MicroRNA与乳腺癌侵袭转移的关系

文献报道显示乳腺原位癌与侵袭癌相关microRNA种类既有相同者,也有相异者。乳腺癌相关microRNA对癌变和(或)转移的调控能力有的兼具二者,有的仅具其一。microRNA对乳腺癌侵袭、转移的作用包括调控癌细胞迁徙、侵袭与生存能力,改变微环境与促进血管生成及启动瘤细胞上皮——间质转变。乳腺癌干细胞在microRNA调控下不仅促进乳腺癌发生,也与癌侵袭转移的发生、发展密切相关。

中国大陆麻醉住院医师毕业后教育的探讨

经过近几年在全国部分省市试点后,2015年教育部和卫计委正式通知在全国范围内改变医学教育的现有模式,新的规范化培养（简称规培）已经逐步开展并日渐规范。各专科住院医师规范化培训的目的是培养具有现代医学素质的专职人员,能够胜任现代医学的临床要求。同时对住院医师进行评估和考核已经日趋重要,同样需要通过规范化的方式进行。现将美国麻醉住院医师培训考核模式与国内麻醉住院医师考核方式进行比较。

microRNA与乳腺癌变

乳腺癌变相关microRNA包括肿瘤抑制性与致瘤性两类,前者在癌细胞中表达低于正常细胞,后者对促进细胞增生及抑制细胞分化和(或)凋亡的基因表达加以抑制。mi-croRNA通过调控细胞周期进展、ER、HER、细胞存亡调控分子及其它调控途径(如Sp、FOXO1等),发挥抑瘤与致瘤作用。乳腺癌变相关microRNA及其靶基因组成相互作用的联网,在乳腺癌形成过程中发挥重要的整体作用。乳腺癌的发生与演进是在表达异常的microRNA作用下乳腺癌干细胞发生与扩增的结果。

Optimal timing and route of nutritional support after esophagectomy: A review of the literature

Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy.Variation in practices during the perioperative period exists including the type of nutrition started,the delivery route,and its timing.Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery,which can affect their ability to regain or maintain weight.Methods of feeding after an esophagectomy include total parenteral nutrition,nasoduodenal/nasojejunal tube feeding,jejunostomy tube feeding,and oral feeding.Recent evidence suggests that early oral feeding is associated with shorter LOS,faster return of bowel function,and improved quality of life.Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe,feasible,and cost-effective,albeit with limited data.However,data on anastomotic leaks is mixed,and some studies suggest that the incidence of leaks may be higher with early oral feeding.This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach.No definitive data is currently available to definitively answer this question,and further studies should look at how these early feeding regimens vary by surgical technique.This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.

Then and now: The progress in hepatitis B treatment over the past 20 years

The ultimate goals of treating chronic hepatitis B(CHB)is prevention of hepatocellular carcinoma(HCC)and hepatic decompensation.Since the advent of effective antiviral drugs that appeared during the past two decades,considerable advances have been made not only in controlling hepatitis B virus(HBV)infection,but also in preventing and reducing the incidence of liver cirrhosis and HCC.Furthermore,several recent studies have suggested the possibility of reducing the incidence of recurrent or new HCC in patients even after they have developed HCC.Currently,six medications are available for HBV treatment including,interferon and five nucleoside/nucleotide analogues.In this review,we will examine the antiviral drugs and the progresses that have been made with antiviral treatments in the field of CHB.

Enteral stents for the management of malignant colorectal obstruction

Colorectal cancer(CRC) is the 3rd most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient's quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may beused to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient's condition for curative surgical intervention. An overall complication rate(major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.

Treatment of inflammatory bowel disease:A review of medical therapy

Crohn’s disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases of the gastrointestinal tract. While a cure remains elusive, both can be treated with medications that induce and maintain remission. With the recent advent of therapies that inhibit tumor necrosis factor (TNF) alpha the overlap in medical therapies for UC and CD has become greater. Although 5-ASA agents have been a mainstay in the treatment of both CD and UC, the data for their efficacy in patients with CD, particularly as maintenance therapy, are equivocal. Antibiotics may have a limited role in the treatment of colonic CD. Steroids continue to be the first choice to treat active disease not responsive to other more conservative therapy; non- systemic steroids such as oral and rectal budesonide for ileal and right-sided CD and distal UC respectively are also effective in mild-moderate disease. 6-mercaptopurine (6-MP) and its prodrug azathioprine are steroid-sparing immunomodulators effective in the maintenance of remission of both CD and UC, while methotrexate may be used in both induction and maintenance of CD. Infliximab and adalimumab are anti-TNF agents approved in the US and Europe for the treatment of Crohn's disease, and infliximab is also approved for the treatment of UC.

