Objective To investigate the efficacy and safety of postoperative analgesia with low-dose esketamine in patients undergoing thoracoscopic radical resection of lung cancer. Methods Eighty patients undergoing thoracoscopic radical resection of lung cancer were equally and randomly divided into esketamine group and control group. Both two groups received anesthesia induction with intravenous injection of 0.05 mg/kg midazolam, 1.5 to 2 mg/kg propofol, 0.6 μg/kg sufentanil and 0.6 mg/kg rocuronium, and meanwhile esketamine group received intravenous injection of 0.1 mg/kg of esketamine. Both two groups received anesthesia maintenance with inhalation of 1% to 2% sevoflurane, intravenous pump of 0.1 to 0.3 μg/（kg·min） remifentanil and intermittent intravenous injection of 0.3 mg/kg rocuronium, and meanwhile esketamine group was continuously pumped with 0.12 mg/（kg·h） esketamine. For postoperative patient-controlled intravenous analgesia, esketamine group was given 50 mg oxycodone+25 mg esketamine+100 mL normal saline, and control group was given 50 mg oxycodone+100 mL normal saline. The dosage of oxycodone, the incidence of adverse reactions such as dizziness, nausea and vomiting in 48 h after operation, the numerical rating scale（NRS） scores at rest in 4, 12, 24, 48 and 72 h after operation, the NRS scores during movement in 24, 48 and 72 h after operation, the first postoperative patient-controlled analgesia time and frequency, the first out-of-bed activity time and the first food intake time were recorded in two groups. The 15-item quality of recovery（QoR-15） score was used to evaluate the recovery of patients in two groups in 24, 48 and 72 h after operation. Results The NRS score at rest in 24hpostoperatively and NRS scores during movement in 24,48and 72hpostoperatively were lower in esketamine group（3.4±1.4;5.3±1.8,4.5±1.5,3.7±1.8）than those in control group（4.6±1.4;6.5±1.2,5.6±1.7,4.7±1.8）（P＜0.05）.QoR-15scores in 24,48and 72hpostoperatively were higher in esketamine group（83.0±9.2,103.7±11.2,115.6±10.9）than those in control group（75.3±12.3,97.2±11.7,108.5±11.5）（P＜0.05）.The first use of patient-controlled analgesia was later in esketamine group [（7.1±1.3）h]than that in control group[（6.2±1.6）h]（P＜0.05）,and the first out-of-bed activity was earlier in esketamine group[（15.1±1.4）h]than that in control group[（15.9±1.7）h]（P＜0.05）.There were no significant differences between two groups in the NRS scores at rest in 4,12,48and 72hafter operation,the consumptions of oxycodone in 24and 48h after operation,the first food intake time after operation,the frequency of postoperative patient-controlled analgesia and the incidences of dizziness,nausea/vomiting and hallucination（P＞0.05）.Conclusion The application of low-dose esketamine during and after thoracoscopic radical resection of lung cancer can reduce postoperative motor pain and promote enhanced recovery after surgery without increasing the incidence of adverse reactions.

Endometrial carcinoma (EC) is the second major female genital malignancy. Genetic signatures may be an improved choice to predict the prognosis of EC patients. The relationship between pyroptosis and tumours has attracted much attention in recent years. Here, we constructed a new pyroptosis-related gene (PRG) signature for predicting the prognosis of EC. In this study, gene data and clinical information of EC patients were obtained from The Cancer Genome Atlas (TCGA). Following the identification of PRGs correlated with EC prognosis, we further investigate the bioinformatics functions of these PRGs by univariate Cox regression analysis and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Then, we used the least absolute contraction and selection operator (LASSO) regression and multiple Cox regression analysis to construct a new PRG signature that contains seven PRGs (NFKB1, EEF2K, CTSV, MDM2, GZMB, PANX1, and PTEN) and performed the Kaplan-Meier (K-M) analysis, receiver operating characteristic curve (ROC) analysis, and principal component analysis (PCA) to evaluate the prognostic value of our novel PRG signature. Finally, we assessed the correlations between pyroptosis and immune cells/checkpoints through the CIBERSORT tool and single-sample gene set enrichment analysis (ssGSEA). The result suggested that our signature was powerful in predicting EC prognosis and may play a part in assessing response to immunotherapy in EC patients. In conclusion, our study established a novel PRG signature for EC, which can be used as an effective prognostic marker in clinical practice in the future.

