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Current Medical Science 2023年第1期43卷 173-183页

作者： Sha LV Jia-tian YUAN Qi-wei XIE Shi-xiong TANG Yao-wen WANG Department of Otolaryngology Ningbo First HospitalNingbo315000China

Objective To investigate the etiology,clinical characteristics,diagnosis,and treatment strategies and efficacy of pulsatile tinnitus(PT)caused by vascular anatomy abnormality.Methods The clinical data of 45 patients with PT in our hospital from 2012 to 2019 were collected and retrospectively analyzed.Results All 45 patients had vascular anatomical abnormalities.The patients were divided into 10 categories according to the different locations of vascular abnormalities:sigmoid sinus diverticulum(SSD),sigmoid sinus wall dehiscence(SSWD),SSWD with high jugular bulb,pure dilated mastoid emissary vein,aberrant internal carotid artery(ICA)in the middle ear,transverse-sigmoid sinus(TSS)transition stenosis,TSS transition stenosis with SSD,persistent occipital sinus stenosis,petrous segment stenosis of ICA,and dural arteriovenous fistula.All patients complained of PT synchronous with heartbeat rhythm.Endovascular interventional therapy and extravascular open surgery were used according to the location of the vascular lesions.Tinnitus disappeared in 41 patients,was significantly relieved in 3 patients,and was unchanged in 1 patient postoperatively.Except for one patient with transient headache postoperatively,no obvious complications occurred.Conclusion PT caused by vascular anatomy abnormalities can be identified by detailed medical history and physical and imaging examination.PT can be relieved or even completely alleviated after appropriate surgical treatments.

关键词： pulsatile tinnitus vessel structural abnormity etiology treatment strategy efficacy

Pathophysiological consequences and treatment strategy of obstructive jaundice

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World Journal of Gastrointestinal Surgery 2023年第7期15卷 1262-1276页

作者： Jun-Jian Liu Yi-Meng Sun Yan Xu Han-Wei Mei Wu Guo Zhong-Lian Li Department of Hepatobiliary and Pancreatic Surgery Tianjin Medical University Nankai HospitalTianjin 300102China Graduate School Tianjin Medical UniversityTianjin 300070China Graduate School Tianjin University of Traditional Chinese MedicineTianjin 301617China

Obstructive jaundice(OJ)is a common problem in daily clinical practice.However,completely understanding the pathophysiological changes in OJ remains a challenge for planning current and future management.The effects of OJ are widespread,affecting the biliary tree,hepatic cells,liver function,and causing systemic complications.The lack of bile in the intestine,destruction of the intestinal mucosal barrier,and increased absorption of endotoxins can lead to endotoxemia,production of proinflammatory cytokines,and induce systemic inflammatory response syndrome,ultimately leading to multiple organ dysfunction syndrome.Proper management of OJ includes adequate water supply and electrolyte replacement,nutritional support,preventive antibiotics,pain relief,and itching relief.The surgical treatment of OJ depends on the cause,location,and severity of the obstruction.Biliary drainage,surgery,and endoscopic intervention are potential treatment options depending on the patient's condition.In addition to modern medical treatments,Traditional Chinese medicine may offer therapeutic benefits for OJ.A comprehensive search was conducted on PubMed for relevant articles published up to August 1970.This review discusses in detail the pathophysiological changes associated with OJ and presents effective strategies for managing the condition.

关键词： Jaundice Obstructive Pathophysiology treatment strategy Traditional Chinese medicine

Incidence rate and treatment strategy of immune checkpoint inhibitor mediated hepatotoxicity:A systematic review

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Cancer Pathogenesis and Therapy 2023年第1期1卷 46-55页

作者： Kang Miao Li Zhang Department of Pulmonary and Critical Care Medicine Peking Union Medical Collage HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China

Background A hepatic adverse event(HAE)is defined as a liver injury that occurs following immune checkpoint inhibitor(ICI)administration in oncology Patients.Immune-mediated hepatotoxicity(IMH)is a type of HAE directly caused by ICI and is associated with immune system hyperactivation.HAE incidence varies across different clinical studies.This study aimed to explore the risk factors of HAE and establish a personalized IMH treatment strategy.Methods Randomized controlled trials(RCTs)on ICIs and case reports related to IMH were collected and summarized separately.Meta-analysis was performed using Review Manager(version 5.0),whereas correlation analysis and linear regression were performed using SPSS(version 24.0)to evaluate any correlations between the two variables.Results Overall,36 RCTs containing 18,515 patients and 39 case reports met our inclusion criteria.The ICI administration increased the HAE risk(risk ratio[RR]=1.40)as well as severe HAE(RR=2.55).The overall HAE incidence and severe incidence were about 15.3%and 4.3%,respectively.Cytotoxic T-lymphocyte-associated protein 4(CTLA-4)inhibitors have a higher incidence of HAE than programmed cell death protein 1(PD-1)and programmed death-ligand 1(PD-L1)inhibitors.Finally,we found a positive correlation between the onset time of IMH and the recovery time of liver injury.Conclusions ICI administration increased the incidence risk of HAE,especially in patients treated with CTLA-4 inhibitors.Regarding IMH treatment,the glucocorticoid dosage must be individually reduced according to the severity and onset time of HAE.

