不同亚型髓母细胞瘤中增殖细胞核抗原的表达差异及意义

目的 探讨增殖细胞核抗原在不同病理类型髓母细胞瘤中的表达差异和临床意义.方法 对34例髓母细胞瘤(经典型61.8%,促硬纤维增生型38.2%)进行增殖细胞核抗原的免疫组化染色,测定不同类型髓母细胞瘤的增殖细胞核抗原指数.结果 经典型髓母细胞瘤的增殖细胞核抗原指数为(81.45±9.29)%,促硬纤维增生型髓母细胞瘤增殖细胞核抗原指数为(39.86±8.37)%,不同髓母细胞瘤亚型的增殖细胞核抗原指数值存在显著差异(P＜0.01).结论 增殖细胞核抗原的表达差异,为不同亚型髓母细胞瘤的生物行为学差异提供了病理学依据,增殖细胞核抗原指数可以作为髓母细胞瘤恶性程度及患者预后判断指标.     

诊断性腹腔镜检查对患者肝肾功能的影响

目的 探讨诊断性腹腔镜检查对患者肝肾功能的影响。方法 对58例腹部疑难疾病患者腹腔镜检查前后的肝肾功能进行对比分析,其中腹水原因待查35例,腹水+腹部包块23例。结果 58例患者中诊断为结核性腹膜炎31例,恶性腹膜间皮瘤23例,腹膜转移癌(腺癌)2例,盆腔结核及慢性盆腔炎各1例。术前所有患者的肝肾功能均正常。术后24h,58例患者中仅4例ALT轻度升高,为40-60U/L,其余患者的ALT及所有患者的TBil、AST、GGT、BUN、Cr均在正常值范围内。术后48h所的患者的上述指标也均在正常值范围内。检查后24h、48h分别与检查前比较,P均>0.05。结论 腹腔镜检查对患者肝肾功能无明显影响。     

急性心肌梗死MRI与心肌坏死标记物及心电图的相关性研究

目的 探讨心脏MRI确定的心肌梗死的梗死质量、梗死百分比、左心室功能等参数与肌酸激酶同工酶(CK-MB)峰值、肌钙蛋白T(TnT)峰值及心电图(ECG)的相关性.方法 对19例首次发病3～7 d的急件心肌梗死患者行心脏MR检查.采用1.5 T MR仪行首过灌注成像及延迟强化成像.分别评价每例患者的梗死质量、梗死百分比、左心室功能,记录TnT峰值、CK-MB峰值并分析ECG.对正态分布资料行Pearson相关性检验,对非正态分布资料行Spearman相关性检验.用独立样本t检验进行2组计量资料的均数比较.结果 19例患者的梗死质量中位数为6,3 g,与左心室射血分数(LVEF)(54.1±15.4)/呈负相关(r=-0.563,P=0.012),与TnT峰值(中位数为0.8μg/L,r=0.487,P=0.0340)、左心室收缩末期容积指数(LVESVI;中位数为23.4 ml/m2,r=0.480,P=0.038)相关.梗死百分比(中位数为6.0/)分别与TnT峰值(r=0.583,P=0.009)、CK-MB峰值(中位数为43.0 U/L,r=0.470,P=0.042)、每搏输出量[LVSV;(57.6±15.0)ml,(r=-0.482,P:0.036)]相关.TnT峰值还与LVSV相关(r=-0.524,P=0.021).心肌梗死ST段抬高与非ST段抬高相比,受累段数(中位数分别为3.0和2.0,t:2.972,P=0.009)更多,TnT峰值(中位数分别为1.0和0.7μg/L,t=2.245,P=0.041)、CK-MB峰值(中位数分别为43和35 U/L,t=2.508,P=0.024)更高.结论 急性期心肌梗死的梗死质最直接影响左心室功能.TnT峰值是反映梗死三百分比及左心室功能的较好指标,ST段抬高心肌梗死的范围更大.     

