4项凝血指标联合CA125检测对良恶性卵巢肿瘤辅助诊断的价值分析

目的探讨4项凝血指标凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板计数(PLT)联合糖类抗原(CA)125检测对良恶性卵巢肿瘤辅助诊断的价值。方法比较62例卵巢癌患者(卵巢癌组)与62例良性肿瘤患者(良性肿瘤组),以及不同国际妇产科协会(FIGO)分期卵巢癌患者,不同病理类型卵巢癌患者中CA125、4项凝血指标水平;采用受试者工作特征(ROC)曲线分析联合检测对良恶性卵巢肿瘤辅助诊断的价值。结果卵巢癌组CA125、TT、FIB、D-D、PLT水平均明显高于良性肿瘤组,差异有统计学意义(P<0.05);卵巢癌早期(FIGO分期Ⅰ~Ⅱ期)患者CA125、FIB水平低于卵巢癌晚期(FIGO分期Ⅲ~Ⅳ期)患者,差异有统计学意义(P<0.05),而TT、D-D、PLT水平比较,差异无统计学意义(P>0.05)。不同病理类型患者之间CA125、D-D水平比较,差异有统计学意义(P<0.05);CA125、TT、FIB、D-D、PLT单项指标对于良恶性卵巢肿瘤具有辅助诊断价值,5项指标联合检测对卵巢癌诊断的ROC曲线下面积为0.982,特异度为100.00%,诊断价值更高。结论CA125及4项凝血指标联合检测比单项指标检测对良恶性卵巢肿瘤具有更高的辅助诊断价值。     

Skp2通过调控Snaill水平对上皮性卵巢癌细胞EMT的作用研究

目的探讨S期激酶相关蛋白2(Skp2)通过调控转录因子Snaill水平对上皮性卵巢癌细胞上皮间质转化(EMT)的作用。方法分别检测15例上皮性卵巢癌组织和正常卵巢组织中Skp2和Snaill mRNA水平;体外培养SKOV3细胞,将其分为阴性对照组(只加脂质体)、Skp2干扰表达组(加Skp2干扰表达载体和脂质体)、Skp2过表达组(加Skp2过表达载体和脂质体),采用Lipofectamine法分别将脂质体、Skp2干扰表达载体和Skp2过表达载体转染到SKOV3细胞中,检测细胞中Skp2、Snaill、E-cadherin和Vimentin mRNA和蛋白表达情况,同时检测细胞体外侵袭、迁移能力。结果Skp2 mRNA在卵巢癌组织中的表达水平明显低于正常卵巢组织,Snaill mRNA在卵巢癌组织中的表达水平明显高于正常卵巢组织(P<0.05)。与阴性对照组相比,Skp2干扰表达组细胞中Skp2、E-cadherin mRNA和蛋白表达水平降低,侵袭细胞数和迁移细胞数以及Snaill、Vimentin mRNA和蛋白表达水平增加(P<0.05);与Skp2干扰表达组相比,Skp2过表达组细胞中Skp2、E-cadherin mRNA和蛋白表达水平增加,侵袭细胞数和迁移细胞数以及Snaill、Vimentin mRNA和蛋白表达水平降低(P<0.05)。结论Skp2通过降低Snaill水平,抑制上皮性卵巢癌细胞EMT,这可能是抑制卵巢癌细胞侵袭和迁移的新靶点。     

