The association between immunoglobulin concentrations and prediabetes prevalence in a large Chinese cohort

AimsPrediabetes has received public attention owing to the increasing prevalence worldwide. Mounting evidence has indicated that inflammation directly contributed to the etiology of glucose metabolism disorders. Although immunoglobulins play a crucial role in immune responses, little research has been done on the link between immunoglobulins and prediabetes in adults. Hence, the aim of the present study was to explore the associations between immunoglobulins levels and prevalence of prediabetes in a general adult population.MethodsA cross-sectional study was conducted among 8856 adults (mean ± standard deviation age: 48.4 ± 10.7 years) in Tianjin, China. The serum immunoglobulins concentrations were measured by the immunonephelometric technique. Prediabetes was diagnosed using the following parameters in accordance with the American Diabetes Association: fasting plasma glucose, postprandial glucose and glycosylated hemoglobin. The associations between concentrations of immunoglobulins and the prevalence of prediabetes were assessed using multiple logistic regression models.ResultsOverall, the prevalence of prediabetes was 37.4% (3311/8856). After controlling for confounders, compared with the lowest quintile, the odds ratios (95% confidence interval) of prediabetes for the highest quintile of immunoglobulins (immunoglobulin G, immunoglobulin E, immunoglobulin M and immunoglobulin A) were as follows: 1.06 (0.91–1.23), 1.31 (1.13–1.52), 0.86 (0.74–1.01), and 1.19 (1.03–1.38) (P for trend were 0.35, < 0.0001, 0.04 and 0.02), respectively.ConclusionsElevated immunoglobulin E and immunoglobulin A levels were independently and positively associated with prediabetes prevalence. There was also a trending association between immunoglobulin M concentrations and prediabetes prevalence. Further studies are necessary to clarify if there is a causal association of immunoglobulins in prediabetes or if they reflect early immunologic disturbances in these patients.     

Polymorphisms in the vitamin D receptor (VDR) genes and skin cancer risk in European population: a meta-analysis

There have been a few epidemiological studies reporting VDR polymorphisms including Fok1, Bsm1, Apa1 and Taq1 with skin cancer incidence and, therefore, risk. The results, however, are controversial, often due to smaller sample size. Concerning most of the studies were performed on Caucasian population, we conducted this comprehensive analysis to better understand roles of the polymorphisms in skin cancer development among Caucasian population. The results showed that Fok1 polymorphism was associated with an overall significantly increased risk of skin cancer (Ff vs. FF: OR = 1.20, 95 % CI = 1.01–1.44; ff vs. FF: OR = 1.41, 95 % CI = 1.08–1.84; Ff + ff vs. FF: OR = 1.26, 95 % CI = 1.04–1.53). Besides, we found that Taq1 polymorphism could contribute to non-melanoma skin cancer susceptibility (Tt vs. TT: OR = 1.88, 95 % CI = 1.29–2.74; tt vs. TT: OR = 2.00, 95 % CI = 1.22–3.28; Tt + tt vs. TT: OR = 1.92, 95 % CI = 1.35–2.73). We also found that the Apa1 polymorphism is associated with skin cancer development (Aa vs. AA: OR = 1.27, 95 % CI = 1.05–1.53; Aa + aa vs. AA: OR = 1.23, 95 % CI = 1.04–1.47) and NMSC subgroup (Aa vs. AA: OR = 1.72, 95 % CI = 1.51–2.57; Aa + aa vs. AA: OR = 1.50, 95 % CI = 1.03–2.17). No significant association was observed between the Bsm1 polymorphism and skin cancer risk. The current meta-analysis shows that Fok1, Taq1 and Apa1 may be the susceptibility biomarker for skin cancer in Caucasians.     

Short-course preoperative radiotherapy with immediate surgery versus long-course chemoradiation with delayed surgery in the treatment of rectal cancer: A systematic review and meta-analysis

BackgroundLong-course chemoradiotherapy (LCRT) with delayed surgery or short-course radiotherapy (SCRT) with immediate surgery is probably the most frequent regimen in the treatment of rectal cancer. Debate is still going on whether SCRT or LCRT is more effective. So we performed this meta-analysis to evaluate the safety and efficacy of SCRT with immediate surgery versus LCRT with delayed surgery for the management of rectal cancer.MethodsLiterature were searched from PubMed, Embase, Web of science, Cochrane Library up to May, 2014. Quality of the randomized controlled trials (RCTs) was evaluated according to the Cochrane's risk of bias tool of RCT. RevMan 5.3 was used for statistical analysis. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated. Subgroup analysis and sensitivity analysis were employed to explore heterogeneity.Results16 trials were included in the qualitative systematic review. 12 trials were included in meta-analyses. 4 of them were RCTs; other 8 were non-RCTs. Meta-analysis demonstrated that there were no significant differences in overall survival (OS), disease free survival (DFS), local recurrence rate (LRR), distant metastasis rate (DMR), sphincter preservation rate, R0 resection rate and late toxicity. Compared with SCRT, LCRT obviously increased pCR rate [RR = 0.15, 95%CI (0.08, 0.28), P = 0.003], while LCRT obviously increased the grade 3–4 acute toxicity [RR = 0.13, 95%CI (0.06, 0.28), P < 0.00001].ConclusionsSCRT with immediate surgery is as effective as LCRT with delayed surgery for treatment of rectal cancer in terms of OS, DFS, LRR, DMR, Sphincter preservation rate, R0 resection rate and late toxicity. Though LCRT increased pCR rate, LCRT also increased acute toxicity compared with SCRT. SCRT is a better choice in centers with a long waiting list or lack of medical resources.     

