简明膳食自评工具在食管癌术后患者中的应用评价

目的将简明膳食自评工具（SDSAT）应用在食管癌术后患者中，评价其信度和效度。 方法本研究通过3个研究分别测量SDSAT的评定者间信度、重测信度和预测效度。研究A选择食管癌术前患者60例，由2位研究者分别进行SDSAT的测量，评价评定者间信度。研究B最终纳入食管癌术后1个月患者30例进行SDSAT的测量，间隔2周复测1次，比较2次结果，评价重测信度。研究C最终共纳入171例食管癌患者通过测量术前、术后1个月和术后3个月3个时间点测量，评价SDSAT对前白蛋白含量的预测程度。 结果评定者间信度是0.854（P<0.01）。 重测信度是0.782（P<0.01）。通过广义预测方程发现SDSAT对患者的前白蛋白含量预测效果好（P<0.01）。结论SDSAT信效度好，适合应用于评价食管癌术后患者的饮食状况。     

Characterization of infections and hypogammaglobulinemia treated with the combination of pertuzumab and trastuzumab

We update a patient series that reported a high incidence of infection with Gram-positive cocci in women treated with the combination of pertuzumab and trastuzumab and further characterize this clinical problem. Treating physicians and advanced practice partners identified women who developed infections while on treatment with pertuzumab and trastuzumab alone or in combination with chemotherapy and enrolled them onto this registry trial. Between March, 2014 and May, 2017, 48 patients with HER2-positive breast cancers were reported to have 59 individual infections. The median age was 48 years. Twenty-four patients received neoadjuvant therapy, 17 were treated for metastatic disease, and 7 were treated in the adjuvant setting. Pertuzumab and trastuzumab were combined with carboplatin and docetaxel in 24 (49%) patients, docetaxel in 10 (21%), nab-paclitaxel in 12 (24%), and without other agents in 2 (4%). Granulocyte growth factors were administered in 24 (49%) patients and no patients were documented to be neutropenic. Folliculitis developed in 25 (52%) patients and was counted as a single infection. Abscesses developed at a number of sites in 24 (49%) patients, including a septic knee requiring total knee replacement. Paronychia occurred in 7 (15%) patients, and 5 (10%) developed cellulitis. When cultures were obtained, Gram-positive cocci were consistently identified. Hypogammaglobulinemia was documented in 14 (36%) of the 33 patients tested. Our data continue to support an increased risk of infections with Gram-positive cocci as a potentially serious adverse event in women treated with pertuzumab and trastuzumab.     

Hepatitis B virus infection and the risk of cancer among the Chinese population

The relationship between hepatitis B virus (HBV) and nonhepatocellular cancers remains inconclusive. This large case-control study aimed to assess the associations between HBV infection status and multiple cancers. Cases (n = 50 392) and controls (n = 11 361) were consecutively recruited from 2008 to 2016 at the First Affiliated Hospital of Nanjing Medical University. Multivariable adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression by adjusting age and gender. A meta-analysis based on published studies was also performed to verify the associations. Of these, 12.1% of cases and 5.5% of controls were hepatitis B surface antigen (HBsAg) seropositive. We observed significant associations between HBsAg seropositivity and esophagus cancer (aOR [95% CI] = 1.32 [1.13-1.54]), stomach cancer (1.46 [1.30-1.65]), hepatocellular carcinoma (HCC; 39.11 [35.08-43.59]), intrahepatic and extrahepatic bile duct carcinoma (ICC and ECC; 3.83 [2.58-5.67] and 1.72 [1.28-2.31]), pancreatic cancer (PaC; 1.37 [1.13-1.65]), non-Hodgkin lymphoma (NHL; 1.88 [1.61-2.20]) and leukemia (11.48 [4.05-32.56]). Additionally, compared to participants with HBsAg−/anti-HBs−/anti-HBc−, participants with HBsAg−/anti-HBs−/anti-HBc+, indicating past HBV-infected, had an increased risk of esophagus cancer (aOR [95% CI] = 1.46 [1.24-1.73]), stomach cancer (1.20 [1.04-1.39]), HCC (4.80 [3.95-5.84]) and leukemia (15.62 [2.05-119.17]). Then the overall meta-analysis also verified that HBsAg seropositivity was significantly associated with stomach cancer (OR [95% CI] = 1.23 [1.14-1.33]), ICC (4.05 [2.78-5.90]), ECC (1.73 [1.30-2.30]), PaC (1.26 [1.09-1.46]), NHL (1.95 [1.55-2.44]) and leukemia (1.54 [1.26-1.88]). In conclusion, both our case-control study and meta-analysis confirmed the significant association of HBsAg seropositivity with stomach cancer, ICC, ECC, PaC, NHL and leukemia. Of note, our findings also suggested that the risk of stomach cancer elevated for people whoever exposed to HBV.     

