血清PCT和CRP检测在社区获得性肺炎诊断中的临床意义

目的 探讨血清降钙素原(PCT)和C反应蛋白(CRP)在社区获得性肺炎(CAP)实验室诊断中的应用价值.方法 分析我院2014年1月至2015年1月社区获得性肺炎患者150例.并选取同期健康体检者150例做为正常对照组.所有各组均进行血清PCT和CRP含量的测定.结果 社区获得性肺炎患者组的血清PCT和CRP含量明显高于正常对照组,相比较有统计学意义(P＜0.05);PCT和CRP的敏感性分别为87.3％和83.3％,二者敏感性比较差异无统计学意义(P＞0.05);但二者的特异度相比较,PCT为95.3％,较CRP的70.7％高,相比较有统计学意义(P＜0.05).结论 血清PCT和CRP的测定在诊断CAP中都有一定的应用价值,特别是PCT在敏感性和特异性方面都优于CRP,是一个较好的诊断与鉴别诊断的指标,更值得临床推广应用.     

PCT及CRP在社区获得性肺炎中的临床价值研究

目的：探讨PCT及CRP与社区获得性肺炎(CAP)患者的诊断,病情严重程度和预后的关系。方法本文选取180例社区获得性肺炎患者,对其临床资料进行回顾性分析。结果①根据是否合并脓毒症分为非脓毒症组和脓毒症组,脓毒症组CAP患者PCT、CRP水平高于非脓毒症组(<0.05);②根据患者好转情况分病情改善组及病情无改善组,CAP患者病情改善组治疗后PCT、CRP、APACHEⅡ评分低于治疗前水平(<0.01);CAP患者病情无改善组治疗前后PCT、CRP、APACHEⅡ差异无显著性。(>0.05)。结论①PCT、CRP对判断肺炎合并脓毒症有一定应用价值,其中PCT优于CRP。②动态监测PCT水平变化有助于判断肺炎,尤其肺炎伴脓毒症患者预后,其水平越高,预后越差,与APACHEII等危重系统评分联用具有更高的预测价值。     

血清降钙素原与C-反应蛋白联合检测在肝硬化并肺部感染患者中的诊断价值

目的 探讨血清降钙素原(procalcitonin,PCT)与C-反应蛋白(C-reactive protein,CRP)联合检测在肝硬化并肺部感染患者中的诊断价值及临床意义.方法 选取2014年8月至2016年5月在本院入院治疗的肝硬化并肺部感染患者83例作为研究对象,根据病原学检测结果将其分为肝硬化细菌致肺部感染组(观察组)42例与肝硬化非细菌致感染组(对照组)41例,另选本院同期进行体检健康者40例作为健康组,检测并记录各组PCT、CRP,并采用SPSS21.0软件对所得数据进行处理.结果 治疗前观察组PCT水平均显著高于对照组和健康组,差异具有统计学意义(均P＜0.05);治疗后观察组PCT水平略高于对照组,差异不具有统计学意义(t=1.524,P＞0.05);观察组治疗后PCT水平显著低于治疗前,差异具有统计学意义(t=11.291,P ＜0.05);对照组治疗后PCT水平略高于治疗前,差异不具有统计学意义(t=0.928,P＞0.05).治疗前观察组CRP水平均显著高于对照组和健康组,差异具有统计学意义(P＜0.05);治疗后观察组CRP水平与对照组相比差异不具有统计学意义(t=0.825,P ＞0.05);观察组治疗后CRP水平显著低于治疗前,差异具有统计学意义(t =6.032,P＜0.05);对照组治疗后CRP水平略高于治疗前,差异不具有统计学意义(t=1.853,P＞0.05).观察组患者PCT、CRP单独检测以及PCT、CRP联合检测的阳性检出率均显著高于对照组,差异具有统计学意义(t值依次为8.517、14.624、5.433,均P＜0.05).PCT、CRP联合检测的特异性、灵敏度、阳性预测值与阴性预测值均显著高于PCT、CRP单独检测,差异具有统计学意义(均P ＜0.05).结论 肝硬化患者存在肺部感染风险,通过对肝硬化患者进行血清PCT与CRP联合检测,对肺部感染疾病的早期鉴别诊断具有积极意义.     

