Clinical relevance of apoptotic markers in breast cancer not yet clear

Currently, the mainly used characteristics to predict outcome or treatment response in patients with breast cancer are tumor size, N-status, histological grade and receptor status (ER/PgR). However, these conventional clinico-pathological characteristics are of limited value. More accurate determinators are needed to select patients who are most likely to benefit from treatment in terms of prognosis as well as treatment response. Proliferation and apoptosis are assumed to play a key role in tumor progression as well as response to treatment. Currently, an increasing number of molecular factors controlling apoptosis as well as proliferation is known. The clinical relevance of apoptotic tumor markers in the treatment strategy of patients with breast cancer is the subject of this review. In addition, potential future developments are discussed.     

低温条件下ABA和钨酸钠对茶树叶片中渗透调节物质含量及抗氧化酶活性的影响

为探讨外源脱落酸( ABA)及其抑制剂钨酸钠对茶树﹝Camellia sinensis ( Linn.) O. Ktze.﹞耐寒性的影响效应,以茶树品种‘龙井43’(‘Longjing 43’)的2年生幼苗为实验材料,在低温(4℃)条件下分别设置50 mg·L-1 ABA和20 mmol·L-1钨酸钠单一及复合处理共6个处理组( T1：仅喷施蒸馏水,对照;T2：仅喷施ABA;T3：仅喷施钨酸钠;T4：同时喷施ABA和钨酸钠; T5：0 h时喷施ABA,24 h时喷施钨酸钠; T6：0 h时喷施钨酸钠,24 h时喷施ABA),对处理0~72 h叶片中渗透调节物质含量和抗氧化酶活性的变化进行了比较分析。结果显示：低温条件下,各处理组幼苗叶片中可溶性糖、游离脯氨酸和可溶性蛋白质含量以及超氧化物歧化酶( SOD)、过氧化氢酶( CAT)和过氧化物酶( POD)活性均在处理初期逐渐升高,之后各指标的变化趋势存在差异。在处理的中后期,除T4处理组的游离脯氨酸含量低于对照组外,各处理组的可溶性糖、游离脯氨酸和可溶性蛋白质含量总体上显著高于对照组;T2处理组的SOD、CAT和POD活性均显著高于对照组,而T3处理组仅SOD活性明显高于对照组,其CAT和POD活性则低于或略高于对照组。对各单一与复合处理组的比较结果显示：T4处理组的SOD和POD活性总体上低于T2处理组,但高于T3处理组;而其CAT活性总体上低于T2和T3处理组。在处理24 h后,T5处理组的可溶性糖、游离脯氨酸和可溶性蛋白质含量以及SOD和POD活性的变化趋势与T2处理组一致;T6处理组的可溶性糖和游离脯氨酸含量及POD活性变化趋势与T3处理组一致,而其可溶性蛋白质含量以及SOD和CAT活性的变化趋势却与T3处理组有一定差异。上述研究结果表明：低温条件下喷施适量的ABA或钨酸钠均可以提升茶树叶片中渗透调节物质含量及抗氧化酶活性,但同时喷施ABA和钨酸钠对茶树叶片中渗透调节物质含量及抗氧化酶活性的影响却不显著。     

牙科焦虑症治疗方法综述

牙科焦虑症主要是对疼痛的恐惧、对未知的恐惧、对机体受到伤害的恐惧等因素导致的焦虑症状。临床中80%的口腔疾病患者都对治疗心存恐惧,因此在很大程度上不能配合医生的治疗甚至逃避治疗。随着生活水平的不断提高,人们要求在舒适的心理环境中接受治疗,因此牙科焦虑症就成为口腔医护工作者必须面对的问题。治疗牙科焦虑症的方法主要分为行为学,药理学和有机放松法三个大类,在实际使用的过程当中往往是各种方法配合使用,而不是单一使用。随着人们研究的逐步深入,提出的具体治疗方法也越来越多,本文就牙科焦虑症目前所使用的治疗方法做详细的介绍及分类,帮助口腔医护工作人员理清治疗思路,为正确的诊断、干预和治疗牙科焦虑症提供治疗方法。     

