Tirzepatide, a newly developed dual glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, has received approval for treating type 2 diabetes (T2D) and is currently being studied for its potential in long-term weight control. We aim to explore the safety and efficacy of once-weekly subcutaneous tirzepatide for weight loss in T2D or obese patients. A comprehensive search was performed on various databases including PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception up to April 29, 2024, to identify randomized controlled trials (RCTs) that assessed the efficacy of once-weekly tirzepatide compared to a placebo in adults with or without T2D. The mean difference (MD) and risk ratio (RR) were calculated for continuous and dichotomous outcomes, respectively. The risk of bias was evaluated using the RoB-2 tool (Cochrane), while the statistical analysis was conducted utilizing RevMan 5.4.1 software. Seven RCTs comprising 4795 individuals ranging from 12 to 72 weeks were identified. Compared to the placebo group, tirzepatide at doses of 5, 10, and 15 mg demonstrated significant dose-dependent weight loss. The mean difference (MD) in the percentage change in body weight (BW) was −8.07

Background. Systemic inflammation may be involved in the entire cancer process as a promoter and is associated with antitumor immunity. The systemic immune-inflammation index (SII) has been shown to be a promising prognostic factor. However, the relationship between SII and tumor-infiltrating lymphocytes (TIL) have not been established in esophageal cancer (EC) patients receiving concurrent chemoradiotherapy (CCRT). Methods. Retrospective analysis of 160 patients with EC was performed, peripheral blood cell counts were collected, and TIL concentration was assessed in H&E-stained sections. Correlations of SII and clinical outcomes with TIL were analyzed. Cox proportional hazard model and Kaplan–Meier method were used to perform survival outcomes. Results. Compared with high SII, low SII had longer overall survival (OS) (P=0.036, hazard ratio (HR) = 0.59) and progression-free survival (PFS) (P=0.041, HR = 0.60). Low TIL showed worse OS (P<0.001, HR = 2.42) and PFS (P<0.001, HR = 3.05). In addition, research have shown that the distribution of SII, platelet-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio were negatively associated with the TIL state, while lymphocyte-to-monocyte ratio presented a positive correlation. Combination analysis observed that SIIlow + TILhigh had the best prognosis of all combinations, with a median OS and PFS of 36 and 22 months, respectively. The worst prognosis was identified as SIIhigh + TILlow, with a median OS and PFS of only 8 and 4 months. Conclusion. SII and TIL as independent predictors of clinical outcomes in EC receiving CCRT. Furthermore, the predictive power of the two combinations is much higher than a single variable.

目的:研究肝动脉灌注榄香烯治疗原发性肝癌的应用价值.方法:研究工作从2017年7月开始,并在2022年7月完成案例数据采集工作,共收录海安市中医院肿瘤科100例原发性肝癌病例.通过随机数字表法分组,每组50例.对照组采用肝动脉灌注碘化油+洛铂+盐酸表柔比星治疗;研究组通过肝动脉灌注榄香烯乳+洛铂治疗.然后收集并分析患者的治疗质量、肿瘤标志物水平、生存质量、肝功能、免疫功能、复发及不良事件情况等,并对数据进行对比分析.结果:治疗后,研究组治疗质量比对照组更高(P<0.05);治疗后,研究组血清肿瘤标志物指标均比对照组更低(P<0.05);治疗后,研究组生存质量评分比对照组更高(P<0.05);治疗后,研究组肝功能各项指标均低于对照组(P<0.05);治疗后,研究组CD3+、CD4+比对照组均更高(P<0.05);研究组复发率低于对照组(P<0.05);研究组不良事件发生率低于对照组(P<0.05).结论:在针对原发性肝癌的治疗中,选择榄香烯为患者进行肝动脉灌注治疗能够提高治疗质量,可以有效提高化疗药物治疗效果,并降低化疗药物对患者身体产生的毒副作用,患者病情能够得到更好的控制,肿瘤标志物水平明显降低,生存质量得到改善,机体免疫系统及肝脏功能得到更好的恢复,并有效降低患者出现复发及其他不良事件发生的概率,在动脉灌注治疗中加入榄香烯对于原发性肝癌的治疗具有十分重要的作用,建议在原发性肝癌的临床治疗中予以积极的借鉴和采纳.

