影像诊断结构化报告的临床应用优势

目的:观察基于医学影像存储与传输系统的放射结构化诊断报告系统的应用效果。方法:实验于2006-03/04在广东省第二人民医院进行。①选择高、中、初级职称的影像诊断医师各3名,均有3年以上应用计算机处理影像诊断报告的经历,按高、中、初级职称配搭方式,将上述9名影像诊断医师随机分为A,B,C3个组,随机选择诊断报告方式,A组为人工书写;B组为计算机报告录入系统;C组为结构化报告系统。②选择正常头颅(共90份)和肝脏病变(63份)CT扫描片,由以上3组分别应用各自的方式进行诊断报告,记录各组每位医师完成的时间。③将上述报告归档后,随机选择50份,由1名初级职称医师按CT号或姓名分别在以上3组中查询已经归档的相应CT资料,记录各次的时间。④应用PEMS 3.1 for windows软件包进行统计处理。结果:①正常头部报告及肝脏病变报告完成时间统计显示3组之间差异均有显著性(正常头部报告:H=238.8196,Hc=238.8356,χ2=238.8356,V=2,P=0.0000;肝癌报告:H=144.7569,Hc=144.7685,χ2=144.7685,V=2,P=0.0000),其中结构化报告组最短,手写报告组最长。②不同职称人员在报告完成时间上差异并无显著性(正常报告:F=0.0413,P=0.9596;异常报告:F=0.0073,P=0.9927)。③归档报告查询时间上3组之间差异均有显著性(H=125.1017,Hc=125.1396,χ2=125.1396,V=2,P=0.0000),以结构化查询时间最短,人工查询报告时间最长。结论:结构化报告缩短报告时间与周期,提高了影像诊断工作效率。     

Effects of solvent dehydration on creep resistance of poly(vinyl alcohol) hydrogel

As a synthetic replacement material for osteochondral defect repair, poly(vinyl alcohol) (PVA) hydrogels offer a great potential due to their high water content and strong mechanical integrity. To survive the high stress environment in the joint space, high creep resistance becomes one of the key requirements for hydrogel implants. We hypothesized that reducing the equilibrium water content (EWC) of hydrogels would improve their creep resistance. We investigated the effect of dehydration of PVA theta-gels in various solvent/solution media followed by rehydration in saline solution. Decreasing EWC increased the creep resistance of PVA theta-gels. The most effective medium was isopropyl alcohol for reducing the EWC and increasing the creep resistance of PVA theta-gels.     

Phase I,multicenter, open‐label,dose‐escalation study of sonidegib in Asian patients with advanced solid tumors

Sonidegib is a selective inhibitor of Smoothened receptor, which is a key regulator of the Hedgehog signaling pathway. The purpose of this study was to determine the maximum tolerated dose based on dose‐limiting toxicity (DLT) and the recommended dose (RD) of sonidegib in Asian patients with advanced solid tumors. This was an open‐label, single‐arm, multicenter, two‐group, parallel, dose‐escalation, phase I study undertaken in Asian patients; group 1 included patients from Japan and group 2 included patients from Hong Kong and Taiwan. Dose escalation was guided by a Bayesian logistic regression model dependent on DLTs in cycle 1 and other safety findings. A total of 45 adult Asian patients with confirmed advanced solid tumors were enrolled. Group 1 included 21 patients (12 treated with 400 mg q.d. [once daily] and 9 treated with 600 mg q.d.) and group 2 included 24 patients (12 treated with 400 mg q.d., 8 treated with 600 mg q.d., and 4 treated with 800 mg q.d.). Elevation in creatine kinase was the DLT in both groups. The most common adverse events suspected to be related to sonidegib in both patient groups were increase in creatine kinase levels, myalgia, fatigue, and abnormal hepatic function. The RD of 400 mg q.d. was defined in both groups. Difference in tolerability was noted between the East Asian patients and Western population. The RD in East Asian patients (400 mg q.d.) was lower than in patients from Europe and the USA (800 mg q.d. and 250 mg twice daily). (Registered with Clinicaltrials.gov : NCT01208831.)     

