ObjectiveTo understand the research advances in molecular classification systems of gastric cancer and explore their clinical application value in precision diagnosis and treatment, as well as future development directions. MethodA literature search was conducted to identify and summarize the classic classification systems, including the Singapore-Duke typing, The Cancer Genome Atlas (TCGA) typing, and the Asian Cancer Research Group (ACRG) typing, as well as novel precision typing frameworks driven by cutting-edge technologies such as single-cell sequencing, spatial transcriptomics, epigenetics, metabolomics, and multi-omics integrative analysis. ResultsGastric cancer is characterized by high heterogeneity, and traditional pathological typing is difficult to meet the requirements of precision diagnosis and treatment. Among the classic molecular classifications, the Singapore-Duke classification classifies gastric cancer into proliferative, mesenchymal, and metabolic subtypes, and which are correlated with drug sensitivity. According to the multi-omics features, the TCGA classification categorizes gastric cancer into four subtypes: Epstein-Barr virus (EBV)-positive, microsatellite instability (MSI), genomically stability (GS), and chromosomal instabilty (CIN), among which EBV-positive and MSI subtypes are associated with the best prognosis, while the GS subtype shows the worst prognosis. The ACRG classification (Asian cohort) categorizes gastric cancer into MSI, microsatellite stable (MSS)/TP53-active, MSS/TP53-inactive, and MSS/epithelial-mesenchymal transition (EMT) subtypes, among which MSI tumors show the best prognosis, and MSS/EMT tumors the worst. Regarding novel frontier classifications, tumor microenvironment ecotypes and cancer-associated fibroblast subpopulations are identified by single-cell and spatial transcriptomics. Additionally, immune consensus subtypes, a PANoptosis-related long non-coding RNA prognostic model, and tumor immune microenvironment classifications, and other subtypes have been constructed through epigenetics, metabolomics, and multi-omics integrative analysis. In clinical translation, different molecular subtypes are matched with corresponding therapeutic strategies, and the combination of molecular classification and TNM staging is enabled to improve the accuracy of prognostic evaluation. ConclusionsMolecular classification of gastric cancer provides a stratification basis for precise diagnosis and treatment, yet its clinical translation still faces challenges such as high technical cost and intratumoral heterogeneity. In the future, relying on artificial intelligence, liquid biopsy, and other technologies, clinically practical subtype-guided individualized therapeutic strategies can be realized.
Objective To evaluate the effectiveness and safety of AAI pacing mode versus DDD pacing mode for treating sick sinus syndrome (SSS). Methods We electronically searched CENTRAL (Issue 2, 2009), MEDLINE (1980 to June 2009), EMbase (1980 to June 2009) and CBM (1990 to June 2009). Randomized controlled trials (RCTs), quasi- RCTs and cross-over studies were identified and assessed, and then RevMan 5.0 software was used to perform metaanalysis. Results A total of 509 patients of six parallel and two crossover RCTs were identified, and the quality of reporting was found poor. Studies showed a statistically significant preference to AAI pacing mode for the reduction of left atrial diameter (MD=2.09, 95%CI 0.22 to 3.97), left ventricular end-diastolic diameter (MD=3.00, 95%CI –1.58 to 7.58), the prevention atrial fibrillation (P=0.026) and the improvement of life quality (Plt;0.05), but with more replacement or remodulation. Non-significant preference was shown to the prevention of all-cause mortality (P=0.51), cardiovascular mortality (P=0.43), stroke (P=0.32) and heart failure (P=0.17), the reduction of left ventricular end-systolic diameter (MD=1.21, 95%CI –0.85 to 3.28) and left ventricular ejection fraction (MD= –2.91, 95%CI –6.53 to 0.70). No significant adverse effects were reported. Conclusion The review shows a trend towards AAI pacing mode compared with DDD pacing mode in terms of effectiveness. However, because of the high bias risk of the included trials, the evidence is insufficient, so more large-sample and high-quality RCTs are needed.
Clinical practice guidelines need to be based on evidence, but traditional Chinese medicine, especially integration of traditional Chinese and Western medicine guidelines, inevitably need to combine clinical research evidence, ancient literature, and expert experience and consensus. In the process of formulating, there are deviations in understanding and application of the expert consensus method and expert experience, resulting in opaque of the recommendations, unclear of the details of the diagnosis and treatment strategy, less prominent of the advantages and value of traditional Chinese medicine, which affects the scientificity, transparency, applicability, promotion and application of the guidelines of traditional Chinese medicine or integration of traditional Chinese and Western medicine. This study discusses the guiding principle of "evidence as a core, consensus as a supplement, and experience as a reference" that was generally followed and puts forward detailed methodological suggestions to the formulation of guidelines for traditional Chinese medicine and integration of traditional Chinese and Western medicine.
In the process of formulation, traditional Chinese medicine clinical practice guidelines are often faced with the dilemma of lack of evidence. Guidelines development groups tend to make final decisions based on expert experience or expert opinion, but the limitations of cognitive bias reduce the credibility and transparency of the guidelines. By clarifying the difference between the expert experience and expert opinion and expert evidence, the expert evidence of traditional Chinese medicine discipline advantages and necessity, providing the recommendation form link using expert evidence methodology design and implementation details, retaining the empirical characteristics of traditional Chinese medicine and improving the lack of evidence, has certain practical application value.