【摘要】 目的 探討乳腺惡性淋巴瘤的臨床病理特征、治療方式及其與預后關系。 方法 1980年1月-2007年12月對收治的21例乳腺惡性淋巴瘤患者的臨床病理特點、診斷和治療方法進行回顧性分析。 結果 21例乳腺惡性淋巴瘤患者均為女性，中位年齡47歲；其中原發性乳腺惡性淋巴瘤18例，繼發性惡性淋巴瘤3例。原發性乳腺惡性淋巴瘤均為非霍奇金淋巴瘤，B細胞來源為主，大多為術后診斷，治療均采用手術+化學療法。 結論 乳腺惡性淋巴瘤治療應強調手術，化學療法和放射治療的綜合治療。【Abstract】 Objective To study the clinico-pathological features and treatment modality of malignant breast lymphoma, and their relationships with the prognosis of the disease. Methods The clinico-pathological features, diagnosis and treatment methods of 21 cases of malignant breast lymphoma diagnosed between January 1980 and December 2007 were analyzed retrospectively and related domestic and overseas literature was reviewed. Results Among the 21 female patients, 18 had primary breast lymphoma (PBL), 3 had secondary breast lymphoma. All cases of PBL were non-Hodgkin’s lymphoma with mainly B cells as the origin. The median age of the patients was 46.5 years old. Most of the cases were diagnosed postoperatively and all patients were treated by operation combined with chemotherapy. Related literature reviewing showed that clinical staging and treatment modality were important factors of prognosis. Conclusion In treating malignant breast lymphoma, operation and chemoradiotherapy should be combined together to get a better result.
This study aims to explore the effect of aortic sinus diameter on aortic valve opening and closing performance in the case of no obvious disease of aortic valve and annulus and continuous dilation of aortic root. A total of 25 three-dimensional aortic root models with different aortic sinus and root diameters were constructed according to the size of clinical surgical guidance. The valve sinus diameter DS is set to 32, 36, 40, 44 and 48 mm, respectively, and the aortic root diameter DA is set to 26, 27, 28, 29 and 30 mm, respectively. Through the structural mechanics calculation with the finite element software, the maximum stress, valve orifice area, contact force and other parameters of the model are analyzed to evaluate the valve opening and closing performance under the dilated state. The study found that aortic valve stenosis occurs when the DS = 32 mm, DA = 26, 27 mm and DS = 36 mm, DA = 26 mm. Aortic regurgitation occurs when the DS = 32, 36 and 40 mm, DA = 30 mm and DS = 44, 48 mm, DA = 29, 30 mm. The other 15 models had normal valve movement. The results showed that the size of the aortic sinus affected the opening and closing performance of the aortic valve. The smaller sinus diameter adapted with the larger root diameter and the larger sinus diameter adapted with the smaller root diameter. When the sinus diameter is 40 mm, the mechanical performance of the valve are good and it can well adapt with the relatively large range of aortic root dilation.
Objective To analyze the hot spot and future application trend of artificial intelligence technology in the field of intensive care medicine. Methods The CNKI, WanFang Data, VIP and Web of Science core collection databases were electronically searched to collect the related literature about the application of artificial intelligence in the field of critical medicine from January 1, 2013 to December 31, 2022. Bibliometrics was used to visually analyze the author, country, research institution, co-cited literature and key words. Results A total of 986 Chinese articles and 4 016 English articles were included. The number of articles published had increased year by year in the past decade, and the top three countries in English literature were China, the United States and Germany. The predictive model and machine learning were the most frequent key words in Chinese and English literature, respectively. Predicting disease progression, mortality and prognosis were the research focus of artificial intelligence in the field of critical medicine. ConclusionThe application of artificial intelligence in the field of critical medicine is on the rise, and the research hotspots are mainly related to monitoring, predicting disease progression, mortality, disease prognosis and the classification of disease phenotypes or subtypes.
