Yantai Yuhuangding Hospital

Radiotherapy represents a crucial therapeutic modality in cancer treatment, yet its efficacy is frequently limited by radiation-induced toxicity. Growing evidence indicates that gut microbiota and their metabolites serve as key regulators of both radioprotective and radiosensitizing effects. This review systematically examines three fundamental regulatory mechanisms through which gut microbiota and its metabolites mitigate radiation-induced injury: (1) modulation of intestinal epithelial cell regeneration and tumor cell apoptosis via Wnt/β-catenin and PI3K/AKT/mTOR pathways; (2) immunomodulation via Toll-like receptor activation and NF-κB signaling; (3) oxidative stress management via Nrf2 signaling. We also evaluate various microbiota-targeted interventions, ranging from probiotics and prebiotics to fecal microbiota transplantation and emerging engineered microbial therapies, highlighting their potential in clinical radiotherapy. Finally, we emphasize current limitations and future research directions, underscoring the need to overcome existing challenges in microbiome analysis and therapeutic durability to fully realize the potential of precision radio-microbiome medicine, which may provide valuable references for developing personalized radiotherapy strategies based on gut microbiota and their metabolites.

This study evaluates and compares the effectiveness and safety of febuxostat and allopurinol in chronic kidney disease (CKD) stages 3-5 patients with asymptomatic hyperuricemia using a network meta-analysis.

A systematic review and network meta-analysis were conducted, adhering to PRISMA-NMA guidelines. Searches included PubMed, Embase, Cochrane Library, and Chinese databases up to June 2024. Randomized controlled trials (RCTs) and cohort studies were assessed for methodological rigor using GRADE.

A total of 12 RCTs and 4 cohort studies (n = 2,423 participants) were included. Febuxostat was associated with greater improvements in estimated glomerular filtration rate compared to allopurinol (MD, 4.99 mL/min/1.73 m²; 95%CI -0.65 to 10.78; certainty: low) and placebo (MD, 4.72 mL/min/1.73 m²; 95%CI 0.67 to 8.82; low). Serum uric acid reduction was also more pronounced with febuxostat (MD, -0.61 mg/dL; 95%CI -1.15 to -0.05; moderate). Safety outcomes, including major cardiovascular events and adverse events, showed no significant differences between febuxostat and allopurinol. Subgroup analyses revealed enhanced effectiveness of febuxostat at six months of treatment.

This analysis provides robust evidence that febuxostat might offers greater improvements in kidney function and uric acid levels compared to allopurinol or placebo in asymptomatic hyperuricemia with CKD stage 3-5 patients, without compromising safety. These findings can guide clinical decision-making and treatment optimization.

Sepsis is a systemic inflammatory response syndrome caused by infection, and sepsis-associated acute kidney injury (AKI) markedly increases mortality. Although aspirin's anti-inflammatory properties show therapeutic promise in sepsis, its specific renal protective effects in septic patients remain underexplored. This study investigated the association between aspirin exposure and severe acute kidney injury in septic patients using two databases: MIMIC-IV (73,181 ICU stays, 2008-2022), and eICU (200,859 ICU stays, 2014-2015). Among 45,562 septic patients, cohorts were stratified by aspirin exposure, and outcome variables were compared using multiple statistical adjustment methods including multivariable regression and propensity score analysis. The primary outcome was severe AKI incidence, with secondary outcomes including overall AKI, continuous renal replacement therapy (CRRT), and mortality. Our study suggests that aspirin exposure was associated with significantly lower severe AKI incidence in both databases (adjusted OR 0.35 in MIMIC-IV; 0.84 in eICU), representing risk reductions ranging from 16% to 65%. Secondary outcomes showed that aspirin exposure was associated with reduced kidney injury incidence, mortality rates and continuous renal replacement therapy requirements. These protective associations were consistent with sensitivity analyses and subgroup analyses. Furthermore, these protective effects were observed across different aspirin doses and formulations. However, aspirin may also increase the risk of thrombocytopenia and gastrointestinal bleeding. Our findings suggest that aspirin may be associated with reduced risk of sepsis-related kidney injury and mortality. Nevertheless, prospective randomized controlled trials are needed to confirm these associations, and individualized risk-benefit assessments remain essential before clinical application.