Nivolumab in routine practice for older patients with advanced or metastatic non-small cell lung cancer

Background

Nivolumab is approved worldwide as second-line treatment for metastatic non-small cell lung cancer (NSCLC). Despite the fact that most of these cancers are being diagnosed in the older patients, few of the patients were included in pivotal trials. We aimed to describe efficacy and safety in a “real-world” older population.

结核分枝杆菌DNA疫苗pVS85B的构建及免疫保护实验研究

评价构建的结核DNA疫苗pVS85B免疫小鼠后脾细胞体外产生细胞因子和抵抗结核分枝杆菌H37Rv攻击的能力。利用基因操作技术将结核菌ag85b插入pVAX1载体,构建表达结核菌Ag85B分泌型蛋白的DNA疫苗pVS85B。将雌性C57BL/6小鼠分成5组,每组20只,分别用pVS85B、pVAX1、pIL2S和PBS分别免疫3次,均间隔2周,以相同剂量加强免疫2次。另一组用BCG(105CFU)免疫1次。每组10只鼠在最后一次加强免疫后,无菌取脾培养,检测上清细胞因子。另10只鼠用结核菌H37Rv经静脉攻击,2周后取脾、肝和肺培养结核菌并进行菌落计数。结果是pVS85B免疫组鼠脾淋巴细胞培养上清的mIL-2和mIFN-γ平均含量分别为(311.3±46.2)和(273.6±55.4)pg/ml,显著高于3个阴性对照组(P<0.001),与BCG免疫组无显著性差异(P>0.05)。5个组的平均mIL-6和mIL-10无显著性差异。pVS85B免疫组小鼠的脾、肝和肺的平均结核菌载量分别为(47 716.6±5 689.0)、(50 113.4±6 532.2)和(51 095.3±2 788.9)CFU/g,分别低于pVAX1、pIL2S和PBS三个阴性对照组的相应器官的结核菌载量(P<0.001)。pVS85B免疫组脾、肝和肺的结核菌载量显著高于BCG免疫对照组。提示,表达结核菌分泌型Ag85B的DNA疫苗pVS85B能够刺激机体产生抗结核菌所需的Th1型免疫应答,免疫鼠获得抵抗H37Rv攻击的能力。     

Studies on the development and role of some cell-mediated immune responses in experimental toxocarosis in mice

The studies were undertaken to investigate the development of some cell-mediated immune responses in experimental toxocarosis in mice and to assess the influence of these responses on the course of infection. Mice were infected orally with 350 eggs of Toxocara canis and reinfected with the same dose of parasites after 8 weeks. Groups of infected animals were killed each week of the experiments to obtain spleens, livers and brains for further studies. Lymphocytes from removed spleens were analysed by flow-cytometry for CD4 and CD8 expression and cultured in vitro to measure their responses to Concanavalin A and excretory-secretory (ES) antigen of T. canis in a lymphocyte transformation test. Pieces of livers were used to prepare paraffin sections to be stained later with haematoxylin and eosin, whereas whole brains of the infected animals were examined for the presence of parasite larvae. The results of the studies showed depression of T-cell responses to ConA in early stages of infection and significant increase in the blastogenic responses to the ES antigen from week 4 following infection. The depression of T-cell responses was accompanied by lowered CD4+/CD8+ ratio resulting from increased percentages of CD8+ T cells. Histopathological examination of liver sections revealed trapping of larvae in T. canis reinfected mice. The intensity of infection as measured by larval recoveries from the brains of mice increased gradually up to the 8th week of infection, but did not show significant changes after reinfection, testifying to the development of long-lasting protective immunity during primary infection.     

Le recours aux dossiers des patients est-il nécessaire pour l’évaluation du risque de récidive sexuelle,violente et générale ?

