miR-4516在鼻咽癌中的表达及临床病理意义研究

［摘要］　目的　探讨miR-4516在鼻咽癌中的表达及临床病理意义。方法　回顾性分析2010年2月至2016年10月广西壮族自治区人民医院收治的60例鼻咽部EB病毒相关性非角化性癌患者（鼻咽癌组）的临床病理资料,另选择同期15例鼻咽黏膜慢性炎患者作为对照组。采用实时荧光定量聚合酶链式反应（RT-PCR）法检测两组病变黏膜组织miR-4516的表达水平并进行比较。分析miR-4516表达水平与鼻咽癌患者临床病理特征及生存预后的关联性。采用受试者工作特征（ROC）曲线分析miR-4516对诊断鼻咽癌转移的效能。结果　鼻咽癌组miR-4516表达水平高于对照组,差异有统计学意义（Z=4.477,P<0.001）。对于发生转移的鼻咽癌患者,其病变组织miR-4516表达水平高于未发生转移者,差异有统计学意义（P<0.05）。miR-4516表达水平与患者性别、年龄、肿瘤部位、T分期、临床分期均无显著关联（P>0.05）。ROC曲线分析结果显示,miR-4516可用于鼻咽癌转移的诊断［AUC(95%CI)=0.696(0.541～0.851),P=0.037］,最佳截断值为6.28,其对应的灵敏度和特异度分别为0.63、0.75。miR-4516低表达组的生存预后显著优于miR-4516高表达组（log-rank检验： χ²=4.230,P=0.040）。结论　鼻咽癌组织miR-4516表达水平上调,可作为预测鼻咽癌转移和临床预后评估的分子标志物。     

乳腺癌新辅助化疗疗效的相关影响因素研究

［摘要］　目的　探讨影响乳腺癌新辅助化疗疗效的影响因素,为提高新辅助化疗疗效提供参考依据。方法　回顾性分析2014-04～2018-10于该院行新辅助化疗的78例女性乳腺癌患者的临床资料。以获得病理完全缓解（pCR）情况分为pCR组（n=13）和非pCR组（n=65）;以临床有效获得情况分为CR+PR组（n=49）和非CR+PR组（n=29）,采用Logistic回归分析患者新辅助化疗获得pCR及临床有效的影响因素。结果　78例患者中,pCR的患者13例,pCR率为16.7%;临床有效49例,临床有效率为62.8%。pCR组在肿瘤直径≤5 cm、Ki-67>30%和非Luminal型的人数比例大于非pCR组,差异有统计学意义（P<0.05）。Logistic回归分析结果显示,肿瘤直径>5 cm、淋巴结状况为阳性者是患者获得pCR的不利因素,而非Luminal型是患者更易获得pCR的积极因素（P<0.05）。另外,CR+PR组在化疗周期≥6、Ki-67>30%和非Luminal型的人数比例大于非CR+PR组,差异有统计学意义（P<0.05）;且两组在化疗方案的比较差异有统计学意义（P<0.05）。Logistic回归分析未发现患者获得临床有效的影响因素。结论　分子分型、肿瘤直径大小以及淋巴结情况是影响患者新辅助化疗后获得pCR的影响因素,在治疗前应对这些指标进行评估。选用含紫杉类化疗方案、化疗周期长（6个周期及以上）及Ki-67表达>30%的患者更易达到临床有效。     

不同中医体质患者对插管全麻腹腔镜手术的反应差异比较

［摘要］　目的　比较不同中医体质患者对插管全麻腹腔镜手术的反应差异。方法　招募2019年1月至2022年9月于南宁市中医医院接受插管全麻腹腔镜腹部手术的患者119例。根据《中医体质分类与判定（ZYYXH/T157-2009）》将其分为平和质组（50例）、阳虚质组（36例）和气虚质组（33例）。比较三组麻醉诱导给药前5 min（T₁）、插管时（T₂）、插管完成后5 min（T₃）的平均动脉压、心率,麻醉维持期丙泊酚用量以及不良反应发生率。结果　在T₁～T₃时间点,三组平均动脉压和心率呈下降趋势。在T₂时间点,阳虚质组平均动脉压显著高于平和质组和气虚质组（P<0.05）;在T₁和T₃时间点,三组平均动脉压比较差异无统计学意义（P>0.05）。在T₁～T₃时间点,三组心率比较差异无统计学意义（P>0.05）。平和质组和阳虚质组的丙泊酚用量显著高于气虚质组（P<0.05）,但平和质组和阳虚质组比较差异无统计学意义（P=0.100）。气虚质组低血压发生率显著高于平和质组和阳虚质组（P<0.05）。平和质组恶心呕吐发生率显著低于阳虚质组和气虚质组（P<0.05）。三组心动过缓发生率比较差异无统计学意义（P>0.05）。结论　不同中医体质患者对插管全麻腹腔镜手术的反应存在差异,临床医师应对患者进行分类管理。     

