蒿甲醚对不同病期小鼠结直肠癌抑瘤效果的实验研究

目的:探讨蒿甲醚(Artemether)对不同病期BALB/c小鼠CT-26结直肠癌的抑瘤作用。方法:BALB/c小鼠皮下接种CT-26结直肠癌细胞(4×105个)。96只小鼠,雌、雄各半,随机分为两个大组,分为中期组(接种5天后)和晚期组(接种10天后);每个大组再随机分为6小组,每组8只,分别为低剂量(33.3mg/kg)、中剂量(50mg/kg)、高剂量(66.6mg/kg)和中剂量(50mg/kg)加铁剂(1.5mg/kg)组、阳性对照组(顺铂5mg/kg)、空白对照组(等体积生理盐水)。结果:中期组口服蒿甲醚高、中、低剂量和中剂量加铁剂对BALB/c小鼠CT-26结直肠癌均有明显的抑制作用,抑瘤率分别为52.0%、51.4%、42.3%和53.5%;晚期组口服蒿甲醚高、中、低剂量和中剂量加铁剂对BALB/c小鼠CT-26结直肠癌亦有明显的抑制作用,抑瘤率分别为35.8%、33.5%、38.2%和44.7%,中剂量单药抑瘤率最低;中、晚期各对应组之间比较有显著差异(P<0.05)。结论:在一定剂量范围内,口服蒿甲醚对小鼠不同病期的CT-26结直肠癌均有明显的抑制作用,中期组强于晚期;蒿甲醚与顺铂相比,具有较小的毒副作用;与铁剂合用具有一定的协同作用,使抑瘤率增加。     

脐带挤压与延迟断脐对胎龄<34周早产儿早期预后影响的Meta分析

目的分析脐带挤压与延迟断脐对胎龄<34周早产儿早期预后的影响。方法计算机检索PubMed、Web of Science、Embase、Cochrane Library、CINAHL、中国知网、万方数据库、维普数据库和中国生物医学文献服务系统数据库从建库到2021年11月发表的胎龄<34周早产儿脐带挤压与延迟断脐的随机对照试验。由2名研究人员根据纳入和排除标准，独立对文献进行筛选和质量评价，并提取数据，采用Review Manger 5.4进行Meta分析。结果最终纳入11篇文献，共1 621例早产儿，其中脐带挤压组809例，延迟断脐组812例。Meta分析结果显示，与延迟断脐相比，脐带挤压提高了早产儿出生后平均血压（WMD=3.61，95%CI：0.73~6.50，P=0.01），但增加了早产儿严重脑室内出血的发生率（RR=1.83，95%CI：1.08~3.09，P=0.02），两者在早产儿出生后血红蛋白水平、红细胞压积、输血率、光疗率、血清胆红素峰值及脑室周围白质软化、坏死性小肠结肠炎等并发症发生的影响差异均无统计学意义（P>0.05）。结论与延迟断脐相比，脐带挤压可能增加胎龄<34周早产儿严重脑室内出血的风险，但仍需更多高质量、大样本的随机对照试验进一步证实。     

Cx26和Cx43在乳腺癌中的表达及与上皮间质转化的关系

目的研究连接蛋白26(Connexin26,Cx26)和连接蛋白43(Connexin43,Cx43)在乳腺癌中的表达及与上皮间质转化(EMT)的关系。方法应用免疫组织化学方法检测70例浸润性导管癌、10例乳腺良性病变(乳腺纤维腺瘤)患者中Cx26和Cx43的表达情况,并分析其与EMT的关系。结果Cx26和Cx43在浸润性导管癌中表达的阳性率分别为31%(22/70)和47%(33/70),与乳腺纤维腺瘤中相比,Cx26和Cx43在浸润性导管癌中的表达明显降低(P0.05);在浸润性导管癌中Cx26和Cx43的表达与EMT状态呈负相关(r=-0.26,r=-0.24)。结论Cx26和Cx43与EMT状态呈负相关,可作为乳腺浸润性导管癌中EMT发生的有价值的标记物。     

维甲酸对新生大鼠高氧肺损伤的干预作用

目的探讨高氧暴露新生大鼠肺组织结构的变化和连接蛋白Connexin26(Cx26)的表达情况及维甲酸对其影响。方法24只3日龄SD大鼠随机分为3组:高氧暴露维甲酸组(维甲酸组)、高氧暴露安慰组(高氧组)、空气暴露对照组(对照组);采用950mL/L氧体积分数条件下制作新生大鼠高氧肺损伤模型;观察大鼠一般情况,用HE染色法观察肺组织结构变化及辐射状肺泡计数(RAC),免疫组织化学检测Cx26的表达。结果体质量、RAC等方面与空气组相比,高氧组、维甲酸组均有显著差异[(13.53±1.27)、(13.38±1.29)、(17.37±0.89)g,F=30.19P=0;(11.15±1.33)、(12.49±1.47)、(13.94±0.98),F=9.59P=0];Cx26蛋白在空气组表达比较局限,高氧组弥散表达,而维甲酸组更多表达;阳性细胞分别为(13.68±1.28)%、(17.82±1.72)%、(19.69±1.77)%,F=29.36P=0。结论维甲酸对新生大鼠高氧肺损伤具有保护作用,可能与间隙连接蛋白Cx26表达的改变有密切的关系。     

