目的:观察氢吗啡酮静脉自控镇痛对剖宫产术后患者急性、慢性疼痛及焦虑、抑郁的影响.方法:剖宫产初产妇339例纳入研究,随机分为舒芬太尼组和氢吗啡酮组,分别于术后给予舒芬太尼或氢吗啡酮行静脉内自控镇痛(PCIA).采用数字评分法(NRS)评估产妇术后疼痛;手术后3个月电话访问患者是否存在慢性疼痛及疼痛评分.术前及术后1周使用医院焦虑和抑郁量表(HADS)评估焦虑和抑郁情况.采用Ramsay量表评估术后24 h镇静情况.记录2组不良反应;记录术后6 h和12 h的血流动力学及血氧饱和度.结果:与舒芬太尼组相比,氢吗啡酮组产妇术后6 h和12 h活动痛评分显著降低(P=0.001和P=0.033),术后48 h内各时间点宫缩痛评分显著低于舒芬太尼组(P<0.05);术后HADS焦虑和抑郁评分均显著低于舒芬太尼组(P<0.05);慢性疼痛发生率较低(P=0.047);而2组血流动力学、Ramsay镇静评分差异无统计学意义(P>0.05).结论:氢吗啡酮静脉自控镇痛可显著缓解剖宫产术后产妇急性和慢性疼痛,尤其可缓解内脏痛,此外也可改善产妇焦虑、抑郁状况,效果优于舒芬太尼.在稳定血流动力学及不良反应方面,与舒芬太尼相当.

目的:探讨铁死亡相关的长链非编码RNAs(long non-coding RNAs,lncRNAs)在口腔鳞状细胞癌(oral squamous cell carcinoma,OSCC)中的预后价值并构建预后风险模型.方法:从癌症基因组图谱(The cancer genome at-las,TCGA)数据库下载OSCC患者RNA测序数据.通过差异分析筛选出在OSCC患者和正常组中差异表达的lncRNAs.将差异lncRNAs与铁死亡基因通过Pearson相关分析得到差异表达的铁死亡相关lncRNAs.通过LASSO回归分析构建铁死亡相关的lncRNAs预后风险模型.使用生存曲线和受试者工作特征曲线(receiver operating char-acteristic curve,ROC)评估模型的准确性.进一步使用单因素和多因素Cox回归分析评估独立预后因子.通过PCA和t-SNE分析,观察高低风险组基因分布;GO和KEGG分析高低风险组差异基因的富集情况.结果:通过差异分析得到454个差异lncRNAs,其中86个铁死亡相关的lncRNAs;生存分析得到8个与OSCC预后相关的铁死亡lncRNAs,包括TTLL11-IT1,HOTAIRM1,ZNF710-AS1,AL022323.1,LINC02454,LINC00294,AC100861.1和LINC02081.生存分析表明高风险组预后较差.3年生存率的ROC曲线下面积(AUC)为0.951.单因素和多因素Cox分析表明风险值可以作为独立预后因子.GO和KEGG通路富集分析发现,差异基因可能与体液免疫反应、化学致癌作用与受体激活等通路有关.结论:通过生物信息学方法筛选出8个影响OSCC预后的铁死亡相关lncRNAs,并成功构建预后风险模型,也为铁死亡相关lncRNAs在OSCC中的研究奠定基础.

Objective To investigate the clinical features of several cases of malignancy with multiple bone lesions as the first manifestation.Methods Forty-nine cases of malignancy with multiple bone lesions as the first manifestation were retrospectively analyzed from May 2018 to July 2019.All patients complained of "pain at the site of bone lesion" upon admission.Baseline patient information,such as age,gender,location of bone lesions,etiology,diagnosis method,time of onset was collected.Results The median age of the patients was 56 years old,of which 83.7% （41/49） were aged ≥50 years.The median time of onset was 2 months.Among the cases,40 were confirmed as solid tumor bone metastasis,whereas the remaining 9 cases as hematological system tumor.Lung cancer and multiple myeloma were the main tumor types,accounting for 40.8% （20/49） and 16.3% （8/49）,respectively.Other common causes were seven cases of cancer affecting the digestive system （three cases of liver cancer,three cases of gastric cancer,and one case of esophageal cancer）,as well as seven cases of unknown primary cancer.Half of the solid tumors had only multiple bone metastases but no other distant metastasis.Conclusion Multiple bone lesions accompanied by pain may be the first clinical manifestation in various malignant tumors.The common tumor types were lung cancer,multiple myeloma,and digestive system tumor.It is more common in people aged 50 years and older.Multiple bone lesions might be the only metastasis site of some solid tumors,and its mechanism needs further investigation.

