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GLP-1-based therapies for the treatment of resistant hypertension in individuals with overweight or obesity: a review. 基于 GLP-1 的疗法治疗超重或肥胖症患者的耐药性高血压:综述。
IF 9.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-15 eCollection Date: 2024-09-01 DOI: 10.1016/j.eclinm.2024.102789
Candace Jarade, Tetiana Zolotarova, Areesha Moiz, Mark J Eisenberg

Despite the availability of a wide range of antihypertensive agents, a significant proportion of individuals with resistant hypertension (RHTN) struggle to achieve blood pressure (BP) control. Obesity ranks among the most significant modifiable risk factors for RHTN, with 56-91% of patients with RHTN classified as overweight or obese. Glucagon-like peptide-1 receptor agonist (GLP-1 RAs) are a class of anti-obesity medications that have recently demonstrated efficacy in reducing BP and improving cardiovascular (CV) outcomes in individuals with overweight or obesity. Among the available GLP-1-based therapies, liraglutide, semaglutide, and tirzepatide have been approved for chronic weight management in this population. Tirzepatide, a dual GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonist, has the greatest effect on weight loss and BP reduction compared to GLP-1 RAs alone. To our knowledge, no trials have directly evaluated the effect of GLP-1 RAs or dual GLP-1/GIP receptor agonists on RHTN management. In this review article, we propose that targeting weight loss through GLP-1-based therapies should be explored as a treatment option for individuals with RHTN who are overweight or obese.

尽管降压药物种类繁多,但仍有相当一部分耐药高血压(RHTN)患者难以达到控制血压(BP)的目的。肥胖是 RHTN 最重要的可改变风险因素之一,56-91% 的 RHTN 患者被归类为超重或肥胖。胰高血糖素样肽-1 受体激动剂(GLP-1 RAs)是一类抗肥胖药物,近来已证明可有效降低超重或肥胖患者的血压并改善心血管(CV)预后。在现有的基于 GLP-1 的疗法中,利拉鲁肽、赛马鲁肽和替齐帕肽已被批准用于此类人群的慢性体重管理。替扎帕肽是一种 GLP-1 和葡萄糖依赖性促胰岛素多肽受体的双重激动剂,与单独使用 GLP-1 RAs 相比,其减轻体重和降低血压的效果最好。据我们所知,还没有任何试验直接评估了 GLP-1 RA 或 GLP-1/GIP 双受体激动剂对 RHTN 治疗的效果。在这篇综述文章中,我们建议将通过 GLP-1 疗法减轻体重作为超重或肥胖 RHTN 患者的一种治疗选择。
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引用次数: 0
Incidence of new onset type 2 diabetes in adults living with obesity treated with tirzepatide or semaglutide: real world evidence from an international retrospective cohort study. 接受替扎帕肽或赛马鲁肽治疗的肥胖症成人中新发 2 型糖尿病的发病率:一项国际回顾性队列研究提供的现实证据。
IF 9.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-15 eCollection Date: 2024-09-01 DOI: 10.1016/j.eclinm.2024.102777
Matthew Anson, Alex E Henney, Nicholas Broadwell, Sizheng S Zhao, Gema H Ibarburu, Gregory Y H Lip, John P H Wilding, Daniel J Cuthbertson, Uazman Alam
<p><strong>Background: </strong>Tirzepatide, a novel dual agonist of glucagon-like-peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), has demonstrated greater magnitude of weight loss compared to semaglutide in a phase 3 clinical trial. However, the effect of tirzepatide on incidence of type 2 diabetes (T2D) in individuals with overweight and obesity, and the effect on major adverse cardiovascular outcomes in individuals with pre-existing T2D, remains unknown.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of anonymised electronic medical records using the TriNetX network (TriNetX LLC, Cambridge, MA, USA) a global federated database. The data used in this study was collected on 5th June 2024. Two cohorts of individuals were generated: <b>1)</b> without pre-existing T2D and, <b>2)</b> with T2D. We adopted an active comparator new user design on new initiations of either tirzepatide <i>or</i> semaglutide therapy. Analysis began from the index event which was defined as individuals on respective therapy for 6 months only. Analysis of outcomes was conducted off-drug, in individuals without a pre-existing history of the disease of interest. Individuals were followed up for 12 months post the index event. <b>Primary outcome</b> for <b>cohort 1</b> was incidence of T2D, and for <b>cohort 2</b> was composite: all-cause mortality, cerebral infarction, acute coronary syndrome, and heart failure. <b>Secondary outcomes</b> for <b>cohort 1</b> were change in HbA1c and body weight and for <b>cohort 2</b>: incidence of micro- and macrovascular complications, suicidal ideation and/or attempt, and all-cause mortality. We propensity score matched (1:1) for potential confounders: baseline demographics, socioeconomic circumstances, HbA1c, weight, relevant co-morbidities, and anti-obesity, hypoglycaemic and cardioprotective agents.</p><p><strong>Findings: </strong>The study population without T2D consisted of 13,846 individuals, equally split between tirzepatide and semaglutide users. Tirzepatide was associated with both lower risk for incident T2D (HR 0.73, 95% CI 0.58-0.92, p < 0.001) and greater weight loss (-7.7 kg, [95% CI -6.8, -8.5 kg], p < 0.001), compared to semaglutide (-4.8 kg, [95% CI -3.9, -5.6 kg], p < 0.001). In individuals with pre-existing T2D (n = 8446), tirzepatide was associated with lower risk of the composite outcome (HR 0.54, 95% CI 0.38-0.76, p < 0.001), cerebral infarction (HR 0.45, 95% CI 0.24-0.84, p = 0.010) and all-cause mortality (HR 0.33, 95% CI 0.15-0.73, p = 0.004) compared to semaglutide.</p><p><strong>Interpretation: </strong>Tirzepatide is associated with significantly reduced risk of developing T2D and major adverse cardiovascular events in individuals living with obesity and T2D respectively. Randomised controlled trials investigating the utility of dual incretin agonists in the primary prevention of T2D and cardiovascular disease in higher risk populations are now required.</p><p
背景:替扎帕肽是一种新型胰高血糖素样肽-1(GLP-1)和葡萄糖依赖性胰岛素促多肽(GIP)双重激动剂,在一项三期临床试验中,与塞马鲁肽相比,替扎帕肽的减重幅度更大。然而,替扎帕肽对超重和肥胖患者 2 型糖尿病(T2D)发病率的影响,以及对已有 T2D 的患者主要心血管不良结局的影响仍是未知数:我们利用全球联合数据库 TriNetX 网络(TriNetX LLC,美国马萨诸塞州剑桥市)对匿名电子病历进行了一项回顾性队列研究。本研究使用的数据收集于 2024 年 6 月 5 日。研究生成了两组个体:1)不存在 T2D;2)患有 T2D。我们对新开始接受替扎帕肽或赛马鲁肽治疗的患者采用了主动比较新用户设计。分析从指标事件开始,指标事件的定义是接受相关治疗 6 个月的患者。疗效分析是在非用药期间进行的,患者在用药前没有相关疾病的病史。指标事件发生后,对患者进行为期 12 个月的随访。队列 1 的主要结果是 T2D 发病率,队列 2 的主要结果是全因死亡率、脑梗塞、急性冠状动脉综合征和心力衰竭的综合指数。队列 1 的次要结果是 HbA1c 和体重的变化,队列 2 的次要结果是微血管和大血管并发症的发生率、自杀意念和/或企图以及全因死亡率。我们对潜在的混杂因素进行了倾向评分匹配(1:1),这些因素包括基线人口统计学、社会经济环境、HbA1c、体重、相关并发症以及抗肥胖、降血糖和心脏保护药物:无 T2D 的研究人群包括 13846 人,其中使用替扎帕肽和使用赛马鲁肽的人数各占一半。地塞帕肽与较低的T2D发病风险有关(HR 0.73,95% CI 0.58-0.92,p 解释:地塞帕肽与较低的T2D发病风险有关:在肥胖和患有 T2D 的人群中,替扎帕肽可显著降低 T2D 和主要不良心血管事件的发病风险。现在需要进行随机对照试验,调查双重增量素激动剂在高风险人群中T2D和心血管疾病一级预防中的作用:无。
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引用次数: 0
Cost-effectiveness of a precision hepatocellular carcinoma surveillance strategy in patients with cirrhosis. 肝硬化患者肝细胞癌精准监控策略的成本效益。
IF 9.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-13 eCollection Date: 2024-09-01 DOI: 10.1016/j.eclinm.2024.102755
Szu-Yu Zoe Kao, Kinpritma Sangha, Naoto Fujiwara, Yujin Hoshida, Neehar D Parikh, Amit G Singal

