A snapshot of cancer in Chile: analytical frameworks for developing a cancer policy

Introduction

The South American country Chile now boasts a life expectancy of over 80 years. As a consequence, Chile now faces the increasing social and economic burden of cancer and must implement political policy to deliver equitable cancer care. Hindering the development of a national cancer policy is the lack of comprehensive analysis of cancer infrastructure and economic impact.

Objectives

Evaluate existing cancer policy, the extent of national investigation and the socio-economic impact of cancer to deliver guidelines for the framing of an equitable national cancer policy.

Methods

Burden, research and care-policy systems were assessed by triangulating objective system metrics – epidemiological, economic, etc. – with political and policy analysis. Analysis of the literature and governmental databases was performed. The oncology community was interviewed and surveyed.

Results

Chile utilizes 1% of its gross domestic product on cancer care and treatment. We estimate that the economic impact as measured in Disability Adjusted Life Years to be US$ 3.5 billion. Persistent inequalities still occur in cancer distribution and treatment. A high quality cancer research community is expanding, however, insufficient funding is directed towards disproportionally prevalent stomach, lung and gallbladder cancers.

Conclusions

Chile has a rapidly ageing population wherein 40% smoke, 67% are overweight and 18% abuse alcohol, and thus the corresponding burden of cancer will have a negative impact on an affordable health care system. We conclude that the Chilean government must develop a national cancer strategy, which the authors outline herein and believe is essential to permit equitable cancer care for the country.     

优化胶粘贴法建立裸鼠胃癌原位种植模型

目的通过对两种胶粘贴法建立的胃癌原位种植动物模型的比较研究,为探讨胃癌的发病机制和实验治疗提供理想的动物模型。方法用OB胶和FS生物蛋白胶法分别建立胃癌原位种植动物模型,观察和比较两种方法所建立的模型肿瘤生长状况、转移情况和形态学变化。结果FS生物蛋白胶组未出现肿瘤大片坏死,腹水形成率为85.7%,幽门梗阻发生率为57.1%;而OB胶组肿瘤大片坏死发生率为100%,腹水形成率为14.3%,未出现幽门梗阻。FS生物蛋白胶组有三例出现了肺和脑转移。结论FS生物蛋白胶法建立的裸鼠胃癌原位种植动物模型能更好的模拟人胃癌患者的临床过程,为研究人胃癌转移机制和实验治疗提供理想的动物模型。     

Duration of use of proton pump inhibitors and the risk of gastric and oesophageal cancer

BackgroundThere is increasing interest in the potential association between proton pump inhibitors (PPIs) and the risk of gastric and oesophageal cancer, yet the effect of duration of treatment needs clarification.MethodsThis Swedish population-based cohort study assessed the influence of time since initiation of PPI treatment on the risk of gastric and oesophageal cancer, presented as standardised incidence ratios and 95% confidence intervals.ResultsThe risk of gastric and oesophageal cancer during the first year was 7–10 times higher than the background population, and remained 24–202% increased without any decrease over time after the first year.ConclusionPPI use was associated with an increased risk of gastric and oesophageal cancer and the risk remained increased over follow-up. These results support our original hypothesis that use of PPIs may be a risk factor for gastric and oesophageal cancer in the general population of maintenance users, independent of underlying indications.     

