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Coenzyme Q10 and resveratrol abrogate paclitaxel-induced hepatotoxicity in rats 辅酶Q10和白藜芦醇可消除紫杉醇引起的大鼠肝毒性
Pub Date : 2019-10-01 DOI: 10.4103/ctm.ctm_31_19
Elias Adikwu, N. Ebinyo, L. Harris
Background: Hepatotoxicity is one of the adverse effects that may characterize the clinical use of paclitaxel (PCL). This study examined the protective effects of coenzyme Q10 (CoQ10) and resveratrol (RSV) on PCL-induced hepatotoxicity in albino rats. Methods: Forty-five adult male albino rats randomized into nine groups of n = 5 were used. Group 1 (placebo control) and Group 2 (solvent control) received 0.2 mL of normal saline and corn oil intraperitoneally (ip) daily for 5 days, respectively. Groups 3–5 received CoQ10 (20 mg/kg), RSV (20 mg/kg), and CoQ10 + RSV ip daily for 5 days, respectively. Group 6 received a dose of 20 mg/kg of PCL ip on the 5th day. Groups 7–9 were pretreated daily with CoQ10 (20 mg/kg), RSV (20 mg/kg), and CoQ10 + RSV ip for 5 days and treated with a dose of PCL on the 5th day, respectively. Rats were sacrificed after treatment; liver samples were estimated for histology and biochemical markers. Serum samples were estimated for liver function markers. Results: The liver of PCL-treated rats showed necrosis which correlates with significant (P < 0.001) increases in serum and liver biochemical indexes; gamma glutamyl transferase, lactate dehydrogenase, bilirubin, aminotransferases, alkaline phosphatase, and malondialdehyde levels when compared to control. Liver superoxide dismutase, catalase, glutathione peroxidase, and glutathione levels were significantly (P < 0.001) decreased in PCL-treated rats when compared to control. Importantly, PCL-induced hepatotoxicity was significantly mitigated in CoQ10 (P < 0.05), RSV (P < 0.01), and CoQ10 + RSV (P < 0.001) pretreated rats when compared to PCL. Conclusion: CoQ10 and RSV were effective against PCL-induced hepatotoxicity in albino rats.
背景:肝毒性是紫杉醇(PCL)临床应用的主要不良反应之一。本研究探讨了辅酶Q10 (CoQ10)和白藜芦醇(RSV)对pcl诱导的白化大鼠肝毒性的保护作用。方法:选取成年雄性白化病大鼠45只,随机分为9组,每组n = 5。组1(安慰剂对照组)和组2(溶剂对照组)分别腹腔注射生理盐水和玉米油0.2 mL,每日5 d。3 ~ 5组每天分别给予辅酶q10 (20 mg/kg)、RSV (20 mg/kg)和辅酶q10 + RSV,连续5 d。第6组于第5天给予PCL注射液20 mg/kg。第7 ~ 9组分别用辅酶q10 (20 mg/kg)、RSV (20 mg/kg)和辅酶q10 + RSV预处理5 d,第5 d用PCL处理1剂量。治疗后处死大鼠;对肝脏样本进行组织学和生化指标的评估。评估血清样本的肝功能指标。结果:pcl处理大鼠肝脏出现坏死,血清及肝脏生化指标显著升高(P < 0.001);谷氨酰转移酶、乳酸脱氢酶、胆红素、转氨酶、碱性磷酸酶和丙二醛水平与对照组比较。与对照组相比,pcl处理大鼠肝脏超氧化物歧化酶、过氧化氢酶、谷胱甘肽过氧化物酶和谷胱甘肽水平显著(P < 0.001)降低。重要的是,与PCL相比,CoQ10 (P < 0.05)、RSV (P < 0.01)和CoQ10 + RSV (P < 0.001)预处理大鼠的PCL诱导的肝毒性显著减轻。结论:CoQ10和RSV对pcl诱导的白化大鼠肝毒性有较好的抑制作用。
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引用次数: 3
Advances on the components of fibrinolytic system in malignant tumors 恶性肿瘤纤维蛋白溶解系统成分的研究进展
Pub Date : 2019-07-01 DOI: 10.4103/ctm.ctm_14_19
Zengzheng Ge, Xiaoyan Xu, Z. Ge, S. Zhou, Xiulin Li, Kai Yao, Lan-qin Deng
The major function of fibrinolytic system is to dissolve the fibrins formed by blood coagulation and maintain the balance between blood coagulation and thrombolysis, which plays an important role in maintaining the liquid state of the blood and unclogging the blood vessels. It is a serious problem that malignant tumor does great harm to human life and health. In recent years, more and more studies signified that the fibrinolytic system in malignant tumors, especially adenocarcinoma, plays a major role in its progression, which indicates that the fibrinolytic system is of great significance in the development of malignant tumors. Besides, the fibrinolytic system has also gradually been known and used to diagnose and treat the adenocarcinoma. This article reviews how the fibrinolytic system works in the occurrence of malignant tumor and summarizes the diagnostic method and treatment of adenocarcinoma according to the latest clinical research progress, laying the foundation for further research.
