山水林田湖草生态问题系统诊断与保护修复综合分区研究——以陕西省为例

山水林田湖草生态保护修复分区的划定,是科学合理的分区域提出生态保护修复方案的基础。但是,目前生态保护修复分区的划定,对于生态系统问题诊断的综合性考虑不足,未能很好的体现山水林田湖草生命共同体的理念。因此,选取了8个指标综合考察了陕西省的山水林田湖草生态系统问题,并以小流域为基本单元,划定了陕西省山水林田湖草生态保护修复综合分区。研究表明：（1）2015年陕西省生态修复指数平均值为0.39（该值越小表明山水林田湖草人的综合问题越严重）,各流域生态修复指数在0.23-0.60之间。总体来看,陕西省生态修复指数的空间分异较为明显,呈现自南向北逐渐递减的格局。（2）划分了8个生态保护修复分区,包括陕南秦岭东部地区、关中平原中部的城镇地区、汉江河谷盆地、陕北黄土高原中南部地区、陕南秦岭山区、陕北黄土高原北部地区、关中平原地区和陕南大巴山地区。在生态系统问题综合诊断方面,水土流失、植被退化、降水资源不足是陕北黄土高原地区主要生态问题;南部秦巴山区的生态系统则易受到极端降水和土壤侵蚀的影响;关中平原主要存在林草植被退化、矿产资源开采强度大和水土流失等生态问题。     

光动力诊疗中的5-氨基酮戊酸及酯类衍生物的研究进展

5-氨基酮戊酸(ALA)是体表光动力疗法的一个重要前体药物,通过代谢产物原卟啉Ⅸ(PpⅨ)介导发挥光敏作用。ALA制剂的研发和优化促生了一系列产品和技术,不仅推动了体表光动力疗法的应用,而且ALA介导的PpⅨ荧光还可用于肿瘤的荧光可视化和辅助手术。本文将对光动力诊疗中ALA及其酯类衍生物和PpⅨ的研究进展作一个系统介绍。     

环状RNA影响肝疾病的发生发展

环状RNA (circular RNA, circRNA)广泛存在于多种生物细胞中,是一类由3′末端和5′末端经反向剪接共价结合形成的RNA分子。circRNA具有保守性、结构稳定、组织细胞特异性表达等特征。它们具有调控基因转录、充当微RNA海绵、参与蛋白质翻译及充当蛋白质诱饵等重要生物学功能,可影响细胞的增殖、凋亡、周期、迁移、侵袭和上皮间质转化等过程。circRNA与病毒性肝炎、肝纤维化、肝细胞肝癌、脂肪性肝病等重要肝疾病的病理生理过程密切相关。鉴于肝疾病是我国最常见的一类重大疾病,本文总结了国内外关于circRNA影响肝疾病发生发展的机制,希望为预防、诊断和治疗肝疾病提供新思路。     

Significance of plasma MACC1 levels on the prognostic stratification in patients with colorectal cancer

The clinical significance of metastasis‐associated in colon cancer‐1 (MACC1) has been investigated but the relevance of peripheral MACC1 levels was rather limited. Herein, our data revealed that plasma MACC1 levels in 117 colorectal cancer patients (CRC) were dramatically higher than that in normal controls (P < 0.001), and with a strong discrimination power between the two groups (AUC = 0.960, P < 0.001). Moreover, MACC1 is an independent prognostic factor for CRC patients. When clinical parameters stratified by MACC1_low and MACC1_high, MACC1 levels exhibited further significant predictive value. Summary, plasma MACC1 levels could be a useful prognostic and diagnostic biomarker, and could improve the prognostic value of traditional prognosticators for colorectal cancer patients.     

Evaluation of serum exosomal LncRNA‐based biomarker panel for diagnosis and recurrence prediction of bladder cancer

Exosomes are small membrane vesicles released by many cells. These vesicles can mediate cellular communications by transmitting active molecules including long non‐coding RNAs (lncRNAs). In this study, our aim was to identify a panel of lncRNAs in serum exosomes for the diagnosis and recurrence prediction of bladder cancer (BC). The expressions of 11 candidate lncRNAs in exosome were investigated in training set (n = 200) and an independent validation set (n = 320) via quantitative real‐time PCR. A three‐lncRNA panel (PCAT‐1, UBC1 and SNHG16) was finally identified by multivariate logistic regression model to provide high diagnostic accuracy for BC with an area under the receiver‐operating characteristic curve (AUC) of 0.857 and 0.826 in training set and validation set, respectively, which was significantly higher than that of urine cytology. The corresponding AUCs of this panel for patients with Ta, T1 and T2‐T4 were 0.760, 0.827 and 0.878, respectively. In addition, Kaplan‐Meier analysis showed that non‐muscle‐invasive BC (NMIBC) patients with high UBC1 expression had significantly lower recurrence‐free survival (P = 0.01). Multivariate Cox analysis demonstrated that UBC1 was independently associated with tumour recurrence of NMIBC (P = 0.018). Our study suggested that lncRNAs in serum exosomes may serve as considerable diagnostic and prognostic biomarkers of BC.     

