基于FNAB的分子检测技术在甲状腺结节诊断中的研究进展

随着各种检测技术的相继问世,甲状腺结节的检出率明显上升。尽管大多数甲状腺结节是良性的,但良恶性病变之间的判定仍然是临床医生面临的挑战。对于所有可疑甲状腺结节患者均应进行颈部超声检查。甲状腺超声可评估结节特征,某些甲状腺结节具有可疑恶性超声征象。然而,这些特征缺乏准确性,无法明确诊断结节的良恶性。目前的指南仍然推荐超声引导细针穿刺活检（FNAB）作为评估甲状腺结节良恶性的首选检查。FNAB是一种经济高效的诊断方法,由于其创伤小,敏感性和特异性较高,可用于术前评估甲状腺结节的性质,已成为临床不可或缺的检查手段之一。近年来国内关于FNAB的报道日益增多,国内外指南关于FNAB指征尚有争议,同时由于其自身存在一定的局限性,FNAB技术的全面实施需要严格把握指征及准确判读穿刺病理结果。FNAB虽然是术前评估甲状腺结节最常用的诊断技术,但仍有灰区结节需要进一步诊断研究。为了制定合理的手术方案及判断预后,指南推荐术前可测定促甲状腺激素（TSH）水平。FNAB作为一个简单且相对无创的技术,但也可产生相应的并发症,FNAB的并发症主要与甲状腺结节的位置、穿刺针的直径、穿刺医师的操作经验等因素相关,严重程度较轻,多呈自限性。对于FNAB无法诊断或意义不明确的非典型病变或滤泡性病变,学者们一直在努力寻找一种新的方法来精确地诊断甲状腺癌。分子生物学方法是目前的最佳选择。分子生物学方法通过检测特定甲状腺肿瘤易感基因的驱动突变来确认甲状腺肿瘤活检的恶性程度,如BRAF和RAS癌基因突变、RET/PTC重排和TERT突变检测,从而提高术前诊断效率。甲状腺乳头状癌最常见的转移部位是局部淋巴结,虽然FNAB对异常淋巴结有诊断价值,但小或囊性淋巴结可能由于缺乏肿瘤细胞而无法诊断。检测可疑颈部淋巴结细针穿刺活检冲洗液中甲状腺球蛋白含量可作为细胞学诊断的辅助手段。笔者认为FNAB联合分子生物学的多层次诊断体系可提高术前诊断的精准性,对指导治疗、判断预后具有重要价值。     

用于评价动物社交偏好程度的新方法

目的：利用一种改进的三箱社交装置评价动物的社交偏好程度,并探索该方法的可行性。方法：采用注意力缺陷多动障碍(ADHD)大鼠作为社交障碍模型动物,以同源大鼠（WKY)大鼠和Wistar大鼠作为对照组,模型组采用治疗ADHD的临床常用中成药小儿黄龙颗粒（1.88 g/kg、3.75 g/kg）灌胃给药16 d。利用改进的三箱社交箱,以待测鼠在陌生鼠侧密切交流区的时间、频次、路程及相关比例作为行为学指标,检测该方法对社交行为评价的可行性。结果：与Wistar大鼠组比较,模型组大鼠与WKY组大鼠在密切交流区域及有陌生鼠侧区域的时间显著减少（P<0.01）,其他指标如频次、路程及比例也均有不同程度减少,小儿黄龙颗粒两剂量均能增加模型大鼠上述各指标数值。结论：该方法能准确捕捉动物的社交行为特征,实现对动物社交偏好程度的全面、客观评价。     

左房粘液瘤X线平片与超声心动图的诊断价值

目的 探讨左房粘液瘤的影像学特征及其鉴别诊断价值。方法 分析２８例手术病理证实的左房粘液瘤的影像学表现。并且加以比较与鉴别。结果 （１）左房粘液瘤的Ｘ线平片与二尖瓣狭窄略有相似,但其具有相对特征。（２）超声波能直接显示左房内团块状回声,并可观察瘤体随心动周期而活动情况。结论 在临床上当瘤体阻塞瓣口后产生类似二尖瓣狭窄的症状和体征,加之两者的Ｘ线平片表现有相似之处,因而有时在鉴别诊断上较困难,超声心     

