【摘要】 目的 探討乳腺浸潤性導管癌中表皮鈣黏蛋白（E-cadherin，E-cad）的表達及其意義。 方法 選取2005年1月－2009年12月的組織病理切塊，用免疫組織化學EnVision二步法檢測63例乳腺浸潤性導管癌（invasive ductal carcinoma，IDC）組織中E-cad的表達情況，設為IDC組；另檢測15例乳腺纖維腺瘤及15例乳腺小葉增生癥乳腺組織中E-cad的表達情況，設為對照組；比較兩組的E-cad表達。 結果 E-cad在IDC組及對照組中表達陽性率分別為58.7%、80.0%；兩組間差異有統計學意義（Plt;0.05）。在乳腺IDC患者中，年齡lt;38歲和≥38歲組的E-cad陽性表達率分別是54.2%、61.5%，兩組間差異無統計學意義（Pgt;0.05）；腫塊直徑lt;3 cm和≥3 cm組的E-cad陽性表達率分別是54.8%、66.7%，兩組間差異無統計學意義（Pgt;0.05）；組織學分級為Ⅰ+Ⅱ級和Ⅲ級組的E-cad陽性表達率分別是76.3%、32.0%，兩組間差異有統計學意義（Plt;0.05）；無、有腋窩淋巴結轉移組的E-cad陽性表達率分別是78.3%、47.5%，兩組間差異有統計學意義（Plt;0.05）。 結論 E-cad的表達與患者年齡及腫塊大小無關，而與組織學分級、淋巴結轉移相關。在乳腺浸潤性導管癌中，無淋巴結轉移者E-cad表達高于有淋巴結轉移者，提示E-cad是乳腺浸潤性導管癌發生淋巴結轉移的重要指標。【Abstract】 Objective To explore the expression of the protein E-cadherin (E-cad) in invasive ductal carcinoma (IDC) of the breast and its significance. Methods We chose 63 cases of pathological wax with IDC between 2005 and 2009, and immunohistochemical EnVision method was used to detect the expression of E-cad protein in these cases which were designated to be the IDC group. At the same time, the E-cad expression in 15 cases of breast adenoma and another 15 cases of breast lobular hyperplasia were also detected, and these cases were designed to the the control group. The expression of E-cad in these two groups were compared. Results The positive rates of E-cad protein expression in the IDC group and the control group were respectively 58.7% and 80.0% with a significant difference between the two groups (Plt;0.05). In the IDC group, the positive rates of E-cad protein expression in patients agedlt;38 and ≥38 years old were respectively 54.2% and 61.5% without a significant difference (Pgt;0.05). The positive rates of E-cad protein expression for tumors with a diameter lt;3 cm and ≥3 cm were respectively 54.8% and 66.7% without a significant difference (Pgt;0.05). The positive rates of E-cad protein expression for class Ⅰ+Ⅱ tumors and class Ⅲ tumors were respectively 76.3% and 32.0% with a significant difference (Plt;0.05). The positive rates of E-cad protein expression for patients without and with axillary lymph node metastasis were respectively 78.3% and 47.5% with a significant difference (Plt;0.05). Conclusions The expression of E-cad is correlated with histological classification and lymph node metastasis and was not related to tumor size and age of the patients. The expression of E-cad is higher in IDC patients without lymph node metastasis than that in IDC patients with lymph node metastasis, which indicates that E-cad is an important index for lymph node metastasis of IDC.
