肝内胆管癌中ErbB4的表达及临床意义

目的:探讨表皮生长因子受体Erb B4在人肝内胆管癌(ICC)组织中的表达及意义。方法:采用免疫组化法分别检测24例ICC患者癌组织(ICC组)、癌旁胆管组织(癌旁组)及16例肝内胆管结石患者胆管组织(结石组)中Erb B4的表达,并分析Erb B4表达与ICC患者临床病理因素的关系。结果:Erb B4的强阳性表达率在ICC组中为75.0%,明显高于癌旁组(45.8%)和结石组(37.5%)(均P0.05);且ICC组胞核Erb B4阳性表达率高于另两组(均P0.05),而胞膜与胞质Erb B4阳性表达率3组间差异无统计学意义(均P0.05)。Erb B4的高表达与ICC患者淋巴结转移及TNM分期有关(均P0.05)。结论:Erb B4的表达增高与核内移与ICC的发生发展以及浸润转移密切相关。     

MMP-2和MMP-9在肝内胆管细胞癌组织中的表达及意义

目的:探讨基质金属蛋白酶2(MMP-2)与基质金属蛋白酶9(MMP-9)在肝内胆管细胞癌(ICC)组织中的表达及其与ICC患者临床病理特征及预后的关系。方法:收集2011年1月—2014年12月收治的50例ICC患者的癌组织与癌旁组织手术标本,采用免疫组织化学方法及RT-PCR方法检测MMP-2和MMP-9在以上组织中的表达,分析MMP-2和MMP-9表达与ICC患者临床病理参数以及术后生存率的关系。结果:免疫组织化学结果显示,ICC组织中MMP-2和MMP-9蛋白阳性表达率分别为34.0%和32.0%,而两者在癌旁组织中无阳性表达;RT-PCR结果显示,ICC组织中MMP-2和MMP-9的相对表达均明显高于癌旁组织(均P0.05)。MMP-2和MMP-9表达与ICC患者是否存在淋巴结转移和肿瘤分化程度有关(均P0.05),而与患者性别、年龄和肿瘤分期无关(均P0.05);MMP-2和MMP-9阳性患者生存率明显低于各自阴性者,而两者均阳性患者的生存率最低(均P0.05)。结论:ICC组织中MMP-2和MMP-9表达明显上调,且两者的表达与ICC患者恶性临床病理特征及不良预后密切相关。     

高迁移率族蛋白1在肝内胆管癌中的作用及其与肿瘤微血管形成的关系

背景与目的:肝内胆管癌(ICC)是源于二级及以上胆管上皮细胞的高度恶性肿瘤,其不良的预后源于对其发病机制认识不足、早期诊断方法匮乏和治疗手段有限。对ICC分子标志物的研究有助于早期诊断、预后判断和指导治疗。本研究旨在探讨促炎症因子高迁移率族蛋白1(HMGB1)在ICC组织中的表达与其临床意义及其与肿瘤微血管生成的关系。方法:用免疫组化法检测65例ICC患者手术标本(ICC组织与癌旁组织)以及30例正常肝内胆管组织标本中HMGB1的表达及肿瘤微血管密度(MVD)计数(CD31的表达),分析HMGB1表达与MVD与ICC患者临床病理特征的关系,两者在ICC组织中的相关性,及两者对ICC患者预后的影响。结果:HMGB1的表达与MVD计数均表现为在ICC组织、癌旁组织、正常胆管组织明显依次降低(均P<0.05)。HMGB1的表达与肿瘤组织分化程度、淋巴结转移、血管浸润与HMGB1有关(均P<0.05);MVD计数与肿瘤血管浸润明显有关(P<0.05);在ICC组织中,HMGB1的表达量与MVD计数呈明显正相关(r=0.330,P=0.008)。全组ICC患者术后的1、3、5年生存率分别为55.4%、36.9%、7.7%。HMGB1阳性ICC患者的生存率明显低于HMGB1阴性ICC患者(χ~2=6.278,P=0.012),高MVD计数ICC患者的生存率明显低于低MVD计数ICC患者(χ~2=5.101,P=0.024);具有HMGB1阳性与高MVD计数两种特征的患者生存率明显低于只具有其中一种特征或两种特征均无的患者(均P<0.05)。结论:HMGB1在ICC组织中表达升高,且与ICC的侵袭转移以及预后情况关系密切,作用机制可能与HMGB1通过各种信号通路系统诱导肿瘤微血管生成,从而促进肿瘤的生长和侵袭转移有关。HMGB1可作为ICC患者预后评估、治疗方案选择的参考指标,以及提供了靶向药物开发的新方向。     

