3M透明敷料贴用于经股动脉穿刺全脑血管造影术的效果观察

目的探讨3M透明敷料贴用于预防经股动脉穿刺全脑血管造影术患者穿刺并发症的效果。方法回顾性分析200例经股动脉穿刺全脑血管造影术患者的临床资料。其中对照组为2012年2月至2013年2月未使用透明敷料贴患者80例,观察组为2013年3月至2014年2月使用3M^TMTegaderm^TM透明敷料贴固定动脉鞘患者120例。分析患者出现动脉鞘管折断、造影管折断、股动脉痉挛、穿刺处淤斑以及皮下血肿等并发症情况,评估使用3M透明敷料贴固定动脉鞘的可行性及有效性。结果观察组动脉鞘管折断、造影管折断、股动脉痉挛、穿刺处淤斑以及皮下血肿总并发症发生率明显低于对照组[5．8％（7／120）比26．2％（21／80）],差异有统计学意义（P〈0．05）。结论3M透明敷料贴价格低廉,安全性好,应用于固定股动脉穿刺鞘管可以有效减少股动脉穿刺相关并发症的发生,且操作方法简单,值得广泛推广使用。     

微小RNA-422a在胃癌组织中的表达及参与多柔比星耐药的机制研究

摘 要 目的：研究微小RNA-422a（miR 422a）在胃癌组织中的表达及参与多柔比星耐药的机制研究。 方法: 检测46例胃癌及癌旁组织中miR 422a的表达水平,分析其与胃癌临床特征和预后的相关性。将miR 422a转染到SGC-7901/多柔比星细胞中,检测不同浓度多柔比星对SGC-7901细胞增殖的影响,计算耐药指数（RI）,同时检测miR 422a和肌细胞增强因子2D（MEF2D）的表达以及细胞凋亡情况。 结果: miR 422a在胃癌组织的表达水平显著低于癌旁组织（P＜0.05）;根据miR 422a的表达水平将患者分为高表达组和低表达组,发现miR 422a的表达水平在分化程度、淋巴结转移和TNM分期有显著差异（P＜0.05或P＜0.01）;与预后良好组患者相比,预后不良组患者miR 422a表达显著降低（P＜0.05）;SGC-7901的半抑制浓度（IC50）为0.33 μg·ml-1,SGC-7901/多柔比星的IC50为12.08 μg·ml-1,RI为36.61;miR 422a mimic组的IC50为4.01 μg·ml-1,RI为2.74;通过转染miR 422a mimic,miR 422a显著上调,同时抑制MEF2D,SGC 790/多柔比星细胞在多柔比星诱导的情况下细胞凋亡率显著升高（P＜0.01）。 结论: miR 422a在胃癌组织中低表达,并与胃癌患者预后不良密切相关,上调miR 422a水平可以增加SGC-7901对多柔比星的敏感性,这一发现可能为逆转肿瘤耐药性提供新的治疗靶点。     

大黄素对胃癌细胞增殖、凋亡及ERK1/2-PKM2/P53通路的影响

摘 要 目的：探讨大黄素对胃癌细胞增殖、凋亡及ERK1/2-PKM2/P53通路的影响。 方法: 实验分为MGC803胃癌细胞组、氟尿嘧啶组、大黄素低剂量组、大黄素高剂量组,测定并比较各组细胞癌细胞活力、癌细胞单克隆形成数目、癌细胞凋亡率、穿膜孔数、以及MGC803胃癌细胞ERK1/2、PKM2、P53mRNA、蛋白水平。 结果: 与MGC803细胞组比较,氟尿嘧啶组、大黄素低、高剂量组吸光度（A）值、存活率水平、克隆形成数目、穿膜数、p ERK1/2、p PKM2 mRNA及蛋白表达水平降低,凋亡率、P53 mRNA及蛋白表达水平升高（P<0.05）。与氟尿嘧啶组比较,大黄素低剂量组A值、存活率水平、克隆形成数目、穿膜数、p ERK1/2、p PKM2 mRNA、蛋白升高,凋亡率、P53 mRNA、蛋白表达水平降低（P<0.05）。与大黄素低剂量组比较,大黄素高剂量组A值、存活率、细胞克隆形成数目、穿膜数、P ERK1/2及P PKM2 mRNA及蛋白表达水平明显降低,凋亡率、P53 mRNA及蛋白表达水平明显升高（P<0.05）。 结论: 大黄素可能通过抑制ERK1/2-PKM2通路诱导P53高表达从而抑制胃癌细胞的增殖及迁徙,促进胃癌细胞的凋亡。     

