Journal of the Chinese Medical Association : JCMA最新文献

Background: Osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), penetrates the blood-brain barrier and provides intracranial tumor control in non-small-cell lung cancer (NSCLC). This study investigated whether combining osimertinib with intracranial radiotherapy (RT) improved outcomes in the patients with EGFR-mutant lung adenocarcinoma and brain metastases.

Methods: This is a retrospective analysis included patients who took osimertinib accompanying with or without RT between 2014 and 2022 from a single tertiary medical center. At least one session of magnetic resonance imaging and clinical follow-up after treatment. Outcomes assessed were intracranial local control, intracranial distant control, and overall survival (OS). Kaplan-Meier curves were used for outcome demonstration. Cox regression analysis was also used to identify independent predictors from age, gender, smoking, characteristics of brain metastases, KPS, gene types (presence of T790M), and radiation modalities.

Results: A total of 567 brain metastases from 69 patients were enrolled: TKI alone (n = 38) and TKI + RT (n = 31). Intracranial local control was significantly higher with TKI+RT compared with TKI alone (77% vs 23%; p < 0.01) at 3-year follow-up. Intracranial distant control was also longer in the TKI + RT group (23.2 vs 8.7 months in median; p < 0.01). No significant difference in OS was observed between the two groups ( p = 0.27). Multivariable analysis demonstrated that the presence of T790M mutation ( p = 0.01) and TKI + RT ( p = 0.01) were associated with improved intracranial local control, while TKI + RT was also associated with improved intracranial distant control ( p = 0.03).

Conclusion: The addition of RT to osimertinib enhanced intracranial local and distant control in the patients with EGFR-mutant lung adenocarcinoma and brain metastases, although no survival benefit was observed. Prospective studies are warranted to validate these findings.

Background: Ulnar-side carpometacarpal joint (CMCJ) fracture-dislocation is a rare hand injury, accounting for <1% of all hand and wrist injuries, and is often overlooked on plain radiographs. Surgical treatment is usually required, but the optimal approach depends on the fracture pattern and timing of diagnosis. The aim of this study is to explore the factors that make open reduction necessary for proper fracture alignment and to evaluate patient recovery after such procedures.

Methods: This study retrospectively reviewed patients who underwent surgical treatment for ulnar-side CMCJ fracture-dislocation between 2009 and 2022. Data on demographics, injury mechanism, time from injury to surgery, and surgical techniques were recorded. Postoperative outcomes were assessed using functional scores, including the Mayo Wrist Score (MWS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), the Visual Analogue Scale (VAS), and radiographic evaluations.

Results: A total of 44 patients (median age 36.4 years; 34 men and 10 women) were included. The median time from injury to surgery was 7 days (range, 1 to 61 days). Open reduction was required in all 17 patients with delayed surgery (≥2 weeks; p < 0.01). Among the 13 patients in the acute group who required open reduction, 11 patients presented with impacted type or intra-articular comminution fractures ( p = 0.04). Anatomic reduction was achieved in 42 of 44 patients (95.2%), who demonstrated favorable outcomes with high functional scores, minimal pain, and absence of radiographic evidence of post-traumatic arthritis during follow-up.

Conclusion: Surgical delay and fracture pattern are key determinants for the need for open reduction. Early recognition and timely surgical management are crucial in the treatment of ulnar-side CMCJ fracture-dislocations. Even in delayed cases, restoring alignment and joint stability can still yield good functional outcomes and reduce the risk of long-term complications.

Background: This meta-analysis was conducted to evaluate the efficacy and safety of liver venous deprivation (LVD) compared with portal vein embolization (PVE) in promoting compensatory liver hypertrophy and improving surgical resectability in liver cancer patients with insufficient future liver remnant (FLR).

Methods: PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched to identify clinical studies comparing the efficacy and safety of LVD and PVE. Following quality assessment and data extraction, a meta-analysis was conducted using RevMan version 5.4.

Results: In total, 13 studies involving 761 patients were included. Meta-analysis revealed that compared with PVE, LVD significantly increased the FLR growth rate after embolization (mean difference (MD) = 24.57, 95% CI, 15.49-33.66, p < 0.01) and the daily FLR volume (MD = 4.30, 95% CI, 0.23-8.36, p = 0.04), shortened the interval to surgery (MD = -5.28, 95% CI, -7.49 to -3.07, p < 0.01) and operation time (MD = -42.54, 95% CI, -79.98 to -5.11, p = 0.03), improved the resection completion rate (odds ratio [OR] = 1.73, 95% CI, 1.12-2.66, p = 0.01), and reduced the incidence of postoperative liver failure (OR = 0.45, 95% CI, 0.2-0.85, p = 0.01). Additionally, LVD was associated with lower recurrence (OR = 0.16, 95% CI, 0.03-0.93, p = 0.04) and 90-day mortality rates (OR = 0.16, 95% CI, 0.03-0.93, p = 0.04).

Conclusion: LVD demonstrates a superior performance over PVE in several key clinical outcomes and holds promise as a potential alternative for patients requiring preoperative FLR augmentation. However, further high-quality randomized controlled trials are warranted to validate its long-term efficacy and safety.

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder that affects women of reproductive age. It is characterized by ovulatory dysfunction, excessive levels of androgens, and the presence of multiple cysts in the ovaries. Although the exact cause of PCOS remains uncertain, recent studies have identified mitochondrial dysfunction as a key contributing factor. Mitochondria, often described as the energy centers of the cell, are essential for producing ATP, generating reactive oxygen species (ROS), and regulating cell death pathways. A growing body of evidence shows that mitochondrial dysfunction occurs in the ovaries, skeletal muscle, and adipose tissue of individuals with PCOS. This dysfunction may play a central role in the development of the disorder by increasing oxidative stress and chronic inflammation, worsening insulin resistance, and interfering with oocyte growth and quality. This review summarizes recent progress in understanding how mitochondrial dysfunction contributes to the underlying biology of PCOS. It also explores emerging treatment strategies that aim to restore mitochondrial health, such as the use of antioxidants, therapies that specifically target mitochondria, and emerging mitochondrial replacement technologies. These approaches hold promise for reducing the symptoms and long-term complications associated with PCOS.

Background: Globus, a non-painful sensation of a lump in the throat, affects nearly half of the population. Its etiology remains uncertain, and standardized treatment is lacking. Ban-Xia-Hou-Pu-Tang (BXHPT, ), a classical formula for "Plum Pit Qi" ( ), closely resembles globus in traditional Chinese medicine. This study investigated the traditional Chinese medicine constitution of patients with globus and evaluated the efficacy and safety of BXHPT combined with western therapy.

Methods: A single-blinded, randomized, placebo-controlled trial was conducted in patients with globus pharyngeus. Participants received either fexofenadine, famotidine, and acetylcysteine plus BXHPT (group A) or plus placebo (group B) for 4 weeks. The Constitution in Chinese Medicine Questionnaire, Reflux Symptom Index (RSI), Glasgow Edinburgh Throat Scale (GETS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), and Reflux Finding Score (RFS) were assessed. Hepatic and renal safety were monitored.

Results: Ninety-two patients completed the trial. Both groups showed significant improvements in RFS, RSI, GETS, BAI, and BDI-II. Group A had greater RFS reduction at week 2 (8.03 ± 1.57 vs 10.12 ± 1.75; p < 0.001) and week 4 (7.43 ± 1.16 vs 9.17 ± 1.80, p = 0.007). No hepatic or renal adverse effects occurred.

Conclusion: BXHPT combined with western therapy provided additional improvement in laryngoscopic findings without safety concerns, supporting its potential as an effective adjunctive treatment for globus sensation.