40例原发性胃肠道弥漫大B细胞淋巴瘤临床特征、细胞来源与预后分析

背景与目的:原发性胃肠道弥漫大B细胞淋巴瘤(primary gastrointestinal diffuse large B-cell lymphoma,PGI-DLBCL)的发病部位及其临床表现与胃肠道其它肿瘤性疾病难以鉴别,误诊率较高,且其标准治疗的方法仍未确定。本研究旨在分析PGI-DLBCL的临床特征、肿瘤细胞来源及预后,并探讨有效的联合治疗方法。方法:分析我院1998～2007年诊治的40例PGI-DLBCL,应用Kaplan-Meier法、log-rank检验和Cox回归模型对其临床资料和实验室检测结果进行生存分析及单因素和多因素预后分析。通过免疫组化染色分析34例患者的肿瘤细胞来源。治疗方法包括联合化疗、手术 联合化疗及放疗、单纯手术等,联合化疗方案为CHOP及CHOP样方案。结果:40例PGI-DLBCL患者中,年龄10～89岁中位年龄56.5岁,男女比例1.86∶1,胃与肠道的发病比率为1.05∶1。预后分析可追访病例38例中,死亡12例(31.6%),3年和5年生存率均为64.7%。9例多部位发病的患者中,8例(88.9%)在3年内死亡。9例(26.5%)肿瘤细胞来源于生发中心(germinal center,GC),25例(73.5%)来源于非生发中心(non-germinal center,non-GC)。单因素预后分析发现肿瘤细胞来源、国际预后指数(international prognosis index,IPI)、B症状对生存率的影响有显著性(P<0.05)。Cox多因素预后分析显示血清乳酸脱氢酶(LDH)升高组患者的死亡风险是LDH正常组的2.87倍。结论:PGI-DLBCL发病以中年男性为主,多部位发病是该类患者死亡的重要原因。肿瘤细胞来源、IPI、B症状对预测患者生存和指导治疗有重要作用,其中初诊时血清LDH水平升高是本组患者的独立预后因素。     

酒精所致精神障碍的临床分析

目的探讨酒精所致精神障碍患者的临床特点。方法回顾分析精神专科医院2011年10月至2012年9月收治的196例酒精所致精神障碍患者,临床资料。结果长期饮酒对神经系统损害较大,精神障碍患者可出现不同程度的幻觉、幻视、妄想、抑郁、情绪高涨、兴奋躁动等不稳定症状,有些患者出现人格障碍及记忆障碍。患病率中文化水平低、体力劳动重的男性居多。对照组总有效率高于常规组（x2=4．6296,P〈0．05）。结论酒精可致精神和躯体损害,早期治疗能改善症状,少量抗精神药物及戒酒等综合性治疗可有效改善患者病情,值得在临床推广应用。     

Topology Optimization and Multiobjective Optimization for Drive Axle Housing of a Rear Axle Drive Truck

As one of the important load-bearing components of a truck, the drive axle housing must meet the requirements of stiffness and strength. The traditional design method uses redundancy design to meet the performance requirements. The joint design between the three-dimensional mathematical model and finite element model is adopted, and the optimal design of the drive axle housing is realized based on topology optimization and multiobjective optimization. Firstly, the static analysis of the drive axle housing of a rear axle drive truck was carried out with four typical working conditions. It was concluded that the four working conditions all operate under the yield limit of the material, and it was found that the maximum equivalent stress of the four working conditions occurs at the step of the half-shaft casing. Among the four working conditions, the most critical one is the maximum vertical force working condition. Then, based on the maximum vertical force working condition, the fatigue life analysis is conducted, and the minimum fatigue life appears at the transition position of the half-shaft sleeve and the arc transition position of the main reducer chamber. The remaining parts can meet the design requirements. The overall safety factor of the drive axle housing is mainly between 1 and 5 when operating under this working condition. Then, through modal analysis, the first to sixth natural frequency and vibration modes of the drive axle housing are extracted. Based on the modal analysis, the dynamic characteristics of the drive axle housing are further studied by harmonic response analysis and random vibration analysis. Finally, two kinds of lightweight optimization schemes for the drive axle housing are given. Topology optimization reduces the mass of the drive axle housing by 17.4%, but the overall performance slightly decreases. Then, the five dimensional parameters of the drive axle housing are selected as design variables. The mass, maximum deformation, equivalent stress, service life, and the first-, second- and third-order natural frequencies are defined as objective functions. Through the optimal space-filling design method, the experimental designs are performed and the sample points are obtained. Based on the results of experiment design, the multiobjective genetic algorithm and response surface method are combined to optimize the objective functions. The analysis results show that the mass is reduced by 4.35%, the equivalent stress is reduced by 21.05%, the minimum life is increased by 72.28%, and the first-, second-, and third-order natural frequency are also increased to varying degrees. Two different optimization strategies are provided for the design of the drive axle housing.     

