弥漫性轴索损伤脑脊液神经元特异性烯醇化酶的动态变化及意义

目的 探讨弥漫性轴索损伤(DAI)病人脑脊液神经元特异性烯醇化酶(NSE)的动态变化及其临床意义.方法 分别用放射免疫测定法检测76例DAI病人(实验组)和15例无神经系统疾病者(对照组)的脑脊液NSE含量.实验组根据入院时GCS评分分为轻型组23例、中型组27例和重型组26例.分别于颅脑损伤后12h、1d、3d、7d、14d采集脑脊液标本,分析NSE水平与颅脑损伤严重程度及预后的关系.结果 与对照组比较,轻型组伤后12 h～3 d、中型组伤后12h～7d、重型组伤后12 h～14 d的NSE水平均明显增高(P＜0.05)；重型组各时间点NSE水平明显高于轻型组和中型组(P＜0.01).随访3个月,轻型组、中型组和重型组预后不良率分别为0％、14.81％及73.08％.结论 脑脊液NSE水平可作为判断DAI损伤程度及预后的指标,并指导选择和调整治疗措施.     

Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer

Introduction: Esophageal cancer is the fourth most common cause of cancer death in China. Patients with esophageal cancer are more likely to suffer from malnutrition. The purpose of this study is to assess nutritional status of patients with esophageal cancer from multiple perspectives and analyze the risk factors. Methods: A total of 1482 esophageal cancer patients were enrolled in the study. We investigated the Scored Patient Generated Subjective Global Assessment (PG-SGA) scores, NRS-2002 scores, Karnofsky performance status scores, anthropometric, and laboratory indicators of patients. Unconditional logistic regression analysis was applied to identify the risk factors of nutritional status. Results: PG-SGA (≥4) and NRS-2002 (≥3) showed the incidence of malnutrition were 76% and 50%, respectively. In the patients with PG-SGA score ≥4, the proportion of patients who did not receive any nutritional support was 60%. The incidence of malnutrition in females was significantly higher than that in males. Besides, abnormality rates of Red blood cell (P < 0.001), MAC (P = 0.037), and MAMC (P < 0.001) in males was significantly higher than that in females, while abnormality rates of TSF (P < 0.001) was lower than that in females. After adjusted with the other potential risk factors listed, unconditional logistic regression analysis indicated smoking (odds ratio: 2.868, 95% confidence interval: 1.660-4.954), drinking (OR: 1.726, 95% CI: 1.099-2.712), family history (OR: 1.840, 95% CI: 1.132-2.992), radiotherapy or chemotherapy (OR: 1.594, 95% CI: 1.065-2.387), and pathological stage (OR: 2.263, 95% CI: 1.084-4.726) might be the risk factors of nutritional status, while nutritional support can reduce the risk of malnutrition. Conclusion: Effective nutritional risk assessment methods and nutritional intervention measures can be adopted according to the research data to improve quality of life of esophageal cancer patients.     

晚期非小细胞肺癌Survivin的表达与铂类耐药性及预后的研究

目的：探讨凋亡抑制蛋白存活素（ Survivin ）在晚期非小细胞肺癌（ NSCLC ）组织中的表达及其与含铂类方案化疗疗效之间的关系。方法应用免疫组化SP法检测82例应用含铂类方案化疗的晚期NSCLC患者癌组织中Survivin蛋白的表达,并结合临床病理指标等进行分析。结果82例患者中Survivin 阳性表达65例（79．3％）;Survivin表达与性别、年龄、病理类型、临床分期、化疗有效率、中位生存期无关（ P＞0．05）。Survivin阳性者1年生存率为23．1％,低于Survivin阴性者的52．9％（P＜0．05）。结论 Survivin表达阴性的NSCLC患者应用含铂类方案化疗可能获得生存受益。 Survivin表达阳性可能存在铂类药物耐药,Survivin的表达可能成为NSCLC个体化治疗的分子预测指标。     

丹参对大鼠肾问质纤维化肾组织TSP-1、VEGF及TGF-β1表达的影响

目的观察丹参提取液对肾纤维化模型大鼠肾组织血小板反应蛋白1（TSP-1）、血管内皮生长因子（VEGF）及转化生长因子-β1（TGF-β1）表达的影响。方法用单侧输尿管结扎方法复制大鼠肾纤维化模型,同时给予丹参提取液灌胃预防,并设立空白对照组、模型对照组,分别于造模2周后取大鼠肾脏组织,分别采用Masson染色观察各组大鼠肾组织病理变化,并采用免疫组织化学方法测定肾间质TSP-1、VEGF、TGF-β1的表达。结果丹参组VEGF表达明显增加,而TSP-1和TGF-β1的表达量明显低于模型组（P〈0．05）;丹参组和空白组比较,二者对TSP-1、TGF-β1及VEGF表达的影响无显著差异（P〉0．05）。结论丹参提取液可能通过调控TSP-1、TGF-β1及VEGF的表达,从而干预肾纤维化的发生。     

Species spectrum of nontuberculous mycobacteria isolated from suspected tuberculosis patients,identification by multi locus sequence analysis

