血清肿瘤标志物YKL-40与乳腺癌预后关系的研究

目的：探讨血清YKL-40水平与乳腺癌预后相关因素的关系。方法：采用酶联免疫吸附试验测定乳腺癌患者（实验组）及健康者（对照组）各40例的血清YKL-40水平,比较YKL-40水平在不同年龄、肿瘤直径、淋巴结转移、病理类型及TNM分期患者间的差异。结果：乳腺癌患者血清YKL-40水平明显高于健康对照组（P〈0.05）。肿瘤直径〉2 cm患者YKL-40水平明显高于直径≤2 cm组患者（P〈0.01）。淋巴结转移阳性患者血清YKL-40水平明显高于淋巴结转移阴性患者（P〈0.05）。随着肿瘤TNM分期进展,血清YKL-40水平逐渐升高（P〈0.01）。不同年龄及病理类型患者间血清YKL-40水平无明显差异。结论：血清YKL-40水平与乳腺癌预后相关,可望成为乳腺癌新的肿瘤标志物及治疗靶点。     

乳腺癌YKL-40表达与预后关系的研究

目的：探讨YKL-40表达水平与乳腺癌预后相关因素的关系。方法：采用免疫组织化学SP法检测60例乳腺癌患者YKL-40表达,比较YKL-40表达与乳腺癌患者年龄、肿瘤直径、淋巴结转移、病理类型及TNM分期间的关系。结果：乳腺癌患者中YKL-40表达水平明显高于对照组（75％VS20％,P〈O．05）。肿瘤直径〉2cm患者YKL-40水平明显高于直径≤2cm组患者（P〈0．05）。随着肿瘤TNM分期进展,血清YKL-40表达水平逐渐升高（P〈O．05）。YKL-40在非浸润性和浸润性导管癌中表达率皆明显高于浸润性小叶癌（P〈O．05）。YKL-40表达阳性患者生存时间短于阴性患者[（36±4．9）月VS（49±7．5）月,P〈O．05],本组平均随访（35．4±2．39）月,YKL-40表达阳性患者病死率为22．2％（10／45）,表达阴性患者病死率为13.3％（2／15）。结论：YKL-40表达与乳腺癌预后相关,可望成为乳腺癌新的肿瘤标志物及治疗靶点。     

Prognostic effect of serum and tissue YKL-40 levels in bladder cancer

ObjectivesYKL-40 is a novel inflammatory serum protein shown to be associated with the presence and prognosis of several malignancies. However, its prognostic relevance has not yet been analyzed in bladder cancer (BC). Therefore, the aim of this study was to assess the tissue, serum, and urinary levels of YKL-40 and their prognostic value in BC.Methods and materialsYKL-40 gene expression levels were analyzed in frozen tissue samples of 91 patients with BC; YKL-40 concentrations were measured in 120 serum (101 patients with BC and 19 controls) and 154 urine samples (125 patients with BC and 29 controls). In 16 cases, corresponding serum samples collected before and after radical cystectomy were analyzed for YKL-40. Results were correlated with clinicopathological parameters and follow-up data.ResultsYKL-40 gene expressions and serum concentrations were higher in patients with BC compared with controls; however, urinary YKL-40 levels remained under the detection limit in both patients and controls. Higher tissue gene expressions and serum concentrations were associated with poor patients’ survival in the univariable analysis (P = 0.037 and 0.022, respectively), but only high YKL-40 serum levels proved to be independent prognostic factors in BC (hazard ratio = 1.755, 95% CI: 1.014–3.039, P = 0.045). We found no significant difference between preoperative and postoperative serum concentrations of YKL-40.ConclusionsYKL-40 serum levels are associated with the presence of BC and poor patients’ survival. The independent prognostic relevance of YKL-40 is of particular interest in patients with muscle-invasive BC treated with radical surgery. Our data suggest that BC tissue is not the main source of serum YKL-40 levels.     

