脑梗死急性期降压治疗对预后的影响

目的 研究脑梗死急性期降压及在不同时间进行降压治疗对患者近期预后的影响.方法 据发病后是否降压及进行降压的时间,将198例急性脑梗死患者分为6组,观察各组患者神经功能缺损程度及心脑血管事件的再发生率和病死率.结果 在发病后进行降压治疗的患者中其心脑血管事件再发率和病死率明显低于未降压组（P＜0.01） 3d后降压组患者神经功能恢复的程度明显好于未降压组（P＜0.01）.结论 降压治疗可以降低患者心脑血管事件的发生率和病死率3d后进行降压治疗的患者神经功能恢复明显要好.     

Influence of mild hypothermia on vascular endothelial growth factor and infarct volume in brain tissues after cerebral ischemia in rats

BACKGROUND: It has been demonstrated that mild hypothermia has obvious protective effect on both whole and local cerebral ischemia. However, the definite mechanism is still unclear for the brain protection of mild hypothermia on cerebral edema, inhibiting inflammatory reaction, stabilizing blood brain barrier, etc. OBJECTIVE: To investigate the effect of mild hypothermia on the expression of vascular endothelial growth factor and the infarct volume after cerebral ischemia in rats, and analyze the brain protective mechanism of mild hypothermia. DESIGN: A randomized grouping and controlled animal trial. SETTING: Department of Neurology, People's Hospital of Yunyang Medical College. MATERIALS: Twenty adult male SD rats of clean degree, weighing (250±30) g, were provided by the animal experimental center, School of Medicine, Wuhan University. The kits for SP immunohistochemistry were purchased from Beijing Zhongshan Golden Bridge Biotechnology Co., Ltd. METHODS: The experiments were carried out in the laboratory of Department of Neurology, Renmen Hospital of Wuhan University from May to July 2005. ① The 20 rats were divided randomly into normal temperature group (n =10) and mild hypothermia group (n =10). Models of permanent middle cerebral artery occlusion were established with modified nylon suture embolization. The rats were assessed with the Longa standards: 0 point for without nerve dysfunction; 1 for mild neurological deficit (fore claws could no extend completely); 2 for moderate neurological deficit (circling towards the affected side); 3 for severe neurological deficit (tilting towards the affected side); 4 for coma and unconscious; 1-3 points represented that models were successfully established. The rats of the normal temperature group were fed at room temperature, and those in the mild hypothermia group were induced by hypothermia from 2 hours postoperatively, and the rectal temperature was kept at 34-35 ℃ for 72 hours. ② Measurement of infarct volume: All the rats were anesthetized by intraperitoneal injection overdose sodium pentobarbital 7 days postoperatively, and then the heads were cut down to harvest brain. The brain tissues were placed into -20 ℃ refrigerator for 20 minutes, coronal sections of 2 mm were prepared. The infarct sites were not stained, whereas normal brain tissues were stained as red. The infarct volumes were calculated by using MPLAS-500 multimedia color pathological image&&word analytical system. ③ Counting positive cells of vascular endothelial growth factor protein: The brains were harvested by cutting heads, then coronal sections of 2 mm were prepared. Routine dehydration, hyalinization, wax immersion and embedding were performed, then the detected with SP immunohistochemistry, the kits were purchased from Beijing Zhongshan Golden Bridge Biotechnology Co., Ltd. The cells whose cytoplasm was yellow-brown were positive ones, a single sample as a unit, peri-ischemic site and ischemic core were selected, and the corresponding sites in controlateral hemisphere were taken as controls. Five visual fields were selected from each site to be observed under microscope, the cells were counted, and the average number of positive cells was calculated in each group. The numbers of positive cells were determined with the image analytical apparatus. MAIN OUTCOME MEASURES: Number of the positive cells of vascular endothelial growth factor protein; Infarct volume of rat brain tissue. RESULTS: All the 20 rats were involved in the analysis of results. ① Number of positive cells of vascular endothelial growth factor protein in brain tissue: It was obviously lower in the mild hypothermia group than in the normal temperature group [(24.02±5.05), (36.07±2.69) cells/high power visual field, P < 0.01]. ② Comparison of infarct volume of brain tissue: After MCAO, it was obviously smaller in the mild hypothermia group than in the normal temperature group [(153.25±23.14), (253.45±36.21) mm3, P < 0.01]. CONCLUSION: Mild hypothermia can inhibit the expression of vascular endothelial growth factor and decrease the volume of cerebral infarction. The inhibition of mild hypothermia on the expression of vascular endothelial growth factor may be one of the brain protective mechanisms.     

