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Objective: To investigate the clinical characteristics and impact of SMARCA4 mutations in patients with non-small cell lung cancer (NSCLC).

Methods: A total of 2,821 patients with NSCLC who underwent next-generation sequencing were retrospectively included. The frequency and types of SMARCA4 mutations and co-mutations were determined, and the clinical outcomes were assessed.

Results: SMARCA4 mutations were identified in 100 samples (3.54%), and 36% were missense mutations. The most frequent co-mutations were TP53 (67%) and EGFR (31%); 13% of SMARCA4 mutations occurred in samples carried EGFR and TP53 mutations. Notably, 63% SMARCA4 mutations did not present druggable driver mutations. SMARCA4 mutations were most prevalent in males and smokers. Patients with SMARCA4 mutant lung adenocarcinoma (LUAD) and EGFR mutations who received EGFR-tyrosine kinase inhibitors (EGFR-TKI) as first-line therapy had a lower objective response rate (ORR, 52.94%). In SMARCA4 mutation and EGFR wild-type (wt) NSCLC cohort who received first-line chemotherapy, age (hazard ratio [HR], 3.090; p = 0.026) and performance score (HR, 5.848; p = 0.045) were identified as independent predictors of progression-free survival (PFS). Conversely, brain metastasis was an independent predictor of superior overall survival (HR, 0.188; p = 0.011). The patients with EGFR wt and SMARCA4 mutant Stage IV LUAD who received chemotherapy plus anti-angiogenic therapy significantly improved median PFS compared to chemotherapy alone (p = 0.04).

Conclusions: SMARCA4 mutations were predominantly males and smokers in NSCLC. SMARCA4 mutations conferred a poorer response for EGFR-mutant LUAD subgroups who received EGFR-TKIs. Additionally, chemotherapy plus anti-angiogenesis as first-line therapy may be more effective for Stage IV-SMARCA4 mutant LUAD with EGFR wt.

Background: Post-intensive care syndrome (PICS) is a post-discharge complication from the intensive care unit (ICU) that manifests as a range of physical, cognitive, and psychological impairments for patients. Given the growing number of ICU survivors and the vital role of this syndrome in identifying individuals at risk of deterioration after ICU discharge, we conducted a systematic review and meta-analysis to assess the prevalence and incidence of PICS.

Method: Between January 1, 2010, and October 5, 2024, a thorough search was conducted across the Web of Science, PubMed, Scopus, Embase, Cochrane Library, and CINAHL databases. Cross-sectional and cohort studies were included. The prevalence and incidence of PICS, as determined by any assessment method, were the primary study outcomes. PICS was defined according to the criteria used in each primary study. A meta-analysis was performed using a random-effects model. Meta-regression analysis was employed to investigate the impact of distinct follow-up durations on the reported prevalence and incidence. The JBI critical appraisal tool for prevalence studies was used to assess the risk of bias in the included studies.

Results: This systematic review and meta-analysis synthesised data from 34 studies involving 6230 participants. The pooled prevalence and incidence of PICS were 60.3% (95% CI: 48.5-72.1) and 52.4% (95% CI: 47.6-57.2), respectively. The I² statistic for heterogeneity in the included prevalence and incidence studies was 98.67% and 81.23%, respectively. Subgroup analyses by country, cutoff definition, and underlying participant disease revealed a substantial reduction in heterogeneity. Only the use of a cutoff substantially reduced heterogeneity in reported incidence across studies.

Conclusion: This systematic review and meta-analysis demonstrate a notable prevalence and incidence of PICS among ICU survivors. These findings highlight the need for early detection of at-risk individuals and the development of evidence-based approaches to monitor and address impairments related to PICS.

Background: Chimeric antigen receptor (CAR) -T cell therapy has emerged as a promising approach for treating severe autoimmune diseases (AIDs), offering distinct advantages over conventional immunosuppressive therapies. This review examines recent advancements in both autologous and allogeneic CAR-T platforms for AIDs.

Methods: We analyzed preclinical and clinical evidence regarding CAR-T therapies. These therapies target signaling molecules across various cells in the myeloid and lymphoid lineages, addressing autoimmune pathologies across dermatological, neurological, gastrointestinal, and hematological systems.

Results: Diversified CAR-T technological innovations have been developed. CAR-T therapy achieves remarkable efficacy in various AID by precisely eliminating pathogenic cells and facilitating a systemic immune reset, thereby maintaining a favorable balance between therapeutic benefit and safety.

Conclusion: CAR-T cell therapy represents a revolutionary therapeutic strategy for the management of refractory AIDs. Addressing current challenges will further promote its clinical translation and expand its application in the treatment of AIDs.

Background: Patients with both acute myocardial infarction (AMI) and chronic kidney disease (CKD) face a markedly poor prognosis, a key driver of which is insulin resistance (IR). This study aims to systematically evaluate and compare the predictive performance of four commonly used IR indices for major adverse cardiovascular events (MACE), and to assess their incremental value over the GRACE score in this patient group.

Methods: This retrospective cohort study analyzed 1,803 patients with AMI and CKD. Multivariable Cox regression determined associations between IR indices and MACE. Predictive performance was evaluated using C-statistics, continuous net reclassification improvement (cNRI), and integrated discrimination improvement (IDI).

