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.     

分层分析影像组学模型在肺腺癌诊断中的价值

目的:建立并验证可高效鉴别肺腺癌及其浸润程度的预测模型,并根据结节/肿块性质分层分析模型的预测效能。方法:回顾性分析本院2011年10月-2018年12月经病理证实的肺结节/肿块患者2105例。根据肿瘤性质,分为磨玻璃组(A组,1711例)和实性组(B组,394例),组内以2017年10月为界,分为训练集和测试集。收集患者的传统影像特征、人口统计学资料;采用3D slicer对兴趣区(ROI)进行手动勾画,Pyraodiomics提取影像组学特征,最大相关-最小冗余(mRMR)和最小绝对收缩选择算子(LASSO)算法对特征进行筛选、降维,构建预测模型,并采用受试者操作特征(ROC)曲线及曲线下面积(AUC),校准曲线和拟合优度检验,临床决策曲线分别评价模型的预测准确性、校准度、临床实用性。结果:在A组、B组分别建立独立组学模型、传统模型和融合组学模型。A组:融合组学模型在训练集、测试集、外部验证集的AUC分别为0.92(0.90~0.93)、0.94(0.93~0.96)、0.87(0.82~0.91);B组:融合组学模型在训练集、测试集以及外部验证集的AUC分别为0.85(0.80~0.90)、0.80(0.72~0.89)、0.70(0.54~0.85)。De-long检验A组测试集组学模型与传统模型间效能差异有统计学意义(P<0.05);B组组学模型与传统模型间的效能结果差异无统计学意义。无论是A组还是B组,Hosmer-Lemeshow拟合优度检验融合组学模型、传统模型P值均大于0.05,校准曲线中融合组学模型预测值与标准基线重合度较高。决策曲线中融合组学模型的净利润率最高。该结果在外部验证集中得到部分验证。结论:影像组学进一步提升了传统诊断模式对肺腺癌的诊断效能。相比于实性肺结节/肿块,融合组学模型在磨玻璃肺结节/肿块中的预测准确性、校准度、临床实用性更为优异。     

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.     

TT genotype of rs10036748 in TNIP1 shows better response to methotrexate in a Chinese population: a prospective cohort study

Psoriasis is a persistent disease that causes inflammation throughout the body and affects approximately 1% to 3% of the world population. It generally appears as red scaly patches and papules over several areas of the skin. Methotrexate is an effective medication for the treatment of psoriasis; however, it is not widely used because its efficacy is unpredictable. This study aimed to determine whether clinical factors of psoriasis and the genes that make people more susceptible to it may affect the effectiveness of methotrexate. The authors identified 221 Chinese patients with psoriasis who were treated with methotrexate for 12 weeks. The patients were divided into the responder and non-responder groups, based on whether their psoriasis improved (responded) after the 12-weeks treatment. The responder group comprised patients with more than 75% improvement while the non-responder group comprised those with less than 50% improvement in psoriasis. Associations between 18 common variations of 14 genes that make people susceptible to psoriasis (LCE3D, IL12B, NFKB1A, TNIP1, ERAP1, ZNF683, MTHFR, AIM2, PTTG1, GJB2, SYNE2, IKZF3, SERPINB8, ZNF816A) and the HLA-Cw6 status were analysed, based on their response to methotrexate. The differences between the clinical factors of methotrexate responders and non-responders were compared. Body mass index, arthritis, and rs10036748 genotype were significantly associated with the patients’ response to methotrexate. The authors concluded that patients with psoriasis and the TT genotype of rs10036748 on the TNIP1 gene, those with lower body mass indices, and those without arthritis will respond better to methotrexate.