纤溶系统的主要功能是溶解凝血形成的纤维蛋白,维持凝血与溶栓之间的平衡,对维持血液的液体状态,疏通血管具有重要作用。恶性肿瘤严重危害着人类的生命健康,是一个严重的问题。近年来,越来越多的研究表明,纤维蛋白溶解系统在恶性肿瘤,特别是腺癌的发展中起着重要作用,这表明纤维蛋白溶解系统在恶性肿瘤的发展中具有重要意义。此外,纤维蛋白溶解系统也逐渐被认识并用于腺癌的诊断和治疗。本文综述了纤溶系统在恶性肿瘤发生中的作用,并根据最新的临床研究进展总结了腺癌的诊断方法和治疗方法,为进一步的研究奠定基础。
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引用次数: 0
Protective activity of selenium against 5-fluorouracil-induced nephrotoxicity in rats 硒对5-氟尿嘧啶所致大鼠肾毒性的保护作用
Pub Date : 2019-07-01 DOI: 10.4103/ctm.ctm_26_19
Elias Adikwu, N. Ebinyo, Beauty Amgbare
Background: The nephrotoxic effect of 5-fluorouracil (5-FU) involves alterations in renal function markers and kidney morphology. This study assessed the protective effect of selenium (Se) on 5-FU-induced alterations in renal function markers and kidney morphology in albino rats. Materials and Methods: Forty adult albino rats of (n = 5) used were randomly grouped. Groups B-D received 0.125 mg/kg, 0.25 mg/kg and 0.50 mg/kg of Se intraperitoneally (ip) daily for 5 days, respectively. Group E received 20 mg/kg of 5-FU ip daily for 5 days. Groups F-H received 0.125 mg/kg, 0.25 mg/kg, and 0.5 mg/kg of Se before receiving 20 mg/kg of 5-FU ip daily for 5 days, respectively. Group A (Control) received 0.2 mL of normal saline ip daily for 5 days. Rats were sacrificed on the 6th day, and blood samples were collected and evaluated for markers of serum renal function. Kidneys were assessed for oxidative stress indices and histology. Results: The nephrotoxic effect of 5-FU was characterized by statistically significant (P < 0.001) elevations in creatinine, urea, uric acid, and malondialdehyde levels in comparison to control. Furthermore, significant (P < 0.001) decreases in potassium, sodium, chloride, bicarbonate, glutathione (GSH), catalase, superoxide dismutase, and GSH peroxidase levels were obtained in 5-FU-treated rats in comparison to control. Necroses of kidney tubular epithelial cells and atrophic glomeruli were observed in rats administered with 5-FU. However, 5-FU-induced nephrotoxic changes were significantly downregulated in a dose-dependent fashion in rats supplemented with 0.125 mg/kg (P < 0.05), 0.25 mg/kg (P < 0.01), and 0.50 mg/kg (P < 0.001) of Se when compared to 5-FU treated rats. Conclusion: Supplementation with Se may have clinical benefit in nephrotoxicity caused by 5-FU.
