Neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy for the treatment of locally advanced esophageal cancer: a population-based analysis

International Journal of Clinical Oncology - Currently, the optimal treatment strategy for locally advanced esophageal cancer (LAEC) remains controversial. We perform the present study to compare...     

抑郁对晚期肺癌患者姑息治疗过程中生活质量的影响

目的 探讨抑郁对晚期肺癌患者姑息治疗过程中生活质量的影响。 方法 通过调查2012年1月至2016年12月在奉贤区中心医院接受姑息治疗的88例晚期肺癌患者,采用抑郁自评量表(SDS)、生活质量核心问卷(QLQ-C30)和自行设计的一般情况问卷调查,了解晚期肺癌患者抑郁的发生情况,并分析抑郁对患者生活质量的影响。 结果 晚期肺癌老年患者姑息治疗过程中合并抑郁的发生率为52.3%;与非抑郁组比较,抑郁组肺癌患者总体健康状况量表评分、功能量表评分明显降低,而症状量表评分、特异性条目评分均显著升高(P<0.05);姑息治疗老年肺癌患者的总体健康状况量表评分在年龄、合并症等方面比较,差异有统计学意义(P<0.05);多元线性回归分析显示,在控制性别、合并症、文化程度、家族史等因素后,年龄、SDS评分均是姑息治疗老年肺癌患者生活质量的独立危险因素(P<0.05)。 结论 姑息治疗老年肺癌患者存在明显抑郁,整体生活质量水平较低,且抑郁严重影响患者的生活质量。     

The early and mid-term results of mitral valve repair for mitral regurgitation in children

Purpose

To review the surgical techniques and mid-term results of mitral valve repair in children with moderate or severe mitral regurgitation (MR).

Methods

One hundred and seven children with moderate or severe MR, aged 19.6 ± 8.5 months, were enrolled in this study. The surgical techniques used for mitral valve repair varied according to the mitral valve morphology, and included annuloplasty, annuloplasty ring, cleft closure, reconstruction of the posterior leaflet, etc. The concomitant cardiac anomalies were treated simultaneously. The results of repair were evaluated by transesophageal echocardiography performed during the operation and by serial transthoracic echocardiography performed during the follow-up.

Results

One hundred and six cases had no more than mild regurgitation intraoperatively, whereas only one case had moderate regurgitation. This patient underwent redo repair immediately, and the subsequent regurgitation was trivial. The in-hospital mortality rate was 0.9 % (1/107). The average follow-up was 46.5 ± 8.2 months. One patient died of heart failure 10 months postoperatively. The freedom from moderate or severe regurgitation after mitral valve repair was 92.3 ± 3.3 %.

Conclusion

Pediatric patients with moderate or severe MR require early surgical treatment. The early and mid-term results of mitral valve repair in pediatric patients were satisfactory.     

MBBS 全英文中医针灸课程混合式学习模式的行动研究

目的:探讨混合式学习模式下中医针灸课程内容的设置、教学方法的选取对教学效果和教师发展的影响。为来华留学医学学士和外科学士(Medicine bachelor and bachelor of surgery,MBBS)全英文中医教学实践的改善和来华留学生学习效果的提升提供数据支持。方法:采用行动研究方法,通过2018年留学生问卷调查发现问题,对2019年中医针灸课程教学方法重新设计并实施,对比授课前后学生参与度、满意度改变。教师通过对教学日志及访谈进行主题分析进行教学反思。结果:MBBS对中医针灸课程的实用性、趣味性及满意度有显著提高,差异有统计学意义(P0.05)。同时教师对教学实践及教师信念有了更深刻的理解并用于指导进一步教学行动。结论:采用(翻转课堂+案例讨论+增加实习)的混合式学习模式对于文化负载重、中医基础缺失的MBBS具有很好效果,对于提高学习参与度、促进知识内化、改进教学有参考意义。     

