Microbiology and clinical characteristics of industrial oil burns

IntroductionInfections complicating burns generally transition from Gram-positive to Gram-negatives over the first couple weeks, but this depends on multiple factors. The microbiology of infections complicating crude oil (CO) and hydraulic fracturing (FRAC) burns is unknown.MethodsWe performed a retrospective study of patients with industrial thermal burns hospitalized >2 days with ≥1 day in the ICU between 4/2011–11/2016. Burns were oil-related (ORB; CO or FRAC) or non-oil related (NORB). Epidemiology and microbiology during the first 15 hospital days was compared.Results149 patients were included, with 11 FRAC and 24 CO. CO burns were more severely burned than those with FRAC and NORB (p < 0.05). Mortality was 17% and 18% for CO and FRAC burns compared to 3% in NORB (p < 0.01). More cultures were obtained from ORB than NORB (p < 0.05). ORB were associated with Stenotrophomonas maltophilia and FRAC associated with Serratia marcescens and Candida glabrata. Patients with FRAC, CO and NORB had a median of 13, 3.5, and 4 days to first positive culture respectively (p = 0.03).ConclusionORB were associated with more severe burns and unique microbiology. FRAC burns had longer to initial positive culture, potentially suggesting our current methodology is inadequate to diagnose infections associated with FRAC.     

Germline mutations in 40 cancer susceptibility genes among Chinese patients with high hereditary risk breast cancer

Multigene panel testing of breast cancer predisposition genes have been extensively conducted in Europe and America, which is relatively rare in Asia however. In this study, we assessed the frequency of germline mutations in 40 cancer predisposition genes, including BRCA1 and BRCA2, among a large cohort of Chinese patients with high hereditary risk of BC. From 2015 to 2016, consecutive BC patients from 26 centers of China with high hereditary risk were recruited (n = 937). Clinical information was collected and next-generation sequencing (NGS) was performed using blood samples of participants to identify germline mutations. In total, we acquired 223 patients with putative germline mutations, including 159 in BRCA1/2, 61 in 15 other BC susceptibility genes and 3 in both BRCA1/2 and non-BRCA1/2 gene. Major mutant non-BRCA1/2 genes were TP53 (n = 18), PALB2 (n = 11), CHEK2 (n = 6), ATM (n = 6) and BARD1 (n = 5). No factors predicted pathologic mutations in non-BRCA1/2 genes when treated as a whole. TP53 mutations were associated with HER-2 positive BC and younger age at diagnosis; and CHEK2 and PALB2 mutations were enriched in patients with luminal BC. Among high hereditary risk Chinese BC patients, 23.8% contained germline mutations, including 6.8% in non-BRCA1/2 genes. TP53 and PALB2 had a relatively high mutation rate (1.9 and 1.2%). Although no factors predicted for detrimental mutations in non-BRCA1/2 genes, some clinical features were associated with mutations of several particular genes.     

Anlotinib Monotherapy for Refractory Metastatic Colorectal Cancer: A Double-Blinded,Placebo-Controlled,Randomized Phase III Trial (ALTER0703)

Background

Treatment options for refractory metastatic colorectal cancer (mCRC) were limited. Anlotinib is a novel multitarget tyrosine kinase inhibitor. ALTER0703 study was conducted to assess efficacy and safety of anlotinib for patients with refractory mCRC.

Materials and Methods

This was a multicenter, double-blinded, placebo-controlled, randomized phase III trial involving 33 hospitals in China. Patients had taken at least two lines of therapies were 2:1 randomized to receive oral anlotinib (12 mg/day; days 1–14; 21 days per cycle) or placebo, plus best supportive care. Randomization was stratified by previous VEGF-targeting treatments and time from diagnosis to metastases. The primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), quality of life (QoL), and safety.

Results

A total of 419 patients (anlotinib: 282; placebo: 137) were treated from December 2014 to August 2016. The median PFS was improved in anlotinib group (4.1 months; 95% confidence interval [CI], 3.4–4.5) over placebo group (1.5 months; 95% CI, 1.4–1.5), with a hazard ratio (HR) of 0.34 (95% CI, 0.27–0.43; p < .0001). However, median OS was similar between two groups (8.6 months; 95% CI, 7.8–9.7 vs. 7.2 months; 95% CI, 6.2–8.8; HR, 1.02; p = .870). Improvements of ORR and DCR were observed in anlotinib over placebo. The most common grade ≥ 3 anlotinib related adverse events were hypertension (20.92%), increased γ-GT (7.09%), and hand-foot skin reaction (6.38%).

Conclusion

Anlotinib was tolerated in Chinese patients with refractory mCRC. Although OS did not reach significant difference, anlotinib still provided clinical benefits by substantially prolonged PFS in these patients.

Implications for Practice

In this randomized clinical trial that included 419 patients with refractory metastatic colorectal cancer, substantial prolonged in progression-free survival was noted in patients who received anlotinib compared with those given placebo. Improvements on objective response rate and disease control rate was also observed in anlotinib group. However, overall survival was similar between the two groups. In a word, in third-line or above treatment of Chinese patients with refractory metastatic colorectal cancer, anlotinib provided clinical benefit by significantly prolonged progression-free survival.

