POSSUM与P-POSSUM评分对髋部骨折患者术后并发症发生率及死亡率预测作用的回顾性分析

目的探讨改良生理学和手术严重性评分系统(POSSUM与P-POSSUM)对髋部骨折术后并发症发生率、病死率的预测作用。方法选取2013年1月至2015年12月在本院骨科接受髋部骨折手术治疗的92例进行研究,采用POSSUM与P-POSSUM对患者手术后进行并发症发生率、病死率进行预测,并与实际并发症发生率、病死率进行比较。结果 92例术后并发症发生27例,其中5例并发2种并发症,死亡1例;手术并发症发生率为29.35%、病死率为1.09%;POSSUM评分系统预测92例髋部骨折手术后并发症为31例(33.70%)与实际发生并发症27例(29.35%)比较差异无统计学意义(P0.05);POSSUM评分系统预测92例髋部骨折手术后死亡8例(8.70%)高于实际病死率1例(1.09%),差异有统计学意义(P0.05);P-POSSUM评分系统预测92例髋部骨折手术后死亡3例(3.26%)与实际病死率1例(1.09%)比较差异无统计学意义(P0.05)。结论 POSSUM评分系统预测髋部骨折手术后并发症具有较高的临床价值,P-POSSUM评分系统预测髋部骨折手术后患者病死率具有较高的临床价值。     

肺功能综合评分对低肺功能肺癌患者术后呼吸衰竭风险预测价值的分析

目的:探讨静态肺功能和运动心肺功能综合评分(CPS)对肺癌患者肺切除术后呼吸衰竭风险的预测价值。方法:回顾性分析129例术前第1秒用力呼气容积占预计值的百分率(FEV1%p)<60%且行肺癌肺切除术患者,结合指标:肺一氧化碳弥散量(DLCO%p)、最大摄氧量(VO2max%p)和运动前后经皮测血氧饱和度差(△SaO2%),以及切除肺段数(LSR),分别按减损程度折算成分值,并计算CPS;行单因素和ROC曲线分析,确定预测术后呼吸衰竭的最佳截值。结果:低肺功能患者术后呼吸衰竭组的CPS高于非呼吸衰竭组(P<0.01);ROC曲线分析显示CPS的曲线下面积最大(AURC=0.808);CPS≥9预测术后呼吸衰竭风险高;与VO2max/kg<15mL/(min.kg)比较,CPS≥9预测术后呼吸衰竭的灵敏度高(74.2%和6.5%,P<0.001),特异度略低(87.8%和96.9%,P=0.035),粗一致性无统计学差异(84.5%和75.2%,P=0.073)。结论:低肺通气功能肺癌患者肺切除术后呼吸衰竭的发生与肺切除范围、肺换气功能和机体摄氧能力等综合因素有关。CPS≥9较VO2max/kg<15mL/(min.kg),更灵敏地预示术后呼吸衰竭风险高。     

食管癌根治性术后预防性IMRT所致放射性胃炎的剂量学研究

目的 研究食管癌根治性术后预防性IMRT后急性放射性胃炎发生与胸腔胃受量关系。方法 对接受根治性术的49例食管癌患者术后预防性IMRT的治疗计划及患者治疗期间的急性放射性胃炎发生的情况进行分析。ROC曲线分析与急性放射性胃炎发生可能相关的物理学指标,组间比较行χ²检验,Logistic法多因素分析。结果 全组共19例(39%)患者出现≥2级急性急性放射性胃炎。ROC曲线分析结果显示与急性放射性胃炎发生相关的物理变量包括胃D_max、胃D_mean、LSTT₅—LSTT₄₀及V₁₀—V₅₀;依据ROC曲线所得各物理指标分界值对患者进行分组,除V₅之外,余指标分界值以上组患者≥2级急性急性放射性胃炎发生率明显高于分界值以下组患者,各物理指标的组间差异均有统计学意义(P=0.000~0.022)。多因素分析结果显示LSTT₅和V₄₀为预测≥2级急性放射性胃炎发生的指标(P=0.026、0.001)。结论 在制定食管癌术后患者预防性IMRT的治疗计划时应注意保护胸腔胃,DVH可以很好预测急性放射性胃炎发生,其中胃LSTT₅及V₄₀为预测指标。但最终有待于增加样本量进一步研究。     

