Predictive model of postoperative pneumonia after neoadjuvant immunochemotherapy for esophageal cancer

BackgroundPostoperative pneumonia (PP) is the most common pulmonary complication of esophagectomy. It is of great importance to identify any high-risk factors and prevent pulmonary complications to improve the prognosis of patients with esophageal cancer undergoing esophagectomy. Thus, we established a predictive model of PP in patients with neoadjuvant immunochemotherapy for resectable esophageal squamous cell carcinoma (ESCC), and provide suggestions for the best strategy for the perioperative period of the patients.MethodWe retrospectively analyzed 78 patients who underwent esophagectomy for squamous cell carcinoma after neoadjuvant immunochemotherapy between September 2019 and August 2021.We used the “glmnet” language package in R to perform least absolute shrinkage and selection operator (LASSO) regression to screen the best predictors of PP, and nomograms predicting PP were constructed utilizing screened factors. The performance of nomograms was internally validated by calibration curves, concordance index (C-index), and the Brier score for overall performance.ResultsTwenty-six patients (33.3%) had postoperative pneumonia. After LASSO regression, the factors that were independently associated with PP were diffusing capacity of the lungs for carbon monoxide (DLCO) (P=0.0002), white blood cell (WBC) difference before vs. after neoadjuvant immunochemotherapy (P=0.0133). We constructed a prediction model, plotted the nomogram, and verified its accuracy. Its Brier score was 0.147, its calibration slope was 0.98, and its C-index was 0.85 (95% CI: 0.75–0.95). Internal validation demonstrated a good discrimination power that the actual probability corresponds closely with the predicted probability.ConclusionsOur prediction model can predict the possibility of PP in patients with neoadjuvant immunochemotherapy for resectable esophageal squamous cell carcinoma and may facilitate physicians’ efforts to reduce the incidence of postoperative pneumonia.     

Fluoro-Jade C揭示小鼠匹罗卡品模型中杏仁核神经变性

目的应用Fluoro-Jade C(FJC)染色方法在小鼠匹罗卡品癫痫模型中探测杏仁核结构中神经元的变性情况,以了解杏仁核结构在慢性颞叶癫痫发生中的病理变化和癫痫反复发作的神经基础。方法雄性昆明小鼠6只(对照组3只,匹罗卡品处理组3只)。在癫痫持续状态后12 h处死处理组小鼠。在杏仁核水平切制冠状切片,行FJC染色,在荧光显微镜下观察FJC阳性细胞的形态和在杏仁核中的整体分布情况。结果在处理组,FJC染色的脑切片上可以很清楚地看到呈亮黄绿色荧光的FJC阳性细胞,呈神经元形态,胞体和突起均清晰显示。杏仁核出现大量FJC阳性细胞,而对照组未见。结论该研究在小鼠匹罗卡品癫痫模型中运用FJC染色技术显示杏仁核中发生了大量神经元变性,有利于更好地理解颞叶癫痫中中枢神经系统所发生的病理变化和自发反复发作的癫痫机制。     

MiR-21 mediates the radiation resistance of glioblastoma cells by regulating PDCD4 and hMSH2

The purpose of this study was to investigate the molecular mechanism by which miR-21 and its target genes mediate radiation resistance of glioblastoma cells.Real-time PCR was employed to detect miR-21 expression in normal brain tissues,glioblastoma tissues and glioblastoma cell lines (A172,T98G and U87MG).T98G cells were transfected with anti-miR-21 oligonucleotides,or plasmids containing PDCD4 or hMSH2 (PDCD4-pcDNA3 and hMSH2-pcDNA3).The survival curve was obtained to investigate the sensitivity of T98G cells to radiation.Cell apoptosis was measured by using the Caspase-3/7 kit and cell cycle by flow cytometry.Western blotting was performed to detect the expression of hMSH2 and PDCD4 in miR-21-inhibiting T98G cells.The results showed that miR-21 expression in glioblastoma cells and tissues was conversely associated with the radiation sensitivity.Over-expression of miR-21 resulted in radiation resistance,while knockdown of miR-21 led to higher sensitivity of glioblastma cells to radiation.After miR-21 knockdown,the apoptosis of T98G cells was significantly increased and the G2 phase arrest was more significant.In addition,miR-21 knockdown increased the expression of endogenous PDCD4 and hMSH2,which contributed to the apoptosis and G2 arrest of T98G cells.The findings suggested that miR-21 may mediate the resistance of glioblastoma cells against radiation via its target genes PDCD4 and hMSH2.MiR-21 and its target genes may be used as potential molecular targets for clinical radiotherapy sensitization in the future.     

