目的 探讨Stanford B型胸主动脉夹层腔内修复(TEVAR)术后不同类型内漏的产生机制及处理措施。方法 收集整理2008年9月—2017年2月间在我院诊断为Stanford B型胸主动脉夹层并接受TEVAR术治疗的105例患者的临床及影像资料,分析术中及术后出现内漏的原因,根据内漏来源及渗漏量给予不同处理,观察处理后内漏的变化情况。结果 术中出现急性内漏11例,包括Ⅰ型内漏8例(7.6%)和Ⅱ型内漏3例(2.8%);迟发内漏3例,包括Ⅰ型内漏1例(1.0%)和Ⅱ型内漏2例(1.9%),内漏总发生率为13.3%。术后患者未出现支架移位、截瘫、肾动脉缺血等严重并发症。结论 根据内漏产生的原因不同,内漏分为5型,其中Ⅰ型及Ⅱ型内漏较为常见,不同类型内漏处理方式不同,正确判断内漏类型是合理、有效处理内漏的前提。

Objective To investigate the causes of different types of endoleak after thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection, and to discuss its management. Methods The clinical data and imaging data of 105 patients with Stanford type B aortic dissection, who were admitted to authors' hospital during the period from September 2008 to February 2017 to receive TEVAR, were collected and reviewed. Reasons of intraoperative endoleak or after operation were analyzed, different treatments for the source of endoleak and leakage were taken and the conversions followed were observed. Results Acute endoleak was occurred in 11 patients during operation, including endoleak typeⅠ (n=8,7.6%)and endoleak type Ⅱ (n=3,2.8%). Delayed endoleak was seen in 3 patients, including endoleak typeⅠ (n=1,1.0%)and endoleak type Ⅱ (n=2,1.9%). Both in-operative and postoperative endoleak occurred in 14 patients (13.3%). After TEVAR, no serious complications such as displacement of stent, paraplegia or renal artery ischemia occurred. Conclusion According to the different reasons, endoleak can be divided into five types, among them, type Ⅰ and type Ⅱ are most common. Different endoleak should be handle in different ways.Correct judgment of endoleak type is the premise of reasonable and effective treatment for endoleak.

目的 比较压力控制通气(PCV)中不同吸气流速对单肺通气(OLV)患者呼吸功能及炎症因子的影响。方法 本研究为2018—2019年对75例单肺通气患者的前瞻性研究。患者在麻醉和单肺通气(OLV)后随机分为吸气流量30 L/min(A组)、50 L/min(B组)或70 L/min(C组)。比较OLV前(T₀)、OLV后30 min(T₁)、60 min(T₂)和120 min(T₃)的呼吸力学、呼吸功能、血流动力学和血气分析,中心静脉血检测分析IL- 6、IL-8、TNF-α和sICAM-1,观察术后3天肺部并发症和ARDS的发生情况。结果 三组一般情况、血流动力学指标差异均无统计学意义(P＞0.05);B组、C组PaCO₂较A组降低(P<0.05);与T₀时比较,T₁-T₃时三组PaO_2、SVO₂均降低(P<0.05);三组PH、SO₂和HB差异均无统计学意义(P>0.05)。与A组比较,B组、C组ΔVT增大(P<0.05);三组Ppeak差异无统计学意义;与A组比较,B组、C组PEEP均增大(P<0.05);与A组比较,T₁-T₃时B组、C组V_D/V_T减少(P>0.05);与T₀比较,T₁-T₃时三组Qs/Qt增加(P<0.05);与A组比较,T₁-T₃时B组、C组Cdyn增大(P<0.05);与T₀相比,T₁-T₃时三组PaO₂/FiO₂降低(P<0.05);与T₀相比,T₁-T₃时三组IL-6、IL-8、TNF-α和sICAM-1的浓度增多(P<0.05),但A组、B组低于C组(P<0.05)。三组患者发生术后肺部并发症和ARDS差异均无统计学意义。结论 在PCV模式下通过增加吸气流速能增加VT,减少死腔率,促进 CO₂的交换,并且改善肺动态顺应性,但并不能很好的改善氧合及肺内分流。吸气流速50 mL/L在较小炎症反应的情况下达到上述改善呼吸功能和呼吸力学,可推荐应用于进行OLV患者。