Results: During a median follow-up of 28.2 months, 462 MACE occurred. Patients with MACE were older, had higher female proportion, elevated GRACE score, and increased diabetes prevalence (all p < 0.05). the triglyceride-glucose (TyG) index and the atherogenic index of plasma (AIP) demonstrated linear associations with MACE risk, whereas TyG-body mass index (TyG-BMI) and metabolic score for insulin resistance (METS-IR) exhibited U-shaped nonlinear relationships (p < 0.001). The Area Under the Curve (AUCs) for MACE prediction were: TyG index 0.62, AIP 0.57, TyG-BMI 0.58, and METS-IR 0.56. Incorporating IR indices significantly enhanced the GRACE score's predictive capacity, with TyG index providing the greatest incremental improvement (cNRI = 0.137, IDI = 0.03).

Conclusion: IR indices predict outcomes in patients with AMI and CKD and enhance GRACE score prediction, with TyG index demonstrating superior performance.

Background: Adhesive capsulitis (AC) is a chronic inflammatory condition with limited range of motion (ROM) in the glenohumeral joint. The main goals in managing AC are pain reduction and returning joint function. Intra-articular hyaluronic acid (HA) has been considered a safe modality in AC. This study compared the effectiveness of intra-articular injection of low molecular weight (LMW) with high molecular weight (HMW) HA in patients with AC.

Methods: Fifty-six patients with AC were randomized in this triple-blinded clinical trial. All underwent standard physical therapy. The outcomes were visual analog scale (VAS), Oxford shoulder score (OSS), active ROM, and patient satisfaction at 4, 12, and 24 weeks.

Results: No significant differences were detected in between-group variables at baseline. Both groups showed marked improvement in VAS, OSS, and ROM over time. At four weeks LMW-HA group had lower pain (P = 0.049). Conversely, the trend of VAS at 12-week and 24-week endpoints favors HMW-HA (Baseline to endpoint: -5.48 ± 1.68 and -3.91 ± 1.31 reduction in VAS as the primary outcome, P < 0.001). Satisfaction had significantly improved in both groups.

Conclusion: HMW-HA was associated with greater pain reduction and functional improvement compared with LMW-HA.

Trial registration: The trial protocol was registered at the Iranian Registry of Clinical Trials (IRCT), a WHO Primary Register setup (registration No: IRCT20170608034390N4; First registration date: 01/01/2020).

Aim: Given the chronic nature of acne, two 6-month studies were conducted to evaluate the long-term efficacy and tolerability of clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide (BPO) 3.1% gel (CAB)-the only approved triple-combination acne topical-and its effects on scarring/dyspigmentation in participants with moderate to severe acne.

Materials and methods: Data were pooled from 2 identical, open-label, single-center studies conducted in participants (N = 50) aged ≥12 years with Investigator's Global Assessment (IGA) score of 3/4. Endpoints included change from baseline in IGA score, inflammatory/noninflammatory lesions, skin appearance (dryness, postinflammatory hyperpigmentation [PIH], postinflammatory erythema [PIE]), and scarring. Adverse events and tolerability (itching, burning, redness, swelling) were assessed.

Results: At week 24, 67% of participants achieved treatment success, and significant reductions from baseline in inflammatory (88%) and noninflammatory (68%) lesions were observed (p < 0.001, both). Significant reductions in scarring (33%), investigator- and participant-assessed PIH (71%; 78%, respectively), and PIE (77%; 77%, respectively) were demonstrated (p < 0.001, all). Most participants (>70%) reported no tolerability issues throughout the studies. Seven adverse events occurred; 4 were related to CAB, and 3 led to study discontinuation (BPO allergy [n = 2], irritant contact dermatitis to BPO [n = 1]).

Conclusions: These findings suggest that CAB is an appropriate and effective topical option for the long-term treatment of acne vulgaris.

Objectives: Vitiligo is an autoimmune skin disorder characterized by melanocyte destruction and frequently associated with autoantibodies such as antinuclear antibodies (ANA). However, the clinical relevance of ANA positivity in relation to phototherapy response remains unclear. This study aimed to evaluate whether ANA positivity influences the efficacy and safety of 308-nm excimer light therapy in patients with vitiligo.

Methods: In this cohort study, 86 patients with vitiligo received 308-nm excimer light therapy combined with topical agents, with oral mini-pulse prednisone added for active disease when necessary. Patients were stratified by ANA status, and therapeutic response was evaluated using the Vitiligo Area Scoring Index and standardized photographs over 6 months.

Results: Of the 23 ANA-positive patients (26.7%), 19 (82.6%) had a titer of 1:100 and 4 (17.4%) had a titer of 1:320, with women comprising 73.9% of this group. ANA-positive lesions on the face and neck more frequently achieved moderate repigmentation (50-74%) but were less likely to reach excellent repigmentation (≥75%) compared with ANA-negative lesions. No significant differences were observed in cumulative treatment doses, adverse events, or the occurrence of new autoimmune conditions.

Conclusions: In conclusion, this single-center cohort study suggests that ANA positivity does not significantly affect the efficacy or safety of 308-nm excimer light therapy in vitiligo, indicating that the impact of low-titer ANA may be limited.