右心室不同间隔部位起搏对左心室收缩功能的影响

目的 通过比较右心室心尖部及不同间隔部位（室间隔高位、中位、低位）起搏患者血浆N端B型利钠肽前体（NT-proBNP）水平、QRS时限,探讨右心室不同部位起搏对左心室收缩功能的影响.方法 选择植入VVI或DDD型起搏器患者122例,按照右心室不同起搏部位采用随机数字法分为4组：右心室心尖部起搏（RVAP）组、右心室间隔面起搏高位组（RVSP1组）、右心室间隔面起搏中位组（RVSP2组）、右心室间隔面起搏低位组（RVSP3组）,观察4组患者起搏器植入术前及术后18个月心电图QRS时限、血浆NT-proBNP水平、左心室射血分数（LVEF）、左心室舒张末期容积（LVEDV）以及出现心血管事件等指标.结果 所有患者均顺利完成导线和起搏器植入,并完成随访.心血管事件发生率比较,RVSP2组较RVAP组显著减低（4.5％对40％,P＜0.05）.术后RVAP组QRS时限最宽,RVSP2组起搏QRS时限最窄,差异有统计学意义（P＜0.05）;术后18个月患者RVAP、RVSP1、RVSP3组NTproBNP均有不同程度增加,其中RVAP组最高（P＜0.05）;4组患者LVEDV术后18个月与术前比较,RVSP3组与RVAP组有不同程度增加（P＜0.05）,其中RVAP组增加显著（P＜0.05）;术后18个月RVSP组LVEF均无显著减低（P＞0.05）,而RVAP组显著减低（P＜0.05）.结论 选择右心室中位间隔部起搏,起搏QRS时限最窄,患者NT-proBNP水平低,可能为起搏器植入患者理想的起搏部位.     

症状指数对胃食管反流性咳嗽的诊断价值

 目的 探讨症状指数(SI)诊断胃食管反流性咳嗽(GERC)的价值及其诊断临界值。方法 回顾性分析118例可疑GERC患者的多通道食管腔内阻抗-pH监测记录,结合日记卡分别计算总SI、酸反流SI和非酸反流SI,根据药物抗反流治疗效果,评估SI对GERC的诊断价值,并与症状相关概率(SAP) 的诊断效率进行比较。结果 100例(84.7%)确诊为GERC。以总SI诊断GERC时,诊断临界值为“≥45%”时的诊断效率最高,敏感度和特异度分别为56.0%和83.3%,Youden指数为0.393;酸反流SI和非酸反流SI诊断酸或非酸GERC时,两者的最佳诊断临界值均为“≥30%”,诊断效率也相似。和SAP≥75%相比,总SI≥45%诊断GERC的灵敏度较低 (56.0%比75.0%, χ²=7.988, P=0.005),特异度较高(83.3%比44.4%, χ²=5.900,P=0.015),而阳性预计值、阴性预计值与SAP相比的差异无统计学意义。联合应用总SI和SAP能提高GERC的诊断效能。结论 总SI诊断GERC的价值与SAP相似,最佳取值以≥45%为宜。
        

High prognostic value of minimal residual disease detected by flow-cytometry-enhanced fluorescence in situ hybridization in core-binding factor acute myeloid leukemia (CBF-AML)

Acute myeloid leukemia (AML) is generally regarded as a disorder of stem cells, known as leukemic initiating cells (LICs), which initiate the disease and contribute to relapses. Although the phenotype of these cells remains unclear in most patients, they are enriched within the CD34⁺CD38^? population. In core-binding factor (CBF) AML, the cytogenetic abnormalities also exist in LIC. The aim of this study was to determine the prognostic power of minimal residual disease (MRD) measured by fluorescence in situ hybridization (FISH) in CD34⁺CD38^? cells sorted by flow cytometry at different periods during therapy. Thirty-six patients under 65 years of age with de novo CBF-AML treated with intensive chemotherapy were retrospectively included in this study. Correlations with relapse-free survival (RFS) and overall survival were evaluated with univariate and multivariate analyses. FISH efficiently identified LICs in the CD34⁺CD38^? population. The presence of FISH⁺CD34⁺CD38^? cells before consolidation was negatively associated with cumulative incidence of relapse (64 vs 18 %, P?=?.012), which showed prognostic value for RFS (12 vs 68 %, P?=?.008) and OS (11 vs 75 %, P?=?.0005), and retained prognostic significance for RFS in multivariate analysis. The detection of FISH⁺CD34⁺CD38^? cells before consolidation therapy significantly correlated with long-term survival. Fluorescence-activated cell sorting (FACS)-FISH could be potentially adopted as a MRD monitor approach in clinical practice to identify CBF-AML patients at risk of treatment failure during therapy.     

