术前预康复对全髋关节置换术后功能锻炼及运动耐力的影响

目的 探讨术前预康复在全髋关节置换（THA）术后患者关节功能和运动耐力中的干预效果。方法 80例THA患者随机分为实验组与对照组,每组各40例。对照组接受常规术前教育,实验组接受预康复训练。两组患者均在入院、术前1天、术后第2天、术后1周、术后2周使用Harris髋关节功能量表 (HHS)、Charnley髋关节功能评分量表（CHS）和6分钟步行试验（6MWT）来评估患者的关节功能及运动耐力状况。使用t检验、重复测量分析评估其干预效果。结果 经预康复训练后,实验组不同时间点HHS、CHS和6MWT有统计学意义(P<0.05);且组别和时间在HHS、CHS和6MWT上有交互作用。实验组HHS在术前1天、术后1周、术后2周均优于对照组（t=3.594、2.437、5.891,P<0.05）;实验组CHS在术前1天、术后1周、术后2周均优于对照组（t=2.318、3.724、6.439,P<0.05）;实验组6MWT在术前1天、术后1周、术后2周均优于对照组（t=3.878、5.891、8.750,P<0.05）。简单效应示,术前预康复对改善患者的HHS、CHS和6MWT直接及持续作用有统计学意义(P<0.05)。结论 术前预康复可改善THA术后患者关节功能和提升运动耐力,且随着时间改变,效果显著。     

Forkhead box protein P1 is a useful marker for the diagnosis of mucinous minimal deviation adenocarcinoma of uterine cervix

Mucinous minimal deviation adenocarcinoma (MDA) is a rare highly differentiated tumor of uterine cervix, of which the confusing histopathology resembling some benign lesions usually makes difficulty for pathologic diagnosis. The expression of forkhead box protein P1 (FOXP1) is found in some kinds of human tumors and is considered to be associated with the progression of the tumors. The purpose of this study is to detect the FOXP1 expression in MDA and evaluate its possible role in the diagnosis of MDA. Twenty-two MDA cases and 20 control cases consisting of 10 cases of lobular endocervical glandular hyperplasia and 10 cases of normal endocervical tissue were included in this study. All available clinical data were collected and immunostaining for FOXP1, carcinoembryonic antigen (CEA), human milk fat globule antigen 1 (HMFG1), estrogen receptor, and progesterone receptor were performed on these cases. The nuclear/cytoplasmic expression of FOXP1 was found in 18 of 22 MDA cases while in 1 of 20 control cases, which showed statistical significance (P = .000). The cytoplasmic CEA expression was found in 14 of 22 MDA cases and 2 of 20 control cases (P = .000), whereas cytoplasmic HMFG1 expression was found in 10 of 22 MDA cases and 4 of 20 control cases (P = .081). No statistical difference was found between FOXP1 and CEA expression (P = .083) or between FOXP1 and HMFG1 expression (P = .375) in MDA. Neither estrogen receptor nor PR expression was found in MDA. The significant expression of FOXP1 in MDA may be helpful to some extent in the pathologic diagnosis of cervical MDA. A widened observation range and further researches are needed to elucidate the potential mechanism.     

情境模拟教学在康复专科护士临床实践教学中的应用探讨

目的分析和探讨康复专科护士学员在临床实践教学中应用情境模拟教学的效果。方法随机将2019年1—12月我院康复医学中心招收的80名康复专科护士学员随机分为观察组和实验组,观察组(40名)采用常规临床带教,实验组(40名)采用情境模拟教学方法。结果实验组学员理论知识平均得分、实践操作平均得分及康复专科护士学员对带教老师满意度均高于观察组(P<0.05)。结论在临床实践教学过程中应用情境模拟教学,能有效提升康复专科护士的理论知识水平及临床实践操作能力,提高教学质量和教学水平,提升教学效果。     

Utility of the Roche Cobas 4800 for detection of high-risk human papillomavirus in formalin-fixed paraffin-embedded oropharyngeal squamous cell carcinoma

