CT-Guided Core Needle Biopsy of Pleural Lesions: Evaluating Diagnostic Yield and Associated Complications

ObjectiveThe purpose of this study was to retrospectively evaluate the diagnostic accuracy and complications of CT-guided core needle biopsy (CT-guided CNB) of pleural lesion and the possible effects of influencing factors.ResultsDiagnostic accuracy, sensitivity, specificity, PPV, and NPV were 89.2%, 86.1%, 100%, 100%, and 67.8%, respectively. The influencing factors had no significant effect in altering diagnostic accuracy. As far as complications were concerned, occurrence of pneumothorax was observed in 14 (16%) out of 88 patients. Multivariate analysis revealed lesion size/pleural thickening as a significant risk factor (odds ratio [OR]: 8.744, p = 0.005) for occurrence of pneumothorax. Moreover, presence of pleural effusion was noted as a significant protective factor (OR: 0.171, p = 0.037) for pneumothorax.ConclusionCT-guided CNB of pleural lesion is a safe procedure with high diagnostic yield and low risk of significant complications.     

Sclerostin Antibody Treatment Increases Bone Formation,Bone Mass,and Bone Strength in a Rat Model of Postmenopausal Osteoporosis

The development of bone‐rebuilding anabolic agents for potential use in the treatment of bone loss conditions, such as osteoporosis, has been a long‐standing goal. Genetic studies in humans and mice have shown that the secreted protein sclerostin is a key negative regulator of bone formation, although the magnitude and extent of sclerostin's role in the control of bone formation in the aging skeleton is still unclear. To study this unexplored area of sclerostin biology and to assess the pharmacologic effects of sclerostin inhibition, we used a cell culture model of bone formation to identify a sclerostin neutralizing monoclonal antibody (Scl‐AbII) for testing in an aged ovariectomized rat model of postmenopausal osteoporosis. Six‐month‐old female rats were ovariectomized and left untreated for 1 yr to allow for significant estrogen deficiency‐induced bone loss, at which point Scl‐AbII was administered for 5 wk. Scl‐AbII treatment in these animals had robust anabolic effects, with marked increases in bone formation on trabecular, periosteal, endocortical, and intracortical surfaces. This not only resulted in complete reversal, at several skeletal sites, of the 1 yr of estrogen deficiency‐induced bone loss, but also further increased bone mass and bone strength to levels greater than those found in non‐ovariectomized control rats. Taken together, these preclinical results establish sclerostin's role as a pivotal negative regulator of bone formation in the aging skeleton and, furthermore, suggest that antibody‐mediated inhibition of sclerostin represents a promising new therapeutic approach for the anabolic treatment of bone‐related disorders, such as postmenopausal osteoporosis.     

Increased RANK ligand in bone marrow of orchiectomized rats and prevention of their bone loss by the RANK ligand inhibitor osteoprotegerin

Orchiectomized (ORX) rats were used to examine the extent to which their increased bone resorption and decreased bone density might relate to increases in RANKL, an essential cytokine for bone resorption.Serum testosterone declined by > 95% in ORX rats 1 and 2 weeks after surgery (p < 0.05 versus sham controls), with no observed changes in serum RANKL. In contrast, RANKL in bone marrow plasma and bone marrow cell extracts was significantly increased (by  100%) 1 and 2 weeks after ORX. Regression analyses of ORX and sham controls revealed a significant inverse correlation between testosterone and RANKL levels measured in marrow cell extracts (R = − 0.58), while marrow plasma RANKL correlated positively with marrow plasma TRACP-5b, an osteoclast marker (R = 0.63). The effects of RANKL inhibition were then studied by treating ORX rats for 6 weeks with OPG-Fc (10 mg/kg, twice/week SC) or with PBS, beginning immediately after surgery. Sham controls were treated with PBS. Vehicle-treated ORX rats showed significant deficits in BMD of the femur/tibia and lower trabecular bone volume in the distal femur (p < 0.05 versus sham). OPG-Fc treatment of ORX rats increased femur/tibia BMD and trabecular bone volume to levels that significantly exceeded values for ORX or sham controls. OPG-Fc reduced trabecular osteoclast surfaces in ORX rats by 99%, and OPG-Fc also prevented ORX-related increases in endocortical eroded surface and ORX-related reductions in periosteal bone formation rate. Micro-CT of lumbar vertebrae from OPG-Fc-treated ORX rats demonstrated significantly greater cortical and trabecular bone volume and density versus ORX-vehicle controls. In summary, ORX rats exhibited increased RANKL protein in bone marrow plasma and in bone marrow cells, with no changes in serum RANKL. Data from regression analyses were consistent with a potential role for testosterone in suppressing RANKL production in bone marrow, and also suggested that soluble RANKL in bone marrow might promote bone resorption. RANKL inhibition prevented ORX-related deficits in trabecular BMD, trabecular architecture, and periosteal bone formation while increasing cortical and trabecular bone volume and density. These results support the investigation of RANKL inhibition as a strategy for preventing bone loss associated with androgen ablation or deficiency.     

