Commentary on “A novel treatment strategy for newly diagnosed high-grade T1 bladder cancer: Gemcitabine and cisplatin adjuvant chemotherapy—A single-institution experience.”

Background

Management of high-grade T1 (formerly T1G3) bladder cancer continues to be controversial. Should patients with T1G3 bladder cancer have an immediate radical cystectomy or should they receive intravesical bacillus Calmette-Guérin preserving bladder? Gemcitabine and cisplatin (GC) adjuvant chemotherapy may help to strike a balance between intravesical and early cystectomy. For purposes of this study, we continue to refer high-grade T1 lesion as “T1G3.”

冠状动脉粥样硬化性心脏病患者升主动脉弹性与颈动脉内-中膜厚度的相关性

目的:观察冠状动脉粥样硬化性心脏病(简称冠心病)患者升主动脉弹性与颈动脉内膜-中层厚度及粥样斑块发生的相关性。方法:于2005-08/2006-04选择石河子大学医学院第一附属医院心内科行冠状动脉造影检查患者97例,根据冠状动脉造影结果分为正常对照组41例和冠心病组56例,对两组患者进行超声检查,分别测量升主动脉扩张性D、僵硬度指数β、测量升主动脉前壁收缩期S波以及舒张期E波、A波的速度、颈动脉内膜-中层厚度及粥样斑块发生率。僵硬度指数β=In(收缩压/舒张压)/[(收缩期内径-舒张期内径)/舒张期内径]。动脉扩张性D=2(收缩期内径-舒张期内径)/[舒张期内径(收缩压-舒张压)]×10-3m2/N。结果:纳入患者97例,均进入结果分析。①冠心病组升主动脉扩张性D低于正常对照组,差异有显著性意义[分别为(15.02±9.99)×10-4,(34.75±20.80)×10-3m2/N,P=0.001];僵硬度指数β高于正常对照组(分别为28.20±21.06,15.23±25.32,P=0.001);升主动脉前壁S波和E波速度低于正常对照组[分别为(0.08±0.01),(0.10±0.03)m/s;(0.05±0.01),(0.07±0.02)m/s,P=0.001];颈动脉内膜-中层厚度和颈动脉斑块发生率高于正常对照组[分别为(0.90±0.15),(0.66±0.09)mm;41.03%,5.88%,P=0.001]。②升主动脉前壁S波速度与扩张性呈正相关(r=0.43,P=0.003),与僵硬度指数呈负相关(r=-0.47,P=0.002)。升主动脉前壁E波速度与扩张性呈正相关(r=0.47,P=0.002),与僵硬度指数无相关性。升主动脉前壁A波速度与扩张性和僵硬度指数均无相关性。③升主动脉扩张性D与颈动脉内膜-中层厚度呈负相关(r=-0.49,P=0.004),而僵硬度指数β与内膜-中层厚度则呈正相关(r=0.46,P=0.003)。S波速度与内膜-中层厚度无相关性(r=-0.26,P=0.15)。结论:冠心病患者升主动脉弹性降低即动脉扩张性降低、僵硬度指数升高、升主动脉前壁S波速度下降,颈动脉内膜-中层厚度增厚及粥样斑块发生率增高,将这些参数结合可作为冠心病很有价值的预测指标。     

Demonstration by the monoclonal antibody-specific immobilization of erythrocyte antigens assay that a new red cell antigen belongs to the Kell blood group system

BACKGROUND: The Kell blood group system comprises 21 antigens residing on a red cell membrane glycoprotein of apparent M(r) 93,000. STUDY DESIGN AND METHODS: Serologic techniques were used to identify a new red cell antigen. The monoclonal antibody-specific immobilization of erythrocyte antigens (MAIEA) assay was used to identify the red cell membrane component carrying that antigen. RESULTS: A new high-frequency red cell antigen was identified and provisionally named RAZ. RAZ is absent from K.o red cells and from red cells treated with 2-amino- ethylisothiouronium bromide and is expressed weakly on McLeod phenotype cells. It differs from all other Kell system antigens, and no depression of other Kell system antigens on RAZ+ red cells was noticed. The RAZ antigen was shown by the MAIEA assay to be located on the Kell glycoprotein. CONCLUSION: RAZ is a new high-frequency antigen located on the Kell glycoprotein. The MAIEA assay is a very effective method of demonstrating the membrane structure carrying a red cell antigen.     

