Discussion on Pathogenesis and Treatment of Diabetes Mellitus Associated with Novel Coronavirus Infection Based on the Theory of Incubative Pathogen / 浙江中医药大学学报

[Objective]To investigate the traditional Chinese medicine(TCM)theory of diabetes mellitus associated with novel coronavirus infection based on the"theory of incubative pathogen"and to broaden the idea of prevention and treatment.[Methods]Using"theory of incubative pathogen"as the cornerstone and combining ancient and modern literature,the etiology,pathogenesis and treatment methods of diabetes mellitus associated with novel coronavirus infection are analyzed.[Results]The theory of incubative pathogen is a theory that describes that the body feels the evil within the body,and the disease develops when it is overdue,which includes the Chinese medical concept of treating the disease before it occurs in a holistic view.Diabetes mellitus associated with novel coronavirus infection is a miscellaneous disease caused by epidemic and plague evils,medicial poisons lie dormant in the body and develop over a long period of time,and its latent and recurring characteristics are common to those of incubative pathogens.The main mechanism is that dampness and poisonous evils enter the body through the mouth and nose,sink into the membranes,flow through the tri-Jiao,diffuse and do not collect,and become feverish over a long period of time and consume Qi and Yin.The pathogenesis is mainly related to pancreatic β cell injury,inflammatory factor release and steroid induction,all of which are intrinsically related to the doctrine of"theory of incubative pathogen".In the treatment of the infectious period,it is important to support the righteousness and drive away the evil,penetrate the membrane,clear the tri-Jiao,and stop the internal growth of volatile evil.As well as in the recovery period,the combination of clearing heat,benefiting Qi and nourishing Yin,and resolving phlegm and eliminating stasis was used to remove the evil at an early stage and prevent the progression of the disease.[Conclusion]Incubative pathogen is closely related to the development of diabetes mellitus associated with novel coronavirus infection.The discussion of diabetes mellitus associated with novel coronavirus infection based on the theory of incubative pathogen opens up a new way of thinking for its clinical prevention and treatment.

Analysis of the correlation between the anatomical features of patent foramen ovale and right to left shunt / 中国现代医生

@#Objective To investigate the correlation between the anatomical structure of patent foramen ovale(PFO)observed by transesophageal echocardiography(TEE)and the right to left shunt(RLS)grade of contrast-enhanced transthoracic echocardiography(c-TTE).Methods Ninety cases in which the presence of PFO was suggested by TEE examination as a diagnostic criterion from November 2021 to December 2022 in the First Hospital of Nanchang were retrospectively analysed.According to the c-TTE results of patients,the RLS was divided into 4 levels,and the correlation between PFO structural characteristics and RLS grading was analyzed.Results There was a positive correlation between PFO diameter size and RLS grading in resting state(r=0.381,P<0.05);The PFO diameter of patients with hypermobile interatrial septum(HIS)was larger and the difference was statistically significant(P<0.05);The PFO diameter of patients with persistent RLS was larger than that of excited phase patients,and the difference was statistically significant(P<0.05);There was no significant difference in RLS shunt degree between patients with long tunnel and those without long tunnel;There was no significant difference in RLS grade and PFO diameter size under Valsalva state.Conclusion Research has shown that certain anatomical structures of PFO interact with RLS grading,and PFO anatomical structures can also interact with each other(the opening diameter of the foramen ovale with HIS is larger);At the same time,TEE can clearly show the morphological characteristics of PFO and predict the degree of RLS,so as to further evaluate the possibility of ischemic stroke in patients with PFO,and provide more evidence for the indications for foramen ovale closure.

Predicting Pathological Complete Response in Breast Cancer After Two Cycles of Neoadjuvant Chemotherapy by Tumor Reduction Rate: A Retrospective Case-Control Study / 한국유방암학회지

