Hyperglycemia as a risk factor in pancreatic cancer: A nested case-control study using prediagnostic blood glucose levels

ObjectiveTo determine the risk association between fasting glucose levels and pancreatic cancer using systematically collected prediagnostic blood glucose samples.MethodsProspective nested case-control study of participants from the Northern Sweden Health and Disease Study, including 182 cases that developed pancreatic cancer and four matched controls per case. Blood glucose levels collected up to 24 years before pancreatic cancer diagnosis were analyzed. The association between fasting glucose levels and pancreatic cancer risk was determined using unconditional and conditional logistic regression models. The association between fasting glucose and the time to pancreatic cancer diagnosis, tumor stage and survival was determined using likelihood-ratio test, t-test and log rank test.ResultsThe unadjusted risk of developing pancreatic cancer increased with increasing fasting glucose levels (OR 1.30, 95% CI 1.05–1.60, P = .015). Impaired fasting glucose (≥6.1 mmol/L) was associated with an adjusted risk of 1.77 for developing pancreatic cancer (95% CI 1.05–2.99, P = .032). In subgroup analysis, fasting glucose levels were associated with an increased risk in never-smokers (OR 4.02, 95% CI 1.26–12.77, P = .018) and non-diabetics (OR 3.08, 95% CI 1.08–8.79, P = .035) (non-significant for interaction). The ratio between fasting glucose and BMI was higher among future pancreatic cancer patients and an increased ratio was associated with elevated risk of pancreatic cancer (OR 1.66, 95% CI 1.04–2.66, P = .034). Fasting glucose levels were not associated with TNM stage at diagnosis or survival.ConclusionsHigh fasting glucose is associated with an increased risk of being diagnosed with pancreatic cancer.     

早期大肠癌内镜治疗的临床评价

背景：早期大肠癌可以采用内镜下切除治疗，但其疗效和预后仍是人们普遍关心的问题。目的：评价内镜治疗早期大肠癌的疗效和预后。方法：对1986年1月～2005年10月经内镜确诊的早期大肠癌患者，按治疗方法的不同分为内镜治疗组和外科手术治疗组，对两组的临床资料、治疗方法和随访结果进行回顾性分析。结果：99例早期大肠癌（104个癌灶）中，无症状人群普查发现34例，临床就诊发现65例。内镜治疗69例（共72个癌灶），外科手术治疗30例（包括内镜治疗后追加手术者，共32个癌灶）。内镜治疗组癌灶完全切除率为97．5％，无严重并发症发生。外科手术治疗组有1例病理证实癌组织浸润达黏膜下深层，肝脏有多个微结节转移灶。内镜治疗组经3个月～19年的随访，除19例失访、6例死于心脏病等疾病外，无一例肿瘤复发。比较两组黏膜和黏膜下层早期大肠癌的临床资料、随访结果和5年生存率，内镜治疗组的疗效与手术治疗组相似（P〉0．05）。结论：早期大肠癌，特别是黏膜层早期大肠癌内镜治疗的疗效和随访结果与手术治疗相似，且损伤小、安全、简便。黏膜下深层癌易发生转移，内镜下切除应注意判断肿瘤黏膜浸润深度，非提起征是内镜切除的关键指征。无症状自然人群普查是发现早期大肠癌的重要途径。     

7种 eGFR公式早期诊断 CKD的性能评价

目的：评价慢性肾脏疾病流行病学协作组（ CKD-EPI）公式、中国eGFR协作组公式和FQ-eGFR公式计算的估算肾小球滤过率（ eGFR）在慢性肾病（ CKD）中的早期诊断性能。方法测定283例住院成人CKD患者和9307例门诊成人就诊者血清中半胱氨酸蛋白酶抑制剂C（Cys C）和肌酐（Cr）水平,计算3个CKD-EPI公式（ Cr-、Cys C-和Cys C-C联合公式）、2个eGFR协作组公式（ Cys C-和Cys C-C联合公式）和2个FQ-eGFR公式（Cys C-和Cys C-C联合公式）的eGFR,依次得到eGFR1～eGFR7。住院患者同时测定血浆99m锝-二乙烯三胺五乙酸（99mTc-DTPA）清除率[作为测量GFR（mGFR）],用于其eGFR差异性、一致性以及分析性能评价的金标准。然后回顾性分析了9307例门诊成人就诊者中各eGFR预测CKD的相对发生率（ IRR）。结果 eGFR2、eGFR3与mGFR比较差异均有统计学意义（P均＝0．000）。 eGFR4、eGFR6和eGFR7与mGFR的一致性相关系数（ρc）值均明显高于eGFR1（P均＜0．01）。对于mGFR＜60 mL／（min·1．73 m2）患者,eGFR4、eGFR6和eGFR7的偏差、精密度和准确性无差异（P均＞0．05）,但与eGFR1比较差异均有统计学意义（P均＜0．05）。相比之下, eGFR4的偏差更小[中位数（M）＝0．3 mL／（min·1．73 m2）],eGFR6的精密度更高[标准四分位距（IQR）＝7．7 mL／（min·1．73 m2）],eGFR7的准确性更好（1－P30＝13．8％）。应用eGFR4、eGFR6和eGFR7预测CKD的发生率高于eGFR1（P均＜0．01）,且年长者（＞65岁）与65岁以下者相比其预测CKD发生率更高（P均＝0．000）。结论对于GFR＜60 mL／（min·1．73 m2）的中国成人CKD患者,CKD-EPI公式并不能提供更为准确的肾功能评估。相对而言,中国eGFR协作组Cys C公式、FQ-eGFR Cys C公式或FQ-eGFR Cys C-C联合公式更适用于中国成人CKD的疾病筛查和早期诊断,其中FQ-eGFR Cys C公式用于疾病筛查可尽可能地避免漏诊或误诊。     