改良POSSUM评分在评估肺癌手术风险的应用价值

目的 探讨改良POSSUM评分系统预测肺癌根治术后并发症发生率和病死率的价值。方法 回顾性分析2010年10月至2011年10月间在解放军八一医院胸外科行肺癌根治术的86例原发性肺癌患者的临床资料。术前患者均行改良POSSUM评分预测术后发生并发症和死亡的例数,并与实际发生并发症和死亡的例数进行比较。结果经改良POSSUM评分系统预测术后发生并发症的例数为29例,实际发生并发症的例数为32例,差异无统计学意义（P＞0.05）;预测术后死亡的例数为8例,实际死亡例数为2例,差异有统计学意义（P＜0.05）。结论改良POSSUM评分系统可用于预测肺癌根治术后的并发症发生情况,但是对术后死亡可能存在过度预测。     

改良整体形态与平衡评分预测脊柱畸形术后机械并发症的临床研究

目的探讨改良整体形态与平衡评分 (modified global alignment and proportion,M-GAP) 预测成人脊柱畸形 (adult spinal deformity,ASD) 长节段矫形固定术后机械并发症的可行性。方法回顾性分析 2016 年 1 月至 2018 年 1 月接受长节段 (≥ 4 个节段) 固定融合手术、随访时间≥ 3 年的 150 例 ASD 患者临床资料,其中男 49 例,女 101 例;年龄 61～84 岁,平均 (68.1±6.2) 岁。在术后全脊柱正侧位 X 线片上测量所有患者的骨盆入射角 (pelvic incidence,PI)、骶骨倾斜角 (sacral slope,SS)、腰椎前凸角 (lumbar lordosis,LL)、躯干整体倾斜角 (global tilt,GT) 及矢状面平衡 (sagittal vertical axis,SVA)。根据 PI 值计算出理想矢状面参数。M-GAP 评分包括相对骨盆倾斜 (relative pelvic version,RPV)=实际测量 SS-理想 SS,相对腰椎前凸(relative lumbar lordosis,RLL)=实际测量 LL-理想 LL,腰椎前凸分布指数 (lordosis distribution index,LDI)=下腰椎前凸 (lower lumbar lordosis,LLL) / LL,相对脊柱骨盆平衡 (relative spinopelvic alignment,RSA)=实际测量 GT-理想 GT。将其分为"协调""中等不协调""严重不协调"三组。机械性并发症如近端交界性后凸 / 失败 (proximal junctional kyphosis / failure,PJK / PJF)、不融合及内固定相关并发症 (螺钉松动、断裂、拔出,断棒)。对 M-GAP 生成预测机械性并发症发生应用标准受试者工作特征 (receiver operating characteristic,ROC)曲线的曲线下面积 (the area under the ROC curve,AUC) 值判断 M-GAP 的预测准确性。M-GAP 评分的三种评估结果间机械性并发症发生率比较采用 Pearson χ~2 检验,并采用线性趋势检验评估评分结果与力学并发症发生率是否存在线性趋势。结果在所有患者中,86 例 (57.3%) 发生了机械性并发症,5 例 (3.3%) 因机械性并发症再次行手术治疗。M-GAP 评分结果为"协调"者 45 例 (30.0%)、"中等不协调"者 69 例 (46.0%) 及"严重不协调"者 36 例 (24.0%),术后机械性并发症发生率分别为 42.2% (19 / 45)、59.4% (41 / 69) 和 72.2% (26 / 36)。ROC 曲线显示 M-GAP 对机械性并发症的预测有一定准确性 (AUC=0.627,P=0.008,95% CI0.538～0.716)。M-GAP 评分不同组间术后机械性并发症发生率差异有统计学意义 (χ~2=7.586,P=0.023),并存在线性上升趋势 (χ~2=7.463,P=0.006)。结论 M-GAP 评分是一种预测 ASD 长节段矫形固定术后机械性并发症的新方法。根据 M-GAP 评分制订个性化的术前计划可以降低术后机械性并发症的发生率。     

