Hepatitis C virus reactivation in cancer patients in the era of targeted therapies

The purpose of this review is to summarize the evidence of hepatitis C reactivation in cancer patients in the era of targeted therapies.Targeted therapies are novel therapeutics frequently used in cancer patients.During treatment with targeted therapies,viral replication is one of the major problems that can occur.The PubMed database,ASCO,and ASCO Gastrointestinal Cancer Symposium abstracts were searched up until September 15,2013 using the following search keywords:"targeted therapies,rituximab,alemtuzumab,brentuximab,hepatitis,hepatitis C reactivation,tyrosine kinase inhibitors,imatinib,mammalian target of rapamycin(mTOR)inhibitors,everolimus,anti-HER therapies,trastuzumab,pertuzumab,lapatinib,antiepidermal growth factor receptor therapies,cetuximab,panitumumab,and ipilimumab".Papers considered relevant for the aim of this review were selected by the authors.The data about rituximab-induced hepatic flare in hepatitis C virus(HCV)positive patients is controver-sial.However,there is the possibility of life-threatening hepatic flare that can develop after HCV ribonucleic acid(HCV-RNA)viral load increases.Routine followup of liver function tests should be advised.Especially in high-risk patients,such as those with baseline chronic active hepatitis and cirrhosis,and where there are plans to administer rituximab concomitantly with corticosteroids,it is advised to have close follow-up of HCV viral load.The data is insufficient to make accurate statements about the association of alemtuzumab therapy and HCV reactivation.However,alemtuzumab may cause deep immunosuppression.Due to this,it is better to follow up with liver function tests and HCV RNA levels during alemtuzumab therapy.Brentuximab has effects on antibody dependent cellular toxicity and may decrease humoral immunity.Thus,we believe that during brentuximab treatment of HCV infected patients,clinicians may encounter hepatitis C reactivation.There have been no reported cases of hepatitis C reactivation with imatinib therapy.However,there are many reports of hepatitis B reactivation with imatinib treatment.Based on the evidence of hepatitis B reactivation with imatinib and the effects of imatinib on immune system functions,we suggest that imatinib therapy might be a risk factor for HCV reactivation.Anti-human epidermal growth factor receptor 2 therapies are not associated with hepatic flare in HCV infected patients.Post-transplant studies reported that mTOR was safely administered to patients with active hepatitis C without causing hepatic flare.Cetuximab and panitumumab have not been associated with HCV reactivation.Two cases of HCV infected melanoma were safely treated with ipilimumab without any HCV reactivation or hepatic flare.Targeted therapies are a new and emerging area of oncology treatment modalities.While treating HCV infected cancer patients,clinicians should be mindful of the immunosuppressive properties of targeted therapies.Further randomized trials are needed to establish algorithms for this issue.     

多方面分析患者病种让外科医生及时救死扶伤

随着交通的日益便捷，生活的水平提高，人们的患病率和病种也在不断的提高和增多。作为外科急诊手术医师，掌握患者病情，了解患者病种，对提高患者的存活率有很大的帮助。所以我院急诊外科医生整理了近三年的手术患者病种的疾病分类并进行了分析，提高了急诊医师的技术水平。     

Ecological study of gastric cancer in Brazil:Geographic and time trend analysis

AIM:To investigate the geographic distributions and time trends of gastric cancer(GC)incidence and mortality in Brazil.METHODS:An ecological study of the DATASUS registry was conducted by identifying hospitalizations for GC between January 2005 and December 2010.The data included information on the gender,age,and town of residence at the time of hospital admission and death.RESULTS:The GC rates,adjusted according to available hospital beds,decreased from 13.8 per 100000in 2005 to 12.7 per 100000 in 2010.The GC rates decreased more among the younger age groups,in which the male-to-female difference also decreased in comparison to the older age groups.Although the lethality rates tended to increase with age,young patients were proportionally more affected.The spatial GC distribution showed that the rates were higher in the south and southeast.However,while the rates decreased in the central-west and south,they increased in the northern regions.A geographic analysis showed higher rates of GC in more urbanized areas,with a coast-toinland gradient.Geographically,GC lethality overlapped greatly with the hospital admission rates.CONCLUSION:The results of this study support the hypothesis of a critical role for environmental factors in GC pathogenesis.The declining rates in young patients,particularly males,suggest a relatively recent decrease in the exposure to risk factors associated with GC.The spatial distribution of GC indicates an ongoing dynamic change within the Brazilian environment.     

超声引导下腓肠肌脉冲射频治疗跟痛症的临床疗效及安全性研究

目的:目前临床仍旧缺乏针对顽固性跟痛症的治疗方案。我们研究在超声引导下腓肠肌脉冲射频治疗(UG-PRF)能否安全有效地缓解跟痛症。方法:这项研究比较UG-PRF组与假手术组治疗100例跟痛症病人。主要评价指标包括:足部健康状态问卷量表(FHSQ-疼痛评分)和"第一步"疼痛在视觉模拟量表(visual analogue scale,VAS)上测量(VAS-"第一步"疼痛)。次要评价指标包括:FHSQ-足部功能和足部健康评分,以及健康调查简表(SF-36)来进行评估。分别在治疗后的第3和6个月评估相关结果。结果:随访中,两组比较,UG-PRF组在3或6个月时,具有更高的FHSQ-疼痛评分[分别比假手术组增加了20.0(P<0.0001)和17.9(P=0.001)],且具有更低的VAS-"第一步"疼痛评分[分别为26.1(P<0.0001)和14.3(P=0.01)]。术后第3和第6个月时,UG-PRF组比假手术组,有更高的FHSQ足功能评分和足部健康评分(P<0.05)。且假手术组的SF-36得分为10.8(P=0.042)和10.4(P=0.044),均低于UG-PRF组。两组治疗期间均没有观察到严重的并发症。结论:超声引导下腓肠肌脉冲射频治疗(UG-PRF)能够安全和有效的治疗跟痛症。     

