纵隔淋巴瘤包括霍奇金淋巴瘤和非霍奇金淋巴瘤两大类. 非霍奇金纵隔淋巴瘤肿块巨大,呈浸润性生长,且生长速度快,常伴有胸腔积液,25％～30％患者以肿块压迫引起的上腔静脉综合征为首发症状,临床症状常无特异性. 就诊时往往已出现结外转移,并表现出相应的临床症状. 淋巴瘤常由影像学检查首先发现病灶,后通过穿刺或手术活检、免疫组化等方法,依据其病理特征作出诊断,其治疗以化疗为主,可结合放射治疗. 本例为胸部外伤后就诊的非霍奇金B细胞淋巴瘤心脏转移,其病史及超声表现均具有不确定性,容易漏诊、误诊,后通过 CT及病理确诊. 现对本病例报告如下,以提高超声医师对本病的认识,对诊断此类病例提供参考.
Objective We aimed to construct a lentivirus expression vector carrying human programmed death protein 1 lig-and(PD-L1)and establish a stable Ishikawa cell line overexpressing PD-L1,providing a cell model for studying the bio-logical function mediated by PD-L1 in endometrial cancer.Methods Total RNA was extracted from Ishikawa cells,and the PDL1 CDS region sequence was cloned by RT-PCR.The PDL1 CDS region was then recombined onto a pCDH vector con-taining FLAG tags and purine resistance.After sequencing and identification,293T cells were co-transfected using a sec-ond-generation lentivirus packaging system to obtain the virus and infect Ishikawa cells.Stable transgenic strains were ob-tained through continuous screening with puromycin,and the expression of the target gene was detected by RT-qPCR and Western blot.Results PD-L1 CDS region sequence was successfully recombined into pCDH plasmid vector.After lentivirus packaging and infection,the mRNA and protein expression levels of PD-L1 were significantly up-regulated in Ishikawa.Conclusion This study successfully constructed a PD-L1 overexpressing lentiviral vector and established an Ishikawa stable transgenic strain overexpressing PD-L1 gene,providing a cell model for studying the role of PD-L1 in endometrial cancer.
Objective To construct a joint clinical and ultrasound image-based radiomics combined with deep learning(DL)model and assess its value in predicting the malignant risk of thyroid nodules.Methods A retrospective analysis was conducted on 164 cases with surgically confirmed initial thyroid nodule ultrasound image data,which were divided into training and test sets in a 7 ∶ 3 ratio.Independent risk factors for malignant thyroid nodules were selected through t-tests and χ2 tests and used as clinical features for the risk model.Based on the ultrasound image,the best radiomics features were extracted and screened to construct the radiomics label score(Rad-score),the best DL features were extracted and screened to construct the DL label score(DL-score),and the radiomics-DL model was constructed.Based on clinical risk indicators,Rad-score and DL-score,we tried to use 9 algorithms to build a joint model.Draw the receiver operating char-acteristic(ROC)curve,calculate the area under the curve(AUC),evaluate the predictive efficacy of each model and the accuracy of benign and malignant thyroid nodules,and apply decision curve analysis(DCA)to compare the clinical bene-fits of different models.Results Age,gender,shape of the border,and echo category were identified as independent risk factors for malignant thyroid nodules.DCA showed that the XGBoost joint model had higher clinical benefits than other diag-nostic models.The GBoost joint model performed the best among the nine models,surpassing logistic regression,Naive-Bayes,Support Vector Machine(SVM),K-Nearest Neighbor(KNN),Light Gradient Boosting Machine(LightGBM),Gradient Boosting,AdaBoost,and Multi-Layer Perceptron(MLP)models,with a test set AUC of 0.93.Subsequently,a radiomics chart was established,facilitating accurate judgment of the benign and malignant nature of thyroid nodules.Con-clusion The joint clinical and ultrasound image-based radiomics combined with deep learning model can effectively predict the benign and malignant nature of thyroid nodules.
