沙鼠肝泡球蚴组织中微血管密度、血管内皮生长因子的表达及意义

目的研究沙鼠肝泡球蚴组织中微血管密度(MVD)-CD34及血管内皮生长因子(VEGF)的表达及意义。方法将60只健康的长爪沙鼠随机平均分为2组,即实验组和对照组。实验组沙鼠采用开腹肝穿刺法,每只鼠接种原头节悬混液0.1 m L,对照组以相同的方法接种等量的PBS。分别于接种后第20、40、60、80、100 d时每组各处死6只沙鼠,实验组分别取泡球蚴组织和泡球蚴周围肝组织,对照组取正常肝组织。免疫组织化学法观察各时间点沙鼠肝泡球蚴组织中MVD-CD34及VEGF的表达情况。结果感染泡球蚴沙鼠肝脏中均见大小不等的团块状囊泡组织,部分播散至腹腔。在感染的各时间点,泡球蚴组织中均可见到MVD-CD34和VEGF的表达,定位于肝泡球蚴组织"外囊"囊壁内皮细胞的细胞浆。在感染后第20 d、40 d、60 d、80 d和100 d时,泡球蚴组织中MVD分别为(9.83±3.87)/HP、(25.33±6.71)/HP、(34.50±5.50)/HP、(37.67±5.71)/HP和(44.67±4.93)/HP,与泡球蚴周围肝组织〔0/HP、(1.17±0.98)/HP、(3.50±1.38)/HP、(5.83±2.71)/HP、(8.83±2.48)/HP〕和正常肝组织(均为0)相比,差异均有统计学意义(P0.05)。各时间点泡球蚴组织中VEGF免疫组织化学评分分别为(2.95±0.46)分、(3.90±0.68)分、(4.27±1.05)分、(5.33±0.95)分和(4.50±0.81)分,与泡球蚴周围肝组织〔(1.07±0.63)分、(1.38±0.75)分、(1.55±0.83)分、(1.67±0.47)分、(2.10±0.55)分〕和正常肝组织〔(1.02±0.83)分、(1.12±0.63)分、(1.26±0.26)分、(1.20±0.74)分、(1.21±0.28)分〕相比,差异均有统计学意义(P0.05)。结论血管生成可能是泡球蚴浸润性生长的机制之一,VEGF可能促进沙鼠肝泡球蚴组织血管新生。     

Network Meta-Analysis of Randomized Controlled Trials: Efficacy and Safety of UDCA-Based Therapies in Primary Biliary Cirrhosis

Major ursodeoxycholic acid (UDCA)-based therapies for primary biliary cirrhosis (PBC) include UDCA only, or combined with either methotrexate (MTX), corticosteroids (COT), colchicine (COC), or bezafibrate (BEF). As the optimum treatment regimen is unclear and warrants exploration, we aimed to compare these therapies in terms of patient mortality or liver transplantation (MOLT) and adverse events (AE).PubMed, the Cochrane Library, and Scopus were searched for randomized controlled trials up to August 31, 2014. We estimated the hazard ratios (HRs) for MOLT and odds ratios (ORs) for AE. A sensitivity analysis based on the dose of UDCA was also executed.Thirty-one eligible articles were included. Compared with COT plus UDCA, UDCA (HR 0.38, 95% confidence interval [CI] 0.09–1.39), BEF plus UDCA (HR 0.29, 95% CI 0.02–4.83), COC plus UDCA (HR 0.39, 95% CI 0.07–2.25), MTX plus UDCA (HR 0.28, 95% CI 0.05–1.63), or OBS (HR 0.49, 95% CI 0.11–2.01) all provided an increased risk of MOLT. With respect to drug AE profile, although not differing appreciably, BEF plus UDCA was associated with more AEs compared with UDCA (OR 3.16, 95% CI 0.59–20.67), COT plus UDCA (OR 2.27, 95% CI 0.15–33.36), COC plus UDCA (OR 1.00, 95% CI 0.09–12.16), MTX plus UDCA (OR 2.03, 95% CI 0.23–17.82), or OBS (OR 3.00, 95% CI 0.53–20.75). The results of sensitivity analyses were highly consistent with previous analyses.COT plus UDCA was the optimal UDCA-based regimen for both MOLT and AEs. BEF plus UDCA was most likely to cause AEs, whereas monotherapy with UDCA and coadministriation of COT plus UDCA appeared to be associated with the fewest AEs for PBC treatment.     

The primary health care physician and the cancer patient: tips and strategies for managing sexual health

There is a large and growing population of long-term cancer survivors. Primary care physicians (PCPs) are playing an increasingly greater role in the care of these patients across the continuum of cancer survivorship. In this role, PCPs are faced with the responsibility of managing a range of medical and psychosocial late effects of cancer treatment. In particular, the sexual side effects of treatment which are common and have significant impact on quality of life for the cancer survivor, often go unaddressed. This is an area of clinical care and research that has received increasing attention, highlighted by the presentation of this special issue on Cancer and Sexual Health. The aims of this review are 3-fold. First, we seek to overview common presentations of sexual dysfunction related to major cancer diagnoses in order to give the PCP a sense of the medical issues that the survivor may present with. Barriers to communication about sexual health issues between patient/PCPs in order are also described in order to emphasize the importance of PCPs initiating this important conversation. Next, we provide strategies and resources to help guide the PCP in the management of sexual dysfunction in cancer survivors. Finally, we discuss case examples of survivorship sexual health issues and highlight the role that a PCP can play in each of these case examples.     

骨碎补化学成分和生物活性研究进展＊

骨碎补是历代临床常用中药，具有疗伤止痛、补肾强骨、消风祛斑等功效。其主要含黄酮、苯丙素、三萜、酚酸及其苷等类化学成分，现代研究表明骨碎补具有抗骨质疏松、促进骨折愈合、促软骨再生、护牙健齿、保护肾功能、抗炎、防治中毒性耳聋、降血脂等多种生物活性，开发前景广阔。本文对近年来骨碎补的化学成分、药理作用及临床应用研究进行综述，以期为骨碎补的进一步深入系统的研究和开发利用提供依据。     

HIV-negative children’s experiences and opinions towards parental HIV disclosure: a qualitative study in China

In HIV/AIDS research, few studies to date have evaluated ways to improve parental HIV disclosure practices using feedback from HIV-negative children who have recently experienced this event. We conducted semi-structured in-depth interviews with 20 children (aged 6–15) who were partially to fully aware of their parents’ HIV status in rural Guangxi, China. Of the 20 children, eight children who were of older age (11.38 years in average) endorsed parental HIV disclosure, five discouraged it and seven expressed uncertainty. Children’s different experiences and attitudes towards disclosure were seen to be associated with their family dynamics (especially the parent–child relationship), social support and care, experiences of stigma and discrimination, psychosocial suffering, comprehension of the disease and the children’s age. Our study contributes to building a child-centered comprehensive understanding for Chinese parental HIV disclosure. It is imperative that counselors and community advocates assess and help parents achieve optimal readiness preceding disclosure of their illness to their HIV-negative children.