目的 探討經陰道B型超聲（B超）在診斷早期宮外孕中的臨床應用價值。 方法 回顧分析2011年5月－2012年3月應用陰道B超與腹部B超對78例宮外孕患者進行對比檢查的臨床資料并回顧性分析，評價兩種檢查方法的臨床效果。 結果 78例宮外孕患者，應用經陰道B超檢查診斷準確率為97.44%，應用腹部B超準確率為61.54%，差異具有統計學意義（χ2=6.472，P＜0.05）；經陰道B超檢查診斷附件包塊、宮內假孕囊、心血管搏動、胚芽、盆腔積液的檢出率明顯高于經腹部B 超檢查的檢出率（P＜0.05）。 結論 陰道B超具有操作簡單、快速、無副作用、無需充盈膀胱等優點，在宮外孕的早期診斷中具有絕對的優越性，為臨床提供了更方便、更快捷的診斷手段，減輕了患者痛苦，提高了診斷的準確率，值得臨床廣泛推廣和應用。
Abstract： Objective To use tissue Doppler strain rate imaging to evaluate the impact of low dose dopamine and milrinone on systolic and diastolic function of the left ventricle of patients undergoing heart valve replacement. Methods Forty patients undergoing selective heart valve replacement in West China Hospital of Sichuan University between March and May 2011 were included in this study. All the patients were randomized into 2 groups with 20 patients in each group： milrione group and dopamine group. After anesthesia induction and before cardiopulmonary bypass setup， left ventricular ejection fraction （LVEF） was measured by echocardiography. Tissue Doppler strain rate imaging was used to measure the left ventricular lateral wall and midventricular segment from the four-chamber view， which was compared with Doppler parameters. Results LVEF， ratio of early-diastolic to end-diastolic velocity （E/A） of transmitral flow， ratio of mitral inflow velocity to early diastolic velocity in the annulus （E/Et） of both 2 groups were significantly different between before and after dopamine and milrinone administration （P＜0. 05）. In the milrinone group， 4 segments systolic peak velocity （Vs）， 1 segment early diastolic peak velocity （Ve）， 4 segments late diastolic peak velocity （Va）， 3 segments Ve/Va ratio， 2 segments systolic peak strain rate （SRs）， 2 segments late diastolic peak strain rate （SRa）， and 3 segments early diastolic peak strain rate SRe/SRa ratio after dopamine and milrinone administration were significantly higher than those before dopamine and milrinone administration （P＜0. 05）. In the dopamine group， 4 segments systolic peak velocity （Vs）， 1 segment Ve， 4 segments Va， 1 segment Ve/Va ratio， 2 segments SRs， 1 segment SRe， 1 segment SRa， and 1 segment SRe/SRa ratio after dopamine and milrinone administration were significantly higher than those before dopamine and milrinone administration （P＜0.05）. To compare the milrione group and dopamine group after medication administration， 2 segments Vs， 4 segments Va， 1 segment SRe， 1 segment SRa， 2 segments Ve/Va ratio， and 2 segments SRe/SRa ratio of the milrione group were significantly higher than those of the dopamine group （P＜0.05）， and 1 segment Vs， two segments SRs of the milrione group were significantly lower than those of the dopamine group （P＜0.05）. Conclusion Both milrinone and dopamine can improve left ventricular systolic function of perioperative patients undergoing heart valve replacement assessed by tissue Doppler strain rate imaging， while milrinone can improve the diastolic function of the left ventricle on the long axis more significantly.
目的：評價低分子肝素(Low molecular weight heparins，LMWH)皮下注射持續時間對注射后皮下出血和疼痛的影響。方法：納入2003年～2004年3月于我院行LMWH皮下注射的住院患者52例，以肚臍兩側作為注射點，任選一側行首次注射，12 h后于另一側以相同劑量注射。臍右注射持續10秒(對照組)，臍左持續30秒(實驗組)。于注射后48 h、72 h觀察注射點有無皮下出血，并用透明紙質毫米尺測量出血面積，用視覺類比量表(Visual analog scale，VAS)測量疼痛強度，記錄疼痛持續時間。采用卡方檢驗及配對t檢驗對兩組皮下出血發生率及面積、疼痛強度及持續時間等指標進行對比分析。結果：實驗組和對照組皮下出血的發生率分別為38.5%(n=20)和61.5%(n=32)(P=0.035)。注射后48h、72h，實驗組的出血面積均顯著低于對照組(48h：17.5±7.3 mm2 VS 101.2±15.0 mm2，P=0.008；72h：20.7±8.0 mm2 VS 110.4±13.5 mm2，P=0.016)。實驗組的注射后疼痛積分為13.0±6.4 mm，對照組為21.5±7.0 mm(P=0.021)。實驗組疼痛持續時間顯著低于對照組(42.5±14.2 s比73.2±20.0 s，P=0.030)。結論：肝素皮下注射持續時間能顯著影響注射后皮下出血和疼痛形成，注射時間持續至30秒能有效降低皮下出血發生率及面積，并顯著減輕疼痛強度、縮短疼痛時間。
