以框架为基础的教学／自学模式实施效果的初步评估

北京协和医学院医学微生物教学中,采用以框架为基础的教学／自学模式,82名学生参与其中。本文对以框架为基础的教学／自学模式在微生物学教学中的实施效果进行了评估,主要从8个方面评估了学生组织自学后的自我展示情况,同时学生也从10个方面对该教学／自学模式的实施效果进行了匿名评估。结果显示,学生自我展示情况各项得分（满分为5分）为（4．30±0．33）分～（4．66±0．21）分;学生匿名评估的各项得分（满分为4分）为（3．13±0．75）分～（2．33±0．79）分。实践证明,学生在以框架为基础的自学训练中表现良好,大部分学生对此教学／自学模式持正面和积极的看法,此教学／自学模式比较适用于现阶段本学院的医学微生物学教学。     

Stage cT3 low rectal cancer: analysis of prognostic factors

BackgroundWhether all cT3 low rectal cancer patients should receive neoadjuvant chemoradiotherapy (nCRT) remains controversial. The depth of invasion beyond the muscularis propria of the cT3 rectal cancer is of great significance to the selection of a treatment plan and the evaluation of prognosis.MethodsA retrospective analysis was conducted of 187 patients with stage cT3 low rectal cancer, who had been treated at the Department of Colorectal Surgery, The First Affiliated Hospital of Xiamen University from June 2010 to December 2012. The patients were divided into the nCRT group (88 cases) and no-nCRT group (99 cases). Possible significant prognostic factors [i.e., primary tumor volume (PTV), cell differentiation, circumferential resection margin (CRM), nCRT, age, sex, carcinoembryonic antigen (CEA), lymph node status, surgical procedure, etc.] were collected for estimation of disease-free survival (DFS), distant metastases rate (DM), local recurrence rate (LR). Independent predictive factors or survival were determined using Cox proportional hazards model.ResultsThe mean PTV was 16.2±11.1 (2.07–72.68) cm³. In the univariate and multivariate analyses: nCRT hazards ratio (HR) =4.258, 95% confidence interval (CI): 1.912–9.483 (P<0.001); PTV HR =0.381, 95% CI: 0.181–0.804 (P=0.011); CRM HR =0.227, 95% CI: 0.097–0.532 (P=0.001). For the PTV ≤15 cm³ group, there were no significant differences between the nCRT and no-nCRT group in 3-year follow-up (P>0.05). For the PTV >15 cm³ group, there were significant differences between the nCRT and no-nCRT group in 3-year DFS (84.2% vs. 51.1%; P=0.001), DM (13.1% vs. 31.2%; P=0.017) and LR (2.9% vs. 26.6%; P=0.009). For the CRM negative group, there were significant differences between the nCRT and no-nCRT group in 3-year DFS (94.0% vs. 79.0%; P=0.008), LR (1.5% vs. 10.7%; P=0.028) and DM (4.5% vs. 13.5%; P=0.039).ConclusionsFor stage cT3 low rectal cancer patients, nCRT, PTV, and CRM were independent prognostic factors. NCRT may improve the survival of PTV >15 cm³ patients, but may not have a significant effect on patient with PTV ≤15 cm³ and CRM negative. Direct surgery is recommended for this group of patients.     

Meta-analysis of human lung cancer microRNA expression profiling studies comparing cancer tissues with normal tissues

