多层螺旋CT双期增强扫描结合仿真内镜成像在膀胱癌术前分期中的诊断价值

目的 探讨多层螺旋CT双期增强扫描结合仿真内镜成像在膀胱癌术前分期中的诊断价值.方法 经纤维膀胱镜或手术病理证实为膀胱癌患者75例.对患者术前螺旋CT双期增强扫描图像和仿真内镜图像进行分析,比较多层螺旋CT分期与病理分期的准确率.结果 75例患者共发现病灶94个.螺旋CT分期:T1 26例、T2a 27例、T2b 13例、T3 12例、T4 16例;病理分期:pT1 28例、pT2a 24例、pT2b 14例、pT3 12例、pT4 16例.螺旋CT双期增强扫描诊断膀胱癌准确率为89.4%(84/94);腔内息肉样病变,仿真内镜诊断敏感性96.6%(84/87);膀胱壁无蒂隆起性病变诊断敏感性为90.9%(10/11).螺旋CT双期增强扫描结合仿真内镜诊断膀胱癌分期准确率为94.5%(91/94),当肿瘤局限于膀胱壁内(≤T2b)时,诊断准确率为91.2%(51/56);肿瘤侵犯膀胱壁外结构时(≥T3),诊断准确率达100.0%(28/28).结论 多层螺旋CT双期增强扫描结合仿真内镜成像对膀胱癌术前临床分期具有重要价值.     

FRAX在中国绝经后女性人群骨折风险预测中的适用性评价

目的评价世界卫生组织发布的骨折风险预测工具(FRAX)对中国绝经后女性人群的适用性,探索有、无股骨颈骨密度(BMD)对FRAX预测结果的影响。方法对2314名绝经后中国女性进行回顾性队列分析。采集所有入选者FRAX预测工具中所包含的各危险因素资料,将包括股骨颈BMDT值等数据输入FRAX,计算10年骨折风险。从所有危险因素数据中得出针对中国绝经后女性骨折风险预测的回归方程,将该方程得出的骨折风险值与FRAX预测值相比较。对有无BMD情况下的FRAX预测值进行比较。结果除吸烟和饮酒外,FRAX预测风险与各危险因素间均具有统计学意义,既往骨折史是最重要的危险因素。骨质疏松引起的主要骨折概率(临床性椎体、髋部、肱骨和前臂骨折)和髋部骨折的概率均随着股骨颈BMD的下降而升高。根据中国绝经后女性骨折风险预测回归方程计算的髋部骨折风险概率与FRAX预测结果一致,有无BMD情况下的FRAX预测结果差异无统计学意义。结论 FRAX可用于中国绝经后女性人群骨折风险预测,无BMD情况下的FRAX预测结果同样可靠。     

开角型青光眼静态视野黄斑光阈值的改变

目的 观察开角型青光眼患者静态视野黄斑光阈值改变，探讨测定黄斑光阈值与青光眼早期视功能损害的关系。方法 采用Dicon全自动静态阈值视野计，分别对89例开角型青光眼(早期青光眼45例，中晚期青光眼44例)和正常人40名黄斑光阈值进行测定。结果 早期青光眼患者黄斑光阈值明显高于正常对照组，中晚期患者高于早期患者，3组数据差异有统计学意义。结论 测定黄斑光阈值对于青光眼早期视功能损害的评价有一定的临床意义。     

胫骨下端恶性骨肿瘤切除后大段异体骨重建

目的应用大段异体骨移植及踝关节融合的保肢方法治疗胫骨下端恶性肿瘤和侵袭性肿瘤，并从预后、术后并发症及功能等几个方面加以评价。方法自1998年1月至2005年12月应用大段异体骨移植及踝关节融合的保肢方法治疗胫骨下端肿瘤患者11例；包括骨肉瘤8例，骨巨细胞瘤2例，软骨肉瘤1例。对骨肉瘤患者行新辅助化疗，按照Enneking分期，手术行边缘切除或广泛切除，应用大段深低温冷冻保存同种异体骨重建，钢板螺钉或带锁髓内钉固定。结果术后随访18-78个月，平均47个月。其中8例骨肉瘤患者随访28-78个月，平均50个月。11例均获得良好的骨愈合，开始出现骨愈合时间为术后3-18个月，平均8个月。无异体骨反应继发感染，无内固定失败。异体骨骨折1例，复发2例，肺转移3例，保肢率为81．8％。术后功能评定采用骨骼肌肉系统肿瘤手术治疗后重建功能评估系统（MSTS系统），评分为16～27分，平均24-3分。结论胫骨下端虽然软组织覆盖较薄，血运相对较差，但保肢术后肿瘤复发率不高，异体骨感染、不愈合、骨折率较低。固定方式以髓内固定为佳。大段异体骨移植及踝关节融合的保肢方法术后功能良好，给患者带来较大的心理安慰，是一种较好的保肢方式。     

Linkage of the MHC to familial multiple sclerosis suggests genetic heterogeneity. The Multiple Sclerosis Genetics Group

