抑癌基因DPC4在胃癌蛋白的表达及临床意义

目的:研究DPC4(SMAD4)蛋白在胃癌的表达及临床意义。方法:应用免疫组化SP法,对40例胃癌及20例癌周粘膜进行检测,并结合临床资料进行研究。结果:胃癌DPC4(SMAD4)蛋白的表达阳性率为75%(30/40),20例癌周粘膜内DPC4(SMAD4)蛋白均呈强阳性表达,两者比较差异有显著性意义(P<0.05)。DPC4蛋白在胃癌的表达与患者年龄、发生部位无关(P>0.05),而与临床分期、淋巴结转移、病理分级、肿物大小有关性(P<0.01)。结论:DPC4(SMAD4)蛋白的表达与胃癌的发生发展密切相关,对预后的判断有参考价值。     

利用ACL与NAT完成内部HIS与外部医保网的对接

结合实际工作中出现的问题,在保证内部网络安全和满足医院医疗服务的前提下,作者提出了利用ACL与NAT技术,实现医院内部信息网与外部医保网络对接的解决方案,并给出了具体的实现方法.     

Smad4和Smad7在人脑胶质瘤中的表达及意义

目的探讨Smad4和Smad7在人脑胶质瘤中的表达及意义.方法采用免疫组化方法,对临床经过石蜡包埋的30例胶质瘤和8例正常脑组织标本进行定位和定性检测.结果 Smad4 和 Smad7蛋白在胶质瘤中有不同程度的表达,在正常脑组织、低、高级别胶质瘤中Smad4的阳性表达分别为44.80±16.19,25.81±9.48,6.73±3.71,P<0.05.Smad7的阳性表达分别为6.69±3.86,18.22±7.84,41.95±17.27,P<0.05.差别均有显著意义.且Smad4与Smad7的表达水平呈负相关,r＝-0.82,P<0.01.结论 Smad4随胶质瘤的病理分级增高阳性表达降低,对胶质瘤的进展有抑制作用.Smad7则相反,可能参与了胶质瘤的恶性进展.     

Individual and joint effects of borderline ankle-brachial index and high plasma total homocysteine on all-cause death in hypertensive adults

BACKGROUNDThe cardiovascular hazards of total homocysteine (tHcy) are long known. In addition, despite the acknowledgment on the importance of low ankle-brachial index (ABI) (< 0.9), borderline ABI (0.91-0.99) was once commonly overlooked. This study aims to explore the independent and joint effect of tHcy level and borderline ABI on all-cause death in hypertensive population.METHODSThis study included 10,538 participants from China H-type Hypertension Registry Study. ABI was described into two groups: normal ABI (1.00-1.40) and borderline ABI. tHcy level was also divided into two groups: < 15.02 and ≥ 15.02 μmo/L. Four groups were analyzed, using COX proportional hazard regression model, separately and pairwise to observe the independent and joint effect on all-cause death.RESULTSA total of 126 (1.2%) deaths were observed in the 1.7 years follow-up time. Borderline ABI has a higher predicted risk of death than normal ABI (HR = 1.87, 95%CI: 1.17-3.00) after adjusting for potential covariates. Compare with tHcy level < 15.02 μmo/L (low tHcy), those with tHcy ≥ 15.02 μmo/L (high tHcy) had higher risk to event outcome (HR = 1.99, 95% CI: 1.30-3.05). According to the cumulative hazard curve, group with borderline ABI and high tHcy level has significantly higher altitude and larger increasing rate over follow-up period compare to other groups. Among those with borderline ABI, participants with high tHcy had higher death risk than those with low tHcy, nevertheless, no significant different between borderline and normal ABI among those with low tHcy levels.CONCLUSIONSBorderline ABI and tHcy level both have independent predictive value on all-cause death. The combined group of borderline ABI and high tHcy has highest risk factor of outcomes, which suggested the mutual additive value of borderline ABI and tHcy. More attention should be given to the importance of borderline ABI in hypertensive population, especially with elevated tHcy level.

Homocysteine (Hcy) is a sulfur-containing, non-proteinogenic amino acid synthesized through the transmethylation of amino acid methionine from one-carbon metabolism. Elevated plasma total homocysteine (tHcy) level is associated with endothelial dysfunction, increased blood coagulation, and metabolic disturbance, promoting cardiovascular diseases, stroke, and coronary artery disease.^[1,2] Notably, patients with high Hcy levels and concomitant hypertension were suggested to be at particularly higher risk.^[3] Moreover, increasing studies have explored a positive association between advanced Hcy level with all-cause mortality. According to a recent dose-response meta-analysis, for each 5-μmol/L increment of tHcy levels, the risk for all-cause mortality increased by 33.6%.^[4]The ankle-brachial index (ABI) is an effective, well-established measure that is commonly used in the diagnosis of peripheral artery disease (PAD),^[5] meanwhile was well studied as an important indicator of atherosclerosis and CVD events.^[6] Although ankle-brachial index (ABI) ≤ 0.90 has been recognized as the threshold value for abnormal/low ABI, which was proven to increase the risk of all-cause mortality,^[7] a study from the American Heart Association has suggested ABI between 0.91 and 1.00 should be considered as “borderline area” in terms of cardiovascular risks,^[8] considering of prior probability and sensitivity of ABI calculation. Emerging studies have aimed to explore the predictive value of borderline ABI,^[9-11] however, controversy remains because of limited and inconsistent data. The current study aimed to explore the individual and joint effect of borderline ABI and tHcy on all-cause mortality among hypertensive adults. Although ABI level ≤ 0.90 has been and is going to remain significant in clinical practice, we believe broader concern should be placed on borderline ABI, especially for its value in risk differentiation and identification. To the best of our knowledge, there are no similar previous studies.     

