The add-on effect of dengzhan shengmai capsules on secondary prevention of ischemic stroke: A multicentre,randomised, placebo-controlled clinical trial

ObjectiveThe Dengzhan Shengmai (DZSM) capsule is a commercially available type of Chinese herbal medicine frequently administered to improve neurological impairment after stroke. Its ability to prevent recurrent stroke, however, has not been determined. This study therefore evaluated the ability of DZSM as an add-on to conventional secondary preventive agents to prevent recurrent ischemic stroke.MethodsIn this randomised, double-blind, placebo-controlled trial, conducted at 83 hospitals in Mainland China, 3143 patients in 14–180 days after the initial onset of ischemic stroke, were randomly allocated to the DZSM (0.36 g, twice daily for 12 months) or the placebo group. All patients in both groups received standard secondary preventive medications. The primary outcome was the 1-year incidence of stroke. Between group differences were assessed using the Cox proportional hazards model.ResultsIntent-to-treat analysis showed that 58 (3.8%) participants in the DZSM group and 82 (5.4%) in the placebo group experienced new stroke events (hazard ratio = 0.70, 95% confidence interval = 0.50–0.98, P = 0.036). The type and incidence of adverse events were similar in the DZSM and placebo groups.ConclusionsThe addition of DZSM capsules to standard secondary preventive agents provides additional benefits after the initial onset of ischemic stroke, reducing recurrent stroke without increasing severe adverse events. However, further study is needed to elucidate the role of DZSM on the updated practice of conventional secondary prevention for ischemic stroke.     

Snail与E-cadherin在上皮性肿瘤中的表达及其临床意义

目的:探讨Snail与E-cadherin蛋白表达在上皮性肿瘤中的临床意义。方法:应用免疫组织化学SP法,研究150例人肝癌、乳腺癌、宫颈癌、子宫内膜癌与卵巢癌临床标本及30例相应正常组织中Snail与E-cadherin蛋白的表达及定位。结果:在上述5种组织中,Snail主要表达于癌组织细胞核、细胞质,相应正常组织往往缺如,且在肝癌、乳腺癌中Snail表达与肿瘤转移有一定的相关性,并与E-cadherin表达呈负相关。E-cadherin定位于细胞膜,在肝、乳腺的正常组织中E-cadherin强表,相应癌组织中其表达往往下降或缺如;而在宫颈癌、内膜癌与卵巢癌中,E-cadherin表达与癌变无明显相关性。结论:Snail、E-cadherin的表达在肝癌、乳腺癌中具有重要意义,Snail有可能作为肝癌、乳腺癌肿瘤转移的生物学标志。     

Neutrophil-to-lymphocyte ratio as a prognostic marker in locally advanced nasopharyngeal carcinoma: A pooled analysis of two randomised controlled trials

PurposeTo assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in patients with International Union Against Cancer (UICC)–staged III/IVA,B nasopharyngeal carcinoma (NPC), who were enrolled into two randomised controlled trials of concurrent/adjuvant chemotherapy when added to radiotherapy (SQNP01), and induction chemotherapy when added to chemoradiotherapy (NCC0901).Material and methodsA post hoc analysis of pooled cohorts from SQNP01 (N = 221) and NCC0901 (N = 172) was performed. We employed a threshold of pre-treatment NLR = 3.0 (median) to stratify patients. Survival outcomes were compared using log-rank test. Multivariable Cox regression analyses were performed to assess association between NLR and overall survival (OS), disease-free survival (DFS), distant metastasis–free survival (DMFS), and locoregional recurrence–free survival (LRFS).ResultsHigh NLR (≥3.0) was associated with advanced T-status (p = 0.002), N-status (p = 0.002), overall UICC stage (p = 0.004), and high pre-treatment Epstein–Barr virus DNA titre (p = 0.001). High NLR was not associated with OS (0.94 [0.67–1.32], p = 0.7), DFS (0.98 [0.73–1.33], p = 0.9), DMFS (1.02 [0.66–1.57], p = 0.9), and LRFS (1.37 [0.84–2.22], p = 0.2) on univariable and multivariable analyses, while conventional clinical indices (T-status, N-status, and overall UICC stage) were prognostic of clinical outcomes. High NLR also did not predict for a treatment effect with the experimental arms in both trials.ConclusionOur pooled analyses that were confined to a homogenous patient population of locally advanced NPC do not suggest that NLR adds prognostic value to conventional clinical indices in identifying patients with unfavourable disease.     