目的 探討不同年齡段老年骨折合并高血壓的動態血壓變化，評估心腦血管事件發生風險。 方法 將2009年4月－2012年2月入住的184例60歲以上老年骨折合并高血壓患者分為低齡老年骨折組（97例，60～79歲）與高齡老年骨折組（87例，≥80歲），對每位患者行動態血壓分析。 結果 兩組患者平均收縮壓均升高，差異無統計學意義（P＞0.05）；但高齡老年骨折組平均舒張壓和平均脈壓差在全天、日間及夜間均低于低齡老年骨折組，差異有統計學意義（P＜0.05）；高齡老年骨折組血壓節律紊亂更明顯，心腦血管事件發生率明顯高于低齡老年骨折組，差異有統計學意義（P＜ 0.05）。 結論 高齡老年骨折患者血壓節律紊亂明顯，應及時調整并制定有效的個體化降壓方案，積極防止以及血管事情的發生。
ObjectiveTo determine the prevalence of aspirin (ASA) resistance in pediatric patients with congenital heart disease and evaluate whether postoperative thrombosis is associated with aspirin resistance.MethodsA total of 52 patients undergoing high-risk congenital cardiac surgery were recruited in a prospective cohort study at Fuwai Hospital from August 2016 to December 2017. There were 29 males and 23 females with a median age of 8 months (6 d to 13 years). The response to aspirin was determined using the thromboelastography with platelet mapping (TEG-PM) system several days after administration. According to the arachidonic acid (AA) inhibition< 50% or not, they were divided into an ASA resistance group (n=14) and an ASA sensitivity group (n=38). Risk factors of ASA resistance were identified using univariate and multivariate analysis. Patients were monitored prospectively for three months for the development of a thrombosis event. ResultsOf 52 children analyzed, 14 (26.9%) were ASA resistance. The prevalence of thrombosis after ASA antiplatelet therapy was 5.9%. Dose escalation based on aspirin testing was performed in 3 of 14 patients, and the ASA sensitivity was observed in 1 patient. No correlation was found between ASA resistance and postoperative thrombosis (r=0.04, P=0.80).ConclusionPostoperative thrombosis is not associated with aspirin resistance in these patients. Our findings also suggest that resistance may be due to lack of aspirin doses, monitoring of aspirin therapy and consideration of dose adjustment or alternative agents for unresponsive patients.
Objective To investigate the correlation between CYP2C19 gene polymorphisms and the incidence and prognosis of heart failure. Methods 1 368 patients who underwent parallel genomic testing and visited the Department of Cardiology at the People’s Hospital of Xinjiang Uygur Autonomous Region between June 2021 and December 2022 were selected. After quality control of genotype data, the patients were divided into a heart failure group and a control group based on diagnostic criteria. Genotyping of 31 genes and 62 single nucleotide polymorphism (SNPs) was performed using TaqMan-SNP genotyping technology. Differences in allele distribution and clinical indicators between the two groups were compared, and the incidence of cardiovascular adverse events in the heart failure group was followed up and calculated. Results A total of 1 352 patients were included. Among them, there were 169 cases in the heart failure group and 1 183 cases in the control group. At the rs12769205 locus of the CYP2C19 gene, the risk of disease for patients carrying the G allele was lower than those carrying the A allele (odds ratio=0.733, P=0.023). In addition to age, coronary heart disease, BMI, and the type of allele was also an independent influencing factor for heart failure (P＜0.05). Moreover, the level of cardiac troponin T in carriers of two mutant alleles was significantly higher than in carriers of one mutant allele (P =0.044) and in carriers of the wild-type allele (P=0.028). During the follow-up period, no significant differences were observed in the cumulative incidence of major cardiovascular adverse events among the three genotypes at the rs12769205 locus. Conclusion The polymorphic locus rs12769205 of the CYP2C19 gene is associated with the occurrence of heart failure, which may provide a theoretical basis for the diagnosis and treatment of heart failure.
