AIM: To assess the clinical efficacy and safety of epithelial-off accelerated corneal collagen cross-linking(CXL)in the management of progressive keratoconus over 1 a period.METHODS:A retrospective pre-post self-controlled study. Data were collected from complete cases of 63 patients(84 eyes)with progressive keratoconus who underwent epithelial-off accelerated CXL between August 2018 and September 2021. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), refraction, corneal transparency, maximum keratometry(Kmax)of the anterior corneal surface, minimum corneal thickness, endothelial cell counts, and intraocular pressure(IOP)were analyzed preoperatively and at 1, 3, 6, and 12 mo postoperatively.RESULTS:No significant differences were observed in UCVA and spherical power before and after surgery(all P>0.05). However, there were significant differences in BCVA, cylinder power, Kmax, minimum corneal thickness, and IOP(all P<0.05). At 12 mo postoperatively, there were no significant differences in BCVA, cylinder power, minimum corneal thickness, and IOP compared with preoperative values(all P>0.05), while Kmax was decreased compared with preoperative value(P<0.05). At 1 mo postoperatively, the corneal endothelial cell count(2519.87±345.28 cells/mm2)was decreased compared with preoperative value(2693.63±313.39 cells/mm2; P<0.001). At 1 wk postoperatively, 22 eyes developed corneal haze(grade 0.5 to 1), and 15 eyes presented with linear corneal stromal opacity at 1 mo postoperatively. In 7 eyes, corneal opacity subsided within 3 to 6 mo after the operation, however, 5 eyes still exhibited corneal nebula or macula without affecting visual acuity.CONCLUSION: After epithelial-off accelerated CXL, the UCVA, BCVA and spherical diopter of patients remained stable over time. The astigmatism and corneal curvature temporarily increased and then gradually decreased. The cornea minimum thickness decreased initially but subsequently returned to preoperative levels. The corneal curvature at 6 and 12 mo after surgery was significantly lower than that before surgery, which could effectively prevent the progression of keratoconus. Despite potential localized corneal opacity and macular complications, as well as a possible decrease in corneal endothelial cell count, BCVA remained unaffected, demonstrating favorable safety outcomes.

AIM: To assess the clinical efficacy and safety of epithelial-off accelerated corneal collagen cross-linking(CXL)in the management of progressive keratoconus over 1 a period.METHODS:A retrospective pre-post self-controlled study. Data were collected from complete cases of 63 patients(84 eyes)with progressive keratoconus who underwent epithelial-off accelerated CXL between August 2018 and September 2021. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), refraction, corneal transparency, maximum keratometry(Kmax)of the anterior corneal surface, minimum corneal thickness, endothelial cell counts, and intraocular pressure(IOP)were analyzed preoperatively and at 1, 3, 6, and 12 mo postoperatively.RESULTS:No significant differences were observed in UCVA and spherical power before and after surgery(all P>0.05). However, there were significant differences in BCVA, cylinder power, Kmax, minimum corneal thickness, and IOP(all P<0.05). At 12 mo postoperatively, there were no significant differences in BCVA, cylinder power, minimum corneal thickness, and IOP compared with preoperative values(all P>0.05), while Kmax was decreased compared with preoperative value(P<0.05). At 1 mo postoperatively, the corneal endothelial cell count(2519.87±345.28 cells/mm2)was decreased compared with preoperative value(2693.63±313.39 cells/mm2; P<0.001). At 1 wk postoperatively, 22 eyes developed corneal haze(grade 0.5 to 1), and 15 eyes presented with linear corneal stromal opacity at 1 mo postoperatively. In 7 eyes, corneal opacity subsided within 3 to 6 mo after the operation, however, 5 eyes still exhibited corneal nebula or macula without affecting visual acuity.CONCLUSION: After epithelial-off accelerated CXL, the UCVA, BCVA and spherical diopter of patients remained stable over time. The astigmatism and corneal curvature temporarily increased and then gradually decreased. The cornea minimum thickness decreased initially but subsequently returned to preoperative levels. The corneal curvature at 6 and 12 mo after surgery was significantly lower than that before surgery, which could effectively prevent the progression of keratoconus. Despite potential localized corneal opacity and macular complications, as well as a possible decrease in corneal endothelial cell count, BCVA remained unaffected, demonstrating favorable safety outcomes.

