Palliative care for end-stage liver disease and acute on chronic liver failure:A systematic review

BACKGROUND End stage liver disease(ESLD)represents a growing health concern characterized by elevated morbidity and mortality,particularly among individual ineligible for liver transplantation.The demand for palliative care(PC)is pronounced in patients grappling with ESLD and acute on chronic liver failure(ACLF).Unfortunately,the historical underutilization of PC in ESLD patients,despite their substantial needs and those of their family caregivers,underscores the imperative of seamlessly integrating PC principles into routine healthcare practices across the entire disease spectrum.AIM To comprehensively investigate the evidence surrounding the benefits of incorporating PC into the comprehensive care plan for individuals confronting ESLD and/or ACLF.METHODS A systematic search in the Medline(PubMed)database was performed using a predetermined search command,encompassing studies published in English without any restrictions on the publication date.Subsequently,the retrieved studies were manually examined.Simple descriptive analyses were employed to summarize the results.RESULTS The search strategies yielded 721 references.Following the final analysis,32 fulllength references met the inclusion criteria and were consequently incorporated into the study.Meticulous data extraction from these 32 studies was undertaken,leading to the execution of a comprehensive narrative systematic review.The review found that PC provides significant benefits,reducing symptom burden,depressive symptoms,readmission rates,and hospital stays.Yet,barriers like the appeal of transplants and misconceptions about PC hinder optimal utilization.Integrating PC early,upon the diagnosis of ESLD and ACLF,regardless of transplant eligibility and availability,improves the quality of life for these patients.CONCLUSION Despite the substantial suffering and poor prognosis associated with ESLD and ACLF,where liver transplantation stands as the only curative treatment,albeit largely inaccessible,PC services have been overtly provided too late in the course of the illness.A comprehensive understanding of PC's pivotal role in treating ESLD and ACLF is crucial for overcoming these barriers,involving healthcare providers,patients,and caregivers.

Portosplenomesenteric vein thrombosis in patients with early-stage severe acute pancreatitis

AIM To investigate the incidence and risk factors of portosplenomesenteric vein thrombosis(PSMVT) in the early stage of severe acute pancreatitis(SAP).METHODS Patients with SAP in a tertiary care setting from January 2014 to December 2016 were retrospectively reviewed. All contrast-enhanced computed tomography(CT) studies were reassessed and reviewed. Clinical outcome measures were compared between SAP patients with and without PSMVT in the early stage of the disease. Univariate and multivariate logistic regression analyses were sequentially performed to assess potential risk factors for the development of PSMVT in SAP patients. A receiver operating characteristic(ROC) curve was generated for the qualifying independent risk factors.RESULTS Twenty-five of the one hundred and forty(17.86%) SAP patients developed PSMVT 6.19 ± 2.43 d after acute pancreatitis(AP) onset. PSMVT was confirmed by contrast-enhanced CT. Multivariate stepwise logistic regression analyses showed that Balthazar's CT severity index(CTSI) scores [odds ratio(OR): 2.742; 95% confidence interval(CI): 1.664-4.519; P = 0.000], hypoalbuminemia(serum albumin level < 25 g/L)(OR: 32.573; 95%CI: 2.711-391.353; P = 0.006) and gastrointestinal wall thickening(OR: 4.367, 95%CI: 1.218-15.658; P = 0.024) were independent risk factors for PSMVT developed in patients with SAP. The area under the ROC curve for Balthazar's CTSI scores was 0.777(P = 0.000), the sensitivity was 52%, and the specificity was 93% at a cut-off value of 5.5.CONCLUSION High Balthazar's CTSI scores, hypoalbuminemia and gastrointestinal wall thickening are independent risk factors for PSMVT developed in the early stage of SAP.

