SDF-1 在乳腺癌患者血清中表达水平及临床意义

目的:分析SDF-1在乳腺癌患者外周血中的表达水平,探讨其临床意义。方法:Elisa法检测乳腺癌患者术前及术后血清SDF-1水平,分析其与乳腺癌临床病理特征的关系。结果:乳腺癌患者术前(69例)血清SDF-1水平明显高于正常对照组(20例)(6406.7±1302.5 pg/m L vs 5217.4±1225.7 pg/m L),有明显统计学差异(P<0.01),发生远处转移的乳腺癌患者(11例)血清SDF-1水平明显高于未发生转移者(58例)(7656.4±784.1 pg/m L vs 6169.7±1364.6 pg/m L),差异具有明显统计学意义(P<0.01)。ER及Her-2表达阳性乳腺癌的患者SDF-1水平较ER及Her-2表达阴性者低,差异亦有统计学意义(P<0.05)。结论:SDF-1可能是预测乳腺癌发生及远处转移的重要标志物。     

甲状旁腺全切术后一过性甲亢的发生情况及影响因素分析

目的:分析继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者行甲状旁腺切除术(parathyroidectomy,PTX)后一过性甲亢的发生情况及影响因素。方法:选自2018年5月因SHPT连续在我院行PTX的28例患者,手术前后定期复查患者的甲状腺功能,并记录患者手术前后心率及有无心慌不适等症状。结果:纳入患者术前的甲功均正常,术后TSH由术前平均值1.96±0.94μIU/m L降到术后第四天最低平均值0.69±0.91μIU/m L(p=0.000)。术后FT3较术前平均值4.66±1.00 pmol/L升高,最高为术后第一天(12.08±8.57 pmol/L)(p=0.003);术后FT4较术前平均值11.15±2.70 pmol/L升高,最高升到术后第一天(24.09±10.91 pmol/l)(p=0.000)。术后,仅有1例合并一过性甲亢的患者(5.9%)出现严重心悸症状,予口服"β-受体阻滞剂25 mg bid"治疗后症状明显缓解。PTX术后甲状腺机能亢进的发生不受年龄、透析龄等一般情况的影响,但其发生率与SHPT严重程度、手术时间呈明显正相关。结论:SHPT患者行PTX术后一过性甲亢的发生率较高,PTX手术前后应对甲状腺功能进行常规监测。     

术后血清PTH下降率预测甲状旁腺全切术后复发的临床价值

目的:探讨甲状旁腺全切术后PTH的监测对于预测手术后是否复发的临床价值,确定具有预测价值的术后PTH的监测时间以及下降率。方法:选取本中心2009年5月至2014年8月收治的338例继发性甲状旁腺机能亢进症(secondary hyperparathyroidism,SHPT)患者作为研究对象,所有患者手术方式均为甲状旁腺全部切除术(total parathyroidectomy,t-PTX)。分别在手术前、术后1小时、术后24小时采集患者的血液标本检测血清PTH水平,并随访至术后一年,观察PTH的下降率与复发的相关性。结果:338名例患者术前、术后1小时和术后24小时的血清PTH水平分别是(1623.2±903.2 pg/m L)、(63.4±80.8 pg/m L)、(20.9±97.0pg/m L)。所有患者术后1小时和术后24小时PTH下降率均大于50%,平均值分别为95.9±5.1%和98.8±4.8%。未复发组术后1小时PTH的下降率中位数为97.1%(63.6-99.9%),复发组术后1小时PTH下降率中位数为79.6%(48.0-96.7%),两组间术后1小时和术后24小时PTH下降率比较差异具有统计学意义(P0.01)。术后1小时及术后24小时PTH下降率的受试者工作特征曲线显示曲线下面积分别为0.907和0.897(P值均0.001)。当PTH下降率为90%时,诊断手术成功的敏感性为87.23%,特异性为88.89%。且术后1小时和术后24小时的PTH下降率基本一致,对于术后复发的临床价值无统计学差异。结论:甲状旁腺全切术后1小时血清PTH的下降率预测术后复发与术后24小时血清PTH的下降率预测手术复发的临床价值相当。     

