同型半胱氨酸、维生素D、C、E、B12及叶酸与胃癌关系的研究进展北大核心

胃癌作为临床最常见的肿瘤之一,常因确诊疾病较晚而影响治疗效果,胃镜活检后的病理虽然作为确诊的金标准,但是由于此方式过程痛苦,操作复杂,费用较高,且具有侵入性,可能会导致患者拒绝操作而难普及于临床,因此积极找寻胃癌有效的监测指标十分必要。近年来,很多学者研究维生素与胃癌的相关关系,并试图通过摄取某些维生素降低胃癌发生率,延缓病情及改善预后,也有通过检测血清中维生素的水平给早期胃癌的诊断提供帮助。本文就同型半胱氨酸、维生素D、维生素C、维生素E、维生素B12及叶酸在胃癌中的作用机制,及其在血清中水平与胃癌关系的相关研究进展进行简要综述,为临床胃癌诊疗提供新思路。     

Genetically predicted childhood obesity and adult atrial fibrillation: A mendelian randomization study

Background and aimsIt is unclear whether the association of childhood obesity with adult atrial fibrillation observed in observational studies reflects causal effects. The aim of this study was to evaluate the association of childhood obesity with adult atrial fibrillation using genetic instruments.Methods and resultsWe used a two-sample Mendelian randomization (MR) design to evaluate the association between childhood obesity and adult atrial fibrillation. Two sets of genetic variants (15 single nucleotide polymorphisms [SNPs] for childhood body mass index [BMI] and 12 SNPs for dichotomous childhood obesity) were selected as instruments. Summary data on SNP-childhood obesity and SNP-atrial fibrillation associations were obtained from recently published genome-wide association studies. Effect estimates were evaluated using inverse-variance weighted (IVW) methods. Other MR analyses, including MR-Egger, simple and weighted median, weighted MBE and MR-PRESSO methods were performed in sensitivity analyses.The IVW models showed that both a genetically predicted one-standard deviation increase in childhood BMI (kg/m²) and higher log-odds of childhood obesity were associated with a substantial increase in the risk of atrial fibrillation (OR = 1.22, 95% CI: 1.11–1.34, P < 0.001; OR = 1.09, 95% CI: 1.04–1.14, P < 0.001). MR-Egger regression showed no evidence of genetic pleiotropy for childhood BMI (intercept = 0.000, 95% CI: ?0.024 to 0.023), but for childhood obesity (intercept = ?0.036, 95% CI: ?0.057 to ?0.015). Similar results were observed using leave-one-out and other MR methods in sensitivity analyses.ConclusionsThis MR analysis found a consistent association between genetically predicted childhood obesity and an increased risk of adult atrial fibrillation. Further research is warranted to validate our findings.     

肠白塞病外周血参数在临床诊疗中的价值

目的 分析肠白塞病(Behcet's disease，BD)外周血参数特点及其与肠溃疡活动度的相关性，为全面评估肠BD提供简易方法。 方法 选择2015年1月-2017年1月复旦大学附属华东医院收治的肠BD患者50例，以单纯皮肤黏膜BD患者50例和复发性阿弗他溃疡(recurrent aphthous ulcer,RAU)患者40例作对照，比较肠BD组外周血参数与单纯皮肤黏膜BD组和RAU组之间的差异。应用简化的内镜下克罗恩病活动度标准(SES-CD)将肠BD分为活动期25例和稳定期25例，评价外周血参数与肠溃疡活动度的相关性。 结果 与对照组比较，肠BD组红细胞(RBC)、血红蛋白(HGB)明显下降(均P<0.05)；纤维蛋白原(FIB)、血沉(ESR)和C-反应蛋白(CRP)明显升高(均P<0.05)；HGB和CRP预测肠BD的受试者工作特征曲线(ROC)下面积分别为0.826和0.871；与肠BD稳定期比较肠BD活动期ESR、CRP和FIB显著升高(均P<0.05)，HGB显著降低(P=0.001)；HGB、ESR、CRP和FIB判断肠溃疡活动度的ROC曲线下面积分别为0.758、0.787、0.888和0.792。 结论 BD患者HGB下降和CRP升高时需警惕肠溃疡；HGB、ESR、CRP和FIB是判断肠BD溃疡活动度的简易指标。      

