尿微量白蛋白/肌酐异常人群炎性和代谢类指标的分析

目的探讨尿微量白蛋白/肌酐(ACR)异常人群炎性和代谢类指标的改变及影响。方法回顾性分析ACR正常组和异常组生化指标,血细胞和糖化血红蛋白。结果男性中ACR正常组与异常组间存在差异的指标分别有BMI、WBC、LYM%、N%、RBC、HbA1c、hs-CRP、TG和HDL。其中指标HbA1c、BMI、LYM%、N%及TG的异常可增加ACR异常的风险。女性正常组与异常组间存在差异的指标分别有HbA1c、hs-CRP和Un。其中指标HbA1c及Un异常可增加ACR异常的风险。结论 ACR的异常与肾脏功能密切相关,是监测肾脏损害的早期的指标;糖代谢异常、肥胖和脂代谢异常,都是肾脏早期受损的风险因素,hs-CRP作为检测指标可非特异的反映肾脏早期损害;ACR早期检测对预防糖尿病肾病有重要意义。ACR不随年龄变化发生改变。     

Influence of cyclophosphamide and its metabolic products on the activity of peritoneal macrophages in mice

2,4,6-Trinitrophenyl (TNP) hapten-labeled peritoneal macrophages (Mf) given intravenously (iv) to recipients are poor inducers of contact sensitivity (CS) reactions unless Mf donors are pretreated with low doses of cyclophosphamide (CY). In vivo CY is converted into active alkylating metabolites, phosphoramide mustard (PM) and acrolein (ACR).Our experiments aimed to test how in vitro treatment of non-immunogenic Mf with different concentrations (10^?5 to 10^?7 M) of CY metabolites will influence their immunogenicity and other biological functions. Instead of chemically unstable PM, we used structurally and functionally similar nitrogen mustard (NM).Our experiments show that treatment of Mf with ACR or NM stimulates the in vitro production of pro-inflammatory IL-6 and IL-12 and down-regulates anti-inflammatory IL-10 and TGF-β cytokines. In vivo non-immunogenic TNP-Mf become capable of inducing CS reactions in two situations: first, after treatment with NM or ACR and second, when cell recipients are received iv before Mf transfer of monoclonal antibodies against IL-10 and/or TGF-β (500 μg per animal). Treatment with NM, but not with ACR, was also an efficient stimulus for production by Mf of significantly increased levels of reactive oxygen intermediates (ROIs).In summary, our experiments show that CY metabolites can significantly increase the specific immune response as well as nonspecific innate reaction (ROIs production) and support the notion that CYand its metabolites can be a promising accessory tool when upregulation of the immune response is desired.     

Gene profiles of a human alveolar epithelial cell line after in vitro exposure to respiratory (non-)sensitizing chemicals: Identification of discriminating genetic markers and pathway analysis

There are currently no accepted biological prediction models for assessing the potential of a substance to cause respiratory sensitization. New tests should be based on mechanistic understanding and should be preferentially restricted to in vitro assays. The major goal of this study was to investigate the alterations in gene expression of human alveolar epithelial (A549) cells after exposure to respiratory sensitizing and non-respiratory sensitizing chemicals, and to identify genes that are able to discriminate between both groups of chemicals. A549 cells were exposed during 6, 10, and 24 h to the respiratory sensitizers ammonium hexachloroplatinate IV, hexamethylene diisocyanate, and trimellitic anhydride, the irritants acrolein and methyl salicylate, and the skin sensitizer 1-chloro-2,4-dinitrobenzene. Overall changes in gene expression were evaluated using Agilent Whole Human Genome 4x44K oligonucleotide arrays. A Fisher linear discriminant analysis was used to obtain a ranking of genes that reflects their potential to discriminate between respiratory sensitizing and respiratory non-sensitizing chemicals. Among the 20 most discriminating genes, which were categorized into molecular and biological gene ontology (GO) terms, CTLA4 could be associated with asthma and/or respiratory sensitization. When categorizing the top-1000 genes into biological GO terms, 22 genes were associated with immune function. Using a pathway analysis tool to identify possible underlying mechanisms of respiratory sensitization, no known canonical signaling pathway was observed to be activated in the A549 cell line.     

