沙库巴曲缬沙坦在心力衰竭治疗中的应用

心力衰竭是一种慢性疾病，是心脏无法泵出足够的血液为其他身体器官提供氧气，从而引发呼吸短促、疲劳和水肿等症状。目前其治疗包括病因治疗、一般治疗、药物治疗及非药物治疗等，其中血管紧张素受体脑啡肽酶抑制剂（ARNI）是当前新研发出的一类抗心衰药物，沙库巴曲缬沙坦是其代表药物，具有阻断肾素-血管紧张-醛固酮系统（RAAS）及抑制脑啡肽酶（NEP）的双重作用，新的欧美指南均推荐用于射血分数降低心力衰竭（HFrEF）的治疗。本文现就沙库巴曲缬沙坦在心力衰竭治疗中的作用机理、临床试验、药物安全性作一综述，旨在为该病的临床治疗提供参考。     

Intermittent Internal Fixation With a Locking Plate to Preserve Epiphyseal Growth Function During Limb-Salvage Surgery in a Child With Osteosarcoma of the Distal Femur: A Case Report

Limb shortening is a problem associated with surgery for osteosarcoma of the lower extremity in adolescents, as the tumors frequently occur near the epiphysis. Herein we report the use of a less invasive stabilization system (LISS) and an intermittent fixation method to preserve the growth function of epiphysis in an 11-year-old patient with an osteosarcoma of the distal femur.The 11-year-old male presented with left knee enlargement and pain for 2 weeks, and magnetic resonance imaging (MRI) and biopsy were consistent with osteosarcoma of the left distal femur. After preoperative chemotherapy, en bloc tumor resection was performed with margins based on MRI findings preserving the epiphyseal growth plate, the tumor cavity was filled with inactivated bone and bone cement, and a LISS was used to stabilize the femur. Aggressive postoperative chemotherapy was given. Approximately 105 weeks after surgery radiography showed that the distal end of the plate had moved superior to the epiphysis along with bone growth. Locking screws were placed in the distal part of the LISS plate to stabilize the re-implanted bone, and external fixation was not needed.The patient was able to walk with the crutches 1 week postoperatively, and bear weight on the extremity 6 weeks postoperatively. At 6 years after surgery, the patient''s height had increased 52 cm, shortening of the affected limb was only 1 cm, and the circumference of the affected limb was 2 cm smaller than that of the contralateral limb. There was no significant discomfort in the affected limb, and there was no gait abnormality. The patient could jump and run, and could participate in sports including basketball and badminton to the same degree as his peers.In summary, the novel method of bone reconstruction and fixation provided good results in a child with an osteosarcoma of the distal femur. This fixation method preserves the osteogenic function of the epiphysis and restored bone integrity simultaneously, and provides good functional recovery.     

偏瘫性肩痛患者腋囊的MRI观测及临床意义

目的通过MRI技术观察偏瘫患者肩疼痛腋囊形态变化,为影像诊断提供依据。方法对47例偏瘫性肩疼痛患者(疼痛组)和47例正常肩部(对照组),运用MRI技术对肩关节腋囊进行测量,观察腋囊下肱盂韧带信号。结果偏瘫性肩疼痛的腋囊厚度(4.1±1.45)mm,高于对照组。腋囊腔高度(8.70±1.80)mm,腋囊腔宽度(4.31±0.56)mm,小于对照组。偏瘫性肩痛下肱盂韧带呈高信号出现率达21%,腋囊厚度与VAS呈正相关,与肩关节外展外旋呈负相关。结论脑中风中后期肩周炎是引起偏瘫性肩疼痛患者的常见原因,腋囊厚度是限制肩关节活动度的重要因素。     

Learning to Discretize: Solving 1D Scalar Conservation Laws via Deep Reinforcement Learning

Conservation laws are considered to be fundamental laws of nature. It has broad applications in many fields, including physics, chemistry, biology, geology, and engineering. Solving the differential equations associated with conservation laws is a major branch in computational mathematics. The recent success of machine learning, especially deep learning in areas such as computer vision and natural language processing, has attracted a lot of attention from the community of computational mathematics and inspired many intriguing works in combining machine learning with traditional methods. In this paper, we are the first to view numerical PDE solvers as an MDP and to use (deep) RL to learn new solvers. As proof of concept, we focus on 1-dimensional scalar conservation laws. We deploy the machinery of deep reinforcement learning to train a policy network that can decide on how the numerical solutions should be approximated in a sequential and spatial-temporal adaptive manner. We will show that the problem of solving conservation laws can be naturally viewed as a sequential decision-making process, and the numerical schemes learned in such a way can easily enforce long-term accuracy. Furthermore, the learned policy network is carefully designed to determine a good local discrete approximation based on the current state of the solution, which essentially makes the proposed method a meta-learning approach. In other words, the proposed method is capable of learning how to discretize for a given situation mimicking human experts. Finally, we will provide details on how the policy network is trained, how well it performs compared with some state-of-the-art numerical solvers such as WENO schemes, and supervised learning based approach L3D and PINN, and how well it generalizes.     