黏蛋白3和黏蛋白4在结石相关肝内胆管细胞癌中的表达及意义

目的:探讨黏蛋白3(MUC3)和黏蛋白4(MUC4)在结石相关肝内胆管细胞癌(ICC)组织中的表达及临床意义。方法:用免疫组化法检测MUC3、MUC4在24例正常胆管组织、44例肝内肝管结石胆管组织、38例结石相关ICC组织中的表达,分析两者表达与ICC患者临床病理因素及预后的关系。结果:MUC3与MUC4在3种组织中的表达均有统计学差异(均P0.05),在正常胆管组织、结石患者胆管组织,结石相关ICC组织中MUC3的表达阳性率依次降低(79.2%、56.8%、36.8%),而MUC4的表达阳性率则相反(29.2%、79.5%、86.8%)。两者的表达均与结石相关ICC患者的肿瘤组织学分级、有无淋巴结转移有关,且MUC4的表达与门静脉有无浸润有关(均P0.05)。结石相关ICC患者中,MUC3阳性表达者术后生存率明显高于阴性患者,MUC4阳性表达患者术后生存率明显低于阴性表达患者(均P0.05)。结论:在结石相关ICC组织中,MUC3表达降低,而MUC4的表达升高,两者表达的变化与结石相关ICC的进展、侵袭及转移紧密相关。     

TIP30在肝内胆管癌中的表达及意义

背景与目的：抑癌基因HIV-1 Tat相互作用蛋白2（TIP30）在人体多种肿瘤中存在表达下调或缺失,并与患者的不良预后相关。然而,在肝内胆管癌（ICC）中尚未见关于TIP30的研究。本研究旨在探讨TIP30在肝内胆管癌中的表达及临床意义。 方法：用免疫组化法检测51对ICC组织与癌旁组织中TIP30的表达,分析ICC组织中TIP30表达与ICC患者临床病理特征的关系,以及与ICC患者总生存率、累积复发率的关系。用软琼脂克隆法检测TIP30-shRNA转染后ICC细胞（ICC-9810、SSP-25和HuH-28）克隆形成能力的变化。通过数据库TargetScan和miRDB预测可能靶向TIP30的3''UTR的miRNA,用qRT-PCR进一步验证此结果。 结果：免疫组化结果显示,TIP30在ICC组织中的表达低于癌旁组织。临床数据分析提示,TIP30表达与淋巴结转移明显有关（P=0.008）;生存分析显示,TIP30高表达患者的5年总生存率明显高于TIP30低表达患者（P=0.041 2）,而累积复发率明显低于TIP30低表达的患者（P=0.037 4）。 TIP30-shRNA转染后的ICC细胞（ICC-9810、SSP-25和HuH-28）形成的集落数均比阴性对照组明显增加（均P<0.001）。数据库预测结果显示,miR-124-3p可能识别并结合TIP30的3''UTR。qRT-PCR验证结果显示,ICC组织中miR-124-3p的相对含量明显高于癌旁组织（P<0.001）;在miR-124-3p转染后的ICC细胞（9810、SSP-25和HuH-28）中TIP30的表达低于阴性对照组（均P<0.05）。 结论：TIP30在ICC中的表达水平下调,且与ICC患者预后不良有关,机制可能与ICC中miR-124-3p介导的相关调控有关。本研究结果可能为今后ICC发病机制及分子靶向治疗的研究提供线索和依据。     

