151例回盲部病变临床诊治分析

目的：回顾分析回盲部病变的病因及临床特征,以提高回盲部病变诊治水平。方法：收集2011年1月至2016年12月重庆医科大学附属第一医院收治的151例回盲部病变的完整临床资料,从临床表现、病因、检查方法和诊断逐一探讨。结果：151例回盲部病变中肿瘤最多见,占58.9%,其次为克罗恩病（Crohn’s disease,CD）、肠结核（intestinal tuberculosis,ITB）、溃疡性结肠炎（ulcerative colitis,UC）、息肉,分别占14.5%、10.5%、3.9%、3.3%,其余少见病因有白塞综合征、憩室、非特异性炎症、黏液囊肿等。男80例,女71例,平均年龄（55.1±18.3）岁。病因的男女构成比差异无统计学意义（ χ2=0.079,P=0.779）。肿瘤性疾病多见于老年人（56/89,62.9%）,非肿瘤性疾病好发于青年人（30/61,49.2%）,差异有统计学意义（ χ2=24.214,P=0.000）。临床表现主要包括腹痛（112/151,74.2%）、体质量减轻（74/151,49.0%）、腹泻（61/151,40.4%）、腹部包块（45/151,29.8%）、消化道出血（41/151,27.2%）。辅助检查以纤维结肠镜加病理活检有效阳性率最高（104/131,79.4%）,腹部增强CT次之（95/133,71.4%）。非肿瘤性疾病误诊率为21.6%（11/51）,以CD和ITB的误诊居多（10/38）。结论：回盲部病变临床表现缺乏特异性,病因以肿瘤性疾病为主,纤维结肠镜加病理活检是其主要检查方法;非肿瘤性疾病易误诊,以CD和ITB多见,纤维结肠镜加病理活检及腹部增强CT等辅助检查配合诊疗随访,可有效提高临床诊治水平。     

临床特征对酒精依赖复发的影响:前瞻性队列研究

目的 探讨人口学因素和心理渴求对酒精依赖患者复发的影响。方法 采用前瞻性研究方法,选择2017年8月至2018年8月在3家精神专科医院招募符合《美国精神疾病诊断与统计手册》第4版(Diagnositic and Statistical Manual Disorder-Fourth Version, DSM-Ⅳ)酒精依赖诊断标准的住院治疗的男性患者158例,进行基线测查,并在基线后3个月进行随访,调查复饮情况。基线测查包括人口学资料、饮酒特征、临床机构酒精依赖戒断评估表(clinical institute withdrawal assessment-advanced revised, CIWA-Ar)、环境线索诱导及戒断期心理渴求视觉模拟标尺评分(visual analog scale,VAS)、密歇根酒精依赖筛查量表(Michigan alcoholism screening test, MAST)、焦虑自评量表(self-rating anxiety scale, SAS)、抑郁自评量表(self-rating depression scale, SDS)及饮酒促迫性量表(alcohol urge questionnaire, AUQ)。根据随访结果,将“复发”定义为在基线和随访之间任何时刻饮用含有乙醇的饮料,“复发时间”定义为首次饮酒距离基线的天数。是否复发和复发时间是主要结局指标,采用Cox比例风险回归模型分析影响酒精依赖复发的因素。结果酒精依赖患者3个月复发率为63.7%, 多因素Cox比例风险回归模型分析发现年龄(OR=0.975,P=0.030)及CIWA-Ar评分(OR=1.126,P=0.010)是影响酒精依赖复发的因素,两种环境下心理渴求与复饮差异无统计学意义(P > 0.05)。结论 年龄与住院期间酒精依赖戒断症状严重程度是酒精依赖复发的影响因素,其中年龄大是保护因素,戒断症状的严重程度重是危险因素,而线索诱导及戒断期心理渴求对酒精依赖患者复发的影响作用较小。     

