Effects of glucocorticoid use on survival of advanced non-small-cell lung cancer patients treated with immune checkpoint inhibitors / 中华医学杂志(英文版)

BACKGROUND@#Lung cancer is the second most common cancer worldwide, with non-small-cell lung cancer (NSCLC) accounting for the majority of cases. Patients with NSCLC have achieved great survival benefits from immunotherapies targeting immune checkpoints. Glucocorticoids (GCs) are frequently used for palliation of cancer-associated symptoms, as supportive care for non-cancer-associated symptoms, and for management of immune-related adverse events (irAEs). The aim of this study was to clarify the safety and prognostic significance of glucocorticoid use in advanced patients with NSCLC treated with immune checkpoint inhibitors (ICIs).@*METHODS@#The study searched publications from PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine disc, Chinese National Knowledge Infrastructure, Wanfang Data, and Chinese Science and Technology Journal Database up to March 1st, 2022, and conducted a meta-analysis to assess the effects of glucocorticoid use on overall survival (OS) and progression-free survival (PFS) in NSCLC patients treated with ICIs through the available data. The study calculated the pooled hazard ratios (HRs) and 95% confidence intervals (CIs).@*RESULTS@#This study included data from 25 literatures that were mainly retrospective, with 8713 patients included. Patients taking GCs had a higher risk for tumor progression and death compared with those not taking GCs (PFS: HR = 1.57, 95% CI: 1.33-1.86, P <0.001; OS: HR = 1.63, 95% CI: 1.41-1.88, P <0.001). GCs used for cancer-associated symptoms caused an obviously negative effect on both PFS and OS (PFS: HR = 1.74, 95% CI: 1.32-2.29, P <0.001; OS: HR = 1.76, 95% CI: 1.52-2.04, P <0.001). However, GCs used for irAEs management did not negatively affect prognosis (PFS: HR = 0.68, 95% CI: 0.46-1.00, P = 0.050; OS: HR = 0.53, 95% CI: 0.34-0.83, P = 0.005), and GCs used for non-cancer-associated indications had no effect on prognosis (PFS: HR = 0.92, 95%CI: 0.63-1.32, P = 0.640; OS: HR = 0.91, 95% CI: 0.59-1.41, P = 0.680).@*CONCLUSIONS@#In advanced NSCLC patients treated with ICIs, the use of GCs for palliation of cancer-associated symptoms may result in a worse PFS and OS, indicating that they increase the risk of tumor progression and death. But, in NSCLC patients treated with ICIs, the use of GCs for the management of irAEs may be safe, and the use of GCs for the treatment of non-cancer-associated symptoms may not affect the ICIs' survival benefits. Therefore, it is necessary to be careful and evaluate indications rationally before administering GCs in individualized clinical management.

Morphology and microscopic identification of Anoectochilus lylei / 药学实践杂志

Objective To perform the pharmacognostic identification of Anoectochilus lylei and establish the foundation for its accurate identification and further development. Methods The macroscopic identification and microscopic identification methods were used to identify A. lylei. Results A. lylei has ovate leaf shape, possessing red reticulated veins. Inverted flowers have Y-shaped and white lip. The anterior part of lip is two-lobed, and the lobes are linear-oblong. There are 1 to 3 shorts serrations on each side of the middle part of lip. Microscopic characteristics mainly show as follows: the cortex is broad in the transverse section of roots and stems; 1-5 and 1-7 vascular bundles in the xylem of transverse section of roots and stem, respectively. Collateral vascular bundle in the main veins of transverse section of leaves. There are multitudinous types of stomas in the leaf abaxial epidermis, most of which are anomocytic. Conclusion These characteristics could provide reference for the correct identification of A. lylei.

