Altered static and dynamic voxel-mirrored homotopic connectivity in subacute stroke patients: a resting-state fMRI study

Sixty-four subacute stroke patients and 55 age-matched healthy controls (HCs) underwent a resting-state functional magnetic resonance imaging scan using an echo-planar imaging sequence and high-resolution sagittal T1-weighted images using a three-dimensional magnetization-prepared rapid gradient echo sequence. Static and dynamic voxel-mirrored homotopic connectivity (VMHC) was computed, respectively. The relationships between the clinical measures, including National Institutes of Health Stroke Scale (NIHSS), illness duration, Fugl-Meyer assessment for upper and lower extremities (FMA-total) and size of lesion volume, and the static/ dynamic VMHC variability alterations in stroke patients were calculated. The stroke patients showed significantly increased static VMHC in the corpus callosum, middle occipital gyrus and inferior parietal gyrus, and decreased static VMHC in the inferior temporal gyrus and precentral gyrus (PreCG) compared with those of HCs. For dynamic VMHC variability, increased dynamic VMHC variability in the inferior temporal gyrus and PreCG was detected in stroke patients relative to that in HCs. Correlation analysis exhibited that significant negative correlations were shown between the FMA scores and dynamic VMHC variability in PreCG. The present study suggests that combined static and dynamic VMHC could be helpful to evaluate the motor function of stroke patients and understand the intrinsic differences of inter-hemispheric coordination after stroke.

     

恶性胸膜间皮瘤误诊为结核性胸膜炎原因分析

目的分析恶性胸膜间皮瘤(malignant pleural mesothelioma,MPM)的临床特点,以减少误诊。方法对我院收治的1例MPM误诊病例资料进行回顾性分析。结果本例因咳嗽、胸闷、胸痛1个月,加重2周入院。外院胸部CT检查提示左侧胸腔积液,经胸腔积液检查考虑结核性胸膜炎,予诊断性抗结核治疗2周,患者症状逐渐加重,遂转我院。转我院后胸部CT、B超检查均提示左侧大量胸腔积液,血清神经元特异性烯醇化酶48 ng/ml,并结合胸腔镜活检病理及免疫组织化学染色检查确诊为MPM。予培美曲塞二钠联合顺铂化疗,胸腔积液大部分吸收,症状明显好转出院。但11个月后病情恶化死亡。结论临床上对于难以定性的胸腔积液,尤其伴有持续性胸痛者,应高度警惕MPM可能,及早行胸腔镜、CT引导下肺穿刺活检、开胸等检查对确诊有重要意义。     

老年抗中性粒细胞胞浆抗体相关性血管炎诊治8例并文献复习

回顾分析8例以肺部感染为首发症状的抗中性粒细胞胞浆抗体相关性血管炎(antineutrophil cytoplasmic autoantibodyassociated vasculitides,ANCA-AAV)老年患者的临床资料,探讨以肺部感染症状为主要表现的ANCA-AAV的临床特征与诊治方法。8例中6例患者接受甲泼尼龙1 mg/(kg·d)治疗4~6周,病情控制后改为泼尼松,逐渐减量,其中3例同时接受免疫抑制剂环磷酰胺2 mg/(kg·d)口服1年;1例加用雷公藤1 mg/(kg·d)治疗3个月;2例因出现肾功能衰竭病死,未用糖皮质激素治疗。8例患者中,除2例因肾功能衰竭死亡外,1例因呼吸功能衰竭死亡,5例患者经治疗后咳嗽、咳痰、贫血、乏力、肌肉酸痛等症状明显好转,体温恢复正常。因此,对于临床表现缺乏特异性且抗感染等疗效不佳的患者应尽早行ANCA检测。糖皮质激素治疗能改善ANCA-AAV患者的预后。     

