SOME OBSERVATIONS ON THE TREATMENT OF CARDIO-RENAL DISEASF)*

The classification of Bright''s Disease has claimed much attcntion during the present century. Some clinicians content themselves with the simple division into acute and chronic nephritis. This seems hardly adequate when one considers the varying types of the disease which one encounters.     

Preparation and distribution of 5-fluorouracil 125I sodium alginate-bovine serum albumin nanoparticles

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胃肠胰胰岛淀粉样多肽的定位和表达

胰岛淀粉样多肽(islet armyloid polypeptide,IAPP)是1986年瑞典学者Westermarket al[1,2 ]从胰岛素瘤患者的瘤组织,糖尿病猫及Ⅱ型糖尿病患者胰岛淀粉样沉积物中分离出来的一种多肽,几乎在同时,英国生物化学家Cooper et al[3,4]也从Ⅱ型糖尿病患者的胰岛淀粉样沉积物中分离出该肽.IAPP又称为amylin.对IAPP的分子结构、基因表达和生理作用等已有许多报道[5].近年来,在IAPP定位、表达及胃肠胰IAPP免疫反应(immunoreactive,IR)细胞定位、发生、发育方面的研究报道,为探讨IAPP的生理作用及疾病状态下的改变,提供了形态学依据,现综述如下.     

Follow-up care over 12 months of patients with prostate cancer in Spain: A multicenter prospective cohort study

The therapeutic approach is crucial to prostate cancer prognosis. We describe treatments and outcomes for a Spanish cohort of patients with prostate cancer during the first 12 months after diagnosis and identify the factors that influenced the treatment they received.This multicenter prospective cohort study included patients with prostate cancer followed up for 12 months after diagnosis. Treatment was stratified by factors such as hospital, age group (<70 and ≥70 years), and D’Amico cancer risk classification. The outcomes were Eastern Cooperative Oncology Group (ECOG) performance status, adverse events (AEs), and mortality. The patient characteristics associated with the different treatment modalities were analyzed using multivariate logistic regression.We included 470 men from 7 Spanish tertiary hospitals (mean (standard deviation) age 67.8 (7.6) years), 373 (79.4%) of which received treatment (alone or in combination) as follows: surgery (n = 163; 34.7%); radiotherapy (RT) (n = 149; 31.7%); and hormone therapy (HT) (n = 142; 30.2%). The remaining patients (n = 97) were allocated to no treatment, that is, watchful waiting (14.0%) or active surveillance (5.7%). HT was the most frequently administered treatment during follow-up and RT plus HT was the most common therapeutic combination. Surgery was more frequent in patients aged <70, with lower histologic tumor grades, Gleason scores <7, and lower prostate-specific antigen levels; while RT was more frequent in patients aged ≥70 with histologic tumor grade 4, and higher ECOG scores. HT was more frequent in patients aged ≥70, with histologic tumor grades 3 to 4, Gleason score ≥8, ECOG ≥1, and higher prostate-specific antigen levels. The number of fully active patients (ECOG score 0) decreased significantly during follow-up, from 75.3% at diagnosis to 65.1% at 12 months (P < .001); 230 (48.9%) patients had at least 1 AE, and 12 (2.6%) patients died.Surgery or RT were the main curative options. A fifth of the patients received no treatment. Palliative HT was more frequently administered to older patients with higher tumor grades and higher Gleason scores. Close to half of the patients experienced an AE related to their treatment.     

Trends in treatment and overall survival among patients with proximal esophageal cancer

BACKGROUND The management of proximal esophageal cancer differs from that of tumors located in the mid and lower part of the esophagus due to the close vicinity of vital structures. Non-surgical treatment options like radiotherapy and definitive chemoradiation(CRT) have been implemented. The trends in(non-)surgical treatment and its impact on overall survival(OS) in patients with proximal esophageal cancer are unclear, related to its rare disease status. To optimize treatment strategies and counseling of patients with proximal esophageal cancer,it is therefore essential to gain more insight through real-life studies.AIM To establish trends in treatment and OS in patients with proximal esophageal cancer.METHODS In this population-based study, patients with proximal esophageal cancer diagnosed between 1989 and 2014 were identified in the Netherlands Cancer Registry. The proximal esophagus consists of the cervical esophagus and the upper thoracic section, extending to 24 cm from the incisors. Trends in radiotherapy, chemotherapy, and surgery, and OS were assessed. Analyses were stratified by presence of distant metastasis. Multivariable Cox proportional hazards regression analyses was performed to assess the effect of period of diagnosis on OS, adjusted for patient, tumor, and treatment characteristics.RESULTS In total, 2783 patients were included. Over the study period, the use of radiotherapy, resection, and CRT in non-metastatic disease changed from 53%,23%, and 1% in 1989-1994 to 21%, 9%, and 49% in 2010-2014, respectively. In metastatic disease, the use of chemotherapy and radiotherapy increased over time. Median OS of the total population increased from 7.3 mo [95% confidence interval(CI): 6.4-8.1] in 1989-1994 to 9.5 mo(95%CI: 8.1-10.8) in 2010-2014(logrank P 0.001). In non-metastatic disease, 5-year OS rates improved from 5%(95%CI: 3%-7%) in 1989-1994 to 13%(95%CI: 9%-17%) in 2010-2014(logrank P 0.001). Multivariable regression analysis demonstrated a significant treatment effect over time on survival. In metastatic disease, median OS was 3.8 mo(95%CI:2.5-5.1) in 1989-1994, and 5.1 mo(95%CI: 4.3-5.9) in 2010-2014(logrank P = 0.26).CONCLUSION OS significantly improved in non-metastatic proximal esophageal cancer, likely to be associated with an increased use of CRT. Patterns in metastatic disease did not change significantly over time.     