Background: Hepatocellular carcinoma (HCC) surveillance is currently performed using a one-size-fits-all strategy with ultrasound plus AFP (US + AFP). There is increasing interest in risk-stratified and precision surveillance strategies incorporating individual risk and variance in surveillance test performance; however, the cost-effectiveness of these approaches has not been evaluated.

Methods: We conducted a cost-effectiveness analysis to evaluate four surveillance strategies (no surveillance, universal US + AFP surveillance, risk-stratified surveillance, and precision surveillance) in a simulated cohort of 50-year-old patients with compensated cirrhosis. The most cost-effective strategy was that with the highest incremental cost-effectiveness ratio (ICER) and below the willingness-to-pay (WTP) threshold of $150,000/QALY gained. Model inputs were based on literature review, and costs were derived from the Medicare fee schedule.

Findings: The precision surveillance strategy demonstrated variation in recommended surveillance test based on HCC risk category and patient factors. US + AFP, risk-stratified, and precision surveillance detected more HCC cases per 100,000 population than no surveillance, with a higher proportion of early-stage cases for precision surveillance (67.6%) than risk-stratified (63.8%), universal ultrasound (63.2%), and no surveillance (38.0%). Compared to no surveillance, precision surveillance was most cost-effective, with an ICER of $104,614/QALY gained, whereas US + AFP and risk-stratified surveillance were both dominated. Compared to US + AFP, risk-stratified surveillance was cost saving and dominated US + AFP, whereas precision surveillance was cost-effective, with an ICER of $98,103/QALY gained. Results were sensitive to survival with early-stage HCC, cost of early-stage HCC treatment, and surveillance utilization. Precision surveillance remained the most cost-effective when WTP thresholds exceeded $110,000/QALY gained.

Interpretation: A precision surveillance strategy is the most cost-effective method for HCC surveillance. This approach could maximize surveillance benefits in high-risk patients, while minimizing surveillance harms in low-risk individuals.

Funding: National Cancer Institute (U01 CA230694, R01 CA222900, R01 CA212008, and U24ca086368) and Cancer Prevention Research Institute of Texas (CPRIT) (RP200554).

