嗓音障碍疾病GRBAS听主观评估特点分析

目的 探讨嗓音障碍疾病GRBAS听主观评估特征.方法 对1 780例嗓音障碍患者行GRBAS评估,包括:听主观总嘶哑度G、粗糙度R、气息度B、无力度A、紧张度S 分级评估,根据疾病种类进行统计分析.结果 声带接触性肉芽肿、慢性单纯性喉炎、声带角化、声带小结、痉挛性发声障碍G、R评估以轻度异常为主,B评估多为正常和轻度异常,除痉挛性发声障碍S评估异常者达85%外,余几种嗓音障碍疾病A、S评估异常者少见;声带息肉、声带囊肿、声带任克水肿G、R、B评估以轻、中度异常为主,A、S评估异常者少见;声带良性肿瘤、声门癌、病理性声带沟、单侧声带麻痹、功能性发声障碍G、B评估以重度异常为主,声带良性肿瘤、声门癌R评估以重度为主,病理性声带沟、单侧声带麻痹R评估中度异常为主,而功能性发声障碍各级比例相近,这几种疾病的嗓音A评估虽然仍以正常者居多,但异常者明显增加,达23%～47%,S评估除功能性发声障碍异常者多达50%,余未见异常.所有嗓音障碍疾病中,声带接触性肉芽肿在G、R、A、S评估中最轻,痉挛性发声障碍在B评估中最轻,声门癌在G、R评估中最重,单侧声带麻痹在B、A评估中最重,痉挛性发声障碍在S评估中最重.从R、B、A、S与G的相关性看,痉挛性发声障碍S与G显著相关(r=0.717),其他各嗓音疾病均为R、B与G显著相关(r＝0.582～0.965),其中,声带接触性肉芽肿、慢性单纯性喉炎、声带角化、声带小结、声带息肉、声带囊肿、声带任克水肿、声带良性肿瘤、声门癌为R与G相关性最高(r＝0.885～0.965),病理性声带沟、单侧声带麻痹、功能性发声障碍则B与G相关性最高(r＝0.746～0.833).结论 GRBAS听主观评估嗓音障碍不仅可显示嗓音障碍的程度,而且可间接反映发声时声带的基本特征,不同嗓音疾病具有不同特点,与声带病变的病理生理改变具有一致性.     

Feasibility of sentinel lymph node biopsy omission after integration of 18F-FDG dedicated lymph node PET in early breast cancer:a prospective phase Ⅱ trial

Objective:Sentinel lymph node biopsy(SLNB) is currently the standard of care in clinically node negative(cN0) breast cancer.The present study aimed to evaluate the negative predictive value(NPV) of ¹⁸F-FDG dedicated lymph node positron emission tomography(LymphPET) in cN0 patients.Methods:This was a prospective phase II trial divided into 2 stages(NCT04072653).In the first stage,cN0 patients underwent axillary LymphPET followed by SLNB.In the second stage,SLNB was omitted in patients ...     

Aligned acupuncture at muscle regions plus cutaneous needle for upper limb spasticity after stroke: A multicenter randomized controlled trial

Objective： To evaluate the clinical efficacy of aligned acupuncture at the muscle regions plus cutaneous needle for post-stroke upper limb spasticity. Methods： By adopting a design of multicenter randomized controlled clinical trial, 488 patients with post-stroke upper limb spasticity were randomized into a treatment group and a control group, 244 in each group. In addition to rehabilitation training, the treatment group received aligned acupuncture at the muscle regions plus cutaneous needle therapy and the control group received conventional Western medicine. After successive 3-week treatments, the clinical efficacy, spasticity degree of the upper limb, joint function, and neurological defect degree were evaluated in the two groups. Results： The total effective rate was 93.4% in the treatment group versus 61.5% in the control group, and the difference was statistically significant （P 〈 0.05）. The upper-limb spasticity degree, joint function, and neurological defect degree were improved significantly in both groups after intervention （P〈0.05）, and the improvements in the treatment group were more significant than those in the control group （P〈0.05 or P〈0.01）. Conclusion： Aligned acupuncture at the muscle regions plus cutaneous needle therapy is effective in treating post-stroke upper limb spasticity.     