C-TIRADS与ACR TIRADS对判断甲状腺结节良恶性的诊断效能比较

目的：　比较中华医学会超声医学分会甲状腺影像报告和数据系统（C-TIRADS）与美国放射学会甲状腺影像报告和数据系统（ACR TIRADS）对甲状腺结节良恶性的诊断效能。方法：　回顾性分析321枚行甲状腺细针穿刺的甲状腺结节,统计穿刺后结节声像图资料,使用C-TIRADS指南、ACR TIRADS指南进行结节再次评估,构建二者的受试者工作特征（receiver operating characteristic,ROC）曲线,计算二者灵敏度、特异度、准确度,比较二者在甲状腺结节诊断中的效能。结果：　C-TIRADS指南甲状腺结节恶性风险为：2类0.0%（0/10）,3类5.0%（1/20）,4a类17.3%（22/127）,4b类44.3%（43/97）,4c类74.4%（32/43）,5类91.7%（22/24）;ACR TIRADS指南为：2类4.3%（1/22）,3类3.4%（2/58）,4类35.9%（52/145）,5类64.6%（62/96）。C-TIRADS指南和ACR TIRADS指南的曲线下面积（area under the curve,AUC）分别为0.798（95%CI=0.749~0.840）、0.765（95%CI=0.715~0.810）,二者差异无统计学意义（P=0.081）,约登指数最大值分别为0.467、0.382,对应的最佳截断值分别为C-TIRADS4a、ACR-TIRADS 4类;C-TIRADS的灵敏度、特异度、准确度分别为81.82%、84.00%、83.18%,ACR TIRADS的灵敏度、特异度、准确度分别为81.82%、60.00%、68.22%,C-TIRADS较ACR TIRADS特异度、准确度更高,差异有统计学意义（P=0.000,P=0.000）,二者灵敏度差异无统计学意义（P=1.000）。结论：　C-TIRADS较ACR TIRADS在甲状腺结节诊断中具有更高的特异度和准确度。     

ACR TI-RADS分类在初学者中的诊断准确性与可重复性

目的 评估初学者运用ACR TI-RADS分类的诊断准确性和可重复性.方法 收集2018年7月～2020年1月在我院行甲状腺超声检查(有完整、合格的影像学资料)、超声引导下甲状腺细针抽吸活检(FNA)细胞学检查并经手术后病理证实的甲状腺结节,通过符合要求的影像学资料对初学者进行循环式的测试-训练-再测试,记录并比较各个...     

A Multimedia Strategy to Integrate Introductory Broad-Based Radiation Science Education in US Medical Schools

US physicians in multiple specialties who order or conduct radiological procedures lack formal radiation science education and thus sometimes order procedures of limited benefit or fail to order what is necessary. To this end, a multidisciplinary expert group proposed an introductory broad-based radiation science educational program for US medical schools. Suggested preclinical elements of the curriculum include foundational education on ionizing and nonionizing radiation (eg, definitions, dose metrics, and risk measures) and short- and long-term radiation-related health effects as well as introduction to radiology, radiation therapy, and radiation protection concepts. Recommended clinical elements of the curriculum would impart knowledge and practical experience in radiology, fluoroscopically guided procedures, nuclear medicine, radiation oncology, and identification of patient subgroups requiring special considerations when selecting specific ionizing or nonionizing diagnostic or therapeutic radiation procedures. Critical components of the clinical program would also include educational material and direct experience with patient-centered communication on benefits of, risks of, and shared decision making about ionizing and nonionizing radiation procedures and on health effects and safety requirements for environmental and occupational exposure to ionizing and nonionizing radiation. Overarching is the introduction to evidence-based guidelines for procedures that maximize clinical benefit while limiting unnecessary risk. The content would be further developed, directed, and integrated within the curriculum by local faculties and would address multiple standard elements of the Liaison Committee on Medical Education and Core Entrustable Professional Activities for Entering Residency of the Association of American Medical Colleges.