针刺抽吸法诱导建立椎间盘退行性变的动物模型

目的:用针刺抽吸法建立椎间盘退行性变动物模型,分析其可行性和优点。方法:实验于2006-10/2007-03在苏州大学附属第一医院骨科实验室完成。新西兰大白兔18只,用持针器夹持21G皮肤穿刺针从椎间隙正前方刺入L3～4、L4～5、L5～6椎间盘的纤维环,深度控制在5mm,拔出针芯,抽吸出部分髓核组织。术前及术后4,8,12周分别对造模后椎间盘及对照椎间盘(L2～3)行免疫组织化学及组织学观察。结果:新西兰大白兔18只均进入结果分析。①组织学观察:苏木精-伊红染色可见对照组髓核组织中有着大量髓核细胞,造模组第4周髓核细胞数量不断减少,第12周时髓核中主要为纤维软骨组织,伴有极少量髓核细胞。Ⅱ型胶原免疫组织化学检测可见:对照组髓核组织间质呈强阳性染色,而各模型组呈弱阳性染色。随着造模时间的延长,染色逐渐减弱,说明髓核组织中Ⅱ型胶原的含量逐渐减少。②髓核细胞凋亡率:对照组、实验组4,8,12周的髓核细胞凋亡率为(3±1)%,(17±4)%,(36±2)%,(23±5)%,差异有显著性意义(F=113.86,P=0.0001<0.01)。结论:纤维环穿刺吸出部分髓核的方法在不破坏自身免疫屏障的前提下可诱导兔椎间盘的缓慢退行性变,为干细胞、髓核细胞、基因治疗等提供有效的动物模型。     

医科大学就业大学生202名人格特征调查

目的:调查分析就业与未就业大学生的人格特质差异及就业的大学生人格特质是否有性别差异。方法:①纳入某医科大学临床、检验、放射、口腔、高护等专业毕业已就业的大学生和未就业的大学生。于2005-07用随机抽样的方式,选取其中录取的202名,其中男生91名,女生111名。未就业的大学生204名,其中男103名,女101名。纳入对象均健康,且对调查项目知情意。②采用加利福尼亚心理调查表进行个体水平、人格特征和自我实现倾向测试。该量表共440个测试题,20个分量表,3个结构量表。主要包括4大因素。人际关系和适应性,包括支配性、进取能力、社交性、社交风度、自我接受;社会化成熟感、责任心和价值感,包括责任心、社会化、自我控制、好印象、同众性、适意感、宽容性;成就潜能和智力水平,包括顺从成就、独立成就、智力效率;个人生活态度和倾向,包括心理感受性、灵活性、女性化/男性化。另外还有2个通俗概念量表即独立性、通情。3个结构量表内外向、常规趋向和常规异向和自我实现。分数越高表明心理素质越适应就业。③计量资料间差异性比较采用t检验。结果:共发出问卷406份,回收填写完整、准确的答卷406份,回收率100%。①就业与未就业大学生加尼福尼亚心理调查表分量表评分比较:就业大学生加尼福尼亚心理调查表分量表支配性、进取能力、社交性、社交风度、自我接受、独立性、通情、责任心、社会化、自我控制、好印象、同众性、适意感、宽容性、顺从成就、独立成就、智力效率、心理感受性评分明显高于未就业大学生(t=3.81～12.62,P<0.01)。②就业男女大学生加尼福尼亚心理调查表分量表评分比较:差异不明显(t=0.04～1.73,P>0.05)。③加尼福尼亚心理调查表结构量表评分比较:就业大学生常规趋向和常规异向和自我实现评分明显高于未就业大学生(t=5.00～10.06,P<0.01)。结论:毕业后能够就业的大学生人格特征较为成熟,较未就业大学更具备适应就业的心理素质和人格特质,此种人格特质无性别差异。     

The mental health assistant practitioner: an oxymoron?

The United Kingdom is currently experiencing a recruitment and retention crisis in its nursing workforce. Mental health care is a particular problem area. Widening access to health and social care careers is a challenge for educational and health care organizations. This discussion paper examines the congruence between an educational programme aimed at developing Mental Health Assistant Practitioners' and the organizational responses to the subsequent opportunities for practice innovation within mental health care services. Whilst the 'learning while working' philosophy of the educational programme has been enthusiastically embraced by many health care organizations, the change in management required for using these assistant practitioners in service innovation appears beset by organizational, cultural and professional concerns. Not least of which are the often ambiguous concepts of the role and purpose of being a mental health nurse. This paper argues that if current mental health nurses are unclear about their role it is oxymoronic to establish the mental health assistant practitioners.     

重组结缔组织生长因子对体外培养成骨细胞核结合因子α1基因表达的影响

目的:研究发现,结缔组织生长因子可促进软骨细胞和成骨细胞的增殖及其表型的发生,在骨骼发育以及骨量维持方面发挥重要作用,但其对成骨细胞的作用机制目前尚不清楚。观察重组结缔组织生长因子对体外培养人成骨细胞核结合因子α1基因表达的影响。方法:实验于2006-01/2007-01在日照市人民医院完成。①实验材料:外科手术取正常成人髂骨松质骨,患者对试验知情同意。②实验方法:体外培养正常人成骨细胞,用不同浓度0,50,100,200,1000μg/L的重组结缔组织生长因子(0μg/L作为空白对照组)干预48h后,抽提细胞总RNA和总蛋白。③实验评估:采用半定量反转录-聚合酶链反应和蛋白免疫印迹分析方法观察不同浓度重组结缔组织生长因子对体外培养人成骨细胞核结合因子α1基因表达的影响。结果:半定量反转录-聚合酶链反应和蛋白免疫印迹结果显示,50,100,200,1000μg/L重组结缔组织生长因子干预后均可显著上调成骨细胞核结合因子α1的表达,并呈明显剂量依赖关系,与空白对照组比较,差异显著(P<0.01)。结论:重组结缔组织生长因子可剂量依赖性上调成骨细胞核结合因子α1基因的表达,核结合因子α1可能参与了结缔组织生长因子对成骨细胞增殖和分化的调节。     

