations between age at surgery and a range of social and clinical factors.A total of 1611 eligible cases were recruited,with a mean age of 54.3 months and a median age of 42 months:234 cases(14.5%)were classified into a“timely operation”group,419(26.0%)cases into a“subtimely operation”group,and 958(59.5%)cases into a“delayed operation”group.According to multivariate regression analyses,the higher the regional economic level,the closer the urethral opening to the perineum,and the higher the educational level of the guardians was,the younger the children were when they underwent the initial surgery for hypospadias;this was also the case for families without other children.Our subgroup analysis showed that the primary educational level of the guardians was a risk factor for subtimely surgery in their children(odds ratio[OR]=1.52,95%confidence interval[CI]:1.08-2.15,P<0.05).A lower regional economic level(OR=1.87,95%CI:1.26-2.78,P<0.01),a lower educational level of the guardians(OR=3.84,95%CI:2.31-6.41,P<0.01),and an anterior-segment urethral opening(OR_(1)[vs middle hypospadias]=2.07,95%CI:1.42-3.03;0R_(2)[vs posterior hypospadias]=2.63,95%CI:1.75-3.95;P<0.01)were all risk factors for delayed surgery in children.
基金Supported by The 13th Five-year Science and Technology Major Project of China,on the Prevention and Treatment of Major Infectious Diseases,No.2017ZX10202202.
文摘BACKGROUND Tenofovir disoproxil fumarate(TDF)is a prodrug of a nucleotide analogue.As an antiviral drug,TDF has been proposed in the first-line treatment of chronic hepatitis B(CHB).Qingzhong,a brand name of TDF,commercialized by Jiangsu Chia-tai Tianqing Pharmaceutical Co Ltd.,and Viread,another brand name of TDF,commercialized by GlaxoSmithKline,have both been approved by the State Food and Drug Administration,China.AIM To investigate the efficacy and safety of the two TDF agents in the treatment of Chinese CHB patients.METHODS This trial was registered at ClinicalTrials.gov with the identifier number of NCT02287857.A total of 330 Chinese CHB patients,among which 232 were hepatitis B e antigen(HBeAg)-positive,were included in this 5-year-long,multicenter,double-blinded,double-dummy,randomized-controlled,noninferiority phase III trial.The participants were initially randomized into two groups:Group A(n=161),in which the participants received 300 mg Qingzhong once a day for 48 wk;and Group B,in which the participants received 300 mg Viread once a day for 48 wk.Starting from week 49,all the participants in Groups A and B received 300 mg Qingzhong once a day until the 96th week.In this study,the primary endpoint was the decrease in plasma level of hepatitis B virus(HBV)DNA at the 96th week,while the secondary endpoints were suppression of HBV replication,alanine aminotransferase(ALT)normalization,HBeAg loss,and HBeAg seroconversion rates.RESULTS For the participants with HBeAg-positive CHB,the decrease in mean HBV DNA level relative to the baseline value was comparable between Groups A and B(5.77 vs 5.73 log10 IU/mL,P>0.05)at the 96th week.In addition,similar percentages of HBeAg-positive participants in the two groups exhibited undetectable levels of HBV DNA,HBeAg loss,and HBeAg seroconversion(71.05%vs 77.97%,31.00%vs 27.27%,and 20.22%vs 15.79%,respectively,in Group A vs Group B;P>0.05).For the participants with HBeAg-negative CHB,the decrease in mean HBV DNA level relative to the baseline value was also comparable between Groups A and B(4.46 vs 4.70 log10 IU/mL,P>0.05)at the 96th week.In addition,similar percentages of HBeAg-negative participants in the two groups exhibited undetectable levels of HBV DNA(87.23%vs 94.12%in Group A vs Group B,respectively;P>0.05).Finally,similar percentages of CHB patients(HBeAg-positive or HBeAg-negative)in the two groups exhibited normalization of ALT(80.14%vs 84.57%in Group A vs Group B,respectively;P>0.05),and similar incidences of adverse events were observed(106 vs 104 in Group A vs Group B,respectively;P>0.05).CONCLUSION Both Qingzhong and Viread are effective and safe in the treatment of Chinese CHB patients according to the results of our clinical trial.
