ITGB1通过激活MAPK/ERK通路促进前列腺癌细胞侵袭

目的 研究ITGB1基因在前列腺癌中的表达情况及对前列腺癌细胞侵袭行为的影响和可能作用机制.方法 实时荧光定量PCR检测ITGB1在前列腺癌标本和前列腺癌细胞株PC3和LNCaP中的表达水平.设计小干扰RNA干扰ITGB1的表达,观察干扰效率以及干扰后对前列腺癌PC3和LNCaP细胞的迁移和侵袭能力的影响.结果 ITGB1 mRNA在前列腺癌标本中表达水平上调(t =5.12,P＜0.05),在前列腺癌细胞株LNCaP和PC3中表达水平也较正常前列腺上皮高(P＜0.01).siRNA成功干扰ITGB1表达后,划痕实验显示,前列腺癌Lncap和PC3细胞迁移能力显著下降.Transwell侵袭实验显示干扰ITGB1后,前列腺癌细胞的侵袭能力较对照组也显著下降.GCBI基因网络分析显示,ITGB1与MAPK通路具有显著相关性.进一步行蛋白质免疫印迹杂交实验显示,干扰ITGB1后,MAPK通路中ERK蛋白和磷酸化的ERK的蛋白表达下降,并且下游MMP9蛋白水平也呈现下降.结论 ITGB1通过激活MAPK信号通路,促进前列腺癌细胞迁移和侵袭.     

SPAG9调控前列腺癌迁移侵袭能力的研究

目的探讨SPAG9对前列腺癌细胞迁移、侵袭能力的影响及其分子机制。方法应用RNA干扰技术下调SPAG9在前列腺癌细胞中的表达,采用Western blot方法评估SPAG9基因干扰效果。采用Transwell实验比较SPAG9干扰前后前列腺癌细胞DU145、PC3的迁移与侵袭能力的改变。用CCK8细胞增殖实验分析SPAG9基因沉默对前列腺癌细胞DU145、PC3增殖能力的影响。用Western blot实验研究SPAG9基因沉默对前列腺癌细胞中MMP-2及TIMP-2蛋白表达的影响。结果特异性SPAG9基因的干扰RNA(siRNA)能够有效沉默DU145、PC3前列腺癌细胞株中SPAG9蛋白的表达。SPAG9敲低后的前列腺癌细胞株迁移与侵袭能力显著降低,差异有统计学意义(P0.05)。siSPAG9组DU145和PC3细胞中MMP-2的蛋白表达水平比siCtrl组显著降低,两组比较差异有统计学意义(P0.05),而TIMP-2的表达量显著升高,差异有统计学意义(P0.05)。SPAG9基因沉默后并不影响DU145及PC3细胞的增殖,组间差异无统计学意义(P0.05)。结论SPAG9基因通过激活MMP-2信号通路增强前列腺癌细胞的迁移与侵袭能力。     

趋化因子CXCL12及其受体在前列腺癌细胞系PC3嗜神经过程中的作用

目的研究CXCL12及其受体CXCR4在前列腺癌嗜神经过程中的作用。方法体外培养前列腺癌PC3细胞，利用Transwell实验观察外源性CXCL12及其受体CXCR4拮抗剂AMD3100对PC3细胞侵袭性的影响。结果体外实验研究表明外源性CXCL12可促进PC3细胞的侵袭性（P〈0．05），而AMD3100明显抑制瘤细胞的侵袭能力（P〈0．05）。结论CXCL12／CXCR4在前列腺癌细胞嗜神经过程中具有重要作用。CXCR4拈抗剂可抑制肿瘤细胞的嗜神经倾向。     

miR-152对前列腺癌细胞株迁移和侵袭能力的影响

目的研究miR-152在前列腺癌、前列腺正常组织中的表达情况及其在前列腺癌细胞系中的作用。方法采用TaqMan荧光定量RT—PCR方法检测8例前列腺癌和8例前列腺正常组织的样本中miR-152的表达水平。运用Transwell细胞迁移实验及侵袭实验评估miR一152对前列腺细胞系PC-3和DU145细胞功能的影响。结果与正常前列腺组织相比,miR-152在前列腺癌组织中的表达水平显著下调（P〈0．05）。体外实验中上调miR152的表达可以显著降低前列腺癌细胞的迁移和侵袭能力（P〈O．05）。结论miR-152在前列腺癌中可作为一种肿瘤抑制因子,影响前列腺癌细胞的迁移和侵袭能力。     

