Aspirin or paracetamol – what’s good for you?

Paracetamol is widely used as an over the counter analgesic because it is perceived to be safer than aspirin. In carefully selected trial populations, aspirin therapy carries a relatively low (but statistically significant) absolute risk increase in gastrointestinal adverse events. The risk from aspirin may potentially be higher in individuals who have risk factors for peptic ulcer or gastrointestinal haemorrhage. As such, paracetamol may well be the preferred choice in many instances.     

铁缺乏症患者缺铁程度对口服铁剂吸收的影响

目的研究铁缺乏症患者缺铁程度对口服铁剂吸收的影响。方法纳入2018年7月至2020年6月于中国医学科学院血液病医院贫血中心门诊就诊并确诊铁缺乏症的非妊娠期女性患者37例，以13例健康查体女性为正常对照，分析缺铁性贫血（IDA）、缺铁性红细胞生成/储存铁不足（IDE/ID）患者及正常对照者Hepcidin水平并进行口服铁剂吸收试验（OIAT），比较服铁后2 h血清铁（C2）与基线血清铁（C0）差值。结果IDA、ID/IDE、正常对照组Hepcidin中位数分别为4.9（2.17～32.86）、26.98（11.02～49.71）、69.89（42.23～138.96）µg/L（P<0.001），IDA组Hepcidin低于ID/IDE组（校正后P＝0.005）和正常对照组（校正后P<0.001），但ID/IDE组与正常对照组差异无统计学意义（校正后P＝0.220）；OIAT IDA、ID/IDE及正常对照组C2–C0平均值分别为（35.30±21.68）、（37.90±14.06）、（23.57±10.14）µmol/L，差异无统计学意义（P＝0.130）。多重线性回归分析显示C0、血清铁蛋白（SF）、可溶性转铁蛋白受体（sTFR）和HGB是铁缺乏症患者Hepcidin的独立影响因素，Hepcidin＝−31.842−0.642*C0+2.239*SF+1.778*sTFR+0.365*HGB−0.274*网织红细胞血红蛋白含量（RET-HB）。未发现C2–C0的独立影响因素。结论铁缺乏程度影响口服铁剂吸收，胃肠功能正常者铁缺乏越重，口服铁剂吸收越多，ID/IDE较IDA铁吸收减缓。Hepcidin较OIAT更能区分不同铁缺乏程度的口服铁吸收。     

Association of β‐1 and β‐2 adrenergic receptor gene polymorphisms with myocardial infarction

Both β₁‐ and β2‐adrenergic receptors (β₁‐ and β₂‐AR) have important roles in heart function mainly in response to catecholamines. Some specific polymorphisms in the β₁‐ and β₂‐AR genes, named ADRB1 and ADRB2, respectively, have been implicated in several cardiovascular and noncardiovascular phenotypes. In this study, we aimed to investigate the possible relationship between Ser49Gly and Arg389Gly polymorphisms of the ADRB1 and Arg16Gly and Gln27Glu polymorphisms of the ADRB2 gene with ST elevation myocardial infarction (MI) in a Turkish population. One hundred patients with ST elevation MI and 100 healthy control subjects were genotyped using the PCR‐RFLP method. Although the Arg389 allele of the ADRB1 gene was associated with an elevated risk of MI, the Glu27 allele of the ADRB2 gene was associated with a decreased risk of MI. Carriers of the ADRB1 Arg389 allele (heterozygotes+homozygotes) had an approximately 3.5‐fold increased risk for MI than Gly389 homozygotes (OR=3.59, 95% CI=0.96–13.47, P=0.045). For the ADRB2 Gln27Glu polymorphism, subjects having one or two copies of the Glu27 allele showed a decreased risk of MI compared with Gln27 homozygote subjects (OR=0.48, 95% CI=0.24–0.94, P=0.03). Haplotype analysis of these polymorphisms showed no significant differences between groups. These results suggest that the Arg389Gly and Gln27Glu polymorphisms may be associated with an altered risk of MI in this Turkish population. J. Clin. Lab. Anal. 23:237–243, 2009. © 2009 Wiley‐Liss, Inc.     