背景:5-氟尿嘧啶(5-FU)的肾毒性作用涉及肾功能标志物和肾脏形态的改变。本研究评估了硒(Se)对5- fu诱导的白化大鼠肾脏功能标志物和肾脏形态改变的保护作用。材料与方法:40只成年白化病大鼠(n = 5)随机分组。B-D组每日分别腹腔注射硒0.125 mg/kg、0.25 mg/kg和0.50 mg/kg,连续5 d。E组每日给予5- fu 20 mg/kg,连用5 d。F-H组分别给予0.125 mg/kg、0.25 mg/kg和0.5 mg/kg硒,然后每天给予20 mg/kg 5- fu,连续5 d。A组(对照组)每日给予生理盐水0.2 mL,连用5 d。第6天处死大鼠,采集血样,测定血清肾功能指标。评估肾脏的氧化应激指数和组织学。结果:与对照组相比,5-FU的肾毒性作用以肌酐、尿素、尿酸和丙二醛水平升高为特征,具有统计学意义(P < 0.001)。此外,与对照组相比,5- fu处理大鼠的钾、钠、氯化物、碳酸氢盐、谷胱甘肽(GSH)、过氧化氢酶、超氧化物歧化酶和谷胱甘肽过氧化物酶水平显著(P < 0.001)降低。5-FU大鼠肾小管上皮细胞坏死,肾小球萎缩。然而,与5-FU处理的大鼠相比,添加0.125 mg/kg (P < 0.05)、0.25 mg/kg (P < 0.01)和0.50 mg/kg (P < 0.001)硒的大鼠,5-FU诱导的肾毒性变化呈剂量依赖性显著下调。结论:补充硒对5-FU所致肾毒性有临床疗效。
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引用次数: 2
A patient with persistent foot swelling after ankle sprain: B-Cell lymphoblastic lymphoma mimicking soft-tissue sarcoma 一例踝关节扭伤后持续足部肿胀患者:模拟软组织肉瘤的b细胞淋巴母细胞淋巴瘤
Pub Date : 2019-07-01 DOI: 10.4103/ctm.ctm_22_19
Crystal Montgomery-Goecker, Andrew A. Martin, C. Timmons, D. Rakheja, V. Rajaram, H. Luu
We describe a case of B-cell lymphoblastic lymphoma with an unusual clinical presentation. A 15-year old male with no significant past medical history presented with persistent foot swelling after an ankle sprain. Imaging revealed a mass in the right foot, which was resected and revealed a diffuse infiltrate of B-lymphoblasts. Peripheral blood and bone marrow examinations revealed no abnormalities. These findings were consistent with B-cell lymphoblastic lymphoma, which is an uncommon disease, accounting for only 2% of lymphomas. This case is a reminder that hematolymphoid malignancies can have presentations that mimic sarcomas with no visible peripheral blood or bone marrow involvement. In addition to describing the clinical and histologic features of this case, we also discuss the challenges that can be encountered when establishing a diagnosis of B lymphoblastic lymphoma
我们报告一个临床表现不寻常的b细胞淋巴母细胞淋巴瘤病例。15岁男性,既往无明显病史,踝关节扭伤后出现持续性足部肿胀。影像显示右脚肿块,切除后发现b淋巴细胞弥漫性浸润。外周血及骨髓检查未见异常。这些发现与b细胞淋巴母细胞淋巴瘤一致,b细胞淋巴母细胞淋巴瘤是一种罕见的疾病,仅占淋巴瘤的2%。这个病例提醒我们,淋巴细胞恶性肿瘤可以有类似肉瘤的表现,没有可见的外周血或骨髓受累。除了描述本病例的临床和组织学特征外,我们还讨论了在确定B淋巴母细胞淋巴瘤诊断时可能遇到的挑战
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引用次数: 0
OSMCC: An online survival analysis tool for Merkel cell carcinoma OSMCC:默克尔细胞癌的在线生存分析工具
Pub Date : 2019-07-01 DOI: 10.4103/ctm.ctm_19_19
U. Saddozai, Qiang Wang, Xiaoxiao Sun, Yifang Dang, Jiajia Lv, Junfang Xin, Wan Zhu, Yongqiang Li, Xinying Ji, Xiangqian Guo
Aims: To develop a free accessible online tool to identify the prognostic markers for Merkel cell carcinoma (MCC) and to estimate the significance of interested gene in a cohort of clinical patients. Settings and Design: R package is used to calculate and plot the Kaplan–Meier survival curve. Subjects and Methods: An online search engine was developed by combining MCC datasets with available anatomoclinical data in Gene Expression Omnibus. In current study, genomic expression profile of thirty patients comprising 42985 probes and 21651 genes was evaluated. Patients