Plant pharmacognostic and microscopic identification of Anoectochilus burmannicus / 药学实践杂志

Objective To identify the crude drugs of Anoectochilus burmannicus, and clarify its original plant pharmacognostical and microscopic characteristics. Methods The pharmacognostical identification method was used to observe the original plant, tissue structure and microscopic characteristics of A. burmannicus. Results Leaves were ovate or ovate elliptic with golden-red veins. Non-inverted yellow flowers had Y-shaped and yellow labellum, which were anteriorly enlarged and 2-lobed. The lobes were narrowly oblong or narrowly oblanceolate. The middle part of labellum was narrow to form a 10 mm long structure with margin narrowly winged. In the microscopic structure, the cortex is obvious in the cross sections of root and stem, together with needle crystals of calcium oxalate and mucous cells. The upper epidermal cells on the cross section of the leaves were papilloid in shape, whereas diverse stomas existed among the lower epidermal cells, with anomocytic stomas as the major type. Needle crystals of calcium oxalate and conduits can be found in the powder. Conclusion These data provide a reference for the identification and resource development and utilization of A. burmannicus.

Value of real-time elastography in predicting the risk of pancreatic fistula after pancreaticoduodenectomy / 临床肝胆病杂志

ObjectiveObjective To investigate the value of pancreatic elasticity based on shear wave elastography (SWE) in predicting the risk of pancreatic fistula, to measure pancreatic hardness by determining the SWE level of the pancreatic body, and to reduce the development of pancreatic fistula after pancreaticoduodenectomy. MethodsA retrospective analysis was performed for the clinical data of 53 patients who were admitted to The Affiliated Hospital of Binzhou Medical University from October 2017 to February 2019 and underwent pancreaticoduodenectomy (PD). The 53 patients were divided into pancreatic fistula group with 10 patients who developed pancreatic fistula after PD and non-pancreatic fistula group with 43 patients who did not develop this disease after PD. The elasticity value of the pancreatic body measured by SWE was used to reflect the tissue elasticity of the pancreas and evaluate the hardness of the pancreas. The t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between groups. A logistic regression analysis was used for univariate analysis, and the Spearman’s correlation coefficient was used to investigate the correlation between SWE and other laboratory data. ResultsBody mass index (BMI) (t=1.321), preoperative total bilirubin (t=1.347), diameter of the main pancreatic duct (t=1.385), maximum SWE value (t=1.728), mean SWE value (t=1.634), and intraoperative pancreatic hardness (χ2=4.983) were risk factors for pancreatic fistula (all P＜0.05). Maximum SWE value and mean SWE value were negatively correlated with age and time of operation (maximum SWE value: r=-0.329 and -0.260, both P＜0.05; mean SWE value: r=-0.282, and -0.282, both P＜0.05) and positively correlated with BMI (r=0.275 and 0.350, both P＜0.05). ConclusionSWE level is an independent risk factor for pancreatic fistula after pancreaticoduodenectomy, and the SWE level of the pancreatic body has a high predictive value and guiding significance in surgical treatment.

Research advances in the role of protective autophagy in regulating vasculogenic mimicry formation in malignancies such as cholangiocarcinoma / 临床肝胆病杂志

Cholangiocarcinoma is a primary malignant tumor derived from the epithelium of the intrahepatic and extrahepatic bile ducts, and vasculogenic mimicry induced by hypoxia and lack of nutrition is a key factor for malignant proliferation, recurrence, and metastasis of cholangiocarcinoma. Previous studies have shown that autophagy maintains cell nutrition metabolism under the condition of a lack of nutrition, and preliminary experiments have confirmed that autophagy was associated with VM in cholangiocarcinoma and there was high expression of PAT4 in cholangiocarcinoma cells; on the basis of these studies, it is pointed out that in cholangiocarcinoma, protective autophagy regulates VM formation by maintaining intracellular metabolic balance and cellular homeostasis. As a nutrient sensor in tumor microenvironment, PAT4 mediates protective autophagy via the PI3K-Akt-mTORC1 signaling pathway to regulate VM formation. Histological, cellular molecular, and in vivo experiments have confirmed that autophagy regulates VM formation by maintaining cell metabolism, stem cell features, and extracellular matrix remodeling, which helps to investigate the signal mechanism for PAT4 mediating autophagy to regulate VM. It is suggested that autophagy is the source of energy and nutrition in cholangiocarcinoma cells under the condition of a lack of nutrition, and PAT4 is the trigger point for autophagy in regulating VM formation. These findings provide new thoughts for the metabolism of cholangiocarcinoma cells and lay a theoretical foundation for antiangiogenic drugs combined with autophagy inhibitors in the treatment of highly aggressive tumors.