白细胞介素6和hepcidin在弥漫大B细胞淋巴瘤中的表达及其与贫血的相关性

目的：研究白细胞介素6（IL-6）和hepcidin在弥漫大B细胞淋巴瘤（DLBCL）患者中的表达及其在贫血发生中的作用。方法收集诊断时伴或不伴贫血的45例DLBCL患者,在诊断时抽取外周血标本,分别检测IL-6、hepcidin、血清铁蛋白和血红蛋白（Hb）浓度等。以24名健康志愿者作为对照。结果DLBCL患者的血浆hepcidin及IL-6水平分别为（347±171）μg／L、0.27 ng／L（0～9.61 ng／L）,与健康对照者的（175±92）μg／L、0相比,差异均有统计学意义（均P＜0.001）。在高乳酸脱氢酶（LDH）（P＝0.003）、有B症状（P＝0.040）和年龄校正的国际预后指数（IPI）评分＞1（P＝0.010）的患者中血浆hepcidin水平升高,差异均有统计学意义。在男性（P＝0.003）、肿瘤分期Ⅲ～Ⅳ期（P＝0.008）和IPI评分＞1（P＝0.004）的DLBCL患者中IL-6水平升高,差异均有统计学意义。 hepcidin水平与血清铁蛋白高度相关（r＝0.77,P＜0.001）,与IL-6弱相关（r＝0.31,P＝0.030）,与Hb无相关性（r＝-0.12,P＝0.300）。IL-6表达水平与Hb呈负相关（r＝-0.35,P＝0.009）。多因素分析提示,IL-6可以预测贫血（P＝0.03）,而hepcidin不能预测贫血（P＝0.89）。结论 DLBCL患者血浆hepcidin常高表达,但IL-6水平升高在DLBCL患者贫血的发生中起主要作用。     

Uterine leiomyosarcoma metastasis to the breast

BACKGROUND: Uterine leiomyosarcoma is a rare female neoplasm with a high recurrent and metastatic rate. However, only a few cases have been reported on metastasis to the breast. The purpose of this work is to stress the role of follow-up and to increase physicians' awareness of such lesion. case: A 62-year-old female suffered from a breast nodule and multiple metastases six years after resection for uterine leiomyosarcoma. Pathology revealed a rare condition of uterine leiomyosarcoma with breast metastasis. CONCLUSION: The case highlights the important role of long-term follow-up in uterine leiomyosarcoma and implies the necessity of tissue proof in patients with the disease.     

Über die Abhängigkeit der Reizwirkung eines Herznerven von der tonischen Erregung der übrigen Herznerven

Zusammenfassung Nach Durchschneidung eines Vagosympathicus sinkt die Schwelle für die vom peripheren Stumpfe des anderen Vagosympathicus ausgelöste Herzhemmung.Bei Kröten, bei denen die Reizung des peripheren Vagosympathicusstumpfes eine Acceleration des Herzschlags bewirkte, sank nach Durchschneidung des kontralateralen Vagosympathicus in analoger Weise die Schwelle für die Acceleranswirkung.Das Absinken der Schwelle für die Vaguswirkung nach Durchtrennung des kontralateralen Vagosympathieus beruht auf einer Steigerung der Empfindlichkeit des Herzens für den Vagusstoff. Dies beweisen Versuche, in denen die Acetylcholinempfindlichkeit des bei erhaltener Innervation präparierten Froschherzens an der Straubschen Kanüle vor und nach Entnervung des Herzens geprüft wurde. Nach Durchschneidung beider Vagosympathici wirkt die Füllung des Herzens mit einer Acetylcholinlösung von bestimmter Konzentration wesentlich stärker negativ inotrop als am normal innervierten Herzen. Dagegen ändert sich die Erregbarkeit eines peripheren Vagusstumpfes (gemessen an seiner Chronaxie) nach Durchschneidung des kontralateralen Vagosympathieus nicht.Die isolierte Durchschneidung der Sympathici steigert die Acetylcholinwirkung ebenso wie die Durchschneidung der Vagosympathici. Im wesentlichen beruht also die Steigerung vagaler Reizwirkungen nach Entnervung des Herzens auf dem Wegfall des Acceleranstonus.Durchschneidungsversuche an verschiedenen Stellen des Zentralnervensystems zeigten, daß der Acceleranstonus von spinalen Zentren unterhalten wird.Isolierte Durchschneidungen des Vagus (intracraniell oder peripher nach vorangegangener Sympathicotomie) änderten die Acetylchohnempfindlichkeit des Herzens meist nicht, aber in einzelnen Fällen trat auch bei diesen Versuchen eine leichte Verstärkung der Acetylcholinwirkung auf, ein Effekt, der an ähnliche Beobachtungen vonHofmeister undTschermak an Kröten und Hunden erinnert.     

