Interpretation of 2023 AHA Scientific Statement:Cancer Therapy Related Hypertension / 医药导报

In January 2023,the American Heart Association(AHA)released A Scientific Statement:Cancer Therapy Related Hypertension,provided an overview of the mechanisms and clinical management of anticancer therapy related hypertension.Contemporary anticancer drugs are mostly at the expense of cardiovascular toxicities,one of the most common side effects is hypertension,especially vascular endothelial growth factor inhibitors,as well as tyrosine kinase inhibitors and proteasome inhibitors.Cancer therapy related hypertension is often dose limiting,and is usually reversible after interruption or discontinuation of treatment.The exact molecular mechanisms underlying hypertension are unclear,recent discoveries indicate an important role for decreased nitric oxide,increased endothelin-1,endothelial dysfunction,increased sympathetic outflow,and microvascular rarefaction.Based on the International Cardio Oncology Society(IC-OS),this article provides an interpretation of the diagnosis and management of hypertension related to cancer treatment.Insufficient evidence exists supporting an antihypertensive medication strategy specific to patients with anticancer therapy induced hypertension,therefore,antihypertensive management should follow current guidelines for the general population..Multidisciplinary cooperation is needed to optimize management to ensure the optimal therapeutic effect from cancer treatment while minimizing competing cardiovascular toxicities.

Research Advances of Anticoagulation on Venous thromboembolism Associated with Gastric Cancer / 医药导报

Patients with gastric cancer are at high risk for venous thromboembolism(VTE)and bleeding,and patients who develop VTE are often associated with poor outcomes,making it clinically challenging to identify and manage the risk of thrombosis in patients with gastric cancer.Risk factors for VTE in gastric cancer patients include age,obesity,surgery,chemotherapy,etc.It is essential to identify high-risk patients and adopt aggressive prevention strategies.The main strategy to prevent and treat VTE is the use of anticoagulant drugs.This article discusses guidelines and recent studies for the prevention and treatment of VTE in patients with gastric cancer to help clinicians make individualized decisions for their patients and maximize clinical outcomes for their patients.

Research Advances on Prophylactic Anticoagulant Therapy for Primary Membranous Nephropathy / 医药导报

Patients with primary membranous nephropathy(PMN)tend to develop thrombosis,especially in the early phase of the disease.The pathogenesis of thrombosis is multifactorial,with hypoalbuminemia being widely regarded as an inde-pendent risk factor.Other factors include proteinuria,M-type phospholipase A2 receptor antibody,and D-dimer.Although prophy-lactic anticoagulation therapy is frequently used in clinical practice to prevent thrombosis in PMN patients,there are still many un-resolved issues regarding the optimal prevention of thrombosis in this condition.The timing of prophylactic anticoagulation,the threshold of serum albumin level,and the choice of treatment regimen are still lacking consensus.This article reviewed the relevant literature on these topics,aiming to establish a standard for thrombosis prevention and treatment for this population in the future and provide guidance for clinical practice.

Interpretation of Acute,Perioperative,and Long-term Antithrombotic Therapy Strategies in the Elderly / 医药导报

In January 2023,the European Society of Cardiology(ESC)Working Group on thrombosis published its 2022 updated consensus document on acute,perioperative,and long-term antithrombotic therapy for the elderly.Since the elderly are often accompanied with multiple organ changes and multiple diseases,the risk of hemorrhagic and ischemic events is increased,and they often take multiple drugs and have poor compliance with treatment,which pose significant challenges to clinical antithrombotic management.This article elaborates on how to assess the risk of thrombosis and bleeding,the treatment strategy of oral antithrombotic drugs,the treatment strategy of parenteral antithrombotic drugs,and the perioperative antithrombotic therapy protocols,with the aim of providing clinicians with references for the treatment of antithrombosis in the elderly.