SPIO纳米颗粒在肝癌磁共振早期诊断的基础研究进展

原发性肝癌(primary hepatic carcinoma,PHC)的早期发现和诊断是肝癌诊疗领域中的重要课题之一。近些年来,对分子影像学(Molecular Imaging)研究的不断深入,为肝细胞癌的早期检测和早期诊断提供了一种全新的思维方法。相对于传统的磁共振对比剂钆剂,超顺磁性氧化铁(superparamagnetic iron oxide,SPIO)具有很多优点,能够产生磁共振负性强化。在生物医学领域,超顺磁性氧化铁的应用很多,可以作为载体应用在多个方面,例如靶向探针的载体、携带药物的载体等,作为科研热点在分子影像学方面被充分关注。本文通过总结既往的研究,对SPIO纳米颗粒在肝癌磁共振早期诊断的基础研究进展进行综述。     

Targeted delivery of adipose‐derived stem cells via acellular dermal matrix enhances wound repair in diabetic rats

Cell‐based therapeutic intervention has emerged as a new approach to accelerate wound closure. Adipose‐derived stem cells (ASCs), as a fascinating cell source, have received much attention in tissue repair and regeneration. In this study we evaluated the potential of acellular dermal matrix (ADM) scaffold serving as a carrier for the delivery of ASCs and investigated its therapeutic effects on wound healing. First, ASCs were isolated and characterized for multidifferentiation potential. ASCs–ADM grafts were then prepared, and ADM scaffold was shown to support the in vitro growth and proliferation of ASCs. Next, we analysed paracrine factors in conditioned medium and found that ASCs–ADM grafts secreted various cytokines, including VEGF, HGF, TGFβ and bFGF. Moreover, ASCs–ADM conditioned medium notably stimulated the migration and proliferation of fibroblasts. In vivo, we established an excisional wound model in diabetic rats which received phosphate‐buffered saline (PBS), ADM or ASCs–ADM grafts, respectively. Our results demonstrated that implantation of ASCs–ADM significantly enhanced tissue regeneration and increased epithelialization, resulting in accelerated wound closure. Immunofluorescence analysis further indicated that capillary density was evidently increased in the ASCs–ADM group compared with the control or ADM group. In addition, western blot analysis showed that ASCs–ADM significantly increased the expression of angiogenic factors, which was consistent with in vitro data. Taken together, our results suggest that targeted delivery of ASCs via ADM scaffold accelerate diabetic wound healing through a paracrine mechanism, with enhanced granulation tissue formation and increased re‐epithelialization and neovascularization. Copyright © 2012 John Wiley & Sons, Ltd.     

Exploration of the early insulin response by two small successive loads of I.V. glucose in normal and obese subjects

Summary Two 5 g glucose loads at 1-h interval were given to healthy controls and obese subjects with slightly altered or normal OGTT in order to explore the capacity of restoration of the ‘rapid insulin response’ to i.v. glucose. In the normal subjects, the two successive loads gave rise to identical responses as far as maximum increase (Δ_max), average increase at 2–5 min (Δ_{2–5 min}), area of increase 0–15 min (Δ_{0–15 min}) for both glucose and IRI, were concerned. Obese subjects could be divided on the basis of their insulin response to the first load into normal responders (group I) and high-responders (group II). In group I obese subjects, the responses to the second load were identical to those to the first. In group II obese subjects Δ_max, Δ_{2–5 min} and Δ_{0–15 min} of the insulin response to the second load were reduced as compared to the first.     

IgA肾病尿沉渣表现与肾脏病理改变的相关性

摘要：目的：观察IgA肾病患者尿沉渣表现与临床表现、肾脏病理改变的相关性。 方法：采用前瞻性横断面观察性研究。病例来自2013年1月至2015年6月中日友好医院肾内科住院的365例IgA肾病患者。根据尿沉渣中红细胞和病理管型数量分为4组。根据临床表现分为3组。根据肾脏病理活动与否分为肾小球有明显活动性病变组和无明显活动性病变组。对尿沉渣表现与临床表现、肾脏病理活动进行相关性分析。 结果：病理类型以局灶增生型最多见,共302例（82.7%）,其次为轻度系膜增生型32例（8.8%）等;不同临床表现分组的尿沉渣表现不同（P=0.013）;肾脏病理活动组与非活动组的尿沉渣表现的差异有统计学意义（P＜0.01）。多因素分析显示,尿沉渣表现是肾脏病理活动与否的危险因素(P＜0.01)。 结论：尿沉渣表现可以部分反映IgA肾病患者临床表现及肾脏病理的活动性。     

粤北山区早期儿童龋患病状况及危险指标调查

目的 描述粤北山区5岁儿童早期儿童龋(early childhood caries,ECC)患病状况,分析影响ECC患病的危险指标,探讨儿童ECC患病状况与留守现象的关系.方法 通过横断面调查方法对粤北山区的河源、韶关和梅州市827名5岁儿童ECC患病状况及可能的危险指标进行调查.结果 827名儿童ECC患病率为88.6％,龋均为7.8±5.7,龋面均为18.0±17.5,龋面充填率为0.28％.协方差分析结果发现,母亲受教育程度初中或以下、有釉质发育缺陷、餐间甜食频率大于2次/d、营养不良、有看牙医行为及河源连平、韶关新丰地区的儿童龋失补牙面值较高.此外,ECC随月龄的递增而加重,其严重程度与留守现象不相关.结论 粤北山区5岁儿童ECC患病状况严重,ECC充填率很低,治疗需要较高;ECC患病的危险指标是母亲受教育程度较低、有牙釉质发育缺陷、较高的餐间甜食频率和营养不良;未发现ECC的患病状况与留守现象相关.