Testing the 2017 PHC reform through pilots: Strengthening prevention and chronic care coordination

Numerous official reports have highlighted insufficient provision of preventive services within primary health care (PHC) in Poland. Other identified weaknesses include inappropriate referrals to ambulatory care that contribute to long waiting times for specialist consultations. Since mid-2018, a new model of PHC organization has been piloted and can be seen as an attempt to address some of these weaknesses. It draws on the Primary Health Care Act of 2017 and puts much more emphasis on disease prevention and health promotion within PHC as well as shifts management of common chronic conditions to multidisciplinary PHC teams. The implementation of this model has been supported by a range of financial and non-financial measures, including a special grant that helps PHC practices to adapt their IT systems to the requirements of the pilot. Yet, the overall requirements were prohibitive to most PHC practices and only 42 were eventually included in the pilot. In this paper, we describe the content of this model, the difficulties in its implementation and how they were addressed and discuss its possible effects on PHC and the health system more broadly.     

The evolution into personalized therapies in pancreatic ductal adenocarcinoma: challenges and opportunities

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is projected to be the second leading cause of cancer related mortality in the United States in 2030, with a 5-year overall survival of less than 10% despite decades of extensive research. Pancreatic cancer is marked by the accumulation of complex molecular changes, complex tumor-stroma interaction, and an immunosuppressive tumor microenvironment. PDAC has proven to be resistant to many cytotoxic, targeted and immunologic treatment approaches.

Areas covered: In this paper, we review the major areas of research in PDAC, with highlights on the challenges and areas of opportunity for personalized treatment approaches.

Expert commentary: The focus of research in pancreatic cancer has moved away from developing conventional cytotoxic combinations. The marked advances in understanding the molecular biology of this disease especially in the areas of the microenvironment, metabolism, and DNA repair have opened new opportunities for developing novel treatment strategies. Improved understanding of molecular abnormalities allows the development of personalized treatment approaches.     

Inflammation-Modulating Effect of Butyrate in the Prevention of Colon Cancer by Dietary Fiber

The intestinal microbiota plays key roles in human health, and adverse dysbiosis shifts of the microbiota have been associated with chronic diseases, including large bowel cancer. High-fiber diets may reduce the risk for large bowel cancer in association with gut microbiota modulation and butyrate production. Butyrate can inhibit histone deacetylases and associated signaling pathways in cultured cancer cells, promoting cancer cell apoptosis. However, butyrate has prevented colon cancer through the regulation of immune homeostasis rather than histone deacetylases inhibition. It could be important to further examine the pathways of how butyrate encourages immune system changes. We posited that butyrate-activated T-regulatory cells block proinflammatory T cells and thus reduce proinflammatory cytokine production; these cytokines increase cell proliferation and cell survival, the 2 most important cancer cell characteristics. Butyrate can exert anticancer effects through inhibition of multiple signaling pathways. It is possible that a low concentration of butyrate could modulate the immune system before other pathways to exert an anticancer effect. Increasing the concentration of butyrate in the intestines may produce a synergistic inhibitory signaling pathway response and an anti-inflammatory effect.     

Imagen de la hipoacusia postraumática

Objective

Hearing loss is the most frequent complication of temporal bone trauma. The role of the radiologist is of great importance; the adequacy and selection of the imaging technique, as well as its correct interpretation, are crucial to establish the diagnosis, prognosis and enable the selection of appropriate treatment. With the aim of systematizing the most relevant concepts in the evaluation of image studies in this scenario, this review will be outlined according to the hearing loss type. The potential lesions of its components will be assessed; In each case the most appropriate imaging technique will be suggested and the findings will be described and depicted.

Biomarker-driven and molecularly targeted therapies for pancreatic adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) remains a deadly disease with few effective treatment options. Our knowledge of molecular alterations in PDAC has significantly grown and helped identify new therapeutic targets. The success of immune checkpoint inhibition in mismatch repair deficient tumors, PARP inhibitors for tumors with DNA repair defects, and targeting hyaluronan with PEGPH20 in patients with high expressing (hyaluronan-high) tumors are examples of promising biomarker-driven therapies. We review the major biological mechanisms in PDAC and discuss current and future directions for molecularly targeted therapies in this disease.     

Insulin-like effects of tungstate and molybdate: mediation through insulin receptor independent pathways