背景:肝细胞癌(HCC)监测目前采用超声波加甲胎蛋白(US + AFP)的 "一刀切 "策略。然而,这些方法的成本效益尚未得到评估:我们进行了一项成本效益分析,在 50 岁代偿性肝硬化患者的模拟队列中评估了四种监测策略(无监测、普遍 US + AFP 监测、风险分层监测和精确监测)。最具成本效益的策略是增量成本效益比(ICER)最高且低于支付意愿(WTP)阈值(150,000 美元/QALY gained)的策略。模型输入基于文献综述,成本来自医疗保险收费表:精准监控策略显示,根据 HCC 风险类别和患者因素推荐的监控测试存在差异。每 10 万人中,US + AFP、风险分层和精确监控检测出的 HCC 病例数高于无监控检测,其中精确监控检测出的早期病例比例(67.6%)高于风险分层检测(63.8%)、通用超声检测(63.2%)和无监控检测(38.0%)。与不监测相比,精确监测最具成本效益,ICER 为 104,614 美元/QALY gained,而 US + AFP 和风险分层监测均占优势。与 US + AFP 相比,风险分层监测可节约成本,且在 US + AFP 中占优势,而精确监测则具有成本效益,ICER 为 98,103 美元/QALY gained。研究结果对早期 HCC 患者的存活率、早期 HCC 治疗成本和监测利用率很敏感。当WTP阈值超过110,000美元/QALY收益时,精确监测仍最具成本效益:精准监测策略是最具成本效益的 HCC 监测方法。这种方法可使高危患者的监测效益最大化,同时将低危患者的监测危害降至最低:国家癌症研究所(U01 CA230694、R01 CA222900、R01 CA212008 和 U24ca086368)和德克萨斯癌症预防研究所(CPRIT)(RP200554)。
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引用次数: 0
Exploring the genetics of airflow limitation in lung function across the lifespan - a polygenic risk score study. 探索肺功能气流受限的遗传学--多基因风险评分研究。
IF 9.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-12 eCollection Date: 2024-09-01 DOI: 10.1016/j.eclinm.2024.102731
Natalia Hernandez-Pacheco, Anna Kilanowski, Ashish Kumar, John A Curtin, Núria Olvera, Sara Kress, Xander Bertels, Lies Lahousse, Laxmi Bhatta, Raquel Granell, Sergi Marí, Jose Ramon Bilbao, Yidan Sun, Casper-Emil Tingskov Pedersen, Tarik Karramass, Elisabeth Thiering, Christina Dardani, Simon Kebede Merid, Gang Wang, Jenny Hallberg, Sarah Koch, Judith Garcia-Aymerich, Ana Esplugues, Maties Torrent, Jesus Ibarluzea, Lesley Lowe, Angela Simpson, Ulrike Gehring, Roel C H Vermeulen, Graham Roberts, Anna Bergström, Judith M Vonk, Janine F Felix, Liesbeth Duijts, Klaus Bønnelykke, Nic Timpson, Guy Brusselle, Ben M Brumpton, Arnulf Langhammer, Stephen Turner, John W Holloway, Syed Hasan Arshad, Anhar Ullah, Adnan Custovic, Paul Cullinan, Clare S Murray, Maarten van den Berge, Inger Kull, Tamara Schikowski, Jadwiga A Wedzicha, Gerard Koppelman, Rosa Faner, Àlvar Agustí, Marie Standl, Erik Melén

Background: Chronic obstructive pulmonary disease (COPD) is caused by interactions between many factors across the life course, including genetics. A proportion of COPD may be due to reduced lung growth in childhood. We hypothesized that a polygenic risk score (PRS) for COPD is associated with lower lung function already in childhood and up to adulthood.

Methods: A weighted PRS was calculated based on the 82 association signals (p ≤ 5 × 10-8) revealed by the largest GWAS of airflow limitation (defined as COPD) to date. This PRS was tested in association with lung function measures (FEV1, FVC, and FEV1/FVC) in subjects aged 4-50 years from 16 independent cohorts participating in the Chronic Airway Diseases Early Stratification (CADSET) Clinical Research Collaboration. Age-stratified meta-analyses were conducted combining the results from each cohort (n = 45,406). These findings were validated in subjects >50 years old.

Findings: We found significant associations between the PRS for airflow limitation and: (1) lower pre-bronchodilator FEV1/FVC from school age (7-10 years; β: -0.13 z-scores per one PRS z-score increase [-0.15, -0.11], q-value = 7.04 × 10-53) to adulthood (41-50 years; β: -0.16 [-0.19, -0.13], q-value = 1.31 × 10-24); and (2) lower FEV1 (from school age: 7-10 years; β: -0.07 [-0.09, -0.05], q-value = 1.65 × 10-9, to adulthood: 41-50 years; β: -0.17 [-0.20, -0.13], q-value = 4.48 x 10-20). No effect modification by smoking, sex, or a diagnosis of asthma was observed.

Interpretation: We provide evidence that a higher genetic risk for COPD is linked to lower lung function from childhood onwards.

Funding: This study was supported by CADSET, a Clinical Research Collaboration of the European Respiratory Society.

