Treatment algorithm in 2014 for advanced non-small cell lung cancer: Therapy selection by tumour histology and molecular biology

The availability of antineoplastic monoclonal antibodies, small molecules and newer cytotoxics such as pemetrexed, the EGFR-tyrosine kinase inhibitors erlotinib, gefitinib, afatinib as well as the anti-angiogenic bevacizumab and the ALK-inhibitor crizotinib has recently changes the treatment algorithm of advanced non-small cell lung cancer.Decision making in 2014 is characterized by customizing therapy, by selecting a specific therapeutic regimen based on the histotype and the genotype of the tumour. This refers to first-line induction therapy and maintenance therapy as well, but also to subsequent lines of therapy since anti-neoplastic drugs and regimens used upfront clinically influence the selection of agents/regimes considered for second-/third-line treatment. Consequently, therapy customization through tumour histology and molecular markers has significantly influenced the work of pathologists around the globe and the process of obtaining an extended therapeutically relevant tumour diagnosis. Not only histological sub-typing became standard but molecular information is also considered of increasing importance for treatment selection. Routine molecular testing in certified laboratories must be established, and the diagnostic process should ideally be performed under the guidance of evidence based recommendation. The process of investigating and implementing medical targeting in lung cancer therefore, requires advanced diagnostic techniques and expertise and because of its large dimension is costly and influenced by the limitation of financial and clinical resources.     

HCV耐药突变在三个Ⅰb期临床试验中对DAA单药给药后短期疗效影响的分析

耐药相关突变(Resistance-associated substitutions,RASs)是丙型肝炎病毒(Hepatitis C virus,HCV)治疗的关键因素,并与一些直接抗病毒药物(Direct acting antivirals,DAAs)为基础的治疗方案的治疗结果相关.在本研究中,我们主要分析了三个Ⅰ...     

铜绿假单胞菌生物被膜形成能力与基因型的相关性分析

目的 探讨铜绿假单胞菌（PA）临床分离株的粘附性、生物被膜形成能力及其与基因型的相关性。方法 采用改良的微量平板法对临床分离的48株PA生物被膜的形成进行定量分析;通过肠杆菌基因间重复一致序列-PCR（ERIC—PCR）技术绘制48株PA的指纹图谱,应用计算机软件建立遗传相似性系数矩阵及聚类分析树状图。结果 48株临床分离PA菌株生物被膜的形成能力不同。生物被膜形成能力不同的PA在基因型上表现出多态性,PA在17％遗传相似性系数上分为A、B、C、D、E五个基因型,生物被膜形成能力强的PA大都属于D型,其遗传相似性系数为42％。结论 绝大多数临床分离的PA株具有较强的生物被膜形成能力;生物被膜形成能力不同的PA在基因型上表现出多态性;生物被膜形成能力较强的PA在基因型上表现出一定的相似性。     

人乳头状瘤病毒亚型PCR/RDB基因分析方法的建立及初步评价

目的建立一种基于PCR和RDB技术的临床实用、价格低廉、能对目前已知的绝大多数高危型及常见的低危型人乳头状瘤病毒(HPV)进行基因分型的检测方法(PCR/RDB法),并对该方法用于HPV分型检测做出方法学评价。方法根据HPV基因序列设计可扩增包含目前常见的HPV型别的通用引物,并根据14种HPV高危亚型(16、18、31、33、35、39、45、51、52、56、58、59、66、68)和7种低危亚型(6、11、42、43、44、53、CP8304)的序列特点设计针对这21种HPV型别的型特异性探针。21种HPV亚型标准毒株PCR产物与HPV型特异性探针进行杂交,建立一次性对21种HPV亚型进行分型的PCR/RDB检测方法。将PCR/RDB法用于213例经杂交捕获法(hybird capture,HCⅡ)检测为高危型HPV阳性样本的HPV型别诊断。结果建立的PCR/RDB法均能鉴定出21种HPV亚型,无假阳性和假阴性结果,未出现交叉反应;含有相当于10个以上HPV分子的质粒标准品均能成功获得PCR产物检测的阳性结果;盲法分析结果显示,195例经HCⅡ法检测为高危型HPV阳性的样品被PCR/RDB检测出具体的HPV型别,共检测出13种高危型HPV亚型,检出率分别是32.31%(16型)、23.08%(52型)、17.95%(58型)、11.79%(31型)、10.26%(68型)、9.74%(33型)、8.21%(18型)、6.15%(66型)、3.08%(59型)、2.05%(45型)、2.05%(39型)、1.54%(56型)、1.03%(51型)。单一HPV亚型感染及2种、3种和4种HPV亚型混合感染构成比分别为59.46%、30.81%、8.65%和1.08%。18例未能检测出HPV的具体型别,PCR/RDB法与HCⅡ法的高危型HPV检测结果的符合率为91.5%(195/213)。结论PCR/RDB法与HCⅡ法高危型HPV检测阳性符合率高,并可一次性分析出21种HPV型别,是一种准确、高效、经济的HPV型别检测方法,可用于HPV的常规基因型分型诊断及人群筛查。     

