老年男性2型糖尿病患者目标范围内时间与长期血糖变异性的关系研究

背景 目标范围内时间(TIR)作为血糖管理的新指标,与短期血糖波动相关,是否与长期血糖变异性相关尚不清楚。目的 探讨老年男性2型糖尿病患者TIR与长期随访期间糖化血红蛋白(HbA_1c)变异系数、HbA_1c变异性评分(HVS)的关系。方法 选取2007年1月至2011年1月在解放军总医院第二医学中心住院行动态血糖监测(CGM)的老年男性2型糖尿病患者200例,根据患者基线TIR水平,将其分为TIR≥85%组(n=141)和TIR<85%组(n=59)。对受试者随访观察(12.5±1.1)年,比较两组长期随访期间HbA_1c变异系数和HVS。采用Pearson相关、多元线性回归分析TIR与HbA_1c变异系数、HVS的关系。结果 TIR<85%组患者的长期HbA_1c变异系数[(9.7±3.8)%比(8.2±4.5)%,P=0.028)]、HVS[(48.7±20.4)分比(32.5±20.8)分,P<0.001)]均明显高于TIR≥85%组。Pearson相关分析结果...     

The downregulation of ANGPTL4 inhibits the migration and proliferation of tongue squamous cell carcinoma

ObjectiveTongue squamous cell carcinoma (TSCC) is the most common malignant cancer in the oral cavity, with a high rate of metastasis to the neck lymphoid node. Angiopoietin-like protein 4 (ANGPTL4) and microvessel density (MVD) may be novel indicators for tumor metastasis. The aim of the present study was to investigate the expression and function of ANGPTL4 in TSCC and the relationship between ANGPTL4 and MVD.MethodsThe expression levels of ANGPTL4 and MVD (CD34) were analyzed in 65 TSCC specimens and the adjacent non-cancerous tissues using immunohistochemistry (IHC). siRNA was delivered into TSCCA cells to downregulate ANGPTL4 expression. Subsequently, validation with real-time RT-PCR and western blot analyses was performed to analyze ANGPTL4 expression levels. In addition, a proliferation assay, migration and invasion assays were carried out.ResultsANGPTL4 expression was associated with tumor stage, lymph node metastasis and MVD expression. Cox regression analysis showed that high levels of ANGPTL4 expression were closely associated with poor survival time. In vitro analyses using qRT-PCR and western blot confirmed that ANGPTL4 was successfully inhibited in TSCCA cells. Suppressing ANGPTL4 resulted in the inhibition of cell proliferation and migration, but neither invasion nor cisplatin resistance was significantly affected.ConclusionHigh expression levels of ANGPTL4 are associated with the T stage, lymphatic metastasis, angiogenesis and poor overall survival in TSCC patients. The downregulation of ANGPTL4 inhibits the migration and proliferation of cells in TSCC. Taken together, ANGPTL4 may serve as a novel biomarker and therapeutic target for TSCC.     

Prediction of early recurrence of hepatocellular carcinoma after liver transplantation based on computed tomography radiomics nomogram

BackgroundEarly recurrence results in poor prognosis of patients with hepatocellular carcinoma (HCC) after liver transplantation (LT). This study aimed to explore the value of computed tomography (CT)-based radiomics nomogram in predicting early recurrence of patients with HCC after LT.MethodsA cohort of 151 patients with HCC who underwent LT between December 2013 and July 2019 were retrospectively enrolled. A total of 1218 features were extracted from enhanced CT images. The least absolute shrinkage and selection operator algorithm (LASSO) logistic regression was used for dimension reduction and radiomics signature building. The clinical model was constructed after the analysis of clinical factors, and the nomogram was constructed by introducing the radiomics signature into the clinical model. The predictive performance and clinical usefulness of the three models were evaluated using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA), respectively. Calibration curves were plotted to assess the calibration of the nomogram.ResultsThere were significant differences in radiomics signature among early recurrence patients and non-early recurrence patients in the training cohort (P < 0.001) and validation cohort (P < 0.001). The nomogram showed the best predictive performance, with the largest area under the ROC curve in the training (0.882) and validation (0.917) cohorts. Hosmer-Lemeshow testing confirmed that the nomogram showed good calibration in the training (P = 0.138) and validation (P = 0.396) cohorts. DCA showed if the threshold probability is within 0.06-1, the nomogram had better clinical usefulness than the clinical model.ConclusionsOur CT-based radiomics nomogram can preoperatively predict the risk of early recurrence in patients with HCC after LT.     