Preoperative comprehensive malignancy risk estimation for thyroid nodules: Development and verification of a network-based prediction model

BackgroundIn order to avoid excessive treatment of thyroid nodules in the clinic, it is necessary to find a simple and practical analysis method to comprehensively and accurately reflect benign or malignant thyroid nodules. This study aimed to construct and validate a comprehensive and reliable network-based predictive model using a variety of imaging and laboratory criteria for thyroid nodules to stratify the risk of malignancy prior to surgery.MethodsWe retrospectively analyzed data from patients who underwent surgical treatment for thyroid nodules at the Thyroid and Breast Diagnosis and Treatment Center of Weifang Hospital of Traditional Chinese Medicine between January 2018 and December 2020. Binary logical regression analysis was performed to predict whether nodules were malignant or benign. The developmental dataset included 457 patients (January 2018–December 2020). The validation set included separate data points (n = 225, January 2018–December 2020).ResultsIn this study, criteria that showed significant predictive value for malignant nodules included TI-RADS: 4b (p = 0.065); Bethesda IV, Bethesda V, Bethesda VI (P < 0.0001); BRAF^V600E mutation (P < 0.0001); Calcitonin>5 pg/ml (p = 0.0037); and FNA-Tg>30 ng/ml (p = 0.0003). A 10-grade risk scoring system was developed. The risk of malignancy risk ranged from 2.06% to 100% and was positively associated with increasing risk grade. The areas under the receiver-operating characteristic curve of the development and validation sets were 0.972 and 0.946, respectively.ConclusionA simple, comprehensive and reliable web-based predictive model was designed using a variety of imaging and laboratory criteria to stratify thyroid nodules by probability of malignancy.     

Immunomodulating activity of Chinese medicinal herbs and Oldenlandia diffusa in particular

The effect of eight different Chinese medicinal herbs (CMHs) on lymphocytes was studied in vitro using murine spleen cells. Among the studied eight CMHs, Astragalus membranaceus and Oldenlandia diffusa markedly stimulated murine spleen cells to proliferate. The responder cells for CMHs were B cells, because the response was depleted by the treatment of spleen cells with anti-immunoglobulin (Ig) antibody and complement and after purification by nylon wool column. This response was not due to contamination by lipopolysaccharide (LPS), because CMHs could stimulate C3H/HeJ spleen cells which are low responders to LPS. CMHs enhanced the production of Ig. CMHs also enhanced the induction of allo-antigen specific cytotoxic T lymphocytes. However, CMHs had no effect on natural killer cells. Furthermore, CMHs stimulated macrophages to produce interleukin-6 and tumor necrosis factor. The electroelution of the proteins from SDS-PAGE gel showed that the active components of Oldenlandia diffusa had an apparent molecular weight of 9-200 kD and were sensitive to pronase E and NaIO₄ treatment, suggesting glycoproteins in nature. These results suggest that CMHs have immunomodulating activity in vitro and this activity could be used clinically for the modulation of immune responses.     

