Volume 103 · Issue 34 · 2023

Chest tightness variant asthma (CTVA) was first reported and named by Chinese scholars in 2013. It is a new clinical type of asthma characterized by chest tightness as the only or primary symptom, without typical asthma manifestations such as recurrent wheezing and shortness of breath, and without wheezing sounds heard during lung auscultation. The overall epidemiological data on CTVA is currently unavailable. Its pathogenesis is similar to that of typical asthma, involving eosinophilic airway inflammation. Due to the lack of typical clinical manifestations, insufficient knowledge of this disease in some clinicians and some other reasons, CTVA is susceptible to misdiagnosis or missed diagnosis. Currently, the diagnostic criteria for CTVA are: chest tightness as the only or primary symptom, without typical asthma symptoms and signs such as wheezing and shortness of breath, and with any one of the objective indicators of variable airflow limitation. Effective anti-asthma treatment is required, and other diseases that cause chest tightness, such as cardiovascular, digestive, nervous, muscular, and mental diseases should be excluded. CTVA treatment follows that of typical asthma, but the specific treatment duration is uncertain and may require long-term management. Traditional Chinese medicine has shown some therapeutic effects on CTVA. Most CTVA patients have a good prognosis after active anti-asthma treatment. This paper analyzes and summarizes the research of CTVA in China from 2013 and provides new perspectives for further exploration of CTVA.

In the past decade, generated data of large-scale clinical research of endocrine therapy and the update of guidelines have changed clinical practice of breast cancer treatment. However, there are unresolved issues on endocrine therapy. Based on new evidences and clinical experience, we expounded our points on neoadjuvant endocrine therapy, CDK4/6 inhibitoradjuvant therapy, concepts of endocrine sensitivity and endocrine resistance, first-line treatment for metastatic breast cancer, treatment options after progression on CDK4/6 inhibitor and treatment ofvisceral crisis.

CDK4/6 inhibitors have become the standard of care for HR-positive, HER2-negative advanced breast cancer. However, there is still a lack of standard recommendations for the subsequent treatment of patients with CDK4/6 inhibitor resistance, especially those with primary resistance or rapid progression. Currently, appropriate treatment strategies included re-challenge of CDK4/6 inhibitors, combination with PI3K/AKT/mTOR inhibitors, new antibody drug conjugate (ADC), novel endocrine therapy drugs, and chemotherapy. In addition, many new targeted drugs and new combination treatment strategies are also being explored. In the future, precise treatment strategies based on biomarkers should be established, as well as the optimal sequence of use of different therapies.

The endocrine therapy of hormone receptor (HR)-positive human epidermal growth factor receptor 2 (HER2)-negative breast cancer has stepped into an era of targeted combination therapy. Many targeted agents, led by cyclin-dependent kinase 4/6 inhibitor (CDK4/6i), have provided abundant treatment options for patients with HR-positive HER2-negative advanced breast cancer. To meet the needs of clinical practice in China and standardize the administration of targeted agents, the stratified endocrine strategy for advanced breast cancer has been proposed by Chinese Society of Clinical Oncology (CSCO) Breast Cancer guidelines based on medicine evidence and drug accessibility, offering scientific and organized decision-making guidance for clinical oncologists.

Chest tightness variant asthma (CTVA) is an atypical asthma, characterized by chest tightness as the only or main clinical manifestation. Due to its lack of typical asthma symptoms and signs, it is prone to misdiagnosis or missed diagnosis. Comprehensive chest tightness symptoms and objective evidence of variable airflow restriction, especially bronchial provocation test, are important criteria of diagnosing CTVA. Patients with CTVA also need to be differentiated from patients with chronic obstructive pulmonary disease, coronary atherosclerotic heart disease, gastroesophageal reflux disease and other diseases. The principle of CTVA treatment is the same as that of typical asthma, and most patients have a good prognosis after standardized asthma treatment. Based on recently research in China, the Asthma Group of the Chinese Thoracic Society organized relevant experts from various specialities, including respiratory and critical care medicine, cardiology, gastroenterology, psychiatry, and traditional Chinese medicine, to develop the expert consensus. This consensus includes: definition, epidemiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis, evaluation, treatment, management education, and prevention of CTVA, and it also proposes a flowchart for CTVA diagnosis and treatment. This expert consensus is intended to provide with expert opinion in improving the understanding and standardized diagnosis and treatment of CTVA among clinicians in China.

