BACKGROUND There has been no study comparing the difference in the failure patterns between patients with or without postoperative radiotherapy(PORT)after esophagectomy for pT3-4N0-3M0 esophageal squamous cell carcino...BACKGROUND There has been no study comparing the difference in the failure patterns between patients with or without postoperative radiotherapy(PORT)after esophagectomy for pT3-4N0-3M0 esophageal squamous cell carcinoma(ESCC).AIM To investigate the difference in the failure patterns of stage pT3-4N0-3M0 ESCC patients with or without PORT.METHODS Patients with stage pT3-4N0-3M0 ESCC,who underwent surgery with or without PORT,were enrolled in this study.The primary endpoint was to investigate the difference in the failure patterns between patients with or without PORT after esophagectomy.The secondary endpoint was to estimate whether patients with stage pT3-4 ESCC could achieve a disease-free survival(DFS)advantage after receiving adjuvant PORT.Statistical analyses were performed by the Kaplan-Meier method,Cox regression model,and Chi-squared test or Fisher’s exact test.RESULTS In total,230 patients with stage pT3-4N0-3M0 ESCC were included in this study.Fifty-six patients who received PORT were screened from a prospective cohort(S+R arm).And 174 patients involving surgery alone were retrospectively selected from July 2006 to October 2014(S arm).There were no significant differences in the clinical or pathological characteristics of patients between the two arms,except for tumor location(P=0.031).The failure patterns between the two arms were significantly different(P<0.001).Patients in the S arm had a significantly higher proportion of locoregional recurrence and a lower proportion of distant metastasis than those in the S+R arm(92.0%vs 35.7%,P<0.001 and 19.0%vs 75.0%,P<0.001,respectively).The difference in the median DFS between the two arms was statistically significant(12.7 vs 8 mo,P=0.048).Univariate analysis and multivariate analysis both demonstrated that the number of lymph node metastases≥3(HR=0.572,95% CI:0.430-0.762,P<0.001)was an independent poor prognostic factor for DFS in patients with stage pT3-4N0-3M0 ESCC.CONCLUSION PORT could improve DFS and local control of patients with stage pT3-4N0-3M0 ESCC.However,further studies need to be conducted to control hematogenous metastasis after PORT.展开更多
Ginkgo biloba L.leaf(GBL)has been reported to protect against ischemic stroke(IS),one of the leading causes of death and longterm disability worldwide,while there is a lack of systematic study on the exact mechanism.H...Ginkgo biloba L.leaf(GBL)has been reported to protect against ischemic stroke(IS),one of the leading causes of death and longterm disability worldwide,while there is a lack of systematic study on the exact mechanism.Here,network pharmacology and bioinformatics were used to predict the active components,important targets,and potential mechanisms of GBL in the treatment of IS.Active compounds of GBL were screened based on drug-like index and oral bioavailability,key target genes were screened based on network pharmacology and gene chip,downstream pathways for the regulation of key target genes were predicted based on gene set enrichment analysis,and the interaction between key targets and active compounds was verified based on molecular docking.The results showed that GBL played a protective role in cerebral ischemia with mainly 14 active compounds,such as isoquercitrin,luteolin-4’-glucoside,beta-sitosterol,campesterol,diosmetin,ginkgolide B,ginkgolide C,ginkgolide J,ginkgolide M,isogoycyrol,laricitrin,luteolin,sesamin,and stigmasterol.Further studies revealed that GBL played important role in immunomodulation and inflammation inhibition after cerebral ischemia by acting on its peripheral targets ARG1 and MMP9 to regulate Toll-like receptor,Chemokine and Notch signaling pathway.Meanwhile,GBL played important role in reducing neuroinflammation and blood-brain barrier damage after cerebral ischemia by acting on its central targets,CCL2,PTGS2,IL6,IL1B and MMP9 to regulate the Cytokine-cytokine receptor interaction,Jak-STAT,and Toll-like receptor signaling pathway.Additionally,molecular docking verified that the active compounds mentioned above could bind to ARG1,MMP9,CCL2,PTGS2,IL6,and IL1B.The present study shows the multicomponent,multitarget and multichannel pharmacological effects of GBL on cerebral ischemia and provides a new strategy for the treatment of IS.展开更多
