肝细胞癌组织中Cyr61、VEGF和HSP27的表达及意义

目的观察富半胱氨酸蛋白61（Cyr61）、血管内皮生长因子（VEGF）和热休克蛋白27（HSP27）在肝细胞癌（HCC）中的表达,分析其与HCC病理学特征和转移的关系。方法采用免疫组化SP法分别检测34例HCC患者肝癌组织和癌旁肝组织中的Cyr61、VEGF和HSP27表达情况,并与HCC患者的临床、病理学特征进行相关性分析。结果VEGF和HSP27在肝癌组织中的表达显著高于癌旁组织（P〈0．05）,Cry61在癌旁组织中的表达显著高于肝癌组织（P〈0．05）;HCC转移者的Cyr61、VEGF和HSP27阳性表达率明显高于无转移者（P〈0．06）。结论Cyr61、VEGF和HSP27的表达与HCC转移密切相关;联合检测Cyr61、VEGF和HSP27的表达情况对判断HCC转移和预后有—定的临床价值。     

乙型肝炎相关慢加急性肝哀竭患者外周血树突状细胞水平及临床意义

目的：探讨乙型肝炎相关的慢加急性肝衰竭（acute －on －Chronic hepatitis B liver failure,ACHBLF）患者外周血树突状细胞（DCs）水平与临床转归的关系。方法收集2010年6月－2014年9月北京佑安医院收治的 ACHBLF 患者70例,以3个月后的临床预后结局分为存活组和死亡组。多因素 Logistic 回归分析影响患者预后的临床指标,同时采用流式细胞术检测外周 DCs 亚群绝对数（107）及百分比（％）;两独立样本 t 检验或秩和检验比较两组 DCs 水平差异并通过线性相关及多因素回归分析确定其是否可作为慢加急性肝衰竭临床转归的独立预测因素。结果TBil 是影响慢加急性肝衰竭3个月预后的临床指标[比值比（OR）＝1．008,95％可信区间（95％CI）：1．003～1．014,P ＝0．003）。存活组外周血髓样 DCs（mDCs）绝对数[（7．3±6．2）×107]明显高于死亡组[（4．1±4．0）×107]（t ＝2．336,P ＜0．05）;存活组患者外周血浆系 DCs（pDCs）绝对数[（0．8±0．6）×107]也明显高于死亡组[（0．4±0．5）×107]（t ＝2．307,P ＜0．05）;mDCs 百分比（Z ＝－0．080,P ＞0．05）及 pDCs 百分比（t ＝－0．248,P ＞0．05）在两组间差异无统计学意义。mDCs 和 pDCs 绝对数与 TBil 无线性相关关系（R2值分别为0．009和0．059）,mDCs 与 pDCs 绝对数可纳入多因素回归方程,结果显示 mDCs（OR ＝0．789,95％CI：0．665～0．935,P ＝0．006）和 TBil（OR ＝1．013,95％CI：1．006～1．020,P＜0．001）是慢加急性肝衰竭预后的独立预测因素。结论ACHBLF 患者外周血 mDCs 及 pDCs 绝对数存活组高于死亡组,mDCs 绝对数是慢加急性肝衰竭预后的独立预测因素。DCs 数量的差异可能是影响肝衰竭患者临床转归的原因之一。     