ABSTRACT: BACKGROUND: Lung cancer is the major cause of cancer death globally, it is often diagnosed at an advanced stage and has one of the lowest survival rates of any type of cancer. The common interest in the field of lung cancer research is the identification of biomarkers for early diagnosis and accurate prognosis. There is increasing evidence to suggest that microRNAs play important and complex roles in lung cancer. METHODS: A meta-analysis was conducted to review the published microRNA expression profiling studies that compared the microRNAs expression profiles in lung cancer tissues with those in normal lung tissues. A vote-counting strategy that considers the total number of studies reporting its differential expression, the total number of tissue samples used in the studies and the average fold change was employed. RESULTS: A total of 184 differentially expressed microRNAs were reported in the fourteen microRNA expression profiling studies that compared lung cancer tissues with normal tissues, with 61 microRNAs were reported in at least two studies. In the panel of consistently reported up-regulated microRNAs, miR-210 was reported in nine studies and miR-21 was reported in seven studies. In the consistently reported down-regulated microRNAs, miR-126 was reported in ten studies and miR-30a was reported in eight studies. Four up-regulated microRNAs (miR-210, miR-21. miR-31 and miR-182) and two down-regulated mcroiRNAs (miR-126 and miR-145) were consistently reported both in squamous carcinoma and adenocarcinoma-based subgroup analysis, with the other 14 microRNAs solely reported in one or the other subset. CONCLUSIONS: In conclusion, the top two most consistently reported up-regulated microRNAs were miR-210 and miR-21. The results of this meta-analysis of human lung cancer microRNA expression profiling studies might provide some clues of the potential biomarkers in lung cancer. Further mechanistic and external validation studies are needed for their clinical significance and role in the development of lung cancer.     

Clinical features of 434 patients with Ota's nevus: a retrospective analysis

目的 描述重庆及周边地区太田痣患者发病特征及变化规律.方法 收集第三军医大学西南医院整形美容科2006年1月至2011年1月临床确诊的太田痣患者434例(男性74例,女性360例;平均年龄24岁),对患者性别、年龄、发病年龄、发病时间、皮损颜色、分布及面积等情况进行统计学分析.结果 受调查患者男女比例为1∶4.86,后天患病者比例约为54.61％.后天患病者中,男性发病高峰出现在儿童早期(3～5岁),女性发病的两个高峰分别是5岁以前、10～14岁.近年来后天患者比例明显升高,病程长的患者黑色皮损比例较高.结论 重庆及周边地区近年太田痣的先后天发病比例随患病时间推移出现变化,皮损颜色与病程长短有关.     

The prevalence of Type 2 Diabetes Mellitus in the United Arab Emirates: justification for the establishment of the Emirates Family Registry

To study the prevalence of Type 2 Diabetes Mellitus (T2DM) in a population of United Arab Emirates (UAE) residents through the creation of the ??Emirates Family Registry?? (EFR). Major hospitals and diabetes centres in the UAE were contacted to establish a bio-banking facility referred to as the EFR. Through assistance made available by the Ministry of Health and collaborators of this network, demographic data of T2DM patients were collected and collated in a database for analysis and longitudinal studies. Clinical specimens were collected for biochemical profiling (such as; glucose, lipids, HbA_1c levels). In the first 24?months of the operation the EFR recruited 23,064 adult volunteers from three major hospitals and nine primary care centres throughout the UAE. Within this cohort, 88% were patients classified as T2DM patients from the medical records. The cohort was divided into age categories with 59% of T2DM patients aged between 40 and 59?years old. UAE nationals comprised 30% of the database of which 21% were diagnosed with T2DM. However the percentage of adults with T2DM was higher in other ethnic groups effecting almost 33% of the Indians who live in the UAE. A total of 741 UAE Nationals consented to donate blood; in phase I of the study; for biochemical testing after which 23% were diagnosed with T2DM, 30% with pre-T2DM and 47% were healthy. This study is consistent with the previously reported high prevalence of T2DM in the UAE. Furthermore, analyses of the factors that predispose to the disease have revealed that obesity, a large waist circumference, consanguineous marriage, family history, lack of physical activity, unhealthy dietary practices, high total cholesterol, and high triglycerides levels were more prevalent in T2DM patients. The classification of these features will contribute to defining more effective and specific plans to screen for and manage diabetes and its complications in UAE and other developing countries.     

iTrace和Pentacam及LOCSⅢ参数在晶状体混浊程度评估中的相关性

目的：分析iTrace视功能分析仪和Pentacam三维眼前节分析系统及晶状体混浊分级系统Ⅲ(LOCSⅢ)在年龄相关性白内障(ARC)患者晶状体混浊评估中的相关性。

