Anti-vascular endothelial growth factor (VEGF) drugs, including monoclonal antibodies (such as bevacizumab and ranibizumab) and fusion protein agents (such as aflibercept and conbercept) have been clinically proven to be effective to treat exudative age-related macular degeneration AMD). However, there are still some patients do not or poorly respond to the initial anti-VEGF agents, usually after several injections, ophthalmologists may switch to another anti-VEGF agent. In general, switching of anti-VEGF agent is considered for recurrent AMD, AMD resistance to anti-VEGF treatments. Current switching protocols include the replacement of monoclonal antibodies with fusion protein agents, the replacement of fusion protein agents with monoclonal antibodies, the substitution of one monoclonal antibody with another one, and the replacement of monoclonal antibodies with fusion protein agents and switching back with monoclonal antibodies. However, current researches on the switching of anti-VEGF drugs for exudative AMD are mostly retrospective and single-arm studies, and there are some differences in the results of different studies. Therefore, for patients with exudative AMD who do not respond to or respond poorly to anti-VEGF drugs, the efficacy of switching of anti-VEGF drugs is uncertain right now. Switching of anti-VEGF agents may improve the retinal anatomical outcome of the affected eye but may not necessarily improve visual acuity. Thus it is an option in the clinical practice to treat AMD. To determine the benefits of above mentioned switching regimens, randomized controlled clinical trials with large sample number and long study period will be needed.
ObjectiveTo investigate the value of serum soluble CD146 (sCD146) in determining acquired epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) resistance in lung adenocarcinoma.MethodsA total of 144 lung adenocarcinoma EGFR sensitive patients in People’s Hospital of Zhengzhou University diagnosed from January 2016 to December 2016 were recruited in the study. According to the different time of taking drugs, the patients were divided into a non-medication group (31 cases), a 1 to 3 month treatment group (25 cases), a 4 to 6 month treatment group (19 cases), a 7 to 12 month treatment group (25 cases), a drug-resistant group (24 cases), and a nonresistant group up to 1 year of treatment (20 cases). The serum levels of sCD146, carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) were measured by ELISA and chemiluminescence and compared between different period of medication. The relationship of serum sCD146 with tumor markers (CEA, NSE) and tumor related clinical parameters (age, gender, tumor stage, metastasis, tumor diameter, number of the lesions) were analyzed.ResultsThe serum sCD146 level was minimum in the non-medication group that did not receive pioglitazone treatment, highest in the 1 to 3 month treatment group (early treatment period), and declined with duration of medication until resistance occurred without significant difference (P>0.05). The level of sCD146 of the drug-resistant group was significantly lower than that of all nonresistant groups, with significant difference (allP<0.05), but still higher than that of the non-medication group (P<0.05). The serum sCD146 levels in the nonresistant patients with medication over 1 year and within 1 year were similar (P>0.05), and significantly higher than the non-medication group and drug-resistance group (allP<0.05). The serum CEA levels did not differ significantly between 6 groups (P>0.05). The serum NSE level of the 4 to 6 month treatment group was lower than that of the 7 to 12 month treatment group (P<0.05), but both in the normal reference range. The NSE levels did not differ in any other groups (P>0.05). Serum sCD146 was associated with metastasis (P<0.05), but not associated with serum CEA or NSE, nor with sex, age, tumor staging, tumor diameter or lesion number (allP>0.05).ConclusionsCD146 may be involved in the mechanism of TKI killing tumor cells and the mechanism of TKI resistance, and may be a serological marker for monitoring the efficacy of TKI and judging the resistance of TKI.
In recent years, there has been a growing emphasis on use of human adipose-derived stem cells (hADSCs)for cartilage tissue engineering owing to their ability to differentiate into chondrocytes, which is mainly induced by growth factors (GFs). In general, GFs for chondrogenic induction come from the transforming growth factor β (TGF-β) superfamily. To date, the most commonly used GFs for chondrogenes is TGF-β1/3. However, the response of hADSCs to GFs may differ significantly from that of human bone marrow stem cells (hBMSCs). It has been reported that bone morphogenetic protein-6 (BMP-6) treatment induced TGF-β receptor-Ⅰ expression of hADSCs. It seems that these two cell populations varied strongly in their potency to undergo chondrogenesis in the same medium conditions. Here, we provide a concise review on various GFs used in chondrogenic differentiation of hADSCs in vitro.