Effects of acupuncture therapy on plasma neuropeptide Y levels and resuscitation in patients with very early stage acute cerebral infarction A randomized controlled study

BACKGROUND： It is known that acupuncture therapy can decrease plasma neuropeptide Y （NPY） levels in patients with cerebral infarction, but different types of acupuncture therapy used in various stages of cerebral infarction have not been evaluated. OBJECTIVE： To explore the effect of acupuncture therapy on resuscitation （Xingnao Kaiqiao） and plasma NPY levels in patients with very early stage acute cerebral infarction. DESIGN, TIME AND SETTING： This case-controlled study was performed at the Affiliated Hospital of the Medical College of the Chinese People＇s Armed Police Force between September 2004 and October 2005. PARTICIPANTS： Sixty patients with acute cerebral infarction of ≤ 6 hours were used in this study. Patients were randomly divided into an acupuncture therapy group （n = 30） and a routine treatment group （n = 30）. Another 30 healthy subjects were used as the control group. METHODS： The acupuncture therapy of Xingnao Kaiqiao used in the acupuncture therapy group was based on routine western medical treatment and was performed at bilateral Neiguan （PCG） using the twirling, reinforcing-reducing method, Renzhong （DU26） using heavy bird-pecking needling, Sanyinjiao （SPG） using reinforcing and reducing by lifting and thrusting the needle, Jiquan （HT1）, Weizhong （BL40） and Chize （LU5） using reinforcing and reducing by lifting and thrusting the needle. The acupuncture lasted for 14 days. Patients in the routine treatment group underwent routine medical treatment and no intervention was given to subjects in the control group. MAIN OUTCOME MEASURES： A 4 mL venous blood sample was obtained at different time points, i.e., immediately after hospitalization, the next morning, 7 and 14 days after treatment, to measure plasma NPY levels pre- and post-treatment using the radio-immunity method. RESULTS： The plasma NPY levels were significantly higher in both the routine treatment group and the acupuncture therapy group than in the control group pre- and post-treatment （P 〈 0.01）. In particular, the plasma NPY levels in both the acupuncture therapy group and the routine treatment group were increased 7 days post-treatment but decreased from 7-14 days post-treatment. In addition, the plasma NPY levels were significantly lower in the acupuncture therapy group than in the routine treatment group on day 7 and 14 post-treatment （P 〈 0.01）. CONCLUSION： Acupuncture therapy of Xingnao Kaiqiao can decrease plasma NPY levels in patients with very early stage acute cerebral infarction. In addition, the therapeutic effect of acupuncture with a prolonged therapy time is superior to routine treatment.

Dual-stage Optimal Iterative Learning Control for Nonlinear Non-affine Discrete-time Systems

根据沿着重复轴的一种新动态 linearization 技术，双阶段的最佳的反复的学习控制为非线性、非仿射的分离时间的系统被介绍。双阶段显示二个最佳的学习阶段分别地被设计反复地改进控制输入顺序和学习获得。主要特征是控制器设计和集中分析仅仅取决于动态系统的 I/O 数据。换句话说，没有知道系统的任何另外的知识，我们能容易选择控制参数。模拟学习沿着重复轴说明介绍方法的几何集中，在哪个马路的一个例子控制为它的内在的工程重要性是引人注目的交通反复的学习。

Prognostic Factors for Survival of Stage IB Upper Lobe Non-small Cell Lung Cancer Patients: A Retrospective Study in Shanghai, China

Objective: To identify clinical and pathologic factors that were associated with the survival of stage IB upper lobe non-small cell lung cancer (NSCLC) patients. Methods: A retrospective study of 147 subjects who had undergone curative resection for stage IB upper lobe NSCLC was performed. Patients who had received any adjuvant or neo-adjuvant chemotherapy were excluded. Survival function curves were estimated using the Kaplan-Meier procedure. Crude and adjusted hazard ratios (HRs) of potential prognostic factors were estimated using Cox proportional hazards models. Results: Five factors, including age, tumor size, histologic grade of differentiation, number of removed superior mediastinal lymph node stations and presence of visceral pleura invasion, were significantly and independently associated with mortality risk. Adjusted HRs were 2.6 [95% confidence interval (95% CI): 1.1?6.5] and 4.6 (95% CI: 1.9?11) for those aged 58?68 years and those >68 years, respectively, relative to those aged <58 years. HRs for those with poorly and moderately differentiated tumors were 6.4 (95% CI: 2.3?18) and 1.4 (95% CI: 0.7?2.8), respectively. HRs for those with tumor size 3.1?5 cm and >5 cm (vs ?3.0 cm) were 2.3 (95% CI: 1.1?4.9) and 4.3 (95% CI: 1.9?10), respectively. The presence of visceral pleura invasion also increased the risk of mortality (HR=4.0, 95% CI: 1.3?12). Conclusion: Advanced age, larger tumor size, poorly differentiated histology, smaller number of removed superior mediastinal lymph node stations, and presence of visceral pleura invasion were associated with poor survival of surgically treated stage IB upper lobe NSCLC patients.

