不同时期脑梗死磁共振弥散加权成像及液体衰减反转恢复序列的应用价值探讨

目的:探讨弥散加权成像(diffusion weighted imaging,DWI)序列和液体衰减反转恢复技术(fluid attenuated inversion recovery,FLAIR)在不同时期脑梗死诊断中的应用价值。方法:选取120例不同时期的脑梗死患者作为研究对象,分别行1.5T磁共振DWI和FLAIR序列检查,以双盲法对比分析发现病例的敏感度和病灶面积。结果::DWI、FLAIR发现病例的敏感度:在超急性期内,分别为100%和26.67%(P<0.05);在急性期内,均为100%;在亚急性期内,分别为80%和86.67%(P>0.05);在慢性期内,分别为11.11%和94.44%(P<0.05)。梗塞灶面积显示,在72 h内DWI大于FLAIR(P<0.05),亚急性期间基本相当(P>0.05),慢性期FLAIR大于DWI(P<0.05)。结论:联合应用DWI和FLAIR能准确诊断不同时期脑梗死,并有助对脑梗死进行分期和新旧病灶的鉴别。     

Meiotic segregation analysis in spermatozoa of pericentric inversion carriers using fluorescence in-situ hybridization

BACKGROUND: Pericentric inversions are structural chromosomal abnormalities resulting from two breaks, one on either side of the centromere, within the same chromosome, followed by 180 degrees rotation and reunion of the inverted segment. They can perturb spermatogenesis and lead to the production of unbalanced gametes through the formation of an inversion loop. METHODS: We report here the analysis of the meiotic segregation in spermatozoa from six pericentric inversion carriers by multicolour fluorescence in-situ hybridization (FISH) and review the literature. RESULTS: The frequencies of the non-recombinant products (inversion or normal chromosomes) were 80% for the inv(20), 91.41% for the inv(12), 99.43% for the inv(2), 68.12% for the inv(1), 97% for the inv(8)(p12q21) and 60.94% for the inv(8)(p12q24.1). The meiotic segregation of 20 pericentric inversions (including ours) is now available. The frequency of unbalanced spermatozoa varies from 0 to 37.85%. The probability of a crossover within the inverted segment is affected by the chromosome and region involved, the length of the inverted segment and the location of the breakpoints. CONCLUSIONS: No recombinant chromosomes were produced when the inverted segment involved <30% of the chromosome length (independent of the size of the inverted segment). Between 30 and 50%, few recombinant chromosomes were produced, inducing a slightly increased risk of aneusomy of recombination in the offspring. The risk of aneusomy became very important when the inverted segment was >50% of the chromosome length. Studies on spermatozoa from inversion carriers help in the comprehension of the mechanisms of meiotic segregation. They should be integrated in the genetic exploration of the infertile men to give them a personalized risk assessment of unbalanced spermatozoa.     

Tissue microarray-based screening for chromosomal breakpoints affecting the T-cell receptor gene loci in mature T-cell lymphomas

The pathogenesis of mature T-cell non-Hodgkin lymphomas (T-NHLs) is poorly understood. Analogous to B-cell lymphomas, in which the immunoglobulin (IgH) receptor loci are frequently targeted by chromosomal translocations, the T-cell receptor (TCR) gene loci are affected by translocations in a subset of precursor T-cell malignancies. In a large-scale analysis of 245 paraffin-embedded mature T-NHLs, arranged in a tissue microarray format and using improved FISH assays for the detection of breakpoints in the TCRalpha/delta, TCRbeta, and TCRgamma loci, we provide evidence that mature T-NHLs other than T-cell prolymphocytic leukaemia (T-PLL) also occasionally show a chromosomal rearrangement that involves the TCRalpha/delta locus. In particular, one peripheral T-cell lymphoma (not otherwise specified, NOS) with the morphological variant of Lennert lymphoma displayed a chromosomal translocation t(14;19) involving the TCRalpha/delta and the BCL3 loci. A second case, an angio-immunoblastic T-cell lymphoma (AILT), carried an inv(14)(q11q32) affecting the TCRalpha/delta and IgH loci. FISH signal constellations as well as concomitant comparative genomic hybridization (CGH) data were also suggestive of the occurrence of an isochromosome 7, previously described to be pathognomonic for hepatosplenic T-cell lymphomas, in rare cases of enteropathy-type T-cell lymphoma.     

SPAIR和Dixon技术在脊柱磁共振成像 脂肪抑制效果的对比研究

目的 比较频率衰减反转恢复（spectral attenuated inversion recovery,SPAIR）和水脂分离（Dixon）技术在脊柱磁共振成像（magnetic resonance imaging,MRI）的脂肪抑制效果。方法 收集2021年12月至2022年4月于福建省肿瘤医院行脊柱MRI检查的60例患者的影像资料,其中颈椎20例,胸椎20例,腰椎20例,分别采用SPAIR T2WI和Dixon T2WI进行扫描,比较两种技术的脂肪抑制均匀性、伪影度及信噪比（signal to noise ratio,SNR）。结果 Dixon技术在颈椎、胸椎部位的脂肪抑制效果显著优于SPAIR技术（P<0.05）,两种技术在腰椎部位的脂肪抑制效果比较差异无统计学意义（P>0.05）。SPAIR技术在胸椎部位的伪影度优于Dixon技术（P<0.05）,两种技术在颈椎、腰椎部位的伪影度比较差异均无统计学意义（P>0.05）。Dixon技术在颈椎、胸椎、腰椎部位的SNR均显著优于SPAIR技术（P<0.05）。结论 Dixon技术可作为脊柱MRI脂肪抑制扫描的首选序列,胸椎扫描可视实际情况使用SPAIR技术替代。     