were divided into first quartile, second quartile, and third quartile. Information about different cancer patients of varying stages (Stage I–IV) was stored using median survival scale of 14.5 months. Data were stored in SQL Server database and hosted on Windows Server 2008 using Apache Tomcat application server. Statistical Analysis Used: Log-rank test was applied and P < 0.05 was considered statistically significant. Results: An Online Survival analysis tool for MCC abbreviating as OSMCC was developed, which can assess the expression level relevance of various genes on the clinical outcome in MCC patients. By OSMCC, the survival curve could be displayed, and the hazard ratio with 95% confidence intervals and log-rank P value can also be calculated. Conclusions: The study demonstrated the ability of OSMCC to identify and analyze transcriptome and clinical datasets for MCC through prognosis significance analysis. So far, OSMCC is the first advanced and specific tool for the prognostic measurement of MCC. Furthermore, OSMCC can prove to be a highly valuable database for the preliminary assessment and identification of potential MCC prognostic biomarkers. OSMCC is accessible at http://bioinfo.henu.edu.cn/MCC/MCCList.jsp.
目的:开发一个免费的在线工具来识别默克尔细胞癌(MCC)的预后标志物,并估计感兴趣基因在临床患者队列中的意义。设置与设计:使用R软件包计算和绘制Kaplan-Meier生存曲线。对象和方法:将MCC数据集与基因表达Omnibus中可用的解剖临床数据相结合,开发了一个在线搜索引擎。本研究评估了30例患者的基因组表达谱,包括42985个探针和21651个基因。患者被分为第一四分位数、第二四分位数和第三四分位数。采用14.5个月的中位生存期来存储不同分期(I-IV期)的不同癌症患者的信息。数据存储在SQL Server数据库中,使用Apache Tomcat应用服务器托管在Windows Server 2008上。方法:采用Log-rank检验,以P < 0.05为差异有统计学意义。结果:开发了MCC在线生存分析工具(简称OSMCC),可以评估MCC患者中各种基因的表达水平与临床预后的相关性。通过OSMCC可以显示生存曲线,并可以计算95%置信区间的风险比和log-rank P值。结论:本研究通过预后意义分析证明了OSMCC能够识别和分析MCC的转录组和临床数据集。到目前为止,OSMCC是首个用于MCC预后测量的先进和专用工具。此外,OSMCC可以被证明是一个非常有价值的数据库,用于初步评估和鉴定潜在的MCC预后生物标志物。OSMCC可通过http://bioinfo.henu.edu.cn/MCC/MCCList.jsp访问。
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引用次数: 0
Progress in diagnosis and treatment of mixed adenoneuroendocrine carcinoma of biliary-pancreatic system 胆胰混合性腺神经内分泌癌的诊断与治疗进展
Pub Date : 2019-04-01 DOI: 10.4103/ctm.ctm_5_19
Zengzheng Ge, H. Ling, Ming-Feng Li, Xiaoyan Xu, Y. Kai, Tongzhen Xu, Zengyu Ge, L. Zhou
With the application of many kinds of advanced examination techniques, the detectable rate of mixed adenoneuroendocrine carcinoma (MANEC) of the biliary-pancreatic system has increased substantially. This kind of tumor with high degree of malignancy is rarely seen. Thus, the clinical studies are difficult to carry out, most of which are just case reports. Besides, its treatments do not work effectively, albeit the diagnosis and management have changed tremendously. To deepen the understanding of MANEC of biliary-pancreatic system, this article is an overview making a generalization and summarization of the related literature as well as reviewing the main diagnosis and therapies of these rare tumors. In addition, it lays the foundation for clinical diagnosis and treatment in the future.
