Patients with severe tumors do not refer to the patients with end-stage tumors,but rather to the patients with a performance status(PS)score between 2 and 4 in certain stages due to various reasons,such as acute or chronic comorbidities,tumor itself,or treatment-related adverse events.To these patients,there is a high probability of achieving survival benefit and/or improvement in PS scores after synergistic management of available life-support technologies and anti-tumor therapies based on dynamic and precise testing.Elderly patients with tumors frequently present with one or more chronic illnesses and have poor toler-ance and compliance to treatment.Moreover,their treatment regimens often lack high-quality clinical evidence,making them more susceptible to developing severe tumors.The management of severe tumors in the elderly is based on three basic diagnosis and treatment technologies:dynamic and precise detection,powerful life support technologies,and skillful application of current anti-tumor treatments.In specific clinical practice,the following 7 flexible and individualized treatment strategies should be adopted for different tumor types:1.concurrent management of cancer and comorbidities,2.upgrading and downgrading of anti-tumor drugs based on PS score,3.dynamic accurate detection,4.skillful combinations for increasing efficacy and reducing toxicity,5.complete overview,paying equal attention to systemic therapy and local therapy,6.safety first in medication for the elderly,7.multi-discipli-nary participation,individualized and comprehensive treatment.This article introduced the concept of severe tumors in the elderly and the associated management strategies,to increase awareness and provide feasible guidance for clinical practice.

Objective:To identify diagnostic markers related to oxidative stress in chronic rhinosinusitis with nasal polyps (CRSwNP) by analyzing transcriptome sequencing data, and to investigate their roles in CRSwNP.Methods:Utilizing four CRSwNP sequencing datasets, differentially expressed genes (DEGs) analysis, weighted gene co-expression network analysis (WGCNA), and three machine learning methods for Hub gene selection were performed in this study. Subsequent validation was carried out using external datasets, as well as real-time quantitative polymerase chain reaction (Real-time qPCR), and immunofluorescence staining of clinical samples. Moreover, the diagnostic efficacy of the genes was assessed by receiver operating characteristic (ROC) curve, followed by functional and pathway enrichment analysis, immune-related analysis, and cell population localization. Additionally, a competing endogenous RNA (CeRNA) network was constructed to predict potential drug targets. Statistical analysis and plotting were conducted using SPSS 26.0 and Graphpad Prism9 software.Results:Through data analysis and clinical validation, CP, SERPINF1 and GSTO2 were identified among 4 138 DEGs as oxidative stress markers related to CRSwNP. Specifically, the expression of CP and SERPINF1 increased in CRSwNP, whereas that of GSTO2 decreased, with statistically significant differences ( P<0.05). Additionally, an area under the curve (AUC)>0.7 indicated their effectiveness as diagnostic indicators. Importantly, functional analysis indicated that these genes were mainly related to lipid metabolism, cell adhesion migration, and immunity. Single-cell data analysis revealed that SERPINF1 was mainly distributed in epithelial cells, stromal cells, and fibroblasts, while CP was primarily located in epithelial cells, and GSTO2 was minimally present in the epithelial cells and fibroblasts of nasal polyps. Consequently, a CeRNA regulatory network was constructed for the genes CP and GSTO2. This construction allowed for the prediction of potential drugs that could target CP. Conclusion:This study successfully identifies CP, SERPINF1 and GSTO2 as diagnostic and therapeutic markers related to oxidative stress in CRSwNP.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

