医用直线加速器的安全防护

医用直线加速器的安全防护一方面要确保加速器本身的安全运行，另一方面对相关操作人员及广大患者进行合理的防护。本文主要从机房的防护设计、辐射防护和非辐射防护三个方面阐述直线加速器安装、使用和维护过程中需要注意的一系列问题和应对方法。     

Delayed acute kidney injury recognition is not associated with poor short?term outcomes: a propensity score matched study

Objective Acute kidney injury (AKI) is common but usually under?diagnosed in hospitalized patients, of the impact of which on patients is still unclear. The paper was aimed to investigate the impact of delayed recognition of AKI on short?time prognosis of patients through a propensity score matched study． Methods From Oct 2013 to Sep 2014，1401 adult hospitalized patients with AKI in the First Affiliated Hospital of Nanjing Medical University were divided into delayed recognition group and timely?diagnosed group according to propensity score matching (1∶1) without replacement method. Primary endpoint was 30?day all?cause mortality, and secondary endpoints included recovery of kidney at discharge, length of hospitalization, length of intensive care unit stay and hospital costs．Results There were significant differences in age, department distribution, complications, stage of AKI, Charlson index, APACHEⅡ score, SOFA score between the two groups before matching. After matching, there were no significant difference in demographic data, department distribution, complications, stage of AKI, Charlson index, APACHE II score, SOFA score between the two groups except in blood urea nitrogen (P=0.039) and use of diuretics (P=0.018). Delayed recognition of acute kidney injury was not associated with 30?day all?cause mortality in univariate (P=0.711) and multivariate Logistic regression analyses. The secondary endpoints did not differ in two groups. Conclusion Delayed acute kidney injury recognition did not associate with poor short?term outcomes in adult hospitalized patients．     

Paraneoplastic syndrome mimicking progressive supranuclear palsy

Paraneoplastic syndrome presenting with progressive supranuclear palsy (PSP) phenotype is extremely rare. We report a patient who presented with features of rapidly progressive parkinsonism similar to PSP and was found to have small cell carcinoma of the lung along with seropositivity for onconeural antigen. The patient was treated with immunomodulation and was given chemotherapy for the malignancy and subsequently improved.     

2型糖尿病患者嗜中性粒细胞相关系数变化研究

目的探讨2型糖尿病患者嗜中性粒细胞相关参数变化规律。方法用Beckman Coulter LH750全自动血液分析仪测定2型糖尿病患者和健康对照组嗜中性粒细胞相关参数,包括白细胞计数(WBC)、嗜中性粒细胞绝对值(NAV)、嗜中性粒细胞平均体积(MNV)、嗜中性粒细胞平均传导率(MNC)、嗜中性粒细胞平均散射值(MNS)。结果 2型糖尿病患者WBC、NAV、MNV、MNC、MNS与正常对照组比较,差异有统计学意义(P<0.01)。结论 2型糖尿病患者不仅有NAV增高,而且嗜中性粒细胞体积的大小及内部结构、核的大小,核质比例及细胞内质粒的大小和密度等均有明显改变,通过对WBC、NAV、MNV、MNC、MNS等指标的测定,可以对2型糖尿病微血管病变,糖尿病肾病的发生、发展进行动态观察。     

卵巢过度刺激综合征相关因素分析及中西医结合护理体会

目的 探讨卵巢过度刺激综合征（OHSS）相关因素及中西医结合护理体会.方法 选择2011年5月～2013年5月江苏省中医院采用辅助生殖技术的患者393例,分析并比较OHSS在年龄、体重指数、不孕时间、不孕原因、促排卵方案、HCG当日＞12 mm卵泡数等因素间的分布情况;采用Logistic回归分析对OHSS相关因素进行分析.结果 本组发生OHSS共11例,发生率为2.9％.OHSS患者及无OHSS患者在多囊性卵巢综合征（PCOS）或多囊卵巢（PCO）改变、人体绒膜促性腺激素（HMG）＋人绝经促性腺素（HMG）方案、HCG当日雌激素（E2）值、HCG当日＞12 mm卵泡数等方面差异有统计学意义（P＜0.05）.PCOS或PCO改变（OR=6.226,P＜0.05）、HCG＋HMG方案（OR=5.475,P＜0.05）、HCG当日E2值（OR=1.480,P＜0.05）、HCG当日＞12 mm卵泡数（OR=2.148,P＜0.05）与OHSS发生相关,且均为危险因素（OR＞1.000）.结论 OHSS是多种因素共同作用的结果,中医特色的舒适护理模式可提高护理服务质量,节约医疗成本,体现以人为本的护理内涵.     

