伴远处转移T1期肾癌原发灶行减瘤性肾部分切除术与减瘤性根治性肾切除术的生存分析

  目的  探索和比较原发灶行减瘤性肾部分切除术（cytoreductive partial nephrectomy,cPN）与减瘤性根治性肾切除术（cytoreductive radical nephrectomy,cRN）对于伴远处转移的T₁期肾癌患者的生存获益。  方法  回顾性分析SEER（Surveillance, Epidemiology, and End Results）数据库中934例符合纳入标准的伴远处转移的T₁期肾癌病例,根据手术方式分为cPN组和cRN组。评估934例患者中与cRN与cPN有关的差异因素,再通过倾向性评分匹配消除混杂后,对得到的141对病例进行生存分析,利用Kaplan-Meier生存分析比较配对前后cPN组和cRN组之间的总生存（OS）、肿瘤特异性生存（cancer specific survival ,CSS）的差异。利用Cox多因素风险评估模型评估匹配后OS和CSS的影响因素。  结果  匹配前,142（15.2%）例患者行cPN,792（84.8%）例病例行cRN,cPN组患者OS和CSS均高于cRN组患者（log rank检验, P<0.01）,T_1b期患者接受cPN的可能性比T_1a期患者小。匹配后,Kaplan-Meier分析发现cPN组的OS和CSS比cRN组更高（log rank检验,P<0.01）,多因素Cox回归分析发现选择行cRN是导致OS及CSS不佳的独立危险因素。  结论  对于伴远处转移的T₁期肾癌患者,cPN的预后生存优于cRN。     

磁共振多b值技术对肝脏局灶性病变的诊断价值

目的 探讨磁共振多b值技术在鉴别肝脏局灶性病变中的应用价值,提高对肝脏局灶性病变的正确诊断率。方法 选取我院 2016年9月～2018 年10月行磁共振检查的肝脏占位病变75例患者为研究对象,其中恶性病变患者40例,良性病变患者35例。同时选取同期健康志愿者30名在GE MR750引导下行MR扫描,记录多b值扩散加权成像不同性质肝脏局灶性病变的信号强度、ADC值,观察不同性质病变的b值 信号强度和b值 ADC值曲线的差异、特点。 结果 肝脏局部良性病变者与肝脏局部恶性病变者的肝脏局灶性病变的信号强度、ADC值,不同性质病变的b值 信号强度和b值ADC值曲线均有显著性差异（P＜0.05）。结论 通过MRI扫描序列的设立及多b值的测算,对扫描结果进行综合分析、判断,可鉴别肝脏不同性质局灶性病变的性质,提高正确诊断率,具有较好的诊断价值。     

两种脾气虚证模型大鼠临床证候特征的比较

目的对比研究复合因素法与利血平皮下注射法所致脾气虚证模型大鼠的临床证候特征。方法将30只雄性SD大鼠随机分为正常组、复合因素组及利血平组,分别采用两种方式造模后,通过一般体征指标及证候量化评分评价临床证候表现;旷场实验评价大鼠心理及自主活动;检测血清D-木糖含量判断消化吸收能力。结果与正常组相比,两模型组大鼠证候量化评分总积分及各单项均升高(P<0.05,P<0.001),且利血平组各个单项及总积分均高于复合因素组(P<0.05);两组大鼠自主活动均较正常组减少(P<0.05);与复合因素组相比,利血平组穿格次数、中央区停留时间、活动距离下降尤为明显(P<0.001);与正常组相比,两组大鼠血清D-木糖含量均下降(P<0.01),两模型组之间差异无统计学意义(P>0.05)。结论两种造模方式都可造成大鼠脾气虚证候,但其临床证候表现有所不同,实验时应结合需求进行选择。     

大数据时代下的中医现代目诊数字化平台建设

中医现代目诊是中医人通过对眼科仪器检查结果的分析,联系本人临床经验得出辨证论治的过程,主要包括中西医虹膜诊法、球结膜微循环诊法及观察视网膜血管诊法等。在当今的大数据时代,基于中医理论,通过与大型医院眼科的合作,将大量的眼部图片资源进行整合,利用图像处理等现代技术手段,借助信息挖掘技术建立数学模型,对眼部症状进行量化,探讨全身疾病与眼部症状的相关性,构建一个有系统理论和临床支持的目诊数字化平台,可以为中医诊疗提供一种新的方法。     

