非医学类大学消防疏散逃生演练引发的思考

西华师范校医院组织了当日下午无课留在宿舍的300名学生进行长达1小时的逃生训练.170名男性和200名女性,年龄在21～27岁.但没有进行医疗知识的讲授.之后是一个虚拟的火灾现场,由广播通知人员撤离.经对响应速度和疏散方式进行观察表明,他们用13分钟逃到安全地带,比医学院校学生和其他一些非医类学校所用时间长.大部分学生用湿毛巾堵住口鼻逃生,然而,仅有15人（4.1%）用完全正确的方式处理.为了提高效果,在训练课表中应加入如碳氧血红蛋白危害的医学知识.     

Thyroglossal duct remnant surgery: A reliable,reproducible approach to the suprahyoid region

BackgroundRecurrence of thyroglossal duct remnants remains a clinical problem despite the success of the Sistrunk procedure. Inadequate excision of disease in the suprahyoid region significantly impacts disease recurrence. The primary aim of this study is to describe and present the author's experience with a simple, reliable, and reproducible approach to the suprahyoid area in a Sistrunk procedure.MethodsA retrospective review of the surgical management of thyroglossal duct remnants by a single surgeon at the Children's Hospital Los Angeles over a 16-year period was performed. Demographic and clinical data including disease recurrence and other complications were collected. Recurrence rates before and after the consistent application of a modified Sistrunk procedure were compared.Results94 patients (54% female and 46% male; mean age 5.2 years) met the inclusion criteria for this study. Overall recurrence rate following a Sistrunk procedure was 2.2%; 11.1% prior to 2004 and 0% after 2004, following consistent implementation of the surgical approach to the suprahyoid region as detailed in this study. Complications were minor and mean follow-up was 5.4 months.ConclusionsThe author has described a simple, reproducible, and reliable approach to the suprahyoid area in a Sistrunk procedure that limits incomplete excision with minimal risk for complications. This approach to the suprahyoid region should be considered for routine use in the management of both primary and revision thyroglossal duct remnants.     

Activity of pyrrolizidine alkaloids against biofilm formation and Trichomonas vaginalis

Crotalaria genus belongs to the subfamily Papilionoideae comprising about 600 species spread throughout tropical, neotropical and subtropical regions. In this study, seeds of Crolatalaria pallida were used to the isolation of usaramine, a pyrrolizidine alkaloid. Thus, Pseudomonas aeruginosa and Staphylococcus epidermidis were utilized as strains to test some activities of this alkaloid, such as antibiofilm and antibacterial. Meanwhile, monocrotaline obtained from Crotalaria retusa seeds, was used as the starting material for synthesis of necine base derivatives with anti-Trichomonas vaginalis potential. Alkaloids were characterized by 1D and 2D NMR techniques and GC–MS analysis. Usaramine demonstrated a highlighted antibiofilm activity against S. epidermidis by reducing more than 50% of biofilm formation without killing the bacteria, thus it could be assumed as a prototype for the development of new antibiofilm molecules for pharmaceutical and industrial purposes. Monocrotaline activity against T. vaginalis was evaluated and results indicated inhibition of 80% on parasite growth at 1 mg/mL, in addition, neither cytotoxicity against vaginal epithelial cells nor hemolytic activity were observed. On the other hand, retronecine showed no anti-T. vaginalis activity while azido-retronecine was more active than monocrotaline killing 85% of the parasites at 1 mg/mL. In conclusion, pyrrolizidine alkaloids are suggested as promising prototypes for new drugs especially for topical use.     

Significance of HMGA2 expression as independent poor prognostic marker in perihilar and distal cholangiocarcinoma resected with curative intent

BackgroundExtrahepatic cholangiocarcinoma requires invasive surgery and is associated with poor prognosis; thus, a prognostic biomarker is highly needed. Extrahepatic cholangiocarcinoma is sub-classified into two types based on their location, namely perihilar and distal. Perihilar cholangiocarcinoma requires lobectomy as curative surgical resection, whereas the distal requires pancreatoduodenectomy. HMGA2 overexpression is reported to correlate with progression, aggressiveness, dissemination and poor prognosis in several types of cancers. Although its association with extrahepatic cholangiocarcinoma has been reported, none of the previous studies assessed its significance in each subtype.MethodsWe assessed the expression of HMGA2 protein in surgical specimens after curative intent surgery in 80 patients including 41 with perihilar cholangiocarcinoma and 39 with distal cholangiocarcinoma by immunohistochemistry. We then examined its association with clinicopathological findings and patient survival outcomes.ResultsWe found that HMGA2 was expressed in 51% (21 of 41) of perihilar cholangiocarcinoma and 41% (16 of 39) of distal cholangiocarcinoma samples. In perihilar cholangiocarcinoma, we found significant correlations between expression and vascular invasion and perineural invasion. In distal cholangiocarcinoma, we found that protein levels correlated with tumor grade. Univariate and multivariate analyses demonstrated that HMGA2 expression was an independent poor prognostic factor for patients with both subtypes of disease.ConclusionsOur results revealed that HMGA2 expression as an independent prognostic marker for both perihilar and distal cholangiocarcinoma that were resected with curative intent.     

