Prognostic validity of the American joint committee on cancer eighth edition staging system for well-differentiated pancreatic neuroendocrine tumors

BackgroundThe American Joint Committee on Cancer (AJCC) made improvements for staging pancreatic neuroendocrine tumors (pNETs) in its 8th Edition; however, multicenter studies were not included.MethodsWe collected multicenter datasets (n = 1,086, between 2004 and 2018) to validate the value of AJCC 8 and other coexisting staging systems through univariate and multivariate analysis for well-differentiated (G1/G2) pNETs.ResultsCompared to other coexisting staging systems, AJCC 7 only included 12 (1.1%) patients with stage III tumors. Patients with European Neuroendocrine Tumor Society (ENETS) stage IIB disease had a higher risk of death than patients with stage IIIA (hazard ratio [HR]: 4.376 vs. 4.322). For the modified ENETS staging system, patients with stage IIB disease had a higher risk of death than patients with stage III (HR: 6.078 vs. 5.341). According to AJCC 8, the proportions of patients with stage I, II, III, and IV were 25.7%, 40.3%, 23.6%, and 10.4%, respectively. As the stage advanced, the median survival time decreased (NA, 144.7, 100.8, 72.0 months, respectively), and the risk of death increased (HR: II = 3.145, III = 5.925, and IV = 8.762).ConclusionThese findings suggest that AJCC 8 had a more reasonable proportional distribution and the risk of death was better correlated with disease stage.     

酶敏感多肽胶束的构建及其向T细胞递送药物的可行性研究

目的 构建包载芳烃受体抑制剂CH223191的酶敏感多肽胶束并对其进行表征,初步评估此多肽胶束向T细胞递送药物的可行性。方法 采用固相合成法合成了序列为stearyl-HHHRRRRRPLGLAGK-(Mal)的多肽(SHRP)。制备了载药胶束SHRP-CH,测定了其粒径、载药量、临界胶束浓度等,评价其细胞毒性及免疫原性,并使用流式及激光共聚焦考察了CD8⁺T细胞对胶束的摄取效率。结果 SHRP-CH的粒径为(133.8±7.4)nm,酶处理后粒径减少为(92±5.8)nm,载药量和包封率分别为(7.1±1.2)%、(67.7±2.3)%,酶解前后的胶束均具备较低的细胞毒性;CD8⁺T细胞摄取实验证实了此胶束体系向T细胞递送药物的可行性。结论 SHRP多肽酶敏感胶束体系具有较好的载药能力及低细胞毒性,有希望成为T细胞药物递送的潜在载体。     

多重耐药病原菌对呼吸机相关性肺炎预后的影响

目的探讨多重耐药病原菌对呼吸机相关性肺炎预后的影响。方法选择2012年1月至2018年6月在上海市肺科医院诊断为VAP的382例患者作为研究对象,观察临床资料与预后的相关性。结果382例VAP患者有172例分离出多重耐药菌。多重耐药和非多重耐药患者性别、年龄、原发肺部疾病、VAP类型、诊断前联合应用抗生素、合并心血管疾病和糖尿病、激素应用情况、28d生存状态等因素均存在差异(P<0.05)。多因素Logistic分析显示,其他菌耐药是导致VAP患者死亡的独立危险因素(P<0.05)。结论非发酵革兰阴性杆菌多重耐药不影响VAP患者的28d生存率,其他菌种耐药,是影响VAP患者28d死亡率的危险因素,值得进一步研究。     

介入手术室医院感染控制和预防临床实践专家共识

【摘要】 介入手术后医院感染严重危害人类健康。制定介入手术室医院感染控制和预防临床实践专家共识可更好地规范介入手术过程中相关临床实践标准，降低医院感染发生率。本共识基于 WHO指南制定手册和GRADE证据质量分级系统，形成了介入手术室环境管理、患者管理、工作人员管理、物品管理、职业暴露、培训与质量控制等6个领域54项推荐意见，供相关人员参考。     

Outcomes following ipsilateral great saphenous vein bypass for lower extremity arterial injuries

