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Traditional chemotherapy is the cornerstone of comprehensive treatment for gastric cancer, but its recurrence and metastasis rates are high, and the overall prognosis is not ideal. The rise of immune checkpoint inhibitors (ICI) has brought new hope to gastric cancer patients and changed the current pattern of comprehensive treatment for gastric cancer. With the increasing use of ICI, immune related adverse reactions (irAEs) such as skin toxicity and gastrointestinal toxicity are becoming increasingly common. Scientific understanding, early diagnosis, and graded management are currently the main strategies for handling irAEs. This article aims to review the mechanisms, clinical manifestations, and prediction, treatment, and management of irAEs after ICI treatment of gastric cancer, in order to enhance the understanding of irAEs among clinical physicians, better manage immunotherapy related adverse reactions, and improve the prognosis and quality of life of patients.
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ObjectiveTo investigate the blood coagulation function in COVID-19 patients, and the correlation between coagulopathy and disease severity. MethodsWe retrospectively collected 147 clinically diagnosed COVID-19 patients at Wuhan Leishenshan Hospital of Hubei, China. We analyzed the coagulation function in COVID-19 patients through the data including thrombin-antithrombin complex (TAT), 2-plasmininhibitor-plasmin Complex (PIC), thrombomodulin (TM), t-PA/PAI-1 Complex (t-PAIC), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), D-Dimer (DD), and platelet (PLT). ResultThe levels of TAT, PIC, TM, t-PAIC, PT, INR, FIB, and DD in COVID-19 patients were higher than health controls (p<0.05), and also higher in the patients with thrombotic disease than without thrombotic disease (p<0.05). Whats more, the patients with thrombotic disease had a higher case-fatality (p<0.05). TAT, PIC, TM, t-PAIC, PT, INR, APTT, FIB, DD, and PLT were also found correlated with disease severity. Meanwhile, we found that there were significant difference in TAT, TM, t-PAIC, PT, INR, APTT, DD, and PLT in the death and survival group. Further using univariate and multivariate logistic regression analysis also found that t-PAIC and DD were independent risk factors for death in patients and are excellent predicting the mortality risk of COVID-19. ConclusionThe coagulation systems in COVID-19 patients are inordinate, and dynamic monitoring of them, might be a key in the control of COVID-19 death.
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BACKGROUND: Recent studies highlighted the protective benefits of a Chinese herb extract from polygonum cuspidatum, trans-polydatin, on cardiac disease. We investigated the therapeutic effect of trans-polydatin on myocardial ischemia/reperfusion (IR) injury and the underlying mechanisms related to the renin-angiotensin system (RAS) and RhoA kinase (ROCK) pathway. METHODS AND RESULTS: Experiments were performed on neonatal rats' ventricular myocytes that were subjected to hypoxia-reoxygenation (simulated IR, SIR) and on adult mice which were subjected to left anterior descending coronary artery occlusion for 45 min followed by a one-week reperfusion. trans-Polydatin significantly increased cell viability and reduced apoptosis in SIR cardiomyocytes. It was also observed to reduce the infarct size and increase the cardiac function in IR mice. trans-Polydatin decreased the expression of angiotensin and inhibited the activities of renin and angiotensin-converting enzyme. Furthermore, trans-polydatin inhibited ROCK activity, especially the angiotensin I receptor-activated ROCK pathway. CONCLUSIONS: trans-Polydatin exerts a cardio-protection against myocardial IR injury likely through inhibiting both RAS and the downstream ROCK pathway.
