The impact of spleen volume on the survival of metastatic pancreatic adenocarcinoma patients receiving nanoliposomal irinotecan

Nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil and leucovorin (NalFL) comprises the current standard for gemcitabine-failed metastatic pancreatic ductal adenocarcinoma (PDAC). As liposomes generally accumulate in the spleen, we evaluated the impact of spleen volume on prognosis. We enrolled patients with metastatic PDAC who failed gemcitabine-based therapy and were initiated on NalFL between August 2018 and November 2020. The spleen volume before NalFL administration was evaluated. They were stratified into dose subgroups (i.e. low, < 48 mg/m²; intermediate, 48 - < 64 mg/m²; high, ≥ 64 mg/m²) by the average nal-IRI dose during the entire treatment, and multivariate analysis of overall survival (OS) was performed. We included 547 patients with a median age of 63 years (range, 27-89 years) and a median of 1 (range, 0-7) palliative chemotherapy regimen. The median spleen volume was 245 mL (range, 82-817 mL). Among patients with splenomegaly (≥ 245 mL), the low-dose subgroup had the worst median time to treatment failure (TTF, 1.8 months vs. 2.5 months vs. 2.5 months, P = 0.020) and OS (3.3 months vs. 5.9 months vs. 6.6 months, P = 0.018) as against no prognostic impact in patients without splenomegaly. In the multivariate analysis of patients with splenomegaly, performance status (PS) ≥ 2, body surface area (BSA) < 1.6 m², prior fluoropyrimidine use, liver metastasis, and low-dose subgroup were independent poor prognostic factors. A low average nal-IRI dose was significantly associated with poor prognosis, especially among patients with splenomegaly. Further pharmacological studies should validate the relevance of spleen volume on the treatment outcomes of nal-IRI.     

Cancer stem-like cells contribute to paclitaxel resistance in esophageal squamous cell carcinoma

Objective: To examine the role of esophageal squamous cell carcinoma (ESCC) stem cells in paclitaxel resistance through the molecular characterization of ESCC stem cells. Methods: A resistant cell line (RR-ECl09) of cells were established using intermittent induction and time increments of high-dose paclitaxel in a human esophageal squamous cell carcinoma line (EC109). The multidrug resistance of RR-ECl09 cells to anticancer agents was evaluated by MTT assay. The RR-EC109 and EC109 cells were used for sphere formation assays, clonogenicity assays, stem cell gene expression, and the expression of epithelial-mesenchymal transition markers. Results: The RR-EC109 cells were established over 7 months. RR-ECl09 cells had 67.258 fold resistance to paclitaxel. The percentage of sphere formation and clone proliferation ability of RR-EC109 cells was higher than that of EC109 cells (P < 0.05). The amount of side population cells in RR-EC109 cells was higher than that of EC109 cells (P < 0.05). RR-EC109 cells produced more mRNA for Bmi1, Nanog, Oct4, Sox2, ABCG2, Nestin, and Ki-67 than EC109 cells (P < 0.05). E-cadherin expression was lower in RR-EC109 cells than in EC109 cells, while N-cadherin, Snail, and Twist expressions were higher in RR-EC109 cells than in EC109 cells (P < 0.05). Conclusions: Cancer stem cell (CSC)-like cells exist among paclitaxel-resistant cells in ESCC and may play a role in ESCC drug resistance.     

2004年三种医学期刊论著中统计方法的应用状况与分析

目的比较三种不同系列医学期刊统计方法的应用状况。方法采用单纯随机抽样法,对确定的2004年度公开发表的三种(中华、中国和军队系列)医学期刊中的全部论著进行调查分析。结果在三种系列期刊中,统计方法应用比均达90%以上(χ2=1.71,P>0.05),误用比分别为7.44%、13.39%和21.57%(χ2=9.35,P<0.01)。多因素分析应用比分别为14.05%、8.04%和2.94%(χ2=8.72,P<0.05)。计量资料和计数资料应用比无差异(χ2=3.45,P>0.05)。统计方法分类应用和误用百分比排序及统计问题分类误用百分比排序前10位存在不一致。结论医学期刊论著中统计方法应用普遍,但出现的统计问题或瑕疵也较多。     

Intactness of membranous structure in canine stunned myocardium shown with colloidal lanthanum nitrate