研究者发起的临床研究用于支持新药研发面临的挑战

在我国开展的大量研究者发起的临床研究（Investigator-initiated clinical trials, IIT），其中部分应该可以为新药研发起到重要的支撑作用。但由于我国IIT尚存在数量多、规模小、质量参差不齐等问题，特别是在方案设计、质量管理以及伦理审查能力等方面与制药企业发起的注册临床试验还存在不小的差距，导致很多IIT还不能用于支持新药研发。因此需要监管部门、申办方、研究机构、伦理委员会和研究者共同提高对于IIT用于支持新药研发作用的认识。只有加强监管，建立有效的质量管理体系、强化对研究者的培训并切实提升伦理审查能力，才能用高质量的研究者发起的临床研究支持新药研发。     

A change in treatment process with a modern record and verify system

Purpose: With the introduction of new treatment devices, such as a multileaf collimator (MLC) and dynamic wedge (DW), therapists have an increased responsibility to ensure correct treatment. Simultaneously, three-dimensional treatment planning (3DTP) has led to an increased number of portals and table movements. To counteract this challenge and maintain efficiency, a comprehensive record and verify (R&V) system is mandatory. We evaluated a commercial system (Varis) for reliability, ease of use, efficiency, and integration with our planning systems.

Methods and Materials: Some key elements of the Varis system are: integration of MLC and DW; auto setup for MLC, jaw, collimator, gantry, and limited table parameters; direct download of simulation beam data; and a regimented field scheduling system that prescribes all beam data for particular fractions. Evaluation of the system was driven by treatment time analysis, error rates, and an increased workload. These issues were governed by how we disseminated duties and how the system accommodated or changed our processes.

Results: Most data entry is performed by our dosimetry staff. Data can be downloaded from the simulator, but more patients now move from CT simulation and/or 3DTP to the treatment machine. Varis does not link to these systems. The physics staff confirms all entries to correct data entry errors. The workload for dosimetrists increased by an average of 8 minutes/patient entry; physics time increased by 7 minutes/patient entry; the weekly electronic chart check takes approximately 3 minutes/patient. Therapists who used Varis efficiently showed a slight decrease in treatment times, attributed to MLC integration and auto-setup. Some therapists experienced a decrease in efficiency, because of unfamiliarity and excess intervention. On a positive note, notable events have decreased by a factor of 10 since full initiation. Unfortunately, the remaining errors are often the result of a therapist relying on incorrect electronic information.

Conclusion: The Varis R&V system has had an impact on our clinic’s process and efficiency. Checking of all beam data and related field scheduling have helped reduce errors and misconceptions. We feel a dual-energy machine can be operated with two experienced therapists and an up-to-date R&V system more accurately and efficiently than with three therapists working without an integrated R&V. We anticipate future Varis releases will further promote efficiency and accuracy.     

缺氧诱导因子-1α和Ets-1在脑膜瘤中的表达及相关性研究

目的研究缺氧诱导因子-1α（hypoxia-inducible factor 1α,HIF-1α）和Ets-1（E26transformation-specific 1）在脑膜瘤中的表达及其意义。方法采用免疫组织化学法分别检测56例脑膜瘤和9例正常脑膜HIF-1α和Ets-1的表达,采用逆转录聚合酶链反应（RT-polymerase chain reaction,RT-PCR）方法检测25例新鲜脑膜瘤和9例正常脑膜组,运用统计学方法分析HIF-1α和Ets-1在脑膜瘤表达的相关性。结果 HIF-1α和Ets-1在正常脑膜不表达或低表达,脑膜瘤中HIF-1α阳性表达率53.6%（30/56）,Ets-1呈阳性表达率48.2%（27/56）;脑膜瘤恶性倾向组HIF-1α的阳性表达率高于脑膜瘤良性组（P〈0.05）;HIF-1α和Ets-1在脑膜瘤的表达呈正相关（γs=0.317、P〈0.05）。脑膜瘤中HIF-1α和Ets-1的mRNA含量高于正常脑膜组（P〈0.05）,脑膜瘤恶性倾向组HIF-1α和Ets-1的表达高于脑膜瘤良性组（P〈0.05）,HIF-1α和Ets-1在脑膜瘤的mRNA水平呈正相关（γ=0.532、P〈0.01）。结论 HIF-1α和Ets-1的表达与脑膜瘤恶性度有关,二者在脑膜瘤发生发展过程中有协同作用,可作为脑膜瘤预后的潜在指标。     

Suppression of Anti-Inflammatory Mediators in Metabolic Disease May Be Driven by Overwhelming Pro-Inflammatory Drivers

