超声引导下甲状腺结节细针穿刺术的个人学习曲线初步研究

目的探讨超声引导下无负压甲状腺细针穿刺细胞学（US-FNAC）的学习曲线规律及其影响因素。 方法收集分析2017年6月至2018年月6月西安交通大学医学院附属陕西省肿瘤医院由同一医师完成的135例US-FNAC患者的操作耗时及临床病例资料，将患者按手术先后分9组（A~I组），每组15例定为一手术阶段后进行两两对比分析，比较各阶段的操作耗时、并发症及操作无效率。根据得出结果将135例患者分为前、中、后（X、Y、Z）3组，比较组间差异，进一步验证结果。 结果在A组至I组进行两两对比统计学分析得出，在A~D组间操作耗时均存在统计学差异（均P<0.05），在D组与E组间出现转折即两组比较差异无统计学意义（P=0.561），而E~I组间差异均无统计学意义（均P>0.05）。X、Y、Z 3组比较中，X组操作耗时明显长于Y组和Z组［分别为（6.23±1.38）min、（3.47±0.45）min、（3.21±0.45）min］，X组与Y组和Z组差异均有统计学意义（t=18.07、23.15，均P<0.05），Y、Z两组对比无显著差异（t=1.92，P=0.067）。随着操作例数的增加，并发症及无效操作的发生率逐渐降低。 结论对于期望熟练掌握US-FNAC技术的超声医师，遵循对操作的全面认知和科学操作步骤，在指导下开展45例左右的US-FNAC后，可望快速安全越过学习曲线转折点。     

筋骨活血汤治疗骨折急性疼痛患者的疗效及对炎性反应递质水平的影响

目的:探讨筋骨活血汤治疗骨折急性疼痛患者的疗效及对炎性反应递质水平的影响。方法:选取2015年4月至2018年5月琼海市中医院收治的骨折急性疼痛患者128例作为研究对象,按随机数字表法分为观察组和对照组,每组64例。入院后2组患者均进行相应的外科手术治疗,术后对照组采用布洛芬治疗,观察组采用筋骨活血汤治疗,2组均连续治疗4周。比较2组患者治疗后临床疗效,治疗前后中医症状改善情况,致痛因子水平,炎性反应递质水平及休息时、活动时、按压时疼痛程度。结果:治疗后观察组总有效率为93. 75%,明显高于对照组的81. 25%,差异有统计学意义(P 0. 05)。与治疗前比较,治疗后2组患者肿胀、红肿、疼痛、活动障碍评分均明显降低,且观察组明显低于对照组,差异有统计学意义(P 0. 05)。与治疗前比较,治疗后2组患者休息时、活动时及按压时视觉模拟评分法(VAS)评分均明显降低,且观察组明显低于对照组,差异有统计学意义(P 0. 05)。与治疗前比较,治疗后2组患者血浆前列腺素E2(PGE2)、缓激肽(BME)及血清白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平均明显降低,且观察组明显低于对照组,差异有统计学意义(P 0. 05)。结论:筋骨活血汤可降低骨折急性疼痛患者炎性反应递质水平,减轻肿胀、红肿等症状,缓解疼痛,改善骨折部位活动障碍,临床疗效优于布洛芬。     

基于光声光谱检测的变压器油中溶解乙炔气体的压强特性

变压器油中溶解气体的检测及分析是运行电力变压器故障诊断最有效的方法之一。气体光声光谱检测技术能很好地应用于气体检测，气体压强对光声光谱检测有重要影响。论文从理论上推导出气体压强与气体吸收系数、谐振频率、光声池品质因素、池常数及气体光声电信号的函数关系。以构建的可调谐光声光谱装置对变压器油中主要故障特征气体C2H2进行实验，验证了上述函数关系的正确性，得到在气体吸收未发生饱和效应时，C2H2光声电信号与气体压强的函数关系:当0＜P＜75kPa时，光声电信号近似与气体压强P^1.5成线性关系；而当75kPa＜P＜100kPa时，光声电信号近似与气体压强 成线性关系。结合吸收谱线增宽及光声电信号变化规律，确定C2H2的谱线6 578.58cm^-1最佳光声检测压强为75kPa，理论及实验结果为进一步完善油中溶解气体光声光谱在线监测提供了技术支撑。     

基于三相桥臂坐标的SVPWM过调制方法

讨论了一种新型的SVPWM过调制方法，并对其过调制性能及谐波成分进行了分析。首先，对经典SVPWM技术进行了分析，探讨了常规过调制策略的实质。其次，引入了新的三相桥臂坐标，在该坐标下将现有的SVPWM的串行合成时间关系推导为并行。最后，给出了线性调制和过调制统一的求解模型，避免了现有过调制算法中控制角和保持角的计算。新方法取消了扇区的概念并简化了计算，可实现从线性调制到六阶梯模式的连续平滑调制。文中介绍了该过调制算法的基本原理，进行了仿真和实验。结果表明，该方法在线性调制和六阶梯模式下调制效果与经典SVPWM方法相当；而过调制区，其输出PWM波形的THD明显小于常规过调制方法。     

