巨噬细胞移动抑制因子在银屑病关节炎疾病活动中的作用研究

目的：探讨巨噬细胞移动抑制因子（MIF）在银屑病关节炎（PsA）中的表达及其与PsA疾病活动度的相关性。方法：纳入40例PsA患者为PsA组,按照DAS28评分≤2.6分为PsA静止组,DAS28评分> 2.6分为PsA疾病活动组;同时招募年龄、性别匹配的健康体检者20例为健康对照组。采用ELISA法检测研究对象血清MIF、肿瘤坏死因子-α(TNF-α)、红细胞沉降率（ESR）、C反应蛋白（CRP）水平,比较PsA组与健康对照组、PsA疾病活动组与PsA静止组之间实验室指标的差异。结果：PsA组患者血清MIF水平显著高于健康对照组（P <0.05）,PsA疾病活动组患者血清MIF水平显著高于PsA静止组（P <0.05）。PsA组患者外周血TNF-α、ESR、CRP水平显著高于健康对照组（P <0.05）,PsA疾病活动组患者外周血TNF-α、ESR、CRP水平均高于PsA静止组（P <0.05）。MIF水平分别与TNF-α、ESR、CRP水平呈正相关（r=0.476,P=0.002;r=0.465,P=0.003;r=0.418,P=0.007）。结论：...     

多种肿瘤标志物联合检测对肝门胆管癌诊断的意义

目的:探讨联合检测肿瘤标志物CA50,CA125,CA242,CA19-9及CEA对肝门胆管癌诊断的意义.方法:选择近2年间住院且术后病理证实为肝门胆管癌患者90例作为观察组,同期胆道良性病变患者91例作为对照组,采用全自动电化学发光分析仪测定两组患者术前血清中CA50,CA125,CA242,CA19-9及CEA的水平.分别计算两组血清中5种肿瘤标志物的敏感性、特异性及准确性.结果:观察组血清CA50,CA242,CA19-9及CEA的水平明显高于对照组(均P＜0.01),而观察组血清CA125水平与对照组血清CA125水平比较无统计学差异(P＞0.05).血清CA19-9在肝门胆管癌中阳性率最高(86.67％),次为CA242( 63.33％)及CA50 (60％);两组患者血清中5种标志物的阳性率比较,除CA125外,各相应组间差异具有统计学意义(P＜0.05).对于肝门胆管癌的诊断,血清CA19-9灵敏度最好(93.98％),而CEA的特异度最好(94.60％).结论:联合检测CA50,CA242,CA19-9和CEA有助于肝门胆管癌与胆道良性疾病鉴别.     

六种血清肿瘤标志物在胰腺癌临床诊断中的意义

目的：评价血清肿瘤标志物检测对胰腺癌的诊断及胰腺良恶性疾病的鉴别诊断的价值。方法：回顾性分析191例患者血清中CA19-9、CA242、CA125、CA50、癌胚抗原（CEA）及甲胎蛋白（AFP）水平,将胰腺癌与肝脏恶性肿瘤、胃肠道恶性肿瘤、胆道恶性肿瘤及其他良性疾病进行对比,分析其临床价值;同时与胰腺良性占位进行比较,分析肿瘤标志物在已明确的胰腺占位性病变中的鉴别诊断价值。绘制各肿瘤标志物的ROC曲线,计算曲线下面积（AUC）并进行分析处理。结果：6种肿瘤标志物中,CA19-9、CA50和CA242水平在胰腺癌组均高于胰腺良性疾病组、肝脏恶性肿瘤组、胃肠道恶性肿瘤组和其他良性疾病组,差异有统计学意义（P〈0.05）。胰腺癌组CA125、CEA水平亦高于胰腺良性疾病组（P〈0.05）。CA19-9的敏感性为79.49%,阴性似然比为0.28,其AUC为0.925。结论：CA19-9、CA50和CA242对胰腺与非胰腺疾病鉴别有意义;CA19-9对胰腺肿瘤良恶性鉴别的综合诊断能力较其他肿瘤标志物强,对胰腺恶性肿瘤与胆道恶性肿瘤鉴别能力较差。     

