~1H-MRS对肺癌脑转移瘤患者放疗疗效的评价

目的:通过测量肺癌脑转移瘤瘤体放射治疗前后MRS代谢物浓度,探讨1 H-MRS代谢物浓度的变化对肺癌脑转移瘤放疗疗效评价的价值。方法:选取经临床及影像学证实的原发性肺癌脑转移患者,患者于放疗前、后均行MRI增强扫描及MRS。将放疗后脑转移瘤的代谢物浓峰比值Cho/Cr、Cho/NAA行配对t检验,同时在治疗前后对肺癌脑转移患者进行Karnofsky(卡氏,KPS,百分法)功能状态评分,将放疗前后脑转移瘤瘤体代谢物比值的变化与KPS评分的变化进行相关性分析。结果:放疗前后转移瘤各峰比值的差值(d)为1.92±0.58,通过对d行正态性检验,2组间差异具有统计学意义(P=0.020 7)。结论:1 H-MRS可定量评估肺癌脑转移患者的治疗效果,对其疗效判定有一定的参考价值。     

Exercise,physical activity,and exertion over the business cycle

Shifts in time and income constraints over economic expansions and contractions would be expected to affect individuals' behaviors. We explore the impact of the business cycle on individuals' exercise, time use, and total physical exertion, utilizing information on 112,000 individual records from the 2003–2010 American Time Use Surveys. In doing so, we test a key causal link that has been hypothesized in the relation between unemployment and health, but not heretofore assessed. Using more precise measures of exercise (and other activities) than previous studies, we find that as work-time decreases during a recession, recreational exercise, TV-watching, sleeping, childcare, and housework increase. This, however, does not compensate for the decrease in work-related exertion due to job-loss, and total physical exertion declines. These effects are strongest among low-educated men, which is validating given that employment in the Great Recession has declined most within manufacturing, mining, and construction. We also find evidence of intra-household spillover effects, wherein individuals respond to shifts in spousal employment conditional on their own labor supply. The decrease in total physical activity during recessions is especially problematic for vulnerable populations concentrated in boom-and-bust industries, and may have longer-term effects on obesity and related health outcomes.     

癌性锚蛋白重复序列蛋白在结直肠癌的研究进展

结直肠癌是我国最常见的恶性肿瘤之一，其发病机制与多种肿瘤基因密切相关。锚蛋白重复序列（Gannankyrinrepeats，Gankyrin）是近年来新发现的癌基因，目前研究表明它在肝细胞癌及很多恶性肿瘤中高表达。近年研究表明Gankyrin与结直肠癌的发病密切相关，但对Gankyrin在结直肠癌的发病机制尚不清楚，对Gankyrin蛋白在结直肠癌肝转移灶中是否表达尚未见报道。本文就Gankyrin蛋白在结直肠癌中的研究进展情况作做一综述。     

锥形束CT测量牙龈厚度准确性的初步研究

目的评价锥形束CT(CBCT)法测量牙龈厚度的可信度及准确性。方法选择20例牙龈健康者的120颗上颌前牙,采用CBCT法和牙龈穿刺法测量唇侧中央龈缘下2mm处牙龈厚度,比较两组差异并用Kappa系数评价两种方法的一致性;应用Kappa系数评价不同检查者用CBCT法测量牙龈厚度的一致性,以及组内相关系数ICC评价同一检查者重复测量数据的可信度。结果CBCT法测量牙龈厚度为(1.23±0.27)mm,牙龈穿刺法测量结果为(1.24±0.26)mm,差异无统计学意义(P>0.05),两组之间一致率为83.33%(Kappa=0.547)。不同的检查者CBCT法测量牙龈厚度的一致性检验Kappa系数为0.814,可信度良好(ICC=0.795),同一检查者CBCT法重复测量数据之间一致性检验Kappa系数为0.864,可信度良好(ICC=0.893);CBCT法对厚牙龈生物型具有高的灵敏度(92.05%)和低的特异度(59.38%)。结论CBCT测量牙龈厚度的结果与牙龈穿刺法的结果较一致,具有良好的可信度。     

