BACKGROUND:GPNMB is a type I transmembrane protein, and emerging evidence supports the relationship between GPNMB and cancers. OBJECTIVE:Through a comprehensive pan-cancer analysis, we examined the expression levels, prognostic significance, and mutation profiles of GPNMB in different cancer types. Subsequently, utilizing in vitro experiments, we elucidated the impact of GPNMB in endometrial cancer (EC). METHODS:TIMER2, GEPIA2, UALCAN and cBioPortal were used to analyze the expression pattern, prognostic values, and mutation status of GPNMB. HEC-1B and Ishikawa cells were used to conduct in vitro analyses of GPNMB overexpression. GeneMANIA and TIMER2 were used to evaluate the potential functions and correlations between GPNMB expression and tumor-infiltrating immune cells in EC. RESULTS:GPNMB was found to be highly expressed in multiple cancers, where it was associated with poor prognosis. Additionally, GPNMB was downregulated at both mRNA and protein levels in EC. Overexpression of GPNMB inhibited the proliferation, migration, and invasion of HEC-1B and Ishikawa cells. Functional analysis showed that GPNMB was enriched in pathways associated with regulation of plasma lipoprotein particle levels. The expression of GPNMB was positively connected with B cell, CD8+ T cell, CD4+ T cell, Macrophage, Neutrophil, and Dendritic cell levels. CONCLUSION:Through pan-cancer analysis, we identified the antitumor effect of GPNMB in EC and predicted the potential mechanisms between GPNMB expression and EC.

PURPOSE:Kashin-Beck disease (KBD) is an endemic osteoarthropathy affecting the epiphyseal growth plate of multiple joints in young and adolescent patients. Previous studies have focused on the visible deformed extremities instead of the spinal radiological features, especially the atlantoaxial joint. The aim of this study was to determine the prevalence and radiographic features of atlantoaxial dislocation (AAD) in adult patients with KBD.METHODS:This study was conducted on KBD patients in three typical endemic counties between October 2017 and November 2019. The patients were evaluated by collecting basic information, clinical signs and symptoms. They underwent dynamic cervical radiography, by which AAD was diagnosed. For those patients with confirmed or suspected AAD, computed tomography (CT) imaging was performed to observe the odontoid morphology and degenerative changes in the lateral atlantoaxial joints. Radiographic evaluations were reviewed to determine the prevalence and features of AAD.RESULTS:A total of 39 (14.6%) of 267 KBD patients were diagnosed with AAD. Compared with the non-AAD patients, the detection rate of AAD was associated with a longer disease duration and stage and was not associated with age, sex or BMI. Thirty-two patients had symptoms at the neck or neurological manifestations, while seven had no symptoms. There were three types of morphologies of the odontoid process in AAD patients: separating in 19 cases, hypoplastic in 15 cases and intact in five cases. Anterior dislocation was noted in 29 cases, and posterior dislocation was noted in ten cases. Thirty-four cases were reducible, and five were irreducible. The lateral atlantoaxial joints had different severities of degenerative changes in 17 cases.CONCLUSIONS:This study revealed that the prevalence of AAD was 14.6% in adult KBD patients. The radiographic features of AAD include manifestations of odontoid dysplasia and chronic degenerative changes in atlantoaxial joints. KBD patients with severe stages and longer disease duration were more vulnerable to the occurrence of AAD. We postulate that this atlantoaxial anomaly might originate from chondronecrosis of the epiphyseal growth plate of the odontoid process in young and adolescent individuals. This study may provide a clinical reference to help clinicians screen, prevent and treat AAD in adult patients with KBD.

