发挥三甲医院优势 探索省-区合作公立医院改革新模式

通过总结省级三甲医院合并区属医院的实践经验,探索省-区合作这种新的公立医院改革新模式。以"输出管理、输出人才、输出技术、输出理念"为重心,深入推进"管理、学科、人才"三方面融合,将省级大医院先进的管理理念、医疗技术、人文思想渗透并扎根于基层。让乡镇老百姓得到了实惠,在家门口享受到省级优质医疗服务;优化了区域医疗卫生资源;进一步改善投资环境,提高区域竞争力。     

MicroRNA-323 regulates ischemia/reperfusion injury-induced neuronal cell death by targeting BRI3

Purpose: MicroRNA-323 (miR-323) has been reported to be upregulated in Ischemia/Reperfusion (I/R) injury-treated neuronal cell. However, the effect and underlying mechanism of miR-323 in I/R-induced neuronal cell death remains poorly understood. The current study was aim to investigate the role and molecular basis of miR-323 in I/R-induced neuronal cell. Methods: An oxygen-glucose deprivation (OGD) model of hippocampal neuron I/R was produced in vitro. Cell apoptosis, cell survival, and the expression of miR-323 were determined after 6 h, 12 h and 24 h after OGD treatment. The up- or down-regulation of miR-323 was performed by miR-323 mimics or anti-miR-323, respectively. Results: OGD induced apoptosis and suppressed survival in rat hippocampal neurons. And the expression levels of miR-323 were increased after OGD treatment. Furthermore, the up-regulation of miR-323 promoted apoptosis and suppressed survival, whereas the inhibition of miR-323 suppressed apoptosis and enhanced survival in OGD-treated neurons. Moreover, miR-323 could directly bind to BRI3 3’-UTR. Notably, the knockdown of BRI3 by BRI3 siRNA apparently abrogated cell survival and induced cell apoptosis in rat neurons. Conclusion: This study indicated that miR-323 might regulate ischemia/reperfusion-induced rat neuronal cell death via targeting BRI3.     

冠心病患者的糖代谢异常分析

目的探讨冠心病患者血糖代谢异常的发生率以及糖代谢异常对心血管事件发生和影响预后的可能机制。方法选择病情稳定的冠心病(NACS)患者和急性冠脉综合征(ACS)患者各110例。抽取静脉血检查空腹血糖(FBG)和餐后2小时血糖(2hPG),若其中任何1项异常,则进行口服葡萄糖耐量试验(OGTT)。根据血糖结果分为糖代谢正常组和糖代谢异常组(包括糖耐量异常组和糖尿病组)。同时行丙二醛(MDA)和超氧化物歧化酶(SOD)测定。结果糖代谢异常发生率在NACS和ACS患者中分别占44.54%和63.64%。无论NACS患者或ACS患者,糖代谢异常组的MDA升高和SOD降低与糖代谢正常组比较差异均有显著性;合并糖尿病和合并糖耐量异常的患者组间MDA及SOD水平比较,差异无显著性。结论糖代谢异常在冠心病患者中发生率较高,其中新识别糖代谢异常需要行OGTT检查;合并糖代谢异常的冠心病患者脂质过氧化程度高;合并糖耐量异常与合并糖尿病一样,对冠心病患者有相等程度的氧化应激。     

2D Dose Reconstruction by Artificial Neural Network for Pretreatment Verification of IMRT Fields

The use of intensity-modulated radiation therapy (IMRT) is developing rapidly in clinical routines. Because of the high complexity and uniqueness of IMRT treatment plans, patient-specific pretreatment quality assurance is generally considered a necessary prerequisite for patient treatment. In this work, we proposed a modified methodology of electronic portal imaging device (EPID)–based dose validation for pretreatment verification of IMRT fields by applying artificial neural networks (ANNs). The ANN must be trained and validated before use for pretreatment dose verification. For this purpose, 20 EPID fluence maps of IMRT prostate anterior-posterior fields were used as an input for ANN (feed forward type) and a dose map of those fluence maps that were predicted by treatment planning system as an output for ANN. After the training and validation of the neural network, the analysis of 10 IMRT prostate anterior-posterior fields showed excellent agreement between ANN output and dose map predicted by the treatment planning system. The average overall fields pass rate was 96.0% ± 0.1% with 3 mm/3% criteria. The results indicated that the ANN can be used as a low-cost, fast, and powerful tool for pretreatment dose verification, based on an EPID fluence map.     

