CT和MRI诊断儿童先天性耳聋的对比

目的 对比先天性耳聋患儿的宝石CT和MRI特点。方法 回顾性分析60例临床诊断的先天性耳聋患儿的宝石CT及MRI资料,将原始数据传至配套工作站,采用MIP、MRP、VR进行重建,分析两种检查的一致性。结果 CT显示耳部骨性结构具有优势,MRI显示耳部神经具有优势。2种检查对于显示乳突炎并大前庭导水管综合征、大前庭导水管综合征及耳蜗半规管畸形的一致性较好（Kappa>0.75）,显示半规管狭窄的一致性尚可（Kappa=0.485）。结论 CT、MR检查诊断儿童先天性耳聋各有优势,可优势互补,具有重要的临床应用价值。     

The meta-analysis of the effect of 68Ga-PSMA-PET/CT diagnosis of prostatic cancer compared with bone scan

Background:⁶⁸Ga-PSMA-PET/CT (positron emission tomography/computed tomography) is a promising method for prostate cancer (PC) detection. However, the ability of ⁶⁸Ga-PSMA-PET/CT to detect malignant bone lesions, and whether this method is superior to the existing bone imaging methods are still lack of systematic analysis.Purpose:To evaluate the value of ⁶⁸Ga-PSMA-PET/CT and bone scan in clinical diagnosis of prostatic cancer from the perspective of evidence-based medicine.Methods:PubMed, The Cochrane Library, EMBASE, Springer Link, Sinomed, CNKI, Wanfang database, and CQVIP database were searched to find the satisfactory studies that needed systematic review of trials and compared the value of 68Ga-PSMA-PET/CT and bone scan. All studies published from inception to March 31, 2020. According to the inclusion and exclusion criteria, 2 reviewers independently evaluated and extracted the literature. Review Manager 5.3 was applied to evaluate the included literature quality. The heterogeneity of the included literature was tested by Meta Disc 1.4, and the effect model was selected according to the heterogeneity test results, and the sensitivity (SEN), specificity (SPE), PLR, NLR and diagnostic odds ratio (DOR) were analyzed. After testing the heterogeneity results of literature by using the 95% confidence interval and the forest map.Results:A total of 4 studies were eligible for inclusion in the meta-analysis, which included 318 patients, 120 cases with bone metastasis and 198 cases without bone metastasis. The results of summary evaluation for ⁶⁸Ga-PSMA-PET/CT and bone scan in diagnosis of prostatic cancer as follow respectively: The SEN were 0.97 and 0.86; the SPE were 1.00 and 0.87; the DOR were 1468.33 and 36.23; PLR were 88.45 and 6.67; NLR were 0.05 and 0.19; and the area under curve (AUC) and 95% CI were 0.9973 (1.0000–0.9927) and 0.8838 (0.9584–0.8092).Conclusion:By comparing the diagnostic results of ⁶⁸Ga-PSMA-PET/CT and bone scan imaging diagnosis methods, the ⁶⁸Ga-PSMA-PET/CT has a higher SEN and SPE than bone scan, and it has a higher diagnostic efficiency for prostate cancer bone metastasis, which is worthy of clinical application.     

Healthy but unhappy? Cross-national comparative analysis of depressive symptoms in Japanese vs. Korean elders

BackgroundJapan and South Korea, two neighbouring countries in East Asia, enjoy the highest life expectancies in the world, yet suffer paradoxically from high suicide rates.AimWe sought to conduct a cross-national comparative analysis of depressive symptoms among older adults in Japan vs. Korea, focusing particularly on poverty and physical health status.MethodsWe used nationally representative samples aged 65 and over from the Comprehensive Survey of Living Conditions in Japan and the Korean Community Health Survey in South Korea. Multivariate logistic regression models were conducted to examine if equivalized household income, poor self-rated health, disability and comorbidity (number of diseases) were associated with depressive symptoms, adjusting for age, education, marital status, alcohol use, smoking and living alone.ResultsOlder Japanese adults with poor self-rated health and disability were more likely to report depressive symptoms, but income level was not significantly associated with mental distress. By contrast, among older Korean people, depressive symptoms were strongly patterned by household income level, as well as poor self-rated health, disability, and comorbidity.ConclusionPoor physical health status was correlated with depressive symptoms among both Japanese and Korean seniors. However, income level was associated with depressive symptoms among only Korean elders, but not Japanese. Thus, the current generation of older Japanese adults appears to enjoy (relative) financial security, longevity, and mental wellbeing. By contrast, older Koreans experience high levels of mental distress, especially if they are financially insecure.     

