Background Thyroid cancer-related deaths mostly result from metastasis. It was reported that the immunometabolism associated enzyme interleukin-4-induced-1 (IL4I1) was related to tumor metastasis. The present study was intended to investigate the effects of IL4I1 on thyroid cancer metastasis and its relationship with the prognosis. Methods Data from Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) were analyzed to find out the different mRNA expressions of IL4I1 between thyroid cancer and normal tissues. And Human Protein Atlas (HPA) was used to assess IL4I1 protein expression. To further differentiate thyroid cancer from normal tissues and estimate the impact of IL4I1 on the prognosis, the receiver operating characteristic curve (ROC) and Kaplan–Meier (KM) method was performed. The protein–protein interaction (PPI) network was established using STRING, and functional enrichment analyses were conducted by “clusterProfiler” package. Then, we assayed the correlation between IL4I1 and some related molecules. The relationship between IL4I1 and immune infiltration was performed using “Gene Set Variation Analysis (GSVA)” package in TCGA and tumor-immune system interaction database (TISIDB). Finally, we did in vitro experiments in order to further prove the bioeffects of IL4I1 on metastasis. Results The expression of IL4I1 mRNA and IL4I1 protein was significantly upregulated in thyroid cancer tissues. The increment of IL4I1 mRNA expression was related to high-grade malignancy, lymph node metastases and extrathyroidal extension. The ROC curve displayed the cutoff value of 0.782, with the sensitivity of 77.5% and the specificity of 77.8%. KM survival analysis showed that there was a worse PFS in patients with high IL4I1 expression than those with low IL4I1 expression ( p = 0.013). Further study indicated that IL4I1 was associated with lactate, body fluid secretion, positive regulation of T cell differentiation, and cellular response to nutrients in Gene Ontology (GO) analysis. Moreover, IL4I1 was found correlated with immune infiltration. Finally, the in vitro experiments revealed the promotion of IL4I1 on cancer cell proliferation, migration and invasion. Conclusions The increased IL4I1 expression is markedly correlated with the immune imbalance in the tumor microenvironment (TME) and predicts poor survival in thyroid cancer. This study reveals the potential clinical biomarker of poor prognosis and the target of immune therapy in thyroid cancer.

Background Systematic review and meta-analysis of the association between sarcopenia and the development of myocardial infarction.Methods PubMed, Cochrane Library, and Embase were searched for studies on the association between sarcopenia and myocardial infarction from their inception until November 26, 2022. The fixed-effects model was used to calculate the combined risk ratio (RR) of sarcopenia in patients with myocardial infarction. Sensitivity analysis was used to test the robust of the combined result, and funnel plot were used to test publication bias.Results Five studies were included finally. There was no significant association between sarcopenia and risk of developing myocardial infarction [RR = 1.01; 95% CI = 0.94, 1.08; P = 0.317]. The sensitivity analysis showed robust of the combined result. The funnel plot showed no significant publication bias.Conclusion Limited evidence suggests no definitive association between sarcopenia and risk of myocardial infarction.

Circular RNA (circRNA) has been shown to participate in various tumors, including lung cancer. In the present study, we explored the expression and functional relevance of hsa_circ_0003288 in human non-small cell lung cancer (NSCLC). We verified that hsa_circ_0003288 expression was upregulated in lung cancer tissues and cell lines. Overexpression of hsa_circ_0003288 dramatically promoted lung cancer cell proliferation, colony formation, inhibited apoptosis, and increased cell migration and invasion in vitro. Xenograft experiments showed that hsa_circ_0003288 overexpression accelerated tumor growth in vivo. Mechanistically, hsa_circ_0003288 negatively regulated miR-145 to exert the oncogenic role in lung cancer. Overexpression of miR-145 decreased cell proliferation, induced apoptosis, and suppressed migration and invasion in lung cancer. Additionally, miR-145 co-transfection abolished the oncogenic role of hsa_circ_0003288. Collectively, these findings identified a novel regulatory role of hsa_circ_0003288/miR-145 axis in the progression of NSCLC.