目的 探讨血清高迁移率族蛋白-1(High mobility group protein-1,HMGB-1)、巨噬细胞炎症蛋白-1α(Macrophage inflammatory protein-1α,MIP-1α)、血清肌红蛋白(Serum myoglobin,Mb)、白细胞介素-6(interleukin-6,IL-6)联合评估急性腹部多发伤病情严重程度中的应用价值.方法 选取2019年11月至2020年12月我院收治的60例急性腹部多发伤患者设为为研究组,同时选取同期在我院进行体检的健康人群80例设为观察组.根据损伤严重程度评分(Injury severity score,ISS)将研究组患者分为重度创伤组(n=15,ISS评分≥25分)、中度创伤组(n=28,16分≤ISS评分<25分)、轻度创伤组(n=17,ISS评分<16分).患者入院后均对其血清HMGB-1、MIP-1α、Mb、IL-6水平进行检测,采用ROC曲线分析各指标以及联合检测下的曲线面积,分析诊断效能.结果 研究组血清HMGB-1、MIP-1α、Mb、IL-6水平均明显高于对照组(P<0.05);轻、中、重度创伤组的血清HMGB-1、MIP-1α、Mb、IL-6水平均有明显差异(P<0.05),重度创伤组的数值均高于其他两组,轻度创伤组的数值最低,组间差异均显著(P<0.05);血清HMGB-1、MIP-1α、Mb、IL-6四种指标联合检测模式下的AUC均高于任一单项检测,且诊断的灵敏度和特异度分别为95.34％、93.02％,高于任一单项检测.结论 急性腹部多发伤患者病情越严重,其血清HMGB-1、MIP-1α、Mb、IL-6水平则越高,临床可联合上述四种生化指标综合预测急性腹部多发伤疾病严重程度.

Objective:To analyze the clinical characteristics of patients with acute glyphosate herbicide poisoning and the differences in the severity of poisoning.Methods:A retrospective analysis was performed on patients with acute glyphosate herbicide poisoning admitted to the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2020. The general information, exposure time, poisoning dose, poisoning cause, poisoning route, clinical manifestations, laboratory examination results during hospitalization, treatment measures, hospital stays and prognosis of the patients were collected. The patients were graded according to the poisoning severity scoring standard of Chinese Expert Consensus on Diagnosis and Treatment of Acute Poisoning in 2016. The highest severity score during hospitalization was used as the final grade. According to the final grade, asymptomatic and mild patients were included in the mild group, and moderate, severe and death patients were included in the severe group. The independent sample T test or Mann-Whitney U test was used for measurement data, and χ2 test or Fisher's exact test was used for counting data. The differences of general data and clinical data between the two groups were compared. Results:According to the inclusion and exclusion criteria, 83 patients with acute glyphosate herbicide poisoning were selected as the study subjects. All patients survived, mainly mild poisoning (56.6%), with a male to female ratio of 33∶50, and an average age of 39 years. The number of poisoning cases increased yearly (the highest in 2019), and most cases occurred in spring and summer. The main cause of poisoning was suicide (71.1%), direct oral administration (83.1%) was the primary route of poisoning, and the dominating clinical manifestations were digestive symptoms (71.1%). Laboratory tests showed increased white blood cell count (WBC), neutrophil percentage (NEUT %) and D-dimer, and decreased hemoglobin and potassium. Compared with the mild group, patients in the severe group were older [(51±17) years vs. (35±19) years], had a higher proportion of suicide and direct oral administration, a longer hospital stay [8.0 (4.8, 12.0) d vs. 3.0 (2.0, 5.5) d], a higher dose of poisoning [200.0 (50.0, 200.0) mL vs. 30.0 (11.3, 57.5) mL], and higher NEUT % within 24 h of admission [(83.4±10.4) vs. (73.2±12.8)]. The increase of WBC, NEUT %, aspartate aminotransferase, prothrombin time, D-dimer and the decrease of serum potassium were more common in the severe group than the mild group, with statistical significance (all P<0.05). Conclusions:The number of patients with acute glyphosate herbicide poisoning is increasing yearly. Generally, the condition is mild and the prognosis is satisfying. The severity is more serious in the middle-aged and elderly patients andthose with direct oral administration, high toxic dose, and high NEUT % within 24 h of admission. Severe poisoning is more likely to cause changes in laboratory indicators.

