Objective:. Despite radical resection, postoperative recurrence of nonfunctional pancreatic neuroendocrine tumors (NF-PanNETs) remains common, particularly among high-risk patients. This study evaluates the adjuvant therapeutic potential of Qizhen Yiliu Formula (QZYL) in a multicenter real-world cohort. Methods:. We retrospectively analyzed patients with NF-PanNETs treated at 5 tertiary centers in China between 2010 and 2022. Patients were divided into QZYL and control groups based on receipt of QZYL as postoperative adjuvant therapy. Baseline differences were adjusted using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) sensitivity analysis. Three hundred and eighty-five eligible patients were analyzed, with 112 matched pairs. Results:. QZYL treatment was associated with longer recurrence-free survival (RFS) compared with controls (median: 78.0 vs 71.9 months; hazard ratio [HR] = 0.60, P = .027), with higher 24-, 36-, and 60-month RFS rates (90.92% vs 80.36%, 86.14% vs 70.07%, 64.97% vs 55.56%, respectively). Subgroup analyses demonstrated trends favoring QZYL across high-risk strata (Ki-67 index 10%–20%, tumor size ≥4 cm, lymph node metastasis, and pathological invasion), although statistical significance varied between PSM and IPTW analyses. Among patients receiving other adjuvant therapies, QZYL use was associated with improved outcomes (HR = 0.56, P = .070). Safety analysis indicated that QZYL did not increase the overall incidence of adverse events (P = .847) and was associated with a lower incidence among patients receiving other adjuvant therapies (P = .010). Conclusions:. QZYL use was associated with a reduced risk of postoperative recurrence in patients with high-risk NF-PanNET, suggesting its role in postoperative management. Prospective validation is warranted.

Background: Thymic neuroendocrine tumors (Th-NETs) are rare and aggressive, with a scarcity of research on predicting patient prognosis. Our study aimed to assess the impact of prognostic markers and temozolomide (TMZ)-based chemotherapy on survival in Th-NETs. Methods: We retrospectively reviewed the medical records of patients diagnosed with Th-NETs between 2013 and 2023 at our institution. We collected clinicopathological data, including tumor pathological grading, staging, serum concentrations of neuron-specific enolase (NSE) and pro-gastrin-releasing peptide, levels of inflammatory factors, and expression of oxygen 6-methylguanine-DNA methyltransferase (MGMT). Treatment details (such as surgery and chemotherapy) and survival outcomes were also documented. Results: A total of 32 patients were included in our study after excluding those without complete available information. The median progression-free survival (PFS) was 12.5 months (95%CI, 8–16 months) for 19 patients who received TMZ-based chemotherapy. Twenty-one patients underwent surgery as the primary treatment, demonstrating a median disease-free survival (DFS) of 51.0 months. The inflammatory factor neutrophil-to-lymphocyte ratio (NLR) was an independent prognostic indicator of DFS in postoperative patients and PFS in TMZ-treated patients. The overall 3-, 5-, and 10-year survival rates were 86.6%, 69.5%, and 33.8%, respectively. Ki67 level exceeding 10% (p = 0.048) and absence of surgical resection (p = 0.003) were significantly associated with worse overall survival (OS). Conclusion: Surgical treatment was currently the primary method for treating Th-NETs, and postoperative adjuvant therapy was an essential consideration for specific patient cohorts. Despite widespread positive MGMT expression, TMZ-based chemotherapy showed promise. Some potential prognostic biomarkers such as NLR and NSE need more attention.

Hematological indicators of chronic systemic inflammation are significant biomarkers for gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs). We performed a systematic review and meta-analysis to assess the impact of certain factors on the overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) of patients with GEP-NENs. These factors include the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and C-reactive protein (CRP) levels. After searching the Medline, Embase, and Cochrane Library databases from January 1, 2000 to October 20, 2022 and the American Society of Clinical Oncology conference proceedings from January 1, 2017, hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted. Subgroup analyses were conducted to identify the origins of heterogeneity and examine the impact of factor grouping. The effects of the cut-off values and sample size were assessed by meta-regression. The results revealed that higher NLRs, PLRs, and CRP levels were associated with shorter OS (HR = 2.09, 95% CI = 1.55-2.8; HR = 1.79, 95% CI = 1.40-2.28; and HR = 2.88, 95% CI = 2.09-3.95, respectively; all p < 0.001). Higher NLRs and lower LMRs were associated with shorter DFS (HR = 3.34, 95% CI = 2.11-5.29 and HR = 2.71, 95% CI = 2.27-3.24, respectively; both p < 0.001). Higher PLRs and CRP levels were correlated with shorter PFS (HR = 3.48, 95% CI = 1.34-9.03, p = 0.01 and HR = 3.14, 95% CI = 1.63-6.08, p = 0.001). As demonstrated in the research, hematological indicators of systemic inflammation are promising biomarkers for GEP-NEN assessment.