背景:慢性阻塞性肺病(COPD)是由整个生命过程中包括遗传在内的多种因素相互作用造成的。一部分慢性阻塞性肺病可能是由于儿童时期肺部发育不良造成的。我们假设,慢性阻塞性肺病的多基因风险评分(PRS)与儿童期直至成年期较低的肺功能有关:方法:根据迄今为止最大的气流受限(定义为慢性阻塞性肺病)GWAS 发现的 82 个关联信号(p ≤ 5 × 10-8)计算出加权 PRS。该 PRS 与肺功能指标(FEV1、FVC 和 FEV1/FVC)进行了关联测试,测试对象来自参与慢性气道疾病早期分层(CADSET)临床研究合作的 16 个独立队列中的 4-50 岁受试者。结合每个队列的结果进行了年龄分层荟萃分析(n = 45,406)。这些结果在年龄大于 50 岁的受试者中得到了验证:我们发现气流受限的 PRS 与以下因素有明显的关联(1) 从学龄期(7-10 岁;β:PRS z 分数每增加 1 分,气流受限 PRS z 分数降低 -0.13 [-0.15, -0.11], q 值 = 7.04 × 10-53)到成年期(41-50 岁;β:-0.16 [-0.19, -0.13],q 值 = 1.31 × 10-24);以及 (2) FEV1 降低(从学龄期:7-10 岁;β:-0.07 [-0.09, -0.05],q 值 = 1.65 × 10-9,到成年期:41-50 岁;β:-0.17 [-0.20, -0.13],q 值 = 4.48 x 10-20)。没有观察到吸烟、性别或哮喘诊断的影响:我们提供的证据表明,慢性阻塞性肺病较高的遗传风险与儿童时期较低的肺功能有关:本研究得到了欧洲呼吸学会临床研究合作组织 CADSET 的支持。
{"title":"Exploring the genetics of airflow limitation in lung function across the lifespan - a polygenic risk score study.","authors":"Natalia Hernandez-Pacheco, Anna Kilanowski, Ashish Kumar, John A Curtin, Núria Olvera, Sara Kress, Xander Bertels, Lies Lahousse, Laxmi Bhatta, Raquel Granell, Sergi Marí, Jose Ramon Bilbao, Yidan Sun, Casper-Emil Tingskov Pedersen, Tarik Karramass, Elisabeth Thiering, Christina Dardani, Simon Kebede Merid, Gang Wang, Jenny Hallberg, Sarah Koch, Judith Garcia-Aymerich, Ana Esplugues, Maties Torrent, Jesus Ibarluzea, Lesley Lowe, Angela Simpson, Ulrike Gehring, Roel C H Vermeulen, Graham Roberts, Anna Bergström, Judith M Vonk, Janine F Felix, Liesbeth Duijts, Klaus Bønnelykke, Nic Timpson, Guy Brusselle, Ben M Brumpton, Arnulf Langhammer, Stephen Turner, John W Holloway, Syed Hasan Arshad, Anhar Ullah, Adnan Custovic, Paul Cullinan, Clare S Murray, Maarten van den Berge, Inger Kull, Tamara Schikowski, Jadwiga A Wedzicha, Gerard Koppelman, Rosa Faner, Àlvar Agustí, Marie Standl, Erik Melén","doi":"10.1016/j.eclinm.2024.102731","DOIUrl":"10.1016/j.eclinm.2024.102731","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is caused by interactions between many factors across the life course, including genetics. A proportion of COPD may be due to reduced lung growth in childhood. We hypothesized that a polygenic risk score (PRS) for COPD is associated with lower lung function already in childhood and up to adulthood.</p><p><strong>Methods: </strong>A weighted PRS was calculated based on the 82 association signals (<i>p</i> ≤ 5 × 10<sup>-8</sup>) revealed by the largest GWAS of airflow limitation (defined as COPD) to date. This PRS was tested in association with lung function measures (FEV<sub>1</sub>, FVC, and FEV<sub>1</sub>/FVC) in subjects aged 4-50 years from 16 independent cohorts participating in the Chronic Airway Diseases Early Stratification (CADSET) Clinical Research Collaboration. Age-stratified meta-analyses were conducted combining the results from each cohort (n = 45,406). These findings were validated in subjects >50 years old.</p><p><strong>Findings: </strong>We found significant associations between the PRS for airflow limitation and: <i>(1)</i> lower pre-bronchodilator FEV<sub>1</sub>/FVC from school age (7-10 years; β: -0.13 z-scores per one PRS z-score increase [-0.15, -0.11], <i>q</i>-value = 7.04 × 10<sup>-53</sup>) to adulthood (41-50 years; β: -0.16 [-0.19, -0.13], <i>q</i>-value = 1.31 × 10<sup>-24</sup>); and <i>(2)</i> lower FEV<sub>1</sub> (from school age: 7-10 years; β: -0.07 [-0.09, -0.05], <i>q</i>-value = 1.65 × 10<sup>-9</sup>, to adulthood: 41-50 years; β: -0.17 [-0.20, -0.13], <i>q</i>-value = 4.48 x 10<sup>-20</sup>). No effect modification by smoking, sex, or a diagnosis of asthma was observed.</p><p><strong>Interpretation: </strong>We provide evidence that a higher genetic risk for COPD is linked to lower lung function from childhood onwards.</p><p><strong>Funding: </strong>This study was supported by CADSET, a Clinical Research Collaboration of the European Respiratory Society.</p>","PeriodicalId":11393,"journal":{"name":"EClinicalMedicine","volume":"75 ","pages":"102731"},"PeriodicalIF":9.6,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Earnings and work loss after colon and rectal cancer: a Swedish nationwide matched cohort study. 结肠癌和直肠癌后的收入和工作损失:瑞典全国范围内的匹配队列研究。
IF 9.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-06 eCollection Date: 2024-09-01 DOI: 10.1016/j.eclinm.2024.102770
S E Boman, I Hed Myrberg, G Bruze, A Martling, C Nordenvall, P J Nilsson

Background: Colorectal cancer is common and prognosis is improving. The conditions of survivors of treatment, including financial consequences, are thus important. The aim of this study was to quantify loss of earnings and work loss in working-age patients with colon and rectal cancer relative to matched comparators.

Methods: The study utilised data from the CRCBaSe database that is generated from the nationwide Swedish ColoRectal Cancer Register and includes data from several Swedish nationwide registers. The study period was 1995-2020 for rectal cancer patients and 2007-2020 for colon cancer patients. A retrospective population-based nationwide cohort study on earnings, disposable income, and work loss, in survivors of stage I-III colorectal cancer treatment was undertaken. Median regression was used to analyse earnings and disposable income, and logistic regression to analyse the probability of work loss.

Findings: A cohort of 8863 colorectal cancer survivors diagnosed before 2017 and 52,514 comparators matched on birth year, legal sex, and county of residence, was analysed. There was a clear reduction in earnings between the calendar year prior to and the calendar year after diagnosis, from € 31,319 to € 23,924 for colon cancer patients and from € 32,636 to € 22,647 for rectal cancer patients, and earnings never fully recovered during the 5-year follow-up. Disposable income was practically unaltered. The probability of work loss increased in the calendar year of diagnosis, from 29.8% to 25.3% the previous year to 83.3% and 84.4% for colon and rectal cancer patients respectively, and never fully recovered. The probability of work loss was similar between colon and rectal cancer survivors, but was higher among patients with rectal cancer who had received neoadjuvant therapy.

Interpretation: This study shows that despite an extensive welfare system providing maintained disposable income, there is a financial burden in the form of increased risk of work loss and a reduction in earnings among survivors of colorectal cancer.

Funding: The study was supported by the Swedish Cancer Society, the Swedish Cancer and Allergy Foundation, and the Stockholm Cancer Society, and supported by grants provided by the Regional Agreement on Medical Training and Clinical Research (ALF) between the Stockholm County Council and Karolinska Institutet.