联合肌肉减少症建立模型预测结直肠癌术后腹腔内感染风险

目的：分析直肠癌术后腹腔内感染与肌肉减少症之间的关系,并构建联合模型预测腹腔内感染风险。方法：收集383例接受结直肠癌根治术的患者,在手术前收集并测量诊断肌肉减少症的三要素,包括腰椎骨骼肌指数、术前握力和步行速度。通过单因素和多因素分析确定影响腹腔内感染的因素。构建由独立风险因素组成的联合预测模型,以量化结直肠癌术后腹腔内感染的个体风险。结果：383例患者中,有93例被诊断出肌肉减少症,而44例被诊断出腹腔内感染。Logistic分析表明,肌肉减少症、肿瘤大小、年龄是 结直肠癌术后腹腔内感染的独立预后因素（P ＜0.05）。腹腔内感染的联合预测模型能够可靠地预测及量化结直肠癌术后发生腹腔内感染的风险（一致性指数为0.710）。结论：术前肌肉减少症是结直肠癌术后发生腹腔内感染的的独立预测因子。本联合预测模型是一种简单实用的工具,可量化腹腔内感染的个体风险,用于识别高风险患者。     

From the Cover: Early Holocene chicken domestication in northern China

Chickens represent by far the most important poultry species, yet the number, locations, and timings of their domestication have remained controversial for more than a century. Here we report ancient mitochondrial DNA sequences from the earliest archaeological chicken bones from China, dating back to ∼10,000 B.P. The results clearly show that all investigated bones, including the oldest from the Nanzhuangtou site, are derived from the genus Gallus, rather than any other related genus, such as Phasianus. Our analyses also suggest that northern China represents one region of the earliest chicken domestication, possibly dating as early as 10,000 y B.P. Similar to the evidence from pig domestication, our results suggest that these early domesticated chickens contributed to the gene pool of modern chicken populations. Moreover, our results support the idea that multiple members of the genus Gallus, specifically Gallus gallus and Gallus sonneratii contributed to the gene pool of the modern domestic chicken. Our results provide further support for the growing evidence of an early mixed agricultural complex in northern China.In his epochal work on domestication, Darwin suggested that domestic chicken (Gallus gallus domesticus) originated from red jungle fowl (Gallus gallus gallus) ∼4,000 y B.P. in the Indus Valley (1). However, more recent evidence, based on both mitochondrial (mt) and nuclear DNA (2–4), refutes a monophyletic origin of G. g. domesticus. Analyses of large-scale mtDNA datasets (5) strongly suggest that chickens were domesticated multiple times in different parts of Asia, including regions in South Asia, Southwest China, and Southeast Asia. Although some of the earliest chicken bones have been discovered in northern China, dating to over 10,000 B.P. at the Nanzhuangtou site and to over 7,000 B.P. at several other sites (e.g., Cishan and Peiligang), northern China has not yet been suggested as a center of chicken domestication for two main reasons. First, it is unclear if the discovered bones really represent domesticated rather than wild members of the genus Gallus (6), and second, northern China is currently a semiarid steppe, and therefore does not provide suitable habitat for jungle fowl, the wild ancestor of domestic chicken. However, abundant remains of tropical animal and plant species excavated at the Cishan and Nanzhuangtou sites show that northern China was much warmer and more humid, with much more extensive forest coverage during the early Holocene (7, 8), providing a potentially suitable habitat for jungle fowl at this time. Moreover, previous studies have revealed northern China as a center for both early pig domestication (9) and the earliest millet domestication (10, 11) already by 10,000 B.P., showing that agriculture existed in this region at the time to which the earliest chicken bones date.Previous studies (9, 12, 13) have shown that ancient DNA analyses can be informative with regard to determining the places of domestication for a species. The time, region, and pattern of chicken domestication in particular regions over the world have also been worked out using ancient DNA analysis (14–17). However, the oldest chicken sequences analyzed to date are only around 4,000 y old, substantially postdating the beginning of chicken domestication.Therefore, we chose 39 ancient chicken bones from three archaeological sites in the area of the Yellow River (Cishan, Nanzhuangtou, and Wangyin), representing the earliest sites for chicken bones both in northern China and worldwide, and one younger archaeological site in the middle area of the Yangtze River (Jiuliandun Chu Tombs) for ancient DNA analyses (Fig. 1 and Table S1.Open in a separate windowFig. 1.Examples of ancient chicken bones and localities of all investigated samples. (A) Map of China showing the location of the four archaeological sites (red dots). (B) Typical ancient chicken bones unearthed in northern China. (C) Close-up of the Yellow River area from which the samples originate. The sites are marked with yellow dots with white asterisks.