The cleft lip and palate (CLP) is one of the most common craniofacial malformations in humans. We collected functional magnetic resonance data of 23 CLP patients before rehabilitation training (Bclp) and 23 CLP patients after rehabilitation training (Aclp), who were performing Chinese character pronunciation tasks, and performed brain activation analysis to explore the changes of brain mechanism in CLP patients after articulation disorder rehabilitation training. The study found that Aclp group had significant activation in the motor cortex, Broca area, Wernicke area and cerebellum. While the Bclp group had weak activation in the motor cortex with a small activation range. By comparing the differences and co-activated brain regions between the two groups, we found that rehabilitation training increased the activity level of negatively activated brain areas (cerebellum, left motor area, Wernicke area, etc.) to a positive level. At the same time, the activity level of weakly activated brain areas (right motor area, Broca area, etc.) was also increased. Rehabilitation training promoted the activity level of articulation-related brain regions. So that the activation intensity of articulation-related brain regions can be used as a quantifiable objective evaluation index to evaluate the effect of rehabilitation training, which is of great significance for the formulation of rehabilitation training programs.
ObjectiveTo analyze the early outcomes of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) patients with severe left ventricular dysfunction after surgical repair, and to explore the predictors for extracorporeal membrane oxygenation (ECMO) support for these patients.MethodsThe clinical data of ALCAPA patients with severe left ventricular dysfunction (left ventricular ejection fraction<40%) who underwent coronary artery reimplantation in the pediatric center of our hospital from 2013 to 2020 were retrospectively analyzed. The patients were divided into an ECMO group and a non-ECMO group. Clinical data of the two groups were compared and analyzed.ResultsA total of 64 ALCAPA patients were included. There were 7 patients in the ECMO group, including 4 males and 3 females aged 6.58±1.84 months. There were 57 pateints in the non-ECMO group, including 30 males and 27 females aged 4.34±2.56 months. The mortality of the patients was 6.25% (4/64), including 2 patients in the ECMO group, and 2 in the non-ECMO group. The postoperative complications rate was significantly higher in the ECMO group than that in the non-ECMO group (P=0.041). There were statistical differences in the cardiopulmonary bypass time [254 (153, 417) min vs. 106 (51, 192) min, P=0.013], aortic cross-clamping (ACC) time (89.57±13.66 min vs. 61.58±19.57 min, P=0.039), and preoperative left ventricular end-diastolic diameter/body surface area (132.32±14.71 mm/m2 vs. 108.00±29.64 mm/m2, P=0.040) between the two groups. Multivariate logistic regression analysis showed that ACC time was an independent risk factor for postoperative ECMO support (P=0.005). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve was 0.757, the sensitivity was 85.70%, specificity was 66.70%, with the cut-off value of 66 min.ConclusionACC time is an independent risk factor for postoperative ECMO support. Patients with an ACC time>66 min have a significantly higher risk for ECMO support after the surgery.
ObjectiveTo explore the natural changes of procalcitonin (PCT) in the early period after pediatric cardiac surgery with cardiopulmonary bypass (CPB).MethodsA prospective and observational study was done on patients below 3 years of age, who underwent cardiac surgery involving CPB, with the risk adjustment of congenital heart surgery (RACHS) score of 2 to 5 and free from active preoperative infection or inflammatory disease. Blood samples for measurement of PCT, C-reactive protein (CRP) and white blood cell (WBC) were taken before surgery and daily for 7 days in postoperative period. Infections and complications within 7 days after operation were investigated. According to the presence or absence of infection and complications within 7 days after operation, the enrolled children were divided into an infection+complications group, a simple infection group, a simple complication group, and a normal group.Results Finally, 429 children with PICU stay≥ 4 days were enrolled, including 268 males and 161 females, with a median age of 8.0 (0.7, 26.0) months. There were 145 children in the simple infection group, 38 children in the simple complication group, 230 children in the normal group and 16 children in the infection+complications group. The levels of PCT, CRP and WBC were significantly higher after CPB. CRP and WBC peaked on the second postoperative day (POD) and remained higher than normal until POD7. PCT peaked on POD1 and would generally decrease to normal on POD5 if without infection and complications. Age, body weight, RACHS scores, the duration of CPB and aortic cross-clamping time were correlated with PCT level. There was a statistical difference in PCT concentration between the simple infection group and the normal group on POD 3-7 (P<0.01) and a statistical difference between the simple complication group and the normal group on POD 1-7 (P<0.01). A statistical difference was found between the simple infection group and the simple complication group in PCT on POD 1-5 (P<0.05).ConclusionWBC, CRP and PCT significantly increase after CPB in pediatric cardiac surgery patients. The factors influencing PCT concentration include age, weight, RACHS scores, CPB and aortic cross-clamping time, infection and complications.