GAS6基因多态性及血浆水平与昆明地区汉族2型糖尿病合并动脉粥样硬化的相关性

目的 探讨生长停滞特异性蛋白6（GAS6）基因多态性及血浆水平与昆明地区汉族2型糖尿病合并动脉粥样硬化（T2DM AS）的相关性。方法 收集181例单纯T2DM患者、171例T2DM AS患者和186例正常对照（NC）者,运用 PCR和单向基因测序检测GAS6基因多态性,ELISA检测血浆GAS6水平,并分析其基因型及等位基因频率、血浆GAS6水平和相关临床指标。结果 T2DM组分别与NC组、T2DM AS组相比,三种基因型频率的分布无差异(2=8031,P=0018;2=1762,P=0414);T2DM AS组GG基因型频率高于NC组,GA、AA基因型频率低于NC组,差异有统计学意义 (2=9286,P=0010)。T2DM组和T2DM AS组的A等位基因频率低于NC组,G等位基因频率高于NC组,差异有统计学意义 (2=7493,P=0006;2=8718,P=0003);T2DM AS组和T2DM组相比,等位基因频率的分布无差异(2=0069,P=0793)。T2DM组和T2DM AS组的体重指数（BMI）、收缩压（SBP）、舒张压（DBP）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL C）、空腹血糖（FBG）均高于NC组（P＜001）,而高密度脂蛋白胆固醇（HDL C）和GAS6水平低于NC组（P＜001）;T2DM AS组的病程、SBP和血管内中膜厚度（IMT）均高于T2DM组,差异有统计学意义(P＜001）,而GAS6水平与T2DM组相比无差异(P＞0.05）。T2DM病程、饮酒、SBP是AS发生的危险因素（OR： 1072、2625、1019;95% CI：1024 1122、1241 5552、1003 1035）。HDL C是AS的保护性因素（OR=0253;95% CI：0071 0902）;而GAS6基因rs8191974多态性及其血浆水平可能与AS无关联。结论 本研究尚未发现GAS6基因rs8191974多态性及其血浆水平与昆明地区汉族AS之间的关联。T2DM病程、饮酒、高血压是AS发生的危险因素,HDL C是AS的保护性因素。     

PBK基因在膀胱癌中的表达及临床意义

【摘要】目的 探讨PBK基因表达对膀胱癌患者临床病理特征及预后的影响,并寻找膀胱癌诊治的新靶点。方法 在GEO数据库中下载膀胱癌样本资料GSE13507及相关临床信息。通过两独立样本t检验分析PBK在膀胱癌组织和正常膀胱组织中的表达差异,运用2检验研究PBK的表达与膀胱癌临床病理特征的相关性;并应用Kaplan Meier法和对数秩检验进行生存分析,最后运用基因集富集分析（GSEA）寻找PBK调控膀胱癌细胞的相关通路。结果 与正常膀胱组织比较,PBK在膀胱癌细胞中高表达（P＜0001）;PBK的高表达与膀胱癌患者性别（P＜0001）,年龄（P=0027）,侵袭性（P＜0001）,高分级（P ＜0001）,T分期（P=0001）,N分期（P=0015）,M分期（P＜0001）,疾病进展（P＜0001）和疾病复发（P＜0001）显著相关。PBK高表达患者的总生存期（P=00023）和肿瘤特异性生存期（P=00003）显著低于低表达患者。GSEA的结果显示PBK可能通过调节MYC信号通路、G2M检查点、精子发生、E2F转录因子、未折叠蛋白反应等影响膀胱癌的发生发展。结论 PBK在膀胱癌中高表达,与膀胱癌的多个临床病理特征相关,可能成为膀胱癌新型肿瘤标志物或者治疗靶点。     