老年人胃内菌群研究

目的研究人体胃内菌群,探讨老年与非老年人胃内菌群的差异。方法选择67例无严重胃肠道疾病的患者为研究对象。其中男性50例、女性17例。年龄≥60岁53例,〈60岁14例。胃镜下取胃组织及胃液,测胃液pH,并做胃组织需氧、厌氧细菌培养及真菌培养,计数胃组织细菌培养数量。16SrRNA法鉴定胃组织细菌种类。真菌的鉴定按微生物科常规菌种方法鉴定。结果老年人中胃内需氧细菌培养阳性为23例（48.93%）,12例（25.53%）胃内需氧菌培养〉1×10^5CFU/g;厌氧细菌培养阳性为22例（46.81%）,12例（25.53%）胃内厌氧菌培养〉1×10^5CFU/g。非老年人中需氧细菌培养阳性为4例（28.57%）,1例（7.14%）胃内需氧菌培养〉1×10^5CFU/g;厌氧细菌培养阳性为4例（28.57%）,1例（7.14%）胃内厌氧菌培养〉1×10^5CFU/g。但老年人与非老年人比较,细菌培养阳性率及细菌培养〉1×10^5CFU/g的比率差异无显著性。仅1例老年人胃组织分离出真菌,为白色念珠菌。胃内共分离出细菌69株,其中革兰阳性球菌31株（44.93%）,革兰阳性杆菌12株（17.39%）,革兰阴性球菌11株（15.94%）,革兰阴性杆菌15株（21.74%）。需氧菌13株（18.84%）,需氧兼性厌氧菌54株（78.26%）,专性厌氧菌2株（2.90%）。老年人胃内常见的细菌是：链球菌、大肠埃希菌、奈瑟菌;非老年人胃内常见的细菌是：链球菌和大肠埃希菌。多为口咽部和胃肠道常见菌群,部分为条件致病菌。结论约46%～48%的老年人胃内细菌培养阳性,约25%的老年人有胃内细菌过度生长（〉1×10^5CFU/g）。约28%的非老年人胃内细菌培养阳性,约7%的非老年人有胃内细菌过度生长。老年人胃内菌群分布与非老年人相似,为口咽部和胃肠道常见菌群,部分为条件致病菌。     

GnRH类似物对培养的大鼠胃平滑肌细胞蛋白激酶C活性的影响

研究GnRH类似物阿拉瑞林（Alarelin)对大鼠胃平滑肌细胞蛋白酶C（PKC）活性的影响,采用放射性同位素法测定PKC的活性,发现：（1）阿拉瑞林可使培养的大鼠胃平滑肌细胞中PKC活性明显升高,3min时达高峰,10min后作用显著降低,且成剂量依赖性。当阿拉瑞林为10^-5mol/L时,PKC活性最高,10^-9mol/L时其对PCK的作用基本消失;（2）当用佛波醇酯（phorbol 12 myristate 13-acetate,PMA)短期作用激活PKC后,再加入阿拉瑞林,仍可使PKC活性略有升高,但无显著性差异;当用PMA长期持续作用耗PKC后,再加入阿拉瑞林作用3min,它不能激活PKC,与单纯的阿拉瑞林作用3min组相比差异显著;（3）在无外Ca^2 时,阿拉瑞林也可使PKC活性升高,但不如单独用阿拉瑞林作用3min组的高。因此PKC活性的增高,并不完全依赖细胞外Ca^2 ,它可以动员胞内Ca^2 的释放激活PKC,说明GnRH类似物可使胃平滑肌细胞中PKC活性增加,PKC参与阿拉瑞林对胃平滑肌细胞调控的信号转导过程。     

纳米四氧化三铁双歧杆菌LTA对实验性胃癌增殖及凋亡的影响

目的 观察纳米四氧化三铁(Fe3O4)双歧杆菌脂磷壁酸(lipoteichoicacid,LTA)对实验性胃癌增殖细胞核抗原(PCNA)和bcl-2、bax蛋白表达的影响.方法 用胃癌BGC-823细胞裸鼠皮下移植瘤模型,观察不同浓度纳米Fe3O4双歧杆菌LTA组与LTA组及环磷酰胺组移植瘤的生长情况,免疫组化法检测bcl-2和bax及增殖细胞核抗原(PCNA)的表达.结果 纳米Fe3O4双歧杆菌LTA各剂量组胃癌移植瘤PCNA阳性细胞面密度以及bcl-2阳性细胞面密度均显著低于肿瘤对照组(P<0.01),而bax 的阳性细胞面密度显著高于肿瘤阴性对照组(P<0.01).结论 纳米四氧化三铁LTA能明显降低人胃癌移植瘤的增殖活性及增强bax的蛋白表达,同时使其bcl-2基因蛋白的表达下调.     

