Forward and Reverse Middle Ear Transmission in Gerbil with a Normal or Spontaneously Healed Tympanic Membrane

Tympanic membranes (TM) that have healed spontaneously after perforation present abnormalities in their structural and mechanical properties; i.e., they are thickened and abnormally dense. These changes result in a deterioration of middle ear (ME) sound transmission, which is clinically presented as a conductive hearing loss (CHL). To fully understand the ME sound transmission under TM pathological conditions, we created a gerbil model with a controlled 50% pars tensa perforation, which was left to heal spontaneously for up to 4 weeks (TM perforations had fully sealed after 2 weeks). After the recovery period, the ME sound transmission, both in the forward and reverse directions, was directly measured with two-tone stimulation. Measurements were performed at the input, the ossicular chain, and output of the ME system, i.e., at the TM, umbo, and scala vestibuli (SV) next to the stapes. We found that variations in ME transmission in forward and reverse directions were not symmetric. In the forward direction, the ME pressure gain decreased in a frequency-dependent manner, with smaller loss (within 10 dB) at low frequencies and more dramatic loss at high frequency regions. The loss pattern was mainly from the less efficient acoustical to mechanical coupling between the TM and umbo, with little changes along the ossicular chain. In the reverse direction, the variations in these ears are relatively smaller. Our results provide detailed functional observations that explain CHL seen in clinical patients with abnormal TM, e.g., caused by otitis media, that have healed spontaneously after perforation or post-tympanoplasty, especially at high frequencies. In addition, our data demonstrate that changes in distortion product otoacoustic emissions (DPOAEs) result from altered ME transmission in both the forward and reverse direction by a reduction of the effective stimulus levels and less efficient transfer of DPs from the ME into the ear canal. This confirms that DPOAEs can be used to assess both the health of the cochlea and the middle ear.     

基于HMGB1/TLR4/NF-κB信号通路研究木兰脂素对急性鼻窦炎大鼠的治疗作用及机制

目的： 观察木兰脂素对急性鼻窦炎(ARS)大鼠的治疗作用，并探讨其通过高迁移率家族蛋白1/ Toll样受体4/核因子-κB(HMGB1/TLR4/NF-κB)信号通路的调控机制方法： 49只大鼠，随机取9 只作为正常组，40只用鼻窦腔内接种金黄色葡萄球菌法制备ARS模型，36只建模成功大鼠随机分为模型组、木兰脂素低剂量组、木兰脂素高剂量组、阳性组，各9只。木兰脂素低剂量组、木兰脂素高剂量组分别灌胃20、80 mg·kg^-1体质量的木兰脂素，模型组和正常组灌胃等体质量溶媒，阳性组灌胃40 mg·kg^-1 体质量左氧氟沙星，连续7 d。给药前、末次给药后1 h评估各组鼻窦炎症状评分；测定给药后各组血白细胞(WBC)计数及中性粒细胞占比，观察鼻窦黏膜病理组织学变化，检测鼻腔灌洗液中肿瘤坏死因子-α(TNF-α)、白介素(IL)-6水平及鼻黏膜中HMGB1、TLR4、NF-κB mRNA和蛋白表达情况结果： 给药后，木兰脂素低剂量组、高剂量组、阳性组的急性鼻窦炎症状评分及血WBC计数均低于模型组，但仍高于正常组，且木兰脂素高剂量组及阳性组均低于木兰脂素低剂量组，差异均有统计学意义(P＜0.05)，而木兰脂素高剂量组与阳性组比较，差异无统计学意义(P＞0.05)。与给药前比较，给药后木兰脂素低剂量组、高剂量组及阳性组急性鼻窦炎症状评分均降低(P＜0.05)，正常组及模型组给药前后无明显差异(P＞0.05)。与模型组比较，木兰脂素低剂量组、木兰脂素高剂量组、阳性组中性粒细胞占比均降低，且木兰脂素高剂量组低于木兰脂素低剂量组，阳性组低于木兰脂素高剂量组，差异均有统计学意义(P＜0.05)，而阳性组与正常组比较，差异无统计学意义(P＞0.05)。HE染色显示，模型组大鼠纤毛脱落、缺失、排列紊乱，黏膜上皮破损、变性，黏膜内及黏膜下可见大量炎症细胞浸润； 木兰脂素低剂量组、木兰脂素高剂量组及阳性组上述病理变化均减轻，且木兰脂素高剂量组和阳性组炎症反应减轻更为明显。与模型组比较，木兰脂素低剂量组、木兰脂素高剂量组、阳性组鼻腔灌洗液中 TNF-α、IL-6水平及鼻黏膜中HMGB1、TLR4、NF-κB mRNA和蛋白相对表达量均降低，但仍高于正常组，且木兰脂素高剂量组及阳性组均低于木兰脂素低剂量组，差异均有统计学意义(P＜0.05)，而木兰脂素高剂量组及阳性组比较，差异无统计学意义(P＞0.05)结论： 木兰脂素治疗ARS效果显著，可能通过HMGB1/TLR4/NF-κB信号通路抑制鼻黏膜炎症反应。     

