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FMO3--TMAO axis modulates the clinical outcome in chronic heart-failure patients with reduced ejection

《医学前沿（英文）》 2022年 第16卷 第2期   页码 295-305 doi: 10.1007/s11684-021-0857-2

摘要： The association among plasma trimethylamine-N-oxide (TMAO), FMO3 polymorphisms, and chronic heart failure (CHF) remains to be elucidated. TMAO is a microbiota-dependent metabolite from dietary choline and carnitine. A prospective study was performed including 955 consecutively diagnosed CHF patients with reduced ejection fraction, with the longest follow-up of 7 years. The concentrations of plasma TMAO and its precursors, namely, choline and carnitine, were determined by liquid chromatography-mass spectrometry, and the FMO3 E158K polymorphisms (rs2266782) were genotyped. The top tertile of plasma TMAO was associated with a significant increment in hazard ratio (HR) for the composite outcome of cardiovascular death or heart transplantation (HR=1.47, 95% CI=1.13–1.91, P=0.004) compared with the lowest tertile. After adjustments of the potential confounders, higher TMAO could still be used to predict the risk of the primary endpoint (adjusted HR=1.33, 95% CI=1.01–1.74, P=0.039). This result was also obtained after further adjustment for carnitine (adjusted HR=1.33, 95% CI=1.01–1.74, P=0.039). The FMO3 rs2266782 polymorphism was associated with the plasma TMAO concentrations in our cohort, and lower TMAO levels were found in the AA-genotype. Thus, higher plasma TMAO levels indicated increased risk of the composite outcome of cardiovascular death or heart transplantation independent of potential confounders, and the FMO3 AA-genotype in rs2266782 was related to lower plasma TMAO levels.

关键词： chronic heart failure     trimethylamine-N-oxide     flavin monooxygenase 3     single nucleotide polymorphism    

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Challenges and opportunities in improving left ventricular remodelling and clinical outcome following

《医学前沿（英文）》 2021年 第15卷 第3期   页码 416-437 doi: 10.1007/s11684-021-0852-7

摘要： Over the last half century, surgical aortic valve replacement (SAVR) has evolved to offer a durable and efficient valve haemodynamically, with low procedural complications that allows favourable remodelling of left ventricular (LV) structure and function. The latter has become more challenging among elderly patients, particularly following trans-catheter aortic valve implantation (TAVI). Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss, valvular-vascular impedance to myocardial activation, force-velocity relationship, and myocardial strain. LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour. Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome. Physiological pacing via the His-Purkinje system for conduction abnormalities, further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression, LV coordinate contraction, and global vascular function. TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions. Until comparable long-term durability and the resolution of TAVI related complications become available, SAVR remains the first choice for lower risk younger patients.

关键词： surgical aortic valve replacement     trans-catheter aortic valve implantation     left ventricular hypertrophy and fibrosis     myocardial force-velocity relationship     His-Purkinje pacing     renin-angiotensin system inhibitors     coronary access impairment    

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Poor adherence to P2Y12 antagonists increased cardiovascular risks in Chinese PCI-treated patients

null

《医学前沿（英文）》 2017年 第11卷 第1期   页码 53-61 doi: 10.1007/s11684-017-0502-2

摘要：

Low adherence to secondary prevention medications (ATM) of patients after acute coronary syndrome (ACS) is associated with poor clinical outcomes. However, literature provides limited data on assessment of ATM and risks associated with poor in Chinese patients with ACS. In the current work, ATM was assessed in consecutively recruited patients with ACS in Tongji Hospital from November 5, 2013 to December 31, 2014. A total of 2126 patients were classified under low adherence (proportion of days covered (PDC)<50%) and high adherence (PDC>50%) groups based on their performance after discharge. All patients were followed up at the 1st, 6th, and 12th month of discharge while recording ATM and major adverse cardiac events (MACE). Bivariate logistic regression was used to identify the factors associated with ATM. Cox regression was used to analyze the association between ATM and MACE within one year after discharge. Results showed that coronary artery bypass grafting (CABG) alone had significantly lower proportion of high adherence to P2Y12 antagonists (83.0% vs. 90.7%, P<0.01) than patients treated with percutaneous coronary intervention (PCI) only. Moreover, in patients undergoing PCI, high adherence to P2Y12 antagonists decreased the risk of MACE (hazard ratio=0.172, 95% confidence interval: 0.039–0.763; P=0.021). In conclusion, PCI-treated patients are more prone to remaining adherent to medications than CABG-treated patients. High adherence to P2Y12 antagonists was associated with lower risk of MACE.

