经内镜黏膜下剥离术治疗直肠神经内分泌肿瘤的疗效及安全性CSCD

目的探讨经内镜黏膜下剥离术(ESD)治疗直肠神经内分泌肿瘤(RNET)的疗效,并评估其安全性。方法回顾性分析2011年1月—2017年12月在江苏省人民医院行直肠ESD治疗、经病理及免疫组织化学确诊为RNET的80例患者(91处病变)的临床资料,并对患者进行随访。结果所有病变均为完整切除病灶。有症状的患者术后3天~2月症状均有不同程度缓解,无严重术后并发症,标本切缘阳性率20.88%(19/91),切缘可疑阳性率35.16%(32/91)。切除标本最大长径20 mm。单因素分析中,肿瘤长径≥10 mm、肿瘤处于G2级与切缘可疑阳性及阳性相关(P<0.05)。肿瘤处于G2级为切缘可疑阳性及阳性的独立危险因素。仅有1例患者术前证实为RNET。中位随访时间34月,复发率4.40%(4/91)。结论ESD在治疗直径<20 mm的G1级和G2级的RNET患者中具有良好疗效。对于ESD术后显示切缘阳性及可疑阳性的RNET患者,可密切随访暂不实施其他治疗。     

Morphological imaging and CT histogram analysis to differentiate pancreatic neuroendocrine tumor grade 3 from neuroendocrine carcinoma

PurposeTo compare morphological imaging features and CT texture histogram parameters between grade 3 pancreatic neuroendocrine tumors (G3-NET) and neuroendocrine carcinomas (NEC).Materials and methodsPatients with pathologically proven G3-NET and NEC, according to the 2017 World Health Organization classification who had CT and MRI examinations between 2006-2017 were retrospectively included. CT and MRI examinations were reviewed by two radiologists in consensus and analyzed with respect to tumor size, enhancement patterns, hemorrhagic content, liver metastases and lymphadenopathies. Texture histogram analysis of tumors was performed on arterial and portal phase CT images. images. Morphological imaging features and CT texture histogram parameters of G3-NETs and NECs were compared.ResultsThirty-seven patients (21 men, 16 women; mean age, 56 ± 13 [SD] years [range: 28-82 years]) with 37 tumors (mean diameter, 60 ± 46 [SD] mm) were included (CT available for all, MRI for 16/37, 43%). Twenty-three patients (23/37; 62%) had NEC and 14 patients (14/37; 38%) had G3-NET. NECs were larger than G3-NETs (mean, 70 ± 51 [SD] mm [range: 18 - 196 mm] vs. 42 ± 24 [SD] mm [range: 8 - 94 mm], respectively; P = 0.039), with more tumor necrosis (75% vs. 33%, respectively; P = 0.030) and lower attenuation on precontrast (30 ± 4 [SD] HU [range: 25-39 HU] vs. 37 ± 6 [SD] [range: 25-45 HU], respectively; P = 0.002) and on portal venous phase CT images (75 ± 18 [SD] HU [range: 43 - 108 HU] vs. 92 ± 19 [SD] HU [range: 46 - 117 HU], respectively; P = 0.014). Hemorrhagic content on MRI was only observed in NEC (P = 0.007). The mean ADC value was lower in NEC ([1.1 ± 0.1 (SD)] × 10⁻³ mm²/s [range: (0.91 - 1.3) × 10⁻³ mm²/s] vs. [1.4 ± 0.2 (SD)] × 10⁻³ mm²/s [range: (1.1 - 1.6) × 10⁻³ mm²/s]; P = 0.005). CT histogram analysis showed that NEC were more heterogeneous on portal venous phase images (Entropy-0: 4.7 ± 0.2 [SD] [range: 4.2-5.1] vs. 4.5 ± 0.4 [SD] [range: 3.7-4.9]; P = 0.023).ConclusionPancreatic NECs are larger, more frequently hypoattenuating and more heterogeneous with hemorrhagic content than G3-NET on CT and MRI.     