阻塞性睡眠呼吸暂停低通气综合征患者血清Chemerin、Apelin水平与胰岛素抵抗关系研究

目的探讨男性OSAHS患者血清Chemerin、Apelin水平与胰岛素抵抗的关系。方法选择0sAHS患者65例和健康对照组28例,分别采用酶联免疫吸附法测定所有研究对象血清Chemerin、Apelin水平,应用稳态模型评估胰岛素抵抗指数（HOMA-IR）。结果与对照组比较,OSAHS患者血清Chemerin、Apelin水平及HOMAIR均高于对照组（P值均〈0．05）。血清Chemerin和Apelin-12水平与AHI呈正相关（r=0．541和0．506,P〈0．01）,与LSaO2和MsaO2均呈负相关（r=-0．451,-0．401和-0．428,-0．385,P值均〈0．01）。血清Chemerin和Apelin-12水平与HOMA-1R呈正相关（r=0．438和0．375,P〈0．05）,血清Chemerin与血清Apelin-12水平两者呈正相关（r值=0．511,P〈0．01）。患者HOMA-IR变化与AHI、LSaO2、血清Chemerin和Apelin-12水平呈线性回归关系。结论OSAHS患者血清Chemerin、Apelin水平与胰岛素密切相关,同时与患者严重程度和低氧相关．     

无痛胃镜与常规胃镜检查的前瞻性对照研究

目的探讨临床上无痛胃镜和常规胃镜检查的取舍原则。方法连续选择自愿接受无痛胃镜检查（无痛胃镜组）和常规胃镜检查（普通胃镜组）的患者各400例,检查结束后完成f可卷调查,统计分析2组检查完成情况、操作时间、检查费用以及问卷调查结果。结果无痛胃镜组和普通胃镜组检查完成率分别为100．0％（400／400）和98．0％（392／400）（P=0．004）,操作时间分别为（257．7-I-133．5）S和（214．2±121．3）S（P〈0．001）,平均检查费用分别为人民币574．23形人和268．00形人（P〈0．001）,患者满意度评分分别为4（3～4）分和3（2～3）分（Z=一18．98,P〈0．001）,操作者满意度评分均为4（4～4）分（Z=一2．645,P=0．008）,胃镜检查摄片质量评分分别为（3．13±0．39）分和（3．18±0．50）分（P=0．153）。无痛胃镜组术中有20例（5．0％）发生SpO：下降,既往心血管疾病病史（OR=2．410,95％CI：0．924—6．287,P=0．004）和患者年龄（OR=1．039,95％CI：1．002一I．077,P=0．002）与发生Sp02下降存在关联。无痛胃镜组和普通胃镜组分别有381例（95．2％）和145例（36．4％）（P〈0．001）愿意再次接受相同检查方式检查,其中普通胃镜组男性（P=0．007）、年龄1〉60岁者（P=0．031）、体质量指数≤24kg／m2者（P=0．039）更愿意再次接受常规胃镜检查。结论在中国目前,由于完成率高、检查时间短、费用低,常规胃镜检查仍是上消化道疾病检查不可欠缺的重要方法。内镜医师在建议患者选择胃镜检查方式时,不仅要考虑减轻患者检查中的不适程度,更要根据患者的实际情况,严格把握适应证,在充分利用医疗资源的前提下使患者得到及时的诊治。     

胆管疤痕相关因子在梗阻型胆管损伤后不同时间段的表达

目的:探讨手术时机的选择对胆道修复后吻合口狭窄的影响.方法:运用家犬制作梗阻型胆管损伤的动物模型,通过HE染色及Masson特染分析损伤后胆管壁的结构改变及胶原增生情况,免疫组织化学法测定胆管梗阻损伤后不同时间段巨噬细胞MΦ、α-平滑肌肌动蛋白(α-smooth muscle actin,α-SMA)、转化生长因子-β1(transforming growth factor-β1,TGF-β1)表达情况.结果:胆管损伤后早期(BDL5)出现黏膜水肿,部分弹力纤维断裂,随着梗阻时间延长,黏膜层变薄,成纤维母细胞及胶原组织不断增生,纤维呈无规则排列,随着损伤时间的延长,胶原纤维增生不断增强[28.47±4.06(BDL5)vs59.92±9.13(BDL30)],但是疤痕相关因子MΦ、α-SMA及TGF-β1在损伤后5d即出现高表达[MΦ:0.262±0.031(BDL0)vs0.409±0.034(BDL5),α-SMA:0.239±0.035(BDL0)vs0.387±0.018(BDL5),TGF-β1:0.245±0.033(BDL0)vs0.386±0.029(BDL5),P>0.05],而后随着损伤时...     