重症肌无力(myasthenia gravis,MG)是一种由体液免疫和细胞免疫参与,抗体和补体介导的神经肌肉接头(neuromuscular junction,NMJ)处传递功能障碍引起的自身免疫性疾病. MG的典型临床特征是部分或全身骨骼肌无力和易疲劳,并伴有活动后症状加重、休息后缓解的临床表现[1] .
浸润性视神经病变(infiltrative optic neuropathy, ION)是以亚急性或急性视力下降、视神经及其鞘内肿瘤细胞或炎性细胞浸润为特征的视神经病变. 其中白血病浸润性视神经病变较为常见,该病易与视神经炎相混淆,临床上极易误诊、漏诊. 本文报道 1例44 岁女性患者,既往被误诊为视神经炎,经过脑脊液检查后确诊为白血病浸润性视神经病变. 为提高眼科临床医生诊疗水平,整理此次就诊经过,为早期发现白血病浸润性视神经病变提供诊疗指导.
川崎病(Kawasaki disease,KD)又称黏膜皮肤淋巴结综合征,是一种原因不明的炎症性血管炎,是 6个月至 5 岁儿童获得性冠状动脉疾病最常见原因[1] ,该病累及冠状动脉可损害心肌灌注,导致心肌梗死、慢性冠状动脉功能不全,甚至心源性猝死[2] ,院外抢救成功率很低. 在此,我们报道一位儿童期有川崎病病史致青少年期急性心脏骤停进行冠脉搭桥救治成功 1 例,希望借此提高临床医师对这类因川崎病病史致心肌梗死、心脏骤停的认识,以减少漏诊和误诊,同时强调对所有川崎病患者进行跟踪是必要的.
Objective This study analyzed global incidence and predicted the incidence and prevalence trends in the next 15 years.Methods The data source was 2019 GBD database.Relevant data were collected from 1990 to 2019,and the Join-point regression model was used to analyze the average annual percentage change(AAPC).The APC model described the long-term trend of AAPC,and ARIMA model was used to predict changes over the next 15 years.Results In terms of inci-dence,in 2019,the overall population incidence,female population incidence and male population incidence were 350.34/100000,407.91/100000 and 291.19/100000,respectively.AAPC increased by 0.2%,0.3%and 0.2%per year,respec-tively.The data source was 2019 GBD database.Relevant data were collected from 1990 to 2019,and the Joinpoint regres-sion model was used to analyze the average annual percentage change(AAPC).The APC model described the long-term trend of AAPC,and ARIMA model was used to predict changes over the next 15 years.It is predicted that in 2034,the o-verall population incidence rate will reach 384.38 per 100000,the female incidence rate will reach 365.75 per 100000 and the male incidence rate will reach 387 per 100000.In terms of prevalence,in 2019,the overall population prevalence,fe-male population prevalence and male population prevalence were 4375.95/100000,5161.36/100000 and 3510.19/100000,respectively.AAPC increased by 0.2%,0.3%and 0.2%per year,respectively.The age effect showed a trend of first in-creasing and then slowly decreasing,the period effect showed an upward trend,and the cohort effect showed a downward trend.It is predicted that in 2034,the overall population prevalence rate will reach 4722.24/100000,the female population prevalence rate will reach 4909.39/100000 and the male prevalence rate will reach 4499.48/100000.Conclusion KOA is a major public health challenge.The incidence and prevalence rates of the whole population,female population and male pop-ulation all showed a trend of first rising and then declining.The incidence rate and prevalence rate of female were higher than those of male.The incidence of KOA and the population affected by KOA are gradually becoming younger.The peak age of onset is 50 to 60 years old and the peak age of illness is 60 to 75 years old.In the next 15 years,the incidence and prevalence of the overall population and the male population may continue to increase,while the female population may ex-perience a downward trend.
