miR-483-5p表达水平与肝癌患者相关病理学参数的关联性分析

目的研究微小RNA-483-5p(miR-483-5p)表达水平与肝癌相关病理学参数关联性分析。方法选取2018年9月至2019年9月某院肝癌患者98例,取其癌组织及癌旁正常组织标本,测定miR-483-5p表达水平,并分析与病理学参数关联性。结果肝癌组织中miR-483-5p表达水平高于癌旁组织(P0.05);肝癌组织中miR-483-5p表达水平与性别、年龄、肿瘤直径无相关性(P0.05),与淋巴结转移、分化程度、TNM分期有相关性(P0.05)。结论 miR-483-5p表达水平在肝癌组织中较高,且与病理学参数淋巴结转移、分化程度、TNM分期有关,有助于肝癌的临床诊断与治疗。     

miR-216a在肾癌中的表达与临床意义

目的探讨miR-216a在肾癌组织及其配对癌旁正常组织中的表达及其与患者临床病理特征之间的相关性。方法提取34例手术切除的肾癌和配对癌旁正常组织中的总RNA,通过反转录获得cDNA,实时荧光定量PCR(q RT-PCR)检测组织中miR-216a的表达水平,采用卡方检验分析其与患者临床病理特征之间的相关性。结果 miR-216a在肾癌组织中的表达量明显低于配对癌旁正常组织(t=2.634,P<0.05),其中29例(85.29%)肾癌组织中miR-216a的表达水平降低,本组病例中肾癌组织中miR-216a的表达水平与患者性别、年龄、病理学分型、TNM分期和AJCC临床分期等临床病理特征之间无明显相关性(P>0.05)。结论 miR-216a在肾癌中的表达明显下调,提示其可能参与肾癌发生。     

微小RNA在结肠癌患者血清及肿瘤组织中的表达及意义

目的探讨微小RNA(miRNA)在结肠癌患者血清及肿瘤组织中的表达及临床意义。方法选取该院普外科2014年1月至2016年12月收治的62例结肠癌患者作为研究对象,同时选取50例健康体检者纳入对照组,比较两组受检者血清miRNA-141的表达;比较结肠癌患者肿瘤组织及癌旁组织miRNA-141的表达及不同TNM分期患者miRNA-141的表达。结果结肠癌患者血清miRNA-141表达量为(5.72±2.45),明显高于对照组的(2.25±0.89),差异有统计学意义(P0.05);结肠癌组织miR-141的表达量为(3.85±1.42),明显高于癌旁组织的(1.25±0.76),差异有统计学意义(P0.05);结肠癌TNM分期Ⅰ~Ⅱ期患者其血清及肿瘤组织的miR-141表达量均明显低于TNMⅢ~Ⅳ期的患者,差异有统计学意义(P0.05);Pearson相关分析显示,结肠癌患者血清中miR-141的表达量与肿瘤组织中miR-141表达量呈正相关(r=0.358,P0.05)。结论结肠癌患者血清及肿瘤组织中均有miR-141的高表达,且miR-141表达水平与结肠癌的发生、进展和转移关系密切。     

