血清学生物标志物对急性呼吸窘迫综合征进展及预后的预测研究

目的 探讨血清学生物标志物对急性呼吸窘迫综合征(ARDS)早期诊断预警及预后判断的预测效果.方法 采用多中心、前瞻队列研究的方法,从2014年1月开始纳入各中心收治的ARDS与ARDS高危病例.采集患者的人口学资料,检测患者在入组24 h内的血清学指标(sRAGE、CC16、Ang-2、sICAM-1、PAI-1、SuPAR、HMGB1).采用Logistic回归分析对影响高危ARDS患者发展成为ARDS危险因素和影响ARDS预后的危险因素.用ROC曲线比较单个危险因素或联合多个危险因素对ARDS发生的预警及ARDS死亡预后的预测效果,计算其预测的灵敏度、特异度及约登指数.结果 共纳入ARDS患者59例,ARDS高危患者41例.ARDS发生的独立危险因素有HMGB1、sICAM-1、Ang-2、CC16、PAI-1.其中HMGB1预测效果最好(AUC=0.908),其次根据AUC大小顺序为CC16(AUC=0.861),Ang-2(AUC=0.858),PAI-1(AUC=0.801),sICAM-1(AUC=0.773).单指标分析中,敏感度最高的单指标为HMGB1与sICAM-1,皆为79.7％,特异度最高的指标为HMGB1、CC16与Ang-2,皆为87.8％.在联合预测中,HMGB1与Ang-2联合预测,特异度最高,为95.1％,其AUC也为最高(0.92).HMGB1、Ang-2与PAI-1指标联合预测,敏感度最高,为89.9％.多指标联合预测,可以在一定程度上提高对ARDS诊断预测的灵敏度和特异度.对ARDS预后分析,sRAGE与Ang-2是其死亡的独立危险因素.sRAGE(AUC=0.791)比Ang-2(AUC=0.67)对ARDS患者死亡预测效果好.两指标联合可以提高ARDS死亡预测的特异性.结论 在ARDS高危患者中,HMGB1、sICAM-1、Ang-2、CC16、PAI-1是其发展成为ARDS的独立危险因素.HMGB1与Ang-2联合预测有较好的特异性,HMGB1、Ang-2与PAI-1联合预测有较好的敏感性.对于ARDS患者,sRAGE与Ang-2的增高预示着ARDS患者预后不良,两者联合预测可以提高预测的特异性.     

MicroRNA-93及Tspan1在结肠癌中的表达及其临床病理意义*

目的 探讨microRNA-93（miR-93）及Tspan1在结肠癌组织及细胞中的表达及其临床病理意义,预测两者的靶向调控关系。方法 选取手术切除结肠癌组织及对应癌旁组织74例,人结肠癌细胞株（SW480、SW620、HCT116、CaCo-2、LoVo、HT29）及正常人结肠上皮细胞株（FHC）,分别采用qRT-PCR及Western blotting检测miR-93、Tspan1 mRNA及Tspan1蛋白表达,观察两者在不同临床病理特征患者的表达差异,Pearson法分析miR-93与Tspan1 mRNA的相关性,采用TargetScan及GeneCard软件预测两者的靶向调控关系。结果 与癌旁组织比较,miR-93在结肠癌组织中表达降低（P?<0.05）,Tspan1 mRNA及蛋白在结肠癌组织中表达升高（P?<0.05）;与正常人结肠上皮细胞比较,miR-93在结肠癌细胞株中表达降低（P?<0.05）,Tspan1 mRNA及蛋白在结肠癌细胞株中表达升高（P?<0.05）;miR-93在远处转移、淋巴结转移阳性、血管浸润阳性及高TNM分期患者中低表达（P?<0.05）,Tspan1 mRNA在远处转移、淋巴结转移阳性、血管浸润阳性及高TNM分期患者中高表达（P?<0.05）。Pearson法相关性分析显示,miR-93与Tspan1 mRNA表达呈负相关[r?=-0.735（95% CI：-0.855,-0.535）,P?=0.000]。生物信息学预测,miR-93及Tspan1在3''-UTR区可能具有靶向调控关系。结论 miR-93在结肠癌中低表达,Tspan1在结肠癌中高表达,miR-93及Tspan1具有靶向调控关系,两者可能成为结肠癌的肿瘤标志物或预测因子。     