Purpose@#We aimed to identify effectiveness-associated indicators and evaluate the optimal tumor reduction rate (TRR) after two cycles of neoadjuvant chemotherapy (NAC) in patients with invasive breast cancer. @*Methods@#This retrospective case-control study included patients who underwent at least four cycles of NAC at the Department of Breast Surgery between February 2013 and February 2020. A regression nomogram model for predicting pathological responses was constructed based on potential indicators. @*Results@#A total of 784 patients were included, of whom 170 (21.68%) reported pathological complete response (pCR) after NAC and 614 (78.32%) had residual invasive tumors. The clinical T stage, clinical N stage, molecular subtype, and TRR were identified as independent predictors of pCR. Patients with a TRR > 35% were more likely to achieve pCR (odds ratio, 5.396; 95% confidence interval [CI], 3.299–8.825). The receiver operating characteristic (ROC) curve was plotted using the probability value, and the area under the ROC curve was 0.892 (95% CI, 0.863–0.922). @*Conclusion@#TRR > 35% is predictive of pCR after two cycles of NAC, and an early evaluation model using a nomogram based on five indicators, age, clinical T stage, clinical N stage, molecular subtype, and TRR, is applicable in patients with invasive breast cancer.

Construction of preoperative rehabilitation program for gastric cancer patients / 中国实用护理杂志

Objective:To construct a preoperative rehabilitation program for gastric cancer patients, aiming to provide scientific and reasonable preoperative guidance for gastric cancer patients.Methods:On the basis of literature research and expert group meeting, the first draft of the preoperative rehabilitation program for gastric cancer patients was constructed. From October 2021 to January 2022, the Delphi method was used to conduct 2 rounds of expert letter inquiries to 16 experts in related fields from 11 hospitals in Jiangsu Province, and the entries were revised according to the experts′ inquiries.Results:In the two rounds of expert correspondence, the positive coefficients of experts were 88.89% and 100.00%, and the authority coefficients of experts were both 0.88. The coordination coefficients of the items in the two rounds of inquiry were 0.279 and 0.290, respectively. The final program consisted of 3 first-level entries, 11 second-level entries and 32 third-level entries.Conclusions:The scheme constructed in this study is scientific, reliable and applicable, and is worth being promoted further in clinical practice.

Left atrial automated functional myocardial imaging to identify patients with paroxysmal atrial fibrillation at high risk of stroke / 中华超声影像学杂志

Objective:To investigate the risk factors of non-valvular paroxysmal atrial fibrillation (NVPAF) with cerebral ischemic stroke(CIS) and analyze NVPAF by using left atrial automatic imaging (AFILA). Logistic regression model was established for left atrial(LA) function parameters.Methods:A total of 205 patients with NVPAF were included in the study and divided into the NVPAF group without ischemic stroke (154 patients) and the CIS group (51 patients). The clinical baseline data, blood biochemical results and AFILA ultrasound data of all patients were collected. Univariate analysis was performed to compare the above data between the two groups of patients. The independent risk factors were obtained by multivariate logistic regression analysis. Logistic regression model was compared with CHA2DS2-VASc scoring system in terms of area under ROC curve, sensitivity and specificity.Results:There were significant differences in age, CHA2DS2-VASc score, taking anticoagulant drugs, history of hypertension, diabetes and coronary heart disease, LAEF, S_R, S_CT, WBC, NEUT, HCY, UREA, NDD, NT-proBNP, Fibrinogen(Fib), Cardiac troponin I(cTnI) and NLR between the two groups (all P<0.05). The results of multifactor analysis showed that: age, hypertension, S_ CT, UREA, NLR, Fib and cTnI were independent risk factors associated with CIS in patients with paroxysmal atrial fibrillation[ OR value: 1.608 ( P=0.003), 3.821 ( P=0.019), 1.259 ( P=0.001), 1.326( P=0.001), 1.352 ( P=0.011), 1.502 ( P=0.042), 7.651( P=0.001)]. After adjusting for the age, sex and history of hypertension included in CHA2DS2-VASc score, S_CT significantly led to NVPAF complicated with stroke[ OR value 1.259 (1.095-1.447), P=0.001]. The diagnostic efficacy of Logistic regression model is better than that of CHA2DS2-VASc scoring (AUC of 0.931 vs 0.717, 95% CI: 0.896-0.967 vs 0.634-0.799, sensitivity of 0.883 vs 0.755, specificity of 0.849 vs 0.713, all P<0.001). Conclusions:Age, hypertension, S_CT, UREA, NLR, fibrinogen, cTnI are independently associated risk factors for patients with combined CIS; The diagnostic efficacy of Logistic regression model is better than that of CHA2DS2-VASc scoring model.And the sensitivity and specificity are high.

