宏基因组二代测序辅助诊断Q热脊柱感染1例报道

<正>Q热是一种在世界各地发生的人畜共患病,其病原体为贝纳特柯克斯体即Q热立克次体(Coxiella burnetii),以急性疾病为主。其中,2%～7%的急性Q热患者可发展为慢性Q热^[1],包括心内膜炎(60%～70%)、血管移植物感染、非典型肺部感染,极少数是脊柱感染^[2-6]。     

贞芪扶正制剂联合含铂化疗对肺癌患者免疫功能影响的Meta分析

目的系统评价贞芪扶正制剂联合含铂化疗对肺癌患者免疫功能的影响,为临床用药提供循证医学依据。方法计算机检索PubMed、EMBase、Cochrane Library、中国知网(CNKI)、维普中文科技期刊(VIP)、万方数字化期刊(Wangfang Data)、中国生物医学文献(CBM)等数据库,检索时限从各数据库建库时间至2020年5月,搜索贞芪扶正联合含铂化疗药对比单纯含铂化疗药治疗肺癌的临床随机对照试验(RCT)。对纳入研究质量评价后,提取数据并运用RevMan5.3软件进行Meta分析。结果共纳入10个RCT,总样本数为844例,试验组使用贞芪扶正联合含铂化疗428例,对照组单用含铂化疗416例。分析结果显示,与单纯含铂化疗相比,贞芪扶正制剂联合含铂化疗治疗肺癌可以改善肿瘤客观缓解率[RR=0.65,95%CI(0.53,0.78),P0.01];增强机体CD3~+水平[MD=4.78,95%CI(2.29,7.27),P0.01]、CD4~+水平[MD=5.15,95%CI(3.10,7.20),P0.01]、CD8~+水平[MD=3.42,95%CI(1.28,5.55),P0.05]、CD4~+/CD8~+水平[MD=0.23,95%CI(0.12,0.35),P0.01]、Th1/Th2水平[MD=2.69,95%CI(2.24,3.13),P0.01]、Th17/Treg水平[MD=0.30,95%CI(0.21,0.39),P0.01];提高机体NK细胞百分比[MD=3.37,95%CI(1.49,5.25),P0.01]。结论在常规含铂化疗的基础上加用贞芪扶正制剂可以提高肺癌患者化疗的近期疗效,增强机体免疫功能。由于纳入研究质量有限,仍需更多高质量的RCT来予以验证。     

胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

骨髓基质细胞联合细胞因子对脐血单个核细胞表面抗原表达的影响

背景：课题组已建立胎儿骨髓基质细胞联合细胞因子的造血细胞体外培养体系,该培养体系能否有效扩增各个发育阶段的造血细胞有待验证。目的：观察骨髓基质细胞联合细胞因子培养体系对脐血单个核细胞表面抗原CD133、CD34表达的影响。方法：将从脐血标本中分离出来的单个核细胞接种于无血清培养体系,实验分为3组：①F组：干细胞因子＋Flt3配体＋促血小板生成素＋单个核细胞。②S组：基质细胞＋单个核细胞。③SF组：基质细胞＋干细胞因子＋Flt3配体＋促血小板生成素＋单个核细胞。在第0,6,10,14天检测有核细胞总数、CD133^＋、CD34^＋、CD133^＋CD34^＋细胞数以及集落形成单位数。结果与结论：SF组有核细胞总数在各个检测时间点均比其他两组高;除了第14天外,第6、10天两个时间点SF组中CD133^＋、CD34^＋、CD133^＋CD34^＋细胞及集落形成单位数均高于其他组;含骨髓基质细胞的S组和SF组中CD133＋细胞/有核细胞、CD34＋细胞/有核细胞、CD133＋CD34＋细胞/有核细胞的比例保持在较高的水平。结果说明骨髓基质细胞联合细胞因子能有效的扩增脐血单个核细胞及其中的CD133^＋、CD34^＋、CD133^＋CD34^＋细胞,基质细胞对维持造血干细胞的原始性具有重要的作用。     

