基于DCE-MRI定量参数图的影像组学模型预测子宫内膜癌脉管浸润

【摘要】目的：探讨基于动态增强磁共振（DCE-MRI）定量参数图的影像组学模型术前预测子宫内膜癌脉管浸润情况的应用价值。方法：回顾性搜集2016年1月－2021年2月于南通大学附属医院术前行DCE-MRI检查的109例子宫内膜癌患者的病例资料。按照7︰3的比例将总样本随机分为训练集（72例）和验证集（37例）。在DCE-MRI定量参数图［容积转移常数（Ktrans）、转运速率常数（Kep）和血管外细胞外容积分数（Ve）］上基于全肿瘤容积ROI提取影像组学特征,然后采用Lasso-Logistics回归分析进行影像组学特征的降维及筛选,建立影像组学模型,分别在训练集和验证集中采用ROC曲线对此模型预测子宫内膜癌脉管浸润的效能进行评估。结果：经降维和筛选,共7个影像组学特征与子宫内膜癌脉管浸润情况相关（P值均<0.05）。这7个组学特征所构建的影像组学模型对预测脉管浸润具有较高的诊断效能,在训练集中的ROC曲线下面积（AUC）为0.926,在验证集中为0.891。结论：基于DCE-MRI定量参数图构建的影像组学特征模型对子宫内膜癌脉管浸润具有较高的预测效能,可为患者治疗方案的制定和预后评估提供重要参考。     

胃癌患者循环中OCT4表达水平与临床病理特征及生存率的关联分析

目的评估血浆八聚体结合蛋白4 (OCT4) mRNA的表达水平与胃癌患者临床病理特征及预后的关联。方法采集137例胃癌患者的血浆样本,抽提总RNA,采用实时荧光PCR法进行定量分析OCT4 mRNA的表达水平,中位随访时间为51月。结果血浆中OCT4 mRNA的表达水平与肿瘤大小(R=0.351, P<0.001)成正相关;血浆中OCT4 mRNA的高表达患者比低表达患者有较差的总体生存期(OS)(P<0.001)。单元Cox风险回归模型分析显示,血浆OCT4 mRNA高表达水平(P<0.001)、低分化(P=0.001)、高N分期(P=0.034)以及高TNM分期(P=0.010)均与患者较差的OS有关。进一步采用多元Cox回归模型分析胃癌患者OS的预测因素,结果显示,血浆OCT4 mRNA高表达水平(P<0.001)能独立预测患者较差的OS。结论血浆OCT4 mRNA的表达水平可作为新颖的可靠的生物标记物,用于评估胃癌患者的临床病理特征和预后情况。     

针刺调控脑缺血再灌注损伤大鼠缺血侧海马差异miRNA信号归属通路及mir-34c-3p表达的研究

摘要 目的：观察针刺调控脑缺血再灌注损伤大鼠缺血侧海马组织差异miRNA信号归属通路及mir-34c-3p表达的作用,探讨mir-34c-3p在脑缺血再灌注损伤中的作用机制。 方法：通过线栓法制作局灶性脑缺血再灌注模型,将60只健康SD大鼠随机分为空白组、假手术组、模型组、针刺组,每组15只,共4组。造模成功约180min后开始针刺,每12h一次,连续进行6次。干预结束后,用Zea Longa评分观察大鼠神经功能缺损状况,测定脑梗死面积比,采用miRNA微阵列芯片技术筛选出缺血侧海马组织组间差异基因并归纳信号传导通路,RT-PCR法检测缺血侧海马组织mir-34c-3p的表达水平。 结果：造模后,与空白组、假手术组比较,模型组神经功能缺失评分升高,梗死面积比均明显增加（P<0.01）;与模型组比较,针刺组神经功能缺失评分降低,梗死面积进一步缩小（P<0.05）。与空白组、假手术组比较,模型组差异基因数分别为4、5个,主要归属MAPK、P53、Calcium、Jak-STAT以及Neurotrophin信号通路;与模型组比较,针刺组差异基因数为16个,主要归属MAPK、P53、Calcium、Jak-STAT以及Neurotrophin信号通路,且每条信号通路差异表达的miRNA不完全相同。与空白组和假手术组比较,模型组大鼠脑缺血侧海马mir-34c-3p表达量明显降低（P<0.05）;与模型组比较,针刺组mir-34c-3p的表达趋势上升明显（P<0.01）。 结论：针刺可降低脑缺血再灌注损伤大鼠神经功能缺失评分,减少脑梗死面积,其机制可能与针刺可激活多种miRNA的表达,多途径、多网络调控脑缺血再灌注及上调mir-34c-3p的表达量有关。     

