体素内不相干运动成像对于周围型肺癌血供情况及细胞密集程度的价值研究

摘要 目的：探究周围型肺癌3.0 T磁共振成像（MRI）的体素内不相干运动成像（IVIM-DWI）各参数值对其血供情况以及细胞密集程度的价值。方法：选取2019年1月-2021年10月于本院行手术切除后并经病理检查证实为周围型肺癌的患者50例,术前均行常规MRI平扫、增强以及IVIM-DWI成像,分别测量所有病灶以及对侧相对称正常肺组织的标准表观扩散系数（sADC）、真实扩散系数（D）、灌注相关扩散系数（Ｄ*）以及灌注分数（?）。比较两者IVIM-DWI参数;比较不同强化程度下周围型肺癌病灶IVIM-DWI参数;Spearman 秩相关分析周围型肺癌病灶IVIM-DWI参数与强化程度的相关性;通过绘制受试者工作特征（ROC）曲线,分析与强化程度存在相关性的IVIM-DWI参数对周围型肺癌血供情况及细胞密集程度的评估价值。结果：周围型肺癌病灶的sADC、D均低于正常肺组织,D*、?均高于正常肺组织,差异均具有统计学意义（P<0.05）。高度强化下周围型肺癌病灶D*高于中度强化、轻度强化,?低于中度强化、轻度强化,而D仅高于轻度强化,差异均具有统计学意义（P<0.05）,不同强化程度间sADC均无统计学差异（P>0.05）。Spearman秩相关分析显示周围型肺癌病灶的D*与强化程度呈正相关（P<0.05）,?与强化程度呈负相关（P<0.05）。通过绘制ROC曲线分析显示D*、?对周围型肺癌血供情况以及细胞密集程度评估的AUC大于0.700,提示其具有较高的评估价值。结论：IVIM-DWI模型既可以反映周围型肺癌的血供情况,也可以反映病变细胞密集程度,有助于提高对周围性肺癌血管情况及细胞密集程度的评估价值。     

2型糖尿病患者血清鸢尾素、摄食抑制因子-1、3-硝基酪氨酸水平与糖脂代谢和阻塞性睡眠呼吸暂停低通气综合征的关系研究

摘要 目的：探讨2型糖尿病（T2DM）患者血清鸢尾素（Irisin）、摄食抑制因子-1（Nesfatin-1）、3-硝基酪氨酸（3-NT）水平与糖脂代谢和阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的关系。方法：选择2020年4月~2021年9月期间中国人民解放军总医院京南医疗区收治的T2DM患者80例作为研究对象,根据多导睡眠图（PSG）检查结果,合并OSAHS的51例患者列为T2DM合并OSAHS组,剩余的29例纳为T2DM未合并OSAHS组。选择同期来中国人民解放军总医院京南医疗区体检的40例健康志愿者作为对照组。对比T2DM患者、对照组的Irisin、Nesfatin-1、3-NT水平,采用Pearson相关性分析显示Irisin、Nesfatin-1、3-NT与糖脂代谢指标的相关性。T2DM患者发生OSAHS的影响因素采用多因素Logistic回归分析。结果：T2DM合并OSAHS组、T2DM未合并OSAHS组Irisin低于对照组,且T2DM合并OSAHS组低于T2DM未合并OSAHS组（P<0.05）。T2DM合并OSAHS组、T2DM未合并OSAHS组Nesfatin-1、3-NT高于对照组,且T2DM合并OSAHS组高于T2DM未合并OSAHS组（P<0.05）。T2DM合并OSAHS组、T2DM未合并OSAHS组糖化血红蛋白（HbAlc）、空腹血糖（FBG）、餐后2 h血糖（2hPG）高于对照组,且T2DM合并OSAHS组高于T2DM未合并OSAHS组（P<0.05）。T2DM合并OSAHS组、T2DM未合并OSAHS组三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、总胆固醇（TC）较对照组高,高密度脂蛋白胆固醇（HDL-C）低于对照组（P<0.05）。Pearson相关性分析结果显示,Irisin与HbAlc、FBG、2hPG呈负相关,Nesfatin-1、3-NT与HbAlc、FBG、2hPG呈正相关（P<0.05）。T2DM合并OSAHS组、T2DM未合并OSAHS组的年龄、合并高血压、体质量指数、AHI、空腹C肽、合并冠心病对比有差异（P<0.05）。Irisin、Nesfatin-1、3-NT、HbAlc、FBG、2hPG、年龄、合并高血压是T2DM患者发生OSAHS的影响因素（P<0.05）。结论：T2DM合并OSAHS患者的Irisin、Nesfatin-1、3-NT水平表达异常,参与着机体的糖脂代谢过程及OSAHS发生,且OSAHS发生同时还受到HbAlc、FBG、2hPG、年龄、合并高血压的影响,可考虑对上述因素进行早期监测,以进行相关干预。     

