深圳市急性缺血性脑卒中复发的危险因素及风险评估

目的探讨急性缺血性脑卒中(AIS)复发的危险因素及复发风险评估。方法通过调查深圳市某三级医院历史病案数据资料,回顾性研究2011—2017年收治新发住院AIS病例及其复发情况共1779例(年龄≥18岁),基于多因素cox回归模型评估深圳市AIS复发的影响因素。结果高血压(HR=2.862)、饮酒史(HR=1.002)、NIHSS≥4分(HR=2.868)和Essen≥3分(HR=2.997~4.743)是AIS患者复发的高危预测因素(P<0.05)。结论高血压、饮酒史、NIHSS及Essen评分高均是AIS复发的危险因素,尽早对AIS患者进行筛查和强化管理是预防复发的关键。     

抗VEGF类药物与传统激光疗法用于治疗糖尿病性黄斑水肿的药物经济学评价

目的从中国全社会角度出发,评价抗血管内皮生长因子(vascular endothelial growth factor,VEGF)类药物(雷珠单抗、阿柏西普)与激光光凝用于治疗糖尿病性黄斑水肿的成本-效果。方法构建Markov模型,通过随机对照试验、已发表文献和医院调研获得3种干预措施治疗糖尿病性黄斑水肿的临床疗效、健康效用及成本数据,对各干预措施下患者终身的疾病转归、质量调整生命年(QALYs)及成本进行长期模拟。计算增量成本-效果比(ICER),并进行单因素和概率敏感性分析。结果与激光光凝相比,雷珠单抗的ICER值为61174元·QALY^-1,阿柏西普的ICER值为138232元·QALY^-1,均小于我国3倍人均GDP(59660元,2017年),抗VEGF类药物具有经济性。比较雷珠单抗与阿柏西普,雷珠单抗QALY更高成本更低,占绝对优势。单因素和概率敏感性分析证明了结果的稳健性。结论雷珠单抗、阿柏西普与激光光凝相比,在治疗糖尿病性黄斑水肿方面均具有成本-效果;其中雷珠单抗效果更好成本更低,在治疗糖尿病性黄斑水肿方面占绝对优势。     

RBC、Ret-He与HbA2联合检测对地中海贫血的临床价值

目的:探讨小细胞或低色素人群中Ret-He和RBC在地中海贫血中的分布情况及联合HbA2对地中海贫血检测的价值。方法:选取本院2018年5月-2019年12月门诊检测出或住院的小细胞或低色素患者145例,将其分为地贫组(68例)及非地贫组(77例),并同时按贫血程度将患者分为非贫血、轻度贫血、中度贫血及重度贫血共4组,对患者进行Ret-He、RBC、RDW-CV及HbA2检测,比较各项参数的分布情况,并分析RBC、Ret-He与HbA2联合检测以辅助诊断地中海贫血的灵敏度特异度。结果:在小细胞或低色素患者中,根据贫血程度分级,Ret-He从非贫血组至重度贫血组逐渐下降(P<0.05);而RDW-CV则从轻度贫血组至重度贫血组逐渐上升(P<0.05);RBC及Ret-He在地贫组患者中均较非地贫组明显升高(P<0.05),而RDW-CV则在地贫组中较非地贫组明显降低(P<0.05);同时Ret-He在α-地贫中较β-地贫明显升高(P<0.05)。进行ROC曲线分析,Ret-He以19.25 pg为截断值,RBC以4.95×10^12/L为截断值时,联合HbA2,特异度为93.51%,灵敏度为66.18%,阳性预测值为90%,阴性预测值为75.189%。结论:在小细胞或低色素患者中,RBC、Ret-He及RDW-CV在地贫组及非地贫组的分布存在差异,并受贫血程度影响。加入Ret-He及RBC可提高小细胞或低色素患者依靠HbA2进行地中海贫血初筛时的特异度。     

A computer-aided diagnosis system using white-light endoscopy for the prediction of conventional adenoma with high grade dysplasia

ObjectivesWe developed a computer-aided diagnosis system called ECRCCAD using standard white-light endoscopy (WLE) for predicting conventional adenomas with high-grade dysplasia (HGD) to optimise the patients' management decisions during colonoscopy.MethodsPretraining model was used to fine-tune the model parameters by transfer learning. 2,397 images of HGD and 2,487 low-grade dysplasia (LGD) images were randomly assigned (8:1:1) to the training, optimising, and internal validation dataset. The prospective validation dataset is the frames accessed from colonoscope videoes. One independent rural hospital provided an external validation dataset. Histopathological diagnosis was used as the standard criterion. The capability of the ECRCCAD to distinguish HGD was assessed and compared with two expert endoscopists.ResultsThe accuracy, sensitivity and specificity for diagnosis of HGD in the internal validation set were 90.5%, 93.2%, 87.9%, respectively. While 88.2%, 85.4%, 89.8%, respectively, for the external validation set. For the prospective validation set, ECRCCAD achieved an AUC of 93.5% in diagnosing HGD. The performance of ECRCCAD in diagnosing HGD was better than that of the expert endoscopist in the external validation set (88.2% vs. 71.5%, P < 0.0001).ConclusionECRCCAD had good diagnostic capability for HGD and enabled a more convenient and accurate diagnosis using WLE.     

