ＥＧＦＲ抑制剂放射增敏机制的研究进展

表皮生长因子受体（ＥＧＦＲ）为肿瘤治疗的重要靶点,ＥＧＦＲ抑制剂可以通过促进细胞凋亡、细胞周期重分布、降低辐射抗性、抑制血管形成、减少放射损伤修复和减少肿瘤细胞再增殖等机制起到放射增敏的效果。靶向治疗联合放疗可能是靶向治疗向前发展的重要途径,也是放射治疗提高自身疗效的良好契机。尽管还有诸多问题尚待解决,但随着基础研究的不断深入,ＥＧＦＲ抑制剂联合放疗会迎来更广阔的临床应用前景。     

国内肺隐球菌病临床资料汇总分析

目的了解国内报道的肺隐球菌病的流行病学特征、临床及影像学特点、确诊方法、误诊情况、治疗及预后,为临床医师快速准确地诊断本病提供重要线索。方法检索1980～2007年中国医院数字图书馆CHKD期刊全文库收录的有关肺隐球菌病的文献,统计分析221例肺隐球菌病患者的临床资料。结果肺隐球菌病好发于青中年男性,其临床表现及影像学表现呈多样性和无特异性,易并发隐球菌性脑膜炎（24．0％）,临床上极易误诊;确诊主要依靠各种临床标本的涂片、培养和病理学检查;治疗手段主要包括手术切除和抗真菌药物的治疗。结论临床上提高对该病的认识是提高确诊率的关键。强调抗真菌药物的治疗作用,尤其是术前、术后应用,可减少隐球菌播散导致隐球菌性脑膜炎。     

Validation of the post-neoadjuvant staging system of the American joint committee on cancer, 8th edition,in patients treated with neoadjuvant chemoradiotherapy followed by curative esophagectomy for localized esophageal squamous cell carcinoma

ObjectiveThe American Joint Committee on Cancer 8th edition staging system presents separate classifications for pTNM and post-neoadjuvant ypTNM (ypTNM-8th) to enhance prognostic prediction after neoadjuvant therapy and surgery. We aimed to validate the ypTNM-8th staging system and to compare the prognostication performance of ypTNM-8th with that of pTNM-7th and pTNM-8th in esophageal squamous cell carcinoma (ESCC) patients receiving neoadjuvant chemoradiotherapy (nCRT).MethodsWe reviewed 207 ESCC patients treated with nCRT between January 2007 and December 2014 and compared the Akaike information criterion (AIC) and Harrell's C-index to determine the prognostic performance of each TNM system.ResultsSurvival curve analysis of pTNM-7th and -8th showed a stepwise drop in survival from ypT0N0 to advanced stages, whereas the survival outcome of ypStage III showed a better prognosis than that of ypStage II according to ypTNM-8th. Lymphovascular invasion, perineural invasion, and tumor regression grade were significantly associated with overall survival on univariate analysis. Each TNM system showed significant p-values for trend (p < 0.0001 each), but after adjusting for prognostic factors, ypTNM-8th did not significantly predict survival (p = 0.15), whereas pTNM-7th remained significant (p < 0.001). pTNM-7th incorporating ypT0N0M0 and ypT0 (is)N + M0 as separate groups was superior in prognostication as its AIC was smaller and its C-index was higher than those of pTNM-8th and ypTNM-8th, respectively.ConclusionsBecause ypTNM-8th did not provide sufficient prognostication for patients with ESCC treated with nCRT followed by esophagectomy, more sophisticated prognostic classification should be developed for the ypTNM staging system in these patients.     

综合康复指导模式对脑卒中患者神经功能的影响

目的研究综合康复指导模式对脑卒中患者神经功能的影响。方法选择2018年1-12月天津医科大学第四中心医院收治的脑卒中患者共计80例,随机分为对照组和观察组,各40例。其中对照组给予常规治疗模式,观察组在此基础上给予综合康复指导。比较两组患者治疗后的康复效果及治疗前后NIHSS、FMA、ADL评分差异。结果治疗前,两组患者NIHSS、FMA、ADL各项评分差异无统计学意义(P>0.05);治疗后,观察组NIHSS、FMA、ADL各项评分情况均明显优于对照组,差异有统计学意义(P<0.05)。结论综合康复指导模式能有效提高脑卒中患者康复疗效,帮助患者提升生活质量,疗效明显,值得临床推广应用。     

术前血清学联合影像学检查预测肝内胆管癌根治性切除术后患者生存获益的研究

背景与目的 肝内胆管癌（ICC）起病隐匿、侵袭性高,患者往往确诊时已失去了最佳手术时机,接受手术者5年生存率也极低。早期判断患者根治性切除术的生存获益至关重要。本研究依据术前影像学联合血清学指标对ICC根治性切除患者生存获益实行预测,以期对临床判断是否适宜行根治性切除提供指导与参考。方法 回顾性收集2010年1月—2021年12月于中国13家三甲医院行根治性切除的821例ICC患者的影像学与血清学检测资料。影像学指标包括：发现肝脏肿块、肝内胆管扩张、门静脉侵犯、淋巴结侵犯、腹水及结石;血清学指标包括：血红蛋白、白细胞计数、淋巴细胞计数、中性粒细胞计数、甲胎蛋白（AFP）、癌胚抗原（CEA）、糖类抗原19-9（CA19-9）、CA125、丙氨酸氨基转移酶（ALT）、总胆红素（TBIL）、白蛋白（ALB）及凝血酶原时间（PT）。通过单因素与多因素Cox回归筛选目标变量,用目标变量构建CoxPH模型并绘制列线图,用Kaplan-Meier生存分析验证评分与患者预后的关系,通过受试者工作特征（ROC）曲线及校准曲线对模型预测效能进行评估。结果 影像学发现腹水、肝内胆管扩张、淋巴结侵犯与血清学指标CEA>5 μg/L、CA19-9>37 U/mL、CA125>40 U/mL是独立预后因素（均P<0.05）。用该六个变量构建CoxPH模型,根据该模型所区分的高风险组患者术后1、3、5年生存率均明显低于低风险组患者（均P<0.05）;所构建的列线图具有较好的区分度及有效性。ROC曲线显示,模型1、3、5年预测的曲线下面积分别为0.711、0.721、0.782;模型1、3、5年预测效能均高于独立指标的预测效能。结论 由CA125、腹水、肝内胆管扩张、淋巴结侵犯、CEA、CA19-9这六个术前指标组成的预后模型能较好地对患者进行高低风险分层,并对ICC患者根治性切除术后生存获益进行较精准的个体化预测,对临床医生判断患者是否适宜行根治性切除具有指导意义。     

