肾透明细胞癌患者血清miR-193a-3p水平增加及早期诊断价值

目的 检测肾透明细胞癌患者血清中miR-193a-3p的表达水平,探讨其作为肾透明细胞癌分子诊断指标的可能性。方法 收集南京军区南京总医院2010～2014年期间107例住院肾透明细胞癌患者(TNM分期Ⅰ期76例、Ⅱ期16例、Ⅲ期2例、Ⅳ期8例和未知5例)未经治疗前血清样本,实时荧光定量PCR(qRT-PCR)方法检测miR-193a-3p含量,并以107例年龄、性别匹配的非癌健康人作对照。ROC曲线分析血清miR-193a-3p水平对肾透明细胞癌的早期诊断价值。结果 qRT-PCR检测证实,miR-193a-3p在总体患者血清中的含量显著高于对照组(3.294 ± 1.526 vs 1.944±0.600,P=0.000)。TNM Ⅰ期(3.411±1.676 vs 1.944±0.600,P=0.000)、Ⅱ期(2.926±0.927 vs 1.944±0.600,P=0.001)和Ⅳ期患者(2.926±0.894 vs 1.944±0.600,P= 0.000)血清中miR-193a-3p的表达水平均明显高于对照组。用于诊断肾透明细胞癌早期(Ⅰ期)的血清miR-193a-3p ROC曲线下面积(AUCROC)为0.820(95% CI,0.756～0.883),敏感度为80.3%,特异度为93.5%。结论 miR-193a-3p在肾透明细胞癌患者血清中的水平显著升高,并有较高的早期诊断准确性,有望作为该病早期诊断的血清学指标。     

非小细胞肺癌患者血清中miR-25的表达水平及筛查价值

目的检测非小细胞肺癌(non-small cell lung cancer,NSCLC)患者血清miR-25的表达水平,探讨其对NSCLC的筛查价值。方法采集南京军区南京总医院82例未经治疗的NSCLC患者(TNMⅠ期4例、Ⅱ期10例、Ⅲ期11例、Ⅳ期53例及未知者4例)和82例年龄、性别匹配的健康人对照血清样本,实时荧光定量PCR法(qRT-PCR)检测患者及对照血清miR-25的表达水平,并通过ROC曲线评估血清miR-25对NSCLC的筛查价值。结果 NSCLC患者血清miR-25的表达水平明显高于健康人对照组(0.017±0.028 vs 0.004±0.004,t=4.098,P0.01)。血清miR-25用于筛查NSCLC的ROC曲线下面积(AUCROC)为0.818(95%CI:0.753~0.882),敏感性为70.7%,特异性为80.7%;血清miR-25筛查Ⅰ/Ⅱ期NSCLC患者的AUCROC为0.852(95%CI:0.728~0.976),敏感性和特异性分别为78.6%和87.8%。Logistic回归分析显示,miR-25是NSCLC的独立危险因素(OR=10.84,95%CI:5.07~23.19,P0.01)。结论 NSCLC患者血清中miR-25表达水平升高,有望成为NSCLC辅助筛查的新型分子标志物。     

食管鳞状细胞癌患者血清全基因组microRNA测序和分析

目的通过测序、分析食管鳞状细胞癌(ESCC)患者血清全基因组微小核糖核酸(miRNA)表达谱,筛选出表达上调的miRNA,探讨其作为ESCC分子标志物的可能性。方法收集未经治疗的199例ESCC患者血清,同时以107例年龄、性别匹配的健康人血清作对照。用Solexa测序技术对血清miRNA进行测序和表达量测定,用实时荧光定量PCR技术对表达上调的miR-223验证,并与血清CEA含量比较。结果 Solexa测序结果显示,ESCC患者和健康人混合血清小分子RNA中miRNA含量所占比例分别是75.46%和81.44%,22种miRNA在患者血清中表达量是健康人对照的2倍以上;PCR分析证实,miR-223在患者血清中的浓度[M(P25,P75)]显著高于健康人对照[893.8(684.8,1 200.7)fmol/L vs 445.6(347.7,664.0)fmol/L,t=10.03,P<0.01];用于ESCC诊断的miR-223 ROC曲线下面积(AUCROC)为0.84(95%CI,0.79～0.89),明显大于CEA的0.55(95%CI,0.48～0.62),P<0.01;当cut off值为710.2 fmol/L时,miR-223诊断ESCC的敏感性和特异性分别为70%、80%;ESCC患者年龄、性别、病理类型、TNM分期、吸烟史、饮酒史与血清miR-223水平无明显相关性(P>0.05)。结论 ESCC患者血清miRNA表达谱与健康人存在差异,miR-223在患者血清中浓度显著升高,是ESCC潜在的分子标志物。     

