[The change of quality of life in 52 patients with non-severe aplastic anemia after cyclosporine A therapy]

目的

研究非重型再生障碍性贫血（NSAA）患者接受环孢素A（CsA）治疗前后生活质量的变化，并分析生活质量改善的影响因素。

方法

收集2014年1月至2016年1月在北京协和医院门诊初次治疗、仅使用CsA的NSAA患者，在治疗前和治疗2年后分别填写SF-36量表，与正常中国人模型（常模）比较；并调查评估患者的年龄、性别、文化程度、家庭年收入、付费方式、依从性、治疗前一般健康状况及治疗2年后的疗效，分析其与生活质量改善的关系。

结果

共52例患者符合入组条件，其中男性27例（51.9％），女性25例（48.1％），中位年龄48（21～85）岁。CsA治疗2年，完全治疗反应（CR）15例（28.8％），部分治疗反应（PR）25例（48.1％），无治疗反应（NR）12例（23.1％），治疗总有效率（CR+PR）76.9％。患者治疗前SF-36量表躯体和心理健康得分差于常模（P值均<0.05）。治疗后，躯体方面及总体生活质量虽仍然低于常模（P值均<0.05），但心理健康与常模比较差异无统计学意义（P值均>0.05），精力（VT）、精神健康（MH）得分高于常模［VT：（58.8±20.1）分对（52.3±20.9）分，P＝0.023；MH：（65.9±17.6）分对（59.7±22.9）分，P＝0.014］。不同社会背景与生活质量改善均无显著相关性。起病时体能状况评分（ECOG评分）较低者生活质量改善更大。CsA治疗有效者生活质量均得到显著改善。

结论

NSAA患者生活质量低于常人，CsA治疗可以改善患者的生活质量，尤其是心理健康情况。不同社会背景的患者均可从治疗中获益，而起病较重者获益更大。

Early drain removal does not increase the rate of surgical site infections following an open transversus abdominis release

PURPOSE

Intraoperative drain placement during an open transversus abdominis release (TAR) is common practice. However, evidence detailing the optimal timing of drain removal is lacking. Surgical dogma teaches that drains should remain in place until output is minimal. This practice increases the risk of drain-associated complications (infection, pain, and skin irritation) and prolongs the burden of surgical drain maintenance. The objective of this study is to review infectious outcomes following TAR with early or late drain removal.

METHODS

Patients who underwent an open bilateral TAR from 1/2018 to 1/2020 were eligible for the study. Prior to 2019, one of the two intraoperative drains was left in place at discharge. In 2019, clinical practice shifted to remove both drains at hospital discharge irrespective of output. The rate of infectious morbidity was compared between the two cohorts.

RESULTS

A total of 184 patients were included: 89 late and 95 early drain removal. No differences in wound complications existed between the two cohorts: surgical site occurrence (SSO): 21.3% vs. 18.9% (p = 0.68); surgical site infection (SSI): 14.6% vs. 10.5% (p = 0.40); abscess: 8.9% vs. 4.2% (p = 0.20); seroma: 6.7% vs. 10.5% (p = 0.36); cellulitis: 14.6% vs. 8.4% (p = 0.19%); or SSO requiring procedural intervention (SSOPI): 5.6% vs. 5.2% (p = 0.92). Rates of antibiotic prescription and 30-day readmission were also similar (p = 0.69 and p = 0.89).

CONCLUSIONS

Early removal of abdominal wall surgical drains at discharge irrespective of drain output does not increase the prevalence of infectious morbidity following TAR. It is likely safe to remove all drains at discharge regardless of drain output.

Work after retirement affects elderly mental health and behaviors in Addis Ababa

This study aimed to determine the impact of being without a job post-retirement on mental health (depression, life satisfaction) and behaviors (alcohol and cigarette). A cross-sectional study was conducted on 330 Ethiopians aged 60-69. Compared to workers, retirees without a job reported higher depression, lower life satisfaction, and hazardous drinking (d = .49, .39 and φ = .65, respectively). Hierarchical multiple regression analyses indicated that being without a job post-retirement was associated with depression and life dissatisfaction. Thus, greater emphasis has to be given to improve the mental health and behaviors of retired elderly.

