踇甲皮瓣联合腓动脉穿支皮瓣游离移植再造拇指并修复足部供区 15 例

目的总结应用踇甲皮瓣再造拇指及腓动脉穿支皮瓣游离移植修复足部供区的手术方法及临床效果。方法2016 年 6 月—2018 年 5 月，应用踇甲皮瓣联合腓动脉穿支皮瓣游离移植再造拇指并修复足部供区 15 例。男 10 例，女 5 例；年龄 21～48 岁，平均 34.6 岁。致伤原因：重物压砸伤 7 例，机器绞伤 5 例，电锯切割伤 3 例。Ⅰ度缺损 9 例，Ⅱ度缺损 6 例。入院至皮瓣手术时间 4～7 d，平均 5.2 d。结果术后踇甲皮瓣及腓动脉穿支皮瓣全部成活，切口均Ⅰ期愈合。患者均获随访，随访时间 8～24 个月，平均 16.4 个月。末次随访时，再造拇指指甲生长平整，有光泽，指腹饱满；足部皮瓣外形良好，颜色及质地接近受区。根据中华医学会手外科学会拇手指再造功能评定标准，获优 9 例、良 6 例；根据 Maryland 足功能评分标准，获优 10 例、良 5 例。患者行走步态正常，无跛行及疼痛不适。结论踇甲皮瓣修复拇指Ⅰ、Ⅱ度缺损，再造拇指可获得良好外观及功能；腓动脉穿支皮瓣具有血供可靠、血管恒定、易切取等优点，可有效修复足部供区。     

肺腺癌竞争内源性RNA网络的综合分析:基于肿瘤基因组图谱数据库

目的:基于肿瘤基因组图谱数据库（TCGA）架构肺腺癌（LUAD）竞争内源性RNA（ceRNA）网络，鉴定潜在的生存关联性生物标志物，并确定特异性治疗的小分子药物。方法:依据纳入研究标准，利用Edger软件筛选LUAD组织与正常组织(mRNA、lncRNA和miRNA)差异表达的基因。通过miRcode、miRDB、TargetScan和miRanda数据库对差异表达的RNA之间的关系进行分析，构建ceRNA网络。采用Kaplan-Meier方法分析ceRNA网络中的RNA表达量与生存预后的关系，通过富集分析对网络中的mRNA基因功能和调控通路进行分析。通过Cmap数据库筛选治疗LUAD的特异性小分子药物。利用D-lnc软件确定与关键的lncRNA相关的特异性小分子药物。结果:mRNAs(ELAVL2和PBK)、miRNAs(miR-13和miR-210)和lncRNAs(AP002478.1、DSCAM-AS1、LINC00269、LINC00470和LINC00483)与总生存期(OS)关系密切。喜树碱和甲萘醌有可能逆转LUAD的状态。卡铂、多西紫杉醇、帕比司他被确定为与关键lncRNA密切相关的药物。结论:ceRNA网络在LUAD中发挥重要作用，多种差异表达RNA与LUAD预后相关，可能成为潜在的肿瘤诊断标志物和治疗靶点。     

Building and Exploitation of Learning Curves to Train Radiographer Students in X-Ray CT Image Postprocessing

IntroductionThis study aims to construct learning curves related to the realization of standardized postprocessing by radiographer students and to discuss their exploitation and interest.Materials and MethodsThis study was carried out in 21 French students in their 3rd year of training. Two postprocessing protocols in CT (#1 traumatic shoulder; #2 petrous bone) were repeated 15 times by each student. Each achievement was timed to obtain overall learning curves. The realization accuracy was also assessed for each student at each repetition.ResultsThe learning rates for the two protocols are 63% and 56%, respectively. The number of repetitions to reach the reference time for each protocol is 11 and 12, respectively. In both protocols, the standard deviations are significantly reduced and stabilized during repetitions. The mean accuracy progresses more quickly in protocol #1.DiscussionThe measured learning rates reflect a rapid learning process for each protocol. The analysis of the standard deviations shows that students have reached a homogeneous level. The average times and accuracies measured during the last repetitions show that the group has reached a high level of performance. Building learning curves helps students measure their progress and motivates them.ConclusionObtaining learning curves allows trainers/supervisors to qualify the learning difficulty of a task while motivating students/radiographers. The use of learning curves is inline with the competency-based training paradigm.     

