Mid-term survival of the Optimys short stem: A prospective case series of 500 patients

BACKGROUND In recent years,there has been an increase in the number of total hip arthroplasty procedures in the younger patient population.This active group has higher expectations of their prosthesis in comparison to the older population,and there is a greater physical demand for the prosthesis.Short femoral stems were in-troduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population.Currently,the long-term survival and functional outcomes of various short stems are still being investigated in different clinics.AIM To determine the 5-year survival of the Optimys hip stem.METHODS This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands.All patients received the Optimys short stem(Mathys Ltd,Bettlach,Switzerland).The primary outcome measure was survival of the hip stem,with revision as the endpoint.The secondary outcome measurements included patient-reported outcome measures(PROMs).Kaplan-Meier analysis was used to calculate the 5-year survival rate.Log-minus-log transformation was performed to calculate the 95%confidence interval(95%CI).Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery.Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs.RESULTS The mean age of the total 500 patients was 62.3 years(standard deviation:10.6)and 202 were male(40%).At a median follow-up of 5.5 years(interquartile range:4.5-6.7),7 patients were deceased and 6 revisions were registered,for infection(n=3),subsidence(n=2)and malposition(n=1).This resulted in an overall 5-year survival of 98.8%(95%CI:97.3-99.5).If infection was left out as reason for revision,a stem survival of 99.4%(95%CI:98.1-99.8)was seen.Baseline questionnaires were completed by 471 patients(94%),317 patients(63%)completed the 1-year follow-up questionnaires and 233 patients(47%)completed the 2-year follow-up.Both outcome measures significantly improved across all domains in the 1st year after the operation(P<0.03 for all domains).In the 2nd year after surgery,no significant changes were observed in any domain in comparison to the 1-year follow-up.CONCLUSION The Optimys stem has a 5-year survival of 98.8%.Patient-reported outcome measures increased significantly in the 1st postoperative year with stabilization at the 2-year follow-up.

Comparison of three data mining methods in predicting 5-year survival of colorectal cancer patients

The prediction of colorectal cancer(CRC) survivability has always been a challenging research issue. Considering the importance of predicting CRC patients' survival rates, we compared the performance of three data mining methods: decision trees(DTs), artificial neural networks(ANNs) and support vector machines(SVMs), for predicting 5-year survival of CRC patients to assist clinicians in making treatment decisions. The CRC dataset used to build the prediction model comes from the surveillance, epidemiology, and end results(SEER) program. The 5-fold cross-validation and random forest algorithm were respectively utilized for measuring the model predictive accuracy and the importance of features. Experimental results show that the predictive accuracy of ANNs(0.73) and SVMs(0.75) were higher than that of DTs, and they also have the best result in the area under the receiver operating characteristic(ROC) curve(area under curve(AUC)=0.82). This result may indicate high predictive power of ANNs and SVMs for predicting 5-year survival of CRC patients.

No long-term survival benefit with sustained-release 5-fluorouracil implants in patients with stages Ⅱ and Ⅲ gastric cancer

BACKGROUND The prognosis of gastric cancer in an advanced stage remains poor. The exact efficacy of the use of intraoperative sustained-release chemotherapy with 5-fluorouracil(5-FU) in advanced-stage gastric cancer is still unelucidated.AIM To explore the long-term survival benefit of using sustained-release 5-FU implants in stage Ⅱ and stage Ⅲ gastric cancer patients.METHODS Patients with gastric cancer in a locally advanced stage and who underwent an R0 radical resection between Jan 2014, to Dec 2016, in this single institution were included. Patients with pathological diagnoses other than adenocarcinoma were excluded. All included patients were grouped according to whether intraoperative sustained-release(SR) chemotherapy with 5-FU was used or not(NSR). The primary end-point was 5-year overall survival. Kaplan–Meier method with logrank test was used to analyze the overall survival of patients and Cox analysis was used to analyze prognosis factors of these patients.RESULTS In total, there were 563 patients with gastric cancer with locally advanced stage, who underwent an R0 radical resection. 309 patients were included in the final analysis. 219(70.9%) were men, with an average age of 58.25 years. Furthermore, 56(18.1%) received neoadjuvant chemotherapy, and 191(61.8%) were in TNM stage Ⅲ. In addition, 158 patients received intraoperative sustainedrelease chemotherapy with 5-FU and were included in the SR group, while the other 161 patients were included in the NSR group. The overall complication rate was 12.94% in the whole group and 10.81%, 16.46% in SR and NSR groups, respectively. There were no significant differences between the two groups in overall survival and complication rate(P > 0.05). The multivariate cox analysis indicated that only N Stage and neoadjuvant therapy were independent influencing factors of survival.CONCLUSION Intraoperative sustained-release chemotherapy usage with 5-FU, did not improve the survival of patients who underwent an R0 radical resection in locally advanced stage of gastric cancer.

