红外光谱数据融合对栽培滇重楼产地鉴别*

目的 多样的环境因素使得不同产地栽培滇重楼的化学成分也丰富多样，不同居群栽培滇重楼的甾体皂苷类成分具有很大的差异，多源数据融合分析能更全面的表征药材化学信息，建立一个高效而准确的产地鉴别模型，为其资源合理开发利用提供依据。方法 以来自云南和四川的8个产地（保山、楚雄、大理、红河、丽江、成都、文山、玉溪）共366份栽培滇重楼根茎为实验材料，采集其傅里叶变换近红外光谱（FT-NIR）和衰减全反射-傅里叶变换中红外光谱（ATR-FTMIR）数据。采用Kennard-Stone算法将不同产地的样品分为2/3的训练集和1/3的预测集，基于4种特征变量提取方法（CARS、VIP、SPA、SO-Covsel）结合2种数据融合策略（低级数据融合和中级数据融合），建立偏最小二乘产地判别分析模型。根据模型参数交叉验证均方根误差（RMSECV）和预测均方根误差（RMSEP）评估模型的稳定性，模型训练集和预测集准确率（ACC）评估模型分类性能。结果 近红外光谱和中红外光谱均能反应不同产地栽培滇重楼的化学成分差异，在中级数据融合中，基于VIP和SPA提取的特征变量建立的模型正确率均大于94%。相较于中级数据融合，低级数据融合模型得到了最为满意的结果，其预测集分类正确率达到100%。结论 根据近红外和中红外数据建立的低级数据融合PLS-DA模型，能够用于栽培滇重楼的产地鉴别分析。     

新型驱动基因融合阳性非小细胞肺癌脑转移的研究进展北大核心

肺癌是我国最常见且死亡率最高的恶性肿瘤之一,随着表皮生长因子受体(EGFR)、间变性淋巴瘤激酶(ALK)及活性氧1(ROS1)等驱动基因及其相应分子靶向药物的出现,晚期非小细胞肺癌的治疗和预后发生了革命性变化。此外,一些少见新型驱动基因融合,包括神经调节蛋白1(NRG1)、神经营养酪氨酸受体激酶(NTRK)和转染重排因子(RET),正逐渐发展成为全身性治疗选择。然而,这些罕见新型融合驱动基因在NSCLC脑转移中的作用机制,以及优化控制和预防脑转移的意义人们所知甚少。因此,本文就近几年罕见驱动基因融合在NSCLC脑转移中的研究进行综述。     

微创和传统开放后路腰椎椎间融合术治疗腰椎退行性疾病的远期预后

目的探讨微创后路腰椎椎间融合术(MIS-PLIF)和传统开放PLIF对腰椎退行性疾病(LDD)远期疗效及安全性的影响。方法 2011年1月-2014年12月收治LDD患者182例,其中96例采用传统开放PLIF治疗(PLIF组),86例采用MIS-PLIF治疗(MIS-PLIF组)。比较2组腰椎矢状位参数、多裂肌横截面积及萎缩率、融合率、疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分、Oswestry功能障碍指数(ODI)及术后并发症发生情况,分析多裂肌萎缩率与顽固性腰背痛的相关性。结果 2组术后各随访时间点椎间隙高度恢复值和节段性前凸角恢复值差异均无统计学意义(P > 0.05)。2组术后1年腰椎前凸角恢复值差异无统计学意义(P > 0.05);但术后5年和末次随访时,MIS-PLIF组腰椎前凸角恢复值显著高于PLIF组,差异均有统计学意义(P < 0.05)。MIS-PLIF组术后各随访时间点多裂肌横截面积大于PLIF组,多裂肌萎缩率低于PLIF组,差异均有统计学意义(P < 0.05)。2组术后随访6个月融合率差异无统计学意义(P > 0.05)。2组术后各随访时间点下肢痛VAS评分差异无统计学意义(P > 0.05);MIS-PLIF组术后各随访时间点腰痛VAS评分、JOA评分及ODI均优于PLIF组,差异有统计学意义(P < 0.05)。MIS-PLIF组顽固性腰背痛发生率显著低于PLIF组,差异有统计学意义(P < 0.05)。合并顽固性腰背痛患者多裂肌萎缩率高于未合并顽固性腰背痛的患者,差异有统计学意义(P < 0.05)。结论术后多裂肌萎缩可能是导致顽固性腰背痛的重要原因,相较于传统开放PLIF,MIS-PLIF治疗LDD能够更有效地保持腰椎生理曲度,改善肢体活动功能,降低多裂肌萎缩程度,有助于避免顽固性腰背痛的发生。     

