鸡尾酒抗体D2-40/CD34-CK对淋巴结检出数量不足结直肠癌标本的临床病理评价

目的探讨鸡尾酒抗体D2-40/CD34-CK双重免疫组化染色在淋巴结检出数量不足的结直肠癌(colorectal cancer,CRC)标本脉管侵犯评估中的应用及意义。方法收集133例淋巴结检出数量<12枚的CRC标本,分别行HE染色及鸡尾酒抗体双重免疫组化染色,比较两种方法在脉管侵犯筛查效果中的差异,并分析应用鸡尾酒抗体免疫组化染色证实的脉管侵犯与临床病理特征及患者总生存期(overall survival,OS)的关系。结果 (1)鸡尾酒抗体D2-40/CD34-CK双重免疫组化染色及HE染色对脉管侵犯的检出率分别为42. 9%(57/133)和21. 8%(29/133),差异有显著性(P <0. 001)。(2)鸡尾酒抗体D2-40/CD34-CK双重免疫组化法证实的脉管侵犯与Dukes分期、浸润深度、临床分期、淋巴结转移、肿瘤出芽相关(P <0. 05)。(3)脉管侵犯、侵犯位置深度、程度及脉管侵犯灶数≤2个灶且癌栓细胞数量≥5. 5个与患者OS密切相关(P <0. 05)。结论鸡尾酒抗体D2-40/CD34-CK双重免疫组化染色对脉管侵犯评估优于常规HE染色切片观察,与肿瘤分期、淋巴结转移及出芽情况密切相关,是患者预后的独立影响因素,可作为淋巴结检出数量不足CRC病例的补充检测指标。国家自然科学基金青年科学基金(81301787

欧盟碳中和政策体系评述及启示

碳中和通过改变人类生产生活方式，不仅影响各国经济发展，还重塑着全球地缘政治格局。中国自2020 年 9 月明确提出 2060 年实现碳中和目标以来，一直在努力探索构建碳中和政策体系。由于欧盟的碳中和政策体系相对完善，因此本文将从政策框架、关键行业措施、研发布局、财政与金融保障措施等方面切入，系统梳理欧盟的碳中和政策体系，剖析其主要特点，以期为构建中国碳中和政策体系提供参考。</p

Aripiprazole versus other atypical antipsychotics for schizophrenia

BACKGROUND: In most western industrialised countries, second generation (atypical) antipsychotics are recommended as first line drug treatments for people with schizophrenia. In this review we specifically examine how the efficacy and tolerability of one such agent - aripiprazole - differs from that of other comparable second generation antipsychotics. OBJECTIVES: To evaluate the effects of aripiprazole compared with other atypical antipsychotics for people with schizophrenia and schizophrenia-like psychoses. SEARCH METHODS: We searched the Cochrane Schizophrenia Group Trials Register (November 2011), inspected references of all identified studies for further trials, and contacted relevant pharmaceutical companies, drug approval agencies and authors of trials for additional information. SELECTION CRITERIA: We included all randomised clinical trials (RCTs) comparing aripiprazole (oral) with oral and parenteral forms of amisulpride, clozapine, olanzapine, quetiapine, risperidone, sertindole, ziprasidone or zotepine for people with schizophrenia or schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS: We extracted data independently. For dichotomous data we calculated risk ratios (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random-effects model. Where possible, we calculated illustrative comparative risks for primary outcomes. For continuous data, we calculated mean differences (MD), again based on a random-effects model. We assessed risk of bias for each included study. MAIN RESULTS: We included 12 trials involving 6389 patients. Aripiprazole was compared to olanzapine, risperidone and ziprasidone. All trials were sponsored by an interested drug manufacturer. The overall number of participants leaving studies early was 30% to 40%, limiting validity (no differences between groups).When compared with olanzapine no differences were apparent for global state (no clinically important change: n = 703, 1 RCT, RR short-term 1.00 95% CI 0.81 to 1.22; n = 317, 1 RCT, RR medium-term 1.08 95% CI 0.95 to 1.22) but mental state tended to favour olanzapine (n = 1360, 3 RCTs, MD total Positive and Negative Syndrome Scale (PANSS) 4.68 95% CI 2.21 to 7.16). There was no significant difference in extrapyramidal symptoms (n = 529, 2 RCTs, RR 0.99 95% CI 0.62 to 1.59) but fewer in the aripiprazole group had increased cholesterol levels (n = 223, 1 RCT, RR 0.32 95% CI 0.19 to 0.54) or weight gain of 7% or more of total body weight (n = 1095, 3 RCTs, RR 0.39 95% CI 0.28 to 0.54).When compared with risperidone, aripiprazole showed no advantage in terms of global state (n = 384, 2 RCTs, RR no important improvement 1.14 95% CI 0.81 to 1.60) or mental state (n = 372, 2 RCTs, MD total PANSS 1.50 95% CI -2.96 to 5.96).One study compared aripiprazole with ziprasidone (n = 247) and both the groups reported similar change in the global state (n = 247, 1 RCT, MD average change in Clinical Global Impression-Severity (CGI-S) score -0.03 95% CI -0.28 to 0.22) and mental state (n = 247, 1 RCT, MD change PANSS -3.00 95% CI -7.29 to 1.29).When compared with any one of several new generation antipsychotic drugs the aripiprazole group showed improvement in global state in energy (n = 523, 1 RCT, RR 0.69 95% CI 0.56 to 0.84), mood (n = 523, 1 RCT, RR 0.77 95% CI 0.65 to 0.92), negative symptoms (n = 523, 1 RCT, RR 0.82 95% CI 0.68 to 0.99), somnolence (n = 523, 1 RCT, RR 0.80 95% CI 0.69 to 0.93) and weight gain (n = 523, 1 RCT, RR 0.84 95% CI 0.76 to 0.94). Significantly more people given aripiprazole reported symptoms of nausea (n = 2881, 3 RCTs, RR 3.13 95% CI 2.12 to 4.61) but weight gain (7% or more of total body weight) was less common in people allocated aripiprazole (n = 330, 1 RCT, RR 0.35 95% CI 0.19 to 0.64). Aripiprazole may have value in aggression but data are limited. This will be the focus of another review. AUTHORS' CONCLUSIONS: Information on all comparisons are of limited quality, are incomplete and problematic to apply clinically. Aripiprazole is an antipsychotic drug with a variant but not absent adverse effect profile. Long-term data are sparse and there is considerable scope for another update of this review as new data emerges from the many Chinese studies as well as from ongoing larger, independent pragmatic trials