Baseline HBV DNA level is the most important factor associated with virologic breakthrough in chronic hepatitis B treated with lamivudine

AIM: To identify the factors associated with virologic breakthrough and to select a subgroup of patients who respond well to lamivudine without developing virologic breakthrough (VBT). METHODS: Of 79 patients who had received lamivudine therapy for 9-57 mo, 34 were HBeAg-positive and 45 were HBeAg-negative, 24 developed virologic breakthrough and 55 did not. Clinical and virologic factors were compared between the two groups. RESULTS: The median duration of therapy was 25 (9-57) mo. Virologic breakthrough was defined as a > 1 log HBV DNA increase following initial suppression. When several factors, including gender, duration of infection, baseline HBV DNA, and baseline ALT in HBeAg-positive chronic hepatitis patients were analyzed by logistic regression, the most important predictor of virologic breakthrough was the baseline HBV DNA (r2 = 0.12, P < 0.05). When HBeAg-postitive chronic hepatitis patients were divided into two groups by a point of 6.6 log HBV DNA, the incidence of virologic breakthough between two groups was significantly different. CONCLUSION: Lamivudine may remain an effective first line therapy for those HBeAg-positive patients with a baseline HBV DNA < 6.6 log10 copies/mL.

Diagnostic value of two dimensional shear wave elastography combined with texture analysis in early liver fibrosis

BACKGROUND Staging diagnosis of liver fibrosis is a prerequisite for timely diagnosis and therapy in patients with chronic hepatitis B.In recent years,ultrasound elastography has become an important method for clinical noninvasive assessment of liver fibrosis stage,but its diagnostic value for early liver fibrosis still needs to be further improved.In this study,the texture analysis was carried out on the basis of two dimensional shear wave elastography(2D-SWE),and the feasibility of 2D-SWE plus texture analysis in the diagnosis of early liver fibrosis was discussed.AIM To assess the diagnostic value of 2D-SWE combined with textural analysis in liver fibrosis staging.METHODS This study recruited 46 patients with chronic hepatitis B.Patients underwent 2DSWE and texture analysis;Young's modulus values and textural patterns were obtained,respectively.Textural pattern was analyzed with regard to contrast,correlation,angular second moment(ASM),and homogeneity.Pathological results of biopsy specimens were the gold standard;comparison and assessment of the diagnosis efficiency were conducted for 2D-SWE,texture analysis and their combination.RESULTS 2D-SWE displayed diagnosis efficiency in early fibrosis,significant fibrosis,severe fibrosis,and early cirrhosis(AUC>0.7,P<0.05)with respective AUC values of 0.823(0.678-0.921),0.808(0.662-0.911),0.920(0.798-0.980),and 0.855(0.716-0.943).Contrast and homogeneity displayed independent diagnosis efficiency in liver fibrosis stage(AUC>0.7,P<0.05),whereas correlation and ASM showed limited values.AUC of contrast and homogeneity were respectively 0.906(0.779-0.973),0.835(0.693-0.930),0.807(0.660-0.910)and 0.925(0.805-0.983),0.789(0.639-0.897),0.736(0.582-0.858),0.705(0.549-0.883)and 0.798(0.650-0.904)in four liver fibrosis stages,which exhibited equivalence to 2D-SWE in diagnostic efficiency(P>0.05).Combined diagnosis(PRE)displayed diagnostic efficiency(AUC>0.7,P<0.01)for all fibrosis stages with respective AUC of 0.952(0.841-0.994),0.896(0.766-0.967),0.978(0.881-0.999),0.947(0.835-0.992).The combined diagnosis showed higher diagnosis efficiency over 2D-SWE in early liver fibrosis(P<0.05),whereas no significant differences were observed in other comparisons(P>0.05).CONCLUSION Texture analysis was capable of diagnosing liver fibrosis stage,combined diagnosis had obvious advantages in early liver fibrosis,liver fibrosis stage might be related to the hepatic tissue hardness distribution.

