济南市2012~2017年手足口病肠道病毒谱变化及流行特征

目的 阐明济南市手足口病肠道病毒病原谱的构成及变化,探索不同肠道病毒类型的流行特征。 方法 收集2012年1月~2017年12月济南市手足口病标本4 929例,采用实时荧光定量逆转录-聚合酶链反应(RT-PCR)方法检测EV-A71、柯萨奇病毒A组16型(CV-A16)、柯萨奇病毒A组6型(CV-A6)和柯萨奇病毒A组10型(CV-A10);对肠道病毒通用(PE)阳性而未明确分型标本采用巢式RT-PCR方法,扩增肠道病毒5'-非翻译区(5'-UTR),经核苷酸序列测定明确肠道病毒类型。 结果 4 929例标本中共检出27种肠道病毒类型,除EV-A71、CV-A16、CV-A6和CV-A10外,柯萨奇病毒A组(CV-A2、4、5、9、12、13、21、22、24)、柯萨奇病毒B组(CV-B1~5)、埃可病毒(E3、6、7、9、11、18、24、25、30)均有检出。轻型病例肠道病毒感染率居前4位的是CV-A16(29.03%)、EV-A71(25.67%)、CV-A6(17.58%)和CV-A10(3.10%),重症病例为EV-A71(77.64%)、CV-A16(5.59%)、CV-A6(1.86%)和CV-A10(1.24%)。CV-A6和CV-A10感染者的发病年龄较EV-A71和CV-A16感染者略小,分别为(3.02±2.43)岁、(2.87±1.67)岁、(3.29±2.34)岁和(3.36±2.18)岁,差异有统计学意义(F=3.659,P=0.003)。流行季节研究显示,EV-A71和CV-A16发病高峰为第2或4季度,CV-A6好发于6~12月份,CV-A10病例6~8月份发病较多。平阴县和章丘区肠道病毒阳性检出率较高,分别为93.49%和91.99%。 结论 济南市手足口病肠道病毒谱以EV-A71、CV-A16、CV-A6和CV-A10为优势型别,27种肠道病毒共存。常年监测非EV-A71非CV-A16肠道病毒的流行特征,及时掌握肠道病毒谱变化,有助于及时完善手足口病疫情的防控措施。     

MRI扩散加权成像对肝细胞癌病理分级的预测价值分析

目的:探讨MRI扩散加权成像(diffusion weighted imaging,DWI)对肝细胞癌(hepatocellular carcinoma,HCC)病理分级的预测价值分析。方法:2014年2月至2018年4月选择在南充市中心医院肿瘤科住院诊治的HCC患者74例,病理分级为Ⅰ级34例,Ⅱ级30例,Ⅲ级10例。所有患者都给予常规MRI与DWI检查,记录诊断特征与预测病理分级状况。结果:Ⅰ级患者中14例DWI为高信号,8例为低信号,12例为等信号;Ⅱ级患者中16例DWI为高信号,7例为低信号,7例为等信号;Ⅲ级患者中DWI为高信号。Ⅲ级患者的病灶ADC值显著低于Ⅰ级与Ⅱ级患者,Ⅱ级患者低于Ⅰ级患者,对比差异都有统计学意义(P<0.05)。在74例患者中,MRIDWI都诊断为HCC,判断为Ⅰ级32例,Ⅱ级32例,Ⅲ级10例,诊断正确率为94.6%。以ADC值=1.42×10^-3mm^2/s与1.13×10^-3mm^2/s作为鉴别诊断HCC病理Ⅰ级/Ⅱ级和Ⅱ级/Ⅲ级的分级标准,诊断AUC值分别为0.786和0.739。结论:MRI DWI对HCC病理分级具有中等的预测诊断价值,可为HCC的病例分级补充提供有价值的鉴别诊断信息。     

“双一流”背景下基于SWOT分析的医学高校图书馆特色资源建设探讨

以中医药院校图书馆为例,阐述特色资源内涵,运用SWOT分析法分析“双一流”背景下医学高校图书馆特色资源建设的优势、劣势、机遇和挑战,提出相应建议,包括提升采访馆员素质、制定特色馆藏标准等。     

