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The 2023 American Society of Clinical Oncology Genitourinary (ASCO-GU) Cancers Symposium reported on the research progress in the field of precision diagnosis and evaluation, molecular detection, clinical treatment, and exploration of new drugs/mechanisms for prostate cancer. This article interprets and reviews important studies to help clinical treatment decisions.
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Objective:To investigate the safety and efficacy of individualized sunitinib schedule for patients with metastatic renal cell carcinoma (mRCC) according to the monitoring results of plasma drug concentration.Methods:The clinical data of patients with mRCC who received sunitinib treatment in our center from January 2014 to December 2020 were retrospectively analyzed, including 20 patients who underwent monitoring of plasma drug concentration (monitoring group), and 45 patients, matched by propensity score matching, received sunitinib but did not undergo monitoring of plasma drug concentration during the same period (unmonitored group). In the monitoring group, there were 12 males and 8 females. The mean age was 52.9 years, and ECOG score ≤1 in 16 cases (80%). Three patients were in the IMDC favorable-risk group, 15 patients were in the intermediate-risk group, and 2 patients were in the high-risk group. There were 18 cases of clear cell carcinoma and 2 cases of non-clear cell carcinoma, 5 cases of ISUP grade 1-2 and 11 cases of grade 3-4. In the unmonitored group, there were 31 males and 14 females. The mean age was 57.7 years, and 30 patients had ECOG score ≤1, 15 cases ≥2. There were 10 cases in IMDC favorable-risk group, 23 cases in intermediate-risk group, and 12 cases in high-risk group. Thirty-seven cases were clear cell carcinoma and 8 cases were non-clear cell carcinoma, 8 cases were in ISUP grade 1-2 and 28 cases in grade 3-4. There were no statistically significant differences between the two groups in the above parameters ( P>0.05). The monitoring group used the regimen of taking sunitinib for 4 weeks and stopping for 2 weeks (4/2 week) in the first cycle. The blood concentration of sunitinib was monitored before the first cycle and on days 4, 7, 10, 14, 21 and 28, and personalized medication plan was formulated according to the curve of the blood concentration. The 4/2 week scheme was adopted in the undetected monitoring group.The two groups were compared in the incidence of adverse events (AEs), progression-free survival (PFS), overall survival (OS), tumor treatment response and other clinical outcomes. Results:In the monitoring group, 90% (18/20) of patients receiving sunitinib had a steady-state plasma concentration of more than 150ng/ml, of which 10 patients (50%) had a plasma concentration of 150-200 ng/ml and 8 patients (40%) had a plasma concentration of more than 200 ng/ml. Meanwhile, all patients with plasma concentration higher than 150 ng/ml developed severe AEs (grade 3 and above) after treatment. The other two patients' plasma concentration were 100-150 ng/ml, and did not have severe AEs.All patients in the monitoring group received individualized medication schedule adjustment according to the plasma drug concentration and the occurrence point of severe AEs, ensuring that the peak plasma drug concentration was maintained at about 100-150 ng/ml. Among them, 6 patients were changed to take 2 weeks and stop for 1 week (2/1 week schedule), 4 patients were changed to take 10 days and stop for 5 days (10/5 d schedule), 7 patients were changed to take 7 days and stop for 3 days (7/3 d schedule), and 3 patients were changed to take 5 days and stop for 2 days (5/2 d schedule). The incidence of severe AEs significantly decreased from 90% (18/20) to 35% (7/20), and the difference was statistically significant ( P=0.003), while the incidence of grade 3 and higher AEs was 55.6% (25/45) in the standard group, which was statistically significant compared with the incidence of severe AEs before adjustment in the monitoring group ( P=0.006). Further analysis of the efficacy difference between the two groups showed that the overall objective response rate in the monitoring group (40%, 8/20) was higher than that in the standard group (20%, 9/45), although the difference was not statistically significant ( P=0.09). Median PFS and OS were significantly longer in the monitored group than in the standard group (PFS: 23 vs. 10 months, P=0.002; OS: not reached vs.25 months, P=0.005). Conclusions:The bioavailability of sunitinib is high in mRCC patients, which may lead to higher plasma drug concentration, adjustment of medication regimen based on blood concentration monitoring significantly improved patient safety and clinical outcomes. However, further validation by larger-scale, multi-center and prospective studies is needed.