LINC00261和miR-31在结直肠癌组织中的表达及与临床病理特征的相关性

目的探讨长链非编码RNA00261(LINC00261)和miR-31在结直肠癌组织中的表达及与临床病理特征的相关性。方法选取2019年6月—2020年5月行手术治疗的结直肠癌30例,采集其结直肠癌组织和正常结直肠组织标本30对,应用生物信息学分析LINC00261在结直肠癌和正常结直肠组织中的表达及相关miRNA,采用qRT-PCR检测LINC00261和miR-31在结直肠癌和正常结直肠组织及细胞中表达,分析结直肠癌组织LINC00261和miR-31表达与结直肠癌患者临床病理特征的相关性,探讨结直肠癌组织LINC00261和miR-31表达的相关性。结果生物信息学分析结果显示,LINC00261在结直肠癌组织中表达低于正常结直肠组织,预测LINC00261与miR-31具有结合位点。qRT-PCR检测结果显示,LINC00261在结直肠癌组织中表达低于正常结直肠组织,miR-31在结直肠癌组织中表达高于正常结直肠组织。LINC00261在结直肠癌细胞株中表达低于正常结直肠上皮细胞,miR-31在结直肠癌细胞株中表达高于正常结直肠上皮细胞(P0.05)。结直肠癌组织中LINC00261表达肿瘤直径5 cm、血管神经浸润阳性、TNM分期Ⅲ或Ⅳ期和低分化程度结直肠癌患者低于肿瘤直径≤5 cm、血管神经浸润阴性、TNM分期Ⅰ或Ⅱ期和高中分化程度结直肠癌患者;miR-31表达肿瘤直径5 cm和TNM分期Ⅲ或Ⅳ期结直肠癌患者高于肿瘤直径≤5 cm和TNM分期Ⅰ或Ⅱ期结直肠癌患者(P0.05或P0.01)。Pearson相关性分析结果显示,结直肠癌组织LINC00261和miR-31表达呈负相关(P0.01)。结论结直肠癌组织中LINC00261低表达,miR-31高表达,二者具有相关性及靶向结合位点,并且与结直肠癌患者临床病理特征具有相关性。     

肺腺癌患者痰液中相关微小RNA表达及临床意义

目的探讨肺腺癌患者痰液中微小RNA(microRNA,miRNA)的表达及临床意义。方法应用高通量miRNA生物芯片筛选10例肺腺癌患者癌组织及癌旁正常组织中差异表达miRNA;应用实时反转录PCR方法在20例肺腺癌和10例健康正常人群痰液中验证生物芯片筛选出的差异表达miRNA。结果 miRNA生物芯片筛选出14个差异表达的miRNA;实时反转录PCR在肺腺癌患者痰液中检测9个miRNA表达,与芯片检测结果一致,且其表达水平与健康人群比较差异有统计学意义(P0.05);肺腺癌患者痰液中miR-9、miR-23、miR-720表达与淋巴结转移和临床分期有关(P0.05)。结论 miRNA在痰液中差异表达,其有望成为肺腺癌新的肿瘤标志物。     

miR-16在肾癌中表达和临床意义的研究

目的检测肾癌组织及癌旁正常组织中miR-16的表达,分析miR-16表达水平与临床病理特征之间的关系,为深入研究miR-16在肾癌的发生发展中功能作用奠定基础。方法在标本库中随机挑选48例手术切除的肾癌及配对癌旁组织标本,提取总RNA并通过反转录获得cDNA,实时荧光定量PCR(qRT-PCR)检测标本中miR-16表达量,统计学分析其表达量与患者临床病理特征间的联系。结果 48对标本中41例(85.42%)肾癌标本miR-16表达上调,统计学分析证实肾癌组织中miR-16表达量明显高于配对的癌旁正常组织(P<0.01)。肾癌中miR-16表达量与患者性别、年龄、肾癌组织类型、TNM分期、AJCC临床分期无明显相关(P>0.05)。结论 miR-16在肾癌标本中明显表达上调,提示其可能与肾癌的发生发展有关。     

利用芯片技术筛选肝癌早期复发密切相关的microRNA

目的:应用miRNA芯片技术筛选肝癌早期复发密切相关的miRNA,为进一步深入探讨miRNA在介导肝癌高侵袭性及术后早期复发中的作用打下基础。方法:从本院肝癌标本库中选取10例肝癌患者进入本研究,其中早期复发组(术后第1年出现肝内复发病灶)和非早期复发组(术后2年以上未出现肝癌复发或转移)各5例,抽提总RNA并分离出小分子RNA进行Cy3荧光标记,将标记的小分子RNA与miRNA芯片进行杂交反应,分析差异表达的miRNA。结果:相对于非早期复发组,早期复发组肿瘤标本中有miR-602、miR-451、miR-144和miR-486-5p等4个miRNAs表达显著上调(上调倍数>2.0);有miR-551b、miR-96和miR-502-3p等3个miRNAs表达显著下调(下调倍数<0.5)。结论:筛选得到肝癌早期复发的miRNA差异表达谱,其可能与肝癌的早期复发发生发展有关。     