Tokuhashi外科评分Tokuhashi外科修正评分和Tomita外科评分预测硬膜外脊柱转移瘤患者预后的临床价值

目的 评价Tokuhashi外科评分、Tokuhashi外科修正评分和Tomita外科评分对脊柱转移瘤患者治疗选择与预后预测的临床价值.方法 回顾性分析104例经病理学确诊并获得随访的硬膜外脊柱转移瘤手术患者的临床和随访资料.绘制Tokuhashi外科评分、Tokuhashi外科修正评分和Tomita外科评分在预期寿命为3个月内死亡、6个月内死亡、12个月内死亡以及24个月内死亡的受试者工作特征(ROC)曲线,计算曲线下面积(AUC),比较它们预测患者生存时间的准确性.绘制Kaplan-Meier生存曲线,计算3种评分系统中各得分段患者的术后中位生存时间,并与预计生存时间进行比较.对3种评分系统的结果与患者的生存时间进行Spearman相关分析.结果 全组患者的中位生存时间为8.0个月.ROC曲线分析结果显示,Tokuhashi外科评分、Tokuhashi外科修正评分和Tomita外科评分的准确性差异无统计学意义(P＞0.05).在各时间段内,Tokuhashi外科评分的AUG值均较小,诊断准确性低.Tokuhashi外科修正评分在12个月内死亡和24个月内死亡组的AUG值均＞0.7,诊断准确性较高.Tomita外科评分在6个月内死亡和24个月内死亡组的AUC值较大,诊断准确率较高.Kaplan-Meier生存分析结果显示,3种评分系统中各得分段患者的术后中位生存时间与预计生存时间并不完全相符.Tokuhashi外科评分和Tokuhashi外科修正评分的结果与患者的生存时间呈正相关(γ=0.414,P=0.0001和γ=0.426,P=0.0001),而Tomita外科评分的结果与患者的生存时间呈负相关(γ=-0.521,P=0.001).结论 3种评分系统的结果与硬膜外脊柱转移瘤患者的预后密切相关.如将Tokuhashi外科修正评分和Tomita外科评分结合使用,可能可以更好地预测硬膜外脊柱转移瘤患者术后生存情况,并用来指导手术的选择.     

食管癌患者术前营养不足和营养风险发生率及临床营养支持现状调查

目的:调查可手术食管癌患者术前营养不足和营养风险发生率以及临床营养支持治疗的应用状况。方法:采用营养风险筛查2002(NRS2002)对住院手术治疗的202例食管癌患者进行营养风险调查,结合体质指数(body mass in-dex,BMI)判断营养风险和营养不足发生率;同时调查患者住院期间营养支持治疗的应用状况。结果:所有患者中,BMI<18.5kg/m2者54例,营养不足发生率为26.7%(54/202);NRS2002评分≥3分者116例,营养风险发生率为57.4%(116/202);年龄是否>65岁(χ2值分别为6.233、4.730)、术后分期(χ2值分别为7.214、7.191)、梗阻程度(χ2值分别为41.507、51.447)、文化程度(χ2值分别为5.158、10.260)是发生营养不良和营养风险的影响因素,P<0.05。城乡差异和工作性质只与营养不足发生率有关,χ2值分别为6.537、9.197,P值分别为0.011、0.010;而与营养风险发生率无关,χ2值分别为0.300、3.668,P值分别为0.584、0.160;营养不足和营养风险与食管癌发生的部位无关,χ2值分别为2.859、4.551,P值分别为0.239、0.103。经Logistic回归分析后发现,术后分期、梗阻程度和文化程度是营养不足和营养风险发生的影响因素。全部患者中,应用了营养支持治疗者137例(72.3%),其中采用肠内营养支持治疗(enteral nutrition,EN)者48例(35.0%),肠外营养支持治疗(parenteral nutrition,PN)者89例(65.0%),EN/PN为1/1.85;EN在术后28～72h,平均为术后56h;在NRS2002评分≥3分的116例患者中,给予营养支持治疗98例(84.5%),而在NRS2002评分<3分的86例患者中,也有39例(45.3%)给予了营养支持治疗。结论:食管癌手术患者营养不足和营养风险发生率较高,营养支持治疗在临床应用中还存在一定的不合理性。     

预后营养指数在食管癌放射治疗患者预后中的意义及预测模型

探讨预后营养指数(PNI)在食管癌放射治疗(简称放疗)患者预后中的意义,并构建相关列线图风险模型。 方法 选取 2018 年 3 月至 2019 年 10 月于阜阳市肿瘤医院行放疗的食管癌患者作为研究对象,根据首次放疗前 1 周内实验室 检查数据计算 PNI。 采用受试者操作特征曲线计算 PNI 的最佳截断值,并据此将患者分为低 PNI 组与高 PNI 组。 比较两组临 床特征。 采用单因素和 Cox 回归多因素分析食管癌放疗患者预后的影响因素,并据此建立列线图预测模型。 结果 PNI 最佳 截断值为 48. 03,低 PNI 组与高 PNI 组的年龄、TNM 分期和肿瘤直径资料间差异有统计学意义(P<0. 05)。 TNM 分期高、肿瘤 直径≥3 cm、处方剂量<60 Gy、和 PNI<48. 03 是食管癌放疗患者死亡的独立危险因素(P<0. 05)。 据此建立预测食管癌放疗患 者死亡的列线图风险模型,模型验证结果显示 C-index 为 0. 846,校正曲线趋近于理想曲线,ROC 曲线的 AUC 为 0. 881 (95%CI = 0. 847~ 0. 912),表明模型具有良好的预测能力。 结论 PNI 对食管癌放疗患者的预后具有较高的预测价值,基于 PNI 构建的列线图模型能够有效预测食管癌放疗患者死亡的风险。     