背景:结肠直肠癌很常见,预后正在改善。因此,治疗幸存者的状况(包括经济后果)非常重要。本研究的目的是量化结肠癌和直肠癌适龄工作患者相对于匹配比较者的收入损失和工作损失:研究利用了 CRCBaSe 数据库中的数据,该数据库由瑞典全国结肠直肠癌登记册生成,并包含瑞典多个全国性登记册中的数据。直肠癌患者的研究时间为 1995-2020 年,结肠癌患者的研究时间为 2007-2020 年。该研究以人口为基础,在全国范围内对接受过 I-III 期结直肠癌治疗的幸存者的收入、可支配收入和工作损失进行了回顾性队列研究。研究采用中位数回归分析收入和可支配收入,采用逻辑回归分析失去工作的概率:研究分析了 8863 名在 2017 年前确诊的结直肠癌幸存者和 52514 名根据出生年份、法定性别和居住地匹配的比较者。结肠癌患者在确诊前一个日历年和确诊后一个日历年之间的收入明显减少,从31319欧元减少到23924欧元,直肠癌患者从32636欧元减少到22647欧元。可支配收入几乎没有变化。结肠癌和直肠癌患者在确诊当年失去工作的几率增加,分别从上一年的 29.8% 和 25.3% 增加到 83.3% 和 84.4%,而且从未完全恢复。结肠癌和直肠癌幸存者的失业概率相似,但接受过新辅助治疗的直肠癌患者的失业概率更高:这项研究表明,尽管广泛的福利制度提供了可维持的可支配收入,但结肠直肠癌幸存者仍有经济负担,表现为失业风险增加和收入减少:这项研究得到了瑞典癌症协会、瑞典癌症和过敏基金会以及斯德哥尔摩癌症协会的支持,并得到了斯德哥尔摩县议会和卡罗林斯卡医学院之间的医学培训和临床研究地区协议(ALF)的资助。
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引用次数: 0
Total neoadjuvant treatment using short-course radiotherapy and four CAPOX cycles in locally advanced rectal cancer with high-risk criteria for recurrence: a Swedish nationwide cohort study (LARCT-US). 采用短程放疗和四个 CAPOX 周期对具有高复发风险标准的局部晚期直肠癌进行全面新辅助治疗:瑞典全国队列研究 (LARCT-US)。
IF 9.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-05 eCollection Date: 2024-09-01 DOI: 10.1016/j.eclinm.2024.102771
Bengt Glimelius, Tanweera Khan, Karin Adolfsson, Eva Angenete, Åke Berglund, Kristina Bonde, Nils Elander, Tone Fokstuen, Johan Haux, Israa Imam, Cecilia Lagerbäck, Ingrid Ljuslinder, Andrzej Piwowar, Marie Zajicova, Per J Nilsson

Background: Total neoadjuvant treatment (TNT) for locally advanced rectal cancer (LARC) increases pathologic complete response (pCR) rate and reduces the risk of systemic recurrences over chemoradiotherapy (CRT) in randomised trials, e.g., the RAPIDO trial. A modified RAPIDO schedule was prospectively explored in Sweden to evaluate TNT in routine health care before the RAPIDO results were published.

Methods: Between July 2016 and June 2020, 273 patients with high-risk LARC (clinical tumour stage cT4, clinical nodal stage cN2, extramural vascular invasion, involved mesorectal fascia or enlarged lateral lymph nodes) were treated in a prospective observational cohort study at 16 hospitals (LARCT-US). Another 189 patients at 18 (including the 16) hospitals were similarly treated (ad modum LARCT-US, AdmL) during the same period. Inclusion and exclusion criteria were identical to the RAPIDO trial. Patients received short-course radiotherapy (5 × 5 Gy for 5 days) followed by four cycles of CAPOX or six FOLFOX-6, followed by total mesorectal excision or, if clinical complete response (cCR), inclusion into a watch-and-wait (W&W) study. The primary endpoint was complete response (CR), i.e., the sum of pCR in specimens and cCR exceeding one year in W&W patients. Safety was assessed in all patients.

Findings: Compared to the RAPIDO trial, patients were older, and tumours more advanced. Median follow-up was 4.8 years (IQR 4.2-5.2). In LARCT-US all patients received radiotherapy and 268 (98%) started chemotherapy whereas in AdmL all patients received radiotherapy and chemotherapy. In LARCT-US 34 patients had pCR and 31 sustained cCR resulting in a CR-rate of 24% (95% CI 20-28). In AdmL, results were similar (23%, 95% CI 17-30). Locoregional recurrences were 6% (95% CI 4-10) and 5% (95% CI 2-9), respectively, both at 3 years and at last follow-up. Neurotoxicity, recorded in LARCT-US, was lower than in RAPIDO (EORTC-QLQ-CIPN20 tingling toes or feet mean score 24 (SD 31) vs 43 (SD 37)). One treatment-associated death occurred.

Interpretation: Despite older patients and more advanced tumours, results similar to the RAPIDO trial were obtained. Hence, two chemotherapy cycles less do not compromise the results maintaining a high CR-rate. This TNT schedule resulted in favourable outcomes in a nation-wide real-life situation.

Funding: Swedish Cancer Society.

背景:在RAPIDO试验等随机试验中,局部晚期直肠癌(LARC)的全新辅助治疗(TNT)与化放疗(CRT)相比,可提高病理完全反应率(pCR)并降低全身复发风险。在RAPIDO结果公布之前,瑞典对修改后的RAPIDO计划进行了前瞻性探索,以评估TNT在常规医疗保健中的应用:方法:2016 年 7 月至 2020 年 6 月期间,一项前瞻性观察性队列研究(LARCT-US)在 16 家医院对 273 例高风险 LARC 患者(临床肿瘤分期 cT4、临床结节分期 cN2、壁外血管侵犯、累及直肠间筋膜或外侧淋巴结肿大)进行了治疗。同期,18 家医院(包括这 16 家医院)的另外 189 名患者也接受了类似治疗(ad modum LARCT-US,AdmL)。纳入和排除标准与 RAPIDO 试验相同。患者先接受短程放疗(5 × 5 Gy,5 天),然后接受四个周期的 CAPOX 或六个周期的 FOLFOX-6,最后进行全直肠系膜切除术,如果出现临床完全反应(cCR),则纳入观察和等待(W&W)研究。主要终点是完全反应(CR),即标本中的 pCR 和 W&W 患者超过一年的 cCR 之和。对所有患者进行了安全性评估:与RAPIDO试验相比,患者年龄更大,肿瘤更晚期。中位随访时间为4.8年(IQR为4.2-5.2)。在LARCT-US试验中,所有患者都接受了放疗,268名患者(98%)开始接受化疗,而在AdmL试验中,所有患者都接受了放疗和化疗。在LARCT-US中,34名患者获得pCR,31名患者持续获得cCR,CR率为24%(95% CI 20-28)。AdmL的结果类似(23%,95% CI 17-30)。3年后和最后一次随访时,局部复发率分别为6%(95% CI 4-10)和5%(95% CI 2-9)。LARCT-US记录的神经毒性低于RAPIDO(EORTC-QLQ-CIPN20脚趾或脚趾刺痛平均得分为24(标度31) vs 43(标度37))。发生了一起与治疗相关的死亡事件:尽管患者年龄更大、肿瘤更晚期,但仍获得了与RAPIDO试验相似的结果。因此,减少两个化疗周期并不会影响维持高CR率的结果。这种TNT方案在全国范围内的实际情况中取得了良好的效果:瑞典癌症协会。
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引用次数: 0
Prevalence of exocrine pancreatic insufficiency at 12 months after acute pancreatitis: a prospective, multicentre, longitudinal cohort study. 急性胰腺炎后 12 个月时胰腺外分泌功能不全的患病率:一项前瞻性、多中心、纵向队列研究。
IF 9.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-02 eCollection Date: 2024-09-01 DOI: 10.1016/j.eclinm.2024.102774
Anna Evans Phillips, Joseph Bejjani, Stacey Culp, Jennifer Chennat, Peter J Lee, Jorge D Machicado, Vikesh K Singh, Elham Afghani, Mitchell L Ramsey, Pedram Paragomi, Kimberly Stello, Melica Nikahd, Phil A Hart, Georgios I Papachristou

