反复发作性尿路感染(rUTI)是指尿路感染6个月内发作≥2次,或1年内发作≥3次[1],属中医学"劳淋"范畴,其中女性发病率高于男性且绝经女性尤为严重[2].目前,抗菌药物在急性发作期治疗作用显著,而在发作间期的预防功效存在长期使用耐药菌增加且复发率高等问题[3].中医药对rUTI病因及发病机制多有论述[4,5],部分医家提出分期论治,主张在清热利湿的基础上予以益气养阴、补肾扶正等[6,7].本文立足rUTI临证以女性为主且以老年为主体的现状[8],结合老年女性生理特点,总结长期临床实践《医学衷中参西录》和《张氏医通·淋》的心得体会,探讨从脾肾论治老年女性rUTI,以期为中医临床治疗该病开拓新的思路和方向.

Skin infection is a major health issue that usually is caused by the continuous proliferation of bacteria in wounds. With the abuse of antibiotics worldwide, the battle against skin infection is becoming more and more difficult. Therefore, the development of new ways with different antibacterial mechanisms to current antibiotics is urgently needed. Inspired by the powerful inhibition of ferroptosis used in cancer therapy, here in our study, ferric-loaded lipid nanoparticles (Fe-LNPs) with unform size (∼130 nm) and surface charge (∼12 mV) were constructed and found to effectively inhibit the growth of both Gram positive (Staphylococcus aureus, S. aureus) and negative (Escherichia coli, E. coli) strains, possibly due to induction of ferroptosis-like cell death mechanisms. Most importantly, Fe-LNPs can also effectively inhibit the proliferation of S. aureus in a skin infection model and promote the healing of wounds. The Fe-LNPs can be applied as a powerful antibacterial formulation for future application in clinic.

目的 探究分化抑制因子1(inhibitor of differentiation 1,Id-1)在胃癌中的表达及其临床意义.方法 选取2012年1月至2018年1月杭州市中医院收治的90例胃癌患者的组织标本和临床病理资料,采用免疫组化染色评估Id-1在胃癌组织及癌旁组织中的表达情况,统计分析Id-1表达与胃癌患者临床病理特征及生存时间的关系.结果 胃癌组织中Id-1的阳性表达率(83.3％)明显高于与癌旁组织(26.7％),差异有显著性(P<0.05).胃癌组织中Id-1的表达与肿瘤浸润深度、分化程度、淋巴结转移及临床分期有关(P<0.05),而与年龄、性别及肿瘤直径无明显关联.生存期低于2年的胃癌患者Id-1阳性表达率(87.2％)高于生存期大于2年的患者(46.5％),差异有显著性(P<0.05).结论 Id-1在胃癌组织中高表达,并与肿瘤浸润深度、分化程度、淋巴结转移、临床分期及生存时间有关,可作为评价胃癌恶性程度的指标.

目的 探讨肝切除手术时机对肝癌破裂出血患者临床治疗效果的影响.方法 回顾性分析2013年6月至2016年2月浙江大学附属第二医院及杭州市中医院收治的72例肝癌破裂出血患者的临床资料,其中46例接受急诊肝切除术治疗(急诊手术组),26例经保守治疗待循环稳定、肝功能改善后接受延期肝切除术治疗(延期手术组).记录两组患者的围术期指标,包括手术方式、术中出血量、术中输血量、手术时间、术后住院时间、首次进食时间、首次离床活动时间并进行组间比较.术后以门诊、电话形式进行随访,随访截止日期为2020年1月1日,比较两组患者的术后生存及复发情况.结果 两组患者的手术方式、手术时间比较差异无显著性(P>0.05).急诊手术组的术中出血量、术中输血量、首次进食时间和首次离床活动时间均高于延期手术组,而术后住院时间短于延期手术组,差异有显著性(P<0.05).急诊手术组与延期手术组的中位无病生存时间分别为9.2个月和8.6个月,腹腔转移率分别为32.6％(15/46)和34.6％(9/26),差异均无显著性(P>0.05),但急诊手术组的复发转移率(43.5％)明显低于延期手术组(69.23％),差异有显著性(P<0.05).急诊手术组术后1、2、3年总体生存率分别为84.8％、76.1％、45.7％,明显高于延期手术组的69.2％、57.7％、34.6％,差异有显著性(P<0.05).急诊手术组的中位总生存时间为22.6个月,明显高于延期手术组的16.5个月,差异有显著性(P<0.05).结论 急诊行肝切除术治疗肝癌破裂出血虽然在短期内恢复较慢,但可获得更好的远期临床结局,降低复发转移率,提高生存率.

