Background:The optimal strategy for adjuvant therapy after curative resection for hepatocellular carcinoma(HCC)patients with solitary tumor and microvascular invasion(MVI)is controversial.This trial evaluated the effi...Background:The optimal strategy for adjuvant therapy after curative resection for hepatocellular carcinoma(HCC)patients with solitary tumor and microvascular invasion(MVI)is controversial.This trial evaluated the efficacy and safety of adjuvant transcatheter arterial chemoembolization(TACE)after hepatectomy versus hepatectomy alone in HCC patients with a solitary tumor≥5 cm and MVI.Methods:In this randomized,open-labeled,phase III trial,HCC patients with a solitary tumor≥5 cm and MVI were randomly assigned(1:1)to receive either 1-2 cycles of adjuvant TACE after hepatectomy(Hepatectomy-TACE)or hepatectomy alone(Hepatectomy Alone).The primary endpoint was disease-free survival(DFS);the secondary end-points included overall survival(OS)and adverse events.Results:Between June 1,2009,and December 31,2012,250 patients were enrolled and randomly assigned to the Hepatectomy-TACE group(n=125)or the Hepatectomy Alone group(n=125).Clinicopathological characteristics were balanced between the two groups.The median follow-up time from randomization was 37.5 months[interquartile range 18.3-48.2 months].The median DFS was significantly longer in the Hepatectomy-TACE group than in the Hepatectomy Alone group[17.45 months(95%confidence interval[CI]11.99-29.14)vs.9.27 months(95%CI 6.05-13.70),hazard ratio[HR]=0.70(95%CI 0.52-0.95),P=0.020],respectively.The median OS was also significantly longer in the Hepatectomy-TACE group than in the Hepatectomy Alone group[44.29 months(95%CI 25.99-62.58)vs.22.37 months(95%CI 10.84-33.91),HR=0.68(95%CI 0.48-0.97),P=0.029].Treatment-related adverse events were more frequently observed in the Hepatectomy-TACE group,although these were generally mild and manageable.The most common grade 3 or 4 adverse events in both groups were neutropenia and liver dysfunction.Conclusion:Hepatectomy followed by adjuvant TACE is an appropriate option after radical resection in HCC patients with solitary tumor≥5 cm and MVI,with acceptable toxicity.展开更多
Crustal recycling at convergent plate boundaries is essential to mantle heterogeneity.However,crustal signatures in the mantle source of basaltic rocks above subduction zones were primarily incorporated in the form of...Crustal recycling at convergent plate boundaries is essential to mantle heterogeneity.However,crustal signatures in the mantle source of basaltic rocks above subduction zones were primarily incorporated in the form of liquid rather than solid phases.The physicochemical property of liquid phases is determined by the dehydration behavior of crustal rocks at the slab-mantle interface in subduction channels.Because of the significant fractionation in incompatible trace elements but the full inheritance in radiogenic isotopes relative to their crustal sources,the production of liquid phases is crucial to the geochemical transfer from the subducting crust into the mantle.In this process,the stability of specific minerals in subducting crustal rocks exerts a primary control on the enrichment of given trace elements in the liquid phases.For this reason,geochemically enriched oceanic basalts can be categorized into two types in terms of their trace element distribution patterns in the primitive mantle-normalized diagram.One is island arc basalts(IAB),showing enrichment in LILE,Pb and LREE but depletion in HFSE such as Nb and Ta relative to HREE,The other is ocean island basalts(OIB),exhibiting enrichment in LILE and LREE,enrichment or non-depletion in HFSE but depletion in Pb relative to HREE.In either types,these basalts show the enhanced enrichment of LILE and LREE with increasing their incompatibility relative to normal mid-ocean ridge basalts(MORB).The thermal regime of subduction zones can be categorized into two stages in both time and space,The first stage is characterized by compressional tectonism at low thermal gradients.As a consequence,metamorphic dehydration of the subducting crust prevails at forearc to subarc depths due to the breakdown of hydrous minerals such as mica and amphibole in the stability field of garnet and rutile,resulting in the liberation of aqueous solutions with the trace element composition that is considerably enriched in LILE,Pb and LREE but depleted in HFSE and HREE relative to normal M展开更多