目的 基于数据挖掘探讨国家专利数据库的中药复方治疗胰腺癌的用药规律.方法 通过中国专利公布公告网站检索建库至2022年5月治疗胰腺癌的中药复方专利,使用Excel软件建立复方数据库,运用古今医案云平台、IBM SPSS Modeler及IBM SPSS Statistics软件将规范后的数据进行用药规律分析.结果 共纳入治疗胰腺癌的中药复方专利55项,包含中药426味.药性以寒、温为主;药味以苦、甘、辛为主;归经以肝、脾、肺为主;高频单味药有白花蛇舌草、甘草、白术、延胡索、半枝莲、当归、薏苡仁、柴胡等.常用药对是白术-甘草、白花蛇舌草-半枝莲等;关联分析获得药物组合27个;高频药物聚类分析获得3个核心药物组合.结论 中药复方专利治疗胰腺癌有规律可循,组方寒温并用,调和肝脾,以扶正固本,解毒抑瘤为基本治法.

目的:探讨芪贞抑瘤方对胰腺神经内分泌肿瘤(pNETs)根治性切除术后患者3年无复发生存的影响.方法:回顾性分析随访资料完整的181例Ⅰ～Ⅳ期pNETs术后患者临床资料,以是否接受累积≥6个月的芪贞抑瘤方治疗分为中药组(79例)和对照组(102例).采用Kaplan-Meier法绘制生存曲线,Log-rank法检验2组患者的无复发生存期(RFS)和第1、2、3年的累积无复发生存率的差异,采用多因素Cox风险比例模型确定RFS的独立影响因素.结果:中药组1、2、3年累积无复发率依次为93.4％、82.2％、71.5％,3年中位RFS未达到;对照组依次为 89.2％、78.2％、67.1％,3 年中位 RFS 为 31.0 个月(95％CI:24.416,37.584),2 组差异有统计学意义(P＜0.05).中药治疗是影响RFS的独立保护因素(P＜0.05),较对照组能降低复发转移风险(HR=0.488,95％CI:0.298,0.799).在病理分级为G1、G2,或临床分期为Ⅱ期的患者中,中药治疗有显著的优势(P＜0.05).结论:芪贞抑瘤方在降低pNETs根治术后患者复发转移风险、延长无复发生存时间方面可能有一定作用.

目的:目前针对抑郁症的随机对照试验(RCT)中普遍使用汉密尔顿量表(HAMD)评价抑郁程度.本研究旨在调查该评分细节报告的完整性,尤其是研究者对研究结果解释中临床意义的重视程度.方法:检索2020年10月至2022年10月发表于国家知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)、临床试验注册系统(ChiCTR)、PUBMED、Cochrane、EMBASE、Web of Science、PROQUEST共9个数据库的以"针刺治疗抑郁症"为主题并报告HAMD结果的RCT.2名研究者独立提取了各研究对HAMD评分的报告细节以及对结果临床意义的报告和解释.结果:共检索到符合标准的RCT91项,超过95％的文献报道了均值、标准差及P值,但仅有3.3％的文献报道95％置信区间.93.4％的文献直接或间接地报道了HAMD值所代表的意义,73.6％报道了HAMD量表类型,19.8％文献报道HAMD的总分,34.1％的文献报道了HAMD具体的评价方法.统计学意义的报道在75％以上,纳入文献均报道了临床意义,但临床意义的解读仅基于统计学意义,并未结合临床实际有效值来判定.组间比较结果显示,学位论文各项报道的百分比均高于普通文献.国外研究报道的完整性普遍高于国内文献.结论:针刺治疗抑郁症随机对照试验的中文文献HAMD评分报道尚且不够完整.建议研究者在试验报告中参考高质量RCT结果,更详细地描述评分类指标的细节、合理解读其临床意义,以提高结局指标报道的质量.

