锂与缺碘性甲状腺肿发病关系的实验研究

实验用Wistar大鼠125只。随机分成五组。动物实验期为20周。结果显示:单纯低碘或单纯高锂的大鼠均表现为增生性甲状腺肿的组织学改变及血清T_4降低、T_3升高;前者甲状腺上皮细胞增生较后者显著,后者甲状腺滤泡腔内胶质含量较多。低碘合并高锂摄入的大鼠,其甲状腺病变较单纯低碘或单纯高锂大鼠严重,并呈明显的胶性甲状腺肿组织学改变,血清T_4降低、T_3正常。可见高锂不仅有致甲肿作用,而且当它与低碘并存时,将加重甲状腺的病变,并使其向胶性甲状腺肿发展。     

共聚焦激光扫描显微镜(MRC600)活体观测川芎嗪和去甲基肾上腺素对休克状态下家兔大脑皮质内微循环的影响

目的 :共聚焦激光扫描显微镜活体观测川芎嗪和去甲基肾上腺素对休克状态下家兔大脑皮质内微循环的影响。方法 :在开放颅窗的家兔模型上 ,荧光素标记血浆 ,罗丹明 6G标记WBC ,用共聚焦激光扫描显微镜活体观测川芎嗪和去甲基肾上腺素对休克状态下家兔大脑皮质内微循环的影响 ,并经图像分析系统测量数据 ,用SAS软件包进行统计学分析。结果 :①川芎嗪抗休克效果优于去甲基肾上腺素 ;②去甲基肾上腺素在休克状态下对口径为 60 .15 μm的动脉血管处未引起明显的血管运动 ,而川芎嗪能引起血管运动 ,尤以大剂量川芎嗪引起强烈的血管运动 ;③川芎嗪和去甲基肾上腺素增加或保持血液缘流厚度不变 ,可能是两者抗休克机制发挥作用的途径之一 ;④川芎嗪和去甲基肾上腺素引起血管运动 ,尤以中小血管处明显。结论 :川芎嗪抗休克效果优于去甲基肾上腺素。川芎嗪和去甲基肾上腺素增加或保持血液缘流厚度不变 ,可能是两者抗休克机制发挥作用的途径之一     

应用多层螺旋CT对耳硬化症的术前评估价值

目的:评估MDCT在术前耳硬化症诊断中的作用。方法:收集经临床证实为耳硬化症、且CT扫描采用螺旋扫描病例共18例,采集的数据传输到4.1工作站,进行多平面重建。结果:18例共36耳显示异常:单独前庭窗异常18耳,表现为前庭窗扩大或狭小,周围骨质密度降低或镫骨底板板密度增高;前庭窗及蜗窗同时受累共8耳;主要累及耳蜗周围迷路骨质10耳,表现为耳蜗骨迷路边缘不整,呈条片状密度减低或双环征。MPR交互重建充分显示了所有重要解剖结构的位置、形态:其中3耳为颈静脉球高位。结论:MDCT可以正确显示耳硬化症病灶的细微改变,提供详细的术前诊断信息;结合MPR技术可全面观察病变范围,并充分显示颞骨内重要解剖结构的位置和形态。对于手术方案的设计、防止手术并发症和提高疗效等具有重要意义。     

心包内处理肺静脉根部或切除部分左房在晚期肺癌手术中的应用

目的:探讨切开心包处理肺静脉或切除部分左心房对提高晚期肺癌患者的外科手术切除率及提高手术疗效的作用.方法:对21例晚期肺癌患者施行肺叶或全肺切除时,在心包内处理肺静脉或切除部分左心房.其中左肺下叶切除6例、左全肺切除4例、右肺中下叶切除6例、右肺下叶切除3例、右全肺切除2例.结果:21例均手术顺利;术后并发心律失常2例,肺炎2例,均治愈.本组1年生存率61.9%(13/21)、3年生存率38.1%(8/21),其中2例生存＞5 a.结论:晚期肺癌累及肺静脉根部或左心房时,通过切开心包处理肺静脉或同时切除部分左心房可提高肿瘤的根治率.     

