The long-term influence of hospital and surgeon volume on local control and survival in the randomized German Rectal Cancer Trial CAO/ARO/AIO-94

BackgroundThe association of treatment volume and oncological outcome of rectal cancer patients undergoing multidisciplinary treatment is subject of an ongoing debate. Prospective data on long-term local control and overall survival (OS) are not available so far. This study investigated the long-term influence of hospital and surgeon volume on local recurrence (LR) and OS in patients with locally advanced rectal cancers.MethodsIn a post-hoc analysis of the randomized phase III CAO/ARO/AIO-94 trial after a follow-up of more than 10 years, 799 patients with stage II/III rectal cancers were evaluated. LR-rates and OS were stratified by hospital recruitment volume (≤20 vs. 21–90 vs. >90 patients) and by surgeon volume (≤10 vs. 11–50 vs. >50 procedures).ResultsPatients treated in high-volume hospitals had a longer OS than those treated in hospitals with medium or low treatment volume (p = 0.03). The surgeon volume was adversely associated with LR (p = 0.01) but had no influence on overall survival. The positive effect of neoadjuvant chemoradiation (CRT) on local control was the strongest in patients being operated by medium-volume surgeons, less in patients being operated by high-volume surgeons and missing in those being operated by low-volume surgeons.ConclusionsPatients with locally advanced rectal cancers might benefit from treatment in specialized high-volume hospitals. In particular, the surgeon volume had significant influence on long-term local tumour control. The effect of neoadjuvant CRT on local tumour control may likewise depend on the surgeon volume.     

Crowdsourced and crowdfunded: the future of forensic DNA?

ABSTRACT

Forensic DNA analysis is dependent on comparing the known and the unknown. Expand the number of known profiles, and the likelihood of a successful match increases. Forensic use of DNA is moving towards comparing samples of unknown origin with publicly available genetic data, such as the records held by genetic genealogy providers. Use of forensic genetic genealogy has yielded a number of recent high-profile successes but has raised ethical and privacy concerns. Navigating family trees is complex, even more so when combined with a comparison of genetic relationships. This intelligence-gathering process has led to occasional false leads, and its use also risks a public backlash, similar to concerns over Cambridge Analytica. A cautious approach to use of this technique is therefore warranted.     

土耳其斯坦东毕吸虫磷酸丙糖异构酶基因的克隆及其序列分析

目的 克隆土耳其斯坦东毕吸虫磷酸丙糖异构酶的全长基因。方法 根据日本血吸虫和曼氏血吸虫磷酸丙糖异构酶基因的保守区设计引物，利用RT—PCR扩增出土耳其斯坦东毕吸虫磷酸丙糖异构酶基闪的大片段，再结合RACE技术分别得到磷酸丙糖异构酶基因的3’端和5’端，将3部分序列拼接后获得磷酸丙糖异构酶基因全长cDNA序列，并提交GenBank。结果 成功克隆了土耳其斯坦东毕吸虫磷酸丙糖异构酶基因全长cDNA序列并提交GenBank，登录号为DQ092331。结论 土耳其斯坦东毕吸虫磷酸丙糖异构酶基因全长cDNA的克隆为进一步表达及其生物学性能的分析提供了理论基础。     

Additional bedtime H2‐receptor antagonist for the control of nocturnal gastric acid breakthrough: A Cochrane systematic review

OBJECTIVES: To assess the effectiveness and safety of additional bedtime H₂‐receptor antagonists (H₂RAs) in suppressing nocturnal gastric acid breakthrough (NAB) via a systematic review. METHODS: Eligible trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2004), MEDLINE (January 1966–June 2004), EMBASE (January 1980–June 2004) and CINAHL (January 1982–June 2004). Additional hand‐searching was conducted on the proceedings of correlated conferences, eight important Chinese journals and references of all included trials. All randomized controlled trials evaluating H₂RAs for the control of NAB were eligible for inclusion. The systematic review was conducted using methods recommended by The Cochrane Collaboration. RESULTS: Only two randomized crossover studies, comprising 32 participants, met the inclusion criteria. Because the design, dosage and duration of the treatments were different between the studies, it was not possible to conduct meta‐analysis. There were no consistent conclusions found between the two included studies in evaluating H₂RAs for the control of NAB. CONCLUSIONS: No implications for practice at this stage can be concluded. Appropriately designed large‐scale randomized controlled trials with long‐term follow up are needed to determine the effects of additional bedtime H₂RAs in suppressing NAB.     