消化道类癌三种内镜治疗方法的比较

目的比较普通圈套器电切、内镜黏膜切除术(EMR)和内镜黏膜下剥离术(ESD)治疗消化道类癌的有效性和安全性。 方法回顾性分析2006年1月至2015年6月病理符合消化道类癌患者的临床资料,比较普通圈套器电切治疗(普通圈套器电切组,12例)、内镜黏膜切除术治疗(EMR组,47例)和内镜黏膜下剥离术治疗(ESD组,39例)的组织学完全切除率、并发症,以及术后随访6～36个月观察其疗效。 结果内镜治疗消化道类癌的组织学完全切除率为78.57%(77/98)。普通圈套器电切组的组织完全切除率为66.67% (8/12),EMR组为82.98% (39/47),ESD组为76.92% (30/39),差异均无统计学意义 (P＝0.463)。仅1例ESD治疗后发生穿孔,其他患者未出现并发症。所有患者随访6～36个月,均未复发。 结论内镜治疗对病变未超过黏膜下层的小的消化道类癌是一种安全有效的方法。     

首次和重复经桡动脉冠状动脉介入术后桡动脉无鞘区急慢性损伤的光学相干断层成像比较

目的 利用光学相干断层成像（optical coherence tomography,OCT）对经皮桡动脉冠状动脉介入（transradial intervention,TRI）术后桡动脉无鞘区（non-sheathed radial artery,NSRA）急慢性损伤进行评估。方法 2016年2月至2017年9月有162例患者在OCT指导下完成TRI后对NSRA进行OCT检查,根据患者有无TRI史分为重复TRI组（n=31）和首次TRI组（n=131）,对比两组急性损伤（内膜撕裂、夹层、穿孔、血栓和痉挛）发生率和慢性损伤指标差异,包括内膜面积、管腔狭窄率（percentage of lumen narrowing,% LN）、血管内膜与中膜厚度比值（intima-media ratio,IMR）和内膜厚度指数（intimal thickness index,ITI）。结果 NSRA急性损伤发生率为31.5%,重复TRI组患者NSRA总体急性损伤发生率明显高于首次TRI组（48.4% vs 27.5%,P=0.032）,内膜撕裂（6.5% vs 5.3%,P=1.000）、夹层（9.7% vs 1.5%,P=0.075）、穿孔（3.2% vs 1.5%,P=1.000）、血栓（12.9% vs 6.9%,P=0.457）及痉挛（29.0% vs 16.0%,P=0.094）的发生率两组差异无统计学意义。重复TRI组患者内膜面积（0.59 mm² vs 0.46 mm²,P=0.011）、IMR（0.40 vs 0.28,P=0.001）和ITI（0.27 vs 0.22,P=0.012）明显大于首次TRI组,而% LN差异无统计学意义（31.70% vs 30.81%,P=0.244）。多因素Logistic回归分析显示,重复TRI是NSRA急性损伤发生的独立危险因素（OR=2.772,95%CI：1.053~7.301,P=0.039）。结论 TRI术后NSRA急性损伤发生率为31.5%,与首次TRI组相比,重复TRI组NSRA急性损伤发生率更高且慢性内膜增生显著,重复TRI是NSRA急性损伤发生的独立危险因素。     

