Therapy Dogs Improve Student Affect but Not Memory

ABSTRACT

While students are increasingly struggling with anxiety and depression, the effects of therapy dogs on student stress has only recently been explored. This study was conducted to investigate whether therapy dogs can improve student affect and to determine if these benefits extend to cognition in the form of enhanced ability to remember information. Forty-four college students were randomly assigned to interact with a therapy dog or not during both learning (session 1) and testing (session 2) in a paired-associates procedure. Arousal, stress, and mood were measured at the beginning and end of each session. As predicted, therapy dogs increased happiness and decreased stress and arousal. However, there was no difference in recognition memory for the paired associates between the therapy dog and control conditions. Mood was a significant predictor of memory, such that decreased happiness in session 2 predicted better recognition performance. These findings indicate that the benefits of therapy dogs are primarily affective and not cognitive.     

聚焦慢性淋巴细胞白血病治疗药物

过去的10 年，慢性淋巴细胞白血病（CLL）的治疗策略已发生变化，其疗法已有长足进展，即从仅可治标性缓解病痛发展到能致病情完全缓解、最大限度根除疾患和提高存活率。Rituxan（rituximab）的开发及其在免疫化疗中的应用使抗CLL 疗法发生了改变，该药已成为目前用于小于65 岁患者的黄金标准治疗药物。然而，基于Rituxan 的免疫化疗仍仅局限用于两类常见CLL 病例——老年患者和具并发症及高危患者的治疗。再者，在为期两年的一线和二线治疗中，约有25% 和50% 的CLL 患者会复发，且已有数年缓解的患者对后续治疗的疗效较差。因此，对于CLL 的治疗，仍远不能满足需求。早期研究发现，B 细胞受体（BCR）信号通路与CLL 的发生和发展以及治疗后的高反应率与病情持续缓解有关联。鉴于此，靶向BCR信号通路的小分子药物得以快速发展。Imbruvic（ibrutinib）是首个口服Bruton 酪氨酸激酶（BTK）抑制剂，近期经快速审批上市，用于治疗复发/ 顽固性恶性淋巴瘤，但其长期生存率数据目前尚不成熟。眼下，新疗法面临着多个挑战：其需提供更高的反应率，特别是对老年患者和具并发症及高危患者，且需克服当前疗法造成的耐药性。目前，唯一的CLL 根治疗法是同种异体造血干细胞移植（HSCT），但其并不适用于大多数CLL 患者。而目前CLL 的标准治疗方案是化学免疫疗法，适用于小于65 岁的患者，但老龄或高危患者的治疗选择是有限的。因此，最终的问题是针对CLL 的小分子疗法是否能达到根治目的，期望随着在鉴定与CLL 发病机制和预后相关的细胞遗传学及分子变化方面取得进展，能促进下一代靶向疗法的快速发展。新型靶向性小分子抑制剂，如Imbruvica 和idelablisib，已展现出对CLL 的显著治疗作用。综述CLL 治疗领域重大行业投资和研发的主要市场博弈者和交易亮点。     

慢性粒细胞白血病耐药机制及治疗策略

慢性粒细胞白血病是一类造血干细胞的恶性克隆性疾病,ph染色体是其特征性细胞遗传学标志,即t(9;22)(q34;ql1),存在BCR/ABL融合基因,现阶段造血干细胞移植是当前最有希望治愈CML的疗法,但受年龄、配型等限制,易发生移植物抗宿主病;复发率较高;传统的化疗、干扰素治疗也有副作用,因此,通过信号传导抑制剂抑制BCR-ABL酪氨酸激酶活性,从而阻止一系列信号传导来治疗CML是一个比较好的治疗方法,伊马替尼是一种酪氨酸激酶抑制剂是治疗慢性粒细胞白血病的靶向治疗药物,治疗疗效显著,但是并不能根治慢性粒细胞白血病,需要长期服药,一些患者出现耐药,导致治疗无效或复发。因此,寻求新的治疗方案至关重要。本文就慢性粒细胞白血病的耐药机制及治疗策略做一综述。     

