血清环状RNA表达与胃癌关系的探索性研究

目的 分析血清中候选环状RNA表达与胃癌的关系,初步探索其是否具有胃癌早期诊断标志物的潜在应用价值。方法 从山东省临朐县人民医院选取48例胃癌病例,并在同期胃镜筛查队列中选择年龄、性别匹配的48例对照。采用实时荧光定量PCR方法对血清中3个候选环状RNA（hsa_circ_002059、hsa_circ_0000096、hsa_circ_0001895）表达水平进行定量检测,并对胃癌组与对照组进行比较。结果 胃癌病例中血清hsa_circ_002059、hsa_circ_0000096、hsa_circ_0001895表达阳性率分别为70.8%、47.9%、75.0%,略高于对照组（58.3%、31.3%、60.4%）,差异均无统计学意义（均P>0.05）。血清中上述3个候选环状RNA表达水平M（P₂₅~P₇₅）在胃癌组中分别为1.60%（0~5.64%）、0（0~0.61%）、0.91%（0.06%~1.88%）,在对照组中分别为0.05%（0~6.07%）、0（0~0.34%）、0.42%（0~1.39%）。多因素分析调整幽门螺杆菌感染、吸烟和饮酒状况后,3种候选环状RNA高表达与胃癌之间的关联强度呈上升趋势,差异无统计学意义（均P>0.05）。进一步将上述3种环状RNA进行组合,对其与胃癌的关系进行联合分析发现,与3种环状RNA均为阴性者相比,随着表达阳性环状RNA个数增加,与胃癌的关联强度呈上升趋势,趋势检验P=0.040。结论 本研究初步提示hsa_circ_002059、hsa_circ_0000096、hsa_circ_0001895表达水平可能与胃癌相关。     

mRECIST应答对经肝动脉化疗栓塞术治疗不可切除肝细胞癌患者预后的预测价值

目的探讨实体瘤疗效评价标准(mRECIST)应答对经肝动脉化疗栓塞术(TACE)治疗的不可切除肝细胞癌的预后价值。方法回顾性纳入2010年1月—2014年12月在空军军医大学第一附属医院消化介入科行TACE治疗连续的不可切除肝细胞癌患者190例。应用mRECIST标准评估TACE术后影像学应答,将肿瘤完全缓解(CR)和部分缓解(PR)患者定义为有应答组(n=89),将疾病进展(PD)和疾病稳定(SD)定义为无应答组(n=101)。采用Kaplan-Meier法计算中位生存时间,log-rank检验进行组间比较。利用Cox回归进行预后影响因素分析。结果根据mRECIST标准,CR、PR、SD和PD的患者分别有39(20.5%)例、50(26.3%)例、67(35.3%)例和34(17.9%)例。总人群的mRECIST客观应答率为46.8%。应答组的生存期明显高于无应答组,中位生存时间分别为29.9(95%CI:25.0~34.8)个月和7.5(95%CI:5.7~9.3)个月(P<0.001)。多因素分析结果显示,mRECIST应答(HR=2.02,P<0.001)、乙型肝炎(HR=4.03,P<0.001)和门静脉侵犯(HR=2.12,P=0.008)是影响患者生存的独立危险因素。结论mRECIST应答对经TACE治疗的不可切除肝细胞癌患者的预后具有一定的预测价值。     

Initial Severity and Depressive Relapse in Cognitive Behavioral Therapy and Antidepressant Medications: An Individual Patient Data Meta-analysis

Cognitive Therapy and Research - Baseline severity has emerged as a key predictor of acute response to treatments for depression. The goals of this individual patient data meta-analysis were to...     

基于胃癌高发区人群筛查队列的不同胃黏膜病变进展为胃癌风险的前瞻性研究

目的 依托胃癌高发区大规模人群筛查队列分析不同级别胃黏膜病变的患病情况,前瞻性探讨不同胃黏膜病变进展为胃癌的风险,为优化胃癌的筛查策略提供科学依据。方法 基于山东省临朐县胃癌高发区开展的国家上消化道癌早诊早治项目,纳入年龄在40~69岁之间,2012-2018年经内镜筛查和病理诊断明确为各级别胃黏膜病变、且未患有高级别上皮内瘤变（HGIN）或浸润性胃癌的14 087例研究对象,随访至2019年12月31日。随访期内新发胃癌通过重复性胃镜筛查、肿瘤发病和死因登记系统报告以及主动入户随访联合判定,经查阅医院信息管理系统中摘抄的临床病历进行确认。应用Poisson回归模型计算各级别胃黏膜病变进展至胃癌风险的相对危险度（RR）及其95%CI。结果 14 087例研究对象中,胃黏膜正常者仅有8例（0.06%）,最高诊断为浅表性胃炎（SG）、慢性萎缩性胃炎（CAG）、肠上皮化生（IM）和低级别上皮内瘤变（LGIN）分别为7 608例（54.00%）、2 848例（20.22%）、3 103例（22.03%）和520例（3.69%）。经过前瞻性随访,共有109例研究对象诊断为HGIN（63例）和浸润性胃癌（46例）。与基线正常或仅有SG的个体相比,患有CAG、IM和LGIN的个体进展为胃癌的风险依次增加为3.85倍（RR=3.85,95%CI：2.04~7.28）、5.18倍（RR=5.18,95%CI：2.79~9.60）和19.08倍（RR=19.08,95%CI：9.97~36.53）,其中LGIN组进展为HGIN和浸润性胃癌的风险分别为SG/正常组的22.96倍（RR=22.96,95%CI：9.71~54.27）和14.64倍（RR=14.64,95%CI：5.37~39.93）。各个年龄组患有LGIN者随访期间发生胃癌的风险均显著增加。结论 基于胃癌高发区的大样本人群研究显示,绝大多数40~69岁的高发区居民患有不同程度胃黏膜病变。随胃黏膜病变严重程度的增加,随访期间发生胃癌的风险呈级联上升趋势。     