腹主动脉球囊阻断在凶险性前置胎盘剖宫产术中的应用效果分析

目的:探讨腹主动脉球囊阻断在凶险性前置胎盘剖宫产术中的应用效果。方法:选取2016年10月～2018年6月我院收治的82例凶险性前置胎盘剖宫产术产妇为研究对象,将其随机分为对照组和观察组,每组41例。对照组给予常规剖宫产手术,观察组则在术前进行腹主动脉球囊预置。比较两组的术中出血量、手术时间、子宫切除率、住院时间、1 min及5 min Apgar评分、手术前后的卵巢功能指标。结果:观察组的术中出血量和子宫切除率均明显低于对照组(P0.05),手术时间及住院时间明显短于对照组(P0.05),而两组的1 min及5 min Apgar评分、术前和术后血清卵泡生成激素(FSH)、雌二醇(E2)及黄体生成激素(LH)水平比较差异均无统计学意义(P0.05)。结论:腹主动脉球囊阻断在凶险性前置胎盘剖宫产术中的应用效果较好,且未对产妇卵巢功能状态造成不良影响,安全性高。     

EB病毒感染导致单核细胞增多症患儿免疫功能的变化及意义

探究EB病毒感染导致单核细胞增多症(IM)患儿免疫功能的变化及意义,以期为EB病毒感致IM的诊疗提供理论依据。研究对象选取2015年6月至2016年6月期间于我院诊治的80例EB病毒感染导致IM患者以及40例体检正常儿童,将确诊未开始治疗的IM患者设为观察组(40例),处于恢复期的IM患者设为治疗组(40例),将体检正常儿童设为对照组。检测淋T巴细胞亚群CD3~+T细胞、CD4~+T细胞、CD8~+T细胞比例以及CD4~+/CD8~+比值,并比较3组观察对象外周血白细胞介素6(IL-6)、白细胞介素8(IL-8)的水平。研究显示观察组CD3~+与CD8~+分别为(0.75±0.13)、(0.45±0.11),均显著高于对照组((0.53±0.09),(0.26±0.09))、治疗组((0.57±0.10),(0.30±0.10)),观察组CD4~+、CD4~+/CD8~+均显著低于对照组与治疗组,差异具有统计学意义(p0.05),治疗组与对照组各项指标差异均不显著(p0.05);观察组IL-6、IL-8分别为(16.34±4.22)pg/m L、(17.96±4.32)pg/m L,显著高于对照组((9.32±3.21)pg/m L、(10.12±3.10)pg/m L)、治疗组((10.32±3.32)pg/m L、(10.78±3.16)pg/m L),差异具有统计学意义(p0.05),治疗组与对照组各项指标差异均不显著(p0.05)。综上可得EB病毒感染后患儿体内CD3~+与CD8~+显著升高,打破CD4~+/CD8~+平衡,免疫功能失常是IM发病的重要原因,对于探究免疫功能的变化对IM的诊治具有重要意义。     

急性心肌梗死患者冠脉介入治疗后血浆apelin的变化及作用

目的:观察急性心肌梗死(AMI)患者围手术期血浆apelin的表达变化,分析AMI合并2型糖尿病(T2DM)患者血浆apelin的表达与预后的相关性,探讨apelin在冠脉介入治疗(PCI)中的心脏保护作用。方法:72例于2012年2月~8月在我院心内科接受冠状动脉造影确诊为AMI并成功完成PCI的冠心病患者,分别在术前、术后0小时、术后4小时、术后24小时收集血清,酶联免疫吸附法测定血浆apelin-13水平;进一步对糖尿病及非糖尿病AMI患者(每组各20例)进行亚组分析,随访两组患者在术后6个月时主要不良心脑血管事件(MACCE)。结果:AMI患者术后0 h组apelin水平与术前基线水平明显降低(31.54±5.48 vs35.15±6.48 ng/L,P0.05);术后4小时及24小时组apelin水平较术前明显升高(39.65±5.48 vs 35.15±6.48 ng/L,43.93±5.37 vs35.15±6.48 ng/L,P0.05)。糖尿病与非糖尿病组apelin水平术前无明显差异;糖尿病组在术后各时间点的apelin水平均明显高于非糖尿病组(31.12±5.50 vs 29.21±6.53 ng/L,40.57±5.37 vs 33.49±3.89 ng/L,43.50±7.41 vs 34.54±3.52 ng/L,P0.05)。两组术后6个月随访T2DM组LVEF值改善明显高于NT2DM组,但MACCE事件无明显差异。结论:AMI患者PCI术后存在血浆apelin表达的升高,其中糖尿病患者在术后血浆apelin表达较非糖尿病患者明显增高,提示PCI冠脉血运重建可促进糖尿病患者apelin分泌,调节胰岛素抵抗改善预后。     