Objective The effects of different inspiratory velocity PCV on respiratory function and inflammatory factors in patients with one-lung ventilation OLV were compared. Methods This was a prospective study of 75 patients with one-lung ventilation in 2018-2019. The subjects were randomized to the inspiratory velocity 30(group A),50(group B)or 70(group C)L/min after anesthesia and one-lung ventilation OLV. Respiratory mechanics,respiratory function,hemodynamics and blood gas parameters were compared between the three groups pre-OLV(T₀)and after 30 (T₁), 60 (T₂), and 120 (T₃)minutes of OLV.Center venous blood was collected to measure interleukin (IL)-6, IL-8,tumor necrosis factor (TNF)-α,andsoluble intercellular adhesion molecule-1 levels.Observation of pulmonary complications and occurrence of ARDS 3 days after operation were made. Results Hemodynamic and general patient status were similar between the three groups (all P>0.05). PaCO₂was lower in the group B and group C compared with the group A (P<0.05). Compared with T₀, PaO₂ and SVO₂were lower at T₁-T₃of the three groups(P<0.05). PH, SO2 and HB were similar between the three groups (all P>0.05).ΔVT was higher in the group B and group C compared with the group A (P<0.05);Ppeak were similar between the three groups (all P>0.05). PEEP was higher in the group B and group C compared with the group A (P<0.05); V_D/V_T decreased in the group B and group C compared with the group A (P<0.05).Compared with T₀,Qs/Qt increased at T₁-T₃ of the three groups (all P<0.05). Cdyn increased at T₁-T₃ of the group B and group C(all P<0.05). PaO₂/FiO₂ decreased at T₁-T₃ of the three groups(all P<0.05).Compared with T₀, the concentrations of Il-6, Il-8, TNF-α and sICAM-1 increased at T₁-T₃of three groups (P<0.05), and in group A and group B were lower than those in group C (P<0.05).The number of patients who had postoperative pulmonary complications PPCS or acute respiratory distress syndrome(ARDS)were similar between the three groups (all P>0.05). Conclusion In PCV mode, it can increase VT by increasing the inspiratory velocity, reduce the V_D/V_T, promote the exchange of CO₂, and increase the Cdyn, but it cannot improve the oxygenation and Qs/Qt.Inspiratory velocity of 50 mL/L to achieve the above improvement in respiratory function and respiratory mechanics in the case of a smaller inflammatory response. It may be recommended for use in patients undergoing OLV.

目的 比较一线伊马替尼疗效欠佳的慢性髓性白血病慢性期(CML-CP)患者,继续伊马替尼原方案或转换为尼洛替尼治疗后的疗效及安全性。方法 收集伊马替尼疗效欠佳的 45 例患者,分为伊马替尼组22例及尼洛替尼转换组23例,22例伊马替尼组患者继续接受原方案伊马替尼治疗,剂量均为400 mg qd,又将尼洛替尼转换组分为早期尼洛替尼转换组7例,晚期尼洛替尼组转换有16例。尼洛替尼转换组的23例患者接受尼洛替尼的剂量均为400 mg,q12h。所有入组患者首诊时测定 Sokal 评分,在治疗过程中随访观察定期监测血液学、细胞遗传学及分子学缓解情况(FISH 和 RQ-PCR),并对患者用药后的基本情况、临床表现及不良反应进行记录。结果 转换尼罗替尼治疗3个月时,早期尼洛替尼转换组中国际标准化 BCR-ABL1融合基因转录本水平(BCR-ABL1^IS)＜10%的患者有 5 例(71.4%),晚期尼洛替尼转换组BCR-ABL1^IS＜10%的患者有6例(37.5%),差异无统计学意义(P＞0.05)。中位观察6(3～12)个月,尼罗替尼组中有17例(73.9%)获得部分细胞遗传学反应,9例(39.1%)患者获得主要分子学反应。伊马替尼组中有9例(40.9%)获得部分细胞遗传学反应,2例(9.1%)患者获得主要分子学反应,尼洛替尼组部分细胞遗传学反应、主要分子学反应患者优于伊马替尼组(P值分别为0.027、0.020)。45例患者中达到完全细胞遗传学反应的患者与未达到完全细胞遗传学反应相比,Sokal 评分偏低(P=0.032)。结论 尼洛替尼可使伊马替尼疗效欠佳的 CML-CP 患者达到更好的疗效,因此需要及时对伊马替尼疗效欠佳的 CML-CP 患者进行评估后及时更换为尼洛替尼等二代酪氨酸激酶抑制剂。