ObjectiveUse of autologous great saphenous vein (GSV) grafts for repair of extremity arterial injuries is well established. Contralateral great saphenous vein (cGSV) is traditionally used in the setting of lower extremity vascular injury given the risk of occult ipsilateral superficial and deep venous injury. We evaluated outcomes of ipsilateral GSV (iGSV) bypass in patients with lower extremity vascular trauma.MethodsPatient records at an ACS verified Level I urban trauma center between 2001 and 2019 were retrospectively reviewed. Patients who sustained lower extremity arterial injuries managed with autologous GSV bypass were included. Propensity-matched analysis compared the iGSV and cGSV groups. Primary graft patency was assessed via Kaplan-Meier analysis at 1-year and 3-years following the index operation.ResultsA total of 76 patients underwent autologous GSV bypass for lower extremity vascular injuries. 61 cases (80%) were secondary to penetrating trauma, and 15 patients (20%) underwent repair with iGSV bypass. Arteries injured in the iGSV group included popliteal (33.3%), common femoral (6.7%), superficial femoral (33.3%), and tibial (26.7%), while those in the cGSV group included common femoral (3.3%), superficial femoral (54.1%), and popliteal (42.6%). Reasons for using iGSV included trauma to the contralateral leg (26.7%), relative accessibility (33.3%), and other/unknown (40%). On unadjusted analysis, iGSV patients had a higher rate of 1-year amputation than cGSV patients (20% vs. 4.9%), but this was not statistically significant (P = 0.09). Propensity matched analysis also found no significant difference in 1-year major amputation (8.3% vs. 4.8%, P = 0.99). Regarding ambulatory status, iGSV patients had similar rates of independent ambulation (33.3% vs. 38.1%), need for assistive devices (58.3% vs. 57.1%), and use of a wheelchair (8.3% vs. 4.8%) compared cGSV patients at subsequent follow-up (P = 0.90). Kaplan-Meier analysis of bypass grafts revealed comparable primary patency rates for iGSV versus cGSV bypasses at 1-year (84% vs. 91%) and 3-years post-intervention (83% vs. 90%, P = 0.364).ConclusionIpsilateral GSV may be used as a durable conduit for bypass in cases of lower extremity arterial trauma where use of contralateral GSV is not feasible, with comparable long-term primary graft patency rates and ambulatory status.     

Outcomes of central hepatectomy versus extended hepatectomy

BackgroundCentral hepatectomy (CH) is more difficult than extended hepatectomy (EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent post-hepatectomy liver failure (PHLF), there is a need to assess outcomes of CH as a parenchyma-sparing procedure for centrally located liver tumors.MethodsA total of 178 major liver resections performed by specialist surgeons from two Australian tertiary institutions between June 2009 and March 2017 were reviewed. Eleven patients had CH and 24 had EH over this study period. Indications and perioperative outcomes were compared between the groups.ResultsThe main indication for performing CH was colorectal liver metastases. There was no perioperative mortality in the CH group and four (16.7%) in the EH group (P = 0.285). No group differences were found in median operative time [CH vs. EH: 450 min (290–840) vs. 523 min (310–860), P = 0.328], intraoperative blood loss [850 mL (400–1500) vs. 650 mL (100–2000), P = 0.746] or patients requiring intraoperative blood transfusion [1 (9.1%) vs. 7 (30.4%), P = 0.227]. There was a trend towards fewer hepatectomy-specific complications in the CH group [3 (27.3%) vs. 13 (54.2%), P = 0.167], including PHLF (CH vs. EH: 0 vs. 29.2%, P = 0.072). Median length of stay was similar between groups [CH vs. EH: 9 days (5–23) vs. 12 days (4–85), P = 0.244].ConclusionsCH has equivalent postoperative outcomes to EH. There is a trend towards fewer hepatectomy-specific complications, including PHLF. In appropriate patients, CH may be considered as a safe parenchyma-sparing alternative to EH.     

标准三步法在改善经腹入路腹腔镜肾癌根治术学习曲线中的应用

目的探讨标准化三步法操作流程在改善经腹入路腹腔镜肾癌根治学习曲线中的应用。 方法回顾性分析我院自2015年2月至2017年5月间由同一位医师实施的经腹入路腹腔镜肾癌根治术的60例患者病历资料，患者资料入院时间先后顺序整理，分实验组和对照组两组，每组选取患者30例，对照组时间范围为2015年2月至2016年7月，期间主刀医生未按照标准三步法手术流程操作，实验组时间范围为2016年8月至2017年5月，期间主刀医师均按照"标准化三步法"操作流程进行操作。 结果两组的年龄，体重，肿瘤侧别以及肿瘤大小比较差异无统计学意义（P>0.05）。实验组手术时间为（100±27）min，低于对照组（117±33）min，两者比较差异有统计学意义（t=6.374，P<0.05），实验组手术出血量为（142±50）ml，显著低于对照组（201±75）ml，差异有统计学意义（P<0.01），实验组术后并发症发生率3.33%，对照组术后并发症发生率6.66%，差异有统计学意义（P<0.05），两者住院时间差异无统计学意义（P>0.05）。我们以手术时间为参照，描绘两组的学习曲线，发现实验组约15例达到平台期，对照组25例左右达到平台期，两组比较差异有统计学意义（P<0.05）。 结论通过标准化三步法操作流程实施经腹腔入路肾癌根治术，能够减少手术时间，减少术中出血量，缩短手术的进程，改善手术的学习曲线。     

我国护理学硕士学术学位研究生课程设置调查

目的了解当前我国护理学硕士学术学位研究生课程设置,拟为教育主管部门和护理院校优化课程设置提供参考。方法采用问卷调查法,调查了国内66所护理学硕士学术学位研究生培养院校的课程设置情况。结果护理学硕士学术学位研究生课程类型以公共必修课、专业必修课和选修课为主;66所院校平均设有23.44门课程,护理专业类课程资源不足;课程主要包括思想政治教育、医学专业知识、护理基础理论、研究方法等。院校间学分要求有所差异,64所院校平均总学分为32.07分。结论我国护理学硕士学术学位研究生课程体系逐渐完善,但存在院校间学分要求差异较大,护理专业课程开设不足等问题。各院校需结合自身情况,从调整学分要求、加强护理专业课程建设、减少医学专业课程等方面优化护理学硕士学术学位研究生课程设置;教育主管部门应帮助各院校更加科学地设置护理专业核心课程。     