IntroductionSexual, violent and general recidivism risk scales are widely used in a number of countries. Their psychometric qualities are generally considered to be good. However, in practice they may vary in the quality of prediction of risk of sexual, violent and general recidivism, in particular because of the sources of the information collected. In France, the medical records of incarcerated patients are kept by health-care professionals. Although regulated, the content and quality of these records vary widely from one patient to another. The criminal justice system holds the criminal records of convicted and imprisoned persons. There is no set list of documents contained in these records. For caregivers and researchers, access to criminal records is difficult because of the confidentiality to which legal professionals are subject. The aim of our study was to investigate whether using medical files in addition to structured interviews can improve the assessment and management of the risks of sexual, violent and general recidivism.Material and MethodA total of 128 perpetrators of violence were assessed using three scales of risk of sexual, violent and general recidivism. Scores for the items of the scales were compared between (a) those that were based on medical records and an interview, and (b) those based only on an interview.Results and discussionFirst, differences in scores between the two groups (assessed through interview only, and assessed through interview and use of medical records) were observed on the RSVP, HCR-20 and LS/CMI scales. Secondly, most of the results indicate that the overall level of risk was perceived as lower when medical records were used, which would, indirectly, lead to a reduction in false positives when evaluating perpetrators of sexual violence. Thirdly, the point-by-point analysis shows that the use of information contained in the medical records reduces the weight of present and future factors (e.g. the physical and psychological stress of recent events), increases the weight of past factors (e.g. history of sexual violence), and can increase the weight of certain factors that can lead to more negative emotions in the assessor (e.g. deviance). These results can be explained by (i) the emotional functioning of the persons assessed (particularly defensive processes or memory difficulties), (ii) the attitude of the aggressor (particularly the presence of emotional and cognitive biases), (iii) the nature of the information (particularly “hot” cognitions or those leading to greater social desirability). The limitations of the study concern the relatively small number of participants, the environment in which the file was transmitted and the very heterogeneous and sometimes relatively incomplete composition of the files.ConclusionThe use of information contained in medical files impacts the results of recidivism risk scales and restores a balance to the factors. In France, risk scales are currently being introduced, although their use is still limited in the health field. However, ethical use of these scales raises the issue of the homogenisation of the content of medical records and access to criminal records in order to enable future research to confirm whether the use of information provided in medical and criminal records can improve the quality of assessment and treatment of offenders.     

Electroconvulsive therapy,depression, the immune system and inflammation: A systematic review

Background

The management and treatment of major depressive disorder are major public health challenges, the lifetime prevalence of this illness being 4.4%–20% in the general population. Major depressive disorder and treatment resistant depression appear to be, in part, related to a dysfunction of the immune response. Among the treatments for depression ECT occupies an important place. The underlying cerebral mechanisms of ECT remain unclear.

应用康奈尔健康问卷评价护士长的身心健康水平

目的探讨护士长身心健康水平。方法采用康奈尔健康问卷（CMI）对215名护士长测查,根据护士长从事的管理年限不同及文化程度的差异进行分组比较。结果从事护理管理5年以内的护士长其愤怒部分的分值高于从事护理管理5年以上护士长（P＜0．05）,呼吸系统、既往病史的分值低于5年以上（P＜0．05）。大专学历的护士长其习惯的分值低于中专学历护士长（P＜0．01）,疲劳感的分值高于中专学历护士长（P＜0．05）。结论护士长身心健康总体水平较好,从事护理管理年限、文化层次不同,在身心健康方面有一定差距。提示在情境多变、情况复杂的工作条件下,护士长要保持积极稳定的情绪状态。     

癫痫儿童T细胞免疫功能与其发病因素的相关性分析

目的 探讨癫痫儿童的T细胞免疫功能与其发病因素的相关性.方法 对符合诊断标准的152例癫痫儿童分别于服药前、服药后检查T细胞免疫功能和血药浓度并与健康对照组进行比较.结果 服药前、服药后癫痫儿童的CD4、CD8、CD19、CD16 56 、CD4/CD8、NK细胞的比例与健康对照组比较差异有统计学意义(P＜0.05);癫痫儿童服药前、服药后T细胞免疫功能比较,无统计学意义(P＞0.05).结论 癫痫儿童存在T细胞免疫功能异常,免疫功能失衡可能参与了儿童癫痫的发病.     

精神科护士心身健康状况和个性特征分析

目的 :了解精神科护士心身状况和个性特征。方法 :采用康奈尔医学指数(CMI)和艾森克个性调查问卷(EPQ)对83位精神科护士与78位非精神科护士进行对照调查。结果 :EPQ的P、E、N、L四个维度评分无显著差异(P>0.05) ,CMI总分、B、G、I因子分在精神科护士与非精神科护士之间存在极显著差异(P<0.01) ,H因子存在显著差异(P<0.05) ;EPQ的四个维度评分和CMI总分在未婚组和已婚组护士之间无显著差异(P>0.05)。结论 :精神科护士存在或潜在多方面的心身健康问题 ,婚姻状况对护士的心身健康无明显影响。     

DRGs相关指标值在医院绩效考核分配体系中的应用

公立医院在内部绩效考核分配体系建设中一般比较关注科室工作量指标和经济效益指标,而对医疗技术水平指标往往关注不够或很少关注,尤其是在医院将缩短平均住院日指标纳入科室绩效考核分配评价体系后,科室是否存在着为单纯追求平均住院日指标的完成而刻意回避收治疑难重症患者的现象,医院管理层往往心中没底。北京大学第三医院在大力缩短平均住院日并取得显著效益的同时．在内部绩效考核分配体系构建中对医院内部各科室医疗技术水平指标实行真正量化考核等方面进行了有益的探索。