ObjectiveThe purpose of this study was to compare the clinical outcomes and toxicities between induction chemotherapy (IC) + chemo-radiotherapy (CRT) and CRT alone in patients with locally advanced esophageal squamous cell carcinoma (ESCC), to explore the appropriate thoracic radiotherapy (TRT) timing after IC and to identify prognostic factors.Methods450 ESCC patients were included from September 2011 to December 2020, 238 of whom received IC/CRT. Propensity score matching was performed to balance potential confounders between the two groups. Multivariate Cox regression analysis was used to identify the independent prognostic factors.ResultsPatients who received IC/CRT experienced improved overall survival (OS) (38.5 vs. 28.8 months) and progression-free survival (PFS) (41.0 vs. 22.0 months) before matching, with similar results after matching. In the IC/CRT group, early TRT had more favorable survival than late TRT both matching before and after. In subgroup analysis, early TRT combination concurrent chemotherapy had better OS and PFS than late TRT combination concurrent chemotherapy. In addition, early TRT had better survival benefits regardless of the N stage. Notably, the IC/CRT group and early TRT group had manageable toxicities reaction compared with CRT alone group and the late TRT group. The nomogram was developed to predict the OS and PFS based on multivariate analysis results. The C-index was 0.743 and 0.722, respectively.ConclusionIC/CRT and early TRT could yield satisfactory clinical outcomes and controllable toxicities in locally advanced ESCC. The IC plus early concurrent CRT might be a promising treatment strategy for improving further survival in ESCC.

Background The nutritional status of cancer patients is a crucial factor in determining their prognosis. The objective of this study was to investigate and compare the prognostic value of pretreatment nutrition-related indicators in elderly esophageal squamous cell carcinoma (ESCC). Risk stratification was performed according to independent risk factors and a new nutritional prognostic index was constructed. Methods We retrospectively reviewed 460 older locally advanced ESCC patients receiving definitive chemoradiotherapy (dCRT) or radiotherapy (dRT). This study included five pre- therapeutic nutrition-related indicators. The optimal cut-off values for these indices were calculated from the Receiver Operating Curve (ROC). Univariate and multivariate COX analyses were employed to determine the association between each indicator and clinical outcomes. The predictive ability of each independently nutrition-related prognostic indicator was assessed using the time-dependent ROC (time-ROC) and C-index. Results Multivariate analyses indicated that the geriatric nutrition risk index (GNRI), body mass index (BMI), the controlling nutritional status (CONUT) score, and platelet-albumin ratio (PAR) could independently predict overall survival (OS) and progression-free survival (PFS) in elderly patients with ESCC (all p < 0.05), except for prognostic nutritional index (PNI). Based on four independently nutrition-related prognostic indicators, we developed pre-therapeutic nutritional prognostic score (PTNPS) and new nutritional prognostic index (NNPI). No-risk (PTNPS = 0–1 point), moderate-risk (PTNPS = 2 points), and high-risk (PTNPS = 3–4 points) groups had 5-year OS rates of 42.3%, 22.9%, and 8.8%, respectively ( p < 0.001), and 5-year PFS rates of 44.4%, 26.5%, and 11.3%, respectively ( p < 0.001). The Kaplan–Meier curves showed that the mortality of elderly ESCC patients in the high-risk group was higher than that in the low-risk group according to the NNPI. Analysis of time-AUC and C-index revealed that the NNPI (C-index: 0.663) had the greatest predictive power on the prognosis in older ESCC patients. Conclusions In elderly ESCC patients, the GNRI, BMI, CONUT score, and PAR can be used as objective assessment measures for the risk of nutrition-related death. Compared to the other four indexes, the NNPI has the greatest prognostic value for prognosis, and elderly patients with a higher nutritional risk have a poor prognosis, which is helpful in guiding early clinical nutrition intervention.