慢性肺源性心脏病患者血清白细胞介素-6、降钙素原、D-二聚体、N端B型脑钠肽前体与心功能分级和预后的关系研究

摘要 目的：探讨慢性肺源性心脏病（CCP）患者血清白细胞介素-6（IL-6）、降钙素原（PCT）、D-二聚体（D-D）、N端B型脑钠肽前体（NT-proBNP）与心功能分级和预后的关系。方法：选取2020年1月～2021年5月合肥市第一人民医院全科医学科及呼吸与危重症科收治的170例CCP患者（CCP组）,其中纽约心脏协会（NYHA）心功能分级Ⅱ级49例、Ⅲ级66例、Ⅳ级55例,根据1年后存活状况分为死亡组26例和存活组144例,另选取同期54名体检健康者（对照组）。收集CCP患者临床资料,采用酶联免疫吸附法检测血清IL-6、PCT、D-D、NT-proBNP水平。通过多因素Logistic回归分析CCP患者预后不良的影响因素,受试者工作特征（ROC）曲线分析血清IL-6、PCT、D-D、NT-proBNP水平对CCP患者预后不良的预测价值。结果：与对照组比较,CCP组血清IL-6、PCT、D-D、NT-proBNP水平升高（P＜0.05）。Ⅱ级、Ⅲ级、Ⅳ级CCP患者血清IL-6、PCT、D-D、NT-proBNP水平依次升高（P＜0.05）。单因素分析显示,死亡组NYHA心功能分级Ⅳ级、肺动脉收缩压、Tie指数和血清IL-6、PCT、D-D、NT-proBNP水平高于存活组,第1秒用力呼气容积（FEV₁）占预计值％、FEV₁/用力肺活量（FVC）、三尖瓣环收缩期位移低于存活组（P＜0.05）。多因素Logistic回归分析显示,NYHA心功能分级Ⅳ级和肺动脉收缩压、IL-6、PCT、D-D、NT-proBNP升高为CCP患者预后不良的独立危险因素,FEV1占预计值％升高为独立保护因素（P＜0.05）。ROC曲线分析显示,血清IL-6、PCT、D-D、NT-proBNP水平单独与联合预测CCP患者预后不良的曲线下面积分别为0.789、0.789、0.792、0.801、0.954,灵敏度分别为93.33％、66.67％、66.67％、86.67％、86.67％,特异度分别为46.67％、82.67％、85.33％、66.67％、94.67％。血清IL-6、PCT、D-D、NT-proBNP水平联合预测CCP患者预后不良的AUC大于单项预测（P＜0.05）。结论：CCP患者血清IL-6、PCT、D-D、NT-proBNP水平升高可增加心功能严重程度并导致预后不良,可作为CCP患者预后不良的辅助预测指标,且四项指标联合检测具有更好的预测效能。     

