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Brain metastasis is a common complication of non-small cell lung cancer (NSCLC) patients. About 25%-55% of patients with NSCLC will develop brain metastases, and the occurrence of brain metastasis predicts a poor prognosis. Traditionally, radiotherapy, chemotherapy, targeted therapy and surgery are the main treatment options for NSCLC patients with brain metastases. In recent years, with the emergence of immune checkpoint inhibitors (ICI), the survival of NSCLC patients with brain metastases has been significantly improved. This article reviews the research progress of ICI treatment for NSCLC patients with brain metastases in order to provide new treatment strategies.
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As an important tumor driver gene, epidermal growth factor receptor (EGFR) gene plays an important role in the development and progression of non-small cell lung cancer (NSCLC). As the latest generation of EGFR-tyrosine kinase inhibitor (TKI) drugs, osimertinib has brought significant therapeutic efficacies and encouraging results both in patients with sensitive EGFR mutations and patients with rare EGFR mutations. Compared with previous EGFR-TKI drugs, osimertinib has strong blood-brain barrier penetration, which can effectively prevent the occurrence of lung cancer brain metastasis. After the resistance of first and second generation of targeted drugs, osimertinib is still effective in the follow-up treatment process. This article reviews the characteristics of EGFR mutation, the action mechanism of osimertinib, and the latest progress of osimertinib in treatment of EGFR mutations in NSCLC.
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Objective:To investigate the feasibility and safety of transvaginal natural orific transluminal endoscopic surgery(vNOTES)in elderly women with adnexectomy.Methods:Using a prospective randomized controlled study method, 90 patients with benign ovarian tumors who met the study inclusion criteria and were treated in the Department of Gynecology of Beijing Hospital from January 2019 to December 2021 were randomly assigned to the experimental group(vNOTES group)according to 1∶1.The conventional laparoscopy group(CL group)and the control group underwent ovarian cystectomy.Preoperative baseline conditions, surgical success rate, operation time, intraoperative blood loss, postoperative complications, visual analogue scale(VAS)within 24 hours and one week after operation, postoperative scar score, and postoperative sexual function score were compared between the two groups.and other related data.Results:The operation of 90 patients was successfully completed, and there was no intraoperative and postoperative complications.There were no significant differences in preoperative general condition, operation time, intraoperative blood loss, health status score and sexual function evaluation between the two groups( P>0.05).The peak airway pressure of mechanical ventilation(21.9±1.8)cmH 2O(1 cmH 2O=0.098 kPa), end-expiratory CO 2 partial pressure(36.6±1.4)mmHg(1 mmHg=0.133 kPa), postoperative exhaust time(8.8±1.7)h, and VAS pain score within 24 hours after surgery(1.3±1.2 points)and scar scores at 1 month, 3 months and 6 months after surgery(1.7±1.1、0.4±0.3、0.0±0.0)were all lower than the control group(29.7±2.6)cmH 2O; (39.9±2.0)mmHg; (21.9±2.7)h; 4.6±2.8、6.5±2.0、4.0±1.6、2.5±1.0), ( P<0.01). 6 months after the operation, the health condition score of the experimental group(124.8±10.6)was higher than that of the TL group.(119.9±10.7)points( P<0.05). Conclusions:For elderly women, transvaginal laparoscopic adnexectomy is safe and feasible, with unique advantages such as less impact on cardiopulmonary function, less pain, less scarring, and faster physical recovery.It is a more minimally invasive method of surgery.It can be used as a surgical modality for adnexectomy in older women.
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Malignant pleural mesothelioma (MPM) is a malignant tumor with strong invasiveness, low survival rate and lack of effective treatment options. As the only first-line treatment plan for the advanced MPM, combination of pemetrexed and cisplatin chemotherapy have been existing since the last 20 years. Immunotherapy has long been considered as a potential treatment plan for MPM, mainly including immune checkpoint inhibitors (ICIs), immunotoxin therapy, anti-cancer vaccine and adoptive T-cell therapy. This review focuses on summarizing the current research status of immune checkpoint inhibitors in MPM, discusses the effect of tumor heterogeneity on ICIs treatment, and describes that the biomarker-oriented immunotherapy is a new vision for the realization of individualized treatment of MPM. .
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Pulmonary neuroendocrine tumors (PNETs) are a kind of epithelial tumors originating from pulmonary neuroendocrine cells, accounting for about 20% of primary lung tumors, including typical carcinoid, atypical carcinoid, small cell carcinoma, and large cell neuroendocrine carcinoma. The morphologic and clinical characteristics of these four types of PNETs are relatively highly heterogeneous. Immune checkpoint inhibitors (ICIs) have been shown robust antitumor activity in a variety of solid tumors. Treatment regimens of advanced PNETs have developed greatly in the past decade, but ICIs are still in their infancy in the field of PNETs. This review focuses on the landscape of current clinical trials and research as well as the situation of ICIs-related biomarkers in PNETs. .
