肾结核的CT征象和病理关系

目的：探讨肾结核的CT征象和病理之间的关系。方法：肾结核26例，分别经手术（16例）和尿培养（10例）证实，综合其CT征象、手术和病理结果，结合文献资料予以分析。结果：26例肾结核，22例呈大小数量不一的囊状低密度区；2例呈实质性肿块；2例以肾盂肾盏壁增厚伴肾功能下降为主。16例有钙化，2例平扫呈均匀的囊状高密度影。共20例有肾盂和输尿管壁增厚，其中2例部分膀胱壁增厚。结论：肾结核是肾脏的慢性炎症性病变，各期的CT表现差异较大，但仍有相对的特征性，CT能客观地显示各期肾结核的病理特征，是目前肾结核最佳的影像诊断方法之一。     

Identification of small-molecule inhibitors of autotaxin that inhibit melanoma cell migration and invasion

Autotaxin (ATX) is a prometastatic enzyme initially isolated from the conditioned medium of human melanoma cells that stimulates a myriad of biological activities, including angiogenesis and the promotion of cell growth, survival, and differentiation through the production of lysophosphatidic acid (LPA). ATX increases the aggressiveness and invasiveness of transformed cells, and ATX levels directly correlate with tumor stage and grade in several human malignancies. To study the role of ATX in the pathogenesis of malignant melanoma, we developed antibodies and small-molecule inhibitors against recombinant human protein. Immunohistochemistry of paraffin-embedded human tissue shows that ATX levels are markedly increased in human primary and metastatic melanoma relative to benign nevi. Chemical screens identified several small-molecule inhibitors with binding constants ranging from nanomolar to low micromolar. Cell migration and invasion assays with melanoma cell lines show that ATX markedly stimulates melanoma cell migration and invasion, an effect suppressed by ATX inhibitors. The migratory phenotype can be rescued by the addition of the enzymatic product of ATX, LPA, confirming that the observed inhibition is linked to suppression of LPA production by ATX. Chemical analogues of the inhibitors show structure-activity relationships important for ATX inhibition and indicate pathways for their optimization. These studies suggest that ATX is an approachable molecular target for the rational design of chemotherapeutic agents directed against malignant melanoma.     

Classification and clinical features of headache patients: an outpatient clinic study from China

This study aimed to analyze and classify the clinical features of headache in neurological outpatients. A cross-sectional study was conducted consecutively from March to May 2010 for headache among general neurological outpatients attending the First Affiliated Hospital of Chongqing Medical University. Personal interviews were carried out and a questionnaire was used to collect medical records. Diagnosis of headache was according to the International classification of headache disorders, 2nd edition (ICHD-II). Headache patients accounted for 19.5% of the general neurology clinic outpatients. A total of 843 (50.1%) patients were defined as having primary headache, 454 (27%) secondary headache, and 386 (23%) headache not otherwise specified (headache NOS). For primary headache, 401 (23.8%) had migraine, 399 (23.7%) tension-type headache (TTH), 8 (0.5%) cluster headache and 35 (2.1%) other headache types. Overall, migraine patients suffered (1) more severe headache intensity, (2) longer than 6 years of headache history and (3) more common analgesic medications use than TTH ones (p < 0.001).TTH patients had more frequent episodes of headaches than migraine patients, and typically headache frequency exceeded 15 days/month (p < 0.001); 22.8% of primary headache patients were defined as chronic daily headache. Almost 20% of outpatient visits to the general neurology department were of headache patients, predominantly primary headache of migraine and TTH. In outpatient headaches, more attention should be given to headache intensity and duration of headache history for migraine patients, while more attention to headache frequency should be given for the TTH ones.     

Diffusion tensor imaging of normal white matter maturation from late childhood to young adulthood: voxel-wise evaluation of mean diffusivity, fractional anisotropy, radial and axial diffusivities, and correlation with reading development

Using diffusion tensor MR imaging (DTI) and advanced voxel-wise analysis tools, we study diffusivity and anisotropy changes of white matter from late childhood to young adulthood, and correlate quantitative diffusion indices with Chinese and English reading performance scores. Seventy-five normal healthy school going ethnic Chinese students and young adults of three age groups were recruited (group 1, n=24, mean+/-SD=7.4+/-0.3 years; group 2, n=27, mean+/-SD=10.3+/-0.5 years; group 3, n=24, mean+/-SD=22.8+/-2.3 years). DTI was performed with 3 mm isotropic resolution to cover the entire brain. Voxel-wise analysis was performed using Tract-Based Spatial Statistics (TBSS) to localize regions of white matter showing significant changes of fractional anisotropy (FA), mean diffusivity (MD), and axial and radial diffusivities between groups. We found increased FA and decreased MD with increasing age in regions of cerebellar white matter, right temporal white matter, and a large portion of the superior frontal and parietal white matter driven by both the reduction of radial diffusivity and axial diffusivity with the former to a greater extent. Changes were continual from late childhood to young adulthood. Findings were confirmed by region-of-interest analysis in specific white matter tracts. After controlling for the effect of age, significant correlation was found between diffusion indices of the anterior limb of the left internal capsule and Chinese reading score (p=0.05), and of the corona radiata and English reading score (p=0.026 and p=0.029 for left and right, respectively).These DTI indices likely reflect the multiple biological processes that occur during brain development which provide the neural substrate for ongoing functional connectivity including for reading development.     

