1990年至2017年中国人群石棉肺的疾病负担分析

目的 分析1990—2017年中国人群石棉肺的疾病负担水平及其变化趋势。方法 利用全球疾病负担2017年（GBD 2017）研究结果和数据，分析1990—2017年中国人群石棉肺的疾病负担状况并与全球人群进行比较。按年份、年龄、性别分析中国人群石棉肺的发病数、死亡数、伤残调整寿命年（DALY）、过早死亡损失寿命年（YLL）、伤残损失寿命年（YLD）；同时采用2000—2025年世界人口的平均年龄结构作为标准人口计算中国和全球人群石棉肺的标化发病率、标化死亡率、标化DALY率、标化YLL率、标化YLD率。计算2017年与1990年的变化幅度，分析疾病负担指标的变化。结果 2017年中国人群因石棉肺造成的DALY为9 984人年，占中国人群因尘肺病造成DALY（247 619人年）的4.03%，占中国总DALY（371 485 307人年）的0.0027%，在293种疾病中排名第262位，较1990年（269位）上升了7位；占全球人群因石棉肺造成DALY（69 074人年）的14.45%，在195个国家和地区中排名第1位。2017年中国人群石棉肺的发病数、死亡数、DALY分别为1 942例、285例、9 984人年，较1990年分别增长85.5%、46.9%、26.2%，增幅均低于全球水平；2017年的标化发病率、死亡率、DALY率分别为0.100/10万、0.016/10万、0.524/10万，分别较1990年下降6.8%、33.5%、34.3%，降幅均高于全球水平。中国人群石棉肺的发病数、死亡数、≥40岁DALY进入高发状态，分别为1 839例（占94.7%）、269例（占94.5%）、8 919人年（占89.3%）；2017年发病年龄和死亡年龄的中位数分别为63.6岁、70.1岁，较1990年分别延长9.4岁、6.4岁。结论 石棉肺对中国人群引起的疾病负担相对较轻，但占全球人群石棉肺疾病负担较大比重，应综合考虑过去我国石棉生产和使用量大、石棉肺潜伏期长等特征，持续关注石棉肺等相关疾病的健康风险和疾病负担。     

Subcutaneous porocarcinoma clinically presenting as a soft tissue tumor

Porocarcinoma is a rare malignancy with glandular adnexal differentiation. A 38‐year‐old Japanese man noticed a subcutaneous mass in right inguinal region about 20 years prior to being examined. Radiological examinations demonstrated the mass, 11 × 10 cm in size, was in the subcutaneous fat tissue. Recently, the mass grew rapidly, and it was biopsied by an orthopedist based on clinical diagnosis of primary soft tissue tumor. Histopathological examination of the resected specimens also revealed that the tumor lacked involvement to the skin. Microscopically, the tumor was mainly composed of poroid cells with partially obvious squamous differentiation, accompanied by focal ductal structures immunoreactive for CEA and EMA. The tumor contained a low‐grade area consisting of poroid cells and high‐grade area with squamous differentiation. This histopathological heterogeneity suggested malignant transformation from poroma. The patient had the tumor in almost same size over the period of 20 years, which is the longest in the previous reports. This unique case of subcutaneous porocarcinoma is reported.     

Proteomics analysis of lysine crotonylation and 2-hydroxyisobutyrylation reveals significant features of systemic lupus erythematosus

Introduction/objectives

To seek significant features of systemic lupus erythematosus (SLE) by utilizing bioinformatics analysis.

Method

Liquid chromatography-tandem mass spectrometry (LC–MS/MS) was used to quantify lysine crotonylation (Kcr) and lysine 2-hydroxyisobutyrylation (Khib) in peripheral blood mononuclear cells (PBMCs) of systemic lupus erythematosus (SLE) patients and normal controls.

Results

Seventy-six differentially modified proteins (DMPs) dually modified by Kcr and Khib were identified between SLE patients and healthy people. GO enrichment analysis prompted significant enrichment of seventy-six DMPs in MHC class II protein complex binding and leukocyte migration. KEGG pathways were enriched in antigen processing and presentation pathway and leukocyte transendothelial migration pathway. Six DMPs (CLTC, HSPA1B, HSPA8, HSP90AB1, HSPD1, and PDIA3) were identified in antigen processing and presentation pathway, of which HSPA8 was the core protein. Significant changes of Kcr and Khib in HSPA8 may increase ATP hydrolysis and promote antigen binding to MHC II molecule. In leukocyte transendothelial migration pathway, 7 DMPs (ACTN1, ACTN4, EZR, MSN, RAC1, RHOA, and VCL) were identified. MSN was the protein with the most modification sites in this pathway. In amino terminal ferm region of MSN, Kcr and Khib expression change may lead to the adhesion between leukocytes and endothelial cells, which was an important step of leukocyte migration.