Objective To explore the relationship between proline-rich protein 11(PRR11),spindle and kinetochore-asso-ciated protein 2(SKA2)and the clinicopathology and prognosis of ovarian epithelial malignant tumors.Methods GEPIA database,LinkedOmics database and Kaplan-Meier Plotter database were used to study the expression and prognostic value of PRR11 and SKA2 in ovarian malignant tumors.The expressions of PRR11 and SKA2 in 15 cases of ovarian benign tissue and 50 cases of ovarian epithelial malignant tumor were detected by immunohistochemistry,and analyze the relationship be-tween the two and the clinical pathology of ovarian epithelial malignancy was analyzed.Results GEPIA database analysis results showed that compared with normal ovarian tissue,the expressions of PRR11 and SKA2 in ovarian malignant tumor were significantly increased(P＜0.05),and there was a correlation between them(P＜0.05).The LinkedOmics database a-nalysis showed that the differentially expressed gene(PRR11)was correlated with SKA2 in the ovarian malignant tumor co-hort.Kaplan-Meier Plotter database analysis results showed that the expression of PRR11 and SKA2 was associated with the Overall surviva rate(OS)of patients,and the overall survival rate of patients with high expression of PRR11 or SKA2 was lower than that of patients with low expression of PRR11 or SKA2 in ovarian tumor tissues(P＜0.001).However,the expression of PRR11 was not related to the progression-free survival(PFS)in patients(P＞0.05),while the expression of SKA2 was associated with PFS in patients(P＜0.05).The positive expression rate of PRR11 in ovarian epithelial malignant tumor and ovarian benign tissue was 84.00%(42/50)and 46.00%(7/15),respectively.The positive expression rates of SKA2 in ovarian epithelial malignant tumor and ovarian benign tissue were 92.00%(46/50)and 40.00%(6/15),respec-tively.The positive expression rates of PRR11 and SKA2 in ovarian epithelial malignant tumor were significantly higher than those in ovarian benign tissue,and the difference was statistically significant(P＜0.05).The expression differences of PRR11 and SKA2 in different FIGO stages of serous ovarian malignant tumors were statistically significant(P＜0.05),indi-cating that the high expression of PRR11 and SKA2 may lead to increased malignancy and the ability of invasive metastasis of ovarian serous malignant tumors.There was no statistical significance in expression levels among age,vascular nerve in-filtration and lymphatic metastasis(P＞0.05).Spearman correlation analysis showed that PRR11 and SKA2 were positively correlated in epithelial ovarian tumors(r=0.475,P＜0.05),and were positively correlated in serous tumors and borderline tumors(r=0.516,P＜0.05 in serous tumors;r=0.459,P＜0.05 in borderline tumors).Conclusion PRR11 and SKA2 are highly expressed in ovarian malignant tumors,and their expression levels are correlated with pathological types.The com-bined detection of PRR11 and SKA2 may have certain guiding significance for evaluating the malignancy of malignant tumors derived from ovarian epithelial tumors.