PCT、CRP和IL-6联合检测在老年社区获得性肺炎中的临床价值

目的 探讨血清降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)及白介素-6(interleukin-6,IL-6)联合检测对社区获得性肺炎(community-acquired pneumonia,CAP)患者诊断及预后评估中的价值.方法 选取2019年2月至2021年2月期间入住北京大学首钢医院急诊科的社区获得性肺炎患者152例为观察组,同期急诊科的健康体检人员30例为对照组.采用肺炎严重程度CURB-65评分将152例观察组分为低危组(n=84例),CURB评分<3分,和高危组(n=68例),CURB评分≥3分.依照观察组住院期间的转归情况分为存活组(n=134例)和死亡组(n=18例).比较观察组和对照组,低危组和高危组,存活组和死亡组患者的PCT、CRP及IL-6的差异,同时采用受试者工作特征(ROC)曲线分析观察组3种血清标志物对社区获得性肺炎患者预后评估的价值.结果 观察组患者的PCT、CRP及IL-6水平明显高于对照组(P<0.05);高危组患者的PCT、CRP及IL-6水平明显高于低危组(P<0.05);死亡组患者的PCT、CRP及IL-6水平明显高于存活组(P<0.05);并经Pearson相关性分析发现,CURB-65评分与PCT、CRP及IL-6呈明显正相关(相关系数r=0.640、0.621、0.529,P均<0.01).ROC曲线分析显示,PCT、CRP及IL-6预测社区获得性肺炎的灵敏度分别为83.30％、77.80％、72.20％,特异性分别85.80％、81.30％、80.60％,而三者联合检测的灵敏度和特异性均明显升高,分别为88.90％、88.10％.结论 PCT、CRP及IL-6联合检测可为社区获得性肺炎的诊断和预后评估提供重要价值,指导临床实践.     

血清降钙素原在评估老年肺炎病情严重程度及预后中的临床应用价值

目的 探讨血清降钙素原(procalcitonin,PCT)在评估老年社区获得性肺炎(community-acquired pneumonia,CAP)病情严重程度及预后中的临床应用价值.方法 选择2015年6月至2017年4月我院收治的120例老年肺炎患者作为观察组,按严重程度(CURB-65分级标准)分为低危组(0～1分),中危组(2分),高危组(3～5分)三组,同时选择72例非感染性疾病患者作为对照组,对比分析治疗前后血清PCT及C-反应蛋白(C-reactive protein,CRP)水平;观察组患者根据治疗前PCT水平分为两组,即PCT≤10 ng/mL组和PCT＞ 10 ng/mL组,分析两组患者的预后差异.结果 治疗前观察组患者PCT(9.24±2.05 ng/mL)及CRP(48.14±5.38 mg/L)水平均高于对照组(0.95±0.52 ng/mL,4.46±0.68 mg/L),差异有统计学意义(P＜0.05);观察组中,治疗前低危组PCT水平(4.33±1.48 ng/mL)低于中危组(8.72 ±2.58 ng/mL)及高危组(19.42±3.88ng/mL),差异具有统计学意义(P＜0.05),中危组PCT水平低于高危组,差异具有统计学意义(P＜0.05),治疗后低危组和中危组PCT水平显著下降,差异有统计学意义(P＜0.05);治疗前低危组、中危组、高危组的CRP水平无统计学差异(P＞0.05),治疗后CRP水平较治疗前相比差异无统计学意义(P＞0.05);治疗前PCT≤10 ng/mL组的痊愈率明显高于PCT＞ 10 ng/mL组(P＜0.01).结论 血清PCT可用于老年肺炎的诊断,血清PCT水平与老年肺炎患者病情严重程度密切相关,也可用于患者疗效判断和预后评估.     

