Surgical modality for stage IA non-small cell lung cancer among the elderly: analysis of the Surveillance,Epidemiology, and End Results database

BackgroundThe appropriate surgical modality for early-stage non-small cell lung cancer (NSCLC) among the elderly remains controversial; identifying appropriate modalities will be helpful in clinical practice.MethodsIt’s a cohort study and we explored the Surveillance, Epidemiology, and End Results (SEER) database for identifying patients aged ≥70 years with pathologic stage IA NSCLC. Three types of surgeries were compared (lobectomy, segmentectomy, and wedge resection) via survival and stratification analyses.ResultsOverall, 6,197 patients were enrolled. Among patients aged ≥76 years with tumor diameters ≤1 cm, significant differences in survival were noted for segmentectomy vs. lobectomy [hazard ratio (HR) =0.294, P=0.007] and wedge resection vs. lobectomy (HR =0.548, P=0.017) but not in those with tumors diameters >1 cm. Among patients aged 70–75 years with tumor diameters >1–2 cm, significant differences in survival were observed for segmentectomy vs. lobectomy (HR =0.671, P=0.037) and segmentectomy vs. wedge resection (HR =0.556, P=0.003) and for wedge resection vs. lobectomy (HR =1.283, P=0.003) among those with tumor diameters >2–3 cm but not in those with tumor diameters ≤1 cm.ConclusionsBoth age and tumor size should be considered when selecting the surgical modality. Lobectomy is not recommended for lesions ≤1 cm among patients aged ≥76 years. Segmentectomy was associated with superior prognosis for tumor diameters >1–2 cm and survival favored lobectomy rather than wedge resection for NSCLCs >2–3 cm among patients aged 70–75 years. Surgeons could rely on personal experience to determine the appropriate surgical modality for NSCLCs >1 cm among patients aged ≥76 years and NSCLCs ≤1 cm among patients aged 70–75 years.     

Atypical Presentation of Hashimoto’s Disease in an Adolescent: Thyroid-Associated Ophthalmopathy

Hashitoxicosis is generally differentiated from Graves’ hyperthyroidism by its shorter course and absence of ophthalmopathy. In this case report, we describe an adolescent girl who presented with significant clinical findings of hyperthyroidism, a diffuse goiter with homogenously increased uptake in scintigraphy, and with ocular findings of ophthalmopathy. The thyroid stimulating hormone receptor antibody test was positive, and the family history revealed thyroid-associated ophthalmopathy. Clinical findings supported the diagnosis of Hashimoto’s disease (HD) in the follow-up period. Radioactive iodine uptake investigation was found to be a reliable method for differential diagnosis. Attention was drawn to the rarity of pediatric cases of HD who present with ophthalmopathy.     

慢性乙型肝炎患者外周血NK细胞杀伤细胞凝集素样受体G1表达及其对NK细胞杀伤功能的影响*

目的 探讨CHB患者外周血NK细胞杀伤细胞凝集素样受体亚家族G成员1(KLRG1)表达的变化以及其对NK细胞杀伤功能的影响。方法 在120例CHB患者和120例健康体检者,抽取外周血,提取外周血单个核细胞,使用流式细胞仪检测NK细胞、KLRG1⁺ NK细胞和分泌γ-干扰素的NK细胞百分率,体外检测NK细胞对LX-2细胞的杀伤力。结果 CHB患者外周血NK细胞百分率为(17.2±7.7)%,显著高于对照组 [(11.3±6.9)%,t=9.85,P=0.01】, KLRG1⁺NK细胞百分率为(52.2±20.3)%,显著高于对照组 【(30.3±16.9)%,t=6.57,P=0.01】,分泌IFN-γ的NK细胞百分率为(14.6±3.8)%,显著低于对照组【(42.5±9.5)%,t=11.24,P=0.01】;CHB患者外周血NK细胞CD38、CD69、HLA-DR和TRAIL表达均显著高于对照组(P=0.012,P=0.015,P=0.025,P=0.019);CHB患者NK细胞诱导LX-2细胞发生早期凋亡率为11.5% (6.6%～13.7%),晚期凋亡率为7.2% (5.1%～8.5%),与对照组的15.4% (11.5%～24.3%)和13.5% (8.1%～20.4%) 比,显著降低 (U=6.50, P=0.025;U=2.02,P=0.002) 。结论 CHB患者NK细胞表达KLRG1增强,通过减少分泌INF-γ而导致其杀伤功能减弱,可能系造成慢性感染的重要原因。     

血清糖化血红蛋白和IL-6对非酒精性脂肪性肝病发病风险的预测价值探讨*

目的 探讨血清糖化血红蛋白(HbA1c)和白细胞介素-6(IL-6)预测非酒精性脂肪性肝病(NAFLD)发病风险的价值。方法 2014年3月～2015年9月在我院行体检的健康人群658名,进行为期3年的随访。采用酶联免疫吸附法测定血清IL-6水平,应用Logistic回归分析NAFLD发生的独立危险因素。结果 在658名体检人群中,随访发现86例(13.1%)发生NAFLD;NAFLD患者BMI为(26.4±2.5)kg/m²,显著大于572例健康人[(21.3±2.6) kg/m²,P＜0.05];NAFLD患者血清ALT、AST和GGT水平分别为(55.1±7.2)U/L、(63.1±9.3)U/L和(73.6±6.2)U/L,显著高于健康人[分别为(23.5±6.3)U/L、(21.7±4.4)U/L和(25.1±6.4)U/L,P＜0.05];NAFLD患者血TG、LDL-C、FPG和2hPG分别为(2.5±1.1)mmol/L、(1.1±0.2)mmol/L、(5.8±1.0)mmol/L 和(7.6±2.3)mmol/L,与健康人[分别为(1.2±0.3)mmol/L、(1.4±0.3)mmol/L、(5.0±0.8)mmol/L 和(6.6±2.1)mmol/L,P＜0.05]比,差异显著;NAFLD患者血清HbA1c为(6.0±0.9)%,显著高于健康人[(5.0±0.6)%,P＜0.05],NAFLD患者血清IL-6水平为(13.3±4.2)ng/L,显著高于健康人[(3.1±0.8)ng/L,P＜0.05];多元Logistic回归分析结果显示HbA1c(OR=1.355,95%CI:1.121～2.315)和IL-6(OR=1.368,95%CI:1.056～2.685)是NAFLD发生的独立危险因素。结论 血清HbA1c和IL-6异常升高对NAFLD的诊断具有一定的预测价值,值得进一步研究。     

Mitochondrial free radical theory of aging: Who moved my premise?

First proposed by D Harman in the 1950s, the Mitochondrial Free Radical Theory of Aging (MFRTA) has become one of the most tested and well‐known theories in aging research. Its core statement is that aging results from the accumulation of oxidative damage, which is closely linked with the release of reactive oxygen species (ROS) from mitochondria. Although MFRTA has been well acknowledged for more than half a century, conflicting evidence is piling up in recent years querying the causal effect of ROS in aging. A critical idea thus emerges that contrary to their conventional image only as toxic agents, ROS at a non‐toxic level function as signaling molecules that induce protective defense in responses to age‐dependent damage. Furthermore, the peroxisome, another organelle in eukaryotic cells, might have a say in longevity modulation. Peroxisomes and mitochondria are two organelles closely related to each other, and their interaction has major implications for the regulation of aging. The present review particularizes the questionable sequiturs of the MFRTA, and recommends peroxisome, similarly as mitochondrion, as a possible candidate for the regulation of aging. Geriatr Gerontol Int 2014; 14: 740–749.