热休克蛋白90a癌胚抗原与糖类抗原199在胃癌患者外周血中的表达与意义

目的 探讨胃癌患者血浆中热休克蛋白90a （Hsp90a）、血清中癌胚抗原（CEA）和糖类抗原199（CA199）的表达水平及其对胃癌诊断及预后判定的临床价值。方法 选取2018年1月至2019年1月安徽医科大学第一附属医院收治的86例初治胃癌患者为胃癌组,选取同期体检中心94例健康体检者作为对照组,采用酶联免疫法和电化学发光法检测两组患者外周血中Hsp90a、CEA和CA199的表达水平,分析对比单一及联合检测的阳性率、灵敏度及特异度,并按临床病理特征进行亚组分析。结果 胃癌组患者的Hsp90a、CEA和CA199的表达水平均高于对照组[（100.38±74.68）vs（60.70±15.62）、（24.11±96.95）vs（2.24±1.51）和（167.96±1 085.37）vs（11.16±15.23）],表达阳性率亦高于对照组,差异有统计学意义（P<0.05）;胃癌组Hsp90a、CEA和CA199的单一检测胃癌的灵敏度分别为51.16%、30.23%和16.28%,差异有统计学意义（P<0.05）,特异度差异无统计学意义（P>0.05）,三者联合检测达到最高灵敏度,总体特异度有所下降;CEA、CA199的表达水平与淋巴结转移数目及临床分期呈显著正相关（P<0.05）,Hsp90a与有无胸腹水、肿瘤部位、分化程度、浸润深度等临床特征无明显相关性（P>0.05）。结论 胃癌患者外周血中的Hsp90a、CEA和CA199呈高表达,三者联合检测具有一定诊断效能。     

功能性消化不良病儿应用双歧杆菌三联活菌胶囊联合多潘立酮的胃动力学指标分析

目的 探讨双歧杆菌三联活菌胶囊联合多潘立酮对功能性消化不良(FD)病儿胃动力学的影响。方法 选取2015年6月至2016年8月在石家庄市第三医院儿科门诊诊治的108例FD病儿,按照随机数字表法分成对照组与治疗组,每组54例。对照组予多潘立酮片(吗丁啉)口服每次10 mg,3次/天;治疗组在此基础上再予双歧杆菌三联活菌胶囊口服(每粒0.21 g)2粒/次,2次/天。检测血清胃肠激素,评估胃动力学相关指标,评价临床症状评分,比较临床效果。结果 治疗组治疗前胃动素(MTL)、神经肽Y(NPY)、血管活性肠肽(VIP)分别为［(206.84±27.14)、(1.40±0.20)、(24.09±3.30)］ pg/mL,治疗后为［(338.29±46.42)、(2.34±0.31)、(10.87±1.43)］ pg/mL;对照组治疗前为［(206.73±26.58)、(1.41±0.18)、(24.17±3.28)］ pg/mL,治疗后为［(281.42±40.02)、(1.88±0.24)、(16.22±2.12)］ pg/mL。与治疗前比较,两组病儿胃动素(MTL)、神经肽Y(NPY)升高(P＜0.01),血管活性肠肽(VIP)降低(P＜0.01)。两组对比,治疗组病儿MTL、NPY较高(P＜0.01),VIP较低(P＜0.01)。胃动力学变化:治疗后治疗组、对照组胃排空时间为［(25.58±3.39)、(30.78±4.33)］ min,较治疗前［(52.62±7.50)、(52.49±7.43)］ min缩短(P＜0.05),胃窦收缩频率治疗后为［(4.74±0.66)、(3.69±0.47)］次/分,较治疗前［(1.80±0.22)、(1.81±0.23)］次/分升高(P＜0.05),胃窦收缩幅度治疗后为［(60.43±8.57)、(51.17±7.07)］ mm,较治疗前［(37.01±5.20)、(36.94±5.12)］ mm变大(P＜0.05);两组对比,治疗组病儿胃排空时间较短(P＜0.05),胃窦收缩频率较高(P＜0.05),胃窦收缩幅度较大(P＜0.05)。临床症状积分两组治疗后均降低(P＜0.01),与对照组比较,治疗组积分降低较明显(P＜0.01),总有效率较高(P＜0.05)。结论 双歧杆菌三联活菌胶囊联合多潘立酮治疗小儿FD效果显著,可能与其调节胃肠激素、胃动力的作用有关。     

