Analysis of parametric histogram from dynamic contrast‐enhanced MRI: application in evaluating brain tumor response to radiotherapy

Dynamic contrast‐enhanced MRI (DCE MRI) has been used to study tumor response to treatment for many years. In this study, the modified full width at half‐maximum (mFWHM), calculated from the wash‐in slope histogram, is proposed as a parameter for the evaluation of changes in tumor heterogeneity which respond to radiotherapy. Twenty‐five patients with brain tumors were evaluated and divided into the nonresponder group (n = 11) and the responder group (n = 14) according to the Response Evaluation Criteria in Solid Tumors (RECIST). All selected tumors were evaluated by mFWHM ratios of post‐ to pre‐therapy (the ratio was defined as the therapeutic mFWHM ratio, TMR). The changes in kurtosis of the histograms and the averaged K^trans within a tumor were also calculated for comparison. The receiver operating characteristic analysis and Kaplan–Meier curves were used to examine the diagnosis ability. The TMR values were significantly higher in nonresponders than in responders (p < 0.001). When compared with the other two parameters, the proposed method also demonstrated better sensitivity and specificity. When adopting the TMR for the estimation of prognosis after therapy, there was a significant difference between the population survival curves. In conclusion, the derived mFWHM reflects tumor heterogeneity, and the ability to depict patient survival probability from TMR corresponds well with that from RECIST. The results reveal that, in brain tumors, progression may be exhibited not only by tumor size, but also by tumor heterogeneity. Copyright © 2012 John Wiley & Sons, Ltd.     

医院职工带薪休假制度实施的现状调查与分析

目的 了解某三级综合医院职工带薪休假制度实施的现状及休假完成情况的影响因素，为逐步完善相关管理制度提供依据。方法 采用问卷调查方式对北京某三甲医院的1850 名职工进行调查。结果 医务人员对带薪休假制度普遍知晓，对落实情况感到满意。过去一年中，职工年假休完率为79.7%。医务人员带薪休假情况受职工个人基本情况、工作岗位、科室是否鼓励休假、休假时间及方式等多因素影响。结论 管理理念是落实带薪休假制度的关键，建议完善管理制度，保障职工带薪休假落实，同时加强人文关怀，建立非物质薪酬管理文化。     

高频超声与磁共振对急性外伤性髌骨外侧脱位的对比研究

目的比较分析高频超声与磁共振(MRI)对急性外伤性髌骨外侧脱位的诊断价值。方法对33例临床证实急性外伤性髌骨外侧脱位的高频超声和MRI资料,以手术结果为金标准,计算高频超声、MRI诊断各种伴随伤的敏感性、特异性和准确性,比较两种检查方法的有效性。结果与手术结果比较,高频超声、MRI诊断MPFL部分撕裂的敏感性、特异性、准确性分别为85.7%、85.7%,94.7%、89.5%,90.9%、87.9%;诊断MPFL完全撕裂的敏感性、特异性、准确性分别为94.7%、89.5%,85.7%、85.7%,90.9%、87.9%。高频超声、MRI诊断关节软骨Ⅱ级损伤的敏感性、特异性、准确性分别为36.4%、81.8%,85%、100%,67.7%、93.5%。高频超声、MRI诊断关节软骨Ⅲ级损伤的敏感性、特异性、准确性分别为81.8%、90.9%,85%、90%,83.9%、90.3%;高频超声、MRI诊断关节软骨Ⅳ级损伤的敏感性、特异性、准确性分别为100%、100%,90.9%、95.5%,93.5%、96.8%。高频超声对MPFL撕裂、关节软骨损伤的诊断与MRI比较差异无统计学意义(P>0.05)。结论高频超声检查与MRI检查同样能对急性外伤性髌骨外侧脱位的各种伴随损伤明确诊断和准确分级,是一种简单可靠、快捷并可重复的诊断方法,可作为急性外伤性髌骨外侧脱位的常规检查方法。     

卡培他滨中有机残留溶剂的检测

目的建立气相色谱法测定卡培他滨原料药中二氯甲烷、乙醇、甲醇和乙酸乙酯4种有机溶剂。方法采用DB-624毛细管柱,FID检测器,以DMSO为溶剂。结果各有机溶剂的平均加样回收率为93.7%～97.6%,RSD为2.5%～3.7%。结论该方法稳定准确,可用于卡培他滨中有机溶剂残留的检测。     