新型靶向治疗药物拉帕替尼的研究进展

拉帕替尼(lapatinib)是一种口服的、小分子可逆性EGFR和HER2双受体阻断剂。临床研究表明对HER2表达阳性的乳腺癌是有效的。近年来关于拉帕替尼在其他肿瘤的研究越来越多,拉帕替尼有望成为一种潜在、多肿瘤的靶向治疗药物。本文对拉帕替尼的作用机制、临床研究、药理特性及临床应用等做一综述。     

Characterization of miRNomes in Acute and Chronic Myeloid Leukemia Cell Lines

Myeloid leukemias are highly diverse diseases and have been shown to be associated with microRNA（miRNA） expression aberrations. The present study involved an in-depth miRNome analysis of two human acute myeloid leukemia（AML） cell lines, HL-60 and THP-1, and one human chronic myeloid leukemia（CML） cell line, K562, via massively parallel signature sequencing. mRNA expression profiles of these cell lines that were established previously in our lab facilitated an integrative analysis of miRNA and mRNA expression patterns. miRNA expression profiling followed by differential expression analysis and target prediction suggested numerous miRNA signatures in AML and CML cell lines. Some miRNAs may act as either tumor suppressors or oncomiRs in AML and CML by targeting key genes in AML and CML pathways. Expression patterns of cell type-specific miRNAs could partially reflect the characteristics of K562, HL-60 and THP-1 cell lines, such as actin filament-based processes, responsiveness to stimulus and phagocytic activity. miRNAs may also regulate myeloid differentiation, since they usually suppress differentiation regulators. Our study provides a resource to further investigate the employment of miRNAs in human leukemia subtyping, leukemogenesis and myeloid development. In addition, the distinctive miRNA signatures may be potential candidates for the clinical diagnosis, prognosis and treatment of myeloid leukemias.     

苏尼替尼治疗46例慢性粒细胞白血病的临床分析

目的比较和评价苏尼替尼治疗慢性粒细胞白血病（CML）的临床效果。方法回顾分析近7年来收治我院的46例CML患者的临床诊疗资料,统计其完全缓解（CR）率、生存期及影响因素。结果完全缓解35例,占总病例数的76.09%;部分缓解7例,占15.22%;未缓解4例,占8.69%。统计至2010年12月,五年存活26例,五年生存率56.52%。结论苏尼替尼是早期治疗CML的有效手段,能较为明显的缓解病情,减少并发症的发生率,提高患者的生存率,治疗过程中仍需要患者及其家属的密切配合。     

Mitochondrial Profiling of Acute Myeloid Leukemia in the Assessment of Response to Apoptosis Modulating Drugs

BH3 profiling measures the propensity of transformed cells to undergo intrinsic apoptosis and is determined by exposing cells to BH3-mimicking peptides. We hypothesized that basal levels of prosurvival BCL-2 family proteins may modulate the predictive power of BH3 profiling and termed it mitochondrial profiling. We investigated the correlation between cell sensitivity to apoptogenic agents and mitochondrial profiling, using a panel of acute myeloid leukemias induced to undergo apoptosis by exposure to cytarabine, the BH3 mimetic ABT-199, the MDM2 inhibitor Nutlin-3a, or the CRM1 inhibitor KPT-330. We found that the apoptogenic efficacies of ABT-199 and cytarabine correlated well with BH3 profiling reflecting BCL2, but not BCL-XL or MCL-1 dependence. Baseline BCL-2 protein expression analysis increased the ability of BH3 profiling to predict resistance mediated by MCL-1. By utilizing engineered cells with overexpression or knockdown of BCL-2 family proteins, Ara-C was found to be independent, while ABT-199 was dependent on BCL-XL. BCL-2 and BCL-XL overexpression mediated resistance to KPT-330 which was not reflected in the BH3 profiling assay, or in baseline BCL-2 protein levels. In conclusion, mitochondrial profiling, the combination of BH3 profiling and prosurvival BCL-2 family protein analysis, represents an improved approach to predict efficacy of diverse agents in AML and may have utility in the design of more effective drug combinations.     

