应用高透氧性角膜接触镜在准分子激光角膜切削术后的病原学分析

目的针对准分子激光屈光性角膜切削术(PRK)后所使用的绷带式高透氧性角膜接触镜的病原学进行分析。方法对接受PRK手术的50例(100只眼)患者,手术前取结膜囊分泌物进行细菌学培养。术后给予术眼配戴高透氧性绷带式角膜接触镜,术后第6~8天摘除角膜接触镜,将角膜接触镜进行细菌学检测,并同时再次取结膜囊分泌物进行细菌学培养。并将接触镜培养阳性的患者与培养阴性的患者分组对比,分析两组间矫正视力、眼压、角膜厚度等相关影响因素的差异性。结果 100片角膜接触镜中,3片(3%)细菌学检测结果呈阳性,均为表皮葡萄球菌。所有患者术前、术后结膜囊均未监测到细菌,术后均未见眼部感染表现。阳性组和阴性组间,泪液分泌量存在差异,可能与培养阳性有相关。结论 PRK术后使用的高透氧性绷带式角膜接触镜具有发生细菌污染的可能,尤其对于泪液分泌量较少的患者,其角膜接触镜发生感染机率较高。手术前后合理用药可有效控制接触镜中细菌的繁殖。     

Analysis of the factors affecting lymph node metastasis and the prognosis of rectal neuroendocrine tumors

Objective: To analyze the factors affecting lymph node metastasis and the prognosis of rectal neuroendocrine tumors after surgical treatment. Methods: A retrospective analysis was conducted using the clinical data from 156 cases of rectal neuroendocrine tumors during the period of January 1999 to December 2013. The Kaplan-Meier method was used to calculate the survival time, Cox regression analysis was performed for statistical analysis of clinicopathological factors that may be associated with lymph node metastasis and prognosis, and correlation analysis was carried out using binary logistic regression. Results: The overall 5-year survival rate of the entire group was 95.7%. Multivariate analysis showed that the depth of invasion was an independent prognostic factor (P < 0.001). The incidence of lymph node metastasis was 7.7% (12/156), and logistic regression analysis showed that lymph node metastasis was related to the depth of invasion (P = 0.003) and tumor diameter (P = 0.006). Conclusion: The surgical approach of rectal neuroendocrine tumors should be selected based on a comprehensive consideration of factors such as tumor size, depth of invasion and lymph node metastasis.     

Diagnostic accuracy of fecal lactoferrin for inflammatory bowel disease: a meta-analysis

Objective: To do a systematic review using meta-analysis to assess the diagnostic accuracy of fecal lactoferrin (FL) in patients with inflammatory bowel disease (IBD). Methods: We performed a literature review and systematically searched the Medline and EMBASE databases for eligible studies. The quality of the included studies was assessed using the QUADAS tool. The sensitivity, specificity, and other diagnostic indexes of FL were pooled using a random-effects model. Results: Seven studies, involving 1816 patients, met the inclusion criteria. In all studies, the pooled FL sensitivity and pooled specificity were 0.82 (95% confidence interval [CI]: 0.72, 0.89) and 0.95 (95% CI: 0.88, 0.98), respectively. The positive and negative likelihood ratios were 16.63 and 0.18, respectively. The area under the summary receiver-operating characteristic curve (SROC) was 0.95 (95% CI: 0.93, 0.97), and the diagnostic odds ratio was 90.04 (95% CI: 37.01, 219.02). The pooled FL sensitivity and specificity for Crohn’s disease (CD) diagnosis (sensitivity =75%, specificity =100%) was not as good as it was for ulcerative colitis (UC) diagnosis (sensitivity =82%, specificity =100%). Conclusion: FL, as a noninvasive and screening marker, has a high specificity and a modest specificity during the diagnosis of suspected IBD.     

NAFLD合并T2DM患者糖化血红蛋白和甲状腺激素水平的变化及其临床意义*

目的 探讨非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者糖化血红蛋白(HbA1C)和甲状腺激素水平的变化及其临床意义。方法 2017年4月～2019年3月我院内分泌科就诊的T2DM患者50例和NAFLD合并T2DM患者55例,检测人体学指标,采用电化学发光法检测空腹胰岛素(FINS)水平,采用胶体金法检测血糖化血红蛋白(HbA1C)水平,采用化学发光免疫分析法测定血清游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)和促甲状腺激素(TSH)水平。结果 NAFLD合并T2DM患者体质指数(BMI)为(28.4±2.7)kg/m²,显著大于T2DM患者【(24.0±2.4)kg/m²,P<0.05】,NAFLD合并T2DM患者腰围为(94.5±8.5)cm,显著大于T2DM患者【(84.0±7.6)cm,P<0.05】,NAFLD合并T2DM患者臀围为(97.1±8.0)cm,显著大于T2DM患者【(89.7±7.2)cm,P<0.05】;NAFLD合并T2DM患者血清谷丙转氨酶(ALT)水平为(79.5±7.6)U/L,显著高于T2DM患者【(42.3±4.3)U/L,P<0.05】,NAFLD合并T2DM患者血清谷草转氨酶(AST)水平为(59.7±6.1)U/L,显著高于T2DM患者【(41.2±3.9)U/L,P<0.05】,NAFLD合并T2DM患者血清谷氨酰转肽酶(GGT)水平为(105.8±9.4)U/L,显著高于T2DM患者【(60.9±6.5)U/L,P<0.05】;NAFLD合并T2DM患者血甘油三酯(TG)水平为(4.2±1.7) mmol/L,显著高于T2DM患者【(2.4±0.9)mmol/L,P<0.05】,NAFLD合并T2DM患者空腹血胰岛素(FINS)水平为(12.0±2.5)mU/L,显著大于T2DM患者【(9.1±1.8)mU/L,P<0.05】;NAFLD合并T2DM患者血清TSH水平为(3.4±1.2)mU/L,显著大于T2DM患者【(1.9±0.8)mU/L,P<0.05】,而两组FT3和FT4水平无显著性差异(P>0.05)。结论 NAFLD合并T2DM患者BMI、肝功能指标、TG、FINS和TSH水平均显著增大或升高,与T2DM患者有明显的不同,在临床诊治过程中应当有所甄别,深入研究NAFLD患者发病机制对诊治将大有裨益。     