目的检索、评价和汇总宫颈癌患者根治术后尿潴留的预防和管理的最佳证据,为临床护理工作提供参考。方法计算机检索BMJ Best Practice、UpToDate、Cochrane图书馆、Joana Briggs Institute循证卫生保健国际合作中心数据库、OVID循证数据...目的检索、评价和汇总宫颈癌患者根治术后尿潴留的预防和管理的最佳证据,为临床护理工作提供参考。方法计算机检索BMJ Best Practice、UpToDate、Cochrane图书馆、Joana Briggs Institute循证卫生保健国际合作中心数据库、OVID循证数据库、中国指南网、美国指南网、ClincalKey for Nursing、加拿大安大略注册护士协会、PubMed、荷兰医学文摘数据库、护理文献累积索引数据库关于宫颈癌患者根治术后尿潴留预防及管理的所有证据,包括临床实践指南、最佳临床实践信息册、证据汇总及系统评价。检索时限从建库至2018年5月。结果共纳入16篇文献,包括临床实践指南5篇、系统评价5篇、证据总结4篇、临床决策2篇,最终获取14条最佳证据。结论临床科室在应用证据时,应结合文化背景、具体的临床环境、患者意愿及偏好等有针对性地选择证据,及时关注相关证据的更新。展开更多
Super-refractory status epilepticus(SRSE)is an important neurological emergency associated with high mortality and morbidity and poses a heavy economic burden on patients.Ketogenic diet parenteral nutrition(KD-PN)is k...Super-refractory status epilepticus(SRSE)is an important neurological emergency associated with high mortality and morbidity and poses a heavy economic burden on patients.Ketogenic diet parenteral nutrition(KD-PN)is ketogenic diet therapy provided through parenteral administration and may be an adjuvant treatment for these who cannot accept enteral diet.However,the calculation and management of KD-PN presents a challenge for clinicians.This review focuses on the practical aspects of KD-PN therapy for treatment of SRSE,including the dietary composition,potential drug-diet interactions,and monitoring during KD-PN treatment.As with all SRSE treatments,KD-PN has many adverse effects,like hyperlipemia,hepatotoxicity,metabolic acidosis,insufficient ketosis or hyper-ketosis,and propofol infusion syndrome.We summarize monitoring and treatment methods in our review.This review provides some practical aspects for treatment of SRSE.展开更多
基金Supported by Emerging Advanced Technology Joint Research Project of Shanghai Shenkang Hospital Development Center,No.SHDC12017103Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support,No.20161433
文摘BACKGROUND There has been no study comparing the difference in the failure patterns between patients with or without postoperative radiotherapy(PORT)after esophagectomy for pT3-4N0-3M0 esophageal squamous cell carcinoma(ESCC).AIM To investigate the difference in the failure patterns of stage pT3-4N0-3M0 ESCC patients with or without PORT.METHODS Patients with stage pT3-4N0-3M0 ESCC,who underwent surgery with or without PORT,were enrolled in this study.The primary endpoint was to investigate the difference in the failure patterns between patients with or without PORT after esophagectomy.The secondary endpoint was to estimate whether patients with stage pT3-4 ESCC could achieve a disease-free survival(DFS)advantage after receiving adjuvant PORT.Statistical analyses were performed by the Kaplan-Meier method,Cox regression model,and Chi-squared test or Fisher’s exact test.RESULTS In total,230 patients with stage pT3-4N0-3M0 ESCC were included in this study.Fifty-six patients who received PORT were screened from a prospective cohort(S+R arm).And 174 patients involving surgery alone were retrospectively selected from July 2006 to October 2014(S arm).There were no significant differences in the clinical or pathological characteristics of patients between the two arms,except for tumor location(P=0.031).The failure patterns between the two arms were significantly different(P<0.001).Patients in the S arm had a significantly higher proportion of locoregional recurrence and a lower proportion of distant metastasis than those in the S+R arm(92.0%vs 35.7%,P<0.001 and 19.0%vs 75.0%,P<0.001,respectively).The difference in the median DFS between the two arms was statistically significant(12.7 vs 8 mo,P=0.048).Univariate analysis and multivariate analysis both demonstrated that the number of lymph node metastases≥3(HR=0.572,95% CI:0.430-0.762,P<0.001)was an independent poor prognostic factor for DFS in patients with stage pT3-4N0-3M0 ESCC.CONCLUSION PORT could improve DFS and local control of patients with stage pT3-4N0-3M0 ESCC.However,further studies need to be conducted to control hematogenous metastasis after PORT.
