Differentiating autoimmune pancreatitis from pancreatic ductal adenocarcinoma with CT radiomics features

PurposeThe purpose of this study was to determine whether computed tomography (CT)-based machine learning of radiomics features could help distinguish autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC).Materials and MethodsEighty-nine patients with AIP (65 men, 24 women; mean age, 59.7 ± 13.9 [SD] years; range: 21–83 years) and 93 patients with PDAC (68 men, 25 women; mean age, 60.1 ± 12.3 [SD] years; range: 36–86 years) were retrospectively included. All patients had dedicated dual-phase pancreatic protocol CT between 2004 and 2018. Thin-slice images (0.75/0.5 mm thickness/increment) were compared with thick-slices images (3 or 5 mm thickness/increment). Pancreatic regions involved by PDAC or AIP (areas of enlargement, altered enhancement, effacement of pancreatic duct) as well as uninvolved parenchyma were segmented as three-dimensional volumes. Four hundred and thirty-one radiomics features were extracted and a random forest was used to distinguish AIP from PDAC. CT data of 60 AIP and 60 PDAC patients were used for training and those of 29 AIP and 33 PDAC independent patients were used for testing.ResultsThe pancreas was diffusely involved in 37 (37/89; 41.6%) patients with AIP and not diffusely in 52 (52/89; 58.4%) patients. Using machine learning, 95.2% (59/62; 95% confidence interval [CI]: 89.8–100%), 83.9% (52:67; 95% CI: 74.7–93.0%) and 77.4% (48/62; 95% CI: 67.0–87.8%) of the 62 test patients were correctly classified as either having PDAC or AIP with thin-slice venous phase, thin-slice arterial phase, and thick-slice venous phase CT, respectively. Three of the 29 patients with AIP (3/29; 10.3%) were incorrectly classified as having PDAC but all 33 patients with PDAC (33/33; 100%) were correctly classified with thin-slice venous phase with 89.7% sensitivity (26/29; 95% CI: 78.6–100%) and 100% specificity (33/33; 95% CI: 93–100%) for the diagnosis of AIP, 95.2% accuracy (59/62; 95% CI: 89.8–100%) and area under the curve of 0.975 (95% CI: 0.936–1.0).ConclusionsRadiomic features help differentiate AIP from PDAC with an overall accuracy of 95.2%.     

优良资源植物——三颗针的质量考查研究之二

对四种同季不同产地采集的“三颗针”不同部位的四种生物碱进行了含量测定和分析,为该类药材的质量研究、生药采收、药厂选投料及开发应用等提供了科学依据。同时对该类资源的可持续利用也具有积极意义。     

不同层次护生对临床教学质量的评价

目的分析不同层次护生对临床教学质量评价的差异,以便采取有针对性的教学方法.方法护生在每个科室实习结束后,采用自行设计的临床教学评价表对每名护生进行问卷调查,然后分别从中专、大专、本科护生填写的调查表中各随机抽取30%进行分析.结果对病房教学氛围和护士长教学管理的评价,本科与中专、大专护生间比较,差异有显著性意义(均P<0.05),中专与大专护生间无差异(P>0.05);对带教老师的评价,本科与中专、大专与中专护生间均差异有显著性意义(P<0.01,P<0.05),本科与大专间无差异(P>0.05).结论不同层次护生对临床教学质量评价的侧重点不同,本科生对病房教学氛围及护士长教学管理的要求较高,大专生次之.在临床教学中应根据护生的学历层次,采取有针对性的教学方法,以便不断提高临床教学质量.     

肉鸡对不同形态锰源的生物利用率研究

目的 :　研究肉仔鸡对不同形态锰源的相对生物学利用率。方法 :　将 62 4只 1日龄肉公鸡随机分为 1 3组 ,分别饲不添加锰的基础饲粮 (对照组 )或以不同锰化合物添加 60、1 2 0、1 80 mg/ kg锰的试验饲粮 2 1 d。结果 :　肉鸡生长性能各指标和腿病发生率以及肉鸡的跖骨灰锰含量、心肌细胞线粒体中 Mn SOD活性均未受到添加锰源以及锰源与锰水平互作的显著影响 ,但受到添加锰水平的显著影响。肉鸡心肌含锰量和 Mn SOD m RNA水平均未受到添加锰源与锰水平互作的显著影响 ,但受到添加锰源及添加锰水平的显著影响。其中中等和强络合强度有机锰源的生物学利用率明显高于无机硫酸锰和弱络合强度有机锰源。结论 :　中等和强络合强度的复合氨基酸锰对肉仔鸡的生物学利用率明显优于无机硫酸锰和弱络合强度的蛋氨酸锰     