Objective:To identify immune related lncRNAs associated with the prognosis of esophageal squamous cell carcinoma (ESCC) by bioinformatics analysis and construct a prognostic risk model.Methods:The transcriptome data and clinical data of patients with esophageal squamous cell carcinoma were downloaded from the TCGA database. Immune genes and transcriptome data were intersected to obtain immune-related genes. The correlation analysis was used to get immune-related lncRNA (correlation coefficient >0.4, P<0.01). The immune lncRNA related to prognosis was obtained through single factor COX analysis. Based on the expression of these lncRNAs in the sample, a COX prognostic risk scoring model was constructed and the risk value was calculated. According to the risk value, the patients were divided into high and low risk groups. The receiver operator characteristic (ROC) curve was used to compare the area under the ROC curve (AUC) to evaluate the effectiveness of the model. Results:Totally, 95 samples of ESCC were downloaded from the TCGA database. Intersection of immune genes and transcript data yielded 331 immune-related genes. Through single-factor COX analysis, we obtained 6 immune lncRNAs (LINC02159, AC092484.1, AC099850.3, AC125807.2, AC105277.1 and AC037459.3) significantly related to prognosis, and constructed a prognosis risk model based on these 6 lncRNAs. According to the risk model, the patients were divided into high and low risk groups based on their risk value. Through survival analysis to compare the 5-year survival rate, it was found that the survival rate in the high risk group was significantly lower than that in the low risk group ( P<0.01). The ROC curve results showe dthat the AUC was 0.844. Conclusion:Immune prognosis-related lncRNA can predict the prognosis of patients with ESCC, and provide clues for the research and treatment of immune-related lncRNA in ESCC.

目的 研究刷牙次数对中国成人肥胖和慢性病的影响.方法 通过2013年和2018年两次国家卫生服务调查(National Health Service Survey,NHSS),两次横断面调查均采用多阶段分层整群随机抽样以获得全国代表性样本.采用多元Logistic回归分析刷牙次数对超重肥胖和慢性病的影响.结果 2013年及2018年调查中,分别有219609人,205777人纳入研究对象.在2013年,不刷牙的人数占总调查人数的3.64％,而在2018年,不刷牙的人数增长到4.67％(P<0.001).与每天刷牙不到2次的人群相比,每天规律刷牙2次或2次以上的人超重肥胖的风险降低12％(OR=0.88,95％CI:0.87～0.90),患慢病的风险降低10％(OR=0.90,95％CI:0.89～0.92).结论 刷牙次数与中国人群超重肥胖及慢病风险密切相关,对我国口腔卫生健康教育的开展与慢病的防治有重要指导意义.

目的 研究肝癌免疫细胞的浸润模式,探索免疫细胞浸润与预后的关系.方法 从TCGA数据库下载肝细胞癌转录本数据及相关临床数据,通过Cibersort软件的反卷积法计算22种免疫细胞的占比.采用K-M生存分析Log-Rank法计算每种免疫细胞与生存的相关性.结果 从TCGA数据库中得到基因转录本数据共424例,包含肝癌组织374例、正常肝组织50例.每个样本检测基因位点60483个,包含mRNA 19658个.数据校正后使用Cibersort软件"反卷积法"得到22种免疫细胞的占比数据,采用P<0.05筛选样本,得到肝细胞癌组织40例、正常肝组织2例.K-M生存分析显示活化的肥大细胞、未活化的自然杀伤细胞、嗜酸性粒细胞组成比例高者预后差,活化的自然杀伤细胞比例高者预后更好.结论 肝癌中存在各类免疫细胞不同程度的浸润,浸润性免疫细胞可以作为影响肝癌患者预后的因素.

目的:研究肿瘤科临床实习生带教中应用循证医学思想的临床价值.方法:纳入本院(2017年04月-2018年04月)接收的临床实习生(n=60)作为研究对象,以随机抽签法为基准,分为实验组(n=30,实施循证医学思想带教)、对照组(n=30,实施常规带教),对60例临床实习生综合能力及考核成绩评估.结果:综合能力:实验组综合能力高于对照组(P＜0.05).考核成绩:实验组考核成绩高于对照组(P＜0.05).结论:肿瘤科临床实习生带教中应用循证医学思想的临床价值显著,既可提高实习生考核成绩,又可改善其综合能力,值得借鉴.

目的:探讨PROS1 5'非翻译区基因多态性c.-190C＞G和c.-189G＞C以及血浆蛋白S(PS)水平与华中地区静脉血栓栓塞症(VTE)的关系.方法:采用病例-对照研究,收集湖北省血栓与止血临床研究中心VTE患者外周血标本1 304例,收集与病例组年龄、性别相对应且无动静脉血栓栓塞病史的正常人外周血标本1 334例.提取全血基因组DNA,PCR扩增目的片段,采用限制性内切酶BsoBI酶切鉴定并测序验证,比较2组间PROS1 c.-190C＞G与c.-189G＞C突变的CC、CG、GG基因型比例.采用ELISA法测定血浆中游离PS抗原水平,对比突变型与野生型有无差异.结果:PROS1 c.-190C＞G等位基因G在病例组中发生率为1.34％,与对照组相比,OR=1.44(0.86-2.41,P=0.17),PROS1 c.-189G＞C等位基因C在病例组中发生率为0.31％,与对照组相比,OR=1.64(0.54-5.02,P=0.38).因此,PROS1的基因多态性c.-190C＞G及c.-189G＞C在病例组与对照组比较差异无统计学意义,2种突变型血浆游离PS抗原水平与野生型比较差异也无统计学意义(P＞0.05).结论:PROS1 5非编码区的基因多态性c.-190C＞G与c.-189G＞C可能不是华中地区VTE的危险因素.未来还需扩大样本量对PS缺乏的VTE患者进行更深入的研究.