OPN和VEGF-C在胃癌中的表达及其临床意义

目的:评价骨桥蛋白(osteopontin,OPN)和血管内皮生长因子C(vascular endothelial growth factor C,VEGF-C)在胃癌中表达及与临床病理参数之间相关性,进一步探讨二者的共表达在胃癌淋巴结转移中的机制.方法:收集复旦大学附属中山医院手术切除胃癌组织标本及患者相关临床资料,对纳入研究的93例胃癌原发灶标本采用免疫组织化学染色法(EnVision二步法),检测OPN与VEGF-C蛋白的表达.结果:93例胃癌组织中OPN与VEGF-C的阳性表达率分别为64.5%(60/93)和69.9%(65/93),在非肿瘤性胃黏膜中均未见其阳性表达;OPN和VEGF-C的表达与胃癌浆膜侵犯、TNM分期以及淋巴结转移呈明显相关(P<0.05).蛋白之间的相关性分析显示,OPN与VEGF-C之间存在正相关(r=0.493,P<0.01).结论:联合检测OPN与VEGF-C有助于阐述胃癌发生发展、浸润转移的机制,OPN可能通过上调VEGF-C的表达促进胃癌的淋巴结转移.     

脉冲电磁场磁疗与骨硬化蛋白单克隆抗体联合干预绝经后新西兰大白兔骨代谢和骨微结构的变化

文题释义：低频脉冲电磁场(pulsed electromagnetic fields,PEMFs)疗法：是目前常用的骨质疏松症物理治疗方法。脉冲电磁场治疗骨质疏松症的原理是采用低频脉冲电磁场改变人体生物电、改善生物场,促使成骨细胞增生,增强成骨能力,提高骨密度治疗骨质疏松。 骨硬化蛋白的单克隆抗体(sclerostin antibody,Scl-Ab)：对骨代谢的影响集中体现在对骨硬化蛋白的拮抗作用上。骨硬化蛋白单克隆抗体在刺激成骨活动的同时,不会刺激破骨活动,对骨合成代谢有显著刺激作用,其已经成为治疗骨质疏松的潜在方法。 背景：脉冲电磁场与骨硬化蛋白单克隆抗体皆能对绝经后新西兰大白兔骨代谢产生良好影响,但关于两者联合干预的效果至今少有报道。 目的：探讨脉冲电磁场联合骨硬化蛋白单克隆抗体对绝经后新西兰大白兔骨代谢的影响,探索其对骨质疏松症的治疗价值。 方法：采用卵巢切除法建立新西兰大白兔绝经后骨质疏松动物模型。将实验动物随机分为4组：卵巢切除组、脉冲电磁场组、骨硬化蛋白单克隆抗体组和脉冲电磁场+骨硬化蛋白单克隆抗体组,每组10只。术后第1天起,脉冲电磁场组给予脉冲电磁场磁疗每天1次;骨硬化蛋白单克隆抗体组给予骨硬化蛋白单克隆抗体皮下注射每周2次;脉冲电磁场+骨硬化蛋白单克隆抗体组接受脉冲电磁场磁疗每天1次、每周5次,骨硬化蛋白单克隆抗体皮下注射每周2次;卵巢切除组皮下注射相同剂量的生理盐水每周2次,干预共8周。8周后行骨代谢指标检查、骨密度测定、MicroCT骨微结构参数检测。动物研究中的所有程序经复旦大学实验动物科学部批准(20171263A193)。 结果与结论：①卵巢切除6个月新西兰大白兔骨密度显著下降,提示骨质疏松模型建立成功;②与卵巢切除组相比,3个治疗组L₃椎体的骨密度均显著增加(P < 0.05);③3个治疗组血清骨特异性碱性磷酸酶水平均显著高于卵巢切除组,血清抗酒石酸酸性磷酸酶5b水平均显著低于卵巢切除组;脉冲电磁场+骨硬化蛋白单克隆抗体组血清抗酒石酸酸性磷酸酶5b的水平明显低于脉冲电磁场组、骨硬化蛋白单克隆抗体组;④脉冲电磁场+骨硬化蛋白单克隆抗体组骨微结构参数(骨体积分数､骨小梁厚度､骨小梁数量､骨小梁分离度)均优于脉冲电磁场组、骨硬化蛋白单克隆抗体组(均P < 0.05);⑤骨硬化蛋白单克隆抗体和脉冲电磁场联合治疗可以增强去势新西兰大白兔骨密度,改善骨代谢和骨微结构。 ORCID: 0000-0001-7052-4262(钱光) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Perceptions of nurses towards oral health in palliative care: A qualitative study