BRP44基因对前列腺癌生物学行为的影响

目的研究BRP44高表达的人前列腺癌细胞PC3细胞系（雄激素非依赖性前列腺癌细胞株）细胞的生物学性状的影响，以了解其在人前列腺癌发生发展中可能的机制和作用。方法将已转染BRP44的PC3细胞提取其RNA，进而行Northern Blot检测证明其高表达，用Alamar Blue检测BRP44高表达的阳性细胞生长情况，流式细胞仪检测其细胞周期变换，采用改良的Transweu侵袭小室方法检测细胞侵袭能力。结果BRP44高表达的PC3细胞增殖速度较转染空载体的PC3细胞和正常PC3细胞快，差异有统计学意义（P〈0．05）。在体外细胞移动实验中，BRP44高表达的PC3细胞也较另两组细胞表现出更强的穿膜能力、侵袭力（P〈0．01）。结论BRP44表达增高与人前列腺癌细胞的恶性表型具有密切相关性，BRP44可能在人前列腺癌的发生、发展中发挥重要作用。     

siRNA靶向沉默OCT4基因对前列腺癌DU145和PC3细胞等生物学行为的影响

目的 观察siRNA靶向沉默OCT4基因对前列腺癌DU145细胞和PC3细胞的生物学行为影响.方法 通过脂质体介导的方法将OCT4 SiRNA分别转染人前列腺癌细胞株DU145细胞和PC3细胞,采用RT-PCR和Western-blot方法分别检测特异性siRNA对0ct4基因在mRNA和蛋白水平上的沉默效果,CCK8法测定细胞生长曲线观察细胞增殖的抑制情况,运用Transwell小室法检测细胞侵袭能力的变化.结果 转染OCT4 SiRNA的两组细胞OCT4的表达均低于阴性对照组(NC)与空白组(P＜0.05),OCT4SiRNA抑制两种细胞的增殖并降低细胞的侵袭能力.结论 OCT4-siRNA可以有效抑制DU45细胞和PC3细胞的OCT4基因的表达,从而抑制细胞增殖,抑制侵袭和迁移,表明OCT4基因在前列腺癌的发生发展中发挥重要作用.     

RBBP4对前列腺癌细胞生长和侵袭能力的影响

目的：研究视网膜母细胞瘤结合蛋白4(retinoblastoma binding protein4,RBBP4)对前列腺癌细胞侵袭、迁移、增殖及肿瘤生长等生物学行为的影响.方法构建 RBBP4过表达慢病毒载体转染及未转染 LNCaP、DU145细胞株,分别通过 Transwell 实验、Wound healing 实验、CCK8及流式细胞技术检测前列腺癌细胞的侵袭、迁移、增殖和凋亡,异体肿瘤种植模型研究RBBP4对前列腺癌细胞成瘤能力的影响.结果 RBBP4上调表达明显促进前列腺癌细胞的迁移(LNCaP：RBBP4 vs Ctrl ＝133．8±14．1 vs 48．6±11．9;DU145：RBBP4 vs Ctrl ＝118．2±10．5 vs 62．3±13．0,P ＜0．001)和侵袭(LNCaP：RBBP4 vs Ctrl ＝252．0±16．3 vs 82．5±12．6;DU145：RBBP4 vs Ctrl ＝232．8±9．2 vs 61．0±8．3,P ＜0．001)能力;RBBP4高表达可以刺激 DU145前列腺癌细胞的增殖并显著加快 DU145细胞移植瘤的生长速度(P ＜0．01).结论 RBBP4能刺激前列腺癌细胞的侵袭、迁移,促进前列腺癌的形成及生长.     