Adenovirus-Mediated Herpes Simplex Virus Thymidine Kinase Gene Transfer Driver by KDR Promoter in Treatment of Experimental Human Hepatocel-Lular Carcinoma in Nude Mice

Objective To investigate the therapeutic efficacy of adenovirus-mediated herpes simplex virus thymidine kinase (HSV-tk) gene transfer under the driving of KDR promoter (AdKDR-tk) in combination of ganciclovir (GCV) against human hepatocellular carcinoma in nude mice. Methods HepG2 cell line was implanted subcutaneously into 32 nude mice, which were subsequently divided into 4 groups (n=8 each group) Ganciclovir group (Ⅰ), Ad group (Ⅱ), AdCMV-tk/GCV group (under the driving of CMV promoter) (Ⅲ) and AdKDR-tk/GCV group (Ⅳ). Then intratumoral injection of recombinant adenovirus or Ad was performed in all nude mice, and repeated 24 h later. For the following 10 d GCV was given at a dose of 100 mg/(kg·d), ip. All the treated animals were killed to evaluate the tumor weight and the histopathological changes and the microvessel density of tumors after the treatment was determined. Results Compared with group Ⅰ, the tumor inhibitory rate was 12.3% in group Ⅲ and 24.5% in group Ⅳ; the inhibition rates were significantly different between group Ⅲ and Ⅳ (P＜0.05). The mean MVDs in group Ⅰ, Ⅱ, Ⅲand Ⅳ were 37.4±8.6, 30.6±7.8, 27.6±7.1, and 10.7±4.1 (microvessels/mm2), respectively. Significant differences were found between group Ⅲ and Ⅱ (P＜0.05), Ⅳ and Ⅱ (P＜0.01), and Ⅳ and Ⅲ (P＜0.01). Conclusion Intratumoral injection of AdKDR-tk results in marked inhibition of HCC growth through inhibition angiogenesis in nude mice. It may be a new treatment approach for human HCC.     

Frequent allelic imbalance and cytogenetic deletion on the short arm of chromosome 1 in nasopharyngeal carcinoma

Thelossofheterozygosity,whichgenerallyoccursonchromosome3pl4,3p2l-p26,llq,13qandsoon,iscurrentlyreportedtobeahighfrequencyeventinnasopharyngealcarcinoma[1-3].Severaltumor-associatedgeneshavebeenclonedfromtheshort-armofchromosome1,whichhasbeenapprovedtoberelatedtotheoccurrenceanddevelopmentofmanytumors[4].ThoughourpreviousresultsofCGH[5-7]andFISHsuggestedtheexistenceofstructuralabnormality(mainlyasdeletion)ontheshortarmofchromosome1innasopharyngealcarcinoma,theextensionandfrequencyofthisabnor…     

正交试验法优选三七止血贴中三七的提取工艺研究

目的 优选三七止血贴中三七药材的最佳提取工艺.方法 采用正交试验法,以提取液中人参皂苷Rg1、人参皂苷Rb1、三七皂苷R1的总含量为指标,优选药材的提取工艺.结果 药材较优的提取工艺为加70%的乙醇8倍,提取3次,每次0.5 h.结论 优选的提取工艺三七总皂苷提取率高,操作简便,适用于生产.     

原发性肾小球疾病中医证型与舌形指数关系的探讨

目的：探讨原发性肾小球疾病中医证型与舌形指数之间的关系。方法：将116例病例按中医辨证本证分为气虚、阳虚、阴虚、气阴两虚4型，标证分为水湿、湿热、湿浊和瘀血4型，观察舌形；利用专用舌象信息处理仪器，采集舌形数据，经计算机处理输出舌形指数。通过肉眼观察和计算机对所采集舌形的定量分析（舌形指数），探讨各中医证型舌形指数间的差异。结果：各证型之间的舌形指数差异均无统计学意义（P〉0．05）。结论：胖大齿痕舌与气虚水湿证有关，舌形指数对中医辨证分型有一定的指导意义。     

3cl-2基因在脓毒症大鼠心肌细胞凋亡中作用的研究

目的：探讨Bcl-2基因在脓毒症大鼠心肌细胞凋亡中的意义。方法：以盲肠结扎并穿刺法制作脓毒症大鼠模型。用电镜和TUNEL法检测其心肌细胞凋亡变化，用免疫组化方法检测Bcl-2蛋白，用RT-PCR法检测其心肌细胞的Bcl-2基因mRNA的表达。用SPSS10．0软件完成统计分析。结果：一定时间内脓毒症大鼠心肌细胞凋亡数均明显高于正常对照组和假手术对照组（P〈0．05），Bcl-2蛋白表达阳性细胞数和mRNA表达量均较正常对照和假手术组明显降低（P〈0．05），其变化均与TUNEL法检测凋亡的结果一致（P〈0．05）。结论：细胞凋亡可能是脓毒症中心肌损害的机制之一。Bcl-2基因的改变可作为脓毒症病情改变的标志。     

MELAS型线粒体脑肌病的多模态MRI诊断

目的：探讨MELAS型线粒体脑肌病的多模态影像学特点.方法：对11例MELAS型线粒体脑肌病患者的脑MRI、MRA、DWI及MRS影像资料进行分析.结果：MRI：MELAS病灶多位于枕顶叶大脑皮层,多发为主,多变性、游走性,与血管的走行不一致,5例海马、海马旁回受累,5例合并基底节核团受累,4例合并大脑和（或）小脑萎缩,7例增强扫描未见强化;MRA：1例病灶处动脉分支增多,6例未见异常;DWI：5例均为高和（或）稍高信号,ADC图为稍高信号2例、稍低信号2例、稍高等稍低混杂信号1例;MRS：病灶区及对侧正常区均可见升高的乳酸（Lac）双峰,病灶区与对侧正常区比较Lac及Lac/Cr均明显增高（P＜0.001）.结论：MELAS型线粒体脑肌病的多模态MRI表现有一定特异性,综合分析,可提示诊断.