基金supported by the National Natural Science Foundation of China(82074056).
文摘Ginkgo biloba L.leaf(GBL)has been reported to protect against ischemic stroke(IS),one of the leading causes of death and longterm disability worldwide,while there is a lack of systematic study on the exact mechanism.Here,network pharmacology and bioinformatics were used to predict the active components,important targets,and potential mechanisms of GBL in the treatment of IS.Active compounds of GBL were screened based on drug-like index and oral bioavailability,key target genes were screened based on network pharmacology and gene chip,downstream pathways for the regulation of key target genes were predicted based on gene set enrichment analysis,and the interaction between key targets and active compounds was verified based on molecular docking.The results showed that GBL played a protective role in cerebral ischemia with mainly 14 active compounds,such as isoquercitrin,luteolin-4’-glucoside,beta-sitosterol,campesterol,diosmetin,ginkgolide B,ginkgolide C,ginkgolide J,ginkgolide M,isogoycyrol,laricitrin,luteolin,sesamin,and stigmasterol.Further studies revealed that GBL played important role in immunomodulation and inflammation inhibition after cerebral ischemia by acting on its peripheral targets ARG1 and MMP9 to regulate Toll-like receptor,Chemokine and Notch signaling pathway.Meanwhile,GBL played important role in reducing neuroinflammation and blood-brain barrier damage after cerebral ischemia by acting on its central targets,CCL2,PTGS2,IL6,IL1B and MMP9 to regulate the Cytokine-cytokine receptor interaction,Jak-STAT,and Toll-like receptor signaling pathway.Additionally,molecular docking verified that the active compounds mentioned above could bind to ARG1,MMP9,CCL2,PTGS2,IL6,and IL1B.The present study shows the multicomponent,multitarget and multichannel pharmacological effects of GBL on cerebral ischemia and provides a new strategy for the treatment of IS.
文摘目的检索、评价和汇总宫颈癌患者根治术后尿潴留的预防和管理的最佳证据,为临床护理工作提供参考。方法计算机检索BMJ Best Practice、UpToDate、Cochrane图书馆、Joana Briggs Institute循证卫生保健国际合作中心数据库、OVID循证数据库、中国指南网、美国指南网、ClincalKey for Nursing、加拿大安大略注册护士协会、PubMed、荷兰医学文摘数据库、护理文献累积索引数据库关于宫颈癌患者根治术后尿潴留预防及管理的所有证据,包括临床实践指南、最佳临床实践信息册、证据汇总及系统评价。检索时限从建库至2018年5月。结果共纳入16篇文献,包括临床实践指南5篇、系统评价5篇、证据总结4篇、临床决策2篇,最终获取14条最佳证据。结论临床科室在应用证据时,应结合文化背景、具体的临床环境、患者意愿及偏好等有针对性地选择证据,及时关注相关证据的更新。
文摘Super-refractory status epilepticus(SRSE)is an important neurological emergency associated with high mortality and morbidity and poses a heavy economic burden on patients.Ketogenic diet parenteral nutrition(KD-PN)is ketogenic diet therapy provided through parenteral administration and may be an adjuvant treatment for these who cannot accept enteral diet.However,the calculation and management of KD-PN presents a challenge for clinicians.This review focuses on the practical aspects of KD-PN therapy for treatment of SRSE,including the dietary composition,potential drug-diet interactions,and monitoring during KD-PN treatment.As with all SRSE treatments,KD-PN has many adverse effects,like hyperlipemia,hepatotoxicity,metabolic acidosis,insufficient ketosis or hyper-ketosis,and propofol infusion syndrome.We summarize monitoring and treatment methods in our review.This review provides some practical aspects for treatment of SRSE.