Galectin-3 may serve as a marker for poor prognosis in colorectal cancer: A meta-analysis

Galectin-3 has an important function in the development of tumors. The purpose of this meta-analysis was to explore the relationships between the expression of galectin-3 on clinicopathological features and prognosis of colorectal cancer (CRC). A comprehensive literature search was used to identify eligible studies, and Stata software was conducted using in this meta-analysis. A total of 15 studies, including 1661 cases, were matched in the inclusion criteria. The pooled analysis indicated that galectin-3 expression was related to the poor overall survival (OS) in CRC patients (HR: 1.77, 95% CI: 1.36–2.31, P < 0.0001). Our meta-analysis also showed that cancerous tissues have higher levels of galectin-3 expression than normal tissues. Besides, positive galectin-3 expression was also related to advanced TNM stages(III/IV vs. I/II: OR 5.30, 95% CI: 2.42–11.61, P < 0.0001), higher Duke’s stages (C/D vs. A/B: OR 4.00, 95% CI: 2.22–7.22, P < 0.0001), venous invasion (venous invasion vs. not: OR 3.02, 95%CI: 1.75–5.22, P < 0.0001) and higher CEA level (CEA≥5 ng/ml vs. ≤ 5 ng/ml: OR 2.09, 95% CI: 1.09–4.03, P = 0.03). In summary, our results indicated that overexpression of galectin-3 is significantly related to the tumor progression and could be a efficient in predicting the prognosis of patients with CRC.     

社区骨关节炎中西医结合标准化防治流程开发：以颛桥社区卫生服务中心为例

背景　骨关节炎是老年人群的第三大常见慢性病，患病人群和高危人群基数均较大。目前，尚缺乏关于社区骨关节炎规范化防治的研究，社区内仍未形成完整、科学的骨关节炎标准化服务流程，使得骨关节炎长期健康管理服务无法提供。目的　开发出一套完整的、可实际应用的“社区骨关节炎中西医结合标准化防治流程”（简称“防治流程”），并详细分析开发过程中的技术要点及难点。方法　于2020年3-12月，分3个阶段开展“防治流程”的开发，包括筹备阶段、开发阶段、信息化阶段。筹备阶段，主要采用文献回顾法、调查法、小组讨论法，形成与骨关节炎防治相关的指南/标准类文献库，并确定“防治流程”涉及的环节、服务范围等。开发阶段，经多轮小组讨论、焦点小组访谈，并结合试运行情况，完成标准操作流程（SOP）1.0至SOP 4.0的不断修订、完善。信息化阶段，以筹备阶段检索到的数据库和SOP 4.0为依据，梳理出“防治流程”中涉及的指标数据库，为进一步信息化开发做好准备。结果　筹备阶段，共纳入符合要求的指南/标准类文献10篇，确定的“防治流程”涉及社区动员、评估（筛查）、诊断、干预、跟踪随访5个环节，以社区动员、评估（筛查）、跟踪随访3个环节为开发重点。开发阶段，形成的SOP 4.0包括服务对象、服务时间、服务地点、服务所需工具、服务人员、服务所需技能、对应服务内容（清单）、所涉服务费用（成本）、生成数据清单、本条操作循证依据共10项内容，形成了完整版“防治流程”。信息化阶段，整理出涉及上述5个环节的数据结构表。结论　本研究开发的“防治流程”可指导社区医务人员基于社区现有资源完成整个社区人群的骨关节炎防治工作，报告的开发流程可以为同行开展骨关节炎及其他单病种社区防治单元建设提供参考。     