乳腺癌组织lncRNA CASC2、miR-532-3p表达水平与患者术后5年内生存的相关性

目的探究乳腺癌(BC)组织长链非编码RNA癌易感性候选基因2(lncRNA CASC2)、微小RNA-532-3p(miR-532-3p)表达与患者术后5年内生存的相关性。方法选择2015年1月—2018年6月大同市第五人民医院普通外科收治BC患者127例,术中收集BC组织及癌旁正常组织,荧光定量PCR法检测BC组织和癌旁正常组织中lncRNA CASC2、miR-532-3p表达;对BC患者术后进行为期5年的随访,记录患者5年内生存和死亡情况。比较癌旁正常组织和BC组织lncRNA CASC2及miR-532-3p表达,BC组织中lncRNA CASC2和miR-532-3p表达在不同临床病理特征中的差异,生存组和死亡组临床病理特征和BC组织中lncRNA CASC2及miR-532-3p表达的差异。分析BC组织lncRNA CASC2、miR-532-3p表达的相关性;BC组织中lncRNA CASC2和miR-532-3p表达与术后5年内生存的关系;影响BC患者术后5年内生存的因素;lncRNA CASC2、miR-532-3p对BC患者术后5年内生存的预测价值。结果BC组织中lncRNA CASC2表达水平低于癌旁正常组织,miR-532-3p表达水平高于癌旁正常组织(t/P=38.239/<0.001,49.406/<0.001);肿瘤直径≥2 cm、TNM分期Ⅲ期、肿瘤低分化、淋巴结转移者比例lncRNA CASC2低表达组高于高表达组,而miR-532-3p低表达组低于高表达组(lncRNA CASC2:χ^(2)/P=17.361/<0.001、17.052/<0.001、14.694/<0.001、13.173/<0.001;miR-532-3p:χ^(2)/P=10.733/0.001、9.813/0.002、10.134/0.001、7.444/0.006);127例BC患者术后随访5年,生存99例(生存组),死亡28例(死亡组),肿瘤直径≥2 cm、TNM分期Ⅲ期、肿瘤低分化、淋巴结转移者比例及miR-532-3p表达水平死亡组高于生存组,而lncRNA CASC2表达水平死亡组低于生存组[χ^(2)(t)/P=5.211/0.022、27.149/<0.001、27.990/<0.001、4.590/0.032、19.155/<0.001、10.818/<0.001];BC组织中lncRNA CASC2与miR-532-3p表达呈负相关(r/P=-0.561/<0.001);lncRNA CASC2高表达组BC患者术后5年内总生存率为89.23%(58/65),高于lncRNA CASC2低表达组66.13%(41/62)(χ^(2)/P=9.854/0.002);miR-532-3p高表达组BC患者术后5年内总生存率为65.57%(40/61),低于miR-532-3p低表达组89.39%(59/66)(χ^(2)/P=10.466/0.001);肿瘤直径≥2 cm、TNM分期Ⅲ期、肿瘤低分化、有淋巴结转移、lncRNA CASC2低表达、miR-532-3p高表达均是影响BC患者术后5年内生存的独立危险因素[HR(95%CI)=2.255(1.192~4.263)、2.143(1.252~3.666)、3.089(1.386~6.887)、2.219(1.223~4.026)、2.606(1.174~5.788)、2.855(1.592~5.120)];lncRNA CASC2、miR-532-3p及二者联合预测BC患者术后5年内生存的AUC分别为0.840、0.852、0.908,二者联合预测的AUC大于lncRNA CASC2、miR-532-3p各自单独预测的AUC(Z/P=2.246/0.025、2.033/0.042)。结论BC组织中lncRNA CASC2表达下调,miR-532-3p表达上调,且术后5年内死亡的BC患者较存活患者变化更显著,二者表达与临床病理特征相关,对预测BC患者术后5年内生存情况价值较高。