不同施肥处理对甜菊生长及糖苷含量和积累量的影响

采用盆栽法,以甜菊( Stevia rebaudiana Bertoni)品种‘中山4号'(‘Zhongshan No.4')当年生扦插苗为研究对象,研究不同形态氮肥(硫酸铵、硝酸钠和尿素)及不同施氮量(纯氮)、施磷量( P2 O5)和施钾量( K2 O)对幼苗生长及糖苷含量和单株积累量的影响。结果显示：随氮肥、磷肥和钾肥施用量的提高,甜菊幼苗的株高、茎粗、叶长、叶宽、单株叶干质量和单株茎干质量均呈先升后降的变化趋势,且总体上与对照无显著差异,仅施磷量300 mg·kg-1处理组的叶长显著高于对照;根据施肥量与单株叶干质量的回归方程,确定硫酸铵、硝酸钠、尿素、磷肥和钾肥的施用量分别为64.87、660.21、735.84、211.54和775.92 mg·kg-1时,幼苗单株叶干质量最高。在硫酸铵处理组中,300 mg·kg-1处理组甜菊叶片中的莱鲍迪苷A( R-A)含量及甜菊苷( St)、R-A和总苷的单株积累量以及600 mg·kg-1处理组的St单株积累量高于对照,多数处理组的St、R-A和总苷含量及单株积累量均低于对照;在硝酸钠处理组中,1200 mg·kg-1处理组的R-A和总苷含量、600和900 mg·kg-1处理组的St单株积累量以及300~900 mg·kg-1处理组的R-A和总苷单株积累量高于对照,其他处理组的St、R-A和总苷含量及单株积累量均低于对照;在尿素处理组中,1500 mg·kg-1处理组的R-A和总苷的含量和单株积累量以及600和900 mg·kg-1处理组的R-A和总苷单株积累量高于对照,其他处理组的St、R-A和总苷含量及单株积累量均低于对照;各施氮处理组中,仅1500 mg·kg-1处理组的R-A含量与对照差异显著,其他指标均与对照无显著差异。在施磷处理组中,100 mg·kg-1处理组的R-A含量以及100和200 mg·kg-1处理组的St、R-A和总苷的单株积累量高于对照,多数处理组的St、R-A和总苷含量及单株积累量低于对照且与对照均无显著差异。在施钾处理组中,各处理组的St、R-A和总苷含量及单株积累量均高于对照,其中仅900 mg·kg-1处理组的St、R-A和总苷含量与对照显著差异。各施肥处理组的St含量占总苷含量的百分率均低于对照、R-A含量占总苷含量的百分率均高于对照,且总体上与对照无显著差异。经过综合分析,建议在甜菊生育期内的施肥量为纯氮600~900 mg·kg-1、P2 O5200~300 mg·kg-1和K2 O 600~900 mg·kg-1,其中氮肥以尿素为宜。     

Treatment implications of comorbid psychopathology in American Indians and Alaska Natives

This paper discusses treatment implications of comorbid psychopathology in the context of American Indian and Alaska Native culture and in the context of the Indian Health Service's Mental Health and Alcohol and Substance Abuse Program Branches. Treatment of comorbidity in this population is a particularly difficult problem due to numerous barriers to treatment and a poorly defined treatment system. As in other clinical populations, these patients are high utilizers of the limited treatment services available, but may not receive the type of treatment they need. After describing the extent of comorbidity in this population, we present an historical perspective of mental illness that provides an Indian's view of why we are where we are today in treating these problems. Next, we discuss Western and traditional treatment implications for comorbidity among adults and adolescents. Finally, we suggest directions for future research in this area.     

The analysis of binary responses from toxicological experiments involving reproduction and teratogenicity.

This paper describes a parametric method for analyzing binary response data from completely randomized experiments in which the experimental units are animal litters. Responses within a litter are assumed to form a set of Bernoulli trials whose success probability varies between litters in the same treatment group according to a two parameter beta distribution. The parameters of the beta distribution for each treatment are estimated by maximum likelihood and treatment differences are tested by asymptotic likelihood ratio tests.     

Guidelines for land‐treating petroleum hydrocarbon‐contaminated soils

During land treatment, environmental parameters are optimized to achieve the fastest and most complete biodegradation of petroleum hydrocarbons present in contaminated soils. This article provides specific guidelines for optimization of the land treatment process at a field site. In particular, the necessary steps in the land treatment procedure are outlined in the time sequence expected under field conditions. Specific steps include sampling and site assessment, determination of contaminant levels and characteristics, estimation of biodegradation potential, estimation of bacterial numbers in soil, design of the land treatment unit, adjustment of the soil pH and moisture content, addition of nutrient fertilizers and bulking agents, operation of the land treatment unit involving tilling and irrigation, periodic monitoring of specific environmental parameters, and final closure of the site. In addition, a number of examples are used to familiarize the reader with the numerical calculations involved in optimization of the land treatment operation.     

WETLANDS AS ACCRETING SYSTEMS: WASTEWATER TREATMENT

SUMMARY

Considerable attention has been directed in the last decade to the use of wetlands for wastewater treatment. They are generally very effective in reducing (by up to 95%) the concentrations of nitrogen, pathogenic bacteria and heavy metals but their efficiencies in reducing phosphorus and organic matter vary widely. While most of the processes which result in removal of wastewater constituents are qualitatively understood, quantitative data are lacking. It is therefore impossible to predict the potential of any wetland for wastewater treatment or to manage wetlands for optimum treatment efficiency. Little is known of either short- or long-term effects of wastewater addition on wetland ecosystems.