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ObjectiveTo explore the impact of COVID-19-related stress on the social adaptation of college students， and to analyze and compare the mediating effects of patience and social support. MethodsStratified cluster sampling method was applied to enroll 3 219 college students， and they were assessed using the COVID-19-related Stress Questionnaire， Social Adaptation Inventory （SAI）， Patience Questionnaire （PQ） and Social Support Rating Scale （SSRS）， thereafter， the mediating effect was assessed via the SPSS Process macro. ResultsCollege students' COVID-19-related Stress Questionnaire score were positively correlated with the scores of PQ and SSRS （r=0.297， 0.229， P<0.01）， and negative correlated with SAI score （r=-0.430， P<0.01）. PQ and SSRS scores were positively correlated with SAI score （r=0.374， 0.283， P<0.01）. PQ score was positively correlated with SSRS score （r=0.271， P<0.01）. Patience partially mediated the relationship between COVID-19-related stress and social adaptation （β=0.049， 95% CI： 0.039~0.062）. Meanwhile， social support also partially mediated the relationship between COVID-19-related stress and social adaptation （β=0.016， 95% CI： 0.009~0.025）. ConclusionCOVID-19-related stress exerts a negative impact on college students' social adaptation ability， while the impact is mediated by patience and social support， and the mediation effect of patience is more significant.
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Objective:To evaluate the impact of metastatic site on the prognosis in patients with metastatic renal cell carcinoma (mRCC), and it′s value for modifying the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria.Methods:The data of 218 patients pathologically diagnosed with mRCC were analyzed retrospectively in West China Hospital from Jan. 2009 to Dec. 2019. Among all patients, 71.6%(156/218) were male, and 89.0% (194/218) underwent nephrectomy. Most of the patients were pathologically diagnosed with renal clear cell carcinoma (176 patients, 80.7%). Lung (137/218, 62.8%) was the most observed metastatic site, following by bone (47/218, 26.1%), lymph node (37/218, 17.0%) and liver (23/218, 10.6%). All patients were classified into favorable (26 patients, 11.9%), intermediate (126 patients, 57.8%) or poor (37 patients, 17.0%) risk group according to IMDC criteria. Endpoints of this study were progression-free survival (PFS), overall survival (OS) and tumor response. The impact of metastatic sites on patients’ prognosis was analyzed, and those that had significant relationship with prognosis were then added into IMDC criteria and a modifying IMDC model was established. Predictive value of this model was further evaluated by calculating concordance index (C-index).Results:In the whole cohort, median PFS and OS were 13.0 and 33.0 months. Survival analysis suggested that patients with bone ( P=0.004), brain ( P=0.042) and liver ( P=0.046) had significantly shorter OS. Thus, patients were divided into two groups: patients with bone/brain/liver metastasis (82 patients, 37.6%) and patients with other metastatic sites (136 patients, 62.4%). Compared with patients with other metastatic sites, those who with bone/brain/liver metastasis had inferior tumor response by TKIs treatment (disease control rate: 51.2% vs. 73.5%, P=0.004). Multivariate analysis suggested that bone/brain/liver metastasis had negative impact on OS (25.0 vs. 47.0 mo, P=0.039). Furthermore, bone/brain/liver metastasis also showed significant relationship with shorter OS in IMDC low (30.0 vs. 62.0 months, P=0.036), intermediate (31.0 vs. 48.0 months, P=0.048) or high (7.0 vs. 18.0 months, P=0.037) risk group, indicating that metastatic site had predictive value for prognosis of mRCC patients. Based on that, bone/brain/liver metastasis were added into the IMDC criteria, and weighting each parameter was weighted according to its coefficient to patients’ OS. Finally, a modified IMDC scoring system were established. C-index of this modified model was 0.669 (0.599 for current IMDC criteria). Conclusions:Bone/brain/liver metastasis in mRCC patients indicated a shorter OS duration. When adding bone/brain/liver metastasis as a predictive parameter for prognosis of mRCC patients into IMDC criteria, the modified IMDC criteria could offer more accurate prediction for patients’ survival.
