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| 1 | 帕博利珠单抗单用或与放疗联用治疗转移性非小细胞肺癌:两个随机试验的汇总分析显示文摘背景放疗可以提高整个机体对免疫治疗的应答。在Ⅱ期PEMBRO-RT研究和Ⅰ/Ⅱ期MDACC研究中,患有转移性非小细胞肺癌(NSCLC)的患者被随机分配入组,接受免疫治疗(帕博利珠单抗)+放疗联合疗法,或免疫治疗单一疗法。当上述2个研究单独分析时,联合疗法组显示出潜在获益。由于每个研究的样本量较小,缓解率和结局并未显示出统计学意义,然而却有显著的临床获益。因此,本研究进行汇总分析,来判断放疗是否会改善转移性NSCLC患者的免疫治疗应答。方法PEMBRO-RT和MDACC研究纳入标准:患者年龄≥18岁,患有转移性NSCLC,且有≥1处未经放疗照射的病灶,以便进行射野外应答监测。PEMBRO-RT研究纳入曾接受过化疗患者,MDACC研究纳入曾接受过治疗或新诊断患者。2个研究中的患者均未接受过免疫治疗。在PEMBRO-RT研究中患者被等比例随机分配入组,并根据吸烟状态进行分层(分为<10年组和≥10年组)。MDACC研究的患者根据放疗计划可行性被等比例随机分配入2个受试组。由于联合治疗组的干预本质,每个研究中的放疗均不适用盲法。在2个研究中,不论是否进行放疗,均静脉滴入帕博利珠单抗(每3周200 mg)。在PEMBRO-RT研究中,在放疗(24 Gy 3次分割照射)结束后1周给予第1剂帕博利珠单抗。在MDACC研究中,在第1次放疗(50 Gy 4次分割照射或45 Gy 15次分割照射)同时给予帕博利珠单抗。仅检测未经照射病灶的应答。本研究的终点为最佳射野外(远隔)应答率(ARR)、最佳射野外疾病控制率(ACR)、12周时ARR、12周时ACR、无进展生存期(PFS)和总生存期(OS)。2个研究的意向治疗(ITT)人群均纳入分析。PEMBRO-RT研究(NCT02492568)和MDACC研究(NCT02444741)均在ClinicalTrials.gov上注册。发现纳入148例患者,76例接受帕博利珠单抗治疗,72例接受帕博利珠单抗+放疗治疗。所有患者随访时间中位数为33个月[四分位距(IQR):32.4~33.6]。148例患者中124例(84%)组织学特征为非鳞癌,111例(75%)患者曾经接受过化疗。组间没有基线特征差异,包括PD-L1表达状态和转移灶体积。最常见的照射部位为肺转移灶(39%,28/72)、胸腔内淋巴结(21%,15/72)和非原发灶(17%,12/72)。帕博利珠单抗组和联合治疗组的最佳ARR分别为19.7%(15/76)和41.7%(30/72),OR=2.96,95%CI:1.42~6.20,P=0.0039;最佳ACR分别为43.4%(33/76)和65.3%(47/72),OR=2.51,95%CI:1.28~4.91,P=0.0071;PFS中位数分别为4.4(IQR:2.9~5.9)和9.0个月(IQR:6.8~11.2),HR=0.67,95%CI:0.45~0.99,P=0.045;OS中位数分别为8.7(IQR:6.4~11.0)和19.2个月(IQR:14.6~23.8),OR=0.67,95%CI:0.54~0.84,P=0.0004。在汇总分析中没有发现新的安全问题。解读帕博利珠单抗免疫疗法+放疗显著提高转移性NSCLC患者的应答和改善治疗结局。这些结果需要在三期临床试验中进行验证。 | 陈大卫(翻译) 于金明(校对) Willemijn S M E Theelen Vivek Verma Brian P Hobbs Heike M U Peulen Joachim G J V Aerts Idris Bahce Anna Larissa N Niemeijer Joe Y Chang Patricia M de Groot Quynh-Nhu Nguyen Nathan I Comeaux George R Simon Ferdinandos Skoulidis Steven H Lin Kewen He Roshal Patel John Heymach Paul Baas James W Welsh | 2021 | 中华肿瘤防治杂志2021，28，24： | 49 |
| 2 | Vitamin D levels do not predict the stage of hepatic fibrosis in patients with non-alcoholic fatty liver disease: A PRISMA compliant systematic review and meta-analysis of pooled data显示文摘AIM To investigate the relationship between 25-hydroxyvitamin D [25(OH)D] levels and fibrosis stage in patients with non-alcoholic fatty liver disease(NAFLD).METHODS Two individual reviewers identified relevant studies using the Pub Med, EMBASE, Cochrane, and Scopus