BACKGROUND: LY01005 (Goserelin acetate sustained-release microsphere injection) is a modified gonadotropin-releasing hormone (GnRH) agonist injected monthly. This phase III trial study aimed to evaluated the efficacy and safety of LY01005 in Chinese patients with prostate cancer. METHODS: We conducted a randomized controlled, open-label, non-inferiority trial across 49 sites in China. This study included 290 patients with prostate cancer who received either LY01005 or goserelin implants every 28 days for three injections. The primary efficacy endpoints were the percentage of patients with testosterone suppression ≤50 ng/dL at day 29 and the cumulative probability of testosterone ≤50 ng/dL from day 29 to 85. Non-inferiority was prespecified at a margin of -10%. Secondary endpoints included significant castration (≤20 ng/dL), testosterone surge within 72 h following repeated dosing, and changes in luteinizing hormone, follicle-stimulating hormone, and prostate specific antigen levels. RESULTS: On day 29, in the LY01005 and goserelin implant groups, testosterone concentrations fell below medical-castration levels in 99.3% (142/143) and 100% (140/140) of patients, respectively, with a difference of -0.7% (95% confidence interval [CI], -3.9% to 2.0%) between the two groups. The cumulative probabilities of maintaining castration from days 29 to 85 were 99.3% and 97.8%, respectively, with a between-group difference of 1.5% (95% CI, -1.3% to 4.4%). Both results met the criterion for non-inferiority. Secondary endpoints were similar between groups. Both treatments were well-tolerated. LY01005 was associated with fewer injection-site reactions than the goserelin implant (0% vs . 1.4% [2/145]). CONCLUSION: LY01005 is as effective as goserelin implants in reducing testosterone to castration levels, with a similar safety profile. TRIAL REGISTRATION ClinicalTrials.gov, NCT04563936.
Humans ; Male ; Antineoplastic Agents, Hormonal/therapeutic use* ; East Asian People ; Gonadotropin-Releasing Hormone/agonists* ; Goserelin/therapeutic use* ; Prostate-Specific Antigen ; Prostatic Neoplasms/drug therapy* ; Testosterone

Objective:To assess the prevalences of hypertension, rates of medication recommendations and failure rates of blood pressure(BP)control in Chinese elderly patients(≥65 years old).Methods:We used data from the 2011 China Health and Nutrition Survey(CHNS). A total of 2, 391 Chinese adults aged≥65 years with complete information comprising BP measurements repeated three times and antihypertensive medication use were included for analysis.Results:The mean age of subjects was 72.6±6.2 years, and females accounted for 53.1%.The numbers of patients with hypertension were 1784(74.6%)and 1221(51.1%)according to the definitions from 2017 ACC/AHA guideline and the 2010 Chinese guideline, respectively.There was a significant difference in the prevalence of hypertension in the subgroup with a cardiovascular disease(CVD)history according to the definitions from the two guidelines( χ2=23.70, P<0.01). The BP thresholds for drug therapy recommendations were the same as those set in the diagnostic criteria of hypertension based on the two guidelines.Therefore, the rates for medication recommendations were 74.6% and 51.1%, respectively.The numbers of patients with BP above the target levels were 622(88.2%)and 346(49.1%), respectively, according to the definitions from the two guidelines.There was no significant difference in failure rate of BP control due to age( χ2=5.36, P>0.05), gender( χ2=0.12, P>0.05)or a CVD history( χ2=0.07, P>0.05)according to analyses using the definitions from the two guidelines. Conclusions:Compared with the 2010 Chinese hypertension guideline, the prevalence of hypertension and rate of medication recommendations are higher in the Chinese elderly population when the 2017 ACC/AHA hypertension guideline is used.Hypertension management and antihypertensive drug treatment should be reinforced to improve the control rate of hypertension.

Objective: To investigate the turnaround time (TAT) of clinical laboratory specimens in Shaanxi Province, and provide evidence for improving quality of laboratories. Methods: The 90th percentiles of pre-analytical TAT and intra-laboratory TAT of emergency and inpatient specimens from four majors, such as biochemistry, immunology, blood-urine-faces routines and blood coagulation, were filled in by laboratories on-line, and the returned data were analyzed by Excel 2007 and SPSS 17.0 software. The comparison of the data between two groups was performed with Mann-Whitney U test, and that from multiple groups by Kruskal-Wallis H test. Results: A total of 267 questionnaires were issued, and 91.0% of laboratories finished the fill-in. Among them, 138 laboratories filled in the specimens′ TAT completely. There was no statistical difference in pre-analytical TAT of emergency specimens from four majors (P＞0.05), and the pre-analytical TAT was within 45 minutes in more than 85% of laboratories. There was significant difference in pre-analytical TAT of inpatient specimens from four majors (P＜0.05), and the pre-analytical TAT was within 120 minutes in 80% of laboratories. The specimens′ TAT of blood-urine-faces routines was slightly shorter than that of immunology. No matter emergency or inpatient specimens, the pre-analytical TAT of four majors in the laboratories of the second-level hospitals was less than that in the third-level hospitals (P＜0.05). Whether emergency or inpatient specimens, there were significant differences in the intra-laboratory TAT of four majors (P＜0.05). The intra-laboratory TAT of blood-urine-faces routines was the shortest, followed by that of blood coagulation and biochemistry, and that of immunology was the longest. The intra-laboratory TATs of emergency specimens for biochemistry, immunology, blood-urine-faces routines and blood coagulation were 30-120 minutes, 30-180 minutes, within 60 minutes and 15-120 minutes respectively, in 80% of laboratories. The intra-laboratory TATs of inpatient specimens for blood-urine-faces routines and blood coagulation were within 120 minutes and within 180 minutes respectively, in 80% of laboratories, while those for biochemistry and immunology were equal or greater than 240 minutes and 300 minutes respectively, in 20% of laboratories. No matter emergency or inpatient specimens, there was no significant difference in intra-laboratory TAT between the second-level hospitals and the third-level hospitals (P＞0.05). Conclusion The TAT of clinical laboratory specimens in Shaanxi Province is quite different. Some laboratories need to optimize the specimens′ turnaround process and shorten the TAT of specimens.

