老年人群亚健康成因及运动处方干预探讨

从当前我国老年退休人群亚健康现状出发,运用文献资料法对老年人群这一特殊群体的亚健康成因进行了探讨与分析,指出社会环境因素、饮食营养因素、生活行为因素、精神心理因素以及自身躯体因素是其产生亚健康状态的主要原因,同时提出了相应的运动干预对策,以其为改善老年人群亚健康状态提供科学依据。     

Whither surgical quality assurance of breast cancer surgery (surgical margins and local recurrence) after paterson

Purpose

The randomized phase III JO21095 trial compared the efficacy and safety of low-dose capecitabine plus docetaxel combination therapy (XT) versus single-agent administration of docetaxel in anthracycline-pretreated HER2-negative metastatic breast cancer.

Methods

Patients were randomized to either low-dose XT (capecitabine 825 mg/m² twice daily, days 1–14; docetaxel 60 mg/m², day 1 every 3 weeks) or docetaxel (70 mg/m², day 1 every 3 weeks). The primary objective was to demonstrate superior progression-free survival (PFS) with low-dose XT versus single-agent docetaxel. Overall survival (OS) and safety were secondary endpoints.

Results

In total, 162 patients were treated. Median PFS was 10.5 months with low-dose XT and 9.8 months with single-agent docetaxel (hazard ratio [HR] 0.62 [95% confidence interval (CI) 0.40–0.97]; p = 0.03). The OS HR was 0.89 (95% CI 0.52–1.53; p = 0.68). Grade ≥3 treatment-related toxicities occurred in 74% of XT-treated patients and 76% of docetaxel-treated patients. The main differences in grade ≥3 treatment-related toxicities were hand-foot syndrome (7.3% of XT-treated patients vs 0% receiving docetaxel), fatigue/malaise (2.4 vs 10.0%), and peripheral edema (1.2 vs 7.5%). Dose modifications were required in 100% of low-dose XT and 49% of docetaxel patients. Toxicity-related treatment discontinuations occurred in 18 and 33%, respectively.

Conclusion

The improved PFS with low-dose XT versus docetaxel alone is consistent with higher-dose XT phase III experience, but the safety profile was more favorable and manageable.

     

The sensitivity of pre-operative axillary staging in breast cancer: Comparison of invasive lobular and ductal carcinoma

Introduction

Axillary ultrasound (AUS) with fine-needle aspiration (FNA) biopsy of abnormal lymph nodes is important for pre-operative staging and planning the surgical management of the axilla. Invasive lobular carcinoma (ILC) metastases are thought to be difficult to detect because the cells are small and on cytology resemble lymphocytes. To investigate this we directly compared the sensitivity of pre-operative axillary staging between ILC and invasive ductal carcinoma (IDC).

Method

Consecutive patients that presented in a single breast unit with pure IDC between April 2005 and December 2006 and pure ILC between January 2008 and December 2012 were retrospectively identified from pathology records. Pre-operative axillary ultrasound and FNA biopsy results were compared with post-operative histopathology from the sentinel node biopsy (SNB) or axillary lymph node dissection (ALND).

Results

A total of 275 and 142 axillae were identified in the IDC and ILC groups respectively. In the node positive patients there was no significant difference in the sensitivity of AUS (IDC vs. ILC; 58.7% vs. 52.8%). However, there was a significant difference in the sensitivity of ultrasound-guided FNA biopsy of abnormal nodes (IDC vs. ILC; 98.4% vs. 53.6%; p < 0.001).

Conclusion

AUS has comparative sensitivities between IDC and ILC populations. In contrast, FNA biopsy of abnormal axillary nodes is clearly less sensitive in the ILC group. In these patients, who have abnormal AUS, we suggest that a core biopsy is required to improve the pre-operative staging and prevent unnecessary surgical procedures.     

Aggregated low‐density lipoprotein induce impairment of the cytoskeleton dynamics through urokinase‐type plasminogen activator/urokinase‐type plasminogen activator receptor in human vascular smooth muscle cell

Summary. Background: Urokinase‐type plasminogen activator (UPA) regulates vascular smooth muscle cell (VSMC) functions relevant in vascular remodeling by facilitating proteolysis at the cell surface and inducing cell signaling pathways. Our previous results demonstrated that aggregated low‐density lipoprotein (agLDL) impair cytoskeleton dynamics, a key event contributing to VSMC behavior during progression of atherosclerotic plaques. Objectives: To investigate whether mechanisms underlying inhibition of cytoskeleton dynamics in lipid‐loaded VSMC occurs through a UPA‐mediated process. Methods: Adhesion assay was performed in lipid‐loaded human VSMC after 16‐h exposition to agLDL (100 μg mL^?1). Protein subcellular localization and actin‐fiber formation were assessed by confocal microscopy. For analysis of protein expression western blots were carried out. Co‐immunoprecipitates of UPAR were examined by one‐dimensional‐ or two‐dimensional electrophoresis (1‐DE or 2‐DE), mass spectrometry MALDI‐TOF and western blot. Results: agLDL induced UPA subcellular delocalization and significantly decreased UPA levels during attachment of VSMC. UPA (enhanced endogenous‐expression or exogenous added) acting as a urokinase‐type plasminogen activator receptor (UPAR)‐ligand restored actin‐cytoskeleton organization and adhesion capacity of lipid‐loaded cells to control levels. UPAR co‐immunoprecipitated with the unphosphorylated form of myosin regulatory light chain (MRLC) in lipid‐loaded cells. The detrimental effects of agLDL on MRLC phosphorylation were reversed by high levels of UPA. The UPA effects on VSMC exposed to agLDL involved FAK phosphorylation. Conclusions: The detrimental effects of atherogenic LDL on VSMC are mediated by a decrease and delocalization of the UPA–UPAR interaction that result in an impairment of cytoskeleton dynamics and adhesion capacity affecting cell phenotype and function.