实时组织弹性成像对甲状腺结节良恶性的鉴别诊断

目的 探讨实时组织弹性成像在甲状腺结节良恶性鉴别诊断中的应用价值.方法 术前使用超声弹性成像技术对80例,共165个甲状腺结节进行常规超声检查,并予以弹性成像分级.结果 结节性甲状腺肿、腺瘤、亚急性甲状腺炎弹性分级以≤Ⅱ级为主,甲状腺癌弹性以≥Ⅲ级为主.良性结节的弹性分级以0～Ⅱ级为主,恶性结节以Ⅲ～Ⅳ级为主,甲状腺良恶性结节弹性分级比较差异有统计学意义（P〈0.05）.弹性分级Ⅲ级时,良恶性结节比较差异有统计学意义（P〈0.05）.对于甲状腺结节良恶性的鉴别,超声弹性分级诊断的敏感度、特异度和准确率分别为100%、93.9%及94.5%.结论 实时组织弹性成像对鉴别甲状腺结节良恶性有着重要的应用价值.     

辽宁省不同职业人群情感障碍、焦虑障碍和酒精使用障碍患病率分析

采用多阶段分层整群随机抽样方法,以复合性国际诊断交谈检查量表对全省6个市/县13 358名18～65岁城乡居民进行了入户调查,DSMⅢ-R标准诊断.结果 显示.情感障碍、焦虑障碍和酒精使用障碍的12月患病率分刺为2.01%、3.97%和3.27%.无业/待业人员(3.88%)、家务劳动者(3.46%)和下岗工人(2.90%)为情感障碍患病率高发人群,农、林、牧、渔劳动者的情感障碍患病率略低于平均水平.家务劳动者(11.24%)、农、林、牧、渔劳动者(4.83%)和无业/待业人员(4.47%)为焦虑障碍患病率最高的职业;国家企事业负责人(5.09%)、生产工人、运输工人和有关人员(5.01%)和无业/待业人员(3.75%)为酒精使用障碍患病高发的职业.     

德都红花-7味散原药方与优化方对肝纤维化大鼠Ⅰ,Ⅲ型胶原mRNA表达的影响

目的:探讨德都红花-7味散原药方及优化方对肝纤维化大鼠Ⅰ,Ⅲ型胶原mRNA表达的影响。方法:40只Wistar大鼠分为正常组、模型组、阳性药组、原药组、优化组。大鼠ip 30%CCl4橄榄油溶液建立肝纤维化模型。同时1次/日ig给药,阳性药组给予秋水仙碱片0.4 mg·kg-1;原药组给予德都红花-7味散0.6 g·kg-1;优化组给予德都红花-7味散优化方0.6 g·kg-1。连续40 d后处死大鼠。取肝脏天狼星红染色,观察肝组织纤维化程度和Ⅰ,Ⅲ型胶原分型。酶联免疫吸附法(ELISA)检测肝组织匀浆Ⅲ型前胶原和Ⅳ型胶原,层粘连蛋白(LN),透明质酸(HA)含量。实时荧光定量PCR法检测Ⅰ型胶原,Ⅲ型胶原mRNA表达变化。结果:天狼星红染色模型组Ⅰ,Ⅲ型胶原纤维较正常组增多,阳性药组、原药组、优化组Ⅰ,Ⅲ型胶原纤维较模型组减少。与正常组比较,酶联免疫法检测模型组Ⅳ型胶原,HA含量升高(P0.05)。与模型组比较,阳性药组、原药组、优化组Ⅲ型前胶原、Ⅳ型胶原、HA含量明显降低(P0.05)。实时荧光定量PCR法检测模型组Ⅰ型胶原mRNA和Ⅲ型胶原mRNA表达较正常组上调(P0.01)。阳性药组、原药组、优化组Ⅰ型胶原mRNA和Ⅲ型胶原mRNA表达较模型组下调(P0.01)。原药组、优化组Ⅰ型胶原mRNA表达较阳性药组下调(P0.05)。优化组Ⅰ型胶原mRNA表达较原药组下调(P0.05)。结论:德都红花-7味散原药方与优化方是通过抑制Ⅰ型胶原mRNA和Ⅲ型胶原mRNA的转录,达到阻断或延缓肝纤维化的发生发展,德都红花-7味散优化方优于原药方。     

Compound heterozygosity of novel missense mutations in the gamma-glutamyl-carboxylase gene causes hereditary combined vitamin K-dependent coagulation factor deficiency

Hereditary combined vitamin K-dependent (VKD) coagulation factor deficiency is an autosomal recessive bleeding disorder associated with defects in either the gamma-carboxylase, which carboxylates VKD proteins to render them active, or the vitamin K epoxide reductase (VKORC1), which supplies the reduced vitamin K cofactor required for carboxylation. Such deficiencies are rare, and we report the fourth case resulting from mutations in the carboxylase gene, identified in a Tunisian girl who exhibited impaired function in hemostatic VKD factors that was not restored by vitamin K administration. Sequence analysis of the proposita did not identify any mutations in the VKORC1 gene but, remarkably, revealed 3 heterozygous mutations in the carboxylase gene that caused the substitutions Asp31Asn, Trp157Arg, and Thr591Lys. None of these mutations have previously been reported. Family analysis showed that Asp31Asn and Thr591Lys were coallelic and maternally transmitted while Trp157Arg was transmitted by the father, and a genomic screen of 100 healthy individuals ruled out frequent polymorphisms. Mutational analysis indicated wild-type activity for the Asp31Asn carboxylase. In contrast, the respective Trp157Arg and Thr591Lys activities were 8% and 0% that of wild-type carboxylase, and their compound heterozygosity can therefore account for functional VKD factor deficiency. The implications for carboxylase mechanism are discussed.     

