创伤超声重点评估仿真模型在舰艇编队救护所队员培训中的应用研究

目的 利用创伤超声重点评估（FAST）仿真模型,探讨一种简单、高效、易行的FAST培训模式。方法 将某舰艇编队救护所队员73人随机分成3组：模特组23人,FAST模型组25人,FAST模型加体表标记组（模型体标组）25人。在所有人员接受2学时共同理论+实例视频教学的学习后,各组分别以人体模特、FAST模型、FAST模型加体表标记进行实操练习。之后进行读图及实操考核,记录比较读图得分及实操考核时间。结果 模特组读图得分（8.52±1.24）分,FAST模型组（8.88±1.20）分,FAST模型体标组（8.72±0.98）分,3组比较差异无统计学意义（P>0.05）。模特组实操考核时间（4.40±0.81）min,FAST模型组（3.27±0.88）min,FAST模型体标组（1.95±0.54）min,3组比较差异有统计学意义（P<0.05）;且3组间两两对比,差异均有统计学意义（P<0.05）。结论 在军队非超声专业人员战伤急救培训中,FAST仿真模型具有较高的应用价值。在此基础上,按照体表定位标志流程化顺序检查更准确、快捷、高效,适合零基础入门级培训。     

成人皮肌炎伴发恶性肿瘤的相关因素分析

目的:探讨成人皮肌炎(DM)患者伴发肿瘤的相关因素。方法:回顾性分析2016年1月至2018年12月在我院皮肤科确诊为成人DM的患者,对其临床特征、实验室检查共16项指标进行统计分析。结果:共分析114例成人DM患者,其中伴发肿瘤21例(18.4%),以肺癌(6例,28.57%)最常见。单因素分析结果显示,单纯DM组和DM伴发肿瘤组年龄、性别、吞咽困难、白蛋白水平和红细胞沉降率(ESR)比较差异有统计学意义(P<0.05)。将上述单因素分析差异有统计学意义的指标纳入多因素Logistic分析结果显示,性别和ESR是影响成人DM伴发肿瘤的危险因素。结论:应考虑将男性DM患者,或者ESR≥35 mm/h纳入成人DM伴发恶性肿瘤的危险因素,加强DM早期的肿瘤筛查工作。     

皮肤分枝杆菌感染的研究进展

皮肤分枝杆菌感染是一类复杂的皮肤疾病,临床和病理无特异表现,易漏诊误诊。临床上大致分为3类,皮肤结核、麻风、非结核分枝杆菌感染性皮肤病。本文就各类分枝杆菌感染相关的皮肤疾病进行流行病学特征、临床表现、诊断及治疗进展进行综述。     

Grape seed powder increases gastrointestinal motility

Grape seed is an important natural bioactive product with various health benefits. Interstitial cells of Cajal (ICCs) are pacemaker cells in the gastrointestinal (GI) tract. The present study investigated the effects of grape seed powder (GSP) on ICC properties and GI motility. GSP depolarized the pacemaker potentials of ICCs in a dose‑dependent manner. Y25130 or SB269970 slightly inhibited GSP‑induced effects. However, Y25130 and SB269970 together completely blocked GSP-induced effects. In the presence of inhibitors of protein kinase C, protein kinase A, or mitogen-activated protein kinase, GSP‑induced ICC depolarization was inhibited. GSP increased the intestinal transit rate in normal mice and in mice with acetic acid-induced GI motility disorder. In addition, the levels of motilin and substance P were elevated after GSP dosing. These results demonstrate that GSP can regulate GI motility, and therefore, it is a potential therapeutic agent for treating GI motility disorders.     

Vitamin D Enhances Neutrophil Generation and Function in Zebrafish (Danio rerio)

Vitamin D (VD) is a major regulator of calcium metabolism in many living organisms. In addition, VD plays a key role in regulating innate and adaptive immunity in vertebrates. Neutrophils constitute an important part of the first line of defense against invading microbes; however, the potential effect of VD on neutrophils remains elusive. Thus, in this study zebrafish in different developmental stages were utilized to identify the potential role of VD in the basal homeostasis and functions of neutrophils. Our results showed that addition of exogenous VD₃ promoted granulopoiesis in zebrafish larvae. Reciprocally, neutrophil abundance in the intestine of adult zebrafish with a cyp2r1 mutant, lacking the capacity to 25-hydroxylate VD, was reduced. Moreover, VD-mediated granulopoiesis was still observed in gnotobiotic zebrafish larvae, indicating that VD regulates neutrophil generation independent of the microbiota during early development. In contrast, VD was incapable to influence granulopoiesis in adult zebrafish when the commensal bacteria were depleted by antibiotic treatment, suggesting that VD might modulate neutrophil activity via different mechanisms depending on the developmental stage. In addition, we found that VD₃ augmented the expression of il-8 and neutrophil recruitment to the site of caudal fin amputation. Finally, VD₃ treatment significantly decreased bacterial counts and mortality in zebrafish infected with Edwardsiella tarda (E. tarda) in a neutrophil-dependent manner. Combined, these findings demonstrate that VD regulates granulopoiesis and neutrophil function in zebrafish immunity.     

