可切除Ⅲa/N2期非小细胞肺癌治疗模式探讨

临床可切除Ⅲa/N2期非小细胞肺癌(non-small cell lung cancer, NSCLC)的治疗模式一直存在争议,化疗、放疗、手术等治疗手段都有可改善其生存的报道,靶向治疗和免疫治疗的研究也有较多新进展,联合治疗的选择更是很多临床试验研究的重点。联合治疗包括化疗联合手术或放疗,以及化疗、放疗和手术三种治疗的联合。对于NSCLC最佳治疗模式目前尚无定论。本文通过对多项II期、Ⅲ期临床试验及meta分析、个案报道的综述回顾,比较不同治疗方式对临床可切除Ⅲa/N2期NSCLC的生存影响,结果显示多学科治疗中手术对于延长患者生存是必要的选择,而新辅助化疗后联合手术并不优于联合放疗。依据肿瘤大小、淋巴结累及情况等进行个体化治疗是未来值得进一步探索的方向。

EGFR敏感突变阴性非小细胞肺癌脑转移患者临床特征

除少见的间变性淋巴瘤激酶(anaplastic lymphoma kinase, ALK)及原癌基因-1受体酪氨酸激酶(c-ros oncogene 1-receptor tyrosine kinase, ROS1)阳性敏感融合外,非表皮生长因子受体(epidermal growth factor receptor,EGFR)敏感突变的非小细胞肺癌(non-small cell lung cancer, NSCLC)脑转移患者目前无有效的全身治疗药物,整体预后较差。由于传统药物血脑屏障透过率低,脑转移的局部治疗尤其是放疗具有非常重要作用。为了更好地认识EGFR突变阴性NSCLC脑实质转移的特点,本文从脑转移的发病率、发病时间、发病部位、病灶数目及大小、发病症状、治疗疗效和病情演变等方面综述了EGFR突变阴性NSCLC脑实质转移的临床特征以及治疗,为脑实质转移局部治疗的介入时机以及局部治疗技术选择提供参考。

抗体偶联药物在肺癌中的研究进展与展望

抗体偶联药物(antibody drug conjugates,ADCs)是一类将特异性单克隆抗体与细胞毒性药物通过接头偶联形成的新型抗肿瘤药物,不仅在乳腺癌、血液系统肿瘤等多个癌种中取得了显著效果,在肺癌中也初见成效。本文通过对ADC的作用原理,在肺癌中的应用,以及面临的问题和挑战等方面进行概述,希望能够给临床工作一些参考。

空气净化干预对学龄儿童血压和心率的影响:一项整群的随机双盲交叉干预试验

空气颗粒物污染是心血管疾病发病和死亡的危险因素,儿童是脆弱人群之一.已有研究显示,室内安装使用空气净化设备可以降低颗粒物浓度,从而改善一般成年人群和老年人群心血管健康,但空气净化设备是否可有效改善儿童心血管健康尚无定论.为了评估空气净化设备使用对儿童血压和心率的影响,本研究基于学龄儿童开展干预周期长达4个月的整群随机双盲交叉干预试验,分别收集干预前和干预后的血压和心率测量数据、暴露数据和健康体检数据,利用双重差分模型进行统计分析,并进一步比较不同性别、体质指数和血压分层儿童间效应的差异.本研究共纳入79名平均年龄为10.6岁的学龄儿童,经过两阶段空气净化干预后发现,干预组教室和家庭内PM_(2.5)浓度低于室外,双重差分模型结果显示,空气净化干预后,儿童脉压差测量值显著降低3.44 mmHg(95%CI:−8.12~−0.11 mmHg).同时,分层分析结果显示,空气净化干预对不同性别和体质指数分层儿童血压和心率的影响存在显著差异.本研究相关结果可为空气净化干预改善儿童心血管健康提供证据,为空气污染相关的儿童心血管健康防护措施选择提供方向.

Ambient Nitrogen Dioxide and Hospitalizations of Full-Spectrum Respiratory Diseases:A National Case-Crossover Study

Few multicity studies have examined the acute effects of nitrogen dioxide(NO_(2))on respiratory disease(RD),especially its specific causes.This study aimed to investigate the associations between short-term exposure to NO_(2)and hospitalization of full-spectrum RDs in China.Hospitalization of 10 major categories and 40 cause-specific RDs were obtained from 20 provinces over the study period of 2013−2020.A time-stratified case-crossover study was conducted at the individual level to explore the associations between NO_(2)and RDs.NO_(2)was significantly associated with increased hospitalization of eight major RDs(acute upper respiratory infections,influenza and pneumonia,acute lower respiratory infections,upper respiratory tract diseases,chronic lower respiratory diseases,respiratory interstitium diseases,pleura diseases,and other respiratory diseases)and 18 specific causes of RDs,with the largest associations observed on lag 0−1 day.The effect estimates ranged from 0.75 to 4.09%per 10μg/m^(3)of NO_(2)exposure.The associations remained robust after controlling for copollutants.The concentration−response curves were mostly positive and linear.This nationwide study provides comprehensive information on the acute effects of NO_(2)on respiratory morbidity across the full spectrum,highlighting the need for caution with regard to this important traffic-related air pollutant in current pollution control programs.

2013~2017年中国空气质量改善与早产疾病负担改变

Preterm birth(PTB)is a leading cause of perinatal mortality and morbidity worldwide[1].Since maternal and fetal health protection has been included in the United Nations Sustainable Development Goals,identification of modifiable risk factors for PTB is particularly crucial.The Global Burden of Disease(GBD)Study 2019 recognized fine particulate matter(PM2.5)pollution as a risk factor for decreased gestational age and low birth weight.

Criteria air pollutants and hospitalizations of a wide spectrum of cardiovascular diseases: A nationwide case-crossover study in China

Few national studies have systemically examined the effects of criteria air pollutants on cardiovascular morbidity.This study aimed to investigate the associations between all criteria air pollutants and hospitalization of causespecific cardiovascular diseases(CVD)in China.We obtained data on CVD hospitalization events of four major categories and 12 specific diseases from 153 hospitals distributed in 20 provincial-level regions from 2013 to 2020.We adopted a time-stratified case-crossover study design using individual cases to capture the effect of short-term exposure to six criteria air pollutants on CVD hospitalizations,using conditional logistic regression models.More than 1.1 million CVD hospitalization events were included.The lag pattern exploration demonstrated the largest effect for six air pollutants on lag 0–1 day.PM_(2.5),PM_(10),NO_(2),and CO were significantly associated with increased hospitalization from ischemic heart diseases,cerebrovascular diseases,other heart diseases,and five specific causes of CVD.The effect estimates of NO_(2)were the most robust when adjusting for copollutants.The concentration-response curves were positive and linear for most pollutant–endpoint pairs(except for O_(3)),and these positive associations remained even below the 24-h levels recommended by WHO Air Quality Guidelines and China Air Quality Standards.This nationwide case-crossover study in China demonstrated that short-term exposure to multiple ambient air pollutants may significantly increase the risk of cause-specific CVD hospitalizations even under the most stringent air quality regulations,striking an alert for potential CVD patients against these environmental risk factors.