目的 比较开放手术与CT引导下微创射频消融手术治疗骨样骨瘤的临床效果.方法 回顾性收集2017年6月至2020年2月在郑州大学第一附属医院治疗的55例骨样骨瘤患者临床资料,按手术方式将患者分为开放手术组(30例)和微创消融组(25例),开放手术组接受开放手术方式治疗,微创消融组接受CT引导下微创射频消融手术治疗.比较两组术后病理结果、手术时间、手术出血量、术后住院时间,比较治疗前和治疗后72 h、1周及1、6、12个月的视觉模拟量表(VAS)评分、并发症和复发情况.结果 两组术后活检成功率比较,差异有统计学意义(P<0.05);微创消融组手术时间、术后住院时间均短于开放手术组,手术出血量少于开放手术组(P<0.001);开放手术组有3例严重并发症(骨折)和3例复发,微创消融组无严重并发症及复发,微创消融组术后出现并发症或复发的概率低于开放手术组(P<0.05);术后72 h、1周及1、6个月,微创消融组术后VAS评分低于开放手术组(P<0.05).结论 CT引导下微创射频消融术治疗骨样骨瘤在手术时间、手术出血量、住院和康复时间、术后并发症或复发等方面较开放手术组有明显优势,可以优先考虑CT引导下微创射频消融术作为治疗骨样骨瘤的方法.

目的 探讨甘草酸(liquiritigenin,Liq)对急性胰腺炎(acute pancreatitis,AP)小鼠模型的疗效及作用机制.方法 24只C57BL/6小鼠随机分为对照组(CON组)、甘草酸对照组(Liq组)、AP组、AP+甘草酸治疗组(AP+Liq组),6只/组.腹腔注射两次L-精氨酸(4 g/kg)建立AP小鼠模型,两次注射间隔1 h;CON组注射等体积生理盐水;Liq组及AP+Liq组于造模前1 h通过腹腔注射甘草酸(30 mg/kg).造模后72 h处死小鼠采集标本,光学显微镜下观察胰腺组织病理改变,ELISA方法检测血清淀粉酶、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)含量,检测胰腺组织中丙二醛(MDA)及超氧化物歧化酶(SOD)含量,免疫荧光检测胰腺组织活性氧(ROS)表达,Western blot检测胰腺组织中核因子E2相关因子2(Nrf2)、血红素加氧酶1(HO-1)的蛋白表达.结果 与CON组比较,AP组小鼠胰腺明显坏死,血清淀粉酶(U/L:107.10±19.29 vs.639.4±59.10)、TNF-α(pg/mL:12.77±1.06 vs.106.20±16.13)、IL-6(pg/mL:11.74±1.75 vs.105.21±11.42)、MDA(U/mg:0.81±0.18 vs.3.73±0.87)明显升高(P<0.01),SOD(U/mg:6.76±1.10 vs.3.02±0.88)明显下降(P<0.01),同时Nrf2/HO-1通路被明显抑制;与AP组比较,AP+Liq组胰腺组织损伤明显减轻,淀粉酶(U/L:216.80±44.73)、TNF-α(pg/mL:36.48±7.06)、IL-6(pg/mL:38.66±11.29)及MDA(U/mg:2.09±0.57)明显降低(P<0.01和P<0.05),SOD(U/mg:5.70±1.01)表达上调,同时Nrf2/HO-1通路表达上调;Liq组与CON组各指标比较差异无统计学意义(P>0.05).结论 甘草酸能够明显减轻AP,其机制可能是通过激活Nrf2/HO-1通路减轻AP氧化应激.