ObjectiveTo systematically review the efficacy of convalescent plasma (CP) in the treatment of coronavirus disease 2019 (COVID-19). MethodsPubMed, EMbase, The Cochrane Library, VIP, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of CP in the treatment of COVID-19 from inception to September 15th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed using RevMan 5.4.1 software. ResultsA total of 16 RCTs involving 15 301 patients were included. The results of meta-analysis showed that CP treatment did not reduce mortality compared with no-placebo (RR=0.99, 95%CI 0.93 to 1.05, P=0.63) or normal saline (RR=1.06, 95%CI 0.60 to 1.86, P=0.84). However, compared with standard plasma, the mortality of CP group was lower (RR=0.59, 95%CI 0.37 to 0.95, P=0.03). In addition, compared with no-placebo or normal saline, CP treatment could not improve the clinical condition at 28-30 days, reduce mortality at early treatment and in patients without invasive mechanical ventilation when randomized. ConclusionCurrent evidence shows that compared with no-placebo or normal saline, CP does not reduce mortality in patients with COVID-19. However, when the disease progresses to the point where standard plasma is required, CP may reduce mortality. In addition, use of CP in patients with early or non-critical COVID-19 failed to reduce mortality. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Objective To systematically evaluate the efficacy and safety of single and bilateral lung transplantation in the treatment of end-stage chronic obstructive pulmonary disease (COPD). Methods Chinese and English databases were searched by computer, including PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, Wanfang database, VIP database and CBM. Case-control studies on single lung transplantation or bilateral lung transplantation for COPD were collected from the inception to July 31, 2022. We evaluated the quality of the literature via Newcastle-Ottawa Scale (NOS). All results were analyzed using Review Manager V5.3 and STATA 17.0. Results A total of 8 studies were included covering 14076 patients, including 8326 patients in the single lung transplantation group and 5750 patients in the bilateral lung transplantation group. NOS scores were≥6 points. The results of meta-analysis showed that there was no statistical difference in the postoperative 1-year survival between the two groups (P=0.070). The 2-year survival rate (P=0.002), 3-year survival rate (P<0.001), 5-year survival rate (P<0.001), overall survival rate (P＜0.001), postoperative forced expiratory volume in one second/predicted value (P<0.001), postoperative forced vital capacity (P<0.001), and postoperative 6-minute walking distance (P=0.002) were lower or shorter than those in the bilateral lung transplantation group, the postoperative intubation time (P=0.030) was longer than that in the bilateral lung transplantation group. Bilateral lung transplantation group showed better surgical results. There was no statistical difference in the mortality, obliterative bronchiolitis, length of hospitalization, primary graft dysfunction, or postoperative adverse events (P>0.05). Conclusion Bilateral lung transplantation is associated with better long-term survival and postoperative lung function compared with single lung transplantation. In-hospital mortality and postoperative complications are similar between them.
Objective To evaluate the efficacy of Gefitinib for patients with non-small-cell lung cancer (NSCLC). Methods We searched several databases, including MEDLINE (1991 to June 2008), The Cochrane Library (Issue 4, 2008) and CBMDisc (1978 to Feb. 2008). Randomized controlled trials (RCTs) were included in the meta-analyses, which were done using The Cochrane Collaboration’s RevMan 4.2 software. We also included retrospective case reports published in Chinese journals. Results Eight RCTs and 36 uncontrolled case reports were analyzed. The results of the RCTs showed that 250 mg/d Gefitinib had similar efficacy to 500 mg/d, but the side effect was significantly less for the lower dose. When used as a combined first-line treatment or a third-line treatment, Gefitinib was not superior to placebo on response rate, survival rate and life span. When used as second-line treatment, it did not prolong median survival, though it gave a higher response rate than placebo. Gefitinib caused many more side effects than placebo. Gefitinib exhibited similar efficacy to docetaxel in objective response rate [OR 1.18, 95%CI (0.84, 1.67), P=0.35], but was better for symptom and quality-of-life improvement [OR 1.58, 95%CI (1.33, 1.89), Plt;0.00001]. The overall uncontrolled clinical studies showed the following results: complete response rate was 2.2%, partial response rate was 25.8%, disease stable rate was 40.0% and progressive disease rate was 32.0%. The average median survival time was 8.9 months; the average time to progressive disease was 5.2 months, and the 1-year survival rate was 44.2%. The average median survival from EAP studies (6.9 months) was shorter than that for all the studies as well as the registered clinical trials (10.0 months). The average periods to progressive disease for registered clinical trials (3.2 months) and EAP studies (4.4 months) were somewhat shorter than that found for all studies combined, though response rate and 1-year survival rate were similar. Since there was no controlled clinical study, it was hard to conclude from the results whether Gefitinib brought any clinical benefit to NSCLC patients in China. Conclusion Gifitinib is not suitable as a combined first-line treatment or a third-line treatment for NSCLC. The clinical favor from gefitinib in the second-line treatment remains uncertain. There is not enough evidence to show whether Chinese people are more sensitive to Gefitinib, and its use in the second-line treatment of NSCLC needs to be tested further.