目的 对针刺治疗抑郁症的随机对照试验(RCT)进行二次分析,探讨研究者主观偏好对非药物疗法临床试验结果的影响.方法 系统检索中国知网中针刺治疗抑郁症的RCT.将原始研究中与不治疗或西药对照的常规针刺组定义为"试验针刺组",而与其他非药物治疗或特殊手法对照的常规针刺组定义为"对照针刺组".采用1:1的比例匹配的方法将抑郁类型、汉密尔顿抑郁量表(HAMD)类型、针刺治则、受试者年龄等非常相似的"试验针刺组"和"对照针刺组"进行匹配重组,比较其组间疗效差异.再分别计算所有纳入研究中"试验针刺组"和"对照针刺组"各自治疗前后的疗效差异,将此差异进行对比分析.Meta分析均使用RevMan5.3软件进行.结果 共纳入63项RCT,匹配后得到13项"新的研究".配对研究结果表明,"试验针刺组"和"对照针刺组"之间HAMD差异具有统计学意义(HAMD-17差异为2.95分,HAMD-24差异为5.55分).未进行匹配的二次分析也发现两组HAMD-17和HAMD-24的差异均有统计学意义(P＜0.05).结论 常规针刺在研究中的分组(试验组或对照组)不同,其缓解抑郁的效果也不同,这表明在未采用盲法时研究者主观偏好会影响针刺临床试验的结果.

Gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN) is a rare, heterogeneous tumor that can be divided into neuroendocrine tumor (NET) and neuroendocrine carcinoma (NEC) due to its degree of differentiation. With the gradual deepening of the exploration of its pathogenesis and treatment methods, the importance of preclinical models has become increasingly prominent. Here we reviewed the published preclinical models such as cell lines, organoid models, patient-derived xenograft models and genetically engineered mouse models. We also discussed the current practical applications of these models and their strengths and weaknesses, to provide threads and directions for future research.

Background To evaluate the possibility and impact of performance and detection bias in randomized controlled trials due to lack of the blinding method. MethodsTrials assessing acupuncture for depression published by March 2020 were searched from China National Knowledge Infrastructure database. Through matching, we reassembled the trials of comparing experimental acupuncture and control acupuncture. Meta-analysis with post-treatment HAMD (Hamilton Depression Scale) of the newly reassembled trials was conducted. Changes of HAMD of all included groups were also analyzed, the between groups difference was then analyzed by t-test. All statistical analyses were performed using RevMan 5.3 software. ResultsThirteen pairs of studies were matched from 63 included trials. Re-analysis from the paired studies showed obvious difference of HAMD scales between the experimental and control acupuncture (Mean Difference was -2.95 for HAMD-17, -5.55 for HAMD-24). Re-analysis from all the included groups also showed the statistical difference between groups at four weeks of HAMD-17 (P=0.01), and four/six weeks of HAMD-24 (P<0.01).Conclusion Effectiveness of acupuncture for decreasing the severity of depression was superior in trials that considered acupuncture as experimental treatment, showing performance and detection bias caused by the absence of blinding method is of great significance in acupuncture trials.

