《癌症进化发育学》简介

正由第二军医大学曹广文教授主编的《癌症进化发育学》一书,在国家973计划研究团队的共同努力下已编撰完成,并于2017年7月正式出版发行。曹广文教授及其团队在总结长期的炎-癌恶性转化研究成果的基础上,综合分析近十年来基因组学的革命性进展后,发现癌症发生发展的机制与生物界中另一个精彩的现象——物种进化过程有着相似之处。在达尔文进化论的启发下,基于国内外大量不同角度的证据,系     

和癌症患者谈“治癌”

和癌症患者谈“治癌”在沈阳市沈河中医新疗法医院的肿瘤门诊，几位癌症患者就治疗癌症疼痛的＂速效止痛拔癌膏＂的有关问题请教了吴琪院长。患者：吴院长，目前治疗癌症的方法很多，＂速效止痛拔癌膏＂治疗癌症机理何在？吴琪：就医学理论而言，人患肿瘤，即使不用任何方...     

肝细胞癌发生及预后性别差异的相关危险因素

肝细胞癌(HCC)是世界最主要的恶性肿瘤类型之一,其中近50%的患者集中在中国。HCC属于男性高发癌症,流行病学数据显示,我国HCC发病率男女比例为2∶1~5∶1。目前发现可能导致HCC性别差异性的危险因素包括:乙型肝炎病毒感染和突变、免疫遗传易感性以及性激素受体作用。相关研究不仅有助于阐明HCC进化发育的具体生物学过程,更揭示了HCC发生和预后与性别差异相关的生物学标志,对完善HCC防控策略具有重要意义。     

《癌症进化发育学》为癌症研究提供新的理论框架

正2018年8月,海军军医大学"国家973计划"首席科学家曹广文教授及其团队的近期成果——《癌症进化发育学》图书研讨会在上海博览中心顺利举行。此专著由第二军医大学出版社出版,获得上海市出版基金和国家出版基金资助,荣获2018年第15届"上海图书奖"一等奖(一等奖及以上奖项中唯一的医学著作),也是国家重点基础研究发展计划——"973计划"(2015CB554000)的     

别把七种“小病”拖成癌

肝炎:原发性肝癌是人类常见的恶性肿瘤之一,而乙肝病毒(HBV)感染与肝细胞癌发生之间存在着明确的关系。慢性溃疡性疾病:口腔溃疡、胃溃疡十分常见,许多人常常不将这些"小病"当回事。但慢性溃疡长期存在可能发生癌变。糖尿病:有研究指出,糖尿病患者癌症     

癌痛患者爆发性疼痛管理的护理进展

癌性疼痛(简称癌痛)是癌症患者最常见、最痛苦也是最难忍受的症状之一。爆发性疼痛(BTP)是癌痛中较难处理的一种。BTP降低患者的生活质量和癌痛的总体治疗效果,是护理人员必须解决的问题。护理评估是BTP控制与管理的基础,持续评估并记录BTP的目的在于了解癌症患者的疼痛发作及终止情况,为调整治疗方案和制订合理、有效地护理措施提供依据。用于治疗BTP的理想药物应该具有起效快和代谢迅速的特点。癌症患者BTP的管理有多重影响因素,因此,应从社会人口学、患者的依从性、心理韧性及护士对疼痛的管理水平入手,探索有效的措施以提高癌症患者BTP的管理水平。     

癌痛可用哪些止痛药

<正>所谓癌症疼痛(癌痛),是指癌症、癌症相关性病变及抗癌治疗所致的疼痛。癌症疼痛多为慢性疼痛。晚期癌症患者疼痛发生率约为50%~60%,其中三分之一的患者为重度疼痛。但癌痛并不是只发生在晚期癌症患者中,早中期癌症患者同样可能会有癌痛。癌痛是影响病人生活质量的重要因素,必须重视癌痛的治疗。很显然,治疗癌症疼痛最重     