Effects of self-efficacy intervention on activities of daily living and outcomes in patients with acute ischemic stroke complicated with white matter lesions / 国际脑血管病杂志

Objective To investigate the effects of self-efficacy intervention on activities of daily living and outcomes in patients with acute ischemic stroke complicated with white matter lesions (WML).Methods From March 2016 to June 2017,patients with acute ischemic stroke complicated with WML admitted to the Departments of Neurology,the Second People's Hospital of Lianyungang were enrolled prospectively.They were randomly divided into intervention group and control group.The control group received routine treatment and nursing,and the intervention group implemented self-efficacy intervention on the basis of the control group.They were followed up until 90 d after onset.Stroke Self-Efficiency Questionnaire (SSEQ) was used to assess the stroke self-efficacy level.The Barthel Index (BI) was used to assess the activities of daily living (ADL) of the patients.The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) were used to assess the outcomes of the patients.Results The SSEQ scores in the intervention group were significantly higher than those at the time of admission and in the control group at 90 d (all P ＜0.01).The BI in the intervention group was significantly higher than that in the control group (66.51 ±22.35 vs.58.41 ±23.17;t =3.473,P =0.001),and the NIHSS score was significantly lower than the control group (5.51 ±2.98 vs.6.95 ±2.94;t =-2.094,P=0.040),and the proportion of patients with good outcomes (mRS score 0-2) was significantly higher than that of the control group (73.7％ vs.56.6％;x2 =4.896,P =0.027).Conclusion For patients with acute ischemic stroke complicated with WML,active self-efficacy intervention could improve the ADL and it was helpful to improve the outcomes of patients.

Study on Purification Technology of Total Flavonoids from Nelumbinis receptaculum by Macroporous Resin / 中国药房

OBJECTIVE:To study the purification technology of total flavonoids from Nelumbinis receptaculum by macropo-rous resin. METHODS:Using adsorption rate and desorption rate of total flavonoids from Nelumbinis receptaculum as index,the type of macroporous resin was selected by static adsorption-desorption tests;With adsorption rate of total flavonoids as index,sin-gle factor test was used to investigate the effects of the concentration of total flavonoids,adsorption time,adsorption speed, drug-loading amount,water amount,volume fraction and amount of eluant and other factors on the purification technology. The op-timal technology was validated. RESULTS:Among 10 kinds of resin,HPD-400 macroporous resin was found to have the best ad-sorption and desorption effects. The optimal purification conditions was as follows as the concentration of total flavonoids 7.00 mg/ml, adsorption time of 3 h,flow rate for sampling of 3 column volume (BV)/h,drug-loading amount of 8 BV,water amount of 6 BV,50% ethanol elution amount of 4 BV. In validation test,mass fraction of total flavonoids from purified Nelumbinis receptacu-lum were 63.88%,62.50% and 63.44%(RSD=1.11%,n=3). CONCLUSIONS:HPD-400 macroporous resin could purify total flavonoids from purified Nelumbinis receptaculum,and established purification technology is stable and practical.