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新型合作医疗定点医疗机构评价体系初探

文章从更好地满足农民医疗需求、有助于提高医疗机构质量和进行有效监管3个方面阐述了建立定点医疗机构评价体系的必要性，然后对评价体系的内容进行了初步的探讨，提出了医疗机构定点的2种模式、评价的主要内容和评价体系的运作的方式，为建立新型合作医疗定点医疗机构评价体系、促进新型合作医疗的可持续发展提供了一种思路。     

防晕帽各组成部分对前庭自主神经反应作用的分析

目的分析防晕帽各组成部分对前庭自主神经反应的作用。方法将90名年轻健康飞行人员随机分为三组：A组为对照组，戴空白帽，将防晕帽中磁片、风扇及负离子发生器去掉者；B组为戴去掉风扇及负离子发生器帽子组；C组为戴防晕帽组。三组均在戴帽15min后进行科里奥利加速度试验，受试者出现I。前庭自主神经反应时停止转椅并观察20min，依照前庭自主神经反应程度进行分度，对受试时间和前庭自主神经反应程度进行比较。结果三组科里奥利加速度试验持续时间分别为（349．43±31．60）s、（366．23±32．62）s、（385．17±35．54）s，差异均有统计学意义（P〈0．05），前庭自主神经反应程度发生率差异亦有统计学意义（P〈0．05）。结论防晕帽中穴位磁片、风扇和负离子发生器的综合作用可有效降低前庭自主神经的反应程度，为运动病的防控提供了新的思路和措施。     

乌司他丁对体外循环术中肺脏的保护作用

目的研究乌司他丁对体外循环术中肺脏的保护作用。方法选择心脏直视手术患者60例,分别设乌司他丁治疗组和对照组各30例,在5个时间点分别检测中性粒细胞弹性酶(NE)、白介素(IL)-8、超氧化物歧化酶(SOD)含量的变化。结果在主动脉开放后的3个时间点两组数据具有显著性差异。结论乌司他丁在体外循环中具有抗蛋白酶分解、调节细胞因子和减少氧自由基的肺保护作用。     

森林脑炎病毒RNA的提取及其性质

从森林脑炎病毒感染的鼠脑组织中直接抽提总核酸,然后经Sepharose4B柱层析将病毒RNA与细胞RNA分离,方法简便、分离的病毒RNA在260nm处有典型的紫外吸收光谱,260/280nm的比值近似2,对RNase敏感,有感染性。     

不同学历护士心理健康调查分析

目的了解不同学历的护士心理健康与应对方式情况。方法采用症状自评量表（SCL-90）和简易应对方式问卷（SCSQ）对130名护士按照学历高低分本科组、大专组、中专组3组进行调查,结果采用SPSS 12进行统计处理,并进行组间对比分析。结果中专护士在人际敏感因子上高于本科组和大专组;本科护士、大专护士在焦虑、偏执2个因子上高于中专护士;本科护士的敌对较其他两组高。本科护士应付方式积分高于大专护士与中专护士,统计学检验P〉0.05。结论学历差异对护士的心理健康有一定的影响,但更关键的是护士从事护理工作的时间和经验,工作经验丰富有利于护士心理健康。     

中国人2型糖尿病合并高甘油三酯血症患者脂蛋白酯酶基因突变及功能分析

目的 研究中国人2型糖尿病合并高甘油三酯血症患者脂蛋白醒酶(1ipoprotein lipase,LPL)基因突变及对酶功能的影响,从脂代谢途径探讨引发糖尿病的遗传因素。方法 对高甘油三酯及血脂正常的2型糖尿病患者和正常人的LPL基因进行研究。利用PCR—SSCP、PCR—RFLP及DNA测序技术对LPL基因的启动子和10个外显子区域进行突变检测,针对特异位点进行体外定点突变和酶活力表达研究,利用网上工具平台Swiss-PDB Viewer对正常和突变蛋白进行二级结构模拟分析。结果 在177例高甘油三酯2型糖尿病患者中检测到4种错义突变：Ala71Thr、Val181IIe、Glyl88Glu和Glu242Lys,在正常血脂的糖尿病患者和健康人组中没有检出以上突变。这4种突变位于进化上高度保守的氨基酸位点,并分别在高度保守的外显子3、5及6区域。体内和体外酶活力研究表明,这4个突变均引起了酶活力降低甚至失活,其改变程度可以从它们所在序列的保守性、在酶功能结构城中的相对位置、相应的二级结构改变和氨基酸特性获得解释。结论 在受累个体中,LPL突变是引起患者血浆甘油三酯升高的直接原因,是其发展成2型糖尿病的遗传性易感因素。