Background: Exocrine Pancreatic insufficiency (EPI) occurs following acute pancreatitis (AP) at variably reported rates and with unclear recovery timeline. The aim of this study was to establish the prevalence and predictors of EPI at 12 months after AP in a prospective cohort.

Methods: In this prospective, multicentre, longitudinal cohort study, adult participants (≥18 years) admitted to the hospital with an AP attack (defined by Revised Atlanta Classification) were enrolled in a United States multi-centre longitudinal cohort (Sites: The Ohio State University, University of Pittsburgh, and Johns Hopkins University). Patients were excluded if they had pancreatic cancer, chronic pancreatitis, or malabsorptive disease (including previously diagnosed EPI). Participant data was obtained by interview and by review of the electronic medical record. EPI was assessed by stool fecal elastase (FE-1) levels collected at baseline, 3 months, and 12 months (primary endpoint). EPI was defined by FE-1 <200 μg/g; severe FE-1 level ≤100 μg/g; mild FE-1 101-200 μg/g. Multivariable logistic regression was used to identify predictors of EPI at 12 months. This study is registered with ClinicalTrials.gov, NCT03063398.

Findings: EPI was observed in 29 (34.1%) of the 85 participants [44 (51.8%) male, mean age 54.7 ± 14.1 years] who provided stool samples at 12 months. For the study overall, participants were recruited between June 22, 2017 and October 18, 2021. A total of 5794 individuals were screened, 311 of whom were eligible for the study. 112 participants provided stool samples at baseline, 79 completed stool samples at 3 months, and 85 completed samples at 12 months. 64 participants included samples at all 3 timepoints. In univariable analysis, factors significantly associated with EPI at 12 months included recurrent (versus index) AP, pre-existing diabetes, alcohol, and idiopathic etiologies, and increasing severity of AP. In multivariable analysis, the odds of having EPI at 12 months increased 4-fold with idiopathic AP etiology (Odds Ratio 4.095, 95% Confidence Interval [CI] 1.418, 11.826), and 3-fold with moderately severe or severe AP (Odds Ratio 3.166, 95% CI 1.156, 8.670), and baseline diabetes mellitus (Odds Ratio 3.217, 95% CI 1.113, 9.298). Even individuals with an index mild attack of AP (n = 39) developed severe EPI at 12 months (prevalence 12.8%).

Interpretation: EPI as diagnosed by FE-1 is present in over one third of prospectively assessed patients at 12 months post-AP. Since EPI develops in patients with mild AP, investigations are needed to understand the mechanisms of injury and identify methods for tailored screening.

Funding: This study was supported by an Investigator Initiated Research Grant from AbbVie, Inc.

