EBUS-TBNA超声内镜对纵隔肿大淋巴结良恶性的鉴别诊断价值

目的:分析超声内镜引导下经支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration，EBUS-TBNA)术中肿大纵隔淋巴结的超声图像特点，探讨EBUS-TBNA超声内镜对纵隔淋巴结良恶性的鉴别诊断价值，以期提高EBUS-TBNA对纵隔淋巴结恶性病变的活检率。方法:回顾性分析2014年10月至2018年11月行EBUS-TBNA患者的超声内镜图像。我们使用以下EBUS超声内镜特征来预测淋巴结的良恶:回声，长轴长度，短轴长度，纵横比，形态，边界，淋巴门有无，淋巴结内血流信号分级。将超声检查结果与最终病理结果或临床随访结果进行比较。采用SPSS 20.0软件进行统计学分析，采用logistic回归分析评价肿大淋巴结EBUS-TBNA超声内镜下的特征与良恶性的相关性，以 P<0.05 为标准判定差异有统计学意义。结果:对130例纵隔淋巴结肿大患者的227个淋巴结进行回顾性分析，67.4%的肿大淋巴结被证实为恶性转移。Logistic回归分析显示回声、长轴及短轴的长度、正常淋巴门结构的消失是诊断恶性淋巴结的独立预测因素。结论:纵隔恶性淋巴结具有一定的超声特征，可以通过这些超声特征提高EBUS-TBNA对纵隔恶性淋巴结的检出率。     

The Current Pediatric Surgery Job Market: A Perspective of Recent Fellowship Graduates

PurposeThis study describes the job market from the perspective of recent pediatric surgery graduates.MethodsAn anonymous survey was circulated to the 137 pediatric surgeons who graduated from fellowships 2019–2021.ResultsThe survey response rate was 49%. The majority of respondents were women (52%), Caucasian (72%), and had a median student debt burden of $225,000. Considering job opportunities, respondents strongly emphasized camaraderie (93%), mentorship (93%), case mix (85%), geography (67%), faculty reputation (62%), spousal employment (57%), compensation (51%), and call frequency (45%). 30% were satisfied with the employment opportunities available, and 21% felt strongly prepared to negotiate for their first job. All respondents were able to secure a job. Most jobs were university-based (70%) or hospital employed (18%) positions where surgeons covered median of two hospitals. 49% wanted protected research time, and 12% of respondents were able to secure substantial, protected research time. The median compensation for university-based jobs was $12,583 below the median AAMC benchmark for assistant professors for the corresponding year of graduation.ConclusionThese data highlight the ongoing need for assessment of the pediatric surgery workforce and for professional societies and training programs to further assist graduating fellows in preparing to negotiate their first job.Type of studySurveyLevel of EvidenceLevel V.     

Esophageal Surveillance Practices in Esophageal Atresia Patients: A Survey by the Eastern Pediatric Surgery Network

IntroductionEndoscopic surveillance guidelines for patients with repaired esophageal atresia (EA) rely primarily on expert opinion. Prior to embarking on a prospective EA surveillance registry, we sought to understand EA surveillance practices within the Eastern Pediatric Surgery Network (EPSN).MethodsAn anonymous, 23-question Qualtrics survey was emailed to 181 physicians (surgeons and gastroenterologists) at 19 member institutions. Likert scale questions gauged agreement with international EA surveillance guideline-derived statements. Multiple-choice questions assessed individual and institutional practices.ResultsThe response rate was 77%. Most respondents (80%) strongly agree or agree that EA surveillance endoscopy should follow a set schedule, while only 36% claimed to perform routine upper GI endoscopy regardless of symptoms. Many institutions (77%) have an aerodigestive clinic, even if some lack a multi-disciplinary EA team. Most physicians (72%) expressed strong interest in helping develop evidence-based guidelines.ConclusionsOur survey reveals physician agreement with current guidelines but weak adherence. Surveillance methods vary greatly, underscoring the lack of evidence-based data to guide EA care. Aerodigestive clinics may help implement surveillance schedules. Respondents support evidence-based protocols, which bodes well for care standardization. Results will inform the first multi-institutional EA databases in the United States (US), which will be essential for evidence-based care.Level of EvidenceThis is a prognosis study with level 4 evidence.     