目的:分析老年急性肺栓塞(acute pulmonary embolism,APE)患者的临床特征.方法:收集2018年1月1日至2020年12月31日上海交通大学医学院附属瑞金医院收治的APE患者临床资料,根据年龄分为老年组(≥60岁)142例和非老年组(<60岁)65例,老年组再分成老年男性组和老年女性组.比较分析老年组与非老年组、老年男性组与老年女性组患者的临床特征.结果:老年组和非老年组APE最常见危险因素均为深静脉血栓,老年组合并高血压、糖尿病、冠心病、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)、心房颤动比例高于非老年组(均P<0.05),合并高血压的老年患者发生APE的风险是非老年组的3.281倍.老年组及非老年组最常见的临床症状均为胸闷,老年组气促比例高于非老年组(P<0.05).老年组D-二聚体阳性率、平均血小板体积值、肺动脉压力、肌钙蛋白I、B型脑钠肽值高于非老年组(P<0.05).老年女性组近期手术或制动史17例(23.6％),显著高于老年男性组(4.3％)(P=0.001).结论:老年APE患者常合并多种基础心肺疾病,临床表现不典型、诊断困难,需识别老年患者易患肺栓塞的高危因素,密切关注临床表现并联合多种检查,综合评估,以提高对老年APE患者诊断的准确性.

As the global median population age increases, neurological diseases associated with aging pose significant challenges to human health. Appropriate modeling systems can be useful tools to better understand the mechanism of age-related neuronal degeneration diseases. Here, we successfully generated an iPSC-derived modeling system of an 82-year-old healthy man, this newly established line showed that all pluripotent markers were expressed, and the differentiation potential was confirmed by trilineage differentiation. STR profiling proved the cell line identity, and G-binding showed the normal karyotype.

Although clinical data suggest remarkable promise for targeting programmed cell death protein-1 (PD-1) and ligand (PD-L1) signaling in non-small-cell lung cancer (NSCLC), it is still largely undetermined which subtype of patients will be responsive to checkpoint blockade. In the present study, we explored whether PD-L1 was regulated by mutant Kirsten rat sarcoma viral oncogene homolog (KRAS), which is frequently mutated in NSCLC and results in poor prognosis and low survival rates. We verified that PD-L1 levels were dramatically increased in KRAS mutant cell lines, particularly in NCI-H441 cells with KRAS G12V mutation. Overexpression of KRAS G12V remarkably elevated PD-L1 messenger RNA and protein levels, while suppression of KRAS G12V led to decreased PD-L1 levels in NCI-H441 cells. Consistently, higher levels of PD-L1 were observed in KRAS-mutated tissues as well as tumor tissues-derived CD4+ and CD8+ T cells using a tumor xenograft in B-NDG mice. Mechanically, both in vitro and in vivo assays found that KRAS G12V upregulated PD-L1 via regulating the progression of epithelial-to-mesenchymal transition (EMT). Moreover, pembrolizumab activated the antitumor activity and decreased tumor growth with KRAS G12V mutated NSCLC. This study demonstrates that KRAS G12V mutation could induce PD-L1 expression and promote immune escape via transforming growth factor-β/EMT signaling pathway in KRAS-mutant NSCLC, providing a potential therapeutic approach for NSCLC harboring KRAS mutations.

目的·分析老年呼吸道病毒感染病例的临床特征以及影响临床结局的可能因素.方法·共入组上海交通大学医学院附属瑞金医院老年病科确诊为呼吸道病毒感染的119例住院患者(年龄≥65岁),分析患者的临床症状、实验室检查结果、治疗经过及转归,并比较治愈患者与死亡患者的各项指标.结果·入选患者平均年龄(85.61±7.67)岁,男性98例,女性21例;死亡病例12例.其中,流行性感冒病毒A型感染患者最多(41例).与治愈患者比较,死亡患者年龄更大,合并细菌感染、胸部CT出现双肺炎症的比例更高(均P<0.05);在入院时实验室检查中,治愈患者与死亡患者的白细胞、中性粒细胞、红细胞计数,血红蛋白、白蛋白、尿素、肌酐水平,及估算肾小球滤过率比较,差异均有统计学意义(均P<0.05).结论·年龄偏大,白细胞计数、中性粒细胞计数偏高,血红蛋白、白蛋白水平偏低,肾功能不全,合并有细菌感染可能是老年呼吸道病毒感染患者死亡的影响因素.

