FHIT对急性髓系白血病细胞HL60影响的研究

目的:进行外源FHIT基因转染人白血病细胞缺乏FHIT表达的HL60,研究FHIT基因对转染细胞生长的生物学影响。方法:构建pEGFP-FHIT真核表达质粒(实验组)与质粒pEGFP-N1(对照组)。分别电穿孔法转染HL60细胞。应用荧光显微镜、RT-PCR、Westernblot检测转染基因的转录和表达情况。四甲基偶氮唑盐(MTT)法、流式细胞术研究转染基因对HL60细胞体外增殖、凋亡情况的影响,并与转染对照质粒的细胞株进行比较。结果:经PCR、酶切和DNA测序证实pEGFP-FHIT真核载体构建成功。荧光显微镜下实验组HL60细胞可见绿色荧光,转染率为40%。RT-PCR和Westernblot分别从mRNA和蛋白水平检测到FHIT的表达。MTT检测结果显示:转染后实验组抑制率明显升高,细胞增殖受到抑制(P<0.05)。流式细胞术结果显示:实验组细胞凋亡率明显增加(P<0.05)。结论:转染FHIT基因对白血病细胞HL60的生长有抑制作用,并能诱导其凋亡。     

小儿扁桃体摘除术全麻拔管后的呼吸道管理

目的总结小儿扁桃体摘除术全麻拔管后的呼吸道管理方法。方法回顾性分析我院2010年6月—2013年3月全麻行扁桃体摘除手术的110例患儿资料,所有患儿均在麻醉恢复室拔管,并接受严格的呼吸道管理。结果110例患儿经过呼吸道管理,呼吸功能恢复良好,均安返病房。结论小儿扁桃体摘除术全麻拔管后,严格评估呼吸功能、充分的口腔吸引、托下颌、放置通气道、处理喉痉挛等均为有效的呼吸道管理方法。     

Preparation of uniaxial multichannel silk fibroin scaffolds for guiding primary neurons

Physical guidance cues have been exploited to stimulate neuron adhesion and neurite outgrowth. In the present study, three-dimensional (3-D) silk fibroin scaffolds with uniaxial multichannels (42-142 μm in diameter) were prepared by a directional temperature field freezing technique, followed by lyophilization. By varying the initial silk fibroin concentration, the chemical potential and quantity of free water around cylindrical ice crystals could be controlled to control the cross-section morphology of the scaffold channels. Aligned ridges also formed on the inner surface of the multichannels in parallel to the direction of the channels. In vitro, primary hippocampal neurons were seeded in these 3-D silk fibroin scaffolds with uniaxial multichannels of ～120 μm in diameter. The morphology of the neurons was multipolar and alignment along the scaffold channels was observed. Cell-cell networks and cell-matrix interactions established by newly formed axons were observed after 7 days in culture. These neurons expressed β-III-tubulin, nerve filament and microtubule-associated protein, while glial fibrillary acidic protein immunofluorescence was barely above background. The ridges on the inner surface of the channels played a critical role in the adhesion and extension of neurons by providing continuous contact guidance. These new 3-D silk scaffolds with uniaxial multichannels provided a favorable microenvironment for the development of hippocampal neurons by guiding axonal elongation and cell migration.     

Intranasal immunization with live attenuated influenza vaccine plus chitosan as an adjuvant protects mice against homologous and heterologous virus challenge

Our previous studies have proven the adjuvanticity of chitosan in mice when administered with inactivated and subunit influenza vaccine. In this study, we investigated the adjuvant effect of chitosan on the immunogenicity and protective efficacy of a live attenuated influenza vaccine. Mice were inoculated intranasally with live attenuated influenza vaccine plus chitosan and then challenged with a high, lethal dose of homologous or heterologous virus. Antibody responses, secretion of IFN-γ by spleen cells, body weight loss, survival rates, and residual lung virus titers were tested. The results demonstrated that live attenuated influenza vaccine with chitosan adjuvant not only protected mice completely against challenge with the homologous virus but also provided good cross-protection against a heterologous virus. In addition, chitosan as adjuvant could significantly increase the levels of antigen-specific antibodies and the population of IFN-γ-secreting T cells. These results reveal the potential of chitosan as a candidate adjuvant for use in a live attenuated influenza vaccine.     

湖北汉族人群APOC3-455T》C基因多态性与MS的相关性

目的 探讨载脂蛋白C3(APOC3)-455T>C基因多态性与湖北汉族人群代谢综合征(MS)及血脂的关系.方法 采集226例MS患者和258名健康者(对照组)血液用聚合酶链反应限制性片段长度多态性(PCR-RFLP)分析APOC3-455T>C基因多态性的分布,并检测其血脂和血糖水平.结果 -455C等位基因在MS与对照组中的分布频率不同,差异有统计学意义(P<0.05).两组中C等位基因携带者三酰甘油(TG)水平比TT纯合子者高(P<0.05),而高密度脂蛋白胆固醇(HDL-C)水平比TT纯合子者低.APOC3等位基因是MS独立影响因子(OR=1.987,P=0.038).结论 POC3-455T>C基因多态性与血脂水平特别是TG及HDL-C有关,APOC3-455C等位基因可能为MS的危险因素.     

