基于生物大数据平台的CBL教学法在医学超声影像学中的应用

大数据、互联网等信息化技术的高速发展,为超声医学教育的改革及传承注入了新动力,并带来了新的发展机遇.我院生物大数据平台已历经5年的探索、创新、发展与沉淀,由临床、病理、影像、基因等多个学科体系交叉融合构成,基于生物大数据平台与案例教学法(Case-based learning,CBL)的深度融合,可作为一种新的教学方法引入医学高等教育体系中.该应用研究通过分析CBL教学法的特点并结合生物大数据平台的优势,旨在通过对医学超声影像学传统授课模式的不足进行补充改进,进而达到优化医学超声影像学的教学效果.     

血清趋化素水平与钙化性主动脉瓣狭窄程度的相关性研究

目的探讨血清趋化素(chemerin)水平在钙化性主动脉瓣狭窄(CAS)发病机制中的作用及与主动脉瓣狭窄程度的相关性。方法选取2016年11月至2019年11月于邯郸市第一医院心内科诊断为CAS的患者40例为CAS组,将CAS患者按主动脉瓣狭窄程度分为三组:轻度CAS组(n=14)、中度CAS组(n=15)及重度CAS组(n=11);另选取同期来院体检的无CAS的患者40例为对照组(年龄、性别与CAS组匹配)。采用酶联免疫吸附法(ELISA)测定各组血清chemerin水平;应用Spearman相关分析法评估chemerin和主动脉瓣狭窄程度的相关性。结果与对照组相比,CAS组患者的血清chemerin水平明显升高[(89.8±14.9)ng/ml vs.(60.1±21.3)ng/ml,P<0.05];三组不同狭窄程度CAS患者的血清chemerin水平较对照组均明显升高,差异有统计学意义(P<0.05),且随狭窄程度的加重,chemerin水平逐渐降低,其中轻度CAS组患者的chemerin水平最高;相关性分析显示,血清chemerin水平与主动脉瓣狭窄程度呈负相关性(r=-0.632,P<0.01)。结论血清chemerin水平与CAS狭窄程度有关,可作为辅助诊断CAS的血清炎症提示指标。     

PTGS1基因多态性与急性脑梗死患者阿司匹林抗血栓疗效的相关性

目的 探讨前列腺素内过氧化物合酶1(Prostaglandin-endoperoxide synthase1, PTGS1)基因多态性与急性脑梗死患者阿司匹林抗血栓疗效的相关性。方法 回顾性分析2017年10月-2020年10月在本院接受治疗的200例急性脑梗死患者的临床资料,按照其阿司匹林抗血栓疗效将其分为阿司匹林抵抗组(n=69)和阿司匹林敏感组(n=131),分析所有患者PTGS1基因多态性情况,比较2组性别、年龄、身体质量指数(Body Mass Index,BMI)、合并症(高血压病、冠心病、糖尿病)、PTGS1基因突变、不良嗜好(吸烟、酗酒)等临床特征及生化指标[血小板计数(Blood platelet,PLT)、超敏C反应蛋白(Hypersensitive-C reactive protein,hs-CRP)]水平,利用受试者工作特征(Receiver operating characteristic,ROC)曲线分析PLT,hs-CRP预测急性脑梗死患者阿司匹林抵抗的价值,将2组有差异的指标纳入Logistic回归分析模型,进行量化赋值,明确引起急性脑梗死患者阿司匹林抵抗的危险因素。结果 本研究200例急性脑梗死患者中PTGS1基因位点以AA为主,发生率为81.50%,其突变基因位点分别为AG,GG,占人数的14.00%、4.50%。阿司匹林抵抗组年龄≥60岁、合并糖尿病、PTGS1基因突变、吸烟患者的比例及PLT,hs-CRP水平显著高于阿司匹林敏感组(P<0.05)。经ROC曲线分析PLT,hs-CRP预测急性脑梗死患者阿司匹林抵抗的曲线下面积分别为0.879、0.866。年龄≥60岁、合并糖尿病、PTGS1基因突变、吸烟、PLT≥202.255×10⁹/L,hs-CRP≥24.695 mg/L是引起急性脑梗死患者阿司匹林抵抗的危险因素。结论 PTGS1基因多态性会增加急性脑梗死患者阿司匹林抵抗风险。除此之外,高龄、糖尿病、抽烟及PLT,hs-CRP异常高表达均可能影响阿司匹林抗血栓治疗效果。     

以患者为中心 加强医院党建工作

党的先进性建设是党建的重要内容,更是医院建设的核心内容,在医院党的建设过程中贯彻党的先进性,在党的建设实践中体现党的群众路线,以患者为中心,以党的群众路线教育实践为载体,加强党的先进性建设,是本院党建工作的重大创新。     