Conclusion

Kcr and Khib may promote the antigen presentation and jointly regulate the tissue damage mediated by leukocyte migration in SLE patients, which may play key roles in the pathogenesis of SLE probably.

术前白蛋白碱性磷酸酶比值对根治性膀胱切除术后总体生存期的影响

目的探讨术前白蛋白碱性磷酸酶比值(AAPR)与根治性膀胱切除术后患者总体生存期(OS)的关系。方法回顾性分析2007年1月至2015年12月青岛大学附属医院收治的166例膀胱癌患者的临床病理资料。男148例,女18例。年龄(65.1±9.4)岁。伴高血压病31例、糖尿病14例。体质指数(BMI)(24.00±3.32)kg/m^2。肿瘤单发92例,多发74例。肿瘤直径<3 cm者43例,≥3 cm者123例。合并肾积水33例,无肾积水133例。术前AAPR(0.62±0.23)。根据AAPR的三分位点将患者分为低AAPR组55例,AAPR(0.42±0.09);中AAPR组55例,AAPR(0.58±0.05);高AAPR组56例,AAPR(0.86±0.21)。美国麻醉医师协会(ASA)分级1级4例,2级65例,3级86例,4级11例。根治术前患者均行经尿道膀胱肿瘤切除术,病理诊断均为膀胱癌,高级别144例,低级别22例。166例均行根治性膀胱切除术,其中腹腔镜手术140例,开放手术26例。术中行输尿管皮肤造口55例,回肠代膀胱96例,回肠原位新膀胱15例。将AAPR连续性变量和AAPR分组作为原始模型,调整年龄、肿瘤大小、pT分期、pN分期、肾积水、ASA分级、辅助化疗的数据作为校准模型1,在校准模型1基础上增加BMI、肿瘤数目、病理等级的数据作为校准模型2。采用趋势性检验检测不同AAPR组间危险比(HR)变化趋势。分析不同因素分层的AAPR与OS的关系。采用Kaplan-Meier法绘制生存曲线。采用基于广义相加模型的曲线拟合表示AAPR与OS的关系。结果本组166例中位随访63个月,生存95例,死亡71例。3年生存率为61%,5年生存率为50%。术后病理分期:T1期27例,T2期82例,T3期48例,T4期9例;N0期145例,N1期14例,N2期6例,N3期1例。术后52例行辅助化疗。单因素Cox回归分析结果显示,AAPR(HR=0.09,95%CI 0.022~0.391,P=0.001)、高AAPR组(HR=0.40,95%CI 0.216~0.742,P=0.003)、年龄(HR=2.42,95%CI 1.294~4.531,P=0.006)、肿瘤大小(HR=2.11,95%CI 1.112~4.014,P=0.023)、肿瘤数目(HR=0.62,95%CI 0.378~1.022,P=0.061)、pT3期(HR=8.93,95%CI 3.173~25.114,P<0.001)、pT4期(HR=10.39,95%CI 3.110~34.707,P<0.001)、N1期(HR=2.80,95%CI 1.422~5.531,P=0.003)、N3期(HR=17.06,95%CI 2.192~132.863,P=0.007)、病理分级(HR=0.30,95%CI 0.113~0.817,P=0.019)、肾积水(HR=2.36,95%CI 1.406~3.939,P=0.001)、术后辅助化疗(HR=2.66,95%CI 1.674~4.247,P<0.001)均与术后OS相关。调整年龄、肿瘤大小、pT分期、pN分期、肾积水、ASA分级、辅助化疗、BMI、肿瘤数目、病理分级后,Cox回归分析结果显示,与低AAPR组相比,高AAPR组的死亡风险降低约59%(HR=0.406,95%CI 0.200~0.822,P=0.012),AAPR每升高1个单位,死亡风险下降约80%(HR=0.199,95%CI 0.051~0.779,P=0.020)。趋势性检验结果显示,原始模型和校准模型中,AAPR不同分组间OS的HR下降趋势均有统计学意义(P=0.016),提示两者呈线性关系。调整年龄、肿瘤大小、pT分期、pN分期、肾积水、ASA分级、辅助化疗、BMI、肿瘤数目、病理分级后,曲线拟合图显示,AAPR与OS呈线性相关,随AAPR升高,术后死亡风险下降,OS延长。结论AAPR与膀胱肿瘤患者根治性膀胱切除术后的OS成线性相关,随AAPR升高,患者术后死亡风险下降,OS延长。     

