经静脉途径应用Eval胶联合弹簧圈栓塞治疗海绵窦区硬脑膜动静脉瘘

目的 探讨经静脉入路应用Eval胶联合弹簧圈栓塞治疗海绵窦区硬脑膜动静脉瘘（CS-DAVF）的安全性和有效性。方法 回顾性分析2015年1月至2020年10月收治的17例CS-DAVF的临床资料。所有病人均经静脉入路应用Eval胶联合弹簧圈栓塞治疗。结果 术后即刻DSA显示,17例CS-DAVF均完全栓塞。术后早期出现治疗相关并发症5 例（29.41%）,其中头痛2例,动眼神经麻痹2例,外展神经麻痹1 例。术后随访3~24个月,平均7.3个月;改良Rankin量表评分0分16 例,1分1例（遗留动眼神经麻痹）。结论 经静脉入路使用Eval胶联合弹簧圈栓塞治疗CS-DAVF,效果良好,治愈率高,并发症少。     

AlphaLISA检测新型冠状病毒

目的 建立均相光激化学发光免疫分析方法(AlphaLISA)快速检测新型冠状病毒(SARS-CoV-2).方法 采用新型冠状病毒抗体偶联发光微球,生物素标记另一抗体,以及链霉亲和素偶联感光微球构建新型冠状病毒AlphaLISA检测体系.采用SARS-CoV-2真核表达抗原和灭活病毒对AlphaLISA方法进行评价,并与商业化ELISA试剂盒进行比对.结果 确定单抗1#与多抗组别作为新型冠状病毒AlphaLISA检测的抗体对,AlphaLISA对新型冠状病毒抗原的检出限为0.39 ng/ml,具有较好的重复性,批内差1.90％～8.93％,批间差1.75％～9.04％,对不同临床样本的检测具有较好的耐受性,与ELISA试剂盒相比对灭活病毒的检测敏感性更高.结论 AlphaLISA可实现对SARS-CoV-2的高效快速检测.     

Development of an instrument for the identification of frail older people as a target population for integrated care

Background

Primary care is increasingly interested in the identification of frailty, as it selects the target population for integrated care. However, instruments for the identification of frailty specifically validated for use in primary care are scarce. This study developed the Easycare Two-step Older persons Screening (Easycare-TOS), which provides a valid, efficient, and pragmatic screening procedure to identify frail older people.

Aim

This paper aims to describe the development of the Easycare-TOS and the data from the pilot studies.

Design and setting

Observational pilot study in seven academic GP practices in and around Nijmegen, The Netherlands.

Method

The Easycare-TOS was developed in a cyclic process with the input of stakeholders. In every cycle, the requirements were first defined, then translated into a prototype that was tested in a pilot study. The Easycare-TOS makes optimal use of prior knowledge of the GP, and the professionals’ appraisal is decisive in the frailty decision, instead of a cut-off score. Further, it considers aspects of frailty, as well as aspects of the care context of the patient.

Results

The pilot data have shown that after step 1, two-thirds of the patients do not need further assessment, because they are judged as not frail, based on prior knowledge of the GP. The overall prevalence of frailty in this pilot study is 24%. Most professionals who participated in the pilot studies considered the time investment acceptable and the method to be of added value.

Conclusion

The Easycare-TOS instrument meets the predefined efficiency, flexibility, and acceptability requirements for use as an identification instrument for frailty in primary care.     

结直肠癌中miR-21的表达及其临床病理学意义

目的 探讨结直肠癌组织中miR-21的表达及其临床病理学意义.方法 采用TaqMan实时定量RT-PCR法检测43例结直肠癌组织及其癌旁正常组织中miR-21的表达,分析miR-21的表达与结直肠癌临床病理因素之间的关系.结果 miR-21在结直肠癌组织中的表达明显高于癌旁正常组织(P<0.05),结直肠癌组织中miR-21的表达与肿瘤病理学分级、淋巴结转移及术后生存率密切相关(P<0.05),与患者性别、年龄、肿瘤部位等无明显相关性(P>0.05).结论 miR-21在结直肠癌中表达升高,miR-21高表达同结直肠癌病理学分级、淋巴结转移及术后生存率密切相关,miR-21可能在大肠癌的发生、发展过程中发挥重要作用.     

