Observation versus radiotherapy with or without temozolomide in postoperative WHO grade II high-risk low-grade glioma: a retrospective cohort study

The optimal adjuvant treatment of high-risk low-grade glioma (LGG) is controversial. We performed this retrospective cohort study to compare three treatments including observation, radiotherapy (RT) alone, and radiotherapy combined with concomitant and adjuvant temozolomide (TMZ) chemotherapy (STUPP regimen) in patients with high-risk LGG. Patients with high-risk (age > 40 or undergoing subtotal resection or biopsy) LGG treated with observation or radiotherapy alone or STUPP regimen after operation were retrospectively analyzed. Survival rates were evaluated by the Kaplan-Meier method; the log-rank test was applied to compare differences between groups. A total of 250 patients met the inclusion criteria. Median follow-up for living people was 70 months. Overall, patients who received radiotherapy with or without temozolomide had better progression-free survival (PFS) and overall survival (OS) when compared with observation (median PFS: observation, 59 months; RT, 82 months; STUPP, not reached; median OS: observation, 96 months; RT, not reached; STUPP, not reached), whereas STUPP regimen did not further prolong PFS or OS than RT alone (PFS, P = 0.203; OS, P = 0.146). In oligodendroglioma (IDH mutant and 1p/19q codeleted) subtype, only STUPP regimen brought longer PFS when compared with observation (P = 0.008). The incidence of grade 3 or 4 neutropenia (P < 0.001) and nausea or vomiting (P = 0.004) was higher in the STUPP group than the figure for the RT alone group. PFS and OS were similarly improved in patients with high-risk LGG receiving RT alone or STUPP regimen. However, only STUPP regimen was able to bring better PFS for oligodendroglioma (IDH mutant and 1p/19q codeleted) subgroup. Longer follow-up time is needed to determine an association with treatment effect in different histological and molecular subgroups.

     

普外科术后不良结局风险评估工具研究现状

普外科手术是最常见的手术之一,其术后不良结局主要集中在一部分高危患者。风险评估工具可以识别出这部分高危患者,为后续的临床干预和资源配置提供参考。目前存在多种评估工具,且具有各自的优缺点,充分了解这些工具是临床应用的前提。通过回顾目前一般常用评估工具、针对急诊普外患者的评估工具和机器学习方法在评估工具上的应用,阐明风险评估工具的基本特征、应用现状和发展趋势。     

Resumen ejecutivo del Documento de Consenso de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) y de la Asociación Española de Cirujanos (AEC) en profilaxis antibiótica en cirugía

Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and antimicrobial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised.The Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis in surgery to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery.     

Changes in humoral immune response after SARS-CoV-2 infection in liver transplant recipients compared to immunocompetent patients

The protective capacity and duration of humoral immunity after SARS-CoV-2 infection are not yet understood in solid organ transplant recipients. A prospective multicenter study was performed to evaluate the persistence of anti-nucleocapsid IgG antibodies in liver transplant recipients 6 months after coronavirus disease 2019 (COVID-19) resolution. A total of 71 liver transplant recipients were matched with 71 immunocompetent controls by a propensity score including variables with a well-known prognostic impact in COVID-19. Paired case–control serological data were also available in 62 liver transplant patients and 62 controls at month 3 after COVID-19. Liver transplant recipients showed a lower incidence of anti-nucleocapsid IgG antibodies at 3 months (77.4% vs. 100%, p < .001) and at 6 months (63.4% vs. 90.1%, p < .001). Lower levels of antibodies were also observed in liver transplant patients at 3 (p = .001) and 6 months (p < .001) after COVID-19. In transplant patients, female gender (OR = 13.49, 95% CI: 2.17–83.8), a longer interval since transplantation (OR = 1.19, 95% CI: 1.03–1.36), and therapy with renin–angiotensin–aldosterone system inhibitors (OR = 7.11, 95% CI: 1.47–34.50) were independently associated with persistence of antibodies beyond 6 months after COVID-19. Therefore, as compared with immunocompetent patients, liver transplant recipients show a lower prevalence of anti-SARS-CoV-2 antibodies and more pronounced antibody levels decline.     