血清降钙素原水平对老年心衰合并肺部感染抗生素治疗的指导价值及对血清WBC、CRP和ESR水平的影响

目的 探讨血清降钙素原(procalcitonin,PCT)动态变化在老年心衰合并肺部感染患者治疗中的临床应用价值.方法 老年心衰合并肺部感染患者共132例,随机分为对照组和实验组各66例.所有患者均给予常规的治疗措施,对照组由主管医师通过分析患者临床症状和病情变化决定使用抗菌药物的治疗时机.实验组于入院后第1、第3、第7和第14天检测血清PCT水平,据PCT水平及其动态变化来决定抗菌药物使用.观察两组患者的抗菌药物疗程、抗菌药物费用、住院时间、住院总费用、二重感染率、临床有效率、住院病死率、半年随访期间肺部感染的发生情况以及停用抗生素时两组患者血清白细胞计数(white blood cell,WBC)、C反应蛋白(C-reactive protein,CRP)和血红细胞沉降率(erythrocyte sedimentation rate,ESR)的差异.结果 对照组总有效率81.8％,病死率6.1％,实验组总有效率87.9％,病死率4.5％,二组差异无统计学意义(P＞0.05).实验组在住院时间、住院费用、抗生素使用疗程、抗生素费用和二重感染发生率方面均显著低于对照组(P均＜0.05).停用抗生素时两组患者WBC、CRP和ESR差异无统计学意义(P均＞0.05).结论 血清PCT水平可作为老年心衰合并肺部感染治疗中决定是否使用抗生素、评价抗菌药物疗效及作为停用抗生素的参考指标.     

支原体肺炎与细菌性肺炎炎性指标及血清降钙素原水平比较

目的 分析血清炎性细胞因子、血清降钙素原（PCT）、C反应蛋白（CRP）在支原体肺炎与细菌性肺炎中的水平变化及临床意义。方法 回顾分析2018年1月~2019年1月在我院诊治的90例儿童肺炎临床资料,其中诊断为支原体肺炎的51例设为观察A组,细菌性肺炎39例设为观察B组,另选取同期健康儿童40例设为对照组,比较各组血清炎性细胞因子（IL-6、IL-10）、PCT、CRP水平以及观察A组和观察B组急性期与缓解期血清PCT、CRP水平。结果 观察A组、观察B组IL-6水平均高于对照组,IL-10水平低于对照组,差异有统计学意义（P＜0.05）,观察A组与观察B组IL-6、IL-10分别比较,差异无统计学意义（P＞0.05）;观察B组PCT水平高于对照组和观察A组,差异有统计学意义（P＜0.05）,观察A组与对照组比较,差异无统计学意义（P＞0.05）;观察A组、观察B组CRP水平均高于对照组,且观察B组高于观察A组,差异有统计学意义（P＜0.05）;观察A组、观察B组急性期血清PCT、CRP 水平均高于缓解期,差异有统计学意义（P＜0.05）。结论 血清IL-6、IL-10、PCT和CRP有助于儿童支原体肺炎和细菌性肺炎的诊断,支原体肺炎和细菌性肺炎患儿炎性细胞因子水平基本相同,而PCT对细菌性肺炎诊断具有良好指导作用,可作为临床诊治中可靠的参考依据。     

