Objective To assess the effectiveness of letrozole in ovulation induction treatment. Methods We searched CBMdisc (1979 to 2009), Wanfang (1994 to 2009), CNKI (1994 to 2009), VIP(1989 to 2009), PubMed (1997 to 2009), PML (1997 to 2009), FMJS(2000 to 2009) and 9 relevant journals to identify randomized controlled trails (RCTs) comparing letrozole with clomiphene citrate in ovulation induction treatment. The quality of the included trials was critically appraised. RevMan 4.2.7 software was used for statistical analyses. Results Ten RCTs involving 3100 patients were included, among which 5 RCTs were graded A, 4 were graded B, and 1 was graded C. Five RCTs showed that endometrial thickness at the time of human chorionic gonadotrophin (HCG) administration in the letrozole group was significantly higher than that in the clomiphene group. One RCT showed that endometrial thickness at the time of HCG administration in the letrozole group was significantly lower than that in the clomiphene group. Three RCTs showed no significant differences between the two groups. Four RCTs showed that the number of dominant follicle at the time of HCG administration in the letrozole group was signficantly lower than that in the clomiphene group. One RCT showed that the number of dominant follicle at the time of HCG administration in the letrozole group was significantly higher than that in the clomiphene group. Two RCTs showed no significant differences between the two groups. Compared with clomiphene citrate, the pregnancy rate in the letrozole monotherapy group was slightly lower at the RR 1.03 and 95%CI 0.82 to 1.29, pregnancy rate in the combination group was higher at RR 1.73 and 95%CI 1.37 to 2.18. The ovulation rate in the letrozole group was higher and no significant differences were found between the two groups at RR 1.23 and 95%CI 0.97 to 1.57. Conclusions There may be differences between letrozole and clomiphene citrate in ovulation induction treatment in terms of endometrial thickness, number of dominant follicle, ovulation rate, and pregnancy rate, but no significant differences. Letrozole can make up for the shortcomings of clinical clomiphene in ovulation induction and serve as an alternative. This conclusion needs to be further confirmed through more well-designed, multi-centered, large-sample RCTs.
ObjectiveTo examine the high-risk factors and prognosis of patients with superior interlobar lymph nodes (11s nodes) metastasis in non-small cell lung cancer (NSCLC) located in the right middle or lower lobe.MethodsThe clinical data of 157 patients with NSCLC in the right middle or lower lobe from January 2015 to July 2020 in our hospital were retrospectively analyzed, including 98 males and 59 females aged 23-86 (60.01±10.58) years. The patients underwent lobectomy and systemic lymph node dissection along with dissection of 11s nodes. They were divided into a 11s (+) group and a 11s (–) group according to whether the 11s nodes were involved.ResultsThere were 31 patients with invasion in the 11s nodes, and the overall incidence of metastasis was 19.75%, including 13.64% with middle lobe tumors and 20.74% with lower lobe tumors. The 2R+4R nodes involvement was the influencing factor associated with 11s nodes metastasis (P=0.026). The 7th nodes and the inferior mediastinal lymph nodes involvement were high-risk factors affecting the prognosis of patients (P<0.05). The 11s nodes metastasis had nothing to do with the location of the tumor, and it was not an independent factor affecting disease-free survival.ConclusionThe 11s nodes may be a transit for 2R+4R nodes metastasis in the right middle or lower lobe lung cancer, and the 11s nodes should be cleared in the surgical treatment for NSCLC in either the middle or lower lobe of the right lung. The influencing factors for disease-free survival after surgery for lung cancer in the right middle or lower lobe are the metastasis of the subcarinal lymph nodes and the inferior mediastinal lymph nodes.
Objective To investigate the correlation between systemic immune inflammatory index (SII) and other metabolic indicators and diabetic epiretinal membranes (dERM). MethodsA retrospective case-control study. From March 2022 to July 2023, 81 patients (81 eyes) with dERM in Department of Ophthalmology, Affiliated Jinhua Hospital of Zhejiang University of Medicine School diagnosed by fundus screening were included in the study. A total of 81 patients (81 eyes) with diabetes who were matched in age, gender, and duration of diabetes and had no dERM or diabetic macular edema in both eyes during fundus screening were selected as the control group. All patients underwent optical coherence tomography (OCT) examination and laboratory tests for peripheral blood neutrophil, lymphocyte, platelet counts, serum albumin, blood lipids, uric acid, and glycosylated hemoglobin (HbA1c). SII was calculated. Random urine samples were collected for urinary albumin/creatinine ratio (ACR) testing. The OCT device's own analysis software obtained the macular volume coefficient, including central foveal thickness (CMT), macular volume, and average macular thickness. The macular volume coefficient, SII, serum albumin, blood lipids, uric acid, HbA1c, and ACR between the two groups were compared using paired t tests or Mann-Whitney U tests. Conditional logistic regression analysis was performed to evaluate the risk factors for dERM; Spearman correlation test was used to analyze the correlation between CMT, SII, ACR, disorganization of retinal inner layers (DRIL), intraretinal cyst (IRC), and hyper-reflective foci (HRF) in patients with dERM. ResultsThere were significant differences in CMT, macular volume, average macular thickness, SII, serum albumin, and ACR between the dERM group and the control group (Z=−7.234, −6.306, −6.400, −3.063, −2.631, −3.868; P＜0.05). Conditional logistics regression analysis showed that high SII [odds ratio (OR)= 3.919, 95% confidence interval (CI) 1.591-9.654, P=0.003] and ACR (OR=4.432, 95%CI 1.885-10.420, P=0.001) were risk factors for dERM. Spearman correlation analysis showed that HRF, IRC, DRIL were positively correlated with CMT (Rs=0.234, 0.330, 0.248; P=0.036, 0.003, 0.026); HRF was positively correlated with SII and ACR (Rs=0.233, 0.278; P=0.036, 0.012). ConclusionElevated SII and ACR are independent risk factors for the occurrence of dERM.
