BACKGROUND Programmed cell death-1(PD-1)inhibitor has been indicated for many types of malignancies.However,these inhibitors also cause immune-related adverse events.Hepatobiliary disorder is a phenotype of immune-rel...BACKGROUND Programmed cell death-1(PD-1)inhibitor has been indicated for many types of malignancies.However,these inhibitors also cause immune-related adverse events.Hepatobiliary disorder is a phenotype of immune-related adverse event affecting 0%–4.5%of patients treated with PD-1 inhibitors.Recent studies have reported PD-1 inhibitor-related sclerosing cholangitis(SC);however,the associated clinical and pathological features are unclear.AIM To evaluate the clinical and pathological features of PD-1 inhibitor-related SC through a systematic review of the literature.METHODS The review,conducted using electronic databases in PubMed,was restricted to the period from January 2014 to September 2019 and focused on case reports/series on PD-1 inhibitor-related SC published in English.We scanned the references of the selected literature to identify any further relevant studies.Six cases previously studied by us,including three that have not yet been published,were included in this review.RESULTS Thirty-one PD-1 inhibitor-related SC cases were evaluated.Median age of patients was 67 years(range,43–89),with a male to female ratio of 21:10.The main disease requiring PD-1 inhibitor treatment was non-small cell lung cancer.Agents that caused PD-1 inhibitor-related SC were nivolumab(19 cases),pembrolizumab(10 cases),avelumab(1 case),and durvalumab(1 case).The median number of cycles until PD-1 inhibitor-related SC onset was 5.5(range,1–27).Abdominal pain or discomfort(35.5%,11/31)was the most frequent symptom.Blood serum tests identified liver dysfunction with a notable increase in biliary tract enzymes relative to hepatic enzymes,and a normal level of serum immunoglobulin G4.Biliary dilation without obstruction(76.9%,20/26),diffuse hypertrophy of the extrahepatic biliary tract(90.5%,19/21),and multiple strictures of the intrahepatic biliary tract(30.4%,7/23)were noted.In 11/23(47.8%)cases,pathological examination indicated that CD8+T cells were the dominant inflammatory cells in the bile duct or peribiliary tract.Although corticosteroids were mainly used for PD inhibitor-related SC treatment,the response rate was 11.5%(3/26).CONCLUSION Some clinical and pathological features of PD-1 inhibitor-related SC were revealed.To establish diagnostic criteria for PD-1 inhibitor-related SC,more cases need to be evaluated.展开更多
目的系统整合护理专业实习生在临床实践中经历患者死亡时的体验,为促进其临终护理教育的发展、提高临床带教水平提供参考依据。方法检索PubMed、Web of Science、CINAHL、Embase、万方数据、维普数据库、中国生物医学文献数据库、中国...目的系统整合护理专业实习生在临床实践中经历患者死亡时的体验,为促进其临终护理教育的发展、提高临床带教水平提供参考依据。方法检索PubMed、Web of Science、CINAHL、Embase、万方数据、维普数据库、中国生物医学文献数据库、中国知网从建库到2022年9月关于护理专业实习生经历患者死亡体验的相关质性研究。由2名研究者独立进行文献质量评价和资料提取。结果纳入了11项研究,提炼出40个研究结果,归纳成5个新类别,并综合成2个整合主题:护理专业实习生采用多元化的调适策略应对复杂的情绪变化,获得个人成长并促进对职业的反思;护理专业实习生觉察到自身不足,渴望获得更多的临终护理教育。结论研究结果反映了国内外不同教育背景下护理专业实习生经历患者死亡后的真实情绪体验和认知变化,为护理专业的教育者对临终护理相关教育的改进和开展提供了参考和依据。展开更多
文摘BACKGROUND Programmed cell death-1(PD-1)inhibitor has been indicated for many types of malignancies.However,these inhibitors also cause immune-related adverse events.Hepatobiliary disorder is a phenotype of immune-related adverse event affecting 0%–4.5%of patients treated with PD-1 inhibitors.Recent studies have reported PD-1 inhibitor-related sclerosing cholangitis(SC);however,the associated clinical and pathological features are unclear.AIM To evaluate the clinical and pathological features of PD-1 inhibitor-related SC through a systematic review of the literature.METHODS The review,conducted using electronic databases in PubMed,was restricted to the period from January 2014 to September 2019 and focused on case reports/series on PD-1 inhibitor-related SC published in English.We scanned the references of the selected literature to identify any further relevant studies.Six cases previously studied by us,including three that have not yet been published,were included in this review.RESULTS Thirty-one PD-1 inhibitor-related SC cases were evaluated.Median age of patients was 67 years(range,43–89),with a male to female ratio of 21:10.The main disease requiring PD-1 inhibitor treatment was non-small cell lung cancer.Agents that caused PD-1 inhibitor-related SC were nivolumab(19 cases),pembrolizumab(10 cases),avelumab(1 case),and durvalumab(1 case).The median number of cycles until PD-1 inhibitor-related SC onset was 5.5(range,1–27).Abdominal pain or discomfort(35.5%,11/31)was the most frequent symptom.Blood serum tests identified liver dysfunction with a notable increase in biliary tract enzymes relative to hepatic enzymes,and a normal level of serum immunoglobulin G4.Biliary dilation without obstruction(76.9%,20/26),diffuse hypertrophy of the extrahepatic biliary tract(90.5%,19/21),and multiple strictures of the intrahepatic biliary tract(30.4%,7/23)were noted.In 11/23(47.8%)cases,pathological examination indicated that CD8+T cells were the dominant inflammatory cells in the bile duct or peribiliary tract.Although corticosteroids were mainly used for PD inhibitor-related SC treatment,the response rate was 11.5%(3/26).CONCLUSION Some clinical and pathological features of PD-1 inhibitor-related SC were revealed.To establish diagnostic criteria for PD-1 inhibitor-related SC,more cases need to be evaluated.
文摘目的系统整合护理专业实习生在临床实践中经历患者死亡时的体验,为促进其临终护理教育的发展、提高临床带教水平提供参考依据。方法检索PubMed、Web of Science、CINAHL、Embase、万方数据、维普数据库、中国生物医学文献数据库、中国知网从建库到2022年9月关于护理专业实习生经历患者死亡体验的相关质性研究。由2名研究者独立进行文献质量评价和资料提取。结果纳入了11项研究,提炼出40个研究结果,归纳成5个新类别,并综合成2个整合主题:护理专业实习生采用多元化的调适策略应对复杂的情绪变化,获得个人成长并促进对职业的反思;护理专业实习生觉察到自身不足,渴望获得更多的临终护理教育。结论研究结果反映了国内外不同教育背景下护理专业实习生经历患者死亡后的真实情绪体验和认知变化,为护理专业的教育者对临终护理相关教育的改进和开展提供了参考和依据。