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Objective To analyze the clinical characteristics of patients with metastatic carcinoma of bone. Methods The clinical data of 217 patients with metastatic carcinoma of bone was retrospectively analyzed. The clinical features were summarized,including primary tumor,age distribution,first symptom,time of onset and bone metastatic site. Visual analogue scale(VAS)was used to evaluate the difference of pain in patients with bone metastases before and after zoledronic acid treatment. Results The bone metastasis occurred more frequently in men(male:female = 1.28:1). The majority of primary tumors were lung cancer(51.61％)and breast cancer (15.67％),respectively. The peak ages of the patients with metastatic carcinoma of bone were between 50 and 70 years old. Most of the patients with metastatic carcinoma of bone initially showed varying degrees of pain ,some of the patients with dysfunction,pathological fracture,or local lumps as the initial symptoms,only a tiny minority of patients were inadvertently found. Onset time was often within 3 months ,which accountings for 54.84％. Bone metastases were mostly in the spine,pelvis,femur and ribs,and most of the bone metastases were multiple. The VAS score of 108 patients who with bone metastases pain treated by zoledronic acid was 0～4(1.31 ± 1.07),with statistically significant differences compared with pretherapy(P<0.01). Conclusion In order to reduce the pain of patients,and to improve the quality of life and prolong the survival time,bone metastases should be diagnosed early and given comprehensive treatment.
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Objective To analyze the clinical characteristics of patients with metastatic carcinoma of bone. Methods The clinical data of 217 patients with metastatic carcinoma of bone was retrospectively analyzed. The clinical features were summarized,including primary tumor,age distribution,first symptom,time of onset and bone metastatic site. Visual analogue scale(VAS)was used to evaluate the difference of pain in patients with bone metastases before and after zoledronic acid treatment. Results The bone metastasis occurred more frequently in men(male:female = 1.28:1). The majority of primary tumors were lung cancer(51.61％)and breast cancer (15.67％),respectively. The peak ages of the patients with metastatic carcinoma of bone were between 50 and 70 years old. Most of the patients with metastatic carcinoma of bone initially showed varying degrees of pain ,some of the patients with dysfunction,pathological fracture,or local lumps as the initial symptoms,only a tiny minority of patients were inadvertently found. Onset time was often within 3 months ,which accountings for 54.84％. Bone metastases were mostly in the spine,pelvis,femur and ribs,and most of the bone metastases were multiple. The VAS score of 108 patients who with bone metastases pain treated by zoledronic acid was 0～4(1.31 ± 1.07),with statistically significant differences compared with pretherapy(P<0.01). Conclusion In order to reduce the pain of patients,and to improve the quality of life and prolong the survival time,bone metastases should be diagnosed early and given comprehensive treatment.
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Objective To investigate the clinical efficacy of mind-regulating and kidney-reinforcing acupuncture in treating attention deficit hyperactivity disorder (ADHD).Methods Fifty-six patients with attention deficit hyperactivity disorder were randomly allocated to treatment and control groups, 28 cases each. The treatment group received mind-regulating and kidney-reinforcing acupuncture and the control group, conventional acupuncture, for a total of 28 days. The American Connell children’s ADHD behavior diagnostic scale and the Chinese version of ADHD SNAP-IV scale-parent form were used as evaluating indicators. The total efficacy rates were compared between the two groups of patients.Results The total efficacy rate was 96.4% in the treatment group and 71.4% in the control group; there was a statistically significant difference between the two groups (P<0.05). There were statistically significant pre-/post-treatment differences in the American Connell children’s ADHD behavior diagnostic scale score and the Chinese version of ADHD SNAP-IV scale-parent form score in the two groups (P<0.05). There were statistically significant post-treatment differences in the American Connell children’s ADHD behavior diagnostic scale score and the Chinese version of ADHD SNAP-IV scale-parent form score between the treatment and control groups (P<0.05). Conclusion Mind-regulating and kidney-reinforcing acupuncture is an effective way to treat attention deficit hyperactivity disorder.
