子宫内膜癌患者手术治疗前后血清 CA125、HE4和D-D水平检测的临床意义

目的 探讨了解子宫内膜癌患者手术治疗前后血清CA125、HE4和D-D水平的变化及临床意义。方法 应用放射免疫法,酶联法和免疫比浊法对31例子宫内膜癌患者进行了手术治疗前后血清CA125、HE4和D-D水平的检测,并与35名正常健康人作比较。结果 子宫内膜癌患者在手术治疗前血清CA125、HE4和D-D水平均非常显著地高于正常人组(P＜0.01),手术治疗6个月后则与正常人比较无显著性差异(P＞0.05)。血清CA125水平与HF4、D-D水平呈显著正相关,(r=0.5918、0.4725,P＜0.01)。结论 检测子宫内膜癌患者手术治疗前后血清CA125、HE4、D-D水平的变化对了解病情、观察疗效和预后判定均具有重要的临床价值.     

血清BDNF和CA125水平对急性心肌梗死患者病情及预后的评估价值

目的分析血清脑源性神经营养因子(BDNF)和糖类蛋白125(CA125)水平对急性心肌梗死(AMI)患者病情及预后的评估价值。方法选取2016年12月-2018年6月北京中医药大学孙思邈医院心血管内科收治的AMI患者136例作为研究组,选取同期门诊健康体检正常者50例作为健康对照组。采用酶联免疫吸附法检测血清BDNF水平,电化学发光免疫分析法检测CA125水平。随访1年记录不良心血管事件发生情况,比较不良心脏事件亚组和无不良心脏事件亚组患者血清BDNF和CA125水平。采用Logistic回归分析急性心肌梗死患者预后影响因素。结果研究组心率及血清BDNF、CA125、c-TnI、BNP水平均高于健康对照组(t=10.196、22.142、12.302、7.301、49.705,P均<0.001)。随访1年发生心脏不良事件38例(27.94%),不良心脏事件亚组患者血清BDNF、CA125水平均高于无不良心脏事件亚组患者(t=3.258、4.496,P均<0.001)。BDNF预测AMI患者1年不良心血管事件发生率的ROC曲线下面积(AUC)为0.871,当BNDF截点值为3.87 ng/ml时预测AMI患者1年不良心血管事件敏感度为84.1%,特异度为82.9%,约登指数为0.670。CA125的AUC为0.746,当CA125截点值为42.54 U/ml时预测AMI患者1年不良心血管事件的敏感度为83.2%,特异度为81.5%,约登指数为0.647。Logistic回归分析结果显示,高龄(OR=1.89,95%CI 1.02~3.51)、心率快(OR=1.77,95%CI 1.06~2.95)、高水平BDNF(OR=4.76,95%CI 2.38~9.56)、高水平CA125(OR=3.49,95%CI 1.71~7.12)、高水平cTnI(OR=3.80,95%CI 1.654~8.750)、高水平BNP(OR=4.90,95%CI 2.23~10.77)为AMI后不良心血管事件的危险因素。结论 AMI患者血清BDNF、CA125水平明显增高,且高水平BDNF、CA125是AMI患者发生不良预后的风险因素,提示二者可作为评估AMI患者病情及预后的预测因子。     

