Time-varying association of second primary malignancy and long-term survival outcomes in patients with head and neck cancer

A high risk of developing second primary malignancy (SPM) has been reported among head and neck cancer patients. Here, we aimed to statistically quantify the impact of SPM development on the survival of head and neck cancer patients. Our study was conducted using the Surveillance, Epidemiology and End Results database to collect the data of 48 316 patients who received curative surgical resection for initial primary head and neck squamous cell carcinoma (IP-HNSCC) in 1975 to 2019. SPM diagnosis was treated as a time-varying covariate and multivariable Cox regression analysis was conducted to estimate the association between SPM development and survival, overall or by the subsite of IP-HNSCC. Of the included patients, 11 238 patients (23.3%) developed SPM during the follow-up period. A significant reduction in survival was observed among patients with SPM (hazard ratio [HR] for overall survival, 3.30; 95% confidence interval [CI]: 3.20-3.41). The impact of SPM development on reduced survival was more significant in patients with localized IP-HNSCC vs regional IP-HNSCC (HR_OS, 3.41; 95% CI: 3.24-3.6 vs HR_OS, 3.18; 95% CI: 3.05-3.31; P for interaction <.001). The survival impact of SPM development was more evident in younger patients than in older patients. SPM in lung and bronchus was associated with the most pronounced reduction in survival, overall and across all subsites of HNSCC. Our results indicated that SPM development led to a significant reduction in survival. A greater survival benefit may be achieved through intensive surveillance for SPM in lung and bronchus targeting younger patients and those with localized HNSCC.     

Clinical Implications of HSC70 Expression in Clear Cell Renal Cell Carcinoma

Purpose: The role of heat shock protein 70 (HSC70) in the progression of clear cell renal cell carcinoma (ccRCC) is unclear. This study explored the effect of the HSC70 on the survival of ccRCC patients.Methods: Immunohistochemical analysis was performed to determine HSC70 expression in samples obtained from 121 ccRCC patients with at least 5 years of follow-up. We also analyzed the association between HSC70 expression and clinicopathological characteristics. Furthermore, the association of overall survival (OS) with HSC70 expression was analyzed using Kaplan-Meier curves. Finally, we used the Oncomine and CCLE databases to determine the effects of HSC70 mRNA expression on ccRCC.Results: HSC70 expression was associated with distant metastasis and death of ccRCC patients. HSC70 was expressed in the nucleus and/or cytoplasm of ccRCC cells. The incidence of distant organ metastasis and death was higher in patients with HSC70 expression than in those without it. Survival analysis revealed that patients with HSC70 expression had significantly shorter OS. Oncomine analyses also showed that the HSC70 mRNA was significantly upregulated in ccRCC tissues.Conclusions: HSC70 expression was related to adverse prognosis, and patients with HSC70 expression had a worse prognosis than those without HSC70 expression. HSC70 may thus serve as a potential therapeutic target for ccRCC.     

Long-term durable repaired cartilage induced by SOX9 in situ with bone marrow-derived mesenchymal stem cells

Background: Microfracture is a common procedure for cartilage repair, but it often produces inferior fibrocartilage. We previously reported that a super positively charged SOX9 (scSOX9) promoted hyaline-like cartilage regeneration by inducing bone marrow derived mesenchymal stem cell differentiation into chondrocytes in vivo. Here we examined the long-term efficacy of cartilage repair induced by microfracture with scSOX9 by assessing the biomechanical property of the repaired cartilage.Methods: A cartilage defect was created at the right femoral trochlear groove in New Zealand female rabbits and microfracture was performed. The scSOX9 protein was administered at the site of microfracture incorporated in a collagen membrane.Results: At 12 and 24 weeks, scSOX9 treatment induced hyaline-like cartilage while collagen-membrane alone induced fibrocartilage and mutant scSOX9-A76E poorly induced cartilage repair. The cartilage matrix in scSOX9-treated group showed highly enriched proteoglycan content. Consistent with the histological feature and the thickness of the repaired cartilage, the mechanical property of scSOX9-induced cartilage was also similar to that of normal cartilage.Conclusion: This long-term in vivo study demonstrated that in combination with microfracture, scSOX9 was able to induce reparative tissue with features of hyaline cartilage which was durable in long-term. This technology has the potential to translate into clinical use for cartilage repair to prevent progression to osteoarthritis.     