乳腺癌组织中CacyBP/SIP的表达情况及临床病理意义

目的:探讨钙周期素结合蛋白(Cacy BP/SIP)在乳腺癌组织中的表达及临床病理意义。方法:应用免疫组织化学染色检测Cacy BP/SIP在86例乳腺癌组织、20例癌旁相对正常乳腺组织及16例乳腺腺病组织中的表达情况并分析临床病理意义。结果:免疫组织化学结果显示,在86例乳腺癌组织、20例癌旁组织、16例乳腺腺病组织中Cacy BP/SIP蛋白的阳性表达率分别为75.6%(65/86)、30.0%(6/20)和43.8%(7/16),差异有统计学意义(P<0.05);Cacy BP/SIP蛋白在乳腺癌组织中的表达与组织学分级、淋巴结转移及TNM分期有统计学意义(P<0.05);Cacy BP/SIP蛋白表达与ER(r=0.275)、HER2(r=0.256)有相关性(P<0.05)。结论:Cacy BP/SIP在乳腺癌组织中高表达,且与ER、HER2的表达呈正相关,可能作为癌基因参与乳腺癌的恶性表型。     

中医辨证施治小儿急性阑尾炎术后肠功能恢复不良72例临床观察

目的观察中医辨证施治小儿急性阑尾炎术后肠功能恢复不良的临床疗效。方法对72例急性阑尾炎术后肠功能恢复不良的患儿在常规治疗的基础上进行辨证分型,分为脾胃湿热、脾胃虚弱、气阴两伤3种证型,分别予平胃散加味、四君子汤加味、生脉散加味治疗,观察肠功能恢复情况。结果经过辨证施治后,59例患儿在服药6 h后即开始排气、排便,13例服药24 h后开始正常排气、排便,所有患儿均在服药后症状缓解,肠功能恢复良好,未发生并发症及后遗症。结论中医辨证施治可以显著改善小儿急性阑尾炎术后肠功能恢复不良,减少并发症及后遗症的发生,为治疗小儿急腹症术后病变提供了有效的治疗方案。     

Laparoscopic versus open pancreatoduodenectomy: an individual participant data meta-analysis of randomized controlled trials

BackgroundRandomized trials have compared laparoscopic pancreatoduodenectomy (LPD) to open pancreatoduodenectomy (OPD) with conflicting results. An IPDMA may give more insight into the differences between LPD and OPD, and could identify high-risk subgroups.MethodsA systematic literature search was performed in the Pubmed, Embase, and the Cochrane library databases (October 2019). Out of 1410 studies, three randomized trials were identified. Primary outcome was major complications (Clavien-Dindo grade ≥ III). Subgroup analyses were performed for high-risk subgroups including patients with BMI of ≥25 kg/m2, pancreatic duct <3 mm, age ≥70 years, and malignancy.ResultsData from 224 patients were collected. After LPD, major complications occurred in 33/114 (29%) patients compared to 34/110 (31%) patients after OPD (adjusted odds ratio (OR) 0.62; 95% confidence interval (CI) 0.3–1.4, P = 0.257). No differences were seen for major complications and 90-day mortality LPD 8 (7%) vs OPD 4 (4%) (adjusted OR 0.2; 95% CI 0.02–1.3, P = 0.080). With LPD, operative time was longer (420 vs 318 min, p < 0.001) and hospital stay was shorter (mean difference ?6.97 days). Outcomes remained stable in the high-risk subgroups.ConclusionLPD did not reduce the rate of major postoperative complications as compared to OPD. LPD increased operative time and shortened hospital stay with 7 days.     

Factors influencing extrauterine growth retardation in singleton-non-small for gestational age infants in China: A prospective multicenter study

BackgroundThe incidence of extrauterine growth retardation (EUGR) varies considerably in different countries due to the distinct definitions and inclusion criteria of individual studies. Most studies included small for gestational age (SGA) very preterm infants (VPIs), resulting in a higher incidence of EUGR. Experts have suggested the accurate definition of “EUGR” in SGA infants is not “true EUGR”. The postnatal growth curve of multiple premature births also differs from that of singletons. As far as we know, there is no study about relationship between singleton-non-SGA preterm infants and EUGR.ObjectivesTo analyze the factors influencing EUGR among VPIs who were singleton-non-SGA in China.MethodsA prospective-multicenter study was conducted in 28 hospitals distributed through China from September 2019 to December 2020. The clinical data on singleton-non-SGA among VPIs were divided into EUGR group (n = 692) and non-EUGR group (n = 912).ResultsCompared to non-EUGR group, the mean gestational age (GA), mean birth weight (BW) and percentage of BW in Fenton curve in EUGR group were lower (P < 0.001 for all). The incidence of EUGR among distinct GA groups (classifications of GA < 28weeks, 28–28⁺⁶ weeks, 29–29⁺⁶ weeks, 30–30⁺⁶ weeks and 31–31⁺⁶ weeks) and distinct BW groups (classifications of BW<1000 g, 1000–1249 g, 1250–1499 g, 1500–1999g and 2000–2500 g) were statistically significant (P = 0.004 and P <.001). Logistic regression analysis indicated that later addition of human milk fortifier (HMF), later attainment of HMF sufficient fortification, later return to BW, more accumulative days of fasting, longer duration of parenteral nutrition, total duration of oxygen support and moderate/severe bronchopulmonary dysplasia (BPD) were risk factors for the development of EUGR in singleton-non-SGA VPIs (P < 0.001, P = 0.002, P < 0.001, P = 0.002, P = 0.017, P = 0.003 and P = 0.002, respectively). The use of full-course antenatal steroids, greater BW as a percentile of the Fenton curve, breastfeeding initiation and faster average velocity of weight growth effectively protected against EUGR (P = 0.008, P < 0.001, P < 0.001 and P < 0.001, respectively).ConclusionsThe overall incidence of EUGR was 43.1% among singleton-non-SGA VPIs in China. Raising the full-course antenatal steroids usage, reducing the incidence of moderate and severe BPD, attaching importance to the management of enteral nutrition in VPIs and increasing the weight growth velocity can reduce the incidence of EUGR.     