利用基因参照品图谱分析克拉玛依地区HBV基因型

目的了解克拉玛依地区HBV基因型分布状况,比较其与GenBank HBV序列同源性以及进化树分析。方法通过对S基因区B、C、D型GenBank序列分析,研究MboⅠ酶和EarⅠ酶在不同型中具有独特的切点,利用限制性片段多态性分析(PCR_RFLP)区分各型,将各个基因型与GenBank序列进行1∶1同源性比对的进化树分析。结果272份样品有241份成功分型。C型44.8%,B型36.9%,D型4.1%,B C型10.8%,B D型3.3%。少数民族C型40.4%,B型30.7%,D型9.6%。B、C、D型的同源性分别是97.8%~98.7%,96.9%~99.3%,97.5%~99.0%。进化树分析发现,克拉玛依地区的2例D型与新疆哈密地区D型进化距离最近。结论克拉玛依地区HBV基因型B、C、D均有,以B、C型占优势,未检测到A型,D型与新疆哈密地区D型有较近的亲缘关系。     

Arg399Gln XRCC1 Polymorphism and Risk of Squamous Cell Carcinoma of the Head and Neck in Jordanian Patients

Background and objective: X-ray repair cross-complementing group1 (XRCC1) is a key protein in base excision repair and closely associated with the coordination of the base excision repair pathway. Many studies have focused on XRCC1 SNPs and have shown an associated between these SNPs and the risk of several types of cancers, including head and neck cancer. There are many single nucleotide polymorphisms XRCC1 gene (SNPs) and the most common SNP that result in amino acid substitutions is exon 10 (Arg399Gln). This study aimed to investigate the association between Arg399Gln SNP and the risk of squamous cell carcinoma of the head and neck. Material and method: Ninety nine patients with squamous cell carcinomas of the head and neck and 89 healthy adult controls were enrolled in this study. The Arg399Gln in XRCC1 allele was genotyped using polymerase chain reaction-restriction fragment length polymorphism method. Results: In the single-locus analyses, Arg399Gln SNP showed a significant association with head and neck cancer risk (p value = 0.016 and odd ratio of 1.8). On the genotype level, we applied three analysis models, namely co-dominant, dominant, and recessive genotypes. Arg/Arg homozygous major genotype was significantly (p value <0.05) associated with head and neck squamous cell carcinoma incidence with odd ratio of 2.23 and 2.24 for the co-dominant and recessive models, respectively. Conclusion: The findings indicated that Arg399Gln allele was associated with squamous cell carcinoma of the head and neck among Jordanian patients. This allele might be used as a genetic biomarker of squamous cell carcinoma of the head and neck.     

Duration of Targeted Therapy in Patients With Advanced Non–small-cell Lung Cancer Identified by Circulating Tumor DNA Analysis

BackgroundOutcomes of therapy targeting molecular driver alterations detected in advanced non–small-cell lung (NSCLC) using circulating tumor DNA (ctDNA) have not been widely reported in patients who are targeted therapy-naive.Patients and MethodsWe performed a multicenter retrospective review of patients with unresectable stage IIIB to IV NSCLC who received matched therapy after a targetable driver alteration was identified using a commercial ctDNA assay through usual clinical care. Eligible patients must not have received targeted therapy prior to ctDNA testing (prior chemotherapy or immunotherapy was permitted). Kaplan-Meier analysis was used to estimate the median duration of targeted therapy. Patients still on targeted therapy were censored at last follow-up.ResultsSeventy-six patients met inclusion criteria. The median age of diagnosis of NSCLC was 64.5 years (range, 31-87 years), 67% were female, 74% were never-smokers, and 97% had adenocarcinoma histology. Twenty-one (28%) patients received systemic treatment prior to targeted therapy, including chemotherapy (n = 17), immunotherapy (n = 5), and/or a biologic (n = 4). Thirty-three (43%) patients remain on targeted therapy at the time of data analysis. The median time on targeted therapy was similar to what has been reported for tissue-detected oncogenic driver mutations in the targeted therapy-naive setting.ConclusionsPatients with ctDNA-detected drivers had durable time on targeted therapy. These treatment outcomes data compliment previous studies that have shown enhanced targetable biomarker discovery rates and high tissue concordance of ctDNA testing when incorporated at initial diagnosis of NSCLC. Identification of NSCLC driver mutations using well-validated ctDNA assays can be used for clinical decision-making and targeted therapy assignment.     

