基于TCGA数据库构建胃癌免疫相关基因的预后风险模型

目的：基于TCGA数据库构建胃癌免疫相关基因的预后风险模型。方法：于2021年1月-12月利用TCGA数据库下载胃癌以及癌旁组织的RNA测序顺序,并从ImmPort数据库中下载免疫相关基因的数据。分析影响胃癌预后相关IRGs的Cox多因素分析,且依据TCGA数据库中100例胃癌的一般情况,统计影响胃癌患者预后的Cox单因素和多因素分析。结果：影响胃癌预后相关IRGs的Cox多因素分析中,共得到9个IRGs(IL1A、APOH、CGB5、GRP、TNFSF18、LGR6、MC1R、NPR1、CTLA4),其中IL1A、APOH、CGB5、GRP、TNFSF18、MC1R、NPR1为高风险基因,而LGR6、CTLA4为保护性基因。单因素分析结果显示：年龄、临床分析、风险评分差异具有统计学意义（P <0.05）,表明与胃癌预后有关;多因素分析结果显示：风险模型的风险评分可以独立于其他临床指标,作为评估胃癌患者预后的独立因素（P <0.05）。结论：构建免疫相关基因预后风险模型能够较高评估胃癌患者预后情况,且能够为后续的靶向治疗提供一定的帮助。     

影响巩膜扣带术视网膜复位及视力恢复因素的临床观察

Objective To discuss the effect of treatment of rhegmatogenous retinal detachments (RRD) by scleral buckling surgery as well as the relative risk factors affecting the anatomical retinal reattachment and visual recovery. Methods Seventy-two patients (72 eyes) with RRD treated by scleral buckling surgery in our hospital during January 2005 to December 2008 were retrospectively analyzed. Patients were followed up for 6 to 30 months, an average of (13.96± 8.28) months, and observed the rate of postoperative retinal anatomic reattachment, the best corrected visual acuity (BCVA) and complications. The Logistic regression was used to analyze the relative risk factors affecting the anatomical retinal reattachment and visual recovery. Results Retinal reattachment was achieved in 90.28% after initial surgery and the final success rate for anatomic reattachment was 97.22% assessed with ophthalmoscope and B-mode ultrasonography. But the first and final retinal reattachment rates assessed with the optical coherence tomography (OCT) were 59.72% and 77.78% respectively. Postoperative BCVA =0.3 reached to 62.5%. Retinal reattachment was affected by Grade Cl PVR and multiple breaks (P=0.0183 and P=0.0181, respectively). Preoperative visual acuity , macular detachment status and time, as well as the grade of PVR affected visual recovery significantly (P =0.0235, P =0.0124, P=0.0325 and P=0.0357, respectively). The complications included uveitis (13.89%), dysmorphopsia (9.72%), proliferative vitreous retinopathy (6.94%), macular pucker (6.94%), ocular hypertension (4.17%) and diplopia (2.78%). After SB, the anterior chamber depth, axial length, re fraction and astigmatism were all changed significantly (P=0.0260, P<0.0001, P=0.0005 and P=0.0018, re spectively) than before. Conclusions Scleral buckling is an effective technique for managing RRD, but grade Cl PVR and multiple breaks are significant risk factors for anatomic failure. Preoperative visual acuity, macular detachment status and time, as well as the grade of PVR affected visual recovery significantly. Simultaneously, the surgery could make anterior chamber depth decrease and axial extension. The refractive and astigmatic changes after buckling surgery were negative shifted.     

高度近视眼黄斑劈裂的OCT影像特征

Objective To improve our understanding of the morphological characteristics of macular retinoschisis in highly myopic eyes by optical coherence tomography and to discuss the probably associated factors of it. Methods In the retrospective study, 268 patients(369 eyes)with high myopia(spherical equivalent 3≥-6.00D)were included, from which a diagnosis of retinoschisis was given by optical coherence tomography, and observed the area and morphological characteristics of the retinoschisis. The factors that were associated with the occurrence and the development of the retinoschisis were investigated. Results OCT showed that 68 patients(93 eyes)had retinoschisis. Outer schisis was present in 78 eyes, mixed schisis in 14 eyes and inner schisis in 1 eye. The retinoschisis in 2 eyes located far from the macular area, and the other 91 eyes located in the macular area, which were involved into one to four quadrants, in which foveoschisis were present in 53 eyes, and parafoveoschisis in 38 eyes. There were several kinds of types in foveoschisis, companied with other pathological changes, such as vitreoretinal traction, preretinal membrane, foveal detachment and lamellar holes.We proceeded the comparison of the axial length, spherical equivalent, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy in retinoschisis and non-retinoschisis in highly myopic eyes, finding that all the differences were significant(P <0.01), but Logistic regression showed that all the factors above were the risk factors associated with the retinoschisis(P =0.002, 0.027, 0.003, 0.011)except the spherical equivalent(P =0.073). Conclusions OCT can display the area and morphological characteristics of retinoschisis clearly, the retinoschisis is mostly present in the fovea, which is usually involved into the whole macular area, and the outer schisis is common. The occurrence and development of the retinoschisis is associated with the axial length, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy.     

