急诊内镜与择期内镜对急性非静脉曲张性上消化道出血的临床价值对比

目的:对比急诊内镜与择期内镜对急性非静脉曲张性上消化道出血(ANVUGIB)的临床价值。方法:选择2018年5月~2019年4月169例ANVUGIB患者,按内镜诊疗时间的不同将其分为两组:急诊内镜组(n=85)与择期内镜组(n=84)。比较急诊内镜与择期内镜对ANVUGIB病因的检出率及治疗效果。结果:急诊内镜明确检出病因81例(95.3%),未能明确病因4例(4.7%),择期内镜明确检出病因73例(86.9%),未能明确病因11例(13.1%),急诊内镜对ANVUGIB病因的检出率明显高于择期内镜(P<0.05)。急诊内镜止血成功82例(96.5%),再次出血4例(4.7%),转手术1例(1.2%);择期内镜止血成功75例(89.3%),再次出血9例(10.7%),转手术5例(6.0%);急诊内镜止血成功率明显高于择期内镜(P<0.05)。结论:对于ANVUGIB应早期行急诊内镜,不仅能及时明确病因,还能有效提高止血成功率。     

加速康复外科在达芬奇机器人胃癌根治术中的应用体会

目的:探讨快速康复外科(FTS)在达芬奇机器人胃癌根治术中的临床应用价值。方法:选取2018年10月至2019年5月53例行达芬奇胃癌根治术的患者,随机分为快速康复组(n=25)与常规组(n=28),快速康复组采取FTS理念指导下的围手术期管理;常规组采取常规围手术期管理。比较两组临床资料、围手术期资料(术后住院时间、C反应蛋白、术后下床活动时间、术后进食流食时间、术后通气时间、清扫淋巴结数量、术中出血量、住院费用)及并发症情况。结果:快速康复组与常规组术后通气时间[(2.16±0.62)d vs.(2.71±0.46)d]、术后进食流食时间[(2.28±0.68)d vs.(3.07±0.47)d]、术后C反应蛋白[(16.54±2.68)mg/dL vs.(18.47±2.99)mg/dL]、术后下床活动时间[(1.20±0.41)d vs.(2.86±0.76)d]、术后住院时间[(9.32±1.73)d vs.(12.57±7.90)d]差异均有统计学意义(P<0.05),两组住院总费用[(89006.59±9202.19)元vs.(90951.84±11549.55)元]、术中出血量[(153.20±107.46)mL vs.(157.14±113.62)mL]、清扫淋巴结总数[(43.24±18.70)vs.(39.54±12.24)]差异无统计学意义(P>0.05)。结论:FTS与达芬奇机器人胃癌根治术的结合可降低临床分期Ⅲ期及以下无远处转移的原发性胃癌患者的手术应激及炎症反应,促进胃肠功能早期恢复,住院时间短,患者短期收益大,值得进一步临床应用。     

社区老年人社会隔离与抑郁症状的纵向研究

目的 采用交叉滞后分析模型探讨社区老年人社会隔离与抑郁症状的纵向关联。方法 采用分层整群抽样法对济南市789名社区老年人在2019年10月至2020年8月进行为期10个月的纵向追踪调查,使用Lubben社会网络量表简化版和老年抑郁量表简化版进行两次测量（T1和T2）。结果 社区老年人社会隔离与抑郁症状均具有一定稳定性;2个时间点的社会隔离与抑郁症状均呈负相关（r=-0.429,-0.327,P<0.001）。交叉滞后回归分析显示,在控制T1抑郁症状后,T1社会隔离显著预测T2抑郁症状（β=-0.136,P<0.001）;控制T1社会隔离后,T1抑郁症状对T2社会隔离的预测作用无统计学意义（β=-0.012,P=0.750）。结论 社会隔离是老年人抑郁症状的前因变量,社会隔离可以显著预测抑郁症状。     