Biomechanical Properties of Esophagus during Systemic Treatment with Epidermal Growth Factor in Rats

The epidermal growth factor (EGF) is a growth factor with effects on many cell types and tissue. Morphometric and passive biomechanical properties were studied in isolated segments of the esophagus in 22 EGF-treated rats and 12 control rats. The rats were divided into groups with EGF treatment for 2, 4, 7, and 14 days (n=6 for each group except n=4 for the 14 days EGF-treatment group) or saline treatment (n=3 for each group). The mechanical test was performed as a distension experiment in vitro where the whole esophagus was stretched to its in situ length and distended with pressures up to 10 cm H₂O using a ramp distension protocol. The pressure and outer diameter were recorded. Circumferential stress (force per area) and strain (deformation) were computed from the diameter and pressure data using the zero-stress state as reference. The zero-stress state was obtained by cutting esophageal rings radially. This caused the rings to open up into a sector. EGF induced pronounced morphometric changes, e.g., the wall thickness, wall cross-sectional area, and inner and outer circumferential lengths significantly increased during the EGF treatment. Histological analysis showed mucosa and submucosa growth during EGF treatment. The opening angle and residual strains increased with the highest value in the 14 days EGF-treated group (P < 0.05). The change in opening angle depended largely on the change in mucosa thickness. Furthermore, the circumferential stiffness of the esophagus reached a maximum after 7 days EGF treatment (P < 0.01). © 2003 Biomedical Engineering Society. PAC2003: 8719Rr, 8717Ee     

生长抑素样免疫反应物在山羊脊髓和背根节的分布─ABC法研究

用免疫细胞化学ＡＢＣ法研究了生长抑素样免疫反应物在山羊脊髓和背根节的分布。在整个脊髓背角，出现浓密的生长抑素样纤维和终末网，在板层Ⅱ和Ⅲ形成不规则的波形带。在带的深面，大量的生长抑素阳性小细胞（直径小于１５μｍ）形成细胞带，这些细胞呈卵圆形或梭形，大多是双极细胞。在背角最表层仅有稀疏的生长抑素阳性纤维。这种分布型式显著不同于以前报道的其它动物。在胸髓中间外侧核有为数不多的生长抑素阳性细胞，在脊髓的其它部位如中间带区和腹角有少量散在纤维和终末。还发现纤细的生长抑素阳性纤维和终末网出现于骶髓中央管的背外侧区域。此外，在所有背根节只见到极少数生长抑素阳性神经元；切断背根时，相应节段的脊髓背角的生长抑素样免疫反应物无明显变化。本研究结果表明，山羊脊髓背角的生长抑素主要来源于脊髓背角的固有神经元，而不是背根节细胞。出现于脊髓板层Ⅱ和Ⅲ的生长抑素阳性神经元可能属于岛细胞。本研究还提示，生长抑素可能在脊髓的感觉和内脏运动系统中起作用，还表明生长抑素免疫反应物的分布存在着种属差异。     

Identification of MEN1 gene mutations in sporadic carcinoid tumors of the lung

Lung carcinoids occur sporadically and rarely in association with multiple endocrine neoplasia type 1 (MEN1). There are no well defined genetic abnormalities known to occur in these tumors. We studied 11 sporadic lung carcinoids for loss of heterozygosity (LOH) at the locus of the MEN1 gene on chromosome 11q13, and for mutations of the MEN1 gene using dideoxy fingerprinting. Additionally, a lung carcinoid from a MEN1 patient was studied. In four of 11 (36%) sporadic tumors, both copies of the MEN1 gene were inactivated. All four tumors showed the presence of a MEN1 gene mutation and loss of the other allele. Observed mutations included a 1 bp insertion, a 1 bp deletion, a 13 bp deletion and a single nucleotide substitution affecting a donor splice site. Each mutation predicts truncation or potentially complete loss of menin. The remaining seven tumors showed neither the presence of a MEN1 gene mutation nor 11q13 LOH. The tumor from the MEN1 patient showed LOH at chromosome 11q13 and a complex germline MEN1 gene mutation. The data implicate the MEN1 gene in the pathogenesis of sporadic lung carcinoids, representing the first defined genetic alteration in these tumors.      