Characteristics of normal newborn transient-evoked otoacoustic emissions: Ear asymmetries and sex effects

Transient-evoked otoacoustic emissions (TEOAEs) were recorded from more than 30000 newborns over a six year period. Analysis was performed on all the TEOAEs that passed the bedside universal hearing screen (n=60431), in order to characterize the normal properties of neonatal TEOAEs and to study ear and sex effects. Short recording times (median=33 s) were observed in combination with high entire TEOAE level (median=18.8 dB SPL for an 81.8 dB SPL peak stimulus), and high reproducibility (median=86%). Signal-to-noise ratio (S/N) of the TEOAE was highly frequency-dependent, being poorer at low frequencies. Prolonged averaging increased median reproducibility to 97%, but the minor S/N-improvement at low frequencies did not justify the longer test time. Highly significant mean lateral asymmetries (right >left) and sex differences (female >male) existed in entire TEOAE level, S/N TEOAE, and in half-octave frequency bands (700–4000 Hz). Mean lateral and sex entire TEOAE level differences were 1.1 dB and 1.3 dB, respectively. Stimulus levels were not affected by ear or sex. Hence, physiological differences at the level of organ of Corti were demonstrated in newborns.     

成年功能性构音障碍患者辅音错误类型及方式分析

目的 探讨成年功能性构音障碍患者辅音发音错误的特点,为制定语音训练方案提供依据.方法以42例成年功能性构音障碍患者为研究对象,借助计算机语音工作站对患者进行语音评估,对其辅音的发音错误类型及方式进行分析.结果42例成年功能性构音障碍患者主要的辅音发音错误类型为置换、扭曲,其次为脱落.按发音部位,错误辅音依次为舌尖后音(39例,92.86%)、舌尖前音(31例,73.81%)、舌面音(22例,52.38%)、舌根音(19例,45.24%)、舌尖中音(18例,42.86%)、唇齿音(6例,14.29%)及双唇音(6例,14.29%);辅音错误频率由高至低依次为/sh/、/zh/、/ch/、/r/、/z/、/c/、/s/、/q/、/x/、/j/、/g/、/k/、/h/、/t/、/l/、/d/、/f/、/p/.辅音错误方式有:舌前音化(22例,52.38%)、非送气化(12例,28.57%)、侧化构音(12例,28.57%)、辅音脱落(9例21.42%)、舌后音化(8例,19.05%)、舌面音化(4例,9.52%)、双唇音化(4例,9.52%)、唇齿音化(3例,7.14%).结论成年功能性构音障碍患者的辅音发音错误类型主要是置换和扭曲;错误辅音主要为舌尖后音、舌尖前音、舌面音、舌根音、舌尖中音;辅音发音错误方式主要为舌前音化、非送气化、侧化构音、辅音脱落.     

凝胶渗透色谱-多角度激光散射联用技术研究 红芪多糖中4个组分分子特征

目的:测定红芪多糖3(HPS-3)中4个组分的绝对分子量,相对分子质量分布,均方根旋转半径(Rg),多分散系数(Mw/Mn)等分子特征参数,以均方根旋转半径(Rg)对重均分子量(Mw)作图,计算4个组分在溶液状态的构象。方法:采用凝胶渗透色谱-多角度激光散射(GPC-MALLS)联用技术,流动相为含0.02%NaN3的0.1 mol.L-1NaNO3溶液,Ultrahydro-gelTM1000,500色谱柱串联。结果:HPS-3的4个组分中,HPS-3-C的Mw最大(1.986×105g.mol-1);其次为HPS-3-B(1.113×105 g.mol-1)和HPS-3-D(8.457×104 g.mol-1);HPS-3-A的Mw最小(1.223×104 g.mol-1),而Rg最大(55.5 nm)。HPS-3-D相对分子质量分布范围最广,Mw/Mn 2.543。在流动相中,HPS-3-A为球型构象,HPS-3-C为无规则线团构象,HPS-3-B和HPS-3-D则均为高枝化度结构。结论:为进一步研究HPS-3中4个组分分子特征与其生物活性的关系提供必要依据。     

青岛地区1306例甲状腺癌的临床病理特征分析

背景与目的：甲状腺癌(thyroid cancer,TC)发病率在全球范围不断攀升,但存在地区差异。该研究旨在探讨青岛这一典型东部沿海城市的TC发病情况和临床病理特点,以及该地区近年来甲状腺手术疾病谱的变化。方法：回顾性分析青岛大学附属医院2014年行甲状腺切除术的2251例甲状腺结节患者,对其中1306例TC患者的临床病理特征进一步统计分析,并与该院前期数据及美国Surveillance Epidemiology End Results(-SEER)数据库比较。结果：随着该院甲状腺手术例数的逐年上升,其中TC的比例亦由2010年的34.8%上升至2014年的59.0%。TC高发于20～54岁年龄段,较SEER数据库前移(U=2289,P=0.000),男女比例为1∶2.80,其中超重和肥胖者占50.2%。78.2%的TC患者初诊时无明显临床症状或体征,16.6%已有可看到或摸到的甲状腺结节,仅有5.2%因声音嘶哑或其他压迫症状就诊。2014年微小癌占该院TC的61.7%,较2010年(37.7%)明显增多。该院TC伴有颈部淋巴结转移者比例明显高于SEER数据库(49.5%vs 26%,χ2=11.806,P=0.001),且微小癌伴有颈部淋巴结转移率亦高达31.3％。TC各病理类型所占比例分别为：乳头状癌97.5%、滤泡癌1.1%、髓样癌1.0%、未分化癌0.5%,乳头状癌比例略高于SEER数据库(U=4654.5,P=0.055)。结论：青岛地区甲状腺手术逐年增多,TC术前诊断准确率逐年提高。该地区TC发病呈相对年轻化、超重化及高淋巴结转移趋势。微小癌比率增高提示该地区筛查及体检等预防意识的普及,微小癌中较高的淋巴结转移率提示该地区微小癌的侵袭性不容忽视。