Dietary Intake of Advanced Glycation End Products (AGEs) and Mortality among Individuals with Colorectal Cancer

Advanced glycation end-products (AGEs) may promote oxidative stress and inflammation and have been linked to multiple chronic diseases, including cancer. However, the association of AGEs with mortality after colorectal cancer (CRC) diagnosis has not been previously investigated. Multivariable Cox proportional hazards models were used to calculate hazard ratios and corresponding 95% confidence intervals for associations between dietary intake of AGEs with CRC-specific and all-cause mortality among 5801 participant cases diagnosed with CRC in the European Prospective Investigation into Cancer and Nutrition study between 1993 and 2013. Dietary intakes of AGEs were estimated using country-specific dietary questionnaires, linked to an AGE database, that accounted for food preparation and processing. During a median of 58 months of follow-up, 2421 cases died (1841 from CRC). Individually or combined, dietary intakes of AGEs were not associated with all-cause and CRC-specific mortality among cases. However, there was a suggestion for a positive association between AGEs and all-cause or CRC-specific mortality among CRC cases without type II diabetes (all-cause, P_interaction = 0.05) and CRC cases with the longest follow-up between recruitment and cancer diagnosis (CRC-specific, P_interaction = 0.003; all-cause, P_interaction = 0.01). Our study suggests that pre-diagnostic dietary intakes of AGEs were not associated with CRC-specific or all-cause mortality among CRC patients. Further investigations using biomarkers of AGEs and stratifying by sex, diabetes status, and timing of exposure to AGEs are warranted.     

浙江省乡村医生参加临床进修的可行性调查

目的：了解浙江省乡村医生参加临床进修,接受临床指导的可行性。方法：采用自行设计的《乡村医生临床进修可行性调查表》,对全省84个县（市、区）卫生局发放问卷调查,对收集的数据进行分析。结果：26个县的乡村医生实行乡村一体化管理;22个县的乡镇卫生院（社区卫生服务中心）实行收支两条线;22个县的乡村医生临床进修费用和工资补助由本级财政和单位共同承担,4个县由所在单位承担;26个县的乡镇卫生院（社区卫生服务中心）在乡村医生临床进修期间,可以派医生到村卫生室顶岗;41个县认为乡村医生参加临床进修1~3个月,可以替代2年一次的注册培训。结论：乡镇卫生院（社区卫生服务中心）对乡村医生实行乡村一体化管理,并实行收支两条线的情况下,乡村医生参加临床进修和临床进修费用及工资补助是可以落实的;临床进修替代注册培训的时机尚不成熟。     

Key Considerations in the Health Technology Assessment of Advanced Therapy Medicinal Products in Scotland,The Netherlands,and England

ObjectivesAdvanced therapy medicinal products (ATMPs) are highly innovative therapies. Their costs and uncertain value claims have raised concerns among health technology assessment (HTA) bodies and payers. Little is known about how underlying considerations in HTA of ATMPs shape assessment and reimbursement recommendations. We aim to identify and assess key considerations that played a role in HTA of ATMPs underlying reimbursement recommendations.MethodsA review of HTA reports was conducted of all authorized ATMPs in Scotland, The Netherlands, and England. Considerations were extracted and categorized into EUnetHTA Core Model domains. Per jurisdiction, considerations were aggregated and key considerations identified (defined as occurring in >1/assessment per jurisdiction). A narrative analysis was conducted comparing key considerations between jurisdictions and different reimbursement recommendations.ResultsWe identified 15 ATMPs and 18 HTA reports. In The Netherlands and England most key considerations were identified in clinical effectiveness (EFF) and cost- and economic effectiveness (ECO) domains. In Scotland, the social aspects domain yielded most key considerations, followed by ECO and EFF. More uncertainty in evidence and assessment outcomes was accepted when orphan or end-of-life criteria were applied. A higher percentage of considerations supporting recommendations were identified for products with positive recommendations compared with restricted and negative recommendations.ConclusionsThis is the first empirical review of HTA’s using the EUnetHTA Core Model to identify and structure key considerations retrospectively. It provides insights in supporting and opposing considerations for reimbursement of individual products and differences between jurisdictions. Besides the EFF and ECO domain, the social, ethical, and legal domains seem to bear considerable weight in assessment of ATMPs.     

