胶质母细胞瘤组织RBM8A表达与病人预后及替莫唑胺化疗敏感性的关系

目的 探讨胶质母细胞瘤（GBM）组织RNA结合基序8A（RBM8A）蛋白表达与病人预后及替莫唑胺（TMZ）化疗敏感性的关系。方法 选取2015年6月至2020年6月手术切除的GBM组织130例及颅脑损伤减压术中切取的非肿瘤脑组织20例（对照）,用免疫组化法检测组织RBM8A表达。术随访时间3~50个月,中位随访时间为12个月。结果 GBM组织RBM8A高表达率[86.15%（112/130）]明显高于对照组[20%（4/20）;P<0.05]。随访期间死亡98例,失访2例;多因素Cox回归分析显示,RBM8A高表达是GBM病人生存预后不良的独立危险因素（P<0.05）。生存曲线分析显示,RBM8A高表达GBM病人中位无复发生存时间和总生存时间均明显低于低表达病人（P<0.05）;RBM8A低表达GBM病人中,TMZ化疗病人无复发生存时间和总生存时间均明显高于未化疗病人（P<0.05）;TMZ化疗与RBM8A高表达GBM病人无复发生存时间和总生存时间无明显关系（P>0.05）。结论 GBM组织RBM8A呈高表达,与病人不良生存预后有关。检测RBM8A有助于评估GBM病人对TMZ化疗敏感性。     

Current trends in the management of acute type A aortic intramural hematoma

Within the spectrum of acute aortic syndromes, intramural hematoma (IMH) is a distinct lesion that is characterized by crescentic or circumferential thickening of the aortic wall in the absence of an intimal defect. The reported incidence of IMH among all type A acute aortic syndromes ranges from 3.5% to 28.3%. As compared with acute aortic dissection, IMH is a disease of the elderly, and it tends to have reduced rates of malperfusion syndromes, aortic insufficiency, and root dilation, yet also tends to have increased rates of pericardial effusion, cardiac tamponade, and periaortic hematoma. With respect to natural history, IMH may progress to classic dissection, frank rupture, or aneurysmal dilation; yet, IMH may also regress and be completely resorbed. However, studies disagree over the rates of progression or regression; as such, few studies agree on the short-term and long-term prognosis associated with IMH. American and European guidelines advocate emergent surgery for all acutely presenting type A IMH. At a minimum, supracoronary replacement of the aorta with hemiarch reconstruction is the preferred extent of operative repair to reduce rates of long-term reintervention for disease progression. However, valve and/or root procedures may be necessary proximally, while total arch reconstruction or hybrid procedures for the descending aorta may be necessary distally. Much remains unknown for IMH, including the ideal extent of aortic repair, risk-stratification for elderly patients, and the optimal treatment paradigm for stable, uncomplicated IMH. As such, IMH remains a diagnostic and therapeutic challenge for the cardiovascular surgeon.     

Pseudomonas aeruginosa biofilm hampers murine central wound healing by suppression of vascular epithelial growth factor

Biofilm‐infected wounds are clinically challenging. Vascular endothelial growth factor and host defence S100A8/A9 are crucial for wound healing but may be suppressed by biofilms. The natural course of Pseudomonas aeruginosa biofilm infection was compared in central and peripheral zones of burn‐wounded, infection‐susceptible BALB/c mice, which display delayed wound closure compared to C3H/HeN mice. Wounds were evaluated histopathologically 4, 7 or 10 days post‐infection. Photoplanimetry evaluated necrotic areas. P. aeruginosa biofilm suppressed vascular endothelial growth factor levels centrally in BALB/c wounds but increased peripheral levels 4–7 days post‐infection. Central zones of the burn wound displayed lower levels of central vascular endothelial growth factor as observed 4 and 7 days post‐infection in BALB/c mice compared to their C3H/HeN counterparts. Biofilm suppressed early, centrally located S100A8/A9 in BALB/c and centrally and peripherally later on in C3H/HeN wounds as compared to uninfected mice. Peripheral polymorphonuclear‐dominated inflammation and larger necrosis were observed in BALB/c wounds. In conclusion, P. aeruginosa biofilm modulates wounds by suppressing central, but inducing peripheral, vascular endothelial growth factor levels and reducing host response in wounds of BALB/c mice. This suppression is detrimental to the resolution of biofilm‐infected necrosis.     