Omission of axillary dissection after a positive sentinel lymph-node: Implications in the multidisciplinary treatment of operable breast cancer

Omission of axillary dissection in women with breast cancer and one or two positive sentinel-node biopsy is a major advancement in the management of this disease. Supported by a sound rationale and confirmed by prospective, randomized trials, omission of axillary dissection is now recommended in women who have undergone breast conserving surgery and who are candidate to adjuvant radiotherapy. Because breast cancer is best managed in the context of a multidisciplinary team, this surgical shift in the paradigm is expected to have implications that extend also to the other specialties involved in the team.In fact, the full evaluation of the axillary tumor burden has been historically considered an essential part of tumor staging and the absolute number of involved node critical information to tailor post-surgical treatments. Lack of this information in a patient with axillary involvement documented by a positive sentinel lymph-node biopsy may represent a challenge when deciding on further, post-surgical treatments. This review will address the critical aspects and the potential implications of omission of axillary dissection in the context of the multidisciplinary breast team.     

Automated cardiac segmentation of cross-modal medical images using unsupervised multi-domain adaptation and spatial neural attention structure

Accurate cardiac segmentation of multimodal images, e.g., magnetic resonance (MR), computed tomography (CT) images, plays a pivot role in auxiliary diagnoses, treatments and postoperative assessments of cardiovascular diseases. However, training a well-behaved segmentation model for the cross-modal cardiac image analysis is challenging, due to their diverse appearances/distributions from different devices and acquisition conditions. For instance, a well-trained segmentation model based on the source domain of MR images is often failed in the segmentation of CT images. In this work, a cross-modal images-oriented cardiac segmentation scheme is proposed using a symmetric full convolutional neural network (SFCNN) with the unsupervised multi-domain adaptation (UMDA) and a spatial neural attention (SNA) structure, termed UMDA-SNA-SFCNN, having the merits of without the requirement of any annotation on the test domain. Specifically, UMDA-SNA-SFCNN incorporates SNA to the classic adversarial domain adaptation network to highlight the relevant regions, while restraining the irrelevant areas in the cross-modal images, so as to suppress the negative transfer in the process of unsupervised domain adaptation. In addition, the multi-layer feature discriminators and a predictive segmentation-mask discriminator are established to connect the multi-layer features and segmentation mask of the backbone network, SFCNN, to realize the fine-grained alignment of unsupervised cross-modal feature domains. Extensive confirmative and comparative experiments on the benchmark Multi-Modality Whole Heart Challenge dataset show that the proposed model is superior to the state-of-the-art cross-modal segmentation methods.     

The aging human cochlear nucleus: Changes in the glial fibrillary acidic protein,intracellular calcium regulatory proteins,GABA neurotransmitter and cholinergic receptor

The human auditory system is highly susceptible to environmental and metabolic insults which further affect the biochemical and physiological milieu of the cells that may contribute to progressive, hearing loss with aging. The cochlear nucleus (CN) is populated by morphologically diverse types of neurons with discrete physiological and neurochemical properties. Between the dorsal and the ventral cochlear nucleus (DCN and VCN), the VCN is further sub-divided into the rostral (rVCN) and caudal (cVCN) sub-divisions. Although, information is available on the age related neurochemical changes in the mammalian CN similar reports on human CN is still sparse. The morphometry and semiquantitative analysis of intensity of expression of glial fibrillary acidic protein (GFAP), calcium binding proteins (calbindin, calretinin and parvalbumin), gamma amino butyric acid (GABA) and nicotinic acetyl choline receptor (nAchR) beta 2 immunostaining were carried out in all three sub-divisions of the human CN from birth to 90 years. There was increased GFAP immunoreactivity in decades 2 and 3 in comparison to decade 1 in the CN. But no change was observed in rVCN from decade 4 onwards, whereas intense staining was also observed in decades 5 and 6 in cVCN and DCN. All three calcium binding proteins were highly expressed in early to middle ages, whereas a significant reduction was found in later decades in the VCN. GABA and nAchR beta 2 expressions were unchanged throughout in all the decades. The middle age may represent a critical period of onset and progression of aging changes in the CN and these alterations may add to the deterioration of hearing responses in the old age.