血液透析患者血清肿瘤标志物的检测及临床意义

目的：观察血液透析（血透）患者血清肿瘤标志物CEA、CA19-9、NSE、CA242、Ferritin、β-HCG、AFP、HGH、CA153、CA125、PSA、fPSA的临床意义。方法：选择143例维持性血透患者作为血透组、143例未行血透的尿毒症患者（CKD5期）作为非透析组,并选择429例健康人作为对照组。将血透组按血透维持时间分为两个亚组比较：A组,维持性透析时间超过3月;B组,维持性透析时间少于3月。结果：血透组和非透析组比较,Ferritin水平差异有统计学意义,其他各肿瘤标志物水平差异无统计学意义（P〉0.05）;血透组、非透析组与对照组比较肿瘤标志物Ferritin、CA19-9、CA125的水平差异有统计学意义（P〈0.05）;其他肿瘤标志物的差异无统计学意义（P〉0.05）。透析组的两个亚组肿瘤标志物水平差异无统计学意义。结论：尿毒症和血透患者肿瘤标志物Ferritin、CA19-9、CA125有不同程度的升高,血透不能清除肿瘤标志物。     

血清肿瘤标志物在胃癌术前评估的作用

目的探讨血清肿瘤标志物CA72-4、CEA、CA199和CA125对胃癌患者术前评估的价值。方法回顾性分析昆明医科大学第二附属医院胃肠外科2013年6月至2014年6月期间收治的70例胃癌手术患者术前血清肿瘤标志物CA72-4、CEA、CA199及CA125及其临床病理资料。结果血清CA72-4浓度与肿瘤直径、TNM分期、肿瘤浸润深度及淋巴转移数目有关(P0.05);CA199浓度与肿瘤直径、TNM分期及肿瘤浸润深度有关(P0.05);CEA和CA125浓度与肿瘤直径、TNM分期及远处转移有关(P0.05);上述4项指标均与患者年龄和性别无关(P0.05)。结论血清肿瘤标志物CA72-4、CEA、CA199及CA125对胃癌术前评估具有一定的临床价值。     

类风湿关节炎寒热证候与血清维生素D的关系

目的探讨类风湿关节炎(rheumatoid arthritis,RA)寒热证候与维生素D的关系。方法收集RA患者72例,其中热证42例,寒证30例。同期确诊为强直性脊柱炎(ankylosing spondylitis,AS)的患者30例,健康人40例。收集患者的血沉(ESR)、C反应蛋白(CRP)、血清维生素D浓度、疼痛视觉模拟评分(Visual analogue scale,VAS)、28个关节疾病活动度(DAS28)等资料,分析各指标在RA寒热证候中的差异。结果 RA中存在维生素D缺乏和不足的比例分别为45.8%和41.7%,其比例显著高于健康人(P0.01);RA组维生素D水平低于AS组和健康组(P0.01);RA热证组维生素D水平低于寒证组(P0.01);RA维生素D水平与RA病程、CRP、DAS28评分、RF、抗CCP之间无明显相关性(P0.05)。结论 RA患者普遍存在维生素D的不足或缺乏,其浓度与RA寒热证候有关,RA热证组维生素D水平低于寒证组,提示维生素D浓度降低是RA热证的客观表现。     

腹腔镜下远端早期胃癌根治术后血清肿瘤标志物及炎性因子指标水平变化的研究

目的 分析腹腔镜下远端早期胃癌根治术后患者肿瘤标志物及炎性因子水平变化情况。方法 回顾性分析2018年6月至2022年6月平湖市第一人民医院和嘉兴市第二医院收治的早期胃患者共64例，研究人员按照患者接受治疗方法不同，将64例患者分为两组，其中观察组36例，行腹腔镜根治术治疗，对照组28例，行开腹手术治疗。结果 观察组的围手术期相关资料明显优于对照组（P<0.05）；两组患者手术治疗前CEA、CA199、CA125、PGI指标水平无明显差异（P>0.05）；手术后3个月，观察组的CEA、CA199、CA125指标水平明显小于对照组，PGI水平明显大于对照组（P<0.05）；两组患者术前CRP、IL-6、TNF-α指标水平无明显差异（P>0.05），术后3个月，观察组的CRP、IL-6、TNF-α指标水平明显小于对照组（P<0.05）。结论 采用腹腔镜远端胃癌根治术治疗早期胃癌患者，围手术期指标、肿瘤标志物及炎性炎症因子指标水平均优于开腹手术患者，疗效确切，适合临床选择应用。     