肝肾胰器官簇移植临床解剖学研究

目的：为了开展肝肾胰器官簇移植提供应用解剖学资料和术式设计方案。方法：对２４具成人尸体进行解剖观察,了解其主要血管分布,胆管、输尿管、胰管的位置以及腹腔内空腔脏器的相互关系。结果：测得主要血管腹主动脉平均长度１９．２０ｃｍ,上端外径２．２１ｃｍ;下腔静脉平均长度１９．４２ｃｍ,上端外径２．６０ｃｍ;门静脉长５．５９ｃｍ,宽度１．４９ｃｍ;肝固有动脉长３．８５ｃｍ,宽０．６４ｃｍ;胆总管长４．１９ｃｍ,宽度０．７８ｃｍ;在输尿管平均长度为２７．１１ｃｍ,右输尿管平均长度为２５．９３ｃｍ。对器管簇移植的整体切取、修整、安放和吻合提供多种方案。结论：肝肾胰器官簇移植手术有应用解剖学依据的可行性,按形态学规律有多种合理的术式设计方案     

带蒂睾丸鞘膜瓣矫治尿道下裂的应用解剖及临床应用

通过25例男性成人尸体和30例手术切除的活体标本的解剖学研究,以精索外动脉为蒂,设计了带蒂睾丸鞘膜矫治尿道下裂新术式,鞘膜取材可达11×5cm。经20例临床应用,效果满意。     

The effect of endogenous formaldehyde on the rat aorta endothelial cells

Previous studies have demonstrated endogenous formaldehyde (FA) may be involved in endothelial damage, and may be a potential factor of vulnerability of atherosclerosis. However, the mechanism has not been characterized. The present studies examined DNA-protein cross-links (DPC) formation in rat aorta endothelial cells (RAECs) treated with formaldehyde, hydrogen peroxide (H2O2), or formaldehyde with equal molar concentration of H2O2, which is produced with formaldehyde in the body at the same time. Using a K+/SDS precipitation assay for DPC determination, concentration-dependent increases in DPC formation were observed 1.5 h after treatment of RAECs with 0.01-2mM FA, H2O2, or FA with equal molar concentration of H2O2. Time-dependent increases in DPC formation were also observed at 0.5-4 h time point after treatment of RAECs with 0.05 and 0.1mM FA, or 0.1mM FA with H2O2. The DPC levels reduced after treatment with FA and equal molar concentration of H2O2, compared with treatment with FA alone. FA may be less cytotoxic, as FA alone did not affect the cell viability even treating for 4h, until the treatment concentration reached 2mM. However, H2O2, and FA with H2O2 induced significant decreases of cell viability. These studies suggest that FA and H2O2 may injure endothelial cells synergistically, and low concentration of FA (0.05-0.1) may contribute to the endothelial injury in the body during aging.     

肝细胞肝癌COMMD1的表达及其意义

目的:检测肝细胞肝癌组织COMMD1蛋白的表达,探讨其临床及病理学意义。方法:采用SP免疫组织化学方法检测COMMD1在正常肝组织及肝癌中的表达,分析其表达水平与临床病理特征的关系。结果:COMMD1在肝癌组中的阳性表达率显著低于正常肝组织(P<0.05)。COMMD1低表达与癌细胞分化程度及TMN临床分期显著相关(P<0.05)。但其表达与肿瘤是否有血管浸润无关(P>0.05)。结论:肝细胞肝癌COMMD1表达显著降低,且与肿瘤分化程度及发展有关,可为判断病理分级及临床分期提供参考。     

随机生存森林:基于机器学习算法的生存分析模型

传统的生存分析方法虽在生物医学领域已有广泛应用,但需满足一些前提假设。随机生存森林方法可克服这一弱点。本文以美国梅奥诊所的肝脏原发性胆汁肝硬化的数据为例,从随机生存森林的原理、建模步骤、实例演示和适用性讨论等方面进行阐述,以期为读者进行生存分析提供新的思路和方法。     

Screening for gastric cancer in China: Advances,challenges and visions

Gastric cancer (GC) is one of the major cancers in China and all over the world. Most GCs are diagnosed at an advanced stage with unfavorable prognosis. Along with some other countries, China has developed the government-funded national screening programs for GC and other major cancers. GC screening has been shown to effectively decrease the incidence of and mortality from GC in countries adopting nationwide screening programs (Japan and Korea) and in studies based on selected Chinese populations. The screening of GC relies mostly on gastroendoscopy, the accuracy, reliability and safety of which have been indicated by previous studies. However, considering its invasive screening approach, requirements on skilled endoscopists and pathologists, and a high cost, developing noninvasive methods to amend endoscopic screening would be highly needed. Numerous studies have examined biomarkers for GC screening and the combination of biomarkers involving pepsinogen, gastrin, and Helicobacter pylori antibodies has been proposed for risk stratification, seeking to narrow down the high-risk populations for further endoscopy. Despite all the achievements of endoscopic screening, evidence on appropriate screening age, intervals for repeated screening, novel biomarkers promoting precision prevention, and health economics need to be accumulated to inform policymakers on endoscopic screening in China. With the guide of Health China 2030 Planning Outline, we have golden opportunities to promote prevention and control of GC. In this review, we summarize the characteristics of screening programs in China and other East Asian countries and introduce the past and current approaches and strategies for GC screening, aiming for featuring the latest advances and key challenges, and illustrating future visions of GC screening.