正常压力性脑积水临床特点及手术疗效

目的 分析、探讨正常压力性脑积水发病机制、临床特点、手术指征及疗效.方法 回顾性分析我院自2005年1月-2015年1月采用侧脑室-腹腔分流术治疗53例正常压力性脑积水患者临床资料.结果 随访0.5~3年,总有效率为79.2%,无效率为20.8%,不良反应发生率为5.6%,不同临床特点患者的疗效有显著性差异(P<0.05).结论 提高对正常压力性脑积水认识,尽早确诊,选用合适压力的分流管,及时行脑室-腹腔分流术,注意防治并发症,以提高手术疗效.     

COX-2选择性抑制剂valdecoxib对LPS刺激牙龈成纤维细胞生成PGE2的影响

目的:观察valdecoxib对细菌脂多糖(lipopolysaccharides,LPS)刺激人牙龈成纤维细胞(human gingival fibroblasts,HGFs)生成前列腺素(prostaglandin E2,PGE2)水平的变化?方法:采用ELISA法定量检测LPS及valdecoxib处理后对体外培养的HGFs生成PGE2水平的改变?结果:1~100 ng/ml LPS处理可明显促进HGFs产生PGE2,其作用效果呈浓度依赖和时间依赖关系;6.25~100 μmol/L valdecoxib 能够明显抑制LPS促HGFs产生PGE2的作用,且其抑制作用呈剂量依赖性关系?结论:valdecoxib能明显抑制LPS促HGFs产生PGE2的作用?     

三仙信力胶囊对小鼠耐缺氧能力的实验研究

目的:探讨三仙信力胶囊对小鼠耐缺氧能力的影响.方法:对实验小鼠进行耐缺氧等实验观察.结果:三仙信力胶囊对小鼠缺氧等应激耐受性的影响显著,可明显延长实验动物在缺氧情况下的生存时间.结论:三仙信力胶囊具有明显的增强机体耐缺氧能力的作用.     

合并白内障的增殖性糖尿病视网膜病变联合手术效果及并发症的观察

目的探讨合并白内障的增生性糖尿病视网膜病变（proliferativediabeticretlnopathy,PDR）玻璃体切除联合超声乳化人工晶状体植入术的临床效果及并发症。方法回顾性分析2006年3月至2010年1月本院手术治疗的合并白内障的增生性糖尿病视网膜病变患者228例（236只眼）。其中男108例,女120例;年龄39—76岁,平均57岁;糖尿病史2～26年,眼病史1月至8年。结果术后平均随访时间分别为6～16个月。患者手术后视力较术前提高198眼（占86．8％）,不变15眼（占6．6％）,术后视力下降或光感消失15眼（占6．6％）;术后前房内纤维素渗出膜形成有76眼（占33．3％）,观察1W～3个月完全吸收的有65眼（占85．5％）;术后角膜水肿、上皮愈合慢有52只眼（占22．8％）,有1例经3个月的营养角膜治疗,最终恢复正常;术后发生后囊膜混浊（后发障）156眼（占68．4％）,于取油同时处理,不注油者单行YAG激光切除;术后网膜再增殖,牵引网脱,或玻璃体再积血者16例（占7．0％）,均再行玻璃体切割术联合剥膜、注油。结论玻璃体切除联合超声乳化白内障摘除人工晶状体植入术治疗增殖性糖尿病视网膜病变是安全、有效的,术后并发症少,能迅速恢复患者视力,减少患者多次手术的痛苦。     

