转化医学研究对恶性肿瘤转移浸润的探讨

恶性肿瘤治疗失败90％的原因是由于治疗后转移复发。Paget早在1889年就提出了“种子与土壤”的学说：Ewing于1928年又提出了肿瘤转移的“流体动力学”的学术观点：均为肿瘤转移相关的基本理论。分子生物学技术的不断发展和转化医学研究的逐渐深入,为临床研究提供了可供筛检、易致肿瘤转移复发的“种子”——肿瘤干细胞或具干性细胞。近些年对肿瘤细胞产生的外排囊泡（tumor derived exosome）的研究,提出了形成前转移壁龛（premetastatic niche）及转移的趋向性的概念。建立了识别这类外排囊泡的方法,均为临床筛检、临床预测与个体诊治提供了可行的手段,并已有临床的报道,是转化医学研究领域进一步干预阻断肿瘤复发转移的新课题。     

急诊绿色通道护理对创伤性膈疝患者救治成功率的影响

目的探究急诊绿色通道护理对创伤性膈疝患者就治成功率的影响。 方法回顾性分析2015年11月至2019年5月,南京医科大学第一附属医院收治的40例创伤性膈疝患者。按急诊护理方法的不同分为对照组和观察组,各20例。对照组行常规护理,观察组行急诊绿色通道护理。分析2组急诊相关指标、术后康复指标,2组护理后1个月的复发率、救治成功率及并发症发生率。采用SPSS 20.0统计软件进行数据分析。 结果与对照组比较,观察组急诊科抢救时间、辅助检查时间、从救治到送入手术室时间、术后机械通气时间均缩短,术后24 h动脉血二氧化碳分压（PaCO₂）水平低于对照组,差异均有统计学意义（均P<0.05）;护理后观察组和对照组的复发率分别为5.00%、25.00%,救治成功率分别为100.00%、90.00%,差异无统计学意义（P>0.05）;护理后观察组并发症总发生率（10.00%）显著低于对照组（45.00%）,差异有统计学意义（P<0.05）。 结论急诊绿色通道护理缩短了创伤性膈疝患者的抢救时间,使患者尽早脱离危险,减少创伤性膈疝患者并发症发生率,可有效改善患者预后。     

肾移植术后人类微小病毒B19感染致纯红细胞再生障碍性贫血2例并文献复习

目的探讨肾移植术后人类微小病毒(HPV)B19感染致纯红细胞再生障碍性贫血(纯红再障)的诊断和治疗特点。方法总结南方医科大学南方医院器官移植科收治的2例肾移植术后HPV B19感染致纯红再障的病例,结合文献复习讨论该病的临床特点、诊断方法、治疗过程及预后。结果两例肾移植受者术后早发严重贫血且进行性加重,输血治疗无效。排除导致贫血的其他原因,综合骨髓穿刺活检、荧光聚合酶链反应(PCR)检测HPV DNA等方法诊断为HPV B19感染致纯红再障。经调整免疫抑制方案、静脉注射用免疫球蛋白(IVIG)等治疗后2例患者贫血症状明显改善。结论对于肾移植术后早期不明原因、进行性加重的贫血患者,特别是伴随网织红细胞缺乏者,应考虑HPV B19感染致纯红再障的可能性。骨髓穿刺及荧光PCR检测结果是诊断纯红再障的主要依据,免疫抑制剂减量和应用IVIG治疗是主要治疗措施。经治疗后,患者预后较好,但易复发。     