方法：前瞻性横断面研究。纳入2021-05/08本院眼科的ARC患者104例104眼。裂隙灯行LOCSⅢ分级; iTrace获取晶状体混浊地形图分级(OMG)和晶状体功能失调指数(DLI); Pentacam获取核分级(PNS)和Scheimpflug图像,ImageJ测量Scheimpflug图像各区域的累积光密度(IntDen)。SPSS 26.0分析参数正态性和相关性。

结果：各参数除3mm范围IntDen和6mm范围后囊区IntDen外均正态分布。PNS与NC、NO均正相关(r=0.521、0.440,均P<0.01)。3mm范围IntDen与NC、NO均正相关(r_s=0.459、0.450,均P<0.01)。3mm范围核区IntDen与NC、NO均正相关(r=0.539、0.543,均P<0.01)。3mm范围后囊区IntDen与NC、NO均负相关(r=-0.315、-0.321,均P<0.01)。6mm范围IntDen与NC、NO均正相关(r=0.321、0.288,均P<0.01)。3mm范围DLI与NC、NO、PSC均负相关(r=-0.257、-0.234、-0.282,均P<0.01)。6mm DLI与NC、NO、PSC均负相关(r=-0.247、-0.304、-0.227,均P<0.05)。3mm范围OMG与CC、PSC均正相关(r=0.268、0.333,均P<0.01)。6mm范围OMG与CC、PSC均正相关(r=0.275、0.245,均P<0.05)。3mm范围DLI与PNS、3mm范围核区IntDen均负相关(r=-0.217、-0.197,均P<0.05)。

结论：三种晶状体混浊评价系统各有优势,将各参数结合可更客观地评价晶状体各区混浊,为临床提供参考。     

新型单侧骨外固定器的设计与临床应用

目的 介绍新型单侧骨外固定器的设计与应用。方法 根据力学观点设计,采用铝合金和不锈钢制作,并进行力学测试和临床应用。结果 各种力学性能测试达到临床使用要求;临床应用８６例,随访８２例,全部愈合。结论新型单侧骨外固定器可治疗各种长骨和股骨颈部骨折,能方便准确地对骨折端进行复位固定。固定牢靠,对骨折端有加压和延长作用,术后调整容易,便于应用。     

胃平滑肌瘤和平滑肌肉瘤的CT诊断

目的：提高胃平滑肌类肿瘤的ＣＴ诊断水平。材料和方法：对经胃肠造影、超声、内窥镜和ＣＴ检查，并经手术证实的２５例胃平滑肌瘤和平滑肌肉瘤进行回顾性对比分析。结果：胃肠造影、胃镜能多体位动态观察胃腔内肿瘤的形态、表面情况。ＣＴ图像可显示完整的胃壁外和胃腔内肿瘤的状态、大小，与邻近脏器有无压迫、浸及，有无胃周围及腹膜后淋巴结和肝脏转移等。结论：以下情况应进行ＣＴ检查：对于胃壁外生长型肿瘤；超声对于５ｃｍ以上肿瘤，容易误诊为肝或脾脏肿瘤者；胃镜显示胃壁受压，提示胃壁外肿瘤者     

Skeletal muscle evaluation by MRI in a rabbit model of acute ischaemia

Objective:

To assess rhabdomyolysis-associated skeletal muscle changes induced by complete ischaemia in rabbits using MRI.

Methods:

Acute ischaemia was induced in the right hind limb of 34 New Zealand white rabbits by arterial ligation. MRI of vastus lateralis was carried out pre-operatively and every hour post-operatively up to 7 h. T₁ weighted images, T₂ weighted images with fat suppression, T₂ maps and diffusion tensor scans were obtained. The correlation of MRI findings with histopathological changes in biopsies of vastus lateralis was examined.

