脓疱型银屑病15例临床分析

通过对15例脓疱型银屑病的临床资料分析,指出在发病诱因中、滥用皮质激素是导致由寻常型转为脓疮型的重要因素。防治方面,严重病例应早期使用皮质类固醇激素,并适时加用MTX（氨甲碟呤）。而对初发病例,病情不甚严重者、则以抗菌素加其他治疗,而不宜以皮质激素为首选药物。     

Endoscopic features of esophageal high-grade intraepithelial neoplasia dominated by cytological atypia

Little is known about esophageal high-grade intraepithelial neoplasia dominated by cytological atypia (HGINc). We aimed to elucidate the endoscopic features of HGINc compared with esophageal high-grade intraepithelial neoplasia dominated by architectural atypia (HGINa). All patients pathologically diagnosed as esophageal high-grade intraepithelial neoplasia after endoscopic submucosal dissection at our center between January 2018 and December 2019 were included in this study. According to the pathological diagnosis, the patients were divided into two groups: HGINa group and HGINc group. Basic characteristics and endoscopic information were collected in detail. Data were analyzed statistically. Binary logistic regression was performed and a predictive model for HGINc was established. Then we evaluated its predictive value and built a nomogram for clinical application. A total of 175 patients were included in this study (126 with HGINa and 49 with HGINc). Among 228 lesions found in all patients, there were 148 HGINa and 80 HGINc. The independent relevant factors for HGINc were tobacco and alcohol usage, color, and gross type. To predict risk of HGINc, a three-factor model (TFM) was established with a highest area under curve (AUC) as 0.869 (95% CI, 0.852, 0.939). When the cut-off value was set as 0.3569184, the diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for HGINc was 81.14%, 88.75%, 77.03%, 67.62%, and 92.68%, respectively. HGINc differs greatly in endoscopic features from HGINa in our study. It’s important to reduce misdiagnosis that our model was established with good predictive value for clinical application.     

The impact of spleen volume on the survival of metastatic pancreatic adenocarcinoma patients receiving nanoliposomal irinotecan

Nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil and leucovorin (NalFL) comprises the current standard for gemcitabine-failed metastatic pancreatic ductal adenocarcinoma (PDAC). As liposomes generally accumulate in the spleen, we evaluated the impact of spleen volume on prognosis. We enrolled patients with metastatic PDAC who failed gemcitabine-based therapy and were initiated on NalFL between August 2018 and November 2020. The spleen volume before NalFL administration was evaluated. They were stratified into dose subgroups (i.e. low, < 48 mg/m²; intermediate, 48 - < 64 mg/m²; high, ≥ 64 mg/m²) by the average nal-IRI dose during the entire treatment, and multivariate analysis of overall survival (OS) was performed. We included 547 patients with a median age of 63 years (range, 27-89 years) and a median of 1 (range, 0-7) palliative chemotherapy regimen. The median spleen volume was 245 mL (range, 82-817 mL). Among patients with splenomegaly (≥ 245 mL), the low-dose subgroup had the worst median time to treatment failure (TTF, 1.8 months vs. 2.5 months vs. 2.5 months, P = 0.020) and OS (3.3 months vs. 5.9 months vs. 6.6 months, P = 0.018) as against no prognostic impact in patients without splenomegaly. In the multivariate analysis of patients with splenomegaly, performance status (PS) ≥ 2, body surface area (BSA) < 1.6 m², prior fluoropyrimidine use, liver metastasis, and low-dose subgroup were independent poor prognostic factors. A low average nal-IRI dose was significantly associated with poor prognosis, especially among patients with splenomegaly. Further pharmacological studies should validate the relevance of spleen volume on the treatment outcomes of nal-IRI.     

负压封闭引流技术治疗烧伤52例

目的 探讨负压封闭引流技术（VSD）治疗烧伤的疗效.方法 选择108例烧伤患者,分为VSD组和换药组进行回顾性分析.接受VSD治疗患者52例,接受传统换药治疗患者56例.结果 相似的创面条件下,观察组的愈合时间和总疗程明显少于对照组（P＜0.05）.观察组治疗比较满意,与对照组相比有显著性差异（P＜0.01）.结论 负压封闭引流技术治疗烧伤效果明显优于对照组,值得推广.     