Visual afference mediates head and trunk stability in vestibular hypofunction

Humans must maintain head and trunk stability while walking. The purpose of this study was to compare the kinematics of healthy controls and patients with vestibular hypofunction (VH) when walking and making head rotations of different frequencies in both light and dark conditions. We recruited eight individuals with VH and nine healthy control subjects to perform four tasks at their preferred gait speed, being normal walk, walking and making yaw head rotations at 1.5 Hz and 2 Hz, and walking in the dark and making yaw head rotations at 1.5 Hz. Linear kinematics as well as head, trunk, and pelvis angular velocities were captured using the Vicon motion analysis system (Vicon Motion Systems, Oxford, UK). We found no difference in walking velocities for any of the four walking conditions across groups. The lateral displacement of the center of mass was increased in VH patients. In the dark, patients had more head instability in pitch (larger amplitudes and velocities) even though they were walking and making active yaw head rotations. Patients also had a smaller relative phase angle (mean 3.50 ± standard deviation 2.13°) than controls (mean 10.31 ± standard deviation 2.70°) (p < 0.01). Our data suggest that patients with VH have difficulty walking with a straight trajectory when turning their head. Additionally, patients with VH have an abnormal excursion of spontaneous pitch head rotation while walking and making active yaw head turns, which is dependent on vision. Rehabilitation for these patients should consider applying unique head rotation frequencies when training gait with head turns as well as alternating their exposure to light.     

The susceptibility of T5-TG12 of theCFTR gene in chronic bronchitis occurrence in a Chinese population in Jiangsu province,China

Mutations in the cystic fibrosis transmembrane conductance regulator(CFTR) gene have been implicated in the onset of cystic fibrosis and other clinical respiratory disorders.In the present study,we investigated the role of CFTR variations,poly-T,TG-repeats,and M470V in susceptibility to bronchial asthma and chronic bronchitis in a Chinese population in Jiangsu province,China.A total of 72 bronchial asthma patients,68 chronic bronchitis patients,and 117 healthy subjects were included in this study.The Tn-TGm haplotype was sequenced and the CFTR variant M470V was detected using restriction fragment length polymorphism(RFLP).We found that the frequency of T5-TG12-V470 in chronic bronchitis patients was 0.07%,which was notably higher than that in healthy subjects(0.01%) and bronchial asthma patients(0.04%).Thus,the presence of the T5-TG12 haplotype of the CFTR gene is likely to play a role in the development and progression of respiratory conditions,such as chronic bronchitis.     

白纹伊蚊β-肌动蛋白基因片段的克隆及其

目的获取白纹伊蚊β-肌动蛋白基因序列并探讨其作为基因表达内参照的作用。方法根据昆虫β-肌动蛋白核苷酸序列的高度保守区设计引物，通过PCR的方法从白纹伊蚊C6／36细胞中扩增获得白纹伊蚊β-肌动蛋白基因片段，进一步通过RT—PCR的方法验证其在稳定转染空载体和40S核糖体蛋白S4（RPS4）基因的白纹伊蚊C6／36细胞中的表达。结果获得白纹伊蚊β-肌动蛋白基因片段，长911bp，与其他几种蚊β-肌动蛋白基因对应序列的相似性在89％以上。在稳定转染空载体和RPS4基因的C6／36细胞中，均可稳定地扩增出目的基因。结论成功获得了白纹伊蚊β-肌动蛋白基因片段，并且该片段完全可以用作基因表达差异分析时的内参照基因。