FIG-ROS融合基因在肝内胆管细胞癌中表达及其意义

目的:探讨FIG-ROS融合基因在肝内胆管细胞癌(ICC)细胞中的表达,以及对其干预后ICC细胞的生物学行为的变化。方法:用Western blot法检测4份不同ICC组织样本及3种ICC细胞株(HUCCT1、REB、QBC939)中ROS蛋白的表达;选择ROS阳性ICC细胞,用一系列表达不同序列ROS-sh RNA与FIG-sh RNA的质粒分别转染该细胞后,用Western blot检测ROS和FIG蛋白表达;选择对ROS和FIG表达抑制作用最强的ROS-sh RNA与FIG-sh RNA序列分别或联合转染上述细胞后,观察细胞增殖、细胞周期、凋亡及集落形成情况。结果:2份ICC组织样本与1个细胞株(HUCCT1)呈ROS阳性表达;转染ROS1-6290 sh RNA和FIG-363 sh RNA对HUCCT1细胞ROS与FIG蛋白表达的抑制作用最强。与未转染的HUCCT1细胞比较,单独转染FIG-363 sh RNA对细胞增殖、凋亡及细胞周期无明显影响(均P0.05),但能明显减少细胞集落形成(P0.05);ROS1-6290 sh RNA单独或联合FIG-363 sh RNA转染均能明显抑制细胞增殖、诱导细胞凋亡与细胞周期阻滞、减少细胞集落形成,且联合转染的效应更为明显(均P0.05)。结论:部分ICC存在FIG-ROS融合基因表达,对两种基因的联合抑制可能是靶向治疗该类ICC的有效途径。     

TGF-β1、survivin和caspase-3在肝内胆管结石相关性肝内胆管癌中的表达及临床意义

目的:探讨肝内胆管结石相关肝内胆管癌(ICC)组织中TGF-β1、survivin和caspase-3的表达及其临床意义。方法:用免疫组化法检测52例ICC患者肝内胆管组织(肿瘤组)和30例肝内胆管结石仅合并慢性炎症患者肝内胆管组织(炎症组)及30例正常肝内胆管组织(正常组)中TGF-β1、survivin和caspase-3的表达,分析三者表达与ICC患者临床病理特征和预后的关系。结果:在肿瘤组、炎症组、正常组中、TGF-β1与survivin的阳性表达率呈依次降低,而caspase-3的阳性表达呈率依次升高(均P0.05);在ICC组织中,TGF-β1与survivin的表达呈正相关(r=0.917,P0.01),且两者与caspase-3的表达呈负相关(r=-0.890,P0.01;r=-0.894,P0.01)。单因素与多因素分析结果显示,TGF-β1、survivin和caspase-3均为肝内胆管结石相关ICC预后的独影响因素(均P0.05),TGF-β1与survivin阳性表达患者生存率明显低于各自的阴性表达患者(χ~2=13.192,P=0.001;χ~2=10.536,P=0.002),而caspase-3阳性表达患者生存率明显高于其阴性表达患者(χ~2=5.469,P=0.023)。结论:TGF-β1、survivin和caspase-3蛋白在肝内胆管结石相关ICC组织中表达异常,三者可能共同参与了该病的发生、发展过程。     

49例肝内胆管细胞癌的临床病理特征与预后分析

肝内胆管细胞癌( Intrahepatic cholangiocarcinoma,ICC)指发生在包括二级胆管在内的末梢侧的原发性胆管细胞癌.在世界范围内,ICC占原发性肝脏恶性肿瘤的10％～20％,其发病率近年来呈上升趋势.随着诊断及治疗技术的不断提高,ICC的根治性切除率也不断提高,但远期疗效仍不理想.本研究回顾分析了49例肝内胆管细胞癌的临床资料,探讨影响其预后的因素. 1 资料与方法 1.1 一般资料     

抗凋亡基因bag 1的表达及其与肝内胆管细胞癌分化的关系

目的　探讨抗凋亡基因bag 1在原发性肝内胆管细胞癌 (ICC )中的表达及其与肿瘤分化的关系。方法　采用免疫组织化学的方法 ,检测bag 1基因在ICC组织 (n =48)及肝细胞肝癌癌旁胆管上皮 (对照组 ,n =2 5 )中的表达情况。结果　ICC组的bag 1基因表达强于对照组 (P <0 .0 1)。在ICC组内 ,2 7例中低分化胆管细胞癌中bag 1基因的表达强于 2 1例高分化胆管细胞癌 (P <0 .0 1)。结论　bag 1的表达在分化越低的胆管细胞癌中越强 ,提示bag 1基因可能与其肿瘤的分化相关。     