腹腔镜手术治疗宫颈癌的临床效果及对生存质量的影响

探讨腹腔镜手术治疗宫颈癌的临床效果及对生存质量的影响。选取2010年2月至2012年3月在我院治疗的宫颈癌患者125例,根据患者最终选取的治疗方式分为观察组(n=68)和对照组(n=57),观察组给予腹腔镜手术,对照组给予开腹手术,观察两组手术时间、淋巴结切除数目、术中出血量等,检测两组手术前后肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)和IL-6水平;随访患者术后5年生存情况和癌症治疗功能总体评价量表(FACT-G)评分。结果显示,观察组手术时间和淋巴结清除数目分别为(224.19±45.28)min和(24.59±3.01)枚,明显多于对照组(p0.05),而术中出血量、排气时间和住院时间分别为(301.02±40.47)m L、(2.19±0.50)d和(17.01±5.11)d,明显少于对照组(p0.05);观察组术后1 d IFN-γ、TNF-α和IL-6分别为(40.01±9.91)pg/m L、(17.30±6.43)pg/m L和(14.01±4.22)pg/m L,明显低于对照组(p0.05);两组手术前后IL-4比较差异无统计学意义(p0.05);观察组术后1年、3年和5年总生存率分别为91.94%、87.10%和80.65%,与对照组比较差异无统计学意义(p0.05);观察组术后1年、3年和5年FACT-G评分分别为(65.37±10.03)分、(75.28±12.13)分和(84.46±12.01)分,明显高于对照组(p0.05)。腹腔镜手术在宫颈癌治疗中有较好的应用价值,对患者全身免疫系统干扰小,患者术后生存质量好。     

羧甲司坦通过巯基上调HDAC2 抑制气道炎症

目的:探究羧甲司坦(carbocysteine,S-CMC)在气道炎症中对组蛋白去乙酰化酶2(histone deacetylase2,HDAC2)表达的调控作用和机制。方法:建立脂多糖(lipopolysaccharide,LPS)诱导大鼠肺泡巨噬细胞(NR8383)炎症模型、短期烟熏Sprague Dawely(SD)大鼠气道炎症模型,采用酶联免疫吸附测定法(enzyme-linked immunosorbent assay,ELISA)检测炎症因子白细胞介素6(interleukin-6,IL-6)和白细胞介素8(interleukin-8,IL-8)的水平,蛋白免疫印迹(Western blotting)及免疫组化染色检测HDAC2的表达。结果:与对照组相比,模型组NR8383细胞中HDAC2的表达明显降低至对照组的0.47±0.11倍,细胞上清IL-6、IL-8水平明显升高,分别为157.6±15.0 pg/m L、378.0±17.9 pg/m L;模型组SD大鼠肺组织中HDAC2的表达明显降低到对照组的0.42±0.12倍,气道灌洗液(bronchoalveolar lavage fluid,BALF)中IL-6、IL-8分别为162.2±51.4 pg/m L、331.4±62.7 pg/m L,炎症因子水平明显升高。而与模型组比较,经S-CMC处理后细胞中HDAC2表达明显上调至对照组的1.23±0.05倍,细胞上清中IL-6为92.3±4.3 pg/m L,IL-8为300.7±17.7 pg/m L,炎症因子水平降低;肺组织中HDAC2为对照组的0.78±0.10倍,表达水平明显升高,BALF中IL-6、IL-8水平分别为100.6±32.7 pg/m L,185.0±50.4 pg/m L(P0.05)炎症因子明显降低。组蛋白去乙酰化酶抑制剂曲古抑霉素A(trichostatin,TSA)能够抑制NR8383细胞中HDAC2的表达至对照组的0.19±0.06倍,增加IL-6(197.0±42.6 pg/m L)、IL-8(567.0±97.4 pg/m L)水平,该作用可以被S-CMC所逆转(P0.05)。另外,加入巯基供体二硫苏糖醇(dithiothreitol,DTT)可增强S-CMC上调HDAC2表达,降低IL-6、IL-8的作用,而巯基耗竭剂丁硫氨酸亚砜亚胺(buthionine-sulfoximine,BSO)可减弱S-CMC的作用(P0.05)。进一步表明S-CMC调控HDAC2的过程与巯基相关。结论:S-CMC可通过巯基上调HDAC2的表达抑制气道炎症。     