Table 1.

Summary of ancient samples analyzed

Prenatal exposure to PCBs in Cyp1a2 knock‐out mice interferes with F1 fertility,impairs long‐term potentiation,reduces acoustic startle and impairs conditioned freezing contextual memory with minimal transgenerational effects

Polychlorinated biphenyls (PCBs) are toxic environmental pollutants. Humans are exposed to PCB mixtures via contaminated food or water. PCB exposure causes adverse effects in adults and after exposure in utero. PCB toxicity depends on the congener mixture and CYP1A2 gene activity. For coplanar PCBs, toxicity depends on ligand affinity for the aryl hydrocarbon receptor (AHR). Previously, we found that perinatal exposure of mice to a three‐coplanar/five‐noncoplanar PCB mixture induced deficits in novel object recognition and trial failures in the Morris water maze in Cyp1a2^?/?::Ahr^b1 C57BL6/J mice compared with wild‐type mice (Ahr^b1 = high AHR affinity). Here we exposed gravid Cyp1a2^?/?::Ahr^b1 mice to a PCB mixture on embryonic day 10.5 by gavage and examined the F₁ and F₃ offspring (not F₂). PCB‐exposed F₁ mice exhibited increased open‐field central time, reduced acoustic startle, greater conditioned contextual freezing and reduced CA1 hippocampal long‐term potentiation with no change in spatial learning or memory. F₁ mice also had inhibited growth, decreased heart rate and cardiac output, and impaired fertility. F₃ mice showed few effects. Gene expression changes were primarily in F₁ PCB males compared with wild‐type males. There were minimal RNA and DNA methylation changes in the hippocampus from F₁ to F₃ with no clear relevance to the functional effects. F₀ PCB exposure during a period of rapid DNA de‐/remethylation in a susceptible genotype produced clear F₁ effects with little evidence of transgenerational effects in the F₃ generation. While PCBs show clear developmental neurotoxicity, their effects do not persist across generations for effects assessed herein.     

电位滴定法测定尼美舒利含量能力验证结果分析

目的：设计组织尼美舒利含量测定的能力验证项目（编号NIFDC-PT093）,评价药品检测机构电位滴定法的测定能力。方法：对参加实验室的测定结果进行稳健统计分析,用Z比分数评价实验室检测能力。结果：共153家实验室反馈了结果,其中33个参加实验室（占21.6%）的结果可疑或不满意。省级以上食品药品检验机构的满意率（占92.6%）高于其他机构。结论：本次能力验证项目检测结果主要受滴定液、电极、电位滴定仪、空白试验和溶剂的影响,建议离群者可采取调整滴定液浓度、选择合适电极和滴定参数等措施以保证结果的准确。     

PDGF-D与MPO在大肠癌组织中的表达及临床意义

目的探讨血小板源性生长因子D(PDGF-D)与髓过氧化物酶(MPO)在大肠癌组织和大肠腺瘤组织中的表达及其临床意义。方法通过免疫组织化学染色法检测大肠癌组织及大肠腺瘤组织中PDGF-D与MPO的表达及其相关性。采用免疫组化染色方法检测88例大肠癌石蜡包埋组织、72例大肠腺瘤组织中PDGF-D与MPO的表达,并分析MPO和PDGF-D的表达与大肠癌临床病理特征的关系。结果大肠癌组织中PDGF-D与MPO阳性表达率分别为85.23%、63.64%,均显著高于大肠腺瘤组织(34.72%、27.78%),差异有统计学意义(P0.01)。PDGF-D与MPO在大肠癌组织中的表达呈正相关(r=0.29,P0.05)。结论 PDGF-D与MPO可能参与了大肠癌的启动及发生过程,在大肠癌的发生、发展和转移过程中起着重要作用。