Clinical laboratories are expected to reliably identify human papilloma virus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) for prognostic and potential therapeutic applications. In addition to surrogate p16 immunohistochemistry (IHC) testing, DNA-based HPV-specific testing strategies are widely utilized. Recognizing the efficiency of the Roche Cobas 4800 platform for testing gynecological cytology specimens for high-risk HPV, we elected to evaluate the potential utility of this platform for testing formalin-fixed paraffin-embedded (FFPE) OPSCC tissue. Using the Roche Linear Array assay for comparison, we tested twenty-eight samples (16 primary OPSCC, 2 lymph node metastases from primary OPSCC, 1 oral tongue carcinoma, 3 benign squamous papillomas, and 3 non-oropharyngeal carcinoma tissues). Excluding two invalid results, the Roche Cobas 4800 testing resulted in excellent inter-assay concordance (25/26, 96.2%) and 100% concordance for HPV-16/HPV-18 positive samples. This data suggests that the Roche Cobas 4800 platform may be a cost-effective method for testing OPSCC FFPE tissues in a clinical molecular pathology laboratory setting.     

阿尔茨海默病外周血中miR-219和CaMKⅡ-γ的表达

目的 探究阿尔茨海默病（AD）患者外周血中miR-219和钙/钙调蛋白依赖性蛋白激酶Ⅱ-γ（CaMKⅡ-γ）表达情况及临床意义。方法 选取四川大学华西医院门诊部2016年2月至2019年2月收治AD患者79例,根据临床痴呆表评分将AD患者分为轻度组29例,中度组24例,重度组26例。选择本院同期健康体检者79例为对照组,采用实时荧光定量聚合酶链反应（qRT-PCR）测定各组研究对象外周血血清miR-219、CaMKⅡ-γ水平,采用酶联免疫法检测白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平,采用Pearson分析法分析miR-219水平、CaMKⅡ-γ mRNA、IL-6、TNF-α水平之间相关性。结果 与对照组相比,AD组患者血清CaMKⅡ-γ mRNA、IL-6、TNF-α水平较高,血清miR-219水平较低,差异均有统计学意义（P<0.05）;与轻度组相比,中度组和重度组AD患者血清CaMKⅡ-γ mRNA、IL-6、TNF-α水平较高,miR-219水平较低,差异均有统计学意义（P<0.05）,与中度组相比,重度组AD患者血清CaMKⅡ-γ mRNA、IL-6、TNF-α水平较高,miR-219水平较低,差异均有统计学意义（P<0.05）。Pearson分析显示miR-219与CaMKⅡ-γ、IL-6、TNF-α呈负相关（r=-0.546、-0.584,P<0.05）,CaMKⅡ-γ与IL-6、TNF-α呈正相关（r=0.523、0.603,P<0.05）。结论 阿尔茨海默病患者血清CaMKⅡ-γ mRNA水平上调,miR-219水平下调,与病情严重程度有关,可能与阿尔茨海默病发生进展存在一定关系。     