远处转移癌“冠军”——骨转移癌

随着某些癌症发病率的上升,癌症患者不断增加,特别是中老年长期存活的癌症患者不断增加,以至出现全身远处器官转移的癌症患者相应增加;而在许多器官癌症的远处转移中,骨转移癌居首位。因此,骨转移癌可谓远处转移癌“冠军”。     

揭开癌症的神秘面纱——癌症认知的三次革命

长期以来,癌症在人们的认知之中是一种绝症。“谈癌色变”是人们对于癌症一直以来所持有的态度。其实对于科研领域来说,癌症早已经不是不可触碰的领域。在众多科研工作者的努力下,人类对于癌症的认知,已经产生了飞跃性的变革。我们之所以恐惧癌症,很大程度上是因为对它知之甚少。其实癌症的真相,并没有那么神秘莫测。下面我们深入浅出地从知癌、防癌、治癌三个方面,揭开癌症的神秘面纱。     

别把七种『小病』拖成癌

肝炎:原发性肝癌是人类常见的恶性肿瘤之一,而乙肝病毒(HBV)感染与肝细胞癌发生之间存在着明确的关系. 慢性溃疡性疾病:口腔溃疡、胃溃疡十分常见,许多人常常不将这些“小病”当回事.但慢性溃疡长期存在可能发生癌变. 糖尿病:有研究指出,糖尿病患者癌症患病率高于非糖尿病患者.所患的癌症包括子宫内膜癌、乳腺癌、前列腺癌、结直肠癌、胰腺癌等.这与糖尿病患者中肥胖症发病率高有关,也与高血糖有关.     

Hepatitis and HIV Risk among Drug-Using Men Who Have Sex with Men: Demonstration of Hart's Law of Inverse Access and Application to HIV

Objectives: The first 215 drug-using men who have sex with men (DU-MSM) evaluated for possible participation in a controlled behavioral intervention study were tested for Hart's law of inverse access, which predicts that access to prevention resources varies inversely to need. Methods: Hepatitis B vaccination, mental health, and substance abuse treatment were used to measure health resource use; hepatitis B (HBV) and HIV infections and unsafe sex measured preventive care needs. Socioeconomic status indicators included education, ethnicity, and income. Results: HBV-vaccinated men were more likely to be white and college educated. HBV-infected men were more likely to be black, older, HIV-positive, and have higher rates of substance use with sex. When stratified according to socioeconomic status indicators, levels of HBV vaccination were inverse to the rates of HBV and HIV infection. This relationship was not found for psychosocial treatment utilization. Conclusions: Demonstration of Hart's law among high-risk DU-MSM has important implications for future HIV prevention efforts among high-risk individuals. Combining HIV, hepatitis, and substance abuse prevention in primary care and substance abuse treatment settings is discussed.     

Hepatitis B ESL Education for Asian Immigrants

Asian communities in North America include large numbers of immigrants with limited English proficiency. Hepatitis B virus (HBV) infection is endemic in most Asian countries and, therefore, Asian immigrant groups have high rates of chronic HBV infection. We conducted a group-randomized trial to evaluate the effectiveness of a hepatitis B English as a second language (ESL) educational curriculum for Asian immigrants. Eighty ESL classes were randomized to experimental (hepatitis B education) or control (physical activity education) status. Students who reported they had not received a HBV test (at baseline) completed a follow-up survey 6 months after randomization. The follow-up survey assessed recent HBV testing and HBV-related knowledge. Provider reports were used to verify self-reported HBV tests. The study group included 218 students who reported they had not been tested for HBV. Follow-up surveys were completed by 180 (83%) of these students. Provider records verified HBV testing for 6% of the experimental group students and 0% of the control group students (P = 0.02). Experimental group students were significantly (P < 0.05) more likely than control group students to know that immigrants have high HBV infection rates, HBV can be spread during sexual intercourse and by sharing razors, and HBV infection can cause liver cancer. Our ESL curriculum had a meaningful impact on HBV-related knowledge and a limited impact on HBV testing levels. Future research should evaluate the effectiveness of ESL curricula for other immigrant groups and other health topics, as well as other intervention approaches to increasing levels of HBV testing in Asian immigrant communities.     

