The surgical outcome of Lisfranc injuries accompanied by multiple metatarsal fractures: A multicenter retrospective study

Background

This study assessed the surgical outcomes of Lisfranc injuries accompanied by multiple metatarsal fractures. Metatarsal fractures here refers to metatarsal head, neck, and shaft (including shaft fractures accompanied by fractures of the base) fractures, as well as mixed (i.e., segmental fracture) fractures, as seen on imaging studies.

Keap1–Nrf2 pathway: A promising target towards lung cancer prevention and therapeutics

ObjectivesDrugs for targeted therapy have become a new strategy of adjuvant therapy for treatment of lung cancer. The Keap1 (kelch-like ECH-associated protein 1)–Nrf2 (nuclear factor erythroid 2-related factor 2) pathway is recognized to be critical in regulating genes related to the cellular protective response and protecting cells from oxidative damages and toxic insult.MethodsPubmed, Embase, OVID, and the Cochrane Library databases were searched from the beginning of each database without any limitations to the date of publication. Search terms were “Nrf2” or “Keap1” and “Lung cancer”.ResultsThe upregulation of Nrf2 had been closely related to tumor protection and drug resistance. The aberrant state of Keap1 or Nrf2 that were frequently found in lung cancer conferred a poor prognosis. Nrf2 could prevent cells from undergoing oncogenesis as a tumor suppressor, while it could also promote cancer progression and resistance to chemotherapeutic drugs as an oncogene, depending on the different stages of tumor progression. Target Nrf2 signaling by specific chemicals showed it could prevent tumor growth or combat chemoresistance.ConclusionsIncreasing evidence has demonstrated the dual roles of the Keap1–Nrf2 pathway in tumor initiation and progression. In this paper, we provide a comprehensive overview of the potency of the Keap1–Nrf2 pathway as an antitumor target, and the current status of Nrf2 activators or inhibitors for therapeutic approaches. Further studies are required to clarify the role of Nrf2 in lung cancer at different tumor stages, in order to maximize the efficacy of Keap1–Nrf2 targeting agents.     

AGR2 and AGR3 play an important role in the clinical characterization and prognosis of basal like breast cancer

Introduction: Basal-like Breast Cancer (BLBC) represents an important molecular subtype of breast cancer characterized by an aggressive behavior, molecular pathology poorly understood and a limited treatment. Objective: We aim to search for molecular differences between non-BLBC and BLBC tumors in order to propose possible diagnostic and prognostic biomarkers using databases. Metodology: Microarray processed data were downloaded from GEO database considering non-BLBC and BLBC. Enrichment analysis was evaluated using GO consortium and Ingenuity, protein–protein interaction, gene Ontology and co-expression analysis using STRING. Gene expression data was extracted using TCGA, METABRIC and Breast Cancer Gene-Expression Miner v4.2 databases. The Survival was evaluated using The Kaplan–Meier plotter. Results: Were identified 58 upregulated and 58 downregulated genes enriched in signaling pathways like PDGF, Angiogenesis, Integrin and WNT. AGR2 and AGR3 expression were reduced in BLBC in relation to non-BLBC tumors, patients aged ≤51 years, and with negativity of ER, PR and HER-2 and nodal status. Low expression of AGR2 and AGR3 were associated with worse OS and RFS for all breast cancer cases. But according to the molecular stratification, low AGR2 conferred worst OS in luminal A, worst RFS in BLBC and good OS and RFS in luminal B. High AGR3 conferred worse OS and RFS in BLBC, but low AGR3 attributed worse OS in luminal A. Conclusion: AGR2 and AGR3 expression were able to differentiate non-BLBC from BLBC. Downregulation of AGR2 and AGR3 was associated with BLBC clinical phenotype. Furthermore, both genes behave different when considering prognosis and molecular stratification.     

Preoperative indocyanine green (ICG) clearance test: Can we really trust it to predict post hepatectomy liver failure? A systematic review of the literature and meta-analysis of diagnostic test accuracy

IntroductionPost hepatectomy liver failure (PHFL) still represents a potentially fatal complication after major liver resection. Indocyanine green (ICG) clearance test represents one of the most widely adopted examinations in the preoperative workup. Despite a copious body of evidence which has been published on this topic, the role of ICG in predicting PHLF is still a matter of debate.MethodsA systematic review of the literature was conducted according to PRISMA-DTA guidelines. The primary outcome was the assessment of diagnostic performance of ICG in predicting PHLF. The secondary outcome was the mean ICG_R15 and ICG_PDR in patients experiencing PHLF.ResultsSeventeen studies, for a total of 4852 patients, were deemed eligible. Sensitivity ranged from 25% to 83%; Specificity ranged from 66.1% to 93.8%. ICG clearance test pooled AUC was 0.673 (95% CI: 0.632-0.713). The weighted mean ICG_R15 was 11 (95%CI: 8.3-13.7). The weighted mean ICG_PDR was 16.5 (95%CI: 13.3-19.8). High risk of bias was detected in all examined domains.ConclusionsPreoperative ICG clearance test alone may not represent a reliable method to predict post hepatectomy liver failure. Its diagnostic significance should be framed within multiparametric models involving clinical and imaging features.     