In view of the substantial economic benefits of using wetlands for wastewater treatment, it is suggested that studies on wastewater treatment by both artificial and natural wetlands in South Africa are urgently required.     

Extracorporeal photopheresis (photochemotherapy) in the treatment of acute and chronic graft versus host disease: immunological mechanisms and the results from clinical studies

Extracorporeal photopheresis (ECP) is an immunomodulatory alternative for treatment of graft versus host disease (GVHD). The blood is then separated into its various components through apheresis; buffy coat cells are thereafter treated with 8-methoxypsoralen before exposure to ultraviolet light and finally reinfused into the patient. There is a general agreement that this treatment has an anti-GVHD effect, but the mechanisms of action behind this effect are only partly understood. However, altered maturation of dendritic cells (DC) and thereby indirect modulation of T-cell reactivity seems to be one important mechanism together with DC-presentation of antigens derived from apoptotic donor T cells and induction of regulatory T cells. The treatment has been best studied in patients with chronic GVHD (both pediatric and adult patients), but most studies are not randomized and it is difficult to know whether the treatment is more effective than the alternatives. The clinical studies of ECP in adults with acute GVHD are few and not randomized; it is not possible to judge whether this treatment should be a preferred second- or third-line treatment. There is no evidence for increased risk of leukemia relapse or suppression of specific graft versus leukemia reactivity by this treatment, so specific antileukemic immunotherapy may still be possible. Thus, even though the treatment seems effective in patients with GVHD, further clinical (especially randomized) as well as biological studies with careful standardization of the treatment are needed before it is possible to conclude how ECP should be used in acute and chronic GVHD.     

紫杉醇联合解毒饮治疗头颈部恶性肿瘤的近期疗效观察

目的观察紫杉醇联合解毒饮对头颈部恶性肿瘤的近期疗效和毒副作用。方法选择51例头颈部恶性肿瘤患者选用紫杉醇与卡铂方案化疗,每4周重复用,共3~6周期,同时煎服解毒饮和静滴鱼腥草注射液。结果初治的19例患者中,CR 2例(10.5%),PR 6例(31.6%),RR为42.1%;复治的32例患者中,CR 2例(6.3%),PR 9例(28.1%),RR为34.4%;初治疗效优于复治。结论紫杉醇联合解毒饮对头颈部恶性肿瘤有较好的近期疗效,尤其对初治者效果更佳,而且毒副作用比较轻。     

Domiciliary Treatment of Tuberculosis

In the present therapy of tuberculosis with antimicrobial agents, most patients receive the major part of their treatment at home, and a significant proportion of active cases never enter sanatorium or stop working during their treatment.Domiciliary treatment in Canada, with and without sanatorium admission, has been reviewed. At present, approximately 7500 patients are being treated on an outpatient basis. Most have had a period of sanatorium treatment for investigation and institution of antimicrobial therapy, but in one province up to 30% of new active cases of tuberculosis, and in another 12%, are treated entirely on an outpatient basis.The indications are that domiciliary treatment is successful and that the practice is expanding. This practice will probably continue to expand as more and better outpatient clinic facilities are developed to provide the necessary supervision and follow-up of tuberculous patients.     

Process engineering in biological aerobic waste-water treatment

A non-comprehensive review of several technical developments in the field of aerobic biological waste-water treatment engineering is carried out, considering the active role the engineers have to play in this field. This paper brings together conventional and advanced problems in the field of aerobic biological waste-water treatment. Such an overview of biological waste-water treatment also precedes comments on some important aspects concerning the microorganisms responsible for waste-water treatment as well as considerations of the application of fundamentals and kinetics to the analysis of the biological processes used most commonly for aerobic biological waste-water treatment. A survey of the development of the biological activated-sludge process and some modifications are given. Some problems implied in the conventional activated-sludge waste-water treatment are analyzed, considering conventional processes and bioreactor models (the continuous stirred-tank reactor model and the plug-flow reactor models of the activated-sludge process) as well as aerated lagoons. Further, modifications of the activated-sludge process are presented. These include additional details on the bioreactor progress and applications, with emphasis on aspects concerning airlift bioreactors and their variants, deep-shaft bioreactors and reciprocating jet bioreactors which are considered as the third generation of bioreactors owing to their important advantages in design, operation and performance in waste-water treatment. Sequencing-batch reactors and aerobic digestion processes, including conventional aerobic digestion, high-purity oxygen digestion, thermophilic aerobic digestion and cryophylic aerobic digestion are also reviewed. Finally, some aspects regarding the operational factors that are involved in the selection of the reactor type are included.     