The traditional surgical technique for esophageal cancer is mainly open esophagectomy. With the innovation of surgical instruments, it is necessary to re-optimize the minimally invasive surgery. Therefore, single-port thoracoscopic minimally invasive esophagectomy (SPTE) is an important direction of development. This study retrospectively analyzed 202 patients with esophageal squamous cell carcinoma undergoing SPTE. Surgical variables and postoperative complications were further evaluated. All procedures were performed using SPTE. The number of patients who received R0 resection was 201 (99.5%). The total number of resected lymph nodes during the whole operation was on average 32.01 ± 12.15, and the mean number of positive lymph nodes was 1.56 ± 2.51. In 170 cases (84.2%), intraoperative blood loss did not exceed 100 ml (ml), while 1 case had postoperative bleeding. Only 1 patient (0.5%) required reoperation after surgery. Postoperative complications included 42 cases of pneumonia (20.8%), 9 cases of anastomotic leak (4.5%), 7 cases of pleural effusion (3.8%), and 1 case (0.5%) of both pleural hemorrhage and acute gastrointestinal hemorrhagic ulcer. Besides, we also recorded the time to remove the drain tube, which averaged 9.13 ± 5.31 days. In our study, we confirmed that the application of SPTE in clinical practice is feasible, and that the postoperative complications are at a low level.

Objective: The differences in the expression levels of differentially-expressed proteins (DEPs) in serum specimens from non-small cell lung cancer (NSCLC) patients presenting with radiation pneumonia (RP) and non-pneumonia at 0, 3, and 6 weeks after ra-diotherapy were compared by a quantitative proteomics approach. This study aims to identify reliable biomarkers for predicting RP.Methods: Twenty-eight patients who were pathologically diagnosed as locally advanced NSCLC and received radiotherapy for the first time from October 2017 to July 2018 were recruited. Serum samples were collected before radiotherapy and 3 and 6 weeks after radiotherapy. Three patients with grade >= 2 RP were assigned into the experimental group (RP group). Three patients with the same sex, pathological type, age, and clinical stage were selected from the remaining 25 patients without RP, and allocated into the control group (C group). DEPs were identified using tandem mass tags (TMT) labeling and liquid chromatography-mass spectrometry, functional annotation, functional enrichment, and protein-protein interaction (PPI) network analyses.Results: 812 quantifiable proteins were identified by mass spectrometry of peptides. Bioinformatics analysis revealed that these proteins were mainly involved in binding, biological regulation, metabolic processes, signaling transduction processes, and per-tussis in the Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway. Using 1.2 times as the threshold for dif-ferential expression change and p < 0.05 as the significance threshold, the expression levels of recombinant zyxin (ZYX) and recombinant fetuin B (FETUB) were up-regulated before radiotherapy and 3 weeks after radiotherapy (both p < 0.05). Recom-binant Cystatin A (CSTA) and calmodulin-like 5 (CALML5) expression levels were down-regulated before radiotherapy and 6 weeks after radiotherapy (both p < 0.05). Nicotinamide nucleotide transhydrogenase (NNT) expression level was significantly down-regulated before radiotherapy and 3 and 6 weeks after radiotherapy, with ratios of 0.296, 0.314 and 0.238, respectively (all p < 0.05). The expression levels of NNT, haptoglobin-related protein (HPR), and pregnancy zone protein (PZP) were significantly down-regulated before radiotherapy, with ratios of 0.296, 0.377 and 0.376, respectively (allp < 0.05). PPI network constructed by STRING database found that fetuin B (FETUB) interacted with PZP among these DEPs, and PZP was associated with the pathophysiological pathways of RP, such as transforming growth factor-beta (TGF-beta), interleukin-1 beta (IL-1 beta), IL-6, tumor necrosis factor (TNF) and inflammatory response-related pathways.Conclusions: Quantitative proteomics analysis identifies the differences in the expression levels of DEPs between NSCLC patients presenting with or without RP throughout radiotherapy. Based on proteomics analysis and PPI network, FETUB and PZP are optimal candidate proteins for RP, which provides evidence for verifying the potential predictive biomarkers of RP.

