超声造影联合血清HE4、CA125、TK1、TAP对子宫内膜恶性病变的诊断价值研究

摘要 目的：探讨超声造影联合血清人附睾分泌蛋白4（HE4）、糖类抗原125（CA125）、胸苷激酶1（TK1）、肿瘤异常蛋白（TAP）对子宫内膜恶性病变的诊断价值。方法：选择2019年1月至2022年1月于济南市人民医院超声科行超声造影检查的95例子宫内膜病变患者。检测其血清HE4、CA125、TK1、TAP水平,通过超声造影检查获得造影参数开始增强时间、达峰时间、峰值强度、梯度、TIC曲线下面积（TIC-AUC）。受试者工作特征（ROC）曲线分析超声造影参数联合血清HE4、CA125、TK1、TAP诊断子宫内膜恶性病变的价值。结果：根据病理结果将患者分为恶性组（37例）和良性组（58例）,恶性组峰值强度、TIC-AUC、血清HE4、CA125、TK1、TAP水平高于良性组（P＜0.05）,恶性组开始增强时间、达峰时间、梯度与良性组比较差异无统计学意义（P＞0.05）。峰值强度、TIC-AUC、HE4、CA125、TK1、TAP 单独诊断子宫内膜恶性病变的曲线下面积为0.767、0.676、0.656、0.691、0.713、0.721,联合诊断子宫内膜恶性病变的曲线下面积为0.896,高于单独指标诊断。结论：超声造影参数峰值强度、TIC-AUC联合血清HE4、CA125、TK1、TAP诊断子宫内膜恶性病变具有较高的价值。     

结核感染T细胞斑点试验联合血清ADA、SAA、CA125对活动性肺结核诊断及治疗转归的评估价值

摘要 目的：探讨结核感染T细胞斑点试验（T-SPOT.TB）联合血清腺苷脱氨酶（ADA）、淀粉样蛋白A（SAA）、糖类抗原125（CA125）对活动性肺结核（APTB）诊断及治疗转归的评估价值。方法：选取2021年10月至2022年10月湖南省胸科医院收治的137例APTB患者（APTB组）和80例非APTB患者（对照组）,所有APTB患者接受常规抗结核治疗,根据治疗后转归情况分为转归组（92例）和未转归组（45例）。治疗前进行T-SPOT.TB,并检测血清ADA、SAA、CA125水平。受试者工作特征（ROC）曲线分析T-SPOT.TB联合血清ADA、SAA、CA125诊断APTB和预测治疗转归的效能。结果：APTB组T-SPOT.TB阳性率,血清ADA、SAA、CA125水平高于对照组（P＜0.05）。未转归组T-SPOT.TB阳性率,血清ADA、SAA、CA125水平高于转归组（P＜0.05）。T-SPOT.TB联合血清ADA、SAA、CA125诊断APTB以及预测其治疗转归的曲线下面积（AUC）分别为0.917、0.833,高于单一指标。结论：APTB患者T-SPOT.TB阳性率增加,血清ADA、SAA、CA125水平增高,与抗结核治疗后转归不良有关,T-SPOT.TB联合血清ADA、SAA、CA125在APTB诊断和治疗转归评估中具有较高价值。     

