术前MRV联合多普勒超声在活动性下肢静脉性溃疡诊断及治疗中的作用

目的 探讨术前磁共振静脉造影(magnetic resonance venography, MRV)检查在活动性下肢静脉性溃疡诊断及治疗中的作用。方法 回顾性分析60例慢性下肢静脉性溃疡患者资料,根据术前进行MRV联合多普勒超声检查(35例)和单纯多普勒超声检查(25例),分别设定为A组和B组。患者行腔内激光治疗技术(endovenous laser ablation, EVLT)联合隐股静脉结扎术,应用Kaplan-Meier生存分析方法对两组患者术后6个月的溃疡愈合率及术后36个月的溃疡复发率进行统计学分析。结果 随访36个月,随访率93.33%。两组患者的性别、年龄、溃疡直径和溃疡持续时间差异无统计学意义。术后6个月,两组患者的累积溃疡愈合率差异没有统计学意义(88.6% vs 92%, P=0.642)。36个月的随访期中,A组累积溃疡复发率明显低于B组(5.7% vs 24%, P=0.037)。结论 术前MRV联合多普勒超声检查对活动性下肢静脉性溃疡的诊断和治疗具有重要的指导价值。     

Surgery Combined with Radiotherapy to Treat Spinal Tumors: A Review of Published Reports

Spinal tumors result in high morbidity and a high rate of lower limb paralysis. Both surgical therapy and radiation therapy (RT) are used to treat spinal tumors; however, how best to combine these two therapies to maximize the benefits and minimize the risks is still being debated. It is also difficult to decide the optimal timing, course and dose of RT, especially in pregnant women and children. The aim of this review is to assist surgeons who are dealing with spinal tumors by providing comprehensive information about advanced techniques for administering RT with greater precision and safety, and about the impact of various ways of combining surgery and RT on therapeutic outcomes. We here review published reports about treating spinal tumors with a combination of these two forms of therapy and attempt to draw appropriate conclusions concerning selection of optimal treatment protocols. Our conclusion is that postoperative radiotherapy, especially with high‐precision, low‐dose and multiple fractions, and brachytherapy are promising therapies to combined with surgery.     

miRNA-93调控细胞信号转导与转录激活因子3信号通路影响喉癌细胞机制研究

目的研究miRNA-93调控细胞信号转导与转录激活因子3(STAT3)信号通路影响喉癌细胞增殖、凋亡的作用及机制。方法选取人喉癌Hep-2细胞,分为对照组、实验组(miRNA-93组)、联合组(miRNA-93+STAT3组)。用逆转录-聚合酶链反应(RT-PCR)检测Hep-2细胞中STAT3及miRNA93的表达,蛋白质免疫印迹检测Hep-2细胞质粒-细胞信号转导与转录激活因子3(p-STAT3)、周期蛋白依赖性激酶(Cyclins)、骨髓细胞瘤病毒癌基因(c-Myc)、细胞周期蛋白依赖性激酶抑制因子(CKI)、B淋巴细胞瘤-2、生存素基因的表达。结果转染miRNA-93对STAT3基因mRNA含量无明显影响(P>0.05);转染miRNA-93可明显下调STAT3蛋白(P<0.05)。故而提示miRNA-93于转录后水平调控STAT3基因的表达;3组对Hep-2细胞周期无明显影响(P>0.05);与对照组比较,实验组可明显诱导细胞凋亡(P<0.05);而与实验组比较,联合组可明显抑制细胞凋亡(P<0.05);转染48 h后,与对照组比较,实验组转染miRNA-93后,p-STAT3、Cyclins、c-Myc、CKI、B淋巴细胞瘤-2、生存素基因明显下调,而联合组可使p-STAT3、c-Myc、B淋巴细胞瘤-2表达明显上升。结论 miRNA-93可通过与STAT3基因mRNA93结合而于转录后水平调控该基因的表达,并且通过下调STAT3信号通路的相关蛋白,从而抑制Hep-2细胞凋亡。     

皮下钉棒系统改良置钉法治疗Tile B型骨盆骨折的临床观察

目的 :探讨皮下钉棒系统改良置钉法治疗Tile B型骨盆骨折的可行性及临床疗效。方法 :自2014年6月至2015年8月选择性应用钉棒系统改良经髂前下棘和耻骨结节置钉治疗14例Tile B型骨盆骨折,男8例,女6例;年龄23~65岁,平均42岁。观察患者的手术时间、术中出血量、骨折愈合情况及术后并发症,并采用Matta复位标准及Majeed功能评分进行疗效评价。结果:所有患者获得随访,时间8~15个月,平均10.5个月。手术时间25~45 min,平均32 min;术中出血量10~35 ml,平均18 ml。术后骨折均Ⅰ期愈合,愈合时间9~14周,平均12.5周。术后无切口感染、内固定失败及异位骨化等并发症发生。4例出现单侧股外侧皮神经损伤,1例出现单侧股神经麻痹,最终均恢复正常。Matta复位标准结果 ,优7例,良5例,中2例。末次随访时Majeed功能评分为(81.50±8.05)分,其中优5例,良7例,中2例。结论 :应用皮下钉棒系统改良经髂前下棘和耻骨结节置钉固定前环创伤小、复位牢靠、并发症少,是治疗Tile B型骨盆骨折一种有前景的手术方式。     