雾化吸入干扰素同沙丁胺醇对重症肺炎患儿的疗效及PCT和CRP水平的影响

目的 研究雾化吸入干扰素同沙丁胺醇对重症肺炎患儿的疗效及降钙素原(PCT)和C反应蛋白(CRP)水平的影响.方法 选择从2016年3月至2017年3月在医院治疗的重症肺炎患儿118例进行研究,分别为对照组和观察组各59例.两组患儿均常规予以吸氧、抗生素和抗病毒治疗、平喘和维持呼吸道通畅,以及相关支持治疗.观察组在此基础上另给予雾化吸入干扰素和沙丁胺醇,对比两组疗效和不良反应,以及治疗前和治疗7d后两组PCT及CRP水平和肺功能指标水平(用力肺活量FVC、第1秒末用力呼气量FEV1及呼气峰流速PEF).结果 观察组的治愈率是45.76％,总有效率是96.61％,均分别较对照组的15.25％,84.75％提高,差异均有统计学意义(均P＜0.05).观察组不良反应的总发生率是13.56％,与对照组的8.47％相比,差异无统计学意义(P＞0.05).治疗后两组的PCT及CRP水平均较治疗前明显降低,且观察组较对照组更低,差异均有统计学意义(均P ＜0.05).治疗后两组的FVC、FEV1及PEF水平均较治疗前明显提高,且观察组较对照组更高,差异均有统计学意义(均P＜0.05).结论 雾化吸入干扰素和沙丁胺醇治疗重症肺炎患儿,具有较好的疗效,且可明显改善患儿的机体炎症状态及肺功能,值得给予推广.     

痰热清注射液联合头孢呋辛钠治疗老年社区获得性肺炎的疗效

目的 探讨痰热清注射液联合头孢呋辛钠治疗老年社区获得性肺炎（CAP）的疗效。方法 选取2016年1月~2018年12月我院收治的老年CAP患者122例,按照随机数字表法分为对照组（60例）和观察组（62例）。对照组给予头孢呋辛钠治疗,观察组给予痰热清注射液联合头孢呋辛钠治疗,比较两组咳嗽、咳痰、退热、肺部啰音消失时间,胸部X线炎症吸收情况、白细胞计数（WBC）、治疗总有效率、炎性因子水平及不良反应发生情况。结果 观察组咳嗽、咳痰、退热、肺部啰音消失时间均短于对照组,差异有统计学意义（P＜0.05）;观察组胸部X线总吸收率为93.55%,高于对照组的78.33%,差异有统计学意义（P＜0.05）;观察组治疗总有效率为95.16%,高于对照组的81.67%,差异有统计学意义（P＜0.05）;观察组IL-6、IL-8、TNF-α水平、WBC计数低于对照组,差异有统计学意义（P＜0.05）;两组不良反应发生率比较,差异无统计学意义（P＞0.05）。结论 痰热清注射液辅助治疗老年CAP具有较好的疗效,可有效缓解患者临床症状、减轻机体炎症反应,安全可靠。     

血清CRP/ALB对纤支镜下肺泡灌洗治疗难治性肺炎疗效的预测价值

目的 分析血清C-反应蛋白(CRP)/白蛋白(ALB)比值对纤维支气管镜(纤支镜)下肺泡灌洗治疗难治性肺炎疗效的预测价值.方法 收集2016年1月至8月于医院行纤支镜下肺泡灌洗治疗126例难治性肺炎患者的临床资料,所有患者入院后均测定CRP、ALB水平,分析CRP、ALB及CRP/ALB比值与难治性肺炎疗效的关系.结果 无效组CRP、CRP/ALB高于有效组,ALB低于有效组,比较差异有统计学意义(P＜0.05);治疗前,无效组CRP高于有效组,ALB低于有效组,CRP/ALB比值高于有效组(P＜0.05),治疗1周,有效组CRP、CRP/ALB比值降低(P＜0.05),无效组CRP上升,ALB降低,CRP/ALB比值上升,与有效组比较差异有统计学意义(P ＜0.05);CRP、CRP/ALB比值均为影响难治性肺炎纤支镜下肺泡灌洗治疗效果的独立危险因素,其中CRP/ALB比值相关度最高(P＜0.05).结论 血清CRP、CRP/ALB比值均为影响纤支镜肺泡灌洗治疗难治性肺炎治疗效果的重要因素,两者表达增加预示疗效不佳.     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.     

Pain and Effusion and Quadriceps Activation and Strength

Context:

Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.

Objective:

To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.

Design:

Crossover study.

Setting:

University research laboratory.

Patients or Other Participants:

Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers.

Intervention(s):

All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.