Microstructure Evolution and Deformation Mechanisms of As-Cast Antibacterial Ti6Al4V-5Cu Alloy for Isothermal Forging Process

The hot workability behavior of antibacterial Ti6Al4V-5Cu alloy was investigated using a hot compression experiment in the temperature range of 790–1040 °C and strain rate of 10⁻³–10 s⁻¹ with a strain of 0.4. The deformation behavior of the alloy was characterized by Gleeble 3800 compression experiment, and the relationship among deformed microstructures and deformation parameters was established. The deformations of Ti6Al4V-5Cu alloy were temperature and strain rate-dependent. Higher temperature and lower strain rate made power dissipation efficiency (η) increase and reach 89%. The activation energies (Q) in the dual-phase (α + β) and single β phase regions were calculated as 175.43 and 159.03 kJ mol⁻¹, respectively. In the dual (α + β) phase region, with an increase in strain rate, flow-softening behavior was dominated, however in the single β phase region such as processing at 940 °C. Flow stress increased slightly in which work-hardening behavior was dominated (especially between strain rates of 10⁻³–1 s⁻¹). The deformation at various conditions exhibited different stress-strain profiles, providing an insight that work hardening and flow softening coexisted in Ti6Al4V-5Cu alloy. The relative intensity of oscillatory change in flow stress profile decreased as the strain rate decreased. The hot workability of Ti6Al4V-5Cu alloy was also accessed from the viewpoint of the sub-grain structure.     

Electrochemical Evaluation of Stress Corrosion Cracking Susceptibility of Ti-6Al-3Nb-2Zr-1Mo Alloy Welded Joint in Simulated Deep-Sea Environment

Titanium alloys have high specific strength and excellent corrosion resistance and have been applied in deep-sea engineering fields. However, stress corrosion cracking may become one of the biggest threats to the service safety of a high-strength titanium alloy, as well as its weldment. In this work, stress corrosion cracking of a gas-tungsten-arc-welded Ti-6Al-3Nb-2Zr-1Mo (Ti6321) alloy influenced by the applied potentials in simulated deep-sea and shallow-sea environments was investigated by combining slow strain rate testing with electrochemical measurements. The results showed that the service environment and applied potential have a substantial effect on the stress corrosion cracking behavior of the Ti6321 welded joint. The Ti6321 welded joint exhibited higher stress corrosion susceptibility in a simulated deep-sea environment and at a strong polarization level owing to the diminishing protection of the passive film under passivation inhibition and the enhancement of the hydrogen effect. The fracture of a Ti6321 welded joint in the weld material could be attributed to the softening effect of the thick secondary α within the coarse-grained martensite. The electrochemical evaluation model of stress corrosion cracking susceptibility of a Ti6321 welded joint in a simulated marine environment was established by adding the criterion in the passivation region based on the literature model, and four potential regions corresponding to different stress corrosion cracking mechanisms were classified and discussed. Our study provides useful guidance for the deep-sea engineering applications of Ti6321 alloys and a rapid assessment method of stress corrosion risk.     

X线与CT诊断空洞型肺结核的价值分析

目的 探讨分析X线与CT诊断空洞型肺结核的价值.方法 在本院2016年2月~2017年2月间接诊的空洞型肺结核患者中随机选取50例作为本次研究的对象,对患者先后进行X线与CT检查,采用X线方式检查的为A组,采用CT方式检查的为B组.比较两种检查方法的差异性及临床诊断应用价值.结果 在50例确诊的患者中,常规X线胸片检查结果显示20例26个空洞,其中厚壁空洞11例,虫蚀样空洞2例,薄壁空洞7例;常规CT检查结果显示50例74个空洞,其中厚壁空洞32例,虫蚀样空洞4例,薄壁空洞14例.B组发现空洞个数及类型数量明显多于A组,两组间比较差异有统计学意义(P<0.05).B组的检查结果中发现空洞、卫星病灶、支气管播散、胸膜增厚、淋巴肿大、胸腔积液等个数明显多于A组,两组间比较差异有统计学意义(P<0.05).B组在病变分布检查中共检出128例,总检出率为93.4%,明显高于A组的64例和46.7%,两组间比较差异有统计学意义(P<0.05).B组病变隐藏部位的检出个数为25个,检出率为100.0%,明显高于A组的2个和8.0%的检出率,两组间比较差异有统计学意义(P<0.05).结论 CT诊断空洞型肺结核与X线相比较更加全面、清晰、准确,具有较高的临床应用价值.     