Objective To assess the clinical efficacy and safety of original scheme or switching to nilotinib in patients with chronic myeloid leukemia in chronic phase(CML-CP)with suboptimal response of first-line imatinib. Methods 45 patients with suboptimal response of imatinib were collected and divided into 22 patients who continued to use original scheme and 23 patients who switched to nilotinib therapy. All the 22 patients of imatinib group received imatinib 400 mg once a day. And the 23 patients of nilotinib group were divided into early switch group and late switch group. Early switch group had 7 patients, late switch group had 16 patients. Both early and late switch to nilotinib group were subsequently to nilotinib 400 mg q12h. Sokal scores of all the enrolled patients were measured at the first diagnosis. Hematology, cytogenetics and molecular remission (FISH and RQ-PCR)were monitored, and the patients' basic information, clinical manifestations and adverse reactions were recorded regularly during the treatment. Results After switching to nilotinib for 3 months,there were 5 patients (71.4%)whose BCR-ABL1^IS<10% in the early nilotinib switch group, while 6 patients (37.5%)in the late nilotenib switch group.There was no statistical difference(P>0.05).With a median observation period of 6(3～12)months,there were 17 (73.9%)patients achieved partial cytogenetic response and 9 (39.1%)patients achieved major molecular response in the nilotinib group,there were 9 patients (40.9%)achieved partial cytogenetic response and 2 patients (9.1%)achieved major molecular response in the imatinib group. Patients who achieved partial cytogenetic response and major molecular response in the nilotinib group were more than those in the imatinib group (P values were 0.027 and 0.020, respectively).Sokal scores of 45 patients who had achieved complete cytogenetic response were lower than those who had achieved it (P=0.032). Conclusion Early switch to nitotinib is feasible and effective to patients who didn't have optimal response to imatinib. It is necessary to assess patients regularly in order to have the proper timing switching patients to nilotinib therapy.

目的 探讨高频经颅磁刺激治疗对 PSD 伴失眠患者的抑郁情绪及睡眠质量的疗效。方法 对63例PSD患者随机分为联合组32例(10Hz高频rTMS+艾司西酞普兰)及药物组31例(艾司西酞普兰+假刺激),每周5次,共治疗4周。于治疗前及治疗后4周末分别对两组患者进行HAMD、PSQI评分及多导睡眠监测。。结果 rTMS 治疗前,2组HAMD、PSQI评分及睡眠参数比较均无差异;治疗后第4周末,两组HAMD评分、PSQI评分、总睡眠时间、睡眠效率及快眼动睡眠期比例均较治疗前改善;研究组HAMD评分下降幅度较对照组明显,而PSQI评分下降幅度及相关睡眠参数改善无差异。结论 高频rTMS治疗对PSD的抑郁症状疗效更明显,而对睡眠质量及睡眠结构的改善则与药物治疗疗效相当。

Objective To investigate the effect of high frequency transcranial magnetic stimulation on depression and sleep quality in poststroke depression patients with insomnia. Methods 63 patients with PSD were randomly divided into observation group (n=32)and control group (n=31). Both groups were treated by 10~20 mg escitalopram citalopram for 4 weeks. The patients in observation group also accepted 10 Hz rTMS 10 times (i.e., as a course), while the patients in control group were treated by sham stimulation. At the baseline and 4th week, the 17-item Hamilton depression scale (17-HAMD), Pittsburgh Sleep Quality Index (PSQI)and polysomnography (PSG)were evaluated. Results The sleep parameters, PSQI scores and HAMD scores among two groups had no significant difference at baseline. After 4 weeks treatment, the HAMD score, PSQI score, total sleep duration, sleep efficiency and proportion of rapid eye movement sleep in both groups were improved compared with those before treatment. The descend range of HAMD score in observation group was larger than that in control group (t=2.590,P=0.012), while the descend range of PSQI scores(t=0.897,P=0.373)and the change of the sleep parameters in the two group had no obvious difference. Conclusion High frequency rTMS has better curative effect than antidepressant therapy on depressive symptoms of PSD,while there was no difference on the effect to improve the sleep quality and sleep structure of PSD between these two treatments.