良性阵发性位置性眩晕的复发影响因素分析

目的 探讨良性阵发性位置性眩晕（BPPV）复发的相关影响因素。 方法 搜集300例BPPV患者的相关资料,给予手法复位治疗后电话随访一年,将完成随访228例患者按照是否复发分为复发组60例和未复发组168例,并对2组患者的年龄、性别、发病部位、伴发基础疾病和生活相关因素情况进行比较,采用Logistic回归模型对BPPV复发的影响因素进行多因素分析。 结果 经单因素统计分析发现,过度劳累（P<0.01）,年龄≥45岁（P<0.01）、经常出差（P<0.01）、长期使用电脑（P=0.003）、有睡眠障碍（P=0.002）、口服钙片（P=0.002）及伴发后循环缺血（P=0.025）和高脂血症（P=0.004）与BPPV复发相关;二元Logistic回归分析发现年龄≥45岁（OR=10.20,P<0.01）、过度劳累（OR=2.612,P=0.006）、经常出差（OR=5.257,P=0.006）、长期使用电脑（OR=3.870,P=0.003）、有睡眠障碍（OR=2.612,P=0.039）、伴发后循环缺血（OR=3.411,P=0.043）或伴发高脂血症（OR=2.299,P=0.047）是BPPV复发的危险因素,而年龄≥45岁对患者复发的影响最大。 结论 年龄是BPPV患者复发的最大危险因素;而后循环缺血、高脂血症、过度劳累、睡眠障碍、长期使用电脑以及经常出差也是BPPV复发的危险因素。     

Endocannabinoid mechanism in amphetamine-type stimulant use disorders: A short review

Recent evidence shows that the endocannabinoid system is involved in amphetamine-type stimulants (ATS) use disorders. To elucidate the role of the endocannabinoid system in ATS addiction, we reviewed results of studies using cannabinoid receptor agonists, antagonists as well as knockout model. The endocannabinoid system seems to play a role in reinstatement and relapse of ATS addiction and ATS-induced psychiatric symptoms. The molecular mechanisms of this system remains unclear, the association with dopamine system in nucleus accumbens is most likely involved. However, the function of the endocannabinoid system in anxiety and anti-anxiety effects induced by ATS is more complicated. These findings suggest that the endocannabinoid system may play an important role in the mechanism of ATS addiction and provide new idea for treating ATS addiction.     

认知反应和认知功能失调预测重度抑郁症复发的可行性分析

目的：评价认知反应和认知功能失调对重度抑郁症(MDD)复发的预测效能.方法选择2009年2月~2013年3月在我院就诊的 MDD 缓解期患者32例,根据随访3年内 MDD 是否复发分为复发组(20例)和未复发组(12例),分别采用莱顿抑郁敏感性量表(LEIDS)和功能失调性状况评定量表(DAS)评价两组患者的认知反应和认知功能失调,分析 LEIDS 和 DAS 对 MDD 复发的预测能力.结果 MDD 复发组 LEIDS 总分、精神淡漠、沉思维度高于未复发组(P ＜0．05),而两组人口学资料、DAS 评分、LEIDS 负面的自我评价、风险逃避、接受及处理能力维度组间比较差异无统计学意义(P ＞0.05);Logistic 回归分析结果表明 LEIDS 总分、精神淡漠、沉思3个因素均为 MDD 复发的独立危险因素(P ＜0．05);LEIDS 总分37分为 MDD 复发的最佳诊断界点,ROC 曲线下面积(AUC)＝0．710(95％ CI ＝0．522~0．899,S ．E ．＝0．096,P ＝0．039),敏感性为85．00％,特异性为66．70％.结论认知功能失调与MDD 复发无明显相关性,而认知反应有可靠的预测效能,但更合理的认知反应评价和诱导方法需要进一步研究.     

Disease Reactivation after Fingolimod Discontinuation in Pregnant Multiple Sclerosis Patients

Recent studies estimated an incidence of 4–25% of disease rebound after withdrawal of fingolimod (FTY) for any reason, but specific data on disease reactivation after FTY withdrawal due to pregnancy are limited. The aim of the study was to evaluate the frequency and predictors of disease reactivation in patients who stopped FTY for pregnancy. A multicentre retrospective cohort study was conducted in four Italian MS centres in 2013–2019. Both planned and unplanned pregnancies were included. The annualized relapse rate (ARR) was calculated before FTY treatment, during FTY treatment, during pregnancy and during the year after delivery. In total, 27 patients (mean age 29 years) were included. The ARR 1 year before FTY treatment was 1.3. Patients were exposed to FTY for a median of 2.9 years. The ARR was 0.04 during the last year before conception (p < 0.001 compared with the ARR before FTY treatment). Eleven patients became pregnant after a mean of 88 days following FTY discontinuation, whereas 16 patients stopped FTY after pregnancy confirmation. Relapses were observed in 22% of patients during pregnancy and in 44% in the postpartum period. ARR increased both during pregnancy (0.49; p = 0.027) and in the first year after delivery (0.67; p < 0.001) compared to the last year before pregnancy. Compared with radiological assessment before pregnancy, more patients showed new or enlarging T2 lesions (63% vs 30%; p = 0.02) and gadolinium-enhancing lesions (44% vs 0; p = 0.0001) on brain Magnetic Resonance Imaging. Relapses during pregnancy were the only significant predictor for postpartum relapses (OR 1.9, 95% CI 1.11–3.1). One case of spontaneous abortion and no cases of abnormal foetal development were observed. Despite adequate and prolonged control of disease activity, women who discontinue FTY because of pregnancy are at risk for disease reactivation. In patients who relapsed during pregnancy, the initiation of high-efficacy disease modifying drugs (DMDs) soon after delivery is advisable to prevent postpartum relapses.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13311-021-01106-6.     

