573例乳腺癌临床资料分析

目的探讨乳腺癌的临床特点以及台疗方法的评价.方法收集1989年～1992年共573例完整的病例资料.按治疗方法分为手术组、手术+放疗、手术+化疗、手术+放疗+化疗、非手术组.对病例的一般临床特点及生存率进行统计学分析.结果年龄35岁～55岁者占408例,发病部位外上象限为333例,病理实性癌占375例.不同治疗方法的生存率分5年和10年如下手术组78%、62%,手术+化疗72%、45%,手术+放疗57%、40%,手术+放疗+化疗60%、45%,非手术组35%.结论乳腺癌高发病率年龄组为中年,病变多位于外上象限,病理多为浸润性非特殊性癌.治疗方法仍以手术治疗为首选,适当地配合放、化疗等.     

An inverted ankle joint orientation at foot strike could incite ankle inversion sprain: Comparison between injury and non-injured cutting motions of a tennis player

Ankle sprain is very common in sports. Research on its prevention is as important as on its treatment as recommended in the 2016 consensus statement of the International Ankle Consortium. Successful prevention depends on the understanding of its mechanism, which has been presented with quantities in some recent case reports. Inciting event was suggested to be an inverted ankle joint at foot strike, however, is still lacking evidence from comparison with non-injury trials. This study investigated the ankle joint orientation at foot strike in successful non-injury cases and compared them with a previously analysed ankle sprain injury case. Two injury-free cutting motions with similar movement approach to a previously analysed ankle sprain injury performed by the same athlete were collected from an online search and were trimmed from 0.05 s before until 0.30 s after the foot strike. The video sequences were then processed by video editing software and then analysed by a model-based image-matching motion analysis technique. Ankle joint orientation at foot strike and the profiles were presented in inversion, plantarflexion and rotation planes, for both the previously analysed injury case and the two non-injury cases. The ankle joint orientation at foot strike was 0–1 degree inverted and 10–21° dorsiflexed in the two non-injury cases, compared to 14° inverted and 16° plantarflexed in the previously analysed injury case. From the case comparison, it can be observed that an inverted ankle joint orientation at foot strike in an inciting event of ankle inversion sprain.     

Pulmonary contusions in patients with rib fractures: The need to better classify a common injury

BackgroundPulmonary contusions are common injuries. Computed tomography reveals vast contused lung volume spectrum, yet pulmonary contusions are defined dichotomously (unilateral vs bilateral). We assessed whether there is stepwise increased risk of pulmonary complications among patients without, with unilateral, and with bilateral pulmonary contusion.MethodsWe identified adults admitted with rib fractures using the largest US inpatient database. After propensity-score-matching patients without vs with unilateral vs bilateral pulmonary contusions and adjusting for residual confounders, we compared risk for pneumonia, ventilator-associated pneumonia (VAP), respiratory failure, intubation, and mortality.ResultsAmong 148,140 encounters of adults with multiple rib fractures, 19% had concomitant pulmonary contusions. Matched patients with pulmonary contusions had increased risk of pneumonia 19% [95%CI:16–33%], respiratory failure 40% [95%CI: 31–50%], and intubation 46% [95%CI: 33–61%]. Delineation showed bilateral contusions, not unilateral contusions, attributed to increased risk of complications.ConclusionsThere is likely a correlation between contused lung volume and risk of pulmonary complications; dichotomously classifying pulmonary contusions is insufficient. Better understanding this correlation requires establishing the clinically significant contusion volume and a correspondingly refined classification system.     

基于UPLC对龙血通络胶囊特征图谱及5个成分含量的测定

目的 建立龙血通络胶囊超高效液相色谱法（UPLC）特征图谱,并测定7,4′-二羟基黄酮、4,4′-二羟基-2,6-二甲氧基二氢查耳酮、龙血素A、龙血素B、紫檀芪5个成分的含量。方法 采用Agilent Infinity Lab Poroshell 120 EC-C₁₈色谱柱（150 mm×3.0 mm,2.7 μm）,以乙腈（A）-0.1%磷酸水溶液（B）为流动相梯度洗脱,柱温为35 ℃,流速为0.5 mL·min^–1,进样体积为2 μL,检测波长为280 nm。结果 建立了龙血通络胶囊UPLC特征图谱,标定了13批样品中的11个共有特征峰,相似度均大于0.95。5个成分在相应质量浓度范围内呈良好的线性关系（r>0.999 5）,加样回收率为97.93%~107.33%,RSD均小于3.0%。结论 建立的UPLC操作简便、高效准确,可为龙血通络胶囊的质量控制提供参考。     

