Personal comorbidities and their subsequent risks for liver,gallbladder and bile duct cancers

Many environmental risk factors for hepatobiliary cancers are known but whether they are associated with specific cancer types is unclear. We present here a novel approach of assessing standardized incidence ratios (SIRs) of previously diagnosed comorbidities for hepatocellular carcinoma (HCC), gallbladder cancer (GBC), cholangiocarcinoma (CCA) and ampullary cancer. The 13 comorbidities included alcohol and nonalcohol related liver disease, chronic obstructive pulmonary disease, gallstone disease, viral and other kinds of hepatitis, infection of bile ducts, hepatic and other autoimmune diseases, obesity and diabetes. Patients were identified from the Swedish Inpatient Register from 1987 to 2018, and their cancers were followed from 1997 onwards. SIRs for HCC were 80 to 100 in men and women diagnosed with hepatitis C virus and they were also >10 in patients diagnosed with hepatitis B virus, other kind of hepatitis, hepatic autoimmune disease and nonalcohol related liver disease. Many of these risks, as well as alcohol related liver disease, were either specific to HCC or were shared with intrahepatic CCA. For GBC, CCA and ampullary cancer infection of bile ducts was the main risk factor. Gallstone disease, nonhepatic autoimmune diseases and diabetes were associated with all hepatobiliary cancers. The limitations of the study include inability to cover some rare risk factors and limited follow-up time. Many of the considered comorbidities are characterized by chronic inflammation and/or overt immune disturbance in autoimmune diseases. The results suggest that local chronic inflammation and a related immune disturbance is the carcinogenic trigger for all these cancers.     

Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists

The Earth’s mean surface temperature is already approximately 1.1°C higher than pre-industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three-stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high-, middle- and low-income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists’ education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re-evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references.     

Mesenchymal neoplasms with NTRK and other kinase gene alterations

Kinase alterations are increasingly recognised as oncogenic drivers in mesenchymal tumours. Infantile fibrosarcoma and the related renal tumour, congenital mesoblastic nephroma, were among the first solid tumours shown to harbour recurrent tyrosine kinase fusions, with the canonical ETV6::NTRK3 fusion identified more than 20 years ago. Although targeted testing has long been used in diagnosis, the advent of more robust sequencing techniques has driven the discovery of kinase alterations in an array of mesenchymal tumours. As our ability to identify these genetic alterations has improved, as has our recognition and understanding of the tumours that harbour these alterations. Specifically, this study will focus upon mesenchymal tumours harbouring NTRK or other kinase alterations, including tumours with an infantile fibrosarcoma-like appearance, spindle cell tumours resembling lipofibromatosis or peripheral nerve sheath tumours and those occurring in adults with a fibrosarcoma-like appearance. As publications describing the histology of these tumours increase so, too, do the variety kinase alterations reported, now including NTRK1/2/3, RET, MET, RAF1, BRAF, ALK, EGFR and ABL1 fusions or alterations. To date, these tumours appear locally aggressive and rarely metastatic, without a clear link between traditional features used in histological grading (e.g. mitotic activity, necrosis) and outcome. However, most of these tumours are amenable to new targeted therapies, making their recognition of both diagnostic and therapeutic import. The goal of this study is to review the clinicopathological features of tumours with NTRK and other tyrosine kinase alterations, discuss the most common differential diagnoses and provide recommendations for molecular confirmation with associated treatment implications.     

PDCA在优化医院新冠病毒核酸检测流程中的应用

目的：应用PDCA循环优化医院新冠病毒核酸检测的流程，提升核酸检测能力，以满足疫情防控和临床患者的需求。方法：应用PDCA循环，分析核酸检测流程存在的问题，建立标准化的核酸检测体系。同时，收集2020年10月至12月（优化前）和2021年10月至12月（优化后）的数据，采用SPSS 22.0软件进行统计分析，以评价PDCA循环的优化效果。结果：经过PDCA循环优化后，总检测中位标本数从20 307个增加至71 403个，优化前后差异有统计学意义（P=0.018）。中位送检时间从224分钟缩短至208分钟，中位检测时间从234分钟缩短至151分钟，中位报告时间从461分钟缩短至371分钟，优化前后差异均有统计学意义（P < 0.001）。结论：应用PDCA循环，能够制定并持续完善标准化的核酸检测流程，有助于提高核酸检测能力和服务水平。     

菊花总黄酮含药血清对干眼细胞模型AR、NF-κB磷酸化蛋白及TGF-β1表达的影响＊

目的 观察菊花总黄酮在体外条件下对泪腺上皮细胞中雄激素受体（Androgen Receptor，AR）的调控作用及对下游的核因子κB（Nuclear Factor kappa B，NF-κB）、转化生长因子-β1（transforming growth factor-beta1，TGF-β1）的表达影响。方法 以过氧化氢（H₂O₂）诱导泪腺上皮细胞凋亡，建立细胞模型，设立无雄激素培养空白对照组、含雄激素培养对照组、无雄激素培养黄酮治疗组。以MTT法摸索含药血清最佳干预加入量；免疫印迹实验（Western Blot）以及实时荧光定量PCR法（Quantitative Real-Time PCR，qPCR）检测泪腺上皮细胞中AR、NF-κB及TGF-β1的表达情况；并应用雄激素受体阻断剂氟他胺进行AR阻断后再次检测上述指标 。结果 MTT法检测后计算得出含药血清干预细胞的最终浓度为13.2%；无雄激素培养黄酮治疗组及含雄激素培养对照组中AR、NF-κB及TGF-β1的表达增强，与空白对照组对比有显著差异（P<0.01）；无雄激素培养黄酮治疗组中NF-κB表达量比含雄激素培养对照组表达量低，两者间的差异有统计学意义。氟他胺及含药血清干预后，无雄激素培养黄酮治疗组及含雄激素培养对照组中AR及NF-κB的表达未见提高，无统计学意义。结论 菊花总黄酮对泪腺上皮细胞可能存在拟雄激素效应，从而使AR、NF-κB表达增加，并通过上调TGF-β1的表达，可能起到在泪腺局部的抗炎作用。     

Association of TPH1 and TPH2 Gene Polymorphisms with the Risk of Developing Psychoneurological Disorders

Neuroscience and Behavioral Physiology - The question of the involvement of impairments to the metabolism of melatonin and its precursors (tryptophan and serotonin) in the development of...     

下一代诊断病理学

随着人类基因组测序、生物大数据信息分析、分子病理检测和人工智能辅助病理诊断等技术进步及其应用, 临床医学发展迈向精准诊疗时代。这一时代背景下, 传统诊断病理学迎来前所未有的历史机遇, 正在向"下一代诊断病理学(next-generation diagnostic pathology)"迈进。下一代诊断病理学以病理形态和临床信息为诊断基础, 以分子检测与生物信息分析、智慧制样与流程质控、智能诊断与远程会诊、病灶活体可视化与"无创"病理诊断等创新前沿交叉技术为主要特征, 以多组学和跨尺度整合诊断为病理报告内容, 实现对疾病的"最后诊断", 并预测疾病演进和结局、建议治疗方案和评估治疗反应, 形成新的疾病诊断"金标准"。未来, 需要激发病理学科创新活力, 加快下一代诊断病理学成熟和应用, 重塑病理学科理论和技术体系, 发挥诊断病理学在疾病"防、诊、治、养"等过程中的重要作用, 促进临床医学进一步发展, 服务健康中国战略。