databases. Inclusion criteria were as follows:(1) Studies that evaluated adults with NAFLD and serum or plasma 25(OH)D levels; and(2) assessed fibrosis stage using liver biopsy. A rigorous analysis yielded six articles as having sufficient data to employ in evaluating the association of serum vitamin D levels in patients with NAFLD based on their liver fibrosis stage by histopathological analysis. The lead investigators of each of the six studies were contacted and the data were collected. To meta-analyze vitamin D levels in F0-F2 vs F3-F4 fibrosis, a random-effects meta-analysis fit using restricted maximum likelihood was applied. To examine trends across each stage of fibrosis with respect to vitamin D levels, a meta-regression was performed. P < 0.05 was considered statistically significant. RESULTS A total of 937 subjects from six studies were included in the final analysis to evaluate the association of serum vitamin D levels in patients with NAFLD based on their liver fibrosis stage by histopathological analysis. The lead investigators of each of the six studies were contacted and the data were collected. First, the investigators performed a meta-analysis to compare serum vitamin D levels in patients with NAFLD with stage F0-F2 compared to F3-F4, which did not show significance [meta-estimate of the pooled mean difference =-0.86, P = 0.08(-4.17, 2.46)]. A metaregression evaluation of serum vitamin 25(OH)D levels across the individual stages(F0-F4) of fibrosis did not show an association for the six included studies.CONCLUSION Low vitamin D status is not associated with higher stages of liver fibrosis in patients with NAFLD. | Behnam Saberi Alia S Dadabhai Julie Nanavati Lin Wang Russell T Shinohara Gerard E Mullin | 2018 | World Journal of Hepatology2018，10，1： | 3 |
| 3 | 欧洲和中国的心脏与肾脏远程缺血预适应研究:一项随机对照试验显示文摘远程缺血预适应(remote ischemic preconditioning,RIPC)对经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后造影剂肾病(contrast-induced nephropathy,CIN)的潜在保护作用尚待确定。该研究为双盲、随机、安慰剂对照的多中心研究,纳入年龄〈85岁,肾清除率为30~60mL/(min·1.73m^2)的有临床适应证的患者,除了直接PCI外均按1∶1给予RIPC或标准治疗。主要终点是CIN的发生率。次要终点是围手术期心肌梗死(peri-procedural myocardial infarction,PMI)的发生率。 | 刘青 叶鹏 Moretti C Cerrato E Cavallero E Lin S Rossi ML Picchi A Sanguineti F Ugo F Palazzuoli A Bertaina M Presbitero P Shao-Liang C Pozzi R Giammaria M Limbruno U Lefèvre T Gasparetto V Garbo R OmedèP Sheiban I Escaned J Biondi-Zoccai G Gaita F Perl L D'Ascenzo F | 2018 | 中华高血压杂志2018，26，4： | 3 |
