超声造影在乳腺叶状肿瘤与纤维腺瘤鉴别诊断中的价值

目的探讨超声造影在乳腺叶状肿瘤与纤维腺瘤鉴别诊断中的应用价值。 方法选取我院病理诊断明确且术前进行过超声造影检查的患者（叶状肿瘤23例、纤维腺瘤57例）,回顾性分析其超声造影表现,采用χ²检验或t检验分析乳腺叶状肿瘤与纤维腺瘤在超声造影表现和病理中微血管密度间的关系。 结果乳腺叶状肿瘤与纤维腺瘤比较,边界是否清晰,差异无统计学意义（P>0.05）,而增强顺序、增强强度、均匀性三者比较,差异均有统计学意义（χ²=22.960、24.419、4.901,P均<0.05）。叶状肿瘤的超声造影表现为增强后边界清晰、散在的离心性不均匀低增强。纤维腺瘤超声造影表现为增强后边界清楚、向心性均匀高增强。 结论超声造影对乳腺叶状肿瘤与纤维腺瘤有一定的鉴别诊断价值,可为临床手术方法的选择提供参考。     

新形势下医疗救护员培养模式的探索

目的探讨在院外急救条例出台的背景下医疗救护员的培养模式,为解决院外急救人员招聘难,留住难,晋升难的实际困难。方法通过专家访谈法等定性方法,论证人才梯队培养模式的可行性。结果根据北京市朝阳区实际情况,建立四级院外急救医疗救护员梯队培养模式。结论通过培养模式的设置,形成人才流动,出入灵活的院外急救人才培养模式,同时为各类医疗卫生组织输送具备应急技能的医疗卫生人才。     

Phospholipase A2 inhibitor and LY6/PLAUR domain-containing protein PINLYP regulates type I interferon innate immunity

Type I interferons (IFNs) are the first frontline of the host innate immune response against invading pathogens. Herein, we characterized an unknown protein encoded by phospholipase A2 inhibitor and LY6/PLAUR domain-containing (PINLYP) gene that interacted with TBK1 and induced type I IFN in a TBK1- and IRF3-dependent manner. Loss of PINLYP impaired the activation of IRF3 and production of IFN-β induced by DNA virus, RNA virus, and various Toll-like receptor ligands in multiple cell types. Because PINLYP deficiency in mice engendered an early embryonic lethality in mice, we generated a conditional mouse in which PINLYP was depleted in dendritic cells. Mice lacking PINLYP in dendritic cells were defective in type I IFN induction and more susceptible to lethal virus infection. Thus, PINLYP is a positive regulator of type I IFN innate immunity and important for effective host defense against viral infection.

Interferon (IFN)-mediated antiviral responses serve as the first line of the host innate immune defense against viral infection. IFNs are divided into three families based on sequence homology: type I, type II, and type III (1, 2). The type I IFN family encodes 13 subtypes of IFN-α in humans (14 in mice), a single IFN-β subtype, and several poorly defined subtypes (3, 4). Type I IFNs were originally identified based on their ability to interfere with viral replication, restrain virus dissemination, and activate adaptive immune responses (5–7). They can be induced in most cell types by microbial pathogen-associated and damage-associated molecular patterns recognized by pattern recognition receptors (PRRs) (3). By inducing the expression of IFN-stimulated genes (ISGs), type I IFNs elicit antiviral innate immunity and mediate adaptive immune responses (8, 9).The induction of antiviral type I IFN response is elicited in response to the stimulation of PRRs that detect pathogen-associated molecular patterns, such as viral nucleic acids, viral replicative intermediates, and surface glycoproteins (10, 11). There are four major subfamilies of PRRs: the Toll-like receptors (TLRs), nucleotide-binding oligomerization domain/leucine-rich repeat-containing receptors, RIG-1-like receptors (RLRs), and the C-type lectin receptors, which are located at the cell surface, in the cytosol, or endosomal compartments (11–14). Among the TLR family members, TLR3, TLR7, TLR8, and TLR9 are involved in the recognition of viral nucleotides. Viral DNA enriched in CpG-DNA motifs is recognized by TLR9, single-stranded RNA is recognized by TLR7 and TLR8, and double-stranded RNA and its synthetic analog polyinosinic-polycytidylic acid (poly I:C) are recognized by TLR3 (15, 16). Some viral envelope proteins can be recognized by TLR4 or TLR2 (16, 17).Following viral infection, cytosolic DNA can be sensed by cyclic guanosine monophosphate (GMP)–adenosine monophosphate (AMP) synthase (cGAS) that induces the production of cyclic GMP-AMP (cGAMP) (18, 19). cGAMP functions as a second messenger that binds and activates the endoplasmic reticulum (ER) adaptor STING (19–22). Translocation of activated STING from the ER to the Golgi apparatus leads to the activation of kinase TBK1, which subsequently phosphorylates IRF3 and triggers the production of type I IFN (22–24). Cytosolic RNA can be recognized by the RLRs like RIG-1 and MDA5, which signal via mitochondrial antiviral signaling protein (MAVS; also known as CARDIF, IPS1, and VISA) and subsequently activate TBK1 and IRF3–IRF7, leading to the induction of type I IFNs and other antiviral genes (25–27).The lymphocyte antigen-6 (Ly6)/urokinase-type plasminogen activator receptor (uPAR) superfamily is characterized by the LU domain and a domain containing 10 cysteines that form distinct disulfide bridges, which create the three-fingered structural motif. The Ly6/uPAR family members regulate a wide range of functions in various cell types (28). Here, we uncovered the previously uncharacterized role of the Ly6/uPAR family member PINLYP in the induction of type I IFNs in response to DNA virus, RNA virus, and other TLR ligands. This study further defined the pivotal function of PINLYP in the effective host defense against virus infection.     