[目的]探讨影响Ⅰ级软骨肉瘤预后的因素.[方法]回顾分析2010年1月-2018年1月郑州大学第一附属医院收治的62例Ⅰ级软骨肉瘤患者的临床资料,采用Kaplan-Meier生存分析比较三类发病部位的两种手术方式对无复发生存率的影响,Cox回归分析影响生存的因素.[结果]随访时间24 ～ 96个月,平均(48.07±21.22)个月,3例患者复发后失访.随访过程中,5例患者出现远处转移,共2例患者死于肺转移,5年生存率96.77％.MSTS评分局部切除组为(28.27±0.65)分,广泛切除组为(25.68±1.45)分,两组间差异有统计学意义(P＜0.05).但是,术后5年无复发生存率,局部切除组为59.67％,广泛切除组为90.32％,差异有统计学意义(P＜0.05).患者是否复发的单因素分析表明,是否复发两组间在性别、年龄、部位、肿瘤直径、Enneking分期、位置分类方面的差异无统计学意义(P＞0.05),但复发组手术广泛切除的比率显著低于未复发组(P＜0.05).Ka-plan-Meier生存分析表明,广泛切除或局部切除对四肢肿瘤无复发生存率的影响差异无统计学意义(P＞0.05).但是,相较于局部切除,广泛切除在中轴组和胸壁组可以获得显著提升的无复发生存率(P＜0.05).Cox回归分析表明,手术方式(HR=9.495,95％CI:1.947～46.311,P＜0.05)是影响生存的独立预后因素.[结论]对四肢Ⅰ级软骨肉瘤,局部切除不增加复发风险且功能更佳.对胸壁、骨盆和脊柱Ⅰ级软骨肉瘤,应广泛切除以减少复发风险.

目的 探讨可扩张通道微创系统下经椎间孔入路腰椎椎体间融合术治疗腰椎管狭窄患者的效果.方法 选取2018年6月至2019年6月河南科技大学第一附属医院收治的105例腰椎管狭窄患者作为研究对象,根据手术方式分为研究组(56例)与对照组(49例).研究组患者接受可扩张通道微创系统下经椎间孔入路腰椎椎间融合术,对照组患者接受开放式常规入路腰椎椎体间融合术.比较两组手术指标(手术时间、术中出血量、术后引流量)、短期随访指标[腰椎功能(ODI量表评分)、疼痛程度(VAS评分)]、骨融合率.结果 研究组手术时间短于对照组,术中出血量、术后引流量少于对照组(P<0.05).术后3个月,两组ODI评分、VAS评分均降低,且研究组低于对照组(P<0.05).研究组骨融合率[91.07％(51/56)]与对照组[93.88％(46/49)]比较,差异无统计学意义(P>0.05).结论 可扩张通道微创系统下经椎间孔入路腰椎椎体间融合术可缩短腰椎管狭窄患者手术时间,减少术中出血量,降低手术创伤性,促进腰椎功能恢复,减轻椎旁肌损伤,缓解疼痛.

Objective:To study the correlation between WW domain-containing oxidoreductase (WWOX) expression and clinicopathological features of osteosarcoma, and explore the effect of WWOX on the proliferation and metastasis of human osteosarcoma in mice.Methods:The expression of WWOX in osteosarcoma tissues was detected by reverse transcriptase-polymerase chain reaction (RT-PCR) and immunohistochemistry. The correlation between the WWOX expression and clinicopathological features of osteosarcoma was evaluated. The osteosarcoma cells 143B were injected into the tibias of immunodeficient mice to establish the osteosarcoma xengrafted model. Lentivirus, lentivirus-delivered WWOX and lentivirus-delivered WWOX short hairpin RNA (shRNA) were injected into tumor respectively. The tumor growth was recorded and compared. The number of pulmonary nodules was assessed using micro CT. For the measurement data that conform to the normal distribution, the independent sample t test was used for difference analysis; for the measurement data that do not conform to the normal distribution, the nonparametric test was used for difference analysis; for the grade data, the nonparametric test was used for difference analysis; for the count data, the test was used for difference analysis. The differences between different groups were analyzed by one-way ANOVA.Results:There was no significant correlation between WWOX expression and some clinicopathological features, including gender, age, primary site, etc. The high WWOX expression was correlated with low microvascular density (MVD) and small tumor volume. The overall survival (OS) and disease-free survival in patients with high WWOX expression was obviously longer than those of patients with low WWOX expression. The growth rate of primary tumor in immunodefient mice was significantly lower in WWOX group and significantly higher in WWOX shRNA group than in vector group. The number of pulmonary nodule was significantly greater in WWOX shRNA group than in vector group. However, there was no significant difference in the number of pulmonary nodule between WWOX group and vector group. WWOX was expressed in a higher level in primary tumor in WWOX group and lower level in WWOX shRNA group than in vector group. WWOX was expressed in the lower level in pulmonary nodule in WWOX shRNA group than in vector group. MVD was expressed in a lower level in primary tumor in WWOX group and higher level in WWOX shRNA group than in vector group. MVD was expressed in the higher level in pulmonary nodule in WWOX shRNA group than in vector group. However, there was no significant difference in WWOX level and MVD between WWOX group and vector group. We further found that WWOX could regulate the expression of proliferation cell nuclear antigen (Ki-67) and matrix metalloproteinase (MMP)-2 through extracellular signal-regulated kinase (ERK) phosphorylation, and further regulate the proliferation and invasion of osteosarcoma.Conclusion:The high expression of WWOX is associated with better prognosis in osteosarcoma. WWOX can inhibit the growth of tumor bearing osteosarcoma in mice with immunodeficiency through ERK signaling pathway, and inhibit the angiogenesis and lung metastasis of tumor bearing osteosarcoma in mice with immunodeficiency.