目的·探究不同Kirsten大鼠肉瘤病毒癌基因(Kirsten rat sarcoma viral oncogene,KRAS)突变型非小细胞肺癌(non-small cell lung cancer,NSCLC)患者肿瘤组织及细胞系与程序性死亡蛋白配体1(programmed cell death ligand 1,PD-L1)表达的关系及其可能的调控机制.方法·通过实时荧光定量PCR和荧光活化细胞分选法,在NSCLC细胞系中验证PD-L1mRNA和蛋白的表达与KRAS突变状态的关系.通过免疫组织化学法检测77例早期(Ⅰa～Ⅱb期)NSCLC患者肿瘤组织中PD-L1的表达情况.通过Western blotting研究KRAS突变对RAS下游信号通路分子蛋白激酶B(protein kinase B,PKB,又称为AKT)、哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)、核糖体 S6蛋白激酶(ribosomal S6 protein kinase,p70S6K)、细胞外调节蛋白激酶(extracellular regulated protein kinase,ERK)的影响.用 RAF抑制剂达拉非尼、有丝分裂原活化蛋白激酶(mitogen activated-protein kinase,MEK)抑制剂司美替尼、磷脂酰肌醇3-激酶抑制剂GDC0941、AKT抑制剂MK2206和mTOR抑制剂雷帕霉素分别处理6个KRAS突变NSCLC细胞株,检测这5种酪氨酸激酶抑制剂对PD-L1表达的调控作用.结果·在NSCLC细胞系中,KRAS突变细胞系的PD-L1 mRNA和蛋白的表达水平均显著高于KRAS野生型细胞系(均P＜0.05),且KRAS G12V细胞系PD-L1的mRNA表达水平最高,KRASG12C细胞系PD-L1的蛋白表达水平最高.对于早期NSCLC患者,PD-L1在KRASG12V和G12D突变型患者肿瘤组织中高表达的比例显著高于KRAS野生型.Western blotting结果显示,KRAS突变NSCLC细胞系中,p70S6K被激活,而ERK、AKT、mTOR未被激活.进一步研究发现,1 μmol/LGDC0941、0.5μmol/L MK2206和10 nmol/L雷帕霉素均未对6个KRAS突变NSCLC细胞株的PD-L1表达产生影响,5nmol/L达拉非尼仅在1个KRASG12V突变株和1个KRASL19F突变株引起PD-L1表达上调(均P＜0.05),而0.1 μmol/L司美替尼在3个KRASG12V突变株和1个KRASL19F突变株引起PD-L1表达下调(均P＜0.05),且呈一定剂量依赖性.结论·KRAS突变,尤其是G12V突变型的NSCLC细胞或组织的PD-L1表达水平明显高于KRAS野生型;司美替尼可下调KRAS G12V突变型NSCLC细胞的PD-L1水平,推测KRAS G12V突变的NSCLC细胞可能通过上调MEK上调PD-L1的表达.

