目的:探讨赖氨酸羟化酶2(PLOD2)在宫颈鳞癌中的表达情况及其对宫颈鳞癌细胞增殖、侵袭和迁移能力的影响及机制.方法:通过生物信息学方法分析PLOD2在宫颈鳞癌组织中的表达及其与宫颈鳞癌临床病理特点的相关性.通过免疫组化和Western Blot方法检测PLOD2蛋白在宫颈鳞癌组织中的表达情况,并分析其与宫颈鳞癌临床病理特点的相关性.在宫颈SiHa、HeLa和H8细胞中,利用pLKO.1-shRNA质粒稳定干扰PLOD2基因表达情况,采用CCK8、平板克隆、划痕、Transwell侵袭实验检测PLOD2基因对宫颈鳞癌细胞增殖、迁移、侵袭能力的影响.通过Western Blot实验检测PLOD2对PI3K/AKT通路的影响,并在过表达PLOD2的情况下加入PI3K抑制剂进一步比较其增殖、迁移和侵袭能力及PI3K/AKT通路表达情况.结果:PLOD2蛋白在宫颈鳞癌组织及细胞中的蛋白表达量高于正常宫颈组织及细胞.结合生物信息学分析及临床标本免疫组化实验发现,宫颈鳞癌中PLOD2蛋白表达与患者组织分型、淋巴结转移、无病生存期有关(P＜0.05).PLOD2可以通过PI3K/AKT通路促进宫颈癌细胞增殖、侵袭和迁移.结论:PLOD2基因通过PI3K/AKT通路影响宫颈鳞癌的增殖、侵袭和迁移.

目的:探讨年轻HSIL患者行宫颈锥切术后病理升级的相关影响因素,以及不同手术方式的治疗价值比较,从而对有生育需求的妇女宫颈病变的管理及治疗提供指导.方法:对2014年1月-2020年6月在某院收治的宫颈活检病理诊断为高级别宫颈上皮内瘤变、年龄≤40岁且随访资料完整的128例患者进行回顾性研究.结果:128例HSIL患者锥切术后发生病理升级的比率达19.5％.多因素Logistic回归模型发现病灶累及位点数、病变累积腺体以及切缘阳性是影响术后病理升级的独立预后因素(P<0.05).LEEP和CKC术在年轻患者治疗HSIL上疗效相当.病灶范围大小是影响手术方式选择的重要因素(P=0.229);而有无生育史、是否感染高危HPV、术前TCT检查结果、是否进行阴道镜检查均不影响治疗方式的选择,组间无统计学差异(P>0.05).结论:年轻HSIL患者将宫颈环形电切术作为治疗CIN及保留生育功能的首选方案.病灶累及位点数、病变累积腺体以及切缘阳性是影响锥切术后病理升级的独立风险因素,充分术前评估,是减少二次手术的重要手段.病理升级后再次评估病灶范围、浸润深度、有无脉管浸润以及切缘状况可为选择后续治疗策略提供依据.

目的 探讨留置输尿管支架患者输尿管支架相关症状的临床特征及其影响因素.方法 选取2019年1月至2021年1月武汉大学中南医院收治的留置输尿管支架患者252例为研究对象,采用中文版输尿管支架相关症状调查问卷对患者进行调查,并采用单因素分析和多重线性回归分析患者输尿管支架相关症状的影响因素.结果 252例留置输尿管支架患者输尿管支架相关症状中,身体疼痛者占比73.41％,其余依次为夜尿(69.05％)、尿频(63.10％)、尿急(57.94％)、尿不尽(50.40％)、排尿困难(42.86％),部分患者可出现血尿(28.97％)、尿失禁(19.44％);单因素分析结果显示,不同年龄(F=4.518,P=0.012)、性别(t=2.435,P=0.016)、远端支架管是否过中线(t=-2.478,P=0.014)的留置输尿管支架患者输尿管支架相关症状得分比较,差异有统计学意义(P<0.05);多重线性回归分析结果显示,年龄(t=4.237,P=0.007)、性别(t=3.961,P=0.017)、远端支架管是否过中线(t=6.789,P<0.001)是影响留置输尿管支架患者输尿管支架相关症状的影响因素.结论 留置输尿管支架患者多存在身体疼痛和泌尿系统症状,年龄、性别、远端支架管是否过中线是患者症状发生的影响因素,临床可采取针对性措施改善其症状,提升患者生活质量.