土耳其斯坦东毕吸虫磷酸丙糖异构酶基因的克隆及其序列分析

目的 克隆土耳其斯坦东毕吸虫磷酸丙糖异构酶的全长基因。方法 根据日本血吸虫和曼氏血吸虫磷酸丙糖异构酶基因的保守区设计引物，利用RT—PCR扩增出土耳其斯坦东毕吸虫磷酸丙糖异构酶基闪的大片段，再结合RACE技术分别得到磷酸丙糖异构酶基因的3’端和5’端，将3部分序列拼接后获得磷酸丙糖异构酶基因全长cDNA序列，并提交GenBank。结果 成功克隆了土耳其斯坦东毕吸虫磷酸丙糖异构酶基因全长cDNA序列并提交GenBank，登录号为DQ092331。结论 土耳其斯坦东毕吸虫磷酸丙糖异构酶基因全长cDNA的克隆为进一步表达及其生物学性能的分析提供了理论基础。     

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现将2005年我国小儿血液系统疾病的临床进展简述如下。1白血病白血病仍然是威胁我国儿童生命的严重疾病之一。由于社会、文化、经济及治疗条件的限制,儿童白血病坚持正规治疗者仍属少数。汤静燕等[1]随访上海地区(包括外地到沪治疗者)急性淋巴细胞白血病(ALL)244例,66例在诊断后不同时段放弃治疗(依从失败),总依从失败为29·5%,在经济发达的上海地区尚且如此,对于经济欠发达地区由此可见一斑。因此,作者提出应当针对不同地区制定治疗强度减弱的化疗方案,倘若能获得50%~60%的5年无病生存率也是一个进步。该组患儿入院并治疗满15d者164例,治…     

桃红四物汤治疗雷诺氏病44例

近年来,笔者采用桃红四物汤治疗雷诺氏病44例,疗效满意,现报告如下. 一般资料 44例患者均为门诊病人,其中女性35例,男性9例;年龄16～58岁,平均26.7岁;病程1～6个月13例,7个月～1年22例,1年以上9例.主要症状均表现为手指皮肤苍白,继而青紫,先从手指尖开始,逐渐累及手指或全掌,呈典型的“手套征”,伴有局部冷、麻、针刺样疼痛或其他异常感觉,接触冷水或遇寒冷或情绪变化时发作,一般脉象沉细.本病发作十数分钟至1小时后症状可自行消失,严重者须保暖治疗（如将患指浸于温水中）方可缓解,皮肤转为潮红,然后恢复正常肤色.     

外科学教学中的审美教育

医学审美教育是医学生全面素质教育不可分割的组成部分,笔者结合长期外科教学实践,阐述了在外科学教学中运用医学美学原理对外科学的美进行开发和挖掘,使医学生在熟练掌握外科学基本理论和基本技能的同时,潜移默化地接受美的教育,美的熏陶,更能激发他们对外科学的热爱和兴趣,达到全面提高医学生整体素质的目的。     

Strategies to enhance transductional efficiency of adenoviral-based gene transfer to primary human fibroblasts and keratinocytes as a platform in dermal wounds

Genetically modified keratinocytes and fibroblasts are suitable for delivery of therapeutic genes capable of modifying the wound healing process. However, efficient gene delivery is a prerequisite for successful gene therapy of wounds. Whereas adenoviral vectors (Ads) exhibit superior levels of in vivo gene transfer, their transductional efficiency to cells resident within wounds may nonetheless be suboptimal, due to deficiency of the primary adenovirus receptor, coxsackie-adenovirus receptor (CAR). We explored CAR-independent transduction to fibroblasts and keratinocytes using a panel of CAR-independent fiber-modified Ads to determine enhancement of infectivity. These fiber-modified adenoviral vectors included Ad 3 knob (Ad5/3), canine Ad serotype 2 knob (Ad5CAV-2), RGD (Ad5.RGD), polylysine (Ad5.pK7), or both RGD and polylysine (Ad5.RGD.pK7). To evaluate whether transduction efficiencies of the fiber-modified adenoviral vectors correlated with the expression of their putative receptors on keratinocytes and fibroblasts, we analyzed the mRNA levels of CAR, alpha upsilon integrin, syndecan-1, and glypican-1 using quantitative polymerase chain reaction. Analysis of luciferase and green fluorescent protein transgene expression showed superior transduction efficiency of Ad5.pK7 in keratinocytes and Ad5.RGD.pK7 in fibroblasts. mRNA expression of alpha upsilon integrin, syndecan-1 and glypican-1 was significantly higher in primary fibroblasts than CAR. In keratinocytes, syndecan-1 expression was significantly higher than all the other receptors tested. Significant infectivity enhancement was achieved in keratinocytes and fibroblasts using fiber-modified adenoviral vectors. These strategies to enhance infectivity may help to achieve higher clinical efficacy of wound gene therapy.