Background The development of sarcopenia is attributed to normal aging and factors like type 2 diabetes, obesity, inactivity, reduced testosterone levels, and malnutrition, which are factors of poor prognosis in patients with coronary artery disease (CAD). This study aimed to perform a meta-analysis to assess whether preoperative sarcopenia can be used to predict the outcomes after cardiac surgery in elderly patients with CAD. Methods PubMed, Embase, the Cochrane library, and Web of Science were searched for available papers published up to December 2020. The primary outcome was major adverse cardiovascular outcomes (MACE). The secondary outcomes were mortality and heart failure (HF)-related hospitalization. The random-effects model was used. Hazard ratios (HRs) with 95% confidence intervals (95%CIs) were estimated. Results Ten studies were included, with 3707 patients followed for 6 months to 4.5 ± 2.3 years. The sarcopenia population had a higher rate of MACE compared to the non-sarcopenia population (HR = 2.27, 95%CI: 1.58–3.27, P < 0.001; I 2 = 60.0%, P heterogeneity = 0.02). The association between sarcopenia and MACE was significant when using the psoas muscle area index (PMI) to define sarcopenia (HR = 2.86, 95%CI: 1.84–4.46, P < 0.001; I 2 = 0%, P heterogeneity = 0.604). Sarcopenia was not associated with higher late mortality (HR = 2.15, 95%CI: 0.89–5.22, P = 0.090; I 2 = 91.0%, P heterogeneity < 0.001), all-cause mortality (HR = 1.35, 95%CI: 0.14–12.84, P = 0.792; I 2 = 90.5%, P heterogeneity = 0.001), and death, HF-related hospitalization (HR = 1.37, 95%CI: 0.59–3.16, P = 0.459; I 2 = 62.0%, P heterogeneity = 0.105). The sensitivity analysis revealed no outlying study in the analysis of the association between sarcopenia and MACE after coronary intervention. Conclusion Sarcopenia is associated with poor MACE outcomes in patients with CAD. The results could help determine subpopulations of patients needing special monitoring after CAD surgery. The present study included several kinds of participants; although non-heterogeneity was found, interpretation should be cautious.

Background: Sarcopenia and handgrip strength have been observed and correlated in association with hypertension among the old-age people. However, the results reported in different studies were inconsistent. In the current study, we conducted a systematic review and meta-analysis to reveal the significant association between sarcopenia, handgrip strength, and hypertension in older adults. Methods: PubMed, MEDLINE, Cochrane Library, and EMBASE databases were searched from inception to 15 November, 2019 to retrieve the original research studies that addressed the association between sarcopenia, handgrip strength, and hypertension. All the relevant data were retrieved, analyzed, and summarized. Results: 19 studies met the inclusion criteria and a total of 21301 participants were included in the meta-analysis. Eight eligible studies have reported the odd ratios (ORs) of hypertension and the ORs ranged from 0.41 to 4.38. When pooled the ORs together, the summarized ORs was 1.29 [95% confidence interval (CI) =1.00-1.67]. The summarized ORs for the Asian group 1.50 (95% CI=1.35-1.67) was significantly higher than that of Caucasian group 1.08 (95% CI=0.39-2.97). Eleven studies have provided the data on association between handgrip strength and hypertension. The overall ORs and 95% CI was 0.99 (95% CI=0.80-1.23), showing no significant association. Conclusion: Sarcopenia was associated with hypertension, but no correlation was found between handgrip strength and hypertension in older adults.

目的:分析Ⅰ期心肺康复对冠状动脉旁路移植(coronary artery bypass grafting,CABG)术后患者心功能、肺功能、运动能力以及生活质量的改善效果.方法:选取2016年1月1日至2017年12月31日于我院心脏外科行CABG术的患者300例,按随机数字表法分为康复组和对照组各150例.对照组行心脏外科常规治疗,康复组在对照组治疗基础上进行为期2周Ⅰ期(入院第1～14天)心肺康复.比较2组患者干预前后心功能、6 min步行距离(6 minutes walk distance,6MWD)、健康调查简表(MOS 36-item short from health survey,SF-36)得分情况及术后低氧血症、肺部感染等肺部并发症发生率、住院天数等指标差异.结果:干预后,2组患者在每搏输出量(stroke volume,SV)、左心室射血分数(left ventricle ejection fraction,LVEF)、左心室舒张末期容积(left ventricular end-diastolic vol-ume,LVEDV)、6MWD、肺部感染及低氧血症发生率、SF-36中生理机能(physical functioning,PF)、情感职能(role emotional,RE)、一般健康状况(general health,GH)3个维度的得分康复组优于对照组(均P<0.05).总住院及胸引流管引流天数康复组较对照组短(均P<0.05).结论:Ⅰ期心肺康复不但提高患者心脏泵血能力及运动耐力,缩短总住院及胸引管引流天数、降低术后肺部感染及低氧血症等呼吸系统并发症发生率,还可降低焦虑及抑郁等负面情绪,改善生活质量.

