The clinicopathological and prognostic significance of TP53 alteration in K27M mutated gliomas: an individual-participant data meta-analysis

This study aimed to investigate the impact of TP53 alteration on survival and clinicopathological features of glioma patients with H3K27M mutations. An individual-participant-data (IPD) meta-analysis was performed to investigate the impact of TP53 alteration on survival and clinicopathological features of patients with H3K27M mutations. Three hundred thirty-one individual records from 12 eligible glioma studies involving the H3K27M mutation were finally included in our meta-analysis, and a pooled hazard ratio (HR) of 1.53 (95%CI, 1.10–2.11; P?=?0.01) indicated that TP53 alterations were associated with a shorter overall survival. The pooled odds ratios (ORs) indicated that TP53 alterations were significantly associated with the age at diagnosis ≥?7 years (OR?=?1.97, 95%CI?=?1.15–3.38, P =?0.01), the status of histone H3.3 mutations (OR?=?9.15, 95%CI?=?4.18–20.06, P < 0.00001), and high WHO grade histology (III?+?IV) (OR?=?2.70, 95%CI?=?1.33–5.48, P?=?0.006). However, no association was found between TP53 alterations and gender or tumor location. This IPD meta-analysis suggests that TP53 alteration is a valuable predictor for the prognosis of patients with H3K27M mutated gliomas. TP53 alteration may be used for identifying a subset of patients who potentially benefit from targeted reactivation of TP53 activity.     

减重手术术后胃食管反流病的研究进展

减重手术做为目前治疗肥胖症有效术式,其安全和持久性得到了广泛的认可。其中腹腔镜袖状胃切除术(LSG)由于操作简单、不改变胃肠道结构、具有安全性高且疗效明显的优点,近年来做为主要的减重术式得到迅速普及应用。但肥胖症患者在行LSG术后,胃食管反流病发病率、疾病的转归、术中是否加做抗反流手术目前尚无统一意见。     

Deceleration and acceleration capacities of heart rate in patients with drug-resistant epilepsy

Clinical Autonomic Research - Epilepsy and seizures can have dramatic effects on cardiac function. The aim of the present study was to investigate deceleration capacity, acceleration capacity and...     

Seizure semiology in leucine-rich glioma-inactivated protein 1 antibody-associated limbic encephalitis

ObjectiveThe objective of this study was to advance the characterization of seizure semiology in leucine-rich glioma-inactivated protein 1 (LGI1) antibody-associated limbic encephalitis (LE).MethodsEighteen patients diagnosed with LGI1 LE were identified. Seizure semiology, demographic features, MRI and fluorodeoxyglucose positron emission tomography (FDG-PET), electroencephalograms, and outcomes following immunotherapy were evaluated.ResultsPatients were divided into the following groups based on seizure semiology: faciobrachial dystonic seizure only (FBDS-only, n = 4), epileptic seizure without FBDS (Non-FBDS, n = 6), and FBDS plus epileptic seizure (FBDS +, n = 8). In the group with Non-FBDS, the majority of patients (5/6) manifested mesial temporal lobe epilepsy (MTLE) like semiology (i.e., fear, epigastric rising, staring, and automatisms) with a frequency of 7 ± 5 times per day and a duration of 15.3 ± 14.3 s. In the group with FBDS +, the distinctive symptom was FBDS followed by epileptic events, especially automatisms (7/8), with a frequency of 16 ± 12 times per day and a duration of 13.0 ± 8.0 s. In these cases, 67% and 50% of the patients showed abnormalities on MRI and FDG-PET, respectively, and the mesial temporal lobe structures were most often involved. Ictal discharges were observed in 0/4, 6/6, and 8/8 of the patients in the groups with FBDS only, Non-FBDS, and FBDS +, respectively. The temporal lobe was mainly affected. Immunotherapy had favorable therapeutic effects.SignificanceThe LGI1 LE should be considered as one disease syndrome with a series of clinical manifestation. Identifying types of unique semiology features will facilitate the early diagnosis and the timely initiation of immunotherapy.     

