基于骰骨MRI的糖尿病足影像组学特征

目的 探究基于MRI影像组学特征辅助诊断糖尿病足（DF）的可行性。 方法 回顾性分析2018年8月至2020年8月于上海中医药大学附属上海市中西医结合医院行足部MRI检查的127例因足部疾患就诊患者的临床资料,其中男性83例、女性44例,年龄16~88（59.3±14.8）岁。根据患者临床诊断的不同分为DF组（85例）和非DF组（42例）;根据影像组学特点,采用简单随机抽样法,将患者以3∶2的比例随机分为训练组（76例）和测试组（51例）。在MRI的T1加权成像（WI）序列和质子密度加权成像（PDWI）压脂序列矢状面图像上勾画骰骨,提取影像组学特征参数,并构建T1WI序列模型、PDWI压脂序列模型及联合模型,联合模型包括性别、年龄、骨髓信号和影像组学特征参数。通过3组模型参数最大绝对值归一化的预处理,经过最优特征和模型选择筛选出最优特征维度。采用受试者工作特征（ROC）曲线,计算曲线下面积（AUC）,评估影像组学特征诊断DF的效能。2组间年龄的比较采用独立样本t检验,2组间性别和中足骨骨髓信号异常的比较采用χ2检验。 结果 DF组和非DF组患者在年龄、男女比例及中足骨骨髓信号异常间的差异均有统计学意义（t=29.2,χ2=17.15、6.53,均P<0.05）。T1WI序列模型、PDWI压脂序列模型和联合模型最终分别筛选出9、7和10个最优特征维度。支持向量机模型区别DF和非DF患者在T1WI序列模型上训练组和测试组的AUC分别为0.86和0.84,准确率分别为78%和69%; PDWI压脂序列模型上训练组和测试组的AUC分别为0.85和0.83,准确率分别为82%和78%;而联合模型上训练组和测试组的AUC分别为0.93和0.85,准确率分别为84%和76%。T1WI序列模型与PDWI压脂序列模型诊断效能相当,而联合模型优于二者单独应用。 结论 MRI影像组学特征能有效区分DF和非DF,有望为DF影像诊断提供一种新型、高效、无创的手段。     

Deoxycytidyl-Deoxyguanosine Oligonucleotide Classes A, B, and C Induce Distinct Cytokine Gene Expression Patterns in Rhesus Monkey Peripheral Blood Mononuclear Cells and Distinct Alpha Interferon Responses in TLR9-Expressing Rhesus Monkey Plasmacytoid Dendritic Cells

To determine if deoxycytidyl-deoxyguanosine oligonucleotides (CpG ODN) can be used effectively as nonspecific inducers of innate immune defenses for preventative or therapeutic interventions in infectious disease models for nonhuman primates, the present study evaluated the response of rhesus monkey peripheral blood mononuclear cells to three different synthetic CpG ODN classes by defining the cytokine gene expression patterns and by characterizing IFN-α/β responses. Depending on the type and dose of CpG ODN used for stimulation, distinct gene expression patterns were induced. CpG ODN class A (CpG-A ODN) and CpG-C ODN, but not CpG-B ODN, were potent inducers of alpha interferon (IFN-α), and this response was due to IFN-α production by TLR9-positive plasmacytoid dendritic cells. Importantly, there was a dose-dependent increase in IFN-α responses to CpG-A ODN but a dose-dependent decrease in IFN-α responses by CpG-B ODN. The most sustained IFN-α response was induced by CpG-A ODN and was associated with a stronger induction of interferon regulatory factor 7 and the induction of several interferon-stimulated genes. In contrast, and independent of the dose, CpG-B ODN were the weakest inducers of IFN-α but the most potent inducers of proinflammatory cytokines. CpG-C ODN induced cytokine gene expression patterns that were intermediate between those of CpG-A and CpG-B ODN. Thus, the different types of CpG ODN induce different post-TLR9 signaling pathways that result in distinct cytokine gene expression patterns. Based on these findings, A and C class CpG ODN, but not B class CpG ODN, may be particularly suited for use as therapeutic or prophylactic antiviral interventions.

