肺癌多种基因同步检测及临床相关性(诊断及预后)的研究

目的 :为检测非小细胞肺癌中多种基因的改变 ,并探讨其临床相关性 (诊断及预后 )。方法 :本研究用LSAB(labelledstreptavidinbiotin)法同步检测 10 4例非小细胞肺癌 (NSCLC)组织中抗癌基因p16,pRb及癌基因cy clinD1,cdk4和转移相关基因nm 2 3 H1,CD4 4v6表达。结果 :3 2 8%的鳞癌和 5 3 7%的腺癌不表达p16蛋白 ,腺癌明显高于鳞癌 (P <0 0 5 ) ;腺癌只有 14 6%完全不表达pRb蛋白 ,鳞癌不表达率为 3 6 2 % (P <0 0 5 ) ;5 7 7%的肿瘤只表达p16或pRb中的一项 ;3 2 7%的肿瘤两者都表达 ,但两者表达强度差异明显 ,9 6%的肿瘤两者均表达且表达强度一致 ;88 6%的肿瘤表达cdk4,在高分化鳞癌中表达率为 66 7% ,中分化鳞癌 96 3 % ,低分化鳞癌达10 0 % ,大约 70 %的肺癌中有cyclinD1表达 ,而正常粘膜中只有 2 0 %有表达 (P <0 0 0 0 1) ,表明非小细胞肺癌中cy clinD1的表达明显增高。在无淋巴结转移组 ,其nm 2 3的表达率高达 78 8% ,与有淋巴结转移组的表达率 2 1 9%相比 ,有非常显著性差异 (P <0 0 0 0 1) ;有淋巴结转移组 ,CD4 4v6的表达率高达 96 9% ,与无淋巴结转移的表达率相比 ,差异具非常显著性 (P <0 0 0 0 1)。结论 :①p16及pRb基因的表达在肺癌中明显减弱 ,均与非小细胞肺癌的组织学类型有关     

Clinical Application of Breast Fiberoptic Ductoscopy in 354 Cases with Abnormal Nipple Discharge

OBJECTIVE To use the breast duct endoscope for studying thepathological characteristics of breast-duct disease with nipple discharge,and offer methods that can improve diagnostic accuracy.METHODS A total of 354 patients with nipple discharge were examinedusing the fiberoptic duct endoscope (FVS-3000M). Ducts and theirbranches were investigated to define and locate the extent of intraductallesions. Core biopsies were taken of suspicious lesions and the findingswere analyzed retrospectively.RESULTS In cases of bloody and serosanguineous nipple discharge,72.3% were papilloma and papillomatosis, 5.2% duct cancer and 22.5%mammary duct ectasia and galactophoritis. In patients with watery nippledischarge, 56.0% were papilloma and papillomatosis, 8.0% were breastcancer and 5 patients without abnormal findings were regarded asnormal.CONCLUSION Fiberoptic duct endoscopy can accurately locate the siteand pathology of nipple discharge allowing the improvement in diagnosisof early breast cancer.     

肺癌组织中黑色素瘤抗原-A3基因mRNA的表达及其序列点突变分析

目的检测肺癌组织中黑色素瘤抗原-3基因(MAGE-A3)mRNA的表达。方法用逆转录-套式聚合酶链反应(RT-PCR)对31例肺癌患者癌组织和相应癌旁组织MAGE-A3mRNA表达情况进行测定;PE-377DNA测序仪对5例10个RT-PCR扩增产物中的目的基因片段进行DNA序列测定。结果31例肺癌患者癌组织中26例表达MAGE-A3mRNA,阳性率为83.9%;相应的癌旁组织均未表达。DNA序列测定证明PCR扩增产物中目的基因片段均为MAGE-A3cDNA序列,所测5例样本中4例样本有两个相同位置的碱基发生了点突变(C2773→T2773;G2807→A2807),导致一个氨基酸残基改变(E143→K)。结论MAGE-A3mRNA在肺癌中呈高比例表达,提示此抗原有可能作为肺癌患者免疫治疗的靶抗原。我国肺癌患者中存在MAGE-A3基因个别位点的变异。     

改进的计算机辅助眶鼻窦重建术治疗复发性眶鼻窦黏液囊肿的效果

目的:评价作者改进的计算机辅助眶鼻窦重建术治疗复发性眶鼻窦黏液囊肿的临床效果。方法:回顾性分析河南省人民医院2008年7月至2018年1月接受改进的计算机辅助眶鼻窦重建术治疗复发性眶鼻窦黏液囊肿45例的临床资料。观察手术效果。术后随访25~44个月。结果:所有患者术后视力(BCVA,logMAR)优于术前(t=7.665,P<0.05),眼球突出度低于术前(t=8.871,P<0.05);鼻窦内引流通道均通畅,无复发,无感染或异物排斥等不良反应。CT显示均得到较好的眶鼻解剖重建,复视现象消失,眼球的位置、运动功能及外观均恢复正常。结论:改进的计算机辅助眶鼻窦重建术是一种较好治疗复发性眶鼻窦黏液囊肿的方法。     

