加工速度、工作记忆以及推理能力的年龄组和受教育程度水平差别

目的:探讨不同年龄阶段人群中,年龄与受教育程度对加工速度、工作记忆及推理能力的作用。方法:在全国6大行政区分年龄段并匹配性别进行取样,选取健康受试1754人[年龄16~86岁;男833人,女921人;受教育年限(10.4±3.2)年],将年龄分为16~24、25~34、35~44、45~54、55~64、65~69、70~86岁7个年龄段,将受教育程度分为小学及以下、初中、高中及以上3个受教育程度]。采用韦氏成人智力量表第四版(WAIS-IV)中文版的译码、背数、矩阵推理分量表分别评估加工速度、工作记忆广度及工作记忆、推理能力4项认知功能。采用多项式曲线拟合的方法对各认知成分随年龄的下降趋势进行拟合;使用单因素方差分析LSD多重比较法或Kruskal-Wallis H两两比较进行组间比较;使用通径分析的方法考察不同年龄阶段年龄、受教育程度对各认知成分的影响。结果:多项式曲线拟合结果发现,除工作记忆外,加工速度、工作记忆广度和推理能力得分随年龄的下降趋势均为非直线性趋势(R2=99.7%、98.5%、98.9%),且下降速度总体上逐渐放缓。受教育程度越高,各项认知成分的水平越高,且在加工速度和推理能力得分上随年龄下降的坡度越大。对不同年龄段各认知成分受教育程度组间的差异分析发现,在65~69岁、70~86岁上推理能力得分受教育程度组间差异无统计学意义(均P>0.05),其他年龄段受教育程度高者各认知得分均要高(均P<0.01)。通径分析表明,在不同的年龄阶段,使用不同的认知随年龄下降模型进行模型拟合时均拟合良好(χ2/df<3,各拟合优度指数均>0.9,残差均<0.05)。结论:加工速度和推理能力随年龄的下降呈非直线性下降趋势;不同的年龄阶段年龄与各认知成分的关系不同,50岁后主要通过加工速度中介;受教育程度在不同的认知成分随年龄的下降中表现不同。     

T型钙通道拮抗剂对未成熟心肌缺血再灌注损伤的保护作用

目的探讨T型钙通道拮抗剂Mibefradil对未成熟心肌缺血再灌注损伤的保护作用。方法2～3周龄新西兰大白兔32只随机分为4组:ST组为St.Thomas液停搏,SV组为St.Thomas液中加入0.1μmolLVerapamil,SM1组为St.Thomas液中加入0.1μmolLMibefradil,SM2组为St.Thomas液中加入1μmolLMibefradil。建立Langendorff模型后,分别在4℃按上述心脏停搏液停搏,维持局部心肌温度在15℃,停止灌注90min,再灌注45min。观测各组停搏前、再灌注后冠状动脉流量、冠状动脉流出液乳酸脱氢酶浓度、心功能(左心室发展压、左心室内压最大上升下降速率)恢复率、心肌丙二醛含量和心肌钙离子含量等指标。结果各组冠状动脉流量没有明显差异。心功能恢复发现再灌注后45min时,SV组的左心室发展压、左心室内压最大上升下降速率恢复率分别为:0.70±0.23、0.72±0.23和0.67±0.25,明显低于其余各组(P<0.05),其余各组之间没有明显差异。SV组乳酸脱氢酶浓度(12.2±2.7IUL)明显高于其他各组(P<0.05),同时ST组(9.3±3.2IUL)也明显高于SM2组(6.6±2.2IUL),P<0.05。心肌丙二醛含量ST组(1.64±0.39μmolg)和SV组(1.76±0.51μmolg)明显高于SM2组(1.14±0.24μmolg,P<0.05)。SV组心肌钙离子含量(0.225±0.041mgg)明显高于其他各组(P<0.05)。同时ST组(0.184±0.021mgg)也明显高于SM2组(0.147±0.020mgg,P<0.05)。结论Mibefradil对未成熟心肌缺血再灌注损伤有保护作用,Verapamil损害未成熟心肌。     