血清肿瘤标志物联合检测在原发性肝癌诊断中的价值研究

目的:探讨细胞周期素A2(CCNA2)与甲胎蛋白(AFP)、癌胚抗原(CEA)、癌抗原199(CA199)及癌抗原724(CA724)的联合检测在原发性肝癌临床诊断中的价值,以期筛选出理想的肿瘤标志物组合,提高肝癌诊断的准确率。方法:选取2020年10月—2021年3月天津市第三中心医院收治的原发性肝癌患者68例为研究对象,作为原发性肝癌组;另选择同期收治的80例肝病患者作为肝良性疾病组,80例健康体检者作为健康对照组。采集各研究对象清晨空腹静脉血5 mL,采用addicare1100酶免仪利用酶联免疫吸附法(ELISA)检测血清CCNA2,采用罗氏e801全自动电化学发光仪及其配套试剂检测血清AFP、CEA、CA199和CA724。评估上述指标单项及联合检测在早期PLC诊断的应用价值。结果:健康对照组血清肿瘤标志物均显著低于肝良性疾病组与原发性肝癌组,差异有统计学意义(P＜0.05)。68例原发性肝癌患者中,对AFP、CEA、CA199、CA724和CCNA2等血清肿瘤标志物水平予以检测,联合检测的特异性和准确性均显著高于各指标的单项检测结果,差异有统计学意义(P＜0.05)。结论: CCNA2作为一种新型的肿瘤标志物,对肝癌的诊断具有一定的价值。CA199、CEA、AFP、CA724、CCNA2联合检测能显著提升原发性肝癌的诊断阳性率,对尽早诊断原发性肝癌具有重要意义。     

扶正生肌油纱条对肛瘘术后创面愈合的影响

目的:观察扶正生肌油纱条对肛瘘术后患者创面愈合的影响。方法:选择 2019年 1月—2021年 1月于南京中医药大学徐州附属医院治疗的 160例行肛瘘手术的低位单纯肛瘘患者 160例,按随机数字表法分为两组,每组 80例,对照组术后给予凡士林纱条治疗,研究组术后给予扶正生肌油纱条治疗,治疗后检测两组患者表皮生长因子( EGF)、血管内皮生长因子( VEGF)、炎症指标、免疫球蛋白指指标,给予视觉模拟评分( VAS)评价,记录两组患者创面愈合时间,比较两组患者临床疗效。结果:研究组 IgG水平高于对照组 [(10.12±3.14)g/L vs (7.52±2.19)g/L],研究组 IgA水平低于对照组 [(1.01±0.30)g/L vs (1.45±0.41)g/L,(P<0.05)],研究组 EGF、VEGF水平 [(7.61±2.18)μg/L、(139.02± 36.32)ng/L vs(5.93±1.26)μg/L、(121.84±33.25)ng/L]高于对照组,差异有统计学意义( P<0.05),研究组 IL-1β水平低于对照组 [(23.66±6.94)ng/L VS (31.31±10.13)ng/L,P<0.05],研究组 IL-10水平高于对照组 [(65.19± 16.06)pg/mL vs(56.61±15.52)pg/mL,P<0.05],研究组患者 VAS评分低于对照组 [(2.73±0.81)分 vs(4.18±1.13)分, P<0.05],研究组患者创面愈合时间低于对照组 [(22.78±6.32)d vs(29.45±8.33)d,P<0.05],研究组患者总有效率( 97%)高于对照组( 76%),差异有统计学意义( P<0.05)。结论:扶正生肌油纱条治疗肛瘘术后患者,可提升患者 EGF、VEGF水平,调控免疫球蛋白分泌,抑制患者炎症,缓解患者疼痛,促进创面愈合,提升临床疗效。     