| 4 | 全颗粒饲料对奶牛生产性能的影响显示文摘饲料中的中性洗涤纤维(NDF)含量和饲料颗粒直径是影响瘤胃功能的重要因素。试验评估了以颗粒饲料为主的奶牛瘤胃健康情况、NDF消化率和生产性能。选取8头荷斯坦母牛(336±30 d,体重346±35 kg),随机分配到交叉重复试验组中,奶牛安置于牛栏,自由采食。试验期为3周,前两周是适应期,最后一周为数据收集期。各组饲粮原料相同,但物理形式不同,分为全混合日粮(TMR)和颗粒料(直径=8 mm)。两组间物理有效NDF(pe NDF)不同,TMR组为39.8%,颗粒料组为11.8%。在试验过程中,干物质采食量(DMI)、饮水量、瘤胃反刍时间、瘤胃温度和pH情况均记录。3周后收集粪样,确定潜在的可消化NDF总消化率(pdNDF)。每阶段结束后计算平均日增重和饲料转化率。颗粒料组的DMI、DMI/体重和饮水量更高。而两组间平均日增重和饲料转化率无显著差异。颗粒料组的瘤胃反刍时间为241 min·d-1低于TMR组的507 min·d-1。饲料的不同物理外形对瘤胃温度、瘤胃pH无显著影响。TMR组的pdNDF总消化率为90.25%高于颗粒料组的86.82%。试验结果表明,动物易接受完整的颗粒饲料,DMI较高,且反刍时间减少,但瘤胃pH无显著变化。TMR组的pdNDF消化率显著增加。尽管两组奶牛在DMI和纤维消化方面表现不同,但总体表现相似,两组饲料的保存时间与其物理形式有关。在短期内,提供能满足NDF需求的完全颗粒饲料可改善瘤胃健康状况和动物生产性能,而较长时间的数据则需要进一步试验。 | Wang J Yang M Cao M Lin Y Che L Q Duraipandiyan V Al-Dhabi N A Fang Z F Xu S Y Feng B Liu G Wu D Bonfante E Palmonari A Mammi L Canestrari G Fustini M Formigoni A | 2016 | 饲料博览2016，0，12： | 2 |
| 5 | Akt Promotes Cell Survival by Phosphorylating and Inhibiting a Forkhead Transcription Factor显示文摘 | Anne Brunet Azad Bonni Michael J Zigmond Michael Z Lin Peter Juo Linda S Hu Michael J Anderson Karen C Arden John Blenis Michael E Greenberg | 1999 | Cell1999，，6： | 2 |
| 6 | 胆固醇酯转移蛋白基因的蛋白质截断型变异体与冠状动脉性心脏病风险的关系显示文摘随机对照试验结果表明,抑制胆固醇酯转运蛋白(cholesteryl ester transfer protein,CETP)的疗法并不能降低冠状动脉性心脏病(coronary heart disease,CHD)的发生风险。研究失败的可能原因包括靶目标无效、靶目标外小分子的不良反应和随机对照设计因素影响等。在编码药物靶点的基因中具有天然存在的遗传变异,以此为基础,人类研究可以深入了解针对基因产物的治疗的潜在功效和安全性。 | Nomura A Won HH Khera AV Takeuchi F Ito K McCarthy S Emdin CA Klarin D Natarajan P Zekavat SM Gupta N Peloso GM Borecki IB Teslovich TM Asselta R Duga S Merlini PA Correa A Kessler T Wilson JG Bown MJ Hall AS Braund PS Carey DJ Murray MF Kirchner HL Leader JB Lavage DR Manus JN Hartze DN Samani NJ Schunkert H Marrugat J Elosua R McPherson R Farrall M Watkins H Juang JJ Hsiung CA Lin SY Wang JS Tada H Kawashiri MA Inazu A Yamagishi M Katsuya T Nakashima E Nakatochi M Yamamoto K Yokota M Momozawa Y Rotter JI Lander ES Rader DJ Danesh J Ardissino D Gabriel S Willer CJ Abecasis GR Saleheen D Kubo M Kato N Ida Chen YD Dewey FE Kathiresan S 刘莉 叶鹏 | 2017 | 中华高血压杂志2017，25，9： | 2 |
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