随着各种先进检查技术的应用,胆胰系统混合性腺神经内分泌癌(MANEC)的检出率大幅提高。这种恶性程度高的肿瘤很少见。因此,临床研究很难开展,大多数只是病例报告。此外,尽管诊断和管理已经发生了巨大的变化,但其治疗并不有效。为加深对胆胰系统MANEC的认识,本文对相关文献进行归纳和总结,并对该类罕见肿瘤的主要诊断和治疗方法进行综述。为今后的临床诊断和治疗奠定基础。
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引用次数: 0
Phosphorylation of BRCA1-associated protein 1 as an important mechanism in the evasion of tumorigenesis: A perspective brca1相关蛋白1的磷酸化在逃避肿瘤发生中的重要机制:一个观点
Pub Date : 2019-04-01 DOI: 10.4103/ctm.ctm_1_19
G. Sharma, Anjali Geethadevi, Jyotsna Mishra, G. Anupa, K. Jadhav, K. Vikramdeo, D. Parashar
The human BRCA1-associated protein 1 (BAP1), a deubiquitinase, is a tumor suppressor protein known to be associated with a multicellular complex containing tumor suppressors, thereby coregulating various cellular processes such as DNA repair, gene transcription, cell cycle progression, and phosphorylation. Mutation and inactivation of BAP1 have long been reported in many malignancies and has been deployed in the prognosis of few malignancies. However, the mechanism of BAP1 regulation and its therapeutic significance have not been thoroughly explored. In addition to deubiquitination, BAP1 also responds to DNA damage and can induce cell death via apoptosis, necrosis, and ferroptosis. The mechanistic insight of BAP1-regulation is a complex subject and its thorough understanding would address the enigma of BAP1 mutation in malignancy. There are various tiers of regulation, though still needs to be explored, of BAP1 activity such as epigenetic regulation and posttranslational modification (PTM). Of various PTMs, posttranslational phosphorylation (PTP) has been poorly understood and meekly addressed in the literature. Here, we aim to provide an updated and integrated understanding of the PTP-mediated BAP1 regulation and its plausible role in cancer prevention. Exploring the functional consequence of BAP1 phosphorylation in its deubiquitinating potential might establish a new paradigm for its regulation in maintaining cellular homeostasis and cancer prevention.
人类brca1相关蛋白1 (BAP1)是一种去泛素酶,是一种肿瘤抑制蛋白,已知与含有肿瘤抑制因子的多细胞复合物相关,从而协同调节各种细胞过程,如DNA修复、基因转录、细胞周期进展和磷酸化。BAP1的突变和失活早已在许多恶性肿瘤中被报道,并在少数恶性肿瘤的预后中得到应用。然而,BAP1的调控机制及其治疗意义尚未被深入探讨。除去泛素化外,BAP1还响应DNA损伤,并可通过凋亡、坏死和铁下垂诱导细胞死亡。BAP1调控的机制是一个复杂的课题,对其透彻的理解将有助于解开恶性肿瘤中BAP1突变的谜团。BAP1活性的调控有不同的层次,但仍需要探索,如表观遗传调控和翻译后修饰(PTM)。在各种ptm中,翻译后磷酸化(PTP)在文献中被理解得很少,也很少被提及。在这里,我们的目标是提供ptp介导的BAP1调控及其在癌症预防中的合理作用的最新和综合理解。探索BAP1磷酸化在其去泛素化潜能中的功能后果可能为其在维持细胞稳态和预防癌症方面的调节建立新的范式。
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引用次数: 1
Alzheimer’s Disease Susceptibility Genes in Malignant Breast Tumors 恶性乳腺肿瘤中的阿尔茨海默病易感基因
Pub Date : 2019-04-01 DOI: 10.4103/2395-3977.261826
S. Lehrer, P. Rheinstein
Background: Cognitive problems have been reported in breast cancer patients after chemotherapy. A small group of older breast cancer survivors carrying the APOE4 gene, receiving chemotherapy, was at increased risk of long-term impairment of brain function. We have analyzed the expression of APOE and the next 23-ranked Alzheimer's disease (AD) susceptibility genes in malignant breast tumors. We wished to determine if these 24 genes might be related to breast cancer. Methods: To identify the most important AD susceptibility genes, we consulted the ALZGENE database (http:// www.alzgene.org/) which displays this information and regularly updates it. To analyze the effect of AD susceptibility genes on breast cancer, we used The Cancer Genome Atlas (TCGA). We analyzed TCGA data with cBioPortal for Cancer Genomics. cBioPortal provides visualization, analysis, and download of large-scale cancer genomic data sets. cBioPortal can analyze APOE in breast tumors but cannot distinguish its three alleles: E2, E3, and E4. Results: About 1.6% of the tumors had APOE amplification (copy number alteration). Two percent of the tumors had CD33 alterations. None of the tumors had APOE mutations. Two tumors had CD33 missense mutations of unknown significance. Expression heatmap shows that over- or underexpression of APOE and CD33 was correlated in most of the tumors. APOE alteration significantly co-occurred with CD33 and CD2AP. Conclusion: Alterations of certain cancer genes tend to co-occur, indicating that they may work in tandem to drive tumor formation and development. This may be the case with the co-occurring alterations of APOE, CD33, and CD2AP. It would be important to know which APOE allele(s) were co-occurrent with CD33 and CD2AP and whether co-occurrence in the tumor predicted increased risk of AD. This information could help in identification of specific risk factors for breast cancer-related cognitive decline in older women, which has important implications for oncology care.
