【摘要】 目的 分析慢性乙肝患者血清生化、血常规、血清病毒载量及乙型肝炎标志物与肝组织炎症分级、纤维化分期的相关性,以找到有较好相关性的临床指标；通过肝活检证实临床诊断与病理诊断的符合情况,探讨肝活检的重要性及价值。方法 对2007年6月—2009年8月在传染科行肝穿刺活检的359例慢性乙型肝炎患者的血清丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、总胆红素(TB)、白蛋白(ALB)、球蛋白(GLB)等指标,白细胞(WBC)、血小板(PLT)等指标,凝血酶原时间(PT),血清HBV DNA定量及乙肝标志物的不同状态与肝穿病理分级、分期的相关性进行分析；统计慢性乙肝患者临床诊断与病理诊断的符合情况。结果 肝组织炎症分级及纤维化分期之间有一定相关性(Plt;0.05)；血清ALT、AST、ALB、GLB、PT有助于判断肝组织炎症程度(Plt;0.05)；ALB、GLB、WBC、PLT、PT对肝组织纤维化程度的评估有意义(Plt;0.05)；HBV DNA复制水平与肝组织炎症及纤维化无关(Pgt;0.05),但存在负相关的趋势；纤维化程度高的患者HBeAg阴性组较HBeAg阳性组更多(Plt;0.05)。慢性乙型肝炎患者临床与病理诊断总符合率为56.3％。结论 动态监测慢性乙肝患者肝功能、血常规、凝血常规在一定程度上有助于判断疾病的程度,但要确诊肝组织炎症分级及纤维化分期,肝组织病理活检是必需的。
腺癌是危及女性生命的恶性肿瘤之一，长期以来人们对乳腺癌的肿瘤标志物的研究非常重视，尤其近年来对癌基因、抑癌基因、各种异种蛋白及肿瘤抗原的深入研究，应用乳腺癌肿瘤标志物发现早期病变、预测肿瘤的预后、检测乳腺癌的转移复发、针对某些肿瘤标志物的药物开发和应用都取得了很大的进展。
ObjectiveTo review the recent advances in the pancreatic cancer stem cells field and identify the research trend in future. MethodsCurrent literatures on pancreatic cancer stem cells were collected and reviewed. ResultsPancreatic cancer was a highly lethal disease and was usually diagnosed at a late stage, for which there were few effective therapies. Emerging evidence had suggested that pancreatic cancer cells proposed a heterogeneous organization. A subpopulation of stem celllike cells sustains tumor growth, propagation, metastasis, and resistance to standard chemotherapy. Cancer stem cells were identified based on their expression of different sets of cell surface markers and functional characteristics. Some important signaling pathways which maintain self-renewal and metastasis were upregulated in pancreatic cancer stem cells. ConclusionsCurrent findings clearly suggest that specific elimination of cancer stem cells is possible and therapeutically relevant. An improved understanding of the biological behavior of such cells may lead to the development of novel diagnosis and treatment regimens for pancreatic cancer.
The high incidence and mortality of acute kidney injury (AKI) have brought great challenges to global health. In recent years, China has made some achievements in the epidemiology, risk factors and treatment of AKI. However, further prevention and treatment are still facing difficulties. Based on current new ideas and research progress, this paper summarized and analyzed the management throughout the whole course of AKI, including AKI risk assessment, early prevention, early identification, treatment and follow-up. The aim is to make Chinese nephrologists realize the focus of AKI prevention and treatment, standardize the management of AKI, and explore the prevention and treatment strategy suitable for AKI in China.
ObjectiveTo explore the values of CA19-9, CA242, CEA, and CA125 single or combined detection on clinical diagnosis and prognosis for patients with pancreatic cancer. MethodsSerum tumor markers CA199, CA242, CEA, and CA125 of 63 patients with pancreatic cancer, 33 patients with cancer of bile duct, and 27 patients with benign pancreatic disease were detected, and those patients were followed up after operation. ResultsThe levels of CA19-9, CA242, CEA, and CA125 in patients with pancreatic cancer were significantly higher than those in patients with benign pancreatic disease and cancer of bile duct (Plt;0.05). The sensitivity of CA19-9 alone was the highest in the four tumor markers for the patients with pancreatic cancer 〔79.4% (50/63)〕, but the specificity (61.9%) was lower than that of CA242 (83.3%) and CEA (80.0%). The specificity of combined detection of CA199+CA242+CEA was the highest 〔93.3% (56/60)〕. The level of CA19-9 in carcinoma of body/tail of pancreas was significantly higher than that of carcinoma of pancreas head or whole pancreas (Plt;0.05). The serum levels of CA19-9 and CA242 in patients with stage Ⅳ were significantly higher than those in stage Ⅰ or Ⅱ/Ⅲ (Plt;0.05). Fifteen patients were lost to follow up, 48 patients were followed up 2－12 months with an average 6 months. The levels of CA242 and CA199 in patients with pancreatic cancer on 0.5 month and 3 months after operation were lower than those before operation (Plt;0.05). ConclusionsSingle detection of CA19-9 can improve the diagnostic sensitivity, and combined detection of tumor markers CA199+CA242+CEA can improve the diagnostic specificity. CA19-9 or CA242 is a valuable marker for evaluating treatment effects and estimating prognosis.