基于机器学习的儿科急诊患者候诊时间预测及关联分析研究

以首都儿科研究所附属儿童医院急诊患者就诊数据为基础,设计并提取19个就诊时间相关变量,构建6种不同的机器学习模型,用于儿科急诊就诊患者候诊时间预测,经检验预测模型表现良好。本研究有助于医院动态分配医疗资源,缓解急诊科拥挤程度,提高患者就诊满意度。     

老年人外周动脉粥样硬化与冠心病

外周动脉粥样硬化(AS)常与冠状动脉(冠脉)病变同时存在,近年研究已证实,颈动脉AS与冠心病(CHD)存在相同的病理生理变化和危险因素[1],二者有密切的关系;颈动脉AS在一定程度上代表了全身AS的进展情况。     

舌下腺癌在多形性腺瘤中1例

发生于舌下腺的癌在多形性腺瘤中极为罕见。本文报道 1例发生于舌下腺的腺样囊性癌在多形性腺瘤的病例。     

进展期结直肠癌动脉灌注新辅助化疗临床疗效观察

目的 探讨术前动脉灌注化疗对进展期结直肠癌的远期临床疗效.方法 选择ⅡB、Ⅲ期的结直肠癌患者128例,随机分为2组:试验组68例行术前动脉灌注化疗,方案为:奥沙利铂(艾恒)130mg/m2、羟基喜树碱20 mg/m2、氟脲苷600 mg/m2,经股动脉插管灌注化疗1、2次,8～14 d后接受手术治疗;对照组60例直接手术治疗.观察动脉灌注化疗不良反应及组织学疗效,比较2组手术切除率、手术并发症、术后病理分期及远期生存率.结果 试验组动脉灌注化疗不良反应主要表现为胃肠道反应和骨髓抑制,均属Ⅰ、Ⅱ度.试验组手术切除率为97.1%(66/68)、根治性切除率为96.9%,分别高于对照组的73.3%(44/60)和79.5%(x2=14.848、8.906,P均＜0.05);试验组组织学有效率达72.7%,病理分期均较术前降低,其中Ⅱ期病例明显较对照组增多(P＜0.05);试验组中位生存期为53.0个月,1、3、5年生存率分别为95.3%、85.9%、44.6%;对照组的中位生存期为42.0个月,1、3、5年生存率分别为92.6%、75.9%、22.0%,试验组生存率高于对照组,但只有5年生存率差异具有统计学意义(x2=6.385,P＜0.05).术后并发症2组比较差异无统计学意义(P＞0.05).结论 术前动脉灌注化疗对进展期结直肠癌降低临床分期、提高手术切除率尤其是根治性切除率作用和疗效确切,并能提高患者的远期生存率.

Abstract：

Objective To evaluate the curative effect of neoadjuvant chemotherapy via arterial infusion on advanced colorectal carcinoma. Methods One hundred and twenty-eight advanced colorectal carcinoma patients in stage Ⅱ B or Ⅲ were randomly divided into 2 groups. Sixty-eight cases received preoperative arterial infusion chemotherapy( the treatment group),and chemotherapy regimen consist of Oxaliplatin(L-OHP) 130 mg/m2, Hydroxycamptothecin (HCPT) 20 mg/m2 and Dexifluridine (FUDR)600 mg/m2. Femoral arterial infusion chemotherapy administrated 8 ～ 14 days preoperative. Sixty cases received surgery directly(the control group). The adverse reaction and histology effect after arterial infusion chemotherapy were observed, and resection rate,complications,pathology stage,together with long term survival were compared. Results Adverse reaction were mostly grade Ⅰ -Ⅱ gastrointestinal discomfort and bone marrow depression with arterial infusion chemotherapy. Resection rate was 97. 1% (66/68) ,and 64 cases(96. 9%) underwent raclical (R0) resection in the treatment group, which were higher than those in the the control group(73. 3%(44/60) and 79. 5%,respectively) (x2 = 14. 848,8. 906, Ps ＜ 0. 05). Histology effect of the treatment group was 72. 7%, and the pathology stage downstaged compared to preopeartion. Percent of patients in stage Ⅱ in the treatment group was higher than that in the control group( P ＜ 0. 05). The median survival time of test group was 53. 0 months, 1- ,3-,and 5-year survival rates were 95.3%,85.9% and 44.6%, respectively. In the control group, the median survival time was 42.0 months, 1-, 3-, and 5-year survival rates were 92.6%, 75.9% and 22.0%,respectively. There was significant difference in 5-year survival rate(x2 = 6. 385, P ＜ 0. 05). No difference in postoperative complications between two groups(P ＞ 0. 05). Conclusion The neoadjuvant chemotherapy via arterial infusion is of great significance on downstnging the pathology of advanced colorectal carcinoma, raising the excision rate, especially radical resection, and long term survival rate.