老年急性肺血栓栓塞症患者627例长期预后及影响因素分析

目的 探讨老年肺血栓栓塞症（PTE）患者的临床特点、预后及影响生存的因素。方法 入选2006年1月1日至2011年3月31日期间在首都医科大学附属北京朝阳医院确诊为急性PTE的患者627例。按年龄分为两组：≥65岁组（n＝309）和＜65岁组（n＝318）。比较两组患者的临床资料,分析对预后及生存的影响因素。结果 两组间静脉血栓栓塞症（VTE）复发率比较,差异无统计学意义（P＝0.157）;≥ 65岁患者组全因死亡率明显高于＜65岁患者组（P＜0.001）。分析具体死亡原因后发现,≥65岁组中死于其他明确原因（包括重症感染、呼吸衰竭、肾脏衰竭、多脏器功能衰竭等）的患者比例明显高于＜65岁组（P＝0.006）。行Cox单因素分析,显示年龄、体质量指数（BMI）、合并恶性肿瘤、肺动脉收缩压（SPAP）＞50mmHg、PTE继发于2个月内的手术、较长的抗凝疗程与发生死亡相关。行Cox多因素分析,结果提示只有年龄、合并恶性肿瘤、SPAP＞50mmHg、PTE继发于2个月内的手术及较长的抗凝疗程是发生死亡的高危因素。结论 老年PTE患者由于合并慢性基础疾病而导致长期预后不佳,应引起临床医师的重视,在规范化诊治PTE之外,应重视合并症的正规治疗。     

健康老年人群血浆可溶性血栓调节蛋白和肾小球滤过率的关系

目的：探讨老年人群血浆可溶性血栓调节蛋白（sTM）与估算的肾小球滤过率（eGFR）的相关性。方法采用整群随机抽样的方法对北京市9个社区283名≥65岁健康老年人进行研究,酶联免疫吸附法测定血浆可溶性血栓调节蛋白水平,应用CKD-EPI公式评估eGFR,同时行人体学测量及血清生化指标测定,并做相关和回归分析。结果北京社区健康老年人群eGFR水平与sTM、年龄、尿素氮、肌酐、C反应蛋白（CRP）及收缩压呈负相关,与白蛋白、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平呈正相关;在校正了年龄、血压、血糖（GLU）、CRP、血脂、尿酸（UA）等指标后,健康老年人血浆sTM仍然和eGFR呈负相关（B＝-3.340,P＝0.000）。在进一步的研究中,将入组的北京社区健康老年人分为老年（65～80岁）和高龄老年（＞80岁）两组;两组之间eGFR和sTM水平差异均无统计学意义（P＞0.05）,老年组和高龄老年组eGFR均与sTM水平呈负相关（r＝-0.229,P＝0.000;r＝-0.3613,P＝0.02）,校正了年龄、血压、GLU、CRP、血脂、UA等指标后差异仍有统计学意义（B＝-3.26,P＝0.000;B＝-4.45,P＝0.013）。结论 sTM可作为判断老年人群肾功能下降的指标。     

用倾向性评分匹配法分析SGLT-2和ARNI对心衰预后影响

目的 基于倾向性评分匹配法分析SGLT-2和ARNI对心衰患者的预后影响。方法 选取2018年6月至2021年12月山西医科大学第一医院诊断的心力衰竭患者369例，根据治疗方法分为达格列净组和沙库巴曲缬沙坦组，两组匹配后比较预后并分析影响因素。采用SPSS 26.0和R Studio( 4.1.2版本)进行数据分析。根据数据类型，组间比较分别采用t检验、秩和检验、χ2或Fisher精确概率法。Cox回归模型分析影响因素并绘制Kaplan-Meier曲线。结果 匹配后每组70例，Kaplan-Meier曲线示两组心衰再住院无差异（P=0.19）。Cox多因素分析显示，达格列净组NYHA分级（HR＝6.923，95%CI=1.032~46.426，P=0.046）、LVEDD（HR＝1.139，95%CI=1.004~1.293，P=0.044）、标准化Z值的NT-proBNP（HR＝1.825，95%CI=1.075~3.097，P=0.026）、饮酒（HR＝0.086，95%CI=0.018~0.413，P=0.002）和HDL-C（HR＝0.012，95%CI=0.000~0.642，P=0.029）是预后影响因素；沙库巴曲缬沙坦组吸烟（HR＝14.376，95%CI=1.657~124.748，P=0.016）、饮酒（HR＝0.082，95%CI=0.012~0.578，P=0.012）和血红蛋白（HR＝0.953，95%CI=0.912~0.995，P=0.030）是预后影响因素。结论 倾向性评分匹配后，达格列净和沙库巴曲缬沙坦对心衰预后无显著差异并得出相关影响因素。     