Randomized trial in malignant biliary obstruction:Plastic vs partially covered metal stents

AIM:To compare efficacy and complications of par-tially covered self-expandable metal stent(pcSEMS)to plastic stent(PS)in patients treated for malignant,infrahilar biliary obstruction.METHODS:Multicenter prospective randomized clinical trial with treatment allocation to a pcWallstent(SEMS)or a 10 French PS.Palliative patients aged≥18,for infrahilar malignant biliary obstruction and a Karnofsky performance scale index>60%from 6 participating North American university centers.Primary endpoint was time to stent failure,with secondary outcomes of death,adverse events,Karnofsky performance score and short-form-36 scale administered on a three-monthly basis for up to 2 years.Survival analyses were performed for stent failure and death,with Cox proportional hazards regression models to determine significant predictive characteristics.RESULTS:Eighty-five patients were accrued over 37mo,42 were randomized to the SEMS group and 83patients were available for analyses.Time to stent failure was 385.3±52.5 d in the SEMS and 153.3±19.8 d in the PS group,P=0.006.Time to death did not differ between groups(192.3±23.4 d for SEMS vs211.5±28.0 d for PS,P=0.70).The only significant predictor was treatment allocation,relating to the time to stent failure(P=0.01).Amongst other measured outcomes,only cholangitis differed,being more common in the PS group(4.9%vs 24.5%,P=0.029).The small number of patients in follow-up limits longitudinal assessments of performance and quality of life.From an initially planned 120 patients,only 85 patients were recruited.CONCLUSION:Partially covered SEMS result in a longer duration till stent failure without increased complication rates,yet without accompanying measurable benefits in survival,performance,or quality of life.

Acute interstitial edematous pancreatitis:Findings on non-enhanced MR imaging

AIM: To study the appearances of acute interstitial edematous pancreatitis (IEP) on non-enhanced MR imaging. METHODS: A total of 53 patients with IEP diagnosed by clinical features and laboratory findings were underwent MR imaging. MR imaging sequences included fast spoiled gradient echo (FSPGR) fat saturation axial T1-weighted imaging, gradient echo T1-weighted (in phase), single shot fast spin echo (SSFSE) T2-weighted, respiratory triggered (R-T) T2-weighted with fat saturation, and MR cholangiopancreatography. Using the MR severity score index, pancreatitis was graded as mild (0-2 points), moderate (3-6 points) and severe (7-10 points). RESULTS: Among the 53 patients, IEP was graded as mild in 37 patients and as moderate in 16 patients. Forty-seven of 53 (89%) patients had at least one abnormality on MR images. Pancreas was hypointense relative to liver on FSPGR T1-weighted images in 18.9% of patients, and hyperintense in 25% and 30% on SSFSE T2-weighted and R-T T2-weighted images, respectively. The prevalences of the findings of IEP on R-T T2- weighted images were, respectively, 85% for pancreatic fascial plane, 77% for left renal fascial plane, 55% for peripancreatic fat stranding, 42% for right renal fascial plane, 45% for perivascular fluid, 40% for thickened pancreatic lobular septum and 25% for peripancreatic fluid, which were markedly higher than those on in-phase or SSFSE T2-weighted images (P < 0.001).CONCLUSION: IEP primarily manifests on non-enhanced MR images as thickened pancreatic fascial plane, left renal fascial plane, peripancreatic fat stranding, and peripancreatic fluid. R-T T2-weighted imaging is more sensitive than in-phase and SSFSE T2-weighted imaging for depicting IEP.