同种异体复合组织移植(CTA)是一门新兴的用于治疗功能性组织或肢体缺损的移植学科,由于绝大多数CTA移植物为带血管的移植物,因此也称为带血管的复合组织移植(VCA).CTA/VCA的移植物包含同种异体的皮肤、皮下组织、骨骼、肌肉、神经和血管等两种或多种组织结构成分.由于大多数CTA/VCA移植物中带有皮肤组织,而皮肤组织是抗原性最强的免疫成分,移植术后的急性排斥反应是导致CTA/VCA移植失败及其移植物失功的首要障碍,因此CTA/VCA移植物中的皮肤排斥反应的组织病理学特征成为首要的关注点.本文就CTA/VCA的排斥反应等病理学特征、2007年Banff诊断标准及其研究进展予以综述,以期为CTA/VCA的排斥反应及其他并发症的诊断及治疗提供参考.

目的:讨论复发性卵巢性索间质肿瘤(OSCST)患者的临床特点及预后相关因素.方法:2012年6月至2021年12月期间武汉大学中南医院共收治OSCST患者127例,对其中随访资料完整的12例复发性OSCST患者进行回顾性研究.结果:12例患者首次复发距初次治疗结束的中位无疾病进展期(PFS)为67.5(6～120)月,除2例仅复发一次外,其余10例患者均经历了 2～6次不等的复发过程,总共有33次复发,多次复发的中位PFS为24(1～110)月,最终6例患者死亡,6例患者存活.通过Kaplan-Meier生存分析结果显示复发治疗后的治疗方式(P=0.001)、术后残余瘤(P=0.012)、复发治疗后可测量病灶(P=0.003)与肿瘤复发密切相关.COX多因素分析复发治疗后治疗方式、可测量病灶大小是复发患者的不良预后因素.结论:复发性OSCST患者需根据复发转移部位、残余肿瘤大小等病情严重程度不同选择适当的联合治疗方案,通过尽可能消灭复发转移病灶来延长患者PFS、缓解病情.

With the maturity of organ transplantation technology, the long-term survival of solid organ grafts has gradually become the primary task after transplantation. The main cause of graft function loss after solid organ transplantation is chronic graft damage. However, its potential mechanism is not clear. Graft pathological biopsy is the gold standard for the diagnosis of graft function, but the routine evaluation of graft function is hindered by the invasiveness of biopsy puncture and the limitation of sampling. Therefore, functional monitoring of micro injury non-invasive samples (such as peripheral blood or urine) is more conducive to the management of grafts after solid organ transplantation. This paper will systematically review the literature on biomarkers of long-term graft survival in solid organ transplantation.