Objective:To observe the protective effect of deproteinized extract of calf blood (DECB) on the kidney injury of the diabetic rats, and to discuss its mechanism preliminarily.Methods:The male Wistar rats were intraperitoneally injected with STZ (65 mg·kg-1) to establish the diabetes models, then the model rats were randomly divided into model (M)group, and metformin (MMet, 105 mg·kg-1) group , low dose of combined administration (ML,105 mg·k-1 metformin+94.5 mg·kg-1 ,DECB) group, medium dose of combined administration(MM, 105 mg·kg-1 metformin+ 189 mg·kg-1 DECB) group, high dose of combined administration(MH, 105 mg·kg-1 metformin +378 mg·kg-1,DECB) group, another ten Wistar rats were selected as normal control(NC)group.The rats were intragastrically administed with metformin and intraperitoneally injected with DECB, once a day, total of 8 weeks.The rats in NC group and M group were given normal saline solution.The weights and blood glucose levels of the rats in various groups were determined;the levels of serum high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), blood urea nitrogen (BUN), urinary albumin (UAlb), urine creatinine (UCR), serum creatinine (SCr), total cholesterol (TC), triglyceride (TG), uric acid (UA), glutathione (GSH), and malondialdehyde (MDA) were detected;the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were determined.The pathological changes of kidney tissue of the rats in various groups were detected by HE staining.Results:Compared with NC group, the weight of the rats in M group was reduced(P<0.05),and the levels of blood glucose,UAlb,UCr,SCr,UA,BUN,LDL-C,TC,TG,and MDA were increased(P<0.05);the levels of HDL-C and GSH were obviously reduced(P<0.05),and the activities of SOD adn GSH-Px were obviously reduced(P<0.05).Compared with M group,the weights of the rats in MM and MH groups were increased (P<0.05), and the levels of blood glucose,UAlb,UCr,SCr,UA,BUN,LDL-C,TC,TG, and MDA were decreased (P< 0.05);the levels of HDL-C and GSH were increased (P<0.05),and the activities of SOD and GSH-Px were increased (P<0.05).The pathological observation of kidney tissue showed that the rats in M group had obvios kidney tissue lesions with glomerular congestion and renal tubular edema compared with NC group;compared with M group,the pathological changes of the kidney tissue of the rats in drug administration groups were significantly improved, the renal tubular vacuoles were reduced, and the interstitial hyperplasia was not obvious.Conclusion:DECB combined with metformin can reduce the blood glucose level, regulate blood lipid, improve the pathological changes of kidney tissue in the diabetic rats, reduce the renal damage, and enhance the antioxidant capacity of the body.

Objective:To investigate the door-to-balloon (D2B) time and its influencing factors for Percutaneous Coronary Intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods:180 cases of patients with STEMI in our hospital from January 2014 to April 2016 were selected.PCI therapy were operated on all patients after their consent.The pre-hospital delay time and D2B time of the patients were recorded.The related information of the patients,including demographic data,clinical factors,background of the disease and psychological factors,were investigated by the questionnaire survey.The patients were divided into short D2B group (D2B time≤ 126 min,n=96) and long D2B group (D2B time＞126 min,n=84).Univariate and multivariate logistic regression methods were used to analyze the influencing factors of D2B time.Results:The median D2B time of all the patients was 126 min,and only 26.7％ of patients' D2B time controlled within 90 min.Univariate analysis showed that differences of sudden attack,pay attention to symptoms,someone was present when attack,symptoms progress was fast,in hospital during holiday,no symptom in CCU,outpatient treatment,transfered by emergency medical service system (EMSS),time in CCU (6 am-10 pm),angina before infarction and pre-hospital delay time between the two groups were statistically significant (P＜0.05).Multivariate logistic regression analysis showed that in hospital during holiday,outpatient service,no symptom in CCU,pay attention to symptoms,use of transfered by EMSS,time in CCU (6am-10pm) are the factors affecting the time of D2B (OR=2.62,2.04,1.59,0.52,0.28,0.61 P＜0.05).Conclusion:The D2B time of most patients with STEMI can not reach the guidelines.The factors of patients,doctors,accepting mechanism of hospital are all related with D2B time.