Background Both sarcopenia and handgrip strength have been observed association with hypertension. However, the results in different studies were inconsistent. In the current study, we conducted a systematic review and meta-analysis to reveal the association between sarcopenia, handgrip strength, and hypertension in older adults. Methods PubMed, MEDLINE, Cochrane Library, and EMBASE databases were searched from inception to 15 November, 2019for original research studies. The studies that addressed the association between sarcopenia, handgrip strength, and hypertension were included and summarized. Results 19 studies met the inclusion criteria and a total of 21301 were included in the meta-analysis. Eight eligible studiesreported the odd ratios (ORs) of hypertension and the ORs ranged from 0.41 to 4.38. When pooled the ORs together, the summarized ORs was 1.29 [95% confidence interval (CI) =1.00-1.67]. The summarized ORs for the Asian group 1.50 (95% CI=1.35-1.67) was significantly higher than that of Caucasian group 1.08 (95% CI=0.39-2.97). Eleven studies provided the data on association between handgrip strength and hypertension. The overall ORs and 95% CI was 0.99 (95% CI=0.80-1.23), showing no association. Conclusion Sarcopenia was associated with hypertension but no correlation was found between handgrip strength and hypertension in older adults.

Background Surgery remains the mainstay of colorectal cancer (CRC) and substantially reduces cancer-related morbidity and mortality. Preoperative assessment for frailty in geriatric patients is critically important in risk stratification and clinical decision-making. In this systematic review and meta-analysis, we aimed to quantitatively summarise the effect of frailty on postoperative outcomes in geriatric patients receiving surgery for CRC. Methods A systematic literature search was conducted in MEDLINE, Cochrane and EMBASE from inception to 30 April 2020. Fully published articles reporting risk estimate(s) of frailty on postoperative complication(s), readmission and/ or mortality in patients aged ≥65 years who received surgery for CRC were eligible for qualitative and quantitative analyses. Results Across 10 articles of 9 unique studies (n = 69332) that were eventually included in the systematic review and meta-analysis, overall prevalence of frailty was 23.0% (95% CI: 11–43%, I 2 = 100%). Odds ratios (ORs) on overall and severe postoperative complications were respectively increased by 2.36- (95% CI: 1.66–3.35, P <0.01; I 2 = 12%) and 2.35-fold (95% CI: 1.30–4.27, P <0.01; I 2 = 72%) in frail patients compared to non-frail counterparts. On pooled analysis, frailty was significantly associated with an increased risk of postoperative readmission (OR:1.91; 95% CI: 1.35–2.70, P <0.01; I 2 = 6%). Whilst a significantly higher risk of frailty on mortality during 12 months after CRC surgery was observed (OR: 5.52; 95% CI:4.40–6.92, P <0.01; I 2 = 89%), the summary OR on 30-day/ inpatient mortality crossed the null line (OR: 1.65; 95% CI: 0.56–4.93, P = 0.37; I 2 = 55%). Funnel plot and Duval-Tweedie’s trim and fill test did not reveal significant publication bias. Conclusions In the studies reviewed, frailty appeared to be associated with increased risks for postoperative complications, readmission and mortality during 12 months in patients aged ≥65 years who received surgery for CRC. Nevertheless, no significant association between frailty and 30-day/ inpatient postoperative mortality was observed.

