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This letter responds to the article “On the Authority of Advance Euthanasia Directives for People with Severe Dementia: Reflections on a Dutch Case,” by Henri Wijsbek and Thomas Nys, in the September-October 2022 issue of the Hastings Center Report.  相似文献   
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ObjectivesTo explore formal and informal care costs in the last 3 months of life for people with dementia, and to evaluate the association between transitions to hospital and usual place of care with costs.DesignCross-sectional study using pooled data from 3 mortality follow-back surveys.Setting and ParticipantsPeople who died with dementia.MethodsThe Client Service Receipt Inventory survey was used to derive formal (health, social) and informal care costs in the last 3 months of life. Generalized linear models were used to explore the association between transitions to hospital and usual place of care with formal and informal care costs.ResultsA total of 146 people who died with dementia were included. The mean age was 88.1 years (SD 6.0), and 98 (67.1%) were female. The usual place of care was care home for 85 (58.2%). Sixty-five individuals (44.5%) died in a care home, and 85 (58.2%) experienced a transition to hospital in the last 3 months. The mean total costs of care in the last 3 months of life were £31,224.7 (SD 23,536.6). People with a transition to hospital had higher total costs (£33,239.2, 95% CI 28,301.8-39,037.8) than people without transition (£21,522.0, 95% CI 17,784.0-26,045.8), mainly explained by hospital costs. People whose usual place of care was care homes had lower total costs (£23,801.3, 95% CI 20,172.0-28,083.6) compared to home (£34,331.4, 95% CI 27,824.7-42,359.5), mainly explained by lower informal care costs.Conclusions and ImplicationsTotal care costs are high among people dying with dementia, and informal care costs represent an important component of end-of-life care costs. Transitions to hospital have a large impact on total costs; preventing these transitions might reduce costs from the health care perspective, but not from patients' and families' perspectives. Access to care homes could help reduce transitions to hospital as well as reduce formal and informal care costs.  相似文献   
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背景与目的:丝氨酸/精氨酸富集剪接因子1(serine/arginine-rich splicing factor 1,SRSF1)与肿瘤的发生、发展密切相关。食管癌是常见的消化系统恶性肿瘤,但SRSF1在食管癌中的作用罕有报道。检测SRSF1在食管鳞状细胞癌(esophageal squamous cell carcinoma,ESCC)组织中的表达及其对ESCC细胞增殖、迁移和侵袭的影响,并初步探讨其作用机制。方法:收集2020年1月—2021年12月于河北医科大学第四医院行手术切除的40例ESCC患者的癌及癌旁组织标本,采用免疫组织化学染色法检测ESCC组织中SRSF1的水平。采用实时荧光定量聚合酶链反应(real-time fluorescence quantitative polymerase chain reaction,RTFQ-PCR)和蛋白质印迹法(Western blot)检测ESCC细胞系中SRSF1 mRNA表达和蛋白水平。筛选SRSF1高表达的Eca9706细胞进行研究。采用小干扰RNA(small interfering RNA,siRNA)技术降低SRSF1 mRNA表达。采用细胞计数试剂盒-8(cell counting kit-8,CCK-8)、transwell和Matrigel基质胶实验分别检测Eca9706细胞增殖、迁移和侵袭能力。采用数据库分析ESCC组织中血管内皮生长因子A(vascular endothelial growth factor A,VEGFA)的表达,并分析SRSF1与VEGFA表达的相关性。采用RTFQ-PCR检测Eca9706细胞VEGFA Iso8a和Iso8b亚型的表达水平,以及敲低SRSF1后VEGFA Iso8a和Iso8b亚型的表达变化。结果:SRSF1在ESCC组织中的表达水平高于癌旁组织(P<0.05)。SRSF1 mRNA表达和蛋白水平在ESCC Eca9706细胞系中最高(P<0.01)。转染siRNA-SRSF1组中SRSF1 mRNA表达和蛋白水平显著低于siRNA-NC组(P<0.01)。与siRNA-NC组相比,siRNA-SRSF1组Eca9706细增殖、迁移和侵袭能力显著降低(P<0.05)。ESCC组织中VEGFA表达明显高于食管正常组织(P<0.05),且与SRSF1表达呈正相关(P<0.01)。Eca9706细胞VEGFA Iso8a亚型表达明显高于VEGFA Iso8b亚型(P<0.01),且敲低SRSF1后VEGFA Iso8a亚型表达降低,VEGFA Iso8b亚型表达升高(P<0.01)。结论:SRSF1可通过作用于VEGFA可变剪接促进ESCC Eca9706细胞增殖、侵袭和迁移。  相似文献   
