浸润性膀胱癌新辅助化疗随机对照试验的Meta分析

目的评价新辅助化疗对肌层浸润性膀胱癌患者预后的疗效。方法系统检索Medline、Embase、Cochrane中的相关文献,检索1991年1月至2012年10月间发表的新辅助化疗有关的相关前瞻性随机对照研究,按预设的标准进行筛选。结果共12个研究符合纳入标准,总样本量3296例,新辅助治疗组1649例,对照组1647例,对纳入研究进行质量评价,并提取数据进行Meta分析。新辅助化疗组与对照组相比,死亡风险优势比OR0．85（95％CI0．73～0．98,P=0．03）。将12个纳入研究按新辅助化疗方案进行亚组分析,单用铂剂组显示新辅助化疗并没有降低患者死亡风险,而以铂剂为基础的多药联合新辅助化疗可降低患者死亡风险（OR 0．79,95％CI0．0．92,P=0．0004）。结论新辅助化疗,尤其是以铂剂为基础的联合化疗方案,适用于肌层浸润性膀胱癌的治疗,可改善预后。     

基于四肢同步检测踝臂指数的方法和临床研究

目的利用优选法在波形特征法和幅度系数法的基础上提出1种同步采集四肢脉搏波信号和袖套压力波信号无创检测踝臂指数的新方法。方法计算出相邻脉搏波的幅度差值和它们的相对比值,并利用优选法在一定范围内进行突变点的判断。结果该方法能够解决将收缩压以前的点和平均压附近的点误判为突变点的问题,大量的病例分析和临床测试证实了该算法的有效性和可靠性。结论踝臂指数是动脉硬化的一个简便可靠的预测因素,它与传统的动脉硬化危险因素如年龄、血压等有相关性。     

抑制白血病K562细胞FoxM1表达可增强细胞对高三尖杉酯碱的敏感性

目的:探讨抑制白血病K562细胞叉头框蛋白M1(Fox M1)是否增强细胞对高三尖杉酯碱(HHT)的敏感性。方法:HHT以不同浓度(0、0.015、0.030和0.045μmol/L)和最低起效浓度不同时间(0.015μmol/L,0、24、48和72 h)作用于K562细胞,real-time PCR和Western blot检测Fox M1 mRNA和蛋白表达;以0.015μmol/L HHT作用K562细胞后转染Fox M1 siRNA,观察沉默K562细胞Fox M1后细胞对HHT的敏感性、细胞增殖和凋亡效应以及Fox M1相关靶分子c-Myc和Sp1表达状况。结果:随着HHT浓度增加和时间延长Fox M1表达逐渐降低,说明HHT抑制K562细胞Fox M1表达;HHT处理K562细胞后转染Fox M1 siRNA,细胞生长和克隆形成显著下降,细胞凋亡增加,因此抑制Fox M1可增加K562细胞对HHT的敏感性;Fox M1 siRNA组c-Myc和Sp1表达显著降低,表明Fox M1可正性调控c-Myc和Sp1表达。结论:HHT可以抑制白血病K562细胞Fox M1表达,干扰Fox M1可增强细胞对HHT的敏感性。     

基于氨基酸性质的EB病毒抗原MHC-Ⅰ类分子限制性表位的定量构效关系建模

目的建立EB病毒(EBV)抗原表位的理论计算模型并用于其定量预测,为肿瘤免疫的多肽疫苗设计提供理论基础。方法从表位数据库中收集33条EBV抗原表位,使用逐步回归(STR)方法筛选2个对平衡解离常数(KD)贡献较大的结构参数用于表位的结构表征,最后用多元线性回归(MLR)方法建立结构参数与KD的定量构效关系(QSAR)模型。结果该模型具有较好的稳定性(R2=0.637,Q2=0.581)与预测能力(R2test=0.501)。结论此方法可确定表位中各个氨基酸的物理性质对于平衡解离常数的贡献,为表位设计与改造提供直接线索;STR和MLR相结合建模方法具有物化意义明确、易于解释及操作简便易行等优点。     

Diabetes mellitus and risk of all-cause mortality among patients with tuberculosis in the state of Georgia, 2009–2012