The Akkermansia muciniphila is a gut microbiota signature in psoriasis

Psoriasis is an immune‐mediated chronic inflammatory skin disease. Although its pathogenesis is not fully understood, Th17 cells and the cytokines they produce, such as IL‐17, IL‐22 and IL‐23, play critical roles in the pathogenesis of psoriasis. Evidence has demonstrated that psoriasis has some common features, including immune responses (due to Th17 cells) and inflammatory cytokine profiles, with systematic diseases including inflammatory bowel diseases (IBDs) and obesity. Recently, studies have demonstrated that the gut microbiota plays a crucial role in host homoeostasis and immune response, particular in Th17 cells, but the role of the gut microbiota in psoriasis remains unclear. To study the relationship between gut microbiota and psoriasis, we analysed microbiota profiles in psoriasis using a 16S rDNA sequencing platform, and we found that the abundance of Akkermansia muciniphila was significantly reduced in patients with psoriasis. A. muciniphila is believed to have an important function in the pathogenesis of IBD and obesity; therefore, A. muciniphila, which is an indicator of health status, may be a key node for psoriasis as well as IBD and obesity. Taken together, our study identified that gut microbiota signature and function are significantly altered in the gut of patients with psoriasis, which provides a novel angle to understanding the pathogenesis of psoriasis.     

联合用药镇痛在肝破裂出血肝切除术中的应用研究

目的 比较肝破裂出血急诊行肝切除术后联合用药镇痛和传统模式镇痛对镇痛效果、术后恢复情况及相关并发症的影响.方法 选取50例肝破裂出血急诊行肝切除术后患者为研究对象,分为联合用药镇痛组和传统模式镇痛组,每组25例.联合用药镇痛组术后静脉留置自控镇痛(PCA)泵(地佐辛20 mg)+帕瑞昔布钠40 mg静脉注射+按需口服镇痛药;传统模式镇痛组术后仅用PCA泵.比较两组患者术后的视觉模拟评分法(VAS)评分、恢复情况和术后10 d相关并发症发生率.结果 联合用药镇痛组术日晚21点及术后1、2、3和4 d VAS评分分别为(4.7±0.8)、(4.2±0.9)、(2.8±0.7)、(2.6±0.6)和(1.6±0.6)分,明显低于传统模式镇痛组的(5.8±0.8)、(5.0±0.6)、(3.8±0.7)、(3.0±0.5)和(2.5±0.6)分(P<0.05).联合用药镇痛组术后首次离床时间、首次排气时间、首次排便时间、首次流质时间均明显早于传统模式镇痛组(P<0.05).两组患者术后10 d均未发生并发症.结论 联合用药镇痛可明显降低肝破裂出血急诊行肝切除手术患者术后疼痛的主观感受.     

童Stevens-Johnson综合征和中毒性表皮坏死松解症：一项回顾性研究

目的 分析儿童Stevens-Johnson综合征(Stevens-Johnson syndrome，SJS)、中毒性表皮坏死松解症（toxic epidermal necrolysis，TEN）和SJS/TEN重叠患儿的致病因素、临床特征、治疗管理以及并发症和预后。 方法 回顾性分析SJS患儿32例、SJS/TEN重叠患儿28例和TEN患儿25例的临床资料。 结果 最常见的致病药物是抗生素(31.7%)、中成药制剂（30.6%）、非甾体抗炎药(17.6%)和抗惊厥药(14.1%)。肺炎支原体（21例，24.7%）是最常见的病原。32例（37.6%）患儿至少存在一种并发症，最常见的并发症是感染(26例，30.6%)，其中皮肤感染（12例，14.1%）和下呼吸道感染（8例，9.4%）。住院期间，8例患儿接受单纯免疫球蛋白治疗，35例接受单纯静脉糖皮质激素治疗，37例患儿同时接受两者，采用静脉丙球联合激素组病死率最低。死亡8例，病死率为9.4%。死亡者入院第1天中毒性表皮坏死松解症严重程度评分(severity-of-illness score for toxic epidermal necrolysis，SCORTEN）评分高于存活者(P＜0.05)。 结论 抗生素和中成药是常见的致敏药物，皮肤感染是常见的并发症，SCORTEN评分≥3分死亡风险增加，系统应用糖皮质激素并早期予以静脉注射免疫球蛋白可能是治疗 SJS 和 TEN 的有效手段。