两种fms-样络氨酸激酶受体-1基因片段对磷脂酰肌醇-3激酶/蛋白酶B之间信号通路的影响

目的 观察可溶性fms-样络氨酸激酶受体-1(sFlt-1)基因胞外第2～3区和2～4区对缺氧、高糖环境下视网膜血管通透性及磷脂酰肌醇-3激酶/蛋白酶B(PI3K/Akt)之间信号通路的影响.方法 构建真核表达质粒编码增强型绿色荧光蛋白质粒(pcDNA3.1-EGFP)/s Flt-1(2～3)和pcDNA3.1-EGFP/s Flt-1(2～4),采用酶切、电泳及基因测序鉴定.将实验分为正常对照组、缺氧组和高糖组进行.以羧甲基化匍聚糖(CMD)纳米磁颗粒为基因载体,分别携带两种重组质粒转染缺氧、高糖条件下培养的人脐静脉血管内皮细胞(HUVEC).采用分光光度计检测各组兔视网膜血管对伊凡思蓝(EB)染料的渗漏量.逆转录聚合酶链反应(RT-PCR)和免疫蛋白印迹(Western blot)法分别检测各组细胞PI3K/Akt信号通路下游特异性磷酸化激酶Akt(p-Akt)mRNA和蛋白的表达.结果 缺氧组和高糖组注射转染细胞上清液后,视网膜血管EB渗漏量较正常对照组明显增加(t=2.476,2.515;P值均＜0.01).缺氧组和高糖组转染了pcDNA3.1-EGFP/sFlt-1(2～3)和pcDNA3.1-EGFP/sFlt-1(2～4)后,视网膜血管EB渗漏量较未转染明显降低(t=2.598,2.679,2.386,2.732;P值均＜＜0.01).缺氧组、高糖组HUVEC p-Akt mRNA表达较正常对照组明显上调(t=2.612,2.545;P值均＜0.01),转染pcDNA3.1-EGFP/sFlt-1(2～3)和pcDNA3.1-EGFP/sFlt-1(2～4)后明显下调(t=2.512,2.189,2.372,2.687;P值均＜0.01).缺氧组和高糖组HUVEC p-Akt蛋白表达较正常对照组明显上调(t=2.376,2.712;P值均＜0.01),转染pcDNA3.1-EGFP/sFlt-1(2～3)和pcDNA3.1-EGFP/sFlt-1(2～4)后明显下调(t=2.259,2.391,2.399,2.413;P值均＜0.01).结论 sFlt-1受体胞外第2～3区和2～4区均可抑制缺氧、高糖环境下的视网膜血管通透性增高和PI3K/Akt通路的信号传导.     

仙桃市一起急性血吸虫病突发疫情的调查与处理

一起急性血吸虫感染（简称急感）突发疫情，暴露出仙桃市血防工作中存在春季查灭螺、健康教育、耕牛查治、防护措施及乡镇、乡村医务人员的血防知识及诊断水平“六”个不到位等薄弱环节。     

原发性闭角型青光眼合并白内障超声乳化术治疗的临床观察

目的研究白内障超声乳化联合后房人工晶状体植入术在原发性闭角型青光眼合并白内障的『临床效果。方法对2008年3月至2012年2月在本院治疗的早期原发性闭角型青光眼合并白内障患者42例（48只眼）,施行白内障超声乳化联合后房人工晶状体植入术,术后随访3-12个月。结果术后所有患者术后视力均有明显提高,眼压得到控制,前房均有不同程度的加深,术前关闭的房角有不同程度的开放。结论白内障超声乳化联合后房人工晶状体植入术对于原发性闭角型青光眼合并白内障患者具有提高视力,控制眼压的效果。     