ME-NBI联合卢戈氏液染色在食管癌高危人群筛查中的诊断价值

【摘要】目的 探讨窄带成像放大内镜（ME NBI）联合卢戈氏液染色内镜在食管癌高危人群筛查中的诊断价值。方法 选择2016年1月～2018年12月在我院消化内镜中心进行食管癌高危人群筛查的500例患者作为研究对象,所有患者均接受白光内镜检查、ME NBI及ME NBI结合卢戈氏液色素内镜镜下诊断,以活检病理或手术术后病理结果为金标准,共筛出198例病变患者,病变处共260例,食管早癌共73例,统计分析三种方法诊断食管早癌灵敏度、特异度、准确度。结果 ME NBI结合卢戈氏液染色内镜诊断食管早癌准确度明显高于白光内镜、ME NBI检查（2=34531,P＜0001; 2=11134,P=0001）;ME NBI结合卢戈氏液染色内镜诊断食管早癌灵敏度、特异度高于白光内镜（2=39806,P＜0001 2=14457,P＜0001）;ME NBI结合卢戈氏液染色诊断食管早癌灵敏度、特异度高于ME NBI诊断（2=17843,P＜001; 2=0205,P=0651）。结论 ME NBI联合卢戈氏液染色可以提高食管癌高危人群食管黏膜病变检出的准确度,并且对食管早癌检测的灵敏度和特异度较高,可在临床推广应用。     

术前血清肿瘤标志物水平对浸润性膀胱癌根治术后生存率的预测价值

【摘要】 目的 探讨术前血清VEGF、CXCL5和MMP 9水平对浸润性肌层膀胱癌（MIBC）根治术后生存率的预测价值。 方法 选择2012年11月~2015年11月在本院行浸润性膀胱癌根治术的82例MIBC患者，分析患者的年龄、性别、T分期、分化程度以及有无淋巴结转移等，采用ELISA检测血清样品中VEGF、CXCL5和MMP 9表达水平；采用单因素生存分析Kaplan Meier绘制生存曲线；采用Pearson相关性分析血清VEGF、CXCL5与MMP 9之间的相关性。 结果 与对照组相比， MIBC患者术前血清中VEGF、CXCL5和MMP 9的表达水平显著升高（P＜005）；术前血清VEGF、CXCL5和MMP 9的表达水平与肿瘤直径、分化程度、T分期以及是否合并淋巴结转移有关（P＜005）；生存分〖JP2〗析显示，VEGF低表达患者生3年总生存率和无病生存率显著高于VEGF高表达患者（7317% vs 5122%，Log rank2=〖JP〗4548，P=0033；5610% vs 3415%，Log rank2=4701，P=0030）；CXCL5低表达患者3年总生存率和无病生存率显著高于CXCL5高表达患者（7561% vs 4878%，Log rank2=6639，P=0010；5854% vs 3171%，Log rank2=7212，P=0007）；MMP 9高表达患者生3年总生存率和无病生存率显著低于MMP 9低表达患者（7561% vs 4878%，Log rank2=6340，P=0012；5610% vs 3415%，Log rank2=5037，P=0025）；相关性分析显示，血清VEGF、CXCL5水平均与MMP 9的表达呈显著正相关关系（r=0594，P＜0001；r=0658，P＜0001）。 结论 术前血清VEGF、CXCL5或MMP 9高表达MIBC患者3年总生存率和无病生存率明显降低，有望应用于临床预后评估。     

低分割放射治疗分次γ-刀治疗后局部复发脑胶质瘤的疗效观察

【摘要】 目的 探讨三维适形低分割放射治疗分次γ 刀治疗后复发脑胶质瘤的临床疗效。方法 收集接受分次γ 刀治疗后局部复发脑胶质瘤25例,单次分割剂量2.5Gy,总剂量30~50Gy;病理分级：Ⅱ、Ⅲ、Ⅳ分别包括5、8、12例。结果 随访2~24个月,随访率100%;放射性脑水肿发生率56%;近期疗效：CR12%、PR32%、NC36%、PD20%;1年生存率400%,2年生存率16%。单因素分析显示,KPS评分≥60分（2=15122,P=0000）、病理分级（2=10678,P=0005）、复发时间大于4个月（2=8957,P=0003）均与预后具有相关性。多因素Cox回归性分析显示,KPS评分和病理分级与预后具有相关性。结论 低分割放疗是治疗分次伽玛刀治疗后复发脑胶质瘤的有效方法,副作用有叠加效果,KPS评分和病理分级是独立预后因素。     

