HIV抗体不确定患者的随访转归及相关生物学因素

目的 探讨HIV抗体不确定患者随访转归、辅助诊断方法及导致出现HIV抗体不确定结果的有关生物学因素。方法 按照《全国艾滋病检测技术规范(2009) ,对笔者所在实验室2005-2009年经Western blotting检测结果为HIV抗体不确定的269例患者进行随访检测,同时以核酸和p24抗原检测为辅助诊断,检测乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、梅毒螺旋体(TP)、人类嗜T细胞病毒(HTLV)Ⅰ型和Ⅱ型的感染状况及抗核抗体(ANA)、甲胎蛋白(AFP)在血液中的含量,并与筛查阳性但Western blotting确认阴性患者的样本进行比较。结果 共有73例HIV抗体不确定者成功随访,其中25例在随访中抗体转阳,确认感染HIV;48例抗体转阴,排除HIV感染。对于随访期间抗体转阳的患者,当回访检测时间超过1周后,任意时间段回访检测的抗体阳转率均为100.00％。HIV抗体不确定患者Western blotting带型主要集中在p24和gp160,抗体转阳组和抗体转阴组带型分布不同。核酸检测与Western blotting检测方法的一致率及灵敏度均高于90.00％,且均高于p24抗原的69.09％( 38/55)和27.27％( 6/22),差异有统计学意义（x2一致率=6.875,x2灵敏度=18.893,P值均＜0.05）。抗体转阴的HIV抗体不确定患者ANA、AFP阳性率分别为20.83％(1 0/28)、6.25％ (3/48),高于筛查阳性Western blotting确认阴性的患者（均为0.00％）,差异有统计学意义（x2ANA= 19.430,x2AFP =5.520,P值均＜0.05）;但两组HBV、HCV、HTLV和TP感染情况类似。结论 对HIV抗体不确定进行随访有利于患者的及时诊断。作为辅助诊断,核酸检测比p24抗原检测具有更强的应用价值;患者体内ANA、AFP水平升高可能是致HIV抗体不确定的非特异性反应的因素。     

鳞癌相关抗原在鳞癌及相关良性疾病中的临床意义

探讨鳞状细胞癌相关抗原（squamous cell carcinoma-related antigen,SCC-Ag）在鳞状细胞癌（鳞癌）和良性疾病中的诊断和临床监测意义及其与病理分级、临床分期的关系。采用微粒子酶免疫分析技术对167例鳞癌患者、96例相关良性疾病患者和96名健康对照者进行了血清SCC-Ag水平的检测,对各组SCC-Ag的表达水平和阳性率进行统计学分析。结果表明,鳞癌患者血清SCC-Ag表达水平显著高于健康对照者和良性疾病患者（P〈0.01）,SCC-Ag对鳞癌的诊断灵敏度为61.1%、特异性为91.7%,其ROC曲线下面积为0.825,表示SCC-Ag对鳞癌的诊断较为准确,可作为重要的诊断依据;宫颈鳞癌SCC-Ag表达水平和阳性率与临床分期呈正相关,但与病理分化不相关;良性疾病患者和健康对照组的SCC-Ag表达水平分布差异显著（P〈0.05）。血清SCC-Ag表达水平可作为肺鳞癌、宫颈鳞癌以及食管鳞癌诊断的特异性指标,在鳞癌及良性疾病的鉴别诊断中有很大的临床意义。     

电子病历辅助临床诊断系统研究

为共享医生诊疗经验,从相似电子病历检索的角度探讨辅助诊断系统的建设,介绍系统功能模块组成和理论算法,包括主诉相似度、诊疗模式相似度、图像相似度、综合相似度计算算法。此方法能够较为全面地根据电子病历的内容计算相似度,检索出的电子病历为医生制订诊疗计划提供参考。     

多重共线性的变量分解处理法初探

本文在回归系数方差分解（ＲＣＶＤ）诊断的基础上，对多元回归自变量间存在的多重共线性问题的处理进行了一些探讨。首先通过建立辅助回归得到自变量间的多重共线性关系，其次再将辅助回归中的应变量分解为多个子变量，最后通过建立回归方程组达到解决多重共线性问题的目的。     

Efficient respiration on TMAO requires TorD and TorE auxiliary proteins in Shewanella oneidensis

Respiration on trimethylamine oxide (TMAO) allows bacterial survival under anoxia. In Shewanella oneidensis, Tor is the system involved in TMAO respiration and it is encoded by the torECAD operon. The torA and torC genes encode TorA terminal reductase and the TorC c-type cytochrome, respectively. Sequence analysis suggests that TorD is the putative specific chaperone of TorA, whereas TorE is of unknown function. The purpose of this study was to understand whether TorD and TorE are two accessory proteins that affect the efficiency of the Tor system by chaperoning TorA terminal reductase. Moreover, by deleting each gene, we established that the absence of TorD drastically affects the stability of TorA, while the absence of TorE does not affect TorA stability or activity. Since TMAO reduction was affected in the ΔtorE mutant, TorE could be an additional component of the TorC-TorA electron transfer chain during bacterial respiration. Finally, a fitness experiment indicated that the presence of TorE, as expected, confers a selective advantage in competitive environments.     