Objective:To investigate the epidemic trend and risk change of acquired immunodeficiency syndrome (AIDS) complicated with malignant tumors after combination antiretroviral therapy (cART).Methods:The types of malignant tumors in patients with AIDS at different stages of cART were analyzed among anti-human immunodeficiency virus (HIV)-positive population in Hubei Province screened in National AIDS/HIV prevention and control information system from 1st January, 2004 to 31st December, 2018. The standardized incidence ratios(SIR) of malignant tumors in AIDS patients was analyzed based on the incidence of malignant tumors in the general population in Hubei Province or China in 2013. The changes in risks for development of malignant tumors in AIDS patients at different cART stages from 2004 to 2013 and 2014 to 2018 were compared.Chi-square test was used for statistical analysis.Results:Three hundred and twenty-three out of 22 994 AIDS patients were diagnosed with malignant tumors. Non-Hodgkin lymphoma(NHL) and cervical cancer were most common types in acquired immunodeficiency syndrome-defining cancers (ADC), while liver cancers and lung cancers were the most common types in non-acquired immunodeficiency syndrome-defining cancers (NADC). The overall risk of malignancy in AIDS patients was similar to that in the general population (SIR=1.06, χ2=0.62, P=0.426). However, the risks of Kaposi sarcoma, NHL, Hodgkin lymphoma, cervical cancer, and head and face cancers (excepting nasopharyngeal cancer) in AIDS patients were significantly higher than those in the general population (SIR=834.09, 9.65, 13.33, 5.22 and 2.94, respectively, χ2=11 747.27, 625.54, 56.65, 184.21 and 13.66, respectively, all P<0.01). The risks of lung cancer, colorectal anal cancer, stomach cancer and breast cancer in AIDS patients were significantly lower than those in the general population (SIR=0.33, 0.36, 0.43 and 0.45, respectively, χ2=33.43, 12.84, 9.01 and 7.21, respectively, all P<0.05). The SIR of cervical cancer, liver cancer and colorectal anal cancer from 2014 to 2018 were 4.06, 0.43 and 0.10, respectively, which were significantly lower than those from 2004 to 2013 (7.42, 1.96 and 0.84, respectively). The differences were all statistically significant ( χ2=5.39, 19.52 and 10.86, respectively, all P<0.05). Conclusions:At present, there are no significant differences of the incidences of malignant tumors between AIDS patients and general population, but the tumor types are different. The most common malignant tumors in this region are NHL and cervical cancer, which should be noted that HIV screening among patients with such tumors is conducive to comprehensive treatment to improve the efficacy.

随着公民逝世后器官捐献供体来源标准扩大之后,移植病理学在器官质量评估中的地位越来越重要.本文参照器官移植病理学临床技术操作规范(2019版)——肝移植/肾移植和相应器官移植的指南,综述了供者器官病理学评估的基本原则、活检时机、活检方法和目前国际上采用的组织病理学评估标准,为供者器官质量评估提供准确的病理学参考依据.

In early 2020, the outbreak of new coronavirus pneumonia broke out globally, and the assessment criteria for organ transplant donor infections also brought new changes. Under the situation of the new crown epidemic, it is necessary to update the infection assessment criteria for organ transplantation with regard to donor quality. The infectious pathogen spectrum of the absolute contraindications of donor organ donation has been updated, and the procedures for evaluating donor quality infections have changed accordingly. This review analyzes the infections from the donors by classification, and summarizes the treatment measures taken by the donors infected by different pathogens, and summarizes the evaluation standards and evaluation procedures of the donors' infection quality. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.

由于器官来源的不足，心脏死亡供肝等质量不佳的肝脏被应用于临床，为修复供肝质量，低温灌注技术逐渐被使用。本文分析了临床肝脏低温机械灌注和低温氧合机械灌注的应用报道，从适应证、实施方法、疗效等方面进行总结，以期为临床应用提供参考。

The data of patients with HIV/AIDS from Hubei Province during 2004 to 2018 were obtained from the National AIDS Comprehensive Prevention and Control Information System. A total of 22 980 HIV-positive or AIDS patients were followed up for 113 164 person-years and 323 malignant tumors were diagnosed. Non-Hodgkin′s lymphoma (NHL), cervical cancer, liver cancer, lung cancer, and Kaposi sarcoma (KS) accounted for 70.0% (226/323) of all malignant tumors in this population. The average crude incidence and mortality of malignant tumors in HIV-infected patients were 285.43/100 000(269.11/100 000 in males and 325.87/100 000 in females), and 169.67/100 000(184.78/100 000 in males and 132.19/100 000 in females), respectively. The result indicates that the overall cancer incidence and mortality in HIV/AIDS population under widely implementation of combination anti-retroviral therapy (cART) are similar to those in the general population of the region. But the incidence and mortality of AIDS-related tumors such as KS, NHL, HD and cervical cancer are higher than those in general population, and attention should be given to screening of these malignancies in HIV/AIDS population.