HIV/AIDS 患者骨髓抑制与CD4+T细胞计数及HIV病毒载量相关性分析

目的 了解HIV/AIDS患者骨髓抑制与CD4⁺T细胞计数及病毒载量的关系。方法 入组53例北京佑安医院2015年1月—2017年12月收治住院的HIV/AIDS患者,观察外周血象特征、骨髓造血情况、CD4⁺T淋巴细胞计数及HIV病毒载量情况,比较不同骨髓抑制程度与CD4⁺T细胞计数、病毒载量的差异。结果 按CD4⁺T细胞计数,将53例患者分为CD4⁺T细胞>200个/μL组和CD4⁺T细胞≤200个/μL组,CD4⁺T细胞>200个/μL组16例,CD4⁺T细胞≤200个/μL组37例。CD4⁺T细胞≤200个/μL组患者外周血中红细胞计数、白细胞计数、淋巴细胞计数均明显低于CD4⁺T细胞>200个/μL组,差异有统计学意义（P<0.05）。CD4⁺T细胞≤200个/μL组中,三系减少8例,两系减少12例,一系减少9例;但在CD4⁺T细胞>200个/μL组,三系减少1例,两系减少2例,一系减少5例,两组比较差异有统计学意义（P<0.05）。按骨髓分级分0、I~Ⅱ、Ⅲ~Ⅳ级三组,HIV病毒载量中位数分别为1.60 、4.08、4.67 Log（copies/mL）,三组比较差异有统计学意义（P<0.05）。三组的CD4⁺T细胞分别为156、131、28个/μL,三组比较差异有统计学意义（P<0.05）。结论 HIV/AIDS 患者病毒载量越高,骨髓抑制现象越明显,导致血细胞减少为主的外周血血象异常。     

严重烫伤大鼠休克期淋巴循环动力学及淋巴液中肿瘤坏死因子α和白细胞介素6、8水平的变化

目的观察严重烫伤大鼠休克期淋巴管运动变化及淋巴液中肿瘤坏死因子(TNF)α、白细胞介素(IL)6 、IL-8水平的变化. 方法将36只雄性Wistar大鼠造成30%TBSAⅢ度烫伤后,随机分为补液组(18只)和未补液组(18只);另设对照组(6只,不烫伤).用放射免疫分析法检测各组大鼠淋巴液中TNF-α、IL-6、IL-8水平,利用倒置显微镜及录像系统观察大鼠伤后6、24、48 h的肠系膜淋巴管运动变化,计算淋巴管收缩频率.经乳糜池插管收集淋巴液,计算淋巴液流速并行组织学观察. 结果伤后6 h两组烫伤大鼠TNF-α、IL-6增多,24 h达高峰,此时补液组TNF-α(1.61±0.27)μg/L,IL-6(398±67)ng/L;未补液组TNF-α(1.86±0.34)μg/L,IL-6(572±97)ng/L,两组间比较差异,有统计学意义(P<0.01),且各时相点浓度均显著高于对照组(P<0.01).伤后24 h两组烫伤大鼠IL-8浓度开始升高,直至48 h升高更明显,此时补液组为(540.29±0.32)ng/L,未补液组为(863.48±0.16)ng/L,两组间比较差异有统计学意义(P<0.01),且显著高于对照组(P<0.01).两组烫伤大鼠淋巴管收缩频率较低,尤以伤后24 h为明显(P<0.01) , 淋巴液流速各时相点均升高(P<0.01) ;镜下见小肠绒毛中央乳糜管扩张. 结论严重烫伤大鼠休克期淋巴管扩张,运动频率减少,但淋巴液流速加快,淋巴液中TNF-α、IL-6、IL-8的水平升高.液体复苏能够改善淋巴循环.     