不同分期系统对晚期肝癌预后预测价值的分析

目的:评价不同分期系统对晚期肝癌预后的预测价值,为晚期肝癌临床预后分组标准的建立提供一定的理论依据.方法:使用1989年Child-Pugh评分、2002年TNM分期和进展期肝癌预后系统(ALCPS)在诊断时对169例进展期肝癌患者进行评分,并随访.通过Kaplan-Meier、接受者工作特征曲线(ROC)及Logistic等方法评价不同评分系统对3个月生存率及总生存的预测价值.结果:Kaplan-Meier曲线提示ALCPS各曲线无效,有良好区分价值.Logistic回归及ROC曲线发现,ALCPS对于不经任何抗肿瘤治疗的晚期肝癌患者3个月生存率的预测价值最大,曲线下面积高达0.85,以14分左右预测切点,具有81.82％ (72/88)的敏感性及79.01％ (64/81)的特异性,P=0.000 1.结论:ALCPS是预测晚期肝癌3个月生存率的良好评分系统,可为晚期肝癌临床预后分组提供参考.     

刺激性甲状腺球蛋白预测分化型甲状腺癌术后转移复发的临床价值

目的 探究刺激性甲状腺球蛋白(ps-Tg)对分化型甲状腺癌(DTC)术后转移复发的预测价值.方法 对80例DTC患者进行血清ps-Tg检测,按随访期内复发转移情况将患者分为有复发转移组48例和无复发转移组32例,采用Logistic回归模型分析DTC术后转移复发的影响因素,并采用受试者工作特征(ROC)曲线分析ps-Tg对DTC术后转移复发的预测价值.结果 有复发转移组与无复发转移组患者TNM分期、病灶数量及ps-Tg水平比较,差异均有统计学意义(P﹤0.01).Logistic回归分析结果显示,TNM分期(OR=1.165)、病灶数量(OR=1.458)、ps-Tg(OR=1.868)均为DTC患者术后复发转移的独立影响因素(P﹤0.05).ROC曲线分析显示,ps-Tg预测DTC患者术后复发转移的ROC曲线的曲线下面积为0.913,95％CI:0.829～0.965,标准误为0.031,约登指数最大为0.781,最佳截断值为148.31 ng/ml,对应的灵敏度为81.25％,特异度为96.87％.结论 ps-Tg是DTC患者术后转移复发的独立预测因子,以148.31 ng/ml作为界值对DTC患者术后转移复发具有较高预测价值.     

Trends in zygomycosis in children

Zygomycosis, or mucormycosis, is associated with significant morbidity and mortality in both children and adults. Studies in adults have shown an increase in the incidence of zygomycosis, particularly among haemtopoietic stem cell transplant (HSCT) recipients and patients with haematologic malignancies. There is a paucity of data on the epidemiology of zygomycosis in children. We performed a retrospective analysis to describe trends in zygomycosis between 1 January 2003 and 31 December 2010. We used the Pediatric Health Information System (PHIS) database to identify paediatric patients who were diagnosed with zygomycosis during the study period. Administrative data on diagnoses, demographics, underlying conditions and clinical experiences were collected. Summary statistics were calculated and tests for trend were conducted. We identified 156 unique patients with zygomycosis. The prevalence of zygomycosis did not significantly increase over time (P=0.284). The most common underlying condition was malignancy (58%) and over half received intensive care. Voriconazole utilisation among all hospitalised children significantly increased during the period (P=0.010). Our study demonstrates that the incidence of zygomycosis is not significantly increasing. During the time period there was a significant increase in the use of voriconazole among children.     