Dear Editor, Neuropathic pain (NP) is far from effectively treated. The failures are more associated with the emotional, rather than the sensory aspects.1 Therefore, the pain-emotion co-curation is of primary importance.2 Our team revealed the analgesic and antidepressant properties of dihydroartemisinine (DHA) in the spinal cord ligation (SNL) mice;3 clarified that the synergistic regulations of TNFα in the spinal cord (SP) and hippocampus (CA3) may explain for the inhibitions of the C-fiber long-term potentiation (LTP) in the SP and the repairs of CA3 pyramidal neurons; identified heterogeneous nuclear ribonucleoprotein A1 (HnRNPA1) as the binding target of DHA, by which DHA regulate the expression of TNFα (Figure 1A). The analgesic and antidepressant effects were evaluated in the first-line drug pregabalin (PGB,45 mg/kg), duloxetine (DLT, 9 mg/kg) and DHA (H-14.5 mg/kg, M-7.25 mg/kg, L-3.625 mg/kg) groups. Shown by Von Frey tests, the 14-day oral application of DHA attenuated the allodynia behaviors in dose-dependent manner (R2 = 0.8508) (Figure 1C). Within this range, the-L was almost ineffective, the-M was equivalent to PGB, and the-H achieved complete relief. The inhibitions of the central sensitization, shown by the rightwards shifts of curves showing the responses of the C-fiber to the electrical stimulations, were achieved by DHA-H and PGB, as compared with the SNL group (Figure 1C). The antidepressant effects, shown by the decreases of the immobility time in the forced swimming and tail suspension tests, were achieved by DHA-M/H and DLT (Figure 1D). The anxiolytic effects, quantified by the open field test, were achieved by DHA-M/H, but not DLT nor PGB (Sup. 1A). TNFα has been reckoned as one of the prominent drug targets when dealing with NP.4 After 14-day oral given, DHA-H was proved to downregulate the expression of TNFα in both the SP and CA3 of SNL mice (Figure 1E); downregulate TNFα (R2 = 0.7565) (Sup. 1B), attenuate the allodynia (R2 = 0.6052), depressant (R2 = 0.5108, 0.3903) and anxious (R2 = 0.6914) (Sup. 1C) behaviors in mice injected with TNFα in the CA3 in the dose-dependent manner (Figure 1F). Similarly, in mice injected with TNFα in the SP, 10-day oral given of DHA was proved to downregulate TNFα (R2 = 0.4825) (Sup. 1E) and C-fiber transmitter cGRP (R2 = 0.6343), attenuate the allodynia behaviours (R2 = 0.4847) in dose-dependent manners (Figure 1G). TNFα injection in the SP did not induce depression (Sup. 1D). Probe-based chemical proteomics experiments were designed to identify molecules underling DHA-mediated downregulation of TNFα. In BV2 cells, 2μM DHA was proved sufficient to downregulate the lipopolysaccharide (LPS) induced overexpression of TNFα on both mRNA and protein levels (Figure 2A). The AP1 probe, which harbors the core structure and activity of ART,5 was used to label and identify the drug binding proteins (Figure 2B). AP1-fluorescent dye was used to clarify the activity and specificity of probe (Figure 2C); AP1-Biotin was used to label and purify the probe-binding proteins as previously described.6 Among the 333 binding proteins, HnRNPA1 were identified as the top hub by the protein–protein interaction analysis (Sup. 2). The binding between DHA and HnRNPA1 was confirmed by the pull-down and the surface plasmon resonance test (SPR) (Sup. 3). One of the widely acknowledged functions of HnRNPA1 is the degradation of IKBα, which contribute to the maximal activation of the NF-kB dependent transcription of TNFα.7 In BV2 cells and SNL mice (SP and CA3), the DHA-mediated downregulation of HnRNPA1 was proved and companied by the upregulation of IKBα (Figure 2E, H, J, K). The expression of HnRNPA1 is regulated in a precise way. In Bv2 cells, LPS-induced overexpression of HnRNPA1 was proved to be accompanied by the decreases of the mature HnRNPA1 mRNA (E1011 included, Figure 2F). Further decreases of the mRNA containing E1011 were achieved by DHA, as compared with LPS. Further, clarified by the Co-immunoprecipitation assay, the enhancement of the IKBα–NF-kB binding and the weakness of the IKBα–HnRNPA1 binding was found by DHA, as compared with LPS (Figure 2G). The DHA–HnRNPA1 binding may (1) downregulate HnRNPA1 by a negative feedback regulation of E1011 splicing; (2) inhibit the transcription of TNFα by the regulations of both HnRNPA1 transcription and the HnRNPA1–IKBα–NF-kB bindings (Figure 2I). The following experiments were designed to clarify the associations between the downregulations of HnRNPA1 in the CA3/SP and the curations of NP (Figures 3A and 4A). In CA3, HnRNPA1 was downregulated by DHA-L/M, adeno-associated virus (AAV) encoding HnRNPA1 shRNA (A1-AAV), and further downregulated by DHA-L/M-A1-AAV (Figure 3B). In accordance with this, DHA and A1-AAV had synergic effects on the down regulation of TNFα. The expressions of HnRNPA1 and TNFα were strongly associated (R2 = 0.7781, Figure 3B). Shown by the results of the morphological and behavioral tests, the repairs of the CA3 pyramidal neurons and the remissions of the pain-emotion syndromes were achieved by the DHA-L/M and A1-AAV. The joint usage of DHA-M/H-A1-AAV showed better co-curations as compared with the solo DHA and A1-AAV (Figure 3C–E). Similar, AAV encoding HnRNPA1 shRNA (A1-sh) resulted in the downregulation of both HnRNPA1 and TNFα as compared with ones injected with the nonsense shRNA (Non) (Figure 4B). Further, A1-sh resulted in significant downregulations of cGRP (Figure 4C), increases of pain threshold (Figure 4D), and decreases of C-fibre LTP (Figure 4E) as compared with the Non. Shown by the decreases of the immobility time in the tail suspension and forced swimming test as compared with Non, A1-sh were proved to be antidepressant (Figure 4D). In conclusion, findings in this work may contribute to a better understanding of the mechanism underlying DHA mediated co-curation of NP, as well as the roles HnRNPA1 assumed in the pain-emotion comorbidity. Findings point out that the synergic regulations of the neuroinflammation in SP and CA3 may deal with NP on not only the sensory but also the emotional aspects.