Objective To study the relationship between bronchial asthma and smoking status in Chinese people.Methods Asthma epidemiological survey and stratified-cluster-random method survey were performed in residents over 14 years in 8 provinces (cities) of China from February 2010 to August 2012.Asthma was diagnosed based upon case history,clinical signs and lung function test.Smoking status was investigated by questionnaire.Results Sampling population was 180 099 and 164 215 were valid.A total of 2 034 subjects were diagnosed as asthma including 79 692 men and 84 523 women.The overall prevalence rate of asthma was 1.24％ (2 034/164 215).Smokers were 23.8％ (39 137/164 215) in the whole population.Smokers were 34.5％ (702/2 034) in asthmatic patients,compared with 23.7％ (38 435/ 162 181) in no-asthmatic population.The incidence of asthma was 1.79％ and 1.06％ in smokers and nonsmokers respectively (P ＜0.001),suggesting that OR of smoking was 1.70 (95％ CI 1.55-1.86,P ＜ 0.001).According to asthma control test (ACT) score,the level of asthma control in non smoking group was higher than that in smoking group(43.2％ vs 35.3％).The times of hospitalization due to acute exacerbations (0.51 vs 0.41 events/person/year),total hospitalization rate (27.35 ％ vs 20.12％),annual emergency room visits (0.80 vs 0.60 events/person/year) and emergency room visit rate (31.77％ vs 24.47％) were all much higher in smoking asthmatic patients than those in non smoking asthmatic patients,indicating that the level of asthma control in smoking patients was significantly worse than in non smoking patients.Conclusions The smoking rate in Chinese people over 14 years is still high.The prevalence rate of asthma in smokers is significantly higher than that of non-smokers.The level of asthma control in smokers is significantly worse than that in non smokers.

Objective:To observe the protective effect of deproteinized extract of calf blood (DECB)on the ethanol-induced liver injury of the mice,and to preliminaryly discuss its mechanism. Methods:Sixty healthy ICR mice were divided into control group,model group,positive drug group,low,medium and high doses of DECB groups (n=10).By intragastric administration,the mice in control group were given 20 mL·kg-1 saline solution, the mice in low,medium and high doses of DECB groups were administrated with 0.125,0.250,0.500 g·kg -1 DECB,and the mice in positive drug group were administrated with 0.63 g·kg -1 Hugan Tablets;once a day for 30 d. 1 h after the last administration,except control group,the mice in other groups were administrated with one-time grant of 50% ethanol 14 mL·kg -1 ,and fasted for 16 h to establish the models of acute alcohol liver injury.The endurance alcohol time and drunk time of the mice were determined,the activities of aspartate aminotransferase (ALT)and alanine transaminase (AST)activity in serum of the mice were detected,the levels of triglyceride (TG),glutathione (GSH)and malonic dialdehyde (MDA)in liver tissue were determined,and the pathological changes of liver tissue were detected.Results:Compared with model group,the drunk symptoms of the mice in different doses of DECB groups were obviously reduced,the endurance time of the mice in high dose of DECB group and positive drug group was prolonged (P <0.05),and the drinking time was shortened (P <0.05);the ALT and AST activities in serum in mediun and high doses of DECB groups were significantly lower than those in model group (P <0.05).Compared with model group,the MDA and TG levels in liver tissue of the mice in medium and high doses of DECB groups and positive drug group were obviously reduced,and the GSH levels were increased (P <0.05);compared with model group,the pathological damages of liver tissue of the mice in high dose of DECB group caused by ethanol were significantly reduced.Conclusion:DECB can improve ethanol-induced liver injury which may be related to the inhibition of hepatic oxidative stress response.