To facilitate the implementation of controlled donation after circulatory death(cDCD)programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation(ECMO)team(Spokes),some countries and Italia...To facilitate the implementation of controlled donation after circulatory death(cDCD)programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation(ECMO)team(Spokes),some countries and Italian Regions have launched a local cDCD network with a ECMO mobile team who move from Hub hospitals to Spokes for normothermic regional perfusion(NRP)implantation in the setting of a cDCD pathway.While ECMO teams have been clearly defined by the Extracorporeal Life Support Organization,regarding composition,responsibilities and training programs,no clear,widely accepted indications are to date available for NRP teams.Although existing NRP mobile networks were developed due to the urgent need to increase the number of cDCDs,there is now the necessity for transplantation medicine to identify the peculiarities and responsibility of a NRP team for all those centers launching a cDCD pathway.Thus,in the present manuscript we summarized the character-istics of an ECMO mobile team,highlighting similarities and differences with the NRP mobile team.We also assessed existing evidence on NRP teams with the goal of identifying the characteristic and essential features of an NRP mobile team for a cDCD program,especially for those centers who are starting the program.Differences were identified between the mobile ECMO team and NRP mobile team.The common essential feature for both mobile teams is high skills and experience to reduce complications and,in the case of cDCD,to reduce the total warm ischemic time.Dedicated training programs should be developed for the launch of de novo NRP teams.展开更多
目的探讨特瑞普利单抗联合FOLFOX方案治疗进展期胃癌的效果及其免疫调节机制。方法选取2021年6月至2023年6月驻马店市中心医院收治的97例进展期胃癌患者纳入研究,按随机数表法分为观察组49例和对照组48例,其中对照组采用FOLFOX方案治疗...目的探讨特瑞普利单抗联合FOLFOX方案治疗进展期胃癌的效果及其免疫调节机制。方法选取2021年6月至2023年6月驻马店市中心医院收治的97例进展期胃癌患者纳入研究,按随机数表法分为观察组49例和对照组48例,其中对照组采用FOLFOX方案治疗者,观察组采用FOLFOX方案+特瑞普利单抗治疗,21 d为一个疗程,持续治疗6个疗程。比较两组患者治疗6个疗程后的治疗效果,以及治疗前、治疗3个疗程和6个疗程后的程序性细胞死亡受体-1(PD-1)/程序性细胞死亡配体-1(PD-L1)信号通路(PD-1蛋白、PD-1 m RNA、PD-L1蛋白、PD-L1 m RNA)、血管新生指标[低氧诱导因子1α(HIF-1α)、血管内皮生长因子(VEGF)、促血管生成素-2(Ang-2)、环氧合酶-2(COX-2)],同时比较两组患者治疗期间的毒副反应以及随访6个月的生存率。结果治疗6个疗程后,观察组患者的疾病控制率为63.27%,明显高于对照组的41.67%,差异有统计学意义(P<0.05)。治疗3个疗程、6个疗程后,观察组患者的PD-1蛋白分别为5.83±1.12、5.77±1.26,明显低于对照组的6.84±1.25、7.11±1.36,PD-1m RNA分别为6.12±1.33、6.01±1.34,明显低于对照组的6.91±1.34、7.20±1.30,PD-L1蛋白分别为6.30±1.05、6.19±1.11,明显低于对照组的7.02±1.33、6.88±1.40,PD-1 mRNA分别为6.41±1.24、6.33±1.25,明显低于对照组的7.19±1.36、7.10±1.38,差异有统计学意义(P<0.05)。治疗3个疗程、6个疗程后,观察组患者的VEGF分别为(224.46±25.25)ng/mL、(150.10±14.14)ng/mL,明显低于对照组的(279.79±30.44)ng/mL、(191.65±16.63)ng/mL,HIF-1α分别为(135.51±16.67)μg/L、(100.10±12.28)μg/L,明显低于对照组的(175.53±18.48)μg/L、(153.53±14.88)μg/L,Ang-2分别为(68.98±7.36)ng/mL、(46.68±5.13)ng/mL,明显低于对照组的(75.51±7.95)ng/mL、(56.64±6.11)ng/mL,COX-2分别为(31.48±4.12)ng/mL、(20.24±3.38)ng/mL,明显低于对照组的(36.64±4.20)ng/mL、(25.74±3.59)ng/mL;差异均有统计学意义(P<0.05)。两组患者治疗6个疗程后的毒副反应发生率与随访期间生存率比较差异均无统计学意义(P>0.05)。结论特瑞普利单抗联合FOLFOX方案治疗进展期胃癌,可阻断PD-1/PD-L1信号通路,增强肿瘤控制效果,且具有较好的安全性。展开更多
