The analysis of cell-free DNA concentrations and integrity in serum of initial and treated of lymphoma patients

ObjectiveTo evaluate cell-free DNA (cfDNA) in plasma as a promising biomarker for lymphoma, altered levels of cfDNA and its association with clinical parameters are investigated in patients suffered from lymphomas.MethodsPeripheral blood specimens were collected from 60 patients with lymphoma during initial diagnosis and those of another 107 patients with lymphoma during treated stage were also collected, 93 healthy volunteers were selected as control group. Quantitative PCR was used to detect cfDNA level in each group, cfDNA level in different groups was analyzed to understand its relationship with lymphoma patients' clinical features. After correlation analysis between cfDNA and clinical characteristics, Receiver operator characteristic curve was performed to analyze sensitivity and specificity of cfDNA and LDH.ResultscfDNA concentration and integrity in initial stage of lymphoma patients were significantly higher than those in treated stage, and cfDNA concentration in treated phase was significantly higher than cfDNA concentration in control group. There was no significant difference in cfDNA integrity at treated stage compared with control group. There was no significant correlation between patient's age, gender, extranodal invasion and lymphoma pathological type and cfDNA concentration and integrity; In contrast, there was a significant correlation between ECOG score, LDH content, Ann Arbor stage, IPI, B-symptoms, Ki-67 expression and radiotherapy and cfDNA concentration and integrity, both at the time of initial diagnosis and treated stage. cfDNA concentration detection is an optimal diagnostic indicator, followed by cfDNA integrity detection, the sensitivity and specificity of both are superior to the traditional LDH detection.ConclusioncfDNA level is significantly increased in lymphomas patient plasma and may help lymphoma screening. cfDNA level may serve as a potential indicator of lymphomas treatment efficacy.     

猪囊尾蚴跨膜蛋白T24基因的克隆及序列分析

目的 寻找猪囊尾蚴病新的免疫学候选诊断分子.方法 设计合成引物,用PCR法从猪囊尾蚴cDNA文库中扩增出猪囊尾蚴跨膜蛋白T24基因编码序列,将其与线性克隆载体PMD-18T连接,分别进行酶切和PCR鉴定及DNA测序证实.结果 PCR法扩增出一条长度约678 bp的特异性片段,将重组质粒PMD-18T-T24作BamHⅠ和XhoⅠ双酶切,均能得到一个大小与PCR扩增产物一致的插入片段,对插入片段的测序结果表明,T24具有一个长度为678 bp的完整开放阅读框,编码225个氨基酸,理论分子量为23.91 kDa,与GenBank收录的猪囊尾蚴T24基因(编号为AY211879)具有高度的同源性(99.85%).结论 猪囊尾蚴跨膜蛋白T24编码基因克隆成功,为进一步的表达、鉴定及免疫诊断研究奠定了基础.     

日本血吸虫(大陆株)14-3-3 epsilon同型信号转导蛋白诱导小鼠保护性免疫的研究

目的：探索日本血吸虫新的疫苗候选分子对小鼠的保护性免疫效果。方法：利用已构建的真核表达质粒pBK-Sj14-3-3在大肠杆菌ＢＬ２１内表达的日本血吸虫（大陆株）14－3－3epsilon同型融合蛋白质，免疫6周龄BALB／c雌性小鼠，免疫3次，每次间隔2周，第3次免疫后2周感染尾蚴。42d后剖杀小鼠，计算其减虫率和肝减卵率。结果：各免疫组与对照组相比，均获得了部分抗血吸虫保护性免疫力，第1、2、3各免疫组的减虫率分别为32．7％（P＜0．05）、30．7％（P＜0．05）、27．5％（P＜0．05）；其肝减卵率分别是48．5％（P＜0．05）、43．1％（P＜0．05）、28．2％（P＜0．05）。结论：首次证明日本血吸虫14－3－3epsilon同型重组融合蛋白可诱导小鼠抗血吸虫感染的部分保护性免疫力。     

一种新的商环内环内置手术路径在成人包皮环切中的临床应用研究

目的:观察商环内环内置手术路径行成人包皮环切的手术特点及术后并发症。方法:因包皮过长或包茎就诊的528例成年患者采用商环内置手术路径实施商环包皮环切手术,其中包皮过长465例(88.1%),包茎63例(11.9%)。对手术时间、术中出血;术后感染、水肿、伤口裂开、出血进行观察。结果:528例患者手术时间为(3.8±0.3)min;术中出血量为(0.6±0.1)ml;术后2 h疼痛评分为(7.3±0.3)分。67例(12.7%)患者选择不拆环,让环切器自行脱落,脱落时间为(21.6±2.1)d,461例(87.3%)患者术后第7天复诊时选择拆环,给予拆外环处理,拆环时没有出现疼痛。术后感染3例(0.56%),轻度水肿9例(1.70%)。未发生术后出血及切口裂开,患者对外观满意度为98.1%。结论:商环内置式手术方式安全,不需要拆内环,操作更简便,需要的手术器械少,与标准的商环技术相比,缩短了手术时间,术后并发症发生率低,满意度高。不过,仍需要进行随机对照研究来证实这些优势。     

