低级别胶质瘤继发性癫痫的易感脑区

低级别胶质瘤患者常常伴有频繁的癫痫发作，但对于这些患者发生癫痫的机制仍然知之甚少。已有研究 提示肿瘤位置与癫痫起始相关，然而，这些相关性研究是基于肿瘤是否累及某个脑叶的二分类数据计算，这种情况 下病变和症状的相关性可能被错误解释。在基于脑叶的分类研究中，由于病灶占位的精确位置和体积被忽略，肿瘤 累及多个脑叶的病例可能被重复计数，不同脑区癫痫易感性的差异不易被发现。基于体素的研究可以将病灶的精确 范围纳入研究模型，从而避免分类统计中的偏倚。基于体素的影像学分析发现低级别胶质瘤累及左侧运动前区的患 者癫痫发生风险明显增加。     

Rapamycin and bafilomycin A1 alter autophagy and megakaryopoiesis

Autophagy is an effective strategy for cell development by recycling cytoplasmic constituents. Genetic deletion of autophagy mediator Atg7 in hematopoietic stem cells (HSCs) can lead to failure of megakaryopoiesis and enhanced autophagy has been implicated in various hematological disorders such as immune thrombocytopenia and myelodysplastic syndrome. Here, we examined the hypothesis that optimal autophagy is essential for megakaryopoiesis and thrombopoiesis by altering autophagy using pharmacological approaches. When autophagy was induced by rapamycin or inhibited by bafilomycin A1 in fetal liver cells, we observed a significant decrease in high ploidy megakaryocytes, a reduction of CD41 and CD61 co-expressing cells, and less proplatelet or platelet formation. Additionally, reduced cell size was shown in megakaryocytes derived from rapamycin, but not bafilomycin A1-treated mouse fetal liver cells. However, when autophagy was altered in mature megakaryocytes, we observed no significant change in proplatelet formation, which was consistent with normal platelet counts, megakaryocyte numbers, and ploidy in Atg7^flox/flox PF4-Cre mice with megakaryocyte- and platelet-specific deletion of autophagy-related gene Atg7. Therefore, our findings suggest that either induction or inhibition of autophagy in the early stage of megakaryopoiesis suppresses megakaryopoiesis and thrombopoiesis.     

连续护理对行正中切口双侧疝修复术高龄患者应用的体会

目的总结连续护理干预在高龄患者行正中切口双侧疝修复术中的应用体会。 方法回顾性分析2016年1～10月于南京医科大学附属南京医院行正中切口腹膜前间隙无张力疝修补术的40例高龄双侧疝患者的资料。总结围手术期护理过程中的连续护理策略。 结果40例患者术中生命体征平稳、术程顺利，手术时间40～60 min，出血量20～50 ml；术后患者恢复良好，随访24个月，无复发。 结论连续护理能够为高龄患者提供持续的护理关怀和支持，能够使患者以轻松、平静的状态来接受手术，并协助其安全度过手术期。     

运用循证护理探讨3M液体敷料降低PICC置管患者接触性皮炎的效果观察

目的 运用循证护理的方法，探讨应用3M液体敷料对PICC置管患者预防接触性皮炎的效果。方法 将2018年1月~6月入院的40例PICC置管患者作为对照组，常规PICC维护。2018年7月~12月入院的40例PICC置管患者作为观察组。在常规方法消毒后，涂一层3M液体敷料，待干后，再贴无菌透明敷料，每七天维护一次，有渗血渗液及时更换。比较两组患者接触性皮炎发生率、换药次数及维护费用。结果 观察组发生皮炎例1例（为轻度），对照组发生皮炎11例（轻度皮炎8例、中度2例、重度1例），轻、中度皮炎发生率差异有统计学意义（P<0.05）。观察组PICC维护次数和总的维护费用均低于对照组，差异有统计学意义（P<0.05）。结论 3M液体敷料的使用能降低PICC患者接触性皮炎的发生率，提高患者带管过程中的舒适度，减少费用支出，减少护士换药工作量，有效改善患者临床结局。     

Gankyrin plays an essential role in estrogen-driven and GPR30-mediated endometrial carcinoma cell proliferation via the PTEN/PI3K/AKT signaling pathway

Gankyrin has been implicated in the formation of multiple cancer types, although its roles in estrogen-driven endometrial carcinoma remain unclarified. We evaluated the expression of Gankyrin in endometrial tissues and further explored its roles in estrogen-driven and GPR30-mediated endometrial cancer cell proliferation. Gankyrin was overexpressed in endometrial carcinoma tissues and showed an inverse relationship with the pattern of PTEN expression. The depletion or overexpression of Gankyrin induced endometrial cancer cell proliferation inhibition or expansion, respectively, which was associated with estrogen-driven GPR30 signaling via the PTEN/PI3K/AKT pathway. This study suggests that Gankyrin is functional in endometrial cancer development.     

