原发性胸腺癌15例外科治疗分析

目的：分析原发性胸腺癌临床特征和外科治疗。方法：对15例手术治疗并经病理证实的原发性胸腺癌患者的临床资料进行回顾性分析，讨论该病的诊断及治疗。结果：患者年龄19～70岁，平均52．8岁。大多具有临床症状，6例有咳嗽咳痰，4例有胸闷或胸部隐痛。X线和CT显示前纵隔内肿块影，术前能确诊仅8例(53．3％)。行手术切除11例，术后平均生存时间23．6个月，1年生存率为40．0％，3年生存率为13．3％，5年生存率为0，有2例复发，8例转移。结论：原发性胸腺癌是一种高度恶性肿瘤，术前确诊率较低，应早期采用外科手术治疗，预后不良。     

Case Report of Rapid-eye-movement(REM) sleep behavior disorder

Summary

A 23-year-old female student presented with a five-year history of abnormal sleep in which she would sit up or stand up for brief periods in the early morning, talk loudly for a couple of minutes and then lie back down. When woken by family members she would remember vivid dreams and nightmares. In one episode she had a fall that resulted in a subdural hematoma. On presentation at the psychiatric hospital she had a normal mental status exam except for being mildly depressed and anxious about the chronic fatigue from poor sleep. Overnight polysomnography (PSG) showed multiple waking periods each night, poor sleep efficiency and a lack of normal muscle paralysis during REM sleep. The patient was diagnosed with REM Sleep Behavior Disorder and treated with 1 mg clonazepam nightly. Her sleep improved dramatically and remained better at a six-month follow-up, but repeat PSG exam found that the lack of muscle paralysis during REM sleep remained.     

Clinical features and management of intracranial subependymomas in children

Subependymoma is a rare low-grade glioma of the central nervous system that occurs most commonly in middle-aged and elderly men and rarely in children. Only a few paediatric patients with subependymomas have been reported. The authors retrospectively analysed five paediatric patients (4 males and 1 female; mean age 8.6 years; age range 5–13 years) at a single institute from July 1998 to April 2009 and summarised the clinical characteristics and management of paediatric intracranial subependymoma. The most common symptom in these five paediatric patients with subependymoma was intracranial hypertension. The tumours were located in the fourth ventricle in two patients, in the fourth ventricle with extension to the cerebellopontine angle (CPA) in one patient; in the right CPA exclusively in one patient, and intraparenchymally in the left parietal lobe in one patient, the latter two of which are rare locations for subependymoma. Surgery was performed on all five patients. The surgical approach was selected as appropriate for the tumor location. Total resection was achieved in three patients, and subtotal resection in two. All five patients had good outcomes without recurrence. We conclude that surgery is the optimal therapy for paediatric patients with intracranial subependymoma.     

新生儿缺氧缺血性脑病合并多器官损害临床分析

【目的】了解缺氧缺血性脑病 (HIE)新生儿心、肝、肾功能及钙、镁、血糖水平的变化状况。【方法】应用日立 7170A全自动生化分析仪对HIE患儿及无窒息新生儿于出生后 3d内所采血样的心肌酶谱、肝功能、尿素氮、钙、镁、血糖进行检测 ,同时检查尿常规。【结果】HIE组患儿心肌酶、肝酶、血总胆红素水平均明显高于对照组 (P <0 .0 5 ) ;HIE组血钙、镁低于对照组 (P <0 .0 1) ;HIE组肾损害发生率、高血糖发生率均高于对照组 (P <0 .0 5 )。【结论】HIE同时可并发多器官功能损害 ,在治疗脑损伤的同时 ,应对其它各器官功能密切监测并加以保护。     

强迫症的临床特征及其与人格障碍的共病情况分析

目的:分析强迫症患者的临床特征及其与人格障碍的共病情况。方法:调查强迫症的临床特征,并采用SCID鄄Ⅱ对115例强迫症和100名健康对照者进行人格障碍的评估。结果:多数强迫症患者于25岁之前发病,男性患者的发病明显早于女性(t=2.35,P=0.02),男性患者的强迫动作分量表评分低于女性(t=2.08,P<0.05);强迫症患者中人格障碍的发生率为71.3%,明显高于对照组的7.0%,差异有非常显著性(P<0.01);强迫症患者中有8种人格障碍的发生率显著高于对照组,其中最常见的类型为强迫型(54.8%)、回避型(32.2%)和偏执型(21.7%);聚类分析显示强迫型人格障碍同强迫症存在密切关系。结论:强迫症多起病于25岁之前,不同性别患者的临床特征存在差异;强迫症与人格障碍的共病是一种常见现象,强迫型人格障碍与强迫症存在密切关系,今后在强迫症的临床诊断与治疗以及生物学研究中应考虑人格特质与人格障碍的影响。     

Correlation Analysis of Linear Viscoelastic (LVE) Properties,Damage Resistance and Microstructure of Unmodified Asphalt Binders with the Same Penetration Grade