外周T细胞淋巴瘤患者65例预后的相关因素分析

目的 从临床角度分析外周T细胞淋巴瘤（PTCL）的相关因素对预后的影响,为临床病情监测及预后评估提供参考。方法 收集2005年1月至2014年12月入住大连医科大学附属第二医院的76例PTCL患者的临床资料,其中65例资料完整,11例病例失访。采用Kaplan-Meier法进行生存分析。对年龄、性别、临床分期、淋巴瘤国际预后指数（IPI）、B症状、血红蛋白（Hb）、血清β2微球蛋白（β2-MG）、乳酸脱氢酶（LDH）、血清白蛋白（ALB）水平,以及治疗方法、病理分型、首发部位、预后指数PIT、骨髓是否受侵等因素进行单因素分析,并进一步采用Cox回归风险模型对单因素分析中有统计学意义的参数进行多因素分析。结果 65例PTCL病例中包括非特异型（PTCL-U）25例,结外自然杀伤细胞（NK）/鼻型T细胞淋巴瘤（TCL）10例,血管免疫母细胞性T细胞淋巴瘤（AITL）9例,间变性大细胞淋巴瘤（ALCL）9例。单因素分析表明,年龄≤60岁的患者比＞60岁的患者预后好（P＝0.008）;Ⅰ/Ⅱ期患者比Ⅲ/Ⅳ期患者的5年生存率高（74.4% vs 19.0%,P＝0.011）;IPI指数低危、中低危、中高危、高危组的5年生存率分别为85.7%、52.5%、0.0%和0.0%（P＝0.004）;初诊时LDH升高的患者预后比LDH正常或降低的患者差（P＝0.048）;初诊时ALB降低的患者比ALB正常者预后差（P＝0.008）;首发部位为结外的患者比首发部位在淋巴结的患者预后较好（P＝0.002）。将PIT指数分为0、1、2和≥3组,其5年生存率分别为92.3%、85.7%、17.4%和0.0%（P＝0.002）。多因素分析显示,PIT评分指数为PTCL的独立预后危险因素（P＝0.002）。结论 年龄、临床分期、IPI指数、LDH、ALB、病理分型、首发部位及PIT为预后影响因素,PIT为PTCL的独立预后影响因素。     

套细胞淋巴瘤18例的预后相关因素分析

目的 通过分析套细胞淋巴瘤（MCL）的临床特征,探讨影响预后的相关因素,指导临床实践。方法 收集2008年7月至2014年7月收治的18例MCL患者的临床资料,回顾性地分析性别、年龄、套细胞淋巴瘤国际预后指数（MIPI）评分、骨髓受侵情况、美国东部肿瘤协作组（ECOG）评分、B症状、Ki-67水平、乳酸脱氢酶（LDH）、白细胞（WBC）、淋巴细胞（LYM）、临床分期、首次治疗方法等各因素,采用Fisher精确检验对累积生存率进行比较,生存资料及预后分析采用乘积极限法（Kaplan-Meier法）绘制生存曲线。多因素分析采用Cox比例风险模型分析各临床要素对疾病预后的影响。结果 年龄＜65岁与≥65岁分组（P＝0.036）、MIPI评分低危、中危、高危分组（P＝0.049）、ki-67＜30%或≥30%（P＝0.001）与预后具有相关性,而性别、B症状、ECOG评分、β2微球蛋白、LDH、WBC、LYM、临床分期、首次治疗方法统计后差异无统计学意义（P＞0.05）。结论 患者的年龄＜65岁预后好。MIPI评分中、低危组预后好,高危组预后差。免疫表型中Ki-67＜30%较≥30%的患者预后好。     

