胰岛素抵抗与结直肠癌相关性的临床研究

目的：研究胰岛素抵抗与结直肠癌（CRC）临床特征、病理特征的关系及危险性。方法选择322例CRC患者和200例健康者作为CRC 组和对照组,对比两组体质量指数（BMI）、腰臀比（WHR）、收缩压（SBP）、舒张压（DBP）、空腹血糖（FPG）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、脂联素,并分析CRC 患病危险因素及胰岛素抵抗与CRC病理特征的关系。结果 CRC组WHR、SBP、FPG、FINS、HOMA-IR、TG值均显著高于对照组（P＜0.05）,HDL-C、脂联素值显著低于对照组（P＜0.05）。两组BMI、DBP、TC、LDL-C值比较,差异无统计学意义（P＞0.05）。家族史、代谢综合征、FINS、HOMA-IR是CRC的危险因素（P＜0.05）。胰岛素抵抗与TNM分期有关（P＜0.05）,与肿瘤部位、分化程度、淋巴结转移、远处转移无关（P＞0.05）。结论胰岛素抵抗、家族史、代谢综合征与结直肠癌患病密切相关,胰岛素抵抗程度可能与结直肠癌进展有关。     

血浆SEPT9甲基化检测对结直肠癌诊断价值的临床研究

背景　结直肠癌（CRC）是消化系统常见的恶性肿瘤之一,其发病率和病死率呈逐年上升的趋势,早诊断和早治疗是防治CRC的关键,然而目前临床上仍缺乏确诊CRC的无创、简便、有效的检测方法。目的　探讨血浆SEPT9甲基化（mSEPT9）检测对CRC的诊断价值,提供CRC诊断依据。方法　选取2017年12月-2018年12月于昆明医科大学第一附属医院消化内科、胃肠外科及肿瘤科就诊的患者共272例（CRC 126例,非CRC 146例）为研究对象,按结肠镜检查及术后病理检查结果分为对照组82例、腺瘤组64例、早期癌组72例、进展期癌组54例,分析血浆mSEPT9阳性表达与CRC患者临床特征的关系;探讨血浆mSEPT9、血清癌胚抗原（CEA）及二者联合检测在4组患者中阳性率的差异;评估血浆mSEPT9、血清CEA及二者联合检测诊断CRC的价值。结果　不同年龄、性别、肿瘤部位、肿瘤最大直径CRC患者mSEPT9阳性率比较,差异无统计学意义（P>0.05）;早期癌患者血浆mSEPT9阳性率低于进展期癌患者,有淋巴结转移患者血浆mSEPT9阳性率高于无淋巴结转移患者（P<0.001）。对照组、腺瘤组、早期癌组和进展期癌组患者血浆mSEPT9、血清CEA及二者联合检测的阳性率比较,差异均有统计学意义（P<0.001）。血浆mSEPT9及血清CEA联合检测的灵敏度、准确度、阴性预测值高于单一指标检测,血浆mSEPT9联合血清CEA检测与金标准诊断一致性检验,Kappa值为0.514。结论　在早期和进展期CRC患者中,血浆mSEPT9检测的阳性率均高于血清CEA,二者联合检测对CRC的诊断价值（灵敏度、准确度、阴性预测值、与金标准诊断的一致性）可进一步提高,这为CRC的确诊提供了新思路、新方法。     

合并代谢综合征结直肠癌患者预后风险模型的构建

目的 探索代谢综合征（MS）对结直肠癌（CRC）患者长期预后的影响,建立合并MS的CRC患者预后风险预测模型。方法 回顾性分析2011年1月至2016年1月温州医科大学附属第二医院收治的284例CRC患者临床资料,采用单因素和多因素分析确定影响总生存率的独立危险因素,并构建预测CRC患者的预后风险模型。结果 纳入的284例CRC患者中,共有50例合并MS（17.61%）。与非MS组相比,MS组患者生存率较低（P<0.01）。多因素分析显示,合并MetS（HR=1.927,P<0.05）、年龄≥65岁（HR=2.518,P<0.01）、肿瘤TNM分期II～III期（HR=15.996,P<0.01;HR=28.866,P<0.01）和术后出现并发症（HR=2.361,P<0.01）是影响CRC患者总生存率的独立危险因素。合并MS可有效预测左半结肠癌患者预后不良（HR=2.080,P<0.05）,但不能预测右半结肠癌患者的预后（HR=1.846,P>0.05）。相比TNM分期模型（c指数为0.635）,合并MS的风险分层模型显示出更好的预测价...     