基于数据挖掘的中药治疗血液病的用药规律分析

目的采用Apriori算法与系统聚类的数据挖掘技术对中药方剂治疗血液病的用药规律进行分析,梳理常用的药物种类,总结药物间的配伍规律和关联规则,为临床血液病治疗的药物组方选择和中成药开发提供数据参考。方法在《中医方剂大辞典》中以"血证""虚劳""急劳""温病""热劳"5个病证作为关键词筛选治疗血液病的方剂,同时在中国知网和万方数据库采用主题"血液病"与全文"中药"进行高级检索,筛选1979——2019年有关中药治疗血液病的文献。根据支持度、置信度、提升度,对治疗血液病的中药方剂的高频次中药、配伍规律、核心中药组合、相互关系网络及聚类结果进行分析。结果共筛选获得100个方剂和中成药制剂,涉及中药64种,总用药频次772,使用频次≥10的中药有25味,频次最高的5味中药是丹参、人参、党参、黄芪和地黄;治疗血液病的中药药性以温(频次291,37.79%)、寒(频次228,29.61%)为主,药味以甘(频次486,41.82%)、苦(频次362,31.15%)为主;其中使用频次较高的核心药物组合包括川芎-当归、白芍-当归、熟地黄-当归、桃仁-当归等7个药对组合和桃仁-川芎-当归、桃仁-红花-当归、红花-川芎-当归等24个3药组合,关联规则分析发现了16种具有潜在配伍关系的白血病治疗药物组合,其中提升度4.7以上的药物组合有4个;聚类分析结果表明,高频使用的单味药物之间,具有关联性的药物组合有8组;高频药物复杂网络分析表明,当归-白芍、当归-茯苓药对和当归-白术-黄芪3药组合间的联系密切。结论治疗血液病高频药物和核心组方中以补虚药、活血药和清热药为主,益气养血、活血化瘀和清热凉血为中医药血液病的主要治法,为恶性血液病的临床用药和新药开发提供理论依据。     

Whole inactivated avian Influenza H9N2 viruses induce nasal submucosal dendritic cells to sample luminal viruses via transepithelial dendrites and trigger subsequent DC maturation

Nasal mucosal barrier is a key impediment for the absorption of influenza whole inactivated virus (WIV) intranasal vaccine. Yet it is still unclear how WIV cross the epithelial cells (ECs) in nasal cavity. Here, in vitro, a coculture system was well established, consisting of surrogate nasal ECs (Calu-3) and dendritic cells (DCs). After adding H9N2 WIV on the apical side of ECs, we found that submucosal DCs extended their transepithelial dendrites (TEDs) and sampled luminal viruses. However, ECs were not involved in the transepithelial transport of viruses. Subsequently, the phenotypic and functional maturation of DCs were also enhanced, whereas they were attenuated after blocking of TED formation by anti-JAM1 antibody. In vivo, we confirmed that H9N2 WIV were capable of inducing nasal submucosal DCs to sample luminal viruses via TEDs in the nasal passage but not nasal-associated lymphoid tissue (NALT). CD103⁺ and CD103⁻ DC subsets participated in this process. Of note, chemokine CCL20, released from the H9N2 WIV-induced ECs, played a vital role in DC recruitment and TED formation. Taken together, our findings indicated that TEDs played a critical role in facilitating viral transport across the epithelial barrier, which may guide the design of novel nasal mucosal vaccine strategies.     

活血化瘀与肿瘤转移机制探讨

血瘀证是恶性肿瘤患者中常见证型,运用活血化瘀法的治疗长久以来在临床和基础研究中争议颇多。分析了肿瘤抗血管治疗研究现状,并在前人基础上提出了活血化瘀与肿瘤血管正常化理论的相关性的新假设。     

中医单病种临床研究数据管理系统的多用户设计策略

中医单病种诊疗方案的临床研究在干预措施、效应指标、研究对象等方面均存在研究质量保证的难点,给随机对照试验设计基本原则的落实带来困难。数据管理系统的多用户设计,将承担不同研究任务的研究者分为5种,分配不同的操作权限,有效保证了隐蔽分组和盲法原则的体现。多用户设计策略可用于多种技术模式的数据管理系统平台,具有可推广性。     

右丙亚胺联合参麦注射液降低蒽环类药物心脏毒性的临床研究

  目的  比较右丙亚胺单用、参麦注射液单用, 或者联合使用参麦注射液和右丙亚胺对血液系统肿瘤患者蒽环类药物多疗程化疗所致心脏不良反应的临床意义, 进一步探讨降低蒽环类药物心脏毒性的途径。  方法  本研究入组120例血液系统肿瘤患者, 共分为4组, 每组30例。A组为参麦组, 在化疗基础上单用参麦注射液, 50 mL/d连用lw; B组为联合使用参麦注射液和右丙亚胺, 在应用蒽环类药物化疗前30 min快速静脉滴入右丙亚胺及阿霉素（剂量10:1）, 非阿霉素蒽环类药物折合成阿霉素。且在化疗开始之日起, 予以参麦注射液50 mL/d, 连用1w;C组为右丙亚胺组, 应用蒽环类药物化疗前30 min予右丙亚胺及阿霉素快速静脉滴入; A、B、C 3组为实验组, D组为空白对照组, 予以常规化疗; 4组患者均按要求完成2个化疗周期, 观察化疗前后4组患者的心电图改变以及超声心动图（左室射血分数LVEF）, B型利钠肽（BNP）, 肌钙蛋白I（TnI）的数值变化。  结果  通过比较化疗前后4组患者的心电图变化和左室射血分数（LVEF）、肌钙蛋白I（TnI）、B型利钠肽（BNP）的数值变化, 实验组心电图异常的发生率、LVEF下降百分比、TnI和BNP的数值升高均小于空白对照组（P < 0.05）。  结论  右丙亚胺、参麦注射液单用以及二者合用, 降低血液系统恶性肿瘤患者接受蒽环类药物多疗程化疗所致心脏毒性, 均有一定疗效, 其中右丙亚胺及参麦注射液联合疗效最佳, 而右丙亚胺单用对心肌细胞保护作用好于参麦注射液单用。在蒽环类药物化疗同时配伍使用参麦注射液及右丙亚胺, 可减低心脏毒性, 值得临床推广应用。