急性冠脉综合征瘀毒互结证诊断标准研究

目的 基于冠心病“瘀毒”病因病机的理论认识,建立急性冠脉综合征瘀毒互结证诊断标准。方法 采用文献系统分析与横断面临床研究构建条目池,采用德尔菲法专家咨询对条目进行筛选,采用层次分析法确定各条目权重。在此基础上,结合条目权重及临床实用性原则建立诊断标准。结果 文献系统分析筛选条目43个,横断面临床研究纳入患者400例,筛选条目39个,归纳分类后形成包含67个条目的条目池;经过两轮德尔菲专家咨询,筛选保留条目28个;通过层次分析法,确定高权重类条目（0.0430~0.1976）9个、中权重类条目（0.0153~0.0289）9个与低权重类条目（0.0060~0.0147）10个。结合临床实用性原则,优化形成包括必要指标（心绞痛程度进行性加重、近1个月反复发作性心绞痛等）、理化指标（心脏肌钙蛋白或肌酸激酶同工酶升高等）及舌象脉象（舌青紫或紫暗等、脉弦细或脉涩）3个维度的急性冠脉综合征瘀毒互结证诊断标准。两轮专家问卷咨询肯德尔和谐系数分别为0.368、0.395,格朗巴赫系数为分别为0.967、0.893,提示专家意见一致性好,结果可信度高。结论 该诊断标准涵盖了反映瘀毒互结致病特点的宏观表征和理化指标,可指导急性冠脉综合征瘀毒互结证的诊断。     

Evaluation of Dietary Quality Based on Intelligent Ordering System and Chinese Healthy Eating Index in College Students from a Medical School in Shanghai,China

We intended to precisely evaluate the dietary quality of male and female medical college students using canteen data from the “Intelligent Ordering System” (IOS), combined with the supplemental food frequency questionnaire (SFFQ) and the Chinese Healthy Eating Index (CHEI) in Shanghai, China, to explore the potential factors influencing dietary quality. A total of 283 college students with the average age of 24.67 ± 3.21 years and Body Mass Index of 21.46 ± 3.49 kg/m² in the medical school were enrolled in this study, and an online questionnaire investigation was conducted to collect the general information, lifestyle behavior, and SFFQ. The dietary data of the study participants from the school canteen were exported from the IOS of the Information Office of Fudan University. The CHEI consists of 17 components and the total score is 100, with a maximum score of each component of 5 or 10. We calculated each component score of the CHEI and aggregated the total score for male and female study participants. The Chi-square test and Wilcoxon rank sum test were employed in comparing the differences between the demographic characteristics and CHEI component scores of males and females. Univariate and multiple linear regression models were employed to examine the potential influencing factors of the total CHEI score. The CHEI median score was 66.65, and the component score for total grains was relatively low. Added sugars was the most overconsumed CHEI component. There were relatively serious deficiencies, based on the CHEI component scores, in fruits, soybeans, fish and seafood, and seeds and nuts in both sexes. Females had significantly higher CHEI scores than males (68.38 versus 64.31). The scores for tubers, total vegetables, dark vegetables, fruits, fish and seafood, dairy, and red meats were significantly higher in females than in males. Influencing factors including sex, education, dietary health literacy, and amount of time spent sedentarily were significantly associated with CHEI score. Our research revealed that the overall dietary quality needs to be further improved for college students at the medical school in Shanghai, China, with low intakes of total grains, fruits, soybeans, fish and seafood, and seeds and nuts, and high intakes of added sugars. Compared with males, females showed higher diet quality and conformed more strongly with the recommended Dietary Guideline for Chinese. Education, dietary health literacy, and amount of time spent sedentarily should be noted for improving the dietary quality of college students.     

冻融胚胎移植周期中不同辅助生殖技术助孕方式和移植不同发育阶段胚胎对出生性别比的影响

目的:探讨冻融胚胎移植（frozen-thawed embryo transfer, FET）周期中不同辅助生殖技术（assisted reproductive technology, ART）助孕方式和移植不同发育阶段胚胎对新生儿性别的影响。方法:回顾性队列研究分析2010年4月至2018年10月期间于广州市妇女儿童...     

难治性精神分裂症CT表现及多靶点联合毁损术后CT征象分析

目的:探讨难治性精神分裂症(TRS)的CT表现和多靶点联合毁损术后CT影像特点.方法:对464例TRS患者术前CT和56例TRS患者术后CT表现进行回顾性分析,并测量毁损灶体积.56例TRS患者术后疗效评定为Ⅰ～Ⅱ级37例,Ⅲ～Ⅳ级19例;Ⅰ～Ⅱ级患者术后2～10 d行CT扫描25例、40～90 d 16例,19例Ⅲ～Ⅳ级患者术后6～7个月行CT扫描.结果:TRS患者的主要CT表现为脑萎缩,发生率为36.2%(168/464),其中皮质型脑萎缩占25%(116/464).术后2～10d,毁损灶呈类圆形和柱形者为93.3%(140/150),片状不规则形为6.7%(10/150);术后40～90 d,病灶呈类圆形和柱形为66.2%(65/96),片状不规则形为33.8%(31/96).结论:术前CT扫描可作为筛选TRS手术患者的一种手段,脑萎缩患者选择手术治疗应慎重;术后不同时期CT扫描可客观评价手术疗效,为手术方案改进、并发症的预防和处理提供参考.     