中美婴儿运动表现测试常模差异分析

目的比较中美婴儿运动表现测试(TIMP)常模,明确本地化研究和修正的重要性,为指导TIMP在国内的推广提供依据。方法经TIMP手册正反译,评估人员培训、信度考核后,分别在华东、华北、华南、华中、西南、西北、东北区域11家医疗机构采样,建立中国TIMP常模,并就样本情况、得分情况及亚组分类与美国常模进行对比。结果中国TIMP常模共13个周龄组,样本总数为1 035例,其中男性占56%,女性占44%,汉族占比95%,少数民族5%,早产儿和足月儿分别占比31%、69%;美国常模共12个周龄组,样本总数为990例,其中男性占52%,女性48%,白种人占58%,黑种人25%,高危、中危、低危婴儿分别占比35%、30%、35%。中国TIMP常模各周龄组得分均值低于同周龄组的美国常模(P<0.01);中国常模第10、50、90百分位数曲线低于美国常模。中国常模足月儿与早产儿亚组对比,大多数周龄组得分无显著差异;美国常模中高危儿亚组得分显著低于低危组(P<0.001)。结论基于两国人口特征和儿童保健发展现状的不同,中美TIMP常模取样人群存在差异。中国常模各周龄组的得分均值低于美国常模同周...     

老年带状疱疹三例误诊原因分析

带状疱疹是由疱疹病毒侵犯神经引起其支配区疼痛及皮肤疱疹为特征的一种皮肤科疾患。老年人因部位不一的剧烈疼痛,常来理疗科(物理除痛)就诊。在发疹前期常因疼痛又无其他表现而误诊为内、外、神经科疾病。现将3例老年带状疱疹作回顾性分析,以探讨误诊原因。1病例资料【例1】女,68岁。既往有冠心病心绞痛病史3年。此次因胸闷、心前区隐痛伴相应背部疼痛2天,心电图提示个别导联T波低平入心内科。医生根据病史按心绞痛处理,效果不明显,患者尤感左侧胸痛及背疼明显,呈针刺状,历时数十秒,要求理疗。遂在背痛区外用小护士热敷贴,症状缓解不明显…     

Using machine learning to aid treatment decision and risk assessment for severe three-vessel coronary artery disease

BACKGROUNDThree-vessel disease (TVD) with a SYNergy between PCI with TAXus and cardiac surgery (SYNTAX) score of ≥ 23 is one of the most severe types of coronary artery disease. We aimed to take advantage of machine learning to help in decision-making and prognostic evaluation in such patients.METHODSWe analyzed 3786 patients who had TVD with a SYNTAX score of ≥ 23, had no history of previous revascularization, and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) after enrollment. The patients were randomly assigned to a training group and testing group. The C4.5 decision tree algorithm was applied in the training group, and all-cause death after a median follow-up of 6.6 years was regarded as the class label.RESULTSThe decision tree algorithm selected age and left ventricular end-diastolic diameter (LVEDD) as splitting features and divided the patients into three subgroups: subgroup 1 (age of ≤ 67 years and LVEDD of ≤ 53 mm), subgroup 2 (age of ≤ 67 years and LVEDD of > 53 mm), and subgroup 3 (age of > 67 years). PCI conferred a patient survival benefit over CABG in subgroup 2. There was no significant difference in the risk of all-cause death between PCI and CABG in subgroup 1 and subgroup 3 in both the training data and testing data. Among the total study population, the multivariable analysis revealed significant differences in the risk of all-cause death among patients in three subgroups.CONCLUSIONSThe combination of age and LVEDD identified by machine learning can contribute to decision-making and risk assessment of death in patients with severe TVD. The present results suggest that PCI is a better choice for young patients with severe TVD characterized by left ventricular dilation.

