PSA、PSAD、f/tPSA对前列腺癌的诊断及穿刺后Gleason评分的预测

目的 对比PSA、前列腺特异性抗原密度(PSAD)、f/tPSA对前列腺癌(prostate cancer,PCa)的诊断及穿刺后Gleason评分(Gleason score,GS)的预测作用。方法 收集2011年1月~2015年1月间笔者医院泌尿外科以前列腺增生住院患者,根据血清PSA值可疑前列腺癌,而后行前列腺穿刺活检。穿刺病理结果总体人群分为前列腺癌(PCa)组和前列腺增生(BPH)组。患者GS根据临床生物化学和病理学实验室得出。采用受试者工作特征曲线(ROC)对PSA、PSAD、f/tPSA分析比较;采用线性回归分析确定其和术后GS之间的关系。结果 PCa组患者的PSA、PSAD明显高于BPH组(P=0.000),f/tPSA明显低于BPH组(P<0.001)。对PSA不同的区段进行ROC曲线分析,得出诊断灰区(PSA 4~10ng/ml,56例)PSAD差异有统计学意义[P=0.000,曲线下面积(AUC)=0.976],f/tPSA及PSA差异无统计学意义(P>0.05);PSA 4~20ng/ml时(151例)PSAD及f/tPSA差异有统计学意义(AUC分别为0.829、0.673,P=0.000),PSA差异无统计学意义(P>0.05);大于20ng/ml时(96例)PSAD及PSA差异有统计学意义(AUC分别为0.785、0.750,P=0.000),f/tPSA差异无统计学意义(P>0.05);纳入全部样本(253例)后则全部差异有统计学意义(AUC分别为0.795、0.868、0.611,P=0.000)。GS 4~10分,平均7.19±1.06分,线性回归结果提示PSA和PSAD与术后GS均呈正相关(分别是β=0.01,P<0.05;β=0.274,P<0.05),而f/tPSA与GS则无相关性。结论 PSA、PSAD、f/tPSA对前列腺癌具有诊断作用且PSAD>PSA>f/tPSA,PSA及PSAD与穿刺后GS呈正相关。     

游离PSA和复合PSA在前列腺癌诊断中的应用

目的评估三种形式的前列腺特异性抗原:总前列腺特异性抗原(tPSA)、游离前列腺特异性抗原(fPSA)、复合前列腺特异性抗原(cPSA)及其比值在前列腺癌诊断中的应用。方法150名研究对象分为三组:正常对照组50人,前列腺增生(BPH)组50人,前列腺癌(PCa)组50人。用全自动化学发光免疫法分别测定他们的tPSA、fPSA和cPSA,并计算其比值。结果Pca组的cPSA／tPSA、fPSA／tPSA和fPSA／cPSA比值的均值与BPH组有显著差异(分别为91.0％／68.0％,12.1％／26.3％和13.3％／38.8％,P<0.001),fPSA／cPSA与fPSA／tPSA比值密切相关(r=0.8820)。结论与tPSA相比,cPSA／tPSA、fPSA／tPSA和fPSA／cPSA都可增强其对BPH和PCa的鉴别诊断作用。     

IIb/IIIa受体抑制剂治疗急性冠脉综合征的最新研究进展

急性冠脉综合征(acute coronary syndrome,ACS)是严重威胁人类健康的一类急性心血管事件,包括不稳定型心绞痛、非S-T段抬高性心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)和S-T段抬高性心肌梗死(ST-segment elevation myocardial infarction,STEMI),以及以上各病症导致的猝死。直接经皮冠状动脉介入术（PCI）已显示是一种治疗ACS的有效方法。接受PCI治疗期间,使用糖蛋白IIb/IIIa受体抑制剂可以减少ACS患者血栓并发症的发生。     

贝克曼Access2和雅培Axsym对tPSA,fPSA测定结果的比较评价

目的 对同一临床实验室的不同免疫自动检测系统进行偏倚评估,探讨不同检测系统间tPSA、fPSA和fPSA/tPSA 3项指标测定结果是否具有可比性,为临床实验室认可和测定项日的标准化提供参考数据.方法 采用美国贝克曼Access2型全自动电化学发光免疫分析系统和美国雅培Axsym全自动化学发光免疫测定仪分别检测173例...     

Can Mean Platelet Volume Serve as a Marker for Prostatitis?

Aim: The aim of the study was to compare the yield of mean platelet volume (MPV), total prostate specific antigen (tPSA), free prostate specific antigen (fPSA), f/t PSA ratio and complex prostate specific antigen (cPSA) in patients with prostatitis.Material and method: The study was designed in the Kayseri Education and Research Hospital. Ninety-six patients with prostatitis were enrolled retrospectively into the study. Laboratory data were obtained from the computerized patient database. We evaluated the correlation between tPSA, fPSa, f/t PSA ratio, cPSA, MPV and extent and aggressiveness of inflammation in the surgical specimens of patients who underwent surgery for benign prostatic hyperplasia (BPH). Inflammation in the prostatic tissues was scored for extent and aggressivity of inflammation using the grading system designed by Irani et al.Results: The total PSA, fPSa, f/t PSA ratio, cPSA and pre- and post-treatment MPV values of each group did not differ (p>0.05) (Table 1). Also there was no correlation between the histopathological grades and the MPV, tPSA, fPSA, f/t PSA ratio and cPSA of patients. However, MPV values significantly decreased after treatment in all grades of prostatitis (p<0.001).Conclusion: MPV values may be used as an inflammation marker in patients with prostatitis.     