Transarterial chemoembolization (TACE) is the most commonly used method in the treatment of unresectable hepatocellular carcinoma (HCC), which is a malignancy of hypervascularity originating from hepatocytes. The experts from Chinese College of Interventionalists (CCI) published Chinese Clinical Practice Guidelines for TACE of HCC in 2018 and updated it in 2021. These guidelines have played an important role in standardizing the clinical practice of TACE treatment for HCC in China. With the updated concept, technological progress, and emergence of high-level evidence in accordance with the principles of evidence-based medicine of TACE for HCC, the guidelines were revised and updated again by the experts from CCI. The 2023 edition guidelines not only adopts a more suitable evidence evaluation and recommendation system, but also adds the following contents: TACE in special circumstances, TACE in multidisciplinary diagnosis and treatment of HCC and the whole process management, TACE quality control, hot spots and development direction of TACE, etc. This guideline is based on the latest evidence-based medical evidence and combined with clinical practice, and aims to standardize TACE treatment of HCC in China.

Since May 2022, Mpox has rapidly spread globally and been posing new challenges. There is no specific treatment drug for monkeypox (Mpox), and how to avoid cross infection has become the key to the prevention and control of the Mpox epidemic. However, current guidelines lack systematic recommendations for reducing Mpox transmission risk in medical institutions. Therefore, the National Medical Institution Infection Surveillance System of China, National Training Center of Hospital Infection in China, National Clinical Research Center of Geriatric Disorders organized 64 experts in the fields of healthcare-associated infection control, clinical medicine, disinfection, etc. nationwide to sort out relevant issues and urgently release the consensus of Chinese experts on mpox healthcare-associated infection prevention and control. The main content includes an overview of the Mpox epidemic, pathogenic characteristics, epidemiology, early identification and diagnosis, infection prevention and control strategies and measures in medical institutions, and occupational exposure assessment and treatment, aiming to strengthen healthcare-associated infection prevention and control of Mpox and reduce cross infection.

Antibody-drug conjugates (ADC) are a new class of antineoplastic agents whose structure is composed of a monoclonal antibody covalently attached to a cytotoxic drug via a chemical linker. The introduction and clinical application of ADC change the treatment pattern of human epidermal growth factor receptor 2 (HER2) and triple-negative breast cancer, which is put forward new requirements for the standardized use and management of ADC drugs for medical staff. ADC drugs infusion norms and the prevention and management of adverse reactions are important prerequisites for ensuring drug efficacy and safety. Therefore, the Breast Cancer Case Manager Branch of the Chinese Medical Education Association and the consensus formulation group on targeted drug infusion norms jointly formulated an expert consensus on management of breast cancer antibody-drug conjugates infusion norms. The aim is to provide practical guidance and the early prevention and timely management of related adverse reactions of ADC drugs such as Trastuzumab Emtansine, Trastuzumab Deruxtecan, and Sacituzumab Govitecan for clinical staff.

To analyze the clinical characteristics of leptomeningeal metastasis (LM) patients from epithelial growth factor receptor (EGFR)-mutated lung adenocarcinoma, and their impacts on the survival of the patients.