Evaluating the population measles susceptibility in Tianjin,China

BackgroundMeasles is a highly infectious illness requiring herd immunity of 95% to interrupt transmission. China has not reached elimination goals despite high vaccination coverage. We estimated the population susceptibility against measles in Tianjin, China and to tailor awareness raising activities in the measles elimination plan.MethodsAge-specific measles seroprevalence was evaluated by Enzyme-Linked Immunosorbent Assay (ELISA) on 12,164 individual aged 0–44 years in 2009–2018. Measles IgG avidity testing was performed to confirm the relationship of the waning immunity after vaccination and secondary vaccination failures (SVF) on 324 confirmed measles cases in 2013–2018.Results11,108 samples (91.32%) tested positive for measles IgG, 239 (1.96%) tested as equivocal and 817 (6.72%) were negative. The age distribution of measles cases in Tianjin followed a U-shaped curve and was highest for those at <8 months and again at 20–39 years which correlated closely with the age distribution of measles susceptibility based on measles IgG antibody status (r = 0.72, P < 0.001). The seropositivity rate and antibody geometric mean concentration (GMC) for the 2018 study population were significantly lower (χ² = 7.45, P = 0.006 and t = 12.01, P < 0.001) compared to 2009. The multivariate stepwise logistic regression analysis showed that age and region were the risk factors for both measles seropositivity rate and GMC after vaccination. The proportion of high avidity cases increased with age, being significantly higher in 75.31% of cases in patients aged 30–34 years (χ² = 18.04, P = 0.003).ConclusionsHigh immunization coverage in children alone will not be adequate to realizing sufficient levels of population herd immunity, particularly given that the potential susceptibility window in adult. Implementation of supplemental immunization activity (SIA) targeted to appropriate group aged 30–34 years is recommended.     

Survival prediction for gallbladder carcinoma after curative resection: Comparison of nomogram and Bayesian network models

BackgroundIn this study, we developed a nomogram and a Bayesian network (BN) model for prediction of survival in gallbladder carcinoma (GBC) patients following surgery and compared the performance of the two models.MethodsSurvival prediction models were established and validated using data from 698 patients with GBC who underwent curative-intent resection between 2008 and 2017 at one of six Chinese tertiary hospitals. Model construction and internal validation were performed using data from 381 patients at one hepatobiliary center, and external validation was then performed using data from 317 patients at the other five centers. A BN model and a nomogram model were constructed based on the independent prognostic variables. Performance of the BN and nomogram models was compared based on area under receiver operating characteristic curves (AUC), model accuracy, and a confusion matrix.ResultsIndependent prognostic variables included age, pathological grade, liver infiltration, T stage, N stage, and margin. In internal validation, AUC was 84.14% and 78.22% for the BN and nomogram, respectively, and model accuracy was 75.65% and 72.17%, respectively. In external validation, AUC was 76.46% and 70.19% for the BN and nomogram, respectively, with model accuracy of 66.88% and 60.25%, respectively. Based on the confusion matrix, the nomogram had a higher true positive rate but a substantially lower true negative rate compared to the BN.ConclusionA BN model was more accurate than a Cox regression-based nomogram for prediction of survival in GBC patients undergoing curative-intent resection.     

Homeopathic Agents or Vitamins in Reducing Ecchymosis after Oculofacial Surgery: A Report by the American Academy of Ophthalmology

PurposeTo review the published literature to determine the efficacy and safety of homeopathic agents or vitamins in reducing ecchymosis after oculofacial surgery or laser surgery.MethodsA literature search was conducted in the PubMed database initially in December 2019 and updated in March 2020 to identify all studies in the English language literature on the use of homeopathic agents or vitamins in oculofacial procedures, including laser surgery. The search yielded 124 citations, and 11 articles met all inclusion criteria for this assessment. A panel methodologist then assigned a level of evidence rating for each study. Eleven studies met inclusion criteria; 9 were rated level I, and 2 were rated level III.ResultsThe agents studied in the articles identified included oral or topical Arnica montana (AM), oral Melilotus extract, topical vitamin K oxide, and topical AM combined with Rhododendron tomentosum. Metrics to describe ecchymosis varied. In 7 controlled studies, perioperative AM provided no or negligible benefit versus placebo. In 2 studies, vitamin K cream was equivalent to placebo. One study of oral Melilotus extract had less ecchymosis compared with controls in paranasal and eyelid ecchymosis at postoperative day (POD) 7, but not at PODs 1 and 4. A lone cohort study of combined topical AM and R. tomentosum lacked objective metrics and adequate controls. No serious side effects from administration of homeopathic agents or vitamins were identified.ConclusionsThe current literature does not support the use of AM, vitamin K oxide, R. tomentosum, or Melilotus extract for reducing ecchymosis after oculofacial surgery or pulsed dye laser surgery.