Correlates of Hepatitis B Testing Among Chinese Americans

Chinese Americans are 10 times more likely to be diagnosed with hepatocellular carcinoma (HCC) than their white counterparts. About 80% of HCC’s among Asian immigrants are associated with hepatitis B virus (HBV) infection. We used data from in-person interviews of Chinese residents in Seattle to examine factors associated with HBV testing. The survey was completed by 206 men and 236 women (cooperation rate: 58%). Less than one-half (48%) of respondents had been tested for HBV. Factors associated (p < 0.01) with ever having tested in bivariate comparisons included knowing that Chinese are more likely to be infected with HBV than Whites; individuals can be infected with HBV for life; HBV infection can cause liver cancer; not believing that HBV can be prevented by having a positive attitude; having a family member, friend, or medical doctor recommend testing; asking for testing from a medical doctor; and not needing interpreter services. In multiple regression analyses, the following factors were independently associated with testing: believing that Chinese were more likely than Whites to get HBV (p = 0.004), having a doctor recommend testing (p ≤ 0.001), asking a doctor for the test (p < 0.001) and not needing an interpreter for doctors visits (p = 0.002). Intervention programs to improve HBV testing rates in Chinese Americans should include strategies to improve knowledge about the risk of HBV and encourage effective communication with health care providers about HBV testing.     

慢性乙型肝炎病人外周血单个核细胞HBV感染后对其细胞免疫功能影响的研究

应用聚合酶链（PCR）方法检测慢性乙型肝炎（乙肝）病人外周血单个核细胞（PBMC）内乙肝病毒DNA （HBV DNA）。54例PBMC内HBV DNA （+）和71例PBMC内HBV DNA （-）病例平行测定自然杀伤细胞（NK）活性、T细胞亚群比值（CD₄/CD₈）和血清可溶性白细胞介素2受体（sIL-2R）。结果示慢性乙肝病人PBMC内HBV DNA （+）组NK、CD₄/CD₈和sIL-2R与正常对照组及PBMC内HBV DNA （-）组病人相比差异均有非常显著性（P<0.001）。同时发现慢性乙肝PBMC内HBV DNA （+）病人NK活性、CD₄/CD₈比值和sIL-2R水平有直线相关性（P均<0.01），而PBMC内HBV DNA （-）病人，仅CD₄/CD₈比值和sIL-2R水平呈相关性（P<0.001） NK活性尚未受到明显影响。结果表明，HBV感染PBMC导致慢性乙肝病人细胞免疫功能紊乱，有助于阐明慢性乙肝的发病机制，并有可能为乙肝的防治提供理论依据。     

Cancers in Australia in 2010 attributable to infectious agents

Objectives: To estimate the proportion and numbers of cancers in Australia in 2010 attributable to infectious agents. Methods: The population attributable fraction (PAF) and number of cancers caused by hepatitis B and C viruses (HBV, HCV), Helicobacter pylori and human immunodeficiency virus (HIV) were calculated using standard formulae incorporating prevalence of infection in the Australian population, the relative risks associated with that infection and cancer incidence. For cancers with very strong associations to the infectious agent (Epstein‐Barr virus [EBV], human papillomavirus [HPV] and HIV/Kaposi's sarcoma herpes virus [KSHV]), calculations were based on viral prevalence in the tumour. Results: An estimated 3,421 cancers (2.9% of all cancers) in Australia in 2010 were attributable to infections. Infectious agents causing the largest numbers of cancers were HPV (n=1,706), H. pylori (n=793) and HBV/HCV (n=518). Cancer sites with the greatest number of cancers caused by infections were cervix (n=818), stomach (n=694) and liver (n=483). Cancers with highest proportions attributable to infectious agents were Kaposi's sarcoma (100%), cervix (100%), nasopharynx (87%), anus (84%) and vagina (70%). Conclusions: Infectious agents cause more than 3,000 cancers annually in Australia. Implications: Opportunities for cancer prevention through infection control are considerable, even in a ‘first world’ nation like Australia.     