黄颡鱼仔稚鱼胃肠发育的显微和超微结构研究

利用光学显微技术和透射电镜技术,观察和研究了出膜后1-35日龄黄颡鱼(Pelteobagrus fulvidraco)仔稚鱼的胃肠发育.水温为23-25℃时,2日龄仔稚鱼的消化道分化出口咽腔、食道、胃、肠;3日龄肠道分化为前肠、中肠、后肠.3日龄黄颡鱼开口摄食时其胃贲门部黏膜层下出现胃腺,为已有鱼类研究报道中胃腺最早出现的日龄.超微结构显示3日龄胃腺细胞中可见胃蛋白酶原颗粒和丰富的管泡系统,为典型的泌酸胃酶细胞;随日龄增加,胃蛋白酶原颗粒越来越丰富而管泡系统越来越不明显.3日龄时前肠吸收细胞胞质中可见脂肪泡,后肠吸收细胞胞质中可见蛋白质胞饮体.直到25日龄后肠吸收细胞胞质中尚可见蛋白质胞饮体.以七结果表明黄颡鱼在3日龄开口摄食时消化道具备细胞外消化功能,但此功能不完善,期间继续通过胞饮作用等细胞内消化来弥补胞外消化的不足,直到25-30日龄后细胞外消化功能发育完善.采用符合其生理机能发育过程的投喂管理策略可以有效提高大规格苗种培育的成活率.     

胎儿胃、小肠内分泌细胞分布及形态学观察

目的探讨人胃肠道内分泌细胞的分布.方法采用银浸染色方法,对10例4～6月胎儿的胃、小肠内分泌细胞行光学显微镜观察.结果胃、小肠中的内分泌细胞(嗜银细胞)形态多种多样,分布于胃、小肠绒毛上皮、小肠腺及十二指肠腺.在小肠固有膜结缔组织中也有散在的嗜银细胞.该细胞主要存在于小肠,胃部较少,其中以十二指肠最多,空肠、回肠顺次递减,而十二指肠乳头又明显高于十二指肠其他部位,在这些部位有时可见该细胞抵达腺腔,并有颗粒释放于腺腔内.结论人胎儿胃肠道含有内分泌细胞,尤其是小肠及其十二指肠乳头部.     

Detection,isolation and characterization of Fusobacterium gastrosuis sp. nov. colonizing the stomach of pigs

Nine strains of a novel Fusobacterium sp. were isolated from the stomach of 6–8 months old and adult pigs. The isolates were obligately anaerobic, although they endured 2 h exposure to air. Phylogenetic analysis based on 16S rRNA and gyrase B genes demonstrated that the isolates showed high sequence similarity with Fusobacterium mortiferum, Fusobacterium ulcerans, Fusobacterium varium, Fusobacterium russii and Fusobacterium necrogenes, but formed a distinct lineage in the genus Fusobacterium. Comparative analysis of the genome of the type strain of this novel Fusobacterium sp. confirmed that it is different from other recognized Fusobacterium spp. DNA-DNA hybridization, fingerprinting and genomic %GC determination further supported the conclusion that the isolates belong to a new, distinct species. The isolates were also distinguishable from these and other Fusobacterium spp. by phenotypical characterization. The strains produced indole and exhibited proline arylamidase and glutamic acid decarboxylase activity. They did not hydrolyse esculin, did not exhibit pyroglutamic acid arylamidase, valine arylamidase, α-galactosidase, β-galactosidase, β-galactosidase-6-phosphate or α-glucosidase activity nor produced acid from cellobiose, glucose, lactose, mannitol, mannose, maltose, raffinose, saccharose, salicin or trehalose. The major fatty acids were C16:0 and C18:1ω9c. The name Fusobacterium gastrosuis sp. nov. is proposed for the novel isolates with the type strain CDW1(T) (=DSM 101753(T) = LMG 29236(T)). We also demonstrated that Clostridium rectum and mortiferum Fusobacterium represent the same species, with nomenclatural priority for the latter.     

扬子鳄胃的组织化学及超微结构研究

爬行动物胃的一般组织学和组织化学的研究资料较多,Luppa1对此作了较为详细的总结.超微结构方面,龟鳖类和蜥蜴类亦有报道2,3,鳄类的资料尚缺.扬子鳄(Alligator sinensisFuval)是我国现存惟一的特有鳄类,陈壁辉4等曾对其食性进行了细致的考察,也对胃的一般组织结构作了描述.作者拟从组织化学和超微结构方面对扬子鳄的胃作进一步的研究,以丰富比较组织和细胞学资料,同时也增进对扬子鳄进化位置及其食性适应性结构的认识.