乳腺癌是女性常见的恶性肿瘤之一，发病率位居女性恶性肿瘤的首位，严重危害妇女的身心健康。目前，通过采用综合治疗手段，乳腺癌已成为疗效最佳的实体肿瘤之一。
To standardize the prevention and clinical management of lung cancer, improve patients' survival outcomes, and offer professional insight for clinicians, the Oncology Society of Chinese Medical Association has summoned experts from departments of pulmonary medicine, oncology, thoracic surgery, radiotherapy, imaging, and pathology to formulate the Oncology Society of Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer in China (2023 edition) through consensus meetings. Updates in this edition include 1) cancer screening: deletion of high-risk traits of lung cancer based on epidemiological investigations in the Caucasian population, while preserving features confirmed by research on the Chinese population. Advice on screening institutions is also added to raise awareness of the merits and demerits of lung cancer screening through detailed illustrations. 2) Principles of histopathologic evaluation: characteristics of four types of neuroendocrine tumors (typical carcinoid, atypical carcinoid, large cell carcinoma, and small cell carcinoma) are reviewed. 3) Surgical intervention: more options of resection are available for certain peripheral lesions based on several clinical studies (CALGB140503, JCOG0802, JCOG1211). 4) neoadjuvant/adjuvant therapy: marked improvement in the prognosis of non-small cell lung cancer (NSCLC) patients receiving neoadjuvant immunotherapy are reviewed; more options for consolidation immunotherapy after radiochemotherapy have also emerged. 5) Targeted and immune therapy: tyrosine kinase inhibitors of sensitive driver mutations such as EGFR and ALK as well as rare targets such as MET exon 14 skipping, RET fusion, ROS1 fusion, and NTRK fusion have been approved, offering more treatment options for clinicians and patients. Furthermore, multiple immune checkpoint inhibitors have been granted for the treatment of NSCLC and SCLC, resulting in prolonged survival of late-stage lung cancer patients. This guideline is established based on the current availability of domestically approved medications, recommendations of international guidelines, and present clinical practice in China as well as integration of the latest medical evidence of pathology, genetic testing, immune molecular biomarker detection, and treatment methods of lung cancer in recent years, to provide recommendations for professionals in clinical oncology, radiology, laboratory, and rehabilitation.
Objective:The effect of serum thyrotropin receptor antibody (TRAb) on permanent hypothyroidism (HT) after 131I treatment in Graves disease patients and its predictive value Methods:479 Graves' disease patients who underwent 131I treatment at the Nuclear Medicine Department of North China University of Technology Affiliated Hospital from October 2013 to October 2021 were selected. Among them, 350 cases (permanent HT group) had permanent HT during follow-up, while 129 cases (non permanent HT group) did not. Collect general clinical data such as gender, age, degree of thyroid enlargement, as well as indicators such as iodine intake rate, thyroid function, and treatment dose 24 hours before treatment, from two groups of patients. Compare the general clinical data and pre treatment levels of various detection indicators between two groups of patients, analyze the risk factors for permanent HT in Graves disease patients after 131I treatment, and evaluate the predictive value of pre treatment serum TRAb levels, and evaluate the consistency between the predicted results and clinical diagnosis. The econometric data with a normal distribution is represented by xˉ± s, and two independent sample t-tests are used for comparison between the two groups; The econometric data that do not conform to the normal distribution are represented by M（ Q1， Q3）, and the Wilcoxon rank sum test is used for comparison between the two groups; The counting data is represented as an example (%), and the comparison between the two groups is conducted using the four grid χ 2 test, while the comparison of grade data is conducted using the Willcoxon rank sum test; The logistic regression model was used for multivariate analysis. Draw a subject work characteristic curve to evaluate the predictive efficacy of TRAb, and screen the predictive threshold based on the Chayoden index; Calculate sensitivity and specificity, and evaluate the consistency between the predicted results and clinical diagnosis by calculating Kappa values. Results:There were no statistically significant differences in gender, age, degree of thyroid enlargement, 24-hour iodine uptake rate, serum thyroid stimulating hormone, free triiodothyronine, free thyroxine levels, and 131I treatment dose between the permanent HT group and the non permanent HT group (all P>0.05); The pre treatment TRAb levels in the permanent HT group were higher than those in the non permanent HT group [14.51(4.95,33.58) U/L vs 3.40(1.67,16.5) U/L], with a statistically significant difference ( Z=5.87, P<0.001). The results of multivariate logistic regression analysis showed that pre treatment TRAb levels were a risk factor for permanent HT in Graves' disease patients after 131I treatment (odds ratio=1.042,95% confidence interval: 1.025-1.059, P<0.001). The area under the working characteristic curve for predicting permanent HT in Graves' disease patients after 131I treatment with pre-treatment TRAb levels is 0.674 (95% confidence interval: 0.616~0.732), and the optimal critical value is 7.025 U/L. Using TRAb>7.025 U/L before treatment as the standard for predicting postoperative permanent HT in patients, the sensitivity and specificity were 73.7% and 75.2%, respectively. The predicted results showed moderate consistency with clinical diagnosis ( Kappa=0.426). Conclusions:The pre treatment TRAb level is a risk factor for permanent HT in Graves disease patients after 131I treatment ( P<0.001), and the diagnostic efficacy of permanent HT is best when TRAb>7.025 U/L.
Bronchiectasis is a complex chronic airway disease characterized by irreversible airway dilation caused by multiple pathogenic factors. Bronchiectasis is prevalent around the world, and the various etiologies, symptoms, comorbidities, complications, and clinical outcomes of each patient may be different. There is no doubt that this issue challenges the diagnosis and management of bronchiectasis. The study summarizes research achievements and experiences of bronchiectasis worldwide and updates management strategies based on clinical phenotypes and endotypes, providing references for the standardized treatment of bronchiectasis in our country.
We reported a rare case with metastatic prostate cancer complicated with hemorrhagic syndrome caused byprimary hyperfibrinolysis.The correct diagnosis of bleeding disorders is a prerequisite for choosing the correct treatment.Tranexamic acid can be used as the preferred treatment for patients with bleeding caused by primary hyperfibrinolysis. In this case, the combination of antifibrinolytics and antiandrogen therapy effectively controlled the severe bleeding symptoms caused by primary hyperfibrinolysis in metastatic prostate cancer. Appropriate treatment after early diagnosis is essential to prevent bleeding and improve prognosis.
