基于影像组学分类器术前预测直肠非黏液性腺癌淋巴结转移

目的：探讨影像组学方法在术前预测直肠非黏液性腺癌淋巴结转移中的价值。方法：回顾性分析91例手术病理切片证实为直肠非黏液性腺癌患者的影像学资料,其中61例为训练样本,30例为验证样本。基于全瘤体积,从每个原发病灶术前高分辨T2加权成像(T2-weighted imaging,T2WI)图像中提取影像组学特征1 301个。基于训练样本,利用最小绝对收缩和选择算子(the least absolute shrinkage and selection operator,LASSO)逻辑回归方法筛选关键特征并构建影像组学分类器。采用受试者工作特征(receiver operating characteristic,ROC)曲线评价影像组学分类器的辨别效能,并将其与形态学标准进行比较。在验证样本中验证影像组学分类器的价值。结果：由5个影像组学特征构建的分类器与淋巴结转移状态有关(P<0.001)。在训练样本和验证样本中,影像组学分类器诊断淋巴结转移的曲线下面积分别为0.874(95% CI：0.787~0.960)和0.878(95% CI：0.727~1.000),形态学标准诊断淋巴结转移的曲线下面积分别为0.619(95% CI：0.487~0.752)和0.556(95% CI：0.355~0.756)。无论是训练样本还是验证样本,影像组学分类器的诊断效能均高于形态学标准(均P<0.05)。结论：影像组学分类器可术前个体化预测直肠非黏液性腺癌淋巴结转移,而且其诊断效能高于形态学标准。     

Individual and joint effects of borderline ankle-brachial index and high plasma total homocysteine on all-cause death in hypertensive adults

BACKGROUNDThe cardiovascular hazards of total homocysteine (tHcy) are long known. In addition, despite the acknowledgment on the importance of low ankle-brachial index (ABI) (< 0.9), borderline ABI (0.91-0.99) was once commonly overlooked. This study aims to explore the independent and joint effect of tHcy level and borderline ABI on all-cause death in hypertensive population.METHODSThis study included 10,538 participants from China H-type Hypertension Registry Study. ABI was described into two groups: normal ABI (1.00-1.40) and borderline ABI. tHcy level was also divided into two groups: < 15.02 and ≥ 15.02 μmo/L. Four groups were analyzed, using COX proportional hazard regression model, separately and pairwise to observe the independent and joint effect on all-cause death.RESULTSA total of 126 (1.2%) deaths were observed in the 1.7 years follow-up time. Borderline ABI has a higher predicted risk of death than normal ABI (HR = 1.87, 95%CI: 1.17-3.00) after adjusting for potential covariates. Compare with tHcy level < 15.02 μmo/L (low tHcy), those with tHcy ≥ 15.02 μmo/L (high tHcy) had higher risk to event outcome (HR = 1.99, 95% CI: 1.30-3.05). According to the cumulative hazard curve, group with borderline ABI and high tHcy level has significantly higher altitude and larger increasing rate over follow-up period compare to other groups. Among those with borderline ABI, participants with high tHcy had higher death risk than those with low tHcy, nevertheless, no significant different between borderline and normal ABI among those with low tHcy levels.CONCLUSIONSBorderline ABI and tHcy level both have independent predictive value on all-cause death. The combined group of borderline ABI and high tHcy has highest risk factor of outcomes, which suggested the mutual additive value of borderline ABI and tHcy. More attention should be given to the importance of borderline ABI in hypertensive population, especially with elevated tHcy level.