ObjectiveTo investigate the effect and predictive value of systemic inflammatory markers on pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) for locally advanced breast cancer (LABC). MethodsThe clinicopathologic data of female patients with LABC who received NACT and radical surgical resection in the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University from February 2019 to February 2022 were retrospectively analyzed. The factors affecting pCR after NACT were analyzed by the multivariate logistic regression and the prediction model was established. The efficiency of the prediction model was evaluated by receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). ResultsA total of 98 patients were gathered, of which 29 obtained pCR, with a pCR rate of 29.6%. The multivariate analysis of binary logistic regression showed that the patients with non-menopausal status, negative estrogen receptor (ER), chemotherapy+targeted therapy, and systemic immune-inflammation index (SII) <532.70 (optimal critical value) were more likely to obtain pCR after NACT (P<0.05). The prediction model was established according to logistic regression analysis: Logit (P)=0.697–2.974×(menopausal status)–1.932×(ER status)+3.277×(chemotherapy regimen)–2.652×(SII). The AUC (95%CI) of the prediction model was 0.914 (0.840, 0.961), P<0.001. ConclusionsIt is not found that other inflammatory indicators such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio are associated with pCR after NACT. But SII is an important predictor of pCR after NACT for LABC and has a good predictive efficiency.
摘要:目的:探讨系统性红斑狼疮（SLE）肝损害的临床特点、肝损害发生率与SLE的病情严重程度的关系。方法:对98例SLE的临床资料进行分析,收集所有研究对象的临床资料,对肝损害组(30例)的症状与体征、病情程度、肝功能指标、影像学检查结果进行数据分析,并将其部分生化及免疫学指标与无肝损害组(68对照组)进行比较。结果:SLE患者中SLE肝损害的发生率为30.61%。肝损害组中,病情重度16例(53.33%),17例患者(56.67%)无明显自觉症状,以ALT、AST轻中度升高为主。7例患者肝脏B超异常。肝损害组患者的白细胞值明显低与无肝损害组(Plt;0.05)。而2组的血红蛋白、血小板、CRP、ESR、抗核抗体、抗dsDNA抗体、IgG、补体3等比较差异均无统计学意义(P均gt;0.05)。11例患者接受肾上腺皮质激素(激素)、免疫抑制剂(环磷酰胺、甲氨蝶呤)等药物治疗,9例在出院时复查肝功能正常或好转,另2例肝功能无明显改善;19例患者在接受激素、免疫抑制剂治疗的同时,给予护肝治疗,15例出院复查肝功能正常或好转,另4例无明显改善。而对照组68例中病情重度8例(11.76%)。结论:肝脏是SLE常见累及的靶器官之一,SLE肝损害的临床表现缺乏特异性,以轻至中度肝细胞损害多见,肝损害发生率与SLE病情严重程度成正相关、与SLE的近期预后无关、与长期预后有待进一步研究。Abstract: Objective: To discuss the relationship between the clinical characteristic, The incidence of liver damage and the severity of SLE. Methods: Carries on the mathematical analysis to 98 example SLE clinical material, the collection all object of study clinical material, to liver harm group (30 examples) the symptom and the symptom，Severity the liver function target， the phantom study inspection result carries on the mathematical analysis, and (68 control groups) carries on its part of biochemistry and the immunology target with the nonliver harm group the comparison.Results: In the SLE patient the SLE liver harms the formation rate is 30.61%.In liver harm group, severe illness in 16 cases (53.33%), 17 example patient (56.67%) not obvious subjective symptom, by ALT, AST light moderate ascension primarily.7 example patient liver B ultra exceptionally.The liver harm group patient’s white blood cell value is lower than the nonliver harm group obviously (Plt;0.05), but 2 groups of hemoglobins, the blood platelet, CRP, ESR, the antinuclear immune body, the antidsDNA immune body, IgG, the complement 3 and so on the comparison differences do not have statistics significance (Pgt;0.05). 11 example patients accept the adrenal cortex hormone (hormone), the immunity inhibitor (endoxan, armor ammonia pterin) and so on the medicine treatments, 9 examples when out of hospital reexamines the liver function normal or the change for the better, another 2 example liver function improves not obviously; 19 example patients while accept the hormone, immunity inhibitor treatment, gives protects the liver treatment, 15 example out of hospital reexamination liver function normal or change for the better, another 4 examples improve not obviously. While the control group, 68 cases of severe illness in 8 cases (11.76%).Conclusion: The liver is one of target organs which SLE implicates common, the SLE liver harm. the clinical manifestation lacks the specificity, by sees lightly to the moderate liver cell harm,The incidence of liver damage and SLE severity is positively correlated with shortterm prognosis of SLE has nothing to do with the longterm prognosis remains to be further studied.