5-hydroxymethyl-2-furfural prolongs survival and inhibits oxidative stress in a mouse model of forebrain ischemia

In the present study, we hypothesized that 5-hydroxymethyl-2-furfural could attenuate ischemic brain damage by reducing oxidative injury. Thus, mice were subjected to bilateral common carotid artery occlusion to establish a model of permanent forebrain ischemia. The mice were intraperitoneally injected with 5-hydroxymethyl-2-furfura130 minutes before ischemia or 5 minutes after ischemia. The survival time of mice injected with 5-hydroxymethyl-2-furfural was longer compared with untreated mice. The mice subjected to ischemia for 30 minutes and reperfusion for 5 minutes were intraperitoneally injected with 5-hydroxymethyl-2-furfural 5 minutes prior to reperfusion, which increased superoxide dismutase content and reduced malondialdehyde content, similar to the effects of Edaravone, a hydroxyl radical scavenger used for the treatment of stroke. These findings indicate that intraperitoneal injection of 5-hydroxymethyl-2-furfural can prolong the survival of mice with permanent forebrain ischemia. This outcome may be mediated by its antioxidative effects.

PIK3CA and TP53 mutations predict overall survival of stage Ⅱ/Ⅲ colorectal cancer patients

AIM To investigate the predictive value of PIK3 CA and TP53 mutation status in colorectal cancer(CRC) patients treated with 5-fluorouracil-based chemotherapy.METHODS In this study, a total of 315 patients with histologically proven CRC were enrolled from Yangpu Hospital affiliated to Shanghai Tongji University between 2007 and 2011. Of these patients, 241 with stage Ⅱ/Ⅲ CRC received 5-fluorouracil-based adjuvant chemotherapy. Formalin-fixed paraffin-embedded lesion samples of the patients with curatively resected CRC were collected.Next-generation sequencing was performed to identify somatic gene mutations. The correlation of PIK3 CA and TP53 mutation status with overall survival(OS) was analyzed using a Cox proportional hazard model and the Kaplan-Meier method.RESULTS Among the 241 patients with stage Ⅱ/Ⅲ in this cohort, the PIK3 CA and/or TP53 mutation was detected in 177 patients, among which 54 patients had PIK3 CA and TP53 double mutations. The PIK3 CA or TP53 mutation was not significantly correlated with OS in univariate and multivariate analyses. Compared with patients without PIK3 CA and TP53 mutations, those with double PIK3 CA-TP53 mutations showed a significantly worse survival(univariate HR = 2.21; 95%CI: 1.15-4.24; multivariate HR = 2.02; 95%CI: 1.04-3.91). The PIK3 CA mutation located in the kinase domain showed a trend toward a shorter OS compared with wild-type tumors(multivariate HR = 1.56; 95%CI: 1.00-2.44; P = 0.052). The Kaplan-Meier curve showed that patients harboring the PIK3 CA mutation located in the kinase domain had a worse clinical outcome than those with wild-type status(Log-rank P = 0.041)CONCLUSION Double mutation of PIK3 CA and TP53 is correlated with a shorter OS in stage Ⅱ/Ⅲ CRC patients treated with 5-fluorouracil-based therapy.