上皮性卵巢癌患者CT、MRI影像学特征及与血清标志物CEA、CA199、CA125水平的相关性研究

摘要 目的：探讨上皮性卵巢癌患者电子计算机断层扫描（CT）、磁共振成像（MRI）影像学特征及与血清标志物癌胚抗原（CEA）、糖类抗原199（CA199）、糖类抗原125（CA125）水平的相关性。方法：回顾性分析2014年4月-2020年2月于我院83例诊断为上皮性卵巢癌患者的CT、MRI影像学资料,以手术病理结果作为金标准。分析患者的CT、MRI影像学特征,检测患者血清CEA、CA199、CA125水平,评价患者CT、MRI影像学特征与血清CEA、CA199、CA125水平的相关性。结果：上皮性卵巢癌肿瘤横截面最大径为14.2mm-121.7mm,平均（18.6±4.3）mm,上皮性卵巢癌以混杂密度/信号为主,形态不规则,病灶多为囊实性,可见壁结节及分隔改变,增强后可见分隔或壁结节明显强化,可伴有腹水、腹膜转移、淋巴结转移。血清CEA、CA199、CA125水平分别为（66.35±7.52）ng/mL、（183.59±22.62）U/mL、（225.27±25.34）U/mL。上皮性卵巢癌边界清晰、不清晰的血清CA199、CA125水平组间差异有统计学意义（P＜0.05）;上皮性卵巢癌形态圆形/类圆形/椭圆形、分叶状、形态不规则的血清CA199、CA125水平组间差异有统计学意义（P＜0.05）;上皮性卵巢癌患者有壁结节、腹膜转移、淋巴结转移的血清CEA、CA199、CA125水平组间差异有统计学意义（P＜0.05）;其余CT、MRI影像学表现特征组间血清CEA、CA199、CA125水平差异无统计学意义（P＞0.05）。上皮性卵巢癌边界与血清CA125水平呈正相关（P＜0.05）,上皮性卵巢癌形态与血清CA199、CA125水平呈正相关（P＜0.05）,壁结节与血清CA125水平呈正相关（P＜0.05）,腹膜转移、淋巴结转移与血清CEA、CA199、CA125水平呈正相关（P＜0.05）,其余指标之间无明显相关性（P＞0.05）。结论：上皮性卵巢癌CT、MRI影像表现具有特征性,血清CEA、CA199、CA125水平的检测有助于对早期上皮性卵巢癌的诊断以及不同病理类型的判断,CT、MRI影像学特征与血清CEA、CA199、CA125水平具有相关性,可判断疾病的进展及患者预后情况,对指导临床综合治疗及评估患者预后可提供客观依据。     

血清糖类抗原125、胸苷激酶-1、半乳激素-9水平与子宫内膜癌患者临床病理特征和预后的关系

摘要 目的：探讨血清糖类抗原125（CA125）、胸苷激酶-1（TK1）、半乳激素-9（Gal-9）水平与子宫内膜癌（EC）患者临床病理特征和预后的关系。方法：选择2016年1月~2018年11月西北妇女儿童医院收治的EC患者114例作为研究组,同期医院体检的健康女性110例作为对照组。比较两组血清CA125、TK1、Gal-9水平及不同临床病理特征EC患者血清CA125、TK1、Gal-9水平。EC患者随访3年并绘制生存曲线,比较不同血清CA125、TK1、Gal-9水平患者预后情况,并应用Cox回归模型分析预后的影响因素。结果：研究组血清CA125、TK1、Gal-9水平显著高于对照组（P<0.05）。病理分期III期、组织分化低分化、肌层浸润深度≥1/2、有淋巴结转移EC患者血清CA125、TK1、Gal-9水平显著高于病理分期I~II期、组织分化中高分化、肌层浸润深度<1/2、无淋巴结转移患者（P<0.05）。随访3年,失访8人,CA125高表达组3年生存率（50.00%）显著低于CA125低表达组（89.29%）;TK1高表达组3年生存率（48.15%）显著低于TK1低表达组（94.23%）;Gal-9高表达组3年生存率（46.67%）显著低于Gal-9低表达组（88.52%）,差异均有统计学意义（P<0.05）。Cox比例风险回归分析显示血清CA125高表达、TK1高表达、Gal-9高表达,病理分期Ⅲ期、肌层浸润深度≥1/2、有淋巴结转移是EC患者死亡的影响因素（P<0.05）。结论：EC患者血清CA125、TK1、Gal-9异常升高,其水平与患者临床病理特征和预后有关,血清CA125、TK1、Gal-9高水平者预后较差。     