Identification of Mycobacterium species is difficult due to a complex and rapidly changing taxonomy, the failure of 16S rRNA to discriminate many closely related species and the unreliability of phenotypic testing. We investigated a collection of nontuberculous mycobacteria (NTM) strains isolated from suspected tuberculosis patients at Tuberculosis Reference Centre (Ahvaz, Iran) and Masoud Laboratory (Tehran, Iran) during 2008–2012 to evaluate the species spectrum of NTM isolates.Based on phenotypic tests, the isolates were identified up to species or complex level; however they were heterogonous by hsp65-PCR restriction fragment length polymorphism analysis (PRA) method. Representative isolates from each hsp65-PRA pattern, were subjected to identification using single locus and multi locus sequence analysis (MLSA) based on 16S rRNA, rpoB, hsp65 and 16S–23S internal transcribes spacer (ITS) fragments to determine their taxonomic affiliations.All 92 NTM isolates from different clinical specimens were considered as etiological agents causing disease according to American Thoracic Society (ATS) guideline. Phenotypic evaluation alone assigned 66 (72%) isolates to a species or complex level and consequently 76 (82%) isolates showed previously reported hsp65-PRA patterns. Although sequence base identification using single locus such as 16S rRNA, rpoB, hsp65 or ITS identified the isolates up to species level, MLSA correctly identified 16 different species of NTM from clinical isolates. In summary, four-locus MLSA is a reliable method for elucidating taxonomic data and reliable species identification of Mycobacterium isolates and therefore, would be more feasible for routine use in Tuberculosis (TB) reference laboratory.     

De-escalating Locoregional Therapy for Axillary Micrometastases in Breast Cancer: How Much is Too Much?

BackgroundThe applicability of modern prospective data on adjuvant radiotherapy (RT) fields in patients with micrometastases is limited because many trials occurred prior to routine measurement of nodal metastasis size and modern sentinel lymph node evaluation techniques. We aimed to determine prognostic factors for patients with micrometastases and evaluate the impact of adjuvant RT on disease outcomes.Patients and MethodsPatients diagnosed with pathologic T1-T3 N1mi breast cancers between 2004-2015 were identified. Cox proportional hazards methods were used to determine characteristics predictive of locoregional recurrence (LRR). Tumor and treatment-specific factors were further evaluated using log-rank statistics to compare rates of LRR-free survival.ResultsThis analysis included 156 patients. On multivariable analysis, grade 3 histology (HR 10.84, 95% CI 2.72-43.21) and adjuvant RT (HR 0.22, 95% CI 0.06-0.81) were independent predictors of LRR. Among patients with grade 1-2 histology, 5-year LRR-free survival was 98.8% in patients who received adjuvant RT versus 100% in patients who did not receive adjuvant RT (P = .82). Among patients with grade 3 histology, 5-year LRR-free survival was 90.1% in patients who received adjuvant RT versus 53.0% in patients who did not receive adjuvant RT (P = .025), and 100% in patients receiving comprehensive nodal irradiation versus 76.7% in patients receiving whole breast irradiation or no RT (P = .045).ConclusionPatients with grade 3 micrometastases are at substantial risk for LRR. Adjuvant RT, including comprehensive nodal irradiation, should be strongly considered in these women.     

巨噬细胞源性泡沫细胞适配子PM1的特异性

目的研究特异性寡核苷酸适配子PM1与巨噬细胞源性泡沫细胞和动脉粥样硬化病变结合的特异性,为动脉粥样硬化的体内靶向治疗提供实验依据。方法对适配子PM1进行FITC标记,荧光显微镜分别观察适配子与血管平滑肌细胞、巨噬细胞、内皮细胞、巨噬细胞源性泡沫细胞结合情况。采用高脂方法建立兔动脉粥样硬化模型,利用PCR方法和荧光显微镜观察适配子与动脉粥样硬化病变结合情况。结果适配子PM1与巨噬细胞源性泡沫细胞和动脉粥样硬化病变组织高度特异性结合,但不结合血管平滑肌细胞、巨噬细胞、内皮细胞和正常动脉组织。结论筛选出的适配子PM1能特异性结合巨噬细胞源性泡沫细胞和动脉粥样硬化病变。     

乌司他丁对体外循环下犬心肌ICAM-1表达的影响

目的研究乌司他丁应用于体外循环(CPB)中对犬心肌组织中细胞间黏附分子-1(ICAM-1)表达的影响及其对心肌的保护作用.方法试验用杂种犬20只,随机平均分为乌司他丁实验组(U组)和对照组(C组),每组各10只.U组在CPB预充液中加1万U/kg乌司他丁,并于CPB转机开始前即经静脉再给1万U/kg乌司他丁持续滴注.C组常规建立CPB并转机.分别于CPB转机前10 min(A时点)和CPB转机后60 min(B时点)两个时点,切取犬心肌右心耳组织,检测心肌组织ICAM-1表达量;记录CPB建立时间、主动脉阻断时间、主动脉灌注时间、CPB转机时间、心脏复跳情况.结果两组实验犬心肌组织中,ICAM-1的表达量在B时点较A时点均明显增高,但在B时点U组ICAM-1表达量低于C组(P<0.05).结论 CPB时,心肌组织的缺血-再灌注损伤可引起心肌组织ICAM-1表达上调,乌司他丁可减轻心肌的炎症反应,进而保护心肌组织.     

腹腔镜技术诊治腹部损伤的应用体会(附102例报告)

目的:探讨腹腔镜技术诊治腹部损伤的价值及疗效.方法:回顾分析为102例腹部损伤患者施行腹腔镜探查的临床资料.结果:102例患者均经腹腔镜探查明确诊断,无漏诊、误诊.18例中转开腹,中转率17.65%,均为闭合性腹部损伤者(22.50%,18/80),开放性损伤者无一例中转开腹手术.29例(28.43%)为非治疗性.3例...