评价“胸痛三联排除”的CT冠状动脉血管成像扫描方法在疑有低到中度急性冠状动脉综合征危险的急诊病人64层CT检查中的应用

目的利用冠状动脉CT血管成像“胸痛三联排除”扫描对临床表现提示为急性冠状动脉综合征（ACS）的急诊（ED）病人进行评估，以确定其是否有助于确定这些病人可出院并在30d内预后良好。方法本研究得到了机构审查委员会的批准。病人在人组前均签署知情同意书。共201例有轻至中度ACS患病风险的病人接受了CT冠状动脉血管成像检查。采用一种排除胸痛三联的扫描方法评估冠心病、肺动脉栓塞、主动脉夹层和其他胸部疾病。由于技术问题，

Persistent risk for new, subsequent new and recurrent hepatocellular carcinoma despite successful anti-hepatitis B virus therapy and tumor ablation: The need for hepatitis B virus cure

Hepatitis B virus(HBV) is one of the most significant hepatocarcinogens. The ultimate goal of anti-HBV treatment is to prevent the development of hepatocellular carcinoma(HCC). During the last two decades, with the use of currently available anti-HBV therapies(lamivudine, entecavir and tenofovir disoproxil fumatate), there has been a decrease in the incidence of HBVassociated HCC(HBV-HCC). Furthermore, several studies have demonstrated a reduction in recurrent or new HCC development after initial HCC tumor ablation. However, during an observation period spanning 10 to 20 years, several case reports have demonstrated the development of new, subsequent new and recurrent HCC even in patients with undetectable serum HBV DNA. The persistent risk for HCC is attributed to the presence of covalently closed circular DNA(cccDNA) in the hepatocyte nucleus which continues to work as a template for HBV replication. While a functional cure(loss of hepatitis B surface antigen and undetectable viral DNA) can be attained with nucleos(t)ide analogues, these therapies do not eliminate cccDNA. Of utmost importance is successful eradication of the transcriptionally active HBV cccDNA from hepatocyte nuclei which would be considered a complete cure. The unpredictable nature of HCC development in patients with chronic HBV infection shows the need for a complete cure. Continued support and encouragement for research efforts aimed at developing curative therapies is imperative. The aims of this minireview are to highlight these observations and emphasize the need for a cure for HBV.

Season of the year influences infection rates following total hip arthroplasty

AIM To research the influence of season of the year on periprosthetic joint infections.METHODS We conducted a retrospective review of the entire Medicare files from 2005 to 2014. Seasons were classified as spring, summer, fall or winter. Regional variations were accounted for by dividing patients into four geographic regions as per the United States Census Bureau(Northeast, Midwest, West and South). Acute postoperative infection and deep periprosthetic infections within 90 d after surgery were tracked. RESULTS In all regions, winter had the highest incidence of periprosthetic infections(mean 0.98%, SD 0.1%) and was significantly higher than other seasons in the Midwest, South and West(P < 0.05 for all) but not the Northeast(P = 0.358). Acute postoperative infection rates were more frequent in the summer and were significantly affected by season of the year in the West.CONCLUSION Season of the year is a risk factor for periprosthetic joint infection following total hip arthroplasty(THA). Understanding the influence of season on outcomes following THA is essential when risk-stratifying patients to optimize outcomes and reduce episode of care costs.

Cardiomyopathy in becker muscular dystrophy:Overview

Becker muscular dystrophy(BMD) is an X-linked recessive disorder involving mutations of the dystrophin gene. Cardiac involvement in BMD has been described and cardiomyopathy represents the number one cause of death in these patients. In this paper, the pathophysiology, clinical evaluations and management of cardiomyopathy in patients with BMD will be discussed.

Endoscopic ultrasound-fine needle injection for oncological therapy

The minimal invasiveness and precision of endoscopicultrasound(EUS) has lead to both its widespread use as a diagnostic and staging modality for gastrointestinal and pancreaticobiliary malignancies, and to its expand-ing role as a therapeutic modality. EUS-guided celiac plexus neurolysis is now a well-accepted modality for palliation of pain in patients with pancreatic cancer. EUS-guided ablation, brachytherapy, fiducial marker placement, and antitumor agent injection have been described as methods of performing minimally invasive oncological therapy. EUS-fine needle injection may be performed as adjunctive, alternative, or palliative treatment. This review summarizes the studies to date that have described these methods. A literature search using the Pub Med/MEDLINE databases was performed. While most published studies to date are limited with disappointing outcomes, the concept of a role of EUS in oncological therapy seems promising.