儿童甲型流感合并川崎病的临床特征

目的分析儿童甲型流感合并川崎病（KD）的临床特征,增强对甲型流感合并川崎病的早期识别。 方法对首都医科大学附属北京地坛医院2018年1月1日至2019年12月31日收治的682例实验室确诊的甲型流感患儿资料进行回顾性分析,筛选甲型流感病毒感染合并川崎病儿童共14例（KD+甲流组）。选择同期就诊的符合纳入标准及排除标准的28例KD患儿为KD组,28例单纯甲型流感患儿为甲流组。比较KD+甲流组和KD组患儿临床表现、发热持续时间及冠状动脉病变发生率。比较KD+甲流组、KD组和甲流组患儿白细胞（WBC）、中性粒细胞百分比、淋巴细胞百分比、血小板、快速C-反应蛋白（CRP）、红细胞沉降率（ESR）、降钙素原（PCT）、血清淀粉样蛋白酶A（SSA）、白蛋白、转氨酶和心肌酶水平。 结果KD+甲流组患儿发热持续时间[（11.21 ± 3.36）d]较KD组[（6.29 ± 2.21）d]更长,差异有统计学意义（t = 5.81、P < 0.001）。KD+甲流组丙种球蛋白无反应型（IVIG）比例（42.9%）较KD组（14.3%）更高,差异有统计学意义（χ² = 4.1、P = 0.41）。KD+甲流组患儿WBC[（13.18 ± 4.39）× 10⁹/L]、ESR[（60.5 ± 15.82）mm/h]、CPR[55.5（17.56,61.0）g/L]、SSA[76.5（23.0,311.6）mg/L]和丙氨酸氨基转移酶（ALT）[49.5（23.1,78.0）U/L]均较KD组和甲流组升高,差异均有统计学意义（F = 27.92、P < 0.001,F = 47.97、P < 0.001,Z = 3.15、P = 0.007,Z = 4.36、P < 0.001,Z = 2.68、P = 0.027）。KD+甲流组较KD组患儿冠状动脉扩张发生概率更高（57.0% vs. 25.0%）,差异有统计学意义（χ² = 4.2、P = 0.041）。KD+甲流组患儿IVIG无反应型发生率较单纯KD组高（42.9% vs. 14.3%）,差异有统计学意义（χ² = 4.1、P = 0.041） 结论甲型流感合并KD患儿发热时间、明确诊断所需时间较长,其IVIG无反应型发生率更高,且血清SSA和ALT水平显著升高。     

肿瘤相关成纤维细胞在甲状腺乳头状癌组织中的表达及其意义

目的检测甲状腺乳头状癌(papillary thyroid carcinoma,PTC)相关成纤维细胞(tumor-associated fibroblasts,TAFs)中成纤维细胞特异性蛋白-1(fibroblast-specific protein 1,FSP1/S100A4)、平滑肌肌动蛋白-ɑ(ɑ-smooth-muscle actin,ɑ-SMA)和成纤维细胞活化蛋白(fibroblast-activated protein,FAP-ɑ)的表达,探究其与PTC发生、发展的关系。方法通过免疫组化SP法检测FSP1/S100A4、ɑ-SMA、FAP-ɑ在正常甲状腺组织和PTC中的表达情况,并分析这些指标与重要临床病理参数的关系。结果FSP1/S100A4、ɑ-SMA和FAP-ɑ在PTC间质细胞中可见阳性表达,而在正常甲状腺组织的滤泡上皮或间质细胞内均不表达。患者肿瘤的大小、是否有淋巴结转移及TNM的不同分期与FAP-ɑ的阳性病例数有统计学差异(χ^2=6.833,P<0.05;χ^2=10.296,P<0.05;χ^2=4.910,P<0.05);ɑ-SMA阳性病例数在是否被膜侵犯、淋巴结转移有显著差异(χ^2=6.008,P<0.05;χ^2=11.766,P<0.05),而S100A4的阳性病例数在患者的性别、年龄、瘤体的大小、有无被膜侵犯、有无淋巴结转移及患者的TNM分期差异均没有统计学意义(P>0.05)。结论PTC中TAFs的存在可能提示肿瘤具有较强的侵袭转移能力,TAFs有望成为PTC诊疗的一个新靶点。