Three-dimensional finite element analysis of the influence of an abutment buffer layer on implant stress distribution

目的 应用三维有限元法分析动态载荷下基台缓冲层对种植体应力分布的影响。方法 根据CT扫描数据建立种植体在人类下颌骨的三维实体几何模型,在种植体上方分别制作基台无缓冲层和基台有缓冲层的修复体,缓冲部分由高聚合度聚氯乙稀制作。分别对2种修复体施加垂直向载荷200 N、水平向载荷100 N（45°）,加载集中于种植体顶部中心。通过三维有限元法分析种植体、中央螺栓、基台的体部和颈部以及下颌骨各部位受到的应力。结果 基台有缓冲层时种植体、中央螺栓、基台的体部和颈部以及下颌骨各部位上受到的应力均明显小于基台无缓冲层时。结论 基台有缓冲层可显著降低种植体、中央螺栓、基台以及下颌骨各部位受到的应力。     

Internet-Based,Culturally Sensitive,Problem-Solving Therapy for Turkish Migrants With Depression: Randomized Controlled Trial

Background

Turkish migrants living in the Netherlands have a high prevalence of depressive disorders, but experience considerable obstacles to accessing professional help. Providing easily accessible Internet treatments may help to overcome these barriers.

Objective

The aim of this study was to evaluate the effectiveness of a culturally sensitive, guided, self-help, problem-solving intervention through the Internet for reducing depressive symptoms in Turkish migrants.

Methods

A two-armed randomized controlled trial was conducted. The primary outcome measure was the severity of depressive symptoms; secondary outcome measures were somatic symptoms, anxiety, quality of life, and satisfaction with the treatment. Participants were assessed online at baseline, posttest (6 weeks after baseline), and 4 months after baseline. Posttest results were analyzed on the intention-to-treat sample. Missing values were estimated by means of multiple imputation. Differences in clinical outcome between groups were analyzed with a t test. Cohen’s d was used to determine the between-groups effect size at posttreatment and follow-up.

Results

Turkish adults (N=96) with depressive symptoms were randomized to the experimental group (n=49) or to a waitlist control group (n=47). High attrition rates were found among the 96 participants of which 42% (40/96) did not complete the posttest (6 weeks) and 62% (59/96) participants did not complete the follow-up assessment at 4 months. No significant difference between the experimental group and the control group was found for depression at posttest. Recovery occurred significantly more often in the experimental group (33%, 16/49) than in the control group (9%, 4/47) at posttest (P=.02). Because of the high attrition rate, a completers-only analysis was conducted at follow-up. The experimental group showed significant improvement in depression compared to the control group both at posttest (P=.01) and follow-up (P=.01).

Conclusions

The results of this study did not show a significant effect on the reduction of depressive symptoms. However, the effect size at posttest was high, which might be an indicator of the possible effectiveness of the intervention when assessed in a larger sample and robust trial. Future research should replicate our study with adequately powered samples.

Trial Registration

Dutch Trial Register: NTR2303. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2303 (Archived by WebCite at http://www.webcitation.org/6IOxNgoDu).     

婴幼儿分娩性臂丛神经损伤的磁共振成像技术最新进展

婴幼儿臂丛神经损伤多由分娩过程中牵拉性损伤所致,延误诊治、错过最佳治疗时机,会导致患儿遗留不同程度的肢体功能障碍.随着磁共振技术的不断发展,磁共振成像技术在成人臂丛神经中的应用已较为成熟,但儿童尤其是婴幼儿的臂丛神经磁共振成像技术应用刚刚开始起步,笔者通过文献学习及结合北京儿童医院、保定市儿童医院在婴幼儿臂丛神经损伤的磁共振成像的临床应用经验,对婴幼儿臂丛神经损伤的磁共振成像技术的最新进展予以综述.     