术前三叶因子3、热休克蛋白40、中性粒细胞/淋巴细胞比值与上皮性卵巢癌患者肿瘤细胞减灭术后复发的关系

摘要 目的：探讨术前三叶因子3（TFF3）、热休克蛋白40（HSP40）、中性粒细胞/淋巴细胞比值（NLR）与上皮性卵巢癌（EOC）患者肿瘤细胞减灭术（CRS）后复发的关系。方法：选取2016年1月～2017年5月南京市第二医院妇科收治的140例接受CRS治疗的EOC患者，根据CRS后是否复发分为复发组和未复发组。检测和计算血清TFF3、HSP40、NLR。采用单因素和多因素Logistic回归分析EOC患者CRS后复发的影响因素，受试者工作特征（ROC）曲线分析EOC患者CRS后复发的预测价值。结果：随访5年，失访2例，138例EOC患者CRS后复发率为52.90%（73/138）。与未复发组比较，复发组国际妇产科联盟（FIGO）分期Ⅳ期、化疗疗程≥6个、术后残留灶为最大残留肿瘤直径≤1 cm（R1）比例更大，术前血清糖类抗原（CA）125、TFF3、HSP40、NLR升高（P＜0.05）。多因素Logistic回归分析显示，肿瘤直径≥3 cm、低分化、FIGO分期Ⅳ期、术后残留灶为R1和TFF3、HSP40、NLR升高为EOC患者CRS后复发的独立危险因素（P＜0.05）。ROC曲线分析显示，术前血清TFF3、HSP40、NLR单独与联合预测EOC患者CRS后复发的曲线下面积（AUC）分别为0.766、0.763、0.765、0.911，术前血清TFF3、HSP40、NLR联合预测EOC患者CRS后复发的AUC最大。结论：术前血清TFF3、HSP40、NLR升高与EOC患者CRS后复发独立相关，可能成为EOC患者CRS后复发的辅助预测指标，且三指标联合应用预测价值更高。     

超声造影联合HE4、CA125、CA153在子宫内膜癌诊断中的价值研究

摘要 目的：为提高对子宫内膜癌的早期诊断,本研究对超声造影联合肿瘤标志物人附睾蛋白4（human epididymis protein-4,HE4）血清糖类抗原125（carbohydrate antigen 125,CA125）及153（CA153）在子宫内膜癌中的诊断价值进行研究。方法：以80例疑似子宫内膜癌患者为研究组,另以80例于本院体检的健康女性为对照组。对患者进行超声造影检查,比较两组血清HE4、CA125以及CA153水平,考察超声造影联合HE4、CA125及CA153对子宫内膜癌的诊断作用。结果：本研究中80例疑似患者中,子宫内膜癌患者有49例,子宫内膜良性病变患者31例,而超声造影检查显示子宫内膜癌患者有41例,良性病变39例,与金标准检查结果有一定的差异,单纯的超声造影检查对子宫内膜癌的诊断有局限性。子宫内膜癌和良性病变患者的病变区灌注的时间、增强强度以及增强均度都有显著差异（P<0.05）。对照组血清HE4、CA125及CA153水平分别为82.31±15.45 pmol/mL、22.31±6.21 U/mL、16.45±4.91 U/mL,研究组血清HE4、CA125及CA153水平分别为159.28±24.01 pmol/mL、42.88±5.73 U/mL、28.30±3.76 U/mL,经统计,研究组各项指标均显著高于对照组（P<0.05）。超声造影的灵敏度为79.3 %、特异度为67.34 %、阳性似然比为2.54、阴性似然比为0.25、阳性预测值为84.63 %、阴性预测值为60.51 %及符合率为72.19 %;联合检测的灵敏度为86.58 %、特异度为78.92 %、阳性似然比为3.11、阴性似然比为0.23、阳性预测值为93.19 %、阴性预测值为67.42 %及符合率为77.90 %。结论：超声造影联合HE4、CA125及CA153检测对子宫内膜癌诊断价值更高,HE4、CA125及CA153能辅助提高超声造影的诊断效果。     

血清TAP、TFF3与晚期胃癌患者含奥沙利铂化疗方案敏感性和预后的关系

摘要 目的：探讨血清肿瘤异常蛋白（TAP）、三叶因子3（TFF3）与晚期胃癌患者应用含奥沙利铂化疗方案敏感性和预后的关系。方法：选择2017年1月至2020年1月河北大学附属医院收治的115例晚期胃癌患者,所有患者接受含奥沙利铂化疗方案治疗,根据疗效分为敏感组（47例）和耐药组（68例）。化疗前检测血清TAP、TFF3水平,受试者工作特征（ROC）曲线分析TAP、TFF3预测晚期胃癌患者接受含奥沙利铂化疗疗效的价值。治疗后随访,Wilcoxon检验不同血清TAP、TFF3表达下晚期胃癌患者中位OS时间差异。结果：耐药组血清TAP、TFF3水平高于敏感组（P＜0.05）。TAP、TFF3预测晚期胃癌患者含奥沙利铂化疗耐药的曲线下面积分别为0.717、0.690,联合TAP和TFF3预测晚期胃癌患者含奥沙利铂化疗耐药的曲线下面积为0.801,高于单独TAP、TFF3单独检测。随访期间失访2例,死亡54例,高水平TAP、高水平TFF3晚期胃癌患者中位OS时间短于低水平TAP、低水平TFF3晚期胃癌患者（P＜0.05）。结论：对含奥沙利铂化疗耐药的晚期胃癌患者血清TAP、TFF3水平显著增高,高水平TAP、TFF3晚期胃癌患者中位OS时间较短,联合检测血清TAP和TFF3可预测晚期胃癌患者化疗反应性和预后。     