Objective:To investigate the predictive value of dynamic platelet and hemagglutination-related parameters in patients with acute pancreatitis (AP).Methods:The patients admitted to the Department of Emergency Surgery in the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2020 were analyzed. According to the inclusion criteria and exclusion criteria, patients with AP were retrospectively enrolled. According to the Chinese Guidelines for the Diagnosis and Treatment of Acute Pancreatitis (Shenyang, 2019), the patients were divided into two groups: severe acute pancreatitis (SAP group) and non-severe acute pancreatitis (non-SAP group) [including mild acute pancreatitis (MAP) and moderate severe acute pancreatitis (MSAP)]. A normal distribution of the maximum and mean aggregation rates of dynamic platelets (arachiidonic acid), plateletcrit (PCT) and bedside index for severity in acute pancreatitis (BISAP) scores and other measurement data were tested by t test, while measurement data of prothrombin time (PT), fibrinogen (FIB) and D-dimer that did not conform to normal distribution were tested by Mann-Whitney U test. χ 2 test was used for the counting data such as sex, age and etiology of patients in the two groups. The prognostic value of statistically significant indicators for non-SAP group and SAP group was further analyzed by receiver operating characteristic (ROC) curve. Results:A total of 146 patients with AP were enrolled, including 50 patients in SAP group and 96 in non-SAP group. The maximum and average aggregation rates of dynamic platelet (aracidonic acid) in the SAP group were (71.76±17.62) % and (67.91±18.10) %, PT (12.02±1.33) s, FIB (4.76±2.08) g/L, D-dimer (3.75±6.04) μg/L, PCT (0.23±0.08) %, and BISAP scores (1.42±1.18), which were all significantly higher than those in the non-SAP group [the maximum and average aggregation rates of dynamic platelet (arachiidonic acid) (46.65±20.11) % and (42.50±20.71) %, PT (11.50±1.51) s and FIB (3.91±1.48) g/L, D-dimer (1.00±1.37) μg/L, PCT (0.19±0.06) %, BISAP scores (0.45±0.66)] (all P<0.05). According to area under the ROC curve, the maximum and average aggregation rates of dynamic platelets (arachiidonic acid) in serum of patients with SAP were 0.83 and 0.82, respectively, and the sensitivities were 0.56 and 0.68, respectively. The specificity was 0.99 and 0.81, respectively, which was better than PT, FIB, D-dimer, PCT and BISAP scores in predicting the severity of AP. Conclusions:The maximum and average aggregation rates of dynamic platelets (arachidonic acid), PT, FIB, D-dimer, PCT and BISAP scores can be used as predictors of the severity of acute pancreatitis. The maximum and average aggregation rates of dynamic platelets (arachiidonic acid) were the best in predicting the severity of AP.

目的 探讨肉瘤样尿路上皮癌(sarcomatoid urothelial carcinoma,SUC)的临床特点及分子病理学特征.方法 回顾性分析20例SUC的临床病理学特征,其中6例采用荧光原位杂交(flourescence in situ hybridization,FISH)技术检测患者尿脱落细胞,分析其分子病理学特征.结果 20例SUC患者中,男性17例,女性3例;发病年龄46～70岁,中位年龄58岁.肿瘤部位:13例位于膀胱、5例位于肾盂、2例位于输尿管.肿瘤侵犯全层12例,浸润深肌层6例,浅肌层2例.18例患者获得随访,随访时间5～17个月,其中15例死亡,3例存活.6例患者行尿脱落细胞FISH检测,4例发现3或7号染色体的多倍体.结论 SUC属于高度侵袭且预后差的肿瘤,好发于老年男性,主要发生于膀胱,确诊需依据其病理形态学特征及免疫组化检测.FISH技术检测患者尿路脱落细胞,是诊断SUC的无创性辅助检查方法.

