肾移植受者发生移植后糖尿病的危险因素分析及预测模型的构建

目的  分析肾移植受者发生移植后糖尿病（PTDM）的危险因素,建立PTDM预测模型并评价其预测价值。方法  回顾性分析915例肾移植受者的临床资料。根据有否发生PTDM,分为PTDM组（78例）和非PTDM组（837例）。收集受者的主要指标,对肾移植受者发生PTDM的危险因素进行单因素和多因素分析; 建立PTDM预测模型并评价其预测价值。结果  糖尿病家族史、体质量指数（BMI）、术前餐后2 h血糖、术前糖化血红蛋白是肾移植受者发生PTDM的独立危险因素。PTDM预测模型为logit（P）=2.199×糖尿病家族史（有=1,无=0）+0.109×BMI+0.151×餐后2 h血糖（mmol/L）+0.508×糖化血红蛋白（%）-9.123。受试者工作特征（ROC）曲线结果显示,联合4种预测因子预测肾移植受者发生PTDM的曲线下面积（AUC）为0.830[95%可信区间（CI）0.786~0.873],界值为0.0608,灵敏度为0.821,特异度为0.700,约登指数为0.521（P < 0.05）。结论  糖尿病家族史、BMI、术前餐后2 h血糖、术前糖化血红蛋白是肾移植受者发生PTDM的独立危险因素。联合4种预测因子的PTDM预测模型具有较好的预测价值。     

High-Resolution Melting Assay (HRMA) is a Simple and Sensitive Stool-Based DNA Test for the Detection of Mutations in Colorectal Neoplasms

BackgroundStool-based DNA testing for colorectal cancer is becoming a favored alternative to existing DNA screening tests. However, current methods of analysis often become more complicated and costly with increased sensitivity. The high-resolution melting assay (HRMA) is a simple and rapid mutation scanning method with low cost and superb accuracy. In this study, we verified the accuracy of HRMA for screening KRAS/TP53 mutations in stool-isolated DNA from patients with colorectal cancer.Materials and MethodsComparing to direct DNA sequencing, the accuracy of HRMA was verified by detecting KRAS/TP53 mutations in 2 independent stages. In study stage I, both tissue and stool samples from colorectal neoplasm patients were analyzed. In study stage II, stool samples from patients with colorectal neoplasms, and normal controls in clinical screening settings were examined.ResultsIn study stage I, the HRMA identified 14 of 17 target mutations (82.4%) in stools from cancer patients, and 4 of 5 (80.0%) target mutations in stools from advanced adenoma patients. The mutation detection rate in fecal samples (45.0%; 18/40) and referred tissue samples (55.0%; 22/40) was highly consistent (κ = 0.79). The HRMA detected 1% mutant DNA in a background of wild type DNA. In study stage II, the HRMA assay detected 58.8% (20/34) mutations in tumor samples, 41.5% (17/41) in advanced adenomas samples, and 3.33% (2/60) in age-matched normal control samples. The results from HRMA and DNA sequencing revealed 100% sensitivity and specificity in both tissue and stool samples.ConclusionHRMA is a simple, reliable, and sensitive method for detecting DNA mutations in the stool samples from patients with colorectal neoplasms.     

小儿肠胃康颗粒治疗小儿腹泻疗效及安全性的Meta分析

目的:采用Meta分析的方法评价小儿肠胃康颗粒治疗小儿腹泻的疗效及安全性。方法:计算机检索Pub Med、EMbase、The Cochrane Library(2015年第6期)、CBM、中国知网、维普数据库和万方数据库,搜集小儿肠胃康颗粒治疗小儿腹泻的相关随机对照试验或半随机对照试验,检索时限均为从建库至2015年6月。由2位研究者独立按纳入排除标准进行文献筛选、资料提取和方法学质量评价,然后采用Rev Man 5.3软件进行Meta分析。结果:最终纳入13个研究共计1 395例患者。Meta分析结果显示在对照组的基础上联用小儿肠胃康颗粒治疗小儿腹泻的总有效率显著高于对照组4.2倍[RR=4.20,95%CI(2.93-6.03),P0.05]。按腹泻类型的亚组分析结果显示:小儿肠胃康颗粒治疗秋季腹泻的总有效率显著高于对照组4.3倍[RR=4.30,95%CI(2.24-8.27),P0.05],小儿肠胃康颗粒治疗消化不良性腹泻的总有效率也显著高于对照组3.92倍[RR=3.92,95%CI(2.51-6.11),P0.05]。结论:当前证据表明与单用其他药物比较,联合应用小儿肠胃康颗粒能显著改善小儿腹泻,特别是秋季腹泻和消化不良性腹泻。但受纳入研究质量和样本量的限制,当前的结果建议开展更多高质量和大样本的研究加以验证。     