基金funded by The Henan Province Young and Middle-aged Health Science and Technology Innovation Young Talent Training Project(,Grant/Award Number:YXKC20200041)National Health Commission Capacity Building and Continuing Education Project(Grant/Award Number:GWJJ2023100101)
文摘Background:Previous single-center studies have demonstrated that drug-coated balloons(DCBs)may reduce restenosis rates,which is an important factor affecting the prognosis for intracranial interventional therapy.However,currently available cardiac DCBs are not always suitable for the treatment of intracranial atherosclerotic stenosis(ICAS).This study aimed to evaluate the safety and efficacy of a novel DCB catheter designed for patients with severely symptomatic ICAS.Methods:This prospective,multicenter,single-arm,target-value clinical trial was conducted in 9 Chinese stroke centers to evaluate the safety and efficacy of a novel DCB catheter for treating symptomatic severe ICAS.Primary metrics and other indicators were collected and analyzed using SAS version 9.4(SAS Institute,Cary,NC,USA).Results:A total of 155 patients were enrolled in this study.The preliminary collection of follow-up data has been completed,while data quality control is ongoing.Conclusion:Results of this study demonstrated the patency rate,safety,and effectiveness of a novel on-label paclitaxel DCB designed for the treatment of ICAS.Ethics and dissemination:This study,involving human participants,was reviewed and approved by the Ethics Committee of Drugs(Devices)Clinical Experiment at Henan Provincial People’s Hospital(reference number:2020-145-03)and other research centers participating in the clinical trial.The results of this study will be presented at international conferences and sent to peer-reviewed journals for publication.Standard protocol items:The Recommendations for Interventional Trials checklist was used when drafting the study protocol.Trial registration number:Registered with the Chinese Clinical Trial Registry on June 11,2021(Chi CTR2100047223).
基金supported by the Beijing Municipal Administration of Hospitals Incubating Program (Px2016022)。
文摘Dear editor,The black widow spider species, also known as the Latrodectus species by its biological nomenclature, is one of more than 40,000 different spider species and one of the most common poisonous species to humans.[1] It is reported to be responsible for most of the clinically significant envenomation among all species of spiders in the USA.
文摘Introduction: Globally, tuberculosis is the leading cause of death from a single infectious agent ahead of HIV/AIDS. Approximately 10 million people contracted TB in 2017, 10% of whom were children aged 0 - 15 years, or about 1 million with 250,000 deaths in 2016 (including children with HIV-associated TB). The signs of TB in children are not always specific and diagnosis remains difficult unlike in adults. According to a study conducted in 2011 in the paediatric department of the CHU-Gabriel Touré, only seventeen cases of all forms of tuberculosis were found, or approximately 0.2% of hospitalised children. The objective of our study was to investigate the epidemiological and clinical aspects of tuberculosis in children. Materials and Method: This was a prospective, cross-sectional and descriptive study that took place from 24 October 2017 to 23 October 2018, or 12 months in children aged 0-15 years. Data were collected from an individual medical record opened for each patient and an individual survey form established for each child. Results: During the study period, 40,434 children were consulted. Tuberculosis was suspected in 91 children, with a frequency of 0.22%. The age range of 1 to 4 years was 36.3% with a median age of 72 months. The sex ratio was 1.8. Chronic cough with 84.6% and malnutrition with 24.17% were the most frequent symptoms. Chest X-ray revealed bilateral pulmonary lesions in 52.7% and mediastinal adenopathy in 12.1%. TST was positive in 10.9% of patients, microscopy in 26.4%, Gene Xpert in 18.7%, and culture in 16.5%. The biological diagnosis of tuberculosis was retained in 48.4% of the patients, the pulmonary form represented 93.2%. The therapeutic regime (2RHZE/4RH) was used in 81.6% of cases and the evolution was favourable in 65.9% of patients. Conclusion: The diagnosis of tuberculosis in children remains difficult in our context. The clinical signs are not always specific, and further studies are needed to further elucidate this disease.
基金founded by the National Natural Sciences Foundation Key Program(grant number:81572971)CAMS Innovation Fund for Medical Sciences(grant number:2017-I2M-1-005)+2 种基金Sanming Project of Medicine in Shenzhen(grant number:SZSM201612063)National Natural Sciences Foundation Key Program of China(grant number:81572971)National Key R&D Program of China(grant number:2018YFC1312104).