髋臼中心定位工具在Crowe Ⅳ型发育性髋关节发育不良关节置换术中的应用

目的 研究髋臼中心定位工具在Crowe Ⅳ型发育性髋关节发育不良关节置换术中的可行性及安全性。方法 回顾性分析2020年1月至2022年1月在新疆维吾尔自治区伊犁哈萨克自治州新华医院行全髋关节置换术的37例（44髋）发育性髋关节脱位患者,分为两组：A组20例（24髋）,参考定位工具,B组17例（20髋）,参考髋臼横韧带,比较两组患者的手术时间、切口大小、术中出血量、下地时间、Harris髋关节评分、双侧肢体长度差,术后臼杯外展角、前倾角,以及术后假体旋转中心与解剖旋转中心的水平、垂直距离差值。结果 所有的患者术后未出现脱位、感染、深静脉血栓形成、假体松动等。两组患者的手术时间、术中出血量、切口大小、下地时间、Harris评分、双侧肢体长度差比较,差异无统计学意义（P＞0.05）。对比两组臼杯外展角、前倾角,差异无统计学意义（P＞0.05）;旋转中心垂直距离A组为（21.54±2.32） mm、B组为（22.40±2.23） mm,水平距离A组为（29.42±2.45） mm、B组为（29.85±2.92） mm,重建髋臼的旋转中心距离及其与解剖旋转中心距离差进行组间比较,差异无统计学意义（P＞0.05）。结论 髋臼中心定位工具可以在Crowe Ⅳ型发育性髋关节发育不良全髋关节置换术中给术者提供髋臼中心点的参考标志,有一定的临床使用价值。     

Nile Red fluorescence spectroscopy reports early physicochemical changes in myelin with high sensitivity

The molecular composition of myelin membranes determines their structure and function. Even minute changes to the biochemical balance can have profound consequences for axonal conduction and the synchronicity of neural networks. Hypothesizing that the earliest indication of myelin injury involves changes in the composition and/or polarity of its constituent lipids, we developed a sensitive spectroscopic technique for defining the chemical polarity of myelin lipids in fixed frozen tissue sections from rodent and human. The method uses a simple staining procedure involving the lipophilic dye Nile Red, whose fluorescence spectrum varies according to the chemical polarity of the microenvironment into which the dye embeds. Nile Red spectroscopy identified histologically intact yet biochemically altered myelin in prelesioned tissues, including mouse white matter following subdemyelinating cuprizone intoxication, as well as normal-appearing white matter in multiple sclerosis brain. Nile Red spectroscopy offers a relatively simple yet highly sensitive technique for detecting subtle myelin changes.

Myelin is a highly ordered, lipid-rich extension of glial cell membrane that facilitates rapid and efficient saltatory conduction of action potentials along axons in the central and peripheral nervous systems. The stability of myelin membranes critically depends on its molecular composition (1–3). Although myelin is maintained roughly at a ratio of 70:30% lipid to protein (4), lipid membranes are highly fluid; changes in lipid composition are defining characteristics of myelin development (5), homeostasis in the adult, and aging in rodents (6, 7), as well as primates (8). Shifts in lipid composition also occur in inflammatory demyelinating disorders like multiple sclerosis (MS) (9, 10). Lipids are even theorized to be targets of immune attacks in autoimmune disorders, a role previously ascribed to proteins (11). Key roles for lipids notwithstanding, tools to interrogate biochemical changes to myelin lipids have largely been restricted to in vitro systems.Once thought to be inert, myelin is now known to be a chemically and structurally dynamic element (12). Specific combinations of proteins and lipids induce formation and compaction of multilamellar vesicles that resemble myelin (13), underscoring the importance of correct chemical composition for assembly. Conversely, alterations in these molecular proportions promote decompaction and myelin vesiculation (3, 14). The polarity of lipid species in cell membranes influences their packing properties and therefore stability (15). Governed by competing thermodynamic forces of lipid curling and hydrocarbon packing (16), myelin sheaths lie at the critical edge of bilayer stability and thus are susceptible to factors in the environment. Indeed, the myelin integrity theory of MS rests on the outsized influence of environmental forces on myelin stability and function (17). Therefore, methods for detecting physicochemical changes in myelin lipid composition in situ would greatly enhance our understanding of early events in myelin development, as well as myelin damage in disease states, with important implications for therapies designed to prevent myelin loss in MS and other demyelinating disorders.The study of myelin lipid biochemistry poses unique challenges (18). Traditional analytical methods, such as thin-layer chromatography and high-performance liquid chromatography (19), depend on tissue homogenization that eliminates informative spatial relationships. Imaging lipid mass spectrometry (20) preserves spatial relationships, but submicron resolution has yet to be realized, and reproducibility at the level of sample preparation remains problematic (21). Coherent anti–Stokes Raman scattering microscopy provides high-resolution, label-free imaging of lipids in histological samples (22), but this method lacks sensitivity and requires expertise in nonlinear optics as well as highly specialized hardware. Finally, fluorescent lipophilic dyes, though widely available and easy to use, have traditionally been employed to detect lipid-rich structures in only a qualitative manner. Conventional fluorescence microscopy is therefore unable to detect subtle shifts in lipid biochemistry. By contrast, Nile Red (NR) is a fluorescent dye that is well situated to report changes in the chemical polarity of cell membranes and myelin, being both lipophilic (23, 24) and differentially fluorescent depending on solvent environment (i.e., exhibits solvatochromism) (25). The current study uses NR fluorescence spectroscopy to identify polarity shifts as an early manifestation of myelin disease prior to overt demyelination. We show that this technique reports subtle biochemical changes in myelin, resulting in a method that is a very sensitive marker of incipient myelin injury.     