扩散峰度成像对上皮性卵巢癌分型的鉴别诊断

目的 探讨扩散峰度成像（DKI）对Ⅰ型与Ⅱ型上皮性卵巢癌（EOC）的鉴别诊断价值。 方法 回顾性收集经手术病理证实的45例EOC病人的临床、病理及影像资料,平均年龄（50±13）岁。根据术后病理结果对EOC病人进行分组,分为Ⅰ型组（24例）和Ⅱ型组（21例）。所有病人均于术前行盆腔DKI检查,由2名放射科医师在DKI各参数伪彩图上分别测量平均扩散峰度（MK）、平行扩散峰度（Ka）、垂直扩散峰度（Kr）、平均扩散系数（MD）、平行扩散系数（Da）、垂直扩散系数（Dr）、各向异性分数（FA）、峰度各向异性分数（FAk）。采用Fisher确切概率检验、独立样本t检验或Mann-Whitney U检验比较2组间临床、病理及影像资料的差异,对差异有统计学意义的参数绘制受试者操作特征（ROC）曲线,分析其鉴别诊断效能。 结果 病理表现上,Ⅰ型中交界性肿瘤占比最高（50.0%）,Ⅱ型中浆液性癌占比最高（61.9%）;Ⅰ型中高分化癌占50%,Ⅱ型多表现为中低分化癌 （76.2%）,Ⅰ型EOC的分化程度高于Ⅱ型;Ⅰ型多数处于Ⅰ期（79.2%）,Ⅱ型多处于Ⅲ期(57.1%)（均P<0.05）。MRI影像上, Ⅰ型病灶多表现为囊性(41.7%)或囊实性（33.3%）,Ⅱ型多表现为实性（52.3%）;Ⅱ型（66.7%）腹水发生率高于Ⅰ型（29.2%）（均P<0.05）。Ⅰ型的MK、Ka和Kr值低于Ⅱ型,MD、Da和Dr值高于Ⅱ型（均P<0.05）。ROC曲线分析显示,MK阈值为0.504时,鉴别2组诊断的曲线下面积（AUC,0.817）最大,诊断敏感度（95.2%）、阴性预测值（92.9%）、准确度（78.9%）也最高,Da阈值为2.190时鉴别诊断的AUC（0.770）最小,而特异度（76.2%）、阳性预测值（75.9%）最高。 结论 DKI序列的定量参数MK、Ka、Kr、MD、Da及Dr均有助于鉴别Ⅰ型与Ⅱ型EOC,其中MK值鉴别诊断效能更大。     

认知-存在团体对社区慢性精神分裂症患者的干预效果

目的探讨认知-存在干预对社区慢性精神分裂症患者的康复疗效。方法将30例日间康复照料机构的慢性精神分裂症患者随机分为干预组(n=15)和对照组(n=15),干预组予以认知-存在团体干预,对照组仅予一般的社区随访。在干预前后分别采用自尊量表(SES)、一般健康问卷(GHQ-20)、生命意义源量表(SML)、生命意义感量表(MLQ)进行评定。结果干预前两组SES、GHQ-20、SML、MLQ评分差异无显著性;干预后,干预组GHQ-20、SML、MLQ总分高于对照组(t=3.05,3.08,2.58;P均<0.05);干预组GHQ-20中抑郁和自我肯定两项因子评分高于对照组(t=2.45,3.17;P均<0.05);干预组SML中自我超越意义因子评分明显高于对照组(t=3.99,P<0.001);干预组MLQ中追寻意义感因子评分明显高于对照组(t=3.77,P<0.001)。结论认知-存在团体对社区慢性精神分裂症患者降低抑郁水平、提升自我肯定、意义感,促进病人康复有积极作用。     