X-射线修复交叉互补蛋白5在脑胶质瘤中的表达及临床意义

目的分析X-射线修复交叉互补蛋白5(XRCC5)在脑胶质瘤(brain glioma,BG)中的表达水平及其与临床病理特征和预后的关系。方法利用癌症基因图谱(TCGA)数据库的RNA测序数据分析XRCC5在636例BG[468例低分级脑胶质瘤(LGG),168例多形性胶质母细胞瘤(GBM)]与正常脑组织的表达差异,比较XRCC5表达水平与年龄、性别、病理分级、生存期以及肿瘤增殖相关抗原67(MKI67)表达水平的相关性。对BG组织芯片(47例LGG、75例GBM及3例正常脑组织)进行XRCC5免疫组化染色,进一步验证XRCC5表达水平与BG病理分级的关系。结果TCGA分析结果显示,XRCC5在BG组织中的表达水平高于正常脑组织(P<0.001),在GBM组的表达水平高于LGG组(P<0.001);XRCC5表达水平与BG病理分级呈正相关(P<0.001),与MKI67表达水平呈正相关(P<0.001);XRCC5高表达组生存期长于低表达组(P<0.001);不同性别、不同年龄段XRCC5表达水平差异均无统计学意义(P均>0.05);XRCC5的免疫组化染色结果显示,肿瘤组织中XRCC5表达水平高于正常人脑组织(P<0.05)。结论XRCC5在BG组织中升高,且与恶性肿瘤的生物标记物MKI67呈正相关。XRCC5表达越高,患者的预后越好,生存期越长。

The interplay mechanism between IDH mutation, MGMT-promoter methylation, and PRMT5 activity in the progression of grade 4 astrocytoma: unraveling the complex triad theory

Background:The dysregulation of Isocitrate dehydrogenase(IDH)and the subsequent production of 2-Hydroxyglutrate(2HG)may alter the expression of epigenetic proteins in Grade 4 astrocytoma.The interplay mechanism between IDH,O-6-methylguanine-DNA methyltransferase(MGMT)-promoter methylation,and protein methyltransferase proteins-5(PRMT5)activity,with tumor progression has never been described.Methods:A retrospective cohort of 34 patients with G4 astrocytoma is classified into IDH-mutant and IDH-wildtype tumors.Both groups were tested for MGMT-promoter methylation and PRMT5 through methylation-specific and gene expression PCR analysis.Inter-cohort statistical significance was evaluated.Results:Both IDH-mutant WHO grade 4 astrocytomas(n=22,64.7%)and IDH-wildtype glioblastomas(n=12,35.3%)had upregulated PRMT5 gene expression except in one case.Out of the 22 IDH-mutant tumors,10(45.5%)tumors showed MGMT-promoter methylation and 12(54.5%)tumors had unmethylated MGMT.All IDH-wildtype tumors had unmethylated MGMT.There was a statistically significant relationship between MGMT-promoter methylation and IDH in G4 astrocytoma(p-value=0.006).Statistically significant differences in progression-free survival(PFS)were also observed among all G4 astrocytomas that expressed PRMT5 and received either temozolomide(TMZ)or TMZ plus other chemotherapies,regardless of their IDH or MGMT-methylation status(p-value=0.0014).Specifically,IDH-mutant tumors that had upregulated PRMT5 activity and MGMT-promoter methylation,who received only TMZ,have exhibited longer PFS.Conclusions:The relationship between PRMT5,MGMT-promoter,and IDH is not tridirectional.However,accumulation of D2-hydroxyglutarate(2-HG),which partially activates 2-OG-dependent deoxygenase,may not affect their activities.In IDH-wildtype glioblastomas,the 2HG-2OG pathway is typically inactive,leading to PRMT5 upregulation.TMZ alone,compared to TMZ-plus,can increase PFS in upregulated PRMT5 tumors.Thus,using a PRMT5 inhibitor in G4 astrocytomas may help in tumor regression.