BACKGROUND Hepatitis B virus (HBV) infection, a liver disease caused by hepatitis B virus, may lead to serious complications such as cirrhosis and hepatocellular carcinoma. People with HBV infection may have co-infections including HIV and other hepatitis viruses (hepatitis C or D), and co-infection may increase the risk of all-cause mortality. Chronic HBV infection increases morbidity and psychological stress and is an economic burden on people with chronic hepatitis B and their families. Radix Sophorae flavescentis, an herbal medicine, is administered most often in combination with other drugs or herbs. It is believed that it decreases discomfort and prevents replication of the virus in people with chronic hepatitis B. However, the benefits and harms of Radix Sophorae flavescentis for patient-centred outcomes are not known, and its wide usage has never been established with rigorous review methodology. OBJECTIVES To assess the benefits and harms of Radix Sophorae flavescentis versus placebo or no intervention in people with chronic hepatitis B. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE Ovid, Embase Ovid, LILACS, Science Citation Index Expanded, Conference Proceedings Citation Index - Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data, and SinoMed. We also searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp), ClinicalTrials.gov (www.clinicaltrials.gov/), and the Chinese Clinical Trial Registry for ongoing or unpublished trials. We conducted the last search in December 2018. SELECTION CRITERIA We included randomised clinical trials, irrespective of publication status, language, or blinding, comparing Radix Sophorae flavescentis versus no intervention or placebo in people with chronic hepatitis B. We excluded polyherbal blends containing Radix Sophorae flavescentis. We allowed co-interventions when the co-interventions were administered equally to all intervention groups. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. Review authors in pairs retrieved data from individual published reports and after correspondence with investigators. Our primary outcomes were all-cause mortality, serious adverse events, and health-related quality of life. Our secondary outcomes were hepatitis B-related mortality, hepatitis B-related morbidity, and adverse events considered 'not to be serious'. We presented meta-analysed results as risk ratios (RRs) with 95% confidence intervals (CIs). We assessed risk of bias using domains with pre-defined definitions. We conducted Trial Sequential Analyses to control the risk of random errors. We used GRADE methodology to evaluate our certainty in the evidence (i.e. "the extent of our confidence that the estimates of the effect are correct or are adequate to support a particular decision or recommendation"). MAIN RESULTS We included 35 randomised clinical trials with 3556 participants. One trial compared Radix Sophorae flavescentis with placebo; the remaining 34 trials compared effects of Radix Sophorae flavescentis in addition to a co-intervention versus the same co-intervention. The included trials assessed heterogenous forms and ways of administering Radix Sophorae flavescentis (e.g. oral capsules, oral tablets, intravenous infusion, intramuscular injection, acupoint (a specifically chosen site of acupuncture) injection) with treatment duration of 1 to 24 months. Two of the trials included children up to 14 years old. Participants in two trials had cirrhosis in addition to chronic hepatitis B. All trials were assessed at high risk of bias, and certainty of the evidence for all outcomes was very low.Only one of the 35 trials assessed mortality; no deaths occurred. Ten trials assessed serious adverse events; no serious adverse events occurred. None of the trials reported health-related quality of life, hepatitis B-related mortality, or morbidity. Adverse events considered 'not to be serious' was an outcome in 19 trials; nine of these trials had zero events in both groups. Radix Sophorae flavescentis versus placebo or no intervention showed no difference in effects on adverse events considered 'not to be serious' (RR 1.10, 95% CI 0.76 to 1.59; I² = 49%; 10 trials, 1050 participants). Radix Sophorae flavescentis showed a reduction in the proportion of participants with detectable HBV-DNA (RR 0.61, 95% CI 0.55 to 0.68; I² = 56%; 29 trials, 2914 participants) and in the proportion of participants with detectable HBeAg (hepatitis B e-antigen) (RR 0.71, 95% CI 0.66 to 0.76; I² = 19%; 20 trials, 2129 participants).Seven of the 35 randomised clinical trials received academic funding from government or hospital. Four trials received no funding. The remaining 24 trials provided no information on funding.Additionally, 432 trials lacked the methodological information needed to ensure inclusion of these trials in our review. AUTHORS' CONCLUSIONS The included trials lacked data on health-related quality of life, hepatitis B-related mortality, and hepatitis B-related morbidity. The effects of Radix Sophorae flavescentis on all-cause mortality and on the proportion of participants with serious adverse events and adverse events considered 'not to be serious' remain unclear. We advise caution in interpreting results showing that Radix Sophorae flavescentis reduced the proportion of people with detectable HBV-DNA and detectable HBeAg because the trials reporting on these outcomes are at high risk of bias and both outcomes are non-validated surrogate outcomes. We were unable to obtain information on the design and conduct of a large number of trials; therefore, we were deterred from including them in our review. Undisclosed funding may influence trial results and may lead to poor trial design. Given the wide usage of Radix Sophorae flavescentis, we need large, unbiased, high-quality placebo-controlled randomised trials in which patient-centred outcomes are assessed.