阿尔茨海默病外周血中miR-219和CaMKⅡ-γ的表达

目的 探究阿尔茨海默病（AD）患者外周血中miR-219和钙/钙调蛋白依赖性蛋白激酶Ⅱ-γ（CaMKⅡ-γ）表达情况及临床意义。方法 选取四川大学华西医院门诊部2016年2月至2019年2月收治AD患者79例,根据临床痴呆表评分将AD患者分为轻度组29例,中度组24例,重度组26例。选择本院同期健康体检者79例为对照组,采用实时荧光定量聚合酶链反应（qRT-PCR）测定各组研究对象外周血血清miR-219、CaMKⅡ-γ水平,采用酶联免疫法检测白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平,采用Pearson分析法分析miR-219水平、CaMKⅡ-γ mRNA、IL-6、TNF-α水平之间相关性。结果 与对照组相比,AD组患者血清CaMKⅡ-γ mRNA、IL-6、TNF-α水平较高,血清miR-219水平较低,差异均有统计学意义（P<0.05）;与轻度组相比,中度组和重度组AD患者血清CaMKⅡ-γ mRNA、IL-6、TNF-α水平较高,miR-219水平较低,差异均有统计学意义（P<0.05）,与中度组相比,重度组AD患者血清CaMKⅡ-γ mRNA、IL-6、TNF-α水平较高,miR-219水平较低,差异均有统计学意义（P<0.05）。Pearson分析显示miR-219与CaMKⅡ-γ、IL-6、TNF-α呈负相关（r=-0.546、-0.584,P<0.05）,CaMKⅡ-γ与IL-6、TNF-α呈正相关（r=0.523、0.603,P<0.05）。结论 阿尔茨海默病患者血清CaMKⅡ-γ mRNA水平上调,miR-219水平下调,与病情严重程度有关,可能与阿尔茨海默病发生进展存在一定关系。     

躯干控制训练对急性期脑卒中偏瘫患者动态坐位平衡和躯干功能影响的随机对照试验

  目的  探讨躯干控制训练对急性期脑卒中偏瘫患者的躯干功能、平衡、移动能力和功能独立性的影响,并与常规脑卒中康复治疗进行疗效对比。  方法  本研究采用随机对照试验设计,受试者和评估者盲,治疗师非盲。通过计算机生成的随机数字表将受试者随机分配到试验组或对照组。试验组（n=15）每次接受30 min高强度躯干控制训练加15 min低强度常规脑卒中康复治疗（共45 min,每天1次,5 d）;对照组（n=15）每次只接受45 min低强度常规脑卒中康复治疗,每天1次,5 d。躯干功能是主要结局指标,采用躯干损伤量表（trunk impairment scale,TIS）评估,次要结局指标包括平衡、移动能力和功能独立性,采用Brunel平衡量表（brunel balance assessment,BBA）、改良的Rivermead移动指数（modified rivermead mobility index,MRMI）和改良的Barthel指数（modified barthel index,MBI）评估。在干预前、后对受试者进行评估。  结果  共纳入30例脑梗死患者,平均年龄（62.93±13.51）岁,男性21例,女性9例。治疗前两组基线可比。最终27例完成规定的康复训练,试验组有2例中途退出,对照组有1例中途退出,评估者在这3例受试者接受第4次治疗后对其进行了结局指标的评估,结果纳入结果分析。两种干预方法都没有发生不良事件。两组患者治疗前,干预前各项观察指标差异无统计学意义。两组患者治疗5 d后,TIS总表、TIS静态坐位平衡亚表、TIS协调亚表、BBA、MRMI和MBI得分均较治疗前增加,但治疗后两组间比较差异无统计学意义（P均>0.05）。与对照组比较,躯干控制训练组治疗后对动态坐位平衡的改善更显著,TIS动态坐位平衡亚表分数的增加更多,差异有统计学意义（P<0.05）。  结论  躯干控制训练对急性期脑卒中偏瘫患者的躯干功能、平衡、移动能力和日常生活活动能力有改善,且躯干控制训练比常规脑卒中康复治疗更能改善动态坐位平衡。     

Evaluation of patients with pathological fractures treated by standard trauma principles but neglecting the underlying malign bone disease