非小细胞肺癌中Pokemon蛋白与P14ARF-MDM2-p53通路蛋白的相关性研究

目的探讨Pokemon蛋白与P14ARF-MDM2-p53通路蛋白在非小细胞肺癌(NSCLC)发病中的作用。方法纳入2015年10月至2016年10月河北医科大学第一医院行手术治疗的35例NSCLC患者为NSCLC组。同时,将癌旁正常支气管断端组织29例及肺炎组织25例分别作为支气管对照组和肺泡对照组。采用免疫组织化学法检测3组中Pokemon、P14ARF、MDM2和p53蛋白的表达情况,分析其与临床病理资料的关系及各蛋白间的相关性。结果Pokemon、MDM2、p53蛋白在NSCLC组中的表达均显著高于支气管对照组和肺泡对照组(P值均<0.01),P14ARF蛋白在NSCLC组中的表达显著低于支气管对照组和肺泡对照组(χ^2=25.39,P<0.01)。p53和MDM2蛋白的表达与NSCLC的分化程度相关(P=0.02、0.03)。在NSCLC组中,Pokemon与P14ARF蛋白表达呈负相关性(r=-0.58,P<0.05),P14ARF与MDM2蛋白表达呈负相关性(r=-0.51,P<0.05),MDM2与p53蛋白的表达呈正相关性(r=0.86,P<0.05)。结论Pokemon通过P14ARF-MDM2-p53通路在NSCLC发病过程中发挥癌基因作用。     

Evolution of a Wavelike Undulation in Polymer Thin Films with Immobilized Film Spanning Nanoparticles

The evolution of wavelike surface undulations in a thin polymer film under thermal stress in the presence of immobilized film spanning nanoparticles (NPs) is investigated. The elastic stresses in the plane of the polymer thin films is induced by fixed lateral constraints within the film (immobilized NPs) that resist in‐plane film thermal expansion as the temperature increases. Wavelike surface undulations arising from stress relaxation are observed as the thin‐film systems are heated above the glass‐transition temperature (T_g). The thermal stress affects both the characteristic wavelengths and the amplitudes of the wavelike surface undulations. Although the origin is different, the dynamic evolution of these wavelike undulations is strikingly similar in characteristics to spinodal decomposition. As compared with typical spinodal‐decomposition kinetics in liquid systems in which the early and intermediate stages are difficult to probe due to the narrow range of time scales, the overall evolutionary process of the wavelike surface undulations in NP‐filled polymer thin films is captured. The growth of the wavelike undulations shows characteristic time dependencies at the intermediate and late stages of instability.

     

体外循环和非体外循环下冠状动脉旁路移植术中 患者脑氧饱和度的变化趋势分析

目的 探讨体外循环和非体外循环下冠状动脉旁路移植术中患者脑氧饱和度（rScO2）的变化趋势。 方法 前瞻性选取2018 年2 月—2019 年6 月在上海市第一人民医院择期行冠状动脉旁路移植术的105 例患 者。其中,56 例接受非体外循环冠状动脉旁路移植术（OPCAB）,49 例患者接受体外循环冠状动脉旁路移植 术（CCABG）。术中分别选择T0 ～ T9 10 个时间点检测rScO2,另外记录术后7 d 内术后认知功能障碍（POCD） 发生率。结果 CCABG 组患者手术时间长于OPCAB 组（P <0.05）,术中最低鼻咽温和红细胞比容（HCT） 低于OPCAB 组（P <0.05）,术中最高血糖（Glu）和血乳酸（Lac）高于OPCAB 组（P <0.05）;但是两组术 中最低rScO2 比较,差异无统计学意义（P >0.05）。两组rScO2 在不同时间、组间、变化趋势上有差别（P <0.05）。 CCABG 组rScO2 与鼻咽温、Lac 呈正相关（r =0.229 和0.283,P =0.005 和0.002）,而OPCAB 组rScO2 只 与Lac 呈正相关（r =0.214,P =0.010）。OPCAB 组和CCABG 组POCD 发生率分别为39.29%（22/56）和 32.65%（16/49）,且CCABG 组POCD 患者最低rScO2 低于非POCD 患者（P <0.05）。结论 虽然OPCAB 与CCABG 术中患者rScO2 变化趋势有差异,但是rScO2 可能不是影响术后早期POCD 发生的主要原因。