[摘 要] 目的：探讨甲基转移酶样蛋白7B（METTL7B）在胶质瘤组织中的表达及其与患者临床病理特征和预后的相关性。方法：基于CGGA数据库胶质瘤数据和GTEx数据库正常脑组织数据，分析METTL7B基因在胶质瘤与正常脑组织中的表达差异，并用GEPIA数据库数据和免疫组织化学染色法进行验证。用Kaplan-Meier生存分析、单因素Cox分析、多因素Cox分析及ROC曲线分析等评估METTL7B在胶质瘤患者预后中的价值，用CGGA数据库数据分析METTL7B表达与胶质瘤患者临床病理特征的相关性，用CIBERSORT及TIMER数据库进行肿瘤免疫细胞浸润分析，进行KEGG通路富集分析及GO功能富集分析，通过基因共表达分析确定与METTL7B相关的基因。结果：METTL7B在胶质瘤组织中明显上调（均P<0.05），METTL7B表达是胶质瘤患者独立的不良预后因素。METTL7B高表达与高龄（>41岁）、肿瘤分级增加、肿瘤复发或继发性肿瘤、IDH野生型、1p19q非共缺失以及肿瘤的恶性病理学有关联（均P<0.01）；METTL7B表达与B细胞、CD4+ T细胞、CD8+ T细胞、单核细胞、中性粒细胞、巨噬细胞、活化肥大细胞等免疫细胞有关联（均P<0.05）。KEGG通路富集及GO功能分析结果显示，肿瘤相关信号通路及多种免疫反应在METTL7B高表达表型中显著富集。基因共表达分析结果表明，METTL7B与TNFRSF12A、CHI3L1、EMP3表达呈正相关（r=0.807、0.804、0.783，均P<0.01），与ELFN2、REPS2、SHANK2表达呈负相关（r=-0.642、-0.627、-0.602，均P<0.01）。结论：METTL7B在胶质瘤组织中的表达上调是预后不良的指标，且与肿瘤免疫浸润相关。

Objective To compare clinical effects on treatment of cerebrospinal fluid leakage using various deep fascia suture techniques in lumbar posterior surgery.Methods There were 39 cases with cerebrospinal fluid leakage after lumbar posterior surgery in our hospital,in whom 22 cases were treated with deep fascia continuous suture,and 17 cases were treated with deep fascia interrupted suture.The extubation time,ambulation time,healing time and VAS scores in different times were recorded.Results The average extubation time,ambulation time,healing time of continuous suture group were better than that in interrupted suture group.The VAS scores on 1,3,7,14 d after operation in the continuous suture group was 3.55,2.64,1.18,0.36,and were 3.35,4.18,2.18,0.59 in the interrupted suture group.There were statistically significant differences in VAS scores on 3,7 d after operation between continuous suture group and interrupted suture group,while no significant differences were found in VAS scores on 1,14 d after operation.Conclusion Deep fascia continuous suture method has better effect on the treatment of cerebrospinal fluid leakage after lumbar posterior surgery.

Objective To compare clinical effects on treatment of cerebrospinal fluid leakage using various deep fascia suture techniques in lumbar posterior surgery.Methods There were 39 cases with cerebrospinal fluid leakage after lumbar posterior surgery in our hospital,in whom 22 cases were treated with deep fascia continuous suture,and 17 cases were treated with deep fascia interrupted suture.The extubation time,ambulation time,healing time and VAS scores in different times were recorded.Results The average extubation time,ambulation time,healing time of continuous suture group were better than that in interrupted suture group.The VAS scores on 1,3,7,14 d after operation in the continuous suture group was 3.55,2.64,1.18,0.36,and were 3.35,4.18,2.18,0.59 in the interrupted suture group.There were statistically significant differences in VAS scores on 3,7 d after operation between continuous suture group and interrupted suture group,while no significant differences were found in VAS scores on 1,14 d after operation.Conclusion Deep fascia continuous suture method has better effect on the treatment of cerebrospinal fluid leakage after lumbar posterior surgery.

