CACNA1C基因表达水平对弥漫性大B细胞淋巴瘤利妥昔单抗耐药的预测价值

目的:探讨钙离子通道A1C（calcium voltage-gated channel subunit alpha1 C，CACNA1C）基因表达水平对弥漫性大B细胞淋巴瘤（diffuse large B cell lymphoma，DLBCL）患者利妥昔单抗耐药的预测价值。方法:选取我院在2015年3月至2017年5月收治的DLBCL患者93例，均采用利妥昔单抗+CHOP方案化疗，随访2年，根据淋巴瘤化疗疗效评定标准，分为利妥昔单抗耐药组和敏感组；免疫组化法检测所有患者肿瘤组织的钙调蛋白CACNA1C基因、B淋巴细胞瘤-2（B-cell lymphoma-2，BCL-2）基因、PRDM1基因表达情况；绘制受试者工作曲线（receiver operating characteristic curve，ROC），分析CACNA1C基因、BCL-2基因、PRDM1基因水平在预测DLBCL利妥昔单抗耐药中的效能。结果:93例患者中共出现利妥昔单抗耐药病例26例，耐药率为27.96%；在一般资料方面耐药与敏感病例比较差异无统计学意义（P>0.05）；耐药组患者CACNA1C着色细胞比例（40.12±15.44)% vs (69.62±17.65）%低于敏感组，BCL-2着色细胞比例（66.31±15.92)% vs (47.43±14.66）%高于敏感组，PRDM1着色细胞比例（73.42±21.64)% vs (56.73±18.59）%高于敏感组，差异具有统计学意义（P<0.05）；ROC曲线显示，CACNA1C基因（AUC=0.848，95%CI=0.765~0.932）曲线下面积大于BCL-2基因（AUC=0.777，95%CI=0.673~0.881）和PRDM1基因（AUC=0.615，95%CI=0.486~0.744）；CACNA1C与BCL-2基因表达联合预测的曲线下面积（AUC=0.915，95%CI=0.854~0.976）显著高于三种基因表达水平单独预测，其中CACNA1C基因的最佳截点值为58.61%，BCL-2的最佳截点值为48.33%，此时联合预测在预测利妥昔单抗耐药的敏感性和特异性分别为80.77%和89.55%。结论:CACNA1C基因表达水平在预测DLBCL患者利妥昔单抗耐药方面具有较好的价值，其中CACNA1C与BCL-2联合预测利妥昔单抗耐药价值更高。     

食管癌术后康复期患者营养状况及生命质量的纵向研究

目的 了解食管癌术后康复期患者营养状况及生命质量的变化趋势及相关关系。方法 以四川省肿瘤专科医院行食管癌手术治疗的75例患者为研究对象，在患者术后1个月、3个月和6个月时运用患者主观整体营养评估量表进行营养评估，采用肿瘤生命质量测评量表和食管癌患者补充量表进行生命质量评定。结果 食管癌患者术后随时间的延长营养不良发生率由73.4%下降至33.5%。生活质量各维度评分在各评估时间点差异均有统计学意义（P<0.05），功能领域和症状领域在术后1个月与术后3个月、术后6个月比较有统计学意义（P<0.05），术后3个月与术后6个月比较差异无统计学意义（P>0.05）。患者营养状态与躯体、角色、情绪及社会功能呈负相关（P<0.05），与吞咽困难、进食、反流、梗阻、食欲减退、咳嗽症状呈正相关（P<0.05）。结论 食管癌术后1个月患者营养状况及生命质量较差，随时间推移逐渐好转。医护人员应根据患者在不同时间点营养状况及生命质量的变化特点，制定规范化和个体化的延续护理方案，以促进患者术后康复、提高生命质量。     