慢性乙型肝炎病毒感染与肝内胆管细胞癌发生和预后的关系研究进展

肝内胆管细胞癌(ICC)起源于二级胆管及其分支上皮细胞,是恶性程度较高和预后较差的肝脏恶性肿瘤之一。淋巴结转移是严重影响ICC患者预后的因素。近年来,许多研究发现乙型肝炎病毒(HBV)是ICC发生的危险因素之一,HBV相关ICC具有类似与肝细胞癌的临床病理表现。另外,新近研究表明HBV阳性ICC患者术后预后优于HBV阴性患者,且HBV阳性ICC患者淋巴结转移率较低。因此,进一步探索HBV在ICC的发生和预后中的作用有着重要的临床意义。     

The clinical value of regional lymphadenectomy for intrahepatic cholangiocarcinoma

ObjectiveThe aim of this study was to explore the clinical value of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC).MethodsClinical and pathological data were collected from 147 ICC patients who attended two tertiary centers over the past 5 years. The patients were classified into two groups: the LND group (group A) and the no-performance LND (NLND) group (group B). Clinical and pathological parameters were compared between the two groups to analyze the impact of LND on the long-term survival time of ICC patients.ResultsOf the 147 patients, 54.4% (80) received LND and 42.5% (34/80) of these were found to have lymph node metastasis (LNM). LND did not increase postoperative complications (27.5%, P = 0.354), but postoperative hospital stays were longer (12.2 ± 6.3 d, P = 0.005) in group A compared with group B (20.9%, 9.5 ± 3.5 d). The 5-year survival rates of groups A and B are almost similar (21% vs 29%, P = 0.905). The overall survival rate of cN0 (diagnosis obtained by imaging) is better than pN1 (diagnosis obtained by histopathology), but lower than pN0 (all P < 0.05). Compared with NLND, the median survival time of LND patients with T1 has not significantly improved (29.3 vs 35.1 months, P = 0.762), but the patients with T2-4 has been significantly increased (29.0 vs 17.1 months, P = 0.040). Elevated CA19-9 level (HR = 1.764, 95% CI: 1.113–2.795, P = 0.016), vascular invasion (HR = 2.697, 95% CI: 1.103–6.599, P = 0.030), and T category (HR = 1.848, 95% CI: 1.059–3.224, P = 0.031) were independent risk factors for poor long-term survival time of the ICC patients (all P values < 0.05).ConclusionICC patients with cN0 may have LNM, and the long-term survival time of LNM patients is usually poor. We suggest that patients with ICC may require routine LND, especially those with T2-4 category.     

Comprehensive analysis of circular RNA-associated competing endogenous RNA networks and immune infiltration in gastric cancer

BackgroundCircular RNA (circRNA) has been proved to be an important regulator of gastric cancer (GC). However, the role and regulatory mechanism of circrna related competitive endogenous RNA (ceRNA) in GC have not been established.MethodsCircRNA data and clinical data were obtained from the GEO and TCGA databases. The ceRNA networks were constructed and a function enrichment analysis was completed. Additionally, correlations between hub genes expression, immune cell infiltration, and clinical phenotypes were determined. The differentially expressed circRNAs and their downstream microRNAs (miRNAs) were validated by quantitative real-time polymerase chain reaction, and the hub genes were validated by western blot analysis. The migration and invasion ability of overexpressed hsa_circ_0002504 was determined by a transwell assay.ResultsThe ceRNA network contained 2 circRNAs, 3 miRNAs, and 55 messenger RNAs (mRNAs). 323 biological processes terms, 53 cellular components terms, 51 molecular functions terms, and 4 signaling pathways were revealed by the function enrichment analysis. The GSEA analysis revealed that the hub genes were positively correlated with the axon guidance and adhesion molecules pathways. The correlation analysis revealed that overexpressed EPHA4 and KCNA1 indicated poor tissue differentiation and were associated with clinically advanced stages of GC. The in vitro experiments showed that hsa_circ_0002504 was significantly down-regulated in GC cell lines. In addition, the overexpression of hsa_circ_0002504 led to a significant downregulation of hsa-miR-615-5p and hsa-miR-767-5p, as well as an upregulation of EPHA4, KCNA1, and NCAM1. Furthermore, it suppressed the migration and invasion ability of GC cells.ConclusionsHsa_circ_0002504 is a potential diagnostic biomarker for GC. High expression of EPHA4 and KCNA1 may indicate poor prognosis.     