Dyna CT与Embolization Guidance技术在前列腺动脉栓塞中的应用

目的探讨Dyna CT与Embolization Guidance技术在前列腺动脉栓塞中的应用。方法收集我科使用SIEMENS Artis Zeego数字减影血管造影机检查和图像采集进行前列腺动脉栓塞的38例患者,用Dyna CT技术明确前列腺癌供血动脉与其他侧支的情况,Embolization Guidance技术指导进行安全性的前列腺癌供血动脉栓塞。结果 38例患者经两名高年资主任医师指导分别进行前列腺癌动脉栓塞术。Dyna CT联合DSA确认前列腺动脉65侧,比例达85.5%(65/76),其中24例患者显示双侧前列腺动脉,10例确认单侧前列腺动脉;前列腺动脉开口起源于髂内动脉38条,起源于闭孔动脉11条,起源于膀胱下动脉9条,起源于阴部内动脉5条,起源于直肠下动脉2条。利用Embolization Guidance技术完成前列腺动脉栓塞89.2%(58/65),其中24例患者完成双侧栓塞,10例完成单侧栓塞,4例因血管迂曲不能进行超选择栓塞。结论 Dyna CT联合Embolization Guidance技术能够准确地显示前列腺优势供血动脉,在前列腺动脉栓塞治疗中具有重要的应用价值。     

乳腺浸润性小叶癌的临床病理特征、诊疗现状及展望

乳腺癌是目前全球范围内发病率最高的恶性肿瘤，且组织学类型多样。乳腺浸润性小叶癌（ILC）是第二大常见浸润性乳腺癌组织学亚型（占5%~15%），近三十年来其发病率有所升高。E-钙黏蛋白表达缺失是乳腺ILC最主要的分子特征，可导致细胞间缺乏黏附性、肿瘤呈特殊弥漫性浸润生长，这给临床查体及影像学检查带来了一定挑战。尽管多数乳腺ILC患者激素受体呈阳性表达、对内分泌治疗反应良好，但也存在内分泌治疗耐药问题。此外，近年研究证实乳腺ILC患者预后并非如既往研究报道的那样良好，仅基于肿瘤分期及分子分型的治疗原则似乎并不完全适用于乳腺ILC，可能有必要将其作为独立的临床实体行进一步研究。本文主要综述了乳腺ILC的流行病学及临床特征、病理学及分子特征、诊断、治疗、预后、未来治疗方向等，以供临床医师更好地了解并优化乳腺ILC的临床诊断和个体化治疗参考。     

First-line nivolumab plus chemotherapy vs chemotherapy in patients with advanced gastric,gastroesophageal junction and esophageal adenocarcinoma: CheckMate 649 Chinese subgroup analysis

First-line chemotherapy for advanced/metastatic human epidermal growth factor receptor 2 (HER2)-negative gastric/gastroesophageal junction cancer (GC/GEJC) has poor median overall survival (OS; <1 year). We report efficacy and safety results from Chinese patients in the phase III global CheckMate 649 study of nivolumab plus chemotherapy vs chemotherapy for the first-line treatment of GC/GEJC/esophageal adenocarcinoma (EAC). Chinese patients with previously untreated advanced or metastatic GC/GEJC/EAC were randomized to receive nivolumab (360 mg Q3W or 240 mg Q2W) plus chemotherapy (XELOX [capecitabine and oxaliplatin] Q3W or FOLFOX [oxaliplatin, leucovorin and 5-fluorouracil] Q2W), nivolumab plus ipilimumab (not reported) or chemotherapy alone. OS, blinded independent central review-assessed progression-free survival (PFS), objective response rate (ORR), duration of response (DOR) and safety are reported. Of 1581 patients enrolled and randomized, 208 were Chinese. In these patients, nivolumab plus chemotherapy resulted in clinically meaningful improvement in median OS (14.3 vs 10.2 months; HR 0.61 [95% CI: 0.44-0.85]), median PFS (8.3 vs 5.6 months; HR 0.57 [95% CI: 0.40-0.80]), ORR (66% vs 45%) and median DOR (12.2 vs 5.6 months) vs chemotherapy, respectively. The safety profile was acceptable, with no new safety signals observed. Consistent with results from the global primary analysis of CheckMate 649, nivolumab plus chemotherapy demonstrated a clinically meaningful improvement in OS and PFS and higher response rate vs chemotherapy and an acceptable safety profile in Chinese patients. Nivolumab plus chemotherapy represents a new standard first-line treatment for Chinese patients with non-HER2-positive advanced GC/GEJC/EAC.