胰岛素样生长因子-Ⅰ在非酒精性脂肪肝病变中的变化

目的研究血清胰岛素样生长因子Ⅰ(IGFⅠ)与非酒精性脂肪肝的关系。方法采用夹心酶联免疫分析的方法测定60例非酒精性脂肪肝患者和40名健康对照血清IGFⅠ水平,并比较两组IGF1、血脂[胆固醇(Chol)、三酰甘油(TG)]、空腹血糖(Glu)、丙氨酸转氨酶(ALT)的测定结果。结果脂肪肝组的血清IGF1水平为(162.0±46.6)ng/ml,健康组血清IGF1水平为(189.0±37.4)ng/ml,结果差异具有显著性(P<0.01)。两组的TG、Glu差异也有显著性(P<0.05),其他指标差异无显著性。结论非酒精性脂肪肝患者的IGF1水平下降与脂肪肝的形成有关,同时可能加重凋亡对已发生脂肪变性的肝细胞的损伤。     

32578例住院患者医院感染调查分析

目的　了解我院住院患者医院感染发病率。方法　对我院 2 0 0 2年 32 5 78例住院患者进行调查。结果　 5 48例发生医院感染 (1.6 8%) ,最高科室为 9.79%,以下呼吸道最常见 (37.79%)。检出病原菌 184株 ,以革兰阴性菌为主 (49.46 %) ,多为铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌。前者对常用抗菌药物耐药率均 >5 0 %,对亚胺培南的耐药率为 81.82 %。结论　加强重点易感区域的监测、细菌的耐药性监测和培训教育 ,以更有效的预防和控制医院感染。     

《伤寒论》六经辨证在IgA肾病诊治中的指导价值

《伤寒论》六经辨证是在《黄帝内经》六经理论及脏象、经络两学说的基础上发展、完善而得来的,是中医的鼻祖。本文的主要目的是探讨《伤寒论》六经辨证在IgA肾病诊治中应用价值。IgA肾病又称为原发性肾小球疾病,在我国常见,其整个发病过程可视为从三阳经(太阳、阳明、少阳)转变为三阴经(太阴、少阴及厥阴)。IgA肾病在各经为病,脉症特点并不相同,因此IgA肾病采用六经辨证为指导,判断病情,能够有效防治IgA肾病,对临床具有重要的意义及价值。     

Constructing Large Scale Cohort for Clinical Study on Heart Failure with Electronic Health Record in Regional Healthcare Platform: Challenges and Strategies in Data Reuse

Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management. It is a common requirement to reuse the data for clinical research. However, we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform. In this paper, we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology. We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform. Secondly, we built special disease case repositories (i.e., heart failure repository) that utilize the graph to search the related patients and to normalize the data. Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure, we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository. After the propensity score matching, the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired. Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients. This paper presents the workflow and application example of big data mining based on regional EHR data.     

中医治疗冠心病合并糖尿病的系统评价

目的评价中药与西药治疗冠心病合并糖尿病的疗效差异及安全性。方法检索PubMed、CBM、CNKI、VIP、万方等数据库,纳入治疗组采用中药或联合西药,对照组采用西药的临床随机对照试验。采用RevMan5.1.6软件作Meta分析。结果 6项Jadad评分较高研究的临床症状改善合并效应量OR=5.6,95%CI[3.11,10.05],P<0.01;5项研究的心电图疗效有效率合并效应量OR=2.66,95%CI[1.71,4.12],P<0.01;其中1项报道了对照组有2例病情加重,治疗组未发生不良反应,其余研究均报道未发生任何肝肾损伤的不良反应。结论现有证据提示中药联合西药治疗冠心病合并糖尿病时,其临床症状和心电图改善情况均优于单纯西药治疗,且不良反应少。     

Comparison of the efficacy and safety of the adalimumab biosimilar TQ-Z2301 and adalimumab for the treatment of Chinese patients with active ankylosing spondylitis: a multi-center,randomized, double-blind,phase III clinical trial

Clinical Rheumatology - To assess the clinical equivalence of TQ-Z2301, a biosimilar of adalimumab, to the reference adalimumab in the treatment of Chinese patients with active ankylosing...     

Downregulation of GSTM2 enhances gemcitabine chemosensitivity of pancreatic cancer in vitro and in vivo

Glutathione-S-transferases (GSTs) not only show cytoprotective role and their involvement in the development of anticancer drug resistance, but also transmit signals that control cell proliferation and apoptosis. However, the role of GST isoforms in chemotherapy resistance remains elusive in pancreatic cancer. Here, we demonstrated that gemcitabine treatment increased the GSTM2 expression in pancreatic cancer cell lines. Knockdown of GSTM2 by siRNA elevated apoptosis and decreased viability of pancreatic cancer cells treated with gemcitabine. Moreover, in vivo experiments further showed that shRNA induced GSTM2 downregulation enhanced drug sensitivity of gemcitabine in orthotopic pancreatic tumor mice. We also found that GSTM2 levels were lower in tumor tissues than in non-tumor tissues and higher GSTM2 expression was significantly associated with longer overall survival. In conclusion, our findings indicate that GSTM2 expression is essential for the survival of pancreatic cancer cells undergoing gemcitabine treatment and leads to chemo resistance. Downregulation of GSTM2 in pancreatic cancer may benefit gemcitabine treatment. GSTM2 expression in patients also shows significant correlation with overall survival. Thus, our study suggests that GSTM2 is a potential target for chemotherapy optimization and prognostic biomarker of pancreatic cancer.     