背景:急性胰腺炎(AP)后会出现胰腺外分泌功能不全(EPI),报告的发生率各不相同,恢复时间也不明确。本研究的目的是在前瞻性队列中确定急性胰腺炎后 12 个月 EPI 的发生率和预测因素:俄亥俄州立大学、匹兹堡大学和约翰霍普金斯大学)。如果患者患有胰腺癌、慢性胰腺炎或消化不良性疾病(包括之前诊断出的 EPI),则排除在外。通过访谈和查阅电子病历获得参与者的数据。EPI 通过基线、3 个月和 12 个月(主要终点)收集的粪便弹性蛋白酶 (FE-1) 水平进行评估。EPI 的定义是 FE-1 检测结果:在 85 名参与者中,有 29 人(34.1%)在 12 个月时提供了粪便样本,其中 44 人(51.8%)为男性,平均年龄为 54.7 ± 14.1 岁。就整个研究而言,参与者是在 2017 年 6 月 22 日至 2021 年 10 月 18 日期间招募的。共筛选出 5794 人,其中 311 人符合研究条件。112 名参与者在基线时提供了粪便样本,79 人在 3 个月时完成了粪便样本,85 人在 12 个月时完成了样本。64 名参与者在所有 3 个时间点都提供了样本。在单变量分析中,与 12 个月时 EPI 显著相关的因素包括:复发性 AP(相对于指数性 AP)、原有糖尿病、酒精、特发性病因以及 AP 的严重程度增加。在多变量分析中,特发性 AP 病因导致 12 个月后出现 EPI 的几率增加了 4 倍(Odds Ratio 4.095,95% 置信区间 [CI] 1.418,11.826),中度或重度 AP 增加了 3 倍(Odds Ratio 3.166,95% CI 1.156,8.670),基线糖尿病增加了 3 倍(Odds Ratio 3.217,95% CI 1.113,9.298)。即使是指数为轻度发作的 AP 患者(n = 39)也会在 12 个月后发展为重度 EPI(发病率为 12.8%):解释:在 AP 后 12 个月的前瞻性评估中,超过三分之一的患者出现了由 FE-1 诊断的 EPI。由于轻度 AP 患者也会出现 EPI,因此需要进行调查以了解损伤机制并确定有针对性的筛查方法:本研究由艾伯维公司(AbbVie, Inc.
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引用次数: 0
Association between internet exclusion and depressive symptoms among older adults: panel data analysis of five longitudinal cohort studies. 互联网排斥与老年人抑郁症状之间的关系:对五项纵向队列研究的面板数据分析。
IF 9.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-02 eCollection Date: 2024-09-01 DOI: 10.1016/j.eclinm.2024.102767
Rui Yan, Xinwei Liu, Ruyue Xue, Xiaoran Duan, Lifeng Li, Xianying He, Fangfang Cui, Jie Zhao
<p><strong>Background: </strong>Internet exclusion and depressive symptoms are prevalent phenomena among older adults; however, the association between internet exclusion and depressive symptoms remains limited. This study aims to investigate the association between internet exclusion and depressive symptoms among older adults from high-income countries (HICs) and low- and middle-income countries (LMICs).</p><p><strong>Methods: </strong>We conducted a comprehensive longitudinal, cross-cultural analysis, and the participants were adults aged 60 years and older from 32 countries participating in five nationally representative longitudinal cohort studies: the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Ageing Study (MHAS). Internet exclusion was defined as the self-reported absence from internet use. Depressive symptoms were evaluated using the Centre for Epidemiologic Studies of Depression scale (CES-D) or the Euro-Depression scale (Euro-D). These five cohorts, being heterogeneous, were respectively conducted with panel data analysis. Logistic regression, implemented within the generalized estimating equations framework, was used to examine the association between internet exclusion and the likelihood of experiencing depressive symptoms, adjusting for the causal-directed-acyclic-graph (DAG) minimal sufficient adjustment set (MSAS), including gender, age, education, labour force status, household wealth level, marital status, co-residence with children, residence status, cognitive impairment, and functional ability.</p><p><strong>Findings: </strong>Our study included a total of 129,847 older adults during the period from 2010 to 2020, with a median follow-up of 5 (2, 7) years. The pooled proportion of internet exclusion was 46.0% in HRS, 32.6% in ELSA, 54.8% in SHARE, 92.3% in CHARLS, and 65.3% in MHAS. Internet exclusion was significantly associated with depressive symptoms across all cohort studies: HRS (OR = 1.13, 95% CI 1.07-1.20), ELSA (OR = 1.22, 95% CI 1.11-1.34), SHARE (OR = 1.55, 95% CI 1.47-1.62), CHARLS (OR = 1.49, 95% CI 1.26-1.77), and MHAS (OR = 1.48, 95% CI 1.39-1.58). Moreover, internet exclusion was found to be associated with all dimensions of depression in the SHARE, MHAS, and ELSA cohorts (except for sleep and felt sad) cohorts.</p><p><strong>Interpretation: </strong>A considerable proportion of older adults experienced internet exclusion, particularly those in LMICs. Internet exclusion among older adults, irrespective of their geographic location in HICs or LMICs, was associated with a higher likelihood of experiencing depressive symptoms, which demonstrated the importance of addressing barriers to internet access and promoting active participation in the internet society among older adults.</p><p><strong>Funding: </strong>National Key R&D P
背景:互联网排斥和抑郁症状是老年人中普遍存在的现象;然而,互联网排斥和抑郁症状之间的关联仍然有限。本研究旨在调查高收入国家(HICs)和中低收入国家(LMICs)老年人中互联网排斥与抑郁症状之间的关联:我们进行了一项全面的跨文化纵向分析,参与者是来自 32 个国家的 60 岁及以上的成年人,他们参与了五项具有国家代表性的纵向队列研究:健康与退休研究(HRS)、英国老龄化纵向研究(ELSA)、欧洲健康、老龄化与退休调查(SHARE)、中国健康与退休纵向研究(CHARLS)以及墨西哥健康与老龄化研究(MHAS)。互联网排斥的定义是自我报告没有使用互联网。抑郁症状采用抑郁流行病学研究中心量表(CES-D)或欧洲抑郁量表(Euro-D)进行评估。这五个队列具有异质性,因此分别采用了面板数据分析方法。在广义估计方程框架内实施的逻辑回归被用来研究互联网排斥与抑郁症状发生可能性之间的关系,并对因果导向-关联图(DAG)最小充分调整集(MSAS)进行调整,包括性别、年龄、教育程度、劳动力状况、家庭财富水平、婚姻状况、与子女同住、居住状况、认知障碍和功能能力:我们的研究在 2010 年至 2020 年期间共纳入了 129847 名老年人,中位随访时间为 5(2,7)年。在HRS、ELSA、SHARE、CHARLS和MHAS中,互联网排斥的总比例分别为46.0%、32.6%、54.8%、92.3%和65.3%。在所有队列研究中,网络排斥与抑郁症状均有明显关联:HRS(OR = 1.13,95% CI 1.07-1.20)、ELSA(OR = 1.22,95% CI 1.11-1.34)、SHARE(OR = 1.55,95% CI 1.47-1.62)、CHARLS(OR = 1.49,95% CI 1.26-1.77)和 MHAS(OR = 1.48,95% CI 1.39-1.58)。此外,在SHARE、MHAS和ELSA队列中(除睡眠和感到悲伤外),网络排斥与抑郁的所有方面都有关联:相当一部分老年人,尤其是低收入和中等收入国家的老年人,都有过被网络排斥的经历。无论老年人的地理位置是在高收入国家还是低收入国家,他们被互联网排斥都与出现抑郁症状的可能性较高有关,这表明了解决老年人上网障碍和促进他们积极参与互联网社会的重要性:国家重点研发计划(批准号:2022ZD0160704)、郑州大学第一附属医院科研创新团队(批准号:ZYCXTD2023005)、郑州市协同创新重大项目(批准号:20XTZX08017)、河南省医学科技联合项目(批准号:LHGJ20220428)、国家自然科学基金(批准号:82373341)。
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引用次数: 0
Safety and efficacy of allogenic human amniotic epithelial cells transplantation via ovarian artery in patients with premature ovarian failure: a single-arm, phase 1 clinical trial. 卵巢早衰患者经卵巢动脉移植异基因人羊膜上皮细胞的安全性和有效性:单臂一期临床试验。
IF 9.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-30 eCollection Date: 2024-08-01 DOI: 10.1016/j.eclinm.2024.102744
Lichun Weng, Liutong Wei, Qiuwan Zhang, Taotao Sun, Xiaojun Kuang, Qin Huang, Yunyun Cao, Xiaoyi Liu, Qian Wang, Ying Guo, Junyan Sun, Lulu Wang, Haihong Tang, Haiou Yang, Qian Chen, Jian Zhang, Bingshun Wang, Zhaoxia Qian, Dongmei Lai