α2-肾上腺受体单核苷酸多态性与乳腺癌患者CRF的相关性研究

【摘要】 目的 探讨乳腺癌癌性疲乏（CRF）与肾上腺素水平、α2 肾上腺受体（α2AR)单核苷酸多态性(SNP)的相关性。方法 抽样法抽取2016年02月～2018年3月在陕西省肿瘤医院及西安交通大学第一、第二附属医院确诊并符合抽样标准的乳腺癌患者240例,分为手术组、化疗组和放疗组,每组各80例,测评其疲乏状况（轻、中、重度疲乏）,并取外周静脉血,采用酶联免疫法测定其肾上腺素浓度,分析不同治疗期肾上腺素水平与癌性疲乏的关系。并将化疗组重度疲乏的59例患者设为病例组,选取同期59例健康人设为对照组,采用PCR RELP方法检测两组受试者的基因型,应用SPSS200统计软件分析α2A 肾上腺受体单核苷酸多态性位点与癌性疲乏程度的关联性。结果 不同治疗期内,乳腺癌患者的疲乏程度均与血液中的肾上腺素水平呈正相关（P＜0.05 )。同等疲乏程度的患者在不同治疗时期内,血液中的肾上腺素水平并不一致：重度疲乏者中,手术组肾上腺素水平显著高于放疗组 (t=237,P＜0.05),化疗组显著高于放疗组 (t=315,P＜0.01);中度疲乏者中,手术组肾上腺素水平显著高于化疗组（t=231,P＜0.01)和放疗组 (t=604,P＜0.05);轻度疲乏者中,手术组、化疗组和放疗组的肾上腺素水平差异无统计学意义（P＜0.05）。病例组和对照组α2A AR 1296位点的基因频数分布均符合Hardy Weinberg平衡定律（P＞0.05）,两组α2A AR的基因型频数分布比较差异无统计学意义（2=1161,P＞0.05）。结论 乳腺癌癌性疲乏程度与肾上腺素水平呈正相关,但可能与α2A AR 1296位点基因多态性无关。     

PDCD-1基因rs 2227982多态性与强直性脊柱炎易感性的Meta分析

【摘要】 目的 采用Meta分析的方法评价程序性细胞死亡因子 1（PDCD 1）基因rs 2227982多态性与强直性脊柱炎（AS）易感性的相关性。方法 计算机检索PubMed、Embase、CBM、CNKI、VIP和WanFang Data,查找关于PDCD 1基因rs 2227982多态性与AS相关性的病例 对照研究,检索时限均为从建库至2015年12月。由2位评价者独立筛选文献、提取资料和质量评价后,共纳入5个病例 对照研究,共计968例AS患者和985例非AS对照,采用Stata 120软件进行Meta分析。结果 Meta分析结果显示,T等位基因人群AS发病风险高于C等位基因人群（OR=174,95%CI 148～206,P<0001）;TT基因型人群AS发病风险高于CC基因型人群（OR=188,95%CI 130～273,P=0001）;TT+CT基因型人群AS发病风险高于CC基因型人群（OR=229,95%CI 165～318,P<0001）;但TT基因型人群AS发病风险与CT基因型人群（OR=081,95%CI 055～119,P=0283）和CT+CC基因型人群（OR=133,95%CI 094～189,P=0118）的差异无统计学意义。结论 当前的证据表明,PDCD 1基因rs 2227982多态性可能会增加AS的发病风险。由于纳入研究数量的限制,该结论尚需进一步开展研究加以验证。     