生物医学工程产业发展与生物医学工程技术人才培养

结合我国生物医学工程产业发展、技术人员队伍建设以及高等医学院校生物医学工程教育的现状，阐述了医科院校生物医学工程教育的特点和规律。结合我国医院生物医学工程技术人员队伍建设以及高等医学院校生物医学工程教育存在问题的分析，提出了推动当前我国生物医学工程技术人员建设以及医学院校生物医学工程高等教育改革的一些思考。     

局部晚期中低位直肠癌患者术前同步放化疗64例疗效分析及其护理

目的：观察分析局部晚期中低位直肠癌患者术前同步放化疗效果,为临床提供参考。方法：选择2008年6月-2012年6月来本院接受治疗的64例局部晚期直肠癌患者,采用5-氟尿嘧啶联合甲酰四氢亚叶酸进行术前同步放化疗,观察疗效和毒副作用。结果：64例患者同步放化疗后5周均行盆腔螺旋CT或MRI,腹部超声检查,总有效率为71.88%;患者表现出的毒副反应主要有腹泻、放射性直肠炎、恶心、呕吐、皮肤黏膜反应、血红蛋白减少、白细胞减少、肝功能异常和神经毒性,患者大多数为Ⅰ~Ⅱ度反应;患者手术治疗,经腹会阴联合切除（Miles术）41例（占64.06%）,低位前切除术（Dixon术）18例（28.13%）,Hartman术5例（7.81%）,全部患者手术顺利,无围手术期死亡,最终行保肛手术者21例,总保肛率32.81%;随访2年后,无病生存47例,生存率为73.44%。结论：术前同步放化疗后,效果明显,不良反应轻,耐受性好,提高手术保肛率,是一较为理想的治疗局部晚期中低位直肠癌患者的方案。     

高龄老人心理衰弱和孤独感的现况调查

目的:了解高龄老人心理衰弱和孤独感的情况及其影响因素,为探讨其预防机制提供理论依据。方法:选取河北省唐山市工人医院和弘慈医院直属的10个社区卫生服务中心的3448名≥75岁及以上的老年人,应用一般人口学资料、The CFAI衰弱综合评估工具、孤独感量表(UCLA)进行心理衰弱和孤独感的评测。结果:社区高龄老年人心理衰弱的评分均分为16.53±2.303分;孤独感评分均分为40.24±10.225分。多元线性回归结果显示,与人倾诉、运动爱好、饮酒爱好、年龄、文化程度、婚姻(β'=-0.202、0.206、0.046、0.102、0.080、0.038)是老年人心理衰弱的影响因素;与人倾诉、运动爱好、吸烟爱好、文化程度、年龄、婚姻(β'=-0.231、0.136、0.049、-0.076、0.065、0.062)是孤独感的影响因素(均P<0.05)。结论:应给与相应的干预措施,延缓心理衰弱和孤独感的进一步发展。     

多西他赛联合表阿霉素治疗晚期乳腺癌的临床观察

目的观察多西他赛联合表阿霉素治疗晚期乳腺癌的临床疗效及毒副作用,并对其安全性进行评估。方法用多西他赛联合表阿霉素治疗晚期乳腺癌患者41例,其中初治患者18例,复治患者23例。结果41例患者中,3例达到完全缓解,21例部分缓解,9例病情稳定,8例出现进展,其中有效率达58．5％,临床获益率达80．5％。结论多西他赛联合表阿霉素对晚期乳腺癌具有较好的疗效和耐受性,可作为晚期乳腺癌的解救方案。     

限食对非酶糖化作用的影响

本研究通过限制小鼠的摄食量（６０％）而维生素和矿物质与对照小鼠等量供给，建立了限食模型。通过制备ＡＧＥ（ＡｄｖａｎｃｅｄＧｌｙｃａｔｉｏｎＥｎｄｐｒｏｄｕｃ－ｔｓ，高级糖化终产物）特异性抗血清，采用竞争性ＥＬＩＳＡ（ＥｎｚｙｍｅＬｉｎｋｅｄＩｍ－ｍｕｎｏｓｏｒｂｅｎｔＡｓｓａｙ，酶联免疫吸附试验）测定了小鼠组织中ＡＧＥ的含量，发现限食可广泛减少体组织中ＡＧＥ的累积。放射受体分析法测定８月龄小鼠限食１２个月盾腹腔巨噬细胞的ＡＧＥ受体，发现其数量比对照鼠高１０倍左右，每个细胞有１．０２９×１０６；其结合常数比对照鼠高出１倍，达１．４２×１０８ｍｏｌ－１。结合前人的研究结果，提出了限食延寿机制的非酶糖化假说。     

Advanced Glycation End Products: Link between Diet and Ovulatory Dysfunction in PCOS?