血清CXCL5、sICAM-1与非肌层浸润性膀胱癌患者术后转归的相关性

目的探析血清趋化因子配体5(CXCL5)、可溶性细胞间黏附分子-1(sICAM-1)与非肌层浸润性膀胱癌(NMIBC)患者术后转归的关系。方法采用便利抽样法,选取118例接受手术治疗的NMIBC患者,术后对患者进行为期1年的随访,观察患者无瘤生存期。比较不同CXCL5、sICAM-1水平的患者临床病理特征和无瘤生存期情况;采用COX回归验证血清CXCL5、sICAM-1水平与患者术后无瘤生存期的关系;采用Kaplan-Meier生存分析检验不同CXCL5、sICAM-1水平患者的无瘤生存期。结果经双变量Pearson相关系数检验,NMIBC患者血清CXCL5、sICAM-1水平之间呈正相关(γ=0.328,P<0.001)。血清CXCL5、sICAM-1高表达组中NMP22≥10 U/ml、低分化患者占比高于低表达组,差异有统计学意义(P<0.05);但血清CXCL5、sICAM-1不同表达组的年龄、性别、TNM分期、病灶大小及病灶数量比较,差异无统计学意义(P>0.05)。118例NMIBC患者中,经为期1年的随访,有34例出现复发,复发率为28.81%;经单因素和多因素COX回归分析结果显示,血清CXCL5、sICAM-1水平与NMIBC患者无瘤生存情况有关(P<0.05);血清CXCL5、sICAM-1水平高表达组的总体无瘤生存时间均低于低表达组,差异有统计学意义(P<0.05)。结论血清CXCL5、sICAM-1水平与NMIBC患者术后转归具有一定的相关性。

Thirty-one patients with primary hepatocellular carcinoma survived for more than 5 years after hepatectomy

Objective: To investigate the factors affecting progno- sis of patients with primary hepatocellular carcinoma (PHC) after resection. Methods: From 1976 to 1992, 213 patients with PHC treated with hepatectomy were followed up for more than 5 years. Thirty-one of the patients who had sur- vived for more than 5 years were compared with 56 patients who had survived for less than 5 years. Results: Early detection of tumor, radical resection, number of tumors, capsule formation, operation safe distance, presence of portal tumor embolus, pre- sence of cirrhosis and tumor size were important fac- tors affecting the prognosis of patients with PHC. The proportion of small liver cancer in the patients who had survived for more than 5 years was greatly larger than that in the control group. Conclusions: Early detection of tumor and radical re- section are of value in raising the 5-year survival rate. Much remains to be investigated about the rela- tionship between safe margin distance and prognosis of patients with PHC.

survivin反义核酸增强PANC-1细胞对5-Fu敏感性的研究

目的研究survivin反义核酸诱导胰腺癌细胞株PANC1的凋亡和增强对5Fu敏感性的影响。方法我们应用构建的survivin反义核酸真核表达载体电转染PANC1细胞,RTPCR检测survivinmRNA表达,细胞计数和MTT实验测定转染后细胞对5Fu敏感性,流式细胞仪检测细胞凋亡。结果survivin反义核酸可抑制PANC1细胞中survivinmRNA的表达,并能抑制PANC1细胞生长,提高PANC1对5Fu敏感性,流式细胞仪检测凋亡率明显增加。结论survivin反义核酸能增强5Fu诱导的PANC1细胞凋亡,联合survivin反义核酸和5Fu可以改善胰腺癌的治疗效果。