Dermatomycosis in Goats in India

Summary: In an extensive survey involving 2176 goats 1.56% of goats manifested clinical lesions of ringworm infection. Animals below the age of 6 months were affected most (4.20%). The incidence of infection was higher during the winter months. T. verrucosum, T. mentagrophytes and M. gypseum were isolated from the skin scrapings of 12, 4, and 2 goats respectively. It is suggested that the infected animals could be a source of disease to human population in which the zoophilic dermatophyte invasion is characterized by severe inflammatory lesions of the skin. The zoonotic importance of different dermatophytes is stressed.
Zusammenfassung: In einer ausgedehnten Untersuchung an 2176 Ziegen wurden bei 1,56% klinische Zeichen einer Hautmykose festgestellt. Tiere, die jühger als 6 Monate alt waren, zeigten mit 4,20% am häfigsten Krankheitssymptome. In den Wintermonaten war die Erkrankungshäufigkeit am gröBten. T. vermcosum, T. mentagrophytes and M. gypseum wurden jeweils von 12,4 bzw. 2 Ziegen isoliert. Die inflzierten Tiere köinnen eine Infektionsquelle für die menschliche Bevölkerung darstellen und dort Mykosen mit stark entzündlichen Veränderungen auslösen. Die Bedeutung verschiedener Dermatophyten als Erreger von Zoonosen wird hervorgehoben.     

Increased apoptosis in cancer cells in vitro and in vivo by ceramides in transferrin-modified liposomes

Lysosomes are a promising therapeutic target for induction apoptosis in cancer cells due to lysosomal membrane permeabilization (LMP) leading to leakage of hydrolytic enzymes, especially the cathepsins, into the cytoplasm. We hypothesized that with the modification of the ceramide-loaded liposomes with transferrin (Tf), we would achieve both tumor targeting and increased delivery of lysosome-destabilizing agents, such as ceramides to lysosomes, to initiate LMP-induced apoptosis. We prepared Tf-modified (TL) and plain (PL) liposomes and loaded with short (C6)- or long (C16) N-acyl chain ceramides. Uptake, intracellular localization of liposomes, stability of the lysosomal membrane and release of cathepsin D were investigated on Hela cells by fluorescence microscopy and flow cytometry. Apoptosis was evaluated by binding of fluorescently-labeled Annexin V. Antitumor and pro-apoptotic effects of C6Cer-loaded Tf-liposomes were demonstrated in vivo in an A2780-ovarian carcinoma xenograft mouse model. TL were internalized specifically via the TfR-dependent endocytic pathway and localized within the endosome-lysosomal compartment. Ceramide-loaded Tf-liposomes significantly increased apoptosis compared with ceramide-free and ceramide-loaded non-modified liposomes. The treatment of cancer cells with TL led to increased LMP and cytoplasmic relocation of the intralysosomal cathepsin D. A strong antitumor and pro-apoptotic effect of C6Cer-loaded TL was also demonstrated in vivo in an A2780-ovarian carcinoma xenograft mouse model. The lysosomal accumulation of ceramides delivered by Tf-liposomes initiates the permeabilization of the lysosomal membranes required for the release of lysosomal cathepsins into the cytoplasm and initiation of the cancer cell apoptosis both in vitro and in vivo.     

Ringworm in animals in a farm in Assiut

Bericht über das Auftreten von Hautmykosen bei Tieren auf der Farm der Landwirtschaftlichen Fakultät der Universität Assiut. Von 70 Kälbern waren 42 pilzkrank, davon 22 durch T. mentagrophytes, 20 durch T. verrucosum. Von 180 Kühen waren 8 pilzbefalien, sämtlich durch T. mentagrophytes. Von 2 kranken Bullen wurde T. verrucosum isoliert. Auch die 3 Pferde und 2 Maultiere der Farm waren pilzinfiziert; Erreger war in diesen Fällen T. equinum. Auch ein Kalb war von T. equinum befallen. Die gleiche Pilzart wurde ferner von 3 Tierpflegern isoliert, die Pilzherde am Hals und an den Armen aufwiesen.     

