乙型肝炎病毒相关性肝细胞癌预测模型的优化北大核心CSCD

目的优化已建立的HBV相关性肝细胞癌（HCC）预测模型（REACH—B评分模型）。方法收集2004年10月1日至2014年5月1日于福建医科大学附属第一医院肝病中心初次入院、HBsAg阳性超过半年的患者,分为HCC组和对照组（非HCC组）,回顾性收集相关指标,进行评分评估。用受试者工作特征曲线判断各模型预测价值。结果预测3年HBV相关性HCC发生,共纳入627例患者,其中HCC组151例,对照组476例。REACHB评分模型预测3年HCC发生的曲线下面积（Auc）为0．78（95％CI：0．74～0．82）,敏感度为73．00％,特异度为78．70％。联合甲胎蛋白（AFP）建立R—AFP评分模型,对3年HCC发生的AUC升至0．80（95％CI：0．76～0．83,Z=2．50,P=0．01）,敏感度为71．03％,特异度为79．13％。联合甲胎蛋白异质体3与AFP之比（AFP—L3％）建立R—AFP—L3％评分模型,对3年HCC发生的AUC进一步升至0．83（95％CI：0．80～0．87,Z=2．45,P=0．01）,敏感度为75．01％,特异度为79．32％。预测5年HBV相关性HCC发生,共纳人159例患者,其中HCC组65例,对照组94例。REACH—B评分模型预测5年HCC发生的AUC为0．79（95％CI：0．72～0．87）,敏感度为73．60％,特异度为75．43％。R-AFP评分模型对5年HCC发生的预测价值AUC升至0．84（95％CI：0．77～0．90,Z=2．70,P=0．006）,敏感度为83．12％,特异度为77．89％。结论联合AFP及AFP—L3％能优化REACHB评分模型对3年和5年HBV相关性HCC发生的预测价值。     

血小板相关指标及Gensini评分在PCI术后预后评估中的作用

目的探讨在行经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者中应用血小板相关指标及Gensini评分进行预后评估的价值。方法选取2016年6月至2020年6月于安徽医科大学附属巢湖医院全科医学科及心内科住院的103例STEMI患者,收集患者PCI术前临床资料、血小板相关指标及Gensini评分等指标。结合患者术后半年是否发生心血管事件(MACE),分为MACE组(n=19)和非MACE组(n=84),比较并分析相关指标与患者6月内MACE发生的相关性。结果 19例患者(18.45%)发生MACE,与非MACE组患者相比,MACE组血小板(PLT)、血小板计数/淋巴细胞计数(PLR)、血小板分布宽度(PDW)、平均血小板体积(MPV)、Gensini评分差异均有统计学差异(P0.001)。受试者工作特征(ROC)曲线显示,当PLR临床分界点为131.8,敏感度为0.842,特异度为0.702,曲线下面积为0.825(95%CI:0.739～0.911,P0.001)。当PDW临床分界点为12.52,敏感度为0.842,特异度为0.798,曲线下面积为0.918(95%CI:0.858～0.977,P0.001)。当MPV临床分界点为12.51,敏感度为0.895,特异度为0.798,曲线下面积为0.823(95%CI:0.729～0.917,P0.001)。当Gensini评分临床分界点为83.50,敏感度为0.947,特异度为0.869,曲线下面积为0.963(95%CI:0.903～1.000,P0.001)。结论血小板相关指标及Gensini评分在预测STEMI患者PCI术后6月内发生MACE具有一定价值。     