华蟾素胶囊联合吡柔比星治疗晚期乳腺癌的临床研究

目的探讨华蟾素胶囊联合注射用吡柔比星治疗晚期乳腺癌的临床疗效。方法选取锦州医科大学附属第一医院在2015年10月—2017年10月接收的乳晚期腺癌患者120例作为研究对象,将所有患者随机分为对照组和治疗组,每组各60例。对照组静脉注射注射用吡柔比星50 mg/m2,1次/d;治疗组在对照组治疗的基础上口服华蟾素胶囊,4粒/次,3次/d。4周为1个疗程,两组患者均持续治疗2个疗程。观察两组患者的临床疗效,同时比较治疗前后两组患者生活质量评分、肿瘤标志物水平、副作用、复发率和生存率。结果治疗组患者客观缓解率(56.67%)显著高于对照组患者客观缓解率(46.67%),两组差异具有统计学意义(P0.05);治疗组患者临床控制率(78.33%)显著高于对照组患者临床控制率(68.33%),两组差异具有统计学意义(P0.05)。治疗后,两组患者生理状态评分、心理状态评分、躯体功能评分、社会功能评分均显著升高,两组差异具有统计学意义(P0.05);并且治疗组患者生活质量评分显著高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者糖类抗原125(CA125)、糖类抗原153(CA153)和癌胚抗原(CEA)水平均显著降低,差异具有统计学意义(P0.05);并且治疗组肿瘤标志物水平显著高于对照组,两组比较差异具有统计学意义(P0.05)。对照组患者复发率(16.67%)显著高于治疗组患者复发率(5.00%),两组比较差异具有统计学意义(P0.05)。治疗组患者生存率(81.67%)显著高于对照组患者生存率(58.33%),两组比较差异具有统计学意义(P0.05)。结论华蟾素胶囊联合注射用吡柔比星治疗晚期乳腺癌具有较好的临床疗效,显著改善患者生活质量,改善患者相关肿瘤标志物水平,安全性较高,值得临床推广。     

华蟾素片联合SOX方案治疗晚期胃癌的临床研究

目的探讨华蟾素片联合SOX方案(奥沙利铂+替吉奥)治疗晚期胃癌的临床疗效。方法选取2015年1月—2017年12月涟水县人民医院收治的60例晚期胃癌患者作为研究对象,根据不同的治疗方式将患者分为对照组和治疗组,每组各30例。对照组患者采用SOX方案治疗:静滴注射用奥沙利铂130 mg/(m~2·d),用10%葡萄糖注射液500 mL稀释后静滴3 h,21 d给药1次;同时餐后用温水送服替吉奥胶囊,80 mg/(m~2·d),2次/d,连续14 d,停药7 d。治疗组在对照组基础上口服华蟾素片,3片/次,3次/d。21 d为1个周期,两组患者均进行2个周期的治疗。观察两组患者的临床疗效,同时比较两组治疗前后的血清肿瘤指标水平、疼痛评分(VAS)和生活质量综合评定问卷评分。结果治疗后,治疗组的总有效率(RR)和肿瘤控制率(DCR)分别为63.3%、83.3%,均明显高于对照组的36.7%、60.0%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者的癌胚抗原(CEA)和糖类抗原19-9(CA19-9)水平均显著降低,同组治疗前后比较差异具有统计学意义(P0.05),且治疗后治疗组血清肿瘤指标均明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者VAS评分均明显降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组的VAS评分明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者的社会功能、心理功能、功能和物质生活评分均明显提高,同组治疗前后比较差异具有统计学意义(P0.05),且治疗后治疗组生活质量水平显著高于对照组,两组比较差异具有统计学意义(P0.05)。结论华蟾素片联合SOX化疗方案治疗晚期胃癌具有较好的临床疗效,在不增加化疗副反应的情况下,可有效缓解患者的癌性疼痛状况并可改善患者的预后,值得临床推广应用。     