Background: Premature ovarian failure (POF) is a prevalent and severe condition that impairs female health but there is currently no effective treatment available to restore ovarian function. Human amniotic epithelial cells (hAECs) exhibit ovarian protection in pre-clinical models. Thus, we conducted a single-arm, phase 1 clinical trial to assess the safety and efficacy of allogenic hAECs in treating POF.

Methods: A total of 35 patients received 6 × 107 hAECs via ovarian artery and completed a five-month follow-up from December 30, 2020 to January 31, 2022. The follow-up assessments were conducted at various intervals after hAECs treatment, including one month (Visit-1, V-1), three months (Visit-2, V-2), and five months (Visit-3, V-3) post-treatment. The primary endpoints were incidence of adverse events (AEs), and clinically significant laboratory abnormalities. Secondary endpoints included evaluation of transvaginal ultrasound results, sex hormone levels, Menopausal Quality of Life (MENQOL) questionnaire, as well as reproductive indicators. This trial was registered at www.clinicaltrials.gov as NCT02912104.

Findings: No serious AEs were observed throughout the five-month follow-up period. The most common AE was hematoma (7/35, 20.00%), and other AEs include pelvic pain (4/35, 11.43%), fever (2/35, 5.71%), anaphylaxis (2/35, 5.71%), and hepatotoxicity (1/35, 2.86%). After hAECs transplantation (hAECT), significant improvements were observed in the levels of endometrial thickness, left ovarian volume, sex hormones (follicle-stimulating hormone (FSH) and estradiol (E2)), and MENQOL scores in all patients during the five-month follow-up period. Among them, 13 participants (37.14%) experienced spontaneous menstrual bleeding, and 20.00% (7/35) reported more than one regular menstrual bleeding post-hAECT. In this response group, significant improvements were observed in endometrial thickness, left ovarian volume, levels of FSH, E2, anti-Müllerian hormone (AMH), and MENQOL scores one month after hAECT in comparison to pre-hAECT.

Interpretation: hAECT via ovarian artery is safe, well-tolerated and temporarily ameliorates endometrial thickness, ovarian size, hormone levels, and menopausal symptoms in POF patients. Further randomized controlled trial of hAECs with longer follow-up period and a larger sample size is warranted.

Funding: National Natural Science Foundation of China (No. 82271664), the Interdisciplinary Program of Shanghai Jiao Tong University (YG2022ZD028), the Shanghai Municipal Health Committee (202240345), Shanghai Key Laboratory of Embryo Original Diseases (No. Shelab2022ZD01), Shanghai Municipal Education Commission (No. 20152236), and National Key Research and Development Program of China (No. 2018YFC1004802), Shanghai Clinical Research Center for Cell Therapy, China (No. 23J41900100).

背景:卵巢早衰(POF)是一种普遍存在的严重疾病,会损害女性健康,但目前还没有有效的治疗方法来恢复卵巢功能。人羊膜上皮细胞(hAECs)在临床前模型中表现出卵巢保护作用。因此,我们开展了一项单臂一期临床试验,以评估异基因 hAECs 治疗 POF 的安全性和有效性:共有 35 名患者通过卵巢动脉接受了 6 × 107 hAECs,并在 2020 年 12 月 30 日至 2022 年 1 月 31 日期间完成了为期 5 个月的随访。随访评估在hAECs治疗后的不同时间段进行,包括治疗后一个月(访问-1,V-1)、三个月(访问-2,V-2)和五个月(访问-3,V-3)。主要终点是不良事件(AEs)的发生率和具有临床意义的实验室异常。次要终点包括评估经阴道超声结果、性激素水平、更年期生活质量(MENQOL)问卷以及生殖指标。该试验在 www.clinicaltrials.gov 登记为 NCT02912104:在五个月的随访期间未发现严重的不良反应。最常见的AE是血肿(7/35,20.00%),其他AE包括盆腔疼痛(4/35,11.43%)、发热(2/35,5.71%)、过敏性休克(2/35,5.71%)和肝毒性(1/35,2.86%)。移植hAECs(hAECT)后,所有患者的子宫内膜厚度、左侧卵巢体积、性激素(卵泡刺激素(FSH)和雌二醇(E2))水平以及MENQOL评分在5个月的随访期间均有显著改善。其中,13 名参与者(37.14%)出现自发性月经出血,20.00% 的参与者(7/35)在接受 HAECT 治疗后报告有一次以上的定期月经出血。解读:通过卵巢动脉进行 hAECT 安全、耐受性良好,可暂时改善 POF 患者的子宫内膜厚度、卵巢大小、激素水平和更年期症状。有必要进一步开展随访时间更长、样本量更大的 hAECs 随机对照试验:国家自然科学基金(编号:82271664)、上海交通大学交叉学科项目(YG2022ZD028)、上海市卫生健康委员会(202240345)、上海市胚胎原发疾病重点实验室(编号:Shelab2022ZD01)、上海市教育委员会(编号:20152236)、国家重点研发计划(编号:2018YFC1004802)、上海市细胞治疗临床研究中心(编号:23J41900100)。
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引用次数: 0
European Society of Human Reproduction and Embryology annual meeting 2024. 欧洲人类生殖与胚胎学学会 2024 年年会。
IF 9.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-29 eCollection Date: 2024-08-01 DOI: 10.1016/j.eclinm.2024.102781
Ben Burwood
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引用次数: 0
期刊
EClinicalMedicine
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