PREDICT-GTN 1: Can we improve the FIGO scoring system in gestational trophoblastic neoplasia?

Gestational trophoblastic neoplasia (GTN) patients are treated according to the eight-variable International Federation of Gynaecology and Obstetrics (FIGO) scoring system, that aims to predict first-line single-agent chemotherapy resistance. FIGO is imperfect with one-third of low-risk patients developing disease resistance to first-line single-agent chemotherapy. We aimed to generate simplified models that improve upon FIGO. Logistic regression (LR) and multilayer perceptron (MLP) modelling (n = 4191) generated six models (M1-6). M1, all eight FIGO variables (scored data); M2, all eight FIGO variables (scored and raw data); M3, nonimaging variables (scored data); M4, nonimaging variables (scored and raw data); M5, imaging variables (scored data); and M6, pretreatment hCG (raw data) + imaging variables (scored data). Performance was compared to FIGO using true and false positive rates, positive and negative predictive values, diagnostic odds ratio, receiver operating characteristic (ROC) curves, Bland-Altman calibration plots, decision curve analysis and contingency tables. M1-6 were calibrated and outperformed FIGO on true positive rate and positive predictive value. Using LR and MLP, M1, M2 and M4 generated small improvements to the ROC curve and decision curve analysis. M3, M5 and M6 matched FIGO or performed less well. Compared to FIGO, most (excluding LR M4 and MLP M5) had significant discordance in patient classification (McNemar's test P < .05); 55-112 undertreated, 46-206 overtreated. Statistical modelling yielded only small gains over FIGO performance, arising through recategorisation of treatment-resistant patients, with a significant proportion of under/overtreatment as the available data have been used a priori to allocate primary chemotherapy. Streamlining FIGO should now be the focus.     

碳离子和质子治疗胰腺癌安全性和有效性的系统评价及Meta分析

目的 评价碳离子和质子治疗胰腺癌（PaC）的安全性和有效性。方法 检索数据库纳入碳离子和质子治疗PaC的临床研究，检索时间为自建库至2019年6月。两位研究者独立筛选文献、提取资料。采用STATA 12.0和MetaAnalyst Beta 3.13软件进行Meta分析。结果 共纳入8篇文献，包含459例PaC患者。效应模型Meta分析显示，碳离子和质子治疗PaC的2、3、5级胃肠道溃疡发生率分别为7%、2%、0；2、3、4级厌食症发生率分别为6%、3%、0；1、2年总生存率（OS）分别为77%、45%；2年局部控制率为81%；1年无局部进展率为88%；1年局部复发率为15%。碳离子和质子治疗PaC的2、3、2～3级胃肠道溃疡发生率分别为6.8%、1.5%、9.2%和3.5%、8.3%、6.1%（均P>0.05）；1、2年OS分别为77.1%、44.4%和77.6%、49.7%（P均>0.05）。结论 碳离子和质子治疗PaC安全有效，两者的安全性和有效性相似。     

反义导向分子a在单一延长应激模型大鼠皮质中的表达及意义

目的探讨反义导向分子a(Repulsive guidance molecule a,RGMa)在创伤后应激障碍模型单一延长应激模型大鼠皮质中的表达及意义。方法随机将30只Wistar大鼠分为对照组(con)、单一延长应激模型组(model)。建模后第7d观察两组大鼠行为学改变,并采用免疫荧光、逆转录PCR检测两组大鼠皮质RGMa的表达改变。结果与正常对照组比较,模型组大鼠僵立行为明显增加(0.01),皮质RGMa蛋白及m RNA表达水平均显著增多(0.01)。结论单一延长刺激诱导大鼠皮质RGMa蛋白及转录水平上调,可能是引起PTSD皮质体积缩小的重要分子机制之一。     

探讨中西医护理改善老年高血压患者生活质量的效果

目的探讨中西医结合护理改善老年高血压患者心理状态及生活质量的效果。方法在医院2018年1月—2018年6月就诊的老年高血压患者中选出60例,按照随机数字法的原则,分成研究组(n=30)和参考组(n=30)。参考组采用单一西医护理,研究组在此之外联合中医护理,比较两组患者的临床疗效。结果入院时研究组与参考组SAS、SDS、SF-6评分差异不显著(P>0.05),护理后1月、3月与参考组相比,研究组SAS、SDS评分显著降低(P<0.05),SF-6评分显著升高(P<0.05);研究组患者对中西结合护理满意度为96.67%,参考组患者对西医护理满意度为73.33%,研究组满意度较参考组高,差异显著(P<0.05)。结论中西医结合护理能够有效改善老年高血压患者的心理状态,提高生活质量。     