PCOS is the most common cause of anovulation in reproductive-aged women with 70% experiencing ovulatory problems. Advanced glycation end products are highly reactive molecules that are formed by non-enzymatic reactions of sugars with proteins, nucleic acids and lipids. AGEs are also present in a variety of diet where substantial increase in AGEs can result due to thermal processing and modifications of food. Elevation in bodily AGEs, produced endogenously or absorbed exogenously from high-AGE diets, is further exaggerated in women with PCOS and is associated with ovulatory dysfunction. Additionally, increased expression of AGEs as pro-inflammatory receptors in the ovarian tissue has been observed in women with PCOS. In this review, we summarize the role of dietary AGEs as mediators of metabolic and reproductive alterations in PCOS. Once a mechanistic understanding of the relationship between AGEs and anovulation is established, there is a promise that such knowledge will contribute to the subsequent development of targeted pharmacological therapies that will treat anovulation and improve ovarian health in women with PCOS.     

局部进展期胰腺癌综合治疗现状

胰腺癌是恶性程度高且预后极差的消化系统肿瘤。对无法切除的局部进展期肿瘤,主要采用局部外放射治疗联合全身化疗的多学科综合治疗。与放射治疗同步应用的化疗药物目前主要包括5-FU、卡培他滨与吉西他滨等。放疗技术目前推荐三维适形放射治疗或调强放疗（IMRT）。IMRT不仅可减低周围正常组织的照射剂量,还可提高肿瘤靶区的照射剂量,实现剂量递增。     

应用UBAF法深度处理垃圾渗沥液的试验研究

北京市某垃圾填埋场渗沥液经二级处理后出水中的CODCr、NH3-N、SS和色度等主要污染物质不能达标排放,在实验室中采用UBAF(升流式曝气生物滤池)小试装置对该出水进行深度处理.结果表明:在进水流速为150cm/s的条件下,出水中CODCr、 NH3-N、SS和色度的去除率可分别达到70%、85%、87%和80%以上,出水水质最终可达标排放.     

Higher Dietary Intake of Advanced Glycation End Products Is Associated with Faster Cognitive Decline in Community-Dwelling Older Adults

Objective: Dietary-derived advanced glycation end products (AGEs) vary for different food types and the methods employed during their preparation may contribute to diverse chronic health conditions. The goal of this study was to investigate the associations of dietary AGEs (dAGEs) with cognitive decline in older adults. Methods: Non-demented older adults (n = 684) underwent annual testing with 19 cognitive tests summarized as a global cognitive score based on five cognitive domains. We modified a previously validated food frequency questionnaire designed to assess dAGE. The modified questionnaire assessed portion size and frequency of consumption of six food groups (meat, poultry, fish, cheese, spreads, and processed foods), as well as the method of their preparation (e.g., grilling, boiling). dAGE was the sum of the scores of the six food groups. Linear mixed-effect models were used to examine the association of baseline dAGE with cognitive decline. All models controlled for age, sex, education, race, and body mass index (BMI). Results: Average follow-up was 3.0 years. Higher baseline dAGEs was associated with a faster rate of global cognitive decline (Estimate = −0.003 (standard error = 0.001, p-value = 0.015). This association was driven by declines in episodic memory (−0.004 (0.002, 0.013)) and perceptual speed (−0.003 (0.001, 0.049)) but not by semantic memory, working memory, and visuospatial domains. These associations were not attenuated by controlling for cardiovascular risk factors and diseases, including diabetes. Levels of dAGE of the specific food groups were not associated with cognitive decline. Conclusions: Higher levels of dietary AGE levels in older adults are associated with faster cognitive decline. These data lend further support for the importance of diet and that its modification may slow or prevent late-life cognitive impairment. Further clinical studies will be needed and the molecular mechanisms underlying these associations will need to be identified.     