全脑血管造影术中顺路行腹主动脉造影81例临床分析

目的评估在全脑血管造影术中顺路行腹主动脉造影的可行性、安全性及其临床意义。方法总结81例在全脑血管造影术中顺路行腹主动脉造影患者的临床资料,分析其肾动脉及髂动脉狭窄检出率及其相关因素,并测定术前术后血清肌酐变化,以评估该检查的安全性。结果全脑血管造影术中顺路行腹主动脉造影简单易行、安全,造影前后血清肌酐无明显变化[术前(76±11)μmol/L,术后(79±9)μmol/L](P0.05);肾动脉狭窄检出率为26%,髂动脉狭窄检出率为20%,肾动脉及髂动脉狭窄总体检出率为33%;有3个及3个以上危险因素的患者其肾动脉及髂动脉狭窄总体检出率明显增高(56%)。结论在全脑血管造影中顺路行腹主动脉造影是安全、简单、可行的,对发现肾动脉、髂动脉狭窄有重要意义。     

替莫唑胺联合放疗对胶质瘤患者VEGF、IL-8表达的影响

为研究替莫唑胺联合放疗对胶质瘤患者血管内皮生长因子(VEGF)、白介素-8(IL-8)表达的影响,本研究选取2010年7月至2011年6月我院收治的60例胶质瘤患者,根据随机抽签法分为试验组和对照组,每组30例。对照组使用放疗方式,试验组患者在此基础上口服替莫唑胺,150 mg·m~(-2)·d~(-1),连续服用5 d,4周为1个治疗周期,根据患者具体情况给药4~6个周期。比较两组患者治疗前后VEGF、IL-8水平、生活质量改善情况,评判两组患者的临床疗效、生存率、不良反应。结果显示,治疗后,试验组的总有效率86.67%(26/30)显著高于对照组63.33%(19/30),差异有统计学意义(p0.05)。试验组的VEGF、IL-8水平显著低于对照组,(65.93±3.55)pg/m L比(85.85±3.26)pg/m L,(20.81±1.92)pg/m L比(31.11±3.10)pg/m L(p0.05);试验组的KPS评分明显高于对照组,(83.06±5.16)分比(71.34±2.82)分(p0.05);试验组1年、2年、3年的生存率显著高于对照组,90.00%(27/30)比73.33%(22/30),80.00%(24/30)比50.00%(15/30),66.67%(20/30)比36.67%(11/30);中位复发时间晚于对照组,(24.32±2.32)月比(16.23±1.45)月,差异均有统计学意义(p0.05);试验组和对照组的不良反应率比较无显著性差异,16.67%(5/30)比20.00%(6/30)(p0.05)。研究结果表明替莫唑胺联合放疗能明显降低胶质瘤患者VEGF、IL-8表达,临床疗效良好,可提高患者的生活质量和生存率,安全性高。     

兔前交叉韧带损伤后膝关节本体感觉、残端血运及膝关节腔尿激酶型纤溶酶原激活物变化的实验研究

摘要 目的：研究兔前交叉韧带（ACL）损伤后膝关节本体感觉、残端血运及膝关节腔尿激酶型纤溶酶原激活物（u-PA）的变化情况。方法：选取80只新西兰兔进行研究,将其以随机数字表法分作模型组及空白对照组各40只。模型组建立单侧ACL损伤模型,空白对照组仅切开关节。比较两组术前及术后2周、4周、8周时膝关节本体感觉、残端血运及膝关节腔u-PA水平的差异。结果：模型组新西兰兔术后2周、4周、8周时的体感诱发电位（SEP）、肌电图（EMG）潜伏期均高于空白对照组,而SEP、EMG波幅均低于空白对照组（P＜0.05）。模型组新西兰兔术后2周、4周、8周时的残端组织微血管密度分别为（2.04±0.24）n/mm²、（2.75±0.61）n/mm²、（1.60±0.33）n/mm²,均高于空白对照组的（1.34±0.24）n/mm²、（1.34±0.25）n/mm²、（1.35±0.26）n/mm²,差异均有统计学意义（P＜0.05）。模型组新西兰兔术后2周、4周、8周时的膝关节液u-PA水平分别为（173.97±14.29）pg/mL、（188.37±15.82）pg/mL、（171.38±14.76）pg/mL,均高于空白对照组的（158.02±10.18）pg/mL、（157.68±10.20）pg/mL、（157.37±10.07）pg/mL,差异均有统计学意义（P＜0.05）。结论：ACL损伤后会在不同程度上影响膝关节本体感觉、残端血运及膝关节腔u-PA含量,值得临床进一步研究。     