上海地区老年男性血脂参考值及其分布

目的分析60岁以上老年男性血清脂类水平的参考值及其分布。方法752名健康老年男性按年龄分组,先按年龄5岁为组距分组并分析各血清脂类水平,根据统计结果重新分组。结果按不同年龄段之间的差异分为3组,其中随年龄增长,致动脉粥样硬化的脂类下降,抗动脉粥样硬化脂类成分上升。在不同年龄组间三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A-I(apo A-I)、载脂蛋白B(apo B)、非高密度脂蛋白胆固醇(non-HDL-C)差异有统计学意义,调查人群各指标的95%范围分别为:胆固醇(Chol)3.18～6.60 mmol/L,TG 0.66～3.66 mmol/L,HDL-C>0.92 mmol/L,低密度脂蛋白胆固醇(LDL-C)1.22～4.16 mmol/L,apo A-I0.91～1.65 g/L,apo B 0.56～1.34 g/L,non-HDL-C 1.87～5.13 mmol/L,LDL/LDL-apo B>1.07。结论老年人群的血脂合适范围较一般人群升高,特别是TG水平,在临床应用时应按不同年龄段选用恰当的合适范围。     

子宫内膜癌淋巴结转移的高危因素分析：附358例报告

目的：探讨子宫内膜癌（EC）的临床病理学特征及淋巴结转移的预测因素。方法回顾性分析2007年3月至2010年4月四川大学华西第二医院妇科收治,并经术后组织病理学结果确诊为 EC 的358例患者的完整临床病历资料。其初治为系统分期手术,并进行盆腔及腹主动脉旁各组淋巴结计数。对本组EC患者进行临床病理特点分析,并进行随访,对EC盆腔淋巴结转移的可能相关因素进行统计学分析（本研究遵循的程序符合四川大学华西第二医院人体试验委员会所制定的伦理学标准,得到该委员会批准,征得受试对象本人的知情同意,并与之签署临床研究知情同意书）。结果本组358例 EC 患者的中位发病年龄为52岁（20-78岁）。对本组患者的中位随访时间为18个月,其中位生存期为18个月（7-43个月）,3年总体生存（OS）率为90.1%（323/358）。本组盆腔淋巴结病理学检查结果呈阳性和呈阴性患者的3年 OS率分别为76.2%（16/21）,97.3%（327/336）,二者比较,差异有统计学意义（χ2=23.423,P〈0.01）。子宫内膜样癌和非子宫内膜样癌患者的3年 OS率分别为：96.2%（306/318）与95.0%（38/40）,差异无统计学意义（P=0.478）。国际妇产科联盟（FIGO）分期不同患者的3年 OS 率分别为：Ⅰ期为97.1%（304/313）,而Ⅱ期为91.7%（11/12）;Ⅲ期为85.2%（23/27）。本组患者随访期内 EC 的相关复发率为3.9%（14/358）,死亡率为3.1%（11/358）,盆腔淋巴结转移率为5.9%（21/357）。对导致21例患者盆腔淋巴结转移的可能相关因素进行单因素 logistic 回归分析结果显示,FIGO 分期[OR=4.169,95%CI（2.693-6.454）,P=0.000],肿瘤体积（肿瘤直径〉2 cm）[OR=7.175,95%CI（2.590-19.876）,P=0.000],淋巴脉管间隙浸润（LVSI）[OR=6.277,95%CI（2.410-16.348）,P=0.000],宫体肌层浸润深度[OR=3.598,95%CI（1.651-7.841）,P=0.001]和宫旁浸润[OR=9.382,95%CI（3.349-26.284）,P=0.000]是导致 EC患者盆腔淋巴结转移的高危因素;对以上单因素 logical 回归分析结果显示,对盆腔淋巴转移有影响的因素（P〈0.05）,进行多因素非条件 logistic 回归分析结果显示,FIGO 分期[OR=3.787,95%CI （2.113-6.786）,P=0.00]是盆腔淋巴结转移的独立危险因素。结论 FIGO 分期晚、肿瘤体积大（直径〉2 cm）、LVSI呈阳性、宫体深肌层浸润及宫旁浸润是导致 EC患者发生盆腔淋巴结转移的高危因素。其中, FIGO分期,是盆腔淋巴结转移的独立危险因素。