Factors Affecting the Development of an Antibody Response to Hepatitis B Immunization in Children With Intestinal Failure: Before and After Small Bowel Transplantation (With and Without Liver Graft)

Background: Small bowel transplant with or without a liver graft (SBTx ± LTx) for children with intestinal failure involves checking their immunity to a range of microorganisms, including hepatitis B virus (HBV), at the time of assessment. HBV vaccination in the United Kingdom is recommended for transplant candidates. The aim of this audit was to find out how many SBTx ± LTx candidates received HBV vaccination before transplantation and how the timing of vaccination influenced the development of immunity. Materials and Methods: Retrospective review of case notes and hospital microbiology database formed the basis of the study. Vaccination history and serology were available in 56 of 87 subjects who had SBTx ± LTx. Results: All patients were seronegative for HBV when assessed for transplant. HBV vaccination was started before transplant in 25 children and after transplant in 31. Eight children died posttransplant before their immunity could be checked, but of the 48 survivors, 20 children developed immunity, of whom 13 (65%) received at least 1 vaccination before SBTx ± LTx (P = .008). Lack of response to HBV vaccine was significantly associated with isolated bowel transplantation and intensification of immune suppression. Of 11 children, 5 lost hepatitis B surface antibody (HbsAb), and 28 never made HBsAb, despite repeated vaccinations. Conclusion: Our study clearly shows that HBV vaccine before transplant is more effective. In line with renal failure patients, we suggest that children with chronic intestinal failure receive HBV vaccine when clinically stable, before referral for transplant. Higher‐dose vaccines, accelerated schedules, and more frequent booster vaccinations are also strategies that may improve HBsAb levels after transplant.     

江苏省2012-2014年HBV携带者进展为慢性乙型肝炎患者的队列特征分析

目的 了解HBV携带者进展为慢性乙型肝炎（慢性乙肝）患者的流行病学特征,为推进HBV携带者的社区规范管理提供依据。方法 2012-2014年对在江苏省传染病防治示范区HBV携带者队列开展定期随访,并行B超检查及ALT、HBsAg、抗-HBe,HBeAg、乙肝病毒核酸（HBV DNA）检测。通过Cox回归分析携带者进展为慢性乙肝的特征及影响因素,通过方差分析和配对t检验分析携带者进展为慢性乙肝时HBeAg变化特征与HBV DNA的关系。结果 2012年4 069例HBV携带者[平均年龄（52.0±12.8岁）]随访到2014年时1 444例进展为慢性乙肝,进展率为21.0/100人年。男性携带者慢性乙肝进展率（24.8/100人年）高于女性（18.4/100人年）;HBV DNA<2 000 IU/ml的携带者慢性乙肝进展率为19.0/100人年,低于2 000～19 999 IU/ml者（23.7/100人年）、20 000～199 999 IU/ml者（31.1/100人年）和≥200 000 IU/ml者（33.8/100人年）。通过Cox回归分析,除性别外,HBV DNA是携带者进展为慢性乙肝的影响因素（P<0.05）。40.7%的HBeAg阳性携带者进展为慢性乙肝时发生了HBeAg转换,1.7%的HBeAg阴性携带者进展为慢性乙肝时发生了HBeAg阳转。结论 江苏省传染病防治示范区HBV携带者慢性乙肝进展率为21.0/100人年,建议对HBV携带者定期检查ALT、B超和HBV DNA,可提高早发现慢性乙肝的可能性。     

A model program for hepatitis B vaccination and education of schoolchildren in rural China

Objectives

Incomplete hepatitis B virus (HBV) vaccine coverage and poor HBV-related knowledge in China leave millions of children unprotected from this life-threatening infection. To address these gaps, a pilot program for HBV education and vaccination was launched in rural China.

Methods

In 2006, public and private organizations in the US and China collaborated to provide HBV education and vaccination to 55,000 school-age children in the remote, highly HBV-endemic area of Qinghai Province. The impact of the educational program on HBV-related knowledge was evaluated among more than 2,800 elementary school students.