扶正抑瘤法治疗激素非依赖性前列腺癌临床疗效观察

目的 寻求激素非依赖性前列腺癌的有效治疗方法.方法 在总结病因病机的基础上,予以激素非依赖性前列腺癌扶正抑瘤法治疗(治疗组),通过观察患者临床症状缓解程度、PSA水平变化、生存质量评分、局部病灶变化,了解扶正抑瘤法治疗激素非依赖性前列腺癌的疗效.结果 扶正抑瘤法改善激素非依赖性前列腺癌临床症状的有效率为78.94%,与对照组比较差异有统计学意义(P<0.05);且治疗组PSA值下降＞50%者有效率为73.68%,与对照组比较差异有统计学意义(P<0.01);在生存质量方面,治疗组的Karnofsky评分在治疗前后差异有统计学意义(P<0.01),而对照组前后对比差异无统计学意义;但治疗组及对照组的局部病灶体积在治疗前后的差异均无统计学意义(P>0.05).结论 扶正抑瘤法可有效改善激素非依赖性前列腺癌的临床症状、有利于患者PSA水平控制,同时可提高患者生存质量.提示扶正抑瘤法是有效治疗激素非依赖性前列腺癌方法之一.     

冠心病患者血清糖化蛋白与内源性分泌型晚期糖化终产物受体水平及意义

目的：测定冠心病患者血清糖化蛋白（GSP）和内源性分泌型糖化终末产物受体（esRAGE）水平，探讨GSP、es-RAGE水平及GSP／esRAGE比值对判断冠心病的存在及冠状动脉病变严重程度的价值.方法：入选患者135例，根据冠脉造影结果和有无糖尿病分为：单纯冠心病组（52例），冠心病合并糖尿病组（48例），正常对照组（35例），根据冠状动脉病变支数分为：单支病变组（24例），双支病变组（29例）和三支病变组（47例）。测定各组血清GSP和eaRAGE水平，计算GSP／esRAGE比值。结果：冠心病合并糖尿病组GSP水平和GSP／esRAGE比值显著高于单纯冠心病组（均P〈0．01）及对照组（均P〈0．011），单纯冠心病组显著高于对照组（P〈0．01）；冠心病合并糖尿病组esRAGE显著低千单纯冠心病组（P〈0．01）和对照组（P〈0.01），单纯冠心病组明显低于对照纽（P〈0.01）；GSP（rs=0.460，P〈0．01）、esRAGE（rs=-0，542，P〈0.001）、GSP／esRAGE比值（fs=0．536，P〈0．001）与冠状动脉病变支数显著相关。结论：血清GSP、esRAGE水平及GSP／esRAGE比值对评价血糖正常或糖尿病患者冠心病的存在和冠状动脉病变程度具有重要临床价值。     

特定体位下损伤方式1例法医分析

1 案例资料 死者,女,24岁,与嫌疑人(男,30岁,173 cm)发生争执时被刺伤,送医院抢救无效死亡.尸体检验:尸长163 cm,发育正常.上身穿红色毛衣,其右侧领口下28 cm、距中线5 cm处有一1.7 cm长的破裂口,创角外钝内锐;内穿粉红色秋衣,其左衣领下16 cm、距中线2 cm处有一1.8 cm长的破裂口,创角外钝内锐,破口周围均有血迹.     