BackgroundAcute radiation-induced esophagitis (ARIE) is one of the most debilitating complications in patients who receive thoracic radiotherapy, especially those with esophageal cancer (EC). There is little known about the impact of the characteristics of gut microbiota on the initiation and severity of ARIE. Materials and MethodsGut microbiota samples of EC patients undergoing radiotherapy (n = 7) or concurrent chemoradiotherapy (n = 42) were collected at the start, middle, and end of the radiotherapy regimen. Assessment of patient-reported ARIE was also performed. Based on 16S rRNA gene sequencing, changes of the gut microbial community during the treatment regimen and correlations of the gut microbiota characteristics with the severity of ARIE were investigated. ResultsThere were significant associations of several properties of the gut microbiota with the severity of ARIE. The relative abundance of several genera in the phylum Proteobacteria increased significantly as mucositis severity increased. The predominant genera had characteristic changes during the treatment regimen, such as an increase of opportunistic pathogenic bacteria including Streptococcus. Patients with severe ARIE had significantly lower alpha diversity and a higher abundance of Fusobacterium before radiotherapy, but patients with mild ARIE were enriched in Klebsiella, Roseburia, Veillonella, Prevotella_9, Megasphaera, and Ruminococcus_2. A model combining these genera had the best performance in prediction of severe ARIE (area under the curve: 0.907). ConclusionThe characteristics of gut microbiota before radiotherapy were associated with subsequent ARIE severity. Microbiota-based strategies have potential use for the early prediction of subsequent ARIE and for the selection of interventions that may prevent severe ARIE.

