1.Advances in neoadjuvant therapy for locally advanced resectable esophageal cancer
Xiaozheng KANG ; Ruixiang ZHANG ; Zhen WANG ; Xiankai CHEN ; Yong LI ; Jianjun QIN ; Yin LI
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2025;32(02):153-159
Neoadjuvant therapy has become the standard treatment for locally advanced resectable esophageal cancer, significantly improving long-term survival compared to surgery alone. Neoadjuvant therapy has evolved to include various strategies, such as concurrent chemoradiotherapy, chemotherapy, immunotherapy, or targeted combination therapy. This enriches clinical treatment options and provides a more personalized and scientific treatment approach for patients. This article aims to comprehensively summarize current academic research hot topics, review the rationale and evaluation measures of neoadjuvant therapy, discuss challenges in restaging methods after neoadjuvant therapy, and identify the advantages and disadvantages of various neoadjuvant therapeutic strategies.
2.Research progress on the molecular mechanism and therapeutic targets of ferroptosis in acute kidney injury
Yang ZHANG ; Fanyi HE ; Kongchun SUN ; Rui YANG ; Xuezhi YU ; Ling ZHANG ; Ruixiang CHEN ; Baochun SHEN
Organ Transplantation 2025;16(2):315-321
Acute kidney injury (AKI) is one of the most common and severe nephropathy syndromes in clinical practice and also one of the most common serious complications after organ transplantation, with high incidence and fatality. Iron is an essential trace element in the body. Ferroptosis is a form of programmed cell death induced by the accumulation of iron-mediated lipid peroxidation, and its occurrence is closely related to iron metabolism, lipid metabolism, amino acid metabolism and multiple signaling pathways. Recent studies have shown that ferroptosis plays a key role in the occurrence and development of AKI and provides therapeutic targets for AKI. This article summarizes the regulatory mechanism of ferroptosis and its role in AKI, as well as the compounds that play an important role in the prevention and treatment of AKI by inhibiting ferroptosis, providing new ideas for the future treatment and research of AKI.
3.Research progress on metformin in the treatment for malignant tumors
Xueyu DUAN ; Binbin LIAO ; Lei LI ; Dingcai ZHANG ; Ruixiang CHEN ; Xiaobo LIU
China Pharmacy 2024;35(15):1915-1922
In recent years, the potential anti-tumor effects of metformin have attracted widespread attention in the field of cancer treatment. This article summarizes the research progress of metformin in the treatment of malignant tumors,finding its potential application in the treatment of malignant tumors in the digestive system (biliary tract cancer,gastric cancer,esophagus cancer,colorectal cancer,pancreatic cancer,liver cancer) and reproductive system (prostate cancer,ovarian cancer,breast cancer, cervical cancer),non-small cell lung cancer,renal cell carcinoma,and melanoma. Metformin can inhibit the proliferation of tumor cells and extend the overall survival of patients. Its mechanisms of action include,but are not limited to,inhibiting the activity of mitochondrial complex Ⅰ,activating adenosine monophosphate-activated protein kinase/p53 signaling pathway,and blocking the cell cycle. Additionally,the combined use of metformin with chemotherapy drugs has shown potential for reducing toxicity and enhancing efficacy. It can enhance the sensitivity of biliary tract cancer,ovarian cancer,and melanoma cells to chemotherapy drugs, improve the drug resistance of gastric and colorectal cancer cells to chemotherapy,and reduce the toxic reactions of breast cancer patients during chemotherapy. Metformin is also used as an immunomodulator,applied in the immunotherapy of patients with esophagus cancer,colorectal cancer,cervical cancer,non-small cell lung cancer,and melanoma.
4.Clinical practice of complete preservation of female reproductive organs during radical cystectomy
Chen YE ; Yi WANG ; Yin CHEN ; Ruixiang SONG ; Shuxiong ZENG ; Chuanliang XU ; Huiqing WANG
Chinese Journal of Clinical Medicine 2024;31(2):246-250
Objective To explore the efficacy and technical points of complete preservation of female reproductive organ in radical cystectomy.Methods In 2020 and 2021,two female patients with bladder cancer undergoing radical cystectomy in The First Affiliated Hospital of Naval Medical University were selected.The clinical conditions of the patients were evaluated before surgery,and the reproductive organs were completely preserved according to the patients'wishes during the operation.The patients were regularly followed up after surgery.The efficacy and prognosis of patients were evaluated.Results The operation was successful and the two patients recovered well without surgery-related complications.The follow-up time for two patients were 22 months and 36 months.During the follow-up period,no tumor recurrence was found,and the scores of sexual function and quality of life were good.One patient was successfully pregnant at 17 months after surgery,and routine prenatal examination and non-invasive fetal DNA testing showed no abnormalities.Conclusions Under the premise of strictly grasping the surgical indications,the complete preservation of female reproductive organs in radical cystectomy can improve patients'quality of life after surgery,especially protect the reproductive function of women of childbearing age.