Registries,Databases and Repositories for Developing Artificial Intelligence in Cancer Care

Modern artificial intelligence techniques have solved some previously intractable problems and produced impressive results in selected medical domains. One of their drawbacks is that they often need very large amounts of data. Pre-existing datasets in the form of national cancer registries, image/genetic depositories and clinical datasets already exist and have been used for research. In theory, the combination of healthcare Big Data with modern, data-hungry artificial intelligence techniques should offer significant opportunities for artificial intelligence development, but this has not yet happened. Here we discuss some of the structural reasons for this, barriers preventing artificial intelligence from making full use of existing datasets, and make suggestions as to enable progress. To do this, we use the framework of the 6Vs of Big Data and the FAIR criteria for data sharing and availability (Findability, Accessibility, Interoperability, and Reuse). We share our experience in navigating these barriers through The Brain Tumour Data Accelerator, a Brain Tumour Charity-supported initiative to integrate fragmented patient data into an enriched dataset. We conclude with some comments as to the limits of such approaches.     

3-(3-吡啶基)-6-芳基-7H-1,2,4-三唑并[3,4-b][1,3,4]噻二嗪的合成与波谱表征

目的：研究分子中含吡啶基的有多个杂环的化合物系列的波谱表征，方法：由烟酸出发，经多步反应，制得有吡啶基的均三唑并噻二嗪化合物，并进行红外，核磁共振氢谱与碳谱测试。结果：得到原料，中间体和产物的红外光谱图，产物的核磁共振氢谱与碳谱图。结论：标题化合物红外光谱1600cm^-1处多有C＝N伸缩振动峰，1250cm^-左右有N－N＝C伸缩振动峰，700cm^-1有C－S－C弯曲振动峰；噻二嗪亚甲基氢的化学位移δ值约为4．46，吡啶基四个氢原子化学位移约为9．3、8．9、8．7、8．0，噻二嗪亚甲基碳化学位移为23。     

针刺夹脊穴治疗痉挛型脑瘫的临床研究

目的:观察针刺夹脊穴治疗痉挛型脑瘫的临床疗效。方法:将62例痉挛型脑瘫患者随机分成两组,治疗组采用针刺夹脊穴,对照组采用假针刺,每日针刺1次,10次为1个疗程,共治疗6个疗程,所有病例均配合常规的康复治疗。同时以修订的Ashworth量表(MAS)、粗大运动功能量表(GMFM)、儿童功能独立检查(WeeFIM)作观察指标,观察评定两组的治疗结果。结果:治疗后两组MAS评分均明显降低(P<0.01),且治疗组MAS评分明显低于对照组(P<0.05);治疗后两组患者的GMFM评分、WeeFIM评分均明显提高(P<0.01),且治疗组GMFM评分、WeeFIM评分明显高于对照组(P<0.01,P<0.05)。治疗组总有效率为84.4%,对照组总有效率为63.3%,两组比较差异具有显著性意义(P<0.05)。结论:针刺夹脊穴治疗痉挛型脑瘫患者的临床疗效确切。     

Identification of differentially expressed proteins in human stage I lung adenocarcinoma and tumor-adjacent tissues with two-dimension gel electrophoresis profiling