Extended-release venlafaxine in relapse prevention for patients with major depressive disorder

Many studies have demonstrated that venlafaxine is an efficacious and safe treatment for major depressive disorder (MDD). This double-blind, placebo-controlled study was performed to evaluate the efficacy of venlafaxine extended-release (XR) (75-225 mg/day) in the prevention of relapse of depression. Patients with MDD who responded to an 8-week course of venlafaxine XR treatment, i.e., had a score < or = 3 on the Clinical Global Impressions scale-Severity of Illness item (CGI-S) and a 21-item Hamilton Rating Scale for Depression (HAM-D(21)) score < or = 10, were randomly assigned to receive continuation treatment (up to 6 months) with venlafaxine XR (n=161) or placebo (n=157). The main efficacy outcome measure was the number of patients who experienced a relapse of depression. Relapse was defined by either a combination of a patient meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for MDD and a CGI-S score > or = 4, two consecutive CGI-S scores > or = 4, or a final CGI-S score > or = 4 for a patient who withdrew from the study. The cumulative probability of relapse was calculated using the Kaplan-Meier method of survival analysis. During the 6-month evaluation period, significantly more patients in the placebo group had a relapse of MDD than did patients who continued treatment with venlafaxine XR. Cumulative relapse rates at 3 and 6 months were 19 and 28%, respectively, for venlafaxine XR, and 44 and 52%, respectively, for placebo. This study demonstrates that venlafaxine XR is an effective and safe continuation therapy.     

Two-year remission and subsequent relapse in children with newly diagnosed epilepsy

PURPOSE: Although remission is the ultimate measure of seizure control in epilepsy, and epilepsy syndrome should largely determine this outcome, little is known about the relative importance of syndrome versus other factors traditionally examined as predictors of remission or of relapse after remission. The purpose of this study was to examine remission and relapse with respect to the epilepsy syndrome and other factors traditionally considered with respect to seizure outcome. METHODS: A prospectively identified cohort of 613 children with newly diagnosed epilepsy was assembled and is actively being followed to determine seizure outcomes. Epilepsy syndrome and etiology were classified at diagnosis and again 2 years later. Remission was defined as 2 years completely seizure-free, and relapse as the recurrence of seizures after remission. Multivariable analysis was performed with the Cox proportional hazards model. RESULTS: Five hundred ninety-four of the original 613 children were followed > or = 2 years (median follow-up, 5 years). Remission occurred in 442 (74%), of whom 107 (24%) relapsed. On multivariable analysis, idiopathic generalized syndromes and age at onset between 5 and 9 years were associated with a substantially increased remission rate, whereas remote symptomatic etiology, family history of epilepsy, seizure frequency, and slowing on the initial EEG were associated with a decreased likelihood of attaining remission. Young onset age (<1 year) and seizure type were not important after adjustment for these predictors. Relapses occurred more often in association with focal slowing on the initial EEG and with juvenile myoclonic epilepsy. Benign rolandic epilepsy and age at onset <1 year were associated with markedly lower risks of relapse. About one fourth of relapses were apparently spontaneous while the child was taking medication with good compliance, and more than half occurred in children who were tapering or had fully stopped medication. CONCLUSIONS: A large proportion of children with epilepsy remit. Symptomatic etiology, family history, EEG slowing, and initial seizure frequency negatively influence, and age 5-9 years and idiopathic generalized epilepsy positively influence the probability of entering remission. Factors that most influence relapse tend to be different from those that influence remission.