Polygalasaponin F inhibits neuronal apoptosis induced by oxygen‐glucose deprivation and reoxygenation through the PI3K/Akt pathway

Cerebral ischaemia is a common cerebrovascular disease and often induces neuronal apoptosis, leading to brain damage. Polygalasaponin F (PGSF) is one of the components in Polygala japonica Houtt, and it is a triterpenoid saponin monomer. This research focused on anti‐apoptotic effect of PGSF during oxygen‐glucose deprivation and reoxygenation (OGD/R) injury in rat adrenal pheochromocytoma cells (PC12) and primary rat cortical neurons. OGD/R treatment reduced viability of PC12 cells and primary neurons. This reduced viability was prevented by PGSF, as shown by MTT assay. OGD/R insult decreased expression of Bcl‐2/Bax both in PC12 cells and primary neurons but elevated levels of caspase‐3 in primary neurons. However, PGSF may up‐regulate expression of Bcl‐2/Bax and down‐regulate caspase‐3 in these particular cells. Furthermore, Bcl‐2/Bax and the ratio between phosphorylated Akt and total Akt were decreased in PC12 cells treated with OGD/R, and both were increased by PGSF. Moreover, increase in the ratios of Bcl‐2/Bax and phosphorylated Akt/total Akt in PC12 cells was suppressed by phosphatidylinositol 3‐kinase (PI3K) inhibitor. Data suggest PGSF might prevent OGD/R‐induced injury via activation of PI3K/Akt signalling. The ability of PGSF to block the effects of OGD/R appears to involve regulation of Bcl‐2, Bax and caspase‐3, which are related to apoptosis.     

股骨近端防旋髓内钉内固定与股骨近端锁定钢板内固定治疗A2.3型股骨转子间骨折合并大转子外侧壁冠状面破损的对比研究

目的:比较股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定与股骨近端锁定钢板(proximal femoral locking plate,PFLP)内固定治疗A2.3型股骨转子间骨折合并大转子外侧壁冠状面破损的临床疗效。方法:回顾性分析2013年5月至2019年8月收治的65例A2.3型股骨转子间骨折合并大转子外侧壁冠状面破损患者的病例资料。37例采用PFNA内固定治疗(PFNA组),28例采用PFLP内固定治疗(PFLP组)。比较2组患者的手术切口长度、手术时间、术中出血量、术后开始负重时间、骨折愈合时间及Harris髋关节评分。结果:①一般指标。PFNA组患者手术切口长度、术中出血量均小于PFLP组[(8.05±1.75)cm,(15.05±6.36)cm,t=15.254,P=0.000;(124.50±8.50)mL,(315.50±6.50)mL,t=76.652,P=0.000],手术时间、术后开始负重时间、骨折愈合时间均短于PFLP组[(53.50±5.50)min,(74.50±7.60)min,t=27.652,P=0.000;(38.50±1.85)d,(64.50±3.35)d,t=30.746,P=0.000;(11.24±1.22)周,(14.06±1.53)周,t=1.620,P=0.026]。②Harris髋关节评分。时间因素和分组因素不存在交互效应(F=6.352,P=0.109);2组患者Harris髋关节评分总体比较,差异有统计学意义,即存在分组效应(F=5.214,P=0.038);术后不同时间点之间Harris髋关节评分的差异有统计学意义,即存在时间效应(F=6.836,P=0.016);2组患者Harris髋关节评分随时间延长均呈逐渐升高趋势,且2组的升高趋势一致[(67.45±4.30)分,(80.35±3.00)分,(88.65±4.20)分,F=4.251,P=0.041;(56.26±2.40)分,(68.25±4.60)分,(78.37±3.30)分,F=7.528,P=0.012];术后3个月、6个月、12个月,PFNA组的Harris髋关节评分均高于PFLP组(t=1.763,P=0.031;t=1.635,P=0.035;t=1.586,P=0.046)。结论:PFNA内固定与PFLP内固定治疗A2.3型股骨转子间骨折合并大转子外侧壁冠状面破损,均能促进髋关节功能恢复,但前者创伤小、骨折愈合快,患者术后可以较早开始负重。     

我国医院管理合法性危机的根源及解决途径探析

文章主要探讨我国医院管理合法性危机产生的深层次原因,并提出相应对策。文章认为,过于重视经济利益,医院管理体制无法适应新的制度环境以及社会监督机制缺乏独立性是造成医院管理合法性危机的深层次根源。而回归公共意识、强化服务功能,建立与政策话语环境相适应的医院管理制度,医院管理监督机构独立化、监督行为法律化,以及强化公关意识、完善公关机制则是解决这一危机的重要途径。     

听神经病患者的耳蜗电图特征

目的:了解听神经病患者的耳蜗电图特征。方法:用外耳道银球电极记录听神经病组和正常对照组的耳蜗电图,比较两者的-SP波幅差异,统计患耳AP出现的情况。结果:听神经病患者-SP波的引出率为100％,并且其波幅与正常对照组的差异有显著性意义(P<0.01)。AP波幅较小,但引出率高达84％。结论:听神经病患者的-SP可引出且波幅增大。