In recent years, many nonhuman primate models of viral infections have been developed to study virus-host interactions and to test the efficacy of possible vaccine candidates (9, 42, 45, 53, 54). Importantly, monkey models of simian immunodeficiency virus (SIV) infection are the best animal models available to study human immunodeficiency virus (HIV) infection and AIDS pathogenesis (48, 49). As the AIDS pandemic continues at an uncontrolled rate, and as new infectious diseases emerge (20, 47), there is an urgent need to design strategies aimed at the prevention of viral transmission and control of early virus replication. Part of this effort is the development of immunomodulatory drugs that have the ability to stimulate innate antiviral immune responses that can block transmission or reduce early virus replication and thereby limit virus dissemination.IFN-α/β are critical cytokines in the initial phase of antiviral immune responses, as they serve two important functions: they exert direct innate antiviral effects via interferon-stimulated genes (ISG), and they promote adaptive cellular antiviral immune responses (6, 11, 12, 14, 18, 29, 32, 39, 40, 43, 51, 52, 57, 58). Thus, the manipulation of the interferon system by immunomodulatory compounds, such as deoxycytidyl-deoxyguanosine oligonucleotides (CpG ODN), has potential utility as a therapeutic intervention aimed at the prevention and control of viral infections (36).There are three main classes of synthetic CpG ODN that differ in the type and magnitude of immune responses induced. CpG ODN of the A class (CpG-A ODN) are very strong inducers of alpha interferon (IFN-α) by plasmacytoid dendritic cells (PDC) and are especially potent NK cell activators (35, 55, 56). CpG-B ODN are weaker inducers of IFN-α, but are potent activators of B cells (25, 35). CpG-C ODN have the combined features of CpG-A and CpG-B ODN: they are strong inducers of PDC IFN-α/β production and strong B-cell activators (24, 44, 67). All classes of CpG ODN promote T helper 1 (Th1) responses to coadministered antigens through the induction of cytokines in activated dendritic cells.Thus, due to the robust induction of IFN-α, CpG-A ODN are potential candidates for prophylactic inducers of innate immune defenses in the prevention of viral infections and other infectious diseases. However, CpG-A ODN are not currently being developed for clinical use, because their poly(G) motifs render them more difficult to produce than the other CpG ODN classes (24, 35). Few studies have yet investigated the immune properties of CpG-C ODN, but based on their known ability to induce strong IFN-α/β production in human cells (24, 44, 67), they could be used for therapeutic interventions in infectious disease settings.Nonhuman primates can respond to the same CpG-A and CpG-B ODN that have strong immune activity in humans, and CpG-B ODN have been used successfully as vaccine adjuvants in several monkey studies (31, 62, 65, 66). However, there are no published reports that CpG ODN can be used effectively for preventative or therapeutic interventions in viral diseases in nonhuman primates or humans.The goal of the present study was to compare the relative suitability of the three CpG ODN classes for in vivo virus studies by defining the gene expression pattern in rhesus monkey peripheral blood mononuclear cells (PBMC) to stimulation with the three CpG ODN classes. Further, we sought to characterize the basis for the very different IFN-α/β responses they induce and to determine the nature of the IFN-α-producing cell types in CpG ODN-stimulated rhesus monkey PBMC. We found that the gene expression pattern induced in rhesus monkey PBMC is dependent on the type and dose of CpG ODN used for stimulation. Thus, CpG-A and CpG-C ODN, but not CpG-B ODN, were potent inducers of IFN-α responses, and this response was mediated predominantly by TLR9-expressing PDC. CpG-A ODN induced the most sustained IFN-α response, and this was associated with a stronger induction of the interferon regulatory factor 7 (IRF-7) and resulted in the strong and prolonged induction of several interferon-stimulated genes. The distinct cytokine expression patterns induced by the different CpG ODN classes suggest that each may have a unique clinical application.     

血清胆红素与糖尿病视网膜病变相关性的临床研究

目的研究2型糖尿病患者血清胆红素与糖尿病视网膜病变之间的关系。方法将263例2型糖尿病患者是否合并糖尿病视网膜病变分为合并糖尿病视网膜病变组（DR组）78例和未合并糖尿病视网膜病变组（NDR组）185例,并对两组患者的临床特征进行分析比较,并对糖尿病视网膜病变的危险因素进行多因素logistic回归分析。结果与NDR组相比,DR组患者的糖尿病病程更长（P＜0.01）,胰岛素抵抗更明显（P＜0.05）,而TBil、DBil、间接胆红素水平均显著下降（P＜0.05或0.01）。logistic回归分析显示：病程（OR=1.124）、年龄（OR=1.023）、BMI（OR=1.036）是其独立危险因素,TBil（OR=0.907）、DBil（OR=0.847）是其保护因素。结论DR的发生与血清胆红素水平下降有一定的相关性,血清胆红素可能是DR的一种有益标记物。     