Coronary artery disease (CAD) is the leading cause of death and disability worldwide.^[1] Three-vessel disease (TVD) is the most severe form of CAD and is characterized by significant stenosis in all three major coronary arteries. The application of myocardial revascularization techniques, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), has significantly improved the clinical outcomes of patients with severe CAD. CABG has traditionally been the standard therapy for complex coronary lesions, including TVD.^[2] In recent years, with the advancements in PCI technology and the accumulation of operators’ experience, the incidence of periprocedural and long-term adverse events of PCI has substantially decreased, and PCI has been gradually applied in the treatment of TVD.^[3,4] Current guidelines recommend use of the SYNergy between PCI with TAXus and cardiac surgery (SYNTAX) score and diabetes status to guide the revascularization strategy for patients with TVD.^[5,6] Current practice guidelines do not recommend PCI for patients with TVD with a SYNTAX score of ≥ 23. However, using the SYNTAX score to guide clinical decision-making between PCI and CABG remains controversial, and its reasonability has been questioned since a newly published meta-analysis showed no significant association between the SYNTAX score and the comparative effectiveness of PCI and CABG.^[7] Moreover, the SYNTAX score is a quantitative indicator of the anatomical complexity of TVD and does not include clinical variables that may have significant effects on the patient’s prognosis. Whether some patients with specific clinical characteristics can obtain a comparable or even greater survival benefit from PCI than from CABG is unclear. Moreover, risk assessment for patients with TVD after revascularization therapy remain challenging.^[8–10]Machine learning has recently emerged as an important research method and has been successfully applied in many scientific fields, including clinical medicine.^[11–13] The decision tree algorithm, a common approach in machine learning, can handle non-linearity, heterogeneous effects, and high-dimensional features and partition a trial population into subgroups characterized by multiple simultaneous characteristics.^[14] In the present study involving a large cohort of patients with TVD with a SYNTAX score of ≥ 23, we employed a decision tree algorithm to generate specific subgroups, compared the long-term prognosis between patients who underwent PCI or CABG in each subgroup, and conducted a comparative analysis of the long-term prognosis between subgroups generated by machine learning. We evaluated whether machine learning can help in selecting the optimal revascularization method and assessing risk in patients with severe TVD.     

有源植入式医疗器械标准研究

介绍了国内、国际有源植入物分技术委员会及有源植入式医疗器械标准的现状.结合日常检测和具体实例,对现行标准中标记要求、包装要求和混合医疗相关要求等进行了总结和论述,有助于正确理解标准要求,并为该类医疗器械的研发、检验和评审等提供了思路和参考,保障了医患的用械安全.     

扶正治癌调控肿瘤免疫研究

中医学重视人体正气在恶性肿瘤防治中的关键作用,强调"调和阴阳,以平为期",刘嘉湘教授创建"以人为本"、"顾护正气"为核心特征的"扶正治癌"学术体系,强调调控机体内在抵抗力(含免疫功能)以防治恶性肿瘤;肿瘤免疫治疗的疗效已经在泛癌种范围内得以确认,被认为是"最有可能治愈癌症"的疗法.从肿瘤免疫学角度深入研究人体"正气"的...     

RNA干扰Geminin基因表达对脑胶质瘤恶性生物学行为的影响

目的:探讨Geminin基因沉默对人脑胶质瘤细胞恶性生物学行为的影响及可能的发生机制.方法:选取南通大学附属医院脑外科2018-2019年手术切除的20例神经胶质瘤患者的新鲜标本,qRT-PCR结合基因表达谱数据动态分析(gene expression profilling interactive analysis,G...     

间苯三酚与硫酸镁治疗先兆早产的临床效果比较

目的比较间苯三酚及硫酸镁治疗先兆早产的临床效果。方法对60例诊断为先兆早产的孕妇作为研究组,给予间苯三酚治疗,并选择43例符合相同条件的病例作为对照组,给予硫酸镁治疗。结果应用间苯三酚及硫酸镁治疗治疗能使有效率分别达90.0%和88.4%,延长孕周至37周数达83.3%和83.7%,两者疗效比较无显著性差异（P〉0.05）,但间苯三酚副作用较硫酸镁少。结论间苯三酚能有效抑制宫缩,是治疗先兆早产有效而且安全和方便的方法。