Lung adenocarcinoma (LUAD) is the most common histologic subtype of lung cancer. Previous research has shown heterogeneity in lung cancer, with the parallel existence of multiple subclones characterized by their own specific mutational landscape. The aim of our study was to gain insight into the evolutionary pattern of lung cancer by investigating the genomic heterogeneity between a nodule and its distant tumor. Luckily, we obtained nodule and tumor samples derived from surgery and a blood sample from a single patient. The samples are very unique, for tissues with the same genetic background from nodules to malignant tumors are rarely available and require precise micro-cutting. In this study, we performed whole-genome sequencing of these two samples, to identify novel candidate driver genes associated with LUAD. The nodule and tumor were found to have common significant ubiquitin-specific protease 40 (USP40) mutations, indicating an important driver role for the gene. Moreover, we also observed the two novel candidate driver genes ASCL5 and CAPNS1 in the LUAD sample. In summary, we pin-point the predominant mutations in LUAD by WES, highlighting the substantial genetic alterations contributing to LUAD tumorigenesis. This may provide a better understanding of the clonal evolution during tumor development.

全球癌症数据分析表明,2012年肺癌约占所有新发癌症的13％,是导致癌症死亡的主要原因[1].受当前检查方式、体检意识、医疗资源分配等因素影响,多数肺癌患者确诊时已为晚期,失去了最佳的治疗时机,5年生存率仅为19.7％[2].2015年,精准医疗的概念被首次提出,指应用现代生物信息及遗传技术结合患者生活环境及临床数据等,实现精准的疾病诊断,并制定个性化的预防和诊疗方案.随着影像技术的创新及人工智能的发展,影像组学(radiomics)和影像基因组学(radiogenomics)应运而生,以此分析肿瘤影像学特征与分子表型之间的关系,增加了临床诊断客观性,对指导个体化治疗和预后评价具有重大意义.影像组学是通过借助计算机软件高通量地从医学影像(CT、MRI、PET等)中提取定量特征,然后利用统计学和(或)计算机学习的方法,筛选出最有价值的影像学特征,来协助临床疾病诊治的影像分析方法[3].影像基因组学则是将基因组学与多种成像特征(如大小、体积、纹理特征等)联系起来,用于分析肿瘤影像学特征与分子表型之间关系的影像分析方法[4].有多项研究证实了影像基因组学在指导脑胶质瘤等疾病诊疗中应用的可行性,而本文将就影像组学与影像基因组学在肺癌诊疗中的应用作一综述.

目的 旨在探讨晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)IV期患者肿瘤微环境的临床常见血液检测指标,建立新的特异性较高的预后参数.方法 收集基线特征包括年龄、性别、吸烟史、PS评分、病变位置、临床TNM期、器官转移数量以及病理类型.研究对象分为回顾性及前瞻性研究组,前者用于建立预测预后的模型并内部验证,后者用于外部验证.将1年后生存状况作为研究终点.采用卡方检验分析死亡率在不同临床病理特征和血液指标的分布,并探讨该研究建立的新指标与器官转移之间关系.回顾性研究患者变量Cox回归分析用于建立临床预后模型.结果 本研究建立的预后模型较TNM分期有较高的预后精准度.NLDA(嗜中性粒细胞计数/淋巴细胞计数×D二聚体计数/白蛋白)与器官转移显著相关,其抗肿瘤治疗前的水平可能是一种方便经济的特异性较高的预测预后的指标.结论 本研究建立肿瘤微环境预后模型,发现NLDA是一种新的临床预后的预测指标.

目的:探讨血高半胱氨酸(homocysteine,Hcy)水平与老年人肾功能的相关性.方法:收集我院老年病科体检者831例,采用酶联免疫法测定其血Hcy水平.采用慢性肾脏病流行病学合作研究公式(CKD-EPI)及肾脏病饮食改良公式(MDRD)计算估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)评估入选者肾功能.将eGFR＜60 mL/(min· 1.73m2)定义为肾功能中重度受损,Hcy≥10,μmol/L定义为高Hcy血症.结果:①肾功能中重度受损者血Hcy水平明显高于肾功能正常或轻度受损者(P＜0.05).②中重度肾功能受损者比例在高Hcy组明显升高(P＜0.05).③相关分析及偏相关分析均提示血Hcy水平与eGFR呈负相关.④Logistic回归分析提示高Hcy水平是老年人慢性肾功能受损的危险因素.结论:高Hcy血症与老年人慢性肾功能不全受损程度相关.