Using the “big picture” to get what you want

Few basic nursing education programs provide the student nurse with courses in business and finance. Those skills were most often acquired by nurse managers when they were promoted from a staff position to a management position and they were acquired on the job. As the health care environment becomes more complex, so too does the scope of business and financial skills. Today's nurse manager must develop a wider range of skills to survive. Among the most important is an ability to connect unit level needs to the overall goals of the organization.     

‘Have you had the test?’ A discourse analysis of media presentation of prenatal screening in Iceland

Scand J Caring Sci; 2010; 24; 414–421
‘Have you had the test?’ A discourse analysis of media presentation of prenatal screening in Iceland Nuchal translucency (NT) screening has come to be widely used in antenatal care in many countries. In the capital area of Iceland, which is the focus of this study, 84% of pregnant women underwent screening in 2005. At the time no official policy had been formulated regarding the use of this screening, and very limited public discussion had taken place on the ethical issues related to its use. Although screening has been widely welcomed as a scientific and technological improvement, it may also have unintended consequences, both for practitioners and prospective parents, and for particular groups such as the disabled, which have not been fully explored. The purpose of this study was to examine how NT screening was introduced as a new practice and came to be adopted in prenatal care in Iceland. Using a genealogical approach, we explored the way in which the value and potential drawbacks of NT screening were presented to the public. The data used in the analysis comprised material published from the beginning of 2000 until the end of 2005, such as television programmes, newspaper and magazine articles and booklets written for prospective parents. The findings reveal that the screening was mainly promoted by staff at the specialized clinic where the test was offered, and that soon after its initiation screening became widespread. In interviews, both practitioners and parents of children with Down’s syndrome questioned the eugenic implications of screening and its impact on the lives of the disabled and their relatives. However, the societal response was fairly muted and a critical debate regarding the routine use of NT screening can hardly be said to have taken place. These findings alert us to the importance of promoting critical discussion of new knowledge and technology in health care, particularly when serious ethical issues are involved.     

初治多发性骨髓瘤患者早期死亡预测模型的建立

目的分析影响初治多发性骨髓瘤（NDMM）患者早期死亡（EM）的因素，建立其预测模型，以期识别EM风险。方法回顾性分析2009年5月至2017年1月吉林大学白求恩第一医院收治的275例NDMM患者，对6个月（EM6）、12个月（EM12）及24个月（EM24）内死亡患者初诊时基线特征进行单因素分析，并根据多因素分析结果建立EM的预测模型。结果本研究中EM6、EM12及EM24的发生率分别是5.5%、12.7%和30.2%；最常见的死亡原因为疾病复发/进展，在EM6、EM12及EM24中分别占60.0%、77.1%及84.3%。影响EM6的因素包括经白蛋白校正的血清钙（校正钙）>2.75 mmol/L和PLT<100×10⁹/L；影响EM12的因素包括年龄>75岁、国际分期系统（ISS） Ⅲ期、修订版国际分期系统（R-ISS） Ⅲ期、校正钙>2.75 mmol/L、血清肌酐>177 µmol/L、PLT<100×10⁹/L及骨髓浆细胞比例≥60%；影响EM24的因素中，除上述影响EM12的因素外，还包括男性和染色体核型1q+。多因素分析尚未发现EM6和EM12的独立预后因素。在EM24的多因素分析中，年龄>75岁、PLT<100×10⁹/L和染色体核型1q+是EM24的独立预后因素。根据Logistic回归系数赋分：年龄>75岁：1分；PLT<100×10⁹/L：2分；染色体核型1q+：1分，建立EM24预测模型，ROC曲线下面积为0.709（95%CI 0.626~0.793）。积分≥3分的患者24个月内死亡风险是0~2分患者的26倍，积分0~4分的NDMM患者中位总生存期分别为59、41、22、17.5及16个月（P<0.001）。结论年龄>75岁、PLT<100×10⁹/L和染色体核型1q+为EM24的独立预后因素，依据上述变量构建的EM24预测模型有助于识别EM风险和预测生存，具有较好标准度与区分度。     