Advances in cancer epidemiology in Japan

Epidemiologists in Japan have been performing calculations to estimate nationwide cancer incidence rates as well as 5‐year survival rates using population‐based cancer registry data. There have been remarkable changes in cancer incidence and/or mortality in cancers of the lung, liver and stomach, which were thought to be attributed to the changing impact of exposure to cigarette smoking, chronic hepatitis C virus infection and Helicobacter pylori infection, respectively. In systematic reviews providing evidence in risk/protective factors for cancer sites using case–control and cohort studies of the Japanese population, there were associations between cancer sites (esophagus, stomach, colo‐rectum, liver, pancreas, lung and breast) and various lifestyle factors. In the past 10 years, a hospital‐based case–control study at Aichi Cancer Center provided valuable evidence of gene‐environment interaction on the development of cancer [i.e., the effects of aldehyde dehydrogenase‐2 (ALDH2) polymorphism and heavy alcohol drinking on esophageal cancer, ALDH2 polymorphism and smoking on lung cancer, methylenetetrahydrofolate reductase polymorphism and heavy alcohol drinking on pancreatic cancer]. The database with stored DNA was also used and identified seven loci containing significant but low‐penetrance polymorphisms associated with the development of breast cancer. These findings together with established risk factors are likely to be useful to predict personalized breast cancer risk in East Asian women. In 2005, the Japan Multi‐Institution Collaborative Cohort (J‐MICC) study was launched to elucidate gene‐environment interactions as well as to confirm preclinical diagnostic biomarkers of cancer. J‐MICC, which has recruited 92,000 healthy individuals by the end of 2012, will follow the individuals until 2025.     

Survey of changes in dietary preferences in cancer patients in China

Objective The aim of this study was to investigate the changes in dietary preferences in cancer patients in China and to determine the need for encouraging the adherence to a sensible diet among such patients.Methods A total of 468 cancer patients were interviewed using a self-designed questionnaire focusing on changes in the intake of specific foods. Data were analyzed using SPSS 16.0. Results Most patients completely avoided roosters and carp(73.1%), condiments(51.9%), and meat of aquatic species(40.4%). All other types of the specific foods were completely avoided by different subpopulations of the patients.Conclusion In addition to focusing on disease treatment, medical professionals need to help cancer patients overcome barriers associated with the customs of avoiding specific foods encompassed by the term ”fawu” and provide them with dietary guidance in order to prevent negative nutritional effects.     

Socioeconomic factors in cancer in Sweden

It is well known that certain cancers have shown clustering in socioeconomic groups, but limited data are available on recent results and time trends in such clustering. We determined standardized incidence ratios (SIR) for cancer, adjusted for age, period, region, parity and age at first childbirth among men and women in 6 socioeconomic groups based on the Swedish Family-Cancer Database. Persons had to be identified with the same socioeconomic status in the census of years 1960 and 1970, or of years 1960, 1970 and 1980; the comparison group was all people according to the same censuses. Cancers were followed from years 1970 to 1998 or from 1980 to 1998. Both increased and decreased SIRs were found, and a consistent pattern emerged, although the overall SIRs for cancer did not differ much, the lowest being for farmers (0.85) and the highest for professional men (1.07) and women (1.11). At individual sites, manual workers were at risk of tobacco-, alcohol- and occupation- and human papilloma virus-related cancers and at a decreased risk at most other cancers. Manual workers and farmers showed an excess of stomach cancer; professionals had an excess of melanoma and squamous cell skin cancer. Male and female SIRs correlated highly for manual and blue-collar workers and for professionals. The overall population-attributable fraction for selected sites was 16.7% for men and 10.9% for women and it was highest, over 50%, for lung cancer in both genders.     

Statistical challenges in preprocessing in microarray experiments in cancer

Many clinical studies incorporate genomic experiments to investigate the potential associations between high-dimensional molecular data and clinical outcome. A critical first step in the statistical analyses of these experiments is that the molecular data are preprocessed. This article provides an overview of preprocessing methods, including summary algorithms and quality control metrics for microarrays. Some of the ramifications and effects that preprocessing methods have on the statistical results are illustrated. The discussions are centered around a microarray experiment based on lung cancer tumor samples with survival as the clinical outcome of interest. The procedures that are presented focus on the array platform used in this study. However, many of these issues are more general and are applicable to other instruments for genome-wide investigation. The discussions here will provide insight into the statistical challenges in preprocessing microarrays used in clinical studies of cancer. These challenges should not be viewed as inconsequential nuisances but rather as important issues that need to be addressed so that informed conclusions can be drawn.     

整合素在急性白血病中的研究进展

急性白血病是一种早期造血干/祖细咆的恶性克隆性疾病.微小残留病和耐药被认为是其复发和难治的根源.近来,越来越多的证据显示白血病细胞通过与骨髓微环境中的基质细胞或细胞外基质相互作用促进其存活,并增强其对常规化疗药物的耐药.整合素是介导细胞与细胞外基质（细胞与非细胞成分）粘连的最主要黏附分子,在细胞增殖、存活等生物学过程中发挥关键作用,但作用机制尚不完全清楚.现就目前揭示的整合素及肿瘤微环境在急性白血病发生、发展中的作用进行综述.