前列腺小体外泌蛋白检测在慢性前列腺炎诊断中的应用

目的　探讨前列腺小体外泌蛋白（prostatic exosomal protein，PSEP）检测对慢性前列腺炎的诊断价值。方法收集102 例慢性前列腺炎患者和70 例健康体检者的尿液标本，应用前列腺小体外泌蛋白检测试剂盒，对患者尿液中PSEP 进行定量检测，评价其诊断前列腺炎的灵敏度、特异度和临界值等指标，比较PSEP 检测体系与临床诊断标准的差异。结果　慢性前列腺炎患者PSEP 检测结果为3.002（1.728~3.966）ng/ml，明显高于健康体检者的0.869（0.565~1.094）ng/ml，差异具有统计学意义（P<0.001）。根据受试者工作曲线计算PSEP 的最佳临界值为1.238 ng/ml，ROC 曲线下面积为0.922，对慢性前列腺炎的诊断敏感度为86.27%，特异度为90%。结论　检测患者尿液中的PSEP，取材方便，结果可靠，能提高患者依从性及就诊舒服度，可作为临床上慢性前列腺炎诊断现有方法的补充，为慢性前列腺炎患者临床诊断提供了新的检测依据，值得向临床推广应用。     

Injectable co-gels of collagen and decellularized vascular matrix improve MSC-based therapy for acute kidney injury

Transplantation of mesenchymal stem cells (MSCs) is promising for treatment of acute kidney injury (AKI), but their therapeutic effects are often limited under normal conditions. In this study, we prepared the co-gels of decellularized vascular matrix and collagen, and investigated whether the co-gels increase the therapeutic potentials of MSCs on AKI. In vitro studies indicated that the co-gels enhanced the paracrine effects of MSCs, and significantly reduced the apoptosis of MSCs under oxidative environments. When the co-gels were co-transplanted with MSCs into the kidney of model rats with ischemia-reperfusion (I/R)-induced AKI, the survival and paracrine effects of MSCs were enhanced in the injured kidney. More importantly, the co-gels increased the therapeutic effects of MSCs for AKI, as indicated by cell apoptosis, tissue damage, vascularization and renal function. Therefore, the co-gels of decellularized vascular matrix and collagen improved the therapeutic effects of MSCs, and might be promising for AKI treatment.     

坎地沙坦联合贝那普利治疗糖尿病肾病并高血压疗效观察

目的观察坎地沙坦联合贝那普利治疗糖尿病肾病并高血压的疗效。方法糖尿病肾病并高血压患者84例,随机分为坎地沙坦组、贝那普利组及联合用药组,每组28例。坎地沙坦组患者给予坎地沙坦8 mg·d-1,贝那普利组给予贝那普利10 mg·d-1,联合用药组给予坎地沙坦8 mg·d-1和贝那普利10 mg·d-1进行治疗。治疗16周后,比较各组治疗前后血压、血清肌酐(SCr)、尿素氮(BUN)、24 h尿蛋白、血钾等指标的变化。结果治疗16周后,3组患者收缩压、舒张压均较治疗前显著下降(P<0.05),且联合用药组患者收缩压、舒张压水平均低于坎地沙坦组和贝那普利组(P<0.05)。与治疗前比较,3组患者的SCr、BUN及24 h尿蛋白水平均显著下降(P<0.05),且联合用药组SCr、BUN和24 h尿蛋白水平较坎地沙坦组和贝那普利组显著降低(P<0.05)。3组患者治疗前后血钾水平无明显变化(P>0.05)。治疗过程中各组未见明显不良反应。结论坎地沙坦联合贝那普利治疗糖尿病肾病并高血压可明显降低患者血压及尿蛋白水平,改善患者肾功能,临床应用疗效显著,较单药治疗效果佳。     