miR-145通过调控MMP-2、MMP-9的表达对卵巢癌细胞调亡、增殖、迁移的影响

目的研究微小RNA-145(miR-145)通过调控基质金属蛋白酶(MMP)-2、MMP-9的表达对卵巢癌细胞调亡、增殖、迁移的影响。方法将卵巢癌细胞株随机分为3组,其中对照组为单纯卵巢癌细胞株,不做其他处理,进行正常培养;miR-145组为含miR-145质粒的慢病毒转染的卵巢癌细胞株;NC组为含NC质粒的慢病毒转染的卵巢癌细胞株。检测3组卵巢癌细胞的凋亡、增殖、迁移情况。检测3组MMP-2、MMP-9蛋白和mRNA表达水平。结果与对照组、NC组比较,miR-145组卵巢癌细胞凋亡率明显升高,卵巢癌细胞增殖数、迁移数明显下降,差异均有统计学意义(P<0.05);对照组与NC组卵巢癌细胞凋亡率、增殖数、迁移数差异无统计学意义(P>0.05)。miR-145组MMP-2、MMP-9蛋白和mRNA表达水平均低于NC组、对照组,差异均有统计学意义(P<0.05)。对照组与NC组MMP-2、MMP-9蛋白和mRNA表达水平差异无统计学意义(P>0.05)。结论miR-145可抑制卵巢癌细胞的增殖、迁移,促进调亡,其作用机制可能与miR-145能降低MMP-2、MMP-9的表达有关。     

川芎嗪逆转脂肪细胞介导的卵巢癌奥沙利铂耐药的作用及机制研究

目的： 研究川芎嗪（Ligustrazine）逆转脂肪细胞介导的卵巢癌奥沙利铂耐药的作用,以及对肿瘤细胞中耐药相关蛋白ABCB1、ABCC1和ABCG2表达的影响。方法： MTS法研究川芎嗪逆转脂肪细胞介导的卵巢癌奥沙利铂耐药的IC₅₀值和逆转耐药系数;流式细胞实验研究川芎嗪对脂肪细胞介导的耐药卵巢癌细胞的凋亡水平的影响;划痕实验研究川芎嗪对脂肪细胞介导的耐药卵巢癌细胞的迁移能力的影响;Western Blot研究川芎嗪对肿瘤细胞中耐药相关蛋白ABCG1、ABCC1和ABCG2表达水平。结果： 川芎嗪能够逆转脂肪细胞介导的卵巢癌奥沙利铂耐药,其逆转耐药系数为2.8;川芎嗪能够增加脂肪细胞和肿瘤细胞共培养体系下肿瘤细胞的凋亡;川芎嗪能够抑制脂肪细胞和肿瘤细胞共培养体系下肿瘤细胞的迁移;川芎嗪能够减少肿瘤细胞中耐药相关蛋白ABCB1、ABCC1和ABCG2的表达。结论： 川芎嗪能够逆转脂肪细胞介导的卵巢癌奥沙利铂耐药的作用且其机制与减少耐药相关蛋白ABCB1、ABCC1和ABCG2的表达有关。     

Ablation of frequent premature ventricular complex in an athlete

Premature ventricular complex are common findings in the exam of many athletes. There is no extensive scientific evidence in the management of this situation particularly when associated with borderline contractile function of the left ventricle. In this case report, we present a 35‐year‐old asymptomatic healthy athlete with high incidence (over 10 000 beats in 24 h) of premature ventricular complex and left ventricular dilatation with dysfunction, which persisted after a resting period of 6 months without training. We performed radiofrequency ablation of the premature ventricular complex focus. After 1‐year follow‐up, he was asymptomatic without arrhythmia and the left ventricle normalized its size and function as shown by echocardiogram and cardiac magnetic resonance.     

Retrograde Inversion Stripping as a Complication of the Clarivein? Mechanochemical Venous Ablation Procedure

The endovenous revolution has accelerated the development of new techniques and devices for the treatment of varicose veins. The ClariVein^® mechanochemical ablation device offers tumescentless treatment with a rotating ablation tip that can theoretically become stuck in tissue. We present the first report of retrograde stripping of the small saphenous vein without anaesthesia following attempted use of the ClariVein^® device, without adverse sequelae.     

