云南个旧和宣威地区肺癌p53突变检测研究

目的　云南个旧及宣威地区是云南省肺癌的两大点状高发区 ,个旧以矿工为高发人群 ,宣威以农民为高发 ,该两地区肺癌发生的病因已初步阐明 ,本研究旨在深入探讨其发病的分子生物学基础。方法　对 2 6例个旧矿工肺癌患者 ,15例宣威农民肺癌患者 ,应用聚合酶链反应 -单链构象多态性法研究 p5 3第 5至第 8外显子突变 ,并对有突变的个体进行测序。结果　发现云锡矿工肺癌患者中有 13例、宣威农民肺癌患者中有 4例发生 p5 3突变 ,应用 DNA测序 ,发现云锡矿工肺癌中有 1例于第 135位密码子发生突变 ,由 GCC→ GTC,导致氨基酸改变 ,由丙氨酸→缬氨酸 (Ala→ Val) ,宣威农民肺癌患者中有 1例于 2 47位密码子突变 ,由 AAC→ TTC,导致氨基酸发生改变 ,由天冬酰氨→苯丙氨酸 (Asn→ Phe)。结论　 p5 3突变在云锡矿工肺癌和宣威农民肺癌中较常发生 ,并发现两例新的突变位点。 p5 3突变与病人的年龄、性别、坑龄及组织学分类无明显联系     

Outcomes and factors associated with early mortality in pediatric postcardiotomy veno‐arterial extracorporeal membrane oxygenation

Mortality and morbidity of children received veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) support after cardiac surgery remain high despite remarkable advances in medical management and devices. The purpose of this study was to describe outcomes and risk factors of applying VA‐ECMO in the surgical pediatric population. We retrospectively analyzed 85 consecutive pediatric patients (aged <18 years) who received postcardiotomy VA‐ECMO from January 2010 to December 2018. Median (IQR) age at ECMO implantation in this cohort was 12.7 (6.4, 43.2) months, median weight was 8.5 (6.0, 12.8) kg, mean ECMO duration was 143.2 ± 81.6 hours and mean hospital length of stay was 48.4 ± 32.4 days. Seventy‐five patients (88.2%) were indicated for postcardiotomy cardiogenic shock. The successful ECMO weaning rate was 70.6% and in‐hospital mortality was 52.9%. The most common diagnosis was transposition of great arteries (n = 18, 21.2%), while acute kidney injury occurred most often (n = 64, 75.3%). Multivariate logistic regression analysis showed that thrombocytopenia, hemolysis, and nosocomial infection were positively correlated with in‐hospital mortality. Multivariate Cox proportional hazard regression analysis presented that thrombocytopenia significantly increased the 180‐day mortality in patients with successful weaning. Therefore, multiple factors had adverse effects on prognosis. Patient selection and procedures from ECMO implantation to weaning need to be closely monitored and performed in a timely manner to improve outcome.     

Long-term mortality of living kidney donors: a systematic review and meta-analysis

International Urology and Nephrology - To date, several studies have reported inconsistent findings regarding the mortality risk faced by living kidney donors and controls. Our study assessed the...     

Central Regulation of Branched-Chain Amino Acids Is Mediated by AgRP Neurons

Circulating branched-chain amino acids (BCAAs) are elevated in obesity and diabetes, and recent studies support a causal role for BCAAs in insulin resistance and defective glycemic control. The physiological mechanisms underlying BCAA regulation are poorly understood. Here we show that insulin signaling in the mediobasal hypothalamus (MBH) of rats is mandatory for lowering plasma BCAAs, most probably by inducing hepatic BCAA catabolism. Insulin receptor deletion only in agouti-related protein (AgRP)–expressing neurons (AgRP neurons) in the MBH impaired hepatic BCAA breakdown and suppression of plasma BCAAs during hyperinsulinemic clamps in mice. In support of this, chemogenetic stimulation of AgRP neurons in the absence of food significantly raised plasma BCAAs and impaired hepatic BCAA degradation. A prolonged fasting or ghrelin treatment recapitulated designer receptors exclusively activated by designer drugs–induced activation of AgRP neurons and increased plasma BCAAs. Acute stimulation of vagal motor neurons in the dorsal motor nucleus was sufficient to decrease plasma BCAAs. Notably, elevated plasma BCAAs were associated with impaired glucose homeostasis. These findings suggest a critical role of insulin signaling in AgRP neurons for BCAA regulation and raise the possibility that this control may be mediated primarily via vagal outflow. Furthermore, our results provide an opportunity to closely examine the potential mechanistic link between central nervous system–driven BCAA control and glucose homeostasis.     

ASO Author Reflections: Do Shorter Tumor-to-Nipple Distances Compromise the Local Oncologic Safety of Nipple-Sparing Mastectomy?

Annals of Surgical Oncology -     

Time for a More Holistic Approach to Peri-Pancreatoduodenectomy Care

Annals of Surgical Oncology -