左心功能中重度不全患儿行左冠状动脉异常起源矫治术后发生急性肾损伤的危险因素分析

目的回顾性分析左冠状动脉异常起源于肺动脉(anomalous origin of the left coronary artery from the pulmonary artery,ALCAPA)伴左心功能中重度不全的患儿行矫治术后发生急性肾损伤(acute kidney injury,AKI)的危险因素。方法选择2010年11月至2017年5月行ALCAPA矫治术伴术前左室射血分数(left ventricular ejection fraction,LVEF)低于50%的患儿43例,男25例,女18例,年龄3个月至14岁。查阅医院电子病例,收集相关围术期临床资料。根据KIDGO标准判断是否发生AKI,将患儿分为两组:非AKI组和AKI组。采用多因素Logistic回归分析术后AKI的危险因素。结果术后发生AKI 31例,AKI发生率为70.5%。AKI组术前Hb含量、术前LVEF和术前血浆肌酐(SCr)浓度明显低于非AKI组(P0.05)。多因素Logistic回归分析显示,术前Hb含量升高为保护性因素(OR=0.917,95%CI 0.848～0.992,P=0.031);术前LVEF升高为保护性因素(OR=0.902,95%CI 0.819～0.993,P=0.036);术前肾小球滤过率(GFR)升高为独立危险因素(OR=1.063,95%CI 1.014～1.113,P=0.011)。结论 ALCAPA伴左心功能中重度不全的患儿行矫治术,术前Hb含量升高和LVEF升高均是术后发生AKI的保护性因素,而术前GFR升高是术后AKI的独立危险因素。     

护士对ICU转出患者在普通病房交接班现状调查分析

目的调查ICU护士和普通病房护士对ICU转出患者交接班认知现状,为有效实施ICU转出患者延续护理服务及相关知识培训提供依据。方法采用自行设计的问卷对广州市三甲医院107名ICU护士和373名普通病房护士在转出患者在认知、态度、执行过程中现状进行调查。结果本研究发现护士ICU护士和普通病房在交接班时对于患者的一般信息、生命体征、专科病情交接、心理情况、药物交接、医院感染交接、患者物品交接等方面,认知有不同;普通病房护士和ICU护士对ICU转出患者交接时的药物、管道和皮肤的交接方面均认为非常重要。结论针对ICU护士和普通病房护士的不同培训需求,应提供不同的系统、规范化的培训。     

靶向表皮生长因子受体Ⅲ型突变体的第三代嵌合抗原受体的构建与表达

目的：构建第三代靶向表皮生长因子受体Ⅲ型突变体（EGFRvⅢ）的嵌合抗原受体表达载体,为肿瘤过继免疫治疗提供实验基础。方法：运用分子克隆方法将嵌合抗原受体的胞外抗原结合区（EGFRvⅢ单克隆抗体的轻链和重链可变区,EGFRvⅢscFv,726 bp）、铰链区/穿膜区（213 bp）、共刺激分子（CD28和CD137的胞内信号区,123 bp和126 bp）和免疫受体酪氨酸活化基序（CD3ζ链,336 bp）连接成EGFRvⅢscFv-CD28-CD137-CD3ζ（EGFRvⅢ/3CAR）,克隆入真核表达载体pCDH-CMV-MCS-EF1-copGFP的EcoRⅠ和BamHⅠ位点,转染293T细胞48 h后提取蛋白,采用SDS-PAGE和Western blotting检测EGFRvⅢ/3CAR的表达。结果： EGFRvⅢscFv和基因合成的CD28-CD137-CD3ζ表达框通过重叠延伸PCR拼接成EGFRvⅢ/3CAR,限制性内切酶片段分析和DNA测序均验证了重组载体序列完全正确,Western blotting应用抗人-CD3ζ抗体检测到EGFRvⅢ/3CAR在293T细胞中的完整表达（相对分子质量约58 kD）。结论：成功构建嵌合抗原受体EGFRvⅢ/3CAR表达载体,为嵌合抗原受体修饰T细胞靶向治疗肿瘤提供研究基础。     

Tetrandrine induces autophagy and differentiation by activating ROS and Notch1 signaling in leukemia cells

All-trans retinoic acid (ATRA) is a differentiating agent for the treatment of acute promyelocytic leukemia (APL). However, the therapeutic efficacy of ATRA has limitations. Tetrandrine is a traditional Chinese medicinal herb extract with antitumor effects. In this study, we investigated the effects of tetrandrine on human PML-RARα-positive acute promyelocytic leukemia cells. Tetrandrine inhibited tumors in vivo. It induced autophagy and differentiation by triggering ROS generation and activating Notch1 signaling. Tetrandrine induced autophagy and differentiation in M5 type patient primary leukemia cells. The in vivo results indicated that low concentrations of tetrandrine inhibited leukemia cells proliferation and induced autophagy and then facilitated their differentiation, by activating ROS and Notch1 signaling. We suggest that tetrandrine is a potential agent for the treatment of APL by inducing differentiation of leukemia cells.