ObjectiveTo explore the diagnostic value of exhaled volatile organic compounds (VOCs) for cystic fibrosis (CF). MethodsA systematic search was conducted in PubMed, EMbase, Web of Science, Cochrane Library, CNKI, Wanfang, VIP, and SinoMed databases up to August 7, 2024. Studies that met the inclusion criteria were selected for data extraction and quality assessment. The quality of included studies was assessed by the Newcastle-Ottawa Scale (NOS), and the risk of bias and applicability of included prediction model studies were assessed by the prediction model risk of bias assessment tool (PROBAST). ResultsA total of 10 studies were included, among which 5 studies only identified specific exhaled VOCs in CF patients, and another 5 developed 7 CF risk prediction models based on the identification of VOCs in CF. The included studies reported a total of 75 exhaled VOCs, most of which belonged to the categories of acylcarnitines, aldehydes, acids, and esters. Most models (n=6, 85.7%) only included exhaled VOCs as predictive factors, and only one model included factors other than VOCs, including forced expiratory flow at 75% of forced vital capacity (FEF75) and modified Medical Research Council scale for the assessment of dyspnea (mMRC). The accuracy of the models ranged from 77% to 100%, and the area under the receiver operating characteristic curve ranged from 0.771 to 0.988. None of the included studies provided information on the calibration of the models. The results of the Prediction Model Risk of Bias Assessment Tool (PROBAST) showed that the overall bias risk of all predictive model studies was high, and the overall applicability was unclear. ConclusionThe exhaled VOCs reported in the included studies showed significant heterogeneity, and more research is needed to explore specific compounds for CF. In addition, risk prediction models based on exhaled VOCs have certain value in the diagnosis of CF, but the overall bias risk is relatively high and needs further optimization from aspects such as model construction and validation.
ObjectiveTo explore the relationship of platelet-activating factors and vascular endothelial activity markers to lacunar infarction (LI).MethodsA total of 100 inpatients diagnosed with LI in Shaanxi Provincial People’s Hospital between March 2018 and February 2019 were included, and 100 matched healthy controls were collected. Basic information, clinical baseline data, laboratory examinations, cerebral MRI and treatment data were collected after admission. The platelet-activating factors (platelet membrane glycoprotein Ⅱb/Ⅲa receptor and P-selectin) and vascular endothelial activity markers [von Willebrand factor (vWF), homocysteine (HCY), and high-sensitivity C-reactive protein (hsCRP)] levels of patients with LI were detected one month and three months after onset, and those of the control group were decteted when they were selected. SPSS 25.0 software was used for statistical analysis.ResultsAt one month after onset, there was no statistically significant difference in the levels of platelet activating factors between the LI group and the control group [platelet membrane glycoprotein Ⅱb/Ⅲa receptor: (2.84±1.00)% vs. (2.59±0.96)%, P=0.065; P-selectin: (3.05±0.63)% vs. (2.98±0.59)%, P=0.419], while the differences in the levels of vascular endothelial activity markers between the two groups were statistically significant [vWF: (141.80±17.60) vs. (124.63±10.65) ng/mL, P<0.001; hsCRP: (5.53±1.37) vs. (2.17±0.55) mg/L, P<0.001; HCY: (18.76±4.07) vs. (15.81±2.63) mmol/L, P<0.001]. At three months after onset, 94 LI patients were followed up. The levels of vWF and hsCRP between the 100 patients one month after onset and the 94 patients three months after onset were statistically different [(vWF: (141.80±17.60) vs. (134.86±13.35) ng/mL, P=0.002; hsCRP: (5.53±1.37) vs. (2.63±0.55) mg/L, P<0.001], but there was no statistically significant difference between the two time points in the levels of HCY or platelet-activating factors (P>0.05).ConclusionChronic platelet activation may not play a core role in LI pathophysiology, and endothelial dysfunction may be one of the pathological mechanisms of LI.
Objective To analyze the clinical characteristics of individuals with high hepatitis B virus (HBV) pregenomic RNA (pgRNA), and further explore the value of pgRNA in the management of patients with chronic hepatitis B. Methods From December 1st, 2020 to April 1st, 2022, chronic hepatitis B patients who had been treated with nucleotide analogues for a long time and followed up in the Hepatitis Clinic of the Center of Infectious Diseases, West China Hospital, Sichuan University were included, and the clinical characteristics of chronic hepatitis B patients with high pgRNA were analyzed and summarized. Results A total of 107 patients were included. Male patients accounted for 66.4%, with an average age of 44.02 years. There were no statistically significant differences in gender, age, aspartate transaminase, alanine transaminase, γ-glutamyl transferase, HBV surface antigen, proportion of patients with HBV e antigen ≥0.1 U/mL, HBV DNA, and alpha fetoprotein between the high and low pgRNA groups (P>0.05). The proportion of patients with HBV surface antigen<100 U/mL in the high pgRNA group was lower than that in the low pgRNA group (4.4% vs. 22.6%, P<0.05). Conclusion The proportion of chronic hepatitis B patients with high pgRNA whose HBV surface antigen≥100 U/mL is higher.
As emerging means of cancer treatment, immunotherapy is the fourth major therapeutic strategy after surgery, chemoradiotherapy, and targeted therapy, which benefits patients a lot. It has been more than 100 years for the medical community exploring how to harness the immune system to fight cancer. Since the advent of ipilimumab in 2011, the first checkpoint inhibitor, cancer immunotherapy represented by checkpoint inhibitors has exploded. Several programmed death protein-1 and programmed cell death ligand-1 inhibitors have successively been approved to treat advanced non-small cell lung cancer in the second-line setting or even the first-line setting. But checkpoint inhibitors therapy has only achieved limited benefit at the present stage. Exploring potential predictive biomarkers and mechanisms of resistance are in need of further consideration to optimize immunotherapy.