关键词： Immune checkpoint inhibitor Hepatotoxicity treatment strategy Systematic review

Clinical relevance of fluorodeoxyglucose positron emission tomography/computed tomography and magnifying endoscopy with narrow band imaging in decision-making regarding the treatment strategy for esophageal squamous cell carcinoma

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World Journal of Gastroenterology 2019年第46期25卷 6767-6780页

作者： Kazuhiro Toriyama Masahiro Tajika Tsutomu Tanaka Makoto Ishihara Yutaka Hirayama Sachiyo Onishi Nobumasa Mizuno Takamichi Kuwahara Nozomi Okuno Shinpei Matsumoto Eiichi Sasaki Tetsuya Abe Yasushi Yatabe Kazuo Hara Keitaro Matsuo Tsuneo Tamaki Yasumasa Niwa Department of Gastroenterology Aichi Cancer Center HospitalNagoya 464-8681Japan Department of Endoscopy Aichi Cancer Center HospitalNagoya 464-8681Japan Department of Gastroenterology Anjo Kosei HospitalAnjo 446-8602Japan Department of Pathology and Molecular Diagnostics Aichi Cancer Center HospitalNagoya 464-8681Japan Department of Gastroenterological Surgery Aichi Cancer Center HospitalNagoya 464-8681Japan Division of Cancer Epidemiology and Prevention Aichi Cancer Center Research InstituteNagoya 464-8681Japan East Nagoya Imaging Diagnosis Center Nagoya 464-0044Japan

BACKGROUND Recent advances in endoscopic technology,especially magnifying endoscopy with narrow band imaging(ME-NBI)enable us to detect superficial esophageal squamous cell carcinoma(ESCC),but determining the appropriate method of resection,endoscopic resection(ER)vs surgical resection,is often challenging.Recently,several studies have reported that 18F-fluorodeoxyglucose positron emission tomography(FDG-PET)is a useful indicator for decision-making regarding treatment for superficial ESCC.Although,there are not enough reports on association between FDG-PET uptake and clinicopathological characteristics of superficial ESCC.And,there are not enough reports on evaluating the usefulness of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.This study evaluated clinical relevance of FDG-PET and ME-NBI in decision-making regarding the treatment strategy for ESCC.AIM To investigate the association between FDG uptake and the clinicopathological characteristics of superficial ESCC and its usefulness of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.METHODS A database of all patients with superficial ESCC who had undergone both MENBI and FDG-PET for pre-treatment staging at Aichi Cancer Center Hospital between January 2008 and November 2018 was retrospectively analyzed.FDG uptake was defined positive or negative whether the primary lesion was visualized or could be distinguished from the background,or not.The invasion depth of ESCC was classified according to the Japan Esophageal Society.Primary endpoint is to evaluate the association between FDG uptake and clinicopathological characteristics of superficial ESCC.Secondary endpoint is to investigate the efficacy of combination of FDG-PET and ME-NBI for determining the treatment strategy for superficial ESCC.RESULTS A total of 82 lesions in 82 patients were included.FDG-PET showed positive uptake in 29(35.4%)lesions.Univariate analysis showed that uptake of FDG-PET had significant corr

关键词： ^18F-fluorodeoxyglucose positron emission tomography Magnifying endoscopy Narrow band imaging Superficial esophageal cancer Squamous cell carcinoma treatment strategy

treatment strategy for Post-Hepatectomy Recurrent Hepatocellular Carcinoma: A Single Center Experience with 556 Consecutive Cases in China

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Journal of Cancer Therapy 2020年第7期11卷 389-400页

作者： Jing Li Liang Huang Caifeng Liu Maixuan Qiu Jianjun Yan Shaohua Wei Yiqun Yan Department of General Surgery The Second Affiliated Hospital of Soochow University Suzhou China Department of Hepatic Surgery Shanghai Eastern Hepatobiliary Surgery Hospital Shanghai China