6970例胃癌辨证分型临床报道的统计分析

目的探讨胃癌的中医辨证分型的客观规律。方法统计分析近10年来的在国内公开发表的有关胃癌中医辨证分型的文献,进行多组间两两比较的卡方检验,同时对其中明确术前术后的病例进行统计分析。结果 6970例胃癌最常见的证型分别为脾胃虚弱型、肝胃不和型、气血双亏型、痰湿凝结型、瘀毒内结(湿热)型。肝胃不和型为胃癌术前最常见的证型,脾胃虚弱型为胃癌手术后最常见的证型。结论胃癌证候的分布具有一定特点,且手术前后证型分布有一定差异。     

Activated cytotoxic lymphocytes promote tumor progression by increasing the ability of 3LL tumor cells to mediate MDSC chemoattraction via Fas signaling

The Fas/FasL system transmits intracellular apoptotic signaling, inducing cell apoptosis. However, Fas signaling also exerts non-apoptotic functions in addition to inducing tumor cell apoptosis. For example, Fas signaling induces lung cancer tumor cells to produce prostaglandin E2 (PGE2) and recruit myeloid-derived suppressor cells (MDSCs). Activated cytotoxic T lymphocytes (CTLs) induce and express high levels of FasL, but the effects of Fas activation initiated by FasL in CTLs on apoptosis-resistant tumor cells remain largely unclear. We purified activated CD8⁺ T cells from OT-1 mice, evaluated the regulatory effects of Fas activation on tumor cell escape and investigated the relevant mechanisms. We found that CTLs induced tumor cells to secrete PGE2 and increase tumor cell-mediated chemoattraction of MDSCs via Fas signaling, which was favorable to tumor growth. Our results indicate that CTLs may participate in the tumor immune evasion process. To the best of our knowledge, this is a novel mechanism by which CTLs play a role in tumor escape. Our findings implicate a strategy to enhance the antitumor immune response via reduction of negative immune responses to tumors promoted by CTLs through Fas signaling.     

中药养生文化的渊源及发展脉络

[目的]系统梳理中药养生文化的历史源流与发展脉络。[方法]利用文献学研究方法结合数据统计,通过对中药养生文献进行系统整理、归纳,阐述中药养生文化的历史源流与发展脉络。[结果]中药养生文化根植于中国传统文化,其源流与发展萌芽于先秦,初成于秦汉,丰富于晋唐,渐趋完善于宋金元,鼎盛于明清,于近现代进入改革和创新时期。中药养生思想在先秦两汉时期初用于临床,开中药养生文化之先河;魏晋至隋唐时期,佛道及民间各流派的养生理论和经验使其内容进一步充实;宋金元时期其呈现出百家争鸣的繁盛景象;明清时期医家不仅整理、继承前代既有成果,更形成众多独特理论;现其已成为中医药养生保健服务中的重要部分。[结论]各时期的中药养生文化丰富和完善了中医养生学,为中医药养生文化事业作出了重大贡献。     

354例胸腺瘤外科治疗的临床分析

目的：分析并探讨影响接受外科治疗的胸腺瘤患者预后的临床、病理等因素。方法：回顾性分析南京医科大学第一附属医院胸外科2008年1—6月收治的胸腺瘤患者354例,评估分析年龄、性别、肿瘤直径、世界卫生组织（World Health Organization,WHO）病理分型、TNM分期、Masaoka?Koga分期、重症肌无力、根治性切除对患者预后的影响。结果：Kaplan?Meier单因素生存分析显示：年龄（P=0.002）、肿瘤直径（P=0.045）、WHO病理分型（P=0.051）、TNM分期（P=0.004）、Masaoka?Koga分期（P < 0.001）、根治性切除（P < 0.001）与患者预后相关。Cox多因素生存分析显示,年龄（P=0.003,危害比：10.151,95%CI：2.239~46.021）、WHO病理分型（P=0.045,危害比：3.376,95%CI：1.030~11.064）、Masaoka?Koga分期（P=0.009,危害比：5.621,95%CI：1.552~20.352）是影响胸腺瘤患者总体生存的独立预后因素。结论：胸腺瘤的早期诊断可以有效提高其外科治疗效果,积极实行根治性切除是改善胸腺瘤患者预后的重要手段,术后准确的病理分析可帮助临床医生预测患者预后。