OBJECTIVE: To explore and evaluate the efficacy and safety of a modified thiotepa-based conditioning regimen combined with autologous hematopoietic stem cell transplantation (ASCT) for the treatment of primary central nervous system lymphoma (PCNSL). METHODS: In a retrospective, single center, single arm study, we collected data of 28 patients with PCNSL who underwent high-dose chemotherapy followed by autologous stem cell transplantation (HDC-ASCT) at our center from March 2021 to December 2024. The clinical characteristics of the patients, the conditioning regimen details, treatment-related toxicities and adverse reactions, post-transplant disease remission status, and survival outcomes were analyzed. RESULTS: A total of 28 patients were included. Among them, 19 patients received ASCT as first-line consolidation therapy in complete response (CR) or partial response (PR) status, and 9 patients with relapsed/refractory disease underwent salvage ASCT. The median time to neutrophil engraftment was 9 days (range: 5-11 days), and the median time to platelet engraftment was 10 days (range: 6-13 days). All patients achieved CR at the initial efficacy evaluation post-ASCT. The main complications during the transplantation period were febrile neutropenia (26 cases) and grade 3 diarrhea (9 cases). No transplantation-related mortality occurred. Post-ASCT, 19 patients received maintenance therapy, which was demonstrated to be safe and effective. Three patients relapse, and one patient died. The median progression-free survival (PFS) and overall survival (OS) of patients were not reached. The estimated 1-year and 2-year cumulative PFS rates were 88.4% and 66.3%, respectively, while the 1-year and 2-year OS rates were both 94.1%. CONCLUSION The modified thiotepa-based conditioning regimen combined with ASCT is safe and effective for the treatment of PCNSL.
Humans ; Thiotepa/therapeutic use* ; Retrospective Studies ; Transplantation, Autologous ; Transplantation Conditioning/methods* ; Central Nervous System Neoplasms/therapy* ; Hematopoietic Stem Cell Transplantation ; Female ; Male ; Middle Aged ; Adult ; Lymphoma/therapy* ; Treatment Outcome ; Aged

OBJECTIVE: To evaluate the dynamic changes of glucocorticoid (GC) dose and the feasibility of GC discontinuation in rheumatoid arthritis (RA) patients under the background of Chinese medicine (CM). METHODS: This multicenter retrospective cohort study included 1,196 RA patients enrolled in the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) from September 1, 2019 to December 4, 2023, who initiated GC therapy. Participants were divided into the Western medicine (WM) and integrative medicine (IM, combination of CM and WM) groups based on medication regimen. Follow-up was performed at least every 3 months to assess dynamic changes in GC dose. Changes in GC dose were analyzed by generalized estimator equation, the probability of GC discontinuation was assessed using Kaplan-Meier curve, and predictors of GC discontinuation were analyzed by Cox regression. Patients with <12 months of follow-up were excluded for the sensitivity analysis. RESULTS: Among 1,196 patients (85.4% female; median age 56.4 years), 880 (73.6%) received IM. Over a median 12-month follow-up, 34.3% (410 cases) discontinued GC, with significantly higher rates in the IM group (40.8% vs. 16.1% in WM; P<0.05). GC dose declined progressively, with IM patients demonstrating faster reductions (median 3.75 mg vs. 5.00 mg in WM at 12 months; P<0.05). Multivariate Cox analysis identified age <60 years [P<0.001, hazard ratios (HR)=2.142, 95% confidence interval (CI): 1.523-3.012], IM therapy (P=0.001, HR=2.175, 95% CI: 1.369-3.456), baseline GC dose ⩽7.5 mg (P=0.003, HR=1.637, 95% CI: 1.177-2.275), and absence of non-steroidal anti-inflammatory drugs use (P=0.001, HR=2.546, 95% CI: 1.432-4.527) as significant predictors of GC discontinuation. Sensitivity analysis (545 cases) confirmed these findings. CONCLUSIONS RA patients receiving CM face difficulties in following guideline-recommended GC discontinuation protocols. IM can promote GC discontinuation and is a promising strategy to reduce GC dependency in RA management. (Trial registration: ClinicalTrials.gov, No. NCT05219214).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Arthritis, Rheumatoid/drug therapy* ; Glucocorticoids/therapeutic use* ; Medicine, Chinese Traditional ; Retrospective Studies

