QT离散度对急危重病人预后的评估

目的　研究QT离散度对急危重病人预后的预测价值。方法　死亡组 4 7例、疾病组 4 0例和正常组 4 3例。记录 12导联心电图 ,人工测量各导联R -R间期和QT间期 ,计算R -R、QTc、QTd和QTcd。结果　死亡组的R -R、QTc、QTd和QTcd分别为 0 5 6 2± 0 2 2 0ms、0 35 6± 0 0 6 9ms、0 0 5 6± 0 0 33ms和 0 0 79± 0 0 4 6ms ;疾病组的R -R、QTc、QTd和QTcd分别为0 80± 0 134ms、0 4 16± 0 0 3ms、0 0 34± 0 0 14ms和 0 0 39± 0 0 16ms;正常组的R -R、QTc、QTd和QTcd分别为 0 82 5± 0 0 88ms、0 4 0 2± 0 0 3ms、0 0 2 7± 0 0 15ms和 0 0 31± 0 0 15ms。比较死亡组、疾病组和正常组发现 ,死亡组和疾病组的R -R、QTc、QTd和QTcd存在显著差异 (P分别 <0 0 0 1、<0 0 0 2 5、<0 0 0 1和 <0 0 0 1)。死亡组和正常组的R -R、QTc、QTd和QTcd存在显著差异 (P分别 <0 0 0 1、<0 0 0 2 5、<0 0 0 1和 <0 0 0 1)。结论　QTd对急危重病人的预后有一定的预测价值 ;但其它临床应用价值存在局限性 ,有待进一步探索。     

Analysis of accuracy of kyphotic angle measurement for vertebral osteoporotic compression fractures

A reliable and reproducible measurement technique for the sagittal contour in vertebral fractures is paramount to clinical decision-making. This study was designed to determine the most reliable measurement technique in osteoporotic vertebral compression fracture. Fifteen lateral radiographs of thoracic and lumbar fractures were selected and measured on two separate occasions by three spine surgeons using six different measurement techniques (centroid, Harrison posterior tangent method and 4 different types of modified Cobb method). The radiograph quality was assessed and the center beam location was determined. The inter- and intraobserver variance of the Cobb method 4 and the Harrison posterior tangent method were significantly lower than for the other four methods. The intraobserver correlation coefficients were the most consistent using the Cobb method 4 (0.982), followed by the Harrison posterior tangent method (0.953) and Cobb method 1 (0.874). The intraobserver agreement (% of repeated measures within 5° of the original measurement) ranged from 42% to 98% for each technique for all three observers, with the Cobb method 4 showing the best agreement (97.8%) followed by the Harrison posterior tangent method (93.7%). The Cobb method 4 and Harrison posterior tangent method, when applied to measuring the kyphosis, were reliable and had a similar small error range. The Cobb method 4 showed the best overall reliability. The centroid method and the other Cobb methods using a fractured endplate did not produce an accurate result due to inter- and intraobserver differences in determining the baseline.     

病人自控硬膜外镇痛泵治疗难治性腰椎间盘突出症临床观察

目的观察病人自控硬膜外镇痛（PCEA）泵治疗难治性腰椎间盘突出症的临床疗效。方法采用临床随机对照的方法，观察组和对照组分别应用病人自控硬膜外镇痛（PCEA）泵和用传统硬膜外注射术进行治疗，并对治疗结果进行统计分析。结果观察组痊愈31例（治愈率68．89％），好转11例（有效率93．33％），对照组痊愈18例（治愈率43．90％），好转16例（有效率82．93％）。两组治愈率比较P=0．019〈0．05，差异有显著性意义，有效率比较P=0．243〉0．05，差异无显著性意义。结论病人自控硬膜外镇痛（PCEA）泵治疗难治性腰椎间盘突出症治愈率要高于传统硬膜外注射术，在药物效应的基础上起液体剥离和持续给药的效果是其可能的作用机制。     

牛去细胞骨基质的生物相容性研究

目的 研究新型骨修复材料牛去细胞基质骨的生物相容性,为其在骨缺损修复领域中的临床应用提供实验依据.方法 对牛去细胞骨基质进行急性毒性实验、热源实验、溶血实验、兔肌肉内种植实验和兔桡骨骨缺损修复实验研究.结果 牛去细胞骨基质无毒性、无热源性、不引起溶血反应,植入兔肌肉后逐渐发生生物降解并被纤维组织取代,兔骨缺损区植入后可被骨组织取代.结论 牛去细胞骨基质具有良好的生物相容性,是理想的骨支架材料.     

联合检测肿瘤标志物对良恶性胸腔积液的诊断价值

目的:探讨联合检测肿瘤标志物ProGRP、CEA、CYFRA21-1、NSE、SCC对良恶性胸腔积液的诊断价值。方法:收集2020年1月-2021年1月在包头医学院第一附属医院收治的确诊为良性胸腔积液(BPE,87例)和恶性胸腔积液(MPE,44例)患者,共131例。应用化学发光法检测患者胸腔积液中ProGRP、CEA、CYFRA21-1、NSE以及SCC的浓度,比较良恶性胸腔积液中肿瘤标志物的水平,将5种肿瘤标志物以不同的方式组合,通过受试者工作特征(ROC)曲线分析比较不同联合方式的诊断价值。结果:ProGRP+CEA+CYFRA21-1+NSE联合方式对应的ROC曲线下面积(AUC)最大(0.841),其约登指数最大时,灵敏度77.3%,特异度85.1%,阳性似然比5.188,阴性似然比0.267,诊断价值最高。结论:通过联合检测不同组合的肿瘤标志物发现,ProGRP+CEA+CYFRA21-1+NSE的组合形式在诊断效能、特异度、灵敏度、阳性似然比、阴性似然比等方面优于其他组合,在鉴别诊断胸腔积液性质方面有重要参考价值。     

A novel mutation in the FcgammaRIIIA gene (CD16) results in active natural killer cells lacking CD16

We report a novel mutation in FcgammaRIIIA (the transmembrane-form CD16) on natural killer (NK) cells in a patient with polyneuropathy. She had no history of recurrent infections. Her NK cells expressed no detectable CD16; however, her NK cytotoxic activity was normal, suggesting that CD16 expression and cytotoxic activity are independent of one another. Molecular analysis revealed a deletion of a single adenine base in exon 4 of CD16 at nucleotide 550. This deletion generates a STOP codon in an extra-cellular domain of the FcgammaRIIIA gene, thereby truncating the CD16 molecule. The patient's NK cells were not recognized by the anti-CD16 monoclonal antibodies 3G8 and Leu11c. Whether the development of her polyneuropathy is associated with this novel mutation is unclear.