背景:已有乳腺癌患者化疗后出现认知问题的报道。一小群携带APOE4基因的老年乳腺癌幸存者接受化疗后,长期脑功能受损的风险增加。我们分析了APOE和接下来的23个阿尔茨海默病(AD)易感基因在乳腺恶性肿瘤中的表达。我们希望确定这24个基因是否可能与乳腺癌有关。方法:通过查阅ALZGENE数据库(http:// www.alzgene.org/)来确定最重要的阿尔茨海默病易感基因信息,并定期更新。为了分析AD易感基因对乳腺癌的影响,我们使用了癌症基因组图谱(TCGA)。我们使用cbiopportal for Cancer Genomics分析TCGA数据。cBioPortal提供大规模癌症基因组数据集的可视化、分析和下载。cBioPortal可以分析乳腺肿瘤中的APOE,但不能区分它的三个等位基因:E2、E3和E4。结果:约1.6%的肿瘤存在APOE扩增(拷贝数改变)。2%的肿瘤有CD33的改变。这些肿瘤都没有APOE突变。两个肿瘤有意义不明的CD33错义突变。表达热图显示,在大多数肿瘤中,APOE和CD33的过表达或过表达是相关的。APOE的改变与CD33和CD2AP同时发生。结论:某些肿瘤基因的改变倾向于同时发生,表明它们可能协同作用,驱动肿瘤的形成和发展。这可能是APOE、CD33和CD2AP共同发生改变的情况。了解哪些APOE等位基因与CD33和CD2AP共发生以及在肿瘤中共发生是否预示着AD的风险增加是很重要的。这一信息有助于确定老年妇女乳腺癌相关认知能力下降的具体危险因素,这对肿瘤治疗具有重要意义。
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引用次数: 1
Surface-Enhanced Raman Spectroscopy to study the biological activity of anticancer agent 表面增强拉曼光谱研究抗癌剂的生物活性
Pub Date : 2019-04-01 DOI: 10.4103/ctm.ctm_18_19
Guoyu Qiu, Xiaohui Xu, L. Ji, Ruiping Ma, Zi-long Dang, Huan Yang
Surface-Enhanced Raman Spectroscopy (SERS) is a sensitive and selective spectroscopic technique for the detection and characterization of analytes, which are adsorbed on suitable metal surfaces. SERS as a strategy has been widely used in detecting target molecules, and the screening of drug activity is mainly to study the biological effects of drug combined with target, so a study on biological activity of anticancer drug based on SERS is a concern to some researchers. SERS combines the advantages of positive identification of molecules in situ, stand-alone detection, well-established instrumentation with high sensitivity, and its noninvasive detection. In this paper, we review on the application of SERS in studying anticancer agent from three aspects, such as studying the effects of anticancer agent on cancer cells, detection of anticancer agent in human plasma, and testing the interaction between anticancer agent and DNA or protein.