目的 探讨基质金属蛋白酶2(MMP2)、ADAM金属肽酶域17(ADAM17)及E-钙黏蛋白(E-cadherin)在结直肠腺癌组织中的表达及临床意义.方法 采用免疫组化PV-9000法检测120例结直肠腺癌组织、56例结直肠腺瘤组织和30例正常结直肠黏膜组织中MMP2、ADAM17及E-cadherin的表达情况,并分析其与结直肠腺癌患者临床特征的关系.结果 结直肠腺癌组织中MMP2、ADAM17阳性表达率均高于结直肠腺瘤组织和正常结直肠黏膜组织,E-cadherin阳性表达率低于结直肠腺瘤组织及正常结直肠黏膜组织,差异均有统计学意义(P﹤0.05).不同肿瘤直径、分化程度、TNM分期及有无淋巴结转移、浆膜浸润结直肠腺癌患者的结直肠腺癌组织中MMP2、ADAM17、E-cadherin阳性表达率比较,差异均有统计学意义(P﹤0.05).结论 MMP2、ADAM17及E-cadherin与结直肠腺癌的侵袭和转移有关,对结直肠腺癌的临床诊断、预后判断及个体化治疗具有重要意义.

目的:提出胸腰椎椎旁占位性病变新的临床分型并评价其对手术治疗方案选择的参考价值.方法:收集2013年1月～2019年12月接受手术切除治疗的35例胸腰椎椎旁占位性病变患者的临床资料,其中男15例,女20例,年龄7～70岁(42.4±16.1岁).后正中入路6例,经椎旁肌间隙切除横突入路7例,腹膜后间隙入路17例,病变后方直接切除5例.依据占位病变的影像学特点,将胸腰椎椎旁占位性病变按部位分为3型:Ⅰ型,病变位于椎体旁,小部分沿神经根向椎间孔生长,未突入中央椎管;Ⅱ型,病变位于椎体旁椎间孔之外;Ⅲ型,病变位于椎弓后方的竖脊肌.每型按占位大小进一步分为a、b两个亚型,病变长轴≤50mm为a型,＞50mm为b型.3名观察者先后进行两次评估分型(间隔1周),并进行Kappa一致性检验.手术前后及末次随访时行疼痛VAS评分,并结合影像学复查进行疗效评定.结果:35例患者中Ⅰa型4例,Ⅰb型3例,Ⅱa型9例,Ⅱb型14例,Ⅲa型3例,Ⅲb型2例.3位观察者分型自身一致性的Kappa值为0.924～1,观察者之间一致性的Kappa值为0.849～0.924,均高度一致.6例经后正中入路切除患者为胸段Ⅰa(1例)、Ⅱa(5例)型,7例经椎旁肌间隙入路切除患者为腰段Ⅰa(3例)、Ⅱa(4例)型,17例经腹膜后间隙入路切除患者为腰段Ⅰ b(3例)、Ⅱb(14例)型,5例病变后方直接切除患者为胸、腰段Ⅲa(3例)、Ⅲb(2例)型.34例一期全切,1例未能全部切除.术后患者症状明显缓解,神经功能均未见明显缺失.33例患者获得3～90个月(42.5±33.3个月)随访,其中32例复查MRI未发现病变复发,1例脂肪肉瘤复发.VAS评分术前为7.7±1.6分,术后1个月2.4±1.3分,末次随访时1.2±1.1分.结论:基于胸腰椎椎旁占位性病变的部位和大小,进行合理临床分型,并制定相应的手术治疗策略能够获得良好的临床疗效.

Objective:To investigate therole of serum amylase elevation in the evaluation of diabetic ketoacidosis (DKA) patients and the related factors affecting serum amylase (AMS) levels in patients with diabetic ketoacidosis.Methods:A total of 249 patients with DKA who were admitted to the First Affiliated Hospital of Zhengzhou University from November 2011 to August 2018 were selected for this retrospective study. The patients were divided into the normal group ( n=176) and the elevated group ( n=73) according to the AMS level measured by fasting venous blood samples. The enumeration data such as sex, type of DM, diabetic vascular complications, number of deaths, number of ICU monitoring, and number of acute pancreatitis (AP) after discharge were analyzed by chi-square test or Fisher test, and the measurement data such as age, pH, HbA1c, CO 2CP, Ca 2+, BUN, and Scr were analyzed by independent sample t test to compare the difference between the two groups. Results:The intensive care unit (ICU) monitoring rate was 50.7%, the median length of stay in ICU was 4 days, the median length of hospital stay was 14 days, and the median treatment cost was 28 000 yuan, which were higher in the elevated group than those in the normal group ( P<0.05). There were no significant differences in mortality, AP during hospitalization, and the probability of AP after discharge between the elevated group and the normal group ( P>0.05). The duration of diabetes, the number of previous DKA, the incidence of diabetic vascular complications, HbA1c, pH, BUN, and Scr in the elevated group were all higher than those in the normal group ( P<0.01 or P<0.05). Conclusions:DKA patients with elevated AMS are more likely to be admitted to ICU, and the length of stay in ICU, total length of hospital stay and total cost of treatment are all increased. Where as the overall mortality rate during hospitalization and the likelihood of AP after discharge are not increased.