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Glucósidos/administración & dosificación , Corazón/efectos de los fármacos , Isquemia/cirugía , Daño por Reperfusión Miocárdica/tratamiento farmacológico , Sistema Renina-Angiotensina/efectos de los fármacos , Estilbenos/administración & dosificación , Quinasas Asociadas a rho/metabolismo , Animales , Apoptosis/efectos de los fármacos , Glucósidos/química , Humanos , Masculino , Ratones , Ratones Endogámicos C57BL , Daño por Reperfusión Miocárdica/enzimología , Daño por Reperfusión Miocárdica/genética , Daño por Reperfusión Miocárdica/metabolismo , Miocardio/metabolismo , Transducción de Señal/efectos de los fármacos , Estilbenos/químicaRESUMEN
[Summary] In newly diagnosed diabetic patients, fasting plasma glucose, HbA1C , and plasma lipid profiles were measured to analyze the association between HbA1C and plasma lipid profiles. HbA1C might affect plasma lipid profiles in newly diagnosed diabetic patients. Higher HbA1C was associated with the worse plasma lipid profiles and more severe insulin resistance.
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OBJECTIVE:To systematically review the efficacy and safety of cinacalcet in the treatment of hemodialysis pa-tients with secondary hyperparathyroidism,and provide evidence-based reference for the clinical treatment. METHODS:Retrieved from Medline,Cochrane Library,EMBase and CBM,randomized controlled trials(RCT)about cinacalcet in the treatment of he-modialysis patients with secondary hyperparathyroidism (SHPT) were collected. Meta-analysis was performed by using Rev Man 5.3.5 software after data extract and quality evaluation by Cochrane systematic Rev Man 5.3.5. RESULTS:Totally 7 RCTs were en-rolled,involving 1 987 patients. Results of Meta-analysis showed cinacalcet can significantly reduce the rate of surgical parathyroid-ectomy[RR=0.23,95%CI(0.06,0.89),P=0.03],incidence of fracture[RR=0.26,95%CI(0.12,0.60),P=0.002] and increase the incidences of hypocalcemia[RR=9.81,95%CI(3.92,4.59),P<0.001],nausea[RR=1.97,95%CI(1.58,2.46),P<0.001] and vomit-ing[RR=1.91,95%CI(1.50,2.42),P<0.001],while it showed no significant effect on the the incidence of all-cause mortality and cardiovascular death. CONCLUSIONS:The clinical efficacy of cinacalcet in the treatment of hemodialysis patients with secondary hyperparathyroidism is good,but there are common adverse reactions such as nausea and vomiting,hypocalcemia.
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<p><b>OBJECTIVE</b>To assess the association of a disintegrin and metallo-proteinase with thrombospondin type 1 motifs (ADAMTS-1) gene polymorphism and ischemic stroke caused by large artery atherosclerosis (LAA).</p><p><b>METHODS</b>In total 767 patients and 506 controls were recruited. Single nucleotide polymorphisms (SNPs) rs416905 (T/C) and rs402007 (G/C) of the ADAMTS-1 gene were genotyped by polymerase chain reaction and DNA sequencing.</p><p><b>RESULTS</b>Frequencies of the rs402007 GC+CC genotype and the C allele were significantly different between the two groups (68.84% vs. 60.67%, χ2=9.012, P=0.003, OR=1.432; 45.24% vs. 38.54%, χ2=11.208, P=0.001, OR=1.318). Binary logistic regression has confirmed that the above difference was significant (P=0.001, OR=1.521, 95%CI: 1.183-1.955). The frequencies of TC+CC and GC+CC genotypes were similar between the two groups, and so was it with the C allele. The two SNPs had been in complete linkage disequilibrium (D'=1.0, r2=1.0).</p><p><b>CONCLUSION</b>The rs416905 and rs402007 polymorphisms of the ADAMTS-1 gene may be associated with ischemic stroke caused by LAA. The C allele of the rs402007 locus may be a susceptibility factor for this subtype of stroke.</p>
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Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteínas ADAM , Genética , Proteína ADAMTS1 , Alelos , Aterosclerosis , Secuencia de Bases , Glucemia , Metabolismo , Isquemia Encefálica , Ayuno , Sangre , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Genética , Genotipo , Modelos Logísticos , Reacción en Cadena de la Polimerasa , Polimorfismo de Nucleótido Simple , Factores de Riesgo , Análisis de Secuencia de ADN , Fumar , Accidente Cerebrovascular , Sangre , GenéticaRESUMEN