目的:冠状动脉疾病(CAD)是威胁人类健康的主要疾病之一.血小板的活化及其与细胞外基质的粘附在CAD的发生、发展中发挥重要的作用.GPVI基因编码的GPα2β1是一种血小板膜蛋白,通过Ca2+离子通道传导信号引起血小板聚集而形成血栓.湖北地区汉族人群中关于CAD易感基因的分子特征尚不明确.因此,我们开展了编码GPα2β1血小板膜蛋白的GPVI基因与CAD易感性的相关研究.方法:将102例CAD患者GPVI基因的启动子区、外显子区、剪切区及非翻译区进行重测序,查找引起CAD的致病突变;采用病例-对照研究评价c.940C＞G(p.Pro314Ala)突变对CAD发生风险的优势比;并用生物信息学工具评价c.430G＞A(p.Ala144Thr),c.655C＞T(p.Pro219Ser),c.940C＞G(p.Pro314Ala)突变的危害性.结果:本研究发现,GPVIc·940C＞G(p.Pro314Ala)与CAD不存在明显的相关性(OR=0.984,95％CI 0.746-1.298,P=0.908 94).结论:本研究发现存在于湖北地区汉族人群中GPVI基因突变体c.940C＞G(p.Pro314Ala)可能不是导致CAD患病风险增加的遗传学因素.

Objective:Antithrombin resistance is a severe type of hereditary thrombophilia newly discovered in the world,which is caused by gain-of-function mutations in the prothrombin gene.These type of mutations have been reported in 3pedigrees of Japan(p.Arg596Leu)and Serbia(p.Arg596Gln),while the existence and frequency of which still remain unclear in other parts of the world including China.We set out to investigate whether antithrombin resistance is common in the population of central China.Method:Sixty unprovoked thrombophilic patients were selected for prothrombin gene re-sequencing.Mutations p.Arg596 Leu and p.Arg596 Gln were detected using a RFLP method with HpaⅡamong the study populations,including 1 304 venous thromboembolism patients and 1 334 controls.Bioinformatics tools were employed to evaluate the consequences of identified variants.Result:Three variants(c.494CT,c.316+36GA and c.423-7GC)were identified in the 60 thrombophilic patients.Their minor allele frequencies are all higher than 0.1and they were predicted to be benign or tolerated.In contrast,the affected amino acid in p.Arg596 Leu and p.Arg596 Gln reported previously were highly conserved among various species.However,the two mutations were not observed in the study population.Conclusion:p.Arg596 Leu and p.Arg596 Gln may be very rare and antithrombin resistance is not a common risk factor for inherited thrombophilia in central China.

In order to optimize the flow field in a full-scale Carrousel oxidation ditch with many sets of disc aerators operating simultaneously, an experimentally validated numerical tool, based on computational fluid dynamics (CFD), was proposed. A full-scale, closed-loop bioreactor (Carrousel oxidation ditch) in Ping Dingshan Sewage Treatment Plant in Ping Dingshan City, a medium-sized city in Henan Province of China, was evaluated using CFD. Moving wall model was created to simulate many sets of disc aerators which created fluid motion in the ditch. The simulated results were acceptable compared with the experimental data and the following results were obtained: (1) a new method called moving wall model could simulate the flow field in Carrousel oxidation ditch with many sets of disc aerators operating simultaneously. The whole number of cells of grids decreased significantly, thus the calculation amount decreased, and (2) CFD modeling generally characterized the flow pattern in the full-scale tank. 3D simulation could be a good supplement for improving the hydrodynamic performance in oxidation ditch designs.

An accurate numerical model including three-dimensional (3D) steady Navier-Stokes equations in Cartesian coordinate system is developed to evaluate the performance of a compressible flow through a solar chimney. This model is validated by comparison with the previous numerical simulated results for one-dimensional compressible flow in a proposed 1500-m-high solar chimney with an inner diameter of 160 m. Results for this 3D numerical model of a compressible flow through a solar chimney are more accurate compared to those from the Boussinesq model and full-buoyancy model. Normally, an incompressible flow is considered in the Boussinesq model, and enthalpy loss is not included in the energy equation in both the Boussinesq model and full-buoyancy model. Moreover, buoyancy reference density is kept as constant in the energy equation in the full-buoyancy model. The results show that the use of the Boussinesq model and full-buoyancy model with some commercial numerical computational fluid dynamics programs usually results in large errors, and the developed model in this article could give more accurate results than the previous commercial Boussinesq model and full-buoyancy model.

The reason of low efficiency of total nitrogen (TN) removal in the first phase of Pingdingshan Sewage Treatment Plant is analyzed. The effective measures are taken to tackle this problem,including adjusting the feed water quality,improving the biodegradability of sewage,changing the Carrousel oxidation ditch into a modified oxidation ditch,etc. Results show that TN in the effluent can meet the Class A of "Discharge Standard of Pollutants of Municipal Wastewater Treatment Plant" (GB18918-2002).