FHIT基因与食管癌发生发展相关性的研究

脆性组氨酸三联体（fragilehistidinetriad，FHIT）基因是1996年克隆确定的一个人类基因，它是作为一个候选抑癌基因被提出的，它被发现在多种肿瘤组织中表达异常。属于组氨酸三联体基因家族，定位于染色体3p14．2区域，其cDNA长1095bp。经研究发现FHIT基因的主要作用为：1）FHIT可诱导细胞凋亡。2）FHIT蛋白可能通过泛素结合酶来调控细胞周期。食管癌是人类常见肿瘤，我国是食管癌高发国家，所以研究其早期诊断方法有很大的临床价值，近年来在研究食管癌的发生与FHIT基因的关系时发现：食管癌在早期阶段大都有FHIT基因的表达缺失。而FHIT基因的甲基化是其中的重要机制，其甲基化是FHIT基因失活的前提。同时，研究发现监测FHIT基因表达缺失对与食管癌的早期诊断及估计预后有一定价值。     

癌症的个体化治疗

个体化是肿瘤治疗过程中常常被忽视的问题，肿瘤生物学的个体化特征决定了肿瘤治疗的个体化。癌症的个体化特性包括时间个体化、空间个体化、解剖上的个体化、结构的个体化、基因的个体化、功能的个体化和人为的个体化等七个方面。医学模式整体观念的形成、后基因组时代的到来，为肿瘤个体化治疗提供了必要的契机和工具。因此，传统的肿瘤临床治疗手段正在逐渐被以更为准确的以分子标志物辅助诊断为依据，分子信息指导下的更为安全有效的个体化治疗所取代。     

复方氨基酸注射液不良反应文献分析

目的:探讨复方氨基酸注射液所致不良反应的一般规律及特点,指导临床合理用药.方法:对医药期刊报道的137例复方氨基酸的ADR进行统计分析.结果:复方氨基酸所致ADR在高年龄组发生率较高,多在用药过程中半小时内发生.ADR累及机体多个器官系统,临床表现复杂多样,主要表现为变态反应,严重者可致过敏性休克甚至死亡.结论:应加强复方氨基酸的应用监测,以减少严重ADR的发生.     

Real-time clinical note monitoring to detect conditions for rapid follow-up: A case study of clinical trial enrollment in drug-induced torsades de pointes and Stevens-Johnson syndrome

Identifying acute events as they occur is challenging in large hospital systems. Here, we describe an automated method to detect 2 rare adverse drug events (ADEs), drug-induced torsades de pointes and Stevens-Johnson syndrome and toxic epidermal necrolysis, in near real time for participant recruitment into prospective clinical studies. A text processing system searched clinical notes from the electronic health record (EHR) for relevant keywords and alerted study personnel via email of potential patients for chart review or in-person evaluation. Between 2016 and 2018, the automated recruitment system resulted in capture of 138 true cases of drug-induced rare events, improving recall from 43% to 93%. Our focused electronic alert system maintained 2-year enrollment, including across an EHR migration from a bespoke system to Epic. Real-time monitoring of EHR notes may accelerate research for certain conditions less amenable to conventional study recruitment paradigms.     

A systematic narrative review of consumer‐directed care for older people: implications for model development

Consumer‐directed care is increasingly becoming a mainstream option in community‐based aged care. However, a systematic review describing how the current evaluation research translates into practise has not been published to date. This review aimed to systematically establish an evidence base of user preferences for and satisfaction with services associated with consumer‐directed care programmes for older people. Twelve databases were searched, including MedLine, BioMed Central, Cinahl, Expanded Academic ASAP, PsychInfo, ProQuest, Age Line, Science Direct, Social Citation Index, Sociological Abstracts, Web of Science and the Cochrane Library. Google Scholar and Google were also searched. Eligible studies were those reporting on choice, user preferences and service satisfaction outcomes regarding a programme or model of home‐based care in the United States or United Kingdom. This systematic narrative review retrieved literature published from January 1992 to August 2011. A total of 277 references were identified. Of these 17 met the selection criteria and were reviewed. Findings indicate that older people report varying preferences for consumer‐directed care with some demonstrating limited interest. Clients and carers reported good service satisfaction. However, research comparing user preferences across countries or investigating how ecological factors shape user preferences has received limited attention. Policy‐makers and practitioners need to carefully consider the diverse contexts, needs and preferences of older adults in adopting consumer‐directed care approaches in community aged care. The review calls for the development of consumer‐directed care programmes offering a broad range of options that allow for personalisation and greater control over services without necessarily transferring the responsibility for administrative responsibilities to service users. Review findings suggest that consumer‐directed care approaches have the potential to empower older people.     

Systematic Searching and Selection of Health State Utility Values from the Literature

Health state utility values (HSUVs) are important parameters in decision models in health technology assessment submissions. Reimbursement agencies, such as the National Institute for Health and Clinical Excellence, recognize that such values are obtainable from the published literature. However, to use published values in health technology assessment submissions, it should be demonstrated that HSUVs have been identified and selected systematically to avoid using biased HSUVs resulting in cost-effectiveness analyses. This article presents guidance on how to conduct a systematic literature review to identify and select HSUVs from the published literature based on the authors’ experience. A case study is used to demonstrate some of the features of a systematic HSUV review. Methods are discussed in relation to identifying and selecting the evidence, performing quality and relevance assessment, and undertaking data extraction. It has been developed from a Technical Support Document produced for the National Institute for Health and Clinical Excellence by the Decision Support Unit at the School of Health and Related Research, University of Sheffield.     

基于数据挖掘的中药辅助化疗治疗晚期结直肠癌的用药规律文献研究＊

目的 分析中药复方辅助化疗治疗晚期结直肠癌的用药规律。方法 借助中国知网、万方数据、重庆维普以及中国生物医学文献数据库数据平台，搜索晚期结直肠化疗并中药经方治疗等相关文献，进行质量评价，剔除低质量文献，罗列组方建立Excel数据库，进行高频药物及其性味归经的描述性统计，基于SPSS Statistics 26.0关联规则及因子分析，SPSS Modeler 18.0聚类分析，Cytoscape软件直观网络图，进行数据挖掘整理与分析。结果 研究纳入相关文献148篇，处方155首，药物191味，用药总频次1823次，核心中药27味（使用频率 ≥ 10%），以白术所用最广。性味以甘温为首，归经以脾经为最。以置信度95%、支持度15%、提升度 > 1进行关联规则分析得到常用三药组合17组。聚类分析以欧式平方距离24为标准得到潜在聚类方剂3个。结论 中药复方用药以清补健脾，甘温扶正；平解邪毒，调气畅腑；肝脾同调，肺胃同治为规律，正合晚期结直肠癌化疗后脾虚毒恋、痰瘀互结之证。研究归纳出中药辅助化疗治疗晚期结直肠癌的用药组方规律，予以临床一定的理论依据及借鉴意义。