肝内胆汁淤积对联合弹性成像评估肝纤维化的影响

目的评估肝内胆汁淤积对联合弹性成像诊断肝纤维化分期的影响。方法收集入组患者的弹性成像、生化学和组织学数据。比较不同总胆红素(TB)组的剪切波速度(Vs)及肝纤维化指数(LF index)。使用ROC曲线下面积计算联合成像的准确度。结果以肝活检为金标准,TB异常组的Vs高于正常组(P<0.001),LF index在TB正常组及异常组中无区别(P>0.05)。不同TB分组中联合成像的准确度并无明显差异。结论肝内胆汁淤积对LF index无任何影响,使Vs轻微升高,但不会降低联合弹性成像评估肝纤维化分期的整体诊断效能。     

一种锁定式钻头保护器

设计一款锁定钻孔深度的钻头保护器，操作简单、安全。     

Phorbol ester-type diterpenoids from the twigs and leaves of Croton tiglium

Phytochemical investigation of the ethanol extract from the twigs and leaves of Croton tiglium led to the isolation of two new phorbol esters (1–2) and seven known ones (3–9). Their structures were elucidated by the analyses of extensive spectroscopic data (IR, MS, and 1D and 2D NMR) and comparing with related compounds. Meanwhile, compounds 1–9 were determined for their cytotoxic activities on human lung cancer cell line A549. Among them, 1–2 were inactive against the cell line A549 (IC₅₀ > 100 μM), but compounds 3 and 7 showed weak activities.     

基于TCGA数据库分析整合素αV在胃癌中的表达差异及临床意义

目的 利用癌症基因组图谱(the cancer genome atlas,TCGA)数据库分析整合素αV(integrinαV,ITGAV)在胃癌中的表达差异及临床意义.方法 在TCGA数据库获取胃癌临床病例资料及对应的ITGAV mRNA转录组数据,利用R软件分析ITGAV在胃癌组织样本及正常胃组织样本中的mRNA表达差异,分析其表达差异与胃癌患者临床病理特征及预后的关系.基因集富集分析(gene set enrichment analysis,GSEA)预测ITGAV在胃癌中调控的可能信号通路.结果 ITGAV在胃癌组织中的mRNA表达量显著高于正常胃组织(W=3161,P=8.837×10-6).ITGAV的表达水平与胃癌患者的T分期、N分期、病理分期及分化程度相关(P<0.05).ITGAV高表达组的患者的生存时间显著短于ITGAV低表达组患者(P=0.00049).单因素分析结果显示T分期、N分期、M分期、病理分期、年龄及ITGAV表达量与胃癌的预后相关(P均<0.05).多因素分析结果显示ITGAV的表达水平与年龄是影响胃癌患者预后的独立危险因素(P均<0.05).ITGAV mRNA高表达样本富集到Janus激酶/信号转导与转录激活子(Janus kinase/signal transducer and activator of tranions,JAK STAT)信号通路、Toll样受体4(Toll-like receptor 4,TLR4)信号通路、转化生长因子(transforming grow th factoryβ,TGF-β)信号通路、丝裂原活化蛋白激酶(mitogen-activated protein kinase,MAPK)信号通路、趋化因子(Chemokine)信号通路、哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)信号通路、erb-b受体酪氨酸激酶(erb-b tyrosine kinase receptor,ERBB)信号通路及血管内皮生长因子(vascular endothe-lial growth factor,VEGF)信号通路上调(P均<0.05).结论 ITGAV在胃癌组织中高表达,且ITGAV表达水平与胃癌恶性程度及不良预后具有一定的相关性,并通过上调JAK STAT等信号通路在胃癌中发挥作用.