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目的 探讨阿帕替尼对胃癌HGC-27细胞放射敏感性的影响及可能的作用机制。方法 以不同浓度阿帕替尼(5 μmol/L、10 μmol/L、15 μmol/L、20 μmol/L)以及不同照射剂量(2 Gy、4 Gy、6 Gy、10 Gy、20 Gy)分别处理HGC-27细胞,再选取2 Gy和6 Gy单独照射或联合10 μmol/L阿帕替尼处理HGC-27细胞;采用ELISA法检测细胞中血管内皮生长因子(vascular endothelial growth factor,VEGF)的表达情况,CCK-8法检测细胞增殖能力,流式细胞术检测细胞凋亡和细胞周期,免疫荧光染色技术检测γ-H2AX的表达情况。结果 阿帕替尼呈浓度及时间依赖性抑制胃癌HGC-27细胞增殖(均P<0.05);不同剂量照射可促进细胞VEGF表达释放,且呈时间及剂量依赖性(均P<0.01)。10 μmol/L阿帕替尼分别联合2 Gy和6 Gy照射后,HGC-27细胞增殖抑制作用、细胞凋亡率及G2/M期的细胞比例均较单照组升高(均P<0.01),且6 Gy联合组的作用强度大于2 Gy联合组(均P<0.01)。6 Gy联合组细胞核内γ-H2AX焦点淬灭较6 Gy单照组延迟。结论 阿帕替尼通过抑制细胞增殖,促进细胞凋亡并诱导细胞周期再分布增强胃癌HGC-27细胞放射敏感性,其作用机制可能与延迟γ-H2AX表达而干扰DNA双链断裂修复有关。  相似文献   
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目的 通过三维CT血管成像(CTA)评估分析直肠癌患者肠系膜下动脉(IMA)分型及解剖特点,为直肠癌手术血管处理提供参考。 方法 回顾分析2018年1月至2019年12月华中科技大学同济医学院附属协和医院接受IMA CTA检查的直肠癌患者临床及影像学资料。通过三维CT血管成像重建IMA图像。对IMA进行分类并测量统计肠系膜下血管各解剖参数。 结果 266例研究对象中男性187例,女性79例。111例(41.7%)左结肠动脉(LCA)从主干独立发出,112例(42.1%)LCA和乙状结肠动脉(SA)共干发出,33例(12.4%)LCA、SA及直肠上动脉(SRA)共干,10例(3.8%)缺乏LCA。全组IMA主干长度(LIMA)为(39.1±10.1)mm、IMA根部至髂血管分叉距离(DIMA)为(44.1±7.4)mm、IMA根部与肠系膜下静脉(IMV)水平距离为(24.6±8.9)mm、IMA分支点与IMV水平距离为(13.0±5.3)mm。LCA走行包括:122例(47.6%)高位型,88例(34.4%)中位型,46例(18.0%)低位型。65例(25.4%)LCA紧贴IMV内侧,136例(53.1%)LCA紧贴IMV外侧,55例(21.5%)LCA外侧远离IMV。 结论 术前利用三维CT血管成像可准确评估IMA分型及肠系膜下血管的形态走行关系,为直肠癌手术中血管处理提供指导。  相似文献   
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BackgroundWhile studies have demonstrated favorable outcomes in utilization of primary total shoulder arthroplasty (TSA) for the treatment of glenohumeral osteoarthritis (OA), adverse events such as infections can still occur. Periprosthetic joint infections (PJIs) are associated with worse outcomes and patient morbidity. The purpose of this study was to: (1) compare patient demographics amongst TSA patients with and without PJIs following primary TSA; and (2) identify patient-related risk factors for PJIs following primary TSA.MethodsPatients undergoing primary TSA for the treatment of glenohumeral OA were identified using the Mariner administrative claims database by CPT code 23,472. Laterality modifiers were utilized to ensure PJIs were developing in the correct laterality as those patients undergoing primary TSA. Inclusion for the study group consisted of patients who developed PJIs within 2-years after the index procedure, whereas patients who did not develop PJIs served as the comparison cohort. Primary outcomes analyzed included patient demographics and patient-related risk factors for PJIs following primary TSA. A stepwise backwards elimination multivariate binomial logistic regression analyses was performed to determine the odds (OR) of PJIs in patients undergoing primary TSA. A P value less than .05 was considered statistically significant.ResultsThe query yielded 15,396 patients who underwent primary TSA for glenohumeral OA, of which 191 patients developed PJIs and 15,205 did not develop PJIs. The study found statistically significant differences amongst patients who did and did not develop PJIs following primary TSA with respect to age, sex, and presence of comorbid conditions. Risk factors associated with developing PJIs following primary TSA included: pathologic weight loss (OR: 2.06, P < .0001), obesity (OR: 1.56, P = .0001), male sex (OR: 1.52, P = .007), and peripheral vascular disease (OR: 1.46, P = .022).ConclusionAs the number of primary TSAs for the treatment of glenohumeral OA increase worldwide, identifying modifiable risk-factors to reduce the incidence of infection is critical. The study found various modifiable and non-modifiable risk factors associated with developing PJIs following primary TSA. This study is valuable to orthopedists in order to identify and risk-stratify patients with regard to PJI in the setting of primary TSA for OA.Level of EvidenceLevel III; Case-Control Study  相似文献   
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