磁共振成像检查联合血清HE4、TK1、CA199检测在卵巢癌诊断中的应用价值

摘要 目的：研究磁共振成像（MRI）检查联合血清人附睾蛋白4（HE4）、细胞质胸苷激酶（TK1）、糖类抗原199（CA199）检测在卵巢癌诊断中的应用价值。方法：将2017年4月～2019年12月我院收治的卵巢癌患者54例作为卵巢癌组,卵巢良性肿瘤患者49例作为卵巢良性肿瘤组,所有受试者均进行MRI检测,并采集受试者血清检测HE4、TK1、CA199水平,以受试者工作特征（ROC）曲线分析MRI检查联合血清HE4、TK1、CA199检测诊断卵巢癌的效能。结果：卵巢癌MRI特点包括以下几点：①囊实性肿块;②形态不规则;③呈长T2/T1等信号;④病灶边界模糊;⑤增强扫描结果呈病灶显著强化;⑥腹膜转移者存在显著腹腔积液以及散在分布的结节状种植病灶。卵巢良性肿瘤MRI特点包括以下几点：①囊壁光滑;②呈长T1以及长T2信;③病灶边界清晰;④增强扫描结果提示病灶无强化/稍有强化。卵巢癌组血清HE4、TK1、CA199水平分别为（87.13±15.32）pmol/L、（2.15±0.13）pmol/L、（95.39±15.25）U/mL,明显高于卵巢良性肿瘤组的（66.42±10.19）pmol/L、（0.85±0.20）pmol/L、（37.94±1.05）U/mL（均P＜0.05）。经ROC曲线分析可得：MRI检查联合血清HE4、TK1、CA199检测诊断卵巢癌的灵敏度、特异度以及曲线下面积均高于上述各项单独诊断。结论：卵巢癌患者血清HE4、TK1、CA199水平较高,MRI检查联合血清HE4、TK1、CA199检测诊断卵巢癌的价值较高,具有一定的临床应用价值。     

磁共振扩散加权成像联合血清AFP、CA125、CEA、CA199检测在早期原发性肝癌中的诊断价值研究

摘要 目的：研究磁共振扩散加权成像（DWI）联合血清甲胎蛋白（AFP）、糖类抗原125（CA125）、癌胚抗原（CEA）、糖类抗原199（CA199）检测在早期原发性肝癌（PHC）中的诊断价值。方法：选取我院自2017年9月开始至2020年5月收治的63例早期PHC患者纳入研究,记作肝癌组,再取同期我院收治的61例良性肝病患者记作对照组。对所有受试者均实施DWI扫描,比较两组DWI图像信号强度。检测并比较两组血清AFP、CA125、CEA、CA199水平,以受试者工作特征（ROC）曲线分析上述各项血清学指标水平检测和DWI诊断早期PHC的效能。另外,比较PHC淋巴结转移患者和无淋巴结转移患者血清AFP、CA125、CEA、CA199水平。结果：肝癌组DWI信号强度为高信号人数占比高于对照组（均P<0.05）。肝癌组血清AFP、CA125、CEA、CA199水平均高于对照组（均P<0.05）。血清AFP、CA125、CEA、CA199水平联合DWI诊断早期PHC的曲线下面积、灵敏度以及特异度均高于上述各检查方式单独检测。PHC淋巴结转移患者的血清AFP、CA125、CEA、CA199水平均高于无淋巴结转移患者（均P<0.05）。结论：DWI联合血清AFP、CA125、CEA、CA199检测诊断早期PHC的价值较高,且淋巴结转移患者的血清AFP、CA125、CEA、CA199水平明显升高。     

