联合检测BRD4、SSBP1与PCDH17在胃癌早期诊断中的应用价值

目的 探讨溴结构域蛋白4（bromodomain protein 4,BRD4）、线粒体单链DNA结合蛋白（single-stranded DNA binding protein,SSBP1）与原钙黏附蛋白17（ proto-cadherin 17,PCDH17）诊断早期胃癌的临床价值。 方法 收集胃癌组织50例,癌前病变组织50例、正常胃黏膜组织50例,应用免疫组织化学染色法分别测定组织标本中BRD4、SSBP1及PCDH17蛋白的表达,分析不同组织样本中BRD4、SSBP1及PCDH17的表达情况,分别采集3组血液标本,检测3组相关血清指标,应用ROC曲线分析BRD4、SSBP1及PCDH17诊断胃癌的价值。 结果 胃癌组织中BRD4和SSBP1呈高表达,而PCDH17呈低表达。3组组织样本中BRD4、SSBP1及PCDH17的阳性率比较差异有统计学意义（P＜0.05）;3组血清癌抗原199（carbohydrate antigen,CA199）、血清胃蛋白酶原（pepsinogen,PG）Ⅰ、PGⅡ、胃泌素17（gastrin-17,G-17）水平及幽门螺杆菌（helicobacter pylori,HP）阳性率差异有统计学意义（P＜0.05）;胃癌组织组患者血清CA199、PGⅠ、G-17水平及HP阳性率明显高于癌前病变组织和正常胃黏膜组织组,而PGⅡ水平低于癌前病变组织和正常胃黏膜组织组,差异有统计学意义（P＜0.05）;临床分期为Ⅲ期~Ⅳ期、发生淋巴结转移的胃癌组织中BRD4、SSBP1、PCDH17的阳性率比较差异有统计学意义（P＜0.05）;BRD4+SSBP1+PCDH17联合诊断的敏感度和特异度均高于单一指标。 结论 联合检测BRD4、SSBP1与PCDH17有利于胃癌的鉴别诊断。     

Aplasia Cutis Congenital - A case of large scalp and skull defects treated with conservative approach

Aplasia cutis congenita (ACC) is an uncommon congenital disease characterized by focal absence of the epidermis, subcutaneous tissue, galea, and, in rare cases, calvarial bone. We herein show that a boy born with ACC presented with a large scalp and skull defect and was treated conservatively with wet dressings. This conservative approach produced complete epithelialization of the skin defect with secondary closure of the cranial vault.     

APS-Ⅰ早期确诊方法(附1例病例报道)

目的:探讨自身免疫性多内分泌腺病综合征Ⅰ型(APS-Ⅰ)的早期确诊方法.方法:报道1例中国APS-Ⅰ病例,结合国外72例APS-Ⅰ患者的表型和基因型进行分析.结果:APS-Ⅰ除3种典型表现外,尚可合并20余种其他病症,临床表现复杂,依靠传统的诊断方法易误诊;APS-Ⅰ的致病基因为自身免疫调节因子(AIRE)基因,对可疑患者积极进行基因检测可明确诊断.结论:APS-Ⅰ比较罕见,基因检测町早期确诊临床进展不典型的APS-Ⅰ.     

辽宁省农村幽门螺杆菌根除术利用情况分析

目的了解辽宁省农村幽门螺杆菌(Hp)根除术利用情况。方法采取随机抽样的方法,在辽宁省庄河、本溪两县调查540例慢性胃病患者及78名医生对Hp根治疗法的知晓和利用情况。结果两县慢性胃病患者及医生对Hp根治疗法知晓率分别为4·4%和78·9%,两县患者对Hp根治法的知晓率间差异有显著性意义(P<0·05),两县医生对Hp根治疗法的知晓率间差异无显著性意义(P>0·05),两县患者的Hp根治疗法使用率间差异无显著性意义(P>0·05),但两县医生Hp根治疗法的使用率间差异有显著性意义(P<0·05)。结论辽宁省农村大多数慢性胃病患者不了解Hp感染与慢性胃病的关系,且医生对Hp根治疗法的知晓率和使用率较低,故Hp根治疗法的普及亟待提高。     

初级卫生保健试点县妇幼保健投入产出分析

  目的  分析2000 — 2017年京沪妇女保健财力资源适宜程度及孕产妇死亡率的变化趋势,明确2地差异,探讨妇女保健财力资源适宜程度。  方法  收集1995 — 2017年涉及京沪妇女保健财力投入政府主导问题（202篇）、投入总量问题（205篇）和投入增长问题（122篇）文献,综合投入政府主导适宜程度、投入总量适宜程度、增长适宜程度等3个指标,计算财力资源的适宜程度。运用Spearman相关、线性回归等分析妇女保健财力资源适宜程度与孕产妇死亡率的关系。  结果  北京妇女保健财力资源适宜程度从2000年的28.40 %升至2017年的42.60 %,上海则由22.60 %升至69.40 %,北京和上海的回归方程均有统计学意义（上海P < 0.01,北京P < 0.05）。  结论  京沪2地妇女保健财力资源适宜程度逐年提高,上海财力资源在孕产妇死亡率下降中作用更大,但财力投入稳定增长仍是薄弱环节;适宜的妇女保健体系应“政府负责、投入适宜、稳定增长”;验证了量化妇女保健财力资源适宜程度的可行性。     