Mitigation of eddy current heating during magnetic nanoparticle hyperthermia therapy

Background: Magnetic nanoparticle hyperthermia therapy is a promising technology for cancer treatment, involving delivering magnetic nanoparticles (MNPs) into tumours then activating them using an alternating magnetic field (AMF). The system produces not only a magnetic field, but also an electric field which penetrates normal tissue and induces eddy currents, resulting in unwanted heating of normal tissues. Magnitude of the eddy current depends, in part, on the AMF source and the size of the tissue exposed to the field. The majority of in vivo MNP hyperthermia therapy studies have been performed in small animals, which, due to the spatial distribution of the AMF relative to the size of the animals, do not reveal the potential toxicity of eddy current heating in larger tissues. This has posed a non-trivial challenge for researchers attempting to scale up to clinically relevant volumes of tissue. There is a relative dearth of studies focused on decreasing the maximum temperature resulting from eddy current heating to increase therapeutic ratio.

Methods: This paper presents two simple, clinically applicable techniques for decreasing maximum temperature induced by eddy currents. Computational and experimental results are presented to understand the underlying physics of eddy currents induced in conducting, biological tissues and leverage these insights to mitigate eddy current heating during MNP hyperthermia therapy.

Results: Phantom studies show that the displacement and motion techniques reduce maximum temperature due to eddy currents by 74% and 19% in simulation, and by 77% and 33% experimentally.

Conclusion: Further study is required to optimise these methods for particular scenarios; however, these results suggest larger volumes of tissue could be treated, and/or higher field strengths and frequencies could be used to attain increased MNP heating when these eddy current mitigation techniques are employed.     

Isoniazid-related fulminant hepatic failure in a child: assessment of the native liver’s early regeneration after auxiliary partial orthotopic liver transplantation

We report the first case of auxiliary partial orthotopic liver transplantation (APOLT) in a patient with isoniazid (INH)-related fulminant hepatic failure (FHF) with the aim to determine the ability of the native liver (NL) to recover after this particular toxic event. A 10-year-old boy with INH-related FHF underwent APOLT after left hepatectomy on the NL. Neurological status and liver function rapidly improved, but, on postoperative day 22, urgent re-transplantation was needed for graft–hepatic artery thrombosis (HAT) and the NLs incapacity to sustain adequate liver function. Histological examination of the NL showed signs evident of its regeneration, however. In conclusion, though we faced the clinical failure of the NL functionally to sustain the patient in the presence of the graft HAT 3, weeks after APOLT, such a failure may be interpreted as time related. In fact, the histological picture in this particular case may suggest the potential for NL recovery after INH-related FHF.     

根据区域灰度变化的食管微小病变的计算机实时辅助诊断

利用计算机图像处理技术捕捉食管微小病变区域的灰度变化,通过色调(H)、饱和度(S)区域均数比较算法和灰度的波动频数积分算法对采集到的食管图像进行实时、快速分析,以期达到对食管微小病变进行快速筛查的目的。结果表明:基于上述两种算法研制的食管图像处理软件,对食管的各种病变,包括正常食管黏膜、食管炎、早期食管癌、中晚期食管癌、食管黏膜不典型增生等都有辅助诊断的价值,基于本算法研制的软件可作为临床辅助诊断食管病变的一种有效手段。     

基于临床大数据的医疗质量监控辅助系统探讨

随着大数据、互联网和信息科技的发展,人工智能技术被逐步应用于医院管理领域。作者利用临床大数据设计了医疗质量监控辅助系统,对医院现有的医疗信息数据进行结构化采集与监控,从环节上把握影响医疗质量与安全的关键点与关键事件,对医护人员的医疗行为进行事前预警、事中监控、事后评价,全面提升医院的医疗质量管理。     

急性一氧化碳中毒辅助检查的临床意义

急性一氧化碳中毒是临床急症,其危害较大,尤其心脏和脑易遭受损害。如果治疗不及时,很容易造成生命危险,还会出现严重并发症。而快速、准确的辅助检查,如心电图、血碳氧血红蛋白、心肌酶、肌钙蛋白和C反应蛋白、血常规、N末端前脑钠肽、乳酸、胃泌素、醛固酮、血浆D-二聚体、脑电图、头CT或头颅磁共振成像有重要的临床意义,可以帮助判断病情、指导治疗、了解预后。