丙型肝炎病毒核心蛋白在患者外周血单个核细胞内的核表达检测

目的　检测和研究丙型肝炎病毒 (hepatitisCvirus,HCV)核心蛋白在患者外周血单个核细胞 (peripheralbloodmononuclearcells ,PBMC)内核表达的意义 ,并探讨其与临床的关系。方法　对 6 6例慢性丙型肝炎患者PBMC标本进行免疫组化检测 ,并将HCV蛋白抗原定位分布情况与患者临床状况进行比较分析 ,对其中 2 7例患者PBMC进行HCVRNA和HCVAg的平行检测和分析。结果　免疫组化结果显示 ,慢性丙型肝炎患者PBMCHCVAg(core +NS3)阳性检出率为 77 2 7% (5 1 6 6 )。结果还证实 ,HCV核心蛋白均定位于胞核内 ,且呈强表达 ;NS3蛋白主要定位于胞质内 ,呈弱表达。当进行HCVAg在PBMC内定位情况与患者临床状况比较分析时显示 ,病情较重患者PBMC内核心蛋白表达阳性率 (35 2 9% )明显高于病情较轻者 (5 88% ) (P <0 0 0 1)。结论　HCV核心蛋白在PBMC内核表达与患者临床状况相关 ,提示其可能是丙型肝炎慢性化的一个指标 ,并可能在肝硬化和肝癌发生上起一定作用     

噬菌体随机肽库分析HIV-1 p24抗原表位

目的：利用噬菌体随机肽库分析抗HIV－1核心区抗原p24单抗体在抗原上的识别位点。方法：用抗HIV－1 p24单抗2C7和3H10作为筛选分子，对噬菌体肽库进行生物洗（biopanning)，并通过DN测序、ELISA效价测定等对所获得的噬菌休克隆进行鉴定，最后对合成的7肽位点通过间接ELISA及免疫抑制试验进行血清学分析。结果：序列分析结果表明，单抗2C7和3H10在HIV－1 p24上的抗原识别表位的保守序列分别为DHPXPXX和XXXXKAF。分别合成这2个7肽氨基酸序列P－C1（DHPSPWG）和P－H3（SPWLKAFGGS），并分析其免疫学结合特性，结果表明与P－H3相比，单抗2C7的抗原识别表位P－C1的固相结合特性较好，固相P－C1检测血样，13份抗HIV阳性本中，12份为阳性（检出率为92．3％），19份抗HIV阴性样本中，仅1份为假阳性结果（特异性为94．7％），与P－C1相比，单抗3H10的抗原表位P－H3的固相结合能力极差，但液相结合活性较好，血样与P－H3的抑制试验表明，13份抗HIV阳性样本中12份样本对P－H3的抑制率大于60％（12／13），而9份抗HIV阴性样本中仅1份对P－H3的抑制率大于50％，结论：用抗HIV－1 p24单抗筛选噬菌体随机肽库，获得单抗在p24抗原上的识别表位的氨基酸序列，血清学结果表明这2个抗原表位存在于p24自然抗原上，在抗HIV－1的感染检测中具有潜在的应用价值。     

CT引导下经皮穿刺活检术在肺癌诊断中的应用

目的 探讨CT引导下穿刺活检术在肺癌诊断中的准确性和并发症发生率。方法 40例使用弹簧芯状活检针经皮穿刺活检，CT扫描确定并引导穿刺途径，达预定位置取材。结果 37例有明确的病理诊断，诊断准确性92．5％。活检后并发气胸3例，咯血2例。结论 CT引导下经皮穿刺活检可以进一步明确肺癌的病理诊断，提高诊断的准确性，并发症发生率低，可为临床提供治疗依据。     

让核心价值观成为员工的精神追求

血站文化建设的核心是促使全体职工形成统一的核心价值观。采用小组讨论、专题讲座、座谈沟通、问卷调查、专题研讨等方法提炼了组织核心价值观,并采用多种形式促进核心价值观落地。使核心价值观真正内化为职工的精神追求,外化为职工的自觉行动,有力地推动了无偿献血事业健康、可持续发展。     