Association between serum visfatin levels and psoriasis and their correlation with disease severity: a meta-analysis

ObjectiveTo determine the association between serum visfatin levels and psoriasis and to evaluate the correlation between serum visfatin levels and the severity of psoriasis.MethodsThe electronic databases PubMed®, Embase® and the Cochrane Library were searched for articles published from inception to 1 May 2020. Data were extracted and then standard mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for pooled estimates.ResultsA total of 11 studies met the inclusion criteria and were included (448 patients diagnosed with psoriasis and 377 controls). This meta-analysis demonstrated that patients with psoriasis had significantly higher levels of visfatin than the controls (SMD = 0.90, 95% CI 0.52, 1.28). Subgroup analyses showed that differences in serum visfatin levels between the patient group and the control group were associated with ethnicity, Psoriasis Area and Severity Index (PASI) and body mass index. Additionally, a meta-analysis of correlations showed that visfatin levels in patients with psoriasis were positively correlated with PASI (r = 0.51, 95% CI 0.14, 0.75).ConclusionsThis meta-analysis showed that serum visfatin levels in patients with psoriasis were significantly higher than those in the controls and a positive correlation between serum visfatin levels and psoriasis severity was observed.     

Rapamycin attenuates articular cartilage degeneration by inhibiting β-catenin in a murine model of osteoarthritis

Purpose: To investigate whether systemic injection of rapamycin attenuates articular cartilage degeneration by inhibiting β-catenin in a murine model of osteoarthritis (OA).

Materials and methods: Ten-week-old male C57BL/6j wild-type (WT) mice and SOST-knockout (SOST^?/?) mice were randomized to a sham group, a vehicle-treated group, and a rapamycin-treated group. Mice in the vehicle-treated group underwent destabilizing of the medial meniscus (DMM) in the right knee, and were then treated with vehicle. Mice in the rapamycin treatment group underwent DMM and were treated with rapamycin. Safranin O-Fast green staining and Osteoarthritis Research Society International (OARSI) modified Mankin score were used to evaluate the histopathological features of the articular cartilage in the knee. The expression of light chain 3 (LC3) was evaluated by immunofluorescence, whereas the expression of ATG5, matrix metallopeptidase 13 (MMP-13), vascular endothelial growth factor (VEGF), sclerostin, and β-catenin were evaluated by immunohistochemistry. TUNEL staining was used to determine apoptosis of chondrocytes.

Results: In vehicle-treated mice when compared with mice in the sham group, the OARSI scores, expression of MMP-13, VEGF, sclerostin, β-catenin, and chondrocyte apoptosis were significantly increased, whereas the expression of LC3 and ATG5 were significantly decreased. A systemic injection of rapamycin activated chondrocyte autophagy, which increased the expression of LC3 and ATG-5, and reduced OARSI scores, the expression of β-catenin, MMP-13, and VEGF, and chondrocyte apoptosis in rapamycin treated mice when compared with vehicle-treated mice.

Conclusions: Systemic injection of rapamycin attenuated articular cartilage degeneration by inhibiting β-catenin in a murine model of OA.     

血管内介入治疗椎动脉颅内段夹层动脉瘤

目的 探讨血管内介入治疗椎动脉颅内段夹层动脉瘤（IVADA）的疗效。方法 回顾性分析2015年1月至2018年12月采用血管内介入技术治疗的24例IVADA的临床资料。结果 23例为单侧椎动脉夹层动脉瘤,1例为双侧椎动脉夹层动脉瘤。25枚夹层动脉瘤中,支架辅助弹簧圈栓塞18枚,单纯双支架治疗2枚,闭塞夹层动脉瘤及载瘤动脉治疗5枚;术后即刻造影显示Raymond分级Ⅰ级16枚,Ⅱ级8枚,Ⅲ级1枚。术后随访6~18个月,改良Rankin量表评分0~2分23例,3分1例;DSA复查显示2例复发,考虑相对稳定,继续随访观察。结论 血管内介入治疗IVADA疗效显著,但具体栓塞方法应进行个体化选择。