Silencing of DNA repair sensitizes pediatric brain tumor cells to γ-irradiation using gold nanoparticles

We present a nanoparticle (NP)-mediated delivery vehicle that effectively carries and protects siRNA in pediatric ependymoma (EP) and medulloblastoma (MB) cells. The delivery vehicle consists of gold NPs coated with a polymeric shell comprising polyethylene glycol (PG), chitosan and polyethyleneimine (Au-CP-PEI). NPs loaded with siRNA knocked down Ape1 expression by over 75% in both MB and EP cells. Further, this reduction in Ape1 expression is associated with an increase in DNA damage after irradiation. The results indicate that NP-associated delivery of siApe1 is a feasible approach to circumventing pediatric brain tumor resistance to radiation therapy.     

Silencing of MicroRNA-21 confers the sensitivity to tamoxifen and fulvestrant by enhancing autophagic cell death through inhibition of the PI3K-AKT-mTOR pathway in breast cancer cells

Tamoxifen (TAM) and fulvestrant (FUL) represent the major adjuvant therapy to estrogen receptor-alpha positive (ER⁺) breast cancer patients. However, endocrine resistance to TAM and FUL is a great impediment for successful treatment. We hypothesized that miR-21 might alter the sensitivity of breast cancer cells to TAM or FUL by regulating cell autophagy. Using the ER⁺ breast cancer cells, we knockdown miR-21.by transfection with miR-21 inhibitor, then the cells were exposed to TAM or FUL and the percentages of apoptosis and autophagy were determined. Knockdown of miR-21 significantly increased the TAM or FUL-induced apoptosis in ER⁺ breast cancer cells. Further, silencing of miR-21 in MCF-7 cells enhanced cell autophagy at both basal and TAM or FUL-induced level. The increase of autophagy in miR-21-knockdown MCF-7 cells was also indicated by increase of beclin-1, LC3-II and increased GFP-LC3 dots. Importantly, knockdown of miR-21 contributed to autophagic cell death, which is responsible for part of TAM induced cell death in miR-21 inhibitor-transfected cells. Further analysis suggested that miR-21 inhibitor enhance autophagic cell death through inhibition of PI3K-AKT-mTOR pathway. MiR-21 coordinated the function of autophagy and apoptosis by targeting Phosphatase and tensin homolog (PTEN) through inhibition of PI3K-AKT-mTOR pathway. In conclusion, silencing of miR-21 increased the sensitivity of ER⁺ breast cancer cells to TAM or FUL by increasing autophagic cell death. Targeting autophagy-related miRNAs is a potential strategy for overcoming endocrine resistance to TAM and FUL.     

血流导向装置治疗颅内大型未破裂动脉瘤的临床疗效分析

目的探讨血流导向装置(FD)治疗颅内大型未破裂动脉瘤的安全性及疗效。方法回顾性分析郑州大学人民医院(河南省人民医院)脑血管介入科2015年2月至2019年7月应用FD(Pipeline+Tubridge)治疗的颅内大型(最大径≥10 mm)未破裂动脉瘤患者的临床资料,共92例(95个动脉瘤)。采用改良Rankin量表评分(mRS)标准评价临床预后,采用O′Kelly-Marotta(OKM)分级标准评估动脉瘤闭塞情况;采用多因素logistic回归分析方法分析影响术后6个月动脉瘤完全闭塞的相关因素。结果92例患者95个动脉瘤共置入101枚FD,手术成功率为100%。术后神经系统并发症发生率为4.3%(4/92),其中缺血性1例,出血性2例(死亡1例),术后出现烦躁等症状1例。77例患者获临床随访,中位随访时间为12(1~51)个月。至末次随访,mRS 0分70例,1分5例,2分、3分各1例。55例患者(56个动脉瘤)行影像学随访,末次中位随访时间为6(3~29)个月,动脉瘤完全闭塞(OKM分级D级)40个(71.4%,40/56),支架内狭窄的发生率为7.1%(4/56)。52例患者(53个动脉瘤)6个月随访时动脉瘤完全闭塞34个(64.2%,34/53),支架内狭窄的发生率为7.5%(4/53)。多因素logistic回归分析显示,联合弹簧圈填塞是术后6个月时动脉瘤完全闭塞的独立影响因素(OR=8.98,95%CI:1.87~43.22,P=0.006)。结论FD治疗颅内大型未破裂动脉瘤的手术成功率高,安全性好,但应警惕严重并发症的发生;联合弹簧圈填塞可促进动脉瘤完全闭塞。     