值班和交接班制度问题分析与改进建议

值班和交接班制度是诊疗过程连续性的重要保障。若落实不到位,可能发生患者伤害的不良后果。采用案例分析结合问卷调查方式,阐述值班和交接班制度存在问题,包括值班人员不在岗,值班人员资质不符,医院总值班能力不足,交接班记录不完整等。提出针对性改进建议:加强医务人员依法执业培训;严格管理值班医师资质;健全医疗值班体系;规范记录交接班内容等。     

Can supplementary contrast-enhanced MRI of the breast avoid needle biopsies in suspicious microcalcifications seen on mammography? A systematic review and meta-analysis

PurposeTo analyze the rate of potentially avoidable needle biopsies in mammographically suspicious calcifications if supplementary Contrast-Enhanced MRI (CE-MRI) is negative.MethodsUsing predefined criteria, a systematic review was performed. Studies investigating the use of supplemental CE-MRI in the setting of mammographically suspicious calcifications undergoing stereotactic biopsy and published between 2000 and 2020 were eligible. Two reviewers extracted study characteristics and true positives (TP), false positives, true negatives and false negatives (FN). Specificity, in this setting equaling the number of avoidable biopsies and FN rates were calculated. The maximum pre-test probability at which post-test probabilities of a negative CE-MRI met with BI-RADS benchmarks was determined by a Fagan nomogram. Random-effects models, I²-statistics, Deek’s funnel plot testing and meta-regression were employed. P-values <0.05 were considered significant.ResultsThirteen studies investigating 1414 lesions with a cancer prevalence of 43.6% (range: 22.7–66.9%) were included. No publication bias was found (P = 0.91). CE-MRI performed better in pure microcalcification studies compared to those also including associate findings (P < 0.001). In the first group, the pooled rate of avoidable biopsies was 80.6% (95%-CI: 64.6–90.5%) while the overall and invasive cancer FN rates were 3.7% (95%-CI: 1.2–6.2%) and 1.6% (95%-CI 0–3.6%), respectively. Up to a pre-test probability of 22%, the post-test probability did not exceed 2%.ConclusionA negative supplementary CE-MRI could potentially avoid 80.6% of unnecessary stereotactic biopsies in BI-RADS 4 microcalcifications at a cost of 3.7% missed breast cancers, 1.6% invasive. BI-RADS benchmarks for downgrading mammographic calcifications would be met up to a pretest probability of 22%.     

Clinico-Radio-Histopathological Correlation by C-Arm Image-Guided Biopsy in Spinal Tuberculosis

Background/Purpose of the StudyC-arm-guided biopsy is a safe and effective technique for evaluating TB spine and is useful in planning therapy. The purpose of this study was to find a correlation between clinically and radiologically suspected TB spine and C-arm image-guided biopsy-proven cases and to study the complications encountered.MethodsAfter evaluating the clinical, laboratory, X-ray and MRI findings, 92 patients with provisionally diagnosed tubercular spine were subjected to C-arm image-guided biopsy.ResultsAmong our 92 cases, histopathology was positive in 55 cases (59.78%). Out of these 55 histologically positive cases, CBNAAT was positive in 42 cases and negative in the rest 13 cases. Overall, among the 92 cases, CBNAAT was positive in 51(55.43%) of cases, and out of these, histopathology turned out to be positive in 42 of cases. Out of 41 cases with negative CBNAAT, histopathology was suggestive of tuberculosis in 13. The strength of agreement between CBNAAT and histopathology was statistically significant (p < 0.0001; kappa = 0.511). No complication such as bleeding, nerve/cord injury, infection, injury to aorta or pneumothorax was encountered during and after the C-arm biopsy in any case.ConclusionC-arm image-guided biopsy is reasonably accurate and should be used as a tool for diagnosis of TB spine. We recommend histopathological examination as a key component for the diagnosis of TB spine, as it is precise and consumes relatively shorter time. CBNAAT is more rapid but is not a substitute for histopathology for spine TB diagnosis.     

