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Objective:To perform a prospective cohort study to identify individual susceptibility of glucocorticoid (GC) -associated osteonecrosis of the femoral head (GA-ONFH) and their clinical and genetic risk factors. Methods:The present prospective cohort study enrolled patients who received their first GC therapy between July 2015 and January 2018 at Zhongshan Hospital. All patients did not receive any GC treatment before enrollment. Further, they planned to start GC treatment with the dose (equivalent prednisone) of ≥30 mg/d, lasted ≥3 weeks, or pulse dose ≥200 mg/d, lasted ≥3 d. Blood samples were collected before GC treatment to evaluate bone metabolism and its released factors. Hip MRI was performed at the 1st, 3rd, 6th, 12th and 24th month to diagnose GA-ONFH. All patients were followed-up for ≥2 years. The endpoint was regarded as diagnosis of GA-ONFH or completion of 2 years follow-up. Lasso regression was performed to determine which clinical features were associated with GA-ONFH. A nested case-control sub-cohort (A, n=12) was established prospectively based on the main cohort by 1∶1 matching. Whole exome sequencing was performed to screen differential and functional candidate single nucleotide polymorphisms and insertion-deletions (SNP/InDels). Another sub-cohort (B, n=50) was constructed retrospectively in patients with GA-ONFH and non-ONFH patients received standard high dose GC treatment for more than two years. The candidate SNP/InDels were verified by Sanger sequencing based on the patients from sub-cohort B. Results:A total of 96 patients were enrolled of which 88 of them (32 males and 56 females, mean age 42.30 years) completed follow-up. Eight cases (9.1%) were diagnosed with GA-ONFH. The median time from the start of GC therapy to the diagnosis of ONFH was 53.00(34.00,13.50) days. The baseline characteristics, such as age, sex and body mass index, indicated no significant difference between the ONFH group and the non-ONFH group. The cumulative GC dose of the ONFH patients in the first month was higher than that of non-ONFH [32.74(29.55, 47.05) mg/kg vs. 24.00(21.10, 29.45) mg/kg, Z=-2.410, P=0.016]. However, there was no significant difference of patients who underwent pulse therapy (37.5% vs. 10.0%, adjusted χ 2=2.829, P=0.093). The ratio of serum apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) in patients with ONFH was higher than that in non-ONFH group before GC use [0.95(0.80, 1.50) vs. 0.70(0.60, 0.80), Z=-2.875, P=0.000]. Due to the multicollinearity, Lasso regression model was performed to reduce overfitting. All variables were included in the model. The results suggested that higher ApoB/ApoA1 ratio, lower serum β-c-terminal telopeptide (β-CTX) and higher cumulative GC dose in the first month were the top three risk factors of GA-ONFH. This model had an accuracy of 0.982 in internal validation. Seven differential candidate SNP/InDels were found by whole exome sequencing of sub-cohort A. We further verified these SNP/InDels in sub-cohort B. The patients with COLEC12 mutation (rs2305027, G1816A) were at risk of GA-ONFH ( OR=6.00, 95% CI: 1.17, 30.73). Conclusion:Higher first-month GC dose, lower serum β-CTX level before treatment, higher ApoB/ApoA1 ratio and COLEC12 mutation (rs2305027, G1816A) could increase the risk of GA-ONFH.
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Malignant melanoma is the most aggressive form of skin cancer and insensitive to almost all clinical cancer therapies.Apoptosis,necrosis,autophagy,senescence and mitotic catastrophe,all of these different manners constitute cell death way.Chemotherapy induces cell death at last by the signal pathway of apoptosis,so the reason for treatment failure of melanoma is the establishment of the mechanism of apoptotic resistance in melanoma cells.This article reviews the death style of melanoma cells and the progress of targeting small molecule drug therapy for malignant melanoma.
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Objective:To analyze the pathologic types and clinical characteristics of lymphoma in Shandong, China. Methods:The clinical data of lymphoma patients admitted from September 2011 to September 2014 in Shandong Cancer Hospital and the Affiliat-ed Hospital of Shandong Academy of Medical Sciences were retrospectively analyzed. Data included age, sex, pathologic classification, and onset locus of lymphoma. Results:The clinical data of 520 lymphoma cases were collected. The ratio of male to female was 1.2:1, and the median age was 51 years old. Among these patients, 67 cases (12.9%) were Hodgkin's lymphoma (HL), whereas 453 cases (87.1%) were non-Hodgkin's lymphoma (NHL). Among NHL cases, 75.9% were B-cell NHL and 24.1% were T/ natural killer-cell NHL. Nodular sclerosis classical Hodgkin's lymphoma was the most common pathologic type of HL, comprising 52.2%. The age of HL onset did not present twin peaks. In NHL, 245 cases (54.1%of NHL) were diffuse large B-cell lymphoma (DLBCL). The constituent ra-tio of DLBCL was higher than in other countries and regions (18%to 42.7%), in which the ratio of male to female was 0.9:1, and the age of onset was slightly earlier (median age was 54 years old). Lymph nodes in the cervical region were the most commonly involved in the disease, and NHL extranodal onset was frequently observed. Conclusion:Among the 520 cases of lymphoma, DLBCL is the most common subtype. Most subtypes show male predominance, but female predominance was observed for DLBCL. The commonly involved sites of extranodal lymphoma are the nasal cavity and gastrointestinal tract.