Calcium Challenge to Confirm Secondary Hyperparathyroidism Caused by Decreased Calcium Intake

ObjectiveSecondary hyperparathyroidism commonly occurs in the setting of mid-to low-normal serum calcium levels, often in the setting of chronic kidney disease, phosphate loading, vitamin D deficiency, or insufficient calcium intake or absorption. In this article, we report 9 patients who had adequate kidney function (estimated glomerular filtration rate >60 mL/min/1.73 m²) and normal 25-hydroxy vitamin D level (≥30 ng/dL) and whose secondary hyperparathyroidism resolved after starting adequate oral calcium intake.MethodsOur retrospective case series included 8 women and 1 man; the mean age was 69.0 ± 12.2 years (mean ± standard deviation). The initial intact parathyroid hormone (iPTH) level was 80.6 ± 13.4 pg/mL (reference range [ref], 10-65 pg/mL), corrected serum calcium level was 9.2 ± 0.2 mg/dL (ref, 8.5-10.5 mg/dL), serum phosphate level was 3.6 ± 0.4 mg/dL (ref, 2.5-4.9 mg/dL), 25-hydroxy vitamin D level was 42.2 ± 10.5 mg/dL (ref, 20-50 ng/mL), and estimated glomerular filtration rate was 72.6 ± 14.4 mL/min/1.73 m². Patients were treated clinically with oral calcium 600 mg twice a day.ResultsiPTH was retested after a mean duration of 17.6 ± 12.7 days of calcium supplementation; the iPTH level decreased to 51.0 ± 10.6 pg/mL, with all patients achieving iPTH in the normal range with normocalcemia, consistent with hyperparathyroidism being because of insufficient calcium intake or absorption. All patients were normocalcemic after supplementation.ConclusionSecondary hyperparathyroidism can result from insufficient oral calcium intake. Calcium challenge is an efficacious and cost-effective tool for confirming and treating secondary hyperparathyroidism in the setting of normal vitamin D levels and kidney function.     

血清C反应蛋白、正五聚蛋白-3对小儿肺动脉高压的诊断价值

目的:研究血清C反应蛋白(CRP)和正五聚蛋白-3(PTX-3)在小儿肺动脉高压(PAH)诊断中的临床价值。方法:选择32例PAH患儿及32例健康小儿,检测和比较其血清CRP、PTX-3水平,分析血清CRP、PTX-3水平的相关性,通过绘制ROC曲线评价其对于PAH的诊断价值。结果:PAH组血清CRP水平(29.63±15.82 mg/L)、PTX-3水平(1.20±1.03 ng/m L)与对照组[CRP水平(3.38±1.74 mg/L)、PTX-3水平(0.64±0.43 ng/m L)]相比均显著升高(P0.01)。血清CRP与PTX-3的相关系数r为0.356(P0.05)。血清CRP诊断PAH的ROC曲线AUC为0.983,临界点为6.6 mg/L;PTX-3诊断PAH的ROC曲线AUC为0.669,临界点为0.95ng/m L;两者联合诊断的AUC为0.986,临界点为1.01。结论:PAH患儿血清PTX-3和CRP水平均显著升高,CRP大于PTX对PAH的诊断价值,两者联合诊断的价值更大。     