Objective To investigate the effect of curcumin on the expression of heat shock protein 70 (HSP70) in the hippocampus and spatial learning ability in APPswe/PS1△9 transgenic mice,and provide a new theoretical basis for the treatment of Alzheimer' s disease (AD).Methods Mice were divided into wild-type (WT) group,APP/PS1 transgenic group,curcumin-treated group,quercetin combined with curcumin-treated group.The 5-month-old mice in curcumin-treated group received 150 mg · kg-1 · d-1 curcumin by intraperitoneal injection for four consecutive weeks.In addition to curcumin,the mice in quercetin combined with curcumin-treated group also received quercetin 50 mg· kg-1 · d-1 intraperitoneally for four consecutive weeks.The expression of HSP70 in the hippocampus of APP/PS1 mice was detected by Western blot.Learning and memory ability of APP/ PS1 mice were measured by Morris water maze test.The latency of finding the platforms and the number of crossing the platforms were observed.Results The results of Western blot analyses showed that the expression of HSP70 in the hippocampus of APP/PS1 transgenic mice decreased significantly compared with that of WT mice (OD:APPswe/PS1△9:0.31±0.14;WT:1.14±0.51;P<0.01).The expression of HSP70 in curcumin-treated group significantly increased compared with that of APP/PS1 transgenic group (OD:0.91±0.20 in curcumin-treated group;P<0.05).The results of water maze test showed that compared with WT group,in APP/PS1 group,the latency of finding the platforms was significantly longer (APPswe/PS 1 △9:(82.3 ± 6.8) s;WT:(19.5±4.4) s),and the number of crossing tbe platforms were significantly decreased (APPswe/PS1 △9:(2.7± 1.1);WT:(5.2± 2.1)).In curcumin-treated group,the latency of finding the platform ((47.7±7.6) s) was significantly shorter and the number of crossing platform ((4.5±1.9) s) was more than those in APP/ PS1 group.However,in quercetin combined with curcumin-treated group,the latency of finding the platform was significantly longer ((69.7±9.1) s) and the number of crossing platform (3.2±1.6) was decreased compared with those in curcumin-treated group.Conclusion Curcumin can promote the expression of HSP70 in the hippocampus of APP/PS1 transgenic mice,thus improve spatial learning ability of APP/PS1 transgenic mice.These results provide evidences that curcumin may have potential therapeutic value for the treatment of AD.
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Objective:To provide recommendations for further improvement of resident standardization training in Shenzhen according to carrying on the appraisal to the present stage of the training work. Methods:A self-designed questionnaire was used to investigate resident trainees. Results:We had collected 870 questionnaires with 86. 8% ef-fectively received rate. The resident trainees’ degree of satisfaction to the base conditions and management is more than 50%. While the degree of satisfaction to the training program is 33. 3%. Compared with the outside training base , the training conditions and management level is poor and lower in local training base. The effect of training pro-gram is better in outside training group than local group. Conclusions: Basement management, assessment, training schedule and trainees’ payment need to be improved.
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Objective To analyze composition principles of prescriptions for the treatment of diarrhoea caused by deficiency of spleen. Methods The prescriptions for diarrhoea caused by deficiency of spleen in the Prescriptions of Traditional Chinese Medicine Dictionary were collected, sorted and entered into the TCM Inheritance Support System (V1.3) to analyze the composition principles through the methods of entropy clustering and apriori. Results Based on the analysis of 1185 prescriptions and 815 medications, there were 33 medications with more than 50 frequencies. Composition principles were obtained through apriori method:50 herbal pairs were used with more than 50 frequencies, and 29 core combinations with more than 40 frequencies. Association principle rule were used for the analysis of those medications in the prescriptions (support≥20%, confidence≥0.9). Principles were obtained through entropy clustering:there were 19 core combinations which composed the new prescriptions, and 19 new prescriptions were found through hierarchical clustering method. There were 17 prescriptions matching with Sijunzi decoction (semblance=0.5). Conclusion Diarrhoea caused by deficiency of spleen should be treated with strengthening spleen and benefiting qi primarily, assisting with warming yang, excreting dampness and checking diarrhoea.
