早期接触临床对医学生综合能力及职业认知提升效果评价

目的探讨早期接触临床对提高医学生综合能力及强化职业认知的作用。方法选择本校2014级儿科专业五年制学生,其中在大二结束的暑假开展早期接触临床教学活动的学生为实验组(78名),未参加的学生为对照组(81名)。在活动结束后,对参加教学活动的学生进行问卷调查。同时对该年级学生小儿外科学理论课成绩及临床实习表现进行统计分析。结果超过90%的学生对早期接触临床教学活动满意,认为该活动有助于提高医学生的临床思维、强化职业认知、增强学习兴趣、提高沟通技能、促进基础与临床知识相结合。同时,后期追踪分析发现,早期接触临床活动可以提高学生理论课考试成绩,实验组学生临床工作熟练度、临床思维、动手能力及医患沟通能力均优于对照组。结论在医学生中开展早期接触临床活动,能够提高学生的综合能力,有利于培养医学生的临床思维能力及医患沟通能力,强化职业认知,为医学教育培养高素质人才奠定良好基础。     

子宫体、乳腺双原发癌的临床病理特征

目的 探讨子宫体、乳腺双原发癌的临床病理特征。方法 回顾性分析首都医科大学附属北京朝阳医院2004年1月至2015年1月收治子宫体、乳腺双原发癌患者（双癌组）29例和子宫体恶性肿瘤患者（单癌组）319例的临床病理资料。结果 双癌组合并糖尿病（χ²=8.02,P=0.007）、肿瘤家族史（χ²=31.76,P<0.001）及其他部位恶性肿瘤（χ²=31.76,P<0.001）的比例显著高于单癌组,双癌组Ⅱ型子宫体恶性肿瘤（χ²=5.52,P=0.030）及低分化癌（χ²=8.39,P=0.020）的构成比明显高于单癌组。单癌组的总生存率（overall survival,OS）明显优于双癌组（Log-rank=6.75,P=0.011）。分层分析显示,在双癌组中,首发子宫体癌的双癌患者Ⅱ型子宫内膜癌的构成比明显高于首发乳腺癌组（58.33%vs 11.76%,χ²=6.882,P=0.014）。首发子宫体癌与首发乳腺癌的两癌发病间隔时间显著不同,前者的间隔时间明显缩短（t=2.23,P=0.028）。两组双原发癌间隔时间的分布差异有统计学意义（χ²=9.60,P=0.010）。结论 合并乳腺癌的子宫体恶性肿瘤与子宫体恶性肿瘤的临床、病理特征不同。乳腺癌后子宫体恶性肿瘤与子宫体恶性肿瘤术后发生乳腺癌的临床、病理特征不同。     

新型头部γ刀建设项目放射防护控制效果评价

目的 评价新型头部γ刀机房的放射防护状态及防护设施的有效性、合理性,进而保证相关人员的健康安全。 方法 依据国家有关法规和标准,结合建设单位提交的新型γ刀及机房的材料,进行现场调查和放射防护检测,然后综合分析评价。 结果 新型头部γ刀性能检测结果满足GBZ 168-2005标准的要求;工作场所的周围剂量当量率在0.11~0.18 μSv/h,γ刀机房屏蔽满足放射防护要求;个人防护用品等放射防护设施和工作人员个人剂量监测、健康体检制度及相应的规章制度均达标。 结论 该新型头部γ刀建设项目可有效控制放射性职业病危害因素,放射防护设施达到了竣工验收的要求。     

Implant Materials for Anterior Column Reconstruction of Cervical Spine Tumor

The spine is the most common site of bone metastases. Many cancer patients will ultimately develop spinal metastatic disease with symptomatic epidural spinal cord compression. At present, the main treatment for cervical spine tumors is surgical resection combined with postoperative radiotherapy. Implant materials for cervical spine anterior column reconstruction need to meet amounts of different properties, such as biocompatibility, bioactivity and the ability to maintain long-term mechanical strength. The selection of different materials determines the surgical efficacy and prognosis of patients to a certain extent. This article provides an overview of a variety of implant materials used for anterior column reconstruction after cervical spine tumor resection, introduces and analyzes their properties, advantages, disadvantages, derivatives, and applications in clinical practice, and looks forward to the future development of implant materials.     