Objective： The aim of this study was to establish reproducible two-dimensional electrophoretic assay used for profiling and identification of differentially expressed proteins in human stage I lung adenocarcinoma and paired normal tumor-adjacent tissue. Methods： The proteins from 12 human stage I lung adenocarcinoma tissues and normal tumor-adjacent tissues were separated using isoelectric focusing electrophoresis （the first dimension） and the subsequent homogeneous SDS-polyacrylamide gel electrophoresis （SDS-PAGE） （the second dimension）. The differentially expressed proteins were determined with PDQuest image analysis software, and identified using matrix-assisted laser desorption/ionization time of flight mass spectrometry （MALDI-TOF-MS） and database searching. Results： The well-reproducible 2-DE gel patterns of human stage I lung adenocarcinoma and normal tumor-adjacent tissues were profiled and 26 differentially expressed proteins uncovered. Nine of these 26 protein spots were cut out from the preparation gels and determined with MALDI-TOF-MS. Searching against the protein database, four candidate proteins were identified. They were 60S acidic ribosomal protein P2, Cathepsin B1, Apolipoprotein A-I precursor, and La 4.1 protein. Conclusion： In this study, high reproducible 2-DE gel protein images of human stage I lung adenocarcinoma and paired normal tumor-adjacent tissues were achieved successfully, and 4 differentially expressed proteins were revealed. These data will be helpful for screen of early biomarker and study of molecular mechanisms of human lung adenocarcinoma.     

加减大黄廑虫丸抑制血管生成的实验研究

目的探讨加减大黄廑虫丸对血管生成的抑制作用。方法鸡胚绒毛尿囊膜（CAM）法检测加减大黄磨虫丸对血管生成的影响；采用MTS比色法观察不同浓度的加减大黄磨虫丸对血管内皮生长因子（VEGF）诱导的ECV-504细胞增殖的影响；Tran—swell小室检测不同浓度的加减大黄廑虫丸对ECV-304细胞移行的影响；Matrigel实验检测不同浓度的加减大黄磨虫丸对ECV-304细胞内皮管腔形成的影响。结果加减大黄磨虫丸中、低浓度组能够抑制鸡胚CAM血管生成；MTS比色法显示，0．05—0．20g/ml浓度的加减大黄鹰虫丸对VEGF诱导的ECV-304细胞增殖具有抑制作用，而更低和更高浓度的加减大黄廑虫丸则无抑制作用。Transwell小室实验显示，加减大黄廑虫丸浓度为0、12．5、25．0和50．0mg/ml时ECV-504细胞移行数分别为208．67±17．16、132．67±16．50、78．33±13．50和18．67±6．66；Matrigel实验显示，加减大黄磨虫丸浓度为0、12．5、25．0和50．0mg/ml时ECV-304细胞内皮管腔形成数分别为25．67±1．53、22．33±1．53、16．33±2．52和2．33±1．53，可见抑制细胞移行和管腔形成的作用随浓度增大而增强。结论加减大黄廑虫丸具有明显抑制血管生成的作用。     

无国界医生在救援中备灾的重要性

无国界医生致力于应对天灾和战祸所引起的人道医疗危机。灾后实时爆发的人道医疗危机包括急性的外科创伤问题和基础医疗系统的破坏导致疫症发生。本文介绍了无国界医生的救援经验以及专业的备灾体系。     

银杏叶提取物对白介素-1β损伤关节软骨细胞一氧化氮体系的影响

目的:观察银杏叶提取物对白介素-1β损伤的关节软骨细胞的作用及对细胞内一氧化氮体系的影响。方法:在无菌环境下消化得到3月龄雌性新西兰白兔膝关节软骨细胞,实验用细胞为第2代软骨细胞。软骨细胞与IL-1β(5μg/L)、IL-1β(5μg/L)+地塞米松(10-7、10-6、10-5mmol/L)、IL-1β(5μg/L)+银杏叶提取物(40mg、80mg、160mg/L)共同孵育,分别在72h后MTT法检测软骨细胞的增殖受到的影响;24h后测定受损伤软骨细胞培养液中的NOi、NOS,逆转录扩增(RT-PCR)检测iNOSmRNA。结果:MTT法显示IL-1β对软骨细胞的增殖有明显的抑制作用;地塞米松同银杏叶提取物均有对抗IL-1β的效应;地塞米松和EGb均能显著减少iNOSmRNAi、NOS、NO的生成(P<0.01);EGb761的这种效应有剂量依赖性。结论:银杏叶提取物通过抑制软骨细胞内的NO生成以保护IL-1β损伤的膝关节软骨细胞。