伴骨髓毛细胞增多的Castleman病一例并文献复习

目的　报道 1例伴骨髓毛细胞增多的Castleman病 ,对其临床特征进行探讨并复习文献。方法与结果　贫血伴左下腹包块患者 ,经骨髓常规和电镜检查提示毛细胞白血病。常规干扰素治疗无效 ,切除左下腹包块 ,病检确诊为透明血管型Castleman病。术后随访 12年血象及骨髓象正常。结论　Castleman病临床表现多样化 ,易误诊。该病常伴有成熟浆细胞增多 ,伴典型毛细胞增多者尚未见报道。其确诊主要依靠病理学检查。本病预后良好 ,手术治疗后一般不复发     

Residual olfactory dysfunction in coronavirus disease 2019 patients after long term recovery

IntroductionHyposmia is among the most common symptoms of COVID-19 patients. Previous research has mainly described this issue at the disease’s early stages. Because olfactory impairment can indicate neurological degeneration, we investigated the possibility of permanent olfactory damage by assessing hyposmia during the late recovery stage of COVID-19 patients.MethodsNinety-five patients were assessed with the Brief Smell Identification Test for Chinese (B-SITC) and Hyposmia Rating Scale (HRS) after 16 weeks from disease onset. Five weeks later, 41 patients were retested with B-SITC.ResultsAt the first visit, hyposmia was identified in 26/82 (31.7%) and 22/95 (23.2%) of participants by HRS (HRS score ≤22) and B-SITC (B-SITC score <8), respectively. The rates of hyposmia in patients who performed B-SITC after 14–15 weeks, 16–17 weeks, and ≥18 weeks from disease onset were 7/25 (28%), 8/35 (23%) and 7/35 (20%), respectively, which demonstrated a trend of olfaction improvement as recovery time prolonging. Hyposmia percentages decreased from the first visit (34.1%) to the second visit (24.4%) for the 41 patients who completed 2 visits. B-SITC scores of the first-visit hyposmia participants increased significantly at the second visit (5.29 ± 2.02 to 8.29 ± 2.40; n = 14, P = 0.001). Severe cases tended to recover less than common cases.ConclusionsHyposmia was present in up to one-third of COVID-19 patients after about 3 months from disease onset. Notable recovery of olfactory function was observed at a next 5-weeks follow-up. Clinical severity had little influence on olfactory impairment and recovery.     

上颌第二磨牙的解剖外形研究

目的:了解上颌第二磨牙的解剖外形,为临床工作提供帮助。方法:收集临床上拔出的61颗上颌第二磨牙,测量牙体全长、牙冠近远中径、牙冠颊舌径、牙冠长和牙根长,观察牙根的数目。结果:上颌第二磨牙牙体全长的平均值为(19.46±1.65)mm,牙冠近远中径大于牙冠颊舌径,牙冠长小于牙根长,且全长与牙冠长、牙根长,及牙冠近远中径与颊舌径之间存在着显著相关关系(P<0.05)。3根居多,占49.18%,其次为融合根(47.54%)和变异根(3.28%)。结论:上颌第二磨牙的解剖外形较为复杂。     