翻转课堂教学法在消化内科临床带教的应用评价

目的 探讨翻转课堂教学法在消化内科临床带教的教学效果.方法 选取2018年10月—2019年10月在消化内科进行临床见习的护生48人(全部为女生),按照实习先后顺序,前24人作为试验组,给予翻转课堂教学法教学;后24人作为对照组,采用传统的带教模式.讨论两组护生在理论和操作成绩和对带教满意度方面有无差异.两组学生在试验开始之前的成绩相比较,差异无统计学意义(P>0.05).结果 试验组在理论、操作、教学满意度等方面的成绩均高于对照组,P<0.05.结论 翻转课堂教学法在消化内科的临床带教中有较好的教学效果,可以提高学生的学习成绩和教学满意度.     

以时机理论为基础的家庭护理干预对急性心肌梗死患者生活质量的影响

目的分析以时机理论为基础的家庭护理干预对急性心肌梗死患者生活质量的影响。方法将102例急性心肌梗死行冠状动脉介入术(PCI)后患者随机分为对照组(n=51)与观察组(n=51),对照组给予常规心内科护理与随访,观察组在对照组基础上采用以时机理论为基础的家庭护理干预。比较2组出院时、出院3个月、出院6个月的治疗依从性、生活质量、心血管事件发生率与再入院率。结果研究过程中,对照组有2例失访或中途退出,观察组有1例中途退出。观察组出院3、6个月后的治疗依从性及生活方式依从性优于对照组,差异有统计学意义(P 0.05)。观察组出院时及出院3、6个月生活质量评分总分及多个维度评分低于对照组,差异有统计学意义(P 0.05或P 0.01)。观察组心血管事件发生率和再入院率均低于对照组,差异有统计学意义(P 0.05)。结论以时机理论为基础的家庭护理可有效提高急性心肌梗死患者的治疗依从性,改善患者生活质量,降低心血管事件发生率和再入院率。     

Translating genomic insights into cardiovascular medicine: Opportunities and challenges of CRISPR-Cas9

The growing appreciation of human genetics and genomics in cardiovascular disease (CVD) accompanied by the technological breakthroughs in genome editing, particularly the CRISPR-Cas9 technologies, has presented an unprecedented opportunity to explore the application of genome editing in cardiovascular medicine. The ever-growing genome editing toolbox includes an assortment of CRISPR-Cas systems with increasing efficiency, precision, flexibility, and targeting capacity. Over the past decade, the advent of large-scale genotyping technologies and genome-wide association studies (GWAS) has provided numerous genotype-phenotype associations for diseases with complex traits. Notably, a growing number of loss-of-function mutations have been associated with favorable CVD risk-factor profiles that may confer protection. Combining the newly gained insights of human genetics with recent breakthrough technologies, such as the CRISPR-Cas9 technologies, holds great promise in elucidating novel disease mechanisms and transforming genes into medicines. Nonetheless, translating genetic insights into novel therapeuties remains challenging. Applications of “in body” genome editing for CVD treatment and engineering cardioprotection remain mostly theoretical. Here we highlight the recent advances of the CRISPR-based genome editing toolbox and discuss the potential and challenges of CRISPR-based technologies for translating GWAS findings into genomic medicines.     

鼓膜大穿孔耳内镜下鼓膜成形术的临床报告

目的探讨对鼓膜大穿孔病例应用耳内镜下单纯鼓膜成形术的疗效。方法选取2015年9月-2018年1月收治的鼓膜大穿孔患者43例(46耳),耳内镜下采取耳屏软骨-软骨膜进行鼓膜成形术,对鼓膜愈合及听力情况进行评价。结果 43耳鼓膜愈合,3耳未愈合,愈合率93.5%,听力改善患者满意,1例出现迟发性面瘫,药物治疗后恢复,其余均无并发症出现。结论耳内镜下应用耳屏软骨-软骨膜修补鼓膜大穿孔操作相对简单,能抵近观察,手术成功率高,比显微镜下手术更具优势,利于年轻医师上手,值得临床推广。     

Morphine reverses the effects of 1-methyl-4-phenylpyridinium in PC12 cells through activating PI3K/Akt

Aim of the study: Parkinson’s disease (PD) is a neurodegenerative disorder. It is caused by the degeneration of dopaminergic neurons and the dopamine (DA) deletion in the substantia nigra pars compacta (SNpc). Morphine elevates the level of dopamine in the mesolimbic dopamine system and plays a role in alleviating PD symptoms. However, the molecular mechanism is still unclear. The aim of the study is to investigate the mechanism on morphine alleviating PD symptoms.

Materials and methods: The viability of PC12 cells was measured by using MTT assay. The expressions of tyrosine hydroxylase (TH), thioredoxin-1 (Trx-1), CyclinD1 and Cyclin-dependent kinase5 (Cdk5) were detected by Western Blot.

Results: In present study, we found that morphine increased the cell viability in PC12 cells. 1-methyl-4-phenylpyridi-nium (MPP+) reduced the cell viability and TH expression, which were reversed by morphine. MPP+ decreased the expressions of Trx-1, CyclinD1, Cdk5, which were restored by morphine. Moreover, the role of morphine in restoring the expressions of Trx-1, CyclinD1 and Cdk5 decreased by MPP+ was abolished by LY294002, phosphatidylinositol-3-kinase (PI3K)/Akt inhibitor.

Conclusions: These results suggest that morphine reverses effects induced by MPP þ through activating PI3K/Akt pathway.