More and more studies have been focusing on marginal donor livers, such as steatotic liver grafts, to alleviate donor shortage and reduce mortality from waiting lists. Poor tolerance of streatotic liver grafts often leads to primary graft nonfunction, early dysfunction, and postoperative vascular and biliary complications. Some studies have shown that moderate and severe macrosteatosis livers can be used for transplantation with rigorous selection of recipients. In this paper, techniques such as venous systemic oxygenated persufflation, hypothermic oxygenated perfusion, subnormothermic machine perfusion, normothermic machine perfusion, improved liver quality, and steatotic liver grafts transplantation were discussed.

当机体生理负荷加重时,肝脏可以额外动员的潜在能力,以及各种致病因子造成肝脏损伤后自我修复且再生的能力,统称为肝脏储备功能[1].目前临床上评估肝脏储备功能的方法有很多种,主要分为肝功能静态检测及肝功能动态检测.肝功能静态检测包括临床上使用最普遍的肝脏血清生化检查,以及肝脏影像学评估和肝功能评分系统.而肝功能动态检测最常用的方法是吲哚菁绿(indocyanine green,ICG)清除试验[2].ICG清除试验主要应用于评估肝脏肿瘤的切除部位及大小,而在肝移植领域中相关报道较少[3].本文就ICG清除试验在肝移植患者中的应用进行综述.

原发性高草酸尿症（primary hyperoxaluria,PH）是一种罕见的常染色体遗传病,临床上多表现为多发性肾结石和肾功能衰竭,单纯肾移植术后预后不良。武汉大学中南医院1例同种异体肾移植术后早期出现肾功能不全的患者,最终确诊为AGXT基因突变的Ⅰ型PH,现报道如下。1临床资料患者男性,38岁,因"发现肌酐升高4月余,规律透析4个月"入院。2017年12月体检发现右肾结石并

线粒体是细胞能量代谢的中心,线粒体的网格形态可通过其融合与分裂而处于一种动态的变化中,以此适应不同环境下的能量需求.线粒体融合蛋白Mitofusin1/2(Mfn1/2),视神经萎缩蛋白(OPA1)和线粒体分裂蛋白(Drp1)分别在线粒体的融合和分裂过程中起到了关键的调节作用.而线粒体融合与分裂功能的异常,参与了人体各个系统许多损伤过程,包括视神经萎缩、缺血再灌注损伤等.本文将回顾上述几种关键蛋白为代表的线粒体融合与分裂关键调控分子、调节机制以及其异常所造成的疾病.

Objective:To explore the preparation method of rat skin wounds of E.coli and S.aureus in fection model,establish the model of back skin wound infection in rats,provide healing small animal models of wound infection after trauma and operation,and provide the model foundation for research of new biomedical dressing and drugs,etc.Methods:The experiment was divided into three groups:(1) non infection group;(2) E.coli infection group;(3) S.aureus infection group.After the rats were given wound preparation,100μl saline or bacterial fluid was added to the wound surface of the corresponding group by grouping.Results:Postoperative wound infection was shown after 48 hours.The optimal concentration to induce infection was no more than 109 CFU/ml and 108 CFU/ml for E.Coli and S.aureus with high survival rate.Conclusion:S.aureus 106-107 CFU/ml (100 μl) and E.coli 100 μl (107-108 CFU/ml) can successfully prepare the wound infection model in rats,and ensure the normal survival of rats.