The insulin-like effects of tungstate (W) and molybdate (Mo) were studied in rat adipocytes and compared to those of vanadate. Other than being less potent, W and Mo resembled vanadate in stimulating lipogenesis, in activating glucose oxidation, in enhancing rate of hexose uptake, and in inhibiting lipolysis. Tungstate and molybdate did not activate the insulinreceptor tyrosine kinase (InsRTK). Quercetin which blocks InsRTK activity and insulin stimulation of glucose metabolism, failed to inhibit when these bioeffects were stimulated by W or Mo. The metalooxide, however, activated a staurosporine sensitive non receptor, cytosolic protein tyrosine kinase (CytPTK), and staurosporine blocked W or Mo dependent lipogenesis in rat adipocytes. Staurosporine did not prevent Mo and W either from activating hexose transport, or from inhibiting lipolysis. Tungstate and molybdate were less effective than vanadate in inhibiting adipose PTPases in cell free systems. Membranal PTPases were more sensitive to W and Mo inhibition than cytosolic PTPases. While the presence of a nucleophile such as hydroxylamine reversed inhibition of PTPase by vanadate it did not affect inhibition by W or Mo. In summary, the insulinomimetic effects of W and Mo appear to resemble qualitatively that of vanadate in all respects. Both act in an insulin receptor-independent-fashion, activate CytPTK and trigger additional effects that are not mediated by the InsRTK or by CytPTK. The quantitative differences may be attributed to reduced capacity of W and Mo relative to vanadate to inhibit the relevant PTPases in intact cells.     

慢性重度乙型肝炎住院患者应用临床路径的效果评价

目的 评价在慢性重度乙型肝炎(CSHB)住院患者中应用临床路径(CP)的效果.方法 选择2014年10月至2016年5月重庆市某三甲医院感染病科收治的CSHB住院患者182例,将其分为CP组和非CP(NCP)组.CP组严格按照临床路径信息化系统所设定的流程进行标准化治疗;NCP组依照传统方法执行.评估两组患者住院时间、住院总费用、药品费用、检查检验费用、综合医疗服务费用和医疗材料费,并对患者进行满意度、疾病知识掌握度、出院后按时服药率及门诊随访率调查.结果 CP组患者的住院时间、住院总费用、药品费用和检查检验费用明显低于NCP组(P＜0.05);患者满意度(100.0％)及疾病知识掌握度(97.3％)均高于NCP组(分别为96.2％和92.4％).CP组患者按时服药率与门诊随访率均为98.7％,高于NCP组的95.3％和92.5％,差异有统计学意义(P＜0.05).结论 在CSHB患者中实施CP,能够明显缩短住院时间,减少住院费用,并提高患者满意度和依从性.     

桃儿七可促进慢性粒细胞白血病K562细胞的凋亡

目的 探讨藏药桃儿七对慢性粒细胞白血病K562细胞凋亡的影响及相关机制.方法 用不同浓度的桃儿七对K562细胞株进行不同时间梯度的处理,应用CCK8试验筛选桃儿七的最佳作用浓度及时间;流式细胞术检测细胞凋亡;瑞氏染色观察细胞形态学改变,DAPI染色观察细胞核形态变化;Western blotting分别检测凋亡相关蛋白PARP、caspase-3、Cleaved-caspase3的活化情况以及BCR/ABL、p-BCR/ABL、STAT5、p-STAT5蛋白表达变化.结果 分别以1、2、3μg/mL浓度的桃儿七处理细胞12、24、36、48、72、96 h,K562细胞增殖呈浓度时间依赖性抑制,并筛选出2μg/mL,48 h为最佳处理方式.流式细胞术检测结果显示凋亡细胞数量呈时间依赖性增加,并在48 h凋亡最为显著;凋亡相关蛋白PARP、caspase-3以及Cleaved-caspase-3均呈时间依赖性活化.以2 μg/mL桃儿七处理细胞48 h后,K562细胞形态发生不规则改变,出现核碎裂、溶解等凋亡特征;BCR/ABL、p-BCR/ABL、STAT5、p-STAT5表达显著降低.结论 藏药桃儿七能够促进慢性粒细胞白血病K562细胞凋亡,其机制可能通过抑制BCR/ABL-STAT5信号通路并激活线粒体凋亡途径来实现.     

宣威地区肺腺癌病人肺组织特异miRNAs表达谱和靶基因及其信号通路预测

目的 筛选出宣威地区肺腺癌病人肺组织miRNAs差异表达谱,预测其相关靶基因和信号通路.方法 选取来自宣威地区肺腺癌24例和非宣威地区肺腺癌10例患者手术切除的肺癌组织和正常肺组织标本,miRNAs芯片检测34对肺癌切除标本,筛选宣威肺腺癌miRNAs差异表达谱,AGO分析和KEGG Pathway分析预测其miRNAs的生物与肺癌相关的靶基因和信号通路.结果 miRNAs芯片检测:与非宣威肺腺癌比较,宣威肺腺癌差异表达显著的特异miRNAs34个:表达上调的miRNAs有23个,表达下调的miRNAs有11个.AGO富集分析及KEGG数据库映射分析发现:预测主要集中在PI3K/Alt信号通路附近,其预测靶基因有:GF、RTK、SOS、IRS1、BCAP、CYTOKINSR、ECM、ITGB、FAK和GBY,可能对肺癌生物学功能产生影响的靶基因主要集中在PI3K/Alt,WNT和MAPK通路.结论 筛选出这些特异性miRNAs可能在宣威肺腺癌癌变和进展中起重要作用,预测的靶基因可能与调节PI3K/Alt,WNT和MAPK信号通路的作用有关.