Logistic回归模型中连续变量交互作用的分析

Rothman提出生物学交互作用的评价应该基于相加尺度即是否有相加交互作用,而logistic回归模型的乘积项反映的是相乘交互作用.目前国内外文献讨论logistic回归模型中两因素的相加交互作用以两分类变量为主,本文介绍两连续变量或连续变量与分类变量相加交互作用可信区间估计的Bootstrap方法,文中以香港男性肺癌病例对照研究资料为例,辅以免费软件R的实现程序,为研究人员分析交互作用提供参考.     

Synergistic interaction between tetrandrine and chemotherapeutic agents and influence of tetrandrine on chemotherapeutic agent-associated genes in human gastric cancer cell lines

PURPOSE: Tetrandrine (Tet), a bis-benzylisoquinoline alkaloid that was isolated from the dried root of Hang-Fang-Chi (Stephania tetrandra S. Moore), is well known as processing a marked antitumor effect in vitro and in vivo. The aim of this study was to assess the interaction between tetrandrine and chemotherapeutic agents widely used in gastric cancer treatment, and to investigate the influence of tetrandrine on chemotherapeutic agent-associated gene expression and apoptosis. METHODS: Synergistic interaction on human gastric cancer BGC-823 and MKN-28 cells was evaluated using the combination index (CI) method. The double staining with both Annexin-V-FITC and PI was employed to distinguish the apoptotic cells from living cells. Expression of chemotherapeutic agent-associated genes, i.e., excision repair cross-complementing 1 (ERCC1), thymidylate synthase (TS), class III beta-tubulin (beta-tubulin III) and tau, of BGC-823 cells with or without tetrandrine treatment were measured by real-time quantitative PCR. RESULTS: Tetrandrine had a synergistic effect on the cytotoxicity of chemotherapeutic agents in both two gastric cancer cell lines. The combination of tetrandrine and chemotherapeutic agents could also induce apoptosis in a synergistic manner. Tetrandrine could suppress the mRNA expression of ERCC1, TS, beta-tubulin III and tau. Most prominently, ERCC1, TS and beta-tubulin III mRNA levels were markedly suppressed at 0.29-, 0.12- and 0.60-fold, respectively, by the presentation of tetrandrine. CONCLUSION: Tetrandrine appears a promising candidate for combining with three chemotherapeutic agents. The possible mechanisms might be the synergistic apoptotic effect and the downregulation of chemotherapeutic agent-associated genes.     

抗菌药物联合中药单体对泛耐药鲍曼不动杆菌生物被膜的影响

摘要：目的 研究4种抗菌药物(亚胺培南、美罗培南、多黏菌素B和替加环素) 和3种中药单体(黄芩苷、盐酸小檗碱和槲皮素二水物)对泛耐药鲍曼不动杆菌(XDRAB)生物被膜形成能力的影响,并探讨以上组合用药对XDRAB的协同抗生物被膜效应。方法 收集2018-2019年成都医学院第一附属医院的不同科室的临床标本分离的9株XDRAB,采用比浊法测定4种抗菌药物、3种中药单体在1 MIC、1/2 MIC、1/4 MIC、1/8 MIC、1/16 MIC对9株XDRAB 24 h内的生长情况;结晶紫棋盘染色法检测工作浓度下亚胺培南、美罗培南、替加环素、多黏菌素B、黄芩苷、盐酸小檗碱和槲皮素二水物单用对生物被膜的抑制作用和组合联用的协同抗生物被膜效应。结果 亚胺培南(4 μg/mL)、美罗培南(2 μg/mL)、多黏菌素B(0.25 μg/mL)、替加环素(0.0625 μg/mL)、黄芩苷(128 μg/mL)、盐酸小檗碱(32 μg/mL)、槲皮素二水物(64 μg/mL)的浓度时24 h内不抑制细菌的生长,以此浓度为基础倍比稀释,设置高、中、低三个浓度梯度;与模型对照组相比,4种抗菌药物、3种中药单体、在高浓度下单用、联用均可以明显抑制XDRAB生物被膜的形成(P＜0.05),联合用药效果均优于单独用药(P＜0.05),表现为不同程度的协同抗生物被膜作用,其中替加环素与黄芩苷的9个浓度组合均能够显著抑制XDRAB生物被膜的形成,0.015625 μg/mL替加环素与32 μg/mL黄芩苷与的浓度组合下,药物剂量最小。结论 4种抗菌药物亚胺培南、美罗培南、多黏菌素B、替加环素,3种中药单体黄芩苷、槲皮素二水物、盐酸小檗碱单用及联用时对XDRAB的生物被膜形成均具有不同程度的抑制作用,联合用药均表现为不同程度的协同抗生物被膜效应。     

Creating a synergy effect: A cluster randomized controlled trial testing the effect of a tailored multimedia intervention on patient outcomes

Objective

Improving adherence is a challenge and multiple barriers are likely to explain non-adherence. These barriers differ per patient and over course of the regimen. Hence, personalized interventions tailored to the specific barriers are needed. In a theoretical and evidence-based Tailored Multimedia Intervention, technology (online preparatory assessment, text messaging) was used as an add-on to a tailored counseling session (learned during a communication skills training), with the expectation of synergistic effects.