文摘Objective:To investigate the optimal management of patients with epidermal growth factor receptor gene(EGFR)mutant locally advanced non-small cell lung cancer(LA-NSCLC).Methods:Patients with unresectable stage III lung adenocarcinoma(LAC)harboring EGFR mutations from 2012 to 2018 were analyzed retrospectively,and were categorized into three groups according to the primary treat-ment:chemoradiotherpy(CRT)(group 1),combined radiation therapy(RT)and EGFR-tyrosine kinase inhibitors(TKI)with/without chemotherapy(group 2),and EGFR-TKI alone until tumor progression(group 3).Inverse probability of multiple treatment weighting(IPTW)of propensity score was used to compare overall survival(OS)and progression free survival(PFS)between treatments and account for confounding.Results:A total of 104,105,and 231 patients were categorized into groups 1,2,and 3,respectively.After IPTW adjustment,the median PFS for each group was 12.4,26.2,and 16.2 months(log-rank P<0.001),and the median OS was 51.0,67.4 and 49.3 months(log-rank P=0.084),respectively.Compared with those in group 1,patients in group 2 had significantly improved PFS[adjusted hazard ratio HR(aHR),0.40;95% confidence interval(CI):0.29,0.54;P<0.001]and OS(aHR,0.61;95%CI:0.38,0.98;P=0.039).Patients in group 3 had prolonged PFS(aHR,0.66;95%CI:0.50,0.87;P=0.003),but not OS(aHR,0.90;95%CI:0.62,1.32;P=0.595).Doubly robust IPTW analysis and multivariable Cox regression analysis yielded similar findings.Conclusions:EGFR-TKIs after chemoradiation or combined with radiation alone correlated with the longest PFS and OS(versus CRT or TKIs alone)in patients with EGFR-mutant unresectable LA-NSCLC.Well-designed prospec-tive trials were warranted.
文摘Clear aligner treatment is a novel technique in current orthodontic practice.Distinct from traditional fixed orthodontic appliances,clear aligners have different material features and biomechanical characteristics and treatment efficiencies,presenting new clinical challenges.Therefore,a comprehensive and systematic description of the key clinical aspects of clear aligner treatment is essential to enhance treatment efficacy and facilitate the advancement and wide adoption of this new technique.This expert consensus discusses case selection and grading of treatment difficulty,principle of clear aligner therapy,clinical procedures and potential complications,which are crucial to the clinical success of clear aligner treatment.
基金supported by the National Natural Science Foundation of China(No.2022YFC82200842)the Zhejiang Provincial Natural Science Foundation of China(No.LQ22H050004).
文摘Background:Following the short-term outbreak of coronavirus disease 2019(COVID-19)in December 2022 in China,clinical data on kidney transplant recipients(KTRs)with COVID-19 are lacking.Methods:We conducted a single-center retrospective study to describe the clinical features,complications,and mortality rates of hospitalized KTRs infected with COVID-19 between Dec.16,2022 and Jan.31,2023.The patients were followed up until Mar.31,2023.Results:A total of 324 KTRs with COVID-19 were included.The median age was 49 years.The median time between the onset of symptoms and admission was 13 d.Molnupiravir,azvudine,and nirmatrelvir/ritonavir were administered to 67(20.7%),11(3.4%),and 148(45.7%)patients,respectively.Twenty-nine(9.0%)patients were treated with more than one antiviral agent.Forty-eight(14.8%)patients were treated with tocilizumab and 53(16.4%)patients received baricitinib therapy.The acute kidney injury(AKI)occurred in 81(25.0%)patients and 39(12.0%)patients were admitted to intensive care units.Fungal infections were observed in 55(17.0%)patients.Fifty(15.4%)patients lost their graft.The 28-d mortality rate of patients was 9.0%and 42(13.0%)patients died by the end of follow-up.Multivariate Cox regression analysis identified that cerebrovascular disease,AKI incidence,interleukin(IL)-6 level of>6.8 pg/mL,daily dose of corticosteroids of>50 mg,and fungal infection were all associated with an increased risk of death for hospitalized patients.Conclusions:Our findings demonstrate that hospitalized KTRs with COVID-19 are at high risk of mortality.The administration of immunomodulators or the late application of antiviral drugs does not improve patient survival,while higher doses of corticosteroids may increase the death risk.
