MedNexus
2023年 · 第09卷第01期
MedNexus
胃肠道癌症难以治愈，复发率高，占全球癌症相关发病率和死亡率的50%以上。
Ductal carcinoma in situ with microinvasion (DCIS-MI) is defined as ductal carcinoma in situ (DCIS) with a microscopic invasive focus ≤1 mm in the longest diameter. The current literature is controversial concerning the clinical prognostic features and management of DCIS-MI. This narrative review described recently reported literature regarding the characteristics, treatment, and prognosis of it.
Searching PubMed for relevant articles covering the period of 1982 to 2021 using the following terms by MeSH and free-word: breast cancer, microinvasion, DCIS, DCIS-MI, and invasive ductal carcinoma (IDC).
DCIS-MI tends to express more aggressive pathological features such as necrosis, HER2+, ER- or PR-, and high nuclear grade. The overall prognosis of DCIS-MI is typically good, however, some indicators such as young age, HR-, HER2+ and multimicroinvasive lesions, were associated with worse prognoses. And there are also conflicting results on the differences between the prognoses of DCIS-MI and DCIS or T1a-IDC. Postoperative chemotherapy and anti-HER2 therapy still have uncertain benefits and are more likely to be used to treat high-risk patients who are HR- orHER2+ to improve the prognosis.
DCIS-MI has more aggressive pathological features, which may suggest its biological behavior is worse than that of DCIS and similar to early IDC. Although the overall prognosis of DCIS-MI is good, when making decisions about adjuvant therapy clinicians need to give priority to the hormone receptor status, HER2 expression and axillary lymph node status of patients, because these may affect the prognosis and treatment response.
Obesity and diabetes mellitus are common metabolic diseases prevalent worldwide. Mice are commonly used to study the pathogenesis of these two conditions. Obesity and diabetes mellitus are induced by administering a high-fat diet in many studies although other diet-induced models are also used. Several factors may influence the outcome of the studies done to study diet-induced obesity in mice. The immune system plays a crucial role in the susceptibility of mice to develop obesity and metabolic disease. In this article, the reasons for differences in susceptibility to develop obesity and diabetes mellitus in mice in response to high-fat-diet feeding and the influence of immunological bias of the mice strain used in studies are evaluated. Mice strains that induce proinflammatory and Th1-type immune responses are found to be susceptible to high-fat-diet-induced obesity. A few studies which directly compared the effect of a high-fat diet on obesity and diabetic phenotype in Th1- and Th2-biased mice strains were briefly analyzed. Based on the observations, it is proposed that the liver and adipose tissue may respond differently to high-fat-diet feeding regimens in Th1- and Th2-biased mice strains. For instance, in Th1-biased mice, adipose tissue fat content was high both in the baseline as well as in response to a high-fat diet whereas in the liver, it was found to be less. It can be inferred that the immune responses to diet-induced models may provide insights into the pathogenesis of obesity and diabetes mellitus.
The overall 5-year survival rate for esophageal cancer patients in low- and middle-income countries was reported to be low, despite the availability of advanced treatments. Thus, this study aimed to assess determinants of survival outcomes among esophageal cancer patients in Kenya.
A retrospective cohort study was employed among 299 adult esophageal cancer patients. The data were collected using a data abstraction tool consisting of patients’ clinical characteristics and survival outcome measuring parameters. Statistical Package for the Social Sciences (SPSS) statistical software (version 20.0, IBM. USA) was used to analyze the data. The Kaplan–Meier and Cox regression analyses were used to determine the survival outcome and determinants of mortality, respectively.
The mortality rate was 43.1%, and 11.1% of patients demonstrated distant metastases in the follow-up period. Despite treatment, 20.1% had progressed disease, and 13.0% did not respond to treatment. Radiotherapy (AHR: 3.3, 95% CI: 1.4-7.8, p = 0.007), chemotherapy (AHR: 3.9, 95% CI: 1.2-6.1, p = 0.020), and chemoradiation (AHR: 5.6, 95%CI: 1.6-10.2, p = 0.006) were the significant determinants of survival in advanced stage (III and and IV) patients.
There was a high mortality rate, disease progression, and nonresponse of esophageal cancer patients. Hence, it is essential to improve the survival of patients through early detection and timely initiation of the available treatment options.
The differential diagnosis of mucoepidermoid carcinoma (MEC) from neoplasm undergoing mucinous features brings more pitfalls to pathologists. Combining specific MAML2 gene rearrangement and histological characteristics may be the solution.