间变性大细胞淋巴瘤20例临床病理学特征探讨

目的探讨间变性大细胞淋巴瘤的临床病理学特征及诊断、鉴别诊断要点。方法对20例间变性大细胞淋巴瘤进行临床病理分析及免疫组化研究,并进行文献复习。结果 20例间变性大细胞淋巴瘤的发病年龄为4～78岁,其中11例发生于颈部淋巴结,表现为多发淋巴结肿大,有或无压痛,伴发热、体重下降、部分有淋巴结融合,镜下普通型12例,占60%,淋巴结结构破坏,瘤细胞多形性、不规则或卵圆形、梭形,胞浆丰富、嗜酸,核空网状,核膜粗,可见1～3个不等的嗜双色核仁、中位或靠边分布,核分裂易见,可见顿挫型病理性核分裂;免疫组化示肿瘤细胞CD30(20例均阳性)、ALK(5例阳性)、CD5(18例阳性)、CD7(12例阳性)、CD138(8例阳性)、Ki-67(60%～85%阳性)、CD3(19例阳性)、CD45RO(19例阳性)、TIA-1(18例阳性)、Vim(20例均阳性)、mum-1(10例阳性)、CD2(11例阳性)、CD8(10例阳性)、CD68(1例阳性)、Bcl-2(6例阳性)、Bcl-6(12例阳性)。结论间变性大细胞淋巴瘤比较少见,其诊断和鉴别诊断需结合组织病理学、免疫组化、基因重排、临床及实验室检查。     

失血性休克再灌注对早期肠黏膜显微结构的影响

目的观察失血性休克再灌注后肠黏膜屏障功能损伤及其病理改变和超微结构变化。方法16只家兔随机分为2组（n=8）：假手术组（A），休克再灌注组（B）。采用失血性休克再灌注模型。检测灌注后0．5、2、4h血清磷脂酶A2（PLA2）、一氧化氮（NO）和丙二醛（MDA）值；实验结束后取回肠末端黏膜测MDA和组织钙含量；分别通过光镜和电镜观察肠黏膜结构的变化。结果B组血清NO相对A组降低明显。而PLA2、MDA显著升高。B组肠黏膜MDA和组织钙含量有明显升高（P〈0．05）；光镜和电镜观察表明B组肠黏膜损伤明显重于A组。结论失血性休克再灌注使肠道经历缺血缺氧和再灌注损伤，导致肠黏膜生理结构被破坏。     

Validation of donor fraction cell-free DNA with biopsy-proven cardiac allograft rejection in children and adults

ObjectivesDonor-specific cell-free DNA shows promise as a noninvasive marker for allograft rejection, but as yet has not been validated in both adult and pediatric recipients. The study objective was to validate donor fraction cell-free DNA as a noninvasive test to assess for risk of acute cellular rejection and antibody-mediated rejection after heart transplantation in pediatric and adult recipients.MethodsPediatric and adult heart transplant recipients were enrolled from 7 participating sites and followed for 12 months or more with plasma samples collected immediately before all endomyocardial biopsies. Donor fraction cell-free DNA was extracted, and quantitative genotyping was performed. Blinded donor fraction cell-free DNA and clinical data were analyzed and compared with a previously determined threshold of 0.14%. Sensitivity, specificity, negative predictive value, positive predictive value, and receiver operating characteristic curves were calculated.ResultsA total of 987 samples from 144 subjects were collected. After applying predefined clinical and technical exclusions, 745 samples from 130 subjects produced 54 rejection samples associated with the composite outcome of acute cellular rejection grade 2R or greater and pathologic antibody-mediated rejection 2 or greater and 323 healthy samples. For all participants, donor fraction cell-free DNA at a threshold of 0.14% had a sensitivity of 67%, a specificity of 79%, a positive predictive value of 34%, and a negative predictive value of 94% with an area under the curve of 0.78 for detecting rejection. When analyzed independently, these results held true for both pediatric and adult cohorts at the same threshold of 0.14% (negative predictive value 92% and 95%, respectively).ConclusionsDonor fraction cell-free DNA at a threshold of 0.14% can be used to assess for risk of rejection after heart transplantation in both pediatric and adult patients with excellent negative predictive value.     

The neoadjuvant rectal score and a novel magnetic resonance imaging based neoadjuvant rectal score are stage independent predictors of long-term outcome in locally advanced rectal cancer

Aim

Neoadjuvant rectal (NAR) score is an early surrogate for longer-term outcomes in rectal cancer undergoing radiotherapy and resection. In an era of increasing organ preservation, resection specimens are not always available to calculate the NAR score. Post-treatment magnetic resonance imaging (MRI) re-staging of regression is subjective, limiting reproducibility. We explored the potential for a novel MRI-based NAR score (mrNAR) adapted from the NAR formula.

Methods

Locally advanced rectal cancer patients undergoing neoadjuvant therapy (nCRT) and surgery were retrospectively identified between 2008 and 2020 in a single cancer network. mrNAR was calculated by adapting the NAR formula, replacing pathological (p) stages with post-nCRT MR stages (ymr). Cox regression assessed relationships between clinicopathological characteristics, NAR and mrNAR with overall survival (OS) and recurrence-free survival (RFS).

