螺旋CT在腕舟骨骨折诊断中的临床价值

目的探讨螺旋CT(SCT)在腕舟骨骨折诊断中的临床应用价值。方法 60例早期腕舟骨骨折患者经腕关节常规X线检查后,采用SCT进行腕关节的螺旋扫描,并在工作站上作多平面重建(MPR)及表面遮盖显示(SSD)影像后处理。60例舟骨骨折病例均按Herbert分型,并对X线平片与螺旋CT影像进行比较及综合分析。结果 60例舟骨骨折病例中,A1型4例(6.6%),A2型5例(8.3%),B1型2例(3.3%),B2型29例(48.3%),B3型15例(25%),B4型5例(8.3%),X线平片漏诊12例,此12例X线平片漏诊的骨折均经螺旋CT确诊。结论螺旋CT能够明确腕舟骨骨折的诊断,多能清晰显示X线平片难以诊断的腕舟骨隐匿性骨折;SSD和MPR成像技术能立体直观观察腕舟骨的骨折线走行及移位情况,能对腕舟骨骨折作出准确的分型,从而为临床治疗方案的拟定提供重要参考。     

The epidemiology and clinical characteristics of co-infection of SARS-CoV-2 and influenza viruses in patients during COVID-19 outbreak

In this study, we performed a single-centered study of 307 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients. It was found that co-infection of SARS-CoV-2 and influenza virus was common during COVID-19 outbreak. And patients coinfected with SARS-CoV-2 and influenza B virus have a higher risk of developing poor outcomes so a detection of both viruses was recommended during COVID-19 outbreak.     

嗅鞘细胞培养上清液促进大鼠周围神经损伤后的修复与再生

文题释义：细胞培养上清：细胞在正常生理过程中会释放一些信息物质,包括可溶性因子、细胞外囊泡、蛋白质、各种RNA等,这些物质能够在细胞间通讯,乃至在多种生理过程中发挥重要作用。在细胞培养过程中,这些物质由细胞分泌至细胞培养液中。这种含有细胞分泌的活性物质并去除了细胞碎片等杂质的培养液,称为细胞培养上清。 神经再生：损伤后的神经再生是一个复杂的生理过程,受多种因素的影响和调节。神经再生过程可归纳为3个方面：受损神经近端轴突的萌芽和伸长,再生轴突的髓鞘化,再生轴突与靶器官之间突触连接的重建。神经再生分为中枢神经再生及周围神经再生。受轴突外部再生微环境的影响,中枢神经再生较外周神经再生更为困难。 背景：既往研究发现嗅鞘细胞培养上清可以促进脊髓损伤后轴突再生及功能恢复,但应用于周围神经损伤治疗方面鲜有报道。 目的：探讨嗅鞘细胞培养上清是否有助于周围神经损伤后的神经修复。 方法：分离纯化嗅鞘细胞并鉴定,制备嗅鞘细胞培养上清。在体外环境将嗅鞘细胞培养上清作用于背根神经节组织块,观察背根神经节轴突生长情况;在体内环境将嗅鞘细胞培养上清应用于大鼠坐骨神经缺损模型,观察坐骨神经轴突再生及髓鞘化情况。 结果与结论：①嗅鞘细胞纯度高达(94.4±3.1)%;②与空白对照组和低剂量嗅鞘细胞上清组对比,高剂量嗅鞘细胞上清组背根神经节组织块的5根最长神经轴突平均长度显著增加(P < 0.05);③免疫荧光显示嗅鞘细胞上清处理组与自体神经移植组类似,再生神经贯通缺损区域,并且再生神经排列有序,神经再生情况显著优于空白对照组;④透射电子显微镜观察显示嗅鞘细胞上清处理组再生神经轴突的数量和髓鞘厚度显著高于空白对照组(P < 0.05);⑤结果表明,嗅鞘细胞培养上清能够促进周围神经损伤后轴突再生及再生轴突的髓鞘化,为周围神经损伤提供了一种新的基于嗅鞘细胞的无细胞疗法。 ORCID: 0000-0002-9558-8585(杨雨洁) 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

Homocysteine,an additional factor,is linked to osteoporosis in postmenopausal women with type 2 diabetes