Objective To compare the sedation effects of remimazolam and dexmedetomidine in elderly patients undergoing arthroplasty.Methods 80 elderly patients who underwent joint replacement under combined spinal-epidural anesthesia from December 2021 to May 2022 were selected and randomly divided into 2 groups:remazolam group and dexmedetomidine group,40 cases in each group.All patients underwent combined spinal-epidural anesthesia in the L2～3 or L3～4 space.After the plane stabilized at the T8～10 level,the remimazolam group was given remimazolam 0.2 mg/kg for 1 min,followed by continuous infusion of 0.3 mg/(kg·h).The dexmedetomidine group was given dexmedetomidine 1 μg/kg for 10 min,fol-lowed by continuous pump infusion of 0.3 μg/(kg·h).The patients'sedation was assessed through BIS and observer's as-sessment of alertness/sedation scale(OAAS).The heart rate(HR),blood pressure(Bp),blood oxygen saturation(SpO2),BIS value,OAAS score value,the incidence of intraoperative adverse reactions at 5 minutes(T1),15 minutes(T2),30 minutes(T3),45 minutes(T4),and 60 minutes(T5),and incidence of postoperative delirium within 72 hours were recorded.Results At 5,15,30,45,and 60 min after sedation,the BIS and OAAS scores of both groups decreased significantly(P＜0.05),and the BIS and OAAS scores of the remimazolam group were significantly lower than those of the dexmedetomidine group(P＜0.05).The incidence of low heart rate in the dexmedetomidine group during surgery was signif-icantly higher than that in the remimazolam group(P＜0.05).The MAP of the remimazolam group decreased significantly in the first 30 min compared with the dexmedetomidine group,and gradually tended to be stable,while the MAP of the dexmedetomidine group showed an increasing trend at 5 and 15 min and then gradually decreased.There was no statistically significant difference in the incidence of intraoperative adverse reactions.Conclusion Remazolam can be safely used for se-dation in elderly patients undergoing joint replacement surgery under spinal anesthesia.Compared with dexmedetomidine,remazolam has the advantages of fast onset,good sedative effect and lower complications.
Objective To systematically evaluate the efficacy and safety of the panretinal photocoagulation(PRP)combined with ranibizumab(IVR)in the treatment of proliferative diabetic retinopathy(PDR).Methods Randomized controlled trials(RCTs)of the combination of PRP and ranibizumab in the treatment of PDR were searched in American Science Citation Index Database(SCI),PubMed,Embase,Cochrane Library,CBM,Wanfang Database and CNKI database.The retrieval time was from database establishment to March 15th,2023.Meta-analysis was performed with Review Manager 5.4 and Stata17.0 software.Results 17 articles were finally included,with a total of 1360 eyes.The study found that the best cor-rected visual acuity(BCVA)after PRP combined with IVR injection treatment was significantly better than that of PRP a-lone(P＜0.0001),and the central macular thickness(CMT)was significantly reduced(P＜0.01).PRP surgery combined with IVR significantly improved postoperative clinical efficiency and reduced the occurrence of postoperative adverse reac-tions.Conclusion Compared with laser alone,PRP combined with ranibizumab in the treatment of PDR has more advanta-ges in reducing CMT and improving BCVA.It can improve the patient's vision and significantly reduce the incidence of ad-verse reactions,with relatively higher safety.
天然三萜类抗肿瘤药物熊果酸(ursolic acid, UA),又名乌苏酸,其广泛存在于木犀科植物女贞叶、杜鹃科植物熊果、唇形科夏枯草的全草、中药山楂、山茱萸等植物中[1] . 现已证实其具有抗炎、抗氧化、抗肿瘤等多种生物学效应[1-3] . 尤其,UA 可以抑制多种癌细胞生长,可通过诱导其凋亡,抗肿瘤血管生成,提高化疗药物敏感性,调节肿瘤微环境等机制发挥抗癌作用[4-9] .
急性心肌梗死( acute myocardial infarction, AMI)是冠状动脉急性、持续性缺血缺氧所引起的心肌坏死,AMI发病突然且病情危急,严重威胁着人类健康[1] . 近年来AMI发病呈现年轻化趋势且发病率逐年上升[2] . 目前AMI最佳治疗方法是早期再灌注治疗,包括经静脉溶栓和经皮冠状动脉介入术,这种治疗方法具有严格的时间依赖性[3] .