基金National Key R&D Program of China (2020YFC1512700, 2020YFC1512705, 2020YFC1512703)National Science&Technology Fundamental Resources Investigation Project (2018FY100600, 2018FY100602)+3 种基金Key R&D Program of Shandong Province (2021ZLGX02, 2021SFGC0503, 2022ZLGX03)Taishan Pandeng Scholar Program of Shandong Province (tspd20181220)Taishan Scholar Program of Shandong Province (tsqn202211310)Interdisciplinary Young Researcher Groups Program of Shandong University (2020QNQT004)。
文摘During cardiac arrest (CA),severe ischemia and hypoxia occur in tissues and organs of the entire body,inflammatory cytokines are released,and ischemiareperfusion injury occurs after the return of spontaneous circulation (ROSC),leading to multiple organ dysfunction in the body;this condition is called post-CA syndrome(PCAS).^([1])According to the BASeline Investigation of Out-of-Hospital Cardiac Arrest (BASIC-OHCA) study,the crude incidence of emergency medical service (EMS)-assessed OHCA was 95.7 per 100,000 individuals,and only1.2%of those individuals survived to hospital discharge or30 d after being resuscitated by the EMS in China.
文摘BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in military personnel.Current guidelines in China state all patients with evidence of active infection with H.pylori are offered treatment.However,the prevalence of H.pylori infection and its regional distribution in the military population remain unclear,which hinders effective prevention and treatment strategies.Understanding the prevalence of H.pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.AIM To investigate the prevalence of H.pylori infection in the Chinese military population in different geographic areas.METHODS This multicenter,retrospective study included 22421 individuals from five tertiary hospitals located in north,east,southwest,and northwest cities of China.H.pylori infection was identified using the urea breath test,which had been performed between January 2020 and December 2021.RESULTS Of the 22421 military service members,7416(33.1%)were urea breath test-positive.The highest prevalence of H.pylori was in the 30-39 years age group for military personnel,with an infection rate of 34.9%.The majority of infected subjects were younger than 40-years-old,accounting for 70.4%of the infected population.The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing,Nanjing,and Guangzhou,with prevalence rates of 44.3%,37.9%,29.0%,31.1%,and 32.3%,respectively.CONCLUSION H.pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.
基金Supported by the“Climbing Program”Construction Project“High Peak Project”Department of Major Infectious Disease Prevention and Control.
文摘BACKGROUND Hepatitis B-associated cirrhosis is an important disease burden in China.However,there is a lack of effective predictors in clinical practice to drive delivery and enable early treatment to delay disease progression.AIM To analyzing the clinical characteristics of patients with hepatitis and cirrhosis,the nomogram model was established and validated.METHODS The clinical data of 1070 patients with hepatitis B who were treated in our hospital from October 2015 to July 2022 were collected.In a 7:3 ratio,749 cases were divided into training cohorts and 321 cases were divided into validation cohorts.In addition,the training cohort and validation cohort were further divided into hepatitis group and hepatitis B-related cirrhosis group based on whether the patient progressed to cirrhosis.Binary logistic regression was used to analyze the influencing factors of hepatitis progression to cirrhosis.A roadmap prediction model was established,and the predictive effect of the model was evaluated by patientsubject receiver operating characteristic curve(ROC),and the effectiveness of the model was evaluated by decision curve analysis.RESULTS Binary logistic regression analysis was performed using hepatitis B-related cirrhosis=1 and hepatitis=0 as dependent variables,and univariate analysis of serological indicators was used as covariates.The results showed that glutamic oxaloacetate aminotransferase/glutamate acetone aminotransferase levels,prothrombin time activity,and hepatitis B e antigen levels were all contributing factors to the progression of hepatitis to cirrhosis.The area under the ROC curve was 0.693[95%confidence interval(CI):0.631 to 0.756]for the training cohort and 0.675(95%CI:0.561 to 0.790)for the validation cohort.In addition,the decision analysis curves of the prediction models of both the training cohort and the validation cohort confirmed the effectiveness of the nomogram prediction model.CONCLUSION Three independent factors influencing the progression to cirrhosis in patients with hepatitis B were identified.The construction of a nomogram prediction model from hepatitis to cirrhosis has high application value as a tool for predicting the occurrence of liver cirrhosis in hepatitis B patients.