Twenty-five tumors with mucinous components were selected for differential diagnosis of MEC. All the cases were detected for MAML2 gene rearrangement. The cases diagnosed as MEC were classified into four variants: classic, oncocytic, Warthin-like, and nonclassified, and they were graded using the Brandwein system. The histological characteristics of non-MECs were summarized for differential diagnosis. Univariate survival analysis was performed on MECs.
There were 16 MECs; 62.5% were MAML2 rearranged. For the low-, intermediate-, and high-grade MECs, the rate of rearrangement was 83.3%, 100%, and 28.6%, respectively. Both the oncocytic and Warthin-like MECs were MAML2 rearranged. For the classic and nonclassified MECs without MAML2 rearrangement, non-keratinized squamoid cells and distinctive mucinous cells were essential diagnostic criteria. On survival analysis, all the disease progression occurred in high-grade MECs (p = 0.038). Nine cases were diagnosed as non-MECs: pleomorphic adenoma with mucinous metaplasia showed no ex-capsular involvement; metaplastic Warthin tumor appeared with overt keratinization and residual oncocytic bilayered epithelium; mix squamous cell and glandular papilloma showed an endobronchial papillary growing pattern; adenosquamous carcinoma was accompanied by squamous carcinoma in situ of the overlying mucosa. All the non-MECs were negative for MAML2 rearrangement.
The application of combining MAML2 rearrangement and histological characteristics is helpful in the differential diagnosis between MEC and other tumors with mucinous components.
The objective of this study was to understand the uptake of hemopoietic stem cell transplantation (HSCT) in neuroimmunological disorders like multiple sclerosis (MS).
An independent University affiliated research organization conducted a global online survey of people having had HSCT, examining demographics, treatment protocol, and effectiveness.
Of 271 participants, useful data were available in 223; women aged 35–54 accounted for 73.5%. Most had a household income greater than US$50,000, and the majority of participants were from Australia and the United States. Nearly 94.6% of people suffer from MS. Most had their treatment in Russia (38.7%) and 78.1% had nonmyeloablative transplants. Nearly half of the participants spent between US$50,000 to US$74,999. There were 54.5% of neurologists who did not support their patients having HSCT. Around 85.5% of participants believed HSCT helped them manage their disease from weeks to years after transplantation, and treatment was recommended by 9.5% of participants. The average reduction in Expanded Disability Status Score after transplantation was 1.2 (95% CI: 0.97–1.41; N= 197; p < 0.01; t: 10.7, df: 196).
Participants were supportive of HSCT despite the costs and would recommend it to others. The data suggest some benefit in minimizing disability in MS and provides justification for large randomized controlled trials.
Noncommunicable diseases (NCDs) place a heavy burden on populations globally and in particular, on lower-income countries (LIC). WHO identified a package of 16 "best buy" lifestyle and management interventions that are cost-effective and applicable in all settings. The purpose of this study was to evaluate and compare NCD risk factors in all WHO countries and make preliminary assessment of "best buy" interventions.
Risk factors estimation was made in 188 countries. NCD attributable "best buys" concern tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol. Management issues are based on the availability of the national NCD guidelines and provision of drug therapy.
Every fourth adult in high-income countries (HIC) has raised blood pressure (RBP). Prevalence of RBP in lower-middle-income countries (LMIC) and LIC is 22%–23% (HIC/LMIC: t= 3.12, p < 0.01). Prevalence of diabetes in LIC is less than half of that in HIC and upper-middle-income countries (UMIC) UMIC/LIC: t= 8.37, p < 0.001. Obesity prevalence is gradually decreasing from HIC to LIC (HIC/LIC: t= 11.48, p < 0.001). Highest level of physical inactivity is seen in HIC, which then gradually declines to LIC (17%). Tobacco prevalence in LIC is almost less than half of that in HIC and UMIC (HIC/LIC: t= 7.2, p < 0.0001). There is a gradual decline in the implementation of "best buys" from HIC to LIC.
Wealthier countries have better implementation of the WHO NCD prevention strategy.
最普遍的年龄相关运动疾病帕金森病（PD）的特征是运动迟缓、静息性震颤、步态不平衡、肌肉僵硬、姿势不稳定以及一些非运动症状，如自主神经和认知功能障碍。
对小编来说，
本期目次