红花黄色素缓解大鼠心肌缺血的作用

目的研究红花黄色素(SY)对异丙肾上腺素(ISO)诱发的大鼠心肌缺血的作用。方法多次ipISO造成大鼠心肌缺血模型;观察大鼠血压、Ⅱ导联心电图J点的改变和出现T波倒置的阳性率,以及光镜下心肌组织形态学的变化;荧光素酶生物发光法测定心肌组织ATP量;硫代巴比妥酸比色法测量心肌组织丙二醛(MDA)量;Falholt法测定血浆脂肪酸(FFA)量。结果SY可明显抑制ISO诱导的大鼠心肌缺血所致最大收缩压、平均收缩压、平均动脉压降低;缓解心肌缺血导致的心肌MDA、血浆FFA水平升高及心肌ATP量的降低,同时SY还可减少心肌缺血后心电图出现T波倒置的阳性率(P<0.05);但对大鼠心电图J点抬高和缺血心肌细胞组织形态学变化未见明显改善。结论SY具有缓解大鼠心肌缺血的作用。     

胃癌根治术后胃瘫综合征的临床诊断

目的探讨胃癌根治切除术后胃轻瘫综合征(postsurgical gastroparesis syndrome,PGS)的病因、诊断及治疗方法。方法回顾性分析作者医院2006/2012年行择期胃癌根治术的612例患者资料,将年龄、性别、手术方式(毕Ⅰ/毕Ⅱ)、体质量指数(body mass index,BMI)、TNM分期、肿瘤大小、伴糖尿病、伴神经系统疾病、围手术期精神药物使用,作为临床相关因素,采用Logistic多因素回归分析确定PGS的分布与临床因素之间的相关性;患者治疗前后采用总症状评分(total symptom score,TSS)比较。结果 612例中有41例出现PGS表现,发生率为6.7%。患者症状主要为恶心,呕吐,腹胀,早饱,腹痛。胃镜检查能顺利通过吻合口,未见机械性梗阻征象。核素标记餐(99 Tcm-DTPA标记混合餐)胃排空显像证实胃排空延迟,性别、伴糖尿病、伴神经系统疾病以及精神药物使用与PGS显著相关。所有患者经保守治疗后均治愈。结论术后胃轻瘫由多因素导致,胃镜检查与胃肠道造影是重要的诊断方法。     

蝙蝠蛾拟青霉菌丝体的研究现状

  目的  探讨蝙蝠蛾拟青霉复合胶囊对四氯化碳与酒精所致小鼠急性肝损伤的保护作用。  方法  分别采用四氯化碳和酒精灌胃诱导小鼠急性肝损伤模型,测定四氯化碳急性肝损伤模型小鼠血清中丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）的含量及酒精急性肝损伤模型小鼠肝组织中丙二醛（MDA）、甘油三酯（TG）、还原型谷胱甘肽（GSH）的含量并观察2组肝组织切片病理形态学变化。  结果  蝙蝠蛾拟青霉复合胶囊675、2 025 mg/kg BW 剂量组四氯化碳急性肝损伤小鼠血清的ALT、AST含量均低于模型对照组,差异具有统计学意义（P < 0.05）。急性酒精性肝损伤模型中,675、2 025 mg/kg BW剂量组的MDA含量和3个剂量组的TG含量明显低于模型对照组,675、2 025 mg/kg BW剂量组的GSH含量明显高于模型对照组,差异均具有显著性（P < 0.05）。小鼠肝组织形态学结果表明,四氯化碳肝损伤模型肝组织中、高剂量组的肝脏细胞坏死程度与模型对照组比较积分显著下降,差异具有显著性（P < 0.05）,各剂量组气球样变积分和高剂量组水样变程度积分也较模型组有显著性降低（P < 0.01）;蝙蝠蛾拟青霉复合胶囊能显著改善急性酒精性肝损伤小鼠肝细胞脂肪变性程度,差异具有显著性（P < 0.05）。  结论  蝙蝠蛾拟青霉复合胶囊对小鼠急性肝损伤具有较好的辅助保护功能。