1 Introduction Rapid socioeconomic progress has greatly affected the lifestyle in China.Consequently,owing to lifestyle changes,urbanization,and accelerated population aging,the risk of cardiovascular diseases(CVD)has...1 Introduction Rapid socioeconomic progress has greatly affected the lifestyle in China.Consequently,owing to lifestyle changes,urbanization,and accelerated population aging,the risk of cardiovascular diseases(CVD)has increased.The incidence of CVD has been increasing continuously and this upward trend is projected to continue in the next decade.The growing burden of CVD has become a major public health issue.展开更多
Nasopharyngeal carcinoma(NPC)is a malignant epithelial tumor originating in the nasopharynx and has a high incidence in Southeast Asia and North Africa.To develop these comprehensive guidelines for the diagnosis and m...Nasopharyngeal carcinoma(NPC)is a malignant epithelial tumor originating in the nasopharynx and has a high incidence in Southeast Asia and North Africa.To develop these comprehensive guidelines for the diagnosis and management of NPC,the Chinese Society of Clinical Oncology(CSCO)arranged a multi-disciplinary team comprising of experts from all sub-specialties of NPC to write,discuss,and revise the guidelines.Based on the findings of evidencebased medicine in China and abroad,domestic experts have iteratively developed these guidelines to provide proper management of NPC.Overall,the guidelines describe the screening,clinical and pathological diagnosis,staging and risk assessment,therapies,and follow-up of NPC,which aim to improve the management of NPC.展开更多
When plate tectonics started to occur on Earth and how it has evolved through time are two of the most fundamental questions in earth sciences. While gravity-driven subducting has been accepted as a critical condition...When plate tectonics started to occur on Earth and how it has evolved through time are two of the most fundamental questions in earth sciences. While gravity-driven subducting has been accepted as a critical condition for the operation of plate tectonics on Earth, it is intriguing how the dynamic regime and thermal state of subduction zones have affected the style of plate tectonics in Earth’s history. The metamorphic rocks of regional distribution along convergent plate boundaries record reworking of crustal rocks through dehydration and melting at lithospheric depths. The property of regional metamorphism is determined by both dynamic regime and thermal state of plate margins. The two variables have secularly evolved in Earth’s history, which is recorded by changes in the global distribution of metamorphic facies series through time. This results in two styles of plate tectonics. Modern-style plate tectonics has developed since the Neoproterozoic when plate margins were rigid enough for cold subducting, whereas ancient-style plate tectonics has developed since the Archean when plate margins were ductile enough for warm subducting. Such a difference is primarily dictated by higher mantle temperatures in the Archean than in the Phanerozoic. The development of plate subduction in both cold and warm realms is primarily dictated by the rheology of plate margins. This leads to a holistic model for the style of plate tectonics during different periods in Earth’s history.展开更多
The novel contagious primary atypical pneumonia epidemic,which broke out in Wuhan,China,in December 2019,is now formally called Coronavirus Disease 2019(COVID-19),with the causative virus named as Severe Acute Respira...The novel contagious primary atypical pneumonia epidemic,which broke out in Wuhan,China,in December 2019,is now formally called Coronavirus Disease 2019(COVID-19),with the causative virus named as Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2).1,2 Recent studies have shown that in addition to dyspnea,hypoxemia,and acute respiratory distress,lymphopenia,and cytokine release syndrome are also important clinical features in patients with severe SARS-CoV-2 infection.3 This suggests that homeostasis of the immune system plays an important role in the development of COVID-19 pneumonia.展开更多