Principles for the rational use of national key monitoring drugs （the second batch） / 中国药房

In order to strengthen the supervision of the use of drugs in hospitals，the Sichuan Academy of Medical Sciences· Sichuan Provincial People’s Hospital took the lead in compiling the Principles for the Rational Use of National Key Monitoring Drugs （the Second Batch） with a number of experts from multiple medical units in accordance with the Second Batch of National Key Monitoring Rational Drug Use List （hereinafter referred to as “the List”） issued by the National Health Commission. According to the method of the WHO Guidelines Development Manual， the writing team used the Delphi method to unify expert opinions by reading and summarizing the domestic and foreign literature evidence of related drugs， and applied the evaluation， formulation and evaluation method of recommendation grading （GRADE） to evaluate the quality of evidence formed， focusing on more than 30 drugs in the List about the evaluation of off-label indications of drugs， key points of rational drug use and key points of pharmaceutical monitoring. It aims to promote the scientific standardization and effective management of clinical medication， further improve the quality of medical services， reduce the risk of adverse drug reactions and drug abuse， promote rational drug use， and improve public health.

Combined alpha-feto protein and contrast-enhanced MRI imaging features in predicting incidence of microvascular invasion in patients with hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To study the predictive value of combining alpha-feto protein (AFP) with contrast-enhanced MRI imaging features in predicting incidence of microvascular invasion (MVI) in patients with hepatocellular carcinoma.Methods:The data of 206 patients with hepatocellular carcinoma treated at Tianjin Medical University Cancer Institute and Hospital from January 2017 to April 2019 were retrospectively analyzed. There were 179 males and 27 females, with an average age of 58.7 years. The roles of preoperative MRI imaging features and clinical data on predicting the incidence of MVI in patients with hepatocellular carcinoma were evaluated by univariate and multivariate logistic regression analyses. Multivariable regression analysis was then used to plot a nomogram.Results:There were 86 patients (41.7%) with MVI positivity and 120 patients (58.3%) with MVI negativity. Multivariate logistic regression analysis showed that AFP >400 μg/L ( OR=3.318, 95% CI: 1.243-8.855, P=0.017), two-trait predictor of venous invasion (TTPVI) ( OR=13.111, 95% CI: 6.797-28.119, P<0.001), diffusion weighted imaging/T 2 weighted imaging (DWI/T 2WI) mismatch ( OR=17.233, 95% CI: 4.731-44.490, P<0.001), and rim enhancement( OR=5.665, 95% CI: 2.579-18.152, P=0.013) predicted increased risks of MVI in patients with hepatocellular carcinoma. The constructed nomogram directly predicted the risk of MVI in these patients. Conclusions:AFP>400 μg/L, TTPVI, DWI/T 2WI mismatch and rim enhancement were independent risk factors in predicting MVI in patients with hepatocellular carcinoma. This predictive model of MVI which was based on multivariate logistic regression analysis was helpful to clinicians in making individualized treatment plans for patients with hepatocellular carcinoma.

Correlation between MRI features and tumor risk grade in gastrointestinal stromal tumors / 中国肿瘤临床

To investigate the correlation between magnetic resonance imaging (MRI) features and tumor risk grade of gas-trointestinal stromal tumors (GISTs). Methods: Between September 2007 to December 2017, 54 patients who underwent MRI and were pathologically diagnosed in Tianjin Medical University Cancer Institute and Hospital were retrospectively reviewed. We analyzed MRI features including the size, location, shape, boundary, and growth pattern of the tumor; cystic necrosis; metastasis; T1WI and T2WI signal intensities; enhancement signal intensity-time (SIT) curve pattern; and average apparent diffusion coefficient (ADC) val-ues. The MRI features were compared with the tumor risk grade. Results: Of the 54 cases, 16 were of low-risk grade, 13 were of inter-mediate-risk grade, and 25 were of high-risk grade. Statistical analysis showed that tumor size, location, shape, boundary, cystic necro-sis, signal intensity, and average ADC values were correlated with tumor risk grade (P<0.05). However, tumor growth pattern, metasta-sis, and enhancement SIT curve pattern were not correlated with tumor risk grade (P>0.05). GISTs with higher aggressive features were more likely to have larger size, irregular shape, unclear boundary, cystic necrosis, heterogeneous signal intensity, and lower ADC values on MRI. Conclusions: MRI has the potential to predict the risk grade of GISTs before surgery, thereby guiding clinical manage-ment, and evaluating prognosis.