临床护理路径在乳腺癌改良根治切除术病人中的应用

乳腺癌是一个世界范围内的严重危害妇女健康的恶性肿瘤.多见于40岁～60岁、绝经期前后的妇女.在我国其发病率呈现不断上升的趋势.手术是治疗乳腺癌的主要手段.由于手术治疗切除组织多、创面大,破坏了形体,且术后治疗的毒副反应给病人身心带来严重的创伤.     

城乡妇女乳腺癌早期检测知识的调查研究

[目的]了解乳腺癌病人疾病发现方式及乳房自查知识掌握情况,为护理人员提供正确的健康教育方式。[方法]分别对60例农村和城市乳腺癌病人进行问卷调查。[结果]农村妇女乳腺癌发现途径侧重于自我无意发现肿块占83.33%,10.00%是由于有自觉症状、疼痛、乳头溢液等,肿瘤多为Ⅱa期、Ⅱb期、缺乏掌握乳腺自我检查的知识。城市妇女自我无意发现肿块途径占56.67%,体检和自查发现肿块各占20.00%。肿瘤多为Ⅰ期、Ⅱa期。不能完全掌握乳腺自我检查的知识和技巧。[结论]医护人员应根据不同人群提供乳腺癌早期检测的知识和技能,建立符合我国国情的乳腺癌的早期检测方案。     

Novel mutations of CYP27B1 gene lead to reduced activity of 1α-hydroxylase in Chinese patients

Pseudovitamin D-deficiency rickets (PDDR) is an autosomal recessive disorder resulting from a defect in renal 25-hydroxyvitamin D 1α-hydroxylase, the key enzyme in the pathway of vitamin D metabolism. We identified ten different mutations in the 1α-hydroxylase gene (CYP27B1) in eight Chinese families with PDDR by DNA-sequence analysis. Six of them are novel missense mutations: G57V, G73W, L333F, R432C, R459C, and R492W; three are novel deletion mutations: c48-60del, c1310delG, and c1446delA; and an insertion mutation c1325-1332insCCCACCC reported previously. Functional assay revealed that the missense mutants identified in this study retain 5.5-12.1% 1α-hydroxylase activity of the wild type. The study describes nine novel mutations in addition to 37 known mutations of CYP27B1 gene and shows the correlation between these mutations and the clinical findings of 1α-hydroxylase deficiency.     

Derivation and validation of a prediction rule for estimating advanced colorectal neoplasm risk in average-risk Chinese

No prediction rule is currently available for advanced colorectal neoplasms, defined as invasive cancer, an adenoma of 10 mm or more, a villous adenoma, or an adenoma with high-grade dysplasia, in average-risk Chinese. In this study between 2006 and 2008, a total of 7,541 average-risk Chinese persons aged 40 years or older who had complete colonoscopy were included. The derivation and validation cohorts consisted of 5,229 and 2,312 persons, respectively. A prediction rule was developed from a logistic regression model and then internally and externally validated. The prediction rule comprised 8 variables (age, sex, smoking, diabetes mellitus, green vegetables, pickled food, fried food, and white meat), with scores ranging from 0 to 14. Among the participants with low-risk (≤3) or high-risk (>3) scores in the validation cohort, the risks of advanced neoplasms were 2.6% and 10.0% (P < 0.001), respectively. If colonoscopy was used only for persons with high risk, 80.3% of persons with advanced neoplasms would be detected while the number of colonoscopies would be reduced by 49.2%. The prediction rule had good discrimination (area under the receiver operating characteristic curve = 0.74, 95% confidence interval: 0.70, 0.78) and calibration (P = 0.77) and, thus, provides accurate risk stratification for advanced neoplasms in average-risk Chinese.     

老年超重患者心脏手术后机械通气潮气量的研究

目的探讨两种方法设置老年超重患者心脏手术后机械通气潮气量的临床效果。方法采用随机数字表法将解放军总医院2014年1-6月在全身麻醉下行心脏开胸手术后返回监护室的老年患者141例分为研究组和对照组,研究组(73例)采用8ml/kg×标准体质量来设置潮气量,对照组(68例)采用8ml/kg×实际体质量来设置潮气量。比较两组患者的潮气量、机械通气时间、并发症发生情况,术后返回监护室行机械通气后15min和拔除气管插管后20min的动脉血气指标,以及需再次调节潮气量设置的具体情况。结果研究组初始潮气量小于对照组,需再次调整潮气量参数的患者比例少于对照组(P0.01);返回监护室机械通气15 min后,研究组二氧化碳分压(PaCO2)高于对照组(P0.01);拔除气管插管后20min,研究组pH值小于对照组(P0.01);对照组中需要再次调整潮气量者的体质量及初始潮气量均明显大于未调整者(P0.05),调整后的潮气量明显小于调整前(P0.01);两组患者均未发生肺损伤、低氧血症及高碳酸血症等并发症。结论根据标准体质量设置潮气量可有效降低老年超重患者过度通气的风险并取得较好的通气效果,同时能减轻医护人员工作量,为临床工作的改进提供了有益的尝试。