Subcutaneous tunneling technique to improve outcomes for patients undergoing chemotherapy with peripherally inserted central catheters: a randomized controlled trial

ObjectiveTo compare the value of the subcutaneous tunneling technique versus the normal technique in improving the outcomes of patients undergoing chemotherapy with peripherally inserted central catheters (PICCs).MethodsOne hundred thirty patients were randomly divided into an experimental group (subcutaneous tunneling technique) and control group (normal technique) according to the PICC placement technique, and clinical data were compared between the groups.ResultsIn total, 129 PICCs were successfully inserted. Compared with the control group, the experimental group had a lower occurrence of complications after placement (especially catheter dislodgement: 3.1% vs. 15.4%, venous thrombosis: 3.1% vs. 15.4%, and wound oozing: 14.1% vs. 27.7%), lower occurrence of unscheduled PICC removal (3.1% vs. 13.8%), greater comfort during placement (14.16 ± 2.21 vs. 15.09 ± 2.49 on a scale ranging from 6 to 30 points, with higher scores indicating lower degrees of comfort), and lower costs of PICC maintenance (median (interquartile range) per-day maintenance cost: 13.90 (10.99–32.83) vs. 15.69 (10.51–57.46) Yuan). The occurrence of complications and amount of bleeding during placement were not significantly different between the two groups.ConclusionsThe subcutaneous tunneling technique can improve PICC placement by reducing complications and costs of maintenance with better patient comfort during placement.     

Establishment of Multiple Locus Variable-number Tandem Repeat Analysis Assay for Genotyping of Borrelia burgdorferi sensu lato Detected in China

Objective Human Lyme Borreliosis （LB）, which is caused by Borrefia burgdorferi sensu lato （B. burgdorferi）, has been identified as a major arthropod-borne infectious disease in China. We aimed to develop a multiple locus variable-number tandem repeat （VNTR） analysis （MLVA） assay for the genotyping of Borrelia burgdorJ：eri strains detected in China. Methods B. garinii PBi complete 904.246 kb chromosome and two plasmids （cp26 and Ip54） were screened by using Tandem Repeats Finder program for getting potential VNTR loci, the potential VNTR loci were analyzed and identified with PCR and the VNTR loci data were analyzed and MLVA clustering tree were constrcted by using the categorical coefficient and the unweighted pair-group method with arithmetic means （UPGMA）. Results We identified 5 new VNTR loci through analyzing 47 potential VNTR loci. We used the MLVA protocol to analyse 101 B. burgdorferi strains detected in China and finally identified 51 unique genotypes in 4 major clusters including B. burgdorferi sensu stricto （B.b.s.s）, B. garinii, B. a[zelii, and B. valaisiana, consistent with the current MLSA phylogeny studies. The allele numbers of VNTR-1, VNTR-2, VNTR-3, VNTR-4, and VNTR-5 were 7, 3, 9, 7, and 6. The Hunter-Gaston index （HGI） of five VNTR loci were 0.79, 0.22, 0.77, 0.71, and 0.67, respectively. The combined HGI of five VNTR loci was 0.96. Clustering of the strains of Xinjiang, Inner Mongolia and Heilongjiang was confirmed, and this situation was consistent with the close geographical distribution of those provinces. Conclusion The MLVA protocol esytablished in this study is easy and can show strains＇ phylogenetic relationships to distinguish the strains of Borrelia species. It is useful for further phylogenetic and epidemiological analyses of Borrelia strains.     

南京市学龄前儿童视觉运动整合发育测验评估及相关因素分析

目的 对南京市学龄前儿童视觉运动整合能力发育情况进行调查,分析相关影响因素,为学龄前儿童的视觉运动整合临床工作提供参考。方法 2017年3—5月采用分层随机抽样的方法抽取南京市主城区6所幼儿园483名学龄前儿童,调查基本情况并进行视觉-运动整合发育测验评估。结果 1)随着儿童年龄增长,视觉运动整合能力原始得分呈上升趋势;2)各年龄组标准分性别间差异无统计学意义(P>0.05);3)除6岁8月~6岁9月组除外,各年龄组标准分均高于美国常模,差异有统计学意义(P<0.01);4)儿童学习舞蹈、乐器、父母文化水平因素与儿童视觉运动整合能力之间相关系数均在0.11~0.13之间,差异有统计学意义(P<0.05)。结论 视觉运动整合能力随年龄增长而提高,无性别差异,且与儿童学习舞蹈、乐器、父母文化水平因素存在一定的相关性。     