EGCG对鼻咽癌CNE-2裸鼠移植瘤放疗的增敏作用及机制

目的探讨表没食子儿茶素没食子酸酯（EGCG）对鼻咽癌裸鼠移植瘤放疗的增敏作用及可能机制。方法将低分化鼻咽癌CNE-2细胞株接种于20只4～6周龄雄性BALA/C裸鼠皮下,肿瘤长至4～6mm时随机分为对照组、EGCG组、放疗组、EGCG＋放疗组。分别采用生理盐水、EGCG、放疗、EGCG＋放疗等干预。21天取出肿瘤,计算肿瘤抑制率;HE染色观察肿瘤细胞形态变化;RT-PCR检测瘤组织Caspase-3mRNA表达。结果与对照组相比,其他三组肿瘤抑制率均明显升高,EGCG＋放疗组显著高于EGCG组及放疗组（P〈0.05）;对照组肿瘤细胞生长旺盛,EGCG组、放疗组、EGCG＋放疗组可见大量凋亡及坏死细胞,其中以EGCG联合放疗组最明显。Caspase-3mRNA表达均明显升高,而以EGCG＋放疗组最为明显（P〈0.05）。结论 EGCG能增强鼻咽癌CNE-2裸鼠移植瘤对放疗的敏感性,其机制可能与上调Caspase-3mRNA的表达有关。     

转化生长因子β1介导的心肌肥厚发生机制研究进展

转化生长因子β是迄今为止已知的最为有效且功能较多的多肽类物质之一。由多种细胞以自分泌、旁分泌和内分泌的方式通过多种受体信号转导通路促进蛋白质的合成,参与调节胚胎发育、细胞生长和分化、细胞增殖与凋亡、胞外基质合成、炎症、创伤修复及免疫反应等许多生物学过程。它分成多个亚型,其中转化生长因子β1促进心肌细胞外基质合成与沉积,是最重要的促心肌纤维化细胞因子,并与多种激素、细胞因子相互作用,促进心肌肥厚的发生发展,本文就此作一综述。     

Expression and cellular distribution of TLR4, MyD88, and NF-κB in diabetic renal tubulointerstitial fibrosis, in vitro and in vivo

Aim

Inflammation and extracellular matrix hyperplasia are crucial in the pathogenesis of tubulointerstitial fibrosis (TIF) involved in diabetic nephropathy (DN). Macrophage accumulation plays a major role, but whether immune factors contribute to DN pathogenesis is not well understood. This study aimed to investigate TLR4-MyD88-NF-κB-dependent pathway's involvement in TIF pathogenesis.

Methods

STZ-induced diabetic rats and rat renal tubular epithelial NRK-52E cells cultured under high glucose conditions were used as in vivo and in vitro models, respectively. Real-time RT-PCR, western blot, immunohistochemistry and immunofluorescence were performed to examine the mRNA and protein levels of TLR4, MyD88, NF-κB, MCP-1, and α-SMA.

Results

Compared with 5.5 mmol/L glucose, treatment of NRK-52E cells with 25 and 50 mmol/L d-glucose resulted in significantly increased TLR4 and MyD88 mRNA and protein levels (P < 0.05). TLR4 and MyD88 were detected in the cytoplasm of most NRK-52E cells cultured under high glucose. Pronounced damage in the renal tubulointerstitium was observed in diabetic rats (scores: 3.82 ± 0.65 vs. 0.38 ± 0.08, P < 0.01). Compared with the normal controls, a sharp upregulation of TLR4, MyD88, NF-κB p65, MCP-1, and α-SMA mRNA and protein levels was observed in diabetic rat kidneys (P < 0.05). In diabetic animals, TLR4 and MyD88 were strongly expressed in the cytoplasm, while NF-κB p65 was widely expressed in cytoplasm and nuclei of renal tubular epithelial cells.

Conclusion

The inflammatory reaction and epithelial-mesenchymal transformation observed in renal tubulointerstitium may be the result of overactivation of the TLR4-MyD88-NF-κB-dependent innate immunity under high glucose, and may be involved in DN occurrence and progression.