MAGE-A1 和MAGE-A3在脑胶质瘤组织中的表达及其临床意义

[摘要] 目的：探讨黑色素瘤抗原基因-A1（MAGE-A1）和MAGE-A3 在脑胶质瘤组织中的表达及其临床意义。方法：选取2006 年1 月至2010 年1 月河北医科大学第四医院神经外科手术切除的78 例脑胶质瘤组织标本和15 例车祸死亡捐献者的正常脑组织标本。用RT-PCR法检测胶质瘤组织中MAGE-A1 和MAGE-A3 的表达，分析其表达水平与患者预后的关系；用MSP-PCR术检测MAGE-A1 和MAGE-A3 基因启动子区的甲基化状态，分析两者表达与甲基化之间的关系；用RT-PCR法检测胶质瘤U251 和U87 细胞中MAGE-A1 和MAGE-A3 表达以及经DNA甲基转移酶抑制剂5-氮杂-2''-脱氧胞苷（5-Aza-CdR）和组蛋白去乙酰化酶抑制剂曲古抑菌素A（TSA）联合作用后两者的表达水平。结果：78 例胶质瘤组织中MAGE-A1 和MAGE-A3 mRNA阳性表达率分别为65.34%和38.46%，而在15 例正常脑组织中未发现2 种mRNA表达。MAGE-A1 阳性组患者5 年生存率较阴性组低（P<0.05）。MAGE-A1 和MAGE-A3 基因启动子区去甲基化水平与其在mRNA水平上的表达均有显著的相关性（均P<0.01）。未经5-Aza-CdR 和TSA处理的U87 细胞未见MAGE-A1 和MAGE-A3 mRNA的表达，U251 细胞则有少量表达。单独给予TSA不能引起MAGE-A1 和MAGE-A3 基因的表达激活，单独给予5-Aza-CdR 或与TSA合用可以引起该2 个基因的表达激活，且两者合用的作用优于单独给药。结论：脑胶质瘤组织中有不同程度的MAGE-A1 和MAGE-A3 基因表达，MAGE-A1 基因表达与患者的预后不良相关。DNA启动子区甲基化和组蛋白乙酰化是MAGE-A1和MAGE-A3基因表达激活的重要机制。     

人工智能影像辅助诊断平台对直肠癌壁外血管侵犯识别多中心临床研究

目的 探索基于区域卷积神经网络（Faster R-CNN）的人工智能影像辅助诊断平台对识别直肠癌壁外血管侵犯（EMVI）的临床应用价值。方法 回顾性分析我国7家医院2016年7月至2019年2月行直肠高分辨MRI检查的500例直肠癌病人的临床资料，其中EMVI阳性174例和EMVI阴性326例。使用随机数字法将病人资料随机分配到训练组（400例，包括EMVI阳性133例和EMVI阴性267例）和验证组（100例，包括EMVI阳性41例和EMVI阴性59例）。利用Faster R-CNN对训练组20 430张高分辨MRI图像进行学习和训练，建立人工智能影像辅助诊断平台。对验证组5107张高分辨MRI图像进行临床验证，应用受试者工作特征曲线（ROC）和曲线下面积（AUC），比较人工智能影像辅助诊断平台与高年资影像专家的诊断结果。结果 人工智能影像辅助诊断平台识别EMVI的准确率、敏感度、特异度、阳性预测值和阴性预测值分别为93.4%、97.3%、89.5%、0.90和0.97。AUC为0.98。自动识别单张图像所需时间为0.2 s，而影像学专家判读时间约为10 s。结论 基于Faster R-CNN的人工智能影像辅助诊断平台对识别直肠癌EMVI具有高效率和可行性，可辅助影像科医生进行成像诊断。     

微酸性次氯酸水用于口腔综合治疗台水路消毒的研究

目的　检测不同浓度微酸性次氯酸水（slightly acidic hypochlorite water，SAHW）应用于口腔综合治疗台水路（dental unit waterlines，DUWLs）的消毒效果。方法    选取32台口腔综合治疗台（dental chair unit，DCU），随机均分为4组（1个对照组和3个实验组，每组8台DCU）。首先，采集高速手机和三用枪基础水样行细菌培养、菌落计数；然后，实验组分别用有效氯含量8 ~ 12 mg/L（实验1组）、18 ~ 22 mg/L（实验2组）、28 ~ 32 mg/L（实验3组）的SAHW供水DUWLs，连续7 d采集高速手机和三用枪水样行细菌培养、菌落计数。第8 d始改用无菌蒸馏水（distilled water，DW）供水DUWLs后采集水样菌落培养计数；对照组用DW替代消毒水，同样程序流动冲洗DUWLs后收集高速手机和三用枪水样菌培养后菌落计数。数据采用SPSS 20.0软件进行统计分析。结果    与基础水样比较，SAHW消毒1 d，3个实验组的高速手机和三用枪水样菌落计数均显著下降（P < 0.05）；SAHW消毒2 d，实验3组高速手机和三用枪水样菌落计数均小于消毒合格水样上限值（100 CFU/mL）；SAHW消毒3 d开始，实验3组菌落计数为0 CFU/mL，实验1组和2组菌落计数均显著小于100 CFU/mL。更换为DW供水后1 ~ 2 d，3个实验组的高速手机和三用枪水样菌落计数维持小于100 CFU/mL，组间差异无统计学意义（P > 0.05）；3 ~ 7 d，3个实验组的高速手机和三用枪水样菌落计数持续增加（149 ~ 1014 CFU/mL），实验1、2、3组的组内不同时间点检测数据比较差异均有统计学意义（均P < 0.05），且均明显大于合格水样上限值（P < 0.05）。结论    高有效氯含量较低有效氯含量的SAHW消毒效果更稳定；低有效氯含量8 ~ 12 mg/L的SAHW持续作用于DUWLs内环境亦可有效控制菌落计数，消毒效果明显。     