Objective Matrix metalloproteinase (MMP)-19 and MMP-20 are important members of the MMP family, and their roles in tumor survivorship and progression are continually reported. This work aimed to determine the expression and prognostic significance of MMP-19 and MMP-20 in pancreatic ductal adenocarcinoma (PDAC). Methods Immunohistochemistry was used to investigate the levels of MMP-19 and MMP-20 expression in carcinoma tissues and paracancerous tissues from 102 PDAC patients. Results The MMP-19 and MMP-20 were, respectively, expressed in 71.6% (73/102) and 70.6% (72/102) of carcinoma tissues, and the expression was positively correlated (r = 0.643, P < 0.001). High-level expression of MMP-19 and MMP-20 was strongly correlated with aggressive clinicopathological characteristics. Kaplan-Meier analysis showed that high-level expression of MMP-19 and MMP-20 was significantly associated with decreased event-free survival (P < 0.001) and overall survival (P < 0.001). Multivariate analysis showed that high-level expression of MMP-19 could act as an independent predictive biomarker for poor event-free survival and overall survival. Conclusions Levels of MMP-19 and MMP-20 expression are significantly increased in PDAC. High-level expression of MMP-19 and MMP-20 is closely correlated to progression and prognosis of PDAC, and these may be considered as promising markers for unfavorable prognoses.

To investigate the expression of homeobox B (Hoxb)-13 and analyze its relationship with tumor angiogenesis, epithelial-mesenchymal transition (EMT)-associated markers (E-cadherin and vimentin), clinicopathologic data and prognosis in pancreatic carcinoma. Immunohistochemistry was applied to determine the level of Hoxb-13 expression in tumor tissues and surrounding non-tumor tissues from 85 subjects with pancreatic carcinoma. Besides, vascular endothelial growth factor (VEGF), CD31, E-cadherin and vimentin were also detected in tumor tissues by immunostaining. We found that the level of Hoxb-13 expression was significantly higher in pancreatic carcinoma tissues than in paracarcinomatous tissues (P < 0.05). Hoxb-13 staining was positively correlated with VEGF (r = 0.429, P < 0.001) and microvessel density (MVD) (r = 0.454, P < 0.001). Likewise, Hoxb-13 staining was positively correlated with vimentin (r = 0.448, P < 0.001); while it was negatively correlated with E-cadherin (r = -0.405, P < 0.001). High Hoxb-13 expression was associated with aggressive clinicopathological characteristics, worse disease-free survival (DFS) (P < 0.001) and worse overall survival (OS) (P < 0.001). Multivariate analysis showed that Hoxb-13 was an independent predictor for poor DFS (P < 0.001) and OS (P = 0.002). In conclusion, our data show that overexpressed Hoxb-13 is correlated with tumor angiogenesis, aberrant expression of EMT-associated markers and aggressive clinicopathological characteristics, and serves as a promising marker for unfavourable prognosis in pancreatic carcinoma.

Objective To investigate the expression clinical significance of Peroxiredoxin 1 ( Prx1 ) and epithelial mesenchymal transition (EMT)-related factors in pancreatic carcinoma. Methods The expression of Prx1, E-cad-herind and Vimentin were detected in 66 pancreatic carcinoma samples and 11 normal pancreatic tissues by immu-nohistochemical method. The correlation between Prx1, E-cadherin, Vimentin and clinicopathologic characteristics was also analyzed. Results The positive expression rates of Prx1, E-cadherind and Vimentin were 69. 70% (46/66), 40. 91% (27/66) and 56. 06% (37/66) in pancreatic carcinoma, and 18. 18% (2/11), 90. 90% (10/11) and 18. 18% (2/11) in normal pancreatic tissue, respectively. The expression rates of Prx1, E-cadherin and Vimentin were correlated with TNM stage, lymph node metastasis, degree of differentiation ( P <0. 05 ) . Prx1 expression was correlated with nerve invasion in pancreatic carcinoma tissue ( P<0. 05 ) . The expression rates of <br> Prx1, E-cadherin and Vimentin were not correlated with sex, age, size, site of tumor. E-cadherin and Vimentin expression were not correlated with nerve invasion inpancreatic carcinoma tissue. Prx1 expression in pancreatic car-cinoma was positively correlated with Vimentin expression ( P<0. 05 );Prx1 and Vimentin were negatively correla-ted with E-cadherin expression ( P<0. 05 ) . Conclusion Prx1 , E-cadherin and Vimentin expressions are associ-ated with the ability of invasion and metastasis in pancreatic carcinoma, Prx1 abnormal expression maybe serve as a potential poor prognostic marker of patients with pancreatic carcinoma.