Background Ante-situm resection and auto-transplantation (ante-situm for short) provides a more aggressive approach to conventionally unresectable hepatocellular carcinoma (HCC). We described the long-term outcomes of patients with HCCs who underwent this technique. Material/Methods Between October 2005 and December 2016, we performed 23 ante-situm liver resections. We evaluated postoperative complications, 90-day mortality, recurrence, and long-term survival rates, and reviewed the literature on this topic. Results Five types of complications associated with six patients were observed.: 1) primary nonfunctioning liver, thus receiving a liver transplantation; 2) initial poor liver function with recovery two weeks after treatment; 3) diagnoses of portal vein tumor thrombosis, biliary fistula, and small-for-size syndrome, respectively. The median follow-up was 3.6 years; 12 out of 23 patients were alive at the end of the study. One patient who had hepatic recurrence was lost to follow-up after three months. One patient died of multiple organ dysfunction syndrome after the operation, nine patients died due to hepatic recurrence and/or extrahepatic metastasis of HCC. The one-year, three-year, five-year, and 10-year survival rates were 65.2%, 56.5%, 50.9%, and 20.3%, respectively. The one-year, three-year, five-year, and 10-year recurrence rates were 60.9%, 50.7%, 50.7%, and 50.7%, respectively. The chi-square test revealed the patients with recurrence after ante-situm technique were more likely to have poor prognosis (mortality of patients with recurrence versus no-recurrence: 88.9% versus 14.3%, p<0.05) and a strong association was evidenced by Cramer’s V statistic (Cramer’s V=0.734). Conclusions Ante-situm procedure showed benefits in select patients with HCCs who had contraindications for conventional resection operations. In our case series, the ante-situm technique resulted in lower mortality compared to other ex-vivo hepatic resection techniques reported in the literature and similar long-term efficacy compared to cases of HCCs suitable for conventional resections. HCCs recurrence was a major risk factor associated with the survival rate of ante-situm technique.

临床上妊娠合并卵巢肿瘤发生率不高 ,其中合并恶性卵巢肿瘤者罕见 ,且因为孕期检查 ,通常发现于早期.穿刺口转移发生率低 ,通常是腹腔肿瘤晚期或远处转移的标志.本文报道1例妊娠合并卵巢癌穿刺口转移 ,结合文献回顾穿刺口转移及妊娠合并卵巢癌的发病率、可能的发生发展机制及临床治疗策略 ,以提高临床医师对该疾病的认识.

At present,the international use of organ preservation technology is divided into two types:cold preservation and mechanical perfusion.And hypothermic machine perfusion is an important way for future organ preservation,it can alleviate the contradiction between supply and demand of organs and improve the quality of the donor.This paper reviews the progress of hypothermic machine perfusion and hypothermic oxygenated perfusion in organ preservation mechanism.

目的 探究家兔肾移植围术期静脉血气值与家兔肾移植预后的关系.方法 应用家兔在体肾脏低温机械灌注(HMP)方式建立家兔自体肾移植模型.根据血气分析分为A组和B组,A组为术中血气值维持在正常范围内,B组为术中血气值下降.术中术后统计每只家兔静脉血气值变化情况,分析术后家兔生存率、24小时后肌酐、尿量与家兔血气值变化情况的相关性.结果 根据家兔术中血气值变化情况分为两组,A组家兔6只灌注过程中家兔血气值基本保持不变,B组家兔8只在灌注过程中pH呈下降趋势(7.40±0.02比7.05±0.08,P<0.001),碱剩余值(BE值)与HCO3-明显下降〔BE:-1.00±1.58比-9.42±1.89,P<0.001;HCO3-(mmol/L):20.34±1.11比14.68±1.44,P<0.05)〕.与A组家兔相比,B组家兔术后生存率明显下降(83.3％比62.5％,P<0.05),24小时后肌酐、尿素氮明显升高〔肌酐(μmol/L):342.00±18.81比518.00±23.54,P<0.001;尿素氮(mmol/L)9.20±2.01比23.40±3.33 mol/L,P<0.05〕,尿量明显降低(116.80±6.55 ml/d比75.20±6.94 ml/d,P<0.05).结论 家兔机械灌注过程中血气值的稳定与家兔肾移植预后有一定的相关性,血气值稳定的家兔预后较好,酸中毒家兔其生存率及肾功能均欠佳.因此,在机械灌注过程中有必要采取一定干预措施保持家兔内环境的稳定性.