CA19-9及CA72-4联合检测在胰腺癌诊断中的应用价值

目的:探究联合检测血清糖类抗原(CA)19-9和CA72-4水平在胰腺癌诊断中的应用价值。方法:回顾性选取我院2016年1月～2017年12月收治的72例胰腺癌患者作为胰腺癌组,以同期住院的68例良性胰腺病患者作为良性胰腺疾病组,同时纳入67例健康体检者作为对照组。检测三组人群血清CA19-9和CA72-4水平,采用受试者工作特征曲线(ROC曲线)及曲线下面积(AUC)分析评估各单项检测指标及联合检测指标对胰腺癌特异性诊断的价值。结果:胰腺癌组患者血清CA19-9和CA72-4水平分别为(137.69±25.32)U/mL和(6.96±1.25)U/mL,显著高于良性胰腺疾病组和对照组(P0.05)。血清CA19-9和CA72-4联合检测诊断胰腺癌的ROC曲线AUC高于其单独检测(P0.05),CA19-9和CA72-4的最佳临界值分别为86.94 U/m L和4.23 U/m L,此时联合检测诊断胰腺癌的敏感性为94.7%,特异性为95.2%。结论:联合检测血清CA19-9和CA72-4诊断胰腺癌的临床价值明显优于其单独检测。     

机化性肺炎患者的CT引导下经皮肺穿刺活检及其临床诊治分析

目的:探讨CT引导下经皮肺穿刺活检对机化性肺炎患者的诊断价值,并总结机化性肺炎的临床诊治经验。方法:回顾性分析2015年7月-2017年9月在南京医科大学附属常州第二人民医院住院行CT引导下经皮肺穿刺活检取得肺部病灶组织确诊为机化性肺炎的14例患者,所有患者行CT引导下经皮肺穿刺活检,总结机化性肺炎患者的临床诊治经验。结果:14例机化性肺炎患者平均年龄为59岁,平均起病时间为21天。主要临床症状以发热、咳嗽、咳痰为主。6例肺部听诊可闻及湿啰音。影像学检查主要表现为肺部斑片状不均匀密度增高影。所有患者初次就诊时均未首先诊断考虑机化性肺炎。所有患者入院后均行CT引导下经皮肺穿刺活检术,术后病理均确诊为机化性肺炎,术中3例出现少量气胸,4例出现少量出血,予吸氧止血等对症处理后好转。14例患者予糖皮质激素治疗后,主要临床症状改善,影像学检查均较前吸收好转。结论:对于持续性干咳、呼吸困难、发热病人,抗生素疗效差,影像学显示片状或块状影病灶,特别是游走性斑片阴影,需要高度警惕机化性肺炎。CT引导下经皮肺穿刺活检可作为明确机化性肺炎诊断的首选方法。机化性肺炎对糖皮质激素治疗敏感,可出现可逆性的好转,一旦确诊,建议及早使用糖皮质激素治疗。     

Targeted next-generation sequencing to diagnose disorders of HDL cholesterol

A low level of HDL cholesterol (HDL-C) is a common clinical scenario and an important marker for increased cardiovascular risk. Many patients with very low or very high HDL-C have a rare mutation in one of several genes, but identification of the molecular abnormality in patients with extreme HDL-C is rarely performed in clinical practice. We investigated the accuracy and diagnostic yield of a targeted next-generation sequencing (NGS) assay for extreme levels of HDL-C. We developed a targeted NGS panel to capture the exons, intron/exon boundaries, and untranslated regions of 26 genes with highly penetrant effects on plasma lipid levels. We sequenced 141 patients with extreme HDL-C levels and prioritized variants in accordance with medical genetics guidelines. We identified 35 pathogenic and probably pathogenic variants in HDL genes, including 21 novel variants, and performed functional validation on a subset of these. Overall, a molecular diagnosis was established in 35.9% of patients with low HDL-C and 5.2% with high HDL-C, and all prioritized variants identified by NGS were confirmed by Sanger sequencing. Our results suggest that a molecular diagnosis can be identified in a substantial proportion of patients with low HDL-C using targeted NGS.     

Toward Innovative,Cost-Effective,and Systemic Solutions to Improve Outcomes and Well-Being of Military Families Affected by Autism Spectrum Disorder

The burdens faced by military families who have a child with autism are unique. The usual challenges of securing diagnostic, treatment, and educational services are compounded by life circumstances that include the anxieties of war, frequent relocation and separation, and a demand structure that emphasizes mission readiness and service. Recently established military autism-specific health care benefits set the stage for community-viable and cost-effective solutions that can achieve better outcomes for children and greater well-being for families. Here we argue for implementation of evidence-based solutions focused on reducing age of diagnosis and improving access to early intervention, as well as establishment of a tiered menu of services, individualized to the child and family, that fit with the military ethos and system of health care. Absence of this new model of care could compromise the utility and sustainability of the autism-specific benefit.