Main Outcome Measure(s):

Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.

Results:

Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05).

Conclusions:

Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles

Key Points

• Knee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps.
• The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction.
• To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.

Quadriceps weakness is a common consequence of traumatic knee joint injury^1,2 and chronic degenerative knee joint conditions.^3,4 Arthrogenic muscle inhibition (AMI), a neurologic decline in muscle activation, results in quadriceps weakness and hinders rehabilitation by preventing gains in strength.⁵ The inability to reverse AMI and restore muscle function can lead to decreased physical abilities,⁶ biomechanical deficits,⁷ and possibly reinjury.⁵ Furthermore, researchers^8,9 have suggested that quadriceps weakness resulting from AMI may place patients at risk for developing osteoarthritis in the knee. In light of the substantial influence of quadriceps AMI on these clinically relevant outcomes, we need to improve our understanding of the factors that contribute to this neurologic decline in muscle activity so efforts to target and reverse it can be implemented and gains in strength can be achieved more easily.Joint injury and disease are accompanied by numerous sequelae (ie, pain, swelling, tissue damage, inflammation), so ascertaining which one ultimately leads to neurologic muscle dysfunction is difficult. Whereas a joint effusion can result in AMI,^10–12 the effects of pain are less understood despite many clinicians attributing AMI to pain. Using techniques that introduce knee pain without accompanying injury may provide insights into the role of pain in eliciting AMI.The degree of knee joint damage may play a role in the quantity of AMI that manifests. Hurley et al^13,14 demonstrated that quadriceps AMI, measured using an interpolated-twitch technique, was greater in patients with extensive traumatic knee injury (eg, fractured tibial plateau, ruptured medial collateral ligament, and medial meniscectomy) than patients with isolated joint trauma (ie, isolated anterior cruciate ligament [ACL] rupture). Similarly, patients with more knee joint symptoms (ie, greater number of symptoms and increased severity of symptoms) may present with greater magnitudes of quadriceps inhibition. Recently, investigators¹⁵ have suggested that patients with more pain display less quadriceps strength, supporting this tenet. Given that effusion and pain often present simultaneously with joint injuries and diseases, such as ACL injury and osteoarthritis, examining both the isolated and cumulative effects of these sequelae appears warranted to determine if they influence the magnitude of muscle inhibition.Experimental joint-effusion and pain models are safe and effective experimental methods that allow for the isolated examination of their effects on muscle function. The effusion model, whereby sterile saline is injected directly into the knee joint capsule,⁷ produces a clinically relevant magnitude of the joint effusion that may be present with traumatic injury. Effusion is thought to activate group II afferents responding to stretch or pressure,^16–18 which in turn may facilitate group Ib interneurons and result in quadriceps AMI.⁵ The pain model involves injecting hypertonic saline into the infrapatellar fat pad to produce anteromedial knee pain similar to that described in patients with patellofemoral pain syndrome.¹⁹ Pain is considered to initiate AMI through activation of group III and IV afferents that act as nocioceptors to signal damage or potential damage to joint structures.^16–18 The firing of these afferents then may lead to facilitation of group Ib interneurons, the flexion reflex, or the gamma loop, ultimately resulting in quadriceps inhibition.²⁰ Thus, these models allow us to create symptoms that are associated with knee injury and have the added benefit of providing a way to examine their effects in isolation.Therefore, the purpose of our study was to determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion would affect the magnitude of quadriceps dysfunction. We hypothesized that pain alone would result in quadriceps inhibition and that the magnitude of inhibition would be greater when effusion and pain were present simultaneously.     