自拟补肾祛瘀方对多囊卵巢综合征模型大鼠的作用及机制研究

目的 探究自拟补肾祛瘀方治疗多囊卵巢综合征（PCOS）的疗效及机制。方法 选取SD雌性大鼠,复制PCOS模型后随机分为对照组、模型组、西药组及联合组。对照组和模型组根据大鼠体重给予1 mL/（kg·d）氯化钠溶液灌胃,联合组每天根据体重给予补肾祛瘀汤剂11 g/kg和4.5 mg/kg二甲双胍灌胃,西药组仅给予4.5 mg/kg二甲双胍灌胃。药物干预后分别采用Western blotting、qRT-PCR、免疫组织化学法检测肿瘤坏死因子-α（TNF-α）、核因子κB（NF-κB）、核因子IκB（IκBα）的蛋白、mRNA及阳性表达。比较各组大鼠的体重及血清睾酮（T）、促卵泡激素（FSH）、黄体生成素（LH）水平。结果 各组大鼠药物干预前的体重比较,差异无统计学意义（P >0.05）;各组大鼠药物干预28 d后的体重比较,差异有统计学意义（P <0.05）;进一步两两比较,模型组的体重高于另外3组（P <0.05）,西药组高于联合组和对照组（P <0.05）,联合组高于对照组（P <0.05）。各组大鼠血清T、FSH、LH水平比较,差异有统计学意义（P <0.05）;进一步两两比较,模型组血清T、FSH、LH水平高于另外3组（P <0.05）,西药组高于联合组与对照组（P <0.05）,联合组高于对照组（P <0.05）。各组大鼠卵巢组织TNF-α、NF-κB、IκBα蛋白相对表达量比较,差异有统计学意义（P <0.05）;进一步两两比较,模型组大鼠卵巢组织TNF-α、NF-κB蛋白相对表达量高于另外3组,IκBα蛋白相对表达量低于另外3组（P <0.05）;西药组大鼠卵巢组织TNF-α、NF-κB蛋白相对表达量高于联合组与对照组（P <0.05）,联合组高于对照组（P <0.05）;西药组大鼠卵巢组织IκBα蛋白相对表达量低于联合组与对照组（P <0.05）,联合组低于对照组（P <0.05）。各组大鼠卵巢组织TNF-α、NF-κB、IκBα mRNA相对表达量比较,差异有统计学意义（P <0.05）;进一步两两比较,模型组大鼠卵巢组织TNF-α、NF-κB mRNA相对表达量高于另外3组,IκBα mRNA相对表达量低于另外3组（P <0.05）;西药组大鼠卵巢组织TNF-α、NF-κB mRNA相对表达量高于联合组与对照组（P <0.05）,联合组高于对照组（P <0.05）;西药组大鼠卵巢组织IκBα mRNA相对表达量低于联合组与对照组（P <0.05）,联合组低于对照组（P <0.05）。各组大鼠卵巢组织TNF-α、NF-κB、IκBα的OD值比较,差异有统计学意义（P <0.05）;进一步两两比较,模型组大鼠卵巢组织TNF-α、NF-κB的OD值高于另外3组,IκBα的OD值低于另外3组（P <0.05）;西药组大鼠卵巢组织TNF-α、NF-κB的OD值高于联合组与对照组（P <0.05）,联合组高于对照组（P <0.05）;西药组大鼠卵巢组织IκBα的OD值低于联合组与对照组（P <0.05）,联合组低于对照组（P <0.05）。结论 自拟补肾化瘀方治疗PCOS可通过影响TNF-α调控的NF-κB/IκBα信号通路促进LH、FSH、T的恢复。     

两种麻醉方式对腹腔镜疝气手术患儿血流动力学及苏醒质量的影响

目的 分析全身麻醉复合骶管阻滞与全身麻醉复合腹横肌平面阻滞对腹腔镜疝气手术患儿血流动力学及苏醒质量的影响.方法 选取2016年5月—2021年5月芜湖市第一人民医院收治的腹股沟疝患儿140例,患儿均行腹腔镜疝气手术治疗,并按随机数表法分为全身麻醉复合骶管阻滞(GS)组、全身麻醉复合腹横肌平面阻滞(GT)组,每组70例....     

基于FMEA的个体化教学对手术室实习医生的带教效果

目的　探讨基于失效模式与效应分析（failure mode and effect analysis,FMEA）的个体化教学在手术室轮转实习医生带教中的作用。方法　选取武汉大学中南医院2019年2月至2019年9月接收的23名手术室轮转实习医生作为对照组,另选取2019年10月至2020年5月接收的23名手术室轮转实习医生作为研究组。对照组采用常规教学,研究组实施基于FMEA的个体化教学。比较两组带教前后理论知识和实践操作考核成绩、自我导向学习能力及实习医生对带教的满意度。使用SPSS 25.0进行t检验和卡方检验,等级资料行秩和检验。结果　带教后两组理论知识[（91.13±6.35）vs. （84.26±5.94）]和实践操作考核成绩[（89.39±5.45）vs.（79.78±5.65）]、各维度自我导向学习能力评分及总分[（280.63±23.39）vs.（248.17±20.68）]均高于带教前,且带教后研究组均高于对照组（P<0.05）;带教后研究组实习医生对带教教师职业素养、带教的合理性、带教的有效性满意度评分均高于对照组（P<0.05）。结论　在手术室轮转实习医生带教中采用基于FMEA的个体化教学不仅可提高考核成绩,增强其自我导向学习能力,还能提高其带教满意度。     

创赛结合的医学生信息素养培养模式及应用

目的　探究概念图结合以团队为基础的学习（team-based learning,TBL）教学法对护理实习生考核成绩、评判性思维能力及教学满意度的影响。方法　选取2019年3月至10月广元市中心医院接受的护理实习生67名,采用随机数字表法分为研究组与对照组;对照组采用TBL教学,研究组采用概念图结合TBL教学;对比两组考核成绩、评判性思维能力及教学满意度。使用SPSS 22.0进行卡方检验和t检验。结果　研究组理论知识与期末考试成绩均高于对照组,差异有统计学意义（P＜0.05）;教学后,研究组求知欲、寻找真相、系统化能力、自信心等4个维度评分及总分均高于教学前,且高于对照组（P＜0.05）;研究组对临床实践有应用价值、提高学习主动性、有助于理解教学内容、培养合作学习能力及能够激发学习的竞争性满意度评分均高于对照组（P＜0.05）。结论　概念图结合TBL教学有利于护理实习生掌握理论知识,提高评判性思维能力,增加教学满意度。