Management and survival rates in patients with glioma in China (2004–2010): a retrospective study from a single-institution

To analyze the clinical characteristics and prognostic factors in patients with glioma in an academic institute in China. From October 2004 to August 2010, total 1,285 patients were diagnosed as glioma at the Glioma Center of Beijing Tiantan Hospital. Clinical and molecular pathology features and survival rates were analyzed. The median overall survival (OS) times were 78.1, 37.6 and 14.4 months for low-grade glioma (WHO grade II), anaplastic glioma (WHO grade III) and glioblastoma (WHO grade IV), respectively. In patients with low-grade glioma, age, preoperative Karnofsky performance scale (KPS), pathological type, radiotherapy, O⁶-methylguanine-DNA methyltransferase (MGMT) expression and Ki-67 expression, were significantly associated with OS in multivariate analyses; and preoperative KPS and radiotherapy were significantly associated with progression-free survival (PFS). For anaplastic gliomas, age, preoperative KPS, pathological type, extent of resection, radiotherapy, p53 expression and phosphatase and tensin homolog (PTEN) expression were associated with OS. For glioblastomas, age, preoperative KPS, pathology type, extent of resection, radiotherapy and chemotherapy were associated with OS; and age, gender, preoperative KPS, extent of resection, radiotherapy and chemotherapy were associated with PFS. This is the largest survey for glioma management in China to date. We found significant differences in age, presenting symptoms and the expression of p53, MGMT, PTEN, and Ki-67 among patients with different types of glioma. Age, preoperative KPS, tumor grades, radiotherapy, chemotherapy and Ki-67 expression were significantly associated with clinical prognosis.     

Integrated NY-ESO-1 antibody and CD8+ T-cell responses correlate with clinical benefit in advanced melanoma patients treated with ipilimumab

Ipilimumab, a monoclonal antibody against cytotoxic T lymphocyte antigen 4 (CTLA-4), has been shown to improve survival in patients with advanced metastatic melanoma. It also enhances immunity to NY-ESO-1, a cancer/testis antigen expressed in a subset of patients with melanoma. To characterize the association between immune response and clinical outcome, we first analyzed NY-ESO-1 serum antibody by ELISA in 144 ipilimumab-treated patients with melanoma and found 22 of 140 (16%) seropositive at baseline and 31 of 144 (22%) seropositive following treatment. These NY-ESO-1-seropositive patients had a greater likelihood of experiencing clinical benefit 24 wk after ipilimumab treatment than NY-ESO-1-seronegative patients (P = 0.02, relative risk = 1.8, two-tailed Fisher test). To understand why some patients with NY-ESO-1 antibody failed to experience clinical benefit, we analyzed NY-ESO-1-specific CD4(+) and CD8(+) T-cell responses by intracellular multicytokine staining in 20 NY-ESO-1-seropositive patients and found a surprising dissociation between NY-ESO-1 antibody and CD8 responses in some patients. NY-ESO-1-seropositive patients with associated CD8(+) T cells experienced more frequent clinical benefit (10 of 13; 77%) than those with undetectable CD8(+) T-cell response (one of seven; 14%; P = 0.02; relative risk = 5.4, two-tailed Fisher test), as well as a significant survival advantage (P = 0.01; hazard ratio = 0.2, time-dependent Cox model). Together, our data suggest that integrated NY-ESO-1 immune responses may have predictive value for ipilimumab treatment and argue for prospective studies in patients with established NY-ESO-1 immunity. The current findings provide a strong rationale for the clinical use of modulators of immunosuppression with concurrent approaches to favor tumor antigen-specific immune responses, such as vaccines or adoptive transfer, in patients with cancer.     

电针联合玻璃酸钠治疗膝骨关节炎伴关节积液临床研究

目的：观察电针联合玻璃酸钠治疗膝骨关节炎伴关节积液的临床疗效,以及对关节液中基质金属蛋白酶（MMP）-3、MMP-9、MMP-13水平的影响。方法：选取90例膝骨关节炎伴关节积液患者,采用随机数字表法分为针药结合组、药物组、电针组各30例。针药结合组给予电针联合关节腔内注射玻璃酸钠治疗,药物组仅给予关节腔内注射玻璃酸钠治疗,电针组仅给予电针治疗。3组均治疗5周。比较3组临床疗效及治疗前后关节液MMP-3、MMP-9、MMP-13水平和生活质量评分。结果：针药结合组总有效率96.67%,高于药物组及电针组76.67%、73.33%(P<0.05)。治疗后,3组关节液MMP-3、MMP-9、MMP-13水平均较治疗前降低（P<0.05）,针药结合组关节液MMP-3、MMP-9、MMP-13水平均低于药物组、电针组（P<0.05）。治疗后,3组睡眠、精神、日常生活评分均较治疗前升高（P<0.05）,针药结合组睡眠、精神、日常生活评分均高于药物组、电针组（P<0.05）。结论：电针联合玻璃酸钠治疗膝骨关节炎伴关节积液的疗效优于仅使用电针或玻璃酸钠治疗,可显著降低患...