错配修复基因hMSH2与慢性粒细胞白血病相关性研究

目的:通过对慢性粒细胞白血病(chronic myeloid leukemia,CML)患者骨髓细胞中错配修复基因(mismatch repair,MMR)h MSH2的表达水平及其调控机制的分析,探讨h MSH2与慢性粒细胞白血病疾病进展的联系。方法:用实时定量PCR方法检测10例对照,27例CML患者(包括慢性期9例,进展期8例,急变期10例)骨髓中4个MMR基因(h MSH2、h MSH6、h MLHl、h PMS2)m RNA的表达;用MSP方法检测MMR基因启动子区甲基化水平;用Western blot方法观察MMR蛋白水平在各组之间的差异。结果:与正常对照比较,CML患者的h MSH2的表达明显降低(P0.05),其表达随疾病恶化而下降,依次为急变期加速期慢性期,而h MLHl、h PMS2、h MSH6的表达却未见异常;27例CML患者中出现3例h MSH2启动子区高甲基化。结论:CML患者的h MSH2表达水平比正常人显著降低,且随着疾病恶化其表达水平逐下降,提示h MSH2可能与CML疾病进展相关。     

EphA2 Is a Therapy Target in EphA2-Positive Leukemias but Is Not Essential for Normal Hematopoiesis or Leukemia

Members of the Eph family of receptor tyrosine kinases and their membrane bound ephrin ligands have been shown to play critical roles in many developmental processes and more recently have been implicated in both normal and pathological processes in post-embryonic tissues. In particular, expression studies of Eph receptors and limited functional studies have demonstrated a role for the Eph/ephrin system in hematopoiesis and leukemogenesis. In particular, EphA2 was reported on hematopoietic stem cells and stromal cells. There are also reports of EphA2 expression in many different types of malignancies including leukemia, however there is a lack of knowledge in understanding the role of EphA2 in hematopoiesis and leukemogenesis. We explored the role of EphA2 in hematopoiesis by analyzing wild type and EphA2 knockout mice. Mature, differentiated cells, progenitors and hematopoietic stem cells derived from knockout and control mice were analyzed and no significant abnormality was detected. These studies showed that EphA2 does not have an obligatory role in normal hematopoiesis. Comparative studies using EphA2-negative MLL-AF9 leukemias derived from EphA2-knockout animals showed that there was no detectable functional role for EphA2 in the initiation or progression of the leukemic process. However, expression of EphA2 in leukemias initiated by MLL-AF9 suggested that this protein might be a possible therapy target in this type of leukemia. We showed that treatment with EphA2 monoclonal antibody IF7 alone had no effect on tumorigenicity and latency of the MLL-AF9 leukemias, while targeting of EphA2 using EphA2 monoclonal antibody with a radioactive payload significantly impaired the leukemic process. Altogether, these results identify EphA2 as a potential radio-therapeutic target in leukemias with MLL translocation.     

Renal Function Can Improve at Any Stage of Chronic Kidney Disease

Introduction

Even though renal function decline is considered relentless in chronic kidney disease (CKD), improvement has been shown in patients with hypertensive nephropathy. Whether this can occur in any type of nephropathy and at any stage is unknown as are the features of patients who improve.

Methods

We identified 406 patients in the NephroTest cohort with glomerular filtration rates (mGFR) measured by ⁵¹Cr-EDTA clearance at least 3 times during at least 2 years of follow-up. Individual examination of mGFR trajectories by 4 independent nephrologists classified patients as improvers, defined as those showing a sustained mGFR increase, or nonimprovers. Twelve patients with erratic trajectories were excluded. Baseline data were compared between improvers and nonimprovers, as was the number of recommended therapeutic targets achieved over time (specifically, for systolic and diastolic blood pressure, proteinuria, and use of renin angiotensin system blockers).