目的 探讨细胞毒素-1(Cytotoxin-1,CTX-1)对人卵巢癌SKOV-3细胞增殖凋亡的影响。方法 利用0、4、8、12 μg/mL浓度 CTX-1处理SKOV-3细胞6、12、24 h,MTS法检测细胞活性,8 μg/mL CTX-1处理SKOV-3细胞24、48 h,Hoechst-33258荧光染色观察细胞核染色质形态。取处理 6、12 h 后细胞,利用流式细胞仪检测SKOV-3细胞的凋亡率。结果 4、8、12 μg/mL的CTX-1可抑制SKOV-3细胞活性及增殖,呈时间-剂量依赖。Hoechst-33258染色观察可见细胞染色质呈固缩或碎裂状、染色质着色不均、核形态各异,随时间增加而更趋明显。8 μg/mL CTX-1处理细胞,6 h细胞坏死率为(1.90±0. 27)%,晚期凋亡率为(10.96±1. 56)%,而早期凋亡率为(1.52±0.39)%;12 h细胞坏死率为(10.62±0.96)%,晚期凋亡率(15.07±1.23)%,而早期凋亡率为(1.88±0.17)%,与对照组比较,差异有统计学意义 (P<0.0 1)。结论 CTX-1可以抑制人卵巢癌细胞活性、抑制其体外增殖、诱导其发生凋亡,该作用呈剂量依赖和时间依赖,主要引起细胞晚期凋亡和坏死。

Objective To investigate the effect of cytotoxin-1 (CTX-1)on the proliferation and apoptosis of ovarian cancer SKOV-3 cells. Methods SKOV-3 cells were treated with CTX-1 at concentrations of 0, 4, 8, 12 μg/mL for 6, 12, and 24 hours respectively. Cell viability was measured by MTS method. SKOV-3 cells were treated with 8 μg/mL CTX-1 for 24 and 48 hours, by Hoechst-33258 fluorescence staining to observe the morphology of nuclear chromatin. The apoptotic rate of SKOV-3 cells was detected by flow cytometry after 6 and 12 hours of treatment. Results CTX-1 at 4, 8, and 12 μg/mL inhibited the activity and proliferation of SKOV-3 cells in a time-dose-dependent manner. Hoechst-33258 staining observation showed that the apoptotic cell chromatin was condensed or fragmented chromatin, the chromatin was unevenly colored, and the nuclear morphology was different. It became more obvious with time. 8 μg/mL CTX-1 treated cells, the 6 h cell necrosis rate was (1.90±0.27)%, the late apoptosis rate was (10.96±1.56)%, and the early apoptosis rate was (1.52±0.39)%; 12 hours cell necrosis rate was (10.62±0.96)%, late apoptosis rate was (15.07±1.23)%, and early apoptosis rate was (1.88±0.17)%, compared with the control group, the difference was statistically significant (P<0.01). Conclusion CTX-1 may inhibit the activity of human ovarian cancer cells, inhibit its proliferation in vitro, and induce its apoptosis. The effect is dose-dependent and time-dependent. Mainly it causes late apoptosis and necrosis of cells.

目的 探究叶酸对子宫内膜癌作用的靶基因。方法 通过转录组测序筛选叶酸作用下子宫内膜癌细胞中的差异基因,生存分析寻找对子宫内膜癌具有生存意义的差异基因,qPCR及western blot检测其在叶酸作用下的表达。结果 转录组测序发现36个差异基因,生存分析发现FMN1,TRIB3,INHBE及NRBP2的表达对子宫内膜癌具有生存意义,qPCR及western blot验证叶酸作用下NRBP2在子宫内膜癌细胞中的表达下调。结论 叶酸下调子宫内膜癌中NRBP2基因的表达,NRBP2可能是叶酸对子宫内膜癌作用的靶标。

