[摘 要] 目的：探讨程序性死亡受体-1（PD-1）单抗联合顺铂或吉西他滨在KRAS基因突变非小细胞肺癌（NSCLC）A549细胞移植瘤小鼠模型治疗中的作用。方法：构建免疫系统-肿瘤双人源化A549细胞小鼠移植瘤模型，将60只小鼠按随机数字表法分成6组（10只/组），分别为对照组（200 μL/kg PBS）、PD-1单抗组（20 mg/kg PD-1单抗）、顺铂组（3 mg/kg顺铂）、PD-1单抗+顺铂组（20 mg/kg PD-1单抗+3 mg/kg顺铂）、吉西他滨组（30 mg/kg吉西他滨）和PD-1单抗+吉西他滨组（20 mg/kg PD-1单抗+30 mg/kg吉西他滨）。TUNEL和DAPI双染色法检测移植瘤组织中细胞凋亡水平，测量移植瘤体积和质量并计算肿瘤生长抑制率，免疫组化法检测移植瘤微血管密度（MVD）。结果：成功构建免疫系统-肿瘤双人源化NSCLC A549细胞小鼠移植瘤模型，PD-1单抗+顺铂组移植瘤的细胞凋亡率、肿瘤生长抑制率均最高，移植瘤体积、质量和MVD均最小，与其他5组小鼠比较差异均有统计学意义（均P<0.05）。结论：顺铂与PD-1单抗具有协同活性，而吉西他滨拮抗PD-1单抗的治疗作用。提示PD-1单抗联合顺铂对KRAS突变NSCLC A549细胞移植瘤小鼠的疗效更好。

Objective To investigate the analgesic effect and safety of transincisional quadratus lumborum block(TQLB)technique for laparoscopic nephrectomy.Methods Sixty patients scheduled for laparoscopic nephrectomy at the Affiliated Lihuili Hospital of Ningbo University from December 2023 to March 2024,the patients were randomly divided into TQLB group(T group)and control group(C group)using a random number table method,with 30 cases in each group.C group received general anesthesia with tracheal intubation,while T group received general anesthesia with tracheal intubation combined with TQLB.Two groups of patients were routinely given sufentanil controlled intravenous analgesia pump after surgery.Record the wound healing status of two groups of patients,postoperative 24h sufentanil consumption,resting and exercise time numerical rating scale(NRS)scores at 6h,12h,and 24h postoperatively,range of sensory blockade at 2h postoperatively,number of salvage analgesia cases at 24h postoperatively,analgesic satisfaction score,and incidence of postoperative complications.Results Compared with group C,patients in group T had a reduced consumption of sufentanil 24h after surgery(P＜0.001);The resting and exercise NRS scores decreased at 6h,12h,and 24h after surgery(P＜0.05);The number of postoperative 24h rescue analgesia cases and the satisfaction score of analgesia were both lower than C group(P＜0.05);The incidence of postoperative nausea and vomiting in group T was lower(P＜0.05);Both groups of patients did not experience serious complications.Conclusion TQLB appears to offer effective postoperative analgesia during the early stages of laparoscopic nephrectomy,while also reducing the occurrence of complications.This suggests that it could serve as a safe and efficient alternative for analgesic management in such surgical procedures.