长链非编码RNA UCA1对人下咽鳞状细胞癌FaDu 细胞增殖、侵袭、凋亡及周期的影响

摘要：目的探讨长链非编码RNA尿路上皮癌抗原1（lncRNA UCA1）对人下咽鳞状细胞癌FaDu细胞增殖、侵袭、凋亡及周期的影响。方法向FaDu细胞转染UCA1-siRNA（si-UCA1组），以转染阴性干扰RNA为阴性对照组（si-NC组），以未转染组为空白对照组（Control组），通过实时荧光定量PCR确定UCA1-siRNA的干扰效果；通过CCK-8实验、Transwell侵袭实验、流式细胞术分别检测UCA1-siRNA对FaDu细胞增殖、侵袭以及细胞周期的影响；Western blot实验检测UCA1-siRNA对FaDu细胞增殖、凋亡及周期相关因子Bax、Bcl-2、cleaved-Caspase 9、cyclin D1和PCNA蛋白表达的影响。结果si-UCA1可有效下调FaDu细胞中UCA1的表达，与Control组及si-NC组相比，si-UCA1组FaDu细胞增殖及侵袭能力显著降低，G1期细胞比例显著升高，S期及G2期细胞比例显著下降，凋亡相关蛋白Bax、cleaved-Caspase 9表达水平显著升高，Bcl-2表达水平显著下调，细胞周期、增殖相关蛋白cyclin D1、PCNA表达水平显著降低（P＜0.05）。结论下调lncRNA UCA1的表达可抑制下咽鳞状细胞癌FaDu细胞增殖、侵袭能力，阻滞细胞周期，并可促进FaDu细胞凋亡。     

稳定表达磷酸化Stat3蛋白的EC-1细胞株的获取

目的:建立稳定表达磷酸化Stat3(p-Stat3)蛋白的EC-1细胞株。方法:应用脂质体Lipofectamine2000将pXJ40-Stat3质粒转染入EC-1细胞中,G418筛选得稳定转染pXJ40-Stat3的EC-1细胞株,IL-6处理20min以获得稳定表达p-Stat3蛋白的EC-1细胞株(转染pXJ40-Stat3+IL-6处理组)。同时以稳定转染pXJ40-Stat3(转染pXJ40-Stat3组)、IL-6处理组(不转染)、空载体组和空白组细胞作为对照。分别用RT-PCR和Western blot法检测各组细胞中Stat3 mRNA和p-Stat3蛋白的表达。结果:5组细胞中Stat3 mRNA和p-Stat3表达差异有统计学意义(FStat3 mRNA=5.971,P=0.010;Fp-Stat3=7.334,P=0.005)。转染pXJ40-Stat3+IL-6处理组EC-1细胞中Stat3 mRNA表达最高(0.72±0.01),其次是转染pXJ40-Stat3组(0.65±0.01),均高于其他3组。转染pXJ40-Stat3+IL-6处理组EC-1细胞中p-Stat3蛋白表达最高(0.72±0.03),其次为IL-6处理组(0.65±0.01),均高于其他3组。结论:成功建立稳定表达p-Stat3蛋白的EC-1细胞株。     

miR-200bc/429 cluster alleviates inflammation in IgA nephropathy by targeting TWEAK/Fn14

Immunoglobulin A nephropathy (IgAN) is one of the most common glomerular diseases worldwide. Various studies have identified a host of microRNAs (miRNAs) abnormally expressed in IgAN and might affect the pathogenesis and progression of IgAN. However, miR-200bc/429 cluster in the pathopoiesis of IgAN remains poorly understood. For this study, we found that miR-200bc/429 cluster is downregulated in IgAN tissues and IgAN podocytes and HK2 cells compared with their matched controls respectively. In addition, overexpression of miR-200bc/429 cluster in IgAN podocytes and HK2 cells could attenuate the release of inflammatory cytokines MCP-1, IL-6 and RANTES. Moreover, the 3′ untranslated region (UTR) of TNF-like weak inducer of apoptosis (TWEAK) was identified to be a direct target of miR-200bc/429 cluster. Furthermore, our results showed that miR-200bc/429 cluster can inhibit TWEAK mediated NF-κB pathway activation in IgAN. Overall, our findings revealed that miR-200bc/429 cluster alleviates inflammation in IgAN through TWEAK/Fn14 system and might serve as a biomarker as well as a promising therapeutic target for IgAN.     

