丹参酮ⅡA对肝癌SMMC-7721细胞COX-2表达的影响

目的:观察丹参酮ⅡA对肝癌SMMC-7721细胞生长和凋亡的影响及其作用机制．方法:体外培养肝癌SMMC-7721细胞株,经丹参酮ⅡA(终浓度0．5 mg／L)作用后,采用四唑盐(MTT)比色法检测细胞增殖,透射电镜观察细胞凋亡,流式细胞仪检测细胞凋亡,免疫细胞化学SABC法检测COX-2蛋白表达,放射免疫法检测前列腺素E2(PGE2)含量．结果:丹参酮ⅡA对肝癌细胞的生长有明显的抑制作用,并呈剂量依赖性．以0．5 mg／L作用终浓度抑制作用最明显,其48 h的抑制率为 69．3％,与对照组相比差异有显著性(P<0．01)．电镜下观察,丹参酮ⅡA作用后肝癌细胞表现为细胞皱缩、核染色质浓缩、核碎裂以及凋亡小体形成等凋亡特征性的形态改变．5 mg/ L丹参酮ⅡA作用后,随时间的延长,凋亡率逐渐升高,48 h达到高峰,随后逐渐下降(24,48, 72 h凋亡率分别为7．45％±0．33％、6．59％± 0．45％、4．78％±1．05％),与对照组比较,各处理组都有显著性差异(均P<0．01),丹参酮作用组肝癌细胞COX-2表达明显减少,其培养液中 PGE2的产生量下降,与对照组相比差异均有显著性(P<0．01)．结论:丹参酮ⅡA可能是通过下调COX-2 mRNA的表达水平发挥其对肝癌细胞生长抑制及促进凋亡作用．     

丙戊酸钠对肝癌SMMC-7721细胞增殖和细胞周期的影响及机制

目的:探讨丙戊酸钠(VPA)对人肝癌SMMC-7721细胞增殖、细胞周期及对p21WAF1/CIP1mRNA表达的影响.方法:实验分为空白对照组、PBS组、VPA0.2mmol/L组、VPA1.0mmol/L组和VPA5.0mmol/L组.不同浓度VPA干预人肝癌SMMC-7721细胞24h、48h和72h,采用MTT法检测细胞存活率,流式细胞仪检测细胞周期;干预72h后,用Real-timePCR法检测VPA干预72h后p21WAF1/CIP1mRNA的表达情况.结果:与空白对照组及PBS组比较,不同浓度的VPA作用24h,48h及72h时组肝癌SMMC-7721细胞增殖均出现了不同程度抑制(请将具体数据列出来P<0.05),随着VPA药物浓度升高,细胞增殖抑制作用逐渐增强,随作用时间延长,抑制程度逐渐增强(P<0.05).随药物浓度升高,G1期细胞比例逐渐增多,S期细胞比例逐渐减少,细胞发生G0/G1期阻滞.VPA干预肝癌SMMC-7721细胞72h后,VPA组p21WAF/CIP1mRNA表达较空白对照组及PBS组表达明显升高(请将具体数据列出来P<0.01).结论:VPA可抑制人肝癌SMMC-7721细胞的增殖,且呈时间及剂量依赖性,并诱导出现G0/G1细胞周期阻滞,同时上调p21WAF1/CIP1mRNA的表达.     

survivin反义寡核苷酸对SMMC-7721细胞增殖和凋亡的影响

目的 观察survivin反义寡核苷酸(ASODN)对人肝癌细胞株SMMC-7721增殖和凋亡的影响.方法 人工合成survivin基因ASODN和正义ODN(SODN),并行硫代磷酸化修饰,通过脂质体途径转染SMMC-7721;分别用RT-PCR和Western blot检测survivin mRNA和蛋白表达;用MTT法检测ASODN对SMMC-7721增殖的影响;流式细胞仪检测细胞周期变化及细胞凋亡率;倒置显微镜观察细胞形态变化.结果 SMMC-7721可强表达survivin mRNA和蛋白;ASODN呈浓度依赖性抑制survivin mRNA和蛋白表达及SMMC-7721增殖,诱导细胞凋亡,使细胞阻滞于G2/M期.SODN对survivin mRNA和蛋白及SMMC-7721的增殖、细胞周期无明显抑制作用.结论 脂质体介导转染survivin ASODN可抑制细胞增殖、使细胞阻滞于G2/M期,从而促进细胞凋亡.     