Background and Purpose: Obesity and depression are highly comorbid and far from effective treating. Celastrol was reported useful for obesity, but its role in the obesity-depression comorbidity remains unknown. This study aims to investigate the efficacy and associated mechanism of celastrol in this comorbidity.

Obesity and COVID-19 are both worldwide epidemics now. There may be some potential relationships between them, but little is known. This study was done to explore this relationship through literature search, systematic review, and meta-analysis. Pubmed, Embase, WOS, Cochrane, CNKI, Wanfang, and Sinomed databases were searched to collect literature concerning obesity and COVID-19. Systematic review and meta-analysis were conducted after literature screening, quality assessment, and data extraction. A total of 180 articles were initially searched after duplicate removal, and 9 were finally included in our analysis. Results show that severe COVID-19 patients have a higher body mass index than non-severe ones (WMD = 2.67; 95% CI, 1.52-3.82); COVID-19 patients with obesity were more severely affected and have a worse outcome than those without (OR = 2.31; 95% CI, 1.3-4.12). Obesity may aggravate COVID-19.

This review aimed to evaluate the impact of obesity on the onset, exacerbation, and mortality of coronavirus disease 2019 (COVID-19); and compare the effects of different degrees of obesity. PubMed, EMBASE, and Web of Science were searched to find articles published between December 1, 2019, and July 27, 2020. Only observational studies with specific obesity definition were included. Literature screening and data extraction were conducted simultaneously by two researchers. A random-effects model was used to merge the effect quantity. Sensitivity analysis, subgroup analysis, and meta-regression analysis were used to deal with the heterogeneity among studies. Forty-one studies with 219,543 subjects and 115,635 COVID-19 patients were included. Subjects with obesity were more likely to have positive SARS-CoV-2 test results (OR = 1.50; 95% CI: 1.37-1.63, I-2 = 69.2%); COVID-19 patients with obesity had a higher incidence of hospitalization (OR = 1.54, 95% CI: 1.33-1.78, I-2 = 60.9%); hospitalized COVID-19 patients with obesity had a higher incidence of intensive care unit admission (OR = 1.48, 95% CI: 1.24-1.77, I-2 = 67.5%), invasive mechanical ventilation (OR = 1.47, 95% CI: 1.31-1.65, I-2 = 18.8%), and in-hospital mortality (OR = 1.14, 95% CI: 1.04-1.26, I-2 = 74.4%). A higher degree of obesity also indicated a higher risk of almost all of the above events. The region may be one of the causes of heterogeneity. Obesity could promote the occurrence of the whole course of COVID-19. A higher degree of obesity may predict a higher risk. Further basic and clinical therapeutic research needs to be strengthened.

In recent years, with an increasing number of oncology patients and continuous introduction of new antitumor drugs in China, the demand for oncology clinical pharmacy services is growing rapidly, which is both an opportunity and a challenge for clinical pharmacists. However, there have not been many reports about different types of oncology clinical pharmacy services in China. In this report, we have summarized different oncology clinical pharmacy services commonly practiced in Chinese hospitals based on our review of the literature and current practice in our hospital. We are reporting the training programs and the certification process for oncology clinical pharmacists, basic and advanced patient services, pharmacist-driven and pharmacist-participated guidelines/expert consensuses/books on oncology pharmacotherapy, as well as professional and public health education performed by pharmacists. Based on what we have observed, oncology clinical pharmacy services in China are relatively comprehensive, however, there are needs for expanding certain advanced pharmacy services. Increasing the time spent on clinical services, improving pharmacists' competency, and optimizing clinical pharmacy workflow and evaluation mechanisms are important for enhancing the value of oncology clinical pharmacists in China.