新型冠状病毒肺炎与传染性非典型肺炎的流行病学特征分析

新型冠状病毒肺炎(COVID-19)与非典型肺炎(严重急性呼吸综合征,SARS)均是由冠状病毒引起的严重的传染性疾病,二者的发病原因至今仍不清楚且目前均无特效的治疗药物。因此,了解COVID-19与SARS的流行病学及病理病原学特征对其预防和治疗就显得尤为重要。本文通过回顾文献,并结合国内外的最新研究现状,从病原学、三间分布和病理学等方面对COVID-19与SARS两种疾病进行了探讨。结果 显示,两种传染病在临床特征上存在很多相同点,但在疾病进程、严重程度和影像学上存在一定差异,COVID-19的传染比SARS更强,但其病死率低于SARS,并且两者的病理改变也有所不同。本文还通过对比SARS流行时的经验与教训,梳理了此次COVID-19疫情期间疾病防控存在的漏洞与不足,以及针对现阶段存在的问题提出建议,从而为两种疾病的预防、治疗及发病机制研究提供一定的科学依据。     

SMYD3 promotes implant metastasis of ovarian cancer via H3K4 trimethylation of integrin promoters

Detachment of cancer cells from the primary tumor and formation of spheroids in ascites is required for implantation metastasis in epithelial ovarian cancer (EOC), but the underlying mechanism of this process has not been thoroughly elucidated. To mimic this process, ovarian cancer cells were grown in 3D and 2D culture. Hey and OVCA433 spheroids exhibited decreased cell proliferation and enhanced adhesion and invasion. SMYD3 expression was elevated in ovarian carcinoma spheroids in association with increased H3K4 methylation. Depletion of SMYD3 by transient siRNA, stable shRNA knockdown and the SMYD3 inhibitor BCI-121 all decreased spheroid invasion and adhesion. Gene expression arrays revealed downregulation of integrin family members. Inhibition assays confirmed that invasion and adhesion of spheroids are mediated by ITGB6 and ITGAM. SMYD3-deficient cells regained the ability to invade and adhere after forced overexpression of SMYD3, ITGB6 and ITGAM. However, this biological ability was not restored by forced overexpression of SMYD3 in ITGB6- and/or ITGAM-deficient cancer cells. SMYD3 and H3K4me3 binding at the ITGB6 and ITGAM promoters was increased in spheroids compared to that in monolayer cells, and the binding was decreased when SMYD3 expression was inhibited, consistent with the expression changes in integrins. SMYD3 expression and integrin-mediated adhesion were also activated in an intraperitoneal xenograft model and in EOC patient spheroids. In vivo, SMYD3 knockdown inhibited tumor metastasis and reduced ascites volume in both the intraperitoneal xenograft model and a PDX model. Overall, our results suggest that the SMYD3-H3K4me3-integrin pathway plays a crucial role in ovarian cancer metastasis to the peritoneal surface.     

Management of hip fracture in COVID-19 infected patients

Given that the global population of elderly individuals is expanding and the difficulty of recovery, hip fractures will be a huge challenge and a critical health issue for all of humanity. Although people have spent more time at home during the coronavirus disease 2019 (COVID-19) pandemic, hip fractures show no sign of abating. Extensive studies have shown that patients with hip fracture and COVID-19 have a multifold increase in mortality compared to those uninfected and a more complex clinical condition. At present, no detailed research has systematically analyzed the relationship between these two conditions and proposed a comprehensive solution. This article aims to systematically review the impact of COVID-19 on hip fracture and provide practical suggestions. We found that hip fracture patients with COVID-19 have higher mortality rates and more complicated clinical outcomes. Indirectly, COVID-19 prevents hip fracture patients from receiving regular medical treatment. With regard to the problems we encounter, we provide clinical recommendations based on existing research evidence and a clinical flowchart for the management of hip fracture patients who are COVID-19 positive. Our study will help clinicians adequately prepare in advance when dealing with such patients and optimize treatment decisions.     

Coexistent light chain deposition disease,light chain cast nephropathy,and vascular light chain amyloidosis in a patient with IgD lambda multiple myeloma

International Urology and Nephrology -