肥胖与大肠高风险腺瘤发病风险研究

目的 探讨肥胖与大肠高风险腺瘤发病风险的关系。方法 以参加2008年上海市社区大肠癌筛查研究中的45~74岁的社区居民为研究对象,收集筛查前风险因素和筛查后肠镜诊断结果,并结合人工主动随访收集大肠高风险腺瘤发病的结局信息,采用多因素Cox比例风险回归模型分析BMI与大肠高风险腺瘤发病的风险比（HR）和95% CI。结果 20 811名研究对象共计随访122 739.36人年,平均随访时间为5.87年,共收集大肠高风险腺瘤657例。与体重正常者相比,肥胖者（BMI≥28.0 kg/m²）大肠高风险腺瘤发病风险增加21%,调整年龄、性别、大肠癌家族史、文化程度、婚姻状况、生活方式特征如吸烟、饮酒、脂肪类食物摄入、油炸或腌制类食物摄入及蔬菜水果摄入情况等因素后,肥胖者发生大肠高风险腺瘤的HR值为1.25（95% CI：1.04~1.51）。进一步按年龄、性别及大肠癌家族史进行分层分析后发现,在男性、>60岁人群中,肥胖者与体重正常者相比,大肠高风险腺瘤的发生风险更大（男性：HR=1.57,95% CI：1.20~2.04;>60岁人群：HR=1.63,95% CI：1.23~2.16）。结论 肥胖是大肠高风险腺瘤发病风险独立的危险因素,发病风险随BMI的增加而增加。     

异环磷酰胺治疗晚期恶性肿瘤病人42例的护理体会

目的　总结采用联合异环磷酰胺化疗的晚期恶性肿瘤人护理对策。方法　对 4 2例晚期恶性肿瘤病人采用联合异环磷酰胺方案化疗 ,全程观察治疗过程所出现的护理问题 ,记录并总结其要点。结果　4 2例病人顺利度过化疗期 ,心理表现也正常。结论　护士熟悉药物的特性和毒性反应 ,及早预防、及时处理和加强毒性反应护理 ,才能保证化疗的顺利进行。     

眼科专用器械的科学管理及合理采购

我院是湖南省长沙市爱尔眼科投资集团在常德市惟一一所眼科专科医院，由于眼科手术的复杂性、精细性、操作难度大等特点，决定了这些手术器械应具备精密度高、完整性、完好性，符合手术需要，眼科专用器械的科学管理及合理采购是保证手术医生手术成功的关键。     

Factors Associated With Family Caregiver Burden of Home-Dwelling Patients With Advanced Dementia

ObjectivesTo realize patients’ preferences for home death, this study aimed to identify factors associated with family caregiver burden of home-dwelling patients with advanced dementia and examine its relationship with end-of-life care treatment decisions.DesignA prospective cohort study.Setting and ParticipantsPatient-family caregiver dyads enrolled in a home-based palliative care program for patients with advanced dementia, with family caregiver burden assessed using the Zarit Burden Interview (ZBI) on enrolment, were included.MethodsIndependent variables included sociodemographic data, patients’ clinical phase, symptom severity, quality of life, informal paid help availability, and community resources utilized. Dependent variable was continuous ZBI scores and ZBI scores dichotomized into <24 and ≥24 for predicting depression risk. Place of death and interventions received 2 weeks before death were also collected. Data were analyzed using multivariate linear and logistic regression.ResultsFrom October 2014 to December 2020, a total of 377 family caregivers were assessed with ZBI. Median score was 25 (IQR 15-36), and 54.4% of them were at risk of depression. Younger family caregivers had higher ZBI scores (β = ?0.22, 95% CI –0.38, ?0.07), with the depression risk doubling for family caregivers aged <60 years (OR 2.13, 95% CI 1.33, 3.43). Absence of informal paid help also increased the ZBI scores (β = ?9.04, 95% CI –14.86, ?3.22) and depression risk (OR 2.50, 95% CI 1.03, 6.09). In addition, caregivers’ ZBI scores increased with patients’ neuropsychiatric symptom severity (β = 0.49, 95% CI 0.08, 0.89), and caregivers of clinically unstable patients had a higher depression risk (OR 1.80, 95% CI 1.03, 3.12). Baseline caregiver burden was not associated with treatment decisions made at the end of life.Conclusions and ImplicationsYounger family caregivers caring for clinically unstable patients with severe neuropsychiatric symptoms experienced greater burden without informal paid help. For end-of-life care at home in advanced dementia to be tenable, relevant national agencies and stakeholders are recommended to work collectively to support family caregivers holistically.     