ABSRACT The development of hepatocellular car-cinoma(HCC)is closely related to the formation of tumour blood vessels.VEGF-mediated angiogenesis is a major driver of the immune escape response in tumours.VEGF binds to vascular endothelial growth factor receptor2(VEGFR2)on endothelial cells,promoting endothelial cell proliferation and migration,inducing vascular changes in HCC,and thus promote the growth of hepatocellular carcino-ma cells.Anti-VEGF and its receptor-targeted mo-lecular drugs are currently effective new treat-ments for HCC.Monoclonal antibodies against VEGF and small-molecule tyrosine kinase inhibitors targeting VEGF have been shown to block its angio-genic activity,alleviate the inhibitory effect of the tumour microenvironment,and ultimately achieve tumour regression.This article provides a review of the research progress of VEGF/VEGFR inhibitors in HCC treatment.

ABSRACT The development of hepatocellular car-cinoma(HCC)is closely related to the formation of tumour blood vessels.VEGF-mediated angiogenesis is a major driver of the immune escape response in tumours.VEGF binds to vascular endothelial growth factor receptor2(VEGFR2)on endothelial cells,promoting endothelial cell proliferation and migration,inducing vascular changes in HCC,and thus promote the growth of hepatocellular carcino-ma cells.Anti-VEGF and its receptor-targeted mo-lecular drugs are currently effective new treat-ments for HCC.Monoclonal antibodies against VEGF and small-molecule tyrosine kinase inhibitors targeting VEGF have been shown to block its angio-genic activity,alleviate the inhibitory effect of the tumour microenvironment,and ultimately achieve tumour regression.This article provides a review of the research progress of VEGF/VEGFR inhibitors in HCC treatment.

ABSRACT The development of hepatocellular car-cinoma(HCC)is closely related to the formation of tumour blood vessels.VEGF-mediated angiogenesis is a major driver of the immune escape response in tumours.VEGF binds to vascular endothelial growth factor receptor2(VEGFR2)on endothelial cells,promoting endothelial cell proliferation and migration,inducing vascular changes in HCC,and thus promote the growth of hepatocellular carcino-ma cells.Anti-VEGF and its receptor-targeted mo-lecular drugs are currently effective new treat-ments for HCC.Monoclonal antibodies against VEGF and small-molecule tyrosine kinase inhibitors targeting VEGF have been shown to block its angio-genic activity,alleviate the inhibitory effect of the tumour microenvironment,and ultimately achieve tumour regression.This article provides a review of the research progress of VEGF/VEGFR inhibitors in HCC treatment.

ABSRACT The development of hepatocellular car-cinoma(HCC)is closely related to the formation of tumour blood vessels.VEGF-mediated angiogenesis is a major driver of the immune escape response in tumours.VEGF binds to vascular endothelial growth factor receptor2(VEGFR2)on endothelial cells,promoting endothelial cell proliferation and migration,inducing vascular changes in HCC,and thus promote the growth of hepatocellular carcino-ma cells.Anti-VEGF and its receptor-targeted mo-lecular drugs are currently effective new treat-ments for HCC.Monoclonal antibodies against VEGF and small-molecule tyrosine kinase inhibitors targeting VEGF have been shown to block its angio-genic activity,alleviate the inhibitory effect of the tumour microenvironment,and ultimately achieve tumour regression.This article provides a review of the research progress of VEGF/VEGFR inhibitors in HCC treatment.

ABSRACT The development of hepatocellular car-cinoma(HCC)is closely related to the formation of tumour blood vessels.VEGF-mediated angiogenesis is a major driver of the immune escape response in tumours.VEGF binds to vascular endothelial growth factor receptor2(VEGFR2)on endothelial cells,promoting endothelial cell proliferation and migration,inducing vascular changes in HCC,and thus promote the growth of hepatocellular carcino-ma cells.Anti-VEGF and its receptor-targeted mo-lecular drugs are currently effective new treat-ments for HCC.Monoclonal antibodies against VEGF and small-molecule tyrosine kinase inhibitors targeting VEGF have been shown to block its angio-genic activity,alleviate the inhibitory effect of the tumour microenvironment,and ultimately achieve tumour regression.This article provides a review of the research progress of VEGF/VEGFR inhibitors in HCC treatment.