Postinfectious immunodeficiency and autoimmunity: pathogenic and clinical values and implications

Autoimmunity is still a mystery of clinical immunology and medicine as a whole. The etiology and pathogenesis of autoimmune disorders remain unclear and, thus, are assessed as a balance between hereditary predisposition, triggering factors and the appearance of autoantibodies and/or self-reactive T cells. Among the immunological armamentarium, molecular mimicry, based on self-reactive T- and B-cell activation by cross-reactive epitopes of infectious agents, is of special value. Hypotheses regarding the possible involvement of molecular mimicry in the development of postinfectious autoimmunity are currently very intriguing. They provide new approaches for identifying etiological agents that are associated with postinfectious autoimmunity, paired microbial- and tissue-linked epitopes targeted for autoimmune reaction determination, postinfectious autoimmunity pathogenesis recognition and specific prevention, and therapy for autoimmune disorder development.     

Beta-endorphin and drug-induced reward and reinforcement

Although drugs of abuse have different acute mechanisms of action, their brain pathways of reward exhibit common functional effects upon both acute and chronic administration. Long known for its analgesic effect, the opioid beta-endorphin is now shown to induce euphoria, and to have rewarding and reinforcing properties. In this review, we will summarize the present neurobiological and behavioral evidences that support involvement of beta-endorphin in drug-induced reward and reinforcement. Currently, evidence supports a prominent role for beta-endorphin in the reward pathways of cocaine and alcohol. The existing information indicating the importance of beta-endorphin neurotransmission in mediating the reward pathways of nicotine and THC, is thus far circumstantial. The studies described herein employed diverse techniques, such as biochemical measurements of beta-endorphin in various brain sites and plasma, and behavioral measurements, conducted following elimination (via administration of anti-beta-endorphin antibodies or using mutant mice) or augmentation (by intracerebral administration) of beta-endorphin. We suggest that the reward pathways for different addictive drugs converge to a common pathway in which beta-endorphin is a modulating element. beta-Endorphin is involved also with distress. However, reviewing the data collected so far implies a discrete role, beyond that of a stress response, for beta-endorphin in mediating the substance of abuse reward pathway. This may occur via interacting with the mesolimbic dopaminergic system and also by its interesting effects on learning and memory. The functional meaning of beta-endorphin in the process of drug-seeking behavior is discussed.     

PTEN与信号转导及肿瘤

ＴＥＮ[1] (ｐｈｏｓｐｈａｔａｓｅａｎｄｔｅｎｓｉｎｈｏｍｏｌｏｇｙｄｅｌｅｔｅｄｏｎｃｈｒｏｍｏｓｏｍｅｔｅｎ)又名ＭＭＡＣ1 [2 ] (ｍｕｔａｔｅｄｉｎｍｕｔｉｐｌｙａｄａｎｃｅｄｃａｎｃｅｒ 1 )和ＴＥＰ1 [3 ] (ＴＧＦ -βｒｅｇｕｌａｔｅｄａｎｄｅｐｉｔｈｅｌｉａｌｃｅｌｌ -ｒｉｃｈｅｄｐｈｏｓｐｈａｔａｓｅ 1 ) (以下均称为ＰＴＥＮ) ,是 1 997年由 3个研究小组先后发现的一个具有双特异磷酸酶活性的抑癌基因。ＰＴＥＮ基因异常广泛存在于人类多种恶性肿瘤 ,如恶性神经胶质瘤、前列腺癌、子宫内膜癌、黑色素瘤等…     