特异性siRNA沉默TDGF-1基因表达对乳腺癌细胞迁移侵袭的影响

目的 探讨RNA干扰(RNA interference,RNAi)沉默TDGF-1基因表达对乳腺癌细胞侵袭的影响.方法 根据TDGF-1基因序列特点设计3个小干扰RNA(small interfering RNA,siRNA)后,转染人乳腺癌MDA-MB-468细胞,用荧光实时定量RT-PCR筛选出效果最好的siRNA.以该siRNA转染处理乳腺癌MDA-MB-468细胞后,分别采用实时定量RT-PCR和western blot检测TDGF-1基因mRNA和蛋白水平,以划痕试验方法评测癌细胞迁移能力;用Boyden模型观察癌细胞侵袭能力.结果 根据TDGF-1基因序列特点设计的3个siRNA均能抑制TDGF-1基因mRNA水平,以S1效果最好.S1 siRNA转染组TDGF-1 mRNA和蛋白水平明显下调,且呈浓度和时间依赖性(P＜0.001,P＜0.001).体外试验发现,TDGF-1 siRNA转染可有效抑制乳腺癌细胞集落生长、侵袭和迁移能力,且与浓度相关(P＜0.005,P＜0.005,P＜0.005).结论 TDGF-1在乳腺癌细胞迁移、侵袭中起着重要的作用;采用TDGF-1 siRNA转染可抑制乳腺癌细胞侵袭.     

miR-363-3p表达异常对人前列腺癌细胞生物学表型的影响

目的 研究微小RNA-363-3p(miR-363-3p)在人前列腺癌细胞和正常前列腺上皮中的表达并探究miR-363-3p对前列腺癌细胞生物学表型的影响。方法 分别提取人前列腺癌细胞DU145、PC3和正常肝细胞RWPE-1的总RNA,采用实时荧光定量PCR(RT-PCR)法检测miR-363-3p的表达。运用脂质体介导的方法分别将慢病毒空载体pCDH-vector(简称PCDH)及构建好的慢病毒质粒pCDH-miR-363-3p(简称miR-363-3p质粒)和pCDH-miR-363-3p sponge(miR-363-3p sponge质粒)转染DU145、PC3细胞,利用CCK8和平板克隆实验检测miR-363-3p表达改变后对细胞增殖能力的影响;Transwell实验检测miR-363-3p表达变化对细胞体外迁移侵袭能力的影响;微管实验检测miR-363-3p表达变化对细胞体外成管能力的改变。结果 miR-363-3p在人前列腺癌细胞与正常前列腺上皮细胞中的表达水平相比,显著上调(P0.05)。体外实验中,过表达miR-363-3p能显著增强人前列腺癌细胞的增殖、迁移侵袭及微管形成能力,下调miR-363-3p后上述生物学表型均受到抑制,且差异显著。结论miR-363-3p在人前列腺癌细胞中表达上调,过表达miR-363-3p可促进人前列腺癌细胞体外增殖、迁移侵袭和微管形成能力。在前列腺癌发病进程中,miR-363-3p可能扮演促癌基因的角色,有望成为前列腺癌治疗的新靶点。     

小干扰RNA沉默血管内皮生长因子对ACHN肾癌细胞黏附、侵袭及迁移的影响

目的 观察小干扰RNA (siRNA)沉默血管内皮生长因子(VEGF)对ACHN肾细胞癌细胞生物学行为的影响.方法 化学合成针对VEGF的小干扰RNA,实验分4组,转染后收集细胞,通过蛋白印迹方法检测VEGF的表达,噻唑蓝(MTT)比色法、细胞黏附实验、划痕实验及Transwell法测定细胞的增殖、黏附、迁移及侵袭能力.结果 siRNA 1～2组VEGF表达水平明显低于空白对照组及阴性对照组;在24、48、72 h,siRNA 1～2的增殖抑制率均高于空白对照组及阴性对照组(P＜0.05),其中以siRNA2组最为显著;与空白对照组比较,siRNA 1～2组的细胞黏附数量明显下降[(81.5±3.1)％比(40.5±2.6)％、P＜0.05,(81.5±3.1)％比(22.5±2.4)％、P＜0.05],其中以siRNA2组最为明显;siRNA1～2组的细胞迁移数量明显下降(162±9比81±5,P＜0.05;162±9比38±4,P＜0.05);siRNA1～2组细胞侵袭能力明显下降(P＜0.05),且siRNA 2组的细胞侵袭能力明显低于siRNA 1组(P＜0.05).结论 VEGF基因在肾细胞癌细胞黏附、迁移和侵袭中发挥着重要作用;以靶向VEGF的siRNA转染肾细胞癌细胞,可抑制肾细胞癌细胞黏附、迁移和侵袭能力.     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