From July 2018 to July 2022, the clinicopathological data of 81 patients diagnosed as EGFR-mutated lung adenocarcinoma LM by cytopathology who admitted to the Department of Oncology of Xiangya Hospital of Central South University were retrospectively analyzed, including 33 males and 48 females. The age ranged from 31 to 76 years, with a median age of 54 years. All the 81 patients were followed up, with a median follow-up of 21.0 months (95%CI: 12.5 to 29.5 months). The Kaplan Meier method was used to draw survival curve. Cox proportional hazards regression model was used to analyze the impact of the factors on the survival of patients.

Among the 81 patients, the interval between the initial diagnosis of lung cancer and the pathological diagnosis of LM in cerebrospinal fluid (CSF) was 0-108 months, with a median interval of 14 months. Fifty-two patients (64.2%) used the third-generation epithelial growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs), while 17 patients (21.0%) used EGFR-TKIs in combination with other drugs, and 12 patients (14.8%) were treated with best supportive care (BSC). Sixty patients (74.1%) had a Kanofsky performance status (KPS) score of less than 60 points, and 71 patients (87.7%) had brain parenchymal metastasis and/or spinal metastasis. Twenty-two patients (27.2%) used pemetrexed through intrathecal CSF, and 17 patients (21.0%) used pemetrexed through the Ommaya sac to the CSF of the ventricle. The incidence of adverse event related to the administration of pemetrexed through CSF was 64.1% (25/39), mainly manifested as myelosuppression, including 22 patients of leukocyte reduction, 25 patients of hemoglobin reduction, and 14 patients of platelet reduction. The median post-leptomeningeal metastasis overall survival (pLM-OS) in 81 patients was 11.0 (95%CI: 7.7-14.3) months. KPS score≥60 points (HR=0.407, 95%CI: 0.170-0.973, P=0.043), CSF cytology negative after treatment (vs persistent positive, HR=0.351, 95%CI: 0.155-0.792, P=0.012), intraventricular administration of pemetrexed (vs non intraventricular administration of pemetrexed, HR=0.319, 95%CI: 0.137-0.745, P=0.008) and the treatment with third-generation EGFR-TKIs after LM (vs EGFR-TKIs in combination with other drugs, HR=0.486, 95%CI: 0.237-0.998, P=0.049) were a factor affecting pLM-OS of patients.

Brain parenchyma, or/and spine are the most sites where the LM patients concurrently metastasize. KPS score≥60 points and CSF cytology negative after treatment, intraventricular administration of pemetrexed and the treatment with third-generation EGFR-TKIs are indictors affecting pLM-OS of the patients.

To study the effect of unexpected follicular development in artificial cycles on the clinical outcomes in frozen thawed embryo transfer based on propensity score matching(PSM).

The retrospective cohort study analyzed the clinical data of 7 064 cycles (5 716 patients) of artificial cycle frozen-thawed embryo transfer (AC-FET) in the Reproduction Center of the Third Affiliated Hospital of Zhengzhou University from January 1, 2016 to December 31, 2020. The clinical data were divided into three groups according to the degree of follicular development in AC-FET: no follicular growth group (group A, 6 349 cycles), small follicular growth group (group B, 248 cycles), and large follicular growth group (group C, 467 cycles). Differences in clinical outcomes between the small follicle growth group (Group B) and the large follicle growth group (Group C) were compared with the no follicle growth group (Group A) after PSM and logistic regression to adjust for confounding factors at baseline. A binary logistic regression model was used to analyze the factors related to the unanticipated follicular development in AC-FET.