三层式nCHAC/PLGA复合膜体外降解行为的研究

目的探讨引导组织再生性复合膜-纳米碳羟磷灰石/胶原/聚乳酸羟基乙酸复合膜(nCHAC/PLGA) 在体外的生物降解行为。方法根据牙周治疗的特点,功能分级材料nCHAC/PLGA膜制备成三层,即8wt％ nCHAC PLGA/4wt％nCHAC PLGA/PLGA。其中一面为多孔结构,利于细胞在其上生长;另一面表面光滑,籍此抑制细胞的粘附。以纯聚乳酸羟基乙酸(PLGA)膜作为对照,将样本浸泡在37℃人工唾液中,比较两者生物降解行为。结果膜重量持续减轻,nCHAC/PLGA三层式功能分级复合膜在4周后重量减少23．1％, 12周后减少88％;单层纯聚乳酸羟基乙酸膜在4周后重量减轻30．7％,12周后减轻98．9％。处理4周后,因纳米碳羟磷灰石的降解,介质中钙离子浓度显著增加。另外,浸泡nCHAC/PLGA膜的溶液pH值略高于浸泡纯PLGA膜者,提示nCHAC复合物可能对溶液中PLGA酸性产物具中和作用。实验过程中,测试样本整体原形能维持4周,8周和12周时变成粉末状。扫描电镜结果显示,随着浸泡时间延长,膜的8wt％ nCHAC PLGA多孔疏松面增加,PLGA致密光滑面亦出现小孔结构。结论复合膜的降解过程符合牙周修复的实际过程;此外,复合膜表面形成新的矿物结构,将对体内新骨再生起积极效应。     

Efficacy and tolerability of anti-asthma herbal medicine intervention in adult patients with moderate-severe allergic asthma

BACKGROUND: Chinese herbal medicine has a long history of human use. A novel herbal formula, anti-asthma herbal medicine intervention (ASHMI), has been shown to be an effective therapy in a murine model of allergic asthma. OBJECTIVE: This study was undertaken to compare the efficacy, safety, and immunomodulatory effects of ASHMI treatment in patients with moderate-severe, persistent asthma with prednisone therapy. METHODS: In a double-blind trial, 91 subjects underwent randomization. Forty-five subjects received oral ASHMI capsules and prednisone placebo tablets (ASHMI group) and 46 subjects received oral prednisone tablets and ASHMI placebo capsules (prednisone group) for 4 weeks. Spirometry measurements; symptom scores; side effects; and serum cortisol, cytokine, and IgE levels were evaluated before and after treatment. RESULTS: Posttreatment lung function was significantly improved in both groups as shown by increased FEV(1) and peak expiratory flow findings (P<.001). The improvement was slightly but significantly greater in the prednisone group (P<.05). Clinical symptom scores, use of beta(2)-bronchodilators, and serum IgE levels were reduced significantly, and to a similar degree in both groups (P<.001). T(H)2 cytokine levels were significantly reduced in both treated groups (P<.001) and were lower in the prednisone-treated group (P<.05). Serum IFN-gamma and cortisol levels were significantly decreased in the prednisone group (P<.001) but significantly increased in the ASHMI group (P<.001). No severe side effects were observed in either group. CONCLUSION: Anti-asthma herbal medicine intervention appears to be a safe and effective alternative medicine for treating asthma. In contrast with prednisone, ASHMI had no adverse effect on adrenal function and had a beneficial effect on T(H)1 and T(H)2 balance.     