We explored the relationship between plasma total homocysteine concentration and osteoporosis in postmenopausal patients with type 2 diabetes. Postmenopausal patients with type 2 diabetes (n = 258) were enrolled in a cross-sectional hospital-based study. Osteoporosis was documented by dual energy X-ray absorptiometry. Plasma total homocysteine concentration was measured using fluorescence polarization immunoassay. Risk factors for osteoporosis and determinants of homocysteine were obtained from blood samples and interviewer questionnaire. We found that plasma total homocysteine levels were higher in subjects with osteoporosis and diabetes than without [(9.5 ± 2.0) vs. (10.4 ± 2.4) μmol/l, p = 0.001]. The association of homocysteine with osteoporosis was independent of possible risk factors for osteoporosis in diabetes (e.g., duration of diabetes, HbA1c, body mass index, serum 25-hydroxyvitamin D, thiazolidinediones, and retinopathy) and determinants of homocysteine concentration (age, serum folate and vitamin B12, renal status, and biguanide use) [OR 1.40 (1.02–1.90), p = 0.036]. In addition, bone mineral density was closely correlated with homocysteine as a continuous variable after adjusting for age [r = ?0.64 (?0.69 to ?0.58), p = 0.002]. Furthermore, per increase of 5.0 μmol/l, plasma homocysteine was related to osteoporosis, after controlling for per unit increase of other factors [OR 1.42 (1.07–1.96), p = 0.027]. The optimal cut-off point for the plasma homocysteine level distinguishing diabetic patients with osteoporosis from without was 10.18 μmol/l. The results suggest that plasma total homocysteine concentration is independently associated with the occurrence of osteoporosis in postmenopausal patients with type 2 diabetes. Future prospective studies are warranted to clarify the relationship.     

Transrectal Saturation Technique May Improve Cancer Detection as an Initial Prostate Biopsy Strategy in Men with Prostate-specific Antigen <10 ng/ml

Background

Using transrectal saturation prostate biopsy (SPBx) as an initial strategy remains a controversial topic.

Objective

To compare SPBx with extended prostate biopsy (EPBx) as an initial biopsy template in a large sequential cohort study.

Design, setting, and participants

We reviewed 438 men with initial SPBx and 3338 men who underwent initial EPBx between January 2002 and October 2011.

Intervention

Office-based SPBx under periprostatic local anesthesia.

Outcome measurements and statistical analysis

The yield of SPBx was compared with EPBx. Multivariable logistic regression models addressed cancer detection (CD) and cancer characteristics.

Results and limitations

Overall CD was 51.6% and 42.6% in men who underwent initial SPBx and EPBx, respectively. Multivariate analysis confirmed that SPBx was an independent predictor factor correlated with the CD (odds ratio [OR]: 1.66; 95% confidence interval [CI], 1.30–1.92). Stratified by prostate-specific antigen (PSA) values, CD was higher in SPBx compared with EPBx, 47.1% versus 32.8% (OR: 2.00; 95% CI, 1.19–3.38) in patients with a PSA <4 ng/ml and 50.9% versus 42.9% in patients with a PSA from 4 ng/ml to 9.9 ng/ml (OR: 1.62; 95% CI, 1.20–2.20). By contrast, SPBx did not increase CD in men with a PSA >10 ng/ml (60.0% vs 61%; OR: 1.42; 95% CI, 0.70–2.89). There was no significant difference in the detection of insignificant cancer (p = 0.223) or low-risk cancer (p = 0.077) between the two biopsy schemes. The limitation of our study is its retrospective nature and inhomogeneity.

Conclusions

Compared with EPBx, SPBx significantly increases CD as an initial biopsy strategy in men with a PSA <10 ng/ml without a significant increase in the detection of insignificant cancer. These findings suggest that SPBx may merit further investigation as an initial biopsy strategy in men with a PSA <10 ng/ml in hopes of avoiding repeat biopsy for missed malignancy during the initial biopsy.     

