经颅直流电刺激对精神分裂症伴迟发性运动障碍患者空间 工作记忆的影响

目的 探讨经颅直流电刺激（tDCS）对精神分裂症伴迟发性运动障碍（TD）患者空间工作记 忆的影响。方法 选取2017 年6 月至2018 年1 月来源于苏州市广济医院、苏州市社会福利总院、太仓市 精神卫生中心、南充市第六人民医院四家精神专科医院的38 例住院精神分裂症伴TD 患者，随机分为试 验组（21 例）和对照组（17 例）。研究期间，两组患者均接受常规药物治疗，试验组予以tDCS 治疗，采用的 电流为2 mA，刺激部位为左侧背外侧前额叶皮质及对侧眶上缘；对照组相应地予以伪tDCS 治疗。在基 线期、治疗15 次结束后及2 周后进行随访，采用剑桥神经心理自动化成套测试（CANTAB）中的空间工作 记忆（SWM）模块分别对两组患者进行认知测评。结果 在完成15 次治疗后，试验组SWM 指标分析中 的总错误数［31.00（28.50，49.00）］、平均第一次响应时间（4 盒子）［3 289.500（1 871.750，5 018.000）ms］、 平均第一次响应时间（6 盒子）［2 862.500（2 128.500，4 672.250）ms］、平均第一次响应时间（8 盒子） ［3 328.500（2 611.250，5 120.750）ms］与对照组比较，差异无统计学意义（P＞ 0.05）；试验组SWM 指标分 析中的策略分［19.00（17.00，20.00）］低于对照组［21.00（19.50，23.00）］，差异有统计学意义（P ＜ 0.05）。 在2 周后的随访中，两组的SWM 各指标比较，差异均无统计学意义（P＞ 0.05）。结论 tDCS 可能对精神 分裂症患者使用策略的能力有即刻改善效应。     

The Comprehensive Analysis of Efficacy and Safety of CalliSpheres^® Drug-Eluting Beads Transarterial Chemoembolization in 367 Liver Cancer Patients: A Multiple-Center,Cohort Study

This study aimed to investigate the efficacy, safety, and prognostic factors of drug-eluting beads transarterial chemoembolization (DEB-TACE) in treating Chinese patients with liver cancer. A total of 367 liver cancer patients from 24 medical centers were consecutively enrolled in this multiple-center, prospective cohort study, including 275 hepatocellular carcinoma (HCC) cases, 37 intrahepatic cholangiocarcinoma (ICC) cases, and 55 secondary liver cancer cases. All the patients received CalliSpheres^® DEB-TACE treatment. Treatment response, overall survival (OS), change of liver function, and adverse events (AEs) were assessed. DEB-TACE treatment achieved 19.9% complete response (CR) and 79.6% objective response rate (ORR), with mean OS of 384 days [95% confidence interval (CI): 375–393 days]. CR and ORR were both higher in HCC patients compared with primary ICC patients and secondary liver cancer patients, while no difference was discovered in OS. Portal vein invasion was an independent risk factor for CR, while portal vein invasion, previous conventional TACE (cTACE) treatment, and abnormal blood creatinine (BCr) were independent risk factors for ORR. In addition, largest nodule size 5.0 cm, abnormal albumin (ALB), and abnormal total bilirubin (TBIL) independently correlated with unfavorable OS. Most liver function indexes were recovered to baseline levels at 1–3 months after DEB-TACE. Common AEs were pain, fever, vomiting, and nausea; most of them were at mild grade. CalliSpheres^® DEB-TACE is efficient and well tolerated in Chinese liver cancer patients. Portal vein invasion, previous cTACE treatment, largest nodule size, abnormal BCr, ALB, and TBIL correlate with worse prognosis independently.     

基于关联规则的老年住院患者跌倒伤害事件发生特征分析

目的 了解老年住院患者跌倒伤害事件的发生特征，探索各特征之间的关联性，旨在为制定跌倒伤害预防措施提供参考。方法 回顾性分析上海市3所综合性医疗机构2014年1月至2018年12月发生的115例老年住院患者跌倒伤害事件，采用Aprior算法对跌倒伤害事件发生特征进行关联规则的数据挖掘。结果 通过设定筛选条件共得到473条强关联规则，结合护理专业知识最终得到9条具有临床实际意义的强关联规则，主要包括发生时间为00:01～06:59、3～6种并存疾病和未主动寻求帮助等。结论 老年住院患者跌倒伤害事件的发生有一定的特征，挖掘出的关联规则能够为护理人员提供跌倒伤害高频场景的指导意见，以此识别易导致跌伤的高危人群及环境，为预防跌倒伤害项目提供较好的案例支持。     

