原发性肝癌的特异性生物学标志物的分析

目的探讨肝癌特异性甲胎蛋白（HS-AFP）、甲胎蛋白（AFP）和γ-谷氨酰转肽酶同工酶Ⅱ（GGT-Ⅱ）对肝硬化患者肝癌发生风险的预警价值。方法对452例肝硬化患者进行跟踪随访15个月,了解肝癌发生情况,分析比较HS-AFP、GGT-Ⅱ和AFP预测肝硬化患者发生肝癌风险的价值。结果 HS-AFP、GGT-Ⅱ阳性组癌变率高于AFP阳性组,但前两者差异不明显;HS-AFP与GGT-Ⅱ及AFP之间存在互补性,其中HS-AFP和GGT-Ⅱ联合检测预测肝硬化癌变的敏感性、特异性和准确度分别达73.2%、93.1%、92.3%。结论 HS-AFP、GGT-Ⅱ和AFP对肝硬化癌变均有预测价值;HS-AFP和GGT-Ⅱ预测肝癌的特异性、准确度优于AFP;HS-AFP与GGT-Ⅱ预测肝癌的特异性、准确度相似;多项指标联合检测可提高预测肝硬化癌变的敏感性、特异性和准确度。     

肿瘤标志物联合检测诊断原发性肝癌的价值

目的 探究肿瘤标志物联合检测诊断原发性肝癌（PHC）的价值。方法 选择2018年4月至2020年6月于医院经病理检查诊断为PHC的70例患者作为PHC组,另选择同期于医院经病理检查明确为良性肝病的66例患者作为良性肝病组,抽取患者4 ml血液,测定肿瘤标志物[甲胎蛋白（AFP）、癌胚抗原（CEA）、糖类抗原199(CA199)、糖类抗原125(CA125)及糖类抗原153(CA153)]水平,比较两组AFP、CEA、CA199、CA125及CA153水平,并以病理结果作为诊断“金标准”,分析AFP、CEA、CA199、CA125及CA153单独及联合检测在PHC中的诊断价值,另计算上述肿瘤标志物单独及联合检测与病理结果的一致性。结果 相比于良性肝病组,PHC组AFP、CEA、CA199、CA125及CA153水平均较高,有统计学差异（P<0.05）;相比于肿瘤标志物单独检测,肿瘤标志物联合检测在PHC诊断中的灵敏度、准确度、阳性预测值及阴性预测值均较高,有统计学差异（P<0.05）;AFP单独检测诊断PHC结果与病理检查结果的一致性尚可（Kappa=0.457,P=0.00...     

血清AFP和AFU联合检测对原发性肝癌诊断的临床意义

目的：探讨血清甲胎蛋白AFP,a-L-岩藻糖苷酶（AFU）联合检测对原发性肝癌诊断的临床价值。方法：正常健康对照组98例,原发性肝癌组67例,肝硬化组54例,均同时检测血清AFP,AFU.结果：原发性肝癌组、肝硬化组、正常健康对照组AFP AFU值比较差异有统计学意义P〈0.01.原发性肝癌组血清AFP、AFU单项检测的敏感性为68.6%86.6%联合检测的AFP、AFU的敏感性为92.5.0%。结论：联合检测AFP、AFU可以提高原发性肝癌,尤其是AFP阴性的原发性肝癌的诊断率。     

多项肿瘤标志物联合检测在肝癌中的诊断效能

目的 探究多项肿瘤标志物联合检测在肝癌中的诊断效能.方法 选择2017年5月至2019年12月经医院临床及病理学诊断为肝癌的73例患者作为试验组,另选取同期医院收治的明确为良性肝病的65例患者作为对照组,采集两组静脉血进行检测,并比较两组各肿瘤标志物[甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原199(CA199)...     

AFP、AFU、GGT、FER联合检测对原发性肝癌的鉴别诊断

目的探讨甲胎蛋白（AFP）、α—L-岩藻糖苷酶（AFU）、γ-谷氨酰转移酶（GGT）、血清铁蛋白（Ferritin,FER）对原发性肝癌（PHC）与肝良性肿瘤的鉴别诊断价值。方法对54例原发性肝癌、48例肝良性肿瘤和52例健康对照者,用电化学发光免疫分析法测定血清AFP和FER浓度;用化学发光检测技术测定血清AFU和GGT。结果PHC组血清AFP、AFU、GGT和FER水平与肝良性肿瘤组及正常对照组比较,差异均有显著性（P〈0．05）;AFP、AFU、GGT和FER联合检测PHC敏感度和特异性增高,检测阳性率达94．4％与四项单独检测阳性率比较,差异均有显著性（P〈0．05）。结论AFP、AFU、GGT、FER联合检测能提高PHC的诊断阳性率,在临床应用中可以采用联合检测作为PHC鉴别诊断指标。     

血清AKP、γ-GT、甲胎蛋白在原发性肝癌患者介入治疗前后的变化及意义

目的 探讨血清碱性磷酸酶(AKP)、γ-谷氨酰转肽酶(γ-GT)、甲胎蛋白在原发性肝癌患者介入治疗前后的变化及意义.方法 选取2017年8月至2018年6月在本院就诊的原发性肝癌患者56例.行肝动脉化疗栓塞术治疗,分别于治疗前和治疗后28 d行增强CT检测,根据实体肿瘤临床疗效评价指标(RECIST1.1)评估治疗效果...     