Mini-CEX在内科临床教学中的应用研究

目的探讨Mini-CEX在内科临床教学中的应用效果。方法将2018年7月-2019年5月入心内科的50名学生列为研究对象,根据其学生类型采用随机函数法进行分组,研究组和对照组每组25名学生,对照组学生采用的是常规带教方式,在对研究组学生的带教中引入Mini-CEX量表,比较两组学生的临床技能水平。结果带教前,两组学生的临床技能各方面评分均差异无统计学意义(P>0.05),带教后,两组学生的临床技能评分均有所提升,并且研究组学生的提升幅度大于对照组(P<0.05)。结论 Mini-CEX作为一种内容全面,操作简便易行,注重人文关怀的新型考评手段,对于提高心内科的临床带教教学质量具有显著效果。     

Analysis of risk factors correlated with angiographic vasospasm in patients with aneurysmal subarachnoid hemorrhage using explainable predictive modeling

Cerebral vasospasm (CAV) is a major complication of aneurysmal subarachnoid hemorrhage (aSAH) in patients with ruptured intracranial aneurysm. Explainable artificial intelligence (XAI) was used to analyze the contribution of risk factors on the development of CAV. We obtained data about patients (n = 343) treated for aSAH in our hospital. Predictive factors including age, aneurysm size, Hunt and Hess grade, and modified Fisher grade were used as input to analyze the contribution and correlation of factors correlated with CAV using a random forest regressor. An analysis conducted using an XAI model showed that aneurysm size (27.6%) was most significantly associated with the development of CAV, followed by age (20.7%) and Glasgow coma scale score (7.1%). In some patients with an estimated artificial intelligence-selected CAV value of 51%, the important risk factors were aneurysm size (9.1 mm) and location, and hypertension is also considered a major influencing factor. We could predict that Fisher grade 3 contributed to 20.3%, and the group using Antiplatelet contributed to 12.2% which is expected to lower cerebral CAV compared to the Control group (16.9%). The accuracy rate of the XAI system was 85.5% (area under the curve = 0.88). Using the modeling, aneurysm size and age were quantitatively analyzed and were found to be significantly associated with CAV in patients with aSAH. Hence, XAI modeling techniques can be used to analyze factors correlated with CAV by schematizing prediction results in some patients. Moreover, poor Fisher grade and use of postoperative antiplatelet agent are important factors for prediction of CAV.     

青风藤中总生物碱的气相色谱-质谱联用分析

目的 采用索氏提取法对青风藤中总生物碱进行提取分离,并利用气相-质谱联用(GC-MS)方法 ,对其化学成分进行分析. 方法 采用90%无水乙醇提取,盐酸酸化后,氨水碱化后三氯甲烷萃取,利用GC-MS对总生物碱中的化学成分进行分离分析,并对其中的15种化学成分进行鉴定. 结果该方法提取时青藤碱含量高,达到80.18%,安贝灵碱3.44%,光千金藤碱3.05%. 采用峰面积归一化法计算各成分相对百分含量,所鉴定的成分占总流出峰面积的95.1%. 结论 实验结果为进一步开发研究青风藤中生物碱提供依据.     

带气囊导管构建脊髓缺血模拟再灌注与缺血分离模型

背景：采用带有气囊的导管急性压迫脊髓缺血模拟人类损伤可以造成再灌注与缺血分离的动物模型。目的：应用免疫组化和生物化学分析方法观察不同缺血时间窗处理对损伤脊髓的影响。方法：SD大鼠36只,随机分为假手术组,带气囊导管造成大鼠脊髓缺血10,30,45,60,90min组。结果与结论：再灌注48h后,随着缺血时间的延长,脊髓前角神经元坏死和凋亡逐渐加重,丙二醛水平逐渐增加,超氧化物歧化酶活性逐渐下降,大鼠的神经行为学病症加重。提示用带气囊的导管建立缺血再灌注大鼠模型成功,再灌注后大鼠脊髓的损伤随缺血时间的延长而加重。