Objective To investigate the mechanism of Polygonum cuspidatum extract on proliferation and migration of cervi-cal cancer Hela cells.Methods Cell Counting Kit-8(CCK-8),adenosine 5'-triphosphate(ATP)and lactate dehydro-genase(LDH)assay kits were used to evaluate the influence of Polygonum cuspidatum extract on the proliferation of Hela cells.The scratch assay was performed to assess the effect of Polygonum cuspidatum extract on the horizontal migration abil-ity of Hela cells.Flow cytometry was employed to detect the impact of Polygonum cuspidatum extract on apoptosis of Hela cells.Western blotting was conducted to analyze the expression levels of caspase 1/3/8/9,poly ADP-ribose polymerase(PARP)and Gasdermin E(GSDME)proteins in Hela cells treated with Polygonum cuspidatum extract.Results The crude extract of Polygonum cuspidatum inhibited the proliferation of Hela cells,significantly inhibited their migration abili-ty,induced Hela cell apoptosis,and significantly increased the expression levels of apoptosis related proteins such as cleaved caspase3/8/9 and PARP in Hela cells.Conclusion Polygonum cuspidatum extract can effectively inhibit the prolif-eration and migration of Hela cells,possibly through inducing apoptosis and causing mitochondrial dysfunction.
Objective To observe the ultrasound characteristics of core muscle groups in patients with chronic low back pain with movement coordination impairments by using musculoskeletal ultrasound,and to analyze the correlation between ultra-sound indicators and low back pain,so as to provide the basis for the development of rehabilitation programs for chronic low back pain with movement coordination disorders.Methods 31 patients with chronic low back pain and movement coordina-tion disorders were selected as the case group,and 31 patients without chronic low back pain who matched the case group were selected as the healthy control group.Musculoskeletal ultrasound was used to measure diaphragm activity,diaphragm thickness,transverse abdominal muscle thickness and multifidus muscle thickness in all subjects.Logistic regression was used to analyze the correlation between the ultrasound detection indexes of core muscle groups in the case group and whether they had low back pain.Results Compared with the healthy control group,the diaphragm mobility,diaphragm thickness,transverse abdominis muscle thickness,and multifidus muscle thickness were significantly reduced in the case group(P＜0.05).In the case group,the greater the diaphragm motion,the thickness of the diaphragm,the thickness of the transverse abdominis muscle,and the thickness of the multifidus muscle,the lower the risk of developing low back pain(P＜0.05).Conclusion Patients with chronic low back pain and movement coordination disorders have lower diaphragm activity,dia-phragm thickness,transverse abdominis muscle thickness and multifidus muscle thickness than healthy people,and the ul-trasonic characteristics of core muscle groups are related to the occurrence of low back pain.Therefore,when formulating clinical rehabilitation programs,attention should be paid to strengthening training for core muscles.
Objective To detect the effect of anti-tumor drugs in osteosarcoma U2OS cells under low oxygen concentration,so as to explore the impact of hypoxic microenvironment on the chemotherapy resistance of osteosarcoma U2OS cells.Meth-ods U2OS osteosarcoma cells were cultured through in vitro experiments,and cells were treated with different concentra-tions of low oxygen inducer CoCl2 for 24 hours.The proliferation of cells in each group was detected by CCK-8,and the op-timal concentration of CoCl2 intervention was established.After adding different concentrations of cisplatin,the proliferation of osteosarcoma cells in each group was detected using CCK-8,and the proportion of cell apoptosis in each group was de-tected by flow cytometry.Results When osteosarcoma U2OS cells were in hypoxic environment,their proliferation ability was enhanced,and there was a significant difference compared with the control group(P＜0.05).CCK-8 results showed that when the cells were in hypoxic environment,antitumor drugs could inhibit the proliferation of osteosarcoma U2OS cells in a dose-dependent manner.Flow cytometry results showed that the apoptosis rate of osteosarcoma U2OS cells after cispla-tin treatment was positively correlated with the drug concentration(P＜0.05).Conclusion Osteosarcoma U2OS cells have stronger proliferative ability under hypoxic conditions and antagonize antitumor drug-mediated the proliferation inhibition and apoptotic promotion,thereby enhancing chemotherapy resistance.