单中心近10年腹主动脉瘤1246例流行病学研究

目的 回顾性分析近10年中国医科大学附属第一医院收治的腹主动脉瘤（AAA）病人的流行病学特点，为研究近10年AAA流行病学变化趋势，以及为AAA的进一步预防和诊治提供依据。方法 纳入自2011年1月至2020年12月中国医科大学附属第一医院诊治的1246例AAA病人的病案资料，回顾性分析包括病人年龄、性别、就诊时间、就诊科室、首发症状、住院时间、住院费用、术式选择等信息，分析近10年AAA流行病学变化特点。结果 入院病人平均年龄为（66.9±10.5）岁，男女占比约为4∶1。男性AAA病人以同型半胱氨酸升高为主，女性以血脂升高为主。AAA病人的主要合并症为3级高血压（41.9%）、冠心病（31.1%）和合并髂动脉瘤（25.8%）。男性AAA合并髂动脉瘤比率明显高于女性（27.8% vs.17.8%，P＜0.01）。72.7%的AAA病人首诊原因为体检发现，其次是AAA破裂（18.7%）。AAA病人急诊与门诊就诊例数呈逐年升高态势，急诊与门诊就诊占比约为2∶3。65~69岁为现阶段住院病人主要年龄段。各年份男性占比约为80%，年龄段65~69岁为男性占比可达近90%。各年份腔内修复术（EVAR）是AAA的主要治疗方式，行EVAR治疗病人的例数和比例总体趋势逐年增加，行EVAR治疗的占比随病人年龄增加而逐渐增大。近10年AAA病人的病死率呈降低趋势，2015年后病死率总体维持在2%～3%，以男性为主，年龄段70~74岁的病死率最高为5.8%。AAA病人平均住院（17.0±16.4）d，平均住院费用为（11.3±10.7）万元。结论 近10年AAA住院病人有逐年增高趋势，主要患病人群为年龄＞60岁男性，男女临床特点有较大差异。采用EVAR治疗的占比逐年增加。对于老年AAA人群，尤其是年龄段65~69岁男性AAA病人，在AAA的防治过程中应给予更多关注。     

Compressive shear bond strength of core buildup materials

New tooth-colored restorative materials have been developed with the goal of replacing amalgam. These restoratives are marketed as packable composite and ormocer. The purpose of the present study was to compare the compressive shear bond strengths of these new materials with that of hybrid composite and amalgam as core materials. Standardized core buildups were made on four groups of extracted molars, with 10 teeth per group. Three tooth-colored restorative materials (Filtek Z 250, Filtek P 60, and Definite) and an amalgam (SDI Permite) were used. Specimens were placed in a special jig at a 45-degree angle. The compressive shear bond strength was obtained using a universal testing machine. The Kruskal-Wallis test was used to compare the groups, and pairwise comparisons were made by Mann-Whitney U test (P < .05). Filtek P 60, a packable composite resin, had the greatest compressive shear bond strength values in all instances, and the ormocer (Definite) had the lowest. The strengths of packable composite, hybrid composite, and amalgam as core materials were not significantly different (P > .05).     

Fracture resistance of teeth with Class II bonded amalgam and new tooth-colored restorations

This study compared the cuspal fracture resistance of posterior teeth restored with four different adhesive restorations. Fifty sound, maxillary human premolars were randomly divided into a control group and four experimental groups with 10 teeth in each. Specimens in the first group were intact teeth that were tested as unprepared. The remaining four groups received mesio-oclusodistal cavity preparations and were restored with a hybrid composite (Filtek Z250), a packable composite (Filtek P60), an ormocer (Definite) and an amalgam (SDI Permite) with an amalgam bonding agent (Amalgam Bond Plus). All groups were stored in water at 37 degrees C for 15 days and thermocycled 1000 times between 5 degrees-55 degrees C. The specimens were preloaded five times in compression to 10 kg using two metal rods that contacted only the teeth on the cuspal inclines. The teeth were then loaded occlusally in an Instron Universal Testing Machine until fracture occurred. The means of force required to fracture the teeth in each of the five groups was analyzed using one-way ANOVA and Tukey Test. The difference between the mean cuspal fracture resistance of the unprepared control teeth and those restored with amalgam groups was found to be statistically significant (p < 0.05). No significant differences in resistance to cuspal fracture were found among the restoration groups, the unprepared control group and those teeth restored with hybrid composite, packable composite and ormocer groups (p > 0.05).     