腹主动脉球囊置入术治疗凶险性前置胎盘疗效和对血清AFP、CK表达以及手术结局的影响

摘要 目的：探讨与分析腹主动脉球囊置入术治疗凶险性前置胎盘疗效和对血清AFP、CK表达以及手术结局的影响。方法：将2019年1月到2021年12月在本院住院剖宫产的凶险性前置胎盘产妇153例作为研究对象,对照组48例为剖宫产术,研究组105例为剖宫产术前行腹主动脉球囊置入术。检测两组血清甲胎蛋白（AFP）、肌酸激酶（CK）表达水平,记录手术结局。结果：所有产妇都顺利完成治疗与分娩,无死亡产妇与新生儿。研究组的产后出血量较对照组低（P<0.05）,而产前出血量在两组对比无差异（P>0.05）。两组新生儿体重对比无差异（P>0.05）,研究组的1 min Apgar评分、5 min Apgar评分较对照组高,而呼吸窘迫综合征发生率较对照组低（P<0.05）。两组手术后3 d的血清AFP与CK含量明显低于术前,研究组也显著低于对照组（P<0.05）。研究组出院时的满意度为94.29 %,明显高于对照组的79.17 %（P<0.05）。结论：腹主动脉球囊置入术治疗凶险性前置胎盘能促进降低血清AFP与CK含量,能促进产妇与新生儿恢复健康,提高产妇的满意度。     

白细胞介素33通过促进上皮细胞黏附分子表达参与干燥综合征发病

摘要 目的：探讨白细胞介素（Interleukin-33,IL-33）可能通过调控上皮细胞黏附分子（Epithelial cell adhesion molecule, EpCAM）表达参与干燥综合征（Sj?gren''s syndrome, SS）发病的作用机制。方法：收集因SS诊断需要行唇腺活检术的患者血清和唇腺组织标本及相关临床资料,根据2016年ACR-EULAR SS分类诊断标准将患者分为SS组和非SS组,选取性别、年龄匹配的21例SS患者和21例非SS患者,利用多重检测流式试剂盒（人炎症因子组合1）检测血清中IL-33水平并用t检验比较SS患者组与非SS患者组、抗SSA抗体阳性与阴性组以及唇腺病理阳性与阴性组之间IL-33水平的差异。对唇腺组织石蜡切片进行IL-33免疫组织化学染色,用流式细胞术检测新鲜唇腺组织中上皮细胞EpCAM表达水平并与血清IL-33水平进行相关性分析。结果：SS患者组IL-33水平为（1736±590.1,n=21, pg/mL）,显著高于非SS患者组（306.8±120.3, n=21, pg/mL）（t=2.373,P=0.027）;唇腺病理阳性组即灶性血清IL-33水平（489.8±170, n=27, pg/mL）高于病理阴性组（1978±793.1, n=15, pg/mL）,2组之间有统计学差异（t=2.368,P=0.023）;而抗SSA抗体阳性组与阴性组之间无明显差异（P＞0.05）。免疫组化染色结果提示SS患者唇腺组织上皮细胞IL-33表达相较于非SS患者上升,且血清IL-33水平与唇腺上皮细胞EpCAM的表达呈中等强度正相关（r=0.4915,P=0.0009,95%CI 0.2205-0.692）。结论：IL-33是与SS密切相关的炎症因子,IL-33可能通过促进唾液腺上皮细胞EpCAM的表达参与SS发病。     

TRPV4 plays an important role in rat prefrontal cortex changes induced by acute hypoxic exercise