碱性成纤维细胞生长因子对环磷酰胺致小鼠睾丸损伤修复的促进作用

目的:观察碱性成纤维细胞生长因子对环磷酰胺致小鼠睾丸损伤的促修复作用。方法:实验于2004-10-01/2005-01-05在泰山医学院形态学实验室完成。选用清洁级昆明种雄性小白鼠50只。以随机数字表法分为5组,即正常对照组、模型对照组、碱性成纤维细胞生长因子400,800,1200 IU/(kg·d)剂量组,每组10只。①建立环磷酰胺致睾丸损伤小鼠模型:腹腔注射5mg/(kg·d)环磷酰胺,正常对照组给予等体积的生理盐水,连续36 d。②给予碱性成纤维细胞生长因子治疗:从第37 d开始,对碱性成纤维细胞生长因子不同剂量组分别给予碱性成纤维细胞生长因子400,800,1200 IU/(kg·d)腹腔注射,连续36 d,模型对照组和正常对照组给予等体积的生理盐水。③末次给药后24h,麻醉下颈椎脱臼法处死小鼠,剥离双侧附睾尾,剪碎,过滤,制精子悬液。400倍光镜观察,检测精子数量、存活率、畸形率、精子活动力。睾丸组织行电镜、光镜观察。SP法检测睾丸组织增殖细胞核抗原的表达。结果:进入结果分析小鼠50只。①碱性成纤维细胞生长因子400,800,1200 IU/(kg·d)剂量组精子数量、存活率、活动力均高于模型对照组,差异有非常显著性意义(P<0.01);精子畸形率低于模型对照组,差异有显著性意义(P<0.01);且上述指标碱性成纤维细胞生长因子800,1200 IU/(kg·d)剂量组与正常对照组比较差异无统计学意义[(65.37±1.39)×108/g,(7.03±1.94)%,(90.90±2.16)%,(80.95±1.96)%,P>0.05]。②碱性成纤维细胞生长因子400,800,1200 IU/(kg·d)剂量组睾丸组织结构、超微结构均较模型对照组有明显恢复,其中碱性成纤维细胞生长因子800,1200 IU/(kg·d)剂量组曲细精管管腔大小一致,结构规则,生精上皮层次增多,排列整齐,管腔内有较多精子,基本恢复正常。③碱性成纤维细胞生长因子400,800,1200 IU/(kg·d)剂量组增殖细胞核抗原阳性细胞数高于模型对照组[(35.9±6.2),(71.1±9.22),(71.3±10.4),(20.4±6.36)个,P<0.01],且800,1200 IU/(kg·d)剂量组与正常对照组相比,差异无统计学意义(P>0.05)。结论:碱性成纤维细胞生长因子对环磷酰胺致睾丸损伤有明显的促修复作用,可能与外源性碱性成纤维细胞生长因子促进生精细胞的分裂增殖等机制有关。     

Treating paracetamol overdose by charcoal haemoperfusion and long-hours high-flux dialysis

After serious paracetamol overdose, charcoal haemoperfusion was used to remove paracetamol from the circulation, aiming to reduce the severity of subsequent hepatic damage. Daily long-hours high-flux dialysis was given to patients with grade III-IV hepatic encephalopathy, and also to those at risk of developing encephalopathy. We reviewed patients treated in this manner who had not received N-acetylcysteine within the first 15 h after overdose. From January 1983 to January 1993, 73 patients with serious paracetamol overdose were seen, of whom 51 received charcoal haemoperfusion and/or high-flux dialysis. Patients who were admitted within the first 42 h after overdose and who received haemoperfusion and/or dialysis had significantly lower peak levels of prothrombin time, bilirubin and creatinine than those who were admitted after 42 h. Mortality was also lower amongst patients admitted before 42 h, at 2/18 (11%) vs. 15/33 (45%), <it>p</it> &lt; 0.05.      