卵巢癌组织中长链非编码RNA生长阻滞特异性抑制物5、微小RNA-205的表达及意义

目的分析长链非编码RNA(lncRNA)生长阻滞特异性抑制物5(GAS5)、微小RNA-205(miR-205)在卵巢癌组织中的表达及其临床意义。方法前瞻性收集2019年1月至2020年6月收治的初诊卵巢癌患者于术中取其癌组织和癌旁组织(距肿瘤边缘>2cm);采用实时荧光定量PCR法检测lncRNA GAS5、miR-205表达情况;问卷调查法统计患者临床病理资料;术后随访2年(截止时间至2022年6月),统计患者生存时间。比较癌组织和癌旁组织lncRNA GAS5、miR-205表达,并采用Pearson相关分析lncRNA GAS5与miR-205的关系;以癌组织lncRNA GAS5、miR-205表达的中位数将卵巢癌患者分为lncRNA GAS5与miR-205高表达组和低表达组,比较不同病理特征卵巢癌患者lncRNA GAS5、miR-205高表达、低表达情况;比较不同lncRNA GAS5、miR-205表达情况的卵巢癌患者生存时间。结果共82例卵巢癌患者纳入本次研究,其中2例失访,最终80例患者进入本次研究。卵巢癌组织lncRNA GAS5相对表达量小于癌旁正常组织,miR-205相对表达量大于癌旁正常组织(P<0.05);Pearson相关分析显示,卵巢癌组织中lncRNA GAS5相对表达量与miR-205相对表达量呈负相关(r=-0.606,P<0.001)。lncRNA GAS5高表达45例,低表达35例;miR-205高表达40例,低表达40例。Ⅲ~Ⅳ期、伴淋巴结转移的卵巢癌患者的卵巢组织中lncRNA GAS5低表达率高于Ⅰ~Ⅱ期、无淋巴结转移患者(P<0.05);Ⅲ~Ⅳ期、伴淋巴结转移的卵巢癌患者的卵巢组织中miR-205高表达率高于Ⅰ~Ⅱ期、无淋巴结转移患者(P<0.05)。lncRNA GAS5低表达量卵巢癌患者2年生存时间(21.50±0.89)个月,低于高表达患者(23.89±0.09)个月(χ2=5.150,P=0.023)。miR-205高表达量卵巢癌患者2年生存时间(21.71±0.79)个月,低于低表达患者(23.98±0.03)个月(χ2=6.337,P=0.012)。结论lncRNA GAS5、miR-205在卵巢癌组织表达存在一定的差异,其中lncRNA GAS5低表达,miR-205高表达,并影响卵巢癌患者的临床病理特征和预后。

食管癌内镜活检组织中Survivin和Mcm5的表达及临床意义

目的研究凋亡抑制因子survivin和增殖因子Mcm5在食管鳞癌发生发展过程中表达的意义及其相互关系。方法采用免疫组织化学(S-P)法检测了85例食管胃镜活检存档蜡块标本中survivin和Mcm5的表达情况,其中11例食管正常黏膜,9例不典型增生,10例原位癌及55例浸润癌。结果食管活检组织中,survivin和Mcm5蛋白在由正常向癌转变的过程中,表达逐渐增高,两者在正常黏膜中的表达均明显低于不典型增生、原位癌及浸润癌(P<0.05);survivin蛋白表达与Mcm5蛋白表达之间呈正相关关系(P<0.01)。结论食管癌的发生发展过程涉及凋亡抑制因子survivin的激活及增殖因子Mcm5功能的增强,同时检测胃镜活检标本中两个指标有助于提高食管癌早期诊断的阳性率。

单中心卵巢癌患者5年生存率随访报告

目的:分析单一妇科肿瘤中心卵巢癌患者的生存情况,为卵巢癌诊治工作提供有用经验。方法:汇总2011年至2016年于山东大学齐鲁医院接受治疗的920例卵巢癌患者的临床数据及随访信息,所有患者随访周期超过5年或5年内出现不良结局事件,分析患者预后情况。结果:2011年至2016年本中心卵巢癌患者总体5年生存率为50.8%。结论:山东大学齐鲁医院卵巢癌患者总体5年生存率显著改善。

Nanomolar concentration of alpha-synuclein enhances dopaminergic neuronal survival via Akt pathway