ObjectiveThis study aims to investigate the effects of TRPV4 on acute hypoxic exercise-induced central fatigue, in order to explore the mechanism in central for exercise capacity decline of athletes in the early stage of altitude training.Methods120 male Wistar rats were randomly divided into 12 groups: 4 normoxia groups (quiet group, 5-level group, 8-level group, exhausted group), 4 groups at simulated 2500 m altitude (grouping as before), 4 groups at simulated 4500 m altitude (grouping as before), 10 in each group. With incremental load movement, materials were drawn corresponding to the load. Intracellular calcium ion concentration was measured by HE staining, enzyme-linked immunosorbent assay, immunohistochemistry, RT-qPCR, Fluo-4/AM and Fura-2/AM fluorescence staining.Results(1) Hypoxic 2–5 groups showed obvious venous congestion, with symptoms similar to normoxia-8 group; Hypoxic 2–8 groups showed meningeal loosening edema, infra-meningeal venous congestion, with symptoms similar to normoxia-exhausted group and hypoxic 1-exhaused group. (2) For 5,6-EET, regardless of normoxic or hypoxic environment, significant or very significant differences existed between each exercise load group (normoxic ? 5 level 20.58 ± 0.66 pg/mL, normoxic ? 8 level 23.15 ± 0.46 pg/mL, normoxic - exhausted 26.66 ± 0.71 pg/mL; hypoxic1-5 level 21.72 ± 0.43 pg/mL, hypoxic1-8 level 24.73 ± 0.69 pg/mL, hypoxic 1-exhausted 28.68 ± 0.48 pg/mL; hypoxic2-5 level 22.75 ± 0.20 pg/mL, hypoxic2-8 level 25.62 ± 0.39 pg/mL, hypoxic 2-exhausted 31.03 ± 0.41 pg/mL) and quiet group in the same environment(normoxic-quiet 18.12 ± 0.65 pg/mL, hypoxic 1-quiet 19.94 ± 0.43 pg/mL, hypoxic 2-quiet 21.72 ± 0.50 pg/mL). The 5,6-EET level was significantly or extremely significantly increased in hypoxic 1 environment and hypoxic 2 environment compared with normoxic environment under the same load. (3) With the increase of exercise load, expression of TRPV4 in the rat prefrontal cortex was significantly increased; hypoxic exercise groups showed significantly higher TRPV4 expression than the normoxic group. (4) Calcium ion concentration results showed that in the three environments, 8 level group (normoxic-8 190.93 ± 6.11 nmol/L, hypoxic1-8 208.92 ± 6.20 nmol/L, hypoxic2-8 219.13 ± 4.57 nmol/L) showed very significant higher concentration compared to quiet state in the same environment (normoxic-quiet 107.11 ± 0.49 nmol/L, hypoxic 1-quiet 128.48 ± 1.51 nmol/L, hypoxic 2-quiet 171.71 ± 0.84 nmol/L), and the exhausted group in the same environment (normoxic-exhausted 172.51 ± 3.30 nmol/L, hypoxic 1-exhausted 164.54 ± 6.01 nmol/L, hypoxic 2-exhausted 154.52 ± 1.80 nmol/L) had significant lower concentration than 8-level group; hypoxic2-8 had significant higher concentration than normoxic-8.ConclusionAcute hypoxic exercise increases the expression of TRPV4 channel in the prefrontal cortex of the brain. For a lower ambient oxygen concentration, expression of TRPV4 channel is higher, suggesting that TRPV4 channel may be one important mechanism involved in calcium overload in acute hypoxic exercise.     

Resuscitative endovascular balloon occlusion of the aorta may increase the bleeding of minor thoracic injury in severe multiple trauma patients: a case report

Background

The resuscitative endovascular balloon occlusion of the aorta, because of its efficacy and feasibility, has been widely used in treating patients with severe torso trauma. However, complications developing around the site proximal to the occlusion by resuscitative endovascular balloon occlusion of the aorta have almost never been studied.

Case presentation

A 50-year-old Japanese woman fell from a height of approximately 10 m. At initial arrival, her respiratory rate was 24 breaths/minute, her blood oxygen saturation was 95% under 10 L/minute oxygenation, her pulse rate was 90 beats per minute, and her blood pressure was 180/120 mmHg. Mild lung contusion, hemopneumothorax, unstable pelvic fracture, and retroperitoneal bleeding with extravasation of contrast media were observed in initial computed tomography. As her vital signs had deteriorated during computed tomography, a 7-French aortic occlusion catheter (RESCUE BALLOON®, Tokai Medical Products, Aichi, Japan) was inserted and inflated for aortic occlusion at the first lumbar vertebra level and transcatheter arterial embolization was performed for the pelvic fracture. Her bilateral internal iliac arteries were embolized with a gelatin sponge; however, the embolized sites presented recanalization as coagulopathy appeared. Her bilateral internal iliac arteries were re-embolized by n-butyl-2-cyanoacrylate. The balloon was deflated 18 minutes later. After embolization, repeat computed tomography was performed and a massive hemothorax, which had not been captured on arrival, had appeared in her left pleural cavity. Thoracotomy hemostasis was performed and a hemothorax of approximately 2500 ml was aspirated to search for the source of bleeding. However, clear active bleeding was not captured; resuscitative endovascular balloon occlusion of the aorta may have been the cause of the increased bleeding of the thoracic injury at the proximal site of the aorta occlusion.