BackgroundOral health problems among people receiving palliative care are common and can significantly affect quality of life. Nurses are at the frontline of palliative care in Australia. However, how optimal oral health care is addressed in clinical practice by palliative nurses is not known.AimTo explore the perceptions of nurses working in Australian palliative care settings to determine the acceptability, challenges and recommendations that need to be considered to develop and implement an oral health care model in palliative care settings.MethodsTwo focus groups were conducted with community (n = 8) and inpatient nurses (n = 10) working in urban palliative care settings.FindingsFour main themes were developed through consensus: 1) Oral health is important in the palliative care setting; 2) Additional training could enhance what nurses already do; 3) Barriers to receiving oral care: a structural issue; 4) Exploring alternative pathways to dental services.DiscussionNurses recognised the importance of oral health in palliative care; however, the paucity of set protocols based on existing guidelines meant that oral care was often unstructured. Systemic factors reduced the number of available options for people receiving palliative care to access professional dental treatment. Although alternative solutions, including teledentistry services, were explored, there were some constraints.ConclusionA palliative care oral health model of care would need to integrate existing formal guidelines into a comprehensive framework specific for palliative care nurses and develop palliative care oral health training for them taking into consideration existing barriers for people to receive professional dental treatment.     

A critical ethnographic study using Bourdieu’s social practice framework to explain vertical and horizontal abuse (VHA) within an undergraduate nurse simulation environment

BackgroundVertical and horizontal abuse (VHA) has been reported in the nursing literature for over 30 years. VHA has also been referred to as workplace bullying, incivility, harassment, and mobbing. Previous work has explicitly focussed on VHA in nurses working in the industry, while other studies explore VHA generally in nursing students. However, there has been little attention paid to episodes of VHA, which may occur among nursing students learning in simulated environments.AimThis study aimed to identify factors which enabled episodes of VHA among second-year nursing students learning in a simulated hospital environment, through the application of Bourdieu’s social practice theory.MethodThis research used a critical ethnographic approach. Methods included observations, and semi-structured interviews with student (n = 40) and academic participants (n = 3) from a second-year undergraduate nursing program.ResultsEpisodes of VHA were evident among second-year nursing students and academics learning and teaching in a simulated environment. This study showed that the organisational and the social spaces of learning and teaching had been influenced by healthcare industry culture and the challenge for capital within the university. This has resulted in the simulated laboratory, becoming a space for cultural reproduction.ConclusionThis study calls for both an educational and organisational response to the findings. An educational response would require a curriculum review to reveal and acknowledge symbolic violence which may be embedded. An organisational response to recognize the symbiotic relationship between the higher education and health care sectors which may result in the reproduction of VHA is also required.     

挤切劈核法在囊膜上超声乳化手术中的应用

目的:探讨囊膜上挤切劈核法在白内障超声乳化手术中的应用。方法:年龄相关性白内障249例(289眼)随机分为囊膜上挤切劈核(crush-and-chop)组125例(147眼)和囊袋内拦截劈核(stop-and-chop)组124例(142眼)。分别在囊膜上和囊袋内原位采用挤切劈核和拦截劈核技术进行白内障超声乳化术。记录术中平均超声能量(AP)、实际超声乳化时间(U/Stime)、累积能量复合参数(AECP)、术中术后并发症、术后1d、1wk视力和术后1d角膜水肿等情况并进行比较。结果:将两组中同级核硬度的亚组进行比较,囊膜上挤切劈核组的AP、U/Stime、AECP均低于拦截劈核组,差异有显著性;且前者角膜水肿均轻于后者。两组术后1d裸眼视力囊膜上挤切劈核组优于拦截劈核组,术后1wk两组最佳矫正视力无差异。晶状体后囊膜破裂在囊膜上挤切劈核组有1眼,拦截劈核组中有3眼,无其他严重手术并发症。结论:囊膜上挤切劈核法操作简便,易掌握,且安全、有效。