Preliminary Analysis of Influencing Factors of Opioid Analgesics Need Within 48 Hours After Arthroscopic Rotator Cuff Repair / 中国微创外科杂志

Objective To investigate the influencing factors of opioid analgesics need within 48 hours after arthroscopic rotator cuff repair.Methods Clinical data of 90 consecutive arthroscopic rotator cuff repairs by the same operator from March 2017 to July 2022 were retrospectively analyzed.The patients were divided into opioid group(62 patients)and control group(28 patients)according to whether they used opioid analgesics within 48 hours after surgery.The control group consisted of patients who did not use analgesics or who had good analgesic effects with conventional analgesic regimens(non-steroidal anti-inflammatory drugs or non-opioid central analgesics)after surgery,and the opioid group consisted of patients who required opioid analgesics as assessed by the surgeon or who need opioid analgesics because of inefficacy of conventional analgesic regimens.The following factors were selected as independent variables:gender,age(whether≥65 years old),duration of disease(whether≥4 weeks),body mass index(BMI)(whether≥25),occupation(whether employed),with or without a history of smoking and alcohol consumption,hypertension,diabetes,heart disease,and trauma,duration of surgery(whether≤180 min),number of torn tendons(whether≥2),number of screws(whether≥2),large nodular osteophyte,and whether there was moderate-to-severe impingement.Single factor analysis was used to screen the factors influencing the need for opioid analgesics within 48 hours after arthroscopic rotator cuff repair.Results The results of univariate analysis showed that among the above independent variables,only the number of torn tendons≥2 was the factor affecting the need for opioid analgesics within 48 hours after arthroscopic rotator cuff repair(OR = 5.263,P = 0.007).Conclusions Patients with rotator cuff tears with≥2 tendons had more severe pain within 48 hours after rotator cuff repair,requiring opioid analgesics.Focus should be placed on postoperative pain in such patients,and a diverse analgesic regimen should be used early.

Research on the Integration of Local Excellent Traditional Culture into Ideological and Political Education in Medical Colleges and Universities: Taking Fujian as an Example / 中国医学伦理学

The organic integration of local excellent traditional culture and ideological and political education in medical colleges and universities is an important content of deeply studying and implementing General Secretary Xi Jinping’s important discourse of inheriting and enriching the excellent traditional Chinese culture, and promoting the comprehensive integration of Chinese excellent traditional culture into college education. The integration of them is helpful to improve the effectiveness of ideological and political education, enhance the cultural confidence of medical students, and cultivate their professional spirit. Guided by Marxist theory and the methods of "creative transformation and innovative development", a group of typical ideological concepts, moral norms, and humanistic spirits such as patriotism, basic civic ethics, medical professional ethics, and global health concepts were selected, and then targeted integrate them into ideological and political education through specific paths such as basing on classroom teaching, enhancing campus culture, and strengthening social practice to cultivate medical talents with noble medical ethics and exquisite medical skills in the new era.

Reflection on the Integration of Great Anti-epidemic Spirit into the Teaching of Ideological and Political Courses in Medical Colleges:Taking the Course of "Outline of Modern Chinese History" as an Example / 中国医学伦理学

The integration of the great anti-epidemic spirit into the teaching of Outline of Modern Chinese History is an important content of the education and teaching reform of ideological and political courses in medical colleges in the post-epidemic era. The integration of them is helpful for optimizing the discourse system of "Outline" course, strengthening the political function of "Outline" course, and deepening the value guidance of "Outline" course. It is necessary to carefully study the teaching content of the "Outline" course, find out its similarities and integration with the great anti-epidemic spirit, and then, by basing on the main position of the classroom, building a large platform for practice, making good use of new network media and other specific paths, "genetically" embedded the great anti-epidemic spirit, the strong leadership of the Communist Party of China, the Marxist standpoint and methods, the remarkable advantages of the socialist system with Chinese characteristics, and the solid national strength of China into the teaching process, so as to improve the effectiveness of the "Outline" course and cultivate medical talents with firm political stance and noble medical ethics in the new era.