小儿胸膜肺母细胞瘤

目的探讨小儿胸膜肺母细胞瘤(PPB)的诊断、治疗及预后.方法回顾22例小儿胸膜肺母细胞瘤病例,按Dehuer病理分型为II型者15例、III型7例,对其进行随访.结果22例年龄3个月～10岁,男女比例1∶1.最早出现的症状均为咳嗽,发热19例,呼吸困难13例.早期X线表现肺囊性病4例,气胸1例,胸腔斑、片状影11例,胸腔积液4例,纵隔占位2例.来院前首诊(县、市级医院)误诊率100%,在我院首诊误诊率77.3%,首诊到确诊时间平均(5.4±6.2)个月.出现症状到确诊时间0.5～24个月.手术18例,术后均化疗.随访1个月～12年.生存9例,2年生存率27.3%,5年生存率9.1%.死亡13例,诊断到死亡时间1     

腹腔镜精索静脉高位结扎术治疗精索静脉曲张

目的:探讨腹腔镜精索静脉高位结扎术治疗精索静脉曲张的临床价值。方法:回顾分析腹腔镜精索静脉高位结扎术治疗精索静脉曲张19例患者的临床资料,并评价手术方法的优缺点。结果:19例患者手术均获成功,手术时间20~80m in,基本无出血,术毕拔除导尿管,术后1~4d出院,平均住院2.5d。结论:腹腔镜精索静脉高位结扎术可避免开腹手术的较大损伤和对输精管的误伤,而且双侧可同时手术治疗;尽管费用稍高,仍不失为一种较好的治疗手段。     

促纤维化小圆细胞肿瘤的临床分析

目的 提高对促纤维化小圆细胞肿瘤的认识和诊断水平。方法 回顾性总结本病2例患者的临床、病理资料,结合文献分析该肿瘤的发病情况、组织来源、病理特征、免疫组织化学、诊治及预后。结果 该肿瘤临床表现复杂多样,病理检查肿瘤细胞呈小圆形、核深染、胞浆少且无特殊排列的巢状,其间有大量增生的纤维结缔组织。免疫组织化学检测上皮、神经、肌、间质的相关蛋白细胞角蛋白、上皮膜抗原、结蛋白、神经原特异性烯醇化酶、波形蛋白表达阳性。2例均于术后9个月内相继死亡。结论 该肿瘤临床表现多样,常规检查不能正确诊断,必须进行免疫组化检测确诊。大多预后险恶。     

ox-LDL特异性人血管平滑肌细胞cDNA消减文库的构建

目的:构建ox-LDL特异性人血管平滑肌细胞cDNA消减文库。方法:35％ug/ml ox-LDL刺激培养的人血管平滑肌细胞,利用消减杂交技术,构建cDNA消减文库,并运用蓝白斑筛选和影印杂交进一步确定文库克隆的特异性。结果:成功构建ox-LDL特异性血管平滑肌细胞cDNA消减文库,约2000个白色克隆。影印杂交后共获82个差异表达克隆。结论:消减文库的构建为进一步克隆ox-LDL特异性基因cDNA片段和全长奠定了基础。     

Recombinant adenovirus mediated prostate-specific enzyme pro-drug gene therapy regulated by prostate-specific membrane antigen (PSMA) enhancer/promoter

Gene directed enzyme pro-drug therapy (GDEPT) is one of the adjuvant therapeutic regimens for advanced prostate adenocarcinoma, and this research intended to explore how to apply targeting therapy of prostate adenocarcinoma under the mediation of a promoter/enhancer of prostate-specific membrane antigen (PSMA(EP)) as a specific regulatory element. Recombinant adenoviruses (Ad-PSMA(E-P)-enhanced green fluorescent protein [EGFP], Ad-CMV-EGFP, Ad-PSMA(E-P)-CD, and Ad-CMV-CD) were constructed and could express cytosine deaminase (CD) or the EGFP reporter gene driven by a PSMA(EP) or cytomegalovirus (CMV) promoter. LNCaP, CL-1, MCF-7, and A549 were infected with CD-produced recombinant adenoviruses and treated with pro-drug 5-fluorocytosine (5-FC) in vivo and vitro; then, the growth inhibition of the cells and the cell cycle variation were assessed by an [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] (MTT) assay and flow cytometry. Growth suppression of the xenograft tumor was also adopted to evaluate the efficiency of the suicide system. Morphologic changes after treatment in vivo were assessed with hematoxylin and eosin staining. In the 4 examined cancer cell lines, PSMA-positive prostate cancer cells LNCap and CL-1 were exclusively sensitive to the Ad-PSMA(E-P)-CD/5-FC system. The S phase of cell cycle arrest was thought to be involved in the cytotoxicity of 5-fluorouracil (5-FU) converted from 5-FC by CD. CL-1 implanted Athymic BALB/c mice showed growth inhibition of tumors when they were treated with the Ad-PSMA(E-P)-CD/5-FC system without systemic conversion toxicity. The PSMA-based, CD-produced adenovirus, deserving further investigation in the future, might be a good candidate for targeting gene therapy of prostate adenocarcinoma.     