胰腺腺鳞癌2例报告及文献综述

目的 探讨胰腺腺鳞癌的临床特征、病理学特点、治疗方法和预后情况,以提高认识和诊治水平。方法 回顾性分析皖南医学院弋矶山医院肝胆外科2014年3月和2015年1月分别收治的2例胰腺腺鳞癌病人的临床资料并结合相关文献进行分析讨论。结果 2例胰腺腺鳞癌病人中男女各1例,术前相应的影像学检查提示:胰腺占位性病变,病灶都位于胰腺头部,1例以上腹部胀痛不适入院,另1例以巩膜黄染、尿黄入院。术前血清肿瘤标志物糖类抗原199(CA199)均增高。完善相关检查后,两者均行手术治疗,1例行完全腹腔镜下胰十二指肠切除术,另1例行腹腔镜辅助下胰十二指肠切除术,术后均辅助以化疗。术后病理提示为胰腺腺鳞癌。术后病人得到有效随访。其中1例随访至术后22个月因肿瘤复发死亡,另1例病人因肝脏多发转移于术后第10个月死亡。结论 胰腺腺鳞癌是一种少见的胰腺恶性肿瘤,易出现神经、脉管的侵犯和肝脏、淋巴结以及远处的转移。具有侵袭性强、恶性程度大、预后差的特点。可通过定期体检、早期发现、早期进行手术并辅助以放化疗的综合治疗来提高疗效。     

Reining in Costs of Kidney Dialysis: US Supreme Court Offers Hope to End Predatory Pricing

PurposeTwo for-profit dialysis providers control >70% of the US kidney dialysis market. They use their excessive market power to force private insurers to pay nearly 4 times the Medicare rate, earning exorbitant profits for themselves at the expense of the health care system. Both the legislative and judicial systems have been called on to address this inequity, so far without success.MethodsWe examined the history of this issue as set forth in official Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Federal Trade Commission, and other regulatory documents as well as court filings and opinions. We analyzed the legislative efforts to address the problem and the judicial response.FindingsWe found that most efforts, to date, have failed. However, a 2022 US Supreme Court decision helps illuminate a path forward, in large part by defining the limits of judicial intervention.ImplicationsWe identify a path forward that would separate the monopolistic players using a multipronged effort involving US Department of Justice, Federal Trade Commission, Office of Inspector General, and states attorneys general. We also caution that, based on our research, the providers could challenge further efforts by deciding to withdraw services in certain areas or refuse to do business with certain insurers, resulting in patients having difficulty accessing dialysis.     

安徽南陵凤丹皮最佳采收期的考察

目的研究安徽南陵凤丹皮最佳采收期,为牡丹皮GAP基地建设提供依据。方法分别与2003年3~12月份采集移栽后1~7年生的凤丹药材(每份样品采集15株去木心后干燥)粉碎药材过20目筛,取本品粗粉0.2 g,精密称定,用水蒸气蒸馏,得样品在274 nm测紫外吸收度,计算丹皮酚含量。结果不同采收期凤丹皮的平均产量以8月份为最高,达1 329.4 g/15株;五年生的凤丹皮丹皮酚平均含量最高,达2.97(。结论4~5年生8-11月份为安徽南陵凤丹皮最佳采收期。建议安徽南陵凤丹皮的最佳采收期定为移栽后4年生者9~10月份。     

创伤后重型急性弥漫性脑肿胀临床治疗策略

目的 探讨重型创伤后急性弥漫性脑肿胀（PADBS）患者保守治疗与手术治疗的疗效。方法 分析 2016年1月—2019年12月该院神经外科收治的44例重型PADBS患者,根据治疗方式分为手术组和保守治疗组,统计入院时格拉斯哥昏迷量表（GCS）评分、头颅CT检查情况、伤后6个月格拉斯哥预后量表（GOS）评分等资料。结果 两组患者入院时年龄、性别及GCS评分比较,差异无统计学意义（P>0.05）。两组患者伤后6个月时GOS评分比较,差异无统计学意义（P>0.05）,但两组住院时间比较,差异有统计学意义（P<0.05）,手术组长于保守治疗组。结论 重型PADBS在无瞳孔变化及GCS评分下降的情况下,可密切观察病情下选择保守治疗。     

右腋下小切口在常见先天性心脏病中的应用

目的探讨右腋下小切口治疗常见先天性心脏病的方法和效果。方法应用右腋下施行心内直视手术22例，其中室间隔缺损（VSD）5例，房间隔缺损（ASD）14例，VSD＋ASD3例。结果全组无手术死亡。术后发生腩栓塞1例，右肺不张2例，术后随访21例，随访半个月～32个月，无残余漏发生，患者均恢复良好。结论应用右腋下小切口剖胸治疗常见先天性心脏病安全可靠，创伤小、恢复快、切口隐蔽、美学效果好。     

经食管超声多普勒观察肺静脉及二尖瓣血流估测肺毛细血管楔嵌压的新方法

目的：本文探讨应用多普勒超声联系观察肺静脉血流（PVF）和二尖瓣前向性血流（MIF）估测平均肺毛细血管楔嵌压（MPCWP）的新途径。方法：研究了20例正常人和28例先天性心脏病患者PVF和MIF的特征,并将其多普勒参数及两者结合衍生的指标与经导管检查测得的MPCWP进行相关比较分析。结果：患者房缩期PVF的流速时间积分与周期MIF的流速时间积分之比（Zi/Ai)与MPCWP相关性最佳（MPCWP＝－7．88＋24．13xZi/Ai,SEE=3.24mm Hg,r=0.86,P＜0.01),且多元逐步回归表明：SBP、DBP、HR、age均不影响之。以Zi/Ai＞1．05估测MPCWP＞18mmHg的敏感性100％、特异性93％。结论：Zi/Ai是判定患者MPCWP正常与否的较好指标,本研究提示超声联系观察PVF和MIF可以为无创估测MPCWP提供新途径。