测定胃癌患者肿瘤组织与外周血中前列腺素E2的临床意义

目的 测定胃癌患者肿瘤组织及外周血中前列腺素E2(prostaglandin E2,PGE2)含量.方法 用PGE2酶联免疫试剂盒分别测定40例胃癌患者肿瘤组织、癌旁切缘组织及术前外周血中PGE2含量.结果 胃癌组织的PGE2含量明显高于癌旁切缘组织,分别为(8.225±2.425)、(1.669±0.287)ng/g,两者差异有统计学意义(P<0.01),低分化和高中分化胃癌组织PGE2含量分别为(9.02±2.28)、(5.38±0.35)ng/g,两者有显著性差异(P<0.05).外周血中PGE2含量与胃癌组织PGE2含量呈正相关(r=0.889,P<0.01).肿瘤直径≥5 cm和<5 cm的胃癌患者外周血中PGE2含量差异有统计学意义(P<0.05).低分化和高中分化胃癌患者外周血中PGE2含量差异也有统计学意义(P<0.05).胃癌组织及外周血中PGE2含量与患者年龄、性别无关,与肿瘤部位、浸润深度、临床病理分期及是否淋巴结转移也无关.结论 胃癌患者肿瘤组织中PGE2含量增高,其外周血PGE2含量也随之增高,表明外周血PGE:水平与胃癌组织释放的PGE2含量成正比.测定外周血中PGE2可以间接评估胃癌患者的肿瘤大小与分化程度.     

Cardiac catheterization in children with pulmonary arterial hypertension

Cardiac catheterization of childhood pulmonary arterial hypertension (PAH) is used to assess the severity of the disease as well as prognosis, selection of the most adequate pulmonary vasodilators, and evaluation of effectiveness. Sudden deterioration of cardiovascular hemodynamics, however, can be easily induced by pain, patient agitation, catheter manipulation, and by vasodilator provocation tests; these could trigger a pulmonary hypertension crisis, vagotony, respiratory distress, and hemoptysis resulting in critical complications, including death. Those patients with New York Heart Association functional class IV are at an especially high risk. It is noteworthy that pulmonary arteriography is a contraindication in patients with PAH. In a review of 7218 adult patients, 76 (1.1%) serious complications, including four deaths, were reported; with regard to the pediatric patients, 29 (10.7%) out of 270 patients with complications, including one with cardiogenic shock requiring cardiopulmonary resuscitation in addition to minor complications, were reported. To prevent serious complications, basic and routine precautions, such as oxygen and concomitant transcutaneous oxygen saturation and electrocardiogram monitoring during transportation to and from the catheter laboratory, are mandatory. Furthermore, the cooperation of experienced physicians and well informed medical staff in addition to meticulous preparation, for example, calculation of prior doses of catecholamine and confirmation of the presence of emergency equipment, is required.     

Breast Nurse Intervention to Improve Adherence to Endocrine Therapy Among Breast Cancer Patients in South Ethiopia

IntroductionMany women in rural Ethiopia do not receive adjuvant therapy following breast cancer surgery despite the majority being diagnosed with estrogen-receptor-positive breast cancer and tamoxifen being available in the country. We aimed to compare a breast nurse intervention to improve adherence to tamoxifen therapy for breast cancer patients.Methods and MaterialsThe 8 hospitals were randomized to intervention and control sites. Between February 2018 and December 2019, patients with breast cancer were recruited after their initial surgery. The primary outcome of the study was adherence to tamoxifen therapy by evaluating 12-month medication-refill data with medication possession ratio (MPR) and using a simplified medication adherence scale (SMAQ) in a subjective assessment.ResultsA total of 162 patients were recruited (87 intervention and 75 control). Trained nurses delivered education and provided literacy material, gave additional empathetic counselling, phone call reminders, and monitoring of medication refill at the intervention hospitals. Adherence according to MPR at 12 months was high in both the intervention (90%) and control sites (79.3%) (P = .302). The SMAQ revealed that adherence at intervention sites was 70% compared with 44.8% in the control sites (P = .036) at 12 months. Persistence to therapy was found to be 91.2% in the intervention and 77.8% in the control sites during the one-year period (P = .010).ConclusionBreast nurses can improve cost-effective endocrine therapy adherence at peripheral hospitals in low-resource settings. We recommend such task sharing to overcome the shortage of oncologists and distances to central cancer centers.     