急性脊髓损伤患者治疗的临床操作指南:关于MRI基线在临床治疗决策与结果预测中作用的几点建议（英文）

The objective of this guideline is to outline the role of magnetic resonance imaging(MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury(SCI).Methods A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI.This review focused on longitudinal studies that controlled for baseline neurologic status.A multidisciplinary Guideline Development Group(GDG) used this information,their clinical expertise,and patient input to develop recommendations on the use of MRI for SCI patients.Based on GRADE(Grading of Recommendation,Assessment,Development and Evaluation),a strong recommendation is worded as " we recommend," whereas a weaker recommendation is indicated by "we suggest." Results Based on the limited available evidence and the clinical expertise of the GDG,our recommendations were:(1) "We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention,when feasible,to facilitate improved clinical decision-making"(quality of evidence,very low) and(2) "We suggest that MRI should be performed in adult patients in the acute period following SCI,before or after surgical intervention,to improve prediction of neurologic outcome "(quality of evidence,low).Conclusions These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.

Complementary and alternative medications in hepatitis C infection

Chronic hepatitis C(CHC) infection affects almost 3% of the global population and can lead to cirrhosis, liver failure, and hepatocellular carcinoma in a significant number of those infected. Until recently, the only treatments available were pegylated interferon and ribavirin, which traditionally were not very effective and have considerable side effects. For this reason, interest in complementary and alternative medications(CAM) in the management of hepatitis C has been investigated. Some CAM has demonstrated therapeutic potential in chronic hepatitis C treatment. Unfortunately, some CAM has been shown to have the potential to cause drug-induced liver injury. This article will review and evaluate many of the natural molecules that interact with the hepatitis C virus(HCV) life cycle and discuss their potential use and safety in HCV therapy, as well as highlight some important interactions between medical and complementary treatments.

Proton therapy dosimetry using positron emission tomography

Protons deposit most of their kinetic energy at the end of their path with no energy deposition beyond the range, making proton therapy a valuable option for treating tumors while sparing surrounding tissues. It is imperative to know the location of the dose deposition to ensure the tumor, and not healthy tissue, is being irradiated. To be able to extract this information in a clinical situation, an accurate dosimetry measurement system is required. There are currently two in vivo methods that are being used for proton therapy dosimetry: (1) online or in-beam monitoring and (2) offline monitoring, both using positron emission tomography (PET) systems. The theory behind using PET is that protons experience inelastic collisions with atoms in tissues resulting in nuclear reactions creating positron emitters. By acquiring a PET image following treatment, the location of the positron emitters in the patient, and therefore the path of the proton beam, can be determined. Coupling the information from the PET image with the patient's anatomy, it is possible to monitor the location of the tumor and the location of the dose deposition. This review summarizes current research investigating both of these methods with promising results and reviews the limitations along with the advantages of each method.

PREPARATION OF POLYELECTROLYTE MULTILAYER COATED MICROBUBBLES FOR USE AS ULTRASOUND CONTRAST AGENT

Objective To prepare and characterize polyelectrolyte multilayer film coated microbubbles for use as ultrasound contrast agent(UCA)and evaluate its effects in ultrasonic imaging on normal rabbit's liver parenchyma.Methods Perfluorocarbon(PFC)-containing microbubbles(ST68-PFC)were prepared by sonication based on surfactant(Span 60 and Tween 80).Subsequently,the resulting ST68-PFC microbubbles were coated using oppositely charged polyelectrolytes by microbubble-templated layer-by-layer self-assembly technique via electrostatic interaction.The enhancement effects in ultrasonic imaging on normal rabbit's liver parenchyma were assessed.Results The obtained microbubbles exhibited a narrow size distribution.The polyelectrolytes were successfully assembled onto the surface of ST68-PFC microbubbles.In vivo experiment showed that polyelectrolyte multilayer film coated UCA effectively enhanced the imaging of rabbit's liver parenchyma.Conclusions The novel microbubbles UCA coated with polyelectrolyte multilayer,when enabled more function,has no obvious difference in enhancement effects compared with the pre-modified microbubbles.The polymers with chemically active groups(such as amino group and carboxyl group)can be used as the outermost layer for attachment of targeting ligands onto microbubbles,allowing selective targeting of the microbubbles to combine with desired sites.