Cost Effectiveness of Pembrolizumab for Advanced Melanoma Treatment in Portugal

Background

The aim of this study was to assess the cost-effectiveness of pembrolizumab in treating patients with ipilimumab-naïve advanced melanoma in Portugal.

沙利度胺联合CP方案对晚期卵巢癌血清血管内皮生长因子、肿瘤坏死因子-α、肿瘤抗原125的影响

目的观察CP方案联合沙利度胺（thalidomide,Thd;反应停）对晚期卵巢癌患者的疗效。方法2004年7月至2007年12月,26例在解放军第452医院确诊为晚期卵巢癌患者,将其随机分为A组（CP方案联合沙利度胺,n=13）与B组（单独使用CP方案,n=13）（本研究遵循的程序符合解放军第452医院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象知情同意,并与之签署临床研究知情同意书）,比较其疗效。A组用药方案为：（500～700）mg／m^2环磷酰胺（cyclophosphamide,CTX）静脉给药＋（50～75）mg／m^2顺铂（diamminedichloroplatinum,DDP）静脉给药＋200mg沙利度胺口服,每晚1次,连续治疗1个月。B组患者除不口服沙利度胺外,用药方案同A组。采用酶联免疫吸附测定（enzyme linked immunosorbent assay,ELISA）试剂盒检测A,B两组患者血清中血管内皮生长因子（vascular endothelial growth factor,VEGF）、肿瘤坏死因子（tumor necrosis factor,TNF）-α、肿瘤抗原125（cancer antigen125,CA125）含量。结果血清中,血管内皮生长因子、肿瘤抗原125含量A组较B组明显降低,血清中肿瘤坏死因子-α含量也显著降低,两组比较,差异均有显著意义（P〈0．01,P〈0．05）。结论在晚期卵巢癌治疗中,沙利度胺与常规化疗药物有协同作用,可增强常规化疗药物作用。     

替吉奥一线治疗晚期胃癌临床观察

目的观察替吉奥（S-1）胶囊作为一线药物治疗晚期胃癌的疗效及安全性。方法对44例具有可测量指标的晚期胃癌患者随机分为两组。观察组23例采用替吉奥胶囊80mg/m~2qd,分早晚2次口服,1～14d,停药7d后重复,连用2周期后评价疗效。对照组21例采用优福定胶囊,每次2粒,每天3次;总量400～600片为1个疗程,1个疗程6～8周。替吉奥胶囊连用4周期后对比两组疗效。结果观察组23例中CR3例、PR6例、SD10例,PD4例。有效率39.13%,疾病控制率82.60%。对照组21例中CR 0例、PR4例,SD7例,PD10例。有效率19.05%,疾病控制率52.38%。两组间疾病控制率比较差异有统计学意义（P〈0.05）。两组主要毒副反应均以消化道反应和血液学毒性为主。两组比较恶心、呕吐发生率差异有统计学意义（P〈0.05）。结论替吉奥胶囊作为一线药物治疗晚期胃癌患者有较好疗效,给药方便,毒副反应轻。     

浙江省平湖市深度处理地面水消毒副产物的监测分析

[目的]监测分析污染较重的地面水（五类或劣五类）经深度处理后,水中消毒副产物的含量及其动态,探[讨深度处理后自来水水质的安全性。[方法]依据水厂生产工艺中使用的臭氧氧化、二氧化氯与氯化混合消毒可能产生的消毒副产物指标,进行两年定时、定点监测。[结果]三卤甲烷、卤代乙酸及亚氯酸盐、氯酸盐、溴酸盐等14项消毒副产物含量明显低于现行国家生活饮用水卫生标准限值。[结论]平湖市对污染较重的自来水源水所采用的深度处理工艺是有效的,产生的消毒副产物含量较低,对人体是安全的。