血清TRAIL水平与晚期非小细胞肺癌患者免疫治疗反应的关联性研究

［摘要］　目的　探讨血清肿瘤坏死因子相关凋亡诱导配体（TRAIL）水平与晚期非小细胞肺癌（NSCLC）患者免疫治疗反应的关联性。方法　回顾性分析2019年1月至2020年5月唐山市人民医院收治的70例晚期NSCLC患者的临床资料。在免疫治疗前24 h内采用酶联免疫吸附试验法（ELISA）测定患者血清TRAIL水平。免疫治疗反应通过客观缓解率（ORR）和临床获益率（CBR）进行评估。分析患者血清TRAIL水平与免疫治疗反应、肺功能及肺气肿、临床预后的关联性。结果　经免疫治疗后,NSCLC患者获得客观缓解23例,临床获益46例。获得客观缓解患者的血清TRAIL水平显著高于未获得客观缓解者［27.77（23.13,39.13）pg/mL vs 12.36（8.76,18.15）pg/mL;Z=4.508,P<0.001］。临床获益患者的血清TRAIL水平显著高于临床未获益者［23.13（16.99,30.63）pg/mL vs 11.75（8.76,15.56）pg/mL;Z=4.887,P<0.001］。Spearman秩相关性分析结果显示,血清TRAIL水平与1秒用力呼气容积/用力肺活量（FEV₁/FVC）呈正相关（r_s=0.288,P=0.016）,与肺气肿总比值（r_s=-0.257,P=0.032）、肺叶肺气肿比率（LER）（r_s=-0.324,P=0.006）呈负相关。多因素logistic回归分析结果显示,以血清TRAIL>27.46 pg/mL为参考,血清TRAIL<18.15 pg/mL患者经免疫治疗不能获得客观缓解和临床获益的风险显著增加（P<0.05）。ROC曲线分析结果显示,血清TRAIL水平可有效预测NSCLC患者对免疫治疗的反应（P<0.05）。TRAIL高水平组（血清TRAIL≥18.15 pg/mL）的总体生存（OS）、无进展生存（PFS）预后显著优于TRAIL低水平组（血清TRAIL<18.15 pg/mL）（P<0.05）。结论　血清TRAIL低水平与晚期NSCLC患者免疫治疗无反应以及临床预后不良有关,该指标监测有助于筛选能从免疫治疗中获益的NSCLC患者。     

肿块强化与非肿块强化乳腺癌患者的临床和病理特征对比分析

［摘要］　目的　对比分析肿块强化与非肿块强化乳腺癌患者的临床和病理特征。方法　回顾性收集解放军总医院第一医学中心2019年1月至2019年12月收治的浸润性乳腺癌患者76例。根据乳腺动态增强MRI检查结果,将其分为肿块强化组(57例)和非肿块强化组(19例)。比较两组患者临床特征和病理特征。结果　与肿块强化组比较,非肿块强化组病灶表观扩散系数（ADC）值增高［(0.95±0.19） vs （0.85±0.17）,P=0.034］,病变边界清晰率下降(15.79% vs 63.16%,P=0.000),人表皮生长因子受体-2（HER-2）阴性表达率显著降低(0.00% vs 26.32%,P=0.013)。两组患者MRI早期强化率、增强平台、病灶大小、雌激素受体（ER）、孕激素受体（PR）、细胞增殖抗原（Ki-67）、腋窝淋巴结转移率、腋窝淋巴结转移数、锁骨上淋巴结转移率、侵及皮肤或胸壁率、病理类型、淋巴细胞浸润率比较差异无统计学意义(P>0.05)。结论　非肿块强化的浸润性乳腺癌患者HER-2阴性表达率更低,且病灶ADC值更高,肿块边界不清晰概率更大,可能与患者预后不良有关。     

穴位埋线治疗失眠症30例临床观察

［摘要］　目的　观察穴位埋线治疗失眠症的临床疗效。方法　将60例失眠患者按就诊顺序半随机分为两组,治疗组（n=30）给予穴位埋线治疗,对照组（n=30）给予阿普唑仑治疗。比较两组睡眠改善情况。结果　治疗组治愈18例,好转9例,未愈3例。对照组治愈13例,好转7例,未愈10例。两组疗效比较差异有统计学意义（P<0.05）。结论　穴位埋线治疗失眠症疗效良好,复发率低,值得临床推广。     

