国产活检枪在甲状腺疾病活组织检查中的临床应用价值

目的：评估国产可调式自动活检装置（活检枪）在临床甲状腺病变活组织检查中的价值。方法：使用国产第二代活检装置（活检枪）在彩超高频探头监视下,经皮穿刺对69例甲状腺疾病进行活检取材。结果：取材成功率100%,手术组88.2%（30/34）可以得出明确病理组织学诊断,对甲状腺疾病的良恶性诊断符合率（34/34）100%,无假阳性或假阴性结果。16例甲状腺疾病细针针吸细胞学诊断（FNAB）与手术病理符合率（12/16）75%,假阴性3例（将2例滤泡性腺癌误判为滤泡性腺瘤,1例将乳头状腺癌误判为滤泡性腺瘤）占（3/16）18.75%,1例恶性淋巴瘤只能作出少量异形细胞的判断,而不能作出定性诊断,占（1/16）6.25%,对1例恶性淋巴瘤只能作出少量异形细胞的判断。结论：国产可调式自动活检枪性能稳定、取材可靠,使用方便;该装置的射程可调范围广,在甲状腺等浅表组织器官病变中的活组织诊断应用中有一定优势。     

高原环境肺功能改变对复方新诺明药物动力学的影响

目的：探讨高原低氧条件下肺功能与复方新诺明（sulfamethoxazole Co,SMZ Co）药物动力学的关系。方法：采用高效液相色谱法测定平原、急进高原和久居高原3组2个群体健康汉族男性青年志愿者口服单剂量复方新诺明前后15个时间点血浆药物浓度。应用德国Jegger肺功能仪测定3组肺功能。采用DAS2．0和SPSS13．0统计软件计算3组受试者口服复方新诺明片后磺胺甲噁唑的药物动力学和肺功能参数。结果：急进高原组受试者的药动物力学参数消除速率常数（Ke）、AUC、平均驻留时间（MRT）、半衰期（t1/2）、清除率（CL）与平原组比较差异有统计学意义,久居高原组受试者的药物动力学参数Ke、MRT、t1/2与平原组比较差异有统计学意义,急进高原纽受试者的药动物力学参数t1/2、表观分布容积（V／F）与久居高原组比较差异有统计学意义。急进高原组的呼出25％肺活量时最大呼气峰流速（FEF25％）和最大呼气峰流速（PEF％）值大于平原和久居组（P〈0．01）,久居组呼出50％肺活量时最大呼气峰流速（FEF50％）、最大呼气中段流速（MMEF％）、用力呼气容积（FEV％）,用力肺活量（FVC％）和肺活量（VC％）与急进高原和平原组相比显著下降（P分别〈0．05和0．01）。最大呼气峰流速（PEF％）、FEF50％与AUC正相关;FVC％、PEF％、FEF50％、MMEF％和用力呼气容积占用力肺活量的百分比（FEV／FVC％）与t1/2和VIF负相关。结论：高原环境肺功能改变对复方新诺明药物动力学参数AUC、t1/2,和V/F有显著影响。     

重组人血管内皮抑制素联合含铂化疗方案治疗晚期非小细胞肺癌的临床观察

目的：观察重组人血管内皮抑素（恩度）联合含铂化疗方案（TP：紫杉醇＋顺铂、TC：紫杉醇＋卡铂、GP：吉西他滨＋顺铂、NP：长春瑞滨＋顺铂）治疗晚期非小细胞肺癌（NSCLC）的疗效和安全性。方法：入组经病理证实的晚期非小细胞肺癌患者78例,实验组37例采用恩度联合含铂化疗方案治疗,对照组41例采用含铂化疗方案治疗,均治疗（2～4）个周期。按照RECIST标准和WHO毒性反应分级标准,分别评价疗效和药物的毒性反应;由KPS评分变化情况评价患者的生活质量改善情况。结果：实验组37例晚期NSCLC患者中,获得完全缓解（CR）1例,部分缓解（PR）9例,稳定（SD）16例,进展（PD）11例,总有效率27.0%,疾病控制率70.3%,中位肿瘤进展时间（TTP）是7.1个月,一年生存率为62.2%。,生活质量改善率83.7%;对照组41例中,获得CR 0例,PR 7例,SD 17例,PD 17例,总有效率17.1%,疾病控制率58.5%,中位TTP是4.2个月,一年生存率为41.5%,生活质量改善率63.4%;两组间疗效差异及生活质量改善率之间有显著性（P〈0.05）。毒性反应主要为骨髓抑制及胃肠道反应和轻度心电图改变等。结论：恩度联合含铂方案治疗晚期非小细胞肺癌（NSCLC）的客观疗效高,安全性好。     