关键词： acute coronary syndromes     adherence to secondary prevention medications     clinical outcome    

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Fertility outcome analysis after modified laparoscopic microsurgical tubal anastomosis

null

《医学前沿（英文）》 2011年 第5卷 第3期   页码 310-314 doi: 10.1007/s11684-011-0152-8

摘要：

Modified laparoscopic microsurgical tubal anastomosis is an alternative for microsurgical anastomosis via laparotomy to reverse sterilization in women with renewed child wish. The current study aims to evaluate the fertility outcome after modified laparoscopic microsurgical tubal anastomosis. A retrospective study was performed. Fifty-eight women who underwent modified laparoscopic microsurgical tubal anastomosis were monitored to investigate the fertility outcome and characteristics of this new technology. Of the 58 patients, the cumulative pregnancy rate (PR) in the 42 patients with follow-up data was 23.8% (10/42), 57.1% (24/42), 66.7% (28/42), and 73.8% (31/42) within 6, 12, 24, and 36 months after surgery, respectively. The intrauterine PR was 69.0% (29/42). Two patients (4.8%) had ectopic pregnancies that occurred within 24 months of surgery; three cases ended in spontaneous abortion. The delivery rate was 83.9% (26/31). The length of operating time was 1.2±0.3 h, with a range of 1.0–2.5 h (60–145 min), and the mean time was approximately 75 min. The blood loss was relatively small, between 10 and 50 ml with an average amount of 22 ml. Thus, the modified laparoscopic tubal anastomosis is a highly successful procedure and a viable alternative to open abdominal microsurgical approaches. Compared with the traditional laparoscopic tubal sterilization reversal, this modified approach has three advantages: (1) less invasive approach via a trocar reduction; (2) remodeling of tube is better performing tied together after 3–4 sutures; and (3) faster operating time.

关键词： modified laparoscopy     tubal anastomosis     microsurgery    

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预测新型冠状病毒肺炎患者临床预后好转概率的列线图—— 以中国浙江省为例 Article

谢娇娇, 石鼎, 鲍明阳, 胡潇逸, 吴文瑞, 盛吉芳, 徐凯进, 王清, 吴静静, 王恺岑, 方戴琼, 李雅婷, 李兰娟

《工程（英文）》 2022年 第8卷 第1期   页码 122-129 doi: 10.1016/j.eng.2020.05.014

摘要：

本研究旨在为临床医生开发一种定量方法，以预测新型冠状病毒肺炎（COVID-19）患者临床预后好转的可能性。本研究收集了2020年1月10日至2月26日入院后经实验室确诊的104例COVID-19感染患者的数据，包括患者的临床基本信息和实验室检查结果，并比较好转和未好转患者的各项参数。本研究使用最小绝对收缩和选择算法（LASSO）logistics 回归模型和双向逐步策略的多因素logistics 回归模型筛选预测预后因素，使用一致性指数（C指数）评估模型，并通过重复抽样进行内部验证，以此构建了一项新的预测列线图。截至2020年2月26日，研究中包括的104位患者（中位年龄为55岁）中，75位（72.1%）预后好转，而29位（27.9%）没有明显好转迹象。临床预后好转的患者与未好转的患者在临床特征和实验室检查结果上存在许多差异。经过多步筛选过程后，本研究筛选出5项预后因素并将其纳入列线图的构建，包括免疫球蛋白A（IgA）、C反应蛋白（CRP）、肌酸激酶（CK）、急性生理学和慢性健康评估表II（APACHE II），以及CK和APACHE II之间的相互作用。本研究建立的模型的C指数为0.962 [95%置信区间（CI）为0.931~0.993]，并且通过重复抽样验证其值仍然达到0.948。预测列线图与理想模型相比，在校准图方面显示出接近的性能，并且决策曲线和临床影响曲线显示，其在临床上具有实用性。本研究构建的列线图有助于临床医生预测每位COVID-19患者的临床预后好转的可能性，将有助于个性化的咨询和治疗。