加味五子散热熨联合综合康复措施促进乳腺癌术后康复效果分析

目的:观察加味五子散热熨联合综合康复措施促进乳腺癌术后康复的效果。方法:将108例乳腺癌术后患者随机分为对照组和观察组各54例。2组均给予综合康复措施,如予布洛芬缓释片、氨酚曲马多片控制疼痛,以绷带加压包扎,并结合空气压力泵治疗仪缓解淋巴水肿,循序渐进地进行康复锻炼,并给予常规术后护理措施;观察组加用加味五子散热熨。2组疗程均为4周。于治疗前与治疗7 d、14 d、28 d评定手术部位疼痛视觉模拟评分法(VAS)评分,统计淋巴水肿的发生率;治疗前后使用上肢功能评定量表(DASH)评价上肢活动情况。统计并比较2组患者对护理措施的满意度。结果:治疗后,2组VAS评分均逐渐下降(P0.01),与治疗前比较,差异均有统计学意义(P0.01)。治疗7 d、14 d、28 d,观察组的VAS评分均低于对照组,差异均有统计学意义(P0.01)。治疗14 d和28 d,观察组淋巴水肿的发生率分别为24.07%和5.56%,低于同期对照组的44.44%和22.22%,差异均有统计学意义(P0.05)。2组DASH评分均较治疗前下降(P0.01),观察组DASH评分低于对照组(P0.01)。观察组的护理满意度高于对照组,差异有统计学意义(P0.05)。结论:在常规综合康复措施的基础上加用加味五子散热熨干预乳腺癌术后患者,能显著减轻术后疼痛程度,减少上肢肿胀的发生,促进上肢活动功能的恢复,有利于患者的康复,并能提高患者对护理措施的满意度。     

仝小林教授分类、分期、分证思想在甲状腺结节及甲状腺癌的治疗中的体现

甲状腺结节是指甲状腺细胞在局部异常生长所引起的散在病变。5%～15%的甲状腺结节为恶性。结合现代医疗，仝小林教授在传承传统辨证论治模式，又开启了“分类、分期、分证”的辨证辨病思想，系统阐述甲状腺结节及甲状腺癌的类型、发展及转归等内容，并构建基于甲状腺结节及甲状腺癌分类、分期(根据自然演变过程可以分为郁、瘀、虚3期)、分证思想体系指导下的甲状腺结节及甲状腺癌防治临床实践。分类、分期、分证思想综合考量疾病共性及患者个性，可为现代慢性病中医理论构建提供启示。     

Ultrasonography and magnetic resonance imaging features of kaposiform hemangioendothelioma and tufted angioma

Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA) primarily occurring in infants are difficult to distinguish. This study evaluated ultrasonography (US) and magnetic resonance imaging (MRI) features of KHE and TA. Pathologically proven TA (n = 21) and KHE (n = 40 [11 KHE + Kasabach–Merritt phenomenon [KMP]]) occurring between January 2015 and December 2017 were reviewed. US (n = 61) and MRI (n = 50) findings were retrospectively evaluated. On US, KHE and TA lesions were subcutaneous, while 40% of KHE exhibited an infiltrative pattern extending into adjacent muscles. Of TA lesions, 42.9% were hyperechoic and 96.15% of KHE lesions exhibited mixed echogenicity. Of TA lesions, 76.2% exhibited well‐defined margins and all KHE lesions exhibited ill‐defined margins. The depth and vascular density of KHE and KHE + KMP were significantly increased compared with TA. The arterial peak systolic blood flow velocity of KHE + KMP was significantly higher than that in TA and KHE. KHE and KHE + KMP were significantly harder than TA on elastography. 3‐D color Doppler revealed branch‐shape blood flow for KHE and KHE + KMP lesions; for TA, it revealed a dot‐like and striped pattern. Considering MRI findings, KHE and KHE + KMP were more likely to exhibit diffuse heterogeneous enhancement after contrast than TA. KHE was infiltrative and more likely to be thick, hypoechoic, ill‐defined, richly vascular and hard than TA on US. KHE lesions were subcutaneous and reticular, with heterogeneous enhancement on MRI. Awareness of these features should prompt radiologists in the differential diagnosis of pediatric masses.     