腹内疝是指腹腔内的脏器(多为小肠),通过腹腔内正常或异常孔道进入其他位置,引起腹痛、肠梗阻等临床症状[1] . 胆总管囊肿切除,胆管空肠Roux-en-Y吻合术后出现腹内疝症状,比较罕见[2] . 腹内疝临床症状多不典型,缺乏特异性,容易漏诊误诊[3] . 原则上一经确诊,需要及时手术治疗,否则会有肠管绞窄坏死风险,危及生命[2,4] . 现将我科收治的一例胆总管囊肿术后横结肠系膜裂孔疝患者病例报道如下.
重症脑卒中是导致患者神经功能重度受损,出现呼吸、循环等多系统功能严重障碍的脑血管疾病,具有高发病率、高致残率、高病死率、高复发率、高经济负担五大特点[1] ,其治疗周期长、预后差. 近年来,脑卒中发病年龄呈现逐渐年轻化的趋势[2] .
Objective To observe the effect of Radial Extracorporeal Shock Wave Therapy(rESWT)combined with proprio-ceptive neuromuscular facilitation(PNF)in the treatment of ankle joint dysfunction in stroke patients.Methods Fifty-four eligible post-stroke patients with ankle dysfunction were studied and divided into three groups.The conventional treatment group received antispasmodic medication every day,the rESWT treatment group added rESWT on the basis of the conven-tional group and received treatment once a week,and the combined treatment group added PNF treatment five times a week on the basis of the rESWT treatment group.The entire treatment process lasted for 4 weeks.Before and after the first week of treatment,evaluation was conducted using visual analogue scale(VAS),range of motion(ROM),and modified Ash-worth scale(MAS)on the 1st,4th and 7th week.Results The VAS,MAS,and ROM scores of patients in the rESWT combined with PNF treatment group were significantly improved compared with the conventional group.Compared with the rESWT group alone,the long-term effect was better and the functional improvement lasted longer.Conclusion The combi-nation of rESWT and PNF has a significantly better therapeutic effect than conventional treatment,significantly improving ankle pain,muscle tone,joint range of motion,and motor function in patients.It can be used to improve ankle dysfunction after stroke.
Objective To establish a LC-MS/MS method and a HPLC method for qualitative analysis and determination of(R,S)-Goitrin,puerarin,calycosin-7-O-β-D-glucosid,prim-O-glucosylcimifugin,forsythoside A,5-O-Methyl-visamminol in Fangwen Jiuwei Decoction.Methods Qualitative analysis was performed using LC-MS/MS(equipped with ESI ion source)method to confirm the six active components.Content determination was performed using HPLC method with Agilent Zorbax SB C18(150 mm×4.6 mm,5 μm)column.The mobile phase was 0.2%phosphoric acid aqueous solu-tion and methanol solution.The detection was set as 254 nm,the flow rate was 1 mL/min and the column temperature was 30℃.Results The mass spectrograms of six active components in Fangwen Jiuwei Decoction were consistent with the refer-ence solution.The six components had good linear relationships in their respective concentration ranges.The average recov-eries were 99.54%～104.99%,and RSD values were 1.24%～3.66%.Conclusion The established method is simple and rapid with the good reproducibility and high sensitivity.The results can provide scientific reference for the quality control system of Fangwen Jiuwei Decoction and the development of hospital preparations.
下肢缺血性疾病(lower extremity ischemic dis-ease,LI)是指因动脉狭窄或闭塞而导致的相应供血区域缺血、缺氧引起的间歇性跛行、静息痛、溃疡及坏疽[1] . 近年来,随着我国人口老龄化的加剧和社会的发展,这类疾病的发病率越来越高,是最严重的外周动脉疾病(peripheral arterial diseases, PAD).根据统计数据,60 岁以上人群中 PAD 发病率为19. 8％[2],而进一步发展为严重的 LI 的大概有10％[3],其中许多人由于年龄、合并症等因素无法通过传统治疗手段(包括药物、介入手术等)获得有效的治疗,因此基因治疗成为一种新的思路[4] .
