Background Immunotherapy is a novel hotspot for the treatment of pancreatic adenocarcinoma (PAAD). However, potential biomarkers which could identify the inflamed tumor microenvironment (TME) are urgently required. Methods In the present study, we measured the levels of B7-H3, B7-H4, and major tumor-infiltrating immune cells (TIICs) using bioinformatics analyses and immunohistochemistry (IHC) staining on PAAD samples represented in the tissue microarray (TMA) format. Statistical analysis and figures exhibition were performed using R 4.1.0, SPSS 26.0, and GraphPad Prism 6.0. Results B7-H3 and B7-H4 were up-regulated in PAAD compared with para-tumor tissues, and their expression exhibited no tight correlation in PAAD tissues. B7-H3 and B7-H4 were lowly expressed in well-differentiated PAAD tissues and correlated with poorly differentiated grades. Besides, single B7-H3 or B7-H4 expression exhibited limited prognostic value, but co-deficiency of B7-H3 and B7-H4 predicted a better prognosis in PAAD. Moreover, co-deficiency of B7-H3 and B7-H4 indicated immuno-hot tumors with high CD8 + T cell infiltration. Conclusions Overall, combined B7-H3 and B7-H4 expression is a promising stratification strategy to assess prognosis and immunogenicity in PAAD, which could be used as a novel classifier in clinical practice.

目的:探究肝癌标志物磷脂酰肌醇蛋白聚糖3(glypican-3,GPC3)与miR-202相互调控的分子机制.方法:取126例临床肝癌组织标本及血清样本,免疫组化检测GPC3表达,qRT-PCR检测循环miR-202的水平;培养肝癌HepG2细胞,转染miR-202 mimics,qRT-PCR检测miR-202表达,Western blot检测GPC3表达;CCK8实验检测miR-202 mimics对HepG2细胞增殖活性的影响;Luciferase报告基因实验检测miR-202对GPC3的调控.结果:临床126例肝癌GPC3总阳性率为77.78％,其表达水平与患者性别、年龄、肿瘤大小、临床分期无关,但与细胞组织学分化类型以及微血管侵犯高度相关.肝癌患者循环miR-202呈低水平状态,且与癌组织GPC3表达水平呈负相关关系.上调HepG2细胞中miR-202表达,GPC3表达随之下调,且癌细胞增殖受抑制.Luciferase实验证实miR-202可直接负调控GPC3的表达.结论:GPC3受miR-202的直接调控,GPC3高表达与肝癌恶性生物学表征密切相关.靶向GPC3的治疗策略如能辅助提高miR-202的功能,将可能产生协同抗肝癌的效果.

Objective To explore the effects of surgery treatment on the diagnostic delay of Crohn's dis-ease(CD)in early stage. Methods The effects of surgical operation on diagnostic delay of early stage CD were an-alyzed,and the risk factors that in high surgical rate on early diagnosis were evaluated by comparing the surgical cases with non-surgical cases before the diagnosis of CD.Results The ratio of male and female in the total 215 pa-tients with CD was 1.7 to 1.There were 114 cases with complications including 75 cases with surgery before diagno-sis,39 cases with non-surgical complications and 101 cases with no complications.The age of onset and age of di-agnosis in the three groups were significantly different(P < 0.05),and there was no significant difference in the time of diagnosis(P > 0.05). The most common complications were perianal lesion(p,abscesses and/or fistula) (49.1%),intestinal obstruction(23.7%),and the diseases of appendix(12.3%).The most common causes of pre-operative diagnosis were perianal lesion(38.7%),the lesion of appendix(17.3%),intestinal obstruction(16.0%) and the abdominal surgery(10.5%)whereas intestinal perforation is most easily recognized by histopathology. The rate of male surgery was high whereas the incidence of female complications was low. All three groups of lesions were found to be in ileocolon(L3)in which the operation group with pure small intestine was significantly higher than that in the group with no complications and in the group with non-surgical complications(P<0.05).Also the proportion of diseases behaving stricturing(B2)+penetrating(B3)was 60%,but the complication group behaving inflammatory(B1)+B2 was 87.2%,the group with no complications behaving B1 reached 68.3%.and The compli-cation group behaving P was 61.5% which was higher than the operation group(44.0%).There was a significant dif-ference between the three groups(P<0.001).Conclusions Diagnostic delay of CD on the early was significantly associated with surgery operation. Male,age 17~40,lesion site L3 or intestinal-type,disease behaving B2 and B3,were the high risk factors for preoperative surgery;while women,aged 17-40,with or without chronic compli-cations,were more likely to obtain early diagnosis,less surgical risk,and relatively good prognosis.Perianal lesion were early characteristic expressions of CD and could be used as an regularization indicator for screening.The sec-ond was the recurrent intestinal obstruction.most of the stomach resection and the repeated diarrhea after gallblad-der should be awared of CD.