心肌肥厚心力衰竭兔室性心律失常与氧化应激

目的研究心肌肥厚和心力衰竭兔氧化应激的变化,并探讨室性心律失常与氧化应激的关系。方法 40只日本长耳白兔随机分为假手术(Sham 1、Sham 2)组、心肌肥厚(LVH)组、心力衰竭(HF)组,每组10只。LVH组和HF组通过缩窄腹主动脉制备LVH与HF模型,Sham 1组和Sham 2组仅游离腹主动脉不进行缩窄术。Sham 1组和LVH组喂养8周;Sham 2和HF组喂养20周。超声心动图观察各组心脏结构变化,检测兔血清中丙二醛(MDA)、超氧化物岐化酶(SOD)和NT-脑钠肽(NT-proBNP)水平,并制备兔左室楔形心肌块的灌注模型,观察在异丙肾上腺素(2μmol/L)灌注下,快频率程序刺激各组触发活动和室性心动过速(简称室速)或心室颤动(简称室颤)的发生率。结果与Sham 1组比较,LVH组室间隔厚度(IVST)明显增厚(P<0.05),血清SOD活性降低、MDA浓度增加,触发活动和室速或室颤发生率明显升高(P<0.05);与Sham 2组比较,HF组左室舒张末期(LVEDd)增大、IVST增厚、射血分数(LVEF)降低(P<0.05),血清SOD活性降低、NT-proBNP和MDA浓度升高,触发活动和室速或室颤发生率增加(P<0.05)。与LVH组比较,HF组LVEDd增大、LVEF降低(P<0.05),血清SOD活性降低、NT-proBNP和MDA浓度升高,触发活动和室速或室颤发生率增加(P<0.05)。结论在应激情况下,晚期HF中室速或室颤发生率明显高于LVH,这种改变与氧化应激水平增加有关。     

应用外踝上皮瓣修复足踝部皮肤缺损

目的 探讨外踝上皮瓣修复足踝部皮肤缺损的临床疗效.方法 2008年3月至2012年10月,应用外踝上皮瓣修复外伤性足踝部皮肤缺损15例,其中合并踝关节,蹠跗关节骨折10例.常规清创后二期设计外踝上皮瓣修复缺损创面,皮瓣面积最大10 cm×8 cm,最小5 cm×4cm,平均8 cm×5 cm.结果 所有皮瓣均成活.其中3例术后24 h皮瓣远端出现水泡,经处理后愈合.结论 外踝上皮瓣血管解剖恒定,切取简单,成活率高,是修复足踝部皮肤缺损的一种较好方式.     

The effects of microenvironment in mesenchymal stem cell–based regeneration of intervertebral disc

Background contextRecent studies have demonstrated new therapeutic strategy using transplantation of mesenchymal stem cells (MSCs), especially bone marrow–derived MSCs (BM-MSCs), to preserve intervertebral disc (IVD) structure and functions. It is important to understand whether and how the MSCs survive and thrive in the hostile microenvironment of the degenerated IVD. Therefore, this review majorly examines how resident disc cells, hypoxia, low nutrition, acidic pH, mechanical loading, endogenous proteinases, and cytokines regulate the behavior of the exogenous MSCs.PurposeTo review and summarize the effect of the microenvironment in biological characteristics of BM-MSCs for IVD regeneration; the presence of endogenous stem cells and the state of the art in the use of BM-MSCs to regenerate the IVD in vivo were also discussed.Study designLiterature review.MethodsMEDLINE electronic database was used to search for articles concerning stem/progenitor cell isolation from the IVD, regulation of the components of microenvironment for MSCs, and MSC-based therapy for IVD degeneration. The search was limited to English language.ResultsStem cells are probably resident in the disc, but exogenous stem cells, especially BM-MSCs, are currently the most popular graft cells for IVD regeneration. The endogenous disc cells and the biochemical and biophysical components in the degenerating disc present a complicated microenvironment to regulate the transplanted BM-MSCs. Although MSCs regenerate the mildly degenerative disc effectively in the experimental and clinical trials, many underlying questions are in need of further investigation.ConclusionsThere has been a dramatic improvement in the understanding of potential MSC-based therapy for IVD regeneration. The use of MSCs for IVD degeneration is still at the stage of preclinical and Phase 1 studies. The effects of the disc microenvironment in MSCs survival and function should be closely studied for transferring MSC transplantation from bench to bedside successfully.