Successful Treatment of Postpeak Stage Patients with ClassⅡ Division 1 Malocclusion Using Non-extraction and Multiloop Edgewise Archwire Therapy: A Report on 16 Cases

Aim To determine cephalometrically the mechanism of the treatment effects of non-extraction and multiloop edgewise archwire （MEAW） technique on postpeak Class Ⅱ Division 1 patients. Methodology In this retrospective study, 16 postpeak Class Ⅱ Division 1 patients successfully corrected using a non-extraction and MEAW technique were cephalometrically evaluated and compared with 16 matched control subjects treated using an extraction technique. Using CorelDRAW software, standardized digital cephalograms preand post-active treatments were traced and a reference grid was set up. The superimpositions were based on the cranial base, the mandibular and the maxilla regions,and skeletal and dental changes were measured. Changes following treatment were evaluated using the paired-sample t-test. Student＇s t-test for unpaired samples was used to assess the differences in changes between the MEAW and the extraction control groups. Results The correction of the molar relationships comprised 54% skeletal change （mainly the advancement of the mandible） and 46% dental change. Correction of the anterior teeth relationships comprised 30% skeletal change and 70% dental change. Conclusion The MEAW technique can produce the desired vertical and sagittal movement of the tooth segment and then effectively stimulate mandibular advancement by utilizing the residual growth potential of the condyle.

Timing and Clinical Efficacy of Laparoscopic Cholecystectomy for Acute Cholecystitis at Different Stages

Objective:To investigate timing and clinical efficacy of laparoscopic cholecystectomy for acute cholecystitis at different stages.Methods:Clinical data of 100 acute cholecystitis patients admitted to our hospital from March 2018 to March 2019 were retrospectively analyzed.Clinical data of 48 patients who had surgery within 72 hours of symptom onset were classified as group A,and clinical data of 52 patients who had surgery at≥72 hours of symptom onset were classified as group B.Clinical indicators,rate of conversion to open surgery,and complication were compared between the two groups.Results:Length of hospital stay,operation time,exhaust time and intraoperative blood loss in group A were lower than those in group B,and the differences were statistically significant(P<0.05).Comparison of rate of conversion to open surgery between group A(2.08%,1/48)and group B(7.69%,4/52)showed no statistically significant difference(P>0.05).Incidence of postoperative complication was 8.33%(4/48)in group A and 11.54%(6/52)in group B,the difference was not statistically significance(P>0.05).Conclusions:Laparoscopic cholecystectomy within 72 hours of symptom onset has better efficacy than after 72 hours for patients with acute cholecystitis.It could effectively reduce surgical trauma and promote recovery.

Clinical outcomes in patients with stage non-seminomatous germ cell cancer

This study assesses the long-term outcomes in Han Chinese patients with clinical stage I non-seminomatous germ cell testicular cancer （CSI NSGCT） treated with surveillance, retroperitoneal lymph node dissection （RPLND） and adjuvant chemotherapy. We retrospectively evaluated 89 patients with a mean age of 26.5 years. After orchiectomy, 37 patients were treated with surveillance, 34 underwent RPLND and 18 were managed with chemotherapy. The overall survival rate, the recurrence-free survival rate and the risk factors were evaluated. The median follow-up length was 92 months （range： 6-149 months）. Thirteen of the 89 patients （14.6%） had relapses, and one died by the evaluation date. The overall survival rate was 98.9%. The cumulative 4-year recurrence-free rates were 80.2%, 92.0% and 100% for the surveillance, RPLND and chemotherapy groups, respectively. The disease-free period tended to be briefer in patients with a history of cryptorchidism and those with stage Is. Therefore, surveillance, RPLND and adjuvant chemotherapy might be reliable strategies in compliant patients with CSI NSGCT. Surveillance should be recommended for patients with the lowest recurrence rate, especially those without lymphovascular invasion. This study might aid the establishment of a standard therapy for CSI NSGCT in China.