肝移植术后新发非酒精性脂肪肝的危险因素

目的探究肝移植术后新发非酒精性脂肪肝(non-alcoholic fatty liver disease NAFLD)的危险因素。方法收集2015年5月至2019年5月于解放军总医院第五医学中心136例行肝移植患者的临床资料。比较移植术后新发NAFLD患者与无NAFLD患者的临床资料。应用logistic回归分析移植术后新发NAFLD的危险因素。结果肝移植术后1年时新发NAFLD的发病率为11.03%(15/136)。新发NAFLD患者与无NAFLD患者比较,术前BMI(27.85比23.17,P=0.003)、酒精性肝硬化(66.7%比23.1%,P=0.001)、术前高血压病史(33.3%比5.4%,P=0.016),肝移植术后1年时的ALT水平(24.0 U/L比21.5 U/L,P=0.012)差异有统计学意义。Logistic回归分析结果显示,术前酒精性肝硬化(OR=4.79,95%CI:1.35~16.98)、术前高BMI(OR=1.23,95%CI:1.05~1.46)是术后新发NAFLD的危险因素。结论肝移植术前酒精性肝硬化和高BMI是术后新发NAFLD的危险因素。     

基于移动存储介质的基层部队体检信息采录流程优化

目的:引入信息化手段,优化为基层部队体检的工作流程,对产生的健康体检信息数据进行数字化同步自动采集,拓宽军人电子健康档案信息数据来源。方法:以移动存储介质为信息载体,使用PowerBuilder 9.0开发移动式健康体检信息采集系统,系统由个人信息采集,项目指标采集、检验标识绑定、数据分类汇总等模块组成。结果:依托移动式健康体检信息采集系统,优化健康体检信息采录流程,将基层部队体检的个人相关健康信息由手工纸质记录方式改造为可以由医疗信息系统自动读取和传递的电子化数据。结论:流程优化后规范统一了健康信息采集的标准,提高了采集信息的准确率和体检人员的工作效率,实现了对健康信息实时准确管理。     

远程医疗协同系统的设计

设计了一种能切合应用需求的面向医疗专业的远程医疗协同系统。介绍了该系统的系统功能、系统架构及关键技术等设计。     

肱骨近端锁定钢板微创手术治疗老年肱骨近端骨折

目的探讨采用肱骨近端锁定钢板（LPHP）微创手术治疗老年肱骨近端骨折的疗效。方法 2008年1月—2012年7月间对25例老年肱骨近端骨折采用肱骨近端锁定钢板（LPHP）微创手术治疗。根据NEER分类,二部分骨折10例,三部分骨折15例。结果该组25例患者均获随访,随访时间6～12个月,平均10个月。采用NEER评分：优12例,良11例,可2例,优良率为92%。结论采用肱骨近端锁定钢板（LPHP）微创手术治疗老年性肱骨近端骨折,具有创伤小、固定牢固、能够早期功能锻炼的优点,治疗效果良好。     

Chinese Physician Perception of Natural Orifice Translumenal Endoscopic Surgery

Background

A gross difference of opinion prevails amongst the physicians about the acceptance of natural orifice translumenal endoscopic surgery (NOTES).

Aims

The purpose of this study was to explore the Chinese physician perception of NOTES.

Methods

This is a questionnaire-based study, which was conducted during a conference on gastroenterology and endoscopy. The information was obtained from the participants about the demographic and practice characteristics and their perception of NOTES.

Results

The study recruited 221 physicians: 192 gastroenterologists and 29 surgeons. The physicians’ awareness of NOTES prior to the survey showed the same confidence with NOTES as compared to those with no knowledge about it (24.2 vs. 25.6 %; P = 0.99). The NOTES preference was not different between female and male doctors (21.8 vs. 26.3 %; P = 0.5952). More surgeons (47.6 %) opted for NOTES as treatment or recommended it for their families than gastroenterologists (21.1 %; P = 0.0165). However, the multivariate analysis confirmed that the physicians chose NOTES only if their hospital had already performed NOTES on humans successfully (OR = 3.53, 95 % CI 1.17–10.60; P = 0.0247). The gastroenterologists believed more often than surgeons that NOTES had the potential to become a mainstream procedure (96.9 vs. 81.0 %; P = 0.0084); but the inclination for NOTES training was similar in both groups (96.9 vs. 95.2 %; P = 0.8027). Safety of NOTES was their major concern and the choice of ideal entry point was thought to be the key barrier to NOTES clinical application. Hybrid NOTES was regarded as the best method for NOTES clinical application at the time of the study.