脑脊液生物学标志物检测分析判断结核性脑膜炎病情的效果

目的探讨脑脊液生物学标志物检测分析判断结核性脑膜炎病情的效果。方法选择2011年8月到2014年8月在我院进行诊治的结核性脑膜炎患者80例作为观察组,对照组选择同期我院住院的80例细菌性脑膜炎患者,两组都提取了脑脊液,进行了肿瘤坏死因子-α(TNF-α)、腺苷脱氨酶(ADA)和乳酸脱氢酶活性的检测与相关性分析。结果观察组的TNF-α、腺苷脱氨酶和乳酸脱氢酶活性都明显高于对照组,对比差异有统计学意义(P0.05)。ROC曲线分析结果显示曲线下面积从大到小依次为腺苷脱氨酶、TNF-α和乳酸脱氢酶。经过判断,腺苷脱氨酶判断结核性脑膜炎的敏感性与特异性都高于其他两个指标(P0.05)。Pearson相关分析显示结核性脑膜炎患者脑脊液中的TNF-α、腺苷脱氨酶和乳酸脱氢酶在两两之间都存在明显正相关性(P0.05)。结论脑脊液中3种生物学标志物的检测能反应结核性脑膜炎的病情,且存在一定的相关性,有利于在疾病早期对结核性脑膜炎进行有效的鉴别诊断。     

建设一所更好的医院——访广州军区广州总医院刘坚院长

<正>刘坚院长说:"当院长怎么考虑医院建设与发展,每一位院长都有自己的经营理念和不同的管理模式。总医院(广州军区广州总医院,以下简称总医院)是一所集医、教、研为一体的三级甲等大型综合医院,不论在军内或军外,应该说是整体实力较强或某种程度上最     

Effect of acupuncture plus mild hypothermia on MAPK/ERK pathway of brain tissues in rats with cerebral ischemia-reperfusion injury

Objective

To observe the protective effect of acupuncture plus mild hypothermia on brain tissues in rats with cerebral ischemia-reperfusion injury (CIRI), and the influence on protein expression levels of phosphorylated Raf-1, MEK-2 and ERK1/2 in the mitogen-activated protein kinase (MAPK)/extracellular regulated protein kinases (ERK) pathway, and to explore the mechanism of acupuncture plus mild hypothermia therapy for the ischemic stroke.

Methods

Ninety Sprague-Dawley (SD) rats were randomly divided into a blank control group, a sham operation group, a model group, an acupuncture group, a mild hypothermia group and an acupuncture plus mild hypothermia group, 15 rats in each group. Except the rats in the blank control group, the remaining rats were used to prepare the middle cerebral artery occlusion (MCAO) models according to the modified occlusion method using lines, while only the occlusion lines were inserted without blocking the brain arteries of rats in the sham operation group. When the vital signs of rats were stable, rats in the blank control group did not receive any intervention; rats in the sham operation group and the model group received fastening without treatment; rats in the acupuncture group, the mild hypothermia group, and the acupuncture plus mild hypothermia group were treated with the corresponding therapeutic methods. 72 h later, observed neurologic injury score, evaluated infarction area ratio by 2,3,5-tripheyl tetrazolium chloride (TTC) staining, determined apoptosis by TUNEL assay, and measured the phosphorylated Raf-1, MEK-2 and ERK1/2 protein expression levels in rat ischemic hippocampal tissues by Western blot assay.

Results

Compared with the blank control group and the sham operation group, after modeling, the neurologic injury score, infarction area ratio and apoptotic cells were increased, and phosphorylated Raf-1, MEK-2 and ERK1/2 protein expression levels were significantly increased in the model group; the differences were statistically significant (P<0.05 or P<0.01). Compared with the model group, after acupuncture or mild hypothermia therapy, neurologic injury score and infarction area ratio were decreased; apoptotic cells and phosphorylated Raf-1, MEK-2 and ERK1/2 protein expression levels were significantly decreased; the differences were statistically significant (P<0.05 or P<0.01). Compared with the acupuncture group, neurologic injury score and phosphorylated Raf-1, MEK-2 and ERK1/2 protein expression levels were decreased in the acupuncture plus mild hypothermia group; differences between the groups were statistically significant (P<0.05 or P<0.01). Compared with the mild hypothermia group, phosphorylated Raf-1, MEK-2 and ERK1/2 protein expression levels decreased in the acupuncture plus mild hypothermia group, and differences were statistically significant (P<0.01).

Conclusion

Acupuncture or mild hypothermia therapy can improve neurologic injury, reduce infarction area and apoptosis, which brought about protective effect on the brain tissues, in the MCAO model. The protective effect of acupuncture plus mild hypothermia group is the strongest. The mechanism may involve the MAPK/ERK pathway, by reducing the phosphorylated Raf-1, MEK-2 and ERK1/2 protein expression levels.

     

Effects of acupuncture on the number of associated protein phosphorylation in brain tissues of MCAO rats based on protein microarray technique

Objective

To investigate the effects of acupuncture on the number of associated phosphorylated proteins in brain tissues of middle cerebral artery occlusion (MCAO) rats, based on the protein microarray technique.

