我们报告了一名36岁的孕妇,因慢性和急性肝功能衰竭(Chronic and acute liver failure,CALF)和肝性脑病被转到重症监护病房。实验室检查显示肝功能异常,其他血清学检查符合乙肝病毒(HBV)感染。超声波检查显示一个死胎。该患者接受了非...我们报告了一名36岁的孕妇,因慢性和急性肝功能衰竭(Chronic and acute liver failure,CALF)和肝性脑病被转到重症监护病房。实验室检查显示肝功能异常,其他血清学检查符合乙肝病毒(HBV)感染。超声波检查显示一个死胎。该患者接受了非常紧急的供体肝移植(Liver transplantation,LT),使用的是一名死于蛛网膜下腔出血的ABO血型相同的56岁男性。肝脏组织学检查显示小结节性肝硬化,急性和慢性肝炎,符合坏死性HBV感染。手术后,患者同种异体移植功能逐渐恢复。免疫抑制方案是巴利昔单抗联合他克莫司。原位肝移植(OLT)后第6天,在超声引导下羊膜腔穿刺后,注射利凡诺引产。OLT后第8天,一个死胎在阴道分娩,并出现大量阴道出血。全麻下超声引导下进行胎盘钳夹术。到目前为止,患者在术后2个月一般状况良好和肝功能正常。展开更多
BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still...BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still not optimistic.In China,the incidence of CRC in the Yangtze River Delta region is increasing dramatically,but few studies have been conducted.Therefore,it is necessary to develop a simple and efficient early screening model for CRC.AIM To develop and validate an early-screening nomogram model to identify individuals at high risk of CRC.METHODS Data of 64448 participants obtained from Ningbo Hospital,China between 2014 and 2017 were retrospectively analyzed.The cohort comprised 64448 individuals,of which,530 were excluded due to missing or incorrect data.Of 63918,7607(11.9%)individuals were considered to be high risk for CRC,and 56311(88.1%)were not.The participants were randomly allocated to a training set(44743)or validation set(19175).The discriminatory ability,predictive accuracy,and clinical utility of the model were evaluated by constructing and analyzing receiver operating characteristic(ROC)curves and calibration curves and by decision curve analysis.Finally,the model was validated internally using a bootstrap resampling technique.RESULTS Seven variables,including demographic,lifestyle,and family history information,were examined.Multifactorial logistic regression analysis revealed that age[odds ratio(OR):1.03,95%confidence interval(CI):1.02-1.03,P<0.001],body mass index(BMI)(OR:1.07,95%CI:1.06-1.08,P<0.001),waist circumference(WC)(OR:1.03,95%CI:1.02-1.03 P<0.001),lifestyle(OR:0.45,95%CI:0.42-0.48,P<0.001),and family