儿科3.0 T专用磁共振对早产儿脑损伤图像质量评价研究

目的 比较3.0 T儿科专用磁共振和3.0 T全身磁共振评估早产儿脑部图像质量,以评估3.0 T儿科专用磁共振在早产儿脑部成像的应用价值。材料与方法 本研究分别在3.0 T儿科专用磁共振和3.0 T全身磁共振进行颅脑成像扫描,采集序列包括常规序列和扩散加权成像(diffusion weighted imaging,DWI)序列,并对两组T2加权成像序列进行主观评分,对3D T1加权成像序列信噪比(signal-to-noise ratio, SNR)、对比噪声比(contrast-to-noise ratio, CNR)和DWI的表观扩散系数(apparent diffusion coefficient,ADC)值进行测量。结果 主观评分显示,3.0 T儿科专用磁共振图像质量与3.0 T全身磁共振评分相当,达到临床诊断需求。儿科专用磁共振图像的双侧额叶、顶叶、颞叶、枕叶灰质和白质,中脑,小脑SNR与全身磁共振图像差异无统计学意义(P>0.05),CNR相当或优于全身磁共振;双侧额叶、顶叶、颞叶、枕叶ADC值与全身磁共振图像差异无统计学意义(P>0.05)。结论 3.0 T儿...     

腹腔镜下微创修补术对胃穿孔术后胃肠动力的影响分析

目的 观察腹腔镜下微创修补术对胃穿孔术后胃肠动力的影响分析。方法 将在医院（2018年1月1日—2020年12月30日）收治胃穿孔患者60例拟手术治疗,以随机数字表法分组,每组各30例患者,其中30例实施传统开腹手术为对照组,另30例患者则实施腹腔镜下微创修补术治疗为研究组。比较围手术期相关指标、胃肠动力指标,术前、术后3 d的机体应激指标与胃泌素分泌水平及疼痛评分,统计围手术期不良事件发生率。结果 研究组患者的手术时间、首次下床时间与住院时长均短于对照组,而术中出血量则少于对照组,差异有统计学意义（P <0.05）。研究组患者的胃肠动力指标恢复时间均明显的短于对照组,差异有统计学意义（P <0.05）。两组患者术前机体应激指标与胃泌素分泌水平及疼痛评分相比,差异无统计学意义（P> 0.05）。两组患者术后3 d时机体应激指标中SOD指标与胃泌素分泌水平则较术前提升,研究组高于对照组,而术后3 d的机体应激指标中MDA指标及疼痛评分均较术前降低,研究组低于对照组,差异有统计学意义（P <0.05）。研究组患者围手术期不良事件发生率低于对照组,差异有统计学意义（P...     

Acute myeloid leukemia: negative prognostic impact of early blast persistence can be in part overcome by a later remission prior to post-induction therapy

In acute myeloid leukemia, there is an ongoing debate on the prognostic value of the early bone marrow assessment in patients receiving intensive therapy. In this retrospective study, we analyzed the prognostic impact of the early response in 1,008 patients with newly diagnosed acute myeloid leukemia, who were treated at our institution with intensive chemotherapy followed by consolidation chemotherapy and/or allogeneic hematopoietic stem cell transplantation (HSCT). We found that early blast persistence has an independent negative prognostic impact on overall survival, event-free survival and relapse-free survival. This negative prognostic impact may only be overcome in patients showing at least a partial remission at the early bone marrow assessment and who subsequently achieve blast clearance by additional induction chemotherapy prior to consolidation therapy with allogeneic HSCT. In accordance, we propose that the time slope of remission is an additional leukemia-related dynamic parameter that reflects chemosensitivity and thus may inform post-induction therapy decision-making. In addition to patient-related factors, European LeukemiaNet risk group, measurable residual disease monitoring and donor availability, this may particularly apply to European LeukemiaNet intermediate-risk patients, for whom a decision between consolidation chemotherapy and allogeneic HSCT remains challenging in many cases.     

新一代基因组编辑技术在基因治疗及生物制药领域中的应用

近年来,随着锌指核酸酶、转录激活子样效应因子核酸酶和成簇可调控间隔短回文重复RNA引导核酸酶的出现,“基因组编辑”技术得到广泛应用。由于此类技术具有高效和可定制的特点,在基因治疗、细胞模型、糖基化工程、细胞工程等方面许多新策略、新方法不断涌现,产生了十分重要的影响。本文就近年来基因组编辑技术的发展及其在基因治疗和生物制药领域的应用进行综述。     