基于扎根理论的中成药上市后再评价专家访谈资料分析＊

目的 开展更全面的中成药临床应用资料收集，并对非定量化资料进行定性处理。方法 运用专家深度访谈的方法，以某中成药的临床应用为例，对临床上使用过该中成药的专家进行半结构式访谈，记录并整理访谈资料，引入扎根理论方法进行访谈资料分析。结果 本研究共访谈了10位专家，经扎根理论分析编码，将该中成药的临床应用编码为该药的背景、有效性、安全性、经济便宜性、依从性、临床定位6个主范畴，最终提炼出一个核心类属，并围绕这几个方面的具体信息进行详细分析。结论 通过收集、整理和分析专家经验性信息，丰富了中成药上市后再评价的临床证据集，明确了已上市中成药的临床应用范围，可为后续的临床和科研研究提供证据支持，同时，专家深度访谈和扎根理论分析是对专家经验的挖掘和利用，还可应用于中医经验传承、医者诊疗思维研究等领域。本研究进行了方法探讨和实例验证，以期为后续更高阶的研究奠定基础。     

基于CT图像的评分模型预测食管鳞癌喉返神经旁淋巴结转移风险

目的:基于原发肿瘤及淋巴结CT特征建立评分模型预测食管鳞癌患者喉返神经旁淋巴结(RLN-LN)转移风险。方法:回顾性收集2014年1月至2019年12月于北京大学肿瘤医院行食管癌根治术并清扫RLN-LN的92例食管鳞癌患者。根据术后淋巴结病理结果分为RLN-LN转移组(n=37)和非转移组(n=55)。评估术前CT图像,记录食管癌患者年龄、性别、分化程度、肿瘤位置、肿瘤大小(肿瘤长度、肿瘤厚度、厚度/长度)、RLN-LN大小(淋巴结短径、长径、短径/多平面重建(MPR)最长径]。采用多元logistic回归筛选独立预测因子并建立评分模型,采用ROC曲线评估评分模型及独立预测因子诊断RLN-LN转移的效能,采用Z检验比较曲线下面积(AUC)的差异。应用Hosmer-Lemeshow检验和校准曲线评估模型拟合度。结果:肿瘤位置、肿瘤长度、RLN-LN短径、短径/MPR最长径是RLN-LN转移的独立预测因子,其诊断RLN-LN转移的AUC分别为0.586、0.705、0.831、0.777。基于以上4个CT特征建立评分模型,评分模型诊断RLN-LN转移的AUC为0.903(95%CI 0.846~0.959),优于各单一CT特征(Z=5.812,P<0.001;Z=2.161,P=0.030;Z=2.929,P=0.003;Z=4.052,P<0.001)。拟合优度Hosmer-Lemeshow检验结果显示P=0.555,校准曲线提示评分模型预测RLN-LN转移风险与实际转移风险之间具有良好的一致性。结论:基于CT图像的评分模型有助于食管鳞癌RLN-LN转移状态危险分层。     

Changes and significance of plasma fibrinogen gamma‐chain concentration in preeclampsia patients

ObjectiveTo investigate the plasma fibrinogen gamma‐chain concentration in preeclampsia patients and explore its value in preeclampsia prediction and auxiliary diagnosis.MethodsFollow‐up of pregnant women who regularly attended perinatal care at two hospitals in China was performed, and clinical data and plasma samples were collected at each examination until delivery. The gamma‐chain concentration was detected by Western blotting, and Quantity One Software was used for gamma‐chain grayscale value measurements.ResultsForty‐two patients with preeclampsia and 42 control patients completed the follow‐up. In the control group, the gamma‐chain concentration at 32 weeks of gestation was higher than that at 20 weeks of gestation, but the difference was not statistically significant (p > 0.05). In the experimental group, the gamma‐chain concentration at preeclampsia diagnosis was significantly higher than that at 20 weeks of gestation (p < 0.05). Compared with the control group, the gamma‐chain concentration was higher at 20 weeks of gestation in the experimental group, but the difference was not statistically significant. However, at 32 weeks of gestation and at the time of diagnosis, the gamma‐chain concentration in the experimental group was significantly higher than that in the control group (p < 0.05). At 32 weeks of gestation and at the time of diagnosis, the AUCs from ROC curve analysis of plasma fibrinogen gamma‐chain concentrations were 0.64 and 0.71, respectively.ConclusionPlasma fibrinogen synthesis and degradation were disrupted in preeclampsia patients before and after diagnosis, and gamma‐chain concentration was significantly increased. Plasma fibrinogen gamma chain may be of some value in preeclampsia prediction and auxiliary diagnosis.     