医学期刊编辑胜任特征研究及其提升途径

【目的】 了解我国医学期刊编辑能力素质现状,并探讨其提升途径。【方法】 以胜任特征研究为基础,探讨我国医学期刊编辑的关键胜任特征,并从素质、技能、知识3个维度了解我国医学期刊编辑能力素质现状,分析我国医学期刊编辑所需及待提高的能力素质。【结果】 通过我国医学期刊编辑胜任特征重要程度及符合情况调查,成功建立我国医学期刊编辑胜任特征模型。我国医学期刊编辑总体能力素质情况良好,但需在判断能力、系统思考能力以及医学知识3个方面加以提升。【结论】 我国医学期刊编辑能力素质的提升是一个系统工程,它既要医学期刊编辑自身努力、主动学习、勇于实践,也离不开各级有关部门的组织、规划、重视与领导。医学期刊单位可将胜任特征模型应用于编辑招聘、人才发展、职业规划与绩效管理中,使理论模型转化成可为实际工作所用的工具。广大医学期刊编辑应努力成为高素质复合型人才,与时俱进,才能出色完成编辑工作,将医学期刊办好、办精。     

Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar

Postural orthostatic tachycardia syndrome (POTS), the most common form of orthostatic intolerance in young people, affects approximately 500,000 people in the United States alone, typically young women at the peak of their education and the beginning of their working lives. This is a heterogeneous disorder, the pathophysiology and mechanisms of which are not well understood. There are multiple contributing factors and numerous potential mimics. This review details the most current views on the potential causes, comorbid conditions, proposed subtypes, differential diagnoses, evaluations, and treatment of POTS from cardiological and neurological perspectives.     

Challenges in the characterization of neutrophil extracellular traps: The truth is in the details

Neutrophil extracellular traps play a key role in defense against extracellular pathogens. The release of these chromatin structures, that contain a combination of cytoplasmic and granule proteins, is known as NETosis, a regulated cell death modality typical of neutrophils. NETosis is induced by pathogens as well as other stimuli such as activated platelets. Our understanding of the molecular events underlying this phenomenon remains incomplete. The currently used experimental approaches to study NETs are semi‐quantitative, subjective in nature, and low throughput, rendering it difficult to compare results between laboratories. This is highlighted in two articles published in this issue of the European Journal of Immunology which present what appear to be contradicting results on NET formation. Considering the extensive research on NETosis and the importance of this phenomenon in the immune response, we find it timely to briefly review the lacunae in the most commonly used methods to investigate NETosis. The impact these technical difficulties have on the advancement of our knowledge in this field as well as potential solutions are also discussed.     

Contribution of neutrophils in the pathogenesis of rheumatoid arthritis

Neutrophils are major innate immune effector cells for host defense and have been a topic of active research for their participation in the pathogenesis of autoimmune inflammatory diseases including rheumatoid arthritis (RA) due to recently discovered neutrophil extracellular trap (NET) formation. NET formation and other mechanisms leading to the release of neutrophil nuclear and cytoplasmic contents are implicated as a source of citrullinated antigens in RA. Further investigations are required to delineate what factors diverge neutrophils from host defense to autoimmune response in RA.     

基于.NET的医院网络设备管理系统设计与应用

目的：开发设计一种远程网络设备管理软件,解决医院网络设备管理手段落后的问题.方法：采用模块化思想和可视化管理,应用.NET程序设计,基于telnet协议,利用网络设备固定命令,实现远程管理功能.结果：经在医院网络中测试运行,实现了网络交换机管理、备份和恢复配置程序、显示接口运行状态等服务,满足了网管人员的基本需求.结论：该系统平台为管理人员提供了方便快捷的可视化服务,同时,减少了维护人员的工作量,提升了工作效率,对医院网络管理智能化起到了推动作用,具有一定的应用和推广价值.     

大型仪器设备共享平台的设计与实现

目的:设计并实现一个基于Web的大型仪器设备共享服务平台,提高大型仪器设备的使用和管理效率.方法:以SQL Server为后台数据库,使用ASP.NET和Ajax技术进行系统平台的构建和实现.结果:该平台已成功应用到大型仪器设备的管理和使用当中,取得了良好的实践效果.结论:大型仪器设备共享平台的投入使用,既提高了仪器设备的管理效率和使用效率,同时也为广大科研人员提供了一个高效的仪器预约使用平台.