Hyperbaric oxygen therapy improves cognitive functioning after brain injury

Hyperbaric oxygen therapy has been widely applied and recognized in the treatment of brain injury; however, the correlation between the protective effect of hyperbaric oxygen therapy and changes of metabolites in the brain remains unclear. To investigate the effect and potential mechanism of hy- perbaric oxygen therapy on cognitive functioning in rats, we established traumatic brain injury models using Feeney＇s free falling method. We treated rat models with hyperbaric oxygen therapy at 0.2 MPa for 60 minutes per day. The Morris water maze test for spatial navigation showed that the average escape latency was significantly prolonged and cognitive function decreased in rats with brain injury. After treatment with hyperbaric oxygen therapy for 1 and 2 weeks, the rats＇ spatial learning and memory abilities were improved. Hydrogen proton magnetic resonance spectroscopy analysis showed that the N-acetylaspartate/creatine ratio in the hippocampal CA3 region was sig- nificantly increased at 1 week, and the N-acetylaspartate/choline ratio was significantly increased at 2 weeks after hyperbaric oxygen therapy. Nissl staining and immunohistochemical staining showed that the number of nerve cells and Nissl bodies in the hippocampal CA3 region was significantly increased, and glial fibrillary acidic protein positive cells were decreased after a 2-week hyperbaric oxygen therapy treatment. Our findings indicate that hyperbaric oxygen therapy significantly im- proves cognitive functioning in rats with traumatic brain injury, and the potential mechanism is me- diated by metabolic changes and nerve cell restoration in the hippocampal CA3 region.     

Application of biochemical markers CA 19-9, CEA and C-reactive protein in diagnosis of malicious and benign pancreatic tumors

Introduction

We would save many lives and spare a lot of suffering if we could only detect and accurately determine the character and TMN staging of pancreatic tumors (PTs). With improved diagnosis, we could offer specific treatment that would result in better treatment outcome. The aim of study was to determine the significance of neoplastic markers CA 19-9 and CEA for prognosis in inflammatory and carcinomatous PTs.

Material and methods

We based our research upon a group of 170 patients. The patients were treated in our Oncologic Surgery Department from January 2007 to December 2010 for PTs. The patients were divided into four groups depending on the character of the tumor and underwent the following treatments: group 1 – 34 patients with carcinoma of the ampulla of Vater, group 2 – 64 patients with PTs at different stages (1, 2, 3) according to TMN classification, group 3 – 62 patients with PTs at stage 4 on the TMN scale (unresectable tumors), group 4 – 28 patients with inflammatory PTs.

Results

The results of Ca 19-9 in group 2 were 736.00 (25–75% 220.40–4285.00) ng/ml before surgery, 53.00 (25–75% 12.60–84.00) ng/ml in the 7 days after surgery, 29.4 (25–75% 7.90–113.00) ng/ml at day 30, and 119.00 (25–75% 96.30–621.00) ng/ml 3 months after the operation. These results were significantly higher than the control group but were significantly lower than the results for group 3 (unresectable tumors). The highest average concentration and median for CA 19-9 and CEA were noted in patients with unresectable PTs (the 3^rd group). The average concentration for CEA was lowest in group 4, but much higher than the lab limits.

Conclusions

The sensitivity of the CA 19-9 marker may be as high as 88%. Values of CA 19-9 above 852 U/ml may indicate TNM stage 4, consistent with an unresectable PT. In the cases where CA 19-9 is within normal limits but C-reactive protein is above normal limits (often thirty times the upper limit), in comparison to the control group and to patients with pancreatic neoplasms, strong consideration should be given towards the inflammatory characteristics of the pancreatic changes and conservative treatment should be applied.     

Outcomes after cardiac arrest in an adult burn center

Objective

Adult burn patients who experience in-hospital cardiac arrest (CA) and undergo cardiopulmonary resuscitation (CPR) represent a unique patient population. We believe that they tend to be younger and have the added burden of the burn injury compared to other populations. Our objective was to determine the incidence, causes and outcomes following cardiac arrest (CA) and cardio-pulmonary resuscitation (CPR) within this population.

Methods

We conducted a retrospective review at the US Army Institute of Surgical Research (ISR) burn intensive care unit (BICU). Charts from 1st January 2000 through 31st August 2009 were reviewed for study. Data were collected all on adult burn patients who experienced in-hospital CA and CPR either in the BICU or associated burn operating room. Patients undergoing CPR elsewhere in our burn unit were excluded because we could not validate the time of CA since they are not routinely monitored with real-time rhythm strips. The study population included civilian burn patients from the local catchment area and burn casualties from the conflicts in Iraq and Afghanistan, but patients with do-not-resuscitate (DNR) orders were excluded.