1 Introduction Major and profound changes have taken place in China over the past 30 years. An epidemic of cardiovascular diseases （CVD） in China is emerging as a result of lifestyle changes, urbanization, and the ...1 Introduction Major and profound changes have taken place in China over the past 30 years. An epidemic of cardiovascular diseases （CVD） in China is emerging as a result of lifestyle changes, urbanization, and the accelerated process of aging. The incidence of CVD is continuously increasing and will remain an upward trend in the next decade. Since 2005,展开更多
There is considerable potential for integrating transarterial chemoembolization(TACE),programmed death-(ligand)1(PD-[L]1)inhibitors,and molecular targeted treatments(MTT)in hepatocellular carcinoma(HCC).It is necessar...There is considerable potential for integrating transarterial chemoembolization(TACE),programmed death-(ligand)1(PD-[L]1)inhibitors,and molecular targeted treatments(MTT)in hepatocellular carcinoma(HCC).It is necessary to investigate the therapeutic efficacy and safety of TACE combined with PD-(L)1 inhibitors and MTT in real-world situations.In this nationwide,retrospective,cohort study,826 HCC patients receiving either TACE plus PD-(L)1 blockades and MTT(combination group,n=376)or TACE monotherapy(monotherapy group,n=450)were included from January 2018 to May 2021.The primary endpoint was progression-free survival(PFS)according to modified RECIST.The secondary outcomes included overall survival(OS),objective response rate(ORR),and safety.We performed propensity score matching approaches to reduce bias between two groups.After matching,228 pairs were included with a predominantly advanced disease population.Median PFS in combination group was 9.5 months(95%confidence interval[CI],8.4-11.0)versus 8.0 months(95%CI,6.6-9.5)(adjusted hazard ratio[HR],0.70,P=0.002).OS and ORR were also significantly higher in combination group(median OS,19.2[16.1-27.3]vs.15.7 months[13.0-20.2];adjusted HR,0.63,P=0.001;ORR,60.1%vs.32.0%;P<0.001).Grade 3/4 adverse events were observed at a rate of 15.8%and 7.5%in combination and monotherapy groups,respectively.Our results suggest that TACE plus PD-(L)1 blockades and MTT could significantly improve PFS,OS,and ORR versus TACE monotherapy for Chinese patients with predominantly advanced HCC in real-world practice,with an acceptable safety profile.展开更多
基金supported by the National Natural Science Foundation of China(No.81172037)Science and Technology Program of Guangdong Province,China(No.2013B021800159)Clinical Trials Project(308 Project)of Sun Yat-sen University Cancer Center(No.308-2015-014).
文摘Background:The optimal strategy for adjuvant therapy after curative resection for hepatocellular carcinoma(HCC)patients with solitary tumor and microvascular invasion(MVI)is controversial.This trial evaluated the efficacy and safety of adjuvant transcatheter arterial chemoembolization(TACE)after hepatectomy versus hepatectomy alone in HCC patients with a solitary tumor≥5 cm and MVI.Methods:In this randomized,open-labeled,phase III trial,HCC patients with a solitary tumor≥5 cm and MVI were randomly assigned(1:1)to receive either 1-2 cycles of adjuvant TACE after hepatectomy(Hepatectomy-TACE)or hepatectomy alone(Hepatectomy Alone).The primary endpoint was disease-free survival(DFS);the secondary end-points included overall survival(OS)and adverse events.Results:Between June 1,2009,and December 31,2012,250 patients were enrolled and randomly assigned to the Hepatectomy-TACE group(n=125)or the Hepatectomy Alone group(n=125).Clinicopathological characteristics were balanced between the two groups.The median follow-up time from randomization was 37.5 months[interquartile range 18.3-48.2 months].The median DFS was significantly longer in the Hepatectomy-TACE group than in the Hepatectomy Alone group[17.45 months(95%confidence interval[CI]11.99-29.14)vs.9.27 months(95%CI 6.05-13.70),hazard ratio[HR]=0.70(95%CI 0.52-0.95),P=0.020],respectively.The median OS was also significantly longer in the Hepatectomy-TACE group than in the Hepatectomy Alone group[44.29 months(95%CI 25.99-62.58)vs.22.37 months(95%CI 10.84-33.91),HR=0.68(95%CI 0.48-0.97),P=0.029].Treatment-related adverse events were more frequently observed in the Hepatectomy-TACE group,although these were generally mild and manageable.The most common grade 3 or 4 adverse events in both groups were neutropenia and liver dysfunction.Conclusion:Hepatectomy followed by adjuvant TACE is an appropriate option after radical resection in HCC patients with solitary tumor≥5 cm and MVI,with acceptable toxicity.