关键词： 新型冠状病毒肺炎（COVID-19）     列线图     临床预后    

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Artificial intelligence in radiotherapy: a technological review

Ke Sheng

《医学前沿（英文）》 2020年 第14卷 第4期   页码 431-449 doi: 10.1007/s11684-020-0761-1

摘要： Radiation therapy (RT) is widely used to treat cancer. Technological advances in RT have occurred in the past 30 years. These advances, such as three-dimensional image guidance, intensity modulation, and robotics, created challenges and opportunities for the next breakthrough, in which artificial intelligence (AI) will possibly play important roles. AI will replace certain repetitive and labor-intensive tasks and improve the accuracy and consistency of others, particularly those with increased complexity because of technological advances. The improvement in efficiency and consistency is important to manage the increasing cancer patient burden to the society. Furthermore, AI may provide new functionalities that facilitate satisfactory RT. The functionalities include superior images for real-time intervention and adaptive and personalized RT. AI may effectively synthesize and analyze big data for such purposes. This review describes the RT workflow and identifies areas, including imaging, treatment planning, quality assurance, and outcome prediction, that benefit from AI. This review primarily focuses on deep-learning techniques, although conventional machine-learning techniques are also mentioned.

关键词： artificial intelligence     radiation therapy     medical imaging     treatment planning     quality assurance     outcome prediction    

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新冠病毒肺炎临床试验核心指标集（COS-COVID） Article

金鑫瑶, 庞博, 张俊华, 刘清泉, 杨忠奇, 封继宏, 刘学政, 张磊, 王保和, 黄宇虹, Alice Josephine Fauci, 马玉玲, Myeong Soo Lee, 元唯安, 谢雁鸣, 唐健元, 高蕊, 杜亮, 张硕, 祁寒梅, 孙宇, 郑文科, 杨丰文, 蔡慧姿, 王可仪, 欧益, 黄明, 朱彦, 喻佳洁, 田金徽, 赵敏, 胡镜清, 姚晨, 李幼平, 张伯礼

《工程（英文）》 2020年 第6卷 第10期   页码 1147-1152 doi: 10.1016/j.eng.2020.03.002

摘要： 本研究旨在构建COVID-19临床试验核心结局指标集（core outcome set, COS），为相关临床研究方案设计、开展和证据转化提供参考。

关键词： 核心指标集     COVID-19     2019-nCoV     冠状病毒疾病     临床试验    

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Ontological reconstruction of the clinical terminology of traditional Chinese medicine

null

《医学前沿（英文）》 2014年 第8卷 第3期   页码 358-361 doi: 10.1007/s11684-014-0348-9

摘要：

This study proposes the ontological reconstruction of the current clinical terminology of traditional Chinese medicine (TCM). It also provides an overview of preliminary work related to the said reconstruction, including the ontology-based analysis of TCM clinical terminology. We conclude that the ontological reconstruction of TCM clinical terminology provides a proper translation from the idealized organizational model to real-world implementation and to a formalized, shared, and knowledge-based framework.

