大范围食管早期癌及癌前病变内镜黏膜下剥离术后发生顽固性狭窄的危险因素分析

目的 探讨大范围早期食管癌及其癌前病变内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）术后发生食管顽固性狭窄的危险因素。方法 2013年7月—2017年12月,在中国医学科学院肿瘤医院内镜科行内镜黏膜下剥离术治疗,病变范围≥3/4食管环周的186例患者（共212处食管早期癌或癌前病变）纳入回顾性分析,根据术后内镜下食管球囊扩张次数分为顽固性狭窄组（69例,扩张≥6次）和非顽固性狭窄组（117例,扩张0～5次）。单因素分析使用t检验或Mann-Whitney U检验、χ2检验或Fisher精确概率法,多因素分析使用Logistic回归。结果 与非顽固性狭窄组比较,顽固性狭窄组在病变纵径、人工溃疡（ESD术后创面）纵径以及病变位置、病变环周范围和固有肌层损伤构成方面差异均有统计学意义（P均＜0.05）。剔除人工溃疡纵径这一因素后（因人工溃疡纵径与病变纵径在临床上存在明显相关性）,多因素Logistic回归分析结果显示,病变纵径＞5 cm（P=0.003,OR=3.531,95%CI：1.547～8.060）、病变位于胸上段（与胸下段比较：P=0.001,OR=36.720,95%CI：4.233～318.551）、颈段（与胸下段比较：P=0.003,OR=24.959,95%CI：2.927～212.795）、全周病变（P＜0.001,OR=10.082,95%CI：4.196～24.226）和存在术中固有肌层损伤（P＜0.001,OR=7.128,95%CI：2.748～18.486）的早期食管癌及其癌前病变行ESD术后易发生食管顽固性狭窄。结论 对于大范围（病变范围≥3/4食管环周）早期食管癌及其癌前病变,病变纵径＞5 cm,病变位于胸上段、颈段,全周病变,以及存在术中固有肌层损伤均是ESD术后发生食管顽固性狭窄的独立危险因素。     

Advances in neuroimaging for HIV-1 associated neurological dysfunction: clues to the diagnosis, pathogenesis and therapeutic monitoring

Persons with advanced human immunodeficiency virus type one (HIV-1) infection seek medical advice for a wide range of neurological disorders including, but not limited to, peripheral neuropathy, toxoplasmosis, cryptococcal meningitis, cytomegalovirus retinitis progressive multifocal leukoencephalopathy, lymphoma and dementia. The diagnosis of HIV-1-associated dementia (HAD) induced as a direct consequence of HIV infection of the brain comes commonly by exclusion. Diagnostic decisions can often be clouded by concomitant depression, motor impairments, and lethargy that follow debilitating immune suppression and weight loss. Indeed, cognitive, motor and behavior abnormalities underlie a variety of neurological dysfunctions associated with advanced HIV-1 infection. Thus, even combinations of clinical, laboratory and neuroimaging tests [for example, magnetic resonance imaging (MRI), computed tomography (CT), single photon emission computed tomography (SPECT) and positron emission tomography (PET)] often fail to provide conclusive diagnostic information. Nonetheless, the recent development of quantitative MR spectroscopic imaging has improved diagnostic possibilities for HAD. We are pleased to discuss these developments as well as taking a forward look into what will soon be made available to improve neuroimaging diagnostic precision. New MR and SPECT testing are being developed in our laboratories and elsewhere both for animal model systems and in humans with HIV-1 disease. Such tests can facilitate dynamic measures of HIV-1 neuropathogenesis providing information for disease events that even 2 years ago were unattainable.     

DNA hypermethylation of SFRP2 influences the pathology of rheumatoid arthritis through the canonical Wnt signaling in model rats

Abstract

In this work, the expression of secreted frizzled related protein 2 (SFRP2) in rheumatoid arthritis (RA) model rats and the mechanisms of SFRP2 on the RA pathogenesis were investigated. Data suggested that SFRP2 was significantly down-regulated in RA model rats compared with normal control, and overexpression of SFRP2 suppressed the RA pathogenesis and the canonical Wnt signaling in fibroblast-like synovial cells (FLS) from RA model rats, whereas knockdown of SFRP2 got an opposite observation. Interestingly, 5-azadC treatment up-regulated the SFRP2 expression, inhibited the FLS proliferation, suppressed the expression of IL-6 and IL-8 and the fibronectin production, suggesting that the decreased SFRP2 in RA model rats was due to the DNA methylation. Furthermore, DNMT1 knockdown up-regulated the SFRP2 expression, DNMT1 overexpression inhibited the SFRP2, and the quantitative methylation-specific PCR (qMSP) confirmed that the DNMT1 has direct methylation roles for the SFRP2 promoter, leading to a regulation of FLS proliferation and fibronectin expression in RA model rats. In addition, up-regulated MeCP2 was involved in the SFRP2 regulation and the pathogenesis of RA model rats, and MeCP2 and DNMT1 have synergistic inhibition roles in the SFRP2 expression. Combination of DNMT1 and DNA methylation may be a promising treatment strategy for individuals with RA in which SFRP2 is down-regulated.     