卡瑞利珠单抗联合标准二线化疗对晚期食管鳞癌患者肿瘤标志物和外周血NLR、LMR的影响及其预后的影响因素分析

摘要 目的：探讨卡瑞利珠单抗联合标准二线化疗对晚期食管鳞癌患者肿瘤标志物和外周血中性粒细胞/淋巴细胞比值（NLR）、淋巴细胞/单核细胞比值（LMR）的影响,并分析影响晚期食管鳞癌预后的因素。方法：选择2019年8月至2021年8月安徽医科大学附属巢湖医院收治的80例晚期食管鳞癌患者,根据治疗方法将其分为对照组（40例）采用标准二线化疗治疗,观察组（40例）采用卡瑞利珠单抗联合标准二线化疗治疗。比较两组疗效、血清肿瘤标志物以及外周血NLR、LMR水平以及安全性差异。绘制Kaplan-Meier曲线,分析不同治疗方案晚期食管鳞癌患者总生存期（OS）期差异,多因素Cox回归分析影响晚期食管鳞癌患者预后的因素。结果：观察组客观缓解率（ORR）、疾病控制率（DCR）高于对照组（P＜0.05）;两组治疗后血清糖类抗原125（CA125）、糖类抗原199（CA199）、癌胚抗原（CEA）、糖类抗原724（CA724）以及外周血NLR水平均较治疗前降低（P＜0.05）,外周血LMR较治疗前增高（P＜0.05）,观察组治疗后血清CA125、CA199、CEA、CA724水平以及外周血NLR低于对照组（P＜0.05）,外周血LMR水平高于对照组（P＜0.05）;两组不良反应发生率比较无差异（P＞0.05）。观察组中位无进展生存期（PFS）、OS生存期长于对照组（P＜0.05）。多因素Cox回归分析结果显示TNM分期Ⅳ期、远处转移、高NLR是影响晚期食管鳞癌患者预后的危险因素（P＜0.05）,高LMR、卡瑞利珠单抗联合标准二线化疗是保护因素（P＜0.05）。结论：卡瑞利珠单抗联合标准二线化疗可提高晚期食管磷癌临床疗效,降低血清肿瘤标志物以及外周血NLR水平,提高外周血LMR水平,TNM分期Ⅳ期、远处转移、高NLR是影响晚期食管鳞癌患者预后的危险因素,高LMR、卡瑞利珠单抗联合标准二线化疗是其保护因素。     

Definitions,measurements, and classifications of stimuli,situations, and environments

A review is presented of issues relevant to the definition, measurement, and classification of stimuli, situations, and environments. Problems such as the lack of adequate definitions of concepts, error and bias in measurement procedures, confusion between measurement of a concept and measurement of its behavioral effects, and the lack of agreement among alternative measures are emphasized. It is suggested that concepts be defined in terms of objective characteristics while allowing for the study of the transactional relationship between organism and environment. The work of the ethologists in defining stimuli while studying their relationship to different organismic states and situational contexts is emphasized in this regard. Following Brunswik, it is also suggested that wherever possible there be a representative sampling of variables in natural settings. Note from the editors: From time to time, Human Ecology will publish a review article. Our first in this series is a review by a psychologist of basic definitional and conceptual problems in environmental studies.This paper was prepared while the author was a Visiting Research Fellow at the Educational Testing Service. The support of ETS and my colleagues in the Division of Psychological Studies is gratefully acknowledged. The review was also supported in part by a grant from the Rutgers University Research Council.     

Exercise, dobutamine, and combined atropine, norepinephrine, and epinephrine compared

We compared the cardiovascular effects evoked in conscious dogs by 1) submaximal exercise; 2) infusion of dobutamine (40 micrograms X kg-1 X min-1); and 3) infusion of a combination of atropine (0.15 mg/kg), norepinephrine (0.19 micrograms X kg-1 X min-1), and epinephrine (0.05 micrograms X kg-1 X min-1). Myocardial O2 demand, as estimated by the double product (heart rate X systolic blood pressure), was similar during all three interventions. Cardiac output and heart rate increased significantly (P less than 0.05) during each of the three interventions. Arteriovenous O2 difference and total body O2 consumption, however, increased only during submaximal exercise. Although myocardial blood flow increased similarly during each of the three interventions, blood flow to skeletal muscle and the tongue increased only during exercise. Exercise and the combined infusion of atropine, norepinephrine, and epinephrine produced similar increases in blood flow to the diaphragm and similar decreases in blood flow to the stomach. These changes in blood flow were associated with appropriate changes in vascular resistance. Additionally, blood flow to the brain, kidney, adrenal glands, liver, and intestine did not change during any of the three interventions. Thus, in dogs, submaximal exercise, infusion of dobutamine, and infusion of a combination of atropine, norepinephrine, and epinephrine to evoke a given level of estimated myocardial O2 consumption produce similar increases in cardiac output, heart rate, and myocardial blood flow. In contrast, the changes in total body O2 consumption, arteriovenous O2 difference, regional blood flow, and regional vascular resistance that occur during each of these three interventions are different.     