HBV相关肝细胞癌肿瘤组织中热休克蛋白mRNA表达水平与肿瘤分期的相关性分析

目的分析肝细胞癌(HCC)肿瘤组织中热休克蛋白(HSP)mRNA表达水平与HCC肿瘤分期的相关性。方法从NCBI网站的基因表达数据库(GEO)下载GSE14520数据集。从GSE14520基因数据库中获取HSP基因25种,通过与数据库下载的临床资料比对,纳入具有HSP基因mRNA表达水平和有对应临床资料的220例HCC患者。提取220例患者癌组织HSP基因的mRNA表达水平及对应的TNM分期及BCLC分期并进行相关性分析。采用Kruskal-Wallis H非参数检验进行多组间比较,采用单因素及多因素logistic回归分析HSP与HCC肿瘤分期的相关性。结果 HSPA12A、HSPA5、HSP90AA1与HSPA13 mRNA随着TNM分期增高,表达逐渐升高(P值均0.05);HSP90AA1 mRNA随着BCLC分期增高,表达逐渐升高(P0.05)。HSPA4L(OR=1.019,P=0.005)、HSPA12A(OR=1.077,P=0.026)与HSP90AA1(OR=1.001,P=0.002)是影响TNM分期的危险因素;HSPA9 mRNA升高与HCC患者TNM分期呈负相关(OR=0.995,P=0.011)。HSPH1(OR=1.005,P=0.041)、HSPA1B(OR=1.002,P=0.048)与HSPA5(OR=1.000,P=0.001)是影响BCLC分期的危险因素;HSPA9 mRNA升高与肝癌BCLC分期呈负相关(OR=0.995,P=0.005)。结论 HSP与HCC患者肿瘤临床分期存在一定相关性。     

肝癌组织中凋亡调控因子Fas、FasL及caspase-3的表达及意义

目的：探讨凋亡调控因子Fas、FasL及caspase-3在肝细胞癌（HCC）组织中的表达及其临床意义。方法应用免疫组织化学SP法检测80例HCC患者肝癌组织及其相应癌旁正常肝组织中Fas、FasL及caspase-3的表达,并分析其表达与 HCC临床病理因素的相关性。结果 Fas、FasL及caspase-3在 HCC、癌旁组织中的表达比较,均差异有统计学意义（P＜0．05）。在TNM 分期（Ⅲ～Ⅳ期）、有门静脉癌栓、有淋巴结转移的肝癌组织中Fas 的阳性表达率明显降低（P＜0．05）;在病理分级（Ⅲ～Ⅳ级）、TNM分期（Ⅲ～Ⅳ期）、有门静脉癌栓、有淋巴结转移的肝癌组织中FasL的阳性表达率明显增高（P＜0．05）;在病理分级（Ⅲ～Ⅳ级）、TNM分期（Ⅲ～Ⅳ期）、有淋巴结转移的肝癌组织中 caspase-3的阳性表达率明显降低（P＜0．05）。80例 HCC患者肝癌组织中Fas、FasL与caspase-3的表达,两两之间并无明显关联性（狉＝0．057,P＞0．05）。结论 Fas/FasL系统的失衡及caspase-3低表达导致肝癌细胞凋亡障碍,在 HCC发生、发展及转移中起着重要作用。     

急性脑梗死早期患者血糖水平对预后的影响

目的：观察急性脑梗死早期患者血糖水平对预后的影响。方法104例发病72 h内入院的急性脑梗死患者,入院后立即行血清葡萄糖测试,采用美国国立卫生研究院卒中量表（ NIHSS）进行评分,运用改良Rankin残障量表评分（mRs）评估预后。结果104例急性脑梗死患者中,43例（41．3％）出现高血糖,高血压（OR＝3．655,95％CI：1．218～10．969,P＜0．05）、糖尿病（OR＝17．714,95％CI：3．568～87．939,P＜0．05）、NIHSS评分（OR＝2．731,95％CI：1．637～5．458,P＜0．05）为急性脑梗死后高血糖的独立危险因素。 NIHSS评分（OR＝0．322,95％CI：0．181～0．572,P＜0．05）、高血糖（OR＝6．782,95％CI：1．654～26．373,P＜0．05）为预后不良的独立危险因素。结论部分急性脑梗死患者早期血糖升高,高血糖为急性脑梗死预后不良的独立危险因素。     