便携式近红外光谱仪用于东阿阿胶鉴定及特征波长筛选研究

目的 采用便携式近红外(near infrared,NIR)光谱仪建立东阿阿胶鉴别分析模型,并优选出特征波段。方法 采用BWS903型NIR光谱仪和microPHAZIR^TMRX型NIR光谱仪2款便携式光谱仪采集了47份阿胶样品的光谱,并采用软独立建模聚类分析(soft independent modeling class analog,SIMCA)和偏最小二乘判别分析(partial least squares discriminant analysis,PLS-DA)等化学计量学算法,建立了东阿阿胶的判别分析模型。结果 所建立模型能够准确区分东阿阿胶和其他品牌阿胶。在此基础上,采用相关系数法优选出BWS903光谱特征波长为1300～1380 nm和1460～1540 nm;microPHAZIR^TMRX光谱特征波长为1600～1680 nm和2160～2240 nm,上述波段分别代表-NH₂和-CONHR肽键的1级倍频吸收,这些波段可作为东阿阿胶的特征波段,并可据此设计专用型、小型化的NIR光谱仪,用于东阿阿胶的品牌...     

经典名方甘草泻心汤基准样品的量值传递研究

目的 建立经典名方甘草泻心汤（Gancao Xiexin Decoction,GXD）基准样品的HPLC图谱及指标性成分含量测定方法,研究GXD基准样品量值传递规律。方法 制备15批GXD基准样品,建立特征图谱并选用《中药色谱指纹图谱相似度评价》软件进行相似度评价,明确特征峰并对其进行归属。测定指标性成分甘草苷、甘草酸、黄芩苷、盐酸小檗碱、表小檗碱、黄连碱、巴马汀的含量,计算指标成分转移率,分析指标成分在饮片-基准样品中量值传递的规律。结果 15批GXD基准样品指纹图谱相似度均大于0.90,共指认22个共有峰,甘草5个、黄芩5个、甘草和黄芩共有3个、黄连6个、黄芩和黄连共有2个、干姜1个;各指标成分从药材-饮片平均转移率分别为98.69%、98.13%、96.94%、94.59%、91.76%、88.08%、94.16%;饮片-基准样品平均转移率为49.08%、42.24%、28.34%、26.72%、29.32%、33.62%、47.93%。结论 特征图谱与多指标成分含量测定方法相结合,对GXD药材-饮片-基准样品的量值传递过程进行分析研究,为经典名方GXD制剂开发提供参考。     

Clinical characteristics and risk factors for fatal outcome of patients receiving Sun's procedure after previous cardiac surgery

BackgroundCardiac reoperation has always been a difficult problem in clinical practice. Because of the difficulty of operation, the incidence of complications and mortality rate is high. Secondary aortic surgery, especially the reoperation involving arch, has higher risk and is more difficult for patients with renal failure. Sun's operation (total arch replacement + stent elephant nose) has achieved good results in the treatment of diseases involving aortic arch, and occupies an important position in the treatment of patients with secondary arch lesions after cardiac surgery.MethodsA total of 395 patients with a history of cardiac surgery were recorded in our center from January 1, 2009 to December 31, 2017, among whom 118 (30.1%) patients underwent aortic reoperation via the original incision using Sun's aortic procedure owing to postoperative great vessel disease. We analyzed the clinical data and survival time, and used Cox regression to analyze the risk factors for 30-day mortality as well as long term mortality.ResultsThe interval between the last operation and the present operation was 0.08–19 years. Sixteen patients died within 30 days after operation and the average mortality rate was 13.6%. During the follow-up period, 28 patients died, with the mortality rate of 23.7%. As of December 31, 2017, the longest survival time was 9.36 years, and the survival time of 70 patients was more than 3.05 years. The main risk factor associated with the 30-day survival was cardiopulmonary bypass (CPB) time. The longer the CPB time was, the greater the risk of death was. The main risk factors associated with the long-term survival were CPB time and 24-h bleeding volume. The longer the CPB time was, the more the 24-h bleeding volume was, the higher long-term mortality rate was.ConclusionThe second Sun's operation, as a surgical treatment after cardiac surgery, showed a high survival rate, with long survival time and good curative effect. CPB is the main risk factor for the 30-day survival state after operation, and CPB time and 24-h bleeding volume are the main risk factors for the long-term survival state after operation.     