基于标准化患者法评价四川农村基层医生两种慢性病诊断准确性及其影响因素

目的 运用标准化患者法评估四川农村地区基层医生不稳定型心绞痛和2型糖尿病两种慢性病诊断准确性现状,探讨基层医生两种慢性病诊断准确性的主要影响因素,为提升基层医生两种慢性病诊断准确性提供科学依据。方法 采用多阶段随机整群抽样方法,抽取四川省自贡市5个区/县50个乡镇100个村为研究现场,以调查当日在岗的全科及内科医生作为研究对象。共进行两轮数据采集,第1轮采集样本乡镇卫生院和村卫生室医生的基本信息;第1轮调查完成1个月后,运用标准化患者法开展第2轮调查,收集农村基层医生对不稳定型心绞痛和2型糖尿病诊断结果信息。运用Logistic回归分析农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性的影响因素。结果 共纳入172名农村基层医生,完成186次标准化患者访问,正确诊断率为48.39%。其中不稳定型心绞痛的正确诊断率为18.68%(17/91),2型糖尿病的正确诊断率为76.84%(73/95)。Logistic回归分析显示,具有执业医师资质的农村基层医生更有可能做出正确诊断(OR=4.857,95%CI=1.076~21.933,P=0.040)。农村基层医生在诊断过程中涉及的必要问诊和检查条目越多,做出正确诊断的概率越高(OR=1.627,95%CI=1.065~2.485,P=0.024)。与不稳定型心绞痛相比,农村基层医生对2型糖尿病做出正确诊断的可能性更高(OR=6.306,95%CI=3.611~11.013,P<0.001)。结论 四川农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性整体较差,建议以基层医生慢性病诊断过程质量改善为突破口,提升基层医生执业水平,进而提高慢性病诊断准确性。     

医院信息化平台住院陪护人员管理功能的开发与应用

目的 探讨医院信息系统中增加住院陪护管理功能的应用效果。方法 基于互联网医院、智慧医院等信息系统，开发信息化住院陪护管理功能，包括流行病学史调查、免费核酸申请、电子陪护证办理、体温监测登记及上报和统计查询。该功能与医院智慧护理链接后全院应用。比较功能应用前和应用后的遵医嘱一患一陪达标率、有效陪护证达标率、体温监测并登记日上报达标率和陪护证使用追溯率，评价护士和管理者疫情防控管理的人均耗时以及对该管理功能的满意度。结果 应用信息化陪护管理功能后，一患一陪达标率、有效陪护证达标率、体温监测并登记日上报达标率和陪护证使用追溯率显著高于应用前（均P＜0.05）；护士陪护管理人均耗时从（554.13±30.77）s降至（311.67±21.54）s（P＜0.05）；护士和管理者对该信息化陪护管理功能的满意度显著提高（均P＜0.05）。结论 信息化住院陪护管理功能的应用有效提升了疫情期间陪护的管理质量和管理效率，提高了一线护士和管理者的满意度。     

Ex vivo porcine model for eye,eyelid, and orbit movement analysis of 4-mm ferromagnetic foreign bodies in MRI

Graefe's Archive for Clinical and Experimental Ophthalmology - Ferromagnetic foreign bodies (FFB) present during magnetic resonance imaging (MRI) explorations can lead to tissue injury due to...     

Somatic hypermutation defects in two adult hyper immunoglobulin M patients

Immunologic Research - Hyper immunoglobulin M (HIGM) syndrome is a rare disorder of the immune system with impaired antibody functions. The clinical picture of the patients varies according to the...     

OCT及OCTA在阿尔茨海默病诊断中的研究进展

阿尔茨海默病是一种进行性且不可逆转的神经系统疾病,由于视网膜和中枢神经系统有相似的胚胎起源和生理特征,眼科检查可提供简单无创的诊断方法。光学相干断层扫描技术(OCT)能够精确地测量视网膜各个组织层面的厚度,以评估视网膜的退行性改变,光学相干断层扫描血管成像(OCTA)可以提供高分辨率三维成像,从而更直观地检测视网膜血管的变化,间接地反映脑神经元和血管的病理特征。就OCT测量视网膜厚度及OCTA测量视网膜血流变化在阿尔茨海默病诊断中的研究进展进行综述。