不同孕期阶段孕妇凝血四项及FDP和D-二聚体的变化及临床意义

目的:研究不同孕期阶段(早、中、晚)孕妇凝血四项、血浆纤维蛋白(原)降解产物[plasma fibrin/fibrinogen degradation products, FDP]、D-二聚体的变化及临床意义,为临床诊疗提供理论支持。方法:回顾性分析2021年1月至2021年12月200例孕妇就诊资料中的凝血四项,纤维蛋白原(fibrinogen, FIB)、凝血酶原时间(prothrombin time, PT)、凝血酶时间(thrombin time, TT)、活化部分凝血活酶时间(activated partial thromboplastin time, APTT)。并对FDP与D-二聚体的检测结果进行统计分析,比较孕早期、中期、晚期三个阶段凝血四项、FDP和D-二聚体水平的变化。结果:孕早期、孕中期与孕晚期PT水平比较,差异有统计学意义(P<0.05);孕早期、孕中期与孕晚期三个阶段的TT相比,差异无统计学意义(P>0.05);孕早期的APTT明显长于中期、晚期孕妇,差异有统计学意义(P<0.05);孕早期、中期、晚期孕妇,随着孕周的增加,FIB水平逐渐升高...     

不同剂量体外冲击波治疗肱骨外上髁炎的疗效对比

目的 比较不同能流密度的体外冲击波(extracorporeal shock wave, ESW)治疗肱骨外上髁炎(lateral epicondylitis, LE)的短期临床疗效,探索ESW的最佳治疗剂量。方法 将120例LE患者分为A、B、C和D 4组,均使用ESW治疗4周,各组的能流密度分别为0.06、0.08、0.10、0.12 mJ/mm²。分别在治疗前及治疗后4、24及48周,比较4组患者疼痛视觉模拟量表(visual analogue scale, VAS)评分、肱骨外上髁炎功能评估(patient-rated tennis elbow evaluation, PRTEE)评分及末次随访患者满意度和复发率。结果 按时间点比较,各组VAS评分治疗前最高,治疗后48周降至最低(P<0.05),4组患者满意度及复发率比较差异无统计学意义(P>0.05),但C组患者满意度(96.67%)明显高于A组(80%),差异具有统计学意义(P=0.04)。按组间比较观察,治疗前各组患肘VAS评分差异无统计学意义(P>0.05);治疗后4、24和48...     

不同镇痛方式在开胸术后的镇痛效果及对肺功能影响

目的观察不同镇痛方式在开胸手术后的镇痛效果及其对肺功能的影响。方法39例ASAⅠ~Ⅱ级,在硬膜外复合全身麻醉下行侧开胸手术的病人,术后随机接受罗哌卡因(罗哌组,n=10)、甲磺酸罗哌卡因(甲罗组,n=10)和布比卡因(布比组,n=10)硬膜外镇痛(patient controlled epidural analgesia,PCEA)及吗啡(吗啡组,n=9)静脉镇痛(patient controlled intravenous analgesia,PCIA)。结果术后1、2、5d静息时的疼痛评分罗哌组和甲罗组均明显低于布比组,但与吗啡组相比无明显差异;术后1d静息时疼痛评分吗啡组也明显低于布比组,但术后2、5d两组间无明显差异。术后1、2、5d咳嗽时疼痛评分罗哌组均明显低于布比组和吗啡组;各时间咳嗽时疼痛评分布比组和吗啡组之间无明显差异。术后1、2dPaCO2罗哌组均明显低于布比组,术后1dPaCO2罗哌组也明显低于布比组;术后1、2dPaCO2罗哌组均明显高于吗啡组,但与布比组之间无明显差异。术后1、2、5d用力肺活量和呼吸峰流速四组间无明显差异。结论罗哌卡因和甲磺酸罗哌卡因加舒芬太尼可安全用于开胸手术后硬膜外镇痛,其镇痛效果优于布比卡因加芬太尼硬膜外镇痛和吗啡静脉镇痛,并使术后病人维持更好的呼吸功能,且不增加副作用的发生率。     