Assessment of seminal YKL-40 in infertile men with varicocele

Several studies attempted to explain the negative impact of varicocele on spermatogenesis and fertilisation processes. YKL-40 is a novel glycoprotein biomarker that had been associated with several diseases. This quasi-interventional study aimed to assess the seminal levels of YKL-40 in infertile men with varicocele before and after varicocelectomy. Overall, 50 men were included in this study divided into 20 healthy fertile men and 30 infertile oligoasthenoteratozoospermic (OAT) men with varicocele that underwent varicocelectomy. All participants were subjected to history taking, clinical examination and scrotal Doppler. Also, semen analysis and seminal YKL-40 assessment were carried out in the start and 6 months after varicocele surgical repair. The results showed a significant increase in the mean seminal YKL-40 level in infertile OAT men with varicocele compared with the healthy fertile men. Six months post-varicocelectomy, the mean seminal KYL-40 level exhibited significant decreases correlated with improved sperm parameters. Overall, seminal levels of YKL-40 showed significant negative correlations with sperm concentration, total sperm motility and sperm normal morphology. It could be concluded that seminal YKL-40 is elevated in infertile OAT men with varicocele where varicocelectomy induces decreased seminal YKL-40 levels correlated with improved semen parameters.     

Mobilization of haematopoietic and non-haematopoietic cells by granulocyte-colony stimulating factor and vascular endothelial growth factor gene therapy in patients with stable severe coronary artery disease

Objectives. To investigate the mobilization of non-haematopoietic and haematopoietic cells from the bone marrow induced by intramyocardial VEGF gene therapy and G-CSF treatment alone or in combination in patients with chronic ischemic heart disease (IHD). Secondly, we tested the hypothesis that the quantity of circulating stem cells correlated with improvement in symptoms. Design. We treated I) 16 patients with intramyocardial placebo injections, II) 16 patients with intramyocardial VEGF-A₁₆₅ gene injections, III) 13 patients with low dose G-CSF, and IV) 16 patients with intramyocardial VEGF-A₁₆₅ gene followed by high dose G-CSF. Results. Circulating CD34+ cells and CD45 ? CD34 ? cells increased by G-CSF in a dose-dependent manner, but did not increase with VEGF gene therapy. The CD45 ? /CD34? cells subgroups increased in both G-CSF treated groups. No association was found between the concentration of mobilized stem cells in the circulation and improvement in symptoms. Conclusions. G-CSF mobilized both haematopoietic and non-haematopoietic cells from the bone marrow in a dose-dependent manner in patients with chronic IHD. However, even high levels of circulating stem cells did not improve symptoms of IHD.     

尿甲壳质酶蛋白-40对新生儿急性尿路感染的早期诊断价值及与其他指标相关性分析

目的 探讨尿甲壳质酶蛋白-40(YKL-40)对新生儿急性尿路感染(UTI)的早期诊断价值,并分析其与其他临床指标的相关性.方法 选择2015年1月至2018年6月在本院就诊的疑似急性UTI患儿88例作为研究对象,取清洁中段尿10 mL,放人带塞无菌试管中并在1 h内送检,经细菌培养后进行成分分析.根据细菌培养结果将患...     

Lack of cardioprotection from metabolic support with glutamine or glutamate in a porcine coronary occlusion model

Objective Previous experimental studies indicate that glutamine or glutamate may provide cardioprotection by improving the oxidative metabolism in myocardial ischemia. We investigated the effect of glutamine or glutamate, given during reperfusion, on resulting infarct size and hemodynamic recovery.

Design A porcine coronary occlusion model was applied. Infusions were initiated 15 min before reperfusion and supplemented with intracoronary bolus doses at reperfusion. The primary outcome measure was infarct size in relation to area at risk determined by a standard tissue staining procedure. Secondary outcome measures were the hemodynamic variables.

Results The infarct sizes as a proportion of the area at risk (mean±SD) were: control group, 0.64±0.19 (n=9); glutamine group, 0.87±0.07 (p<0.05 vs control group) (n=8); glutamate group, 0.72±0.11 (n=9). Glutamine increased systemic vascular resistance, while glutamate preserved cardiac output during infusion.

Conclusion Substrate supplementation with the anaplerotic precursors glutamine and glutamate is ineffective as adjunctive therapy for severe myocardial ischemia. Beneficial effects documented in less complex experimental systems could not be transferred to a more pathophysiological relevant model.     