Expression of recombinant mouse IL-1beta significantly down-regulates NK cell mediated cytotolysis against H22 hepatoma cells]

AIM: To investigate the effect of the expression of recombinant IL-1beta in H22 hepatoma cells on its response to NK cell mediated cytotoxicity. METHODS: BALB/c mouse was stimulated by 6% of starch. Total RNA was prepared from peripheral blood monocytes (PBMCs). IL-1beta gene (843 bp) was obtained by RT-PCR. The purified PCR product digested by Xho I and EcoR I was cloned into pIRES2-EGFP to construct the recombinant pIRES2-EGFP-mIL-1beta expression vector which was verified by PCR, restriction enzyme assay (Xho I and EcoR I) and DNA sequencing. Then the purified pIRES2-EGFP-mIL-1beta plasmid was transfected into H22 hepatoma cells by jetPEI. The expression level of recombinant IL-1beta was detected by RT-PCR and confocal microscopy. The cytotoxicity of wild-type spleenic NK cells against H22 cells was assessed by MTT assay. RESULTS: After the total RNA isolated from the starch stimulated BALB/c mouse PBMC, 843 bp IL-1beta gene in length was prepared by RT-PCR. The purified PCR product digested by EcoR I and Xho I was ligated by pIRES2-EGFP to create pIRES2-EGFP-mIL-1beta expression plasmid which was verified by PCR, restriction enzyme assay and DNA sequencing. Then pIRES2-EGFP-mIL-1beta was transfected into H22 hepatoma cells by jetPEI. RT-PCR and confocal microscopy assay showed these cells expressed high level of recombinant IL-1beta expression vector. In a 4-hour based MTT assay, IL-1beta in H22 cells was more resistant to NK92 cell mediated cytotoxicity compared with the cells transfected with pIRES2-EGFP. Meanwhile, the cytolytic capacity of the spleenic NK cells separated from wild-type mouse decreased about 10% when the ratio of effector to target was 40:1. CONCLUSION: The expression of proinflammatory cytokine IL-1beta can significantly down-regulate the cytolytic activity of NK cells against H22 hepatoma cells. It plays a crucial role in the immune escape of hepatoma from NK cell mediated innate immunity.     

直视下行大鼠气管插管的改良方法

目的 提高大鼠气管插管的成功率;方法 对比传统闭式法与改良直视法的成功率;结果传统闭式法的成功率为50％,改良直视法的成功率为100％。结论 改良直视法优于传统闭式法,值得推广应用。     

胸腺因子D对实验性大鼠肝纤维化防治作用的研究

目的　研究胸腺因子D(TFD)的体内抗肝纤维化作用。方法　用四氯化碳 (CCL4 )复制大鼠肝纤维化模型 ;造模开始或造模 30d后予TFD ;实验结束后分别测定肝功能、纤维化指标 (Ⅲ型前胶原、透明质酸和层粘连素 )、肝组织中谷胱甘肽、超氧化物岐化酶及丙二醛含量 ,并作肝病理检查。结果　TFD可显著减轻CCl4 肝纤维化程度 ,能明显降低血清Ⅲ型前胶原、透明质酸、层粘连素和肝组织中丙二醛含量 ;显著提高谷胱甘肽和超氧化物岐化酶活性 ,改善肝功能 ,组织学检查亦显示具有抗肝纤维化作用。结论　TFD在体内具有抗肝纤维化的作用 ,可望用于肝纤维化的防治。     

CD3AK细胞冻融提取液的抗肿瘤活性研究

为研究ＣＤ３ＡＫ细胞冻融提取液的抗肿瘤作用,作者采集正常人外周血分离单个核细胞（ＰＢＭＣ）,先用抗ＣＤ３的单克隆抗体（ＣＤ３ＭｃＡｂ）的ｒＩＬ－２诱导和激活,使之成为ＣＤ３ＭｃＡｂ激活的杀伤细胞（ＣＤ３ＡＫ）,再制备ＣＤ３ＡＫ的冻融提取液,然后进行体内,外抗肿瘤实验。结果;低剂量的ＣＤ３ＭｃＡｂ和ｒＩＬ－２能明显诱导ＰＢＭＣ的活化和增殖;激活后的ＣＤ３ＡＫ细胞冻融提取液可抑制小鼠肝癌实体瘤细胞Ｈ２