多西紫杉醇联合奥沙利铂治疗晚期胃癌的临床疗效观察

目的：观察多西紫杉醇（TXT）联合奥沙利铂（OXA）方案治疗晚期胃癌的临床疗效及不良反应。方法：对38例晚期胃癌患者,采用TXT 75mg/m2,静脉滴注（第1天）;OXA 130 mg/m2,静脉滴注（第2天）;21天为1个周期,至少2个周期后评价疗效。结果：38例患者均按计划完成（2～6）个周期化疗,共完成148个周期,均可评价疗效。其中CR 2例,PR 21例,NC 9例,PD 6例,RR（CR＋PR）%为60.52%;KPS改善30例（78.94%）;中位无进展生存期（PFS）6.2个月,中位总生存期（OS）11.9个月。不良反应主要是骨髓抑制,（Ⅲ～Ⅳ）级白细胞减少率达63.16%,其次为脱发、胃肠道反应及周围神经毒性,均为可逆性。本组无治疗相关性死亡。结论：多西紫杉醇联合奥沙利铂治疗晚期胃癌疗效确切,毒性反应轻,患者耐受性好,且两药联合方案与在此基础上联用氟尿嘧啶类药物的三药联合方案疗效相似,即减轻了毒副反应,又节省了治疗费用,给药方便,值得临床推广应用。     

2型糖尿病肾病患者厄贝沙坦联合阿托伐他汀治疗后血尿转化生长因子β_1水平的变化

目的：对糖尿病早期肾病患者进行降糖及厄贝沙坦和阿托伐他汀治疗,检测血和尿转化生长因子β1（TTGF-β1）水平,比较厄贝沙坦、阿托伐他汀以及两药联合治疗对早期DN患者TTGF-β2的影响。方法：选取糖尿病早期肾病患者65例,随机分为厄贝沙坦组、阿托伐他汀组、厄贝沙坦联合阿托伐他汀治疗组,选取29名健康体检者作为正常对照。12周后采用放射免疫法检测24h尿白蛋白排泄率（UAER）,双抗体夹心酶联免疫吸附试验（ELISA法）检测血清和尿液TTGF-β1水平。结果：早期DN患者血和尿TTGF-β1水平显著高于健康志愿者（P〈0.01）。与治疗前基础值相比,两药均能减少UAER以及血和尿中TTGF-β1（P〈0.05）,以联合治疗更为明显。结论：早期DN患者血和尿TTGF-β1水平升高,厄贝沙坦、阿托伐他汀以及厄贝沙坦联合阿托伐他汀能有效降低TTGF-β1,血和尿TTGF-β1水平可以作为DN早期诊断和治疗效果评估的有效指标。     

ER、VEGF、MVD在肺癌组织中的表达及其临床意义

目的探讨雌激素受体(ER)与血管内皮生长因子(VEGF)在非小细胞肺癌(NSCLC)中的表达及其与生物学行为的关系。方法76例临床资料完整的肺癌手术切除标本,采用免疫组化方法检测其中ER、VEGF及微血管密度(MVD)的表达情况。结果76例NSCLC的ER的阳性表达率为69.7%(53/76),VEGF的阳性表达率为48.7%(37/76)。临床分期低、无淋巴结转移和中高分化的ER表达要高于临床分期高、有淋巴结转移和低未分化的的肺癌组织,临床分期低、有淋巴结转移和低未分化的VEGF和MVD的表达要高于临床分期低、无淋巴结转移和中高分化的的肺癌组织,差异均具有统计学意义(P<0.05),并且ER的表达与VEGF和FⅧ的表达呈负相关。结论肺癌组织中ER、VEGF和MVD可能在非小细胞肺癌的发生、发展中共同起作用。联合检测可作为评价非小细胞肺癌恶性程度和预后的共同指标。     

Efficacy and safety of no-touch radiofrequency ablation for small hepatocellular carcinoma-a systematic review and single-arm meta-analysis