Cell Origin Subtypes Predict Outcomes in Localized-Stage Diffuse Large B-Cell Lymphoma Treated with Curative Radiotherapy

Diffuse large B-cell lymphoma (DLBCL) is regarded as a heterogeneous group of lymphomas. The aims of this study were to determine the clinical significance and prognostic value of different immunophenotypic profiles in localized-stage head and neck DLBCL treated with curative radiotherapy. We included 102 localized-stage head and neck DLBCL patients in this study. We classified DLBCL patients into germinal center B-cell (GCB) and non-GCB groups by immunohistochemical analysis. Statistical analysis was used to correlate the GCB and non-GCB subgroups, CD5 and Ki67 expression, B-ALPS (a modified International Prognostic Index for early stage lymphoma), chemotherapy regimen, and sex. Multivariate analysis was performed using the Cox proportional hazard regression model to compare cause-specific survival (CSS) and relapse-free rate (RFR) distributions. The cell of origin classification (GCB or non-GCB subtypes) was an independent predictor of CSS (p = 0.040) and RFR (p = 0.023). In the non-GCB group, chemotherapy with rituximab was an independent predictor of CSS. In conclusion, this study shows that the prognosis of the non-GCB group was significantly poorer than that of the GCB group, and that rituximab improved CSS in localized-stage head and neck DLBCL, especially in the non-GCB group.

针刺联合艾灸治疗急性期周围性面瘫的疗效观察

目的 观察针刺联合艾灸治疗急性期周围性面瘫的临床疗效。方法 将60例急性期周围性面瘫患者随机分为治疗组和对照组,每组30例。对照组采用针刺联合药物治疗,治疗组在此基础上采用按摩灸治疗。观察两组治疗前后面部House-Brackmann(H-B)面神经功能分级、肌电图、面部残疾指数(facial disability index,FDI)量表评分变化,比较两组治疗前后炎性因子[超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白细胞(white blood cell, WBC)计数、中性粒细胞与淋巴细胞的比值(neutrophil-to-lymphocyte ratio, NLR)和血小板与淋巴细胞的比值(platelet-to-lymphoccyte ratio, PLR)]变化,并比较两组临床疗效。结果 治疗组总有效率为96.7%,对照组总有效率为86.7%,两组比较差异有统计学意义(P<0.01)。两组治疗后H-B面神经功能分级优于治疗前(P<0.05),且治疗组的H-B面神经功能分级优于对照组(P<0.05)。两组治疗后口轮匝肌、眼轮匝肌、额肌肌电图潜伏期明显低于治疗前(P<0.05),治疗组低于对照组(P<0.01)。两组治疗后口轮匝肌、眼轮匝肌、额肌患健侧肌电图波幅比值高于治疗前(P<0.01),治疗组高于对照组(P<0.01)。两组治疗后FDI躯体功能评分(facial disability index physical function,FDIP)和社会功能评分(facial disability index social function, FDIS)评分优于治疗前(P<0.01),治疗组优于对照组(P<0.01)。两组治疗后炎性因子水平低于治疗前(P<0.05),治疗组低于对照组(P<0.05)。结论 在药物治疗的基础上,针刺联合艾灸可有效促进急性期周围性面瘫患者面神经功能和社会功能的恢复,疗效优于单纯针刺治疗,其机制可能与改善急性期面神经炎症反应有关。

Estimating a Finite Population Mean under Random Non-Response in Two Stage Cluster Sampling with Replacement

Non-response is a regular occurrence in Sample Surveys. Developing estimators when non-response exists may result in large biases when estimating population parameters. In this paper, a finite population mean is estimated when non-response exists randomly under two stage cluster sampling with replacement. It is assumed that non-response arises in the survey variable in the second stage of cluster sampling. Weighting method of compensating for non-response is applied. Asymptotic properties of the proposed estimator of the population mean are derived. Under mild assumptions, the estimator is shown to be asymptotically consistent.