海马与新皮质组织特异性GABRG2基因敲除小鼠模型的构建及其在遗传性癫痫伴热性惊厥附加症中的初步研究 *

建立基于Cre/loxp重组酶系统调控的海马和新皮质特异性GABA_A受体γ2亚基(GABRG2)基因条件基因敲除小鼠模型,为深入研究海马区和新皮质GABRG2在癫痫发生中的功能作用提供动物模型.将引进的GABRG2 ^fl/wt转基因小鼠与海马和新皮质特异性表达Cre ^+/+重组酶工具鼠分别进行繁配和鉴定,然后再将2种小鼠进行杂交并对其子代小鼠的基因型进行鉴定,其子代基因型为GABRG2 ^fl/wtCre ⁺的小鼠为构建的海马区和新皮质特异性GABRG2基因条件性敲除小鼠.利用PCR技术鉴定小鼠基因型,Real-Time PCR和Western blot技术检测GABRG2基因在小鼠海马和新皮质中的mRNA水平和蛋白质水平的表达情况.PCR结果显示子代小鼠基因型符合GABRG2 ^fl/wtCre ⁺;海马与新皮质特异性GABRG2基因敲除小鼠海马和新皮质中GABRG2的mRNA水平和蛋白质水平显著低于对照组;热造模过程中,实验组小鼠癫痫发作更明显.利用Cre/Loxp技术成功构建了海马与新皮质GABRG2基因敲除小鼠,可为进一步研究GABRG2在癫痫发生中的作用机制奠定基础.     

A recurrent KCNT1 mutation in two sporadic cases with malignant migrating partial seizures in infancy

We performed analysis of KCNT1 in two unrelated patients with malignant migrating partial seizures in infancy. Both patients had intractable focal seizures since two months of age. Their seizures were characterized by a shift of epileptic focus during a single seizure and were resistant to most antiepileptic drugs but responded to vagus nerve stimulation in one and clorazepate in the other. Bidirectional sequencing for KCNT1 was analyzed by standard Sanger sequencing method. A de novo c.862G > A (p.Gly288Ser) missense mutation was identified at the pore region of KCNT1 channel in both patients, whereas all KCNT1 mutations in the previous reports were identified mostly in the intracellular C-terminal region. Computational analysis suggested possible changes in the molecular structure and the ion channel property induced by the Gly288Ser mutation. Because the G-to-A transition was located at CG dinucleotide sequences as previously reported for KCNT1 mutations, the recurrent occurrence of de novo KCNT1 mutations indicated the hot spots of these locations.     

Whole mitochondrial DNA variations in hippocampal surgical specimens and blood samples with high-throughput sequencing: A case of mesial temporal lobe epilepsy with hippocampal sclerosis

Introduction

Hippocampal sclerosis is the most common lesion in patients with mesial temporal lobe epilepsy. Recently, there has been growing evidence on the involvement of mitochondria also in sporadic forms of epilepsy. In addition, it has been increasingly argued that mitochondrial dysfunction has an important role in epileptogenesis and seizure generation in temporal lobe epilepsy. Although mtDNA polymorphisms have been identified as potential risk factors for neurological diseases, the link between homoplasmy and heteroplasmy within tissues is not clear. We investigated whether mitochondrial DNA (mtDNA) polymorphisms are involved in a case report of a patient with mesial temporal lobe epilepsy-hippocampal sclerosis (MTLE-HS).

Design

We report the whole genome mtDNA deep sequencing results and clinical features of a 36-year-old woman with MTLE-HS. We used pyrosequencing technology to sequence a whole mitochondrial genome isolated from six different regions of her brain and blood. To assess the possible role of mitochondrial DNA variations in affected tissues, we compared all specimens from different regions of the hippocampus and blood.

Results

In total, 35 homoplasmic and 18 heteroplasmic variations have been detected in 6 different regions of the hippocampus and in blood samples. While the samples did not display any difference in homoplasmic variations, it has been shown that hippocampus regions contain more heteroplasmic variations than blood. The number of heteroplasmic variations was highest in the CA2 region of the brain and accumulated in ND2, ND4 and ND5 genes. Also, dentate and subiculum regions of the hippocampus had similar heteroplasmic variation profiles.

Discussion

We present a new rare example of parallel mutation at 16223 position. Our case suggests that defects in mitochondrial function might be underlying the pathogenesis of seizures in temporal lobe epilepsy.