基金supported by funds from the Chinese Academy of Sciences(XDB18020303)the Chinese Ministry of Science and Technology(2015CB856100)the National Natural ScienceFoundation of China(41590620)
文摘Crustal recycling at convergent plate boundaries is essential to mantle heterogeneity.However,crustal signatures in the mantle source of basaltic rocks above subduction zones were primarily incorporated in the form of liquid rather than solid phases.The physicochemical property of liquid phases is determined by the dehydration behavior of crustal rocks at the slab-mantle interface in subduction channels.Because of the significant fractionation in incompatible trace elements but the full inheritance in radiogenic isotopes relative to their crustal sources,the production of liquid phases is crucial to the geochemical transfer from the subducting crust into the mantle.In this process,the stability of specific minerals in subducting crustal rocks exerts a primary control on the enrichment of given trace elements in the liquid phases.For this reason,geochemically enriched oceanic basalts can be categorized into two types in terms of their trace element distribution patterns in the primitive mantle-normalized diagram.One is island arc basalts(IAB),showing enrichment in LILE,Pb and LREE but depletion in HFSE such as Nb and Ta relative to HREE,The other is ocean island basalts(OIB),exhibiting enrichment in LILE and LREE,enrichment or non-depletion in HFSE but depletion in Pb relative to HREE.In either types,these basalts show the enhanced enrichment of LILE and LREE with increasing their incompatibility relative to normal mid-ocean ridge basalts(MORB).The thermal regime of subduction zones can be categorized into two stages in both time and space,The first stage is characterized by compressional tectonism at low thermal gradients.As a consequence,metamorphic dehydration of the subducting crust prevails at forearc to subarc depths due to the breakdown of hydrous minerals such as mica and amphibole in the stability field of garnet and rutile,resulting in the liberation of aqueous solutions with the trace element composition that is considerably enriched in LILE,Pb and LREE but depleted in HFSE and HREE relative to normal M
文摘1 Introduction Rapid socioeconomic progress has greatly affected the lifestyle in China.Consequently,owing to lifestyle changes,urbanization,and accelerated population aging,the risk of cardiovascular diseases(CVD)has increased.The incidence of CVD has been increasing continuously and this upward trend is projected to continue in the next decade.The growing burden of CVD has become a major public health issue.
文摘Nasopharyngeal carcinoma(NPC)is a malignant epithelial tumor originating in the nasopharynx and has a high incidence in Southeast Asia and North Africa.To develop these comprehensive guidelines for the diagnosis and management of NPC,the Chinese Society of Clinical Oncology(CSCO)arranged a multi-disciplinary team comprising of experts from all sub-specialties of NPC to write,discuss,and revise the guidelines.Based on the findings of evidencebased medicine in China and abroad,domestic experts have iteratively developed these guidelines to provide proper management of NPC.Overall,the guidelines describe the screening,clinical and pathological diagnosis,staging and risk assessment,therapies,and follow-up of NPC,which aim to improve the management of NPC.
基金supported by the Strategic Priority Research Program of Chinese Academy of Sciences (XDB18020303)the National Natural Science Foundation of China (41590620 and 41890831).