THE TREATMENT OF ACUTE INFECTIONS OF THE HAND

Acute infections of the hand are serious and frequently arise from a trivial wound which has been neglected or improperly treated. Accurate diagnosis, prompt institution of treatment, and early restoration of function are essential for successful treatment. Results in the treatment of acute infections of the hand are greatly improved by the rigid practice of a method of operation which recognizes fundamental surgical principles.     

A comparison of methods for estimating the causal effect of a treatment in randomized clinical trials subject to noncompliance

Summary .  We consider the analysis of clinical trials that involve randomization to an active treatment ( T  = 1) or a control treatment ( T  = 0), when the active treatment is subject to all-or-nothing compliance. We compare three approaches to estimating treatment efficacy in this situation: as-treated analysis, per-protocol analysis, and instrumental variable (IV) estimation, where the treatment effect is estimated using the randomization indicator as an IV. Both model- and method-of-moment based IV estimators are considered. The assumptions underlying these estimators are assessed, standard errors and mean squared errors of the estimates are compared, and design implications of the three methods are examined. Extensions of the methods to include observed covariates are then discussed, emphasizing the role of compliance propensity methods and the contrasting role of covariates in these extensions. Methods are illustrated on data from the Women Take Pride study, an assessment of behavioral treatments for women with heart disease.     

总体平均处理效应的拟极大似然估计

本文给出可交换条件下多维协变量的带有测量误差的多维结构回归模型,利用该模型研究总体平均处理效应的估计,给出当暴露组和对照组的协变量测量误差同分布时总体平均处理效应的拟极大似然估计及其性质．     

Lymphatic malformations

Lymphatic malformations are rare forms of vascular anomalies. They are most frequently diagnosed at birth and most often occur in the head and neck area. Their treatment continues to be challenging, and treatment methods continue to evolve. In this article, the embryology of the lymphatic system is reviewed, and the classification of lymphatic malformations and their natural history and treatment are discussed.     

Double Inverse‐Weighted Estimation of Cumulative Treatment Effects Under Nonproportional Hazards and Dependent Censoring

Summary In medical studies of time‐to‐event data, nonproportional hazards and dependent censoring are very common issues when estimating the treatment effect. A traditional method for dealing with time‐dependent treatment effects is to model the time‐dependence parametrically. Limitations of this approach include the difficulty to verify the correctness of the specified functional form and the fact that, in the presence of a treatment effect that varies over time, investigators are usually interested in the cumulative as opposed to instantaneous treatment effect. In many applications, censoring time is not independent of event time. Therefore, we propose methods for estimating the cumulative treatment effect in the presence of nonproportional hazards and dependent censoring. Three measures are proposed, including the ratio of cumulative hazards, relative risk, and difference in restricted mean lifetime. For each measure, we propose a double inverse‐weighted estimator, constructed by first using inverse probability of treatment weighting (IPTW) to balance the treatment‐specific covariate distributions, then using inverse probability of censoring weighting (IPCW) to overcome the dependent censoring. The proposed estimators are shown to be consistent and asymptotically normal. We study their finite‐sample properties through simulation. The proposed methods are used to compare kidney wait‐list mortality by race.     

单个协变量带有测量误差的多维结构回归模型

给出可交换条件下单个协变量的带有测量误差的多维结构回归模型,利用该模型研究总体平均处理效应的估计,给出当暴露组和对照组的协变量测量误差同分布时总体平均处理效应的拟极大似然估计及其性质.     

The Narrative Challenge to Cognitive Behavioral Treatment of Sexual Offenders

Imprisoned sexual offenders undergoing treatment are expected to deduce and follow a treatment schema constructed on the foundations of cognitive behavioral therapy (CBT). A key element of their treatment program is the presentation of a core narrative, their autobiography, to treatment staff and peers. Examining this form of prison-based treatment through the lens of narrative theory, I argue that the autobiographies and other stories that are developed and performed as part of this treatment process are largely the product of the imposition of this treatment schema in combination with dynamic group processes. Ironically, the treatment schema and the prevailing dynamics work to subvert the fundamental forensic goal of having inmates disclose aspects of their lives and crimes as an essential stepping stone toward rehabilitation. The narratives that emerge, both in detail and in meaning, cannot be seen as simply reflections of any single individual's life but, instead, as composites built on, and reflective of, cultural processes somewhat unique to the forensic context. Narrative, a fundamental mode of thinking and communication, necessarily challenges the directed nature of autobiographical presentation derived from CBT. In such circumstances, the effectiveness of CBT for sexual offenders is questionable.