Objective To compare the effect of quadratus lumborum block at supra-arcuate ligament(SA-QLB)and erector spinae plane block(ESPB)on postoperative analgesia and recovery quality in the pa-tients undergoing thoracoscopic surgery.Methods Sixty patients undergoing elective thoracoscopic surgery,aged 18-70 years old,ASA grade Ⅰ-Ⅱ,served as the study subjects and were randomly divided into the two groups by the random number table method:SA-QLB group(group Q,n=30)and ESPB(group E,n=30).Before induction of general anesthesia,the group Q conducted SA-QLB in the operation side under the ultra-sound guide and the group E conducted ESPB,the both were given 30 mL of 0.25％ropivacaine.All patients in both groups were given the patient-controlled intravenous analgesia(PCIA)after surgery.The dosage of remifentanil during surgery,recovery time,Visual Analogue Scale(VAS)score at rest and cough at 1,6,12,24,48 h after surgery,first pressing time of patient-controlled analgesia,times of effective pressing,dosage of sufentanil and number of cases of rescue analgesia at 24 h after surgery,forced vital capacity(FVC)and forced expiratory volume first second(FEV1)at 1 h before surgery and 24 h after surgery,scores of quality recovery at postoperative 24 h(QoR-15)and Barthel score,hospitalization duration after operation and the occurrence of adverse reactions were recorded.Results Compared with the group E,the intraoperative remifentanil dos-age in the group Q was decreased(P＜0.05);the VAS scores in rest and cough at postoperative 6,12,24 h were decreased(P＜0.05);the first pressing time of postoperative analgesia pump in the group Q was pro-longed,number of effective pressures of analgesia pump,dosage of sufentanil and cases number of remedy an-algesia were decreased(P＜0.05);FEV1 and FVC at postoperative 24 h in the group Q were significantly in-creased(P＜0.05);the scores of QoR-15 and Barthel at postoperative 24 h were increased(P＜0.05).The in-cidence rates of postoperative nausea and vomiting in the group Q were lower than those in the group E(P＜0.05),and no serious adverse events occurred in the two groups.Conclusion Compared with ESPB,SA-QLB could provide more perfect postoperative analgesia effect,which is conducive to postoperative early pulmonary function recovery,and the postoperative recovery quality is higher.

Objective:To analyze the influence of serological indexes on the liver cirrhosis (LC) in patients with chronic hepatitis B, and to construct a nomogram model.Methods:The clinical data of 220 patients with chronic hepatitis B in Xianning Central Hospital from January 2019 to December 2021 were retrospectively analyzed. Among them, 42 patients developed LC (LC group), and 178 cases did not develop LC (non-LC group). The patient′s fasting peripheral venous blood was taken in the morning. The platelet, red blood cell, white blood cell, fasting blood glucose, alanine aminotransferase (ALT), aspartate aminotransferase (AST), triacylglycerol (TG), total cholesterol (TC), total bilirubin (TBiL), albumin, globulin, alkaline phosphatase (ALP), γ-glutamyltransferase (GGT), prothrombin time (PT), thrombin time (TT), D-dimer (D-D), alpha-fetoprotein (AFP) and C-reactive protein (CRP) were detected. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of each index in predicting LC in patients with chronic hepatitis B. Multivariate Logistic regression was used to analyze the independent risk factors for LC in patients with chronic hepatitis B. The R software "rms" package was used to construct a nomogram model to predict the LC in patients with chronic hepatitis B, the correction curve was used to internally verify the prediction model, and the decision curve evaluated the efficacy of the prediction model.Results:The TBiL, ALP, GGT, PT, TT, D-D, AFP and CRP in LC group were significantly higher than those in non-LC group: (50.57 ± 5.61) μmol/L vs. (46.69 ± 3.92) μmol/L, (105.23 ± 30.60) U/L vs. (75.14 ± 26.45) U/L, (68.73 ± 19.47) U/L vs. (50.39 ± 14.21) U/L, (13.88 ± 1.98) s vs. (13.01 ± 2.10) s, (18.88 ± 2.56) s vs. (15.98 ± 2.43) s, (2.62 ± 1.04) mg/L vs. (1.34 ± 0.63) mg/L, (4.19 ± 1.95) μg/L vs. (2.66 ± 1.21) μg/L and (8.54 ± 1.22) mg/L vs. (7.47 ± 0.79) mg/L, the platelet, ALT, AST and albumin were significantly lower than those in the non-LC group: (129.63 ± 32.66) × 10 9/L vs. (183.53 ± 56.31) ×10 9/L, (131.27 ± 22.19) U/L vs. (157.57 ± 38.67) U/L, (112.76 ± 19.57) U/L vs. (125.16 ± 21.84) U/L and (29.79 ± 6.17) g/L