[目的]对儿童股骨远端骨肉瘤(San-Julian分型Ⅲ型)行关节囊外整块切除联合使用保留胫骨骨骺可延长肿瘤型人工关节假体重建术的早期临床研究.[方法] 2017年10月～2018年10月,共6例患儿在本院行穿刺活检病理学证实为骨肉瘤,影像学分型,均为San-Julian分型Ⅲ型,其中男2例,女4例;年龄7～ 12岁;左侧3例,右侧3例.均在本科接受关节囊外整块切除联合保留胫骨骨骺可延长肿瘤型人工假体重建术,术后指导患儿进行功能锻炼,伤口2周后拆线,再过1周后即给予术后的规范化化疗,并进行随访.[结果]6例患儿手术时间分别为2.5 h、3h、3h、3.2 h、3.5 h和4h,平均(3.20±1.14)h;术中出血量600～1 200ml,平均(850.00±484.77) ml.6例患儿均获随访9～21个月,平均(15.17±9.53)个月.根据美国骨肿瘤学会评分系统(Musculoskeletal Tumor Society,MSTS),术后3个月功能评分18～27分,平均(22.83±7.67)分,患儿肢体功能达到良好标准.末次随访,患肢膝关节屈曲角度90°～110°共4例,110°～130°共2例,伸直均能达到180°;共5例患儿双下肢长度相差＜1.5 cm,1例患儿双下肢长度差异约为2.5 cm.随访期间所有患儿均未出现局部复发及肺部转移.[结论]通过严格把握手术适应证,对于股骨远端骨肉瘤San-Julian分型中的Ⅲ型的患儿,关节囊外切除联合使用保留胫骨骨骺可延长肿瘤型人工关节假体重建术提供了一种安全有效的手术方式.

[目的]骨水泥治疗脊柱成骨性转移瘤的安全性存在争议,本研究通过分析前列腺癌晚期脊柱转移患者,探讨经皮椎体成形术的有效性和安全性.[方法]2009年9月～2019年5月28例接受经皮椎体成形术联合药物治疗的患者,平均年龄(72.52±4.71)岁,所有患者随访时间至少3个月.通过疼痛视觉模拟评分(vAs)、体力状况卡氏评分(KPS)、功能障碍评分(ODI)的变化情况评价经皮椎体成形术的临床疗效.[结果]骨水泥用量1.5～4 ml,平均(2.31:±.0.73) ml,骨水泥填充情况良好,均无渗漏,术后卧床时间平均(2.61±0.53)d.VAS评分、ODI评分术后1d,术后1、3个月及最后一次随访与术前相比明显降低,KPS基线评分增加,差异均有统计学意义(P＜0.05);止痛药用量术后明显减少,差异有统计学意义(P＜0.05).[结论]对于脊柱成骨性转移瘤的患者,骨水泥填充可以快速缓解疼痛,提高患者生存质量,可作为有效、安全的微创治疗术式.

目的 探讨丙酮酸激酶M2(PKM2)蛋白、葡萄糖转运蛋白-1(GLUT-1)在胃腺癌中的表达意义.方法 选取收治的胃腺癌患者132例作为研究对象,取癌组织作为观察组、癌旁组织作为对照组,对比两组及不同TNM分期PKM2蛋白、GLUT-1表达水平,分析其在胃癌组织中的表达意义.结果 观察组PKM2蛋白阳性表达率为75.76％(100/132)、GLUT-1阳性表达率为78.79％(104/132),高于对照组的9.09％(12/132)、10.61％(14/132),差异显著(P<0.05);Ⅳ期PKM2蛋白、GLUT-1阳性表达率高于Ⅲ期,Ⅲ期高于Ⅱ期,Ⅱ期高于Ⅰ期(P<0.05);经Spearman分析,PKM2蛋白、GLUT-1阳性表达率与TNM分期呈正相关(P<0.05).结论 PKM2蛋白、GLUT-1表达水平与胃腺癌TNM分期关系密切,检测二者表达水平可为临床诊断及预后评估提供数据支持.