Age [M(Q₁,Q₃)] was [31.0 (28.0, 36.0)] years in Group A, [34.5 (30.0, 40.0)] years in Group B, and [36.0 (31.0, 41.0)] years in Group C. After adjusting for confounders, the differences between Groups A and B in clinical pregnancy rate (P=0.169), live birth rate (P=0.318), early abortion rate (P=0.470), and miscarriage rate (P=0.783) were not statistically significant. The differences in clinical pregnancy rate (P=0.743), live birth rate (P=0.486) and miscarriage rate (P=0.080) between Groups A and C were not statistically significant, while early miscarriage rate (P=0.034) differences were statistically significant. The age, BMI, basal AFC, AMH and starting dose of estrogen were correlates of the emergence of non-expected small follicles in Groups B and A. The adjusted OR (AOR) values (95%CI) were 1.03 (1.01-1.06), 0.93 (0.90-0.98), 0.97 (0.95-0.99), 0.96 (0.95-0.97), and 0.59 (0.45-0.77), all P<0.05. Age, basal AFC, AMH and starting dose of estrogen were the associated factors of the appearance of non-expected large follicles in Groups C and A. The AOR values (95%CI) were 1.03 (1.01-1.05), 0.93 (0.91-0.95), 0.96 (0.95-0.97), and 0.52 (0.42-0.64), all P<0.05.

In AC-FET, the clinical outcome of small follicular growth is similar to that of unfollicular growth; Compared with the growth without follicles, the growth and development of large follicles can reduce the early abortion rate; Patients with older age, less AFC, lower AMH, and lower initial dose of estrogen could be more likely to have unanticipated follicular development during endometrial preparation.

To evaluate the awareness, diagnosis and treatment of chest tightness variant asthma (CTVA) among pediatricians in China.

The survey was conducted by convenient sampling method. Pediatricians with professional title of attending physician and above from different grades hospitals in 30 provinces were invited to conduct online questionnaire surveys through WeChat, pediatricians scan QR codes to complete electronic questionnaires in the mini program from January 16th to February 4th, 2021. The contents of questionnaire included the awareness, diagnosis and treatment of CTVA, and comparing the differences between pediatricians in secondary hospitals and tertiary hospitals.

A total of 1 529 pediatricians participated in the survey, and 1 484 (97.06%) pediatricians completed the questionnaire and included in the analysis, including 420 males (28.30%). The awareness rate of CTVA among pediatricians was 77.83 % (1 155/1 484). Pediatricians in tertiary hospitals had higher rates of awareness of CTVA than pediatricians in secondary hospitals [81.86% (898/1 097) vs 66.41% (257/387), P<0.001] and had better execution of the guidelines [89.15% (978/1 097) vs 79.59% (308/387), P<0.001]. A total of 93.06 % (1 381/1 484) of pediatricians′ first-line treatment included inhaled corticosteroids (ICS) for CTVA. Among them, a higher proportion of pediatricians in tertiary hospitals used ICS included regimens for first-line treatment of CTVA compared with pediatricians in secondary hospitals [94.90% (1 041/1 097) vs 87.86% (340/387), P<0.001]. The reported well control rate of CTVA was 32.08% (476/1 484), which was significantly lower in secondary hospitals than that in tertiary hospitals [17.31% (67/387) vs 37.28% (409/1 097), P<0.001].

Most pediatricians are well aware of CTVA, among which there is a certain gap in clinical practice between pediatricians in secondary hospitals and tertiary hospitals in terms of understanding, diagnosis, and treatment of CTVA.

In recent years, the role of endometrial cell senescence in the process of pregnancy failure has gradually emerged. This broke the academic community's cognition of the single effects of cell microenvironment changes, tissue structure and function degradation caused by cell senescence, and introduced the possibility of two-way interaction between cell senescence and tissues, thus giving birth to tissue replacement for senescent cells. This article will review the recent research progress on cellular senescence, uterine decidualization during implantation and the relationship between them, summarize new therapeutic options in this field, and put forward the prospect of clinical application.

Chest tightness variant asthma (CTVA) is an atypical type of asthma with chest tightness as the only manifestation. Due to the lack of typical asthma symptoms, diagnostic tests are required. The aim of this study was to explore the value of exercise provocation test (ECT) and exhaled nitric oxide (FeNO) in the diagnosis of CTVA in children.

Chest tightness is the only symptom of atypical asthma in children, which has not been widely recognized. This study attempts to discover the risk factors of this disease, summarize its clinical features, and provide some suggestions for the diagnosis of this disease.