Objective To investigate the symptom clusters of gastric cancer patients before chemotherapy,so as to provide a theoretical basis for the development of targeted management strategies.Methods A total of 228 gastric cancer patients who were treated in the General Surgery Department and Oncology Department of the Second Affiliated Hospital of Zhengzhou University from September 2016 to August 2017 were selected as the survey subjects by convenience sampling method.A cross-sectional survey was used to conduct a questionnaire survey.The Chinese Version Memorial Symptom Assessment Scale(MSAS)was used to evaluate the patients' symptoms before chemotherapy.Correspondence analysis was used to extract symptom clusters.Results A total of 228 questionnaires were distributed,and 224 were effective.The effective recovery rate was 98.2％.Before chemotherapy,the 5 most prevalent symptoms of gastric cancer patients were weight loss(97.8％),dry mouth(95.1％),pain(90.6％),sweating(84.4％)and lack of vitality/fatigue(79.5％).The top 5 symptoms of severity were lack of vitality/fatigue,difficult to focus,body swelling/bloating,swelling of the arms or legs and anxiety.Using the correspondence analysis to get 5 symptom clusters,the 5 symptom clusters were the energy deficiency symptom cluster,digestive tract symptom cluster,physical and mental symptom cluster,surgical related symptom cluster and neurological symptom cluster.The Cronbach's α coefficient was 0.95,0.89,0.92,0.93 and 0.87 respectively.Conclusions This study clarified the pre-chemotherapy symptom clusters of gastric cancer patients,and provided a scientific basis for exploring practical and effective methods of symptom management.At the same time,this research can also provide reference for the applicationof correspondence analysis method in the study of cancer symptom clusters.

Objective To compare the biomechanical stabilities among different combinations of anterior and medial cortical supports after intramedullary nailing for unstable intertrochanteric fractures.Methods Twenty-seven synthesized femur specimens were used to create models of unstable intertrochanteric fracture of type 31A2.1 according to AO/ASIF classification.They were divided into 9 groups (n =3) according to 9 combinations of anterior and medial cortical supports on the anteroposterior and lateral X-ray films:positive-positive,positive-neutral,positive-negative,neutral-positive,neutral-neutral,neutral-negative,negative-positive,negative-neutral,negative-negative groups.After all the fractures were fixated with the newly adapted femoral intertrochanteric nails (FITN),static loadings were applied for tests of fatigue and destruction to investigate the relative displacements and yield loads of the head-neck fragments.Results For the positive-positive,positive-neutral,positive-negative,neutral-positive,neutral-neutral,neutral-negative,negative-positive,negative-neutral,negative-negative groups,the vertical displacements of the head-neck fragments under fatigue loading were respectively 5.33 ±0.58 mm,7.83 ±0.29mm,7.73 ±0.15 mm,8.17 ± 0.29 mm,8.33±1.15 mm,8.83±0.29 mm,9.33±0.58 mm,9.67±1.15 mm and 12.0±1.0 mm,showing significant differences (P ＜ 0.05).The smallest displacement was observed in the positive-positive group,significantly smaller than that in any other groups (P ＜ 0.05).For the above 9 groups,the yield loads were respectively 4,967 ± 153 N,4,467 ± 58 N,3,717 ± 76 N,2,767 ± 58 N,2,533 ± 58 N,2,267 ± 58 N,1,833 ± 58 N,1,667 ± 58 N and 1,333 ± 58 N,showing significant differences between any 2 groups (P ＜ 0.05).In the destruction test,bone interface loosening in the femoral head happened in 2 cases,bone interface loosening in the intertrochanteric zone in 15 cases,split fracture at the zone of distal locking nail in 2 cases,and loosening and breakage of the internal fixator in the distal femur in 8 cases.Conclusions The medial cortical support plays a major role and the anterior cortical support plays a secondary role in the stability of unstable intertrochanteric fracture.In the surgical procedure,surgeons should avoid the medial cortical negative support as much as possible.