Integrating pharmacists into Aboriginal Community Controlled Health Services (IPAC project): Protocol for an interventional,non-randomised study to improve chronic disease outcomes

BackgroundAboriginal and Torres Strait Islander peoples experience a higher burden of chronic disease yet have poorer access to needed medicines than other Australians. Adverse health outcomes from these illnesses can be minimised with improved prescribing quality. This project aims to improve quality of care outcomes for Aboriginal and Torres Strait Islander adult patients with chronic disease by integrating a pharmacist within primary health care teams in Aboriginal Community Controlled Health Services (ACCHSs).MethodologyThis non-randomised, prospective, pre and post quasi-experimental study, will be pragmatic, community-based and participatory, comparing outcomes and costs using paired patient data. Pharmacists will be integrated at 22 sites for approximately 15 months to conduct patient-related and practice-related activities through 10 core roles: providing medication management reviews, assessing adherence and medication appropriateness, providing medicines information and education and training, collaborating with healthcare teams, delivering preventive care, liaising with stakeholders, providing trnsitional care, and undertaking a drug utilisation review. With patients’ consent, de-identified client-level data will be extracted from clinical information systems and pharmacists will record deidentified activity in an electronic logbook. Primary expected outcomes include improvements in biometric indices (glycated haemoglobin, systolic and diastolic blood pressure, lipids, cardiovascular risk, albumin-creatinine ratio) from baseline to end of study. Expected secondary outcomes include improvements in estimated glomerular filtration rate, prescribing indices (appropriateness, overuse and underuse), medication adherence, self-assessed health, and health service utilisation indices. A qualitative assessment of stakeholder and patient perceptions and a cost-effectiveness analysis will be undertaken.DiscussionNumerous inquiries have recommended evaluating the impact of pharmacists integrated within primary health care settings. This study is the first to explore this impact on the health of Aboriginal and Torres Strait Islander peoples who are medically underserved. Evaluation of innovative integrated workforce models is necessary to address the challenges of delivering quality care together with this population.     

Relationships between increased circulating YKL-40, IL-6 and TNF-α levels and phenotypes and disease activity of primary Sjögren's syndrome

BackgroundThere is now no single score or marker useful for evaluating disease activity of primary Sjögren's syndrome (pSS). This study was designed to explore the associations of circulating YKL-40, interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) with systemic activity and phenotypes of pSS.MethodsThis study included 58 pSS patients and 30 healthy controls (HC). The sera were measured by multiplex immunoassay for YKL-40, IL-6 and TNF-α concentrations. The disease activity of pSS patients was evaluated by European league against rheumatism (EULAR) SS disease activity index (ESSDAI). Local severity was assessed in accordance with the Tarpley score.ResultsSerum YKL-40, IL-6 and TNF-α levels significantly elevated in pSS patients compared with those in HC (all P < 0.001). These cytokines correlated with ESSDAI, ESR, CRP, and IgG (all P < 0.05). Serum YKL-40 level correlated markedly with age (r = 0.405, P = 0.002), neutrophil count (r = 0.399, P = 0.002) and neutrophil-to-lymphocyte ratio (NLR) (r = 0.401, P = 0.002), while IL-6 did weakly with NLR (r = 0.296, P = 0.024) and C3 (r = 0.288, 0.036). Serum levels of all three cytokines were substantially lower in patients with eye/mouth dryness vs. those without (all P < 0.05). Additionally, patients with pulmonary, renal involvement or anemia had remarkably higher concentrations of YKL-40 (all P < 0.05), while those with leukocytopenia had lower levels (P = 0.01). Fever or anemia patients showed higher serum concentrations of IL-6 (both P < 0.05), while serum levels of TNF-α were much higher in patients with presence of ANA, anti-SSA or anti-SSB antibodies (All P < 0.05). Serum IL-6 level correlated strongly with YKL-40 (r = 0.452, P < 0.001) and TNF-α (r = 0.743, P < 0.001) in pSS patients. A significant correlation was also found between YKL-40 and TNF-α (r = 0.308, P = 0.022) .ConclusionThe circulating YKL-40, IL-6 and TNF-α levels increase in pSS, and all of them are significantly correlated with indicators (ESSDAI, ESR, CRP, and IgG) for systemic inflammation of pSS. Each cytokine is separately associated with specific pSS phenotype.     

MRI对原发性中枢神经系统淋巴瘤的诊断价值探讨

目的探讨磁共振成像(MRI)对原发性中枢神经系统淋巴瘤(PCNSL)的诊断价值。方法 50例疑似原发性中枢神经系统淋巴瘤患者,随机分为对照组与研究组,各25例。对照组患者接受CT检查,研究组患者接受MRI检查。分析所有患者的手术病理结果;对比两组患者对病灶的检测准确率。结果 50例患者均接受手术病理确诊,对照组患者中有64个病灶,边界清晰的38个,边界较为清晰的19个,边界模糊不清的7个;所有病灶均未出现出血以及钙化,仅有18个病灶周围未见水肿;研究组患者中有73个病灶,边界清晰的43个,边界较为清晰的21个,边界模糊不清的9个;所有病灶均未出现出血以及钙化,仅有20个病灶周围未见水肿。研究组患者的病灶、边界清晰、边界较为清晰、病灶周围未见水肿的检测准确率分别为95.89%、95.35%、95.24%、95.00%,均高于对照组的73.44%、78.95%、63.16%、55.56%,差异有统计学意义(P<0.05);研究组边界模糊不清的检测准确率为100.00%,与对照组的71.43%比较,差异无统计学意义(P>0.05)。结论原发性中枢神经系统淋巴瘤采用进行MRI诊断,结合患者的个体情况,可对于确诊原发性中枢神经系统淋巴瘤有一定的提示作用,同时MRI还能探查到患者的病灶具体情况,为患者临床治疗方案提供参考依据,该诊断方式值得推广。     