创伤对远期代谢综合征发病率的影响

[摘要] 目的 探讨创伤对患者远期代谢综合征（metabolic syndrome, MS）的影响。方法 采用回顾性研究方法，对创伤组和对照组的基本临床资料、MS发病率和各种病因之间的关系进行分析。结果 ⑴创伤组MS发病率高于对照组（19.72%，15.35%，Ｐ<0.05）。Logistic回归分析显示,性别、吸烟史、高血压家族史等是MS的独立危险因素，创伤的RR值1.24（95%CI 0.85～1.81)，创伤不是MS的独立危险因素。结论 创伤后MS发病率明显增高,但创伤不是原发性MS病的独立危险因素。     

甲基化敏感性高分辨率熔解曲线分析筛查大肠癌的性能评价

目的：评价通过甲基化敏感性高分辨率熔解曲线分析（MS‐HRM）检测粪便中人DNA甲基化筛查大肠癌（CRC）的性能。方法收集合格的新鲜粪便标本82例,其中CRC患者27例（CRC组）、进展期腺瘤（AA）患者25例（AA组）和结肠镜阴性的正常人30例（对照组）,在LightCycler480设备上应用MS‐HRM技术检测上述粪便中vimentin基因的甲基化状态,并与粪便潜血试验（FOBT）的诊断性能相比较。结果MS‐HRM在CRC组、AA组和对照组中检测vimentin基因甲基化的阳性率分别为81．5％（22／27）,80．0％（20／25）和6．7％（2／30）。FOBT在CRC组、AA组和对照组中的阳性率分别为37．0％（10／27）,12．0％（3／25）和3．3％（1／30）。在病例组中,MS‐HRM和FOBT的诊断敏感性分别为80．8％（42／52）和25．0％（13／52）,前者显著高于后者（P＜0．05）;在对照组中两者的诊断特异性分别为93．3％（28／30）和96．7％（29／30）,两者差异无统计学意义（P＞0．05）。结论在CRC筛查中,MS‐HRM技术检测粪便中vimentin基因甲基化状态的诊断性能明显优于FOBT,具有潜在的应用价值。     

结直肠癌患者血清5'-核苷酸酶、氧化三甲胺与肿瘤恶性进展和预后的关系

目的探讨结直肠癌（CRC）患者血清5''-核苷酸酶（NT5E）、氧化三甲胺（TMAO）水平与肿瘤恶性进展和预后的关系。方法选择2014年6月至2016年7月石家庄市人民医院收治的CRC患者150例（CRC组）、良性大肠息肉患者93例（良性息肉组）和健康体检志愿者93例（健康对照组）。采用酶联免疫吸附试验检测3组对象血清NT5E水平,稳定同位素稀释液相色谱质谱联用技术（ID-LC-MS）检测血清TMAO水平并作比较,并分析CRC患者血清NT5E、TMAO水平与临床病理特征的关系。CRC患者治疗后随访5年,Kaplan-Meier生存曲线分析血清NT5E、TMAO高/低表达患者预后的差异,采用ROC曲线分析血清NT5E联合TMAO检测对CRC患者死亡的预测效能。结果血清NT5E、TMAO水平CRC组高于良性息肉组,良性息肉组高于健康对照组,差异均有统计学意义（均P＜0.05）;分化程度越低、TNM分期越高的CRC患者,血清NT5E、TMAO水平越高（均P＜0.05）;血清NT5E高表达组5年生存率为60.8%（48/79）,低于低表达组的82.1%（55/67）,血清TMAO高表达组5年生存率为60.5%（46/76）,低于低表达组的81.4%（57/70）,差异均有统计学意义（均P＜0.05）;血清NT5E联合TMAO检测预测CRC患者死亡的AUC（95%CI）为0.836（0.743～0.920）,灵敏度、特异度分别为0.814、0.835。结论NT5E、TMAO参与了CRC患者肿瘤的恶性进展过程,与预后密切相关,血清NT5E联合TMAO检测对CRC患者死亡的预测具有较好效能。     