Tobacco and alcohol and the risk of head and neck cancer

Summary We carried out two case-control studies on the relative risk of head and neck cancer in association with tobacco and alcohol consumption. The first study carried out at the ENT Department of the University hospitals of Heidelberg and Giessen (FRG) comprised 200 male patients with squamous cell cancer of the head and neck and 800 control subjects matched for sex, age, and residential area (1:4 matching design). Of the tumour patients, 4.5% had never smoked, in contrast to 29.5% of the control group. The average tobacco and alcohol consumption of the patients was approximately twice as high as in the control subjects. The highest alcohol and tobacco consumption was observed in patients suffering from oropharyngeal cancer. Tobacco and alcohol increased the risk of head and neck cancer in a dose-dependent fashion and acted as independent risk factors. In heavy smokers (> 60 pack-years) a relative risk of 23.4 (alcohol adjusted) was calculated. Combined alcohol and tobacco consumption showed a synergistic effect. The risk ratio increased more in a multiplicative than in an additive manner. Oral and laryngeal cancer were associated with the highest tobacco-associated risk values. The highest ethanol-associated risk values were associated with oropharyngeal and laryngeal cancer. The second study was carried out at the ENT Department of the University of Heidelberg on 164 males with squamous cell carcinoma of the larynx and 656 control subjects matched for sex, age and residential area (1:4 matching design). Of the cases, 4.2% had never smoked, compared with 28.5% of the control subjects. The risk of laryngeal cancer by tobacco consumption was dose dependent, reaching a maximum value of 9.1 (adjusted for alcohol) for a consumption of more than 50 tobacco-years (TY). The relative risk of laryngeal cancer associated with alcohol intake was also dose dependent, reaching a value of 9.0 (adjusted for tobacco) for a mean daily consumption of more than 75 g alcohol. An analysis of subsite specific risks showed that heavy smokers (> 50 TY) carried a nearly ten times higher risk of supraglottic cancer than of glottic cancer. The risk of supraglottic cancer from alcohol consumption was also higher than that of glottic cancer.     

Muscle strength and serum testosterone,cortisol and SHBG concentrations in middle-aged and elderly men and women

Forty healthy males (M) and females (F) divided into two different age groups i.e. M50 years (range 44–57; n= 9), F50 years (range 43–54; n= 9), M70 years (range 64–73; n= 11) and F70 years (range 63–73; n= 11) volunteered as subjects for examination of muscle cross-sectional area (CSA) and maximal voluntary isometric force production characteristics of the leg extensor muscles and serum androgen and sex hormone binding globulin (SHBG) concentrations. The CSA in the male groups was greatly larger (P < 0.01) than in the female groups and both elderly groups demonstrated slightly (n.s.) smaller values in the CSA than the two middle-aged groups. Maximal force of 2854 ± 452 N in M50 was greater (P < 0.05) than that of 2627 ± 752 N recorded for F50 as well as the force of 2787 ± 843 in M70 was greater (P < 0.001) than that of 1849 ± 295 recorded for F70. The force between F50 and F70 differed significantly (P < 0.05) from each other. The maximal rate of force production in M50 was greater (P < 0.01) than in F50 as well as in M70 greater (P < 0.001) than in F70. Both middle-aged groups demonstrated greater (P < 0.05) values than the respective elderly groups of the same sex. The individual values in the CSA correlated with the values in maximal force both in the middle-aged subjects (r= 0.66; P < 0.01) and in the elderly subjects (r= 0.69; P < 0.01). The mean concentration of serum testosterone in M50 was slightly (n.s.) greater than in M70 and in F50 significantly (P < 0.05) greater than in F70. Serum SHBG levels were lower in the males (P < 0.01) than in the females and serum testosterone/SHBG ratio in M70 and in F70 were lower (P < 0.05) than in M50 and in F50, respectively. In the females significant positive correlations were observed between the individual values in serum testosterone concentration and the values both in the CSA (r= 0.46; P < 0.05) and in maximal force (r= 0.62; P < 0.01) as well as between serum testosterone/SHBG ratio and both the CSA (r= 0.55; P < 0.05) and maximal force (r= 0.68; P < 0.01). The present results imply that the decreasing basal level of blood testosterone over the years in aging people, especially in females, may lead to decreasing anabolic effects on muscles thus having an association with age-related declines in the maximal voluntary neuromuscular performance capacity in aging people.     

海洛因成瘾与学习记忆

海洛因成瘾是我国发病最高,危害最大的一种成瘾性疾病,而其中枢机制则是解决临床预防和治疗的关键,至今仍不清楚。既往工作表明,学习记忆功能在海洛因成瘾的中枢机制中居于重要的中心环节。本文在总结既往海洛因成瘾研究工作基础上联系学习记忆功能,试图从系统整合层次分析相关领域研究工作的不足和今后工作的发展方向。