ABSTRACT
With the rapid development of hospice care, more and more people pay attention to the quality of life of patients at the end of life. Due to the dialysis-related complications, heavy burden of comorbidities and cognitive impairment, elderly hemodialysis patients have poor quality of life, which brings heavy physiological, psychological and economic burdens to patients, families and society. Advance care planning can improve patients′ quality of life and save limited medical resources. By referring to relevant literature at home and abroad, this paper reviewed the overview of advance care planning, the necessity of discussing advance care planning with elderly hemodialysis patients, the implementation status and the obstacle factors. The purpose was to provide theoretical reference for better implementation of intervention treatment in elderly hemodialysis patients in China in the future.
ABSTRACT
Objective To investigate the diagnosis, therapeutic monitoring and prognosis value of the total procollagen type 1 amino-terminal propeptide(tP1NP), beta-C-terminal telopeptide(β-CTx)and bone alkaline phosphatase(BAP)in the bone metastasis of lung cancer.Methods With the case-control study method, the serum levels of tP1NP, β-CTx and BAP in 196 lung cancer patients, including 109 patients with bone metastases,87 patients without bone metastases,and 106 healthy controls at the Shanghai Sixth People′s East Hospital affiliated to Shanghai Jiao Tong University between 2014 and 2015 were quantitatively detected by chemiluminescent immunoassay.Receiver operating characteristic(ROC)curve was calculated to assess the diagnostic value.Survival curve was performed by Kaplan-Meier method. Results The concentration of tP1NP,β-CTx and BAP in the lung cancer patients with bone metastasis were significantly higher than that in the lung cancer patients without bone metastasis(Z=-5.642,P<0.001;Z=-3.783,P<0.01;Z=-8.923,P<0.01).ROC curve analysis showed that the AUC of tP1NP, β-CTx and BAP were 0.874,0.776 and 0.678 respectively(P<0.05).The AUC of the combined three markers was 0.925(95%CI 0.867-0.963),with sensitivity of 77.11% and specificity of 98.11%.The levels of tP1NP and β-CTx were associated with the clinical response.The concentration of tP1NP,β-CTx were significantly decreased in patients achieved remission(t=4.607,P<0.05;t=5.355,P<0.05). Survival analysis showed that higher concentration of tP 1NP was correlated with poor prognosis[OR=3.287, 95%CI(1.118-9.661),P<0.05].Conclusions The levels of tP1NP,β-CTx and BAP cloud be used for the differential diagnosis of bone metastasis of lung cancer,and the combined usage was more effective. tP1NP and β-CTx cloud be used in therapeutic monitoring of lung cancer patients with bone metastasis. Moreover,tP1NP could be used as prognostic biomarker in lung cancer patients.
ABSTRACT
Refractoriness of acute myeloid leukemia (AML) cells to chemotherapeutics represents a major clinical barrier. Suicide gene therapy for cancer has been attractive but with limited clinical efficacy. In this study, we investigated the potential application of herpes simplex virus thymidine kinase/ganciclovir (HSV-TK/GCV) based system to inhibit chemoresistant AML cells. We first generated Ara-C resistant K562 cells and doxorubicin-resistant THP-1 cells. We found that the HSV-TK/GCV anticancer system suppressed drug resistant leukemic cells in culture. Chemoresistant AML cell lines displayed similar sensitivity to HSV-TK/GCV. Moreover, HSV-TK/GCV killing of leukemic cells was augmented to a mild but significant extent by all-trans retinoic acid (ATRA) with concomitant upregulation of Connexin 43, a major component of gap junctions. Interestingly, HSV-TK/GCV killing was enhanced by expression of vesicular stomatitis virus G glycoprotein (VSV-G), a fusogenic membrane protein, which also increased leukemic cell fusion. Co-culture resistant cells expressing HSV-TK and cells stably transduced with VSV-G showed that expression of VSV-G could promote the bystander killing effect of HSV-TK/GCV. Furthermore, combination of HSV-TK/GCV with VSV-G plus ATRA produced more pronounced antileukemia effect. These results suggest that the HSV-TK/GCV system in combination with fusogenic membrane proteins and/or ATRA could provide a strategy to mitigate the chemoresistance of AML.