自体髓核移植接触神经根后大鼠诱发电位及神经显微结构的观察

目的:探索髓核移植接触神经根后对大鼠诱发电位及神经显微结构的影响。方法:20只SD大鼠随机分成2组,A组、B组分别取大鼠自体皮下筋膜脂肪及尾部的髓核组织,无压迫下放置在L4~5神经根周围。分别在术前、术后即刻、术后3天检测大鼠术侧诱发电位。3天时处死大鼠,进行神经根的病理切片观察。结果:A组大鼠感觉及运动诱发电位手术前后没有明显变化,B组诱发电位潜伏期延长。神经显微结构观察,A组少量炎性细胞浸润,B组神经外膜水肿、大量炎性细胞侵润,髓鞘水肿。结论:髓核接触神经根后可引起神经周围急性炎症病理改变,并引起神经传导功能的下降。     

Pregnancy outcomes in women with type 1 diabetes in China during 2004 to 2014: A retrospective study (the CARNATION Study)

BackgroundWe aimed to report pregnancy outcomes of women with type 1 diabetes (T1D) in China, on which data were sparse.MethodsThis is a nationwide retrospective study conducted in 11 general medical centers in 8 cities across China. We investigated the clinical data of all women who attended these centers with a singleton pregnancy and whose pregnancy ended between 1 January 2004 and 31 December 2014. Pregnancies of women with pregestational T1D were ascertained and compared with those of women without T1D.ResultsFrom over 300 000 pregnancies over the 11‐year study period, we identified 265 singleton pregnancies of women with T1D. One maternal death was documented among 265 (0.37%) women with T1D and 83 among 318 486 (0.03%) women without T1D. Women with T1D suffered from higher rates of pregnancy loss (13.21% vs 2.92%, crude risk ratio [cRR] 5.08 [95% CI, 3.56‐7.26]) and preeclampsia (17.74% vs 4.20%, cRR 4.94 [95% CI, 3.60‐6.77]) compared with those without T1D. Infants of these women with T1D had elevated rates of neonatal death (5.65% vs 0.16%, cRR 37.36 [95% CI, 21.21‐65.82]) and congenital malformation(s) (8.26% vs 3.53%, cRR 2.46 [95% CI, 1.54‐3.93]) compared with those of women without T1D. No significant improvement in pregnancy outcomes in women with T1D was observed over the period 2004 to 2014.ConclusionsPregnancy outcomes were persistently poor in women with T1D during 2004 to 2014 in China. Pregnancy care needs to be improved to reduce adverse pregnancy outcomes among Chinese women with T1D.     

Underlying mechanisms of saphenous vein graft stenosis after coronary artery bypass caused by clipping of the side branches: an experimental study

BackgroundSaphenous veins are regular bypass conduits selected in non-left anterior descending artery (LAD) coronary artery bypass graft (CABG) surgery. Despite the technical errors, acute thrombosis, intimal hyperplasia and arteriosclerosis which could lead to saphenous vein graft (SVG) failure, the metal-clipping-related SVG failure is unique and rare. This study was conducted to investigate the clinical and underlying mechanisms of the metal-clipping-related SVG failure.MethodsWe collected 6 typical cases of the metal-clipping-related SVG failure in 41 patients who were diagnosed graft stenosis by coronary angiograph after CABG in the Department of Cardiology, Beijing Anzhen Hospital, from January 2020 to September 2021. Furthermore, we built an in vitro model to verify the identical intravascular ultrasound (IVUS) pattern of metal clip.ResultsThere were 6 in 41 cases of SVG stenosis caused by clipping of the side branches. We found that the stenosis of SVG caused by metal clipping mostly occurred at the corner and multipole clipping points. In this situation, great resistance could be felt when pushing the instruments through the stenosis and crystallized cholesterol was rarely caught by the distal protection device. We verified the similar IVUS pattern of metal clip at the side-branches of SVG in vitro.ConclusionsThe metal-clipping-related stenosis may lead to SVG failure. The stenosis of SVG caused by metal clipping mostly occurred at the corner and multipole clipping points. IVUS showed great modality for clarification.     

维持性血液透析患者皮肤并发症的临床特点和护理对策

目的分析维持性血液透析患者皮肤并发症的临床特点,研究对应的护理方法。方法将该研究中的维持性血液透析且并发皮肤病的100例患者随机均分为护理组和对照组,对照组患者维持常规血液透析,护理组患者采用血液灌流联合血液透析法,同时,加强对患者的护理和健康指导,以2个月为一个观察期,对护理结果进行评判、统计疗效。结果护理组患者的皮肤病症状得到有效缓解,对照组患者的皮肤并发症情况没有明显改善。结论恰当的治疗护理、心理护理和健康教育等措施,对缓解维持性血液透析患者的皮肤并发症有显著功效。