miR-221在卵巢上皮癌患者中的表达及意义

目的分析miR-221在卵巢上皮癌(epithelial ovarian cancer,EOC)患者血清中的表达水平,并探讨其在EOC诊断中的临床应用价值。方法实时荧光定量聚合酶链反应(qRT-PCR)检测EOC组、卵巢良性肿瘤组及健康人对照组血清miR-221的表达水平,分析其与EOC患者临床病理参数的关系,同时检测各组血清CA125的含量,ROC曲线分析血清miR-221及CA125对EOC的诊断效能。结果血清miR-221在EOC组中的表达水平明显高于卵巢良性肿瘤组(U=133.12,P0.05)和健康人对照组(U=194.86,P0.05),而后两组间的差异无统计学意义(U=69.45,P0.05)。血清miR-221单独诊断EOC的ROC曲线下面积(AUCROC)为0.874(95%CI:0.826~0.922),当cut off值为4.32时,其敏感性为78.2%、特异性为81.3%;血清miR-221和CA125联合诊断EOC的AUCROC为0.923(95%CI:0.887~0.958),当cut off值为0.313时,敏感性为86.2%、特异性为83.5%。血清miR-221表达水平与EOC患者年龄(U=102.68,P=0.097)、有无淋巴结转移(U=86.85,P=0.134)、病理组织分型(H=5.74,P=0.295)无关,而与临床分期有关(H=15.21,P=0.023)。结论血清miR-221在EOC患者中的表达水平升高,与CA125联合检测可以提高对EOC诊断的效能。     

尘肺患者血清miR-21的表达及其与临床分期的关系

目的检测不同临床分期尘肺患者血清中miR-21的表达水平,探讨其作为尘肺分子标志物的可能性。方法采集118例男性尘肺患者(Ⅰ期57例、Ⅱ期48例和Ⅲ期13例)静脉血标本,收集血清,用实时荧光定量RT-PCR法检测其miR-21的表达水平,并以115例年龄、性别匹配的健康人作为对照。结果健康对照者血清miR-21的相对表达量为(0.004±0.003),Ⅰ期和Ⅱ~Ⅲ期尘肺患者分别为(0.011±0.008)和(0.022±0.018)。Ⅰ期和Ⅱ~Ⅲ期尘肺患者血清miR-21水平显著高于健康对照组(t分别为-6.39,-7.81,P均0.01)。且Ⅱ~Ⅲ期患者高于Ⅰ期(t=-4.28,P0.01)。用于尘肺诊断时miR-21的ROC曲线下面积(AUCROC)为0.85(95%CI:0.78~0.93),以相对表达量0.007为临界值,诊断尘肺的敏感性和特异性分别为83.9%和90.4%。结论 miR-21在尘肺患者血清中高表达,且与临床分期有关,有望成为用于尘肺诊断的分子标志物。     