Identification of circular RNA expression profiles in renal fibrosis induced by obstructive injury

IntroductionAdvancing renal fibrosis is the common histopathological feature of chronic obstructive nephropathy, representing the final pathway of nearly all chronic and progressive nephropathies. Increasing evidences suggest that circular RNAs (circRNAs) are crucial regulatory molecules present at virtually every level of the cellular pathophysiological process. Nonetheless, there are a few evidences for the role of circRNAs in renal fibrosis induced by obstructive nephropathy.AimsWe performed RNA-seq analysis to analyze the expression profiles of circRNAs in the obstructed kidneys to identify the potential circRNAs and their network.MethodsWith silk ligated the left ureter to establish a mice unilateral ureteral obstruction (UUO) model. Renal tissue circRNAs were obtained and were screened by a circRNA microarray. The circRNA-miRNA-mRNA regulatory network and the target genes were visualized using Cytoscape software.ResultsThe microarray results showed that 5454 and 2935 circRNAs were detected in the control and UUO group, respectively. There were 605 circRNAs up-regulated and 745 circRNAs down-regulated in the obstructive kidneys. The top 5 up-regulated and down-regulated circRNAs were chosen for predicting the circRNA/miRNA/target mRNAs triple network. The GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) analysis showed that these circRNAs and the triple network were enriched in the process of apoptosis, p53 signaling pathway, cell growth and cell death, which might participate in the pathogenesis of obstructive nephrology.ConclusionOur results show that the dis-regulated circRNAs might play crucial roles in the pathogenesis of obstructive nephropathy, which proceeds to identify novel therapeutic targets for chronic kidney disease.     

基于血脂异常及相关因素的肝内胆管癌发生风险列线图预测模型构建

背景与目的：肝内胆管癌（ICC）起病隐匿,进展迅速,患者诊断时往往错过最佳手术时机。ICC的发生机制尚不明确,可能与多种因素有关,目前发现血脂异常可能是风险因素之一。因此,本研究探讨血脂异常及其他危险因素与ICC发生风险的关联,并构建列线图预测模型,以期对ICC高危人群实现早期预防并最终降低发病率。方法：回顾性分析2015年1月—2023年1月于浙江大学医学院附属邵逸夫医院普通外科就诊的5 906例肝脏手术患者,其中ICC患者和非癌症患者分别设为病例组和对照组,收集患者治疗前基本资料和生化指标,将血脂指标和其余风险因素纳入单因素、多因素回归分析,筛选ICC发生的独立风险因素,构建列线图预测模型评估各因素影响程度,采用受试者工作特征曲线（ROC）、校准曲线和决策曲线评估列线图模型临床预测效能。结果：共纳入351例ICC患者和2 145例非癌症患者,单因素分析显示,两组患者的性别、年龄与糖尿病、高血压、肝硬化、乙肝、胆管结石病史、血吸虫病史比例,以及血清甘油三酯、血清总胆固醇、血清高密度脂蛋白胆固醇（HDL-C）水平的差异均有统计学意义（均P<0.05）。Logistic多因素回归分...     

Snail在肝内胆管癌中的表达及其临床意义

目的:探讨Snail在肝内胆管癌组织中的表达及其与患者临床病理特征和生存预后的关系。方法:回顾性分析1999年12月—2010年1月外科手术治疗的55例肝内胆管癌病例及随访资料,免疫组织化学检测上述患者癌组织及癌旁组织标本中Snail的表达情况,分析Snail表达与临床病例资料、病理特征及预后的关系。结果:肿瘤组织中Snail表达量(2.764 vs.0.914)与高表达率(48.6%vs.18.0%)均明显高于癌旁组织(均P0.05),且Snail表达与肿瘤分化(χ~2=4.231,P=0.040)、TNM分期(χ~2=6.631,P=0.010)、淋巴结转移(χ~2=4.134,P=0.042)、微血管侵犯(χ~2=10.197,P=0.001)以及复发(χ~2=4.610,P=0.032)有关,与Snail低表达患者比较,Snail高表达患者总体生存率降低(P=0.018)、术后累计复发率升高(P=0.032)。单因素分析与多因素Cox回归模型分析结果示,微血管侵犯、淋巴结转移以及Snail表达是肝内胆管癌患者预后的独立影响因素(均P0.05)。结论:Snail在肝内胆管癌组织中表达增加,且Snail过表达与肝内胆管癌患者恶性病理特征及不良预后密切相关。     