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Humans , Carcinoid Tumor , Carcinoma, Neuroendocrine , Immune Checkpoint Inhibitors , Lung Neoplasms/drug therapy , Neuroectodermal Tumors, Primitive , Neuroendocrine Tumors/drug therapyABSTRACT
Objective:To investigate the effect of optimized construction of green channel under plan-do-check-action (PDCA) on shortening the door-to-needle time (DNT) and improving early neurological improvement in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis.Methods:The clinical data of 120 patients with AIS treated with intravenous thrombolysis from June 2018 to September 2019 in Liangxiang Teaching Hospital of Capital Medical University were retrospectively analyzed. Among them, 60 patients were admitted to hospital before optimized as non-optimized group, and 60 patients were admitted to hospital after optimized as optimized group. The time from visit to CT examination completion, time from CT examination completion to informed consent, time from informed consent to intravenous thrombolysis, DNT, DNT ≤ 60 min ratio, National Institutes of Health stroke scale (NIHSS) score 2 h after intravenous thrombolysis and at discharge from hospital, early neurological improvement (ENI) rate, hospital stays, adverse outcomes and mortality were compared between 2 groups.Results:The time from CT examination completion to informed consent and DNT in optimized group were significantly shorter than those in non-optimized group: 29 (14, 36) min vs. 37 (21, 54) min, 55 (45, 67) min vs. 76 (54, 93) min, the DNT ≤ 60 min ratio was significantly higher than that in non-optimized group: 68.3% (41/60) vs. 35.0% (21/60), the ENI rate was significantly lower than that in non-optimized group: 28.3% (17/60) vs. 46.7% (28/60), and there were statistical differences ( P<0.05 or<0.01). There were no statistical differences in the time from visit to CT examination completion, time from informed consent to intravenous thrombolysis, NIHSS score 2 h after intravenous thrombolysis, hospital stays, NIHSS score at discharge from hospital, adverse outcomes rate and mortality between 2 groups ( P>0.05). Conclusions:The optimized construction of green channel under PDCA can effectively shorten the DNT of intravenous thrombolysis in patients with AIS, and may be significantly important for improving the long-term prognosis of patients.
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In recent years,immunotherapy has gradually become a new treatment method of neoplasms,and the patients with solid tumors can benefit from immunotherapy.Immunotherapy has also been used in the treatment of non-small cell lung cancer (NSCLC),which shows a remarkable effect.At present,programmed death 1 (PD-1) and programmed death ligand 1 (PD-L1) inhibitors have achieved obvious effects in the treatment of NSCLC.With the continuous study of clinical trials,immunosuppressants have obtained indications in the first-line and second-line treatment of advanced NSCLC.This new treatment changes the treatment mode of lung cancer,and it also brings challenges for the treatment of efficacy evaluation and treatment-related adverse reactions of the tumors.This review summarizes the progress of immunotherapy as the first-line treatment of patients with advanced NSCLC.
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Hyponatremia is the most common electrolyte abnormality in cancer patients, which is usually related to the syndromes of inappropriate antidiuretic hormone secretion (SIADH). Despite not frequent life-threatening, it mostly causes prolonged hospitalization, delaying in scheduled chemotherapy, reducing of the efficacy, worsening of patients' prognosis and quality of life. The optimal treatment strategy should be chosen based on the severity and the onset time of the symptoms in clinic. Hypertonic saline solution is appropriate for acute, symptomatic patients with hyponatremia caused by SIADH, nevertheless fluid restriction is advised to chronic symptomless hyponatremia which recommends correcting at a slower rate. When fluid restriction is limited, pharmacological therapy should be a necessary choice. This review summarizes the recent progress of hyponatremia in international guidelines and discusses the defect of hyponatremia managements and the research prospect in the future.
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Objective In patients with non -small cell lung cancer(NSCLC)undergoing radical surgery,there were still many inevitable recurrences and distant metastases,even after systemic postoperative adjuvant chemotherapy.At the same time,many patients were in the stage Ⅳ at the time of initial treatment.The aims of this study were to investigate and compare the first-line chemotherapy(First-line Chemotherapy at Recurrence Post-adjuvant Chemotherapy,FCRPC)in NSCLC patients with distant metas-tasis after adjuvant chemotherapy with initial treatment at the phase Ⅳ of NSCLC patients with first-line chemotherapy(Initial First-line Chemotherapy,IFC).Methods A total of 603 patients with distant metastatic NSCLC were collected in this study.Among them,73 of them were FCRPC and 530 of them for IFC.Statistical methods for propensity score matching were used to balance the clinical features between FCRPC and IFC groups.Chi-square test was used to compare the short-term efficacy between FCRPC and IFC groups.Survival analysis was performed using regression analysis and Kaplan-Meier analysis.Results There was no significant difference in objective response rate(ORR)and disease control rate(DCR)between FCRPC and IFC groups in NSCLC patients with dis-tant metastases(ORR rate:27.46% in the FCRPC group,24.7% in the PFC group,P=0.851 and DCR rate:78.1% in the FCRPC group,65.6% in the PFC group,P=0.140).There was also no significant difference in the median progression-free survival(9.8 months in the FCRPC group and 8.5 months in the PFC group,P=0.337)and median overall survival(20.0 months in the FCRPC group and 14.4 months in the PFC group,P=0.087).Conclusion There is no significant difference in the prognosis of first-line chemotherapy between NSCLC patients with distant metastases and with initial treatment at the stageⅣafter adjuvant chemotherapy.