Objective To explore the target genes of folic acid on endometrial carcinoma. Methods The differential genes in endometrial cancer cells treated with folic acid were screened by transcriptome sequencing. Survival analysis was used to find the differential genes with survival significance. QPCR and western blot were used to detect their expression under the action of folic acid. Results 36 differential genes were found by transcriptional sequencing. Survival analysis showed that the expression of FMN1,TRIB3,INHBE and NRBP2 had survival significance in endometrial carcinoma. QPCR and western blot confirmed that the expression of NRBP2 in endometrial cancer cells was down-regulated by folic acid. Conclusion Folic acid down-regulates the expression of NRBP2 gene in endometrial carcinoma, and NRBP2 may be the target of the effect of folic acid on endometrial carcinoma.

目的 探讨二氢丹参酮Ⅰ在胃癌细胞中的抗癌作用。方法 采用 3-(4,5-二甲基噻唑-2)-2,5-二苯基四氮唑溴盐法(MTT法)测定细胞活力。流式细胞术检测细胞内活性氧(ROS)水平。荧光法测定Caspase活性。裸鼠胃癌模型验证DHTS的抗癌活性。结果 MTT实验结果表明,DHTS对HCG27和AGS细胞活力具有明显的剂量依赖性和时间依赖性。在DHTS处理的HCG27和AGS细胞中,细胞内ROS水平升高,凋亡细胞增多。 在DHTS处理的HCG27和AGS细胞中发现caspase-3和caspase-8活性增高,caspase-9活性不变。用N -乙酰半胱氨酸阻断ROS生成可显著逆转DHTS诱导的细胞凋亡。DHTS显著抑制小鼠肿瘤瘤体体积的增加。结论 所有的研究结果都有力的说明,DHTS可以在HCG27和AGS人胃癌细胞中启动活性氧生成,诱导氧化应激和细胞凋亡,值得作为抗癌药物进一步开发。

Objective To evaluate the anticancer actions of dihydrotanshinone Ⅰ(DHTS)in gastric cancer cells. Methods Cell viability was determined using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)assay. Intracellular reactive oxygen species (ROS)levels were determined using flow cytometry. Caspase activities were measured with fluorometric assay. The anticancer activity of DHTS in nude mouse gastric cancer model was verified. Results MTT assay showed that DHTS greatly inhibited HCG27 or AGS cell viability in dose- and time-dependent manners. Elevated intracellular ROS levels and increased apoptotic cells were observed in DHTS-treated HCG27 or AGS cells. In addition, activation of caspase-3 and caspase-8, rather than caspase-9, were noticed in DHTS-treated HCG27 or AGS cells. Furthermore, blocking ROS generation with N-acetylcysteine markedly reversed DHTS-induced cell apoptosis. DHTS inhibited the increase of tumor volume in mice. Conclusion All the findings strongly suggest that DHTS may initiate ROS generation and induce oxidative stress and cell apoptosis in HCG27 or AGS human gastric cancer cells, which deserves to be further developed as an anticancer agent.

目的 应用iTRAQ联合质谱技术筛选COPD大鼠肺组织差异表达蛋白。方法 20只雄性SD大鼠(200~220 g),随机分为对照组和模型组,每组10只,采用熏烟法建立COPD大鼠模型。观察大鼠肺组织病理学改变,测定肺功能,BALF白细胞数,肺组织总蛋白iTRAQ标记后质谱鉴定,用生物信息学方法分析蛋白表达变化。结果 与对照组相比,模型组大鼠支气管黏膜下肌层增厚,肺内可见大量炎性细胞浸润,肺功能降低,BALF白细胞数升高(均P<0.05)。质谱鉴定出4 916种蛋白,筛选出468个差异表达蛋白,其中285个表达上调,183个表达下调。筛选了上皮细胞粘着连接蛋白、fMLP、整合素等与COPD相关蛋白。结论 基于iTRAQ技术的蛋白质组学方法筛选出COPD大鼠差异表达蛋白,为进一步研究COPD的发生机制奠定了基础。