Subcortical Structural Alterations in Autism Spectrum Disorder Aged 12-18 Years Old / 中国医学影像学杂志

Purpose To explore the subcortical structure characteristics in autism spectrum disorder(ASD)aged 12-18 years old and the developmental characteristics of abnormal regions with age.Materials and Methods A total of 102 adolescents aged 12-18 years old meeting the diagnostic criteria for ASD in diagnostic and statistical manual,fifth edition and 42 gender and age matched typically developing controls were enrolled from March 2013 to January 2021 in Peking University Sixth Hospital.Structural magnetic resonance imaging scans were performed on all participants.The freeSurfer software was used to process the 3D T1 images of all participants and segment the subcortical regions.Covariance analysis was performed to compare the volumes of subcortical regions between the two groups.Analysis of variance and covariance were used to explore the developmental differences of brain regions with significant group differences within the ASD and control groups in the age groups of 12-13,14-15 and 16-18,as well as between the ASD and control groups in these age groups.Results Compared to the control group,the volumes of the right caudate,right pallidum,left hippocampus,and corpus callosum anterior region were significantly increased in the ASD group(F=4.522,5.955,7.191,5.326,P<0.05).The volume of the corpus callosum anterior region showed significant differences among the aged 12-13,14-15 and 16-18 years groups of the control group(F=5.248,P=0.01),while there was no significant difference among these three groups of the ASD group(F=2.345,P=0.101).Conclusion Adolescents with ASD aged 12-18 years show abnormalities in multiple subcortical structures,and the developmental characteristics of the corpus callosum anterior region are different from typically developing controls,suggesting that the brains of adolescents with ASD have distinct developmental features.

The influence of application-audit system for doctoral enrollment on scientific research ability and employment development of medical graduate students / 中华医学教育探索杂志

Objective:To investigate and analyze the differences of PhD student scientific research ability, employment and development among types of postgraduate students that admitted by various of doctoral admissions under the perspective of medical students to assess and optimize the existing applications-audit system (AAS).Methods:A self-compiled questionnaire was used to investigate the opinions of medical students at different grades and types on the AAS related issues. Excel and SPSS were used to perform frequency statistics, chi-square test and independent sample t-test. Results:The PhD enrolled from AAS tended to complete the paper-publication at first and second year (38.71%, 12/31; 35.48%, 11/31), while unified enrollment (UE) tended to complete in the second year (33.33%, 10/30) and seven-year degree (SYD) in the third year (40.54%, 15/37) ( P=0.021). In terms of the value of the materials required in the application stage to the doctoral research, 74.19%(23/31) of AAS students and 48.65%(18/37) of SYD students believed that scientific research results were the most helpful to the doctoral research process, while UE believed that English helped the most (26.67%, 8/30), with significant differences among groups ( P=0.002). In terms of fair recognition of enrollment in the application system, 71.53% (304/425) of graduate students believed that AAS for doctoral enrollment was fair. The institution ( P=0.001) and type of master's degree ( P=0.001) significantly affected graduate students' recognition of the fairness of AAS. Conclusion:The degree and speed of dissertation completion of the AAS PhD are prior, reflecting the advantages of AAS in the cultivation of medical doctors' scientific academic ability and achievements. The AAS plays a significant role in enhancing the reserve of high-level scientific researchers in China, and has a high recognition and influence in medical students. In the future, the application examination system will be optimized to create the most suitable way for doctoral enrollment in China.

Adult linear scleroderma with ptosis: a case report and literature review / 中华神经科杂志

Objective:To discuss the clinical features, diagnosis and treatment of linear scleroderma (LS).Methods:A case of LS diagnosed in the Second Hospital of Shandong University in October 20, 2020, was reported and the clinical features and pathological documentation of the disease reported in the literature were reviewed.Results:A 24-year-old woman presented cicatricial alopecia on the left frontoparietal area and facial atrophy for about 10 years. Two years before, she began to suffer ptosis and neurological complaints. Clinical features of different stages of the disease are presented. All 15 patients reported in the literature were analyzed, with a median of 22 years and a male to female ratio of 9∶6. There were 4 cases of linear scleroderma with ipsilateral drooping eyelids and lateral contraction, 3 cases of linear scleroderma with demyelinating lesions, combined with lateral contraction, 3 cases of linear scleroderma combined with lateral atrophy, and 1 case of linear scleroderma with ipsilateral facial spasm. Two cases were with the chest sclerosing spot. Two cases of linear scleroderma were with epileptic seizure and white matter demyelination lesion. Six cases were treated with hormone, 2 cases were treated with methotrexate. One case was treated with both hormone and methotrexate. One case was treated with botulinum toxin. Three cases were treated with surgical correction of eyelid ptosis. One case was treated with ultraviolet A1 radiation phototherapy and 1 case was treated with vitamin therapy.Conclusions:Patients with scleroderma may have ipsilateral facial atrophy, blepharoptosis and facial spasm. Some patients involving the nervous system may have epilepsy and myelitis. And demyelinating lesions can be seen in magnetic resonance imaging. Localized scleroderma may develop into systemic scleroderma. Therefore, it is recommended to combine immunosuppressants as soon as possible to control the development of the disease if necessary.