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ObjectiveTo determine the prevalence of nutritional risk and application of nutrition support in hospitalized patients in the department of general surgey,and to evaluate the relationship between nutrition support and clinical outcome as well as between nutritional risk and clinical outcome.MethodsHospitalized patients in the department of general surgery were enrolled from September 2009 to April 2010.The patients were screened using Nutritional Risk Screening 2002 ( NRS 2002) on admission.Data were collected on the application of nutrition support within 2 weeks,complication rate,length of stay,and hospital charges.ResultsAltogether 3000 patients were included in the present study.The overall prevalence of nutritional risk was 18.5%,in which gastric cancer patients showed the highest prevalence (48.3% ).The proportion of patients receiving nutrition support was 44.1% in those with nutritional risk and 14.3% in those without nutritional risk.The ratio of parenteral nutrition to enteral nutrition was 1.2:1.The patients with nutritional risk had higher complication rate,longer length of stay,and higher hospital charge [24.1% vs.14.2%,(11.1 ±4.8) daysvs.(9.6±3.7) days,(12891.5±4831.2) yuan vs.(9982.7 ±3996.4) yuan,all P=0.0000].Among the gastric cancer,colorectal cancer,and hepato-biliopancreatic cancer patients with nutritional risk,the complication rate,length of stay,and hospital charge were significantly lower in the patients receiving nutrition support than those in the patients receiving no nutrition support ( all P < 0.05 ).ConclusionsA number of inpatients in general surgery department are at nutritional risk.The prevalence of nutritional risk is considerably high in gastric cancer patients.Nutritional risk is correlated with the clinical outcome of the patients.Nutrition support may improve the clinical outcome of gastric cancer,colorectal cancer,and hepato-bilio-pancreatic cancer patients.
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Objective To analyze the association of the morbidity,the management of blood glucose,and the prognosis of patients with hyperglycemia in the medical intensive care units(ICU).Methods Medical records of ICU patients of Renji Hospital from 2002 to 2009 were reviewed using Medical Record Inquiry System,and the data were retrospectively analyzed.Results(1)2631 subjects were included in the present study,blood glucose was determined at least once during hospitalization in 2168 of them.The incidence of hyperglycemia was 26.3%,in which 12.9% presented a known history of diabetes and 13.4% without.In the patients with diabetes history,93.2% of them received anti-diabetic treatment during hospitalization.mainly with oral anti-hyperglyeemic agents (53.0%)or subcutaneous insulin injection(24.9%).However,in the patients without diabetes history,84.4% were not treated against hyperglycemia.The mortality was increased in the latter group(30.4% vs13.9%,P<0.01).(2)In the patients with diabetes history,the mortality in patients whose blood glucose>10 mmol/L was higher than those with blood glucose≤7.0 mmol/L(20.5% vs 9.9%,P<0.05):while in the patients without diabetes history,the mortality began to rise as blood glucose>7.0 mmol/L(P<0.01).(3)Multiple stepwise regression analysis revealed that the average blood glucose level was an independent risk factor for death(OR=1.26).Conclusions The ICU patients showed a high prevalence of hyperglycemia,the management of hyperglycemia should be emphasized.Hyperglycemia in critically ill patients might be an independent risk factor of increased mortality.
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Forty women with polycystic ovary syndrome( PCOS) were enrolled. Basal plasma and urine cortisol, pituitary hormones, homeostasis model assessment for insulin resistance, and plasma cortisol in 0. 25 mg dexamethasone inhibition test were determined. In over-weight or obese PCOS patients, cortisol levels before and after inhibition test were increased (P<0. 05 or P<0. 01 ). The results suggest that the feed-back regulation of glucocorticoids to hypothalamas-pituitary is impaired and the change in hypothalamic-pituitary-adrenal axis is associated with insulin resistance.