深圳地区12960例地中海贫血筛查受检者的地中海贫血基因型分析

目的 探讨深圳地区地中海贫血基因型特征,及其罕见基因型碱基突变位点.方法 选择2014年5月至2015年10月于广东省深圳市第二人民医院拟行地中海贫血筛查的12 960例受检者为研究对象.研究对象纳入标准:①红细胞平均体积(MCV)＜80 fl的门诊及住院患者;②于本院行产前筛查的孕妇.排除标准:①不愿意参加本试验者;②已被确诊为其他血液系统疾病者.受试者先进行血常规MCV、血红蛋白(Hb)电泳和红细胞脆性检测的地中海贫血筛查试验,对筛查试验阳性(红细胞脆性＜70％)的患者,采用跨越断裂点PCR及反向斑点杂交(RDB)技术进行地中海贫血基因常见缺失型和点突变的基因型检测.对常见基因型检测不能确诊的患者,采用巢式PCR和PCR-直接测序(SBT)技术进行罕见基因型分析.本研究遵循的程序符合深圳市第二人民医院制定的伦理学标准,得到该委员会批准,并征得受试对象本人的知情同意,与之签署临床研究知情同意书.结果 12 960例受检者中,地中海贫血筛查试验阳性患者为2 194例,通过常见基因型检测,确诊1 019例为地中海贫血,检出率为46.4％.537例α地中海贫血患者中,以东南亚缺失型(--SEA/αα)比例最高,占66.1％(355/537),其次为α地中海贫血2(-α 3.7/αα)占15.6％(84/537),而基因型(αCS α/αCSα、αQS α/αQS α、αWS α/αWSα)和4种HbH病基因型(-α3.7/αQS ααQS、--SEA /αCS αCS、--SEA/αQS αQS、--SEA/αWS αWS)较为少见.α地中海贫血罕见基因型检出率为0.1％(3/2 194),包括2例HKαα/--SEA及1例HKαα/αα.在456例β地中海贫血患者中,β41-42(-TCTT)/β和β654(C＞T) /βA基因型检出率最高,分别为33.8％(154/456)和30.3％(138/456).在26例β复合α地中海贫血患者中,以β复合α地中海贫血1(--SEA/αα)基因型检出率最高(34.6％,9/26).β地中海贫血罕见基因型检出率为0.2％(4/2 194),包括2例β37G＞A),突变点为413 G＞A或405 G＞A,1例β88-93(-AGTG),突变点为557处出现杂合峰,1例β-88(C＞T),突变点为-88 C＞T.结论 深圳地区地中海贫血基因型有独特的分布特征,巢式PCR技术有助于发现HKαα/--SEA及HKαα/αα基因型.采用PCR-SBT技术能鉴定罕见地中海贫血基因型并发现新突变点.本研究结果为在深圳地区开展遗传咨询和产前诊断提供了参考数据.     

惠州地区亚甲基四氢叶酸还原酶基因多态性特征分析

目的 调查惠州地区人群中亚甲基四氢叶酸还原酶(MTHFR)基因C677T位点多态性的分布特征,为个体化指导育龄妇女增补叶酸及有效地降低新生儿出生缺陷风险提供科学依据.方法 收集2017年6月至2019年12月在产前诊断中心门诊就诊的育龄妇女、妊娠期夫妇的外周血样本765例.采用PCR-荧光探针法检测MTHFR基因C67...     

乙型肝炎病毒B、C基因与临床关系的探讨

[目的]探讨HBV基因型与肝脏组织学及其临床的关系。[方法]对在福州市传染病院就诊的114例慢性乙肝患者进行肝活检及病理组织学检查,乙肝"两对半"、HBV-DNA、ALT和AST检测,对其中的74例进行血清基因型检测。[结果]74例患者分别为B、C基因型(分别为38例与36例)。两组基因型比较:①在炎症分期及纤维化分级上差异无显著性;②在肝组织各部位纤维化程度的比较中,仅小叶内纤维化程度比较差异有显著性;③临床和病理诊断符合率类似;④HBV-DNA两型间差异有显著性;⑤ALT与AST两型间差异无显著性;⑥B与C型HBeAg阳性率类似。[结论]慢性乙肝B、C基因型的HBV-DNA差异有显著性,而肝脏组织学改变、ALT、AST和HBeAg的差异无显著性。