The penetration grade system is still widely adopted for selecting asphalt binder with desired paving performance. However, the initial material compositions of asphalt binder with the same penetration level are still different, and vary with the crude oil source and essentially result in different rheological performance. This study aimed to assess the linear viscoelastic (LVE) properties, and high- and intermediate-temperature and microscale characteristics of seven unmodified asphalt binders from different sources and countries with the same penetration level of 70. The LVE parameters were firstly evaluated followed by comparisons to various damage-based indexes. The microstructure of asphalt binders was further investigated followed by correlations between morphology and performance parameters. Experimental results indicate the |G*|/sin δ is well related to the MSCR-based non-recoverable creep compliance; furthermore, the R and |G*|·sin δ can generally represent the LAS-based failure strain and fatigue life, respectively. The viscoelastic nature of tested binders was clearly distinguished and related to rheological performance by atomic force microscopy (AFM). The roughness parameters and the phases’ content derived from AFM images showed significant correlations with LVE characteristics and fatigue resistance nature, respectively. This research provides theoretical foundations for further investigating the rheological performance and microstructure characteristics, and their correlations with asphalt binders.     

Profile Change Law of Clad Rebars and the Formation Mechanism of Composite Interfaces during Hot Rolling

Rough- and intermediate-rolled composite billets and finished clad rebars were cut using flying shears. The law of metal rheology and the mechanism of composite interface generation during clad rebar formation were then investigated using metallographic microscopy, electron backscatter diffraction, and scanning electron microscopy. The radial deformation trend of the clad rebars was greater than that of HRB400 rebars and “ears” were more likely to appear during the rolling process. The widths of the decarburization and composite zones and diffusion distances of each element decreased as the cumulative reduction rate increased. Furthermore, as deformation increased, the number of oxides on the composite interface significantly decreased, the proportion of recrystallized grains increased, and the grains became more refined. These changes led to increases in the bond and tensile strengths of the composite interface. According to the research above, the pass filling degree should be within 0.85–0.9 and the cumulative reduction rate should be over 80% when rolling clad rebars.     

Evaluation of Thermophysical and Mechanical Properties of Sandstone Due to High-Temperature

In this study, thermophysical and mechanical tests were conducted on sandstone samples from room temperature to 1000 °C. Based on the test results, the thermophysical properties (such as specific heat capacity, thermal conductivity, and thermal expansion coefficient) of sandstone after high-temperature treatment and the variations of mechanical properties (including peak strength, peak strain, elastic modulus, and whole stress-strain curve) with temperature were analyzed. Indeed, the deterioration law of sandstone after high-temperature treatment was also explored with the aid of a scanning electron microscope (SEM). The results show that with the increase in temperature, the specific heat capacity and thermal expansion coefficient of sandstone samples after high-temperature treatment increase first and then decrease, while the thermal conductivity gradually decreases. The range from room temperature to 1000 °C witnesses the following changes: As temperature rises, the peak strength of sandstone rises initially and falls subsequently; the elastic modulus drops; the peak strain increases at an accelerated rate. Temperature change has a significant effect on the deterioration rules of sandstone, and the increase in temperature contributes to the transition in the failure mode of sandstone from brittle failure to ductile failure. The experimental study on the thermophysical and mechanical properties of sandstone under the action of high temperature and overburden pressure has a guiding significance for the site selection and safety evaluation of UCG projects.     

Serum creatinine to absolute lymphocyte count ratio effectively risk stratifies patients who require intensive care in hospitalized patients with coronavirus disease 2019

Patients with preexisting kidney disease or acute kidney injury had poorer outcomes in coronavirus disease 2019 (COVID-19) illness. Lymphopenia was associated with more severe illness. Risk stratification with simple laboratory tests may help appropriate site patients in a cost-effective manner and ease the burden on healthcare systems. We examined a ratio of serum creatinine level to absolute lymphocyte count at presentation (creatinine-lymphocyte ratio, CLR) in predicting outcomes in hospitalized patients with COVID-19. We analyzed 553 consecutive polymerase chain reaction-positive SARS-COV-2 hospitalized patients. Patients with end-stage kidney disease were excluded. Serum creatinine and full blood count (FBC) examination were obtained within the first day of admission. We examined the utility of CLR in predicting adverse clinical outcomes (requiring intensive care, mechanical ventilation, acute kidney injury requiring renal replacement therapy or death). An optimized cutoff of CLR > 77 was derived for predicting adverse outcomes (72.2% sensitivity, and 83.9% specificity). Ninety-seven patients (17.5%) fell within this cut off. These patients were older and more likely to have chronic medical conditions. A higher proportion of these patients had adverse outcomes (13.4% vs 1.1%, P < .001). On receiver operating curve analyses, CLR predicted patients who had adverse outcomes well (area under curve [AUC] = 0.82, 95%CI 0.72–0.92), which was comparable to other laboratory tests like serum ferritin, C-reactive protein and lactate dehydrogenase. Elevated CLR on admission, which may be determined by relatively simple laboratory tests, was able to reasonably discriminate patients who had experienced adverse outcomes during their hospital stay. This may be a simple and cost-effective means of risk stratification and triage.