表面增强拉曼光谱(SERS)是一种灵敏和选择性的光谱技术,用于检测和表征吸附在合适金属表面的分析物。SERS作为一种检测靶标分子的策略已被广泛应用,而药物活性的筛选主要是研究药物与靶标结合后的生物效应,因此基于SERS的抗癌药物生物活性研究受到一些研究者的关注。SERS结合了分子原位阳性鉴定、独立检测、仪器完善、灵敏度高、无创检测等优点。本文从研究抗癌药物对癌细胞的作用、检测人血浆中的抗癌药物、检测抗癌药物与DNA或蛋白质的相互作用三个方面综述了SERS在抗癌药物研究中的应用。
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引用次数: 1
The prognostic role of lactate in patients who achieved return of spontaneous circulation after cardiac arrest: A systematic review and meta-analysis 乳酸在心脏骤停后恢复自然循环患者中的预后作用:一项系统回顾和荟萃分析
Pub Date : 2019-01-01 DOI: 10.4103/ctm.ctm_6_19
Dongni Ren, Xin Wang, Y. Tu
Aim: The aim of the study is to conduct a systematic review and meta-analysis of data showing the association of lactate levels with mortality and neurologic outcome in patients who achieved return of spontaneous circulation (ROSC) after cardiac arrest. Methods: An electronic search of PubMed, Embase, Web of Science, and Cochrane Library databases was conducted. Lactate levels at 0, 6, 12, 24, and 48 h after ROSC in survivors versus nonsurvivors and in good versus poor neurologic outcome patients were extracted. Continuous variable and odds ratio were applied for data analysis. Inverse-variance fixed effects model with 95% confidence interval (CI) was used depending on interstudy heterogeneity. Results: A total of 18 articles meeting the study criteria were included for systematic review and 15 for meta-analysis. The results showed that initial serum lactate levels in nonsurvivors were significantly higher than survivors (standardized mean difference [SMD] = −0.43; 95% CI = [−0.52, −0.33]; P < 0.00001), and a higher lactate level at admission was associated with increased hospital mortality. In addition, initial serum lactate levels were significantly higher in poor neurologic outcome patients than good neurologic outcome patients (SMD = −0.44; 95% CI = [−0.54, −0.34]; P < 0.00001), and initial higher lactate level was associated with poor neurologic outcome. There was a statistically significant difference in lactate levels at 6, 12, 24, and 48 h after ROSC, among survivors versus nonsurvivors and among patients presenting good neurologic outcome versus poor neurologic outcome. However, the included studies had small sample size and highly inconsistent data. Conclusions: Higher lactate levels were associated with increased mortality and poor neurologic outcome. Lower lactate levels or faster lactate clearance was associated with higher survival and good neurologic outcome.
目的:该研究的目的是对心脏骤停后实现自然循环恢复(ROSC)的患者的乳酸水平与死亡率和神经系统预后的关系进行系统回顾和荟萃分析。方法:电子检索PubMed、Embase、Web of Science、Cochrane Library数据库。提取ROSC后0、6、12、24和48小时幸存者与非幸存者以及神经系统预后良好与较差患者的乳酸水平。采用连续变量和优势比进行数据分析。根据研究间异质性,采用95%置信区间(CI)的反方差固定效应模型。结果:共有18篇符合研究标准的文章被纳入系统评价,15篇被纳入元分析。结果显示,非幸存者的初始血清乳酸水平显著高于幸存者(标准化平均差[SMD] = - 0.43;95% ci =[−0.52,−0.33];P < 0.00001),入院时较高的乳酸水平与住院死亡率增加相关。此外,神经转归差患者的初始血清乳酸水平显著高于神经转归好患者(SMD = - 0.44;95% ci =[−0.54,−0.34];P < 0.00001),初始较高的乳酸水平与较差的神经预后相关。在ROSC后6、12、24和48小时,幸存者与非幸存者以及神经系统预后良好与神经系统预后较差的患者中,乳酸水平存在统计学上的显著差异。然而,纳入的研究样本量小,数据高度不一致。结论:较高的乳酸水平与死亡率增加和神经系统预后不良相关。较低的乳酸水平或较快的乳酸清除与较高的生存率和良好的神经系统预后相关。
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引用次数: 3
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Cancer Translational Medicine
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