长链非编码RNA在结直肠癌中的研究进展

长链非编码RNA（LncRNA）是近十年来肿瘤领域分子机制研究的热点之一，被证实在生物体内对基因的表达具有调控作用，与肿瘤的发生与发展密切相关。结直肠癌是一种严重危害人类健康的恶性肿瘤，研究发现许多LncRNA在结直肠癌中表达失调。异常表达的LncRNA作为关键的调控因子，参与了多种生物学过程，影响肿瘤细胞的增殖和凋亡、侵袭转移及调节肿瘤耐药。研究LncRNA在肠癌中的作用机制可以为结直肠癌临床治疗提供一些新思路。此外，LncRNA还可作为一种潜在的生物标志物用于结直肠癌早期诊断及预后评估。     

Compliance with temperature and time requirements during in-hospital distribution of blood components: A national survey among transfusion services

IntroductionTemperature and time conditions during storage and distribution of blood components (BC) and their permissible deviations are strictly regulated. The degree of compliance with these requirements in daily practice of transfusion services (TS) is not well known.Materials and methodsWe conducted a survey among Spanish hospital TS covering different aspects of BC management in their daily activity.ResultsEighty-three TS managing 56 % of total transfusions answered the survey. Monitoring of red blood concentrates (RBC) temperature during in-hospital distribution was routinely performed by only 12 % of the TS. The main criterion for BC re-entry into the stock was the total time spent outside controlled temperature. Up to 41 % of the TS apply the “30-minute rule” to distributed RBC, while most services use a 60-minute rule for PC. No adverse events were detected when RBC that had remained longer than 30 or 60 min outside the TS were transfused. Fresh frozen plasma is usually thawed 2 h preissue and stored at 4 °C up to 24 h.Discussion and conclusionsIn the Spanish context, the 30- and 60-minute rules for re-entry of RBC and PC into the TS stock are loosely followed. Feedback for a large number of TS suggests that the extension of the 30-minute RBC rule to at least 60 min is feasible, if other safety requirements are met. Flexibility with some requirements could help reduce product loss without deleterious effect on BC safety.     

Mevalonic aciduria: Does stem cell transplant fully cure disease?

MA is a rare, autosomal recessive disorder characterized by episodes of inflammation and periodic fevers. In its most severe form, it can result in facial dysmorphism, growth inhibition, ataxia, liver dysfunction, intellectual disability, and at times can be fatal. A number of case reports exist stating that SCT is curative in these patients. We present the case of a patient diagnosed with MA at birth, who underwent SCT at the age of 14 months with intent to cure. She achieved complete engraftment and urine mevalonate became undetectable. However, 18 months following transplant, she developed frequent episodes of fevers, rashes, arthritis, and a rising urinary mevalonate. She was subsequently diagnosed with relapse. She now requires treatment with steroids and canakinumab to manage her disease. This case is the first report of disease relapse following transplant for MA. It runs contrary to prior reports that SCT is fully curative of MA and suggests that transplant may instead provide a means of decreasing disease severity without entirely eradicating the condition.     

肺癌早期诊断方法的研究进展

目的 肺癌是全球发病率及死亡率最高的恶性肿瘤，患者5年生存率仍低于20%，提高早期诊断及筛查至关重要，本文对肺癌早期诊断方法进行文献综述。方法 检索PubMed、知网、万方、维普等数据库，选择与肺癌筛查相关的文献，进一步选择如CT、核磁共振、MiRNA、自身抗体等文献，提炼其相关结果结论。结果 肺癌早期诊断方法较多，每一种诊断方法均有其优缺点。结论 目前尚无任何一种技术被证实能独立完成早期肺癌的筛查，需要将目前早期诊断技术加以优化组合，以提高早期肺癌的诊断率。     

下胫腓联合损伤的诊断和治疗进展

目的对下胫腓联合损伤的诊断和治疗进展进行综述。方法查阅近年来有关下胫腓联合损伤的研究文献，并进行整理分析。结果下胫腓联合损伤是常见的踝关节损伤类型，下胫腓联合复杂的解剖结构给诊断和治疗带来了一定难度。术前体格检查、影像学检查及术中的加压试验对明确诊断有重要作用。下胫腓联合损伤应积极治疗，避免引起相关的远期并发症。治疗方法以内固定为主，包括金属螺钉、可降解螺钉、弹性固定及混合固定等方法，金属螺钉固定仍是当前主流，但以 Suture-button 为代表的弹性固定更符合踝关节生理特性，且二次手术率低，临床应用效果满意度高，具有较好的应用前景。结论下胫腓联合损伤的修复对于踝关节骨折患者至关重要，如何更精确、更简便地诊断下胫腓联合损伤，以及如何增加复位成功率、减少手术并发症等方面仍值得进一步探索。