Contributions of myocardial ischemia and heart rate to ST segment changes in patients with or without coronary artery disease

Background: ST changes related to ischemia at different heart rates (HRs) have not been well described. We aimed to analyze ST dynamic changes by vectorcardiography (VCG) during pacing-induced HR changes for subjects with proven coronary artery disease (CAD) and without (non-CAD).
Methods: Symptomatic CAD patients scheduled for elective surgery were enrolled along with a non-CAD group. During anesthesia, both groups were placed at multiple ascending levels. VCG ST data, and in particular in ST change vector magnitude (STC-VM) from baseline, along with arterial and great coronary artery vein (GCV) blood samples were collected to determine regional myocardial lactate production.
Results: A total of 35 CAD and 10 non-CAD patients were studied over six incremental 10 beat/min HR increases. STC-VM mean levels increased in the CAD group from 9±5 to 131±37 μV (standard deviation) compared with non-CAD subjects with 8±3–76±34 μV. Myocardial ischemia (lactate production) was noted at higher HRs and the positive predictive value for STC-VM to detect ischemia was 58% with the negative predictive value being 88%. STC-VM at 54 μV showed a sensitivity of 88% and a specificity of 75% for identification of ischemia.
Conclusions: Both HR and ischemia at higher HRs contribute to VCG ST elevation. Established ST ischemia detection concerning HR levels is suboptimal, and further attention to the effects of HR on ST segments is needed to improve electrocardiographic ischemia criteria.     

YKL-40 as a clinical biomarker in adult patients with CF: Implications of a CHI3L1 single nucleotide polymorphism in disease severity

BackgroundYKL-40 (chitinase 3-like 1 gene; CHI3L1) is an inflammatory marker that is increased in the blood of patients with inflammatory diseases, including cystic fibrosis (CF). The objective of our study was to explore the relationship between circulating levels of YKL-40, selected CHI3L1 single nucleotide polymorphisms (SNPs) and the severity of CF disease.MethodsA prospective cohort of 188 adult patients with CF was established in 2015. Blood samples and clinical data were collected over 2 years to analyze the circulating levels of YKL-40 and to genotype selected CHI3L1 SNPs. We also looked for an association between these factors and clinical parameters.ResultsWe found that according to the serum YKL-40 concentration, the patients could be categorized into two distinct groups: low and high YKL-40. Compared to the patients in the low YKL-40 group, the patients in the high YKL-40 group had lower lung function (P < 0.001), a higher proportion of delF508 homozygote mutations (P= 0.027) and dysglycemia (P= 0.015). They were also more colonized with Pseudomonas aeruginosa (P= 0.003) and required more frequent antibiotic intravenous courses (P < 0.001). We also observed that patients expressing the C/C-rs4950928 genotype had higher levels of YKL-40 in their blood and were more frequently dysglycemic.ConclusionOur study suggests that YKL-40 could be a potential biomarker of CF disease severity. Furthermore, the CHI3L1 rs4950928 SNP could be a susceptible gene that could be used by CF health professionals to identify patients who are the most at risk of having a severe clinical profile.     

经皮冠状动脉介入治疗对冠心病非心肌梗死患者心肌二维应变的影响

目的运用速度向量成像（VVI）技术评价冠心病非心肌梗死患者心肌二维应变以及经皮冠状动脉介入治疗（PCI）的疗效。方法选取经冠脉造影证实并接受PCI手术的非心肌梗死患者20例（PCI组）,以及性别、年龄匹配的经冠脉造影除外冠心病的患者20例（对照组）。在术前、出院前及术后3个月接受VVI,测量左心室心肌纵向、径向、圆周方向上的应变及应变率,以及左心室扭转角度,评价病变冠状动脉灌注区内的心肌功能及PCI术后改善情况。结果与对照组对应的血管灌注节段相比,PCI组术前的病变血管灌注节段径向应变、径向收缩期峰值应变率、径向舒张晚期峰值应变率显著降低（均P〈0.05）;PCI组术前左心室内膜扭转角度较对照组明显下降。PCI组出院前径向应变较PCI组术前出现改善（P〈0.01）,经向收缩期峰值应变率和舒张晚期峰值应变率在术后3个月得到改善。结论 VVI技术可用于识别灌注异常导致的肉眼无法识别的心肌功能损害;PCI术后早期即可出现径向应变的改善。     