vs. (33.52 ± 5.89) g/L, and there were statistical differences ( P<0.01 or <0.05); there were no statistical differences in red blood cell, white blood cell, fasting blood glucose, TG, TC and globulin between the two groups ( P>0.05). ROC curve analysis result showed that the area under the curve (AUC) of AFP, platelet, ALT, AST, ALP, GGT, TBiL, albumin, D-D, CRP, PT and TT for predicting LC in patients with chronic hepatitis B were 0.731, 0.798, 0.723, 0.676, 0.766, 0.762, 0.710, 0.673, 0.856, 0.759, 0.603 and 0.786, and the optimal cut-off values were 4.64 μg/L, 162.56 × 10 9/L, 155.67 U/L, 122.37 U/L, 95.17 U/L, 68.96 U/L, 49.95 μmol/L, 28.8 g/L, 1.64 mg/L, 8.55 mg/L, 12 s and 18 s. Multivariate Logistic regression analysis result showed that AFP (>4.64 μg/L), platelet (≤162.56 × 10 9/L), ALP (>95.17 U/L), GGT (>68.96 U/L), D-D (>1.64 mg/L) and TT (>18 s) were independent risk factors for LC in patients with chronic hepatitis B ( OR = 1.278, 1.428, 1.488, 1.356, 1.513 and 1.369; 95% CI 1.109 to 1.369, 1.269 to 1.623, 1.217 to 1.894, 1.127 to 1.669, 1.342 to 1.878 and 1.169 to 1.583; P<0.05 or <0.01). The AFP, platelet, ALP, GGT, D-D and TT were used as predictors to construct a nomogram model for predicting the LC in patients with chronic hepatitis B. The correction curve of the nomogram model to predict the LC in patients with chronic hepatitis B was close to the ideal curve (C-index was 0.739, 95% CI 0.615 to 0.876); the decision curve analysis result showed that the prediction model had higher clinical net benefit when the risk threshold > 0.26 than a single index, and that it had significantly additional clinical net benefit. Conclusions:The AFP, platelets, ALP, GGT, D-D and TT are independent risk factors for LC in patients with chronic hepatitis B, and the nomogram model constructed based on these factors could provide important guidance for the prevention and treatment of LC in patients with chronic hepatitis B.

Objective To explore the effect of neutrophil to lymphocyte ratio(NLR)and other related in-dicators on the prognosis of advanced non-small cell lung cancer patients treated with programmed death 1(PD-1)inhibitor and construct a nomogram prediction model.Methods A total of 198 patients with advanced non-small cell lung cancer who received PD-1 inhibitor treatment in the hospital from February 2020 to April 2022 were selected and followed up to August 2022.According to the clinical outcome,they were divided into the death group(46 cases)and the survival group(152 cases).The clinical data of the death group and the survival group were recorded,and the prognostic factors of advanced non-small cell lung cancer patients trea-ted with PD-1 inhibitor were analyzed.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of NLR,platelet to lymphocyte ratio(PLR)and lymphocyte to monocyte ratio(LMR)for the prognosis of patients.Multivariate Logistic regression model was used to analyze the independent risk factors affecting the prognosis of patients.A prediction nomogram model for the prognosis of patients was construc-ted using R software 4.0"rms"package,and the calibration curve was used to internally validate the nomo-gram prediction model.Results Compared with the survival group,the proportion of smoking,TNM stageⅣ,ECOG score 2,and NLR,PLR,LMR were higher(P<0.05).The area under the curve of NLR,PLR and LMR were 0.707,0.793 and 0.819,respectively,and the optimal cut-off value were 4.72%,179.21%and 3.44%,respectively.Smoking,TNM stage,ECOG score,NLR,PLR,and LMR were independent risk factors for the prognosis of advanced non-small cell lung cancer patients treated with PD-1 inhibitor(P<0.05).The internal validation results show that the nomogram inhibitor treatment of PD-1 model prediction the prognosis of patients with advanced non-small cell lung cancer C-index was 0.847(95%CI 0.769-0.902),the calibra-tion curve tends to be the ideal curve.The threshold value of the nomogram model for predicting the prognosis of patients with advanced non-small cell lung cancer treated with PD-1 inhibitor was>0.22.The nomogram prediction model provided a net clinical benefit,and the net clinical benefit was higher than that of smoking,TNM stage,ECOG score,NLR,PLR and LMR.Conclusion Based on smoking,TNM stage,ECOG score,NLR,PLR,and LMR,a nomogram prediction model for the prognosis of advanced non-small cell lung cancer patients treated with PD-1 inhibitor is constructed,which has important clinical application value.

