糖尿病患者血清中IL-4、TNF-a的检测及分析

目的 探讨白介素４（ＩＬ－４）、肿瘤坏死因子（ＴＮＦ－ａ）水平与糖尿病关系。方法 采用ＥＬＩＳＡ法测定５４例糖尿病患者及４０例健康人血清ＩＬ－４、ＴＮＦ－ａ含量。结果 糖尿病患者ＩＬ－４平均含量明显低于健康人（Ｐ〈０．０５）,且与血糖一负相关（ｒ＝－０．３４７,Ｐ〈０．０５）。ＴＮＦ－ａ含量略高于对照组,但无统计学意义。结论 糖尿病患者内存在细胞免疫功功能紊乱,自身免疫功能调节失衡影响糖尿病的发生     

E-钙黏附素和α-连接素在乳腺癌组织中的表达及其临床意义

目的　探讨E 钙黏附素 (E Cad)和α 连接素 (α Cat)在乳腺癌组织中的表达及其临床意义。方法　应用免疫组织化学方法 ,检测 77例乳腺癌、15例乳腺增生和 15例乳腺纤维腺瘤组织中E Cad、α Cat表达水平。结果　E Cad及α Cat在乳腺癌组织中的阳性率分别为 5 5 .8% ( 4 3 /77)及 3 9.0 % ( 3 0 /77) ,均明显低于乳腺增生和乳腺纤维腺瘤组织 (P <0 .0 5 ) ;E Cad与乳腺癌腋窝淋巴结转移、远处转移有关 (P <0 .0 5 ) ,α Cat与乳腺癌腋窝淋巴结转移有关 (P <0 .0 5 )。结论　E Cad、α Cat在乳腺癌浸润和转移中可能起重要作用 ,对判断乳腺癌预后有一定的指导意义     

Interaction of Sleep Duration and Sleep Quality on Hypertension Prevalence in Adult Chinese Males

Background

Previous studies demonstrated conflicting results about the association of sleep duration and hypertension. Given the potential relationship between sleep quality and hypertension, this study aimed to investigate the interaction of self-reported sleep duration and sleep quality on hypertension prevalence in adult Chinese males.

Methods

We undertook a cross-sectional analysis of 4144 male subjects. Sleep duration were measured by self-reported average sleep time during the past month. Sleep quality was evaluated using the standard Pittsburgh Sleep Quality Index. Hypertension was defined as blood pressure level ≥140/90 mm Hg or current antihypertensive treatment. The association between hypertension prevalence, sleep duration, and sleep quality was analyzed using logistic regression after adjusting for basic cardiovascular characteristics.

Results

Sleep duration shorter than 8 hours was found to be associated with increased hypertension, with odds ratios and 95% confidence intervals (CIs) of 1.25 (95% CI, 1.03–1.52) for 7 hours, 1.41 (95% CI, 1.14–1.73) for 6 hours, and 2.38 (95% CI, 1.81–3.11) for <6 hours. Using very good sleep quality as the reference, good, poor, and very poor sleep quality were associated with hypertension, with odds ratios of 1.20 (95% CI, 1.01–1.42), 1.67 (95% CI, 1.32–2.11), and 2.32 (95% CI, 1.67–3.21), respectively. More importantly, further investigation of the association of different combinations of sleep duration and quality in relation to hypertension indicated an additive interaction.

Conclusions

There is an additive interaction of poor sleep quality and short sleep duration on hypertension prevalence. More comprehensive measurement of sleep should be performed in future studies.Key words: sleep duration, sleep quality, hypertension     

24h动态脑电图对晕厥与癫痫的诊断价值

目的探讨24h动态脑电图（AEEG）对晕厥与癫痫的诊断价值。方法回顾性分析2008年1月～2013年8月,在河北联合大学开滦总医院神经外科及神经内科住院的发作性意识丧失患者52例。结合病史、临床表现、查体、血尿生化检查、直立倾斜试验、头颅影像学等,分析常规脑电图（REEG）、AEEG监测结果,进行诊断与鉴别诊断。结果52例患者27例（27／52,51．9％）诊断为癫痫,19例（19／52,36．5％）诊断为晕厥,6例（6／52,11．5％）无法明确诊断。27例癫痫患者中AEEG监测发现特异性癫痫样放电。19例晕厥患者中5例（5／19,26．3％）诊断为心源性晕厥,12例（12／19,63．2％）诊断为血管迷走性晕厥。2例（2／19,10．5％）为体位性低血压性晕厥。结论AEEG对于晕厥与癫痫有较高的诊断及鉴别诊断价值。晕厥发作期脑电图显示弥漫性低波幅慢波的患者应警惕心源性晕厥的可能。     