新型自脱落式胆道支架在腹腔镜胆总管探查术中的应用（附视频）

背景与目的：腹腔镜胆总管探查术（LCBDE）是治疗胆总管结石的常规方法，术中胆道支架置入（BSI）可能降低术后胆汁漏风险，但支架可能存在滞留、过早脱落等风险。本研究探讨新型自脱落式BSI在LCBDE治疗胆囊结石合并胆总管结石中的安全性和有效性。方法：回顾性分析2019年6月—2020年12月西安交通大学第一附属医院收治的胆囊结石合并胆总管结石的患者临床资料，将行LCBDE联合新型自脱落式BSI的患者作为观察组，行LCBDE联合一期缝合的患者作为对照组。所用支架直径5 Fr，长度5 cm，主体上有长度标识，其防滑侧翼采用同向开口，可预防支架过早脱落及长期滞留，螺旋尾部留置于十二指肠乳头外，可在消化道流体带动下牵引支架通过消化道排出体外。BSI方法：胆道镜下直视胆总管末端乳头内口，将0.035"导丝插过十二指肠乳头，使用取石网篮外鞘作为推送器将支架沿着导丝推入胆道内，当支架主体1 cm标记处通过乳头内口后，边退镜边推送支架，当支架末端完全脱离镜头后，撤除导丝完成直视下BSI。比较两组患者一般资料、术前血液化验指标、胆总管结石数量及最大直径、BSI所需时间、手术时间、术后并发症、术后住院时间...     

Impact of Immunosuppressive Strategies on Post–Kidney Transplantation Thrombocytopenia

BackgroundThrombocytopenia after kidney transplantation is a common complication, partly induced by immunosuppressive therapies. Peritransplant thrombocytopenia may cause serious hemorrhages. We assessed the incidence of early posttransplantation thrombocytopenia (defined as a platelet count of <150,000 mm³ or <150 G/L) in de novo kidney transplant recipients (KTRs) across 4 immunosuppressive regimens.MethodsThis was a single-center observational study that included all consecutive KTRs who received either Thymoglobulin (THY) or Grafalon (GRA) and maintenance therapy of either mycophenolate-mofetil (MMF) or everolimus (EVR), associated with tacrolimus/corticosteroids.ResultsBetween July 27, 2016, and September 7, 2018, 237 KTRs were included; 64.6% experienced thrombocytopenia within the first week. Thrombocytopenia was significantly more frequent (P = .004) among GRA-treated patients (73.4%) compared to THY-treated patients (61.3%). These patients also had lower nadir platelet count (120 ± 52 vs 142 ± 48 G/L; P = .002) and lower platelet count at discharge (227 ± 94 vs 243 ± 92 G/L; P = .25). More of the GRA-EVR group had thrombocytopenia (81.0% vs 61.4% in THY-MMF, 60.9% in THY-EVR, and 69.8% in GRA-MMF; P = .081) and a worse nadir platelet count (109 ± 41 in GRA-EVR vs 141 ± 47G/L in THY-MMF, 145 ± 52 G/L in THY-EVR, and 125 ± 56 G/L in GRA-MMF; P = .011) but GRA was the only risk factor for thrombocytopenia in multivariate analyses (P = .002). Rates of hemorrhage, red blood cell transfusions, reoperations needed within the first week, delayed graft function, acute rejection, graft loss, and death did not differ between the groups after a mean follow-up of 25 ± 8 months.ConclusionsGRA associated with EVR led to more frequent and severe thrombocytopenia, although we found no significant clinical consequences.     