目的 分析总结《新型冠状病毒肺炎疫情期间乳腺癌合理化诊疗指南》线上推广公益项目的经验,为今后其他指南的推广和落实提供重要参考.方法 收集2020年3月20日至2020年4月16日举办的15期指南线上推广公益项目的日程、会议讲者和主持名单、观看人次、观众地域分布、部分观众的单位等相关信息并进行统计分析.结果 15期线上会议的讲者及主持人共66人.共31297人次观看,单场最高观看人次为4338人次.中医药相关场次平均观看人次显著高于非中医药场次(t=2.450,P=0.029).观众来自全国34个省级行政区,覆盖地域为100％.在4685人次的有效单位信息中,来自医院的观众为3877人次(82.8％),涉及224个城市的587家医院.与医务工作者相比,患者较少参加中医药场次的线上项目(χ2=8.131,P=0.004).与工作日场次相比,患者更愿意参加周末场次的线上项目,但二者比较差异无统计学意义(χ2=3.335,P=0.068).结论 本次线上推广活动得到多方的支持和关注,顺利完成预期目标的同时也为后续指南线上推广积累了经验.

目的 探讨"互联网+"时代肿瘤医院新媒体平台的建设运营实践.方法 通过横向统计和纵向对比,详细介绍医院官方网站、微博和微信的运营情况.结果 新媒体平台的建设与运营对医院扩大受众、增强宣传效果、完善信息公开渠道和促进和谐医患关系等工作,均有明显优势.结论 肿瘤专科医院可通过新媒体平台的有效应用和合理布局,推进预防筛查、早诊早治和科研攻关,着力缓解肿瘤这一重大疾病的民生痛点.

To evaluate the clinical efficacy of single administration of Tripterygium Glycosides Tablets(TGT) or combined administration with methotrexate(MTX) against rheumatoid arthritis(RA) based on American College of Rheumatology(ACR) efficacy standard. Six databases, namely CNKI, WanFang, VIP, PubMed, Embase and Cochrane Library, were retrieved for randomized controlled trials(RCT), and clinical trials were screened out according to the preset inclusion and exclusion criteria. Then, the study quality was evaluated by the risk assessment tools. Data extraction and analysis were performed by using RevMan 5.3 software for Meta-analysis. Sensitivity analysis and publication bias analysis were made to test the stability and reliability of results. Until December 2018, a total of 1 709 articles were obtained, and finally 10 clinical RCT studies with a total of 1 184 patients were included. As a result, the single administration of TGT showed a significantly better ACR efficiency(RR=1.31, 95%CI[1.15, 1.49], P<0.000 1) than methotrexate(MTX). The combined administration of TGT and MTX showed a significantly better ACR efficiency(RR=1.28, 95%CI[1.20, 1.38], P<0.000 01) than the single administration of MTX. In conclusion, the single administration of TGT and the combined administration of TGT and MTX were more effective in achieving ACR20, ACR50, ACR70 compliance than the single administration of MTX. Further validations based on more RCT studies with high-quality are required.