Retrospective study of photodynamic therapy for pulsed dye laser-resistant port-wine stains

Pulsed dye laser-resistant port-wine stains present a therapeutic challenge. The aim of this study was to evaluate the efficacy and safety of photodynamic therapy for treating these lesions. A total of 67 patients with pulsed dye laser-resistant cervicofacial port-wine stains were retrospectively assessed after undergoing photodynamic therapy mediated with a combination of hemoporfin and 532-nm light. For objective evaluation of photodynamic therapy efficacy, first, the colorimetric changes in the port-wine stain lesions were evaluated according to the L*a*b* color coordinate system, then the values of color changes (ΔE) and blanching rate were calculated. For subjective evaluation of improvement, photographs taken before and after photodynamic therapy were evaluated by three independent assessors blindly. Patient satisfaction was also used as a factor in the subjective evaluation. Adverse events were recorded after treatment. The median ΔE decreased significantly from the pretreatment value of 13.42 to 9.90 at the 2-month follow up (P < 0.001). The median blanching rate of port-wine stains was 28.04% after an average of 1.21 sessions of photodynamic therapy. Based on the overall visual assessment, 46.2% patients showed excellent or good levels of improvement (>50% color blanching). Adverse events were minimal, transient and self-limiting. In conclusion, photodynamic therapy serves as an alternative means to treat pulsed dye laser-resistant port-wine stains.     

MMSE和MoCA测试对颅脑损伤患者行为记忆障碍的预测价值

目的： 研究分析认知筛查量表在颅脑损伤患者中对行为记忆障碍的预测功效。 方法： 58名颅脑损伤患者接受简易智力状况检查量表（mini-mental state examination,MMSE）、蒙特利尔认知评估量表（Montreal cognitive assessment scale,MoCA）及Rivermead行为记忆测验（第三版）（Rivermead behavioural memory test-third edition,RBMT-3）3种认知量表测试,对测试结果进行分析比较。 结果： 行为记忆（RBMT-3得分）与MMSE子项目中注意力和计算（MMSE-AC：P=0.007,β=0.371）以及回忆（MMSE-Re：P=0.016,β=0.352）显著相关,MMSE两个子项目得分之和以及MMSE总分对行为记忆障碍均具备中间预测价值（AUC=0.845、0.793）。行为记忆与MoCA子项目中视空间/执行（MoCA-VE：P=0.004,β=0.278）、语言（MoCA-L：P=0.003,β=0.250）、延迟回忆（MoCA-DR：P<0.001,β=0.479）和定向（MoCA-O：P=0.002,β=0.240）存在显着相关性,MoCA四个子项目得分之和以及MoCA总分对于行为记忆障碍具有高预测值（AUC=0.953、0.938）,当MoCA四个子项目得分低于13.5,或总分低于24.5提示患者行为记忆障碍可能。 结论： 可以根据颅脑损伤患者MMSE或MoCA得分预判行为记忆障碍,其中MoCA的诊断价值更高。     

裸鼠异种移植急性T淋巴细胞白血病模型的建立

目的 比较尾静脉注射和皮下注射入Jurkat细胞建立异种移植急性T淋巴细胞白血病模型的优缺点.方法 雌性BALB/c裸鼠随机分为正常组、尾静脉移植组和皮下移植组.除正常组外,其余裸鼠造模前连续2d给予环磷酰胺(2 mg/只),尾静脉移植组连续2 d尾静脉接种5×106个Jurkat细胞,皮下移植组连续2 d皮下接种5×106个Jurkat细胞,正常组裸鼠尾静脉注射相同体积PBS缓冲液.观察并记录裸鼠体质量、弓背以及精神状态.第7天和第14天通过流式细胞术检测Jurkat细胞在裸鼠外周血中浸润情况.第28天待尾静脉移植组和皮下移植组裸鼠出现衰竭体征濒临死亡时处死裸鼠,记录裸鼠体质量,瑞氏-吉姆萨染色检测外周血和骨髓中Jurkat细胞的浸润情况,流式细胞术检测脾脏和骨髓中Jurkat细胞的百分比,HE染色、免疫组化法检测肝脏和脾脏中浸润的Jurkat细胞表达,ELISA检测血清中Jurkat细胞分泌IL-2水平.结果 与正常组相比,尾静脉移植组和皮下移植组裸鼠均逐渐出现体质量下降、弓背、食欲减退等表现,肝脏、脾脏及骨髓中均有人Jurkat细胞表达.尾静脉移植组成模率73％,皮下移植组成模率40％.结论 尾静脉注射和皮下注射异种移植Jurkat细胞两种方法均可成功建立急性T淋巴细胞白血病动物模型,尾静脉注射移植效果更佳.