不同针法分期治疗肩关节周围炎90例

ObjectiveTo observe the clinical efficacy of different acupuncture modalities in the treatment of adhesive capsulitis a tthrough different clinical stages.MethodsNinety patients of adhesive capsulitis weregraded in three different stages based on clinical presentations. Patients in painful stage were treated with silver needles once every 5to 7 days for two courses; patients in adhesive stage were given acupotomy treatment every 7 to 10 days for two courses; while patients in recovery stage were treated with acupuncture with warm needles by moxibustion on tendon knots, once a day 10 times in a course, for two courses of treatment. The disease scores were compared between all groups before and after the treatment, and clinical efficacy was evaluated after the treatment.ResultsThe disease scores in patients of all three stages were higher after treatment, and the differences were statistically significant (all P < 0.05). Among 90 patients with adhesive capsulitis, 32 cases were clinically under controlled, 37 cases claimed remarkably effective, 18 were effective, and 3 ineffective cases, thus the total effective rate for this stage-based treatment is 96.7%.ConclusionFor adhesive capsulitis,different acupuncture modalities targeting patients in different clinical stages were feasible and effective, the disease scores of patients were significantly improved.     

心房颤动对不同时间窗内急性缺血性脑卒中患者静脉溶栓疗效的影响

目的探讨急性缺血性脑卒中合并心房颤动患者不同时间窗内静脉溶栓的疗效差异。方法选取急性缺血性脑卒中行静脉溶栓治疗患者172例,根据发病-溶栓时间窗差异分为3组,时间窗分别为≤3.0 h(观察A组)、>3.0~4.5 h(观察B组)、>4.5 h(观察C组),对其中合并心房颤动者溶栓疗效进行评估分析。结果3组患者溶栓24 h后出血转化结果、溶栓3个月时神经功能结局良好率、病死率均无明显差异(P>0.05);溶栓时间窗>3 h者,心房颤动可显著增加患者发生PH型、HI型出血转化发生率,差异有统计学意义(P<0.05);单因素分析显示,合并心房颤动可造成溶栓时间窗≤4.5 h患者神经功能结局不良发生率增加,差异有统计学意义(P<0.05)。多因素分析显示,合并心房颤动与不同时间窗急性缺血性脑卒中患者静脉溶栓治疗后神经功能结局不良发生情况无明显相关性(P>0.05)。结论溶栓时间窗仍是影响急性缺血性脑卒中患者静脉溶栓疗效的重要因素,对于溶栓时间窗≤3.0 h者,合并心房颤动不会对溶栓疗效造成影响;对于发病-溶栓时间>3 h者,心房颤动可能造成患者溶栓后出血风险增加。     

Subclinical and clinical atherosclerosis in non-alcoholic fatty liver disease is associated with the presence of hypertension

Background and aimsNon-alcoholic fatty liver disease (NAFLD) is associated with increased cardiovascular (CV) risk. However, it is unclear whether NAFLD contributes independently to the development of CV disease. Our study aimed at assessing the differences in several indices of atherosclerosis, arterial stiffness and cardiac morphology among patients with isolated NAFLD, isolated hypertension (HT) or a combination of the two conditions.Methods and resultsA total of 169 participants (mean age = 50.4 ± 10.2 yrs; males = 73.6%) were divided according to the presence of NAFLD and HT into three groups: only NAFLD (55 patients), only HT (49 patients), and NAFLD + HT (65 patients). Exclusion criteria were a BMI≥35 kg/m² and a diagnosis of diabetes mellitus. Carotid ultrasonography was performed to measure markers of atherosclerosis and arterial stiffness. Cardiac remodeling was analyzed using echocardiography. The prevalence of subclinical and overt atherosclerosis was significantly higher in the NAFLD + HT patients as compared to the other two groups (atherosclerotic plaques: 43.1%, 10.9%, and 22.4% (p < 0.001) in NAFLD + HT, NAFLD, and HT groups, respectively). No differences were found among indices of arterial stiffening and cardiac remodeling across the three groups. In multivariate regression analysis, the coexistence of NAFLD and HT was an independent risk factor for overt atherosclerosis (OR = 4.88, CI 95% 1.14–20.93), while no association was found when either NAFLD or HT was considered alone.ConclusionOvert atherosclerosis was significantly present only in NAFLD + HT patients, but not in patients with isolated NAFLD. This implies that the impact of NAFLD on vascular structure and function could depend on the coexistence of other major CV risk factors, such as HT.