基于VOSviewer的2019新型冠状病毒病中医临床诊疗可视化分析＊

目的 通过对公开发表在网络和数据库的有关中医药治疗2019新型冠状病毒肺炎（corona virus disease 2019，COVID-19）的文献进行方、药、证的可视化分析，客观全面的对COVID-19的中医药治疗进行探讨，为现代中医临床诊疗提供参考。方法 本文选用运用文献计量学方法和VOSviewer可视化软件对纳入文献中的用药情况进行数据拆分、整理和分析。结果 本研究高质量数据的主要期刊来源是核心期刊《中医杂志》；新冠临床用方以解表清热剂、开窍补益剂、辟秽祛湿剂为主；临床用药以解表药、清热解毒药、化湿祛痰药以及补益药为主；临床治病思路以六经辨证、三焦辨证和卫气营血辨证理论为指导；临床常见证型为湿、热、寒、毒相关证型；重视新冠前期预防以及后期恢复调养；治疗过程用药考究，注重养阴与祛邪并进。结论 新冠的中医临床诊治考病全面，并注重养阴与祛邪并进，可为官方制定治疗方案提供参考。     

基于聚类分析和因子分析的肺小结节患者中医证候特点研究

目的分析肺小结节患者中医证候分布特点,为中医治疗肺小结节提供参考依据。方法收集385例肺小结节患者中医四诊信息,运用聚类分析、因子分析方法对肺小结节患者的中医证候特点和分布规律进行分析。结果肺小结节患者中医症状以虚为主,神疲乏力、夜寐不安、舌红、咳嗽、口渴、口干咽燥、面萎黄、气短、脉细弱、食少纳呆等居多。中医证候以肺脾气虚证最多,占52.2%,其余依次为肺阴亏虚证、气虚血瘀证、肝肾不足证。肺脾气虚证主症为喘息、大便稀溏、腹胀、食少纳呆、神疲乏力、自汗、舌淡红、齿痕舌、苔薄白、脉细弱,次症为夜寐不安、面萎黄;肺阴亏虚证主症为口干咽燥、口渴、咳嗽、痰少难咳、盗汗、痰中血丝、裂纹舌、苔少、脉细,次症为烦躁易怒、面红润、舌红;气虚血瘀证主症为头晕、胸痛、气短、面晦黯、舌黯红,次症为心悸;肝肾不足证主症为胸胁隐痛、喜太息、脉细弦、苔白、腰膝酸软、胸闷、耳鸣、便秘,次症为浮肿。结论肺小结节中医证候以肺脾气虚证、肺阴亏虚证、气虚血瘀证、肝肾不足证为主,正气亏虚是肺小结节变化发展的主要病机。     

Motor unit number index (MUNIX) in the quantitative assessment of severity and surgical outcome in cervical spondylotic amyotrophy

ObjectiveTo assess the feasibility of motor unit number index (MUNIX) in the quantitative assessment of the cervical spondylotic amyotrophy (CSA).MethodsMUNIX was recorded bilaterally on the abductor pollicis brevis, abductor digiti minimi, biceps brachii and middle deltoid in 41 normal controls and 47 patients with CSA (distal-type to proximal-type ratio: 25 to 22). Additionally, patients were assessed on handgrip strength (HGS), the disabilities of arm, shoulder and hand (DASH) and Medical Research Council (MRC) scales. These examinations were re-evaluated approximately 18 months after surgery in 37 of these CSA patients.ResultsMUNIX values were noticeably lower in the mainly affected muscles of CSA patients than those in controls (P < 0.05), and 49.0% (51/104) of the tested muscles with abnormal MUNIX measurements showed normal muscle strength. Significant correlations between MUNIX measurements and both DASH and MRC scores were observed in both CSA patient groups (P < 0.05). Postoperative longitudinal follow-up analysis identified significant increase in motor unit number in both CSA patient groups within approximately 18 months (P < 0.05), with or without improved measures of motor function.ConclusionsA significant reduction in MUNIX values related to motor impairment was observed in CSA patients, even in the subclinical stage. Compared to measures of motor function, the MUNIX measurements in the patients with CSA improved more noticeably after surgical intervention.SignificanceMUNIX may serve as an available supplementary test to quantitatively evaluate the motor dysfunction in CSA and to track its progression, that is complementary to conventional electromyography.     