Hypofractionated Radiotherapy for Stage I Non-small Cell Lung Carcinoma in Patients Aged 75 Years and Older

Purpose: We report our single-institution experience using hypofractionated radiotherapy in a patient population 75 years and older diagnosed with stage IA or IB (T1/T2 N0) Non-Small Cell Lung Carcinoma. Materials and methods: This is a single-institution, retrospective analysis examining disease free and overall survival and toxicity after hypofractionated radiation therapy in a patient population 75 years and older diagnosed with stage IA or IB (T1/T2 N0) NSCLC. Between 1991 and 2005, a total of 33 such patients were identified with a median age of 79 years. Patients were treated with a median total dose of 7000 cGy using median daily dose fractions of 250 cGy. Analysis of competing risks (local failure, distal failure or death as the first event) was performed and cumulative incidence functions (CIF) were estimated. Results: The median length of follow-up was 19.8 months (range: 4.3 - 103.8 months). Of the 33 patients treated, 21 (63.6% of total) had no evidence of disease recurrence on follow-up imaging over the course of the study. Of the 12 patients with disease recurrence, 6 (18.2% of total) had local failure as the first event and 6 (18.2% of total) had distant metastasis as the first event. Analysis of competing risks showed that at 5 years, the probability of local failure as the first detected event was 19.5% (95%CI: 7.6%, 35.6%);the probability of distal failure as the first detected event was 21.5% (95%CI: 7.9%,39.4%);and the probability of death without recording a failure was 44.1% (95%CI: 26.1%, 60.7%). There were no treatment related deaths reported. Conclusions: Elderly patients diagnosed with stage I non-small cell lung cancer may safely be offered hypofractionated radiotherapy as an effective option with curative intent.

Nonlinear Modeling for a Two-Stage Degradation System Based on Nonhomogeneous Poisson Process

The degradation process modeling is one of research hotspots of prognostic and health management(PHM),which can be used to estimate system reliability and remaining useful life(RUL).In order to study system degradation process,cumulative damage model is used for degradation modeling.Assuming that damage increment is Gamma distribution,shock counting subjects to a homogeneous Poisson process(HPP)when degradation process is linear,and shock counting is a non-homogeneous Poisson process(NHPP)when degradation process is nonlinear.A two-stage degradation system is considered in this paper,for which the degradation process is linear in the first stage and the degradation process is nonlinear in the second stage.A nonlinear modeling method for considered system is put forward,and reliability model and remaining useful life model are established.A case study is given to validate the veracities of established models.

安罗替尼联合一线化疗治疗晚期非小细胞肺癌的效果

目的研究安罗替尼联合化疗一线治疗晚期非小细胞肺癌(NSCLC)的价值。方法回顾分析2018年3月至2022年5月郑州大学第五附属医院收治的90例晚期NSCLC患者资料,其中45例接受单纯一线化疗的患者纳入对照组,45例联合安罗替尼治疗的患者纳入观察组。两组均连续治疗4个化疗周期。记录两组治疗效果、肿瘤标志物水平[细胞角蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原(CEA)和神经元特异性烯醇化酶(NSE)]、生存情况、不良反应发生情况。结果治疗后,观察组治疗总有效率高于对照组(P<0.05)。治疗前,两组CYFRA21-1、NSE、CEA差异无统计学意义(P>0.05);治疗后,两组CYFRA21-1、NSE、CEA均降低,且观察组低于对照组,差异有统计学上的意义(P<0.05)。观察组生存时间长于对照组,生存率高于对照组,差异有统计学上的意义(P<0.05)。治疗期间,两组不良反应发生率差异无统计学意义(P>0.05)。结论安罗替尼联合化疗一线治疗晚期NSCLC可以进一步提高效果,降低肿瘤标志物水平,有助于延长患者生存时间,且不会增加不良反应,安全性较好。