PurposeTo estimate the association between diabetes mellitus (DM) and all-cause mortality during tuberculosis (TB) treatment.MethodsFrom 2009 to 2012, a retrospective cohort study among reported TB cases in Georgia was conducted. Patients aged 16 years or older were classified by DM and human immunodeficiency virus (HIV) status at the time of TB diagnosis and followed during TB treatment to assess mortality. Hazard ratios were used to estimate the association between DM and death.ResultsAmong 1325 patients with TB disease, 151 (11.4%) had DM, 147 (11.1%) were HIV-infected, and seven (0.5%) had both DM and HIV. Patients with TB-DM were more likely to have cavitary lung disease compared with those with TB alone (51.0% vs. 34.7%) and those with TB-HIV were more likely to have military/disseminated disease (12.9% vs. 3.4%) and resistance to rifampin or isoniazid (21.8% vs. 9.0%) compared with those without HIV infection (P < .05). In multivariable analysis, DM was not associated with death during TB treatment (hazard ratio, 1.22; 95% confidence interval, 0.70–2.12) or any death (adjusted odds ratio, 1.05; 95% confidence interval, 0.60–1.84).ConclusionsAmong TB patients in Georgia, the prevalence of comorbid DM and coinfection with HIV was nearly identical. In adjusted models, TB patients with DM did not have increased risk of all-cause mortality.     

我国药物经济学研究的现状和建议

目的:为推进我国药物经济学研究提供理论参考。方法:通过对药物经济学文献进行分析,总结出国内研究现状,探讨存在问题的原因,并提出建议。结果与结论:中国地广人多,共享信息的途径太少;药物经济学研究涉及面广,医药卫生行业的人员对经济学、社会学的知识掌握不够;"以药养医"现象的存在,药物经济学研究成果的推广难免会触及多方经济利益。建议应加强药物流行病学研究,整合研究人员知识结构;深化医药卫生体制改革,破除"以药养医"现象。     

基于手术的洁净方舱研究与应用

目的：为在自然灾害与突发公共卫生事件中对伤病员进行有效的医疗手术救治,研究一种配套功能完整、平战结合并可在特殊环境下使用的新型车载洁净手术方舱。方法：根据手术方舱的功能定位,结合国内外方舱的优点,研究洁净手术方舱内部的结构布局形式,开展手术车扩展结构形式的研究,研制车载空调净化系统。结果：该洁净方舱在救援过程中,从单体自我保障、机动性、手术环境和手术平台前移等方面均发挥了切实有效的医学救援作用。结论：该洁净方舱作为满足危急重症现场抢救、重大灾害事故医疗应急救援的主要单元,在应用中体现出对突发灾害等公共卫生的快速反应和应急处理能力。     

琥珀酸索利那新治疗膀胱过度活动症的疗效和安全性

目的对琥珀酸索利那新治疗膀胱过度活动症（OAB）的疗效和安全性进行评估。方法将76例确诊为OAB病程超过3个月的患者采用随机、双盲法分为2组：对照组38例,给予托特罗定2mgbid,早晚口服;实验组38例,给予琥珀酸索利那新5mgqd,早饭后口服。2组疗程均为8周。2组患者在用药前1周及用药后1周自行记录排尿日记,通过排尿日记比较2组患者服药前后1周平均24h内排尿次数和尿急次数的改善情况,同时结合患者治疗前后最大尿流率、初始尿意容量、最大膀胱压容量的变化对琥珀酸索利那新的疗效进行评价;通过用药不良反应发生率的对比分析,对其安全性进行评估。结果实验组患者的24h尿急次数和排尿次数以及初始尿意容量、最大膀胱压容量、最大尿流率较对照组有明显改善（P〈0.05）;实验组患者口干、视野模糊、便秘等不良反应发生率均较对照组低（P均〈0.05）。结论琥珀酸索利那新治疗OAB较托特罗定有更好的效果和更高的安全性,琥珀酸索利那新将可能成为治疗OAB的首选药物     

The Effects of Grain Boundary Misorientation on the Mechanical Properties and Mechanism of Plastic Deformation of Ni/Ni3Al: A Molecular Dynamics Study

The effects of grain boundary misorientation angle (θ) on mechanical properties and the mechanism of plastic deformation of the Ni/Ni₃Al interface under tensile loading were investigated using molecular dynamics simulations. The results show that the space lattice arrangement at the interface is dependent on grain boundary misorientations, while the interfacial energy is dependent on the arrangement. The interfacial energy varies in a W pattern as the grain boundary misorientation increases from 0° to 90°. Specifically, the interfacial energy first decreases and then increases in both segments of 0–60° and 60–90°. The yield strength, elastic modulus, and mean flow stress decrease as the interfacial energy increases. The mechanism of plastic deformation varies as the grain boundary misorientation angle (θ) increases from 0° to 90°. When θ = 0°, the microscopic plastic deformation mechanisms of the Ni and Ni₃Al layers are both dominated by stacking faults induced by Shockley dislocations. When θ = 30°, 60°, and 80°, the mechanisms of plastic deformation of the Ni and Ni₃Al layers are the decomposition of stacking faults into twin grain boundaries caused by extended dislocations and the proliferation of stacking faults, respectively. When θ = 90°, the mechanisms of plastic deformation of both the Ni and Ni₃Al layers are dominated by twinning area growth resulting from extended dislocations.