Immune evasion mechanisms and therapeutic strategies in gastric cancer

Gastric cancer (GC) is a malignancy with a high incidence and mortality. The tumor immune microenvironment plays an important role in promoting cancer development and supports GC progression. Accumulating evidence shows that GC cells can exert versatile mechanisms to remodel the tumor immune microenvironment and induce immune evasion. In this review, we systematically summarize the intricate crosstalk between GC cells and immune cells, including tumor-associated macrophages, neutrophils, myeloid-derived suppressor cells, natural killer cells, effector T cells, regulatory T cells, and B cells. We focus on how GC cells alter these immune cells to create an immunosuppressive microenvironment that protects GC cells from immune attack. We conclude by compiling the latest progression of immune checkpoint inhibitor-based immunotherapies, both alone and in combination with conventional therapies. Anti-cytotoxic T-lymphocyte-associated protein 4 and anti-programmed cell death protein 1/programmed death-ligand 1 therapy alone does not provide substantial clinical benefit for GC treatment. However, the combination of immune checkpoint inhibitors with chemotherapy or targeted therapy has promising survival advantages in refractory and advanced GC patients. This review provides a comprehensive understanding of the immune evasion mechanisms of GC, and highlights promising immunotherapeutic strategies.     

89例非霍奇金淋巴瘤相关噬血细胞综合征临床特点和疗效分析

目的回顾性分析不同病理类型非霍奇金淋巴瘤相关噬血细胞综合征（HLH）的临床特征及预后影响因素。方法收集和分析2013年3月至2020年5月复旦大学附属华东医院确诊的89例非霍奇金淋巴瘤相关HLH患者的临床资料，应用Log-rank法对影响预后的因素进行单因素分析，应用Cox比例风险回归模型进行多因素分析。结果89例淋巴瘤相关HLH患者中位生存时间10.2个月，B细胞淋巴瘤患者未达到中位生存时间，T细胞淋巴瘤患者中位生存时间10.2个月，NK细胞淋巴瘤患者中位生存时间为3个月，差异具有统计学意义（P＝0.012）。非霍奇金淋巴瘤病理类型［总生存（OS）：P＝0.041，无进展生存（PFS）：P＝0.015］，美国东部肿瘤协作组评分（OS：P＝0.031，PFS：P＝0.030），是否行造血干细胞移植（OS：P＝0.005，PFS：P＝0.040），是否伴淋巴结肿大（OS：P＝0.007，PFS：P＝0.012），是否伴脾脏肿大（OS：P＝0.276，PFS：P＝0.324）是影响非霍奇金淋巴瘤相关HLH患者OS和PFS的因素。脾脏切除手术能够改善淋巴瘤相关HLH患者的生存，尤其是T细胞淋巴瘤相关HLH。结论不同病理类型非霍奇金淋巴瘤相关HLH患者临床特点相似，但长期生存率和预后影响因素不同。非霍奇金淋巴瘤相关HLH不仅需要联合化疗，B细胞淋巴瘤和NK细胞淋巴瘤相关HLH患者需尽早进行造血干细胞移植，T细胞淋巴瘤相关HLH患者应考虑脾脏切除手术，以改善患者预后。