An update in pathologic diagnosis of uterine mesenchymal tumours

Recent discovery of new disease-defining molecular alterations and development of novel targeted therapies has dramatically changed the classification and management of uterine mesenchymal neoplasms. This review discusses diagnostic updates in endometrial stromal sarcoma, PEComa, uterine tumor resembling ovarian sex cord tumor (UTROSCT), inflammatory myofibroblastic tumor, NTRK fusion uterine sarcoma, COL1A1-PDGFB fusion sarcoma, and SMARC-deficient uterine sarcoma. Key clinical, morphologic, immunophenotypic, and molecular features are reviewed, with emphasis on common differential diagnoses and pitfalls, and their impact on prognosis or management. Where applicable, the role of novel targeted therapies is discussed. A stepwise approach to uterine mesenchymal neoplasms can achieve a proper diagnosis and guide appropriate clinical management in most cases. Nonetheless, given the rarity of these tumors, their overlapping pathologic features, and rapid evolution in their classification and management, we advocate a low threshold for diagnostic consultation.     

Selective Laser Melting of Al-Based Matrix Composites with Al2O3 Reinforcement: Features and Advantages

Aluminum matrix composites (AMC) are of great interest and importance as high-performance materials with enhanced mechanical properties. Al₂O₃ is a commonly used reinforcement in AMCs fabricated by means of various technological methods, including casting and sintering. Selective laser melting (SLM) is a suitable modern method of the fabrication of net-shape fully dense parts from AMC with alumina. The main results, achievements, and difficulties of SLM applied to AMCs with alumina are discussed in this review and compared with conventional methods. It was shown that the initial powder preparation, namely the particle size distribution, sphericity, and thorough mixing, affected the final microstructure and properties of SLMed materials drastically. The distribution of reinforcing particles tends to consolidate the near-melting pool-edges process because of pushing by the liquid–solid interface during the solidification process that is a common problem of various fabrication methods. The achievement of an homogeneous distribution was shown to be possible through both the thorough mixing of the initial powders and the precise optimization of SLM parameters. The strength of the AMCs fabricated by the SLM method was relatively low compared with materials produced by conventional methods, while for superior relative densities of more than 99%, hardness and tribological properties were obtained, making SLM a promising method for the Al-based matrix composites with Al₂O₃.     

脊髓损伤患者及其配偶二元应对体验的质性研究

目的 探讨脊髓损伤患者及其配偶二元应对体验,为开展针对性的干预对策提供参考依据。 方法 采用目的抽样法,选取2020年4月—2021年3月入住安徽省某三级甲等综合医院脊柱外科的脊髓损伤患者12例及其配偶12名进行半结构化访谈,采用Colaizzi 7步分析法进行资料归纳并提炼主题。 结果 基于二元应对系统交互模型归纳出积极应对（共同面对、一致的疾病信念、转变沟通态度）、消极应对（适应困难、过度的保护行为、回避或冲突）、困难与挑战（亲密感丧失、寻求外部支持、构建新常态）共3个主题和9个亚主题。结论 脊髓损伤患者及其配偶积极应对与消极应对并存。医护人员需重视对患者及其配偶积极二元应对的引导,重点开展以夫妻为中心的应对干预,使其能更好地面对疾病,改善临床结局。     

A novel CDKN1A-JAZF1 gene fusion in low-grade endometrial stromal sarcoma arising from endometriosis in abdominal wall cesarean section scar: A case report and literature review

ObjectiveWe report a low-grade endometrial stromal sarcoma (ESS) with a novel CDKN1A-JAZF1 fusion gene arising from abdominal wall endometrioma.Case reportA 40-year-old woman presented with a 5.5-cm abdominal wall mass juxtaposed to the postoperative scar of two cesarean sections. Histologically, the tumor exhibited obvious tongue-like protrusions into the surrounding tissue, showed spindle cells with multinodular growth pattern that occasionally rotate around small arteries. Immunohistochemically, the tumor cells were positive for CD10, estrogen receptor (ER), progesterone receptor (PR), negatively stained for smooth muscle actin (SMA), CD117, CyclinD1. In addition, a previously undescribed gene fusion between CDNK1A 5′ end of exon 1(NM_000389.5) and JAZF1 3′ end of exon 5 (NM_175,061,3) was reported in this case.ConclusionThis report of ESS suggesting that rapidly growing abdominal wall masses without menstruation-related should be promptly evaluated and treated aggressively. In addition, we have expanded the molecular landscape of low-grade ESS.