43例腹壁切口延迟愈合的临床分析

腹壁切口延迟愈合是腹部外科常见并发症,严重者可造成切口裂开等严重并发症。回顾分析我院2002年1月～2005年1月腹壁切口延迟愈合病例共43例,分析其发生原因及处理方法,提出预防措施,报告如下。     

The Relationship between Fat Mass Percentage and Glucose Metabolism in Children and Adolescents: A Systematic Review and Meta-Analysis

To assess the relationship between fat mass percentage (FMP) and glucose metabolism in children aged 0–18 years we performed a systematic review of the literature on Medline/PubMed, SinoMed, Embase and Cochrane Library using the PRISMA 2020 guidelines up to 12 October 2021 for observational studies that assessed the relationship of FMP and glucose metabolism. Twenty studies with 18,576 individuals were included in the meta-analysis. The results showed that FMP was significantly associated with fasting plasma glucose (FPG) (r = 0.08, 95% confidence interval (CI): 0.04–0.13, p < 0.001), fasting plasma insulin (INS) (r = 0.48, 95% CI: 0.37–0.57, p < 0.001), and homeostasis model assessment (HOMA)- insulin resistance (IR) (r = 0.44, 95% CI: 0.33–0.53, p < 0.001). The subgroup analysis according to country or overweight and obesity indicated that these associations remained significant between FMP and INS or HOMA-IR. Our results demonstrated that there is a positive relationship between FMP and FPG. Moreover, subgroup analysis according to country or overweight and obesity indicated that FMP is significantly associated with INS and HOMA-IR. This is the first known systematic review and meta-analysis to determine the associations of FMP with glucose metabolism in children and adolescents.     

Study on Toughening and Temperature Sensitivity of Polyurethane Cement (PUC)

Polyurethane cement (PUC) is now commonly used in the reinforcement of old bridges, which exhibit various issues such as poor toughness, temperature-sensitive mechanical properties, and brittle failure. These problems can lead to the failure of the reinforcement effect of the PUC on old bridges in certain operating environments, leading to the collapse of such reinforced bridges. In order to alleviate these shortcomings, in this study, the toughness of PUC is improved by adding polyvinyl alcohol (PVA) fiber, carbon fiber, and steel fiber. In addition, we study the change law of the flexural strength of PUC between −40 °C and +40 °C. The control parameters evaluated are fiber type, fiber volume ratio, and temperature. A series of flexural tests and scanning electron microscope (SEM) test results show that the flexural strength first increases and then decreases with the increase in the volume-doping ratio of the three fibers. The optimum volume-mixing ratios of polyvinyl alcohol (PVA) fiber, carbon fiber, and steel fiber are 0.3%, 0.04% and 1%, respectively. Excessive addition of fiber will affect the operability and will adversely affect the mechanical properties. The flexural strength of both fiber-reinforced and control samples decreases with increasing temperature. Using the flexural test results, a two-factor (fiber content, temperature) BP neural network flexural strength prediction model is established. It is verified that the model is effective and accurate, and the experimental value and the predicted value are in good agreement.     

Insight into the Epidemiology and Evolutionary History of Novel Goose Astrovirus-Associated Gout in Goslings in Southern China

A novel gout disease, characterized by visceral urate deposition with high-mortality, with outbreaks in goslings in China since 2016 was caused by a novel goose astrovirus (GoAstV) and resulted in serious economic loss. However, the epidemiology and variation of the GoAstV in goslings in southern China and its evolutionary history as well as the classification of the GoAstV are unclear. In the present study, systematic molecular epidemiology, and phylogenetic analyses of the GoAstV were conducted to address these issues. Our results showed that the GoAstV is widespread in goslings in southern China, and the genomes of six GoAstV strains were obtained. Two amino acid mutations (Y36H and E456D) were identified in capsid proteins in this study, which is the dominant antigen for the GoAstV. In addition, the GoAstV could be divided into two distinct clades, GoAstV-1 and GoAstV-2, and GoAstV-2 is responsible for gout outbreaks in goslings and could be classified into Avastrovirus 3 (AAstV-3), while GoAstV-1 belongs to Avastrovirus 1 (AAstV-1). Moreover, the emergence of GoAstV-2 in geese was estimated to have occurred in January 2010, approximately 12 years ago, while GoAstV-1 emerged earlier than GoAstV-2 and was estimated to have emerged in April 1985 based on Bayesian analysis. The mean evolutionary rate for the GoAstV was also calculated to be approximately 1.42 × 10⁻³ nucleotide substitutions per site per year. In conclusion, this study provides insight into the epidemiology of the GoAstV in goslings in southern China and is helpful for understanding the origin and evolutionary history as well as the classification of the GoAstV in geese.