[Effect of posterior lumbar fusion on the degeneration of adjacent segments using cortical bone trajectory screw fixation]

Objective: To compare the degenerative changes of adjacent segments after posterior lumbar fusion surgery using cortical bone trajectory (CBT) screws and pedicle screws (PS) in lumbar spinal degenerative disease. Methods: According to certain inclusion and exclusion criteria, prospective non-randomized study on cases of the single-segment lumbar spinal fusion surgery using cortical bone trajectory screws fixation and pedicle screws fixation in Beijing Chao-Yang Hospital from January 2015 to February 2016 was performed. The intervertebral space height (ISH), foramen height (FH), foramen width (FW), cephalad adjacent segment (CAS) and intervertebral disc degeneration grades at MRI scans were measured before surgery and during follow-up. Clinical symptoms were evaluated by Oswestry Dysfunction Index (ODI) score and pain visual analogue scale (VAS) before and during the follow-up. Radiologic adjacent segment degeneration (R-ASD) and symptomatic adjacent segment disease (S-ASD) patients were diagnosed during the follow-up. Paired sample t test was performed when data were compared before surgery and during follow-up. Results: A total of 69 patients were included in the study, 33 in the CBT group (male/female, 15/18), with an average age of (65±11) years, and 36 in the PS group (male/female, 17/19), with an average age of (64±10) years. The follow-up time was no less than 36 months. At the last follow-up, the ISH of the adjacent segments in the CBT group were not statistically different from that before surgery; the ISH of the adjacent segments in the PS group were significantly reduced compared with that before surgery (t=6.78, P<0.05). The loss of ISH, FH, and FW in the adjacent segments in the CBT group were smaller than those in the PS group, and the differences were statistically significant. During follow-up, 4 cases (12.1%) of R-ASD and no S-ASD were found in the CBT group, while 12 cases (33.3%) of R-ASD appeared in the PS group, which was significantly higher than that in the CBT group (χ(2)=4.35, P=0.04). According to MRI, the adjacent discs of PS group had significantly more severe degeneration at the last follow-up than the CBT group (Z=-2.14, P=0.03). Conclusions: Compared with the PS fixation fusion, the CBT screw fixation can effectively reduce the occurrence of adjacent segment degeneration.

LncRNA LINC02418 regulates proliferation and apoptosis of non-small cell lung cancer cells by regulating miR-4677-3p/SEC61G

OBJECTIVE

Increasing studies indicated that long non-coding RNA (lncRNA) has crucial roles in cancer development, including non-small cell lung cancer (NSCLC). LINC02418 was reported to promote colorectal cancer development. However, whether LINC02418 has a role in NSCLC remains to be explored.

MATERIALS AND METHODS

First, expression level of LINC02418 in NSCLC tissues and normal tissues was analyzed at ENCORI. Moreover, expression level of LINC02418 in NSCLC cells and normal cell was analyzed with quantitative real-time PCR. Cell counting kit-8 assay, transwell invasion assay, and flow cytometry assay were used to analyze cell proliferation, cell invasion, and cell apoptosis.

RESULTS

LINC02418 was found as upregulated expression in both NSCLC tissues and cells. Functional assays showed that LINC02418 knockdown suppressed NSCLC cell proliferation and invasion but promoted cell apoptosis, while the overexpression of LINC02418 exerts opposite effects. Mechanistically, we showed LINC02418 could interact with microRNA-4677-3p (miR-4677-3p) to regulate Sec61 gamma subunit (SEC61G) expression.

CONCLUSIONS

These results indicated that LINC02418 functions as an oncogene, and regulated miR-4677-3p/SEC61G axis to accelerate NSCLC progression.

MicroRNA-149 suppresses the malignant phenotypes of ovarian cancer via downregulation of MSI2 and inhibition of PI3K/AKT pathway

OBJECTIVE

Ovarian cancer (OC) is one of the most lethal gynecologic malignant tumors. Emerging evidence has indicated that the dysregulation of microRNAs (miRNAs/miRs) participates in the OC progression. It has been revealed that miR-149 acts either as an oncogene or a tumour suppressor in various human tumors. The current study focused on the biological roles and potential mechanism of miR-149 in OC.