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Objective To examine the expression variation of toll-like receptor 2 (TLR 2)in peripheral blood monocytes of patients with rheumatoid arthritis (RA)and explore its role in pathogenesis of RA.Methods Mean fluorescence intensity of TLR 2 expression on the surface of peripheral blood monocytes were detected by flow cytometry and independent samples t-test was used for statistical analysis.Results Mean fluorescence intensity of TLR 2 expression on the surface of peripheral blood CD14+ CD45+ cell of RA patients was 357.68±86.97,while in normal control it was 223.71±87.70.It indicates that the expression of TLR 2 on peripheral blood monocytes in patients with active disease was higher than in normal indi-viduals (t=5.478,P=0.005,P<0.01).Conclusion Increase of the TLR 2 expression on peripheral blood monocytes in patients with active disease suggests its import role in pathogenesis of RA.
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MicroRNA (miRNA) is a kind of naturally occurring short non-coding small molecular RNA,which regulates gene expression at the posttranscriptional level through its sequence complementation with target mRNAs.Researches have shown that different malignant tumors,including diffuse large B cell lymphoma,have specific miRNA expression profiles.Therefore,miRNAs expression level of specimens of body fluids and tissues is expected to be the new indicator for assessing diffuse large B cell lymphoma.
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Objective To study and analyze the development velocity of impaired glucose regulation (IGR)and its influencing factors for nursing interventions to prevent the development of IGR to type 2 diabetes.Methods 155 cases of type 2 diabetes patients of more than one year duration participated in questionnaire survey.According to the length of IGR duration,the sample was divided into rapid,medium and slow velocity groups which were compared by questionnaire on IGR groups of the influencing factors.Results 91.6％ IGR patients had family history of diabetes; the rate of cognition in slow group was higher than the others.Overweight and obesity rate in rapid group were 61.7％ and 17.0％,higher than the other two groups.The main diet structure was subsistence mode in medium and slow velocity group;movement and occasional movement ratio in rapid velocity was low.The excellent sleep quality rate in medium velocity group was higher than the other two groups.Conclusions Family history of type 2 diabetes and metabolic disorders are the important factors influencing the program duration in patients with IGR.Diet habits and exercise can directly affect the metabolic state.More nursing assessment,intervention and reasonable supervision should be given to the rapid velocity group in order to slow down the development velocity to type 2 diabetes mellitus.
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Objective To explore the effects of pneumoperitioneal on respiratory function and haemodynamic and liver function in laparoscopic hcpatectomy under general anesthesia. Methods changes of pneumoperitioneal on respiratory function and haemodynamic were analyzed retrospectively in 15 LH.Results SBP、DBP、HR were higher significant after C02 insufflation(P＜0.05).SpO2 were lower significant after CO2 insufflation(P＜0.05),there was significant difference between after 30 min after deflation and before CO2 insufflation(P＞0.05);VT were lower significant after CO2 insumation(P＜0.05),there was no significant difference between after 30 min after deflation and before CO2 insufflation (P＞0.05);Ppeak were higher significant after CO2 insufflation(P＜0.05),there was no significant difference between after 30 min afterdefiation anal before CO2 insufflation (P＞0.05). Conclusion there were significant effects of pneumoperitioneal on respiratory function and haemodynamic in laparoscopic hepatectomy under general anesthesia,there weren,t significant effects of liver function.
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OBJECTIVE:To discuss the application of biomedical fibrin glue in laparoscopic hepatectomy(LH).METHO-DS:40 patients undergoing LH were randomly divided into biomedical fibrin glue group(trial group) and control group:the patients in trial group underwent LH,transection of liver by ultrasound knife,with the transected liver surface sprayed with biomedical fibrin glue guided by laparoscope;the control group underwent routine LH only.The postoperative blood loss and bile leakage were observed by T-tube drainage.RESULTS:In the biomedical fibrin glue group,the operations for all the patients were successful,the postoperative recovery was smooth,the postoperative drainage volume,RBC in the drained fluid,level of hemoglobin and length of hospital stay were all significantly lower than in the control group(P
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OBJECTIVE:To observe the clinical effects of interstitial implantation of 125 I particles together with5-FU slow-release particles for advanced pancreatic cancer.METHODS:A total of12patients with advanced pancreatic cancer whose tumors were unsuitable to be resected were implanted with5-FU slow-releasing particles and then 125 I particles.The intensity of radioactive 125 I particles was0.4mCi～0.5mCi,the matched peripheral dose was60Gy～100Gy,and an average of16 125 I particles and1000mg5-FU were used for each patient.RESULTS:Relief of pain was achieved in all the subjects,with the effective rates of odynolysis at91.7%.The tumor size in all the subjects was diminished to some degree,with local control rate at83.3%.1y survival rate was25%.CONCLUSION:Interstitial implantation of 125 I particles and5-FU slow-release particles for advanced pancreatic cancer is simple,safe and effective.
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Objective: To provide theoretical basis and experimental evidence for diagnosis and therapy of dental pulp indirect injuries by gunshot wounds. Methods: The levels of IL 8 in different stages were studied using immunohistochemical method to evaluate its functions in inflammation process of dental pulps. Results: IL 8 expression was detected by immunohistochemical assay in postwound conditions. The results showed that positive staining of IL 8 was observed predominantly on infiltrating inflammatory cells, vascular endothelial cells and some fibroblasts, which was consistent with the recruitment and activation of inflammatory cells, and with the severity duration of pulpal tissue injury and response. Conclusion: These results indicate that IL 8 is involved in regulating physiologic responses of dental pulp injuries in maxillofacial trauma by a projectile. [