短暂后循环缺血患者脑白质变性严重程度的相关因素分析

目的：分析短暂后循环缺血（ PCI）患者脑白质变性（ LA）严重程度的独立相关因素。方法连续选取313例短暂PCI患者,根据Wahlund改良LA分级量表（ ARWMC）评分对LA严重程度的分级进行分组,记录各临床资料;对各计量资料与ARWMC评分进行Spearman相关分析,对各计数资料与ARWMC评分进行Kendall相关分析;对有统计意义的变量,进行有序多分类Logistic回归分析。结果各临床资料与LA得分的相关分析筛选结果显示,年龄、性别、心电图RV5＋SV2、颈动脉斑块、CRP、HDL、Hcy、叶酸与短暂PCI患者LA严重程度相关（ P均＜0．1）;Logistic回归分析结果显示,未发现心电图RV5＋SV2、CRP、Hcy、性别与短暂PCI患者LA严重程度的独立相关性（P均＞0．05）;而年龄（P＝0．000,OR＝1．119,95％CI：1．089～1．149）、HDL（P＝0．042,OR＝0．390,95％ CI：0．157～0．967）、叶酸（P＝0．006,OR＝0．914,95％ CI：0．856～0．974）、颈动脉斑块形成（P＝0．000,OR＝5．023,95％CI：2．672～9．440）与短暂PCI患者LA严重程度独立相关（P均＜0．05）。结论年龄、有无颈动脉斑块及HDL、叶酸水平是短暂PCI患者LA严重程度的独立相关因素。     

急性白血病患者细胞周期蛋白E及依赖激酶抑制剂表达的意义

目的：探讨细胞周期蛋白E（cyclin E)、细胞周期蛋白依赖激酶抑制剂（p27KIP1)对成人初治急性白血病（AL）发展及预后的作用。方法：用流式细胞术检测60例AL及17例对照cyclin E、p27 KIP1、多药耐药基因蛋白p170表达及细胞周期分布;逆转录－聚合酶链反应检测46例成人AL患者及17例对照的骨髓cyclin E、p27KIP1、多药耐药蛋白的mRNA水平。结果：60例AL患者全周期及G2／M期cyclinE表达均高于对照组（＜0．01或0．05）;p27KIP1全周期表达亦均高于对照组,但G2／M期差异无显著性（P＞0．05）;cyclinE与p27KIP1的表达呈正相关;AL患者cyclin E高表达组缓解率（44．8％）低于正常表达组（77．4％）（P＜0．01）;复发率（92．3％）高于正常表达组（41．7％）（P＝0．003;p27KIP1表达对AL缓解率、复发率的影响无统计学意义（P＞0．05,P＝0．89）。结论：cyclinE在成人AL有异常高表达,并可能促使AL的发展,是AL缓解率、复发率的重要危险因素。     

非小细胞肺癌组织中 PGSK-3β、TCF-4、NET-1的表达及意义

目的：探讨非小细胞肺癌（ NSCLC）组织中PGSK-3β、TCF-4、NET-1的表达及意义。方法采用免疫组化SP法检测90份NSCLC组织中PGSK-3β、TCF-4、NET-1的表达，并分析其阳性表达的相关性。结果 NSCLC不同组织类型（腺癌、鳞癌）间PGSK-3β、TCF-4、NET-1的阳性表达比较P均＞0．05，不同分化程度（中低分化、高分化）中阳性表达比较P均＜0．05。 PGSK-3β阳性表达与TCF-4、NET-1阳性表达均呈正相关（ r分别为0．2478、0．4093，P均＜0．05），TCF-4阳性表达与NET-1阳性表达亦呈正相关（r＝0．2609，P＜0．05）。结论 PGSK-3β、TCF-4、NET-1在NSCLC组织中均有阳性表达，并共同促进了肿瘤的发生、发展。     

原发性肝细胞癌及癌旁组织中环氧合酶-2的表达及其意义

目的：研究人原发性肝细胞癌（HCC）组织和癌旁非瘤组织中的环氧合酶－2（COX－2）蛋白及基因表达情况,方法：采用免疫组织化法和原位分子杂交法,研究27对原发性肝细胞癌及癌旁非肿瘤组织,5例正常肝组织中COX－2的蛋白和基因表达,结果：高分化HCC中COX－2蛋白表达显著高于中分化和低分化HCC（P分别＜0．05）以及癌旁组织和正常组织（P分别＜0．01）,癌旁组织的COX－2表达显著高于正常组织（P＜0．05）,癌旁组织,中分化和低分化HCC之间COX－2的表达强度差异无显著性（P＞0．05）,在COX－2蛋白阳性的肝癌细胞和癌旁肝细胞胸胞胞质中可见到COX－2mRNA呈阳性表达,结论：COX－2的过度表达可能参与了高分子HCC的致癌过程。     