急诊科护理人力资源分层配置和工作现状调查分析

目的：了解急诊科护理人力资源分层配置和工作现状。方法采取整群抽样,于2014年7~8月对本市4家三级综合医院急诊科各层级护理人员工作内容中实施直接护理和间接护理的频次进行问卷调查。结果直接护理中,不同学历、职称、年资的护理人员护送检查、卫生处置、预检分诊、院前急救差异有统计学意义(P<0.05);间接护理中,不同年资、职称的护理人员临床带教、护理质控、护理科研差异有统计学意义(P<0.01)。低学历、低职称、低年资的护理人员实施护送检查、卫生处置、院前急救的频次高;高年资、高职称的护理人员实施预检分诊、临床带教、护理质控、护理科研的频率高。急诊科各层级护理人员能力不等,但实际工作中,除护送检查、卫生处置、预检分诊、院前急救、护理教学、护理质控、护理科研等少数项目外,其余工作内容基本相同。结论急诊科人力资源应科学合理分层配置,以保证急诊护理工作的质量,提高急诊患者的满意度。     

流入反转恢复序列在肝移植术后MR门静脉成像中的应用

目的 探讨流入反转恢复（IFIR）序列在肝移植术后门静脉成像中的应用价值。方法 对26例肝移植术后患者依次行上腹部IFIR序列成像和对比增强MRA（CE-MRA）,由2名医师采用盲法对门静脉显示质量进行评分,比较2组图像评分的差异并测量吻合口直径。比较2组图像测量值的差异,评价医师间图像质量评分和测量吻合口直径的一致性。结果 26例IFIR序列和CE-MRA均能显示门静脉主干及门静脉左、右支近端血管,图像质量≥ 3分者分别为92.31%（24/26）和96.15%（25/26）。2名医师对IFIR序列与CE-MRA图像质量评分差异均无统计学意义（医师1：Z=-1.077,P=0.282;医师2：Z=-0.629,P=0.529）。2组图像吻合口直径测量值间差异均无统计学意义（医师1：t=0.369,P=0.546;医师2：t=0.020,P=0.889）。2名医师图像质量评分和测量吻合口直径的一致性好。结论 IFIR序列可作为评估肝移植术后门静脉的有效方法之一。     

Prevalence of anti-FVIII antibodies in severe haemophilia A patients with inversion of intron 22

The aim of our study was to investigate whether haemophilia A patients with inversion of intron 22 are at high risk for non-inhibitory anti-FVIII antibodies development detected by ELISA. It is known that patients with severe forms of haemophilia A are more likely to develop anti-FVIII antibodies. The incidence of inhibitory anti-FVIII antibodies in patients with factor VIII gene inversion has been extensively evaluated, but if this defect has to be considered a predisposing factor is still debatable. Non-inhibitory anti-FVIII antibodies are attracting interest, due to the potential influence on FVIII half-life. Our data show that FVIII gene inversion was a major predisposing factor for anti-FVIII antibodies development.     

一种新型手术/急救医疗方舱方案探讨

目的：研究一种新型手术/急救医疗方舱,使该舱在方舱医院系统模块化组合中更加灵活,有效减少装备数量.方法：分析原方舱医院中手术方舱和急救方舱的功能、配置和布局,从医学勤务布局等方面探讨手术/急救方舱复合的可能性.结果：将手术/急救2种功能集中在1个方舱内方案可行.在抽组30张床位的移动方舱医院时,较原方舱医院减少了方舱模块,床位配置更加合理.结论：开展手术/急救方舱功能研究,能保证在满足原方舱医院战技指标的情况下,使得方舱医院抽组更加合理,使用更加方便,机动性大大提高.     

一种保留哺乳功能的乳头内陷矫正术研究

目的:探索一种保留育龄期孕前患者哺乳功能的乳头内陷矫正方法。方法:临床纳入乳头内陷程度为Ⅰ型、Ⅱ型的孕前育龄患者各60例,随机分为Ⅰ型手术组、Ⅰ型对照组、Ⅱ型手术组及Ⅱ型对照组各30例。手术组孕前进行手术,并佩戴矫正器6个月,对照组不予手术处理。同时以乳头发育正常的30例孕前育龄者作为正常组。纳入成功妊娠、生产并尝试哺乳患者,统计乳头高度,母乳喂养情况,乳头皲裂及乳腺炎的发生情况。结果:对于Ⅰ型和Ⅱ型患者,手术组术后即刻及孕晚期,其乳头高度相对术前及对照组均有显著性改善(P0.01),母乳喂养4个月成功率显著提高(P0.05),乳头皲裂和乳腺炎的发生率显著降低(P0.05),且除Ⅱ型患者的术后乳头高度外,与正常组比较差异无统计学意义(P0.05)。结论:对于Ⅰ型及Ⅱ型乳头内陷,佩戴乳头内陷矫正器除可增加乳头高度外,可在保留哺乳功能的同时,降低产后乳头皲裂和乳腺炎发生率。