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1.
目的 观察双能量CT (DECT)定量参数术前预测实性肺腺癌气道播散(STAS)状态的价值。方法 回顾性分析52例经手术病理确诊实性肺腺癌患者的DECT及病理学资料,评估其STAS状态(阳性或阴性);对比STAS阳性、阴性实性肺腺癌CT表现(最大径、周围不透明影、空气支气管征、胸膜凹陷征)及DECT定量参数的差异。针对差异有统计学意义的DECT定量参数绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估DECT定量参数单独及联合预测实性肺腺癌STAS的效能,并以二元logistic回归分析筛选实性肺腺癌STAS的独立预测因子。结果 52例中,25例STAS阳性,27例STAS阴性,其间病灶CT表现差异均无统计学意义(P均>0.05),DECT定量参数中的动脉期碘浓度(ICA)、动脉期标准化碘浓度(NICA)及静脉期碘浓度(ICV)差异均有统计学意义(P均<0.05)。ICA、NICA及ICV预测实性肺腺癌STAS的AUC为0.82、0.83及0.73;ICA和NICA均为实性肺腺癌STAS的独立预测因子,其联合AUC为0.89。结论 DECT定量参数可有效预测实性肺腺癌STAS。  相似文献   
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通过调查澳大利亚中医政策、中医从业人员现状和中医教育情况,对联邦医管局和教育机构发布的中医药服务发展数据进行分析,梳理中医药体系在澳大利亚的发展情况,为中医药国际化传播提供参考和建议。澳大利亚作为最早进行中医立法的国家,其发展历程对于欧美国家,特别是对于后来的加拿大中医立法产生了深远的影响。中医药在澳大利亚的发展已经形成一定体系,其接受度逐步提升,从业人员数量稳步增加,中医药教育有序发展。为进一步推进中医药国际化发展,需要加强官方交流与合作,将中医药文化传播上升至国家文化战略高度,积极探索建立中医药国际人才认证体系,拓宽中医药服务国际人才培养渠道,聚焦高质量发展,提升中医药国际化产业能力。  相似文献   
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PurposeThe non-invasive pneumococcal disease (NIPD) is a common infection during childhood. We aimed to define the clonal spread of pediatric non-invasive isolates recovered during the PCV10-period in Bulgaria concerning the serotype and antimicrobial susceptibility.Materials and methodsSerogrouping/serotyping were performed using latex agglutination and capsular swelling reaction. Serogroup 6 strains were subjected to serotype-specific PCR's. The antibiotic susceptibilities were assessed by broth microdilution. MLST was performed to define the clonal composition.ResultsWe analyzed 154 pediatrics non-invasive S. pneumoniae isolates. The PCV10-vaccinated children were 94.1%. We disclosed 88% non-vaccine serotypes (NVTs) and 12% PCV10 - serotypes. All common serotypes among PCV10-vaccinated children (n ?= ?145) were non-vaccine types (NVTs): 19A (13.8%), 6C (11.7%), 3 (9.6%), 15A (8.3%) and 23A (5.5%). Antimicrobial non-susceptibility showed highest levels in erythromycin (50.0%), oral penicillin (49.4%), clindamycin (45.4%), trimethoprim-sulfamethoxazole (43.5%), tetracycline (42.2%), and ceftriaxone (14.3%). The multidrug-resistant strains (MDR) were 51.3%. MDR-serotypes were 6C (20.2%), 19A (17.7%), 15A (11.4%), 19F (10.1%), and 23A (8.9%). MLST presented 17 clonal complexes (CCs) with prevalence of CC320, CC386, CC505, CC8029 and CC2613 clustered 83% MDR isolates.ConclusionsAll emergent pediatric non-invasive serotypes in our geographic area during the studied PCV10-period were NVTs (19A, 6C, 3, 15A, and 23A). The fifth widespread CCs: CC320, CC386, CC505, CC8029 and CC2613 clustered 83% MDR isolates. Future surveillance of vaccine-induced changes in the clonality and the antimicrobial resistance of the pneumococcal population is needed.  相似文献   
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目的 探讨急诊患者的时空分布规律,优化急诊护理人力资源的管理。方法 回顾分析2017-2019年笔者所在医院急诊科就诊患者的资料,对患者每年不同月份、不同工作日、不同时间段及省内外就诊辐射特点进行时空分布的统计分析。结果 急诊患者就诊量呈逐年上升趋势,节假日的日均就诊量最高,就诊患者大部分集中在1-4月和9-12月,9∶00和20∶00是全天就诊的2个高峰时间点。空间上以笔者所在医院为中心就诊患者呈中心辐射状分布,人群主要为湖北省内患者为主,省内集中在武汉、黄冈、孝感等城市;省外以河南居首,其次为江西、湖南、浙江。结论 应根据患者的时空分布规律,科学合理地配置及利用护理人力资源,以保障患者安全和提高急救护理质量。  相似文献   
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BackgroundThe mechanisms by which spasticity reductions after botulinum toxin A (BoNT) affect gait in stroke are not well understood. We systematically reviewed the effects of BoNT on spatiotemporal, kinematic, kinetic and electromyographic (EMG) measures during gait.QuestionWhat are the effects of botulinum toxin on gait mechanics in stroke patients?MethodsSystematic search using PubMed and Web of Science. We considered all studies that reported laboratory-based and instrumented gait measures as primary or secondary outcomes to determine the effects of BoNT on walking performance in stroke populations only. Selected studies were classified and analysed based on the injection sites.ResultsA total of 240 articles were identified of which 22 were selected for analysis. Overall, 91% of the studies reported spatiotemporal, 64% kinematics, 23% kinetics, 32% EMG and 23% other gait measures. All but one study found significant effects of BoNT on gait measures using instrumented assessments even when clinical measures (i.e. speed) did not significantly improve. However, the majority of the studies had a high risk of bias. Overall, BoNT improved: a) dorsiflexion during stance, propulsive forces and timing and activity of more proximal musculature with injections in the plantarflexors; b) hip, knee and ankle angles and velocities, coordination and energetic cost with injections in the rectus femoris; c) segmental coordination and energetic cost when several lower limb muscles were injected; and, d) elbow and trunk angles when upper limb muscles were injected.ConclusionInstrumented and laboratory measures of gait improve after BoNT injections in different muscle groups even in the absence of clinical changes.  相似文献   