依托咪酯复合丙泊酚在门诊无痛人流术中的临床观察

目的 分析依托咪酯复合丙泊酚在门诊无痛人流术中的临床效果.方法 选择我院2013年1～10月接受无痛人流手术的妇女300例作为研究对象,分别给予丙泊酚（A组）、依托咪酯乳剂（B组）、依托咪酯复合丙泊酚（C组）麻醉,比较三组妇女的生命体征平稳性、用药剂量、苏醒时间、恢复行走时间、不良反应等.结果 C组用药后MAP、HR、SPO2与基础值比较差异无统计学意义,A、B两组MAP值显著降低,A组用药后1min时SPO2明显低于基础值;C组用药剂量（81.2±18.6/7.2±4.2）mg、清醒时间（6.0±2.1）min、恢复行走时间（15.8±2.3）min明显低于A、B两组;不良反应明显低于A、B两组.结论 依托咪酯复合丙泊酚麻醉通过发挥协同作用,维持生命体征平稳性,减少用药剂量,降低不良反应.     

Broad-spectrum analgesic efficacy of IBNtxA is mediated by exon 11-associated splice variants of the mu-opioid receptor gene

μ-Opioids remain vastly important for the treatment of pain, and would represent ideal analgesics if their analgesic effects could be separated from their many side effects. A recently synthesized compound, iodobenzoylnaltrexamide (IBNtxA), acting at 6-transmembrane (6-TM) splice variants of the μ-opioid receptor gene, was shown to have potent analgesic actions against acute, thermal pain accompanied by a vastly improved side-effect profile compared to 7-TM-acting drugs such as morphine. Whether such analgesia can be seen in longer-lasting and nonthermal algesiometric assays is not known. The current study demonstrates potent and efficacious IBNtxA inhibition of a wide variety of assays, including inflammatory and neuropathic hypersensitivity and spontaneous pain. We further demonstrate the dependence of such analgesia on 6-TM μ-opioid receptor variants using isobolographic analysis and the testing of Oprm1 (the μ-opioid receptor gene) exon 11 null mutant mice. Finally, the effect of nerve damage (spared nerve injury) and inflammatory injury (complete Freund’s adjuvant) on expression of μ-opioid receptor variant genes in pain-relevant central nervous system loci was examined, revealing a downregulation of the mMOR-1D splice variant in the dorsal root ganglion after spared nerve injury. These findings are supportive of the potential value of 6-TM-acting drugs as novel analgesics.     

超声辐照血卟啉单甲醚和声诺维协同杀伤MDA-MB-231细胞的实验研究

目的探讨超声辐照中血卟啉单甲醚(HMME)和声诺维(SonoVue)杀伤人乳腺癌细胞株MDA-MB-231细胞的协同作用。方法将处于对数生长期的MDA-MB-231细胞分为8组(M组、H组、H+M组、U组、U+M组、U+H组、U+H+M组和对照组)。采用优化后的实验参数,以50Hz脉冲波照射60s,以MTT法检测照射后的MDA-MB-231细胞存活率,观察细胞形态学改变。结果 M组、H组、H+M组、U组、U+M组、U+H组、U+H+M组及对照组中MDA-MB-231细胞存活率分别为(91.90±1.41)%、(95.28±3.30)%、(90.76±4.01)%、(77.59±1.52)%、(52.12±2.90)%、(46.72±1.35)%、(31.47±1.48)%和(99.95±0.66)%。U+H+M组细胞存活率与其他各组差异均有统计学意义(P均<0.01)。结论超声辐照时,SonoVue和HMME能够相互协同杀伤MDA-MB-231细胞。     

Implantation of the Synergy Pulse Generator in the Gluteal Area: Surgical Technique

We describe a technique for the safe and aesthetically pleasing implantation of the Synergy pulse generator in the posterior iliac region for spinal cord stimulation. The technique can be applied to both thin and obese patients.     

Synergy of the human spine in neutral postures

The neutral position of the spine is the posture most commonly sustained throughout daily activities. Previous investigations of the spine focused mainly on maximal exertions in various symmetric and asymmetric postures. This report proposes a new synergetic approach for analysis of the spine in neutral postures and evaluates its performance. The model consists of passive components, the osteoligamentous spine, and active components, the spinal muscles. The muscle architecture includes 60 muscles inserting onto both the rib cage and lumbar vertebral bodies. The passive spine is simulated by a finite element model, while kinematic constraints and optimization are used for resolution of a redundant muscle recruitment problem. Although the passive spine alone exhibits little resistance to a vertical load, its load-bearing capacity in neutral posture is significantly enhanced by the muscles, i.e., the passive spine and its muscles must be considered as a synergetic system. The proposed method is used to investigate the response of the spine when the T1 vertebra displaces 40 mm anteriorly and 20 mm posteriorly from its initial position. The sacrum is fixed at all times and the T1 displacements are achieved by the action of muscles. The results suggest that relatively small muscle activations are sufficient to stabilize the spine in neutral posture under the body weight. The results also indicate that muscles attaching onto the rib cage are important for control of the overall spinal posture and maintenance of equilibrium. The muscles inserting onto the lumbar vertebrae are found mainly to enhance the stability of the spine. The proposed method also predicts forces and moments carried by the passive system. Flexion moments ranging from 8000 Nmm to 15,000 Nmm, corresponding to decreases in lordosis of 6° and 7.5° respectively, are found to be carried by the passive spine at the thoracolumbar junction when the T1 vertebra is 40 mm anterior to its initial position. Received: 7 October 1997 Revised: 8 May 1998 Accepted: 25 May 1998