Results

In total, 381 NAR and 177 mrNAR scores were calculated. On univariate analysis NAR related to OS (hazard ratio [HR] 2.05, 95% confidence interval [CI] 1.33–3.14, p = 0.001) and RFS (HR 2.52, 95% CI 1.77–3.59, p = 0.001). NAR 3-year OS <8 was 95.3%, 8–16 was 88.6% and >16 was 80%. mrNAR related to OS (HR 2.96, 95% CI 1.38–6.34, p = 0.005) and RFS (HR 2.99, 95% CI 1.49–6.00, p = 0.002). 3-year OS for mrNAR <8 was 96.2%, 8–16 was 92.4% and >16 was 78%. On multivariate analysis, mrNAR was a stage-independent predictor of OS and RFS. mrNAR corresponded to NAR score category in only 15% (positive predictive value 0.23) and 47.5% (positive predictive value 0.48) of cases for categories <8 and >16, respectively.

Conclusions

Neoadjuvant rectal score is validated as a surrogate end-point for long-term outcomes. mrNAR categories do not correlate with NAR but have stage-independent prognostic value. mrNAR may represent a novel surrogate end-point for future neoadjuvant treatments that focus on organ preservation.     

PSA密度在PSA 2.5～10.0 ng/mL和10.1～20.0 ng/mL患者前列腺癌诊断价值的多中心研究

目的探讨前列腺特异性抗原密度(PSAD)在前列腺特异性抗原(PSA)值位于2.5~10 ng/m L和10.1~20.0 ng/m L患者前列腺癌诊断的效能。方法回顾性分析广州地区两家医院中PSA在2.5~20.0 ng/m L之间,行经直肠前列腺体积测量并行前列腺穿刺的461名患者临床资料,入选者分为PSA 2.5~10.0 ng/m L和PSA10.1~20.0 ng/m L两组,通过受试者工作特征曲线(ROC)分析法评价PSAD与PSA在预测前列腺癌的诊断效力。结果 PSA 2.5~10.0 ng/m L和PSA 10.1~20.0 ng/ml两组的曲线下面积比较,PSAD均高于PSA。在PSA 2.5~10.0 ng/m L组,PSAD预测前列腺癌的最佳临界点为0.15 ng·m L~(-1)·m L~(-1),敏感性和特异性分别为64.4%和64.6%;在PSA10.1~20.0 ng/m L组,PSAD预测前列腺癌的最佳临界点为0.33 ng·m L~(-1)·m L~(-1),敏感性和特异性分别为60.3%和82.7%。结论对于PSA2.5~10.0 ng/m L和10.1~20.0 ng/m L的中国男性,PSAD是一种更优的前列腺癌预测指标。     

内皮抑素在大鼠腹膜的表达及其与腹膜血管新生的关系

目的 研究大鼠腹膜血管内皮抑素（endostatin, ES）基因及蛋白表达与腹膜血管新生的关系。 方法 32只雄性SD大鼠,按随机数字表法分为正常组、肾衰竭非透析组（非腹透组）、1.5%腹膜透析组（1.5% PD组）、4.25%腹膜透析组（4.25% PD组）,每组8只。PD组经规律PD 28 d后,取各组大鼠新鲜腹膜组织,用RT-PCR检测ES mRNA表达;用组织免疫组化染色检测ES蛋白表达;以CD34染色观察腹膜组织毛细血管密度（MVD）。 结果 各组均有ES mRNA表达,正常组为0.47±0.05;非腹透组为0.45±0.04;1.5% PD组为0.46±0.04;4.25% PD组为0.47±0.03;各组表达差异无统计学意义。正常组ES蛋白表达积分0分;非腹透组积分2分;1.5%PD组积分4分;4.25%PD组呈高表达,积分9分。正常组MVD为3.13±1.13;非腹透组为5.13±1.14;1.5%PD组为9.00±1.51;4.25%PD组为10.75±1.83;组间差异均有统计学意义（P < 0.05）。 结论 尿毒症状态和非生理性腹透液刺激可使大鼠腹膜组织ES蛋白表达升高,其在长期透析所致腹膜组织毛细血管生成增多中可能发挥一定的作用。     

病理性瘢痕成纤维细胞中连接蛋白43的免疫电镜观察

目的：观察连接蛋白43（Connexin43,Cx43）在病理性瘢痕成纤维细胞中的表达,探讨Cx43及其构成的缝隙连接在病理性瘢痕中的调控作用。方法：取正常皮肤2例、正常修复组织2例、增生性瘢痕5例、瘢痕疙瘩5例,用特异性抗体（Cx43）作为标记物,用胶体金标记的IgG作示踪物进行免疫电镜观察Cx43的分布与表达,并对其进行定位,同时观察不同标本成纤维细胞的超微结构变化。结果：Cx43在正常修复组织及正常皮肤成纤维细胞的胞浆及近胞膜上表达,且明显集中于粗面内质网;Cx43在增生性瘢痕成纤维细胞的表达明显减少,粗面内质网中见到少许Cx43金颗粒的聚集;瘢痕疙瘩成纤维细胞仅在胞浆中见到少许Cx43散在金颗粒。结论：成纤维细胞Cx43的表达下调可能是造成病理性瘢痕组织中成纤维细胞间缝隙连接细胞间通讯异常,从而导致病理性瘢痕发生的因素之一。