Objective To summarize the recent progress in the research on the mechanism and treatment of lung metastasis of hepatocellular carcinoma, in order to provide reference for clinical workers to systematically treat patients with lung metastasis of hepatocellular carcinoma, guarantee their survival and improve their quality of life. Method The literatures about mechanism and clinical treatment of lung metastasis of hepatocellular carcinoma in recent years were reviewed. Results At home and abroad, there was no unified treatment standard for patients with lung metastasis of hepatocellular carcinoma. For patients with early metastasis, some scholars proposed resection of the metastasis, or ablation, radiotherapy and other methods for the metastatic site. For patients with advanced lung metastasis, systematic therapy was used. Conclusions The treatment effect is not ideal due to the limitations of few clinical studies, low level of evidence and complex disease mechanism, and there is no unified treatment standard. Therefore, in view of the differences between patients and the specific reality in clinical treatment, personalized treatment is implemented.
RoB2 (revised version 2019), an authoritative tool for assessing the risk of bias in randomized controlled trials, has been updated and improved based on the original version. This article elaborated and interpreted the background and main content of RoB2 (revised version 2019), as well as the operation process of the new software. Compared with the previous version of RoB2 (revised version 2018), RoB2 (revised version 2019) has the advantages of rich content, complete details, accurate questions, and simple operation, etc. Additionally, it is more user-friendly for researchers and beginners. The risk bias assessment of randomized controlled trials is more comprehensive and accurate, and it is an authoritative, trustworthy, and popular tool for evaluating the risk of bias in randomized controlled studies in medical practice.
【摘要】 目的 总结2例特重烧伤患者在ICU的救治经验和体会，旨在进一步提高特重烧伤患者的救治水平。 方法 回顾分析2009年6月2例重症烧伤患者的诊治经过程和临床资料。 结果 1例患者病情好转，转出ICU继续治疗，1例患者伤后37 d因消化道出血死亡。 结论 特重烧伤患者的治疗需要整体计划和多科协作。【Abstract】 Objective To summarize the experiences of the management of two patients with severe burn, so as to improve the treatment of severe burn patients. Method Treating processes and clinical data of two patients with severe burn in June 2009 were analyzed retrospectively. Result After prompt treatments, one patient died of severe bleeding in the digestive tract 37 days after the burn and the other patient recovered and left ICU for further treatment. Conclusion Bundle treatment and multi-subject cooperation are important for treating patients with severe burn.
Objective To systematically review the diagnostic value of 18F-FDG PET/CT in recurrent epithelial ovarian cancer after treatment. Methods The PubMed, EMbase, Cochrane Library, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect diagnostic tests of 18F-FDG PET/CT for epithelial ovarian cancer from inception to February 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Meta-Disc 1.4 and Stata 15.0 software. Results A total of 15 studies involving 792 patients were included in this study. The results of meta-analysis showed that the sensitivity, specificity, and area under the curve of 18F-FDG PET/CT in the diagnosis of recurrent epithelial ovarian cancer were 0.88 (95%CI 0.85 to 0.90), 0.80 (95%CI 0.75 to 0.85) and 0.91, respectively. The results of the subgroup analysis showed that the sensitivity of the prospective studies was the same as that of the retrospective studies, but the specificity of the prospective studies was higher than that of the retrospective studies. The diagnostic sensitivity and specificity of 18F-FDG PET/CT in recurrent epithelial ovarian cancer were higher in Asian studies than in European/North American studies. Conclusion 18F-FDG PET/CT has high diagnostic value in recurrent epithelial ovarian cancer. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo review the current status and progress of surgical methods for inducing hepatic volume hyperplasia. MethodThe procedures inducing liver volume regeneration in clinical practice, including portal vein embolization, liver venous deprivation, Yttrium-90 selective internal radiation therapy, and associating liver partition and portal vein ligation for staged hepatectomy were reviewed and summarized. ResultsAll kinds of surgical methods to induce liver volume hyperplasia could effectively stimulate the increase in liver volume, which could provide more surgical opportunities for patients with too small future liver remnant, but there were differences in the degree of trauma, proliferation efficiency and popularization and acceptance. ConclusionsAll kinds of operations provide new hope for patients with too little residual liver volume after operation, and have good application scenarios. However, at present, there is no unified opinion on the comparison between the advantages and disadvantages of each operation and the best indication, which needs further study.