妊娠并发甲减患者血清脂蛋白相关磷脂酶A2水平与母婴预后的相关性分析

目的　探讨血清脂蛋白相关磷脂酶A2（LP-PLA2）水平在妊娠并发甲减患者中的表达,并分析其与母婴预后的关系。方法　选取2018年7月~2020年7月妊娠并发甲减患者105例作为研究对象,其中妊娠并发临床甲减46例作为临床甲减组,妊娠并发亚临床甲减59例作为亚临床甲减组,另选取同期产检健康者50例作为对照组。采用酶联免疫吸附法检测血清LP-PLA2水平,采用全自动生化分析仪检测血清三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）水平,并记录母婴结局。采用Pearson检验分析妊娠并发甲减患者血清LP-PLA2与血脂水平的相关性;采用ROC曲线分析血清LP-PLA2及血脂水平对妊娠并发甲减患者母婴不良结局的预测价值。结果　三组患者血清LP-PLA2,TG,TC和LDL-C和HDL-C水平比较,差异均有统计学意义（F=31.177,97.170,18.242,25.286和9.423,均P＜0.05）;血清LP-PLA2,TG,TC,LDL-C水平由高到低为临床甲减组、亚临床甲减组、对照组,血清HDL-C水平由高到低为对照组、亚临床甲减组、临床甲减组,两两比较差异均有统计学意义（均P＜0.05）。妊娠并发甲减患者血清LP-PLA2与TG,TC,LDL-C水平均呈正相关（r=0.504,0.481和0.552,均P＜0.05）,与HDL-C水平呈负相关（r=-0.433,P＜0.05）。亚临床甲减组和临床甲减组患者总母婴不良结局发生率分别为69.49%和78.26%,均明显高于对照组（32.00%）,差异有统计学意义（均P＜0.05）。母婴不良结局组患者血清LP-PLA2,TG,TC和LDL-C水平均明显高于母婴正常结局组（t=4.389,4.072,2.662,3.099,均P＜0.05）,血清HDL-C水平明显低于母婴正常结局组（t=3.131,P＜0.05）。血清LP-PLA2水平预测妊娠并发甲减患者母婴不良结局的价值（曲线下面积0.942,敏感度和特异度分别为85.50%和96.40%）高于血脂指标。结论　妊娠并发甲减患者血清LP-PLA2水平升高,可作为评估母婴不良结局的血清指标。     

In which stage we diagnose and how we treat lung cancer?

To determine the stage of the disease, performance status of the patients on admission and treatment modalities, records of 226 patients with lung cancer diagnosed between January 1992 and December 1999 were evaluated retrospectively. The mean age of the patients were 61.3 +/- 10.3 years (mean +/- standard deviation) and 217 (96%) were men and 9 (4%) were women. Of the 192 cases with non-small cell lung cancer 22.9% were stage 4, 40.6% were stage 3b, 22.4% were stage 3a, 4.2% were stage 2, 9.9% were stage 1. Of the 34 (15.1%) patients with small cell lung cancer, 26.5% were extensive and 73.5% were in limited stages. The performance status according to European Cooperative Oncology Group (ECOG) was between 0-2 in 88.4% and 3-4 in 11.6% of the cases. A positive correlation between the performance status and the stage of the disease was observed (p= 0.0331). It was detected that the performance status of the patients who underwent surgery was better than the patients who treated with radiotherapy (p= 0.0008). Radiotherapy (RT), chemotherapy (CT), surgery, combined therapy (RT + CT), adjuvant RT and palliative therapy were performed in 27%, 20.4%, 11.5%, 1.3%, 1.8% and 14.6% of the cases respectively. No information about treatment protocol was able to obtained in 23.4% of the patients, probably due to referrals, early deaths etc. In conclusion, more than half of our cases with lung cancer were diagnosed in advanced stages as a possible result of late admission to physician and surgery were performed in only a small part of the cases. It was detected that performance status of the patients operated was better than the patients treated with radiotherapy. On the other hand, combination therapy was applied in few cases.