Synthesis,tautomerism, and antimicrobial,anti-HCV,anti-SSPE,antioxidant, and antitumor activities of arylazobenzosuberones

2-Dimethylaminomethylene-1-benzosuberone 1 was coupled with diazotized aniline derivatives to afford a series of the hitherto unreported 2-arylazo-1-benzosuberones 3a–i. The tautomeric structure and the effect of substituents on the tautomeric form (s) of the products 3a–i were discussed. Similar coupling of the enaminone 1 with diazonium salts of heterocyclic amines gave the respective fused azolotriazino-benzosuberones. Some of the newly synthesized compounds showed potent antimicrobial, anti-HCV, antioxidant, antitumor (as topoisomerase I inhibitors), and antimicrobial activities.     

Indians, Markets, and Rainforests: Theory, Methods, and Analysis

Indians, Markets, and Rainforests: Theory, Methods, and Analysis. Ricardo A. Godoy. New York: Columbia University Press, 2001. 274 pp.     

Incorporating Science,Technology, Fairness,and Accountability in Environmental,Health, and Safety Decisions

The Precautionary Principle is in sharp political focus today because (1) the nature of scientific uncertainty is changing and (2) there is increasing pressure to base governmental action on more “rational” schemes, such as cost-benefit analysis and quantitative risk assessment, the former being an embodiment of ‘rational choice theory’ promoted by the Chicago school of law and economics. The Precautionary Principle has been criticized as being both too vague and too arbitrary to form a basis for rational decision making. The assumption underlying this criticism is that any scheme not based on cost-benefit analysis and risk assessment is both irrational and without secure foundation in either science or economics. This paper contests that view and makes explicit the rational tenets of the Precautionary Principle within an analytical framework as rigorous as uncertainties permit, and one that mirrors democratic values embodied in regulatory, compensatory, and common law. Unlike other formulations that reject risk assessment, this paper argues that risk assessment can be used within the formalism of tradeoff analysis—a more appropriate alternative to traditional cost-benefit analysis and one that satisfies the need for well-grounded public policy decision making. This paper will argue that the precautionary approach is the most appropriate basis for policy, even when large uncertainties do not exist, especially where the fairness of the distributions of costs and benefits of hazardous activities and products are a concern. Furthermore, it will offer an approach to making decisions within an analytic framework, based on equity and justice, to replace the economic paradigm of utilitarian cost-benefit analysis.     

Whales,lifespan, phospholipids,and cataracts

This study addresses the question: why do rats get cataracts at 2 years, dogs at 8 years, and whales do not develop cataracts for 200 years? Whale lens lipid phase transitions were compared with the phase transitions of other species that were recalculated. The major phospholipids of the whale lens were sphingolipids, mostly dihydrosphingomyelins with an average molar cholesterol/phospholipid ratio of 10. There was a linear correlation between the percentage of lens sphingolipid and lens lipid hydrocarbon chain order until about 60% sphingolipid. The percentage of lens sphingolipid correlated with the lens lipid phase transition temperature. The lifespan of the bowhead whale was the longest of the species measured and the percentage of whale lens sphingolipid fit well in the correlation between the percentage of lens sphingolipid and lifespan for many species. In conclusion, bowhead whale lens membranes have a high sphingolipid content that confers resistance to oxidation, allowing these lenses to stay clear relatively longer than many other species. The strong correlation between sphingolipid and lifespan may form a basis for future studies, which are needed because correlations do not infer cause. One could hope that if human lenses could be made to have a lipid composition similar to whales, like the bowhead, humans would not develop age-related cataracts for over 100 years.