Cyclic neutropenia (CN): a clue to the control of granulopoiesis

A simple quantitative feedback model of granulopoiesis is presented and discussed within the framework of existing data on granulopoiesis in both normals and patients with cyclic neutropenia (CN). The model assumes that the controlled compartment is the bone marrow pool of mature neutrophils (PMNs), which sends a negative feedback signal to the mitotic pool of early granulocyte precursors (i.e., CFU-C, myeloblasts, etc.) thus controlling the granulocyte production rate. Three parameters are found to play important roles in determining the response of the system to perturbations. These are: TM, the granulocyte maturation time; a, a parameter reflecting the strength of the negative feedback exerted by mature PMNs on the granulocyte production rate; and b, a parameter describing the leakiness of the bone marrow for PMN egress. It is shown that depending on the relative magnitudes of a and b, the system will either respond to perturbations with a damped oscillation (a less than b: the normal state) or with a sustained oscillation (a greater than b: the CN state). In both cases, the oscillation period is found to approximately equal 2TM. Deductions of the values of a, b, and TM from experimental data are consistent with the predictions of the model and show an increased value of a in CN relative to the normal state. This suggests an overly active feedback mechanism as the pathophysiologic basis of CN. In addition, the model can explain how various therapeutic agent correct CN and also provides insight into why other hematologic cell lines and CSA oscillate in CN.     

大豆异黄酮对大鼠骨密度及骨代谢生化指标的影响

目的 研究植物雌激素-大豆异黄酮对大鼠骨密度及骨代谢生化指标的影响。方法 将断乳Wister大鼠按体重随机分为4组，分别给予基础饲料和不同剂量的大豆异黄酮。每周称体重，调整给食量。12周后处死大鼠，取脏器称重，计算脏体比值；剥离股骨，测骨矿物质含量(BMC)、骨密度(BMD)和骨钙、骨磷的含量；对血清中骨形成生化指标碱性磷酸酶、骨钙素和骨吸收生化指标抗酒石酸酸性磷酸酶进行检测，同时测定雌激素-雌二醇(E2)的含量。结果 具有弱雌激素样作用的大豆异黄酮对实验大鼠的子宫、卵巢无刺激作用。与对照组相比，给予大豆异黄酮能提高BMC、BMD及骨钙含量，并随剂量的增加而增大。大豆异黄酮可影响骨代谢，高剂量的大豆异黄酮(41．6mg／kg)同时抑制骨形成和骨吸收，使骨转化率降低，但对骨吸收的作用大于骨形成。给予大豆异黄酮组血清雌激素水平大于对照组。结论 大豆异黄酮通过调整骨代谢生化指标的活性，提高大鼠的骨钙含量和骨密度，可预防骨质疏松的发生。     

Bacteraemia post-autologous haematopoietic stem cell transplantation in the absence of antibacterial prophylaxis: a decade’s experience from Lebanon

Purpose

In this study, we assessed the incidence, contributing factors and outcome of prolonged neutropenia above 7 days and of bacteraemia in patients with lymphoma and multiple myeloma who underwent autologous haematopoietic stem cell transplantation (AHSCT) without antibacterial prophylaxis.

Methods

This is a retrospective chart review of 190 adult patients who underwent AHSCT between 2005 and 2015 at a Lebanese hospital.

Results

Neutropenia of 7 days duration and longer was documented in 66% of the patient population. Through univariate analysis, patients with lymphoma were significantly more likely to have prolonged neutropenia (≥?7 days) compared to those with myeloma. Mucositis above grade 3, diarrhoea and fever were more likely to occur in patients with prolonged neutropenia. Bacteraemia was documented in 12.6% of the patients. Total mortality rate was 3.7%, and that attributed to bacteraemia was 12.5% in the bacteraemia subgroup. Among bacterial isolates recovered from clinical specimens (89 isolates), 70% were Gram-negative, of which 57% were fluoroquinolone susceptible. Ninety-five percent of the Gram-negative bacteria causing bacteraemia were susceptible to fluoroquinolones.

Conclusion

Bacterial pathogens causing bacteraemia were still highly susceptible to fluoroquinolones, despite the high prevalence of fluoroquinolone-resistant strains in the general bacterial ecology. Accordingly, the pertinence of fluoroquinolone prophylaxis in the AHSCT setting warrants further investigation. Moreover, continuous surveillance of local antibiograms in this patient population has become a must in an era of preponderant antibiotic resistance.