青年与中老年大肠癌的临床及病理特征比较

目的探讨青年大肠癌的临床及病理特征。方法 2003年1月~2009年5月我院收治大肠癌患者680例,其中年龄≤40岁者50例作为观察组,年龄〉40岁的630例作为对照组,比较两组患者临床及病理特征方面的差异。结果与对照组比较,观察组女性发病率高、有肿瘤家族史比例高、病程长、以黏液脓血便及大便习惯改变多见、病理类型以低分化腺癌或黏液腺癌为主、转移多、选择手术治疗比例高（P〈0.05）。两组发病部位、生存期无显著差异（P〉0.05）。结论青年大肠癌发生相对较少,具有特殊的临床生物学行为和临床病理特点,应提高对本病的认识,强调早期诊断,一经确诊应行根治手术。     

风险预警机制下针对性护理对结直肠癌术后肠道功能恢复和深静脉血栓发生的影响

目的：探讨风险预警机制下针对性护理对结直肠癌(CRC)术后肠道功能恢复和深静脉血栓(DVT)发生的影响。方法：回顾性选取2020年1月～2021年8月在江西省肿瘤医院收治的107例CRC患者作为研究对象,根据收治时间将2020年1～10月的53例CRC患者纳入对照组,将2020年11月～2021年8月的54例CRC患者纳入观察组。两组患者均行CRC腹腔镜切除术,对照组予以围术期常规护理,观察组行风险预警机制下针对性护理干预,均持续护理2周。比较两组患者肠道功能恢复指标、DVT发生率、10 cm处平面周径、并发症发病率、自我效能水平、睡眠质量、护理满意度与生活质量。结果：观察组术后首次排气时间、术后首次排便时间和肠鸣音恢复时间均短于对照组,差异有统计学意义(P<0.05)。护理2 w后观察组DVT发生率明显低于对照组,两组髌骨下缘10 cm周径、髌骨上缘10 cm周径均短于护理前且观察组短于对照组,差异均有统计学意义(P<0.05)。观察组出血、感染、腹胀和肠梗阻总并发症发病率为5.56%,与对照组7.55%比较差异无统计学意义(P>0.05)。护理2 w后两组患者自我...     

2型糖尿病患者高血压家族史与红细胞钠—锂逆转活力的关系

目的：为探讨糖尿病肾病与高血压家族史的关系。方法：采用Ｃａｎｅｓｓａ改良法４１例２型糖尿病患者测定红细胞钠－锂逆转运（ＲＢＣＳＬＣ）活力及尿白蛋白排泄率（ＵＡＥＲ）。结果：伴有高血压家族史２型糖尿病（ＤＨ）组的ＲＢＳＳＬＣ活力明显高于不伴高于不伴高血压家族史２型糖尿病（ＤＮ）组和对照组,且ＤＨ组ＵＡＥＲ均值较ＤＮ组和对照组亦显著增加,瓶民ＲＢＣＳＬＣ的升高平行。结论：遗传因素对２型糖尿病（ＤＮ）组     

常规检验指标对部分非选择性肿瘤联合诊断的效果观察

目的：探讨在常规检验指标的基础上对部分非选择性肿瘤实施联合诊断的临床效果。方法：选取2011年12月—2013年12月我院收治的癌症患者180例;同期选择于我院健康体检人员80例作为对照组。对所有人员的常规检验指标进行系统评价,分析肿瘤标志物的临床诊断价值。结果：肿瘤组与对照组进行比较,淋巴细胞（LY#）、红细胞（RBC）、血红蛋白（HGB）,组间比较差异明显（P〈0.05）;此外尿酸（UA）、白蛋白（ALB）、总蛋白（TP）以及胆碱酯酶（CHE）等指标比较,肿瘤组低于对照组非常明显（P〈0.05）;碱性磷酸酶（ALP）、总胆汁酸（TBA）以及超敏C反应蛋白（hs CRP）比较,肿瘤组高于对照组非常明显（P〈0.05）。甲胎蛋白（AFP）、糖链抗原19-9（CA19-9）、糖类抗原125（CA125）以及癌胚抗原（CEA）比较,肿瘤组高于对照组患者极为明显（P〈0.05）。结论：癌症患者,其临床生化常规、血液常规以及肿瘤标志物指标出现不同程度变化,此种变化分析应该伴有肿瘤特征的模式。在常规检验基础上,对相关指标进行联合诊断,可以显著提高非选择性肿瘤临床诊断效果。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.