硬膜外麻醉时皮肤电传导变化的临床观察

目的探讨硬膜外麻醉时皮肤电传导(SC)基态值和反应波的变化。方法选择25例ASAⅠ或Ⅱ级下肢手术患者。记录硬膜外给药前(T0)、给予1%利多卡因5ml后5min(T1)、给予0.75%罗哌卡因10ml后5、10、15、25和45min(T2～T6)时的SC基态值(SC0)、针刺非阻滞区SC反应波的振幅差值(SC1)和痛觉阻滞区的SC反应波的振幅差值(SC2)。使用ROC曲线、逻辑回归分析评价SC反应波的振幅差值区分痛觉阻滞区和非阻滞区的准确性。结果与T0时比较,T3～T6时的SC0及SC1的均值明显降低(P<0.05),T1～T6时SC2明显低于SC1(P<0.05)。SC反应波的振幅差值ROC曲线下面积为0.928±0.017(P<0.01),特异性与敏感性分别为78%和88%,预测整体准确率84%。结论 SC基态值及反应波振幅差值的变化对定位硬膜外麻醉平面有一定指导作用。     

One‐Year Clinical Outcome of a Randomized Trial of Polymer‐Free Paclitaxel‐Eluting Stents Versus Biodegradable Polymer‐Based Rapamycin‐Eluting Stents in Patients with Coronary Heart Disease

Background: More widespread use of drug‐eluting stents (DES) to treat coronary heart disease (CHD) has recently generated more attention to thrombosis, which was relative to the polymer. Polymer‐free and biodegradable polymer‐based stents are more frequently studied, but their efficacy on preventing detrimental clinical events is unclear. Methods and Results: To assess whether polymer‐free paclitaxel‐eluting stent (YINYI stent) was noninferior or equivalent to biodegradable polymer‐based rapamycin‐eluting stents (EXCEL stent) in preventing detrimental clinical cardiovascular events, a total of 167 consecutive CHD patients requiring DES implantation were randomly divided into the YINYI group (n = 82) and the EXCEL group (n = 85). The primary end‐point was major adverse cardiac events (MACE). The secondary end‐points included stent thrombosis events, all‐cause mortality, and rehospitalization. The study was designed to test the noninferiority or equivalence of the YINYI stent compared with the EXCEL stent with respect to one‐year MACE according to a noninferiority or equivalence margin of 0.1. One‐year MACE was 6.10% in the YINYI group versus 5.88% in the EXCEL group. The lower limit of the one‐sided 95% confidence interval was ?0.0582 (P = 0.002 from the test for noninferiority). The 95% confidence interval for the equivalence test was [?0.0698, 0.0742] (P₁=0.004 and P₂=0.007 from 2 times the 1‐sided test for equivalence). There was no statistically significant difference in thrombosis events, all‐cause death, and rehospitalization (all P > 0.05). Conclusions: In this small randomized trial, polymer‐free paclitaxel‐eluting stents appear to be noninferior or equivalent to biodegradable polymer‐based rapamycin‐eluting stents. (J Interven Cardiol 2012;25:604–610)     

老年人肺癌外科治疗

 目的　总结老年人肺癌外科诊治经验。方法　 64例肺癌患者经胸部X -线和CT检查、诊断性抗炎抗痨治疗、支气管镜检查和剖胸手术中快速病理诊断 ,以及同时进行肺癌的手术治疗。结果　肺癌切除率 90 .8% ,无手术死亡 ,2例出现呼吸衰竭 ,需延长呼吸器辅助时间。结论　老年肺癌患者经认真术前准备 ,及时采取微创手术治疗 ,加强术后处理是提高手术疗效的关键     

肺部周边小结节术前定位在胸腔镜外科的应用

目的：明确胸腔镜切除肺周边小结节术前Hook-wire标记的价值及意义。方法：我院于2000-2010年胸腔镜下或辅助小切口进行肺周边小结节切除共30例,其中在螺旋CT指引定位下穿刺留置Hook-wire16例,其定位的肺小结节直径〈10mm,或距壁层胸膜〉10mm。结果：16例术前CT引导下Hook-wire定位,成功率100%,并发症12.5%,转化为开胸者6.25%,中位住院时间5天。术后组织学结果：原发性肺腺癌9例,鳞癌2例,小细胞肺癌1例,转移瘤3例,炎性假瘤1例。结论：术前肺周边小结节Hook-wire定位对于VATS术中定位具有指导作用。