Background: Dysregulated expression of matrix metalloproteinase (MMP)-2 and tissue factor pathway inhibitor (TFPI)-2 is closely associated with tumorigenesis and tumor progression. The aim of this work was to determine the predictive values of MMP-2 and TFPI-2 in identifying lymph node metastasis (LNM) and perineural invasion (PNI) in pancreatic carcinoma.Methods: Formalin-fixed and paraffin-embedded tissue samples containing pancreatic carcinoma tissues and their corresponding para-carcinoma tissues were obtained from 122 patients with pancreatic carcinoma. The expression levels of MMP-2 and TFPI-2 were evaluated by immunohistochemistry. The roles of MMP-2 and TFPI-2 in predicting LNM and PNI in pancreatic carcinoma were analyzed.Results: The level of MMP-2 expression was markedly increased in pancreatic carcinoma tissues (76.9%) compared with para-carcinoma tissues (29.2%; P<0.05). In contrast, there was obviously decreased TFPI-2 expression level in pancreatic carcinoma tissues (29.2%) compared with para-carcinoma tissues (77.7%; P<0.001). Additionally, MMP-2 expression was significantly positively correlated with LNM (r=0.468, P<0.01) and PNI (r=0.637, P<0.01). In contrast, TFPI-2 expression was strongly negatively correlated with LNM (r=-0.396, P<0.001) and PNI (r=-0.460, P<0.001). Logistic regression analysis showed that high MMP-2 expression and low TFPI-2 expression acted as independent predictors for LNM and PNI in pancreatic carcinoma.Conclusion: Taken together, our findings suggest that upregulated MMP-2 and downregulated TFPI-2 serve as useful predictors for a high risk of LNM and PNI. Obtaining information on the expression of MMP-2 and TFPI-2 before surgery may predict the occurrence of LNM and PNI, thereby permitting reasonable and effective surgical treatment for patients with pancreatic carcinoma.

Aberrant expression of matrix metalloproteinase (MMP)-2 and tissue factor pathway inhibitor (TFPI)-2 not only correlate with tumorigenesis, but also with tumor invasion and metastasis. This study aims to investigate the correlation and prognostic significance of MMP-2 and TFPI-2 differential expression in pancreatic carcinoma. Immunohistochemistry was used to evaluate MMP-2 and TFPI-2 expression in tumor tissues and corresponding non-tumor tissues from 122 patients with pancreatic carcinoma. The results showed that the expression of MMP-2 was significantly (P < 0.05) higher in tumor tissues (78.7%) than in adjacent non-tumor tissues (27.9%), whereas the expression of TFPI-2 was significantly (P < 0.001) lower in tumor tissues (27.9%) than in adjacent non-tumor tissues (79.5%). Spearman's rank correlation test showed a negative correlation between MMP-2 and TFPI-2 expression (r = -0.346, P < 0.001). Kaplan-Meier survival analysis showed that high MMP-2 expression was significantly correlated with decreased disease-free survival (DFS) (P < 0.001) and overall survival (OS) (P < 0.001), while high TFPI-2 expression was significantly associated with increased DFS (P < 0.001) and OS (P < 0.001) of the patients. Multivariate analysis showed that high MMP-2 expression can act as an independent predictive factor for poor DFS (P = 0.01); and low TFPI-2 expression as an independent prognostic factor for poor DFS (P < 0.001) and OS (P < 0.001). In conclusion, our findings suggested that the differential expression of MMP-2 and TFPI-2 have a negative correlation in pancreatic carcinoma tissues; they may be considered as valuable biomarkers for prognosis of pancreatic carcinoma.

Objective To detect MMP-26 expression in human pancreatic cancer and to investigate its role and sig-nificance in the progression of pancreatic cancer. Methods Immunohistochemistry, RT-PCR and Western blot were used to detect MMP-26 mRNA and protein in pancreatic cancer and adjacent normal tissue, to investigate the relationship between the clinical and pathological features of pancreatic cancer with MMP-26 . Results The posi-tive expression rate of MMP-26 protein was significantly higher in pancreatic cancer ( 72%) than in adjacent nor-mal tissues (6%) by immunohistochemical method, difference was considered statistically significant (P<0. 05). The high expression of MMP-26 was correlated with pancreatic differentiation, TNM stage and lymph node metasta-sis. RT-PCR detected 10 cases of pancreatic cancer tissues and adjacent normal tissues respectively, in which 7 ca-ses (70%) were discovered the positive expression of MMP-26 mRNA was significantly unregulated in pancreatic tissue than in adjacent normal tissues. Western blot detected 7 cases of pancreatic cancer tissues and adjacent nor-mal tissues respectively, in which 5 cases (71. 4%) were discovered the positive expression of MMP-26 mRNA was significantly higher in pancreatic tissue than in adjacent normal tissue. Conclusion The expression of MMP-26 is correlated with pancreatic differentiation, TNM stage and lymph node metastasis, may become a novel biomarker and clinical therapeutic target of pancreatic cancer.