新疆南疆维吾尔族女性血清中微量元素含量与宫颈疾病的相关性研究

目的:探讨新疆南疆维吾尔族女性不同病程阶段宫颈疾病患者血清微量元素的变化情况,为微量元素在预防控制和治疗宫颈疾病方面提供依据?方法:采用病例对照研究方法,对58例宫颈癌患者?129例宫颈疾病患者及同期到该医院健康体检者50例进行问卷调查并用石墨炉原子吸收光谱法测定血清中微量元素的含量,采用单因素分析及Logistic多因素分析方法分析血清微量元素水平与宫颈癌的相关性?结果:与健康对照组及宫颈疾病组相比较,宫颈癌组在年龄结构?文化程度?第一次结婚年龄?初次分娩年龄?怀孕次数?人类乳头瘤病毒(HPV)检出阳性率方面均不同,差异均有统计学意义(P < 0.05);宫颈癌组患者机体锌?硒?铜?镉?镍?砷水平与健康对照组及宫颈疾病组相比较均有明显差异(P < 0.05);Logistic回归分析表明,文化程度高?血清锌?硒水平高是宫颈癌的保护性因素,初婚年龄早,初次分娩年龄小?怀孕次数多?血清铜含量高是宫颈癌的危险因素?结论:血清微量元素的水平与宫颈疾病的发生发展相关,为宫颈癌的防治提供了新思路?     

K i67在621例乳腺癌患者各亚型中的表达及临床意义

目的：分析K i67指数在各分子分型乳腺癌组织中的表达水平及临床意义。方法回顾性分析该院2013年1月至2013年12月收治的621例乳腺浸润性导管癌患者的临床病理资料,通过免疫组织化学（IHC）方法测定雌激素受体（ER）、孕激素受体（PR）、表皮生长因子受体-2（HER-2）及Ki67的表达情况以区分不同的分子亚型。结果621例女性乳腺浸润性导管癌患者的K i67指数为0％～95％,平均为40．83％。以14％为界,将乳腺癌患者的K i67指数分为两组,其中,K i67指数小于或等于14％乳腺癌患者109例（17．6％）,K i67＞14％乳腺癌患者512例（82．4％）。患者年龄、肿瘤大小、淋巴结转移状态、肿瘤病理分期与Ki67指数均无关（均 P＞0．05）。患者组织学分级、ER状态、PR状态、HER-2状态与Ki67指数均有关（均 P＜0．01）。Luminal A型、Luminal B型、HER-2过表达型、三阴性患者的Ki67指数分别为10．00％、40．00％、40．00％、70．00％,其中,其他三型的Ki67指数均明显高于Luminal A型（均 P＜0．01）,Luminal B型、HER-2过表达型、三阴性三者之间的Ki67指数比较差异有统计学意义（ P＜0．05）。三阴性乳腺癌患者的K i67指数（70．00％）显著高于非三阴性乳腺癌患者（30．00％）。结论 K i67与乳腺癌的临床病理特征有一定的相关性,与ER、PR、HER-2同时检测可能对判断乳腺癌预后有重要意义。     

急性缺血性脑卒中患者血清血小板膜糖蛋白水平的变化及对预后的评估价值

目的 分析急性缺血性脑卒中患者入院时血清血小板膜糖蛋白-血小板活化因子-1(PAF-1)水平与疾病严重程度和患者90d临床预后的关系,为疾病早期诊断和预后评估提供敏感的生化指标.方法 选择2019年3月至2020年9月入我院初次确诊急性缺血性脑卒中患者共102例,采用改良Rankin量表(MRS)评分评估观察组出院后90d神经预后,并以此分为良好组(共81例,MRS评分0～2分)和较差组(共21例,MRS评分3～6分).另选同期门诊体检的80名健康人员作为对照组.分析患者入院血清PAF-1水平与美国国立卫生研究院卒中量表(NIHSS)评分的相关性;比较两组临床资料以及相关生化指标和入院PAF-1水平的差异.采用多因素Logistic回归分析筛选观察组90d预后的主要影响因素,采用受试者工作曲线(ROC)分析入院PAF-1水平预测90 d预后的效能.结果 缺血性脑卒中组血清PAF-1水平高于对照组(P<0.01).患者入院血清PAF-1水平与NIHSS评分呈现较好的正相关性(r=0.812,P=0.008).治疗90d预后良好组的PAF-1水平、NIHSS评分和梗死体积明显小于较差组(P<0.05).多因素Logistic回归分析显示,入院PAF-1水平和NIHSS评分是90d预后的主要影响因素(P<0.05).ROC分析显示,入院PAF-1水平截断值为9.5ng/mL预测90d预后不良的AUC为0.867,灵敏度为80.5％,特异性为73.6％.结论 急性缺血性脑卒中患者血清PAF-1水平升高与疾病发生以及90 d预后有紧密联系,可作为临床早期诊断脑卒中和判断短期预后的重要生化指标.