Although alpha-synuclein is generally thought to have a pathological role in Parkinson＇s disease, accumulative evidence exists that alpha-synuclein has a neuroprotective effect. The aim of this study was to evaluate the effect of extracellular alpha-synuclein on dopaminergic cell survival. We assessed cell viability using the 3-（4,5-dimethyt-thiazol-2-yt）-2,5-diphenyltertazolium bromide （MTT） assay both in undifferentiated SH-SY5Y （SHSY） cells and neuronally-differentiated SH-SY5Y （ndSHSY） cells after 24 hour treatment with monomeric alpha-synuclein at various concentrations （0 [control], 50, 100 nmol/L, 1 IJmol/L）. To determine whether cell viability assessed by MTT assay was affected by cell proliferation, 5-bromo-2＇-deoxyuridine （BrdU） incorporation assay was per- formed. Level of both Akt and phosphorylated Akt was measured using western blot method in ndSHSY cells with or without 24 hour alpha-synuclein treatment. Cell viability was increased in ndSHSY cells at the nanomolar concentration of alpha-synuclein, but not in SHSY cells. Proportion of BrdU-positive ndSHSY cells was decreased in alpha-synuclein-treated group compared with control group. Level of phosphorylated Akt in alpha-synuclein-treated group was higher compared with the control group. Our study shows that extracellular alpha-synuclein at nanomolar concentra- tion benefits dopaminergic cell survival via Akt pathway.

Serum VEGFR-3 and survival of advanced gastric cancer patients treated with FOLFOX

AIM: To explore if vascular endothelial growth factor receptor-3 (VEGFR-3) and carcinoembryonic antigen (CEA) can predict overall survival in advanced gastric cancer.METHODS: VEGFR-3 level was assessed by enzymelinked immunosorbent assay,and CEA was assessed by chemiluminescence immunoassay in the sera of 81 advanced gastric cancer patients before treatment with oxaliplatin plus 5-fluorouracil and folinic acid.RESULTS: Median survival time in patients with a low serum VEGFR-3 level was significantly longer than in those with a higher VEGFR-3 level (15.4 mo vs 7.7 mo,P < 0.001).Patients with a low CEA level had a longer survival than those with a higher CEA level (15.8 mo vs 8.6 mo,P < 0.001).Thirty-nine patients with low VEGFR-3 and low CEA levels had a median survival of 19.7 mo (P = 0.0006).The hazard ratio for patients with a high VEGFR-3 level was 2.443 (P = 0.002).CONCLUSION: High serum VEGFR-3 level is correlated significantly with poor survival.In patients with a high serum level of VEGFR-3,alternative chemotherapy regimens should be considered.

Laser-assisted dacryocystorhinostomy in nasolacrimal duct obstruction：5-year follow-up

AIM：To evaluate the long-term sucess rate of laserassisted dacryocystorhinostomy （L-DCR） in patients with nasolacrimal duct obstruction （NDO）.METHODS：Forty-one eyes of forty patients aged between 21-85y （mean 56.7y） who underwent L-DCR for the treatment of NDO were included in this retrospective,non-randomized study. The follow-up time was 72mo.Functional sucess was defined as the disappearance of epiphora under normal conditions and the presence of a patent ostium on lacrimal irrigation. Anatomical success was defined as a patent lacrimal passage on syringing besides continuing epiphora. Surgical failure was defined as persistent epiphora and closed ostium.RESULTS：Twenty-seven of 40 patients （67.5%） were female and 13 of 40 patients （32.5%） were male. The NDO was right-sided in 17 （42.5%） patients and left-sided in 22（55%） patients whereas 1 （2.5%） patient had undergone bilateral surgery. In 11 （27.5%） patients there were additional nasal abnormalities requiring simultaneous surgical approach. The average time for L-DCR was 26.50±4.9min（16-39min） and the average total amount of laser energy used was 287±27.9 J （239-367 J）. At the 5y follow-up, anatomical sucess rate was 75.0%（30 patients） and functional success rate was 65.0%（26 patients）, whereas surgical failure was seen in 25%（10 patients）. Revision of surgery was performed in 10 cases （25.0%）; failure of revision surgery was seen in 2 cases（5.0%）.CONCLUSION： Transcanalicular L-DCR is a reliable and fast procedure in the treatment of NDO. It can be alternative to external DCR which is accepted as the gold standard currently. The functional and anatomical success rate is higher in the first months and years, but still satisfactory at fifth year.