文摘BACKGROUND The prevalence and clinical characteristics of chronic kidney disease(CKD)among patients with ketosis-onset diabetes(also known as ketosis-prone diabetes)remain unclear.Furthermore,the classification of ketosis-onset diabetes remains controversial and requires further investigation.AIM To investigate the prevalence and clinical features of CKD in patients with newly diagnosed ketosis-onset diabetes.METHODS This real-world study included 217 patients with type 1 diabetes mellitus(T1DM),698 with ketosis-onset diabetes,and 993 with non-ketotic T2DM.The prevalence and clinical characteristics of CKD were compared among the three groups.Risk factors associated with CKD were evaluated using binary logistic regression for each group.RESULTS After adjusting for age and sex,the prevalence of CKD among patients with ketosis-onset diabetes(17.8%)was significantly higher than that in those with T1DM(8.3%,P=0.007),but was not statistically different compared to those with non-ketotic T2DM(21.7%,P=0.214).Furthermore,some risk factors for CKD,including age,and serum uric acid and C-reactive protein levels,in patients with ketosis-onset diabetes were similar to those with T2DM,but significantly different from those with T1DM.CONCLUSION The prevalence,clinical characteristics,and risk factors for CKD among patients with ketosis-onset diabetes were more similar to those with non-ketotic T2DM but considerably different from those with T1DM.These findings further support the classification of ketosis-onset diabetes as a subtype of T2DM rather than idiopathic T1DM.
基金supported by the National Key Research and Development Program of China(No.2023YFC2508500)National Natural Science Foundation of China(No.82272951)National Natural Science Foundation of China(No.82272953)。
文摘Drug resistance continues to be the principal limiting factor in achieving a cure for patients with cancer,significantly hindering the long-term efficacy of novel cancer drugs.Accumulating evidence has shown that metabolites derived from tumor cells regulate immune cell metabolism via tumor microenvironment crosstalk.However,as immunometabolic research has deepened,the leading role played by the intrinsic metabolic regulation of immune cells in the drug resistance of tumor cells has been discovered.Immune metabolites have been shown to cause immune resistance,target therapy resistance,and chemotherapy resistance,and drugs that target immune metabolism have great potential.To date,researchers have not fully explored the impact of immune-derived metabolites on tumor cells and their influence on the responsiveness to cancer drugs.In this review,we focus on the lactate,fatty acid,glucose,and nucleotide metabolic alterations that take place in T cells and macrophages and how these changes can impair anti-tumor immunity,ultimately promoting tumor cell survival and decreasing responsiveness to the corresponding therapeutic approaches.We present the current developments in drugs targeting immunometabolic pathways and propose constructive suggestions,such as precise delivery to immune cell targets to enhance efficacy and safety,offering novel perspectives for cancer drug development.
基金Supported by Special Fund for the Beijing Hope Marathon of the China Cancer Foundation,No.LC2019 L05and the Capital Health Development Research Special Fund Project,No.2024-2-4026.
文摘BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gastrectomy(PG)or total gastrectomy(TG)should be used for advanced proximal GC,and the choice of postoperative gastrointestinal reconstruction method remains controversial.AIM To compare the short-term efficacy,long-term survival,and postoperative reflux outcomes of PG with tubular stomach reconstruction vs TG with Roux-en-Y re-construction in patients with proximal GC following neoadjuvant chemotherapy(NACT)in an effort to provide valuable insights for clinical decision-making regarding the optimal surgical approach.METHODS A multicenter retrospective cohort study was conducted at two Chinese medical centers between December,2012 and December,2022.Patients with histologically confirmed proximal GC who received NACT followed by either PG with tubular stomach reconstruction or TG with Roux-en-Y reconstruction were included.Propensity score matching(PSM)was performed to balance baseline characteristics,and the primary endpoint was 5-year overall survival(OS).Se-condary endpoints included recurrence-free survival(RFS),postoperative complications,and reflux severity.RESULTS After PSM,244 patients(122 PG,122 TG)were finally included and all baseline characteristics were comparable between groups.The PG group had a significantly shorter operation time compared to the TG group(189.50 vs 215.00 minutes,P<0.001),with no differences in intraoperative blood loss or postoperative complications(19.68%vs 14.75%,P=0.792).The 5-year OS rates were 52.7%vs 45.5%(P=0.330),and 5-year RFS rates were 54.3%vs 47.6%(P=0.356)for the PG and TG groups,respectively.Reflux symptoms(18.0%vs 31.1%,P=0.017)and clinically significant reflux based on gastroesophageal reflux disease questionnaire scores≥8(7.4%vs 21.3%,P<0.001)were significantly less frequent in the PG group.Multivariate analysis identified histological differentiation(HR=2.98,95%CI:2.03-4.36,P<0.001)and tumor size(HR=0.26,95%CI:0.17-0.41 for tumors≤4 cm,P<0.001)as independent prognostic factors.CONCLUSION PG with tubular stomach reconstruction is comparable to TG in terms of surgical safety and long-term oncological outcomes for proximal GC patients following NACT.Additionally,PG has the advantages of shorter operation time and lower rates of postoperative reflux,suggesting potential benefits for patient quality of life.Notably,the analysis of postoperative prognostic factors,including histological differentiation and tumor size,further informs clinical decision-making and highlights the importance of individualized treatment strategies.