Contrast echocardiography: transmission of echoes to the left heart across the pulmonary vascular bed

All available reports indicate that the echoproducing qualityof agents used for contrast echocardiography is lost duringtheir passage through the pulmonary or systemic capillary bed.A technique has been developed to transmit echoes to the leftheart across the pulmonary vascular bed with the use of venouscatheterization. In 43 patients with acquired or congenitalheart disease, a balloon-tipped catheter was wedged in a pulmonaryarterial branch, the balloon was inflated, then rapidly deflatedafter injection of an echoproducing substance, while M-Modeor two-dimensional echocardiograms were recorded. Echoes consistentlyappeared in the left heart following injection of indocyaninegreen (5–10 mg), saline (5 ml) or CO₂ (0.5–1 ml).In 25 patients with a documented left-to-right shunt, echoesalso appeared in the right heart chamber receiving the shunt.There were no false negatives nor false positives. No complicationsor side effects were observed. The presumed mechanism of transmissionis the achievement of a high concentration of echoes and/orbypassing of pulmonary capillaries through physiological intrapidmonaryshunts. The method is proposed as a screening procedure to be used duringright heart catheterization so as to avoid, if possible, theinjection ofradioopaque contrast and the invasion of the leftheart     

慢性1-烯丙基氯-3中毒性周围神经病神经肌肉组织电生理及超微结构改变的研究

中毒组为已确诊的慢性1-烯丙基氯-3中毒性周围神经病患者31例,对照组为健康者25例。中毒组肌电图在静息状态时,插入电位降低,部分病例出现自发性失神经电位(正锐波及纤颤电位);轻度收缩时,单个运动单位电位多相电位增多、电压降低、时限延长;最大收缩时,出现混合型。刺激腓总神经诱发胫前肌、腓骨长肌及伸趾短肌反应性肌电位出现多相电位、低电压及时限延长。腓总神经运动传导速度减慢及远端潜伏时延长,腓肠神经感觉传导速度及远端潜伏时无明显改变。腓肠神经髓质内微管及神经微丝变性,线粒体嵴脱落成变性空泡,光面内质网扩张和肿胀,髓鞘未见异常改变。腓肠肌肌原纤维部分断裂及间隙扩大并且内充满肌质网及线粒体变性空泡,Z线弯曲、断裂及崩解。     

糖尿病患者足底压力分布及其影响因素

目的：了解糖尿病患者和正常人群足底压力峰值、分布情况及其主要因素。方法：采用足底压力测量仪检测218例糖尿病患者和102例健康正常人以正常步态行走时的动态足底压力,每个受试者均检测5次后取平均值。将足底分为10个不同区域,计算平均足底最大峰值压力（MPP）和足底各区域MPP的分布情况。结果：正常人群和糖尿病患者足底MPP分别为（402±129）kPa和（417±113）kPa,在调整了年龄、性别、BMI等协变量的影响后,两组间的差异无统计学意义（P〉0．05）。糖尿病组第1跖骨、第5跖骨区压力高于正常人群。多元线性回归分析结果显示,其中合并周围神经病变和胼胝2个因素进入回归方程,这2个因素可解释足底压力总变异量的38．2％。结论：糖尿病患者和正常人群之间MPP无差别,但压力分布不同。合并周围神经病变和胼胝的形成可显著影响糖尿病患者足底压力。     

髓系抑制细胞、Th17细胞在哮喘患儿外周血中的表达

目的 分析髓系抑制细胞(MDSCs)及Th17细胞在哮喘患儿外周血中的表达情况和临床意义.方法 选取自贡市第一人民医院儿科2013年6月至2015年8月收治的120例哮喘患儿作为观察组,另外选择87例健康儿童作为对照组.应用流式细胞术检测MDSCs、Th17细胞在哮喘患儿外周血中的表达情况.结果 和对照组相比,观察组MDSCs占有核细胞的百分比和Th17细胞占单个核细胞的百分比都显著升高(Hc值分别为56.14、45.98,均P<0.05),差异具有统计学意义.结论 从MDSCs、Th17细胞在哮喘患儿外周血中的表达情况来看,它们可能参与了婴幼儿哮喘的发生与发展过程.     