Results

Between September 2006 and March 2007, the three-shot hepatitis B vaccine series was administered to 54,680 students, with a completion rate of 99.4%. From low pre-existing knowledge levels, classroom educational sessions statistically significantly increased knowledge about HBV risks, symptoms, transmission, and prevention.

Conclusions

This program offers an effective and sustainable model for HBV catch-up vaccination and education that can be replicated throughout China, as well as in other underserved HBV-endemic regions, as a strategy to reduce chronic HBV infection, liver failure, and liver cancer.     

C型HBV感染者发展为肝癌的危险因素及风险预测

目的 研究C型HBV感染者进展为肝癌的危险因素,构建相应的风险评估系统。方法 采用队列研究设计,对C型HBV感染者进行随访,采用巢式PCR技术检测HBV核心启动子区及PreS区的相关位点突变情况并进行分型。构建列线图模型,计算各项指标的风险系数并在验证队列中进行验证。结果 共纳入1 110例C型HBV感染者,平均随访8.52（5.36～11.68）年,肝癌发生率为11.93/1 000人年。在C型HBV感染者中,男性、年龄≥40岁、4种HBV核苷酸突变（T1674CG、A1762T/G1764A、A3120T和A2962G）可以增加肝癌发生的危险性（P<0.05）;干扰素治疗可以降低肝癌发生的危险性（P<0.05）。在此基础上构建风险评估体系,结果显示,预测与实际的无病生存率拟合效果较好,预测值与实际值较相符,预测效果可信度较高。结论 C型HBV基因突变与肝癌发生关系密切。新构建的风险评估体系预测效果良好。     

Multiagent Simulation of the Hepatitis B Epidemic Process

Objective

To develop multiagent model of hepatitis B (HBV) infection spreading.

Introduction

The standard approaches to simulation include solving of differential equation systems. Such approach is good for obtaining general picture of epidemics (1, 2). When the detailed analysis of epidemics reasons is needed such model becomes insufficient. To overcome the limitations of standard approaches a new one has been offered. The multiagent approach has been offered to be used for representation of the society. Methods of event-driven programming give essential benefits of the processing time of the events (3).

Methods

For model development C# computing language has been used. We have used demographical data, the incidence rate of HBV infection of all population and different population groups (age, professional and other groups), coverage of hepatitis B vaccination, the proportion of HBV carriers in population, the prevalence rate of chronic HBV infection, percent of dominated transmission routes and factors and other rates in Kharkiv region. All parameters, expressed in the model were estimated using sero-surveys data and data of epidemiological surveillance of Kharkiv region sanitary-epidemiological station. Also the theoretical knowledge about HBV infection has been used. 26 conditions have been derived from the problem domain. The transition from one condition to another depends on stochastic value and time of the event change. All events are organized in priority queue which results in high rate of computation performance. The dependence on time and random value determines automata theory conceptions.

Results

The prototype of software system, which includes a subsystem of the multiagent simulation and specialized statistical and mathematical sub-system which can process the simulation results and perform a conditional optimization of the selected objective functions (morbidity, the effectiveness of specific preventive and control activities and their price, measure of reducing the socio-economic impact of HBV infection, etc.) have been developed. Screen form is presented in Figure 1.Open in a separate windowFig. 1.The main panel of simulation management and graphic visualization.

Conclusions

The multiagent simulation model of the HBV infection epidemic situation development, based on data obtained in Kharkiv (Ukraine) has been created.The simulation results allow us to:

1. predict the dynamics of the epidemic process in time in a particular area, taking into account specific epidemic situation;test the effectiveness of various preventive measures (sterilization of instruments, coverage of hepatitis B vaccination of certain groups of people, etc.).

Using the present model in public health system suggests improvment of the epidemiological diagnostics of HBV infection and of the quality of management decisions about epidemiological surveillance. The evolution of multiagent simulation in epidemiology will broaden the possibilities of epidemiological surveillance and control.