Isatuximab plus carfilzomib and dexamethasone versus carfilzomib and dexamethasone in relapsed multiple myeloma patients with renal impairment: IKEMA subgroup analysis

Renal impairment (RI) is common in patients with multiple myeloma (MM) and new therapies that can improve renal function are needed. The phase III IKEMA study (clinicaltrials gov. Identifier: {"type":"clinical-trial","attrs":{"text":"NCT03275285","term_id":"NCT03275285"}}NCT03275285) investigated isatuximab (Isa) with carfilzomib and dexamethasone (Kd) versus Kd in relapsed MM. This subgroup analysis examined results from patients with RI, defined as estimated glomerular filtration rate <60 mL/min/1.73 m². Addition of Isa prolonged progression-free survival (PFS) in patients with RI (hazard ratio: 0.27; 95% confidence interval [CI]: 0.11–0.66; median PFS not reached for Isa-Kd versus 13.4 months for Kd [20.8-month follow-up]). Complete renal responses occurred more frequently with Isa-Kd (52.0%) versus Kd (30.8%) and were durable in 32.0% versus 7.7% of patients, respectively. Treatment exposure was longer with Isa-Kd, with median number of started cycles and median duration of exposure of 20 versus 9 cycles and 81.0 versus 35.7 weeks for Isa-Kd versus Kd, respectively. Among patients with RI, the incidence of patients with grade ≥3 treatment-emergent adverse events was similar between the two arms (79.1% in Isa-Kd vs. 77.8% in Kd). In summary, the addition of Isa to Kd improved clinical outcomes with a manageable safety profile in patients with RI, consistent with the benefit observed in the overall IKEMA study population.     

梗阻性黄疸18F-FDG PET/MR成像中国专家共识

梗阻性黄疸病因复杂,定性和定位诊断具有挑战性。一体化正电子发射计算机断层成像/磁共振（positron emission tomography/magnetic resonance, PET/MR）检查,通过PET与MR在梗阻性黄疸诊断中的优势互补,形成整合优势。在满足诊断需求的前提下,如何缩短PET/MR扫描时长、选择适宜的个性化扫描协议是临床关注的焦点。本文在文献复习和大量临床应用积累基础上,基于病灶是否具有显像剂聚集,建立简繁不同的PET/MR成像协议和报告,并形成专家共识。     

宫颈癌全子宫切除术后发生毛细血管渗漏综合征 1例

目的探讨宫颈癌病人术后发生毛细血管渗漏综合征( capillary leakage syndrome,CLS)的病因、临床表现及处理措施,为临床医师提供可靠经验,提高此类疾病诊治水平。方法分析 1例 2022年 7月于潍坊医学院附属医院术前诊断为子宫颈原位癌而术后病理为浸润性宫颈癌的病人术后发生 CLS的过程及诊疗经过,结合相关文献报道,总结宫颈癌病人术后发生 CLS的机制及处理措施。结果病人术中生命体征平稳,手术结束恢复体位时出现血压下降,给予去甲肾上腺素升压,待血压升至 100/60 mmHg返回病房后陆续出现胸闷、憋气及双下肢中度水肿,行 CT检查提示大量胸腹腔积液,给予地塞米松、羟乙基淀粉、血浆及人血白蛋白改善毛细血管通透性,补充血容量,限制性补液并间断性给予利尿剂等处理,经过积极治疗后病人病情好转。结论针对宫颈癌术后的病人,医务人员需严密观察,对胸闷、憋气、双下肢水肿等症状提高警惕,首先排除是否出现 CLS,一旦确诊立即给予相应的处理。     

结直肠癌前病变中医病机探讨

在癌毒病机理论的指导下,提出结直肠癌前病变的共性病机为湿热毒蕴,脾气亏虚.湿、热之邪在脾虚的基础上产生并相互胶结于肠腑,日久内生癌毒.脾气亏虚是结直肠癌前病变发生的根本病机,湿热蕴结是其发展条件,癌毒内生是癌变的关键所在.结合内镜下病理分级,根据癌毒内生与否可将结直肠癌前病变的演变过程分为无癌毒期及癌毒期.癌毒致病的过...     

微等离子束与点阵铒激光治疗痤疮后凹陷性瘢痕疗效对比研究

目的:探究微等离子束与点阵铒激光治疗痤疮后凹陷性瘢痕的临床效果及安全性。方法:选取2018年10月-2019年10月笔者医院收治的64例痤疮凹陷性瘢痕患者,按随机数字表法分为两组,每组32例。对照组采用点阵铒激光治疗,实验组采用微等离子束激光治疗,对比两组患者治疗前后痤疮瘢痕权重评分(ECCA)、治疗效果、并发症及持续时间。结果:治疗前,两组患者ECCA评分比较,差异无统计学意义(P>0.05);治疗后,两组评分较治疗前均下降,但实验组评分优于对照组,差异有统计学意义(P<0.05)。治疗后,实验组总有效率84.38%,高于对照组的53.13%,差异有统计学意义(P<0.05);治疗后,两组红斑持续时间及脱痂时间比较,差异无统计学意义(P>0.05),但实验组色素沉着消退时间及误工时间均短于对照组,差异有统计学意义(P<0.05)。结论:微等离子束应用于痤疮后凹陷性瘢痕临床效果更好,ECCA评分更低,色素沉着少,安全性高。通过调整优化治疗方案及加强术后护理,可缩短误工期,减轻患者经济压力,值得临床推广。