Risk factors and treatment efficiency for lung cancer patients with venous thromboembolism / 实用医学杂志

Objective To investigate the risk factors and treatment efficiency for lung cancer patients with venous thromboembolism (VTE). Methods Total 282 cases of lung cancer patients with VTE were enrolled into two groups , including the VTE group and the non-VTE group , for comparation analysis based on a series of clinical data. Results The occupation rate of adenocarcinoma and Ⅳ period were 65.28% and 87.50% in VTE group, respectively, higher than those of 51.43% and 75.71% in the non-VTE group. The increased rate of blood viscosity and d-dimer respectively were 65.28% and 70.83%, higher than those of 51.43% and 56.67% in the non-VTE group, with significant differences (P < 0.05, respectively). Result of logistic regression analysis showed that tumor stage , d-dimer levels , smoking , age , and blood viscosity levels were highly correlated with venous thrombosis in patients with lung cancer, and the OR value among them was 3.802, 2.339, 5.814, 3.875 and 6.404, respectively, with significant differencees (P < 0.05, respectively). Conclusions Lung adenocarcinoma with stage Ⅳ, smoking , age and increase of blood viscosity and d-dimer were the important risk factors for VTE in patients with lung cancer chemotherapy. Timely assessment of risk factors and early anticoagulation therapy in lung cancer patients with venous thromboembolism associated with VTE can improve the treatment efficacy and reduce the complications.

Diagnostic significance of combination of secretory leukocyte protease inhibitor (SLPI), interferon-γ(IFN-γ) and adenosine deaminase (ADA) for tuberculous pleural effusion / 实用医学杂志

Objective To compare the diagnostic significance of pleural SLPI,IFN-γ and ADA for differenti-ating TPE from pleural effusions with the other etiologies. Methods Pleural effusion samples were obtained from 93 patients who were divided into the following groups: tuberculous pleural effusion,malignant pleural effusion, bacterial pleural effusion and transudative pleural effusion. The pleural effusion and/or serum levels of SLPI , IFN-γand ADA were determined. Results 1.The concentrations of SLPI, IFN-γand ADA in tuberculous pleural effusion was higher than that in malignant group, bacterial group and transudative group. 2. The diagnostic value of SLPI, IFN-γor ADA for the diagnosis of tuberculous PE is high respectively. The combinations of SLPI, IFN-γand/or ADA gained the more valuable diagnostic performance. Conclusion Pleural SLPI, IFN-γand ADA may be helpful for the differential diagnosis of tuberculous pleural effusion and the other pleural effusion. The combinations of SLPI or/and IFN-γor/and ADA further increased diagnostic value.

Evaluation of clinical pathway in pulmonary thrombus embolism / 重庆医学

Objective To evaluate the effect of clinical pathway in pulmonary thrombus embolism (PTE) .Methods 60 cases of PTE were admitted department of respiratory from 2011 to 2012 and divided into the experimental group and the control group ,30 cases for each group .The control group was implemented with normal process of hospital management while experimental group de-veloped clinical pathways .The efficacy ,department of respiratory drug costs ,complications and patient satisfaction were recorded and computed .Results The average department of respiratory and drug costs in experimental group respectively was (17 .13 ± 2 .22)days ,(16 545 .04 ± 1 557 .44) RMB and (7 050 .83 ± 372 .74) RMB ;less than (19 .77 ± 3 .41)day ,(17 709 .45 ± 1 902 .05) RMB and (7 345 .75 ± 450 .82) RMB in control group ,there were significant difference between the two groups (P0 .05) .Conclusion The effect of clinical pathway in PTE have a positive role in reducing hospitalization time ,total costs ,drug costs and increasing satisfaction ,it is worth to develop in primary hos-pital .

Design, synthesis of quinolinone acid-containing compounds with anti-HIV integrase activity / 药学学报

A series of novel quinolinone acid-containing compounds were designed and synthesized. Their structures were confirmed with 1H NMR and MS. The target compounds were tested for anti-HIV-1 integrase activities in vitro with enzyme linked immunosorbent assay (ELISA). The result showed that D-2, D-4 and D-7 have anti-integrase activity with IC50 < 100 micromol L(-1).