How first-time platelet donors become regular donors: the influencing factors / 中国输血杂志

【Objective】 To analyze the related factors affecting first-time platelet donors to become regular donors in Guangzhou in 2018, so as to provide reference for the retention of platelet donors. 【Methods】 The data of 4 361 first-time platelet donors in Guangzhou in 2018, including age, gender, initial donation unit, time for the primary and secondary donation were collected. The relevant factors affecting first-time blood donors to become regular donors were analyzed by Logistic regression analysis. 【Results】 Among the influencing factors, first-time donors returned in the first month were more likely to become regular donors (5.569 times that of those did not return)(OR 95% CI: 4.748~6.533, P<0.05). First-time donors who aged 45~60, and initially donated 2 units were more likely to become regular donors than those aged 18~24(1.857 times) (OR 95% CI: 1.413~2.441, P<0.05), and those initially donated only one unit (1.695 time) (OR 95% CI: 1.486~1.933, P<0.05). 【Conclusion】 The returning in the first month, age and initial donation units predict long-term commitment for first-time donors. Encouraging first-time platelet donors to return within 1 month is more likely to convert them into regular blood donors.

Spatial distribution analysis of blood donors′ intended donation addresses based on ArcGIS / 中国输血杂志

【Objective】 To apply the spatial distribution analysis based on ArcGIS software, which has been applied widely in other fields, so as to analyze the intended locations for whole blood donation. 【Methods】 After a random stratified sampling was conducted among blood donors in the 17 donation sites during August 1st, 2021- July 30th, 2022, their intended blood donation locations were collected by an e-questionnaire. Addresses of donors′ intended donation locations were derived for GCJ-02 coordinates form and transformed by pandas module of Python to WGS84 coordinates, which further loaded to ArcGIS Arcmap module using Grouping Analysis for 17 median centers. The addresses of 17 blood donation sites in Guangzhou Blood Center were transformed to WGS84 coordinates and loaded to ArcGIS Arcmap module using the same methods for 3 ring buffer analysis. The criterion for judging whether the two were " matched" was whether the intended blood donation sites were covered by or adjacent to the 3 ring buffer zone of the existing blood donation sites. 【Results】 Of the 17 potential sites obtained from the spatial distribution analysis of 40 523 valid addresses of donors, 8 sites were covered or adjacent to the buffer of the existing donation sites, while the other 9 sites were far away from the existing donation sites. 【Conclusion】 By analyzing the spatial distribution of donors′ intended donation addresses, we can find out the service needs of donors for donating blood conveniently, which can provide basis for further blood donation service optimization.

Fluctuation of peripheral blood levelamongapheresis platelet donors aged 56~60 in Guangzhou / 中国输血杂志