交感神经及其递质在椎动脉型颈椎病中的调控机制

目的:验证交感神经因素在椎动脉型颈椎病发病中对椎动脉供血不足的调控机制。方法:将40只家兔随机分为两组:模型组和对照组,每组各20只,在造模当日及造模后4周,分别检测每组的SPNs放电次数及NA的含量。结果:模型组胸髓侧角的SPNs放电次数57.45±7.89,56.60±7.44;对照组胸髓侧角的SPNs放电次数10.08±2.26,10.00±2.24。两组比较,P<0.001。模型组血浆中NA含量(5.48±0.46)pmol/ml,(5.36±0.43)pmol/ml;对照组血浆中NA含量(3.31±0.43)pmol/ml,(3.30±0.32)pmol/ml。两组比较,P<0.001。结论:交感神经因素在椎动脉型颈椎病发病中对椎动脉的供血不足起到重要的调控作用。     

长链非编码RNA MCM3AP-AS1在胆管癌细胞中的表达及其功能

背景与目的 长链非编码RNA MCM3AP-AS1（MCM3AP-AS1）在原发性肝癌、乳腺癌及胶质母细胞瘤等多种肿瘤中发挥癌基因功能,然而MCM3AP-AS1在胆管癌中的表达、功能及作用机制尚知之甚少。因此,本研究观察MCM3AP-AS1在胆管癌细胞中的表达及其对细胞增殖和侵袭的影响,并初步探讨机制。方法 采用qRT-PCR法检测胆管癌细胞株（CCLP、RBE、9810、HuCCT1）及人肝内胆管上皮细胞株（HIBEC）中MCM3AP-AS1的表达。将胆管癌细胞转染MCM3AP-AS1 siRNA后,以转染无义序列的胆管癌细胞为阴性对照,分别用MTT实验和Transwell实验检测细胞增殖与侵袭能力的变化,用Western blot法检测JAK/STAT3信号通路与上皮间质转化（EMT）相关蛋白表达的变化;最后,用JAK/STAT3通路激动剂白血病抑制因子（LIF）行功能拯救实验验证。结果 所有胆管癌细胞系中MCM3AP-AS1表达量均明显高于HIBEC（均P<0.05）。与阴性对照组比较,CCLP细胞转染MCM3AP-AS1 siRNA后增殖能力与侵袭能力均明显减弱（均P<0.05）;JAK1/2与STAT3表达量无明显变化（均P>0.05）,但p-JAK1/2与p-STAT3表达量明显降低（均P<0.05）,同时,EMT相关蛋白E-cadherin表达升高、vimentin表达降低（均P<0.05）。功能拯救实验结果显示,同时加入LIF后,MCM3AP-AS1沉默对CCLP细胞后的以上作用均被取消,与阴性对照组间差异均无统计学意义（均P>0.05）。结论 胆管癌细胞中MCM3AP-AS1表达上调,MCM3AP-AS1可能通过活化JAK/STAT3通路与EMT过程而促进胆管癌细胞增殖和侵袭。     

First experience of junior surgeons with laparoscopic totally extraperitoneal herniorrhaphy: Comparison with experienced surgeons in a single institution

Background/objectiveLaparoscopic totally extraperitoneal (TEP) herniorrhaphy is among the current leading inguinal hernia repair methods. This study aimed to investigate the safety and feasibility of a junior surgeon's first experience with laparoscopic TEP herniorrhaphy.MethodsA retrospective review was performed between January 2017 and December 2019 to analyze the medical records of patients with inguinal hernia who underwent laparoscopic TEP herniorrhaphy. The operative outcomes and complications of patients undergoing surgery by an experienced surgeon (group A, n = 100) were compared with those undergoing surgery by a junior surgeon (group B, n = 100).ResultsThe mean operative time for group B was significantly longer than that for group A (52.0 ± 15.1 min vs 60.1 ± 17.4 min; P = 0.03). A statistical difference was also found in the mean postoperative stay (1.1 ± 0.3 d vs 1.4 ± 0.7 d; P = 0.02) between the two groups. There were 2 and 3 cases of recurrence in these two groups respectively (P = 0.72). Considering the operating time as a variable of learning curve, significant stabilization can be achieved after 30 cases (67.3 ± 17.8 min vs 53.1 ± 11.1 min; P = 0.02).ConclusionsThe surgical outcomes of laparoscopic TEP herniorrhaphy performed by a well-trained junior surgeon were similar to the outcomes of an experience surgeon.