细胞周期依赖性蛋白激酶对体外培养人肝癌细胞侵袭力的影响

目的:探讨CDKs对体外培养的人肝癌细胞SMMC-7721侵袭力的影响及其分子机制.方法:将细胞分为A、B两组(A组用终浓度为0μmol/L Roscovitine.B组用终浓度为32μmol/L Roscovitine,均培养24 h),采用流式细胞术检测PACDKs特异性抑制剂Roscovitine干预后的人肝癌细胞SMMC-7721的细胞周期,并用Transwell小室、划痕实验、PCR技术分别检测处于不同细胞周期下的人肝癌细胞侵袭能力、水平运动能力及uPA、MMP-9mRNA表达.结果:经终浓度为32μmol/L的Roscovitine干预24 h后的人肝癌细胞SMMC-7721处于G0/G1期细胞比例迅速升高(72.19%±0.47%vs 59.22%±0.54%,P<0.05),细胞侵袭能力下降,穿膜细胞数明显减(71.40±5.59 vs 149.60±16.36,P<0.05);细胞水平运动能力明显下降(P<0.05);uPA mRNA的表达下降、但MMP-9mRNA的表达却无明显变化.结论:Roscovitine干预使人肝癌细胞SMMC-7721侵袭能力和水平运动能力下降,其机制可能与肝癌细胞周期时相分布发生改变和uPAmRNA的表达下降有关.     

丹参酮ⅡA对人肝癌细胞TGF-β1基因表达的影响

目的探讨丹参酮ⅡA对人肝癌细胞TGF-β1表达的影响及其抗肿瘤作用机制。方法体外培养SMMC-7721肝癌细胞株，采用倒置相差显微镜、Hoechst 33342染色荧光显微镜观察，以及“梯状”DNA确定凋亡的发生并计算凋亡率；用RT—PCR方法检测肝癌细胞TGF．岛的表达。结果倒置相差显微镜观察可见各试验组细胞的生长不同程度受抑，并可见典型的凋亡形态改变；Hoechst 33342染色可见凋亡细胞核浓染，亮度明显加深或有染色质边集现象，亦可见典型的凋亡小体；提取基因组DNA电泳检测，出现典型的梯状条带；RT—PCR检测显示，丹参酮ⅡA作用48小时后TGF—β1表达量随药物浓度的增大而逐渐减低。结论丹参酮ⅡA可抑制人肝癌细胞SMMC-7721的细胞增殖，促进其凋亡，此作用可能与细胞内TGF-β1表达下调有关。     

蟾毒灵介导JNK信号通路诱导人胰腺癌细胞的凋亡

目的:研究蟾毒灵诱导人胰腺癌细胞凋亡以及凋亡相关基因表达的JNK信号转导通路,揭示其抗胰腺癌的部分机制.方法:MTT法观察蟾毒灵对人胰腺癌BxPC-3细胞的生长抑制作用;0.16、0.32、0.64mg/L蟾毒灵分别作用人胰腺癌BxPC-3细胞48h后,流式细胞仪(flow cytometry,FCM)检测细胞周期和细胞凋亡;Western印迹法检测蟾毒灵作用BxPC-3细胞后SAPK/JNK信号通路的激活情况,荧光定量PCR检测Survivin基因mRNA的表达水平;并比较阻断JNK信号通路后丹参酮ⅡA对胰腺癌细胞凋亡Survivin基因mRNA的表达.结果:MTT法测得蟾毒灵对人胰腺癌BxPC-3细胞具有显著的抑制作用,其作用效果与剂量和作用时间成正相关;0.16、0.32、0.64mg/L浓度蟾毒灵作用人胰腺癌细胞后的细胞凋亡率分别为19.36%±0.39%、40.69%±0.44%、59.63%±1.14%,与对照组2.24%±0.37%比较均有显著性差异(P<0.01);蟾毒灵作用人胰腺癌细胞1h后JNK信号通路被激活,2h达峰值;阻断JNK信号通路后,凋亡率明显降低(P<0.01);0.32mg/L蟾毒灵作用人胰腺癌细胞48h后Survivin mRNA的表达明显下降;阻断JNK信号通路后,蟾毒灵作用人胰腺癌细胞的Survivin mRNA的表达明显上升.结论:蟾毒灵通过JNK信号转导通路下调人胰腺癌BxPC-3细胞Survivin mRNA的表达,可能是其诱导胰腺癌细胞凋亡的机制.     