Objective iTRAQ and mass spectrometry were used to screen the differentially expressed proteins in the lung of COPD rats. Methods 20 male SD rats (200-220g)were randomly divided into control group and treatment group, with 10 rats in each group. COPD rat model was established by smoking. The lung function, the number of BALF leukocytes, the total protein iTRAQ in lung tissue were measured and identified by mass spectrometry. The differentially expressed proteins were identified by bioinformatic analysis. Results Compared with the control group, the submucous layer of bronchus in the model group was thickened, a large number of inflammatory cells were seen in the lung, the lung function was reduced, and the number of BALF leukocytes was increased. 4 916 proteins were identified by mass spectrometry, 468 differentially expressed proteins were screened, 285 of which were up-regulated and 183 down regulated. Among them, the important COPD related proteins were epithelial adhesion connexin, fMLP and integrins. Conclusion iTRAQ technology screened out the differentially expressed proteins of COPD rats, which laid the foundation for the further study of COPD mechanism

目的 探讨高脂血症大鼠模型前后血液中氨基酸代谢谱的变化,寻找高脂血症大鼠血液中氨基酸代谢标志物。方法 将SD大鼠随机分为正常对照组、模型组,连续灌胃给药4周后收集大鼠血液,测定各组大鼠血清中TG、TC、HDL-C、LDL-C含量,并运用超高效液相色谱-四极杆-飞行时间质谱(UPLC-Q-TOF-MS/MS)法测定血清中氨基酸代谢谱,利用统计学分析研究不同组动物间的氨基酸代谢的差异。结果 与正常对照组比较,模型组TG、TC、LDL-C含量升高,HDL-C含量降低,高脂血症大鼠模型建模成功;与正常对照组比较,模型组蛋氨酸、苯丙氨酸、脯氨酸、苏氨酸、缬氨酸、甘氨酸等6种氨基酸发生明显改变(P<0.05)。结论 高脂血症大鼠存在氨基酸代谢的紊乱,其中蛋氨酸、苯丙氨酸、脯氨酸、苏氨酸、缬氨酸、甘氨酸等6种氨基酸为其潜在的生物标志物。

Objective To investigate the amino acid metabolism profiles changes in the serum of SD rats, and identify the potential biomarkers. Methods SD rats were divided into normal group and model group. The contents of TG, TC, HDL-C, and LDL-C in the serum of each group were measured, after 4 weeks of continuous intragastric administration. Ultra performance liquid chromatography coupled with electrospray time-of-flight tandem mass spectrometry (UPLC-Q-TOF-MS/MS)was used to determine amino acid metabolism profile in serum, and statistical analysis was applied to determine metabolic differences among different groups of rats. Results As compared with normal group, TG, TC, LDL-C were increased and HDL-C was decreased in model group, hyperlipidemia rat model successfully modeled. As compared with normal group, methionine, phenylalanine, proline, threonine, valine, glycine in the amino acid metabolic profiling were decreased in model group (P＜0.05). Conclusion Hyperlipidemia rats have disorders of amino acid metabolism, of which methionine, phenylalanine, proline, threonine, valine, and glycine are potential biomarkers.

目的 探讨早期康复训练对高龄股骨骨折内固定患者术后康复的影响研究。方法 抽选我院2015年3月—2017年7月收治的98例高龄股骨骨折患者,均以防旋股骨近端髓内钉（PFMA）内固定治疗,根据患者自愿及实际自身状态原则分为对照组（n=45例,仅开展常规术后康复护理）和观察组（n=53例,在内固定治疗期给予早期康复训练）,比较术前及术后3、6个月髋关节运动功能（Harisr评分）及日常生活活动能力（Barthel指数）,观察6个月内并发症发生情况。结果 观察组干预3、6个月后Harisr髋关节活动评分、Barthel指数均高于对照组（P<0.05）。观察组锻炼6月后,髋关节运动功能恢复优良率高于对照组（P<0.05）。观察组发生骨延迟愈合、压疮、切口感染、肺炎、泌尿系感染等并发症的概率低于对照组（P<0.05）。结论 高龄股骨骨折患者PFMA内固定术后开展早期康复训练,可促进患者骨关节功能恢复,改善运动功能,降低并发症发生率,值得临床推广。