Clinical trail

临床线索
  • 文章类型: Journal Article
    由于肝脏的重要功能和复杂性,因此需要在手术中仔细处理。传统开腹肝切除术,虽然标准,是侵入性的,需要很长的恢复期。腹腔镜肝切除术是一种侵入性较小的选择,有自己的挑战。机器人手术的兴起,例如达芬奇®系统,提高精度和控制,解决传统方法的局限性,但带来了新的担忧,比如成本和培训。这篇综述集中在2022/23文章中机器人肝切除术的最新进展,深入研究诸如“肝移植中的机器人手术”之类的主题,机器人肝切除术治疗肝门部胆管癌,肝切除术后的机器人血管重建,机器人重复肝切除术,机器人肝切除术的“和”前瞻性试验。\"要检索文章,使用PubMed对2022/23年的文章进行了重点文献检索,使用5年过滤器,不包括评论。最初,摘要经过筛选,和有关机器人手术的相关文章进行了全面检查,以纳入本综述。尽管以上所有项目都是尖端的,许多参考文献必须在病例报告级别,最近的文章仍然伴随着手术视频,对读者有用,尤其是那些正在考虑模仿手术的外科医生。总之,我们研究了机器人肝切除术的最新进展。包含呈现新技术的视频有助于知识转移。我们预计这一研究领域的持续增长。
    The liver requires careful handling intra-operatively owing to its vital functions and complexity. Traditional open hepatectomy, while standard, is invasive and requires long recovery periods. Laparoscopic hepatectomy is a less invasive option, with its own challenges. The rise of robotic surgery, such as the da Vinci® system, improves precision and control, addressing the limitations of conventional methods, but brings new concerns, such as costs and training. This review focuses on the latest advancements in robotic hepatectomy from 2022/23 articles, delving into topics like \"robotic surgery in liver transplantation,\" \"robotic hepatectomy for hilar cholangiocarcinoma,\" \"robotic vascular reconstruction following hepatectomy,\" \"robotic repeat hepatectomy,\" and \"prospective trials in robotic hepatectomy.\" To retrieve articles, a focused literature search was conducted using PubMed for articles from 2022/23 with a 5-year filter, excluding reviews. Initially, abstracts were screened, and relevant articles on robotic surgery were examined in full for inclusion in this review. Although all the above items are cutting-edge, and many of the references are necessarily at the level of case reports, recent articles are still accompanied by surgical videos, which are useful to readers, especially surgeons who are considering imitating the procedures. In summary, we examined the recent advancements in robotic liver resection. The inclusion of videos that present new techniques aids in knowledge transfer. We anticipate the continued growth of this field of research.
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  • 文章类型: Journal Article
    在过去的十年里,肠道类器官技术为体外复制肠道生理过程中的组织或器官形态发生以及研究各种肠道疾病的发病机理铺平了道路。肠道类器官在药物筛选中受到青睐,因为它们具有高通量体外培养的能力,并且与患者的遗传特征更相似。此外,作为疾病模型,肠道类器官在筛选诊断标志物方面有广泛的应用,确定治疗目标,探索疾病的表观遗传机制。此外,作为一个可移植的细胞系统,在溃疡性结肠炎和短肠综合征等疾病中,类器官在受损上皮的重建中发挥了重要作用,以及肠道物质交换和代谢功能恢复。跨学科方法的兴起,包括类器官芯片技术,基因组编辑技术,和微流体,大大加速了类器官的发展。在这次审查中,首先使用VOSviewer软件可视化肠道类器官的热合被引期刊和关键词趋势。随后,我们总结了目前肠道类器官技术在疾病建模中的应用,药物筛选,和再生医学。这将加深我们对肠道类器官的理解,并进一步探索肠道的生理机制和肠道疾病的药物开发。
    In the past decade, intestinal organoid technology has paved the way for reproducing tissue or organ morphogenesis during intestinal physiological processes in vitro and studying the pathogenesis of various intestinal diseases. Intestinal organoids are favored in drug screening due to their ability for high-throughput in vitro cultivation and their closer resemblance to patient genetic characteristics. Furthermore, as disease models, intestinal organoids find wide applications in screening diagnostic markers, identifying therapeutic targets, and exploring epigenetic mechanisms of diseases. Additionally, as a transplantable cellular system, organoids have played a significant role in the reconstruction of damaged epithelium in conditions such as ulcerative colitis and short bowel syndrome, as well as in intestinal material exchange and metabolic function restoration. The rise of interdisciplinary approaches, including organoid-on-chip technology, genome editing techniques, and microfluidics, has greatly accelerated the development of organoids. In this review, VOSviewer software is used to visualize hot co-cited journal and keywords trends of intestinal organoid firstly. Subsequently, we have summarized the current applications of intestinal organoid technology in disease modeling, drug screening, and regenerative medicine. This will deepen our understanding of intestinal organoids and further explore the physiological mechanisms of the intestine and drug development for intestinal diseases.