胸段食管癌切除术患者的预后分析

Objective To investigate the prognostic factors and influence of the number of lymph node metastases on survival and UICC-TNM classification in patients with thoracic esophageal cancer after curative resection. Methods From 1985 to 1990, 1224 patients were surgically treated for thoracic esophageal cancer. The patients who died within 30 days after operation were not included in this study. Fifteen factors possibly influencing survival of these patients were selected and analyzed. A multivariate analysis of these individual variables was performed by Cox proportional hazard model. According to the n, mher of lymph node metastases (0, 1 and ≥ 2), a new modification of the TNM classification was suggested: stage Ⅱ a (T2N0M0 and T3N0M0), stage Ⅱb [T1N1M0 and T2N1 (1) M0], stage Ⅲ a [T2N1 (2)M0 and T3N1 (1)M0] and stage Ⅲ b [T3N1 (2)M0 and T4NanyMO]. Results According to multivariate analysis, lymph node metastases, depth of invasion, location of tumor, histological classification and length of the tumor were of prognostic significance (P < 0.01). There was obvious correlation between the rate of lymph node metastasis and the depth of invasion, length of tumor and grade of differentiation. The 5-year survival rate of the patients with 0, 1 and ≥2 positive metastatic lymph nodes was 59.1%, 32.0% and 8.9%, respectively. The 5-year survival rate of the patients with stage T2N1M0 and stage T3N1M0 was significantly higher in those with only one lymph node involved than in those with two or more lymph nodes involved (43.1% vs. 18.0% and 28.0% vs. 9.6%, P<0.01). The 5-year survival rate of the modified stage Ⅱa, Ⅱb, Ⅲa and Ⅲb was56.5%, 43.9%, 25.6% and 11.1%, respectively, with a statistically significant difference among different stages (P < 0. 01). Conclusion The lymph node metastasis is the most important prognostic factor for thoracic esophageal cancer after resection. The major influencing factors of lymph node metastasis are the depth of invasion, length of tumor and grade of differentiation. Therefore, the lymphadenectomy along with esophngectomy and subsequently combined modality therapy against lymph node metastasis is necessary to improve the S-year survival rate. Our proposed new classification based on number of lymph node metastases (0, 1, ≥2 positive nodes) is more applicable because it can well reflect the correlation between lymph node metastasis and the survival, and provides evidence for the modification of the currently used UICC TNM staging system for surgically treated thoracic esophageal cancer.     

缩泉止遗胶囊提取工艺研究

缩泉止遗胶囊由黄芪、益智仁、补骨脂等药物组成 ,具有补肾健脾、缩泉止遗功能 ,临床上主要用于治疗遗尿症。本文采用正交试验法对该制剂的提取工艺进行了考察 ,优选出了最佳提取工艺 ,现报告如下。1　仪器、试剂和药材UV - 2 6 0紫外分光光度计 (日本岛津 )。所用试剂均为分析纯 ;药材购自郑州市医药公司。2　实验方法和结果根据处方中药物的理化性质 ,我们采取了总皂苷的吸收度作为考察指标 ,采用L9(34)正交方案进行试验 ,试验因素水平见表 1。2 .1　总皂苷测定方法最大吸收波长的测定[1] :吸取提取液 2ml,置分液漏斗中 ,加水饱和的正丁…     

脑肽精对阿尔茨海默病模型大鼠的治疗作用

目的 :观察脑肽精 (BPC)对阿尔茨海默病 (AD)大鼠学习记忆力的影响。方法 :雄性SD大鼠 84只 ,随机分成 7组 ,每组 1 2只。Ⅰ组为正常对照组 ,Ⅱ组为AD模型组 ,Ⅲ组为AD模型 +生理盐水组 ,Ⅳ组为AD模型 +脑复康 0 .3g/kg治疗组 ,Ⅴ组为AD模型 +BPC 1 5mg/kg治疗组 ,Ⅵ组为AD模型 +BPC 30mg/kg治疗组 ,Ⅶ组为AD模型 +BPC 6 0mg/kg治疗组。采用大鼠脑组织立体定位微量注射技术 ,用鹅膏蕈氨酸 (IBO)损毁大鼠双侧迈纳特基底核 (nbM)。手术后BPC连续灌胃 2 0d ,1次 /d ,每次 2ml。灌胃期满后即做迷宫实验及跳台实验以测学习、记忆能力。结果 :①与正常对照组比较 ,模型组的学习记忆能力均显著下降 (P <0 .0 1 ) ;②与模型组比较 ,生理盐水组无明显改变 (P >0 .0 5 ) ;③与模型组比较 ,脑复康组及BPC各浓度组的学习记忆能力均显著升高 (P <0 .0 1 )。结论 :脑肽精对AD模型大鼠有良好的治疗作用