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The human prolyl isomerase PIN1, best known for its association with carcinogenesis, has recently been indicated in the disease of pancreatic ductal adenocarcinoma (PDAC). However, the functions of PIN1 and the feasibility of targeting PIN1 in PDAC remain elusive. For this purpose, we examined the expression of PIN1 in cancer, related paracarcinoma and metastatic cancer tissues by immunohistochemistry and analyzed the associations with the pathogenesis of PDAC in 173 patients. The functional roles of PIN1 in PDAC were explored in vitro and in vivo using both genetic and chemical PIN1 inhibition. We showed that PIN1 was upregulated in pancreatic cancer and metastatic tissues. High PIN1 expression is significantly association with poor clinicopathological features and shorter overall survival and disease‐free survival. Further stratified analysis showed that PIN1 phenotypes refined prognostication in PDAC. Inhibition of PIN1 expression with RNA interference or with all trans retinoic acid decreased not only the growth but also the migration and invasion of PDAC cells through regulating the key molecules of multiple cancer‐driving pathways, simultaneously resulting in cell cycle arrest and mesenchymal‐epithelial transition in vitro. Furthermore, genetic and chemical PIN1 ablation showed dramatic inhibition of the tumorigenesis and metastatic spread and then reduced the tumor burden in vivo. We provided further evidence for the use of PIN1 as a promising therapeutic target in PDAC. Genetic and chemical PIN1 ablation exerted potent antitumor effects through blocking multiple cancer‐driving pathways in PDAC. More potent and specific PIN1 targeted inhibitors could be exploited to treat this aggressive cancer.  相似文献   
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PurposeTo compare the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) with a modified fluorouracil, leucovorin, and oxaliplatin (mFOLFOX) regimen with that of transarterial chemoembolization as a locoregional treatment for patients with locally advanced hepatocellular carcinoma (HCC).MethodsThis retrospective study included adult patients with locally advanced HCC who received first-line treatment with either HAIC-mFOLFOX or conventional transarterial chemoembolization monotherapy from January 2015 to December 2016. The outcomes, including tumor response rates, evaluated via imaging assessment using the modified response evaluation criteria in solid tumors; overall survival; progression-free survival; and safety, were compared. The propensity score–matching methodology was used to reduce the influence of confounding factors on the outcomes.ResultsThe study included 131 patients with locally advanced HCC who underwent transarterial chemoembolization and 101 who received HAIC-mFOLFOX as initial treatment. After propensity score matching (n = 67 in each group), patients who received HAIC-mFOLFOX had a higher objective response rate (43.3% vs 13.4%, P = .001), longer median overall survival (13.9 vs 6.0 months, P < .001), and longer median progression-free survival (6.4 vs 2.8 months, P = .001) than those who underwent transarterial chemoembolization. The survival benefit with HAIC-mFOLFOX was strengthened in patients with HCC with vascular invasion (hazard ratio: 0.379; 95% confidence interval: 0.237–0.607). HAIC-mFOLFOX was associated with lower incidences of severe adverse events (8.9% vs 22.9%) and liver toxicity than transarterial chemoembolization.ConclusionsCompared with transarterial chemoembolization, HAIC-mFOLFOX is a potentially safer and more effective locoregional therapy for patients with locally advanced HCC.  相似文献   
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目的 分析我国麻疹病例时空分布和空间聚集性特征。方法 资料来源于中国疾病预防控制信息系统传染病疫情报告监测系统2001-2016年全国麻疹病例数据,人口学数据来源于国家统计局。运用ArcGIS 10.2软件进行全局和局部空间自相关分析,运用SaTScan 9.6软件进行时空扫描分析。结果 2001-2016年全国共报告麻疹1 012 537例,年发病率整体呈下降趋势。2001-2004、2005-2008和2009-2012年的麻疹发病存在全局空间聚集性,其Moran''s I值分别为0.29、0.26和0.31。局部空间自相关分析结果显示,麻疹在各时间阶段均存在高-高聚集区域并主要集中在西部地区,同时2005-2008年广东省是一个单独的高-低离散区域,未检测到低-低聚集区域。时空扫描结果显示,2001-2008年我国麻疹病例在西部地区、华中地区和华北地区、山西省和广西壮族自治区形成一个广泛的聚集区。结论 2001-2016年我国麻疹的发病在空间、时间上均存在一定的聚集性,可根据聚集情况,为麻疹防控策略的制定提供依据。  相似文献   
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