剖宫产术后子宫瘢痕妊娠术中出血的危险因素

目的 探讨影响剖宫产术后子宫瘢痕妊娠（CSP）术中出血的相关危险因素。方法 回顾性分析2013年1月~2019年1月于南充市中心医院及武汉市妇幼保健院接受手术治疗的410例CSP患者的临床资料,根据术中出血量,分为出血组67例和对照组343例,通过卡方检验或t检验比较出血组和对照组CSP患者的临床特征,采用多因素二分类Logistic回归分析可能影响CSP患者术中出血的可能因素,并绘制受试者工作特征（ROC）曲线对危险因素进行评估。结果 出血组与对照组单因素分析表明年龄、CSP病灶清除手术方式、停经天数、妊娠囊最大直径及CSP分型差异有统计学意义（P＜0.05）,将有统计学意义的因素纳入多因素logistic回归分析显示CSP病灶清除手术方式、妊娠囊最大直径和CSP分型是CSP术中出血的独立危险因素（P＜0.05）。ROC分析结果为妊娠囊最大直径、CSP分型及CSP病灶清除手术方式曲线下面积分别为077（95%CI=0713 0827,P＜0001）、075（95%CI=0686 0815,P＜0001）和0438（95%CI=0273 0423,P＜0001）,妊娠囊最大直径最佳临界值为3cm,灵敏度852%,特异度691%。结论 CSP术中出血受CSP病灶清除手术方式、妊娠囊最大直径及CSP分型影响,妊娠囊直径＞3cm和CSPⅢ型是术中出血的高危因素。     

肺癌化疗患者血常规变化与骨髓抑制发生的危险度

【摘要】目的 探讨肺癌患者化疗后血常规变化与骨髓抑制发生的危险度。方法 纳入 2009年9月～2019年9月南通大学附属第三医院、海门市人民医院、中国人民解放军空军986医院3个医院的140例肺癌患者,其中68例在化疗后出现重度骨髓抑制（重度骨髓抑制组）及72例化疗后出现轻度骨髓抑制（轻度骨髓抑制组）。分析两组单核细胞、淋巴细胞与中性粒细胞等血常规变化的相关性及其与骨髓抑制发生的危险度。结果 两组肺癌患者在年龄、性别、治疗前白细胞水平、血红蛋白水平、白蛋白水平及进食减少等比较差异均无统计学意义（P＞005）,在早期出现单核细胞明显下降比较差异具有统计学意义（P＜005）,且早期出现单核细胞计数明显下降是重度骨髓抑制的独立危险因素(OR=0532, 95%CI=1157 3809,2=0876,P=0034)。化疗后血液中单核细胞计数与中性粒细胞下降计数成正相关（r=0673,P＜005）。结论 化疗后早期单核细胞计数大幅度下降的肺癌患者发生重度骨髓抑制的危险度高,临床需要提早干预。     

前列腺癌主动监测期间组织ERG蛋白表达与肿瘤进展的关系

【摘要】目的 探讨前列腺癌患者组织ERG蛋白表达与肿瘤进展的关系。方法 纳入2012年3月～2016年2月前列腺穿刺证实为前列腺癌且符合主动监测条件的56名患者,收集患者年龄、血清前列腺特异性抗原（PSA ）水平、格里森评分（GS）、临床分期等临床病理学参数,采用免疫组织化学的方法检测前列腺癌穿刺组织中ERG蛋白的表达。ERG蛋白表达与患者临床病理学特征之间的关系采用2检验,Kplan meier生存分析模型及Cox回归模型用于分析ERG蛋白表达状态与前列腺癌进展间的关系。结果 56名患者中,48名纳入最后的研究,ERG蛋白表达阳性率375%（18/48）。Kplan meier生存分析模型中,ERG蛋白阳性及阴性组中位组织学无进展生存期分别为32个月和48个月（2=4476,P=0.034）;中位PSA无进展生存期分别为21个月及26个月（2=4272,P=0.039）;在多变量分析中,穿刺组织ERG蛋白表达是前列腺癌主动监测期间进展的独立危险因素（Hr=2024,P=0.044）。结论 组织ERG蛋白的表达增加了主动监测前列腺癌进展的风险,通过对其检测和分析可以为制定个体化的主动监测方案提供参考。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.