肝癌细胞放射敏感性与survivin蛋白表达的关系

目的 探讨肝癌细胞放射敏感性与survivin表达的关系.方法 肝癌细胞HepG2和SMMC-7721在接受不同剂量γ射线照射后,分别采用克隆形成法、免疫细胞化学法、流式细胞术、比色法等检测细胞存活率、survivin蛋白表达、细胞周期变化和Caspase-3活性.结果 在2Gy照射下HepG2和SMMC-7721细胞的存活分数分别为0.43±0.01与0.70±0.02,SMMC-7721较HepG2放射抗拒.γ射线对SMMC-7721细胞的G2/M期阻滞时间较HepG2细胞长(48 h对24 h),在阻滞峰各剂量点SMMC-7721细胞的G2/M期比例也更高.γ射线可上调两株肝癌细胞survivin蛋白的表达,照射后48～72 h,SMMC-7721细胞的survivin蛋白表达水平显著高于HepG2细胞(t值为2.81～5.20,P值均＜0.05).而Caspase-3的活化水平在放射敏感的HepG2细胞中更高(t值为6.05～6.72,P值均＜0.01).结论 射线诱导的survivin表达上调及survivin对Caspase-3的负调控可能是SMMC-7721细胞较HepG2细胞放射抗拒的原因之一.     

NRF2/PI3K通路介导肝癌细胞SMMC-7721出现索拉非尼耐药的机制研究

目的探讨NRF2PI3K通路介导肝癌细胞SMMC-7721出现索拉非尼耐药的机制研究。方法建立肝癌细胞系SMMC-7721耐药细胞株SMMC-7721-SR,构建NRF2-siRNA转染肝癌细胞,并给与10μmol/L索拉非尼处理48 h。采用CCK-8法检测细胞活力,采用流式细胞仪检测细胞凋亡,Western blot检测NRF2、Keap1、ARE、p-PI3K和p-Akt蛋白表达水平。Real-Time PCR检测NRF2、Keap1、ARE、p-PI3K和p-Akt基因表达水平。结果索拉非尼明显抑制肝癌细胞SMMC-7721的存活率,促进肝癌细胞SMMC-7721凋亡发生(P0.05)。索拉非尼对SMMC-7721细胞促凋亡作用明显强于SMMC-7721-SR细胞(P0.05)。SMMC-7721-SR细胞中NRF2蛋白水平及mRNA表达明显高于SMMC-7721细胞,Keap1、ARE、PI3K和Akt蛋白水平及mRNA表达明显增加(P0.05)。索拉非尼明显上调SMMC-7721细胞中NRF2蛋白水平及mRNA表达(P0.05)。抑制NRF2 mRNA表达并给予索拉非尼处理后,SMMC-7721-SR细胞存活率明显降低,凋亡率显著升高,Keap1、ARE、p-PI3K和p-Akt蛋白水平及mRNA表达明显降低(P0.05)。结论索拉非尼激活NRF2后诱导肝癌细胞SMMC-7721出现耐药;抑制NRF2可逆转肝癌细胞SMMC-7721对索拉非尼的耐药情况。     