结直肠癌根治术后肿瘤标志物水平与患者预后的相关性分析

目的 探讨结直肠癌根治术后肿瘤标志物水平与患者预后的相关性。方法 选取2017年1月至2021年10月本院收治的76例结直肠癌根治术后患者，对其临床资料进行回顾分析，采集所有患者病理特征，并行血清肿瘤标志物检测，包括糖类抗原125(CA125)、糖类抗原19-9(CA19-9)、癌胚抗原（CEA），评价肿瘤标志物水平与结直肠癌根治术患者预后的相关性。结果 不同年龄、性别、肿瘤部位、肿瘤大小的血清CA125、CA19-9、CEA水平相比差异无统计学意义（P>0.05），不同肿瘤分化程度、TNM分期、淋巴结转移、复发情况患者上述指标相比有显著差异（P<0.05）；将患者预后作为因变量（无转移或复发=0，有转移或复发=1），以肿瘤大小、肿瘤分化程度、TNM分期、淋巴结转移、肿瘤标志物水平作为自变量，应用Cox回归模型行多因素分析，结果显示分化程度、TNM分期、淋巴结转移、CA125、CA19-9、CEA水平为影响结直肠癌根治术患者预后的独立相关因素（P<0.05）；经Pearson相关性分析，CA125、CA19-9、CEA均与结直肠癌根治术患者预后呈正相关性（P<0...     

Ⅰ期、Ⅱ期胰腺导管腺癌根治术后血清CA125、CEA、CA19-9及预后分析

目的研究Ⅰ期、Ⅱ期胰腺导管腺癌根治术后患者血清CA125、CEA、CA19-9水平及预后分析,为患者的诊断提供临床指导。方法选取2017年2月至2020年3月期间在本院行胰腺导管腺癌根治术的60例Ⅰ期、Ⅱ期患者作为研究对象。随机分为对照组和观察组,各30例,检测所有患者血清癌抗原125(CA125)、癌胚抗原(CEA)、糖链抗原19-9(CA19-9)水平,探究这三种标志物对胰腺癌的诊断和预后价值。结果术后3种标志物CA19-9、CA125、CEA的水平和阳性率显著低于术前,差异有统计学意义(P0.05);三种标志物CA19-9、CA125、CEA联合的诊断性显著高于各单一指标组,CA19-9的特异性、敏感性、准确性显著高于CA125和CEA,CEA的诊断性显著高于CA125,差异有统计学意义(P0.05)。结论 CA125和CEA的检测水平对胰腺癌的诊断和预后有一定的辅助作用,联合CA19-9三种指标水平诊断和预后效果更好。     

CA153、CA125、CEA联合检测在乳腺癌诊断中的应用价值

目的探讨CA153、CA125、CEA三项肿瘤标志物联合检测对乳腺癌早期诊断和鉴别诊断的应用价值。方法采用电化学发光免疫分析技术检测68例乳腺癌患者、38例乳腺良性病变者、30例健康人的血清中CA153、CA125、CEA含量,并分析阳性检出率和敏感性、特异性。结果乳腺癌患者血清CA153、CA125、CEA的含量高于健康人和良性病变者（均P〈0.01）。三项指标联合检测的敏感性和特异性为70.6%和84.9%,乳腺癌组与健康人及乳腺良性肿块组有显著性差异（P〈0.01）。结论 CA153、CA125、CEA三项肿瘤标志物联合检测能提高乳腺癌早期诊断的敏感性且有较好的特异性,具有一定的临床应用价值。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。