宫腔内灌注粒细胞集落刺激因子联合低分子肝素在薄型子宫内膜患者冻融胚胎移植周期中的研究

目的:探讨宫腔内灌注粒细胞集落刺激因子(G-CSF)联合低分子肝素(LMWH)对薄型子宫内膜患者冻融胚胎移植(FET)周期中的临床疗效。方法:选取2018年6月-2019年10月于山西医科大学第一医院进行FET助孕治疗的薄型子宫内膜患者175例,根据患者自身意愿分为3组,A组:63例患者仅接受激素替代治疗;B组:52例患者接受激素替代治疗+宫腔内G-CSF灌注;C组:60例患者接受激素替代治疗+宫腔内G-CSF灌注+皮下注射LMWH。对3组患者的子宫内膜厚度、子宫内膜血流阻力指数(RI)、搏动指数(PI)、周期取消率、胚胎种植率、临床妊娠率、早期流产率、异位妊娠率等指标进行比较。结果:在内膜转化日,与A组相比,B、C组子宫内膜厚度、Ⅱ+Ⅲ型血流比例均增加,RI、PI均降低(P<0.05)。治疗结局方面,与A组相比,B、C组胚胎种植率、临床妊娠率增加,周期取消率降低,差异有统计学意义(P<0.05);B、C组间比较差异无统计学意义(P>0.05);C组早期流产率较B组降低,差异有统计学意义(P<0.05)。结论:在FET周期中宫腔内灌注G-CSF可提高薄型子宫内膜患者的子宫内膜厚度,改善子宫内膜的血流情况,提高胚胎种植率及临床妊娠率,注射LMWH可降低早期流产率。     

Muscle cell differentiation and development pathway defects in Emery-Dreifuss muscular dystrophy

Emery-Dreifuss muscular dystrophy (EDMD) is a rare genetic disorder characterised by the early development of muscle contractures, progressive muscle weakness, and heart abnormalities. The latter may result in serious complications, or in severe cases, sudden death. Currently, there are very few effective treatment options available for EDMD and so there is a high clinical need for new therapies. Various genetic mutations have been identified in the development and causation of EDMD, each encoding proteins that are components of the Linker of Nucleoskeleton and Cytoskeleton (LINC) complex, which spans the nuclear envelope and serves to connect the nuclear lamina to the cytoskeleton. Within this review, we examine how mutations in the genes encoding these proteins, including lamins A/C, emerin, nesprins 1/2, FHL1, and SUN1/2 lead to muscle cell differentiation and development pathway defects. Further work to identify conserved molecular pathways downstream of these defective proteins may reveal potential targets for therapy design.     

完全腹腔镜下与开腹胰十二指肠切除术治疗壶腹周围肿瘤近期疗效比较

目的探讨完全腹腔镜下胰十二指肠切除术(TLPD)与开腹胰十二指肠切除术(OPD)治疗壶腹周围肿瘤的近期疗效。方法回顾性分析山西医科大学第一医院2016年6月至2019年3月收治的50例壶腹周围肿瘤患者的临床资料,根据手术方式不同分为TLPD组(22例)及OPD组(28例),比较两组患者围术期及术后各项指标情况。结果两组患者均顺利完成手术,TLPD组手术时间[(665±213)min]长于OPD组[(447±215)min],差异有统计学意义(t=-0.356,P=0.001);TLPD组术中出血量[100 ml(50~325 ml)]少于OPD组[300 ml(100~500 ml)],差异有统计学意义(Z=-2.230,P=0.026)。TLPD组与OPD组术中输血者比例、淋巴结清扫数量、切除肿瘤长径、术后禁饮食时间、术后拔管时间、术后住院时间及术后并发症发生率比较,差异均无统计学意义(均P>0.05)。结论TLPD与OPD治疗壶腹周围肿瘤临床近期疗效相近,TLPD手术时间较OPD长,但可有效控制术中出血量。     

冠状动脉心肌桥的诊疗现状与研究进展

由于冠状动脉心肌桥患者通常无症状,长期以来,这一解剖异常一直被认为是一种良性变异。但是,随着冠状动脉造影技术的应用普及和临床研究的深入,越来越多学者认为心肌桥可能发生严重并发症,甚至威胁人类生命。目前其发病机制、诊断及治疗已经得到广泛的关注和研究,但尚无明确的指南指导临床诊疗。文章就心肌桥的发病率、病理生理、诊疗现状及研究进展进行综述,为心肌桥的规范化诊治提供依据,使越来越多患者受益。     

纳洛酮联合醒脑静对一氧化碳中毒患者的催醒作用

目的观察纳洛酮联合醒脑静对急性一氧化碳中毒患者的催醒效果。方法将71例患者随机分为3组:A组25例,应用纳洛酮联合醒脑静治疗,B组24例,单用纳洛酮治疗,C组22例,单用醒脑静治疗,比较3组患者开始治疗到清醒的时间。结果 A组患者平均清醒时间(4.10±1.33)h,显著低于B组及C组(P<0.01)。结论纳洛酮联合醒脑静对急性一氧化碳中毒的促醒效果显著,优于单用纳洛酮或醒脑静治疗。     

中成药中非法添加物N-苄基他达拉非的结构确证

目的 鉴定中成药中一种新型他达拉非类似物。方法 采用HPLC-DAD初筛和制备液相色谱仪对中成药中非法添加物进行分离和纯化，采用高分辨质谱确定其精确分子量和结构碎片，结合碳谱和氢谱，最终确定该添加物的结构。结果 该添加物为N-苄基他达拉非。结论 N-苄基他达拉非的化学结构已有文献报道，但作为一种非法的中成药添加物首次被检出。