Immunohematologic complications of ABO-unmatched liver transplants

Transplantation of ABO-unmatched livers has been associated with the development of donor-derived antibody (DDAb) and hemolysis. Nine (22%) of 41 consecutive patients undergoing liver transplantation at our institution received 10 ABO-unmatched livers. Five (56%) of nine patients developed DDAbs and hemolysis. All five patients were group A1 and received group O livers. DDAbs appeared a mean of 9.2 +/- 2.8 (1 SD) days after surgery and persisted for 15.2 +/- 10.3 days. All patients with DDAbs developed hemolysis. During the period when DDAbs were demonstrable, the hemoglobin dropped by a mean of 4.8 g per dL (48 g/L), and the patients were transfused with a mean of 7.8 +/- 2.3 units of group O red cells. One patient with hemolysis underwent exchange transfusion for acute renal failure. Patients with hemolysis required significantly more red cells postoperatively (15.0 vs. 6.9 units, p = 0.04) than did ABO-matched patients. None of the parameters examined (age, recipient or donor gender, secretor status, rejection, or donor isoagglutinin titers) were predictive of DDAb or hemolysis, although hemolysis occurred in three of four cases in which donor serum IgG anti-A titers were > or = 128, as opposed to one of four cases in which titers were < 128. Because recipients of ABO-unmatched livers are at high risk for transiently developing DDAb and hemolysis with associated morbidity, the prophylactic use of donor-type red cells for surgery and after operation is justified.     

Combination of resveratrol‐containing collagen with adipose stem cells for craniofacial tissue‐engineering applications

Repair and regeneration of craniofacial tissues is particularly challenging because they comprise a complex structure of hard and soft tissues involved in intricate functions. This study combined collagen scaffolds and human adipose stem cells (hASCs) for oral mucosal and calvarial bone regeneration by using resveratrol (RSV), which affects the differentiation of mesenchymal stem cells. We have evaluated the effect of collagen scaffold‐containing RSV (collagen/RSV) scaffolds both in vitro and in vivo for their wound healing and bone regeneration potential. Scanning electron microscopy and immunostaining results reveal that hASCs adhere well to and proliferate on both collagen scaffolds and collagen/RSV scaffolds. Oral mucosal lesion experiments demonstrated that the collagen/RSV scaffold is more effective in wound closure and contraction than the collagen scaffold. The micro‐computed tomography (μCT) images of calvarial bone display regenerating bone in defects covered with hASCs on collagen/RSV scaffolds that are more visible than that in defects covered with hASCs on a collagen scaffolds. RSV was more effective at inducing hASC differentiation on the collagen scaffold, suggesting that collagen/RSV scaffolds can provide useful biological cues that stimulate craniofacial tissue formation.     

Prevalence and implication of TT virus infection: minimal role in patients with non-A-E hepatitis in Taiwan.

TT virus (TTV) is a newly identified human DNA virus and little is known about its clinical significance. The aim of the study was to explore the prevalence of TTV infection in different risk populations and in patients with various liver diseases. Viral DNA was studied in 190 high-risk individuals, 97 household contacts, 52 patients with acute hepatitis A, 32 patients with non-A-E hepatitis including 13 fulminant hepatitis, 200 asymptomatic hepatitis B surface antigen (HBsAg) carriers, 100 patients with chronic hepatitis C, and 100 healthy adults. TTV infection was more frequent in high-risk groups (26-70%), patients with acute or fulminant non-A-E hepatitis (42-45%), and hepatitis C carriers (36%) than in healthy adults (10%) and hepatitis B carriers (15%). However, most of subjects with TTV infection alone had no or only mild hepatitis, and the same rate of TTV DNA in pre-hepatitis serum samples and constant serum TTV titers during hepatitis episodes were observed in two patients with acute non-A-E hepatitis. Phylogenetic analysis of the Taiwanese TTV isolates showed genetic heterogeneity and most (68%) isolates were TTV type 1. No particular strain was found to be associated with fulminant non-A-E hepatitis.