原发性干燥综合征合并自身免疫性肝病的临床特点及预后分析

目的:分析原发性干燥综合征(primary Sjögren’s syndrome,pSS)合并自身免疫性肝病(autoimmune liver disease,ALD)的临床特点和预后。方法:回顾性分析浙江大学医学院附属第一医院2014年2月至2017年12月住院的pSS患者,比较pSS伴或不伴ALD两组间的临床表现和预后的差异。结果:共纳入203例pSS患者,其中合并ALD者68例(自身免疫性肝炎31例,原发性胆汁性胆管炎37例),不合并ALD者135例。两组间年龄、性别比例、口干、眼干、疼痛、乏力、淋巴结肿大、涎腺肿大、皮疹、肺部病变、肾脏受累等临床表现,其他免疫性疾病(如自身免疫性甲状腺疾病、类风湿关节炎和血管炎)的发生率,抗核抗体(antinuclear antibody,ANA)滴度,抗干燥综合征A抗体(Sjögren’s syndrome A antibody,SSA)、SSA52、抗干燥综合征B抗体(Sjögren’s syndrome B antibody,SSB)阳性率,红细胞沉降率和C反应蛋白水平差异均无统计学意义。pSS合并ALD的患者病程较短、抗线粒体-M2抗体 (anti-mitochondrial M2 antibody, AMA-M2)和抗着丝点抗体阳性率高,IgG、IgM水平高,C3水平低,血细胞减少,肝脏相关血清学指标(如谷丙转氨酶、谷草转氨酶、谷氨酰转肽酶、碱性磷酸酶、总胆红素、直接胆红素、间接胆红素)水平升高,肝硬化的比例增加,死亡事件明显增多(死亡率13.24% vs. 2.96%, P=0.013),预后更差。二元Logistic回归分析发现,pSS合并ALD的患者出现死亡事件的不良因素为肝硬化、EULAR干燥综合征疾病活动性指数评分(the EULAR Sjögren’s syndrome disease activity index,ESSDAI)和总胆红素水平。Kaplan-Meier生存曲线提示合并ALD的患者生存率低于对照组。结论:pSS合并ALD的患者病情更重、死亡事件发生率高,需要临床重视并加强对症治疗。     

Erdheim-Chester disease with asymmetric talus involvement: A case report

BACKGROUND Erdheim-Chester disease(ECD) is a rare multi-system or multi-organ histiocytic proliferative disease with diverse clinical manifestations, and the development of the disease is complex, which makes clinical diagnosis and treatment difficult.The characteristic clinical manifestations include multi-organ involvement,especially in the symmetrical diaphysis and metaphysis of the bilateral extremities. ECD with a unilateral talus lesion is extremely rare. Here, we report an unusual case of ECD invading the asymmetric talus and tibia without involving other organs. The patient had good outcome after surgery.CASE SUMMARY We report a case of a 67-year-old man who was referred to our outpatient department because of left ankle chronic pain for 5 years, which exacerbated after a foot sprain 6 mo previously. We discovered multiple sclerotic lesions of the tibia and talus on his previous X-ray films, which were initially missed in a local hospital. Therefore, enhanced computer computed tomography(CT) and magnetic resonance imaging were performed. These examinations showed multiple lesions in the bone marrow cavity of the left tibia, and cortical sclerosis and osteonecrosis of the left talus. Specimens were collected via bone puncture from the two lesions, and a final diagnosis of ECD was confirmed by pathological and immunohistochemical examinations. In addition, other auxiliary examinations including head CT, pulmonary CT, spinal CT, abdominal CT,cardiac ultrasound and thyroid ultrasound showed no obvious abnormalities.The patient underwent surgery for the tibia lesion scraping and talus lesion scraping combined with cement casting. The patient started on a progressive rehabilitation at 4 wk, and felt no pain after surgery. During a 2-year follow-up period, the patient exercised normally without pain, and there were no signs of recurrence.CONCLUSION This study shows that surgery treatment may also achieve good results for ECD patients with only bone involvement.     

Vascular ring and sling in a fetus who developed esophageal and airway compression after birth

Vascular ring and sling are congenital anomalies of the vascular structure in the thorax with a prevalence of 2.4/10,000 live births. Double aortic arch (DAA), right aortic arch with left ductus arteriosus and aberrant left subclavian artery (RAA-ALSA), and pulmonary artery sling (PAS) are the three common types of vascular ring and sling. These anomalies can be isolated or accompanied by intracardiac malformation. The presence of both vascular ring and PAS is extremely rare. Here, we report a fetus who was prenatally diagnosed with PAS and RAA-ALS, and developed symptoms due to esophageal and airway compression after birth.