文摘To facilitate the implementation of controlled donation after circulatory death(cDCD)programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation(ECMO)team(Spokes),some countries and Italian Regions have launched a local cDCD network with a ECMO mobile team who move from Hub hospitals to Spokes for normothermic regional perfusion(NRP)implantation in the setting of a cDCD pathway.While ECMO teams have been clearly defined by the Extracorporeal Life Support Organization,regarding composition,responsibilities and training programs,no clear,widely accepted indications are to date available for NRP teams.Although existing NRP mobile networks were developed due to the urgent need to increase the number of cDCDs,there is now the necessity for transplantation medicine to identify the peculiarities and responsibility of a NRP team for all those centers launching a cDCD pathway.Thus,in the present manuscript we summarized the character-istics of an ECMO mobile team,highlighting similarities and differences with the NRP mobile team.We also assessed existing evidence on NRP teams with the goal of identifying the characteristic and essential features of an NRP mobile team for a cDCD program,especially for those centers who are starting the program.Differences were identified between the mobile ECMO team and NRP mobile team.The common essential feature for both mobile teams is high skills and experience to reduce complications and,in the case of cDCD,to reduce the total warm ischemic time.Dedicated training programs should be developed for the launch of de novo NRP teams.
文摘目的探讨特瑞普利单抗联合FOLFOX方案治疗进展期胃癌的效果及其免疫调节机制。方法选取2021年6月至2023年6月驻马店市中心医院收治的97例进展期胃癌患者纳入研究,按随机数表法分为观察组49例和对照组48例,其中对照组采用FOLFOX方案治疗者,观察组采用FOLFOX方案+特瑞普利单抗治疗,21 d为一个疗程,持续治疗6个疗程。比较两组患者治疗6个疗程后的治疗效果,以及治疗前、治疗3个疗程和6个疗程后的程序性细胞死亡受体-1(PD-1)/程序性细胞死亡配体-1(PD-L1)信号通路(PD-1蛋白、PD-1 m RNA、PD-L1蛋白、PD-L1 m RNA)、血管新生指标[低氧诱导因子1α(HIF-1α)、血管内皮生长因子(VEGF)、促血管生成素-2(Ang-2)、环氧合酶-2(COX-2)],同时比较两组患者治疗期间的毒副反应以及随访6个月的生存率。结果治疗6个疗程后,观察组患者的疾病控制率为63.27%,明显高于对照组的41.67%,差异有统计学意义(P<0.05)。治疗3个疗程、6个疗程后,观察组患者的PD-1蛋白分别为5.83±1.12、5.77±1.26,明显低于对照组的6.84±1.25、7.11±1.36,PD-1m RNA分别为6.12±1.33、6.01±1.34,明显低于对照组的6.91±1.34、7.20±1.30,PD-L1蛋白分别为6.30±1.05、6.19±1.11,明显低于对照组的7.02±1.33、6.88±1.40,PD-1 mRNA分别为6.41±1.24、6.33±1.25,明显低于对照组的7.19±1.36、7.10±1.38,差异有统计学意义(P<0.05)。治疗3个疗程、6个疗程后,观察组患者的VEGF分别为(224.46±25.25)ng/mL、(150.10±14.14)ng/mL,明显低于对照组的(279.79±30.44)ng/mL、(191.65±16.63)ng/mL,HIF-1α分别为(135.51±16.67)μg/L、(100.10±12.28)μg/L,明显低于对照组的(175.53±18.48)μg/L、(153.53±14.88)μg/L,Ang-2分别为(68.98±7.36)ng/mL、(46.68±5.13)ng/mL,明显低于对照组的(75.51±7.95)ng/mL、(56.64±6.11)ng/mL,COX-2分别为(31.48±4.12)ng/mL、(20.24±3.38)ng/mL,明显低于对照组的(36.64±4.20)ng/mL、(25.74±3.59)ng/mL;差异均有统计学意义(P<0.05)。两组患者治疗6个疗程后的毒副反应发生率与随访期间生存率比较差异均无统计学意义(P>0.05)。结论特瑞普利单抗联合FOLFOX方案治疗进展期胃癌,可阻断PD-1/PD-L1信号通路,增强肿瘤控制效果,且具有较好的安全性。