Does Arthroplasty Provide Better Outcomes Than Internal Fixation At Mid- and Long-term Followup? A Meta-analysis

Background

Arthroplasty has been shown to be superior regarding low risk of reoperation and better function score to internal fixation for treatment of displaced femoral neck fractures at short-term followup. However, there are unanswered questions regarding the efficacy of arthroplasty in the longer term compared with internal fixation.

Questions/purposes

We performed a meta-analysis comparing arthroplasty (hemiarthroplasty or THA) with internal fixation in patients with displaced femoral neck fractures with respect to (1) mortality, (2) reoperation, (3) functional recovery, and (4) complications, including only randomized trials with a minimum of 4 years followup.

Methods

Computerized databases, including PubMed (MEDLINE), EMBASE, Cochrane Register of Controlled Trials databases, and Web of Science^™ were searched for studies published from the inception date for each database to March 2014. Eleven randomized controlled trials that compared arthroplasty (either hemiarthroplasty or THA) with internal fixation for treatment of patients with a femoral neck fracture were included in our analysis. The quality of the trials was assessed according to the Cochrane Handbook and meta-analyses were conducted using RevMan 5.2 software from the Cochrane Collaboration. The heterogeneity among studies was evaluated by the I-squared index (I²) and publication bias was assessed using forest plots.

Results

There were no differences between the internal fixation and arthroplasty groups for patient mortality at mid-term (48.4% vs 46.8%) or long-term followup (83.2% vs 81.5%). Arthroplasty was associated with a lower risk of reoperation at mid-term (7.2% vs 39.8%; relative risk [RR] = 0.10; 95% CI, 0.06–0.07) and at long-term followup (14.3% vs 43.8%; RR = 0.10; 95% CI, 0.06–0.07). Arthroplasty was associated with better functional recovery at mid-term followup (standard mean difference [SMD] = 0.55; 95% CI, 0.02–1.09), whereas function at long-term followup (SMD = 0.14; 95% CI, −0.35 to 0.62) was not different between the arthroplasty and internal fixation groups. There were no significant differences in subsequent ipsilateral fractures (1.5% vs 1.2%; RR = 2.18; 95% CI, 0.32–14.67; p = 0.42) and deep infections (2.7% vs 2.9%; RR = 0.89; 95% CI, 0.40–2.01; p = 0.78) between patients treated with arthroplasty and internal fixation.

Conclusions

Based on our results, we found that compared with internal fixation, arthroplasty may result in a lower rate of subsequent reoperation at mid- and long-term followup, and better mid-term functional recovery. Future studies should investigate the mid- and long-term results of THAs compared with hemiarthroplasty.     

锁定钢板外置与外固定支架固定骨折的生物力学研究

目的 通过对锁定钢板(LCP)外置与外固定支架固定骨折进行生物力学分析,为应用锁定钢板外置固定治疗提供理论依据。方法 选择不同长度的牛小腿骨,制备成骨折标本,分别采用锁定钢板外置固定和外固定支架固定,观察标本在不同载荷下承受的轴向压缩、扭转和弯曲位移。结果 两组在100、200、300、400、500、600和700 N载荷下轴向压缩值比较,均有显著差异(P<0.05),且随着载荷越大轴向压缩值差距越大。两组在4、6、8、10、12和14 N.cm载荷下扭转角度比较,差异均有统计学意义(P<0.05),且随着载荷越大则扭转角度值差距越大。两组在50、100、150、200、250和300 N载荷下弯曲位移值比较,差异均有统计学意义(P<0.05),且随着载荷越大弯曲位移值差距越大。结论 锁定钢板外置固定骨折在生物力学性能上优于外固定支架,可在临床应用,为治疗开放性骨折提供了一种新的方法。