预后营养指数、控制营养状况对多发性骨髓瘤患者预后的影响

目的探讨预后营养指数（PNI）、控制营养状况（CONUT）对多发性骨髓瘤（MM）患者预后的影响。方法回顾性分析2014年1月至2018年12月徐州医科大学附属医院收治的157例MM患者的临床资料，通过受试者工作特征（ROC）曲线得出最佳截断值，PNI、CONUT评分分别以44.45、3.5为界值进行分组，分析各组年龄、性别、血清钙、β₂-微球蛋白、血肌酐、LDH、HGB等的差异，分析MM患者的预后影响因素。结果PNI、CONUT评分是总生存（OS）时间的影响因素；单因素分析结果显示年龄、LDH、浆细胞比例、β₂-微球蛋白、ISS分期、PNI、CONUT评分是影响MM患者OS时间的危险因素；多因素分析显示，年龄（HR＝1.636，95％ CI 1.014～2.640）、浆细胞比例（HR＝1.953，95％ CI 1.232～3.096）、PNI（HR＝0.513，95％ CI 0.287～0.917）是影响MM患者的OS时间独立危险因素。结论初诊MM患者PNI低提示预后不良，是影响预后的独立危险因素。     

CD19嵌合抗原受体T细胞治疗病灶大于7.5 cm的复发/难治B细胞淋巴瘤肿瘤局部反应与疗效分析

目的观察病灶>7.5 cm的复发/难治B细胞非霍奇金淋巴瘤（R/R NHL）患者CD19嵌合抗原受体T细胞（CAR-T细胞）治疗的肿瘤局部反应及疗效。方法以2018年8月至2020年5月接受CD19 CAR-T细胞治疗的病灶>7.5 cm的32例R/R NHL患者为研究对象，流式细胞仪检测CD19CAR-T细胞的体内扩增情况；酶联免疫吸附测定法检测患者外周血中细胞因子水平；观察全身不良反应及肿瘤局部反应，分析总有效率（ORR）及总生存（OS）情况。结果① 32例患者CAR-T细胞治疗后，13例获得完全缓解（CR）（40.63％），10例获得部分缓解（PR）（31.25％），ORR为71.88％。② 23例有效患者均发生细胞因子释放综合征（CRS），其中1～2级13例，3～4级10例；而疾病稳定+疾病进展（SD+PD）组9例患者CRS均为1～2级（P＝0.030）。③共15例（46.9％）患者发生肿瘤局部反应，其中CR 9例、PR 5例、SD 1例，肿瘤局部反应包括：浅表肿物直径增大且伴红肿热痛；深部肿物表现为腹痛、腹胀、憋气以及肿瘤局部疼痛、烧灼，瘤体增大或伴局部水肿；肿瘤局部出现渗出性病变，可见于腹腔、胸膜腔等。④有效组CD19 CAR-T细胞峰值高于SD+PD组［16.8％（5.3％～48.2％）对2.9％（1.5％～5.7％），z＝−4.297，P<0.001］，有效组中出现肿瘤局部反应患者CD19 CAR-T细胞峰值高于未出现肿瘤局部反应患者［22.2％（10.5％～48.2％）对12.6％（5.3％～21.6％），z＝−3.213，P＝0.001］，多发肿块组CD19 CAR-T细胞峰值高于单发肿块组［35.8％（1.5％～48.2％）对16.8％（10.5％～18.5％），z＝−2.023，P＝0.040］。⑤肿瘤局部反应出现和瘤体缩小时间，均较全身不良反应时间延迟。⑥有效患者中出现肿瘤局部反应者OS率高于未出现肿瘤局部反应者，但差异无统计学意义（75.0％对34.6％，P＝0.169）。结论病灶>7.5 cm的R/R NHL患者CD19 CAR-T细胞治疗，近一半出现肿瘤局部反应，发生时间迟于全身不良反应开始的时间。临床试验注册：中国临床试验注册中心（ChiCTR1800018059）     