Prognostic value of CT characteristics in crizotinib-treated patients with advanced non-small cell lung cancer / 中国肿瘤临床

Objective: To investigate the prognostic value of chest computed tomography (CT) characteristics in crizotinib-treated pa-tients with advanced non-small cell lung cancer (NSCLC). Methods: Forty-seven patients with advanced ALK-rearranged NSCLC who re-ceived crizotinib treatment from January 2014 to March 2017 were enrolled in this retrospective study. Pre-treatment CT characteris-tics were evaluated. Patients were followed up after crizotinib treatment, and the best overall response and progression-free survival (PFS) were assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST version 1.1). Results: The median PFS of all patients was 10 months. There was no association between CT characteristics and response. In univariate analysis, large tumor size (P=0.009), central type (P=0.002), consolidation of surrounding lung tissue (P=0.002), pleural effusion (P=0.001), and lymphangitic carcino-matosis (P=0.019) suggested a poor prognosis. Multivariate Cox regression analysis showed that location (hazard ratio, 3.219; 95% con-fidence interval: 1.517-6.833; P=0.002) was an independent prognostic predictor. Conclusions: Pre-treatment CT characteristics are useful in predicting the PFS of crizotinib-treated patients with advanced NSCLC harboring ALK rearrangement.

The clinical value of predicting the invasiveness of pulmonary mixed ground-glass nodules by CT quantitative parameters / 中国肿瘤临床

Objective:To discuss the value of CT quantitative parameters in prediction of the invasiveness of pulmonary mixed ground glass nodules(mGGNs).Methods:CT images of 164 patients with pulmonary ground-glass nodules(mGGNs),enrolled in Tianjin Medi-cal University Cancer Institute and Hospital from January 2013 to September 2016,confirmed by surgical pathology were analyzed ret-rospectively.CT quantitative parameters including maximum diameter,largest diameter perpendicular to the maximum diameter,vol-ume on both pulmonary window and mediastinal window,mean CT value and TDR(tumor shadow disappear rate)were evaluated be-tween minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) with ROC and Logistic regression analysis. Re-sults:Logistic regression analysis showed that the maximum diameter of the pulmonary window(OR=3.080,95% CI:1.135-8.355,P=0.027)and the maximum diameter of the mediastinal window(OR=5.881,95%CI:1.634-21.166,P=0.007)independently predicted the invasiveness of mGGNs;the corresponding values of area under the curve of the combination of two parameters were 0.855,with sen-sitivity of 77.61% and specificity of 86.67 %.The cut-off point to the corresponding value of the maximum diameter on pulmonary win-dow and mediastinal window was 1.902cm and 1.273cm,respectively.Conclusions:CT quantitative parameters are helpful in predict-ing the invasiveness of mGGNs.The maximum diameters on both pulmonary window and mediastinal window are independent predic-tors.

The relationship between serum albumin, bilirubin and cognitive impairment in patients with mild cognitive impairment / 实用医学杂志

Objective To investigate the relationship between serum albumin, bilirubin and cognitive impairment in patients with mild cognitive impairment (MCI). Methods Serum albumin, total bilirubin, direct bilirubin, indirect bilirubin were analyzed in 89 cases of MCI and 82 cases of cognitively normal control. All of the cases underwent neuropsychological testing by Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). The risk factors of MCI were subject to Logistic regression analysis. Results The serum level of total bilirubin in MCI group were significantly lower than that in controls (P 0.05). The bilirubin level was positively correlated with MMSE scores and MoCA scores (including attention, delayed recall and abstract) (P 0.05) by using Spearman correlation analysis. Logistic regression analysis showed that age, education level, diabetes and serum bilirubin levels were independent risk factors for MCI. Conclusion Our data show that decreased serum level of bilirubin is positively related to cognitive impairment.

Significance and detection of Aβ42 and P-tau levels in CSF of patients with mild cognitive impairment / 实用医学杂志

Objective To investigate Aβ42 and P-tau levels in cerebrospinal fluid (CSF) of patients with mild cognitive impairment (MCI). Methods CSF of 25 cases of MCI and 14 cases of cognitively normal (CN) were investigated. The CSF levels of Aβ42 and P-tau were detected by ELISA method. Correlation analysis was used to analyze the correlation between P-tau level and MMSE score in MCI. Results The CSF level of Aβ 42 was higher and P-tau was lower in MCI than CN group(P<0.05). P-tau level in MCI was also negatively correlated with MMSE score (P<0.05). Conclusion Aβ42 and P-tau levels in CSF may be valuable biological markers in the diagnosis of MCI. P-tau level in CSF of MCI may be related to the severity of cognitive impairment.