HO-1 upregulation suppresses type 1 IFN pathway in hepatic ischemia/reperfusion injury

Upregulation of heme oxygenase (HO)-1, a heat shock protein 32, protects against hepatic ischemia/reperfusion (I/R) injury. Activation of "innate" toll-like receptor (TLR) 4 system triggers the I/R injury cascade. This study explores cytoprotective functions of HO-1 overexpression following exogenous administration of cobalt protoporphyrin (CoPP), and its relationship with the TLR4 pathway in a model of mouse partial hepatic warm I/R injury. CoPP treatment markedly improved hepatic function and histology, and suppressed pro-inflammatory cytokine elaboration profile, as compared with untreated controls. Although administration of CoPP did not affect intrahepatic TLR4, it downregulated IFN-inducible protein 10 (IP-10) expression. As IP-10 is the major product of type-1 IFN pathway downstream of TLR4, we then infused recombinant IFN-beta (rIFN-beta) directly into mouse livers. Interestingly, infusion of rIFN-beta upregulated hepatic IP-10 expression. In contrast, adjunctive CoPP treatment decreased IP-10 levels in mouse livers infused with rIFN-beta. Thus, CoPP-induced HO-1 upregulation suppresses type-1 IFN pathway downstream of TLR4 system in hepatic warm I/R injury model.     

Genetic and environmental determinants on bone loss in postmenopausal Caucasian women: a 14-year longitudinal twin study

Summary  This longitudinal twin study documented that genetic factors explain 44–56% of the between-individual variance in bone loss at femoral neck, lumbar spine, and forearm in postmenopausal Caucasian women, providing a rationale for identifying the specific genes involved. Introduction  Although there is a significant genetic effect on peak BMD, until recently, no substantive studies on heritability of bone loss in human were available. The aim of the study was to estimate the heritability of the bone loss at multiple sites in postmenopausal Caucasian women. Methods  Postmenopausal female monozygotic (MZ) and dizygotic (DZ) twins aged 40 or above at baseline were selected from the TwinsUK registry and followed up for an average of 8 years (range 5–14 years). All twins were noncurrent hormone replacement therapy users and not on any osteoporosis treatment. They had dual-energy X-ray absorptiometry (DXA) scans of their hip, lumbar spine, and forearm several times (range 2–9) during the follow-up period. Individual bone losses at femoral neck, lumbar spine, and forearm were estimated by linear regression modeling. Structural equation modeling was utilized to estimate the heritability of the bone loss. Results  A total of 712 postmenopausal Caucasian female twins (152 MZ and 204 DZ pairs) were included. MZ twins were older and had slightly lower BMD at all sites than DZ twins. DZ twins had slightly higher bone loss at lumbar spine, but similar at femoral neck and forearm compared to MZ twins. Intraclass correlation coefficients (ICC) for the bone loss at all sites were significantly higher in MZ than DZ twin pairs (p = 0.0045, 0.0003, and 0.0007 for femoral neck, lumbar spine, and forearm, respectively), indicating a significant genetic influence on bone loss at these sites. After adjustment for age at baseline and weight change during the follow-up, the heritability estimate was 47% (95% CI 27–63%) for bone loss at femoral neck, 44% (95% CI 27–58%) for lumbar spine, and 56% (95% CI 44–65%) for forearm. Conclusions  Our data suggest that up to 56% of the between-individual variance in bone loss is due to genes, providing a rationale to identify specific genetic factors for bone loss.     

CT仿真胃镜的临床及实验研究

目的CT仿真胃镜与纤维胃镜、钡餐造影、手术对比,研究其临床价值及其在理想状态下,可辨别的最小病变。材料与方法21例患者及两个离体新鲜胃标本,用相同扫描条件扫描。在工作站进行后处理,形成CT仿真胃镜(CTvirtualgastroscopyCTVG)和胃SSD影像,与纤维胃镜、气钡双对比造影(DC)、手术标本进行对比。结果CTVG和胃SSD影像对恶性肿瘤,溃疡、息肉、外压性改变诊断率相当于或高于纤维胃镜和DC,但对胃炎的诊断率较低,CTVG可以发现0．3cm以上的病变,但对扁平性、浅凹陷性病变敏感性低。结论CT仿真胃镜是对钡餐造影和纤维胃镜很好补充,CT仿真胃镜与CT轴位结合可以对上消化道疾病作出更准确的诊断。     

Biodegradable urethral stents seeded with autologous urethral epithelial cells in the treatment of post‐traumatic urethral stricture: a feasibility study in a rabbit model

OBJECTIVE

To evaluate the adhesion and growth of rabbit urethral epithelial cells (UECs) on a biodegradable unbraided mesh urethral stent, and to assess the feasibility and effect of the cell‐seeded urethral stent for treating post‐traumatic urethral stricture (PTUS) in a rabbit model.