黄芪及其复方制剂含量测定方法的研究概况

黄芪(Astragalus Lepsensis Bge)以豆科紫云属膜荚黄芪(Astragalus M em branceus Fisch Bge)或蒙古黄芪(A,m ongholicus Bge)的干燥根作为正品使用。该药具补气固表、脱疮生肌和强心利尿等作用,可用于治疗体虚自汗、久泻等病症[1]。黄芪还具有增强免疫系统、抗氧化、延缓衰老、改善心功能状态、抗病毒、抗癌等功效[2]。黄芪的化学成分众多,主要有皂甙类、黄酮类、多糖类以及氨基酸类等,其不同的化学成分具有不同的药理活性。因此我们对近些年黄芪中活性成分的含量测定作简要概述。1皂甙类物质的含量测定黄芪中数种皂甙成分经过醇制氢氧…     

直接测定红细胞平均血红蛋白含量在贫血诊断中的应用

目的探讨直接测定红细胞平均血红蛋白含量(celluarHb,CHb)在贫血诊断中的意义。方法通过全自动血液分析仪检测健康人群及不同类型贫血患者的CHb,并进行ROC曲线分析。结果CHb的正常参考范围是27.74～31.21pg;除了正常细胞均一性贫血患者的CHb与健康人群无显著性差异(P>0.05)外,下述四类贫血患者的CHb与健康人群均有极显著性差异(P<0.01):在大细胞均一性贫血诊断时,若以CHb>31.2pg为分界值,其敏感度0.94、特异性0.99、诊断效率0.97;在大细胞不均一性贫血诊断时,以CHb>31.2pg为分界值,其敏感度1.00、特异性0.99、诊断效率0.99;在诊断正常细胞不均一性贫血时,以CHb<29.4pg为分界值:敏感度0.62、特异性0.54、诊断效率0.57;在诊断小细胞性贫血时,以CHb<27.2pg为分界值,诊断敏感度1.00、特异性1.00、诊断效率1.00。结论直接测定能真实反映机体红细胞血红蛋白含量,结合合适的分界值,在各种贫血的诊断与鉴别诊断中,尤其是小细胞性贫血,CHb是一项理想的诊断指标,值得进一步推广应用。     

Differential temporal neural responses of pain-related regions by acupuncture at acupoint ST36: a magnetoencephalography study

Background  Previous neuroimaging studies primarily focused on the spatial distribution of acupuncture needling stimulation. However, a salient feature of acupuncture was its long-lasting effect. This study attempted to detect the spatial-temporal neural responses evoked by acupuncture at an analgesia acupoint ST36 by using magnetoencephalography. To further verify its functional specificity, we also adopted acupuncture at Pericardium 6 and nonacupoint as separated controls.

Methods  Forty-two college students, all right-handed and acupuncture naïve, participated in this study. Every participant received only one acupoint stimulation, resulting in 14 subjects in one group. Both magnetoencephalography data (151-channel whole-head system) and structural functional magnetic resonance imaging data (3D sequence with a voxel size of 1 mm³ for anatomical localization) were collected for each subject. All processing procedures were performed in BrainStorm Toolbox.

Results  Acupuncture at ST36 showed a significantly time-varied brain activities with different onset time. Our results presented that acupuncture at different acupoints (or comparing with nonacupoint) can specifically induce neural responses in different brain areas—acupuncture at ST36 can specifically induce the neural responses of pain-inhibition areas, while acupuncture at PC6 can specifically induce the activities of the insula and amygdala.

Conclusions  In the present study, we attempted to detect the temporal neural responses underlying the functional specificity of acupuncture at ST36, using acupoint belonging to different meridians and non-acupoint with efficacy-irreverent as separate controls. The specific neural substrates involving acupuncture at different acupoints may be related to its functional specificity in clinical settings.