目的 探讨采用颈后路内固定植骨融合术治疗寰枢椎脱位的临床疗效.方法 回顾性分析2015年1月至2019年10月陕西省人民医院骨科收治的寰枢椎脱位患者18例,其中男10例,女8例,年龄24～71岁,平均(49.50±13.00)岁.根据术前颈椎动力位片评估、颅骨牵引实验,将18例患者分为寰枢椎不稳(instability)、可复性寰枢椎脱位(reducible dislocation)、不可复性寰枢椎脱位(irreducible dislocation),寰枢椎不稳共6例(33.33％),行经后路寰枢椎椎弓根螺钉固定术;可复性寰枢椎脱位共8例(44.44％),行颈后路寰枢椎内固定植骨融合术;不可复性寰枢椎脱位4例(22.22％),行前路经口寰枢关节松解、后路复位固定融合术.通过术前和末次随访时患者日本骨科学会(Japanese orthopaedic association,JOA)评分及颈椎功能障碍指数(neck disability index,NDI)评估颈脊髓神经功能改善程度及临床疗效.通过术前及术后末次随访影像学检查,比较寰齿前间隙(atlantodental interval,ADI)、寰椎平面脊髓有效空间(space available for the spinal cord,SAC)、斜坡枢椎角(clivus-axial angle,CAA),评估寰枢椎复位及脊髓压迫解除情况.结果 所有18例患者均顺利完成手术,并获得随访,随访时间平均12～48个月,平均(22.40±6.80)个月.16例为经后路寰枢椎椎弓根螺钉固定植骨融合术,2例为枕颈固定融合术.术中无脊髓、神经及椎动脉损伤,无椎弓根劈裂等并发症发生.术后取髂骨区伤口渗液1例,经对症处理后好转.末次随访时,JOA评分为(15.39±1.42)分,较术前(10.22±1.35)分明显升高.NDI评分末次随访为(16.22±7.17)分,较术前(35.72±5.70)分明显降低.ADI由术前(5.53±0.81)mm 降至末次随访时(0.88±0.71)mm,SAC 由术前(7.72±2.24)mm 升至术后(14.56±1.69)mm,CAA由术前(124.11±9.15).升至末次随访时(148.83±5.38)°.以上指标术后与术前相比差异均有统计学意义(P＜0.05).术后影像学随访提示所有患者寰枢椎脱位复位满意,脊髓减压充分.随访中影像学检查示植骨区获得骨性融合,无内固定松动、断裂或拔出等情况出现.结论 根据术前颈椎动力位X线片评估及全麻下颅骨牵引实验,对寰枢椎脱位进行分型,可指导实施相应的手术策略.颈后路内固定植骨融合术治疗寰枢椎脱位可有效复位,改善脊髓压迫症状,临床疗效令人满意.

目的:探究人乳头瘤病毒(HPV)分型检查联合液基薄层细胞学检测(TCT)在宫颈病变早期筛查的临床应用价值.方法:回顾性分析2018年1月-2020年1月本院门诊收治的可疑宫颈病变患者418例,其中行HPV分型检查200例为对照组,行HPV联合TCT检测218例为观察组,均行阴道镜活检并以病理学检测结果为"金标准".分析两种检测方案在宫颈病变早期筛查价值.结果:筛查异常阳性率对照组(54.0％)低于观察组(72.5％)(P＜0.01);与组织病理学结果对比,对照组阳性符合率(75.9％)低于观察组(88.0％)(P = 0.010),阴性预测值对照组(95.7％)与观察组(96.7％)无差异(P = 0.954).ROC曲线显示,HPV检测宫颈病变的AUC为0.816,特异度为70.3％,灵敏度为67.9％;HPV+TCT检测宫颈病变的AUC为0.871,特异度为90.2％,灵敏度为88.5％.结论:HPV分型检查联合TCT检测能够提高宫颈病变早期筛查的灵敏性和特异性,提高宫颈病变早期筛查效能,对临床筛查宫颈病变有一定应用价值.