Correlation between Serum 25-Hydroxyvitamin D Level and Peripheral Arterial Stiffness in Chronic Kidney Disease Stage 3–5 Patients

Vitamin D deficiency and high brachial-ankle pulse wave velocity (baPWV) are each independently associated with higher incidence of mortality and cardiovascular (CV) disease or CV events, respectively. This study aimed to evaluate the relationship between serum 25-hydroxyvitamin D levels and baPWV in non-dialysis patients with stage 3–5 chronic kidney disease (CKD). We enrolled 180 CKD patients. A commercial enzyme-linked immunosorbent assay was used to measure 25-hydroxyvitamin D levels. BaPWV values were measured using an automatic pulse wave analyzer. Either left or right baPWV > 18.0 m/s was considered indicative of peripheral arterial stiffness (PAS). In this study, 73 (40.6%) patients were found to have PAS. Compared to those without PAS (control group), patients with PAS were older and had higher incidence of diabetes mellitus, higher systolic and diastolic blood pressure, higher levels of intact parathyroid hormone, and C-reactive protein, and lower levels of 25-hydroxyvitamin D. Multivariate logistic regression analysis found 25-hydroxyvitamin D levels (odds ratio [OR]: 0.895, 95% confidence interval [CI] 0.828–0.968, p = 0.005) and old age (OR: 1.140, 95% CI 1.088–1.194, p < 0.001) to be independently associated with PAS in patients with stage 3–5 CKD. Lower serum 25-hydroxyvitamin D levels and older age were associated with PAS in these patients.     

Clinical profile and distribution of peripheral retinal changes in myopic population in a hospital-based study in North India

Purpose:To evaluate the prevalence of different types of peripheral retinal changes in a myopic population in North India and correlate them with axial length.Methods:This cross-sectional, hospital-based survey included 600 eyes of 300 myopic individuals, aged between 10 and 40 years, attending the outdoor ophthalmology clinic of a tertiary eye care hospital in North India were examined from July 2019 to July 2020. They were divided into mild, moderate, high, and severe myopia according to the spherical equivalent of refraction. Axial length was recorded. Peripheral retinal changes were examined by scleral indentation binocular indirect ophthalmoscopy. Standardized findings considered with their fundus location were lattice degeneration, white without pressure and white with pressure, snail-track degenerations, peripheral chorioretinal atrophy, retinal holes, tears, and detachment. The study was approved by the institutional ethics committee, and all participants provided informed consent.Results:Peripheral retinal degenerations were found in almost half (53%) of all myopes included in the study. The most common peripheral retinal degeneration found was lattice degeneration, followed by white without pressure, white with pressure, and chorioretinal atrophy. Most of the peripheral retinal degenerations were seen in the temporal quadrant of the fundus, either superotemporal or inferotemporal. There was a significant positive association between the prevalence of peripheral retinal degeneration with age, increased axial length, and severity of myopiaConclusion:The results of our study indicate the necessity for careful peripheral fundus examinations of all myopes, irrespective of age and degree of myopia, for early diagnosis and better management of visual-threatening complications like retinal detachment.     

Surgical Management of Craniovertebral Junction Schwannomas: A Systematic Review

Background: Craniovertebral junction (CVJ) schwannomas are rare, with surgery and stereotactic radiosurgery (SRS) being effective yet challenging options. We systematically reviewed the literature on CVJ schwannomas. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA statement to include studies reporting CVJ schwannomas. Clinical features, management, and outcomes were analyzed. Results: We collected 353 patients from 101 included articles. Presenting symptoms were mostly neck pain (30.3%) and headache (26.3%), with most cranial neuropathies involving the XII (31.2%) and X (24.4%) nerves. Most tumors originated from C2 (30.9%) and XII (29.4%) nerves, being extracranial (45.1%) and intradural-extradural (44.2%). Erosion of C1–C2 vertebrae (37.1%), the hypoglossal canal (28.3%), and/or jugular foramen (20.1%) were noted. All tumors were operated, preferably with the retrosigmoid approach (36.5%), with the far-lateral approach (29.7%) or with the posterior approach and cervical laminectomy (26.9%), far-lateral approaches (14.2%), or suboccipital craniotomy with concurrent cervical laminectomy (14.2%). Complete tumor resection was obtained most frequently (61.5%). Adjuvant post-surgery stereotactic radiosurgery was delivered in 5.9% patients. Median follow-up was 27 months (range, 12–252). Symptom improvement was noted in 88.1% of cases, and cranial neuropathies showed improvement in 10.2%. Post-surgical complications occurred in 83 patients (23.5%), mostly dysphagia (7.4%), new cranial neuropathies (6.2%), and cerebrospinal fluid leak (5.9%). A total of 16 patients (4.5%) had tumor recurrence and 7 died (2%), with median overall survival of 2.7 months (range, 0.1–252). Conclusions: Microsurgical resection is safe and effective for CVJ schwannomas. Data on SRS efficacy and indications are still lacking, and its role deserves further evaluation.