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  • 文章类型: Systematic Review
    背景:基因组不稳定性是指细胞分裂过程中基因组改变的增加,在大多数癌细胞中很常见。基因组不稳定性增加了初始致癌转化的风险,产生新的肿瘤细胞克隆,增加肿瘤异质性。尽管基因组不稳定会导致恶性肿瘤,它也是一个“致命弱点”,构成了治疗上可利用的弱点-当足够先进时,它可以通过产生DNA损伤和突变事件来降低肿瘤细胞的存活率,从而压倒癌细胞修复这些病变的能力。此外,它可以通过产生编码能够被免疫系统识别的新免疫原性抗原的突变来促成外在的降低生存的事件。特别是当免疫治疗药物增强抗肿瘤免疫力时。这里,我们描述了基因组失稳如何诱导癌症患者的免疫激活,并系统地回顾了临床上利用的基因组不稳定性的诱导,结合免疫检查点阻断。方法:我们对利用联合方法成功治疗癌症患者的临床试验进行了系统评价。我们系统地搜索了PubMed,Cochrane中央控制试验登记册,Clinicaltrials.gov,并从相关文章的参考列表中发表。最相关的纳入标准是以英文发表的同行评审临床试验。结果:我们确定了1,490项研究,其中164项是临床试验.共有37项临床试验符合纳入标准,纳入研究。主要结果测量为总生存期和无进展生存期。大多数临床试验(37个中的30个)显示患者预后显着改善。结论:大多数纳入的临床试验报道了靶向DNA修复途径概念的有效性,结合免疫检查点抑制剂,创造一个“协同作用环”,用合理的组合来治疗癌症。
    Background: Genomic instability is increased alterations in the genome during cell division and is common among most cancer cells. Genome instability enhances the risk of initial carcinogenic transformation, generating new clones of tumor cells, and increases tumor heterogeneity. Although genome instability contributes to malignancy, it is also an \"Achilles\' heel\" that constitutes a therapeutically-exploitable weakness-when sufficiently advanced, it can intrinsically reduce tumor cell survival by creating DNA damage and mutation events that overwhelm the capacity of cancer cells to repair those lesions. Furthermore, it can contribute to extrinsic survival-reducing events by generating mutations that encode new immunogenic antigens capable of being recognized by the immune system, particularly when anti-tumor immunity is boosted by immunotherapy drugs. Here, we describe how genome-destabilization can induce immune activation in cancer patients and systematically review the induction of genome instability exploited clinically, in combination with immune checkpoint blockade. Methods: We performed a systematic review of clinical trials that exploited the combination approach to successfully treat cancers patients. We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and publication from the reference list of related articles. The most relevant inclusion criteria were peer-reviewed clinical trials published in English. Results: We identified 1,490 studies, among those 164 were clinical trials. A total of 37 clinical trials satisfied the inclusion criteria and were included in the study. The main outcome measurements were overall survival and progression-free survival. The majority of the clinical trials (30 out of 37) showed a significant improvement in patient outcome. Conclusion: The majority of the included clinical trials reported the efficacy of the concept of targeting DNA repair pathway, in combination with immune checkpoint inhibitors, to create a \"ring of synergy\" to treat cancer with rational combinations.
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  • 文章类型: Systematic Review
    糖尿病(DM)是一种广泛的代谢紊乱,全球每年有670万人死亡。有几种治疗选择,但有常见的副作用,如体重增加,心血管疾病,神经毒性,肝毒性,和肾毒性。因此,民族医学正在引起研究人员对DM治疗的兴趣。民族医学通过防止肠道吸收和肝脏产生葡萄糖以及增强肌肉和脂肪组织中的葡萄糖摄取和增加胰岛素分泌来发挥作用。多种植物已经进入临床试验,但很少有植物获得批准使用。本研究提供了对此类临床试验的评估。为此,使用“民族医学糖尿病临床试验”等关键词从数据库中进行了广泛的文献综述,“临床试验”,“糖尿病临床试验”,\"糖尿病\",“糖尿病中的天然产物”,“天然产物与糖尿病的药理学相关性”,等。根据合格标准评估了20种植物和天然产物的临床试验。与这些临床试验相关的主要限制是缺乏患者依从性,剂量-反应关系,以及小样本量和治疗持续时间的生物标志物评估。可以考虑在严格的法规方面采取措施,以实现临床试验的质量。本系统综述的一个具体目标是根据过去7年的最新临床试验,通过种族医学讨论DM治疗。
    Diabetes mellitus (DM) is a widespread metabolic disorder with a yearly 6.7 million deaths worldwide. Several treatment options are available but with common side effects like weight gain, cardiovascular diseases, neurotoxicity, hepatotoxicity, and nephrotoxicity. Therefore, ethnomedicine is gaining the interest of researchers in the treatment of DM. Ethnomedicine works by preventing intestinal absorption and hepatic production of glucose as well as enhancing glucose uptake in muscles and fatty tissues and increasing insulin secretion. A variety of plants have entered clinical trials but very few have gained approval for use. This current study provides an evaluation of such clinical trials. For this purpose, an extensive literature review was performed from a database using keywords like \"ethnomedicine diabetes clinical trial\", \"clinical trials\", \"clinical trial in diabetes\", \"diabetes\", \"natural products in diabetes\", \"ethno-pharmacological relevance of natural products in diabetes\", etc. Clinical trials of 20 plants and natural products were evaluated based on eligibility criteria. Major limitations associated with these clinical trials were a lack of patient compliance, dose-response relationship, and an evaluation of biomarkers with a small sample size and treatment duration. Measures in terms of strict regulations can be considered to achieve quality clinical trials. A specific goal of this systematic review is to discuss DM treatment through ethnomedicine based on recent clinical trials of the past 7 years.
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