     

牙周引导组织再生术治疗根分叉区骨缺损临床观察

目的 :对引导组织再生术治疗Ⅱ°～Ⅲ°根分叉区骨缺损的近期临床疗效进行评价。方法 :　选取Ⅱ°～Ⅲ°根分叉区骨缺损患牙 2 1个 ,牙周引导组织再生术 (GTR)治疗 11个 ,常规翻瓣术治疗 10个 ,术后 3个月观察附着水平、牙周袋深度的变化 ,通过计算机测量分析根尖片 ,对两种手术方法进行比较。结果 :术后 3个月 ,两组牙周袋探诊深度自身对照 ,有明显改善 ,差异有显著性 (P <0 .0 5 )。GTR组临床附着水平有明显改善 ,且有显著性差异 (P <0 .0 5 ) ,翻瓣组临床附着水平变化则无显著性差异 (P >0 .0 5 ) ;GTR组与翻瓣术组比较 ,各项临床指标均有显著性差异 (P <0 .0 5 )。计算机测量分析根尖片 ,GTR组较翻瓣组垂直向骨高度增加显著 ,有统计学意义 (P <0 .0 5 )。结论 :治疗Ⅱ°～Ⅲ°根分叉区骨缺损 ,GTR术可获得良好的近期临床疗效。     

The association between burn and trauma severity and in-hospital complications

ObjectiveThe aim of this study was to analyze the association between in-hospital complications and burn and trauma severity, inhalation injury, length of intensive care unit and hospital stay, and mortality in burned patients.MethodThis observational and retrospective study included 68 burn patients hospitalized in a university hospital located in São Paulo, Brazil. The severity of the burn injury and trauma were measured by means of Abbreviated Injury Scale and the Injury Severity Score, respectively. Thecomplications were considered as a dependent variable. The statistical analysis for continuous variables was performed using the Student‘s t or the Mann–Whitney test and for categorical variables the Chi-square test, Fisher’s Exact or Verisimilitude Ratio test, considering a significance level of 5%.ResultsThe majority (60.3%) of patients had complications, and among them, those with infections were the most frequent (70.7%). Burned patients with complications had higher burn injury severity, were hospitalized for longer and their mortality was higher. Cardiovascular complications were associated with severe burns and mortality; infectious ones with a larger length of hospitalization.ConclusionComplications are frequent in patients with severe burns and inhalation injuries, increasing length of hospital stay and mortality. Burn studies measuring severity of thermal and inhalation injuries and other associated traumas allow to expand the analysis of burned patients.     

Epidemiology and outcome analysis of facial burns: A retrospective multicentre study 2011–2015

BackgroundThe head and neck regions are frequent sites of burns, but few studies have analysed and reported the epidemiology of facial burns. As the face is the centre of one’s identity and persona, facial injuries often result in physical and psychological morbidity. The aim of this article is to describe the epidemiology and outcome of facial burns in China and to suggest future preventive strategies.MethodsThis retrospective analysis included all patients with facial burns in a database at eight institutions from 2011–2015. The data collected included sex, age, month distribution, aetiology, location, presence of inhalation injury, total burn surface area, burn surface area with full-thickness and outcome including Post-traumatic stress disorder Checklist-Civilian Version scores and mortality. SPSS 19.0 software was used to analyse the data.ResultsA total of 1126 patients were included; 65.63% (739) had facial burns, of which 546 (73.88%) were male patients and 193 (26.12%) were female patients. Predictors of facial burns were being of male sex, working-related place, flame burns, total body surface area, and full-thickness burns. In addition, total body surface area and full-thickness burns increased the risk of poor prognosis for post-traumatic stress disorder and mortality.ConclusionsFacial burns benefit not only the healing of wound, but also the prevention of their incidence and PTSD symptom. This study may contribute to the elaboration of strategies to prevent facial burns and the establishment of a nationwide burn database in China.     

22L毒株感染雌性BALB/c小鼠的生物学特征检测

“唯蛋白”假说指出,朊蛋白PrP^C的错误折叠体PrP^Sc是朊病毒病的重要的感染因子。本文中,用22L Scraipe毒株感染BALB/c小鼠,在脑内注射后,130 d左右小鼠出现明显的神经症状,150 d陆续出现濒死症状。对濒死期患病小鼠进行检测,表现出典型的朊病毒病的病理特征:抗PK酶消化,神经纤维网内出现空泡结构,神经元消失,朊蛋白聚集,星形胶质细胞增多等。     

肠型放射病时小肠隐窝细胞增殖活动变化及WR-272l防护效应

本实验采用³H-TdR掺入,放射自显影方法观察大20Gy全身照射后8天内10个时间点的肠隐窝细胞增殖活动变化,应用WR-2721照前预防观察对肠型放射病时隐窝增殖细胞的辐射防护效应。结果显示,照射后隐窝增殖细胞立即抑制,隐窝内增殖细胞数量和增殖能力急剧下降。照后9小时增殖细胞的DNA合成略有恢复,分裂细胞在照后13小时才开始出现。照前应用WR-2721预防动物,隐窝细胞损伤较轻,增殖活动有一定改善,细胞分裂和DNA合成增多,隐窝细胞数量增多,照射后2.5～3天有少数再生肠腺形成。