胃癌患者血清p53、PDCD-5、survivin表达水平及其联合应用的价值

目的探讨胃癌患者血清p53、程序性细胞死亡分子-5(PDCD-5)、细胞凋亡抑制蛋白存活素(survivin)表达水平及其联合应用的价值。方法选择2012年9月到2015年9月在本院被确诊的108例胃癌患者,收集同期同年龄阶段健康体检者的54例血清样本作为对照组。分析胃癌患者的一般资料,包括年龄、性别、TNM分期、肿瘤大小、肿瘤分化程度、肿瘤浸润深度以及有无淋巴结转移;采用ELISA检测血清样品中p53、PDCD-5和survivin表达水平;治疗后随访患者的生存时间;采用单因素生存分析Kaplan-Meier绘制生存曲线。结果与对照组相比,胃癌患者血清中PDCD-5的表达水平显著下降(P<0.05),p53和survivin的表达水平显著升高(P<0.05);胃癌组患者血清p53、PDCD-5和survivin的表达水平与肿瘤直径、分化程度、浸润深度、TNM分期以及是否合并淋巴结转移有关(P<0.05);生存分析显示,胃癌患者血清中p53、survivin高表达患者3年总生存率和无病生存率显著低于p53、survivin低表达患者(P<0.05);PDCD-5、survivin高表达患者3年总生存率和无病生存率显著高于PDCD-5、survivin低表达患者(P<0.05)。结论胃癌患者血清p53、survivin低表达且PDCD-5高表达可以提高其3年总生存率和无病生存率,临床有望作为其预后标识物。

抗黑色素瘤分化相关基因5抗体阳性皮肌炎患者临床特征及生存分析

目的 探讨抗黑色素瘤分化相关基因5抗体阳性皮肌炎(MDA5+DM)患者的临床特征及与生存时间的关系。方法 回顾性分析2014年12月—2021年12月南京医科大学炎性肌病及结缔组织病相关间质性肺病专病联盟共249例抗MDA5阳性皮肌炎患者的临床资料,采用t检验、Mann-Whitney U检验、χ2检验分析死亡患者临床特征,应用Kaplan-Meier法计算累计生存率,Log-rank法比较生存率及COX模型法多因素分析。结果 本组MDA5+DM患者死亡率为24.1%(60/249),死亡组男性比例、平均年龄高于非死亡组,实验室检查天冬氨酸氨基转移酶(glutamic oxaloacetic transaminase, AST)、乳酸脱氢酶(lactate dehydrogenase, LDH)、肌酸激酶(creatine kinase, CK)、C-反应蛋白(C-reactive protein, CRP)、血清铁蛋白(serum ferritin, SF)水平、抗Ro52抗体阳性率及高滴度抗MDA5抗体比例在死亡组中均明显升高,快速进展型间质性肺病(rapidly progressive interstitial lung disease, RPILD)发生率高于非死亡组,但关节炎发生率低于非死亡组,差异有统计学意义(P<0.05)。Log-rank单因素分析显示,抗MAD5抗体滴度、性别、年龄、LDH、CK、CRP、SF、抗Ro52抗体阳性、关节炎、皮疹、RPILD与MDA5+DM患者的生存情况相关(P<0.05);其中,年龄、CK、CRP、关节炎与MDA5+DM伴RPILD患者的生存期相关(P<0.05)。COX多因素分析提示,CK、CRP升高及抗Ro52抗体阳性是MDA5+DM预后的独立危险因素(P<0.05);CK、CRP升高是MDA5+DM伴RPILD亚组预后的独立危险因素(P<0.05),而关节炎是预后良好因素(HR=0.427,P<0.05)。结论 MDA5+DM患者死亡率较高,伴RPILD的患者生存期更短,CK、CRP升高及抗Ro52抗体阳性可能增加死亡风险,而关节炎的存在可能是预后良好因素。