Relative impact of earlier diagnosis and improved treatment on survival for colorectal cancer: A US database study among elderly patients

PurposesTo estimate what proportion of improvement in relative survival was attributable to smaller stage/size due to early detection and what proportion was attributable to cancer chemotherapy in patients with colorectal cancer (CRC).MethodsWe studied 69,718 patients with CRC aged ≥66 years in 1992–2009 from Surveillance, Epidemiology, and End Results registries. Study periods were categorized into three periods according to the major changes or advances in screening and chemotherapy regimens: (1) Period-1 (1992–1995), during which there was no evidence-based recommendation for routine CRC screening and 5-fluorouracil was the mainstay for chemotherapy; (2) Period-2 (1996–2000), during which evidences and guidelines supported the use of fecal occult blood test (FOBT) and sigmoidoscopy for routine CRC screening; and (3) Period-3 (2001–2009), during which Medicare Program added the full coverage for colonoscopy screening to average-risk individuals, and several newly developed chemotherapy regimens were approved. Outcome variables included the likelihood of being diagnosed at an early stage or with a small tumor size, and improvement in relative survival.ResultsCompared to period-1, likelihood of being diagnosed with early stage CRC increased by 20% in period-2 (odds ratio = 1.2, 95%CI: 1.1–1.2) and 30% in period-3 (1.3, 1.2–1.4); and likelihood of being diagnosed with small-size CRC increased by 60% in period-2 and 110% in period-3. Similarly, 5-year overall relative survival increased from 51% in period-1 to 56% in period-2 and 60% in period-3. Increase in survival attributable to migration in stage/size was 9% in period-2 and 20% in period-3, while the remaining survival improvement during period-2 and period-3 were largely attributable to more effective chemotherapy regimens (≥71.6%) and other treatment factors (≤25%).ConclusionsImprovements in CRC screening resulted in a migration of CRC toward earlier tumor stage and smaller size, which contributed to ≤20% of survival increase. Survival improvement over the past 2 decades was largely explained by more effective chemotherapy regimens (≥71.6%).     

α-硫辛酸对2型糖尿病早期肾病的保护作用研究

目的：探讨注射用α-硫辛酸对2型糖尿病早期肾病（DN）的保护作用。方法：将56例2型糖尿病早期肾病患者随机分为治疗组28例,采用注射α-硫辛酸加常规治疗;对照组28例,仅给予常规治疗。治疗前后测定尿微量白蛋白排泄率（UAER）、超氧化物歧化酶（SOD）、／丙二醛（MDA）、一氧化氮（NO）水平。结果：与治疗前比较,治疗组UAER及MDA均显著降低（P〈0．05）,SCr、SOD及NO显著升高（P〈0．05）。对照组SCr、UAER、SOD、MDA及NO与治疗前比较差异无统计学意义（P〉0．05）。结论：注射用α-硫辛酸能减少2型糖尿病肾病患者尿微量白蛋白的排泄,对早期肾病具有保护作用。     

肺炎支原体感染的研究进展

肺炎支原体是引起呼吸道感染的常见病原体之一。近年来,肺炎支原体感染的发病率呈逐年增长趋势。肺炎支原体是介于病毒和细菌之间的原核生物,传播途径是呼吸道飞沫或气溶胶。感染该疾病后主要表现为上呼吸道感染、鼻咽炎、支气管炎、肺炎及严重的肺外并发症,如免疫性溶血性贫血、脑膜脑炎、心肌炎、心包炎、肾炎,严重感染者甚至可导致死亡。肺炎支原体有很强的传染性,经常在儿童集居地及家庭成员中交叉感染,导致久治不愈。对支原体肺炎进行早期诊断不仅可以避免并发症的发生率,也可遏制其继续传播。本文就肺炎支原体感染的致病机制及检测方法的研究,探讨了其对于支原体肺炎的早期诊断和病程监测的意义,将研究现状及展望作一综述。     

早期大剂量乌司他丁治疗急性肺挫伤的疗效观察

目的：探讨早期大剂量乌司他丁治疗急性肺挫伤的临床疗效。方法：选择102例在湖南中医药大学第一附属医院胸外科治疗的急性肺挫伤患者,随机分为A组（对照组）、B组（常规剂量组）和C组（大剂量组）,每组各34例。A组患者给予常规治疗;B组在对照组治疗基础上给予乌司他丁10万单位加入0．9％氯化钠100mL静脉滴注,每8h1次,连用7d;C组在对照组治疗基础上给予乌司他丁40万单位加入0．9％氯化钠100mL静脉滴注,每8h1次,连用7d。分别测定和比较3组患者在治疗前、治疗第1天、治疗第4天、治疗第7天的动脉血氧分压（PaO2）、动脉二氧化碳分压（PaCO2）、氧合指数（PaO2／FiO2、血清肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）的水平以及治疗期间3组患者急性呼吸窘迫综合征（ARDS）T2．肺部感染的发生率。结果：治疗后,B组的PaO2水平在第7天较A组升高,C组的PaO2水平在第1、4、7天较A组均有升高,在第1、4天较B组亦有升高（P〈0．05）;B、C两组PaCO：水平在第4天较A组均有升高（P〈0．05）;B组的PaO2／FiO2水平在第7天较A组升高,C组的PaO/FiO2水平在第4、7天较A、B两组均有升高（P〈0.05）。B组的TNF—α水平在第7天较A组降低,C组的TNF-α水平在第4、7天较A组降低,在第4天较B组降低（P〈0．05）;B组的IL-6水平在第7天较A组降低,C组的IL-6水平在第4、7天较A、B组均降低（P〈0．05）。各组ARDS及肺部感染的发生率比较无统计学差异（P〉0．05）。结论：早期大剂量乌司他丁对急性肺挫伤具有明显的临床疗效。     