Objective:To analyze the pregnancy complications and outcomes in adolescent women in minority areas in China and the factors affecting the pregnancy outcomes.Methods:This retrospective study enrolled 697 singleton pregnant women who were younger than 20 years old and delivered at Sanjiang Dong Autonomous County People's Hospital of Liuzhou City from January 1, 2014, to December 31, 2018, as the case group. Meanwhile, 2 592 cases aged between 20 to 25 years and delivered during the same period were selected as the control group in an allocation ratio of 1∶4. Chi-square test, t test and binary logistic regression were used for comparing the differences of general characteristics, pregnancy complications, comorbidities and pregnancy outcomes between the two groups. Results:(1) The body mass index before delivery of the case group was lower than that of the control group [(24.7±3.4) vs (25.1±3.1) kg/m 2, t=－2.062, P=0.039]. The proportion of Dong minority was accounted for 48.06%(335/697) in the case group and 52.04%(1 349/2 592) in the control group. The proportion of women with junior school education or lower was higher in the case group than that in the control group [95.41% (665/697) vs 90.27% (2 340/2 592), χ2=45.086, P<0.001]. (2) The case group was noted for higher incidence of anemia [24.25% (169/697) vs 15.20% (394/2 592), χ2=31.683], premature delivery [7.17% (50/697) vs 4.55% (118/2 592), χ2=7.786], premature rupture of membranes [13.34% (93/697) vs 9.10% (237/2 592), χ2=10.731] and oligohydramnios [9.76% (68/697) vs 7.02% (182/2 592), χ2=5.848] than the control group (all P<0.05). (3) The incidence of cesarean section [27.26% (190/697) vs 38.04% (986/2 592), χ2=27.791, P<0.001] and the neonatal birth weight [(3 047.29±453.46) vs (3 131.01±472.44) g, t=－4.188, P<0.001] in the case group were lower, but the incidence of episiotomy [40.17% (280/697) vs 8.72% (226/2 592)] and the proportion of neonatal intensive care unit admission[10.76% (75/697) vs 3.82% (99/2 592)] were higher when comparing to the control group ( χ2=417.439 and 52.816, both P<0.001). (4) Multivariate binary logistic regression analysis showed that the risk of cesarean section ( aOR=0.62, 95% CI: 0.51-0.75) was reduced in adolescent women, but the risks of episiotomy ( aOR=6.20, 95% CI: 4.99-7.71) and neonatal intensive care unit admission ( aOR=2.68, 95% CI: 1.92-3.75) increased. Conclusions:Most of the pregnant adolescents are less-educated and ethnic minorities in this study, among which the Dong minority was predominant. Adolescent pregnancies are at a higher risk of anemia, preterm birth and premature rupture of membranes. Therefore, enhanced perinatal management of adolescent pregnancy is recommended to reduce adverse pregnancy outcome.