目的 系統評價標準桃金娘油治療分泌性中耳炎的療效及安全性。 方法 電子檢索Cochrane圖書館、PubMed、EMBASE、中國期刊全文數據庫（CNKI）、維普（VIP）、中國生物醫學文獻數據庫（CBM）六大數據庫，檢索時間自建庫截止至2012年2月。根據Cochrane協作網手冊評估納入隨機對照試驗（RCT）的方法學質量，采用RevMan 5.0軟件對數據進行Meta分析。 結果 共納入8個RCT，研究結果顯示，標準桃金娘油聯合常規治療分泌性中耳炎的總有效率優于單用常規治療，但差異無統計學意義[RR=1.21，95% CI（0.98，1.50），P=0.08]。 結論 標準桃金娘油治療分泌性中耳炎有一定療效，但并不顯著。因納入研究質量較低，上述結論還需高質量、大樣本的研究進一步驗證。
Objective To systematically evaluate the effectiveness of dasatinib in doses of 140 mg once daily and 70 mg twice daily for chronic myeloid leukemia (CML). Methods The randomized controlled trials (RCTs) were retrieved from Embase (1974 to November 2011), Pubmed (1966 to November 2011), The Cochrane Library (Issue 11, 2011), CBM (1979 to November 2011), VIP (1989 to November 2011), CNKI (1994 to November 2011), Wanfang Data (1997 to November 2011) and references listed in all articles. RCTs meeting inclusive criteria were included, the data were extracted, the quality was evaluated and cross-checked by two reviewers independently according to Cochrane Handbook for Systematic Reviews of Interventions, and then meta-analyses were conducted using RevMan 5.1 software. Results A total of four studies involving two RCTs and 862 patients were included. Results of meta-analyses showed that when dasatinib was used in the long-term treatment of CML, no significant difference was found between 140 mg once daily and 70 mg twice daily in the complete hematologic response (RR=0.97, 95%CI 0.88 to 1.07, P=0.58), complete cytogenetic response (RR=0.94, 95%CI 0.80 to 1.11, P=0.47) and major cytogenetic response (RR=0.99, 95%CI 0.86 to 1.13, P=0.86). In the short-term treatment of CML, there were no significant differences in the complete hematologic response (RR=0.99, 95%CI 0.90 to 1.07, P=0.73), complete cytogenetic response (RR=0.99, 95%CI 0.78 to 1.26, P=0.95) and major cytogenetic response (RR=1.01, 95%CI 0.83 to 1.22, P=0.95). The subgroup analyses on the long-term treatment of CML in both chronic phase and advanced phase showed that there were no significant differences in the complete hematologic response, major cytogenetic response and complete cytogenetic response. Conclusion In the effectiveness of dasatinib for CML, the dose of 140 mg once daily is similar to the dose of 70 mg twice daily. Considering possible moderate selection bias existing in the methodological quality of the included studies which may affect the authenticity of outcomes, this conclusion should be further proved by conducting more high-quality, large-scale and double- blinded RCTs.