5.Surgical treatment and prognosis analysis of hilar cholangiocarcinoma
Xiangcheng LI ; Changxian LI ; Hui ZHANG ; Feng CHENG ; Feng ZHANG ; Liyong PU ; Chuanyong ZHANG ; Ke WANG ; Lianbao KONG ; Xiaofeng QIAN ; Donghua LI ; Wenxiong LU ; Ping WANG ; Aihua YAO ; Jianfeng BAI ; Xiaofeng WU ; Ruixiang CHEN ; Xuehao WANG
Chinese Journal of Surgery 2024;62(4):290-301
Objective:To investigate the surgical treatment effect and prognostic factors of hilar cholangiocarcinoma.Methods:This is an ambispective cohort study. From August 2005 to December 2022,data of 510 patients who diagnosed with hilar cholangiocarcinoma and underwent surgical resection at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively collected. In the cohort,there were 324 males and 186 females,with an age of ( M (IQR)) 63(13)years (range:25 to 85 years). The liver function at admission was Child-Pugh A (343 cases,67.3%) and Child-Pugh B (167 cases,32.7%). Three hundred and seventy-two(72.9%) patients had jaundice symptoms and the median total bilirubin was 126.3(197.6) μmol/L(range: 5.4 to 722.8 μmol/L) at admission. Two hundred and fourty-seven cases (48.4%) were treated with percutaneous transhepatic cholangial drainage or endoscopic nasobiliary drainage before operation. The median bilirubin level in the drainage group decreased from 186.4 μmol/L to 85.5 μmol/L before operation. Multivariate Logistic regression was used to identify the influencing factors for R0 resection,and Cox regression was used to construct multivariate prediction models for overall survival(OS) and disease-free survival(DFS). Results:Among 510 patients who underwent surgical resection,Bismuth-Corlett type Ⅲ-Ⅳ patients accounted for 71.8%,among which 86.1% (315/366) underwent hemi-hepatectomy,while 81.9% (118/144) underwent extrahepatic biliary duct resection alone in Bismuch-Corlett type Ⅰ-Ⅱ patients. The median OS time was 22.8 months, and the OS rates at 1-,3-,5-and 10-year were 72.2%,35.6%,24.8% and 11.0%,respectively. The median DFS time was 15.2 months,and the DFS rates was 66.0%,32.4%,20.9% and 11.0%,respectively. The R0 resection rate was 64.5% (329/510), and the OS rates of patients with R0 resection at 1-,3-,5-and 10-year were 82.5%, 48.6%, 34.4%, 15.2%,respectively. The morbidity of Clavien-Dindo grade Ⅲ-Ⅴ complications was 26.1%(133/510) and the 30-day mortality was 4.3% (22/510). Multivariate Logistic regression indicated that Bismuth-Corlett type Ⅰ-Ⅲ ( P=0.009), hemi-hepatectomy and extended resection ( P=0.001),T1 and T2 patients without vascular invasion (T2 vs. T1: OR=1.43 (0.61-3.35), P=0.413;T3 vs. T1: OR=2.57 (1.03-6.41), P=0.010;T4 vs. T1, OR=3.77 (1.37-10.38), P<0.01) were more likely to obtain R0 resection. Preoperative bilirubin,Child-Pugh grade,tumor size,surgical margin,T stage,N stage,nerve infiltration and Edmondson grade were independent prognostic factors for OS and DFS of hilar cholangiocarcinoma patients without distant metastasis. Conclusions:Radical surgical resection is necessary to prolong the long-term survival of hilar cholangiocarcinoma patients. Hemi-hepatectomy and extended resection,regional lymph node dissection and combined vascular resection if necessary,can improve R0 resection rate.
6.Interpretation of the key points of "Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries"
Peiyu WANG ; Qi HUANG ; Shaodong WANG ; Xiankai CHEN ; Ruixiang ZHANG ; Jia ZHAO ; Mantang QIU ; Yin LI ; Xiangnan LI
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2024;31(07):933-954
"Global cancer statistics 2022" based on the latest GLOBCAN data from the International Agency for Research on Cancer (IARC) was recently released, providing a systematic analysis of the incidence and mortality of 36 types of cancer across 185 countries worldwide. The international burden of cancer is expected to continue to increase over the next 30 years, posing a severe public health and social challenge for many countries, including China. This article offers a key point interpretation of the "Global cancer statistics 2022", focusing on the evolution of cancer epidemiology and future development trends. The aim is to broaden the international perspective on cancer prevention and treatment, with the hope of providing reference and guidance for cancer prevention and treatment efforts in our country.