Carotid intima-media thickness in relation to macrovascular disease in patients with type 2 diabetes mellitus

BACKGROUND: Increased carotid intima-media thickness is regarded as a marker of atherosclerosis. Type 2 diabetes mellitus is associated with a high prevalence of macrovascular disease. MAIN PURPOSE: The present study aimed to examine the relationship between carotid intima-media thickness and the presence of macrovascular disease in patients with type 2 diabetes. METHODS: 71 patients with type 2 diabetes mellitus were studied. The distal common carotid artery and carotid bifurcation intima-media thickness were measured bilaterally with high-resolution ultrasonography. The relationship between the presence of coronary artery disease, cerebrovascular disease and peripheral arterial disease and carotid intima-media thickness was evaluated. RESULTS: Patients with coronary artery disease had significantly (p = 0.048) increased intima-media thickness of the distal common carotid artery. This difference ceased to be significant after adjustment for cardiovascular risk factors. Patients with peripheral arterial disease had a significantly higher bifurcation (p < 0.0001), distal common carotid (p = 0.03) and mean intima-media thickness (p = 0.0008) than did those without peripheral arterial disease. This difference remained significant even after adjustment for other cardiovascular risk factors. In the multiple linear regression analysis, the presence of peripheral arterial disease, age and male gender significantly predicted bifurcation intima-media thickness, while age and the presence of peripheral arterial disease significantly predicted mean intima-medial thickness. CONCLUSIONS: In the present study, the increased carotid intima-media thickness in patients with type 2 diabetes mellitus was related to the presence of peripheral arterial disease. This finding probably reflects morphologic and hemodynamic similarities between the two vascular beds and indicates that increased carotid intima-media thickness in patients with type 2 diabetes may be a marker of atherosclerosis in different locations.     

孤立性髂动脉瘤介入治疗39例临床分析

目的 探讨孤立性髂动脉瘤介入治疗的临床经验。方法 回顾性分析2010年1月至2018年9月昆明医科大学附属延安医院血管介入科采用覆膜支架介入治疗孤立性髂动脉瘤39例,术后3个月、6个月及之后的每年对病人进行随访,探讨相关治疗方法。结果 39例病人分型有1A：Ⅰ型1例,1B：Ⅱ型8例,1D：Ⅳ型17例,2B：Ⅱ型2例,2D：Ⅳ型1例,2E：V型10例。平均瘤体最大直径为（42.4±11.2）mm（23.0～77.0 mm）。39例病人均顺利完成介入手术治疗,技术成功率100%,术中保留双侧髂内动脉1例,保留一侧髂内动脉29例,双侧髂内动脉均封闭9例,术中行一侧髂内动脉栓塞9例,行双侧髂内动脉均栓塞1例,手术时间为（49.0±17.0）min（35.0～87.0 min）,术后随访（31.9±17.7）个月（5～69个月）,术后除1例左髂动脉瘤破裂且合并肾衰竭的病人死亡,其余病人均好转出院,复查CTA示髂动脉瘤被完全封闭,支架形态位置良好,无内漏及其他并发症。结论 孤立性髂动脉瘤起病隐匿,早期多无症状,CT等检查能够早期诊断。介入治疗是安全有效的方法。应注意在术前根据髂动脉瘤的累及范围,近远端有无足够的锚定区进行分型,并对不同分型进行有差别的个体化治疗。     

重度阻塞性睡眠呼吸暂停患儿临床预测模型研究

目的　建立习惯性打鼾患儿中重度阻塞性睡眠呼吸暂停（OSA）的临床预测模型,为临床诊疗提供依据。方法　选择2019年1月至12月就诊于首都医科大学附属北京儿童医院睡眠中心的3～12岁习惯性打鼾患儿。所有患儿完成一般资料收集、OSA-18问卷、PSQ-SRBD量表及多导睡眠监测。应用决策树方法构建重度OSA患儿的临床预测模型。结果　共纳入受试患儿1441例,根据PSG结果,重度OSA 1152例,非重度OSA 289例。重度OSA组年龄、男性比例、体重指数（BMI）、颈围/身高比、腹围/臀围比、SRBD量表呼吸维度、其他维度及总分均高于非重度OSA组（P均<0.01）。OSA-18问卷各个维度得分及总分在两组患儿间比较,差异无统计学意义（P均>0.05）。基于决策树构建的重度OSA患儿预测模型,对非重度OSA患儿预测精确率为90%,召回率76%,F1得分82%,对重度OSA患儿的预测精确率32%,召回率58%,F1得分41%,整体准确率为73%。 结论　该研究构建的重度OSA患儿临床预测模型整体准确率73%,有一定的预测价值,能为临床排除重度OSA患儿提供一定的依据,指导临床决策,但仍需更多的临床资料进一步优化模型。