泡沫硬化剂聚多卡醇联合大隐静脉高位结扎剥脱术治疗D-二聚体升高静脉曲张患者的疗效

目的 观察局部注射泡沫硬化剂聚多卡醇联合大隐静脉高位结扎剥脱术对D-二聚体升高的大隐静脉曲张患者的疗效,并随访并发症发生情况。方法 回顾性分析2020年3月至2021年2月潍坊市人民医院血管外科收治的838例大隐静脉曲张患者的临床资料,从中筛选66例术前D-二聚体指标升高的患者纳入试验组,筛选66例术前D-二聚体指标正常的患者纳入对照组,2组患者均接受大隐静脉高位结扎并剥脱术+曲张静脉聚多卡醇注射治疗。术后观察2组患者大隐静脉曲张的治疗效果及普通静脉炎、表浅血栓性静脉炎、深静脉血栓等并发症的发生情况。采用SPSS 19.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ²检验进行组间比较。结果 2组患者治疗前与术后1个月CEAP评分[试验组:(2.86±1.02)和(0.97±1.48)分;对照组:(2.80±1.13)和(0.92±1.49)分]比较,差异均有统计学意义(P＜0.05);但试验组和对照组术后1个月CEAP评分[(0.97±1.48)和(0.92±1.49)分]比较,差异无统计学意义(P＞0.05)。试验组和对照组并发症发生率比较(59.1%和53.0%),差异无统计学意义(P＞0.05)。结论 泡沫硬化剂聚多卡醇局部注射联合大隐静脉高位结扎并剥脱术治疗D-二聚体升高的静脉曲张患者,整体疗效确切且安全可行。     

Regional whole-course trauma care e Experiences from a county-level hospital

Fifty percent of the deaths caused by severe trauma occur within 1 h after injury. With the concepts of “golden 1 h” and “platinum 10 min”, the professionals in the field of emergency trauma treatment have agreed on the necessity of establishing a rapid and efficient trauma rescue system. However, due to the size of the hospital, the population in the neighborhood, the local economic conditions and geographical features, how to establish an optimal trauma rescue system remains an issue. In this paper, we introduced our experiences in a county-level hospital located in middle-and high-income areas.     

应用表面加强激光解吸电离飞行时间质谱方法检测喉鳞状细胞癌及淋巴结转移的血清蛋白质标志物

目的 应用表面加强激光解吸电离飞行时间质谱（SELDI-TOF-MS）方法筛选喉鳞癌（LSCC）血清蛋白质标志物,建立喉癌诊断预测模型。并检测喉癌淋巴结转移相关的血清蛋白标志物。方法收集252例血清标本,其中喉癌患者血清142例,正常对照110例。其中89例喉癌血清,30例有淋巴结转移的喉癌血清和65例正常对照为试验组,53例喉癌血清及45例正常对照为盲法验证组。应用弱阳离子交换芯片（WCX2）经SELDI-TOF-MS测定得到蛋白质谱,通过Biomarker Wizard和Biomarker Pattern（BIaS）软件分析喉癌和正常人血清的蛋白质谱差异,建立喉癌诊断预测模型并进行盲法验证。寻找喉癌转移相关蛋白标志物。结果 在质荷比（M／Z）2000～50000范围内,弱阳离子（WCX2）芯片共检测出18个差异蛋白峰,可以鉴别喉癌和正常对照。BIaS自动选用其中一个差异蛋白质峰（4176）建立决策树模型,灵敏性为86．52％,特异性为84．62％（32／36）。盲法验证的灵敏性为84．91％,特异性为82．22％。伴或不伴淋巴结转移的喉癌患者之间检测到14个差异蛋白峰。结论应用SELDI-TOF-MS方法可以从血清中筛选出喉癌及淋巴结转移相关的标志蛋白。建立的喉癌诊断预测模型可能对早期发现早期诊断喉癌具有重要的临床意义。     

Intrahepatic cholangiocarcinoma is more complex than we thought: A case report

BACKGROUNDBrain metastasis from intrahepatic cholangiocarcinoma is rare. To the best of our knowledge, only a few cases have been reported. The biological behavior was complex, and treatment requires further investigation.CASE SUMMARYA 62-year-old woman complained of left limb weakness. Abdominal computed tomography showed a 5.0 cm × 5.6 cm lesion in the left lobe of the liver. Tumor markers were normal. Serological analysis indicated absence of hepatitis virus. Brain magnetic resonance imaging revealed a 1.0 cm × 1.3 cm mass in the right frontal lobe. Intrahepatic cholangiocarcinoma with brain metastasis was diagnosed by our liver cancer multidisciplinary team. After sufficient preparation, the patient underwent partial frontal lobotomy and left hemihepatectomy. Histopathological results confirmed that both the lesions were cholangiocarcinoma. Six cycles of gemcitabine combined with S1 were administered. During a 39 mo postoperative follow-up, no sign of local recurrence or distant metastasis was observed. CONCLUSIONThis case expands our knowledge concerning the complex and heterogeneous nature of tumor metastasis.     