教学督导会诊在超声医学科住院医师规范化培训中的应用

目的总结住院医师规范化培训阶段的会诊需求概况，评价教学督导会诊在住院医师规范化培训阶段的作用。 方法回顾性收集2015年8月至2017年8月间于北京协和医院超声医学科参加北京市住院医师规范化培训的住院医师43名及其于2017年11月至2018年8月申请教学督导会诊的病例，随访申请教学督导会诊的病例，总结会诊原因和部位，参照病理或临床诊断，对会诊医师作出教学评价（技术操作、定位、定性）。采用χ²检验比较不同年资、不同学历住院医师申请会诊原因和部位的差异，并采用t检验比较应用教学督导会诊前、后3年以下住院医师客观结构化临床考试（OSCE）阶段考核平均成绩的差异。 结果43名住院医师共随访1727份会诊病例。第一、二、三年住院医师申请会诊次数占比分别为53.0%（915/1727）、42.9%（741/1727）、4.1%（71/1727）。住院医师申请会诊原因：定性70.9%（1224/1727）、技术操作22.7%（392/1727）、定位6.4%（111/1727）。第一、二、三年住院医师因技术操作原因申请会诊比例分别为26.9%（246/915）、18.6%（138/741）、11.3%（8/71）；因定位原因申请会诊比例分别为7.8%（71/915）、4.5%（33/741）、9.8%（7/71）；因定性原因申请会诊比例分别为65.3%（598/915）、76.9%（570/741）、78.9%（56/71），不同年资住院医师申请会诊的原因不同，差异具有统计学意义（χ²=33.293，P＜0.001）。申请会诊的检查部位前三位为妇科27.9%（482/1727）、浅表器官23.3%（402/1727）和腹部20.1%（347/1727），共占71.3%，不同年资住院医师申请会诊的部位不同，差异具有统计学意义（χ²=167.583，P＜0.001）。第一、二年住院医师申请会诊主要为腹盆腔脏器技术操作和定性，第三年住院医师申请会诊集中在浅表器官病变的定性。不同学历住院医师申请会诊部位分布不同，差异具有统计学意义（χ²=64.942，P＜0.001），申请会诊原因分布差异无统计学意义（χ²=8.131，P=0.087），平均申请会诊次数相近。97.7%（383/392）的技术操作问题通过教学督导会诊得到解决；教学督导会诊定位正确率73.0%（81/111）；定性正确率92.7%（1135/1224）。应用教学督导会诊后的住院医师OSCE成绩高于应用前［（85.7±6.6）分vs（75.7±7.5）分］，差异具有统计学意义（t=-2.426，P=0.036）。 结论随着住院医师年资增加，申请会诊次数减少。不同年资住院医师申请会诊的部位和原因不同。住院医师因技术操作原因申请会诊次数逐年下降，定性需求逐年增加。教学督导会诊能有效帮助住院医师解决技术操作难点、定位和定性，提升住院医师临床胜任力。     

宫颈癌患者治疗后性功能状况变化的临床调查分析

目的:探讨宫颈癌患者治疗后性功能状况及其影响因素,以期提高临床治疗水平。方法:回顾性分析2011年1月至2013年1月我院收治的130例宫颈癌患者,采用性功能指数进行性功能状况评定,并总结影响因素。结果:治疗后患者在围绝经期症状方面无症状66.94%,轻度占18.18%,中度占9.09%,重度占5.79%;主要表现为性欲望、性兴奋、阴道润滑、性高潮、满意度下降,疼痛感增强。影响因素有年龄(≥45岁)、文化程度低(初中以下)、肿瘤晚期(Ⅳ期)、手术+放化疗、病情严重、心理障碍、配偶配合差、悲观(P均0.05)。其中年龄、文化程度、治疗方法、心理因素、肿瘤分期、性格、病情、配偶态度是宫颈癌治疗后性功能独立危险因素(P均0.05)。结论:宫颈癌患者治疗后会出现性功能障碍,在临床上要注重对性功能康复治疗,并注重防范影响因素,从而提高性生活质量。     

Radiomics signature as a new biomarker for preoperative prediction of neoadjuvant chemoradiotherapy response in locally advanced rectal cancer

