Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes mellitus. Considering complicated conditions, poor general condition, severe infection and poor outcomes as the feature characteristics of Chinese DFU patients, comprehensive and systematic evaluation, including general condition, region of the foot, and psychological status, is essential and fundamental for successful treatment. This commentary summarizes the evaluation contents in scientific and standardized diagnosis and treatment of diabetic foot ulcer, and looking forward to reducing morbidity, recurrence rate and mortality, and increasing limb salvage rate.
ObjectiveTo evaluate the effect of post mastectomy radiation therapy (PMRT) on breast reconstruction after mastectomy in breast cancer patients, in order to provide evidence support for clinical treatment decision.MethodsFive databases searched in the current study include the Cochrane Library, PubMed, CNKI, VIP and WanFang database. A systematic search for control trials was performed in each database from the starting date of each database to March 1, 2021. After the two evaluators independently selected literatures, extracted data and conducted quality evaluation according to the inclusion and exclusion criteria, the meta analysis was carried out by Revman 5.3 software.ResultsA total of 9 cohort studies (3 447 cases) were included, including 699 cases in PMRT group and2 748 cases in non-radiotherapy group. The results of meta-analysis showed that: PMRT was associated with significant increase in capsular contracture. The incidence of capsular contracture increased from 4.34% in the non-radiotherapy group to 34.10% in patients receiving PMRT [OR=9.25, 95%CI (3.76, 22.78), P<0.000 01]. In addition, PMRT was associated with a significant increase in incidences of reconstructive failure [OR=2.55, 95%CI (1.74, 3.74), P<0.000 01] and revisional surgery [OR=2.24, 95%CI (1.58, 3.18), P<0.000 01]. Moreover it was associated with a significant reduction in patient satisfaction [OR=0.29, 95%CI (0.15, 0.57), P=0.000 30] and cosmetic outcome [OR=0.26, 95%CI (0.15, 0.43), P<0.000 01].ConclusionThis meta-analysis demonstrates that breast cancer patients who received PMRT after breast reconstruction, the rate of adverse events is increased and patients’ satisfaction and cosmetic outcome are decreased.
Objective To systematically review the efficacy and safety of immune checkpoint inhibitors (ICIs) as first-line treatment for advanced non-small cell lung cancer (NSCLC). MethodsTo collect clinical randomized controlled trials of ICIs for the first-line treatment of patients with NSCLC, computer searches were conducted on PubMed, The Cochrane Library, and EMbase databases. The search time frame was inception to January 2023. A meta-analysis was performed using Revman 5.4 software. ResultsTwelve clinical studies were included, all of which were assessed as high-quality literature with a total of 7 121 patients. Meta-analysis showed that the first-line treatment of NSCLC patients with ICIs significantly improved median overall survival (OS) (HR=0.72, 95%CI 0.64 to 0.80, P < 0.000 01), prolonged median progression-free survival (PFS) (HR=0.65, 95%CI 0.53 to 0.78, P<0.000 01), and improved objective response rate (ORR) (RR=1.52, 95%CI 1.28 to 1.79, P<0.000 01), compared to chemotherapy. Subgroup analysis showed that the ICIs combination therapy group significantly improved OS, PFS, and ORR in NSCLC patients compared to the ICIs monotherapy group. In terms of safety, the ICIs group had a lower risk of treatment-related adverse events (TRAEs) of any grade and grade 3-5 TRAEs than the chemotherapy group. However, the ICIs group had a higher incidence of TRAEs leading to treatment cessation than the chemotherapy group. Subgroup analysis showed that the incidence of any grade TRAEs, grade 3-5 TRAEs, leading to treatment discontinuation TRAEs was higher in the immune combination therapy group than in the immune monotherapy group. ConclusionThe first-line treatment of NSCLC patients with ICIs inhibitors significantly improved OS, PFS, and ORR compared to chemotherapy. Immune-combination chemotherapy significantly improved the outcomes of NSCLC patients, compared to immune monotherapy, but patients were at a higher risk of TRAEs.