ObjectiveTo summarize the mechanism of action of programmed cell death protein 1 (PD-1)/programmed cell death ligand-1 (PD-L1) inhibitors, the application in breast cancer in recent years and the advances in the study of their bio-markers of effects. MethodRelevant literatures on PD-1/PD-L1 inhibitors and the study in the field of breast cancer were reviewed and summarized.ResultsIn recent years, the monotherapy of immune checkpoint inhibitors represented by PD-1/PD-L1 inhibitors or in combination with other therapies had brought new hope for patients with breast cancer especially triple-negative breast cancer (TNBC). However, only a small number of patients could benefit from breast cancer immunotherapy. The current researchers think that the efficacy of these drugs is related to PD-L1 expression in tumor tissue, tumor mutation burden (TMB), high level of microsatellite instability (MSI-H) and deficient mismatch repair (dMMR).ConclusionBreast cancer can benefit from the immunotherapy of PD-1/PD-L1 inhibitors, but formulating personalized medicine model, finding biomarkers that can predict efficacy and selecting patients with breast cancer who can benefit from it for targeted therapy are the new requirements in the new era of breast cancer immunotherapy.
Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related deaths worldwide. Although surgery can cure some early-stage resectable patients, the postoperative recurrence rate remains as high as 30%-55%. Perioperative immune checkpoint inhibitor (ICI) therapy, which includes "neoadjuvant" therapy before surgery and "adjuvant" therapy after surgery, has significantly improved survival outcomes in resectable NSCLC patients. Large clinical studies, such as CheckMate 816, have demonstrated the superiority of neoadjuvant ICIs combined with chemotherapy in increasing the pathological complete response rate (pCR) and prolonging event-free survival (EFS). However, even with these advanced treatments, some patients do not achieve long-term benefits and experience early recurrence. This paper reviews the latest research progress of perioperative ICIs in NSCLC treatment, particularly the effectiveness of neoadjuvant chemoimmunotherapy in improving pCR and extending EFS. It further explores the recurrence patterns, resistance mechanisms, and potential biomarkers in NSCLC patients after neoadjuvant immunotherapy. By integrating basic research and clinical data, we analyze the mechanisms of early recurrence following perioperative immunotherapy and discuss future research directions and therapeutic strategies, providing new insights into precision treatment and recurrence prevention for NSCLC patients.
ObjectiveTo investigate the clinical characteristics and treatment of primary mediastinal yolk sac tumor (PMYST). MethodsWe collected the clinical data of PMYST patients who were admitted to the Department of Thoracic Surgery of Peking Union Medical College Hospital from September 2000 to September 2020. The clinical and pathological characteristics, treatment and prognosis of PMYST patients were retrospectively analyzed. Results Finally 18 patients were enrolled, including 17 males and 1 female with a median age of 22.0 (16.6, 26.2) years. Patients had increased level of alpha fetoprotein (AFP). The pathological type can be single yolk sac tumor or combined with other mediastinal germ cell tumors. Chemotherapy and radical surgery were the main treatment methods. Extensive resection was feasible for patients with tumor invasion of other organs. Seven patients developed lung or pleural metastasis after operation, and 3 of them had extrapleural metastasis. One patient recurred within 1 year after surgery. All patients were followed up by telephone or outpatient department. At the last follow-up, 5 patients survived, 9 died, and 4 were lost to follow up, with a median survival of 16.8 months. The median disease-free survival was 14.9 months. The survival rates at 1, 3 and 5 years were 73.3%, 28.6% and 11.8%, respectively. ConclusionPMYST often occurs in young-middle aged male patients. Preoperative puncture can provide an effective diagnostic basis. R0 resection, AFP returning to normal after treatment and no metastasis may be potential indicators of good prognosis. The overall prognosis of PMYST is poor, and some patients can achieve long-term survival after treatment.