MATERIALS AND METHODS

Rabbit UECs were collected by biopsy from adult rabbit urethra and seeded onto the outer layer of a mesh biodegradable urethral stent. The growth of UECs in cell‐scaffolds was assessed by scanning electron microscopy, immunohistochemical and fluorescence staining. In all, 32 male New Zealand rabbits were used, with either PTUS or uninjured, as a control group. Cell‐seeded stents were implanted into the rabbits strictured urethra. The histological and immunohistochemical findings were assessed after death at 1, 2, 8, 12 and 24 weeks, respectively. The reconstruction and function were evaluated by urethroscopy and retrograde urethrography.

RESULTS

The cultured UECs adhered to the stent and grew well. Immunohistochemistry showed that the cells were stained positively for cytokeratin. At 4 weeks, vs 2 weeks, the thickness of the papillary projections of the epithelium decreased and inflammatory cell infiltration diminished. At 24 weeks the injured urethra was completely covered by integrated regeneration of three to five layers of urothelium. There was no evidence of voiding difficulty, stricture recurrence or other complications.

CONCLUSIONS

The unbraided mesh biodegradable urethral stent with autologous UECs seemed to be feasible for treating PTUS in the rabbit urethra, and provides a hopeful avenue for clinical application allowing reconstruction of PTUS.     

“Dynamic spot sign” on CT perfusion source images predicts haematoma expansion in acute intracerebral haemorrhage

Objectives

To evaluate the association between dynamic progressive enhancing foci (“dynamic spot sign”) in acute haematoma on CT perfusion source images (CTP-SI) and haematoma expansion.

Methods

One hundred twelve consecutive patients with spontaneous intracerebral haemorrhage according to unenhanced CT, CTP and CT angiography within 6 h of symptom onset were prospectively evaluated. Patients were dichotomised according to the presence/absence of the dynamic spot sign on CTP-SI in haematoma. The predictive value of haematoma expansion was analysed.

Results

Haematoma expansion was detected in 28 patients (25.0 %) on follow-up unenhanced CT images. Thirty patients (26.8 %) demonstrated the dynamic spot sign on CTP-SI, about 83.3 % of patients with haematoma expansion (P?<?0.001). Sensitivity, specificity, positive predictive value, negative predictive value and kappa value for expansion were 89.3 %, 94.0 %, 96.3 %, 83.3 % and 0.814, respectively. In multiple regression, the presence of the CTP dynamic spot sign within acute haematomas independently predicted haematoma expansion; the univariate analysis OR value was 131.667 (29.386–590.289), P?<?0.0001. Moreover, the multivariate analysis CTP dynamic spot sign OR value was 203.996 (32.123–1295.488), P?<?0.0001.

Conclusions

The CTP-SI dynamic spot sign is associated with acute haematoma expansion, is more direct in showing active ongoing bleeding and has a higher predictive value than the CTA spot sign.

Key Points

? It is important to identify potential progression of spontaneous intracerebral haemorrhage. ? Dynamic enhancement within CT perfusion source images is associated with haemorrhage expansion. ? The CTP dynamic spot sign may be present throughout arterial to venous phase imaging. ? The CTP dynamic spot sign carries a higher predive value for haematoma expansion than CTA.     

体外冲击波疗法联合钻孔减压术治疗战士训练后股骨头缺血性坏死的效果观察

目的探讨战士训练后股骨头缺血性坏死(ANFH)的发病机制及体外冲击波疗法(ESWT)的疗效。方法ARCO分期Ⅰ-Ⅲ期的股骨头坏死战士(排除股骨颈骨折后股骨头坏死者)108例,男86例,女22例,年龄18~25岁,由患者自愿选择治疗方法。其中50例采用ESWT联合钻孔减压术治疗,于钻孔减压术后第2天将9~12kV(0.16~0.22mJ/mm2)的体外冲击波作用于患处,治疗后6、12个月复查双髋X线、MRI及髋关节Harris评分(HHS)。58例患者采用单纯钻孔减压术治疗。对两组治疗结果进行统计学分析。结果随访两组中均无ANFH恶化。ESWT治疗后ARCOⅠ、Ⅱ、Ⅲ期病例股骨头坏死区分别减小了22.9%、32.8%、34.3%,其中ARCOⅡ、Ⅲ期改善程度明显优于单纯钻孔减压治疗组(P<0.01)。治疗后6、12个月复查显示,ESWT联合钻孔减压治疗组HHS升高较早、较快,由54.2分分别升至90.2、83.2分,疗效优于单纯钻孔减压治疗,其中ARCOⅡ、Ⅲ期改善程度明显优于单纯钻孔减压治疗组(P<0.01)。结论ESWT对早中期ANFH疗效显著,有望在临床治疗骨肌系统慢性损伤性训练伤中发挥更为积极的作用。