Objective To investigate the risk of emergency cesarean section during labor with the pre-pregnancy body mass index or gestational weight gain.Methods A total of 6 908 healthy nullipara with singleton pregnancy and cephalic presentation who was in term labor in Beijing Obstetrics and Gynecology Hospital from August 1st,2014 to September 30th,2015 were recruited.They were divided into two groups,the vaginal delivery group (92.88％,6 416/6 908) and the emergency cesarean section group (7.12％,492/6 908).According to WHO body mass index (BMI) classification criteria and the pre-pregnancy BMI,the 6 908 women were divided into three groups,the underweight group(BMI＜18.5 kg/m2;17.39％,1 201/6 908),the normal weight group(18.5-24.9 kg/m2;73.00％,5 043/6 908),the overweight and obese group (≥ 25.0 kg/m2;9.61％,664/6 908).According to the guidelines of Institute of Medicine (IOM),they were divided into three groups,the inadequate gestational weight gain (GWG) group (16.72％,1 155/6 908),the appropriate GWG group (43.11％,2 978/6 908),the excessive GWG group (40.17％,2 775/6 908).Unadjusted and adjusted odds ratio (OR) and confidence interval (CI) of the risk of emergency cesarean section were calculated by bivariate logistic regression.Results (1) Comparing to the vaginal delivery group,women in the emergency cesarean section group were older,with a lower education level.Their prepregnancy BMI was higer and had more gestational weight gain.They had higher morbidity of pregnancy induced hypertension and gestational diabetes mellitus.Comparing to the vaginal delivery group,the neonates in the emergency cesarean section group were elder in gestational week,with higher birth weight.More male infants and large for gestation age infants were seen in the emergency cesarean section group (all P ＜ 0.05).(2) Overweight and obesity were associated with the increased risk of emergency cesarean section for nullipara,with the unadjusted OR of 1.98 (95％CI:1.54-2.54),adjusted OR(aOR) of 1.66 (95％CI:1.27-2.16).In the inadequate GWG group and the excessive GWG group,overweight and obese women had increased risk of emergency cesarean section,with adjusted OR of 2.33 (95％CI:1.06-5.14) and 1.62 (95％CI:1.44-2.28),respectively.In the appropriate GWG group,there was no significant difference in the risk of emergency cesarean section between the overweight and obese women and the normal weight women,with aOR of 1.54 (95％CI:0.94-2.54).The underweight group was associated with decreased risk of emergency cesarean section (OR=0.55,95％CI:0.40-0.74;aOR=0.66,95％ CI:0.48-0.90).While no significant difference in the risk of emergency cesarean section was found between the underweight women,the overweight and obese women,with the aOR of 0.31 (95％CI:0.07-1.32),0.73 (95％CI:0.48-1.10),0.66 (95％CI:0.38-1.12),respectively.(3) Absolute value of gestational weight gain was associated with the increased risk of emergency cesarean section,(aOR=1.03,95％CI:1.01-1.05).GWG above IOM giudelines did not independently affect the risk of emergency cesarean section (OR=1.30,95％CI:1.07-1.58;aOR=1.01,95％CI:0.82-1.24).In the underweight group,the normal weight group and the overweight or obese group,the excessive GWG women and the appropriate GWG women had no significant difference in the risk of emergency cesarean section (aOR=1.03,95％CI:0.55-1.12;aOR=1.02,95％CI:0.80-1.30;aOR=1.03,95％ CI:0.59-1.78),respectively.GWG below IOM giudelines was associated with decreased risk of emergency cesarean section (OR=0.62,95％ CI:0.45-0.85;aOR=0.64,95％ CI:0.46-0.88).In the underweight group and the overweight or obese group,there was no significant difference in the emergency cesarean section risk between the inadequate GWG women and the appropriate GWG within women (aOR=0.24,95％CI:0.06-1.01;aOR=0.90,95％CI:0.40-2.04).In the normal weight group,the inadequate GWG women had lower risk of emergency cesarean section (aOR=0.65,95％ CI:0.45-0.95).Conclusions Overweight and obese women have increased risk of emergency cesarean section.The prepregnancy BMI is supposed to be an appropriate level.Absolute value of gestational weight gain is associated with increased risk of emergency cesarean section.There is no correlation between the excessive GWG and the risk of emergency cesarean section.

Objective To explore and analysis feasibility of the prevention of edaravone on myocardial ischemia after beating cor-onary artery bypass grafting .Methods From June 2011 to December 2012 ,78 patients which accepted beating heart coronary artery bypass grafting were randomly divided into treatment group (39 cases) and control group(39 cases) .After induction of anesthesia , the treatment group were continued to intravenous edaravone 60 mg ,while the control group were continued infusion of equivalent saline .The serum superoxide dismutase(SOD) ,malondialdehyde(MDA) levels were compared between the two groups at different times which were before surgery (T1) ,after incision 1 h(T2) ,surgery (T3) ,and after 24 h(T4) ,plasma brain natriuretic peptide (BNP) ,troponin I(cTnI) levels were compared at T1 and T4 .Left ventricular ejection fraction(LVEF) were also be compared .Re-sults The two groups of patients before treatment ,there were not statistically significant difference between the two groups on SOD ,MDA ,CK-MB ,BNP and cTnI(P> 0 .05) .At T2 ,T3 ,T4 point ,the SOD activity of the treatment group was significantly higher than that of control group(P<0 .05) .The MDA ,CK-MB value were significantly lower than that of control group (P<0 . 05) .At T4 ,the BNP and cTnI in the treatment group were less than that of control group (P<0 .05) .The postoperative LVEF% in treatment group were significantly higher than that of control group (P<0 .05) .Postoperative ventilator treatment time and ICU stay time and total hospitalization time of the treatment group were all significantly less than that of control group (P<0 .05) .Con-clusion For the beating heart coronary artery bypass surgery patients ,edaravone can effectively scavenge oxygen free radicals and reduce the release of enzymes ,reduce injury caused by myocardial ischemia-reperfusion and protect myocardial cells .