联合检测肿瘤标志物在妇科疾病诊断中的应用价值

目的:探讨糖类抗原(CA12-5)、糖类抗原(CA19-9)、癌胚抗原(CEA)、甲胎蛋白(AFP)、糖类抗原(CA15-3)5种肿瘤标志物联合检测在妇科肿瘤中应用价值。方法:用罗氏E1010电化学发光免疫分析仪联合检测240例妇科疾病患者肿瘤标志物。结果:妇科恶性肿瘤患者共29例,肿瘤标志物阳性结果仅10例占34.5,存在阳性率较低的问题。结论:适当联合检测肿瘤标志物对提高所观察恶性肿瘤的阳性率有一定价值,各肿瘤标志物间有明显的互补性,但无明显组织特异性,对妇科肿瘤的诊断具有一定参考意义。     

血清联合检测在肝癌中的诊断价值

目的探讨血清甲胎蛋白(AFP)、癌胚抗原(CEA)、肿瘤标志物(CA19-9)联合检测在肝癌中的诊断价值。方法 2008年1月-2009年1月住院的肝癌患者36例,另选30例肝硬化患者及同期在医院内体检的健康者32例作对照,检测3组的血清AFP、CEA、CA19-9水平。结果肝癌组AFP、CEA、CA19-9水平明显高于肝硬化组和对照组;肝癌组的联合检测阳性率为88.9%,明显高于肝硬化组的46.7%及对照组的6.3%,差异有统计学意义(P<0.05)。结论对肝癌患者进行血清AFP、CEA、CA19-9的联合检测,对于肝癌的早期诊断有重要的临床价值。     

甲胎蛋白异质体在原发性肝癌中的诊断价值

目的:探讨甲胎蛋白异质体在肝脏良恶性疾病诊断中的意义。方法:采用微量离心柱法对240例肝病患者(原发性肝癌70例,肝癌术后10例,肝硬化63例,慢性肝炎97例),采用化学发光法检测AFP及AFP-L3水平,计算AFP-L3和AFP比例。结果:原发性肝癌组患者血清中的AFP,AFP-L3%阳性率显著高于肝癌术后组,肝硬化组和慢性肝炎组。AFP-L3%的灵敏度为86.96%,特异性为88.30%,Youden指数为0.75。AFP的灵敏度为75.68%,特异性为85.54%,Youden指数为0.61。从Youden指数可以知道AFP-L3%是比AFP更好的诊断肝癌的指标。原发性肝癌组患者血清中的AFP、AFP-L3%含量显著高于肝癌术后组、肝硬化组和慢性肝炎组(F值分别为74.45、54.85,P值均<0.01)。诊断为原发性肝癌病人中,当AFP>400 ng/ml时,AFP-L3%的阳性率为95.23%。AFP-L3%与AFP水平无相关性。结论:AFP-L3%对于肝癌的诊断有较高的灵敏性和特异性;是比AFP更好的诊断指标;可以作为诊断肝癌的独立指标。     

联合检测四项指标对原发性肝癌的诊断价值

甲胎蛋白(AFP)是原发性肝癌(PHC)的重要标志物之一,但由于受肝细胞分化程度等因素的影响,阳性率仅为70％左右。α-L-岩藻糖甘酶(AFU)是PHC的另一个新的标志物,对PHC的诊断敏感性和特异性较高,而β_2-微球蛋白(β_2-m)、血清铁蛋白(SF)作为某些癌症的辅助诊断指标报道已很多。本文通过上述四项指标对52例PHC患者的联合检测分析,旨在寻找提高PHC诊断敏感性和特异性的新途径现报道如下。1 材料与方法1.1 对象 PHC组52例,男39例,女13例,年龄16～68岁。均为经临床表现,AFP定量、B超、CT证实已确诊的病例。肝炎,     

溴结构域蛋白4影响胃癌恶性生物学行为的机制研究

目的探讨溴结构域蛋白4(bromodomain-containing Protein4,BRD4)影响胃癌细胞恶性生物学行为的潜在分子机制。方法在胃癌细胞HGC27和AGS中使用BRD4抑制剂JQ1,通过免疫印迹实验(western blot,WB)检测BRD4及c-MYC的蛋白水平改变,采用细胞活性测定(CCK-8)实验检测细胞增殖情况。运用shRNA构建BRD4敲减的稳定胃癌细胞HGC27和AGS,通过Western Blot验证BRD4的敲减效率,采用流式细胞术检测细胞凋亡,采用Transwell实验分析侵袭转移等恶性生物学行为。结果在胃癌细胞HGC27和AGS中,BRD4抑制剂JQ1可显著下调c-MYC的蛋白水平,且具有一定的浓度依赖性;JQ1分别与5-氟尿嘧啶(5-FU)、顺铂(cisplatin)、紫杉醇(paclitaxel)三种抗肿瘤化疗药物联合使用,明显抑制了胃癌细胞的增殖能力,且具有一定的时间、浓度依赖性。此外,敲减BRD4可促进胃癌细胞凋亡,抑制胃癌细胞的侵袭转移能力。结论BRD4在胃癌的增殖及侵袭转移等恶性进程中起到了重要的作用,有望成为胃癌临床治疗的潜在靶点。     