脊柱转移瘤外科治疗的现状与进展

随着人口老龄化和肿瘤诊治水平的提高，脊柱转移瘤的发病率逐年上升。外科治疗可以缓解局部疼痛、增强脊柱稳定、控制肿瘤复发、提高生存质量、延长生存时间。随着脊柱转移瘤治疗理念和技术的不断进步，骨科医师亟需掌握脊柱转移瘤外科治疗的进展和原则。本文针对脊柱转移瘤外科治疗术前检查与评估、外科治疗方式的选择和围手术期管理三个维度进行总结，以期为脊柱转移瘤的外科治疗提供循证医学证据，规范诊疗流程，进而提高脊柱转移瘤的外科诊疗水平。     

提高选题策划质量 提升行业期刊品牌影响力——以金属加工杂志社实践为例

【目的】 探讨行业期刊进行选题策划的方法,提升选题策划的质量。【方法】 利用互联网技术及新媒体资源,结合金属加工杂志社选题策划实例,归纳出几种选题策划的途径及方法。【结果】 结合行业热点进行选题策划,注重实效性和内容深度,提升期刊内容的可读性,可使期刊获得更多读者的关注和认可,提升期刊的行业影响力。【结论】 提高选题策划质量,可有效提升期刊内容的可读性,从而进一步提升期刊在行业的影响力。     

Iron Deficiency Anemia Associated With Acid-Modifying Medications: Two Cases and Literature Review

Iron deficiency anemia is often listed among potential adverse effects of gastric acid-suppressive medications, given that gastric acidity promotes intestinal absorption of nonheme iron. Additionally, the antacid calcium carbonate can inhibit iron absorption. However, there is little direct clinical evidence that proton-pump inhibitors, histamine-2 receptor antagonists, or calcium carbonate cause iron deficiency anemia. Most case reports have had substantial limitations (e.g., minimal follow-up and presence of other causes of iron deficiency), and retrospective cohort studies have lacked sufficient patient-specific detail to make strong causal inferences. We present 2 cases—both with detailed, prospective 10-year follow-up—in which combinations of proton-pump inhibitors, histamine-2 receptor antagonists and calcium carbonate were clearly associated with development of iron deficiency anemia. Overt iron-deficiency anemia is probably uncommon in patients who use acid-modifying medications and who have no other conditions that predispose to iron deficiency. Nevertheless, clinicians should be aware of this potential complication, given widespread use of these agents.     

The use of Trichomonas vaginalis purine nucleoside phosphorylase to activate fludarabine in the treatment of solid tumors

Treatment with fludarabine phosphate (9-β-D-arabinofuranosyl-2-F-adenine 5′-phosphate, F-araAMP) leads to regressions and cures of human tumor xenografts that express Escherichia coli purine nucleoside phosphorylase (EcPNP). This occurs despite the fact that fludarabine (F-araA) is a relatively poor substrate for EcPNP, and is cleaved to liberate 2-fluoroadenine at a rate only 0.3% that of the natural E. coli PNP substrate, adenosine. In this study, we investigated a panel of naturally occurring PNPs to identify more efficient enzymes that may be suitable for metabolizing F-araA as part of experimental cancer therapy. We show that Trichomonas vaginalis PNP (TvPNP) cleaves F-araA with a catalytic efficiency 25-fold greater than the prototypic E. coli enzyme. Cellular extracts from human glioma cells (D54) transduced with lentivirus stably expressing TvPNP (D54/TvPNP) were found to cleave F-araA at a rate similar to extracts from D54 cells expressing EcPNP, although much less enzyme was expressed per cell in the TvPNP transduced condition. As a test of safety and efficacy using TvPNP, human head and neck squamous cell carcinoma (FaDu) xenografts expressing TvPNP were studied in nude mice and shown to exhibit robust tumor regressions, albeit with partial weight loss that resolved post-therapy. F-araAMP was also a very effective treatment for mice bearing D54/TvPNP xenografts in which approximately 10% of tumor cells expressed the enzyme, indicating pronounced ability to kill non-transduced tumor cells (high bystander activity). Moreover, F-araAMP demonstrated activity against D54 tumors injected with an E1, E3 deleted adenoviral vector encoding TvPNP. In that setting, despite higher F-araA cleavage activity using TvPNP, tumor responses were similar to those obtained with EcPNP, indicating factors other than F-Ade production may limit regressions of the D54 murine xenograft model. Our results establish that TvPNP is a favorable enzyme for activating F-araA, and support further studies in combination with F-araAMP for difficult-to-treat human cancers.