Sleep quality and risk of cancer: findings from the English longitudinal study of aging

Study ObjectiveTo prospectively examine the association between sleep quality and incident cancer risk in the elderly.MethodsA total of 10,036 participants aged ≥50 years free of cancer at baseline from the English Longitudinal Study of Ageing at wave 4 (2008) were included, and followed up until 2016. The primary endpoint was new onset physician-diagnosed cancer. Sleep quality was assessed by four questions regarding the frequency of sleep problems and overall subjective feeling of sleep quality in the last month, with higher score denoting poorer sleep quality. The multivariable Cox regression model was used to calculate hazard ratio (HR) with 95% confidence interval (CI) for incident cancer risk according to sleep quality.ResultsAt 8-year follow-up, a total of 745 (7.4%) participants developed cancer. Compared with good sleep quality at baseline, HR (95% CI) for incident cancer risk was 1.328 (1.061, 1.662) for intermediate quality, 1.586 (1.149, 2.189) for poor quality. Similarly, compared with maintaining good sleep quality in the first 4 years, HR (95% CI) for incident cancer risk was 1.615 (1.208, 2.160) for maintaining intermediate quality and 1.608 (1.043, 2.480) for maintaining poor quality. The exclusion of participants with family history of cancer or abnormal sleep duration yielded consistent results.ConclusionsPoor sleep quality is positively associated with the long-term risk of developing cancer in an elderly cohort. Both medical staffs and the general public should pay more attention to improving sleep hygiene.     

Di-functional luminescent sensors based on Y3+ doped Eu3+ and Tb3+ coordination polymers: fast response and visible detection of Cr3+, Fe3+ ions in aqueous solutions and acetone

With the careful modulation of the relative ratio of Y³⁺/Eu³⁺and Y³⁺/Tb³⁺, two series of bimetallic RE-CPs (Eu_xY_1−x and Tb_xY_1−x) were successfully obtained through the isomorphous substitution method. Interestingly, the introduction of Y³⁺ ions does not change the fluorescence characteristic peak of 1-Eu and 1-Tb, but enhances its fluorescence lifetime and quantum yield. Experimental and theoretical simulation results show the co-doping process changes the intramolecular energy transfer process and reduces the non-radiative transition resulting from concentration quenching. Eu_0.1Y_0.9 and Tb_0.1Y_0.9 with the largest luminescence lifetime were selected as the representative research objects, their potential application for the detection of toxic metal ions and organic molecules was further investigated. Interestingly, Eu_0.1Y_0.9 and Tb_0.1Y_0.9 demonstrate high sensitivity and good selectivity towards Fe³⁺, Cr³⁺ and acetone. Besides, fine fluorescence visibility provides the necessary conditions for the preparation of simple and fast response fluorescent test papers in order to achieve real-time and convenient detection of these toxic materials.

Two series of doped coordination polymers (Eu_xY_1−x and Tb_xY_1−x) through isomorphous substitution method utilizing Y³⁺ in place of partial Eu³⁺/Tb³⁺ were obtained. The doped materials could detect Fe³⁺, Cr³⁺, and acetone selectively and sensitively.     

Temperature-dependent variations in toxicity of diamide insecticides against three lepidopteran insects

The effect of temperature on the toxicities of four diamide insecticides (chlorantraniliprole, cyantraniliprole, flubendiamide, tetraniliprole) against three lepidopteran insects (Helicoverpa armigera, Plutella xylostella, Athetis lepigone) were determined from 15 to 35 °C by exposing third-instar larvae to dip-treated cabbage leaf. The results indicated that increase in temperature led to an increase significantly and regularly in the toxicities of the four diamide insecticides against P. xylostella and H. armigera, but not for A. lepigone. The temperature coefficients (TCs) of the four diamide insecticides increased from 15 to 35 °C. Tetraniliprole for H. armigera (+825.83), chlorantraniliprole for P. xylostella (+315.65) and cyantraniliprole for H. armigera (+225.77) exhibited high positive TCs. For A. lepigone, temperature had a positively weak or no effect on the toxicities of most of the diamide insecticides from 20 to 30 °C, but a higher effect from 30 to 35 °C. In addition, the toxicities of chlorantraniliprole, cyantraniliprole and tetraniliprole all decreased from 15 to 20 °C. This study can guide pest managers in choosing suitable ambient field temperature when spraying diamide insecticides against lepidopteran insects.     

Intranasal delivery of rapid-onset antidepressants: a new trend of treating major depressive disorder

Existing antidepressants seem to have an onset time of several weeks. However, newly found depression-related receptors and pathways may enlighten us to find more rapid-onset antidepressants, in which ketamine is one of the most potential antidepressants. By intranasal administration, drugs can be directly delivered to the brain via olfactory nerve route, which is proved to be suitable for some antidepressants. Well-designed rapid-onset antidepressants are the urgent requirements of the patients with depression. Intranasal administration, as a potential strategy to deliver antidepressants to brain, can improve drug efficacy and largely shorten the onset time. In this article, we sorted out some new formulation approaches in treating depression with different mechanisms and pathways compared with traditional treating strategies, along with new findings in clinical studies, proving that the combination of rapid-onset antidepressants with intranasal delivery will lead a new trend in treating depression.     

药护协同管理在急性心肌梗死患者溶栓治疗中的实践

目的 探讨药护协同管理在急性心肌梗死患者溶栓治疗中的实践效果.方法 将100例急性心肌梗死溶栓治疗的患者按数字随机法分为常规组(n=50)和协同管理组(n=50),常规组按照常规护理,协同管理组在此基础上实施药护协同管理,干预6个月后比较治疗效果.结果 两组入院后明确诊断至开始溶栓时间、冠脉有效灌注率和住院天数比较,协同干预组显著优于常规组,48h内恶性心律失常发生例数协同组显著少于常规组,差异有统计学意义(均P＜0.05).两组患者溶栓治疗后12h、24 h、48 h、7d的LVEF值比较,差异有统计学意义(均P＜0.05);出院后6个月心脏不良事件发生比例比较,差异无统计学意义(P＞0.05).结论 药护协同管理能够有效缩短急性心肌梗死患者入院后至溶栓的时间,提高冠脉有效灌注,减少48 h内恶性心律失常发生和缩短住院天数,促进心功能恢复.