To systematically evaluate the effects of Tripterygium Glycosides Tablets alone or in combination with methotrexate(MTX) and leflunomide(LEF) on the levels of pro-inflammatory cytokines in patients or animal models with rheumatoid arthritis(RA), and to provide reference for clinical application and related basic research, this study systematically searched databases of CNKI, VIP, WanFang, PubMed, Embase and Cochrane Library, collected relevant clinical or animal experimental studies, used risk assessment tools to evaluate the quality of research, and used Revman 5.3 software to conduct Meta-analysis or descriptive analysis of the outcome indicators included in the literatures. Of the 1 709 papers retrieved, 3 clinical studies and 12 animal experiments were included. The results showed that compared with MTX alone, Tripterygium Glycosides Tablets combined with MTX could further reduce the expression levels of peripheral blood TNF-α(SMD=-8.88,95%CI[-10.77,-6.99],P<0.000 01),IL-1β(P<0.000 01) and IL-6(SMD=-8.63, 95%CI[-10.57,-6.69], P<0.000 01) in RA patients. Compared with LEF alone, the combination of Tripterygium Glycosides Tablets and LEF could not further reduce the expression levels of TNF-α(P=0.20), IL-1β(P=0.17), IL-6(P=0.31). In RA animal model, compared with model group, Tripterygium Glycosides Tablets could reduce the expression levels of peripheral blood IL-1β(SMD=-6.29,95%CI[-9.64,-2.93],P<0.000 2)in peripheral blood(SMD=-1.39,95%CI[-1.77,-1.02],P<0.000 01), joint fluid(P<0.000 01) and paw plasma(P=0.02), and also reduce the expression levels of TNF-α in RA animal model group. Compared with MTX alone, Tripterygium Glycosides Tablets alone reduced the same levels of TNF-α(P=0.42) and IL-6(P=0.08) in joint fluid, while Tripterygium Glycosides Tablets combined with MTX could further reduce the levels of IL-6(P=0.000 1) in joint fluid; compared with LEF alone, Tripterygium Glycosides Tablets have the similar effects on reducing the expression levels of peripheral blood TNF-α(P=0.16), IL-1β(P=0.32), IL-6(P=0.12), while Tripterygium Glycosides Tablets combined with LEF could further reduce the expression levels of TNF-α(P=0.008), IL-1β(P=0.02), IL-6(P<0.000 1) in peripheral blood. Therefore, Tripterygium Glycosides Tablets combined with MTX could further reduce the expression levels of pro-inflammatory cytokines in peripheral blood of RA patients. Tripterygium Glycosides Tablets alone could reduce the expression levels of pro-inflammatory cytokines in peripheral blood and local joint of RA animal models. Tripterygium Glycosides Tablets combined with MTX or LEF could further reduce the express levels of pro-inflammatory cytokines in peripheral blood of RA animal models. Due to the limitation of literature, this conclusion needs to be further validated.

随着我国医药卫生体制改革的不断深入开展与改进,新一轮医改已全面开展,全民健康的目标对医疗卫生机构的院务公开工作提出了更高的要求.全文通过对中国医学科学院肿瘤医院院务公开工作现状的分析,结合其工作实际,对医院院务公开工作创新的具体实践及改进进行讨论.不断创新与提高医院院务公开管理水平,可督促医院各部门院务公开工作的推进与改善,将院务公开纳入绩效考核可以提高医院对院务公开的重视程度,从而不断改善医疗服务,增强医院民主建设,有利于促进医院长远发展.

目的:针对原发性肝细胞癌(HCC)肿瘤分级预测难题,提出一种基于灰阶超声成像的影像组学预测模型.方法:首先,由超声医生对肿瘤区域进行手动分割,其次,采用影像组学方法对肿瘤区域提取形状、一阶统计、纹理特征,计算特征间Pearson相关系数剔除冗余特征,最后通过单变量分析筛选得到特征子集,采用LASSO构建HCC分级预测模型;利用留一法计算模型的受试者操作特性曲线下的面积(AUC)评估模型对HCC分级的预测能力.结果:利用43例经手术病理证实的HCC患者的灰阶超声图像构建HCC分级预测模型,所建模型由6个与分级高度相关的影像特征组成,模型具有较强的预测能力(AUC=0.76).结论:基于灰阶超声成像的影像特征与HCC分级高度相关,所建影像组学模型能够较好地预测HCC分级.