An Innovative Model of ISS-Based Multiple Fractures and Gastrointestinal Dysfunction Related to c-Kit Protein Expression on Interstitial Cells of Cajal

Objective

Gastrointestinal dysfunction seriously affects the prognosis and quality of life of patients with multiple fractures. However, experimental evidence of this relationship is lacking. Here we describe a newly developed mouse model of postoperative gastrointestinal dysfunction after multiple fractures.

Methods

Trauma severity was assessed using the injury severity score (ISS). Based on the ISS, a multiple fracture model was established in mice as follows: limb fractures with pelvic fractures and multiple rib fractures; limb fractures with multiple rib fractures; closed fracture of both forelegs with pelvic fracture and rib fractures; closed limb fractures; limb fracture with pelvic fracture; spinal fractures; hind leg fractures with pelvic fractures; pelvic fracture with multiple rib fractures; closed fracture of both fore legs with pelvic fracture; and closed fracture of both fore legs with multiple rib fractures. In each model group, gastrointestinal motility was assayed and the histopathology of the small intestine was examined. Western blot and immunohistochemical analyses of jejunal tissue were performed to detect c-kit protein expression, the level of which was compared with that of a control group. The results of ANOVA are expressed as mean ± standard deviation.

Results

In mice with multiple fractures, food intake was greatly reduced, consistent with histopathological evidence of an injured intestinal epithelium. The jejunal tissue of mice in groups a, c, f, and h was characterized by extensively necrotic and exfoliated intestinal mucosal epithelium and inflammatory cell infiltration in the lamina propria. In the gastrointestinal function assay, gastrointestinal motility was significantly reduced in groups a, b, c, f, and g; these group also had a higher ISS (p < 0.01). The expression of c-kit protein in groups with gastrointestinal dysfunction was significantly up-regulated (p < 0.001) compared with the control group. The close correlation between c-kit expression and the ISS indicated an influence of trauma severity on gastrointestinal motility.

Conclusion

Gastrointestinal dysfunction after multiple fractures was successfully reproduced in a mouse model. In these mice, c-kit expression correlated with gastrointestinal tissue dysfunction and might serve as a therapeutic target.     

Expression and significance of MMP3 in synovium of knee joint at different stage in osteoarthritis patients

Objective:To investigate the expression and significance of MMP-3 in synovium of knee joint at different stage in osteoarthritis(OA)patients.Methods:Knee synovial tissue were collected in90 OA patients(the OA group).Patients in the OA group was divided into 3 subgroups:gradeⅠsubgroup(n=30),gradeⅡsubgroup(n=30),gradeⅢsubgroup(n=30).Thirty patients served as control group,lmmunohistochemical assay was used to detect the expression of MMP-3 protein in the knee synovial tissue.Results:MMP-3 protein was detected in all knee synovial tissue.The expression of MMP-3 protein in the OA group was significantly higher that in the normal synovium(P0.05),and the MMP-3 protein was mainly located in the cytoplasm.There was significant difference in the expression of MMP-3 protein between the gradeⅢsubgroup and the gradeⅠ,gradeⅡsubgroups(all P0.05).The expression of MMP-3 protein was positively related to the severity of OA(r=0.912,P0.05).Conclusions:The expression of MMP-3 protein are closely related to pathogenic mechanism of OA.It may be an important indicator of early diagnosis and the activity of the disease of osteoarthritis.     

膝下动脉闭塞性病变40例腔内治疗的疗效分析

目的 探讨经皮腔内血管成形术（PTA）对膝下动脉闭塞性病变（包括血栓闭塞性脉管炎、下肢动脉硬化闭塞症、糖尿病足）的治疗效果。方法 回顾性分析山东省潍坊市人民医院2008年3月至2014年7月40例（40条患肢）膝下动脉闭塞性病变的临床资料,采用PTA对狭窄或闭塞性病变进行球囊扩张。结果 39条肢体获得影像学成功（残余狭窄率＜20%）,技术成功率及初次开通率为97.5%（39/40）。肢体保全率为95%（38/40）,保肢率为97.5%（39/40）。并发症有动脉穿孔（2例）、穿刺点血肿（1例）、急性心肌梗死（1例）。39例术后肢体间歇性跛行、疼痛、溃疡等临床症状均改善,踝肱指数(ABI)由术前的（0.32±0.27）增至术后10d的（0.86±0.19）,差异具有统计学意义（P＜0.01）。术后12个月ABI值为（0.80±0.20）,术后12个月肢体保全率为95%（38/40）。结论 PTA治疗膝下动脉闭塞性病变是一种安全有效的治疗方法。