基于FNAB的分子检测技术在甲状腺结节诊断中的研究进展

随着各种检测技术的相继问世,甲状腺结节的检出率明显上升。尽管大多数甲状腺结节是良性的,但良恶性病变之间的判定仍然是临床医生面临的挑战。对于所有可疑甲状腺结节患者均应进行颈部超声检查。甲状腺超声可评估结节特征,某些甲状腺结节具有可疑恶性超声征象。然而,这些特征缺乏准确性,无法明确诊断结节的良恶性。目前的指南仍然推荐超声引导细针穿刺活检（FNAB）作为评估甲状腺结节良恶性的首选检查。FNAB是一种经济高效的诊断方法,由于其创伤小,敏感性和特异性较高,可用于术前评估甲状腺结节的性质,已成为临床不可或缺的检查手段之一。近年来国内关于FNAB的报道日益增多,国内外指南关于FNAB指征尚有争议,同时由于其自身存在一定的局限性,FNAB技术的全面实施需要严格把握指征及准确判读穿刺病理结果。FNAB虽然是术前评估甲状腺结节最常用的诊断技术,但仍有灰区结节需要进一步诊断研究。为了制定合理的手术方案及判断预后,指南推荐术前可测定促甲状腺激素（TSH）水平。FNAB作为一个简单且相对无创的技术,但也可产生相应的并发症,FNAB的并发症主要与甲状腺结节的位置、穿刺针的直径、穿刺医师的操作经验等因素相关,严重程度较轻,多呈自限性。对于FNAB无法诊断或意义不明确的非典型病变或滤泡性病变,学者们一直在努力寻找一种新的方法来精确地诊断甲状腺癌。分子生物学方法是目前的最佳选择。分子生物学方法通过检测特定甲状腺肿瘤易感基因的驱动突变来确认甲状腺肿瘤活检的恶性程度,如BRAF和RAS癌基因突变、RET/PTC重排和TERT突变检测,从而提高术前诊断效率。甲状腺乳头状癌最常见的转移部位是局部淋巴结,虽然FNAB对异常淋巴结有诊断价值,但小或囊性淋巴结可能由于缺乏肿瘤细胞而无法诊断。检测可疑颈部淋巴结细针穿刺活检冲洗液中甲状腺球蛋白含量可作为细胞学诊断的辅助手段。笔者认为FNAB联合分子生物学的多层次诊断体系可提高术前诊断的精准性,对指导治疗、判断预后具有重要价值。     

Culture-Expanded Autologous Adipose-Derived Mesenchymal Stem Cell Treatment for Osteonecrosis of the Femoral Head

BackgroudOutcomes of traditional treatment for osteonecrosis of the femoral head (ONFH) are not always satisfactory. Hence, cell-supplementation therapy has been attempted to facilitate necrotic-tissue regeneration. Adipose-derived mesenchymal stem cell (ADMSC) transplantation is potentially advantageous over bone marrow-derived MSC implantation, but its outcomes for ONFH remain unclear. The aim of this study was to determine 2-year radiological and clinical outcomes of culture-expanded autologous ADMSC implantation for ONFH.MethodsEighteen hips with necrotic lesions involving ≥ 30% of the femoral head were included. ADMSCs were harvested by liposuction and culture expanded for 3 passages over 3 weeks. With a 6-mm single drilling, ADMSCs were implanted into the necrotic zone. All patients underwent magnetic resonance imaging (MRI), single-photon emission computed tomography/computed tomography (SPECT/CT) at screening and 6 months, 12 months, and 24 months postoperatively. The primary outcome was the change in the size of necrotic area on MRI. Secondary outcomes were changes in clinical scores and radioisotope uptake on SPECT/CT. Conversion total hip arthroplasty (THA) was defined as the endpoint.ResultsPreoperatively, the necrotic lesion extent was 63.0% (38.4%–96.7%) of the femoral head. The mean Harris hip score was 89.2, the University of California at Los Angeles (UCLA) score was 5.6, and Western Ontario and McMaster Universities Arthritis index (WOMAC) was 79.4. Three patients underwent THA and 1 patient died in an accident. Finally, 11 patients (14 hips) were available for ≥ 2-year follow-up. At the last follow-up, no surgery-related complications occurred, and 14 of 17 hips (82%) were able to perform daily activities without THA requirement. There was no significant decrease in lesion size between any 2 intervals on MRI. However, widening of high signal intensity bands on T2-weighted images inside the necrotic lesion was observed in 9 of 14 hips (64%); 11 of 14 hips (79%) showed increased vascularity on SPECT/CT at 2 years postoperatively. No significant differences were observed between preoperative and 24-month mean Harris hip score (89.2 vs. 88.6), WOMAC (79.4 vs. 75.7), and UCLA score (5.6 vs. 6.2).ConclusionsOur outcomes suggest that culture-expanded ADMSC implantation is a viable option for ONFH treatment without adverse events.