烧伤后增生性瘢痕成纤维细胞中TRAIL受体的表达及意义

目的检测肿瘤坏死斟子相关凋亡诱导配体（TRAIL）的受体住烧伤后增生期增生性瘢痕成纤维细胞上的表达，并探讨其意义。方法应用RT-PCR和流式细胞术，检测了30例处于增生期的烧伤后增牛性瘢痕成纤维细胞中TRAIL各受体的表达，并以30例正常皮肤成纤维细胞作为对照。结果RT-PCR和流式细胞术的检测结果均显示：与正常对照组相比，增生期瘢痕的成纤维细胞中步匕亡受体DR5的表达显著降低（P〈0．05），诱导受体DcR1的表达显著升高（P〈0．05），其余受体的表达住两组间差异无统计学意义。结论烧伤后增生性瘢痕的形成可能与TRAIL介导的瘢痕内成纤维细胞凋亡受阻有关。     

Is Patient-Specific Instrumentation Accurate and Necessary for Open-Wedge High Tibial Osteotomy? A Meta-Analysis

The purpose of this meta-analysis was to identify if patient-specific instrumentation (PSI) could increase the accuracy of the correction in high tibial osteotomy (HTO) and to explore the assessment indices and the necessity of using a PSI in HTO. A systematic search was carried out using online databases. A total of 466 patients were included in 11 papers that matched the inclusion criteria. To evaluate the accuracy of PSI-assisted HTO, the weight bearing line ratio (WBL%), hip-knee-ankle angle (HKA), mechanical medial proximal tibial angle (mMPTA), and posterior tibial slope angle (PTSA) were measured preoperatively and postoperatively and compared to the designed target values. Statistical analysis was performed after strict data extraction with Review Manager (version 5.4). Significant differences were detected in WBL% (MD = −36.41; 95% CI: −42.30 to −30.53; p < 0.00001), HKA (MD = −9.95; 95% CI: –11.65 to –8.25; p < 0.00001), and mMPTA (MD = –8.40; 95% CI:−10.27 to −6.53; p < 0.00001) but not in PTSA (MD = 0.34; 95% CI: −0.59 to 1.27; p = 0.47) between preoperative and postoperative measurements. There was no significant difference between the designed target values and the postoperative correction values of HKA (MD = 0.14; 95% CI: −0.19 to 0.47; p = 0.41) or mMPTA (MD = 0.11; 95% CI −0.34 to 0.55; p = 0.64). The data show that 3D-based planning of PSI for HTO is both accurate and safe. WBL%, HKA, and mMPTA were the optimal evaluation indicators of coronal plane correction. Sagittal correction is best evaluated by the PTSA. The present study reports that PSI is accurate but not necessary in typical HTO.     

Absolute myocardial flow quantification with 82Rb PET/CT: comparison of different software packages and methods

Purpose

In clinical cardiac ⁸²Rb PET, globally impaired coronary flow reserve (CFR) is a relevant marker for predicting short-term cardiovascular events. However, there are limited data on the impact of different software and methods for estimation of myocardial blood flow (MBF) and CFR. Our objective was to compare quantitative results obtained from previously validated software tools.

Methods

We retrospectively analyzed cardiac ⁸²Rb PET/CT data from 25 subjects (group 1, 62?±?11 years) with low-to-intermediate probability of coronary artery disease (CAD) and 26 patients (group 2, 57?±?10 years; P?=?0.07) with known CAD. Resting and vasodilator-stress MBF and CFR were derived using three software applications: (1) Corridor4DM (4DM) based on factor analysis (FA) and kinetic modeling, (2) 4DM based on region-of-interest (ROI) and kinetic modeling, (3) MunichHeart (MH), which uses a simplified ROI-based retention model approach, and (4) FlowQuant (FQ) based on ROI and compartmental modeling with constant distribution volume.

Results

Resting and stress MBF values (in milliliters per minute per gram) derived using the different methods were significantly different: using 4DM-FA, 4DM-ROI, FQ, and MH resting MBF values were 1.47?±?0.59, 1.16?±?0.51, 0.91?±?0.39, and 0.90?±?0.44, respectively (P?<?0.001), and stress MBF values were 3.05?±?1.66, 2.26?±?1.01, 1.90?±?0.82, and 1.83?±?0.81, respectively (P?<?0.001). However, there were no statistically significant differences among the CFR values (2.15?±?1.08, 2.05?±?0.83, 2.23?±?0.89, and 2.21?±?0.90, respectively; P?=?0.17). Regional MBF and CFR according to vascular territories showed similar results. Linear correlation coefficient for global CFR varied between 0.71 (MH vs. 4DM-ROI) and 0.90 (FQ vs. 4DM-ROI). Using a cut-off value of 2.0 for abnormal CFR, the agreement among the software programs ranged between 76 % (MH vs. FQ) and 90 % (FQ vs. 4DM-ROI). Interobserver agreement was in general excellent with all software packages.