Objective To investigate the effect of different endoscopic sclerotherapy for esophageal variceal bleed-ing caused by rupture. Methods 66 cases of liver cirrhosis with esophageal variceal bleeding were randomly divided into treatment group A, endoscopic lauromacrogol sclerotherapy group B and endoscopic aethoxysklerol 1% German agents in treatment of group C, then observe the successful hemostasis, the curative effect and follow-up of patients with varices, bleeding, fever and other adverse conditions. Results Group B and group C with success rate of hemostasis has obvious advantages compared with group A, <0.05, the difference was statistically significant;total effective rate of group B was significantly higher than that in group A, < 0.05, the difference was statistically sig-nificant; early period of rebleeding, delayed again bleeding in group B was occurred less than that of group C, >0.05, the difference was not statistically significant; adverse conditions such as fever, ulcers, pain in group B was less than that in group C, <0.05, the difference was statistically significant. Conclusion Endoscopic lauromacrogol injection sclerotherapy for esophageal variceal bleeding is a safe, fast speed, timely, effective and repeatable treat-ment, it is worthy of promoting clinical application.

目的:探讨低分子肝素(LMWH)、胰岛素联合血浆置换(PE)治疗高脂血症性急性胰腺炎(HLAP)的临床效果.方法:选取2010年1月至2015年1月无锡市人民医院收治的100例HLAP患者,按随机数字表法将其分为对照组和观察组,每组50例.对照组采取LMWH、胰岛素治疗,观察组在此基础上联合PE治疗.比较两组患者的临床疗效及各项治疗指标情况.结果:治疗后,观察组总有效率为94.0％高于对照组的70.0％,差异具有统计学意义(P＜0.05).与治疗前相比,治疗后两组患者血甘油三酯(TG)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)、血清淀粉酶水平及氧合指数(PaO2/FiO2)、Balthazar CT评分均明显改善,差异均具有统计学意义(P＜0.05);观察组治疗后血TG、IL6、TNF-α、血清淀粉酶水平及Bahhazar CT评分均低于对照组,而PaO2/FiO2高于对照组,差异均具有统计学意义(P＜0.05);观察组症状缓解时间及血清淀粉酶转阴时间均较对照组短(P ＜0.05).结论:LMWH、胰岛素联合PE治疗HLAP的临床效果显著,不仅症状明显缓解,且血脂浓度及炎症因子水平均明显下调,值得临床推广应用.

目的：探讨癔球症患者食管动力特点。方法选取2004年6月至2013年6月我院消化科门诊就诊的24例癔球症患者，同期体检患者20例作为健康对照组，采用MMS Solar－2020多导胃肠功能测定仪进行食管压力测定，比较两组LESP、LESR、LEPP、UEPP、食管体异常收缩百分数、UESP、UESR等指标。结果癔球症组UEPP、食管体部异常收缩百分数、UESP明显高于健康对照组，LESR、UESR低于健康对照组（P＜0．05），差异有显著性。结论癔球症患者均存在一定程度的食管动力异常。

甘草酸制剂具有保护肝细胞、减轻炎症反应、改善肝功能的作用,目前已用于临床治疗各种肝病[1].作为国家一类新药,异甘草酸镁与以往的甘草酸制剂比较,具有构型优势、疗效突出、安全性高、半衰期长、应用范围广等特点[2-3].本研究回顾性分析了异甘草酸镁对肝脏手术和脂肪肝患者的肝功能保护作用,现报道如下.