Improved pairwise kinship analysis using massively parallel sequencing

In the present study, 67 individuals from two families were analyzed to explore the efficacy of the ForenSeq^™ DNA Signature Prep Kit for pairwise kinship analysis. Six types of pairwise relationships including 81 parent-offspring, 60 full siblings, 48 grandparent-grandchildren, 147 uncle/aunt-nephew/nieces, 97 first cousins and 190 non-relatives were generated from these two families and the corresponding likelihood ratio (LR) was calculated using either sequence-based or length-based STR genotype data (i.e., LR_sequence and LR_length). In addition, 10,000 pairs of different relationships were simulated to estimate the system powers of the STRs and SNPs in this panel. The results showed that 54, 9 and 5 additional alleles were observed based on sequence for 27 autosomal STRs, 24 Y-STRs and 7 X-STRs, respectively, compared to those based on length information and 11 novel alleles were identified. Five mutations were found for 58 STRs in 81 parent-offspring but no mutations were observed for SNPs. For 27 autosomal STR loci, the LRs were increased from 9.20, 7.87, 2.01, 2.07, 0.42 for log₁₀LR_length to 11.52, 10.12, 2.61, 2.60, 0.52 for log₁₀LR_sequence for paternity index (PI), full siblings index (FSI), grandparent-grandchild index (GI), uncle/aunt-nephew/niece index (UNI) and first cousins index (FCI), respectively. PI values for 94 SNPs separated more than those of 27 STRs if two individuals were non parent-offspring relatives. For the simulation study, the effectiveness was 1 for the parent-offspring relationship at the thresholds of t₁ = − 4 and t₂ = 4 and was 0.9998 for full siblings (t₁ = − 2, t₂ = 2). With an error rate of 0.42%, 93.02% of second degree relatives could be identified at the thresholds of t₁ = − 1 and t₂ = 1. However, the effectiveness was only 0.4300 for first cousins with a relatively high error rate of 2.68% (t₁ = − 1, t₂ = 1). In conclusion, STR typing according to the sequence information is more polymorphic, which increases the discrimination power for kinship testing. Compared to these 27 STR markers, 94 SNP markers in this panel have advantages in paternity testing especially when mutated STRs are involved or when a relative is an alleged parent. This panel is powerful enough to resolve paternity and full sibling testing. Most of the second degree relationships could be identified with low error rate while more markers are still needed for first cousins testing.     

非小细胞肺癌组织Ki-67 与PD-L1 表达的相关性及其对患者预后的影响

[摘要] 目的：探讨NSCLC患者癌组织中Ki-67 与PD-L1 表达的相关性及两者对患者预后的影响。方法：选取符合纳入标准的2012 年1 月至2018 年8 月在海军军医大学附属长海医院，手术确诊为NSCLC并进行免疫组化PD-L1 和Ki-67 检测的患者401 例，收集其临床病理资料，定期生存随访，应用统计学方法分析Ki-67 与PD-L1 表达的相关性及两者对患者术后DFS和化疗后PFS的影响。结果：NSCLC组织中PD-L1 和Ki-67 表达阳性率分别为37.9%（152/401）和96.3%（386/401），单因素分析显示Ki-67 为PDL1表达相关的影响因素（OR=0.33，95%CI=0.28～0.39，P<0.0001），曲线拟合分析显示Ki-67 与PD-L1 表达显著正相关，阈值效应分析、分段多因素Logistic 和ROC曲线分析表明14%是Ki-67 较适宜与PD-L1 联用的阈值。Kaplan-Meier 分析显示，术后DFS，Ki-67 高表达组显著短于Ki-67 低表达组[(21.88±11.25) vs (41.22±16.25)个月，P<0.0001]，PD-L1 阳性组显著短于PD-L1 阴性组[(24.75±14.59) vs (38.27±16.75)个月，P<0.0001]，Ki-67 高表达/PD-L1 阳性组与其余3 组相比术后DFS 最短[(20.57±11.33) vs(24.11±10.79) vs (36.00±16.79) vs (42.91±15.77)个月，P<0.0001]；化疗PFS，Ki-67 高表达组显著长于Ki-67 低表达组[(7.70±3.01) vs(5.80±2.99)个月，P=0.016]，PD-L1 阳性组与阴性组相比差异无统计学意义[(7.04±3.21) vs (6.33±3.06)个月，P=0.22]，Ki-67 与PDL1联合测评，Ki-67 高表达两组的PFS显著长于Ki-67 低表达两组[(7.74±3.25) vs (7.43±2.38) vs(4.91±1.97) vs (6.02±3.19)个月，P=0.041]。结论：NSCLC组织中Ki-67 与PD-L1 表达呈正相关，Ki-67 14%是适宜与PD-L1 联用的阈值，Ki-67 和PD-L1 均为患者预后不良的预测因子，两者联合对预后不良的预测有“叠加效应”，同时Ki-67 高表达患者对化疗的敏感性较好。