Conclusion

Quantitative assessment of resting and stress MBF with ⁸²Rb PET is dependent on the software and methods used, whereas CFR appears to be more comparable. Follow-up and treatment assessment should be done with the same software and method.     

Maximum principle for optimal control of anticipated forward–backward stochastic differential delayed systems with regime switching

This paper is concerned with a Pontryagin maximum principle for optimal control problem of stochastic system, which is described by an anticipated forward–backward stochastic differential delayed equation and modulated by a continuous‐time finite‐state Markov chain. We establish a necessary maximum principle and sufficient verification theorem for the optimal control by virtue of the duality method and convex analysis. To illustrate the theoretical results, we apply them to a recursive utility investment‐consumption problem, and the optimal consumption rate is derived explicitly. Copyright © 2015 John Wiley & Sons, Ltd.     

低剂量与常规剂量螺旋CT显示磨玻璃密度结节的对照研究

目的探讨低剂量及常规剂量螺旋CT扫描在检出磨玻璃密度肺结节(ground-glass nodule,GGN)的数目、边缘、内部结构与周边结构是否在统计学上存在显著差异。方法对经常规剂量(200mA)与层厚(5mm)螺旋CT扫描发现GGN患者56例同时行肺部低剂量(30mA)螺旋CT扫描,所得图像分别重建2mm、1mm,并按结节直径5mm,5~10mm,10mm不同大小分组,记录结节数目、边缘、内部特征以及周边结构等。结果低剂量与常规剂量螺旋CT扫描在检出GGN的数目、边缘、内部结构与周边结构无统计学意义。结论30mA低剂量螺旋CT扫描及层厚2mm可对GGN作出较好的判断,值得在早期肺癌筛查中应用。     

Laparoscopic colectomy for colonic polyps

Background  Benign colonic polyps not amenable to colonoscopic resection or those containing carcinoma require surgical excision. Traditionally, formal colectomy with clearance of the lymphatic basin has been performed. The aim of this study was to review our experience with the laparoscopic approach for retrieval of colonic polyps with specific emphasis on safety, feasibility, and tumor localization. Methods  Retrospective chart review of all patients who underwent laparoscopic colectomy for colonic polyps was performed. Initial colonoscopic biopsies were compared with the postoperative pathology report of the resected specimen. Results  Forty-nine patients (22 males, 27 males, mean age 66 years) underwent laparoscopic colectomy for colonic polyps. Indications for surgery were presumably benign polyps in 38 patients, and superficial carcinoma in a polyp, diagnosed by colonoscopy, in 11; twenty-three patients underwent preoperative localization procedures. In 19% of patients who did not have preoperative localization, difficulties locating the polyp were encountered during surgery, requiring intraoperative endoscopy or conversion to laparotomy. In 7 of the 38 patients with presumably benign lesion, colon cancer was diagnosed in the colectomy specimen. None of the 18 patients who had cancerous lesions had any positive lymph nodes. Conclusions  Laparoscopic surgery for the treatment of colonic polyps seems to be feasible and safe, with a low complication rate. Tumor localization is crucial for adequate resection. Although one-fifth of presumably benign polyps harbored cancer, none of these patients had positive lymph nodes. These preliminary results may question the need for radical lymph node clearance in these patients. Poster presentation at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Dallas, TX, USA, April 26–29, 2006. Poster presentation at the annual meeting of the European Society for Endoscopic Surgeons (EAES), Berlin, Germany, September 13–16, 2006.