Conclusions

Physicians were hesitant when considering the NOTES approach. However, most of the physicians were interested in NOTES training and had confidence in NOTES.     

A retrospective analysis of primary gastric diffuse large B-cell lymphoma with or without concomitant mucosa-associated lymphoid tissue (MALT) lymphoma components

Primary gastric diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease entity that includes patients with (DLBCL/MALT) and without detectable mucosa-associated lymphoid tissue (MALT) lymphoma components (de novo DLBCL). We sought to evaluate the clinical characteristics and outcome of this disease in a large number of cases. Patients with primary gastric DLBCL (n?=?162) seen on 2001–2011 at the Tianjin Medical University Cancer Institute and Hospital and the First affiliated Hospital of Chinese PLA General Hospital were retrospectively reviewed. The distribution of sex, age, Lugano staging, and other main clinical characteristics was similar between the de novo DLBCL and DLBCL/MALT groups (p?>?0.05). However, the proportion of patients with a stage-modified international prognostic index (m-IPI)?≥?2 was higher in the de novo DLBCL (34 %) than the DLBCL/MALT group (17 %) (p?=?0.026). In addition, the Helicobacter pylori infection rates were higher in the DLBCL/MALT (75 %) than the de novo DLBCL group (36 %) (p?<?0.001). Five-year progression-free survival (PFS) and overall survival (OS) estimates were similar for patients in the de novo DLBCL (p?=?0.705) and DLBCL/MALT groups (p?=?0.846). Surgical treatment did not offer survival benefits when compared with chemotherapy for 5-year PFS (p?=?0.607) and OS estimates (p?=?0.554). There were no significant differences in 5-year PFS and OS estimates for patients treated with rituximab–chemotherapy (p?=?0.261) or conventional chemotherapy (p?=?0.227). Non-GCB subtype and m-IPI?≥?2 were independently associated with shorter OS, and advanced stages of lymphoma were independently associated with shorter PFS.     

Low expression of glucocorticoid receptor alpha isoform in adult immune thrombocytopenia correlates with glucocorticoid resistance

The expression of glucocorticoid receptor (GR) isoforms has been linked to glucocorticoid (GC) resistance in various diseases treated with GC. However, existing data are conflicting in these diseases, and little information is available regarding immune thrombocytopenia (ITP). To further investigate the role of GR isoforms in GC resistance in adult ITP patients, we measured the mRNA expression of GR isoforms (GRα, GRβ, GRγ, GRp) in peripheral blood mononuclear cells (PBMC) from 54 newly diagnosed ITP patients, including GC-sensitive (GCS) and GC-resistant (GCR) patients and 35 healthy volunteers. The GRα and GRβ proteins in PBMC, nuclear factor-κB (NF-κB), and activator protein-1 (AP-1) in the nucleus were detected by Western blotting. Compared to normal subjects, both GRα and GRβ mRNAs were significantly increased in ITP patients (p?<?0.05), while there was no significant difference in the mRNA expression of GRγ and GRp. Compared to GCR patients, the expressions of GRα mRNA and GRα protein were significantly higher in GCS patients (p?<?0.05). Moreover, no significant difference in the mRNA expression of the GRβ, GRγ, and GRp isoforms was observed between GCS and GCR patients and the GRβ protein could not be detected. Compared to GCS group, the expression of p65/NF-κB was significantly higher in the GCR group (p?<?0.05). Overall, we did not find differences in c-Jun/AP-1 protein expression between GCS and GCR patients. In summary, GC resistance in adult ITP patients is associated with a reduced expression of GRα, which may be related with increased NF-κB. GRβ was very low and may not be involved in GC resistance in adult ITP, warranting further exploration.