PDCA提升分子诊断自动审核通过率的效果研究

目的探讨PDCA提升分子诊断自动审核通过率的效果。方法基于PDCA思路,使用系统导出的自动审核效能数据作为现状调查数据,以此确定目标、分析原因并确定主因,然后在此基础上制订措施并实施,再次使用自动审核效能数据进行效果分析,不达标者再次进行原因分析,进入PDCA循环,目标达到者固化措施,总结并制订下一步计划。结果分子诊断自动审核通过率由31.2%提升至66.2%,报告单审核效率提升了60.0%,检测项目标本周转时间(TAT)缩短2.2 h。结论使用PDCA循环结合实验室预警效能分析能够有效推进自动审核工作,该方法亦可推广用于实验室其他方面的改进。     

观察血府逐瘀汤加减治疗中老年2型糖尿病失眠患者的临床疗效

目的:探讨血府逐瘀汤加减治疗中老年2型糖尿病失眠患者的临床疗效.方法:选取2017年1月至2019年3月福州市长乐区中医院诊治的中老年2型糖尿病失眠患者60例作为研究对象,按照随机数字表随机分为对照组和观察组,每组30例.对照组患者给予西药右佐匹克隆片+常规治疗干预,观察组患者给予血府逐瘀汤加减+常规治疗干预.比较2组患者干预后1个月睡眠状态.结果:观察组患者治疗有效率为83.3%,对照组患者治疗有效率为80.0%,比较差异无统计学意义(P>0.05);观察组患者不良反应发生率为3.3%,对照组患者不良反应发生率为36.7%,比较差异有统计学意义(P<0.05);观察组与对照组患者干预后主观睡眠时间、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能障碍及PSQI总分均优于干预前(P<0.05);2组患者干预前后主观睡眠时间、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能障碍及PSQI总分比较,差异无统计学意义(P>0.05).结论:采用血府逐瘀汤加减治疗中老年2型糖尿病失眠,能够有效改善患者的睡眠质量,改善患者生命质量.     

内镜联合部分脾动脉栓塞术治疗肝硬化合并脾功能亢进和食管胃底静脉曲张出血效果的分析研究

背景　肝硬化合并脾功能亢进和食管胃底静脉曲张出血（EGVB）患者,由于白细胞和血小板减少、凝血因子减少、凝血功能障碍、出血量大、再出血发生率高,经内镜及药物紧急治疗急性出血后,需进一步采用部分脾动脉栓塞术（PSE）治疗脾功能亢进。目的　评价内镜治疗（ET）联合PSE治疗肝硬化合并脾功能亢进和EGVB的效果。方法　选取2008年7月-2018年2月南方医科大学附属萍乡医院收治的肝硬化合并脾功能亢进和EGVB住院患者158例,根据随机数字表法将其分为ET组（78例）和ET+PSE组（80例）。ET组给予基本治疗和内镜处理,ET+PSE组给予基本治疗、内镜处理和PSE治疗。比较两组静脉曲张消失率、静脉曲张复发率及再出血率;于术前、术后4、12周检测白细胞计数、血小板计数、肝纤维化指标〔透明质酸（HA）、Ⅲ型前胶原肽（PⅢP）、层黏蛋白（LN）和Ⅳ型胶原（Ⅳ-C）〕以及门静脉直径、血流速度、血流量和脾静脉直径、血流速度、血流量;并观察并发症发生率。结果　ET组和ET+PSE组病死率比较,差异无统计学意义（P=1.000）;ET+PSE组静脉曲张消失率高于ET组,静脉曲张复发率、3个月再出血率、6个月再出血率均低于ET组（P<0.05）。治疗方法和时间对白细胞计数、血小板计数、HA、PⅢP、LN和Ⅳ-C均存在交互作用（P<0.001）;治疗方法和时间对白细胞计数、血小板计数、HA、PⅢP、LN和Ⅳ-C主效应均显著（P<0.001）。其中ET+PSE组术后4、12周白细胞计数和血小板计数均高于术前和同时间点ET组,HA、PⅢP、LN和Ⅳ-C均低于术前和同时间点ET组（P<0.05）。治疗方法和时间对门静脉直径、血流速度、血流量和脾静脉直径、血流速度、血流量均存在交互作用（P<0.001）;治疗方法和时间对门静脉直径、血流速度、血流量和脾静脉直径、血流速度、血流量主效应均显著（P<0.001）。其中ET+PSE组术后12周门静脉直径、脾静脉直径均低于术前和同时间点ET组;ET+PSE组术后4、12周门静脉血流速度和血流量、脾静脉血流速度和血流量均低于术前和同时间点ET组（P<0.05）。两组胸痛发生率比较,差异无统计学意义（P>0.05）。ET+PSE组发热、腹痛、腹腔积液发生率均高于ET组（P<0.05）。结论　ET能有效治疗肝硬化合并脾功能亢进和EGVB,PSE能进一步提高疗效。