帕金森病CT表现及微电极导向脑内核团毁损术后CT影像分析

目的探讨帕金森病(PD)的CT表现及微电极导向脑内核团毁损术后CT影像特点。资料与方法(1)对240例PD患者术前CT影像进行回顾性分析。(2)30例PD患者在术后3~12个月(平均6·5个月)CT扫描,观测脑内核团毁损灶33个(其中3例患者为双侧手术):右苍白球腹后内侧核(Gpi)毁损灶14个、左Gpi核毁损灶6个,右丘脑腹外侧核(Vim)毁损灶2个、左Vim核毁损灶11个,对毁损灶最大层面积、术侧CT值(任意值)、健侧对应点CT值(标准值)测量,并算出毁损灶与健侧CT值的差值。结果(1)PD的CT表现主要为中央型弥漫性脑萎缩,以脑室系统扩大为主,轻度脑萎缩46.67%(112/240),中度脑萎缩40%(96/240),重度脑萎缩3.33%(8/240),正常10%(24/240)。(2)33个毁损靶灶之圆形占27·27%(9/33);类圆形占60·61%(20/33);片状不规则形占12·12%(4/33)。毁损灶的面积Gpi核平均(28·01±2.15)mm2,Vim核平均为(14.03±1.24)mm2,两者对比有显著性差异(P<0.01);毁损灶Gpi核CT值较健侧平均下降(11.80±0.87)HU,Vim核CT值较健侧平均下降(10.80±1.28)HU,两者亦有差异性(P<0·05)。结论PD患者术前CT扫描对掌握手术适应证较重要,重度脑萎缩患者提示不宜做外科手术治疗。术后CT扫描观察毁损灶之形态、面积、密度变化等影像学改变,有利于对手术疗效、并发症等评估提供一定证据。     

儿童卵巢扭转影像学研究及治疗进展

卵巢扭转为小儿急腹症之一,需立即诊断并及时治疗,否则可造成卵巢缺血坏死等不可逆损伤。儿童卵巢扭转临床表现缺乏特异性,主要依靠影像学检查,包括超声、CT及MRI进行诊断;目前以腹腔镜下保守复位为首选治疗方式。本文就儿童卵巢扭转影像学研究及治疗进展进行综述。     

Fragment-Resistant Property Optimization within Ballistic Inserts Obtained on the Basis of Para-Aramid Materials

A high protection level without an excessive weight is a basic assumption in the design of modern armors and protection systems. Optimizing armors is a task of development of the utmost importance, and is the subject of the work contained within this article. Optimization of ballistic inserts was carried out using multicriterial analysis (MCA), which enables the selection of the optimal composition, taking into account properties such as ballistic resistance, physicomechanical, and/or functional properties. For this purpose, various types of composite systems were produced and tested in terms of their fragment-resistant properties according to STANAG 2920 and the composite areal density of different ballistic inserts: Soft inserts made of Twaron^® para-aramid sheets, hard ballistic inserts made of multilayer hot-pressed preimpregnated sheets, and hybrid hard ballistic inserts prepared on the basis of multilayer hot-pressed preimpregnated sheets and ceramics. The application of MCA and performance of experimental fragment resistance tests for a wide spectrum of para-aramid inserts are part of the novelty of this work. The obtained test results showed that depending on the composition of the composite system, we could obtain a wide range of fragmentation resistance in the range of 300 to >1800 m/s, which depended on the areal density and type of composite system used. The results also confirmed that MCA is a good computational tool to select the optimal design of para-aramid ballistic inserts.     

微波消融猪乳腺的最佳模式

目的 观察对猪乳腺行微波消融(MWA)的最佳模式。方法 分别对4只猪以不同模式行MWA:模式1为约400 J能量+5 mm针型,模式2为约400 J能量+3 mm针型,模式3为约1 000 J能量+3 mm针型,模式4为约2 000 J能量+3 mm针型;比较不同模式下消融灶超声表现及病理特征(仅对模式2、3、4消融灶切开送病理)和消融致皮肤热损伤发生率。结果 MWA前及以模式1~4行MWA后,猪乳腺硬度差异均有统计学意义(F=50.281,P=0.009);MWA后乳腺硬度均明显高于MWA前(P均＜0.05),模式1消融灶硬度明显大于模式2~4(P均＜0.05)。超声造影显示消融灶长径为(21.24±3.68)mm,与大体标本所见差异无统计学意义(P=0.465);宽径为(9.43±1.50)mm,大于大体标本所见(P=0.001)。大体标本显示,模式2、3、4之间,消融灶长径差异具有统计学意义(P＜0.001)。以模式1行MWA后猪皮肤见3处红肿、1处水泡,以模式4行MWA后见3处红肿、2处水泡,模式2、3均未见皮肤热损伤;各模式间皮肤热损伤差异均有统计学意义(P均＜0.05)。结论 低能量+3 mm发射前端针型为MWA用于猪乳腺最佳模式。     

分子诊断在小细胞肺癌中的临床应用

目前应用于小细胞肺癌的分子诊断技术发展很快,主要表现在肿瘤标记物测定、癌基因及抑癌基因异常表达、DNA序列分析、蛋白组学临床应用等方面。这些技术的应用将对小细胞肺癌患者早期诊断、判断预后、治疗方案的个体化选择产生重要意义。