新型冠状病毒Delta变异株引起的广州市荔湾区本土疫情流行特征分析

目的 分析新型冠状病毒（新冠病毒）B.1.617.2（Delta）变异株引起的广州市荔湾区本土疫情流行特征,为Delta变异株疫情防控工作提供参考依据。方法 资料来源于中国疾病预防控制信息系统传染病报告信息管理系统和广州市荔湾区CDC,收集2021年5月21日至6月18日广州市荔湾区新冠病毒感染者（确诊病例和无症状感染者）相关信息。采用频数（构成比）、直方图、百分比堆积面积图等对本次Delta变异株疫情的流行病学特征进行描述,并应用潜伏期、动态再生系数（R_t）估计进行分析。结果 截至6月18日广州市荔湾区累计报告新冠病毒感染者127例,年龄范围2~85岁,<18、18~59和≥60岁年龄组分别占18.9%（24/127）、43.3%（55/127）和37.8%（48/127）。男女性别比为1：1.35（54：73）;职业以离退休人员32.3%（41/127）、家务及待业18.1%（23/127）和学生16.5%（21/127）为主;主要集中在荔湾区的白鹤洞街道（70.1%,89/127）与中南街道（23.6%,30/127）;Delta变异株的中位潜伏期6（范围：1~15）d;临床分型以普通型（64.6%,82/127）为主;基本再生系数（R₀）=5.1,R_t先上升后下降,最高达7.3;传播方式以密闭空间为主,具有明显的家庭聚集性,主要传播场所为家庭（26.8%,34/127）、餐馆（29.1%,37/127）、小区（3.9%,5/127）和市场（3.1%,4/127）。密切接触者筛查（66.1%）和社区排查（33.1%）是发现感染者的主要途径。结论 本次疫情新冠病毒Delta变异株的传染性较强,广州市荔湾区本土疫情具有明显的家庭聚集性,新冠病毒感染者以18~59和≥60岁年龄组为主。     

中国国家出生队列研究调查对象的基线特征分析

目的 探讨生命早期环境因素、遗传因素和遗传与环境交互作用对子代近期和远期健康的影响以及系统评价和比较辅助生殖受孕和自然受孕人群的妊娠结局和子代健康相关结局。方法 中国国家出生队列（CNBC）研究是一项覆盖辅助生殖受孕家庭和自然受孕家庭的多中心前瞻性出生队列研究。2016年,CNBC项目陆续在我国12个省（自治区、直辖市）的24所医院启动,以家庭为单位纳入研究对象,并在辅助生殖治疗前、胚胎移植、孕早期、孕中期、孕晚期及分娩时以及出生后第42天、6个月、12个月、36个月多个时点采集数据信息和生物样本。结果 截至2020年6月,CNBC共纳入27 044个辅助生殖受孕家庭,29 589个自然受孕家庭,CNBC的研究人群中绝大部分为城市居民。在辅助生殖受孕家庭中,男女双方分别有65.5%和63.7%为大学及以上文化程度,年龄为（33.83±5.52）和（32.38±4.67）岁;女方83.2%为初产妇,吸烟率为0.8%,饮酒率为2.1%。在自然受孕家庭中,男女双方分别有81.5%和86.5%为大学及以上文化程度,年龄为（32.06±5.09）和（30.40±4.27）岁,女方67.2%为初产妇,吸烟率为0.1%,饮酒率为2.2%。不同地区的辅助生殖受孕家庭和自然受孕家庭的基线特征均有差异。结论 CNBC的建立将为研究生命早期遗传、环境因素、遗传-环境交互作用以及辅助生殖技术治疗相关因素对出生后子代健康的影响提供了重要资源。