目的 探讨后路姑息性椎板减压椎弓根螺钉内固定联合病变椎体骨水泥成形术治疗胸腰椎转移瘤的临床疗效.方法 回顾性分析2017年8月至2019年12月我院收治的胸腰椎转移瘤致胸腰背部疼痛、双下肢出现神经压迫症状的患者21例,其中男9例,女12例;年龄45～76岁,平均(58.8±7.84)岁.所有患者采用经后路姑息性肿瘤切除、椎管减压,椎弓根螺钉内固定系统重建脊柱序列稳定,病变椎体经椎弓根注入骨水泥.评价术前1d、术后1周及末次随访时疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI),评估患者胸腰背部疼痛及生活质量改善情况.结果 所有21例患者均顺利完成手术,肿瘤病变椎体强化过程中发生骨水泥渗漏7例,无放热效应及毒性反应引起的并发症.所有患者均获得随访,随访时间为6～12个月,平均(9.0±1.5)个月.术后胸腰背部疼痛明显缓解,VAS由术前(8.40±1.28)分下降至术后1周(2.52±0.60)分,末次随访时为(2.86±1.04)分;ODI由术前(69.43±7.45)％下降至术后1周(24.16±4.41)％,末次随访时为(26.48±5.22)％.术后胸腰背痛VAS、ODI与术前相比明显改善,差异均有统计学意义(P＜0.05).无内固定松动、断裂或拔出,骨水泥无移位.肿瘤局部复发4例,其中1例术后8个月随访时Frankel分级为B级,未再次手术;另外3例有神经根压迫症状,继续行局部放疗或化疗.结论 后路姑息性椎板减压椎弓根螺钉内固定联合病变椎体骨水泥成形术,能明显缓解晚期胸腰椎转移瘤患者疼痛症状,改善功能,提高生活质量,该术式可获得满意的短期疗效.

Objective To determine the expression level of MicroRNA-15b in premenopausal endometrial carcinoma and analyze its relationship with pathological parameters. Methods From March 2016 to June 2018, 64 cases of premenopausal endometrial carcinoma tissues and 28 cases of premenopausal normal endometrial tissues that were surgically resected and examined in Shaanxi People′s Hospital were collected. The expression of microrna- 15b was detected by reverse transcription polymerase chain reaction (rt-pcr), and the relationship between the expression level of microrna-15b and the pathological parameters of premenopausal endometrial carcinoma was analyzed. Results The relative expression level of microrna-15b in premenopausal endometrial cancer (1.38 ± 0.28) was lower than that in normal endometrial tissue (2.55 ± 0.36), and the difference was statistically significant (P<0.05). MicroRNA-15b expression level in premenopausal endometrial carcinoma tissue of Ⅲ period, infiltration depth 1/2 or more muscle layer, lymph node metastasis, ER negative and negative PR was significantly lower than that of stage Ⅰ ～ Ⅱ, < 1/2 muscularis infiltration depth, no lymph node metastasis, and positive ER and PR(P < 0.05). However, there was no significant difference in the expression level of microrna-15b in premenopausal endometrial cancer tissues with different ages, pathological types and pathological grades (P>0.05). Conclusions The expression of MicroRNA-15b in premenopausal endometrial carcinoma is low, and it is closely related to pathological stage, depth of invasion, lymph node metastasis and hormone receptor. Up-regulation of microRNA-15b expression may become a new treatment direction for premenopausal endometrial cancer.

目的 探讨腹腔镜子宫肌瘤剥除术的临床应用价值.方法 分析我院2014年1月至2016年6月采取腹腔镜子宫肌瘤剥除术治疗的121例子宫肌瘤患者的临床资料,观察其治疗效果.结果 121例患者均在腹腔镜下完成手术,除1例患者因术中发现系子宫腺肌瘤而行腹腔镜全子宫切除术,其余120例均行肌瘤剥除术.肌瘤剥除术后患者均月经正常,术后3个月B超检查,子宫恢复正常大小,肌层无明显异常回声.结论 在微创理念贯穿的外科时代,腹腔镜子宫肌瘤剥除术是一种安全可行、临床效果佳的微创术式,值得推广应用.

