The role of selective estrogen receptor modulators on breast cancer: from tamoxifen to raloxifene

The link between hormones and breast cancer growth and development has been recognized for more than a century. Estrogen stimulates the proliferation of breast epithelial cells, and both endogenous and exogenous estrogens have been implicated in the pathogenesis of breast cancer. Classically, estrogen action at target sites around the body is mediated through related but distinct estrogen receptors (ERs), designated ERalpha and ERbeta, to alter gene expression. This accumulating understanding of the mechanism of action of estrogen led ultimately to the design of antiestrogenic agents that work by virtue of their interaction with the ER; these drugs have come to be known as selective estrogen receptor modulators (SERMs). Tamoxifen, a SERM, emerged as the first antiestrogenic agent that is clinically applicable to breast cancer. Tamoxifen became the "gold standard" and established the principles of tumor targeting and identified the appropriate treatment strategy to aid survivorship in breast cancer patients, with enhancement of disease-free survival and a 50% decrease in recurrences observed in ER-positive patients 15 years after diagnosis. However, because of the many adverse events in the use of tamoxifen, some of which have contributed to significant morbidity and mortality, drug modification which has resulted in fewer incidences of adverse events without compromising the therapeutic effect for breast cancer prevention may face an easier road to acceptance. Raloxifene may be a better alternative, since evidence from large clinical trials showed that raloxifene not only decreases the incidence of osteoporosis and related fractures, but also offers benefits for breast cancer prevention. The results from the Study of Tamoxifen and Raloxifene (STAR) trial showed the superiority of raloxifene over tamoxifen, not only for the equal efficacy in the prevention of invasive breast cancer but also for the fewer serious adverse events. Taken together, without other competition so far, raloxifene is recommended for postmenopausal women with osteoporosis who also need breast cancer prevention.     

NiCoP–CeO2 composites for efficient electrochemical oxygen evolution

In this study, a novel NiCoP–CeO₂ composite was constructed on a Ni foam by a simple hydrothermal method and thermal phosphating strategy. In the OER test, NiCoP–CeO₂ exhibited a low overpotential of 217 mV at 10 mA cm⁻², 45 mV dec⁻¹ of Tafel slopes. With the help of theoretical calculations and experimental characterization, the reason for performance improvement was analyzed in depth. The results show that CeO₂ leads to a confinement effect, maintaining the nanosheet morphology of NiCo-LDHs, which contributes to sustaining the catalyst in favourable contact with H₂O and minimizing the OER potential. Furthermore, by loading CeO₂ onto NiCoP, the hydrophilicity of the catalyst is significantly enhanced. Our work provides an ingenious synthesis strategy for the preparation of efficient and inexpensive electrocatalytic materials.

A NiCoP–CeO₂ composite was constructed by a simple hydrothermal method and thermal phosphating strategy. Benefiting from the confinement effect and optimized H₂O adsorption ability, NiCoP–CeO₂ exhibits superior OER performance than NiCoP.     

自身免疫性胰腺炎13例临床诊治分析

目的：分析并总结我院收治的自身免疫性胰腺炎（ AIP）临床特征及诊治经验。方法回顾性分析2009年至2013年我院收治的13例AIP的临床资料。结果13例AIP中,中位年龄48岁,临床表现主要为上腹疼痛不适,梗阻性黄疸及体重下降。胰腺弥漫性增大及局限性增大各6例,胰体尾假性囊肿及胰腺结石各1例,胰管扩张4例。胰腺外器官受累9例（胆管病变8例、胆囊病变7例、腹膜后纤维化1例、腹腔淋巴结肿大6例、脾静脉变细4例、干燥综合征及溃疡性结肠炎各1例）。7例行血免疫标志物检查,IgG升高5例,类风湿因子（ RF）及抗核抗体（ ANA）升高各3例。8例被误诊而行手术治疗。经激素治疗后,患者预后良好。结论 AIP是一种少见的自身免疫性疾病,无特异临床表现,易与胰腺癌及胆管癌混淆,误诊率高。必须充分认识和重视AlP的诊治,避免因误诊而行不必要的手术治疗。     

表现为肾病综合征的IgM肾病及非IgA系膜增殖性肾炎的临床病理差异

分析临床表现为原发性肾病综合征的微小病变肾病（ＭＣＤ）、ＩｇＭ肾病（ＩｇＭＮ）和非ＩｇＡ、ＩｇＭ系膜增殖性肾炎（ＭｓＰＧＮ）病理改变（微机定量图像分析）和临床表现的联系。发现：（１）３种疾病以ＩｇＭＮ发生率最高（４８．８９％），一过性肾功损害、激素依赖比例以ＭｓＰＧＮ为高，ＩｇＭＮ、ＭｓＰＧＮ存在明显血尿；（２）病理定量分析表明：ＩｇＭＮ和ＭｓＰＧＮ的系膜细胞数、系膜基质增宽及间质改变较ＭＣＤ明显增高（Ｐ＜０．０１），ＭｓＰＧＮ系膜区增宽比ＩｇＭＮ更明显（Ｐ＜０．０１）；（３）ＩｇＭＮ、ＭｓＰＧＮ间质病变越重，越易伴有高血压、血尿、一过性肾功损害和激素依赖，其中以ＭｓＰＧＮ更明显。表明ＩｇＭＮ肾病预后相对较好，而ＭｓＰＧＮ相对较差。     

恶性黑色素瘤80例临床病理分析

本文总结我室活检诊断恶黑80例,对其临床和病理进行详细分析。结果表明,恶黑主要发生在41-60岁年龄组,占54％,男性:女性1.8:1。皮肤恶黑的发生部位主要在手、脚、头面部、粘膜恶黑发生在鼻腔和眼部,恶黑的发病一般认为与日光照射、损伤、遗传等因素有关。恶黑组织结构复杂,细胞形态多样。多形的瘤细胞排列成肉瘤样,巢状、血管外皮瘤样、腺样等类型。同时也讨论了恶黑的分型、核分裂、浸润深度之间的关系。结节型核分裂最多且浸润深,预后就最差。     

慢性乙型肝炎的基因治疗进展

全球约有3.5亿乙型肝炎病毒（HBV）携带者,我国约1.3亿,其中1/4为慢性乙型肝炎,易发展为肝硬化、肝癌.近年来,慢性乙型肝炎的治疗已取得较大进展.尤其是d干扰素（IFNα）和核苷（酸）类似物药物的开发与应用．使慢性乙型肝炎的治疗有了较大进步,但其疗效还不理想。     

183例不育症患者的生精细胞检查与病因分析

检查１８３例男性不育患者精液，无精子症中６３．８９％（２３／３６）无生精细胞；少精子症精子计数＞２５０×１０６／ｍｌ，均有生精细胞。５８例无及少精子症生精细胞分型：细胞缺乏型３９．６５％（２３／５８）；比例异常型３６．２１％（２１／５８）；形态异常型２４．１４％（１４／５８）。病因：环境２２．４２％（１３／５８）；服棉籽油１７．２４％（１０／５８）；疾病３４．４９％（２０／５８）；不明２５．８６％（１５／５８），对生精细胞与病因关系进行讨论。     

柯楠次碱和哌唑嗪对豚鼠心房的作用

本文发现柯楠次碱(Cory)对豚鼠左房有降低收缩力,抑制自律性,延长不应期等作用,不影响兴奋性。哌唑嗪(Pra)不影响收缩力、不应期和兴奋性;但能抑制自律性。二者差别的原因可能是Cory还有抗钙作用。此外实验还提示左心房的α_1受体参与自律性的调节。