Temporal trends in primary total hip and knee arthroplasty surgery: results from a UK regional joint register, 1991�C2004

INTRODUCTION

The aim of this study was to evaluate temporal trends in the prevalence of primary total hip and knee replacements (THRs and TKRs) throughout the Trent region from 1991 to 2004.

PATIENTS AND METHODS

The Trent Regional Arthroplasty Study records details of primary THR and TKR prospectively and data from the register were examined. Age and gender population data were provided by the Office for National Statistics.

RESULTS

A total of 26,281 THRs and 23,606 TKRs were recorded during this period. Analysis showed that females had an increased incidence rate ratio (IRR) for both primary THR (IRR = 1.29; 95% CI 1.26–1.33; P < 0.001) and TKR (IRR = 1.17; 95% CI 1.14–1.20; P < 0.001). Patients aged 74–85 years had the largest IRR for both primary THR (IRR = 6.7; 95% CI 6.4–7.0; P < 0.001) and TKR (IRR = 15.3; 95% CI 14.4–16.3; P < 0.001).

CONCLUSIONS

The prevalence of primary TKR increased significantly over time whereas THR remained steady in the Trent region between 1991 and 2004.     

Review: Understanding sorbent dialysis systems

Although maintenance haemodialysis once had the benefit of two distinctly different dialysate preparation and delivery systems – (1) a pre‐filtration and reverse osmosis water preparation plant linked to a single pass proportioning system and (2) a sorbent column dependent dialysate regeneration and recirculation system known as the REDY system – the first came to dominate the market and the second waned. By the early 1990s, the REDY had disappeared from clinical use. The REDY system had strengths. It was a small, mobile, portable and water‐efficient, only 6 L of untreated water being required for each dialysis. In comparison, single pass systems are bulky, immobile and water (and power) voracious, typically needing 400–600 L/treatment of expensively pretreated water. A resurgence of interest in home haemodialysis – short and long, intermittent and daily – has provided impetus to redirect technological research into cost‐competitive systems. Miniaturization, portability, flexibility, water‐use efficiency and ‘wearability’ are ultimate goals. Sorbent systems are proving an integral component of this effort. In sorbent dialysate regeneration, rather than draining solute‐rich dialyser effluent to waste – as do current systems – the effluent repetitively recirculates across a sorbent column capable of adsorption, ion exchange or catalytic conversion of all solute such that, at exit from the column, an ultra‐pure water solution emerges. This then remixes with a known electrolyte concentrate for representation to the dialyser. As the same small water volume can recirculate, at least until column exhaustion, water source independence is assured. Many current technological developments in dialysis equipment are now focusing on sorbent‐based dialysate circuitry. Although possibly déjà vu for some, it is timely for a brief review of sorbent chemistry and its application to dialysis systems.     

Aquaporin-4 autoantibodies in neuromyelitis optica spectrum disorders: comparison between tissue-based and cell-based indirect immunofluorescence assays

Background  

Neuromyelitis optica spectrum disorders (NMOSD) are severe central nervous system inflammatory demyelinating disorders (CNS IDD) characterized by monophasic or relapsing, longitudinally extensive transverse myelitis (LETM) and/or optic neuritis (ON). A significant proportion of NMOSD patients are seropositive for aquaporin-4 (AQP4) autoantibodies. We compared the AQP4 autoantibody detection rates of tissue-based indirect immunofluorescence assay (IIFA) and cell-based IIFA.     

Social Workers as Patient Navigators for Breast Cancer Survivors: What Do African-American Medically Underserved Women Think of This Idea?

Patient navigation (PN) is a new initiative in health care aimed at reducing disparities by assisting patients in overcoming barriers within the health care system. As PN programs grow around the country, it is important to consult the key stakeholders in the development of these programs. The purpose of this qualitative study was to discuss the needs of medically underserved cancer patients and allow them the opportunity to provide input on models of care to meet their needs. Four focus groups were conducted in three major cities across Tennessee. Research participants (n = 36) were recruited by the staff in area cancer support programs and treatment programs across the state and through recruitment flyers at various treatment centers and community organizations. Findings revealed four key themes in the development of PN programs: (1) the PN needs to address access to quality care issues; (2) the PN needs to address the emotional and practical concerns of the cancer survivor; (3) the PN needs to address family concerns; (4) the PN needs to be involved across the continuum of care from time of diagnosis into long-term survivorship. Oncology social workers have a unique opportunity to meet the needs of medically underserved cancer patients through the PN movement. Our profession is a key stakeholder in this movement. We need to advocate for trained oncology social workers to actively pursue the role of patient navigators to ensure that the needs of medically underserved cancer survivors and their families are met.