Results:

Histopathology demonstrated early cellular oedema 1 h post ischaemia and irreversible injuries by 7 h, including loss of striation and broken muscle fibres. T₂ weighted images with fat suppression showed inhomogeneous high signal intensity of vastus lateralis, which progressively increased from 2 h following ischaemia. The T₂ relaxation rate of ischaemic vastus lateralis was significantly greater than normal muscle (p<0.001) and demonstrated a linear increase with time following ischaemia. A similar linear increase was also found in the ischaemic vastus lateralis apparent diffusion coefficient (ADC) 1–5 h post ischaemia (p=0.006). Both the T₂ ADC and fractional anisotropy (FA) were significantly higher on the ischaemic side 7 h post ischaemia (for T₂, p=0.02; for ADC, p=0.004).

Conclusion:

Muscle oedema is detectable on MR images and is reflected well by T₂, ADC and FA values. MRI may have value in clinical evaluation of rhabdomyolysis.

Advances in knowledge:

Ischaemic changes detected by MRI may have value in the diagnosis of rhabdomyolysis.Rhabdomyolysis is a syndrome of skeletal muscle breakdown characterised by myonecrosis and subsequent leakage of intracellular contents into the circulation. The most common causes include muscle injury, excessive exercise, drug and alcohol abuse, muscle ischaemia, heat stroke, toxins and infections [1]. Definitive diagnosis of rhabdomyolysis is predominately based on laboratory findings, which include an elevated level of serum creatine kinase (CK) and myoglobin as well as the presence of urinary myoglobin. Immediate and aggressive interventions are critical in clinical management of rhabdomyolysis; by preventing complications, such as hyperkalaemia and acute renal failure, the prognosis can be significantly improved [2].Clinical manifestations of rhabdomyolysis vary extensively from asymptomatic to life threatening. Also, the aetiology remains elusive particularly in the early phase, posing a challenge to identify the underlying causes. Although elevation of the serum CK level is the most sensitive indicator of muscle injury, levels peak rather early and decrease rapidly after injury. When a patient is not admitted immediately, recognition and evaluation of rhabdomyolysis may become difficult. Reports suggest that over one-quarter of patients with rhabdomyolysis are not clinically diagnosed [3,4].MRI plays an important role in the detection of skeletal muscle lesions that change muscle size, shape or signal intensity [5,6]. Review of medical records has shown that MR images can be used to effectively localise muscle lesions in rhabdomyolysis and assess extent [4,7–12]. MRI has been shown to be more sensitive for detection of rhabdomyolysis skeletal muscle lesions than ultrasonography and CT [8]. It has also been reported that MR findings in rhabdomyolysis patients correlate well with clinical symptoms and can help distinguish aetiologies [9]. Nevertheless, prospective studies of MRI for rhabdomyolysis and histopathological correlation of imaging findings remain scarce.In this study, we describe MRI of skeletal muscle changes in a modified rabbit hind limb model of complete ischaemia and correlate findings with histopathological features of the affected muscle.     

颈前肌群胸骨端离断入路在双侧巨大甲状腺肿物切除术中的应用

目的探讨胸骨端离断颈前肌群翻转固定在双侧巨大甲状腺肿物切除术中的应用优势。方法采用胸骨端离断颈前肌群翻转固定法完成甲状腺手术53例(观察组),采用颈白线切口行甲状腺手术44例(对照组),手术均由同一组医师完成。分别对2组患者的手术时间、手术野显露效果、术中出血量、术后并发症及术后引流量进行比较。结果 2组患者在性别、年龄、疾病构成以及肿瘤大小方面的差异均无统计学意义(P>0.05)。观察组的手术时间、术中出血量及术后引流量短(少)于对照组(P<0.01),术后并发症发生率低于对照组(P=0.04);手术野暴露效果优于对照组(P<0.01)。结论经胸骨端入路行双侧巨大甲状腺手术是可行的,手术操作简便,手术野显露优于颈白线切口,术后并发症少,值得临床推广。