IntroductionThere are several studies in the literature about pathological fractures but almost no information about patients whose pathological fracture caused by a malignant lesion misdiagnosed and treated as a simple fracture. The aim of this study was to investigate patient and fracture characteristics, and outcomes in cases where fractures occurred in the presence of a malign pathology but were treated as simple fractures.Patients and MethodsCases of malign bone lesions between 2000 and 2020 were retrospectively reviewed. Patients with a final diagnosis of malign bone lesion but whose pathological fractures were treated ignoring the underlying malign bone disease were included. Demographic, clinical and outcome data were collected from patient's medical records and analyzed.ResultsSix patients met the inclusion criteria. Three of the patients were female and the cohort mean age was 56.8 ± 21.8 years at the time of admission. Patient diagnoses were: renal cell carcinoma metastasis (n = 1); colon cancer metastasis (n = 1); chondrosarcoma (n = 2); osteosarcoma (n = 1); and undifferentiated pleomorphic sarcoma of bone (n = 1). In all cases surgical management differed from those that should have been applied if the pathological fracture had been identified. Furthermore, surgical management after definitive histological diagnosis were more aggressive compared to if the malignancy had been identified at first admission. All patients died after a mean follow-up of 16.67 ± 11.7 months and the complication rate was 100%.ConclusionWhen a pathological fracture is misdiagnosed and managed as a simple bone fracture, outcomes are extremely poor. In these situations, remedial surgery is more extensive, with increased complication rates and there is poor life expectancy.     

Risk factors for loss to follow up of pelvis and acetabular fractures

IntroductionPelvic and acetabular fracture incidence is increasing worldwide for more than four decades. There is currently no evidence examining risk factors for loss to follow up in patients with these injuries.MethodsPatients presenting with pelvic and/or acetabular fractures at our institution between 2015 and 2020 were included. Demographic, injury, treatment, and follow up information was included. Excluded patients were those who sustained a pathologic fracture, has a course of treatment prior to transfer to our centre, or expired prior to discharge.Results446 patients, 263 with a pelvic ring injury, 172 with an acetabular fracture, and 11 with combined injuries were identified. 271 (61%) of patients in our cohort followed up in Orthopaedic clinic (p = 0.016). With an odds ratio of 2.134, gunshot wound mechanism of injury was the largest risk factor for loss to follow up (p = 0.031) followed by male sex (OR= 1.859) and surgery with general trauma surgery (OR=1.841). The most protective risk factors for follow up with Orthopaedic surgery were operatively treated pelvic and acetabular fractures (OR=0.239) and Orthopaedic Surgery as the discharging service (OR=0.372).DiscussionNumerous risk factors exist for loss to follow up including male sex, ballistic mechanism, and discharging service. Investigation into interventions to improve follow up in these patients are warranted.     

Influence of anchoring ligands and particle size on the colloidal stability and in vivo biodistribution of polyethylene glycol-coated gold nanoparticles in tumor-xenografted mice

Polyethylene glycol (PEG)-coated (pegylated) gold nanoparticles (AuNPs) have been proposed as drug carriers and diagnostic contrast agents. However, the impact of particle characteristics on the biodistribution and pharmacokinetics of pegylated AuNPs is not clear. We investigated the effects of PEG molecular weight, type of anchoring ligand, and particle size on the assembly properties and colloidal stability of PEG-coated AuNPs. The pharmacokinetics and biodistribution of the most stable PEG-coated AuNPs in nude mice bearing subcutaneous A431 squamous tumors were further studied using ¹¹¹In-labeled AuNPs. AuNPs coated with thioctic acid (TA)-anchored PEG exhibited higher colloidal stability in phosphate-buffered saline in the presence of dithiothreitol than did AuNPs coated with monothiol-anchored PEG. AuNPs coated with high-molecular-weight (5000 Da) PEG were more stable than AuNPs coated with low-molecular-weight (2000 Da) PEG. Of the 20-nm, 40-nm, and 80-nm AuNPs coated with TA-terminated PEG₅₀₀₀, the 20-nm AuNPs exhibited the lowest uptake by reticuloendothelial cells and the slowest clearance from the body. Moreover, the 20-nm AuNPs coated with TA-terminated PEG₅₀₀₀ showed significantly higher tumor uptake and extravasation from the tumor blood vessels than did the 40- and 80-nm AuNPs. Thus, 20-nm AuNPs coated with TA-terminated PEG₅₀₀₀ are promising potential drug delivery vehicles and diagnostic imaging agents.