肝硬化病人大量腹水时,采取单次穿刺放腹水治疗或者用中心静脉导管留置引流腹水的治疗方法,临床上这两种治疗方法都会在放腹水后在穿刺的针眼处有长时间的腹水渗漏,浸湿覆盖的敷料、腹带和棉被,需频繁更换敷料及棉被,增加工作量,同时增加感染机会并严重影响了病人的休息和舒适感.鉴此,笔者从2010年至今对严重腹水放液后的患者利用人工肛门袋粘贴在穿刺针眼处,克服了上述弊端.现将方法介绍如下.

Epidemiological studies have evaluated the association between ataxia telangiectasia mutated (ATM) gene polymorphisms and breast cancer risk. However, published data are still inconclusive. We performed a meta-analysis for the first time, based on currently available evidence, by searching PubMed, ISI Web of Knowledge, and Embase databases to derive a more precise assessment of the relationship. Following the inclusion and exclusion criteria, nine publications were included in this meta-analysis. Of these studies, one had a deviation from the Hardy-Weinberg equilibrium (HWE) at a statistical significance level of 0.01 in controls, and another two had no available data for HWE. We observed that the ATM 5557G>A polymorphism was significantly correlated with breast cancer risk when all studies were pooled into the meta-analysis (recessive model: odds ratio, OR = 0.67; 95% confidence interval (CI) 0.51-0.89). For the ATM IVS38-8T>C polymorphism, no significant association was found in the allele contrast, heterozygote codominant, and dominant models. There were no available data to perform this meta-analysis in the homozygote codominant and recessive models. For the ATM IVS1+19A>T polymorphism, a significant association with breast cancer risk was found in the allele contrast model (C vs. T: OR = 1.60; 95% CI 1.02-2.52). For the IVS34+60G>A polymorphism, no significant association was found in the allele contrast, codominant, dominant, and recessive models. Egger's test did not suggest any evidence of publication bias (P = 0.47 for the recessive model). In conclusion, there is limited evidence to indicate that ATM polymorphisms are associated with increased risk of breast cancer.

Objective To investigate the clinical efficacy of high dose dexamethasone-predominant regimens in newly diagnosed patients with multiple myeloma(MM) and renal failure(RF).Methods Medical records of 40 patients with MM and RF newly diagnosed were reviewed.Of 40 patients,22 cases(given A) were given the regimen of high dose dexamethasone and 18 cases(given B) were given additional thalidomide and/or bortezomib.Results The overall response rate(complete remission and partial remission) to chemotherapy were 50.0% and there were no significant defferences between two groups(P 0.05).The effective rate of response to the treatment was higher in the patients who achieved renal function reversal than those who did not(P 0.05).There was no significant difference in the rate of RF reversal in two groups(P 0.05).However,the median time to RF reversal was shorter in group B than that in group A (P 0.01).Logistic regression multivariate analysis showed that serum creatinine level was associated with renal function recovery.ConclusionThe addition of thalidomide and/or bortezomib to high dose dexamethasone induces a more rapid renal function reversal.Serum creatinine level is an independent factor associated with renal function recovery.

目的观察参附注射液减轻消化道肿瘤患者化疗后毒副作用的疗效及其对生活质量的影响。方法将80例晚期消化道肿瘤患者随机分为两组,治疗组予参附注射液联合化疗,对照组予单纯化疗;比较两组临床疗效、毒副作用、外周血中白细胞数、淋巴细胞总数及T细胞亚群的变化。结果两组治疗效果相近,治疗组在减轻化疗毒副作用,改善KPS评分,提高机体免疫功能方面优于对照组。结论参附注射液能减轻化疗药物对机体的毒副作用,增强机体的免疫功能,提高患者的生活质量。