贞芪扶正颗粒和复方阿胶浆干预再生障碍性贫血模型小鼠外周血及骨髓象的变化

目的:观察贞芪扶正颗粒和复方阿胶浆对苯油溶液致小鼠再生障碍性贫血模型的疗效。方法:实验于2005-06/09在河南中医学院药理实验室完成。①选用昆明种成年雄性小鼠90只。按随机数字表法将小鼠分为9组,每组10只:大、中、小剂量贞芪扶正颗粒组:按15,10,5g/kg剂量灌服贞芪扶正颗粒混悬液(主要成分:黄芪、女贞子;甘肃扶正药业科技股份有限公司生产;批号040803,15g/袋)。大、中、小剂量复方阿胶浆组:分别按10,20,30mL/kg剂量灌胃复方阿胶浆(主要成分:阿胶、熟地黄、党参、山楂、人参、蔗糖;山东东阿阿胶股份有限公司生产,批号050446,250mL/瓶),司坦唑醇组:按4mg/kg剂量灌胃司坦唑醇混悬液(司坦唑醇片,广西南宁百会药业集团有限公司生产,批号050306,30mg/片)。空白组和模型组:灌胃同体积的生理盐水(20mL/kg)。每天给药1次,连续给药14d。除空白组外,其余组小鼠皮下注射体积分数0.25苯的玉米油溶液4mL/kg复制苯油溶液致小鼠再生障碍性贫血模型,空白组皮下注射同体积玉米油。②各组小鼠分别于末次给药后24h,进行血常规检测。取右侧股骨,冲出骨髓细胞,采用BI-2000医学图像分析仪计数骨髓有核细胞数。③计量资料符合正态分布、方差齐者用t检验;方差不齐者用t’检验。结果:小鼠90只均进入结果分析。①血细胞测定结果比较:模型组小鼠血红细胞、白细胞、血小板计数和血红蛋白水平明显低于空白组(t=3.39～11.89,P<0.01)。司坦唑醇组3项血细胞计数和血红蛋白水平明显高于模型组(t=4.94～6.73,P<0.01)。大、中剂量贞芪扶正颗粒组和各剂量复方阿胶浆组血白细胞计数明显高于模型组(t=2.32～3.03,P<0.05￣0.01)。中剂量贞芪扶正颗粒组和各剂量复方阿胶浆组小鼠血红细胞计数明显高于模型组(t=2.15～4.84,P<0.05￣0.01)。大、中剂量贞芪扶正颗粒组和各剂量复方阿胶浆组血红蛋白水平明显高于模型组(t=2.33～4.45,P<0.05￣0.01)。大、中剂量贞芪扶正颗粒组和各剂量复方阿胶浆组血小板计数明显高于模型组(t=4.06～6.24,P<0.01)。②骨髓有核细胞数:模型组明显低于空白组(t=8.99,P<0.01)。司坦唑醇组、中剂量贞芪扶正颗粒组和小剂量复方阿胶浆组明显高于模型组(t=2.39～2.82,P<0.05)。结论:贞芪扶正颗粒、复方阿胶浆对皮下注射苯所致小鼠再生障碍性贫血模型血细胞状况及骨髓象均有较好的改善作用,以贞芪扶正颗粒有较为明显的剂量依赖关系。     

Sensitivity and specificity of the Distress Impact Thermometer for the detection of psychological distress among CRC survivors

This study assessed the relative screening performance of the Distress Impact Thermometer (DIT) and cutoff levels with the established clinical case threshold of the Hospital Anxiety and Depression Scale (HADS) among a sample of colorectal cancer (CRC) survivors. Fifty-nine CRC survivors completed the DIT, HADS, and provided demographic information at baseline, and 45 of these patients completed the same measures at follow-up, giving a total of 104 participant data. Receiver operating characteristic (ROC) analysis was performed to determine the accuracy of the DIT compared to the HADS, with a cutoff score ≥8 on each HADS subscale (depression and anxiety) and ≥15 on the HADS total scale used to identify patients with psychological distress. The sample comprised slightly more males (63%) than females, with an average age of 59 years (SD = 9.53) and ranging from 33 to 77 years. The optimum DT cutoff score of ≥5 yielded a sensitivity of 60% and specificity of 86.1%; the area under the curve was 0.771 (95% confidence interval [CI] [0.646, 0.896]). For the depression subscale, the DT performed better on specificity than sensitivity, however the opposite was true for the anxiety subscale. The addition of an impact thermometer did not enhance screening performance. The results of this study provide support for a DT score of ≥5 for detecting psychological distress among CRC survivors and do not support the addition of an impact thermometer. The use of the DT might underestimate depression but overestimate anxiety.