A pharmacokinetic approach to the establishment of biopharmaceutic characteristics of different acetylsalicylic acid formulations in man

Eleven acetylsalicylic acid (ASA) formulations were administered to 26 healthy volunteers in a cross-over design. The properties of the preparations differed from conventional, effervescent, buffered to buccal. The objectives of this study were:

• 1 Consideration of the general aspects of a biopharmaceutical study: which parameter for which biopharmaceutic characteristic?
• 2 Measurement of the kinetic parameters of ASA: first-pass effect, mean residence time, mean appearance time, total body clearance, apparent volume of distribution, half-lives, etc.
• 3 Comparison of the formulations.

Most of the formulations yield mean residence times for ASA of 0.3–1.0h, which do not differ significantly (p > 0.05). For most of the products the first-pass effect is about 40 per cent; the average values of the apparent volume of distribution and whole body clearance, corrected for the first-pass effect, are about 201 and 650 ml min^?1, respectively. Peak levels are reached slowly for the buccal formulations, and rapidly for the buffered products. It is difficult, especially for ASA, to characterize the gastro-intestinal absorption with pharmacokinetic model parameters, because the first-pass effect is large and often elimination of ASA is faster than absorption. The model-independent approach has the special advantages of calculating reliable pharmacokinetic parameters, and creating theoretical possibilities to characterize the absorption patterns of the different formulations in a quantitative way. No significant differences in the values of the parameters are found between most of the formulations. The ASA first-pass effect is reasonably constant and buccal application has no advantage. Enteric coating of the outer layer of ASA formulations causes inconsistent absorption and may be categorized under ‘artificial mistakes’.     

中药类保健食品中地黄生熟异用的配方规律分析

目的:分析地黄在中药类保健食品中生熟异用下的配方规律。方法:收集国家市场监督管理总局(SAMR)特殊食品信息查询平台公布的生、熟地黄保健食品数据,对其保健功能及中药组方等进行统计,运用Apriori算法和Kulc、不平衡比参数对地黄生熟异用的保健食品配方规律进行分析。结果:保健食品中,生地黄主要用于辅助降血糖,熟地黄主要用于增强免疫力、缓解体力疲劳、改善营养性贫血。在辅助降血糖类生地黄保健食品中,生地黄主要与补气药、补阴药、解表药、解热药配伍,代表性组合为生地黄-黄芪-苦瓜;在增强免疫力类熟地黄保健食品中,熟地黄主要与补气药、补血药、补阴药配伍,代表性组合为熟地黄-党参-阿胶;在缓解体力疲劳类熟地黄保健食品中,熟地黄主要与补气药、补阳药、补阴药配伍,代表性组合为熟地黄-人参-淫羊藿、熟地黄-人参-枸杞子;在改善营养性贫血类熟地黄保健食品中,熟地黄主要与补气药、补血药配伍,代表性组合为熟地黄-黄芪-阿胶、熟地黄-黄芪-当归。结论:地黄在保健食品中的使用遵循生熟异用的规律,在不同保健功能中,组方配伍基本符合中医理论和现代医学理论,可为生、熟地黄保健食品研发提供借鉴和依据。     

非靶向代谢组学揭示天葵不同部位差异代谢物及其主要代谢途径

目的:利用非靶向代谢组学挖掘天葵非药用部位潜在的药用价值。方法:以天葵茎、叶、花为材料,利用超高效液相色谱-质谱法对其进行非靶向代谢组学分析。结果:天葵茎、叶、花中共鉴定出16大类101个差异代谢物(DAMs),其中包含羧酸及其衍生物、有机含氧化合物、脂质、苯及其取代衍生物、生物碱、黄酮类、萜类、苯丙素类、酚酸类、核苷酸、有机盐、内酯、有机酸、内源性植物激素、氨基酸和13个其他物质。通过聚类和京都基因与基因组百科全书(KEGG)分析发现,天葵不同部位的DAMs代谢模式存在一定的差异;其主要代谢途径为苯丙氨酸代谢途径、ABC转运途径、氨酰-tRNA合成途径及苯丙氨酸、酪氨酸和色氨酸生物合成途径。结论:通过天葵不同部位间DAMs的鉴定及其生物合成途径的分析,确定天葵茎、叶、花富含多种具有药用功效的代谢活性物质,可为天葵茎、叶、花的资源开发利用提供参考。