Multiple sclerosis (MS) is a demyelinating autoimmune disease of the central nervous system. While its etiology is not well understood, genetic factors are clearly involved. Until recently, most genetic studies in MS have been association studies using the case-control design testing specific candidate genes and studying only sporadic cases. The only consistently replicated finding has been an association with the HLA-DR2 allele within the major histocompatibility complex (MHC) on chromosome 6. Using the genetic linkage design, however, evidence for and against linkage of the MHC to MS has been found, fostering suggestions that sporadic and familial MS have different etiologies. Most recently, two of four genomic screens demonstrated linkage to the MHC, although specific allelic associations were not tested. Here, a dataset of 98 multiplex families was studied to test for an association to the HLA-DR2 allele in familial MS and to determine if genetic linkage to the MHC was due solely to such an association. Three highly polymorphic markers (HLA-DR, D6S273 and TNFbeta) in the MHC demonstrated strong genetic linkage (parametric lod scores of 4.60, 2.20 and 1.24, respectively) and a specific association with the HLA-DR2 allele was confirmed (TDT; P < 0.001). Stratifying the results by HLA-DR2 status showed that the linkage results were limited to families segregating HLA-DR2 alleles. These results demonstrate that genetic linkage to the MHC can be explained by the HLA-DR2 allelic association. They also indicate that sporadic and familial MS share a common genetic susceptibility. In addition, preliminary calculations suggest that the MHC explains between 17 and 62% of the genetic etiology of MS. This heterogeneity is also supported by the minority of families showing no linkage or association with loci within the MHC.      

Bile duct obstruction: radiologic evaluation of level, cause, and tumor resectability

In a prospective study of 65 patients with bile duct obstruction, various radiologic modalities were compared for their capability to demonstrate the level and cause of obstruction and to indicate accurately tumor resectability. Ultrasound (US) was performed in 65 patients, computed tomography (CT) in 51, direct cholangiography (DC) in 57, and angiography in 35. The level of obstruction was correctly indicated by US in 95% of patients and by CT in 90%, and the cause was correctly indicated by US in 88%, by CT in 63%, and by DC in 89%. In predicting tumor resectability, US was correct in 71% of patients, compared with 42% for CT, 58% for DC, and 25% for angiography. US therefore appears to be the single most useful modality in the evaluation bile duct obstruction.     

心肌桥近端冠脉狭窄程度预测模型的建立及其临床应用价值

目的:探讨基于传统logistic回归分析和机器学习方法建立心肌桥(MB)近端冠脉狭窄程度预测模型的可行性及其临床应用价值.方法:选取2019年10月-2021年5月在本院行冠状动脉CTA及侵入性冠状动脉造影(ICA)检查并确诊存在MB的152例患者作为研究对象,将患者按照7︰3随机分为训练集(107例)和验证集(45...     

多囊卵巢综合征患者中胰岛素抵抗与子宫内膜局部炎症因子及葡萄糖转运蛋白-4表达的相关性

目的 探讨子宫内膜局部炎症因子及葡萄糖转运蛋白-4(GLUT-4)在多囊卵巢综合征(PCOS)患者子宫内膜上的表达,分析PCOS患者胰岛素抵抗与子宫内膜炎症因子及GLUT-4表达的相关性。 方法 选取2018年6月至2020年7月就诊的60例PCOS患者,根据胰岛素抵抗指数(HOMA-IR)分为PCOS胰岛素抵抗组(A组,n=30)和PCOS非胰岛素抵抗组(B组,n=30);选取同期的60例非PCOS患者作为对照,分为胰岛素抵抗组(C组,n=30)和正常对照组(D组,n=30)。检测血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E₂)、睾酮(T)、泌乳素(PRL)、抗苗勒氏管激素(AMH)、空腹血糖及胰岛素水平。采用免疫组化法检测4组患者子宫内膜肿瘤坏死因子-α(TNF-α)、核因子-κB(NF-κB)p65、GLUT-4的表达。 结果 (1)4组患者间BMI、AMH、LH、T比较,差异有统计学意义(F值分别为57.35、29.54、16.77、21.20, P<0.001))。其中,与B组相比,A组患者BMI升高;与D组相比,C组患者BMI升高。与C、D组相比,A、B两组患者血清中AMH、LH升高。A组患者血清中T高于B组;(2)4组患者间子宫内膜中NF-κB p65、TNF-α及GLUT-4的表达差异均有统计学意义(F值分别为76.90、 45.13、47.75, P<0.001)。其中,与B组相比,A组患者子宫内膜中NF-κBp65、TNF-α表达升高,而GLUT-4的表达降低。与D组相比,C组患者子宫内膜中NF-κBp65、TNF-α表达升高,而GLUT-4表达降低;(3)Logistic回归分析结果显示,在PCOS及非PCOS患者中, HOMA-IR与NF-κBp65呈正相关(P<0.05),与GLUT-4呈负相关(P<0.05)。在非PCOS患者中,HOMA-IR与BMI呈正相关(P<0.05)。 结论 PCOS患者胰岛素抵抗与NF-κBp65及GLUT-4相关,可能会导致子宫内膜局部炎症因子表达增加,GLUT-4表达降低。     

鹰嘴豆豆芽降血糖功效成分纯化研究

目的研究分离纯化鹰嘴豆豆芽降血糖功效成分的工艺。方法采用聚酰胺-大孔树脂联用技术,考察了HPD100、HPD300、HPD450、HPD600、D101、D141、SA-3、FL-3等8种大孔树脂对鹰嘴豆豆芽降糖活性成分纯化的研究。结果聚酰胺与FL-3大孔树脂联用富集鹰嘴豆豆芽降糖活性成分效果最好,药材与聚酰胺比为5∶1,药材与大孔树脂比为3∶1,树脂径高比为1∶6,以4倍体积的40%乙醇洗除杂,再以70%乙醇洗脱,收集5倍体积洗脱液。富集物降糖活性成分纯度可达52%。结论聚酰胺与FL-3大孔树脂联用富集鹰嘴豆豆芽降血糖功效成分效果最佳,是理想的分离纯化介质。