模拟舰船磁场与噪声、高温复合对机体作用的方差分析

目的 研究模拟舰船两种剂量水平磁场复合噪声、高温对机体联合作用的特点。方法 采用有交互作用的三因素二水平的正交试验设计方法及方差分析法，按正交表L8（2^7）的要求安排8种复合暴露剂量组合，分别将兔和大鼠分为8个复合暴露组和8个对照组。结果 兔球结膜毛细血管管径、大鼠肝和脾脏HSP70的分析结果显示出磁场是对其影响的主因素（均为P〈0．01），其次是高温（均为P〈0．05）,大鼠下丘脑AVP和大鼠脑组织HSP70的分析结果显示出磁场是对其影响的主因素（均为P〈0．05）。兔血浆内皮素的分析结果显示出磁场与噪声交互作用所对应的F值有非常显著性意义（P〈0．01），磁场与噪声、高温三者之间交互作用所对应的F值也有显著性意义（P〈0．05）。结论 磁场是对上述指标影响的主因素，而高温也是重要因素；磁场与噪声有交互作用，磁场与噪声、高温三者之间也有交互作用；应该重视舰船环境因素对舰船人员的复合作用。     

Comparison of parent and teacher reports of attention-deficit/hyperactivity disorder symptoms from two placebo-controlled studies of atomoxetine in children.

BACKGROUND: The validity of parent reports regarding children's attention-deficit/hyperactivity disorder (ADHD) symptoms has been questioned. This study assessed whether parent reports were as sensitive as teacher reports to document change in ADHD symptoms during clinical trials with atomoxetine. METHODS: Data were compared from two randomized, double-blind, placebo-controlled clinical trials of atomoxetine using different versions (parent or teacher) of the same rating scale (Attention-Deficit/Hyperactivity Disorder Rating Scale-IV [parent or teacher] Version: Investigator Administered and Scored - ADHD RS). Exclusion criteria included history of bipolar disorder, psychosis, seizures, alcohol abuse, or positive drug screen. Patients (6-16 years old) were treated with atomoxetine (titrated to a maximum dose of 1.8 mg/kg/day) administered once daily for up to 7 weeks. Parent and teacher ratings were compared using an analysis of covariance (ANCOVA) model. RESULTS: The analysis (n = 318) showed that treatment effects (mean change, baseline to endpoint) were similar between parent and teacher ratings (total, p = .762; inattention, p = .519; hyperactive/impulsive, p = .955). Effect sizes also were similar based on total scores (parent ratings = .69; teacher ratings = .63). CONCLUSIONS: Parent reports are as sensitive as teacher reports in assessing the efficacy of long-acting pharmacologic treatment for ADHD in children during clinical trials using the nonstimulant atomoxetine.     

Cerebral autoregulation is preserved in multiple system atrophy: A transcranial Doppler study.

Patients with multiple system atrophy (MSA) present large changes in blood pressure (BP) due to autonomic disturbances. We analyzed how this change may influence dynamic cerebral autoregulation (DCA). Simultaneous recordings of arterial BP (Finapres) and middle cerebral artery (MCA) blood flow velocity (BFV) (transcranial Doppler) were performed in 10 patients with MSA (61 +/- 12 yr of age) and 12 healthy volunteers (61 +/- 11 yr of age): cerebral BFV response to oscillations in mean BP was studied in the supine position by cross-spectral analysis of mean BP and mean MCA BFV. The DCA was also studied during the decrease in BP the first seconds when standing up from a sitting position by the assessment of the cerebrovascular resistance index (CR; mean BP/mean MCA BFV ratio). The MCA BFV/BP cross-spectral analysis showed a phase for the mid-frequency band (0.07-0.2 Hz) significantly larger in MSA, suggesting more active autoregulation in response to larger changes in BP. Changes in CR reflecting the rate of autoregulation, when standing did not differ between the two groups. These data suggest that dynamic cerebral autoregulation is preserved in MSA.     

慢性肾衰竭急性加重的临床特征及相关因素分析

目的：探讨慢性肾衰竭（CRF）急性加重因素及其治疗措施对预后的影响。方法：对2001年1月～2005年6月住院治疗的CRF急性加重患者42例，按其加重原因、基础疾病、治疗方式和疗效进行回顾性总结。结果：CRF急性加重因素依次为各种感染（45．2％）、原发病加重（19．0％）、高血压未控制（14．3％）、水电解质紊乱（11．9％）、肾毒性药物（11．9％）、心功能不全（9．5％）、尿路梗阻（4．8％）、血高粘滞状态（2．4%），7例同时存在≥2种上述病因（16．7％）。CRF急性加重原发病以慢性肾小球肾炎（52．4％）和糖尿病肾病（11．9％）为主。积极治疗后肾功能恢复达到或接近原来水平者40例，死亡2例，死亡2例的年龄均在60岁以上。结论：对于CRF肾功能急剧恶化的患者，应积极寻找其加重因素，并采取非透析和透析相结合治疗，改善肾功能，降低病死率，延长患者生命。