history(OR:4.28,95%CI:4.04-4.54,P<0.001)were the most significant predictors of high-risk CRC.Healthy lifestyle was a protective factor,whereas family history was the most significant risk factor.The area under the curve was 0.734(95%CI:0.723-0.745)for the final validation set ROC curve and 0.735(95%CI:0.728-0.742)for the training set ROC curve.The calibration curve demonstrated a high correlation between the CRC high-risk population predicted by the nomogram model and the actual CRC high-risk population.CONCLUSION The early-screening nomogram model for CRC prediction in high-risk populations developed in this study based on age,BMI,WC,lifestyle,and family history exhibited high accuracy.展开更多
目的探讨核因子相关因子2/抗氧化反应元件(Nrf2/ARE)信号通路关键因子与妊娠期肝内胆汁淤积症(ICP)孕妇肝功能和预后的关联性。方法选取2020年1月至2023年6月新乡医学院第一附属医院收治的89例ICP孕妇作为研究组,另按照1∶1配对原则选...目的探讨核因子相关因子2/抗氧化反应元件(Nrf2/ARE)信号通路关键因子与妊娠期肝内胆汁淤积症(ICP)孕妇肝功能和预后的关联性。方法选取2020年1月至2023年6月新乡医学院第一附属医院收治的89例ICP孕妇作为研究组,另按照1∶1配对原则选择孕周、年龄等因素匹配的正常妊娠期女性作为对照组。统计两组孕妇入院当天Nrf2/ARE信号通路关键因子[Nrf2蛋白、血红素加氧酶-1(HO-1)蛋白、醌氧化还原酶1(NQO1)蛋白]、肝功能指标[总胆红素(TBIL)、天冬氨酸氨基转氨酶(AST)、总胆汁酸(TBA)],采用Spearman分析Nrf2/ARE信号通路关键因子与ICP孕妇肝功能指标相关性,同时以不良母婴结局为预后判定标准,比较预后良好和不良孕妇Nrf2/ARE信号通路关键因子、肝功能指标,采用受试者工作特征(ROC)曲线及曲线下面积(AUC)、净重新分类指数(NRI)、整体鉴别指数(IDI)分析上述指标单一及联合预测预后效能。结果研究组孕妇的Nrf2、HO-1、NQO1蛋白表达及TBIL、AST、TBA含量明显高于对照组,差异均有统计学意义(P<0.05);ICP孕妇Nrf2、HO-1、NQO1蛋白表达与TBIL、AST、TBA呈正相关(r_(1)=0.592、0.587、0.624,r_(2)=0.571、0.599、0.611,r_(3)=0.566、0.576、0.598,P<0.05);预后不良组孕妇的Nrf2、HO-1、NQO1蛋白表达及TBIL、AST、TBA含量分别为1.70±0.39、1.59±0.33、1.75±0.44、(24.46±7.34)μmol/L、(50.51±16.11)U/L、(61.77±13.38)μmol/L,明显高于预后不良组1.40±0.33、1.35±0.30、1.34±0.36、(16.24±4.88)μmol/L、(41.24±12.34)U/L、(49.68±8.89)μmol/L,差异均有统计学意义(P<0.05);Nrf2+HO-1+NQO1蛋白预测ICP孕妇预后效能近似TBIL+AST+TBA(AUC:0.924 vs 0.929);Nrf2+HO-1+NQO1蛋白、TBIL+AST+TBA较单一指标可显著提升ICP孕妇预后预测能力,IDI分别为0.714(0.448~0.970)、0.709(0.423~1.457)、NRI分别为0.077(0.021~0.119)、0.089(0.018~0.027)。结论Nrf2/ARE信号通路关键因子与ICP孕妇肝功能密切相关,三者联合检测有助于提高预后预测效能,为本病鉴别诊治提供依据。展开更多
基金Supported by the Project of NINGBO Leading Medical Health Discipline,No.2022-B11Ningbo Natural Science Foundation,No.202003N4206Public Welfare Foundation of Ningbo,No.2021S108.