多重定量抗体芯片检测系统在肝癌早期诊断中的应用

目的 利用多重定量抗体芯片同时检测肝细胞癌(HCC)及肝硬化患者血清中肿瘤相关血清学标志物的水平,建立HCC早期诊断模型,以提高HCC早期诊断的准确度.方法 运用双抗体夹心原理建立了相关指标的多重定量抗体芯片检测系统,8种肿瘤相关血清学标志物作为芯片检测目标:甲胎蛋白(AFP)和7种细胞因子包括肝细胞生长因子、胰岛素样生长因子、白细胞介素6、白细胞介素8、白细胞介素10、转化生长因子β1和血管内皮生长因子.应用该系统检测临床确诊的160例HCC和58例肝硬化(LC)患者血清,随机抽取其中60％为训练集(HCC 96人;LC36人),40％为测试集(HCC64人;LC 22人),通过对结果和临床资料进行回顾性研究,应用SPSS软件做logistic回归分析,利用训练集创建诊断模型,获得受试者工作曲线(ROC曲线下面积以及cut off值,并在测试集中验证模型的诊断价值.结果 AFP联合7种细胞因子在训练集中诊断的敏感度为93.3％,特异度为83.3％,准确度为90.9％；而在测试集中敏感度为89％,特异度为77.3％,准确度为86％；传统血清AFP值(cut off值为20 ng/ml)诊断的敏感度为70％,特异度为59％,准确度为64％. 结论 多重定量抗体芯片检测系统具有较高敏感度和特异度,AFP联合7种细胞因子诊断模型对肝癌早期诊断优于传统AFP,具有潜在的临床应用价值.     

血清甲胎蛋白、γ-谷氨酰基转肽酶Ⅱ、高尔基体蛋白73检测在原发性肝癌早期诊断中的价值

目的：探讨血清甲胎蛋白（AFP）、γ-谷氨酰转肽酶（GGT）Ⅱ、高尔基体蛋白73（GP73）对于原发性肝癌患者的早期诊断价值。方法抽取2013年2月至2014年2月在南通市第三人民医院进行治疗的100例肝病患者（50例肝炎及肝硬化患者为肝脏良性病变组,50例原发性肝癌患者为原发性肝癌组）和50例正常体检者血清,分别利用电化学发光法、特异免疫膜吸附法、酶联免疫吸附法检测血清中的 AFP、GGTⅡ、GP73水平。计量资料多组间比较采用方差分析,两两比较采用 q 检验;对单项及联合检测结果作图绘成受试者工作特征曲线（ROC 曲线）,计算曲线下面积（AUC）,观察 AFP、GGTⅡ、GP73单独和联合检测的 AUC、敏感度、特异度。结果血清 GGTⅡ水平在对照组或肝脏良性病变组、原发性肝癌组的两两比较中差异均有统计学意义（P 值均＜0．05）,但是对照组与肝脏良性病变组差异没有统计学意义（P 值均＞0．05）。AFP 和 GP73水平在原发性肝癌组、肝脏良性病变组,对照组的两两比较中差异均有统计学意义（P 值均＜0．05）。单独检测时 GP73的特异度为69％,敏感度为92％;GGTⅡ的特异度为64％,敏感度为84％;AFP 的特异度为51％,敏感度为76％。联合检测特异度为94．6％,敏感度为98．8％。结论单独检测时 GP73指标最好,3个指标联合检测,诊断原发性肝癌的特异度及灵敏度均提高。     

乙型肝炎病毒相关肝硬化患者肝细胞癌风险评分验证

目的评估肝细胞癌预测评分(PAGE-B)和改良肝细胞癌预测评分(mPAGE-B)预测经核苷(酸)类似物(NA)治疗的乙型肝炎病毒(HBV)相关肝硬化患者肝细胞癌发生风险的准确性和实用性。方法回顾性收集2009年6月至2014年12月于福建医科大学附属第一医院肝病中心经NA治疗的707例HBV相关肝硬化患者临床资料并对患者进行随访, 分析肝细胞癌发生的危险因素, 比较PAGE-B(纳入参数包括血小板计数、年龄、性别)、mPAGE-B(纳入参数包括血小板计数、年龄、性别、白蛋白)、Child-Turcotte-Pugh(CTP)评分和天冬氨酸转氨酶与血小板计数比值指数(APRI)预测5年内肝细胞癌发生的受试者操作特征曲线下面积(AUROC), 并对mPAGE-B和PAGE-B进行风险分层分析。采用多因素Cox回归分析、受试者操作特征曲线(ROC)、Mann-WhitneyU检验和Kaplan-Meier法进行统计学分析。结果 707例患者年龄为(46.7±12.2)岁, 其中男567例(80.2%)、女140例(19.8%);乙型肝炎e抗原阳性率为56.4%(399/707);PAGE-B...     