骨髓浆细胞比例小于10％的新诊断多发性骨髓瘤36例临床特征及预后分析

目的提高对骨髓单克隆浆细胞比例小于10％的新诊断多发性骨髓瘤（NDMM）患者的认识。方法回顾性总结2009年1月至2017年12月北京协和医院36例骨髓浆细胞比例小于10％的NDMM患者的临床特点、实验室检查、治疗反应和预后情况，选择同期诊断的72例骨髓浆细胞比例≥10％的NDMM患者作为对照组，两组患者年龄和性别匹配。结果①在818例NDMM患者中，骨髓浆细胞比例小于10％的患者36例（4.4％），其中国际分期系统（ISS）Ⅲ期11例（30.6％），显著低于对照组患者［45例（62.5％）］（P＝0.002）。与对照组相比，骨髓浆细胞比例小于10％的患者合并髓外病变比例更高（33.3％对5.6％，P<0.001），血清M蛋白中位值更低［1.04（0～50.10）g/L对4.50（0～63.10）g/L，P＝0.016］，24 h尿轻链定量中位值更低（510 mg对2800 mg，P＝0.023）。②骨髓浆细胞比例小于10％患者与对照组患者一线治疗后中位无进展生存（PFS）时间分别为26.4个月和19.9个月（HR＝1.703，95％CI 0.167～0.233，P＝0.002），总生存（OS）时间分别为65.8个月和46.2个月（HR＝2.626，95％CI 0.439～0.541，P＝0.058）。③按照M蛋白水平将研究组分为低肿瘤负荷组和高肿瘤负荷组，中位OS时间分别为66.4个月和24.0个月（HR＝2.349，95％CI 0.603～0.696，P＝0.046），中位PFS时间分别为33.1个月和15.5个月（HR＝1.806，95％CI 0.121～0.399，P＝0.077）。硼替佐米治疗对患者的生存结局无影响。结论骨髓浆细胞比例小于10％的NDMM患者疾病分期较早，肿瘤负荷较低，尽管合并髓外病变比例更高，一线疗效以及总体预后优于骨髓浆细胞比例≥10％的患者。     

circ-KEL在急性髓系白血病中的表达及其对白血病细胞的调控作用和机制

目的探讨circ-KEL在急性髓系白血病（AML）患者中的表达及其对AML细胞的调控作用和机制。方法收集116例AML患者以及40名健康者骨髓标本，分离骨髓单个核细胞，使用实时定量RT-PCR法检测circ-KEL的表达水平并分析其与AML患者临床特征之间的关系。通过生物信息学分析以及双荧光素酶报告基因实验等验证circ-KEL与miR-335-5p/LRG1的靶向关系。运用CCK-8、流式细胞术等方法检测circ-KEL在AML细胞中的生物学作用。结果circ-KEL在AML患者中的表达较正常人群明显增高（−7.117±1.831对−8.669±1.771，P<0.001），circ-KEL高表达患者总生存期（OS）明显短于低表达者（P＝0.037）。AML患者接受化疗后circ-KEL表达水平较初诊时下降。同时，circ-KEL可充当miR-335-5p的“海绵”，靶向调节LRG1。数据库分析显示miR-335-5p高表达患者预后好，且其与LRG1水平呈负相关。LRG1可促进AML细胞的增殖，抑制其凋亡，在AML患者中表达水平较健康人群也显著升高。circ-KEL可以通过miR-335-5p/LRG1轴发挥对白血病细胞的促增殖以及抑制凋亡作用。结论circ-KEL在AML患者中高表达，与AML患者预后高度相关，通过影响miR-335-5p/LRG1在AML疾病进展中发挥重要作用。