血尿酸水平对老年冠心病心力衰竭患者预后的影响

目的 分析老年冠心病心力衰竭患者的血尿酸水平对其预后的影响.方法 入选2005年1月至2007年12月老年冠心病合并慢性心力衰竭患者783例.按尿酸水平的四分位间距分为低水平组(195例)、较低水平组(195例)、较高水平组(195例)和高水平组(198例),比较各水平组的病死率.按随访期是否死亡分为死亡组(199例)和生存组(584例),采用多因素Cox回归分析尿酸水平对老年冠心病合并心力衰竭患者预后的影响.结果 从低到高水平尿酸组的病死率依次为23.6％、21.0％、15.9％和43.4％,组间比较差异有统计学意义(x2=44.66,P＜0.01).死亡组患者的年龄[(73.3±8.7)岁比(70.0±9.7)岁,t=-4.24,P=0.000]、尿酸水平[(423.71±189.84) μmol/L比(353.28±122.58) μmol/L,t=-6.014,P=0.000]及合并贫血(24.1％比17.6％,x2=4.008,P=0.045)、心房颤动(31.2％比17.5％,x2=16.800,P=0.000)、肾衰竭(34.7％比22.1％,x2=12.441,P=0.000)的比例均大于生存组,而射血分数(49.43％±12.19％比56.49％±11.14％,t=5.33,P=0.000)、服用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂的比例(70.9％比78.9％,x2=5.458,P=0.019)小于生存组.高水平的尿酸(≥437.0μmol/L,HR=1.520,P=0.044)、年龄(HR=1.026,P=0.002)、纽约心脏病协会(NYHA)心功能分级Ⅲ～Ⅳ级(HR=1.300,P=0.006)及心房颤动(HR=1.547,P=0.006)是老年冠心病心力衰竭患者预后不良的独立危险因素.结论 血尿酸水平可作为老年冠心病心力衰竭患者心原性死亡的预后指标,其作用独立于影响心力衰竭患者生存的其他因素,具有一定的临床预后判断价值.     

厄洛替尼治疗老年非小细胞肺癌的疗效和安全性

目的 评价厄洛替尼在中国老年晚期非小细胞肺癌（NSCLC）患者中的安全性、疗效以及临床因素与疗效之间的关系。方法 回顾性分析2005年3月至2010年10月于北京协和医院呼吸内科服用厄洛替尼的非临床试验的43例老年NSCLC患者的临床资料,分析其生存情况及相关临床因素对生存的影响。结果 43例患者中,部分缓解（PR）12例,病情稳定（SD）17例,疾病进展（PD）14例,客观有效率（ORR）为27.9%,疾病控制率（DCR）为67.4%。影响ORR的临床因素有性别（P＝0.001）、肿瘤分化程度（P＝0.022）和吸烟史（P＝0.001）;影响DCR的因素有性别（P＝0.031）、美国东部肿瘤协作组（ECOG）评分（P＝0.004）、肿瘤分化程度（P＝0.018）、吸烟史（P＝0.005）和服药后皮疹（P＜0.001）。服药后中位无进展生存期（PFS）为27周（95%CI：8.32～45.7周）,服药后总生存期（OS）为46周（95%CI：26.7～65.3周）。对PFS有显著影响的临床因素包括病理类型（P＝0.024）、肿瘤分化程度（P＝0.036）、ECOG评分（P＝0.001）、服药后皮疹（P＝0.006）;而病理类型（P＝0.040）、肿瘤分化程度（P＝0.023）、ECOG评分（P＜0.001）、使用厄洛替尼后续治疗（P＝0.028）对OS有显著影响。EGFR19/21外因子突变阳性的患者ORR（P＝0.004）和DCR（P＝0.033）均显著高于阴性组,中位PFS也显著高于阴性组（46.1 vs 12.8周,P＝0.004）。常见副反应为皮疹（51.2%）和腹泻（23.2%）。结论 使用厄洛替尼治疗我国老年晚期NSCLC患者的疗效和安全性均较好,体能状态良好的患者尽早使用厄洛替尼可能获得更好的疗效。     