Results

Measured GFR improved over time in 62 patients (15.3%). Their median mGFR slope was +1.88[IQR 1.38, 3.55] ml/min/year; it was −2.23[−3.9, −0.91] for the 332 nonimprovers. Improvers had various nephropathies, but not diabetic glomerulopathy or polycystic kidney disease. They did not differ from nonimprovers for age, sex, cardiovascular history, or CKD stage, but their urinary albumin excretion rate was lower. Improvers achieved significantly more recommended therapeutic targets (2.74±0.87) than nonimprovers (2.44±0.80, p<0.01). They also had fewer CKD-related metabolic complications and a lower prevalence of 25OH-vitamin-D deficiency.

Conclusion

GFR improvement is possible in CKD patients at any CKD stage through stage 4–5. It is noteworthy that this GFR improvement is associated with a decrease in the number of metabolic complications over time.     

High-Dimensional Analysis of Acute Myeloid Leukemia Reveals Phenotypic Changes in Persistent Cells during Induction Therapy

The plasticity of AML drives poor clinical outcomes and confounds its longitudinal detection. However, the immediate impact of treatment on the leukemic and non-leukemic cells of the bone marrow and blood remains relatively understudied. Here, we conducted a pilot study of high dimensional longitudinal monitoring of immunophenotype in AML. To characterize changes in cell phenotype before, during, and immediately after induction treatment, we developed a 27-antibody panel for mass cytometry focused on surface diagnostic markers and applied it to 46 samples of blood or bone marrow tissue collected over time from 5 AML patients. Central goals were to determine whether changes in AML phenotype would be captured effectively by cytomic tools and to implement methods for describing the evolving phenotypes of AML cell subsets. Mass cytometry data were analyzed using established computational techniques. Within this pilot study, longitudinal immune monitoring with mass cytometry revealed fundamental changes in leukemia phenotypes that occurred over time during and after induction in the refractory disease setting. Persisting AML blasts became more phenotypically distinct from stem and progenitor cells due to expression of novel marker patterns that differed from pre-treatment AML cells and from all cell types observed in healthy bone marrow. This pilot study of single cell immune monitoring in AML represents a powerful tool for precision characterization and targeting of resistant disease.     

CBX4与HOXA5在慢性粒细胞白血病中的表达及相互作用研究

Polycomb group complex（PcG）作为发挥转录抑制作用的重要表观遗传调控复合物,参与发育、衰老以及肿瘤发生等重要病生理过程。PcG成员众多,分为PRC1与PRC2两种复合物,各组分间功能既协同,又不失特性。PRC1中的CBX4独特的结构域使其功能尤为特殊。近年发现,作为一类造血干细胞恶性克隆性疾病,白血病中常伴有PcG基因的异常表达或者突变。本研究通过qPCR发现,在慢性粒细胞白血病（chronic myeloid leukemia, CML）患者外周血白细胞中存在CBX4的表达明显下调,而PcG经典靶基因HOX家族中的HOXA5则表现为上调。给予伊马替尼（Imatinib）治疗后,二者均向相反方向恢复至正常人的表达水平,并且CBX4的表达水平与CML的经典分子标志物BCR ABL1融合基因有较好的相关性。上述结果提示,CBX4可以作为CML潜在的预后标志物。为了进一步揭示CBX4与HOXA5是否存在相互作用关系,本文通过双荧光素酶实验证实,CBX4能通过HOXA5的启动子而负调控其表达。本研究发现,CBX4与HOXA5在CML中存在负相关的异常表达,且证明CBX4可作为HOXA5的负调控因子。     