文摘When plate tectonics started to occur on Earth and how it has evolved through time are two of the most fundamental questions in earth sciences. While gravity-driven subducting has been accepted as a critical condition for the operation of plate tectonics on Earth, it is intriguing how the dynamic regime and thermal state of subduction zones have affected the style of plate tectonics in Earth’s history. The metamorphic rocks of regional distribution along convergent plate boundaries record reworking of crustal rocks through dehydration and melting at lithospheric depths. The property of regional metamorphism is determined by both dynamic regime and thermal state of plate margins. The two variables have secularly evolved in Earth’s history, which is recorded by changes in the global distribution of metamorphic facies series through time. This results in two styles of plate tectonics. Modern-style plate tectonics has developed since the Neoproterozoic when plate margins were rigid enough for cold subducting, whereas ancient-style plate tectonics has developed since the Archean when plate margins were ductile enough for warm subducting. Such a difference is primarily dictated by higher mantle temperatures in the Archean than in the Phanerozoic. The development of plate subduction in both cold and warm realms is primarily dictated by the rheology of plate margins. This leads to a holistic model for the style of plate tectonics during different periods in Earth’s history.
文摘The novel contagious primary atypical pneumonia epidemic,which broke out in Wuhan,China,in December 2019,is now formally called Coronavirus Disease 2019(COVID-19),with the causative virus named as Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2).1,2 Recent studies have shown that in addition to dyspnea,hypoxemia,and acute respiratory distress,lymphopenia,and cytokine release syndrome are also important clinical features in patients with severe SARS-CoV-2 infection.3 This suggests that homeostasis of the immune system plays an important role in the development of COVID-19 pneumonia.
文摘1 Introduction Major and profound changes have taken place in China over the past 30 years. An epidemic of cardiovascular diseases （CVD） in China is emerging as a result of lifestyle changes, urbanization, and the accelerated process of aging. The incidence of CVD is continuously increasing and will remain an upward trend in the next decade. Since 2005,
基金The study was supported by National Key Research and Development Program(2018YFA0704100,2018YFA0704104)National Natural Science Foundation of China(81827805,82130060)Jiangsu Provincial Special Program of Medical Science(BE2019750).The funding sources had no role in the writing of the report,or decision to submit the paper for publication.
文摘There is considerable potential for integrating transarterial chemoembolization(TACE),programmed death-(ligand)1(PD-[L]1)inhibitors,and molecular targeted treatments(MTT)in hepatocellular carcinoma(HCC).It is necessary to investigate the therapeutic efficacy and safety of TACE combined with PD-(L)1 inhibitors and MTT in real-world situations.In this nationwide,retrospective,cohort study,826 HCC patients receiving either TACE plus PD-(L)1 blockades and MTT(combination group,n=376)or TACE monotherapy(monotherapy group,n=450)were included from January 2018 to May 2021.The primary endpoint was progression-free survival(PFS)according to modified RECIST.The secondary outcomes included overall survival(OS),objective response rate(ORR),and safety.We performed propensity score matching approaches to reduce bias between two groups.After matching,228 pairs were included with a predominantly advanced disease population.Median PFS in combination group was 9.5 months(95%confidence interval[CI],8.4-11.0)versus 8.0 months(95%CI,6.6-9.5)(adjusted hazard ratio[HR],0.70,P=0.002).OS and ORR were also significantly higher in combination group(median OS,19.2[16.1-27.3]vs.15.7 months[13.0-20.2];adjusted HR,0.63,P=0.001;ORR,60.1%vs.32.0%;P<0.001).Grade 3/4 adverse events were observed at a rate of 15.8%and 7.5%in combination and monotherapy groups,respectively.Our results suggest that TACE plus PD-(L)1 blockades and MTT could significantly improve PFS,OS,and ORR versus TACE monotherapy for Chinese patients with predominantly advanced HCC in real-world practice,with an acceptable safety profile.