Diversidad de los genotipos vacA y cagA de Helicobacter pylori y expresión de interferón gamma en pacientes con gastritis crónica y cáncer gástrico

BackgroundHelicobacter pylori (H. pylori) is the main risk factor for the development of chronic gastritis, gastric ulcer, and gastric cancer. In H. pylori-infected individuals, the clinical result is dependent on various factors, among which are bacterial components, the immune response, and environmental influence.AimsTo compare IFN-γ expression with the H. pylori vacA and cagA genotypes in patients with chronic gastritis and patients with gastric cancer.MethodsNinety-five patients diagnosed with chronic gastritis and 20 with gastric cancer were included in the study. Three gastric biopsies were taken; one was used for the molecular detection and genotyping of H. pylori; another was fixed in absolute alcohol and histologic sections were made for determining IFN-γ expression through immunohistochemistry.ResultsNo differences were found in the cells that expressed IFN-γ between the patients with chronic gastritis (median percentage of positive cells: 82.6% in patients without H. pylori and 82% in infected persons) and those with gastric cancer (70.5% in H. pylori-negative patients and 78.5% in infected persons). IFN-γ expression was 69% in chronic gastritis patients infected with H. pylori vacAs2m2/cagA^-, it was 86.5% in patients infected with H. pylori vacAs1m2/cagA^-, 86.5% in vacAs1m1/cagA^-, and 82% in vacAs1m1/cagA⁺. Similar data were found in the patients with gastric cancer.ConclusionsIFN-γ expression varied depending on the H. pylori vacA and cagA genotype, but not in accordance with the presence of chronic gastritis or gastric cancer.     

基于第3代双源CT双低检查技术在肺栓塞成像的临床应用研究

目的 探讨第3代双源CT大螺距70 kV联合超低对比剂用量16 ml在肺栓塞低辐射剂量成像的临床应用价值。方法 将83例临床可疑肺栓塞行CT肺动脉成像患者,按随机数表法,分为两组：常规组,36例,管电压100 kV,螺距1.0,对比剂总量60 ml;双低组,47例,管电压70 kV,螺距2.2,对比剂总量16 ml。记录两组的容积CT剂量指数（CTDI_vol）和剂量长度乘积（DLP）以计算有效剂量（E）,测量各级肺动脉增强CT值、背景噪声及肌肉CT值以计算信噪比（SNR）、对比噪声比（CNR）。两组的总体图像质量和上腔静脉引起的线束硬化伪影均采取3级评分进行主观评价。结果 两组患者之间性别、年龄、身高、体重、体质量指数（BMI）、肺栓塞比例及各级肺动脉增强CT值差异均无统计学意义（P>0.05）。双低组E为（0.76±0.13）mSv,常规组为（1.91±0.54）mSv,两组比较差异有统计学意义（Z=-5.23,P<0.001）。双低组背景噪声高于常规组（Z=-4.99,P<0.001）,且SNR和CNR均低于常规组（Z=-4.56、-4.48,P<0.001）,但两组总体图像质量主观评分差异无统计学意义（P>0.05）,且双低组上腔静脉引起的线束硬化伪影评分（1.34±0.60）低于常规组（2.94±0.23）,两组比较差异有统计学意义（Z=-5.15,P<0.001）。结论 第3代双源CT大螺距70 kV联合16 ml超低对比剂用量,可以显著降低对比剂线束硬化伪影对右肺动脉、右肺上叶动脉的干扰,保证肺栓塞诊断图像质量,并大幅度降低辐射剂量约60%,同时减少73%对比剂总量。     

Routine Coagulation Testing: Do We Need a Discard Tube?