关键词： ontology     traditional Chinese medicine     clinical terminology    

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The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant

《医学前沿（英文）》 2023年 第17卷 第3期   页码 527-533 doi: 10.1007/s11684-022-0967-5

摘要： In this study, we aim to elucidate the clinical impact and long-term course of tricuspid regurgitation (TR), taking into account its dynamic nature, after biatrial orthotopic heart transplant (OHT). All consecutive adult patients undergoing biatrial OHT (1984−2017) with an available follow-up echocardiogram were included. Mixed-models were used to model the evolution of TR. The mixed-model was inserted into a Cox model in order to address the association of the dynamic TR with mortality. In total, 572 patients were included (median age: 50 years, males: 74.9%). Approximately 32% of patients had moderate-to-severe TR immediately after surgery. However, this declined to 11% on 5 years and 9% on 10 years after surgery, adjusted for survival bias. Pre-implant mechanical support was associated with less TR during follow-up, whereas concurrent LV dysfunction was significantly associated with more TR during follow-up. Survival at 1, 5, 10, 20 years was 97% ± 1%, 88% ± 1%, 66% ± 2% and 23% ± 2%, respectively. The presence of moderate-to-severe TR during follow-up was associated with higher mortality (HR: 1.07, 95% CI (1.02–1.12), p = 0.006). The course of TR was positively correlated with the course of creatinine (R = 0.45). TR during follow-up is significantly associated with higher mortality and worse renal function. Nevertheless, probability of TR is the highest immediately after OHT and decreases thereafter. Therefore, it may be reasonable to refrain from surgical intervention for TR during earlier phase after OHT.

关键词： orthotopic heart transplant     tricuspid regurgitation     clinical impact     biatrial heart transplantation    

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Obesity-related glomerulopathy: pathogenesis, pathologic, clinical characteristics and treatment

null

《医学前沿（英文）》 2017年 第11卷 第3期   页码 340-348 doi: 10.1007/s11684-017-0570-3

摘要：

In light of the rapid increase in the number of obesity incidences worldwide, obesity has become an independent risk factor for chronic kidney disease. Obesity-related glomerulopathy (ORG) is characterized by glomerulomegaly in the presence or absence of focal and segmental glomerulosclerosis lesions. IgM and complement 3 (C3) nonspecifically deposit in lesions without immune-complex-type deposits during ORG immunofluorescence. ORG-associated glomerulomegaly and focal and segmental glomerulosclerosis can superimpose on other renal pathologies. The mechanisms under ORG are complex, especially hemodynamic changes, inflammation, oxidative stress, apoptosis, and reduced functioning nephrons. These mechanisms synergize with obesity to induce end-stage renal disease. A slow increase of subnephrotic proteinuria (<3.5 g/d) is the most common clinical manifestation of ORG. Several treatment methods for ORG have been developed. Of these methods, renin–angiotensin–aldosterone system blockade and weight loss are proven effective. Targeting mitochondria may offer a novel strategy for ORG therapy. Nevertheless, more research is needed to further understand ORG.

关键词： obesity-related glomerulopathy     pathogenesis     pathologic     clinical characteristics    

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Coronavirus disease 2019 (COVID-19): a clinical update

Min Zhou, Xinxin Zhang, Jieming Qu

《医学前沿（英文）》 2020年 第14卷 第2期   页码 126-135 doi: 10.1007/s11684-020-0767-8

摘要： Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed a significant threat to global health. It caused a total of 80 868 confirmed cases and 3101 deaths in Chinese mainland until March 8, 2020. This novel virus spread mainly through respiratory droplets and close contact. As disease progressed, a series of complications tend to develop, especially in critically ill patients. Pathological findings showed representative features of acute respiratory distress syndrome and involvement of multiple organs. Apart from supportive care, no specific treatment has been established for COVID-19. The efficacy of some promising antivirals, convalescent plasma transfusion, and tocilizumab needs to be investigated by ongoing clinical trials.