Background: treatment strategy for recurrent hepatocellular carcinoma (HCC) remains scantily defined. This study was aimed to establish a treatment strategy to manage post-hepatectomy recurrent HCC and report the clin... 详细信息

Background: Treatment strategy for recurrent hepatocellular carcinoma (HCC) remains scantily defined. This study was aimed to establish a treatment strategy to manage post-hepatectomy recurrent HCC and report the clinical outcomes. Methods: From January 2006 to December 2016, 556 consecutive patients who developed post-hepatectomy HCC recurrence were enrolled in the study. The patients were clinically stratified and treated according to a strategy established by a multi-disciplinary team. Clinical data and survival times were collected prospectively and analyzed retrospectively. Results: According to the strategy, there were 298 (53.6%), 214 (38.5%), 32 (5.7%) and 12 (2.2%) patients stratified into Early, Intermediate, Advanced and Terminal stages, respectively. In Early stage patients, 164 (55.0%) received curative treatment in the form of repeat resection or local ablation, 134 (45.0%) received transarterial chemoembolization (TACE), and the 1-, 3-, and 5-year overall survival (OS) rates were 82.0%, 46.8% and 37.3%, respectively. In Intermediate stage patients, 207 (96.7%) received TACE, 7 (3.3%) radiotherapy, and the 1-, 3-, and 5-year OS rates were 73.2%, 31.8% and 15.9%, respectively. In Advanced stage patients, 22 patients received sorafenib, 10 radiotherapy, and the mean survival time (MST) was 25.1 ± 3.1 months. All the 12 patients in Terminal stage received the best supportive treatment, and the MST was 6.5 ± 3.4 months. Clinical stages and duration of disease-free interval were independent factors relating to overall survival. Conclusions: A treatment strategy de

关键词： Post-Hepatectomy Recurrent Hepatocellular Carcinoma Clinical Classification treatment strategy Clinical Outcomes

Study on the treatment strategy of Batches of the Wounded and Partial First-Aid Procedures in Public Emergencies in Tertiary General Hospitals

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Open Journal of Emergency Medicine 2021年第2期9卷 25-31页

作者： Chenyu Wang Xiantao Huang Xueping Zhao Limin Pan Yumei Jia Tian Tian Lijun Gao The First Affiliated Hospital of Hebei North University Zhangjiakou China Medical Administration Division Director of Health Committee of Hebei Province Shijiazhuang China

Objective: The purpose is to formulate treatment strategies of batches of the wounded and partial first-aid procedures, and further improve the emergency rescue capability of hospitals. Methods: This study analyzed the emergency treatment case that we participated in. In this case, we used various means to start the emergency plan, run the emergency procedures, optimize diagnosis, treatment, and rescue procedures, mobilize medical rescue resources, provide a reference for emergency command decisions, formulate a set of coping strategies of tertiary general hospitals on public emergencies. Results: Through the scientific and effective management of our hospital, 20 wounded have been discharged from the hospital and achieved the ideal effect of zero deaths in the hospital. Conclusions: The new mode of first-aid and health emergency management on the scene of modern disaster needs to find ways to minimize the loss of life and property brought by public emergencies, integrate the various sections of modern disaster medicine, integrate a large number of international and domestic basic and clinical research achievements of disaster first-aid, and upgrade to information, digital system.

关键词： Public Emergency Batches of the Wounded treatment strategy First-Aid Procedure

Rare tumors: a blue ocean of investigation

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Frontiers of Medicine 2023年第2期17卷 220-230页

作者： Shuhang Wang Peiwen Ma Ning Jiang Yale Jiang Yue Yu Yuan Fang Huilei Miao Huiyao Huang Qiyu Tang Dandan Cui Hong Fang Huishan Zhang Qi Fan Yuning Wang Gang Liu Zicheng Yu Qi Lei Ning Li Clinical Trial Center National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Phase I Clinical Trial Center Fujian Medical University Cancer Hospital/Fujian Cancer HospitalFuzhou 350014China Key Laboratory of Molecular Epigenetics of the Ministry of Education Northeast Normal UniversityChangchun 130024China GenePlus-Shenzhen Shenzhen 518118China

Advances in novel drugs,therapies,and genetic techniques have revolutionized the diagnosis and treatment of cancers,substantially improving cancer patients’prognosis.Although rare tumors account for a non-negligible number,the practice of precision medicine and development of novel therapies are largely hampered by many obstacles.Their low incidence and drastic regional disparities result in the difficulty of informative evidence-based diagnosis and subtyping.Sample exhaustion due to difficulty in diagnosis also leads to a lack of recommended therapeutic strategies in clinical guidelines,insufficient biomarkers for prognosis/efficacy,and inability to identify potential novel therapies in clinical trials.Herein,by reviewing the epidemiological data of Chinese solid tumors and publications defining rare tumors in other areas,we proposed a definition of rare tumor in China,including 515 tumor types with incidences of less than 2.5/100000 per year.We also summarized the current diagnosis process,treatment recommendations,and global developmental progress of targeted drugs and immunotherapy agents on the status quo.Lastly,we pinpointed the current recommendation chance for patients with rare tumors to be involved in a clinical trial by NCCN.With this informative report,we aimed to raise awareness on the importance of rare tumor investigations and guarantee a bright future for rare tumor patients.