Novel long noncoding RNA LINC02323 promotes cell growth and migration of ovarian cancer via TGF‐β receptor 1 by miR‐1343‐3p

BackgroundThis study was aimed at investigating the effects of long noncoding RNA (lncRNA) LINC02323 in ovarian cancer and its possible mechanism.MethodsMicroarray analysis and QPCR were utilized to identify lncRNA LINC02323 expression in patients with ovarian cancer. MTT assay was used for analysis of ovarian cancer cell proliferation. Western blot was utilized to investigate its possible mechanism.ResultsIn patients with ovarian cancer, lncRNA LINC02323 expression was up‐regulated and miR‐1343‐3p expression was down‐regulated. Over‐expression of lncRNA LINC02323 promoted cell growth and reduced LDH activity levels in vitro model by suppression of miR‐1343‐3p expression. Down‐regulation of lncRNA LINC02323 reduced cell growth and increased LDH activity levels in vitro model by induction of miR‐1343‐3p expression. Over‐expression of miR‐1343‐3p reduced cell growth and reduced LDH activity levels in vitro model by suppression of TGF‐β receptor. Down‐regulation of miR‐1343‐3p promoted cell growth and reduced LDH activity levels in vitro model by induced of TGF‐β receptor.ConclusionOur findings show that Novel long noncoding RNA LINC02323 promotes cell growth of ovarian cancer via TGF‐β receptor 1 by miR‐1343‐3p.     

基于类芬顿反应构建磁性纳米粒治疗卵巢癌:体外实验

目的 构建具有类芬顿反应性能的磁性靶向纳米粒,评价其体外光声成像效果及联合催化反应下抑制卵巢癌细胞的作用。方法 以双乳化法制备包裹四氧化三铁（Fe₃O₄）及葡萄糖氧化酶（GOx）的磁性聚乳酸羟基乙酸共聚物（PLGA）纳米粒Fe₃O₄@PLGA-GOx,观察其基本特性、体外稳定性及释药效果;采用酶标仪监测其联合催化活性,以共聚焦显微镜观察细胞摄取纳米粒能力;以荧光显微镜和流式细胞术观察纳米粒在联合催化作用下产生细胞毒性活性氧的能力;用细胞计数试剂盒（CCK-8）检测磁性Fe₃O₄@PLGA-GOx体外杀伤人卵巢癌SKOV3细胞的能力,并评价其体外光声成像效果。结果 成功制备出磁性纳米粒Fe₃O₄@PLGA-GOx,平均粒径（290.81±108.52）nm,表面电位（－18.41±5.90）mV;Fe₃O₄及GOx的包封率分别为（91.34±2.35）%和（26.53±6.72）%。外部磁场作用下,细胞对纳米粒摄取增加;随纳米粒浓度增加,光声信号增强。Fe₃O₄@PLGA-GOx可介导类芬顿反应,产生活性氧并发挥细胞毒性作用杀伤肿瘤细胞。结论 成功制备的具有类芬顿反应性能磁性纳米粒在光声成像引导下具有体外催化治疗肿瘤细胞作用。     

“Follow the Fallopian tube”: A technique to improve sonographic identification of ovaries in children

Ovary detection is the first step in confirming ovarian lesions. The daughter cyst sign is widely used for this purpose; however, it is not always applicable. Recent improvements in image resolution allow Fallopian tube delineation, which can serve as a guide to identify the ovary. This anatomical approach (“follow the Fallopian tube” technique) comprises three steps: (1) confirm the uterus; (2) follow the Fallopian tube; and (3) find the ovary. Other applications of this approach include the differentiation between nonovarian and ovarian masses and ruling out ovarian torsion and an auto‐amputated ovary.     

体质量管理对肥胖型多囊卵巢综合征女性的内分泌激素水平和辅助生育结局的影响

目的 探讨体质量管理对肥胖型多囊卵巢综合征（PCOS）不孕症女性的内分泌激素水平和辅助生育结局的影响。方法 收集62例进行辅助生殖技术（ART）治疗的肥胖型PCOS不孕症患者的临床资料,选择接受常规辅助生育治疗的28例患者为对照组,在常规辅助生育治疗的基础上接受定期体质量管理的34例患者为体质量管理组。比较2组患者的内分泌激素水平和辅助生育结局。结果 减重后,体质量管理组肥胖型PCOS患者的体质量、BMI、体脂、腰臀均较减重前以及对照组降低（P均< 0.05）。减重后,体质量管理组肥胖型PCOS患者的空腹胰岛素[（13.2 ± 4.2）mU/L]均较减重前[（21.5 ± 6.1）mU/L]以及对照组[（20.3 ± 5.8）mU/L]降低（P < 0.001）。体质量管理组的人工授精累积临床妊娠率（25% vs. 13%）和首次胚胎移植后的临床妊娠率（61% vs. 39%）略高于对照组,但组间比较差异均无统计学意义（P均> 0.05）。结论 体质量管理可以有效降低肥胖型PCOS不孕症患者的BMI、空腹胰岛素水平,可能潜在地改善其辅助生育的妊娠结局。