文摘BACKGROUND Colorectal cancer(CRC)is a serious threat worldwide.Although early screening is suggested to be the most effective method to prevent and control CRC,the current situation of early screening for CRC is still not optimistic.In China,the incidence of CRC in the Yangtze River Delta region is increasing dramatically,but few studies have been conducted.Therefore,it is necessary to develop a simple and efficient early screening model for CRC.AIM To develop and validate an early-screening nomogram model to identify individuals at high risk of CRC.METHODS Data of 64448 participants obtained from Ningbo Hospital,China between 2014 and 2017 were retrospectively analyzed.The cohort comprised 64448 individuals,of which,530 were excluded due to missing or incorrect data.Of 63918,7607(11.9%)individuals were considered to be high risk for CRC,and 56311(88.1%)were not.The participants were randomly allocated to a training set(44743)or validation set(19175).The discriminatory ability,predictive accuracy,and clinical utility of the model were evaluated by constructing and analyzing receiver operating characteristic(ROC)curves and calibration curves and by decision curve analysis.Finally,the model was validated internally using a bootstrap resampling technique.RESULTS Seven variables,including demographic,lifestyle,and family history information,were examined.Multifactorial logistic regression analysis revealed that age[odds ratio(OR):1.03,95%confidence interval(CI):1.02-1.03,P<0.001],body mass index(BMI)(OR:1.07,95%CI:1.06-1.08,P<0.001),waist circumference(WC)(OR:1.03,95%CI:1.02-1.03 P<0.001),lifestyle(OR:0.45,95%CI:0.42-0.48,P<0.001),and family history(OR:4.28,95%CI:4.04-4.54,P<0.001)were the most significant predictors of high-risk CRC.Healthy lifestyle was a protective factor,whereas family history was the most significant risk factor.The area under the curve was 0.734(95%CI:0.723-0.745)for the final validation set ROC curve and 0.735(95%CI:0.728-0.742)for the training set ROC curve.The calibration curve demonstrated a high correlation between the CRC high-risk population predicted by the nomogram model and the actual CRC high-risk population.CONCLUSION The early-screening nomogram model for CRC prediction in high-risk populations developed in this study based on age,BMI,WC,lifestyle,and family history exhibited high accuracy.
文摘目的探讨核因子相关因子2/抗氧化反应元件(Nrf2/ARE)信号通路关键因子与妊娠期肝内胆汁淤积症(ICP)孕妇肝功能和预后的关联性。方法选取2020年1月至2023年6月新乡医学院第一附属医院收治的89例ICP孕妇作为研究组,另按照1∶1配对原则选择孕周、年龄等因素匹配的正常妊娠期女性作为对照组。统计两组孕妇入院当天Nrf2/ARE信号通路关键因子[Nrf2蛋白、血红素加氧酶-1(HO-1)蛋白、醌氧化还原酶1(NQO1)蛋白]、肝功能指标[总胆红素(TBIL)、天冬氨酸氨基转氨酶(AST)、总胆汁酸(TBA)],采用Spearman分析Nrf2/ARE信号通路关键因子与ICP孕妇肝功能指标相关性,同时以不良母婴结局为预后判定标准,比较预后良好和不良孕妇Nrf2/ARE信号通路关键因子、肝功能指标,采用受试者工作特征(ROC)曲线及曲线下面积(AUC)、净重新分类指数(NRI)、整体鉴别指数(IDI)分析上述指标单一及联合预测预后效能。结果研究组孕妇的Nrf2、HO-1、NQO1蛋白表达及TBIL、AST、TBA含量明显高于对照组,差异均有统计学意义(P<0.05);ICP孕妇Nrf2、HO-1、NQO1蛋白表达与TBIL、AST、TBA呈正相关(r_(1)=0.592、0.587、0.624,r_(2)=0.571、0.599、0.611,r_(3)=0.566、0.576、0.598,P<0.05);预后不良组孕妇的Nrf2、HO-1、NQO1蛋白表达及TBIL、AST、TBA含量分别为1.70±0.39、1.59±0.33、1.75±0.44、(24.46±7.34)μmol/L、(50.51±16.11)U/L、(61.77±13.38)μmol/L,明显高于预后不良组1.40±0.33、1.35±0.30、1.34±0.36、(16.24±4.88)μmol/L、(41.24±12.34)U/L、(49.68±8.89)μmol/L,差异均有统计学意义(P<0.05);Nrf2+HO-1+NQO1蛋白预测ICP孕妇预后效能近似TBIL+AST+TBA(AUC:0.924 vs 0.929);Nrf2+HO-1+NQO1蛋白、TBIL+AST+TBA较单一指标可显著提升ICP孕妇预后预测能力,IDI分别为0.714(0.448~0.970)、0.709(0.423~1.457)、NRI分别为0.077(0.021~0.119)、0.089(0.018~0.027)。结论Nrf2/ARE信号通路关键因子与ICP孕妇肝功能密切相关,三者联合检测有助于提高预后预测效能,为本病鉴别诊治提供依据。