MicroRNA在胃癌中的作用及研究进展

MicroRNA(miRNA)是一类含有18-25个核苷酸的小分子非编码RNA,通过与与其靶基因mRNA 3’-非编码区的碱基互补配对,降解靶基因mRNA导致转录后沉默或者抑制靶基因mRNA的翻译过程,影响细胞的增殖、分化、衰老和凋亡.研究显示部分microRNA在胃癌组织中确实存在表达异常,且异常表达的microRNA通过对其靶基因表达的调控影响胃癌的发生、发展及转移等过程.外周血中microRNA检测技术的发展使得microRNA应用于胃癌的临床诊疗具有了一定的可行性.众多研究提示microRNA在胃癌的演进中的作用可能作为胃癌早期诊断和疗效预测的生物标记物,本文就microRNA在胃癌中的作用及研究进展作一综述.     

Multichannel surface electrodes increase the sensitivity of diagnosis of neuropathy in diabetic patients

This prospective study investigated the diagnostic sensitivity of a novel multichannel surface electrode for detecting electrophysiologic changes in symptomatic diabetic neuropathy. We recruited healthy subjects without neuropathic complaints and diabetic patients with distal symmetric sensory symptoms who had normal nerve conduction studies (NCS). Eight compound muscle action potentials (CMAPs) were recorded using a multichannel electrode from each subject’s abductor pollicis brevis muscle by stimulating the median nerve at the wrist. Latency- and amplitude-related variables were obtained and analyzed to compare the two groups. We used the Classification and Regression Tree (CART) algorithm to determine the cut-off values for selected predictors of diabetic neuropathy. All of the variables related to CMAP latency showed statistically significant differences between the median values for the diabetic group and the healthy control group. For example, the median value of the maximum latency and standard deviation of the eight CMAP onset latencies in diabetic patients (3.82 ms and 0.15 ms, respectively) were significantly larger than those in controls (3.26 ms and p < 0.001; 0.09 ms and p < 0.001, respectively). The CART analysis revealed that these variables were the most sensitive and specific variables for discriminating between patients with diabetic neuropathy and normal subjects. The multichannel surface electrode demonstrated both high sensitivity and specificity in detecting neurophysiologic abnormality of diabetic neuropathy, even when conventional NCS did not detect the abnormality.     

Human serum albumin cysteinylation is increased in end stage renal disease patients and reduced by hemodialysis: mass spectrometry studies

Abstract

The aim of the present work was to monitor the covalent modifications of human serum albumin (HSA) in end stage renal diseases (ESRD) non-diabetic patients, before and after hemodialysis (HD), by direct infusion electrospray mass spectrometry (ESI-MS). Human serum samples were collected from healthy subjects (n = 10, 20–60 yr) and age-matched ESRD patients (n = 8) before and after HD, purified by affinity chromatography and analyzed by a triple-quadrupole mass spectrometer. The deconvoluted spectra from healthy subjects were all characterized by three peaks attributed to non-glycated mercaptoalbumin (HSA-SH) and to the corresponding adducts with cysteine (HSA-Cys) and glucose (HSA-Glc); relative contents: mercaptoalbumin in both glycated and non-glycated form, HSA-SHt (74 ± 6%), HSA-Cys (26 ± 5%) and HSA-Glc (24 ± 3%). HSA isolated from ESRD patients before HD was characterized by a significant reduction of HSA-SHt (42 ± 7%), and by a concomitant increase of the HSA-Cys adduct (58 ± 7%). Hemodialysis significantly reduced the cysteinylated form (37 ± 7%) and restored HSA-SHt (63 ± 8%) in all the ESRD patients. The mechanism of thiol oxidation and cysteinylation was then studied by mass spectrometry, using LQQCPF as a model peptide and H₂O₂ as an oxidizing agent.     

Dispersals as demographic processes: testing and describing the spread of the Neolithic in the Balkans

Although population history and dispersal are back at the forefront of the archaeological agenda, they are often studied in relative isolation. This contribution aims at combining both dimensions, as population dispersal is, by definition, a demographic process. Using a case study drawn from the Early Neolithic of South-Eastern Europe, we use radiocarbon dates to jointly investigate changes in speed and population size linked to the new food production economy and demonstrate that the spread of farming in this region corresponds to a density-dependent dispersal process. The implications of this characterization are evaluated in the discussion.This article is part of the theme issue ‘Cross-disciplinary approaches to prehistoric demography’.     

新疆准噶尔盆地早侏罗世掌鳞杉科植物化石 及古大气CO2浓度

植物化石气孔参数分析是目前恢复古大气二氧化碳浓度较为精准的方法之一,银杏类和松柏类等是恢复古大气CO_2浓度常用的化石类群。本文利用新疆准噶尔盆地下侏罗统三工河组的松柏类掌鳞杉科Brachyphyllum(Hirmeriella?)sp.化石对早侏罗世大气CO_2浓度进行了重建,获得早侏罗世大气CO_2浓度为～1200ppm,丰富了早侏罗世大气CO_2浓度信息,进一步说明掌鳞杉科植物通过气孔比率法在重建侏罗纪大气CO_2浓度方面的可靠性。掌鳞杉科植物的旱生构造和较高的大气CO_2浓度表明早侏罗世Toarcian期大洋缺氧事件在陆地生态系统内可能产生了一定的响应。