关键词： rare tumors diagnosis flowchart treatment strategy clinical trials recommendation

treatment of advanced non-small cell lung cancer with driver mutations: current applications and future directions

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Frontiers of Medicine 2023年第1期17卷 18-42页

作者： Jia Zhong Hua Bai Zhijie Wang Jianchun Duan Wei Zhuang Di Wang Rui Wan Jiachen Xu Kailun Fei Zixiao Ma Xue Zhang Jie Wang State Key Laboratory of Molecular Oncology Department of Medical OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China

With the improved understanding of driver mutations in non-small cell lung cancer (NSCLC), expanding the targeted therapeutic options improved the survival and safety. However, responses to these agents are commonly temporary and incomplete. Moreover, even patients with the same oncogenic driver gene can respond diversely to the same agent. Furthermore, the therapeutic role of immune-checkpoint inhibitors (ICIs) in oncogene-driven NSCLC remains unclear. Therefore, this review aimed to classify the management of NSCLC with driver mutations based on the gene subtype, concomitant mutation, and dynamic alternation. Then, we provide an overview of the resistant mechanism of target therapy occurring in targeted alternations (“target-dependent resistance”) and in the parallel and downstream pathways (“target-independent resistance”). Thirdly, we discuss the effectiveness of ICIs for NSCLC with driver mutations and the combined therapeutic approaches that might reverse the immunosuppressive tumor immune microenvironment. Finally, we listed the emerging treatment strategies for the new oncogenic alternations, and proposed the perspective of NSCLC with driver mutations. This review will guide clinicians to design tailored treatments for NSCLC with driver mutations.

关键词： non-small cell lung cancer driver mutations treatment strategy resistant mechanism immune-checkpoint inhibitors

Is adjuvant chemotherapy necessary for early gastric cancer?

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Cancer Biology & Medicine 2022年第4期19卷 518-532页

作者： Yu Mei Tienan Feng Min Yan Zhenggang Zhu Zhenglun Zhu Department of General Surgery Shanghai Key Laboratory of Gastric NeoplasmsShanghai Institute of Digestive SurgeryRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China Clinical Research Institute Shanghai Jiao Tong University School of MedicineShanghai 200025China

Objective:To quantify the potential benefit of adjuvant chemotherapy(ACT)with respect to survival,and to identify factors for predicting prognoses in early gastric cancer patients.Methods:Patients with pT1 gastric cancer(GC)who underwent radical resection with D2 lymphadenectomy were retrospectively analyzed.Based on lymph node metastasis(LNM)status and treatment regimens,patients were classified into groups,and clinicopathological variables,overall survival(OS),and disease-specific survival(DSS)were compared.Results:Of 1,050 enrolled patients,151 patients(14.4%)had a positive LNM status.Submucosal invasion,undifferentiated state,tumor size>2 cm,ulceration,and lymphovascular invasion were independent risk factors for LNM using multivariate analyses.The 5-year OS of all patients was 96.4%.HER2 positive,perineural invasion,and LNM were independent factors for worse survival.Patients with pT1N3 GC had a worse 5-year OS and DSS than pT1N0,pT1N1,and pT1N2 patients(Ptreatments.For pT1N3 patients,7(36.8%)received S-1,while 12(63.2%)received Xelox treatment.Patients receiving Xelox treatment showed a better 5-year OS(75.0%vs.14.3%)and DSS(81.8%vs.20.0%)than patients receiving S-1(P<0.05).Conclusions:Curative surgery only was adequate for patients with pT1N0 and pT1N1.Xelox showed no survival benefits for pT1N2 patients.Therefore,S-1 is the optimal choice for pT1N2 patients,when considering adverse effects.Xelox is recommended for pT1N3 patients.

关键词： Early gastric cancer adjuvant chemotherapy treatment strategy

A 10-year change of the diagnosis and treatment strategy of primary immune thrombocytopenia among Chinese hematologists

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A 10-year change of the diagnosis and treatment strategy of ...