PURPOSEWhether radiomics methods are useful in prediction of therapeutic response to neoadjuvant chemoradiotherapy (nCRT) is unclear. This study aimed to investigate multiple magnetic resonance imaging (MRI) sequence-based radiomics methods in evaluating therapeutic response to nCRT in patients with locally advanced rectal cancer (LARC).METHODSThis retrospective study enrolled patients with LARC (06/2014–08/2017) and divided them into nCRT-sensitive and nCRT-resistant groups according to postoperative tumor regression grading results. Radiomics features from preoperative MRI were extracted, followed by dimension reduction using the minimum redundancy maximum relevance filter. Three machine-learning classifiers and an ensemble classifier were used for therapeutic response prediction. Radiomics nomogram incorporating clinical parameters were constructed using logistic regression. The receiver operating characteristic (ROC), decision curves analysis (DCA) and calibration curves were also plotted to evaluate the prediction performance.RESULTSThe machine learning classifiers showed good prediction performance for therapeutic responses in LARC patients (n=189). The ROC curve showed satisfying performance (area under the curve [AUC], 0.830; specificity, 0.794; sensitivity, 0.815) in the validation group. The radiomics signature included 30 imaging features derived from axial T1-weighted imaging with contrast and sagittal T2-weighted imaging and exhibited good predictive power for nCRT. A radiomics nomogram integrating carcinoembryonic antigen levels and tumor diameter showed excellent performance with an AUC of 0.949 (95% confidence interval, 0.892–0.997; specificity, 0.909; sensitivity, 0.879) in the validation group. DCA confirmed the clinical usefulness of the nomogram model.CONCLUSIONThe radiomics method using multiple MRI sequences can be used to achieve individualized prediction of nCRT in patients with LARC before treatment.

Colorectal cancer is one of the most common malignancies. It ranks fourth for morbidity and third for mortality among malignant tumors, among which the proportion of rectal cancer with poor prognosis is over 60% (1, 2). Neoadjuvant therapy, combined with total mesorectal excision, has become a common strategy for rectal cancer (3). Response to neoadjuvant chemoradiotherapy (nCRT) is a marker of good prognosis in patients with locally advanced rectal cancer (LARC) (4). Tumor regression grading (TRG) is a reliable biomarker for evaluating the efficacy of nCRT (5, 6). TRG reflects the treatment effect of nCRT by evaluating fibrosis and the ratio of residual tumor cells (4). The accurate nCRT evaluation can only be achieved by postoperative histopathological TRG (3, 4), and there is still no technology that can noninvasively evaluate the therapeutic response.Magnetic resonance imaging (MRI) is commonly used in the diagnosis, preoperative staging, and therapeutic efficacy evaluation of rectal cancer. Prediction of the efficacy of nCRT by MRI has been rarely reported, partly due to the heterogeneity of the tumor combined with the prevalence of fibrosis and edema of lesions and surrounding tissue after nCRT. Over the recent years, a magnetic resonance TRG system was proposed for the evaluation of nCRT efficacy by using MRI and evaluating residual tumor and fibrosis. Nevertheless, the magnetic resonance TRG method has a low predictive value for pathological TRG and poor consistency, which hinders its clinical applications (7, 8).In recent years, radiomics has drawn increasing attention in oncology. Radiomics features selected from medical images have shown to be highly associated with the diagnosis and prognosis of cancers, and even with gene expression patterns (9). Studies highlighted the value of radiomics approaches in determining tumor status, preoperative staging, and efficacy evaluation (9, 10). Nevertheless, the application of the radiomics methods in evaluating therapeutic responses to nCRT is limited (11).Accordingly, the aim of the present study was to establish an nCRT prediction model based on multiple MRI sequences combined with tumor anatomy and biological characteristics so as to achieve a comprehensive preliminary prediction of nCRT efficacy for rectal cancer before treatment, to provide an essential basis for the rational formulation of clinical diagnosis and treatment decisions, and to avoid unnecessary exposure to radiotherapy and chemotherapy and the related risks such as toxicity and delayed definitive surgery.     

多普勒超声与同步心电图测定正常人左室收缩期时相的方法学研究

探讨以多普勒超声结合同步心电图定义左室收缩期时相的可行性。采用多普勒超声与同步心电图同时显示主动脉瓣口血流频谱及心电图的波形 ,测定 13例正常人左室收缩期各时相的时间与二维容积参数 ,比较常规法与多普勒超声法的测值之间差异 ;分析两种方法测值之间相关性和一致性。结果 :两种方法测量的左室收缩末期的时间无统计学差异 (P>0 .0 5 ) ,两者具有高度线性相关关系 (r=0 .91,P<0 .0 1)。 Bland- Altm an分析两种方法测值一致性良好 ;两种方法测量的左室收缩末期的容积无统计学差异 (P>0 .0 5 ) ,两者具有高度线性相关关系 (r=0 .97,P<0 .0 1)。两种方法测量的容积一致性良好 ;多普勒法测量的左室等容收缩末期的容积和常规法测量的左室舒张末期的容积经比较无统计学差异 (p>0 .0 5 ) ,两者具有高度线性相关关系 (r=0 .98,P<0 .0 1)。多普勒法测量左室等容收缩末期容积与常规法测量左室舒张末期容积一致性良好。多普勒超声结合同步心电图确定左室收缩期时相的方法是可行的 ,并与常规法具有相互替代性。     

特大火灾爆炸事故烧伤伤员专科护理应对

良好的突发事件卫生应急能力与医学救治和专科护理能力是有效降低事故灾害中人员伤亡的根本保证。本文结合某特大火灾爆炸事故救援救治实践,在专科护理应对视角下,总结提炼出事故中应急救援救治五个阶段的护理工作重点,以期为火灾爆炸事故中救援护理工作提供经验与借鉴。