多元文化需求就医服务体系构建及应用

目的调查外籍患者多元文化服务需求,构建就医服务体系,探究应用效果。方法采用“外籍患者多元文化服务需求问卷”,对某院2020年1月-6月372例外籍就诊患者进行调查,识别其多元文化服务需求,建立就医服务体系。结果外籍患者对语言交流的需求度最高（98.39%）,对医院环境的需求度最低（65.59%）。应用基于多元文化需求的就医服务体系后,外籍患者在语言交流、专业知识、隐私保护、饮食习惯、就诊流程、社交礼仪、医务人员服务态度和医院环境等方面的满意度均得以提高（P＜0.05）。结论多元文化服务需求调查在外籍患者就医服务体系构建中具有重要作用,有助于提高外籍患者就医满意度。     

基于Midkine/Notch2/Hey1信号通路探讨二陈汤加味对慢性阻塞性肺疾病大鼠的抗炎作用

目的 探讨二陈汤加味对慢性阻塞性肺疾病（COPD）大鼠肺组织中肝素结合因子（Midkine）/跨膜受体蛋白（Notch2）/Hey1信号通路中的影响及其抗炎的分子机制。方法 60只SD大鼠随机分为正常组、模型组、二陈汤加味低、中、高剂量组（5、10、20 g·kg^-1·d^-1）和γ-分泌酶抑制剂组（Notch1通路抑制剂,DAPT）,每组10只。以烟熏联合脂多糖（LPS）法制备COPD大鼠模型。二陈汤加味各干预组灌胃（ig）给药;DAPT组ig DAPT（0.02 g·kg^-1）;正常组及模型组ig等体积生理盐水。采用酶联免疫吸附测定法（ELISA）检测支气管肺泡灌洗液（BALF）中Midkine、中性粒细胞趋化因子-1（CINC-1）、大鼠巨噬细胞来源趋化因子（MDC）、大鼠CXC趋化因子5（CXCL5）、中性粒细胞弹性蛋白酶（NE）和核转录因子-κB（NF-κB）p65的含量;实时荧光定量聚合酶链式反应（Real-time PCR）检测肺组织中Midkine、Notch2和Hey1 mRNA表达;免疫组化（IHC）检测大鼠肺组织中Midkine、Notch2和Hey1蛋白表达。结果 与正常组比较,模型组BALF中Midkine、CINC-1、MDC、CXCL5、NE和NF-κB p65含量均显著升高（P<0.01）;肺组织Midkine、Notch2和Hey1 mRNA和蛋白表达均显著增加（P<0.01）。与模型组比较,二陈汤加味中、高剂量组和DAPT组BALF中Midkine、CINC-1、MDC、CXCL5和NF-κB p65含量均显著减少（P<0.01）;Midkine、Notch2和Hey1 mRNA表达显著下降（P<0.01）。结论 二陈汤加味对COPD有抗炎作用。其机制可能是通过下调Midkine、Notch2和Hey1 mRNA表达,抑制Midkine、CINC-1、MDC、CXCL5释放有关。     

Machine Learning Algorithms to Predict Mortality and Allocate Palliative Care for Older Patients With Hip Fracture

ObjectivesTo evaluate a machine learning model designed to predict mortality for Medicare beneficiaries aged >65 years treated for hip fracture in Inpatient Rehabilitation Facilities (IRFs).DesignRetrospective design/cohort analysis of Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility–Patient Assessment Instrument data.Setting and ParticipantsA total of 17,140 persons admitted to Medicare-certified IRFs in 2015 following hospitalization for hip fracture.MeasuresPatient characteristics include sociodemographic (age, gender, race, and social support) and clinical factors (functional status at admission, chronic conditions) and IRF length of stay. Outcomes were 30-day and 1-year all-cause mortality. We trained and evaluated 2 classification models, logistic regression and a multilayer perceptron (MLP), to predict the probability of 30-day and 1-year mortality and evaluated the calibration, discrimination, and precision of the models.ResultsFor 30-day mortality, MLP performed well [acc = 0.74, area under the receiver operating characteristic curve (AUROC) = 0.76, avg prec = 0.10, slope = 1.14] as did logistic regression (acc = 0.78, AUROC = 0.76, avg prec = 0.09, slope = 1.20). For 1-year mortality, the performances were similar for both MLP (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.96) and logistic regression (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.95).Conclusion and ImplicationsA scoring system based on logistic regression may be more feasible to run in current electronic medical records. But MLP models may reduce cognitive burden and increase ability to calibrate to local data, yielding clinical specificity in mortality prediction so that palliative care resources may be allocated more effectively.