ObjectiveThe purpose of this study was to report the efficacy and safety of no-touch radiofrequency ablation (NT-RFA) in the treatment of small hepatocellular carcinoma (HCC).MethodsWe systematically searched for eligible studies in PubMed, Embase and Cochrane library until June 1, 2022. Random effect model was applied to synthesize the pooled proportions of local tumor progression-free survival (LTP), recurrence-free survival (RFS) and overall survival (OS) respectively, as well as adverse events, for small HCC treated by NT-RFA.ResultsOf the 10 included studies, 3 of them reported local tumor recurrence. One reported local tumor recurrence at 19 months (range, 12–24), and 2 studies had no tumor recurrence with 24-months of follow-up. The 1- and 2-year LTP pooled proportions were 99.3% (95%CI, 97.5–100) and 97.8% (95%CI, 94.6–99.6) respectively, and two studies reported a 3-year LTP rate of 96.4% (204/212, 36/37). The 1-yearRFS rates was 91.3% (95%CI, 84.1–98.4), 2-year was 86.4% (95%CI, 75.3–97.5). The 1-, 2- and 3- year OS rates were 92.4% (95%CI, 82.8–92.7), 84.1% (95%CI, 74.7–93.6) and 81.8% (116/181, 33/36) respectively, and only one study reported a 5-year OS rate of 47.0% (85/181). The ablative success rate of the HCC nodules was 96.6% (95%CI, 91.3–99.5) and the proportions of mild and severe adverse events following ablation were 18.3% (95%CI, 8.1–41.6) and 5.0%, respectively.ConclusionNT-RFA provides safely very high rate of sustained local control for the treatment of HCC up to 5 cm.     

Association between migraine or severe headache and hypertension among US adults: A cross-sectional study

Background and aimsEpidemiological evidence of the association between migraines, severe headaches, and hypertension is contradictory. Hypertension is a critical risk factor for cardiovascular diseases. Migraine is a common neurological disease and a major cause of disability worldwide. Therefore, we aimed to investigate the relationship between migraine, severe headaches, and hypertension among US adults.Methods and resultsCross-sectional data from 5716 subjects were obtained from the National Health and Nutrition Examination Survey between 1999 and 2004. Weighted logistic regression models investigated the association between migraines, severe headaches, and hypertension. In total, 5716 subjects were enrolled in the present study, of whom 1134 (19.8%) had migraine or severe headaches. Participants with migraine were predominantly younger females and had a higher body mass index (BMI), lower educational level, lower dietary intake of potassium and calcium, lower serum levels of total cholesterol (TC), creatinine, and hemoglobin, as well as a higher estimated glomerular filtration rate (eGFR) (all P < 0.05). After fully adjusting for potential confounders, migraine or severe headaches were positively associated with hypertension (OR 1.25, 95% CI: 1.03–1.53).ConclusionOur study found a positive association between migraine, severe headaches, and hypertension. Further studies are needed to verify the causality of this association and elucidate the underlying mechanisms.     

Habitual intakes of sugar-sweetened beverages associated with gut microbiota-related metabolites and metabolic health outcomes in young Chinese adults

Background and aimsReducing consumption of sugar-sweetened beverages (SSBs) is a global public health priority because of their limited nutritional value and associations with increased risk of obesity and metabolic diseases. Gut microbiota-related metabolites emerged as quintessential effectors that may mediate impacts of dietary exposures on the modulation of host commensal microbiome and physiological status.Methods and resultsThis study assessed the associations among SSBs, circulating microbial metabolites, and gut microbiota–host co-metabolites, as well as metabolic health outcomes in young Chinese adults (n = 86), from the Carbohydrate Alternatives and Metabolic Phenotypes study in Shaanxi Province. Five principal component analysis-derived beverage drinking patterns were determined on self-reported SSB intakes, which were to a varying degree associated with 143 plasma levels of gut microbiota-related metabolites profiled by untargeted metabolomics. Moreover, carbonated beverages, fruit juice, energy drinks, and bubble tea exhibited positive associations with obesity-related markers and blood lipids, which were further validated in an independent cohort of 16,851 participants from the Regional Ethnic Cohort Study in Northwest China in Shaanxi Province. In contrast, presweetened coffee was negatively associated with the obesity-related traits. A total of 79 metabolites were associated with both SSBs and metabolic markers, particularly obesity markers. Pathway enrichment analysis identified the branched-chain amino acid catabolism and aminoacyl-tRNA biosynthesis as linking SSB intake with metabolic health outcomes.ConclusionOur findings demonstrate the associations between habitual intakes of SSBs and several metabolic markers relevant to noncommunicable diseases, and highlight the critical involvement of gut microbiota-related metabolites in mediating such associations.