Detection of postoperative myocardial ischemia by bedside ST-segment analysis in coronary artery bypass graft patients

To determine if the ST-segment monitoring software of a bedside electrocardiograph (ECG) monitor would detect postoperative myocardial ischemia (POMI) as reliably as the clinical gold standard 12-lead ECG, and to compare the characteristics of ischemia thus detected with prior studies performed using Holter monitoring. Prospective study. University hospital. One hundred patients who had undergone coronary artery bypass grafting (CABG). Continuous ST-segment trends in leads II and V₅ were recorded using Hewlett-Packard Merlin monitors postbypass until discharge from the postsurgical unit, and printouts were analyzed for episodes of ischemia. Simultaneous 12-lead ECGs and monitor strips were recorded during ischemic episodes in 24 patients and were independently analyzed by two blinded cardiologists quantitatively for ST-segment values and qualitatively for an overall ischemia rating.

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The ST-segment values directly measured by the cardiologists on the simultaneous 12-lead ECGs and those recorded by the monitor during ischemic episodes were found to be clinically comparable (bias, 0.1 mm for both leads; precision, 0.5 mm lead II, 0.9 mm lead V₅). The sensitivity of the monitor compared with 12-lead ECGs for the detection of POMI was 73%. Ninety eight episodes of significant ST deviation were identified in 39 patients. The characteristics of the ischemia detected in this study were similar to those reported in other studies performed using continuous Holter-type monitoring. Bedside monitoring of the ST segment in leads II and V₅ using Hewlett-Packard Merlin monitors after CABG surgery is as accurate for the measurement of ST deviation in those leads as the clinical gold standard of a 12-lead ECG read by an experienced cardiologist. However, the 12-lead ECG will detect POMI more reliably than an automated two-lead bedside ST-segment analyzer because it allows evaluation of more leads and of ST-segment and T-wave morphology. Bedside ST-segment monitoring in this study confirmed the high incidence of ischemia after CABG surgery shown previously using Holter monitoring.     

老年稳定性冠心病患者认知衰弱风险预测模型的建立

目的 建立老年稳定性冠心病患者认知衰弱风险的列线图模型,为临床早期识别和干预提供参考.方法 便利选取848例老年稳定性冠心病患者,采用 自制一般资料调查表、蒙特利尔认知评估量表、临床痴呆评定量表、衰弱表型量表进行评估;Logistic回归分析确定认知衰弱的独立危险因素,同时建立认知衰弱风险列线图预测模型并进行内部验证....     

Detection and management of concomitant coronary artery disease in patients undergoing thoracic aortic surgery

OBJECTIVES: No method has been established to detect and manage coronary artery disease in patients undergoing thoracic aortic surgery. METHODS: Subjects were 192 patients scheduled for elective thoracic aortic surgery. Selection criteria for coronary angiography included a history of coronary artery disease or a positive dipyridamole myocardial perfusion imaging test. RESULTS: Four patients were inoperable due to complications associated with coronary angiography or aneurysm rupture following coronary revascularization. A total of 55 patients with coronary angiography (group A) underwent 57 thoracic aortic operations and 133 patients without coronary angiography (group B) underwent 143 similar operations. Of 13 group A patients with significant coronary stenosis, 9 underwent either preoperative percutaneous transluminal coronary angioplasty (n = 3) or concomitant coronary artery bypass (n = 6). Perioperative myocardial infarction occurred in 3 group A patients (5%) and in 4 group B patients (1%, ns). The incidence of cardiac events--perioperative myocardial infarction or cardiac death--in group A (11%, 6/57) was higher than that in group B (3%, 4/143; p < 0.05). Multivariate analysis demonstrated incomplete revascularization of major coronary arteries with significant stenosis as a risk factor for cardiac events (p = 0.0106). CONCLUSIONS: Although dipyridamole myocardial perfusion imaging was useful, additional selection criteria for coronary angiography is needed. Complete revascularization of major coronary arteries with significant stenosis is essential to reduce postoperative cardiac events.