bax、bcl-w基因在肝细胞癌中表达及其临床意义

采用免疫组织化学方法检测石蜡包埋的人肝细胞癌（HCC）标本中凋亡相关基因bax,bcl-w的表达。bax在HCC中阳性率（18／40）低于肝硬变（11／15），而bcl-w在HCC中阳性率（22／40）高于肝硬变（3／15），P均＜0．05。高、中分化型者,bax表达高于低分化者，bcl-w表达低于分化者。临床分期为I、Ⅱ期者，bax表达高于临床Ⅲ期者，bcl-w表达低于临床Ⅲ期者。胎甲球蛋白（AFP）≤400μg/L患者，bax表达高于胎甲球蛋白（AFP）＞400μg/L患者，bcl-w表达低于胎甲球蛋白（AFP）＞400μg/L患者（P＜0．05或P＜0．01）。但两者在不同 性别和不同年龄组（＞60岁与≤60岁）之间则无显著性差异（P＞0．05）。结果提示凋亡相关基因bax、bcl-w在HCC中表达对肝癌细胞的凋亡起调节作用，并与分化程度、临床分期、AFP水平有关。     

Use of fab fragments of digoxin-specific antibodies in the therapy of massive digoxin poisoning

A case of massive digoxin ingestion with multiple arrhythmias, consisting of high grade A-V block and ventricular ectopy not responsive to lidocaine, is described. The arrhythmias ceased following administration of digoxin-specific Fab fragments. The patient improved and was transferred to the psychiatric unit.     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

Role of microRNA in regulation of myeloma-related angiogenesis and survival

Multiple myeloma (MM) is a malignant disease caused by clonal proliferation of plasma cells that result in monoclonal gammopathy and severe end organ damage. Despite the uniform clinical signs, the disease is very diverse in terms of the nature and sequence of the underlying molecular events. Multiple cellular processes are involved in helping the malignant cells to remain viable and maintain proliferative properties in the hypoxic microenvironment of the bone marrow. Specifically, the process of angiogenesis, triggered by the interactions between the malignant MM cells and the stroma cells around them, was found to be critical for MM progression. In this review we highlight the current understanding about the epigenetic regulation of the proliferation and apoptosis of MM cells and its dependency on angiogenesis in the bone marrow that is carried out by different microRNAs.     

Comparison of intravenous and oral routes of theophylline loading in acute asthma

In a prospective, randomized clinical trial, 19 patients with an acute exacerbation of asthma were given a loading dose of aminophylline by the IV (n = 10) or oral route (n = 9) of administration following treatment with epinephrine. Plasma concentrations of theophylline were measured prior to giving the loading dose, and one, two, three, and 24 to 48 hours later. Therapeutic effectiveness was evaluated by analyzing spirometric measurements prior to giving the loading dose, and one, three, and 24 to 48 hours later. Side effects also were recorded. In the IV group, the mean peak plasma theophylline concentration was 15.1 micrograms/mL one hour after loading, and in the oral group the mean peak serum theophylline concentration was 14.2 micrograms/mL three hours after loading. There was no correlation between theophylline concentrations and normalized change in spirometric values. There was no significant difference in spirometric values between the IV and oral groups. Nausea was slightly more common in the IV group. We conclude that there is no therapeutic advantage to giving a loading dose of aminophylline by the IV route rather than orally in patients with mild-to-moderate exacerbation of asthma initially treated with epinephrine.     