【Objective】 To study and analyze the fluctuation of peripheral blood of apheresis platelet donors aged 56~60, so as to provide data support for safe recruitment and retention of elderly donorsin China. 【Methods】 Elderly apheresisplatelet donors, aged 56~60, donated for 6 769 occasions from 2017 to 2019 in Guangzhou Blood Center were analyzed retrospectively and grouped by gender and age. The fluctuation of peripheral blood was analyzed byone way ANOVA.Further pairwise comparison was carried out by Turky if there were statistical differences. 【Results】 All the peripheral blood levels were statistically significant between men and women aged around 56 (P<0.05). The Plt(×109 / L), RBC(×1012 / L) and Hb(g/L) of women after and before 56 were (274.33±49.47) vs (296.61±44.89), (4.48±0.35) vs (4.4±0.3), and (125.87±9.08) vs (128.33±8.79), respectively, and the differences were statistically significant (P<0.05), while no differences was noticed between them inWBC(×109 / L) and Hct, (6.29±1.36) vs (6.26±1.46) and (0.39±0.05) vs (0.39±0.02), respectively(P>0.05). The RBC(1012 / L), Hb(g/L), WBC(×109 / L) and Hctof men after and before 56 were (4.94±0.39) vs (4.91±0.35), (137.15±12.83) vs (141.29±10.67), (5.77±1.23) vs (6.03±1.26) and (0.42±0.03) vs (0.42±0.03), respectively, and the differences were statistically significant (P<0.05), and no significant difference was noticed in Plt(×109 / L)(283.94±59.63) vs (283.5±62.7)(P>0.05). There was no significant difference in Plt between men and women after 56 (P>0.05). The RBC, Hb and Hct of men around 56 were higher than those of women (P<0.05). The deferral rate of pretransfusion blood testing increased as the platelet donors were older than 56, showing statistical significance(P<0.05). 【Conclusion】 Fluctuation of peripheral blood levelof platelet donors aged 56~60 occurred when they were around 56 years old, but within the normal range.Therefore, blood donation is generally safe under the current policy. As the physiological regulation function of these donors has decreased, the monitoring of peripheral blood routine before and after blood donation needs to be strengthened to ensure blood quality and the health of elderly platelet donors.

Influencing factors related to repeated blood donation among college students in Guangzhou / 中国输血杂志

【Objective】 To investigate the positive and negative influencing factors concerning repeated blood donation among college students, in order to provide reference for the maintenance and retention of college student blood donors. 【Methods】 The questionnaire was made in terms of motivators, barriers and social supports related to repeated blood donation based on relevant literature at home and broad and the results of semi-structured interviews. From November to December 2020, 1 200 college donors from 10 colleges in Guangzhou were selected. The results of questionnaires were analyzed with Chi-square test and multivariate logistic regression by SPSS 26.0. 【Results】 Good for health, shortage of blood, favorable policy concerning blood donation, and blood need of family members were the four motivators of repeated blood donation. The inconvenience of blood donation location and dissatisfaction with blood donation souvenir were the two barriers. In addition, encouragement from classmates and curiosity were the two motivators, and harmful to health was the barrier in first-time college blood donors. 【Conclusion】 Blood banks should strengthen the publicity of blood related knowledge, preferential policies concerning blood donation, and status of blood collection and supply, etc, make full use of the influence of peers and the favorable environment of colleges to form a right atmosphere for blood donation, and enhance the reputation and service of blood banks.

An injectable micelle-hydrogel hybrid for localized and prolonged drug delivery in the management of renal fibrosis

Localized delivery, comparing to systemic drug administration, offers a unique alternative to enhance efficacy, lower dosage, and minimize systemic tissue toxicity by releasing therapeutics locally and specifically to the site of interests. Herein, a localized drug delivery platform ("plum‒pudding" structure) with controlled release and long-acting features is developed through an injectable hydrogel ("pudding") crosslinked

Placebo and nocebo effects in headache treatment / 中华神经科杂志

Randomized placebo-controlled trials are the primary means of evaluating the effectiveness of treatments. Patients experience symptom relief or adverse effects after taking placebo, which is called placebo effects or nocebo effects. The placebo and nocebo effects are particularly common in headache and have an important impact on the results of clinical trials, so it is important to understand its mechanism and influencing factors. This review describes the mechanism, clinical manifestations and risk factors of placebo and nocebo effects in headache treatment, and discusses how to avoid the placebo and nocebo effects on clinical treatment.

Advances in bowel delineation and dose-volume constraint in intensity modulated radiation therapy and 3D conformal radiation therapy for pelvic tumors / 中华放射医学与防护杂志

Intestinal injury is an important toxic response during radiation therapy of pelvic tumors. With the widespread use of precision radiotherapy techniques such as intensity modulated radiation therapy (IMRT), the dose exposed to normal tissues and organs has been significantly reduced. However, the toxic response of the bowel still limits the increase of the dose to the target volume. Therefore, the protection of important organs at risk (OAR), such as the bowel, becomes more and more important while giving adequate irradiated dose to the target volume. Most current studies used loop to contour bowel. For patients who underwent IMRT, the meaningful dose-volume predictors of grade 2 acute intestinal adverse events using bowel loop (small loop + big bowel) delineation included V45 Gy < 50 cm 3,V50 Gy < 13 cm 3, and V55 Gy < 3 cm 3, and the corresponding predicators using bowel bag delineation were V40 Gy < 170 cm 3,V45 Gy < 100 cm 3, and V50 Gy < 33 cm 3.