降钙素基因相关肽受体成分蛋白在肝细胞癌中的表达及其与预后的关系

目的 检测降钙素基因相关肽受体成分蛋白（CRCP）在肝细胞癌及癌旁组织中的表达水平，探究其与肝细胞癌临床病理和患者预后的相关性。方法 收集2003年6月—2009年9月在海军军医大学附属东方肝胆外科医院行手术切除治疗的79例肝细胞癌患者的肝癌组织及相应癌旁组织标本，制作组织芯片，免疫组化定量分析，提取蛋白进行Western Blot检测，比较CRCP在肝癌组织与癌旁组织中的表达差异。计数资料组间比较采用χ²检验，采用受试者工作特性曲线（ROC曲线）分析获得曲线下面积（AUC）,评估拟合优度，并使用Youden指数确定最佳截断值，利用Kaplan-Meier生存分析法分析CRCP表达与肝细胞癌预后的关系，两组间比较采用log-rank检验。结果 79例肝细胞癌患者中，男67例，女12例，年龄10～72岁；病理分级4级1例,3级61例,2级17例;20例合并门静脉癌栓；巴塞罗那分期0期5例,A期55例,B期11例,C期8例。免疫组化结果显示,75.9%的患者肝癌组织中CRCP表达水平明显低于癌旁组织。CRCP低表达肝细胞癌患者的CK19阳性、肿瘤包膜不完整、合并门静脉...     

三种评分方法在缺血性卒中合并心房颤动筛查中的应用

目的探讨心房颤动筛查评分(STAF)和包括左心房直径(L)、年龄(A)、卒中/短暂性脑缺血发作(D)、发病前1年吸烟(S)4个指标的LADS评分以及包括年龄、美国国立卫生研究院卒中量表(NIHSS)评分、左心房扩大及血管病因4个指标的ASAS评分3种方法在缺血性卒中合并心房颤动患者筛查中的临床应用价值。方法回顾性分析2016年4月至2017年4月于广州医科大学附属第二医院神经内科住院的急性缺血性卒中患者317例的临床及影像学资料,依据患者是否合并心房颤动分为房颤组(56例)和非房颤组(261例),收集患者的性别、年龄、既往史、NIHSS评分、超声心动图结果及脑血管评估情况等相关临床资料,对所有患者分别进行STAF、LADS和ASAS评分,绘制受试者工作特征曲线(ROC),计算曲线下面积并比较3种方法预测缺血性卒中合并心房颤动发生的敏感度、特异度以及准确度。结果房颤组与非房颤组患者比较,年龄[(69±11)岁比(62±12)岁]、NIHSS评分[(8.2±1.3)分比(4.4±0.3)分]、左心房内径[(42.3±6.8)mm比(31.7±2.5)mm]差异均有统计学意义(t值分别为2.99、3.38、6.32,均P0.01)。STAF评分诊断缺血性卒中合并心房颤动的曲线下面积为0.801,最佳截断点为STAF≥5分,敏感度为58.9%,特异度81.2%,准确度77.3%;LADS评分诊断缺血性卒中合并心房颤动的曲线下面积为0.846,最佳截断点为LADS≥4分,敏感度66.1%,特异度83.5%,准确度80.4%;ASAS预测值评分诊断缺血性卒中合并心房颤动的曲线下面积为0.835,最佳截断点为ASAS预测值≥0.09分,敏感度85.7%,特异度56.7%,准确度61.8%;3种评分方法敏感度、特异度及准确度差异均有统计学意义(χ2值分别为10.308、59.685、32.054,均P0.01)。结论 LADS≥4分在筛选急性缺血性卒中合并心房颤动中的准确度最高。     

预测慢性HBV感染发生HCC的评分系统是否适用于所有患者

我国台湾学者杨怀懿等关于慢性乙型肝炎病毒(HBV)感染肝细胞癌(HCC)发生风险预测评分系统的研究是一项非常有价值的研究。该评分系统的建立基于REVEAL前瞻性研究数据库中年龄在30～65岁、中位随访时间12年的3584例HBsAg阳性患者(预测组,其中131例发展为HCC)。验证组选自我国香港和韩国3家医院的1505例患者,平均随访时间     