血清lncRNA-ENST00000414355与原发性高血压病的关联性研究

［摘要］　目的　探讨血清lncRNA-ENST00000414355与原发性高血压病的关联性。方法　选择2019年7月至2019年11月深圳市福田区第二人民医院收治的原发性高血压患者360例（观察组）,按照1∶1配对原则选择同期于深圳市福田区第二人民医院接受体检的健康者360名（对照组）。应用实时定量逆转录聚合酶链反应（RT-qPCR）法检测研究对象血清lncRNA-ENST00000414355的表达水平。比较两组的临床资料,分析lncRNA-ENST00000414355水平与原发性高血压病的关联性。结果　两组饮酒、定期锻炼、糖尿病史情况,以及空腹血糖、甘油三酯（TG）、高密度脂蛋白（HDL）水平比较差异无统计学意义（P>0.05）。观察组吸烟人数比例,以及体质量指数（BMI）、总胆固醇（TC）、低密度脂蛋白（LDL）、lncRNA-ENST00000414355水平均高于对照组,差异有统计学意义（P<0.05）。logistic回归分析结果显示,有吸烟行为（OR=2.231）、较高水平的BMI（OR=1.994）、TC（OR=1.278）和lncRNA-ENST00000414355（OR=2.057）是促进原发性高血压发生的危险因素（P<0.05）。Pearson相关分析结果显示,血清lncRNA-ENST00000414355水平与收缩压、舒张压、BMI、TC及LDL呈正相关（P<0.05）。结论　原发性高血压患者血清lncRNA-ENST00000414355呈高表达,并与血压和血脂呈正相关性。lncRNA-ENST00000414355具有作为原发性高血压病标志物的应用前景。     

直肠癌患者外周血循环肿瘤细胞围手术期变化及临床意义

［摘要］　目的　探讨直肠癌患者围手术期外周血循环肿瘤细胞（CTCs）的变化情况及其对患者预后的影响。方法　选择2015-09～2016-12广西壮族自治区人民医院胃肠外科收治的直肠癌患者30例,采用随机数字表法将其分为腹腔镜手术组和开腹手术组,每组15例。采用CanpatrolTM 2代技术对患者手术前后的外周血CTCs进行分型检测。术后随访22～33个月,分析两组患者手术前后的CTCs水平变化,术前各分型CTCs与疾病特征的关联性以及手术前后CTCs对患者预后的影响。结果　腹腔镜手术组术后总CTCs水平较术前显著降低（P<0.05）。腹腔镜手术组术前混合型CTCs水平显著高于开腹手术组（P<0.05）,但术后两组差异无统计学意义（P>0.05）。两组手术前后间质型CTCs和上皮型CTCs水平比较差异均无统计学意义（P>0.05）,且同组手术前后比较差异亦无统计学意义（P>0.05）。间质型阴性组肿瘤直径≤3 cm的人数比例显著高于间质型阳性组（P<0.05）。术前总CTCs、混合型CTCs、上皮型CTCs情况与患者年龄、性别、T分期、N分期及肿瘤直径的关联性不显著（P>0.05）。3例术后CTCs阴性者在随访过程中均未发生死亡;27例术后CTCs 阳性者在随访过程中出现死亡4例,术后CTCs阴性者的生存情况显著优于阳性者（log-rank检验： χ²=6.553,P=0.031）。2例术前CTCs阴性者在随访过程中均未死亡,28例术前CTCs阳性者在随访过程中出现死亡4例,术前CTCs阴性者的生存情况显著优于阳性者（log-rank检验： χ²=5.245,P=0.027）。结论　外周血CTCs可用于直肠癌患者预后评价,指导临床治疗。     

TP与IP化疗方案治疗非小细胞肺癌效果比较

［摘要］　目的　探讨TP方案与IP方案在非小细胞肺癌治疗中的应用效果。方法　将136例非小细胞肺癌患者采用随机数字表法分为TP组68例和IP组68例,TP组予紫杉醇+顺铂治疗,IP组予伊立替康+顺铂治疗,21 d为1个周期,治疗3个周期。结果　TP组完全缓解（CR）16例,部分缓解（PR）15例,稳定（SD）22例,进展（PD）15例,IP组依次为17、13、25、13例,两组临床疗效比较差异无统计学意义（P>0.05）;TP组和IP组的不良反应主要为血液系统毒性,两组比较差异无统计学意义（P>0.05）。结论　TP方案与IP方案治疗非小细胞肺癌临床疗效确切,有效率和安全性均较好,无明显差异,应根据患者特点个体化选择化疗方案。     

急诊介入与择期介入对左室急性心肌梗死治疗的影响分析

［摘要］　目的　探讨急诊介入与择期介入对左室急性心肌梗死治疗的影响。方法　选取86例左室急性心肌梗死患者,根据患者出现相应临床症状到行经皮冠脉介入治疗（PCI）的时间分为急诊组（n=29）、延迟1组（n=27）及延迟2组（n=30）,测定住院期间及治疗后6个月的左室射血分数（LVEF）及左室舒张末期内径（LVEDD）。结果　急诊及延迟1组LVEF及LVEDD改善明显,差异有统计学意义（P<0.05）,而延迟2组改善无明显差异。结论　左室急性心肌梗死的急诊介入及2周前延迟介入对心脏功能均有所改善。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.