Homocysteine (Hcy) is a sulfur-containing, non-proteinogenic amino acid synthesized through the transmethylation of amino acid methionine from one-carbon metabolism. Elevated plasma total homocysteine (tHcy) level is associated with endothelial dysfunction, increased blood coagulation, and metabolic disturbance, promoting cardiovascular diseases, stroke, and coronary artery disease.^[1,2] Notably, patients with high Hcy levels and concomitant hypertension were suggested to be at particularly higher risk.^[3] Moreover, increasing studies have explored a positive association between advanced Hcy level with all-cause mortality. According to a recent dose-response meta-analysis, for each 5-μmol/L increment of tHcy levels, the risk for all-cause mortality increased by 33.6%.^[4]The ankle-brachial index (ABI) is an effective, well-established measure that is commonly used in the diagnosis of peripheral artery disease (PAD),^[5] meanwhile was well studied as an important indicator of atherosclerosis and CVD events.^[6] Although ankle-brachial index (ABI) ≤ 0.90 has been recognized as the threshold value for abnormal/low ABI, which was proven to increase the risk of all-cause mortality,^[7] a study from the American Heart Association has suggested ABI between 0.91 and 1.00 should be considered as “borderline area” in terms of cardiovascular risks,^[8] considering of prior probability and sensitivity of ABI calculation. Emerging studies have aimed to explore the predictive value of borderline ABI,^[9-11] however, controversy remains because of limited and inconsistent data. The current study aimed to explore the individual and joint effect of borderline ABI and tHcy on all-cause mortality among hypertensive adults. Although ABI level ≤ 0.90 has been and is going to remain significant in clinical practice, we believe broader concern should be placed on borderline ABI, especially for its value in risk differentiation and identification. To the best of our knowledge, there are no similar previous studies.     

青壮年股骨颈骨折患者行闭合复位内固定手术后发生股骨头无菌性缺血坏死影响因素分析

目的探讨青壮年股骨颈骨折患者经闭合复位内固定手术治疗后发生股骨头无菌性缺血坏死的影响因素。方法回顾性分析自2015年1月至2020年1月北部战区总医院骨科收治的经闭合复位内固定手术治疗的62例青壮年股骨颈骨折患者临床资料,包括年龄、性别、体质量指数、骨折侧、Garden分型、损伤至手术前时间、术前是否牵引、内固定是否取出、股骨头后倾角度、是否有股骨颈皮质粉碎、术后负重活动时间、复位质量等,并分析上述指标对术后发生股骨头无菌性缺血坏死的影响。结果青壮年患者发生术后股骨头无菌性缺血坏死与Garden分型、内固定是否取出、股骨头后倾角度、股骨颈皮质粉碎情况、复位质量相关(P<0.05)。多因素Logistic分析显示,内固定是否取出、复位质量、股骨头后倾角度与术后发生股骨头无菌性缺血坏死关系密切(P<0.05)。结论青壮年股骨颈骨折闭合复位内固定术后发生股骨头坏死的影响因素较多,其中,内固定是否取出、复位质量、股骨头后倾角度与术后发生股骨头坏死密切关系。     

IgE介导的食物过敏诊断程序及临床评价

目的 对IgE介导的食物过敏的诊断流程进行临床评价。探讨高效的食物过敏诊断程序。方法 0～6岁患儿88例,以支气管哮喘、过敏性鼻炎、特应性皮炎以及消化道症状为主要临床表现,进行食物过敏原皮肤点刺试验（skin prick test,SPT）,皮肤试验阳性者检测血清特异性IgE（sIgE）、sIgE阳性者进一步进行双盲安慰剂食物激发试验（double-blind placebo-control food challenge,DBPCFC）证实诊断。sIsE阴性者通过DBPCFC建立或排除诊断。结果 88例患儿中SPT（＋）者25例。其中SPT（＋）sIgE（＋）者16例,SPT（＋）sIsE（-）者9例;前者经DBPCFC进一步证实为食物过敏的有14例;后者通过DBPCFC建立诊断的3例。排除诊断的6例,根据SPT（＋）sIgE（＋）或SPT（＋）sIsE（-）诊断食物过敏的阳性预计值为87．5％．阴性预计值为77．8％。结论 皮肤点刺试验结合sIgE检测有较高的食物过敏确诊率,当前两者不一致时,需要通过DBPCFC建立诊断。     

内源性一氧化碳对肺动脉平滑肌细胞增殖基因表达谱的影响

目的 运用芯片技术研究内源性一氧化碳（CO）刺激下血管平滑肌细胞内增殖相关基凼表达谮的变化。方法 取SD大鼠肺动脉平滑肌细胞进行离体培养,用血小板源性生长因子（PDGF,20ng／m1）和Hemin（20μmol／L）进行刺激后,用Affymetrix表达基因谱芯片检测其基因表达谱变化。结果 Hemin刺激与PDGF刺激相比差异表达基因366条,与增殖相关的差异表达基因21条,上调11条,下调10条。其中原来在PDGF刺激下上调表达的一些基因（Map2k3、cyclinD1、PDGFA、mybL1、a．nape10、MMP14等）在经内源性CO刺激后其表达则显著下调。结论 内源性CO很可能是通过作用于MAPK途径来抑制PDGF的促增殖功能,同时伴有cyclinD1、cyclinG1、P21等的参与。     