老年2型糖尿病患者非甲状腺疾病综合征血清学特征及与慢性肾脏病的关系

目的 通过分析住院老年2型糖尿病（T2DM）患者非甲状腺疾病综合征（NTIS）与慢性肾脏病（CKD）的相关性,探讨NTIS在防治老年T2DM中的价值。方法 根据甲状腺功能测定,将2012年10月至2014年9月在我院住院的126例老年T2DM患者分为NTIS组30例及非NTIS（NNTIS）组96例,检测并比较其血肌酐（SCr）、尿白蛋白排泄率（ACR）等临床指标。根据估算的肾小球滤过率（eGFR）及ACR诊断CKD,eGFR＜60ml/（min·1.73m2）被定义为肾功能不全。结果 （1）126例患者中NTIS的发生率为23.81%（30/126）。（2）126例患者肾功能不全的患病率为57.94%（73/126）。NTIS组患者[76.67%（23/30）]肾功不全的患病率较NNTIS组患者[52.08%（50/96）]高（P＝0.017）。（3）NIST组患者较NNITS组患者年龄较高（P＜0.001）,TT3（P＝0.001）、TT4（P＝0.005）、FT3（P＜0.001）、FT4（P＝0.036）、TSH（P＝0.012）、ALB（P＜0.001）、TC（P＝0.027）、TG（P＝0.034）、LDL（P＝0.032）、eGFR（P＝0.004）及Ca（P＜0.001）水平较低。（4）Spearman单因素相关分析显示,NTIS与ACR（P＝0.011）、年龄（P＜0.001）、肾功能不全（P＝0.001）正相关,与ALB（P＜0.001）、Ca（P＜0.001）负相关。（5）多因素logistic回归分析发现ALB（OR＝0.246,P＝0.006）及肾功能不全（OR＝5.346,P＝0.004）是影响NTIS发生的独立因素。结论 住院老年T2DM患者NTIS可能提示其CKD已达到3期以上,并可能是病情严重及预后不良的预测因子。     

糖尿病对维持性血液透析患者生存率的影响及其危险因素分析的回顾性队列研究

目的 探讨糖尿病作为原发病和伴发病对维持性血液透析患者预后的影响并分析全因死亡的危险因素。方法选取2010年1月1日至2016年12月31日于大连市中心医院接受维持性血液透析的602例患者进行回顾性研究,随访至2021年12月31日。根据疾病状况分为原发性糖尿病肾病（DKD）组（257例）,糖尿病作为伴发疾病（DCM）组（61例）及无糖尿病（NDM）组（284例）。按年龄≤60岁（324例）及>60岁（278例）进行亚组分析。采用Kaplan-Meier生存曲线分析3组患者的生存率差异,单因素及多因素Cox回归分析探讨全因死亡的危险因素。结果 所有患者随访中位时间62个月,全因死亡共329例。三组患者第2～5年的生存率差异有统计学意义（P<0.05）。生存分析结果显示,NDM组患者生存率高于其他2组,差异有统计学意义（P<0.05）,DKD组和DCM组患者生存率差异无统计学意义（P=0.162）。多因素Cox回归结果显示,开始透析时年龄（HR 1.01,95%CI 1.01～1.02,P=0.002）、脑卒中（HR 1.44,95%CI 1.08～1.92,P=0.0...     

离休干部237例体质量指数与全因死亡的分析研究

目的 分析第二军医大学离休干部体质量指数（BMI）与全因死亡的关系。方法 收集2000年1月至2013年10月于长海医院老年病科住院的我校离休干部共237例的临床资料,并进行随访,随访截止时间为2014年10月31日。根据BMI分为4组：低体质量组,BMI＜20kg/m2;理想体质量组,BMI 20～24.9 kg/m2;超重组,BMI 25～27.9 kg/m2;肥胖组,BMI≥28kg/m2。采用Cox回归方法分析各组的全因死亡风险。结果 中位随访时间59个月,均无失访,随访结束时发生全因死亡115例。Cox回归分析不同BMI分组的全因死亡风险,校正混杂因素后,相对于低体质量组,理想体质量组、超重组和肥胖组的全因死亡风险分别下降53.6%（HR＝0.464,95%CI：0.239～0.901,P＜0.05）、65.2%（HR＝0.348,95%CI：0.162～0.749,P＜0.05）、74.2%（HR＝0.258,95%CI：0.103～0.644,P＜0.05)。结论 随着BMI增加,离休干部全因死亡风险呈下降趋势。     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.     

Secondary aortoduodenal fistula

Aorto-duodenal fistulae （ADF） are the most frequent aorto-enteric fistulae （80%）, presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication （0.3%-2%） of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.     

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV‐positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. Results We recruited 148 spouses of smear‐positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear‐positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15–5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV‐positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV‐positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV‐positive community controls. Of 54 HIV‐positive spouses, 18 completed 6‐month IPT. At 2 year follow‐up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34–3.29). Conclusions Spouses are a high‐risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short‐duration therapy.     

