中性粒细胞与淋巴细胞比值对三阴性乳腺癌临床预后及与Ki - 67表达的影响

目的 探讨中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）对三阴性乳腺癌的临床预后影响及与Ki - 67表达的关系。方法 回顾性分析2006年1月 - 2012年12月于我院乳腺外科住院治疗的134例三阴性乳腺癌患者。NLR最佳临床分界值采用ROC曲线确定，并依此分NLR＜2.64组和NLR≥2.64组。临床独立预后因素采用单因素和多因素Cox回归模型分析。术后生存时间和生存曲线比较采用Kaplan - Meier和log - rank方法。Ki - 67的表达采用免疫组织化学方法检测。结果 NLR是三阴性乳腺癌的独立预后因素，最佳临界值为2.64。NLR＜2.64组术后中位DFS为39.10月，中位OS为52.30月；NLR≥2.64组术后中位DFS为27.35月，中位OS为37.35月。2组术后DFS和OS比较，差异具有统计学意义（P＜0.05）。NLR低组伴Ki - 67表达阴性的三阴性患者术后中位DFS和OS生存时间显著高于其他情况。结论 NLR是三阴性乳腺癌的关键影响预后因素，具有重复性强、非侵袭性、方便实用等特性，可用于预测三阴性乳腺癌临床预后。     

Effect of multidisciplinary team care on the risk of recurrence in breast cancer patients: A national matched cohort study

BackgroundCancer has been the leading cause of death in the past decade in Taiwan, with breast cancer being the most common type of cancer in females. Very few studies looked at the risk of recurrence in patients who received multidisciplinary team (MDT) care. We analyzed the influence of MDT on the risk of recurrence and death in breast cancer patients.MethodIn this retrospective study, we included newly diagnosed patients from 2004 to 2010. The study included 9,266 breast cancer patients who were enrolled in MDT care and 9,266 patients who were not. The study used log-rank test to analyze patients’ characteristics, hospital characteristics, cancer staging, and treatment methods to compare the recurrence rates in MDT care and non-MDT care participants. We used Cox proportional hazards model to examine the effect of MDT and associated factors on the risk of recurrence and mortality of breast cancer patients.ResultsRelative risk of recurrence was lower for patients who received MDT care than for patients who did not (HR, 0.84; 95%CI: 0.70–0.99) after matching. The mortality risk for breast cancer patients with relapse was 8.48 times (95%CI: 7.53–9.54) than that for patients without relapse.ConclusionsThe relative risk of recurrence and death was significantly lower for breast cancer patients who received MDT care than for those who did not. We suggest that MDT care be implanted in the National Health Policy settings of breast cancer patients.     

Distribution of the HTT Gene A1 and A2 Haplotypes Worldwide: A Systematic Review

Background:Huntington’s disease (HD)(MIM:143100) is an severe autosomal dominant neurodegenerative disease caused by the dynamic expansion of CAG trinucleotides (> 35) in the HTT gene [Genomic Coordinates- (GRCh38):4:3,074,680-3,243,959].Objectives:The aim of this systematic review was to investigate the reported associations between the frequencies of the A1 and A2 haplotypes in HD-affected and non-affected populations from different countries on different continents, in order to demonstrate the overall profile of these haplotypes worldwide, pointing towards the most frequent haplotypes that could be useful for HTT mutant-specific allele silencing in different populations.Methods:Publications in MEDLINE (PubMed) and Embase from the last 10 years (PROSPERO CRD42018115282) were assessed.Results:A total of 20 articles from 113 were selected for evaluation in their entirety, and eight were eligible for this study.Conclusion:Regardless of the size of the CAG tract, the articles included in this review demonstrate that populations with high HD prevalence present higher frequencies of the A1 or A2 haplotypes than populations exhibiting low HD prevalence, even when similar average CAG numbers are noted. Based on the presented articles, we suggest that the haplotypic profile is more closely related to the ancestral origin than to the size of the CAG tract. The identification of populations presenting a higher frequency of high-risk genotypes can contribute to more accurate genetic counseling, in addition to providing knowledge on HD epidemiology. According to the continued progress in the development of specific genetic silencing therapies by different research groups and pharmaceutical companies, such as haplotype targeting strategies for allele-specific HTT suppression, we conclude that the definition of haplotypes in phase with CAG expansions will contribute to the design of gene-silencing drugs specific for different populations worldwide.     

Multidisciplinary team approach to diabetes. An outlook on providers’ and patients’ perspectives

Objective/BackgroundThis study sought to uncover the perspectives of various stakeholders towards multidisciplinary team (MDT) care, discover new understandings and help inform current practice on MDT care for diabetic patients.Methods5 electronic databases were searched for articles that evaluated patients’ and providers’ perspectives on type 2 Diabetes Mellitus (T2DM) MDT management. Articles retrieved were sieved, coded and findings were analytically themed together in accordance to Thomas and Harden methodology.Results15 articles were identified with three common themes: interactions between healthcare providers, benefits to patients and constraints and facilitators of the healthcare system. Trust and synergistic teamwork are important factors in promoting effective care. Patients commended MDT's improved accessibility and convenience and felt more welcomed. Often plagued by poor support, lack of manpower and resources, MDTs are less efficient and incapable of realizing their full potential.ConclusionThis review illustrates that the MDT model does improve diabetes treatment outcome, help prevent or reduce complications. Nevertheless, the MDT model can be a double-edged sword as poor interactions between HCPs can hamper quality patient care. The current MDT model is also based on available resources of the health system. More effort is needed to modify the MDT model to meet the changing needs of patients.     

血清Lp-PLA2,BDNF及Ang1-7表达水平与血管性痴呆患者病情严重程度的相关性

目的 探讨血管性痴呆(VD)患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)、脑源性神经营养因子(BDNF)及血管紧张素1-7(Ang1-7)表达水平及其与VD患者病情严重程度的相关性。方法 选取本院2017年10月-2019年10月收治的120例VD患者,依照简易精神状态检查量表(MMSE)分为轻度组、中度组和重度组,各40例,比较各组相关危险因素,颈动脉超声检测颈动脉内膜中层厚度(IMT),检测血清生化指标[低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)、三酰甘油(TG)、糖化血红蛋白(GHb)、空腹血糖(GLU)]、血清指标[Lp-PLA2,BDNF,Ang1-7、神经元特异性烯醇化酶(NSE)、C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、同型半胱氨酸(Hcy)]水平, 分析Lp-PLA2,BDNF及Ang1-7水平之间的相关性,也分析血清Lp-PLA2,BDNF及Ang1-7水平与MMSE评分的相关性。结果 3组患者年龄、受教育程度、高血压病史、高血脂症史、饮酒、吸烟等临床资料比较均无明显差异(P>0.05),冠心病史、糖尿病史、IMT比较均有明显差异(P<0.05); 3组患者血清LDL-C,HDL-C,TC,TG,GHb,GLU水平比较均无明显差异(P>0.05),血清Lp-PLA2,BDNF,Ang1-7,NSE,CRP,IL-6,TNF-α及Hcy水平比较均有明显差异(P<0.05)。相关性分析显示,血清Lp-PLA2,BDNF及Ang1-7与冠心病史、糖尿病史、血清NSE,CRP,IL-6,TNF-α,LDL-C,TC水平及MMSE评分存在明显相关性。结论 血清Lp-PLA2、BDNF及Ang1-7水平与血管性痴呆患者血清因子水平及VD患者的病情严重程度存在明显相关性,检测血清Lp-PLA2,BDNF及Ang1-7水平有助于VD患者的预防和治疗