经腹腹膜前疝修补术并发症分析

目的：探讨经腹腹膜前疝修补术（TAPP）并发症的发生原因，以期提高手术安全性。方法回顾性分析2011年3月至2013年3月，临汾市尧都区第二人民医院收治的腹股沟疝患者80例，均行TAPP，对术后并发症的发生原因进行分析。结果本组患者手术时间50～75 min，平均（65＆#177;6）min，术后住院时间2～6 d，平均（4＆#177;1）d 。术后发生血清肿8例，尿潴留6例，暂时性感觉神经异常5例。结论在经过专业、规范的学习后，熟悉肌耻骨孔和腹膜前间隙解剖结构，规范手术操作，可有效降低并发症发生率。     

Low-Density Lipoprotein Receptor-Related Protein 6 (LRP6) rs10845498 Polymorphism Is Associated with a Decreased Risk of Non-Small Cell Lung Cancer

Objectives: Low-density lipoprotein receptor-related protein 6 (LRP6) modulates Wnt signaling transduction. Altered LRP6 expression leads to abnormal Wnt protein activation, cell proliferation and tumorigenesis. This study investigated the association between LRP6 single-nucleotide polymorphisms (SNPs) and non-small-cell lung cancer (NSCLC) in a Chinese population. Methods: A total of 500 NSCLC patients and 500 healthy controls were recruited for assessment of four LRP6 SNPs using the SEQUENOM MassARRAY matrix-assisted laser desorption ionization-time of flight mass spectrometry. The association between genotype and NSCLC risk was evaluated by computing the odds ratio (OR) and 95% confidence interval (CI) with multivariate unconditional logistic regression analyses. Results: The frequency of the LRP6 rs10845498 genotype was 60.9% (A/A), 35.5% (AG) and 3.6% (GG) in patients with lung squamous cell carcinoma (SCC) and 69.2% (A/A), 27.2% (A/G) and 3.6% (GG) in controls. Logistic regression analysis revealed that the LRP6 rs10845498 A/A major allele was associated with a reduced risk in developing lung SCC (OR = 0.69; 95% CI, 0.48-1.00; P=0.04), and tobacco smokers had a 2.21 fold greater risk in developing SCC than nonsmokers (p<0.01, 95% CI, 1.72-2.85), and tobacco smokers who carried an “A” allele (AA+AG) in rs6488507 had a 2.34-fold greater risk in developing NSCLC than other patients (p< 0.01, 95%CI, 1.74-3.13). Conclusions: The LRP6 rs10845498 SNP is associated with a reduced risk of lung SCC, while tobacco smoke increases the risk. LRP6 rs6488507 polymorphism synergistically increased the risk of NSCLC in tobacco smokers. Further studies are needed to elucidate the functional impact of LRP6 expression and activity in NSCLC.     

Criteria for Emergency Brain MRI During Stroke-Alert

ObjectivesIntravenous (IV) tissue plasminogen activator (tPA) should be given to patients with acute ischemic stroke (AIS) and avoided in stroke mimics (SM). Select use of emergency brain magnetic resonance imaging (eMRI-brain) in stroke-alerts aids diagnosis, but accepted utilization criteria for eMRI-brain do not currently exist. We developed criteria for eMRI-brain and report the yield of eMRI-brain in stroke-alert patients.Materials and MethodsWe developed three history-based criteria for performing eMRI-brain during stroke-alerts: (1) history of previous similar deficits, (2) change in consciousness at onset of symptoms, (3) symptom presentation consistent with migraine aura. We then performed a retrospective chart review of patients who presented as a stroke-alert over a 5-year period and determined how these criteria affected administration of IV tPA to AIS and SM patients.ResultsAmong 3,512 stroke-alerts, 230 (8.1%) patients met our criteria for eMRI-brain exams: 217 (92.6%) had SM and 17 (7.4%) had AIS. Our IV tPA decision-making analysis showed that based on eMRI-brain IV tPA was less frequently administered to SM patients (PCC-0.841, p=0.036) with less failures to administer IV tPA to patients with AIS (PCC -0.907, p-value=0.013, Pearson correlation coefficient). No patients became ineligible for IV tPA due to MRI-related time delays.ConclusionsOur history based criteria for performing eMRI-brain during stroke-alerts show a high yield of stroke mimics. Selective eMRI-brain improves decision-making accuracy regarding IV tPA administration.