原发性卵巢黏液性癌的临床特征分析

目的:探讨原发性卵巢黏液性癌的临床特点,寻求恰当的治疗策略。方法:回顾分析24例卵巢黏液性癌和108例非黏液性癌患者的年龄、手术病理分期、残留病灶、化疗反应率,比较生存情况,分析影响预后的因素。结果:黏液性癌患者FIGO分期早(P=0.001)、肿瘤分级低(P=0.000)。两组患者的年龄没有差异,Ⅲ～Ⅳ期患者的手术满意率无差异(P=0.453)。黏液性癌组与非黏液性癌组初治时对紫杉醇+卡铂的化疗反应率无差异(63.2%vs 85.2%,P=0.212),黏液性癌组的耐药病例似乎与肿瘤分期、手术满意度无关,而且复发后耐药率明显升高至60%。黏液性癌组和非黏液性癌组患者的总体中位无进展生存期(PFS)(22个月vs 17个月,P=0.393)和中位总生存期(OS)(22个月vs 37.5个月,P=0.670)无差异。Ⅰ～Ⅱ期黏液性癌与非黏液性癌两组患者中位PFS(37.5个月vs 44个月,P=0.304)和OS(49个月vs 45个月,P=0.621)亦无差异。满意肿瘤细胞减灭术后的Ⅲ～Ⅳ期患者,黏液性癌组中位PFS比非黏液性癌组短(12个月vs27个月,P=0.003),中位OS也缩短(18个月vs 45个月,P=0.044);不满意肿瘤细胞减灭术后的Ⅲ～Ⅳ期患者两组中位PFS(7.5个月vs 16个月,P=0.533)和中位OS(18个月vs 33个月,P=0.192)无统计学差异。Cox多因素回归分析结果提示,影响患者无进展生存期的因素包括肿瘤病理类型、FIGO分期和手术满意度;而影响总生存期的因素只有手术满意度。结论:卵巢黏液性癌是上皮癌的一个独立类型,晚期黏液性癌患者比非黏液性癌预后差,化疗耐药可能是预后差的原因,需要筛选有效的化疗方案。     

石菖蒲对脐血干细胞成骨分化的影响

背景:研究表明石菖蒲及其活性成分能促进成体神经的发生,对抗衰老和治疗相关神经退行性疾病有良好疗效。目的:探究中药石菖蒲浸提液对脐血干细胞增殖、成骨分化的影响,从中药学角度为促进干细胞的成骨分化提供新的思路。方法:采用溶剂提取法提取中药石菖蒲浸提液;流式细胞分选技术分离筛选脐血干细胞;电子显微镜观察脐血干细胞生长情况;CCK8法观察石菖蒲对脐血干细胞增殖的影响;ELISA方法检测石菖蒲对脐血干细胞培养上清液中骨钙素、骨形态发生蛋白2含量的影响;碱性磷酸酶染色试剂盒检测石菖蒲对脐血干细胞中碱性磷酸酶分布表达的影响。结果与结论:(1)分选出脐血单核细胞中的脐血干细胞纯度可达到(89.66±3.47)%;(2)加入石菖蒲浸提液低剂量、中剂量、高剂量培养脐血干细胞24,48,72 h后,干细胞的增殖率明显高于空白对照组(P<0.05),中剂量组的增殖率高于低剂量、高剂量组(P<0.05);(3)加入石菖蒲浸提液培养脐血干细胞5,10,15 d后,上清液中骨形态发生蛋白2、骨钙素的含量明显高于空白对照组(P<0.05),中剂量组的骨形态发生蛋白2、骨钙素含量高于低剂量、高剂量组(P<0.05);(4)碱性磷酸酶染色结果显示,加入石菖蒲浸提液培养干细胞10 d后碱性磷酸酶的分布表达明显高于空白对照(P<0.05),中剂量组和高剂量组的表达明显高于低剂量组(P<0.05)。(5)结果提示中药石菖蒲可以促进脐血干细胞的增殖以及其成骨分化。     

Detection of human papillomavirus genotypes associated with mucopurulent cervicitis and cervical cancer in Changchun,China

ObjectiveTo determine the prevalence and genotype distribution of human papillomavirus (HPV) infection among Chinese patients with mucopurulent cervicitis (MPC) or cervical cancer (CC).MethodsIn total, 191 cases of CC (n = 66), acute MPC (n = 84), and healthy cervix controls (n = 41) were initially included; samples were collected between May 21, 2008, and October 9, 2011. Cervical specimens were screened for HPV using a nested polymerase chain reaction assay and DNA sequencing.ResultsOverall prevalence of HPV infection was 20.0% in the control group, 53.3% in the MPC group, and 93.8% in the CC group. The predominant genotype detected in all 3 groups was the oncogenic variant HPV 16 (87.7%, 18.7%, and 10.0% in the CC, MPC and control specimens, respectively). The second most frequent genotype among patients with MPC was HPV 58. This variant is also oncogenic and was detected at a higher rate in the MPC group (9.3%) than in the control (2.5%) and CC (1.5%) groups.ConclusionInfection with HPV was prevalent among Chinese women with MPC or CC. Furthermore, the high prevalence of oncogenic genotypes observed among HPV-positive patients with MPC suggests that this group is at increased risk of developing CC.