血浆凝血因子VIII水平与IgA肾病患者临床病理改变及预后的关系

目的探讨血浆凝血因子VIII(factor VIII,FVIII)水平与IgA肾病(IgAN)患者临床参数及预后的关系。方法收集2016年1月至2016年12月中南大学湘雅二医院确诊的IgAN患者的临床资料。按照时间依赖的受试者工作特征曲线(ROC)得出的血浆FVIII预测IgAN预后的临界值,将患者分为高FVIII组(FVIII>140.50%)和低FVIII组(FVIII≤140.50%),比较两组患者肾活检时基线临床参数的差异。以估算肾小球滤过率(eGFR)下降≥30%或进入终末期肾脏病(ESRD)为终点事件,采用Kaplan-Meier生存曲线及Cox回归方程法分析血浆FVIII水平对IgAN患者预后的影响。结果共93例IgAN患者纳入本研究,中位随访时间为35.15(33.77,36.76)个月,12例(12.90%)患者发生终点事件。高FVIII组患者年龄、血肌酐、尿素氮、血三酰甘油、血总胆固醇、血浆纤维蛋白原、D-二聚体、24 h尿蛋白量、蛋白C、蛋白S和eGFR下降速率高于低FVIII组(均P<0.05);eGFR、血白蛋白、中位随访时间低于低FVIII组(均P<0.05)。Kaplan-Meier生存分析结果显示,与低FVIII组比较,高FVIII组患者肾脏累积生存率降低(χ2=5.635,P=0.018)。在校正收缩压、eGFR、尿蛋白、肾小管萎缩/间质纤维化程度等因素后,多因素Cox回归分析结果显示,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素(HR=4.147,95%CI 1.055~16.308,P=0.042)。结论血浆FVIII水平与IgAN患者临床指标及预后相关,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素。     

Factors Associated With Reoperation After Silicone Proximal Interphalangeal Joint Arthroplasty

Background: Silicone proximal interphalangeal (PIP) joint arthroplasty has a high revision rate. It has been suggested that persistent ulnar deviation and joint instability influence the durability of PIP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone PIP arthroplasty. Methods: We retrospectively evaluated all adult patients who underwent PIP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory-, posttraumatic-, and primary degenerative arthritis. After manual chart review, we included 91 patients who underwent 114 arthroplasties. Fingers operated included 14 index, 41 middle, 38 ring, and 21 small fingers. Results: The overall reoperation rate was 14% (n = 16). Non-Caucasian race (P = .040), smoking (P = .022) and PIP silicone arthroplasty for post-traumatic osteoarthritis (P = .021) were associated with reoperation. The 1-, 5- and 10-year implant survival rates were 87%, 85%, and 85%, respectively. Conclusion: Caution should be exercised when considering PIP silicone arthroplasty of the index finger or in patients with post-traumatic osteoarthritis. It may be worthwhile addressing smoking behavior before pursuing silicone PIP arthroplasty.     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Effect of the implementation of NICE guidelines for ultrasound guidance on the complication rates associated with central venous catheter placement in patients presenting for routine surgery in a tertiary referral centre

BACKGROUND: The National Institute for Clinical Excellence (NICE) guidelines of 2002 recommended the use of ultrasound (US) for central venous catheterization in order to minimize complications associated with central line placement. An ongoing audit of line placement by anaesthetists in the theatre complex of a tertiary referral centre looked at the associated complication rates. The objective of the study was to compare complication rates pre- and post-implementation of NICE guidelines. METHODS: This prospective, single centre audit looked at all patients in whom a central venous catheter was placed for surgery. Complication rates were assessed for procedures that were performed pre- and post-implementation of NICE guidelines. In total, 438 patients were identified for the study, and the procedures were performed either by trainee or by consultant anaesthetists. RESULTS: The pre- and post-implementation complication rates were 10.5% (16/152) and 4.6% (13/284), respectively, representing an absolute risk reduction of 5.9% (95% CI 0.5-11.3%). Comparison of those procedures in which US was used when compared with the landmark technique after implementation found a reduction of 6.9% in complications (95% CI 1.4-12.4%). The reduction in complication rates was larger for specialist registrars than for consultants (11.2% vs 1.6%). CONCLUSIONS: The implementation of NICE guidelines has been associated with a significant reduction in complication rates in our tertiary referral centre. In the light of the cross-speciality evidence of US superiority and our results, it is imperative that routine use of US guidance becomes more widespread.