超声测量心外膜脂肪组织厚度与冠心病的相关性研究

目的 评价心外膜脂肪组织厚度(EAT)与冠心病(CHD)的相关性及其诊断预测价值.方法 共298例符合入选标准的对象行冠状动脉造影,符合CHD诊断标准的200例为CHD组,余98例为对照组,通过经胸彩色多普勒超声心动图测量EAT,用SPSS 17.0软件进行数据分析,比较两组EAT差异.结果 CHD组EAT大于对照组[(5.44±1.50)mm比(4.52±1.31)mm,P＜0.01];EAT与CHD呈正相关(OR=1.598);EAT诊断CHD的受试者工作特征曲线下面积:男性为0.67,诊断敏感度59％,特异度82％,诊断切点值为5.06 mm;女性为0.71,诊断敏感度58％,特异度72％,诊断切点值为4.88 mm.结论 EAT是CHD的一个独立危险因素,经胸彩色多普勒超声心动图测量EAT可以作为CHD预测评估的一个有效指标.     

PIVKA-Ⅱ联合AFP对原发性肝癌的诊断价值

目的研究PIVKA-Ⅱ联合AFP检测对原发性肝癌的诊断价值。方法收集我院2012年2月至2014年2月原发性肝癌住院患者血清80例,非原发性肝癌住院患者血清180例,健康人群血清40例,利用全自动免疫分析仪检测血清中PIVKA-Ⅱ及AFP表达水平。结果比较血清PIVKA-Ⅱ及AFP水平,原发性肝癌患者较非原发性肝癌患者及健康人群表达显著升高(P0.01)。利用PIVKA-Ⅱ指标单独诊断原发性肝癌的检测结果敏感度为71.25%,特异度为90.00%;AFP检测结果敏感度为60.00%,特异度为82.73%;PIVKA-Ⅱ检测结果的敏感度和特异度明显优于AFP检测结果;ROC曲线分析也显示PIVKA-Ⅱ曲线下面积为0.879,AFP曲线下面积为0.783,PIVKA-Ⅱ更具有诊断价值。联合诊断方案1可将原发性肝癌诊断特异度显著提高至98.64%,联合诊断方案2可将原发性肝癌诊断敏感度显著提高至82.50%。结论 PIVKA-Ⅱ血清学检测结果在原发性肝癌较AFP检测结果更具有诊断价值,同时PIVKA-Ⅱ联合AFP检测可显著提高原发性肝癌诊断的敏感度与特异度。     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

Use of fab fragments of digoxin-specific antibodies in the therapy of massive digoxin poisoning

A case of massive digoxin ingestion with multiple arrhythmias, consisting of high grade A-V block and ventricular ectopy not responsive to lidocaine, is described. The arrhythmias ceased following administration of digoxin-specific Fab fragments. The patient improved and was transferred to the psychiatric unit.     

Comparison of intravenous and oral routes of theophylline loading in acute asthma

In a prospective, randomized clinical trial, 19 patients with an acute exacerbation of asthma were given a loading dose of aminophylline by the IV (n = 10) or oral route (n = 9) of administration following treatment with epinephrine. Plasma concentrations of theophylline were measured prior to giving the loading dose, and one, two, three, and 24 to 48 hours later. Therapeutic effectiveness was evaluated by analyzing spirometric measurements prior to giving the loading dose, and one, three, and 24 to 48 hours later. Side effects also were recorded. In the IV group, the mean peak plasma theophylline concentration was 15.1 micrograms/mL one hour after loading, and in the oral group the mean peak serum theophylline concentration was 14.2 micrograms/mL three hours after loading. There was no correlation between theophylline concentrations and normalized change in spirometric values. There was no significant difference in spirometric values between the IV and oral groups. Nausea was slightly more common in the IV group. We conclude that there is no therapeutic advantage to giving a loading dose of aminophylline by the IV route rather than orally in patients with mild-to-moderate exacerbation of asthma initially treated with epinephrine.     

Application of Granular Biocomposites Based on Homogenised Peat for Absorption of Oil Products