三磷酸腺苷结合盒G2调控肝癌细胞多药耐药的作用

目的探讨三磷酸腺苷结合盒(ABC)G2在肝癌耐药细胞中的表达及其在肝癌细胞耐药中的作用。方法 MTT法检测阿霉素(ADM)作用肝癌SMMC-7721细胞24 h后半数生长抑制浓度(IC50)。利用药物浓度递增细胞培养方法建立肝癌耐药细胞,在SMMC-7721细胞培养液中加入ADM,逐渐提高ADM浓度,浓度从0.001μg/ml提高至0.100μg/ml,使细胞在0.100μg/ml ADM中稳定生长,命名为SMMC-7721/ADM细胞。倒置显微镜下观察SMMC-7721/ADM及其亲代SMMC-7721细胞形态。MTT法检测ADM作用肝癌耐药细胞SMMC-7721/ADM 24 h后的IC50,计算耐药指数。流式细胞术(FCM)检测SMMC-7721/ADM及其亲代SMMC-7721细胞凋亡、周期及细胞中ABCG2蛋白表达水平。结果 ADM对SMMC-7721细胞的IC50=(1.11±0.09)μg/ml。历时3个月时间成功使SMMC-7721/ADM细胞在含0.100μg/ml ADM的细胞培养液中稳定生长,细胞命名为SMMC-7721/ADM。倒置显微镜下观察,SMMC-7721/ADM细胞体积增大,细胞形态变得更不规则。SMMC-7721/ADM与SMMC-7721细胞相比细胞凋亡率无显著差异(P0.05),细胞G0/G1期显著降低(P0.05),细胞S及G2/M期无显著差异(P0.05)。SMMC-7721/ADM与SMMC-7721细胞相比,细胞中ABCG2蛋白表达水平显著增高(P0.05)。结论 ABCG2在肝癌多药耐药细胞中异常增高,高表达的ABCG2参与了肝癌多药耐药的形成。     

辛二酰苯胺异羟肟酸对人肝癌SMMC-7721细胞增殖和凋亡的影响

目的：探讨辛二酰苯胺异羟肟酸（SAHA）对人肝癌细胞株SMMC-7721细胞增殖和凋亡的影响。方法体外培养SMMC-7721细胞,给予不同浓度（2.5、5.0和7.5μmol/L）SAHA处理12~72h,采用噻唑蓝（MTT）比色法检测细胞增殖;加入SAHA（5.0和7.5μmol/L）处理SMMC-7721细胞24h或48h,使用流式细胞仪检测细胞凋亡和细胞周期的变化;采用RT-PCR法检测p53、bcl-2及bax基因mRNA水平;采用分光光度法检测Caspase-3蛋白表达。结果经5.0μmol/L SAHA处理细胞24h和48h时,细胞增殖率较对照下降了25.8%和28.8%,经7.5μmol/L SAHA处理细胞24h和48h时,下降了30.6%和48.6%;经5.0μmol/L或7.5μmol/L SAHA处理细胞24 h后,S期细胞从对照水平（24.33±0.17）%分别显著上升至（32.08±0.160）%和（33.96±0.20）%,（P=0.00）,早期凋亡率均由（0.19±0.04）%显著上升至（1.67±0.59）%和（8.92±0.94）%,（P=0.03）,而在48h后,S期细胞由（24.33±1.18）%分别显著上升至（32.25±0.53）%和（34.61±0.08）%,早期凋亡率由（0.19±0.04）%分别显著上升至（14.49±2.26）%和（26.23±0.55）%,（P=0.00）;SAHA能够上调p53、bax基因mRNA水平,下调bcl-2基因mRNA水平;经5.0μmol/L和7.5μmol/L SAHA处理细胞24h后,Caspase-3蛋白活性由对照水平（0.41±0.07）分别上升至（0.81±0.02）,（P=0.01）和（1.09±0.21）,（P=0.00）,而在处理48 h后,Caspase-3蛋白活性由对照水平分别上升至（1.43±0.23）和（2.01±0.01）,（P均=0.00）。结论 SAHA通过影响p53、bcl-2及bax凋亡相关基因水平及Caspase-3蛋白的活性,对人肝癌细胞株SMMC-7721细胞具有抑制增殖和促进凋亡的作用。     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.     

Secondary aortoduodenal fistula

Aorto-duodenal fistulae （ADF） are the most frequent aorto-enteric fistulae （80%）, presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication （0.3%-2%） of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.     

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV‐positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. Results We recruited 148 spouses of smear‐positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear‐positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15–5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV‐positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV‐positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV‐positive community controls. Of 54 HIV‐positive spouses, 18 completed 6‐month IPT. At 2 year follow‐up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34–3.29). Conclusions Spouses are a high‐risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short‐duration therapy.     