关键词： coronavirus disease 2019     epidemiology     pathology     radiology     clinical characteristics     treatment    

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Hypertension in patients with CKD in China: clinical characteristics and management

null

《医学前沿（英文）》 2017年 第11卷 第3期   页码 307-309 doi: 10.1007/s11684-017-0578-8

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Bone metastasis of hepatocellular carcinoma: facts and hopes from clinical and translational perspectives

《医学前沿（英文）》 2022年 第16卷 第4期   页码 551-573 doi: 10.1007/s11684-022-0928-z

摘要： Patients with hepatocellular carcinoma (HCC) and bone metastasis (BM) suffer from greatly reduced life quality and a dismal prognosis. However, BM in HCC has long been overlooked possibly due to its relatively low prevalence in previous decades. To date, no consensus or guidelines have been reached or formulated for the prevention and management of HCC BM. Our narrative review manifests the increasing incidence of HCC BM to sound the alarm for additional attention. The risk factors, diagnosis, prognosis, and therapeutic approaches of HCC BM are detailed to provide a panoramic view of this disease to clinicians and specialists. We further delineate an informative cancer bone metastatic cascade based on evidence from recent studies and point out the main factors responsible for the tumor-associated disruption of bone homeostasis and the formation of skeletal cancer lesions. We also present the advances in the pathological and molecular mechanisms of HCC BM to shed light on translational opportunities. Dilemmas and challenges in the treatment and investigation of HCC BM are outlined and discussed to encourage further endeavors in the exploration of underlying pathogenic and molecular mechanisms, as well as the development of novel effective therapies for HCC patients with BM.

关键词： HCC     bone     osteotropism     clinical     basic researches     advances    

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Heterogeneity of the tumor immune microenvironment and clinical interventions

《医学前沿（英文）》 2023年 第17卷 第4期   页码 617-648 doi: 10.1007/s11684-023-1015-9

摘要： Heterogeneity of the tumor immune microenvironment and clinical interventions

关键词： Heterogeneity tumor immune    

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标题 作者 时间 类型 操作

FMO3--TMAO axis modulates the clinical outcome in chronic heart-failure patients with reduced ejection

期刊论文

Challenges and opportunities in improving left ventricular remodelling and clinical outcome following

期刊论文

Poor adherence to P2Y12 antagonists increased cardiovascular risks in Chinese PCI-treated patients

null

期刊论文

Fertility outcome analysis after modified laparoscopic microsurgical tubal anastomosis

null

期刊论文

预测新型冠状病毒肺炎患者临床预后好转概率的列线图—— 以中国浙江省为例

谢娇娇, 石鼎, 鲍明阳, 胡潇逸, 吴文瑞, 盛吉芳, 徐凯进, 王清, 吴静静, 王恺岑, 方戴琼, 李雅婷, 李兰娟

期刊论文

Artificial intelligence in radiotherapy: a technological review

Ke Sheng

期刊论文

新冠病毒肺炎临床试验核心指标集（COS-COVID）

金鑫瑶, 庞博, 张俊华, 刘清泉, 杨忠奇, 封继宏, 刘学政, 张磊, 王保和, 黄宇虹, Alice Josephine Fauci, 马玉玲, Myeong Soo Lee, 元唯安, 谢雁鸣, 唐健元, 高蕊, 杜亮, 张硕, 祁寒梅, 孙宇, 郑文科, 杨丰文, 蔡慧姿, 王可仪, 欧益, 黄明, 朱彦, 喻佳洁, 田金徽, 赵敏, 胡镜清, 姚晨, 李幼平, 张伯礼

期刊论文

高敬书：基于就医人群的中国多囊卵巢综合征女性的临床表型和治疗结局（2021年7月23日）

2021年10月23日

会议视频

Ontological reconstruction of the clinical terminology of traditional Chinese medicine

null

期刊论文

The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant

期刊论文

Obesity-related glomerulopathy: pathogenesis, pathologic, clinical characteristics and treatment

null

期刊论文

Coronavirus disease 2019 (COVID-19): a clinical update

Min Zhou, Xinxin Zhang, Jieming Qu

期刊论文

Hypertension in patients with CKD in China: clinical characteristics and management

null

期刊论文

Bone metastasis of hepatocellular carcinoma: facts and hopes from clinical and translational perspectives

期刊论文

Heterogeneity of the tumor immune microenvironment and clinical interventions

期刊论文