Nursing diagnoses in cardiac surgery patients

Exploratory and transversal research accomplished with postoperative patients outgoing coronary bypass. It was aimed at identifying nursing diagnoses according to Taxonomy II of NANDA and nursing interventions according to Nursing Interventions Classification, associating with the results of Nursing Outcomes Classification. The data were collected fom 22 patients using formularies and physical examination. The information made possible the identification of fifteen nursing diagnosis, according to Taxonomy II of NANDA. Among them, stand out: risk of infection; Risk of constipation; Deficit in self-care intimate hygiene and integrity of harmed skin. The study revealed being fundamental to develop studies about nursing diagnoses to direct analyses of problems that concern to the demanding patients of specific nursing actions, that contribute to the devepoment of the profession.     

Accuracy of syndrome definitions based on diagnoses in physician claims

Background  

Community clinics offer potential for timelier outbreak detection and monitoring than emergency departments. However, the accuracy of syndrome definitions used in surveillance has never been evaluated in community settings. This study's objective was to assess the accuracy of syndrome definitions based on diagnostic codes in physician claims for identifying 5 syndromes (fever, gastrointestinal, neurological, rash, and respiratory including influenza-like illness) in community clinics.     

B超诊断技术行卵泡监测方法最优化研究

目的:分析经阴道超声和经腹部超声进行卵泡监测的共性及差异,提高卵泡监测的准确性。方法:对100例不孕症患者分别行经阴道超声、经腹部超声检查的结果进行回顾性分析。结果:在卵泡监测中,经阴道超声的图像分辨率、诊断精确度均明显优于经腹部超声,尤其在排卵前监测时,两者具有显著的差异性。结论:经阴道超声在卵泡监测中的价值明显优于经腹部超声,对指导妇科医师治疗不孕症具有重要意义。     

Validity of diagnoses of major coronary events in national registers of hospital diagnoses and deaths in Finland

We validated diagnoses of acute myocardial infarction (AMI) and death from coronary heart disease (CHD) found in the Finnish National Hospital Discharge Register and the Register of Causes of Death from a sample of the 29,133 men participating in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. The cases were traced to hospitals and institutes performing medico-legal death cause examinations and all relevant information was collected. The cardiac events were re-evaluated according to the diagnostic criteria of the Finnish contribution to the WHO MONICA project, i.e. the FINMONICA criteria. Altogether 408 cases of non-fatal AMI (n = 217) and death from CHD (n = 191) were reviewed. In the re-evaluation 94% of them (95% confidence interval 92--96%) were diagnosed as either definite (57%) or possible (37%) AMI. Non-fatal cases were more often classified definite AMI in the review, whereas fatal cases were more often classified possible AMI. Age or trial supplementation group did not affect classification, and no secular trend was observed. In conclusion, the diagnoses of AMI and death from CHD in the registers were highly predictive of a true major coronary event defined by strict criteria, thus their use in endpoint assessment in epidemiological studies and clinical trials is justified.     

Improving risk equalization using information on physiotherapy diagnoses

Background

Worldwide, risk-equalization (RE) models in competitive health insurance markets have evolved from simple demographic models to sophisticated models containing diagnosis and pharmacy-based indicators of health. However, these models still have important imperfections; adding information on (diagnoses of) physiotherapy treatment may further improve RE-models. Therefore, a new risk-adjuster based on physiotherapy costs in the prior year was introduced in the Dutch RE-model of 2016.

Methods

Physiotherapy claims-data (2012) and administrative data on costs and risk-characteristics (2013) for 94% of the Dutch population (N = 15.8 million) are used to evaluate the current risk-adjuster based on physiotherapy costs and to assess the effects of replacing it by different modalities of a risk-adjuster based on physiotherapy diagnoses. Of the 89 diagnoses in the claims-data, 62 are dropped because they relate to temporary health problems. The 27 retained diagnoses are added to the Dutch model in 4 modalities: 27 separate risk-classes, 9 diagnosis-clusters based on main pathology category, 4 diagnosis-clusters based on residual costs, and the 4 clusters of modality 3 interacted with age.

Results

Although the cost-based risk-adjuster improves the model’s predictive power and removes the average undercompensation (€919) for enrollees with physiotherapy costs in the prior year, it is outperformed by all 4 diagnosis-based modalities. Of these modalities, modality 3 is preferred based on its simplicity and comparable predictive power.

Conclusions

Adding information on physiotherapy can further improve the performance of sophisticated RE-models. Regarding the Dutch model, a risk-adjuster containing 4 risk-classes for clustered diagnoses based on residual costs is the preferred modality.