Mechanical ventilation in critically-ill pregnant women: a case series

BackgroundApproximately 0.1–0.2% of pregnancies are complicated by respiratory failure requiring mechanical ventilatory support, but few data exist to inform clinical management. This study aimed to characterize current practice and the effect of delivery on respiratory function.MethodsA retrospective review was performed of pregnant women who received mechanical ventilation for more than 24 h, from four intensive care units in institutions with large-volume obstetric units.ResultsData were collected from 29 patients with a mean gestation at intensive care unit admission of 25.3 ± 6 weeks. Tidal volumes were 7.7 ± 1.7 mL/kg predicted body weight. Estimated respiratory system compliance was reduced, but was higher in four patients ventilated for neurological conditions without lung disease. Three maternal and three neonatal deaths occurred. Ten patients delivered while on ventilatory support: one spontaneous delivery, four for obstetric indications and five for worsening maternal condition. Following delivery of these 10 patients, three demonstrated a greater than 50% decrease in oxygenation index and five a greater than 50% increase in compliance. No characteristics identified which patients may benefit from delivery.ConclusionsReview of current practice in four centers suggests that mechanical ventilation in pregnant patients follows usual guidelines applicable to non-pregnant patients. Delivery was associated with modest improvement in maternal respiratory function in some patients. Any potential benefit of delivery in improving maternal physiology must be weighed against the stress of delivery. The risks of premature birth for the fetus must be weighed against continued exposure to maternal hypoxemia and hypotension.     

IgG4相关性疾病泌尿系统损害的临床特点分析

目的 总结和分析IgG4相关性疾病(IgG4-RD)泌尿系统损害的临床特点.方法 收集24例IgG4相关性疾病泌尿系统损害患者的临床资料,回顾性分析患者肾脏受累、治疗前后Scr、Hb、炎性反应指标和IgG4亚类水平的变化情况.结果 2010年8月至2014年5月经北京协和医学院肾内科确诊的IgG4相关性疾病泌尿系统损害病例24例,平均受累器官数目(4.38±1.55)个.治疗前血清IgG4[M(范围)]为12 750(1 460～ 59 400) mg/L,均伴炎性反应指标明显升高.20例患者有检测尿蛋白量,其中19例尿蛋白量升高,6例伴肾病综合征.21例患者Scr升高,均值为(410.48±352.17) μmol/L,其中3例需接受透析治疗.14例患者伴贫血,8例伴单侧或双侧肾脏体积缩小.21例Scr升高的患者中,11例患者肾功能不全因肾后性梗阻所致,3例病理证实为肾小管间质肾炎.与治疗前相比,24例患者糖皮质激素联合或不联合免疫抑制剂治疗1周后Scr明显下降(P＜0.05),治疗1个月后Scr下降更为明显(P＜0.01),3例透析患者均脱离透析.血沉于治疗1个月后亦明显下降(P＜0.01).IgG4亚类水平在治疗1个月时无显著下降(P＞0.05),治疗2个月时明显下降(P＜0.01).结论 IgG4相关疾病合并肾功能不全并不少见,对中至大量糖皮质激素治疗反应良好,治疗后Scr下降早于血沉和IgG4亚类.     

腔内激光消融术治疗下肢静脉性溃疡临床分析

目的探讨腔内激光消融术(EVLA)治疗下肢静脉性溃疡(VULE)的疗效和安全性。方法 32例(36条患肢,42处溃疡)VULE患者,均行大隐静脉高位结扎+EVLA闭合曲张浅静脉及溃疡床周围穿通支静脉,术后穿循序弹力袜(20~30 mmHg)。结果手术时间30~90 min,平均50min;术中出血量2~20 ml,平均10 rnl;术后住院时间3~10 d,平均5 d。术后随访6~24个月,溃疡愈合率为90%(38/42),平均愈合时间为28 d(14~45 d),2年内累积溃疡复发率为7.9%(3/38)。患者生活质量较术前明显改善,无严重并发症。结论 EVLA能有效治疗VULE,具有损伤小、并发症少、安全性高、溃疡复发率低等优点。