岳阳市城区小学生血吸虫病防治健康教育现状调查

目的 调查湖南省岳阳市城区小学生血吸虫病防治知识、行为现状及健康教育需求情况,为制定科学有效的小学生血吸虫病健康教育方案提供参考依据。方法 采用分层整群抽样方法,抽取岳阳市城区洞庭湖湖畔学校和中心城区学校各2所,每所再从五、六年级分别抽取2个班的学生,通过调查问卷了解小学生血吸虫病相关知识、预防行为及健康教育需求,并进行统计分析。结果 共调查湖畔小学353人、中心城区小学363人,两组学校小学生年龄、性别、年级构成差异无统计学意义（t=-0.494,χ²_性别=1.615,χ²_年级=2.152;P均>0.05）。学生血吸虫病防治知识总知晓率为42.60%（305/716）,其中,湖畔学校小学生血防知识知晓率（52.97%）高于中心城区（32.51%）,差异有统计学意义（χ²=30.661,P<0.05）;学生行为正确率为76.68%（549/716）,血防知识知晓组行为正确率（81.31%）高于不知晓组（71.24%）,差异有统计学意义（χ²=6.384,P<0.05）。学生血防知识主要来源于老师（47.49%）;91.90%的学生愿意了解更多的血防知识,最喜欢的血防知识学习方式是参加课外活动（50.42%）。结论 岳阳市城区小学生的血防知识知晓率及行为正确率偏低,对血吸虫病防治健康教育需求较高。建议针对学生开展形式多样的血防健康教育,以增强学生的血吸虫病防护意识,提高自我防护能力。     

欧洲儿童肝豆状核变性诊疗推荐意见简介

正肝豆状核变性(Wilson’s disease,WD)是常染色隐性遗传相关的铜代谢障碍性疾病,估计患病率为1:30000。该病是由于编码P型ATP酶的ATP7B基因突变,影响铜的分泌及排泄所致铜沉积。儿童肝豆状核变性的临床表现可以从无症状肝脏疾病到肝硬化或者肝衰竭,但是神经精神症状却非常少见。常规的检测方法包括血清铜蓝蛋白、24 h尿铜。最终的诊断需要基于症状、评估铜代谢的生化学检     

RNA-Seq在老年神经退行性疾病研究中的应用

阿尔茨海默病及帕金森病是老年人最常见的两种神经退行性疾病,但其发病机制及治疗是研究的热点。随着高通量测序技术的进步及成本的下降,RNA-Seq也成为神经退行性疾病机制研究及生物标志物发现的有力手段。RNA-Seq相对于microarray具有高灵敏度、高准确性、高重复性以及噪声低等优势,在阿尔茨海默病及帕金森病研究中有较为广泛的应用,包括检测差异表达基因,可变剪接、新长链非编码RNA预测分析和miRNAs调控等,但是容易受病理复杂性及样本等因素影响。目前阿尔茨海默病及帕金森病转录组研究相比于癌症等还不够深入,在临床诊断及治疗应用还面临较大挑战。但是随着新技术及新方法的发展,RNA-Seq将进一步推动神经退行性相关疾病的研究和临床转化。     

Predicting, treating and preventing postoperative recurrence of Crohn's disease: the state of the field

The majority of patients diagnosed with Crohn's disease eventually require surgical intervention. Unfortunately, postsurgical remission tends to be short lived; a significant number of patients experience clinical relapse and many require additional operations. The pathogenesis of this postoperative recurrence is poorly understood and, currently, there are no reliable tools to predict when and in whom the disease will recur. Furthermore, the postoperative prophylaxis profiles of available Crohn's disease therapeutic agents such as 5-aminosalicylates, immunomodulators, steroids and probiotics have been disappointing. Recently, the combination of antibiotics and azathioprine in selected high-risk patients has demonstrated some potential for benefit. The goal of the present article is to provide a coherent summary of previous and new research to guide clinicians in managing the challenging and complex problem of postoperative Crohn's disease recurrence.     

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation

The role of the external and internal anal sphincters in the mechanism of anal continence is presented. The external sphincter induces continence by 1) preventing internal sphincter relaxation, what I have called the “voluntary inhibition action,” and 2) mechanical compression of the rectal neck and anal canal proper. The mechanism of both actions is described. The internal sphincter plays a significant role not only in involuntary, but also in voluntary, continence. The importance of this role in the correction of anal incontinence is clarified. “Stress defecation,” a condition which follows internal sphincter damage, is discussed. A “single loop continence” theory is presented, based on the fact that each of the three loops of the external sphincter has its own innervation, attachment, and direction of muscle bundles; each loop thus acts as a separate sphincter. The clinical application of this theory is presented.