商陆皂苷甲的联用可显著提高tApoptin凋亡蛋白的抗肿瘤活性

凋亡蛋白（apoptin）因可特异性诱导肿瘤细胞和转化细胞凋亡而备受广大研究人员的关注。但由于凋亡蛋白质本身结构特性等方面的原因,导致通过原核表达的蛋白质不稳定,很容易聚集沉淀,并且凋亡蛋白质本身也不能自主跨膜进入胞内发挥其生物学作用。本文考察了一种野生型凋亡蛋白N-末端缺失突变体tApoptin（1～43氨基酸残基缺失）在大肠杆菌中以可溶性形式表达,并且通过荧光显微镜和共聚焦显微镜观察到,这种N-端缺失突变体tApoptin与绿色荧光蛋白（green fluorescent protein, EGFP）的融合蛋白质具有自主进入A549、HeLa、H460和SK-OV-3等多种肿瘤细胞的能力,而且这种转运效率具有细胞特异性。与肝素钠共孵育可抑制tApoptin进入细胞的能力,推测tApoptin可能是通过与细胞表面硫酸乙酰肝素多糖结合后被内吞进入细胞。MTT的结果显示,突变体tApoptin依然保持了全长凋亡蛋白质的抗肿瘤特性,对所测试的多种肿瘤细胞生长都具有不同程度的抑制作用。与tApoptin给药组相比,tApoptin与传统中药材来源的商陆皂苷甲（esculentoside, EsA）联用的给药组,对测试的4种肿瘤细胞的药效提升约100倍以上。其中,对SK-OV-3细胞的提升效果最显著,提升463倍,半抑制浓度（half maximal inhibitory concentration, IC50）从27.37 ± 2.25 μmol/L 降低到 0.059 ± 0.003 μmol /L。流式细胞术分析表明,与tApoptin给药组相比,tApoptin与EsA联合的给药组细胞凋亡率显著增加（6.46 ± 0.34% vs. 41.9 ± 0.47%, P<0.001）。与溶酶体共定位的共聚焦结果表明,EsA可能通过破坏细胞中的溶酶体促使tApoptin释放到胞质内有效发挥其药理作用。     

基于诊疗规范的慢性髓细胞白血病治疗单元费用研究

依据《血液病诊疗规范》中慢性髓细胞白血病(CML)诊疗规范,结合专家咨询,将CML慢性期临床治疗中多种情况分成不同治疗单元组,按组计算费用;再依据实际病历数据,采用回顾性分析法进行实际费用分组测算。比较两种分组费用确定合理标准,为内科疾病按病种付费测算方式提供思路,为医保部门合理制定基金预算提供理论依据。     

三种药物联合治疗假丝酵母菌性阴道炎的临床疗效评价

目的:研究克霉唑阴道片、硝夫太尔制霉素阴道软胶囊联合定君生栓治疗复发性假丝酵母菌性阴道炎的临床疗效,为临床治疗提供依据。方法:选取2014年9月到2015年6月我院就诊的复发性假丝酵母菌性阴道炎患者60例,按照随机数字表法将患者分为实验组和对照组,每组30例,实验组给予克霉唑阴道片、硝夫太尔制霉素阴道软胶囊联合定君生栓治疗,对照组给予克霉唑阴道片和定君生栓治疗,治疗前检测所有患者病原菌分布情况,治疗后随访3个月,分析两组临床疗效和不良反应。结果:细菌培养结果共分离出158株假丝酵母菌,其中白色假丝酵母菌最多,占66.46%;实验组总有效率为93.33%,显著高于对照组的76.67%,两组比较差异具有统计学意义(P0.05);两组不良反应发生率比较无统计学意义(P0.05)。结论:克霉唑阴道片、硝夫太尔制霉素阴道软胶囊联合定君生栓治疗复发性假丝酵母菌性阴道炎具有较好的临床疗效,且无明显不良反应。