Objective To explore the application value of CarboprostSuppositories pretreatment in laparoscopic hysteromyomectomy.Methods A total of 100 patients diagnosed as hysteromyoma Shaanxi Provincial People's Hospital from December 2013 to December 2016 were randomly and equally allocated to have laparoscopic ectomy with or without pretreatment of CarboprostSuppositories (routine group vs pretreatment group,n =50).Hemoglobin and erythrocrit were detected before and after operation.Surgical indexes,exhaust time,hospitalization time,complications and recurrence were analyzed.Results Levels of hemoglobin and hematocrit 1 d after surgery in the pretreatment group were significantly higher than those in the routine group[(126 ± 13)g/L vs (115 ± 11)g/L,(43 ± 4) ％ vs (39 ± 4) ％] (both P ＜ 0.05).Intraoperative blood loss,operative time,postoperative drainage,hospital stay time in the pretreatment group were significantly less/shorter than those in the routine group(all P ＜ 0.05).Incidence of complications in the pretreatment group was significantly lower than that in the routine group [8.0％ (4/50) vs 22.0％ (11/50)] (P ＜ 0.05).No recurrence cases were observed in 6 months after operation.Conclusion CarboprostSuppositories pretreatment can effectively reduce intraoperative bleeding,alleviate postoperative anemia and reduce complications in patients undergoing laparoscopic hysteromyomectomy.

目的 分析80例子宫内膜不典型增生患者的临床特征,观察患者合并子宫内膜癌情况,探讨子宫内膜不典型增生合并子宫内膜癌的临床特征及可能的危险因素.方法 选取2015年9月-2018年9月陕西省人民医院因子宫内膜不典型增生接受全子宫切除术治疗的80例患者为研究对象,回顾性分析其临床资料,采用临床资料收集问卷记录患者相关临床资料,包括年龄、身高、体质量、婚育史、内科合并疾病、术前子宫内膜厚度、术前相关血清学指标表达情况等.根据患者术后病理诊断结果将合并子宫内膜癌者纳入研究组,其他单纯子宫内膜不典型增生者纳入对照组,观察并记录子宫内膜不典型增生患者子宫内膜癌合并情况,对比两组患者临床特征,分析子宫内膜不典型增生患者合并子宫内膜癌的危险因素.结果 80例接受全子宫切除术的子宫内膜不典型增生患者中有25例合并子宫内膜癌,患病率为31.25％ (25/80);25例子宫内膜不典型增生合并子宫内膜癌患者接受全子宫切除术后病理结果证实多为高分化者,且Ⅰ期患者占主要比重,多为浅肌层浸润,且多为子宫内膜样腺癌.多因素Logistic回归分析结果显示,高龄、绝经、术前内膜病理结果重度是子宫内膜不典型增生患者合并子宫内膜癌的危险因素(OR＞1,均P＜0.05).结论 子宫内膜不典型增生患者合并子宫内膜癌风险高,多表现为高分化的Ⅰ期子宫内膜腺样癌,可能受年龄、绝经、子宫内膜病理结果等因素影响,应引起临床重视.

目的:探讨V-Loc TM180可吸收缝合线在腹腔镜子宫肌瘤剔除术中的应用价值.方法:74例子宫肌瘤患者分为试验组(n=30)和对照组(n=43),试验组术中应用V-Loc TM180可吸收线缝合,对照组术中应用2-0号薇乔可吸收缝线缝合;比较2组患者手术平均时间、术中平均出血量、术中血红蛋白(hb)下降数值及盆腔引流时间,比较2组患者术后最高体温、体温恢复时间、下床时间、住院时间及术后中转开腹例数、术后发热例数及肛门排气时间.结果:与对照组比较,试验组术中指标手术平均时间、术中出血量、Hb下降数值、盆腔引流时间明显降低(P＜0.05),术后2组患者最高体温、体温恢复时间、下床时间及术后住院时间比较,差异无统计学意义(P＞0.05);术后两组患者术后中转开腹及术后发热例数,肛门排气时间比较,差异无统计学意义(P＞0.05).结论:V-Loc TM180可吸收缝合线适合腹腔镜子宫肌瘤剔除术,效果优于薇乔可吸收缝缝合线.