高度近视眼黄斑劈裂的OCT影像特征

目的 观察高度近视眼黄斑劈裂的OCT形态学特征,分析其发生的相关危险因素.方法 回顾性分析268例(369只眼)屈光度≥-6.00D的高度近视眼患者继发视网膜劈裂的OCT表现以及与眼轴长度、屈光度、后巩膜葡萄肿、后极部脉络膜视网膜萎缩变性等因素的相互关系.结果 OCT显示68例(93只眼)存在视网膜劈裂;其中78只眼为外层劈裂,14只眼为混合性劈裂,1眼为内层劈裂.所有存在劈裂眼中,2只眼劈裂远离黄斑区,91只眼位于黄斑区,累及一至四个象限不等,其中53只眼为中央凹劈裂,38只眼为旁中央凹劈裂,中央凹劈裂的形态多样,并伴有视网膜前膜或玻璃体牵引、局限性视网膜脱离、黄斑板层裂孔等改变.所有高度近视眼患者中,视网膜劈裂眼与未发生视网膜劈裂眼的眼轴长度、屈光度、后巩膜葡萄肿、玻璃体牵引或视网膜前膜以及后极部脉络膜视网膜萎缩变性比较,差异均有统计学意义(P均<0.01),Logistic回归结果示:超长眼轴(≥29mm)是视网膜劈裂发生的危险因素,屈光度并不是其发生的危险因素,后巩膜葡萄肿、玻璃体牵引或视网膜前膜以及后极部脉络膜视网膜萎缩变性均是其发生的危险因素(P=0.002,0.073,0.027,0.003,0.011).结论 OCT能明确视网膜劈裂发生的部位,清晰地显示视网膜劈裂的形态特征,视网膜劈裂多发生在黄斑中央凹.可累及整个黄斑区,以外层劈裂多见.视网膜劈裂的发生与超长眼轴、后巩膜葡萄肿、玻璃体视网膜牵引以及后极部脉络膜视网膜萎缩变性等因素有关.

Abstract：

Objective To improve our understanding of the morphological characteristics of macular retinoschisis in highly myopic eyes by optical coherence tomography and to discuss the probably associated factors of it. Methods In the retrospective study, 268 patients(369 eyes)with high myopia(spherical equivalent 3≥-6.00D)were included, from which a diagnosis of retinoschisis was given by optical coherence tomography, and observed the area and morphological characteristics of the retinoschisis. The factors that were associated with the occurrence and the development of the retinoschisis were investigated. Results OCT showed that 68 patients(93 eyes)had retinoschisis. Outer schisis was present in 78 eyes, mixed schisis in 14 eyes and inner schisis in 1 eye. The retinoschisis in 2 eyes located far from the macular area, and the other 91 eyes located in the macular area, which were involved into one to four quadrants, in which foveoschisis were present in 53 eyes, and parafoveoschisis in 38 eyes. There were several kinds of types in foveoschisis, companied with other pathological changes, such as vitreoretinal traction, preretinal membrane, foveal detachment and lamellar holes.We proceeded the comparison of the axial length, spherical equivalent, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy in retinoschisis and non-retinoschisis in highly myopic eyes, finding that all the differences were significant(P <0.01), but Logistic regression showed that all the factors above were the risk factors associated with the retinoschisis(P =0.002, 0.027, 0.003, 0.011)except the spherical equivalent(P =0.073). Conclusions OCT can display the area and morphological characteristics of retinoschisis clearly, the retinoschisis is mostly present in the fovea, which is usually involved into the whole macular area, and the outer schisis is common. The occurrence and development of the retinoschisis is associated with the axial length, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy.     

探讨产后出血原因的急救与护理干预

目的：分析产后出血原因及急救护理干预。方法：2011年4月~2012年1月,在我院住院分娩的54例患者,观察产妇出血状态,分析出血的原因,实施急救及护理。结果：导致产后出血病因：①人流及刮宫病史;②胎盘因素及软产道损伤;③凝血机能差及产妇恐惧紧张心理。④胎儿娩出2h内是产后出血的高发期段,阴道流出的血量超过500ml,发生率占产妇总数的2%~5%。结论：重视妊娠保健,减少非意愿妊娠系数及过期妊娠,做好妊娠期及分晚期护理,预防宫缩乏力,积极有效控制出血,防止脏器衰竭。减少病死率。     

视网膜大动脉瘤临床分析

目的观察视网膜大动脉瘤的临床特征和荧光素眼底血管造影及吲哚菁绿血管造影（FFA、ICGA）及相干光断层扫描（OCT）的图像特征,提高其诊断准确性。方法对14例诊断为视网膜大动脉瘤患者的临床资料和FFA、ICGA及OCT等检查结果进行回顾性分析。结果14例患者中男性5例,女性9例。年龄57～82岁,平均71岁。多数患者伴有高血压、糖尿病等病史。均为单眼发病,单个大动脉瘤瘤体均位于视网膜颞侧动脉分支,其中颞上支动脉10例,颞下支动脉4例;动脉瘤都位于2—3级分支内。瘤体呈灰黄色或红色,周围有不同程度的视网膜出血和环形或弧形渗出。FFA和ICGA检查显示动脉瘤呈圆点状强荧光,晚期有不同程度的荧光渗漏和瘤体壁染,出血呈遮蔽荧光。OCT图像显示视网膜出血使视网膜隆起,视网膜内呈现高反射,出血为暗区,遮挡下方组织反射,水肿呈低反射;可伴有视网膜神经上皮的出血性和（或）浆液性脱离,呈现低反射。结论FFA和ICGA检查有助于视网膜大动脉瘤的早期正确诊断;应掌握视网膜大动脉瘤的临床特征和FFA、ICGA及OCT的图像特征,注意与渗出型年龄相关性黄斑变性（AMD）、成人型Coats病等眼病相鉴别。