清热透邪法在新冠肺炎中的应用＊

目前新冠肺炎中医归属于“疫病”“瘟疫”范畴。其病因为疫戾邪气从口鼻而入，病理特点主要涉及湿、热、毒、瘀、浊、虚6个方面，但对于其病邪的性质，中医学界尚无完全统一认识。呈现百花齐放百家争鸣状态，此次疫病，王灿晖教授认为部分患者虽极早期或早期疠气挟夹寒湿为患，但速传于肺，以致出现高热、咳嗽、苔黄腻等肺热之征，秉承“祛邪为第一要义”，笔者临床根据王灿晖教授理论观点，施以“清热透邪”之法，获得良好效果，并列举典型案例，以期丰富中医药治疗新冠肺炎的理论与实践。     

课程思政改革背景下温病学思政教育探索与实践

在新的时代背景下，将课程思政教育全面深入高校教学课程已经成为中医药高等教育教学改革工作的重要目标。作为中医学重要的经典及专业课程之一，《温病学》的教学内容中蕴含着丰富的课程思政元素。在前期对2018级中医学本科五年制学生开展课程思政需求的问卷调查基础上，进行学情分析。并以此为依据，在《温病学》教学内容中融入和渗透思想政治教育，从爱国情怀和奉献精神、救死扶伤的医学精神、职业伦理和道德、科学精神和社会责任、文化传承与创新创业等多角度探索实施温病学课程思政的有效路径，达到增强爱国精神、培养奉献精神、培育传承精神、激发创新精神、唤起人文精神的目的。以期在传授温病学知识的同时，构建思政教育与温病学课堂教学有效整合的教学环境，全面落实立德树人的根本任务，实现知识传授与世界观、人生观、价值观教育同频共振，为中医药事业培养德才兼备的优秀人才。     

异丙酚持续静脉泵入麻醉对接受微波消融治疗的原发性肝癌患者血管内皮糖萼和脑代谢的影响

目的 探讨应用丙泊酚持续静脉泵注麻醉对接受手术治疗的原发性肝癌(PLC)患者血管内皮糖萼和脑代谢的影响。方法 2017年8月～2020年7月在我院行微波消融术治疗的PLC患者78例,其中一半患者接受异丙酚麻醉,另一半接受地佐辛麻醉。在术前(T0)、术后1 d(T1)和术后7 d(T2),行血气分析,计算脑氧摄取率(CEO₂),采用ELISA法检测硫酸乙酰肝素酶(HS)和多配体蛋白聚糖-1。结果 异丙酚麻醉组诱导时间和苏醒时间分别为(40.3±3.2) s和(6.5±0.8)min,显著短于地佐辛麻醉组【分别为(52.0±3.1) s和(9.8±1.1) min, P<0.05】;在T1和T2,异丙酚麻醉组HS分别为(17.3±2.1)pg/ml和(8.2±0.4)pg/ml,显著低于地佐辛麻醉组【分别为(37.2±5.6)pg/ml和(16.0±2.5)pg/ml,P<0.05】,血清多配体蛋白聚糖-1水平分别为(8.2±0.1)pg/ml和(3.8±0.1)pg/ml, 显著低于地佐辛麻醉组【分别为(11.7±1.4)pg/ml和(5.9±0.2) pg/ml,P<0.05】,CEO₂分别为(28.0±2.4)%和(32.7±3.7)%,显著高于地佐辛麻醉组【分别为(25.0±3.1)%和(29.7±4.1)%,P<0.05】。结论 应用异丙酚持续静脉泵注麻醉在接受微波消融治疗的PLC患者能抑制血管内皮糖萼的激活,改善脑代谢,提高麻醉效果,减少并发症的发生。