Programmed cell death-1 (PD-1)/programmed cell death-ligand 1 (PD-L1) signaling pathway has been found capable of affecting anti-tumor immune effect in many malignancies in recent years. Patients who are diagnosed with advanced non-small cell lung cancer (NSCLC) have considerable responses after receving inhibitors against PD-1/PD-L1. This paper reviews the clinical progress of PD-1/PD-L1 inhibitors in the treatment of NSCLC.
ObjectiveTo systematically review the effectiveness of Tai Chi for improving negative symptoms and activity participation in patients with schizophrenia. MethodsDatabases including PubMed, The Cochrane Library (Issue 3, 2016), EMbase, CBM, CNKI, VIP and WanFang Data were electronically searched to collect the randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCT) about Tai Chi for improving negative symptoms and activity participation in patients with schizophrenia from inception to Apirl 1st 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of three RCTs and two quasi-RCTs were included. The result of meta-analyses showed that no significant difference was found in negative symptom scores (MD=–0.95, 95% CI –3.78 to –1.89, P=0.51) and positive symptoms scores of PANSS (MD=–0.02, 95% CI –0.50 to 0.46, P=0.94) between two groups. However, the Tai Chi group was superior to the control group in items including attention, avolition, anhedonia-asociality, alogia and affective flattening/blunting of SANS (all P values<0.05). ConclusionTai Chi may have positively influence on various negative symptoms in patients with schizophrenia, but no evidence to support the Tai Chi's effects for activities participation. Larger and higher quality studies are needed.
Objective To systematically review respiratory muscle training (RMT) on respiratory functions of patients with spinal cord injury (SCI). Methods PubMed, EMbase and The Cochrane Library were electronically searched to collect the randomized controlled trials (RCTs) about RMT on pulmonary functions in patients with SCI from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 11 RCTs involving 263 patients were included. The results of meta-analysis showed that, compared with conventional rehabilitation group, RMT effectively improved vital capacity (MD=0.41, 95%CI 0.12 to 0.69, P=0.005), inspiratory capacity (MD=0.35, 95%CI 0.05 to 0.65, P=0.02), maximal inspiratory pressure (MD=7.75, 95%CI 0.11 to 15.39, P=0.05) and maximal voluntary ventilation (MD=17.52, 95%CI 8.11 to 26.93, P=0.000 3). There were significant differences between two groups. Conclusion Current evidence shows that RMT can effectively improve the respiratory function of patients with SCI. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
Thymic neuroendocrine tumors (TNETs) are a series of rare diseases with aggressive biology and poor prognosis. Clinical manifestations of TNETs are atypical, and ectopic secretion of adrenocorticotropic hormone can be found in some cases, resulting in associated endocrine symptoms. Due to the low morbidity and strong heterogeneity, it’s difficult to diagnose, treat and obtain new treatment regimen. Early complete surgical resection is an effective treatment. For advanced cancer, clinical trials of new drugs are expected to improve the survival of patients.
ObjectiveTo systematically review the clinical utilization of robotic bronchoscopes in diagnosis of pulmonary nodules, including MonarchTM and IonTM platforms, and then evaluate the efficacy and safety of the procedure. MethodsPubMed, EMbase, Web of Science and Cochrane Central Register of Controlled Trials databases were searched by computer for literature about the biopsy of pulmonary nodules with robotic bronchoscope from January 2018 to February 14, 2022. The quality of research was evaluated with Newcastle-Ottawa Scale. RevMan 5.4 software was used to conduct the meta-analysis. ResultsFinally, 19 clinical studies with 1 542 patients and 1 697 targeted pulmonary nodules were included, of which 13 studies used the IonTM platform and 6 studies used the MonarchTM platform. The overall diagnostic rate of the two systems was 84.96% (95%CI 62.00%-95.00%), sensitivity for malignancy was 81.79% (95%CI 43.00%-96.00%), the mean maximum diameter of the nodules was 16.22 mm (95%CI 10.98-21.47), the mean procedure time was 61.86 min (95%CI 46.18-77.54) and the rate of complications occurred was 4.76% (95%CI 2.00%-15.00%). There was no statistical difference in the outcomes between the two systems. Conclusion Robotic bronchoscope provides a high efficacy and safety in biopsy of pulmonary nodules, and has a broad application prospect for pulmonary nodules diagnosis.