Dénervation rénale pour HTA réfractaire sans anesthésie générale : intérêt d’un protocole MEOPA Morphine. Expérience préliminaire

Renal denervation using the technique of radiofrequency is used only recently for the treatment of resistant hypertension. Normally, it is done under general anesthesia because the ablation point technique is painful. We suggest an alternative to general anesthesia comprising an association of morphin 0.1 mg/kg IV to MEOPA (gas combining oxygen and azot protoxyd) delivered through an oxygen mask. Our series includes 12 consecutive patients treated between October 2011 and June 2013, the first five patients (group 1) have received only an hydroxizin and morphin sedation. Every five have felt the ablation painful, in two cases bearable pain (EVA < 5), in three cases intense (EVA > 5) pain leading to increasing doses of morphin, (total dose of 0.25 mg/kg in two cases, 0.17 mg in one case). For the seven following patients, a protocol including hydroxyzin, morphin and MEOPA given through a mask has been set up. Only one patient has felt a mild pain (EVA 5) leading to an increasing dose of morphin (total dose 0.17 mg/kg). None of the six other patients has felt any pain during the procedure. The average dose of morphin is 0.17 mg/kg in group 1, 0.11 mg/kg in group 2. This is a preliminary study; if confirmed, it will allow a lot of hospitals without on-site possibilities of general anesthesia, to realize such procedures. Conclusion: regarding pain, the procedure of renal ablation was well tolerated for six among seven patients receiving the association MEOPA and IV morphin. In contrast, in the five patients treated only with IV morphin, we observed a less good tolerance to pain and the need to increase the doses of IV morphin.     

Scale‐up of TB and HIV programme collaborative activities in Zambia – a 10‐year review

Objective To review the activities, progress, achievements and challenges of the Zambia Ministry of Health tuberculosis (TB)/HIV collaborative activities over the past decade. Methods Analysis of Zambia Ministry of Health National TB and HIV programme documents and external independent programme review reports pertaining to 2000–2010. Results The number of people testing for HIV increased from 37 557 persons in 2003 to 1 327 995 persons in 2010 nationally. Those receiving anti‐retroviral therapy (ART) increased from 143 in 2003 to 344 304 in 2010. The national HIV prevalence estimates declined from 14.3% in 2001 to 13.5% in 2009. The proportion of TB patients being tested for HIV increased from 22.6% in 2006 to 84% in 2010 and approximately 70% were HIV positive. The proportion of the HIV‐infected TB patients who: (i) started on ART increased from 38% in 2006 to 50% in 2010; (ii) commenced co‐trimoxazole preventive therapy (CPT) increased from 31% in 2006 to 70% in 2010; and (iii) were successfully treated increased to an average of 80% resulting in decline of deaths from 13% in 2006 to 9% in 2010. Conclusions The scale‐up of TB/HIV collaborative programme activities in Zambia has steadily increased over the past decade resulting in increased testing for TB and HIV, and anti‐retroviral (ARV) rollout with improved treatment outcomes among TB patients co‐infected with HIV. Getting service delivery points to adhere to WHO guidelines for collaborative TB/HIV activities remains problematic, especially those meant to reduce the burden of TB in people living with HIV/AIDS (PLWHA).     

C-MET在非小细胞肺癌对表皮生长因子受体酪氨酸激酶抑制剂耐药中的作用研究进展

以表皮生长因子受体(EGFR)为靶点的酪氨酸酶抑制剂(TKI)是近年来非小细胞肺癌(NSCLC)治疗的重大突破.但是随着临床的广泛应用,耐药成为新的难点.新近研究已发现对EGFRTKI的耐药产生主要涉及原癌基因C-MET的扩增突变.C-MET是原癌基因,是蛋白产物肝细胞生长因子/离散离子(HGF/SF)的受体,具有酪氨酸酶活性,C-MET基因扩增激活ErbB3-PI3K信号途径导致NSCLC对EGFR-TKI产生耐药,大量研究证实NSCLC患者对EGFR-TKI耐药约20％归因于C-MET基因扩增.     

Artificial intelligence in pancreaticobiliary endoscopy

Artificial intelligence (AI) applications in health care have exponentially increased in recent years, and a few of these are related to pancreatobiliary disorders. AI‐based methods were applied to extract information, in prognostication, to guide clinical treatment decisions and in pancreatobiliary endoscopy to characterize lesions. AI applications in endoscopy are expected to reduce inter‐operator variability, improve the accuracy of diagnosis, and assist in therapeutic decision‐making in real time. AI‐based literature must however be interpreted with caution given the limited external validation. A multidisciplinary approach combining clinical and imaging or endoscopy data will better utilize AI‐based technologies to further improve patient care.