目的 分析通过阴道进行子宫切除在妇产科的临床应用效果.方法 对妇产科通过检查符合手术指征的20例经阴道行子宫切除术的患者按照手术步骤进行子宫切除,同时和妇产科临床上同一个时期进行20例腹腔子宫切除术的患者进行对照研究.结果 阴式子宫切除术的手术患者在手术期间在出血量方面和经腹子宫切除相比较的效果比较差,但是在后期恢复的过程中疼痛度、排气、住院时间等方面效果还是很明显的,差异有统计学意义(P<0.05).结论 阴式子宫切除术在妇产科的临床效果较好,患者术后恢复时间短且并发症少.

ABSTRACT:Objective To study the expressions of adrenomedullin (ADM)andβ-catenin in human osteosarcoma of different differentiation grading and their clinical significance.Methods We chose 33 cases of human osteosarcoma with different pathological grading (14 cases of high differentiation grading and 1 9 cases of low grading)and 10 cases of human osteochondroma to detect the expressions of ADM protein,total (T)β-catenin and phosphorylated (P)β-catenin using immunohistochemical method. Results The expression of ADM was detected in the cytoplasm.In osteosarcomas of higher and lower differentiation grading,the positive rate of ADM was 57.1% (8/14)and 100% (1 9/1 9),respectively,with significant differences (P =0.003<0.05).The expression of T-β-catenin was observed in both the cytoplasm and the nucleus in higher differentiation grading and in only cytoplasm in lower grading.In osteosarcomas of higher and lower differentiation grading,the positive rate of T-β-catenin was 85.7%(12/14)and 94.7% (18/1 9),with no significant difference (P =0.561>0.05).The expression of P-β-catenin was detected in the cytoplasm.In osteosarcomas of higher and lower differentiation grading,the positive rate of P-β-catenin was 35.7% (5/14)and 78.9% (1 5/1 9),with a significant difference (P =0.029 <0.05).There was a significant correlation between ADM and P-β-catenin (r =0.424,P =0.025<0.05),but no significant correlation between ADM and T-β-catenin (P = 0.078 > 0.05 )or between T-β-catenin and P-β-catenin (P = 0.052 > 0.05 ).Conclusion The expressions of ADM and P-β-catenin proteins and the different distributions of expression of T-β-catenin protein in cytoplasm and/or nucleus are important indicators for judging the pathological grading of osteo-sarcoma.

Adrenomedullin (ADM), a multifunctional regulatory peptide, is potentially induced by hypoxia in physiological and pathological tissues, including many types of malignant tumors. Recent research has demonstrated that ADM expression is highly associated with the prognosis and disease severity of human osteosarcoma. However, the effect of ADM on the apoptosis of osteosarcoma cells and its possible mechanism remain to be elucidated. In the present study, we observed that mRNA and protein levels of ADM were increased in human osteosarcoma SOSP-F5M2 cells under a hypoxic microenvironment induced by cobalt chloride (CoCl2) in a time-dependent manner. Treatment with ADM significantly blunted hypoxic-induced apoptosis, evaluated by Hoechst 33342 staining and Annexin V-FITC/PI labeling. The expression of B-cell lymphoma-2 (Bcl-2) was increased by administration of ADM; meanwhile, this effect was reversed by exogenously adding U0126, a selective inhibitor of MEK or ADM22-52 (ADM-specific receptor antagonist). These results demonstrated that ADM acted as a survival factor to inhibit hypoxic-induced apoptosis via interacting with its receptors CRLR-RAMP (2,3) in osteosarcoma cells. The anti-apoptotic function of ADM was found to be mediated by upregulation of the expression of Bcl-2 partially through activation of the MEK/ERK1/2 signaling pathway. Therefore, targeting of the ADM/ADM acceptors/ERK1/2/Bcl-2 pathway may provide a potential strategy through which to induce the apoptosis of osteosarcoma cells.