Methods

The MCAO model was prepared according to the modified occlusion method using occlusion lines. Forty healthy Sprague-Dawley (SD) rats were randomly divided into 4 groups using the lottery method: a sham operation group, a model group, a control point group and an acupoint group, with 10 rats in each group. Rats in the sham operation group and the model group only received binding without acupuncture. Rats in the acupoint group received acupuncture at Dazhui (GV 14), Baihui (GV 20) and Shuigou (GV 25); rats in the control point group received acupuncture at non-acupoint control points. The needle was twisted once for 1 min after insertion and another time in the middle of the 30 min needle retaining. Acupuncture was conducted once every 12 h for 6 consecutive times. At the end of the experiment, the neurological impairment score was collected, and cells of the ischemic brain tissues were extracted. The protein phosphorylation of the related signaling was detected using the 720 phosphorylated antibody microarray technique, and the differentially expressed proteins between groups were screened.

Results

The neurological impairment scores after 72 h of treatment: compared with the sham operation group, the scores of the model group, the control point group and the acupoint group were significantly increased (P<0.01); compared with the model group, the scores of the acupoint group and the control point group were significantly decreased (P<0.01, P<0.05); the score of the acupoint group was better than that of the control point group (P<0.05). The results of the protein microarray: compared with the sham operation group, 48 proteins showed up-regulated phosphorylation (≥1.5 times) in the model group and the down-regulated was 28; compared with the model group, 35 proteins showed up-regulated phosphorylation in the control point group, and the down-regulated was 24. There were 29 proteins showing up-regulated phosphorylation in the acupoint group and the down-regulated was 51. The numbers of proteins involved in the function and signal transduction pathways were also different.

Conclusion

Acupuncture at Dazhui (GV 14), Baihui (GV 20) and Shuigou (GV 25) can effectively repair brain injury. The ischemic injury of brain tissue may be caused by imbalance of a variety of proteins, and acupuncture can promote brain tissue repair by multi-functional and multi-channel regulation of the protein disorders.

     

后路椎板减压病灶清除钛网植骨内固定术治疗胸椎结核

目的探讨后路椎板减压病灶清除钛网植骨内固定术治疗胸椎结核的安全性及有效性。方法回顾性分析2013年10月—2015年7月采用后路椎板减压病灶清除钛网植骨内固定术治疗的28例胸椎结核患者资料。记录手术时间、术中出血量,比较术前、术后1周和末次随访时患者胸腰背部疼痛视觉模拟量表(VAS)评分、胸椎后凸Cobb角、脊柱矢状面偏移(SVA)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、红细胞沉降率(ESR)、C反应蛋白(CRP),观察神经功能改善情况、植骨融合情况及并发症发生情况。结果所有患者均得到随访,随访(20.3±4.4)个月,手术时间(194.1±27.3)min,术中出血量(921.4±199.3)m L。术后患者胸腰背部疼痛VAS评分、胸椎后凸Cobb角、SVA、PT、SS、ESR、CRP均较术前明显改善,差异有统计学意义(P0.05)。术后大部分患者神经功能得到明显改善,植骨融合率达100%,所有患者均无结核复发、均未发生严重并发症。结论后路椎板减压病灶清除钛网植骨内固定术治疗胸椎结核安全、有效。     

胸腔镜手术治疗自发性性气胸的临床价值

目的：比较保守治疗与胸腔镜手术治疗对于自发性气胸的临床价值。方法收集2008年6月至2013年6月就诊的肺大疱破裂引起的自发性气胸患者522例,其中209例患者接受单操作口的胸腔镜手术,另外313例患者行胸膜腔引流等保守治疗,比较2组在住院时间,气胸复发率,胸腔感染率,疼痛程度以及住院费用进行比较。结果保守治疗组的住院时间与胸腔镜手术治疗组差异没有统计学意义（ P ＞0．05）。保守治疗的气胸复发率18．2％（57/313）,而胸腔镜手术治疗组为2．4％（5/209）,2组差异有统计学意义（ P ＜0．05）。胸腔的感染率比较,保守治疗组为3．8％（12/313）,胸腔镜手术治疗组为4．8％（10/209）,2组差异没有统计学意义（ P ＞0．05）。疼痛分级评分保守治疗组与胸腔镜手术治疗组比较差异无统计学意义（ P ＞0．05）。住院费用胸腔镜手术治疗组与保守治疗组相比有显著性差异（ P ＜0．05）。其中胸腔镜手术治疗组肺大疱的检出比例为87％（182/209）,保守治疗组中57例复发转胸腔镜手术。结论单操作口的胸腔镜手术治疗较保守治疗复发率降低,减轻了患者的痛苦,对于自发性气胸的治疗的疗效确切。