地中海饮食模式和急性非ST段抬高型心肌梗死发生风险的关系研究

目的探讨地中海饮食模式与急性非ST段抬高型心肌梗死(NSTEMI)发生风险的相关性。方法本研究是一项单中心大型病例对照研究。收集2017年1月至2020年12月在首都医科大学附属北京安贞医院首次确诊为急性NSTEMI的患者600例作为急性NSTEMI组。根据年龄、性别进行1∶1匹配选取同期本院体检中心健康体检者600人作为对照组。比较2组一般资料。根据饮食频率调查问卷计算出改良地中海饮食评分(AMEDS)。将所有受试者按AMEDS分为AMEDS<4分组、AMEDS 4~5分组和AMEDS≥6分组。分析总体及不同AMEDS组的急性NSTEMI发生风险,分析AMEDS中不同种类食物与急性NSTEMI发生风险的相关性。结果急性NSTEMI组有高血压病、糖尿病病史的患者比例、收缩压、体重指数、目前吸烟者比例均高于对照组,家庭收入≥120000元/年的比例、AMEDS均低于对照组,差异均有统计学意义(均P<0.05)。相对于AMEDS<4分组的受试者而言,AMEDS 4~5分组以及AMEDS≥6分组受试者急性NSTEMI发生风险明显降低(调整年龄、性别、受教育年限、家庭年收入、病史、体重指数、血压、血红蛋白、生活方式等多个协变量后的多因素分析比值比=0.72,95%置信区间:0.53~0.94,P=0.031;比值比=0.62,95%置信区间:0.47~0.84,P=0.008)。将患者按年龄和性别进行分层,多因素回归分析后发现,随AMEDS增加,急性NSTEMI发生风险降低的趋势在男性和年龄<60岁的人群依然存在(均P<0.05),在女性和≥60岁的人群中,趋势差异无统计学意义(均P>0.05),同时分层之间交互性分析后差异均无统计学意义(均P>0.05)。AMEDS食物种类分析结果显示,蔬菜、鱼类降低急性NSTEMI发生风险,红肉或加工肉类增加其发生风险(比值比=0.51,95%置信区间:0.42~0.66,P<0.001;比值比=0.75,95%置信区间:0.59~0.94,P=0.010;比值比=1.51,95%置信区间:1.21~1.90,P<0.001)。结论地中海饮食模式和急性NSTEMI的发生相关,改良地中海饮食的高依从性可能降低急性NSTEMI的发生风险。

Immunotherapy in Early Stage Non-Small Cell Lung Cancer

Immune-checkpoint inhibitors are extensively used in cancer treatment and have transformed the therapeutic landscape by inducing durable responses. Immunotherapy with checkpoint inhibitors targeting programmed death 1 (PD-1) receptor and programmed death ligand-1 (PDL-1) are used alone or with chemotherapy for treatment of metastatic non-small cell lung cancer (NSCLC). There is a great need for improving outcomes of patients with early stage NSCLC after surgical resection and with recent F. D. A. approval, immune checkpoint inhibitors are used as neoadjuvant or adjuvant therapy to enable curative resection and prevent or delay disease progression. In this article, we review the clinical studies evaluating the role of adjuvant and neoadjuvant immune checkpoint inhibitors in NSCLC and discuss the role of immunotherapy with radiation therapy in locally advanced non-metastatic NSCLC.

替雷利珠单抗联合化疗一线治疗中晚期非小细胞肺癌的临床研究

目的探讨中晚期非小细胞肺癌患者在化疗一线治疗的基础上联合使用替雷利珠单抗的临床效果。方法选取2020年6月—2023年6月滨州市中心医院肿瘤科行化疗一线治疗的320例中晚期非小细胞肺癌患者为研究对象,以随机数表法分为对照组(160例)和观察组(160例),对照组采取PP(顺铂+培美曲塞)、GP(顺铂+吉西他滨)、NP(顺铂+长春瑞滨)或TP(顺铂+紫杉醇)化疗,观察组在对照组基础上联合使用替雷利珠单抗,治疗3个周期后,比较两组近期疗效和肿瘤标志物水平。结果观察组的疾病控制率和客观有效率分别为88.13%、63.75%,高于对照组的64.38%、33.75%,差异有统计学意义(P均<0.05)。化疗3个周期后,观察组的癌抗原125、癌胚抗原、鳞状上皮细胞癌抗原、细胞角蛋白19的可溶性片段水平均低于对照组,差异有统计学意义(P均<0.05)。结论在化疗一线治疗的同时合理应用替雷利珠单抗能够有效提高近期疗效,并显著降低肿瘤标志物指标水平,具有临床应用价值。

Effect of TCM Combined with Chemotherapy on Immune Function and Quality of Life of Patients with Non-small Cell Lung Cancer inStage Ⅲ-Ⅳ

Objective: To observe and compare the effect of traditional Chinese medicine (TCM) combined with chemotherapy (CT) on immune function and quality of life (QOL)of patients with non-small cell lung cancer (NSCLC) in stage Ⅲ-Ⅳ. Methods: One hundred cases with stage Ⅲ-Ⅳ NSCLC were randomly divided into two groups. The treated group (n=50) received CT combined with TCM, and the control group received CT alone. The percentage of T lymphocyte subset in peripheral blood and the change of natural killer (NK) cell count were observed after treatment. The QOL and tolerance of CT were also compared between the two groups after treatment. Results: In the treated group, CD3 cell count, CD4 cell count, CD4/ CDg ratio and NK cell activity were higher than those in control group, while CD8 cell count in the treated group was lower than that in the control group (P<0.05), and QOL and tolerance of CT in the treated group were also better (P<0.05). Conclusion: TCM combined with CT could raise the patients' ability in tolerating CT in stage Ⅲ-ⅣNSCLC.