结核性腹膜炎并发不完全性肠梗阻的中西医结合治疗及护理

结核性腹膜炎是由结核分枝杆菌引起的一种慢性弥漫性腹膜感染,起病隐匿,常被误诊和漏诊,部分患者确诊时常已形成腹腔内器官广泛粘连并出现不同程度的肠梗阻。肠梗阻可以分为完全性肠梗阻和不完全性肠梗阻[1]。完全性肠梗阻多采用外科手术治疗,而不完全性肠梗阻多采用保守治疗,但是疗效参差不齐。     

替罗非班对急性冠脉综合征患者血小板CD40L及血清MMP-9水平的影响

目的观察盐酸替罗非班对急性冠脉综合征（ACS）患者血小板CD40L表达、血清MMP-9水平的影响。方法ACS患者60例,随机分为试验组与对照组,应用流式细胞术及明胶酶谱法分别检测药物治疗前及48小时后血小板CIMOL及血清MMP-9水平。结果试验组血小板CIMOL及血清MMP-9升高水平较对照组低（P〈0．05）。结论替罗非班可以减弱ACS患者血小板CD40L、血清MMP-9表达,对预防ACS患者进一步的心脏缺血事件有积极作用。     

PD 1／PD L1通路及其抗体耐药机制的研究进展#br#

程序性死亡受体1（PD 1）／程序性死亡受体配体1（PD L1）能通过调节细胞信号通路和表观遗传修饰来抑制T细胞、B细胞的增殖和效应作用。近几年来,在多种恶性肿瘤中,PD 1／PD L1通路的免疫检查点抑制剂取得了令人惊喜的临床治疗效果,但随之而来的原发性和继发性耐药成为了新的问题,不仅影响了PD 1／PD L1抗体的治疗效果,也限制了其在临床的广泛应用。本文就PD 1/PD L1相关信号通路以及导致PD 1/PD L1抗体耐药的相关机制作一综述。     

Screening and identification of neuroprotective compounds relevant to Alzheimer׳s disease from medicinal plants of S. Tomé e Príncipe

Ethnopharmacological relevance

Alzheimer?s disease (AD) neuropathology is strongly associated with the activation of inflammatory pathways, and long-term use of anti-inflammatory drugs reduces the risk of developing the disease. In S. Tomé e Príncipe (STP), several medicinal plants are used both for their positive effects in the nervous system (treatment of mental disorders, analgesics) and their anti-inflammatory properties. The goal of this study was to determine whether a phenotypic, cell-based screening approach can be applied to selected plants from STP (Voacanga africana, Tarenna nitiduloides, Sacosperma paniculatum, Psychotria principensis, Psychotria subobliqua) in order to identify natural compounds with multiple biological activities of interest for AD therapeutics.

Materials and methods

Plant hydroethanolic extracts were prepared and tested in a panel of phenotypic screening assays that reflect multiple neurotoxicity pathways relevant to AD—oxytosis in hippocampal nerve cells, in vitro ischemia, intracellular amyloid toxicity, inhibition of microglial inflammation and nerve cell differentiation. HPLC fractions from the extract that performed the best in all of the assays were tested in the oxytosis assay, our primary screen, and the most protective fraction was analyzed by mass spectrometry. The predominant compound was purified, its identity confirmed by ESI mass spectrometry and NMR, and then tested in all of the screening assays to determine its efficacy.

Results

An extract from the bark of Voacanga africana was more protective than any other plant extract in all of the assays (EC₅₀s≤2.4 µg/mL). The HPLC fraction from the extract that was most protective against oxytosis contained the alkaloid voacamine (MW=704.90) as the predominant compound. Purified voacamine was very protective at low doses in all of the assays (EC₅₀s≤3.4 µM).

Conclusion

These findings validate the use of our phenotypic screening, cell-based assays to identify potential compounds to treat AD from plant extracts with ethnopharmacological relevance. Our study identifies the alkaloid voacamine as a major compound in Voacanga africana with potent neuroprotective activities in these assays.     

替罗非班对急诊经皮冠状动脉介入术患者的疗效

目的:探讨替罗非班治疗急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入术(PCI)患者的有效性及安全性。方法:对阿司匹林加氯吡格雷常规治疗组(对照组)50例和加用替罗非班三联抗血小板治疗组(观察组)50例的临床资料进行回顾分析。结果:PCI术后30 d,观察组出现的主要不良心血管事件,包括心源性死亡、非致死性心肌再梗死、靶血管再次血运重建、严重心绞痛的发生率为4.0%,低于对照组的18.0%(P0.05);PCI术后48 h及30 d,2组轻度出血及血小板减少并发症的发生率差异均无统计学意义(P0.05),2组均未发生严重出血并发症。结论:STEMI患者行急诊PCI术中及术后48 h联合应用替罗非班治疗能进一步减少术后30 d主要不良心血管事件,且安全性良好。