糖尿病肾病患者院内感染危险因素分析

目的探讨2型糖尿病临床肾病（IV期）患者院内感染发生的危险因素。方法回顾性分析糖尿病临床肾病（IV期）患者共245例,其中发生医院感染116例,非感染129例,比较两组患者的一般情况,采用二分类条件logistic回归分析。结果2型糖尿病肾病（IV期）发生医院感染,以泌尿道（45.7%）和呼吸道（35.3%）感染最为常见。糖尿病肾病感染组与非感染组基线资料比较,两组间年龄、病程、住院天数、血白蛋白、24h尿蛋白、血肌酐、肾小球滤过率（GFR）、糖化血红蛋白（HbA1C）差异均有统计学意义（均P＜0.05）;两组间性别差异无统计学意义（P＞0.05）。logistic回归分析显示,尿蛋白（OR=1.147,P＝0.019）是糖尿病临床肾病患者发生医院感染的危险因素;血白蛋白（OR＝0.799,P＝0.000）是保护因素;年龄（OR＝1.011,P＝0.425）、性别（OR＝1.221,P＝0.492）、病程（OR＝1.061,P＝0.064）、血肌酐（OR＝1.008,P＝0.090）、GFR（OR＝0.981,P＝0.751）、HbA1C（OR＝1.138,P＝0.561）未见相关。结论尿蛋白是糖尿病肾病患者发生医院感染的独立危险因素,血白蛋白是保护性因素,对预测和预防医院感染有重要意义。     

浅析中小型医院中心消毒供应部平面布局

为解决中小型医院高层住院综合楼中心消毒供应部门（CSSD）的平面布局问题，文章在两种高层住院综合楼平面范式的基础上，根据中心消毒供应部门的面积要求，提出两种规模的中心供应部的平面排布，从中反思标准层排布需要注意的问题。     

A theory-based problem-solving approach to recruitment challenges in a large randomized field trial

Despite best-laid plans, recruitment problems arise in large field trials. Research teams must work hard on problem solving and push comfort zones to sustain recruitment and accrual levels. A systematic theory-based problem-solving approach helped us look deeply for challenges and implement strategies continuously to sustain accrual to our target enrollment.     

关于我国农村卫生事业目标模式的设计构想

该文首先阐述了对我国农村卫生事业目标模式进行设计的重要性,认为改革必先设计,设计是成功之母,“系统“是确定目标模式的基本要求,正确的目标定位是框架设计的出发点和立足点.在此基础上从组织体系、运行机制和管理体制等方面,提出了我国农村卫生事业目标模式框架设计的思路.     

新生儿高胆红素血症与心肌损害的关系探讨

目的了解新生儿高胆红素血症对心功能的影响。方法对154例高胆红素血症和40非高胆红素血症的新生儿进行血胆红素、心肌肌钙蛋白Ⅰ（cTnⅠ）、肌酸激酶同功酶（CK-MB）测定。结果轻度组发病期和恢复期与对照组CK-MB差异均无统计学意义（均〉0.05）;轻度组恢复期cTnI与对照组差异无统计学意义（P〉0.05）,发病期差异有统计学意义（P〈0.05）。中度组发病期CK-MB与cTnI与对照组差异均有统计学意义（均〈0.05）;恢复期CK-MB与cTnI与对照组差异均无统计学意义（均P〉0.05）。重度组发病期CK-MB与cTnI与对照组差异均有统计学意义（均〈0.05）;恢复期CK-MB与cTnI与对照组差异均无统计学意义（均P〉0.05）。结论高胆红素对新生儿心肌功能有暂时性损害。联合测定cTnⅠ、CK-MB水平可以监测高胆红素血症新生儿的心功能变化。     

宫腔镜下输卵管插管通液术对输卵管妊娠腹腔镜术后输卵管通畅度的评定价值

目的探讨宫腔镜下输卵管插管通液术对输卵管妊娠腹腔镜手术后输卵管通畅度评定价值.方法输卵管妊娠患者56例腹腔镜手术后2～24个月,行宫腔镜下输卵管插管通液术,判断输卵管的通畅程度.结果 15例患侧输卵管切除术,宫腔镜单侧输卵管插管通液术的完全通畅率60.0%(9/15),41例输卵管妊娠物剔出术,双侧通畅率43.9%(18/41),单侧完全通畅率43.9%(18/41).有生育要求的37例随访4～25个月,平均10.8月,已获得正常宫内妊娠20例(54.0%),输卵管完全梗阻采取IVF受孕3例,重复宫外孕1例(2.3%).结论宫腔镜下输卵管插管通液术对输卵管妊娠腹腔镜手术后输卵管通畅度评定较为直观、准确,对患者获得正常宫内妊娠有指导作用.     

关于静脉输注液体温度偏低引发相关问题的思考

目前,临床上所采用的疾病治疗方法主要是静脉输液,它也是抢救危重病人的主要方法。是一个快速简单,行之有效的方法。但同时也有一些负面影响,这也是临床面临的一个问题。1静脉输注液体温度偏低引发的问题输入药物温度偏低引发的问题:身体发冷、寒战、麻木甚至疼痛;四肢发绀;易产生气泡,微小晶粒或沉淀;造成过滤器堵塞;进入人体后产生不良刺激。有关资料显示,短期输注1个单位冷凝血或1L室温晶体液可使机体平均体温下降0.25℃,低体温可导致凝血机制障碍,伤口愈合时间延迟,感染几率增加住院时间增加,药物代谢减慢及严重的心肺疾患。引发一些并…