全国187所医院腹部手术术前皮肤准备现状调查

目的了解我国医院腹部手术术前皮肤准备情况,并提出改进建议。方法2016年4—5月选取全国187所二级及以上医院,采用问卷调查的方式,对医院腹部手术术前手术部位毛发去除方法、术野皮肤消毒方法和手术贴膜使用情况进行调查。结果共调查14个省份187所医院,其中三级医院108所,二级医院79所。87.70%的医院在腹部手术术前仍常规去除手术部位毛发,其中二级医院常规去除率（93.67%）高于三级医院（83.33%）,差异有统计学意义（χ2=4.520,P=0.033）。85.98%的医院用刀片刮除的方式,少数医院选择化学脱毛（7.93%）或电动剪毛（23.78%）方式。大多数医院在病房（98.17%）备皮,98.17%的操作人员为病房护士,手术当日备皮占56.10%。86.63%的医院术野皮肤消毒使用碘伏,29.95%使用碘酒+乙醇,3.74%使用氯己定醇。92.51%的医院在术中使用皮肤/切口保护贴膜,其中74.57%的医院为有选择性的使用。结论我国大部分医院腹部手术术前仍常规去除手术部位毛发,且多数采用刀片刮除的方式,超过一半的医院在手术当日去除毛发。碘伏是主要的术野皮肤消毒方法,大多数医院使用手术贴膜,但使用的手术有限。     

BICD货物接头蛋白1基因作为胶质瘤级别进展分子标志物的研究

目的 检测BICD货物接头蛋白1（BICD1）基因在中国人群各级别胶质瘤样本中的表达水平,并探讨其在低级别胶质瘤向高级别胶质瘤进展过程中的潜在作用。方法 从中国脑胶质瘤基因组图谱（CGGA）的全转录组表达谱芯片数据库和全转录组测序数据库中收集BICD1的mRNA表达数据,结合胶质瘤的世界卫生组织（WHO）级别、分子亚型、患者无进展生存期和总生存期及经典分子标志物的表达与突变数据,分析BICD1表达与胶质瘤的级别进展及恶性程度的相关性。收集WHO Ⅱ、Ⅲ和Ⅳ级胶质瘤组织各10例,提取RNA并反转录为cDNA进行实时荧光定量PCR（qPCR）,分析各级别胶质瘤样本中BICD1在转录水平上的表达差异。结果 CGGA全转录组表达谱芯片和全转录组测序数据库中提取的表达数据显示,BICD1的表达水平随着胶质瘤的级别升高而升高（WHO Ⅲ及Ⅳ级vs WHO Ⅱ级：t=7.901,P<0.01）。qPCR结果显示较高级别的胶质瘤组织中BICD1的表达水平更高（WHO Ⅲ级vs WHO Ⅱ级：t=3.514,P<0.01;WHO Ⅳ级vs Ⅲ级：t=2.128,P=0.037 6）。BICD1高表达与胶质瘤患者更短的无进展生存期和总生存期均有关（P均<0.01）。BICD1在前神经元型、神经元型、经典型和间质型胶质瘤样本中的表达水平不同（F=21.8,P<0.01）,其中间质型胶质瘤样本中BICD1表达水平最高,前神经元型胶质瘤样本中表达水平最低。BICD1的表达水平与异柠檬酸脱氢酶1（IDH1）突变、染色体1p19q联合缺失、人第10号染色体缺失的磷酸酶和张力蛋白同源基因（PTEN）突变等指示胶质瘤恶性程度的经典分子标志物相关,其中IDH1突变胶质瘤样本中BICD1的表达水平低于野生型样本（t=7.769,P<0.01）。结论 BICD1可能是指示低级别胶质瘤发生级别进展和恶性进展的潜在分子标志物。     

Preparation and characterization of paclitaxel-loaded poly lactic acid-co-glycolic acid coating tracheal stent