SYBR Green Ⅰ荧光定量PCR检测类风湿关节炎患者血清miR-146a的表达及意义

目的用SYBR GreenⅠ实时荧光定量PCR法检测类风湿关节炎(RA)患者血清miR-146a的表达水平,探讨其在RA诊断中的意义。方法以U6为内参照,用SYBR GreenⅠ实时荧光定量PCR检测RA患者48例(活动期30例、缓解期18例)、骨性关节炎(OA)患者22例和体检健康者25例血清miR-146a的表达水平,并进行ROC曲线分析;对各组进行红细胞沉降率(ESR)检测。结果 SYBR GreenⅠ实时荧光定量PCR检测结果表明,活动期RA患者血清miR-146a水平为(2.42±0.75),显著高于缓解期RA患者(1.66±0.29)、OA患者(1.12±0.43)和体检健康者(1.01±0.34),差异均有统计学意义(P均0.05);miR-146a诊断活动期RA的ROC曲线下面积(AUCROC)为0.914(95%CI:0.872~0.926);以1.96为cut off值,敏感性为95.0%、特异性为87.5%、准确性为91.9%。活动期RA组ESR为(37.5±5.2)mm/h,缓解期RA组为(14.4±4.7)mm/h,OA组为(11.6±5.1)mm/h,健康对照组为(9.6±3.9)mm/h,各组间差异有统计学意义(F=177.01,P0.01)。结论建立的SYBR GreenⅠ实时荧光定量PCR可用于RA患者血清miR-146a的检测。miR-146a可用于诊断活动期RA。     

支气管肺泡灌洗液半乳甘露聚糖抗原检测对非免疫功能低下患者侵袭性肺曲霉病的诊断价值

目的评价支气管肺泡灌洗液(BALF)半乳甘露聚糖(GM)检测对非免疫功能低下患者侵袭性肺曲霉病(IPA)的诊断价值,并探索其最佳诊断cut off值。方法收集95例非免疫功能低下患者的血清及BALF标本,分为IPA组42例(确诊19例、临床诊断17例、拟诊6例)和非IPA组53例;采用双抗体夹心ELISA法测定血清及BALF样本GM浓度;统计分析诊断cut off值分别为0.5、1、1.5和2时BALF-GM和血清GM检测对IPA的诊断价值;通过ROC曲线分析,确定最佳cut off值。结果IPA组BALF-GM检测结果[1.53(0.48,4.72)]高于非IPA组[0.33(0.23,0.47)],差异有统计学意义(Z=5.022,P0.05);IPA组血清GM测定结果[0.38(0.16,0.66)]高于非IPA组[0.2(0.17,0.39)],差异有统计学意义(Z=2.231,P0.05)。cut off值分别为0.5、1、1.5和2时,BALF-GM测定的敏感性均高于血清GM,差异有统计学意义。χ2值分别为23、25、20和15,P均0.05);BALF-GM检测特异性除诊断cut off值为2时与血清GM检测相同,其他3个诊断cut off值的特异性结果均低于血清GM;随着cut off值的增加,BALF-GM测定的特异性增加,相应地敏感性降低。BALF-GM检测的最佳cut off值为0.65,其敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)分别为71.4%、84.9%、78.9%和78.9%;血清GM最佳cut off值为0.425,其敏感性、特异性、PPV和NPV分别为47.6%、86.8%、80.0%和68.6%。结论 BALF-GM试验在诊断非免疫功能低下的IPA的敏感性明显高于血清标本GM试验,其最佳诊断cut off值为0.65。     