PATIENTS AND METHODS

Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was performed to examine the level of miR-149 expression in 72 pairs of OC tissues and para-cancerous specimens. We further measured the miR-149 levels in OC cells. As we indicated that miR-149 inhibited OC cell viability, we further explored the roles of miR-149 in OC cell invasion and migration by performing the transwell assays. As we suggested that MSI2 was one target for miR-149 in OC cell lines, the expressions and clinical significance of MSI2 in OC were further investigated.

RESULTS

We first detected miR-149 expressions in the OC tissues using quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) and the data showed that miR-149 was dramatically downregulated in the OC tissue samples in comparison to matched normal tissue samples. Additionally, the downregulation of miR-149 in OC was found to be related to the poor prognosis and malignant clinicopathologic characteristics of patients with OC. MiR-149 overexpression significantly suppressed the OC cell proliferation, invasion, and migration as determined by functional assays, including MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assays and transwell assays. Furthermore, the dual-luciferase reporter assay demonstrated that MSI2 was an efficient target of miR-149 in OC cells. Finally, some findings also revealed that miR-149 exerted its biological function in OC cells via direct regulation of phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT).

CONCLUSIONS

Collectively, miR-149 exerted anti-OC roles at least partially by regulating MSI2 via PI3K/AKT. The findings of this study suggested that miR-149 might be a promising target in the diagnosis and prognosis for OC patients.

Comparing nanoparticle polymeric micellar paclitaxel and solvent-based paclitaxel as first-line treatment of advanced non-small-cell lung cancer: an open-label, randomized, multicenter, phase III trial

BACKGROUND

Polymeric micellar paclitaxel (pm-Pac) is a novel Cremophor EL-free, nanoparticle micellar formulation of paclitaxel. We aimed to compare the efficacy and safety between pm-Pac plus cisplatin and solvent-based paclitaxel (sb-Pac) plus cisplatin in advanced non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

A total of 448 stage IIIB to IV NSCLC patients were randomly assigned (2:1) to receive six 3-week cycles of either pm-Pac (230 mg/m²) plus cisplatin (70 mg/m²; n = 300), followed by dose escalation of pm-Pac to 300 mg/m² from the second 3-week cycle if prespecified toxic effects were not observed after the first cycle, or sb-Pac (175 mg/m²) plus cisplatin (70 mg/m²; n = 148). The primary end point was objective response rate (ORR) assessed by independent review committees (IRCs). The secondary end points included IRC-assessed progression-free survival (PFS), overall survival (OS), and safety.

RESULTS

Patients in the pm-Pac-plus-cisplatin group showed significant improvements in IRC-assessed ORR compared with those in the sb-Pac-plus-cisplatin group (50% versus 26%; rate ratio 1.91; P < 0.0001). Additionally, subgroup analysis showed that a higher ORR was consistently observed in both squamous and nonsquamous histological types. IRC-assessed median PFS was significantly higher in the pm-Pac-plus-cisplatin group than in the sb-Pac-plus-cisplatin group (6.4-month versus 5.3-month; hazard ratio 0.63; P = 0.0001). Median OS was not significantly different between the two groups. The incidence of treatment-related serious adverse events (9% versus 18%; P = 0.0090) was significantly lower in the pm-Pac-plus-cisplatin group than in the sb-Pac-plus-cisplatin group.

CONCLUSION

Pm-Pac plus cisplatin yielded superior ORR and PFS along with a favorable safety profile and should become an option for patients with advanced NSCLC.

CLINICAL TRIAL IDENTIFIER

ClinicalTrials.gov NCT02667743; https://clinicaltrials.gov/ct2/show/NCT02667743.