肺癌位居我国肿瘤发病率的第一位,其中非小细胞肺癌(non-small-cell lung cancer,NSCLC)占肺癌的85％.多数肺癌患者确诊时即为晚期,预后差.据统计,有近15％的NSCLC患者发现病变时仍处于早中期,但其5年生存率却仅略高于晚期患者[1],重要原因之一就是初始治疗后的高复发率.2006年一项纳入了840例患者的临床试验证明,使用化疗(VP方案)作为辅助治疗能够使早、中期NSCLC患者的7年生存率整体提高8.6％[2].近年来,针对NSCLC的新药层出不穷,包括靶向药物和免疫药物 有研究发现,携带有表皮生长因子受体(epidermal growth factor receptor,EGFR)基因敏感突变的患者,术后使用靶向药物作为辅助治疗,其无病生存时间较辅助化疗组明显延长,且其不良反应发生率显著低于辅助化疗组[3].

目的·评估阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnoea hypoxia syndrome,OSAHS)合并非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者血清脂肪代谢相关激素水平及其潜在作用.方法·选取因鼾症就诊患者,根据多导睡眠图监测及NAFLD筛查分为OSAHS+NAFLD组、OSAHS组、NAFLD组和对照组,比较血清脂肪代谢相关激素等指标;将OSAHS患者分别依据呼吸暂停低通气指数(apnea hypopnea index,AHi)和夜间最低动脉血氧饱和度(minimum arterial oxygen saturation,MinSaO2)分为轻度、中度、重度3组,比较NAFLD发生情况;采用多元回归分析明确NAFLD发病的独立预测因素.结果·OSAHS组、NAFLD组及OSAHS+NAFLD组的AHI、MinSaO2、动脉血氧饱和度＜90％的时间百分比(TSaO2＜90％)、体质量指数、脂联素、瘦素、高敏C反应蛋白及脂多糖与对照组比较,差异均有统计学意义(均P＜0.05);不同程度OSAHS患者的NAFLD发生率(17.0％、51.6％和97.2％)比较,差异有统计学意义(P=0.006);不同程度MinSaO2的OSAHS患者NAFLD发生率(18.2％、57.1％和91.9％)比较,差异也有统计学意义(P=0.011).多元回归分析显示体质量指数、AHI、脂联素为NAFLD发病的独立预测因素(P=0.006,P=0.020,P=0.008).结论·随着OSAHS严重程度增大,NAFLD发病率逐渐升高;OSAHS合并NAFLD患者血清脂联素、瘦素水平与NAFLD病情严重程度有关.

Circulating tumor cells (CTCs) possess profound influence on tumor metastases and disease progression. This study aimed to investigate the correlation of CTCs with clinical characteristics and T-cell immunity, and to explore whether CTCs and the subpopulations can serve as an independent prognostic factor in advanced non-small cell lung cancer (NSCLC). A prospective study was conducted in late stages of NSCLC patients. The levels of overall CTCs and the three subpopulation CTCs were enumerated using the CanPatrol™ CTC enrichment system. The information about the patients which included the clinical characteristics, survival status at the 200th day postdiagnosis, and the levels of T cells was collected. Mann-Whitney U test, Kruskal-Wallis H test, Cox regression, and Spearman's rank correlation coefficient were the statistical methods used in this study. We detected CTCs in 27 of the 31 eligible patients; the level of epithelial-mesenchymal circulating tumor cells (EMCTCs) was higher than that of epithelial circulating tumor cells and that of mesenchymal circulating tumor cells (MCTCs) in the majority of NSCLC patients. Organ metastases were positively associated with the levels of overall CTCs, EMCTCs, and MCTCs (P<0.05). EMCTCs and MCTCs were associated with worse clinical outcomes. Additionally, the levels of EMCTCs were negatively associated with the levels of CD3+ T cells (P=0.01) and CD8+ T cells (P=0.04). In conclusion, the levels of CTCs were positively associated with organ metastases, particularly bone metastases, but were negatively associated with T-cell levels. The levels of EMCTCs and MCTCs had negative prognostic value.