不同分期原发性肝癌患者肿瘤组织MVD与Survivin表达的相关性研究

目的探讨不同分期原发性肝癌患者肿瘤组织微血管密度(MVD)与Survivin表达的相关性。方法选取接受原发性肝癌手术治疗的患者40例,采用免疫组织化学法检测不同分期肿瘤组织、癌旁组织以及正常肝脏组织中Survivin和CD34单克隆抗体标记的MVD的表达。结果肿瘤组织中Survivin的阳性表达率高于癌旁组织中Survivin的阳性表达率(P0.05);肿瘤组织Survivin阳性表达率随TNM分期升高而增加(P0.05);癌旁组织Survivin阳性表达率随TNM分期升高而增加(P0.05);肿瘤组织MVD表达水平高于癌旁组织(P0.05);TNM分期为Ⅰ、Ⅱ期肿瘤组织中MVD表达水平低于Ⅲ、Ⅳ期肿瘤组织(P0.05);TNM分期为Ⅰ、Ⅱ期癌旁组织中MVD表达水平低于Ⅲ、Ⅳ期癌旁组织(P0.05);肿瘤组织中Survivin表达阳性组MVD水平高于Survivin表达阴性组MVD水平(P0.05);肝癌肿瘤组织中Survivin表达与MVD呈正相关关系(P0.05)。结论原发性肝癌患者肿瘤组织MVD与Survivin表达水平与临床TNM分期有关,TNM分期越高,MVD与Survivin表达水平越高,且Survivin表达水平与MVD表达水平正相关,Survivin可能参与了肝癌的血管形成过程。     

MiR-20b在胃癌中表达及其临床意义

【目的】探讨miR-20 b表达在中国人群胃癌中表达及临床意义。【方法】收集75例新鲜胃腺癌组织以及20例癌旁胃组织,利用Trizol常规方法提取组织总总核糖核酸（RNA）。进一步,将这些 RNA反转录成miRNA cDNA后,利用 qPCR的方法检测miR-20b在这些组织中的表达。SPSS 11．5软件统计分析 miR-20b在胃癌中表达与其临床参数之间的关系。【结果】与癌旁胃组织相比,miR-20b在胃癌中表达明显升高。miR-20 b表达与肿瘤大小、淋巴结转移以及临床分期呈明显正相关。【结论】miR-20 b 在胃癌组织中表达增加,并促进了胃癌发病的进展。     

miR-221在胃癌组织中的表达及其临床病理意义

目的:分析miR-221在胃癌组织中的表达及其与临床病理特征及预后的关系。方法:分别取96例胃癌手术标本及相应癌旁组织,提取总RNA,采用茎环逆转录实时定量PCR方法检测miR-221在胃癌及其癌旁正常组织中的表达量,并分析其与临床病理特征及预后的关系。结果:与癌旁组织比较,miR-221在胃癌组织中表达显著上调(P<0.001);miR-221的表达与肿块大小、微血管密度(MVD)、侵袭深度、淋巴结转移、远处转移、TNM分期、P53及Ki-67的表达显著正相关(P<0.001);而与年龄、性别、肿瘤部位、生长方式、细胞分化程度及nm23的表达无关(P>0.05)。Pearson相关分析显示,-△△Ct与肿瘤直径及MVD存在线性相关(r=0.721,P<0.001;r=0.725,P<0.001)。Log-Rank检验显示miR-221表达水平与3年生存率显著相关(P<0.001)。结论:miR-221在胃癌组织中表达上调,并与肿块大小、MVD、侵袭深度、淋巴结转移、远处转移、TNM分期、P53及Ki-67的表达显著正相关。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。