进展期直肠癌新辅助放化疗疗效评估模型的建立及评价:基于MRI和网状蛋白1C

目的建立基于MRI和网状蛋白1C（RTN-1C）的进展期直肠癌新辅助放化疗疗效评估模型并评价该模型的效能。方法选取2018年8月~2020年11月在开滦总医院林西医院就诊的134例进展期直肠癌患者作为研究对象,并根据是否达到病理学完全缓解将其分为2组:完全缓解组（n=39）和未完全缓解组（n=95）。用Ficoll密度梯度分离法获取外周血中单个核细胞,用蛋白质免疫印迹法检测单个核细胞中RTN-1C表达量。用Logistic回归分析进展期直肠癌新辅助放化疗疗效的风险因素,并构建上述风险因素的列线图回归模型;用ROC曲线、校准曲线和决策曲线分析评价预测模型的价值。结果完全缓解组的容积转运常数（Ktrans）、血管外细胞外间隙容积比（Ve）、回流速率常数（K_ep）和RTN-1C相对表达量均高于未完全缓解组（P < 0.05）;表观弥散系数（ADC）低于未完全缓解组（[0.88±0.05）×10-3 mm2/s vs（0.92±0.05）×10-3 mm2/s, P < 0.05]。Logistic回归分析结果显示T4期和高ADC值是进展期直肠癌新辅助放化疗疗效独立危险因素（P < 0.05）,高Ktrans值、高Ve值和高RTN-1C相对表达量是进展期直肠癌新辅助放化疗疗效的独立保护因素（P < 0.05）。当阈值概率在0.39%~0.42%,0.75%~0.80%和0.86%~0.88%时,模型B评价进展期直肠癌新辅助放化疗疗效的净收益高于模型A;当阈值概率在其他范围时,模型A评价进展期直肠癌新辅助放化疗疗效的净收益高于模型B。结论基于MRI和RTN-1C构建的模型A对进展期直肠癌新辅助放化疗疗效有较高的区分度、校准度和临床应用价值,可辅助临床做出更好决策。      

Compensatory recombination phenomena of neurological functions in central dysphagia patients

We speculate that cortical reactions evoked by swallowing activity may be abnormal in patients with central infarction with dysphagia. The present study aimed to detect functional imaging features of cerebral cortex in central dysphagia patients by using blood oxygen level-dependent functional magnetic resonance imaging techniques. The results showed that when normal controls swallowed, primary motor cortex(BA4), insula(BA13), premotor cortex(BA6/8), supramarginal gyrus(BA40), and anterior cingulate cortex(BA24/32) were activated, and that the size of the activated areas were larger in the left hemisphere compared with the right. In recurrent cerebral infarction patients with central dysphagia, BA4, BA13, BA40 and BA6/8 areas were activated, while the degree of activation in BA24/32 was decreased. Additionally, more areas were activated, including posterior cingulate cortex(BA23/31), visual association cortex(BA18/19), primary auditory cortex(BA41) and parahippocampal cortex(BA36). Somatosensory association cortex(BA7) and left cerebellum in patients with recurrent cerebral infarction with central dysphagia were also activated. Experimental findings suggest that the cerebral cortex has obvious hemisphere lateralization in response to swallowing, and patients with recurrent cerebral infarction with central dysphagia show compensatory recombination phenomena of neurological functions. In rehabilitative treatment, using the favorite food of patients can stimulate swallowing through visual, auditory, and other nerve conduction pathways, thus promoting compensatory recombination of the central cortex functions.     

目标导向液体治疗在腹腔镜胰十二指肠切除术中的临床应用

【摘要】目的 探讨目标导向液体治疗对胰十二指肠切除术患者肠道功能的影响。方法 选取2017年6月~2019年6月开滦总医院择期全麻下行腹腔镜胰十二指肠切除术患者60例,根据随机数字表法分为随机分为G组和C组。G组采用目标导向液体治疗,C组采用常规补液治疗。记录两组患者术中液体出入量、血管活性药用量、手术时间、尿量、失血量、浓缩红细胞输入例数、术后气管拔管时间、住院时间。记录麻醉前（T0）、手术开始（T1）、标本切除时（T2）、手术结束（T3）患者的平均动脉压（MAP）、心率（HR）、心脏指数( CI) 、中心静脉压（CVP）、每搏量变异度（SVV）、乳酸（Lac）、中心静脉血氧饱和度（Scv02）等情况。在T0～T3及术后第 1、2、3 天(T4、T5、T6 )七个时间点抽取患者中心静脉血,测定血浆二胺氧化酶（DAO）、D 乳酸、脂多醣（LPS）;在T0～T3抽取患者中心静脉血,测定血浆神经营养因子 3(NT 3)和甘丙肽(GAL)的浓度。结果 在T2 和T3时间点G组与C组相比MAP升高、 CVP下降、 SVV下降、CI增加、乳酸（Lac）降低、ScvO2升高(P＜005)。与C组相比,G组胶体液入量和多巴胺使用量多,晶体液入量、输液总量少（P＜005）,去甲肾上腺素用量少（P＜005）,气管插管的拔管时间G组比C组要早。在T2～T6时,与C组相比,G组血浆DAO、D 乳酸和LPS降低。术后第1天血浆DAO、D 乳酸和LPS均达到峰值,之后开始下降。与T0比较, 在T1~T2时两组患者血浆NT 3均升高, T3时均下降, 而G组比C组变化明显,而血浆GAL 在T2 和T3时持续升高, G组比C组变化明显。结论 在腹腔镜胰十二指肠切除术中应用目标导向液体治疗,可维持有效循环血容量及血压以保证全身灌注,改善微循环,对患者肠黏膜屏障功能和运动功能有保护作用。     

IL-6基因多态性与乙型肝炎慢性化的相关性

目的探讨汉族成人IL-6基因多态现象与乙型肝炎慢性化的关系。方法收集118例慢性乙型肝炎(CHB)患者和61例急性乙型肝炎(AHB)患者外周血,提取基因组DNA;采用聚合酶链反应-限制性片断长度多态性(PCR-RFLP)分析方法进行IL-6-572C/G和-597G/A基因分型。结果 CHB组IL-6-572G等位基因频率显著高于AHB组(χ2=8.627,P=0.003)。与CC基因型相比,CG和GG基因型携带者发生慢性化的危险性升高(ORCG=2.024,95%CI:1.009～4.065;ORGG=3.367,95%CI:1.169～9.709)。结论 IL-6-572基因位点多态性与乙型肝炎慢性化有关,携带-572GG基因型的乙型肝炎患者易发生慢性化。