Objective:To explore the risk factors of prognosis and develop a nomogram to predict the risk of short-term mortality in patients with acute respiratory failure (ARF).Methods:The clinical data of 827 ARF patients in MIMIC-III database and 296 ARF patients in the Second Affiliated Hospital of Wenzhou Medical University from January 2010 to December 2019 were collected and analyzed by the univariate and multivariable logistic regression analysis. A nomogram was developed to predict 30-day mortality in ARF patients according to the risk factors.Results:Multivariate logistic regression analysis showed that the lowest systolic blood pressure, the highest respiratory rate, the lowest fingertip oxygen saturation, the highest bilirubin, the lowest albumin and 24 h urine volume were independent risk factors of ARF ( OR=0.988, 1.028, 0.980, 0.750, 1.059 and 0.999, all P<0.05). Combined with the clinical situation, mechanical ventilation, the highest heart rate and age were also included in the nomogram model. The AUC of ROC curve in this model was 0.752 (95% CI: 0.719-0.784), the AUC of ROC curve in external validation set was 0.666 (95% CI: 0.621-0.711). The calibration curves both in the primary cohort and validation cohort were close to the standard curve. Conclusions:This nomogram has good differentiation and generalization, which is helpful for clinicians to accurately evaluate the mortality risk of ARF.

Objective:To explore the methods, complications and follow-up results of limb salvage for primary malignant tumors of the femoral shaft.Methods:From October 2006 to October 2019, 41 cases of primary malignant tumors of femoral shaft were analyzed retrospectively, 37 cases were followed up, including 22 males and 15 females, aged 8-46 years with an average age of 20.56±4.72 years old. All the lesions were located in the femoral shaft, and The Enneking stage was IIB. Tumor lesion ranged in the femur from 10 cm to 24 cm, and there was no pathological fracture. Pre-operative puncture biopsy was performed in all cases.22 cases were confirmed as osteosarcoma, 8 as chondrosarcoma, 5 as Ewing sarcoma, 2 as malignant fibrous histiocytoma. Neoadjuvant chemotherapy has been used to treat both osteosarcoma and Ewing sarcoma. Among the 37 patients, 8 cases of patients received total femoral prosthesis replacement, 14 cases of intramedullary nail fixation with allogenic bone graft, 8 cases of allograft-prosthetic composite (APC), and 7 cases of 3D printed prosthesis. The limb function was graded according to MSTS 93 system.Results:37 out of 41 patients were followed up, and the average follow-up time was 23.15±16.74 months (6-62 months). There were 9 patients with pulmonary metastases (26.47%), among which 6 patients passed away due to multiple metastases. 28 patients survived without tumor at last follow-up. The MSTS score was18-28 (average of 22.55±2.57). The average score of 3D printing prosthesis group was 27±1.74, allogeneic bone transplantation group was 22.85±2.59, total femoral prosthesis replacement group was 20.25±2.25, and the APC prosthesis group was 20.5±2.07. There was statistical difference between 3D printing group and other groups. The overall excellent and good rate of lower limb function was 79.41%, in which the 3D group was 100%, allogeneic bone group was 78.5%, APC prosthesis group was 87.5%, total femoral prosthesis replacement group was 62.5%. There was no statistical difference in the excellent and good rate of limb function among the groups. There weren't any cases of hip joint dislocation after total femoral prosthesis replacement. Delayed union of bone healing was seen in 3 cases of allogeneic bone transplantation and 2 cases APC patients. One patient suffered from the postoperative hemorrhage-related diseases-sciatic nerve compression, and the nerve recovered after emergency debridement. One patient suffered from poor wound healing. The overall complication rate was 24.32% (9/37).Conclusion:The patients with primary malignant tumors of the femoral shaft can effectively recover the lower extremity function by choosing the appropriate surgical scheme, in order to achieve the purpose of limb preservation and improve the quality of life of the patients. 3D printing prosthesis provides a new choice in the treatment of femoral shaft tumors.