血清miR-107在结直肠癌患者中的表达及其诊断价值分析

目的 探究血清微小RNA(miR)-107在结直肠癌患者中的表达及其对疾病的诊断价值。方法选取2016年1月至2019年1月该院收治的结直肠癌患者60例作为结直肠癌组,并选取同期在该院接受治疗的60例结直肠息肉患者作为息肉对照组,另选取同期在本院体检的健康志愿者60例作为健康对照组。采用实时荧光定量PCR法检测miR-107的相对表达量,比较3组研究对象血清癌胚抗原(CEA)、糖类抗原199(CA199)、miR-107的水平,分析血清miR-107与结直肠癌患者临床病理特征的关系,受试者操作特征曲线(ROC)分析血清miR-107、CEA、CA199对直结肠癌的诊断价值。结果 结直肠癌组的血清miR-107相对表达量以及血清CEA、CA199水平高于息肉对照组和健康对照组,差异有统计学意义(P<0.05);结直肠癌患者血清miR-107的水平与性别、年龄、肿瘤最大径无关,差异无统计学意义(P>0.05),而与分化程度、TNM分期、淋巴结转移有关,差异有统计学意义(P<0.05);miR-107所得ROC曲线下面积为0.882(95%CI:0.814~0.950),灵敏度和特异度分别为85.0%和82.9%。若和CEA及CA199进行联合应用,则灵敏度和特异度可提高至91.7%和86.7%。结论 miR-107在结直肠癌患者血清中呈高水平,而且其水平与分化程度、TNM分期、淋巴结转移有关,且对结直肠癌有较高的诊断价值。     

肾透明细胞癌患者血清miR-214的表达及临床意义

目的探讨血清miR-214在肾透明细胞癌患者中的表达及在诊断、治疗及预后判断方面的临床意义。方法选择我院确诊的肾透明细胞癌30例(肾癌组),选取同期在我院体检健康的30例(对照组)。对照组随机检测血清miR-214水平,肾癌组于术前、术后1周及术后1个月检测血清miR-214变化,比较组间的表达差异及其与临床参数的关系。结果肾癌组术前、术后1周与对照组血清miRNA-214相对表达量比较差异有统计学意义(P0.05);肾癌组术前与术后1个月、术后1周与术后1个月之间比较差异均有统计学意义(P0.05);肾癌组术前与术后1周、术后1个月与对照组之间比较差异无统计学意义(P=0.318,P=0.383)。利用受试者工作特征曲线做鉴别检验,获得曲线下面积(AUC)=0.858[95%CI(0.756,0.960),P0.05],根据Youden指数找出最佳诊断点为2.91,敏感度为80.0%,特异度为90.0%。结论血清miR-214与肾透明细胞癌有明显相关性,可作为该病的潜在生物标记物。     

血清miRNA-21与肿瘤标志物CEA、CYFRA21-1、NSE对早期非小细胞肺癌的诊断价值

目的探讨miRNA-21与CEA、CYFRA21-1、NSE对早期非小细胞肺癌(non-small cell lung cancer,NSCLC)的诊断价值。方法以50例NSCLC患者作为病例组、60例健康人为对照组,检测所有研究对象的血清癌胚抗原(CEA)、细胞角蛋白片段21-1(CYFRA21-1)、神经元特异性烯醇化酶(NSE)及miRNA-21(miR-21)水平。结果病例组血清CEA、NSE、CYFRA21-1、miR-21水平均显著高于对照组(P0.01)。CEA、NSE、CYFRA21-1、miR-21诊断NSCLC患者的受试者特征工作曲线(ROC曲线)下面积(AUC)分别为0.918、0.826、0.853、0.866,以CEA诊断效能最高。TNMⅠ-Ⅱ期的NSCLC患者血清miR-21水平、血清CYFRA21-1水平均低于TNMⅢ-Ⅳ期的患者(P0.05)。Logistic多元回归分析结果显示,早期NSCLC(TNMⅠ-Ⅱ期)的发生与血清CYFRA21-1水平、血清miR-21水平均具有相关性(P0.05)。CEA、NSE、CYFRA21-1、miR-21诊断早期NSCLC的AUC分别为0.752、0.806、0.843、0.882,miR-21诊断早期NSCLC的效能最高。单独应用血清CYFRA21-1水平检测、单独应用血清miR-21水平检测和联合应用两种血清标志物检测的AUC分别为0.843、0.872和0.909。结论 NSCLC患者血清miRNA-21与CEA、CYFRA21-1、NSE表达异常,血清miR-21水平对于早期NSCLC的诊断效能较高,可作为辅助诊断的重要血清标志物,将其与血清CYFRA21-1水平进行联合检测,可提高其诊断效能。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.