个体化肠道准备方案在静脉麻醉下老年患者肠镜检查中的应用

 目的 探讨个体化肠道准备方案在老年患者肠镜检查中的应用。方法 选取2021-03至2022-03在解放军总医院第二医学中心消化内镜中心丙泊酚镇静麻醉下、接受无痛肠镜检查的老年患者98例,随机分为对照组与观察组,每组49例。对照组采用常规肠道准备,观察组采用个体化的肠道准备方案下的肠镜检查前肠道准备。对比两组肠道准备清洁度及患者对此肠道准备方案的满意度。结果 观察组波士顿肠道准备量表得分为(7.83±0.35)分,高于对照组的(6.91±0.73)分,差异有统计学意义(P＜0.05);两组患者满意度比较,观察组满意率98.00%高于对照组的79.60%,差异有统计学意义(P＜0.05)。结论 应用个体化肠道准备方案,波士顿评分高,清洁度好,患者满意度更高,值得推广。     

肺部超声与脉搏指示连续心排血量监测评价急性心力衰竭患者肺水肿程度

目的 对比肺部超声与脉搏指示连续心排血量监测（PiCCO）评价急性心力衰竭肺水肿的价值。方法 对11例急性心力衰竭患者先后行常规超声心动图、肺部超声及PiCCO,共获得26例/次数据,将其分为轻度组[血管外肺水指数（EVLWI）≤ 10 ml/kg,n=12]和重度组（EVLWI>10 ml/kg,n=14）,比较组间血清N末端B型脑钠肽前体（NT-proBNP）值、超声及PiCCO参数的差异。采用Spearman相关性分析各指标与EVLWI的相关性;绘制受试者工作特征（ROC）曲线,计算曲线下面积（AUC）,判断各指标评价肺水肿的效能。结果 轻度组舒张压及左心室射血分数（LVEF）明显高于重度组（P均<0.05）;NT-proBNP、心率、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、肺动脉压（PAP）、下腔静脉直径（IVCD）、E/e''、B线总分、全心舒张末期容积指数（GEDVI）及EVLWI明显低于重度组（P均<0.05）。B线总分与EVLWI呈显著正相关（r=0.955,P<0.001）;其诊断EVLWI>10 ml/kg的AUC为0.95,截断值为15.00时,敏感度为92.90%,特异度为66.70%。结论 肺部超声可较准确地评价急性心力衰竭患者肺水肿程度;B线总分与EVLWI呈显著性相关。     

影响住院行结肠镜诊疗老年患者肠道准备质量的主要因素及其参考界值分析

 目的 探讨影响住院行结肠镜诊疗老年患者肠道准备质量的主要因素,分析相应因素下肠道准备不充分的风险分级及参考界值。方法 回顾性分析在解放军总医院第二医学中心住院行结肠镜诊疗的患者病例资料,包括基本资料、基础疾病、肠道准备相关情况及肠道准备质量,采用病例对照研究,进行单因素分析及多因素回归分析探讨肠道准备质量的影响因素。结果 共160例患者纳入研究,肠道准备合格率为71.25%,多因素回归分析显示,年龄(OR=0.899,P＜0.001)、排便次数(OR=2.223,P＜0.001)及肠道准备方案(OR=0.275,P=0.007)是老年住院行结肠镜诊疗患者肠道准备质量的独立影响因素。进一步分层分析,＜60岁、60～79岁、≥80岁各年龄段肠道准备合格率递减,排便次数＜5次、5～6次、≥7次各段肠道准备合格率明显递增。结论 以60岁和80岁为肠道准备不充分的风险预测参考界值,随着年龄增长肠道准备不充分的风险倍增;肠道准备合格率随排便次数增多而升高,以排便5次和7次划分肠道准备不充分的风险等级具有临床价值;分次肠道准备方案能提高肠道准备的质量。     

CD40-mediated immune cell activation enhances response to anti-PD-1 in murine intrahepatic cholangiocarcinoma

1. Download : Download high-res image (164KB)
2. Download : Download full-size image