Methods for development of a core outcome set for clinical trials integrating traditional Chinese medicine and Western medicine

Clinical trial outcome reporting differs between studies integrating traditional Chinese medicine (TCM) and Western medicine, so that some clinical trials are not eligible for inclusion in a systematic review. The excluded studies are therefore less widely disseminated, and even valid studies are less likely to yield impact. This problem may be addressed by developing core outcome sets (COSs) for integrative medicine in specific healthcare areas. The first stage of development is to define the scope of the COS for integrative medicine, the second stage is to establish the need for such a COS, and the third stage is to develop a protocol and register the COS. The final stage involves three steps: (i) development of a comprehensive list of outcomes (including efficacy outcomes and safety outcomes and TCM syndromes) using systematic review, qualitative or cross-sectional research, and reviews of package inserts and medical records; (ii) merging and grouping of outcomes within domains; (iii) conducting two rounds of Delphi survey and consensus meetings with a range of stakeholders. The final COS will include a general COS and core TCM syndrome- set. Development of COSs for clinical trials of integrative medicine may help to standardize outcome reporting and reduce publication bias in the future.     

Association Between RET Fusions and Efficacy of Pemetrexed-based Chemotherapy for Patients With Advanced NSCLC in China: A Multicenter Retrospective Study

BackgroundRearranged during transfection (RET) proto-oncogene gene fusions are rare in non–small-cell lung cancer (NSCLC). We compared the efficacy of pemetrexed-based chemotherapy with other chemotherapy regimens in patients with NSCLC with different RET fusion subtypes.Patients and MethodsA retrospective, multicenter study of patients with pathologically confirmed stage IIIB/IV lung adenocarcinomas was conducted. RET rearrangements were detected using next generation sequencing. We analyzed the clinical characteristics of patients with RET-rearranged NSCLC and the efficacy of chemotherapy regimens. We also evaluated the efficacy between groups of patients with and without KIF5B-RET–rearranged lung cancer.ResultsWe evaluated 62 patients with NSCLC and RET rearrangements, including 41 with KIF5B-RET, 15 with CCDC6-RET, and 6 with other rare fusion subtypes. Of these 62 patients, 50 had stage IIIB/IV. We also evaluated 40 patients with first-line chemotherapy information available. The median progression-free survival was significantly different between those receiving pemetrexed-based chemotherapy and those receiving other chemotherapy regimens (9.2 vs. 5.2 months; P = .007). The median progression-free survival for patients with KIF5B-RET fusion and non–KIF5B-RET fusion was not significantly different statistically (7.8 vs. 11.2 months; P = .847). For second-line chemotherapy, a statistically significant difference was found between the chemotherapy regimens (4.9 vs. 2.8 months; P = .049). Survival follow-up data were available for 38 patients with advanced NSCLC. The median overall survival was 26.4 months. The overall survival of the patients with RET-rearranged NSCLC who had received pemetrexed-based chemotherapy versus no pemetrexed-based chemotherapy was 35.2 versus 22.6 months (P = .052). No difference in survival was observed between the patients with KIF5B-RET and non–KIF5B-RET rearrangements.ConclusionsPemetrexed-based treatment should be considered first when selecting the chemotherapy regimen for patients with NSCLC and RET rearrangements.     

临床分离肺炎克雷伯菌的分布及药敏试验结果分析

目的分析近三年来本院住院部分离出的肺炎克雷伯菌对本院常见抗菌药物的敏感性,为临床治疗方案提供借鉴,并验证本科室自行创建的细菌耐药预警检测系统。方法以本院近三年来住院患者肺炎克雷伯菌阳性的样本167株为研究对象,采用法国ATB Expression微生物鉴定系统对肺炎克雷伯菌进行鉴定并对20种抗菌药物进行药敏试验。所有数据均在Excel软件进行统计学处理分析。结果 167株肺炎克雷伯菌感染最严重的是烧伤科(60株,占35.92%),感染率最高的标本类型是痰液及下呼吸道分泌物(113株,占67.66%),肺炎克雷伯菌对亚胺培南、美洛培南和哌拉西林/他唑巴坦的敏感率分别为95.21%、94.01%和85.63%;阿莫西林、替卡西林、哌拉西林三种抗菌药物敏感率为0%;阿米卡星、奈替米星、头孢西丁这三种抗菌药物敏感率在60%~80%之间;其余9种抗菌药物均在30%~70%之间;在不同性别患者来源菌株中,仅有美洛培南具有统计学意义(U=2.2,p<0.05),在不同标本来源菌株中,哌拉西林/他唑巴坦具有统计学意义(U=2.27,p<0.05)。结论肺炎克雷伯菌的耐药性已十分严重,但某些抗菌药物在不同性别、不同标本来源中具有显著差异,实验室应加强感染菌株的监测,建立更加完善的细菌耐药预警监测系统及制度,临床应根据药敏试验结果合理使用抗生素,避免无效治疗及菌株耐药。