Obesity is a multifactorial disease and is associated with an increased risk of developing metabolic syndrome and co-morbidities. Dysregulated expansion of the adipose tissue during obesity induces local tissue hypoxia, altered secretory profile of adipokines, cytokines and chemokines, altered profile of local tissue inflammatory cells leading to the development of low-grade chronic inflammation. Low grade chronic inflammation is considered to be the underlying mechanism that increases the risk of developing obesity associated comorbidities. The glucocorticoid induced protein annexin A1 and its N-terminal peptides are anti-inflammatory mediators involved in resolving inflammation. The aim of the current study was to investigate the role of annexin A1 in obesity and associated inflammation. To achieve this aim, the current study analysed data from two feasibility studies in clinical populations: (1) bariatric surgery patients (Pre- and 3 months post-surgery) and (2) Lipodystrophy patients. Plasma annexin A1 levels were increased at 3-months post-surgery compared to pre-surgery (1.2 ± 0.1 ng/mL, n = 19 vs. 1.6 ± 0.1 ng/mL, n = 9, p = 0.009) and positively correlated with adiponectin (p = 0.009, r = 0.468, n = 25). Plasma annexin A1 levels were decreased in patients with lipodystrophy compared to BMI matched controls (0.2 ± 0.1 ng/mL, n = 9 vs. 0.97 ± 0.1 ng/mL, n = 30, p = 0.008), whereas CRP levels were significantly elevated (3.3 ± 1.0 µg/mL, n = 9 vs. 1.4 ± 0.3 µg/mL, n = 31, p = 0.0074). The roles of annexin A1 were explored using an in vitro cell based model (SGBS cells) mimicking the inflammatory status that is observed in obesity. Acute treatment with the annexin A1 N-terminal peptide, AC2-26 differentially regulated gene expression (including PPARA (2.8 ± 0.7-fold, p = 0.0303, n = 3), ADIPOQ (2.0 ± 0.3-fold, p = 0.0073, n = 3), LEP (0.6 ± 0.2-fold, p = 0.0400, n = 3), NAMPT (0.4 ± 0.1-fold, p = 0.0039, n = 3) and RETN (0.1 ± 0.03-fold, p < 0.0001, n = 3) in mature obesogenic adipocytes indicating that annexin A1 may play a protective role in obesity and inflammation. However, this effect may be overshadowed by the continued increase in systemic inflammation associated with rapid tissue expansion in obesity.     

癌胚抗原阳性CT26结肠癌细胞株的构建及鉴定

目的构建适于普通小鼠的癌胚抗原（CEA）阳性结肠癌细胞株。方法以重组CEACAM5cDNA-Lentivims慢病毒转染小鼠结肠癌CT26细胞．抗生素筛选2周．以有限稀释法获得癌胚抗原阳性细胞CT26CEA,体外培养至第7代和第14代进行鉴定。用RT．PCR法和Western blot法分别检测CEACAM5mRNA及蛋白表达．用荧光显微镜和免疫细胞化学法观察CEACAM5表达位置：并以第14代CT26CEA细胞建立BALB／c鼠皮下种植瘤模型．用活体荧光成像法和免疫组织化学染色观察瘤体CEACAM5表达情况。结果在第7代和第14代CT26CEA细胞内可以检测到CEACAM5mRNA及CEACAM5蛋白表达．荧光显微镜和免疫细胞化学法观察到其表达主要在细胞质,活体荧光成像法和免疫组织化学染色观察到小鼠瘤体有丰富CEACAM5表达。结论成功构建小鼠结肠癌CT26CEA细胞株,能够在体外培养及小鼠体内稳定表达癌胚抗原．为研究正常免疫环境下癌胚抗原对结肠癌进展的影响及作用机制提供了适用工具．     

MLL5基因敲除对小鼠结肠癌CT26细胞移植瘤生长的影响及其机制

目的：探讨混合谱系白血病5(MLL5)基因在小鼠结肠癌CT26细胞移植瘤生长中的作用及其分子机制。方法：利用CRISPR/Cas9技术构建MLL5基因缺失、MLL5和DDX58双基因缺失的结肠癌CT26细胞模型,用Sanger测序和WB法验证敲除效果。将基因敲除的CT26细胞接种到野生型BALB/c小鼠和免疫缺陷型NSG小鼠皮下,构建基因缺失结肠癌CT26细胞移植瘤小鼠模型,并观察移植瘤的生长及荷瘤小鼠的总生存期（OS）。结果：在野生型小鼠中,MLL5基因缺失的CT26细胞移植瘤生长速度显著性低于野生型癌细胞移植瘤,并延长荷瘤小鼠的OS(P<0.01);在NSG小鼠中,MLL5基因缺失对CT26细胞移植瘤的生长速度以及荷瘤小鼠的OS没有明显改变。MLL5基因缺失提高了癌细胞中视黄酸诱导基因1(RIG-1)蛋白水平,DDX58基因缺失可逆转MLL5基因缺失在CT26细胞移植瘤中的作用。结论：MLL5基因缺失可提高结肠癌CT26细胞中RIG-1蛋白水平、促进肿瘤免疫,从而抑制荷瘤小鼠肿瘤生长,提示MLL5可能成为结肠癌治疗的新靶点。