Dénervation rénale pour HTA réfractaire sans anesthésie générale : intérêt d’un protocole MEOPA Morphine. Expérience préliminaire

Renal denervation using the technique of radiofrequency is used only recently for the treatment of resistant hypertension. Normally, it is done under general anesthesia because the ablation point technique is painful. We suggest an alternative to general anesthesia comprising an association of morphin 0.1 mg/kg IV to MEOPA (gas combining oxygen and azot protoxyd) delivered through an oxygen mask. Our series includes 12 consecutive patients treated between October 2011 and June 2013, the first five patients (group 1) have received only an hydroxizin and morphin sedation. Every five have felt the ablation painful, in two cases bearable pain (EVA < 5), in three cases intense (EVA > 5) pain leading to increasing doses of morphin, (total dose of 0.25 mg/kg in two cases, 0.17 mg in one case). For the seven following patients, a protocol including hydroxyzin, morphin and MEOPA given through a mask has been set up. Only one patient has felt a mild pain (EVA 5) leading to an increasing dose of morphin (total dose 0.17 mg/kg). None of the six other patients has felt any pain during the procedure. The average dose of morphin is 0.17 mg/kg in group 1, 0.11 mg/kg in group 2. This is a preliminary study; if confirmed, it will allow a lot of hospitals without on-site possibilities of general anesthesia, to realize such procedures. Conclusion: regarding pain, the procedure of renal ablation was well tolerated for six among seven patients receiving the association MEOPA and IV morphin. In contrast, in the five patients treated only with IV morphin, we observed a less good tolerance to pain and the need to increase the doses of IV morphin.     

Scale‐up of TB and HIV programme collaborative activities in Zambia – a 10‐year review

Objective To review the activities, progress, achievements and challenges of the Zambia Ministry of Health tuberculosis (TB)/HIV collaborative activities over the past decade. Methods Analysis of Zambia Ministry of Health National TB and HIV programme documents and external independent programme review reports pertaining to 2000–2010. Results The number of people testing for HIV increased from 37 557 persons in 2003 to 1 327 995 persons in 2010 nationally. Those receiving anti‐retroviral therapy (ART) increased from 143 in 2003 to 344 304 in 2010. The national HIV prevalence estimates declined from 14.3% in 2001 to 13.5% in 2009. The proportion of TB patients being tested for HIV increased from 22.6% in 2006 to 84% in 2010 and approximately 70% were HIV positive. The proportion of the HIV‐infected TB patients who: (i) started on ART increased from 38% in 2006 to 50% in 2010; (ii) commenced co‐trimoxazole preventive therapy (CPT) increased from 31% in 2006 to 70% in 2010; and (iii) were successfully treated increased to an average of 80% resulting in decline of deaths from 13% in 2006 to 9% in 2010. Conclusions The scale‐up of TB/HIV collaborative programme activities in Zambia has steadily increased over the past decade resulting in increased testing for TB and HIV, and anti‐retroviral (ARV) rollout with improved treatment outcomes among TB patients co‐infected with HIV. Getting service delivery points to adhere to WHO guidelines for collaborative TB/HIV activities remains problematic, especially those meant to reduce the burden of TB in people living with HIV/AIDS (PLWHA).     

C-MET在非小细胞肺癌对表皮生长因子受体酪氨酸激酶抑制剂耐药中的作用研究进展

以表皮生长因子受体(EGFR)为靶点的酪氨酸酶抑制剂(TKI)是近年来非小细胞肺癌(NSCLC)治疗的重大突破.但是随着临床的广泛应用,耐药成为新的难点.新近研究已发现对EGFRTKI的耐药产生主要涉及原癌基因C-MET的扩增突变.C-MET是原癌基因,是蛋白产物肝细胞生长因子/离散离子(HGF/SF)的受体,具有酪氨酸酶活性,C-MET基因扩增激活ErbB3-PI3K信号途径导致NSCLC对EGFR-TKI产生耐药,大量研究证实NSCLC患者对EGFR-TKI耐药约20％归因于C-MET基因扩增.     

Artificial intelligence in pancreaticobiliary endoscopy

Artificial intelligence (AI) applications in health care have exponentially increased in recent years, and a few of these are related to pancreatobiliary disorders. AI‐based methods were applied to extract information, in prognostication, to guide clinical treatment decisions and in pancreatobiliary endoscopy to characterize lesions. AI applications in endoscopy are expected to reduce inter‐operator variability, improve the accuracy of diagnosis, and assist in therapeutic decision‐making in real time. AI‐based literature must however be interpreted with caution given the limited external validation. A multidisciplinary approach combining clinical and imaging or endoscopy data will better utilize AI‐based technologies to further improve patient care.