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BACKGROUND: Dexmedetomidine has been shown to fight against ischemia/reperfusion injury induced by tourniquets. OBJECTIVE: To study the effects of dexmedetomidine on the oxidative stress and inflammatory damage caused by tourniquet-induced ischemia/reperfusion injury. METHODS: Seventy-six patients scheduled for lower limb operation were randomized into two groups: patients in dexmedetomidine group were given the intravenous injection of 1 μg/kg dexmedetomidine for 10 minutes, followed by 0.5 μg/kg?h until the end of operation; while the controls were subjected to 0.9% saline injection at an equivalent velocity and volume. The levels of serum propanediol, lactic dehydrogenase, superoxyde dismutase, tumor necrosis factor-α, interleukin-6 and -8 were detected before tourniquet inflation, 10, 60 and 120 minutes after tourniquet release. RESULTS AND CONCLUSION: In both two groups, the serum levels of propanediol, lactic dehydrogenase, tumor necrosis factor-α, interleukin-6 and -8 after tourniquet release were significantly higher and the serum superoxide dismutase level was significantly lower than those before tourniquet inflation (P < 0.05). Compared with the control group, dexmedetomidine significantly reduced the serum levels of propanediol, lactic dehydrogenase, tumor necrosis factor-α, interleukin-6 and -8, and increased the serum superoxyde dismutase level after tourniquet release (P < 0.05). These results suggest that dexmedetomidine can attenuate the oxidative stress and inflammatory damage resulting from tourniquet-induced ischemia/reperfusion injury probably by up-regulating the serum superoxyde dismutase level, and down-regulating the serum levels of propanediol, lactic dehydrogenase, tumor necrosis factor-α, interleukin-6 and -8.
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BACKGROUND:Total hip arthroplasty is usualy taken to cure patients with ankylosing spondylitis combined with affected hip, to increase their life quality. But, its effects on sagittal balance of the spine-pelvis are not wel known. OBJECTIVE:To analyze the effects of total hip arthroplasty on sagittal balance of the spine-pelvis and life quality in patients with ankylosing spondylitis combined with affected hip. METHODS: Clinic data of 47 consecutive patients with ankylosing spondylitis combined with affected hip who had total hip arthroplasty and were folowed up for more than one year after operation from December 2008 to December 2013 were retrospectively analyzed. The spine-pelvis sagittal balancing parameters were measured. According to the SF-36 questionnaire, the dimensional scores were calculated to assess the life quality. Pearson correlation analysis was performed to analyze the correlation between the balancing parameters and SF-36 scores pre-operation, and the change of the balancing parameters and SF-36 scores pre- and post-operation were analyzed. RESULTS AND CONCLUSION:According to the data before total hip arthroplasty, sagittal vertical axis was negatively correlated with physiological function, body pain and vitality. Total kyphosis was negatively correlated with physiological function and general health. Lumbar lordosis was positively correlated with physiological function. Pelvic tilt angle was negatively correlated with the vitality and social function. Pelvic incident angle was negatively correlated with body pain, vitality and emotional role. No significant correlation was shown between sacral inclination angle and SF-36 items. After total hip arthroplasty, lumbar lordosis and sacral inclination angles were significantly increased, while sagittal vertical axis and pelvic tilt angle were significantly decreased compared with those before surgery. Total kyphosis and pelvic incident angle showed no significant differences before and after surgery. The SF-36 scores al got a statisticaly significant increase. Results showed that, sagittal vertical axis, total kyphosis, lumbar lordosis, pelvic incident angle and pelvic tilt angle are the potential factors influencing the life quality in patients with ankylosing spondylitis combined with affected hip. The total hip arthroplasty, which induces a better sagittal balance with an increased lumbar lordosis and sacral inclination angle, and a decreased sagittal vertical axis and pelvic tilt angle, can result in better life quality.
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Objective To investigate the feasibility and safety of day surgery holmium:YAG laser lithotripsy for urinary tract calculi.Methods A total of 294 cases of urinary tract calculi were treated with ureteroscopic holmium:YAG laser lithotripsy from October 2010 to September 2011.There were 147 cases for day surgery and 147 cases for inpatient surgery group.The time of waiting to be admitted,success rate,operative time,intraoperative and postoperative complications,hospitalization costs were analyzed in each group.Results The mean operative time of the day surgery group and the inpatient surgery group was 46.4± 16.5 and 52.1± 18.3 min.The difference in the mean operative time between the two groups was not statistically significant (P＞0.05).The stone free rate was not statistically significant between the day surgery group (95.9％) and the inpatient surgery group (92.5％,P＞0.05).The complication rate of the day surgery group was slightly lower than the inpatient surgery group (5.0％ VS 5.4％),but the differences between the two groups was not statistically significant (P＞0.05).The mean time of waiting to be admitted of the day surgery group was statistically shorter than the inpatient surgery group(2.5±1.3d VS 7.6±3.6 d,P＜0.05).Patients in the day surgery groups spent statistically less money than patients in the inpatient surgery group (5433.4 VS 8612.9,P＜0.05).Conclusions Day surgery for ureteroscopic holmium:YAG laser lithotripsy could be safe with lower costs and incidence of postoperative complications,faster postoperative recovery.Pre-operative adequately and selecting appropriate patients are helpful to reduce and control of intraoperative and postoperative complications.