儿童急性白血病骨髓活检免疫标记的研究进展

儿童急性白血病骨髓活检标本能够全面地了解骨髓病态特点,弥补骨髓涂片的不足.随着许多抗体能在石蜡切片上标记,加上抗原修复方法的改进,免疫组织化学已广泛应用于骨髓活检标本.这些特异性抗体不仅能确认微小残留病灶的存在,而且对确定骨髓中的微小浸润病灶极为重要,对临床治疗效果的评价及预后的判断有着积极的意义.该文就可作为儿童急性白血病骨髓活检免疫标记的特异性抗体的研究进展作一综述.     

IgE介导的食物过敏诊断程序及临床评价

目的 对IgE介导的食物过敏的诊断流程进行临床评价。探讨高效的食物过敏诊断程序。方法 0～6岁患儿88例,以支气管哮喘、过敏性鼻炎、特应性皮炎以及消化道症状为主要临床表现,进行食物过敏原皮肤点刺试验（skin prick test,SPT）,皮肤试验阳性者检测血清特异性IgE（sIgE）、sIgE阳性者进一步进行双盲安慰剂食物激发试验（double-blind placebo-control food challenge,DBPCFC）证实诊断。sIsE阴性者通过DBPCFC建立或排除诊断。结果 88例患儿中SPT（＋）者25例。其中SPT（＋）sIgE（＋）者16例,SPT（＋）sIsE（-）者9例;前者经DBPCFC进一步证实为食物过敏的有14例;后者通过DBPCFC建立诊断的3例。排除诊断的6例,根据SPT（＋）sIgE（＋）或SPT（＋）sIsE（-）诊断食物过敏的阳性预计值为87．5％．阴性预计值为77．8％。结论 皮肤点刺试验结合sIgE检测有较高的食物过敏确诊率,当前两者不一致时,需要通过DBPCFC建立诊断。     

嗅球成鞘细胞移植对成年大鼠皮质脊髓束损伤的修复

目的 研究嗅球成鞘细胞(OECs)对成年大鼠皮质脊髓束损伤(CSI)的作用.方法 采用电解损毁大鼠C1-C2脊髓节段的皮质脊髓束(CST)的方法 制备脊髓损伤(SCI)模型.原代培养OECs后移植到SCI大鼠.分别进行斜板实验和皮层运动诱发电位(MEP-C)的记录,测定斜板角度以及潜伏时、阈刺激强度、波幅等电生理指标的改变.结果 与对照组比较,损伤组的斜板角度下降,MEP-C潜伏期延长,阈刺激强度增加,所记录三个峰值均减小,且各项指标均与对照组有显著性差异.这反映出大鼠CST的受损.与损伤组比较,损伤 移植组动物显示出斜板角度增大,MEP-C各项指标中,潜伏期缩短,阈刺激强度减小,所记录三个峰值均增大,且各项指标与损伤组比较有显著性差异.这提示CST的功能恢复.结论 OECs可能有促进CST修复的作用.     

人工股骨头置换治疗老年不稳定性股骨转子间骨折近期疗效

目的探讨人工股骨头置换术治疗老年股骨转子间不稳定性骨折的近期疗效。方法应用人工股骨头置换术治疗高龄、有明显骨质疏松的股骨转子间不稳定性骨折患者20例。结果20例获2-24个月随访,患者术后14-35d负重行走,无坠积性肺炎、尿路感染的发生。术后X线片示假体位置良好,无下沉松动,无脱位,未出现髋内翻。Harris评分为75-92分。1例行走髋关节疼痛,1例9个月时X线片发现髋臼磨损。结论该手术方法具有功能恢复好、并发症少、能早期负重等优点,有临床上推广应用的价值,但应严格掌握其适应证。     

多发性硬化168例临床分析

目的探讨多发性硬化（MS）的临床特点。方法综合分析168例多发性硬化患者的一般资料、病变部位、重要辅助检查及治疗方法。结果168例MS患者最常见的临床症状为肢体无力和感觉异常,其次为肌肉痉挛性疼痛、视力障碍、排便异常、共济失调,个别患者可有周围神经改变。实验室检查示：脑脊液蛋白水平和IgG指数增高最常见。磁共振（MRI）异常率高达90．98％。糖皮质激素治疗有效。结论MS是一种临床表现复杂、累及中枢神经系统白质多部位、病程表现多时相的自身免疫性疾病。根据临床特点,综合神经电生理、脑脊液免疫学及影像学检查能大大提高临床确诊率．茸中磁其据成像意义较大。