基金supported by the Capital's Funds for Health Improvement and Research(CFH2024-2-2175).
文摘In China,approximately 13% of people living with human immunodeficiency virus(HIV)(PLWH)are receiving lopinavir/ritonavir(LPV/r)-based regimens.These PLWH typically have a history of either treatment failure or intolerance to first-line efavirenz-based regimens.Given the considerable pill burden and adverse effects associated with LPV/r,treatment optimization is important for this population.This multicenter retrospective study aimed to evaluate the efficacy and safety of switching from LPV/r-based regimens to the single-tablet regimen of bictegravir/emtricitabine/tenofovir alafenamide(BIC/FTC/TAF).Virological suppression rates(HIV-RNA<40 copies/mL)were primarily compared between the 48-week periods before and after switching to BIC/FTC/TAF.CD4 counts and metabolic data were also assessed.A total of 461 PLWH were recruited between January 2021 and December 2023,with 92.2% being male,a median age of 38 years,and a median antiretroviral therapy duration of 8 years.Prior to initiating LPV/r,23.0%(106/461)had documented virological failure.During LPV/r treatment,18.9%(20/106)of these individuals experienced viral rebound.Among all participants,the overall virological suppression rates significantly increased from 94.6%(pre-switch)to 98.6%(post-switch)(P<0.001).Notably,among participants with prior virological failure,suppression rates improved significantly from 81.1%to 97.2%(P<0.001),whereas no significant difference was observed in those without such history(from 98.6% to 99.2%,P=0.764).The median triglyceride level decreased from 2.4 mmol/L to 1.8 mmol/L(P<0.001),while no difference in CD4 counts was observed.These findings demonstrate that BIC/FTC/TAF is an effective and metabolically favorable treatment option for PLWH switching from LPV/r based regimens,regardless of whether they have a prior history of virological failure.
基金supported by the National Natural Science Foundation of China(No.82260297)Yunnan Province Clinical Research Center for Chronic Kidney Disease(No.202102AA100060).
文摘Objective This is a self-controlled multicenter retrospective study based on the clinical efficacy and complications of physiological reconstruction in the treatment of moderate and severe pelvic organ prolapse.Methods From December 2014 to August 2021,517 women were included and registered for physiological reconstruction at four Chinese urogynecology institutions.We enrolled 364 women with POP-Q stage≥3.The degree of POP was quantified via a POP-Q system.The surgical purpose of physiological reconstruction is to repair the vagina,levator ani muscle,perineum,and urogenital hiatus and adopt a repair method in accordance with the axial direction of physiology.All 330 evaluable participants were followed for 2 years.The evaluation indices included the PFDI-20,PGI-I,PFIQ-7,PISQ-12,PGI-I,and PGI-S.All complications were coded according to the category-time-site system proposed by the International Urogynecological Association(IUGA)and International Continence Society(ICS).Results Compared with the preoperative POP-Q scores,statistically significant improvements were observed at the 6-month,1-year and 2-year time points(P<0.001).Statistically significant improvements in quality of life were observed across all time points.Conclusions Physiologic reconstructive surgical techniques combined with modified anterior pelvic floor mesh implantation could help restore the physiologic axis and vaginal shape,which may be the most important factors in maintaining the functional position of pelvic floor organs and is the most effective method for repairing the pelvic fascia tendon arch.This surgical method is safe,feasible,and effective in patients with severe prolapse.