Updated Bayesian Network MetaAnalysis of Adjuvant Targeted Treatment Regimens for Early Human Epidermal Growth Factor Receptor-2 Positive Breast Cancer / 한국유방암학회지

Purpose@#Combining targeted agents with adjuvant chemotherapy prolongs survival in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients, but also increases the risk of adverse effects. The updated results of 3 randomized controlled trials (RCTs) were reported in 2019. Given the lack of adequate head-to-head pairwise assessment for anti-HER2 agents, network meta-analysis facilitates obtaining more precise inference for evidence-based therapy. @*Methods@#RCTs comparing at least 2 anti-HER2 regimens in an adjuvant setting for HER2-positive early-stage breast cancer (EBC) were included. Hazard ratios for overall survival (OS) and disease free survival (DFS), with respective 95% confidence intervals were pooled for assessment of efficacy. A Bayesian statistical model was used, and odds ratios (ORs) for adverse events (AEs) were used to pool effect sizes. @*Results@#We demonstrated that 1-year trastuzumab plus chemotherapy had increased efficacy compared to shorter or longer treatment duration. The OR of cardiac events gradually increased from 6 months to 1 and 2-year trastuzumab arms, relative to chemotherapy only.Compared to trastuzumab plus chemotherapy, dual HER2-targeting therapies increased DFS, especially for hormone receptor negative patients. Dual anti-HER2 blockade regimens revealed an increased probability of gastrointestinal reactions. As a second agent, pertuzumab showed significantly higher DFS and OS. @*Conclusion@#We conclude that 1-year adjuvant trastuzumab should remain as the standard treatment for HER2-positive EBC patients, as it has greater efficacy and a manageable proportion of AEs. Clinical efficacy can be increased for hormone receptor-negative tumors by including a second HER2-targeted agent to the treatment regimen. For hormone receptorpositive cases with basal disease, it is acceptable to reduce the risk of cardiotoxicity by shortening the duration of trastuzumab.

Updated Bayesian Network MetaAnalysis of Adjuvant Targeted Treatment Regimens for Early Human Epidermal Growth Factor Receptor-2 Positive Breast Cancer / 한국유방암학회지

Purpose@#Combining targeted agents with adjuvant chemotherapy prolongs survival in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients, but also increases the risk of adverse effects. The updated results of 3 randomized controlled trials (RCTs) were reported in 2019. Given the lack of adequate head-to-head pairwise assessment for anti-HER2 agents, network meta-analysis facilitates obtaining more precise inference for evidence-based therapy. @*Methods@#RCTs comparing at least 2 anti-HER2 regimens in an adjuvant setting for HER2-positive early-stage breast cancer (EBC) were included. Hazard ratios for overall survival (OS) and disease free survival (DFS), with respective 95% confidence intervals were pooled for assessment of efficacy. A Bayesian statistical model was used, and odds ratios (ORs) for adverse events (AEs) were used to pool effect sizes. @*Results@#We demonstrated that 1-year trastuzumab plus chemotherapy had increased efficacy compared to shorter or longer treatment duration. The OR of cardiac events gradually increased from 6 months to 1 and 2-year trastuzumab arms, relative to chemotherapy only.Compared to trastuzumab plus chemotherapy, dual HER2-targeting therapies increased DFS, especially for hormone receptor negative patients. Dual anti-HER2 blockade regimens revealed an increased probability of gastrointestinal reactions. As a second agent, pertuzumab showed significantly higher DFS and OS. @*Conclusion@#We conclude that 1-year adjuvant trastuzumab should remain as the standard treatment for HER2-positive EBC patients, as it has greater efficacy and a manageable proportion of AEs. Clinical efficacy can be increased for hormone receptor-negative tumors by including a second HER2-targeted agent to the treatment regimen. For hormone receptorpositive cases with basal disease, it is acceptable to reduce the risk of cardiotoxicity by shortening the duration of trastuzumab.