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Autophagy is a highly conservative biological behavior in eukaryotic cells .This dynamic process involves wrappingcytoplasmic components and combining with lysosomes in cells for catabolism .Auto-phagy can not only take part in maintaining homeostasis ,but also be closely related with tumor development and resistant.Therefore,autophagy is a potential target for antitumor drug resistant .Specific inhibition of autophagy in cancer cells combined with chemotherapy is expected to be an effective cancer treatment strategy .
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Objective This study aims to examine expression of Caveolin -1 in non smoking cell lung cancer(NSCLC)and to discusses the relationship between expression of Caveolin -1 and the Epidermal growth factor receptor mutations .Methods Immunohistochemical staining was used to determine the Caveolin -1 ex-pression and ARMS-qPCR was used to measure EGFR mutations in 40 cases of lung cancer tissue .The clinical pathological characteristics and correlations in patients were analyzed .Results The expression of Caveolin -1 in human lung cancer was significantly lower than that in normal lung tissue ,and negatively correlated with EGFR mutations ,which was statistically significant .Conclusion Caveolin -1 expression is negatively correlated with EGFR mutations in non-small cell lung cancer and related to the histologic type .Caveolin-1 may be a molecu-lar target for diagnosis and judgment of NSCLC .
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To assess the effect of cystocele (anterior pelvic organ prolapse,AOP)or stress urinary incontinence (SUI) on sex life quality in postmenopausal women under 65 years and observe the change of sex life quality after individualized surgical repair and tension-free vaginal tape-obturator (TVT-O).The postmenopausal patients aged 48 to 65 years at Beijing Hospital were observed from June 2008 to December 2010.They were divided into 3 groups of AOP (n =52),SUI (n =30) and control without gynecological and urinary system diseases on routine examinations (n =25).Their sexual life qualities were evaluated by pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-31)with 31 items before treatment and at 3,6 months after surgical treatment in AOP and SUI groups.The sexual life quality scores were significantly lower in SUI group than those in control and AOP groups(P ＜ 0.01).It significantly increased after TVT-O treatment(P ＜0.01).There was no significant difference after treatment when compared with that before treatment in POP group.
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Objective To observe characteristics of the activity in resting brain of asymptomatic reflux esophagitis (RE) patients,and explore the role of default network in the pathogenesis of asymptomatic RE.Methods Functional magnetic resonance imaging (fMRI) was performed to scan the brains of 15 asymptomatic RE patients,15 symptomatic RE patients and 15 healthy volunteers under no-mission-stimulation state.With fractional amplitude of low frequency fluctuation (fALFF),characteristics of the strengthened and weakened regions of asymptomatic RE patients,symptomatic RE patients and healthy individuals were compared and analyzed.SPM 5 was applied for data preprocessing.Single-sample t test was performed to observe the noticeable active regions of each group under resting state,and then double-sample t test was used to compare the characteristics of active regions of the entire brain between asymptomatic RE patients and symptomatic RE patients or healthy individuals.Results Under resting state,the active brain regions of asymptomatic RE patients,symptomatic RE patients and healthy individuals were similar.The activity of only small part of brain regions in visceral sensory processing relevant networks changed.There was no significant difference in the active regions of default network under resting state between asymptomatic RE patients and healthy individuals.Compared with symptomatic RE patients,fALEF decreased at right central sulcus cover,right superior temporal gyrus,right insula,right transverse temporal gyrus,right postcentral gyrus,superior temporal gyrus and temporal pole (X=50,Y=-6,Z=12,t=2.7874,P＜0.01).Conclusion The difference in characteristics of activity in default network under resting state may play an important role in the pathogenesis of asymptomatic RE.
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OBJECTIVE To explore the systemic prevention messures of ventilator-associated pneumonia(VAP).METHODS Mesures were taken to 54 patients to prevent infection in 54 from 2006 to 2008 and 52 patients with similar symptoms at the same interval time were chosed as control.RESULTS In the test group VAP occurred in 14.81%,with(11.11%) of mortality.In control group VAP accounted for 42.31%,with(26.92%) of mortality.CONCLUSIONS Systemic prevention messures can decrease VAP occurrance.
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Objective To study the expression of hemeoxygenase-1 (HO-1) and change of superoxide dismutase (SOD) activity in perihematoma after intracerebral hemorrhage (ICH). Methods The rats were randomly divided into sham operating group and intracerebral hemorrhage group.Rat ICH models were induced using stereotactic infusion autologous blood 50 ?l into the caudate nucleus. At the due time, the rats were killed and brain tissues were removed for detection of HO-1 and measurement of SOD by immunohistochemical and xanthine hydrocarbonylation methods. Results Following ICH, few HO-1 positive cells were observed in brain tissue perihemota at 6 h, peaked at 48 h ( P0.05), then decreased gradually and reached the minimum at 72 h ( P0.05). The change of SOD in brain tissue perihematoma was negatively correlated with the expression of HO-1 (r=-0.878, P