不同分期痛风性关节炎患者NALP3炎性体及外周血γδT细胞水平观察

目的观察不同分期痛风性关节炎(GA)患者NALP3炎性体及外周血γδT细胞水平。方法回顾性选取2022年7月至2023年7月在河北省沧州中西医结合医院接受治疗的96例GA患者作为研究对象。依据GA临床分期,分为急性关节炎期组(n=38)、间歇期组(n=26)、慢性关节炎期组(n=32)。另选取同期于本院体检中心体检的健康者35名设为对照组。观察各组NALP3炎性体及外周血γδT细胞水平,分析各组GA患者的临床指标,包括血尿酸、血肌酐、总胆固醇、甘油三酯、血清C反应蛋白(CRP)水平及白细胞计数(WBC)。采用Pearson相关性分析急性关节炎期患者外周血γδT细胞及其亚型、NALP3炎性体与临床指标的关系。结果各组NALP3、γδT1细胞比较,差异均无统计学意义(P>0.05);各组Caspase-1、ASC、γδT细胞、γδT2细胞比较,差异均有统计学意义(P<0.05),其中,急性关节炎期组、间歇期组、慢性关节炎期组Caspase-1水平均高于对照组,γδT细胞和γδT2细胞比例均低于对照组,且病情程度越高,Caspase-1水平越高,γδT细胞和γδT2细胞比例越低;急性关节炎期组、间歇期组、慢性关节炎期组ASC水平均高于对照组,但急性关节炎期组低于间歇期组、慢性关节炎期组,差异均有统计学意义(P<0.05)。各组总胆固醇、甘油三酯、CRP水平比较,差异均无统计学意义(P>0.05);各组血尿酸、WBC、血肌酐水平比较,差异均有统计学意义(P<0.05),其中,急性关节炎期组、间歇期组、慢性关节炎期组的血尿酸、WBC、血肌酐水平均高于对照组,差异均有统计学意义(P<0.05),且病情程度越高,血尿酸、WBC、血肌酐水平越高。相关性分析显示,γδT细胞在淋巴细胞中的比例及γδT1细胞在γδT细胞中的比例与血尿酸、血肌酐、总胆固醇、甘油三酯、WBC、CRP指标无明显相关性;γδT2在γδT细胞中的比例与甘油三酯、WBC呈负相关(P<0.05)。相关性分析显示,NALP3 mRNA表达与血肌酐、总胆固醇、甘油三酯、WBC指标无明显相关性;与血尿酸、CRP呈正相关(P<0.05)。结论NALP3炎性体及外周血γδT细胞参与GA的发展,Caspase-1、γδT细胞和γδT2细胞可作为痛风的急性炎症标记物,而ASC不能作为痛风的急性炎症标记物,同时γδT2在γδT细胞中的比例与甘油三酯、WBC呈负相关,NALP3 mRNA表达与血尿酸、CRP呈正相关,为临床病情评估和治疗提供参考。

从“急性虚证”理论探析急危重症辨治

“急性虚证”理论是基于急危重症所具有的特殊正气虚损状态及其发生发展过程提出的涵盖病因病机、治则治法的当代中医理论,对各种急危重症救治具有重要指导意义。脓毒症以正虚邪盛为基本病机,以补虚、扶正、固本为主要治则,早期扶正、祛邪兼顾补虚,可阻止病情进行性恶化;急性脑卒中基本病机是气血、阴精亏虚,在此基础上病理产物积聚,遇诱发因素而突然发病,治疗当扶正祛邪、标本兼顾,尤其重视及早应用扶助元气药;重症急性胰腺炎以正脱邪陷、气阴两虚为主要病机,治疗以补气养阴为基本治则,应用参麦注射液可调节免疫、保护器官功能,改善预后。“急性虚证”理论强调重视正气,“早期扶正、积极扶正”对急危重症救治具有重要临床价值。