7.Methodology for Developing Patient Guideline (3):Reporting Frameworks and Presentation
Lijiao YAN ; Ning LIANG ; Haili ZHANG ; Nannan SHI ; Ziyu TIAN ; Ruixiang WANG ; Xiaojia NI ; Yufang HAO ; Wei CHEN ; Yingfeng ZHOU ; Dan YANG ; Shuyu YANG ; Yujing ZHANG ; Ziteng HU ; Jianping LIU
Journal of Traditional Chinese Medicine 2024;65(22):2304-2309
Standardized reporting is a crucial factor affecting the use of patient guidelines (PGs), particularly in the reporting and presentation of recommendations. This paper introduced the current status of PG reporting, including the research on PG content and presentation formats, and provided comprehensive recommendations for PG reporting from aspects such as overall framework, recommendations, presentation format, and readability. First, the presentation of PG recommendations should include clearly defined clinical questions, recommendations and their rationale, and guidance on how patients should implement the interventions; for specific content in the PG, such as level of evidence, level of recommendation, it is recommended to explain in text the reasons for giving different levels of recommendation, i.e., to present the logic behind giving the level of recommendation to the patient; additional information needed in the recommendation framework should be supplemented by tracing references or authoritative textbooks and literature that support the recommendations. Subsequently, the PG text should be written based on the Reporting Checklist for Public Versions of Guidelines (RIGHT-PVG) reporting framework. Finally, to enhance readability and comprehension, it is recommended to refer to the Patient Education Materials Assessment Tool (PEMAT) for translating PG content. To enhance the readability of PGs, it is suggested to present the PG content in a persona-lized and layered manner.
8.Methodology for Developing Patient Guideline(1):The Concept of Patient Guideline
Lijiao YAN ; Ning LIANG ; Ziyu TIAN ; Nannan SHI ; Sihong YANG ; Yufang HAO ; Wei CHEN ; Xiaojia NI ; Yingfeng ZHOU ; Ruixiang WANG ; Zeyu YU ; Shuyu YANG ; Yujing ZHANG ; Ziteng HU ; Jianping LIU
Journal of Traditional Chinese Medicine 2024;65(20):2086-2091
Since the concept of patient versions of guidelines (PVGs) was introduced into China, several PVGs have been published in China, but we found that there is a big difference between the concept of PVG at home and abroad, and the reason for this difference has not been reasonably explained, which has led to ambiguity and even misapplication of the PVG concept by guideline developers. By analyzing the background and purpose of PVGs, and the understanding of the PVG concept by domestic scholars, we proposed the term patient guidelines (PGs). This refers to guidelines developed under the principles of evidence-based medicine, centered on health issues that concern patients, and based on the best available evidence, intended for patient use. Except for the general attribute of providing information or education, which is typical of common health education materials, PGs also provide recommendations and assist in decision-making, so PGs include both the patient versions of guidelines (PVG) as defined by the Guidelines International Network (GIN) and "patient-directed guidelines", i.e. clinical practice guidelines resulting from the adaptation or reformulation of recommendations through clinical practice guidelines.
9.Methodology for Developing Patient Guideline (2):Process and Methodology
Lijiao YAN ; Ning LIANG ; Nannan SHI ; Sihong YANG ; Ziyu TIAN ; Dan YANG ; Xiaojia NI ; Yufang HAO ; Wei CHEN ; Ruixiang WANG ; Yingfeng ZHOU ; Shibing LIANG ; Shuyu YANG ; Yujing ZHANG ; Ziteng HU ; Jianping LIU
Journal of Traditional Chinese Medicine 2024;65(21):2194-2198
At present, the process and methodology of patient guidelines (PGs) development varies greatly and lacks systematic and standardised guidance. In addition to the interviews with PG developers, we have sorted out the relevant methodology for the adaptation and development of existing clinical practice guideline recommendations and facilitated expert deliberations to achieve a consensus, so as to finally put forward a proposal for guidance on the process and methodology for the development of PGs. The development of PGs can be divided into the preparation stage, the construction stage, and the completion stage in general, but the specific steps vary according to the different modes of development of PGs. The development process of Model 1 is basically the same as the patient version of the guideline development process provided by the International Guidelines Network, i.e., team formation, screening of recommendations, guideline drafing, user testing and feedback, approval and dissemination. The developer should also first determine the need for and scope of translating the clinical practice guideline into a patient version during the preparation phase. Model 2 adds user experience and feedback to the conventional clinical practice guideline development process (forming a team, determining the scope of the PG, searching, evaluating and integrating evidence, forming recommendations, writing the guideline, and expert review). Based on the different models, we sort out the process and methods of PG development and introduce the specific methods of PG development, including how to identify the clinical problem and how to form recommendations based on the existing clinical practice guidelines, with a view to providing reference for guideline developers and related researchers.
10.Definitions of Yin-Yang Based on Set Partitioning Theory
Journal of Traditional Chinese Medicine 2024;65(24):2504-2509
This paper investigated the corresponding relationships between wuji (无极), taiji (太极), yin-yang (阴阳) and certain mathematical concepts, i.e. wuji directly corresponds to the empty set, the number 0 and the intial origin; taiji corresponds to the universe set, the number 1 and the unit circle; yin-yang directly corresponds to the binary opposition division of universe set, the combination of numbers or characters 0 and 1, and the binary division of unit circle (into upper and lower semicircles, or left and right semicircles). In addition, the definitions of set descrication, set partitioning, and the set of basic equations (in a generalised sense) for yin and yang were given. The relationships between two set equations

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