诺贝尔获奖者不一定是最佳供精者

近来,博士捐精猝死捐精赚首付等等新闻,把捐精一事摆到了人们的关注视野内。其实,人类精子质量的下降早已经不是新闻了。有说白领的精子质量尤其下降得厉害,因为饮食失衡、营养不均衡使精子处于饥饿状态;而热衷于夜生活、吸烟酗酒的不良习惯,更会令精子质量直线下降;加上长期的工作节奏快、工作压力大、心理紧张也会影响精子质量。那么,不育不孕症的发生率增加也是自然的了。所以,全球社会对辅助生育及精子库的要求与日俱增。     

Genetic damage induced by organic extract of coke oven emissions on human bronchial epithelial cells

Coke oven emissions are known as human carcinogen, which is a complex mixture of polycyclic aromatic hydrocarbon. In this study, we aimed to clarify the mechanism of action of coke oven emissions induced carcinogenesis and to identify biomarkers of early biological effects in a human bronchial epithelial cell line with CYP1A1 activity (HBE-CYP1A1). Particulate matter was collected in the oven area on glass filter, extracted and analyzed by GC/MS. DNA breaks and oxidative damage were evaluated by alkaline and endonucleases (FPG, hOGG1 and ENDO III)-modified comet assays. Cytotoxicity and chromosomal damage were assessed by the cytokinesis-block micronucleus cytome (CBMN-Cyt) assay. The cells were treated with organic extract of coke oven emissions (OE-COE) representing 5, 10, 20, 40 μg/mL extract for 24 h. We found that there was a dose–effect relationship between the OE-COE and the direct DNA damage presented by tail length, tail intensity and Olive tail moment in the comet assay. The presence of lesion-specific endonucleases in the assays increased DNA migration after OE-COE treatment when compared to those without enzymes, which indicated that OE-COE produced oxidative damage at the level of pyrimidine and purine bases. The dose-dependent increase of micronuclei, nucleoplasmic bridges and nuclear buds in exposed cells was significant, indicating chromosomal and genomic damage induced by OE-COE. Based on the cytotoxic biomarkers in CBMN-Cyt assay, OE-COE may inhibit nuclear division, interfere with apoptosis, or induce cell necrosis. This study indicates that OE-COE exposure can induce DNA breaks/oxidative damage and genomic instability in HBE-CYP1A1 cells. The FPG-comet assay appears more specific for detecting oxidative DNA damage induced by complex mixtures of genotoxic substances.     

Immediate bail-out TAP-stenting for the treatment of iatrogenic aortocoronary dissection involving left main bifurcation

Iatrogenic aortocoronary dissection is a rare but potentially disastrous complication of percutaneous coronary intervention. The left main dissection extending into distal bifurcation involving both the left anterior descending and left circumflex is a complex and vital complication, which is classified as Eshtehardi Type II dissection. We presented a case of iatrogenic left main coronary artery dissection with upcoming closure of both major branches, which was successfully managed by immediate bail-out TAP-stenting. The 77-year-old patient was dis-charged without any complication, and 1-year follow-up indicated stent patency and favorable clinical result. Immediate bail-out stenting is a feasible and reasonable initial management for this lethal complication.     

多普勒超声对妊娠自然终止患者血流动力学变化的研究

目的应用多普勒超声评价妊娠自然终止患者子宫动脉和卵巢动脉的血流动力学的变化。方法选择在北京妇产医院就诊的273名患者进行超声检查,其中正常早期妊娠者156例,自然妊娠终止患者117例(胚胎停止发育52例,无胚胎妊娠65例)。应用经腹超声测量孕妇双侧子宫动脉上行支和卵巢动脉,并对数据进行统计学分析。结果妊娠自然终止患者优势侧和非优势侧子宫动脉的搏动指数(pulse index,PI)、阻力指数(resistant index,RI)、收缩期最大血流速度与舒张期最小血流速度比值(ratio between the peak of systolic velocity and the end of diastolic velocity S/D)测量值均明显低于正常早期妊娠妇女,差异均有统计学意义。而胚胎停止发育和无胚胎妊娠患者之间差异无统计学意义。卵巢动脉血流动力学变化在3组之间差异无统计学意义。结论子宫动脉上行支的PI、RI值可用来辅助判断妊娠是否终止,当优势侧子宫动脉上行支的PI、RI值明显减低时(PI<1.80,RI<0.77),提示妊娠终止的可能性极大。