ObjectiveTo analyze the research hotspots and progress of surgical treatment of myasthenia gravis. MethodsThe top 100 most cited articles on surgical treatment of myasthenia gravis were identified by searching the Web of Science database, and a bibliometric analysis was conducted. ResultsThe publication year of the top 100 most cited articles ranged from 1939 to 2021, and the number of citations ranged from 55 to 850 per article. Most of the included articles were original research articles (75/100), which were mainly retrospective studies (64/75). The United States was the country with the most published articles and most citations, and Annals of Thoracic Surgery was the most sourced journal (n=20). Through VOSviewer analysis, high-density keywords were thymectomy, maximal thymectomy, extended thymectomy, transcervical thymectomy, thymoma, and autoantibodies. ConclusionThe scope of surgical resection, surgical approach and pathogenesis are the current hotspots in the field of surgical treatment of myasthenia gravis. It is hoped that this paper can provide references for future researches in this field.
ObjectiveTo explore the expressions of P27Kip1, RalA, and SPOCK1 in cancer tissues of the elderly patients with colorectal cancer (CRC) and the relations between their expressions and clinical pathological characteristics as well as prognosis. MethodsThe clinicopathologic data of elderly CRC patients treated and underwent surgical resection in Kailuan General Hospital Linxi Hospital from May 2019 to May 2022 were collected in a retrospective manner. The immunohistochemistry was used to detect the expressions of P27Kip1, RalA, and SPOCK1 proteins in the CRC tissues and corresponding adjacent tissues. The Kaplan-Meier method was applied to analyze the survival of CRC patients with p27Kip1, RalA, and SPOCK1 positive and negative expressions. The multivariate Cox risk regression model was applied to analyze the influencing factors of prognosis in the patients with CRC. The test level was set as α=0.05. ResultsA total of 149 elderly CRC patients were enrolled. All patients were followed up for 2 years, and 45 cases died of cancer during the follow-up period. The positive rate of p27Kip1 protein expression in the CRC tissues was lower than that in the corresponding adjacent tissues (P<0.05), while the positive rates of RalA and SPOCK1 protein expressions were higher than those in the corresponding adjacent tissues (P<0.05). The proportions of mucinous carcinoma, TNM stages Ⅲ–Ⅳ, low differentiation, positive lymph node metastasis, and T staging T2–T4 in the patients with negative p27Kip1 and positive RalA and SPOCK1 expressions were higher than those in the patients with positive p27Kip1 and negative RalA and SPOCK1 expressions (P<0.05). The proportions of patients with TNM stages Ⅲ–Ⅳ, negative p27Kip1 and positive RalA and SPOCK1 expressions in the death group were higher than that in the survival group (P<0.05). The survival curves plotted by the Kaplan-Meier method showed that the survival curves of patients with positive expression of p27Kip1 and negative expression of RalA and SPOCK1 in the cancer tissues were significantly better than those with negative expression of p27Kip1 and positive expression of RalA and SPOCK1 (respectively: log-rank χ²=11.678, P=0.001; log-rank χ²=10.836, P=0.001; log-rank χ²=10.792, P=0.001). The multivariate Cox proportional hazards regression model analysis revealed that the negative expression of p27Kip1 [HR(95%CI)=2.807(1.490, 5.287)], positive expression of RalA [HR(95%CI)=2.769(1.493, 5.134)], and positive expression of SPOCK1 [HR(95%CI)=3.075(1.610, 5.871)] were independent risk factors for postoperative mortality in CRC patients. ConclusionThe results of this study suggest that the positive rate of p27Kip1 protein expression is low in CRC tissues, while the positive rates of RalaA and SPOCK1 protein expression are high, and the protein expression of these three indicators are associated with tissue type, TNM stage, degree of differentiation, lymph node metastasis, and T stage. Negative expression of p27Kip1 and positive expression of RalA and SPOCK1 are unfavorable for the prognosis of CRC patients.