When coagulation tests are performed, the recommended guideline is that a discard tube be used and the coagulation testing should be done only on the second tube. This guideline is however inconsistently enforced and most laboratories follow a single tube draw for routine coagulation testing. Few studies have however, challenged this guideline and have shown that comparable results can be obtained in both tubes when a two tube draw is used. This prospective study was done over a 3 months period in the hematology laboratory under the Clinical Hematology unit of a tertiary care teaching institution in North India. Fifty-six paired specimens were drawn from healthy volunteers following the prescribed “two tube draw” method. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were performed within 1 h of sample collection on a fully automated photo-optical coagulation instrument (Ceveron-Alpha). Paired results for PT and APTT were compared using Bland–Altman plots for method comparison. There was good correlation between the PT, INR and APTT of the first and second tubes with bias of 0.09, −0.05 and 0.3 respectively). Bland–Altman plots showed acceptable agreement between the two values with 95 % confidence interval ranging from −0.62 to 0.79 for PT, −0.05 to 0.06 for INR and −3.9 to 4.6 for APTT. Our study has shown no significant difference between PT and APTT values for the first and second tubes. Hence the use of a discard tube is not required.     

两种三联疗法治疗幽门螺杆菌感染性胃溃疡合并复发性口腔溃疡疗效对比

目的对比观察克拉霉素三联疗法与甲硝唑三联疗法治疗幽门螺杆菌(helicobacter pylori,Hp)感染性胃溃疡合并复发性口腔溃疡的临床疗效。方法选取2015年1月至2019年1月信阳市中医院收治的56例Hp感染性胃溃疡合并复发性口腔溃疡患者作为研究对象,并按照随机数表法将其随机分为试验组(28例)和对照组(28例),其中试验组患者采用克拉霉素、奥美拉唑、阿莫西林三联疗法予以治疗,对照组患者采用甲硝唑、奥美拉唑、阿莫西林三联疗法予以治疗,对比观察两组患者的Hp清除情况、胃溃疡与口腔溃疡愈合情况以及免疫功能变化情况。结果试验组患者Hp清除率及胃溃疡愈合率显著高于对照组(χ~2=4.978、14.275,P=0.026、0.000)、胃溃疡复发率显著低于对照组(χ~2=12.600,P=0.000)、口腔溃疡治疗有效率显著高于对照组(Mann-Whitney U=216.500,Z=-3.104,P=0.002);治疗4周后,两组患者CD3^+、CD4^+ 、CD4^+ /CD8^+水平均显著高于治疗前(CD3^+:t=19.170、8.853,P=0.000、0.000;CD4^+ :t=12.892、4.430,P=0.000、0.000;CD4^+ /CD8^+:t’=20.192、9.040,P=0.000、0.000),CD8^+水平显著低于治疗前(t’=14.224、5.403,P=0.000、0.000),且治疗后试验组患者CD3^+、CD4^+ 、CD4^+ /CD8^+水平均显著高于对照组(t=9.397、7.789、9.551,P=0.000、0.000、0.000),CD8^+水平显著低于对照组(t=12.237,P=0.000)。结论克拉霉素三联疗法可明显增强Hp感染性胃溃疡合并复发性口腔溃疡患者的免疫功能,提高Hp清除率及胃溃疡与口腔溃疡愈合率,降低胃溃疡复发率,效果显著优于甲硝唑三联疗法,值得临床推广应用。     

Otitis media with effusion in Nigerian children with cleft palate: incidence and risk factors

Otitis media with effusion is common in children with cleft palate, and the aim of this study was to find out its incidence and risk factors in Nigerians. We prospectively studied 84 patients (42 with cleft palate and 42 control subjects); 27 were male and 15 female, who were age and sex matched with control subjects. The extent and size of the clefts were measured using a dental cast and Vernier calipers, and the otitis media was diagnosed with otoscopy and tympanometry. The mean (SD) age of the groups was 11 (7) months (range 1–33). Twelve children in the cleft group had otitis media compared with three in the control group. Infants and boys were more likely to be affected. There was a significant association between age (p = 0.02), sex (p = 0.01), and size of cleft (p = 0.00). However, only the size of the cleft was confirmed to be an independent predictor, with children who had extremely wide clefts being more likely to develop otitis media than those with narrow clefts (OR = 8.71, 95%CI = 1.07 to 70.5).We conclude that the incidence of otitis media with effusion was higher among children with cleft palate than among those who did not have a cleft. Infants had a higher incidence than older children, and boys had a higher incidence than girls. Age, sex, and the size of the palatal cleft were significantly associated with otitis media, but not the extent of clefting.