Gene-Loaded Nanoparticle-Coated Sutures Provide Effective Gene Delivery to Enhance Tendon Healing

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左、右半结肠癌骨转移病理特征及预后分析

目的:比较左半结肠癌（LSCC）和右半结肠癌（RSCC）骨转移的病理特征和临床预后差异。方法:对漯河市中心医院2007年1月至2015年12月收治的103例结肠癌骨转移病例资料进行回顾性分析，据解剖位置将64例纳入LSCC组，39例纳入RSCC组，对比分析其病理学特征,绘制并分析生存曲线,筛选预后因素。结果:RSCC骨转移相对LSCC表现为:CA199 阳性率高、年龄大、分化程度更差、分期更晚、预后更差。单因素分析结果示原发肿瘤位置、TNM分期、LDH水平、ALP水平是影响结肠癌骨转移3年生存的相关因素。Logistic多因素回归分析显示原发肿瘤位置、TNM分期、ALP水平是结肠癌骨转移的独立危险因素。结论:左、右半结肠癌在病理特点、临床表现、生物学行为、生存预后等方面存在差异，本文为区分左、右半结肠癌骨转移的不同病理特征及预后评价提供了依据。     

全面两孩政策下已育育龄妇女生育意愿的影响因素及其对策研究

目的：在全面两孩政策下，通过抽样调查上海市户籍已育育龄妇女二孩生育意愿，并分析其影响因素，为生育政策的实施及相关配套的完善提供参考。方法：采用目的抽样的方法，对上海市2个区4个街道的920名夫妻一方为上海市户籍家庭中15~49岁已育一孩妇女进行问卷调查，采用卡方检验、多因素Logistic回归模型进行二孩生育意愿影响因素分析。结果：回收有效问卷904份，其中有二孩生育意愿者20.7%，无意愿者57.7%，不确定者21.6%。回归分析结果显示，育龄妇女年龄、家庭年收入、夫妇类型、生育偏好和区域差异是妇女二孩生育意愿的重要影响因素。结论：全面两孩政策的实施对已生育一孩妇女的二孩生育意愿影响有限，意愿生育子女数明显低于政策允许生育子女数，除生育政策外，还有很多因素制约着人们的二孩生育意愿。全面两孩政策之后，延长产假、哺乳假和提供经济支持是最受期待的育儿支持政策。     

p53 and BLC2 Immunohistochemical Expression Across Molecular Subtypes in 1099 Early Breast Cancer Patients With Long-Term Follow-up: An Observational Study

Introductionp53 and antiapoptotic B-cell leukemia/lymphoma 2 (BLC2) have been proposed as prognostic markers for early breast cancer (BC), although their relationship with conventional parameters and patient prognosis, as well as their distribution within the molecular BC subtypes remains uncertain.Patients and MethodsIn this observational study, we analyzed the immunohistochemical expression of p53 and BLC2 in 1099 early BC patients surgically treated between 2000 and 2006 and followed for at least 5 years, also considering their association with pathologic factors and molecular subtypes, as well as their influence on disease-free survival.Resultsp53 and BLC2 are distributed differently across molecular subtypes (P < .0001); in particular, p53 positivity and BLC2 negativity seems to be associated with more aggressive conventional tumor phenotypes. Moreover, BLC2 negativity seems to be a significant discriminating factor for disease-free survival (P = .003) according to Kaplan-Meier analysis, while p53 seems to have no discriminating effect. Among patients with discordant p53/BLC2 phenotype, the combination p53⁺BLC2⁻ seems to be associated with the worst outcomes (P = .007) and significantly influenced the clinical course of node-negative patients treated only with hormone therapy (P = .004).ConclusionThese two biomarkers, in addition to conventional pathologic factors and molecular subtype, could help define the risk and outcome of BC.     

Hyperprogressive Disease in Patients With Urothelial Carcinoma or Renal Cell Carcinoma Treated With PD-1/PD-L1 Inhibitors

BackgroundA rapid progression pattern called hyperprogressive disease (HPD) has been observed during early cycles of programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitor therapy. Data regarding HPD in patients with genitourinary cancer are limited.Patients and MethodsWe included 203 patients with genitourinary cancer treated with PD-1/PD-L1 inhibitors between February 2015 and June 2018. HPD was defined as a greater than 50% increase in tumor burden, greater than 2-fold increase in tumor growth rate, or development of extensive (10 or more) new lesions.ResultsPatients (n = 102) with renal cell carcinoma (RCC) and patients (n = 101) with urothelial carcinoma (UC) were included. HPD was observed in 13 (6.4%) patients. The median overall survival for patients with progressive disease and HPD was 7.3 months and 3.5 months, respectively. HPD occurred more frequently in patients with UC than in those with RCC (11.9% vs. 0.9%; P = .01). Multivariate analysis showed that UC and creatinine above 1.2 mg/dL were independent predictive factors for HPD. A 30% increase in lymphocyte number following PD-1/PD-L1 inhibitor treatment was a negative predictor of HPD. The incidence of HPD in patients with UC treated with paclitaxel-based chemotherapy was one-third of those treated with PD-1/PD-L1 inhibitors.ConclusionHPD developed predominantly in patients with UC, and the incidence of HPD in patients with RCC was negligible. Treatment with PD-1/PD-L1 inhibitors should be prescribed with caution in patients with UC and creatinine above 1.2 mg/dL.     

小柴胡汤对非酒精性脂肪性肝炎模型小鼠的保护作用研究

目的通过构建蛋氨酸-胆碱缺乏(MCD)饮食诱导的小鼠非酒精性脂肪性肝炎(NASH)模型,研究小柴胡汤对NASH模型小鼠的保护作用。方法选择C57BL/6小鼠为研究对象,将其随机分为对照组、模型组、小柴胡汤(高、中、低剂量)组、易善复组和强肝胶囊组。通过饲喂MCD饲料建立NASH模型,造模同时按分组给予不同药物进行干预;实验过程中记录小鼠体质量、日摄食量、日饮水量变化,实验结束对肝组织进行HE染色观察病理变化,检测血清生化指标丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、白细胞介素6(IL-6)和肿瘤坏死因子-α(TNF-α)的水平变化,检测肝组织中TC、TG的水平变化,利用q RT-PCR技术检测肝组织脂肪酸合成酶(FAS)和固醇调节元件结合蛋白1c(SREBP-1c)的表达水平。结果小鼠体质量、日摄食量、日饮水量及肝脏系数等数据显示MCD饮食诱导的模型组小鼠会出现体质量降低、摄入量减少及肝脏湿质量下降的特点,而小柴胡汤给药组小鼠体质量、摄入量及肝脏系数较模型组小鼠显著升高;HE染色结果显示小柴胡汤可明显减轻肝组织脂肪变性和炎症程度,改善肝细胞的形态和结构;生化指标检测结果显示小柴胡汤能显著降低NASH模型小鼠血清及肝组织TG、TC水平,升高血清中HDL-C水平,降低血清中AST、ALT、IL-6、TNF-α水平;q RT-PCR结果显示模型组小鼠肝组织FAS和SREBP-1c的基因表达水平明显升高,小柴胡汤可显著降低FAS和SREBP-1c的基因表达水平。结论小柴胡汤对MCD饮食诱导的NASH模型小鼠有明显保护作用,其机制可能通过调控抑制脂肪酸合成基因(FAS、SREBP-1c)的表达,减少脂肪堆积,实现调脂作用,并通过抑制炎症因子的表达改善肝组织的损伤。