Conclusions

It is necessary to note that the use of resuscitative endovascular balloon occlusion of the aorta may increase bleeding in sites proximal to occlusions, even in the case of minor injuries without active bleeding at the initial diagnosis.

     

15例儿童心动过速性心肌病的诊疗体会

目的:探讨儿童完全性心动过速性心肌病(pTIC)的临床特点、治疗及预后。方法:回顾分析2009年1月至2016年10月安徽省儿童医院心内科收治的15例完全性心动过速性心肌病患儿的临床表现、心功能、心电图、心脏彩超的特点,观察心律失常控制后的心室率、心脏左室内径大小及心功能恢复情况。结果:15例pTIC患儿以室上性快速心律失常多见(14例),10例单纯药物治疗,3例接受射频消融转为窦性心律,2例失访。随访半年至3年与治疗前比较心室率明显下降[(116±27)次/分vs.(189±28)次/分]、NT-proBNP降低[(404±355)pg/mL vs.(6280±3155)pg/mL]、心脏左室舒张末内径变小[(3.12±0.48)cm vs.(3.69±0.70)cm]、左室射血分数升高[(57.9±9.3)%vs.(42.2±9.5)%]、改良ROSS评分下降[1(0-5)分vs.7(4-10)分]。结论:儿童pTIC由各种快速心律失常引起,心脏扩大和心功能障碍可完全恢复,早期识别、有效治疗的儿童pTIC长期预后良好。     

血清AFP,CEA,CA125单独或联合检测对原发性肝癌早期诊断的临床价值研究

目的:探讨血清中甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原125(CA125)单独以及联合检测对于原发性肝癌的早期诊断临床价值。方法:选择2012年1月~2016年6月在我院检验科确诊的120例原发性肝癌患者作为观察组,并以80例健康志愿者作为对照组,检测和比较两组的AFP、CEA和CA125水平,分析血清AFP、CEA、CA125单项及联合检测检出原发性肝癌的阳性率和约登指数。结果:观察组血清AFP(319.53±35.78 ng/mL)、CEA(81.4±27.8 ng/mL)、CA125(20.67±4.61 ng/mL)水平均明显高于健康对照组(P0.05)。血清AFP、CEA、CA125在单独检测时诊断原发性肝癌的敏感性分别为65%(78/120)、75%(90/120)和60%(72/120),而三者的联合检测能够使检测的敏感性达到92%(112/120),显著高于单独检测时的敏感度(P0.05)。血清AFP、CEA、CA125单项检测约登指数均显著低于联合检测(P0.05)。结论:相较于血清AFP、CEA、CA125的单独检测,三者联合检测可明显提高原发性肝癌的检出率。     

腹腔镜膀胱癌根治术的治疗效果及对血清前梯度蛋白-2的影响及其意义

目的:探讨腹腔镜膀胱癌根治术的治疗效果及对血清前梯度蛋白-2(AGR2)的影响及其意义。方法:选取2013年3月～2016年5月我院收治的80例膀胱癌患者为研究对象,同时选取同期体检健康的志愿者30例作对照组。膀胱癌患者择期行腹腔镜根治术,观察手术时间、术中出血量、术后肠道排气时间、住院时间和术后并发症。采用ELISA法检测膀胱癌患者术前和术后4周血清AGR2水平的变化。术后随访至2017年12月25日,分析血清AGR2水平与患者总生存期(OS)和无进展生存期(PFS)的关系。结果:80例患者顺利完成腹腔镜根治术,无中转开放手术,无死亡,手术时间(359.8±45.7)min,术中出血量(423.8±109.4)mL,术后肠道排气时间(3.2±1.4)d,术后住院时间(12.9±2.4)d。膀胱癌患者术前血清AGR2水平显著高于对照组[(33.5±9.4) vs.(8.5±2.1)ng/m L,P0.05],术后4周血清AGR2较术前显著降低[(17.8±4.1) vs.(33.5±9.4) ng/mL,P0.05]。术后4周血清AGR2低水平患者PFS(23vs14月,P0.05)和OS (36vs23月,P0.05)均显著大于高水平患者(P0.05)。结论:腹腔镜膀胱癌根治术治疗效果满意,可显著降低患者血清AGR2水平。血清AGR2水平的变化有助于腹腔镜根治术的治疗效果和预后预测。