Background In-stent restenosis caused by airway granulation poses a challenge due to the high incidence of recurrence after treatment.Weekly applications of anti-proliferative drugs have potential value in delaying the recurrence of airway obstruction.However,it is not practical to subject patients to repeated bronchoscopy and topical drug applications.We fabricated novel pacilitaxel-eluting tracheal stents with sustained and slow pacilitaxel release,which could inhibit the formation of granulation tissue.And we assessed the quality and drug release behaviors of drug-eluting stents （DESs） in vitro.Methods Stents were dipped vertically into a coating solution prepared by dissolving 0.5 g （2％ w/v） of poly lactic acid-coglycolic acid （PLGA） and 0.025 g （0.1％ w/v） of pacilitaxel in 25 ml of dichloromethane.DES morphology was examined by scanning electron microscopy （SEM）.Pacilitaxel release kinetics from these DESs was investigated in vitro by shaking in PBS buffer followed by high performance liquid chromatography （HPLC）.Results Using an orthogonal experimental design,we fabricated numerous pacilitaxel/PLGA eluting tracheal stents to assess optimum coating proportions.The optimum coating proportion was 0.1％ （w/v） pacilitaxel and 2％ （w/v） PLGA,which resulted in total pacilitaxel loading of （16.380 6±0.002 1） mg/stent.By SEM the coating was very smooth and uniform.Pacilitaxel released from DES was at （0.376 3±0.003 8） mg/d,which is a therapeutic level.There was a prolonged,sustained release of pacilitaxel of ＞40 days.Conclusions Paclitaxel-loaded PLGA coating tracheal stents were successfully developed and evaluated.Quality assessments demonstrated favorable surface morphology as well as sustained and effective drug release behavior,which provides an experimental reference for clinical practitioners.     

中国七城市卒中患者急诊溶栓情况分析

目的 超早期重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator,rt-PA）溶栓治疗是缺血性卒中有效的治疗方法,但目前缺血性卒中救治过程中存在溶栓率偏低的问题,本调查的目的在于了解实际溶栓状况及未溶栓原因。方法 本调查在中国的7个城市31家中心展开前瞻性调查,调查采用标准的登记数据,内容包括患者的一般人口学信息、院前卒中急救信息、院前院内关键延误时间、溶栓信息等。结果 在研究期间,共有1091例患者确诊符合入选标准,其中754例（69.6%）急性缺血性卒中患者中共有20例（2.7%）患者溶栓,其中静脉rt-PA15例、动脉rt-PA2例、静脉尿激酶（Urokinase,UK）3例。在静脉rt-PA中,93.3%（14/15）存在方案违背。大部分病例（17/20）在2 h内就到达了医院,院前延迟平均中位时间为1.17 h。急诊接诊到获得检查（CT或磁共振）平均中位时间为0.67 h。未进行溶栓的主要原因除年龄（>80岁或<18岁）（28.9%）、卒中症状太轻（24.0%）、病情迅速恢复（16.5%）、CT影像已有病灶（15.7%）、时间>3 h（15.7%）、卒中症状太重（7.4%）等因素外,患者/家属主观拒绝仍占了18.2%。结论 急性缺血性卒中溶栓比例偏低,溶栓药物使用不规范且存在方案违背,存在院前延迟问题,亟待整合院前急救中心与医院间医疗资源,规范院前转运途径,缩短延误时间,提高溶栓率。     

侧脑室脑膜瘤的显微手术治疗

目的:总结侧脑室肿瘤的诊治经验、手术方式和临床效果。方法:回顾性分析26例显微手术治疗的侧脑室肿瘤的临床特点。颞枕经皮质入路23例,经额胼胝体入路1例,经颞入路2例。结果:全切25例,大部切除1例。术后恢复良好24例,不全偏瘫、失语各1例。结论:根据肿瘤的部位和大小,选择合适的手术入路,有助于改善侧脑室肿瘤患者的预后。