Results

We found 57 burn patients who had in-hospital CA and CPR yielding an incidence of one or more in-hospital CA of 34 per 1000 admissions (0.34%). Fourteen of these patients (25%) survived to discharge while 43 (75%) died. The most common initial cardiac rhythm was pulseless electrical activity (50.9%). The most common etiology of CA among burn patients was respiratory failure (49.1%). The most significant variable affecting survival to discharge was duration of CPR (P < 0.01) with no patient surviving more than 7 min of CPR.

Conclusions

CPR in burn patients is sometimes effective, and those patients who survive are likely to have good neurological outcomes. However, prolonged CPR times are unlikely to result in return of spontaneous circulation and may be considered futile. Further, those who experience multiple CA are unlikely to survive to discharge.     

Differences in expression patterns of cathepsin C/dipeptidyl peptidase I in normal,pathological and aged mouse central nervous system

Cathepsin C (CC) (EC 3.4.14.1, dipeptidyl peptidase I) is a lysosomal cysteine protease that is required for the activation of several granule‐associated serine proteases in vivo. CC has been shown to be constitutively expressed in various tissues, but the enzyme is hardly detectable in central nervous system (CNS) tissues. In the present study, we investigated the regional and cellular distribution of CC in normal, aging and pathological mouse brains. Immunoblotting failed to detect CC protein in whole brain tissues of normal mice, as previously described. However, low proteolytic activity of CC was detected in a brain region‐dependent manner, and granular immunohistochemical signals were found in neuronal perikarya of particular brain regions, including the accessory olfactory bulb, the septum, CA2 of the hippocampus, a part of the cerebral cortex, the medial geniculate, and the inferior colliculus. In aged mice, the number of CC‐positive neurons increased to some extent. The protein level of CC and its proteolytic activity showed significant increases in particular brain regions of mouse models with pathological conditions – the thalamus in cathepsin D‐deficient mice, the hippocampus of ipsilateral brain hemispheres after hypoxic–ischemic brain injury, and peri‐damaged portions of brains after penetrating injury. In such pathological conditions, the majority of the cells that were strongly immunopositive for CC were activated microglia. These lines of evidence suggest that CC is involved in normal neuronal function in certain brain regions, and also participates in inflammatory processes accompanying pathogenesis in the CNS.     

Contributions of the hippocampal subfields and entorhinal cortex to disambiguation during working memory

The hippocampus and medial temporal lobes (MTL) support the successful formation of new memories without succumbing to interference from related, older memories. Computational models and animal findings have implicated the dentate gyrus (DG), CA3, CA1, and entorhinal cortex (EC) in the disambiguation and encoding of well‐established, episodic events that share common elements. However, it is unknown if these hippocampal subfields and MTL (entorhinal, perirhinal, parahippocampal) cortices also contribute during working memory when overlapping stimuli that share related features are rapidly encoded and subsequently maintained over a brief temporal delay. We hypothesized that activity in CA3/DG hippocampal subfields would be greater for the rapid encoding of stimuli with overlapping features than for the rapid encoding of stimuli with distinct features. In addition, we predicted that CA1 and EC, regions that are associated with creating long‐term episodic representations, would show greater sustained activity across both encoding and delay periods for representations of stimuli with overlapping features than for those with distinct features. We used high‐resolution fMRI during a delayed matching‐to‐sample (DMS) task using face pairs that either shared (overlapping condition, OL) or did not share (non‐overlapping condition, NOL) common elements. We contrasted the OL condition with the NOL condition separately at sample (encoding) and during a brief delay (maintenance). At sample, we observed activity localized to CA3/DG, the subiculum, and CA1. At delay, we observed activity localized to the subiculum and CA1 and activity within the entorhinal, perirhinal, and parahippocampal cortices. Our findings are consistent with our hypotheses and suggest that CA3/DG, CA1 and the subiculum support the disambiguation and encoding of overlapping representations while CA1, subiculum and entorhinal cortex maintain these overlapping representations during working memory. © 2013 Wiley Periodicals, Inc.