Among the various methods for collecting oil spills and oil products, including from the water surface, one of the most effective is the use of sorbents. In this work, three-component bio-based composite granular adsorbents were produced and studied for oil products’ pollution collection. A bio-based binder made of peat, devulcanised crumb rubber from used tyres, and part fly ash as cenospheres were used for absorbent production. The structure, surface morphology, porosity, mechanical properties, and sorption kinetics of the obtained samples were studied. Composite hydrophobicity and sorption capacity to oil products, such as diesel fuel (DF) and motor oil (MO), were determined. The obtained pellets are characterised by a sufficiently pronounced ability to absorb oil products such as DF. As the amount of CR in the granules increases, the diesel absorption capacity increases significantly. The case of 30-70-0 is almost three times higher than the granules from homogenised peat. The increase in q is due to two factors: the pronounced surface hydrophobicity of the samples (Θ = 152°) and a heterogeneous porous granule structure. The presence of the cenosphere in the biocomposite reduces its surface hydrophobicity while increasing the diesel absorption capacity. Relatively rapid realisation of the maximum saturation by the MO was noted. In common, the designed absorbent shows up to 0.7 g·g⁻¹ sorption capacity for MO and up to 1.55 g·g⁻¹ sorption capacity for diesel. A possible mechanism of DF absorption and the limiting stages of the process approximated for different kinetic models are discussed. The Weber–Morris diffusion model is used to primarily distinguish the limiting effect of the external and internal diffusion of the adsorbate on the absorption process.     

Role of microRNA in regulation of myeloma-related angiogenesis and survival

Multiple myeloma (MM) is a malignant disease caused by clonal proliferation of plasma cells that result in monoclonal gammopathy and severe end organ damage. Despite the uniform clinical signs, the disease is very diverse in terms of the nature and sequence of the underlying molecular events. Multiple cellular processes are involved in helping the malignant cells to remain viable and maintain proliferative properties in the hypoxic microenvironment of the bone marrow. Specifically, the process of angiogenesis, triggered by the interactions between the malignant MM cells and the stroma cells around them, was found to be critical for MM progression. In this review we highlight the current understanding about the epigenetic regulation of the proliferation and apoptosis of MM cells and its dependency on angiogenesis in the bone marrow that is carried out by different microRNAs.     

RNA-Seq在老年神经退行性疾病研究中的应用

阿尔茨海默病及帕金森病是老年人最常见的两种神经退行性疾病,但其发病机制及治疗是研究的热点。随着高通量测序技术的进步及成本的下降,RNA-Seq也成为神经退行性疾病机制研究及生物标志物发现的有力手段。RNA-Seq相对于microarray具有高灵敏度、高准确性、高重复性以及噪声低等优势,在阿尔茨海默病及帕金森病研究中有较为广泛的应用,包括检测差异表达基因,可变剪接、新长链非编码RNA预测分析和miRNAs调控等,但是容易受病理复杂性及样本等因素影响。目前阿尔茨海默病及帕金森病转录组研究相比于癌症等还不够深入,在临床诊断及治疗应用还面临较大挑战。但是随着新技术及新方法的发展,RNA-Seq将进一步推动神经退行性相关疾病的研究和临床转化。     

安徽巢湖市丝虫病控制、消除历程和监测报告

【摘要】 目的  回顾并总结巢湖市丝虫病的流行、控制,以及消除丝虫病的历程。 方法  统计分析1970~1989年在该市采取以消灭传染源、切断传播途径为主的防治策略,以及展开大规模防治的各个阶段。 结果  1989年,采用分层整群抽样调查方法调查,微丝蚴率下降至0.032%,以行政村为单位,微丝蚴率已控制在1.0%以下,达到卫生部规定的基本消灭丝虫病标准;1991年,经省级调查考核,认定全市已达到卫生部规定的基本消灭丝虫病标准。1996年,省级审评确认已达到卫生部颁布的消灭丝虫病标准。经过10年的监测和跟踪治疗,到2005年,全市丝虫病病原学监测未查见微丝蚴阳性者,解剖镜检人房内淡色库蚊1 348只,蚊体内均未查见人体幼丝虫。 结论  巢湖市达到了消除丝虫病的标准。     

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation

The role of the external and internal anal sphincters in the mechanism of anal continence is presented. The external sphincter induces continence by 1) preventing internal sphincter relaxation, what I have called the “voluntary inhibition action,” and 2) mechanical compression of the rectal neck and anal canal proper. The mechanism of both actions is described. The internal sphincter plays a significant role not only in involuntary, but also in voluntary, continence. The importance of this role in the correction of anal incontinence is clarified. “Stress defecation,” a condition which follows internal sphincter damage, is discussed. A “single loop continence” theory is presented, based on the fact that each of the three loops of the external sphincter has its own innervation, attachment, and direction of muscle bundles; each loop thus acts as a separate sphincter. The clinical application of this theory is presented.