曾被误诊的麻痹性痴呆23例分析

目的:研究麻痹性痴呆的诊断与治疗。方法:对曾被误诊的23例麻痹性痴呆,使用简明精神病评定量表(BPRS)及简易精神状态检查(MMSE)评定。并予驱梅毒及抗精神病药治疗。结果:驱梅毒治疗后可显著提高疗效。结论:麻痹性痴呆应及早正确诊断,作驱梅毒及抗精神病治疗。     

慢性乙型肝炎组织中肝前体细胞的免疫组化特征

目的研究肝前体细胞（hepatic progenitor cells,HPCs）、小管样反应、中间型肝细胞在慢性乙型肝炎组织中的分布特征和数量变化,以及与肝细胞再生之间的可能联系。方法对42例慢性乙型肝炎组织行常规病理HE染色,按炎症活动度（G）分为轻、中、重三度,免疫组织化学方法观察肝胆细胞标记（AFP、GST-π、CK7、CK19）和造血干细胞标记（c-kit、CD34）的表达,并以Ki-67标记增殖的肝细胞,用CK7／CK19作为标记物对符合定义的HPCs、中间型肝细胞进行计数,小管样反应程度的判定利用彩色病理图象分析系统。结果慢性乙型肝炎的早期阶段即存在HPCs的活化和小管样反应,其数量随着炎症活动度的增加而增加,均表达CK7、CK19、GST-π和AFP,肝细胞增殖指数在轻、中度肝炎中逐渐增加,重度肝炎、肝硬化患者增殖的肝细胞数下降,而中间型肝细胞数量显著增加。小管样反应面积百分比与HPCs数目正相关（r=0．739,P〈0．05）,中间型肝细胞数目与HPCs数目正相关（r=0．614,P〈0．05）。结论慢性乙型肝炎中不仅有成熟肝细胞增殖,也存在肝前体细胞活化和分化,可能参与肝脏损伤后的再生修复。     

左房黏液瘤一例误诊并文献复习

左房黏液瘤是常见的心脏原发性良性肿瘤,容易发生猝死及栓塞,所以及时诊断及治疗对挽救病人生命,改善病人预后有重要意义。我院近日收治并误诊1例,本文结合文献对其临床资料进行分析。1病例资料男,50岁。因发热伴上腹胀20天,左小指末端憋胀、疼痛4天入院。患者20天前无明显诱因出现发热伴上腹胀,体温波动在37.8~38.4℃,以午后16~17时明显,无盗汗、寒战、咳嗽、恶心及呕吐,曾先后在多家医院就诊,予抗感染及对症治疗,症状时轻时重。入院前4天出现左小指末端憋胀、疼痛,在我院门诊按感染予头孢他啶、氧氟沙星治疗2天,未见好转,左小指疼痛剧烈收…     

MEAW技术矫治错(牙合)的临床观察

目的:通过多曲方丝弓(MEAW)技术矫治各类骨性错(牙合),观察临床矫治效果.方法:前牙开(牙合)病例2例,骨性Ⅲ类错(牙合)12例,骨性Ⅱ类错(牙合)7例,均采用MEAW技术进行前牙覆(牙合)、覆盖的矫治以及磨牙关系的调整.结果:2例前牙开(牙合)病例前牙覆(牙合)平均增加6mm;7例骨性Ⅱ类错(牙合)病例覆(牙合)覆盖平均减小3.62 mm和4.5 mm;12例骨性Ⅲ类错(牙合)病例覆盖平均改变4.14 mm.结论:MEAW技术在骨性错(牙合)病例的非手术方法矫治上有明显的临床疗效.     

不规则抗体的筛查和输血安全

红细胞ABO血型以外的不规则抗体是引起输血不良反应、新生儿溶血病、血型鉴定困难及疑难配型等的主要原因,患者常由于输血和妊娠产生免疫抗体,导致输血不良反应和输血相关疾病的发生。因此,在输血前进行患者血清中不规则抗体的筛查,对于保障输血安全、避免输血反应非常重要。2003年11月～2005年12月笔者对2268例有输血史及妊娠史而需要输血的住院患者进行输血前不规则抗体的筛查和鉴定,结果检出抗体阳性17例,现报告如下。