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OBJECTIVE@#To evaluate urinary dynamics in the diagnosis, differential diagnosis, disease grades, complications, prognosis, and curative effect on benign prostatic hyperplasia (BPH) patients accompanied with diabetic mellitus (DM), and to investigate the clinical significance of urodynamic studies.@*METHODS@#A total of 106 BPH patients with lower urinary tract symptoms were studied, aged 53-92(63.21+/-7.18) years. The mean duration of voiding symptoms was 3-12 years. These patients were divided into 2 groups: Group A consisted of 59 BPH patients while Group B consisted of 47 BPH patients combined with DM. Both groups were evaluated the international prostate symptom score(IPSS), urine flow rate, and residual urine volume. All patients underwent urodynamic examination. Correlation analysis was conducted to determine the correlation among the patients. The urodynamic results in different groups were compared.@*RESULTS@#The IPSS in Group A was higher than Group B, while the Qmax was lower than Group B. The unsatisfactory results of Group A was higher than Group B. There was significant difference between the 2 groups (P0. 05). There was significant difference between the 2 groups in detrusor instability of the bladder, low compliance bladder, and damaged detrusor function (P<0.05).@*CONCLUSION@#The influence of DM on the function of the bladder in BPH patients is significant. Urodynamics can provide objective basis for the selection of therapeutic methods, and forecast the postoperative effect. It has an important reference value in BPH patients accompanied with DM.
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Aged , Aged, 80 and over , Humans , Male , Middle Aged , Diabetes Complications , Prostatic Hyperplasia , Urinary Bladder , UrodynamicsABSTRACT
Objective: To observe the clinical effect of treating remission-stage cerebral infarction with mind-refreshing and orifice-opening needling method. Method: Six hundred cases of cerebral infraction were randomized on the basis of disease phase. The 234 cases in remission stage were randomized into treatment group (116 cases) and control group (118 cases). Besides routine Western therapies, the cases in the treatment group were combined mind-refreshing and orifice-opening needling method and the cases in the control group were combined with conventional needling method. The treatment was done once every day for 4 weeks. The follow-up was done for six months. Result: the baseline material in the two groups has good compatibility (P>0.05) and the treatment group is better than the control group (P<0.05). Conclusion: the mind-refreshing and orifice-opening method is safe and act to improve symptoms of patients during remission stage, reduce disability, prevent disease progression and improve quality of life.
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Objective To experiment the use of allodecellular skin extracellular matrix for the replacement of urethral. Methods Skin extracellular matrix was obtained from 2 dogs by decellularization process.18 experimental dogs were used and a 4 cm segment of urethral was resected in each.In the experimental group of 15 dogs,the resected urethral was replaced by the allo skin ECM.In the control group of 3 dogs,the resected urethral was replaced by allograft transplantation of untreated skin.The neourethral segment was studied with ecectronmicroscopy and immunohistochemical procedures. Results In the experiment animals,urothelial and monocytes could be seen in the ECM area and fully filled up the area after 6 weeks.The histological structure was not much different with a normal urethra.In the control group with allograft transplantation,rejection and necrosis occurred 8～10 days after the transplantation.On the basis of the experiment,skin ECM has been successfully used in clinical practice for 2 patients. Conclusions Alloskin ECM may be an ideal tissue engineering material for the replacement of urethral.
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50%).RT-PCR results were classified as positive and negative according to the presence or absence of corresponding electrophoretic bands. Results Immunohistochemically,integrin ?2 and ?3 subunits were all expressed strongly in 12 cases of normal bladder tissues (100%).In 53 cases of BTCC tissues,?2 was strongly positive in 10 cases (19%),positive in 22(42%),negative in 21(40%);?3 was strongly positive in 16 (30%),positive in 24 (45%),negative in 13(25%).The expressions of ?2 and ?3 were significantly different between normal and BTCC tissues ( P 0.05).RT-PCR results showed that ?3 expression was positive in all normal tissues (100%) and in 36 (68%) out of the 53 cases of BTCC tissues;the difference was significant ( P 0.05),but ?3 mRNA positive expression was significantly related to clinical stages [T is ～T 1:83%(19/23),T 2～T 4:57%(17/30); P