Objective To evaluate the effect of edaravone on myocardial injury in patients undergoing offpump coronary artery bypass grafting (OPCABG).Methods Forty ASA physical status Ⅲ-Ⅳ patients,aged 45-64 yr,weighing 55-95 kg,with NYHA class Ⅱ-Ⅲ,scheduled for elective OPCABG,were randomly divided into 2 groups (n =20):edaravone group (group E) and control group (group C).After induction of anesthesia,edaravone 60 mg (in 100 ml of normal saline) was infused over 30 min in group E,while the equal volume of normal saline was given instead of edaravone in group C.Venous blood samples were taken before operation (T1),after skin incision (T2),at the end of operation (T3),and at 24 h after operation (T4) to measure the serum levels of myocardial enzymes and cardiac troponin Ⅰ (cTnI).The time for ventilator treatment,duration of stay in the intensive care unit and duration of stay in hospital were recorded.Results Compared with group C,the activities of serum creatine kinase,creatine kinase isoenzyme-MB,aspartate aminotransferase and lactate dehydrogenase and cTnI concentrations were significantly increased at T3 and T4 (P ＜ 0.05) and no significant changes were found at T1 in group E (P ＞ 0.05).The parameters mentioned above were significantly higher at T3 and T4 than at T1 in the two groups (P ＜ 0.05).The time for ventilator treatment,duration of stay in the intensive care unit and duration of stay in hospital were significantly shortened in group E as compared with group C (P ＜ 0.05 or 0.01).Conclusion Edaravone 60 mg infused before OPCABG can provide effective myocardial protection in patients.

To assess the ability of the previously selected human vaginal isolates of Lactobacillus crispatus (L. crispatus) T79-3, T90-1 and Lactobacillus jensenii (L. jensenii) T118-3, T231-1 to inhibit the growth of Staphylococcus aureus and block their adhesion to HeLa cells. The inhibitory bioactive substances produced by these Lactobacillus were also identified. Inhibitory substances interaction tests were carried out by using a streak-diffusion method on agar plates. Three types of interaction were performed to determine the inhibitory effect of Lactobacillus on adhesion of Staphylococcus aureus to HeLa cells: Exclusion Group (Lactobacillus and HeLa followed by pathogens), Competition Group (Lactobacillus, HeLa and pathogens together) and Displacement Group (pathogens and HeLa followed by the addition of Lactobacillus). The number of HeLa cells adhered to Staphylococcus aureus was quantified by bacteria colony counts on LB plate. The results showed that lactic acids produced by the Lactobacillus are the main substances that can inhibit Staphylococcus aureus growth and there is variation among the three types of interaction regarding the inhibitory activity against Staphylococcus aureus. The effects of Lactobacillus on blocking the adhesion to HeLa cells were concentration dependent. All four Lactobacillus isolates displayed the ability to inhibit Staphylococcus aureus growth and block Staphylococcus aureus adherence to HeLa cells. Exclusion Group was the most effective, and T79-3 showed greater capacity to block Staphylococcus aureus adherence compared with the other three isolates. The present study suggests the potential ability of L. crispatus T79-3 as probiotic for the treatment and prevention of urogenital infections in women.
Bacterial Adhesion ; physiology ; Cell Wall ; chemistry ; Female ; HeLa Cells ; Humans ; Lactobacillus ; classification ; physiology ; Probiotics ; Staphylococcus aureus ; growth & development ; pathogenicity ; Vagina ; microbiology