[Evaluation of the efficacy of cyclosporin A combined with recombined human thrombopoietin for treating patients with non-severe aplastic anemia]

Objectives: To compare the efficacy of cyclosporin A (CsA) alone and CsA combined with recombined human thrombopoietin (rhTPO) in patients with non-severe aplastic anemia (NSAA) . Methods: Data from 83 patients with NSAA between August 2014 and February 2019 were collected retrospectively. The study population included 35 men and 48 women, with a median age of 45 years (14-85 years) . Among them, 57 had been treated with CsA + rhTPO, TPO was administered at 15 000 U QD for 7 days, once a month for 3 months, and the other 26 patients with compatible baseline characters were treated with CsA alone. All the enrolled patients had been treated with CsA for at least 6 months and were followed up for at least 1 year. The efficacy and outcome were compared between the two groups. Results: Total 23 men and 34 women, with a median age of 46 years (14-85 years) were treated with CsA + rhTPO. The median duration of CsA treatment was 17 (8-28) months, and the patients were followed up for a median of 27 (12-45) months. Total 12 men and 14 women, with a median age of 40 years (20-64) were treated with CsA alone. The median duration of CsA treatment was 19 months (9-30 months) , and the median follow-up duration was 29 months (16-66 months) . There was no significant difference in the baseline characteristics of the two groups (P>0.05) . There was no significant difference in the CR and OR rates of the two groups at 1, 3, 6, 12, and 24 months of treatment (P>0.05) . The change in the platelet level for the CsA + rhTPO treated group after 1 month[8 (-12-86) ×10(9)/L vs. 3 (16-57) ×10(9)/L, P=0.029) , 3 months[24 (-6-102) ×10(9)/L vs. 7 (-9-76) ×10(9)/L, P=0.006], and 6 months[33.5 (-4-123) ×10(9)/L vs. 12.5 (-14-109) ×10(9)/L, P=0.048] of treatment was higher than that in the CsA alone group, while no significant difference was found between the two groups at other time points. There was no significant difference in the change in the megakaryocyte level between the two groups[3 (0-4) vs. 2 (0-5) , z=-0.868, P=0.385] after 6 months of treatment. Apart from 10.5% (6/57) of the patients in the CsA + rhTPO treated group who reported soreness at the injection site, there was no other significant difference between the two groups in terms of adverse effects. During the follow-up period, there were two cases of increasing paroxysmal nocturnal hemoglobinuria clone to over 10%, one in the CsA + rhTPO treated group, the other in the CsA alone group; and there was one case of progression to SAA in the CsA + rhTPO treated group; while no case of death or thromboembolic event (TEE) , fibrosis or reticulin proliferation, progression to myelodysplastic syndrome (MDS) , or acute myeloid leukemia was observed in either group. There was one case of progression to SAA in the CsA + rhTPO treated group but none in the CsA alone group. Conclusion: Compared to CsA alone, CsA + rhTPO treatment can accelerate the recovery of the platelet level with acceptable adverse effects.

Assessing cure status prediction from survival data using receiver operating characteristic curves

Survival analysis relies on the hypothesis that, if the follow-up is long enough, the event of interest will eventually be observed for all observations. This assumption, however, is often not realistic. The survival data then contain a cure fraction. A common approach to modelling and analysing this type of data consists in using cure models. Two types of information can therefore be obtained: the survival at a given time and the cure status, both possibly modelled as a function of the covariates. The cure status is often of interest to medical practitioners, and one is usually interested in predicting it based on markers. Receiver operating characteristic, Roc, curves are one way to evaluate the predicted performance; however, the classical Roc curve method is not appropriate since the cure status is partially unobserved due to the presence of censoring in survival data. We propose a Roc curve estimator that aims to evaluate the cured/noncured status classification performance from cure survival data. This estimator, which handles the presence of censoring, decomposes sensitivity and specificity by means of the definition of conditional probability, and estimates these two quantities by means of weighted empirical distribution functions. The mixture cure model is used to calculate the weights. Based on simulations, we demonstrate good performance of the proposed method, and compare it with the classical Roc curve nonparametric estimator that would be obtained if the cure status was fully observed. We also compare our proposed method with the Roc curves of Heagerty et al. (2000) for classical survival analysis. Finally, we illustrate the methodology on a breast cancer dataset.